Lung Cancer is one of the leading causes of cancer deaths in Singapore. Lung cancer is the number 2 killer in males and 3rd in females in Singapore.
Men have a 3 times higher risk of lung cancer than women. Among the 3 major ethnic groups, the Chinese have the highest risk. Between 2010 and 2014,
there was an average of 1370 people in Singapore diagnosed with lung cancer yearly. Most persons diagnosed with lung cancer are older than 40 years of
age. Usually there is no symptoms in the early stage. When the disease is advanced, one may complain of:
- Chronic cough
- Changes in chronic cough or smoker’s cough
- Coughing up blood
- Shortness of breath
- Chest pain
- Wheezing
- Hoarseness
- Recurrent chest infection
- Enlarged lymph nodes
There are two types of lung cancer
- Small cell lung cancer: It occurs almost exclusively in heavy smokers and is less common than non-small cell lung cancer. It makes up 10-15% of the cases.
- Non-small cell lung cancer: This is an umbrella term for several types of lung cancers that behave in a similar way. This includes squamous cell carcinoma, adenocarcinoma and large cell carcinoma.
Cigarette smoking is the main cause of lung cancer. The risk of lung cancer developing in a smoker is 15-25 times more than a non-smoker.
The risk is greater with increasing number of years of smoking and with higher number of cigarettes smoked per day. Pipe, cigar and marijuana
smoking also increase the risk of lung cancer. Breathing in cigarette smoke (second hand smoke) can increase the risk by about 30%. Exposure to
certain workplace chemicals such as asbestos, coal gas, chromium, nickel, arsenic chloride, radon and mustard gas also increase risk of lung
cancer. Despite the strong association of smoking with lung cancer, it has also been recognised that more than one quarter of the cases in
Singapore occur in people who have never smoked or have prior smoke exposure.
Diagnosis
- Imaging tests
An X-ray image of the lungs may reveal an abnormal mass. A CT Scan can reveal small lesions.
- Sputum cytology
Examination of the sputum under microscope may reveal cancer cells.
- Tissues samples
A sample of abnormal cells may be removed in a procedure called biopsy. This can be performed in the following ways:
- Bronchoscopy:
The abnormal areas of the lung will be examined using a lighted tube that is passed down the throat and into the airway.
- Mediastinoscopy:
An incision is made at the base of neck and surgical tools inserted behind breastbone to take samples from lymph nodes.
- Percutaneous needle biopsy:
The radiologist uses CT images to guide a needle through your chest and into a suspicious nodule to collect cells.
- Lymph node biopsy:
The cells can be sampled from enlarged peripheral lymph nodes.
Staging
Once your lung cancer is diagnosed, the extent of the cancer will be determined. This will help to decide the most appropriate
treatment. Staging tests may include imaging procedures such as MRI brain, PET and bone scans.
Treatment
You will be advised on a treatment regimen based on a number of factors such as your overall health, the type and stage of
cancer and your own preferences. Treatment options include surgery, chemotherapy, radiation, targeted drug therapy,
immunotherapy and palliative care.
Surgery
The surgeon will remove the cancer and a margin of healthy tissue. Procedures:
- Wedge resection: a small section that contains the tumour along with a margin of healthy tissue is removed.
- Lobectomy: the entire lobe is removed.
- Pneumonectomy: an entire lung is removed.
Chemotherapy
Chemotherapy uses drugs to kill cancer cells. One or more drugs may be administered through your vein in your arm or taken orally.
A combination of drugs is given in a series of treatment over a period of weeks or months, with breaks in between. It is used as first
line treatment or as an additional treatment after surgery.
Radiation therapy
This uses high-powered energy beams to kill cancer cells. Radiation can be directed at the cancer area from outside your body (external beam radiation) or it
can be put inside needles, seeds or catheters and placed inside the body near the cancer (brachytherapy). It can be used alone or along with other
treatments. It can be used to lessen the side effect of lung cancer.
Targeted drug therapy
These are newer cancer treatment that target specific abnormalities in cancer cells. This can be used for advanced and recurrent non-small cell lung
cancer that has not been helped by chemotherapy.
Immunotherapy
Immunotherapy is a relatively new treatment option for a variety of cancers, including lung cancer. Immunotherapy helps the body's existing immune system recognize and attack cancer cells. People who have certain types of non-small cell lung cancer (NSCLC) are typical recipients of immunotherapy.
Often, immunotherapy is given to people whose cancer has returned after treatment. Sometimes, however, immunotherapy is a primary treatment and is often coupled with chemotherapy.
Unfortunately, doctors are not yet able to predict which people will benefit from immunotherapy.
There are a few different types of immunotherapy for fighting lung cancer. These
include:
- Immune checkpoint inhibitors
- Adoptive T cell therapy
- Therapeutic vaccines
The different types of therapies offer alternative ways for the body to attack cancer cells. There is still a need for
further research into how effective these treatments are, who benefits most from their use, and their overall safety.
Supportive (palliative) care
This means that you will receive treatment to cease the symptoms and to make you more comfortable.
There will not be treatment that aim at stopping the cancer.
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