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Cancer Trends No 9. Cancers of colon, rectosigmoid junction and rectum
May 2011
Figure 2. Colorectal cancer incidence rates by site, females,
1994-2009
Cancer
Trends
Cancers of colon and rectum
Anatomical sites
1 Sigmoid colon was the commonest site of colon cancers for
both sexes (Figure 1). The distribution of cancers within the
colon and rectosigmoid was similar for men and women, but
rectal cancers were relatively more common in men. There was
no change in the relative proportions of left- and right-sided
colon cancers between 1994-1997 and 2006-2009.
Figure 1. Anatomical site of colorectal cancers, 2005-2009:
number and % of cases
300
caecum
200
number of cases per year 2005‐2009
100
0
100 200 300 400
12%
17%
appendix
2%
ascending colon
hepatic flexure of colon
7%
3%
5%
2%
descending colon
3%
2%
4%
21%
20%
colon, not specified
8%
9%
rectosigmoid junction
rectum
3%
5%
splenic flexure of colon
sigmoid colon
1%
9%
transverse colon
500
8%
7%
31%
22%
female
male
Time trends
There has been very little change in the incidence rate for
cancers of the colon, rectosigmoid or rectum since 1994
(Figures 2 and 3). The incidence rate for cancer of the colon has
risen by 1.2% annually for women and 2.5% annually for men
since 2003. However, there have been falls of a similar
magnitude in rectosigmoid and rectal cancers over the same
period, so this may be a result of improving anatomical
localisation through endoscopy and imaging.
50
40
30
20
10
colon
rectosigmoid
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
0
1994
An annual average of 1445 colon cancers, 657 (45%) in
females and 797 (55%) in males, 166 rectosigmoid cancers, 63
(38%) in females and 103 (62%) in males) and 606 rectal
cancers, 209 (34%) in females and 398 (66%) in males, was
registered between 2005 and 2009.
Figure 3. Colorectal cancer incidence rates by site, males,
1994-2009
age‐standardised incidence rate per 100,000 per year
As the aetiology, presentation and clinical course of cancers of
the colon, rectosigmoid junction and rectum are quite similar,
cancers of these three sites have been combined in this report.
Anal cancers, which are comparatively rare, and constitute a
separate entity both aetiologically and morphologically, are not
included.
rectum
International variation in incidence
Within Europe in 2008, the highest incidence of colorectal
cancer for men was in Hungary, Slovakia and the Czech
Republic and for women in Denmark and Norway (Figure 3).1
The lowest incidence, for both sexes, was in Cyprus and Greece.
Apart from these, there was relatively little variation in colorectal
cancer incidence across Europe.
Figure 4. Estimated incidence of colorectal cancer, 2008
(world age-standardised rate)1
Hungary
Czech Republic
Slovakia
Denmark
Norway
Italy
Slovenia
The Netherlands
Germany
Ireland
Belgium
Luxembourg
Portugal
Spain
France
United Kingdom
Iceland
Austria
Bulgaria
Sweden
Estonia
Lithuania
Switzerland
Malta
Poland
Latvia
Finland
Romania
Cyprus
Greece
60
40
20
0
20
40
60
80
100
120
age‐standardised incidence rate per 100,000 (world standard population)
female
male
Histological types
93% of cancers were adenocarcinoma, almost all of the
remainder being of unspecified type. Just over 1% (24 cases
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Cancer Trends No 9. Cancers of colon, rectosigmoid junction and rectum
annually) were classified
neuroendocrine tumours.
as
carcinoid
or
other
May 2011
cancers were at stage I or II in 2008 (Table 1) while 48% of
Surgery for rectosigmoid and rectal surgery followed a
similar pattern to that for colon (Figure 8), but there was a
larger increase between 1994-1998 and 2004-2008 in the
percentage having chemotherapy (from 27% to 51%) and a
much higher percentage (increasing from 26% to 41%)
having radiotherapy.
colon and 50% of rectal/rectosigmoid cancer were at stages
Figure 7.Treatment for colon cancer, 1994-20082
Stage at diagnosis
38% of colon cancers and 31% of rectal/rectosigmoid
III or IV.
number of cases
Table 1. Percentage of cases by stage 2008
0
I
II
III
IV
unknown
colon
10%
28%
26%
22%
14%
rectum/rectosigmoid
14%
19%
31%
19%
17%
The percentage of stage III (Dukes C) colon cancers
increased by 2% annually and stage IV cancers by 1%
between 1994 and 20082, while the percentage of stage I
cancers (Dukes A) fell by 2% and that of stage II cancers
(Dukes B) by 1% (Figure 5).
Figure 5. Colon cancer, percentage of cases by stage, 199420082
1000 2000 3000 4000 5000 6000
77%
76%
surgery
79%
1994‐1998
1999‐2003
25%
chemotherapy
2004‐2008
35%
39%
7%
7%
5%
radiotherapy
Figure 8. Treatment for rectosigmoid and rectal cancer,
1994-20082
35%
number of cases
percentageof cases
30%
2 0
1,000
2,000
3,000
4,000
25%
20%
I
15%
II
77%
74%
75%
surgery
1994‐1998
III
10%
IV
5%
1999‐2003
27%
chemotherapy
51%
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
0%
1994
2004‐2008
44%
unknown
26%
radiotherapy
39%
41%
year of incidence
Over the same period, the percentage of stage III
rectosigmoid and rectal cancers increased by 3% annually
and of stage IV cancers by 1% annually (Figure 6), while the
percentage of stage I cancers fell by 3% annually, and of
stage II cancers by 2%.
Survival
This increase in later stage colorectal cancers may be partly
attributable to more thorough staging.
Figure 9. Cause-specific five-year survival for cancers
diagnosed 1994-2005
Cause-specific survival for cases of colon cancer diagnosed
in 1994-2005 was 51% (95% confidence interval 50%-52%)
at five years, for rectosigmoid cancer 48% (46%-51%) and
for rectal cancer 50% (48%-51%) (Figure 9).
Figure 6. Rectosigmoid and rectal cancer, percentage of
cases by stage, 1994-20082
0%
20%
30%
40%
50%
60%
70%
1994‐1997
colon
35%
30%
1998‐2001
2002‐2005
20%
I
15%
II
III
10%
rectosigmoid
25%
IV
5%
unknown
year of incidence
Treatment2
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
0%
female
1994‐1997
male
1998‐2001
2002‐2005
1994‐1997
rectum
percentageof cases
10%
1998‐2001
2002‐2005
There was an improvement in survival for all colorectal
cancers for both sexes between 1994-1997 and 20022005; the increases for colon cancer were statistically
significant, but those for rectal and rectosigmoid cancer,
either separately or combined, were not. Survival from colon
and rectal cancer (but not rectosigmoid) in the period 19942005 was significantly better for women.
Almost 80% of patients with colon cancer had surgery and
this changed little with time (Figure 7). The percentage
having chemotherapy increased from 25% to 39% between
1994-1998 and 2004-20082, and the percentage having
radiotherapy fell slightly, from 7% to 5%, in the same period.
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© National Cancer Registry 2011.
Cancer Trends No 9. Cancers of colon, rectosigmoid junction and rectum
International variation in survival
International variation in mortality
Across Europe, five-year relative survival from colorectal
cancer for patients diagnosed in 2000-2002 ranged from
45% in the Czech Republic to 64% in Switzerland (Figure
10).3 Survival in Ireland was similar to that in the UK, and, at
54%, below the European median.
The highest colorectal cancer mortality in Europe for both
men and women was in Hungary (Figure 12)1 and the lowest
in Greece and Cyprus. Mortality for Ireland was close to the
European median.
Figure 10. Five year relative survival for colorectal cancer
diagnosed 2000—20023
Switzerland Spain Germany Belgium France
Sweden Norway Italy Finland Austria Iceland Netherlands Northern Ireland Ireland Scotland Wales England Malta Slovenia Poland Czech Republic 0%
10%
20%
30%
40%
50%
60%
70%
five‐year relative survival
Figure 12. Estimated mortality from colorectal cancer, 2008
(world age- standardised rate)1
Hungary
Slovakia
Czech Republic
Slovenia
Denmark
Norway
Latvia
Portugal
Lithuania
Estonia
Poland
The Netherlands
Malta
Spain
Ireland
Bulgaria
Germany
Romania
Austria
Belgium
Italy
France
United Kingdom
Sweden
Luxembourg
Iceland
Switzerland
Finland
Greece
Cyprus
30
Mortality
20
10
0
10
20
30
40
50
60
age‐standardised mortality rate per 100,000 (world standard population)
Age-standardised mortality rates from colorectal cancer for
women have been falling by 2% annually since 1970 (Figure
11).4 Although male and female mortality rates were similar
up to 1970, this fall in female rates was not initially matched
by a similar fall for males. However, male mortality began to
fall in about 1989, and has been falling by 1% annually
since then. The male mortality rate in 2008 was 75% greater
than the female rate.
females
males
Figure 11. Age-standardised mortality rate (world standard
population) for colorectal cancer 1950-20084
References and notes
30
25
1.
European Cancer Observatory (ECO)
http://eu-cancer.iarc.fr/
2.
Stage and treatment data is incomplete for 2009
and is not reported on here.
3.
Recent cancer survival in Europe: a 2000-02
period analysis of EUROCARE-4 data. Verdecchia
A, Francisci S, Brenner H, Gatta G, Micheli A,
Mangone L, Kunkler I; EUROCARE-4 Working
Group.
Lancet Oncol. 2007 Sep;8(9):784-96.
4.
WHO mortality database
http://www-dep.iarc.fr/WHOdb/WHOdb.htm
20
15
males
10
females
5
2006
2003
2000
1997
1994
1991
1988
1985
1982
1979
1976
1973
1970
1967
1964
1961
1958
0
1955
age‐standardised mortality rate per 100,000 per year
3 May 2011
year of death
More information on cancer is available on our website www.ncri.ie
© National Cancer Registry 2011.