onkommon.com
Common cancers · free patient guide
Lung & thoracic cancer
Non-small cell and small cell lung cancer, mesothelioma, thymic tumours
Thoracic cancer clinic
What it is
Lung cancer is separated first into small cell and non-small cell disease, because they behave and are treated completely differently. Non-small cell disease is then separated further by what is driving it at a molecular level.
This is the disease where molecular testing has changed treatment most. Finding a driver alteration can open a route that is not available otherwise, which is why testing before starting treatment matters here more than almost anywhere else.
Lung cancer in India occurs in never-smokers more often than in Western datasets, and at a younger age. That matters because it changes who should be investigated, a persistent cough in a 45-year-old non-smoker is not automatically benign.
Warning signs worth acting on
- Coughing blood, in any amount
- A cough that persists after a full course of treatment for it
- A chest infection or shadow that does not clear on repeat imaging
- New breathlessness without an obvious cause
- Unexplained weight loss with any respiratory symptom
- Persistent chest, shoulder or arm pain
- A hoarse voice lasting more than three weeks
How it is diagnosed
- Chest imaging: X-ray first, then CT
- Bronchoscopy or a guided needle biopsy to obtain tissue
- PET-CT for staging where indicated
- Molecular testing on the tissue, or on blood where tissue is inadequate
- Independent pathology review, including whether the sample is adequate for testing at all
Driver-mutation testing is central here. Where tissue is insufficient or a repeat biopsy would be unsafe, liquid biopsy is used instead. Re-testing at progression is protocol, not an afterthought, resistance changes the biology, and a two-year-old profile describes a tumour that no longer exists.
Is it inherited?
Inherited lung cancer syndromes are uncommon. Family history is recorded, and unusual patterns, several affected relatives, very young onset, are referred for counselling.
Genetic counselling & family risk →
Prevention & early detection
Stopping smoking changes risk at any age, including after a diagnosis. Indoor air quality and biomass cooking smoke are relevant exposures in India and are worth raising with your doctor.
Treatment options
What may form part of a plan
Which of these apply to you depends on your stage, your pathology, your other health and what you want from treatment. That decision belongs at a tumour board, not on a website.
Surgery
Operability assessment and planning here; the operation at the appropriate partner centre.
Targeted therapy
Medicines matched to a specific alteration found in your tumour.
Immunotherapy
Treatment that works on the immune system rather than directly on the tumour.
Chemotherapy
Drug treatment that acts on rapidly dividing cells throughout the body.
Radiotherapy
Targeted radiation to a defined area, planned in millimetres.
Clinical trials
Most Indian patients never learn a trial exists, because nobody is looking.
Conservative management & active surveillance
Sometimes the right decision is to watch carefully and treat nothing yet.
At KPCIRC
The pathway for this disease
- Driver-mutation strategy and the sequencing of targeted therapy
- Liquid-biopsy-first testing where tissue is inadequate
- A written re-profiling protocol at progression
- Tobacco cessation linked into the pathway rather than mentioned in passing
- Breathlessness and cough management from the start, not only at the end
Support that matters most here
Research we are doing on this
- R1 · Which variants seen in Indian patients are actually pathogenic?
- R2 · Can we predict, before treatment starts, who will progress early?
- R4 · What do scans carry that human reading does not extract?
- R5 · Beyond TMB and MSI, what actually predicts benefit in Indian patients?
- R7 · What monitoring interval actually changes management?
Take this with you
Questions to ask your own doctor
These work wherever you are treated. Print the page or take a photograph of this list.
- Is this small cell or non-small cell disease?
- Has molecular testing been done, and what did it show?
- If there is not enough tissue, can a blood test be used instead?
- What is the plan if this treatment stops working, do we re-test?
- What can be done about the breathlessness now?
This page is not an emergency service. Severe breathlessness, chest pain, uncontrolled bleeding, a high fever during chemotherapy, or a sudden change in alertness means going to your nearest emergency department now, not reading further.