Lung Cancer

Lung cancer is the top leading cancer killer in Hong Kong. Cigarette smoking is the main factor for development of lung cancer. Approximately 90% male lung cancer patients are smokers. A prolonged exposure to secondhand cigarette smoke also doubles the risk of developing lung cancer.

Detection of lung cancer in its early stages can increase chances of cure. However, most of the patients are not diagnosed until the lung cancer is in metaphase or advanced stage, thus making it more difficult to cure. Therefore, people at high risk of lung cancer (smokers and those who are frequently exposed to secondhand smoke) should be ever vigilant for respiratory diseases in order to increase chances of cure via early discovery.

(Special thanks to Dr. Winnie TIN, Consultant, Department of Clinical Oncology, Tuen Mun Hospital, and Dr. Florence MOK, Associate Consultant, Department of Clinical Oncology, Prince of Wales Hospital)

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Lung cancer is a malignant tumour developed in the lower part of the respiratory system including cells in the bronchus and bronchiole wall.

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90% lung cancer cases are related to cigarette smoking. Please pay special attention to lung cancer symptoms if you belong to one or several of the following groups:

  • Smokers
  • Aged 50 or above
  • Having a long-term history of smoking started at young age (this would increase the risk of getting lung cancer)
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  • If you smoke, quit smoking now.  If you have a relative or friend who smokes, talk with him or her about quitting.
  • Avoid exposure to excessive cooking oil fumes by: choose cooking methods like steaming, boiling, and stewing. Avoid frying when cooking meals at home. Always use the exhaust gas ventilator in order to reduce cooking oil fumes.
  • Diet: Avoid intake of preserved or barbecued food.
  • Living: Reduce incense burning.

 

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Cigarette smoking is a known principal factor for development of lung cancer. If you smoke, it is important to be aware of the following facts:

  • Smokers have a risk of getting lung cancer 20 times higher than nonsmoker
  • 1 in 10 smokers gets lung cancer
  • Frequent exposure to second-hand smoke will greatly increase the risk of getting lung cancer (two to three times higher than normal)
Besides smoking, the following factors may also increase the risks of getting lung cancer:
  • A prolonged absence of fresh vegetables and fruits, and foods rich in vitamin A in the diet
  • Prolonged exposure to oil fumes produced during cooking
  • Frequent intake of BBQ and preserved foods
  • Prolonged inhalation exposure to smoke produced by incense burning
  • Race or hereditary factor
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Any of the following signs and symptoms could indicate lung cancer:

  • Prolonged fatigue
  • Poor appetite and weight loss
  • Persistent cough
  • Wheezing
  • Sputum with blood
  • Chest pain: vague pain or agonizing pain in the chest when coughing or taking a deep breath

Patients with more advanced lung cancer may also experience the following: scrofulous swelling of the neck, face and hand; abdominal distention, bone pain, headache, partial epilepsy or hemiplegia (paralysis of one side of the body)

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While smokers should have regular chest checkups, people having any of the aforesaid symptoms should also visit their family doctors promptly. Diagnostic tests for lung cancer include the following:
  • Chest X-ray
  • Sputum cytology examination (sample of sputum being examined under a microscope to check for abnormal cells)
  • Bronchoscopy: examination of the airways by bronchoscopy to visualize the mucosal status. This may reveal areas of tumour that can be biopsied for diagnosis of cancer cell type. The results can then help doctors to determine whether surgery should be given.
  • CT scan / Positron emission tomography (PET) scan: this can help to determine whether the tumour may have spread within the chest, such as local lymph nodes. The doctor will then decide if the patient's lung cancer can be treated with surgery.
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Treatments for lung cancer may include surgery, external radiotherapy, systemic anti-cancer treatment (e.g. chemotherapy, targeted therapy, immunotherapy) and other supportive measures for palliation such as laser, internal radiation therapy, and medicines. Single or combined modalities treatments may be used depending upon the patient's general health status. Medical team will recommend the most appropriate treatment plan based on the patient's clinical condition.

(1)      Surgery
This treatment method offers the best chance of cure for patients who have early-stage lung cancer that has not spread beyond the lungs. The curative rate of surgery stands at more than 60% among patients in the earliest stage of disease. The volume of resection depends (depends) on the status of the malignant tumour. The operation may involve the removal of a tumour together with some surrounding tissue, while some may involve removal of a whole lobe or even one whole lung.

(2)      External radiotherapy
This may be given as curative therapy of early-stage lung cancer for patients who are not suitable for surgery because of being too old or having other diseases. Radiotherapy will be useful for destroying cancer cells in patients if there is local spread of tumour, surgically irremovable cancer cells left after operation, or symptoms caused by cancer spread (such as bone pain and brain metastases).

(3)      Chemotherapy
Chemotherapeutic drugs (anticancer drugs) will be used to help stop cancer cells from dividing and multiplying. A single or combination of anticancer drugs will be injected into the patient's body by way of intravenous infusion. The patient will need to take three to four weeks of rest before receiving another infusion, while usually four to six infusions are given during the whole course.

(4)      Targeted therapy
This targets at specific molecules involved in a certain tumour type. It causes fewer side effects than traditional chemotherapy by having less impact on hematopoietic stem cells or the immune system.

(5)      Immunotherapy

Immunotherapy uses cells or antibodies of the immunity system to treat cancer. The side effect from immunotherapy is milder than chemotherapy.

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Radiotherapy
Patient may experience short-term side effects such as nausea, loss of appetite, difficulty in swallowing, dry cough, skin redness, etc. during radiotherapy, but usually disappear in two to four weeks after completing the treatment. For long-term side effects such as skin discolouration, lung fibrosis, radiation pneumonitis, etc., may occur months or years after radiotherapy and may persist. These side effects are mostly mild and are tolerable to most patients.

Chemotherapy
While chemotherapeutic drugs can kill cancer cells, they also destroy normal cells in the body, resulting in side effects. Patients may experience nausea, vomiting, hair loss, mouth sores, anaemia, low resistance to bacterial infection, and internal hemorrhage, etc. Hence, your doctor will manage the entire course of chemotherapy with special caution.

Targeted Therapy
Targeted therapy may cause side effects such as skin rash, mouth sores or diarrhea. Please strictly follow medical advice in using this type of treatment.

Immunotherapy
In general, the most common immunotherapy-induced side effects may include but are not limited to coughing, nausea, vomiting, diarrhea, decreased appetite, fatigue, fever, muscle ache, hypothyroidism, itching and rash, etc. Though most of these side effects are mild compared with chemotherapy, there might be fatal immune-related side effects, and patients should seek immediate medical attention if they have severe symptoms.
 
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The following are some important notes for patients during rehabilitation after surgery, radiotherapy or anticancer drug treatment:
Regular checkups:
Surgery and drug treatment may lead to a partial or even complete relief from symptoms of lung cancer. However, lung cancer has a relatively high chance of recurrence. This is largely due to the fact that most patients are not treated until their cancer have worsened and disseminated, thus affecting the success rate of curative. Patients should persist in regular subsequent visits to allow close monitor of progress. If cancer recurs, treatment can also be given promptly and hence increase the chance of survival.
Reminders on daily lifestyle:

  • Stop smoking
  • Ensure good ventilation at home
  • Do appropriate exercises to improve lung function
  • Stay away from crowded and air-polluted public areas to avoid respiratory infection
Diet:
  • Increase intake of food that contains substantial amount of vitaminA and C such as carrot, grape, and pear, etc.
  • Cancer treatment might weaken the immune system. Immunocompromised patient is advised to avoid to eat raw or undercooked meat, poultry, eggs, seafood, raw or unpasteurized dairy products, and ready-to-eat raw vegetables.
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