الفهرس 
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Abstract
Rectal cancer become very common nowadays due to multiple genetic mutations. Bleeding per rectum ,anal discharge and weight loss are the most common presentations. The diagnostic tools are MRI ,lower GIT endoscopy and biopsy. Surgical treatment is the standard treatment for rectal cancer. But due to proximity of the lower rectal tumors to the anal canal and its sphincters ,dissection of the tumor away of them with safety margin is very difficult ,so abdominoperineal resection was the standard treatment.
Due to changes in the chemo radiotherapy that became a standard preoperative treatment option especially in lower rectal tumors, as it leads to tumor shrinkage so resection away from the anal canal became easier so we can avoid permanent colostomy .
In our study, that was carried on 30 patients with lower rectal carcinoma, all are subjected to neoadjuvant Chemoradiation ,the response to neoadjuvant chemo radiotherapy was different as there was no response in 10% of cases and abdominoperineal resection was the treatment in these cases ,while incomplete response was recorded in 70% of cases but was beneficial as most of these cases had sphincter saving surgery and the remaining had abdominoperineal resection .
In the remaining 20% of cases there was complete response to neoadjuvant chemo radiotherapy in which inter sphincter resection was done. But 2 cases refused surgery, recurrence had occurred in the 2 cases while there was no recurrence in the 4 cases who undergone inter sphincter resection.
Recently there is a theory called watch and wait theory for casas with complete response to neoadjuvant chemotherapy in lower rectal cancer ,in
Summary
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which close observation of these cases is done after complete disappearance of the tumor after neoadjuvant chemo radiotherapy.
But in our study ,during follow up of these cases for 2 years recurrence had occurred in the 2 cases, while the 4 cases of inter sphincteric resection no recurrence had occurred, this is because there is morphological cure but there was no pathological cure and residual malignant foci was found in the specimen after resection.