رجل عمره ٦١ سنة لاحظ من ٣ أشهر تغيراً في عادة الإخراج بين إمساك وإسهال، ونقص وزنه ٦ كيلو بدون رجيم، ويتعب بسرعة. الهيموغلوبين ٩٫٤ مع كريات صغيرة. لم يعمل منظار قولون من قبل. ما الإجراء الأنسب؟

A 61-year-old man has noticed 3 months of alternating constipation and diarrhoea, 6 kg unintended weight loss and fatigue. Hb 9.4 g/dL with small cells. He has never had a colonoscopy. What is the most appropriate action?

1. Give iron tablets only and review in a year
2. Refer for colonoscopy to exclude colorectal cancer
3. Advise more fibre and reassess at a later date
4. Reassure him it is IBS and prescribe a mild laxative

Answer: B) Refer for colonoscopy to exclude colorectal cancer. A change in bowel habit after 50 with weight loss and iron-deficiency anaemia are red flags for colorectal cancer needing colonoscopy. Iron deficiency in a man or postmenopausal woman is GI blood loss until proven otherwise.