Colorectal cancer (CRC) remains one of the most formidable health challenges worldwide, ranking as the third most prevalent malignancy and a leading cause of cancer-related mortality. Despite global advancements in cancer diagnosis and treatment, regional epidemiological data often remain sparse, impeding tailored healthcare strategies. A groundbreaking study from Bhutan provides new insights into the clinical and epidemiological patterns of colorectal cancer in this Himalayan kingdom, reflecting trends that may inform both local and global oncology practices.
The study, conducted at Bhutan’s sole center equipped with onco-surgical services, the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), offers a cross-sectional analysis of CRC patients diagnosed over a six-year interval from 2018 to 2024. It marks a pioneering effort to systematically document patient profiles in this resource-limited setting, highlighting demographic, symptomatic, pathological, and treatment-related features of CRC within Bhutanese society.
From a geographic perspective, the highest incidence rates emerged from eastern and southern districts, with Trashigang displaying the most cases (28 patients, 15.4%), followed by Pema Gatshel, Mongar, Samtse, and Sarpang. This geographic clustering prompts speculation about potential environmental, dietary, or genetic factors endemic to these regions, warranting further analytic epidemiological investigations.
Age distribution revealed a mean diagnostic age of 61.5 years, underscoring colorectal cancer as a disease predominantly affecting older adults. Nearly half the cohort comprised males (52.2%), consistent with global CRC gender patterns that often show a slight male predominance. Notably, 45.1% of patients were aged 65 or older, emphasizing the need for age-specific screening and early detection protocols tuned to Bhutan’s demographic spectrum.
Clinically, patients presented chiefly with abdominal pain (26.4%), altered bowel habits (19.2%), and per rectal bleeding (18.1%). These symptoms epitomize classical CRC manifestations; however, their relatively moderate frequency underscores challenges in early-stage detection, as these signs can overlap with benign gastrointestinal disorders, potentially delaying diagnosis.
Tumor localization predominantly involved the middle and lower rectum (23.6%) and the right colon (22%). Such tumor site distribution aligns with global observations, where left-sided and rectal cancers are commonly reported, influencing surgical approaches and adjuvant therapy decisions. The predominance of rectal tumors may reflect specific anatomical, physiological, or perhaps lifestyle-related factors unique to Bhutanese patients.
Staging data unearthed that a substantive proportion of patients presented with advanced disease: 32.4% at Stage III and 8.8% at Stage IV. Advanced presentation often correlates with poorer prognosis and limited therapeutic efficacy, underscoring the critical imperative to enhance early detection mechanisms through public health interventions, awareness campaigns, and possibly genetic screening where feasible.
Histopathological characterization identified adenocarcinoma as the dominant subtype (20.9%), confirming the malignant histology typically associated with colorectal cancer globally. However, the relatively low percentage might suggest either underreporting or diagnostic challenges in subtyping, calling for strengthened pathology services and enhanced diagnostic accuracy in Bhutan’s healthcare framework.
In treatment paradigms, the majority of patients were managed with a combination of surgery and chemotherapy (40.7%), reflecting contemporary standard-of-care protocols for operable and locally advanced CRC. This combined modality approach, though resource-intensive, illustrates Bhutan’s capacity to deliver multidisciplinary oncological care despite infrastructural limitations, offering hope for improved survival outcomes.
The study’s cross-sectional design and reliance on hospital records represent both strengths and limitations. They facilitate comprehensive capture of demographic and clinical variables over time, but may be influenced by referral bias and incomplete data. Future prospective studies incorporating molecular profiling and patient-reported outcomes could enrich the understanding of CRC’s natural history and therapeutic response in this unique population.
From a public health perspective, these findings illuminate crucial gaps in awareness, access, and early diagnosis of colorectal cancer in Bhutan. The predominance of late-stage disease presentation signals an urgent need for implementing national screening programs, possibly employing stool-based tests or colonoscopy, adapted to local resource constraints and population health literacy levels.
Moreover, lifestyle factors such as diet, physical activity, and tobacco use—known contributors to CRC risk—remain underexplored in this context. Integrating epidemiological surveillance with lifestyle intervention research could potentiate primary prevention strategies, ultimately curbing the CRC burden in Bhutan.
Engaging with community stakeholders and healthcare providers to develop culturally appropriate educational materials may foster earlier health-seeking behaviors. Enhanced training for primary care clinicians to recognize CRC red flags can expedite referrals, potentially improving stage at diagnosis and survival rates.
Health policy makers in Bhutan may utilize these data to prioritize investment in oncology infrastructure, including diagnostic facilities, pathology labs, and therapeutic capacities. Collaborations with international cancer research consortia could facilitate technology transfer, capacity-building, and clinical trial participation, propelling Bhutan to the forefront of CRC care innovation in the Himalayan region.
In conclusion, this landmark study provides vital epidemiological and clinical insights into colorectal cancer in Bhutan, emphasizing the prevalence among older adults and the tendency toward advanced-stage diagnosis. As the first comprehensive report from JDWNRH, it establishes a foundational knowledge base to drive research, public health initiatives, and clinical practice improvements aimed at mitigating the impact of this formidable malignancy.
The implications extend beyond Bhutan’s borders, offering a microcosm of CRC challenges in similarly resource-limited and geographically isolated settings. Bridging gaps in data, awareness, and care delivery holds promise for transforming colorectal cancer outcomes not only in Bhutan but across underserved regions worldwide.
Subject of Research: Clinical and epidemiological characteristics of patients diagnosed with colorectal cancer in Bhutan.
Article Title: Clinical and epidemiological profile of patients with colorectal cancer in Bhutan: a cross-sectional study
Article References:
Pradhan, P., Chophel, U., Wangmo, S. et al. Clinical and epidemiological profile of patients with colorectal cancer in Bhutan: a cross-sectional study. BMC Cancer 25, 1673 (2025). https://doi.org/10.1186/s12885-025-15037-4
Image Credits: Scienmag.com
DOI: https://doi.org/10.1186/s12885-025-15037-4
