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Dr Chin Tan Min, Senior Consultant, Medical Oncology explained how women can take charge of their health by increasing awareness of lung cancer prevention, detection and treatment, in a talk at the Empowering Women Webinar.

Lung cancer is a common disease, with over 8,000 cases diagnosed in Singapore between 2015–2019¹, and over 2 million cases worldwide². It is known as a disease of the elderly, as the incidence of lung cancer increases with age, with those aged 65 and above at the highest risk of developing the disease³.

Lung cancer can affect anyone, including smokers and non-smokers. While it is commonly thought to be a male-predominant disease, lung cancer can also affect women. In fact, lung cancer is the third most common cancer in both Singaporean men and women, and one of the leading causes of cancer deaths.

Signs, symptoms and diagnosis of lung cancer

Like many cancers, lung cancer does not show signs at the early stage, only presenting when it is more advanced and has affected other parts of the body.

The signs and symptoms of lung cancer are similar between men and women. Some common symptoms include:

• Persistent cough
• Chest pain
• Shortness of breath
• Loss of weight and appetite

If these symptoms are persistent (lasting about 3–4 months), or you are a smoker or have a family history of cancer, see a doctor for further evaluation.

Doctors will generally conduct an X-ray, CT scan and a biopsy to confirm the lung cancer diagnosis and determine the primary site of the tumour. They will then stage the cancer to determine whether the disease is localised or has spread to other parts of the body.

Treatment options for lung cancer

There are no gender-specific differences when it comes to lung cancer treatment. Rather, treatment is dependent on the patient’s individual disease profile.

The main treatment modalities for lung cancer are surgery, radiation therapy and systemic treatment such as chemotherapy.

Patients with localised disease may be offered curative surgery, where the tumour is removed either through wedge resection (in which a small, wedge-shaped piece of lung tissue is removed), lobectomy (in which one of the lobes of the lungs is removed) or pneumonectomy (in which one of the lungs is removed).

In recent years, keyhole surgery (also known as minimally invasive surgery, where small incisions are made to access the tumour) is also applicable for certain types of lung cancer, offering faster recovery to patients without compromising effectiveness.

Patients with localised disease may also be offered radiation treatment for curative or palliative intent.

Patients with metastatic disease are offered chemotherapy to control the cancer.

Many patients tend to be concerned about side effects commonly associated with chemotherapy, such as hair loss, nausea and vomiting. Fortunately, the treatment has evolved over the years with new chemotherapy agents and good supportive medicine to help patients manage such side effects.

The only downside of chemotherapy that remains is that it acts on actively dividing cells, which can cause patients to be immunocompromised and at risk of infections. However, the benefits outweigh the risks, and antibiotics can be given to help patients manage possible infections.

The next wave of lung cancer treatment

Treatment advances over the last two decades have given rise to new treatment options such as targeted therapy and immunotherapy.

The discovery of mutations in certain lung cancer patients in the mid-2000s have enabled us to identify corresponding medication that targets the specific mutation to control the cancer. From the EGFR mutation to ALK, ROS, k-RAS, HER2, RET and B-RAF amongst a growing list of targets, targeted therapy drugs that target these mutations allow us to treat patients harbouring these mutations with minimal side effects.

The emergence of immunotherapy also offers lung cancer patients a new treatment option to harness the patient’s own immune system to control the cancer.

Because of this, treatment is now more personalised. Doctors will assess a patient’s age, condition, general health and tumour profile to prescribe the most appropriate treatment. By doing so, doctors can offer patients more effective treatment tailored to their individual disease profile.

The outlook

In the past, the survival outlook for patients with advanced lung cancer was low, with a survival rate of about 6 months.

Fortunately, with the emergence of new treatment advances, things are looking up for patients with the disease.

The incidence of lung cancer is on the decline, with fewer deaths in both men and women. Thanks to treatment advances over the last two decades, survival rates, disease control, and management of side effects have greatly improved, and patients generally have better quality of life. About half of patients survive at the 3- to 4-year mark when treated with targeted therapy. Meanwhile, 30–40% patients treated with immunotherapy have good disease control at the 5-year mark.

For the oncologist, this is an exciting time as there are now many treatment options that can make a positive difference to patients. For patients, this brighter outlook brings much hope that treatment can add many more meaningful years to their lives with little pain and side effects.

Great progress has been made over the last two decades in our fight against cancer. Whether men or women, the only thing as relentless as cancer is our commitment to fighting cancer.

¹ Singapore Cancer Registry Annual Report 2019

² World Health Organization, Cancer Fact Sheet 2020

³ Singapore Cancer Registry Annual Report 2019