 Today I will talk about the patient of rectal cancer and also a few lessons we can learn from her history as well as treatment. Mrs. Janan Kudair presented to us in March of this year. She was having rectal bleeding for more than two years but was being treated for inflammatory bowel disease and no further investigations were done. She did not improve and finally underwent a colonoscopy in her home country, Iraq which showed a rectal ulcer and a large growth. She came to India for further investigations and found to have locally advanced rectal cancer. Since it was locally advanced in the form of involvement of multiple nodes and a large growth in the rectum, we gave her chemo and radiation first and followed by surgery. This surgery we could save her normal passage by using modern techniques like use of staplers but we had to make a temporary stoma here for passage of stool which will be closed after a few months. This needed to be done because that area was radiated and if we just join it back it won't heal very well and we needed to divert the stool. Now coming to the lessons that we can learn, this lady had rectal bleed for more than two years but was treated for something else rather than being investigated further and ruling out or diagnosing a cancer at a much earlier stage. Had that happened she would have probably required only surgery, avoided chemotherapy, radiation therapy and as a result also avoided the temporary stoma that we have given. The other lesson is in cases where the rectal cancer becomes locally advanced that patient will need not only surgery but also chemo as well as radiation. It is better to give chemo and radiation before surgery because once the radiation is given we can have a better response of the tumor and we can save sphincters in larger number of patients. Also if radiation and chemotherapy are given after surgery is done the tolerance of the patient is also poor and the reaction to radiation is higher because the area which we empty, the area from which we remove the intestine is occupied by other normal intestine and they get radiated. Fortunately she has undergone all the treatment and tolerated it very well and currently is recovering from surgery. We have been able to do this for two years and we decided to do it here in Iraq. So they made it clear that they had cancer in the future. When we found out the result we decided to come to India. We asked one of our friends at the hospital in Manipal that they were able to do the treatment for the cancer and for the wife. We came to the hospital in Manipal and did the treatment and we went to the hospital in the village of Kewsh, Allahbhai. We decided to do a complete treatment with a chemical treatment. After this treatment, we went to the hospital. We decided to do a surgery. The surgery was good. The results were good. After this treatment, we went to the hospital.