Neoadjuvant Therapy for Colon Cancer

A 40-year-old woman who was otherwise healthy presents to urgent care with worsening crampy abdominal pain over the past month. She has noticed blood occasionally mixed into her stool and has never had a colonoscopy. Laboratory workups, including a basic metabolic panel and a complete blood count, were normal except for hemoglobin of 9 mg/dL. On imaging, CT of the abdomen and pelvis with intravenous contrast is concerning for a sigmoid colon mass extending into the bladder dome. There is bulky lymphadenopathy around the inferior mesenteric artery pedicle. No free intra-abdominal air. The colon distal to the mass is decompressed. No other concerning lesions are seen within the abdomen or pelvis.