Skip to main contentLast updated: 04-Nov-2026
Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
Rectal Cancer Surgeon
Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad · 18 years of experience
In short
When a rectal cancer is large or has grown close to the pelvic wall, treatment comes first and surgery follows. This shrinks the tumour and treats hidden cells early.
Total neoadjuvant therapy, or TNT, gives radiation and chemotherapy together before the operation. Many teams now prefer it for higher-risk tumours.
The plan depends on your MRI, your age and your health. A tumour with a certain gene change may need a different path.
Surgery for the rectum is explained on the middle rectal cancer surgery page. This post covers what is done before the operation.
It is a rectal cancer that has grown through the bowel wall, or reached nearby glands, or come close to the edge of the pelvis. It has not spread to distant organs.
The MRI decides this. Any one of these findings counts:
Our post on how rectal cancer is staged explains these terms. Each finding pushes the plan toward stronger treatment before surgery.
Treatment before surgery shrinks the tumour, makes a clean removal more likely, and often helps keep the sphincter. It also starts work on hidden cells early.
The cost is time and side effects. You will wait weeks before surgery, and the treatment itself can tire you.
TNT means all the non-surgical treatment is given before the operation. This includes radiation and the full course of chemotherapy.
The older plan was radiation first, then surgery, then months of chemotherapy. Many people could not finish the chemotherapy after a big operation. TNT moves it forward.
| Plan | What it involves | Who it often suits |
|---|---|---|
| Short radiation alone | One week of radiation, then surgery | Older or frail people, or lower-risk tumours |
| Long chemoradiation | About five to six weeks of radiation with a tablet chemotherapy, then surgery after a rest | The usual plan for many higher-risk tumours |
| TNT with short radiation | One week of radiation, then months of chemotherapy, then surgery | High risk of spread, fit enough for chemotherapy |
| TNT with long radiation | Chemotherapy first, then chemoradiation, then surgery | Younger, fit people with a high-risk tumour |
| Chemotherapy alone first | Several cycles of chemotherapy, radiation only if the tumour responds poorly | Selected lower-risk tumours with a clear margin |
| Immunotherapy | Months of an immune drug | Tumours with a mismatch-repair gene change |
The right plan is the one your tumour board agrees on after reading your MRI. It is not the same for everyone.
Both work. Short course takes one week and is easier to schedule. Long course takes over five weeks and is gentler day to day.
Young people who wish to have children should ask about egg or sperm storage before radiation starts.
Yes, in a carefully chosen group. A large trial called PROSPECT showed chemotherapy alone first can work for selected lower-risk tumours.
This route can protect fertility and bowel function. It is a choice made with your team, not a shortcut.
A small group of rectal cancers carry a mismatch-repair gene change, also called MSI-high. These may respond to immunotherapy alone, without radiation or surgery.
Our post on what the pathology report says explains these tests.
After a rest, the MRI and a scope check are repeated. The result decides if you go to surgery, or if close watching is possible.
Surgery after treatment is harder. The tissue is scarred and the planes are less clear. Dr Harsh Shah removes the rectum with its surrounding fat, either by keyhole surgery or open surgery. The choice depends on your pelvis, your build and the tumour. After radiation, a temporary stoma often protects the join.
Four trials shaped today’s plans: RAPIDO, PRODIGE 23, PROSPECT and OPRA. They compared ways of giving treatment before surgery.
| Trial | What it tested | What it showed |
|---|---|---|
| RAPIDO | Short radiation, then chemotherapy, then surgery, against the usual chemoradiation | Fewer spread cancers and more tumours fully cleared. Return in the pelvis was somewhat higher |
| PRODIGE 23 | Strong three-drug chemotherapy first, then chemoradiation | Better time free of cancer and more tumours fully cleared |
| PROSPECT | Chemotherapy alone first, against chemoradiation | Similar cancer control in selected lower-risk tumours, and most avoided radiation |
| OPRA | TNT to raise the chance of keeping the rectum | Many people had no visible tumour and could be watched |
Our post on key trials in rectal cancer goes through them one by one.
No. TNT is a treatment plan. Watch and wait is one possible result after it, offered only when no tumour is left on scans and scope.
Read our page on rectal cancer organ preservation for this path.
It is all the radiation and chemotherapy given before the operation. Surgery comes last. This helps people finish the full chemotherapy and may shrink the tumour more.
A large tumour near the pelvic wall is hard to remove with a clear margin. Treatment first shrinks it, lowers the chance of return in the pelvis, and may help keep the sphincter.
Neither is better for everyone. Short course takes one week. Long course takes over five weeks. Your tumour, age, health and travel needs decide the choice.
In selected lower-risk tumours, chemotherapy alone first is an option. Scans are repeated, and radiation is added if the tumour shrinks too little. It does not suit tumours at the pelvic wall.
A tumour with a mismatch-repair gene change may respond to immunotherapy alone. This can change the whole plan, so the test is done before treatment starts.
Most people do. If the repeat MRI and scope show no tumour, a few are offered close watching instead. That path needs a clear response and strict follow-up.
Usually several weeks after the last treatment. The tumour keeps shrinking in this rest period. Your team sets the date after the repeat MRI.
The full range of rectal cancer care starts at the middle rectal cancer page. For questions before you travel, call +91-63555-64601.
Dr Harsh Shah — Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad
Dr. Jivraj Mehta Hospital, Dr Jivraj Mehta Marg, Vasna, Ahmedabad 380007.
Consultations, review of reports and scans, operations and follow-up. OPD Monday to Saturday, 9 am to 5 pm.
Appointments: +91-63555-64601 · +91-63590-11009 · Hospital 079-2663 6363
Directions to the hospital · WhatsApp +91-63555-64601
Has your MRI shown a rectal tumour that is large, or close to the pelvic wall, or with swollen glands? Treatment usually starts before any operation. Bring your biopsy, MRI and colonoscopy reports. Dr Harsh Shah will go through the plan with you, step by step. Call, or send a message on WhatsApp. Call +91-63555-64601 Ask on WhatsApp
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