Bob W. is a 64-year-old architect who recently visited his primary care physician for a regular check-up. He complained of fatigue and was sent to the lab for a complete blood count. The results showed that Bob was anemic. A battery of tests was ordered along with a repeat blood count. His PCP performed a fecal occult blood (FOB) screening test in the office, which turned out to be positive for fecal occult blood. Based on this result, and the fact that Bob had never had a colonoscopy, which is a recommended screening test after 45 years of age, his PCP referred him to a gastroenterologist.

One week later, a colonoscopy was performed and the gastroenterologist noted a suspicious lesion in Bob's ascending colon. This turned out to be a 4-centimeter non-obstructing circumferential mass. A biopsy was performed on the mass and the pathologist report indicated it was an adenocarcinoma.

A right hemicolectomy was performed to remove the mass. The pathology report indicated a moderately differentiated adenocarcinoma staged as a T3N0 colon cancer (Stage II). Twelve lymph nodes were removed at the time of surgery and all were negative for metastatic disease. No adjuvant chemotherapy was administered.