Question 1

Many doctors at a first or second-level hospital see colorectal cancer patients they cannot treat, and even the most advanced hospital available to them locally cannot treat these cases either. What should a doctor in this position do?

Dr. Kaushal Kishore Yadav · Accepted Answer

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.

Question 2

Confirmed that no CT scan is available for him to order at his level-one facility. What workup can still be done in that situation?

Dr. Kaushal Kishore Yadav · Accepted Answer

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.

Question 3

Shared what is available at his own facility: a fecal occult (or immunochemical) blood test can be sent as a general surgeon at his primary or general hospital, but what happens beyond that?

Dr. Kaushal Kishore Yadav · Accepted Answer

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.

Question 4

Asked whether sphincter-preserving surgery (intersphincteric resection) can really be done even for a distal rectal cancer, one lying very low in the rectum.

Dr. Kaushal Kishore Yadav · Accepted Answer

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.

Question 5

Followed up: in a setup where frozen section pathology is not available, how can a surgeon be confident of a clear margin, and how should the patient be followed afterward?

Dr. Kaushal Kishore Yadav · Accepted Answer

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.

Question 6

Working in a region with very limited healthcare infrastructure, asked what to do when none of the described tests (MRI, CT, PET-CT, tumour markers) are available locally.

Dr. Kaushal Kishore Yadav · Accepted Answer

Do whatever is genuinely achievable under your own control. If something cannot be done locally, it is better to refer the patient to a centre where it can be done with precision, because cancer gives only one real chance to get the treatment pathway right.

Question 7

Asked Dr. Yadav to clarify the name of the surgical technique he had just described for colon cancer.

Dr. Kaushal Kishore Yadav · Accepted Answer

It is called complete mesocolic excision with central vascular ligation, sometimes shortened to CME with CVL. The feeding blood vessels of the tumour are ligated right at their origin so that all the draining lymph nodes and the complete mesocolic fascia are removed together; this has been published in international journals and is associated with better survival than the standard technique.

Question 8

Relayed a case: a patient with sigmoid colon cancer who has liver metastases only. How should a case like this be managed?

Dr. Kaushal Kishore Yadav · Accepted Answer

If the liver metastases are limited, roughly one to three, and can be completely removed, liver metastasectomy can be done at the time of the primary surgery or as a second stage. If the liver is diffusely involved in both lobes, there is no role for curative surgery and only palliative chemotherapy is appropriate. If instead there is peritoneal-only spread with no other site involved, cytoreductive surgery combined with HIPEC gives a survival advantage of about fifty percent in colorectal cancer, provided the disease is limited and combined with chemotherapy before and after.

Question 9

Explained what an online OPD is, for doctors wanting to bring a relevant patient to Dr. Yadav.

Dr. Kaushal Kishore Yadav · Accepted Answer

When a Jivo doctor partner has a relevant patient, they collect the case details and share the information with the Jivo team in advance. The patient is invited to the partner doctor's own clinic, where Dr. Yadav then joins the consultation by video call, so the consultation is guided jointly by doctors in both India and Africa.

Question 10

Relayed a French-speaking participant's request: will the session recording and presentation be shared afterward?

Dr. Kaushal Kishore Yadav · Accepted Answer

Yes. The webinar recording link will be shared with participants, and Dr. Yadav's presentation, in English, will also be shared.

Diagnosis and Management of Rectum Cancer

Questions Doctors Asked Dr. Kaushal Kishore Yadav