Internal Medicine

0521779407-C03 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:54

Coccidioides Immitis Colon Polyps and Tumors 367

Prognosis

■Good for normal hosts

■With acute presentation/septic picture, very poor prognosis

Colon Polyps and Tumors..............................

DAVID A. LIEBERMAN, MD

history & physical

History

■patients with (+) history should be considered for complete colon

exam

■family history of colorectal cancer (CRC) in first-degree relative

■family history of CRC under age 50

■personal history of colon polyps or cancer

■personal history of ulcerative colitis – duration >8 years

Signs & Symptoms

■findings prompting a colon examination:

➣recurrent/persistent rectal bleeding in patient over age 40

➣significant change in bowel habits

➣weight loss

➣iron deficiency anemia

➣rectal exam reveals mass

tests

Screening of Asymptomatic, Average Risk

■colon screening is recommended to begin at age 50; screening

options include:

➣fecal occult blood test (FOBT) annually

home testing performed on 3 stool samples has higher positive

predictive value than office test on digital exam; digital exam

in office is not an adequate screening test

➣there is controversy regarding rehydration of FOBT slides

➣flexible sigmoidoscopy every 5 years

➣colonoscopy every 10 years

■NOTE: overall health and comorbidities should be considered when

assessing risk and benefit of continuing screening beyond age 75

Surveillance

■Positive family history of CRC

➣risk of CRC in family member increased by 2–4 fold