Lung cancer is the commonest cancer in Hong Kong. In 2021, there were 5 978 new cases, accounting for 15.5% of all new cancer cases in Hong Kong. The male to female ratio was about 1.4 to 1. The crude annual incidence rate of lung cancer was 81 people per 100 000 Hong Kong population, with a median age at diagnosis of 70 years for males and 68 years for females. Lung cancer was also the leading cause of cancer deaths in Hong Kong. In 2021, a total of 4 037 people died from this cancer, accounting for 26.7% of all cancer deaths.
Detection of lung cancer in its early stages can increase chances of cure. However, most of the patients are not diagnosed until the lung cancer is in metaphase or advanced stage, thus making it more difficult to cure. Therefore, people at high risk of lung cancer such as smokers and those who are frequently exposed to secondhand smoke should be ever vigilant for respiratory diseases in order to increase chances of cure via early discovery. According to the Cancer Registry statistics, the overall five-year relative survival rate with lung cancer was 21.8%. The five-year relative survival rates were 72.4% at stage I, 45.4% at stage II, and 24.6% at stage III. Stage IV lung cancer had a five-year relative survival rate of 7.8%.
Lung cancer is a malignant tumour developed in the lower part of the respiratory system including cells in the bronchus and bronchiole wall.
The risk factors for lung cancer include:
Any of the following signs and symptoms could indicate lung cancer:
To reduce the chance of getting lung cancer, members of the public are recommended to:
Taking into consideration the available international scientific evidence and local actual situation, the Government’s Cancer Expert Working Group on Cancer Prevention and Screening has made the following recommendations on lung cancer screening which serve as general reference for doctors to provide individualised advice on lung cancer screening in local population:
Primary prevention is the most important strategy for reducing the risk of developing lung cancer. Current smokers should quit smoking and non-smokers should never start smoking.
Routine screening for lung cancer (including chest X-ray, sputum cytology, or low-dose computed tomography (LDCT)) is not recommended for asymptomatic persons at average risk.
There is currently insufficient data to assess the benefit vs harm and cost-effectiveness of LDCT screening and its associated criteria such as target groups and optimal screening protocol in the local setting. Based on overseas literature, asymptomatic persons with heavy smoking history (i.e., more than 20-30 pack-year* and who either currently smoke or have quit for not more than 10-15 years) that put them at increased risk of lung cancer may benefit from LDCT screening. In the majority of overseas recommendations, the usual starting and finishing age for screening is 50-55 years and 74-80 years respectively, and screening is most commonly performed annually or biennially. Since the local applicability of these criteria has not been sufficiently characterised, persons with heavy smoking history are advised to discuss with their doctors the benefits and harms (including false-positive findings and potential follow up investigations) of LDCT screening before making an informed and individualised decision.
Screening for lung cancer with chest X-ray or sputum cytology is NOT recommended.
* pack-year = multiply number of packs of cigarettes per day by number of years smoked
While smokers should have regular chest checkups, people having any of the aforesaid symptoms should also visit the doctors promptly. Diagnostic tests for lung cancer include the following:
Treatments for lung cancer may include surgery, external radiotherapy, chemotherapy and other supportive measures for palliation such as laser, internal radiation therapy, and medicines. Single or combined modalities treatments may be used depending upon the patient’s general health status.
This treatment method offers the best chance of cure for patients who have early-stage lung cancer that has not spread beyond the lungs. The curative rate of surgery stands at more than 60% among patients in the earliest stage of disease. The volume of resection depends on the status of the malignant tumour. The operation may involve the removal of a tumour together with some surrounding tissue, while some may involve removal of a whole lobe or even one whole lung.
This may be given as curative therapy of early-stage lung cancer for patients who are not suitable for surgery because of being too old or having other diseases. Radiotherapy will be useful for destroying cancer cells in patients if there is local spread of tumour, surgically irremovable cancer cells left after operation, or symptoms caused by cancer spread (such as bone pain and brain metastases).
This targets at specific molecules involved in a certain tumour type. It causes fewer side effects than traditional chemotherapy by having less impact on hematopoietic stem cells or the immune system. It is suitable for a certain specific type of metastatic lung cancer patient.
Targeted therapy may cause side effects such as skin rash, mouth sores or diarrhea. Please strictly follow medical advice in using this type of treatment.
The following are some important notes for patients during rehabilitation after surgery, radiotherapy or anticancer drug treatment:
Surgery and drug treatment may lead to a partial or even complete relief from symptoms of lung cancer. However, lung cancer has a relatively high chance of recurrence. This is largely due to the fact that most patients are not treated until their cancer have worsened and disseminated, thus affecting the success rate of curative. Patients should persist in regular subsequent visits to allow close monitor of progress. If cancer recurs, treatment can also be given promptly and hence increase the chance of survival.
Bronchoscopy is a procedure that a thin and flexible endoscope is passed through the nose or mouth or through a breathing tube (endotracheal tube or tracheostomy tube) directly into the major airway. It enables the doctor to perform examination of the trachea and bronchus under direct vision.
For further information please contact your doctor.