Dr Capalang on Lung Cancer

Hi from Mommy! She can finally smile and eat now, knowing that her cancer is fully localised...=D

Mommy's diagnosis with lung cancer has really put us into an extensive reading mode. We read up so many articles on lung cancer and its treatment so that we could understand what the doctor was trying to tell us. Of course, what he had explained to us were all in layman, simplified, summarized terms, but at the very least, we understood where he came from and why he did it. I thought it is crucial to know and understand what the doctor is doing, just in case of any unwanted dispute later on you see.

In fact, mommy had been so depressed that she didn't realize a wrong report was placed under her name - There was a report stating that her gastrointestinal biopsy tested positive for gastric cancer, and luckily we went to clarify it, for we knew, no tissue had been taken out from her gastrointestinal tract. Her oncologist was confused too at first and luckily he went to further check with the other doctor too and called for a PET scan just to make sure everything was really as what reported... Had he not, congratulations mommy, you would have been diagnosed with a metastatic cancer instead, aka spreading of cancer to body. PS: See the importance of knowing what your doctor writes in his report ?

And now, let me share with you what I have read. Call me Dr Capalang, and I shall give you a quick understanding on Lung Cancer. Tada...

SCLC & NSCLC

Ok so, lung cancer can be divided into two main types, one is Small Cell Lung Cancer (SCLC) and the other is Non-Small Lung Cancer (NSCLC) . (Please don't ask me whether the sub-type was named due to small cancerous cell and large cancerous cell ....) Among these two, SCLC is the more maglinant one and it grows very quickly and therefore, more deadly. NSCLC on the other hand, grows slower compared to SCLC and therefore, higher survival rate. It also accounts for most of the lung cancer being diagnosed (around 85% if not wrong)

And within NSCLC, there are even more subtypes : Squamous Cell Carcinoma (SCC), Adenocarcinoma and large cell lung carcinoma. They are identified and diagnosed based on the characteristics of the tissue cell collected during bronchoscopy. Anyway, mommy's lung cancer was classified under Squamous Cell Carcinoma (SCC).

Symptoms

Lung cancer may be more common in smokers than non-smokers, but that doesn't mean we can take it for granted. In mommy's case, she is a non-smoker too. And well, we all breathe the same air too, and we didn't seem to develop cancer either...(hopefully never... #amen)

Often, it is very hard to identify lung cancer especially when it is still at early stages as there are rarely any outstanding symptom that may make you raise your guard against it. It is also very insensitive towards cancer marker test and therefore may mislead you into thinking you are all well. Mommy has in fact checked on her cancer marker every year, and all the time, it showed negative for cancer even though there is a maglinant tumor in her lungs. =.= 

Staging of Lung Cancer

The staging of lung cancer is determined by a number of factors, the size of tumor, whether it has spread to surrounding organs etc. This can be determined through a combination of CT Scan, MRI and even PET Scan. 

Mommy's tumor was around 7-10cm, but very thankfully, through her PET Scan, the result showed that her cancer was fully localised within her left lung upper lobe. With these factors combined, the doctor diagnosed her cancer to be Stage 3A Lung Cancer.

Treatment 

Upon diagnosis, the doctor would then come up with a recommended treatment to battle this cancer. 

For most cancer, the cleanest way to getting rid of it would be through surgery. But when surgery is not an option, there it comes the radiotherapy / chemotherapy / chemoradiotherapy (the concurrent treatment of chemotherapy and radiotherapy).  For mommy's case, surgery is not possible due to her large tumor size in which it has grown quite near to the heart, and thus, higher risk. As a result, chemoradiotherapy was recommended as her first line treatment. Doctor recommended 2 shots of chemotherapy (Paclitaxel and Carboplatin) and 35 times for radiotherapy across 7 weeks (Each radiotherapy session will only be 10 minutes, hence the side effects from radiotherapy is minimal). Due to Paclitaxel (taxol), hair loss is unavoidable but on the bright side, the effect is temporary too.  

As good and flawless the treatment may be in killing off the cancerous cells, in fact the good cells are affected too. By the end of radiotherapy, mommy's left lung would hardly be functioning anymore and she will be depending solely on her right lung to live. Thankfully, human can in fact still live a normal lifestyle with just one lung. So, all is well I guess. 

The treatment doesn't end there. Mommy's tissue biopsy shows that she has very high PDL1 component in her cancer. To put it very simply, PDL1 is a type of protein produced by the cancer cells to inhibit the body's immune system from identifying them and killing them, in other words, the body's immune system would have mistaken these cancerous cells as healthy cells and therefore, let it grow. This was one of the possible reasons that mommy's tumor could have grown so big.

To prevent this from happening, the doctor recommended Immunotherapy, a newly approved treatment to naturally boost the immune system to help them identify these cancerous cells and to kill them. It is like an antibiotic shot. This treatment is meant to be carried out once every 2 weeks, for 1 year (that is the recommended period). And in case you think it is just a antibiotic shot, it is in fact the most expensive part of the entire treatment - it costs around RM15k for just one shot. To do it for one year means you need to fork out around RM400k in total, just for this booster treatment. (Chemoradiotherapy should cost around RM40k, depending on your hospital)

PS: I am no insurance agent, but this is when insurance really comes in handy. 

So here is a small sharing from Dr Capalang on lung cancer. Till next time.

xoxo