A 63-year-old man is evaluated because of a several-month history of increasing fatigue and some vague upper abdominal discomfort. His medical history includes gastroesophageal reflux disease, coronary artery disease, and clinical depression, all of which are well controlled with medications. The patient has been working full time. On physical examination, he has mild hepatomegaly. His hemoglobin is 12.2 g/dL, serum alkaline phosphatase level 280 U/L, and serum aspartate aminotransferase level 65 U/L. CT scan of the abdomen and pelvis shows multiple hepatic lesions ranging in size from 1 cm to 4 cm; mesenteric, para-aortic, and paracaval lymphadenopathy, and a colonic mass at the splenic flexure. Colonoscopy reveals a nonobstructing, non bleeding lesion; biopsy shows it to be poorly differentiated adenocarcinoma. Fine- needle aspiration of one of the liver lesions confirms the presence of malignant cells consistent with a primary colon cancer. What is the most appropriate next step in

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Quizplus · Accepted Answer

The most appropriate next step for this patient, who has metastatic colon cancer (evidenced by multiple hepatic lesions and mesenteric, para-aortic, and paracaval lymphadenopathy), is systemic chemotherapy. Given the widespread nature of the disease, localized treatments such as surgery or regional chemotherapy are not suitable as initial approaches. Systemic chemotherapy can help control the spread of the cancer and potentially improve symptoms and survival.

A 63-Year-Old Man Is Evaluated Because of a Several-Month History