Colorectal cancer natural history

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To view the natural history of familial adenomatous polyposis (FAP), click here
To view the natural history of hereditary nonpolyposis colorectal cancer (HNPCC), click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Saarah T. Alkhairy, M.D.; Elliot B. Tapper, M.D.; Roukoz A. Karam, M.D.[2]


The progression from an adenomatous polyp to colorectal cancer may take 10-15 years. Complications may arise if the cancer is not eradicated or from the treatment itself. Complications include intestinal obstruction, gastrointestinal bleeding, metastasis, cancer recurrence, radiation therapy adverse effects, chemotherapy adverse effects, post-surgical complications, metachronous colon cancer, and death. The 5 year survival rates depend upon the stage of colorectal cancer.

Natural history


Common complications of colorectal cancer include:[2]


Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as poor.

The 5 year survival rate at diagnosis of colon cancer:[3]

Stage 5-year Relative Survival Rate
I 74.0%
IIA 66.5%
IIB 58.6%
IIC 37.3%
IIIA 73.1%
IIIB 46.3%
IIIC 28.0%
IV 5.7%

The 5 year survival rate at diagnosis of rectal cancer:[3]

Stage 5-year Relative Survival Rate
I 74.1%
IIA 64.5%
IIB 51.6%
IIC 32.3%
IIIA 74.0%
IIIB 45.0%
IIIC 33.4%
IV 6.0%

CEA level may also be directly related to the prognosis of disease, since its concentration correlates with the bulk of tumor tissue.

Poor prognostic factors of patients with hepatic metastasis include the following:


  1. Winawer SJ (1999). "Natural history of colorectal cancer". Am J Med. 106 (1A): 3S–6S, discussion 50S-51S. PMID 10089106.
  2. Tebbutt, N C (2003). "Intestinal complications after chemotherapy for patients with unresected primary colorectal cancer and synchronous metastases". Gut. 52 (4): 568–573. doi:10.1136/gut.52.4.568. ISSN 0017-5749.
  3. 3.0 3.1 Amin, Mahul (2017). AJCC cancer staging manual. Switzerland: Springer. ISBN 978-3-319-40617-6.

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