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.

Normal 11/19 WBC 4-11x109/L 5.60 RBC 4-6x1012/L 3.99 Hgb 120-180g/L 129 Hct 0.370-0.540% 0.373 Platelets 150-450x109/L 176 Neut% 0.5-0.7 0.584 Lymph% 0.2-0.5 0.255 Mono% 0.02-0.09 0.092 Eo% 0.0-0.06 0.0064 Baso% 0.0-0.02 0.005

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

Date Normal 11/19 Glucose 3.9-6.1mmol/L 4.39 BUN 2.6-6.4 mmol/L 4.40 Creatinine 53-115 umol/L 98 Sodium 140-148mmol/L 142 Potassium 3.6-5.2mmol/L 3.9 Chloride 99-110mmol/L 108 Calcium 2.12-2.75mmol/L 2.15 Magnesium 0.70-1.05/1.4-2.1 0.82 Albumin 38-51g/L 33 AST (SGOT) 0-34U/L 30 ALT (SGPT) 0-30U/L 19

Date Normal 11/19 Color Yellow Transparency Clear/Hazy Clear SG 1.016-1.022 1.03 PH 4.6-6.5 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

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

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

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