Introduction

Lung cancer is considered in the medical field as one of the most fatal diseases in the world, and a serious public health issue in India, characterized by the uncontrolled proliferation of abnormal cells in the lungs, which can invade adjacent tissue and metastasize to other parts of the body. It can occur in never-smokers, ex-smokers, and smokers. Even with substantial advances in surgical, radiation, molecularly targeted, and immunotherapies, treatment outcomes depend largely on the type, stage, molecular profile, and health status of the patient.

When analyzing the data about the number of new/recent cases and deaths caused by lung cancer in India, it is important to understand what the data means. The data provided by government sources or other international organizations may differ depending on the time period, the population under observation, and other characteristics. Thus, the number of newly diagnosed cases differs from the number of casualties; the total number of cases in the whole country differs from the number of cases in one of the states of India; the number of cases of lung cancer among adults differs from the total number of cases in the population.

According to the WHO (World Health Organization), which is an International Agency for Research on Cancer, in 2022, there were 81,748 new cases of lung cancer and 75,031 deaths from it in India. These numbers have been estimated using GLOBOCAN 2022, a project designed to monitor the global cancer situation. It was about 5.8% of all new cancer cases and 8.2% of cancer-related deaths in India.

The National context of Lung Cancer in India

The national burden offers a crucial foundation for comprehending the circumstances in Uttar Pradesh.

Based on statistics published by the World Cancer Research Fund (WCRF), there are about 81,748 incidences of lung cancer and approximately 75,031 deaths due to lung cancer in India in the year 2022. These numbers made India the fourth in the world in terms of the number of new cases of lung cancer.

These WCRF statistics are national estimates and cannot be used to determine state-specific numbers by multiplying them by population size, because not all regions have the same risk and detection capabilities.

Lung Cancer Incidence in India: 2012-2019

Spread of Lung Cancer Among Men (%)

Spread of Lung Cancer Among Women (%)

AdC = Adenocarcinoma; SqCC = Squamous Cell Carcinoma; LCC = Large Cell Carcinoma; SCC = Small Cell Carcinoma

The National Cancer Registry Program provides projections for different cancer types and populations. The study performed on a regional level showed that the incidence of lung cancer varies greatly among Indian regions, with higher incidences of cancer in selected northern, southern, and north-eastern regions. Among men, the maximum incidence was registered in Srinagar; among women, it was in Aizawl.

Burden of disease: What do these numbers really mean?

National Incidence & Mortality

GLOBOCAN 2022 India fact sheet provides the following estimates:

Indicator India, 2022

• New Lung Cancer Cases, both sexes 81,748
• Estimated Lung Cancer Deaths, both sexes 75,031
• % of All New Cancer Cases 5.8%
• % of All Cancer Deaths 8.2%
• Five-Year Prevalence of Lung Cancer 113,990

[Source: IARC, Global Cancer Observatory, GLOBOCAN 2022 India fact sheet]

How does the burden compare to other cancers?

In 2022, lung cancer ranked as the fourth most common cancer type and had the fourth highest death rate in India. Taking into account both sexes, lung cancer was the second most frequent cancer type among men and the fourth most frequent among women. Among women, lung cancer was less common than breast and cervical cancer, whereas among men, it was more common than other cancers. The following table gives the rank of different cancer types:

Incidence Rates: Why they are important?

Cases alone are not sufficient to describe the burden of the disease, except when the population is one. In essence, the incidence rate is the probability of developing a particular disease in a typical patient over a given period. It is usually calculated per 100,000 patients.

Age-standardized Incidence Rate (ASIR) plays an important role when it comes to establishing the prevalence of lung cancer. An age-standardized incidence rate is an indicator used to determine the incidence of a disease in a population with the same age distribution as another population. In this manner, it becomes possible to compare two populations with various age distributions. However, it is essential to understand that ASIR is a purely hypothetical indicator. Thinking that ASIR refers to the actual number of cases in a certain state or county is incorrect.

After studying and analyzing the epidemiological patterns and designs of lung cancer, a report on the age-standardized incidence rate in 2022 was published in the Indian Journal of Medical Research in 2025.According to the report, for every 100,000 females, 3.2 cases of lung cancer were recorded, and for males, it was higher, at 8.5 per 100,000. These statistics were collected among 57 communities of India.

Data source for Lung Cancer Incidence, Mortality, Tobacco & Alcohol prevalence in India

Source: Indian Journal of Medical Research

The findings show the burden of lung cancer in India and are very informative for any policymaking purposes. However, these statistics cannot be applied to all of India’s 29 states since the study uses data from only a few registries.

What causes lung cancer?

Many factors can cause lung cancer to develop in an individual, but all of these factors may work separately or jointly. The common factor among these factors is that they cause genetic mutations in cells, leading to cancer. The development of lung cancer depends on the number of predisposing factors, the age of a patient, genetic predisposition, and so on.

Tobacco Smoking

One of the main risk factors for the illness in question is tobacco use. Any tobacco use affects the respiratory system of a patient and can lead to the development of lung cancer. Moreover, the risk depends not only on the amount of tobacco consumed but also on the duration of its use. Therefore, it is very important to encourage never-smokers to stop using tobacco completely and encourage smokers to give up smoking whenever it is possible.

After a given amount of time, the risk of lung cancer among former smokers will significantly decline, even though it will never match that of non-smokers.

Even though tobacco use history is essential in a doctor's examination of a patient, it should not serve as the basis for diagnosis. In other words, just because one smokes does not mean that they will get lung cancer and vice versa. Second-hand smoke

Another factor that can lead to the development of lung cancer is second-hand smoke. Non-smokers can inhale environmental tobacco smoke at home, at work, in the car, and other places. A smoke-free home environment and a smoke-free workplace are crucial for minimizing the risk of second-hand smoke exposure.

Family members of a smoker should not be blamed for being diagnosed with lung cancer. At the same time, second-hand smoke cannot serve as an excuse for having lung cancer. Families need to make some changes and make their homes tobacco-free.

Pollution in the Outdoors

Outdoor pollution is yet another risk factor for lung cancer. The important thing about outdoor pollution that contributes to the formation of cancerous cells is fine particulate matter. Examples of environmental pollutants that contribute to the development of cancerous lung cells include emissions from vehicle exhausts, industrial activities, and more. It all depends on the level of exposure, the type of pollutant, and the duration of exposure. Particulate matter pollution is a problem affecting several cities in India and should be treated as a public health issue.

Pollution in Households

Smoke from burning solid fuels pollutes the households where people live. Pollutants from particular fuel types are linked to lung cancer and many other health conditions. The risk depends on the type of fuel used, housing, cooking techniques, and amount of time spent indoors. The use of cleaner fuel and efficient cookstoves helps reduce indoor air pollution.

There is no way to identify a particular household as an exposure point for a given patient without proof. The only sensible approach would be to minimize exposure to indoor air pollution generally.

Occupational Exposures

Being exposed to specific substances at work could also contribute to lung cancer development. Certain types of occupation create a high-risk environment for people working in this setting in terms of their work, potential risk of contact with carcinogenic substances, and the chances that such exposure could be constant. The basic preventive approach in this case is to reduce occupational exposure to carcinogens. It is important to ensure proper workplace ventilation, the use of personal protective equipment, and other necessary measures.

A detailed analysis of a patient's occupational history could be helpful if a patient is being examined on suspicion of lung cancer. However, it is not enough to establish the presence of a disease solely on the basis of a risk factor.

Age, Family History, & Lung Cancer in Never-smokers

Lung cancer is usually an age-related issue. Family history is a risk factor, but most of the time, this type of cancer is not hereditary. The possibility of developing lung cancer in never-smokers is considerably lower compared to the risk for smokers.

One needs to take into consideration the fact that some of the lung cancers among never-smokers are characterized by certain molecular alterations, which might play a very important role in deciding upon the treatment. In other words, it is wrong to reassure the patient that they are a never-smoker and vice versa.

What are the types of lung cancer?

Histology, or how cancer cells appear under a microscope, is used to categorize lung tumors. This feature plays an important role in establishing the prognosis and deciding upon the treatment.

Non-small-cell Lung Cancer

Lung cancers are mostly non-small-cell lung cancers (NSCLC), constituting up to 85% of all cases. The most prevalent histological types of non-small-cell lung cancers are squamous cell carcinoma and adenocarcinoma.

Adenocarcinoma originates from epithelial cells and often arises in the periphery of the lungs. It may arise both among never-smokers and current/former smokers and is characterized by some molecular alterations that might be targeted using precision drugs.

People addicted to tobacco smoking are more likely to develop squamous cell carcinoma, which typically develops in the middle of the lung, close to the main airways. The approach to treating squamous cell carcinoma is based on the tumor's stage and size. Other forms of NSCLC are rare but should still be considered. The pathology test results and any additional required research must be taken into account when selecting a treatment for non-small cell lung cancer. It is important to determine the histology and molecular tumor profile to select the optimal treatment.

Small-cell Lung Cancer

One more type of lung cancer is small-cell lung cancer (SCLC), highly connected with smoking, and which grows very fast and can metastasize early. Treatment of SCLC is usually chemotherapy, and there are some cases when radiation treatment is needed, depending on the stage.

It is extremely important to understand that small-cell and non-small-cell lung cancer are completely different kinds of cancer diseases. These kinds of cancer are managed differently and have different prognoses.

What is the importance of Pathology?

Information from the pathology report shows what kind of cancer there is and helps determine the best treatment strategy. In particular, for many patients with NSCLC, molecular profiling of tumors is a necessary step for choosing a targeted therapy. This statement is true primarily for patients with advanced stages of lung cancer because their treatment will depend on the genotype of tumor cells. This is once again proof of the disease's complexity and personalization.

According to the 2025 Indian Journal of Medical Research, adenocarcinoma became the most widespread histological form of lung cancer in the majority of communities.

Indian Journal of Medical Research

What are the symptoms & warning signs of Lung Cancer?

Initially, patients with lung cancer may not exhibit any symptoms, but they may report certain indications of compromised lung function. In particular, lung cancer may be confused with tuberculosis, pneumonia, severe bronchial asthma, or COPD. However, the disease does not tend to resolve on its own or even with standard medical intervention, so it is crucial to see a physician to rule it out.

The following symptoms call for an examination and testing:

• Constant cough or changes in a chronic cough
• Bloody sputum
• Breathlessness that has appeared recently or become more severe
• Chronic chest pain that has not gone away or is getting worse when breathing
• Repeated pneumonia or other chest infection
• Unexplained weight loss and poor appetite
• Extreme fatigue
• Hoarse voice that does not disappear
• Constant bone pain
• Serious headaches or other neurologic symptoms indicating that the cancer has already spread to the brain.

The presence of bloody sputum requires medical attention; choking is to be considered a medical emergency. Moreover, one needs to see a doctor if there is any worsening of breathing and sharp pains appear in the chest area.

In India, there is a frequent occurrence of tuberculosis, which often appears due to prolonged coughing. This way, cough symptoms should not be immediately referred to as tuberculosis; it is necessary to consider the possibility of lung cancer. At the same time, doctors should not ignore the disease of tuberculosis for the sake of lung cancer in patients with symptoms of both diseases.

In addition, one should bear in mind not to delay visiting a doctor until all signs appear. It would be useful to adhere to certain guidelines concerning warning signs of lung cancer and additional tests.

How is lung cancer diagnosed?

The main purpose of diagnostic testing is either to confirm or reject a diagnosis of lung cancer. Depending on factors such as the tumor's location and the patient’s health, certain tests must be performed. In general, while diagnosing lung cancer, the following steps can be taken:

Clinical Assessment & Initial Imaging

The physician assesses the patient's symptoms, medical history, and current condition, and prescribes an X-ray if any suspicious symptoms are present. Nevertheless, it is necessary to understand that the X-ray can neither prove nor reject lung cancer. To evaluate the lungs, tumor, and lymph nodes, a chest CT scan has to be performed.

Imaging may be necessary to establish the disease stage and develop a treatment plan. In some cases, a PET-CT scan may be necessary to evaluate the tumor's biology and its response to treatment. If there is a chance of metastasis, radiation therapy may be administered to the brain of certain patients. Nevertheless, imaging alone cannot diagnose lung cancer - the clinical picture must support the findings.

Biopsy Procedures & Pathology

A biopsy is a procedure in which a tissue sample is taken from a patient and examined under a microscope. The location/site of the tumor, the patient's health, and other variables all influence the selection of the biopsy procedure. A bronchoscope may be used to obtain a sample of tumor tissue from the bronchi; image-guided and lymph node biopsies may also be considered.

The main aim of a biopsy is to confirm the diagnosis and determine the tumor histology, which is important for choosing the appropriate treatment regimen. In particular, it is possible to identify molecular characteristics of the tumor using biopsy to apply targeted therapy to treat advanced cancers. It is important to note that a biopsy is a complex procedure, and the type is chosen by a physician based on the situation. One should always ask their doctor whether a biopsy is required and what the advantages and risks of such a procedure are.

Molecular Testing & Biomarkers

For most patients with advanced NSCLC, it is extremely important to perform molecular testing to detect biomarkers and select the optimal targeted treatment. In particular, it is possible to detect mutations in EGFR, ALK, ROS1, BRAF, MET, RET, NTRK, and KRAS, or in PD-L1, to evaluate the effectiveness of immunotherapy.

It is necessary to emphasize that such tests are not needed for all patients with lung cancer; besides, they require some time. Therefore, it is very important to consult with a physician about the necessity of molecular testing and which biomarkers to test.

Staging

Staging of groups is significant when dealing with cancer treatment since it determines the treatment goals. Specifically, lung cancer may be curative, palliative, or supportive depending on the stage. Staging is done using various examinations, such as imaging and pathology.

Lung cancer may be localized (located in the lung only), regional (reached the lymph nodes), and distant (metastasized to other parts of the body). The final staging is provided by the physician, who analyzes all test results and takes into account the patient's individuality.

Treatment

The treatment for lung cancer is integrated and depends on several factors. In particular, this dependency is due to the type of cancer, its stages, molecular abnormalities, lung function, and patient preferences. Surgery, radiation, chemotherapy, immunotherapy, targeted therapy, or a mix of these treatments is available for lung cancer.

Surgery

This procedure can be used as a curative treatment in patients with early NSCLC who are candidates for resection. Nevertheless, it is necessary to understand that it is a risky operation and the patient and the doctor need to discuss whether this type of treatment is suitable for the patient. During the surgery, the part of the lung and, in some cases, the whole lung, along with some lymph nodes, is removed.

In particular, video-assisted thoracoscopic surgery and robotic-assisted surgery may be used in some cases of lung cancer treatment. Many factors influence the decision to perform surgery, such as tumor location and size, the patient's overall health, and the surgeon's experience. Therefore, it is important to remember that every patient's case is unique.

Radiotherapy

High-energy radiation used in radiotherapy damages cancer cells. Radiotherapy can be applied to patients with lung cancer in various situations: it can be used as a primary therapy for early lung tumors, together with other treatments, or as symptom control in advanced cancers.

Stereotactic body radiotherapy is one of the most efficient forms of radiotherapy, delivering high doses of radiation to the tumor. There can also be an option of radiotherapy in case of limited-stage small-cell lung cancer. It is crucial to note that radiotherapy planning is highly personalized and depends on numerous factors.

Chemotherapy

Chemotherapy involves the use of different medicines to destroy cancer cells or at least slow their growth. As a result, it can be used either on its own or in conjunction with other cancer treatments, including radiation and surgery. It can be used as an adjuvant therapy to stop cancer from returning after surgery or as a neoadjuvant therapy to reduce the tumor before surgery. Specifically, chemotherapy medicines are selected based on the cancer type, stage, and other factors.

It is important to note that chemotherapy can lead to such side effects as nausea, weakening of the immune system, anemia, and weight loss. Nevertheless, it can be helpful for some patients with lung cancer.

Targeted Therapy

Targeted therapy is another approach to lung cancer treatment that uses specialized medicines to target specific molecules in cancer cells. There are different ways to use targeted therapy, depending on the tumor's histology and molecular profile. It is important to point out that targeted therapy cannot be used by everyone who has lung cancer.

There are various kinds of targeted therapy, including inhibitors of cancer cell growth, substances that inhibit blood vessel development necessary for tumor development, and agents that weaken the tumor's resistance to treatment. However, targeted therapy is not universal, and the doctor should evaluate whether the method will work for the patient based on the results of the tumor analysis. Selecting the best course of action without adding to the patient's burden is essential.

Immunotherapy

One kind of targeted treatment that strengthens the immune system's inherent capacity to fight cancer cells is immunotherapy. Immunotherapy can be applied to those patients who have advanced lung cancer and have experienced recurrence of the disease despite standard therapy. In particular, the use of immune checkpoint inhibitors can enable the immune system to recognize tumor cells and prevent their growth and metastasis. It is important to note that immunotherapy is only possible in a limited number of cases and only with the physician's recommendation.

In particular, it is important to take into account factors such as the stage of cancer, the patient's general health, and other factors. Immunotherapy can be very helpful in slowing cancer growth in some patients for a long time. On the other hand, immunotherapy is associated with a variety of adverse effects and can only be taken according to the doctor's recommendations. In particular, symptoms such as worsening shortness of breath, diarrhea, yellowing of the skin, and extreme fatigue during treatment should be discussed with the doctor.

GLOBAL Incidence of LUNG Cancer

The following tables show the 10 countries with the highest lung cancer incidence in 2022 - first by sex, then by sex (men and women separately). We have also included the age-standardized rates (ASR) for each of these countries.

Both Sexes

Men

Women

Multidisciplinary Approach & Supportive Care

There is a need to adopt a comprehensive approach to treating lung cancer, including methods such as surgery, radiotherapy, and drugs. The selection of a particular therapy depends on several factors, including the stage of cancer development, the presence of molecular tumor markers, and the patient's general condition. For example, surgical intervention might be used together with other cancer treatments or following radiotherapy. It is important to note that the sequence of treatment is also very important, as multiple strategies can be applied at any given moment.

Supportive care is very important for patients with lung cancer since it can help them cope with the difficulties associated with this illness and its treatment. In particular, supportive care helps alleviate pain, breathing problems, and fatigue. It will also help patients enjoy a good quality of life and effectively cope with stress related to the diagnosis of lung cancer. Moreover, it is also possible to get support during rehabilitation, quit smoking, and solve other social problems.

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