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Colorectal Cancer Surgery

Nov 12 | 2:30 PM

Colorectal cancer (CRC) is a common illness that affects people all over the world, with the majority of instances happening in western countries. In India, while the prevalence of CRC is lower than in western countries, it is the seventh leading cause of mortality The low incidence of CRC in the developing world is assumed to be due to differences in dietary habits and lifestyles. Join us as Dr. Sharad Desai discusses the line of management for CRC.

[Music] hello everyone good evening i am dr samadhya and i welcome you all on behalf of team netflix uh today we have with us dr shara desai uh who is a surgical oncologist he's the chief surgeon and director madhman gandhi cancer hospital secretary of go karma oncology association and go karma medical trust serve as the past president of indian medical association whereas an ex-secretary of indian association of surgical oncology [Music] secretary of the indian association of surgical oncology and today's topic for us is the current management of colorectal cancer i have designed my talk basically to the general practitioners only so coming to colorectal cancer let me talk about a little about colonic colon anatomy as we all know the colon starts at the ileocecal junction so the colon starts with the cecum first then comes the ascending column the ascending column is a fixed structure it stays in the gutter of the right side of the abdomen the ascending coron goes up till the liver that is at at the point when it is obstructed by the liver the ascending coron suddenly turns from vertical to horizontal this horizontal part is called the transverse colon now transverse colon is a mobile structure and it is intimately wrapped by the momentum most of it so from a fixed structure of the ascending column now the transistor column comes which is a free mobile structure and which ends at the lower border of the spleen where it is called the splenic flexure and then again it descends in the left-sided gutter of the abdomen and that i get part is again a fixed structure so descending colon and the semicolon are fixed structures and the discerning colon goes down up to the left iliac fossa wherein it again becomes a free mobile structure called the sigmoid column the sigmoid colon is called sigmoid because it is cs shaped and it comes in various sizes in various people so in people who have a high fiber diet the sigmoid colon is suppose expected to be a little larger and longer compared to those people who eat purely and non-vegetarian diet the sigmoid colon ends up at the recto sigmoid junction the and then it becomes the rectum the rectum as the name suggests rectum in straight and it is basically a straight structure of course there's a small curve to the left but it can be ignored and rectum is a relatively straight structure it's a relatively fixed structure and it is comparatively a different kind of part of the quran compared to the rest of the color that we will discuss later now coming to the blood supply of the uh colon half of the colon is supplied from the vessels of the supreme centric army and the rest is supplied from the vessels from the inferno centric so the supreme centric graph supplies the cecum the ascending column a major part of the transverse colon and this blood vessels which supply that are the light colic artery a part of the eyelid colic artery and the mid colic artery so these vessels of the supreme centric artery supply the right part of the colon and the proximal part of the column and the rest of it is separate from the branches of the inferior mesenteric artery now i have a reason i don't want to teach you anatomy but i have a reason why i want to tell you that that we must know the anatomical vascular supply of the of the colon because that is very much intimidatingly related to the surgery of the quran the venous supply of course is in two parts one the right side coron which goes which has venous tributaries which end up into the supreme centric vein which later becomes the portal vein or on the left side it becomes the infamous centric vein which ends into the splenic vein again which joins to be the portal the lymphatics are more or less along with the vessels that that is the artery arteries which supply the colon so this again is very important as far as the treatment and the knowledge of colon cancer is concerned now coming to colon cancer it is very it's a very common cancer 10 percent of all cancers worldwide are supposed to be colon cancers the exact uh data worldwide is supposed to be that it has nearly about two to three million uh cancer patients worldwide of which six lakh deaths occur every year because of colorectal cancers so in india we don't have the clear data that is not because our government doesn't collect or government does its best there are the national informatics centers and all that they try to collect the data as much as possible however in india it is very difficult to collect the data and uh as we all know that the data which we get may not be up to the mark so invariably what happens is that we have to extrapolate or try to get a uh kind of ballpark figure of how the number of cancer cases which are there every year in our country so we must be having around two hundred thousand cancer patients every year that is true like cancer is every year however most of our uh data says that it has only about one lakh cancer cases every year this approximately turns out to be about 15 cases per one lakh population so if you have a district of about 20 lakhs so you can expect about 600 cancer patients for that particular district so this is how we calculate on the number of patients which we have and the number of magnitude of the case load which we have in our country so this is a significant case load actually and uh we must all know the causes of colon cancer the risk factors so if we all uh understand what what are risk risk what are the causative factors as you all know there is not a it's not a single uh one point problem there is not there is no single uh only one ecological factor there are multiple ecological factors and some of them are to be blamed significantly the modern foods the modern foods when i mean the modern foods it's all these processed foods the fast foods the refrigerated foods the foods which contain a lot of additives a lot of extracted foods and all many of them contain fertilizers let me tell you they are not poisons all these modern foods are not poisons but then there are kind of new foods which our body human body has not uh has not been used to that so if you uh can say the evolution of the human body has not significantly occurred as the number of modern visual foods which are coming up so what happens is that for the human body this is something kind of a new uh return to the column so when the food comes the end products of the food that is either it is the metabolic products or is the waste products which concentrate into the color they go on irritating the colon the colonic mucosa in the evolutionary history has not seen all these products so what happens is that the colon gets irritated and then the mucosa changes and then at one point it undergoes malignant transformation i would uh not say just plain some they are not poisons but even some things like plain sugars which are not seen in history like we all came from monkeys monkeys never ate sugar monkey is never a pure fat so all these things which actually was used in a combination is now coming pure and direct which when because of our modern constraints where we have got sugar intact like as its fats oils and packets so all these things they are definitely new to the human body and these cause a little irritation and a little new environment to the colonic mucosa which leads to malignant transformation non-vegetarian foods as you all know is always known to be a significant uh positive factor for colon cancer especially the red meat so beef is very harmful for the body and so also is the red meat like mutton and all that the white meat like fish and chicken and all that are relatively less harmful now as evolution has occurred most of our diet has become low fiber diet we are eating pure like something like sugars we are eating like fats which hardly contain any fiber so this is a changing trend in our diet and that is one of the reason why colon cancers are rising all over the world today's uh society is ubiquitous i mean everybody wants to have an apple or orange even a person in this hara desert or a car desert where it doesn't have anything else still wants to have fruits and all that so what happens is the whole system is that we have started to store foods uh prepare things in a different way and this ends up in having uh poor nutrients in our food and especially we have a low vitamin diet so this less vitamin diet also is a cause for malignancies of the gastrointestinal tract i don't have to talk much about smoking and alcohol they are known to be bad for health anytime any day anywhere and all for everything [Music] else in the human body smoking and alcohol have been blamed also also for colon cancer smoking and alcohol have been blamed society present human um a human being has got low physical activity about two century two to three centuries ago the average human used to walk about about 10 to 18 kilometers per day today's human human on an average doesn't even walk totally about four to five kilometers per day so they say that the today's human just hardly works totally on an average not more than two kilometers per day so then the total amount of physical activity in human beings has decreased and this has caused a lot of changes in the git so as you all know that if your physical activity is more so the gi activity is also more if the physical activity goes down the gi activity because down and that the movement of the food decreases so the mucosa of the git gets stimulated and exposed to the irritants and to the substances for a longer period of time so this causes cancers apart from that the genetic causes there are two types familial and non-familial familial uh [Music] and there is a particular group of families who don't have polyposis that is the hereditary non-polyposed colon concept families so there are we we tend to see these families a lot actually i as an oncologist i remember that if a person has come forward i usually try to keep him very comfortable because i am very sure that he brings in the next patients also because there are family qualities in families mainly it is because of the diet but in india most of the communities especially because a lot of congenital marriages and the very small communities are there they try to marry have inter customer inter in intra caste marriages and that leads to a poor genetic pool which causes cancers then of course we all know that olympus that is a familiar adenomatous polyposis especially the leave from any syndrome or the gardener syndromes which are not not very much common in india but still these are known to cause cancers and they are definitely known to cause they keep on causing cancers definitely on the non-familial side i would say that the diabetes and the inflammatory bowel disease for various reasons they tend to cause they are related to the causes of colon cancer now common presentations now when i say common presentations let me tell you some of you people may be senior to me some of them may be very very young to me so basically every disease in the human body keeps on changing with time so colon cancers as we all know what the way they used to present about about few three to four decades ago or a little more ago are not the way the same how they present nowadays when i was a student i remember mainly as masses mainly yes obstruction of the ball and mainly [Music] [Music] once they are investigated for uh building up per rectum uh the either by colonoscopy or imaging then the colonic cancers are usually diagnosed secondly patients who nowadays detect molina and anemia unlike before before the patients did not did uh there was i mean uh they used to ignore them in any anime which was going [Music] [Music] constipation or something [Music] [Music] some patients do present today with mass in the abdomen mostly on the right side on the left side it's little unlikely left side more of obstructive symptoms in the right side more of masses okay answer is again it's disease and some unlucky patients who [Music] follow chronic cancer may present with extension of that that is ascites into the bones so the science clinical science which you see on physical examination we can see anemia we sometimes see the mass in the abdomen the abdomen may be distended because either of gas because of obstruction or may be destroyed because of oscillates some patients show signs of loss of appetite and loss of weight and there are others who show signs of metastasis elsewhere like he may be having a track chair or he may be having the tenderness or the spine you may be having some pluto efficient and all that presently how we we see the pathological features the pathological features nowadays are basically seen as a colon cancer mostly present with as obstructive masses especially on the left side and in the rectum so that what happens is the growth occurs and it goes on constricting the rectum and holds it and the colonic lumen gets obstructed so it basically forms a structure on the right side however the masses are exo-fighting usually the lumen of the cecum and the ascending coron is more spacious and the tumor tends to grow as a polypoid structure like a crawley for flower so this doesn't obstruct second thing on the right side the stool is more liquid and it is not it's solidified and this so this liquid can keep on passing without having any oxygen for significant period of time thus the masses the tumors on the right side tend to grow slowly and for a long time and then they form they tend to form masses while on the left side it's usually form structures colon is only of colony cancer to be at multiple spots at the same time so whenever you investigate a case of colon cancer you must always remember that there can be another can sitting elsewhere in the whole of the problem so it is always better to do a colonoscopy which is the ideal more to investigate [Music] how to describe the magnetologist geometrical shape like it is not circular or square and basic way to describe the disease today modern science is by the dna [Music] was so this was a very simple method of colors classification however as our practice grows how as science grows how information grows we keep on keep on changing the [Music] information what we want so the dnm staging is also a dynamic staging it keeps on changing from error to people and experts from all over so this stage standard all over the you know almost all cancers of the body so the t1 staging is against which is limit any tumor which invades to the limit either into the peritoneum or into the periconic tissues or into the neighboring organs they are described as t4a and t4b the nodal stages again depending has been basically classified as nodes uh depending on the number of nodes from one one node positive to seven more than seven nodes positive so it combines again two groups node n one n one and n two n one is described further into n one a which contains only one node into n one b which contains about two to three nodes and into is described further into four to six nodes and seven plus nodes let us not go into the details of this because this is more specific for oncologist only so here uh is a more descriptive picture of equal representation of the p stages so as you can see the uh t1 stage that the t stage is basically limited to the mucosa t1 is limited to the mucus and submucosa e2 goes into the musculus proper t3 goes into the serosa and t4 goes into the pericular tissue so this is a this is the representation of it of the t stages of the colon cancer so broadly the four stages which have been described this is a very simple classification which i have done for you that is t1 says early stage very curable e1 is limited to the bowel and t3 and t4 little extensive diseases but limited to the bowel there are no nodes in this so stage one and two are stages which are limited to the vowel these are highly terrible the next is the lymph nodes when the nodes are positive without any metastasis this is the stage three this corresponds to the duke's b stage of the previous classifications so stages one two three are basically commonly treated cured by surgery while stage four is metastatic disease where the disease has spread beyond the complaints of the colon and the the particular region so you may need to have additional treatment required for this kind of disease now basically stage is not the only method to describe a disease basic people want to know the patient wants to know what stage it is because he has to take some decisions however the simple staging is not the only method to know the magnitude of the disease or how bad it is when we want to know uh more information on the dc we need to understand its histopathology so these are the problems factors of the of the cancer of the colon is described depending on its better so more nodes are positive but if the size of the node that is become if the disease is extending into dc it becomes bad as far as the t stages i i is concerned as i just described you that the t1 to t4 the larger the disease the more input is the disease this decision is bad grade so in history the pathologist looks upon to the grade of the disease so well differentiated and the uh moderately differentiated really poorly dictated which goes deep into the wall of the colon or sometimes into the neighboring tissues or neighboring organs so this depth of inflation is measured in millimeters or centimeters and this is again a very important prognostic factor for colon cancer now coming to the extent of organ involved so the common organs in the near vicinity of the colon especially are there like the prostate the vagina the uterus and sometimes the urinary bladder high up above we have the duodenum your kidneys and pancreas and all that so but then these are little literally less commonly more so multiple organs involved is a bad for a bad prognostic factor then we have got something called the satellite nodules or the peritomoral deposits what happens is that the malignancy of the colon has got two more cells which separate out from the main mother mother uh group of cells and then it gets separated out and it forms its own colony and it starts surviving separately from the independent of the the previous tumor mass and this can migrate away from the the main mass and it forms a separate nodule and this separate nodule especially when it is described within three centimeters of the main nodule is called a satellite nodule so these satellite nodules when they appear are usually of bad prognosis that suggests that the tumor cells are capable of leaving the mother cells and going elsewhere and surviving so this kind of cells are bad for the patient then again the cells like the lymphovascular invasion and the perineuriation so if the cancer has got a tendency to go along the blood vessels that it goes forms a track or a colony which pierces through the blood vessels and moves or sometimes it tracks around the nerves in the sheath so these are tumors which usually can cause harm to the patient more than those patients which are more than the tumors which are limited to the primary site only now investigations i am not going to give a big description of universities let us go straight to the common industries usually sonography of the abdomen does not give much information especially because it is very often dependent and secondly it cannot be recorded so well so most of the common investigations are done for and evaluating a colon cancer are colonoscopy almost always require ct scan nowadays is available in almost all the small towns of our country and it is the most common uh investigation to give the maximum description of the size of the corner uh the tumor use information about the loads it reduce information in any [Music] [Music] as much as possible we want to cure cancers thoroughly so mri gives a lot of description because the victim as you all know flip planes on the rectum important organs like the ureter the vagina the prostate the seminal vesicles and the urinary bladder are very closely related to the rectum so all these are best defined in the mri so for the victim mri is little better but then a combination of ct scan and mri will always give more and more information pets and getting very popular in our country but however presently breast can should be resolved only for advanced cases for early cases pet scan doesn't have any advantage because the disease profile is not a very metastatic kind of disease serum ca is good serum ca is raised in those patients who have got metastatic disease but again a single ca level does not give much information only serial ca accounts [Music] is on the rising trend then it tends to be important if it is not rising if it is limited to some particular uh [Music] at one particular level then it does it is not very important occasionally some uh innovative investigations as innovative uh some sometimes the cases still keep on getting confused and we want to do some invasive investigations like laparoscopy so lapras will use a little more uh [Music] information of the cancers so i just want to know what is the idea or what goes on in the general practice i mean your brains about what treatment modality is good for colon cancer and which do you feel is the most safe and the most effective therapy surgery radiation chemotherapy or you have got a very realistic attitude and you feel that all are ineffective so please take a pull for this kindly give your opinion yes okay so predominantly everybody believes that surgery is the mainstay of the treatment of colon cancer and truly it is presently it is really so so surgery is basically the uh most commonly used method so treatment is concerned for acne cancers mostly the three three arms of treatment one is just radiation so as we you all uh have just informed me that surgery is the mainstay of treatment of colon cancer right now so in today's world the disease profile what we see the colon cancer is what we see so basically most of them are treated with surgery as a mainstay so now what are the principles of surgery basically surgery as you all know has got two parts one is the resection of the disease and the reconstruction so third important part is surgery is the only method the only modality of therapy it's invasive and it retrieves you a lot of data that is you get a lot of information during surgery so then i would like to now describe surgery as has got three principles one is resect that is remove the disease second is to reconstruct the [Music] defect after the surgery and the third part is you have to get data that is get information because that is the way how we understand the disease so surgery basically has one is the total removal of the tumor that is the primary the tumor with good margins that is margins on both sides of the tumor like of the whether it's the colon or the rectum so on either side we must have adequate colon lumen which is free of disease as far as lymph node is concerned you must understand that the lymph nodes the lymph node drainage is just not linear so what happens is once along the tumor the lymph node basin it goes a little wide it was little more approximately little more distantly and so and you cannot just get away with just plain simple margins you have to do a little wide restriction for colonic cancer because you have to encompass on the lymph node basin so that is why we do like for even a small mass in the cecum even small mass in the hepatic lecture we do a total right hemi collector we don't do just a local wide excision so because we have to take all the lymph nodes and the lymph node basin also the so basically that is the lateral extent of the lymph node accession now it is it is also recommended that we do a uh vertical uh distraction with significant accident so basically we have something called it what is called in today's world called force or the just limited uh along the para along the colon that is the parabolic nodes which was called d1 dissections intermediate nodes between the uh the parabolic nodes and the arbitral nodes were called the intermediate nodes that was called the d2 discussion that was what was followed for a long time and now these 3d sections are basically the apache nodes that is the nodes which come from the right from the apex or the origin of the vessels so for removal of all these nodes is important and this kind of discipline the degree detection and this is the state the cancers after resection to be again have to be resolved astomosis so basically anastomosis is very important because these anaesthetists can be dangerous they look very you know because that they look very simple that is just like uh [Music] a [Music] dangerous surgeries as far as the treatment of quran cancer is concerned all of you must be knowing the right and thomas sometimes these collections are extended the [Music] me alone and then there are two important surgeries for the rectum which are known as the anterior resection and the abdominal pelvic restrictions so the rectum has got a bit or a different kind of surgeries compared to the rest of the formula especially because of its location uh minimal access surgeries basically uh as you all know that today the buzzword is a laparoscopy robotic and everybody is talking about that so in today's world [Music] and the robots are used to aid at the laparoscopic technique there are some advantages with these minimal surgeries the laptop and the robots basically with these new techniques then you have what a scope and which you got long instruments so your reach is better your vision [Music] [Music] to that area and then this group can detect all the uh the structures better so laparoscopy and uh robot have i would say the disadvantage of laparoscopic and the robotic surgeries are that they take time they take a long time and then they are definitely very costly there is no doubt about it would say that it comes cheap is not very true so they it is very difficult to give you the same uh point of service to poorer patients which where in our country 80 to 85 percent of our patients are relatively of the poorer sector becomes concerned have still not been proven but there have been some studies which show that they are not very inferior to the open method now i would like to know because many of you would have heard about laparoscopy robotic open i would like to know if any one of you has emblems of the colon cancer which one of them would you prefer so let us take a poll for this and uh i please vote for all the options open laparoscopic robotic or you all feel that all of the same result which has got the best results some of they cannot have the pole so we have 40 for laparoscopics okay so a good number of people believe laparoscopy is a good technique compared to the open but let me tell you just one thing that open is still the gold standard as far as the restriction is concerned and all the results of laparoscopy or robotic are related to the open so till date open is supposed to be the best for the restriction is concerned and till more data comes we will still hold laparoscopy and robotic with a little pinch of salt but then they are catching up in good centers and in good hands and especially in the early stages laparoscopy or robotic also have good results so now uh coming to any other methods so as you all know we uh we are going to do colonoscopy for most common cancers and when the cancers are little in early stage as when they are relatively small so many of them can be managed with colonoscopy alone so as a limited only to the mucosa so if they are very small they can be functionated and they can be restricted by from the colonoscopy alone especially the lesions in the rectum which is very commonly removed by calculation or sneering through economic so as the modern man advances as technology advances as screening keeps on taking place more and more commonly as surveillance keeps on occurring for many patients so all these patients who are undergo repeated and colonoscopy as a particular procedure so early diseases can be detected and early diseases can be man [Music] colonos so this is the trend which is going to come in the near future and we secondly the endoscopy is very important because we need to get a biopsy without biopsy okay the most one of the most important feature about colonoscopies not done previously was that uh previously for every colonic obstruction or advanced disease we have to do a colostomy which is a little unpleasant but now today's endoscopists are try able to and try to put in a strength and open up the abstraction so this can relieve the obstruction whether it is temporary and then go on for further therapy radiation was not very well known for just about for about two decades ago but now it is coming with full energy and full force so this is mainly showing of right now what happens is like like when i describe the anatomy of the rectum as you know the rectum has got a predictable anatomy and it has got a fixed anatomy in the pelvis and the rectum is does not have any many dangerous right so this can read it with impunity so [Music] [Music] [Music] now what happens is after the resection of the cancer of the rectum [Music] and there was a chance that would be a trophy since the radiation would be going to areas which did not happen and the cancer area would have had uh uh would sometimes miss out from getting radiation therapy so there has been a trend to give pre-operative radiation therapy so previous operating radiation therapy the radiation therapist knows where exactly this is then he radiates exactly to the disease and it's uh in his system so with this idea pre-operative radiation there he was born a study was done with comparatively real produce radiation therapy with post-operative radiation therapy and now the trend has shown that trigger operative radiotherapy is little better than post-operative therapy and of course because of many other factors there is has been a trend to do radiation pre-operatively so this is a change which i would like to inform you people and which is offering in is usually done before surgery because traditionally relation was always given post-operatively but nowadays it is given pre-operatively the other rules of radiation therapy are basically in palliative like when it's advanced and when bleeding keeps on occurring and we cannot do any of surgical techniques so you try to decrease the disease you try to decrease feeling or that radiation therapy can be used the common radiation therapy techniques are the external beam therapy that is the common techniques which are the popular techniques which are used are the imrt that intensity modulated radiation therapy which is a different technique like if you so it is basically a complex technique more or less limit the radiation therapy given to a geographic area of the tumor and the information and you spare all the structures nearby the rapid are or the what they call rapidart technique is a technique wherein the whole it's done a little more faster and a weaker way than imrp and it's more or less the same thing so these are the new techniques of excellent therapy which come with linear accelerators the old machines the cobalt machines have actually been being um two different uh duration courses also now so there is short course therapy and the long course therapy they have got advantages so that i'm not going to detail of that but then there is a tendency for a shortcut and they were doing short quality for a few visits to the radiation center brachytherapy in rectum is still not sure just so much in work in the sense it is a little difficult to pierce the needles and know that but then it is a promising method of threat coming to the chemotherapy is concerned chemotherapy basically the drugs are given especially in the post-operative settings however there are some settings especially like just like radiation therapy in the rectum or in the colon is when there is no obstruction there is areas where chemotherapy is again investigated will be given before surgery that is what we call neurogen therapy so being practicing and whenever the disease is advanced whenever this is metastatic whenever you cannot do any uh great help to the patient so many times chemotherapy has a lot of palliative value so uh i will not go uh much in the details of the chemotherapy gyms only uh forward forward is the main reason for all over colorectal cancer everywhere and a cousin of the same regime are the cat box that is instead of uh five reduce the capacity which is the cousin of a high flow rate so box is a similar regime and then there is the pull fury that is instead [Music] is that nowadays we are we are using drugs which are relatively lesser different and these are drugs so zuma is one of the very popular drug used in quarantine same way newer drugs are coming up also i would have want to have very small colostomy so colostomy is a very unpleasant procedure many people don't like it but of course who want to have this tool it's on the right all the time so unfortunately however many patients are destined to end up with having a prosthetic so basically colon cancer ranges and for that you need to escape our sun in some manner and colostomy tends uh needs to be done for many distance colostomys can be temporary temporarily especially for obstruction of the colon temporary equation you do when you are doing systems surgery for the rectum or the colon and you want to have some safety that you don't have stools in the anaesthetic side so for that again you do a proximal colostomy i mean again emergency sometimes a patient comes in obstructions big complex picture which i'm showing you these are basically the nccm guidance these are the most popular violins in the world these come from the national comprehensive cancer network from the united states and this is how basically how the most of the cancer conditions are taken taking place so in a nutshell i can say that most of the cancer cases require surgery and some of them require may require production in chemotherapy and a good majority of them require only chemotherapy for metastasis so the clinical decision taking again can be said after the opposite addition after getting information on the histopathological uh which is after surgery now till now as we all know in cancers medicine was probably any uh interest rating [Music] [Music] so this can be resected without significant morbidity or morality so you can reset them out so solution after resection give a good amount of cure also now coming to the uh peritoneal disease sometimes what happens is that the colon cancer it has a lot of petrol disease it has got a scientist but there are no metastases in the body not even liver metastases so a lot there are a lot of platelet seedlings all over the colon so these cases have been known to be amenable to aggressive surgery on to the peritoneal cavity so what we do is use some a procedure called hyper ipec is hyperthermic intraoperatively chemotherapy followed by cyto reduction cytoreduction is removable all of that all the disease totally and follow up you what you do is you circulate warm water i mean the water is aligned with chemotherapy so commonly we use either oxygen once we circulate this schema [Music] issues becoming more and more popular nowadays so and finally in the nutshell let me describe about the surgical model we did gain more delivery [Music] [Music] [Music] their life and give them positive life so these patients are very good results more than 90 percent in states one and two but in stages four and uh the royal can be a little bad so it is hardly around 25 4. again colon cancer [Music] and the last point which i want to tell you is about genetics so nowadays a lot of information is coming in the future more and we'll see more of more gene pool stories being taken place people will study the genetics of the [Music] patients get risk and then these patients will become repeated surveillance colonoscopically foreign cancers early and then try to treat them with colonoscopy alone where they may not require for radiation or chemotherapy so it [Music] so with this small talk i would thank you for a patient hearing and i would find netflix also for giving me an opportunity to share my thoughts with all of you friends and it was very nice talking to you i would like to just go through the comments many of them is that you see [Music] the blood is mixed up with the stools or it is uh in the stores but in hemorrhoids usually the patient starts bleeding after [Music] [Music] thank you sir we have quite a few questions in the comments um so one is um if radiation given pre-op operatively how many days we need to wait for the surgery yeah radiation when it is given pre-operatively we tend to uh wait for about usually a month one month to uh one and a half months six weeks so four to six weeks later we tend to plan our surgery so that is a common trend practice now okay so um so dr sheesh is saying wonderful presentation thank you sir thank you dr garcia siddique is also saying pleasantly nicely thank you sir there is one question which says what do you mean temporary colostomy so temporary i mean no specific time duration for the thing so basically it depends finally you see basically we are all doctors and we are not some something like computer engineers or yes we don't really deal with some instruments when the human body is different so once you feel that the human is fit for another surgery and the closure of the colostomy and the distal tract is clear and normal well then you can go ahead and close the colostrum so that can occur even after about three weeks after the primary cost and sometimes which has to be [Music] [Music] endoscopy so on endoscopy there was some angel erosions and in colonoscopy there was an up this ulcer and chronic fissures so for which biopsy is taken so my question is like can it be turned to be a malignant one or what is the next step and in such case so pain abdomen and bloating is still there even after colonoscopy itself and secondly [Music] okay uh [Music] it is basically something like antibiotic therapy which was called as selected like bullets so it goes and chooses the cell and destroys so this targeted therapy is coming coming in a lot with a lot of enthusiasm nowadays however unfortunately not all cancers have the same targets as before so as much as possible time related therapies are being used to destroy the tumor cells so we have a question from doctor vios um any treatment different for sporadic or uh familial crc cases um is there any follow-up recurrence yeah basically once for specific cancers honestly the treatment in sporadic and the family the treatment is not going to change however whenever you are known [Music] so we have a question uh [Music] [Music] [Music] so all these factors come into picture before collecting those and then the treating physician may modify the drugs may increase the tolerance or lessen the drugs thoughts at the genes basically but we keep on going right now there is nothing gene therapy so it is not being done in our country but in future we made uh try to modify the genetics of a human body so that he doesn't get it so this is this so one last question sir uh dr pooja is asking sir if it is fresh blood it's definitely indicate um it is a hemorrhoid yes yeah fresh blood is with the indicator that is mixed blood did that it would be black if the blood is not destroyed then it presents so it doesn't mean that the malinock is only enough for gi t and does not occur so a proximal colon [Music] but then it is a sinister sign and the sign is not good and then you have always investigated has it is kind of diffuse disease that there are very small ulcers and the mucosa is not very good and it gradually fades so this is a way of presentation of infinite politicians that doesn't have a clear geography and working informative so it's little diffuse thank you so much for the wonderful sensation and looking forward for your next session it was a wonderful joining life

BEING ATTENDED BY

Dr. Huzaifa Shaikh & 615 others

SPEAKERS

dr. Sharad Desai

Dr. Sharad Desai

Director, Mahatma Gandhi Cancer Hospital, Miraj

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dr. Sharad Desai

Dr. Sharad Desai

Director, Mahatma Gandhi Cancer Hospital, Mir...

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