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Lung Cancer

Lung cancer is the commonest cancer in Hong Kong. In 2021, there were 5 978 new cases, accounting for 15.5% of all new cancer cases in Hong Kong. The male to female ratio was about 1.4 to 1. The crude annual incidence rate of lung cancer was 81 people per 100 000 Hong Kong population, with a median age at diagnosis of 70 years for males and 68 years for females. Lung cancer was also the leading cause of cancer deaths in Hong Kong. In 2021, a total of 4 037 people died from this cancer, accounting for 26.7% of all cancer deaths.

Detection of lung cancer in its early stages can increase chances of cure. However, most of the patients are not diagnosed until the lung cancer is in metaphase or advanced stage, thus making it more difficult to cure. Therefore, people at high risk of lung cancer such as smokers and those who are frequently exposed to secondhand smoke should be ever vigilant for respiratory diseases in order to increase chances of cure via early discovery. According to the Cancer Registry statistics, the overall five-year relative survival rate with lung cancer was 21.8%. The five-year relative survival rates were 72.4% at stage I, 45.4% at stage II, and 24.6% at stage III. Stage IV lung cancer had a five-year relative survival rate of 7.8%.

What is Lung Cancer?

Lung cancer is a malignant tumour developed in the lower part of the respiratory system including cells in the bronchus and bronchiole wall.

Who have higher chance of having Lung Cancer?

The risk factors for lung cancer include:

  • Smoking. 90% of lung cancer cases are related to cigarette smoking. Having a long-term history of smoking started at young age would further increase the risk of getting lung cancer.
  • Aged 50 or above.

What are the symptoms of Lung Cancer?

Any of the following signs and symptoms could indicate lung cancer:

  • Prolonged fatigue.
  • Poor appetite and weight loss.
  • Persistent cough.
  • Wheezing.
  • Sputum with blood.
  • Chest pain: vague pain or agonizing pain in the chest when coughing or taking a deep breath.
  • Patients with more advanced lung cancer may also experience the following: scrofulous swelling of the neck, face and hand; abdominal distention, bone pain, headache, partial epilepsy or hemiplegia (paralysis of one side of the body).

Prevention

Cigarette smoking is the most important risk factor for lung cancer. Other risk factors include:
  • Increasing age
  • Exposure to secondhand smoke
  • Air pollution, including outdoor and indoor
  • Occupational exposure to certain carcinogens (e.g. radon, asbestos, etc.)
  • Previous lung diseases (e.g. chronic obstructive pulmonary disease)
  • Family history of lung cancer, especially with a first-degree relative

To reduce the chance of getting lung cancer, members of the public are recommended to:

  • Quit smoking or never start smoking
  • Avoid secondhand smoke
  • Minimise occupational exposure of carcinogenic substances by adhering to occupational safety and health rules (e.g. use of protective gear)

Screening

Taking into consideration the available international scientific evidence and local actual situation, the Government’s Cancer Expert Working Group on Cancer Prevention and Screening has made the following recommendations on lung cancer screening which serve as general reference for doctors to provide individualised advice on lung cancer screening in local population:

1.

Primary prevention is the most important strategy for reducing the risk of developing lung cancer. Current smokers should quit smoking and non-smokers should never start smoking.

For asymptomatic population at average risk

2.

Routine screening for lung cancer (including chest X-ray, sputum cytology, or low-dose computed tomography (LDCT)) is not recommended for asymptomatic persons at average risk.

For symptomatic persons at increased risk

3.

There is currently insufficient data to assess the benefit vs harm and cost-effectiveness of LDCT screening and its associated criteria such as target groups and optimal screening protocol in the local setting. Based on overseas literature, asymptomatic persons with heavy smoking history (i.e., more than 20-30 pack-year* and who either currently smoke or have quit for not more than 10-15 years) that put them at increased risk of lung cancer may benefit from LDCT screening. In the majority of overseas recommendations, the usual starting and finishing age for screening is 50-55 years and 74-80 years respectively, and screening is most commonly performed annually or biennially. Since the local applicability of these criteria has not been sufficiently characterised, persons with heavy smoking history are advised to discuss with their doctors the benefits and harms (including false-positive findings and potential follow up investigations) of LDCT screening before making an informed and individualised decision.

4.

Screening for lung cancer with chest X-ray or sputum cytology is NOT recommended.

* pack-year = multiply number of packs of cigarettes per day by number of years smoked

How to investigate and make diagnosis for Lung Cancer?

While smokers should have regular chest checkups, people having any of the aforesaid symptoms should also visit the doctors promptly. Diagnostic tests for lung cancer include the following:

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    Chest x-ray

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    Sputum cytology examination (sample of sputum being examined under a microscope to check for abnormal cells)

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What are the treatments for Lung Cancer?

Treatments for lung cancer may include surgery, external radiotherapy, chemotherapy and other supportive measures for palliation such as laser, internal radiation therapy, and medicines. Single or combined modalities treatments may be used depending upon the patient’s general health status.

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    Surgery

    This treatment method offers the best chance of cure for patients who have early-stage lung cancer that has not spread beyond the lungs. The curative rate of surgery stands at more than 60% among patients in the earliest stage of disease. The volume of resection depends on the status of the malignant tumour. The operation may involve the removal of a tumour together with some surrounding tissue, while some may involve removal of a whole lobe or even one whole lung.

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    External radiotherapy

    This may be given as curative therapy of early-stage lung cancer for patients who are not suitable for surgery because of being too old or having other diseases. Radiotherapy will be useful for destroying cancer cells in patients if there is local spread of tumour, surgically irremovable cancer cells left after operation, or symptoms caused by cancer spread (such as bone pain and brain metastases).

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    Targeted therapy

    This targets at specific molecules involved in a certain tumour type. It causes fewer side effects than traditional chemotherapy by having less impact on hematopoietic stem cells or the immune system. It is suitable for a certain specific type of metastatic lung cancer patient.

What are the complications of Chemotherapy or Targeted therapy?

  1. Chemotherapy

  2. Targeted therapy

    Targeted therapy may cause side effects such as skin rash, mouth sores or diarrhea. Please strictly follow medical advice in using this type of treatment.

How to take care of Lung Cancer patient?

The following are some important notes for patients during rehabilitation after surgery, radiotherapy or anticancer drug treatment:

  1. Regular checkups

    Surgery and drug treatment may lead to a partial or even complete relief from symptoms of lung cancer. However, lung cancer has a relatively high chance of recurrence. This is largely due to the fact that most patients are not treated until their cancer have worsened and disseminated, thus affecting the success rate of curative. Patients should persist in regular subsequent visits to allow close monitor of progress. If cancer recurs, treatment can also be given promptly and hence increase the chance of survival.

  2. Reminders on daily lifestyle

    • Stop smoking.
    • Ensure good ventilation at home.
    • Do appropriate exercises to improve lung function.
    • Stay away from crowded and air-polluted public areas to avoid respiratory infection.
  3. Diet

    • Increase intake of food that contains substantial amount of vitamins A and C such as carrot, grape, and pear, etc.
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Bronchoscopy

  1. Introduction

    Bronchoscopy is a procedure that a thin and flexible endoscope is passed through the nose or mouth or through a breathing tube (endotracheal tube or tracheostomy tube) directly into the major airway. It enables the doctor to perform examination of the trachea and bronchus under direct vision.

  2. Preparation before the procedure

    • Blood tests including blood gases will be checked by blood taking.
    • Eating or drinking might not be allowed for certain period of time before the procedure according to patient’s condition.
    • Dentures should be removed if it was not done already.
  3. The procedure

    • Patient is kept in face-up position.
    • Supplementary oxygen is given.
    • The bronchoscope is inserted through the nose, mouth or breathing tube, and passed into the windpipe then the bronchial tree for examination. The procedure can be used in obtaining sputum specimen or lung tissue for testing, or during treatment.
    • Airway irritation resulting in coughing may happen.
    • Depending on the route of insertion of the bronchoscope, nostrils and throat may be sprayed with local anaesthetic agent before the procedure to reduce discomfort. Sedative drugs may be administered when necessary.
    • Patient’s vital signs (e.g. blood pressure, pulse rate and oxygen saturation) are closely monitored.
    • If patient is intolerant to the procedure or occurrence of side effects or complications. The doctor may terminate the procedure.
  4. After the procedure

    • Depends on the doctor’s decision, there would be a period of fasting after the procedure.
    • Chest x-ray might be taken after the procedure to look for any complication related to the procedure.
    • Feeling of sleepiness or dizziness may occur if sedation is given during the procedure. Bed rest for a few hours is recommended.
    • Mild sore throat and coughing with blood stained sputum may be expected for a short period of time.
  5. Risks and complications

    • General risks include discomfort during procedure (e.g. cough, sore throat) and side effect of sedative drugs (e.g. sleepiness, dizziness, drop in blood pressure) or local anaesthetic agent.
    • Specific risks include:
      • Pneumothorax.
      • Bleeding from lung/trachea/bronchus.
      • Worsening of patient’s respiratory condition.
      • Risk of infection.
  6. Remarks

    For further information please contact your doctor.