These chemicals include per- and polyfluoroalkyl substances (PFAS), GenX, perfluorooctanesulfonic acid, perfluorooctanoic acid, byproducts of production of the fluoropolymer Nafion; and intermediates used to make other fluoropolymers (e.g. PPVE, PEVE and PMVE perfluoroether).

It flows southeast past Lillington, Fayetteville, and Elizabethtown, then receives the Black River about 10 miles (16 km) northwest of Wilmington.

During the colonial era, the river provided a principal transportation route to the interior of North Carolina.

The Cape Fear River is polluted by industry, cities, and farmland in its drainage basin.

[13] As with any river, the water quality varies in different regions, depending on abiotic and biotic factors.

[6] In 2020, a study found that striped bass in the river have the highest rates of PFAS documented in North American fish.

[8] In July 2023, the North Carolina Department of Health and Human Services issued a fish consumption advisory for certain freshwater fish species from the middle and lower Cape Fear River due to contamination with perfluorooctane sulfonic acid (PFOS).

[15] Suspended solids refers to any particle (living or nonliving) discharged into an aquatic system that remains in suspension.

GenX is a chemical in the group of manmade per- and polyfluoroalkyl substances, or PFAS used for nonstick, water- and stain-repellent items.

PFAS were detected in striped bass caught from the Cape Fear, and the chemical affected the liver and immune system.