Lung cancer is a top cancer killer in the world. Lung cancer is always treatable, no matter the size, location, and how far it has spread. Although cigarette smoking is the main cause, anyone can develop lung cancer.

Lung Cancer Treatment In Malaysia



The 2 main classifications of lung cancer are small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC).

 

Risk Factors

Smoking
Regular exposure to second hand smoke will increase your risk of lung cancer, even if you are a non-smoker.
Asbestos
Asbestos is found in fireproof insulation in buildings. Many studies show smoking combined with asbestos exposure is particularly dangerous.
Radon
This is an invisible, odorless gas naturally released by some soil and rocks. Exposure to radon has been associated with an increased risk of some types of cancer, including lung cancer.
Other Substances
Exposure to cooking flames from coal or wood, fumes from diesel gas, radiation, arsenic, nickel, and chromium could increase the risk of lung cancer.
Genetics
People with parents, or siblings with lung cancer could have a higher risk of developing lung cancer themselves.

Screening And Prevention Of Lung Cancer

Based on results from the National Lung Screening Trial, lung cancer screening is done with a test called a low-dose CT lung scan. Yearly scan is recommended for people aged 55 to 74 who have smoked for 30 pack years or more or who have quit within the past 15 years.

 

Treatment Overview

Talk to our oncologists at Onco Life Centre about your treatment options. Treatment recommendations by our oncologists at Onco Life Centre are tailored and personalized and depends on type and stage of lung cancer, genetic changes in the tumor, and the patient’s preferences and overall health. The landscape of drug treatment in NSCLC has evolved immensely over the last 5 years.

Surgery

The goal of surgery is complete removal of the lung tumor and the nearby lymph nodes in the chest.

The types of surgery used for NSCLC include lobectomy, wedge resection, segmentectomy and pneumonectomy.

Adjuvant therapy

Adjuvant chemotherapy is given after surgery to lower the risk of the lung cancer returning. It is intended to get rid of any lung cancer cells that may still be in the body after surgery.

Radiation therapy

The most common type of radiation treatment is called external-beam radiation therapy. A radiation therapy regimen usually consists of a specific number of treatments given over a set period of time. CT scans may be used to plan out exactly where to direct the radiation to lower the risk of damaging healthy parts of the body. This is called intensity modulated radiation therapy (IMRT) or stereotactic body radiation therapy (SBRT).

Chemotherapy

Chemotherapy stops the cancer cells’ ability to grow and divide. Chemotherapy improves both the length and quality of life for people with lung cancer of all stages. The type of lung cancer you have, such as adenocarcinoma or squamous cell carcinoma, affects which drugs are used for chemotherapy. Side effects of new and modern drugs are well managed by our health care team.

Targeted Therapy

Targeted therapy targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. To find the most effective treatment, our oncologist may run tests to identify the genes, proteins, and other factors in your tumor.

Anti-angiogenesis therapy is focused on stopping the process of making new blood vessels. Because a tumor needs the nutrients delivered by blood vessels to grow and spread, the goal of anti-angiogenesis therapies is to “starve” the tumor. You can find out more about these FDA approved anti-angiogenic drugs that are given along with chemotherapy for lung cancer at our Centre, during consultation with our oncologists.

Epidermal growth factor receptor (EGFR) inhibitors block EGFR to stop the growth of lung cancer. The U.S. Food and Drug Administration has approved at least two drugs for patients with locally advanced and metastatic NSCLC.

Drugs that target other genetic changes in lung tumors may help stop the growth of NSCLC.

  1. Anaplastic lymphoma kinase (ALK) inhibitors. Mutations in the ALK gene are found in about 5% of patients with NSCLC.
  2. Drugs that target changes in a gene called ROS1.
  3. Drugs that target changes in a gene called NTRK fusion.

Please consult our oncologists about the use of such targeted agents that have enabled lung cancer to be treated in a personalized way.

Immunotherapy

Immunotherapy is designed to boost your body's natural defences to fight the cancer. The PD-1 pathway is critical in the immune system’s ability to control cancer growth. PD-1 and PD-L1 antibodies block this pathway and can stop the growth of NSCLC. The FDA has approved two immunotherapy drugs for use in metastatic NSCLC.

 

Treatment of NSCLC by stage:

 

 
Stage I and II NSCLC

In general, stage I and II NSCLC are treated with surgery. Some patients with large tumors or signs that the tumor has spread to the lymph nodes may benefit from chemotherapy. Chemotherapy may be given before surgery (neo-adjuvant chemotherapy) or after surgery (adjuvant chemotherapy) to reduce the chance the cancer will return.

 
Stage III NSCLC

Treatment options depend on the size and location of the tumor and the lymph nodes that are involved. A combination of chemotherapy and radiation therapy is usually recommended. Surgery may be an option after initial chemotherapy or chemotherapy with radiation therapy.

Metastatic or stage 4 NSCLC

Patients with stage IV NSCLC typically do not receive surgery or radiation therapy. The goals of systemic therapy are to shrink the cancer, relieve discomfort caused by the cancer, prevent the cancer from spreading further, and lengthen a patient’s life. Treatment often continues as long as it is controlling the cancer’s growth.

1) First-line systemic therapy depends on the genetic changes found in the tumor. For patients with tumors that have a genetic change on the EGFR, ALK, ROS1 or NTRK genes, targeted therapies called Tyrosine Kinase Inhibitors (TKI) are the preferred first-line systemic options.
For patients with tumors without these genetic changes in the tumor, the treatment options are based on the type of tumor histopathology and on the intensity of PDL1 expression.
For patients with non-squamous cell carcinoma with high PD-L1 expression, immunotherapy-alone or combined with chemotherapy and anti-angiogenesis therapy maybe recommended.
For patients with squamous cell carcinoma with high PD-L1 expression, immunotherapy-alone or combined with chemotherapy maybe recommended.

2) Second-line treatment and beyond depends on the gene mutations found in the tumor and the treatments which patients have already received.
For patients with tumors that do not have a genetic change on the EGFR, ALK, ROS1 or NTRK genes and have received chemotherapy for first-line treatment, immunotherapy can be the next line of treatment if their tumors express a high level of PD-L1.
For patients with tumors that have an EGFR gene mutation, the best treatment option depends on whether the cancer has developed a mutation called T790M, which makes it resistant to the TKI. For patients with tumors that have an ALK, ROS1, BRAF gene mutation, our oncologist will help you plan your subsequent lines of treatment, which includes new generation TKIs and immunotherapy.

3) Palliative care will also be important to help relieve symptoms and side effects. Radiation therapy or surgery may also be used to treat metastases that are causing pain or other symptoms. Bone metastases that weaken major bones can be treated with surgery, and the bones can be reinforced using metal implants.

Patients and their families have opportunities to talk about the way they are feeling with our oncologists, nurses, counselors, or join our psychosocial program and support group at Onco Life Centre.

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