Cancer types · Common solid tumours
Lung Cancer
Lung cancer is broadly divided into non-small cell lung cancer (NSCLC), which includes adenocarcinoma and squamous cell carcinoma, and small cell lung cancer. In non-squamous NSCLC in particular, molecular profiling looks for alterations for which targeted-therapy evidence exists.
Several driver alterations are now tested routinely in advanced NSCLC, and EGFR alterations are reported more frequently in Asian populations than in many Western cohorts. Lung cancer also occurs in people who have never smoked. Because respiratory symptoms can overlap with other conditions, including tuberculosis, an adequate tissue diagnosis matters.
Clinical and molecular questions that often arise
- Was broad molecular profiling performed on adequate tissue, or could a plasma test add information?
- How should multiple findings be prioritised, and which have evidence specifically in lung cancer?
- If the disease progresses on targeted therapy, does a new report show a resistance alteration, and what does it mean?
- How do PD-L1 level and any driver alteration interact in the questions being discussed?
Information that may be part of an individual assessment
- Histopathology and immunohistochemistry to confirm subtype.
- Molecular profiling of tissue and, where appropriate, plasma (ctDNA).
- PD-L1 testing by an assay validated for lung cancer.
- Staging imaging, often including CT and PET-CT, and brain imaging where indicated.
Which investigations are appropriate is decided by the treating team for each person.
Molecular profiling and biomarker interpretation
Depending on the setting, molecular and biomarker questions in lung cancer may involve:
- EGFR mutations, including resistance alterations at progression
- ALK and ROS1 fusions
- BRAF V600E
- KRAS, including G12C
- MET exon 14 skipping and MET amplification
- RET and NTRK fusions
- HER2 (ERBB2) mutations
- PD-L1 tumour proportion score
Biomarkers, panels and available tests vary by subtype, disease setting, assay and guideline version. A detected alteration is not automatically actionable.
How KPCIRC pathways may apply
POAS
POAS may help structure a report with several alterations, distinguish drivers from findings of uncertain significance, flag resistance alterations, and set out trial and access questions, including regulatory status and indicative cost in India, for the treating clinician to verify.
Molecular Tumour Board
An MTB discussion may help when tissue and plasma results differ, when a rare or compound alteration is found, or when progression raises questions about the next line of investigation.
Second opinion and progression review
A second opinion may be considered when the subtype, stage or treatment plan needs clarification. Progression review can organise the treatment timeline, prior responses and new molecular findings for discussion.
Hereditary risk and screening
Inherited predisposition is less often the focus in lung cancer, although rare germline findings can occur and should be discussed if a report suggests them. For people with a significant smoking history, a lung-cancer screening discussion may be relevant; eligibility follows current guidance and the confirmed Cancer Screen scope.
How to access the relevant pathway
Patients and families
- Talk to your treating oncologist about whether an additional review may help.
- Request a consultation and tell us which question you want answered.
- Share records only when asked, through the secure route.
Referring doctors
- Define the clinical question and the pathway: POAS, MTB, second opinion or progression review.
- Start a case enquiry without patient identifiers.
- Scope, fees and timing are confirmed before any review proceeds.
Questions and limitations
What if my tissue sample was too small for full testing?
This is common. Options may include repeat biopsy or plasma testing, depending on the situation. The treating team decides, and POAS can flag where information is missing.
Does an EGFR or ALK result mean the same as in another cancer?
No. Evidence is specific to the tumour type and setting. A finding in lung cancer should be read against lung-cancer evidence.
Does this page apply to my situation?
This page is educational. It explains common questions but cannot account for individual circumstances. Your treating clinician is best placed to interpret your reports and plan your care.
Educational content reviewed against the KPCIRC service scope. It is not a diagnosis, a treatment recommendation or a statement that a specialist or service is available for this cancer type.