The recent improved survival in advanced colorectal cancer, owing in a large part to advances in adjuvant treatment, has mainly been reported in studies of younger patient groups. Less is known about outcome in elderly patients, the fastest growing cohort of cancer patients. The antimetabolite capecitabine used sequentially or concomitantly with the topoisomerase 1 inhibitor irinotecan or the DNA cross linking agent oxaliplatin are now considered to be the standard first line chemotherapy regime. The role of surgery in advanced colorectal cancer in the elderly is restricted to the relief of bowel obstruction and where appropriate resection of hepatic metastasis. Advanced chronological age has not been shown to be a contraindication to the consideration of these interventions. Indeed, chronological age alone does not provide sufficient guidance when considering the appropriateness of any palliative treatment regime in the elderly.