Between 1957 and 1981, 49,904 patients with large bowel cancer were registered at the Birmingham Cancer Registry. The annual incidence was 24.5 per 100,000 population for colonic cancer and 18.4 per 100,000 for that of the rectum. The annual number of patients increased by 41.9 per cent. The age-adjusted 5-year survival rate was 26.4 per cent for colonic carcinoma and 28.2 per cent for rectal cancer. Between 1977 and 1981 these rates increased significantly to 30.3 and 30.0 per cent respectively (P < 0.01). Stage for stage, colonic cancer was associated with longer survival than that of the rectum. Curative and palliative resection rates increased, especially for anterior resection. The operative mortality rate remained constant at 8 per cent. Despite increases in palliative resection rates 50 per cent of these patients required a stoma. Treatment was not undertaken in 37.4 per cent of patients. The end results of treatment are little better than those reported previously from this registry.