Physicians have been inundated with news as to how advances in genetics, and developments in genetic technology, will alter their daily practice. While it is true the complexity of the underlying genetic basis for colorectal cancer predisposition is slowly being recognized, the impact of these advances has been limited in the clinical setting. Cancer genetics assessment has yet to become a routine clinical service offered in the management of people with, or at-risk for, colorectal cancer. As the clinical impact of genetic medicine expands, the need for a multidisciplinary approach, including clinical genetics assessment, takes on an even greater significance. This article serves to revisit the role of genetics assessment in the care of families with an increased family-based cancer risk. Three practical cases are used to demonstrate this role and to discuss issues associated with hereditary gastrointestinal cancer syndromes.