Investigation

1)
Full blood count
Parameters
Value Normal values

Comment

2)
Blood urea and serum electrolytes / creatitine
Parameters
Value Normal values Comment

3)
Electrocardiogram (ECG)
Shows normal sinus rhythm. Shows no ischemic changes. Patient has been experienc
ing mucous and blood passage per rectum. This may cause electrolyte alteration a
s well as asymptomatic anemia which may cause conduction defect or high output f
ailure of the heart. Thus, considering the patient s age and history of hyperlipid
emia, hypertension and diabetic mellitus, it is important to obtain the ECG of t
he patient.
4)
Chest x ray
Shows clear lung fields. No cardiomegaly noted. In the case of malignancy, it is
important to rule out distant metastasis. Presences of multifocal masses or enl
arged hilar lymph node may indicate metastatic lesion.
5)
Colonoscopy
Shows fungating mass about 25 cm from the anal verge with evidence of contact bl
eeding. Colonoscopy allows direct visualization of entire colon.
6)
Computed Tomography Scan
CT scan of thorax/abdomen and pelvis was performed on the 2nd October 2013.
Thorax: Thyroid gland appears normal. A small nodule of in apical segment of rig
ht upper lobe measures 0.2cm can be due to granuloma. Follow up was suggested. A
ir space opacities of the right upper lobe. No mediastinal or axillary lymphaden
opathy.
Abdomen: An intraluminal polypoidal mass within sigmoid colon approximately 26cm
from the anal verge. It causes luminal narrowing of the sigmoid colon. It measu
res approximately 8.4cm 3.9cm 4.2 cm. There is surrounding fatty streakiness aroun
d the lesion. Enlarged mesenteric lymph node with largest measuring 0.7cm in sho
rt axis. No small or large bowel dilatation.
Hypodense lesion at segment Iva, likely focal fatty infiltration. Anothe
r small enhancing lesion noted posterior to it, measuring 1.0 0.7cm, possible liv
er hemangioma. Ultrasound of the abdomen suggested.
Gall bladder, pancreas, spleen and both adrenals are normal. Urinary bla
dder is normal. No ascites. There is fibroid at the fundus of the uterus measuri
ng about 3.6 4.1 cm. No lytic or sclerotic bone lesion to suggest bone metastasi
s.
Impression : Features of sigmoid carcinoma with nodal metastasis. Fundal leiomyo
ma.
Suggest ultrasound of the abdomen to asses lesion in the segme
nt IV of the
Liver. Right upper lobe lung nodule, can be due to granuloma.
Follow up
Suggested.
7)
Carcinoembryonic antigen : 2.9
The normal range for CEA in an adult non-smoker is <2.5 ng/ml and for a smoker <
5.0 ng/ml. The best use of CEA is as a tumor marker, especially for cancers of t

he gastrointestinal tract. When the CEA level is abnormally high before surgery
or other treatment, it is expected to fall to normal following successful surger
y to remove all of the cancer. A rising CEA level indicates progression or recur
rence of the cancer. In addition, levels >20 ng/ml before therapy are associated
with cancer which has already spread (metastatic disease).
Both benign and malignant conditions can increase the CEA level. The mos
t frequent cancer which causes an increased CEA is cancer of the colon and rectu
m. Others include cancers of the pancreas, stomach, breast, lung, and certain ty
pes of thyroid and ovarian cancer. Benign conditions which can elevate CEA inclu
de smoking, infections, inflammatory bowel disease, pancreatitis, cirrhosis of t
he liver, and some benign tumors in the same organs in which an elevated CEA ind
icates cancer. Chemotherapy and radiation therapy can cause a temporary rise in
CEA due to the death of tumor cells and release of CEA into the blood stream. Be
nign disease does not usually cause an increase above 10 ng/ml.
CEA is not an effective screening test for hidden (occult) cancer since
early tumors do not cause significant blood elevations. Also, many tumors never
cause an abnormal blood level, even in advanced disease. Because there is variab
ility between results obtained between laboratories, the same laboratory should
do repeat testing when monitoring a patient with cancer.
The major role for CEA levels is in following patients for relapse after intende
d curative treatment of colorectal cancer. CEA levels typically return to normal
within 4 to 6 weeks after successful surgical resection. The CEA level can also
be used to assess the response to chemotherapy.

8)
Barium enema ( not done in this patient)
It is an x-ray examination of the large intestine (colon and rectum). It is used
to help diagnose disease and problems of the large intestine.. To make intesti
ne visible on x-ray, it is filled with contrast material containing barium. Ther
e are 2 types of barium enema.
a)
In a single contrast study, the colon is filled with barium which outlin
es the intestines and reveal large abnormalities.
b)
In a double contrast studies or air contrast studies, the colon is first
filled with barium which will be then drained out, leaving only a thin layer of
barium on the wall of the colon. Then colon is then filled with air. This provi
de detail view about the inner surface of the colon, making it easier to see nar
rowed areas (strictures), diverticula, or inflammation.
The indications are as below:
a)
Identify inflammation of intestinal wall such as in ulcerative colitis
or crohn s disease.
b)
To detect problems associated with the structure of the large intestines
such as strictures or pockets of sac as in diverticula.
c)
Therapeutic for ileocolic intussuception.
d)
Also to evaluate abdominal symptoms such as pain, blood in the stools, o
r altered bowel habits.