MU/SE Magazine: 肺癌的十大医学误区 Top 10 Misunderstandings About Lung Cancer

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Channel 5 Let's Talk About Health: Coughing - Is It Good, Is It Bad, Lung Health and The 100 Day Cough

The Straits Times: Robotic surgery for lung cancer - Innovative approach may offer shorter recover time 2023

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10 Medical Myths About Lung Cancer Answered By a Lung Specialist

Introduction

Lung cancer happens due to excessive and uncontrolled cell division of cells in the lung, resulting in the growth of tumours. There are 2 major types of lung cancer—non-small cell lung cancer (NSLC) and small cell lung cancer (SCLC).

In Singapore, lung cancer is the second most common type of cancer among men and the third most common among women. It is also the most common cause of cancer death worldwide.

Here are 10 medical myths about lung cancer, answered by a lung specialist:

Myth #1: “Only smokers can get lung cancer”

While lung cancer has always been thought to have been mainly associated with people who smoke, there is now a significantly higher proportion of non-smokers among those diagnosed with lung cancer in Singapore.

A 2018 study by the National Cancer Centre Singapore (NCCS) showed that 48% of people diagnosed with non-small cell lung cancer were actually non-smokers, and the trend has been rising, especially in non-smoking women.

Myth #2: “I’ve smoked for years, there’s no point stopping now”

Smoking cessation is always a good thing, no matter how many years you have smoked. Damage and risks associated with tobacco smoking usually have a cumulative effect, and sequelae of smoking may only manifest many years later.

Quitting smoking as soon as possible will help to minimise your health risks in the future, and may also halt the progression of any lung and organ damage that has already occurred. In fact, after smoking, your lungs start to heal and regenerate. For example, the cilia (tiny hair-like structures that line the lungs) start to regain normal function in weeks to months.

Myth #3: “If you have lung cancer, it doesn’t pay to quit smoking”

No matter which stage you are at in your health journey, quitting smoking is beneficial for your health. In fact, when you have lung cancer, your treatment plan will require surgery or chemotherapy and/or radiotherapy. This will require you to maintain your health well to minimise side effects of these treatments and ensure they are the most effective they can be. Continuing to smoke increases the chance of recurrence in a previously treated cancer.

If lung cancer is detected early, there is as high as an 80% chance of cure (Stage I). Early diagnosis may also make you eligible for a minimally invasive thoracic procedure, which entails faster recovery and a shorter hospital stay.

Myth #4: “Lung cancer surgery causes cancer to spread”

A properly done operation will not spread lung cancer. A thorough lung surgeon, along with advancements in equipment and detailed imaging tests, makes this risk very low.

Lung cancer surgery is usually done to remove the tumour from the lungs, and to ensure that all of it is removed, a small sliver of normal lung tissue is usually removed together with the tumour to make sure nothing is left behind.

Myth #5: “I don’t have symptoms, so I don’t have lung cancer”

Lung cancer may be very insidious, and signs and symptoms typically only present in the late stages of the disease. In fact, only around 20%-25% of lung cancers are detected early.

Early lung screening involves a low-dose CT scan, which allows your doctor to detect asymptomatic lung cancer.

Myth #6: “Lung cancer is definitely terminal”

Not all lung cancers are diagnosed during end-stage disease. In some cases, patients maybe cured completely after surgical removal of the tumour. This is especially so if the cancer is detected in its early stages.

Myth #7:“Smoking is the only risk factor for lung cancer”

Other environmental risk factors aside from tobacco smoking include second-hand smoke exposure and air pollution. Chemical exposure to substances such as asbestos and occupational hazards for those working in chemical industries.

Myth #8: “A polluted environment poses a greater risk for lung cancer than smoking”

Although both smoking and air pollution is linked to lung cancer, smoking remains the biggest risk factor for lung cancer.

Myth #9: “I am too old to receive lung cancer treatment”

Nobody is too old to receive treatment. In fact, elderly patients are candidates for cancer treatment for all types of cancers. Whether or not you are eligible typically depends on your medical background and overall health condition.

Myth #10: “Switching to e-cigarettes (vaping) reduces my risk of lung cancer”

E-cigarettes typically contain substances such as nicotine and other toxic chemicals, which can still damage the lung and increase the risk of lung cancer. It is also important to note the long-term effects of vaping are still being studied, and it is advised to err on the side of caution. A better alternative would be to stop smoking completely, and not use e-cigarettes as a replacement, as they are still harmful to health.

Summary

Overall, lung cancer is very common, and understandably, there are many misconceptions surrounding the topic. However, because of its prevalence, it is important to be well-informed.

In Singapore, lung cancer screening is not part of the general population-level cancer screening regimen yet. However, lung cancer screening may be recommended by some doctors for those with risk factors such as having a ≥20 pack-year (1 pack year refers to smoking an average of 1 pack of cigarettes per day, for a year) smoking history, in the elderly, or those who have been regular smokers anytime within the last 15 years, people with a family history of lung cancer, and people with a history of other cancers. Lung cancer screening may be done using a low-dose computed tomography (LDCT) scan, which can help to take detailed images of the lungs to help look out for any tumours.

References

Blaha, Michael Joseph. “5 Vaping Facts You Need to Know.” Johns Hopkins Medicine. Accessed 31 January 2023.

Lung Cancer Among People Who Never Smoked | CDC” Centers for Disease Control andPrevention. Accessed 31 January2023.

Lung cancer-Symptoms and causes” Mayo Clinic, 22 March 2022. Accessed 31 January 2023.

Risks of Cancer Surgery” American Cancer Society, 2 October 2019. Accessed 31 January 2023.

Why is Robotic Surgery in Singapore More Efficient?


Robotic surgery (also known as robotic-assisted surgery), is the most advanced form amongst the minimally invasive surgery (MIS) platform – procedures performed through keyhole incisions (8mm) on the body. Robotic surgery is the most advanced type of MIS and is used in place of surgeries that were once traditionally done by open methods, i.e. ones that involve making a big incision on the body. Here at ICTS, robotic lung resection is the preferred modality used for patients who will be undergoing lung resections.

Robotic surgery in Singapore consists of a system that includes one robotic arm with a camera attached to it, as well as several mechanical arms with surgical instruments attached to them. These arms are thin, long, and hollow tubes that are inserted into the body through the small incisions made on the surgical site. The surgeon will then control these arms through a computer console located near the operating bed. The console allows the surgeon to get magnified views of the surgical site in high-definition, thereby allowing them to perform complex procedures with great precision. Other members of the surgical team will also be present during the operation to assist the main surgeon.

Is robotic surgery more effective?

Given the nature of robotic surgery, many surgeons who use the robotic surgery system have found it to be more precise and accurate as the use of mechanical arms allow surgeons to move with greater precision, range of motion, and control compared to doing the surgery with their own hands. The use of the stereoscopic 3D video camera also allows better visualisation of the surgical site with high-definition views that will be seen in the console (has better magnification than the naked eye and provides surgeons with greater depth perception of the surgical site). Given the greater depth perception, precision, range of motion and control, robotic surgery is also very accurate.

Furthermore, from a patient’s perspective, given the minimally invasive nature of robotic surgery, there is also a lower risk of complications such as bleeding, pain, infection, and scarring. Since the incisions are also smaller, patients will also have a shorter recovery time and shorter hospital stay. Having a shorter recovery time enables the patient to get back to their normal lives as soon as possible or to head further onto oncological treatment for their lung cancers.

Why is Robotic Surgery In Singapore More Efficient

What is the success rate of robotic surgery?

Based on a study conducted in 2019, overall survival rates following lung resection for early-stage lung cancer was 86.1% with robotic surgery and 83.2% for open surgery, demonstrating that robotic surgery is a safe and feasible technique that can bring about comparable long-term and progression-free survival rates. 

Why do patients prefer robotic surgery?

Advantages vs Disadvantages

The advantages of robotic surgery are many, with the main one being that it enables surgeries to be carried out in a minimally invasive manner with smaller incisions created in the body. This allows for lower risk of surgical complications such as bleeding, infection, and pain, and also allows for shorter hospital stays and recovery times. There is also smaller scars after recovery.

Furthermore, through the use of the robotic surgery system, robotic surgery allows surgeons to have better visualisation of the surgical site as well as the ability to perform the surgery with greater precision through the use of mechanical arms.

Disadvantages of robotic surgery include:

Can everyone undergo robotic surgery? 

Anyone can undergo robotic surgery as long as the indication for the surgery is correct. In fact, some patients who may not be a candidate for surgery by open methods, will become candidates on the robotic platform due to the minimally invasive nature of this procedure.

So the decision to undergo robotic surgery depends on indication, fitness for surgery and the discussion with your surgeon, who will determine if the robotic platform is suitable for your case. 

Summary

Robotic surgery is a new type of MIS that is effective, cost-effective, and more accurate. Here at ICTS, Dr Aneez is trained in robotic surgery to treat many lung conditions. To find out if robotic surgery is an option for you, do come to our centre and we will answer any doubts and queries that you may have, in addition to deciding the best treatment modality should you need one.

References 
Spaggiari, Lorenzo, et al. “A Brief Report on Survival After Robotic Lobectomy for Early-Stage Lung Cancer.” Journal of Thoracic Oncology, Journal of Thoracic Oncology, 19 August 2019, https://www.jto.org/article/S1556-0864(19)30666-5/fulltext. Accessed 8 December 2022.

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Reasons Why You Would Be Referred To A Thoracic Surgeon

What is a Thoracic Surgeon?

A thoracic surgeon is a doctor who operates on the heart, lungs, oesophagus, and major blood vessels within the chest/thorax, in addition to bony structures and tissues that form the chest cavity. Thoracic surgeons treat an entire spectrum of both benign and malignant conditions in the chest.

A thoracic surgeon may specialise in areas such as adult cardiac surgery, paediatric heart surgery, or general thoracic surgery, which can cover organs such as the lungs, chest wall, etc. Thoracic surgery is an overall broad discipline that encompasses many fields of medicine. 

Thoracic surgeons in Singapore are doctors who have obtained medical degrees and who have undergone further postgraduate training to train in the field of thoracic surgery. During the course of their specialist training, thoracic surgeons will often obtain further postgraduates qualifications such as a Masters of Medicine and a Membership of the Royal College of Surgeons (MRCS) specialist certification, which is obtained after passing the MRCS, an intercollegiate exam for surgical trainees. 

What Conditions Does a Thoracic Surgeon Treat?

A thoracic surgeon is able to treat many different types of conditions that may be related to the organs and tissues found in the chest wall, such as the heart, lungs, oesophagus, and chest wall reconstruction. Such disorders include but are not limited to: 

Reasons to See a Thoracic Surgeon

In Singapore, you may be referred to see a thoracic surgeon if you experience the following symptoms:

Overall, there are many reasons that you or a loved one may require a consult with a thoracic surgeon. 

Any illness, medical condition, accident, growth, or disease in the chest area may require the expertise of a thoracic surgeon who will be able to diagnose your condition and recommend ideal treatment options for your condition.

What to Expect from the Thoracic Surgeon

Prior to your consult with a thoracic surgeon, it would be good to come prepared with information on your medical history, as well as a list of all the medications you are currently on, as well as to have a clear, concise, and accurate list of all your relevant medical histories, including any past surgeries or admissions. 

During the consult, the surgeon will first take a medical history from you and review your medical records. They will ask you for a list of your current symptoms, and your medical history, as well as explore more about you and your background to help to understand your overall health situation better. Following this, they may perform a physical examination which includes listening to your heart and lungs, as well as taking your blood pressure. In addition, you may also be sent for further diagnostic testing such as a chest x-ray or an ECG.

After the consult, your thoracic surgeon may suggest more conservative forms of treatment for your condition. A detailed discussion about the operation, including its benefits, risks, alternatives, and complications, will be brought up, and you will be able to explore the whole array of treatment options that have been offered to you. You will also be briefed more on the surgical; procedure itself, and this can include finding out more about its indication, aims, recovery time, etc. 

At the International Centre for Thoracic Surgery, Dr Aneez will discuss your condition and work with you in creating a personalised treatment plan that best suilts your needs.

What is the most common thoracic surgery?

Currently, the most common thoracic surgeries in Singapore are usually done to treat lung cancer, whereby surgery is done to remove the cancer, as well as to obtain tissue samples from the lungs for further testing. Cardiac surgeries such as heart valve replacements and coronary artery bypass grafts (CABGs) are also done for many patients who have heart conditions such as coronary artery disease.

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A Guide To Understanding And Treating Chylothorax In Singapore

 

A Guide To Understanding And Chylothorax In Singapore3

What is Chylothorax?

The lymphatic system plays a key role in helping to maintain fluid levels in our tissues, fat and protein transport, and optimising the function of our immune system through the transport of inflammatory cells throughout the body. 

The lymphatic system filters and drains lymph fluid from all over the body, including through our chest and thoracic cavity. When the lymphatic system is blocked, or if a part of it leaks, the normal flow of lymph fluid is obstructed. This can result in leakage of lymph fluid or a collection of lymph fluid within the body cavity.

Chylothorax, also known as a chylous effusion, is a rare condition where lymphatic fluid, or chyle, collects in the thin spaces around the lungs (the pleural space). Chylothorax can occur in one lung or both lungs and is caused by an abnormal circulation of lymphatic fluid. When there is a little fluid within the pleural space, symptoms may not be present. However, as the fluid builds up, chylothorax can result in symptoms such as:

What is the most common cause of Chylothorax?

Chylothorax occurs when there is a disruption to the normal flow of lymph through the lymphatic vessels, resulting in leakage of chyle out of the vessels and into the pleural space. There are many causes of chylothorax, including: 

Is Chylothorax life-threatening?

Chylothorax is a serious and potentially fatal disease if not treated in time. This is because chylothorax can lead to sequelae such as respiratory distress when a significant amount of fluid accumulates in the lungs as the flow of air and oxygen in the lungs gets obstructed by the lymph fluid. This can lead to rapid deterioration and can be fatal, especially in the case of traumatic chylothorax, where there is an injury to the main lymph vessels. 

Other complications of chylothorax include malnutrition, immunosuppression, and dehydration. The rates at which these complications develop depends on how quickly the chylothorax accumulates, its size, and how long the chylothorax has been in the lungs. 

How do you treat Chylothorax?

A Guide To Understanding And Chylothorax In Singapore2

Chylothorax treatment in Singapore depends on the underlying cause. Here at ICTS, the management of chylothorax is divided into 3 primary phases:

The mainstay of initial management would be to treat the underlying cause of chylothorax to prevent further management. This includes management of the primary medical condition such as heart failure and ensuring good cancer control in lung cancer patients who have developed chylothorax as a result of the tumour growth.

Medical management of a chylothorax includes putting a drain in the chest to drain fluid from the pleural space. Another treatment option involves medications administered directly into the bloodstream. 

Patients usually need to be fasted before carrying out an intercostal chest drain. This helps to decompress the lungs and reduce pressure within the pleural space, thereby helping to restore lung function. Patients with large chylothoraces may also require some nutritional support as chylothorax can lead to a loss of proteins and electrolytes within the body. 

At ICTS, there are several procedures that can be done for chylothorax. These include robotic surgery, video-assisted surgery, and open thoracic surgery. Surgery is done to repair any damage to the thoracic duct and to seal the defect. 

Surgery is often indicated in cases such as post-traumatic chylothorax and cases of chylothorax which do not respond to other treatments. Sometimes, a shunt may also be done in rare cases to allow the drainage of fluid to other parts of the body. 

Can Chylothorax go away?

Chylothorax can be cured, and the long-term outlook, with proper management, is good. Treatment of the underlying cause of chylothorax can help provide a cure to patients. 

How long can you live with Chylothorax?

You can live with a chylothorax, although the risks of complications are high, and if there is no treatment, the chylothorax can progress and result in a condition that is potentially life-threatening. As such, it is important to seek early management of chylothorax and to treat its underlying cause.

If you experience any of the aforementioned symptoms, please visit your thoracic surgeon for a proper diagnosis and a personalised treatment plan. 

References:

Adams, Sasha D., and BS Anand. “Chylothorax: Background, Etiopathophysiology.” Medscape Reference, 20 November 2020, https://emedicine.medscape.com/article/172527-overview. Accessed 5 September 2022.

“Chylothorax - StatPearls.” NCBI, 24 January 2022, https://www.ncbi.nlm.nih.gov/books/NBK459206/. Accessed 5 September 2022.

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Oesophageal Cancer Symptoms To Look Out For

oesophageal cancer singapore

Oesophageal cancer refers to the uncontrolled growth of cells in the oesophagus or gullet. It is the sixth most common cause of cancer death worldwide.

Who Is at Risk of Oesophageal Cancer?

A risk factor refers to anything that increases your risk of getting a disease. With regards to oesophageal cancer, there are several risk factors:

However, it is important to note that having a risk factor does not automatically mean you will get cancer, and not having any of the risk factors does not mean you will not get cancer. It is important to talk to your doctor if you think you may be at risk.

Signs and Symptoms of Oesophageal Cancer

signs of oesophageal cancer singapore

When oesophageal cancer gets more advanced, several symptoms may result as the cancer becomes bulkier and begins to obstruct the oesophagus. Sometimes, cancer may also invade nearby structures and result in symptoms.

Signs and symptoms to take note of include:

Experiencing pain or difficulty when swallowing

When the tumour gets advanced and begins to obstruct the oesophagus, you may experience a phenomenon known as dysphagia, which refers to difficulty swallowing. There may also be pain when swallowing, which is referred to as odynophagia.

Oesophageal cancer is rapidly progressive, and dysphagia may occur suddenly, and progress very fast. Typically, you may first experience some difficulties with swallowing solid foods, and this difficulty may progress to being unable to swallow liquids, leading to regurgitation of fluids that you ingest. Dysphagia due to oesophageal cancer is a mechanical cause, and the severity of the dysphagia typically depends on how large the tumour is. As such, if you experience difficulty swallowing/feel, there is an obstruction, this should be a warning sign.

Indigestion and heartburn

When there is cancer in the oesophagus, you may begin to experience some slight discomfort in the chest as the cancer may lead to heartburn and indigestion. Other symptoms include abdominal pain, acid reflux, and general discomfort in the upper abdomen.

Chest pain, pressure, or burning

Sometimes, oesophageal cancer may also cause chest pain. This chest pain is chronic and usually feels like a pressure or a burning sensation in the middle of the chest. This typically occurs when the swallowed food reaches the part of the oesophagus where the tumour is growing and may occur a few seconds after swallowing. The pain gets more noticeable as cancer further develops.

Unexplained weight loss

Many with oesophageal cancer develop unexplained weight loss. Cancer is an anabolic process, and the growth of the tumour often takes up a large amount of energy expenditure. This is why people often lose weight, as the growth of cancer causes the body to have an energy deficit. In oesophageal cancer, eating difficulties may also cause people to lose weight, as they are unable to swallow their food. Loss of appetite may also happen in cancer, thereby resulting in poorer oral intake.

Coughing or hoarseness

Having a hoarse voice that sounds scratchy and does not go away may be a sign of oesophageal cancer.

Summary

Hopefully, this short guide has helped you better understand oesophageal cancer and the signs and symptoms to look out for. Oesophageal cancer is treatable. However, this largely depends on the size, type and location of the tumour, as well as your general health. If you experience any of these symptoms, please visit an Oesophageal cancer specialist in Singapore for a proper diagnosis and treatment plan.