Skip to main contentShah's Gastro, Cancer & Robotic Surgery Centre · Ahmedabad & Gandhinagar
Sigmoid colon cancer treatment in Ahmedabad · Gota OPD, Ahmedabad · Apollo Hospital, Bhat, Gandhinagar
The sigmoid is the S-shaped last loop of the colon, just above the rectum, and it is one of the commonest places in the large bowel for a cancer to grow. When the cancer is found on a planned colonoscopy, the usual treatment is a keyhole operation that removes the sigmoid with its blood supply and lymph nodes and joins the bowel again, followed by chemotherapy only if the final report shows the need. When it first shows itself as a blocked or burst bowel, the order changes: the blockage is dealt with first, by a stent or an emergency operation, and the planned treatment follows.
The sigmoid lies low in the left side of the pelvis. Its blood comes from one main artery, the inferior mesenteric artery, and its lymph nodes travel along that artery — so the operation is built around that vessel. Because the sigmoid joins the rectum, the first question on every scan is where exactly the tumour sits: a cancer at the junction with the rectum may need the rectal pathway instead.
Shah’s Gastro, Cancer & Robotic Surgery Centre. Trained in super-specialty surgical gastroenterology programmes, qualified twice over in the specialty, with 18 years of experience in colon and gastro cancer surgery. Colonoscopy review, CT staging, keyhole and open colon resection, emergency surgery for blocked or perforated bowel, coordination of stenting and chemotherapy, stoma care and long-term follow-up sit within one practice.
Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
Colon Cancer Surgeon · Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad
Google rating 4.89 from 216 reviews at the Gota clinic, and 4.94 from 18 reviews at Apollo, Bhat.
A sigmoid cancer usually announces itself through the bowel habit: stools becoming looser or more frequent for more than a month, dark blood mixed with the stool, a feeling of not emptying, or cramps on the left side. Some people have no bowel symptoms at all and are found because of iron-deficiency anaemia — in any man, or in a woman after the menopause, anaemia without an obvious cause is investigated with a colonoscopy. In India a large share of colon cancers are first seen as an emergency: a bowel so narrowed that it blocks, with swelling, vomiting and no passage of wind, or a bowel that has burst. The left colon is narrower than the right and its contents are firmer, which is why blockage is a particular feature of sigmoid cancer.
The sigmoid is also the home of diverticular disease — small pouches in the bowel wall that can become inflamed. Diverticulitis and sigmoid cancer can look almost identical on a CT scan: both thicken the bowel wall, both cause left-sided pain, and both can narrow the bowel. The difference is settled by a colonoscopy with biopsy, never by the scan alone.
Features that make cancer more likely on a scan include a short thickened segment with sharp “shoulders”, enlarged lymph nodes next to the bowel, and spots in the liver. Inflammation from diverticulitis tends to involve a longer segment with stranding of the fat around it. When a patient has been treated for diverticulitis, a colonoscopy is done once the inflammation has settled, because a cancer can hide behind the same picture. Other conditions that can mimic a growth include inflammatory bowel disease, an infection or a narrowing from reduced blood supply. A polyp — a benign growth from the lining — is removed during colonoscopy; a polyp that turns out to contain cancer is assessed on its own merits, sometimes needing no further operation.
The order is fixed: colonoscopy with biopsy first, then a CT scan of the chest, abdomen and pelvis to stage the cancer, then blood tests including CEA. Every colon cancer is tested for mismatch repair (MMR) or microsatellite instability (MSI). Only when these are complete is a treatment plan made.
| Test | What it decides |
|---|---|
| Full colonoscopy to the caecum, with biopsy | The diagnosis; and whether a second growth or polyps are present elsewhere in the colon, because the whole colon must be cleared |
| Ink tattoo at the growth during colonoscopy | Where the tumour is at surgery, when it is too small to feel from outside |
| CT colonography, or colonoscopy after surgery | If a blocking growth stops the scope, the colon beyond it is checked another way — never left unexamined |
| Contrast CT of the chest, abdomen and pelvis | The stage: how deep the tumour has grown, nearby lymph nodes, and spread to the liver or lungs |
| CEA blood test | A baseline to follow after treatment — not a diagnosis on its own |
| MMR or MSI test on the biopsy | Screens for Lynch syndrome, guides chemotherapy for stage II, and opens immunotherapy if the cancer has spread |
| Blood count, kidney and liver tests, albumin, clotting | Fitness for surgery; anaemia and nutrition are corrected before a planned operation |
| MRI of the liver | Only when a liver spot on CT is uncertain; a PET-CT is not routine |
A rigid scope or the CT also confirms the height of the tumour. A growth within reach of the rectum, below the fold of the abdominal lining, follows the rectal cancer pathway, which may involve treatment before surgery; a true sigmoid cancer does not. Genetic tests on the tumour such as RAS and BRAF are needed only if the cancer has spread, not to treat cancer confined to the bowel.
After the operation, four items in the pathology report decide whether chemotherapy is needed: how many lymph nodes were examined and how many contain cancer, whether the cut edges are clear, the MMR or MSI status, and any high-risk features — growth through the bowel wall, cancer in small vessels or nerves, perforation or poor differentiation.
At least twelve lymph nodes should be examined. Fewer than twelve is itself treated as a high-risk feature, because it means the stage may be underestimated. This is why the operation removes the full fan of tissue carrying the nodes, not only the tumour. The final stage — and therefore the chemotherapy decision — is known only after this report, usually at the two-week visit.
Treatment climbs with the stage. Early cancers need surgery alone. Cancers that have reached the lymph nodes need surgery followed by chemotherapy. Cancers that have spread are treated with medicines first, and some patients with limited spread to the liver or lungs are still offered an operation aimed at removing all disease.
| Stage | What it means | Usual plan |
|---|---|---|
| Stage I | Confined to the inner layers of the wall, no nodes | Operation alone |
| Stage II, average risk | Through the muscle, no nodes, no high-risk feature | Operation, then observation |
| Stage II, high risk | Growing through the wall, perforation, blockage, fewer than twelve nodes examined, or vessel or nerve invasion | Operation; chemotherapy discussed as a shared decision |
| Stage III, lower risk | A few nodes involved, tumour not through the wall | Operation, then three months of CAPOX chemotherapy |
| Stage III, higher risk | Growing through the wall, or many nodes involved | Operation, then six months of chemotherapy |
| Stage IV | Spread to the liver, lungs or elsewhere | Medicines chosen by tumour genetics; removal of limited liver or lung spread in selected patients |
A stage II cancer that is MSI-high (or dMMR) is not given single-drug fluoropyrimidine chemotherapy; it has a favourable outlook and gains no benefit from it. Fitness matters as much as stage: a patient who is fully active receives the standard plan, one who is limited may receive a single tablet drug such as capecitabine, and one confined to bed is offered supportive care. Every non-metastatic case, and every case with spread, is discussed by the multidisciplinary team before treatment begins.
Not every sigmoid cancer goes straight to an operation. A cancer confined to a polyp that has been completely removed at colonoscopy may need no further surgery. A cancer that has spread widely is treated with medicines, with surgery kept for a blockage or bleeding. And a patient too unwell for a major operation may have a blocking growth opened with a stent instead.
When the cancer has spread, the medicines are chosen from the tumour’s genetics. An MSI-high cancer is treated first with immunotherapy (pembrolizumab), which works better than chemotherapy for this group. A RAS-normal cancer on the left side — which includes the sigmoid — is usually treated with chemotherapy and an anti-EGFR antibody; a RAS-mutant cancer with chemotherapy and bevacizumab; a BRAF V600E cancer has targeted options after the first line. When spread is limited to a few spots in the liver or lungs, the team considers removing them with the bowel growth, at the same time or in stages — a decision made at the team meeting, never in a corridor. Early involvement of palliative care and nutrition support is part of treatment for everyone with spread, not a sign of giving up.
The operation removes the sigmoid colon with the tumour, at least five centimetres of healthy bowel on either side, and the whole fan of fat (mesentery) that carries its lymph nodes, tying the inferior mesenteric artery near its origin. The two cut ends are then joined. When the tumour is low in the sigmoid, the join is made to the upper rectum, and the operation is called an anterior resection.
Four principles are not negotiable. The artery is tied at its root so the nodes along it come out with the specimen, which is called high ligation with complete mesocolic excision. At least twelve nodes are aimed for. If the tumour is stuck to the bladder, the womb or another loop of bowel, that part is removed in one piece with it, because peeling a tumour off a neighbouring organ can leave cancer behind. And the tumour is not handled or spilled. The ink tattoo placed at colonoscopy shows where a small tumour lies.
Laparoscopic (keyhole) surgery is the validated standard for colon cancer, with the same cancer results as open surgery and a faster recovery; robotic surgery is an acceptable alternative in experienced hands. An open operation is chosen for a bulky tumour stuck to other organs, when several organs must be removed together, or when previous surgery has left dense adhesions — that is a sound judgement, not a failure. Before the operation, a stoma nurse marks a site on the abdomen if there is any chance of a stoma, so that the bag sits comfortably if it is needed.
A blocked sigmoid is an emergency, but the right treatment depends on how fit the patient is. In a fit patient the growth is removed and the bowel joined, sometimes with a temporary stoma to protect the join, or a stoma alone (Hartmann’s operation) if the patient is unstable or the abdomen is contaminated. In a patient who is unfit, or whose cancer has spread, a metal stent placed through a scope can open the blockage and avoid an emergency stoma.
| Situation | First treatment |
|---|---|
| Blocked bowel, fit patient | Resection; a primary join with or without a protective stoma, or Hartmann’s operation if unstable or contaminated |
| Blocked bowel, unfit patient or spread disease | Self-expanding metal stent — as a bridge to a planned operation, or as lasting relief |
| Burst (perforated) bowel | Resection, thorough washing of the abdomen, and usually a stoma |
| Heavy bleeding from the tumour | Resuscitation and urgent senior surgical review |
A tender, hugely swollen bowel upstream of the block is a warning that it may burst, and that patient is reviewed by the consultant surgeon the same day. A perforation, even without lymph node involvement, counts as a high-risk feature and is part of the later chemotherapy discussion. After a stent, the planned operation is usually done once the bowel has settled and the colon has been examined, so that it can be done as a keyhole procedure with a join rather than an emergency stoma.
Before a planned colon operation, the body is prepared as carefully as the bowel. Anaemia is corrected — with intravenous iron if tablets are too slow — diabetes is controlled, and smoking and alcohol are stopped at least four weeks ahead. The bowel is cleaned with a preparation taken together with oral antibiotics, which lowers the chance of infection and leaks.
★★★★★
“My wife was suffering from colon cancer. Dr harsh shah performed her surgery 1 year back. And now she is cancer free with the grace of almighty and dr harsh shah’s treatment. He treats patients as his own family member. I may blindly tell any patient to approach him. Dr. harsh. Thank you is not enough. My sincere gratitude for all the help and advice you have given to us! — Joseph Sibi, Google review, Gota clinic listing”
★★★★★
“(Translated by Google) Dr. Harsh Shah's personality is very nice. He always talks in a good way. He has undergone surgery for colon cancer. Without any problem. Yours faithfully.🙏 — Ismailbhai Shaikh, Google review, Gota clinic listing”
★★★★★
“I am writing to express my sincere gratitude for the exceptional care provided by Dr. Harsh Shah and his team. Dr. Harsh Shah is an outstanding expert in intestinal surgery, executing complex procedures with remarkable calm and precision. Dealing with gastrointestinal diseases is incredibly stressful for both patients and their families. In my experience, what sets Dr. Harsh Shah apart is his incredible patience; he takes the time to listen to every question and provides clear, reassuring answers to every concern. As a grateful patient, I highly commend Dr. Harsh Shah and the entire team at Apollo Hospital. They did not just treat our physical condition—they truly cared for our mental and emotional well-being — Dipen Shah, Google review, Apollo Hospital, Bhat listing”
The video is a patient of Dr Harsh Shah speaking after laparoscopic colon cancer surgery. The reviews below are from the two Google listings, quoted exactly as the families wrote them.
Recovery after a keyhole sigmoid colectomy follows a planned day-by-day path. Patients sit out of bed and drink on the day of surgery, eat and walk on the first day, and most go home on the fourth or fifth day once eating, passing wind or stool, walking and comfortable on tablets.
| Day | What happens |
|---|---|
| Day of surgery | Sitting out of bed within hours, clear fluids, chewing gum, pain relief with few opioids |
| Day one | Normal diet as tolerated, walking four times, urinary catheter removed, drip stopped |
| Day two | Full diet, more walking, pain relief by mouth only, wind usually passing |
| Day three | Bowel opening; drain removed if one was placed; readiness for home checked |
| Day four or five | Home, with a written follow-up date, a date to discuss the report and warning signs |
No tube through the nose and no drain are used routinely. A patient with a stoma goes home only when the patient or a family member can change the bag without help. The path is stopped and the surgeon called at once for a fast pulse, fever, new or worsening abdominal pain, or a patient who was improving and then goes backwards — these can be the first signs of a leak from the join.
Every colon operation carries risks, and they are higher in an emergency, in older or frailer patients, and when the bowel was blocked or burst. The complication that matters most is a leak from the join, which usually shows itself between the third and seventh day. The figures that apply to each patient are given at the consent discussion, not quoted generally.
General: bleeding needing transfusion, wound infection, clots in the leg or lung, heart or breathing problems, anaesthetic complications, and conversion from keyhole to open surgery. Specific to this operation: a leak from the join, a slow return of bowel function (ileus), injury to the ureter (the tube from the kidney), a collection or abscess in the abdomen, the need for a temporary or permanent stoma, narrowing of the join, a hernia at the wound later, and adhesions causing blockage years later. There is a risk to life, which is higher after emergency surgery. About the disease: the final stage is known only after the report, chemotherapy may be advised, the cancer can return despite complete removal, and colonoscopy is needed for life. If a stoma is possible at all, it is discussed every time, even when unlikely.
Most stage I and average-risk stage II patients need no chemotherapy. Stage III patients are advised chemotherapy, ideally starting within six to eight weeks of the operation, because its benefit falls after eight weeks. For lower-risk stage III, three months of CAPOX is the standard, with far less nerve damage than six months.
CAPOX combines oxaliplatin by drip every three weeks with capecitabine tablets; FOLFOX is a fortnightly drip-based alternative. Higher-risk stage III is treated for six months. Older patients, or those who cannot take oxaliplatin, receive capecitabine alone. Before any fluoropyrimidine, a DPYD test is done where available, because a patient who lacks this enzyme can be seriously harmed by a standard dose. Chemotherapy is given by the medical oncologist, with the surgeon following the patient alongside.
Follow-up is every three months for three years — examination, weight and CEA — then every six months to five years, with a CT scan every year for three to five years and a colonoscopy one year after surgery. If that colonoscopy is normal, the next is at three years and then every five years.
At two weeks the wound is checked, the report is discussed and, if needed, a referral for chemotherapy is made. A colon that could not be fully examined before surgery is examined within three to six months after it. Genetic counselling is offered for a MMR-deficient tumour not explained by a common change in the tumour (MLH1 methylation), for anyone under fifty, or for a strong family history. A rising CEA with a normal CT is not ignored: the test is repeated in four to six weeks and a PET-CT considered. Stoma reversal, if a temporary stoma was made, is planned as part of follow-up.
The cost depends on whether the operation is planned or an emergency, keyhole or open, whether a stoma is made, and how long the stay is. A written estimate is given and explained before a planned admission.
Apollo Hospital, Bhat, works with the major insurers and cashless schemes, and the office handles pre-authorisation directly. Chemotherapy and stent costs are estimated separately. Bring: colonoscopy and biopsy reports with photographs, CT images on a disc or drive with reports, CEA and blood reports, any earlier discharge papers, a list of medicines, the insurance card and identification.
No. Diverticulitis, inflammation and benign polyps can look similar on a scan. A colonoscopy with biopsy settles the diagnosis before any treatment is planned.
Most planned keyhole operations end with the bowel joined and no stoma. A stoma is more likely after an emergency for a blocked or burst bowel, and is often temporary; the possibility is discussed before every operation.
The rest of the colon must still be checked, either by CT colonography before surgery or by colonoscopy within three to six months after it, because a second growth can be present.
It depends on the final pathology report. Stage I and most stage II cancers need none; cancers in the lymph nodes are usually advised three or six months of chemotherapy, started within six to eight weeks.
It screens for an inherited cause (Lynch syndrome), it decides whether chemotherapy helps in stage II, and it decides whether immunotherapy is the first treatment if the cancer has spread.
Laparoscopic surgery is the standard for most sigmoid cancers and gives the same cancer results as open surgery with a faster recovery. Open surgery is chosen for a bulky tumour stuck to other organs or a difficult abdomen.
Shah’s Gastro, Cancer & Robotic Surgery Centre — Gota, Ahmedabad
Consultations, review of colonoscopy and CT reports, follow-up after surgery and chemotherapy.
Google: Dr Harsh Shah · 4.89 from 216 reviews
Directions to the Gota clinic · +91-63555-64601
Apollo Hospital — Bhat, Gandhinagar
Apollo Hospital International Limited, Plot No. 1 A, GIDC Bhat Industrial Estate, Bhat, Gandhinagar.
Google: Dr Harsh Shah – Robotic GI Surgeon · 4.94 from 18 reviews
Directions to Apollo, Bhat · WhatsApp +91-63555-64601
Patients come to Ahmedabad for colon cancer treatment from across Gujarat — Gandhinagar, Mehsana, Banaskantha, Nadiad, Anand, Bhavnagar, Rajkot, Jamnagar and Kutch — and from southern Rajasthan and western Madhya Pradesh.
Told there is a growth in the sigmoid colon, or admitted with a blocked bowel? The colonoscopy report and photographs, the biopsy report, the CT scan images and report, and the CEA and blood reports can be sent ahead of the appointment, so the consultation starts with them already read; treatment is decided at the consultation, after examination. Call +91-63555-64601 · Send the reports ahead on WhatsApp
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