What should I look for in a colorectal cancer program?

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Find out what to consider when choosing a colorectal cancer program so you have the best possible experience and outcome.


By Adam Boruchov, MD, System Chair, Cancer Institute, Nuvance Health and Nicole Carreau, MD, Colorectal Cancer Medical Oncologist, Norwalk Hospital


A cancer diagnosis can understandably be overwhelming and scary. If you or a loved one has recently been diagnosed with colorectal cancer, you probably have many questions and concerns and may feel uncertain about what to do next.


Please know you are not alone! It may also help to know what to expect because accurate information can help alleviate fear. Here is a guide to finding the best possible care if you or a loved one is diagnosed with colorectal cancer.



What is colorectal cancer?


Colorectal cancer happens when cells grow out of control in the colon or rectum, which are part of the digestive tract. Colorectal cancer usually does not cause symptoms in the early stages, which is why colonoscopy screenings are important. Signs of colorectal cancer may vary from person to person depending on where the cancer is in the large intestine or rectum.



The good news is colorectal cancer is treatable, especially in the early stages before it has spread outside the large intestine. Often, surgery alone can treat early-stage colorectal cancer. A short course of chemotherapy may be recommended after surgery to prevent it from returning. With developments in personalized and targeted therapies, individuals with advanced cancer have more options now, too.


How is colorectal cancer diagnosed?


A colonoscopy is the most common test used to diagnose colorectal cancer. If you have questions about how your colorectal cancer was diagnosed, consider the following:


  • Did you have a colonoscopy? A gastroenterologist performs colonoscopies to see inside your large intestine. They biopsy tissue if it looks abnormal. A pathologist examines the tissue to confirm if it is cancer.

  • Were you experiencing symptoms? Did you have symptoms of colorectal cancer, such as a change in bowel habits or blood in your stool, and see your primary care provider? Did they refer you to a gastroenterologist for further evaluation, including a colonoscopy?



After the colonoscopy, you might also have other imaging taken of your abdominal area, including a CT scan or MRI to determine if the cancer has spread to nearby lymph nodes or tissues. You may also have bloodwork or other tests.



What happens after a colon cancer or rectal cancer diagnosis?


If your gastroenterologist suspects you have colorectal cancer based on the colonoscopy results, they will connect you with a colorectal surgeon. Most people will see a colorectal surgeon first. Your colorectal surgeon will review your test results and details about the location and type of cancer you have. Depending on the location and stage, you may have surgery first or chemotherapy first. In most cases, you will have surgery to remove the cancer. If your cancer is in an advanced stage, you may need chemotherapy first to shrink the cancer before surgery.



What should I ask my colorectal cancer surgeon?


Your colorectal surgeon should provide the following information. It is helpful to know what to expect from them so you can ask any questions they may not address or you have concerns about. It is helpful to have a family member or friend with you to take notes and support you.


  • What are colorectal surgery options and the possible outcomes of each? For example, there are minimally invasive surgeries using laparoscopic and robotic-assisted techniques or open surgery. Learn more about colorectal cancer surgery.

  • What colorectal treatment options are optimal for my personal health goals and lifestyle? For example, some individuals might choose an aggressive treatment to reduce the risk of recurrence.

  • How often do you perform these types of surgeries and what is your experience and training?

  • What should I do before and after surgery to have the best possible experience and outcome? Understanding what to expect and how you can prepare for it can help alleviate worry. For example, what foods you can eat and when, and how to prepare your home to recover comfortably and safely.

  • How can I manage any pain after surgery?

  • How long will it take to recover from surgery?

  • What will my bowel function be like after surgery?

  • What support services are available before and after surgery, such as registered dietitian nutritionists, therapists and sources of information?

  • Should I get a second opinion? Your colorectal surgeon should support your decision to seek a second opinion.

  • Who should I contact if I have questions?



What should I look for in a colorectal cancer program?


Of course, quality care is a critical component of a colorectal cancer program. Finding a care team you trust and who listens to you is also vitally important. Your care team should:


  • Follow the latest evidence-based guidelines for colorectal cancer care.

  • Incorporate your personal health goals and lifestyle into your treatment plan.

  • Effectively communicate so you fully understand what is happening. Watch a surgical oncologist use drawings to communicate surgical plans.

  • Listen to you and answer all your questions.

  • Validate how you feel.

  • Support you every step of the way so you never feel alone.


Choose a colorectal cancer program that offers coordinated, multispecialty care. Your care team should communicate with each other. You should have access to all your medical information in a single electronic medical record.


Find a colorectal cancer team that includes:


  • Primary care: The role of a primary care provider is crucial in early detection and navigating you through the initial diagnosis, referral to specialists and follow-up care. Your primary care provider is also important because they can effectively communicate with your cancer care team about your medical history. Learn more about primary care.

  • Gastroenterology: Gastroenterologists play a critical role in diagnosing colorectal cancer through procedures like colonoscopies and are essential in the ongoing monitoring of your gastrointestinal health. Learn more about the Nuvance Health Digestive Health Institute.

  • Surgical oncology: Colorectal surgeons specialize in removing tumors from the gastrointestinal tract.

  • Medical oncology: Many people with colorectal cancer will see a medical oncologist, even if they do not ultimately need systemic (full body) therapy. Medical oncologists are responsible for chemotherapy and other targeted therapies tailored to the genetic makeup of your specific cancer. Learn more about medical oncology.

  • Radiation oncology: Most people will not need radiation therapy for colon cancer. It is more common for people with rectal cancer. This specialty focuses on the precise delivery of radiation therapy to shrink tumors and eliminate cancer cells. Learn more about radiation therapy.

  • Pathology: Pathologists analyze tissue samples to provide the definitive diagnosis of cancer, guiding the treatment plan with crucial details about the cancer’s stage and characteristics.

  • Imaging and radiology: Advanced imaging techniques are essential for accurately staging the cancer and monitoring response to treatment

  • Nurse navigators: These nurses specialize in oncology and guide patients through the treatment process, providing education, support and coordination of care.

  • Genetic counselors: Understanding the genetic factors of colorectal cancer can influence treatment decisions and help identify at-risk family members. Learn more about genetic counseling.

  • Oncology nutritionists: Proper nutrition is essential during cancer treatment. Registered dietitians who specialize in oncology nutrition develop personalized plans to support your overall health and strength during treatments.

  • Oncology therapists: Cancer can take a toll physically and mentally. Therapists who specialize in oncology can help you manage your emotional and mental health.

  • Social workers: Cancer can affect many aspects of your life, from family and work to your finances. Social workers provide emotional support and help with accessing resources, including financial assistance, transportation and childcare during cancer treatment.

  • Survivorship resources: Post-treatment support is vital for adjusting to life after cancer, managing long-term side effects, and monitoring for recurrence.



Also, choose a colorectal cancer program that has accreditations as a key indicator of quality. Look for a program accredited by the Commission on Cancer (CoC), which sets rigorous standards for cancer care. The National Accreditation Program for Rectal Cancer (NAPRC) is also a notable quality achievement.



The bottom line: Facing colorectal cancer can be a challenging journey, but you do not have to walk it alone. Seek a program with a multispecialty team committed to delivering the best possible care tailored to your unique needs. Everyone on your team should listen to you, coordinate with each other, and follow the latest evidence-based guidelines. Look for an accredited program that exemplifies excellence in medical and surgical care as well as vital support services. Finding comfort and confidence in your colorectal cancer team can help you focus on what truly matters — your health and healing.