Consider the following medical report that includes the patient's historical health records. Use it to predict the disease that the patient is high likely exposed to. 

 Medical Report: allergies: no known allergies / adverse drug reactions attending: chief complaint: ampullary mass major surgical or invasive procedure: : 1. diagnostic laparoscopy. 2. exploratory laparotomy. 3. lysis of adhesions. 4. pylorus-preserving pancreaticoduodenectomy with harvest of pedicled omental flap for protection of pancreatic and duodenal anastomoses. 5. placement of gold fiducials for possible postoperative cyberknife therapy. history of present illness: mr. is a very nice 81-year-old gentleman with newly diagnosed ampullary adenocarcinoma. mr. presented approximately a year ago with right-sided abdominal pain. he was referred for endoscopy and found to have adenomatous polyps. most of these were resected endoscopically. on , he underwent a repeat upper endoscopy. this demonstrated recurrent adenomas. biopsy this time showed poorly differentiated adenocarcinoma. he continues to have persistent abdominal pain and anorexia. he states he has lost 35 pounds over the last year. he did have a ct scan done today which demonstrated large mass lesion in the second portion of the duodenum. the patient was evaluated by dr. in her clinic and after discussion with the patient, he was scheduled for elective whipple resection on . past medical history: tia afib bph chf . psh ccy social history: smokes 1 ppd, 60 py hx, occa etoh, no drugs, worked as engineer w/ ge, lives w/ 44 yo son family history: non contributory physical exam: on discharge: vs: 98.1, 60, 110/56, 14, 98% ra gen: very thin man in no acute distress cv: irregularly irregular rate and rhythm pulm: ctab abd: midline abdominal incision opent to air and c/d/i, old rlq jp site with occlusive dressing and c/d/i. extr: warm, no c/c/e pertinent results: 07:38am blood wbc-8.9 rbc-3.54* hgb-10.9* hct-30.6* mcv-87 mch-30.9 mchc-35.7* rdw-14.0 plt ct-201 01:00pm blood pt-11.3 inr(pt)-1.0 07:38am blood glucose-87 urean-12 creat-0.9 na-140 k-3.6 cl-104 hco3-32 angap-8 07:38am blood calcium-7.9* phos-2.6* mg-1.6 pathology examination name birthdate age sex pathology # , 81 male report to: dr. gross description by: dr. /mtd specimen submitted: whipple specimen. procedure date tissue received report date diagnosed by dr. /mn???????????? previous biopsies: gi bx's (2 jars) gi bx's (2 jars) diagnosis: whipple resection, pylorus-sparing pancreaticoduodenectomy (a-ac): 1. invasive adenocarcinoma of the periampullary duodenum, poorly differentiated, arising from an adenomatous precursor lesion with high grade dysplasia, with invasion into subserosal adipose tissue (pt3); lymphovascular and perineural invasion is present; see synoptic report. 2. seven of thirteen lymph nodes with involvement by adenocarcinoma (- pn2). 3. extrahepatic bile duct segment and ampulla, within normal limits. 4. pancreatic parenchyma with focal changes of low grade intraepithelial neoplasia (panin-1), focal dilation of pancreatic ducts, and squamatization of duct epithelium. small intestine: segmental resection, pancreaticoduodenectomy (whipple resection) synopsis ajcc/uicc tnm, 7th edition protocol web posting date: macroscopic specimen type: duodenum. other organs received: head of pancreas, ampulla, common bile duct. tumor site: duodenum. tumor configuration: infiltrative. tumor size: greatest dimension: 4.2 cm. microscopic macroscopic tumor perforation: not identified. histologic type: adenocarcinoma (not otherwise characterized). histologic grade: g3: poorly differentiated. extent of invasion primary tumor (pt): pt3: tumor invades through the muscularis propria into the subserosa or into the nonperitonealized perimuscular tissue (mesentery or retroperitoneum) with extension 2 cm or less. regional lymph nodes (pn): pn2: metastasis in 4 or more regional lymph nodes. lymph nodes number examined: 13. number involved: 7. distant metastasis: pmx: cannot be assessed. margins segmental resection or pancreaticoduodenectomy (whipple) proximal margin: uninvolved by invasive carcinoma. distal margin: uninvolved by invasive carcinoma. circumferential (radial) or mesenteric margin : uninvolved by invasive carcinoma (tumor present 1 mm from margin; see slide n). pancreaticoduodenectomy (whipple) bile duct margin: margin uninvolved by invasive carcinoma. pancreatic margin: margin uninvolved by invasive carcinoma. lymphovascular invasion: present perineural invasion: present additional pathologic findings: adenoma(s). comments: adenomatous precursor of the duodenum is present in multiple sections, but is shown best on slide k. no dysplastic precursor is found within the ampullary region itself, arguing against the tumor origin from this site. clinical: ampullary mass. 06:20am blood pt-13.9* inr(pt)-1.3* brief hospital course: the patient with ampullary mass was admitted to the surgical oncology service on for elective whipple procedure. on , the patient underwent pylorus-preserving pancreaticoduodenectomy and placement of gold fiducials for possible postoperative cyberknife therapy, which went well without complication (reader referred to the operative note for details). inraoperatively patient was transfused with 2 units of rbc for low hct, he was extubated post operatively and transferred in icu for observation. the patient was hemodynamically stable. in icu patient was hypotensive with low urine output, which was treated with fluid boluses. on pod # 2, patient was transferred on the floor in stable condition. the hospital course was uneventful and followed the whipple clinical pathway without deviation. post-operative pain was initially well controlled with epidural catheter and dilaudid pca, which was converted to oral pain medication when tolerating clear liquids. the ng tube was discontinued on pod#2, and the foley catheter discontinued at midnight of pod# 3. the patient subsequently voided without problem. the patient was started on sips of clears on pod# 3, which was progressively advanced as tolerated to a regular diet by pod# 5. jp amylase was sent in the evening of pod# 5; the jp was discontinued on pod#7 as the amylase level were low and output continue to decrease. patient was started on home dose of coumadin on pod # 6, and he was bridged with sc lovenox prior discharge as his inr was subtherapeutic. patient will continue on sc lovenox and coumadin until his inr reach therapeutic level, inr will be motinored by hospital clinic as outpatient. during this hospitalization, the patient ambulated early and frequently, was adherent with respiratory toilet and incentive spirrometry, and actively participated in the plan of care. the patient received subcutaneous heparin and venodyne boots were used during this stay. the patient's blood sugar was monitored regularly throughout the stay; sliding scale insulin was administered when indicated. at the time of discharge on , the patient was doing well, afebrile with stable vital signs. the patient was tolerating a regular diet, ambulating, voiding without assistance, and pain was well controlled. the patient was discharged home without services. the patient received discharge teaching and follow-up instructions with understanding verbalized and agreement with the discharge plan. medications on admission: coumadin (held since , on lovenox bridge prior to or), alendronate 70' qweek, amiodarone 200', lisinopril 2.5', methimazole 7.5', metoprolol 12.5', simvastatin 20', discharge medications: 1. reglan 5 mg tablet sig: one (1) tablet po four times a day for 2 weeks. disp:*56 tablet(s)* refills:*0* 2. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po daily (daily). 3. lisinopril 2.5 mg tablet sig: one (1) tablet po once a day. 4. methimazole 5 mg tablet sig: 1.5 tablets po daily (daily). 5. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 6. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 7. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 8. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*5* 9. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 10. warfarin 5 mg tablet sig: one (1) tablet po once daily at 4 pm: please follow up with clinic on at 11:30 to check inr level. 11. oxycodone 5 mg tablet sig: 0.5 tablet po q4h (every 4 hours) as needed for pain. disp:*30 tablet(s)* refills:*0* 12. enoxaparin 80 mg/0.8 ml syringe sig: one (1) injection subcutaneous (2 times a day). disp:*10 injection* refills:*0* discharge disposition: home with service facility: discharge diagnosis: locally advanced ampullary adenocarcinoma discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: please resume all regular home medications , unless specifically advised not to take a particular medication. also, please take any new medications as prescribed. please continue to follow up with clinic as outpatient to adjust you coumadin doses. please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. avoid lifting weights greater than lbs until you follow-up with your surgeon, who will instruct you further regarding activity restrictions. avoid driving or operating heavy machinery while taking pain medications. please follow-up with your surgeon and primary care provider (pcp) as advised. incision care: *please call your doctor or nurse practitioner if you have increased pain, swelling, redness, or drainage from the incision site. *avoid swimming and baths until your follow-up appointment. *you may shower, and wash surgical incisions with a mild soap and warm water. gently pat the area dry. *if you have staples, they will be removed at your follow-up appointment. *if you have steri-strips, they will fall off on their own. please remove any remaining strips 7-10 days after surgery. followup instructions: department: surgical specialties when: tuesday at 3:30 pm with: , md building: sc clinical ctr campus: east best parking: garage . please follow up with dr. (pcp) in weeks after discharge. . clinic. thursday at 11:30 am. procedure: laparoscopy radical pancreaticoduodenectomy other lysis of peritoneal adhesions diagnoses: acidosis other iatrogenic hypotension tobacco use disorder chronic airway obstruction, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation thyrotoxicosis without mention of goiter or other cause, and without mention of thyrotoxic crisis or storm hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) chronic kidney disease, unspecified other and unspecified hyperlipidemia peritoneal adhesions (postoperative) (postinfection) osteoporosis, unspecified long-term (current) use of anticoagulants malignant neoplasm of duodenum secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes secondary malignant neoplasm of other digestive organs and spleen secondary malignant neoplasm of retroperitoneum and peritoneum 

Answer: The patient is high likely exposed to