Colorectal cancer is common with around 43,000 new cases diagnosed every year across the UK. Curative treatment of localised disease traditionally involves surgery to remove the primary tumour with the associated lymph nodes and other mechanisms of tumour spread. Surgery carries significant risks for the patient, especially if elderly, with a high chance of major morbidity and a significant risk of mortality, despite recent improvements.

Patients with rectal cancer are commonly offered neoadjuvant (chemo)radiotherapy prior to surgery to increase the chances of complete tumour removal and reduce the risks of tumour recurrence. A small proportion of patients undergo a complete response to treatment with no residual tumour remaining in the resection specimen. Traditionally patients with colon cancer, comprising the majority of colorectal cancer, proceeded straight to surgery if they are considered suitable for curative treatment.

A number of recently delivered and planned clinical trials have sought to personalise the treatment of patients with potentially curative colorectal cancer by exploiting neoadjuvant treatment strategies to improve outcomes for patients with both rectal and colonic cancer. Some of these strategies will allow patients to avoid surgery altogether and thereby reduce their risk of significant morbidity and mortality. These trials are underpinned by high quality support from pathologists across the UK and beyond. This talk will summarise some of the key UK and international clinical trials that have recently been delivered and are in the process of being rolled out with central pathology support through the University of Leeds. These include ARISTOTLE, APHRODITE, ARTEMIS, TREC, STAR-TREC and the FOxTROT platform trials.