A 68-year-old man is evaluated in the clinic for progressive fatigue and a 6-kg (13.2-lb) weight loss over the past four months. He reports occasional dark stools but denies abdominal pain, nausea, or vomiting. His past medical history is unremarkable, and he has not had a colonoscopy in the past 15 years. Vital signs are within normal limits. Laboratory results show a hemoglobin of 9.4 g/dL, mean corpuscular volume of 74 fL, and ferritin of 10 ng/mL. Based on his presentation, a lower gastrointestinal malignancy is highly suspected. Arrange the following diagnostic and therapeutic steps in the most appropriate chronological order for the evaluation and management of this patient.
- 1Perform a complete colonoscopy
- 2Obtain a tissue biopsy of the suspicious lesion
- 3Perform a computed tomography (CT) scan of the chest, abdomen, and pelvis
- 4Proceed with surgical bowel resection and regional lymphadenectomy
Cevap
The correct sequence is: Perform a complete colonoscopy, followed by obtaining a tissue biopsy, then performing a CT scan for staging, and finally proceeding with surgical resection.
The standard of care for a patient presenting with symptoms highly suspicious for colorectal cancer (iron deficiency anemia, weight loss, positive fecal occult blood) is to first locate the primary lesion via colonoscopy. During this endoscopic procedure, a tissue biopsy must be taken for histopathologic confirmation of adenocarcinoma. Only after a malignancy is pathologically confirmed should the patient undergo clinical staging with a CT scan of the chest, abdomen, and pelvis to assess for metastatic spread. Finally, the results of the staging dictate whether the patient is a candidate for definitive surgical resection, making surgery the final step in this clinical pathway.
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Anahtar Kavram
Diagnostic and management sequence for suspected colorectal cancer