(i) Surgery-Related List of Questions


In patients with potentially curable colorectal cancer, a properly performed surgical operation is essential for optimal results. In the majority of such cases, operative intervention involves a resection (removal) of the primary cancer and regional lymph nodes, along with the removal of sections of normal bowel on both sides of the cancer when treating colon cancer (see diagram below), and the removal of the mesorectum (the tissue attached to and supporting the rectum) when treating rectal cancer (see diagram below).

Surgery for Colon Cancer - Colectomy

Illustration of colectomy surgery for colon cancer

During a colectomy, surgery for colon cancer, the cancer and nearby tissue is removed and the remaining sections of colon are rejoined.
Source: http://www.riversideonline.com/health_reference/Cancer/DS00035.cfm

Illustration of Total Mesorectal Excision for Rectal Cancer

Rectal Cancer The Basics

In TME, the rectum and the mesorectum are removed. The mesorectum is the area of fatty tissue below the rectum that contains lymph nodes, which are the most common area for the cancer to spread. Source: Oncolink http://oncolink.com/types/article.cfm?c=5&s=11&ss=605&id=9457&p=3

There are several different types of surgical procedures used in the treatment and management of colorectal cancer. The referenced surgical procedures appearing above are merely two commonly employed surgical treatment of colorectal cancer. The size and spread of the cancer, as well as the experience of the surgeon determine the appropriate procedure. Palliative colorectal cancer surgery is treatment that is intended to relieve symptoms, such as pain, but is not expected to cure the disease because of the macrometastases identified in distant organs upon the discovery of the primary colon or rectal tumor. The main purpose of palliative treatment is to improve the patient’s quality of life. Approximately 20% of patients with colorectal cancer already have distant metastases at the time of diagnosis (JAMA, Vol. 287, No. 3, pp.321-328). In this group of patients, palliative colorectal resection is generally recommended to prevent bleeding, obstruction and symptoms related to local organ invasion.

The following list of questions is meant as a guide to issues you should discuss with your surgeon and medical team before undergoing surgical treatment of colorectal cancer.

Physician-Directed List of Surgically-Related Questions for Colon/Rectal Tumors

Click to print questions
Questions to Ask Before Surgery:
  • May I tape record our discussion?
  • Do you have a specialty in surgical oncology?
  • What is the stage of my cancer?
  • Is surgery the standard therapy for my stage of disease?
  • Why do you recommend surgery for my colon/rectal cancer?
  • What type of surgery do you recommend (conventional vs. laparoscopic)?
  • Can you describe the surgery that you recommend?
  • What is the goal of surgery?
  • What are you planning to remove during surgery (the colon, nearby colon tissue, rectum, mesorectum, lymph nodes)?
  • How many times have you performed the recommended surgery?
  • Will you personally be performing the surgery?
  • What is your success rate and how do you define success?
  • What is your experience with complications? What should I do if I develop complications after surgery? Tel. # to call: _________________________
  • Is a biopsy part of the surgery?
  • How soon after surgery will I have all test results and a firm diagnosis?
  • Will I need blood transfusions and can my family donate blood?
  • Why is bowel preparation necessary for abdominal surgery?
  • Will I have a catheter to drain my bladder and, if so, how long will it be in?
  • Will you perform a pelvic lymph node dissection?
  • I have read that at least 12 lymph nodes need to be examined to accurately stage colon and rectal cancers, do you routinely accomplish this? Can more than 12 lymph nodes be examined? If so, how many are you willing to examine in excess of 12?
  • What happens if one or more of the lymph nodes is found to be positive?
  • Do you use drains and how will you decide?
  • How long will I be unable to eat?
  • Will I have a nasogastric tube (NG tube) after surgery?
  • What are my options for pain control after surgery?
  • Do you think I will require a temporary or permanent colostomy? If so, what will this involve? (If yes, proceed to List of Questions in Respect of Colostomy Found Below.)
  • If you find that the disease is more extensive than originally believed, what will you do?
  • Considering my age and general health, am I at a higher or lower risk for complications?
  • What might my recovery involve? Restrictions: _______________________ Date to resume normal activities: _________________________
  • What are my options besides surgery?
  • Are there clinical trials for my stage of disease?
  • Will I require adjuvant (post surgical) therapy after my surgery?
  • Are there any protocols for neoadjuvant (before surgery) therapy for my stage of disease?
  • What are the pros and cons of each type of colon/rectal surgery for the treatment of my particular cancer?
  • What diagnostic tests are needed prior to surgery and how will these assist in surgical planning?
  • Do you feel it is appropriate to perform surgery even if there are metastases present in more than one place? If yes, under which conditions?
  • 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?
  • Might I require special assistance at home after the procedure? If so, how can I arrange for the help I need?

  • For rectal cancer:
  • Should I have radiation therapy and chemotherapy before my rectal cancer surgery?

  • Questions To Ask After Surgery:
  • What is my official diagnosis based on the results of surgery and biopsy reports? Kindly provide in TNM format (T=tumor extent, N=Affected lymph node extent, M= extent of metastatic involvement; the higher the number, the more extensive the involvement respectively). For more information on the TNM staging system, please visit the Colorectal Cancer Association of Canada’s website at www.colorectal-cancer.ca/en/just-the-facts/what-cancer/
  • Can you explain my pathology report (laboratory test results) to me?
  • What is my prognosis?
  • What additional treatment do you recommend? Why?
  • What is the goal of this treatment?
  • Is it a standard treatment or part of a clinical trial?
  • What are the risks and possible side effects of treatment, both in the short term and the long term?
  • How will the treatment affect my daily life? Will I be able to work, exercise, engage in sexual activity and perform my usual daily activities?
  • How long will it be before I can go back to work after surgery? Can I work during chemotherapy?
  • What follow-up tests will I need, and how often will I need them? When will I be seen for a follow-up examination?
  • What support services are available to me? To my family?