Colorectal cancer, the third leading cause of cancer and cancer-related mortality in both men and women in the USA, is certainly a major public health concern. The annual incidence of colorectal cancer has increased from 130,200 in 2000 to 142,820 in 2013 [1,2]. In 2000, it accounted for a total of 56,300 deaths, whereas in 2013, the number of estimated deaths slightly declined to an estimated 50,830 individuals . Although the outcomes have improved in general, there has only been a modest improvement in long-term overall survival of metastatic colorectal cancer, particularly in African–Americans . Conversely, the cost of colorectal cancer care has dramatically increased, and continues to rise. The National Cancer Institute has projected the cost of colorectal cancer care (all stages) to increase from an estimated US$7.49 billion in 2000 to an estimated US$14.03 billion in 2020, if it follows the current epidemiologic trend . In this article, I discuss the pattern of changes in the management of metastatic colorectal cancer, the long-term outcomes and the associated cost.