A 57-year-old man comes to his primary care physician complaining of increasing fatigue in the past few months. He is unable to walk up to his third floor apartment without becoming short of breath. The physician orders a basic blood test. Laboratory tests show:
WBC count = 5000/mm3
Hemoglobin = 10.2 g/dL
Hematocrit = 37%
Platelet count = 221,000/mm3
Mean corpuscular volume = 70 fL
Additionally, the patient’s stool is guaiac-positive. The physician sends the patient for a colonoscopy which is shown in the image. With the new diagnosis the patient is concerned about his 35-year-old son. What recommendations should the physician make?
- His son should be screened with a colonoscopy every 1–2 years starting now
- His son should be screened with a colonoscopy every 5 years starting at the age of 40
- His son should be screened with a colonoscopy every 5 years starting at the age of 50
- His son should be screened with a colonoscopy every 5 years starting now
- His son should be screened with a fecal occult blood test every year starting at the age of 50
View Explanation
The patient in the question has colon cancer. His presentation and blood tests are consistent with microcytic anemia. The colonoscopy reveals an exophytic mass in the colon consistent with adenocarcinoma. The current American Gastroenterological Association guidelines state that people with first-degree relatives diagnosed with colon cancer or adenomatous polyps diagnosed at an age of < 60 years should be screened with a colonoscopy every 5 years beginning at the age of 40, or 10 years younger than the earliest diagnosis in the family, whichever comes first. Since the patient was diagnosed with colon cancer at the age of 57 the son should be screened at the age of 40 since that is earlier than 10 years younger than his father’s diagnosis.