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: penicillins attending: chief complaint: upper back and bilateral rib pain, metastatic rectal cancer. major surgical or invasive procedure: 1. c7 bilateral hemilaminotomy. 2. t1 laminectomy for removal biopsy tumor neoplasm. 3. t2 bilateral hemilaminotomy. 4. posterolateral fusion c7-t1. 5. posterolateral thoracic fusion t1-t2. 6. iliac crest bone graft harvest for fusion. 7. posterior instrumentation c7, t1, t2. history of present illness: mr. is a 71yo man with htn, copd, and metastatic rectal cancer to the bones admitted from clinic for upper back and bilateral rib pain. his pain has worsened over the last one week since restarting capecitabine. it is worse with movement and inspiration. he also has similar pain in the front of his chest. fentanyl patch was increased from 100mcg/hr to 200mcg/hr . in addition, he has been needing hydromorphone 4mg every 3hrs for a few days, but this has been inadequate. he was in the clinic due to a prerequisite for enrollment in the mersana clinical trial. pet/ct showed progression of disease. . ros: he notes anorexia and night sweats. he denies fever, chills, n/v, wght loss, headache, dizziness, dyspnea, cough, abdominal pain, constipation, diarrhea, hematochezia, melena, hematuria, other urinary symptoms, weakness, or rash. he has chronic numbness in his feet. all other ros were negative. past medical history: oncologic history: # early stage lung cancer status post right upper lobectomy and mediastinal lymph node dissection in without evidence of recurrence. # rectal cancer: t3n2m0; diagnosed in 10/. - : the pt develops abdominal pain and lower gi bleed, further investigation by colonoscopy reveals an ulcerated 4-5 cm mass in the mid rectum at 10cm, the pathology examination of the biopsies shows poorly differentiated carcinoma. - : the patient undergoes low anterior resection and diverting loop ileostomy and mesenteric and periaortic lymphadenectomy (t3n2m0, lymph nodes involved, with a distal margin that was clear by < 1 mm, k-ras wild time) after completion of neo-adjuvant capecitabine-based chemoradiation - the patient started adjuvant therapy with flox (5-fu + leucovorin 500 mg/m2 on day 1, 8, and 15 and oxaliplatin 85 mg on day 1,5 of four-week cycles). - on a nonocclusive thrombus was demonstrated in the left renal vein and the patient was started on anticoagulation. - on , he started cycle #4 of flox at reduced dose of 5-fu 400 mg/m2 only on d1,15 and oxaliplatin at 85 mg/m2 on d1,15. he subsequently completed two more cycles, the last one being on . therapy was also complicated by the developments on oxaliplatin-related neuropathy involving the palms, feet and distal calves. - bone scan and spine mri showed multiple bone metastasis, in a bone scan and now ct scan torso showed progression of bone metastates, but no evidence of other site of metastatic disease. - start palliative chemotherapy with single irinotecan (350 mg/m2 q21d). - ct torso showed increased sclerotic bony metastatic disease unclear if due to disease progression or response to treatment. . treatment history: 06/09,16,23: c1 flox (5-fu 500 mg/m2 d1,8,21 + oxaliplatin 85 mg/m2 d1,15). : c2 flox. *c2d1 changed from to due to development of abdominal pain and nausea. urgent ct demonstrated nonocclusive thrombus of left renal vein and interval enlargement of sclerotic focus in left aspect of t12. *hospitalized for neutropenic fevers (100.5, anc 500,) llq pain, and dehydration. ct demonstrated small bowel thickening suggestive of enteritis. stool and blood cultures negative. discharged on course of cipro + flagyl. : c3 flox. *hospitalized for weakness, abdominal pain, and increased ostomy output and dehydration. ct revealed epiploic appendagitis. : c4 flox (5-fu 400 mg/m2 d1,15 + oxaliplatin 85 mg/m2 d1,15). : c5 flox. : c6 flox. : start irinotecan (350 mg/m2 q21d) x7 cycles. : cetuximab added to irinotecan. : restarted capecitabine. . other pmhx: hypertension. copd. depression/anxiety disorder. arthritis. gastritis. non-occlusive left renal vein thrombus, on enoxaparin. bph. social history: he is married with 12 children. he lives in and is currently unemployed. he previously worked as an auto mechanic. he quit smoking ~20yrs ago. he rarely drinks alcohol and denies illicit drug use. family history: unremarkable for colorectal or other malignancy. physical exam: admission physical examination: vs: t 97.0f, bp 102/68, hr 117, rr 18, o2 sat 98% ra. gen: a&o, nad, ill appearing, thin. heent: sclerae non-icteric, eom intact, cns normal, o/p clear, dry mm. neck: supple, no thyromegaly, no jvd. lymph nodes: no cervical, supraclavicular, axillary, or inguinal lad. cv: s1s2, reg rate and rhythm, no mrg. chest pain not reproducible by palpation. resp: good air movement bilaterally, no added sounds. chest: markedly tender bilateral ribs, large asymmetry/mass at right posterior ribs at thoracotomy scar. abd: soft, non-tender, non-distended, no hsm. extr: no edema, calf tenderness, or finger clubbing. derm: no rash. neuro: strength 5/5, sensation to touch diminished at feet, down-going plantar reflexes, no focal deficits. psych: appropriate and calm. pertinent results: admission labs: 06:00pm blood wbc-10.8 rbc-3.97* hgb-10.4* hct-31.6* mcv-80* mch-26.3* mchc-33.0 rdw-16.7* plt ct-360 06:00pm blood neuts-80.7* lymphs-8.9* monos-9.5 eos-0.6 baso-0.2 06:00pm blood pt-14.3* ptt-36.7* inr(pt)-1.2* 06:00pm blood glucose-119* urean-12 creat-0.9 na-134 k-4.4 cl-97 hco3-25 angap-16 06:00pm blood albumin-3.6 calcium-9.0 phos-2.7 mg-1.9 06:00pm blood alt-9 ast-42* alkphos-395* totbili-0.4 . mri t-spine: impression: 1. significant progression of metastatic lesions involving the thoracic and visualized lumbar spine since the previous mri from . multiple sclerotic deposits are demonstrated throughout the thoracic spine with diffuse involvement at multiple sites. 2. large epidural deposit causing cord compression is demonstrated at t1 level. several other epidural deposits are seen, most prominent at t9 and t12 levels. . ct c/a/p: impression: 1. interval worsening of extensive osseous metastasis, most prominently noted along the right rib cage, with expansile osseous and soft tissue components. small right pleural effusion. worsening of multilevel osseous metastases in the spine as described. no acute pathologic fracture. 2. unchanged small parastomal hernia, but without bowel obstruction at the loop ileostomy in the right lower quadrant. 3. stable presacral soft tissues. . mri c/l-spine: impression: 1. multiple sclerotic metastases in the cervical, visualized thoracic and lumbar spine. 2. large epidural mass at t1 causing severe cord compression as seen on the earlier thoracic spine study. 3. small epidural deposit at t12 level indenting the dorsal aspect of the distal cord as seen on the recent thoracic spine study. 4. small posterior epidural deposits at l2-3 and l3-4 levels without canal compromise. 5. minor degenerative changes in the lower lumbar spine with disc bulges, small protrusions and facet arthropathy causing foraminal narrowing. . mri brain: impression: sclerotic bony metastatic lesions are identified in both frontal bones and left temporal bone with dural enhancement adjacent to the bony metastases in the right frontal and left temporal regions. sclerotic metastatic disease to the spinous process of c2 is also noted, which was observed on the cervical spine mri of . no brain parenchymal metastasis is seen. . cxr: impression: lung volumes are slightly lower, but lungs are clear of any focal abnormality. blastic bone lesions in the ribs and the thoracic spine have increased substantially. there is no pneumonia or pulmonary edema or even appreciable pleural effusion. et tube is in standard placement, right subclavian infusion port ends low in the svc and a nasogastric tube ends in the mid stomach. no pneumothorax. . discharge labs: brief hospital course: 71yo man with htn, copd, and metastatic rectal ca admitted for back and bilateral rib pain. pain improved with iv hydromorphone. mri t-spine confirmed t1 cord compression. neurosurgery and radiation oncology were consulted. dexamethasone was started. he went for neurosurgical decompression at t1 . after surgery, he developed atrial fibrillation, which was controlled with metoprolol. he was not anticoagulated because of the recent neurosrugery. radiation oncology planned radiation to the remaining t-spine regions at risk and pt scheduled to start as an outpt. # back and rib pain and t1 cord compression: mri t-spine showed severe t1 cord compression. dexamethasone started. consulted neurosurgery and radiation oncology. he went for neurosurgical decompression of t1 .palliative care was also consulted for pain control.fentanyl patch was increased to 250 mcg /hr. in addition hydromorphone was added for breakthrough pain. scheduled acetamoniphen was also state gabapentin increased to 600 mg. pain wa soverall well ocntrolled with this regimen. . # rectal ca, kras wild-type: hold capecitabine. mr. did not qualify for this recent clinical trial. he plans to pursue other trials or chemo agents after discharge. . # atrial fibrillation: developed after surgery and controlled with increased doses of metoprolol. not anticoagulated because of recent neurosurgery.a chest cta was done and was neagtive fo ra pe. . # anemia: likely chemo-induced. stable. . # renal vein clot: mr. had decided in the past to discontinue enoxaparin, so this was not restarted during this admission. . # htn: changed metoprolol xl to short-acting and increased dose to 25mg to improve bp, tachycardia, and prep for surgery. . # copd: continued albuterol/ipratropium and fluticasone/salmeterol. . # bph: continued tamsulosin. . # depression: continued citalopram. . # fen: regular diet. iv fluids given for decreased po and clinical dehydration. repleted hypophosphatemia. . # gi ppx: ppi and bowel regimen. . # code: full. medications on admission: albuterol sulfate benzonatate 200mg po tid prn citalopram 10mg po daily enoxaparin 80 mg/0.8 ml daily (was not taking) fentanyl 200mcg/hr patch q72hr fluticasone propionate fluticasone-salmeterol 500mcg-50mcg/dose 2 puffs inhaled gabapentin 300mg po tid hydromorphone 4mg tablet po q3hr prn ipratropium-albuterol 18mcg-103mcg (90 mcg)/actuation aerosol - 1-2 puffs inhalation qid prn lorazepam 2-4mg po qhs prn anxiety metoprolol succinate 25mg extended release po daily metronidazole 1% gel apply on face omeprazole 40mg po daily ondansetron hcl 8mg po q12hr days 2 and 3 after chemotherapy potassium chloride 20 meq er particles/crystals po bid (not taking) tamsulosin 0.4mg po qhs benzocaine 20% paste apply locally 2-3 times daily prn mouth sores discharge medications: 1. ipratropium-albuterol 18-103 mcg/actuation aerosol sig: puffs inhalation q6h (every 6 hours) as needed for dyspnea, wheeze. 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation: over the counter. 3. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 4. citalopram 20 mg tablet sig: 0.5 tablet po daily (daily). 5. tamsulosin 0.4 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po hs (at bedtime). 6. fluticasone-salmeterol 500-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 7. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*0* 8. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 9. fentanyl 100 mcg/hr patch 72 hr sig: two (2) transdermal q72h (every 72 hours). disp:*20 patches* refills:*0* 10. fentanyl 50 mcg/hr patch 72 hr sig: one (1) transdermal every seventy-two (72) hours: total dose of fentanyl 250 mcg/hr. disp:*10 patchs* refills:*0* 11. benzonatate 100 mg capsule sig: one (1) capsule po tid (3 times a day) as needed for cough. 12. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily): apply for 12hrs every 24 hrs. disp:*30 adhesive patch, medicated(s)* refills:*0* 13. hydromorphone 4 mg tablet sig: four (4) tablet po every four (4) hours as needed for pain. disp:*120 tablet(s)* refills:*0* 14. gabapentin 300 mg capsule sig: one (1) capsule po bid (2 times a day). 15. gabapentin 300 mg capsule sig: two (2) capsule po hs (at bedtime). disp:*60 capsule(s)* refills:*0* 16. lorazepam 2 mg tablet sig: 1-2 tablets po at bedtime as needed for insomnia. discharge disposition: home with service facility: art of care discharge diagnosis: 1. back and rib pain. 2. metastatic rectal cancer to the bones. 3. t1 spinal cord compression. 4. atrial fibrillation discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to the hospital for back and rib pain due to metastatic rectal cancer to the bones.you were found to have cord compression at the the level of t1 and underwent neurosurgical decompression. you tolerated the surgery well. after surgery you had a rapid heart rate ( atrial fibrillation) and metoprolol dosing was changed. your pain medications were also adjusted for better pain control. you should keep the surgical incisional wound open to air, but cover during showers and then pat to dry. do not take baths or swim until further instructed by dr . change in medications: 1.fentanyl patch dose increased to 250 mcg 2.metoprolol succinate chanegd to metoprolol tartate 25 mg po tid 3.night time gabapentin increasd to 600 mg 4.tylenol 650 mg four times dailyx7 days 5.lidocaine patch 6.hydromprophone increased to 16mg as needed every 4 hrs. 7. docusate and senna as needed for constipation followup instructions: radiation oncology: ,8:00 building . tel department: orthopedics when: wednesday at 3:25 pm with: ortho xray (scc 2) building: sc clinical ctr campus: east best parking: garage department: spine center when: wednesday at 3:45 pm with: , md building: campus: east best parking: garage department: hematology/oncology when: wednesday at 11:30 am with: , md building: sc clinical ctr campus: east best parking: garage department: hematology/oncology when: wednesday at 11:30 am with: , md, phd building: sc clinical ctr campus: east best parking: garage procedure: imageless computer assisted surgery excision or destruction of lesion of spinal cord or spinal meninges enteral infusion of concentrated nutritional substances excision of bone for graft, other bones dorsal and dorsolumbar fusion of the posterior column, posterior technique other cervical fusion of the posterior column, posterior technique fusion or refusion of 2-3 vertebrae diagnoses: unspecified essential hypertension atrial fibrillation personal history of malignant neoplasm of bronchus and lung hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) dysthymic disorder antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use chronic obstructive asthma, unspecified secondary malignant neoplasm of bone and bone marrow obstructive chronic bronchitis without exacerbation myelopathy in other diseases classified elsewhere personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus antineoplastic chemotherapy induced anemia 

Answer: The patient is high likely exposed to