Rectal Bleeding and Weight Loss

🗒️ Question

A 65 year old man presents with a six-month history of intermittent rectal bleeding, unintentional weight loss and a change in bowel habits, characterised by alternating diarrhoea and constipation. He reports a family history of bowel cancer in his father, diagnosed at age 72.

On examination, his blood pressure is 125/80 mmHg, heart rate is 84 bpm and regular and there is pallor. Abdominal examination reveals no palpable masses, however digital rectal examination identifies a firm, irregular lesion 6 cm from the anal verge.

Investigations:

• Haemoglobin: 95 g/L (130–175)

• Mean corpuscular volume (MCV): 72 fL (80–96)

• Faecal immunochemical test (FIT): Positive

What is the most appropriate initial management?

(A) Arrange urgent colonoscopy

(B) Commence iron supplementation

(C) Perform staging CT of the chest, abdomen, and pelvis

(D) Refer for neoadjuvant chemoradiotherapy

(E) Start oral laxatives for symptom control