Rectal cancer is among the leading causes of cancer-related illness across the world. Globally, colorectal cancer ranks third in terms of incidence and second in terms of cancer-related deaths. In India, rectal cancer is increasingly being diagnosed at more advanced stages due to low awareness and lack of regular screening—especially in rural and semi-urban populations.

That’s where neoadjuvant therapy plays a crucial role. This pre-surgical treatment approach improves surgical outcomes and, in some cases, may help avoid surgery altogether.

Dr. Sandeep Nayak, a seasoned Surgical Oncologist in India, explains:

“Neoadjuvant therapy allows us to gain the upper hand before surgery begins. By shrinking the tumor and targeting unseen cancer cells, we create better conditions for long-term success. It’s a forward-thinking strategy that is now considered standard in managing advanced rectal cancer.”

This guide explains what neoadjuvant therapy is, why it’s used, and how it’s transforming rectal cancer treatment in India and around the globe.

Neoadjuvant therapy refers to treatments given before surgery. These can include:

Chemotherapy: A combination of chemotherapy and radiotherapy (chemoradiation)

Immunotherapy: In certain trials or advanced cases

Regardless of the specific therapy, if it’s administered before surgery, it is termed neoadjuvant therapy.

But why treat cancer before surgery at all?

The answer lies in strategy. When cancer is first detected, especially in the rectum, it may already be large or close to vital structures. Jumping straight to surgery without first controlling the disease could result in less effective outcomes or unnecessary complications.

Neoadjuvant therapy helps doctors shrink the tumor, assess how it responds to treatment, and better plan the surgical procedure for safer, more precise removal.

Still wondering why it matters? Let’s dig deeper.

Tumor Downstaging

The primary benefit is shrinking the tumor. By making the tumor smaller before surgery, it becomes easier to remove while preserving healthy tissue.

Improved Surgical Margins

Surgery is all about precision. Neoadjuvant therapy helps clear the tissue planes around the tumor. This means that when the surgeon operates, there’s a higher chance of completely removing the cancer with “clear margins”—areas free of cancer cells.

Lower Recurrence Rates

By targeting cancer cells early, neoadjuvant therapy reduces the risk of local recurrence. This improves the long-term success rate and overall survival.

Organ Preservation (In Select Cases)

One of the most exciting advances in recent years is the potential to avoid surgery altogether in select patients. Those who have an exceptional response to neoadjuvant therapy may be managed with a “wait-and-watch” approach, sparing them the side effects and complications of rectal surgery. While this isn’t suitable for everyone, it’s a life-changing option for those who qualify.

Dr. Sandeep Nayak, an eminent Surgical Oncologist in Bangalore, shares:

“Organ preservation is a major leap forward in rectal cancer care. In select cases, avoiding surgery is not only safe but also significantly improves quality of life. But careful selection and follow-up are key to making this work effectively.”

Now, let’s explore the types of neoadjuvant therapy commonly used.

Neoadjuvant Chemoradiation

This is the most commonly used form. Chemotherapy drugs are given alongside radiation therapy to shrink the tumor and increase the effectiveness of both treatments.

Neoadjuvant Chemotherapy Alone

In certain cases, especially when radiation isn’t appropriate, chemotherapy alone may be used. This approach is being studied more frequently, particularly in cases with distant metastases.

Short-Course Radiotherapy (SCRT)

A quicker form of radiation therapy often completed in a week, SCRT is sometimes followed by delayed surgery and is particularly useful for patients who can’t tolerate longer radiation courses.

Total Neoadjuvant Therapy (TNT)

A newer and increasingly popular approach where all chemotherapy and radiation are completed before surgery. TNT improves tumor response and reduces the risk of systemic spread.

Immunotherapy (in selected cases)

Although not yet standard, ongoing trials are exploring the use of immune-based therapies in rectal cancers, particularly for patients with a specific genetic condition known as mismatch repair deficiency (dMMR).

Dr. Sandeep Nayak explains:

“Mismatch repair deficiency, or dMMR, is a genetic alteration where the body’s natural ability to repair DNA damage is impaired. In such cases, tumors are more likely to respond to immunotherapy because they produce more mutations, making them easier for the immune system to recognize and attack. Identifying this condition early opens doors to highly effective, targeted treatment options.”

Here’s what you can typically expect if you’re prescribed neoadjuvant therapy:

Step 1: Diagnostic Work-up

This includes scans (MRI, CT, PET), colonoscopy, biopsy, and tumor marker tests to determine the exact stage and plan the treatment.

Step 2: Therapy Begins

Most patients receive therapy for 5–6 weeks. If chemoradiation is planned, it’s usually done five days a week over five weeks, with chemotherapy taken orally or intravenously.

Step 3: Waiting Period

After treatment ends, patients wait for about 6–8 weeks to allow the tumor to shrink further and recover from therapy side effects.

Step 4: Assessment

Another scan or evaluation is performed to assess tumor response. Based on the results, patients either proceed to surgery or, in rare cases, are considered for non-surgical monitoring.

Now let’s talk results.

Neoadjuvant therapy has revolutionized rectal cancer care. Here’s how:

Increased tumor resectability: Tumors that were once considered inoperable can now be safely removed after therapy.

Better survival rates: Numerous studies, including data from Indian institutions, show improved 5-year survival rates in patients who receive neoadjuvant therapy.

Lower local recurrence: Especially when combined with precise surgical techniques, this therapy reduces the chance of the cancer returning to the pelvis.

Organ preservation rates: In some studies, up to 20% of carefully selected patients avoided surgery altogether.

Indian oncology centers, especially those in urban hubs like Bangalore, are increasingly offering advanced neoadjuvant protocols with outcomes comparable to global standards.

Neoadjuvant therapy in rectal cancer is not just a pre-surgical formality—it’s a transformative approach that enhances surgery, lowers recurrence, and in some cases, replaces surgery altogether. With proper staging, planning, and execution, it leads to better outcomes and, importantly, more tailored, patient-friendly treatment plans.

If you or a loved one is navigating a rectal cancer diagnosis, discussing the possibility of neoadjuvant therapy with an expert may open up better, more effective treatment pathways.

References:

https://my.clevelandclinic.org/health/treatments/neoadjuvant-therapy

https://www.sciencedirect.com/science/article/pii/S1040842823002846

Disclaimer: The information shared in this content is for educational purposes only and not for promotional use.

Low Anterior Resection Syndrome (LARS) is a common post-surgical condition observed in patients who undergo low anterior resection for rectal cancer treatment. It leads to bowel dysfunction, affecting the quality of life. LARS is a temporary problem that occurs as we save the anal sphincter and avoid permeant stoma.

According to Dr. Sandeep Nayak, a leading surgical oncologist in India, “LARS is a prevalent but manageable condition. With appropriate care, patients can regain bowel control and live comfortably. Timely symptom detection and effective management are crucial for this post-operative issue.”

With long-standing experience in surgical oncology, Dr. Nayak is an expert in complex colorectal cancer surgeries and post-surgery rehabilitation. With his team, he ensures patients receive individualized treatment protocols to deal with LARS effectively. Dr. Nayak and his team are well-known for their expertise in minimally invasive surgery and advanced cancer treatment in Bangalore, allowing quicker recovery with fewer complications.

When a portion of the rectum is excised and modified, the body needs time to adapt, and the associated symptoms may persist for months to years. Adequate treatment and management of LARS can significantly improve the patient’s quality of life.

Do you have unexpected bowel changes after surgery? We will discuss the most frequent symptoms of LARS and how they impact daily living.

•  Constipation & Clustering – Alternating between hard stools and multiple small bowel movements in a short period.
•  Gas and Bloating– Increased discomfort due to excess gas buildup.
•  Unpredictable Bowel Habits– Irregular stool frequency and consistency, making daily life cumbersome.
•  Nocturnal Bowel Movements– Bowel urges experienced at night, resulting in disturbed sleep.

“Most symptoms occur immediately after surgery. However, within one and a half to two years, most patients experience significant improvement and return to normal,” mentions Dr. Sandeep Nayak.

The severity of LARS symptoms is graded on a scoring system, which helps guide dietary modifications and other management strategies based on individual needs.

The following strategies can help manage LARS:

• Dietary Adjustments
  • Increase fiber intake gradually to regulate bowel movements.
  • Avoid foods that trigger diarrhea, such as caffeine, dairy, and spicy foods.
  • Stay hydrated to ease constipation and promote regularity.

• Pelvic Floor Exercises
  • Pelvic muscle strengthening by some exercises can enhance bowel control.
  • Kegel exercises tighten sphincter function and reduce incontinence.

• Toilet Routine
  • Develop a regular bowel movement routine to promote regularity.
  • Sit on the toilet and place a footstool to achieve an even better position for bowel emptying.

• Stress Management & Mental Well-being
  • Reduce anxiety through meditation, breathing exercises, and counseling.
  • Join support groups to connect with others experiencing similar challenges.

• Monitor Food Triggers
  • Maintain a food diary to identify and exclude foods that trigger symptoms.
  • Take small, frequent meals in order not to burden the digestive system.

Low Anterior Resection Syndrome is a challenging condition, but with the right approach, symptoms can be managed effectively. From dietary changes to medical treatments, various ways exist to improve bowel function and enhance overall well-being. LARS will have to be managed in consultation with your treating doctors.

Reference links:

https://www.hopkinsmedicine.org/surgery/specialty-areas/colorectal-surgery/low-anterior-resection-syndrome 

https://colorectalsurgery.wustl.edu/patient-care/low-anterior-resection-syndrome/ 

Disclaimer: This page is for informational purposes and not for promotional use.

Think you can use your own skin and muscle to restore the natural shape of your breast. That is precisely what latissimus dorsi flap for breast reconstruction achieves.

The LD flap reconstruction employs the latissimus dorsi muscle, found in your upper back, to form a new breast mound. Part of this muscle, along with fat and skin, is brought to the chest with its blood supply intact. The procedure can be done with or without an implant, depending on the volume required for reconstruction.

Step 1: A portion of the latissimus dorsi muscle, skin, and fat is separated while leaving its blood supply intact.

Step 2: The tissue is tunneled from under the arm to the chest.

Step 3: The tissue is molded by the surgeon to create a new breast.

Step 4: If needed, an implant is inserted to create desired volume.

This technique is particularly beneficial for patients lacking sufficient abdominal fat for other flap-based reconstructions such as the DIEP or TRAM flaps.

Read on to know if LD flap reconstruction is a preferred option nowadays.

Now, let’s understand the advantages and disadvantages of the LD flap.

Benefits

• High success rate – The LD flap has a very low failure rate, so it’s a good choice.
• Suitable for thin patients – If you don’t have sufficient abdominal fat for a DIEP or TRAM flap, this method can be a great alternative.
• Can be used with implants – If more volume is desired, the flap can be done with an implant.
• Few donor-site complications – The back heals well after the muscle is transferred.

Drawbacks

• Loss of muscle function – Although not a significant problem for most, athletes who use upper body strength may experience some weakness.
• Feels firmer than natural breast tissue – The muscle-based reconstruction may not feel as natural as fat-based approaches.
• Potential scarring – There will be a scar on the back, although it is often concealed by clothes.

Are you worried about the risks?

Although LD flap reconstruction is considered safe, as with any surgery, it does involve some risks, which include:

• Fluid buildup (seroma) – Fluid may accumulate in the back, necessitating drainage.
• Infection – As with any surgery, there’s a small risk of infection.
• Weakness in upper body movement – Some patients may experience reduced strength in the shoulder and back.
• Scar formation – Both on the back (donor site) and chest (reconstructed breast).

Following your surgeon’s post-operative care instructions can help minimize these risks and promote a smoother recovery.

Natural products have been used in medicine for centuries. From traditional herbal remedies to plant-based extracts, many believe that nature holds the key to curing diseases, including cancer. But how do these natural substances interact with cancer treatments?

Dr. Nayak, a well-known surgical oncologist in India, explains:

“It may interest you that a group of medicines called taxanes are derived from tree bark. These alkaloids were refined through medical research to create chemotherapy drugs like Paclitaxel and Docetaxel. However, consuming raw tree bark without refinement means ingesting multiple unknown compounds. The problem lies in dosage control—too much can cause toxicity, and too little may be ineffective. Additionally, when taken alongside prescription medicines, natural products can dangerously amplify toxicity.”

While some natural compounds have led to medical breakthroughs, not all plant-based substances are safe or effective. Misusing them could lead to severe side effects, organ damage, or even interference with standard cancer treatments.

Still, many people believe that natural remedies are completely safe. Is this true?

Myth 1: Natural products have no side effects
Many assume that because a remedy is “natural,” it must be safe. However, natural does not always mean harmless. Certain plant-based compounds can be toxic, causing liver damage, heart problems, or severe allergic reactions.

Myth 2: Herbs and supplements can replace chemotherapy
Some believe that chemotherapy alternatives such as herbal teas or special diets can treat cancer without the need for medical intervention. However, no scientific evidence supports this claim. Avoiding proven cancer treatments can allow the disease to progress unchecked.

Myth 3: If it worked for someone else, it will work for me
Personal testimonials and word-of-mouth recommendations are often misleading. Cancer treatments must be tailored to an individual’s medical condition, type of cancer, and overall health. A remedy that works for one person may not be safe or effective for another.

Dr. Nayak emphasizes:

“If you ask me as a qualified doctor, it is unwise to consume natural products during cancer treatment. Simply consuming raw tree bark or extracts can introduce unpredictable toxicity and interfere with ongoing treatment. If medical options are still available, they should always be the first choice.”

One of the biggest risks with tree bark medicine for cancer is the lack of dosage control. Unlike pharmaceutical drugs, which are carefully measured, natural products vary in potency. Consuming too much can cause poisoning, while too little may have no effect.

Potential Drug Interactions
Natural products can interfere with chemotherapy, radiation therapy, and other cancer treatments. Some plant compounds may reduce the effectiveness of medical treatments, while others may dangerously increase toxicity levels.

False Sense of Security
Relying on natural remedies instead of proven treatments can delay life-saving medical care. Some patients turn to alternative therapies in the hope of avoiding side effects, only to find that their cancer has progressed to an advanced stage.

Dr. Nayak, a trusted oncologist in Bangalore, cautions:

“If you are undergoing treatment, adding unverified remedies can create serious complications. Cancer drugs are designed for precision, and any additional substances can disrupt their intended effect. Natural products should only be considered when all medical options have been exhausted—and even then, with caution.”

Cancer is a complex disease, and the search for a cure is ongoing. Understandably, patients seek hope in natural cancer treatment, especially when modern medicine feels overwhelming. However, unverified remedies should not replace scientifically proven treatments. The use of tree bark medicine for cancer or other plant-based therapies may seem appealing, but they carry risks that one cannot ignore.
Dr. Nayak reminds us:

“Medical research has come a long way in the fight against cancer. While alternative therapies may offer comfort, they should never replace evidence-based treatments. The best approach is to work closely with your medical team, make informed decisions, and trust in advancements that have been scientifically tested. Hope should always be accompanied by wisdom and caution.”

Dr. Nayak concludes:

“While the allure of natural remedies is strong, they should never replace professional medical care. Many of these substances contain active compounds that interact with prescription drugs unpredictably. The biggest risk is that patients may unknowingly increase toxicity or weaken the effectiveness of their treatment. When it comes to cancer treatment, science-backed medicine remains the safest and most effective approach.”

Reference Links:
https://www.webmd.com/breast-cancer/taxanes-breast-cancer
https://www.mskcc.org/news/truth-behind-three-natural-cures

Disclaimer: The information shared in this content is for educational purposes only and not for promotional use.

With years of expertise in minimally invasive and robotic cancer surgeries, Dr. Nayak has pioneered innovative approaches to improve patient care. His strong grasp of oncological imaging, including PET CT scans, helps him direct patients to optimal diagnostic and treatment options, ensuring early detection and effective management of cancer.

How does a PET CT scan work, and why is it vital for cancer detection? Let’s explore the science behind this imaging technique.

Positron Emission Tomography (PET) scan, often combined with a Computed Tomography (CT) scan, is an advanced imaging technique that detects abnormal metabolic activity in the organs of the body. Commonly it involves injecting a small amount of radioactive glucose (FDG), which cancer cells absorb at a higher rate than normal cells, making them visible on the scan. There are other radioactive traces that are specific for some cancers like PSMA for prostate cancer and Dota for Neuroendocrine tumors.

This allows doctors to identify cancerous growths, assess their spread, and monitor treatment response with high precision. PET CT scans provide a functional view of cancer activity, offering crucial insights beyond what traditional imaging can reveal, making them essential in cancer care.

Can a PET CT scan do more than detect cancer? Let’s discuss how it plays a vital role in diagnosis and treatment planning.

Are PET CT scans as dangerous and inaccurate as many believe? Let’s address the most common myths and misconceptions.

Despite being a widely used diagnostic tool in oncology, there are several misconceptions about PET CT scans. Let’s debunk some of the most common myths:

Myth 1: PET CT scans expose patients to excessive radiation.

Fact: While PET CT scans use a small amount of radiation, the exposure is within medically safe limits. It should never be used more often than needed.

Myth 2: PET CT scans can diagnose all types of cancer.
Fact: PET CT cannot diagnose cancer. Diagnosis happens with biopsy. PET CT is used only for staging of cancer and to assess response. Although highly effective, PET CT scans may not always detect slow-growing tumors or very small cancerous lesions. In such cases, doctors may recommend additional tests.

Myth 3: PET CT scans always confirm cancer.
Fact: Increased metabolic activity can sometimes be due to infections or inflammation, not just cancer. A biopsy is needed for confirming diagnosis.

Myth 4: PET CT scans are only for cancer detection.
Fact: PET CT scans are also used to diagnose neurological conditions like Alzheimer’s disease and heart diseases, not just cancer.

Myth 5: PET CT scans are painful and uncomfortable.
Fact: The procedure is painless. The only minor discomfort is from injecting of the dyes.

Dr. Sandeep Nayak, a distinguished oncologist in Bangalore, India, notes,

“It’s important to understand that PET CT scans are highly advanced but should always be interpreted alongside clinical findings for accurate diagnosis.”

1. It’s a Painless and Non-Invasive Procedure

A PET CT scan does not involve surgery or invasive techniques. The only minor discomfort is caused by the small injection.

2. It Detects Cancer at an Early Stage
It is not used for this purpose. It is only used for staging the cancer.

3. It Helps Differentiate Between Benign and Malignant Tumors
Unlike conventional imaging, PET CT scans show metabolic activity, helping doctors distinguish between non-cancerous and cancerous growths.

4. It Provides a Whole-Body Overview
PET CT scans can detect cancer in multiple body areas at once, making it easier to assess if cancer has spread (metastasized).

5. It’s Used in Combination with Other Imaging Techniques
For accurate diagnosis, sometimes PET CT is used alongside MRI scans to provide a complete picture of a patient’s condition.

How can PET CT scans improve cancer treatment outcomes? Let’s discover their advantages.

1. Early and Accurate Detection
PET CT scans can identify cancer spread earlier than otherwise.

2. Precise Treatment Planning
By showing the exact location and extent of cancer, PET CT helps oncologists plan targeted treatments such as surgery or radiation therapy.

3. Monitoring Treatment Response
Doctors use PET CT scans to evaluate the effectiveness of a treatment. If cancer is not responding, adjustments can be made to improve outcomes.

4. Reducing Unnecessary Procedures
Since PET CT scans can differentiate between benign and malignant growths, they help avoid unnecessary biopsies or surgeries when the cancer is already spread.

5. Detecting Cancer Recurrence
PET CT scans are used in follow-ups to check for cancer recurrence, ensuring continuous monitoring and early intervention if needed.

PET CT scans are vital for staging, and treatment monitoring. They offer insights into abnormal cell activity and do not confirm cancer on their own. However, they assist oncologists in making accurate diagnoses and creating effective treatment plans.

Understanding the facts about PET CT scans helps patients make informed healthcare choices. With experts like Dr. Sandeep Nayak leading advancements in oncology, the integration of this technology continues to improve cancer care and patient outcomes.

Reference links:

https://www.cancerresearchuk.org/about-cancer/tests-and-scans/pet-ct-scan
https://www.umms.org/ummc/health-services/imaging/diagnostic/pet-scan/cancer

Disclaimer: This page is for informational purposes and not for promotional use.

Chemotherapy, commonly known as “chemo,” uses specialized drugs to destroy cancer cells and stop their spread. But how does it work?

• Targets Fast-Growing Cells:Cancer cells divide rapidly, and chemotherapy drugs target these cells effectively.
• Combined Approach:Chemotherapy can be used alongside surgery, radiation, or immunotherapy for comprehensive treatment.
• Improves Survival Rates:Research shows that chemotherapy improves outcomes for various cancers, including testicular cancer, lymphomas, and breast cancer.

💡 Key Point: Chemotherapy is never prescribed lightly. Doctors evaluate your case carefully, balancing benefits and risks to ensure the treatment is right for you.

Still unsure? Let’s address the most common myths surrounding chemotherapy.

It’s time to separate myths from facts so you can make informed decisions.

1. Myth: Chemotherapy makes cancer worse.
   Fact:Chemotherapy destroys cancer cells and improves survival rates. In cancers like testicular cancer, cure rates increase by 90%with chemotherapy.
2. Myth: Everyone loses their hair during chemotherapy.
   Fact:Hair loss depends on the type of drugs used. With some treatments, patients may not lose hair at all.
3. Myth: Chemotherapy causes unbearable pain.
   Fact:The chemotherapy process itself is not painful. Side effects like nausea or fatigue are temporary and manageable with proper care.
4. Myth: Chemotherapy is only for advanced-stage cancer.
   Fact:Chemotherapy is used in all stages of cancerto stop its progression, prevent recurrence, and improve survival.
5. Myth: Chemotherapy weakens the immune system permanently.
   Fact:Chemotherapy may temporarily lower immunity, but the body recovers with time. Supportive care ensures your health is closely monitored.

Let’s move on to key facts that highlight why chemotherapy is essential for cancer treatment.

Here are some important facts about chemotherapy that every patient should understand:

1. Chemotherapy Saves Lives:
   • In cancers like lymphomas, chemotherapy is the backbone of treatment, leading to excellent survival outcomes.
   • For testicular cancer, chemotherapy increases cure rates by up to 90%, making it a life-saving option.
2. It’s Part of a Comprehensive Plan:
   • Chemotherapy is often combined with surgery or radiationfor better results.
3. Modern Chemotherapy is Personalized:
   • Doctors tailor the drugs, dosages, and schedules to minimize side effects while maximizing treatment benefits.
4. Side Effects are Manageable:
   • With advancements in medicine, nausea, fatigue, and other side effects can now be effectively controlled with supportive therapies.
5. Improves Quality of Life:
   • By preventing cancer from spreading or recurring, chemotherapy helps patients lead healthier, longer lives.

💡 Remember: If your doctor suggests chemotherapy, it’s because the treatment offers you the best chance at beating cancer.

Still worried? Let’s look at how to take the next steps toward understanding your treatment.

The idea that “chemotherapy is bad” is a myth that often arises from fear and misinformation. While chemotherapy does have side effects, it remains a life-saving treatment that improves survival rates, prevents recurrence, and, in some cases, offers a cure.

Dr. Sandeep Nayak, a respected surgical oncologist in India, believes in providing patients with clear, compassionate guidance. He and his team ensure that chemotherapy is recommended only when it offers substantial benefits, empowering patients to make informed choices.

If you or a loved one is facing cancer treatment, remember that chemotherapy is prescribed to save lives. With the right care and support, you can overcome cancer and regain your health.

References

1. American Cancer Society: Understanding Chemotherapy
2. Cancer Research UK: Chemotherapy Myths and Facts