Abstract Introduction: Colorectal cancer (CRC) is a disease of global importance. The practice and formulation of effective health policies in developing countries is marred by lack of appropriate colorectal cancer screening and up-to-date cancer registry. Aims: To study the frequency and presentation pattern of CRC in two metropolitan cities in a region of Nigeria. Materials and Method: An observational study of lower gastrointestinal (GI) endoscopy performed from April 2013 to April 2018 at private/public health facilities with endoscopy service in 2 major cities in the Niger Delta area, Nigeria. A questionnaire was distributed for completion to all practicing endoscopists in the area. The variables collated included demographics, indications, endoscopic findings and histopathology. Analysis was done using IBM SPSS Statistics for Windows, version 20 Armonk, NY. Results: A total of 466 flexible lower GI endoscopies were recorded: 434 colonoscopies; 32 sigmoidoscopies. Histologically confirmed cases of CRC were 45 (44 adenocarcinoma and 1 non-Hodgkin’s lymphoma) with age range from 28 years to 79 years; mean age of 52.3±13.7 years. There were 30 males and 15 females; predominant site was the rectum with 25 (55.6%) cases recorded. Conclusion: Colorectal cancer is not uncommon in this Nigerian population. A targeted screening policy is recommended.