The Professor (2018) and Stage IV Lung Cancer

Richard Brown teaches literature at a comfortable New England college. At a routine appointment he is told he has stage IV lung cancer: roughly eighteen months if he begins treatment immediately, about six if he does not. He declines treatment and tells nobody. That same evening his wife Veronica admits an affair with the dean, his superior; soon after, his daughter Olivia comes out to him. Instead of falling apart, Richard begins dismantling the life he has been performing. He empties his seminar of students who are not genuinely interested, drinks and smokes openly, sleeps with a student, and teaches with a recklessness colleagues read as breakdown. He confides in his best friend Peter, then in Olivia, and finally announces the diagnosis at a faculty dinner in front of the dean. The film never shows him in a hospital bed. It closes with Richard driving away with his dog, leaving the road for an open field, his fate deliberately unresolved.

Spoilers throughout. Discussing the cancer storyline means discussing how this ends.

The film is honest about one specific thing: the disorienting ordinariness of the moment of diagnosis. Richard is told, walks out, and the world carries on exactly as before. It captures how a terminal diagnosis is often experienced first as social isolation rather than physical suffering — the impulse to protect other people by not telling them, the awkward etiquette of when and how to say it, the fear of being converted into a patient by everyone who knows. His choice to refuse treatment because the extra months on offer are not months he wants is a real and legitimate decision that oncologists encounter regularly, and the film pointedly does not moralise about it. The scene where he finally tells his daughter, and she is angrier about being kept out than about the illness itself, rings true to how families actually receive this news.

Richard stays articulate, mobile and physically unmarked for the entire film. Untreated stage IV lung cancer does not usually permit that: breathlessness, pain, weight loss and profound fatigue typically arrive well within six months. There is no oncology follow-up, no palliative care team and no symptom management on screen — an omission that matters, because palliative care is standard alongside or instead of anti-cancer treatment. The film also never addresses how a professor in his fifties reached stage IV without noticed symptoms, and never mentions smoking history or the low-dose CT screening that might have found it earlier in an eligible person.

Lung cancer often causes no symptoms at all in its early stages, which is a major reason so many cases are found late. When symptoms do appear, NCI lists a cough that does not go away or worsens, chest pain or discomfort, trouble breathing, wheezing, blood in sputum, hoarseness, trouble swallowing, loss of appetite, unexplained weight loss, fatigue, and swelling of the face or of veins in the neck. Any of these persisting more than a few weeks warrants a doctor's assessment, particularly in a current or former smoker.

Screening does exist, but only for people at high risk. The USPSTF gives a grade B recommendation for annual low-dose CT (LDCT) in adults aged 50 to 80 who have at least a 20 pack-year smoking history and who currently smoke or quit within the past 15 years. Screening stops after 15 smoke-free years, or if other health problems would rule out curative lung surgery. There is no recommended lung cancer screening for people who have never smoked or who fall outside those criteria; for them, reporting symptoms promptly is the route to earlier diagnosis. Not smoking, and stopping if you do, remains the single largest risk reduction.

A film is not a diagnosis, and a dramatised illness is not a guide to your own. What a story like this is genuinely good for is lowering the barrier to a conversation you might otherwise put off.

If something in your body has changed and stayed changed for a few weeks, that is worth raising with a doctor — not because it is likely to be cancer, but because most of the time it will not be, and finding that out is the point. Where screening exists for a cancer, it is the one thing you can do before anything is wrong at all. See screening and possible warning signs.

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The Professor is worth watching as a film. It is not a guide to the disease it portrays. The gap between the two is what this page is for — and the thing worth carrying away is that a change which persists is worth a conversation, whatever a story led you to expect.

This page describes a work of film or television for education. It is not medical advice, and nothing here is a judgement of anyone's real medical care. Spotted an error? Please email [email protected].