From the Guidelines
The best investigation for a male patient with a history of right hemicolectomy for colonic cancer (T1a, N0, M0) presenting with right lower quadrant pain, weight loss, and constipation is a contrast-enhanced CT scan of the abdomen and pelvis, as recommended by the most recent guidelines 1. This should be performed promptly to evaluate for cancer recurrence, which is the primary concern given the patient's history and current symptoms. The CT scan should be accompanied by measurement of carcinoembryonic antigen (CEA) levels, as this tumor marker can help detect recurrence when elevated compared to the patient's baseline. Some key points to consider in the investigation and management of this patient include:
- The patient's symptoms of right lower quadrant pain, weight loss, and constipation are concerning for possible recurrence of colonic cancer, despite the original cancer being early stage (T1a, N0, M0) 1.
- The timing of recurrence is typically within the first 2-3 years after surgery, and these symptoms warrant urgent investigation rather than watchful waiting 1.
- Additional blood work including complete blood count, liver function tests, and comprehensive metabolic panel should be performed to assess for anemia, liver metastases, and overall health status.
- Colonoscopy is also essential to evaluate the anastomosis site and remaining colon for recurrent or metachronous lesions, and should be performed according to the guidelines for follow-up after colon cancer resection 1. It is worth noting that PET-CT scan is not routinely recommended for surveillance in patients with a history of colon cancer, unless there is a high clinical suspicion of recurrence and other imaging modalities are negative 1.
From the Research
Best Investigation for Colonic Cancer Patient
The patient has a history of right hemicolectomy for Colonic cancer (T1a, N0, M0) and is now presenting with right lower quadrant pain, weight loss, and constipation. The best investigation for this patient would be:
- Abdominal CECT (B): This is because the patient has a history of colonic cancer and is now presenting with symptoms that could be indicative of a recurrence or metastasis. Abdominal CECT is a sensitive and specific imaging modality for detecting liver metastases, which are a common site of recurrence for colonic cancer 2.
- PET/CT (C): This imaging modality can also be useful in detecting recurrence or metastasis, especially in patients with a history of cancer. PET/CT can provide information on the metabolic activity of the tumor, which can be helpful in diagnosing and staging the disease 3.
- Colonoscopy (A): While colonoscopy is an important tool for detecting and diagnosing colonic cancer, it may not be the best investigation for this patient given their symptoms and history. Colonoscopy is more useful for detecting lesions in the colon, whereas the patient's symptoms suggest a possible recurrence or metastasis outside of the colon.
Other Investigations
Other investigations such as US (D) and MRI (E) may also be useful in certain situations, but they are not the best choice for this patient given their history and symptoms. US is not as sensitive or specific as CECT or PET/CT for detecting liver metastases, and MRI is not as widely available or commonly used for this purpose 2, 4, 5, 6.