Apollo Rectal Cancer (ARC) Programme: A New Era in Rectal Cancer Surgery

Introduction

Apollo Rectal Cancer (ARC) Programme at the Apollo Proton Cancer Centre is the dedicated programme aimed at revolutionizing the management of rectal cancer care in India. With a focus on single organ cancer, our mission is to deliver unparalleled outcomes for patients battling rectal cancer by Apollo’s excellence in colorectal surgery. ARC is headed by Professor Venkatesh Munikrishnan, an eminent robotic rectal cancer surgeon along with his distinguished team of doctors, Dr Sudeepta Kumar Swain, Dr Senthil Kumar Ganapathi, and Dr Bala Murugan. ARC programme offers cutting-edge treatments with world-class outcomes. Prof. Munikrishnan and his team have performed the highest volume robotic colorectal cancer procedures in the country, achieving remarkable success rates. Additionally, they have pioneered the world’s most cost- efficient robotic rectal cancer resection technique, ensuring accessibility to top-tier surgical care for patients from all walks of life.

Understanding the Disease Burden

Rectal cancer poses a significant healthcare challenge in India, with steadily rising incidence rates and high mortality rates attributed to late diagnosis and advanced stages of presentation. With approximately 40,000 new rectal cancer cases annually and a projected 80% increase in the next decade, there’s an urgent need for comprehensive and specialized care to combat this disease.

Symptoms of Rectal Cancer

Recognizing the signs and symptoms of rectal cancer is crucial for early detection and timely intervention. Common symptoms include:

• Persistent changes in bowel habits, such as diarrhea, constipation, or narrowing of stools
• Blood in the stool or rectal bleeding
• Abdominal discomfort, cramps, or pain
• Unexplained weight loss
• Fatigue or weakness
• Feeling of incomplete bowel evacuation
• Rectal pain or discomfort
• Anemia (low red blood cell count) due to chronic bleeding

Risk Factors for Rectal Cancer

Understanding the risk factors associated with rectal cancer can help individuals make informed decisions about their health. Common risk factors include:

• Age: Rectal cancer incidence increases with age, particularly after 50.
• Personal or family history of colorectal cancer or polyps
• Inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis
• Genetic syndromes such as Lynch syndrome or familial adenomatous polyposis (FAP)
• Lifestyle factors, including a diet high in red or processed meats, low in fiber, lack of physical activity, obesity, smoking, and heavy alcohol consumption

While these factors may increase the risk of developing rectal cancer, it’s important to note that many cases occur in individuals with no identifiable risk factors. Regular screening

Tests for Rectal Cancer

Diagnosing rectal cancer typically involves a combination of medical history review, physical examination, and diagnostic tests, including:

• Digital rectal examination (DRE): A healthcare provider examines the rectum using a lubricated, gloved finger to detect abnormalities.
• Colonoscopy: A procedure that allows visualization of the entire colon and rectum using a flexible tube with a camera.
• Flexible sigmoidoscopy: Similar to colonoscopy but focuses on examining the lower part of the colon and rectum.
• Imaging tests: CT scan, MRI, PET scan, or ultrasound may be used to evaluate the extent of the cancer and determine if it has spread to nearby structures or distant organs.
• Biopsy: Tissue samples may be collected during a colonoscopy or sigmoidoscopy for pathological examination to confirm the diagnosis of rectal cancer.

Early detection through screening tests can significantly improve treatment outcomes and survival rates for individuals with rectal cancer.

Treatment of Rectal Cancer

The treatment approach for rectal cancer depends on various factors, including the stage of the disease, overall health, and personal preferences. Treatment modalities may include:

• Surgery: The primary treatment for early-stage rectal cancer involves surgical removal of the tumor and surrounding tissues. Options may include local excision, transanal resection, or more extensive procedures such as low anterior resection or abdominoperineal resection.
• Chemotherapy: Systemic chemotherapy may be used before or after surgery to shrink tumors, reduce the risk of recurrence, or treat metastatic disease.
• Radiation therapy: External beam radiation or brachytherapy may be used to target and destroy cancer cells, particularly in cases where the tumor is large or located close to vital structures.
• Targeted therapy: Certain medications may target specific molecular pathways involved in cancer growth and spread, offering additional treatment options for advanced or metastatic rectal cancer.
• Immunotherapy: Immunotherapy drugs help the immune system recognize and attack cancer cells, offering new avenues for treatment in certain cases.

Treatment plans are individualized based on the patient’s unique circumstances and may involve a multidisciplinary team of healthcare professionals, including colorectal surgeons, medical oncologists, radiation oncologists, and other specialists.

By offering comprehensive information on symptoms, risk factors, diagnostic tests, and treatment options, the Apollo Rectal Cancer Programme aims to empower patients with the knowledge they need to navigate their journey with confidence and hope.

The Importance of a Dedicated Programme and Surgeon

Rectal cancer requires nuanced and complex treatment, distinct from colon cancer. It is imperative to have a dedicated rectal cancer programme led by specialists who possess expertise in this specific area. When choosing a treatment path, patients must consider several factors, including the reputation and outcomes of the programme and surgeon, the use of advanced technologies like robotics, and the emphasis on post-operative quality of life.

Key Considerations for Patients

Identifying a Dedicated Programme: The ARC Programme offers a multidisciplinary team of experts focused solely on rectal cancer, ensuring personalized treatment plans tailored to each patient’s needs.

Choosing the Right Surgeon: Our internationally trained, board-certified colorectal surgeons specialize in rectal cancer surgery, delivering superior outcomes backed by published data.

Examining Surgical Outcomes: Transparency and data-driven decision-making are central to our approach, with our surgeons’ world-class outcomes readily available for patients’ review.

Utilizing Advanced Technologies: Robotics play a pivotal role in enhancing surgical precision and patient outcomes, making rectal cancer surgery safer and more effective.

Prioritizing Quality of Life: Our focus extends beyond curing cancer to preserving patients’ quality of life, with an emphasis on continence, sexual function, and post-operative care.

Establishing Follow-Up Protocols: Our standardized follow-up protocol ensures comprehensive post- operative care, supported by advanced telemedicine technologies and patient support groups.

World-Class Infrastructure

At the Apollo Proton Cancer Centre, we offer state-of-the-art infrastructure to support our rectal cancer programme, including advanced diagnostic and treatment facilities under one roof, ensuring a seamless and comprehensive patient experience.

Conclusion

Rectal cancer surgery demands specialized expertise and dedicated resources, and the Apollo Rectal Cancer Programme is committed to meeting these challenges head-on. With our team of world-class surgeons, cutting-edge technology, and patient-centric approach, we aim to set new standards of care and provide hope to patients battling rectal cancer across India.