MCCQE Part I Colorectal cancer Questions: 10 Free Practice MCQs
Colorectal cancer questions test the pathway from a symptom to a diagnosis and then to treatment. The MCC objectives expect you to apply the screening recommendations, recognise iron deficiency anaemia and a change in bowel habit as red flags, and know the staging investigations that follow a positive result. They also cover surveillance after treatment and the family history that changes screening for relatives.
Where candidates lose marks
- Investigating iron deficiency anaemia in an older adult without a colonoscopy.
- Reassuring a patient with a change in bowel habit because there is no visible bleeding.
- Forgetting family history when deciding the screening interval for a relative.
- Missing the staging investigations before a treatment decision.
Guideline to follow: The MCCQE Part I follows the Canadian Task Force on Preventive Health Care colorectal cancer screening recommendations and provincial cancer programme pathways.
Ten MCCQE Part I-style colorectal cancer questions with the answer and the reasoning behind it. They come from the CA.med bank, which has 12 colorectal cancer questions and many more across every topic.
1 / 10
A 60-year-old man with no bowel symptoms participates in the provincial colorectal screening programme and receives a positive fecal immunochemical test result. He has no personal or family history of colorectal neoplasia.
What is the most appropriate next step?
Show answer
Answer: C. Refer for colonoscopy
Why: A positive fecal immunochemical test is specific for human blood and must be followed by colonoscopy; the test is not repeated. Repeating the stool test, reassurance with return to routine screening and substitution with barium enema all delay or fail to provide the diagnostic endoscopy that a positive result requires.
- A. Because the test detects human blood, repeating it rather than proceeding to endoscopy delays diagnosis and is explicitly discouraged.
- B. A positive result reflects an abnormal finding that requires evaluation, so simple reassurance is inappropriate.
- D. Barium enema is listed among the tests that are not recommended, and it does not replace colonoscopy here.
Sources: Government of British Columbia. BC Guidelines: Colorectal Cancer Part 1, Screening (2022).
2 / 10
A 57-year-old man presents with a three-month history of rectal bleeding and a change in bowel habit. He is anaemic on bloodwork.
According to the Choosing Wisely Canada gastroenterology recommendations, what is the most appropriate next step?
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Answer: B. Refer for diagnostic colonoscopy
Why: Guaiac fecal occult blood testing has no acceptable performance as a diagnostic tool, so a symptomatic patient with alarm features needs direct colonoscopy. Ordering the stool test, delaying with repeat bloodwork, or attributing the bleeding to haemorrhoids all risk missing a colorectal cancer that the presentation already suggests.
- A. Guaiac fecal occult blood testing should not be used to evaluate symptoms, signs or laboratory abnormalities such as rectal bleeding or anaemia.
- C. Delaying assessment with repeat bloodwork risks missing a colorectal cancer that is already suggested by alarm features.
- D. Bleeding with anaemia and a change in bowel habit are alarm features that require investigation, not simple reassurance.
Sources: Choosing Wisely Canada. Canadian Association of Gastroenterology recommendations (2026).
3 / 10
A 63-year-old woman has completed curative resection and adjuvant treatment for colon cancer. She asks her family physician for an annual colonoscopy to check for recurrence.
According to Choosing Wisely Canada oncology recommendations, what is the most appropriate advice?
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Answer: B. Routine annual colonoscopic surveillance is not recommended
Why: Routine annual colonoscopy after colon cancer surgery is not recommended; the interval should reflect the prior colonoscopy findings and guidelines. A fixed annual schedule is excessive, tumour markers do not replace colonoscopy, and surveillance is still required rather than abandoned.
- A. Yearly examination is excessive; surveillance intervals are set by the previous colonoscopy result rather than by a fixed annual schedule.
- C. Blood tumour markers do not replace colonoscopic surveillance for detecting new lesions.
- D. Surveillance is still required, only at intervals guided by findings rather than every year.
Sources: Choosing Wisely Canada. Canadian Association of Medical Oncologists recommendations (2026).
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4 / 10
A 64-year-old woman had a screening colonoscopy four years ago in which the entire colon was examined and no precancerous lesions or cancer were found. She now asks whether she needs further testing.
According to the BC Guidelines for colorectal cancer screening, what is the most appropriate recommendation?
Show answer
Answer: D. No additional screening is required
Why: Average-risk individuals who have had colonoscopy or flexible sigmoidoscopy within ten years with no precancerous lesions do not require additional screening. Annual stool testing is not the recommended interval, five-yearly repeat colonoscopy ignores the ten-year figure for a normal examination, and switching modality is unnecessary when a good recent examination was normal.
- A. Annual stool testing is not the recommended interval, and no further screening is needed in this situation.
- B. The interval after a normal examination is governed by the ten-year figure, not a five-year rule.
- C. There is no indication to change modality when a recent high-quality examination showed no lesions.
Sources: Government of British Columbia. BC Guidelines: Colorectal Cancer Part 1, Screening (2022).
5 / 10
A 68-year-old man with advanced frailty and a limited prognosis attends for review. He is asymptomatic, has no personal or family history of colorectal neoplasia, and has not been screened before.
According to Choosing Wisely Canada, what is the most appropriate approach to colorectal cancer screening for this patient?
Show answer
Answer: A. Avoid screening tests because his life expectancy is less than ten years
Why: Choosing Wisely Canada advises against screening asymptomatic patients whose life expectancy is under ten years and who have no personal or family history of colorectal neoplasia. Offering colonoscopy overstates benefit in a frail patient, stool testing is not an acceptable substitute when colonoscopy is inappropriate, and urgent referral is not indicated without symptoms.
- B. Colonoscopy carries increased risk in patients with advanced age and comorbidity, and no realistic benefit is expected within his remaining lifespan.
- C. If colonoscopy is judged unsafe or inappropriate, stool testing should not be offered as a substitute.
- D. There is no clinical indication for urgent referral in an asymptomatic patient for whom screening is not appropriate.
Sources: Choosing Wisely Canada. Canadian Association of General Surgeons: General Surgery recommendations (2026).
6 / 10
A 48-year-old woman with no symptoms, no family history of colorectal cancer and no other risk factors asks her family physician to begin colorectal cancer screening because she read that screening now starts at age 45.
According to the BC Guidelines, what is the most appropriate response?
Show answer
Answer: C. Screening average-risk individuals under age 50 is not recommended
Why: The BC Guidelines state that screening average-risk individuals under age 50 is not recommended, and the American recommendation to start at 45 has not been adopted here. Starting stool testing now, beginning screening colonoscopy, or annual stool testing below age 50 all contradict the Canadian position.
- A. The American recommendation to start at 45 has not been adopted here, and screening average-risk individuals under 50 is not recommended.
- B. Colonoscopy is not used as a primary screening test, and there is no indication to start it in this age group.
- D. An annual stool test schedule is not recommended, and starting any screening below age 50 is not supported.
Sources: Government of British Columbia. BC Guidelines: Colorectal Cancer Part 1, Screening (2022).
7 / 10
A 45-year-old woman reports that her father was diagnosed with colorectal cancer at the age of 52. She is asymptomatic and has not had a colonoscopy before.
What screening strategy does the BC Guidelines document recommend for her?
Show answer
Answer: A. Colonoscopy every five years starting at age 40
Why: One first-degree relative with colorectal cancer diagnosed before age 60 calls for colonoscopy every five years starting at age 40 or ten years younger than the relative's age at diagnosis. Stool testing is inadequate for this level of family history, a single examination with symptom-triggered follow-up is insufficient, and waiting until 50 ignores the earlier onset of disease in the family.
- B. A first-degree relative diagnosed before age 60 calls for colonoscopy rather than stool testing.
- C. A single examination with symptom-triggered testing does not match the recommended five-yearly surveillance for this level of family history.
- D. One first-degree relative affected before age 60 removes her from the average-risk group and brings screening forward.
Sources: Government of British Columbia. BC Guidelines: Colorectal Cancer Part 1, Screening (2022).
8 / 10
A 58-year-old man asks whether a blood test for a tumour marker could be used to screen for colorectal cancer instead of a stool test.
Which statement reflects the BC Guidelines on tests not recommended for colorectal cancer screening?
Show answer
Answer: D. Carcinoembryonic antigen testing is not supported for screening
Why: Carcinoembryonic antigen testing, barium enema and the combined use of stool testing with flexible sigmoidoscopy are all listed as not recommended for primary screening in asymptomatic patients. Treating a tumour marker as a first-line screen, using barium enema, or combining the two tests are therefore all inconsistent with the guideline.
- A. Blood tumour markers are not validated for detecting colorectal cancer in asymptomatic people and are not recommended as a screen.
- B. Barium enema is one of the tests the guideline states should not be used as a primary screening tool.
- C. Adding flexible sigmoidoscopy to stool testing for primary screening is explicitly not recommended.
Sources: Government of British Columbia. BC Guidelines: Colorectal Cancer Part 1, Screening (2022).
9 / 10
A 53-year-old man mentions that his mother was diagnosed with colorectal cancer at the age of 66. He is otherwise well and has no bowel symptoms.
How should his colorectal cancer screening be managed according to the BC Guidelines?
Show answer
Answer: B. Fecal immunochemical testing every two years from age 50
Why: A first-degree relative diagnosed after age 60 does not increase risk, so standard screening with fecal immunochemical testing every two years from age 50 is appropriate. The five-yearly colonoscopy schedule applies to relatives diagnosed before 60, annual colonoscopy is far more intensive than recommended, and some screening is still warranted rather than none.
- A. The five-yearly colonoscopy schedule applies when a first-degree relative is diagnosed before age 60, not after.
- C. Annual colonoscopy is far more intensive than any recommended schedule and is not justified by this history.
- D. A relative affected after age 60 still leaves him eligible for routine average-risk screening.
Sources: Government of British Columbia. BC Guidelines: Colorectal Cancer Part 1, Screening (2022).
10 / 10
A 62-year-old man with no symptoms and an average risk of colorectal cancer tells his family physician that he would prefer a colonoscopy every ten years rather than a stool test for colorectal cancer screening.
Which screening approach does the Canadian Task Force on Preventive Health Care recommend for adults aged 60 to 74?
Show answer
Answer: B. Fecal occult blood testing every two years or flexible sigmoidoscopy every ten years
Why: For adults aged 60 to 74 the Task Force recommends screening with fecal occult blood testing every two years or flexible sigmoidoscopy every ten years. Colonoscopy is explicitly not recommended as a screening test, computed tomography colonography is not a recommended modality, and this age group is precisely the one the guideline targets rather than excludes.
- A. Colonoscopy is not recommended as a screening test by the Task Force, although it remains the follow-up test after a positive stool result.
- C. Computed tomography colonography is not one of the modalities the Task Force recommends for this age group.
- D. Adults between 60 and 74 years fall within the group for whom screening is recommended, not excluded.
Sources: Canadian Task Force on Preventive Health Care. Colorectal Cancer (2016).
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