Angiogenesis is a spatially regulated hallmark of colorectal cancer (CRC) progression, yet current analytical frameworks fail to resolve how nutraceutical bioactive compounds interact with angiogenic signalling within the heterogeneous tumour microenvironment. This review advances a central hypothesis: that the spatial localisation of palm oil mill effluent (POME)-derived bioactive compounds within CRC tumour tissues is predictive of their functional anti-angiogenic activity. POME—the largest waste stream of palm oil processing—contains a chemically diverse array of bioactives, including tocotrienols, phenolics, carotenoids, and fatty acids, with reported antioxidant, anti-inflammatory, and anti-angiogenic properties. However, the existing evidence is predominantly derived from bulk in vitro analyses, limiting mechanistic conclusions about compound behaviour within spatially organised tumour architectures. To address this gap, we propose an integrated framework positioning mass spectrometry imaging (MSI)—across matrix-assisted laser desorption/ionisation (MALDI), desorption electrospray ionisation (DESI), and secondary ion mass spectrometry (SIMS) platforms—as the analytical bridge between compound localisation and angiogenic function. By enabling the label-free, spatially resolved co-localisation of POME-derived compounds with key angiogenic mediators, including VEGF, HIF-1α, and NF-κB, within intact CRC tissues, MSI provides a mechanistic platform that transcends the limitations of conventional molecular analyses. A four-component translational roadmap is outlined, encompassing POME bioactive profiling, spatial compound mapping, angiogenic co-localisation analysis, and functional validation. Critically, the existing evidence on oil palm-derived bioactives is appraised with respect to study quality, mechanistic depth, and translational limitations, identifying the most analytically tractable candidate compounds for spatial investigation. Collectively, this framework positions POME valorisation within a precision nutraceutical oncology paradigm, offering a spatially informed strategy for anti-angiogenic intervention in CRC while simultaneously addressing the environmental burden of palm oil processing waste.