News

Medical Diagnosis

This is what the medical diagnosis says for April 26, 2010. It is written by doctors at the Skyline Hospital in White Salmon, Washington.

Findings

CT scan of the abdomen and pelvis was performed with intravenous and oral contrast administration. Reconstruction images were obtained in 2 planes.

There are multiple hepatic lesions present, most likely metastic disease. The spleen is normal in size. No irregularity of the pancreas or kidneys is demonstrated. The left adrenal gland is thickened.

A few distended distal small bowel loops are noted. Evidence of a 4.5 centimeter (cm) mass in the cecum is seen. Partial small bowel obstruction must be considered.

There is a small amount of ascites present in the right pericolic gutter. Sigmoid diverticulosis is seen. No evidence of diverticulitis is demonstrated. The bladder is normal in contour. The prostate gland appears diffusely enlarged. There is moderate calcification of the aorta present with areas of ectasia noted. The gallbladder is not well-distended.

Mild decrease in stature of T12 vertebral body is noted.

Impression

1.   Evidence of metastic disease to the liver is noted.
2.   Cecal mass.
3.   Small ascites.
4.   Partial small bowel obstruction.
5.   Diverticulosis.
6.   Thickened left adrenal gland.

Reported by:  Nartnucha Unhanand, M.D.
Signed by: Nartnucha U. Unhanand
____________________

This is the medical evidence found on May 18, 2010. It is written by doctors in The Dalles, Oregon.  

Medical Evidence - May 18, 2010
 
Laboratory Data
 
April 25th                                     May 18th
 
WBC - 12.4                                  WBC - 9.6
Hemoglobin  - 16.7                        Hemoglobin - 13.7
Platelet Count - 287,000                Platelet Count - 260,000
Sodium - 136
Potassium - 3.6
BUN - 10
CEA - 561.1                                  CEA - 1054
Creatinine - 0.9
AST - 20                                      AST - 14
ALT - 29                                      ALT - 20
Alkaline Phosphatase - 126            Alkaline Phosphatase - 89
Total Bilirubin - 0.4                       Total Bilirubin - 0.4
 
Impression
 
A 67-year old gentleman with recently found cecal mass as well as many liver nodules, clinically consistent with metastatic colon cancer. Although there is no biopsy at this point, his CEA also supports the above diagnosis. He does not have any evidence of obstruction at this point, but his lesion in the cecum is fairly concerning and is definitely the cause of his abdominal pain. His liver metastases are too many for radiofrequency ablation and involve both the right and left lobe, making surgical resection impossible.
 
I discussed with the patient regarding the general approach to treatment. Surgery is not always required in patient's diagnosed with metastatic colon cancer. However, in his case, he would be better off to have the primary tumor removed before starting systemic therapy. This is because of concerns of obstruction, bleeding, pain, etc. Systemic chemotherapy with combination chemotherapy plus biological agent has been demonstrated to prolong survival, although it is technically incurable.
 
Signed:  X Steve Fu, MD, Oncologist