Lung cancer has become a very common disease around the world, with 14.1 million new cases diagnosed each year.
Malaysian statistics also show that this cancer is prevalent in our country. In 2014, there were over 4,000 cases of lung cancer, with a mortality rate of 80%.
It is also worrying that lung cancer is one of the most common cancers in Malaysian men (Globocan, 2012).
Generally, there are two main types of lung cancer: non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC).
The majority of lung cancer cases in Malaysia are NSCLC, specifically the subsets adenocarcinoma and squamous carcinoma – with the former being more common.
“Lung cancer is responsible for more deaths than breast, prostate and colon cancers combined,” said Dr Tho Lye Mun, consultant clinical oncologist at Sunway Medical Centre (SunMed).
It isn’t surprising to find that the most common cause of lung cancer is cigarette smoking.
The cancer-causing compounds and toxins in cigarettes change the lung tissues and damage the cells there, causing cancer to develop.
However, smoking isn’t the only cause of the disease.
“Fifty per cent of my patients with lung cancer have never smoked or are only light smokers,” explains Dr Tho.
Pollution, chemical exposure and genetic factors also play a part in causing lung cancer.
“People who work in factories or are exposed to dyes, chemicals or asbestos in the roofing industry, may have a higher risk of lung cancer through inhalation,” he says.
There is also emerging data that potentially links lung cancer to pollution, but more studies need to be done.
Statistics from Europe suggest that people exposed to pollution may be at risk, but a strong causal link has yet to be been determined, according to Dr Tho.
Seeing a doctor early
A major challenge that oncologists such as Dr Tho face when it comes to treating lung cancer is late stage diagnosis.
Cancer is often detected in patients at a late stage and this makes it more difficult to treat.
Lung cancer is more prevalent in men and Dr Tho feels that this may be a reason for the late diagnosis.
“Men tend to brush things off or leave it for another day, compared to women who may feel a lump in their breast and would go see their healthcare provider,” he says.
The symptoms of lung cancer are also not always clear and this may contribute to someone not seeking medical help early.
Common symptoms such as coughing, weight loss, chest pains and tiredness, can often be confused for other diseases.
Patients may not have all the symptoms as well.
“I would emphasise that if someone has a persistent cough, coughing up blood, persistent shortness of breath, chest pains that don’t go away with painkillers, or unexplained weight loss of more than 5%-10% of body weight, he/she should see a healthcare provider with the view to exclude lung cancer,” he says.
Screening for lung cancer
What is a good way to test if you have lung cancer?
Would going for a blood test for cancer markers help?
Not really, says Dr Tho. “There are too many false positives and false negatives with blood markers.”
A better would be to go to your healthcare provider and do a proper cancer screening.
Doctors would take note of the symptoms and try to find out the cause. They would check to determine if the symptoms are from a simple infection or a more serious condition such as tuberculosis, which is endemic in Malaysia.
Next, the patient may undergo a scan such as an x-ray, Computed Tomography (CT) scan, Positron Emission Tomography (PET)-CT Scan, and a biopsy may be done.
“I would say a minority of those with symptoms would actually have cancer.
“They may end up with a more common variety problem such as an infection,” Dr Tho says.
When lung cancer is detected
“We would usually do a PET-CT scan, as a staging tool,” he says.
This is standard procedure for patients who are considering curative treatment such as surgery or radiotherapy.
The PET-CT scan is an ultra-sensitive scan, more sensitive than a CT scan when it comes to detecting lung cancer in the body.
Staging determines the progression of the cancer and the necessary treatment.
Usually, the majority of patients would be at a late stage (stage 3 or 4) because of a late diagnosis. This means the tumour is either too advanced or has spread to the brain, bones or lymph nodes.
The conventional next step is chemotherapy, and this comes with side effects.
The good news
“In the modern era, I would say about half of our patients do not need to undergo chemotherapy because we now have other treatments,” says Dr Tho.
One of the new treatments available is targeted therapy that usually comes in the form of pills or tablets that patients take once or twice a day.
Radiotherapy is another possible treatment for those with early stage lung cancer. Using a state-of-the-art machine called Truebeam STX, tumours can be burnt away externally, similar to a laser.
He continues, “There is no need for any invasive needle placements unlike other technologies.
“We have patients who drive here in the morning for the treatment and drive home later in the day.”
The side effects are also a lot less severe compared to surgery.
Using immunotherapy in treating cancer
In the past, the chances of survival for those with stage 3 and 4 lung cancer have not been good.
Only about 5% survive five years after the cancer diagnosis, Dr Tho explains.
“With immunotherapy, we are getting about 26% survival at three years after diagnosis for a particularly aggressive group of lung cancer and the numbers are improving every year,” he says.
Unlike radiotherapy, targeted therapy and chemotherapy, which are designed to find the cancer cells and destroy them, immunotherapy works to build up the body’s immune system to get rid of the cancer cells.
“There have been patients who failed chemotherapy and other therapies, but found that immunotherapy improved their condition,” explains Dr Tho.
While the benefits of immunotherapy are evident, it is crucial that patients not be fooled by fake forms of this therapy.
There are many companies out there who sell products and treatments that purport to be immunotherapy, but they do not work.
The Malaysian Oncology Society and its Singaporean counterpart are concerned about the proliferation of these non-genuine therapies, and have been vocal about this, hoping to educate the public, says Dr Tho.
“In Malaysia, there are plenty of such ‘therapies’,” cautions Dr Tho.
These non-genuine immunotherapy treatments are often promoted as being effective without clinical trials or any evidence to back them up.
Seeking alternate therapy
After a cancer diagnosis, it is understandable that a patient would be fearful.
They often want more treatment options and this is when they may seek out alternate therapy.
“That’s fine,” says Dr Tho. “But I advise that they also seek the opinion of an oncologist well versed in genuine lung cancer treatment to see what they have to offer.
“Patients don’t need to accept everything, but they do need to have a frank and open discussion on the options, risks and benefits.”
Seeking alternate therapy may hurt a patient’s chance of getting timely treatments.
Also, alternate therapy may be costly. Dr Tho relates a case where a patient spent RM30,000 a month on supplements that didn’t work.
“From a small tumour that was potentially curable, it developed into a very extensive stage 4 tumour that was incurable. And this was after six months of spending RM30,000 a month,” he says.
The bright side
“The perception that we only have very toxic and limited types of treatments in cancer is no longer the case,” says Dr Tho, who is very optimistic about the future of lung cancer treatment.
Toxic treatments that affect the quality of life for patients just isn’t the case anymore.
Dr Tho suggests talking to an oncologist because new and better treatments are always developing.
“I have seen huge changes in the field of cancer treatments in the last 10 years, and I can’t imagine where the next 10 years will lead us.”