KUALA LUMPUR - Lung cancer, long known as a ‘silent killer’ and consistently among the top three causes of cancer-related deaths in Malaysia, is now seeing a shift in outlook.
Clinical Oncologist at Sunway Medical Centre, Sunway City (SMC), Dr David Lee Dai Wee said, thanks to advances in modern therapies, patient survival rates are doubling, offering new hope where it was once scarce.
He highlighted that nearly 60 per cent of lung cancer patients in Malaysia are only diagnosed at stage four, the most advanced stage, with a five-year survival rate of less than 15 per cent, according to the National Cancer Registry.
"In the early stages, such as stage one or two, patients often experience no symptoms at all. As a result, lung cancer is frequently diagnosed at a later stage when symptoms begin to appear. These may include a persistent cough lasting two to three weeks or longer,” he told Bernama.
Other symptoms may include coughing up blood (hemoptysis), chest pain during breathing, shortness of breath and unexplained weight loss, said Dr Lee, adding that the spread of cancer to other organs may also cause pain in different parts of the body.
He noted that while tobacco smoking is responsible for around 80 per cent of lung cancer cases, exposure to secondhand smoke, hazardous substances such as asbestos and coal, as well as genetic predisposition, also contribute significantly to the disease's risk profile.
Dr Lee also highlighted that 20 to 30 per cent of lung cancer patients in Asia are non-smokers, challenging the common misconception that only smokers are affected, a belief that may lead patients or primary care doctors to delay further testing to determine whether symptoms are related to lung cancer.
"But now, due to advances, firstly in molecular pathology, we are able to run this test called Next Generation Sequencing (NGS), which allows us to read the DNA (deoxyribonucleic acid) of the cancer cells and understand them better.
"And this has significantly improved treatment for this type of cancer. So, for example, let's say in a hundred patients of lung cancer that I see, about 50 per cent have this genetic change called Epidermal Growth Factor Receptor (EGFR) mutation,” he said.
Dr Lee said that while conventional treatments often result in a life expectancy of less than a year, newer therapies, including more convenient options such as oral targeted tablets, can now extend survival to as long as three years.
"Another example is the use of immunotherapy, which is administered through an intravenous drip. It works by revealing cancer cells that have become adept at ‘hiding’ from the immune system, helping the body to recognise and destroy these harmful cells,” he said.
He explained that one of the advantages of modern therapies, such as immunotherapy, is their tolerability, with nearly 80 per cent of patients experiencing minimal side effects and avoiding issues like hair loss or vomiting.
However, he pointed out that the biggest challenges to personalised cancer treatment in Malaysia remain limited access to advanced technologies and high costs, as many of these drugs are not listed in the national formulary and are not subsidised in public hospitals.
"So imagine if a patient is living in the rural areas and they need this NGS test. They need their lung cancer tissue to be sent to a lab in Kuala Lumpur,” he said.
These challenges often lead to delays in initiating treatment, a critical concern in lung cancer care, where early intervention significantly improves disease control and outcomes.
As such, he emphasised the importance of shared decision-making between oncologists, patients and their families to tailor each treatment plan, with the goal of not only extending survival but also maintaining the patient’s quality of life.
"Because not every patient is the same, treatment decisions are largely based on the patient's age, fitness level, stage of the disease, and molecular (DNA) subtype. Through NGS (genetic) testing, we can be more precise in targeting the cancer cells, with safer treatment options,” he said.
He emphasised that treatment decisions should go beyond simply extending life, as the ultimate goal is to help patients maintain a good quality of life, enabling them to return to work, spend time with loved ones and lead fulfilling lives.
Dr Lee is the first Malaysian to receive the International Association for the Study of Lung Cancer (IASLC) Academy Award 2024, a milestone since the award’s inception in 2017.
He was also honoured with the American Society of Clinical Oncology (ASCO) International Development and Education Award (IDEA) 2024 in Chicago, United States. - BERNAMA