Questions to Ask a Surgical Oncologist
For someone with a cancer diagnosis who has been referred to a surgical oncologist, and for the relative in the next chair taking notes. The 53 questions run in the order a treatment consultation tends to: whether and when to operate, what the operation removes, the surgeon and the hospital, the risks and the preparation, recovery, and what the pathology report decides afterward. Pick the ten or so that fit your cancer and keep the recovery ones for the pre-operative visit if time runs out.
The questions
Each question, and why to ask it
Is surgery right
Is surgery the right first step for this cancer, or should another treatment come before it?
Why ask it
Some cancers go straight to the operating room and others get drugs or radiation first, and the order is a decision in its own right. Ask what in your scans and biopsy points to the order being recommended, and whether a test still outstanding could change it.
What is the operation meant to achieve: removing all of the cancer, removing most of it, or easing a symptom?
Why ask it
Those are three different operations in terms of what you can expect afterward, and surgeons do not always say which one they mean. Have the aim stated in one sentence and put it at the top of your notes, because every later answer about risk is weighed against it.
Can the whole tumor be removed, and what on the scans makes you confident of that?
Why ask it
You may hear the words resectable, borderline or unresectable. Anything short of a plain yes should come with the name of the structure in the way, such as a blood vessel or a neighboring organ, and with what would have to change for the answer to improve.
What are the alternatives to operating, and how do their results compare with surgery for a case like mine?
Why ask it
For some cancers radiation, ablation, drug treatment or careful monitoring are real choices, and for others surgery is the only route to a cure. A surgeon who describes the alternatives fairly, including the ones other specialists deliver, is easier to trust on the recommendation.
How soon should the operation happen, and what is the risk in waiting a few weeks?
Why ask it
The answer tells you whether there is time for a second opinion, a fertility appointment or getting fitter first. A date range is more use than 'soon', together with whatever sign would make the surgeon bring the date forward.
What is likely to happen over the next months if I do not have the operation?
Why ask it
Nobody is obliged to have surgery, and a surgeon can describe the likely course without it as plainly as the course with it. Listen for whether declining now closes the door or whether the operation could still be done later, which is not the same for every tumor.
If I have chemotherapy or radiation first, when would you operate afterward, and what would you recheck before going ahead?
Why ask it
There is usually a planned gap and a repeat scan before surgery is confirmed. Get the rough calendar on paper with the name of whoever books that scan, because the handover between two departments is where weeks get lost.
If the treatment before surgery works very well, could the operation become smaller or change?
Why ask it
Sometimes a strong response opens a less extensive option, and sometimes the original operation is still advised whatever the scan shows. Knowing which applies to you stops a good scan from raising a hope the surgeon never shared.
Did the tumor board agree on this plan, or was there a debate about it?
Why ask it
Many centers review each new case at a meeting of surgeons, oncologists, radiologists and pathologists, though the name and the practice differ by hospital. A split opinion is worth hearing in detail, since it usually marks the decision that is yours to weigh.
Should I have genetic testing before the operation, in case the result changes what you remove?
Why ask it
For a few cancers an inherited gene change can alter how much surgery is advised, and for many it makes no difference to the operation. Results can take weeks, so this belongs before the date is fixed. A close relative with the same cancer is the detail to mention.
The operation
What exactly will you remove, and can you draw it or show me on my scan?
Why ask it
A sketch does more than the name of the procedure, which is often long and tells a patient little. Keep the drawing, and have the full name of the operation written beside it for insurance forms and second opinions.
Will this be open, laparoscopic or robotic surgery, and why that approach for my tumor?
Why ask it
The approach decides where the incisions go, how the scars will look and how the first weeks feel, and it depends on the tumor and on what this surgeon does most. Two follow-ups: is the cancer result expected to be the same either way, and what would make them switch to an open operation partway through?
What margin are you aiming for, and how will you know whether you got it?
Why ask it
The margin is the rim of healthy tissue taken around the tumor, and how much counts as enough differs from one cancer to another. Some teams have a pathologist check the edges while you are still asleep, called a frozen section, and others wait for the final report, so find out which happens there.
Which lymph nodes will you take, and is that a sampling of a few or a full clearance?
Why ask it
The two differ a great deal in recovery and in lasting effects such as swelling in a limb. Find out whether the nodes are being removed to learn something or to treat something, and what the surgeon does if a node looks involved on the day.
Is there anything you might find once you begin that would make you stop without removing the tumor?
Why ask it
A hard possibility to hear, and harder for a family to learn of in the waiting room with no warning. Get the surgeon's own estimate of how likely it is on your scans, and what the plan would be the following week if it happened.
Will anything need rebuilding or rerouting, such as a stoma, a graft, a feeding tube or reconstruction?
Why ask it
For each one named, pin down two things: certain or only possible, temporary or permanent. If a stoma is on the list, request a meeting with the specialist nurse before the operation, since the position is often marked on the skin ahead of time.
How will my body work differently afterward, and which of those changes are permanent?
Why ask it
There are two lists here: what losing part of an organ does to digestion, breathing, hormones, speech or movement, and what the operation itself can leave behind, such as numbness or a changed bowel or bladder habit. Press for the day-to-day version, meaning what you will eat, take or do differently a year from now, and who helps with each change.
How long does the operation usually take, and who updates my family while it is going on?
Why ask it
Give the team one name and one phone number. If your family knows in advance that updates come only at the end, and where the surgeon will find them afterward, a long wait is less likely to be read as bad news.
Will some of the tumor be kept for biomarker testing or for a clinical trial?
Why ask it
Tissue from the operation is often the fullest sample anyone will have, and some tests and trials need it handled a particular way on the day. Raising it before surgery gives the team time to arrange that, or to tell you it is already routine there.
Surgeon and hospital
How many of this particular operation do you perform in a year, and how many does this hospital do?
Why ask it
Both numbers count, because the nurses, the anesthesia staff and the ward look after you once the surgeon has finished. A surgeon who does it often tends to answer with a figure and takes no offense, and a vague reply deserves one polite second try.
Is this kind of cancer the main part of your practice, and what specialist training do you have in it?
Why ask it
Training routes and titles vary by country, so have the surgeon explain what their fellowship or certification means where you are. What you are listening for is whether your cancer is their everyday work or an occasional case.
What are your own results with this operation: complications, clear margins, and patients who had to go back to surgery?
Why ask it
Some surgeons track their own figures and some can only quote published ones, and it is fair to ask which you are hearing. Either is useful as long as it comes with how your case compares with the usual one.
Which parts of the operation will you do yourself, and who else will be operating?
Why ask it
In teaching hospitals, residents and fellows take part under supervision, and a complex operation may bring in a second specialist surgeon. Asking at the consultation is much easier than asking on the morning of surgery.
If something goes wrong at night or on a weekend, what does this hospital have on hand to deal with it?
Why ask it
You are asking about intensive care, interventional radiology and an on-call surgeon who knows this operation, because how a hospital handles a complication counts as well as how rarely one occurs. If some problems mean a transfer, find out where patients are sent and how often that has been needed.
Is there a center that does far more of these, and would you refer me if I wanted to go?
Why ask it
For rare tumors and the largest operations the question is routine, and a confident surgeon answers it without bristling. You can also ask where they would send a relative who had the same scan.
If I want a second surgeon to review this, how do my scans and biopsy slides reach them?
Why ask it
A second surgeon generally wants the images themselves and sometimes the slides, not only the written reports. The office can tell you how the transfer works there and how long it takes. Whether that delay would do any harm in your case is one for the surgeon.
Who coordinates between you, the medical oncologist and the radiation oncologist, and who do I call with a question that sits between you?
Why ask it
Plans fall into gaps when each specialist assumes another one is in charge. Leave with one named person, often a nurse navigator or coordinator, and a direct line to them.
Besides your fee, which separate bills should I expect, and who can estimate my share before I book?
Why ask it
The hospital, anesthesia, pathology and an assisting surgeon may each bill separately, and what you pay depends entirely on your country, insurer or health service. Where an insurer is involved, find out whether anything needs approval in advance and who in the office chases it.
Risks and prep
What goes wrong most often after this operation, and how is each problem dealt with?
Why ask it
Listen for specifics tied to this procedure, such as a leak, an infection, bleeding or a gut that is slow to wake up, and not a general remark that all surgery has risks. The practical point about each one is whether it usually means a longer stay, a procedure or another operation.
What is the most serious thing that could happen, and how likely is it for someone with my health?
Why ask it
This includes the risk of dying from the operation, which surgeons will discuss when asked plainly. Write the figure down as a number out of a hundred, and check whether it describes patients in general or someone of your age with your conditions.
How likely is it that I will need a blood transfusion, and is there anything to sort out beforehand?
Why ask it
The answer depends on the operation and on your blood count going in. If you are anemic, the surgeon may want that looked at in the weeks before, and if you would refuse blood for religious or other reasons, the team needs to hear it at this visit and not on the day.
Could this operation affect my fertility or sexual function, and does anything need arranging beforehand?
Why ask it
It applies to more operations than people assume, including many in the pelvis and abdomen, and surgeons do not always bring it up first. Where preserving fertility is possible it generally has to be organized before the operation, so raise it even if you are unsure what you want.
Is my general health good enough for this operation, and what would you want checked or improved first?
Why ask it
Expect to hear about heart and lung tests, blood work or a visit with the anesthesia team. Should the surgeon have doubts, the next question is whether a smaller operation or a few weeks of building up strength would change the picture.
What can I do in the weeks before surgery to lower my risk?
Why ask it
Some hospitals run a program of exercise, nutrition and stopping smoking before major operations, sometimes called prehabilitation. Where there is none, have the surgeon name the two or three things they would most like you to work on.
Which of my medicines and supplements should I stop before surgery, and exactly when?
Why ask it
Blood thinners, diabetes medicines and some supplements often need a plan, and it should come from the surgical team together with whoever prescribed the drug. Get the stop dates and the restart dates in writing.
What kind of anesthesia will I have, and will I meet the anesthesia team before the day?
Why ask it
Mention any bad reaction you or a blood relative has had to an anesthetic, along with sleep apnea or loose teeth. The pre-anesthesia visit is also where to ask about a nerve block or an epidural for pain.
What happens between today and the operation, and what do I need to have done by which date?
Why ask it
Pre-operative tests, the consent form, an anesthesia visit and medication changes each have their own deadline. Read the list back aloud with the dates, and get the name of the person to tell if you catch a cold or run a fever in the final week.
Recovery
How many nights should I expect in the hospital, and will any of them be in intensive care?
Why ask it
A planned night in intensive care after a big operation is routine in many hospitals and does not mean something went wrong, so tell your family in advance. The other half of the answer is what usually keeps people in longer than planned, which is also what the ward will be watching for.
What tubes, drains or lines will I wake up with, and when does each one come out?
Why ask it
Waking up attached to equipment nobody mentioned is frightening for patients and for visitors. Some of it may go home with you, so find out which pieces and who teaches you to manage them.
What is the plan for pain, and does it rely on opioids or on other methods as well?
Why ask it
Many teams combine several kinds of pain relief, and what is offered varies by hospital. Say so now if opioids have made you ill before, if you are in recovery from addiction, or if you already take daily pain medicine.
When will I be eating and drinking normally, and will my diet change for good?
Why ask it
This matters most after surgery on the stomach, bowel, pancreas, throat or mouth, and is a quick one otherwise. A dietitian may see patients before discharge there. Either way, leave knowing how much weight loss would be worth a phone call.
What will I be unable to do for myself in the first weeks at home?
Why ask it
Stairs, showering, cooking and lifting a child are the practical tests. Describe your home and who lives in it, then ask whether patients like you usually go straight home or spend time in a rehabilitation unit first.
How many weeks until I can drive, lift and do my job, given what my work involves?
Why ask it
Describe the job in physical terms: hours on your feet, weights carried, the commute. Request the estimate as a letter, because what an employer or insurer asks for differs by country and workplace.
Once I am home, which symptoms mean I call your office and which mean I go to an emergency room?
Why ask it
You want the list on paper, with the number that is answered after hours. If the nearest emergency room is not at the hospital where you had surgery, ask what to tell the staff there and whether the surgeon wants to be phoned.
Will I need physical therapy, wound care, a stoma nurse or home nursing, and who sets it up?
Why ask it
Find out whether referrals are made before discharge or left to you, and how such services are arranged where you live. Anything that can be booked before the operation is then ready the day you get home.
How long before most of your patients feel like themselves after this operation?
Why ask it
The answer is often months, well past the weeks that discharge leaflets cover. Knowing which part is usually slowest, whether energy, appetite or mood, keeps a flat month from looking like a setback.
Pathology and after
What will the pathology report tell us that we do not know today?
Why ask it
Scans and biopsies are estimates, and the examined specimen gives the final size, the margins, the node count and sometimes a different stage. The finding to single out is whichever one would most change what happens next.
Who gives me the pathology result, and about how many days after the operation?
Why ask it
Decide in advance whether you want it by phone or face to face, and whether you want company for it. In some systems the report reaches a patient portal before the surgeon has called, so ask how it works there if you would prefer not to read it alone.
If a margin comes back positive, what happens: another operation, radiation, or close watching?
Why ask it
Hearing the options before the result arrives makes a disappointing report easier to act on. If a second operation is among them, find out roughly how soon it would follow and whether it would be smaller than the first.
If cancer is found in the lymph nodes, how does the plan change?
Why ask it
Node results often decide whether drug treatment or radiation is recommended afterward. That stage is usually led by a different doctor, and you can ask to meet that person before the result instead of after it.
Am I likely to need chemotherapy, radiation or another treatment after surgery, and how soon would it have to begin?
Why ask it
The surgeon can usually say what is probable even though the final call waits on pathology. It lets you plan work and help at home for the whole stretch, not only for the operation.
After this operation, what is the chance of the cancer returning, and where would it most likely show up?
Why ask it
Check whether the figure describes people at your stage who went on to have all of the recommended treatment. The answer about where also tells you which symptoms deserve a call in the years ahead.
What follow-up will I have, with which scans or blood tests, and which doctor is in charge of it?
Why ask it
After surgery people often see three specialists and are unsure which of them owns the schedule. Get the first year laid out, with the one number to use if a symptom turns up between visits.
Getting the most from a surgical oncology consultation
Practical guidance for the conversation itself
Before you see the surgeon
Send the images, not only the reports
A surgeon plans from the scans themselves as well as the written reports. Call the office a few days ahead to ask what has arrived and how outside images reach them, whether on a disc, through a portal or by a transfer between hospitals. Arriving to find the scans missing can turn the visit into a rebooking.
Sort your questions by doctor
The surgical oncologist answers for the operation: whether, when, what is removed, the risk and the recovery. Questions about drug treatment belong to the medical oncologist and questions about radiation to the radiation oncologist, though the surgeon can usually say what is likely and who to see about it. Sorting the list this way keeps the visit from being spent on answers this doctor has to defer.
Choose about ten and rank three
Nobody gets through the whole list in one consultation. Mark the questions that fit your cancer and your point in the decision, then put the three you most need answered at the top of the page in case the visit runs short.
Write down what you want protected
Before you go, note what matters to you beyond getting the cancer out: keeping a function, being well for a particular date, avoiding a permanent stoma, staying able to do your job. Surgeons sometimes have more than one way to do an operation, and they can only weigh what you tell them.
Bring a note taker, or ask to record
Have whoever comes with you write answers down word for word wherever a number is involved. You can also ask the surgeon whether the conversation may be recorded on a phone; many agree, and the rules on recording differ from place to place.
Words the surgeon will use
Resectable, borderline, unresectable
These words describe whether the surgeon believes the tumor can be taken out completely at an acceptable risk. The judgment comes from the scans and can shift after treatment given first, so ask what it rests on in your case.
Margins
The margin is the edge of the tissue that was removed. A pathologist reports whether cancer cells reach that edge, usually in words like clear, close or positive. How wide a margin is wanted depends on the type of cancer, so ask for the target in yours.
Sentinel node and node dissection
A sentinel node biopsy removes the first node or few nodes draining the tumor area to see whether cancer has reached them. A dissection removes a whole group of nodes. Which one is planned depends on the cancer and on what the scans have shown, and the after-effects of the two are not alike.
Neoadjuvant and adjuvant
Neoadjuvant treatment is given before surgery and adjuvant treatment after it. When you hear either word, ask what the treatment is, who gives it and how it moves the date of the operation.
Tumor board
A regular meeting where surgeons, oncologists, radiologists and pathologists go through cases together. Hospitals have different names for it, including multidisciplinary team meeting. You can ask whether your case has been presented and what was recommended.
Asking about experience without souring the room
Say why you are asking
An opener such as 'I ask every surgeon this' takes the edge off. Then ask for the number of these operations in the past year, for the surgeon and for the hospital.
What a straight answer sounds like
It contains a figure, even a rough one, and a sentence on how your case compares with the usual one. A reply about years in practice or the hospital's reputation has not answered the question, and you can put it again without apology.
When to raise a bigger center
It tends to come up for rare tumors, for the largest operations, and whenever the surgeon describes your case as unusual. Travel has real costs, so ask what would be gained by going and whether follow-up could still happen close to home.
If you want a second surgeon to look
Say so openly, since surgeons are asked for this regularly. Have the office release the imaging, the pathology report and, if the second surgeon wants them, the slides. The first surgeon is the one to tell you how long you can take without it mattering.
Between the consultation and the operation
Get the plan on one page
Request the name of the operation, the proposed date, the tests still to come and the contact person in a letter or a portal message. That page is what you hand to a second surgeon, an employer or an insurer.
Save the practical half for the pre-operative visit
Recovery questions about drains, driving and help at home often get fuller answers from the nurse at the pre-operative appointment than from the surgeon at a first consultation. If time is short, hold those back and spend the surgeon's minutes on the decision itself.
Read the consent form early
Try to get the consent form days before the operation instead of on the morning. It lists the procedure and the risks as the hospital records them, and anything on it that was never said aloud is a question for the surgeon.
Agree who gets the calls
Name one person to be phoned after the operation, and decide who will be with you for the pathology result. Give the team that person's number, and if the hospital needs a signed form before it can share information, sign it beforehand.