Introduction: The knowledge surrounding colorectal cancer (CRC) genetics is continuously expanding. Previously, the diagnosis of a familial cancer syndrome relied solely on targeted clinical assessments and family history, without considering genetic mutations. However, with the recognition that surgical and medical treatments can now be guided by identifying pathological variations in a patient's DNA, it has become evident that genetic factors significantly contribute to CRC. Consequently, physicians should exhibit heightened suspicion of a hereditary component in high-risk CRC patients. This article systematically examines published studies that explore the influence of tumor genetics on medical management and surgical decisions regarding hereditary CRC syndromes. Methods: The methodology employed in this study was based on systematic review and qualitative research approaches. Extensive searches were conducted across prominent databases, resulting in the identification of 25 relevant studies. Out of these, 8 studies met the inclusion criteria, and 6 were deemed to possess strong methodological quality upon appraisal. Results: It is recommended to test the tumor for BRAF V600E or hypermethylation of the MLH1 promoter due to a false negative rate of 5-10% when using IHC. Additionally, colonoscopy screening effectively reduces the risk of CRC associated with MSH2 mutation. Furthermore, initial screening colonoscopy is advised to commence between the ages of 7-10 years for patients with APC mutation. Conclusions: The genetic understanding of CRC provides valuable insights for implementing early endoscopic and/or surgical interventions. This approach not only aids in the prevention and treatment of CRC for the individual patient but also enables comprehensive care for the entire family.