What ’s the number one killer among all cancers?

Approximately 1500 people are diagnosed with lung cancer in Singapore every year.

 

Advanced stage lung cancer 

Lung cancer is the number one killer among males, and second among females in Singapore. Although it is the second most common cause of cancer deaths among females, the difference between the number of patients dying from breast and lung cancer is only 100.

Treatment Recommendations for the Different Stages of Lung Cancer

Stages 1 and 2 

  • Surgical resection, regardless of
    histological subtype

Stage 3a 

  • Chemotherapy and radiotherapy
  • Surgery
  • Subsequent chemotherapy and radiotherapy
  • Requires multi-disciplinary discussion (tumour board meetings) among Respiratory Physician, Thoracic Surgeon, Radiologists & Oncologists

Stages 3b and 4
(For histological subtypes other than adenocarcinoma)

  • Chemotherapy with or without radiotherapy
 

Diagnosis begins with a chest radiograph, as it is effective in raising any suspicion of advanced stage lung cancer. However, a chest radiograph is not an ideal tool, as it will miss cancer tumours <1 cm in size, and cannot detect early or curable stage lung cancers for potentially meaningful outcomes. Instead, chest Computed Tomographies (CTs) are the essential choice of imaging.

Once a CT has discovered the suspected lesion, the next step is to biopsy the lesion to confirm the initial diagnosis. This can be done through various techniques, with choices depending on location of lesion, patient’s preference, and the availability of skills/techniques involved. Lesions with airways leading to it are best diagnosed with bronchoscopy. Central lesions or patients with mediastinal involvement can be best diagnosed with Endobronchial Ultrasoundguided Trans-Bronchial Needle Aspiration (EBUS-TBNA). Traditionally, peripheral lesions are best diagnosed using CT-guided biopsy, as the conventional bronchoscopy for such lesions can carry high failure rates.

Recently available technology has since improved the guidance of bronchoscopy, through a 3D road map that makes it easier for physicians to reach the suspected lesion with greater accuracy and safety. 

Patients with extra-thoracic spread of cancer or pleural effusion could be diagnosed by the biopsy of the extra-thoracic site or pleural fluid analysis respectively.

Once the diagnosis is established, patients need staging because therapy is determined according to the stage of cancer. Positron Emission Tomography (PET) and MRI brain scans are ideal, and necessary for staging.

 

Early stage lung cancer 

In addition to the above-mentioned targeted therapy, a new therapy called immunotherapy is emerging rapidly, and showing significant benefits for the treatment of lung cancer.

By Adj Assistant Professor Verma Akash,
Senior Consultant,
Department of Respiratory & Critical Care,
Tan Tock Seng Hospital

For more information on lung cancer diagnosis, treatment and referral, email to Clinic4B@ttsh.com.sg.