Gastric Cancer in the Zambian Copperbelt: Endoscopic and Histopathological Profile from the First Documented Audit at Ndola Teaching Hospital

Background Gastric cancer surveillance across sub-Saharan Africa remains sparse, and Zambia’s Copperbelt Province, the country’s second most populous and industrial region, has no previously published gastric cancer data. This study reports the first systematic audit of endoscopically suspected gastric malignancy at Ndola Teaching Hospital (NTH), the regional tertiary referral centre for the Copperbelt. Methods We conducted a retrospective audit of all patients with endoscopically suspected gastric malignancy presenting to NTH between March 2023 and December 2025. Data on age, sex, endoscopic findings, site of lesion, and histopathological diagnosis were extracted from gastroscopy records and the DISA electronic health information system. Descriptive statistics were generated using SPSS version 29.0. Reporting followed STROBE guidelines. Results Fifty-nine patients were included. Thirty-six (61.0%) were male and 23 (39.0%) were female (M:F ratio 1.57:1). Median age at presentation was 60 years (range 30–78). Fourteen patients (23.7%) were aged 50 years or younger, and five (8.5%) were aged 40 or younger. Histopathological data were retrievable for 48 of 59 patients (81.4%); 11 (18.6%) had no result recorded. Thirty-one patients (52.5%) had confirmed malignancy and 17 (28.8%) showed no evidence of malignancy (gastritis or non-specific inflammation). Adenocarcinoma, including reclassified non-standardised carcinoma descriptors, accounted for 30 of 31 malignancies (96.8%); 25.8% were explicitly graded as poorly differentiated or undifferentiated. The antrum or pylorus and the gastric body were the commonest sites of confirmed tumours (11 of 31 each). Conclusion Gastric malignancy identified endoscopically at NTH is male-predominant, affects a clinically significant proportion of patients under 50, and is dominated by adenocarcinoma of frequently aggressive grade. An 18.6% rate of unrecoverable histopathological results indicates a structural deficit in the diagnostic pathway. These findings establish the first baseline for gastric cancer burden in the Zambian Copperbelt.