Concierge oncology · London
Circulating tumour DNA (ctDNA) monitoring - private in London.
Signatera, Guardant Reveal and RaDaR arranged through Royal Marsden Private, UCLH Private, HCA London Bridge and Bupa Cromwell. A tumour-informed liquid biopsy that can detect recurrence six to twenty-four months before imaging.
Why patients choose us
- 01
Clinician-led matching
A consultant reviews your case and chooses the assay best suited to your cancer type, stage and prior treatment.
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Independent by design
We never accept payment to influence which lab or clinic we recommend. Free of charge to you.
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A vetted London panel
Sample collection through Royal Marsden Private, UCLH Private, HCA London Bridge and Bupa Cromwell partners.
What ctDNA is
A liquid biopsy that reads tumour signals in the blood.
Tumours continuously shed short fragments of their own DNA into the bloodstream. Modern sequencing can find them at parts-per-million level, well before a scan can see disease.
Circulating tumour DNA, or ctDNA, is the small fraction of cell-free DNA in your plasma that originates specifically from cancer cells. When a tumour grows, treatment kills cells, or metastatic deposits establish, DNA fragments 150 to 200 base pairs long are released into the circulation. Ultra-sensitive PCR and next-generation sequencing detect these fragments at levels as low as one mutant molecule per hundred thousand normal molecules.
The clinical value sits in one idea: minimal residual disease, or MRD. After surgery, radiotherapy or systemic treatment finishes, standard scans have a resolution floor of roughly one centimetre. Below that floor, microscopic disease can persist and eventually cause recurrence. A well-designed ctDNA assay closes that gap by up to a thousand-fold and gives your oncologist a molecular window on what imaging cannot see.
In one line
A blood test that looks for the fingerprint of your tumour, months before a scan would show it.
Assay types
Tumour-informed, or tumour-agnostic.
The two families of ctDNA test answer different questions. Choosing the right one is the single most important decision in setting up monitoring.
Tumour-informed (personalised)
Signatera, RaDaR, Guardant Reveal
A bespoke panel is built from whole-exome sequencing of your resected tumour. Every subsequent blood sample is tracked against those specific mutations, giving the highest possible sensitivity for microscopic residual disease.
Tumour-agnostic (off-shelf)
Guardant360 CDx, FoundationOne Liquid CDx
A fixed multi-gene panel scans plasma for known actionable mutations. Lower sensitivity for MRD, but no tumour tissue is needed and it identifies emerging resistance during systemic therapy.
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Signatera (Natera)
Tumour-informed bespoke 16-plex panel built from your resected tumour. The most published MRD test in colorectal, bladder and breast cancer.
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Guardant Reveal
Tumour-informed methylation and mutation panel. Strong evidence base in colorectal and gastro-oesophageal MRD detection.
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RaDaR (NeoGenomics / Inivata)
Personalised 48-plex panel with ultra-low limits of detection. Widely used in head and neck, lung and breast studies.
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Guardant360 CDx
Tumour-agnostic 74-gene panel. Not personalised, but identifies actionable resistance mutations during systemic therapy.
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Natera Renasight
Germline hereditary cancer panel used alongside Signatera to guide risk-based surveillance.
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FoundationOne Liquid CDx
Tumour-agnostic 324-gene panel for treatment selection in advanced disease. Not designed for MRD.
Clinical use
Where ctDNA changes decisions today.
Not every cancer, and not every stage. Below is the current evidence-backed landscape our oncology partners work to.
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Colorectal cancer MRD
After surgical resection. The DYNAMIC trial showed ctDNA-guided adjuvant chemotherapy is non-inferior to standard care with less chemotherapy exposure.
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Melanoma MRD
After resection of stage IIB-IV disease. Positive ctDNA identifies patients who benefit most from adjuvant immunotherapy.
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NSCLC MRD
After curative-intent chemoradiation or surgery. Rising ctDNA precedes radiological progression by 6-12 months.
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Breast cancer MRD
Early-stage disease after primary treatment. Emerging evidence supports escalation decisions in HER2-negative and triple-negative subtypes.
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Muscle-invasive bladder
Post-cystectomy MRD to guide adjuvant immunotherapy. IMvigor010 subgroup analysis supports ctDNA-directed atezolizumab.
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Systemic therapy tracking
Serial ctDNA quantification during chemotherapy, immunotherapy or targeted therapy signals response or emerging resistance.
Timing and cadence
A monitoring schedule that matches your risk.
Most protocols run quarterly for the first two years, then twice yearly. A positive result triggers imaging even if standard follow-up scans were clear.
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Month 0
Baseline draw
First blood draw four to six weeks after surgery, once acute release of DNA from healing tissue has cleared.
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Yr 1-2
Every 3 months
The window of highest recurrence risk for most solid tumours. Quarterly ctDNA plus routine imaging.
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Yr 3-5
Every 6 months
Cadence relaxes as competing risk of recurrence falls. Continued alongside CT or MRI surveillance.
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On positive
Imaging trigger
A positive ctDNA prompts targeted imaging within two weeks, even if the last scheduled scan was normal.
Performance
High specificity, meaningful lead time.
Numbers vary by cancer type and assay. The figures below reflect the published evidence for the personalised, tumour-informed tests we use most.
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Specificity above 99%
Signatera reports specificity >99.5% across peer-reviewed studies. A positive result is highly unlikely to be a false alarm.
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Sensitivity 88% for recurrence
Detects returning disease in around 88% of eventual recurrences on serial testing, higher when combined with imaging.
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Lead time 6-24 months
ctDNA positivity typically precedes radiological recurrence by 6-9 months on average, with a range up to 24 months.
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Parts-per-million detection
Tumour-informed assays detect mutant allele fractions as low as 0.001%, well below the reach of standard next-generation sequencing.
Indicative pricing
Honest ranges for private ctDNA monitoring.
Prices reflect our partner labs and clinics in London. We confirm a firm quote within one working day, with two or three options where possible.
In short
Typical annual monitoring programme: £4,500-£8,500, three to four blood draws with results in 10-14 days.
| Assay / step | Indicative range | Turnaround | Cadence |
|---|---|---|---|
| Signatera - initial tumour tissue setup | £1,800-£2,400 | 3-4 wks | One-off |
| Signatera - each follow-up blood draw | £650-£950 | 10-14 days | Q3-6 monthly |
| Guardant Reveal - per test | £2,200-£3,200 | 10-14 days | Q3-6 monthly |
| RaDaR - initial personalisation | £1,900-£2,800 | 4-6 wks | One-off |
| RaDaR - each follow-up | £850-£1,200 | 2-3 wks | Q3-6 monthly |
| Guardant360 CDx (tumour-agnostic) | £2,400-£3,500 | 7-10 days | On progression |
| FoundationOne Liquid CDx | £2,600-£3,800 | 10-14 days | On progression |
| Natera Renasight germline panel | £450-£850 | 2-3 wks | One-off |
| Typical annual monitoring programme | £4,500-£8,500 | Ongoing | Per plan |
Insurance coverage varies. Bupa, AXA and Vitality reimburse Signatera for colorectal and bladder MRD with pre-authorisation and an oncologist referral. Self-funded pricing shown above.
Where it happens
Sample collection in London, sequencing in the reference lab.
The blood draw takes ten minutes. Samples are couriered to Natera or Guardant in the United States, or NeoGenomics in the United Kingdom for RaDaR.
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Royal Marsden Private
Chelsea and Cavendish Square. Full oncology MDT integration for complex cases.
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UCLH Private Care
The Harley Street Clinic and Grafton Way. Strong translational oncology programme.
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HCA London Bridge
Leaders in Oncology Care (LOC) at 95 Harley Street. Same-day phlebotomy slots.
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Bupa Cromwell Hospital
Kensington. Integrated with imaging and infusion for a full monitoring pathway.
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Christie Private Care
Manchester partner for patients travelling south. Long-standing molecular oncology unit.
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Home phlebotomy
Concierge blood draw in central London Zones 1-3 by appointment. Samples couriered to the accessioning lab.
Interpreting the report
What each result means, in plain English.
Every ctDNA report is discussed with your consultant oncologist. We route the report to your specialist and, where you would like it, to your GP.
- 01 Positive
MRD detected
Molecular residual disease is present below the level of imaging. Discuss escalation, PET-CT or MRI, and adjuvant systemic therapy with your oncologist.
- 02 Negative
No MRD detected
Reassuring at this time point. Continue scheduled follow-up. A single negative test does not exclude future recurrence.
- 03 Rising
Rising quantitative level
Serial increase in mean tumour molecules per millilitre signals biological recurrence. Trigger cross-sectional imaging even if the last scan was clear.
- 04 Indeterminate
Below reporting threshold
A borderline signal that does not meet positivity criteria. Repeat sampling in 4-6 weeks before acting.
A note on evidence
Not yet standard of care for every cancer.
We say this plainly because it matters. ctDNA monitoring is a rapidly evolving field. The right question is always whether it will change your management.
Strong evidence
Colorectal, muscle-invasive bladder, resected melanoma, non-small cell lung after curative-intent treatment.
Emerging evidence
Early breast, gastro-oesophageal, head and neck, pancreatic. Discuss with your oncologist and the MDT before starting a programme.
Related tests and treatments
Where ctDNA sits in your care.
A ctDNA programme rarely stands alone. These are the pathways it most commonly connects to.
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Tumour molecular profiling
Comprehensive genomic profiling of tumour tissue to identify actionable targets.
Learn more -
Immunotherapy infusion
Checkpoint inhibitors delivered privately in London.
Learn more -
Antibody-drug conjugate infusion
Targeted delivery of cytotoxic payload to tumour cells.
Learn more -
CAR-T cell therapy
Engineered T-cell therapy for haematological malignancy.
Learn more -
Oligometastasis SBRT
Stereotactic radiotherapy for limited metastatic disease.
Learn more -
Colorectal cancer
The condition with the strongest ctDNA-guided evidence base.
Learn more -
Breast cancer
Emerging role for ctDNA in early-stage MRD monitoring.
Learn more -
Prostate cancer
ctDNA use largely restricted to advanced castration-resistant disease.
Learn more
Recognised by major UK insurers
Coverage for ctDNA varies by insurer, cancer type and indication. We confirm with your insurer before booking.
Frequently asked
Everything patients ask before starting a ctDNA programme.
Straight answers on reliability, insurance, cadence and what a positive result actually means.
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How reliable is ctDNA monitoring?
Tumour-informed assays like Signatera and RaDaR report specificity above 99% and sensitivity around 88% for detecting recurrence. False positives are rare, and a positive result typically precedes imaging change by six to nine months.
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Will my insurance cover ctDNA testing?
Coverage varies. Bupa, AXA and Vitality reimburse Signatera for colorectal and bladder MRD with pre-authorisation and an oncologist referral. Guardant Reveal and RaDaR are less consistently covered - we confirm with your insurer before ordering.
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Is ctDNA useful in every cancer?
Evidence is strongest in colorectal, bladder, melanoma and non-small cell lung cancer. Breast, gastro-oesophageal and head and neck evidence is emerging. For rare or haematological cancers, the role is limited. Your oncologist and the MDT will guide suitability.
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Will a positive ctDNA change my management?
It can. In colorectal cancer, the DYNAMIC trial supports using ctDNA to decide whether to give adjuvant chemotherapy. In bladder cancer, it supports adjuvant immunotherapy. In other settings, positivity usually triggers earlier imaging rather than an immediate change in treatment.
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What is the difference between tumour-informed and tumour-agnostic assays?
Tumour-informed tests use your resected tumour tissue to build a bespoke panel of your specific mutations. This gives ultra-high sensitivity for residual disease. Tumour-agnostic tests use a fixed panel of common cancer mutations and are better suited to identifying actionable resistance in advanced disease.
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How often should ctDNA be repeated?
Typically every three to six months for the first two years after treatment, then every six to twelve months for a further three years. Frequency is adjusted to your cancer type, stage and how far you are from primary treatment.
Speak to a consultant
Considering ctDNA monitoring after your treatment? We will help you decide if it fits.
A short, confidential conversation with a clinician. Free. We come back within one working day with a recommendation, a firm quote and, where useful, an oncology introduction.