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Gastrointestinal: weight loss

Mr Brown is a 67 year old gentleman who presents to his GP. He has not been to his GP in a long time, but he recently noticed when shopping for new clothes, as his old clothes were feeling looser, that he was more tired than usual. This had been going on for some time. He also had some alternating bowel habits over the last few months, but did not feel too worried as he had not passed any blood. What is the most important differential for the GP?

Mr Brown mentions that his brother had a polyp after he was invited for a screening test in the mail. He asks if this kind of test would be a good idea for him to have. Why is the screening test (looking for faecal occult blood) not useful for Mr Brown?

The GP finds recent blood results for Mr Brown showing Hb at 11.4g/dl, MCV at 65fl and platelets at 230. What do the bloods indicate?

  • Iron deficiency anaemia
  • Fresh PR bleeding
  • Large bowel obstruction
  • Tenesmus
  • Mucus PR
  • Altered bowel habit
  • Altered bowel habits
  • Weight loss
  • Small bowel obstruction
  • RIF mass
  • PR bleeding

  • 65-75% 5 year survival
  • 1% 5 year survival
  • Distant metastases
  • Penetrated bowel wall
  • Limited to bowel wall
  • Lymph node metastases
  • 30-40% 5 year survival
  • 95-100% 5 year survival

Fortunately Mr Brown's cancer does not come back and the only evidence that remain are the abdominal scars.
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Polyp seen on colonoscopy. This can be removed with the same instrument by use of snare cauterisation. © 2009 Dr FC Turner.

Colonoscopy showing a large malignant poly.

Video showing a laproscopic sigmoid colectomy.

For those so inclined.