Lung cancer is the third most common cancer in Singapore. It is also the leading cause of cancer death in men, and the third in women. Early detection saves lives and leads to better long-term outcomes. New treatment options have also improved the survival rate of patients with advanced lung cancer in Singapore over the past two decades. 

Dr Gillianne Lai, a consultant in the Division of Medical Oncology at the National Cancer Centre Singapore, explains thedisease and what can be done aboutit. 

Q: How does lung cancer occur and does it only affect smokers?

Lung cancer occurs when lung cells acquire changes whichcause them to grow uncontrollably.These abnormal cells can spread to other parts of the body through blood and lymphatic vessels. Lung cancer types vary with different rates of growth, which influences the type of recommended treatment. 

While smoking remains the most important modifiable risk factor, more non-smokers have been diagnosed with the disease in the past decade. Lung cancer in non-smokers is common in Asia, where genetic alteration drives the abnormal growthof cancer cells in many of these cases. 

Q: What are the symptoms of lung cancer?

Patients with early stage lung cancer often do not have any symptoms. This is why many of them are diagnosed in the late stage - when cancer cells have spread to other parts of the body. 

Symptoms, when present,can also be general, such as unexplained weight loss, fatigue, cough and shortness of breath.

Q: What tests will your doctor order if you experience symptoms that are a concern?

The doctor will ask about your medical history and possible risk factors, examine you and may refer you to a lung specialist,if necessary.

Imaging tests may include a chest X-ray and CT/ MRI scans to assess potentially cancerous areas or 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 and classify the type of lung cancer. 

Taken together, this information will be used to decide the stage of the cancer and treatment. 

Q: What are the treatment options available?

Lung cancer may be managed with one or more of these treatments: 

  • Surgery, which aims to remove part or all of the affected lung 
  • Radiotherapy, which is the use of high energy X-rays to destroy cancer cells 
  • Chemotherapy, which uses drugs to kill cancer cells 
  • Targeted therapy, which targets specific genes to control the growth of cancer cells 
  • lmmunotherapy, which activates the body's immune system to recognise and attack cancer cells 

A multidisciplinary team of doctors,which may include a cardiothoracic surgeon, radiation oncologist and medical oncologist,will work together and decide which treatmentis most appropriate for each patient. 

Dr Gillianne Lai
Division of Medical Oncology
NationalCancer Centre Singapore