While lung cancer shares the stage with colon cancer as the common form of cancer in men, lung cancer has a higher mortality rate because it is often detected too late, says Dr Anand Sachithanandan, consultant cardiothoracic surgeon at Subang Jaya Medical Centre.
“In Malaysia, at initial presentation and diagnosis of lung cancer, only 3% of people are in stage one and 7% in stage two. The remaining 90% of lung cancer patients were diagnosed in either stages three or four.”
He adds, “According to the Malaysian Study on Cancer Survival 2018, the five-year relative survival rate for lung cancer across all stages is 11%. Hence, lung cancer is the worst performing of all cancers, and the median time of survival after being diagnosed is only 6.8 months.”
Spreading The Word
“From the results of several local surveys, it was noted that around 90% of people know that smoking causes lung cancer, which is good. However, 50% to 60% of participants mistakenly think only men get lung cancer, and about 70% think that lung cancer is a communicable disease,” says Dr Anand.
“These results tell us that awareness on lung cancer in Malaysia is still quite low. We need to help the public be more aware of the disease, so they are better informed to self-refer earlier on to medical professionals should they feel something is wrong.”
For primary care doctors, Dr Anand has some advice, “These doctors see many patients with various ailments daily, hence some may overlook the differential diagnosis of lung cancer and provide patients with ‘normal’ treatments such as cough mixture or antibiotics.
“Doctors need to be more aware and think more about the possibility of lung cancer so they can do thorough checks and refer their patients to a specialist.”
Receive The Right Care
When it comes to treatment, Dr Anand emphasises the need for early detection of lung cancer. “There are two goals when treating lung cancer. The goal of treatment for early stage cancer is curative, where we hope to cure the patient.
For curative treatment, Dr Anand recommends surgery as the best treatment option if the patient is fit enough, as it will remove the cancerous part of the lung. “It is the best chance to cure the disease, and it presents the patient with his best chance for long-term survival.”
After surgery, follow-up screenings are done for a minimum of five years to ensure total eradication of the cancer from the body.
Multimodality in treatment is practised, as some patients require further treatment before or after surgery such as chemotherapy and radiotherapy to ensure complete tumour clearance and minimise the chances of recurrence.
Patients with later stages of lung cancer will usually be treated with palliative or symptomatic intent, where treatment focuses on controlling the tumour.
Rarely is surgery performed to relieve the patients of their pain or distressing symptoms, such as if the tumour is eroding into the chest wall, they are coughing up blood, and they have fluid around their lungs.
Changing Minds, Changing Lives
Recent policy changes passed by the government to ban smoking from eateries and restaurants show that efforts are being made towards increasing public awareness on the dangers of smoking.
Dr Anand also provides some advice to reduce the risks of lung cancer:
♦ Non-smokers should know that they have the right to inhale smoke-free fresh air.
♦ Make a sincere and concerted effort to quit smoking. Better still, don’t start smoking in the first place.
♦ Eat in moderation and exercise regularly.
♦ Go for health screenings.
However, he recognises that prevention itself is not enough as there is still a problem with stigma and misconceptions relating to lung cancer, which affects the way the public and even doctors view lung cancer patients.
He explains, “There is the common assumption that all lung cancer patients are smokers, and that they have brought it upon themselves. Our role is not to judge, but to treat these people. While we can advise them against smoking, this is not the right time to chastise them for smoking.”
Dr Anand adds that people have to realise that an increasing number of non-smokers and women are getting lung cancer. Some factors include:
♦ Cooking with a wok
Cooking fumes at high temperatures in a confined space may contribute to lung cancer.
♦ Second-hand smoke
Long-term exposure to second-hand smoke inadvertently makes people passive smokers.
♦ Third-hand smoke
Cigarette residue on furniture and surroundings may also cause lung cancer.
He continues, “We should not be complacent because anyone could get lung cancer depending on our lifestyle choices or genetic predisposition. The only things you can do is to not smoke, live a healthy lifestyle, and go for screening if you are in a high-risk group.”