This review identified and mapped the current evidence on emergency presentation of colorectal cancer in Africa.

Scoping review based on methodology by Arksey and O’Malley.

Medline (via PubMed), Embase and African Journals Online were searched between 29 January 2025 and 6 March 2025.

Studies published in English and describing the burden, risk factors and management options for emergency presentation of colorectal cancer in Africa were included. Full-text articles of all epidemiological study designs were considered with no publication date limit. Grey literature such as conference abstracts and letters to the editor were considered if sufficient study detail was provided to map data to the research questions.

Two independent reviewers extracted data from the included studies onto a standardised electronic form. Data were narratively synthesised using predefined themes.

Twenty-seven studies are included in this review. There was wide variability in reported emergency presentation colorectal cancer rates (8.3% to 64.9%). There were few data on early mortality, and none on long-term outcomes following surgery for colorectal cancer. Emergency presentation of colorectal cancer was characterised clinically by bowel obstruction, bowel perforation and peritonitis. Only one study reported on risk factors for emergency presentation of colorectal cancer. Use of diagnostic modalities was variable and depended on resource availability. Surgery was the mainstay of treatment. Endoscopic stenting was only available as a treatment option in South Africa.

Emergency presentation of colorectal cancer is a significant clinical, oncological and health system metric, yet there is a dearth of evidence on the subject in the African context. Available evidence demonstrates the need for more studies on emergency presentation of colorectal cancer, focused on risk factors, prevalence, treatment options and short-term and long-term outcomes.

Despite the benefits of early diagnosis, most cancers in sub-Saharan African (SSA) countries are diagnosed at an advanced stage due to late presentation of symptoms, inadequate referral systems and poor diagnostic capacity. Health communication interventions have been used extensively in high-income countries to increase people’s awareness of cancer symptoms and encourage timely help-seeking. However, in SSA, there is still limited evidence on the effectiveness of these interventions and existing evaluations are mainly focused on communicable diseases rather than cancer.

A randomised, multisite, controlled community trial will evaluate a culturally tailored health infographic toolkit delivered in rural and urban settings in the Western Cape Province in South Africa and Harare and surrounding provinces in Zimbabwe. Participants will be randomised to receive one of three African aWAreness of CANcer and Early Diagnosis (AWACAN-ED) cancer awareness tools, coproduced with local communities, comprising health communication infographics with descriptions of breast, cervical and colorectal cancer symptoms plus messages to encourage consultation with primary care providers if symptoms occur, all presented in English and four local languages. We will recruit 144 participants in each of the three intervention groups (N=432). The primary outcome will be recall of symptoms and the secondary outcomes will be (1) intention to seek help, (2) emotional impact and (3) acceptability of the toolkit. Outcomes will be measured preintervention and at two points postintervention: after 15 min and 1 month.

Ethical approval was obtained in both participating countries, South Africa (148/2025) and Zimbabwe (363/2021). All participants will be required to provide written informed consent prior to participation. Findings will be disseminated through peer-reviewed publications, conference presentations and the AWACAN-ED programme website.

PACTR202505475803308.