There is a wealth of evidence that nonsteroidal anti-inflammatory drugs (NSAIDs) can prevent colorectal cancer. In this article the role of cyclooxygenase 1 and 2, the principle target of NSAIDs, in the development of colorectal cancer is reviewed. Cyclooxygenase is constitutively expressed in normal colonic epithelium and surrounding stroma and could catalyse the generation of malondialdehyde which is a known mutagen and could initiate colorectal carcinogenesis. Mutation of APC which is an early genetic event leads to the expression of cyclooxygenase 2 which may prevents the appropriate apoptosis of mutant adenoma cells. Other proneoplastic effects of cyclooxygenase include changing the action of Transforming Growth Factor beta from anti-proliferative to pro-proliferative, reducing adherence to extracellular matrix, promotes metastasis and angiogenesis. These properties of cyclooxygenases suggest that inhibition of both isoforms may have important protective effects against colorectal cancer.