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What Should You Ask Your Doctor When You’re Diagnosed With Colon Cancer?

Hearing the words "you have colon cancer" can understandably overwhelm you. It’s hard to process important information, or know what to ask your doctor, when you’re in shock.

If you’ve just been diagnosed with colorectal cancer (cancers of the colon and rectum, or CRC), here are a few key facts you’ll need to establish at the start of your cancer journey:

Where, and at what stage, is your cancer?

The first thing you need to know is if your cancer is in your colon or your rectum (the last portion of the colon). Your treatment may differ based on the location.

Next, your doctor will determine the stage of your colorectal cancer. Staging describes the size of tumor and if, and how far, it has spread into the layers of the colon wall or into the lymph nodes. There are four stages of colon cancer: 1, 2, 3 and 4. The more localized your cancer (the lower the stage), the less it has spread and the better your prognosis. Stage 4 colorectal cancer has spread (metastasized) to other parts of the body.

You want to ask your doctor if there’s a cure available or if your cancer is just controllable, says Dr. Sreeram Maddipatla, medical oncologist/hematologist for the Liver Center and Pancreas Center at UF Health Cancer Center – Orlando Health. Many patients don’t ask this important question. "If [your cancer is] controllable, we can make your symptoms better and prolong your life," he says. "Sixty to 70 percent of patients with advanced colon cancer don’t know their disease is not curable, yet they still undergo rigorous treatment intended to cure."

[See: 8 Questions to Ask Your Doctor About Colon Cancer.]

What are the treatment options?

Surgery is the most common treatment for all stages of colorectal cancer. For early stage cancer, surgery is often the only treatment you need. Patients with stage 2 or 3 cancer may also receive chemotherapy to kill any cancer cells left over after surgery and to reduce the risk of the cancer returning.

A total mesorectal excision, removing tumors in the middle and lower rectum, is the standard of care for rectal cancers. It significantly reduces recurrence and improves survival. Ask your doctor if you need chemotherapy or radiation before surgery to shrink the tumor before attempting to remove it. You’ll also want a surgeon who has experience in rectal cancer surgery, since the rectum is so close to other organs. "The expertise of the surgeon makes a big difference," says Dr. Randolph Hecht, director of the UCLA Gastrointestinal Oncology Program and member of UCLA’s Jonsson Comprehensive Cancer Center.

Is there a genetic link?

Maddipatla encourages patients to ask their doctor if their particular cancer has a genetic link. Several hereditary diseases increase your risk for developing CRC and can potentially affect treatment decisions. Genetic testing is becoming standard practice when patients are diagnosed with CRC. If your physician determines you do have a hereditary condition, your family members may want to be tested. If they also have the genetic mutations, they should start screening earlier or undergo screening more frequently, knowing they have an above average risk of developing CRC.

[See: 10 Seemingly Innocent Symptoms You Shouldn’t Ignore.]

Do you have a multi-disciplinary team that evaluates and reviews cases?

Cancer care is a team sport, Hecht says, so most large institutions have tumor boards. "Oncologists present cases [to the tumor board], especially those that require more than one doctor. This has been shown to improve care."

Furthermore, colorectal cancer patients undergo rigorous follow-up for at least five years following treatment, so if their cancer comes back, they can catch it – and treat it – as early as possible. This requires that someone oversee your overall care. "Who is going to be your quarterback?" Hecht says. "Who is going to follow you for the next five years through treatment and follow-up?"

Are there clinical trials available?

Through clinical trials – large studies with people – the medical community gains new life-saving treatments and ways to help patients manage side effects. Participating in a clinical trial can give you access to potential new treatments before they’re widely available, as well as the opportunity to make a difference for future patients. Ask your doctor if there’s a clinical trial you might qualify for, Maddipatla says. "If there is, you should go into a clinical trial as soon as possible."

[See: 10 Ways to Prepare for Surgery.]

Why You Should Get a Second Opinion

It isn’t a question, but it’s an important point. Undergoing treatment for cancer is a major life event. You should have an oncologist and medical team you feel comfortable with. Furthermore, another hospital, or a bigger cancer center, may offer procedures and expertise that your local hospital does not. This is especially important for less common types of cancer. "It’s important to get more information," Maddipatla says. "There may be advanced treatments available at another facility."

"It’s never wrong to ask for a second opinion," Hecht says. "If you’re unhappy with your doctor, [he or she] is not the right doctor."

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