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CION Cancer Clinics
Who orders which test: the oncologist or the geneticist? | CION Cancer Clinics
Your oncologist orders tests on the tumour, because those results guide treatment. Tests for inherited faults, especially for relatives without cancer, usually sit with a genetic counsellor or clinical geneticist. Oncologists increasingly order the inherited test for their own patients too. This page explains who does what, how patients move between them, and who should explain your result. 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
- Who orders a genetic test, the oncologist or the geneticist?
- Who does what when tumour and blood tests meet?
- How does a patient usually move between the two?
- The roles and terms, in plain language
- Which test usually sits with which doctor?
- What this page cannot tell you
- Four things patients assume about who orders what
- Common questions about who orders which test
The short answer
Who orders a genetic test, the oncologist or the geneticist?
Your oncologist orders tests on the tumour, because those results guide your treatment. A genetic counsellor or clinical geneticist usually handles tests for inherited faults, especially for relatives who do not have cancer. More and more, oncologists also order the inherited test for their own patients, with genetics support for anyone who tests positive.
Why there are two routes
The two tests answer different questions. A tumour test asks which medicine is likely to work. A test for an inherited fault asks whether the cancer runs in the family, and it affects people who are not in the room. That second question needs time for the family tree, for consent, and for what to tell relatives. It also raises questions about marriage, insurance and children that a tumour test never does, and families in India often want those discussed before anyone gives blood.
Why it matters who orders it
The person who orders a test is the person who must explain the result. An inherited result handed over without counselling can cause real harm: a relative tested too early, a harmless variant mistaken for a fault, or a family told nothing. Knowing who owns each test tells you who to ask.
Tumour tests that guide medicines are covered on our targeted therapy pages. This page is about who arranges each test.The people involved
Who does what when tumour and blood tests meet?
You may meet all four, or only one or two. Each has a different job.
Your treating oncologist
Orders tumour tests to plan treatment and reads the results with you. Increasingly orders the inherited blood test too, when the result could change treatment straight away. They are also the person most likely to notice that your age or type of cancer is a reason to ask about the family.
The pathologist
Reads your tissue under the microscope and runs any tests the lab's rules require, such as the MMR stain. You may never meet them, but their report starts much of what follows.
The genetic counsellor
Draws your family tree, explains testing before it happens, and helps you understand the result afterwards.
Usually leads on
- Testing relatives who do not have cancer
- Explaining uncertain results
- The letter your family will need
The clinical geneticist
A doctor trained in inherited conditions. Sees complex families, rare syndromes and children, and advises on screening plans once a fault is confirmed. If a condition affects more than one organ, or a child in the family, this is usually the doctor you will be sent to.
Not sure whether this applies to you?
Ask an oncologistA typical path
How does a patient usually move between the two?
The oncologist orders tumour tests
Soon after diagnosis, the tumour is tested to plan treatment. Some of these tests run automatically in the lab.
A result or the family history raises a flag
A tumour finding, your type of cancer, your age or a striking family history suggests an inherited cause is possible.
The inherited test is arranged
Either your oncologist orders it after a short explanation, or you are referred to a genetic counsellor first. Both routes are sound when the result is properly explained.
A positive or uncertain result goes to genetics
Whoever ordered the test, a counsellor should see anyone with a positive or uncertain result. That is where family testing is planned.
Words you may hear
The roles and terms, in plain language
- Genetic counsellor
- A trained professional who explains genetic testing and its results, and helps families decide what to do next.
- Clinical geneticist
- A doctor who specialises in inherited conditions and can examine, diagnose and plan care.
- Mainstreaming
- When the cancer team, not a genetics clinic, offers the inherited test to its own patients.
- Pre-test counselling
- The conversation before a test about what it can find and what that would mean for you and your family.
- Post-test counselling
- The conversation after the result, about what it means and who else should be told.
- Predictive testing
- Testing a well relative for a fault already found in the family.
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Side by side
Which test usually sits with which doctor?
Usually the oncologist
Usually genetics
Tumour profiling and biomarker tests
Testing a well brother, sister or child
An inherited test that changes treatment now
A complex family history with many cancers
Deciding treatment on the result
Explaining an uncertain variant
Referring you on when a flag appears
Planning screening and family letters
Being straight with you
What this page cannot tell you
It cannot tell you which test you need, or who should order it in your case. That depends on your cancer, your treatment plan and your family. What any result means for you is a question for the doctor or counsellor who ordered the test.
It cannot describe every hospital
Arrangements differ across India. Trained genetic counsellors and clinical geneticists are still few, and most work in large cities. In some districts the oncologist does all of it. In others, a counsellor sees patients by video call. What matters is that someone qualified explains the result.
Who this does not apply to
Most people with cancer only ever need tumour tests from their oncologist. If nothing in your report, your age or your family history points to an inherited cause, you may never need a genetics appointment at all. Your oncologist will tell you if you do.
Be wary of a lab that offers an inherited test with no counselling before or after. A result nobody explains can do more harm than no result.Commonly believed
Four things patients assume about who orders what
"Only a geneticist can order a genetic test."
Oncologists regularly order inherited tests for their own patients when the result affects treatment. What matters is that a counsellor is involved for anyone with a positive or uncertain result.
"My oncologist already tested the tumour, so genetics is done."
A tumour test is not a test of inherited genes. If your family question has not been addressed, it is fair to ask whether a blood test or a referral is needed.
"We can just book the test at a private lab ourselves."
Some labs will do it. Without counselling, families are often left with results they cannot interpret, or test the wrong person first. The order and the explanation matter as much as the test.
"A genetics referral means my case is serious."
It means someone wants the family question answered properly. Many referrals end with reassurance and no further testing at all.
Questions we are asked
Common questions about who orders which test
Do I need a referral to see a genetic counsellor?
It depends on the clinic. Many accept a referral from your oncologist, and some let you book directly. A referral helps, because it comes with your reports. Ask your oncologist first, or call the CION helpline to find out what the clinic you want needs.
Can my oncologist order the BRCA blood test?
Often, yes, particularly in breast, ovarian, pancreatic and prostate cancer where the result may change treatment. Your oncologist should explain the test first and refer you to a counsellor if the result is positive or uncertain.
Who orders a test for my healthy sister?
Usually a genetic counsellor or clinical geneticist. Your sister does not have cancer, so the test is about her future risk, not treatment. She needs her own counselling before testing, and a copy of your result helps the lab target the exact fault.
Is a genetic counsellor the same as a doctor?
Not always. Many counsellors are trained specialists who are not medical doctors. They work closely with oncologists and clinical geneticists, who are doctors. For explaining a result and planning family testing, a counsellor is often the right person to see.
Can counselling happen in Telugu?
It can be arranged. Genetic terms are hard enough in any language, and it helps to hear them in the one you think in. Ask for Telugu when you book, and bring a family member who will help you remember what was said.
We live in a district far from Hyderabad. What are our options?
Many counselling sessions can happen by video call, and blood or saliva samples can often be collected locally and sent to the lab. Your oncologist can start the process. Ask whether a remote session is possible before you plan the journey.
Who explains the result if two doctors were involved?
The person who ordered the test should explain it. If your oncologist ordered it and the result is positive or uncertain, a counsellor should also see you. Ask at the start who will give you the result, so nobody assumes the other did.
Where do I start if nobody has mentioned genetics?
Ask your oncologist whether an inherited cause is possible in your case and who would test for it. Call the CION helpline if you are unsure who to approach, and someone will point you to the right clinic.
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
Medical Oncologist
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Sources
- National Cancer Institute — Genetic Testing for Inherited Cancer Susceptibility Syndromes
- National Cancer Institute — Cancer Genetics Risk Assessment and Counseling (PDQ)
- MedlinePlus Genetics — What is genetic counseling?
- National Cancer Institute — Biomarker Testing for Cancer Treatment
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.
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Not sure who should order your test?
Tell us what tests have been done so far and who in your family has had cancer. We will point you to the right person and arrange a referral if one is needed. One helpline serves every CION centre.