ANSWER 6
The microcytic, hypochromic anaemia and the altered bowel habit, the only symptom
referable to the gastrointestinal tract, point to a carcinoma of the colon, which would also
explain her weight loss. A barium enema revealed a neoplasm in the sigmoid colon, con-
firmed by colonoscopy and biopsy. Chest X-ray and abdominal ultrasound showed no pul-
monary metastases and no intra-abdominal lymphadenopathy or hepatic metastases
respectively.
She proceeded to a sigmoid colectomy and end-to-end anastamosis, and was regularly
followed-up for any evidence of recurrence. Histology showed a grade I tumour.
Carcinoma of the colon is increasing in frequency. If it presents at an early stage then
the prospect for cure is good. Rectal bleeding, alteration in bowel habit for longer than
1 month at any age, or iron-deficient anaemia in men or postmenopausal women are indi-
cations for investigation of the gastrointestinal tract.
Smoking is a risk factor for carcinoma of the colon.
- Carcinoma of the colon can present with few or no symptoms or signs in the gastro-
intestinal tract. - Carcinoma of the colon must be considered as a cause of iron-deficient anaemia.