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colon cancer

Practice targeted AMC-style multiple-choice questions on colon cancer.

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A 28-year-old woman with a mother diagnosed with colorectal cancer at 45 and a maternal uncle at 50 seeks advice. She is otherwise well. What is the most appropriate next step in her management?

A. Annual FIT testing.
B. Consider prophylactic colectomy.
C. Genetic counselling and testing.
D. Colonoscopy screening at 40.
E. Reassurance and review.
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A 45-year-old woman has a mother diagnosed with colorectal cancer at age 55 and a maternal aunt with endometrial cancer at age 60. What is the most appropriate initial step regarding genetic testing for hereditary cancer syndrome?

A. Advise increased surveillance with colonoscopy every 5 years starting now.
B. Order germline testing for MLH1, MSH2, MSH6, and PMS2 genes.
C. Referral to a familial cancer clinic for risk assessment and counselling.
D. Order tumour testing for microsatellite instability (MSI) and immunohistochemistry (IHC).
E. Reassure the patient that this family history is not strongly suggestive of a hereditary syndrome.
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Endoscopy image of colon adenocarcinoma in sigmoid colon.
Image by Unknown CC BY-SA 3.0 · Source

A 70-year-old man presents with a 3-month history of worsening constipation, occasional bright red rectal bleeding, and unexplained fatigue. His GP notes mild pallor. Full blood count reveals a haemoglobin of 105 g/L and low ferritin. A colonoscopy is performed, and the image provided is a representative view of a finding in the sigmoid colon. Biopsies were taken. Considering the clinical context and the endoscopic appearance, which of the following is the most appropriate next step in the management pathway to determine the extent of disease?

A. Referral for immediate surgical resection
B. Repeat colonoscopy in 6 months to assess response to medical therapy
C. CT scan of chest, abdomen, and pelvis for staging
D. PET scan for metabolic activity assessment
E. Commencement of iron supplementation and review in 4 weeks
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Endoscopy image of colon adenocarcinoma in sigmoid colon.
Image by Unknown CC BY-SA 3.0 · Source

A 58-year-old male presents with fatigue and microcytic anemia. He denies overt bleeding but reports occasional dark stools. Colonoscopy reveals the image shown. Biopsies confirm adenocarcinoma. What is the MOST appropriate next investigation to stage the cancer?

A. Carcinoembryonic antigen (CEA) level
B. Endoscopic ultrasound
C. MRI of the abdomen and pelvis
D. CT scan of the chest, abdomen, and pelvis
E. PET-CT scan
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A patient has a pathogenic variant in MLH1 identified via genetic testing. What cancer screening is most strongly indicated?

A. Colonoscopy every 1-2 years from age 25
B. Gastroscopy every 3-5 years from age 50
C. Annual mammography from age 30
D. Renal ultrasound every 2 years from age 30
E. Annual PSA testing from age 40
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A 28-year-old woman presents for a check-up, reporting occasional mild abdominal discomfort. Her father was diagnosed with colorectal cancer at age 48, and his tumour showed microsatellite instability. A paternal aunt had endometrial cancer at 55. Physical exam is normal. What is the most appropriate next step regarding genetic testing?

A. Order a colonoscopy immediately.
B. Test for FAP-associated genes.
C. Order faecal occult blood testing.
D. Offer genetic counselling and testing for Lynch syndrome.
E. Reassure and advise standard screening at age 50.
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Endoscopy image of colon adenocarcinoma in sigmoid colon.
Image by Unknown CC BY-SA 3.0 · Source

A 72-year-old woman presents with a 3-month history of worsening constipation, occasional bright red rectal bleeding, and unintentional weight loss of 4 kg. She reports feeling increasingly tired. Her past medical history includes hypertension and osteoarthritis. On examination, her vital signs are stable. Abdominal examination is soft, non-tender, with no palpable masses. Digital rectal examination reveals no palpable lesion. Blood tests show a haemoglobin of 108 g/L, MCV 78 fL, and ferritin 12 µg/L. A colonoscopy was performed, and the image provided was captured during the procedure. Considering the clinical presentation and the finding observed during the colonoscopy, which of the following investigations is most crucial for determining the extent of disease and guiding definitive treatment planning within the multidisciplinary team framework?

A. Repeat colonoscopy in 3 months
B. Commencement of iron supplementation and review in 4 weeks
C. Urgent surgical consultation for immediate resection
D. CT scan of chest, abdomen, and pelvis
E. Referral for palliative care assessment
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Endoscopy image of colon adenocarcinoma in sigmoid colon.
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A 72-year-old male presents to his general practitioner with a 3-month history of progressively worsening constipation alternating with episodes of loose stools, associated with occasional bright red blood per rectum and an unintentional weight loss of 4 kilograms over the same period. He denies any significant past medical history or family history of bowel disease. His vital signs are stable, and physical examination, including abdominal palpation and digital rectal examination, is unremarkable. Routine blood investigations reveal a haemoglobin of 105 g/L with a mean corpuscular volume of 78 fL, and normal inflammatory markers. Given the clinical presentation, a colonoscopy is performed. The image provided is a representative view obtained during this procedure. Based on the findings demonstrated in the image, what is the most appropriate immediate next step in the management of this patient?

A. Refer for urgent surgical resection without further investigation.
B. Obtain biopsies from the lesion and arrange for CT staging of the chest, abdomen, and pelvis.
C. Initiate a course of broad-spectrum antibiotics for presumed infectious colitis.
D. Schedule a repeat colonoscopy in 6 months to monitor the lesion's progression.
E. Prescribe a high-fibre diet and laxatives to manage the constipation.
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Endoscopy image of colon adenocarcinoma in sigmoid colon.
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A 72-year-old patient presents with a 4-month history of tenesmus and occasional bright red rectal bleeding. Colonoscopy was performed, and a representative image is shown. Biopsies confirm adenocarcinoma. Considering the likely stage suggested by the endoscopic appearance, which investigation is MOST crucial for pre-operative staging?

A. PET scan
B. Endorectal ultrasound
C. Repeat colonoscopy to assess proximal colon
D. CT scan of the chest, abdomen, and pelvis
E. Bone scan
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Endoscopy image of colon adenocarcinoma in sigmoid colon.
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A 70-year-old presents with iron deficiency anaemia and intermittent rectal bleeding. Colonoscopy was performed, and a representative image is shown. Biopsies are pending but malignancy is strongly suspected based on the endoscopic appearance. What is the MOST appropriate next investigation to guide definitive management?

A. Referral for palliative care
B. PET scan
C. Repeat colonoscopy in 3 months
D. CT scan of chest, abdomen, and pelvis
E. Endoscopic ultrasound
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Endoscopy image of colon adenocarcinoma in sigmoid colon.
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Mr. Arthur Jenkins, a 72-year-old retired accountant, presents to his GP complaining of a change in bowel habit over the past 4 months, now experiencing increased frequency and occasional loose stools mixed with some mucus. He also reports intermittent small amounts of bright red blood on the toilet paper, which he initially attributed to haemorrhoids. He denies significant weight loss or abdominal pain. His past medical history includes hypertension well-controlled on medication and osteoarthritis. On examination, his abdomen is soft and non-tender, and digital rectal examination is unremarkable. Routine blood tests, including FBE and LFTs, are within normal limits. A faecal occult blood test is positive. Given these findings, a colonoscopy is arranged. The image provided was captured during the procedure. Considering the patient's presentation and the findings observed during the colonoscopy as depicted in the image, what is the most appropriate immediate next step in the management plan?

A. Attempt endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) of the lesion.
B. Advise the patient on dietary modifications to increase fibre intake and schedule a follow-up appointment in 3 months.
C. Prescribe a course of antibiotics for presumed infectious colitis and repeat colonoscopy in 6 weeks.
D. Refer the patient directly for urgent surgical consultation for a potential sigmoid colectomy.
E. Obtain multiple biopsies from the lesion for histological examination and arrange for CT staging of the chest, abdomen, and pelvis.
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Endoscopy image of colon adenocarcinoma in sigmoid colon.
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A 72-year-old woman presents with iron deficiency anaemia and a 4-month history of intermittent lower abdominal pain and tenesmus. Colonoscopy was performed, and the image shows a finding in the sigmoid colon. Biopsies are pending but highly suspicious for malignancy. What is the MOST appropriate initial staging investigation?

A. CT scan of chest, abdomen, and pelvis
B. Endoscopic ultrasound
C. PET scan
D. MRI pelvis
E. Bone scan
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Endoscopy image of colon adenocarcinoma in sigmoid colon.
Image by Unknown CC BY-SA 3.0 · Source

A 58-year-old male presents with fatigue and iron deficiency anemia. Colonoscopy reveals the image shown. Biopsies are taken. Assuming pathology confirms malignancy, what is the MOST appropriate next investigation to determine disease stage?

A. CT scan of the abdomen and pelvis
B. PET-CT scan
C. Endoscopic ultrasound
D. MRI of the abdomen and pelvis
E. Carcinoembryonic antigen (CEA) level
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A 33-year-old lady has an HNPCC gene mutation and two sisters with bowel cancer. She reports no change in bowel habits. What is the best surveillance for bowel cancer in this patient?

A. Annual or biennial colonoscopy starting now; discuss aspirin.
B. Colonoscopy at age 40, then every 5 years.
C. Annual iFOBT starting now.
D. Refer to a bowel cancer specialist.
E. Immediate colonoscopy, 5-year repeat, 2-year iFOBT, aspirin at 50.
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Endoscopy image of colon adenocarcinoma in sigmoid colon.
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A 72-year-old male presents with a 4-month history of increasing constipation and occasional streaks of blood on stool. He denies significant weight loss. Physical exam is unremarkable. A colonoscopy was performed, and the image is shown. Biopsies are taken from the lesion. Assuming the biopsy confirms adenocarcinoma, what is the MOST appropriate initial investigation to guide further management?

A. Referral for neoadjuvant chemotherapy
B. CT scan of chest, abdomen, and pelvis
C. Repeat colonoscopy in 3 months
D. PET scan for distant metastases
E. Endoscopic ultrasound for local staging
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Endoscopy image of colon adenocarcinoma in sigmoid colon.
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A 68-year-old male presents to his GP complaining of a change in bowel habit over the past 6 months. He reports increasing constipation alternating with episodes of diarrhea. He also mentions unintentional weight loss of approximately 5 kg during this period. He denies any family history of bowel cancer. A colonoscopy was performed, and a representative image is shown. Assuming the lesion is confirmed as malignant, what is the MOST appropriate next step in the management of this patient?

A. Referral for palliative care
B. Repeat colonoscopy in 3 years
C. CT scan of the chest, abdomen, and pelvis
D. Initiate adjuvant chemotherapy with FOLFOX
E. Administer a course of broad-spectrum antibiotics
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Endoscopy image of colon adenocarcinoma in sigmoid colon.
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A 62-year-old male presents with a three-month history of intermittent rectal bleeding and a change in bowel habits. He reports increased constipation alternating with episodes of diarrhea. His family history is significant for a father who had colon cancer at age 70. A colonoscopy was performed, and an image from the procedure is shown. What is the MOST appropriate next step in management?

A. Order a CT scan of the abdomen and pelvis
B. Administer stool softeners and schedule a follow-up appointment in 6 months
C. Biopsy the lesion
D. Initiate a high-fiber diet and repeat colonoscopy in 5 years
E. Prescribe anti-inflammatory medication
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Endoscopy image of colon adenocarcinoma in sigmoid colon.
Image by Unknown CC BY-SA 3.0 · Source

A 72-year-old presents with recent onset tenesmus and passage of mucus. He has lost 4kg over 2 months. Colonoscopy was performed, and a representative image is shown. Biopsies are pending but the appearance is highly suspicious for malignancy. What is the MOST appropriate initial investigation to assess for metastatic disease?

A. PET scan
B. Tumour markers (e.g., CEA)
C. MRI of the pelvis
D. Endoscopic ultrasound
E. CT scan of chest, abdomen, and pelvis
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Endoscopy image of colon adenocarcinoma in sigmoid colon.
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A 68-year-old man presents with a 4-month history of increasing constipation alternating with loose stools, occasional rectal bleeding, and fatigue. He denies significant weight loss. Physical examination is unremarkable. Full blood count shows a haemoglobin of 115 g/L with low ferritin. A colonoscopy was performed, and the image provided is a representative view. Biopsies were taken from the observed lesion. Considering the clinical presentation and the endoscopic finding, what is the most appropriate next investigation to determine the extent of disease and inform definitive management planning?

A. PET scan
B. CT scan of chest, abdomen, and pelvis
C. Bone scan
D. Endoscopic ultrasound
E. MRI of the pelvis
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Endoscopy image of colon adenocarcinoma in sigmoid colon.
Image by Unknown CC BY-SA 3.0 · Source

A 68-year-old man presents to his GP with a 4-month history of increasing constipation alternating with loose stools, occasional rectal bleeding, and a feeling of incomplete evacuation. He reports fatigue but denies significant weight loss. His physical examination, including digital rectal examination, is normal. Full blood count shows a haemoglobin of 115 g/L with low ferritin. A colonoscopy is performed, and the image provided is a representative view from the procedure. Considering the clinical presentation and the finding observed during the colonoscopy, what is the most appropriate immediate next step in the management of this patient?

A. Obtain biopsies from the lesion for histological assessment and arrange for staging investigations.
B. Schedule a repeat colonoscopy in 6 months to assess for changes in the appearance of the lesion.
C. Prescribe a course of oral corticosteroids for presumed inflammatory bowel disease.
D. Recommend dietary modification and bulk-forming laxatives to manage the change in bowel habit.
E. Refer the patient directly for urgent surgical consultation and resection planning.
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