Treatment Choices & Checklist

• Ask about tumor testing. NCCN Guidelines recommend universal MSI/MMR testing plus KRAS, NRAS, BRAF, HER2, and NTRK testing to guide targeted therapy.
• Ask about germline (genetic) testing, especially if you were diagnosed under age 50 or have a family history of colorectal cancer.
• Treatment differs by stage and location: colon cancer often starts with surgery; rectal cancer often starts with chemoradiation.
• Clinical trials are an option at any point in your care, not only after other treatments have been tried.
• A second opinion is normal and encouraged — it builds confidence in your plan rather than delaying it.
• Timely treatment matters: Fight CRC’s national goal is for 80% of patients to start treatment within six weeks of diagnosis.

Hearing the words “you have colorectal cancer” can turn your world upside down. You don’t have to figure it out alone. This checklist is designed to help you take one steady step at a time. 

You don’t need to have all the answers right now. Start by gathering the information that will help you and your care team plan the next steps.

Ask your doctor or nurse for:

• Copies of your pathology and imaging reports (CT, MRI, or PET).
• Your lab results, including the CEA blood test.
• A clear explanation of your stage and what it means.

Ask if your tumor has been tested for biomarkers:

• NCCN Guidelines recommend universal MMR/MSI testing for everyone diagnosed with colorectal cancer, along with expanded biomarker testing (KRAS, NRAS, BRAF, HER2, NTRK) to guide targeted therapy selection.^[1]
• If results aren’t back yet, it’s okay to ask when they’ll be ready.
• Biomarker results help your team match you to the right treatment — including FDA-approved targeted options such as encorafenib + cetuximab for BRAF V600E-mutated disease, tucatinib + trastuzumab for HER2-positive disease, and adagrasib + cetuximab for KRAS G12C-mutated disease — and possibly clinical trials.^[6]

Ask if you should have genetic (germline) testing:

This is especially important if you are under 50 years old at diagnosis, have a family history of colorectal cancer, or have a known hereditary syndrome such as Lynch syndrome.

For young-onset patients:

• Talk to your doctor about fertility preservation before you begin treatment. ASCO recommends this conversation happen as early as possible, ideally before chemotherapy, radiation, or surgery.^[7]  Many patients tell us this was one of the most valuable early conversations they had.

Your medical team may include:

• A colorectal surgeon, medical oncologist, and — if rectal cancer is part of your diagnosis — a radiation oncologist.
• A nurse navigator, social worker, or palliative care specialist who helps manage symptoms and stress from the beginning.
• Consider a second opinion. It’s common and encouraged — you’re not starting over, you’re gathering confidence in your plan.

Ask about practical details early:

• “Will I need prior authorization before scans or surgery?”
• “Are my doctors in-network?”
• “Who can help me understand my insurance coverage?”

Invite your personal circle in. A family member, friend, or faith leader can help take notes, drive you to appointments, or simply sit with you.

Every person’s path looks a little different. Your doctors will design a plan based on your stage, test results, and personal goals, most often following NCCN Clinical Practice Guidelines in Oncology for colon and rectal cancer.[1] Ask them to walk you through it slowly — you can always take notes or record the conversation.

Questions to ask:

• “What is the goal — cure, control, or quality of life?”
• “How will we know if it’s working?”
• “What side effects should I expect, and who should I call if they happen?”

If chemotherapy with a fluoropyrimidine (5-FU or capecitabine) is planned, you can also ask whether DPYD genotype testing is available — this can identify patients at risk for severe toxicity before treatment begins.[5] If rectal cancer is part of your diagnosis and radiation is recommended, ask how your care team is following current evidence-based radiotherapy guidelines.[4]

Clinical trials aren’t just for later — they can be an option at any point. They help you access promising new treatments while contributing to future breakthroughs.

You can ask:

• “Am I eligible for any trials right now?”
• “If not, when should we check again?”
• “Who can help me look?”

Bring your biomarker report, stage, and prior treatments to appointments. By federal law, most health plans and Medicare must cover the routine patient-care costs associated with participating in an approved clinical trial — you can ask your care team or insurer to confirm this applies to you.[10][11]

Upload your biomarker report to ChatCRC’s Biomarker Report Reader to receive a clear, easy-to-understand explanation of your results. ChatCRC can help you better understand your biomarkers, prepare informed questions for your healthcare team, and learn how your results may impact treatment options. ChatCRC also helps you explore relevant clinical trials by searching ClinicalTrials.gov based on your cancer type, biomarkers, and location.

The start of treatment often brings both relief and new worries. It’s okay to take things one infusion, one day, one meal at a time.

Before you begin:

• Review your medications and schedule.
• Ask about nutrition, exercise, and fertility if relevant.
• Confirm that any needed insurance prior authorizations are complete.
• Get your nurse line and after-hours contact information.
• Ask which side effects warrant a doctor visit.

During treatment:

• Keep a short symptom journal (what, when, how severe).
• Call for fever ≥ 101°F, bleeding, uncontrolled vomiting, or pain.
• Ask your care team about support for anxiety, sleep, or fatigue.

If surgery is part of your plan, it can feel intimidating. Knowing what to expect can help you feel more prepared.

Ask your surgeon:

• “Will my surgery be open, laparoscopic, or robotic-assisted?”
• “Will I have an ostomy — and will it be temporary or permanent?”
• “After a Low Anterior Resection (LAR), can I see a pelvic-floor physical therapist?”[9]
• “What can I do to prepare my body and home for recovery?”

Pack for comfort:
Soft clothes · Warm socks · Lip balm · Headphones · Notebook

Treatment may end, but care continues. Follow-up visits help your team watch for recurrence and support your recovery.

NCCN recommends:

• CEA tests: every 3–6 months for 5 years[1][8]
• CT scans: every 6–12 months for higher-stage disease
• Colonoscopy: 1 year after surgery, then every 3–5 years

Ask for:

• A written Survivorship Care Plan summarizing your treatment.
• Referrals for physical therapy, nutrition, or mental health support.
• Help navigating work, finances, or insurance questions.

Staying Connected

You are now part of a powerful community of survivors, caregivers, and advocates. Stay connected, learn, and let others learn from you.

Join Fight CRC’s monthly eNews for research and stories.

• Attend webinars and events to stay up to date on treatment advances.
• Connect during March Colorectal Cancer Awareness Month
• Share your story — it may be the encouragement someone else needs.

Sources & References

This checklist was developed with reference to the following clinical guidelines, regulatory sources, and Fight CRC educational materials.

Clinical guidelines & evidence sources

1. National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®): Colon Cancer (Version 4.2025); Rectal Cancer (Version 3.2025). Retrieved October 2025. nccn.org/guidelines/category_1
2. Benson AB, et al. (2022). Systemic therapy for metastatic colorectal cancer: ASCO guideline update. Journal of Clinical Oncology, 40(35), 4021–4048. doi.org/10.1200/JCO.22.01047
3. Shaukat A, et al. (2022). ACG Clinical Guidelines: Colorectal cancer screening 2021. American Journal of Gastroenterology, 117(3), 481–501.
4. ASTRO (American Society for Radiation Oncology). National guidelines for evidence-based radiotherapy in rectal cancer (2024). Practical Radiation Oncology, 14(2).
5. Clinical Pharmacogenetics Implementation Consortium (CPIC). CPIC Guideline for Fluoropyrimidines and DPYD Genotype (update 2024). cpicpgx.org/guidelines
6. U.S. Food and Drug Administration (FDA). FDA Approvals and Safety Updates for CRC Therapies (2023–2025): encorafenib + cetuximab ± mFOLFOX6 for BRAF V600E metastatic CRC (2024); tucatinib + trastuzumab for RAS wild-type, HER2-positive mCRC (2023); adagrasib + cetuximab for KRAS G12C mCRC (2024). fda.gov

Fertility & survivorship guidance

1. Oktay K, et al. (2018, reaffirmed 2023). Fertility preservation in patients with cancer: ASCO clinical practice guideline update. Journal of Clinical Oncology, 36(19), 1994–2001.
2. National Cancer Institute (NCI). (2024). Life After Cancer Treatment (PDQ®) — Patient Version. cancer.gov/about-cancer/survivorship/follow-up-care
3. American Physical Therapy Association (APTA) Oncology Section. (2024). Pelvic floor rehabilitation after colorectal surgery and LARS.

Care coordination, insurance, and access

1. Centers for Medicare & Medicaid Services (CMS). National Coverage Determination (NCD) for Routine Costs in Clinical Trials (310.1). cms.gov/medicare-coverage-database
2. 42 U.S.C. § 300gg–8 (2025). Coverage for individuals participating in approved clinical trials. uscode.house.gov
3. National Cancer Institute. (2024). Paying for Cancer Treatment (PDQ®) — Patient Version. cancer.gov/about-cancer/managing-care/financing/paying