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28th February 2025
A 46-year-old man presents to the emergency department with worsening breathlessness on exertion
A 46-year-old man presents to the emergency department with worsening breathlessness on exertion. He has a history of ulcerative colitis which is well controlled on aminosalicylate. His last colonoscopy 1 year ago showed extensive colitis with no active inflammation. He has been opening his bowels once or twice daily, with no rectal blood or black tarry stool. He has smoked 10 cigarettes daily for the past 25 years and consumes around 14 units of alcohol per week.
His father was diagnosed with bowel cancer at age 45 and died 5 years later and his uncle has just been diagnosed with bowel cancer at the age of 49. His paternal grandfather also died of bowel cancer.
On examination, temperature is 36.9°C, BP 100/70 mmHg and heart rate 101 bpm.
His blood results are given below:
| Hb | 76 g/L | (135-180) |
| MCV | 72 fL | (80 – 100) |
| WBC | 10.1 x 10⁹/L | (4.0 – 11.0) |
| Na+ | 136 mmol/L | (135 – 145) |
| K+ | 5.1 mmol/L | (3.5 – 5.0) |
| Urea | 5.0 mmol/L | (2.0 – 7.0) |
| Creatinine | 99 µmol/L | (55 – 120) |
| CEA | Positive | |
Which of the following factors increases his risk of colorectal cancer the most?
Select the SINGLE most appropriate option from the list below. Select ONE option only.
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