The fear of recurrence is one of the greatest challenges of surviving cancer. Sometimes fleeting, sometimes lingering, the uncertainty can be a source of concern for many cancer survivors, including myself. Recent advancements in medical technology now offer new ways to monitor for recurrence, giving people a sense of control and peace that once seemed out of reach.

When I first learned about circulating tumor DNA (ctDNA) testing for recurrence monitoring, it felt like a monumental breakthrough. Here is a way to detect the earliest signs of cancer’s return through a simple blood sample long before it shows up on a scan or causes symptoms. Studies on the new technology continue and released results are very promising.

As a doctor, I understood the science behind it—small fragments of DNA released by cancer cells floating in the bloodstream; their presence, if detected, directly correlates with an increased risk of recurrence or metastasis. As a naturopathic doctor with a focus on integrative oncology, I have thought about all the possible interventions if a test came back positive. But as a survivor, what resonates most with me is the reassurance that a negative test could offer.

The power of ctDNA testing lies in its specificity. It’s tailored to the individual’s cancer, analyzing the unique genetic material of their tumor biopsy. This powerful tool can monitor for residual disease post-treatment and early recurrence in a very personal way. For my patients and myself, this means a way to stay vigilant without being consumed by anxiety—a way to live our lives with a little less fear.

Desert Health Publisher Lauren Del Sarto has written about her cancer journey and experience with the multi-cancer early detection (MCED) test Galleri, so let me touch on the difference. While Galleri also detects DNA circulating in the blood, which may be ctDNA from a cancer tumor, its focus is on methylation rather than identifying specific mutations in ctDNA. The difference is that tests like Signatera (ctDNA) look at your tumor tissue and look for those particular mutations in the circulating DNA. It is more specific for cancer recurrence because you must have a previous tumor biopsy as a reference before running a ctDNA test. So, the main difference is that the ctDNA test focuses on identifying and tracking specific mutations linked to a patient’s known cancer. Another important note is that while Galleri is yet to be covered by insurance, as of February of this year, Natera tests are covered for several stage II-IV cancer types including breast, colon, ovarian and as monitoring for immune checkpoint inhibitors.

But ctDNA is just one part of the picture. In my residency, I’ve also seen the benefits of functional lab testing, which looks at a broader range of biomarkers that can indicate potential health issues before they become serious. These tests can reveal underlying imbalances, like chronic inflammation, immune dysfunction and oxidative stress, which are known to contribute to cancer recurrence. By working closely with cancer survivors to proactively address these issues, naturopathic doctors help empower them to create a healthier internal environment, making it less likely for cancer to return.

Combining ctDNA with functional lab testing provides a comprehensive approach to post-treatment cancer care. While ctDNA keeps a close eye on any possible recurrence at the molecular level, functional testing helps us manage the broader aspects of health that might influence recurrence. Together, they form a powerful combination, empowering cancer survivors to address identified risks and take charge of their health.

As a doctor, I’ve always believed in the power of knowledge. And as a survivor, I’ve come to appreciate how much peace that knowledge can bring. These new technologies allow us to move from a reactive stance, waiting for something to go wrong, to a proactive one, where we’re actively working to prevent it.

The fear of recurrence may never completely disappear, but with advances like ctDNA and functional lab testing, we can face that fear with greater empowerment.

Dr. Ceja is a primary care naturopathic doctor and resident at Live Well Clinic in La Quinta and can be reached at (760) 771.5970. For more information, visit www.livewellclinic.org.

Sources: 1) https://www.cancer.gov/news-events/cancer-currents-blog/2024/colorectal-cancer-ctdna-may-guide-adjuvant-therapy; 2) https://www.nature.com/articles/s41523-024-00626-6; 3) https://www.natera.com/oncology/billing