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A little upset
My husband had surgery in August, after going through 4 rounds of FLOT. His surgeon said the margins were clear and lymph nodes were negative for cancer. Norm then did 2 rounds of 46 hour 5FU, after which he was too beat up to do any more. He is scheduled for a scan in a couple of weeks and we are hoping that there is not any evidence of recurrence. We asked for a Signatera test but his oncologist did an NGS liquid biopsy instead. I thought Signatera is better for trying to determine if the cancer is gone? I feel like she’s acting like there is still cancer there, in spite of there currently being no proof of that. She’s looking for targetable mutations instead of anything even being there, as we asked her to. Am I overreacting? At the least, maybe they should have run both tests? We want to know if there is any ctdna from the original tumor, if there’s a good chance they got it all in order to feel a little bit better about not doing more chemo in the event that the scan returns clear. A clear scan sometimes won’t show the minuscule meanies- will the NGS test do that? Everything during this whole experience has been a fight. I am not happy with the care available locally to us. Every progress Norm has made has come from us fighting for treatments advised by doctors other than the ones at the clinic who neglected to even give my husband options or explain the reasons for them. We got better advice from the surgeon and an oncologist friend of my cousin who backed up what the surgeon said. Sorry that I’m ranting. 2025 was a long, scary year for my husband and our family and I don’t want to take a wrong turn now because of a doctor who isn’t listening and seemed almost offended that my husband was too sick to keep doing chemo that he might or might not have needed. He’s doing better now, about 3 weeks out from his last chemo, but he’s experiencing pretty serious muscle wasting and the 5FU made eating impossible.
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Try to find the best oncologist in your area so you can be more comfortable with his care. My surgeon was very well recommended and everything turned out well in spite if some complications. I did not need chemotherapy so I did not have to deal with that though. My doc is in Miami, Florida in case you need recommendation.
Your husband’s journey mirrors mine. Diagnosed in July 2025. FLOT every 2 weeks with immunotherapy every month August-Sept. Complicated surgery November. 11 days in hospital. Restarted same schedule of FLOT end of Dec. My oncologist has ordered 3 Signatera tests. I was positive after 1st chemo. Negative after 4th and still negative after surgery. She was very pleased as are all of us. Seek a second opinion if you can.
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1 ReactionI had 4 years of post-op Signatera ctDNA blood draws (every 3 months). Ok... not yet FDA approved, so buy-in by oncologists and insurance companies is a bit iffy across America. I'll simply attach what AI says, in comparing basic NGS testing vs personalized Signatera (and Tempus) type ctDNA testing. Read on...
Signatera-type blood tests and general next-generation sequencing (NGS) liquid biopsies are not equivalent in how they approach, nor in their accuracy for, detecting real-time cancer recurrence.
While both are NGS-based technologies that look for circulating tumor DNA (ctDNA) in the blood, they serve different purposes:
Signatera-type tests (Tumor-Informed): These are personalized, "bespoke" assays that analyze a patient's own resected tumor tissue to create a custom test targeting the specific, unique mutations of their cancer.
General NGS Tests (Tumor-Naive/Plasma-Only): These use a standardized, pre-designed panel of genes to look for common mutations across a cancer type without needing the patient's original tumor tissue.
Here is a breakdown of why they are not equivalent:
Key Differences
Sensitivity (Precision): Because Signatera uses a personalized "fingerprint" of the tumor, it is designed to be far more sensitive for detecting Molecular Residual Disease (MRD)—the tiny amounts of cancer left after treatment.
Tumor-Informed vs. Naive: Signatera selects the top 16 most clonal (dominant) mutations from the patient's own tumor, whereas standard NGS panels are not personalized.
Speed of Detection: Studies show Signatera can detect molecular recurrence months before it becomes visible on conventional imaging scans (CT/MRI).
Comparison Table: Signatera vs. Generic NGS Liquid Biopsy
Feature Signatera-type (Tumor-Informed) Generic NGS (Tumor-Naive/Panel)
Method Personalized: Analyzes tissue + blood Standardized: Only blood
Sensitivity Very High (designed for MRD) Lower (less effective for tiny amounts)
Focus Tracking unique tumor mutations Scanning for common mutations
Main Use Long-term surveillance/recurrence Initial treatment selection/diagnosis
False Positive Rate Extremely Low (< 1-2%) Higher
Summary for Real-Time Recurrence
For monitoring for recurrence, Signatera-type tests are considered superior to generic NGS panels because they are specifically tailored to the patient’s unique genetic signature, which increases the likelihood of detecting recurrence, or "molecular residual disease" (MRD), much earlier.
A positive result on a Signatera test suggests a very high likelihood (98% or more) that cancer has returned or is still present, often long before traditional imaging can see it.
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1 ReactionThank you mrgvw for that detailed explanation of why I am so grateful my oncologist encouraged me to approve Signatera testing. I am 3 yrs 10 months in remission from advanced metastatic ESCC. I derive a great deal of comfort knowing that if my quarterly Signatera tests score higher than "0", my oncologist can respond immediately to the likely recurrence. It's a tool in his toolbox that gives me peace of mind that the "beast" can be confronted before it is apparent. And to emersonmoon - it is absolutely imperative that you have confidence and very open and clear lines of communication with everyone on your husband's cancer care team. One way of trying to achieve this is to communicate via the patient portal directly to your team member(s) perhaps even before an appointment so you establish a "record" of your concerns that you can refer to when necessary. the patient portal is a tool in your toolbox.
So happy to be a "0" and hope your husband becomes one, too.
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1 Reaction@mrgvw thank you!