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 CT scan of the abdomen and pelvis with contrast, as recommended by the NCCN guidelines 1 and endorsed by the American Society of Clinical Oncology 1.
Key Considerations
- The patient's symptoms of right lower quadrant pain, weight loss, and constipation raise concern for cancer recurrence at the anastomotic site or regional lymph nodes.
- A CT scan of the abdomen and pelvis with contrast provides detailed images of the abdomen and can identify masses, obstruction, or metastatic disease.
- Blood tests, including a complete blood count and carcinoembryonic antigen (CEA) level, should also be obtained to assess for anemia and potential recurrence.
Investigation Approach
- The CT scan should be performed promptly, given the patient's symptoms and history of colon cancer.
- Following the CT scan, a colonoscopy would be appropriate to directly visualize the anastomosis and remaining colon to rule out local recurrence or metachronous lesions.
- This approach is supported by the NCCN guidelines, which recommend annual CT scans of the chest, abdomen, and pelvis for up to 5 years after surgery for patients with stage I-III colon cancer 1.
Rationale
- The patient's initial disease was early-stage (T1a), but the new symptoms warrant thorough investigation for recurrence, which typically develops within the first 2-3 years after resection.
- The American Society of Clinical Oncology recommends surveillance guided by presumed risk of recurrence and functional status of the patient, with medical history, physical examination, and CEA testing every 3-6 months for 5 years 1.
Additional Recommendations
- The patient should be counseled on secondary prevention measures, including maintaining a healthy body weight and active lifestyle.
- A treatment plan from the specialist should have clear directions on appropriate follow-up by a nonspecialist.
From the Research
Best Investigation for Male Patient with History of Right Hemicolectomy
The patient presents with right lower quadrant pain, weight loss, and constipation, which could be indicative of a recurrence of colonic cancer or other complications.
- The patient's history of right hemicolectomy for Colonic cancer (T1a, N0, M0) suggests that a thorough investigation is necessary to rule out any recurrence or metastasis.
- Considering the patient's symptoms, the best investigation would be one that can accurately diagnose any potential recurrence or metastasis, as well as assess the patient's overall condition.
Investigation Options
The following investigation options are available:
- Colonoscopy: This is a crucial test for detecting any recurrence of colonic cancer, especially in patients with a history of the disease 2.
- Abdominal CECT: This test can help identify any potential recurrence or metastasis in the abdominal region, including the liver and lymph nodes 3, 4.
- PET/CT: This test is highly sensitive and specific for detecting malignant disease, including recurrence and metastasis, and can provide valuable information for treatment planning 2, 5.
- US: This test may not be as sensitive or specific as other tests, such as CECT or PET/CT, for detecting recurrence or metastasis.
- MRI: This test can provide detailed images of the abdominal region, but may not be as sensitive or specific as PET/CT for detecting malignant disease.
Recommended Investigation
Based on the patient's history and symptoms, the best investigation would be a PET/CT scan, as it can provide highly sensitive and specific information about any potential recurrence or metastasis, and can help guide treatment planning 2, 5.