2. Staging Work-up Colonoscopy Rigid proctoscopy CEA Endorectal UTZ MRI
CT of chest, pelvis and abdomen
PET scan should not be routine
T staging – comparable Sn, UTZ more specific
N staging (Sn, Sp)- CT (55, 74), UTZ (67,78) and MRI (66, 76). CT and MRI for iliac and retroperitoneal nodes.

3. Normal
11/19
WBC
4-11x109/L
5.60
RBC
4-6x1012/L
3.99
Hgb
g/L
129
Hct %
0.373
Platelets
x109/L
176
Neut%
0.584
Lymph%
0.255
Mono%
0.092
Eo%
0.0064
Baso%
0.005

4. PT 11/19 Protime Ctrl 11.8 Patient 13.5 Activity 0.82 INR 1.13 PTT
PT/PTT: PT
11/19
Protime Ctrl
11.8
Patient
13.5
Activity
0.82
INR
1.13
PTT
11/19
Control
35.6
Patient
41.5

5. Date
Normal
11/19
Glucose
mmol/L
4.39
BUN
mmol/L
4.40
Creatinine
umol/L 98
Sodium
mmol/L
142
Potassium
mmol/L
3.9
Chloride
99-110mmol/L
108
Calcium
mmol/L
2.15
Magnesium /
0.82
Albumin
38-51g/L 33
AST (SGOT)
0-34U/L 30
ALT (SGPT)
0-30U/L 19

6. Date
Normal
11/19
Color
Yellow
Transparency
Clear/Hazy
Clear SG
1.03 PH 6
Sugar
(-)
Albumin
trace
RBC
0/0-2/hpf
2-5/hpf
WBC
0-2/0-5/hpf
0-1/hpf
Casts
hyaline, coarse, fine, granular, RBC, WBC, waxy -
Crystals
Small amounts
Epith cells
Occasional
Bacteria
Rare
Mucus thread
Few
(-) yeast, hyphal elements, (-) bilirubin, leukocytes, nitrates, normal urobilinogen

7. Date
Exam
Rsults D8
CEA
1.87 (0-5) D1
CXR PAL
Unremarkable findings; normal X-ray of chest D2
Plain abdominal scan
(-) air-fluid levels noted

8. Colonoscopy
Scope inserted up to the terminal ileum, (+) circumferential, friable, fungating mass, occupying approximately 60% of the lumen, beginning at level 10cm to 12 cm FAV.
Distal to that mass are two sessile polyps (measuring around 0.4 and 0.2 cm in diameter, approximately 6-8cm FAV). These were removed using cold biopsy forceps.
Rectal mass, likely malignant; rectal polyps, s/p polypectomy

9. Proctoscopy
(+) fungating mass, 11 cm FAV, 70% obstructing the lumen, (+) bleeding
Rectal mass, t/c malignancy