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Colorectal cancer — MCCQE Part 1 MCQ

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ModerateWeight LossColorectal cancerMCCQE Part 1

67-year-old man presents with unintentional weight loss and altered bowel habit. He reports intermittent rectal bleeding and iron deficiency anaemia. Which of the following is the most appropriate next step?

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Correct answer: B — Arrange urgent colonoscopy and staging if malignancy is found

Arrange urgent colonoscopy and staging if malignancy is found is best because alarm symptoms plus iron deficiency make colorectal cancer a key concern. Discharge with reassurance and routine follow-up only is suboptimal because it underestimates acute or progressive risk; Treat symptomatically and defer definitive assessment is suboptimal because symptom control alone does not address the likely underlying diagnosis; Arrange non-urgent outpatient imaging in several months is suboptimal because delayed imaging is unsafe when the presentation has red flags; Start long-term corticosteroids without confirming the diagnosis is suboptimal because empiric steroids can obscure infection, malignancy or other diagnoses. Symptomatic patients need diagnostic evaluation, not routine screening.

Reference: Canadian Association of Gastroenterology colorectal cancer guidance