Clinical Assistant Professor Gillianne Lai, Consultant from the Division of Medical Oncology at National Cancer Centre Singapore (NCCS), answers your questions about lung cancer.
In Singapore, lung cancer is the third most common cancer among men and women.
Lung cancer is also the leading cause of cancer death for men and third cause of cancer death for women.
It is a type of cancer that begins in the lungs and develops because of the uncontrolled growth of abnormal cells.
Growth of these abnormal cells can interfere with normal lung function. The abnormal cells can pass from the original part of the lung to other parts of the body, such as the opposite lung, our lymph nodes, bones, liver and more.
Over a five-year period, from 2016-2020,
close to 8,620 cases of lung cancer were diagnosed in Singapore.
Lung cancer is more commonly diagnosed in individuals above 40 years old, however the disease can occur in younger individuals.
In this Q&A forum,
Clinical Assistant Professor Gillianne Lai, Consultant with the
Division of Medical Oncology at
National Cancer Centre Singapore (NCCS), a member of the
SingHealth group, answers your questions on lung cancer.
This 'Ask the Specialist' forum has closed. Thank you for your interest and participation.
Question posted by g*********
Will there be screening options for non small cell lung cancer (NSCLC) available in the future? Currently, I understand there are no such options and most times when a patient develops symptoms of NSCLC, the cancer is already into the late stages (Stage 3B and 4) and not curable.
Answered by Dr Lai :
Dear g*********,
Thank you for your question. Early detection of lung cancer increases the chances of cure and improves long-term outcomes.
The best way to date to detect lung cancer early is to screen with low dose computed tomography (LDCT) scan, to find abnormal areas in the lungs that could be cancer. The greatest benefit to screening lies in males, heavy smokers, aged between 55 and 74 years.
At present, there remains no screening recommendation for never smokers. Hence under the auspices of the National Medical Research Council, the National Cancer Centre Singapore is extending a large clinical study across to assess the impact of LDCT as a screening tool among smokers and never smokers with relevant risk factors.
If you would like to learn more about how to participate, please visit https://form.gov.sg/632c084cfa189900120b4219
For lung cancer patients with metastasis to the brain, is Osimertinib (Tagrisso) the most effective medication?
Answered by Dr Lai :
Hi w****,
Thank you for your question. About one-fifth of patients with non-small cell lung cancer (NSCLC) develop brain metastasis. Targeted agents can be used in NSCLC patients with certain driver mutations, for e.g. epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase (ALK).
Osimertinib is one of the oral targeted therapies for patients with epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer. Studies have demonstrated that osimertinib has significant activity against brain metastases in patients who harbour the EGFR mutation. Other oral targeted agents such as alectinib and lorlatinib have been found to have intracranial activity in patients with ALK-positive NSCLC.
I recommend a discussion with the treating oncologist regarding the various therapeutic options and their pros and cons.
Question posted by Z*** *******
I have a chest pain/lung pain after COVID-19 pandemic , is it possibly related to Lung cancer ? Coughing is often occuring as well.
Answered by Dr Lai :
Hi M*******,
Thank you for your question. Symptoms such as chest pain and cough may be experienced after a chest infection. For lung cancer in particular, symptoms can be very general, and may include cough, shortness of breath, chest discomfort, fatigue and weight loss. There may even be no symptoms at all, making lung cancer difficult to detect in its early stages.
If you are concerned about your symptoms, do see a doctor early for an evaluation. Take care!
Question posted by y*******
What are the symptoms for lung cancer and what tests can one do to detect it? Is it advisable to do lung x-ray yearly if this helps to detect the cancer?
Answered by Dr Lai :
Hi y*******,
Thank you for your question.
Patients with early-stage lung cancer often do not have any symptoms, and thus many lung cancer patients are diagnosed in the late stage, when cancer cells have spread to other parts of the body.
Symptoms can also be general, such as unexplained weight loss, fatigue, cough and shortness of breath. It is important to see a doctor early if you are concerned about your symptoms. Your doctor will ask about your medical history and possible risk factors, as well as examine you for signs of lung cancer, and may refer you to a Lung specialist if necessary.
Imaging tests which may include a chest X-ray and CT/MRI scans will be needed to assess if there are suspicious areas that might have cancer and to find out how far the cancer might have spread. A biopsy, which is a procedure to remove a small piece of tissue from the abnormal growth, will also be needed to confirm the diagnosis of lung cancer and classify the type of lung cancer. Taken together, this information will be used to decide on the stage and recommended treatment.
In an individual without symptoms, there is no evidence that having an annual chest X-ray is useful in prolonging life. Current expert guidelines recommend against the use of chest X-ray to screen for lung cancer.
Question posted by 1********@gmail.com My mother has lung cancer at 84. Am I genetically predispose?
Answered by Dr Lai :
Thank you for your question.
Family history of lung cancer has been associated with a higher lung cancer risk, especially amongst never smoking women of Chinese ethnicity. Lung cancer among never smokers is common in Asia, where the growth of lung cancer in these individuals is commonly driven by a single genetic alteration.
There is ongoing research to gain a better understanding of why never smokers should develop lung cancer, including the potential contribution of a positive family history.
Question posted by T****
Dear Dr,
My girlfriend passed away a few years’ ago due to lung cancer.
She was a healthy lady in her mid-sixties with no health problems. She was not a smoker and exercised (taichi) regularly.
Did she contract lung cancer due to second hand smoking as her boss is a smoker? How serious is second hand smoking related to lung cancer? Appreciate your response.
Answered by Dr Lai :
Hi T****,
Thank you for your question. Smoking is the most important modifiable risk factor for lung cancer, and an association between second hand smoke exposure and lung cancer has been described. Efforts to reduce smoking among our young and improve environmental air quality should continue to be encouraged.
Despite the strong association of smoking with lung cancer, nearly half of the lung cancer cases in Singapore occur in people who have never smoked.
Given the higher proportion of never smokers who develop lung cancer in Singapore and Asia, which is a stark contrast to the West, it is likely that additional genetic susceptibilities or environmental and lifestyle risks remain unidentified.
Family history of lung cancer has also been associated with a higher lung cancer risk. Further evidence generated from local population research will enable us to better understand causative links between lung cancer and the East Asian, never-smoker phenotype, as well as to develop lung cancer screening guidelines in the local context.
Question posted by J*****
Dear Dr,
I have a family history of lung cancer whereby both my parents and a sibling were diagnosed with it.
Please advise what precautionary measures I should take?
Also, the low dose CT scan screening for lungs, is it harmful in view of the radiation? If not, why? What is the recommended frequency for such scans? Once every 2 years?
Any other info which may be helpful for my profile with family history?
Thank you and look forward to your response.
Answered by Dr Lai :
Hi J*****,
Thank you for your question.
There is currently no formalised screening programme for lung cancer in Singapore. Annual lung cancer screening with low-dose computed tomography (LDCT) scan can be done as an individual-level decision test for high risk groups:
Individuals aged between 55 to 74 who have smoked 30-pack years or more and are continuing to smoke, and
Individuals aged between 55 and 74 years who have smoked 30 pack-years or more but have quit within the last 15 years.
During the LDCT, an individual undergoes a series of X-ray images using a low dose of radiation (less than one-fifth of the radiation dose for a standard chest CT scan, or approximately equivalent to 4-6 long haul flights) which is performed to make detailed images of the lungs. The scan only takes a few minutes and does not require any injection of contrast.
While a family history of lung cancer has been associated with a higher lung cancer risk, the role of LDCT in lung cancer screening for non-smokers with a positive family history is currently an area of ongoing research, and formal recommendations have not been made in this context.
The SingapOre Lung cancer Screening Through Integrating CT with other biomarkErs (SOLSTICE) study is the first local lung cancer screening research effort and aims to recruit both smoking and at-risk non-smoking participants. This study has started enrolment in January 2023 on SingHealth Outram campus.
If you would like to learn more about how to participate, please visit https://form.gov.sg/632c084cfa189900120b4219
Take care!
Question posted by P****
Hi Doctor,
My dad died from lung cancer at 82 years old and he never smoked and I’ve been seeing more and people die from lung cancer and they never smoked too.
The fatality rate for smokers and non-smokers seem to be about the same hence what is the real cause of lung cancer; evidently smoking may contribute but there seemed to be another vital factor causing it?
What are the chances of me (54 years old) and my children (22 and 21 years old) getting lung cancer since my dad had it?
Answered by Dr Lai :
Hi P****,
Lung cancer among never smokers is common in Asia. Associated modifiable risk factors include exposure to second hand smoke, dietary excess of meat, as well as air pollution particularly tiny PM 2.5 particles.
Family history has also been shown to be associated with the development of lung cancer, especially amongst never smoking women of Chinese ethnicity.
The growth of lung cancer in never smokers is commonly driven by a single genetic alteration in majority of these individuals. Ongoing local population research will enable us to better understand causative links between lung cancer and the Asian, never-smoker patient profile.
Question posted by F*****
Hi Dr,
When is a good time to do tests and x-ray since most lung cancer cases are detected late? Look forward to hearing from you. Many thanks in advance.
Answered by Dr Lai :
Hi F*****,
Thank you for your question. As you mentioned, many lung cancer patients are diagnosed in the late stage, as patients with early stage lung cancer typically do not have any symptoms.
The symptoms of lung cancer can also be general, such as unexplained weight loss, fatigue, cough and shortness of breath, making an early diagnosis challenging. Do see a doctor early if you have any symptoms which you are concerned about.
Your doctor will examine you for signs of lung cancer and arrange for you to undergo tests which may include a chest X-ray and CT/MRI scans to assess if there are suspicious areas that might have cancer.
Take care!
About Clin Asst Prof Gilliane Lai
Clinical Assistant Professor Gillianne Lai is a Consultant in the Division of Medical Oncology at the National Cancer Centre Singapore (NCCS), sub-specialising in thoracic, head and neck, and genitourinary cancers.
She received her undergraduate training from the Yong Loo Lin School of Medicine, National University of Singapore and is a member of the Royal College of Physicians of the United Kingdom.
Dr Lai currently leads the Lung Cancer Consortium Singapore (LCCS), and is the Principal Investigator of the National Lung Cancer Research (NLCR) study which aims to improve lung cancer care.
Ref: I23
