Rectal Cancer Survival Rate and Prevalence Statistics

Rectal cancer occurs when an uncontrollable growth of unregulated cancer cells form in the tissues of the rectum.

Rectal cancer is commonly grouped together with colon cancer and is referred to as colorectal cancer, as they arise in close proximity and share many common features.

How common is rectal cancer?

Colorectal cancer is the fourth most common cancer diagnosed in the US In 2021, the estimated number of new colorectal cancer cases in the US, according to the American Cancer Society¹, is 149,500.

Since the mid-1980s, the rates of diagnosis for colon or rectal cancer every year have dropped, which is attributed to more people getting screened and adjusting their lifestyle-related risk factors.

In the US, the incidence of colorectal cancer was declining at a rate of approximately 2% per year, slowing to approximately 1% per year from 2013 to 2017. The downward trend is mostly observed in older adults, whereas the incidence of colorectal cancer has been increasing for those under 50 years old.

At-risk demographics

Rectal cancer doesn’t discriminate based on sex or age. Both males and females are similarly at risk of developing colorectal cancer in their lifetime, although it is slightly more prevalent in males. While it is more common among individuals aged 50 years and over, rectal cancer can also occur in younger people.

It is important to undergo regular screening, as the majority of cases of colorectal cancers occur in people with no known risk factors. However, certain hereditary forms of colorectal cancer, a personal or family history of sporadic colorectal cancers or adenomatous polyps, inflammatory bowel disease, and a history of abdominal irradiation can all increase your risk of developing colorectal cancer. 

Risk factors

Hereditary colorectal syndromes

If you have one of the following genetic disorders, you have a significantly higher risk of developing colorectal cancer:

• Familial adenomatous polyposis

• Lynch syndrome

• Mutations in other cancer-predisposing genes

Personal or family history of sporadic colorectal cancers or adenomatous polyps

Your risk of developing colorectal cancer is also increased if you have:

• A personal history of large (>1 cm) adenomatous polyps and polyps with villous or tubulovillous histology or with high-grade dysplasia, especially if you have more than one.

• A family history of colorectal cancer:

• • Your risk doubles over the general population if you have a single affected first-degree relative (parent, sibling, or child) with colorectal cancer. 

  • The risk is further increased if you have two first, or one first, and one or more first or second-degree relatives with colon cancer, or if a first-degree relative is diagnosed below 50 years of age. 

• A family member with an adenomatous colonic polyp.

Up to 30% of colorectal cancer patients have a family history of the disease. 

Other personal history

Your risk of developing colorectal cancer is also increased if you have a personal history of one or more of the following:

• Inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis. The extent, duration, and activity of disease are primary determinants

• Abdominopelvic irradiation

• Cystic fibrosis

• Other types of cancers, like breast and ovarian.

Other risk factors

The following have been consistently identified as risk factors for colorectal cancer in observational studies:

• Being obese or overweight

• Low physical activity

• High consumption of red and processed meat

• Not eating enough fruits or vegetables

• Smoking tobacco

• Alcohol consumption (it is estimated that alcohol increases the chance of colorectal cancer by 60%, depending on the amount of alcohol consumed as it is particularly significant with heavy drinking)

• African Americans have the highest colorectal cancer rates of all ethnic groups in the US

Annual rates of rectal cancer cases

Annual rates² of new cases of colorectal cancer from 1999-2018 in the US:

While colorectal cancer incidence rates generally increased from 1975 through to the mid-1980s, since then, rates have generally decreased³. The decline prior to 2000 is attributed equally to a reduction in risky behaviours, such as smoking, and the uptake of colorectal screening.

How do US rectal cancer survival rates compare globally?

Cancer survival rates state the percentage of individuals that survive a specific type of cancer over a certain period of time. 

Survival rates often use an overall five-year survival rate. For example, if a five-year survival rate for a specific cancer is 80%, then for every 100 people diagnosed with that type of cancer, 80 will still be living five years after diagnosis.

Survival rates are calculated based on extensive research from information gathered from large population samples who have a specific type of cancer. Overall survival rates include individuals of all ages, demographics, and health conditions who have been diagnosed with specific cancer.

Your doctor might be able to give you more precise statistics based on the stage of colorectal cancer you have.

What does the survival rate tell you?

Cancer survival rates can give you a general idea about your prognosis after you have been diagnosed. However, as every individual case is unique, they cannot tell you your exact chances of recovery or remission. This is because the survival rate for rectal cancer is likely to have been based on data collected from thousands of patients.

While rectal cancer survival rates can’t tell you how long you will live after diagnosis, they may help to give you a better understanding of the potential chances of success of your treatment.

Survival rate by stage

The American Cancer Society relies on the Surveillance, Epidemiology, and End Results (SEER) database to provide survival statistics⁴ for different types of cancer. This database is maintained by the National Cancer Institute and tracks five-year survival rates for colorectal cancer in the US-based on the spread and severity of the disease

The SEER database doesn’t group cancers by the traditional prognostic stage groups (stages I to IV). Instead, it groups them instead into localized, regional, and distant stages:

• Localized – No sign that cancer has spread outside the colorectal region.

• Regional – Cancer has spread outside the colorectal region to nearby lymph nodes, tissues, or organs.

• Distant – Cancer has spread to remote parts of the body, such as the liver or lungs.

Survival rate by age

The death rates for colorectal cancer increase with age. Younger patients are more likely to be diagnosed with one of the hereditary colorectal syndromes. These patients usually have better general health, can tolerate more intensive treatment options, and recover better. Other predictors of survival for rectal cancer are the stage of the disease and any comorbidities. Despite the mortality rates of a colorectal cancer diagnosis, researchers have discovered that the patient’s baseline characteristics⁵ are still largely predictive of their individual outcome.

Five-year relative survival rate for cancer

The relative survival rates compare patients with the same type of cancer, such as rectal cancer, and its stage compared to other people in the overall population.  It is calculated by dividing the percentage of patients with the disease who are still alive at the end of the five-year period by the percentage of people in the general population of the same sex and age who are alive by that time.

In the table below, the five-year relative survival rate for localized rectal cancer is 89%. This means that patients with this type of cancer are, on average, about 89% as likely as other people who do not have localized rectal cancer to live for at least five years after diagnosis.

Five-year relative survival rates⁶ for rectal cancer

Recurrence rates

Rectal cancer can be recurring. This means that even if you recover, cancer can come back at some point in the future. Recurrent cancer usually develops in the first five years post-surgery and often carries a negative prognosis for the patient. While recurrence of all cancers can be local or distant, local recurrence⁷ is more common among cases of rectal cancer.

Types of recurrent rectal cancer:

• Local  – When cancer returns to the same place it started.

• Regional  – When cancer has come back close to the original tumor in the lymph nodes or nearby tissues.

• Distant  – Also known as metastasis, when cancer has traveled to a distant site.

Recurrence of rectal cancer means that there was a chance it was never entirely removed or it has spread to distant sites which have gone undetected on tests and screens.

Reported local recurrence rates of rectal cancers have ranged from 3.7% to 50%, depending on the tumor grade, stage, location, and surgical resection margins. Among patients who undergo definitive resection for their rectal cancer, the rates of local recurrence are up to 10%⁸. The majority of local recurrences occur within two years of primary surgery, although they can also occur later down the track.

When the signs and symptoms related to your rectal cancer are reduced or gone, you are considered to be in remission. Most cancers that return do so within the first five years after treatment. However, there is a chance it could return at a later date, so even if you have been in remission for five years, doctors cannot absolutely say that you have been “cured” of cancer.

What if you don’t get treatment?

Typically, patients with locally advanced rectal cancer undergo a combination of treatment options for maximum effectiveness. This may consist of pre-or post-operative chemotherapy, radiation, and surgery to remove some or all of the rectum. Pre-op chemoradiotherapy or radiotherapy may be required for more advanced cancers, as it helps to shrink the tumor and make it easier to then remove.

But what if someone chooses to forgo treatment entirely? Every case is unique, so for your individual prognosis, it’s essential to discuss it with your health professional. Treatment is usually highly recommended, as they have been shown to increase relative survival rates for rectal cancer. It is important to review your treatment options and the statistics to ensure any treatment you select is right for you.

Research has indicated that survival rates of patients with metastatic advanced rectal cancer without treatment are 65% after one year and 10% after two years. This may be due to the biological characteristics⁹ of rectal cancer and the slow-growing nature of the tumor.

The lowdown

Rectal cancer is a relatively common disease, as the fourth most common cancer diagnosed in the US. Your risk for developing rectal cancer depends on a wide range of factors. If you have rectal cancer, survival rates can also vary among patients. Factors affecting your livelihood of developing rectal cancer and your chances of recovery if you are diagnosed include your age, sex, ethnicity, family history, lifestyle habits, cancer stage, and treatment options. As every case of rectal cancer is unique, it is important to discuss it with your doctor. Make sure to also have regular screenings to ensure that if you do develop rectal cancer, it is identified at the earliest opportunity to increase your likely survival rate.