Hi Doctor Do you have any alternative treatment for this case , please tell me in my contact : YYYY@YYYY

File No. 69799 26/07/2016 MEDICAL REPORT Name of the patient Hamad Mosleh A4Najem DOB Sex, Nationality 1963 Male Syrian Ref. No. KCCC 169799 Civil No. 0000 Diagnosis Mets. Rectal Ca. 53 years old, known HTN, diabetic with diabetic ne and cKD, under dialysis. Patient conditon startedin 20 with 6 cm, from anal verge mass 7 cm, in length. Histopathology from colonoscopy showing Grade 1 adenocarcino T3 N1 by MRI. Received neo-adjuvant cRT, finished in November 2014. Restaging MRI showing significant disea regression T2N1... Seen by Prof. Bell healed mostly complete resolution for Fu MRI. FU MRI further disease regression sigmoidoscopy with biopsy showing intra mucosal carcinoma. PET cT-hyper metabolic rectallesion and Merfocal, segment vil and caudate lobe (cose to MC. New MRI reviewed in MDT meeting that suggesting resectable disease (November 2015). in view of being high R that may hinder any more chemotherapy. Surgeon requested new PETcT done on January 2016 confirming increase uptake both at liver focal and rectallesi Patient admitted under surgical side operated on 17H2016 Giresistible)as mass found to be fixed to portal vein. Case discussed with Dr. Nemec in our MDT meeting again and he advised for RFAif possible. case discussed with Mubarak Intervention Radiologist that stated no role for RFA. Patient admitted in Ward 6 for pain control and possible sepsis controled and discharged on 14l6/2016. In view of being surgically inesistible, cannot tolerate more chemotherapy and he is not a candidate for RFA, s may consider starting him with single agent targeted therapy. The patient was admitted with a picture suggesting sepsis, antibiotics started. his blood cultures came a negative, he was under hemodialysis at Adan Hospital as well, and we requested a blood culture from the Perm but the patient refused and asked to do it at Adan hospital during his dialysis session. Now the patient is admit Adan hospital for the treatment of a new eventually cardiac arrhythmia and chestinfection.