You will undergo a physical examination as well as blood tests, a chest x-ray, and an electrocardiogram (EKG). A few days before the procedure, your intestines will need to be cleaned out. This may mean that you will have to be on a clear liquid diet for one to three days before the procedure, followed with laxatives on the day of the procedure. Please let your doctor know about all medication that you are taking as some will need to be stopped before the procedure. You will probably need to stop your liquid diet six to eight hours before the procedure, or as recommended by the doctor.

A transanal excision may be performed with local or general anesthesia, depending on your doctor’s recommendation and your preference. The surgery may be done with or without an endoscope. (When performed with an endoscope, this procedure is called transanal endoscopic microsurgery.) Polyps, if present, will be removed with a wire snare then loops around the polyp. Electricity is then used to burn or destroy the tissue. Other growths will be removed with appropriate tools. A minimal amount of normal tissue (margin) is also usually removed. No incision will be made on the skin and no stitches are necessary.

Some pain is normal after the procedure and can be managed with medication. You will probably be able to go home the next day if there are no complications. You can return to normal activities as you are comfortable doing so, but will likely need to take it easy for a few days. The doctor will discuss further treatment with you as it is common for patients to follow up the surgery with radiation and/or chemotherapy for the most effective results.

Complications are uncommon with this procedure, but may include bleeding from the surgical site and perforation of the colon or rectum. There is also the risk of infection and reaction to anesthesia, usually if general anesthesia is used.

• ·        If you are taking any blood-thinning medication/anticoagulant, please let your doctor know as some may need to be stopped before you travel for the procedure.

  ·        Travelers to Thailand should plan to stay in the country for at least two to three weeks or for the entire duration of treatment.

  ·        If you plan to return home after the procedure, please speak to your doctor before making travel arrangements.

  ·        During your follow-up appointment your medical team will assess your health and your incision and you will receive documents detailing your medical and treatment history and your "Fit to Fly" certificate (if needed).

The success of the procedure depends on a number of factors. Please discuss the likelihood of success with your doctor before the procedure.

What if the procedure is not performed?

Cancerous cells, if not removed, will spread to nearby organs and then other parts of the body. If cancer, when in stage 1, is not removed, it will progress deeper into the layers of the rectum and move up the digestive system. Treatment is then more complicated and requires extensive surgery that can impact quality of life. Cancer is most effectively treated in its earliest stages. Ultimately, if left untreated, cancer is life-threatening.

There are many alternatives to transanal excision, depending on the extent of the disease. If only a polyp is found to be cancerous, a polypectomy can be carried out to remove it. If the cancer has spread into the wall of the rectum, that section of the rectum, along with some healthy tissue, will be removed. Sometimes lymph nodes near the rectum have to be removed so they can be looked at under a microscope for signs of cancer. Radiofrequency ablation may be an option in some cases; this involves inserting a tiny probe will electrodes into the area to kill cancer cells. Cryosurgery may be another alternative, using an instrument to freeze and destroy abnormal tissue.