Jehovah’s Witness followers pose a clinical dilemma to the medical practitioners due to their religious belief of an absolute prohibition of blood transfusion under any circumstances. We present a case of Jehovah’s Witness follower who underwent an ultra-low anterior resection for rectal cancer after neo-adjuvant chemo-radiotherapy. The challenges in the perioperative management are highlighted and managed accordingly.

Squamous cell carcinoma of the rectum is a very rare malignancy. In the literature, the incidence has been reported as 0.25 to 0.1 per 10000 colorectal carcinomas. Due to its rarity, the treatment and behavior of this tumor have only been discussed in case reports. As a result, several theories regarding their pathogenesis have been proposed. We will describe our experience in managing this rare malignancy in a 69-year-old man who presented with altered bowel habit. Surgery remains the mainstay of treatment. Issues regarding additional treatment have been presented in the literature. The rarity of this tumour also raises issues regarding criteria for diagnosis which we will try to highlight and discuss.

Introduction: Many studies have shown the effectiveness of educational modules on increasing colorectal cancer screening uptake at individual level but not adjusted for potential clustering effect such as workplace. Longitudinal studies on workplace colorectal cancer screening require a series of analysis under different conditions due to heterogeneity of workplace population. To achieve this, a sensitivity analysis based on Generalized Estimating Equations was conducted to determine the robustness of the predictive performance of health education module in increasing screening uptake. Materials and Method: A parallel, single blind, cluster randomized trial was conducted among 15 organizations in Kuantan, Pahang. Intervention group received a complex Health Education Module comprising of group education, practical session on fecal occult blood test usage and WhatsApp group follow-up, while control group received standard colorectal cancer screening brochure. Sensitivity analyses using intention to treat analysis with interaction term, compatibility term, behavioral intention term and key assumption term were performed. Data were imputed and analysed using generalized estimating equation with IBM SPSS version 23. Pooled adjusted odds ratio was calculated using random effect model with inverse variance weighting using RevMan version 3.5. Results: A total of 166 participants from 15 organizations were recruited in the study. Intervention and control group were comparable at baseline (P>0.05). Health Education Module given in intervention group significantly increased the uptake of FOBT by nearly 5 times compared to control group in sensitivity analyses (pooled adjusted OR=4.60, 95% CI=2.65-7.99, I2=47%, P<0.001). Conclusions:  Health Education Module was robust in facilitating fecal occult blood test uptake in different predictive models. Health Education Module should be implemented as a workplace health promotion program to improve colorectal cancer screening for early detection and prompt treatment.