Lung cancer is one of the leading causes of cancer deaths in Malaysia. The five- year survival rate in lung cancer is poor because most lung cancer cases present late. Less than 5% of lung cancer patients survive after 5 years. The late presentation, leading to poor survival, is because of the similarity to other common respiratory illnesses such as chest infection. That is why early consultation is advocated especially in those who are at high risk such as smokers above 40 years old. In Prince Court Medical Centre, we have the expertise and facilities to diagnose lung cancer early.
Lung cancer is cancer of the respiratory system. It can occur anywhere in the airways or lungs. Different types of lung cancer grow at different rates. It can remain in one lung but can spread to the other. Like any other cancer it can invade other organs and parts of the body such as the bones, the liver and even the brain. Lung cancer also has a tendency to spread early.
The primary cause of lung cancer is smoking. Other factors include exposure to radiation and genetic mutation of cells in the lungs. People who never smoke may also get lung cancer, unfortunately. This could be due to certain mutation in their genes which increases the likelihood of them developing the disease.
In terms of early detection, lung cancer affliction falls broadly into two categories, i.e. those with symptoms and those without. For those with symptoms, the main ones include coughing, chest discomfort, shortness of breath and coughing up blood. Non-specific symptoms are loss of weight and appetite, night sweats and fever.
In Malaysia, it is easy to confuse symptoms associated with lung cancer with more common respiratory problems such as tuberculosis. For this reason, it is best for the patient to see a doctor for an assessment and treatment. If the symptoms persist, patients should see a specialist. GPs can help make early detection by requesting a chest x-ray and referring early, the patient with an abnormal chest x-ray result.
A recent study suggests that, especially for patients who exhibit no discernible symptoms, early detection through a procedure known as Low Dose CT Screening can cut the fatality rate by up to 20% (New England Journal of Medicine 2011:365:395-409). This facility is available at Prince Court Medical Centre and is highly recommended in consultation with the respiratory physician for those in the high risk group, i.e. smokers and particularly those who are over 50 years old and had smoked for more than 20 years. In other words, around 20 cigarettes a day for 20 years.
Prince Court Medical Centre offers the full complement of diagnostic techniques and advanced medical expertise. Skilled and highly experienced respiratory physicians in collaboration with radiologists, pathologists, cardiothoracic surgeons, oncologists and palliative care physicians to ensure that patients get high quality of care and lung cancer management. These include but are not limited to:
Bronchoscopy – inserting a tube with a camera at the end into the airways either through the mouth or nasal passage. This procedure enables real-time video feed to allow the respiratory physician to see inside the throat all the way into the air passages to look for abnormalities. Biopsies can be done through this procedure. It is very safe, minimally invasive and patients can leave the same day.
Pleuroscopy – Its an useful tool that has revolutionized the way respiratory physicians treats a condition called pleural effusion which is an accumulation of fluid outside the lung but inside the chest wall. In Malaysia, common causes include cancer and tuberculosis.
With pleuroscopy the respiratory physician uses a camera inserted into the chest to view the chest wall enabling him to maneuver in real time to get both fluid and tissue samples from inside the chest wall (pleura) for analysis. Only a small cut is made on the anesthetized patient’s side and the diagnosis is achieved without pain and discomfort. A chest tube is inserted at the end of the procedure to allow the lung to expand. The hospital stay is usually short. Pleuroscopy also allows a procedure called pleurodesis to be done. Sterile talc is instilled in cases of cancer to reduce the risk of the fluid re-accumulating. PCMC is planning to introduce this service in the future.
The Radiology Department at Prince Court Medical Centre works hand in hand with respiratory physicians to get the most accurate results in the least amount of time, so that early diagnosis can not only be made, but also alleviate the anxiety of patients and their loved ones. The radiologists work with current imaging modalities and offer timely reports to allow physicians to make the best decision for their patients. Some of the services and techniques they offer include:
CT scan – Computed Tomography (CT) scan is a technique of computer generated visuals using x-rays of the cross-sections of the body. CT scans are often employed to confirm which stage the patient’s cancer is at. Low-dose CT scan is a tool that can be employed to screen for lung cancer. In certain cases, lung cancers cannot be biopsied by conventional tools of the chest physicians. Hence, radiologists may offer help in such instance by performing a CT-guided lung biopsy.
MRI – Magnetic Resonance Imaging (MRI) involves using electromagnetic and radio waves to construct computer generated visuals of internal organs and tissues. The higher quality and detail of MRI makes this an invaluable asset in the radiologist’s diagnostic arsenal. In cases of lung cancer, it is often deployed to scan the spine and brain to see whether the cancer has spread there.
PET-CT scan – Positron Emission Tomography (PET) CT scan is a combination of nuclear medicine imaging techniques which involve the injection of radiotracers into the body, and computed tomography (CT). In cancer management, it is deployed for detecting tumour and is able to differentiate tumour from non-tumour structures.
Bone scan – Bone scan is usually done to see if cancer has spread to the bones. It can determine whether the cancer is localized or has spread to other parts of the body, therefore providing a more accurate staging system for the patient.
Once the lung cancer type and stage have been confirmed, a range of treatment options including surgery, chemotherapy, radiotherapy and best supportive care are available. The care is individualized and depends on many factors such as fitness of the patient and patient wishes. The respiratory physician would sit down with the patients and their families to decide together the best treatment plan for them.
If the cancer has advanced beyond a certain point and is no longer amenable or responsive to chemotherapy, radiotherapy or surgery then the next stage is palliative care. Here at Prince Court Medical Centre the palliative care physician becomes involved in order to guide and provide assistance for the patients, their families and loved ones in this most trying of times.
It’s all about quality of life care and the palliative care physician is instrumental in providing their best care to alleviate any symptoms that the patients may be suffering from. These would include medications, nutritional supplementation and exercises besides engaging with them on their fears and worries for the present and the future and doing all they can to make this difficult period as painless as possible. The doctors and other healthcare professionals work together to provide counseling and comfort to patients and their loved ones about the patient living their remaining days with dignity.
At Prince Court Medical Centre, patients can expect a thorough consultation with trained respiratory physicians who will review the patients’ history, perform physical examination and decide on the best course of investigation and treatment in collaboration with other healthcare professionals. The comprehensive assessment will result in individualized care that is suitable for the patient’s type of cancer, fitness to undergo treatment and their wishes. There is always consultation between doctors, patients, families and loved ones to ensure that any comprehensive care and treatment plan meets the patient’s individual needs.