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: history of present illness: patient is an 81 year-old gentleman with the history of bladder cancer with spread to the rectum who is currently being treated with chemotherapy who presents with two to three weeks of progressively worsened nausea nd vomiting. the nausea and vomiting is worse after meals. he has developed a dysphagia originally to solids and more recently now to liquids. he describes a pressure in his chest after eating which lasts for several minutes to hours followed by vomiting which relieves that pressure. he presented to an outside hospital for evaluation and it was thought that due an admission ct scan for bladder cancer follow up work he might have retained contrast in his gastrointestinal system. he was prescribed magnesium citrate for bowel clean out. the symptoms persisted and the patient then presented to the for further work up. regarding the patient's bladder cancer it was discovered in when he presented with enuresis. prior to this patient had been followed for abnormal digital rectal examination and he underwent a transrectal biopsy which showed poorly differentiated carcinoma positive for cea cytokeratin 7 and 20 but negative for psa for psap. patient has had further work up including a negative bone scan and mri which revealed an asymmetric bladder wall thickening and thickening of the rectum. he was started on gemcitabine and ciscarboplatin chemotherapy which has improved his symptoms and on follow up ct scan the disease appears stable on . review of systems: patient just reports a ten pound weight loss over the last two to three weeks. he denies any fevers, chills, shortness of breath, chest pain. past medical history: significant for 1) hypertension, 2) paroxysmal atrial fibrillation, 3) bladder cancer. past surgical history: none. medications: on admission include coumadin 5 mg/5 mg/2.5 mg repeated. parnate 10 mg p.o. q.d. dyazide 37.5/25 p.o. q.d., elavil 50 mg p.o. q.h.s., bioptic ggt b.i.d. and lopressor 50 mg p.o. b.i.d. allergies: patient has no known drug allergies. social history: patient is married, lives with his wife in . physical examination: patient is in no acute distress, blood pressure 110/80, heart rate 66, respirations 14. oropharynx is clear, no lymphadenopathy in neck. lungs are clear to auscultation bilaterally. he is regular rate and rhythm with a ii/vi systolic ejection murmur. abdomen is soft and nontender, no palpable hepatosplenomegaly, no abdominal distention. there is no inguinal lymphadenopathy. rectal examination revealed narrow canal with firmness on the left side of the prostate. no peripheral edema. laboratory data: on admission included white count of 9.4, hematocrit of 36.4, platelets 224. pt 13.3, inr of 1.2. sodium of 134, potassium 3.3, chloride of 90, bicarbonate of 33, bun 19, creatinine 1.5, glucose 101, alt 15, ast of 39, alk phos of 88, total bilirubin of 0.6, calcium 8.3, magnesium 2.0. electrocardiogram showed sinus tachycardia with a rate of 100, no acute ischemia. chest x-ray was significant for elevated left hemidiaphragm and minimal subsegmental atelectasis of the left lung. ct scan done on was significant for no bladder wall or rectal wall thickening of any significance. bilateral moderate hydronephrosis which is stable and increased atrophy of the left kidney. hospital course: patient was admitted to medicine, made n.p.o. and patient underwent a barium swallow . it showed irregular erosions of the esophageal wall, elevation of the left hemidiaphragm and abnormal position of the stomach. patient then underwent esophagogastroduodenoscopy by the gastrointestinal service on which was significant for grade 2 esophagitis of the lower third of the esophagus and open pylorus and an extrinsic stenosis of the second part of the duodenum. the patient felt symptomatically better after several days of bowel rest. patient was restarted on liquid diet, was on protonix for his gastritis and subsequently developed nausea and vomiting once again and intolerance to any p.o. intake. at this point patient had a picc line placed. total parenteral nutrition was started. a second esophagogastroduodenoscopy with biopsies was performed. the esophagogastroduodenoscopy was significant for gastric inlet patch, gastritis of the stomach and extrinsic stenosis of the second part of the duodenum once again. the biopsies were negative for any malignancy. surgery was consulted and once being cleared by cardiology due to his history of paroxysmal atrial fibrillation patient was taken to the operating room on for planned gastrojejunostomy. during rapid induction for intubation patient became hypotensive with systolic blood pressure in the 60s and the monitor showed an eight beat run of ventricular tachycardia. patient was intubated, started on pressors and was taken to the intensive care unit without undergoing any procedure. patient in the intensive care unit remained hemodynamically stable. he was weaned off pressors and extubated without incident. cks were flat. troponin is were 1.9 and 1.8 respectively. there were no electrocardiographic changes post event. after spending several days in a closely monitored setting it was decided the patient would once again return to the operating room on . patient was inducted without any incident. patient on underwent a gastrojejunostomy, anal dilatation and a biopsy of intraoperative finding of a retroperitoneal mass which was compressing the duodenum. patient tolerated this procedure well, was transferred to the post anesthesia care unit extubated and in stable condition. he was then transferred to the surgical intensive care unit for close monitoring and after spending one night patient was then transferred to the floor for the remainder of his recovery. postoperatively cardiology-wise patient remained stable with no postoperative electrocardiogram changes. postoperatively the patient has remained afebrile. he received a five day course of levaquin. on postoperative day number one after being transferred to the floor patient received rapid atrial fibrillation with a stable blood pressure. he was treated with intravenous lopressor and became rate controlled. patient then converted spontaneously to sinus. on postoperative two the patient once again had an episode of rapid atrial fibrillation which was rate controlled and patient converted back to normal sinus. patient has remained on beta blockade with adjustments as appropriate. patient was restarted on his coumadin on postoperative day number three and his current inr is 1.7. the patient received 5 mg of coumadin for tonight and will be followed by dr. as he has been doing in the past. patient's respiratory status has remained stable. he has been weaned off oxygen with o2 saturations in the high 90 percents. patient's nasogastric tube was discontinued on postoperative day number two and he has been advanced to a soft diet which he is tolerating. patient's total parenteral nutrition was weaned and the picc line was removed. patient has been cleared by physical therapy for discharge to home and has been ambulating without problem. patient's hematocrit has remained stable at 30. patient's electrolyte balance has remained sable and kidney function has remained stable with his last bun and creatinine being 33 and 1.0. patient is stable and ready for discharge to home. the biopsy of the retroperitoneal mass pathology has returned result of poorly differentiated adenocarcinoma, signet cell features, positive for keratin and cytokeratin 7 and 20. this is the same staining properties as the mass biopsied from the bladder and is likely metastatic disease. patient was seen by the oncology service and outpatient chemotherapy and will continue. patient will follow up with dr. in one week and will follow up with dr. in one week for coumadin adjustment and atrial fibrillation management. discharge diagnoses: 1. duodenal obstruction secondary to metastatic bladder cancer, status post gastrojejunostomy. 2. anal stenosis, status post anal dilatation. 3. hypertension. 4. paroxysmal atrial fibrillation. 5. hypertension. 6. gastritis. discharge medications: include protonix 40 mg p.o. q.d., dilaudid 2 mg p.o. 1 to 2 p.o. q 4 hours p.r.n., colace 100 mg p.o. b.i.d., parnate 10 mg p.o. q.d., dyazide 37.5 mg/25 p.o. q.d., elavil 50 mg p.o. q.h.s., coumadin 5/5/2.5 p.o. repeated, bioptic ggt b.i.d. and lopresor 50 mg p.o. b.i.d. condition n discharge: stable. patient will be discharged to home to follow up with dr. in one week and dr. in one week, and oncology service which patient will call for appointment. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances other endoscopy of small intestine insertion of endotracheal tube arterial catheterization other gastroenterostomy without gastrectomy esophagogastroduodenoscopy [egd] with closed biopsy open biopsy of small intestine dilation of anal sphincter diagnoses: cardiac complications, not elsewhere classified atrial fibrillation paroxysmal ventricular tachycardia esophagitis, unspecified surgical or other procedure not carried out because of contraindication unspecified gastritis and gastroduodenitis, without mention of hemorrhage secondary malignant neoplasm of retroperitoneum and peritoneum malignant neoplasm of bladder, part unspecified other obstruction of duodenum 

Answer: The patient is high likely exposed to