Getting a second opinion isn’t about second-guessing your doctors. It’s about making sure you have the best information, the right team, and a treatment plan that fits you. Whether you stay the current course or take a new path, the confidence that comes from hearing another expert’s perspective is pretty powerful.
What do I really need to know?
- Second opinions can be valuable for anyone, not just stage IV patients, but they are especially helpful in advanced or complex cases.
- A second opinion may confirm your plans or change them drastically.
- Oncology is complicated. Doctors are usually comfortable with patients seeking additional expertise.
- Setting them up does take time, so get started as soon as you can.
- There could be multiple points in your cancer journey when a second opinion might be helpful.
- There are practical considerations to keep in mind – finances, travel, time. Planning for these up front can help you manage them down the road.
- Getting your records and questions organized can help the process go more smoothly.
- COLONTOWN is a great place to do research. Ask questions about other patients’ experiences with specific doctors and cancer centers.
- Know when you’ve gathered enough expert opinions to move forward – seek expertise but don’t delay decision-making too long.
What is a second opinion?
When you’re first diagnosed, your care team (often a medical oncologist and a surgeon) will recommend a treatment plan. This is called your first opinion.
A second opinion means having one or more additional specialists (often at a different cancer center) review your case. This additional recommendation may confirm your current plan or offer new treatment options you hadn’t heard about or considered. Some patients even seek a third or fourth opinion—especially when dealing with a complex case or limited options.
Even if the second opinion confirms the first, it can help you walk away with peace of mind, the confidence to move forward—and hopefully a better understanding of why that plan was recommended.
Why get a second opinion?
Most oncologists and surgeons are familiar with and welcoming of different perspectives on their cases. Second opinions are not about distrust — they’re about gaining clarity, especially when:
- You’re newly diagnosed
- You’re facing a major decision
- Your case is complex
- You’ve been told you’re not a candidate for surgery or other treatments
- You want to explore alternatives like clinical trials, watch-and-wait for rectal cancer, or a new localized treatment — as these may not be available at your closest cancer center
Doctors vary widely in experience and perspective. Another doctor or cancer center may confirm your current plan, or offer new options. Some patients find out that they’re eligible for surgery or advanced therapies they weren’t previously offered. Others learn that their imaging results were misread, or that additional tests are needed.
Just because you get a second opinion, it doesn’t mean you necessarily need to move your primary cancer care. Often, these visits serve as one-time consultations to verify or tweak your treatment plan or a specialized procedure. Then you can go home to continue your treatment.
You might also find that a second opinion doesn’t seem necessary in your case. If you feel confident in your treatment plan and it lines up with patients in similar situations (COLONTOWN is a great place to compare notes with others), then it is certainly fine to move forward with treatment. Don’t feel pressured to seek another opinion unless it makes sense to you.
Do second opinions really make a difference?
“A 2018 study published in the Annals of Surgical Oncology that found that a second review by a multidisciplinary tumor board at a National Cancer Institute-designated cancer center changed the diagnosis for 43% of the 70 patients in the study.”
Who should get a second opinion?
Many patients might benefit from a different perspective. Below, we go over some scenarios where second opinions might be particularly helpful.
Stage IV patients
- Patients who are told they will be on “chemo for life”
- Patients who have not received tumor testing and don’t have information about their tumor biomarkers
- Patients with oligometastatic disease — only a few metastases at diagnosis
- Rarer subsets of CRC, like tumors with BRAF V600E mutations, MSI-H tumors or patients with actionable genetic alterations.
- Patients considering clinical trials
- Patients who don’t want to leave any stone unturned in their treatment planning
How do I know if my tumor mutations are actionable?
Take a look at “What do I really need to know?” inside CRC101, our comprehensive guide to all things colorectal cancer.
Non-metastatic patients
- Stage IIIC patients with specific concerns about recurrence (even if scans are clear)
- Stage II or III patients who want to make sure they have been offered the most up-to-date treatment options
- Locally advanced rectal cancer patients exploring watch-and-wait
- Patients considering clinical trials
Specific situations
- Patients with complex cases, like coexisting illnesses, pregnancy or multiple cancers
- Patients with specific genetic factors, such as Lynch Syndrome
- Patients who suspect or have evidence of peritoneal mets
- Patients who feel like their team isn’t a good fit and are seeking better rapport with their team
- Anyone who has a gut feeling that something isn’t quite right
Don’t wait until you’re in crisis — start the process before you need to make any urgent decisions. One more thing to keep in mind: Any new information you receive from your second opinion might make decision-making more complicated, so account for that in your timeline.
When should I get a second opinion?
It might be the right time for a second opinion if…
- You’ve experienced a recurrence or disease progression
- Your latest scans or test results are unclear or conflicting
- You’re considering clinical trials, surgery, or a watch-and-wait approach (for rectal cancer)
- You suspect growth or recurrence, are anticipating an important scan or test results, and want a solid plan in place if something changes
- If you have stage IV CRC and have not had genetic or biomarker testing
Don’t wait for test results before starting the process. Appointments, insurance approvals, and record transfers all take time. Getting on a specialist’s calendar early can save you stress later. If you find out you don’t need the appointment, you can always cancel (and give someone on the waiting list a nice surprise!)
Ask yourself…
Are you feeling uncertain?
Uncertainty doesn’t always mean you’re on the wrong path. Decision-making in cancer isn’t black and white — and not even the best doctor can tell you with 100% certainty what will happen in your disease trajectory.
All decisions are based on “best-guesses,” which vary greatly based on the clinicians expertise and experience. These “best-guesses” are also based predominantly on average cases and scientific data so rare circumstances can lack a clear, tried-and-true answer.
The goal is to find a path that fits you and that requires treating the whole you, not just your cancer.
Are you doubting your doctors?
It’s common to feel unsure when you get conflicting advice. Ask yourself: Is this discomfort about the treatment options, or about how you’re being treated? Sorting that out can help you move forward with more clarity.
Do you know when to stop?
At some point, additional opinions stop adding value and can delay important treatment. Sometimes patients may find themselves searching for an answer or solution that just isn’t available. If that’s you, consider that when multiple experts align, you may be ready to shift from searching for a different answer to focusing on following the treatment plan and living your life.
Need financial support to get a second opinion? Apply now
COLONTOWN’s Second Opinion Project provides financial support for stage IV patients seeking second opinions.
Interested in applying? Fill out the form here.
Other resources
Where should I go and who should I see?
The right second opinion comes from the right kind of doctor. You’re looking for someone who has more experience with your specific situation — not just any oncologist, surgeon or other specialist, but someone who can bring a particular new perspective or experience level to your case.
You really want both a strong institution and the right doctor within it. Patient communities like COLONTOWN can help you identify doctors with real-world experience treating patients like you. Patients often find that institutions have an overarching personality or risk tolerance, so look for a team that fits your needs.
Prioritize:
- Expertise over bedside manner (although ideally you get both!)
- High-volume specialists in colorectal cancer and/or the specific procedure you are discussing
- High-volume specialists in your specific circumstances (mutations, tumor locations, etc), especially if you are stage IV
- High-volume CRC centers, like NCI-designated cancer centers, which often offer more advanced options.
What does “high-volume” mean?
High-volume means that a doctor or cancer center sees a lot of people with a specific type of cancer — which means high expertise. Studies show that surgeons and hospitals with higher volumes usually have better outcomes with lower complication rates. High volume NCI centers may see hundreds or thousands of new cases every year. All that experience means everyone involved in your care — from surgeons to nurses — has likely managed patients with situations very similar to yours.
If you have liver metastases, see a liver surgeon. If you’re considering radiation, talk to a radiation oncologist. Subspecialists often know things generalists don’t. It’s usually not wise to take specialized advice from someone outside of your needed subspecialty.
At this time, some leading institutions offer virtual second opinions. So traveling may not be necessary, especially to start the process. If you don’t plan on moving your day-to-day care, you might be able to travel once or twice and then continue with virtual, consultative check-ins in the future.
Why should I find a different hospital for my second opinion?
Second opinions are most useful when they come from doctors that are not affiliated with your original team. This allows for more candid recommendations. It also potentially expands your treatment options, as another cancer center may have different resources from your primary center. Just keep in mind that a new place might mean a new culture or personality, a different sequence of testing and procedures, or even a change in treatment and chemo preferences.
What to expect
First of all, a second opinion consult appointment will feel similar to a clinic appointment without treatment. You’ll get your vitals checked, say your DOB multiple times, review history, etc. Some institutions may use your current records but others will suggest you get new scans or tests.
Some patients are seeking clinical trial options through their second opinions. If this is you, expect that you may have to complete some additional pre-screening steps. These could include scans, tests, procedures or other processes. The extra testing adds extra time to the process but it ensures you are a good fit for the trial.
Second opinions can bring peace of mind or new questions — these outcomes are normal and useful. Here are three potential outcomes:
Agreement or concordance
Your second doctor might agree with your original team, and this can reassure you that you’re on the right track, in turn helping you commit to your plan with more confidence. You might get another explanation of your situation that helps you understand the plan better.
But if you were hoping for something different, don’t be discouraged. Getting the same answer is often a good outcome, it shows that both teams see the same picture.
New ideas or alternatives
Your second doctor might suggest a different approach — from new treatments to surgery options your original team didn’t offer. That can feel empowering, but might also be overwhelming. Take time to ask questions, weigh tradeoffs, and lean on your support network.
Some people find it useful to make a pros and cons list of the suggestions they have heard. Your different care teams can help you fill in the details of this list. Asking about “best case, worst case, most likely case” outcomes can help you compare treatment options. Your team’s expertise and experience will provide additional insights you may not have.
These potential different outcomes may lead to some additional questions, but this is all part of the second opinion process. Almost all patients find it is worth the process in the end.
Complete disagreement
It’s rare, but you could find yourself with two opinions that completely contradict one another. In this case, it is helpful to ask both teams why they disagree and likely seek a third opinion.
Patient perspective by Michele
My second opinion didn’t just change my treatment plan—it gave me clarity and confidence.
I got a second opinion during a recurrence scare about seven months after finishing chemo. A routine scan showed some suspicious pelvic spots, and while follow-up scans weren’t definitive, the tumor board at my original cancer center thought I might need a major surgery. My colorectal surgeon encouraged me to get another opinion first.
At the NCI center I went to, they repeated scans and didn’t see anything alarming at that point. But a few months later, a new scan there did show a problem. Thankfully, it was addressed with a much smaller surgery—and it turned out to be benign.
I stayed with the NCI center for the procedure and now split my follow-up care between both places. The second opinion didn’t just influence my care—it helped me understand the options, ask better questions, and feel more confident about what came next.
Steps to a second opinion
Scheduling a second opinion can be pretty straightforward. Below, we go over the main steps involved, but make sure to ask for advice from the personnel at the second opinion institution as you go along. They can help you navigate their specific institution’s processes.
1. Check your insurance
Most plans cover second opinions—but call to confirm, especially if you’re going out of network or state. Ask about your specific coverage to help estimate your costs and find out if you need to get a referral before seeking a second opinion. The second opinion institution may also have financial specialists that can help you complete this task.
2. Call the office
Let them know you are seeking a second opinion consult and provide a quick overview of your situation. Depending on who you are hoping to see and your needed time frame, you might need to meet first with a mid-level provider (a nurse practitioner or physician assistant) to take your case history. However, your treatment recommendations should always come from the specialist(s) you came to see.
Ask
- Do you offer in-person or virtual consults?
- Do I need new scans or tests, or will you review existing ones? (If new tests are needed, check your insurance coverage)
- What records do you want?
- Should I provide my records?
- Who should I communicate with prior to my appointment? How should I contact them? (Getting a direct number, email, name for portal of an assistant can be helpful vs a general office line)
Tip: Always bring a backup—like a thumb drive or CD of your scans and most recent oncologist notes—even if the office has digital access.
Patient perspective by Alex
I had been waiting months for my second opinion appointment and when the day finally arrived, just my luck, there was a cyber attack on my hospital’s computer system that had shut it down. The specialist had no access to any of my files or scans and without those I wouldn’t have been able to have my appointment! Luckily, I remembered that I had copies of most of my files on my phone and we were able to continue with the appointment using my tiny phone screen.
Once the visit is scheduled and the team has time to preview your records, you might also ask:
- How do I access your patient portal?
- How many days should I plan to stay?
- Will I need to do any special prep for the visit, i.e., bowel prep or nothing to eat or drink beforehand?
3. Prepare your files and your thoughts (a "case summary")
Preparing a brief, organized overview of your diagnosis, treatment to date, and current questions and concerns can make the appointment smoother for both you and the doctor. You may find a document called a “progress note” in your medical file. This is usually updated at each oncology appointment and can be a good place to help you start pulling together your own case summary.
Even if you’re not actively looking for clinical trials, this Clinical Trial Assessment print-out worksheet is a great first step. It can help you organize all your medical information.
Tip: Call a few days before your appointment to confirm they’ve received everything. If they haven’t, follow up or bring paper and digital copies yourself.
Prepare some questions to ask. Some examples are below
- What is standard-of-care treatment for my situation, and is there more than one option?
- Are there any local treatment techniques (eg, surgeries, ablation, radiation approaches) here or elsewhere that would be an option for me?
- What clinical trials are relevant to me — both here and at other institutions?
- Do I need to receive treatment here? Some clinical trials and treatments are often restricted to certain hospitals, but they may be able to collaborate with your local oncologist to help you get the same treatment.
- Are there are any other specialties or subspecialties I should see here? Will my case be discussed with them?
- What is your opinion on my other care team’s recommendations? Do you offer all the same treatments? (Note: it’s helpful to know if the recommendation differs because a center doesn’t offer a treatment and/or the doctor isn’t as familiar with it or if they don’t recommend it.)
- What is the best case scenario, worst case scenario and most likely outcome?
- Can I reach out to you for further questions?
- Will my case be presented to your multidisciplinary tumor board (MDTB?) If so, how will I get the results?
Who is on a multidisciplinary tumor board?
- Medical oncologist, preferably one who specializes in CRC cases
- Colorectal surgeon
- Liver, thoracic, lung and/or peritoneal surgeon, if needed
- Radiation oncologist
- Interventional radiation oncologist
- Pathologist
- Geneticist
- Palliative care physician to manage side effects of treatment
- Social worker to provide mental, emotional or practical support
- Nurse navigator to provide guidance and education through the treatment and recovery process
Do I need a second opinion every time I get scan results?
No. But if your situation changes, you hit a new decision point, or something doesn’t feel right, it may be time to check in with another expert. You don’t have to commit to ongoing care with them; just get their perspective.
How can I get a second opinion if my insurance/time/finances don't allow it?
Sometimes there are creative ways to get another review of your case. You can ask your doctor to contact another doctor for an informal consultation. Another option might be a virtual tumor board where smaller institutions present cases remotely to a group of outside experts for collaborative input.
What if I want a second opinion but my caregiver doesn't — or vice versa?
This is your treatment and you deserve to feel confident in your care. It’s okay to disagree and still advocate for yourself. Talk through the reasons together, and consider involving a neutral third party, like a nurse navigator or counselor.
Know that there are many pathways to getting a second opinion, and that COLONTOWN offers financial support for stage IV patients seeking a second opinion.
What if I already feel confident in my team and don't want a second opinion?
That’s great! If you’ve weighed your options and feel well-informed, you don’t have to seek another opinion. The goal is confidence in your plan—how you get there is up to you.
How do I know when to stop seeking second opinions?
At some point, additional opinions stop adding value and can delay important treatment. Sometimes patients find themselves searching for a solution that just isn’t available to them. Take a step back and consider how patients with a similar profile have been treated. Have they been offered something you’ve not yet discussed with a doctor? Or, have you and your doctors considered all the currently available, viable options? When multiple experts align, you may be ready to shift from searching for a new answer to focusing on implementing the leading treatment option.
Watch this COLONTOWN DocTalk to hear Dr. Lidsky from Duke University give his perspective on and evidence for second opinions.
Asking for a second opinion
Asking for a second opinion can feel awkward, but it really shouldn’t. Many doctors expect it and encourage it, but some do dislike patients seeking other opinions. Oncology is one of the most complex and rapidly changing fields of medicine so it’s literally impossible for a single doctor to know everything. More brains and collective experience regularly equal better outcomes – research shows that receiving a second opinion often leads to an adjustment in care.
Even experts can disagree
A 2020 Annals of Surgery study found that top liver surgeons around the world often chose different treatments for the same colorectal cancer cases. The authors called it a “throw of the dice.”
One of the study’s authors, Dr. Hernandez-Alejandro, mentioned the research in a DocTalk (at time stamp 11:22). As Dr. Hernandez put it, “They were experts around the world. The conclusions [of the study] were there was minimal agreement on therapeutic strategies, a lot of inconsistencies, and patients should consider second and third opinions… If your case is complex, you need to listen to more [experts]; you need to have a better option[s].”
Our conclusion? When your case is complicated, second opinions often provide new ideas and strategies for your care.
If you’re nervous about bringing it up, try using one of these conversation starters:
- “My family really wants me to get a second opinion, just to be sure we’re exploring everything.”
- “I trust you—and I want to feel 100% confident moving forward. These are such big decisions, I’d like to get a second opinion before we decide.”
- “Would you be open to collaborating with another specialist?”
- “Do you have colleagues at other centers you’d recommend for a second opinion?”
In most hospital systems, especially ones using electronic medical records, your doctor will see that you’ve had a second opinion anyway. Knowing that you’ve sought a second opinion actually helps them coordinate care more effectively. But we do recommend that you tell your primary doctor before they find out through your EMR. Telling them yourself encourages an open and respectful relationship.
What if my doctor is upset?
If your doctor becomes upset or hostile after you mention getting a second opinion, you should use this as confirmation that the second opinion is quite necessary — and it might be time to move your care to another team entirely.
If you are in a situation where it’s not practical or feasible to move your regular care elsewhere, work on your relationship with your doctor to get them on board about a second opinion. You could say that collaborating with a more experienced oncologist on difficult or complex cases might be useful to a community oncologist. Consider sharing COLONTOWN resources and DocTalks that are relevant to your case.
A doctor's perspective
Any doctor will tell you that medicine is complex. They’ve likely been someone else’s second opinion themselves. Most doctors want you to get all the information you need to feel empowered in your care.
Bottom line, a good doctor won’t be offended by your second opinion. They’ll support your decision—and may learn something, too.
Practical & emotional considerations
Getting a second opinion can be empowering—but it also takes time, energy, and often money. With proper planning you can minimize the downsides and maximize the effectiveness of your efforts. Here are some big things to think through:
Set clear goals
When you are dealing with a cancer diagnosis, you’re likely dealing with so many new questions and complexities in your life. All this change makes having a plan and goals more important than ever. You don’t want to waste time or energy, so ask yourself:
- What do I hope to learn from the second opinion?
- Am I looking for more options, validation, or peace of mind?
- Am I looking to change my primary care team or just establishing a consultative relationship?
- What tradeoffs am I willing to make between quality of life and treatment intensity?
- What is my risk tolerance for clinical trials or new treatments?
- Do my short-term goals differ from my long-term goals? For example, are you willing to have reduced quality of life now for a higher chance of long-term success?
Knowing what matters most to you—quality of life (QOL, for short); mobility; work; travel; time with family; continuing a certain lifestyle or hobbies—will help you choose the best path forward.
Consider travel
Second opinions always take planning and, often, travel. Your appointment may be scheduled for weeks out or there might be a last minute cancellation you can fill. In all of these cases, virtual consults can be a great option, so ask if they’re available.
However, if you need to travel, consider:
- What form of transportation seems best?
- Can I physically manage it during any ongoing treatment?
- Will I need help getting there?
- Where will I stay?
- If the appointment leads to future treatment, can I stay locally for surgery and follow-ups?
Tip: Some patients travel only once for a consult and/or surgery, then continue care locally with remote input from their second opinion doctor.
Can you delay treatment?
Everyone’s cancer is different. Some patients have a more stable disease, while others have issues needing urgent attention like an imminent intestinal blockage requiring surgery. If you need a treatment to start immediately, don’t delay getting a second opinion.
Think about finances
Even if insurance covers some or all of the appointment, you may face out-of-pocket costs like:
- Additional tests
- Transportation, lodging and food
- Time off work
- Child or pet care
Ask for help when you schedule your appointment by telling the staff your areas of financial concern. They may have financial counselors available that specialize in oncology patients. The larger cancer centers often have lists of discounted lodging available. Some even have local pet or child care suggestions if you plan to bring them along.
COLONTOWN’s Second Opinion Project provides financial support for stage IV patients seeking second opinions. Interested in applying? Fill out the form here.
Balance the emotional load
Big decisions, conflicting advice and scanxiety are often part of the cancer journey. It may seem counter-intuitive, but second opinions can potentially increase these emotional burdens.
Just as with everything around cancer, you don’t have to navigate these issues alone. COLONTOWN is a great place to ask questions about what to expect and how to get help. Your local cancer center may also have social workers or other professionals to help you apply logic and reasoning to balance out the emotions of difficult decisions.
Watch this COLONTOWN Resource Fair that brings together a helpful collection of support organizations that can help ease the burden.
Bottom line: You deserve options and the best care possible
Getting a second opinion is about making sure you have the best information, the right team, and a plan that fits you. Whether you stay the current course or take a new path, the confidence that comes from hearing another expert’s perspective is pretty powerful.
But your situation is unique. You may only need one second opinion or you may need a few. Another opinion could make sense at the beginning of your cancer journey or later on. Or, after reading this guide, you may decide a second opinion isn’t necessary for you. These are all valid decisions.
If you’re unsure where to begin, reach out to others who’ve walked this road. In COLONTOWN and other communities, patients support each other in navigating the questions, logistics, and emotions of seeking a second opinion.
Come join us in COLONTOWN
Interested in learning more about second opinions? Find practical information in our BILLING OFFICE group — and so much more in COLONTOWN.
Interested in joining? Fill out the registration form here.
