Colorectal cancer – can an emergency be avoided?

Dr Simbarashe Chinyowa, one of the AWACAN-ED Scholars at the University of Zimbabwe, attempts to understand why many colorectal cancer patients in Zimbabwe present first as emergencies and whether opportunities for earlier diagnosis are missed.

Colorectal cancer (CRC) is the third most common cancer worldwide and the third most common cause of cancer deaths. Historically, CRC has not been common in Zimbabwe and Sub-Saharan Africa. Still, in the past 10-20 years, the incidence has been increasing, ostensibly due to the Westernisation of diet and lifestyle (1).  In our experience in Harare, many cases of CRC in the public sector present as an emergency admission, with the patient in critical condition.  The disease is often advanced, resulting in poor treatment outcomes (2). Personal, societal, and health-system factors probably contribute to this emergency presentation of CRC.  Understanding these factors will help identify intervention points that could lead to earlier diagnosis, down-staging of disease at diagnosis, and improved treatment outcomes.


The decision to seek help for CRC is complex and multi-layered.  Some challenges are outlined below.

Research outline

I will focus on the emergency presentation of CRC in Zimbabwe and examine the pathway leading up to diagnosis, asking whether this emergency could have been averted?

My research will:

Outcomes & Impact

The results of this research are potentially valuable for clinicians, hospital administrators, and policy leaders in the Ministry of Health and Childcare in Zimbabwe.  I hope to prompt discussion on improved access to care and more efficient distribution of resources around CRC management.


  1. Katsidzira L, Gangaidzo I, Thomson S, Rusakaniko S, Matenga J, Ramesar R. The shifting epidemiology of colorectal cancer in sub-Saharan Africa. lancet Gastroenterol Hepatol. 2017 May;2(5):377–83.
  2. Golder AM, McMillan DC, Horgan PG, Roxburgh CSD. Determinants of emergency presentation in patients with colorectal cancer: a systematic review and meta-analysis. Sci Rep. 2022;12(1):1–13.

Simbarashe is a general surgeon at the University of Zimbabwe. His research interest lies in earlier diagnosis and treatment of cancer in low-income settings. Previous work includes anal HPV and anal cancer precursor lesions. He is currently pursuing a PhD at the University of Zimbabwe funded by the AWACAN-ED programme.

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