Survival of patients with untreated rectal cancer

Untreated rectal cancer is uncommon given modern surgical techniques and chemoradiotherapy. However, neglected cancer may still occur in patients with limited access to medical care or who refuse conventional interventions. Outcome data on such patients is scarce, though valuable in educating patients on their prognosis or to compare with present therapeutic options.

To identify such data, a review was made of archival literature documenting outcomes in patients with untreated rectal cancer. A review of the Index Medicus and its predecessor volumes and an extensive MEDLINE search led to nine articles that contained relevant age at presentation data of patients with rectal cancer. Six articles also included patient survival data for untreated rectal cancer. Actuarial analysis of the data through 5 years post-diagnosis was completed.

Symptoms most often presented in the fifth and sixth decades. Median survival of the 1326 patients fell within the second year after presentation of symptoms. Five-year actuarial survival for these patients was 4.4%. When the data published prior to 1925 were analyzed separately from that published post-1925, two survival patterns emerged. Median survival of pre-1925 patients fell within the second year after presentation of symptoms (at 21.5 months by curve fitting) and of post-1925 patients fell within the first year (10.2 months).

Clearly, advances in antibiotics, surgery, chemoradiotherapy, and supportive care have contributed to increased survival for patients with treated rectal cancer. Recognizing the hazards of generalizing too extremely from the data, they reveal that relatively long survival for patients with untreated lesions is possible.