Lung Cancer Treatment in Singapore

Lung cancer is an uncontrolled growth of cells that start off in the lungs. Usually, lung cancer starts in the cells that line the air passages. Instead of developing into healthy lung tissue, the cells divide rapidly and form tumours.

Lung cancer can grow and spread beyond the lung to reach other parts of the body through metastasis. Lung cancers can begin in any part of the lung, but 90 percent of lung cancers begin in the epithelial cells, which are the cells lining the larger and smaller airways also known as bronchi and bronchioles.

This is the reason why lung cancers are sometimes called bronchogenic cancers or bronchogenic carcinomas. Lung cancer is the most common cancer in the world, among both men and women. It is the leading cause of cancer deaths worldwide.

Lung Cancer: Causes and Risk Factors

Long-term smoking is the main cause of lung cancer. After smoking, genetic factors and exposure to radon gas, asbestos, second-hand smoke or other forms of air pollution can also increase the risk of lung cancer.

Types of Lung Cancer

There are two major types of lung cancers, based on the appearance of lung cancer cells under the microscope:

• Non-small cell lung cancer (NSCLC): It is an umbrella term for several types of lung cancers that behave in a similar way, such as squamous cell carcinoma, adenocarcinoma, and large cell carcinoma.
• Small cell lung cancer (SCLC): This type of lung cancer occurs mostly in heavy smokers and it is less common than non-small cell lung cancer. 
  
  

Lung Cancer Stages

It is necessary to determine the stage of lung cancer by finding out how far cancer has spread, before initiating treatment of lung cancer.
The following are the four lung cancer stages of NSCLC:

• Stage 1 lung cancer: Cancer is restricted to the lung
• Stage 2 lung cancer: Cancer has spread to the nearby lymph nodes
• Stage 3 lung cancer: (3a) Cancer is in the lung and the lymph nodes located on the same side  (3b) Cancer is in the lung and has spread to lymph nodes on the opposite side
• Stage 4 lung cancer: Cancer has spread to both the lungs and other organs and surrounding tissues
  
  

The following are the two lung cancer stages of SCLC:

• Limited stage: Cancer is present in just one lung and lymph nodes on the same side of cancer.
• Extensive stage: Cancer has spread throughout the lung or both the lungs, to the lymph nodes on the opposite side, to the bone marrow, and to the distant organs.

After the determination of stage, treatment of lung cancer starts with choosing the best suitable option for the patient. However, there is usually no single treatment for lung cancer. So the patient often receives a combination of therapies and palliative care. 

Lung Cancer Symptoms

Lung cancer symptoms may vary, depending upon where and how widespread the tumour is. A person with lung cancer may have following lung cancer symptoms:

• A persistent or chronic coughing
• Pain in chest, shoulder or back
• Difficulty in breathing and shortness of breath
• Hoarseness or change of voice
• Chronic bronchitis, pneumonia or respiratory infections
• Blood in the sputum and cough

Stage 3 lung cancer symptoms include the following:

• Wheezing
• General pain in the chest or when breathing
• Persistent cough with or without blood
• Altered voice
• Loss of appetite
• Unplanned weight loss
• Fever, headache, weakness, and bone pain
• Difficulty swallowing

The treatment of lung cancer may include the following modalities:

Surgery:

Surgery is the best treatment if the lung cancer is in its early stages. In the early stages, it is possible to cure a patient completely by removing the tumor and the nearby lymph nodes. But after cancer has spread, it is nearly impossible to remove all of the cancer cells with the help of surgery.

There are some specific types of surgical procedures for different location and kinds of lung cancers, such as wedge resection of the lung (removal of a portion of one lobe), lobectomy (removal of one lobe), pneumonectomy (removal of an entire lung) and lymphadenectomy (removal of lymph nodes in the region of the lungs). After the surgery, margin tissues are further studied to see if cancer cells are present or not.

Lung cancer surgery is a major surgical procedure that requires hospitalization, general anesthesia, and follow-up care for a few weeks to several months. It also carries side effects like any other surgery, including complications related to bleeding, infection, and general anesthesia.

Radiation therapy:

This treatment uses high-energy X-rays or other types of radiation to destroy or shrink lung cancer tumors. Radiation therapy can be given as a curative therapy, palliative therapy, or as adjuvant therapy combined with surgery or chemotherapy.

Radiation therapy damages the molecules that make up the cancer cells. However, it can damage the normal, healthy tissues. But nowadays improved technology can focus the radiation on precise locations for certain lengths of time, thus reducing the risk of damage to the surrounding healthy tissues.

Chemotherapy for Lung Cancer Treatment:

Chemotherapy is a strong medication treatment, which interferes with the cell division process and damage proteins or DNA to reduce cancer cells. NSCLC and SCLC, both types of lung cancers can be treated with chemotherapy. Chemotherapy might be given in the form of pills, intravenous infusion, or as a combination of both.

However, drugs used in chemotherapy also kill normally dividing cells in the body that may lead to unpleasant side effects. Some of the common side effects of chemotherapy are vomiting, diarrhea, appetite loss, hair loss, fatigue, anemia, infections and more. These side effects may be felt temporarily during treatment, and several drugs exist to help patients cope with the symptoms.

Targeted drug therapy:

Drugs used in this treatment work by targeting specific abnormalities in the cancer cells. Some of the drugs in this treatment can also strengthen the activity of the immune system against cancer cells. But mostly this treatment only works in people whose cancer cells show certain genetic mutations.

• Immediately after the surgery, you will be shifted to a recovery room until you wake up from the influence of anaesthesia. You will be monitored regularly as you stay in the recovery room for a few hours after the surgery.
• If needed, you will be transferred to the intensive care unit (ICU) from the recovery room, where you will be connected to a ventilator. You will be transferred to a normal hospital room after your health stabilizes.
• You will be required to stay in the hospital for up to a week after the surgery. Supportive care is a necessary part of cancer treatment. Palliative care is a specialty area of medicine that involves working with a doctor to minimize your signs and symptoms of cancer and side effects of cancer treatment. Palliative care can improve mood and quality of life.
• A respiratory therapist will be assigned to you. He or she will guide you on how to use a spirometer and breathing exercises to recover from the surgery.
• You are likely to have a drainage tube in place for a few days or until the surgeon feels that the drainage has stopped. You will be gradually asked to increase your activity to regain strength.