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3 Questions to Ask When Being Diagnosed with Lung Cancer

December 2017 Vol 3 No 6
Bruce Gershenhorn, DO
Medical Oncologist and Medical Director of the Lung Center, Midwestern Regional Medical Center, Cancer Treatment Centers of America (CTCA), Chicago, IL

Few things are more stressful than being told you have lung cancer. Lung cancer is the second most common cancer among Americans, and the first cause of cancer-related deaths in men and women. When hearing they have lung cancer, most people have a sense of urgency to treat the disease, but they often don’t know where to begin. To begin treatment in a timely manner, patients should first ask the following 3 questions after learning they have lung cancer:

  1. What type of lung cancer do I have?
  2. What is the stage of my cancer?
  3. Who do I need on my medical team?

1. What Type of Lung Cancer Do I Have?

First and foremost, you need to understand what type of lung cancer needs to be treated. The 2 main types of lung cancer are called “small-cell lung cancer” and “non–small-cell lung cancer” (or “NSCLC”).

Small-cell lung cancer is most often caused by tobacco smoking; it accounts for about 15% of all lung cancer diagnoses. This type of lung cancer typically forms in the airway passages of the respiratory tract and spreads to other parts of the body.

NSCLC is much more common and is usually slower growing than small-cell lung cancer. NSCLC has several subtypes, with the cancer usually starting anywhere from the area of mucus production to the lining of the lungs.

In addition to the types of lung cancer, there may be genetic mutations (changes) that are responsible for the cancer, which is different for each patient. Genomic testing allows doctors to determine what is driving the cancer at the molecular level. This information enables oncologists to develop a precise and individualized treatment plan that is appropriate for the specific patient.

In some instances, through genomic testing, we have learned that a patient’s specific lung cancer may respond better to treatments that before were used for another type of cancer, such as melanoma. This is personalized (or precision) medicine at its finest.

2. What Is the Stage of My Cancer?

When it comes to treating lung cancer, an early diagnosis is crucial. If caught at an early stage (stage I or II) through screening techniques, it provides an opportunity to treat the cancer with less toxic therapies, and the patient has a higher likelihood of surviving. However, most lung cancers (about 80%) are found in the later stages (stage III or IV), when treatment is more complicated.

Staging of lung cancer depends on whether the lymph nodes are involved, the size of the tumor, and whether the cancer has spread (metastasized) from the lungs to other parts of the body. Generally, advanced cancers at a later stage are larger in tumor size, are found in the surrounding lymph nodes, and/or have spread to other organs, such as the liver, bones, or brain.

3. Who Do I Need on My Medical Team?

Treating lung cancer is not a one-size-fits-all approach. Patients need a multidisciplinary team of experts who specialize in different areas to support them; this could include a medical oncologist, a radiation oncologist, a pulmonologist, and a thoracic surgeon. These experts should work together seamlessly, discussing the patient’s case regularly to ensure that the patient receives the best care and the most comprehensive treatment plan possible.

This team should also have an understanding about the patient’s sense of urgency, making a correct diagnosis the first priority. If a patient has any concerns, it never hurts to get a second opinion. Patients need to surround themselves with the team they are most comfortable with.

Reduce Anxiety of the Unknown

Sometimes, the anxiety of not understanding what is happening with the disease is even greater than the anxiety of knowing that you have cancer. Getting a fast and accurate diagnosis with a team that is dedicated to being responsive to the patient’s needs is essential for peace of mind. The answers to these 3 questions will help in the development of an individualized treatment plan, which will increase the patient’s quality and longevity of life.

Understand Your Treatment Options

  • Surgery & Chemotherapy. Once as much information about the diagnosis is determined, treatment options will be considered. Typically, for patients with early-stage lung cancer, surgery is one of the first options, and, in many cases, additional treatment is not needed. In more advanced stages of lung cancer, chemotherapy may be the best approach.
  • Supportive Care. Patients may benefit from supportive therapies, such as nutrition, naturopathic medicine, or mind–body medicine, to help address the potential side effects of the treatment or the cancer.
  • New Treatments. As mentioned earlier, genomic testing will pinpoint what is driving the cancer, which will indicate if additional types of treatments—such as immunotherapy or targeted therapies—are appropriate. More and more anticancer treatments are moving in this direction.
  • Immunotherapy. Immunotherapies harness the power of the body’s own immune system, teaching it how to identify, recognize, and kill cancer cells that are otherwise overlooked and are not treated. Using immunotherapies is like forcing the cancer cells to wave a white flag to the immune system. Right now, several immunotherapies are approved and are available for NSCLC, but not for small-cell lung cancer. My hope is that this will change in the near future.
  • Targeted Therapy. Targeted therapies work by matching drugs with specific genetic mutations that encourage cancer cells to grow, and those therapies block the cancer’s growth. These drugs stop cancer cells from dividing, or destroy cancer cells, without touching the healthy cells. Depending on the type and stage of cancer, some targeted therapies may be used alone, or in combination with chemotherapy or radiation therapy.

Key Points

  • Catching lung cancer early can improve chances of survival
  • Genomic testing helps oncologists tailor lung cancer treatment to individual patient needs
  • Treating lung cancer requires a team of experts that patients feel comfortable consulting
  • Lung cancer treatment depends on the stage and the type of lung cancer
American Lung Association
American Cancer Society
National Cancer Institute

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