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Lung Cancer

  • What is Lung Cancer?

    anatomy of a human lung

    The lungs are an important part of the respiratory system, enabling us to breathe. Lung cancer is the uncontrolled growth of abnormal cells in one or both lungs, usually in the cells lining air passages. These abnormal cells do not develop into healthy lung tissue, but divide rapidly to form tumours which interfere with lung function.

    In Singapore, lung cancer is the 2nd most common cancer in men, and the 3rd most common cancer in women. The risk of developing lung cancer is 3 times higher in men as compared to women.

    There are 2 main types of lung cancer:

    Non-small cell lung cancer (NSCLC)

    Non-small cell lung cancer (NSCLC) accounts for the majority of all lung cancers and is less aggressive. Early detection with prompt treatment can offer a chance of cure. Treatment may involve a combination of treatment methods such as surgery, radiation therapy and chemotherapy.

    Small cell lung cancer (SCLC)

    Small cell lung cancer is an aggressive form of lung cancer which usually results in the rapid spread of cancer to other parts of the body through the bloodstream. SCLC is usually diagnosed at advanced stages, with treatment usually prescribed in the form of chemotherapy.

    What causes lung cancer?

    Studies have shown that people with certain risk factors are more likely to develop lung cancer. Tobacco smoke exposure, one of the main risk factors, contributes to over 80% of global lung cancer incidence. Tobacco smoke emitted from cigarettes, pipes or cigars contains harmful chemicals known as carcinogens – a class of compounds directly responsible for damaging cells and affecting the cell’s ability to function and to divide normally. Over time, the damaged cells may become cancerous. Even exposure to second-hand smoke can lead to cell damage that aids in cancer formation. The more exposure to tobacco smoke, the greater the risk of developing lung cancer.

    Other risk factors include exposure to radon (a radioactive gas), asbestos, arsenic, chromium, nickel, and air pollution. Some families have a higher risk of developing lung cancer.

  • Signs & Symptoms

    man having chest pain

    Lung cancer, especially at the early stages, often do not present any symptoms. As the condition worsens, certain symptoms may arise, including:

    • Prolonged, persistent cough
    • Wheezing or shortness of breath
    • Presence of blood when coughing
    • Hoarse voice
    • Chest pain
    • Loss in appetite
    • Difficulty in swallowing
    • Unexplained weight loss
    • Fatigue or weakness
    • Frequent lung infection such as pneumonia

    Lung cancer symptoms resemble those of many other conditions and these symptoms, when they occur, should not be taken lightly. If you experience any of the above symptoms, it is important to speak to your doctor for prompt diagnosis and early treatment.

    Screening

    Going for regular screening may help in the early detection and treatment of lung cancer. Several tests may be conducted to screen for lung cancer, such as chest x-ray, sputum (phlegm) testing, or computed tomography (CT) scans. Consult your doctor to understand more.

  • Diagnosis & Assessment

    chest x-ray

    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.
  • Treatment & Care

    doctor advising patient on treatment options

    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.