Introduction. Kidney transplant recipients (KTRs) from around the world are at greater risk of developing cancer compared to the general population. In addition, some common cancers in the general population occur at a higher incidence rate in KTRs (e.g. colorectal cancer). Case report. In this report, we describe a case of a 54year-old male with an advanced stage colorectal cancer (CRC) causing urinary obstruction as cardinal symptom for its diagnosis. He underwent living-related kidney transplantation from his 70-years-old mother in 2005 with a stable renal function in the following years (serum creatinine around 180 μmol/l). However, the patient had a poor compliance not regularly attending our outpatient clinic. Thus, at his last visit a slight progression of anaemia was found, although, he denied a possibility for bleeding from any part of the gastrointestinal tract. The motive for his next consultation to the hospital was the problem of voiding urine. The pain from the bladder glob at admission immediately disappeared after the urocatheterisation with ensuing poliuria and serum creatinine (278 μmol/l) decreased gradually in the following days. CT scan showed a tumour mass from an advanced CRC pressuring the lower bladder wall and distant metastasis and disseminated lymphnodes. The surgical revision was not considered as treatment option, thereby chemotherapy was initiated. Two years after the diagnosis of the CRC he passed away with an advanced chronic allograft nephropathy, yet without a need for renal replacement therapy. Conclusion. There is a possibility to develop CRC as an advanced metastatic form at diagnosis in relatively short period after renal transplantation as in our case. Periodic CRC screening pre and post-transplant in this population is important as treatment options are limited and survival of such KTRs is very poor. Since an older age is the most important risk factor, a more aggressive screening for malignancy in transplant recipients after 50 years of age, especially in those with poor compliance and anaemia development, should be employed in the hospital condition.