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. 2020 Jul 6;17(12):757–770. doi: 10.1038/s41571-020-0392-0

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© The Author(s) 2020

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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Fig. 1 — Circulating tumour DNA (ctDNA) provides a more sensitive method of detecting malignancies than imaging or other conventional approaches. This sensitivity can be exploited in several ways: early diagnosis of colorectal cancer prior to the emergence of clinical or radiological manifestations and in the detection of minimal residual disease (MRD), defined as the detection of ctDNA with no other clinical evidence of disease recurrence in patients who have completed all potentially curative therapies. In patients with radiographically evident disease, ctDNA also seems to be more sensitive to changes in tumour burden and might assist in tailoring the intensity of therapy in the neoadjuvant setting and in monitoring for tumour response in patients requiring palliative treatment. Furthermore, qualitative assessments of the types of aberrations and their subsequent alterations might assist in assessments of tumour evolution and heterogeneity that lead to the emergence of resistance as well as in selection of the most appropriate therapies.