In this manuscript, we review CRC in acromegaly, discussing the GH-IGF-I axis in cancer (especially in CRC), risk factors for CRC, specific characteristics of colonic polyps, the limitations of colonoscopies in this population, data from epidemiological studies and their biases, and the different guideline recommendations for CRC screening in acromegaly. The gene discussed is IGF1; the disease is colorectal carcinoma.