# Adenocarcinoma of the lung

Source: https://onco.cc/cancers/lung-adenocarcinoma/  
OnCo record `lung-adenocarcinoma` (Cancer). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Lung adenocarcinoma is the most common type of lung cancer and the form that non-smokers usually get; it starts in the mucus-making gland cells of the small airways, most often at the edge of the lung. It is the type in which testing for a driver mutation matters most, because half of cases have one that a tablet can target.

## Summary

Adenocarcinoma is defined by glandular differentiation or mucin production, or by expression of the pneumocyte markers TTF-1 and napsin A in a poorly differentiated tumour. The IASLC/ATS/ERS classification of 2011, carried into the WHO classifications of 2015 and 2021, retired the terms bronchioloalveolar carcinoma and mixed subtype, introduced adenocarcinoma in situ and minimally invasive adenocarcinoma for small lepidic tumours, and classifies invasive tumours by predominant pattern (lepidic, acinar, papillary, micropapillary, solid) after recording the percentage of each; the 2021 edition adds a formal grading system built from those patterns, counts only the invasive component for T size, and recognises spread through air spaces as a prognostic feature (Travis 2011; Nicholson 2022). Invasive mucinous adenocarcinoma has its own page.

How it differs from its parent: the non-small-cell lung cancer page and its driver subpages describe treatment by mutation; this page is the histology in which those mutations concentrate. In 2,142 adenocarcinomas at Memorial Sloan Kettering, EGFR exon 19 deletions and L858R were found in 15 percent of tumours from former smokers and 6 percent from current smokers, with higher rates in never-smokers (NCI PDQ). The corpus's EGFR, ALK, ROS1, RET, MET, HER2, NTRK and KRAS G12C pages are, in practice, pages about adenocarcinoma.

How common: about 40 percent of lung cancers (NCI PDQ), against 25 percent squamous and 10 percent large cell.

Treatment follows the parent's pathway with two histology-specific points: pemetrexed and bevacizumab are used in non-squamous disease only, and every advanced adenocarcinoma is tested for the drivers listed above before first-line therapy. For driver-negative metastatic disease the standard is pembrolizumab with platinum and pemetrexed (KEYNOTE-189: median overall survival 22.0 against 10.7 months with chemotherapy alone, hazard ratio 0.56 in the 2020 update of the trial linked here). The TROP2 antibody-drug conjugate datopotamab deruxtecan improved progression-free survival over docetaxel in non-squamous but not squamous disease (TROPION-Lung01), and nintedanib with docetaxel is licensed in the EU for second-line adenocarcinoma.

## Fields

- Kind: Cancer
- Last checked: 2026-09-24
- Also known as: Lung adenocarcinoma; Pulmonary adenocarcinoma; Adenocarcinoma; Adenocarcinoma (~50%); Non-squamous non-small-cell lung cancer (in trial entry criteria); Bronchioloalveolar carcinoma (term retired in 2011)
- Tags: subtype-page; wave4; lung
- Group: lung
- Burden: About 40 percent of all lung cancers, the commonest histological type in many countries (NCI PDQ); Cancer Research UK also lists it as the most common type. GLOBOCAN counts it within the 2,480,675 lung cancers of 2022.
- Subtypes: Lepidic predominant adenocarcinoma; Acinar predominant adenocarcinoma; Papillary predominant adenocarcinoma; Micropapillary predominant adenocarcinoma (poor prognosis pattern); Solid predominant adenocarcinoma; Invasive mucinous adenocarcinoma (own page); Colloid, fetal and enteric-type adenocarcinoma (rare variants); Adenocarcinoma in situ and minimally invasive adenocarcinoma (own page)
- Biomarkers: TTF-1 and napsin A on immunohistochemistry; EGFR, ALK, ROS1, BRAF, MET exon 14, RET, KRAS G12C, HER2 and NTRK testing before first-line therapy; PD-L1 tumour proportion score; Predominant pattern and WHO 2021 grade; spread through air spaces

## Sections of this record

The page is a hub with ten sections in reading order; large sections have their own page. The same plan as JSON: https://onco.cc/api/v1/cancers/lung-adenocarcinoma/sections.json

- Overview (on the hub): The TL;DR, the family this cancer belongs to, the organ, who gets it and what the state of the art is. https://onco.cc/cancers/lung-adenocarcinoma/#overview
- What it is (on the hub): Anatomy, the subtypes and how they differ, how it is staged, and where advanced disease spreads. https://onco.cc/cancers/lung-adenocarcinoma/#what-it-is [8 subtypes]
- Finding it (on the hub): How it shows itself, how it is confirmed, what screening exists, and the biomarkers clinicians test for. https://onco.cc/cancers/lung-adenocarcinoma/#finding-it [4 biomarkers]
- Treating it (on the hub): The standard of care by setting, the medicines, surgery and radiotherapy named in it, and the regimens behind them. https://onco.cc/cancers/lung-adenocarcinoma/#treating-it [3 settings, 1 decision with options]
- Evidence (on the hub): Trials recruiting now, the landmark trials, the key papers and what they mean, the latest literature, and the milestones year by year. https://onco.cc/cancers/lung-adenocarcinoma/#evidence [2 trials]
- The science (on the hub): The molecular landscape: the targets and how often each appears, the pathways, the mechanics stages and the preclinical models. https://onco.cc/cancers/lung-adenocarcinoma/#science [7 targets]
- Where you are (own page): Cases by country, the UK and NHS pathway and other country lenses, and the expert centres with trials on record. https://onco.cc/cancers/lung-adenocarcinoma/where-you-are/
- Living with it (on the hub): The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask. https://onco.cc/cancers/lung-adenocarcinoma/#living-with-it [11 questions, 6 red cards]
- What is coming (own page): Everything in development, the open problems and what is being done about them, the roadmaps, and what changed on this record. https://onco.cc/cancers/lung-adenocarcinoma/coming/ [7 medicines]
- Data (own page): Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked. https://onco.cc/cancers/lung-adenocarcinoma/data/ [31 connected records]

## Standard of care

- Advanced, driver-negative: Pembrolizumab with platinum and pemetrexed (KEYNOTE-189), or the parent's PD-L1-high pathway when the score is 50 percent or more; datopotamab deruxtecan after chemotherapy (TROPION-Lung01). ([Pembrolizumab](https://onco.cc/drugs/pembrolizumab/), [Pemetrexed](https://onco.cc/drugs/pemetrexed/), [Carboplatin](https://onco.cc/drugs/carboplatin/), [Cisplatin](https://onco.cc/drugs/cisplatin/), [TROPION-Lung01](https://onco.cc/trials/tropion-lung01/), [PD-L1-high non-small-cell lung cancer without a driver mutation](https://onco.cc/cancers/pdl1-high-nsclc/))
- Advanced with a driver: Treated on the parent's driver pages (EGFR, ALK, ROS1, RET, MET, KRAS G12C, HER2, NTRK, BRAF). ([Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/), [EGFR-mutated non-small-cell lung cancer](https://onco.cc/cancers/egfr-mutant-nsclc/), [ALK-positive non-small-cell lung cancer](https://onco.cc/cancers/alk-positive-nsclc/), [KRAS G12C-mutant non-small-cell lung cancer](https://onco.cc/cancers/kras-g12c-nsclc/), [MET exon 14 and MET-amplified non-small-cell lung cancer](https://onco.cc/cancers/met-altered-nsclc/))
- Early stage: Treated as the parent's resectable and stage III pages describe; histology does not change the surgery. ([Resectable stage I to III non-small-cell lung cancer](https://onco.cc/cancers/resectable-nsclc/), [Unresectable stage III non-small-cell lung cancer](https://onco.cc/cancers/stage-iii-unresectable-nsclc/), [Lobectomy](https://onco.cc/terms/lobectomy/))

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Adenocarcinoma_of_the_lung
- NCI PDQ (health professional): non-small cell lung cancer treatment, histological shares: https://www.cancer.gov/types/lung/hp/non-small-cell-lung-treatment-pdq
- Cancer Research UK: types of lung cancer: https://www.cancerresearchuk.org/about-cancer/lung-cancer/stages-types/types
- Nicholson 2022, JTO: the 2021 WHO classification of lung tumours: https://doi.org/10.1016/j.jtho.2021.11.003
- Travis 2011, JTO: IASLC/ATS/ERS international multidisciplinary classification of lung adenocarcinoma: https://doi.org/10.1097/jto.0b013e318206a221
- KEYNOTE-189 (Gandhi 2018, NEJM): pembrolizumab plus chemotherapy in metastatic non-squamous NSCLC: https://doi.org/10.1056/nejmoa1801005

## Connected records

- cancers: [Adenocarcinoma in situ and minimally invasive adenocarcinoma of the lung](https://onco.cc/cancers/lung-adenocarcinoma-in-situ-and-minimally-invasive/), [Adenosquamous carcinoma of the lung](https://onco.cc/cancers/lung-adenosquamous-carcinoma/), [ALK-positive non-small-cell lung cancer](https://onco.cc/cancers/alk-positive-nsclc/), [EGFR-mutated non-small-cell lung cancer](https://onco.cc/cancers/egfr-mutant-nsclc/), [Invasive mucinous adenocarcinoma of the lung](https://onco.cc/cancers/invasive-mucinous-adenocarcinoma-lung/), [KRAS G12C-mutant non-small-cell lung cancer](https://onco.cc/cancers/kras-g12c-nsclc/), [Large cell carcinoma of the lung](https://onco.cc/cancers/large-cell-lung-carcinoma/), [MET exon 14 and MET-amplified non-small-cell lung cancer](https://onco.cc/cancers/met-altered-nsclc/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/), [PD-L1-high non-small-cell lung cancer without a driver mutation](https://onco.cc/cancers/pdl1-high-nsclc/), [Pulmonary blastoma (adult)](https://onco.cc/cancers/pulmonary-blastoma/), [Resectable stage I to III non-small-cell lung cancer](https://onco.cc/cancers/resectable-nsclc/), [Sarcomatoid carcinoma of the lung](https://onco.cc/cancers/pulmonary-sarcomatoid-carcinoma/), [Squamous cell carcinoma of the lung](https://onco.cc/cancers/lung-squamous-cell-carcinoma/), [Unresectable stage III non-small-cell lung cancer](https://onco.cc/cancers/stage-iii-unresectable-nsclc/)
- targets: [EGFR](https://onco.cc/targets/egfr/), [KRAS](https://onco.cc/targets/kras/), [MET](https://onco.cc/targets/met/), [TROP2](https://onco.cc/targets/trop2/)
- drugs: [Bevacizumab](https://onco.cc/drugs/bevacizumab/), [Carboplatin](https://onco.cc/drugs/carboplatin/), [Cisplatin](https://onco.cc/drugs/cisplatin/), [Docetaxel](https://onco.cc/drugs/docetaxel/), [Nintedanib](https://onco.cc/drugs/nintedanib/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/), [Pemetrexed](https://onco.cc/drugs/pemetrexed/)
- trials: [KEYNOTE-042](https://onco.cc/trials/keynote-042/), [TROPION-Lung01](https://onco.cc/trials/tropion-lung01/)
- terms: [Lobectomy](https://onco.cc/terms/lobectomy/)

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JSON: https://onco.cc/api/v1/entities/lung-adenocarcinoma.json