When I was told I had stage IV oesophageal adenocarcinoma, my kids named the tumour Dave. Black humour helps when life gets sharp. What helped even more was clarity. That’s why I pushed for next-generation sequencing, often abbreviated as “NGS”. It didn’t hand me a miracle. It did something more useful – it turned a foggy battlefield into a map my team and I could actually use.
This post explains what NGS is, how it shapes real decisions, where it falls short, how I picked my provider, and what I’d do if I were in your shoes. I’m not selling miracles or bashing medicine. I’m aiming for clarity and practical steps.
What NGS actually is
NGS (next-generation sequencing) is a lab technology that reads all of the DNA or RNA from a cancer sample at once, instead of looking at only one gene at a time. For instance, instead of asking a single yes-or-no question about one gene, NGS can scan dozens or hundreds of genes in one go. It can identify point mutations (small changes in a DNA sequence), fusions (when two genes join together), copy-number changes (when a gene or genes are duplicated or missing), and composite biomarkers like tumour mutational burden (a measure of the number of mutations in tumor DNA) and microsatellite instability (a condition where repetitive DNA sequences become unstable). You’ll also hear the terms “comprehensive genomic profiling” or “biomarker testing.” For a practical explainer: https://www.cancer.gov/about-cancer/treatment/types/biomarker-testing-cancer-treatment
There are two main ways to do this:
- Tissue NGS – a biopsy sample is sequenced. In some cases an existing sample can be gathered and used, to save the patient having to go through a second biopsy (as in my case).
- Liquid biopsy: a blood test that looks for tumour DNA floating in your blood. It’s not always a full substitute for tissue, but sometimes it’s faster or the only option that works. Reviews and clinical summaries: https://ascopubs.org/doi/10.1200/EDBK-25-481114 and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10813828/
There is also then, Whole-genome sequencing (WGS) which is the much bigger tool. Instead of just a panel, WGS reads the entire genome. In the UK, the NHS Genomic Medicine Service and the National Genomic Test Directory make it easier to know who can get which tests and when: https://www.england.nhs.uk/publication/national-genomic-test-directories/ and https://www.england.nhs.uk/genomics/the-national-genomic-test-directory/
Genomics England’s large-scale data show that WGS, combined with clinical data, can refine diagnoses and guide treatment planning in routine care: https://www.genomicsengland.co.uk/news/landmark-national-study-supports-use-of-whole-genome-sequencing-in-standard-cancer-care
Liquid-biopsy pathways are also being introduced in England for specific cancers to speed targeted decisions: https://www.theguardian.com/society/2025/may/29/revolutionary-dna-blood-test-to-offer-thousands-in-england-tailored-cancer-care
Why I did it
I wanted to know if there were actionable alterations that opened targeted drugs or trials. I wanted to know if my tumour was MSI-high, what my TMB looked like, and how to plan next steps instead of reacting in panic. I also wanted to avoid dead ends. Precision oncology is about matching the mechanism to the human in front of you, not chasing headlines. Frameworks like ESMO’s ESCAT help rank which genomic findings actually change outcomes. Translation: not every mutation you can name is worth chasing: https://www.annalsofoncology.org/article/S0923-7534(19)34179-1/fulltext
Why I chose Astron Health
I looked at multiple routes and companies – Tempus, Foundation Medicine, Caris Life Sciences, Guardant, OncoDNA, Datar Cancer Genetics, and others. I ultimately used Astron Health for two very practical reasons.
- Patient-first process
From the start, Astron treated me as a person, not just a case. I spoke directly with their medical lead (Dr. Padman Vamadevan), not just an admin. They were both kind and practical. They even suggested cheaper options if those made more sense. That approach matters when you’re overwhelmed with choices.
Astron site: https://www.astron.health/
About Astron: https://www.astron.health/about-us
FAQ: https://www.astron.health/faq - In-house interpretation by a doctor
Most companies will happily take your money for the test; then you have to scramble to find a specialist who can translate the data into a plan. Astron included expert interpretation of the raw NGS output and their report. For me, that meant fewer plates to spin and a far more usable end product. They also had Dr Hari Kuhan on their interpretation panel, whom I was already working with. That continuity reduced noise when I needed less, not more.
Transparency: I now have an Astron affiliate link. I’m not here to push them. I’m recommending Astron because they were the best I found, and they worked for me. If you use my link, it helps cover blog costs. If not, that’s fine. Always use your own judgement and talk to your clinical team.
Link Here: Astron Affiliate Link
Watch: what NGS is – my story and Astron’s role
If you prefer video to text, here’s a short webinar where we keep it simple. We explain what next-gen sequencing is, how it fits into real-world decisions, and where it sat in my own stage 4 journey. We also touch on why I chose Astron Health – patient-first process and in-house medical interpretation – and how that reduced the noise for me. Watch here: https://youtu.be/WhdREDOx6UE?si=ioE9dOkKEXtWMv3M.
What you will see:
- What NGS is in plain English – tissue panels, whole-genome sequencing, and liquid biopsy.
- Where NGS helped me choose and stop choosing – no miracle claims, just clearer decisions.
- Why Astron stood out in my case – direct access to the medical lead and integrated interpretation.
Transparency note: I now have an affiliate link with Astron. I recommend them because they were the best fit I found, not because of the link. If you choose to use my link it helps cover the costs of keeping this site running. If you prefer to go direct or use another provider, please do. Your case and your clinical team come first.
Alternatives to compare – different tools for different jobs
I’m not linked to any of the companies below. I’m listing them so you can see your options and pick what fits your cancer, timing, and what’s available to you.
Comprehensive genomic profiling – tissue and liquid
- Foundation Medicine – FoundationOne CDx (tissue) and FoundationOne Liquid CDx (blood): https://www.foundationmedicine.com/test/foundationone-cdx and https://www.foundationmedicine.com/portfolio.
- Caris Life Sciences – MI Profile multi-platform profiling: https://www.carislifesciences.com/physicians/physician-tests/mi-profile/ and https://www.carislifesciences.com/why-order-molecular-profiling/.
- Guardant Health – Guardant360 (liquid) and Guardant360 Tissue: EU overview https://guardanthealth.eu/ and products https://guardanthealth.com/products/tests-for-patients-with-early-and-advanced-stage-cancer/
- OncoDNA – OncoDEEP CGP and lab solutions: https://oncodna.com/article/solid_tumor_cgp_oncodeep_tso500/ and https://oncodna.com/for-laboratories/
- NeoGenomics – PanTracer Tissue and LBx (liquid): https://www.neogenomics.com/providers/oncology-solutions/ and press release https://ir.neogenomics.com/news-events/press-releases/detail/305/neogenomics-launches-pantracer-lbx-expanding-access-to-comprehensive-genomic-profiling-with-liquid-biopsy
- Illumina TruSight Oncology – research-use pan-cancer assays for local labs: https://emea.illumina.com/products/by-type/clinical-research-products/trusight-oncology-500.html and ctDNA v2: https://emea.illumina.com/products/by-type/clinical-research-products/trusight-oncology-500-ctdna.html
- Datar Cancer Genetics – tissue CGP and blood-based solutions: UK page https://uk.datarpgx.com/excta-comprehensive-tumor-analysis and global hub https://datarpgx.com/
- MSK-IMPACT – a leading academic panel at Memorial Sloan Kettering: https://www.mskcc.org/msk-impact and clinical validation: https://pmc.ncbi.nlm.nih.gov/articles/PMC5808190/
MRD and recurrence monitoring – different purpose from CGP
- Natera Signatera – personalised ctDNA MRD assay: https://www.natera.com/oncology/signatera-advanced-cancer-detection/ and NICE briefing: https://www.nice.org.uk/advice/mib307/chapter/The-technology
- Exact Sciences – Oncotype DX for early breast cancer decision-making (not CGP, but often part of adjuvant planning): https://www.exactsciences.com/cancer-testing/oncotype-dx-breast-recurrence-score-invasive-ductal
Tip: Match the tool to the job. Use CGP to decide what to treat now or at the next line. Use MRD to determine whether the disease is likely present after treatment and when to act.
What NGS can unlock in real life?
- Targeted therapy eligibility
Some alterations have high-grade evidence for your specific tumour type. ESCAT Tier I means ‘ready for routine decisions.’ A good molecular board will separate signal from noise: https://www.annalsofoncology.org/article/S0923-7534(19)34179-1/fulltext - Immunotherapy context
MSI-high or dMMR tumours often respond better to PD-1 or PD-L1 inhibitors. TMB adds context, but neither is perfect: https://www.sciencedirect.com/science/article/pii/S0923753419312694 and https://www.nature.com/articles/s41591-024-03398-5 - Trial navigation
Basket and biomarker-driven trials now need a genomic ‘ticket.’ Getting results early lets you spot options and prepare for inclusion criteria. - Avoiding dead ends
A negative for a target can save months of chasing the wrong drug. - When tissue is scarce
A validated liquid biopsy can speed decisions in selected settings and is being rolled out in England for particular pathways: https://www.theguardian.com/society/2025/may/29/revolutionary-dna-blood-test-to-offer-thousands-in-england-tailored-cancer-care
Where NGS falls short
- Some tumours don’t yield easy targets.
Oesophageal adenocarcinoma often shows TP53 mutations and chromosomal instability across several genes: ERBB2, CDKN2A, SMAD4, ARID1A, and others. Outside HER2-positive disease, there may be fewer clear targets. Information without an obvious drug is still useful, but set expectations: https://www.nature.com/articles/nature20805, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8428370/ , and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11026501/ - Variants of unknown significance
You will likely see VUS. Ask that your report follow AMP-ASCO-CAP standards and clearly separate clinically actionable from “interesting.” Standards overview: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9081216/ and PubMed entry: https://www.ncbi.nlm.nih.gov/pubmed/27993330 - Consent and data choices
In the NHS, genomic testing has a proper consent workflow. It covers what’s tested, data sharing, and how extra findings are handled. It’s good practice, not red tape: https://www.genomicseducation.hee.nhs.uk/supporting-the-nhs-genomic-medicine-service/requesting-whole-genome-sequencing-information-for-clinicians/ and https://www.genomicseducation.hee.nhs.uk/genotes/knowledge-hub/incidental-findings/ - Turnaround and tissue quality
NGS takes time, and poor samples can fail. Plan biopsy handling upfront to avoid decalcified bone samples that won’t sequence well. A practical primer on tissue stewardship: https://www.jnjprecisionmedicine.com/pdfs/PM-Biomarker-Testing-Challenges-Opportunities-and-the-MDT-Digital-Chapter.pdf - Predictive markers are NOT perfect.
PD-L1 and TMB shift probabilities. They do not guarantee a response. Keep the nuance in view: https://www.nature.com/articles/s41591-024-03398-5
How NGS shaped my path
NGS gave me a plan. It confirmed what not to chase, highlighted what to monitor, and framed trial options to line up early. It did not replace chemo or immunotherapy. It sat alongside them – with microbiome care, nutrition, strength work, sleep, and stress control. Not a miracle, but a map.
A field guide you can take to the clinic
1) Eligibility and timing
- Am I eligible for an NHS-commissioned test under the National Genomic Test Directory for my cancer and stage?
- If not, what alternatives exist – research, private testing, or a trial that includes testing
Directory hub: https://www.england.nhs.uk/publication/national-genomic-test-directories/ and about: https://www.england.nhs.uk/genomics/the-national-genomic-test-directory/
2) Test type
- For me, is tissue NGS or liquid biopsy more appropriate first, and why
- If liquid biopsy is used, which validated assay is available locally, and what will it replace versus complement
ASCO liquid biopsy overview: https://ascopubs.org/doi/10.1200/EDBK-25-481114
3) Reporting and actionability
- Will a molecular tumour board review my results?
- Which findings are ESCAT Tier I in my disease, and what is the next step
ESCAT: https://www.annalsofoncology.org/article/S0923-7534(19)34179-1/fulltext
4) Turnaround and repeats
- How long will the results take
- If we need new tissue later, which site and handling methods will best preserve nucleic acids?
Tissue stewardship primer: https://www.jnjprecisionmedicine.com/pdfs/PM-Biomarker-Testing-Challenges-Opportunities-and-the-MDT-Digital-Chapter.pdf.
5) Immunotherapy context
- Will MSI and TMB be reported, and how would those results change the plan
ESMO biomarker guidance: https://www.sciencedirect.com/science/article/pii/S0923753419312694
6) Trials – now, not later
- Which two or three trials could fit me, and what inclusion criteria should I prepare for
- Who on the team owns the search
7) Consent, data and family
- What choices am I making about data sharing and additional findings
NHS Genomics Education – WGS requesting info and incidental findings: https://www.genomicseducation.hee.nhs.uk/supporting-the-nhs-genomic-medicine-service/requesting-whole-genome-sequencing-information-for-clinicians/ and https://www.genomicseducation.hee.nhs.uk/genotes/knowledge-hub/incidental-findings/
8) Copies for me
- Please provide the full PDF report, any MTB summary, and a plain-language note labelling actionable findings, interesting but not actionable, and VUS. Use AMP-ASCO-CAP classification tiers where possible: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9081216/
A quick reality check on Oesophageal Adenocarcinoma
If you have OAC like me, set expectations properly. OACs often have TP53 mutations and broad chromosomal instability. HER2 amplification is a meaningful subset, but many OACs won’t fall into a clean drug bucket. That doesn’t make NGS pointless – it makes it a tool for avoiding blind alleys, finding trials, tracking evolution, and moving faster when biology gives you an opening: https://www.nature.com/articles/nature20805, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8428370/, and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11026501/
If I were starting today
- Check eligibility in the National Genomic Test Directory and order the right NHS-commissioned test with the right timing. If not eligible, discuss alternatives. https://www.england.nhs.uk/publication/national-genomic-test-directories/
- Plan tissue handling and ask whether a liquid biopsy is appropriate now or at progression for speed. ASCO liquid biopsy overview: https://ascopubs.org/doi/10.1200/EDBK-25-481114
- Request an MTB review and an ESCAT-framed summary so the language of actionability is shared by everyone. ESCAT: https://www.annalsofoncology.org/article/S0923-7534(19)34179-1/fulltext
- Set up a trial shortlist during first-line therapy, not in crisis.
- Keep expectations grounded for OAC and use NGS to avoid wasted time, not to buy fairy tales. OAC review: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8428370/
Building my protocol with Dr Hari Kuhan
On Monday 8 December 2025, I recorded a webinar for Astron with Dr Hari Kuhan. We walked through how we built my treatment protocol step by step, and how Hari used the Astron and Datar reports to inform off-label medications alongside standard care. We tried to keep it practical – what the reports actually said, what we did next, and what we chose not to do. Link will be added here once published.
Final thought
NGS didn’t make my cancer simple. It made it legible. It helped my team pick the right fights and stop shadow-boxing the wrong ones. If you’re reading this in a kitchen at midnight, you’re allowed to ask for clarity. You’re allowed to ask for tests that change decisions. Pair precision with patience – one informed step at a time.
References and further reading
- National Genomic Test Directories – NHS England: https://www.england.nhs.uk/publication/national-genomic-test-directories/
- About the National Genomic Test Directory: https://www.england.nhs.uk/genomics/the-national-genomic-test-directory/
- Genomics England – WGS in standard cancer care: https://www.genomicsengland.co.uk/news/landmark-national-study-supports-use-of-whole-genome-sequencing-in-standard-cancer-care
- NCI – Biomarker testing for cancer treatment: https://www.cancer.gov/about-cancer/treatment/types/biomarker-testing-cancer-treatment
- ASCO Educational Book – liquid biopsy overview: https://ascopubs.org/doi/10.1200/EDBK-25-481114
- Clinical review – ctDNA in practice: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10813828/
- NHS liquid biopsy rollout – news coverage: https://www.theguardian.com/society/2025/may/29/revolutionary-dna-blood-test-to-offer-thousands-in-england-tailored-cancer-care
- ESMO ESCAT scale: https://www.annalsofoncology.org/article/S0923-7534(19)34179-1/fulltext
- Oesophageal adenocarcinoma genomics – TCGA: https://www.nature.com/articles/nature20805
- Oesophageal adenocarcinoma – genomic reviews: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8428370/ and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11026501/
- AMP-ASCO-CAP somatic variant standards: https://www.ncbi.nlm.nih.gov/pubmed/27993330 and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9081216/
- NHS Genomics Education – WGS requesting info and incidental findings: https://www.genomicseducation.hee.nhs.uk/supporting-the-nhs-genomic-medicine-service/requesting-whole-genome-sequencing-information-for-clinicians/ and https://www.genomicseducation.hee.nhs.uk/genotes/knowledge-hub/incidental-findings/
- Astron Health: https://www.astron.health/, https://www.astron.health/about-us, and https://www.astron.health/faq
- Tempus – genomic profiling: https://www.tempus.com/oncology/genomic-profiling/
- Foundation Medicine – FoundationOne CDx and portfolio: https://www.foundationmedicine.com/test/foundationone-cdx and https://www.foundationmedicine.com/portfolio
- Caris Life Sciences – MI Profile and rationale: https://www.carislifesciences.com/physicians/physician-tests/mi-profile/ and https://www.carislifesciences.com/why-order-molecular-profiling/
- Guardant Health – EU site and product pages: https://guardanthealth.eu/ and https://guardanthealth.com/products/tests-for-patients-with-early-and-advanced-stage-cancer/
- OncoDNA – OncoDEEP and CGP solutions: https://oncodna.com/article/solid_tumor_cgp_oncodeep_tso500/ and https://oncodna.com/for-laboratories/
- NeoGenomics – oncology solutions and PanTracer LBx: https://www.neogenomics.com/providers/oncology-solutions/ and https://ir.neogenomics.com/news-events/press-releases/detail/305/neogenomics-launches-pantracer-lbx-expanding-access-to-comprehensive-genomic-profiling-with-liquid-biopsy
- Illumina TruSight Oncology 500 – tissue and ctDNA v2: https://emea.illumina.com/products/by-type/clinical-research-products/trusight-oncology-500.html and https://emea.illumina.com/products/by-type/clinical-research-products/trusight-oncology-500-ctdna.html
- Datar Cancer Genetics – UK and global: https://uk.datarpgx.com/excta-comprehensive-tumor-analysis and https://datarpgx.com/
- MSK-IMPACT – test info and validation: https://www.mskcc.org/msk-impact and https://pmc.ncbi.nlm.nih.gov/articles/PMC5808190/
- Natera Signatera – MRD overview and NICE briefing: https://www.natera.com/oncology/signatera-advanced-cancer-detection/ and https://www.nice.org.uk/advice/mib307/chapter/The-technology
- Exact Sciences – Oncotype DX: https://www.exactsciences.com/cancer-testing/oncotype-dx-breast-recurrence-score-invasive-ductal
Not medical advice: this blog is educational and based on my experience plus published sources. Always discuss testing and timing with your own clinical team.
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