Lung cancer is the leading cancer in both incidence and mortality in Hong Kong. It is mainly divided into two major types: Non‑Small Cell Lung Cancer (NSCLC), which accounts for approximately 85% of cases, and Small Cell Lung Cancer (SCLC). These two types differ significantly in growth rate and treatment strategies.

Causes of Lung Cancer

Although long‑term smoking and exposure to second‑hand smoke remain the leading causes of lung cancer, a considerable proportion of lung cancer patients in Hong Kong—especially women—have never smoked. These cases are often associated with specific genetic mutations, such as EGFR and ALK mutations. Other risk factors include long‑term exposure to air pollution, exposure to asbestos, and family history of lung cancer.

Recognising Early Symptoms of Lung Cancer

Early lung cancer symptoms can easily be mistaken for a common cold or bronchitis. If any of the following symptoms persist for more than three weeks, medical attention should be sought promptly:

• Persistent cough that does not resolve, or coughing up blood‑stained sputum (haemoptysis)
• Shortness of breath, wheezing, or chest pain during deep breathing
• Unexplained hoarseness, recurrent pneumonia, or recurrent bronchitis

At OncoCare, our multidisciplinary team utilises advanced imaging scans and molecular biopsy testing to develop the most precise cancer treatment strategy for each patient. Whether through surgery, chemotherapy, targeted therapy, or immunotherapy—the cornerstone treatments for lung cancer—we are committed to achieving the best possible survival outcomes and quality of life.

Lung cancer treatment depends on the stage at diagnosis (Stage I to IV) and the tumour's genetic characteristics.

1. Three Main Types of Lung Cancer Chemotherapy

Lung cancer chemotherapy commonly uses platinum‑based drugs (such as Cisplatin and Carboplatin) in combination with other anticancer medications, delivered intravenously to target cancer cells throughout the body.

• Neoadjuvant Chemotherapy: For locally advanced non‑small cell lung cancer, chemotherapy (sometimes combined with immunotherapy) is administered before surgery to shrink the tumour and improve the likelihood of complete surgical removal.
• Adjuvant Chemotherapy: Given after surgical tumour removal, with the aim of eliminating microscopic residual cancer cells and significantly reducing the risk of recurrence.
• Palliative Chemotherapy: For patients who are not suitable for surgery or those with small cell lung cancer, chemotherapy can effectively slow tumour growth, relieve symptoms such as pain and breathlessness, and extend survival.

2. Other Treatment Options

Modern lung cancer chemotherapy is often used together with the following treatments to achieve synergistic effects:

• Surgery: For early‑stage non‑small cell lung cancer, surgical removal of the affected lung lobe and surrounding lymph nodes is the preferred curative treatment.
• Targeted Therapy: If genetic testing confirms specific mutations (such as EGFR or ALK), oral targeted therapies can be prescribed to precisely block cancer growth pathways.
• Immunotherapy: Medications such as PD‑1 or PD‑L1 inhibitors are administered intravenously to reactivate the patient's immune system to recognise and destroy cancer cells.
• Radiotherapy: Uses high‑energy radiation to precisely target tumours. It is often combined with chemotherapy (concurrent chemoradiotherapy) and is suitable for patients who are not candidates for surgery.

Lung cancer chemotherapy is usually administered in cycles. A standard cycle typically lasts 3 to 4 weeks.

On the first day (or first few days) of each cycle, patients receive intravenous chemotherapy at our day chemotherapy centre. This is followed by a rest period, allowing healthy cells to recover.

Depending on the treatment goal (pre‑operative, post‑operative, or advanced disease control), a complete chemotherapy course generally consists of 4 to 6 cycles. During treatment, the medical team will arrange regular imaging examinations, such as CT scans, to assess the effectiveness of chemotherapy in shrinking the tumour.

Part 1: Common Expected Reactions and Medical Management

• Gastrointestinal discomfort (nausea and vomiting):
  This is one of the most common concerns among patients. Clinical oncologists, where necessary, and following an assessment of clinical needs and each patient’s individual conditions, may routinely administer highly effective anti‑nausea medications before chemotherapy and prescribe oral medications for home use. In most cases, gastrointestinal symptoms can generally be well controlled.
• Bone marrow suppression (low white blood cell count):
  Chemotherapy may temporarily affect blood cell production. The medical team, after accessing clinical needs and the patient’s individual conditions, will perform regular blood tests, and if necessary, prescribe white blood cell growth factor injections to strengthen immunity and reduce infection risk.
• Fatigue and hair loss:
  Fatigue is a common side effect, and patients are encouraged to maintain light activities such as walking. Depending on the chemotherapy regimen, some patients may experience temporary hair loss, which usually improves after treatment is completed.

Part 2: Emergency Guidelines for High‑Risk Symptoms

During the chemotherapy rest period, particularly between Day 7 and Day 14 when immunity may be at its lowest, the following high‑risk symptoms should not be ignored as a simple cold. Patients should contact our specialist nursing team or seek immediate medical attention:

• Possible severe infection: Fever of 38°C or above, severe chills or shivering
• Possible respiratory complications: Sudden worsening of breathlessness, persistent chest pain, coughing up large amounts of fresh blood
• Signs of severe dehydration: Severe diarrhoea for several consecutive days, frequent vomiting causing inability to eat or drink, significant reduction in urine output

OncoCare is committed to supporting patients throughout their lung cancer chemotherapy journey. Our in-house daychemotherapy centre provides a quiet and comfortable treatment environment, staffed by experienced oncologists and registered nurses. We offer close one‑to‑one monitoring and prompt side‑effect management, allowing patients to undergo treatment safely and comfortably in a highly private setting.