1. Smoking remains one of the main causes of lung cancer. Quitting smoking at any age can help lower the risk of developing lung cancer.
2. As early-stage lung cancer may not cause any noticeable symptoms, if you have smoked for 20 or more pack years and are continuing to smoke, or have quit less than 15 years ago, you can consider undergoing a low dose CT scan to screen for lung cancer.
Lung cancer patients can expect to live longer with new drug therapy.
Lung cancer is the third most common cancer in men and third most common in women.
It is also the leading cause of cancer death in men and third leading cause of cancer death in women.
According to the Singapore Cancer Registry, from 2019 to 2023, approximately 9,700 cases of lung cancer were diagnosed in Singapore.
“Most people diagnosed with lung cancer are over the age of 40. However, the onset of the disease may be years earlier,” said Clinical Assistant Professor Teh Yi Lin, Senior Consultant from the Division of Medical Oncology at National Cancer Centre Singapore (NCCS), a member of the SingHealth group.
4 Ways to Prevent Lung Cancer
1. Primary Prevention: As smoking is one of the main causes of lung cancer, the best way to minimise the risk of developing lung cancer is to avoid smoking – If you have never smoked, don’t start.
With vaping now becoming increasingly popular, especially among the young even though it is illegal in Singapore, we asked Prof Tan if vaping causes lung cancer.
“As vaping is relatively new, its long-term impact on the risk of developing lung cancer is not yet well-established. Nonetheless, vaping devices release harmful chemicals which may damage lung tissue and lead to the development of lung cancer over time,” added Prof Tan.
2. Secondary Prevention: If you are a smoker, stop smoking. Stopping smoking at any age can help to reduce the risk of developing lung cancer. If you are non-smoker, avoid exposure to second-hand smoke.
3. Screening: If you are aged between 50 to 80 and have smoked 20 or more pack years* and are continuing to smoke or quit less than 15 years ago, you can consider undergoing a low dose CT scan to screen for lung cancer.
4. Lead a healthy lifestyle: It is also recommended to eat a diet rich in fruits and vegetables and to exercise regularly.
* Pack years are calculated by multiplying the number of cigarette packs smoked daily by the number of years smoking.
Symptoms of Lung Cancer
Lung cancer often develops silently. In its early stages, there may be no symptoms at all. As the disease progresses, patients may experience:
- Persistent cough that changes or worsens
- Shortness of breath and wheezing
- Bloodstained sputum or phlegm
- Chest pain
- Recurrent chest infections and fever
- Headaches
- Sudden and unexplained weight loss
- Loss of appetite
- General weakness and tiredness
- Bone pain
“A persistent cough, wheezing and chest pain can be caused by other conditions as well and may not necessarily indicate lung cancer. It is therefore important to consult your doctor if any of the symptoms of lung cancer persist or are bothering you,” Prof Tan said.
Seek early medical attention if one experiences breathlessness, chest pain, blood stained phlegm and unintentional weight loss.
2 Types of Lung Cancer
Lung cancer is divided into two main categories:
1. Non-small cell lung cancer (NSCLC): NSCLC accounts for approximately 85% of all lung cancers and arises from a type of cell that lines the surface of organs (epithelial cells).
2. Small cell lung cancer (SCLC): SCLC accounts for 15% of all lung cancers and is strongly associated with cigarette smoking. It grows and spreads quickly to other parts of the body.
How Lung Cancer Is Diagnosed
A combination of imaging tests and biopsy of an area of abnormal growth detected are often used to diagnose lung cancer.
Initial imaging tests
- Chest X-ray
- Computerised Tomography(CT) Scan: A CT scan can show details such as the size, shape and position of any lung tumours. It can also help detect areas where the cancer may have spread to, such as the lymph nodes , or other organs such as the adrenal glands, liver and brain.
Tests to determine stage of lung cancer
After confirming the diagnosis of lung cancer, further tests may be performed to determine the stage of lung cancer and if has spread to other parts of the body. Tests include:
- Bone Scan
- Positron Emission Tomography (PET) Scan
- Magnetic Resonance Imaging (MRI) Scan
- Mediastinal staging: In patients suspected to have stage 3 lung cancer, additional biopsy procedures may be recommended such as:
- Endobronchial Ultrasound
- Mediastinoscopy
- Video-Assisted Thoracoscopic Surgery (VATS)
Stages of Lung Cancer
Small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) are staged differently.
SCLC
- Limited stage: Cancer cells are only on one side of the chest, without spread to other parts of the body.
- Extensive stage: Cancer cells have spread to the other side of the lungs and/or other parts of the body.
NSCLC
- Stage 1-3: Cancer cells have grown into lungs at the area they originated, and may have spread to nearby lymph nodes but not to the other side of the lungs nor other parts of the body.
- Stage 4 (metastatic): Cancer cells have spread to other parts of the body away from the original lung tumour. Common sites of spread include the other lung, or the brain, liver, bone and adrenal gland.
Treatment Options for Lung Cancer
Treatment depends on the cancer type and stage, and may include:
- Surgery
- Radiation therapy
- Chemotherapy
- Targeted Therapy
These medicines target specific abnormalities (eg EGFR, ALK) in cancer cells. Examples include erlotinib,gefitinib, afatinib, osimertinib, alectinib, lorlatinib,which block specific receptors that drive cancer cell growth. - Immunotherapy
Drugs called Immune checkpoint inhibitors (ICI) help the body’s immune system recognise and destroy cancer cells. - Clinical trials – NCCS has various clinical trials available to improve outcomes of cancer patients. To find out if you are eligible, speak to your doctor.
“Ultimately, prevention is better than cure and I would strongly advise smokers to quit smoking. Quitting smoking will reduce your risk of lung cancer even if you have been smoking for many years,” says Prof Tan.
New Developments
Patients with lung cancer may now live longer thanks to improved understanding of cancer biology and new therapies.
“Traditionally, lung cancer patients would go through the first four to six cycles of chemotherapy then wait to see if the disease returned or worsened before resuming treatment,” explains Prof Tan.
Advances in histology and molecular science allow doctors to predict who benefits most from precision therapies and tailor treatment for each patient.
For patients with advanced lung cancer, targeted therapy and immunotherapy have improved survival with improved quality of life. These may be used in combination with chemotherapy.
For patients with early stage lung cancer, adjuvant targeted or immunotherapy have also reduced relapse rates and improved survival outcomes.
A select group of patients planning for curative surgery may also benefit from receiving chemotherapy together with immunotherapy before undergoing surgery, with good surgical outcomes and improved cure rates.
For suitable patients, radiotherapy using newer delivery techniques like proton therapy can reduce side effects for patients.
Conclusion
Lung cancer remains one of the leading causes of cancer-related deaths in Singapore. Early detection, accurate staging, and personalised treatment—especially targeted therapy and immunotherapy—are helping patients live longer and better.
If you experience persistent respiratory symptoms, it’s important to seek medical assessment early.
Ref: F26
Check out other articles on cancer and lung cancer:
Must-Eat Foods for Cancer Patients
Why Non-Smoking Asian Females Can Still Be at Risk of Lung Cancer
Stay Healthy the Easy Way
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