Rectal Bleeding and Fatigue

🗒️ Question

A 65 year old man presents to his GP with a 3 month history of rectal bleeding and a change in bowel habit to more frequent loose stools. He reports unintentional weight loss and feels increasingly fatigued. His father was diagnosed with colorectal cancer at the age of 68.

On examination, his abdomen is soft and non-tender with no palpable masses. Digital rectal examination reveals a hard, irregular mass in the rectum.

What is the most appropriate initial investigation?

(A) Abdominal ultrasound

(B) Colonoscopy

(C) CT abdomen and pelvis

(D) Flexible sigmoidoscopy

(E) Stool testing for faecal occult blood