Mr. LaCologne is a 38-year-old man from the Eastern townships of Quebec. His brother died within the past year of colon cancer at age 42 years, as did his father nearly twenty years ago (at age 63 years). Philippe saw his family doctor, and because of his anxiety about developing cancer, he was referred for consideration of a screening colonoscopy. He was seen 4 months later by a gastroenterologist; history and physical exam were unremarkable. Colonoscopy was performed 1 month later, and a mass was discovered at the hepatic flexure. Biopsies were taken, and pathology confirmed that this was poorly differentiated colonic adenocarcinoma.