by Sachin Murdeshwar

Mumbai: A team led by Dr Imran Shaikh, Consultant Surgical Gastroenterology, HPB Surgery & GI Oncosurgery, Wockhardt Hospital, Mira Road gave a fresh lease of life to a 48-year-old woman with cancer of rectum reaching till anal canal (cancer of stool passing opening). She underwent abdominal perineal resection with a permanent colostomy, recovered, and was discharged after 6 days. The outcome of cancer treatment that is initiated will hamper if it is delayed or postponed.

 48-year-old Neha Kumar (name changed), a resident of Malad, who is homemaker was jolted out of her normal life owing to sudden abdominal pain, fatigue, and painful bowel movements. The patient-initiated treatment at a hospital located in Mira road, wherein she underwent endoscopy and biopsy that revealed that the patient suffered from rectal cancer. She advised for a CT scan for the staging of disease and found locally involving the muscle that controls our motions (called anal sphincter). The patient was planned for Neoadjuvant Short course Radiation (five days of radiation given just before surgery) followed by Surgery that was an ideal treatment for the patient.

Later, she got admitted to another hospital for the Radiation course which supposed to finish in one week. Unfortunately, due to the corona crises, she couldn’t receive treatment for 3 weeks, and finally after 4 weeks of delay, she could complete the treatment. Ideally, the patient should have undergone surgery within two weeks from the date of completion of Radiation but her treatment got delayed. However, the patient visited Wockhardt hospital and met Dr Imran Shaikh, who helped her get back on track.

Dr Imran Shaikh, Consultant Surgical Gastroenterology, HPB Surgery & GI Oncosurgery, Wockhardt Hospital, Mira Road, evaluated her got few tests before surgery including COVID 19 test. Due to radiation she had pain and discharge per rectum.  The patient suffered from rectal cancer and its common to involve proximal rectum. Though the involvement of lower rectum specially involving anal sphincter is rare.  Rectal cancer is malignant (cancerous) tissue that tends to grow in the wall of the rectum. And it had reached till anal canal (cancer of stool passing opening).  Most of these cancers have no exact cause. 

The patient encountered issues such as delayed initiation of radiation and she came exactly at two-week, post-radiation. That means it is an emergency as surgery can’t be delayed further. The reason for operating not later than two weeks are many. The local area becomes very tough (fibrosis) that it becomes impossible to operate after two weeks. Radiation was a short course so its low dose than normal and waiting longer would lead to the spread of cancer.  Also, after such time radiation loses its benefit. She was refused treatment at other hospitals due to the ongoing Corona pandemic. Dr Imran counseled the patient and her family members and admitted her.

Dr Imran said, “The patient underwent abdominal perineal resection (APR) with permanent colostomy in April 2020. It removes the distal colon, rectum, and anal sphincter complex using both anterior abdominal and perineal incisions, resulting in a permanent colostomy. Also, the lower end of the colon was brought outside the body through the skin on the abdomen and this can be termed as colostomy. Since, the rectum and anus will be removed, a new place for the stool to leave the body.”

 Dr Imran added, “Space will be closed by sutures, and the patient was instructed on how you sit, lie down, and do other activities. The end of the colon on the outside of the abdomen is called a stoma. After the surgery, the stool will leave the body from the stoma. The patient was suggested to wear a colostomy pouch over the stoma. This pouch will collect the stool. Surgery was lasted for 4 hours and had minimal blood loss. She recovered and was discharged after 6 days. Fortunately, her final pathology report showed that it was a stage I cancer and no further treatment needed.”

“I would find it difficult to do my daily chores, so I have modified my daily schedule. But I am very happy that even after the corona crisis and delay in starting my initial treatment, my cancer is in the First stage and I am now free of cancer. Also, I am very happy that no further treatments like chemotherapy needed. I would like to thank the doctors at Wockhardt Hospital who saved my life without delaying the treatment. Once this course of treatment is started then don’t break the chain at any cost,” said patient Neha Kumar.