Lung Cancer: What a Thoracic Surgeon Wants You to Know

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Lung cancer is a deadly global disease that kills 1.5 million people every year. In Malaysia, it is the third common cancer, with approximately 2,000 new cases diagnosed annually, and remains the number one cancer killer, responsible for one in every five cancer-related deaths. Sadly, despite such alarming statistics, general awareness remains poor.

Programmed cell death (or apoptosis) is a normal physiological process essential for living. In cancer, there is a loss of apoptosis, and uncontrolled cell growth leads to the formation of a tumour. Malignant tumours are cancerous growths that can aggressively invade surrounding tissues and can spread via the bloodstream or lymphatics to distant locations elsewhere in the body.

Unfortunately, most people (90%) diagnosed with lung cancer already have an advanced stage tumour. Early stage (stage I and II) tumours carry a better prognosis and curative treatment (surgery) can usually be offered. Advanced tumours (stage III and IV) have a worse prognosis, carry a poor survival rate, and a cure is usually not feasible.

As a thoracic (chest) surgeon, I would like to share my Four S Strategy for trying to win this war on lung cancer: Smoking cessation; Sign and Symptom awareness; Screening and Surgery.


Smoking is the single most important yet modifiable risk factor for developing lung cancer, as 90% of lung cancer victims are smokers or ex-smokers. The risk increases the more often and longer one has been smoking, while quitting can reduce this risk considerably. Smoking cessation clinics and nicotine replacement therapy (inhalers, patches, and gum) are widely available in most developed countries including Malaysia. Lung cancer can also develop nonsmokers via passive smoking, as cigarette

smoke contains over 7,000 chemicals. More smoke-free zones must be created and strictly observed; it is your right and responsibility to ensure you and your family are not inadvertently exposed to hazardous, second hand smoke.


An increased awareness of the early signs and symptoms of lung cancer is vital. A persistent cough (beyond two weeks), coughing up blood (haemoptysis), recurrent chest infections, unexplained weight loss, or breathlessness are all possible symptoms and warrant investigation.


The earlier lung cancer is diagnosed, the better the chance of a cure and hence the better the prognosis or outcome. The five-year survival time for a treated, stage I lung cancer is approximately 70-80%, while a stage IV tumour has a 5-10% five-year survival rate. Unfortunately, most cases are diagnosed too late. Current guidelines recommend screening for men aged 50-75 years who have been smoking a pack or more a day for approximately 20 years and also for individuals with a family history of lung cancer.

Recent advances in radiological imaging and new research has raised hopes for detecting lung cancer early and has been shown to save lives. The National Lung Screening Trial (USA) found a 20% reduction in the mortality risk by screening “high risk” individuals for lung cancer with a yearly computed tomography (CT) scan for three years. CT scans are six times more likely to detect an early (small) tumour than a traditional, old fashioned chest X-ray. The challenge is to determine who should be screened, as it is not cost effective or feasible to screen entire populations, plus screening must be done in a systematic and scientific manner or it can lead to “false positive” test results.


For early stage tumours, surgery provides the best chance of a cure, provided the patient is fit enough to withstand the operation. Surgery is only contemplated after meticulous assessment and methodical investigation. The operation involves removing the part of the lung that contains the tumour although, occasionally, the entire lung must be removed.


Surgery is not appropriate for advanced stage lung cancers that have already spread to surrounding lymph glands or metastasised to distant organs such as the brain or liver. Palliative chemotherapy or radiotherapy is the treatment of choice for such patients.


If you, a family member, work colleague, or friend have any of the symptoms outlined above then seek a medical opinion urgently; it could save your life. Similarly, if you or anyone you know falls into that “high risk” group, a CT scan could be a good idea. Above all else, quit smoking or, better yet, don’t start. Lung cancer is largely preventable in many cases and should be detected earlier to offer the best outcome. An increased awareness is a necessary first step.


Dr Anand Sachithanandan is a UK-trained and board-certified adult cardiothoracic surgeon with an interest in lung cancer.


Source: The Expat November 2012

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