Medical Oncologist
CION Cancer Clinics
Having tumour and germline tests at the same time | CION Cancer Clinics
Tumour and germline tests can be sent together, and for some cancers this is now the usual approach. Both answers can shape the first treatment decisions, so doing them at once can save weeks of waiting. They are still two tests, with two consents and two reports. This page explains when sending both makes sense, what happens to each sample, and what to ask before you agree. At CION Cancer Clinics in Hyderabad, our oncologists review your family history with you and guide you to the right genetic counselling and testing.
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Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed September 2026, next review due September 2027
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On this page
- Can tumour and germline tests be done at the same time?
- When is it worth sending both tests together?
- What happens when both tests are sent together?
- The words you may hear, in plain language
- Both at once or one after the other?
- Four things people assume about doing both at once
- What this page cannot tell you
- Common questions about having both tests at once
The short answer
Can tumour and germline tests be done at the same time?
Yes, and for some cancers it is now the usual approach. Both results can shape the first treatment decisions, so waiting for one before starting the other can cost weeks. They remain two separate tests with two consents, even when they are ordered together.
Why sending both together saves time
In some cancers, whether a BRCA fault is inherited or only in the tumour affects which medicines are offered. It can also shape surgery discussions. If the tumour test comes back first and then raises a germline question, a second round of counselling, sampling and waiting begins. Sending both at the start avoids that second wait.
What it does not change
The germline part still needs proper counselling, because its answer reaches your brothers, sisters and children. In many centres, oncology teams trained in genetics now take this consent themselves. A genetic counsellor then sees anyone whose result shows a fault, and anyone whose family history needs a closer look. Either way, you should know before the blood is drawn exactly what is being tested and why.
Two tests ordered together are still two tests, with two reports and two sets of questions.When it makes sense
When is it worth sending both tests together?
Your oncologist weighs the cancer type, the urgency of treatment and your family history. These are the usual reasons to do both at once.
The cancer type calls for it
For some cancers, guidelines advise offering germline testing to everyone at diagnosis, whatever the family history.
These commonly include
- Ovarian cancer
- Pancreatic cancer
- Prostate cancer that has spread
- Some breast cancers, depending on type and age
A treatment decision is waiting
When a medicine choice or a surgery plan depends on BRCA status, having both answers early avoids starting one plan and then changing it. It also spares you a second round of anxious waiting at a time when there is already a great deal to take in.
Travel is hard
For a family coming from a district, one visit for both samples saves a second journey, a second day off work and a second night away from home. Results and follow-up counselling can often be given by phone or video.
When it may not be needed
Many cancers need only a tumour test, or no genetic test at all. If nothing about the cancer or the family points to an inherited cause, adding a germline test may change nothing.
Not sure whether this applies to you?
Ask an oncologistStep by step
What happens when both tests are sent together?
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One consultation, two consents
Your oncologist explains the tumour test. You also consent to the germline test, after a discussion of what it could mean for relatives. You can agree to one and not the other.
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Two samples are collected
The pathology lab releases tissue from your biopsy or surgery. You give a blood or saliva sample for the germline test, often on the same day.
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The lab reads them apart or side by side
Some labs run two separate tests. Others run a paired test, reading tumour and blood together so inherited changes are told apart from ones in the cancer alone.
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Results come back separately
The two reports rarely arrive on the same day. Ask each lab when to expect its result, and who will call you.
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The results are read together
Your oncologist uses both to plan treatment. If the germline test shows a fault, a genetic counsellor explains it and helps you tell the family.
On the forms
The words you may hear, in plain language
- Paired tumour-normal testing
- Tumour and blood are read side by side, so the lab can say which changes were inherited.
- Mainstream testing
- Germline testing arranged by the cancer team itself, with a genetic counsellor seeing those whose result shows a fault.
- Tissue block
- The small wax block holding your biopsy or surgery sample, stored by the pathology lab.
- Germline
- Present from birth in every cell, so it can be passed on. The opposite, somatic, means found only in the tumour.
- Turnaround
- The time between the lab receiving a sample and releasing the report.
- Family letter
- A letter your counsellor writes so relatives can take your result to their own doctor and be tested for the same fault.
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Side by side
Both at once or one after the other?
Both at once
One after the other
Full picture sooner
Second answer arrives later
Fewer visits and samples
More visits, especially from a district
Both bills arrive together
Costs are spread out
Family news may come during early treatment
More time to absorb one result first
Results compared straight away
Comparison waits for the second test
Commonly believed
Four things people assume about doing both at once
"Sending them together means one test covers both questions."
They are two analyses of two kinds of DNA. The tumour report speaks about the cancer. The germline report speaks about you and your family.
"I have to decide about the germline test today."
You can take time to think and to talk with your family. If a treatment decision depends on the answer, your oncologist will explain how much time there is.
"If both come back clear, the family is safe."
A clear result lowers concern but no test finds everything. A strong family history can still justify earlier screening for relatives.
"The germline result will be in the tumour report."
Usually it is a separate report, on a separate day. It should be explained by someone who can talk through what it means for your relatives.
Being straight with you
What this page cannot tell you
It cannot tell you whether your cancer needs both tests. That depends on the cancer type, its stage, the treatment being planned and your family history. Your oncologist makes that call, with a genetic counsellor where needed.
It cannot read your results
When two reports mention the same gene, it is easy to read them wrongly. What your specific variant means is a question for the counsellor or oncologist who ordered the test.
Who this does not suit
Most people with cancer do not need a germline test at diagnosis. Some people are also not ready to hear about family risk in the first weeks after a diagnosis. For them, waiting is a reasonable choice, unless treatment depends on the answer.
The practical side in India
Both tests usually have to be paid for at the start. Insurance and schemes such as Aarogyasri or Ayushman Bharat may not cover genetic tests, so ask first. Blood samples can often be couriered from a district, and counselling can be given in Telugu.
Not sure whether both tests have been sent? Call the helpline and we will help you check.Questions we are asked
Common questions about having both tests at once
For which cancers are both tests usually sent together?
Most often ovarian cancer, pancreatic cancer and prostate cancer that has spread. Some breast cancers are included, depending on the type, the age at diagnosis and the family history. Your oncologist follows current guidelines and will explain whether yours is one of them.
Does it cost more to have both at once?
Usually not. You pay for the same two tests, just at the same time. Some labs price a paired test as one order. Ask each lab for the full price, including counselling, before the samples are sent.
Do I need counselling before the germline part?
Yes. Someone trained should explain what the germline test could show and what it means for your family. This may be your oncology team or a genetic counsellor. You should never find out afterwards that you had a germline test.
Can I say yes to one test and no to the other?
Yes. The two consents are separate. You can have the tumour test now and decide on the germline test later. If a treatment choice depends on the germline answer, your oncologist will tell you honestly what waiting could mean.
Which result usually comes back first?
It varies. Tumour tests can be delayed while the tissue block is found and checked. Germline tests can take longer when a variant needs careful review. Ask each lab for its expected turnaround and plan your appointments around it.
What if the tumour and blood results disagree?
That is common, and it is informative. A change in the tumour but not in blood arose in the cancer alone. A fault in blood is inherited whatever the tumour shows. Your counsellor explains what the combination means for you.
I live in a district. Do I need to travel twice?
Often not. Both samples can usually be arranged in one visit, and the tissue block moves between labs without you. Results and follow-up counselling can often be given by phone or video, in Telugu if you prefer.
Will my relatives be told automatically?
No. Your result is yours. If a fault is found, your counsellor helps you decide who to tell and how, and can write a family letter for relatives to take to their own doctor. Nobody contacts them without your agreement.
Your Specialists
Meet CION's oncologists. Bring your family history or genetic report to them.
Our medical oncologists see people with a strong family history of cancer, arrange genetic counselling and testing where it fits, and plan the checks that follow.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
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Sources
- NCCN — Genetic/Familial High-Risk Assessment Guidelines
- National Cancer Institute — Biomarker Testing for Cancer Treatment
- National Cancer Institute — Genetic Testing for Inherited Cancer Susceptibility Syndromes
- ESMO — ESMO Clinical Practice Guidelines
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
How tumour and germline testing fit togetherThe two tests explained from the startSequencing the tests in the right orderWhen one test should come before the otherPaired tumour-normal testing explainedOne order that reads tumour and blood side by sideWho orders which testOncologist or geneticist, and who explains what
Talk to us
Should both tests be sent for your cancer?
Tell us the cancer type and what your oncologist has ordered so far. We will explain whether a germline test belongs alongside the tumour test. One helpline serves every CION centre.