COLORECTAL ONCOLOGY · CONDITION GUIDE
Rectal Cancer
Malignancy of the rectum requiring precise surgical excision with total mesorectal excision — often combined with neoadjuvant chemoradiotherapy to optimise oncological and functional outcomes.
ABOUT THIS CONDITION
What is Rectal Cancer?
Rectal cancer is a malignancy arising in the rectum — the final 15 cm of the large intestine. It requires meticulous surgical technique using total mesorectal excision (TME) to remove the tumour with an intact mesorectal envelope and clear circumferential margins. Many patients receive neoadjuvant chemoradiotherapy before surgery to downstage the tumour, improve the prospect of sphincter preservation, and reduce local recurrence. Dr. Tagore Mohan Grandhi performs laparoscopic TME for rectal cancer at Lux Hospitals, Hyderabad, as part of a multidisciplinary oncology team. The surgical approach — anterior resection preserving the sphincter, or abdominoperineal resection requiring a permanent stoma — is determined by tumour level, stage, and sphincter involvement.
SIGNS TO WATCH
Common Symptoms
Symptoms that need attention
WHY IT HAPPENS
Causes & Risk Factors
- Adenomatous polyp progression to invasive cancer
- Previous colorectal cancer or family history of rectal cancer
- Hereditary syndromes — Lynch syndrome, FAP
- Long-standing ulcerative colitis or Crohn’s colitis
- Diet, obesity, smoking, and excess alcohol
- Prior pelvic radiotherapy increasing secondary cancer risk
CLINICAL DETAILS
KeyFacts
Total Mesorectal Excision (TME) for mid and low rectal cancer
Chemoradiotherapy prior to surgery in selected cases
Anterior resection in majority; APR for low tumours
Below 5–8% with TME in experienced centres
Temporary loop ileostomy; permanent only with APR
Available at Lux Hospitals, Hitech City, Hyderabad
HOW WE TREAT IT
Treatment Approach
Total Mesorectal Excision (TME)
TME is the gold-standard oncological technique for rectal cancer, removing the rectum with its entire mesorectal envelope intact in the correct embryological tissue plane. This maximises lymph node clearance and reduces local recurrence to below 5–8%. Dr. Grandhi performs laparoscopic TME with careful nerve preservation to protect bladder and sexual function.
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Staging & MDT Assessment
MRI pelvis and CT thorax/abdomen stage the tumour and assess mesorectal fascia involvement. The multidisciplinary team determines whether neoadjuvant chemoradiotherapy is required prior to surgery.
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Neoadjuvant Therapy (if indicated)
Short-course radiotherapy or long-course chemoradiotherapy is administered pre-operatively for T3/T4 or node-positive disease, followed by restaging MRI to assess response before surgical planning.
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Laparoscopic TME
Total mesorectal excision is performed laparoscopically with autonomic nerve preservation. Anterior resection with colorectal or coloanal anastomosis is performed for sphincter-preserving cases. APR is performed for very low tumours.
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Recovery & Oncological Follow-up
Enhanced recovery with temporary ileostomy reversal at 8–12 weeks. Adjuvant chemotherapy as determined by MDT. Surveillance CT and MRI at regular intervals monitor for recurrence.
AVAILABLE TREATMENTS
TreatmentOptions
Total Mesorectal Excision (TME)
Gold-standard oncological excision of the rectum with intact mesorectal envelope, performed laparoscopically for mid and low rectal cancer.
Anterior Resection
Sphincter-preserving resection of the rectum with primary colorectal or coloanal anastomosis for tumours where adequate distal clearance is achievable.
Abdominoperineal Resection (APR)
Combined abdominal and perineal excision of the rectum and anus with permanent end colostomy, for very low rectal cancers where sphincter preservation is not oncologically safe.
Ileostomy
Temporary defunctioning loop ileostomy to protect a low colorectal anastomosis, typically reversed at 8–12 weeks after confirmation of anastomotic integrity.
COMMON QUESTIONS
Frequently Asked Questions
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