Report from Urological Surgeon
Saskatoon, Saskatchewan, Canada

Re: MR. STEPHEN SERENELLI - PHN: 222 339 950

Thank you very much for asking me to see Stephen. This 45-years-old man had emergency surgery in 2000 because of bowel obstruction. A splenic flexure carcinoma was found and resected. He remains well but in March this year was found to have an elevated CEA. He is otherwise asymptomatic. Subsequently a colonoscopy revealed an ulcerating carcinoma about 15 cm. from the anal verge. A CT scan at that time also showed right hydronephrosis with the area of obstruction quite low down and close to the UVJ. He is totally asymptomatic in regards to that. He is voiding well and has no urinary symptoms. His creatinine, however, has risen slightly to 135 which may reflect obstruction of the right kidney.

We had a long discussion today about the problem. It is very likely that the tumor is obstruction the ureter behind the bladder. My concern is that it may also block off the left ureter. Therefore, he needs to be carefully monitored. He told me that he is going for a repeat blood test soon and a repeat creatinine would be helpful. He is also going to repeat the CT scan at the end of the month and that will show us how much more hydronephrosis he is getting. We discussed possible treatments. since we are not treating his primary cancer aggressively, we can improve his kidney drainage by stenting. However, often stents do not work very well where there is significant external compression. I discussed all this with him, and he is quite happy to wait for the next CT Scan to see whether the kidney is being more obstructed or whether the other side is obstructing as well. I will arrange to see him after the next CT Scan for furtehr discussion on that.

Thank you again for asking me to see him. Kind regards.

Your sincerely,

Peter Lau, M.D.

cc: Dr. Unsworth