Lung Cancer

Your doctor may enquire on your medical history and perform a physical examination. Further diagnostic procedures and blood tests, such as a chest x-ray and computed tomography (CT) scan, may be required to determine the presence of lung cancer. Other tests to collect samples for laboratory testing include:

Sputum cytology: Samples of sputum (thick fluid coughed up from lungs) are collected and sent to the laboratory to check for presence of cancerous cells.

Thoracentesis: Pleural fluid (fluid from the chest area) is extracted using a long needle, and sent to the laboratory for testing.

Bronchoscopy: A bronchoscope is inserted through the nose or mouth to reach the lung for extraction of cell samples. The cell samples are then sent to the laboratory to check for the presence of cancerous cells.

Fine-needle aspiration: A thin needle is used to extract tissue or fluid from the lung or lymph node. Collected samples are then sent to the laboratory for testing.

Open biopsy: This procedure is prescribed when suspected cancerous tissue is situated in a location that is difficult to access. A small incision in the chest wall is performed for direct biopsy of the lung tumour or lymph nodes.

What are the stages of lung cancer?

Based on lung cancer type, your doctor will then perform clinical staging to determine whether the cancer is localised (contained) or has spread to other parts of the body. It is important to understand the difference in various stages of lung cancer.

a) Stages of non-small cell lung cancer (NSCLC)

For practical purposes, it can be helpful to look at NSCLC staging as follows:

• Occult (hidden) cancer: Cancer cells are detected in the sputum or within lung fluids. However, other tests have not found the source of the cancer, so its location cannot be confirmed.
• Early stage and surgically operable: The lung cancer is still confined to the lung or immediate vicinity, and is potentially curable with surgery.
• Early stage but not amenable to surgery: The lung cancer has spread to nearby areas such as the lymph nodes in the middle of the chest. Surgery may not be feasible but the cancer may still be curable through radiotherapy and chemotherapy.
• Advanced stage: Cancer has spread throughout the rest of the body and other parts of the lungs, or has spread to the pleural space around the lung.

b) Stages of small cell lung cancer (SCLC)

• Limited stage: Cancer cells are detected only in one lung and its surrounding tissue.
• Extensive stage: Cancer has spread to other parts of the body.

Depending on the stage and severity of the spread of lung cancer, your doctor will recommend personalised treatment for the control and management of symptoms. Treatment may be recommended in the form of the following, as a singular module or in combination.

Surgery

If a cancer is in stage 1 or 2 and has not spread to other parts of the body, complete cure is possible by surgically removing the tumour and the nearby lymph nodes. Several different types of surgery can be applied:

• Lobectomy: Removal of a section of the lung
• Pneumonectomy: Removal of the entire lung
• Wedge resection: Removal of part of a lobe

Radiation therapy

Radiation therapy, also known as radiotherapy, destroys or shrinks lung cancer tumours by focusing high-energy rays on the cancer cells. This damages the cellular molecules in cancer cells and results in cell death.

Chemotherapy

Chemotherapy utilises strong chemicals that interfere with the cell division process, leading to cell death. This treatment targets all rapidly dividing cells and not only cancer cells. The drugs travel throughout the entire body, killing both the original tumour cells as well as cancer cells that have spread throughout the body.

Targeted therapy

Targeted therapy uses drugs to specifically block the growth and spread of cancerous cells. This form of therapy is designed to only treat cancer cells while leaving other normal and healthy lung cells alone.