Hx:
70 y/o male
CC: hematochezia x 2 mo.
+ moderate, intermittent bleeding
+ constipation, weight loss, fatigue x 3 mo.
PMH: internal hemorrhoids
(-) DRE 1 yr ago, (-) sigmoidoscopy 6 yrs ago
remote 20 pack-year hx

PEx:
VSS s/p IVF
Abd: NABS. Firm, slightly distended, NT, no HSM
Rectal: no palpable masses, (+) guaiac

Dx: colorectal cancer

Labs/Procedures:
CBC: microcytic anemia
Chem panel: mild prerenal picture
Coags: WNL
Anoscopy: Grade I hemorrhoids, no tears or clots
Flex sig: circumferential exophytic mass with central ulceration at upper rectum (approx. 8 cm above anal verge)
Chest XRay: normal
CT: negative for LN, lung, liver mets
Barium enema: annular rectal carcinoma at rectosigmoid junction
CEA: 15
LFTs: normal
Path: well-differentiated adenocarcinoma, to subserosa

Management: