Professor Philip Eng

Professor Philip Eng was in Sri Lanka recently to address a session to Chest physicians. An authority on lung cancer he graduated from the National University of Singapore in 1984 and subsequently completed his Masters of Medicine, (Internal Medicine) in 1989.

He then went on to do residency training in Pulmonary and Critical Care Medicine at the Cleveland Clinic Foundation and the University of California, San Diego, both in USA. In 1997, he was appointed the Head, Department of Respiratory & Critical Care Medicine at the Singapore General Hospital at the age, of 37. He was one of the youngest Head of Department in Singapore at that time.

In his nine year tenure, he built one of the strongest departments in the region in Respiratory and Critical Care Medicine with strong linkages with Chest Radiology, Thoracic Surgery and Thoracic Oncology. His interests are in Lung Cancer, branchoscopy (both flexible and rigid), Intensive Care and Chest Radiology. He has performed more than 300 rigid bronchoscopies, stents, NdYAG lasers and Argon Plasma photo-coagulation.

He has published close to 100 peer reviewed articles and books. In 2005, he published a book, "Chest X-rays: Illustrated with 100 cases", in collaboration with Cambridge University Press, UK that went on to sell more than 5000 copies within 2 years. It has become a major textbook amongst medical students and trainee doctors in Asia. He has lectured in many countries including USA, China, Japan, Korea, Australia, India, Malaysia, Brunei, Indonesia, Hong Kong, Thailand, Myanmar, Vietnam and Philippines. He has trained many doctors from China, Philippines, Macau, India, Indonesia and Hong Kong. In 2007, he was Congress President at the 2nd Asia Pacific Congress of Bronchology, held in Singapore.

In May 2008, he moved his practice to Mt. Elizabeth Hospital in Singapore. He continues to practice academic medicine, together with his teaching duties involving medical students and post graduates at the Singapore General Hospital and the National University of Singapore. He met the Sunday Island for a brief interview. Here are excerpts of an interview.

Professor Philip Eng

What is lung cancer?

It is uncontrolled growth in the lungs and 90% of cases of lung cancer are due to smoking either active or passive. Lung cancer is fatal, in most cases many patients present late and by the time they see a doctor, the conditions have deteriorated.

What are the common early symptom?

Coughing it is known as coughers smoke. In most cases it is fatal,by early detection it can be controlled by surgery.

Coughing of blood, breathing difficulties, chest pains are some of the symptoms shown. How long can you survive?

All depends on the stage of the cancer growth. If detected early there are good chances to cure but if it has spread the patient can only live for 3 months.

Interventional Bronchoscopy is used to treat lung problems

This therapeutic procedure, is used to treat certain lung problems. Usually the rigid branchoscopy is used but sometimes in combination with the flexible branchoscopy. An example is the removal of foreign bodies in the breathing tube. I have removed foreign bodies like peanuts, dislodged teeth, fish bones … etc. Another example is to use the branchoscopy to relieve airway obstruction e.g. due to lung cancer. In this situation, the cancer blocks up the main breathing tubes resulting in patient feeling breathless. The branchoscopy is used to carry a laser to remove the tumour. In some patients, a stent is deployed to keep the airway patent.

Can you describe a few memorable patients?

The first patient was a 30 years old man referred to me from another country. He had been coughing for 6 months. He finally did a Chest X-ray and they found a shadow in the right lung. His doctors told him he had tuberculosis and proceeded to treat him as such for about 6 months. He didn’t get better and they did a flexible branchoscopy. They found a tumour in the right lung which they thought was lung cancer but their biopsy was negative. They sent him to me for a rigid branchoscopy under general anesthesia. I did that and found that the so called tumour was scar tissue. As I was removing the scar tissue with laser and forceps, I found a piece of cashew nut. That was the cause of the scar tissue and the shadow in the lung. I removed that his cough went away and his Chest X-ray normalized. The next day, I quizzed him about the cashew nut. He then recalled an incident some time ago when he fell down while trying to toss a nut in the air and catch it with his mouth.

Another patient was referred to me for airway stinting. He had cancer of the esophagus (swallowing tube) and his cancer had eroded into the trachea (main breathing tube). Whenever he ate the food went down the swallowing tube and right through to the breathing tube causing him to cough uncontrollably. We placed a stent in the trachea and another in the esophagus and you should have seen the joy on his face when he was able to eat again during the last days of his life.

A third patient was a 50 year old male with lung cancer involving the trachea (windpipe). He was progressively short of breath and required to be admitted to the Intensive Care Unit for life support via a breathing machine. He had no cancer disease elsewhere. He was referred to me and transferred over for a laser branchoscopy. I used a rigid branchoscopy and a laser to remove the tracheal tumour. Immediately after, he was able to breathe on his own and get off the breathing machine and get out of hospital.

Is Interventional branchoscopy a new field? Why is it unheard of unlike Interventional Cardiology?

Interventional branchoscopy is a relatively new field. The first official papers were only published 4 to 5 years ago by the Americans and Europeans although many of us, including myself, have been trained in these techniques and working in the field for the, past 12 years. It lags cardiology by about two decades or so. The principles are similar balloons, lasers and stents are used to unblock a critical thoroughfare. In interventional cardiology, they deal with the coronary arteries. In interventional branchoscopy, we deal with the trachea and bronchi.