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Background The growth pattern of colorectal cancer is seldom investigated. This cohort study aimed to explore tumour growth rate in colorectal cancers managed non‐surgically or deemed not resectable, and to determine its implication for prognosis. Methods Consecutive patients with colonic or rectal adenocarcinoma were identified through the colorectal multidisciplinary team database at Leeds Teaching Hospitals NHS Trust over a 2‐year interval. Patients who received no treatment (surgery, stenting, colonic defunctioning procedures, chemotherapy, radiotherapy) and who underwent CT twice more than 5 weeks apart were included. Multidetector CT/three‐dimensional image analysis was performed independently by three experienced radiologists. Results Of 804 patients reviewed, 43 colorectal cancers were included in the final analysis. Median age at first CT was 80 (73–85) years and the median interval between scans was 150 (i.q.r. 72–471) days. An increase in T category was demonstrated in 31 of 43 tumours, with a median doubling time of 211 (112–404) days. The median percentage increase in tumour volume was 34·1 (13·3–53·9) per cent per 62 days. The all‐cause 3‐year mortality rate was 81 per cent (35 of 43) with a median survival time of 1·1 (0·4–2·2) years after the initial diagnostic scan. In those obstructed, the relative risk of death from subsequent perforation was 1·26 (95 per cent c.i. 1·07 to 1·49; P = 0·005). Conclusion This study documented a median doubling time of 211 days, with a concerning suggestion of tumour progression, which has implications for the current management standard., Few studies have evaluated the growth pattern of colorectal cancer. Forty‐three patients who underwent CT twice more than 5 weeks apart were included over a 2‐year interval. The median doubling time was 211 days, with a concerning suggestion of tumour progression. This has implications both under the current 62‐day UK standard and following the rapid emergence of COVID‐19 and its global impact on surgical cancer care. Tumor volume changes in colorectal cancer