Lung Cancer: Diagnosis & Treatments

Lung Cancer Diagnosis

Initial Imaging Test

Lung cancer diagnosis often starts with an imaging test. Imaging allows your healthcare team to examine your lungs and identify changes that shouldn’t be there.

Chest X-Ray

Healthcare professionals usually find initial potential signs of lung cancer during chest X-rays while looking for other conditions.  An X-ray can reveal an abnormal area, but it cannot always determine its nature. If there is concern, a CT scan provides a clearer, more detailed image of the lungs.

Some people have imaging before symptoms begin. If you smoke or used to smoke, you may consider screening. Screening aims to detect lung cancer early, when treatment may be more effective.

Low-Dose CT Scan

Patients with an increased risk of lung cancer may consider yearly screening with a low-dose CT scan. Low-dose CT scans use less radiation than a standard CT and are designed for screening. Lung cancer screening is generally offered to people aged 50 and older who smoked heavily for many years. It is also offered to some non-smokers who quit smoking within the past 15 years. Talk with your healthcare professional about your lung cancer risk. Together, you can decide whether lung cancer screening is right for you and what the next steps should be.

Test to Determine Staging

If you are diagnosed with lung cancer, your healthcare team may recommend more tests to see whether the cancer has spread. These tests show the extent of the cancer, also known as cancer staging. Staging usually involves imaging tests. The scans look for signs of cancer in the lymph nodes and in other parts of the body. Your healthcare team uses the results to build a treatment plan tailored to your cancer and overall health.

Imaging tests used for staging may include CT, PET-CT, MRI, and, in some cases, bone scans. Not every test is right for every person. Your healthcare professional will recommend the tests most useful for your situation and explain what each test is designed to detect.

Bone Scan

A bone scan looks for signs that cancer has spread to the bones. It is not always necessary for everyone, but it may be used if you have bone pain or if other scans raise concerns.

PET-CT Scan

A PET-CT scan looks for areas in the body that are more active than normal. Cancer cells often consume more energy than healthy cells, so they may appear on this scan. PET-CT can help evaluate lymph nodes and detect spread to distant sites. It cannot confirm cancer on its own because infection or inflammation can sometimes look similar.

MRI Scan

An MRI scan uses magnetic fields to generate detailed images. A brain MRI is often used if you have neurological symptoms such as headaches, weakness, or changes in vision. It may also be recommended when there is a higher chance the cancer has spread, such as when a Stage III cancer is suspected, and treatment is being planned.

Endobronchial Ultrasound (EBUS)

EBUS is a type of bronchoscopy that uses ultrasound to look at lymph nodes in the centre of the chest. The doctor passes a thin tube through the mouth into the airways. Ultrasound helps identify lymph nodes that need sampling. A needle can then take small tissue samples through the airway wall. EBUS is minimally invasive and is commonly used for cancer staging.

Biopsy

A biopsy is the removal of a small sample of tissue or cells for laboratory testing. A biopsy confirms the diagnosis and helps identify the lung cancer type. It can also provide information to guide treatment decisions.

Bronchoscopy

During a bronchoscopy, a healthcare professional passes a lighted, camera-equipped tube down the throat into the lungs. It allows the doctor to examine the airways and collect samples. Specialised tools can be used to collect tissue, or bronchoscopy may be combined with EBUS to sample lymph nodes.

Mediastinoscopy

Mediastinoscopy is a surgical procedure used to take samples from lymph nodes in the chest. A small cut is made at the base of the neck, and instruments are passed behind the breastbone to reach the lymph nodes. It is often considered when needle-based sampling is not possible, or when results still leave uncertainty.

Needle Biopsy (CT-Guided Biopsy)

In a needle biopsy, a doctor uses CT images to guide a needle through the skin and into the lung to collect cells or tissue. This is commonly used for nodules or tumours near the outer parts of the lung.

If you are undergoing staging tests, it can help to ask what each test is intended to detect and how the result will affect the plan. That way, each step feels purposeful rather than overwhelming.

Understanding Lung Cancer Stages

Lung cancer stages range from 1 to 4. Lower numbers mean the cancer is smaller and confined to the lung. Higher numbers indicate a larger tumour, lymph node involvement, or extrapulmonary spread. Stage 4 lung cancer has spread to other areas of the body.

For most non-small cell lung cancers (NSCLC), staging is based on the TNM system. TNM stands for Tumour, Node and Metastasis.

• T describes the size and extent of the main tumour, from T1 to T4.
• N describes whether cancer has spread to nearby lymph nodes, from N0 to N3.
• M describes whether cancer has spread to distant sites, recorded as M0 or M1.

Small-cell lung cancer (SCLC) is often described in different ways. Instead of Stages 1 to 4, it may be described as a limited-stage or an extensive-stage approach. In the limited stage, the cancer is mainly on one side of the chest and can usually be treated within one radiation field. In the extensive stage, the cancer has spread to the other lung or to other parts of the body.

These results are combined to determine the overall stage. Staging helps describe whether the cancer is localised, regionally advanced, or metastatic. Accurate staging is the foundation of effective treatment because the best plan depends on the stage, the cancer type, and your overall health.

Molecular Testing

In Singapore, molecular profiling (biomarker testing) is strongly recommended and widely considered standard of care, especially for advanced (stage IV) non-squamous NSCLC, because the results directly determine whether targeted therapy or immunotherapy is appropriate.

Lung Cancer Treatments

Lung cancer is one of the biggest health challenges in Singapore, but with advances in detection and lung cancer treatment, especially minimally invasive thoracic surgery, there is hope. At Neumark Lung & Chest Surgery Centre, led by Dr Harish Mithiran, we provide comprehensive, patient-centric lung cancer care that integrates cutting-edge diagnostics, molecular-guided therapy, and precision surgery to deliver top-tier care.

To ensure patients receive expert, tailored care, our multidisciplinary team at Gleneagles and Mount Alvernia Hospitals comprises experienced cancer specialists. Whether you have an early-stage lung cancer tumour or complex metastatic disease, every decision is informed, timely and personal for you.

Lung Cancer Surgery

During surgery, the surgeon removes the lung cancer and a rim of healthy tissue around it. The aim is to remove the tumour completely while preserving as much healthy lung tissue as possible.

Procedures to remove lung cancer include:

• Wedge resection: A wedge resection removes a small, wedge-shaped piece of lung that contains the cancer, along with a margin of healthy tissue.
• Segmentectomy: A segmentectomy removes a larger portion of the lung than a wedge resection, but not the entire lobe. The surgeon removes one anatomical segment of the lung.
• Lobectomy: A lobectomy removes an entire lobe of the lung. It is a common operation for early-stage lung cancer because it can remove the tumour with a wider margin and reduce the risk of recurrence in selected patients.
• Pneumonectomy: A pneumonectomy removes an entire lung. This is considered when the tumour is too large or too central to be removed safely with a smaller operation.

During lung cancer surgery, the surgeon usually removes lymph nodes from the chest as well. Lymph nodes are tested to determine whether cancer has spread. This helps confirm the stage and guides whether further treatment is needed.

Surgery is most often an option when the cancer is confined to the lung and can be removed completely. If the tumour is larger or lymph nodes are involved, chemotherapy or radiotherapy may be used before surgery to shrink the cancer.

Lung cancer surgery can be done minimally invasively. Neumark surgeons utilise three different types of minimally invasive surgeries for lung cancer:

• Robotic-Assisted Thoracic Surgery (RATS) is used for certain thoracic procedures, including lung cancer and mediastinal tumours.
• Video-Assisted Thoracic Surgery (VATS) uses small incisions and a camera to remove cancerous tissue. Surgeons insert a thoracoscope with a camera through a small cut to see inside the chest and instruments through other small incisions to do the surgery.
• Uniportal Video-Assisted Thoracic Surgery (U-VATS) assesses and treats lung and mediastinal diseases through a single incision.

For each type of surgery, preoperative assessments and risk management are crucial to achieving optimal outcomes and ensuring patient safety.

Chemotherapy

Chemotherapy treats lung cancer using medicines that travel through the bloodstream. These medicines are often given by injection or drip. Chemotherapy works by damaging cancer cells and preventing their division. This slows or stops cancer growth and helps destroy cancer cells.

Chemotherapy can also affect healthy cells that divide quickly. This is why side effects can happen. Possible side effects include a temporary drop in blood counts, lower immunity, nausea, vomiting, diarrhoea or constipation, tiredness, loss of appetite, hair loss, skin and nail changes, and numbness or tingling in the hands and feet. Many side effects can be managed and often improve after treatment ends.

Radiation Therapy

Radiation therapy treats cancer using powerful energy beams. The energy may come from X-rays, protons, or other sources. During treatment, you lie on a table while a machine moves around you. The machine directs radiation to specific areas of the body. The goal is to damage the cancer cells so that they cannot grow.

Radiation therapy may be used in different ways depending on where the cancer is and what the treatment plan is trying to achieve. If lung cancer is within the chest, radiation may be given before surgery or after surgery. It is often used together with chemotherapy. If surgery is not an option, chemotherapy and radiation may be used as the main treatment.

If lung cancer has spread to other parts of the body, radiation therapy can also be used to relieve symptoms. It may help reduce pain, control bleeding, or ease pressure caused by tumours in specific areas.

Immunotherapy

Immunotherapy is a treatment that helps your immune system fight cancer. The immune system normally detects and eliminates abnormal cells. Cancer can sometimes evade the immune system by sending signals that prevent immune cells from attacking. Immunotherapy medicines, including immune checkpoint inhibitors, block these signals. This helps the immune system recognise cancer cells and attack them.

Immunotherapy may be used in lung cancer under various circumstances. It can be used on its own, combined with chemotherapy, or given after chemoradiotherapy, depending on the type and stage of cancer and the treatment goals. It is not only for patients who have exhausted other options. For some patients, it is included in the initial treatment plan.

Immunotherapy often causes fewer day-to-day side effects than chemotherapy, but it can sometimes trigger unpredictable and serious immune reactions. Side effects may include diarrhoea, nausea or vomiting, a rash or pruritus, headaches, fatigue, and hormonal changes. More rarely, immunotherapy can cause inflammation in organs such as the lungs, liver, bowel or glands. Your specialist will explain what to watch for and when to seek help.

Stereotactic Body Radiotherapy

Stereotactic body radiotherapy is a type of radiation therapy that delivers a high dose to a small target. The machine aims beams from multiple angles so the highest dose reaches the cancer while reducing exposure to nearby healthy tissue. Treatment is usually completed in one or a few sessions.

You may also hear this approach described as stereotactic radiotherapy. When the target is in the brain, the procedure is often referred to as stereotactic radiosurgery.

Stereotactic body radiotherapy may be an option for patients with small lung cancers who cannot have surgery. It may also be used to treat cancer that has spread to other parts of the body by targeting specific areas, depending on the cancer’s location and the treatment plan’s objectives.

Targeted Therapy

Targeted therapy treats lung cancer with medicines that target specific changes in cancer cells. Some lung cancers have abnormal proteins or signalling pathways that drive cell growth and metastasis. Targeted therapy blocks those signals. This can slow the cancer’s growth or shrink the tumour.

Targeted therapy is used when tests show that the cancer has a specific abnormality that the medicine can target. Because these drugs are designed to target specific cancer pathways, they can affect healthy cells less than some other treatments. But side effects can still happen. Possible side effects include nausea or vomiting, diarrhoea or constipation, bloating, mouth ulcers, a rash or other skin changes, and vision problems. Your healthcare team will explain what to watch for and how to manage side effects during treatment.

Palliative Care

Palliative care is a type of healthcare that focuses on helping you feel better when you have a serious illness. If you have cancer, palliative care can help relieve pain and other symptoms such as breathlessness, nausea, tiredness, poor appetite and anxiety. The goal is to improve your quality of life and that of your family.

Palliative care is provided by a team that may include doctors, nurses and other health professionals with special training. These specialists work with you, your family, and your primary care team, providing an additional layer of support and helping you manage symptoms and stress.

You can receive palliative care at the same time as active cancer treatment. It can be part of your care plan whether you are having surgery, chemotherapy, radiation therapy, immunotherapy, or other treatments.