P4600 - Stage III Colorectal Cancer in a 44-Year-Old Indigenous Highland Patient: Exposing Guatemala’s Rural Screening Gap

Isidro Pérez coché, MD, MSc¹, Carlos Fernando. Funez López, MD, MSc², Jennifer Judith. López González, MD³, Katherine Estefanía Palacios Rosales, MD, MSc², Michael López Santos, MD⁴, Luis Fernando. López Díaz, MS³, Bernardo D. Lopez Samayoa, MD, MPH⁵
1Hospital Nacional de Uspantán, Quiché, Guatemala C.A., Guatemala, Solola, Guatemala; 2Hospital Nacional de Uspantán, Quiché, Guatemala C.A., Quiche, Quiche, Guatemala; 3Hospital Nacional de Uspantán, Quiché, Guatemala C.A., Quetzaltenango, Quetzaltenango, Guatemala; 4Universidad San Carlos de Guatemala, Uspantan, Quiche, Guatemala; 5Johns Hopkins Bloomberg School of Public Health, San Bernardino, CA

Introduction: In 2022 Guatemala recorded 894 new colorectal cancer (CRC) cases and 544 deaths, ranking CRC 7ᵗʰ for incidence and 6ᵗʰ for mortality nationwide — yet still just 5 % of the country’s cancer burden. Published data come almost exclusively from urban referral centres; indigenous highland departments such as Quiché are largely invisible in national registries. With no organised faecal immunochemical test (FIT) or colonoscopy programme, fewer than 3 % of Guatemalans undergo any CRC screening. We present a late-presenting rural case to illustrate how these gaps translate into advanced disease in young adults.

Case Description/

Methods: A 44-year-old K’iche’ woman from Uspantán (Quiché) reported three years of untreated constipation and left-sided abdominal pain, culminating in sepsis. Abdominal CT revealed multiple pelvic abscesses and concentric thickening of the sigmoid colon. Emergency laparotomy found a 10 cm perforated tumour 10 cm above the rectosigmoid junction with ~150 mL purulent fluid; no hepatic lesions or regional adenopathy were seen. The surgical team performed a Hartmann’s resection with 5 cm margins and end colostomy. Histopathology showed a well-differentiated adenocarcinoma with 5-9 tumour buds per 20× field (Fig. 1) and focal mucinous differentiation with extracellular mucin lakes (Fig. 2). She recovered and was referred for adjuvant chemotherapy at the national oncology unit in Guatemala City.

Discussion:

This patient typifies Guatemala’s emerging CRC profile: diagnosis before age 50, prolonged symptom neglect, and life-altering surgery. Her three-year diagnostic delay reflects low cancer awareness, heavy reliance on traditional healers, and a 150 km journey to tertiary care. Living with a permanent stoma in poverty adds stigma and recurring supply costs. Nationally, the absence of FIT-based screening and scarce rural endoscopy capacity allow CRCs to progress silently; more than 60 % present at stage III/IV. Implementing low-cost FIT outreach in primary-care posts—paired with subsidised colonoscopy and culturally adapted education—could down-stage tumours, particularly in indigenous regions where poverty exceeds 80 %. Enhanced case documentation from rural hospitals would also refine incidence estimates now derived largely from modelling. This vignette therefore not only expands the clinical literature beyond Guatemala City but also underscores an actionable path toward equity-driven cancer prevention in Central America.

 


Figure: H&E image of sigmoid colon tumour displaying 5–9 tumour buds per 20× field, consistent with an intermediate tumour-budding score.


Figure: Deeper H&E section of sigmoid colon adenocarcinoma showing mucinous differentiation with prominent extracellular mucin lakes.

Disclosures:
Isidro Pérez coché indicated no relevant financial relationships.
Carlos Funez López indicated no relevant financial relationships.
Jennifer López González indicated no relevant financial relationships.
Katherine Estefanía Palacios Rosales indicated no relevant financial relationships.
Michael López Santos indicated no relevant financial relationships.
Luis López Díaz indicated no relevant financial relationships.
Bernardo Lopez Samayoa indicated no relevant financial relationships.

Isidro Pérez coché, MD, MSc¹, Carlos Fernando. Funez López, MD, MSc², Jennifer Judith. López González, MD³, Katherine Estefanía Palacios Rosales, MD, MSc², Michael López Santos, MD⁴, Luis Fernando. López Díaz, MS³, Bernardo D. Lopez Samayoa, MD, MPH⁵. P4600 - Stage III Colorectal Cancer in a 44-Year-Old Indigenous Highland Patient: Exposing Guatemala’s Rural Screening Gap, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.