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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:
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.
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.
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.
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.
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.
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.
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.
Although both smoking and air pollution is linked to lung cancer, smoking remains the biggest risk factor for lung cancer.
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.
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.
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.
Robotic surgery (also known as robotic-assisted surgery), is the most advanced form of surgery in Singapore 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.
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.
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.
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:
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.
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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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.
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:
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.
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.
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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