"請問沒有癌症險、醫療險..."
這個我會再研究。

你的朋友
腸子腫瘤大約~7cm..>併發症:腸阻塞>已移轉肝、肺
[CT] IMP: Sigmoid colon cancer carcinoma T3-4aN1bM1b
這個是確診病例,加上遠方轉移.

希望你的朋友是在醫學中心開刀, 因為後續的處理要很多科的合作.

在新竹馬偕..
不是醫學中心(新竹也沒有這種規模..)..

今天開刀先處理結腸..
用腹腔鏡, 如果取不出..
就只能用傳統手術去切開...
其他的再看情況..

我上次在高雄做大腸鏡，結果那間診所是用噴水的，一點也不痛
還可以順便把有便便的地方洗乾淨
後來我去查，這是新的檢查方法叫「換水法」

這一個方法, 台灣說得相當好, 我隨便調美國一篇胃腸內視鏡文章, "說值得研究".
這一篇文章包括發明者 Felix W. Leung, MD,
http://www.giejournal.org/article/S0016-5107(08)02426-7/abstract

我上次有檢查到一顆內痔
為什麼醫生說坐辦公室的人難免
只要是軟便就沒關係
也沒叫我要治療？

國內醫學中心治療腸癌 "5年存活率, 即使是已移轉的第4期也有接近20%
http://www.nownews.com/n/2015/09/14/1813210
這篇文章寫得不錯。

術後的報告..
朋友後端系統撈出來給我看..
sorry, 有的還是看無.....

Preoperative Diagnosis：
1533 Sigmoid colon Ca.

Operation：
4576 經腹腔鏡乙狀結腸切除術加吻合術(惡性腫瘤適用)Laparoscopic sigmoidectomy

Remarks：

Operative Findings：
The liver: multiple nodule on the surface r/o mets.
The small bowel: some nodule on small bowel and peritoneum.
The colon: A 4x3x2cm tumor was found at sigmoid colon.

Operative Procedure：
[Operative procedure]:
Under general anesthesia, the patient was put on table in Lithotomy position. The op field was prepared with alcohol B-I solution and was draped in aseptic manner.
Under laparoscopic assisstance,
The liver: multiple nodule on the surface r/o mets.
The small bowel: some nodule on small bowel and peritoneum.
Biopsy of the peritoneum was done.
The colon: A 4x3x2cm tumor was found at sigmoid colon.
Sigmoid colectomy was done with Harmonic scalple dissection.
The distal end was cut with Endo-GIA 60 X2.
The proximal end was cut between De-martel clamp.
A small incision was made and the tumor removed.
End to end anastomosis with CDH 30 .
A penrose drain was inserted to pelvis.
After checked the entire organ intraabdominal, we closed the wound by 1-0 Dexon suture and clip. During whole operation, total blood loss was 150ml. And the patient tolerated the whole procedure well.

Operative Findings：
The liver: multiple nodule on the surface r/o mets.可能肝移轉
The small bowel: some nodule on small bowel and peritoneum.可能小腸 腹膜移轉
The colon: A 4x3x2cm tumor was found at sigmoid colon.正確的腫瘤大小
已移轉肝、肺+可能小腸 腹膜移轉=4

病徵依然未變..
不看好, 朋友不知道能活多久......
今年標靶治療和電療, 健保有給付的樣子...
他老兄才30出頭..

項目...
急乙種診斷書（中文）CERTIFICATES FEE非2TMS 2 1.
乙狀結腸惡性腫瘤合併肝臟及肺臟轉移。
2. 腸阻塞。

患者於民國104年09月03日及09月10日至門診求治，於民國104年09月13日經門診住院，於民國104年09月14日接受乙狀結腸切除術及腸吻合手術治療，因病情穩定於民國104年09月19日出院，宜休養兩週及門診追蹤治療。

病理報告:
Sigmoid colon, sigmoidectomy, adenocarcinoma.
Lymph node status: Metastasis in regional lymph node(s)(4/6).
[pT4aN2aM1b]

SUMMARY OF GROSS AND MICROSCOPIC FINDINGS:
SPECIMEN: Sigmoid colon.
SPECIMEN LENGTH: 11 cm.
TUMOR SIZE: 6.5x2.5x0.9 cm.
MACROSCOPIC TUMOR PERFORATION: not identified.
HISTOLOGIC TYPE: adenocarcinoma.
HISTOLOGIC GRADE: well differentiated.
TYPE OF POLYP IN WHICH INVASIVE CARCINOMA AROSE: None identified.
HISTOLOGIC FEATURES SUGGESTIVE OF MICROSATELLITE INSTABILITY:
Intratumoral Lymphocytic Response: Mild to moderate.
Peritumor Lymphocytic Response: Marked.
Tumor Subtype and Differentiation: Nil.
TNM DESCRIPTORS:
PRIMARY TUMOR(pT): pT4a: Tumor penetrates the visceral peritoneum.
REGIONAL LYMPH NODES(pN): pN2a= Metastasis in 4 to 6 regional lymph nodes.
DISTANT METASTASIS(pM): pM1b: Metastasis to more than one organ/site or to the peritoneum.
MARGINS:
Proximal margin: uninvolved.
Distal margin: uninvolved.
Circumferential (radial) or mesenteric margin: involved by invasive carcinoma (tumor present 0-1 mm from margin).
TREATMENT EFFECT: No prior treatment.
LYMPHATIC INVASION: Present.
VASCULAR INVASION: Venous: Present.
PERINEURAL INVASION: Present.
PERITONEUM: involved by tumor.
ADDITIONAL PATHOLOGIC FINDINGS: None identified.

GROSS DESCRIPTION:
The specimen (1) received consists of a segment of sigmoid colon, 11 cm in length. The external surface of mesocolon and serosal surface are focally firm and retracted. On the mucosal surface, 2 cm away from one resection margin and 2 cm away from another resection margin, there is a grayish friable fungating and ulcerative tumor measuring 6.5x2.5x0.9 cm in size. On cut section, the tumor appears to invade into pericolic fat. The tumor is 4.5 cm away from the circumference (radial) surgical margins grossly. Multiple regional lymph nodes measuring up to 1.7 cm in greatest dimension are dissected out. Two separate rings of colon tissue, labelled as proximal and distal surgical margins are present.

The specimen (2) submitted consists of a piece of soft tissue measuring 1.5 cm in greatest dimension, labeled as peritoneal biopsy, with a tan white and firm lesion, 0.5 cm in greatest dimension.
All for section.

Representative sections are taken & labelled as follows:
a1-13: main tumor.
a14: non-neoplastic colon.
b1-5, x: regional lymph nodes and/or tumor deposit(s)
c1-2: surgical margin (c1: proximal, c2: distal) from separate rings.
d: cut end of mesocolon at high point of resection.
e: peritoneal biopsy.