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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.
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.
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.
Central tumours arise in the large airways, peripheral ones in the alveoli; both drain to hilar then mediastinal nodes, and the pleural lining is a separate cancer site.
Same organ: Mediastinal germ cell tumour, Pleuropulmonary blastoma (types I, Ir, II and III), Type A and type AB thymoma, Type B1 and type B2 thymoma, Type B3 thymoma, Micronodular thymoma with lymphoid stroma, Squamous cell carcinoma of the lung, Large cell carcinoma of the lung, Sarcomatoid carcinoma of the lung, Adenosquamous carcinoma of the lung, Invasive mucinous adenocarcinoma of the lung, Adenocarcinoma in situ and minimally invasive adenocarcinoma of the lung, Basaloid squamous cell carcinoma of the lung, Lymphoepithelial carcinoma of the lung, Pulmonary blastoma (adult), Non-small-cell lung cancer, Lung cancer (all types), Small-cell lung cancer, Mesothelioma, Pleural mesothelioma, Thymoma and thymic carcinoma, Childhood lung and airway tumours (pleuropulmonary blastoma, tracheobronchial tumours), Inflammatory myofibroblastic tumour (IMT), EGFR-mutated non-small-cell lung cancer, ALK-positive non-small-cell lung cancer, KRAS G12C-mutant non-small-cell lung cancer, ROS1-positive non-small-cell lung cancer, MET exon 14 and MET-amplified non-small-cell lung cancer, RET fusion-positive non-small-cell lung cancer, BRAF V600E-mutant non-small-cell lung cancer, HER2-mutant non-small-cell lung cancer, NTRK fusion-positive non-small-cell lung cancer, PD-L1-high non-small-cell lung cancer without a driver mutation, Resectable stage I to III non-small-cell lung cancer, Unresectable stage III non-small-cell lung cancer, Limited-stage small-cell lung cancer, Extensive-stage small-cell lung cancer, Lung neuroendocrine tumours (typical and atypical carcinoid), Thymoma (WHO types A, AB, B1, B2 and B3), Thymic carcinoma
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).
Treated on the parent's driver pages (EGFR, ALK, ROS1, RET, MET, KRAS G12C, HER2, NTRK, BRAF).
Treated as the parent's resectable and stage III pages describe; histology does not change the surgery.
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Query for this cancer: (TITLE:"Adenocarcinoma of the lung" OR ABSTRACT:"Adenocarcinoma of the lung" OR TITLE:"Lung adenocarcinoma" OR ABSTRACT:"Lung adenocarcinoma" OR TITLE:"Pulmonary adenocarcinoma" OR ABSTRACT:"Pulmonary adenocarcinoma" OR TITLE:"Adenocarcinoma" OR ABSTRACT:"Adenocarcinoma" OR TITLE:"Adenocarcinoma ~50%" OR ABSTRACT:"Adenocarcinoma ~50%" OR TITLE:"Non-squamous non-small-cell lung cancer in trial entry criteria" OR ABSTRACT:"Non-squamous non-small-cell lung cancer in trial entry criteria") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Adenocarcinoma of the lung, not a curated reading list.
The targets of this cancer's medicines and the ones linked to it directly.
Cases by country, the UK and NHS pathway and other country lenses, and the expert centres with trials on record.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
Bleeding that will not stop, black or bloody stools, or unexplained bruising when platelets are expected to be low.
Persistent headache with extreme tiredness, nausea, dizziness on standing or low blood pressure. Vomiting, severe weakness or collapse is adrenal crisis.
No pharmacokinetic interactions expected (antibody). See the irAE guide for toxicity management.
Dose by Calvert formula using GFR (see the calculators).
Dose reduce or avoid for CrCl below 60 (carboplatin is the alternative).
Not recommended for CrCl below 45.
See all on the product pages:CarboplatinCisplatinPembrolizumabPemetrexed·Printable cards in the navigator
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