In many countries, colorectal cancer is one of the common cancers. It has been confirmed that microsatellite instability (MSI) is one of the most important molecular changes in colorectal cancer. As the recognized precursor lesions of colorectal cancer, adenomas and some polyps also have MSI phenomenon. This article analyzes the MSI of colorectal cancer and its closely related adenomas and polyps in domestic and foreign literature, and further discusses how to identify colorectal cancer at an early stage and the impact of MSI on the prognosis and treatment of colorectal cancer.