Background: Colorectal carcinoma (CRC) is an increasing public health challenge in low- and middle-income countries, where rural populations often experience delayed diagnosis and fragmented care. Real-world data on patterns of care from such settings remain limited. Methods: This retrospective observational study evaluated 140 consecutive patients with histologically confirmed CRC treated between 2019 and 2023 at a tertiary care center serving a predominantly rural population. Demographic characteristics, stage at presentation, tumor site, treatment modalities, tumor marker response, and survival outcomes were analysed using descriptive statistics. Results: The cohort comprised 94 men (67.1%) and 46 women (32.9%), with a mean age at diagnosis of 57 years. All patients were from rural areas. Advanced disease at presentation was common, with stage III (41.4%) and stage IV (17.1%) accounting for the majority; only 12.8% presented with stage I disease. The rectum was the most frequent primary site (30%), followed by the transverse (24.3%) and ascending colon (21.4%). Systemic chemotherapy formed the backbone of treatment, most commonly CAPEOX (50%), while 28.6% received radiotherapy, largely for rectal or locally advanced disease. A high proportion of patients (37.1%) were lost to follow-up, and 25.7% required multiple lines of chemotherapy. Mean overall survival was 20.7 months and mean disease-free survival was 9.7 months. Serum carcinoembryonic antigen levels showed a marked post-treatment decline, indicating partial biochemical response. Conclusions: This study highlights substantial gaps in CRC care in rural settings, characterized by late-stage presentation, treatment discontinuity, and limited survival outcomes. Strengthening early detection strategies, improving access to multidisciplinary oncology services, and ensuring continuity of follow-up are critical to improving outcomes for rural CRC populations. These findings underscore the need for context-specific health system interventions to reduce rural–urban disparities in colorectal cancer care