A lung cancer diagnosis can raise many questions about what comes next. In this video, lung cancer expert Dr. Thomas Marron reviews key information that patients and care partners need to understand after a diagnosis—starting with cancer staging and genetic testing that can help guide treatment decisions. Dr. Marron also discusses why patients should be actively involved in conversations about care, ask questions, and even consider a second opinion.
Dr. Thomas Marron is Director of the Early Phase Trials Unit and Associate Director for Translational Research at the Mount Sinai Tisch Cancer Center. Dr. Marron is also Professor of Medicine and Professor of Immunology and Immunotherapy at the Icahn School of Medicine at Mount Sinai. Learn more about Dr. Marron.
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Transcript
Katherine Banwell:
Dr. Marron, when someone is diagnosed with lung cancer, what key questions need to be answered about the diagnosis?
Dr. Thomas Marron:
So, the first question that we always need to answer ourselves as doctors and help our patients understand their own cancer is what stage of the cancer.
Most solid cancers like lung cancer, breast cancer, colon cancer, we use a staging system where we say things are stage I, II, III, or IV. And stage IV lung cancer really means that it has left the lung, where it started and went somewhere else in the body. Stage I lung cancer, on the other end of the spectrum, is a tumor that is very small. Typically, it’s less than 4 centimeters, which is an inch-and-a-half or so. And then Stage II and III cancers are somewhere in between being very small and having spread to far away parts in their body.
So, the first question that we always want to ask is what stage it is because that’s going to be super important in us deciding what are the best options treatment-wise? And then increasingly, we need to have some genetic information about the cancer. So, we send tests on the tissues that have been sampled. Usually, patients have undergone a biopsy that demonstrated that they have lung cancer. And also, oftentimes we can do tests on the blood that looks for small amounts of genetic DNA in the tumor that are floating around in the blood. We call this a liquid biopsy.
And that gives us an idea of what’s causing this cancer and if you have any specific genetic changes in the cancer that might suggest that we can use a medicine like an oral medicine that’s very targeted for that mutation. But the majority of the time, that’s not the case. The majority of the time we use that information really to help guide our decision making as far as what treatments we think are best for the patient in front of us.
Katherine Banwell:
Why is it essential that patients and care partners participate in conversations about their care plan?
Dr. Thomas Marron:
I think it’s always important that not only are the patients there, but also loved ones, family members, friends be part of the conversation because everyone brings a different understanding and expertise to the table. But also, this is a terrifying diagnosis that patients are dealing with. It’s terrifying for patients and also their family members. And what we realize is that often people don’t necessarily hear 100 percent of what it is that we’re saying.
You know, a lot of the times, my patients will record conversations. It’s always good to ask your doctor if that’s okay because some doctors don’t like being recorded. I’m totally fine with it. Or they might also conference in some of their family members that don’t live here in New York City. But the more ears the better is usually what I say because everybody is going to hear different parts of the conversation. And they’re also going to have their own interpretation. And they’re also going to ask different clarifying questions.
It’s good to have people advocating for you. It’s very important that patients and their loved ones advocate for themselves to get as much information as possible. The more people involved in the process, the better. I’d also say it’s always very important that people think about getting second or third opinions. A lot of my patients, they come to me and they just want to start treatment immediately. And that’s fine. Most of the time, what I recommend is what is recommended elsewhere as well.
But a lot of the times, family members will feel more confident with the decision-making, and patients will feel more confident with the decision-making if you’ve seen two or three lung specialists, and everyone is saying the same thing. And we as doctors, we don’t take it personally if you go out and seek some additional advice. I think it’s always good to have as many smart people in the room as possible. I think any doctor who’s threatened by a second opinion as a doctor, you probably shouldn’t be going to in the first place.