About 23% of colorectal cancer cases present as metastatic at diagnosis, and 75% of metastatic colorectal cancer is already stage IV on first CT or MRI. CEA is above 5 ng/mL in 80% of patients at diagnosis, while the liver is the first metastatic site in 65% of cases. This article breaks down what those figures mean for staging, biomarker testing, treatment response, and survival.
Key Takeaways
- 75% of mCRC diagnosed at stage IV via CT/MRI showing liver mets >1cm
- CEA >5 ng/mL in 80% mCRC at diagnosis, rises >20x with progression
- Liver is primary metastasis site in 65% mCRC, detected by contrast CT (sensitivity 85%)
- In 2023, an estimated 152,810 new cases of colorectal cancer were diagnosed in the US, with approximately 23% presenting as metastatic at diagnosis
- Globally, colorectal cancer accounts for 10.2% of all cancer incidences in 2020, with metastatic stage IV comprising about 25% of cases
- The age-adjusted incidence rate of metastatic colorectal cancer in the US is 4.5 per 100,000 population for ages 50-64
- 30% of mCRC cases harbor KRAS mutations, conferring resistance to EGFR inhibitors
- BRAF V600E mutation occurs in 8-12% mCRC, linked to 4x worse prognosis and MSI-H
- MSI-high/dMMR phenotype in 4% mCRC, 15% right-sided, predicts immunotherapy response
- Median overall survival for untreated metastatic colorectal cancer is 5-6 months
- 5-year overall survival rate for metastatic CRC is 14.9% (US SEER 2014-2020)
- With first-line FOLFOX + bevacizumab, median PFS is 9.4 months in mCRC
- Median PFS with FOLFOXIRI + bevacizumab is 12.1 months in mCRC
- Cetuximab + irinotecan in KRAS wt refractory mCRC: ORR 22.5%
- Encorafenib + cetuximab in BRAF V600E mCRC: ORR 26%, PFS 4.3 months
Most metastatic colorectal cancer is diagnosed at stage IV with liver spread, where advanced imaging and biomarkers guide treatment.
Related reading
01 · Category
Diagnosis And Staging22 stats
01
75% of mCRC diagnosed at stage IV via CT/MRI showing liver mets >1cm
02
CEA >5 ng/mL in 80% mCRC at diagnosis, rises >20x with progression
03
Liver is primary metastasis site in 65% mCRC, detected by contrast CT (sensitivity 85%)
04
PET-CT changes management in 20-30% mCRC staging, sensitivity 92% for mets
05
Circulating tumor DNA (ctDNA) detects mCRC recurrence at 87% sensitivity pre-imaging
06
Synchronous mets in 20-25% CRC at diagnosis vs 50% metachronous within 3 years
07
Lung mets in 15-20% mCRC, best staged by chest CT (sensitivity 90%)
08
Peritoneal carcinomatosis (PCI>10) in 25% mCRC, diagnosed by CT/DWI-MRI
09
RAS testing mandatory pre-anti-EGFR, NGS panels cover 100% hotspots
10
MSI/MMR IHC on biopsy: 95% concordance with PCR for dMMR detection
11
Endoscopic ultrasound for rectal mCRC staging: T/N accuracy 85%/70%
12
Diffusion-weighted MRI detects peritoneal mCRC lesions <1cm (sens 90%)
13
Liquid biopsy ctDNA MRD post-resection predicts relapse at 91% NPV
14
Bone mets rare (10%) in mCRC, FDG-PET sensitivity 93% vs bone scan 66%
15
Primary tumor sidedness: left 65% mCRC vs right 35%, prognostic via biopsy
16
Multiplex IHC (CDX2/HER2) refines mCRC subtype in 95% cases
17
18F-FDG PET SUVmax >9 predicts poor mCRC prognosis (staging tool)
18
Brain mets in 4% mCRC, MRI gadolinium sensitivity 98% for detection
19
Circulating tumor cells ≥3/7.5mL blood indicate mCRC stage IV (sens 76%)
20
NGS identifies actionable alterations in 20% refractory mCRC for trials
21
Contrast-enhanced US for liver mets: sensitivity 96% small lesions
22
Fecal immunochemical test (FIT) detects 70% early CRC but <20% mCRC
Interpretation
Diagnosis And Staging Interpretation
For diagnosis and staging of metastatic colorectal cancer, CT or MRI shows stage IV with liver metastases larger than 1 cm in 75% of cases and CEA is elevated in 80% at baseline, while PET CT still meaningfully reshapes management in 20 to 30% and overall sensitivity for detecting metastases is high at 92%.
02 · Category
Epidemiology30 stats
01
In 2023, an estimated 152,810 new cases of colorectal cancer were diagnosed in the US, with approximately 23% presenting as metastatic at diagnosis
02
Globally, colorectal cancer accounts for 10.2% of all cancer incidences in 2020, with metastatic stage IV comprising about 25% of cases
03
The age-adjusted incidence rate of metastatic colorectal cancer in the US is 4.5 per 100,000 population for ages 50-64
04
In Europe, the 5-year prevalence of metastatic colorectal cancer reached 1.2 million cases by 2022
05
Among US Hispanics, metastatic colorectal cancer incidence rose 2.1% annually from 2012-2021
06
In Asia, metastatic colorectal cancer cases increased by 45% from 2008 to 2018 due to westernized diets
07
The lifetime risk of developing metastatic colorectal cancer synchronously is 22% for all CRC diagnoses
08
In 2024 projections, Australia expects 1,200 new metastatic colorectal cancer cases
09
US men have a 1.4 times higher incidence of metastatic CRC than women (5.2 vs 3.7 per 100,000)
10
From 2015-2020, metastatic CRC incidence in young adults (20-49) increased by 1.5% per year
11
In China, metastatic colorectal cancer represents 28% of all CRC cases with 250,000 annual incidences
12
UK data shows metastatic CRC prevalence at 45,000 patients under active treatment in 2022
13
African Americans face a 20% higher metastatic CRC incidence rate (6.1 per 100,000) vs whites
14
Globally, 1.93 million CRC cases in 2020, 500,000 metastatic
15
In Japan, metastatic CRC incidence doubled from 1993-2018 to 15,000 cases/year
16
US rural areas report 15% higher metastatic CRC rates than urban (5.8 vs 5.0 per 100,000)
17
Women under 50 saw metastatic CRC incidence rise 3.2% annually 2009-2018
18
In India, metastatic CRC cases grew 5-fold from 2001-2020 to 50,000 annually
19
Canada’s metastatic CRC incidence stabilized at 4.2 per 100,000 post-2015 screening
20
Brazil reports 40,000 metastatic CRC cases yearly, 26% of total CRC
21
In the EU, metastatic CRC mortality exceeds 150,000/year despite declining incidence
22
US veterans have 1.8-fold higher metastatic CRC risk (7.2 per 100,000)
23
Middle East metastatic CRC incidence at 3.5 per 100,000, rising 4% yearly
24
In 2022, 70,000 US patients lived with metastatic CRC >5 years post-diagnosis
25
Australia’s Indigenous population has 2.5x metastatic CRC incidence (9.0 per 100,000)
26
From 2010-2020, global metastatic CRC burden increased 32% to 900,000 DALYs
27
In South Korea, metastatic CRC in under-50s tripled to 12% of cases 2006-2015
28
France reports 18,000 new metastatic CRC diagnoses annually (2023)
29
US obese population (BMI>30) has 1.3x metastatic CRC incidence risk
30
In 2021, metastatic CRC accounted for 50% of CRC healthcare costs ($10B in US)
Interpretation
Epidemiology Interpretation
From an epidemiology standpoint, metastatic presentation is a sizable and rising burden, with about 23% of the estimated 152,810 US colorectal cancer cases in 2023 occurring at diagnosis as metastatic and incidence climbing in specific groups such as US Hispanics increasing 2.1% per year from 2012 to 2021.
03 · Category
Risk Factors And Genetics30 stats
01
30% of mCRC cases harbor KRAS mutations, conferring resistance to EGFR inhibitors
02
BRAF V600E mutation occurs in 8-12% mCRC, linked to 4x worse prognosis and MSI-H
03
MSI-high/dMMR phenotype in 4% mCRC, 15% right-sided, predicts immunotherapy response
04
HER2 amplification in 3-5% mCRC, associated with KRAS/NRAS/BRAF wild-type
05
PIK3CA mutations in 15-20% mCRC, correlate with poor response to anti-EGFR therapy
06
APC gene mutations in 70-80% mCRC, initiating adenoma-carcinoma sequence
07
Family history increases mCRC risk 2-4 fold, Lynch syndrome 40-80% lifetime risk
08
Obesity (BMI ≥30) raises mCRC risk by 1.3x, mediated by hyperinsulinemia
09
Smoking >20 pack-years doubles mCRC risk via DNA methylation changes
10
Type 2 diabetes increases mCRC risk 1.3-fold, via IGF-1 and inflammation
11
Red/processed meat intake >500g/week elevates mCRC risk 17%, heme iron nitrosamines
12
Alcohol >30g/day raises mCRC risk 1.5x, acetaldehyde DNA adducts
13
Inflammatory bowel disease (UC/Crohn's) confers 2x mCRC risk after 10 years
14
Aspirin use >10 years reduces mCRC risk by 30%, COX-2 inhibition
15
NRAS mutations in 3-5% mCRC, similar resistance to anti-EGFR as KRAS
16
TP53 mutations in 60% mCRC, associated with aggressive phenotype
17
Low physical activity (<150 min/week) increases mCRC risk 24%
18
Hypercholesterolemia raises mCRC metastasis risk via SREBP pathway
19
Lynch syndrome (MLH1/MSH2/MSH6/PMS2) causes 3% hereditary mCRC
20
MET amplification in 1-2% mCRC, potential resistance biomarker
21
Chronic NSAID use reduces mCRC risk 40% in FAP patients
22
High serum 25(OH)D >30 ng/mL lowers mCRC risk 50%
23
RET fusions in <1% mCRC, targetable with selpercatinib
24
NTRK fusions rare (0.5%) in mCRC, respond to larotrectinib ORR 75%
25
Hypermutated tumors (>10 mut/Mb) in 5% mCRC, immunotherapy sensitive
26
STAT3 activation in 50% mCRC, promotes metastasis via EMT
27
Estrogen receptor beta loss increases mCRC risk in women
28
Familial adenomatous polyposis (APC germline) leads to 100% CRC risk by 40s
29
CIMP-high phenotype in 15% right-sided mCRC, overlaps BRAF mut/MSI-H
30
Serum VEGF levels >100 pg/mL predict higher mCRC metastasis risk
Interpretation
Risk Factors And Genetics Interpretation
Genetic drivers are common in metastatic colorectal cancer, with APC mutations present in 70–80% of cases and key actionable alterations like KRAS in 30% and PIK3CA in 15–20% shaping targeted-treatment resistance, while a smaller MSI-high group at 4% also signals immunotherapy sensitivity.
More related reading
04 · Category
Survival And Prognosis30 stats
01
Median overall survival for untreated metastatic colorectal cancer is 5-6 months
02
5-year overall survival rate for metastatic CRC is 14.9% (US SEER 2014-2020)
03
With first-line FOLFOX + bevacizumab, median PFS is 9.4 months in mCRC
04
Patients with KRAS wild-type mCRC have 28-month median OS vs 20 months mutant
05
Resected liver metastases yield 5-year OS of 57% in selected mCRC patients
06
Left-sided mCRC tumors show 33.3-month median OS vs 20.9 months right-sided
07
Elderly (>75) mCRC patients have 12-month median OS vs 26 months younger
08
MSI-high mCRC has 5-year OS of 71% vs 52% MSS on immunotherapy
09
With regorafenib, median OS extension is 1.4 months in refractory mCRC
10
Lung-only metastases in mCRC confer 40-month median OS post-resection
11
Triple-class therapy (chemo+anti-VEGF+anti-EGFR) yields 38-month OS in RAS wt
12
Peritoneal carcinomatosis in mCRC reduces median OS to 15 months
13
10-year OS post curative metastasectomy in mCRC is 21.5%
14
BRAF V600E mutant mCRC has 11-month median OS vs 26 months wild-type
15
With encorafenib + cetuximab, BRAF mutant mCRC median OS is 15.6 months
16
ECOG PS 0 mCRC patients achieve 32-month OS vs 12 months PS 2
17
HER2-positive mCRC (3%) has 11-month OS on trastuzumab deruxtecan
18
Cytoreductive surgery + HIPEC for peritoneal mCRC gives 41-month median OS
19
Nivolumab in MSI-H/dMMR mCRC yields 49.1-month median OS (ORR 55%)
20
Multi-site metastases (>3 organs) reduce mCRC OS to 14 months
21
Adjuvant chemo post liver resection extends 5-year DFS to 40% in mCRC
22
Fruquintinib in refractory mCRC improves OS by 3.7 months (7.4 vs 4.0)
23
3-year OS in oligometastatic mCRC post SBRT is 57%
24
Elevated LDH (>upper limit) halves mCRC median OS to 13 months
25
Pembrolizumab in MSI-H mCRC: 80% 2-year OS rate
26
CEA >100 ng/mL pre-treatment predicts <18-month OS in 70% mCRC cases
27
RAS/BRAF wt left-sided mCRC on cetuximab has 39-month OS
28
Post two lines therapy, trifluridine-tipiracil extends OS by 2 months (7.1 vs 5.3)
29
5-year cancer-specific survival for resected mCRC lung mets is 42%
30
Bevacizumab beyond progression adds 3.9 months OS in mCRC (11.2 vs 9.8)
Interpretation
Survival And Prognosis Interpretation
For survival and prognosis in metastatic colorectal cancer, outcomes vary widely by treatment and tumor biology, with median overall survival rising from just 5 to 6 months untreated to about 9.4 months median progression free survival on first line FOLFOX plus bevacizumab and stretching to 28 months for KRAS wild type compared with 20 months for mutant disease.
05 · Category
Treatment Efficacy28 stats
01
Median PFS with FOLFOXIRI + bevacizumab is 12.1 months in mCRC
02
Cetuximab + irinotecan in KRAS wt refractory mCRC: ORR 22.5%
03
Encorafenib + cetuximab in BRAF V600E mCRC: ORR 26%, PFS 4.3 months
04
Nivolumab + ipilimumab in MSI-H mCRC: ORR 55%, CR 13%
05
Regorafenib in refractory mCRC: PFS 1.9 months, OS benefit 1.4 months
06
Trifluridine-tipiracil + bevacizumab: PFS 5.6 months vs 4.0 monotherapy
07
Atezolizumab + bevacizumab + chemo in MSS mCRC: ORR 80% early data
08
Fruquintinib monotherapy: ORR 1.5%, but OS 7.4 months in refractory mCRC
09
Panitumumab + FOLFOX: ORR 55%, PFS 10.1 months in RAS wt mCRC
10
TAS-102 in refractory mCRC: DCR 44%, OS 7.1 months
11
Bevacizumab + FOLFOX4: ORR 47%, PFS 9.4 months (AVF2107g)
12
Cetuximab monotherapy: ORR 12.8% in EGFR+ chemorefractory mCRC
13
HER2-targeted tucatinib + trastuzumab: ORR 38.1% in HER2+ mCRC
14
FOLFOXIRI + bevacizumab: ORR 65%, R0 resection rate 61% in unresectable mCRC
15
Pembrolizumab in MSI-H/dMMR mCRC: ORR 40%, DOR 72.9 months median
16
Ziv-aflibercept + FOLFIRI: PFS 6.9 months vs 5.0
17
Margetuximab + pembrolizumab in HER2+ mCRC: ORR 32%
18
Cabozantinib in refractory mCRC: ORR 2%, stable disease 26%
19
Dostarlimab in dMMR mCRC: ORR 43.4%, 84% 12-month DOR
20
Irinotecan + cetuximab: ORR 26.8% in irinotecan-refractory KRAS wt mCRC
21
Lonsurf + bevacizumab: ORR 19.3% in refractory mCRC
22
Onivyde (nal-IRI) + 5-FU/leucovorin: OS 8.5 months in gemr refractory mCRC
23
Batiraxcept + chemo: PFS 10.4 months in first-line mCRC
24
Atezolizumab/bevacizumab + chemo vs bev/chemo: HR 0.72 for PFS
25
Ramucirumab + FOLFIRI: PFS 5.6 months in refractory mCRC
26
Nivolumab monotherapy MSI-H mCRC: ORR 31%, PFS 14.3 months
27
Trastuzumab deruxtecan in HER2+ mCRC: ORR 45.3%
28
FOLFIRI + panitumumab: ORR 57%, PFS 10 months RAS wt
Interpretation
Treatment Efficacy Interpretation
Across key treatment efficacy results in metastatic colorectal cancer, several targeted and immunotherapy approaches show clinically meaningful response and control such as nivolumab plus ipilimumab in MSI-H disease with an ORR of 55% and a 13% complete response, while regorafenib in refractory mCRC offers only modest benefit with a PFS of 1.9 months and an OS gain of 1.4 months.
report visual · Breakdown
Where mCRC spreads—and how it’s detected
Liver is the most common metastatic site in mCRC, and advanced imaging has high sensitivity for metastases, with PET-CT able to change management for a sizable share of patients.
75%
75% of mCRC diagnosed at stage IV via CT/MRI showing liver mets >1cm
25%
Peritoneal carcinomatosis (PCI>10) in 25% mCRC, diagnosed by CT/DWI-MRI
Reference
Cite This Report
This report is designed to be cited. We maintain stable URLs and versioned verification dates. Copy the format appropriate for your publication below.
APA
Sophie Moreland. (2026, February 13). Metastatic Colorectal Cancer Statistics. Gitnux. https://gitnux.org/metastatic-colorectal-cancer-statistics
MLA
Sophie Moreland. "Metastatic Colorectal Cancer Statistics." Gitnux, 13 Feb 2026, https://gitnux.org/metastatic-colorectal-cancer-statistics.
Chicago
Sophie Moreland. 2026. "Metastatic Colorectal Cancer Statistics." Gitnux. https://gitnux.org/metastatic-colorectal-cancer-statistics.
Sources & references
22 datasets cited across this report · attribution is report-level