Questions to ask if you have been diagnosed with lung cancer

If you’ve been diagnosed with lung cancer, it’s important to know where to go first and what questions to ask your care team.

Over the past two decades, significant advances have been made in the understanding and treatment of lung cancer, from better screening procedures to vital new treatments, and MSK has helped pave the way for many advances.

But lung cancer remains a very serious diagnosis, causing more deaths than breast, colorectal and prostate cancer combined, according to the American Cancer Society.

Thoracic oncologist Mark Awad, MD, has successfully treated many people with lung cancer and compassionately guides them and their loved ones through the next steps after diagnosis.

He is Chief of Thoracic Oncology at Memorial Sloan Kettering Cancer Center (MSK) and a leading investigator of some of the newest and most promising lung cancer treatments, including cellular and immunotherapies.

Dr. Awad suggests asking your care team these questions to help you get started.

What type of lung cancer do I have?

This distinction is based on how the cancer looks under the microscope to a pathologist, who is a doctor who specializes in diagnosing diseases.

Non-small cell lung cancer can be further divided into more specific subtypes, including:

It’s important to understand the type of lung cancer, says Dr. Awad, “because the way we treat small cell lung cancer is different than adenocarcinoma, which in turn is different from squamous cell carcinoma.”

What is the stage of the lung cancer and have I had all the right scans to accurately determine the stage of the cancer?

“The stage tells us where the cancer is in the body,” says Dr. Awad.

For non-small-cell lung cancer, which is the most common type, “we assign a number — stage 1, 2, 3 or 4,” says Dr. Awad, where 4 means the cancer has spread (metastasized) to other parts of the body.

Dr. Awad explains that determining the stage of cancer usually requires a comprehensive scan:

“To determine the stage, we need a complete assessment of where the cancer is in the body,” says Dr. Awad.

What genomic or biomarker testing do you offer for lung cancer?

Genomic testing, also known as biomarker testing or genetic testing, checks whether cancer cells have mutations in their genes. Some mutations can be targeted with therapies that can slow or stop cancer growth.

“We use as much information as possible about the patient and the tumor to personalize the treatment and tailor it as precisely as possible, because fortunately there are many different treatments,” says Dr. Awad. “Comprehensive genomic tests can help us determine which treatment to choose and in what order we should use different treatments to best suit the patient.”

“Sometimes I talk to patients who have been diagnosed somewhere else,” says Dr. Awad, “and the genomic testing they’ve done only includes three or four genes. This is not enough nowadays.”

Dr. Awad says there are FDA-approved treatments for certain gene mutations, including:

BEAUTY
EGFR
ALK
ROS1
BRAF
MET
RET
HER2
NTRK

“At MSK, we also have clinical trials investigating treatments for more mutations that are very promising,” says Dr. Awad. “The list of mutations that a comprehensive test should look for will continue to grow.”

He also encourages people to ask about another biomarker called PD-L1.

“Testing for this biomarker gives us a signal about how a person might respond to a form of immunotherapy called an immune checkpoint inhibitor,” says Dr. Awad. This treatment helps the patient’s immune system fight the cancer, and for some people it can be a powerful treatment for lung cancer.

Is your team focused exclusively on lung cancer?

“Lung cancer is complex and quite nuanced,” says Dr. Awad. “Receiving care from a dedicated group of thoracic oncologists who truly only treat lung cancer is critical to receiving first-class care.”

Experience is also important for lung cancer surgery. Dr. Awad suggests asking how many operations the surgeon has performed. Surgical teams, such as those at MSK, that have performed a high volume of procedures tend to have better outcomes. MSK lung cancer surgeons have also helped pioneer minimally invasive surgery and other advances.

“For a serious diagnosis like lung cancer, I think getting a second opinion can only be helpful, and we routinely do that at MSK in our thoracic oncology group.”

“Once a person contacts us,” says Dr. Awad, “we always consider ourselves part of their care team, even if they seek treatment elsewhere. They are always happy to come back to us, or we can coordinate care with other doctors.”

When should I start treatment and can I do it close to home?

“Obviously, it can be a difficult time for patients after they’ve been diagnosed with lung cancer and want to start treatment. But it is important that we collect as much information as possible, and not rush.”

The reality, says Dr. Awad, is that “it’s not unusual for us to have urgent treatment. It’s usually best to wait a few more days, or in some cases, a few more weeks, to get the test results to personalize the treatment plan for the individual patient.”

For people treated at MSK, Dr. Awad says much of their treatment can be done at a facility as close to their home as possible. “There are thoracic oncologists who treat lung cancer at all MSK locations in New Jersey, Westchester and Long Island, except Manhattan. It means people can be closer to home and the people they love, which can be a huge help.”

What is my prognosis or prognosis?

Dr. Awad notes that this question can be difficult to answer early in treatment because there are so many variables, including how each person responds to treatment individually.

He suggests framing the question as an ongoing conversation between the oncologist and the patient. He recommends asking:

What can I expect my life to look like next year or beyond?
What should I expect in terms of quality of life, side effects, and treatment schedule?

He also recommends being open with your oncology team about what is most important to you in terms of your priorities and wishes. “For example, do you have such an important event ahead of you as the birth of a grandchild or a wedding? We have great flexibility in treatment planning and extensive experience in symptom management to help people continue to do the things that are most important to them during their treatment.”

“At MSK, we have excellent support services,” he adds. “Whether it’s dealing with symptoms and side effects, nutrition, social work, financial issues and more. We are here to support your whole life, not just treat cancer.”