With the widespread adoption of screening programs and advances in endoscopic technology, the detection rate of early colorectal cancer has significantly increased. However, controversies remain regarding its definition, optimal treatment strategies, and follow-up surveillance. This article discusses the definition of early colorectal cancer from multiple perspectives, and highlights the indications for endoscopic resection as the preferred initial treatment, the preoperative precision assessment framework, and the postoperative decision-making algorithm on whether to perform additional salvage radical surgery based on high-risk pathological features. We also explore the value and limitations of transanal local excision in sphincter-preserving management for early low rectal cancer, and clarifies the refined operative essentials of radical surgery as a fallback strategy for high-risk cases, including precise tumor localization, adequate bowel resection margins, and the extent of lymph node dissection. Furthermore, based on domestic and international guidelines, the present article proposes the follow-up protocols after treatment of early colorectal cancer. The diagnosis and management of early colorectal cancer has entered an era pursuing minimally invasive, precise, and individualized care, and it is necessary to integrate technologies, such as artificial intelligence and molecular biomarkers, to achieve an optimal balance between oncologic efficacy and quality of life.