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Questions To Ask Before Agreeing To Surgery For Colorectal Cancer

Questions To Ask

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Surgery is the most common treatment for colorectal cancer. There are three main types of surgery. Colonoscopy, Laparaoscopy and Open Surgery. To learn about them, see the section of this article: Types of Colorectal Surgery.

Studies show that knowing what to expect before, during, and after a surgical procedure reduces anxiety and fear about an operation and improves overall recovery. 

Ask the surgeon all your questions before agreeing to the surgery. At least ask :

  • What kind of surgery are you suggesting for me?
  • Why is the surgery necessary?
  • Are there any surgical or non-surgical alternatives?

Preferably, ask the following questions noted below in bold to ensure that the surgery is necessary, that you understand what is being proposed, and that you agree to it. Patients who ask the most questions and are assertive about their concerns tend to have the best outcomes.

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  • Why do I need the operation?
    • Why is the doctor is recommending the operation?
    • How does the surgery relate to your medical condition?
  • What operation are you recommending? It is important to understand all aspects of the surgery before consenting. Continue to ask questions until you are satisfied that you understand what is being proposed, as well as the alternative methods of performing the operation. Following are examples of questions that will help clarify what operation is being recommended:
    • What will happen in the surgical procedure? For example:
      • If something is going to be repaired or removed, what is being removed and what effect it will have?  Could less be removed?
      • Where will the incision be?
      • How long will the incision be?
      • Could the incision be somewhere less noticeable?
      • Will organs have to be moved to clear a path?
    • Are there different ways of performing the operation? 
      • What are the advantages and disadvantages of each procedure? 
      • Why the suggested procedure instead of the other alternatives? 
      • If the surgeon does not voice a preference between competing procedures, ask: If you had a child with my condition, and a choice had to be made between these competing procedures, what would you choose for your child?
    • Will you perform the surgery with a normal invasive opening or laparoscopically through a small opening? Traditionally an incision is large. This is known as “Open Surgery.” More recently, surgeons have been able to perform minimally invasive surgery by making small incisions through Laparoscopic or Robotic Surgery. Which will be used?
      • If the surgery will not be laparoscopic, is it because you do not perform them or laparoscopic doesn't work for the type of surgery we're talking about or because of my particular situation? If it could be laparascopic and you don't do that type of surgery, can you recommend someone who does?
      • If it will be laparaoscopic, what percentage of the operations you perform are performed this way? (Alternatively: how many surgeries have you performed this way in the past few years?)
    • Will any lymph nodes be removed? If so, which ones? Why?
    • Will other tissues be removed? If so, which ones? Why?
    • Will I need a colostomy? If so, will the stoma be permanent? 
      • A colostomy is a procedure to create an opening of the colon through the skin of the abdomen to allow for the passage of feces. A colostomy is also ; also the opening itself.
      • A stoma is an artificial opening between a body cavity or canal (such as the colon) and the skin.)
    • How long will the surgery last?
    • What kind of anesthesia will be used? Does the operation call for local, regional, or general anesthesia? (To learn more , see Anesthesia.)
    • About the scar:
      • How large will the scar be?
      • Where will the scar be
    • If it would help, ask your surgeon to draw a picture or a diagram or show you on a doll or a model of the human body what is proposed and to explain the steps involved in the procedure.
    • Is there a pamphlet or other information about the operation I can read?
    • If you want more information about the procedure: The American College of Surgeons (ACS) has a free series of brochures on specific types of surgery: Frequently Performed Operations. These documents are available online at offsite link. For print copies, write to the ACS, Office of Public Information, 633 N. Saint Clair Street, Chicago, IL 60611. There may also be a video of the actual or simulated version of the surgical procedure you can watch. Videos of procedures may be difficult to watch, but they can help you make decisions. At the least, a video may help you formulate questions for your doctor. For additional help locating videos about various surgeries, see: Videos Of Medical Procedures.
    • Once you think you have a grasp of the operation being proposed, repeat it back to the surgeon in your own words to be sure your understanding is correct.
  • What are the benefits of the operation?
    • What will I gain by having the operation? For example, a hip replacement may mean that you can walk with ease.
    • How long are the benefits likely to last? For some procedures it is not unusual for the benefits to last only for a short time. There might be a need for a second operation at a later date. For other procedures the benefits may last a lifetime.
    • Is there published information about the outcomes of the procedure? Published information can give you an idea of what happens to a large number of people who have had the operation. Published information becomes a base point from which to compare the experience of your surgeon and hospital.
    • Are there other people with whom I can speak who can tell me about  the practical realities of the benefits?
    • Is there a quality of life measurement applicable in this situation?
  • What are the risks relating to the operation? While it may be difficult to consider, all operations have some risk. It is up to you to decide whether the possible benefits are worth the risks such as:
    • Complications - unplanned events such as infections, or reaction to anesthesia. Some people have an increased risk of complications because of other medical conditions. Make certain that the surgeon is aware of all of your medical conditions. Ask about complication rates: the percentage of times there have been significant complications resulting from this procedure.
    • Side effects - such as pain or swelling.
    • The surgery not being successful.
    • The surgery possibly making things worse.
    • Possibly dying. What is the percentage of people who have died (the "mortality rate")?
    • NOTE: Computer based risk calculators let surgeons know individual patient's chances of surgical complications based on personal medical history and physical condition. For example, the calculator may say a particular person's risks while undergoing a particular surgery are 1% of dying, 12% risk of a minor complication and an 8% chance of a more serious complication such as cardiac arrest. The calculators are currently not available to the public. However, you can ask if there is such a program for the surgery you are considering, and, if so, what it says. The calculators help you give "informed consent."
  • What can be done to minimize the risks? For example:
    • There is almost always some pain with surgery. Doctors can control pain. Controlling pain will help you to be more comfortable while you heal, enable you to get well faster, and improve the results of your operation. (For information about Pain, click here.)
    • Starting antibiotics within one hour before starting surgery dramatically cuts infection rates.
  • What are the long term effects of the operation? For instance:
    • Will there be any lasting effects?
    • What, if anything, will I be able to do better?
    • What, if anything, won't I be able to do at all? Or only in part?
  • What are the alternatives to the surgery you are proposing? There are times when surgery is not the only solution to a medical problem. Ask your surgeon or primary care doctor about the benefits and risks of the alternatives. Common alternatives to surgery are:
    • Medications
    • A change in diet
    • Special exercises
    • Radiation treatment
    • "Watchful waiting." You and your doctor periodically check to see if your problem gets better or worse. If your condition gets worse, you may need surgery at that time. If it gets better, you may be able to postpone surgery, perhaps indefinitely.
  • What if I don't have the surgery? 
    • Am I likely to be in more pain?
    • Could my condition get worse?
    • Could the problem go away on its own?
  • Who will perform the surgery? It frequently happens that a patient meets with and vets a surgeon, and expects that person will perform the surgery. In fact, if a surgeon works with other people, the consent form for the operation usually permits the surgeon's partners or associates to perform the surgery as well as the person with whom you met. If this is not all right with you:
    • Let the surgeon know that you only want him or her to perform the surgery.
    • Change the consent form so that it only gives consent to the doctor you want to do the operation. Be sure to initial the change.
  • Where will the surgery be performed?
    • Will the operation be done in the hospital or in an outpatient setting? Until recently most surgery was performed on an inpatient basis and patients stayed in the hospital for one or more days. Today, many surgeries are done on an outpatient basis in a day surgery unit of a hospital, in special surgical centers and in doctors' offices. Outpatient surgery is less expensive because you do not have to pay for staying in a hospital room.
    • If the surgery will be performed as an outpatient, ask whether you will need someone to drive you home.
    • If your doctor recommends inpatient surgery for a procedure that is usually done as outpatient surgery, or recommends outpatient surgery that is usually done as inpatient surgery, ask why. You want to be in the right place for your operation.
    • If the surgery will be performed in the hospital:
      • Which hospital does the surgeon recommend?
      • How many times has the procedure been performed in the last few years in that hospital?
      • With what success rate? Some operations have higher success rates if they are done in hospitals that perform many of those procedures. If the hospital does comparatively few of the operation in question, or has a low success rate for the operation, consider asking to have it at another hospital. For more information, see Choosing a Hospital.
      • An increasing number of hospitals are letting families stay in the operating room during surgery. The concept is known as "family presence." It is result of a growing body of evidence shows both patients and families can benefit from remaining near each other in stressful situations. Apparently family members aren't a hindrance to doctors or nurses. If this matters to you, ask whether your family can be present.
  • Who will the anesthesiologist be? The anesthesiologist is in charge of sedating you and monitoring your vital signs during surgery. You usually have a choice as to who your anesthesiologist will be. The anesthesiologist performs an essential task for successful surgery. The anesthesiologist maintains the patient's blood pressure and vital signs while keeping the person unconscious so that the surgeon can do his or her job. Anesthesiologists also play a key role in pain management during the initial post-operative healing. The anesthesiologist and surgeon work together as a team. If you think of sports, a team of qualified basketball players is likely to do better than a team of stars who haven't worked together before. Ask:
    • What are the qualifications of the person who will administer the anesthesia? Preferably the person is board certified. To learn more about board certification, see: Surgery Board Certification.
    • Do the two of you work together regularly?
    • Does the anesthesiologist have a lot of experience with the type of surgery?
    • Is the anesthesiologist experienced with a patient population like me?
    • If they haven't worked together much, ask your surgeon if there's an anesthesiologist he or she has worked with a lot, and whether that person is available for your surgery.
  • What do I need to do to prepare for the surgery? For example:
    • Are there drugs, supplements, vitamins or herbs I am taking that I should stop taking for a while? If the answer is "yes", consult with the prescribing doctor to let him or know you will be taking a drug vacation and find out if you should be doing something else in the meantime.
    • Should I be exercising?
    • Changing my diet?
    • NOTE: "Prehab" is usually covered by health insurance. Prehab involves physical therapy as well as nutritional counseling to improve your body's ability to handle the stress of an operation.
  • What additional tests will I need before the surgery? Ask about:
    • The test
    • When and where it will be performed
    • Whether the test will be covered by your insurance
    • The cost.
      • If the cost is covered by insurance, how much will you have to pay as co-insurance or a co-pay?
      • If the test is not covered, or you do not have health insurance, are there less expensive ways to perform the test, or less expensive places in which the test can be done? (To learn how to save money on medical bills, click here.
    • How much time the test will take
    • Will there will be time lost from work either preparing for, or recovering from, the test? If so, how do I minimize it? For example, if a colonoscopy is suggested, if you schedule it for the first day of the work week, you do not lose time from work cleaning your insides.
  • After surgery, how and when I learn about its success?
    • How long do I have to wait for my laboratory test results? Do I call you, or do you call me?
    • Will a pathologist examine the tissue and write a report? Who will explain that report to me?
    • When will I need to return for a follow-up appointment?
  • What will the recovery be like and how long will it take? Knowing what to expect can help you cope better with the recovery.
    • How will I feel, and what will I be able to do for the first few days, weeks and months after surgery?
    • Describe your basic life activities. What won't you be able to do, and for how long? If applicable, ask when you can start regular exercise again and when you can go back to work. You do not want to do anything that will slow down the recovery process. Lifting a ten-pound bag of potatoes a week or two after your operation may not seem to be "too much," but it could be.
    • How long will I be in the hospital?
    • Will I have to go to a rehabilitation facility? If so, for how long?
    • Will I need supplies, equipment, and/or help when I go home? If changes will be required in your home, like moving scatter rugs, consider making them before going for the operation so you don't have to tend to these matters when you're not feeling well.
    • Will I be bedridden at home? If so, for how long?
    • Will I need help at home? If so, to do what? For how long?
    • Will there be surgical drains? If so, what will they be like and how long will they be used? (A surgical drain is a tube inserted into the body to remove liquids.)
    • How long before I am physically able to return to my normal activities?
    • How long will it before before I am able to return to work: part time? Full time?
    • Will I need an accommodation to help me do my work? If so, what kind, and for how long?
    • How long before I can have sex?
  • How much will the operation cost? Even if you are insured, there are some costs you may have to pay. Find out about such costs as:
    • The surgeon's fee and what it covers. Surgical fees often include several visits after the operation.
    • The anesthesiologist's charge.
    • The costs for other doctors or other professionals who may be involved in the surgery.
    • The hospital charge for inpatient or outpatient care and by the anesthesiologist and others providing care related to your operation. (The doctor can tell you how long to expect to be in the hospital. The hospital business office can tell you about their rates.)
    • What expenses relating to the surgery am I likely to incur afterward? For example: physical therapy, occupational therapy, home nursing care, help getting around, private transportation. 
    • Check with your insurance company to find out how much of these costs it will pay and how much you will have to pay yourself.
  • Where can I get a second opinion? Since surgery is such an invasive procedure that always has some degree of risk, even the National Institute of Aging recommends getting a second opinion from another surgeon who is not in your doctor's same practice. Don't worry about offending your doctor. Most doctors welcome second opinions. Also consider getting another opinion from a doctor who is not a surgeon, such as your primary care doctor. There may be less invasive procedures or other treatments that may work. There may also be new developments coming along that are worth waiting for. Just because there is a less invasive procedure, or something new is coming along, doesn't mean they're necessarily better. Ask the appropriate questions. Come up with your own conclusion. Your primary care doctor may be a great help in this area. To learn more see Questions To Ask Before Agreeing To A TreatmentObtaining a Second Opinion.
    • Many health insurance plans actually require patients to obtain a second opinion before they have certain non-emergency operations. Most insurers, including Medicare, pay for second opinions even if it's not required.
    • If your insurer balks at paying for a second opinion but you and/or your doctor feel that it is necessary, you can argue your position. To learn more, read Obtaining a Second Opinion and Appealing Your Health Policy.
    • When obtaining a second opinion: 
      • Make certain to get your records from the first doctor to the second doctor so he or she does not have to repeat tests.
      • Tell the second doctor your symptoms, the type of surgery that has been recommended and the results of any tests you've already had.
      • Ask the same questions you asked of the first doctor.
    • If you still have questions after seeing a second doctor, consider seeing a third doctor. Your primary care doctor may also be able to answer questions and help you decide what to do.
  • By when do I have to make a decision? You do not want to postpone a decision to the point that the delay hurts your chances for healing and a satisfactory recovery. Delay could also result in complications which require you to go to the nearest emergency room for care rather than the facility in which you would prefer to be treated.


  • If the surgeon doesn't have time to answer all your questions when you are together, ask what is the best way to ask your additional questions. The doctor may set another appointment or suggest you send them by e mail or perhaps speak with another doctor or nurse in his or her practice.
  • Choose a surgeon with as much consideration as you give any important decision in your life. For information about how to do that like an educated health care consumer, click here.
  • If you have difficulty getting the doctor to answer your questions, see the video, Talking With Your Doctor, and/or read How To Work Most Effectively With Your Doctor.
  • Consider getting a second opinion from a surgeon not in the same practice as your surgeon. If there are options available other than surgery, also consider getting an opinion of a doctor who is not a surgeon such as your primary care doctor. (Second opinions are usually covered by health insurance.) For information about second opinions, including why asking for one should not be a problem for your doctor, click here.
  • If you have difficulty getting the doctor to answer your questions, see the video, Talking With Your Doctor, and/or read How To Work Most Effectively With Your Doctor.
  • Before you enter a hospital as an inpatient, read Hospitals to help limit stress, save money, reduce medical error, and maximize your stay and post discharge period.
  • For information about avoiding medical error with respect to surgery, click here.
  • For information about dealing with the stress of waiting for a procedure, click here. 

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