{
  "schema": "fcai-oneview",
  "schemaVersion": "0.1",
  "builtOn": "HL7 mCODE (structure)",
  "meta": {
    "version": "1.1",
    "asOfDate": "2026-10-21",
    "nextReview": "after the November CT",
    "mode": "public"
  },
  "disease": {
    "cancerType": "Colorectal adenocarcinoma, moderately differentiated",
    "primarySite": "Rectosigmoid colon",
    "diagnosisYear": 2021,
    "tnm": {
      "t": "ypT4a",
      "n": "ypN1b",
      "m": "M1a",
      "type": "pathological (post-neoadjuvant)",
      "notes": "3/24 nodes; V+"
    },
    "stageGroup": "IV",
    "sitesOfDisease": [
      {
        "site": "Lungs (left perihilar, right lower lobe, nodules)",
        "dateFound": "2023-02"
      },
      {
        "site": "Mediastinal lymph nodes",
        "dateFound": "2024-11"
      },
      {
        "site": "Liver segment VII",
        "dateFound": "2026-07-23"
      }
    ],
    "provenance": "Clinician letter 2026-05-18; Imaging report 2026-07-23"
  },
  "genomics": {
    "source": "Exacta, 2025-09-01",
    "variants": [
      {
        "gene": "APC",
        "hgvs": "c.4245del p.S1415Rfs*4",
        "vafTissue": 8.5,
        "vafBlood": 0.62,
        "class": "pathogenic"
      },
      {
        "gene": "TP53",
        "hgvs": "c.1024C>T p.R342*",
        "vafTissue": 9.21,
        "class": "pathogenic"
      }
    ],
    "standardMarkers": [
      {
        "marker": "KRAS",
        "result": "wild-type"
      },
      {
        "marker": "NRAS",
        "result": "wild-type"
      },
      {
        "marker": "BRAF",
        "result": "wild-type"
      },
      {
        "marker": "MMR/MSI",
        "result": "pMMR / MSS"
      },
      {
        "marker": "HER2",
        "result": "not amplified"
      },
      {
        "marker": "TMB",
        "result": "3 Mut/Mb (low)"
      },
      {
        "marker": "PD-L1",
        "result": "<1%"
      }
    ],
    "vus": [
      "RUNX1T1",
      "FANCM",
      "CIC",
      "BCR",
      "CYP2D6"
    ],
    "exploratory": {
      "source": "Astron, 2025-09-10",
      "icc": [
        "mTOR positive",
        "VEGFR1/2 positive",
        "HMGB1 overexpressed"
      ]
    }
  },
  "tumourMarkers": [
    {
      "name": "CEA",
      "unit": "ug/L",
      "referenceRange": "0-4.9",
      "date": "2026-04-20",
      "value": 16.8
    },
    {
      "name": "CEA",
      "unit": "ug/L",
      "referenceRange": "0-5.2",
      "date": "2026-07-23",
      "value": 49.4
    },
    {
      "name": "CEA",
      "unit": "ug/L",
      "referenceRange": "0-5.2",
      "date": "2026-08-07",
      "value": 87.6
    },
    {
      "name": "CEA",
      "unit": "ug/L",
      "referenceRange": "0-5.2",
      "date": "2026-09-01",
      "value": 146.0
    },
    {
      "name": "CEA",
      "unit": "ug/L",
      "referenceRange": "0-5.2",
      "date": "2026-09-14",
      "value": 50.9
    },
    {
      "name": "CEA",
      "unit": "ug/L",
      "referenceRange": "0-5.2",
      "date": "2026-09-29",
      "value": 44.6
    },
    {
      "name": "CEA",
      "unit": "ug/L",
      "referenceRange": "0-5.2",
      "date": "2026-10-12",
      "value": 47.3
    }
  ],
  "healthAssessment": {
    "performanceStatus": {
      "scale": "WHO",
      "value": 0,
      "date": "2026-08-24"
    },
    "otherConditions": [
      "Smouldering myeloma (surveillance)",
      "Gilbert's syndrome",
      "Persistent cough (2026-08)"
    ],
    "allergies": [
      "No known drug allergies"
    ]
  },
  "treatmentLines": [
    {
      "label": "Neoadjuvant",
      "regimen": "XELOX",
      "cycles": 4,
      "start": "2021-12",
      "stop": "2022-02",
      "bestResponse": "good partial response"
    },
    {
      "label": "Surgery",
      "regimen": "High anterior resection",
      "start": "2022-03-28"
    },
    {
      "label": "Surgery",
      "regimen": "Liver 4b/5 resection R0 + cholecystectomy",
      "start": "2022-06-30"
    },
    {
      "label": "Peri-operative",
      "regimen": "XELOX",
      "cycles": 4,
      "start": "2022-05",
      "stop": "2022-10",
      "notes": "1 stopped for liver progression; 3 adjuvant"
    },
    {
      "label": "Radiotherapy",
      "regimen": "SABR 55 Gy/5 to lung",
      "start": "2023-04"
    },
    {
      "label": "Ablation",
      "regimen": "Percutaneous lung ablation, 6 lesions",
      "start": "2024-06",
      "stop": "2024-08"
    },
    {
      "label": "Line 1",
      "regimen": "FOLFIRI + cetuximab",
      "cycles": 6,
      "start": "2025-04",
      "stop": "2025-07",
      "bestResponse": "good partial response"
    },
    {
      "label": "Line 1 rechallenge",
      "regimen": "FOLFIRI + cetuximab",
      "cycles": 6,
      "start": "2026-02",
      "stop": "2026-05",
      "bestResponse": "good response (CT 2026-05-12)"
    },
    {
      "label": "Line 1 rechallenge, block 3",
      "regimen": "FOLFIRI + cetuximab",
      "start": "2026-08-19",
      "stop": null,
      "cyclesGiven": 4,
      "nextCycle": "2026-10-14"
    }
  ],
  "latestImaging": {
    "date": "2026-07-23",
    "summary": "Progression in chest; new liver segment VII lesion. CT the week of 2 November, results 9 or 10 November."
  },
  "latestBloods": {
    "date": "2026-10-12",
    "flags": [
      "ALP 190 U/L HIGH",
      "Hb 129 g/L LOW",
      "RBC 4.13 LOW",
      "RDW 15.2 % HIGH"
    ],
    "inRange": "platelets 290 · WBC 9.79 · neutrophils 6.84 · bilirubin 14 · ALT 30 · AST 39 · GGT 28 · albumin 44 · Mg 0.86 · K 4.0 · creatinine 72 · eGFR >90",
    "note": "29 Sep platelets confirmed at 280."
  },
  "openQuestions": [
    "Is now the time to treat the liver lesion: surgery or ablation?",
    "If responding, continue or step down (e.g. drop irinotecan)?",
    "What comes next after this line?"
  ],
  "_notes": {
    "whatThisIs": "FC:AI One View — the short, structured summary. The fuller record, with every blood panel, the chemo log and the sequencing manifest, is at fcancerwith.ai/full-record.",
    "notMedicalAdvice": "Patient-maintained. Verify against source records before acting on anything here.",
    "privacy": "Deliberately carries no date of birth, address, phone, NHS number, hospital or lab reference numbers, or care team names."
  }
}