15 Frequently Asked Questions : Colorectal Cancer Treatment and Surgery in India for Zambian Patients

Q1 · What Treatments Are Available for Colorectal Cancer in India?

Treatment depends on whether the cancer is in the colon or rectum, as well as its stage.

Surgical Treatment

Possible procedures include:

• Polypectomy for selected early cancers
• Local excision for selected rectal cancers
• Right hemicolectomy
• Left hemicolectomy
• Sigmoid colectomy
• Total/subtotal colectomy in selected cases
• Low anterior resection
• Abdominoperineal resection
• Total mesorectal excision
• Transanal procedures for selected rectal tumours
• Metastasectomy in selected patients
• Stoma/colostomy or ileostomy creation
• Reversal of a temporary stoma
• Complex multivisceral resection

Other Treatments

Depending on the stage and tumour biology:

• Chemotherapy
• Chemoradiation
• Radiotherapy
• Targeted therapy
• Immunotherapy
• Ablation for selected metastatic disease
• HIPEC in carefully selected peritoneal disease

NCI identifies surgery, chemotherapy, radiation therapy, targeted therapy and immunotherapy among the major treatment options for colorectal cancer.

Q2 · What Is the Cost of Colorectal Cancer Treatment in Zambia Compared with India?

For planning purposes, the following exchange rates are used:

• US$1 ≈ ZMW 19.5
• US$1 ≈ INR 96

Indicative Cost Comparison

These are planning ranges rather than standardized national tariffs. The final cost depends heavily on the type and stage of cancer, whether the operation is open/laparoscopic/robotic, whether a stoma is required, the need for chemotherapy or radiotherapy and the complexity of the surgery.

For metastatic colorectal cancer, additional treatment can substantially increase the overall cost because systemic medicines, targeted medicines and immunotherapy may be required. NCI notes that treatment for advanced colorectal cancer can include systemic chemotherapy, targeted therapy, immunotherapy and selected surgery or local treatments.

Q3 · Which Major Indian Cities Can Zambian Patients Consider for Colorectal Cancer Treatment?

For patients requiring complex colorectal surgery, it is useful to confirm availability of colorectal surgical oncology, gastrointestinal surgery, advanced imaging, pathology, intensive care and medical/radiation oncology at the selected centre.

Q4 · Which Hospitals in India Can Zambian Patients Consider?

Important: Not every hospital listed necessarily performs every colorectal operation, robotic procedure or HIPEC procedure. The patient's exact diagnosis and proposed operation should be confirmed before travel.

Q5 · What Types of Colorectal Cancer Surgery Are Available in India?

Colon Cancer Surgery

Depending on tumour location, surgery may include:

• Right hemicolectomy
• Extended right hemicolectomy
• Transverse colectomy in selected cases
• Left hemicolectomy
• Sigmoid colectomy
• Subtotal colectomy
• Total colectomy in selected cases

The cancer-bearing segment and regional lymph nodes are removed, and the bowel may be reconnected when appropriate. NCI identifies colon resection with anastomosis as a major surgical treatment for many colon cancers.

Rectal Cancer Surgery

Possible procedures include:

• Local excision for selected early cancers
• Low anterior resection
• Total mesorectal excision
• Abdominoperineal resection
• Transanal procedures in selected cases
• Pelvic exenteration for selected locally advanced cancers

Rectal cancer surgery is strongly influenced by tumour location, stage and the possibility of preserving the anal sphincter.

Minimally Invasive Surgery

Selected patients may undergo:

• Laparoscopic colorectal surgery
• Robotic colorectal surgery

Stoma Surgery

Some patients may require:

• Temporary ileostomy
• Temporary colostomy
• Permanent colostomy

A temporary stoma may later be reversed if healing and the overall treatment plan allow.

Q6 · What Is the Difference Between Colon and Rectal Cancer Treatment?

Although colon and rectal cancers are grouped together as colorectal cancer, their treatment pathways can differ.

Colon Cancer

Surgery is a major treatment for localized colon cancer.

Depending on stage, chemotherapy may be recommended before or after surgery. Advanced disease may require systemic therapy, targeted therapy, immunotherapy or selected surgery for metastatic sites.

Rectal Cancer

Rectal cancer is located close to the pelvis and important structures controlling bowel, urinary and sexual function.

Treatment may therefore include:

• Chemotherapy
• Radiation or chemoradiation
• Total neoadjuvant therapy in selected patients
• Surgery
• Active surveillance in carefully selected complete responders

The exact sequence depends on stage and tumour characteristics. NCI describes a multidisciplinary approach to rectal cancer involving gastroenterology, medical oncology, surgical oncology, radiation oncology and radiology.

Q7 · Who May Be Suitable for Colorectal Cancer Surgery?

Surgery may be considered when:

• The primary tumour is technically resectable
• The patient's general health permits major surgery
• There is no medical contraindication to anaesthesia
• The tumour can be removed with appropriate margins
• Lymph nodes or nearby structures can be managed surgically
• Selected metastatic disease can also be removed or treated

For advanced disease, surgery may still be considered in selected situations, particularly when metastases are limited and technically removable.

NCI notes that selected patients with liver-only or lung-only metastatic colon cancer may be candidates for surgical resection, while systemic treatment and other local therapies may also be used.

For rectal cancer, the decision depends heavily on tumour location, stage, relationship to the sphincter and response to preoperative treatment.

Q8 · What Medical Reports Should a Zambian Patient Send Before Travelling to India?

A complete medical record should ideally include:

Diagnosis

• Biopsy report
• Histopathology
• Immunohistochemistry where performed
• Tumour grade
• Molecular testing
• MSI/MMR results
• KRAS/NRAS results where applicable
• BRAF testing where applicable

Colonoscopy

• Colonoscopy report
• Biopsy details
• Location of tumour
• Photographs where available
• Colonoscopy images/video if available

Imaging

• CT chest/abdomen/pelvis
• MRI pelvis for rectal cancer
• PET-CT where clinically indicated
• Liver imaging
• Actual scan images/files

Previous Treatment

• Surgery reports
• Chemotherapy records
• Radiotherapy records
• Targeted therapy
• Immunotherapy
• Discharge summaries
• Previous treatment-response scans

General Health

• Complete blood count
• Kidney function
• Liver function
• Electrolytes
• ECG
• Cardiac assessment where necessary
• Current medication list

For rectal cancer, pelvic MRI can be particularly important for local staging and surgical planning.

Q9 · What Is the Typical Colorectal Cancer Treatment Process in India?

Step 1 – Specialist Review

The colorectal/surgical oncology team reviews:

• Biopsy
• Colonoscopy
• CT/MRI
• Previous treatment
• Medical history

Step 2 – Staging

The team determines:

• Tumour location
• Tumour depth
• Lymph-node involvement
• Metastatic disease
• Resectability

Step 3 – Molecular Assessment

Where appropriate, testing may include:

• MMR/MSI
• KRAS
• NRAS
• BRAF
• Other molecular markers

Step 4 – Multidisciplinary Discussion

The patient may be assessed by:

• Colorectal surgeon
• Surgical oncologist
• Medical oncologist
• Radiation oncologist
• Radiologist
• Pathologist
• Gastroenterologist

Step 5 – Preoperative Treatment

Selected patients may receive:

• Chemotherapy
• Chemoradiation
• Radiation therapy
• Targeted therapy
• Immunotherapy

before surgery.

Step 6 – Surgery

The operation may be:

• Open
• Laparoscopic
• Robotic

depending on the cancer and surgical assessment.

Step 7 – Histopathology

The resected tumour and lymph nodes are examined.

Step 8 – Additional Treatment

Depending on the final pathology, the patient may require:

• Chemotherapy
• Radiation
• Targeted therapy
• Immunotherapy
• Surveillance

NCI describes multimodal treatment for colorectal cancer, particularly for rectal cancer, where chemotherapy and radiation may be given before surgery.

Q10 · Are There Alternatives to Colorectal Cancer Surgery?

Yes, depending on the cancer stage and clinical situation.

Potential alternatives or additional treatments include:

• Chemotherapy
• Radiotherapy
• Chemoradiation
• Targeted therapy
• Immunotherapy
• Endoscopic removal of selected early lesions
• Local ablation for selected metastases
• Active surveillance in carefully selected rectal-cancer patients with complete clinical response
• Palliative treatment
• Stenting for selected bowel obstruction situations

For selected rectal cancers, some patients who have a complete clinical response after neoadjuvant treatment may be considered for intensive surveillance rather than immediate surgery, although this requires careful specialist assessment.

Q11 · What Should Be Included in the Colorectal Cancer Treatment Quotation?

A Zambian patient should request a detailed written quotation covering:

Surgical Costs

• Surgeon fees
• Operating-room charges
• Anaesthesia
• Surgical consumables
• Laparoscopic/robotic equipment where applicable
• Histopathology
• Lymph-node examination

Possible Additional Procedures

Clarify whether the quotation includes or excludes:

• Stoma creation
• Stoma reversal
• Bowel reconstruction
• Multivisceral resection
• Liver surgery
• Lung surgery
• Adhesiolysis
• ICU care

Cancer Treatment

Ask for separate estimates for:

• Chemotherapy
• Radiotherapy
• Targeted therapy
• Immunotherapy
• HIPEC where appropriate

Hospital Costs

Confirm:

• Room category
• ICU/HDU charges
• Medicines
• Blood products
• Laboratory tests
• Imaging
• Follow-up consultations

International Patient Planning

Also confirm:

• Expected hospital stay
• Expected total India stay
• Postoperative follow-up
• Expected timing of additional treatment

A final quotation should be prepared only after the medical team has reviewed the patient's diagnosis and imaging.

Q12 · How Long Should a Zambian Patient Stay in India?

The required stay depends on the treatment sequence.

The exact hospital stay depends on bowel recovery, nutrition, wound healing, stoma management, complications and the patient's overall condition.

Patients should allow additional time beyond the minimum estimated stay before booking a non-flexible return flight.

Q13 · What Is Recovery Like After Colorectal Cancer Surgery?

Recovery varies according to the operation.

Early Recovery

Patients may experience:

• Abdominal pain
• Fatigue
• Temporary bowel changes
• Reduced appetite
• Nausea
• Constipation or loose stools
• Abdominal swelling
• Incision discomfort

After Colectomy

Recovery may involve:

• Gradual return to normal diet
• Bowel-function monitoring
• Walking and physiotherapy
• Wound care
• Monitoring for infection

After Rectal Surgery

Patients may require additional attention to:

• Bowel frequency
• Bowel urgency
• Stool consistency
• Pelvic-floor function
• Urinary function
• Sexual function

After Stoma Surgery

The patient will receive instruction on:

• Stoma care
• Appliance changes
• Skin protection
• Diet
• Hydration
• Warning signs

After Chemotherapy

Possible effects include:

• Fatigue
• Nausea
• Appetite changes
• Low blood counts
• Infection risk
• Neuropathy with certain chemotherapy medicines

Physiotherapy, nutrition and gradual mobilization can be important components of recovery.

Q14 · What Follow-up Care Is Required After Returning to Zambia?

Before returning home, the patient should collect:

• Final diagnosis
• Operative report
• Histopathology
• Lymph-node report
• Tumour stage
• Molecular testing
• MSI/MMR results
• KRAS/NRAS/BRAF results where performed
• Discharge summary
• Chemotherapy summary
• Radiotherapy summary
• Targeted-treatment summary
• Immunotherapy summary
• Medication list
• Follow-up schedule

Follow-up May Include

• Clinical examination
• CEA or other tumour markers when appropriate
• CT scans
• MRI for selected rectal cancer patients
• Colonoscopy
• PET-CT in selected situations
• Assessment of bowel function
• Stoma review
• Nutritional assessment

If Additional Treatment Is Required

The Indian oncology team should provide:

• Drug names
• Dose
• Number of cycles
• Treatment interval
• Radiation plan
• Targeted-treatment plan
• Immunotherapy plan

The complete treatment record should be shared with the patient's oncology team in Zambia so that surveillance and further treatment can continue.

Q15 · Is India a Suitable Option for Zambian Patients Seeking Colorectal Cancer Treatment?

India can be considered by Zambian patients seeking comprehensive colorectal cancer evaluation and treatment.

Treatment may include:

• Colorectal surgery
• Laparoscopic surgery
• Robotic surgery
• Open surgery
• Chemotherapy
• Radiotherapy
• Targeted therapy
• Immunotherapy
• Selected liver/lung metastasis surgery
• Selected CRS + HIPEC

For colon cancer, surgery is a major treatment for localized disease, while advanced disease may require combinations of surgery and systemic treatment.

Rectal cancer often requires particularly careful multidisciplinary planning because the tumour's location within the pelvis can affect the use and timing of chemotherapy, radiation, surgery and sphincter-preservation strategies.

For selected metastatic disease, surgery may still be considered when metastatic deposits can be completely or appropriately treated. NCI identifies selected surgical treatment of liver- or lung-limited metastatic colorectal cancer as one possible approach.

For Zambian patients, a useful first step is to provide the complete colonoscopy, biopsy, histopathology, CT/MRI scans, molecular reports and previous treatment records for an Indian colorectal cancer specialist review before travelling.

The final treatment plan should be determined by the treating multidisciplinary cancer team after detailed evaluation.