What practical questions should a patient newly diagnosed with stage III colon cancer ask their oncologist? Please...

Essential Questions for Your Stage III Colon Cancer Care Team

I'll help you organize the most important questions to ask your oncologist, organized by the key decision points in your care. These questions are grounded in the NCCN Guidelines for Patients: Colon Cancer (2025) and are designed to help you understand your specific situation and participate actively in your treatment decisions.

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1) STAGING & PATHOLOGY: Understanding Your Cancer

Why this matters: Your exact stage and tumor characteristics determine which treatments are most likely to help you. Getting clear answers here sets the foundation for all other decisions.

Questions to Ask:

On Your Stage:

• "Can you explain my stage 3 diagnosis in simple terms? Specifically, has the cancer spread to my lymph nodes, and how many?"
• "What does the TNM staging mean for me?" (This refers to Tumor size, Node involvement, and Metastasis spread—the system doctors use to classify colon cancer)
• "Are there any tumor deposits (small tumors in the fat around my colon) that were found?"

On Pathology Results:

• "Can you walk me through my pathology report? What are the key findings?"
• "Can I get a copy of my complete pathology report to keep for my records?"

On Critical Biomarkers: According to the NCCN Guidelines, all colon cancers should be tested for mismatch repair (MMR) status. This is crucial because it affects your treatment options:

• "Has my tumor been tested for mismatch repair deficiency (dMMR) or microsatellite instability-high (MSI-H)?"
• "If not, when will this testing be done, and how long will results take?"
• "What do my results mean—am I dMMR/MSI-H or pMMR/MSS?" (These abbreviations indicate whether your tumor has specific genetic features that respond to different treatments)

On Lynch Syndrome Testing: The NCCN Guidelines recommend that if your cancer is found to have dMMR or MSI-H, you should be tested for Lynch syndrome, an inherited condition that increases cancer risk:

• "Because of my tumor's characteristics, should I be referred to a genetic counselor to discuss Lynch syndrome testing?"
• "What are the implications for my family members if I have Lynch syndrome?"
• "Will genetic counseling be covered by my insurance?"

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2) SURGERY: TIMING & EXTENT

Why this matters: Surgery is typically the main treatment for stage 3 colon cancer. Understanding exactly what will happen helps you prepare physically and mentally.

Questions to Ask:

On Surgery Planning:

• "Am I a candidate for surgery (colectomy) to remove the cancerous part of my colon?"
• "How much of my colon will need to be removed?"
• "Will the surgery be done using the open method (large incision) or minimally invasive method (laparoscopic or robotic with small cuts)?"
• "What are the benefits and risks of each surgical approach?"

On Timing:

• "When is surgery scheduled, and why that timing?"
• "Will I receive chemotherapy before surgery, or after surgery, or both?"
• "If chemotherapy comes first, how long will that take before surgery?"

On What to Expect: According to the NCCN Guidelines, your care team should explain:

• "How should I prepare for surgery?"
• "What should I expect during recovery?"
• "What are the possible short-term side effects (like leaking where the colon is reconnected, changes in bowel habits, or blockage from scar tissue)?"
• "What are the possible long-term side effects?"
• "Will I need a colostomy (a temporary or permanent opening for stool to exit through my abdomen)?"

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3) ADJUVANT CHEMOTHERAPY: TYPE, DURATION & INTENSITY

Why this matters: Chemotherapy after surgery (called adjuvant chemotherapy) is designed to kill any cancer cells that may have spread beyond what surgery removed. The specific regimen and duration depend on your risk factors.

Questions to Ask:

On Whether You Need Chemotherapy:

• "Based on my stage 3 diagnosis, do I need chemotherapy after surgery?"
• "What is the goal of chemotherapy in my case—to reduce recurrence risk or to improve survival?"

On Chemotherapy Regimens: According to NCCN Guidelines, stage 3 colon cancers are typically treated with one of these chemotherapy combinations:

• "Will my chemotherapy be FOLFOX (a combination of 5-FU, leucovorin, and oxaliplatin) or CAPOX (capecitabine and oxaliplatin)?"
• "Why is one regimen recommended over the other for me?"
• "Are there other chemotherapy options available?"

On Duration: 3 Months vs. 6 Months This is a critical decision point. The NCCN Guidelines note that treatment length depends on risk factors:

• "Will I receive 3 months or 6 months of chemotherapy?"
• "What factors determine whether I get the shorter or longer course?" (High-risk features include: T4 tumors that have grown through the colon wall, fewer than 12 lymph nodes removed during surgery, or other concerning pathology findings)
• "What is the difference in benefit between 3 and 6 months for my specific situation?"
• "What are the side effects of the longer course, and do the benefits outweigh the risks for me?"

On Immunotherapy as an Alternative: If your tumor has dMMR/MSI-H status, immunotherapy (checkpoint inhibitors) may be an option instead of or in addition to chemotherapy:

• "Because my tumor has [dMMR/MSI-H status], am I a candidate for immunotherapy?"
• "What are the checkpoint inhibitor options?" (The NCCN Guidelines list options including nivolumab, pembrolizumab, dostarlimab, and others)
• "How does immunotherapy compare to chemotherapy for my situation?"
• "Can I receive both immunotherapy and chemotherapy?"

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4) GENETIC TESTING: MMR/MSI & LYNCH SYNDROME

Why this matters: These tests reveal whether your cancer has specific genetic features that change treatment recommendations and may indicate inherited cancer risk in your family.

Questions to Ask:

On MMR/MSI Testing (Already Covered Above, But Key Questions):

• "When will my MMR/MSI test results be available?"
• "Who will explain these results to me, and when?"
• "If my results show dMMR/MSI-H, what does that mean for my treatment options?"

On Lynch Syndrome Genetic Counseling:

• "Should I meet with a genetic counselor before or after my treatment starts?"
• "What is involved in Lynch syndrome testing?" (Typically a blood or saliva sample)
• "If I'm found to have Lynch syndrome, what screening should my family members have?"
• "Are there support resources for families with Lynch syndrome?"

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5) CIRCULATING TUMOR DNA (ctDNA) TESTING

Why this matters: ctDNA (also called liquid biopsy) is an emerging test that detects cancer DNA in your blood. It may help monitor whether treatment is working and predict recurrence risk.

Questions to Ask:

• "Should I have ctDNA testing (liquid biopsy) as part of my initial workup?"
• "If ctDNA testing is recommended, when should it be done—before surgery, after surgery, or both?"
• "How will ctDNA results affect my treatment decisions?"
• "Will ctDNA testing be repeated during or after treatment to monitor my response?"
• "Is ctDNA testing covered by my insurance?"

Important context: While ctDNA testing is increasingly used in colon cancer care, the NCCN Guidelines note that this is an emerging area. Ask your oncologist whether this testing is part of their standard approach for stage 3 patients.

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6) SIDE EFFECTS: WHAT TO EXPECT & HOW TO MANAGE

Why this matters: Understanding potential side effects helps you prepare, recognize problems early, and work with your team to manage them.

Questions to Ask:

On Chemotherapy Side Effects: According to NCCN Guidelines, common side effects of FOLFOX and CAPOX include:

• "What are the most common side effects I might experience?"
• "Which side effects should I report immediately versus manage at home?"
• "What symptoms mean I should call you right away?" (Examples: severe nausea/vomiting, fever, severe diarrh