Q1. What are the causes of lung cancer?
There are various causes of lung cancer, with smoking as the leading one. While many studies have confirmed that smoking is related to lung cancer, it is also found that a family history of lung cancer may increase the risk of developing the disease in certain individuals. Other factors are environmental, such as a history of radiation therapy, exposure to radiation or certain substances, such as asbestos, radon gas, or heavy metals. Lifestyle factors such as alcohol consumption, overweight, lack of physical exercise, and an unhealthy diet may also lead to lung cancer.
Q2. What are the common symptoms of lung cancer? Why is it usually diagnosed in advanced stages?
Late detection is common as it is mostly asymptomatic in early-stage lung cancer. Even if the tumour is growing in the lungs, patients may not feel anything. Only when the airways are irritated or changes occur in the airways that the patients begin coughing or cough up blood. Other symptoms may include chest pain or shortness of breath due to airway obstruction or pleural effusion.
Hoarseness may occur when a tumour goes deeper and compress on the nerves. The face may swell up if it presses upon a large blood vessel. Metastasis to bones may result in pain and factures, while liver metastases may cause abdominal bloating or impaired liver function, leading to jaundice. Impaired limb movement or numbness may occur if it spreads to the brain.
For early detection, seek medical attention as soon as possible if you notice any abnormalities or symptoms.
Q3. How to prevent and detect lung cancer early?
To reduce the risk of lung cancer, you must first quit smoking. It is relatively easy, manageable and avoidable. Smoking cessation is remarkably effective for smokers, as they are far more prone to lung cancer than non-smokers. Lifestyle modifications, e.g. more frequent exercise and a healthy diet, can also help prevent lung cancer.
For early detection of lung cancer, some studies suggest that people at high risk should undergo low-dose chest CT scan on a regular basis. The earlier the detection, the higher the chances of recovery. If you have a family history of lung cancer, e.g. it had occurred in your immediate family members like siblings and parents, you should consult your family doctor or a specialist in respiratory medicine or cardio-thoracic surgery to discuss regular screening for early detection.
Q4. How to manage lung cancer?
When lung cancer is suspected, your doctor will first confirm if the tumour is cancerous and decide the staging. Further tests such as CT scans, PET scans, blood tests, etc. will be arranged to determine the extent and size of the tumour. Some patients may also need to undergo biopsy, by which tissue samples are extracted to identify the tumour type. There are various types of lung cancer, including small-cell carcinoma, non-small-cell carcinoma, adenocarcinoma, squamous cell carcinoma, etc. Treatment methods vary with the cancer type. Genetic or molecular testing may also be considered, as many “personalised” treatment methods are now tailor-made for individual conditions. Patients may be given treatment options other than chemotherapy, such as targeted therapy, immunotherapy, etc.
Early-stage lung cancer is primarily treated by surgical removal or local excision. If the tumour is still localised without affecting other organs such as the pleura or lymph nodes, surgical removal is an ideal treatment option. Some patients may not be suitable for surgery due to their medical condition or other reasons. They may consider high-dose and precise radiation therapy to achieve similar outcome as surgery.
During the treatment journey, your doctor may extract the surrounding tissues to ascertain lymph node involvement. If the condition is not in its early stage, your doctor will prescribe the most suitable treatment based on one’s condition and staging. Nowadays personalised medicine is the preferred approach. If there is still a chance for surgery but the risk is high, adjuvant therapies like chemotherapy, targeted therapy, immunotherapy or radiation therapy may be performed before or after the surgery. Pre-surgery chemotherapy, immunotherapy or targeted therapy may also be recommended to shrink the tumour, together with other post-surgery treatments. Some patients may have to undergo surgery first, followed by chemotherapy and other tailored therapies. Surgery may not be viable for some patients at middle or advanced stage. They can first receive radiation therapy, along with chemotherapy concurrently or other adjuvant treatments.
Q5. Is there no treatment available for stage 4 lung cancer?
For advanced cases, such as those in stage 4 with metastasis to other organs, the treatment goal is disease control. Based on the cancer type, targeted therapy or immunotherapy is considered to control the progression with medications. Despite the advanced stage of the disease, the new generation of treatment can achieve effective disease control and years of normal life for some patients.
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