Use Bailey and Love Short Practice of Surgery 28th Edition, Sabiston Textbook of Surgery 21st Edition, and Shwartz's Principles of Surgery 11th Edition and discuss the following patient's diagnosis: Stage IV Metastatic Sigmoid Colorectal Adenocarcinoma secondary to normocytic anaemia and reactive thrombocytosis, complicated by localised tumour perforation with intrapelvic abscess, liver metastasis, extensive retroperitoneal matted lymphadenopathy and indeterminate lung nodules. Highly specific serum tumour markers CEA levels >20-50 ng/mL are strongly indicative of distant metastatic colorectal cancer. A level of 245 ng/mL effectively excludes benign diverticulitis as the primary etiology. Co-elevation of CA 19-9 alongside a markedly high CEA occurs in roughly 1.3rd of advanced Stage IV colorectal cancers, particularly when liver metastases / extensive nodal burden are present. Normal AFP and PSA rules out primary hepatocellular carcinoma as the cause of the liver lesion and excludes primary prostate adenocarcinoma driving the retroperitoneal lymphadenopathy. Clinical history and physical findings 10 kg weight loss over 2 months, significant anorexia, and chronic ill appearance. Lower GI symptoms including increased frequency, watery stools containing mucus and blood, faecal urgency, incontinence, and tenesmus directly map to a left-sided/sigmoid rectosigmoid neoplasm. Right lower quadrant / suprapubic pain with localised guarding and tenderness points to localised peritoneal inflammation secondary to micro-perforation of the sigmoid tumour into the pelvis. Palmar and conjunctival pallor consistent with documented anaemia. Radiological evidence Primary site: Sigmoid circumferential bowel thickening with surrounding reactive changes and an adjacent intrapelvic collection indicates an ulcerated / perforated sigmoid adenocarcinoma with localised micro-abscess formation. Distant metastases: Segment IV irregular hypodense lesion (classic appearance of a colorectal liver metastasis) Multiple enlarged, matted paraarotic and aortocaval nodes encasing the aorta and partial inferior vena cava, directly causing extrinsic compression of the right ureter and resultant mild right hydronephrosis. Indeterminate lung nodules requiring further evaluation for pulmonary metastatic spread Laboratory and inflammatory profile Progressive normocytic anaemia without coagulopathy Persistent leukocytosis, marked reactive thrombocytosis, elevated CRP and hypoalbuminaemia Mild hyponatraemia secondary to chronic fluid loss / diarrhoea and systemic inflammatory state This is his HOPI and PE summary: Mr. Muhammad Fauzi, a 58-year-old male with a significant medical history including myocardial infarction, hyperlipidemia, hypertension, acute decompensated heart failure (EF <30%), and diabetes mellitus, presented with a two-month history of burning epigastric and suprapubic pain. This pain, rated 8/10 and relieved by sitting, radiates to the flanks and back. He also reported a significant 10 kg weight loss, decreased appetite, and altered bowel habits characterized by increased frequency, watery stools containing mucus and blood, fecal urgency, incontinence, and incomplete evacuation. On physical examination, the patient appeared ill-looking and obese, with intermittent signs of distress. Observations included palmar pallor and cold hands with a capillary refill time of less than 2 seconds. Vital signs at the time of clerking were a blood pressure of 119/72 mmHg, pulse rate of 69 bpm, respiratory rate of 19 breaths/min, and SpO2 of 100%. Abdominal examination revealed a fatty abdomen with right lower quadrant tenderness and guarding, while bowel sounds were noted in the right iliac fossa. A per rectal examination found a rubbery, bilobed, and symmetrical prostate. Cardiovascular assessment showed an apical impulse displaced laterally and inferiorly to the 6th intercostal space, the presence of a third heart sound, and a soft pansystolic murmur radiating to the axilla. Make the discussion in a paragraph format and more clinical and to this patient-based. Also include subheadings. Also include proposed investigations, and expected management as well.