Although I have spent the past 2 decades of my medical career as a primary care physician, educator, and researcher in conditions that disproportionately affect people of Asian descent, including lung cancer, I was still unprepared to hear the words “You have stage IV non–small cell lung adenocarcinoma.” The diagnosis came just before by 50th birthday in June 2024.
I had been experiencing some mild coughing, which became more severe as time went on, and shortness of breath for several months. I ran through the gamut of potential causes, including asthma, even though I had no history of the condition; allergies; postnasal drip; and acid reflux. My primary care physician prescribed an inhaler, followed by a steroid, and an antibiotic, but my symptoms persisted. Still, there was no reason to suspect I could have a life-threatening disease like lung cancer. I’m not just a never smoker; I’ve never had a single puff of smoke of any kind.
Bryant Lin, MD, MEng
After ruling out other potential causes of my symptoms, including bronchitis and pneumonia, my physician recommended a chest x-ray, which showed a cloudy opaqueness on my left lung. The finding surprised me, and I hoped it signified nothing more serious than some kind of unusual infection that could be easily eradicated with treatment. It turns out that doctors are not such good judges of their own health, or maybe it was just wishful thinking.
A computed tomography scan found inflammation in the chest lymph nodes and fluid in my left lung. A bronchoscopy confirmed the presence of cancer in both lungs and surrounding lymph nodes. A magnetic resonance imaging scan, followed by a positron-emission tomography test, gave the full picture of the extent of the disease. Cancer was everywhere. I had 50 lesions in my brain alone. I have been in practice for 20 years and have never had patients with that many lesions. I also had metastases to my liver, bones, and parts of my skin. I had pain in my spine and ribs and was rapidly losing weight.
Cancer was taking over my life. Rather than identifying as a husband, father, physician, teacher, and researcher, I now thought of myself primarily as a patient with an incurable cancer.
Achieving Stable Disease
Because of my relatively young age and the fact that I am a nonsmoker, my oncologist recommended genomic testing of the cancer cells to look for any mutation that may be responsible for the development of my type of lung cancer. The test was positive for EGFR exon 19 deletion, which is prevalent in people of Asian heritage. I later learned that my uncle had early-stage, EGFR-mutated non–small cell lung cancer (NSCLC) that was successfully removed, so I did have an inherited risk factor for this cancer.
Testing positive for this gene mutation meant I was eligible for the targeted therapy osimertinib, which I received in combination with the chemotherapies carboplatin and pemetrexed. The treatment regimen has been successful in eliminating the brain lesions, and I no longer have evidence of intracranial metastatic disease, which is great. The primary tumors are shrinking, and cancer progression has slowed. I remain on osimertinib and pemetrexed, which is keeping the cancer stable, and I’m currently in the progression-free survival category. I believe the median time to disease progression for late-stage lung cancer is about 25 months, and I’m hoping to exceed that time frame, but you never know.
Staying Positive
A friend of mine from medical school recently commented that I just have to live long enough for the next breakthrough in treatment. Hopefully, there will be a new drug or clinical trial for me when the cancer starts to progress, but I know the odds are not in my favor. The 5-year survival rates for stage IV NSCLC are dismal, hovering around just 9%.1 Anecdotally, survivors of many types of late-stage cancers are living longer, as more of these cancers are converted into chronic diseases, and I’m staying positive that I will be among that group.
Living the Life I Love
What makes me sad about having cancer is that I probably won’t experience the joy of growing old with my wife, Christine Chan, or seeing my teenage sons, Atticus, 13, and Dominic, 17, grow into adulthood with families of their own. But I remain optimistic and value every day.
When I was first diagnosed, I wondered how I should spend my time and decided to continue living the life I love for as long as I can.
I’m fortunate that except for some nausea and mucositis following my chemotherapy treatments, I feel well most of the time and have maintained a high-quality life. I have decided to continue my work teaching and researching at Stanford University and have maintained my clinical practice.
Although I have always prided myself on attempting to holistically take care of the whole patient and not just the disease, now I truly understand what patients experience when they are diagnosed with a serious disease like cancer. I am walking in their shoes and have learned the important role of hope in these circumstances—hope that progress in incurable cancers continues at lightning speed, hope that a survival statistic may not apply to you personally, and hope that you can grow old with your spouse and see your kids grow into adulthood.
Understanding the Patient’s Perspective
This past fall, I decided to share my diagnosis with my medical students and developed a unique course—MED 275: From Diagnosis to Dialogue: A Doctor’s Real-Time Battle With Cancer—and the experience was amazing (www.youtube.com/watch?v=d5UP8tRy57k). Part of my goal for the course was to give medical students a better sense of the patient’s perspective of what it’s like to be diagnosed with a serious illness. Based on the feedback I received, many of the students commented on how impactful the class was and how they would carry the lessons of the class with them in the future. About one-third even said they would go into a field related to cancer care, which was very satisfying.
Living in the Moment
Despite my continued full academic and clinical schedule, I’m living more in the moment than I did before my cancer diagnosis. I’ve always been an optimistic, positive, and happy person; that’s my baseline, and it’s how I continue to live my life. It’s not helpful to marinate in the fact that I have stage IV lung cancer; so early on, I decided to make lemonade out of lemons or, as one colleague said, fertilizer out of crap.
I’m grateful to all the basic and clinical researchers who have made advancements in treatments for this cancer possible and that are keeping me alive. My goal is to live long enough to benefit from the next treatment breakthrough—and the next.
I said to my class that I consider myself the luckiest man in the world, and I meant it. I’m lucky to have two sons who bring joy and laughter into my life; a close Stanford community of colleagues, students, and residents; patients I admire; and the love of my wife, parents, and friends.
I may have had a tough break, but I have a lot to live for. I’m a big believer in being open to what life brings your way. I’m choosing to use this time to tell my story in the hope that other patients find comfort; that researchers continue to discover more effective therapies for late-stage cancers; and that it raises awareness of the need to increase screening for early-stage lung cancer, especially in vulnerable populations.
I truly appreciate having this opportunity.
REFERENCE
1. American Cancer Society: Lung cancer survival rates. Available at www.cancer.org/cancer/types/lung-cancer/detection-diagnosis-staging/survival-rates.html. Accessed April 30, 2025.
Dr. Lin, 50, is Clinical Professor in Primary Care and Population Health at Stanford Medicine; co-founder of Stanford’s Center for Asian Health Research and Education; and Director of Medical Humanities and Arts at Stanford. He lives in Menlo Park, California, with his wife, Christine Chan, and sons, Atticus and Dominic.
Editor’s Note: Columns in the Patient’s Corner are based solely on information The ASCO Post received from patients and should be considered anecdotal.
