S3950 Stage III Colorectal Cancer in a 44-Year-Old Indigenous Highland Patient: Exposing Guatemala’s Rural Screening Gap

Introduction: In 2022 Guatemala recorded 894 new colorectal cancer (CRC) cases and 544 deaths, ranking colorectal cancer (CRC) seventh for incidence and sixth for mortality nationwide—yet still just 5% of the country’s cancer burden. Published data come almost exclusively from urban referral centers; indigenous highland departments such as Quiché are largely invisible in national registries. With no organized fecal immunochemical test (FIT) or colonoscopy program, 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 3 years of untreated constipation and left-sided abdominal pain, culminating in sepsis. Abdominal computed tomography revealed multiple pelvic abscesses and concentric thickening of the sigmoid colon. Emergency laparotomy found a 10 cm perforated tumor 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 tumor buds per 20× field and focal mucinous differentiation with extracellular mucin lakes. 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 3-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 subsidized colonoscopy and culturally adapted education—could down-stage tumors, 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.