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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 yearly with over 3,000 deaths. In the early stages, symptoms for lung cancer are rather obscure, many would dismiss their symptoms as being flu-like causing almost half of the patients to be diagnosed during the advanced stages, with a smaller chance for a full recovery. To make matters worse, around 20% of all lung cancer patients would find their cancer cells having spread to the brain.

 

Fortunately, over the past 20 years, with the rapid development, radiotherapy, targeted therapy and immunotherapy, lung cancer treatment has become more diversified raising the chances of full recovery for lung cancer patients. On this page, you will find the latest information about lung cancer treatments and an overview of services follows below. This includes: an FAQ section covering patients queries regarding diagnosis to treatment, types of treatment, cancer stages, the symptoms and the survival rates.

Symptoms and Signs of Lung Cancer

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 of above. This means that for every 10 smokers, there will be one lung cancer patient. However, we mustn’t forget that 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; most of these kind of cases are young female non-smokers. In addition, air pollution potentially increases the chance of lung cancer too, as well as exposure to radon and asbestos is also a known risk factor of lunch cancer.

Lung Cancer Screening Options

Compared to the survival rate of other cancers such as colorectal (64.5%), breast (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 diagnosed during the early stages and receive appropriate treatments, the 5-year survival rate can be increased by as much as 56%. This highlights the importance of regular check-ups and screening. These include:

 

  • Imaging test: 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 removes a sample of cancer cells for examination

 

Recent clinical evidence has shown that people with high risk of lung cancer can reduce mortality by using 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 25-30 years of smoking history by 26% and 60%, respectively.

 

The American Cancer Society also recommends that people aged between 55 to 74, with over 30 years smoking history or have quit smoking for less than 15 years, should get screened by low-dose CT for lung cancer yearly. 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 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 stages advance as the numbers representing them increases, and vice-versa. The later the cancer stage, the greater the spreading of the lung cancer tumours 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, mainly caused by smoking. Starting in the trachea, cancer cells rapidly develop and spread to other pars of the body, including the lymph nodes.

 

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

NSCLC stages

Cancer cells are discovered in a sample of sputum or other lung fluids. However, not found with imaging tests, 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 areas of the lung and rest 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 grown into the chest wall.

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

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

SCLC stages

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

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

Lung Cancer Treatment

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. Take stage III NSCLC for example, the cancer might be showing signs of spreading therefore, surgical removal of the tumour alone will see a limited chance of recovery. However, 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.

Surgery

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Includes lung wedge resection, segmentectomy, lobectomy, and pneumonectomy.

Radiotherapy

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Often used 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 lung cancer at advanced stages. It can also offer pain relief to patients with late-stage cancers that have spread throughout the body.

Chemotherapy

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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

This uses drugs to target the cancer’s specific genes to block or turn off signals that tell cancer 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

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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 about the effectiveness of combination therapy on lung cancer clinical outcomes. It shows how 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

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

    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 love 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 used 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 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. This prolongs the survival rates of patients whose 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 fight them, 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.

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/