In 2020, lung cancer was the second most commonly diagnosed type of cancer and the primary cause of cancer-related deaths in the Philippines.^[1]

It typically affects older adults and is rare in people younger than 45. Lung cancer affects both  smokers and non smokers. For people who smoke the risk is higher, while for those who don’t smoke the risk is lower.^[2]

This is why it is vital to screen for lung cancer. Early detection of cancer can significantly improve the chances of surviving lung cancer.^[3]

This article will highlight the different aspects of lung cancer, including treatment options and other resources that may help to fight cancer.

What is lung cancer?

Lung cancer is a type of cancer that starts in the lungs. Cancer starts when cells in the body begin to grow out of control.

Types of lung cancer ^[4]

Lung cancer is divided into two types 

Small cell lung cancer

About 10% to 15% of all lung cancers are SCLC and it is sometimes called oat cell cancer. 

This type of lung cancer tends to grow and spread faster than NSCLC. About 70% of people with SCLC will have cancer that has already spread at the time they are diagnosed.  

Non-small cell lung cancer

About 80% to 85% of lung cancers are NSCLC. The main subtypes of NSCLC are adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. These subtypes, which start from different types of lung cells are grouped together as NSCLC because their treatment and prognoses (outlook) are often similar.

What are the signs and symptoms of lung cancer?^[5] 

Lung cancer can be hard to detect because many patients will have no noticeable signs and symptoms until the later stage of cancer.

It is essential to keep an eye on the following symptoms of lung cancer:

• Shortness of breath
• Chest pain
• Cough that won’t go away
• Coughing up blood or rust-colored phlegm
• Hoarseness
• Unexplained weight loss
• Loss of appetite 
• Wheezing
• Fatigue

Note that having these symptoms does not immediately mean its lung cancer for sure. However, it is recommended to consult a doctor if someone is experiencing these symptoms for proper assessment.

What are the risk factors of lung cancer?

Smoking

In addition to the carcinogenic and epigenetic chemicals present in the smoke of the cigarette, cigars, pipes, etc, nicotine may also contribute to the genesis of the lung cancer.^[6]

Cigarette smoking is the single biggest risk factor for lung cancer. It is responsible for more than  70% of the cases. Tobacco smoke contains more than 60 different toxic substances, which are known to be carcinogenic (cancer-producing). 

If you smoke more than 25 cigarettes a day, you are 25 times more likely to get lung cancer than a non-smoker.^[7]

Passive smoking

If you don’t smoke, breathing in the smoke of others (called secondhand smoke or environmental tobacco smoke) can increase your risk of developing lung cancer. Secondhand smoke is thought to cause more than 7,000 deaths from lung cancer each year.^[8] 

Occupational exposure to harmful chemicals and pollution

• Radon is a naturally occurring radioactive gas that results from the breakdown of uranium in soil and rocks. Breathing it in exposes your lungs to small amounts of radiation. This may increase a person’s risk of lung cancer.
• People who work with asbestos (such as in mines, mills, textile plants, places where insulation is used, and shipyards) are several times more likely to die of lung cancer.

Other carcinogens (cancer-causing agents) found in some workplaces that can increase lung cancer risk include 

• Arsenic
• Beryllium
• Cadmium
• Coal products
• Nickel compounds
• Silica

Lung cancer screening

The US Preventive Services Task Force (USPSTF) recommends annual screening for lung cancer with low-dose computed tomography (LDCT) in adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. ^[9]

A pack-year is smoking an average of one pack of cigarettes per day for one year. For example, a person could have a 20 pack-year history of smoking if he is smoking one pack a day for 20 years or two packs a day for 10 years.^[10]

Cancer that’s diagnosed at an early stage, when it isn’t too large and hasn’t spread, is more likely to be treated successfully.^[11]

Here are the most common tests to diagnose lung cancer^[12]:

• Imaging tests. An X-ray image of your lungs may reveal an abnormal mass or nodule. A CT scan can reveal small lesions in your lungs that might not be detected on an X-ray. 

• Sputum cytology. If you have a cough and are producing sputum, looking at the sputum under the microscope can sometimes reveal the presence of lung cancer cells. 

• Tissue sample (biopsy). A sample of abnormal cells may be removed in a procedure called a biopsy. 

Your doctor can perform a biopsy in a number of ways, including bronchoscopy, in which your doctor examines abnormal areas of your lungs using a lighted tube that’s passed down your throat and into your lungs 

Another technique is called Mediastinoscopy, wherein a small cut is made at the base of the neck to take tissue samples from the lymph nodes.

A needle biopsy can also be used, wherein a guided needle will pass through the chest wall to collect suspicious lung tissues.

It is recommended for smokers to undergo lung cancer screening even if they are not experiencing symptoms. The results of lung cancer screening will allow the medical team to identify the specific type of cancer and proceed with the best treatment option.

Cost of lung cancer screening in the Philippines

The cost of cancer screening in the Philippines varies among hospitals and the kind of tests required. 

HMOs and Philhealth may cover some of the tests needed to help the person to save on expenses. It is also best to ask for available packages or discounts in the hospital or clinic.

Please check out our guide on finding financial assistance in the Philippines.

What are the treatments for lung cancer?^[13]

Having lung cancer is not a death sentence. Now, new treatments and therapeutic interventions are available to help fight cancer. 

Treatment will depend on the overall health status, cancer mutation, the size and position of the cancer, how advanced the cancer is (the stage).

In the Philippines, numerous hospitals around the country are equipped with facilities and experts capable of diagnosing and treating cancer patients.

Here are some of the common treatment options for lung cancer:

1. Surgery

There are 3 types of lung cancer surgery: 

Lobectomy – where one or more large parts of the lung (called lobes) are removed. 

Pneumonectomy – where the entire lung is removed. This is used when the cancer is located in the middle of the lung or has spread throughout the lung. 

Wedge resection or segmentectomy – where a small piece of the lung is removed. This procedure is only suitable for a small number of patients. This is usually very early-stage non-small-cell lung cancer” 

2. Radiation therapy

Radiotherapy uses pulses of radiation to destroy cancer cells. There are a number of ways it can be used to treat lung cancer. An intensive course of radiotherapy, known as radical radiotherapy, may be used to treat non-small-cell lung cancer if patient is not healthy enough for surgery. 

For very small tumours, a special type of radiotherapy called stereotactic radiotherapy may be used instead of surgery. Radiotherapy can also be used to control the symptoms, such as pain and coughing up blood, and to slow the spread of cancer when a cure is not possible.

3. Chemotherapy

Chemotherapy uses powerful cancer-killing medicine to treat cancer. There are several ways that chemotherapy can be used to treat lung cancer. 

For example, it can be

• given before surgery to shrink a tumour,   
• given after surgery to prevent the cancer returning. 
• used to relieve symptoms and slow the spread of cancer when a cure isn’t possible. 
• combined with radiotherapy. Chemotherapy treatments are usually given in cycles. A cycle involves taking chemotherapy medicine for several days, then having a break for a few weeks to let the therapy work and for your body to recover from the effects of the treatment.

4. Immunotherapy

Immunotherapy is a group of medicines that stimulate your immune system to target and kill cancer cells. It can be used on its own or combined with chemotherapy.

5. Supportive care 

Patients with cancer experience debilitating morbidity and complex symptoms, resulting from cancer and/or its treatment across the entire cancer journey. Supportive care has been shown to improve quality of life, symptom burden and survival, as well as benefitting the health economy.^[14]

How much is the cost of lung cancer treatment in the Philippines?

The cost of cancer treatment in the Philippines varies depending on the treatment procedures. This may range from hundreds of thousands to a million pesos. 

Cancer can be a financial burden for patients and their loved ones. To lessen the financial impact of cancer, government institutions have programs that can provide with financial support.

Click our quick guide on how to apply for DOH medical assistance and other financial help from other government institutions.

Outlook

The lung cancer experience is complex and evolving. Lung cancer is not the “death sentence” it once was as significant treatment changes are emerging. It is important to understand how these changes are experienced by individuals diagnosed with the disease if appropriate support is to be made available to them.^[15] 

The changing face of lung cancer creates the potential for lung cancer survivors to become engaged not only in participating in their own care but also become more involved in peer support and advocacy than lung cancer patients have been able to do in the past.

Better access to cancer care

Based on a study conducted by the University of the Philippines’ Institute of Human Genetics, 4 Filipinos die from cancer every hour, and it is estimated that 189 of every 100,000 Filipinos are afflicted with cancer.^[16]  

The National Integrated Cancer Control Act (NICCA) aims to give better support to cancer patients, especially those from the underserved, throughout every step of their cancer patient journey — from diagnosis, to getting access to treatment options, and to getting post-cancer care all while ensuring that the entire journey isn’t as physically, emotionally, and financially burdensome as it is typically known to be.

Ultimately, the law shall serve as a framework for all cancer-related activities of the government.

Filipino cancer patients, whose quality of life have been greatly affected by the pandemic situation, are looking for support with their treatment and critical care. National Integrated Cancer Control Act (NICCA), was signed on February 14, 2019. However, the law IS STILL NOT FULLY IMPLEMENTED within the PhilHealth system. It is high time to bring the NICCA Law to its full potential by shining the light on these important issues. Support the fight against cancer by signing the petition to fully implement the NICCA now and help in saving more Filipino lives.

References:

1. Global Cancer Observatory. (2021, March). 608-philippines-fact-sheets.pdf. International Agency for Research on Cancer https://gco.iarc.fr/today/data/factsheets/populations/608-philippines-fact-sheets.pdf 
2. American Cancer Society. (2022, February 14). “About Lung Cancer”. Cancer.org. https://www.cancer.org/cancer/lung-cancer/about/key-statistics.html#references 
3. Blandin Knight, S. (2017). Progress and prospects of early detection in lung cancer. Open biology, 7(9), 170070. https://doi.org/10.1098/rsob.170070 
4. American Cancer Society. (2022). “Types of Lung Cancer”. Cancer.org https://www.cancer.org/cancer/lung-cancer/about/what-is.html  
5. Mayo Clinic Staff. (2022, March 22). “Lung cancer”. Mayoclinic.org. https://www.mayoclinic.org/diseases-conditions/lung-cancer/symptoms-causes/syc-20374620 
6. Yamaguchi. N. (2019). Smoking, immunity, and DNA damage. Translational Lung Cancer Research, 8(1), S3-S6. doi: 10.21037/tlcr.2019.03.02
7. National Health Service. (2019, August 15). “Lung Cancer”. nhs.uk https://www.nhs.uk/conditions/lung-cancer/causes/#:~:text=develop%20the%20condition.-,Smoking,carcinogenic%20(cancer-producing) 
8. Lung cancer risk factors

https://www.cancer.org/cancer/lung-cancer/causes-risks-prevention/risk-factors.html

9. US Preventive Services Task Force. (2021). Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 325(10), 962-970. doi:10.1001/jama.2021.1117  
10. Centers for Disease Control and Prevention. (2021, October 18). “Who Should Be Screened for Lung Cancer?”. cdc.gov. https://www.cdc.gov/cancer/lung/basic_info/screening.htm#:~:text=may%20work%20better.-,The%20only%20recommended%20screening%20test%20for%20lung%20cancer%20is%20low,minutes%20and%20is%20not%20painful 
11. Cancer Research UK. (2021). “Why is early diagnosis important?”. Cancerresearchuk.org 

https://www.cancerresearchuk.org/about-cancer/cancer-symptoms/why-is-early-diagnosis-important

12. Mayo Clinic Staff. (2022, March 22). “Lung Cancer”. mayoclinic.org. https://www.mayoclinic.org/diseases-conditions/lung-cancer/diagnosis-treatment/drc-20374627 
13. National Health Service. (2019). “Treatment – Lung Cancer” . nhs.uk https://www.nhs.uk/conditions/lung-cancer/treatment/#:~:text=The%20most%20common%20treatment%20options,a%20combination%20of%20these%20treatments. 
14. Berman, R., et al (2020). Supportive Care: Indispensable Component of Modern Oncology. Royal College of Radiologist Clinical Oncology Information Network, 32(11), 781-788. doi: 10.1016/j.clon.2020.07.020
15. Fitch M., (2019). The Changing Face of Lung Cancer: Survivor Perspectives on Patient Engagement. Asia-Pacific journal of oncology nursing, 6(1), 17-23. https://doi.org/10.4103/apjon.apjon_43_18 
16. Department of Health. (n.d). “Philippine Cancer Control Program”. Doh.gov.ph https://doh.gov.ph/philippine-cancer-control-program 

Lung: PH-LAM-00025 03/10/2022 10/08/2023