Colorectal Cancer Consult

I had the pleasure of seeing John Smith on 1 November 2024. He is a 62-year-old male seen today with his wife. He has been recently diagnosed with stage IIIB colorectal cancer. The patient reports abdominal pain for 3 months. The patient denies weight loss. The patient reports changes in bowel habits and fatigue. He has a 5-year history of type 2 diabetes, which may have worsened over the past year. This was his third colonoscopy. He had a CT scan in 2023 which was inconclusive. Family History: Father had colon cancer at age 70. Surgical/Medical History: Appendectomy in 1990, hypertension. Procedures: Colonoscopy (Dr. Thomas Doe - 1 November 2024): Large mass in the sigmoid colon. Known Allergies: Penicillin Medications: Metformin, Lisinopril Lifestyle Notes: Non-smoker, occasional alcohol use Investigations: Blood Test (1 November 2024): Elevated CEA levels Normal liver function Anemia Normal kidney function Elevated glucose MRI (1 November 2024): Mass in sigmoid colon No metastasis Oncology: Previous chemotherapy for colon cancer in 2022 Examination: Clinical examination demonstrated tenderness in the lower abdomen. There was evidence of a palpable mass. Rectal examination was normal. He has pallor and mild dehydration. He has absence of lymphadenopathy. Impression/Plan: I have ordered the following: PET scan and biopsy to assess the extent of the disease, in case he requires further chemotherapy. His case will be presented at the oncology board meeting. He has a stage IIIB colorectal cancer. Although the mass is large, it appears localized. I am not sure he will need surgery. He is a suitable surgical candidate. He was quite anxious and had several questions today, which were answered. I will refer him to oncology to get their formal opinion regarding chemotherapy, in the interim. I have suggested a treatment plan involving possible surgery and chemotherapy. I will see him next following these investigations. If he does not need surgery, we will plan for chemotherapy in 2 weeks. My office will be in touch with John Smith. Thank you for involving me in his care. (45 min)