Colorectal Cancer

ON THIS PAGE: You will find a drawing of the main body parts affected by colorectal cancer. Use the menu to see other pages.

Copyright 2021 American Society of Clinical Oncology. Robert Morreale.

The next section in this guide is Risk Factors and Prevention . It describes the factors that may increase the chance of developing colorectal cancer. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find out more about screening for colorectal cancer. You will also learn the risks and benefits of screening. Use the menu to see other pages.

Screening is used to look for cancer before you have any symptoms or signs. Scientists have developed, and continue to develop, tests that can be used to screen a person for specific types of cancer before signs or symptoms appear. The overall goals of cancer screening are to:

• Lower the number of people who die from the disease, or eliminate deaths from cancer altogether

• Lower the number of people who develop the disease

• Identify people who may need more frequent screening or a different type of screening because they have a higher risk of developing cancer due to genetic mutations, hereditary syndromes, or family history

Learn more about the basics of cancer screening .

How are people screened for colorectal cancer?

Colorectal cancer can often be prevented through regular screening, which can find polyps before they become cancerous. Talk with your doctor about when screening should begin based on your age and family history of the disease. See more information below for screening recommendations.

Because colorectal cancer usually does not cause symptoms until the disease is advanced, it is important for people to talk with their doctor about the pros and cons of each screening test and how often each test should be given. Under the guidelines below, people should begin colorectal cancer screening earlier and/or undergo screening more often if they have any of the following risk factors for colorectal cancer:

• A personal history of colorectal cancer or adenomatous polyps.

• A strong family history of colorectal cancer or polyps, such as cancer or polyps in a first-degree relative younger than 60 or in 2 first-degree relatives of any age. A first-degree relative is defined as a parent, sibling, or child.

• A personal history of chronic inflammatory bowel disease (IBD).

• A family history of any hereditary colorectal cancer syndrome, such as familial adenomatous polyposis (FAP ), Lynch syndrome , or other syndromes (see Risk Factors and Prevention ).

The tests used to screen for colorectal cancer are described below.

• Colonoscopy. A colonoscopy allows the doctor to look inside the entire rectum and colon while a patient is sedated. A flexible, lighted tube called a colonoscope is inserted into the rectum and the entire colon to look for polyps or cancer. During this procedure, a doctor can remove polyps or other tissue for examination (see “Biopsy” in the Diagnosis section). The removal of polyps can also prevent colorectal cancer.

• Computed tomography (CT or CAT) colonography. CT colonography , sometimes called virtual colonoscopy, is a screening method being studied in some centers. It requires interpretation by a skilled radiologist to provide the best results. A radiologist is a doctor who specializes in obtaining and interpreting medical images. CT colonography may be an alternative for people who cannot have a standard colonoscopy due to the risk of anesthesia, which is medication to block the awareness of pain, or if a person has a blockage in the colon that prevents a full examination.

• Sigmoidoscopy. A sigmoidoscopy uses a flexible, lighted tube that is inserted into the rectum and lower colon to check for polyps, cancer, and other abnormalities. During this procedure, a doctor can remove polyps or other tissue for later examination. The doctor cannot check the upper part of the colon, the ascending and transverse colon, with this test. This screening test can be used to remove polyps, which can also prevent colorectal cancer, but if polyps or cancer are found using this test, a colonoscopy to view the entire colon is recommended.

• Fecal occult blood test (FOBT) and fecal immunochemical test (FIT). A fecal occult blood test is used to find blood in the feces, or stool, which can be a sign of polyps or cancer. A positive test, meaning that blood is found in the feces, can be from causes other than a colon polyp or cancer, including bleeding in the stomach or upper gastrointestinal (GI) tract and even eating rare meat or other foods. There are 2 types of tests: guaiac (FOBT) and immunochemical (FIT). Polyps and cancers do not bleed continually, so FOBT must be done on several stool samples each year and should be repeated every year. Even then, this screening test provides a fairly small reduction in deaths from colorectal cancer, around 30% if done yearly and 18% if done every other year.

• Stool DNA tests. This test analyzes the DNA from a person’s stool sample to look for cancer. It uses changes in the DNA that occur in polyps and cancers to find out if a colonoscopy should be done.

• Double contrast barium enema (DCBE). For patients who cannot have a colonoscopy, an enema containing barium is given, which helps make the colon and rectum stand out on x-rays. A series of x-rays is then taken of the colon and rectum. In general, most doctors would recommend other screening tests because a barium enema is less likely to detect precancerous polyps than a colonoscopy, sigmoidoscopy, or CT colonography.

Colorectal cancer screening recommendations

Different organizations have made different recommendations for colorectal cancer screening, described below. Talk with your doctor about the best test(s) and time between tests based on your health history and personal colorectal cancer risk .

The American Society of Clinical Oncology (ASCO) developed guidelines in 2019 for colorectal cancer screening to help prevent cancer for people with an average risk. Beginning at age 50, both men and women with an average risk of colorectal cancer should follow 1 of these testing schedules. People with an average risk do not have a family history of the disease, an inherited syndrome such as Lynch syndrome, or IBD, and they have not been diagnosed with colorectal cancer in the past.

The following tests detect both polyps and cancer:

• Flexible sigmoidoscopy every 5 years, or every 10 years with FIT or FOBT every year

• Colonoscopy, every 10 years

• DCBE, every 5 years

• CT colonography, as often as your doctor recommends

These tests primarily detect cancer:

• Guaiac-based FOBT, every year

• FIT, every year

• Stool DNA test, as often as your doctor recommends

Access to certain screening services may be limited in rural and other underserved areas. Talk with your health care team about your options nearby, and learn more about ASCO's recommendations for preventing colorectal cancer.

The U.S. Preventive Services Task Force (USPSTF) also has guidelines for colorectal cancer screening, which do not recommend any specific screening method. Instead, USPSTF simply recommends that people between ages 45 and 75 should receive regular screening.

According to the USPSTF, adults between ages 76 and 85 should talk with their doctor to see if screening is right for them. However, people who have a history of polyps or colorectal cancer have a higher risk of the disease, and screening may still be recommended at an older age. Learn more about treatment decisions in older patients.

Due to the rising incidence of colorectal cancer in younger people, the American Cancer Society recommends that people at average risk of colorectal cancer start regular screening at age 45.

It is important to note that, regardless of which screening test and schedule used, any test that indicates an abnormality should be followed up with a colonoscopy.

The next section in this guide is Symptoms and Signs . It explains what changes or medical problems colorectal cancer can cause. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If the cancer has spread, it is called metastasis. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know whether an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

How colorectal cancer is diagnosed

There are different tests used for diagnosing colorectal cancer. Not all tests described here will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

• The type of cancer suspected

• Your signs and symptoms

• Your age and general health

• Your medical and family history

• The results of earlier medical tests

In addition to a physical examination, the following tests may be used to diagnose colorectal cancer.

• Colonoscopy. As described in Screening , a colonoscopy allows the doctor to look inside the entire rectum and colon while a patient is sedated. This test is usually done by a gastroenterologist or colorectal surgeon. If colorectal cancer is found, a complete diagnosis that accurately describes the location and spread of the cancer may not be possible until the tumor is surgically removed.

• Biopsy. A biopsy is the only way to make a definite diagnosis, even if other tests can suggest that cancer is present. During a biopsy, a small amount of tissue is removed for examination under a microscope. A pathologist analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. A biopsy may be performed during a colonoscopy, or it may be done on any tissue that is removed during surgery. Sometimes, a CT scan or ultrasound (see below) is used to help perform a needle biopsy. A needle biopsy removes tissue through the skin with a needle that is guided into the tumor.

• Biomarker testing of the tumor. Your doctor may recommend running laboratory tests on a tumor sample to identify specific genes, proteins, and other factors unique to the tumor. This may also be called molecular testing or next generation sequencing of the tumor. Results of these tests may help determine your treatment options .

  All colorectal cancers should be tested for problems in mismatch repair proteins, called a mismatch repair deficiency (dMMR). There are 2 reasons for this testing. First, it is a way to look for Lynch syndrome (see Risk Factors and Prevention ). Second, the results will be used to find out if immunotherapy should be considered in the treatment of metastatic disease. This testing can either be done using special staining of the tissue taken from a biopsy or surgery or by doing analyses that look for changes called microsatellite instability (MSI).

  If you have metastatic or recurrent colorectal cancer, a sample of tissue from the area where it spread or recurred is preferred for testing, if available.

• Blood tests. Because colorectal cancer often bleeds into the large intestine or rectum, people with the disease may become anemic . A test of the number of red cells in the blood, which is part of a complete blood count (CBC) , can indicate that bleeding may be occurring.

  Another blood test detects the levels of a protein called carcinoembryonic antigen (CEA). High levels of CEA may indicate that a cancer has spread to other parts of the body. CEA is not a perfect test for colorectal cancer because levels are high for only about 60% of people with colorectal cancer that has spread from the colon to other organs. In addition, other medical conditions can cause CEA to increase. A CEA test is most often used to monitor colorectal cancer for people who are already receiving treatment. It is not useful as a screening test. Learn more about tumor markers for cancer .

• Computed tomography (CT or CAT) scan. A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image that shows any abnormalities or tumors. A CT scan can be used to measure the tumor’s size. Sometimes a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow. In a person with colorectal cancer, a CT scan can check for the spread of cancer to the lungs, liver, and other organs. It is often done before surgery (see Types of Treatment ).

• Magnetic resonance imaging (MRI). An MRI produces detailed images of the inside of the body using magnetic fields, not x-rays. MRI can be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow. MRI is the best imaging test to find where rectal cancer has grown.

• Ultrasound. An ultrasound creates a picture of the internal organs using sound waves to find out if cancer has spread. Endorectal ultrasound is commonly used to find out how deeply rectal cancer has grown and can be used to help plan treatment. However, this test cannot accurately detect cancer that has spread to nearby lymph nodes or beyond the pelvis. Ultrasound can also be used to view the liver, although CT scans or MRIs (see above) are better for finding tumors in the liver.

• Chest x-ray. An x-ray creates a picture of the structures inside of the body using a small amount of radiation. An x-ray of the chest can help doctors find out if the cancer has spread to the lungs. However, CT scans of the chest are better for finding tumors in the lungs or chest.

• Positron emission tomography (PET) or PET-CT scan. A PET scan creates pictures of organs and tissues inside the body. A PET scan is usually combined with a CT scan (see above), called a PET-CT scan . However, you may hear your doctor refer to this procedure just as a PET scan. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. However, the amount of radiation in the substance is too low to be harmful. A scanner then detects this substance to produce images of the inside of the body. PET scans are not regularly used for all people with colorectal cancer, but there are specific situations when your doctor may recommend one.

After diagnostic tests are done, your doctor will review the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer. This is called staging.

The next section in this guide is Stages . It explains the system doctors use to describe the extent of the disease. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will learn about the different types of treatments doctors use for people with colorectal cancer. Use the menu to see other pages.

This section explains the types of treatments, also known as therapies, that are the standard of care for colorectal cancer. “Standard of care” means the best treatments known. Information in this section is based on medical standards of care for colorectal cancer in the United States. Treatment options can vary from one place to another.

When making treatment plan decisions, you are encouraged to discuss with your doctor whether clinical trials offer additional options to consider. A clinical trial is a research study that tests a new approach to treatment. Doctors learn through clinical trials whether a new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Clinical trials are an option for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.

How colorectal cancer is treated

In cancer care, different types of doctors who specialize in cancer, called oncologists, often work together to create a patient’s overall treatment plan that usually includes or combines different types of treatments. This is called a multidisciplinary team. For colorectal cancer, this generally includes a surgeon, medical oncologist, radiation oncologist, and a gastroenterologist. A gastroenterologist is a doctor who specializes in the function and disorders of the gastrointestinal tract. Cancer care teams include other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, genetic counselors, dietitians, physical therapists, occupational therapists, and others. Learn more about the clinicians who provide cancer care.

Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. These types of conversations are called “shared decision-making.” Shared decision-making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision-making is important for colorectal cancer because there are different treatment options. Learn more about making treatment decisions .

Studies have shown that these various treatment approaches provide similar benefits regardless of the patient’s age. However, adults age 65 and older may have unique treatment challenges. Learn more about the specific effects of surgery, chemotherapy, and radiation therapy on adults 65 and older. In order to tailor the treatment to each patient, all treatment decisions should consider such factors as:

• The patient’s other medical conditions

• The patient’s overall health

• Potential side effects of the treatment plan

• Other medications that the patient already takes

• The patient’s nutritional status and social support

The common types of treatments used for colorectal cancer are described below, followed by a brief outline of treatment options listed by stage. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.

READ MORE BELOW:

• Surgery

• Radiation therapy

• Chemotherapy

• Targeted therapy

• Immunotherapy

• Physical, social, emotional, and financial effects of cancer

• Treatment by stage of colorectal cancer

• Remission and the chance of recurrence

• If treatment does not work

Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. It is often called surgical resection. This is the most common treatment for colorectal cancer. Part of the healthy colon or rectum and nearby lymph nodes will also be removed.

While both general surgeons and specialists may perform colorectal surgery, many people talk with specialists who have additional training and experience in colorectal surgery. A surgical oncologist is a doctor who specializes in treating cancer using surgery. A colorectal surgeon is a doctor who has received additional training to treat diseases of the colon, rectum, and anus. Colorectal surgeons used to be called proctologists.

In addition to surgical resection, surgical options for colorectal cancer include:

• Laparoscopic surgery. Some patients may be able to have laparoscopic colorectal cancer surgery. With this technique, several viewing scopes are passed into the abdomen while a patient is under anesthesia. Anesthesia is medicine that blocks the awareness of pain. The incisions are smaller, and the recovery time is often shorter than with standard colon surgery. Laparoscopic surgery is as effective as conventional colon surgery in removing the cancer. Surgeons who perform laparoscopic surgery have been specially trained in that technique.

• Robotic surgery. In this procedure, the surgeon controls robotic surgical tools to remove the tumor and, if needed, lymph nodes through small incisions. The technology provides the surgeon with a magnified view of the surgical area and precise control of small surgical tools. This means that the surgery can be performed using fewer and smaller incisions, or cuts, in the body, which may lower the risk of side effects from the surgery. Robotic surgery may also be helpful when the surgical area, such as the rectum, is harder to operate in using larger surgical tools held in a surgeon’s hand.

• Colostomy for rectal cancer. Less often, a person with rectal cancer may need to have a colostomy. This is a surgical opening, or stoma, through which the colon is connected to the abdominal surface to provide a pathway for waste to exit the body. This waste is collected in a pouch worn by the patient. Sometimes, the colostomy is only temporary to allow the rectum to heal, but it may be permanent. With modern surgical techniques and the use of radiation therapy and chemotherapy before surgery when needed, most people who receive treatment for rectal cancer do not need a permanent colostomy. Learn more about colostomies .

• Radiofrequency ablation (RFA) or cryoablation. Some patients may have surgery on the liver or lungs to remove colorectal cancer that has spread to those organs. Optional treatments include using energy in the form of radiofrequency waves to heat the tumors, called RFA, or to freeze the tumor, called cryoablation. Not all liver or lung tumors can be treated with these approaches. RFA can be done through the skin or during surgery. While this can help avoid removing parts of the liver and lung tissue that might be removed in a regular surgery, there is also a chance that parts of tumor will be left behind.

Side effects of surgery

Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have and ask how side effects can be prevented or relieved. In general, the side effects of surgery include pain and tenderness in the area of the operation. The operation may also cause constipation or diarrhea , which usually goes away after a while. People who have a colostomy may have irritation around the stoma. If you need to have a colostomy, the doctor, nurse, or an enterostomal therapist, who is a specialist in colostomy management, can teach you how to clean the area and prevent infection.

Many people need to retrain their bowel after surgery. This may take some time and assistance. You should talk with your doctor if you do not regain good control of bowel function.

Learn more about the basics of cancer surgery .

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Radiation therapy

Radiation therapy is the use of high-energy x-rays to destroy cancer cells. It is commonly used for treating rectal cancer because this kind of tumor tends to recur near where it originally started. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time.

External-beam radiation therapy. External-beam radiation therapy uses a machine to deliver x-rays to where the cancer is located. Radiation treatment is usually given 5 days a week for several weeks. It may be given in the doctor's office or at the hospital.

Stereotactic radiation therapy. Stereotactic radiation therapy is a type of external-beam radiation therapy that may be used if colorectal cancer has spread to the liver or lungs. This type of radiation therapy delivers a large, precise radiation dose to a small area. This technique can help save parts of the liver and lung tissue that might otherwise have to be removed during surgery. However, not all cancers that have spread to the liver or lungs can be treated in this way.

Other types of radiation therapy. For some people, specialized radiation therapy techniques, such as intraoperative radiation therapy or brachytherapy, may help get rid of small areas of cancer that can not be removed with surgery.

• Intraoperative radiation therapy. Intraoperative radiation therapy uses a single, high dose of radiation therapy given during surgery.

• Brachytherapy. Brachytherapy is the use of radioactive "seeds" placed inside the body.

• Yttrium-90. In this form of radiation therapy, tiny amounts of a radioactive substance called yttrium-90 are injected into the liver to treat colorectal cancer that has spread to the liver when surgery is not an option. The radioactive beads dissolve and disappear in a few weeks. Limited information is available about how effective this approach is, but some studies suggest that it may help slow the growth of cancer cells. This procedure is performed by an interventional radiologist.

Radiation therapy for rectal cancer. For rectal cancer, radiation therapy may be used before surgery, called neoadjuvant therapy, to shrink the tumor so that it is easier to remove. It may also be used after surgery to destroy any remaining cancer cells. Both approaches have worked to treat this disease. Chemotherapy is often given at the same time as radiation therapy to increase the effectiveness of the radiation therapy. This is called chemoradiation therapy.

Chemoradiation therapy is often used in rectal cancer before surgery to avoid colostomy or reduce the chance that the cancer will recur. One study found that chemoradiation therapy before surgery worked better and caused fewer side effects than the same radiation therapy and chemotherapy given after surgery. The main benefits included a lower rate of the cancer coming back in the area where it started, fewer patients who needed permanent colostomies, and fewer problems with scarring of the bowel where the radiation therapy was given.

Radiation therapy is typically given in the United States for rectal cancer over 5.5 weeks before surgery. However, for certain patients (and in certain countries), a shorter course of 5 days of radiation therapy before surgery is appropriate and/or preferred.

A newer approach to rectal cancer is currently being used for many patients. It is called total neoadjuvant therapy (TNT). With TNT, both chemotherapy and chemoradiation therapy are given for about 6 months before surgery.

Side effects of radiation therapy

Talk with your doctor about the possible side effects of your radiation therapy regimen. Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. It may also cause bloody stools from bleeding through the rectum or blockage of the bowel. Most side effects go away soon after treatment is finished.

Sexual health problems, as well as infertility (the inability to have a child), may occur after radiation therapy to the pelvis. Before treatment begins, talk with your doctor about the chances that the treatment will affect sexual health and fertility and the available options for preserving fertility .

Learn more about the basics of radiation therapy .

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Therapies using medication

The treatment plan may include medications to destroy cancer cells. Medication may be given through the bloodstream to reach cancer cells throughout the body. When a drug is given this way, it is called systemic therapy. Medication may also be given locally, which is when the medication is applied directly to the cancer or kept in a single part of the body.

This type of medication is generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication.

Medications are often given through an intravenous (IV) tube placed into a vein using a needle or as a pill or capsule that is swallowed (orally). If you are given oral medications to take at home, be sure to ask your health care team about how to safely store and handle them.

The types of medications used for colorectal cancer include:

• Chemotherapy

• Targeted therapy

• Immunotherapy

Each of these types of therapies is discussed below in more detail. A person may receive 1 type of medication at a time or a combination of medications given at the same time. They can also be given as part of a treatment plan that includes surgery and/or radiation therapy.

The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications.

It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications, causing unwanted side effects or reduced effectiveness. Learn more about your prescriptions by using searchable drug databases .

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells.

A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time or a combination of different drugs given at the same time.

Chemotherapy may be given after surgery to eliminate any remaining cancer cells. For some people with rectal cancer, the doctor will give chemotherapy and radiation therapy before surgery to reduce the size of a rectal tumor and reduce the chance of the cancer returning.

Many drugs are approved by the U.S. Food and Drug Administration (FDA) to treat colorectal cancer in the United States. Your doctor may recommend 1 or more of them at different times during treatment. Sometimes these are combined with targeted therapy drugs (see “ Targeted therapy ” below).

• Capecitabine (Xeloda)

• Fluorouracil (5-FU)

• Irinotecan (Camptosar)

• Oxaliplatin (Eloxatin)

• Trifluridine/tipiracil (Lonsurf)

Some common treatment regimens using these drugs include:

• 5-FU alone

• 5-FU with leucovorin (folinic acid), a vitamin that improves the effectiveness of 5-FU

• Capecitabine, an oral form of 5-FU

• FOLFOX: 5-FU with leucovorin and oxaliplatin

• FOLFIRI: 5-FU with leucovorin and irinotecan

• Irinotecan alone

• FOLFOXIRI: 5-FU with leucovorin, oxaliplatin, and irinotecan

• XELOX/CAPEOX: Capecitabine with oxaliplatin

• Use of a targeted therapy in combination with chemotherapy may be recommended: bevacizumab (Avastin), cetuximab (Erbitux), or panitumumab (Vectibix).

Side effects of chemotherapy

Chemotherapy may cause vomiting, nausea, diarrhea, mouth sores, or neuropathy, which is tingling or numbness in feet or hands. However, medications to prevent these side effects are available. Because of the way drugs are given, these side effects are less severe than they have been in the past for most people. In addition, patients may be unusually tired or fatigued, and there is an increased risk of infection. Major hair loss is an uncommon side effect with many of the drugs used to treat colorectal cancer, although it is more common with chemotherapy regimens that include irinotecan.

If side effects are particularly difficult, the dose of the drug may be lowered or a treatment session may be postponed. If you are receiving chemotherapy, you should regularly talk with your health care team about any side effects and ask which symptoms and side effects your doctor should know about right away. Read more about managing side effects . The side effects from chemotherapy usually go away after treatment is finished.

Learn more about the basics of chemotherapy .

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Targeted therapy

Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells and limits damage to healthy cells.

Not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. This helps doctors better match each patient with the most effective treatment whenever possible. In addition, research studies continue to find out more about specific molecular targets and new treatments directed at them. These drugs are becoming more important in the treatment of colorectal cancer. Learn more about the basics of targeted treatments .

Studies have shown that older patients are able to benefit from targeted therapies, similar to younger patients. In addition, the expected side effects are usually manageable in both older and younger patients.

For colorectal cancer, the following targeted therapies may be options.

Anti-angiogenesis therapy. Anti-angiogenesis therapy is focused on stopping angiogenesis, which is the process of making new blood vessels. Because a tumor needs the nutrients delivered by blood vessels to grow and spread, the goal of anti-angiogenesis therapies is to “starve” the tumor. The medications described below block a protein called VEGF, which is involved in the development of new blood vessels. They may also be called VEGF inhibitors.

• Bevacizumab (Avastin). When bevacizumab is given with chemotherapy, it can help people with advanced colorectal cancer live longer. In 2004, the FDA approved bevacizumab along with chemotherapy as the first treatment, or first-line treatment, for advanced colorectal cancer. Recent studies have shown it is also effective as second-line therapy along with chemotherapy. There are 2 drugs similar to bevacizumab, bevacizumab-awwb (Mvasi) and bevacizumab-bvzr (Zirabev), that have also been approved by the FDA to treat advanced colorectal cancer. These are called biosimilars .

• Fruquintinib (Fruzaqla). Fruquintinib may be used to treat people with metastatic colorectal cancer who have previously received chemotherapy and targeted therapy. This drug targets several VEGF receptors, which may explain why it still works for people who have already received treatment with a different VEGF inhibitor, such as bevacizumab. Fruquintinib is the latest targeted therapy to be approved in many years for treating advanced colorectal cancer that does not require a specific genetic mutation.

• Regorafenib (Stivarga). This drug is used to treat people with metastatic colorectal cancer who have already received certain types of chemotherapy and other targeted therapies.

• Ziv-aflibercept (Zaltrap) and ramucirumab (Cyramza). Either of these drugs can be combined with FOLFIRI chemotherapy as a second-line treatment for metastatic colorectal cancer.

Epidermal growth factor receptor (EGFR) inhibitors. Researchers have found that drugs that block EGFR may be effective for stopping or slowing the growth of colorectal cancer.

• Cetuximab (Erbitux)

• Panitumumab (Vectibix)

Recent studies show that cetuximab and panitumumab do not work as well for tumors that have specific changes, called mutations or alterations, to a gene called RAS . ASCO recommends that all people with metastatic colorectal cancer who may receive an EGFR inhibitor have their tumors tested for RAS and RAF gene mutations. If a tumor has a mutated form of the RAS gene or a specific BRAF mutation called V600E, ASCO recommends that they do not receive EGFR inhibitors. Research has also shown that these drugs do not work for HER2-positive colorectal cancer.

Combined targeted therapies. Some tumors have a specific mutation, called BRAF V600E, that can be detected by an FDA-approved test. A class of targeted treatments called BRAF inhibitors can be used to treat tumors with this mutation. A combination using the BRAF inhibitor encorafenib (Braftovi) and the EGFR inhibitor cetuximab may be used to treat people with metastatic colorectal cancer with this mutation who have received at least 1 previous treatment.

HER2-targeted therapy. Some tumors express a protein called HER2 that can be targeted by specific medications. If this happens, the cancer is called HER2-positive. For people with HER2-positive advanced colorectal cancer, treatment with a combination of tucatinib (Tukysa) and trastuzumab (Herceptin and other brand names) may be an option. This combination may only be used if there are no mutations in the RAS gene, surgery is not an option, and chemotherapy has stopped working and/or caused side effects that require stopping treatment. It also appears that HER2-targeted therapies do not work as well in tumors with PIK3CA mutations, so if your cancer has this, discuss with your doctor whether HER2-targeted therapy is right for you.

Tumor-agnostic treatment. Larotrectinib (Vitrakvi) and entrectinib (Rozlytrek) are types of targeted therapy that are not specific to a certain type of cancer but focus on a specific genetic change called an NTRK fusion. This type of genetic change is rare but is found in a range of cancers, including colorectal cancer. These medications are approved as treatment for colorectal cancer that is metastatic or cannot be removed with surgery and has worsened with other treatments.

The tumor may also be tested for other molecular markers, including PIK3CA mutations and others. These markers do not have FDA-approved targeted therapies yet, but there may be opportunities to receive treatment in clinical trials that are studying these molecular changes.

Side effects of targeted therapies

Talk with your doctor about possible side effects for a specific medication and how they can be managed. The side effects of targeted treatments can include a rash to the face and upper body, which can be prevented or reduced with various treatments. Find out more about skin reactions to targeted therapies .

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Immunotherapy

Immunotherapy uses the body's natural defenses to fight cancer by improving your immune system’s ability to attack cancer cells.

Checkpoint inhibitors are an important type of immunotherapy used to treat colorectal cancer. Learn more about the basics of immunotherapy .

• Pembrolizumab (Keytruda). Pembrolizumab targets PD-1, a receptor on tumor cells, preventing the tumor cells from hiding from the immune system. Pembrolizumab is used to treat unresectable or metastatic colorectal cancers that have a molecular feature called microsatellite instability (MSI-H) or mismatch r.epair deficiency (dMMR) (see Diagnosis ). Unresectable means surgery is not an option.

• Nivolumab (Opdivo). Nivolumab is used to treat people who are 12 or older and have MSI-H or dMMR metastatic colorectal cancer that has grown or spread after treatment with chemotherapy with a fluoropyrimidine (such as capecitabine and fluorouracil), oxaliplatin, and irinotecan.

• Dostarlimab (Jemperli). Dostarlimab is a PD-1 immune checkpoint inhibitor. It may be used to treat recurrent or metastatic colorectal cancers that have dMMR.

• Nivolumab and ipilimumab (Yervoy) combination. This combination of checkpoint inhibitors is approved to treat patients who are 12 or older and have MSI-H or dMMR metastatic colorectal cancer that has grown or spread after treatment with chemotherapy with a fluoropyrimidine, oxaliplatin, and irinotecan.

Side effects of immunotherapies

Different types of immunotherapy can cause different side effects. The most common side effects of immunotherapy may include fatigue, rash, diarrhea, nausea, fever, muscle pain, bone pain, joint pain, abdominal pain, itching, vomiting, cough, decreased appetite, and shortness of breath. Immunotherapy can increase the risk of inflammation in different organs in your body. Talk with your doctor about possible side effects for the immunotherapy recommended for you and what symptoms to watch for.

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Physical, emotional, social, and financial effects of cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative and supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative and supportive care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative and supportive care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments, such as chemotherapy, surgery, or radiation therapy, to improve symptoms.

Before treatment begins, talk with your doctor about the goals of each treatment in the recommended treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative and supportive care options. Many patients also benefit from talking with a social worker and participating in support groups. Ask your doctor about these resources, too.

Cancer care is often expensive, and navigating health insurance can be difficult. Ask your doctor or another member of your health care team about talking with a financial navigator or counselor who may be able to help with your financial concerns .

During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative and supportive care in a separate section of this website.

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Treatment by stage of colorectal cancer

Different treatments may be recommended for each stage of colorectal cancer. The general options by stage are described below. For more detailed descriptions, see “How colorectal cancer is treated,” above. Your doctor will work with you to develop a specific treatment plan based on your specific diagnosis and needs. Clinical trials may also be a treatment option for each stage.

In general, stages 0, I, II, and III are often curable with surgery. However, many people with stage III colorectal cancer, and some with stage II, receive chemotherapy after surgery to increase the chance of eliminating the disease. People with stage II and III rectal cancer will also receive radiation therapy with chemotherapy either before or after surgery. Stage IV is not often curable, but it is treatable, and the growth of the cancer and the symptoms of the disease can be managed.

Stage 0 colorectal cancer

The usual treatment is a polypectomy, or removal of a polyp, during a colonoscopy. There is no additional surgery unless the polyp cannot be fully removed.

Stage I colorectal cancer

Surgical removal of the tumor and lymph nodes is usually the only treatment needed.

Stage II colorectal cancer

Surgery is often the first treatment. People with stage II colorectal cancer should talk with their doctor about whether more treatment is needed after surgery because in some cases adjuvant chemotherapy may be recommended. Adjuvant chemotherapy is treatment after surgery with the goal of trying to destroy any remaining cancer cells. ASCO does not recommend adjuvant chemotherapy for many people with stage II colon cancer. Cure rates for surgery alone are quite good, and there are limited benefits of additional treatment for many people with this stage of colon cancer. However, adjuvant chemotherapy may be recommended for some people with cancer that has invaded nearby organs, penetrated through the entire bowel wall, or has features that indicate a high risk of recurrence. Talk with your doctors about the risks and benefits of adjuvant chemotherapy. A clinical trial is also an option after surgery.

For stage II rectal cancer, radiation therapy is usually given in combination with chemotherapy, either before or after surgery. Additional chemotherapy may be given after surgery as well.

Stage III colorectal cancer

Treatment usually involves surgical removal of the tumor followed by adjuvant chemotherapy. A clinical trial may also an option. The duration of adjuvant therapy depends on the risk of recurrence (based on characteristics of the cancer that was removed at surgery). In determining duration of therapy, recent ASCO guidelines recommend a shared decision-making approach, taking into account patient characteristics, values and preferences, and other factors and including a discussion of the potential for benefit and risks of harm associated with duration.

For rectal cancer, radiation therapy may be used with chemotherapy before or after surgery, along with adjuvant chemotherapy.

Metastatic (stage IV) colorectal cancer

If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. Colorectal cancer can spread to distant organs, such as the liver, lungs, lymph nodes, ovaries, and the tissue called the peritoneum that lines the abdomen. If this happens, it is a good idea to talk with doctors who have experience treating this stage of cancer. Doctors can have different opinions about the best standard treatment plan. Clinical trials might also be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.

Your treatment plan may include a combination of chemotherapy, targeted therapy, immunotherapy, surgery, and radiation therapy, which can be used to slow the spread of the disease and shrink a cancerous tumor. Palliative and supportive care will also be important to help relieve symptoms of cancer and side effects of treatment.

For stage IV colorectal cancer, surgery to remove the portion of the colon where the cancer started is not generally recommended, but it may help relieve blockage of the colon or other problems related to the cancer. Surgery may also be used to remove parts of other organs that contain cancer, called resection, and can cure some people if a limited amount of cancer spreads to a single organ, such as the liver or a lung.

For people with metastatic colorectal cancer that does not have dMMR or MSI-H ( see above ) and cannot initially be treated by surgery, ASCO recommends starting with FOLFOX, FOLFIRI, or CAPOX chemotherapy. For some people, FOLFOXIRI may be recommended instead.

For individuals with left-sided colorectal cancer that is not dMMR/MSI-H and has no mutations in the RAS or BRAF genes or HER2 overexpression, treatment should begin with an EGFR inhibitor combined with a chemotherapy regimen using 2 drugs.

For people with metastatic colorectal cancer with dMMR or MSI-H, ASCO recommends starting treatment with immunotherapy using pembrolizumab.

If the cancer has not been stopped by the initial treatment and the cancer has a BRAF V600E mutation, then combination targeted therapies using encorafenib plus cetuximab may be recommended.

If the colorectal cancer has spread to the peritoneum, then surgery to reduce the size of the tumors combined with chemotherapy may be recommended.

If the colorectal cancer has spread only to the liver and if surgery is possible—either before or after chemotherapy—there is a chance of complete cure. Even when curing the cancer is not possible, surgery may add months or even years to a person’s life. Sometimes the surgery may be combined with chemotherapy. Determining who can benefit from surgery for cancer that has spread to the liver is often a complicated process that involves multiple doctors with different specialties working together to plan the best treatment option. If surgery is not an option for colorectal cancer that has spread to the liver, then radiation therapy may be offered instead.

For many people, a diagnosis of metastatic cancer is very stressful and difficult. You and your family are encouraged to talk about how you feel with doctors, nurses, social workers, or other members of your health care team. It may also be helpful to talk with other patients, such as through a support group or other peer support program.

This information is based on the ASCO guideline, “ Treatment of Metastatic Colorectal Cancer .” Please note that this link takes you to a separate ASCO website.

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Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence .

If the cancer returns after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

If a recurrence happens, a new cycle of testing will begin to learn as much as possible about it. After this testing is done, you and your doctor will talk about the treatment options. Often the treatment plan may include the treatments described above, such as surgery, radiation therapy, chemotherapy, immunotherapy, or targeted therapy, but they may be used in a different combination and will depend on molecular characteristics of your cancer and how your body is doing overall. Your doctor may suggest clinical trials that are studying new ways to treat recurrent colorectal cancer. Generally, the treatment options for recurrent cancer are the same as those for metastatic cancer. Whichever treatment plan you choose, palliative and supportive care will be important for relieving symptoms and side effects.

People with recurrent cancer sometimes experience emotions such as disbelief or fear. You are encouraged to talk with your health care team about these feelings and ask about support services to help you cope. Learn more about dealing with cancer recurrence .

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If treatment does not work

Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and for some people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

Planning for your future care and putting your wishes in writing is important, especially at this stage of disease. Then, your health care team and loved ones will know what you want, even if you are unable to make these decisions. Learn more about putting your health care wishes in writing.

People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning .

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss .

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The next section in this guide is About Clinical Trials . It offers more information about research studies that are focused on finding better ways to care for people with cancer. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will read about the scientific research being done to learn more about colorectal cancer and how to treat it. Use the menu to see other pages.

Doctors are working to learn more about colorectal cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the best diagnostic and treatment options for you.

• Improved detection methods. Researchers are developing tests to analyze stool samples and blood samples to find genetic changes associated with colorectal cancer. By finding and removing polyps or identifying cancer early, doctors have a better chance of curing the disease.

• Tests to predict the risk of cancer recurrence. Various genes play important roles in the growth and spread of tumors. Tests to identify these genes can help doctors and patients decide whether to use chemotherapy after treatment. Researchers hope that these tests can help people with a lower risk of recurrence avoid the side effects of additional treatment.

• Immunotherapy. In the past several years, researchers have discovered a class of drugs that targets the ways that tumor cells avoid the immune system. These immunotherapy drugs are called checkpoint inhibitors. The latest research has shown that certain checkpoint inhibitors, called PD-1 or PD-L1 inhibitors, can be effective against a type of metastatic colorectal cancer that is microsatellite high (MSI-H) or has mismatch repair deficiency (dMMR). There are ongoing clinical trials looking at combining checkpoint inhibitors with other drugs or cancer-directed treatments to see if they can be helpful in tumors that are not MSI-H.

• Chemotherapy and targeted therapy. New types of chemotherapy and targeted therapy are being studied for colorectal cancer, including advanced colon and rectal cancers. Most of these newer drugs are only available through clinical trials.

• Palliative and supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current colorectal cancer treatments to improve comfort and quality of life for patients.

Looking for More About the Latest Research?

If you would like more information about the latest areas of research in colorectal cancer, explore these related items that take you outside of this guide:

• To find clinical trials specific to your diagnosis, talk with your doctor or search online clinical trial databases now .

• Read about research presented at the 2023 , 2022 , and 2021 ASCO Annual Meetings.

• Listen to a podcast about research about colorectal cancer at the 2023 , 2022 , and 2021 ASCO Annual Meetings.

• Visit the Cancer.Net Blog to read about other recent research and information in colorectal cancer.

• Get updates from Cancer.Net delivered right to your inbox. Subscribe to the Inside Cancer.Net email newsletter.

• Visit the website of Conquer Cancer, the ASCO Foundation , to find out how to help support cancer research. Please note that this link takes you to a different ASCO website.

The next section in this guide is Coping with Treatment . It offers some guidance on how to cope with the physical, emotional, social, and financial changes that cancer and its treatment can bring. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will read about your medical care after cancer treatment is completed and why this follow-up care is important. Use the menu to see other pages.

Care for people diagnosed with cancer does not end when active treatment has finished. Your health care team will continue to check to make sure the cancer has not come back, manage any side effects, and monitor your overall health. This is called follow-up care.

Your follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your recovery in the months and years ahead. Follow-up care is especially important in the first 5 years after treatment for colorectal cancer because this is when the risk of recurrence is highest.

Cancer rehabilitation may be recommended, and this could mean any of a wide range of services, such as physical therapy, occupational therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent as possible. Learn more about cancer rehabilitation.

Learn more about the importance of follow-up care .

Watching for recurrence

One goal of follow-up care is to check for a recurrence, which means that the cancer has come back. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will ask specific questions about your health. Some people may have blood tests or imaging tests done as part of regular follow-up care, but testing recommendations depend on several factors, including the type and stage of cancer first diagnosed and the types of treatment given.

The anticipation before having a follow-up test or waiting for test results may add stress to you or a family member. This is sometimes called “scanxiety.” Learn more about how to cope with this type of stress .

Recommended follow-up care for colorectal cancer

The tests your doctor recommends and how often you need to have them will be based on your risk of recurrence and your overall health. In general, it is common for a patient to visit the doctor and receive follow-up screening every 3 to 6 months for 5 years after diagnosis. It is important to remember that different people have different risks of recurrence, so it is important to talk with your doctor about the possibility of the cancer coming back.

ASCO has recommendations for follow-up care for people who had stage II or stage III colorectal cancer. It is less certain what testing should be done for people who had stage I colorectal cancer because this stage is less likely to come back. If you have had treatment for metastatic colorectal cancer, it is important to talk with your doctor about creating a survivorship care plan specifically for you, since there is currently no standardized follow-up care schedule for this stage of colorectal cancer. It is also important to remember that these follow-up care recommendations are for people who had colorectal cancer that was not inherited (see Risk Factors ).

First year after treatment

• Physical examination and carcinoembryonic antigen (CEA) testing every 3 to 6 months

• Abdominal and chest computed tomography (CT) scan each year (every 6 to 12 months for people with a high risk of recurrence)

• For people with rectal cancer, pelvic CT scan every 6 to 12 months

• Colonoscopy 1 year after surgery (the results of this colonoscopy will guide if or when future colonoscopies will be needed)

• Rectosigmoidoscopy every 6 months for people with rectal cancer who did not have radiation therapy to the pelvis.

Second year after treatment

• Physical examination and CEA testing every 3 to 6 months

• CT scan each year (every 6 to 12 months for people with a high risk of recurrence)

• For people with rectal cancer, pelvic CT scan every 6 to 12 months

• Rectosigmoidoscopy every 6 months for people with rectal cancer who did not have radiation therapy to the pelvis

Third year after treatment

• Physical examination and CEA testing every 3 to 6 months

• CT scan each year (every 6 to 12 months for people with a high risk of recurrence)

• For people with rectal cancer, pelvic CT scan every 6 to 12 months

• Rectosigmoidoscopy every 6 months for people with rectal cancer who did not have radiation therapy to the pelvis

Fourth year after treatment

• Physical examination and CEA testing every 3 to 6 months

• For people with rectal cancer, pelvic CT scan each year

• Rectosigmoidoscopy every 6 months for people with rectal cancer who did not have radiation therapy to the pelvis

Fifth year after treatment

• Physical examination and CEA testing every 3 to 6 months

• For people with rectal cancer, pelvic CT scan each year

• Rectosigmoidoscopy every 6 months for people with rectal cancer who did not have radiation therapy to the pelvis

This information is based on the ASCO endorsement of the Cancer Care Ontario guideline, " Follow-Up Care, Surveillance Protocol, and Secondary Prevention Measures for Survivors of Colorectal Cancer Endorsement ." Note that this link takes you to a different ASCO website.

Managing long-term and late side effects

Most people expect to have side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects . Other side effects called late effects may develop months or even years after treatment has ended. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on your diagnosis, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may have certain physical examinations, scans, or blood tests to help find and manage them.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to discuss any concerns you have about your future physical or emotional health. The American Society of Clinical Oncology (ASCO) offers forms to help keep track of the cancer treatment you received and develop a survivorship care plan when treatment is completed.

This is also a good time to talk with your doctor about who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the care of their primary care doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, treatments received, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with them and with all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship . It describes how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find some questions to ask your doctor or other members of the health care team, to help you better understand your diagnosis, treatment plan, and overall care. Use the menu to see other pages.

Talking often with the health care team is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for a digital list and other interactive tools to manage your care. It may also be helpful to ask a family member or friend to come with you to appointments to help take notes.

Questions to ask about choosing a treatment and managing side effects

• What are my treatment options based on my diagnosis?

• What types of research are being done for colorectal cancer in clinical trials? Do clinical trials offer additional treatment options for me?

• What treatment plan do you recommend? Why?

• What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?

• What are the risks and possible side effects of each treatment, both in the short term and the long term?

• Who will be part of my health care team, and what does each member do?

• Who will be leading my overall treatment?

• How will this treatment affect my daily life? Will I able to work, exercise, and perform my usual activities?

• Could this treatment affect my sex life? If so, how and for how long?

• Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins?

• If I’m worried about managing the costs of cancer care, who can help me?

• What support services are available to me? To my family?

• If I have questions or problems, who should I call?

Questions to ask before surgery

• Where exactly is the cancer located?

• What do you know about my cancer at this point?

• If I have rectal cancer, should I have radiation therapy and chemotherapy before my surgery?

• What other tests will be done before surgery?

• Can you describe the surgery I will be having?

• What are you planning to remove during surgery? The colon, rectum, or lymph nodes?

• Is a biopsy part of the surgery?

• How soon after surgery will I have all test results and a firm diagnosis?

• Do you think I may need a temporary or permanent colostomy?

• Is this the standard type of surgery for my condition?

• How many times have you performed this type of operation successfully?

• Who will give me information about how I should get ready for surgery and a hospital stay? How long will I be in the hospital?

• How will my pain be controlled after surgery?

• What other side effects are possible with this type of surgery?

• Can you describe what my recovery from surgery will be like?

Questions to ask after surgery

• What is my diagnosis based on the results of surgery and biopsy reports, in TNM staging format?

• Can you explain my pathology report (laboratory test results) to me?

• Did the pathologist test my tumor for a possible genetic cause? Do I need genetic counseling or testing?

• Does my diagnosis mean that my relatives have a higher risk of colorectal cancer? Should they talk with their doctors about screening?

• Will the cancer be tested for mutations or other genetic features, like MSI-H or dMMR?

• What is my prognosis?

• How will additional treatment after surgery affect my prognosis?

• What additional treatment do you recommend? Why?

• What are the benefits and risks of adjuvant chemotherapy? How does it affect my prognosis?

• What is the goal of each treatment?

• Is it a standard treatment or part of a clinical trial?

• How long will it be before I can go back to work after surgery?

• If I need a colostomy, will you refer me to a specially trained nurse to decide on the best place for my colostomy and help me learn to manage it after the surgery?

• Who should I contact about any side effects I experience? And how soon?

Questions to ask about having radiation therapy

• What type of treatment is recommended?

• What is the goal of this treatment?

• How long will it take to give this treatment?

• What side effects can I expect during treatment?

• Who should I contact about any side effects I experience? And how soon?

• What are the possible long-term or late effects of having this treatment?

• What can be done to prevent or relieve the side effects?

Questions to ask about having therapies using medications

• What type(s) of medication is recommended?

• What is the goal of this treatment?

• How long will it take to give this treatment?

• Will I receive this treatment at a hospital or clinic? Or will I take it at home?

• What side effects can I expect during treatment?

• Who should I contact about any side effects I experience? And how soon?

• What are the possible long-term or late effects of having this treatment?

• What can be done to prevent or relieve the side effects?

Questions to ask about planning follow-up care

• What is the chance that the cancer will come back? Should I watch for specific signs or symptoms?

• How often will I need CEA testing? Where will it be done?

• How often do I need a computed tomography (CT) scan? Where will it be done?

• How often do I need a colonoscopy? Who will do it and where will it be done?

• (Rectal cancer only) How often do I need a rectosigmoidoscopy?

• What long-term side effects or late effects are possible based on the cancer treatment I received?

• What follow-up tests will I need, and how often will those tests be needed?

• What type of follow-up care do I need beyond 5 years after treatment?

• How do I get a treatment summary and survivorship care plan to keep in my personal records?

• When should I return to my primary care doctor for regular medical care?

• Who will be leading my follow-up care?

• What survivorship support services are available to me? To my family?

The next section in this guide is Additional Resources . It offers more resources on this website that may be helpful to you. Use the menu to choose a different section to read in this guide.