A 68-year-old woman is evaluated because of rectal bleeding that began recently and a sense of fullness in the rectum. Flexible sigmoidoscopy shows a mass 11 cm from the anus, and biopsy reveals adenocarcinoma. The patient is referred to a colorectal surgeon, and a low anterior resection is performed. The primary tumor, a 4-cm moderately differentiated adenocarcinoma, penetrates the bowel wall. No lymph nodes are involved. What is the most appropriate next step in this patient s management?

Postoperative pelvic radiation therapy

No chemotherapy or radiation therapy; annual flexible sigmoidoscopy

Postoperative adjuvant chemotherapy and pelvic radiation therapy

Complete colonoscopy within the first year, repeated every 3 to 5 years

A 68-year-old woman is evaluated because of rectal bleeding that began

1.	A 68-year-old woman is evaluated because of rectal bleeding that began recently and a sense of fullness in the rectum. Flexible sigmoidoscopy shows a mass 11 cm from the anus, and biopsy reveals adenocarcinoma. The patient is referred to a colorectal surgeon, and a low anterior resection is performed. The primary tumor, a 4-cm moderately differentiated adenocarcinoma, penetrates the bowel wall. No lymph nodes are involved. What is the most appropriate next step in this patient s management?
A.	No chemotherapy or radiation therapy; annual flexible sigmoidoscopy
B.	Postoperative adjuvant chemotherapy and pelvic radiation therapy
C.	Postoperative pelvic radiation therapy
D.	Complete colonoscopy within the first year, repeated every 3 to 5 years
Answer» C. Postoperative pelvic radiation therapy

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