Lung Cancer Diagnosis & Treatment in Singapore
What Are the Lung Cancer Treatments in Singapore?
Lung cancer, considered one of the most common cancers worldwide, is commonly caused by tobacco smoke or other air-borne pollutants. There is, however, a rising trend of even non-smokers being afflicted by the disease.
The approach to lung cancer treatment is dependent on a variety of factors including the type, severity and stage of the cancer, as well as the condition of the patient. There have been many advances in medical approaches for lung cancer in recent years, including treatment for lung cancer (stage 4) which has been diagnosed at a late stage (where the cancer cells have spread). Patients are advised to seek professional medical help as soon as possible.
Depending on the stage and where the cancer is located, your lung cancer specialist or medical oncologist in Singapore may recommend any or a combination of the following treatments:
Surgery
Early-stage lung cancer (stage 1 or stage 2), which has not spread to organs beyond the lungs may be potentially cured by surgery. With lung cancer surgery, tumours and the lymph nodes nearby will be removed.
Possible surgical procedures for lung cancer patients include:
- Lobectomy: Surgery to remove a section of the lung.
- Pneumonectomy: Surgery to remove the entire lung.
Radiation Therapy
Radiation therapy (also known as radiotherapy) is an approach that helps to shrink or destroy lung tumours with high-energy rays. This may damage the molecules within the cancer cells, potentially destroying the abnormal cells. Lung cancers, which are considered to be advanced but have not spread to other parts of the body (locally advanced), and where lung cancer surgery is not possible, radiotherapy in combination with chemotherapy may be recommended. In some cases, this may be followed by immunotherapy.
Chemotherapy
Chemotherapy refers to lung cancer treatment using specially developed medication. They are usually administered via injection or drip. Chemotherapy helps by preventing the potential division of cells. As a result, the cancer may not continue to grow and get destroyed.
Targeted Therapy
Targeted therapy, as the term implies, refers to drugs that help block specific cancer-inducing process that promotes the growth and spread of lung cancer. This form of treatment is recommended for patients whose cancer cells express specific abnormalities, which helps destroy cancerous cells while sparing other healthy cells.
Immunotherapy
Immunotherapy is another approach to addressing lung cancer that helps to activate the immune system to recognise and kill cancer cells. It may be recommended to certain patients as a stand-alone treatment or combined with chemotherapy.
Are There Any Side Effects of Lung Cancer Treatment?
Side Effects of Surgery
Potential side effects and complications of lung cancer surgery may include post-operative pain, infection, and bleeding.
Side Effects of Radiation Therapy
Possible side effects of radiation therapy for lung cancer include the following:
- Nausea
- Tiredness
- Pain on swallowing
- Breathlessness
- Skin pigmentation
Side Effects of Chemotherapy
Possible side effects of chemotherapy for lung cancer include:
- Drop in blood counts (transient)
- Lowered immunity
- Nausea and vomiting
- Diarrhoea or constipation
- Tiredness
- Loss of appetite
- Hair loss
- Skin and nail changes
- Numbness and tingling
- Body aches
Side Effects of Targeted Therapy
Targeted therapy may cause less severe side effects compared to other forms of lung cancer treatment. Side effects of targeted therapy may include:
- Nausea and vomiting
- Diarrhoea or constipation
- Bloated feeling
- Mouth ulcers
- Rash and other skin changes
- Vision problems
Side Effects of Immunotherapy
Immunotherapy typically has fewer side effects compared to chemotherapy. However, there are sometimes less predictable and more serious side effects that the doctor or lung cancer specialist will discuss with you. Some of the side effects of immunotherapy may include:
- Diarrhoea
- Nausea or vomiting
- Rash, dry and itchy skin
- Headaches
- Tiredness
- Hormonal imbalances
- Rarely, organ inflammation
Oncologists at OncoCare with Clinical Interests in Lung Cancers
If you suspect that you or your loved one has lung cancer, it is advisable to get the support you need. Early detection and diagnosis of lung cancer are key to treating the disease.
Regardless of what stage your lung cancer may be, you are advised to schedule an appointment with a lung oncologist as soon as possible and to learn more about lung cancer diagnosis and lung cancer treatment in person.
Our team of cancer doctors in Singapore specialise in lung cancer treatment and will be able to guide and advise you based on your condition. Other than lung cancer, we also offer advice on different types of cancer, including stomach, lymphoma, and kidney cancer. Whether you seek an initial diagnosis, a treatment plan, or a second opinion, our oncologists offer the support and expertise you need.
Senior Consultant, Medical Oncologist
MBBS (Singapore) – MRCP (United Kingdom))
Dr Tan Chee Seng is interested in lung/thoracic and head/neck cancer. Dr Tan has also authored multiple publications in international journals such as Lancet Oncology, Clinical Cancer Research, Molecular Cancer, Lung Cancer, Oncotarget, Target Oncology, Journal of Cancer Research and Clinical Oncology, Journal of Translational Medicine, and Journal of Oncology Practice.
He has been invited to speak at local and regional oncology meetings and has also held public talks about the latest innovative treatments for cancer. Dr Tan has also received several grants including National Medical Research Council (NMRC) Clinician Investigator Salary Support Programme and Investigational Medicine Unit (IMU) Bridging Funds.
- Graduated from the National University of Singapore in 2005
- Obtained Membership of the Royal College of Physician (United Kingdom) in 2007
- Awarded ASEAN Scholarship (1998-2000) and KUOK Foundation Scholarship (2000-2005)
- Awarded prestigious AMDA Academic Medicine Development Award (AMDA) (2014-2015) for fellowship training at Addenbrooke’s Hospital Cambridge University, United Kingdom on personalization of treatment for lung cancer
- Clinical lecturer, Yong Loo Lin School of Medicine, National University of Singapore from 2012-2018
- Director of Undergraduate (Medical Oncology), Yong Loo Lin School of Medicine, National University of Singapore from 2012-2018
- Assistant Professor Yong Loo Lin School of Medicine, National University of Singapore from 2016-2018
- Invited as examiner for Yong Loo Lin School of Medicine final year MBBS examinations
- Authored or co-authored publications in peer-reviewed international journals including Lancet Oncology, Clinical Cancer Research, Molecular Cancer, Lung Cancer, Oncotarget, Target Oncology, Journal of Cancer Research and Clinical Oncology, Journal of Translational Medicine, and Journal of Oncology Practice
- Recipient of several grants including National Medical Research Council (NMRC) Clinician Investigator Salary Support Programme and Investigational Medicine Unit (IMU) Bridging Funds
- Member of several professional bodies including American Society of Clinical Oncology (ASCO), European Society of Medical Oncology (ESMO), International Association for the Study of Lung Cancer (IASLC) and was an executive committee member of the Singapore Society of Oncology
- Sub-specialty oncology interest in thoracic/lung (small cell and non-small cell lung cancers, mesothelioma) and head/neck cancers (including nasopharyngeal carcinoma, NPC)
Senior Consultant, Medical Oncologist
MBBS (Singapore) – M.Med (Singapore) – MRCP (United Kingdom) – FAMS (Medical Oncology)
Dr Leong has been working in the Department of Medical Oncology, Singapore General Hospital / National Cancer Centre since 1995. She has provided cancer care for patients with breast cancer, colorectal cancer, stomach cancer, lung cancer, head & neck cancer, ovarian/uterine/cervical cancers, lymphomas and other solid tumours.
Dr Leong has also been involved in teaching. She was a Clinical Lecturer for medical students, involved in undergraduate teaching as well as teaching for junior staff and nurses. Dr Leong’s subspecialty interests are in lung cancer, thyroid cancer and head & neck cancer.
- Graduated from the National University of Singapore
- Obtained Master of Medicine (Internal Medicine) and Membership of the Royal College of Physicians (United Kingdom) in 1995
- Awarded the Ministry of Health Manpower Development Programme (HMDP) Scholarship HMDP for further training, with special focus on Thoracic Oncology under Dr Mark Green at Holling’s Cancer Centre in 1997. In 2000, she obtained Specialist Accreditation in Medical Oncology as well as European Society of Oncology (ESMO) certification
- She was the Director of the Ambulatory Treatment Unit at National Cancer Centre and was the Chairperson of the Code Blue Team
- She has been actively involved in clinical and translational research for many years, in lung cancer and head and neck cancer
- Research work by Dr Leong has been published in both local and international reputable journals including Journal of Clinical Oncology, Chest, Cancer and has written book chapters for the staging and treatment of lung cancer
What is Lung Cancer?
Lung cancer occurs when abnormal cells located in the lungs start to grow uncontrollably. As these cancerous cells grow, they may interfere with the function of normal cells in the lungs and may affect your ability to breathe. In advanced stages, the cancerous cells may spread to lymph glands around the airways and other parts of the lungs and body, including the bones, brain and liver.
There are two major types of lung cancer: Small Cell Lung Cancer (SCLC), which makes up about 10-15% of all lung cancer cases, and Non-Small Cell Lung Cancer (NSCLC). Lung cancer is often caused by cigarette smoking. Exposure to other environmental pollutants may also have a causative role.
What Are the Signs and Symptoms of Lung Cancer?
Many patients with lung cancer will not notice any symptoms until the cancer has spread. However, depending on the location of the cancer, some patients may develop early warning symptoms and signs.
If you or a family member experience any of the following symptoms, it is advisable to visit a lung cancer specialist early so that you can be screened, diagnosed and treated where needed. The outcome of treatment is likely to be better if the cancer is diagnosed earlier.
The most common symptoms of lung cancer are:
- A cough that does not go away or gets worse over time
- Coughing up blood or sputum (spit or phlegm) stained with blood
- Chest pain, which may be made worse with deep breathing or coughing
- Hoarseness of voice
- Breathlessness
- Infections such as bronchitis and pneumonia that won’t go away or keep coming back
- New occurrence of wheezing
In more advanced stages where the cancer has spread to other organs, patients may also experience the following symptoms:
- Loss of weight and appetite
- Persistent or worsening headache, dizziness, weakness or unsteadiness
- Bone aches
- ‘Lumps’ in the neck
Screening for Lung Cancer in Singapore
The goal of lung cancer screening in Singapore is to detect cancer at its earliest and most treatable stage. The need for specific screening tests is based on your age, gender, a history of smoking. If you feel that you may have a high risk of developing lung cancer but show no signs or symptoms of the cancer, you may consider consulting a specialist.
If indicated, the doctor may arrange for a Low-Dose Computed Tomography (LDCT) chest scanning. This imaging allows the visualisation of any lung tumours but has less radiation than a standard scan.
What Are the Types of Lung Cancer?
There are two major types of lung cancer:
- Non-Small Cell Lung Cancer (NSCLC): These account for most of the lung cancers diagnosed. They tend to be slower-growing tumours and include Adenocarcinoma (the commonest cell type) and squamous cell carcinoma.
- Small Cell Lung Cancer (SCLC): These cancers usually affect patients who have a history of smoking. These cancers are aggressive and will require treatment urgently.
What Are the Causes and Risk Factors of Lung Cancer?
A risk factor is anything that may increase your likelihood of developing a disease such as cancer. Several risk factors may make you more likely to develop lung cancer:
- Lifestyle habits, particularly smoking of tobacco products
- Exposure to radon (a radioactive gas)
- Exposure to asbestos
- Exposure to other cancer-causing agents in the workplace: radioactive ores such as uranium, inhaled chemicals or minerals such as arsenic, beryllium, cadmium, silica, vinyl chloride, nickel compounds, chromium compounds, coal products, mustard gas, and chloromethyl ethers
- Diesel exhaust from vehicles
- Air pollution
- Arsenic in drinking water
- Previous radiation therapy to the lungs
How is Lung Cancer Diagnosed?
If a specialist or medical oncologist suspects the presence of lung cancer, specific imaging scans and biopsy will be needed to confirm (or rule out) the diagnosis of lung cancer.
Radiological Imaging for diagnosis and assessment may include:
- Chest XR
- CT (Computed Tomography) scan or PET (Positron Emission Tomography) scan
- Bone scan
- MRI (Magnetic Resonance Imaging) of the brain
Tests to diagnose lung cancer include:
- Tissue testing may be recommended to confirm a diagnosis of lung cancer. There are different ways to obtain tissue for analysis:
- Pleurocentesis: If there is fluid around the lungs, this fluid can be extracted using a needle and sent to the laboratory for testing.
- Bronchoscopy: A scope is inserted through the nose or mouth into the airways to obtain tissue, which is then examined for cancer cells in the laboratory.
- Transthoracic Needle Aspiration Biopsy: A biopsy needle is inserted directly into the lung tumour to extract cells/tissue under CT scan guidance.
- Open Biopsy: If the tumour is in an area that is difficult to reach by needle, a biopsy may be performed via a limited surgery.
What Are the Stages of Lung Cancer?
The stage of lung cancer indicates how far the cancer has spread to other parts of the body. Staging helps cancer specialists decide the potential course of treatment for each patient. Regardless of the stages of lung cancer, early detection and diagnosis can potentially improve the outcome for patients.
Non-Small Cell Lung Cancer (NSCLC)
- Stage 1: Cancer is confined to the lung.
- Stage 2: Cancer is found in the lung and adjacent lymph nodes.
- Stage 3: Cancer is found in the lung and lymph nodes in the middle of the chest (mediastinum).
- Stage 4: Cancer has spread to other parts of the lungs or organs outside the lungs.
Small Cell Lung Cancer (SCLC):
- Limited stage: During this stage, the cancer is found on one side of the chest. It may be in one part of the lung or affect lymph nodes nearby.
- Extensive stage: At this stage, the cancer cells may have spread to other regions of the chest or other parts of the body.
