An Asymptomatic 52-Year-Old Man Is Evaluated for a Nonobstructing Mass

question 243

Multiple Choice

An asymptomatic 52-year-old man is evaluated for a nonobstructing mass in his left colon (32 cm from the anorectal verge) found on routine screening colonoscopy.  There were no other lesions.  The mass was biopsied and diagnosed as grade II colon adenocarcinoma.  His other medical problems include hypertension treated with lisinopril and amlodipine.  The patient is a former smoker with a 20-pack-year history.  He drinks 1 or 2 cans of beer per week.  His father died of lung cancer at age 80.
Temperature is 36.7 C (98 F) , blood pressure is 140/80 mm Hg, pulse is 72/min, and respirations are 18/min.  BMI is 25 kg/m².  Lungs are clear to auscultation.  No enlarged lymph nodes are present.  Abdominal examination reveals no masses.  The liver span is normal, and the spleen cannot be palpated.
Laboratory results are as follows:
CT scan of the chest, abdomen, and pelvis shows a 2.5-cm left colonic lesion that appears to invade the serosa and an enlarged 1.5-cm adjacent lymph node.  Two 1.5-cm masses with irregular borders are seen within the right lobe of the liver close to, but not abutting, the capsule.  There are no other imaging abnormalities.
Which of the following is the most appropriate course of action in management of this patient?

• A)Biopsy of the liver lesion
• B)Chemotherapy and hospice assessment
• C)Chemotherapy followed by surgical assessment
• D)Hemicolectomy and resection of liver masses followed by chemotherapy
• E)Hemicolectomy and resection of liver masses only