Lung & Thoracic Cancers

Lung cancer is among the leading cancers in India in both incidence and mortality. It includes non-small cell lung cancer (NSCLC, the most common type) and small cell lung cancer (SCLC). Other thoracic cancers include tumours of the pleura (mesothelioma) and mediastinum (such as thymoma). While smoking is the strongest risk factor, a significant proportion of lung cancer patients in India are non-smokers.

Common signs and symptoms

• A persistent cough or a change in a chronic cough
• Coughing up blood
• Breathlessness, chest pain, or hoarseness of voice
• Unexplained weight loss or fatigue
• Recurrent chest infections

Diagnosis

Work-up usually includes a CT scan of the chest, a biopsy (bronchoscopic, CT-guided, or surgical), and staging scans such as PET-CT. Modern lung cancer care depends heavily on molecular testing of the tumour — for mutations such as EGFR, ALK, ROS1, and others, and for PD-L1 expression — because these results determine which treatments will work.

Treatment

Treatment depends on the type, stage, and molecular profile of the cancer, and may combine surgery, radiation, and systemic therapy. Systemic options planned by the medical oncologist include:

• Targeted therapy — oral tablets for cancers with actionable mutations (EGFR, ALK, and others)
• Immunotherapy — alone or with chemotherapy, guided by PD-L1 status
• Chemotherapy — as curative-intent treatment alongside radiation or surgery, or to control advanced disease

Advances in targeted therapy and immunotherapy over the past decade have substantially changed how lung cancer is treated, making accurate molecular diagnosis an essential first step.