Keywords: iron deficiency anemia, ascending colon cancer, adenocarcinoma, young male, prevention

Introduction:

Iron deficiency anemia, indicated by low serum ferritin, red cell microcytosis or hypochromia, can be an early sign of colon cancer, which is increasingly affecting younger individuals under 50 who typically fall outside standard screening criteria. That include factors such as age over 50, a family history of colorectal cancer, a history of inflammatory bowel disease, or the presence of hereditary conditions. Recognizing this condition is vital, emphasizing the importance of GPs in prompt cancer detection and referral.

Case:

A 38-year-old male with no past medical or surgical history presented his GP with symptoms of chronic fatigue lasting a few weeks. The patient did not have a history of gastrointestinal bleeding, alcohol consumption, or smoking. Also, there was no family history of gastrointestinal malignancies. Laboratory tests showed severe microcytic hypochromic anemia with hemoglobin of 124 g/L, hematocrit of 0.409 L/L, MCV of 79.1 fL, serum ferritin of 8 ng/ml, serum iron of 5 μmol/L, transferrin saturation of 6%, TIBC of 86 μmol/L, UIBC of 81 μmol/L, transferrin saturation of 4%. He had a normal serum CEA and CA 19-9 levels. To urgently determine the cause of his anemia, the GP promptly referred him for a total colonoscopy which revealed a polypoid neoplastic mass in the ascending colon. Histopathology of the mass showed invasive well-differentiated adenocarcinoma, and the CT scan confirmed an infiltrative process of the cecum and ascending colon without signs of disease dissemination. The patient underwent a right hemicolectomy and for now, is only under follow-up as recommended by oncology.

Discussion:

This clinical case underscores the important role of primary care in recognizing iron deficiency anemia as an indicator of potential colon cancer in young male patients. Early diagnosis of the malignancy reported significantly improved the patient's prognosis and survival, avoiding complications and more severe therapies.