ctDNA testing is now available as standard of care for non-small cell lung cancer, ESR1 in breast cancer, and Cancer of Unknown Primary (CUP). Testing requires NHS Trusts to procure their own sample collection kits, which are then sent to certain regional Genomic Medicine Services (GMSs) for testing. In the East region, ctDNA testing will be delivered via the North Thames Genomic Medicine Service.
Non-urgent advice: NEW July 2026; ctDNA testing for Cancer of Unknown Primary
From 16 July 2026, patients with CUP can be referred for circulating tumour DNA (ctDNA) testing via the NHS Genomic Test Directory. Already used in non-small cell lung cancer (NSCLC) and ESR1 in breast cancer, ctDNA testing uses a simple blood test to detect tumour DNA circulating in the bloodstream. For patients with CUP, this can help:
- Identify the likely tissue of origin
- Detect clinically actionable genomic alterations
- Support diagnosis, treatment decisions and access to clinical trials
For the East region testing will be routed through the North Thames Genomic Medicine Service.
You can view a webinar held on 7 July below. You can also:
ctDNA for CUP: Webinar
Link: https://www.youtube.com/watch?v=c5HDA6aeZcI
Ordering ctDNA blood collection kits
Those in the East Genomics region should order tests and send samples to the North Thames GMS.
We have worked with Trusts across our region to support the funding and procurement of appropriate sampling kits. If you are unsure how to access testing, please contact:
- East of England Cancer Alliance - Liz Lawrence elizabeth.lawrence5@nhs.net
- East Midlands Cancer Alliance - Aisha Minhas aisha.minhas1@nhs.net
Ordering kits
Contact Marsden360@rmh.nhs.uk
Laboratory address
Clinical Genomics
The Centre for Molecular Pathology
The Royal Marsden NHS Foundation Trust
Cotswold Road
Sutton Surrey
SM2 5PT
ctDNA test request form (North Thames GMS)
- See 'Liquid biopsy biomarker testing' (opens in a new tab) on the North Thames GMS website.
- See also information about report interpretation (opens in a new tab)
Benefits of ctDNA testing
Detection of ctDNA can be a fast and effective way to detect cancer and demand for these tests is expected to continue to grow.
Key benefits of testing include:
- Earlier access to targeted treatments and reduced need for repeated invasive procedures
- System-wide cost savings from diagnostic procedures for patients with failed genomic tests
- Cost savings from avoided mistreatment and associated consequences
- Improved quality of life for patients accessing treatment sooner
- Reduced cancer waiting times