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JAMA. 2009;302(6):678.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

In a Clinical Crossroads article published in May 2007,¹ Gerald Smetana, MD, weighed the pulmonary risks of colon cancer surgery for Mr A, a 68-year-old man with severe chronic obstructive pulmonary disease, peripheral vascular disease, high cholesterol, high blood pressure, and extensive tobacco use. In December 2005, Mr A had a colonoscopy revealing a malignant-appearing, friable infiltrative sigmoid mass. Mr A subsequently consulted 2 general surgeons; both recommended that the tumor be resected.

Mr A had a 75-pack-year history of smoking. He had tried to quit smoking several times with a nicotine patch but never had any long-term success. The discovery of the mass in his colon increased his dependence on cigarettes for stress management and impeded any further efforts to quit. He regularly coughed up sputum in the morning, experienced a chronic cough, and had several episodes of "bronchitis" and upper respiratory tract infections. He also had intermittent episodes . . . [Full Text of this Article]

DR N

Anna A. Mattson-DiCecca, BA; Eileen Reynolds, MD

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