Challenges and proposed solutions to the adoption of cell free DNA in screening, detecting and prognosticating colorectal cancer

Figure 1 The role of cell free DNA in patients with normal, precancerous or cancerous colon. Figure was created with Biorender.com. Cell free DNA can play different roles in different patient populations. In presymptomatic individuals, it can be used to screen for colorectal cancer (CRC) by detecting the presence of circulating tumour DNA in plasma or non-plasma samples. Even if patients are proven to be CRC-free, they can be evaluated for driver mutations which would predict their risk of developing CRC. In individuals with CRC however, cell free DNA can be used for the surveillance of minimal residual disease post-surgery, to prognosticate, or to inform therapeutic decision making. CRC: Colorectal cancer; cfDNA: Cell free DNA; ctDNA: Circulating tumour DNA.