WATCH: Using ctDNA to Detect Recurrence & Guide Management of Hepatocellular Carcinoma

Circulating tumor DNA (ctDNA) is rapidly reshaping the field of precision oncology, including how oncologists assess and guide treatment of a patient's specific cancer.

In this whiteboard demonstration, Dr. Maen Abdelrahim, chief of GI Medical Oncology at Houston Methodist, explains the biological rationale, clinical applications and institutional data supporting ctDNA as a dynamic, quantitative biomarker for hepatocellular carcinoma (HCC) — the most common form of primary liver cancer.

Drawing on real-world experience in surgical resection and liver transplantation, Dr. Abdelrahim highlights how ctDNA can outperform traditional surveillance tools, refine post-curative risk stratification and enable earlier, more actionable clinical decisions.

Key highlights

• By detecting minimal residual disease (MRD) within weeks of resection or transplant, ctDNA allows clinicians to distinguish patients at high risk for recurrence from those who may safely avoid additional therapy.

• While traditional tools — imaging every three months, alpha‑fetoprotein testing — have known limitations, ctDNA provides an additional, more sensitive layer of surveillance for recurrence.

• Because ctDNA levels rise and fall in real time, clinicians can assess whether systemic or locoregional therapies are benefiting the patient — often before changes are visible on imaging.

• How ctDNA (tumor‑derived) and circulating free DNA (donor‑derived) can be assessed together — helping clinicians monitor both oncologic outcomes and early organ rejection.

• As transplantation expands as a treatment option for select GI malignancies, ctDNA emerges as a critical biomarker to guide patient selection, post‑transplant surveillance and long‑term management.