Colorectal cancer is the 4th most common cancer in the world. The diagnosis is usually made be means of colonoscopy. Staging investigations include CT scan of chest abdomen and pelvis. Current staging classification is the TNM 8 classification. There are various surgical options available according to the site of the cancer. 

Although rectal cancer is often described together with colon cancer its staging and treatment remains different from colon cancer. Diagnosis is usually made by means of colonoscopy. Staging investigations include CT scan of chest abdomen, pelvis and MRI Pelvis. In certain cases, neo-adjuvant chemotherapy or chemo-radiotherapy may be required before undertaking surgery. Operative options include anterior resection or abdominoperineal resection.

Staging and treatment of anal cancer is different from colorectal cancers. Anal cancer usually refers to squamous cell cancer arising in the anal canal. Staging investigations involved CT chest, abdomen, pelvis, MRI pelvis and PET scan. Treatment relies upon chemoradiotherapy.

Haemorrhoids or piles are vascular cushions found in anal canal or lower rectum. They can present as bleeding, perianal pain/itching or a perianal lump. Investigations range from proctoscopy to colonoscopy depending upon risk factors and symptoms. Treatment options range from conservative to a number of surgical options.

The risk of getting colorectal cancer increases with age. Most of the colon cancers arise from benign polyps. Screening for colorectal cancer aims to detect the benign polyps or early stage of colorectal cancer. Screening methods include faecal occult blood testing and faecal immunohistochemical testing. If any of these are positive patient should undergo a colonoscopy.

Rectal prolapse is a condition commonly seen in females. Risk factors include previous pelvic surgery and vaginal delivery. Surgical options include perineal approach (Altemier or Delorme) or abdominal approach (ventral mesh rectopexy or posterior stitch rectopexy). Discussion of these patients within a pelvic floor MDT has now become mandatory in UK and most of the European countries.

Inflammatory bowel disease (IBD) includes Crohn’s disease and Ulcerative colitis. It affects millions of individuals but unfortunately in Pakistan its diagnosis and treatment remain poor. Symptoms can be wide ranged. Diagnostic tests include stool samples, imaging and gastroscopy/colonoscopy with biopsies. Treatment revolves around a multidisciplinary team of gastroenterologists and colorectal surgeons. About one third of patients with IBD will require surgery at some stage. 

Standardized colorectal follow up after resection of colorectal cancer is extremely important to pick up early recurrence. Often the recurrences are localized and solitary which can be treated. An optimal cancer follow-up surveillance programme can result in increased overall patient survival.

Diverticular disease is a benign colorectal condition where benign pockets of colon mucosa pouch out of the colon. This presents more commonly in the European population. Diverticular disease is on rise in Pakistan. Possible reason is the change in Asian diet to westernised one. The common presentations are bleeding per rectum, inflammation, strictures, and perforation. We aim to educate on management of diverticular disease and focus will be added in teaching sessions.

Anal fistula is a very complex condition which results from abscess around anal canal. Due to lack of colorectal specilaist input it can get neglected and not managed in a proper way. This results in transformation of a simple fistula into a complex fistula in ano. Presenting symptoms can be variable and management can be challenging. We aim to pay special attention to this area and will focus on investigation and different treatment options.

Anal fissure is very common condition. We aim to introduce and teach new treatment options. They are poorly understood and managed. The treatment options are also very limited.

Pelvic floor pathologies often get neglected both by patients and clinicians resulting in decreased quality of life. The symptoms range from bladder problems (urinary retention or leakage), defecatory disorders, faecal incontinence and rectal prolapse. Diagnostic tools range from clinical assessment to dynamic imaging and anorectal physiology. It is important to establish the correct diagnosis in order to start the optimal treatment which could range from conservative options of pelvic floor exercises to interventions requiring bowel resection.