Trends in gastrointestinal cancers at a major tertiary hospital in Alexandria, Egypt: a 10-year retrospective study (2010–2019)

BACKGROUND: Gastrointestinal (GI) cancers account for over one-quarter of global cancers, with marked regional variation in site distribution. In Egypt, contemporary data from large urban referral centres remain limited, particularly outside population-based cancer registries. METHODS: A hospital-based retrospective review was conducted of patients diagnosed with GI cancers at Alexandria Main University Hospital between 2010 and 2019. Age, sex, residence, year of diagnosis, and cancer site were analysed using SPSS and Joinpoint regression to assess temporal trends in hospital-registered case counts. Sensitivity analyses examined yearly proportions of GI cancers relative to all cancers to account for fluctuations in hospital volume. RESULTS: Among 21,949 cancers registered during the study period, 3,995 (18.2%) were GI cancers. Colorectal and liver cancers were the most frequently registered GI sites, followed by pancreatic cancer. Using raw counts, overall hospital-registered GI cancer trends showed no statistically significant change across the decade. Small intestinal cancers demonstrated a significant decline in hospital-registered cases during 2015-2019 (annual percent change = - 22.2%; 95% CI - 64.8 to - 5.8; P = 0.019). The mean age at diagnosis was 55.1 ± 12.2 years, and 27.4% of cases were early-onset (< 50 years). Joinpoint analysis by age-onset category showed a significant increase in late-onset cases, while early-onset cases declined after 2014. Males predominated overall (male-to-female ratio 1.38:1), particularly in liver cancers (2.71; 95% CI 2.40-3.10). Patients residing in Alexandria more frequently presented with colorectal and gastric cancers, whereas liver cancers were more common among patients residing outside Alexandria. Sex-specific Joinpoint analyses for major GI cancer sites showed no statistically significant temporal changes. CONCLUSION: GI cancers represent a substantial proportion of hospital-registered malignancies at Alexandria Main University Hospital, with largely stable case-count trends over the past decade. Sensitivity analyses suggest that relative burden may change even when absolute counts appear stable. These findings reflect hospital presentation patterns rather than population incidence and highlight the need for expanded population-based cancer registration and regional surveillance in Egypt.