Ease Into Prep with a PANCE^® Question of the Day

The correct answer is C. The barium enema demonstrates an irregular lesion that causes obstruction in the sigmoid colon. This finding on barium enema is highly suspicious for adenocarcinoma. Cancers arising in the left and sigmoid colon are characterized by rectal bleeding, obstructive symptoms, and possibly constipation alternating with diarrhea. Stools may have a narrow caliber as the tumor encroaches onto the lumen.

Although anemia (choice A) , Blumer shelf (metastasis to the pelvic cul-de-sac) (choice B) , Virchow node (palpable lymph node in the left supraclavicular space) (choice D) , and weight loss (choice E) can be associated with cancers of the left and sigmoid colon, they are more commonly associated with right-sided colon cancer or a highly advanced left-sided colon cancer.

PEARL: Remember the most common signs for colon masses; some of them will depend on the location of the mass.

• A growing mass in the left colon is most likely to produce obstruction to the passage of feces, and thus, likely to present with constipation alternating with diarrhea or bloody bowel movements.
• A mass in the right side of the colon is most likely to present with chronic blood loss and anemia.