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 / fentanyl / nickel attending: chief complaint: diarrhea, tenesmus, abdominal bloating. major surgical or invasive procedure: exploratory laparotomy, supracervical hysterectomy with bilateral salpingo-oophorectomy, omentectomy, sigmoid resection with rectal anastamosis, repair of cystotomy and tumor debulking. history of present illness: the patient is a 59-year-old g2, p2 who presented with a several-week history of diarrhea, tenesmus, and abdominal bloating. she had a ct of the abdomen and pelvis on at , which revealed a small amount of ascites. there was para-aortic lymphadenopathy measuring up to 12 mm. the left adnexum had a 5.6-cm mass. there was an additional 9-mm enhancing peritoneal implant in left pericolic gutter. other peritoneal implants could not be excluded. a ca-125 was noted to be elevated at 1587. the patient otherwise feels well. she is tolerating a regular diet. she denied any urinary complaints. she has had no vaginal bleeding. her weight has been stable. she had a colonoscopy several years ago which was normal per her report. she denied any rectal bleeding. past medical history: significant for adenoid cystic carcinoma of the right jaw, status post maxillectomy and radiation therapy in . she has been disease free since then. she is followed by dr. at . she reports that she had a chest ct several months ago which revealed a question of an enlarged lymph nodes and was to have followup for this. also, history of nsaid nephropathy, postoperative atrial fibrillation following maxillectomy, squamous cell carcinoma of the face status nose surgery. past surgical history: as above. allergies to medications: penicillin and fentanyl. current medications: evoxac, tylenol, oral rinse, and vitamins. ob history: vaginal delivery x2. history: last pap smear was recently normal. last mammogram was recently abnormal but followup was recommended. social history: the patient neither smokes nor drinks. family history: significant for a maternal aunt who had breast cancer in her 70s, another maternal aunt with esophageal cancer, and paternal relatives with lung cancer. physical exam: general: well developed and thin. heent: sclerae were anicteric. there were postoperative and post-radiation changes on the right side of the face. lymphatics: lymph node survey was negative. lungs: clear to auscultation. heart: regular without murmurs. breasts: without masses. abdomen: soft and moderately distended and without palpable masses. extremities: without edema. pelvic: the vulva and vagina were normal. the cervix was normal to palpation. bimanual and rectovaginal examination revealed a large firm mass in the cul-de-sac which was somewhat immobile. there was a question of cul-de-sac nodularity. the rectal was intrinsically normal. pertinent results: 08:35pm blood wbc-11.5* rbc-3.28* hgb-10.1* hct-30.7* mcv-94 mch-31.0 mchc-33.0 rdw-13.2 plt ct-498* 08:35pm blood glucose-150* urean-12 creat-0.6 na-139 k-4.1 cl-105 hco3-25 angap-13 08:35pm blood calcium-8.2* phos-3.9 mg-1.5* . surgical pathology: 1. uterus, right fallopian tube and ovary, hysterectomy and salpingo-oophorectomy (a-h): a. carcinoma in myometrium and para-metrial soft tissue, present at inked parametrial soft tissue margin. b. carcinoma in paratubal soft tissue. c. unremarkable endometrium. d. unremarkable ovary and fallopian tube. 2. ovary and fallopian tube, left, salpingo-oophorectomy (i-n): a. papillary serous carcinoma, ovary. b. unremarkable fallopian tube. 3. cul de sac tumor, biopsy (o): carcinoma in fibrous tissue. 4. lymph nodes, peri-aortic, biopsy (p-s): metastatic carcinoma in three lymph nodes (). 5. omentum, excision (t): carcinoma in adipose tissue. 6. cecum, tumor, biopsy (u): carcinoma in fibrous tissue. 7. rectosigmoid colon, resection (v-aa): a. carcinoma in bowel mesentery. b. blood vessels with lymphoplasmacytic and granulomatous "vasculitis". see note. 8. lymph node, peri-aortic, biopsy (ab-ag): metastatic carcinoma in seven lymph nodes (). extra-nodal extension of tumor is present. 9. rectum, proximal donut, excision (ah): a. blood vessels with lymphoplasmacytic and granulomatous "vasculitis". see note. b. no malignancy identified. 10. rectum, distal donut, excision (ai): a. blood vessels with lymphoplasmacytic and granulomatous "vasculitis" and vascular thrombus. see note. b. no malignancy identified. 11. lymph node, left gutter, biopsy(aj): metastatic carcinoma in one lymph node (). . echo: the left ventricular cavity is small. left ventricular systolic function is hyperdynamic (ef 70-80%). there is severe focal hypokinesis/dyskinesis of the apical half free wall of the right ventricle. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. trivial mitral regurgitation. mild pulmonary artery systolic hypertension. . echo: left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%) the right ventricular cavity is dilated. there is focal hypokinesis of the apical free wall of the right ventricle. right ventricular systolic function appears depressed. the aortic valve leaflets (3) are mildly thickened. mild pulmonary artery systolic hypertension. compared with the findings of the prior study (images reviewed) of , overall rtight ventricular contractile function appears somewhat improved. brief hospital course: ms. was admitted after undergoing an exploratory laparotomy, supracervical hysterectomy with bilateral salpingo-oophorectomy, omentectomy, sigmoid resection with rectal anastomosis, repair of cystotomy and tumor debulking for a pelvic mass previously visualized on ct. prior to her surgery, an epidural was placed by anesthesia for post-operative pain management. her post-operative course was complicated by hypotension, right ventricular hypokinesis, nstemi, a-fib, anemia and oxygen desaturation. she was admitted to the icu on post-op day four for management of post-operative a-fib. # hypotension: on post op day one and two, the patient was hypotensive to the 80s/40s. there was no evidence of acute blood loss as her hct remained stable post-operatively. her urine output was adequate. an epidural was in place for pain control. her sbp was maintained > 90 with aggressive fluid management. the ddx for her hypotension included epidural induced sympathectomy versus myocardial ischemia. her ekg was unchanged. when the hypotension did not resolve after capping the epidural an echocardiogram performed which showed focal right ventricular hypokinesis. she had a positive troponin which peaked at 0.2 on post-op day two. # elevated cardiac enzymes: no known h/o cad prior to this hospitalization. troponin bumped to max of 0.20, then trended down slightly to 0.06. mbi negative x3. ces sent initially in the setting of hypotension and finding on tte of rv free wall hypokinesis. reportedly this was prior to a. fib w/ rvr so troponin leak appears to predate the rapid a. fib. picture is suggestive of perioperative nstemi per cardiology. differential, however, includes ischemia vs. less likely myocarditis as cause of elevated troponin. ekg when in nsr in the setting of hypotension did not reveal evidence of ischemia, but w/ atrial fibrillation now has new twi in i, avl which may represent demand ischemia in lcx distribution. a statin, bb, and asa were started for risk factor modification per cardiology. # right ventricular hypokinesis: severe free wall motion hypokinesis on echocardiogram likely represents small rv nstemi. ces elevated, but plateaued prior to a. fib w/ rvr. the patient was initially hypotensive requiring ivf boluses and 2u rbc, but remained hemodynamically stable for the remainder of her icu course. repeat tte showed somewhat improved rv contractile function. # atrial fibrillation: pt. reportedly has h/o post op a. fib after her surgery in which responded well to lopressor and was self limited. she denies any further episodes since. rate responded poorly to iv and po metoprolol on the floor, but improved control after second dose of diltiazem (15mg iv on the floor, 20mg iv in the icu), approximately 100 down from 140s on transfer with rate ~110s-120s on diltiazem 5mg/hr gtt. she was loaded with amiodarone on and cardioverted to nsr on at noon. at this point the diltiazem drip was discontinued and she was started on po lopressor. remains in nsr with hr 70s - 80s. she was started on lovenox for thromboembolic prophylaxis. an attempt to transition her to coumadin was abandoned after her inr was noted to be 4.7 after three days of coumadin at 5mg qd. she was given vitamin k, her hct was monitored serially, and there was no evidence of acute bleeding as her inr returned to baseline. bridging to coumadin may be re-attempted as an outpatient once her nutritional status improves. # hypoxia: mid 90s on 2l nc. cxr does show evidence of b/l pleural effusions and possible lll opacity vs. atelectasis, o/w without significant pulmonary edema. no evidence of left ventricular wall motion abnormalities nor depressed ef to suggest significant risk for pulmonary edema, but has been receiving fluids for bp maintenance given rv wall motion abnormalities and mild bibasilar crackles were heard on exam . likely hypoxia is secondary to fluid overload and dependent atelectasis. responded well to 20mg iv lasix during icu course with good response (neg. 1700cc) which resulted in improved pulmonary function and oxygenation at 99% on 2l. pt ruled out for pe on cta. # leukocytosis: wbc was max 17.0 without left shift with pt afebrile. she denies cough, ua did show occ. bacteria, neg. nitrites, small amount of leuk. esterase, lg. blood. treated with 3 days of cipro for presumed uti, however urine cx showed no growth. no diarrhea. at the time of discharge she was afebrile and her wbc had trended downward to 10.7. # anemia: previously normal baseline, but most recently 30-33 in early . postoperatively hct has been 24-27, without evidence of bleeding. up 34.0 s/p 2u prbcs then dropped to 27.3 . stabilized around 30.4. # proph: lovenox pt was transferred out of the icu on pod8 and did well on the floor, maintaining her o2 sats well on room air, ambulating, and tolerating a regular diet. she was discharge on post-op day twelve in stable condition. she has follow up with her pcp, oncology and cardiology. medications on admission: evoxac tylenol oral rinse vitamins discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 2. percocet 5-325 mg tablet sig: 1-2 tablets po every 4-6 hours as needed for pain. disp:*50 tablet(s)* refills:*0* 3. enoxaparin 60 mg/0.6 ml syringe sig: one (1) syringe subcutaneous (2 times a day). disp:*30 syringe* refills:*0* discharge disposition: home with service facility: greater vna discharge diagnosis: pelvic mass discharge condition: stable discharge instructions: you may resume your regular diet. please resume your regular home medications. please do not lift anything heavier than 10 pounds for 6 weeks. no intercourse for 4 weeks. you may shower, but not tub baths or swimming for 6 weeks. please call dr. if you have increasing pain, fever, chills, nausea, vomiting, shortness of breath or chest pain. followup instructions: provider: , . phone: . date/time: 11:30 (cardiology clinic) provider: , . phone: date/time: 10:00 (cardiology) provider: , md phone: date/time: 1:30 procedure: venous catheterization, not elsewhere classified other removal of both ovaries and tubes at same operative episode excision or destruction of peritoneal tissue division or crushing of other cranial and peripheral nerves regional lymph node excision suture of laceration of bladder other anterior resection of rectum other and unspecified subtotal abdominal hysterectomy diagnoses: subendocardial infarction, initial episode of care unspecified pleural effusion congestive heart failure, unspecified cardiac complications, not elsewhere classified atrial fibrillation accidental puncture or laceration during a procedure, not elsewhere classified pulmonary collapse removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation other specified hypotension secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes secondary malignant neoplasm of retroperitoneum and peritoneum malignant neoplasm of ovary secondary malignant neoplasm of large intestine and rectum secondary malignant neoplasm of genital organs personal history of malignant neoplasm of bone 

Answer: The patient is high likely exposed to