BMJ Case Reports 2017; doi:10.1136/bcr-2017-219289
  • Global health

A 15-year-old Nepali boy with metastasised colorectal cancer

  1. Zvi Howard Perry2,3
  1. 1 The Medical School for International Health, Ben-Gurion University of the Negev Faculty of Health Sciences, Beer Sheva, Israel
  2. 2 Surgery Ward A, Soroka University Medical Center, Beer Sheva, Israel
  3. 3 Department of Epidemiology and Health Evaluation, Ben-Gurion University of the Negev Faculty of Health Sciences, Beer Sheva, Israel
  1. Correspondence to M.Sc. Chloe Pinto, chloe.pinto{at}
  • Accepted 11 May 2017
  • Published 3 June 2017


Nepal suffers from vast inequalities in modern healthcare. The low-income country wrestles with far-reaching insufficiencies in minimal preventative medicine, health awareness, limited infrastructure and difficult topography—all of which contribute to poor access and poor care-seeking behaviour. Our patient came from rural Nepal, where primary healthcare outposts are frequently understaffed and underequipped. He received supportive treatment in his village from the time symptoms presented until he was diagnosed 2 years later, at a tertiary medical centre, with colorectal cancer. An examination of the relevant literature indicates that younger patients often present in later stages of the disease due to initial misdiagnosis or overlooking colorectal cancer as a possibility. Beyond the rarity of the patient’s condition, the logistical and financial obstacles he faced in Nepal, particularly outside of the capital of Kathmandu, deterred his access to a higher level of care and delayed his correct diagnosis and treatment.


  • Contributors CP, planned, conducted, reported and acquired the information for this case report. ZHP contributed to the writing of the paper and revised the draft paper.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Register for free content

The full text of all Editor's Choice articles and summaries of every article are free without registration

The full text of Images in ... articles are free to registered users

Only fellows can access the full text of case reports (apart from Editor's Choice) - become a fellow today, or encourage your institution to, so that together we can grow and develop this resource

Don't forget to sign up for content alerts so you keep up to date with all the case reports as they are published, and let us know what you think by commenting on the Editor's blog

Navigate This Article