Lung cancer has emerged as one of the most important public health concerns in India over the last decade. Recent research published between 2018 and 2025 highlights significant changes in incidence, histological distribution, molecular patterns, and socioeconomic burden. Population-Based Cancer Registries (PBCRs) report rising or stable-but-high incidence in many regions, with Mizoram continuing to record the highest age-adjusted rates in Asia. Hospital-based cohorts reveal adenocarcinoma surpassing squamous cell carcinoma, while molecular studies document a high prevalence of Epidermal Growth Factor Receptor (EGFR) mutations and Anaplastic Lymphoma Kinase (ALK) rearrangements. Despite advances, over half of patients are still diagnosed at Stage IV, with median survival around 10–12 months. Risk attribution studies confirm tobacco, particularly bidi smoking, as the dominant cause, but biomass fuel exposure, long-term incense use, and worsening urban air pollution also contribute significantly. The financial burden of targeted therapies and immunotherapies remains catastrophic for families, forcing many to discontinue treatment prematurely. This study synthesizes Indian evidence published between 2018 and 2025 to present a comprehensive analysis of incidence, risk factors, histological and molecular trends, stage of diagnosis, survival outcomes, and socioeconomic implications. Our findings indicate that lung cancer in India is largely preventable, but addressing it requires strong tobacco control, clean household energy, urban air quality management, early detection, and financial protection for patients.