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Colorectal Cancer: Warning Signs

Bowel cancer symptoms no Nigerian should ignore

Colorectal cancer (cancer of the colon and rectum) is increasing in Nigeria as diets become more westernised and physical activity decreases. While less common than in Western countries, it is increasingly seen in Nigerian teaching hospitals. The disease is largely preventable and highly curable if detected early — 90% survival for stage I compared to less than 10% for stage IV. Most Nigerians have never heard of bowel cancer or the warning symptoms, leading to late presentation and poor outcomes.

Signs and Symptoms

✓ Change in bowel habit lasting more than 4 weeks: diarrhoea, constipation, or alternating pattern
✓ Rectal bleeding: fresh or dark blood mixed with or coating the stool
✓ Black tarry stools (melaena): from right-sided colon cancer bleeding
✓ Unexplained weight loss and loss of appetite
✓ Abdominal pain, bloating, or cramping
✓ Feeling of incomplete emptying after defecation (tenesmus) — rectal cancer
✓ Iron deficiency anaemia without obvious cause: pallor, fatigue, breathlessness

Risk Factors

When to Seek Help

See a doctor within 2 weeks — red flag symptomsRectal bleeding with or without change in bowel habit; unexplained weight loss with bowel symptoms; mass felt in the abdomen; unexplained iron deficiency anaemia in any adult over 40
Routine screening from age 50Colonoscopy every 10 years from age 50 for average-risk individuals; earlier and more frequently for high-risk (family history, IBD, polyps); available at gastroenterology departments of teaching hospitals
EmergencyAcute bowel obstruction (no stool or gas passage for 48+ hours with severe abdominal pain and vomiting) — may be caused by colorectal cancer; go to A&E

Tests & Diagnosis

🧪 Digital rectal examination (DRE)
Doctor examines the lower rectum with a gloved finger — detects low rectal tumours; simple and should be done in all adults with rectal symptoms
🧪 Colonoscopy
Flexible camera examination of the entire colon — the gold standard; detects cancer and polyps (precancerous lesions); allows biopsy; available at major Nigerian teaching hospitals
🧪 Flexible sigmoidoscopy
Examines the lower colon only — useful where full colonoscopy is not available
🧪 CT colonography (virtual colonoscopy)
CT scan reconstruction of the colon; less invasive than colonoscopy but requires same bowel preparation; available at some Nigerian centres
🧪 CT chest, abdomen, pelvis
Staging imaging — assesses lymph nodes, liver (most common site of metastasis), and lung metastases

Treatment Options

1
Surgery
Resection of the cancerous segment of bowel — the primary treatment; hemicolectomy (right or left), sigmoid colectomy, or anterior resection for rectal cancer; laparoscopic approach available at major Nigerian centres
2
Colostomy
Permanent stoma (bowel opening onto abdomen with bag) sometimes necessary for very low rectal cancers or emergency surgery — significant adjustment required; stoma care support essential
3
Adjuvant chemotherapy
FOLFOX (fluorouracil + oxaliplatin) or CAPOX for stage III colon cancer after surgery — significantly reduces recurrence; available at oncology departments of teaching hospitals
4
Chemoradiotherapy for rectal cancer
Pre-operative concurrent chemotherapy and radiotherapy for locally advanced rectal cancer shrinks tumour before surgery — improves complete resection rates
5
Targeted therapies (bevacizumab, cetuximab)
For metastatic colorectal cancer with specific molecular features; highly effective but very expensive; limited availability in Nigeria

Frequently Asked Questions

Is rectal bleeding always cancer?
No — most rectal bleeding in Nigeria is from haemorrhoids (piles) or anal fissures. However, bleeding should always be investigated to exclude cancer, particularly if associated with change in bowel habit, weight loss, or in patients over 40. Do not assume haemorrhoids without examination.
Are haemorrhoids the same as bowel cancer?
No — haemorrhoids (piles) are dilated veins in the lower rectum and anus, causing bleeding and discomfort. They are not cancerous and do not become cancerous. However, bleeding from haemorrhoids can mask or be confused with bleeding from a rectal cancer above — always have rectal bleeding properly assessed.
Can bowel cancer be prevented?
Significantly reduced by: increasing dietary fibre (fruits, vegetables, whole grains, legumes); reducing processed and red meat; maintaining healthy weight; regular exercise; not smoking; limiting alcohol; and colonoscopy screening to remove polyps before they become cancerous.
Is colonoscopy available in Nigeria?
Yes — colonoscopy is performed at gastroenterology departments of federal teaching hospitals (LUTH, UCH, UNTH) and many private hospitals. The procedure requires bowel preparation (laxatives) the day before. It is performed under sedation and takes 20-45 minutes.
Does bowel cancer always require a colostomy bag?
No — most colon and many rectal cancers can be removed with restoration of bowel continuity (no permanent stoma). Permanent colostomy is needed for very low rectal cancers and sometimes in emergency situations. Discuss specifically with your surgeon.

Related Pages

Prostate Cancer Screening in NigeriaPalliative Care in NigeriaCancer Treatment Options in NigeriaChildhood Cancers in Nigeria

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