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 general ailments, almost half of all lung cancers are diagnosed at the most advanced stage where complete recovery seems unlikely. Worse still, about 20% of lung cancer patients found that their cancer cells have spread to the brain.
Fortunately, over the past 20 years, novel forms of medical treatment have been rapidly developed. With the rise of chemotherapy, radiotherapy, targeted therapy and immunotherapy, lung cancer treatment has become diversified, raising the prospect of full recovery for lung cancer patients. Below is the latest information about lung cancer treatment and services overview, including frequently asked questions and answers during diagnosis and treatment. You can also learn more about lung cancer staging, symptoms and survival rates.
Common lung cancer symptoms
If the following lung cancer symptoms persist, please consult a doctor as soon as possible:
1. A cough that does not go away or get worse
2. Coughing up blood or rust-colored sputum
3. Shortness of breath
4. Chest pain
5. Bone pain
6. Weight loss
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 male aged 50 years or above. It means that for every 10 smokers, there will be one lung cancer patient. However, non-smokers are also potentially susceptible to lung cancer. Among all the 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 also potentially increases the chance of lung cancer. Exposure to radon and asbestos is also a known risk factor of lung cancer.
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 American Lung Association, if patients detect lung cancer early and receive appropriate treatment, the 5-year survival rate can be improved by 56%, highlighting 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 males with 25 to 30 pack years and in females by 26% and 60% respectively.
The American Cancer Society also recommends that people aged between 55 and 74 years, with over 30 pack years or those who have quit smoking for less than 15 years should get screened with 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 treatment varies according to cancer types, staging and the patient’s health conditions. Lung cancer is largely classified into non-small-cell and small-cell lung cancer, both of which have different staging methods. The small number of the stage usually denotes early-stage cancer while the large stage denotes late-stage cancer. The later the cancer stage is, the greater the extent to which a lung cancer tumor 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 from the trachea, with cancer cells rapidly developing and spreading to other areas in the body, including lymph nodes.
Although SCLC grows at a faster rate than NSCLC, SCLC generally responds better to chemotherapy than NSCLC.
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 tumor is too small to be detected.
Stage 0 NSCLC
This stage is also called cancer in situ. The cancer tumor is small and has not invaded deeper into other lung cancers and spread to distant parts of the body.
Stage I NSCLC
The cancer tumor might be located in lung tissues but has not spread to nearby lymph nodes.
Stage II NSCLC
Cancer might spread to nearby lymph nodes or grow into the chest wall.
Stage III NSCLC
The tumor has spread from lung to nearby lymph nodes or other side of the body such as heart, bronchus and esophagus.
Stage IV NSCLC
The cancer has spread as a single tumor outside of the chest, such as a distant lymph node or an organ, such as the liver, bones or brain.
The cancer tumor is only in one lung and might have also reached 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).
Surgery, radiotherapy, chemotherapy, targeted therapy and immunotherapy are all used for lung cancer treatment. Lung cancer treatment depends on a number of factors such as the patient’s health conditions and cancer stage. For example, for stage III NSCLC, because the cancer might show signs of spreading, surgical removal of tumor alone will have a limited chance of recovery. But by combining chemotherapy and state-of-the-art radiotherapy, the survival rate of lung cancer can be increased by 20% over a 3-to 5-year period.
Including lung wedge resection, segmentectomy, lobectomy, pneumonectomy
Often used together with chemotherapy. The more recent radiotherapy technologies include Stereotactic Body Radiation Therapy (SBRT) and Active Breathing Coordinator, targeting the tumor 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 cancer and lung cancer that spreads to other parts of the body for pain relief.
Patients with early-stage lung cancer are advised to perform chemotherapy to kill the remaining cancer cells after surgery
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.
Common types of immunotherapy include PD-1 and PD-L1 checkpoint inhibitors. It works to help the immune system respond more strongly to a tumor and fight cancer. Before deciding to take immunotherapy, patients should get the PD-L1 test to see whether they are a fit so that they will not waste the money and time on unsuitable treatment.
The doctor will use a combination therapy based on his or her understanding of medications of targeted therapy, immunotherapy and chemotherapy 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, highlighting that NSCLC patients who receive chemotherapy and immunotherapy simultaneously have seen their survival rates extended by 2 months to a year.
Wedge resection removes an area less than one lobe of the lung, including the tumor 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.
It depends. Doctors might use chemotherapy alone or combine it with radiotherapy to treat the patients. Some patients are advised to receive chemotherapy before operation to shrink the tumor, making it easier to remove through surgical means. As for late-stage lung cancer patients, chemotherapy is usually used to relieve pain or other symptoms.
Quite a few patients mention loss of appetite and nausea as side effects of chemotherapy. However, next-generation antiemetics have proved quite effective in alleviating these side effects.
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 an added focus on the second-generation of targeted therapy medications that cross the blood-brain barrier (BBB) and prevent cancer from developing in several malignancies, prolonging the survival rates of patients whose lung cancer tumor has spread to the brain.
Although immunotherapy works by helping the patient’s immune system identify cancer cells and fight cancer, it still has side effects. They tend to be less extreme than that of other therapies, however, mainly including inflammation in different organs such as pneumonia, colitis, hepatitis and dermatitis.