A 36-Year-Old Man Comes to the Office for a Routine

A 36-year-old man comes to the office for a routine preventive visit.  The patient feels well, but for the past 2 days he has occasionally noticed blood on the tissue paper after defecation.  Otherwise, his bowel movements have remained normal in consistency and frequency.  He has no melena, vomiting, abdominal pain, or unexpected weight changes.  Medical history is unremarkable, and the patient has no family history of malignancy.  Vital signs are normal.  The abdomen is soft and nontender with normal bowel sounds and no hepatosplenomegaly or masses.  Digital rectal examination is unremarkable except for traces of red blood visible on the glove.  Which of the following is the most appropriate next step in management?

A) Anoscopy
B) Colonoscopy
C) CT colonography
D) Fecal DNA testing
E) Reassurance and periodic follow-up

Correct Answer:

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