A 68-year-old female presents to your office with several episodes of hematochezia over the past three months. She denies abdominal pain but has noticed a 10-pound weight loss over the past three months inspite of a good appetite and no dieting. Her bowel habits had been regular with a daily evacuation, but in the past three months, she has been constipated with three to four days between evacuations. Laxatives helped to some extent. She placed herself on over the counter fiber supplements but discontinued these because of bloating.
Her past medical history includes a cholecystectomy at age 54 for gallstones. Her father died at age 81 of a CVA but had colon cancer resected at age 76. No allergies. Uses Zocor for hyperlipidemia.
The physical examination is normal. The rectal reveals no stool in the vault.