Circulating Tumor DNA–Guided Risk Stratification in Colorectal Cancer: Evolving Evidence and Future Utility

1. Circulating tumor DNA (ctDNA) provides real-time insights into disease activity and recurrence risk. 2. It is particularly applicable in colorectal cancer due to high DNA shedding rates. 3. Two major testing approaches for ctDNA are tumor-informed and tumor-uninformed. 4. Postoperative ctDNA status strongly correlates with recurrence risk. 5. Prospective trials like DYNAMIC and CIRCULATE-North America are evaluating ctDNA-guided therapy for stage II and III colon cancer. 6. Longitudinal ctDNA surveillance shows promise in providing early warning signals for recurrence.