Clinicopatholigical Presentation and Treatment Modalities of Colorectal Cancer in a Low-Middle-Income Country

Background
Colorectal cancer (CRC) is one of the leading causes of cancer morbidity and mortality worldwide, with a rising incidence in low- and middle-income countries (LMICs). In Sub-Saharan Africa (SSA), limited screening, diagnostic delays, and weak health infrastructure contribute to late-stage presentation and poor outcomes. This study assessed the clinicopathological presentation and treatment modalities of CRC patients in a tertiary cancer centre within a resource-constrained setting.
Methods
A retrospective review was conducted using electronic medical records of CRC patients managed at the MEDSERVE–LUTH Cancer Centre, Lagos, Nigeria, between May 2019 and June 2024. Data extracted included demographic characteristics, clinical presentation, histology, stage, metastatic sites, and treatment received. Descriptive and correlation analyses were performed using SPSS version 27.
Results
A total of 448 CRC patients were analyzed, with a mean age of 54.07 ± 14.08 years (range: 10–89 years). Males comprised 57.2%. The most frequent presenting symptoms were rectal bleeding (51.3%), weight loss (44.2%), and abdominal pain (38.2%). Adenocarcinoma was the predominant histological type (87.3%), with 77.5% of tumors located on the left side. Nearly half (46%) presented with stage IV disease. The liver (27.2%) and lungs (20.5%) were the most common metastatic sites. Surgery was performed in 64.1% of patients, chemotherapy administered to 35.9%, and radiotherapy to 44.4%. Comorbidities were present in 46.2% of patients, mainly hypertension and diabetes.
Conclusion
Colorectal cancer in Nigeria continues to present at a relatively young age and advanced stage, with left-sided adenocarcinoma predominating. Limited access to screening, diagnostics, and comprehensive treatment underlies poor outcomes in LMICs. Strengthening public awareness, early detection programs, and health-system capacity are essential to improve survival and reduce the growing burden of CRC in Sub-Saharan Africa.

Colorectal Cancer, Clinicopathological Presentation

1. Zingeta GT, Worku YT, Getachew A, Feyisa JD, Furgassa H, Belay W, et al. Clinical presentation, treatment patterns, and outcomes of colorectal cancer patients at Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia: A prospective cohort study. Cancer Rep (Hoboken) [Internet]. 2023 Jul 15 [cited 2025 Oct 13];6(9):e1869. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10480423/ [Google Scholar] [Crossref]

2. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021 May;71(3):209–49. [Google Scholar] [Crossref]

3. Bebington B, Singh E, Fabian J, Jan Kruger C, Prodehl L, Surridge D, et al. Design and methodology of a study on colorectal cancer in Johannesburg, South Africa. JGH Open. 2018 Aug;2(4):139–43. [Google Scholar] [Crossref]

4. Ashktorab H, Vilmenay K, Brim H, Laiyemo AO, Kibreab A, Nouraie M. Colorectal Cancer in Young African Americans: Is It Time to Revisit Guidelines and Prevention? Dig Dis Sci. 2016 Oct;61(10):3026–30. [Google Scholar] [Crossref]

5. Davis DM, Marcet JE, Frattini JC, Prather AD, Mateka JJL, Nfonsam VN. Is it time to lower the recommended screening age for colorectal cancer? J Am Coll Surg. 2011 Sep;213(3):352–61. [Google Scholar] [Crossref]

6. Agyemang-Yeboah F, Yorke J, Obirikorang C, Batu EN, Acheampong E, Frempong EA, et al. Patterns and presentations of colorectal cancer at Komfo-Anokye teaching hospital Kumasi, Ghana. Pan Afr Med J. 2017;28:121. [Google Scholar] [Crossref]

7. Irabor DO, Afuwape OO, Ayandipo OO. The Present Status of the Management of Colon and Rectal Cancer in Nigeria. Journal of Cancer Research [Internet]. 2014 [cited 2025 Oct 13];2014(1):267190. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1155/2014/267190 [Google Scholar] [Crossref]

8. Suryani ND, Wiranata JA, Puspitaningtyas H, Hutajulu SH, Prabandari YS, Handaya AY, et al. Determining factors of presentation and diagnosis delays in patients with colorectal cancer and the impact on stage: a cross sectional study in Yogyakarta, Indonesia [Internet]. 2024 [cited 2025 Oct 13]. Available from: http://ecancer.org/es/journal/article/1761-determining-factors-of-presentation-and-diagnosis-delays-in-patients-with-colorectal-cancer-and-the-impact-on-stage-a-cross-sectional-study-in-yogyakarta-indonesia [Google Scholar] [Crossref]

9. Deo SVS, Kumar S, Bhoriwal S, Shukla NK, Sharma A, Thulkar S, et al. Colorectal Cancers in Low- and Middle-Income Countries—Demographic Pattern and Clinical Profile of 970 Patients Treated at a Tertiary Care Cancer Center in India. JCO Global Oncology [Internet]. 2021 Dec [cited 2025 Oct 13];(7):1110–5. Available from: https://ascopubs.org/doi/10.1200/GO.21.00111 [Google Scholar] [Crossref]

10. Dare AJ, Olatoke SA, Okereke CE, Abdulkareem FB, Adeyeye A, Badejo O, et al. The African Research Group for Oncology: A decade fostering colorectal cancer research in Nigeria. J Surg Oncol [Internet]. 2023 Nov [cited 2025 Oct 17];128(6):1011–20. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11325740/ [Google Scholar] [Crossref]

11. Alatise OI, Ayandipo OO, Adeyeye A, Seier K, Komolafe AO, Bojuwoye MO, et al. A Symptom-Based Model to Predict Colorectal Cancer in Low-Resource Countries: Results From a Prospective Study of Patients at High Risk for Colorectal Cancer. Cancer [Internet]. 2018 Jul 1 [cited 2025 Oct 17];124(13):2766–73. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6005740/ [Google Scholar] [Crossref]

12. Wismayer R, Kiwanuka J, Wabinga H, Odida M. Colorectal adenocarcinoma in Uganda: are right-sided and left-sided colon cancers two distinct disease entities? World J Surg Oncol [Internet]. 2023 Jul 22 [cited 2025 Oct 17];21:215. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10362740/ [Google Scholar] [Crossref]

13. Tazinkeng NN, Pearlstein EF, Manda-Mapalo M, Adekunle AD, Monteiro JFG, Sawyer K, et al. Incidence and risk factors for colorectal cancer in Africa: a systematic review and meta-analysis. BMC Gastroenterol [Internet]. 2024 Sep 9 [cited 2025 Oct 17];24:303. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11382465/ [Google Scholar] [Crossref]

14. Awedew AF, Asefa Z, Belay WB. Burden and trend of colorectal cancer in 54 countries of Africa 2010–2019: a systematic examination for Global Burden of Disease. BMC Gastroenterology [Internet]. 2022 Apr 25 [cited 2025 Oct 17];22(1):204. Available from: https://doi.org/10.1186/s12876-022-02275-0 [Google Scholar] [Crossref]

15. Katsidzira L, Laubscher R, Gangaidzo IT, Swart R, Makunike-Mutasa R, Manyanga T, et al. Dietary patterns and colorectal cancer risk in Zimbabwe: A population based case-control study. Cancer Epidemiology [Internet]. 2018 Dec 1 [cited 2025 Oct 17];57:33–8. Available from: https://www.sciencedirect.com/science/article/pii/S187778211830331X [Google Scholar] [Crossref]

16. Parker RK, Ranketi SS, McNelly C, Ongondi M, Topazian HM, Dawsey SM, et al. Colorectal cancer is increasing in rural Kenya: challenges and perspectives. Gastrointest Endosc [Internet]. 2019 Jun [cited 2025 Oct 17];89(6):1234–7. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7476216/ [Google Scholar] [Crossref]

17. Onwuka JU, Wuraola FO, Owoade IA, Ogunyemi YF, Di Bernardo M, Dare AJ, et al. Delays in Presentation, Diagnosis, and Treatment among Gastrointestinal Cancer Patients in Southwest Nigeria. JCO Glob Oncol [Internet]. 2024 Oct [cited 2025 Oct 17];10:e2400060. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC12212892/ [Google Scholar] [Crossref]

18. McCabe M, Penny C, Magangane P, Mirza S, Perner Y. Left-sided colorectal cancer distinct in indigenous African patients compared to other ethnic groups in South Africa. BMC Cancer [Internet]. 2022 Oct 24 [cited 2025 Oct 17];22:1089. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9590207/ [Google Scholar] [Crossref]

19. Wismayer R, Kiwanuka J, Wabinga H, Odida M. Risk Factors for Colorectal Adenocarcinoma in an Indigenous Population in East Africa. Cancer Manag Res [Internet]. 2022 Sep 6 [cited 2025 Oct 17];14:2657–69. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9464000/ [Google Scholar] [Crossref]

20. Baldwin M, Niyibizi BA, Rangira D, Rangira B, Kazindu MK, Seifu D, et al. Colorectal cancer disease profile and treatment patterns at an urban tertiary hospital in Rwanda [Internet]. 2024 [cited 2025 Oct 17]. Available from: http://ecancer.org/en/journal/article/1687-colorectal-cancer-disease-profile-and-treatment-patterns-at-an-urban-tertiary-hospital-in-rwanda [Google Scholar] [Crossref]

21. Alatise OI, Knapp GC, Sharma A, Chatila WK, Arowolo OA, Olasehinde O, et al. Molecular and phenotypic profiling of colorectal cancer patients in West Africa reveals biological insights. Nat Commun [Internet]. 2021 Nov 24 [cited 2025 Oct 17];12(1):6821. Available from: https://www.nature.com/articles/s41467-021-27106-w [Google Scholar] [Crossref]

22. Kassem NM, Emera G, Kassem HA, Medhat N, Nagdy B, Tareq M, et al. Clinicopathological features of Egyptian colorectal cancer patients regarding somatic genetic mutations especially in KRAS gene and microsatellite instability status: a pilot study. Egyptian Journal of Medical Human Genetics [Internet]. 2019 Nov 19 [cited 2025 Oct 17];20(1):20. Available from: https://doi.org/10.1186/s43042-019-0028-z [Google Scholar] [Crossref]

23. Agyemang-Yeboah F, Yorke J, Obirikorang C, Batu EN, Acheampong E, Frempong EA, et al. Patterns and presentations of colorectal cancer at Komfo-Anokye teaching hospital Kumasi, Ghana. Pan Afr Med J [Internet]. 2017 Oct 6 [cited 2025 Oct 17];28:121. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC5837135/ [Google Scholar] [Crossref]

24. Ngwa W, Addai BW, Adewole I, Ainsworth V, Alaro J, Alatise OI, et al. Cancer in sub-Saharan Africa: a Lancet Oncology Commission. Lancet Oncol. 2022 Jun;23(6):e251–312. [Google Scholar] [Crossref]

25. Qiu M, Hu J, Yang D, Cosgrove DP, Xu R. Pattern of distant metastases in colorectal cancer: a SEER based study. Oncotarget [Internet]. 2015 Oct 15 [cited 2025 Oct 17];6(36):38658–66. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC4770727/ [Google Scholar] [Crossref]

26. Makau-Barasa LK, Greene SB, Othieno-Abinya NA, Wheeler S, Skinner A, Bennett AV. Improving Access to Cancer Testing and Treatment in Kenya. J Glob Oncol [Internet]. 2017 Aug 4 [cited 2025 Oct 17];4:JGO.2017.010124. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6180746/ [Google Scholar] [Crossref]

27. Brand NR, Qu LG, Chao A, Ilbawi AM. Delays and Barriers to Cancer Care in Low‐ and Middle‐Income Countries: A Systematic Review. Oncologist [Internet]. 2019 Dec [cited 2025 Oct 17];24(12):e1371–80. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6975966/ [Google Scholar] [Crossref]

28. Ranganathan P, Dare A, Harrison EM, Kingham TP, Mutebi M, Parham G, et al. Inequities in global cancer surgery: Challenges and solutions. J Surg Oncol [Internet]. 2024 Jan [cited 2025 Oct 17];129(1):150–8. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11186466/ [Google Scholar] [Crossref]

29. Salako O, Okediji PT, Habeebu MY, Fatiregun OA, Awofeso OM, Okunade KS, et al. The pattern of comorbidities in cancer patients in Lagos, South-Western Nigeria. Ecancermedicalscience [Internet]. 2018 Jun 13 [cited 2025 Oct 17];12:843. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6027981/ [Google Scholar] [Crossref]

30. Rashed Adam T, Bakhamees BH, Abdulla Ali Ahmed Ali M, Hamed AM, Alotaibi A, Mohamed Hamato A, et al. A Systematic Review of the Impact of Dietary and Lifestyle Factors on Colorectal Cancer Prevention in Gulf Cooperation Council Countries. Cureus [Internet]. [cited 2025 Oct 17];16(9):e69439. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11474415/ [Google Scholar] [Crossref]

• Tribal Child Nutrition and Health in District of Sundargarh: A Public Health Review of ICDS Intervention
• Knowledge, Attitudes and Practices Towards Prostate Cancer Screening Amongst Men Aged 40-60 Years in The Buea Health District: A Cross-Sectional Study
• Compliance with JCI Protocols: A Focus on Employee Safety
• Influence and Involvement of Teachers in Menstrual Hygiene Management of Female Secondary School Students in Kogi State, Nigeria
• A Critical Evaluation of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana in Bihar