Printable Questionnaire

Following is a printed version of the questionnaire contained within My Colon Cancer Coach. If you answer these questions using the online questionnaire, you will receive a report outlining treatment options for your specific stage of colon cancer. You may wish to talk to your doctor about these questions and then come back to the questionnaire to enter your answers and receive your customized treatment report.

1. Have you received a diagnosis of colon cancer from your physician?
   • Yes
   • No
2. Has your cancer metastasized, or spread beyond your colon?
   • Yes
   • No
   • I don't know
3. Have you undergone surgery for colon cancer?
   • Yes
   • No
4. Do you have a copy of your pathology report?
   • Yes
   • No
5. What stage is your cancer?
   • Stage 0
   • Stage I
   • Stage II
   • Stage III
   • Stage IV
   • Recurrent

• For Stage II ONLY: What is your MMR/MSI Tumor Status?
  • MSI-H
  • MSI-L
  • I Don't Know/Haven't Been Tested
• For Stage IV ONLY: Has your tumor(s) been tested for KRAS mutation? If so, what were the results?
  • Tumor carries KRAS mutation
  • KRAS Wild-Type (Normal)
  • I Don't Know/Haven't Been Tested

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