A 26-year-old man comes to the office with a 4-week history of malaise, abdominal pain, and diarrhea. Two days ago, he noticed streaks of blood in his stool. The patient has not traveled recently and has not eaten anything out of the ordinary. He has no prior medical conditions. The patient occasionally drinks alcohol but does not use tobacco or illicit drugs. His father was diagnosed with colon cancer at age 55 and died of metastatic disease 5 years later.
Temperature is 38 C (100.4 F). Abdominal examination reveals tenderness in the periumbilical area and left lower quadrant with no guarding or rebound tenderness. Bowel sounds are increased. Rectal examination shows no hemorrhoids or fissures, but blood-streaked stool is present in the rectal vault.
Stool cultures and testing for infections, including Clostridioides difficile, are negative. Colonoscopy shows edematous, friable mucosa; multiple ulcerations; and exudates involving the entire colon. Biopsies reveal mononuclear cell infiltrates, cryptitis, and crypt abscesses.
Medical therapy is started. A follow-up colonoscopy 8 weeks later shows minimal mucosal edema but is otherwise unremarkable.
Which of the following is the best recommendation regarding colorectal cancer screening in this patient?

Question

A 26-year-old man comes to the office with a 4-week history of malaise, abdominal pain, and diarrhea.  Two days ago, he noticed streaks of blood in his stool.  The patient has not traveled recently and has not eaten anything out of the ordinary.  He has no prior medical conditions.  The patient occasionally drinks alcohol but does not use tobacco or illicit drugs.  His father was diagnosed with colon cancer at age 55 and died of metastatic disease 5 years later.
Temperature is 38 C (100.4 F).  Abdominal examination reveals tenderness in the periumbilical area and left lower quadrant with no guarding or rebound tenderness.  Bowel sounds are increased.  Rectal examination shows no hemorrhoids or fissures, but blood-streaked stool is present in the rectal vault.
Stool cultures and testing for infections, including Clostridioides difficile, are negative.  Colonoscopy shows edematous, friable mucosa; multiple ulcerations; and exudates involving the entire colon.  Biopsies reveal mononuclear cell infiltrates, cryptitis, and crypt abscesses.
Medical therapy is started.  A follow-up colonoscopy 8 weeks later shows minimal mucosal edema but is otherwise unremarkable.
Which of the following is the best recommendation regarding colorectal cancer screening in this patient?

Quizplus · Accepted Answer

11ec193a_9800_a76e_853d_97b2e209b9f9_MD0002_00 This patient has ulcerative colitis (UC), presenting with abdominal pain, fever, and bloody stools. The diagnosis of UC is confirmed on colonoscopy showing rectal (and contiguous proximal) inflammation, friable mucosa, and exudates; typical biopsy features include mononuclear cell infiltrates, cryptitis, and crypt abscesses. Individuals who have inflammatory bowel disease (IBD) (eg, UC, Crohn disease) with extensive colonic involvement (eg, >1/3 of the colon) are at increased risk for adenocarcinoma of the colon. These patients should undergo surveillance colonoscopy 8-10 years after diagnosis and every 1-3 years thereafter. Optimal screening intervals in those with less extensive colonic involvement is uncertain, but these patients also generally warrant periodic colonoscopy. (Choice A) Annual surveillance colonoscopy is indicated for patients with genetic colorectal cancer syndromes (eg, familial adenomatous polyposis) and is an appropriate interval for those with IBD once screening colonoscopy has been initiated. (Choice B) Annual fecal immunochemical testing (FIT) is appropriate for patients at average risk for colon cancer but has lower sensitivity than colonoscopy and is not recommended for those with UC. (Choice C) Patients who have a first-degree relative with colorectal cancer or advanced (eg, high-grade dysplasia) adenomatous polyps diagnosed at age <60 should begin surveillance colonoscopy at age 40 (or 10 years younger than the age of the relative at diagnosis, whichever is earlier) and then repeat every 5 years. Although this patient has a significant family history, his UC is an even greater risk factor for colon cancer and therefore surveillance should commence 8-10 years from his initial diagnosis instead of at age 40. (Choice D) Screening colonoscopy for average-risk patients should begin at age 45 and continue every 10 years thereafter. This patient is at increased risk and warrants more aggressive screening. Educational objective: Patients with inflammatory bowel disease (ulcerative colitis or Crohn disease) who have extensive colonic involvement (>1/3 of the colon) are at increased risk for developing colorectal cancer. These patients should undergo surveillance colonoscopy 8-10 years after diagnosis and every 1-3 years thereafter. __________ References: How to manage the risk of colorectal cancer in ulcerative colitis. (http://www.ncbi.nlm.nih.gov/pubmed/21466491)

A 26-Year-Old Man Comes to the Office with a 4-Week