I’m an Oncologist. Here’s What I Tell Patients Newly Diagnosed With Lung Cancer

Written by Keri Wiginton
Medically Reviewed by Melinda Ratini, MS, DO on March 03, 2026

By Lary A. Robinson, MD, as told to Keri Wiginton

I've spent decades treating lung cancer. 

I'm a thoracic surgeon at Moffitt Cancer Center in Tampa, Florida. I run both a lung cancer early detection program and a lung nodule clinic. That means I see the full spectrum of this disease, from the first scary scan that shows a "spot on the lung" to advanced cancers that require complex treatment decisions.

I've operated on small tumors that were cured with surgery alone. I've also watched treatments evolve in ways that would've been hard to imagine 20 years ago. Today, lung cancer care looks very different than it once did.

When someone is newly diagnosed and sitting across from me, they're usually overwhelmed. They've searched online. They've heard stories from friends. They're bracing for the worst. I don't give them false reassurance, but I do try to shift their perspective.

Here's what I want newly diagnosed people with lung cancer to understand right away.

Before we make any treatment decisions, we have to be very clear about what you have and where it is. 

Since I run a lung nodule clinic, I see many people who are told they "probably have cancer." The truth is, most lung nodules are not cancerous. In fact, about half of people over 40 have them. Most turn out to be something harmless, such as old scarring, tiny lymph nodes, or small inflammatory changes.

If you've seen an experienced doctor and cancer has been confirmed, the next key step is staging. Staging means we determine exactly where the cancer is in your body.

We're asking:

  • Is it only in the lung?
  • Has it reached nearby lymph nodes in the center of the chest?
  • Has it spread outside the chest or into the lining around the lungs?

Where the cancer sits drives almost everything that follows. That includes whether surgery makes sense; whether radiation is part of the plan; whether you need chemotherapy, targeted therapy, immunotherapy, or some combination.

This is why it's important not to rush the process. 

Lung cancer care today is precise. Most tumors have been present for years before we find them. Taking a few weeks to complete scans and gather the full staging picture rarely changes the biology of the disease. But it can change the quality of the decisions we make.

If you have non-small-cell lung cancer, which most people do, your tumor should be tested for gene changes, often called biomarkers. This is one of the biggest changes in lung cancer care.

Some tumors carry specific mutations. If that mutation is present, there may be a pill or targeted drug designed specifically for it. If it isn't there, that drug won't work at all. This kind of testing guides the entire treatment plan, so it shouldn't be optional. 

I tell people with lung cancer to ask directly: "Have all my gene tests been sent? Are we waiting on results before we start?"

Waiting for those results can be one of the most anxious parts of this process. But starting treatment without that information can mean missing your best first option. The more we know about your tumor, the more tailored and often more effective your treatment can be.

I'm a big believer in second opinions. 

That doesn't mean your local oncologist isn't good. Many are excellent. But a comprehensive cancer center often offers access to multiple specialists, clinical trials, and experience with rare mutations that smaller centers may not see often. 

It's common for people to come to us for a second opinion and then go back home for treatment. The plan doesn't always change. Sometimes we say, "What your oncologist suggested is exactly what we'd do." But they leave with more confidence that they're not missing something. And that peace of mind matters.

Clinical trials, in particular, are worth asking about. Many of the biggest advances in lung cancer have come from trials. A good example is stage III disease: Adding immunotherapy after chemotherapy and radiation came out of a trial. What was experimental 10 years ago is now standard care.

So I tell people to ask their oncologist very directly: 

  • Are there clinical trials I qualify for? 
  • Would you support me getting a second opinion at a cancer center?

If you're nervous about bringing it up, you should know you're not insulting your doctor. It doesn't mean you don't trust them. You're doing what most people would do with any serious, complicated problem. You're letting another expert look at it.

Years ago, if the first treatment failed, there were very few options left. That's not the case anymore. This is no longer a one-shot decision. 

If a targeted drug stops working, we often test again to see what changed and whether another drug fits. If immunotherapy doesn't do what we hoped, there may be another combination to try. And clinical trials are often designed specifically for people whose first treatment stopped working. 

In most cases, the urgency people feel is emotional, not medical.

If you have early-stage lung cancer, especially a small tumor found on a scan, it's usually been growing slowly for years. Waiting a few weeks to schedule surgery doesn't typically change the outcome.

If you have advanced disease, we still need time to complete biomarker testing, get insurance approval, and build the right plan.

One of the most common questions I get is some form of this: "I just found out I have lung cancer, and I have a big trip planned in two weeks. Do I need to cancel it?"

In most cases, my answer is no. Go.

There are exceptions. If you're very sick – short of breath at rest, in a lot of pain, losing weight quickly, or hospitalized – we need to focus on stabilizing you. But many people with early-stage or even moderately advanced disease who are otherwise doing reasonably well can safely take a short trip.

If you're unsure, ask your doctor: "Given my stage and how I'm feeling, is it medically safe to wait a few weeks? Will that realistically change my outcome?"

If the honest answer is that waiting won't make a difference, and often it won't, then I'm firmly in the take-the-trip camp. What matters more than starting immediately is starting correctly.

Your overall health matters just as much as the drugs we give you. 

We call it performance status. In simple terms, that refers to how active and functional you are day to day. It predicts outcomes better than age. I've seen vigorous 80-year-olds do beautifully with treatment, and much younger patients respond poorly because they were already run down.

So don't underestimate the basics: exercise, nutrition, sleep, and quitting smoking. 

You don't need to train for a marathon. But if you feel well enough to walk, walk. Regular movement improves strength, mood, and immune function. We have good evidence that people who stay active during treatment often tolerate therapy better.

Nutrition is a big deal, too. If you're losing weight or barely eating, say so. Ask to see an oncology dietitian. "Just drink a supplement shake" isn't good enough advice. Your body needs protein and other nutrients from real food to heal and to respond to treatment.

Sleep isn't optional. Every cancer therapy depends on your immune system. And your immune system depends on rest. Protect your sleep like you would a medication schedule. Aim for seven to nine hours a night.

And if you're still smoking or vaping, stopping matters. Nicotine can interfere with how well some treatments work. There's emerging evidence that marijuana may also blunt immune-based therapies. These are hard conversations, but they're important.

These may sound like small things compared to chemotherapy or immunotherapy. But they're not. A healthy lifestyle is a part of the treatment.

When people hear "lung cancer," they often think of what this disease meant 20 or 30 years ago. That picture is out of date. 

Today, we tailor treatment based on tumor genetics. We use immunotherapy in ways that give some people with advanced disease long-term control. We have more choices when the first plan stops working, and clinical trials keep adding new tools.

At the same time, oncologists are trained to warn you about what can go wrong. You may hear every possible side effect and a lot of worst-case numbers. It's important to take in the information your doctor gives you. But remember that statistics describe groups, not you as an individual.

How you think about what might happen to you can make a difference. I've seen expectations affect how people handle treatment. So yes, ask the hard questions. Make sure you understand the plan and the realistic risks. But don't automatically put yourself in the worst-outcome group.

Someone is always in the group that does better than expected and responds well to therapy. There's no reason to assume that can't be you.

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