By Racheal Abujah,
In spite of campaigns urging Nigerians to seek early medical treatment, cancer is still frequently misdiagnosed.
When severe illnesses masquerade as common problems like diarrhea or ulcers, patients often delay seeking the urgent care they need to survive.
Following initial treatment, persistent symptoms often lead to follow-up consultations or transitions to other healthcare facilities.
Months can elapse under revised prescriptions before clinicians consider the critical differential diagnosis: could this be cancer?
For oncologists, that possibility should not be ignored when symptoms persist, recur, worsen or are accompanied by warning signs such as unexplained weight loss or abnormal bleeding.
Dr Ololade Kehinde, Oncologist and Medical Director of Jacaranda Cancer Centre, said gastric and colorectal cancers could initially resemble common gastrointestinal conditions.
Kehinde said some patients were repeatedly treated for ulcer or other gastrointestinal complaints without an underlying cancer being recognised.
“Sometimes they have constipation; sometimes they have abdominal discomfort and all that; but you just realise that that same individual suddenly will start dropping weight,” he said.
He urged healthcare practitioners to maintain a high index of suspicion when symptoms persisted or recurred despite treatment.
Kehinde also warned women not to dismiss bleeding during sexual intercourse or unusual vaginal discharge as ordinary problems, urging proper medical evaluation.
Dr Sam Kwis, Radiation and Clinical Oncologist and Chief Oncologist, Kano Cancer Treatment Centre, similarly said cancer could initially present with symptoms that appeared ordinary.
Kwis urged Nigerians to pay attention when a symptom became persistent, recurrent, unexplained or progressively worse, and encouraged healthcare workers to reconsider an initial diagnosis when a patient did not improve as expected.
These warnings go beyond cancer awareness.
They raise a more difficult question about Nigeria’s health system: how long can a patient remain inside the healthcare system before receiving the right diagnosis?
Some patients told the News Agency of Nigeria (NAN) that a year can disappear before diagnosis.
A 2025 study published in BMC Health Services Research, titled Diagnosis of cancer in the South and North of Nigeria: duration and causes of delay, provides important evidence.
Led by Olufunke Fayehun and colleagues, the study examined 264 patients with breast, colorectal, head and neck, and cervical cancers recruited from tertiary facilities in Kano and Ibadan.
The researchers found a median interval of 12 months between the first cancer symptom and diagnosis. For head and neck cancers, the median diagnostic delay was 15 months.
Patients spent a median of three months from first noticing symptoms to seeing a healthcare professional. After their first formal presentation, another five months passed, on average, before diagnosis.
The median number of health facilities visited before diagnosis was three, while a quarter of colorectal and cervical cancer patients visited four or more centres.
The researchers concluded that “long delays were observed” and that more than half of the delay occurred after patients had entered the local health sector.
The finding challenges the familiar explanation that late cancer diagnosis is simply the result of patients waiting too long before seeking care.
According to experts, some patients undoubtedly delay seeking help.
But others seek care, and still spend months moving through the system.
When an ulcer is not an ulcer, colorectal cancer illustrates the problem particularly clearly.
The Fayehun-led study documented cases in which colorectal cancer was initially attributed to conditions including haemorrhoids, ulcers, appendicitis and typhoid.
The misdiagnoses occurred in both public and private healthcare facilities. Some patients underwent multiple investigations and received varied or contrasting conclusions before cancer was eventually identified.
For patients, each incorrect assumption can mean another prescription, another consultation, another test and another month.
Recent cases from Ile-Ife illustrate the consequences.
Three patients eventually diagnosed with colorectal cancer had initially been treated for other conditions. One was diagnosed with appendicitis, while two patients with prolonged stomach pain had reportedly been told they had ulcers.
All eventually required major surgery and prolonged chemotherapy.
Prof. Olusegun Alatise, a professor of surgery involved in their treatment, told CNN that although colorectal cancer was once considered rare in the setting, the teaching hospital was seeing about a case every week.
The cases show why persistent symptoms require reassessment rather than endless repetition of the original diagnosis.
Experts say that age can create another diagnostic blind spot.
A study by Adamu Samaila and Muhhamad Borodo at Aminu Kano Teaching Hospital found that 57.14 per cent of the colorectal cancer patients studied were below 50 years, while more than 70 per cent had aggressive variants of the disease.
The researchers said that the finding does not mean that every young person with abdominal symptoms has cancer. It does, however, challenge the assumption that colorectal cancer is exclusively a disease of older adults.
They said that when age and familiar symptoms point clinicians towards a common ailment, cancer can remain outside the immediate differential diagnosis. That is why persistence matters.
The consequences become more serious when patients eventually reach specialist care with advanced disease.
In one cohort of 138 Nigerian colorectal cancer patients reported by the African Colorectal Cancer Group, 64.3 per cent had stage IV disease, while 26.4 per cent had stage III disease.
The 12-month overall survival for that particular cohort was 48.4 per cent.
The figures should not be interpreted as representative of every Nigerian colorectal cancer patient, but they demonstrate the consequences of advanced presentation.
A 2024 JCO Global Oncology study of gastrointestinal cancer patients in Southwest Nigeria also found that about half did not reach tertiary care until more than 90 days after symptoms began.
The researchers highlighted limitations in primary healthcare capacity for diagnosing many cancers; and diagnosis itself is not the end of the journey.
Surgery, chemotherapy, imaging, pathology and supportive care can impose substantial financial pressure on households largely paying out of pocket.
Thus, a patient can lose months waiting for the correct diagnosis and then lose additional time because treatment is unaffordable or difficult to sustain.
The relationship between gastrointestinal infection and cancer is also attracting research interest.
A modelling and evidence-synthesis study led by Prof. Shailja Shah, MD, MPH, a gastroenterologist and Professor of Medicine at the University of California San Diego, and colleagues examined the possible association between Helicobacter pylori (H. pylori) exposure and colorectal cancer.
Shah said that based on estimates from 43 studies, H. pylori exposure was associated with a 1.59-fold higher risk of colorectal cancer.
She said a pooled model estimated that 22 per cent of global colorectal cancer cases could potentially be related to H. pylori exposure, although the estimate fell to 11.9 per cent when based on 14 population-based and cohort studies.
She stressed that the findings were exploratory and that further well-designed studies were required to establish whether the association was causal.
“The finding therefore does not establish H. pylori as a cause of colorectal cancer.
“For clinical practice, however, it reinforces an important principle: an ulcer or H. pylori diagnosis should not automatically become the final explanation for persistent gastrointestinal symptoms,” she said.
She said that when symptoms continue, recur or are accompanied by weight loss, bleeding or significant bowel changes, the diagnosis may need to be reconsidered.
Nigeria’s diagnostic problem cannot be explained entirely by poverty.
Patients with greater financial means may have easier access to private hospitals, diagnostic centres and specialists; but access does not automatically guarantee accuracy.
A Biomedical Laboratory Scientist, Mr Odeh Agabi, said that the Nigerian diagnostic-delay study found colorectal cancer misdiagnoses in both public and private facilities, with some patients moving between several providers before the diagnosis became clear.
Agabi said that a scan is useful only when the appropriate investigation is requested and correctly interpreted.
“A pathology result matters only when it reaches the clinician and leads to appropriate action.
“A referral matters only when the patient actually reaches the next level of care.
“Money can improve access, but it cannot buy back time lost through fragmented care,” he said.
Dr Kemi Adebowale, a healthcare policy expert, said that repeated treatment for ulcer, haemorrhoids, typhoid or other common conditions before cancer was diagnosed inevitably raised questions about accountability.
“But a missed diagnosis is not automatically medical negligence.
“Medical negligence involves questions of duty of care, the applicable professional standard, whether that standard was breached and whether the breach caused harm.” he said.
The core takeaway from doctors, scientists, and patients is clear: persistent symptoms should never be ignored.
While an everyday stomach ache, change in bowel habits, or vaginal discharge isn’t always a sign of something severe, it becomes a red flag when it won’t go away.
Experts say the goal isn’t to spark panic over minor ailments, but to ensure people take lasting changes seriously.
When cancer is caught late, the critical question isn’t just why it happened, but how long it went unnoticed—because with cancer, early detection saves lives. (NANFeatures)
News Agency of Nigeria.
