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General: Essentially negative. Pt admitted because of hemoccult positive stools.
Rectal exam: Palpable lesion 10-11 cm from anal verge.
CT abdomen: negative.
CT pelvis: abnormal thickening c/w rectal carcinoma.
Colonoscopy: 6 cm obstructive lesion 10 cm from anal verge
CEA: 8.3 (elevated)
Biopsy, rectal mass: infiltrating adenoca arising in mixed adenomatous villous adenoma.
Rectosigmoid colon: previous biopsy site, moderately differentiated infiltrating adenocarcinoma showing invasion beyond muscularis propria. 0/8 LNs positive, margins free, tumor size 3.5 cm.
Chemotherapy: 5FU concurrent with radiation preoperatively followed by four rounds of FOLFOX postoperatively.
Radiation: Began 4500 cGy to pelvis, 180 cGy in 25 treatments with 18MV photons.
Surgery: Low anterior resection with colorectal anastomosis, incidental appendectomy and regional lymph node dissection.