A 53-year-old woman has noticed increasing malaise. On physical examination, there are no abnormal findings, but a stool guaiac test is positive. Her hemoglobin level is 7.9 g/dL. A colonoscopy is performed, and a 3-cm sessile mass is found in the cecum. A biopsy specimen of the mass shows a moderately differentiated adenocarcinoma confined to the mucosa. An abdominal CT scan shows no lymphadenopathy or hepatic lesions. Given this information, which of the following is the best course of action?
Administer a multiagent chemotherapeutic regimen
Observe the lesion for further increase in size
Remove the entire colon to prevent a recurrence
Resect the tumor and some normal surrounding tissue
A malignant epithelial neoplasm arises in the mucosa but has a tendency to invade locally. A benign neoplasm is often well-circumscribed, and compressed normal surrounding tissue appears to form a discrete border. This localized lesion can be resected easily, with adequate margins. Without evidence for spread outside the colon, chemotherapy is unlikely to be of benefit. The biopsy specimen shows a malignant lesion; it must be removed before it increases in size and invades locally or metastasizes. If there is no family history, familial cancer with a high risk of recurrence from multiple polyps is unlikely; local excision is adequate. Such a solitary mucosal lesion is unlikely to represent a metastasis.
Neoplasia