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The median age of diagnosis of colorectal cancer is during the seventh decade and the incidence of the disease increases continuously with age. However, as a patient ages, the likelihood of receiving adequate cancer treatment diminishes and mortality rises. The geriatric population is a very heterogeneous group in which patients with an excellent health status coexist with both comorbidities and functional dependency. Therefore, there is a great need to redefine treatment strategies in elderly patients with colorectal carcinoma, personalizing the treatment according to the degree of vulnerability of the elderly patient. It is essential to perform a multidimensional geriatric assessment in order to consider the cancer and the stage of the cancer as well as to identify features that could modify the survival or interfere with therapy. The aim of this review is to discuss the factors that are relevant for the therapeutic management of colorectal cancer in elderly patients.