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21. A previously healthy 85-year-old man has had abdominal
distention, decreased caliber of stools, and decreased appetite over the past 2 weeks and a 9-kg (20-lb) weight loss over the past 3 months. On sigmoidoscopy, he is found to have a constricting adenocarcinoma of the sigmoid colon; imaging studies show three 1-cm metastases to the liver. Which of the following is the most appropriate next step inmanagement?

A) No treatment
B) Radiation therapy
C) Chemotherapy
D) Combination radiation therapy and chemotherapy
E) Resection of the colon tumor

Expl your answer Pls

1. Also what would you have picked as an asnwer if this was a Pt that was btw 50 to 70 years of age?? Any Difference??

resection of colon tumor...
b/c this is exception in colon ca u can do colectomy if the pt has liver metastasis
plz correct me..but i,m 90% sure

kaplan step3 says stage III n IV -surg n chemo.NO RADIATION. m not sure though

u r right but this is exception....see kaplan notes step 3 in surgery

E,
you do resection not to cure the disease but to relieve the obstruction! Obstructed colon from tumor needs resection independently from Duke's staging otherwise the pt is going to die on you secondary to bowel perforation.
Age doesn't make any difference

E...i think its would be better to resect the colon to relieve the obstruction

hey ben...how r u buddy...long time no see....hows it going??

the Q is what is the most approp next step...so indeed, it's tumor resection; next it's chemo with 5fu +/- resection of the liver mets, when there are 3 or less

I think it'd be E for this patient, to relieve the obstruction, but if he were younger, then it probably would be resection of the colon + resection of liver mets and adjuvant chemotherapy.

thx for ur time & input friends