Non-invasive Technology Advances in Cancer-A Review of the Advances in the Liquid Biopsy for Endometrial and Ovarian Cancers

Abstract

Improving cancer survival rates globally requires improvements in disease detection and monitoring, with the aim of improving early diagnosis and prediction of disease relapse. Traditional means of detecting and monitoring cancers rely largely on imaging and, where possible, blood-based protein biomarkers, many of which are non-specific. Treatments are being improved by identification of inherited and acquired genomic aberrations in tumors, some of which can be targeted by newly developed therapeutic interventions. Treatment of gynecological malignancy is progressively moving toward personalized therapy, as exemplified by application of PARP-inhibition for patients with BRCA-deficient tubo-ovarian cancers, or checkpoint inhibition in patients with mismatch repair-deficient disease. However, the more recent discovery of a group of biomarkers described under the umbrella term of "liquid biopsy" promises significant improvement in our ability to detect and monitor cancers. The term "liquid biopsy" is used to describe an array of tumor-derived material found in blood plasma and other bodily fluids such as ascites, pleural fluid, saliva, and urine. It includes circulating tumors cells (CTCs), circulating nucleic acids including DNA, messenger RNA and micro RNAs, and extracellular vesicles (EVs). In this review, we discuss recent advancements in liquid biopsy for biomarker detection to help in diagnosis, prognosis, and planning of treatment of ovarian and endometrial cancer.

Keywords: DNA; biomarker; circulating tumor (ctDNA); circulating tumor cell (CTC); microRNA.

Figure 1

Molecular aberrations in different subtypes of Ovarian Cancer. Image created and exported form biorender.com under a paid subscription.

Figure 2

Molecular subtypes of Endometrial Cancer. Image created and exported form biorender.com. CN, Copy number; MSS, Microsatellite stable; and MSI, Microsatellite instability.

Figure 3

Potential Machanism of release of ctDNA and ct.miRNA from living tumor cells. (1) Active secretion, of unbound miRNA or in conjuction with Ago protein/HDL. DNA may be secreted in unbound from or in association with histones (as a nucleosome) or other proteins. The transporters for active secretion of nucleic acids are not fully characterized, however HDI/mRNA complexes are believed to be released through exocytosis. Alternative routes included secretion via formation of (2) microvesicles and (3) exosomes. Image created and exported form biorender.com under a paid subscription.