8 Questions to Ask Your Doctor About Colon Cancer
Understanding the basics
Being diagnosed with colon cancer, as with any cancer, is scary. It also might be a little embarrassing, since it involves a part of the body that's distinctly hidden from view. But colon cancer is the second leading cause of cancer death in the U.S. When detected early, it's highly treatable. It's also preventable with regular colonoscopies starting at age 50. If you're diagnosed with colon cancer, don't be shy about getting the information you need to cope with the diagnosis and the journey it's going to set you on. Here are eight questions to ask your doctor.
Do I have colon or rectal cancer, and what's the difference?
Two-thirds of people will have colon cancer, and one-third, rectal cancer, says Martin Weiser, a surgical oncologist specializing in colorectal surgery at Memorial Sloan Kettering Cancer Institute in New York. Rectal cancer affects the rectum; it's much harder to treat, the recurrence rates are higher and the outcomes tend to be worse, Weiser says. Colon cancer affects the colon and is curable with surgery and chemotherapy if you're diagnosed with stages I to III, Weiser adds.
What is the treatment, and how will it affect my life?
If the cancer is in the early stages (I to III), patients will generally have surgery first, followed by chemotherapy and radiation if necessary. If the cancer is in a later stage, patients will likely undergo chemotherapy first to shrink the tumor. Patients with rectal cancers (and large colon tumors) will probably have to go to the bathroom more frequently, Weiser says, adding that some patients may have to use an ostomy, a bag for waste, either temporarily or permanently.
What are some of the treatment (drug) side effects?
If you have to undergo chemotherapy, you'll probably start on a platinum-based one, which can cause neuropathy, a condition that impairs sensations, says Elizabeth Ezra, the pancreatic cancer coordinator for CancerCare, a national support group for cancer patients. Neuropathy may cause people to be very sensitive to hot or cold, adds Ezra, who also oversees all gastrointestinal cancers. "People put on drugs to take food out of the fridge; they can't drink cold water anymore," she says. "Of all the side effects from chemo, that's the worst." Ask your doctor about new, targeted therapies with fewer side effects, she adds.
Do I need to change my diet?
This is a frequent question, given the associations between diet and colorectal cancer -- which are somewhat tenuous, Weiser says. High red meat intake has been linked to colon cancer, so eating it in moderation can be protective, as is a high-fiber diet. However, Weiser doesn't recommend drastic dietary changes. "I recommend all foods in moderation," he says. Exercise, Ezra adds, can greatly reduce your risk of recurrence. "I encourage anyone on chemo to walk. They need to get the dead cancer cells out of the body as soon as possible."
Is the chemotherapy working?
This may seem self-evident, but you really want to know two things, Ezra says: Will the chemotherapy work on this particular tumor type, and how will your body withstand the rigors of treatment? The doctor will take scans to check the status of your tumor, but you want to ask: "Are you able to work? How long after treatments do you bounce back?" You will also want to know how long you have to undergo treatment. Colon cancer generally consists of 12 treatments but can be shorter. "A lot of times, people get to eight or nine, and the doctor will say, 'That's OK,'" meaning that's enough, Ezra says.
What kind of surgery will I have?
There are two types of surgical approaches: open surgery, which is usually reserved for tumors that are very large or invading other organs, and laparoscopic, which is minimally invasive. Ask your surgeon which procedure he or she is most comfortable with, and go with that approach, Weiser says, adding that patients should ask how many procedures their surgeon has done. The range should be 20 to 30 per year.
Should I see a genetic counselor?
There are certain conditions that predispose one to colorectal cancer, most notably Lynch syndrome, which can also cause other types of cancer, like endometrial cancer in women. Patients testing positive for Lynch syndrome may consider a prophylactic colectomy, in which part of the intestine is removed. This procedure can cause side effects, such as a more frequent need to go to the bathroom and certain dietary restrictions, Weiser says, so be sure you do in fact have Lynch syndrome or one of the other more rare conditions that genetically predispose you to colorectal cancer before going that route.
Where do I seek support?
"Our feeling is that any cancer diagnosis is traumatic -- is a shock," Ezra says. CancerCare offers support groups both online and over the telephone for various types of cancer. Called "Hopeline," people can call 1-800-813-HOPE and talk to others who are going through what they're going through for an hour each week. "It's a lifeline for them," Ezra says. "They can say whatever they want because they aren't a burden" to people at home. Local wellness communities are also good places to find on-the-ground support groups.
Kristine Crane is a Patient Advice reporter at U.S. News. You can follow her on Twitter, connect with her on LinkedIn or email her at kcrane@usnews.com.
