‘Lung cancer’ is Curable with Correct Understanding

Almost 100,000 Thai people died from cancer each year, and this trend appears to be on the rise. In 2022, the National Cancer Institute showed that approximately 400 new cancer patients are diagnosed every day and 11% of these are lung cancer patients, making lung cancer the second most common type of cancer in Thai people. 

Although statistics may seem terrifying, there are ways to reduce the threat of the disease. According to Dr Virote Sriuranpong, Chair of the Thai Lung Cancer Group (TLCG) and Advisor to the Chulalongkorn Comprehensive Cancer Center, King Chulalongkorn Memorial Hospital, what is worse than the number of lung cancer patients is the lack of literacy and misbelief, which prevents many patients from early diagnosis and curative treatment. 

‘Lung cancer is the main killer among all cancers because it does not cause symptoms at an early stage until it invades the important structure or spreads far. Usually, when a patient presents a symptom, it usually means stage III or IV already ‘Assoc. Prof. Dr Virote spoke of the challenges in treating lung cancer.  

“Moreover, patients are often afraid to undergo checkups for fear of contracting the disease, as well as the cost of the treatment involved. This leads to missed opportunities because if lung cancer is detected at an early stage and appropriate treatment is received, the patient has a better chance of recovering from the disease,” Dr Virote mentions in the seminar “Can Lung Cancer Be Completely Cured?” at the Excellence Chulalongkorn Comprehensive Cancer Center. The seminar was held at King Chulalongkorn Memorial Hospital to help inform the public about lung cancer in all aspects, including causes, symptoms, and treatment options, as well as misunderstandings about the treatment of lung cancer in general. 

“Cigarettes”: The Number One Lung Cancer Risk Factor  

Lung cancer is a disease that can happen to anyone, regardless of gender, age, and socio-economic status. There are many causes of cancer, but the number one risk factor of lung cancer is still smoking. 

“People who don’t smoke have a chance of getting lung cancer, too, but smoking increases the risk. For example, out of 1,000 non-smokers, we may encounter fewer than 1 person with lung cancer. However, if we examine 1,000 smokers, we may find 4-5 people with lung cancer,” says Dr Virote.  

Smoking, in this context, includes people in a family that contains smokers.  

“If the family has a smoker, the family members become second-hand smokers and third-hand smokers and are also at risk of lung cancer themselves. This is because the carcinogens contained in cigarettes will remain in the house and on objects, as well as the smell of cigarettes, even when the person is not smoking. Once this is inhaled often, it settles into the lungs.” 

Apart from smoking, other risk factors include 

•    Chronic pulmonary diseases such as emphysema and pulmonary fibrosis  

•    Longer-term exposure to radiation therapy 

•    Pollution caused by factories, oil refineries, construction sites, dusty atmospheres, car exhaust fumes, combustion, PM2.5, or certain chemicals, e.g., radon, asbestos, benzine, hydrocarbon (for in-depth information on “radon” please visit  https://www.chula.ac.th/highlight/97284/ 

“Most cases of lung cancer are from close exposure to environmental carcinogenic factors like being in a family with smokers.” 

Therefore, we can reduce our chances of developing lung cancer by avoiding risk factors. 

“First of all, do not smoke or avoid areas where people smoke. Avoid staying in or going into areas with high pollution. Find an area in your home that is a “safe zone” with air purifiers, plant trees, or create an environment that helps to improve the air.” 

Symptoms of “Lung Cancer”  

“Cough, fatigue, shortness of breath, persistent blood-tinged sputum, and a big lump on the neck– If the aforementioned symptoms continue for about 2-3 weeks without the symptoms being reduced, you should see a pulmonologist as soon as possible,” explains Dr Nophol Leelayuwatanakul from the Division of Pulmonary Disease and Pulmonary Critical Care, King Chulalongkorn Memorial Hospital. Besides these early symptoms that could mean lung cancer, patients may also have other symptoms, depending on which organ the cancer cells have spread to. “For example, if the cancer spreads to the brain, the patients may develop symptoms related to the brain; if the cancer has spread to the bone, the patients will have bone pain; if the cancer spreads to the liver, the patients will have distension and jaundice. In addition, cancer cells may produce certain substances that increase the risk of stroke, thrombosis, and meningitis. We also sometimes see patients with brain or nerve symptoms without cancer cells in that system.”  

Lung Cancer Screening Technology  

Lung cancer screening is currently performed using a low-dose CT scan, which can detect 60-90% of early-stage lung cancers, four times more than chest X-rays.  

“As cancer detection rates increase, the survival rate from lung cancer also increases,” says Dr Nophol Leelayuwatanakul. 

Computed tomography will classify the risk of disease based on the appearance of nodules found in the lungs. In many cases, further screening tests are needed such as bronchoscopy, biopsy, and surgery, etc. 

However, screening with this technology is suitable for people at high risk of lung cancer, such as “smokers”, especially those aged 50-75 years old, whether they are still smoking or have quit smoking for less than 15 years, and smoke more than 20 pack-year (Pack-year is calculated from packs of cigarettes smoked per day x number of years, e.g., 1 pack per day x 20 years = 20 pack-year). 

For non-smokers or those living in a family with a history of smoking, doctors need to assess the need for a screening with this technology as they may be affected by the diagnostic tests or the surgery, such as pneumothorax, bleeding from biopsy, etc. The cost of the screening is also an issue.  

Dr Virote says that the treatment of lung cancer depends on the stage of the disease.  

“If lung cancer is found in the early stages, surgery is the main method of treatment. If the disease enters the middle stage, radiation therapy may be added, along with surgeries and medication. But if the disease has already spread significantly, medication may be the only treatment or with radiation to alleviate the symptoms” 

Type of Lung Cancer 

Lung cancer can vary in type from person to person. Dr Piyada Sitthideatphaiboon, an oncologist, said that there are 2 main groups of lung cancer, namely 

1.    Small Cell Lung Cancer refers to cancer cells that spread quickly and is often found in patients who are “smokers” even after having stopped a long time. 

2.    Non-Small Cell Lung Cancer (NSCLC) is caused by a variety of carcinogenic factors which are not related to smoking. Dr Piyada said, “This type of lung cancer is the most common. At present, 90% of all lung cancer patients fall into this group.” 

Among Asians, Epidermal Growth Factor Receptor (EGFR) mutations are found in 50% of these cells compared to other mutated genes. Dr Piyada adds that currently detection of lung cancer cells at the gene level is possible for over 10 types.  

Surgery: Weapon for Early-Stage Cancer  

Surgery remains the main treatment for lung cancer, says Dr Nopporn Pornpatrtanarak from the Cardiact Center. “But it needs to be customized to each patient by considering the cancer, the size and location of the biopsy, the stage of the cancer, and the patient’s physical condition and congenital disease, especially in the treatment of early-stage cancer. The surgery can be performed before or after taking medication.” “Surgery is the first method of treatment chosen in the case that cancer cells remain in one particular site in the lung and it is determined that there is likely no metastasis. For a surgery to cover the real extent of lung cancer completely and for the lung cancer to be cured, the cancerous mass must be removed along with surrounding lung lobes, as well as the lymph nodes around the bronchus, respiratory tract, and down to the upper trachea,” says Dr. Nopporn. 

Nowadays, there are 2 types of lung surgery: 

1.    Thoracotomy is used in the case of large cancerous mass or where the cancer is spread widely in the lung. 

2.    Minimally Invasive Surgery, VATS: Video-Assisted Thoracoscopic Surgery is the use of a specific long device which can remove the cancerous lobe without stretching the ribs. The advantage is that the surgical wound is as small as about 3 cm. The patient receives less pain, and their response is better than an open surgery. The Excellence Chulalongkorn Comprehensive Cancer Center, King Chulalongkorn Memorial Hospital, mainly uses this surgery method, including single port surgery, hybrid operation, and robot-assisted lung surgery.

Radiation Therapy: High Precision  

Besides surgery, lung cancer is also treated with radiation therapy. At King Chulalongkorn Memorial Hospital, the standard radiation used is stereotactic body radiation therapy, also known as “Radiation Surgery.”  
“We provide radiation alongside Image-Guided Radiation Therapy for precision. The frequency or duration of treatment depends on the stage of the lung cancer,” says Asst. Prof. Dr Danita Kannarunimit, Department of Radiology.  

“When lung cancer reaches stages 2-3, radiation is used along with chemo-immunotherapy, instead of surgery, or in combination before and after surgery. For stage-4 cancer, radiotherapy is used to control and alleviate the symptoms so that the patient can lead a life free of the symptoms. Other additional radiation may also be used at the doctor’s discretion, such as proton radiation directed at the cancer to reduce the radiation dose and side effects on vital organs such as lesions that require repeated radiation or lesions near the heart wall.” 

“If the patient’s physical condition is not strong, radiation is one of the options that results in a high rate of disease control, thus increasing the survival rate,” said Dr Danita. 

Cancer Medication and Immunotherapy: Hope for Lung Cancer Patients  

The treatment of early-stage lung cancer (stages 1-2) using “surgery” has a relatively high chance of the patient being completely cured, but there is a chance of recurrence as well. Hence, medication plays a role as a ‘supplement’ after surgery. 

“The biopsy will tell us the risk of disease in percentage and help in the selection of medication to treat a specific individual. We cannot use the same drugs for everyone. Each patient must also be thoroughly examined to determine what type of cancer they have,” Dr Piyada elaborated.  

There are 3 main groups of medication used for treatment: chemotherapy, targeted therapy, and immunotherapy, which must be selected according to the type and stage of the disease. Some patients may also need a combination of medications. 

Dr Piyada explained with specific examples that “One out of three patients with non-small cell lung cancer who are treated with immunotherapy revealed satisfactory results, but for small cell lung cancer patients, immunotherapy may be used in combination with other treatments.” 

At present, the treatment of lung cancer patients is like the treatment of chronic diseases, which means that the patients can live with the disease, maintain a quality of life, and live longer. There are more than 10 types of medication for the treatment, for example, immunotherapy drugs, often used to treat stage-4 cancer patients, can help patients live longer and have a better quality of life than before. Moreover, a new option of “cancer immunotherapy” is now available.  

Regarding the mechanisms of cancer immunotherapy Dr Piyada explained, “Normally, cancer cells send signals that interfere with the function of white blood cells, which are like “soldiers protecting the body,” causing them to not see the abnormality of cancer cells.” 

“Immunotherapy drugs block these signals in cancer cells, while the cancer vaccine allows white blood cells to remember specific characteristics of cancer cells. When the two work together, white blood cells will become more efficient and able to eliminate foreign matter, such as cancer cells. The vaccine is currently in the testing and research stage for use in different stages of cancer.”  

The team hopes that these drugs can enable the body’s immune system to kill cancer cells without relying 100% on medication.  

Don’t Be Afraid of Lung Cancer  

Lung cancer can be cured especially when receiving treatment in the early stages, but it is also a disease that takes a lot of Thai people’s lives each year. This is due to a lack of knowledge about the disease, fear, anxiety, misunderstandings arising from misinformation from people around you and from social media. 

“These are significant obstacles that have claimed many lives,” said the Chair of Thai Lung Cancer Group (TLCG), Dr Virote, along with some words to ease the concerns about lung cancer, such as  
“Don’t be afraid to be diagnosed with lung cancer because there are treatments, especially in the early stages.” 

“Don’t worry about the cost. From early stage to advanced disease, essential treatments of lung cancer are covered by the National Health Security reimbursement scheme.” 

“Don’t assume that the treatment will cause certain side effects like what others have said, such as hair loss or low blood cells, because the treatment is not the same for each type of cancer, whether surgery, radiation or medication. Sometimes chemotherapy does not cause hair loss in the patients who receive it.” 

“Cancer is curable, but it is quite difficult and takes time. Dietary and behavioral adjustments alone will not cure cancer. Medical treatment is still needed. However, said adjustments can assist the body in tolerating the treatment well.” 

“The same with herbs, although they come from nature, they can be dangerous or cause unwanted side effects. It’s not that herbs are 100% safe, or that chemotherapy is 100% dangerous. Many types of chemotherapy were created from natural products, but have passed through certified research processes.” 

Finally, Dr Virote confirm that with knowledge and medical advancements, as well as various treatment technologies, there is a cure for lung cancer, especially when detected in the early stages. When the cancer is found at an advanced stage, there are ways to help assure patients that they can live longer with good quality of life.