What Happens When You’ve Been Newly Diagnosed With Lung Cancer

When you or someone you love is diagnosed with lung cancer, the news can be overwhelming. There are, however, things to know and questions to ask that can be helpful in planning the best treatment possible for each individual.

Dr. Patrick Forde, a thoracic oncologist at Johns Hopkins Medicine, recently sat down with SurvivorNet to talk about the first steps typically taken after a lung cancer diagnosis.

First, your medical team will stage the cancer with imaging, a CT scan usually and sometimes an MRI and MRI scan of the brain. Then they need to get a sample of the tumor biopsy on which they perform some routine tests, the most important of which is a  PD-L1 test, which helps direct the use of immunotherapy, but also more complicated testing looking for gene mutations in the tumor.

“There are two main types of lung cancer, non-small cell lung cancer, which is about 85% of lung cancers, and small cell lung cancer, which is about 15%,” Forde says. “Within that non-small cell category, there’s a subtype called non-squamous adenocarcinoma, and that’s the group of patients for whom genetic testing is very important on the tumor. Genetic testing is looking for mutations in the DNA, in the tumor, which are not present in your normal DNA.”

Dr. Forde says the important questions to ask when you receive a lung cancer diagnosis are:

-Ask about the histology or type of lung cancer

-Ask about the stage of the cancer

-If the cancer is metastatic or stage 4, ask about the genetic mutation results and also the PD-L1 testing

The PD-L1 test is a “simple test” that involves staining a sample of the tumor with a marker for PD-L1. The lab gives the tumor a  percent expression score ranging from from zero where none of the cells have PD-L1 expression and up to 100 percent where all of the cells have PD-L1 expression.

“The likelihood of the tumor responding to immunotherapy depends to a degree on the level of expression,” Dr. Forde says. A tumor with 90% expression PD-L1 on the surface is more likely to respond than one that has no expression.

Dr. Forde says that non-smokers should make sure genetic testing is performed before going directly on immunotherapy.