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Laboratory Trends
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Hepatic Function

Liver enzymes — ALT/AST/GGT/ALP elevated during chemotherapy treatments

FOLFOX (oxaliplatin): marked transaminitis during cycles 3–4, with peak AST 311 U/L and ALT 278 U/L; spontaneous normalisation followed cycle completion (2025-03-03). ALP and GGT remained persistently elevated throughout FOLFOX — pattern consistent with sinusoidal obstruction syndrome. No hepatic parenchymal lesions on MRI 2026-02-12. FOLFIRI (irinotecan): transaminitis has persisted with cycling elevation pattern. As of 2026-03-23 (post-cycle 5): AST 74 U/L, ALT 132 U/L, GGT 136 U/L. ALP shows a sustained downward trend (peak 223 during FOLFIRI; 175 U/L at latest draw), the strongest positive hepatic signal. LDH is within normal range but trending upward (149 → 184 U/L over FOLFIRI course); to be monitored.
Complete Blood Count — Red Cell Series

Haemoglobin, haematocrit, erythrocyte indices, platelets — anaemia monitoring; Hb nadir relevant to surgical planning

Haemoglobin has remained stable and within normal limits throughout both chemotherapy courses (most recent 14.4 g/dL, 2026-03-23), with no clinically significant anaemia. RDW has been intermittently flagged HIGH, reflecting minor red cell size variability without evidence of macrocytosis or iron-deficiency pattern. Platelet count has remained within normal range.
Complete Blood Count — White Cell Series

WBC and differential percentages — chemotherapy myelosuppression and immune monitoring

Lymphocytes have been borderline low (most recent 19.9%, 2026-03-23), consistent with irinotecan-associated lymphopenia. No neutropenia has been documented. WBC total count has remained within normal limits throughout treatment.
Tumour Markers

CEA and CA 19-9 — oncological surveillance pre/post surgery and during chemotherapy

CA 19-9 was elevated at 72 U/mL on emergency presentation (2024-05-14) and normalised within weeks of surgical resection. It has remained within normal limits throughout the chemotherapy courses, with the most recent value of 13 U/mL (2026-03-23). CEA has shown low-level elevation in recent cycles: 0.53 (2026-01-12), 0.60 (2026-01-26), a below-detection value of ≤0.50 on 2026-02-10 coinciding with apparent complete metabolic response on PET/CT, then 0.60 (HIGH) on 2026-03-23 — likely reflecting residual peritoneal disease and irinotecan-associated hepatocyte stress rather than a definitive progression signal. Pre-treatment CEA baseline (2024-05-14) was not measured at initial emergency presentation; the earliest available value is 0.53 U/mL (2026-01-12).
Inflammatory Markers

CRP, ESR (acute phase), albumin (nutritional reserve) — relevant to HIPEC candidacy assessment

CRP has remained elevated throughout active treatment (range 2.20–3.10 mg/L over FOLFIRI cycles), consistent with ongoing peritoneal inflammation and post-cycle cytokine response. The most recent value of 3.06 mg/L (2026-03-23) represents an uptick from the cycle-5 nadir of 2.20 mg/L — consistent with cycle-driven fluctuation rather than a new inflammatory process. Albumin has remained stable. ESR data are available from select draws only.
Lipid Panel

Cholesterol fractions and triglycerides — cardiovascular risk baseline

Historical lipid data is sparse (four pre-treatment draws 2021–2024) with a single on-treatment draw on 2026-04-16: Total Cholesterol 221 mg/dL (HIGH), LDL 144 mg/dL (HIGH), HDL 52 mg/dL, Triglycerides 126 mg/dL. LDL has been persistently elevated across all draws since 2021. Pattern consistent with familial hypercholesterolaemia or dietary contribution rather than treatment effect.
Iron Studies

Ferritin, serum iron, transferrin saturation — iron-deficiency and acute-phase tracking

Pre-diagnosis ferritin was profoundly depleted (1.2 ng/mL, 2023-08-21), consistent with occult GI blood loss from the undiagnosed cecal tumour. Ferritin spiked to 561 ng/mL post-surgery (2024-05-29), reflecting acute-phase response. Most recent draw (2026-04-16): ferritin 36.9 ng/mL (low-normal), serum iron 65 µg/dL (bottom of range), transferrin saturation 18% (LOW). Pattern consistent with chronic disease anaemia on chemotherapy.
Vitamin D

25-hydroxyvitamin D — nutritional reserve, relevant to HIPEC candidacy

Vitamin D has dropped from 31.2 ng/mL (2020-06-09) to 15.7 ng/mL (2026-04-16, INSUFFICIENT). Levels below 20 ng/mL are associated with impaired immune function, bone metabolism disruption, and worse outcomes in colorectal cancer. Supplementation warranted.