Colorectal cancer Quiz: Ace Your Exams

A 46-year-old woman presents to the clinic with episodic lower abdominal discomfort, bloating, and hematochezia for 4 months. She has not had diarrhea and the amount of stool she passes with each bowel movement has been smaller than usual. She reports weight loss of 4 kg (8.8 lbs) over the past 4 months. Her appetite has remained unchanged, but she feels "full" earlier than usual after starting meals. Past medical history includes gastroesophageal reflux disease (GERD) managed with omeprazole and irritable bowel syndrome diagnosed in her 30s. Family history is positive for endometrial cancer in her mother at the age of 32. Her diet is significant for high consumption of dairy products. Body mass index (BMI) is 20 kg/m². Temperature is 36.9°C (98.4°F), blood pressure is 124/80 mm Hg, pulse is 76/min, respiratory rate is 14/min, and oxygen saturation is 99% on room air. Abdominal examination shows mild distention with hyperactive bowel sounds and mild tenderness in the left lower quadrant without palpable masses. Digital rectal examination (DRE) reveals stool with blood in it and no evidence of hemorrhoids or fissures. Laboratory results are significant for a hemoglobin of 10.3 g/dL, and an MCV of 72 fl. Which of the following features would most significantly increase this patient’s risk for the most likely underlying condition?