This chapter explores the complex relationship between the gut microbiota and the pathogenesis of colorectal cancer (CRC), highlighting the role of microbial dysbiosis in promoting inflammation, DNA damage, and immune dysregulation. It reviews key pro-carcinogenic bacteria, such as Fusobacterium nucleatum, Bacteroides fragilis, and pks+ Escherichia coli, which contribute to tumor initiation and progression. The chapter also discusses the protective effects of beneficial microbes like Lactobacillus and Bifidobacterium, which help maintain gut health and inhibit carcinogenesis. Therapeutic strategies aimed at modulating the gut microbiota, including dietary interventions, probiotics, prebiotics, fecal microbiota transplantation (FMT), and postbiotics, are examined for their potential in CRC prevention and treatment. Finally, future directions in personalized microbiome-based therapies, diagnostic biomarkers, and the challenges facing clinical translation of gut microbiota research are addressed. The chapter emphasizes the growing importance of targeting the microbiome in CRC management to enhance prevention, diagnosis, and therapeutic outcomes.