Hi Dear All, My Mother Was Diagnosed With The Following

Hi dear all, my mother was diagnosed with the following diagnose but we do not know what to do with CHEMOTHERAPY . COULD you please share ,what do you think : DIAGNOSIS WITH CO-MORBIDITIES: Ca sigmae ( T3 N0 M0). Fibrothecoma ovarii sinister. Subileus per obturationem.
Histological result C18.7 B 6788-98 30.09.2016 Well differentiated G1 adenocarcinoma of colon with infiltration of subserous adipose tissue with tumor destruction and forming of subserous abscess; lymph nodes No 13 – chronic hyperplastic lymphadenitis; ovary – fibrothecoma; clear resection lines.

pT3 pN0 Mx G1 L0 R0 Operation: Laparotomia. Hemicolectomia sinistra. Ovariectomia cum adnexectomia sinistra. Drainages No3 cavi abdomini.
Following thorough cleansing of operative site under general intubation anesthesia and total median laparotomy was penetrated into abdominal cavity. In exploration was identified:
1.Tumor process on the border of colon descendens – colon sigmoideum, more to the last sigmoideum ( on postoperative section – Scirrhous hardly lobular carcinoma, obstructing almost entirely the lumen of colon, without narrowing it completely, with central necrotic destruction and diameter ~ 6-7 cm affecting the serosa; presence of 3 polyps with aspect of tubulovillous, on narrow pedicles and with diameter ~ 15 mm). Tumor involves left lateral abdominal canal, left ureter, as well as left ovary with adnexa. There was an impression, that peritumor inflammation involve flexure lienalis, as well as the surrounded tissues in proximity on wide site. Careful dissection dully and to achieve release of ureters and mobilization of lineal flexure. Due to infiltration of left ovary and adnexa was undertaken an ovariectomy with adnexectomy post ligature of a. ovaria sinistra.
2. Liver – no evident and palpable focal lesions;
3. Several different calibres regional significant lymph nodes, which were dissected with agent.
4. Other abdominal organs – normal.
Skeleting of left colon and distal part of sigma, ligature of left extension of a. colica media, a. colica sinistra and aa. Sigmoidei. Proximally the system was interrupted through the middle of colon transversum ( protection border 15 cm), and distally – in the distal part of the sigma with protection border 5 cm. The continuity was recovered with terminolateral transverso-sigmo anastomosis with mechanic annular stapler No 31. The anastomosis was protected and alienated with second level interrupted sutures assufil 3-0, and the stump of discharged intestinal loop was closed blindly with solitary ligatures. Thorough haemostasis and lavage. 3 tube drains were put- 2, under anastomosis and 1, situated in Cavum Douglasi. Abdominal cavity was closed in back anatomic order. Dry sterile dressing.

ANAMNESIS: Based on information, provided by the patient and enclosed medical records. Admitted due to stated on FCS- tumor formation with obstructive character in left colon at Gastroenterology clinic. Currently with strong colic pain in abdomen, started 24 h ago with disorder in defecation, reduction in airy passage, nausea, without vomiting, ballooned abdomen. Permanently no febrile. No statement for blood and mucus defecation, leading is the pain syndrome and obstructive syndrome. Admitted for diagnostic verification and treatment with clinical and x-ray evidence for subileus.

CO-MORBIDITIES: Anemia secundaria;
ALLERGIES: Not reported!
OBJECTIVE STATUS: 57-year-old woman. Alo-and auto psychic oriented. Peripheral lymph nodes – not enlarged. Skin and visible mucous membranes – pale pink. Pulmo- vesicular breathing without physically noted pathological finding. Abdomen – meteorism, spontaneous and palpable pain in left iliac fossa, where is palpated a formation with size ~15 cm, which is difficultly motile. Peristalsis –uneventful character in mesogastrium and left side. Hepar and lien – not palpated enlarged. Succussio renalis- bilateral negative. Extremities- no characteristics.
LABS:
Hematology : MCH (pg): 24; MCH (pg): 24; MCH (pg): 23; MCHC ( g/L): 314; MCHC (g/L): 307; MCHC (g/L): 304; MCV (fl): 75; MCV (fl): 77; MCV ( fl): 76; MPV (fl): 6,4; MPV ( fl): 6,6; PCT (L/L): 0,33; PCT ( L/L): 0,29; PCT ( L/L): 0,25; PDW (): 49,2; PDW (): 34,8; PDW (): 51,6; RDW (%): 14,6; RDW(%): 15,1; RDW (%): 15,2; Basophiles (%): 0,3; Basophiles ( %): 0; Basophiles (%): 0,1; Basophiles (%): 0; Basophiles (%): 0; Basophiles (%): 0; Eosinophiles (%): 0,6; Eosinophiles (%): 0,1; Eosinophiles (%): 1,3; Eosinophiles (G/l): 0; Eosinophiles (G/l): 0,2; Erythrocytes (T/l): 4,51; Erythrocytes ( T/l): 3,8; Erythrocytes (T/l): 3,47; Leucocytes (G/l): 9,7; Leucocytes (G/l): 19; Leucocytes ( G/l): 11,8; Lymphocytes (%): 16,3; Lymphocytes (%): 2,8; Lymphocytes (%): 12,5; Lymphocytes (G/l): 1,6; Lymphocytes (G/l): 0,5; Lymphocytes ( G/l): 1,5; Monocytes (%): 4,1; Monocytes (%): 3,1; Monocytes (%): 3,7; Monocytes (G/l): 0,4; Monocytes (G/l): 0,6; Monocytes (G/l): 0,4; Neutrophiles (%): 77,6; Neutrophiles (%): 93,5; Neutrophiles (%): 81,6; Neutrophiles ( G/l): 7,5; Neutrophiles (G/l): 17,7; Neutrophiles (G/l): 9,7; Complete blood count 22 parameters (): Complete blood count 22 parameters (): Complete blood count 22 parameters (): Thrombocytes (G/l): 524; Thrombocytes ( G/l): 452; Thrombocytes (G/l): 386; Hematocrit (L/L): 0,34; Hematocrit ( L/L): 0,29; Hematocrit ( L/L): 0,26; Hemoglobin (g/l): 106; hemoglobin (g/l): 90; Hemoglobin (L/L): 80;
Biochemistry : ALAT (GPT) (U/l): 15; ASAT( GOT) (U/l): 22; Glucose (mmol/l): 7,56; Glucose (mmol/l): 8,67; ka(mmol/l): 4,4; Creatinine (umol/l): 58; Na( mmol/l): 139; Urea (mmol/l) : 4,6; Cl (mmol/l): 106;
Coagulation: Prothrombine time (INR) (): Prothrombine time- % (%): 76; Prothrombine time – INR(INR):1,22;
Blood group : “A1”(-) negative.
X-ray: Overview x-ray study of abdomen (): Two hydroaeric shadows on the right. No x-ray evidence for free air.
X-ray of thorax and lung (): Bilateral lungs and heart are within normal limits.
Abdominal echography: Liver- homogeneous echo-structure, no evidence for evident focal lesions. Gallbladder – preserved sizes, flat walls, no evident lithiasis in lumen. Bile ducts- not dilated. Pancreas- preserved sizes, homogeneous echo-structure, no evidence for evident focal lesions and effusion peripancreatic. Not dilated pancreatic canal. Spleen – not enlarged. Kidneys- preserved sizes, parenchymal zone and drainage. No evidence for ascites in abdomen. Large pathological “cockade” involving the transition colon descendens - sigma and the larger part of sigma, with width of the wall in some sites > 2 cm, polycyclic outlines, some narrowing of the lumen, some alteration of pericolic adipose tissue. In some areas manifested hypoechogenicity and unclear differentiation – it can’t be rule out abscessing and infiltration in neighbouring.
Impression : Obs. N. coli desc./sigma. In DD plan less possible severe differentiated inflammatory process in type of complicated diverticulitis.
FCS: On the background of bad cleansing was reached in some distance in proximal sigma - ~35-40 cm – spiral-shaped stenosing formation in necrotic destruction, distally from the formation – lymphedema of the mucosa ~ 3-4 cm
Impression: N sigme/

DISCUSSION: 57 year-old woman, who was admitted for the first time in the clinic with clinical-laboratory evidence for lower dyspeptic syndrome, iron deficiency anemia, consume syndrome, subfebrility in echography observed neoplastic process in the area of colon descendens/sigma. Following preliminary preparation was performed FCS in which was visualized spiral-shaped stenosing Tumor formation in necrotic destruction in sigma. In patient was performed emergent operative treatment in postponed order with anamnesis, clinical and imaging evidence for subileus, which wasn’t influenced using conservative therapy. Intra-operative was stated tumor process on the border of colon descendens – colon sigmoideum, more to colon sigmoideum with involvement of left lateral abdominal canal, left ureters, as well as the left ovary with adnexa. Performed left hemicolectomy, left ovariectomy and adnexectomy.

HOSPITAL COURSE: Typical for disease.
POSTOPERATIVE PERIOD: Uneventful postoperative period after performed operative treatment. Early moving and feeding.

STATUS UPON DISCHARGE: 57 year-old woman. In god general status. Active position in bed. Alo and auto psychic oriented, no febrile.
Head and neck – no characteristics. Peripheral lymph nodes and thyroid gland- not palpated enlarged.
Skin and visible mucus membranes- pale-pink. Tongue- moist, uncoated.
Respiratory system: Vesicular breathing – bilateral, no added rales finding.
Cardiovascular system: rhythmic heartbeat, RR- 140/90. FR – 92 bpm.
Abdomen: at the level of thorax, respiratory motile, soft, palpable and spontaneously painless, no evidence for peritoneal irritation. Blumberg (-) negative, physiological peristalsis.
Suc. Renalis (-). Extremities- no characteristics.

RESULT OF TREATMENT: With recovery.
RECOMMENDATIONS UPON DISCHARGE: To keep diet regime. Histological result of permanent agent is forthcoming as the discussion of the case before Oncology board considering the postoperative medical treatment plan.
Follow-up of the status and consultation with specialist in case of necessity.
PRESCRIBED MEDICINES AFTER TREATMENT: Analgesics in case of necessity.