Primary lung cancer is a type of cancer that begins in the lungs. It is the 2nd most common cancer in men in Malaysia before colorectal cancer in 1st place and after prostate cancer in 3rd place.

Click to view CancerResearch UK video on Lung Cancer

Symptoms

Early lung cancers do NOT have much symptoms.  Unfortunately, over 90% of lung cancers present late at stage 3 or 4 when the symptoms appear.  These symptoms include;

• A persistent cough that does not go away
• Coughing up blood (haemoptysis)
• Hoarseness or change of voice
• Shortness of breath (due to obstruction or fluid in the lungs)
• Unexpected loss of weight or appetite
• Tiredness and fatigue
• Pain on breathing
• Bone pain (from cancer spread to the bone)

Risk factors

• Smoking (which damages the cells lining the lungs) is a significant risk factor
• Exposure to secondhand smoke (by family members or friends who smoke in your presence)
• Previous radiation therapy
• Exposure to asbestos or other carcinogens
• Severe air pollution
• Family history of lung cancer

Types of primary lung cancers

• Small cell carcinoma
• Non-small cell carcinoma (this is the most common type accounting for 70-80% of lung cancers and includes squamous cell, adenocarcinoma and large cell carcinoma)

Click to view You&Your Lung video on Staging of Lung Cancer

Staging of Lung Cancer

Stage 1. The cancer is confined to the lung tissues

Stage 2. The cancer has spread to the lung wall or lymph nodes

Stage 3. The cancer has spread to nearby organs such as the heart, trachea or oesophagus

Stage 4. The cancer has spread beyond the lungs to other areas such as the liver, brain or bone

Credit. JohnWayneCancerInstitute

Tests and Diagnosis

You will be required to undergo a series of tests to 1) get a diagnosis of Cancer Cell Type and 2) determine the extent or spread of the lung cancer to provide a Staging of the Cancer.  The tests may include the following;

• Blood tests (to check your blood count as well as liver and kidney function)
• Chest X-ray and/or CT scan to determine the size and location of the lung cancer
• PET-CT scan is an imaging test which uses a radioactive tracer to look for small areas of cancer which may have spread outside the body or to other parts of the lung
• Bone scan to look for any cancer spread into the bones
• MRI scan to look for cancer spread to other organs

Tissue biopsy is required to remove a small piece of cancer from the lung so that the pathologist can identify the cancer cell type. The biopsy can be done using

• Bronchoscopy internal biopsy
• Ultrasound or CT Scan guided external biopsy
• Endobronchial Ultrasound Biopsy (EBUS)
• Transbronchial Needle Aspiration (TBNA)
• Thoracoscopy (where a scope is inserted between the ribs into the chest)

Prognosis

The prognosis and treatment options depends on the following factors

• Lung cancer cell type
• Stage of the lung cancer
• Patient’s age, health and other medical conditions

Discuss with your lung specialist and oncologist on your treatment options

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