The Correct Answer is B!

A 19-year-old male high school athlete noted some bright red blood on the toilet paper after a bowel movement and presents to your office. Physical examination is normal except for a small nodule approximately 5 cm from the anal verge. You refer him for a flexible sigmoidoscopy and nearly a hundred polyps are noted. Biopsies are consistent with adenomatous polyps. He is adopted and has no knowledge of his family history.

What do you recommend next?

A. Annual screening flexible sigmoidoscopy
B. Total proctocoloectomy
C. Colonoscopy with endoscopic removal of polyps
D. Abdominal computed tomography for metastatic disease

Rationale:

The patient has evidence for having familial adenomatous polyposis (FAP), which results from the deletion of one copy of the APC gene from birth. These patients will begin to develop hundreds of adenomatous polyps in the early teen years and will almost uniformly develop colon cancer by the age of 40. The recommendation is for a total proctocolectomy once polyposis phenotype is established.

 

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