A 39 year Chinese man with locally advanced rectal cancer. Mr Chia first presented with difficulty in motion in Jan 2005. He was then in severe pain and had bleeding whenever he went to the toilet. He also passed motion with difficulty and pain. Clinical examination showed a huge rectal mass fixed to the pelvis and protruding into the anal canal. The lower end of the cancer was only 2 cm from the bottom of the anus. He saw a surgeon elsewhere and he was advised that no treatment was possible and that he should go home and await the end.

Mr Chia became desperate until a friend recommended him to see me at Mt Elizabeth Hospital. Clinical examination showed Mr Chia to be a well built man in his late 30’s. He was fit and physical examination showed no abnormality except for the huge fixed cancer in the pelvis and rectum. CT films showed gross infiltration outside the rectum and a huge mass was immediately clearly seen. The cancer was clearly not completely respectable at this stage. He was advised to undergo chemotherapy and radiotherapy in an effort to shrink the cancer. This strategy worked well.

Six weeks of chemo and radiotherapy shrunk the mass completely. After 6 weeks, no residual cancer was felt on rectal examination. Further X rays showed spread elsewhere and Mr Chia was advised for rectal surgery. An ultra-low anterior resection was done on Oct 2006. Histological examination of the resected specimen showed complete clearance of cancer. Mr Chia is expected to have a good prognosis.

A 39 year old Caucasian with serious bleeding from external piles was seen by a general surgeon who operated on him in February 2005. Following surgery, he continued to have severe pain two months after surgery.

He was seen and re-operated by the same surgeon for piles but continued to have severe pain even on sitting three months after surgery and was referred to see me. Clinical examination showed that he had a previously unrecognized chronic anal fissure with large external skin tags.

He underwent an excision of the skin tags and a simple procedure called a lateral sphincterotomy to cure the chronic fissure and was totally well the following day. Expert examination and accurate diagnosis and surgery will ensure prompt healing and minimal complications in all cases undergoing surgery.

A 50 year old Caucasian man first complained of anal symptoms including bleeding and anal pain in May 2005. He was seen in Russia initially and was diagnosed to have a very low rectal cancer about 2 cm from the anal verge. Complete removal including removal of the anus was advised in Russia. The patient was adamant against this and sought treatment with me. Clinical examination showed a very muscular and large man who was otherwise very fit for his age.

As the cancer was indeed 2 cm from the outside skin edge an abdominal-perineal excision or removal of the rectum and anus was discussed with him. He was firmly fixed against the idea that he will have a permanent colostomy bag on his abdomen. As all scanning showed that the tumour was localized without spread to other parts of his body, it was felt that it might be possible to attempt an inter-sphincteric dissection of his anus and remove the cancer totally by this method and allow him to preserve anal function.

This operation was performed successfully on the 3rd August. The cancer was removed with a good margin and no chemotherapy or radiotherapy was needed. He remains very well with good ability to control his anus on follow up.

A 63 year old man in another country had a colonoscopy and removal of a colonic polyp on the 10th Jan 2003. The following day, he complained of severe abdominal pain and was hospitalized and underwent emergency surgery on the 13th January 2003. Surgery was performed during which the perforated removal of polyp site was sutured closed and a tube inserted into his caecum.

Unfortunately this too perforated and a second operation was performed on the 19th Jan 2005. However, this was not done in proper fashion and again, an emergency surgery had to be done. The patient became frightened of surgery in his own country and flew to see me on the 11 Jan 2005. Examination showed that he had two stomas(intestinal openings) on his abdomen, one on the right and one on the left. There was also a very large anterior hernia. A complete repair and restoration of all his stomas was suggested by me.

The patient was anxious about more surgery but after consideration, underwent surgery by me on the 15 July 2005. This difficult surgery was successful as the two stomas were restored back to the abdomen and the hernia repaired. The patient made a good recovering and flew home.

A 28 year old man with huge intra-abdominal cancer. Mr TF first presented in April 2005 in his own country with a problem of a large intra-abdominal swelling. X rays revealed a very large intra-abdominal tumour and he was operated upon. Although 2.5 kg of tumour was removed, the surgery was evidently incomplete. Histological examination showed this to be a desmoplastic small cell tumour. The patient was given a combination of adriamycin, ifosfamide, vincristine, dacarbazine and mesna. However, after 5 cycles, residual mesenteric thickening was still evident. The patient relapsed in Feb 2006. CT scan then showed large soft tissue mass in the pelvis invading the rectum, sigmoid colon, prostate, seminal vesicles and numerous intra-abdominal nodules with a larger mass in the upper abdomen.

He received further chemotherapy but the masses increased in size. In July 2006 he developed severe pain in the buttocks and constipation and examination showed a very large abdominal mass arising from the pelvis. Palliative radiotherapy was given in an attempt to shrink the tumour and he received a total of 4500 cgy in 25 fractions. However repeat CT scans on 17 August 2006 showed further increase in the size of the masses. He was told to go elsewhere for treatment and was finally referred to see me at Mt Elizabeth Hospital.

I first saw Mr TF on the 12 Oct 2006. Physical examination showed a very large abdominal mass up to the level of the umbilicus. Rectal examination showed a hard fixed pelvic mass. CT scans showed a 20 cm large pelvic tumour, a 13 cm abdominal tumour, a 5 cm splenic hilar mass and multiple smaller abdominal masses. He was initially tried on further chemotherapy but no response was noted.

Finally as the pain and constipation became progressively worse, surgery was performed on the 15 Feb 2007. During surgery, despite the hugeness of the mass, expert dissection and manipulation enabled all the masses to be totally removed. Mr TF now has a very good chance of complete cure.