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Chapter 16: Colorectal Cancer

JM is a 55-year-old African American man concerned about colorectal cancer screening. He inquires about screening recommendations for someone of his age. Which of the following screening tests would be most appropriate for this patient?

a. CT/PET of chest, abdomen, and pelvis

b. Digital rectal examination

c. Flexible sigmoidoscopy

d. Colonoscopy

e. CEA blood test

Answer d is correct. The advantages of colonoscopy are that the full colon is visualized and any abnormal polyps can be removed for a biopsy. The disadvantages include the invasiveness, cost, and need for sedation.

Answer a is incorrect. Whole body scans have not shown to be an effective monitoring tool for colorectal or any cancer. Unnecessary imaging studies also expose the patient to unnecessary levels of radiation and put a financial burden on the health care system. In contrast, CT colonography is an accepted tool for screening, but is limited by the need for a follow-up colonoscopy if any abnormalities like adenomas are discovered.

Answer b is incorrect. However, JM should get a digital rectal examination and PSA blood test to detect prostate cancer if he has not gotten one this year.

Answer c is incorrect. Flexible sigmoidoscopy only images the lower part of the colon and requires a follow-up full colonoscopy if any abnormalities are found.

Answer e is incorrect. CEA may be elevated in other malignant and benign conditions and is not considered a valid screening method for colorectal cancer. The level may be helpful to determine the extent of disease already diagnosed by other means, evaluate treatment response, and for recurrence surveillance.

According to national guidelines, what is the recommended age to begin screening for colorectal cancer in a person with average risk?

a. No later than 21 years old

b. 40 years old

c. 45 years old

d. 50 years old

Answer d is correct. The frequency of screening tests depends on the method of screening.

Answer a is incorrect. Average-risk women should receive Pap tests beginning 3 years after first vaginal intercourse, but no later than 21 years old.

Answer b is incorrect. Average-risk women should receive annual mammograms starting at age 40.

Answer c is incorrect. High-risk men, such as African Americans, should be offered prostate cancer screening at age 45 per the American Cancer Society with careful consultation about the ...

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