Hi, I am, Chandra Narayan Mukherjee, a small entrepreneur belongs from a middle class family. I live in a rented house along with my wife, daughter (16 yrs.) and son (11 yrs.). This year my daughter appeared West Bengal HS exam and my son is in Class-VII. Though it was getting tough for me to lead a healthy life for my family with very low profile income, but still we were very happy with our small requirements. In the year 2010 my daughter lost her eye-sight due to a severe brain disease. Till time she is under treatment and we have to take her to Vellore for regular check-ups, thrice in a year and I am the only earning member of my family. Unfortunately, 3 months back, I noticed bleeding PR which was insidious in onset and progressive in nature, I initially developed bleeding PR 1 year back on and off which used to get resolved on controlling diet and taking medication. Then I went to Tata Medical Centre, Kolkata, as per advice of my house physician for treatment.
HISTORY AS PER TATA MEDICAL CENTRE, KOLKATA
Patient also c/o altered bowel habits, loose variety ; h/o weight of 2 kgs in last 2 months ; no h/o fever, loss of appetite, mass per recturm, loss of appetite, fever, jaundice ; on 4th March 2018 he got admitted for hypotension and dizziness and got evaluated.
6/3/18 - Colonoscopy : seen upto 15 cm from anal verge, Sigmoid stricture, nodular compromising 70% of lumen concentrically.
PT:14 INR:1.2 Blood grouping : O positive HIV I,II, HBsag HCV : Negative.
USG Abdomen: Concentric wall thickening of rectum, enlarged prostate, mild hepatomegaly.
8/3/18 - CECT WA: long segment concentric wall thickening of sigmoid colon with pericolic fat stranding, hepatomegally.
16/3/18 - HPE: Well differentiated adenocarcinoma.
24/3/18 - Hb:10.2 TLC: 7800/cumm FBS:101 Total bilirubin :0.45 ALP : 77
Past Medical History : DM since 2 years on treatment, HTN since 8 years on treatment.
Drug History : OHA, anti-hypertensives
INVESTIGATION RESULTS BY TATA MEDICAL CENTRE
CT THORAX AND WHOLE ABDOMEN (02/4/18)
Chest wall and bony cage appears normal. No pleural effusion or pleural thickening is seen. No significant mediastinal adenopathy is seen on CECT. Trachea and main stem bronchi appear normal. Cardiac chamber and major vessels appear normal. Esophagus appears normal.
Lung fields are well expanded and aerated. No active long lesion is seen. No mass lesion is seen. Vascular markings and airways are well visualised. Few calcified nodules in left lung.
CECT WHOLE ABDIMEN
Asymmetric circumferential wall thicking with luminal narrowing of rectosigmoid 9 cms above ano-rectal junction and measuring 4.7 cms in cranio-caudal extent.
Surrounding fat stranding and multiple subcentimetric pericolonic nodes (>6)
Few expanded tortuous pericolonic vessels - s/o positive EMVI.
Liver is normal in size, outline and attenuation. Multiple hypoenhancing lesions involving segments II,IV,VI and VII- s/o metastases. Cyst in segment II of liver. IHBRs are not dilated. HV and PV radicals appear normal.
GB, Pancreas, Spleen, bilateral adrenals and kidneys - unremarkable.
Retroperitoneal structures appear normal. No significant retroperitoneal adenopathy is seen.
Mesenteric vessels appear normal. No mesenteric adenopathy is seen.
Stomac, duodenom and small gut appear normal. Rest of large gut appears normal.
No ascites is seen.
UB is well distended and shows no luminal or mural lesion. Perivesical region appear normal.
Pelvic organs appear normal.
Bone window shows no abnormality.
Multiple (>10) nodular lesions in both lobes of liver --- consistent with metastases simple cyst in segment 2/3 of liver.
FUTURE PLAN OF HOSPITAL : Urgent Palliative resection for bleeding then treatment of liver.
You are, therefore, requested you to kindly help me mentally & financially for my better treatment as I have no other alternative to save my family from ruin.