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Lung Cancer

Learn more about lung cancer and lung cancer in Singapore – what it is, its types, symptoms, risk factors, and tests for diagnosis.

Lung Cancer

Lung cancer is the third most frequent incident cancer diagnosed in men and women in Singapore from 2017 to 2021.

Lung Cancer

Lung Cancer

What Is Lung Cancer?

Lung cancer starts when abnormal cells grow and multiply in an uncontrolled way. Lung cancer begins in the lungs and may spread to lymph nodes or other organs in the body.  If cancer begins in another part of the body and spreads to the lungs it is known as secondary or metastatic cancer in the lung.

Categories Of Lung Cancer

Lung cancers are usually grouped into two main types: small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). This is diagnosed based on how the cells look under a microscope.

Non-Small Cell Lung Cancer (NSCLC)

NSCLC is the more common type of lung cancer, comprising approximately 85% of lung cancers. It is less aggressive and spread less quickly than SCLC. If discovered early, surgery and/or radiation therapy, or chemotherapy may be used as treatment.

There are sub-types of non-small cell lung cancer. The most common are: 

  • Adenocarcinoma – begins in mucus-producing cells and makes up about 40% of lung cancers. While this type of lung cancer is most commonly diagnosed in current or former smokers, it is also the most common lung cancer in non-smokers. 
  • Squamous cell (epidermoid) carcinoma - commonly develops in the larger airways of the lung. 
  • Large cell undifferentiated carcinoma - can appear in any part of the lung and is not clearly squamous cell or adenocarcinoma. 

Small Cell Lung Cancer (SCLC)

SCLC is fast-growing, aggressive, and rapidly spreads through the bloodstream and lymphatics to other parts of the body. Though not as common, it is often advanced at diagnosis. It is usually treated with chemotherapy alone or in combination with radiotherapy.

Other Types Of Lung Tumours

Along with the main types of lung cancer, other tumours can occur in the lungs.

  • Lung carcinoid tumours: Carcinoid tumours of the lung account for fewer than 5% of lung tumours. Most of these grow slowly.
  • Other lung tumours: Other types of lung cancer such as adenoid cystic carcinomas, lymphomas, and sarcomas, as well as benign lung tumours such as hamartomas are rare. These are treated differently from the more common lung cancers and are not discussed here.
  • Cancers that spread to the lungs: Cancers that start in other organs (such as the breast, pancreas, kidney, or skin) can sometimes spread (metastasize) to the lungs, but these are not lung cancers. For example, cancer that starts in the breast and spreads to the lungs is still breast cancer, not lung cancer. Treatment for metastatic cancer to the lungs is based on where it started (the primary cancer site).

Mortality Rate For Lung Cancer In Singapore

Lung cancer has the highest mortality rate among cancers for males in Singapore and the third highest among women living in Singapore, respectively. According to the Singapore Cancer Registry’s 2021 report, lung cancer accounted for 24.8% of cancer deaths in males and 14.9% of cancer deaths in females in Singapore between 2017 – 2021.

Is Lung Cancer Treatable?

Although in Singapore lung cancer has poor survival rates, the silver lining is that lung cancer can be treated. Moreover, lung cancer treatments are continuously being improved.

Symptoms of Lung Cancer

Lung cancer does not always produce noticeable symptoms in the early stages. Because there are very few nerve endings in the lungs, a tumour could grow without causing pain or discomfort. As a result, many people are not diagnosed until the disease has advanced. However, there are a few early symptoms that do occur in some people. When symptoms are present, they may also present differently in each person.

  • A new cough that does not go away, and worsens over time.
  • Coughing up blood, even a small amount (Hemoptysis).
  • Shortness of breath, wheezing, or hoarseness.
  • Constant chest pain.
  • General weakness, tiredness, and unexplained weight loss.
  • A change in the voice.
  • Loss of appetite.
  • Headache.

Symptoms May Appear In Other Parts Of The Body

When lung cancer metastasizes (i.e., grows and spreads) to other parts of the body, it can result in symptoms that appear in those areas as well.

  • Lumps – If cancer makes it to the lymph nodes, tumours near the skin’s surface may look like lumps.
  • Horner syndrome – When tumours cause nerve damage, symptoms could affect one side of the face. Droopy eyelids or pupil reduction may occur.
  • Paraneoplastic syndrome – Sometimes cancer can produce chemicals that force other reactions in particular areas of the body. This can evoke high blood calcium levels (hypercalcemia), blood clots, or excessive bone growth.
  • Superior vena cava syndrome – Also known as SVC, the superior vena cava is a vein that moves blood from the head and arms to the heart. It also passes the upper part of the right lung and lymph nodes. Tumours can push on the SVC and cause blood to back up into the veins. In turn, this can generate swelling in the face, neck, arms, and upper chest. Other symptoms include a bluish skin colour.
  • Metastases – Sometimes lung cancer can spread to the bones, liver, brain, or spinal cord.
  • Bone – If cancer moves to the bones, it can cause pain in the ribs or vertebrae. This can also cause fractures, constipation, and loss of ability to focus.
  • Liver – When tumours make it to the liver, nausea, fatigue, swelling of the abdominal and hands, yellowing, or itchy skin can occur.
  • Nervous System – Cancer spreading to either the brain or spinal cord may cause chronic headaches, blurred or double vision, speech issues, or seizures

Who Should Consider Lung Cancer Screening?

Medical experts recommend lung cancer screening with low-dose computed tomography (LDCT) for adults who are:

  •  50 to 80 years old.
  • Have a 20 pack-year smoking history and currently smoke or have quit smoking within the past 15 years.
Screening should be stopped once the individual has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery. 

What Are The Tests For Diagnosis Of Lung Cancer?

Diagnosing lung cancer starts with a check-up with a lung specialist and a physical exam. They’ll want to go over your medical and family history and any symptoms you’re having. You will also need blood tests, scans and/or biopsies to confirm the diagnosis. The tests may include:

Imaging Tests

  • Chest X-Ray – This is usually the first test for spotting large lesions.
  • CT scan – This is used to confirm the x-ray findings. It helps in detecting smaller lesions and other pathologies, if any.
  • MRI – This is occasionally used to gauge the location and size the tumour.
  • PET CT scan – Once the cancer is confirmed or suspected, this scan is done to evaluate the spread of the disease and for purposes of staging or as a response to treatment.

Sputum Cytology

If you have a cough and currently produce sputum, looking at the sputum under the microscope can sometimes reveal the presence of lung cancer cells.

 Tissue Sample (Biopsy)

A sample of abnormal cells may be removed in a procedure called a biopsy.

Your doctor can perform a biopsy in several ways, including bronchoscopy, in which your doctor examines abnormal areas of your lungs using a lighted tube that’s passed down your throat and into your lungs.

Mediastinoscopy

In this procedure, the doctor aims to take tissue samples from the lymph nodes. This is done through an incision at the base of the neck followed by using surgical tools to take the tissue samples.

 Careful analysis of your cancer cells in a lab will reveal what type of lung cancer you have. Results of sophisticated testing can tell your doctor the specific characteristics of your cells that can help determine your prognosis and guide your treatment.

When To See A Doctor

It is advisable to consult your doctor or see a lung specialist if you notice symptoms of lung cancer. These lung specialists can also recommend strategies for quitting smoking, such as counselling, medications, and nicotine replacement products to those who are planning on quitting smoking or are unable to give up the habit of smoking.

Book A Screening Test With Us

Health365, in partnership with trusted medical providers in Singapore, Malaysia, and Thailand offers booking for lung cancer diagnostic tests.

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