Expert Videos

Module 1: Understanding Non-Small Cell Lung Cancer

What is non-small cell lung cancer (NSCLC)?
Non-small cell lung cancer (NSCLC) is the most common type of lung cancer, accounting for about 80% of lung cancers diagnosed every year. NSCLC has several sub categories. The most common sub category is called “adenocarcinoma” which makes up about half of all patients. Another category is called “squamous cell carcinoma” which makes up about a quarter of all patients. There are also other rarer subtypes such as “large cell carcinoma” and other neuroendocrine type of cancers.
Watch now
What are the risk factors for non-small cell lung cancer (NSCLC)?
The most common risk factor for non-small cell lung cancer is cigarette smoking (former and current smokers). Other risk factors include second-hand smoke, and prior exposure to asbestos, radon, and radiation. There are also individuals for whom there is no clear identified risk factor - these can be individuals who are “never smokers” and who have not had exposure to any of the traditional factors that can lead to an increased risk of lung cancer.
Watch now
What are the symptoms of non-small cell lung cancer (NSCLC)?
There are no specific symptoms for lung cancer. Lung cancer starts in the chest and can be masked by other diseases that begin in the chest, like pneumonia, or bronchitis. Patients often come to the attention of their doctors because they have pulmonary symptoms such as coughing, or wheezing, or shortness of breath and the doctor might order further tests to look for the presence of lung cancer.
Watch now
What are my options for treatment and management of non-small cell lung cancer (NSCLC)?
The treatment options for non-small cell lung cancer (NSCLC) depend on the stage or extent of the cancer, and may include surgery, radiation therapy, chemotherapy, targeted therapy, and immunotherapy. The earlier the stage of the cancer, the more likely it can be operated on and removed. If the cancer has entered the lymph nodes it can still potentially be operated on, but sometimes requires additional treatments like chemotherapy and/or radiation therapy. If the cancer has spread outside the lungs into other organs of the body, it is typically no longer something that is operated on but treated with either chemotherapy, or targeted therapy, or immune therapy.
Watch now

Module 2: Understanding Small Cell Lung Cancer

What is small cell lung cancer (SCLC)?
Small cell lung cancer (SCLC) accounts for about 15-20% of lung cancers diagnosed every year in the United States. It is rarer than non-small cell lung cancer. The term “small cell” refers to the size and shape of the cancer cells as seen under a microscope. Small cell lung cancer appears as small blue cells, instead of the larger cells associated with more common forms of lung cancer. Small cell lung cancer typically starts in the middle part of the chest in a unique set of cells different to non-small cell lung cancer. Small cell lung cancer is treated differently to non-small cell lung cancer.
Watch now
What are the risk factors for small cell lung cancer (SCLC)?
Being a smoker or smoking in the past may raise a person’s risk of developing small cell lung cancer. Small cell lung cancer is almost exclusive to patients who are current or former smokers. It's very rare for someone who has never smoked to have small cell lung cancer, unlike non-small cell lung cancer which can occur in 15-20% of never smokers.
Watch now
What are the symptoms of small cell lung cancer (SCLC)?
Small cell lung cancer typically starts in the middle part of the chest and is often associated with breathing difficulties. Sometimes coughing occurs, or coughing up blood. Sometimes the tumor presses on one of the large veins that drain blood from the arms or head, resulting in swelling in the arms or sometimes swelling around the neck or the head.
Watch now
What are my options for treatment and management of small cell lung cancer (SCLC)?
Treatment options for small cell lung cancer depend on the stage or extent of the cancer, and may include a combination of chemotherapy and radiation therapy. Surgery is rarely used for patients with small cell lung cancer. If the small cell lung cancer occurs only in the chest, it’s called “limited stage” and treated with chemotherapy and radiation at the same time. If the cancer has spread outside the chest to other parts of the body it’s called “extensive stage”, and treated with chemotherapy. After chemotherapy, additional radiation therapy to the head may be given to lessen the risk that the cancer will spread to the brain.
Watch now

Module 3: Diagnosis and Staging of Lung Cancer

How is non-small cell lung cancer (NSCLC) diagnosed?
Diagnosis of non-small cell lung cancer is “tissue based”. This means that typically if a patient has been given a CAT Scan or X-Ray which identifies an abnormality in the lungs, the next step is to do a biopsy which can done in a variety of ways. It can be done by the radiologist at the time of the CAT scan (or CT scan). A piece of the tissue is looked at by a pathologist under the microscope. Another way is using a “bronchoscopy” which involves a tube being placed through the nose or into the mouth and into the airway. The pulmonologist can use this tool to see the cancer and then take a sample of the tissue for biopsy. In some cases, surgeons can be involved in the diagnosis of small cell lung cancer. In these cases its usually when the cancer is located in places like the lymph nodes which are difficult for the pulmonologist or radiologist to reach.
Watch now
How is small cell lung cancer (SCLC) diagnosed?
Small cell lung cancer is typically diagnosed by a pulmonologist. The reason is that the cancer is usually centrally located and easily accessed by the pulmonologist using a bronchoscope. A pulmonologist will use a bronchoscope, which is essentially a tube with a light and a camera on the end of it to try to see the cancer. The bronchoscope can be passed through the nose or mouth and be guided into the lung to try to see the cancer and then biopsy it (take a sample of the tissue). Sometimes this is not feasible and then an interventional radiologist needs to be involved in the diagnosis.
Watch now
What is screening for lung cancer?
Screening for lung cancer means looking for lung cancer using a screening technique in individuals that do not currently have lung cancer, but who may be at risk for lung cancer. In the US, screening is approved for patients older than 55 years of age and also have smoked greater than 30 pack years of cigarettes in their lifetime. “Pack years” is defined by the number of packs smoked X(multiplied by) the number of years smoked. For this group, screening is associated with better outcomes. Other individuals might benefit from screening however this is an area still being studied. The technique used for screening involves the use of CAT scans (with Low Dose radiation). These have a much lower amount of radiation exposure than a typical diagnostic CAT scan (or CT scan).
Watch now
What is staging for lung cancer and how is it determined?
The treatment of any type of lung cancer depends on the stage of the cancer. The stage is based on how far the cancer has spread - whether the lung cancer is local or has spread outside the lungs to the lymph nodes or to other parts of the body. For non-small cell lung cancer, doctors want to determine the size of the primary cancer and whether it has spread to the lymph nodes or spread to the middle part of the chest, or spread outside those areas. Doctors use different diagnostic tests to determine the cancer’s stage. These tests include CT scans, magnetic resonance imaging (MRI), and positron emission tomography (PET) scans. If undergoing surgery, a procedure called a “mediastinoscopy” can provide additional information on the stage of the lung cancer. Knowing the lung cancer stage helps the doctor to decide what kind of treatment is best and can help predict a patient’s prognosis (outlook).
Watch now
What is stage I, II, III or IV lung cancer?
The stage of a cancer describes the extent of the cancer. It is based on the size and location of the tumor, and whether it has spread to the lymph nodes or other parts of the body. A stage 1 lung cancer is located only in the lungs and has not spread to any of the lymph nodes. A stage 2 lung cancer is a bit more advanced, where the cancer has spread to the localized lymph nodes. A stage 3 cancer is one where the lymph nodes in the middle part of the chest are also involved (the area called the mediastinum). A stage 4 lung cancer is one that has spread outside the chest, either to the other lung, or to other parts of the body, such as the bone or brain or liver or adrenal glands.
Watch now
If someone with lung cancer has very poor lung function, what should they be aware of?
It’s most important that patients discuss their lung function with their doctor. They need to consider what their lung function is both before surgery and what it might be like after surgery. The decision about surgery can be very much a personal decision. In certain patients, if their lung function is excellent then the standard of care might be surgery and they can discuss this with their physician.
Watch now
What does it mean if a patient has “metastatic lung cancer”?
The words “metastatic lung cancer” can mean a lot of different things and it is an important topic to discuss with your doctor as it may relate to your situation. In the past patients with “metastatic lung cancer” were considered untreatable when it came to surgery. Today we have a more hopeful situation. For example, there is a new term that sounds very complex and it is called “Oligometastatic lung cancer”. In these patients surgery can be an option to consider.
Watch now
What is “multi-focal lung cancer”?
Some patients might have what is called “multi-focal lung cancer”. They might have a genetic mutation, for example an EGFR mutation, and they might have 2 different types of lung cancers growing in their body. Decisions about surgery in these patients can be complex.
Watch now
What is “bronchoscopic ablation”?
Bronchoscopic ablation is when you navigate a camera through the airway and then pass a catheter through the center of the instrument to the part of the lung where a tumor might be. The instrument has the ability to apply an energy source to the center of a tumor. The energy source can be freeze therapy or microwave therapy or other types of therapy. This is somewhat still an experimental procedure and being tested in a number of settings.
Watch now
What kind of healthcare team is a lung cancer patient likely to see?
It’s important to think about a team approach if you have lung cancer. It’s important to realize that your family and friends are part of that team approach, as well as your healthcare professionals. In terms of your healthcare team, it’s important to have what’s called a "multidisciplinary" approach where different doctors and healthcare members bring different types of expertise to help you fight your lung cancer.
Watch now
What does pulmonary lung function mean and how is it tested?
Pulmonary lung function testing is one of the essential ways that doctors use to decide if you are a candidate for lung cancer surgery. It’s a breathing test and someone on your healthcare team will coach you on how to do this test. Sometimes patients get nervous about this test. It’s important to do it well and to the best of your ability. Some doctors even suggest a second time for the testing to make very sure that it is as accurate as possible.
Watch now
What is a lung biopsy?
Take a small needle and pass it through the CAT scan to watch the needle going in towards the center of the nodule. Once there the healthcare member can take a sample. Sometimes they apply suction to the needle or sometimes they will pass what’s called a “needle core”. The different types of biopsies can help your doctor test for genetic mutations in the tumor and help to guide the type of therapy or treatment. For example, it can show that a patient has small cell lung cancer, which is very rarely treated with surgery. You should discuss the different biopsy techniques with your doctor.
Watch now

Module 4: Treatment and Management of Lung Cancer

What kind of surgery is used for Non-Small Cell Lung Cancer (NSCLC)?
Surgery for non-small cell lung cancer is quite varied. There is no “one size fits all” because it depends on multiple factors. First of all, it depends on the location of the cancer. Secondly, it depends on the extent of the cancer, for example, to what extent does it involve the lymph nodes and the middle of the chest. Thirdly, it depends on the “cardiopulmonary reserve” of the patient. That includes factors like the amount of normal lung that can be spared from the surgery to ensure that the patient has sufficient lung function after the surgery is completed. The different types of surgery explained in this video are wedge resection, lobectomy, and pneumonectomy.
Watch now
What factors determine the extent of lung cancer surgery?
The extent of lung cancer surgery depends on multiple factors. First, it depends on the location of the cancer and if it can be removed with a simpler kind of surgery or if it requires a more complicated surgery. Second, it depends on the amount of normal lung that the patient would lose as part of the surgery and their existing lung function. If their lung function is already weak, then it’s possible that the amount of surgery a patient can tolerate will be much less and that will impact the choice of surgical procedure as well. Lung cancer patients may be seen by a lung specialist called a pulmonologist, who can evaluate what their lung capacity is by conducting some tests. Surgery can range from limited surgery called wedge resections (also called a segmentectomy), to bigger surgeries, where a lobe of the lung is removed (called a lobectomy) and in some cases an entire lung needs to be removed (called a pneumonectomy).
Watch now
Is surgery an option for small cell lung cancer?
Surgery is typically not used in patients who have been diagnosed with small cell lung cancer. The reason is that small cell lung cancer tends to spread much quicker into the blood stream than non-small cell lung cancer. Small cell lung cancer is more often a systemic disease and as such the primary treatment is usually chemotherapy and/or radiation therapy. There may be situations where surgery was used to remove a large mass in someone who was not yet diagnosed with lung cancer, however it’s rare.
Watch now
What is chemotherapy? When is it needed?
Chemotherapy is a type of treatment for lung cancer that tries to eradicate the cancer cells. There are different types of chemotherapy drugs. They work by affecting the general process in which cells divide (or make copies of themselves during the normal cell growth cycle). Cancer cells tend to grow much faster than normal cells in the body, and this makes them more sensitive to chemotherapy than the other cells in the body. Chemotherapy is used for lung cancer in patients with advanced lung cancer (in cases which cannot be treated by surgery). It is also sometimes used after surgery in cases where there are risk factors of the cancer that increase the likelihood of it coming back again (“adjuvant” setting). Finally, chemotherapy can be used with someone who has locally advanced lung cancer and is given together with radiation to enhance the effect of the radiation. This can be done prior to another round of surgery.
Watch now
What is radiation therapy? When is it needed?
Radiation therapy, unlike chemotherapy, is a focused type of treatment that is used in localized cancers. A radiation beam is directed at a specific area of the lung for example. It’s used as a local therapy when a surgeon cannot remove the cancer in the chest. It is also used in cases where there are no other treatment options, for example if the lung cancer has spread to the brain then chemotherapy has difficulty passing the blood-brain barrier, so radiation therapy will be used. Radiation therapy is also used if the lung cancer has spread to the bone.
Watch now
What is targeted therapy? When is it needed?
Targeted therapy is a cancer treatment that uses drugs to target specific features (genes or proteins) of an individual’s cancer. Cancer patients need to have their tumors tested to see if they are candidates for a particular type of “targeted” therapy.
Watch now
What is immune therapy? When is it needed?
Immune therapy is very different to chemotherapy and targeted therapy. Instead of targeting the cancer cell, immune therapy boosts the naturally present immune system in your body to fight the cancer. It’s rapidly becoming our “3rd” treatment approach for lung cancer patients and offers a lot of hope for the future.
Watch now
What is genomic testing? And why is it needed?
Genomic testing for lung cancer is used to understand the unique characteristics (genomic alterations) of the individual patient’s cancer. Doctors look for genomic alterations that impact the growth and development of the person’s cancer, which helps to determine the best treatment options for the individual. The tests can take days or a few weeks to complete.
Watch now
What is a clinical trial?
Clinical trials are research studies that evaluate new ways to improve treatments and quality of life for people with diseases, like lung cancer. Clinical trials take place in various phases, each designed to answer important research questions that lead to the next phase. The earliest phase of a clinical trial is called a Phase 1 trial where the treatment is usually being tested in humans for the first time. Other phases of clinical trials are called Phase 2, Phase 3 and Phase 4.
Watch now
Is a “Placebo” always used in a controlled clinical trial?
Not all clinical trials are “Placebo-Controlled Trials”. Most of the time placebo controlled trials are quite rare, because in lung cancer trials the patients almost always get the best standard of care available. It’s very rare that a cancer clinical trial patient would get “no active therapy” as a placebo. Patients need to discuss the details of each clinical trial very carefully with their healthcare provider to make sure they understand the potential benefits and risks involved.
Watch now
When would a patient with lung cancer consider “Palliative Care”?
Understanding what “Palliative care” means is very important for lung cancer patients. Palliative care are those options available to lung cancer patients that help them get the best quality of life possible. Every person is unique and needs to consider their treatment options carefully. The goal of palliative care is to minimize suffering in a very respectful and meaningful way.
Watch now
What should a patient think when their doctor says: “We do not want to do surgery”?
A lot of patients ask their doctors: “Am I a candidate for surgery”?. The answer to this question is complex and may differ depending on the center of care or the healthcare team that is involved. It is important for patients to get a second opinion or even more opinions to reassure them about the first opinion they received on surgery. There are always a lot more options out there and many patients can benefit from a more extensive search for answers.
Watch now
What is a “lobectomy”?
A lobectomy is performed when surgery is used to take out a part of the lung. A “lobe” is a functional unit of the lung. The lungs typically have 3 lobes in the right lung and 2 lobes in the left lung. Each lobe is also divided into smaller parts called "lung segments". A lobectomy is a type of surgery that is done to remove a specific lobe from one of the lungs. It may be part of a minimally invasive surgery or it may be part of a more extensive type of surgery.
Watch now
What is a lung ablation?
A lung ablation is when a surgeon uses a special technique to apply an energy source to kill the tumor. Different types of energy sources can be used (cryotherapy, or microwave ablation, or radiofrequency ablation) and the amount of energy applied to the tumor is carefully calculated using different software programs. It’s still considered somewhat experimental however it can help certain patients to spare as much lung tissue as possible.
Watch now
Can you have lung ablation after radiation therapy?
Whether you can have lung ablation after radiation therapy is a difficult question to answer and may require a detailed discussion with your physician.
Watch now
What is “percutaneous ablation”?
Percutaneous ablation of the lung is a procedure where the doctor takes a needle and passes it through the chest wall and puts it in the center of the tumor. Doctors will use imaging techniques (such as a CAT scan) to guide the needle to the center of the tumor. Once there, they will apply the energy source (cryotherapy, or microwave ablation, or radiofrequency ablation) to kill the tumor.
Watch now
What is a “wedge surgery”?
A wedge surgery or wedge resection of the lung is the least amount of lung that a doctor will remove when performing surgery for a cancer or a tumor nodule or a benign nodule.
Watch now
What are “lung sparing techniques”?
Lung sparing techniques are very important and are becoming more widespread for lung cancer surgery. Lung sparing techniques include a segmentectomy, a bisegmentectomy, and a trisegmentectomy. Instead of removing the entire lobe of a lung, the surgeon will remove just a segment of the lung.
Watch now
What is a segmentectomy?
A segmentectomy is a surgical procedure that removes the basic segment unit of the lung. It is a more difficult type of surgery to perform than a “wedge resection”. The goal is to balance the best possible surgery for the patient with maximizing the lung function after the surgery.
Watch now
What is an EGFR mutation for lung cancer?
An EGFR mutation means an “epidermal growth receptor factor” mutation. Some patients may have this mutation and it means that they might be a candidate for targeted therapy. Targeted therapy is a way to treat the individual cancer patient’s unique genetic identifiers.
Watch now

Module 6: Biomarker Testing and Targeted Therapy in NSCLC

What is 'comprehensive biomarker testing' and why is it important in lung cancer?
Robert Winn, MD, of the Virginia Commonwealth University Massey Cancer Center, explains what biomarkers are, how they were first discovered, and how they can predict cancer risk and help determine treatment. He describes the history of lung cancer treatment and how understanding biomarkers can help doctors prescribe the most effective lung cancer treatment.
Watch now
What is a driver mutation?
Dr. Robert Winn, an expert on cancer mutations, describes the ways variations in genes can affect the course of lung cancer. He describes how knowing about specific mutations can mean knowing which medicines to use in treatment. He also discusses the difference between inherited and acquired mutations and how mutations being active may lead to cancer.
Watch now
How is biomarker testing carried out?
Robert Winn, MD, of the Massey Cancer Center at Virginia Commonwealth University, discusses different ways to take samples for lung cancer biomarker testing, including VATS (video assisted thoracoscopy), bronchoscopy, and blood, urine, or saliva testing. He also discusses the number of different biomarkers a laboratory may look for in the biological samples and shares questions patients should ask before and after biomarker testing, including about insurance coverage, when to expect results, and when to call with questions.
Watch now
When should biomarker testing be done in NSCLC?
Cancer expert Dr. Robert Winn talks about the importance of discussing biomarker testing as soon as possible, even before getting a definitive diagnosis of non-small-cell lung cancer. Patients should also ask about removing additional tissue or repeating biomarker testing if samples are taken, in order to yield the most accurate results. Dr. Winn encourages patients to take advantage of precision medicine to receive lung cancer treatments tailored to their specific mutations.
Watch now
Which biomarkers exist for NSCLC?
Robert Winn, MD, of Virginia Commonwealth University discusses EGFR, KRAS, and ALK, three of the main biomarkers for non-small-cell lung cancers, and the importance of testing for these to deliver precision medicine. He also encourages patients to ask which additional biomarkers will be included in the test panel.
Watch now
What happens if my tumor tests positive for a biomarker? What happens if it doesn’t test positive?
Dr. Robert Winn, cancer expert from the Massey Cancer Center at Virginia Commonwealth University, discusses the benefits of knowing which biomarkers are present in non-small-cell lung cancer in order to choose a specific treatment. He also explains the promising options available to people whose tumors do not test positive for biomarkers, including immunotherapy and new chemotherapy drugs.
Watch now
What if I have already had a biopsy and my tumor was not tested for biomarkers?
Robert Winn, MD, of Virginia Commonwealth University, explains that even without biomarker testing for non-small-cell lung cancer (NSCLC), the standard of care can provide effective treatment. However, he advocates for talking with your doctor about biomarker testing before any biopsies or procedures are done to diagnose NSCLC.
Watch now
What should newly diagnosed lung cancer patients do if biomarker testing is not offered to them?
Cancer expert Dr. Robert Winn explains the vital importance of patients with suspected non-small-cell lung cancer asking about biomarker testing if it is not offered. Patients have the right to seek a second opinion about their NSCLC diagnosis and request biomarker testing.
Watch now
Why is biomarker testing so important for certain ethnic groups, such as African Americans?
Director of the Virginia Commonwealth University's Massey Cancer Center Dr. Robert Winn explains that biomarker testing is important for all people, but lung cancer is the #1 leading cause of cancer death for African Americans in the United States. African Americans may have EGFR, KRAS, and other biomarkers for non-small-cell lung cancer, but biomarker testing may also identify mutations that lead to lifesaving treatment through precision medicine.
Watch now
How can we close the gaps to make sure all NSCLC patients get tested?
Robert Winn, MD, director of the Massey Cancer Center at Virginia Commonwealth University, discusses the disparity in care for metastatic non-small-cell lung cancer between Black and White Americans and describes various ways to close this and other gaps, including through clinical trial participation, routine biomarker testing, patient education and involvement, and knowledge of the potential of precision medicine for lung cancer treatment.
Watch now
What is targeted therapy for lung cancer?
Cancer expert Dr. Robert Winn explains that targeted therapy for lung cancer is based on identifying specific mutations in non-small-cell lung cancer that indicate what drug the patient will best respond to. Biomarker testing provides the targets for specific, precision medicine therapies that are more likely than older, non-precision treatments to help patients survive and thrive.
Watch now
What targeted therapies are used for people with the EGFR mutation?
Erlotinib, gefitinib, and afatinib are commonly used to treat EGFR mutations in non-small-cell lung cancer, according to Robert Winn, MD, director of the Massey Cancer Center at Virginia Commonwealth University. He also discusses second-line drugs, what happens if patients do not respond to targeted therapies, and how biomarker testing for EGFR and other driver mutations can lead to use of additional targeted therapies for lung cancer.
Watch now
What targeted therapies are used for people with the ALK mutation?
Robert Winn, MD, director of Virginia Commonwealth University's Massey Cancer Center, identifies crizotinib and alectinib as first-line targeted therapies for people with the ALK mutation, as well as second-line therapies ceritinib and brigatinib are additional targeted therapies if the earlier treatments do not work well.
Watch now
What targeted therapies are used for people with the ROS1 mutation?
Dr. Robert Winn, cancer expert, describes the potential of crizotinib as a targeted therapy for people with ROS1 mutations in non-small-cell lung cancer, and how the health care team can help reduce and relieve side effects of this and other targeted therapies.
Watch now
What is the importance of combination therapies for BRAF?
Dr. Robert Winn, an expert on cancer mutations, explains the importance of combination therapies for BRAF mutations in non-small-cell lung cancer. BRAF mutations are targeted with combination, or two-drug, therapy. He explains how using more than one drug can be more effective at treating non-small-cell lung cancer and how this approach applies to other mutations as well.
Watch now
What is the future of combination therapy for lung cancer?
Robert Winn, MD, describes using molecular targeted therapy plus immunotherapy to treat lung cancer. Dr. Winn also discusses how cancers may adapt to treatment by a single medicine, but combination therapy can be more effective.
Watch now
Can biomarker testing help identify clinical trial opportunities for me?
Biomarker testing can allow patients to be matched with specific clinical trials through the US National Institutes of Health, says Dr. Robert Winn, an expert on cancer treatment from Virginia Commonwealth University. These precision medicine treatments are not yet widely available, but biomarker testing can help patients identify the trials that may be most helpful for their specific non-small-cell lung cancer.
Watch now
How can communities of color increase their participation in clinical trials?
Dr. Robert Winn, director of Virginia Commonwealth University's Massey Cancer Center, discusses the importance of a team approach to removing barriers to clinical trial participation, especially for communities of color. Dr. Winn describes reframing the concept of clinical trials as community-based opportunities for access to care, rather than an "experiment" that exploits people of color.
Watch now