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: pelvic mass major surgical or invasive procedure: exploratory laparotomy, bilateral salpingo-oophorectomy, excision of pelvic mass, cysto with right ureteral stent placement, illeocecal resection with primary re-anastamosis, low anterior resection with colostomy for pelvic tumor history of present illness: ms. is a 66-year-old gravida 5, para 5 with a history of breast cancer, diabetes, and chronic kidney disease who was seen by her primary care and complaint of irregular bowel movements with alternating constipation and diarrhea as well as diffuse abdominal pain. she underwent a ct scan, which revealed within the pelvis, a complex cystic and solid right adnexal mass measuring 7.6 cm in maximal dimension. the mass was inseparable from the sigmoid colon, cecum, and right ureter. there was also mild hydronephrosis with hydroureter extending from the pelvis. she then underwent an mri, which revealed this large multilobulated heterogeneous mass in the right adnexa which appears to be arising from the right ovary. both the cecum and sigmoid were inseparable from the mass and the right ureter was also inseparable from the mass. this mass appears to be obstructing the right ureter. she also complains of intermittent nausea, denies any vaginal bleeding or blood in her stool. no chest pain, shortness of breath. past medical history: - iddm - htn - ckd stage iv (baseline cr 2.9) - right-sided breast cancer s/p neoadjuvant chemo followed by surgery, then radiation - lung nodules (? mets) - hypercholesterolemia - cataracts - morbid obesity past surgical history: -hysterectomy postpartum -cholecystectomy ob/gyn history: - five spontaneous vaginal deliveries - last menstrual period was age 25 with her hysterectomy - menarche at age 12 with regular periods lasting 3 days - no history of abnormal paps, stis, fibroids, or cysts - her last pap was approximately two years ago and was normal social history: lives in with her son. retired transit authority worker. has other children and family members in the area. prior tobacco use, quit 10-15 years prior. no etoh or illicit drug use. family history: sister with dm, mi at age 46. maternal grandmother with cad, dm. mother deceased at age 80. brother with dm. physical exam: on day of discharge: general: no acute distress, well appearing. cardiovascular: regular rate and rhythm. lungs: clear to auscultation bilaterally. abdomen: soft, diffusely tender. no rebound or guarding. + bowel sounds. 15 cm midline incision with wound vac in place. 1/2 cm jp port side on right at the level of the umbilicus c/d/i. ostomy pink with stool and gas. extremities: non-tender, no edema. pertinent results: 11:10pm type-art po2-247* pco2-37 ph-7.32* total co2-20* base xs--6 11:10pm lactate-0.9 11:01pm glucose-163* urea n-29* creat-3.3* sodium-140 potassium-4.1 chloride-110* total co2-19* anion gap-15 11:01pm calcium-8.1* phosphate-5.3* magnesium-2.2 10:57pm hct-29.3* 05:39pm glucose-180* urea n-27* creat-3.2* sodium-141 potassium-4.0 chloride-111* total co2-19* anion gap-15 05:39pm estgfr-using this 05:39pm calcium-7.7* phosphate-4.6*# magnesium-1.7 05:39pm wbc-8.5 rbc-3.40* hgb-10.1* hct-28.4* mcv-84 mch-29.8 mchc-35.7* rdw-15.4 05:39pm plt count-192 05:39pm pt-13.0* ptt-28.6 inr(pt)-1.2* 02:03pm type-art po2-240* pco2-39 ph-7.26* total co2-18* base xs--8 02:03pm glucose-173* lactate-2.1* na+-135 k+-4.9 cl--112* 02:03pm hgb-8.1* calchct-24 o2 sat-97 02:03pm freeca-1.10* 02:03pm freeca-1.10* 01:50pm wbc-7.6 rbc-3.00* hgb-8.8* hct-26.0* mcv-87 mch-29.4 mchc-33.9 rdw-15.7* 01:50pm plt count-214 01:50pm pt-14.0* ptt-27.1 inr(pt)-1.3* 01:50pm fibrinoge-415* 12:54pm type-art rates-/8 tidal vol-500 o2-50 po2-235* pco2-45 ph-7.24* total co2-20* base xs--7 -assist/con intubated-intubated 12:54pm glucose-155* lactate-0.8 na+-138 k+-4.0 cl--112* 12:54pm hgb-7.4* calchct-22 o2 sat-98 12:54pm freeca-1.11* 07:50am type- po2-41* pco2-35 ph-7.33* total co2-19* base xs--6 07:50am glucose-89 lactate-0.9 na+-141 k+-3.9 cl--115* 07:50am hgb-11.5* calchct-35 o2 sat-76 07:50am freeca-1.16 brief hospital course: ms. is a 66 yo g5p5 with breast cancer, diabetes, htn, and chronic kidney disease, admitted for resection of pelvic mass. on she underwent an ex-lap, bso, excision of pelvic mass, cysto with right ureteral stent placement, ileocecal resection with primary re-anastomosis, and lar with colostomy. intra-operative consults included urology and -rectal surgery. intra-operatively she received 5 units of prbcs, 2 of ffp and of 2 albumin. estimated blood loss was 2500 cc's. intra-operative findings included a mass filling the right pelvis with involvement of the rectosigmoid and posterior cul-de-sac. the cecum was also densely adherent to the mass. frozen pathology revealed low-grade adenocarcinoma. please see operative notes by dr and dr for details. . # post-op: post-operatively she was transferred to the icu intubated and sedated. she was weaned off ventilator a few hours after arrival once the paralytics had worn off. she remained on high flow facemask overnight, however she was weaned to nasal cannula by the am. on post-operative day 1, the patient was transferred out of the icu and to the floor. on post-op day her pain was controlled with an epidural, and she was followed by the pain service. on post-op day 2 the epidural was discontinued and she was started on a dilaudid pca. over the next few days she was slowly transitioned off the pca and she received iv dilaudid for pain control. by post-op day 5 her pain was controlled with po pain meds with iv dilaudid for breakthrough. . # anemia: pre-operative hct was 27. intra-operative hct was 22 and she received 5 units of prbcs intraoperatively. her hct was 28 post-op however this was likely falsely elevated and had not yet equilibrated from her large volume shifts and blood loss during surgery. over night on pod 0 to pod 1 she was transfused and additional 2 units of prbcs and she remained hemodynamically stable with good urine output. on post-op day 1 her post-transfusion was hct was 29 and it remained stable on several serial hcts. . # chronic renal disease: her baseline cr was 2.9. her urine output was poor intraoperatively and her cr trended up to a peak of 3.6 on pod 2. the renal consult team was called who suggested that this was likely acute atn secondary to intra-operative hypovolemia. by post-operative day 4 her cr trended back to her baseline and she continued to have adequate urine output. the right ureteral stent placed intraoperatively by urology was removed at the bedside and the foley catheter was discontinued. she will follow up with her primary care provider as an outpatient. through her hospitalization nephrotoxins were avoided, even fluid balance was attempted and she was started on a low k/phos & diabetic diet. . # dm type ii: on nph and humulog at home, last a1c 10.4 in 5/. started on home dose of nph and gentle sliding scale, fingersticks kept in the mid 100s range. when tolerating a regular diet nph slowly advanced to home doses. she will follow up with her primary care provider as an outpatient within a week of discharge. . # hypertension: on carvedilol 12.5 mg po bid as an outpatient. by post-operative day 3 her blood pressures trended up to the 170-180/70-80 range. she received several doses of iv hydralazine and iv metoprolol for elevated blood pressures. her carvedilol was increased to 25 mg po bid and amlodipine 5 mg po daily and lasix 40 mg po daily was added per renal consult recommendations. by discharge her blood pressures were in the 150-160/70-80 range. she will follow up with her primary care provider as an outpatient within a week of discharge. . # history of breast cancer: held anastrazole in the acute post-surgical setting, given pro-thrombotic risk. re-started on discharge from hospital. . # wound: on pod 3 she developed a seroma and the inferior aspect of her incision was opened up when the staples were removed. a wound vac was applied. the fascia was probed and found to be intact and there was clean granulation tissue without evidence of infection. she was followed by the wound and ostomy nurse who helped her care for her incision and wound vac. the jp drain was discontinued on pod 5 by -rectal surgery. . #) gi: she remained npo with ivf and an ngt in place until pod 2. she received an iv ppi for prophylaxis. overnight on pod 2 the ngt was clamped and then discontinued. on pod 3 she was advanced to sips. on pod4 she tolerated clear without nausea or vomiting. on pod 5 her ostomy started to put out stool. she was advanced to a regular diet on pod 6. on pod 6 the output from her ostomy stopped and she developed nausea and vomiting. a kub was done which did not show evidence of sbo. she was made npo and a picc line was placed for iv hydration given that she had no peripheral access. a suppository was placed in her ostomy. on pod 7 her ostomy again put out stool and the nausea resolved. by pod 8 she was tolerating a regular diet without nausea or vomiting. the picc line was discontinued. . #) l arm swelling: on pod 4 left upper extremity swelling was noted but there was no erythema and no pain. a leni was negative for dvt. this was attributed to her piv which was discontinued. the swelling decreased on pod 5. . #) prophylaxis: she received sq heparin 2-3 times a day during her hospitalization. she worked with physical therapy to improve her ambulation after she became deconditioned and she was encouraged to ambulate. she was discharged home in stable condition on pod 10. she was tolerating a regular diet and her pain was controlled with oral pain meds. she was ambulating and voiding spontaneously. a vna service was arranged to help her with her wound vac and ostomy. final pathology revealed a colon cancer. she will follow up with -rectal surgery, med-onc, radiation oncology and her primary care provider in addition to following up with dr . medications on admission: anastrazole 1mg qd, carvedilol 12.5 qd, humalog w/, 81 qd, nph 40 units w/breakfast, 22 u w/dinner discharge medications: 1. percocet 5-325 mg tablet sig: 1-2 tablets po every 4-6 hours as needed for pain. disp:*50 tablet(s)* refills:*0* 2. colace 100 mg capsule sig: one (1) capsule po twice a day. disp:*60 capsule(s)* refills:*2* 3. carvedilol 12.5 mg tablet sig: two (2) tablet po bid (2 times a day). tablet(s) 4. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). disp:*60 tablet(s)* refills:*0* 5. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). disp:*60 tablet(s)* refills:*0* 6. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). disp:*60 capsule, delayed release(e.c.)(s)* refills:*0* 7. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po q6h (every 6 hours) as needed for constipation. disp:*1 bottle* refills:*2* 8. nph insulin human recomb 100 unit/ml suspension sig: one (1) 40 subcutaneous q breakfast. 9. nph insulin human recomb 100 unit/ml suspension sig: one (1) 22 subcutaneous q dinner. 10. anastrazole 1mg qd discharge disposition: home with service facility: homecare discharge diagnosis: colon cancer acute on chronic renal failure discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted for surgery for a pelvic mass. the mass was a colon cancer. while in the hospital your renal function worsened but then returned to your baseline. you will need outpatient followup with your primary care provider, , radiation oncology, -rectal surgery and gyn-onc surgery. you should also follow up with your primary care provider to discuss your diabetes and hypertension. while you were in the hospital additional blood pressure medications, amlodipine and lasix were added to better control your high blood pressure. your insulin was not changed. you have a new colostomy and you received teaching on ostomy care prior to discharge. a visiting nurse will come to the house to take care of your wound vac and ostomy. general instructions: * take your medications as prescribed. * do not drive while taking narcotics. * do not combine narcotic and sedative medications or alcohol * do not take more than 4000mg acetaminophen (apap) in 24 hrs * no strenuous activity until your post-op appointment * nothing in the vagina (no tampons, no douching, no sex), no heavy lifting of objects >10lbs for 6 weeks. * you may eat a regular diabetic diet incision care: * no bath tub. vna will help you shower between wound vac changes. to reach medical records to get the records from this hospitalization sent to your doctor at home, call . followup instructions: you will need to see dr in colorectal surgery, in weeks. please call his office to make an appointment. . you should follow up with dr at . you have an appointment on at 2 pm to see her at the office. dr would like you to see a rad-. the rad-onc physicians that visited you at will call you to make an outpatient appointment for you soon. on at 1:20pm you have an appointment to see dr , , md your primary care provider. you have an appointment to see dr on at 2pm on the of the building at . do 16-adl procedure: other removal of both ovaries and tubes at same operative episode excision or destruction of peritoneal tissue ureteral catheterization other lysis of perirenal or periureteral adhesions retrograde pyelogram anterior resection of rectum with synchronous colostomy insertion of catheter into spinal canal for infusion of therapeutic or palliative substances systemic to pulmonary artery shunt open and other cecectomy central venous catheter placement with guidance diagnoses: acidosis hypocalcemia esophageal reflux acute kidney failure with lesion of tubular necrosis acute posthemorrhagic anemia chronic kidney disease, stage iv (severe) hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified personal history of malignant neoplasm of breast personal history of tobacco use pulmonary collapse nausea with vomiting disorders of phosphorus metabolism surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation long-term (current) use of insulin morbid obesity other respiratory complications seroma complicating a procedure hypovolemia accidents occurring in residential institution hydronephrosis disorders of magnesium metabolism diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled electrolyte and fluid disorders not elsewhere classified unspecified cataract stricture or kinking of ureter secondary malignant neoplasm of retroperitoneum and peritoneum benign neoplasm of ovary secondary malignant neoplasm of large intestine and rectum other specified disorders of kidney and ureter swelling of limb secondary malignant neoplasm of other urinary organs encounter for change or removal of surgical wound dressing body mass index 38.0-38.9, adult malignant neoplasm of appendix vermiformis other nonspecific abnormal finding of lung field 

Answer: The patient is high likely exposed to