| Feature | Hodgkin Lymphoma | Non-Hodgkin Lymphoma |
|---|---|---|
| Defining Pathology | Reed-Sternberg cells present | Reed-Sternberg cells absent; classified by cell of origin |
| Frequency | Less common | More common |
| Subtypes | Small number of recognized subtypes | Over 60 recognized subtypes |
| Typical Spread | Orderly spread from one node group to adjacent groups | Variable; may be widespread or involve extra-nodal organs |
| Age Distribution | Bimodal (younger adults and older adults) | Incidence increases with advancing age |
| Growth Rate | Typically aggressive; requires prompt therapy | Ranges from indolent (slow-growing) to highly aggressive |
| Treatment Planning | Standardized treatment protocols by stage | Highly subtype-dependent treatment planning |
Lymphoma Treatment in Singapore for Filipino Patients
Lymphoma is a group of cancers that begin in lymphocytes, white blood cells that form part of the immune system. Treatment depends on the subtype, stage, and how the disease behaves.
This page explains how lymphoma is diagnosed, staged, and treated in Singapore, and how enquiries from the Philippines are handled.
What Is Lymphoma?
Lymphoma is a cancer that starts in lymphocytes, a type of white blood cell that helps the body fight infection. When lymphocytes develop genetic changes, they can grow and survive abnormally, collecting in lymph nodes or other parts of the lymphatic system.
Lymphoma is a group of more than 60 recognised conditions that differ in appearance under microscopic examination, growth rate, response to treatment, and clinical management.
According to the Singapore Cancer Registry Annual Report 2023, lymphoma is the fourth most common cancer in males and the fifth most common in females in Singapore, with more than 5,000 new cases diagnosed between 2019 and 2023.
How Lymphoma Affects the Lymphatic System
The lymphatic system is part of the immune system and includes lymph nodes in the neck, armpits, chest, abdomen, and groin, alongside the spleen, thymus, tonsils, bone marrow, and lymphatic vessels. Because lymphatic tissue is distributed throughout the body, lymphoma can present in multiple anatomical regions.
Hodgkin vs Non-Hodgkin Lymphoma
Indolent vs Aggressive Lymphoma
Indolent Lymphomas
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Grow slowly and may produce minimal symptoms initially. Some cases do not require immediate treatment and are managed via active surveillance.
Aggressive Lymphomas
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Grow rapidly and require prompt medical intervention, but frequently demonstrate high responsiveness to therapy aimed at long-term remission.
Causes and Risk Factors for Lymphoma
Lymphoma develops when acquired genetic changes occur inside a lymphocyte, altering cell growth and survival. In most cases, these changes are not inherited and cannot be traced to a single event.
Risk Factors for Lymphoma
| Risk Factor | Clinical Context |
|---|---|
| Increasing Age | Incidence of most non-Hodgkin lymphomas increases with age, though Hodgkin lymphoma frequently affects younger adults. |
| Immune System Impairment | Conditions such as HIV infection, primary immunodeficiencies, or post-transplant immunosuppressive therapy elevate risk. |
| Autoimmune Conditions | Rheumatoid arthritis, Sjogren’s syndrome, and coeliac disease carry a modest association with specific subtypes. |
| Specific Infections | Infections such as Epstein-Barr virus (EBV), Hepatitis C, and Helicobacter pylori (associated with gastric MALT lymphoma) are linked to certain subtypes. |
| Family History | Having a first-degree relative with lymphoma carries a modest increase in statistical risk, though most cases are non-hereditary. |
What Causes Lung Cancer?
Lung cancer develops when the DNA inside lung cells undergoes damage over time, leading to uncontrolled cell division. Tobacco smoke is the primary identified cause. Cigarette smoke contains carcinogens that damage airway linings; repeated exposure over years increases the probability of malignant transformation.
Other recognized environmental carcinogens include radon gas, asbestos, and specific occupational chemical exposures.
Importantly, a significant proportion of lung cancer cases in Singapore (particularly adenocarcinoma) occur in individuals who have never smoked. Never having smoked does not exclude the possibility of lung cancer, and persistent symptoms warrant clinical evaluation regardless of smoking history.
Risk Factors for Lung Cancer
| Risk Factor | Clinical Context |
|---|---|
| Tobacco Smoking | The most significant modifiable risk factor. Risk increases with duration and quantity smoked. |
| Second-Hand Smoke | Regular passive exposure to environmental tobacco smoke increases risk. |
| Radon Gas | A naturally occurring radioactive gas and established respiratory carcinogen. |
| Occupational Exposures | Includes industrial exposure to asbestos, silica, diesel exhaust, and specific chemicals. |
| Air Pollution | Outdoor particulate pollution is classified as carcinogenic by the International Agency for Research on Cancer. |
| Prior Chest Radiotherapy | Previous radiation therapy to the chest for another malignancy can elevate long-term risk. |
| Family History | A history of lung cancer in a first-degree relative is associated with increased risk. |
| Age | Most diagnoses occur in individuals over 40 years of age. |
Progression, Diagnosis, and Staging
Left untreated, lung cancer typically continues to grow locally and spread to distant organs. Local tumour growth can obstruct airways, lead to recurrent infections, or cause pleural effusion (fluid accumulation around the lungs).
Disease stage at diagnosis significantly influences treatment objectives. Early-stage, localized disease can often be managed with curative intent through surgical resection. When cancer has spread broadly, treatment focuses primarily on disease control, slowing progression, and symptom management.
Diagnostic Workup
Diagnosing lung cancer involves a structured sequence of evaluations:
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Imaging Studies
A chest X-ray is often followed by a high-resolution CT scan of the chest to evaluate tumour size, location, and structural relationships. A PET-CT scan assesses metabolic activity and checks for regional or distant spread.
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Tissue Biopsy
Diagnostic confirmation requires a tissue sample examined by a pathologist. Biopsy methods include bronchoscopy, Endobronchial Ultrasound (EBUS), CT-guided needle biopsy, or surgical biopsy.
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Biomarker & Molecular Testing
Tissue samples from non-small cell lung cancer are routinely tested for specific genetic alterations (such as EGFR or ALK mutations) and PD-L1 expression to determine suitability for targeted therapy or immunotherapy.
Signs and Symptoms of Lung Cancer
Early-stage lung cancer frequently produces no noticeable symptoms. When symptoms do develop, they may include:
- A persistent cough lasting longer than three weeks
- A change in a chronic cough (becoming more frequent, painful, or altered in tone)
- Coughing up blood or blood-streaked phlegm (haemoptysis)
- New or worsening shortness of breath
- Chest, shoulder, or back discomfort, particularly when breathing deeply
- Persistent hoarseness
- Recurrent chest infections or bronchitis that fails to resolve
- Unexplained weight loss, reduced appetite, or persistent fatigue
These symptoms are more commonly caused by non-cancerous conditions. However, persistent or changing symptoms require medical assessment to identify the underlying cause.
Emergency Triage Warning: Seek immediate local emergency medical care if you experience severe breathlessness, coughing up large volumes of blood, or acute chest pain. If you are in the Philippines, go to the nearest hospital emergency department immediately. Do not delay urgent emergency care to plan international travel. Once stabilized, our 24/7 liaison team can coordinate medical transfer to Singapore if indicated.
When to See a Doctor
See a doctor if a cough lasts more than three weeks and is not improving, if a long-standing cough changes in character, if you become breathless doing things you previously managed comfortably, or if you have unexplained weight loss or a chest infection that keeps returning.
Anyone who coughs up blood should be assessed promptly, regardless of how small the amount, and regardless of smoking history.
Assessment exists to find an explanation. In most people the explanation will not be cancer. The purpose of seeing a doctor early is to identify what is happening, not to confirm a fear.
Symptoms That Need Urgent Medical Attention
Some symptoms need immediate assessment rather than a scheduled appointment. Go to your nearest emergency department or call your local emergency services if you experience:
- Coughing up a large amount of blood
- Severe or rapidly worsening breathlessness
- Severe chest pain
- Fainting, collapse or confusion
If you are in the Philippines and any of these occur, seek care at your nearest hospital immediately. Do not wait for a reply from Ascle Healthcare Group, and do not plan travel to Singapore first. Emergency stabilisation must happen where you are. Once a patient is stable, our 24/7 urgent care coordination team and medical evacuation service can manage the Singapore side of a transfer if one is later required.
Stages of Lung Cancer
| Stage Group | Clinical Definition (TNM System) |
|---|---|
| Stage I | Cancer is localized within the lung tissue and has not spread to lymph nodes. |
| Stage II | Cancer is larger or has spread to nearby peribronchial/hilar lymph nodes. |
| Stage III | Cancer has spread to mediastinal lymph nodes in the centre of the chest or adjacent structures. |
| Stage IV | Cancer has spread to the contralateral lung, pleural fluid, or distant organs (metastatic). |
Treatment Options for Lung Cancer
Treatment plans are personalized based on cancer type, stage, molecular profile, underlying lung function, and overall patient health. Care may involve surgery, chemotherapy, radiotherapy, targeted therapy, immunotherapy, or a combination of these modalities.
How Treatment Decisions Are Made
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A multidisciplinary team (MDT) comprising thoracic surgeons, medical oncologists, radiation oncologists, respiratory physicians, radiologists, and pathologists evaluates each case. Key factors considered include:
- Exact histological cancer type and subtype
- Disease stage and anatomical tumour location
- Biomarker and genomic test results
- Pre-operative lung function (spirometry and diffusion capacity)
- Patient cardiovascular fitness and personal
- treatment preferences
Which Specialists May Be Involved
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Lung cancer care commonly draws on several disciplines: thoracic surgery for assessment and surgical treatment, medical oncology for chemotherapy, targeted therapy and immunotherapy, radiation oncology for radiotherapy, respiratory medicine for diagnostic procedures and lung function assessment, and radiology and pathology for imaging interpretation and tissue diagnosis. Which of these are involved depends on the diagnosis and the treatment plan.
When Is Lung Cancer Surgery Considered?
Surgical resection aims to remove the primary tumour completely alongside a surrounding margin of healthy lung tissue and regional lymph nodes. It is primarily considered for early-stage Non-Small Cell Lung Cancer (Stage I and Stage II, and selected Stage III cases). Surgery plays a very limited role in Small Cell Lung Cancer. Offering surgery requires satisfying two distinct criteria:
Resectability (The Tumour)
Evaluates whether the tumour can be completely removed surgically based on its size, location, and absence of distant metastatic spread.
Operability (The Patient)
Evaluates whether the patient possesses sufficient cardiovascular fitness and post-operative lung capacity to undergo and recover safely from the procedure.
Non-Surgical Candidates
Surgery may not be advised if the cancer involves unresectable vital structures, if distant metastases are present, or if baseline lung function is insufficient to tolerate lung tissue removal. In such cases, non-surgical options, such as stereotactic body radiotherapy (SBRT), chemotherapy, targeted therapy, or immunotherapy, are evaluated.
Types of Surgical Resection
How much lung tissue is removed depends on tumour size, location, and baseline lung function:
Sublobar Resection (Wedge Resection / Segmentectomy)
Removes the tumour along with a margin of healthy tissue or an anatomical segment. Considered for small peripheral tumours or patients with compromised lung function.
Lobectomy
Removes the entire lobe containing the tumour (three lobes exist on the right, two on the left). Lobectomy remains the standard surgical approach for early-stage NSCLC when lung function permits.
Pneumonectomy
Removes an entire lung. Reserved for large or centrally located tumours where partial resection is not technically feasible.
Lymph Node Dissection
Regional lymph nodes within the chest are systematically sampled or removed during surgery to establish final pathological staging.
Surgical Modalities: Open vs Minimally Invasive
Minimally Invasive Surgery
Performed via small incisions using specialized cameras. Includes Video-Assisted Thoracoscopic Surgery (VATS) and Robotic-Assisted Thoracic Surgery (RATS). These approaches are associated with reduced post-operative pain and shorter hospital stays.
Open Surgery (Thoracotomy)
Performed via a larger incision between the ribs. Indicated for complex, large, or centrally invasive tumours.
Dr Lim Chong Hee, Senior Consultant Cardiothoracic Surgeon (Visiting Consultant) at Ascle Healthcare Group, performs minimally invasive lung surgery in Singapore. Surgical suitability is determined during clinical consultation.
Surgical Risks, Preparation, and Recovery
Treatment plans are tailored according to cancer type, stage, molecular profile, and overall patient fitness. Care may involve a single treatment modality or a combination of approaches:
Potential Surgical Risks
While complete surgical resection offers the potential for long-term disease-free survival in early-stage disease, major lung surgery carries recognized clinical risks:
Pre-Operative Preparation
Preparation includes formal pulmonary function testing (spirometry), cardiac evaluation (ECG/Echocardiogram), medication adjustments (pausing blood thinners), and smoking cessation support. Stopping smoking prior to surgery significantly reduces pulmonary complications and enhances healing.
Recovery Workflow
Post-operative recovery involves close monitoring, pain management, early chest physiotherapy, and gradual removal of chest drains once air leaks have sealed. Removed tissue and lymph nodes undergo histological analysis; if cancer cells are identified in regional lymph nodes, adjuvant chemotherapy, targeted therapy, or immunotherapy may be recommended to lower recurrence risk.
Non-Surgical Therapies and Preventive Health
Potential Surgical Risks
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- Chemotherapy: Uses cytotoxic medications to target rapidly dividing cells. Administered as primary treatment, neoadjuvantly (before surgery), or adjuvantly (after surgery).
- Radiotherapy: Delivers targeted radiation to destroy tumour cells. Stereotactic Body Radiotherapy (SBRT) provides high-dose targeted radiation for early-stage non-surgical candidates.
- Targeted Therapy: Uses specific oral medications to inhibit cancer growth driven by specific genetic alterations (such as EGFR mutations or ALK rearrangements).
- Immunotherapy: Immune checkpoint inhibitors that help the patient’s immune system recognize and destroy cancer cells.
Risk Reduction and LDCT Screening
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While lung cancer cannot be entirely prevented, risk is reduced by avoiding tobacco smoke, minimizing occupational carcinogen exposure, and testing for household radon.
Low-Dose CT (LDCT) Screening: Targeted screening using Low-Dose CT scans is recommended for asymptomatic individuals meeting high-risk criteria (typically adults aged 50–80 with a 20+ pack-year smoking history who currently smoke or quit within the past 15 years).
Lung Cancer Specialists in Singapore
There is no single specialty that manages every case of lung cancer. Which lung cancer specialist in Singapore is the right one depends on what the individual needs at that point in their pathway.
For a patient with a suspicious finding on a scan and no tissue diagnosis, the first appropriate referral is often to a respiratory physician or a thoracic surgeon. For a patient who already has a confirmed diagnosis and staging, the appropriate specialist depends on the treatment being considered. Care is commonly coordinated across several of these disciplines.
Ascle Healthcare Group is a Singapore medical group. Our Patient Liaison Centre coordinates specialist appointments, hospital admission and clinical handover in Singapore. You can view our specialist team and our medical centres in Singapore. Ascle Healthcare Group does not itself provide diagnosis; diagnosis and treatment are provided by registered medical specialists at their consulting premises and at Singapore hospitals.
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A respiratory physician commonly leads initial investigation, including bronchoscopy and lung function assessment.
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A thoracic surgeon assesses whether surgery is appropriate, and performs it where it is.
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A medical oncologist manages chemotherapy, targeted therapy and immunotherapy.
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A radiation oncologist plans and delivers radiotherapy.
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Radiologists and pathologists provide the imaging interpretation and tissue diagnosis on which everything else depends.
Cost of Lung Cancer Treatment in Singapore
The cost of lung cancer treatment in Singapore depends on what the treatment actually involves. The main variables are:
- Whether surgery is part of the plan, and which resection is performed
- The surgical approach used
- Hospital and operating theatre charges, which differ between hospitals
- Anaesthesia
- Diagnostic investigations, including CT, PET-CT, bronchoscopy and biopsy
- Pathology and molecular testing
- Length of hospital stay
- Any complications requiring additional care
- Any further treatment recommended after surgery, such as chemotherapy, targeted therapy, immunotherapy or radiotherapy
- Follow-up imaging and review
Because a treatment plan is only finalised after diagnosis and staging, an accurate estimate is not possible before assessment. An indicative estimate can normally be prepared once the proposed treatment is known.
International patients should note that Singapore public healthcare subsidies, MediSave and MediShield Life apply to Singapore citizens and permanent residents, and are not available to overseas patients. Coverage under private or international insurance depends on the individual policy, and pre-authorisation may be required.
Considering Lung Cancer Treatment in Singapore from the Philippines
All healthcare services described on this website are provided in Singapore. Ascle Healthcare Group does not operate a hospital, clinic, or medical facility in the Philippines. Consultations, investigations, surgery and other treatment take place in Singapore, at Singapore hospitals and consulting premises, with doctors registered with the Singapore Medical Council.
Patients in the Philippines who are considering specialist care in Singapore can enquire before arranging any travel. Enquiring first is generally the sensible order, because it allows a specialist to indicate whether assessment in Singapore is likely to be useful in your particular circumstances before you commit to the cost and disruption of a trip.
To make that initial review possible, you may be asked to provide records you already hold, which commonly include:
- Imaging, such as chest X-rays, CT or PET-CT scans, ideally the original image files as well as the reports
- Pathology or biopsy reports
- Laboratory results
- Summaries of any treatment already received
- A current list of medications
- Correspondence from your current treating doctors
Please share these only through the secure channel provided when you enquire. Do not send medical records, images or identity documents through unsecured channels such as ordinary email attachments or public messaging groups.
Two things to be clear about. A remote review of records is not a diagnosis, and it does not replace in-person assessment. And an enquiry does not guarantee that treatment in Singapore will be recommended or accepted: whether a specialist can help, and whether travel is clinically advisable, depends on the individual case. Some patients are better served by continuing care where they are, and a specialist will say so where that is the case.
If your condition is urgent or unstable, seek care at your nearest hospital in the Philippines first. Travel decisions can follow once you are stable. Where a transfer is clinically appropriate, our medical evacuation coordination service manages the Singapore side of the arrangements.
Arrange a Lung Cancer Specialist Consultation in Singapore
If you have a persistent respiratory symptom, an abnormal scan result, or a lung cancer diagnosis and want a specialist assessment, our Patient Liaison Centre can arrange a consultation in Singapore and coordinate appointments, hospital admission and clinical handover.
Whether lung cancer surgery in Singapore is suitable for you, or whether another form of lung cancer treatment would be more appropriate, is determined at specialist assessment based on your cancer type, stage, imaging, pathology and general health.
Frequently Asked Questions about Lung Cancer Surgery in Singapore
Can lung cancer be managed with surgery alone?
In selected early-stage non-small cell lung cancers where a complete surgical resection with clear margins is achieved, surgery alone may provide long-term disease-free survival. However, if pathological analysis of removed lymph nodes reveals microscopic disease spread, post-operative adjuvant therapy (such as chemotherapy or targeted therapy) may be recommended to reduce recurrence risk.
Can an individual live normally after a pneumonectomy?
Many individuals maintain a good quality of life following the removal of a lung (pneumonectomy), though physical exertion capacity is reduced. Pre-operative pulmonary function testing evaluates baseline breathing capacity to ensure remaining lung tissue can support daily activities safely.
When is air travel safe following lung cancer surgery?
Commercial air travel is typically restricted for several weeks following chest surgery to allow lung tissue to seal, prevent pneumothorax from cabin pressure changes, and reduce deep vein thrombosis risk. Your thoracic surgeon will advise when flying is clinically safe based on post-operative imaging.
How long should an international patient plan to stay in Singapore for surgical care?
Duration of stay varies. Initial diagnostic workup and pre-operative staging generally require several days. Following surgery, hospital stay ranges from 3 to 7 days for uncomplicated minimally invasive resections, followed by 1 to 2 weeks of outpatient recovery before air travel clearance is evaluated.
Can I request a second opinion on a lung cancer diagnosis in Singapore?
Yes. International patients frequently request a specialist review of existing scan files, pathology slides, and proposed treatment plans. Providing original DICOM scan files and pathology reports allows our specialist team to review your case accurately.
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