Female 59 years old with pelvic spread of colorectal cancer with invasion of bladder in area of trigone seen intraoperatively. Please evaluate extent of disease for consideration of pelvic radiation therapy. Overall image quality: GoodPELVIS:UTERUS, ADNEXA: The uterus and ovaries are surgically absent. BLADDER: The bladder is incompletely distended. There is an poorly defined 1.5 x 1.0 cm (series 1201, image 37) enhancing soft tissue mass along the right aspect of the vaginal cuff and bladder trigone which has decreased in size since the CT in March 2016 but remains stable when compared to the CT from September 2016. LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: NoneLymph nodes outside the mesorectal fascia: 1.0 x 0.8 cm left internal iliac lymph node measured 1.1 x 1.1 cm on the most recent prior CT.BOWEL, MESENTERY: Status post right hemicolectomy.Rectal Tumor: N/ABONES, SOFT TISSUES: An irregular, enhancing lesion along the right pelvic sidewall measures 1.9 x 1.3 cm (series 1104, image 409) is suspicious for residual or partially treated disease versus postsurgical change. The lesion involves the adjacent right acetabular wall which appears slightly eroded.OTHER: No significant abnormality noted.
1.A small foci of abnormal soft tissue enhancement in the right pelvis involving the bladder trigone and vaginal cuff and and additional focus along the right pelvic sidewall are suspicious for residual or partially treated disease versus postsurgical change.2.Left internal iliac lymph node has decreased in size. There is no new lymphadenopathy.INDEX LESION MEASUREMENTS (Current exam date/time: 11/18/2016 17:30:00)LEFT INTERNAL ILIAC LYMPH NODE: 1.0 x 0.8 cm (Image 48, Series 501); 1.0 x 1.0 cm on prior (9/3/2016) (Image 122, Series 3).BLADDER TRIGONE MASS: 1.5 x 1.0 cm (Image 37, Series 1201).RIGHT PELVIC SIDE WALL MASS: 1.9 x 1.3 cm (Image 409, Series 1104).