Lung Cancer

Prevention, Screening & Early Diagnosis

Dr Cheah Soon Keat, MD (Unimas), Master of Clinical Oncology (UM), Fellowship in Clinical Oncology (Houston, USA)

14th September 2017

Dr Cheah Soon Keat

Lung cancer remains one of the most lethal and aggressive cancers afflicting Malaysians. According to the The National Cancer Registry Report lung cancer is the commonest cancer afflicting Malaysian males. The cancer was diagnosed mostly in men older than 50 years of age. Unfortunately, most presented late as around 60% presented as stage 4 disease.

It is important to stress on prevention and early screening. There is a saying that prevention is better than cure. Therefore it is important to identify potential risk factors of lung cancer in order to reduce the risk of lung cancer. The non-modifiable risk factors include age and genetic factors. The modifiable risk factors are due to lifestyle and habit such as tobacco smoking. Cigarette contains various chemicals associated with carcinogenesis. As carcinogenesis may take some time, some tumours may develop many years after exposure. Other known risk factors include exposure to toxic chemicals/fumes or asbestos.

There is an increased risk in patients with concurrent underlying lung disease or chronic lung infection. A healthy holistic lifestyle not only includes eating and sleeping well and regular exercise/activity. Maintaining a good balance in spiritual and mental health is equally important as it may directly or indirectly influence our general well-being.

It is important to note the medical benefit of cessation of smoking as early as possible. Although it may be difficult to quit smoking initially, the benefits can be seen as early as weeks to months after cessation of smoking. For our patients with lung cancer, they will be able to tolerate treatment with less adverse effects. They will be able to breathe easier and able to complete their treatment successfully. 

It is important to recognize the early symptoms of lung cancer such as coughing for more than 2 weeks, blood in sputum, shortness of breath, hoarseness of voice and chest pain. Although these symptoms may be due to other illnesses, there is possibility of diagnosing the disease earlier for improved outcome. Ultimately, some patients were diagnosed incidentally while undergoing investigation for other diseases or while undergoing health screening. Certainly there a certain high risk groups who may benefit from lung cancer screening with low dose CT thorax. The American Association of Thoracic Surgery guideline identifies among those with high risk as individuals 55 to 80 years of age with history of heavy smoking more than 30 pack years. It is important to consult your physician for a consultation before embarking on such as investigations to weigh the advantages and disadvantages of the test.

The survival outcome usually measured in 5 years is markedly different among the different stages of cancer. For example, for stage I the survival rate has been quoted as about 70% whereas for stage 4 lung cancer usually the prognosis is quite poor at 1-5%. These are just statistical estimates and may not reflect the exact timeline for your disease. The common trimodality frequently used in various combinations include surgery, chemotherapy/targeted therapy or radiotherapy. It is beyond the scope of this article to discuss in detail how each and every component of these modality may be used. However, what I would like to highlight here is the avenue for new breakthrough in cancer therapy in the past few years culminating in the introduction of immunotherapy as potential therapy in stage 4 lung cancer. In fact, cancer immunotherapy was recognised as Science magazine ‘Breakthrough of the Year for 2013’. This strategy works by harnessing the body’s own immune system to fight tumors. At the moment, several drugs are currently approved to treat certain subgroups of stage 4 lung cancer. Let us not forget that many diseases cannot be cured. Certainly, for patients with advanced cancer and too weak for active treatment, palliative and hospice care plays an important role to relief any form of suffering. These caregivers will be able to make home visits for those too ill or wishes to continue supportive care at home with their family members.

In summary, every person should be more proactive and cognizant of lung cancer. Identified and treated early, there is a higher potential for cure. Doctors hold steadfast to the axiom ‘to cure sometimes, to relieve often, to comfort always’.