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A blood test that reads fragments of DNA shed by the tumour, so you can genotype or monitor cancer without a needle in the tumour.
Circulating tumour DNA assays (Guardant360 CDx, FoundationOne Liquid CDx) are approved companion diagnostics for EGFR, PIK3CA, ESR1, and others. Used when tissue is insufficient, to track resistance mutations (EGFR T790M, ESR1), and to follow clonal dynamics. Fragmentomics and methylation extend it to tumour-agnostic detection.
Cell-free DNA extracted from plasma; deep NGS with error suppression detects variants at <0.1% allele fraction.
Dependencies are what this technology cannot be delivered without: manufacturing steps, instruments, software, upstream methods. See its full chain on the map.
Camizestrant is an oral oestrogen-receptor degrader approved in September 2026 for a new kind of decision: switching treatment when a blood test shows resistance developing, before the cancer visibly grows.
Exact Sciences' multi-cancer blood test, sold since 2025 as a lab test that has not been through FDA approval.
The lung cancer gene test that became the first blood-based companion diagnostic the FDA ever approved.
Elacestrant was the first oral oestrogen-receptor degrader (2023), for ESR1-mutant breast cancer detected by blood test.
The FDA-approved tissue (324 genes) and blood genomic tests that serve as companion diagnostics for dozens of drugs.
A blood test screening for more than 50 cancers at once, before the FDA in September 2026.
A blood test for leftover cancer after surgery that needs no tumour sample, so results come faster than tumour-informed tests.
A blood test that reads a tumour's mutations without a tissue biopsy and is the FDA-approved gateway to several targeted drugs.
Exact Sciences' entry into the leftover-cancer blood test market, launched in 2025 for bowel cancer follow-up.
NeoGenomics' personalised blood test for tiny amounts of leftover cancer, tracking up to 48 mutations from the patient's own tumour.
A blood test approved with adagrasib to find the KRAS G12C mutation in lung cancer when a tissue biopsy is not possible.
The first FDA-approved blood test for colorectal cancer screening (2024), now optionally reporting other cancers too.
Signatera is Natera's tumour-informed blood test that tracks 16 mutations from each patient's own tumour to detect residual or returning cancer after surgery. Medicare covers it in colorectal, breast, bladder, lung and ovarian cancer and for immunotherapy monitoring, and in 2026 it selected the bladder cancer patients for the first approval based on circulating tumour DNA.
The second FDA-approved blood test for bowel cancer screening, from Freenome, sold by Abbott from late 2026.
The 48 most recent of 58 papers; see them all →
Residual-disease testing may not need the tumour to be sequenced first, which would remove the slowest step of tumour-informed assays; the comparison with tumour-informed results in the same patients is the evidence that matters.
The current honest statement of where early detection stands: no blood test is ready, and the research is about finding the threshold at which to operate.
For someone offered the test, these are the numbers that describe what a result means in an NHS population: about 1 in 100 tests came back positive each year, between 46 and 58 in 100 positives were cancer, and a negative result left about 1 in 100 with an undetected cancer within the year. The test found between a quarter and a third of all cancers diagnosed in a screening round, and about half to two thirds of the 12 cancer types it was designed to find. Whether finding them this way reduces late-stage diagnoses is the primary question, and this paper says only that the answer was no; the primary-endpoint paper had not appeared on Europe PMC by 23 September 2026.
Together with the JCO Precision Oncology cohort this makes residual disease testing in biliary cancer prognostic to the same degree as in colon cancer. Nobody has yet shown that acting on it helps; that is the trial gap the ideas on this page name.
This is the validation study behind the July 2026 FDA approval of SimpleScreen CRC. For someone who will not take a stool test or colonoscopy it offers a real option for catching cancer, but because it misses most advanced polyps it prevents fewer cancers than the established tests, and a positive result still needs a colonoscopy.
Very wide confidence intervals from a small cohort, but the direction matches the larger 2026 analysis. Gallbladder cancer recurs early and distantly after re-resection, which is exactly the setting where a residual disease test could pick who gets more than capecitabine.
After bladder removal, a blood test can now tell who needs immunotherapy and who can safely be spared it. This is the model for MRD-guided adjuvant therapy across cancers: treat the blood-positive, watch the blood-negative.
The blood test stratifies risk far better than stage or pathology. It supports treating ctDNA-positive patients and suggests ctDNA-negative patients gain little from chemotherapy, but because treatment was not randomised the de-escalation claim needs the randomised trials that are now under way.
Query for this technology: (TITLE:"liquid biopsy" OR ABSTRACT:"liquid biopsy" OR TITLE:"circulating tumor DNA" OR ABSTRACT:"circulating tumor DNA" OR TITLE:"cell-free DNA" OR ABSTRACT:"cell-free DNA") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Liquid biopsy (ctDNA), not a curated reading list.
Shares Maximilian Diehn, Personalis (Tempus), c-TRAK TN analysis: tissue-free versus tumour-informed ctDNA assays for residual disease in early triple-negative breast cancer, Take the blood test, and give the drug, at the right time of day.
Shares A public biomarker validation utility with pre-diagnostic biobanks and blinded testing, A commons for leftover trial biospecimens with standard access for approved research, Take the blood test, and give the drug, at the right time of day, A blood test for the pre-metastatic niche.
Shares Universal DX, ClearNote Health, Helio Genomics, Match each blood-detected clone to the lesion it comes from on the scan.
Shares Prognostic and predictive value of circulating tumor DNA during neoadjuvant chemotherapy for triple negative breast cancer, Oncodetect, Plasma circulating tumor DNA in pancreatic cancer patients is a prognostic marker, Circulating nucleic acids are associated with outcomes of patients with pancreatic cancer.
Shares Daniel A. Haber, Ryan B. Corcoran, Alberto Bardelli, Inivata.
Shares C2i Genomics, Valius Sciences, Nitzan Rosenfeld, Haystack Oncology.
Shares Resolution ctDx FIRST, Ryan B. Corcoran, Alberto Bardelli, Inivata.
Shares Strip the platelet coat off travelling tumour cells in ctDNA-positive patients, Use tumour DNA in blood to decide when to pause treatment in metastatic cancer, A national residual-disease weather service: serial blood tests for every curatively treated patient, pooled, Analysis of plasma cell-free DNA by ultradeep sequencing in patients with stages I to III colorectal cancer.
Open-source projects that implement or serve this technology, from OnCo's own catalogue: licence and last activity as the repository reported them on the day of the fetch. Listing is not endorsement; check the licence before reuse and the validation before clinical use.
Tools for working with unique molecular identifiers in sequencing reads, the duplex and consensus calling that deep ctDNA assays depend on.
Estimates tumour fraction in cell-free DNA from ultra-low-pass whole-genome sequencing, a workhorse of liquid biopsy research.
Code behind the DELFI cell-free DNA fragmentation approach to cancer detection, from the Velculescu lab at Johns Hopkins.
Nucleosome profiling of cell-free DNA to infer tumour phenotypes, such as subtype, from plasma sequencing.
Open-source software, hardware and data projects catalogued by a third party, the Open Medical Registry, that bear on this technology. Listing is not endorsement; check each project's own licence and validation before clinical use.
Identification of gene-fusions, including EML4-ALK
Detect somatic SNVs from deep targeted UMI-seq cfDNA
From the Open Medical Registry (openmedical.sh), an MIT-licensed catalogue of open-source medicine. Blurbs are one line from each registry record; every project keeps its own licence.