A 72-year-old man comes to the office for follow-up. He was recently diagnosed with a 4.2-cm adenocarcinoma of the cecum, with CT scans showing no evidence of metastases. The patient underwent right hemicolectomy, with histopathology indicating that the tumor involved only the mucosa and submucosa but not the muscular layers of the colon. Complete tumor resection was achieved with clear margins and without lymph node involvement. The patient feels well and has no symptoms. Medical history is significant for hypertension and obesity. Temperature is 37.5 C (99.5 F), blood pressure is 140/80 mm Hg, and pulse is 80/min. Heart and lung sounds are unremarkable. There is a well-healed surgical scar on the abdomen, which is otherwise soft and nontender. Which of the following is recommended for this patient?

Question

A 72-year-old man comes to the office for follow-up.  He was recently diagnosed with a 4.2-cm adenocarcinoma of the cecum, with CT scans showing no evidence of metastases.  The patient underwent right hemicolectomy, with histopathology indicating that the tumor involved only the mucosa and submucosa but not the muscular layers of the colon.  Complete tumor resection was achieved with clear margins and without lymph node involvement.  The patient feels well and has no symptoms.  Medical history is significant for hypertension and obesity.  Temperature is 37.5 C (99.5 F), blood pressure is 140/80 mm Hg, and pulse is 80/min.  Heart and lung sounds are unremarkable.  There is a well-healed surgical scar on the abdomen, which is otherwise soft and nontender.  Which of the following is recommended for this patient?

Quizplus · Accepted Answer

11ec25c8_d8e8_1d80_bc81_0bd45ad30eba_MD0003_00 This patient has undergone surgical resection for localized (eg, stage I) colon adenocarcinoma. These tumors are limited to the superficial layers of the colon (eg, mucosa and submucosa only in this patient) and are not metastatic. Although most patients with localized colon adenocarcinoma are cured after surgical resection, some develop recurrent neoplastic lesions of the colon. Early detection is key because treatment with surgery and/or chemotherapy is most effective when initiated promptly. Colonoscopy is the most accurate diagnostic test and must be performed soon after surgical resection (eg, 1 year) because recurrent neoplasia can develop quickly. Surveillance is continued lifelong (or until comorbidities no longer allow it) with periodic colonoscopy every 3-5 years (Choice E). There may be some differences in the exact surveillance guidelines of different professional societies. (Choice A) Unlike localized colon adenocarcinoma, tumors that invade the muscular and serosal layers (eg, stage II) or exhibit lymph node involvement (eg, stage III) have a significant risk of distant metastasis despite appropriate treatment. Surveillance in these individuals requires frequent abdominal CT scans and serial serum carcinoembryonic antigen (CEA) levels in addition to colonoscopy. (Choice B) Although annual fecal occult blood testing can be used for colon cancer screening in low-risk individuals, it is not recommended in those at high risk (eg, personal or family history of colon cancer or polyps) because it is less accurate than colonoscopy for diagnosing neoplastic lesions. (Choice D) Early detection of recurrent colon cancer enables the prompt initiation of treatment. Deferring colonoscopy later than a year after surgical resection is discouraged because recurrent malignancy might be metastatic and incurable by the time it is recognized. Educational objective: Although most patients with localized (eg, stage 1) colon adenocarcinoma are cured after surgical resection, some develop recurrent neoplastic lesions of the colon. Therefore, a colonoscopy should be performed 1 year after surgical resection and every 3-5 years thereafter. References: Colonoscopy surveillance after colorectal cancer resection: recommendations of the US multi-society task force on colorectal cancer. (http://www.ncbi.nlm.nih.gov/pubmed/26892199)

A 72-Year-Old Man Comes to the Office for Follow-Up