家母(78歲)CT結果顯示有Colon Cancer，因為也懷疑有淋巴和肺部轉移，家庭醫生安排了PET-Tumor-Total Body。如果已經轉移到淋巴和肺部的話，一般不建議手術。家母比較抵抗外科手術。
腸鏡醫生建議先看腫瘤醫生，PET可以延後，聽腫瘤醫生安排，因為肺部結果可能是年輕時肺結核遺留的。
到底應該先做PET-Tumor-Total Body還是先看腫瘤醫生？
多謝！
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Conlonnoscopy results:
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We performed your procedure due to an indication of:
Colonic mass - K63.89
Elevated CEA: 795.81 - R97.0
Hematochezia: 578.1 -K92.1
Protruding Lesions
A large fungating mass of malignant appearance was found in the rectosigmoid junction at 10 cm from the anus.
The mass caused a complete obstruction. The scope could not traverse the lesion and the exam could not be finished. Cold forceps biopsies were performed. 4mL of SPOT ink injections were successfully applied for tattooing at 2 opposite walls just distal to the mass. Medium grade/stage lI internal hemorrhoids were noted.
FINDINGS:
CHEST:
Thyroid gland: Homogenous.
Lymphadenopathy: None. Calcified mediastinal and hilar nodes related to old granulomatous disease. Heart: Normal in size.
Aorta and pulmonary artery trunk: Dilated pulmonary artery trunk measuring up to 4.4 cm suggestive of underlying pulmonary artery hypertension. Ascending thoracic aorta is also aneurysmal measuring up to 5.2 cm. Aortic arch and descending thoracic aorta are normal in diameter. No aortic dissection or central or segmental pulmonary embolism.
Tracheobronchial tree: Patent.
Lungs and pleural: Large 5x4 cm right upper lobe calcified granulomas with associated pulmonary distortion. Scattered smaller calcified granulomas are also present. There are several bilateral pulmonary micronodules measuring up to 5 mm in the left lower lobe.
ABDOMEN & PELVIS: Liver: Unremarkable.
Gallbladder: Cholecystectomy.
Pancreas: Unremarkable.
Spleen: Unremarkable.
Adrenal Glands: Unremarkable.
Kidneys and ureters: No nephrolithiasis or hydroureteronephrosis.
Bladder: Unremarkable.
Gastrointestinal tract: Long segment circumferential thickening of the rectosigmoid consistent with malignancy. This is insuperable from posterior uterine serosa. There is nodal metastasis to the sigmoid mesocolon nodes which measure up to 1cm.
Reproductive organs: Fibroid uterus. No adnexal mass. Aorta: Atherosclerotic changes without aneurysmal dilatation.
Lymphadenopathy: No retroperitoneal lymphadenopathy.
Bones: Multilevel degenerative changes. No acute fracture or suspicious lesions. Extraabdominal soft tissues: Unremarkable.
Unless otherwise recommended, any incidental findings identified above require no follow up imaging based on consensus recommendations. Fleischner 2017 criteria utilized when applicable for pulmonary nodule follow-up.
IMPRESSION:
1 Long segment circumferential thickening of the rectosigmoid consistent with malignancy. This is inseparable from posterior uterine serosa. There is nodal metastasis to the sigmoid mesocolon nodes which measure up to 1cm. No liver metastasis or retroperitoneal nodal metastasis.
2. Several bilateral pulmonary micronodules are present and could be related to metastasis or benign.
