Colorectal cancer (CRC) is the leading cause of all new cancer cases and the second major cause for all cancer deaths in Spain. CRC survival has improved over the past few decades and is now higher than the 5-years European average, but this is associated with improved treatment than to early detection. A number of screening pilot programs have been completed in various regions, likely leading to national implementation in the future. Treatment guidelines have been developed and implemented to set standards and reduce practice variability. Newer treatments are available, including laparoscopic surgery, adjuvant chemotherapy and the use of targeted treatments. Specific programs are in place for rural patients, as well as programs to reduce waiting times. Overall, Spain is aware of the issues raised by CRC oncology management and has acted to improve patient outcomes, adding screening to its arsenal will further impact survival rates.