For one year, financial adviser Lee Hui Wah went from one doctor to another, hoping to find a less extreme method of dealing with a slow-growing tumour in her lung.
Three specialists had told the 54-year-old that her entire left lung may have to be removed. But it was such a frightening prospect that Madam Lee thought it might be better to "live with cancer".
It was not until January when she consented to a landmark operation that preserved three-quarters of her lung. This meant she lost only 11 per cent of her lung capacity, compared with 45 per cent if she were to have her entire left lung removed to halt her cancer, said her surgeon, Associate Professor John Tam, who heads National University Heart Centre, Singapore's (NUHCS) division of thoracic surgery.
The mother of two grown-up children had sensed something was amiss when her weight plummeted 10kg over three years.
In April 2013, a series of tests at Tan Tock Seng Hospital confirmed that she had a lung carcinoid tumour, which makes up about
1 per cent to 2 per cent of all adult lung cancer cases. Moreover, her slow-growing tumour was in a unique position - at the junction of the two lobes of her left lung. The right lung has three lobes, while the smaller left lung has two.
If her tumour had been confined to one lobe, doctors could simply remove part of her left lung.
Madam Lee found it hard to agree to sacrifice her entire left lung to get rid of the 4cm-wide tumour.
But when she heard from Prof Tam that she had a 50 per cent chance of not losing her entire left lung, she relented to surgery on Jan 22.
A CUSTOMISED SOLUTION
Prof Tam said it was a "one-of-a-kind operation tailored to the specifications and location of her tumour".
Each lobe of the lung comprises four segments. Prof Tam first identified two segments of her left lung where the tumour was.
The three-hour operation was a precarious one because removing two segments from two different lobes is more challenging than removing them from the same lobe, said Prof Tam.
Each lobe of the lung has its own supply of blood vessels and bronchioles (smaller airways).
Prof Tam had to navigate and cut through two different sets of these delicate structures, while being careful not to cut into the tumour and risk spreading the cancer cells to other parts of the body.
Each year, doctors at NUHCS perform at most 10 operations that involve removing segments of the lung.
Yet, Madam Lee is the first case which involves removing a segment each from two lobes simultaneously so her tumour is removed in one piece, with a good margin of tissue surrounding it, he said.
If she had undergone a more drastic operation of removing her entire left lung (pneumonectomy), she would face a higher risk of bleeding and infection, said Prof Tam. And in the first two days after such an operation, she has a
10 per cent to 20 per cent chance of developing acute respiratory distress syndrome (ARDS), a life-threatening condition which prevents enough oxygen from reaching the lungs. This occurs if the remaining lung is unable to cope with receiving all the blood pumped out by the heart. With the customised surgery, her risk of developing ARDS drops to less than 1 per cent, Prof Tam said.
An NUHCS spokesman said that Madam Lee's procedure costs about $6,800, while a pneumonectomy costs about $6,000.
While most lung cancer patients would have one lobe of the lung removed, lung-preserving surgery, like what Madam Lee had gone through, may be offered to those with poor lung function and those whose cancer had spread from other body parts to the lungs, said Prof Tam.