A 64-year-old male presents with changes in bowel habits, iron deficiency anemia, and positive fecal occult blood. Colonoscopy reveals an obstructing mass in the sigmoid colon. Biopsy confirms adenocarcinoma. What is the mandatory radiological staging workup for colorectal cancer?

Answer and explanation

Correct answer: C. Contrast-enhanced CT of the chest, abdomen, and pelvis

  1. Step 1: Colorectal adenocarcinoma spreads predominantly via lymphatic channels to regional nodes and hematogenously to the liver and lungs.
  2. Step 2: Standard clinical staging requires contrast-enhanced computed tomography (CT) of the chest, abdomen, and pelvis to detect hepatic, pulmonary, and peritoneal metastases prior to definitive resection.
Answer
Contrast-enhanced CT of the chest, abdomen, and pelvis.
Why not the others: 'Bone scan and whole-body PET scan only' is not standard first-line staging in the absence of bone symptoms or equivocal CT lesions; 'Transabdominal ultrasound of the liver only' fails to evaluate pulmonary metastases and retroperitoneal lymphadenopathy; 'Upper GI endoscopy and small bowel follow-through' evaluates upper gastrointestinal pathology unrelated to colorectal staging.

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A 64-year-old male… | Oman Medical Specialty Board Examination (OMSB)