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Understanding Lung Cancer

In this article:

Incidence and Mortality Statistics
Common Symptoms
Risk Factors
Complications and Risk of Metastasis
Diagnostic Methods
Treatment Methods
Personal Care
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Higher Prevalence Among Males

Hong Kong Lung Cancer Incidence And Mortality Statistics: Latest Data And Trend Analysis

Lung cancer is the commonest cancer in Hong Kong. In 2022, there were 5 707 new cases, accounting for 16.1% 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 78 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 2022, a total of 3 782 people died from this cancer, accounting for 25.7% 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 Symptoms

What Are The Common Symptoms Of Lung Cancer?

Early-stage pulmonary carcinoma frequently presents without clinically apparent symptoms; however, with disease progression and subsequent local tissue invasion, patients manifest a constellation of characteristic signs including exertional dyspnea, persistent non-productive cough, hemoptysis, dysphonia, odynophagia, pleuritic chest pain exacerbated by respiratory effort, and recurrent lower respiratory tract infections with impaired resolution. Notably, these pulmonary manifestations are frequently accompanied by constitutional symptoms such as cancer-associated anorexia-cachexia syndrome and cancer-related fatigue, which, despite their non-pulmonary origin, represent clinically significant paraneoplastic phenomena associated with bronchogenic malignancies.

However, cancer cells may spread within the body. In such cases, in addition to the symptoms above, patients may experience swollen lymph nodes in the neck, abdominal distension, bone pain, headaches, or swelling in the neck, face, and hands. In severe cases, localised seizures or hemiplegia may even occur. Therefore, if any of the above symptoms are noticed, it is crucial to seek medical attention promptly to determine whether lung cancer is present.

Understanding Cancer Causes

Can Non-Smokers Get Lung Cancer? What Are The Risk Factors For Lung Cancer?

The risk of developing lung cancer is primarily associated with the following factors:

  • Smoking
    • Tobacco use stands as one of the significant causes of lung cancer, with smokers facing a 20-fold higher risk compared to non-smokers. Approximately 10% of smokers will develop lung cancer during their lifetime. Notably, among male lung cancer patients, about 90% are smokers.
  • Second-hand Smoke Exposure
    • In addition to active smoking, secondhand smoke represents a significant causative factor for lung cancer. Individuals with chronic second-hand smoke exposure demonstrate more than double the risk of developing lung cancer compared to unexposed populations.
  • Chemical Exposure
    • Chronic exposure to certain hazardous substances, including industrial and construction materials such as asbestos, nickel, and uranium, can significantly increase lung cancer risk. Additionally, inhalation of cooking fumes, incense smoke, or radon gas (Note 1), particularly in poorly ventilated environments, may contribute to carcinogenesis.
  • Poor Dietary Habits
    • A diet chronically deficient in fresh vegetables, fruits, and other vitamin A-rich foods may compromise pulmonary health and increase cancer susceptibility. Furthermore, frequent consumption of grilled, barbecued, or preserved foods has been clinically associated with elevated lung cancer risk.
  • Family history
    • Family history represents a significant non-modifiable risk factor; patients’ parents or siblings affected by lung cancer demonstrate a clinically elevated risk compared to the general population.

To mitigate the various risk factors for lung cancer, multiple preventive measures should be adopted, for example: non-smokers must resist initiating tobacco use while current smokers should quit immediately; individuals should encourage family and friends to quit smoking and avoid smoke-heavy environments like bars to minimise second-hand exposure. Workers must adhere to safety protocols for hazardous substances by wearing protective respirators, and homeowners should regularly test for radon accumulation. Dietary modifications include increased consumption of fresh fruits and vegetables while avoiding excessive vitamin supplementation, which may cause adverse effects.

Impact on the Body

Does Lung Cancer Spread Quickly? Common Metastatic Sites And Complications Of Lung Cancer

When lung cancer remains undetected or untreated, the disease typically progresses with severe complications. For instance, tumour growth may obstruct airways. In contrast, pleural effusion and fluid accumulation around the lungs restrict pulmonary expansion, causing significant respiratory distress. Metastasis to pulmonary linings or distant organs frequently manifests as systemic pain, nausea, and cephalgia. Crucially, disseminated lung cancer becomes therapeutically challenging with markedly reduced treatment efficacy upon extra-pulmonary spread.

Common Diagnostic Methods

What Are The Diagnostic Methods For Lung Cancer?

If you notice potential symptoms of lung cancer, you should promptly consult a doctor for examination. Typically, physicians will conduct the following diagnostic tests:
  • Chest X-Ray
    • A chest X-ray is used to examine the lungs and detect any tumours or other abnormal materials inside.
  • Sputum Sample Examination
    • Microscopic examination of the patient’s coughed-up phlegm was used to detect cancer cells.
  • Bronchoscopy
    • The physician inserts a flexible tube through the throat to examine the condition of the bronchial mucosa. If necessary, abnormal tissue may be removed for further analysis. Before the procedure, the patient is given anaesthesia and may also receive a sedative to facilitate tube insertion. The entire process typically takes a few minutes.

Along with the above tests, the physician might recommend these additional diagnostic procedures:

  • Mediastinoscopy
    • The patient undergoes general anaesthesia while the surgeon makes two to three small incisions at the base of the neck, above the sternum. A mediastinoscope is then inserted to examine the lymph nodes and thymus near the lungs and heart. If swollen lymph nodes are detected, surgical instruments are introduced through another incision to remove them. The procedure typically takes about one hour, and patients generally require hospitalisation for one to two days post-operation.
  • Computed Tomography (CT) Scan
    • The patient is administered a contrast agent [Note 2] either by injection or orally. A CT scanner then captures X-ray images of the internal tissues from multiple angles, which are reconstructed into three-dimensional images.
  • Endoscopic Ultrasound (EUS) Examination
    • The physician inserts a flexible tube with an ultrasound probe through the mouth into the oesophagus. Sound waves reflected from the heart and lungs are converted into images by a computer, allowing the physician to assess whether lymph nodes in the thoracic cavity are enlarged. The physician may also extract a small lymph node tissue sample for further testing if necessary.

After a thorough examination, the physician will classify and stage the patient’s lung cancer. Lung cancer can generally be divided into three main categories:

  • Small Cell Lung Cancer (SCLC)
    • Accounting for approximately 15% of all lung cancer cases, this type is primarily caused by smoking. It is characterised by rapid growth and aggressive metastasis.
  • Non-Small Cell Lung Cancer (NSCLC)
    • Squamous Cell Carcinoma
      • Most are found in the lining of the bronchial tubes, primarily caused by smoking.
    • Adenocarcinoma
      • Develops from mucus-producing cells in the airway lining.
    • Large Cell Carcinoma
      • Characterised by large, rounded cancer cells.
  • Mesothelioma
    • A rare cancer that develops in the lining of the pleura or peritoneum, predominantly caused by asbestos exposure.

After completing the diagnostic tests, the physician will stage the patient’s condition, which is generally classified into four main stages:

StageScope of Impact
Stage I   Small in size, localised to the primary site.
Stage II  Cancer cells begin to spread to the lymphatic tissue surrounding the tumour.
Stage III  Cancer cells begin to spread to the lymphatic tissue surrounding the tumour.
Stage IV   Cancer cells spread to other parts of the body.

However, the staging of non-small cell lung cancer (NSCLC) can be more complex:

StageScope of Impact
IAThe tumour is less than 3 cm and can be removed by surgery.
IBThe tumour ranges from 3 to 5 cm and may involve nearby structures such as the bronchus and pleura. Part of the lung may have collapsed.
IIAThe tumour can be up to 7 cm and may involve nearby structures or lymph nodes.
IIBThe tumour is larger than 5 cm. The lung may have collapsed, or there may be more than one tumour in the same lobe. Cancer cells may have spread to nearby structures or the diaphragm and nearby lymph nodes.
IIIATumours can be of any size, but nearby structures may have been affected, or the cancer may have spread to the chest wall and heart-lung area. There may be at least two tumours in the same lobe, or even cancer cells in the other lobe. Surgery can remove it, but other therapies are needed to assist.
IIIBCancer cells may have spread to lymph nodes on one side, or to the lymph nodes at the top of the lung or on either side of the chest cavity near the shoulder blade. The tumour cannot be entirely removed by surgery alone.
IVCancer cells have spread to the other lung, or there is malignant effusion in the lungs or heart, or the cancer has spread to other areas such as the brain, liver, and bones.

Three Primary Treatment Approaches

What Are The Latest Treatment Methods For Lung Cancer?

The main treatment options for lung cancer include three primary modalities: surgery, radiation therapy, and chemotherapy, along with other palliative care methods to alleviate symptoms. Depending on the patient’s specific condition, these approaches may be used individually or in combination.

  • Surgical Treatment
    • Surgical intervention for lung cancer may involve removal of one lobe (lobectomy), two lobes (bilobectomy), or an entire lung (pneumonectomy), depending on disease progression. The procedure requires opening the chest cavity (thoracotomy). However, surgeons often employ minimally invasive video-assisted thoracic surgery (VATS) using an endoscope to minimise incision size, reduce scarring, and decrease postoperative pain. Following surgery, recovery typically takes several weeks to months. While patients can breathe normally even after complete lung removal, they may require temporary intravenous nutrition and chest tube placement between the ribs for fluid drainage during the initial postoperative period.
  • Chemotherapy
    • This treatment involves administering drugs intravenously or orally to circulate throughout the body via the bloodstream. The medication disrupts the growth and division of cancer cells, ultimately causing them to die. Treatment typically follows a three-week cycle, which includes two to three weeks of rest, though the total number of cycles depends on the patient’s condition and response to the drugs.

Patients may experience various side effects after treatment, such as hair loss, vomiting, diarrhoea, mouth sores, loss of appetite, and fatigue due to decreased red blood cell counts.

  • Radiation Therapy
    • This treatment utilises high-energy radiation beams to precisely target and destroy cancer cells. It can be administered either as a primary standalone therapy or as an adjuvant treatment following surgery to eliminate any remaining cancer cells. The therapy is delivered through two main approaches: External beam radiation therapy, conducted over a typical 7-week course with five weekly sessions using specialised large-scale radiation equipment; and Internal radiation therapy (brachytherapy), which involves the precise placement of low-intensity radioactive sources directly at the tumor site to deliver continuous, localised radiation exposure. Both methods are designed to maximise therapeutic effectiveness while minimising damage to surrounding healthy tissue.

Patients may undergo X-rays and/or CT scans during the initial consultation to capture detailed images of the tumour location. These scans help the medical team determine the precise radiation entry points and beam angles for optimal treatment accuracy. The radiation therapist may mark the patient’s skin with minor, temporary reference points. These markings ensure consistent positioning for every treatment session and can be easily removed after therapy completion.

Patients may experience specific side effects after treatment, including fatigue, hair loss, and nausea. Additionally, months or even years later, some individuals might develop dysphagia, an increased risk of choking, or thinning of the sternum. If any of these symptoms occur, patients should seek medical attention promptly to prevent further complications and receive appropriate management.

  • Targeted Therapy
    • The treatment is a type of medication designed explicitly for the characteristics of specific cancer cells with fewer side effects than traditional chemotherapy and less impact on bone marrow hematopoietic cells or the immune system, making it suitable for certain advanced lung cancer patients.
  • Radiofrequency Ablation
    • The patient undergoes local and general anaesthesia, after which the physician uses CT imaging to guide the insertion of a surgical needle emitting radiofrequency waves into the lung tumour to destroy the cancer cells.
  • Cryosurgery
    • After the patient is placed under general anaesthesia, the physician uses a bronchoscope to guide a cryoprobe near the tumour and injects liquid nitrogen at temperatures below -200°C. This method is primarily used for small tumours blocking the bronchial tubes, can be repeated as needed, and may be reused if the tumour recurs.

Healthy Living

Post-Surgery And Rehabilitation Care For Lung Cancer: Dietary And Lifestyle Adjustments During Treatment

Since most patients discover and begin treatment only after lung cancer has spread, the risk of recurrence is high. Even after surgery or other treatments, regular follow-ups are necessary to monitor recovery progress closely. Patients should also avoid crowded and poorly ventilated public spaces while ensuring good airflow at home to prevent respiratory infections. In terms of diet, consuming more vegetables and fruits such as carrots and pears can help replenish vitamins A and C.

Regarding mental well-being, some patients may experience a low mood or even fear after diagnosis. Any concerns should be noted and discussed with a doctor during the next appointment for professional advice. Talking to trusted individuals like family, friends, social workers, or psychologists can also help ease emotional distress. Additionally, adequate sleep plays a key role in reducing stress for patients.

Further Understanding

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Note 1: Radon is a colourless, odourless, and tasteless radioactive gas primarily produced by natural radioactive substances in soil, rocks, and walls. When inhaled, radioactive particles accumulate in the lungs and release radiation, damaging lung tissue.

Note 2: Contrast agents are chemical substances that create a sharp contrast by appearing denser or less dense than surrounding tissues, making scan images more straightforward.

Sources:

Centre for Health Protection

Hospital Authority

Cancer Fund

Hong Kong Anti-Cancer Society

Mayo Clinic

Cancer Online Resource Hub



▣ The information on this website has been reviewed by the HEAL Medical Team and is regularly updated according to the most recent clinical evidence. All content is provided for general informational purposes only and should not replace professional medical advice. Please consult your doctor or another qualified healthcare professional for personalized medical guidance.

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