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Lung cancer ranks second among the top ten most common cancers in Hong Kong and is the leading cause of cancer death in women and men. According to the latest statistics published by Hong Kong Cancer Registry, there are 5,000 new cases of lung cancer every year with over 3,000 deaths. Because lung cancer symptoms are not obvious in the early stages and many patients dismiss the symptoms as being flu-like, almost half of all lung cancers are diagnosed in the advanced stages, having already passed the golden period for treatment. Worse still, in about 20% of lung cancer patients it is found that their cancer cells have spread to the brain.

 

Fortunately, over the past 20 years, with the rapid development of chemotherapy, radiotherapy, targeted therapy and immunotherapy, lung cancer treatment has become much more diversified and has raised the prospect of full recovery for lung cancer patients. The latest information about lung cancer treatment and an overview of services follows below, which includes an FAQ section that covers patients queries regarding diagnosis to treatment, types of treatment, cancer stages, the symptoms and the survival rates.

Common lung cancer symptoms

Please consult your doctor should the following symptoms for lung cancer persist:

 

  • A cough that does not go away or get worse
  • Coughing up blood or rust-colored sputum
  • Shortness of breath
  • Chest pain
  • Bone pain
  • Weight loss

Lung cancer causes and risk factors

Apart from a family history of lung cancer, smoking is among the high-risk factors. According to the statistics published by the Cancer Fund, smokers represent 90% of all lung cancer patients, the majority of which are males aged 50 years or above. This means that for every 10 smokers, there will be one lung cancer patient. However, non-smokers are potentially susceptible to lung cancer too. Among all lung cancer cases, nearly 80% of the patients are diagnosed with non-small-cell lung carcinoma (NSCLC), 5% of which have anaplastic lymphoma kinase (ALK) gene rearrangements. The majority of these kinds of cases are young female non-smokers. In addition, air pollution potentially increases the chance of lung cancer too. Exposure to radon and asbestos is also a known risk factor of lung cancer.

Lung cancer screening to increase survival

Compared to the survival rate of other cancers such as colorectal cancer (64.5%), breast cancer (89.6%) and prostate cancer (98.2%), lung cancer has a lower survival rate, with only 18.6% over a 5-year period. However, according to the American Lung Association, if patients are detected with lung cancer early on and receive appropriate treatments, the 5-year survival rate can be increased by as much as 56%. Which highlights the importance of regular check-ups and screening, such as:

 

  • Imaging tests: x-rays, CT, PET-CT, etc.
  • Sputum cytology: a sputum sample will be collected and examined under a microscope
  • Other screening methods: surgical procedures such as bronchoscopy and lung biopsy that remove a sample of cancer cells for examination

Recent clinical evidence has shown that people with high risk of lung cancer can reduce mortality through the use of low-dose computed tomography (CT). A 10-year research study by the International Association for the Study of Lung Cancer (IASLC) demonstrated that early detection of cancer through regular CT screening can reduce lung cancer mortality in men and women with 25 to 30 years of smoking history by 26% and 60%, respectively.

 

The American Cancer Society also recommends that people aged between the ages of 55 and 74 years, with over 30 years smoking history or those who have quit smoking for less than 15 years should get screened by low-dose CT for lung cancer every year. Getting screened for three consecutive years can reduce mortality by 20% and improve survival rates.

Lung cancer staging and types

Lung cancer treatment varies according to the cancer type, staging and the patient’s health status. Lung cancer is largely classified into non-small-cell and small-cell lung cancer, both of which have different staging. The smaller the number of the stage denotes an early-stage cancer and vice-versa. The later the cancer stage is, the greater the extent to which a lung cancer tumour has spread to other areas.

 

Non-small cell lung cancer (NSCLC) represents 85% of all lung cancer cases, including the most common adenocarcinoma, squamous-cell carcinoma (SqCC) and large-cell carcinoma. Small-cell lung cancer takes up less than 20% of all lung cancer cases. It is mainly caused by smoking; starting in the trachea, with the cancer cells rapidly developing and spreading to other parts of the body, including the lymph nodes.

 

Although SCLC grows at a faster rate than NSCLC, SCLC generally responds better to chemotherapy than NSCLC.

NSCLC stages

Cancer cells are discovered in a sample of sputum or other lung fluids, but cancer is not found with imaging tests or bronchoscopy, or the cancer tumour is too small to be detected.

This stage is also called cancer in situ. The cancer tumour is small and has not invaded deeper into other lung cancers and spread to distant parts of the body.

The cancer tumour might be located in lung tissues but has not spread to the nearby lymph nodes.

Cancer might have spread to nearby lymph nodes or has grown into the chest wall.

The tumour has spread from lung to nearby lymph nodes or other side of the body such as heart, bronchus and oesophagus.

The cancer cells have spread widely throughout the lung, to the other lung or to other parts of the body, including bone marrow (chest wall).

SCLC stages

The cancer tumour is only in one lung and might have also reached the nearby lymph nodes.

The cancer cells have spread widely throughout the lung, to the other lung or to other parts of the body, including bone marrow (chest wall).

Lung cancer treatment methods

Surgery, radiotherapy, chemotherapy, targeted therapy and immunotherapy are all used in lung cancer treatment. Lung cancer treatment depends on a number of factors such as the patient’s health conditions and the cancer stage. For example, for stage III NSCLC, because the cancer might show signs of spreading, surgical removal of the tumour alone will see a limited chance of recovery. But by combining chemotherapy with state-of-the-art radiotherapy, the survival rate of lung cancer can be improved by 20% over a 3-to 5-year period. Understand the latest lung cancer treatments.

Surgery

surgery-in-operation-room

including lung wedge resection, segmentectomy, lobectomy, pneumonectomy

Radiotherapy

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often used together with chemotherapy. The more recent radiotherapy technologies include Stereotactic Body Radiation Therapy (SBRT) and Active Breathing Coordinator, targeting the tumour with greater accuracy and less damage to other organs. Radiotherapy can be used as part of pre- or post-operative treatment to local lung cancer at advanced stages. It can also treat late-stage lung cancers and lung cancer that has spread to other parts of the body and offers pain relief.

Chemotherapy

colored-tablets

patients with early-stage lung cancer are advised to perform chemotherapy to kill the remaining cancer cells following their surgery.

Targeted therapy

targeted-therapy-for-brain

targeted therapy uses drugs to target the cancer’s specific genes to block or turn off signals that tell cancer cells to grow and divide.

Immunotherapy

Immunotherapy

common types of immunotherapy include PD-1 and PD-L1 checkpoint inhibitors. These help the immune system to respond more aggressively to a tumour and fight the cancer. Before deciding to take immunotherapy, patients should undergo a PD-L1 examination to see whether they are a fit for this treatment option to prevent them from wasting time and money on an unsuitable treatment.

Combination therapy

Researcher-load-Sample

the doctor chooses a combination of therapies from the above to meet the patient’s needs. The World Conference of Lung Cancer (WCLC) 2018 announced the latest clinical research results on the effectiveness of combination therapy on lung cancer clinical outcomes, highlighting that NSCLC patients who receive chemotherapy and immunotherapy simultaneously have seen their survival rates extended by as much as 2 months to a year.

Frequently asked questions about lung cancer symptoms, stages and treatment

  • Q1. How much of the lung will be removed during lung cancer surgery?

    Wedge resection removes an area less than one lobe of the lung, including the tumour and some surrounding healthy tissues. Segmentectomy removes a larger area of lung tissues but not the whole lobe. Lobectomy removes one lobe of the lung. Pneumonectomy removes the whole lung.

  • Q2. Are radiotherapy and chemotherapy necessary for lung cancer treatment regardless of the stage?

    It depends. Doctors may use chemotherapy alone or combine it with radiotherapy to treat patients. Some patients are advised to receive chemotherapy before their operation to shrink the tumour, making it easier to remove it through surgical means. As for late-stage lung cancer patients, chemotherapy is usually used to relieve their pain or other symptoms.

  • Q3. Do the side effects of chemotherapy severely affect everyday life?

    Quite a few patients mention loss of appetite and nausea as side effects of chemotherapy. However, next generation antiemetic medications for relieving symptoms of nausea have proven quite effective in alleviating these side effects.

  • Q4: Are there many options for lung cancer targeted therapy?

    Doctors will identify different gene changes in cancer for targeted therapy. Apart from EGFR, medical research has also identified changes in ALK, ROS1 and HER2, with medications developed accordingly. Recent medical research has put added focus on the second-generation targeted therapy medications that cross the blood-brain barrier (BBB) and prevent the cancer from developing into several malignancies, thereby prolonging the survival rates of patients whose lung cancer tumour has spread to the brain.

  • Q5. Does immunotherapy cause any side effects?

    Although immunotherapy works by helping the patient’s immune system identify cancer cells and so fight the cancer, it still has side effects. These tend to be less extreme than those of other therapies, however, they primarily include the inflammation of various organs and presents with pneumonia, colitis, hepatitis and dermatitis.

Related Articles

References:

 

    1. 5,000 new cases every year with over 85% death rate, a leading cause of cancer death
      https://www.hkioc.com.hk/zh/immunotherapy-helps-the-risk-of-recurrence-of-stage-iii-non-small-cell-lung-cancer/
    2. Over the next 20 years, rapid development has been achieved in targeted therapy medications, chemotherapy drugs, SBRT and immunotherapy, bringing new hopes to lung cancer treatment
      https://www.hkioc.com.hk/zh/a-new-era-of-hope-in-lung-cancer/
    3. According to the statistics on Cancer Fund, smokers represent 90% of all lung cancers, majority of which are male aged 50 years. For every 10 smokers, there is one lung cancer patient
      https://www.cancer-fund.org/lung-cancer/?cat=266
    4. According to American Lung Association, if patients detect lung cancer early and receive appropriate treatment, the 5-year survival rate can be improved by 56%. So far, there are only 16% of lung cancer diagnosed at early stages. Over 50% of lung cancer patients died a year after being diagnosed
      https://www.cancer-fund.org/lung-cancer/?cat=266
    5. Hong Kong Chinese University: nearly 80% of lung cancer patients are diagnosed with NSCLC, 5% of which have ALK rearrangements
      https://www.cpr.cuhk.edu.hk/tc/press_detail.php?id=2533&t=%E4%B8%AD%E5%A4%A7%E9%A0%98%E5%B0%8Ealk%E9%99%BD%E6%80%A7%E8%82%BA%E8%85%BA%E7%99%8C%E7%A0%94%E7%A9%B6%E8%AD%89%E5%AF%A6-%E6%96%B0%E6%A8%99%E9%9D%B6%E8%97%A5%E6%88%90%E6%95%88%E8%B6%85%E7%8F%BE%E6%99%82%E6%A8%99%E6%BA%96%E7%99%82%E6%B3%95%E5%85%A9%E5%80%8D&id=2533&t=%E4%B8%AD%E5%A4%A7%E9%A0%98%E5%B0%8Ealk%E9%99%BD%E6%80%A7%E8%82%BA%E8%85%BA%E7%99%8C%E7%A0%94%E7%A9%B6%E8%AD%89%E5%AF%A6-%E6%96%B0%E6%A8%99%E9%9D%B6%E8%97%A5%E6%88%90%E6%95%88%E8%B6%85%E7%8F%BE%E6%99%82%E6%A8%99%E6%BA%96%E7%99%82%E6%B3%95%E5%85%A9%E5%80%8D
    6. Dr. Choy Tim Shing from HKIOC: the majority of patients with ALK are female non-smokers
      http://www.metrodaily.hk/metro_columns/%E8%82%BA%E7%99%8C%E4%B8%8A%E8%85%A6%E9%9D%9E%E7%B5%95%E8%B7%AF/