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Back to the Colorectal cancer hub →54 questions · 6 red cards

The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask.

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Decisions you may face

16 with more than one option · full decision page →

One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.

Screening Stage II-III2 Metastatic, MSS4 Metastatic, dMMR3 Screening (average risk, age 45-75)2 Stage I-II colon2 Stage III colon, pMMR2 Stage III colon, dMMR2 Locally advanced rectal, pMMR2 Locally advanced rectal, dMMR Metastatic, dMMR/MSI-high, first line3 Metastatic, RAS/BRAF wild-type, left-sided4 Metastatic, RAS-mutant or right-sided (non-G12C)4 Metastatic, BRAF V600E4 Metastatic, KRAS G12C4 Metastatic, HER2-amplified, RAS wild-type3 Metastatic, refractory (third line and beyond)4 Oligometastatic liver or lung disease3

Red cards

From the labels and guidelines behind the standard of care. Your team's thresholds win.

Emergency services now
Fainting or palpitations
Fainting, near-fainting, or an irregular or racing heartbeat; several kinase inhibitors prolong the QT interval and the labels require ECG and electrolyte monitoring.
Adagrasib Daraxonrasib Encorafenib Fruquintinib Regorafenib Sotorasib Tucatinib source
Emergency services now
Hypophysitis or adrenal crisis
Persistent headache with extreme tiredness, nausea, dizziness on standing or low blood pressure. Vomiting, severe weakness or collapse is adrenal crisis.
Atezolizumab Dostarlimab Ipilimumab Nivolumab Pembrolizumab source
Emergency services now
Bleeding or bruising
Bleeding that will not stop, black or bloody stools, or unexplained bruising when platelets are expected to be low.
CAPOX (capecitabine, oxaliplatin)FOLFIRI (5-FU, leucovorin, irinotecan)FOLFOX (5-FU, leucovorin, oxaliplatin)Trifluridine/tipiracil source
Emergency services now
Bowel perforation
Sudden severe abdominal pain, a hard or very tender abdomen, or abdominal pain with vomiting and fever. Boxed warning for gastrointestinal perforation on bevacizumab.
Bevacizumab Fruquintinib Regorafenib source
Emergency services now
Skin reaction
Blisters, peeling, or sores in the mouth or eyes with a rash. Enfortumab vedotin carries a boxed warning for Stevens-Johnson syndrome and toxic epidermal necrolysis, mostly in the first cycle.
Trastuzumab deruxtecan source
Call the 24-hour line now
Interstitial lung disease or pneumonitis
Any new or worsening cough, breathlessness or fever. The label says to interrupt treatment for any suspected ILD and to permanently discontinue for grade 2 or higher.
Trastuzumab deruxtecan source

See all on the product pages:Adagrasib Atezolizumab Bevacizumab CAPOX (capecitabine, oxaliplatin)Daraxonrasib Dostarlimab Encorafenib FOLFIRI (5-FU, leucovorin, irinotecan)FOLFOX (5-FU, leucovorin, oxaliplatin)Fruquintinib Ipilimumab Nivolumab Pembrolizumab Regorafenib Sotorasib Trastuzumab deruxtecan Trifluridine/tipiracil Tucatinib·Printable cards in the navigator

Treatment journeys

What the next twelve months look like, phase by phase, with the decision points.

Stage III colon

Questions to ask

Bring to your appointment

Questions to ask your oncologist about Colorectal cancer

Generated from this cancer's standard of care, biomarkers, and pipeline · 54 questions

Newly diagnosed

What is my exact diagnosis, stage, and grade, and which tests established them?
Why: Everything else follows from an accurate stage and subtype.
Which biomarkers have been tested on my tumour (for example RAS, BRAF V600E, MSI/dMMR, HER2, NTRK), and what were the results?
Why: These results decide eligibility for targeted therapy, immunotherapy, and trials.
Which subtype is my cancer, and does that change the recommended treatment?
Why: Recognised subtypes for this cancer include Chromosomal instability / APC-KRAS-TP53 pathway, Mismatch-repair deficient / MSI-high, Lynch syndrome.
Is germline (inherited) genetic testing recommended for me or my family?
Why: Inherited variants can change treatment and matter for relatives.

Screening

For my situation (screening), which of the standard options do you recommend and why?
Why: Guideline options include: Colonoscopy, FIT, Cologuard, Shield blood test from age 45.
Am I a candidate for Shield, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Stage II-III

For my situation (stage ii-iii), which of the standard options do you recommend and why?
Why: Guideline options include: Surgery; adjuvant chemotherapy guided by risk and (in trials) ctDNA; exercise programme.
Am I a candidate for Signatera, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of DYNAMIC apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Metastatic, MSS

For my situation (metastatic, mss), which of the standard options do you recommend and why?
Why: Guideline options include: Doublet/triplet chemotherapy + biologic by genotype; targeted combinations for BRAF, KRAS G12C, HER2.
Am I a candidate for Encorafenib, Sotorasib, Adagrasib or related drugs, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Metastatic, dMMR

For my situation (metastatic, dmmr), which of the standard options do you recommend and why?
Why: Guideline options include: Checkpoint inhibitors; organ preservation in rectal cancer.
Am I a candidate for Pembrolizumab, Nivolumab, Dostarlimab, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Screening (average risk, age 45-75)

For my situation (screening (average risk, age 45-75)), which of the standard options do you recommend and why?
Why: Guideline options include: Colonoscopy every 10 years, annual FIT, multitarget stool DNA every 3 years, CT colonography, or the Shield blood test every 3 years; start at 45 (USPSTF 2021). Lynch carriers: colonoscopy every 1-2 years from age 20-25.
Am I a candidate for Shield, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Stage I-II colon

For my situation (stage i-ii colon), which of the standard options do you recommend and why?
Why: Guideline options include: Surgical resection; observation for stage I and low-risk stage II. High-risk stage II (T4, obstruction, <12 nodes, LVI): consider 3-6 months fluoropyrimidine ± oxaliplatin; ctDNA-negative patients can safely omit (DYNAMIC). dMMR stage II derives no benefit from 5-FU alone.
Am I a candidate for CAPOX (capecitabine, oxaliplatin), and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of DYNAMIC apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Stage III colon, pMMR

For my situation (stage iii colon, pmmr), which of the standard options do you recommend and why?
Why: Guideline options include: Resection then adjuvant CAPOX for 3 months (T1-3 N1, low risk) or FOLFOX/CAPOX for 6 months (T4 or N2), per IDEA.
Am I a candidate for FOLFOX (5-FU, leucovorin, oxaliplatin), CAPOX (capecitabine, oxaliplatin), and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Stage III colon, dMMR

For my situation (stage iii colon, dmmr), which of the standard options do you recommend and why?
Why: Guideline options include: Resection then FOLFOX + atezolizumab for 12 months (ATOMIC, 3-year DFS 86% vs 77%). Neoadjuvant nivolumab + ipilimumab (NICHE-2) is an alternative under evaluation.
Am I a candidate for Atezolizumab, FOLFOX (5-FU, leucovorin, oxaliplatin), and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of ATOMIC (Alliance A021502) and NICHE-2 apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Locally advanced rectal, pMMR

For my situation (locally advanced rectal, pmmr), which of the standard options do you recommend and why?
Why: Guideline options include: Total neoadjuvant therapy: short-course radiation or long-course chemoradiation plus FOLFOX/CAPOX, then TME surgery or watch-and-wait for clinical complete response (OPRA). Non-operative management for select cCR.
Am I a candidate for FOLFOX (5-FU, leucovorin, oxaliplatin), and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Locally advanced rectal, dMMR

For my situation (locally advanced rectal, dmmr), which of the standard options do you recommend and why?
Why: Guideline options include: Dostarlimab monotherapy for 6 months with organ preservation (MSK cohort 100% cCR; AZUR-1 registrational, PDUFA February 2027). Chemoradiation and surgery reserved for non-responders.
Am I a candidate for Dostarlimab, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of AZUR-1 apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Metastatic, dMMR/MSI-high, first line

For my situation (metastatic, dmmr/msi-high, first line), which of the standard options do you recommend and why?
Why: Guideline options include: Pembrolizumab (KEYNOTE-177) or nivolumab + ipilimumab (CheckMate 8HW, PFS 54 months); nivolumab monotherapy alternative. Chemotherapy reserved for IO-refractory disease.
Am I a candidate for Pembrolizumab, Nivolumab, Ipilimumab, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of KEYNOTE-177 and CheckMate 8HW apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Metastatic, RAS/BRAF wild-type, left-sided

For my situation (metastatic, ras/braf wild-type, left-sided), which of the standard options do you recommend and why?
Why: Guideline options include: FOLFOX or FOLFIRI + panitumumab or cetuximab (PARADIGM OS 37.9 months); bevacizumab if anti-EGFR contraindicated. Maintenance fluoropyrimidine ± biologic after induction.
Am I a candidate for Panitumumab, Cetuximab, FOLFOX (5-FU, leucovorin, oxaliplatin) or related drugs, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of PARADIGM and CRYSTAL & FIRE-3 apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Metastatic, RAS-mutant or right-sided (non-G12C)

For my situation (metastatic, ras-mutant or right-sided (non-g12c)), which of the standard options do you recommend and why?
Why: Guideline options include: FOLFOX, FOLFIRI, or FOLFOXIRI + bevacizumab; anti-EGFR contraindicated. KRAS G12D and other alleles: RAS(ON) inhibitors in trials.
Am I a candidate for Bevacizumab, FOLFOX (5-FU, leucovorin, oxaliplatin), FOLFIRI (5-FU, leucovorin, irinotecan) or related drugs, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Metastatic, BRAF V600E

For my situation (metastatic, braf v600e), which of the standard options do you recommend and why?
Why: Guideline options include: First line: encorafenib + cetuximab + mFOLFOX6 or FOLFIRI (BREAKWATER, OS 30.3 vs 15.1 months). Later line: encorafenib + cetuximab (BEACON).
Am I a candidate for Encorafenib, Cetuximab, FOLFOX (5-FU, leucovorin, oxaliplatin) or related drugs, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of BREAKWATER apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Metastatic, KRAS G12C

For my situation (metastatic, kras g12c), which of the standard options do you recommend and why?
Why: Guideline options include: Sotorasib + panitumumab (CodeBreaK 300) or adagrasib + cetuximab after chemotherapy; first-line trials ongoing.
Am I a candidate for Sotorasib, Adagrasib, Panitumumab or related drugs, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of CodeBreaK 300 apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Metastatic, HER2-amplified, RAS wild-type

For my situation (metastatic, her2-amplified, ras wild-type), which of the standard options do you recommend and why?
Why: Guideline options include: Tucatinib + trastuzumab (MOUNTAINEER) or trastuzumab deruxtecan 5.4 mg/kg (DESTINY-CRC02) after chemotherapy; MOUNTAINEER-03 tests first-line use.
Am I a candidate for Tucatinib, Trastuzumab, Trastuzumab deruxtecan, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of MOUNTAINEER & MOUNTAINEER-03 and DESTINY-CRC02 apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Metastatic, refractory (third line and beyond)

For my situation (metastatic, refractory (third line and beyond)), which of the standard options do you recommend and why?
Why: Guideline options include: Trifluridine/tipiracil + bevacizumab (SUNLIGHT, OS 10.8 months), then fruquintinib (FRESCO-2) or regorafenib; NTRK inhibitor if fusion; clinical trials.
Am I a candidate for Trifluridine/tipiracil, Fruquintinib, Regorafenib or related drugs, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of SUNLIGHT and FRESCO-2 apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Oligometastatic liver or lung disease

For my situation (oligometastatic liver or lung disease), which of the standard options do you recommend and why?
Why: Guideline options include: Resection, thermal ablation, or SBRT with curative intent after multidisciplinary review; perioperative chemotherapy; 5-year survival 30-50% after complete resection of liver metastases.

Any stage

Are there clinical trials I could join, for example of Daraxonrasib, Autogene cevumeran, Signatera, PF-08634404?
Why: Trials are how the next standard of care is set; asking early keeps options open.
Would a second opinion at a high-volume centre change anything, and can you help arrange it?
Why: Rare or high-stakes decisions benefit from a centre that treats many similar patients.
What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
Why: Supportive care improves quality of life and helps patients complete treatment.
I read that “MSS metastatic disease is immunotherapy-resistant”. How does that affect my plan?
Why: Open problems are where trials and second opinions matter most.
I read that “Early-onset CRC causes unknown”. How does that affect my plan?
Why: Open problems are where trials and second opinions matter most.

Newly diagnosed? Read the first 60 days with Colorectal cancer, then print the one-page appointment sheet with room for the answers.

Print this page for your appointment (your browser's print command). These prompts are for discussion; your clinical team knows your case.

Model panel1 model

Machine commentary by named AI models on a date, not clinical review. Claims are tied to the record's own sources; check them before relying on anything here.

FableAnthropic · v5.12026-09-17medium confidence

The record's epidemiology, its account of adjuvant therapy (IDEA duration, lack of 5-FU benefit in dMMR stage II) and its molecular stratification of metastatic disease are consistent with the Wikipedia article and the NCI PDQ summary. Its most specific and most recent claims, including ATOMIC survival figures, an AZUR-1 PDUFA date, BREAKWATER full approval and blood-based screening intervals, rest on NCCN landing pages that cannot be read without a login and are not corroborated by any other listed source, so they remain unverified here. One history entry misplaces MOSAIC in 1990 while the record itself puts it in 2004, and the history, biomarkers and openProblems lists contain duplicated entries that should be merged. The record omits modifiable risk factors and non-Lynch hereditary syndromes despite framing the disease around prevention.

Right 3Disputed 1Missing 1Unclear 2Show verdicts

Right
It is the third most common cancer worldwide (about 1.9 million cases a year) and the second most common cause of cancer death (900,000 a year).
These figures match the GLOBOCAN 2020 estimates that the Wikipedia article reports for incidence, deaths and world ranking. The record does not say which GLOBOCAN year it uses, and the linked GLOBOCAN 2022 paper would give slightly different numbers, so a year should be attached.
Wikipedia
Right
Resection then adjuvant CAPOX for 3 months (T1-3 N1, low risk) or FOLFOX/CAPOX for 6 months (T4 or N2), per IDEA.
The PDQ colon treatment summary describes the IDEA pooled analysis and the risk-based 3 versus 6 month choice, with the non-inferiority of 3 months clearest for CAPOX in low-risk stage III. The record's wording is consistent with that.
NCI PDQ colon cancer treatment
Right
dMMR stage II derives no benefit from 5-FU alone.
The PDQ summary discusses the retrospective pooled analyses showing that stage II patients with mismatch-repair-deficient tumours did not benefit from fluoropyrimidine monotherapy, which is the basis for the guideline recommendation the record paraphrases.
NCI PDQ colon cancer treatment
Disputed
1990: MOSAIC and the adjuvant era; adjuvant 5-FU/levamisole shown to improve survival in stage III (1990).
The record contradicts itself. Its own 2004 history entry states that 'MOSAIC establishes adjuvant FOLFOX', and PDQ places MOSAIC among the oxaliplatin-era adjuvant trials of the 2000s. The 1990 milestone was the 5-FU/levamisole result and NIH consensus, not MOSAIC; the title should be corrected. The history list also carries duplicate entries for 2004, 2017, 2022, 2024 and 2026.
NCI PDQ colon cancer treatment
Unclear
Resection then FOLFOX + atezolizumab for 12 months (ATOMIC, 3-year DFS 86% vs 77%); dostarlimab with organ preservation (AZUR-1 registrational, PDUFA February 2027); BREAKWATER full approval in 2026.
The record lists NCCN as the guideline for these settings, but the NCCN URL given is a login-gated landing page and none of the other listed sources report ATOMIC's DFS figures, an AZUR-1 PDUFA date or a BREAKWATER full approval. The internal ATOMIC and AZUR-1 records are consistent with the text, but the specific numbers and regulatory dates cannot be checked against the sources supplied.
NCCN Colon Cancer guideline
Unclear
Colonoscopy every 10 years, annual FIT, multitarget stool DNA every 3 years, CT colonography, or the Shield blood test every 3 years; start at 45 (USPSTF 2021).
Screening from age 45 and the stool and endoscopic intervals are consistent with the Wikipedia summary of US recommendations. Whether the NCCN screening guideline lists a blood-based test at a 3-year interval as an equal option alongside the others cannot be confirmed from the landing page cited, and the record's own linked ECLIPSE record notes the test detects few advanced adenomas, a limitation the approach text does not mention.
Guideline (Screening (average risk, age 45-75))
Missing
Risk factors and hereditary syndromes other than Lynch syndrome
The summary and subtypes cover the molecular pathways and Lynch syndrome but say nothing about established risk factors (processed and red meat, alcohol, obesity, smoking, inflammatory bowel disease) or about familial adenomatous polyposis and other polyposis syndromes, all of which the Wikipedia article covers and many of which have linked records in the graph. For a record that leads with 'screening works best', the causes that prevention targets are a notable gap.
Wikipedia

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ProvenanceLast edited 2026-09-18 · Jude Gomila · Merge duplicate trial records onto their named keepers · diff · file · history

Wikipedia

Colorectal cancer

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