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Iron deficiency anaemia from colorectal cancer — MCCQE Part 1 MCQ

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HardFatigueIron deficiency anaemia from colorectal cancerMCCQE Part 1

A 67-year-old man presents with 3 months of fatigue and reduced exercise tolerance. He has no overt bleeding. Haemoglobin is 86 g/L, MCV is 72 fL, ferritin is low, and stool FIT is positive. He has never had colorectal screening. What is the most appropriate investigation?

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Correct answer: A — Colonoscopy with evaluation for gastrointestinal malignancy

Iron deficiency anaemia in an older man is gastrointestinal blood loss until proven otherwise, and a positive FIT strengthens the need for colon evaluation. Iron replacement is important but should not replace investigation for colorectal cancer. Bone marrow biopsy is not first-line when iron deficiency is established. Venous Doppler does not address the presentation.

Reference: Canadian Association of Gastroenterology; CTFPHC colorectal screening guidance