Referring a Colorectal Cancer Patient for Treatment in India

Nothing stops a doctor from referring the complex case to an Indian oncologist in parallel, so the patient has a second treatment pathway. Many patients from African countries who present to India face the same underlying problem: the evaluation, diagnosis and route to treatment usually takes a long time in the home country, and by the time they present to us the disease is already at an advanced stage, sometimes stage four with limited options.

For a patient with a change in bowel habit and an otherwise unexplained low haemoglobin level, send a colonoscopy first. Do a colonoscopy and CT scan whenever there is real suspicion, and don't delay. Even at a primary level, a fecal occult blood test can be done; it is not very specific and may miss some cases, but it can still help.

That test is the only early reading that can be done at that level; genetic-level investigation is not available in that setup. For colonoscopy, the patient has to go to a tertiary hospital and bring the results back. At least the fecal occult blood test is available, and even though it is not very specific, it can help catch some cases.

Yes. Rectal cancer spreads upward along its natural embryological lymphatic supply rather than downward, so staying strictly within that anatomical plane allows the tumour to be removed completely, following guidelines that show even a minimal distal margin of one centimetre is adequate. An intraoperative frozen section can confirm all microscopic cancer cells have been cleared, and this makes it possible to go between the internal and external anal sphincter even for the lowest-lying tumours, preserving a normal passage instead of requiring a permanent stoma.

Follow the natural avascular surgical plane, doing sharp dissection between the internal and external sphincter. On gross examination, aim for about one centimetre of margin at the lowest extent of the tumour, or three to five centimetres higher up depending on where the tumour is located. Stay within the correct surgical plane and the margin should come back clear; the final histopathology report, once it arrives, confirms this.

As early as possible: complex cases can be referred in parallel to an Indian oncologist for a second treatment pathway rather than waiting until every local option is exhausted, since delayed referral often means the disease has advanced by the time the patient is seen.

Do whatever is genuinely achievable locally, and refer early for anything that isn't, since cancer allows only one real chance to get the treatment pathway right.

A process where a partner doctor collects a patient's case details, shares them with the Jivo team in advance, and then joins a video consultation from their own clinic alongside the patient, so guidance comes jointly from doctors in India and Africa.