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: lower back pain and hip pain major surgical or invasive procedure: posterior surgical fusion t9-l1 with anterior column reconstruction at t11 level history of present illness: a 68 year-old female with history of bilateral breast cancer and metastatic kidney cancer, with extensive osseous and pulmonary metastases presented with chronic and acute lower back pain and hip pain. she has chronic lower pain and b/l hip pain for 2 years. the pain has gotten worse over the past one month. the pain was constant and in intensity. any movement would aggravate the pain and only pain med would relieve the pain. because of the pain, she underwent a ct of abd and pelvis on , which found that dramatic increase in overall tumor burden and metastatic disease at t11/t12 results in focal spinal instability with a invasion of the spinal canal with nearly 50% canal narrowing and greater than 50% vertebral body involvement. she denied focalized weakness, numbness, fecal or urine incontinence, buttock area numbness, or urine retention. however, she has constipated over the past one week. review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies blurry vision, diplopia, loss of vision, photophobia. denies sinus tenderness, rhinorrhea or congestion. denies chest pain or tightness, palpitations, lower extremity edema. denies cough, shortness of breath, or wheezes. denies nausea, vomiting, diarrhea, constipation, abdominal pain, melena, hematemesis, hematochezia. denies rashes or skin breakdown. no numbness/tingling in extremities. all other systems negative. past medical history: oncologic history: : left nephrectomy for 11 cm clear cell renal cell carcinoma : diagnosted with bilateral breast cancer (node-positive on left, er/pr positive, her-2 negative). treated with neoadjuvant dose-dense ac and weekly taxol ending , bilateral mastectomy (after lumpectomy with positive margins), radiation ending . on arimidex since completion of chemotherapy. : ct torso (done because of elevated alk phos) showed 1.5 and 0.6 cm left upper lobe nodules. : left upper lobectomy showed two foci of clear cell renal cell carcinoma. : mri of t/l spine with disease at t10, t11 vertebral bodies, soft tissues t10-t12, and l3 body. ct-guided biopsy consistent with renal cell carcinoma. bone scan also showed involvement of several left ribs. subsequently received xrt to thoracic spine. : began sunitinib; dose reduced over time to 25 mg because of toxicities. sutent ended in because of disease progression. : mri l-spine with t11 disease with persistent mass effect on thecal sac but no significant cord compression, and t9 and t10 disease, all likely unchanged. new t12 compression fracture. significant progression of l3 vertebral body lesion with pathologic fracture and retropulsion of posterior cortex. : ct torso with interval marked progression of innumerable pulmonary mets since . destructive lytic lesion within left femoral head. : xrt to lumbar spine : signed consent for 08-184 trial of avastin and temsirolimus. ct torso showed osseous mets in spine and left ribs, with interva lincrease in size in soft tissue component at t11 encasing thecal sac, invading cord, and invading more than 50% of the spinal canal. at l3, compression fracture with soft tissue component extending into spinal canal. increase in number and size of numerous pulmonary mets bilaterally. destructive lytic lesion within left femoral head. : c1d1 08-184 (avastin/temsirolimus) : ct torso with significant decrease in size of bilateral pulmonary lesions and stable osseous disease with decrease in soft tissue mass at t11 - : admitted for pna, mental status changes, found to have frontal cva, taken off study - ct torso: stable disease other past med hx: - hypertension - breast cancer s/p resection - gout social history: she lives with her 3 sons who assist with her medical care. she used to work at in the gi division. she is a non-smoker, no alcohol or other drugs. family history: father had esophageal cancer. her maternal grandmother had breast cancer in her 70s. physical exam: vitals: 98.2 99 132/73 18 97% general: aaox3 nad heent: nc/at, eomi, anicteric, slightly dry mm, chin-to-chest normal motion and not painful cv: rrr, nl s1/s2, no m/r/g lungs: clear to auscultation bilaterally without rales or rhonchi abdomen: + bowel sounds, nondistended, no tenderness to palpation, no organomegaly appreciated extremities: no edema or rash neurologic: a&ox3, cn ii-xii grossly intact. however, due to the pain, other neurologic exam wa sunable to performed psych: appropriate, pleasant, cooperative pertinent results: 09:29pm glucose-100 k+-3.9 09:20pm glucose-105* urea n-10 creat-1.0 sodium-134 potassium-4.0 chloride-100 total co2-23 anion gap-15 09:20pm estgfr-using this 09:20pm wbc-5.6 rbc-3.99* hgb-11.6* hct-34.0* mcv-85 mch-29.0 mchc-34.0 rdw-17.4* 09:20pm neuts-83.9* lymphs-8.4* monos-6.2 eos-1.0 basos-0.5 ct of the abd on : dramatic increase in overall tumor burden, including increase in size and number of numerous pulmonary nodules, and increased size of destructive bony lesion and soft tissue metastases. metastatic disease at t11/t12 results in focal spinal instability with a invasion of the spinal canal with nearly 50% canal narrowing and greater than 50% vertebral body involvement, placing the patient at high neurological and pathologic fracture risk. a large right femoral head mass is at increased risk for pathologic fracture as well. skeletal survey:: mri shows cord compression. ortho spine will pursue surgery on wednesday. pt states pain control improved but not optimal. pall care came by and meds adjusted. toradol stopped, deemed not safe for pt with one kidney. stopped asa in prep for surgery. : pall care came by again in am and uptitrated pain meds. pt reports in pm it is better. surgery plan for tomorrow. final mri read in and shows cord compression. neuro exam stable. mri t- and l-spine:1. heterogenous expansile lesion invlolving t11 vertebral body and posterior elements. there is posterior epidural soft tissue noted at this level which along with retropulsion of vertebral body causes compression of the spinal cord at this level. there is increase in the amount of compression of the vertebra as compared to the prior study, with increased epidural soft tissue and increased spinal canal stenosis. 2. hyperintense signal in the spinal cord extending from t3-t12, which likely represent syrinx and is unchanged since the prior study. 3. heterogenous lesion in the posterior elements of t12 vertebra on the left side with associated periosseous soft tissue. hypointense lesion in c6 vertebral body. these are new since the prior study. 4. decreased height of l3 vertebral body with biconcave shape. there is retropulsion of the vertebral body causing moderate spinal canal stenosis and indentation of the ventral thecal sac. 5. multiple nodules in bilateral lung fields suggestive of metastases. brief hospital course: a 68 year-old female with history of bilateral breast cancer and metastatic kidney cancer, with extensive osseous and pulmonary metastases presented with chronic and acute lower back pain and hip pain found to have metastatic bone disease. # bony mets: pt was admitted for pain crisis and found to have extensive bony lesions in the spine and femur, likely secondary to known renal carcinoma. no focal neurologic deficits. mri and skeletal survey were ordered and pt was found to have cord compression near t11-t12. skeletal survey also showed metastatic disease in t11, t12, l3 and lungs bilaterally. pt was started on dexamethasone for cord compression protocol. sliding scale insulin and gi prophylaxis with raniditine were also started. ortho spine and rad/onc were consulted consulted and decision was made to pursue surgery of spine for decompression. ortho spine team wanted embolization of tumor prior to procedure so pt underwent angio on ..... # pain crisis: palliative care was consulted to assist in pain control after several days of difficulty controlling pain. pt was satisfied with regimen of neurontin and oxycontin standing, with oxycodone for breakthrough and dilaudid for refractory pain. # htn: continued home valsartan # anemia: likely secondary to underlying cancer. hct was near baseline and remained stable. medications on admission: anastrozole 1 mg tab 1 tablet(s) by mouth once a day diovan 160 mg tab 1 tablet(s) by mouth once a day hold for bp < 110 ondansetron 4 mg tab, rapid dissolve 1 tablet(s) by mouth every 8 hours as needed for nausea aspirin 81 mg chewable tab 1 tablet(s) by mouth daily acetaminophen 325 mg tab 1 tablet(s) by mouth every 6 hours ativan 0.5 mg tab tablet(s) by mouth three times a day as needed for anxiety do not drive while taking this medication simvastatin 10 mg tab 1 tablet(s) by mouth once a day prochlorperazine maleate 10 mg tab 1 tablet(s) by mouth every six (6) hours as needed for nausea/vomiting docusate sodium 100 mg cap 1 capsule(s) by mouth levothyroxine 50 mcg tab 1 tablet(s) by mouth once a day oxycontin 10 mg 12 hr tab 2 tablet(s) by mouth twice a day oxycodone 5 mg tab 1 tablet(s) by mouth every 4 hours as needed for pain discharge disposition: extended care facility: healthcare & rehabilitation center - discharge diagnosis: unstable t11 spinal metastasis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: you have undergone the following operation: thoracic/lumbar decompression with fusion immediately after the operation: - activity: you should not lift anything greater than 10 lbs for 2 weeks. you will be more comfortable if you do not sit or stand more than ~45 minutes without getting up and walking around. - rehabilitation/ physical therapy: o 2-3 times a day you should go for a walk for 15-30 minutes as part of your recovery. you can walk as much as you can tolerate. o limit any kind of lifting. - diet: eat a normal healthy diet. you may have some constipation after surgery. you have been given medication to help with this issue. - brace: you may have been given a brace. this brace is to be worn when you are walking. you may take it off when sitting in a chair or while lying in bed. - wound care: remove the dressing in 2 days. if the incision is draining cover it with a new sterile dressing. if it is dry then you can leave the incision open to the air. once the incision is completely dry (usually 2-3 days after the operation) you may take a shower. do not soak the incision in a bath or pool. if the incision starts draining at anytime after surgery, do not get the incision wet. cover it with a sterile dressing. call the office. - you should resume taking your normal home medications. - you have also been given additional medications to control your pain. please allow 72 hours for refill of narcotic prescriptions, so please plan ahead. you can either have them mailed to your home or pick them up at the clinic located on 2. we are not allowed to call in or fax narcotic prescriptions (oxycontin, oxycodone, percocet) to your pharmacy. in addition, we are only allowed to write for pain medications for 90 days from the date of surgery. - follow up: o please call the office and make an appointment for 2 weeks after the day of your operation if this has not been done already. o at the 2-week visit we will check your incision, take baseline x-rays and answer any questions. we may at that time start physical therapy. o we will then see you at 6 weeks from the day of the operation and at that time release you to full activity. please call the office if you have a fever>101.5 degrees fahrenheit and/or drainage from your wound. physical therapy: activity: activity: activity as tolerated tid pneumatic boots per pt treatments frequency: dressing can be changed prn when wet to dry sterile dressing followup instructions: brain clinic date: phone: ( please call the spine care clinic and make a follow up appointment for two weeks at procedure: arteriography of femoral and other lower extremity arteries arteriography of other intrathoracic vessels dorsal and dorsolumbar fusion of the anterior column, anterior technique other excision of joint, other specified sites other endovascular procedures on other vessels dorsal and dorsolumbar fusion of the posterior column, posterior technique open biopsy of soft tissue other repair and plastic operations on spinal cord structures insertion of interbody spinal fusion device fusion or refusion of 4-8 vertebrae diagnoses: unspecified essential hypertension unspecified acquired hypothyroidism gout, unspecified personal history of malignant neoplasm of breast spinal stenosis, thoracic region other nervous system complications constipation, unspecified other acute pain do not resuscitate status secondary malignant neoplasm of lung personal history of malignant neoplasm of kidney delirium due to conditions classified elsewhere secondary malignant neoplasm of bone and bone marrow anemia in neoplastic disease neoplasm related pain (acute) (chronic) myelopathy in other diseases classified elsewhere pathologic fracture of vertebrae accidental cut, puncture, perforation or hemorrhage during surgical operation accidental puncture or laceration of dura during a procedure 

Answer: The patient is high likely exposed to