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Iron deficiency anaemia from occult colorectal cancer — MCCQE Part 1 MCQ

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HardFatigueIron deficiency anaemia from occult colorectal cancerMCCQE Part 1

A 58-year-old man presents with 3 months of fatigue and reduced exercise tolerance. He has microcytic anaemia, ferritin 8 µg/L, and no overt gastrointestinal bleeding. He has unintentionally lost 4 kg and has never completed colorectal cancer screening. What is the most appropriate investigation?

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Correct answer: B — Colonoscopy with upper gastrointestinal evaluation if colonoscopy is unrevealing

Iron deficiency anaemia in an older man is gastrointestinal blood loss until proven otherwise, and colonoscopy is required rather than screening FIT. Iron replacement should occur, but it must not delay evaluation for malignancy. Bone marrow biopsy is not the next step when iron studies clearly show deficiency.

Reference: Canadian Association of Gastroenterology guidance; CTFPHC colorectal cancer screening