Colorectal cancer (CRC) affects largely elderly populations. However, older patients with CRC are generally excluded from randomized clinical trials, and the healthy subjects who are recruited are not representative of the general elderly patient population. Nevertheless, recent data from clinical trials specifically targeting elderly patients and related subgroup analyses indicate that well-selected elderly patients can have a similar response to that of younger patients. Chronological age should not determine the candidacy for adjuvant or palliative chemotherapy in elderly patients with CRC. The appropriate management of healthy elderly patients would mean that they could receive aggressive chemotherapy in a similar regimen to that of younger patients, whereas the care of frail elderly patients and those with a short life expectancy should focus on palliation. The use of a comprehensive geriatric assessment could allow the use of safe and beneficial chemotherapy regimens in elderly patients with CRC. (Korean J Med 2014;87:530-536)