In this lockdown time when everyone avoiding going out specially to hospitals. But some diseases really can not wait. Rectal cancer is one such disease where multimodality treatment is needed.
Patient is 48 years female, diagnosed case of Cancer of rectum reaching till anal canal ( cancer of stool passing opening). She was taking treatment in other hospital. She had underwent endoscopy from below and biopsy was taken to confirm. She also underwent CT scan for staging of disease and found locally involving muscle which control our motions ( called anal sphincter). Patient was planned for Neoadjuvant Short course Radiation ( five days of radiation given just before surgery ) followed by Surgery. This is ideal treatment for patient. Patient got admitted to another hospital for Radiation course which suppose to finish in one week. But unfortunately due to corona crises she couldn’t receive treatment for 3 weeks and finally after 4 weeks delay she could complete the treatment. Ideally patient should undergo Surgery within two weeks from date of completion of Radiation but primary hospital was shut down due to Covid crisis. Now patient has come to Wockhartd hospitals and met Dr Imran Shaikh ( Consultants GI Oncosurgery). She had two issues as first she delayed her starting of Radiation and second she has come exactly at two weeks post radiation. That means this is kind of emergency as we can’t delay surgery further because after two weeks of radiation local area become very tough ( fibrosis ) that it becomes impossible to operate. Both of her problems were because of covid pandemic.
Dr Imran immediately counsel the patient and relatives and admitted. Next day itself patient underwent Abdominal perineal resection with permanent colostomy. Patient recovered uneventfully and discharged after 6 days. Fortunately her final pathology report says it’s stage I Cancer and no further treatment needed.
It is important to highlight here that many cancer patients are going in scheduled treatment course like here Radiation followed Surgery. Few patients may need Surgery followed by Chemotherapy +/- Radiation or Chemotadiation followed by Surgery. So once these course of treatment started then we can’t or rather should not break the chain at any cost. Outcome of treatment will definitely hamper if we delay or postpone schedule which is already started.