🫁

Lung Cancer

NSCLC · Non-Small Cell Lung Cancer · SCLC · Small Cell Lung Cancer · Lung Carcinoma

Leading cause of cancer death worldwide — ~2.2 million new cases/year

Lung cancer is broadly divided into NSCLC (~85%) and SCLC (~15%). NSCLC is further classified histologically as adenocarcinoma (most common), squamous cell, and large cell. Molecular profiling is mandatory in all non-squamous NSCLC — over 10 actionable driver mutations are now targetable with approved drugs. PD-L1 expression guides immunotherapy selection. Never-smokers and former light smokers are more likely to harbour targetable mutations (EGFR, ALK, ROS1).

Subtypes

Diagnostic Tests

Treatment Options

For Informational Purposes Only

Content on this page is for educational purposes only and does not constitute medical advice.

🗺 What Do I Do Next? — Your Roadmap

Just diagnosed with Lung Cancer? Here are your essential next steps.

Get the Full Diagnostic Workup

Before any treatment begins, you need 10 key tests — imaging, blood markers, biopsy, and molecular profiling. See the Diagnostic Workup section below. Do NOT start treatment without molecular testing — it determines which therapies work for your specific subtype.

Know Your Molecular Subtype

Lung Cancer is not one disease — it has 5 distinct subtypes defined by biomarkers (EGFR, ALK, ROS1, KRAS G12C, and more). Your subtype determines which treatments apply to you. See Subtypes & Mutations below.

Assemble Your Care Team

You need a multidisciplinary team: oncologist (medical, surgical, radiation), pathologist, radiologist, and ideally a molecular tumour board review. Seek a second opinion at a major cancer centre for any Stage III-IV diagnosis.

Review All Treatment Options

Treatment for Lung Cancer spans Surgery, Chemotherapy, Radiation, Targeted Therapy, Immunotherapy. See the full Treatment Options section below. Ask your oncologist which options apply to your specific subtype and stage.

Ask About Clinical Trials

Many of the most effective treatments started as clinical trials. Ask your oncologist about eligibility. Search clinicaltrials.gov with your cancer type + molecular profile. Academic centres have the most trials.

Key Biomarkers & Mutations

EGFRALKROS1KRAS G12CBRAF V600EMET exon 14RETNTRKHER2PD-L1TMBSTK11KEAP1

Subtypes & Molecular Profiles

EGFR-mutant NSCLC is the most extensively studied molecularly targetable lung cancer. Osimertinib (3rd-generation EGFR TKI) is first-line standard — FLAURA trial showed superior OS vs earlier TKIs. EGFR exon 20 insertions are resistant to standard EGFR TKIs — amivantamab or mobocertinib are approved for this subset.

KEY THERAPIES FOR THIS SUBTYPE

Osimertinib (Tagrisso) — first-lineErlotinib / Gefitinib / Afatinib (older TKIs)Amivantamab (exon 20 insertion)Osimertinib re-challenge or chemotherapy (T790M resistance)

Diagnostic Workup

10 tests

IMAGING

CT Chest / Abdomen / Pelvis with contrast

At diagnosis

Primary tumour characterisation, mediastinal/hilar lymph nodes, liver, adrenal metastases. Essential staging.

Brain MRI with contrast

At diagnosis for Stage III-IV

Brain metastasis detection — mandatory at staging for all NSCLC Stage III-IV. SCLC always.

PET-CT (FDG)

At diagnosis — especially before curative-intent surgery or chemoradiation

Full body metastatic survey — identifies occult nodal disease and distant metastases. Guides radiation planning.

BIOPSY & PATHOLOGY

CT-guided or Endobronchial Biopsy

At diagnosis

Histology (NSCLC vs SCLC), subtype (adeno vs squamous), and tissue for molecular testing.

PD-L1 IHC (22C3, SP263 assay)

At diagnosis — all NSCLC

PD-L1 TPS score (0%, 1–49%, ≥50%) guides first-line immunotherapy decisions — pembrolizumab monotherapy requires TPS ≥ 50%.

GENETIC & MOLECULAR

Comprehensive NGS Panel (tissue or liquid)

At diagnosis — all non-squamous NSCLC

Detects all actionable mutations simultaneously: EGFR, ALK, ROS1, KRAS, BRAF, MET, RET, NTRK, HER2. Mandatory for all non-squamous NSCLC.

ALK / ROS1 FISH or IHC

At diagnosis — all non-squamous NSCLC

ALK and ROS1 rearrangements — targetable with ALK TKIs (alectinib) and ROS1 TKIs (crizotinib, entrectinib).

Liquid Biopsy (ctDNA — Guardant / FoundationACT)

At diagnosis if tissue insufficient; at progression for resistance testing

When tissue insufficient. Also monitors acquired resistance mutations (e.g., EGFR T790M) without rebiopsy.

ENDOSCOPY & PROCEDURE

Pulmonary Function Tests (PFTs)

Pre-surgery or pre-curative-intent radiation

Assess respiratory reserve before surgery or high-dose radiation. Essential pre-operative.

Endobronchial Ultrasound (EBUS)

When mediastinal nodes enlarged on CT/PET

Mediastinal and hilar lymph node sampling — essential for staging before surgery to confirm N2/N3 disease.

Treatment Options

12 options

SURGERY

Surgery

Lobectomy / Pneumonectomy / VATS

Stage I-II NSCLC — curative intent. Video-assisted thoracoscopic surgery (VATS) preferred for early-stage. Lobectomy is gold standard.

CHEMOTHERAPY

Chemotherapy

Platinum + Pemetrexed (Adenocarcinoma)

Cisplatin + pemetrexedCarboplatin + pemetrexed

Non-squamous NSCLC chemotherapy backbone — with or without immunotherapy. Pemetrexed maintenance after response.

Chemotherapy

Platinum + Paclitaxel / Gemcitabine (Squamous)

Carboplatin + paclitaxelCisplatin + gemcitabine

Squamous NSCLC — pemetrexed NOT effective in squamous. Gemcitabine or paclitaxel backbone.

Chemotherapy

Carboplatin + Etoposide + Atezolizumab (SCLC)

IMpower133

Extensive-stage SCLC first-line — atezolizumab added to chemotherapy provides modest OS benefit.

SCLC

RADIATION

Radiation

Concurrent Chemoradiation (Stage III)

Unresectable Stage III NSCLC — platinum-doublet chemotherapy with concurrent thoracic radiation (60–66 Gy). Followed by durvalumab (PACIFIC trial).

Radiation

SBRT / SABR (Stage I inoperable)

Stereotactic body radiotherapy for Stage I NSCLC in patients unfit for surgery — local control rates >90%.

Radiation

Prophylactic Cranial Irradiation (PCI)

SCLC limited-stage complete responders — reduces brain metastasis risk by 50%. Overall survival benefit.

SCLC

TARGETED THERAPY

Targeted Therapy

Osimertinib (Tagrisso)

EGFR exon 19 del or L858R mutant — first-line metastatic (FLAURA) or adjuvant Stage IB-IIIA (ADAURA, significant DFS benefit).

EGFR mut

Targeted Therapy

Alectinib (Alecensa)

ALK-rearranged NSCLC — preferred first-line. Superior CNS activity vs crizotinib. ALEX trial.

ALK+

Targeted Therapy

Sotorasib (Lumakras) / Adagrasib (Krazati)

KRAS G12C-mutant NSCLC — second-line after platinum-doublet. First approved KRAS-targeted drugs.

KRAS G12C

IMMUNOTHERAPY

Immunotherapy

Pembrolizumab (Keytruda)

PD-L1 ≥50%, no driver mutation — first-line monotherapy (KEYNOTE-024). PD-L1 ≥1% — first-line with chemotherapy.

PD-L1 ≥50%

Immunotherapy

Durvalumab (PACIFIC — Stage III)

Unresectable Stage III NSCLC — 12 months durvalumab after concurrent chemoradiation. Doubles 5-year OS.

Key Clinical References

Back to Cancer Guide