Professor Shepherd is honoured to give the 20th Doniach Lecture of the Pathological Society, following the 19 previous lecturers, who represent a galaxy of senior Pathological Society superstars, not least because he worked with Professor Doniach as a trainee in St Bartholomew’s Hospital, London. He is very grateful to Professor Sir Nicholas Wright, an old friend and colleague, for his nomination.

The lecture will describe the changes that have occurred in colorectal cancer (CRC) reporting and how this has influenced the management and prognosis of CRC patients. Adjuvant chemotherapy has greatly improved the prognosis of those patients and the selection of patients for that therapy is largely determined by pathological staging and other pathological prognostic parameters. It therefore follows that such patient selection requires optimal pathological practice.

The lecture will describe the development of this pathological practice, starting 100 years ago in a small specialist hospital in London and following the careers of the only Consultant Pathologists in that hospital in a 60-year period, Dukes, Morson and Jass, and their clinical research in CRC. That hospital was one of two Alma Maters of the current lecturer, who, on moving to Gloucester, established a 1000-strong unselected, prospective CRC series from which much of his research in CRC has evolved. Many of his papers, especially on peritoneal involvement, are cited in CRC reporting guidelines in the UK and internationally today.

The lecture will then describe the six major developments that have led to a dramatic improvement in the quality of CRC reporting in the last 20 years, driven by good clinical research, mainly undertaken in UK centres, including Gloucester. Finally, the lecture will describe how the Gloucester series remains relevant and is still being used in important international collaborative studies, particularly looking at the influence of artificial intelligence in CRC prognostication.