Colorectal cancer (CRC) is the third most common cause of cancer death in kidney transplant recipients and among the top six causes of cancer death in patients on dialysis. Anal cancer is a rare malignancy of the gastrointestinal tract, whose incidence increases in immunosuppressed patients. Screening strategies are of paramount importance, as early detection of cancer with prompt intervention allows good outcomes to be achieved. Pancolonoscopy is the tool of choice for detecting colonic pathology, while human papillomavirus (HPV) testing and yearly assessment of the perianal area with biopsy of any suspicious lesions allow the diagnosis of anal cancer. Patients with end-stage renal disease (ESRD) who need colorectal surgical resection should be carefully selected, prepared and closely managed in the postoperative period, since they are recognized as very fragile and sensitive to hemodynamic changes, with a trend toward delayed healing. Laparoscopic interventions allow surgical complications to be reduced and, for patients on peritoneal dialysis, by preserving peritoneal integrity, they decrease the risk of shift to hemodialysis along with allowing an earlier resumption of peritoneal dialysis. Although surgery for CRC produces good results also in this class of patients, ESRD itself as well as dialysis have been shown to be significant risk factors for survival, with an effect on oncologic outcomes.