Colorectal Cancer Cases Rise in Nigeria as Misdiagnoses Delay Treatment

Three residents of Ile-Ife and nearby areas in southwestern Nigeria spent years being treated for illnesses they did not actually have. An entrepreneur was diagnosed with appendicitis, while a university lecturer and a civil servant who had complained of abdominal pain for more than a year were prescribed treatment for ulcers. All three were later diagnosed with colorectal cancer.

After receiving the correct diagnosis, the patients had to undergo complex surgeries and nearly a year of gruelling chemotherapy. They received treatment at Obafemi Awolowo University Teaching Hospital under the supervision of Professor of Surgery Olusegun Alatise.

In the early 2000s, Olusegun Alatise was taught that colorectal cancer was extremely rare in sub-Saharan Africa. However, the cases he saw at his hospital soon painted a very different picture.

In the United States and Western Europe, approximately two out of three patients with colorectal cancer survive for at least five years after diagnosis. In Nigeria, the rate is far lower – just one in five. One of the main reasons is that people seek help too late: they dismiss warning signs or spend a long time being treated for other illnesses.

Which colorectal cancer symptoms should not be ignored

According to Olusegun Alatise, many patients arrive at the teaching hospital only after the disease has already spread. The combination of rectal bleeding, weight loss and changes in bowel habits should be a particular cause for concern.

In 2014, a group of African oncologists launched the first of three pilot projects aimed at detecting cancer early. Free colonoscopies were offered to 362 people who had experienced rectal bleeding. Nearly 20% of those screened were diagnosed with colorectal cancer, and 74% of the tumours were at a potentially curable stage.

The study showed that bleeding alone is not always a reliable sign of cancer. At the same time, the risk of colorectal cancer rises markedly when weight loss and changes in bowel movements occur alongside bleeding.

As part of another initiative, healthcare workers at local clinics were trained to look out for characteristic symptoms, ask patients more detailed questions about their health and refer them promptly for further tests. An information campaign was also carried out on the radio for residents of Ile-Ife, and leaflets were distributed.

The pilot programme showed that spreading this information produces practical results. More than 300 people were referred for free colonoscopies. Early-stage cancer was detected in four patients, while another 13 had precancerous polyps with a high risk of becoming malignant. The polyps were successfully removed.

Why patients delay treatment

Some patients said that previous doctors had avoided speaking openly about cancer because the subject remains taboo. Two people learned about their diagnosis not from healthcare professionals but from relatives. Others delayed seeking help because of fear, religious beliefs, lack of transport or the high cost of consultations. Some patients tried to treat themselves with traditional remedies.

The high cost of testing is an additional barrier. In Nigeria, a standard colonoscopy costs approximately half the average monthly income. Researchers also concluded that cheaper faecal occult blood tests would be difficult to introduce on a large scale: a positive result requires a follow-up colonoscopy, and performing so many procedures could place an excessive burden on the healthcare system.

In 2013, Olusegun Alatise and American surgeon Peter Kingham founded the African Research Group for Oncology. Today, its network brings together more than two dozen medical institutions in Nigeria, over 60 staff members and nearly 10,000 participants in various research programmes.

At the beginning of the year, the group began trials of tislelizumab, a drug that helps the immune system recognise and destroy cancer cells. Scientists believe the medicine may be particularly effective for patients with a certain genetic trait. In Nigeria, it occurs approximately three times as often as in the United States.

The university lecturer who survived a late diagnosis now shows no signs of the disease. Her story has become a reminder of the importance of timely screening: the brief discomfort of screening is far less than the consequences of advanced colorectal cancer.