Lungs are part of the respiratory system that works together to help you breathe. The respiratory system’s main function is to move fresh air into your body while removing waste gases.
Lung cancer is a type of cancer that begins in the lungs and develops because of the uncontrolled growth of abnormal cells. Growth of these abnormal cells can interfere with normal lung function. The abnormal cells can pass from the original part of the lung to other parts of the body, such as the opposite lung, our lymph nodes, bones, liver and more.
There are two main types of lung cancer:
Over a five-year period, from 2017 to 2021, close to 9,000 cases of lung cancer were diagnosed in Singapore. Lung cancer is third most common cancer in men and women in Singapore. It is also the leading cause of cancer death for men and third cause of cancer death for women. Lung cancer is more commonly diagnosed in individuals above 40 years old, however the disease can occur in younger individuals.
Early-stage lung cancer may not cause any noticeable symptoms.
Common symptoms of lung cancer at a more advanced stage include:
When to see a doctor
Make an appointment with your doctor if you have any signs or symptoms that worry you.
As smoking is one of the main causes of lung cancer, the best way to minimise the risk of developing lung cancer is to avoid smoking. There are several ways to do this:
*Pack years are calculated by multiplying the number of cigarette packs smoked daily by the number of years smoking.
It is also recommended that you eat a diet rich in fruits and vegetables and to exercise regularly.
A number of different behaviours and environmental exposure are known to increase the risk of developing lung cancer such as:
Despite the strong association of smoking with lung cancer, it has been recognised that more than one-quarter of lung cancer cases in Singapore occur in people who have never smoked, and who do not have prior smoke exposure. The causes of lung cancer in this population are being investigated and are likely due to environmental exposure and genetic mutations.
Tests and procedures used to diagnose lung cancer include a combination of imaging tests and biopsy of an area of abnormal growth detected on a scan, or on clinical examination.
Initial imaging tests
Results of imaging investigations may suggest that a person has lung cancer, but a diagnosis of cancer can only be made after identifying cancer cells in a biopsy specimen obtained from the area of abnormal growth.
Diagnostic tests may include:
Tests to determine the stage of lung cancer
After confirming the diagnosis of lung cancer, further tests may be performed to determine if the cancer has spread to other parts of the body. This information is used to decide the stage of lung cancer. Different stages of lung cancer require different types of treatment.
Examples of these tests:
Stages of lung cancer
Small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) are staged differently.
Molecular/ Biomarker testing (for NSCLC)
Treatment for lung cancer depends on the type of lung cancer, stage of cancer and general health and fitness of the patient. An individual with cancer should be assessed by a specialist to determine which modality of treatment is best suited for them.
Treatment by type and stage of lung cancer
Limited stage disease is usually treated with a combination of chemotherapy and radiotherapy to the lungs and mediastinal lymph nodes. After completion of chemoradiation, radiotherapy to the brain may be recommended to reduce the risk of cancer relapse in the brain. Extensive stage disease is usually treated with a combination of chemotherapy and immunotherapy. Some patients may also be treated with radiotherapy depending on their sites of spread and response to treatment.
Types of treatment
Your surgeon will perform a comprehensive medical work-up including physical examination, lung function test, blood tests and scans to see if you are suitable for surgery and advise you on the risks involved. This treatment recommendation is often based on consensus by a group of different specialists' opinions (tumour board) which weighs the pros and cons of every treatment strategy.
Before surgery, the anaesthesia team will also assess your fitness for surgery and advise you on various aspects of general anaesthesia and pain control after surgery. As with all surgical procedures, complications can occur during and/or after surgery. Some of these risks and complications are inherent in any operative procedure, especially when general anaesthesia is administered. You should ask your doctors about these risks.
You should stop smoking as soon as possible, ideally at least two weeks before surgery in order to minimise your risk of developing complications after surgery. You should also inform your doctor if you are on any blood thinning medication or traditional medication, as these need to be stopped prior to surgery to minimise risk of bleeding after surgery. Finally, you should try to walk at least an hour a day prior to surgery, as you will be required to walk after surgery to improve your recovery.
Specialist nurses will also provide pre-surgery counselling.
Immediately after the surgery, you will have a chest tube that will prevent any accumulation of air or fluid in the chest. There will be post-operative pain from the operation, and you will be given medication to treat the pain. If the pain is not controlled, please let your nurse or doctor know, as the medication may need to be adjusted. You will also need to walk or move about as early as possible in order to help your lung expand and aid your recovery.
Most patients will return to their original functioning after recovery from surgery. However, there is a possibility that the loss of lung from surgery may cause you to be more breathless on exertion than before. In rare instances, you may even require supplemental oxygen for a prolonged period of time after a lung resection. However, your doctor will perform an evaluation to determine how likely this is the case prior to recommending surgery.
After recovering from surgery, you will be given regular outpatient appointments to see your team of doctors. These visits may include scans to monitor and check if the cancer recurs. It is important to follow your doctors’ advice, keep to scheduled clinic visits and do the prescribed tests so that timely treatment can be administered if the cancer or other problems arise.
Lung Cancer in 4 minutes (Chinese)
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