A 68 year old presents to your clinic with weight loss and a blood per rectum. He says that he has not been feeling well for the past 4 months. You tell him that he needs to be worked up to rule out a malignancy. Which of the following about colon cancer is false?

1. Elevated levels of CEA are diagnostic
2. Left sided colon cancer can present with an anemia
3. Metastases to the liver can occur
4. Barium enema is suggestive but not diagnostic
5. Most common cell type is Squamous cell carcinoma

Symptoms of colorectal cancer are dependent where the cancer is located in the colon or rectum. In many cases, the patients have no symptoms until late. The prognosis tends to be worse in symptomatic as compared to asymptomatic individuals. The most common presenting symptom of colorectal cancer is bright red blood pre rectum. Cancers arising from the left side of the colon generally cause bleeding (and present with anemia), or in their late stages may cause constipation, abdominal pain, and obstructive symptoms. On the other hand, right-sided colon lesions may produce vague abdominal discomfort, but are unlikely to present with bowel obstruction or altered bowel habit. Other non specific symptoms may include general malaise, weakness, weight loss, or anemia resulting from chronic blood loss. Anytime one has the above symptoms, one should see a physician. The most common cell type of colon cancer is adenocarcinoma.

2.A 55 year old comes to you because he is worried that he may have common cancer. He denies any symptoms. You recommend that he undergo a Colonoscopy. Which of the following is true of colonoscopy?

1. bowel is usually prepared for examination after a fleet enema
2. good tool to make a diagnosis of anal fissure
3. must be done every year after the age of 40 to screen for colon cancer
4. The test has no obvious complications
5. Is very useful to make a diagnosis of small bowel cancers
6. The main advantage of colonoscopy versus barium is that biopsies can be taken

Recommendations vary among the leading organizations in this field, namely the American Cancer Society (ACS), the World Health Organization (WHO), the US Preventive Services Task Force (USPSTF), and the American College of Physicians (ACP). It is generally recommended, however, that average-risk adults should begin colorectal cancer screening at age 50 years, utilizing one of several options for screening, among which is colonoscopy, every 10 years. Annual fecal occult blood testing (FOBT) and periodic flexible sigmoidoscopy with follow-up colonoscopy are also recommended for average-risk screening.

Colonoscopy enables visual inspection of the entire large bowel from the distal rectum to the cecum. The procedure is a safe and effective means of evaluating the large bowel. The technology for colonoscopy has evolved to provide a very clear image of the mucosa through a videocamera attached to the end of the scope. The camera connects to a computer, which can store and print color images selected during the procedure. Compared with other imaging modalities, colonoscopy is especially useful in detecting small lesions such as adenomas; however, the main advantage of colonoscopy is that it allows for intervention, since biopsies can be taken and polyps removed.

Screening for and follow-up of colorectal cancer are among the indications for colonoscopy. Although colorectal cancer is highly preventable, it is the second most common cancer and cause of cancer deaths in the United States. Both men and women face a lifetime risk of nearly 6% for the development of invasive colorectal cancer. Proper screening can help reduce mortality rates at all ages, and colonoscopy plays an important role in this effort.