• Subject is any sex and ≥45 years of age

• Subject must be advised to have or be scheduled for a screening colonoscopy

• Subject is at average risk for colorectal cancer according to the United States Preventive Services Task Force (USPSTF) guidelines, including:

‣ no prior diagnosis of colorectal cancer, adenomatous polyps, or inflammatory bowel disease

⁃ no family history of colorectal cancer (defined as one or more first degree relatives including parent, sibling, or child)

⁃ no personal diagnosis or family history of known genetic disorders that predispose them to a high lifetime risk of colorectal cancer including:

• Inflammatory bowel disease (IBD) including chronic ulcerative colitis (CUC) and Crohn's disease

∙ Familial adenomatous polyposis (also referred to as FAP, including attenuated FAP)

∙ Hereditary non-polyposis colorectal cancer syndrome (also referred to as HNPCC or Lynch Syndrome)

∙ Other hereditary cancer syndromes including but are not limited to Peutz-Jeghers Syndrome, MYH-Associated Polyposis (MAP), Gardner's Syndrome, Turcot's (or Crail's) Syndrome, Cowden's Syndrome, Juvenile Polyposis, Neurofibromatosis and Familial Hyperplastic Polyposis

∙ Cronkhite Canada Syndrome

• Subject can understand the study procedures, and is able to provide consent to participate in the study and authorizes release of relevant protected health information through reviewing and consenting to a Health Insurance Portability and Accountability Act (HIPAA) medical release form

• Subject is able and willing to provide stool samples within ninety (90) days before the colonoscopy procedure

• Subject is any sex and ≥ 18 years of age

• Subject is able and willing to give informed consent

• Through imaging, a positive non-invasive screening test, or colonoscopy requiring additional intervention subject is suspected or known to have Colorectal Cancer or Advanced Adenoma

• Subject has not yet been treated (e.g., ablation, surgical resection, radiation, chemotherapy, etc.) and still has at least one intact or partially intact lesion

• Subject must have a diagnostic colonoscopy or surgical intervention scheduled within 90 days of sample collection

• Subject can understand the study procedures and is able to provide consent to participate in the study and authorizes release of relevant protected health information through reviewing and consenting to a Health Insurance Portability and Accountability Act (HIPAA) medical release form