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Molecular & Genomic Testing

Which Molecular Tests — Does Your Cancer Need?

Molecular testing tells your oncologist which treatments are likely to work for your specific tumour — but the tests that matter depend entirely on your cancer type. Ordering the wrong ones adds cost and delay without helping your treatment plan.

Medically reviewed by Dr. Mohammed Imaduddin, Surgical Oncologist, MBBS · MS (General Surgery) · M.Ch (Surgical Oncology) · Last reviewed September 2026

  • Cancer type determines the tests — Lung cancer needs different markers than breast or ovarian cancer. There is no universal panel that applies to everyone.
  • Your biopsy tissue is usually enough — Most molecular testing is done on tissue from your existing biopsy. A new procedure is only needed when the original sample is too small.
  • Results change real treatment decisions — Molecular results decide which treatment pathway is chosen first — not just whether an add-on is considered.
  • Over-testing has a real cost — Tests that are not indicated for your cancer type add expense without giving your oncologist useful information.
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Which molecular tests you need depends on your cancer type, not a universal checklist. NCCN and ASCO guidance maps specific markers — such as EGFR for lung cancer, HER2 for breast and gastric cancer, or BRCA for ovarian cancer — to specific cancer types. Your oncologist selects the tests relevant to your tumour.

Which molecular tests are ordered for which cancer?

Cancer typeTests commonly orderedWhat the results help decide
Lung (non-small cell)EGFR, ALK, ROS1, RET, KRAS, MET, HER2, PD-L1, TMBWhether targeted therapy or immunotherapy is the recommended first treatment
BreastHER2, ER, PR, BRCA1/2, PIK3CAHormone sensitivity; HER2-targeted treatment relevance; hereditary risk
ColorectalKRAS, NRAS, BRAF, MSI/MMR, HER2Whether certain targeted treatments will not work; whether immunotherapy may help (MSI-high)
Stomach / gastricHER2, PD-L1, MSI, FGFR2HER2-targeted treatment suitability; immunotherapy eligibility
Head and neckPD-L1, TMB, HPV statusWhether immunotherapy is likely to benefit; treatment planning
OvarianBRCA1/2, HRDWhether DNA-repair pathway treatment applies; hereditary risk counselling
Thyroid (advanced or recurrent)BRAF, RET, NTRK, RASWhich targeted treatment pathway may work in advanced or recurrent disease
Bile duct (cholangiocarcinoma)IDH1, FGFR2, BRAF, NTRKWhich targeted pathway applies — this cancer type has several actionable mutations

What do these test names actually mean?

PD-L1
A protein on cancer cells that can hide them from the immune system. Higher levels are associated with better immunotherapy response, though the relationship varies by cancer type and is not absolute.
MSI / MMR
Measures how your tumour handles DNA copying errors. MSI-high means immunotherapy may help regardless of cancer type — one of the few markers recognised by NCCN and ASCO as tumour-type-independent.
HER2
A growth signal protein on the surface of some cancer cells. When it is overexpressed or amplified, specific targeted treatment pathways become relevant for breast, gastric, and colorectal cancers.
EGFR
A cell growth signal mutated in some lung cancers. The specific mutation type — including whether a resistance mutation has developed — shapes which treatment is chosen and in what sequence.
KRAS / NRAS / BRAF
Growth signals inside the cell. Mutations in KRAS and NRAS typically mean certain targeted treatments will not work. BRAF mutations open a different targeted treatment pathway in colorectal, lung, and thyroid cancers.
BRCA1 / BRCA2 and HRD
Genes that repair broken DNA. When mutated in a tumour, treatments that exploit this repair defect may be effective. HRD is a broader measure of the same defect, used mainly in ovarian cancer. A positive result also has implications for blood relatives.
NGS / Comprehensive genomic profiling
A laboratory method that reads many genes at once from a single tissue sample. More efficient than sequential single-gene tests when multiple markers are needed — as in lung cancer, which may require eight or more markers.

What should you confirm before molecular testing?

  • Your biopsy tissue block (FFPE block) or adequate slides are available and have been sent to the laboratory.
  • You know which specific tests have been ordered and what each one will help decide.
  • You have confirmed whether existing tissue is sufficient or whether a new biopsy is needed.
  • You know when results are expected and whether treatment will start before or after they are ready.
  • The laboratory your sample is going to is NABL- or CAP-accredited.
  • You have asked whether your insurance or Ayushman Bharat scheme covers the cost of the tests ordered.

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Does everyone with cancer need all of these tests?

No. Only tests relevant to your cancer type and likely to change your treatment plan are worth ordering. A KRAS test on an ovarian tumour, for example, does not give your oncologist information that guides treatment for that cancer.

The risk of over-testing is real — it adds cost, takes time, and can produce results that confuse rather than help. If you are unsure why a specific test was or was not ordered, ask your oncologist to explain the reasoning.

What else do families ask about molecular testing?

Why did my oncologist order different tests than my relative who has the same cancer?

Two people with the same cancer type can have tumours that behave very differently at the molecular level. Stage, prior treatment history, and whether testing guidelines have been updated since your relative's diagnosis can all change which tests are ordered. Ask your oncologist which specific markers are being tested and what each one is helping to decide for your plan.

Can we skip testing and start with the treatment that worked for someone else?

Starting treatment without relevant molecular information carries real risk. For cancers where multiple treatment pathways exist — lung cancer being the clearest example — starting the wrong pathway first can make it harder to switch later and may delay the treatment most likely to work for your tumour. NCCN and ASCO guidance consistently recommends testing before the first treatment decision, not after.

My biopsy sample is very small — can we still get molecular results?

Laboratories can work with small samples, but there is a minimum below which results become unreliable. Your pathologist will assess whether the sample is adequate. If it is not, a repeat biopsy will be discussed. In some situations, a liquid biopsy from a blood sample may partially substitute for tissue testing, though it is generally less sensitive for an initial baseline result.

A result came back borderline, inconclusive, or marked as a variant of uncertain significance — what does that mean?

A variant of uncertain significance means a change was found in the gene, but current evidence is insufficient to say whether it affects treatment. These results are reviewed in the full clinical context and may be discussed at a tumour board. Repeat testing on a new sample or with a different method is sometimes recommended. It does not mean your tumour cannot be tested — it means more information is needed.

Did you know?

NCCN guidance now recommends testing for eight or more molecular markers on all newly diagnosed advanced non-small-cell lung cancers — a single comprehensive panel on the biopsy tissue answers questions that would have required multiple separate tests a decade ago.

Testing once, at the right time, gives your oncologist the clearest picture for the fewest procedures.

Source: NCCN Guidelines for Non-Small Cell Lung Cancer

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Common questions

Frequently asked questions

Which cancers in India most urgently need molecular testing?

Non-small-cell lung cancer has the most extensive testing panel and the clearest evidence that results change the first treatment choice — NCCN, ASCO, and ESMO all recommend testing before treatment starts in advanced disease. Breast, colorectal, and gastric cancers have well-established markers that guide specific decisions. Ovarian cancer testing for BRCA and HRD has become standard in ASCO and ESMO guidance. For other types, your oncologist will tell you whether testing is indicated for your specific diagnosis.

How long does molecular testing take, and can treatment start before results are ready?

Single-marker tests typically take five to ten working days. Comprehensive panel tests can take two to three weeks, longer if the sample must go to a specialist laboratory. Whether treatment should wait depends on how urgently it needs to start and which cancer type you have. For lung cancer, most oncologists wait for the full panel because starting without it can mean choosing the wrong treatment. Your oncologist will tell you whether waiting is safe in your situation.

How much does molecular testing cost in India?

Costs vary depending on how many tests are ordered and whether they run as individual tests or a comprehensive panel. Indicative costs as of 2025 range from a few thousand rupees for a single marker to considerably more for a large panel. Some insurance plans and the Ayushman Bharat scheme cover approved tests — ask specifically before assuming the cost is entirely out of pocket. Your hospital's billing team can give you current figures.

My oncologist did not mention molecular testing — should I ask?

Yes, it is a reasonable question. Testing is not relevant for every cancer type or stage, and there are situations where it would not change the treatment plan. But if you have a lung, breast, colorectal, gastric, or ovarian cancer at a stage where treatment decisions are being made, ask directly: have the relevant molecular markers been tested, and will results be available before the plan is finalised? A clear answer either way is reasonable to expect.

What is the difference between a single-gene test and a panel or NGS test?

A single-gene test looks at one specific marker. A panel or NGS test reads many genes at once from the same tissue sample. For cancers that need multiple markers — lung cancer being the most common example — a panel is more efficient and often uses less tissue than running each test separately. For cancers that need only one or two markers, a single-gene test may be faster and less expensive. Your oncologist selects the approach based on the information needed for your cancer type.

If my molecular test result is negative, does that mean my cancer cannot be treated?

No. A negative result means the specific marker was not found in your tumour — not that your cancer is untreatable. It means a particular targeted treatment pathway is not the right fit, and your oncologist will use that result to direct you toward treatments appropriate for your cancer type and stage. In some cancers, a negative result on one marker actually opens a specific treatment option rather than closing one.

Full index

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What Is a Biopsy?

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Types of Biopsy Compared

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Preparing for a Biopsy

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Recovery and Aftercare

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IHC and Molecular Markers

IHC and Molecular Markers on a Biopsy: What They Mean →

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If Your Result Is Benign

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