Lung & thorax
The field where molecular testing changed practice outright — and where the adequacy of the biopsy sample can open or close treatment options.
The figures at a glance
What it is
Lung cancer falls into two broad categories that behave very differently: non-small cell (NSCLC), which accounts for the great majority, and small cell (SCLC), which is more aggressive but often highly sensitive to initial treatment.
The other thoracic malignancies belong here too, including mesothelioma and thymic tumours.
Symptoms and diagnosis
Symptoms are often non-specific and appear late, which is why diagnosis is frequently made at an advanced stage: a persistent cough or a change in a chronic one, breathlessness, chest pain, coughing blood, weight loss or recurrent infections.
Work-up includes CT, PET-CT for staging and a biopsy — bronchoscopic, percutaneous or via EBUS — with enough material for molecular testing.
Biomarkers: why a small biopsy is not enough
Non-small cell lung cancer is one of the areas where molecular characterisation changed practice outright. Alterations such as EGFR, ALK and ROS1 rearrangements, and PD-L1 expression, determine whether first-line treatment is an oral targeted drug, immunotherapy or chemotherapy.
This is why the amount of biopsy material matters. A biopsy sufficient for diagnosis but not for full molecular testing can cost a treatment option.
Treatment options
In localised stages, treatment is surgical or radiotherapeutic, often with systemic therapy before or after. In metastatic disease the choice is driven by the molecular profile: targeted therapy where a target exists, immunotherapy with or without chemotherapy otherwise.
How this is approached at the practice
Every case is discussed in a multidisciplinary team meeting (MDT) — surgeon, radiation oncologist, pathologist, radiologist and, where needed, psycho-oncologist and dietitian. The treatment decision is not made by one doctor alone.
Before any treatment is proposed, the tumour undergoes full molecular and immunohistochemical characterisation, so the choice targets your specific biology rather than a generic protocol. Every alternative is presented with its trade-offs, and a second opinion is treated as an ally.
Biomarkers tested
Molecular and immunohistochemical characterisation is done before treatment is chosen, so the decision rests on this particular tumour’s biology.
Frequently asked questions
Does lung cancer occur in people who never smoked?
Yes. A proportion of cases occur in people who never smoked, and targetable alterations such as EGFR are more common in that group — which makes molecular testing all the more important.
Is there screening for lung cancer?
There is, using low-dose CT, but it is intended only for high-risk groups with a heavy smoking history, not for the general population.
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