Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Nov 24, 2020; 11(11): 868-889
Published online Nov 24, 2020. doi: 10.5306/wjco.v11.i11.868
Liquid biopsy in ovarian cancer: Catching the silent killer before it strikes
Laura Feeney, Ian JG Harley, W Glenn McCluggage, Paul B Mullan, James P Beirne
Laura Feeney, Paul B Mullan, Patrick G Johnston Centre for Cancer Research, Queens University, Belfast BT9 7AE, United Kingdom
Ian JG Harley, Northern Ireland Gynaecological Cancer Centre, Belfast Health and Social Care Trust, Belfast BT9 7AB, United Kingdom
W Glenn McCluggage, Department of Pathology, Belfast Health and Social Care Trust, Belfast BT12 6BL, United Kingdom
James P Beirne, Trinity St James Cancer Institute, St. James’ Hospital, Dublin 8, Ireland
Author contributions: Beirne JP and Feeney L wrote the manuscript; Mullan PB provided guidance on, and reviewed the content of, the scientific aspects of liquid biopsy; McCluggage WG provided guidance on, and reviewed the content of, the pathological aspects of the manuscript; Harley IJ provided guidance on, and reviewed the content of, the clinical aspects of the manuscript; and all authors reviewed and approved the article prior to submission.
Conflict-of-interest statement: The authors have no conflicts to report.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: James P Beirne, MBChB, PhD, Doctor, Trinity St James Cancer Institute, St. James’ Hospital, James’ Street, Dublin 8, Ireland.
Received: March 29, 2020
Peer-review started: March 29, 2020
First decision: June 20, 2020
Revised: July 29, 2020
Accepted: November 4, 2020
Article in press: November 4, 2020
Published online: November 24, 2020

Epithelial ovarian cancer (EOC) is the most lethal gynaecological malignancy in the western world. The majority of women presenting with the disease are asymptomatic and it has been dubbed the “silent killer”. To date there is no effective minimally invasive method of stratifying those with the disease or screening for the disease in the general population. Recent molecular and pathological discoveries, along with the advancement of scientific technology, means there is a real possibility of having disease-specific liquid biopsies available within the clinical environment in the near future. In this review we discuss these discoveries, particularly in relation to the most common and aggressive form of EOC, and their role in making this possibility a reality.

Keywords: Epithelial ovarian cancer, Molecular profile, Liquid biopsy, Circulating tumor DNA, Biomarker discovery, Precision medicine

Core Tip: Epithelial ovarian cancer (EOC), particularly high-grade serous carcinoma, is a gynaecological malignancy with a poor survival rate. Currently there is no effective disease-specific biomarker, which could improve detection rates and treatment algorithms, for any of the EOC types - this is an area of unmet clinical need. Circulating tumour DNA (ctDNA) analysis has emerged as a potential blood-based “liquid biopsy” for early detection, diagnosis, staging and prognosis, monitoring response to treatment, monitoring minimal residual disease and relapse and identifying acquired drug resistance mechanisms. However, there are several obstacles to the development of cfDNA-based biomarkers which are discussed further in this in-depth review.