Asian Journal of Case Reports in Surgery

Rectal cancer is an emerging public health concern in Nigeria, with increasing incidence and late presentation in many tertiary centers. Lower rectal carcinoma commonly presents with painless rectal bleeding, a symptom frequently attributed to benign anorectal conditions, resulting in diagnostic delay. We report the case of a 63-year-old Nigerian female with type 2 diabetes mellitus who initially presented in 2018 in a private facility with rectal bleeding and underwent polypectomy. In 2022, she was diagnosed with stage I lower rectal carcinoma and was said to have received neoadjuvant chemotherapy instead of the standard neoadjuvant chemoradiotherapy. Also declined definitive surgical management. Subsequent overseas evaluation reportedly showed dysplasia; however, documentation was unavailable. She presented to us for the first time in 2026 with recurrent rectal bleeding. Digital rectal examination upon evaluation revealed a fungating mass 4cm from the anal verge. Colonoscopy with biopsy confirmed moderately differentiated adenocarcinoma of the rectum. This case highlights the multifactorial causes of delayed rectal cancer diagnosis and treatment in Nigeria, including symptom overlap with benign disease, fragmented continuity of care, sociocultural resistance to stoma formation, and lack of structured surveillance systems. Strengthening patient education, documentation practices, and multidisciplinary management is critical to improving outcomes.