Situation
A patient who had undergone a right hemicolectomy for carcinoma of the colon
three months ago is referred to you with an abnormal CXR. Their are two nodules,
one on each side. What do you do ?
The pre operative CXR is said to be normal, but is not available.
Points in the history to look out for:
poor appetite
weight loss
bone pain
headaches
Measure the CEA, and check if their was a preoperative level.
Serum Ca2+, and Alk Phos
Perform a bone scan to eliminate skeletal metastasis.
Perform a high resolution CT scan to look if any other nodules are present. As the bowel operation was only three months ago, it would be quite reasonable to perform a second HRCT in another 3 months time to make sure no more metastasis have appeared before even contemplating a bilateral metastatectomy.