The median age of patients with newly diagnosed colorectal carcinoma is about 70 years. Due to a steady rise of the life expectancy in the Western world the group of patients being older than 70 to 75 years will grow substantially. This will result in increased numbers of colorectal cancers. Patients in this age group are underrepresented in controlled clinical trials if not excluded to begin with. This is particularly true for trials conducted for adjuvant or palliative chemotherapy for colorectal cancer. Partly due to this lack of data leading to uncertainty chemotherapy is offered tients. However, the present data for patients >70 years show equall effectivity with regard to tumor response. This is true for all standard chemotherapy agents, such as 5-FU, folinic acid, capecitabine, irinotecan and oxaliplatin. With respect to toxicity some trials show an increased risk in toxic side effects for 5-FU-based combination therapies. There are no age-specific differences for the other drugs. Therefore, patients who are older than 70 years should be offered state-of-the-art chemotherapy in the adjuvant as well as palliative setting. For a balanced treatment decision one has to take into account the overall performance and organfunction alongside the mental and social capacity of the elderly patient.