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Like many cancers, lung cancer does not show symptoms in its early stages. Many patients with the disease usually present late in the course of the disease.

By the time Rany presented with symptoms and went to seek medical advice, her cancer was already in Stage 4. She was later determined to have advanced stage Epidermal Growth Factor Receptor (EGFR)-positive lung cancer, with metastasis to the brain.

• Lung cancer accounts for approximately 1 in 13 cases of cancer diagnosed in Singaporean women, shares Dr Chin Tan Min, Senior Consultant, Medical Oncology. This makes it the third most common cancer in women, after breast cancer and colorectal cancer.
• Lung cancer can be caused by a number of genetic mutations, from EGFR to ALK and KRAS. EGFR-positive lung cancer refers to lung cancer that has a positive EGFR gene mutation.
• In EGFR-positive lung cancer, the EGFR is mutated, causing it to be constantly turned on, hence resulting in cells growing uncontrollably and leading to cancer. At advanced stages of the disease (Stage 3, 4), the malignant cells have spread beyond the primary site of the cancer and surrounding lymph nodes, and to other parts of the body such as the brain, liver and bones.

"Life had to go on"

“I was really shocked and frightened when I received the news,” Rany recalled.

Rany’s biggest worry when she learnt about her condition was her immediate family. Her son and her two grandchildren lived abroad in the United Arab Emirates, and were a 10-hour flight away.

At home, she only had her husband to turn to. The couple lived together in Bandung, Indonesia with only a part-time helper at their house to help around with the household chores. Without an adequate support system under their roof, it was a struggle for Rany and her husband to adapt to this 360 degree turn in their lives.

“It was really hard for me and my husband to deal with these changes,” shared Rany. “But life had to go on.”

Determined to get the health support she needed for her condition, Rany went to seek advice and recommendations on hospitals and cancer centres in the region. She knew that Singapore had a great reputation for its efficient and effective healthcare system, so she decided to fly to Singapore with her husband to seek treatment.

Treating a once untreatable disease

In the past, advanced lung cancer was an incurable disease. At late stages of the disease, treatment options are aimed at control rather than cure, and are generally more intense, with modest efficacy.

Fortunately, advances in cancer treatment have led to more precise and accurate novel diagnostics and treatment modalities that make effective management of advanced disease possible.

Lung cancer patients who carry EGFR genetic mutations can be treated with an oral targeted agent that targets the EGFR protein. This targeted agent will then block the particular receptor and disrupt cancer cell growth.

Compared to traditional treatment modalities for Stage 4 lung cancer (i.e. chemotherapy), the side effects of targeted therapy are usually less, with a longer period of disease control and significantly improved survival outlook. In fact, the survival rate of these patients are no longer measured in terms of months, but in terms of years.

Despite her age, Rany was able to undergo brain surgery in Singapore to treat her secondary brain cancer. This was followed by a course of treatment including oral targeted treatment and chemotherapy, to keep her primary disease under control.

After her initial treatment, Rany was well, relatively symptom free, and able to maintain a good quality of life in Bandung with her family. For the past 8 years, she has been returning to Singapore for regular follow-up treatments to keep her disease under control. Due to the COVID-19 pandemic and border closures between Singapore and Indonesia, her follow-ups in Singapore had to be rescheduled, but her cancer treatment continues with close collaboration between her Singapore and Bandung doctors. Rany sees COVID-19 and travel difficulties as a temporary challenge. Importantly, Rany finds herself fortunate that her cancer had an actionable target that can be treated, and is hopeful that her future will continue to remain positive and bright.