September 2, 2019

Lung Cancer—what you need to know

What is lung cancer?

Lung cancer is a type of cancer which starts in the lungs, but may spread to other areas of the body. It is one of the most common cancers in Malaysia. Lung cancer patients in Malaysia are often only diagnosed at late stages of the disease; it is resposible for nearly a quarter of all cancer deaths in the country. Lung cancer is the most common cause of cancer death among Malaysian males and the second most common cause of cancer death among Malaysian females (after breast cancer).

Types of lung cancer

There are a few different types of lung cancer, although non-small cell lung cancer and small cell lung cancer comprise the majority of lung cancers.

Non-small cell lung cancer (NSCLC)

There are several different subtypes of NSCLC, which include adenocarcinoma, squamous cell, and large cell carcinoma. Being the more common form of lung cancer, it affects between 80-85% of all lung cancer patients. NSCLC is considered a less aggressive cancer and may not invade the surrounding tissues.

Small cell lung cancer (SCLC)

SCLC comprises of between 15-20% of lung cancer cases. It is the more aggressive type of lung cancer and is less likely to respond to treatment.

Persistent coughing is one of the symptoms of lung cancer. Patients may also experience general symptoms such as loss of appetite and fatigue.

Symptoms of lung cancer

Lung cancer patients may exhibit symptoms related to the respiratory system, as well as general symptoms. Symptoms include persistent coughing, wheezing, coughing up bloody mucus, difficulty swallowing, shortness of breath, chest pain, loss of appetite and unexplained fatigue.

The symptoms for NSCLC and SCLC are largely similar. Patients with SCLC, however, may exhibit symptoms of fatigue or weight loss, due to the aggressive spread of SCLC. Regardless, many patients do not experience (or ignore) early symptoms of lung cancer. As a result, lung cancer is frequently only detected at the late stages, when the cancer is no longer operable.

Tobacco smoking is a major risk of lung cancer. Most Malaysian male cancer patients have a significant smoking history.

Risk factors for lung cancer

An extensive history of tobacco smoking (more than 30 pack-year) is frequently associated with development of lung cancers. The smoking prevalence in Malaysia is rather high: around 50% of adult Malaysian males are smokers. This is reflected in the lung cancer patient profile in the country, in which just over 90% of male lung cancer patients have a significant smoking history.

Other than a first-hand smoking habit, exposures to second-hand smoke, sources of radiation, carcinogenic chemicals (e.g. asbestos, soot, tar) or air pollution are also considered preventable risk factors of lung cancer. Non-preventable risk factors include having a family history of lung cancer and increased age (especially people between 55-80 years old).

How is smoking history calculated?

The extent of a person’s smoking history is assessed using “pack-years”. This unit is defined as the number of packs of cigarette smoked per day multiplied by the number of years of smoking history. For example, a 30 pack-year smoking history indicates a one pack a day for 30 years’ worth of tobacco smoking, or two packs a day for 15 years, and so on.

What can you do if a family member or close friend gets diagnosed with cancer?

Finding out a cancer diagnosis in a loved one is never easy, let alone for the patient receiving the diagnosis. There are many ways one can support their loved ones:

  • Help them in their cancer treatments: If you are a close family member or caregiver, your loved one might appreciate you accompanying them to doctors’ appointments. These appointments might get overwhelming; help them keep up with their appointments and treatments, take good notes and get any questions answered on their behalf. However, let the patient do most of the talking with the doctor. You can follow up with the doctor separately if you have additional concerns, provided your loved one has agreed to your doing so.
  • Be a listening ear: It might be difficult to find the words to say to someone who has cancer. The best way to communicate may be a genuine expression from the heart (“I’m sorry that you are going through this, and I am here if you need me”). Offer support and be encouraging, and try to listen if they need to talk about their fears, concerns or sadness.
  • Respect their privacy: Do not share the cancer diagnosis with others, unless you have the permission to do so. It may take a while for a patient to come to terms with their diagnosis, and they may prefer to tell others on their own.
  • Treat them as normally as possible: Include your loved one in normal activities, plans and social events. Let them decide and tell you if they aren’t up to committing to these activities.
  • Take care of yourself: Staying at the best of health will help you be a better caretaker to your loved one. You should eat right, exercise regularly and get enough sleep. Take advantage of the support offered by people around you, and don’t hesitate to reach out if you need a break from caregiving.

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References

  1. Ministry of Health Malaysia. National strategic plan for cancer control programme, 2016-2020.pdf. http://www.moh.gov.my/index.php/dl/554756755a584a6961585268626938794d4445334c314a31616e567259573476546d46306157397559577866553352795958526c5a326c6a5831427359573566516d39766131396d61573568624541794e564e46554651794d4445334c6e426b5a673d3d. Accessed 4 October 2019.
  2. Kan CS, Chan, KMJ. A review of lung cancer research in Malaysia. Med J Malaysia. 2016;71(1):70-8.
  3. Medical News Today. Small cell vs. non-small cell lung cancer—what are the differences? Available at https://www.medicalnewstoday.com/articles/316477.php. Accessed on 31 July 2018.
  4. Healthline. Everything you need to know about lung cancer. Available at https://www.healthline.com/health/lung-cancer. Accessed on 31 July 2019.
  5. American Lung Association. Three important actions to take for World Lung Cancer Day. Available at https://www.lung.org/about-us/media/press-releases/world-lung-cancer-day.html. Accessed on 31 July 2019.
  6. NCI Dictionary of Cancer Terms. Pack year. Available at https://www.cancer.gov/publications/dictionaries/cancer-terms/def/pack-year. Accessed on 4 October 2019.
  7. American Lung Association. Helping with lung cancer treatment. Available at https://www.lung.org/lung-health-and-diseases/lung-disease-lookup/lung-cancer/family-and-friends/taking-care-of-your-loved-one/helping-with-treatment.html. Accessed on 4 October 2019.
  8. American Lung Association. How to support your loved one with lung cancer. Available at https://www.lung.org/lung-health-and-diseases/lung-disease-lookup/lung-cancer/family-and-friends/taking-care-of-your-loved-one/how-to-support.html. Accessed on 4 October 2019.
  9. American Cancer Society. When someone you know has cancer. Available at https://www.cancer.org/treatment/caregivers/when-someone-you-know-has-cancer.html. Accessed on 4 October 2019.
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