Precision oncology at the nanoscale: nano-optical biosensors for early cancer detection

Cancer remains one of the foremost global health challenges, accounting for approximately 10 million deaths annually worldwide. Early and accurate diagnosis is pivotal in improving patient survival rates and enabling curative therapeutic interventions. Over the past two decades, nano-optical biosensors have emerged as transformative diagnostic tools that exploit the unique optical properties of nanomaterials-including localized surface plasmon resonance (LSPR), surface-enhanced Raman scattering (SERS), fluorescence enhancement, and photonic crystal phenomena-to detect cancer biomarkers at ultralow concentrations. This comprehensive review critically examines the state-of-the-art advances in nano-optical biosensing platforms designed for the early diagnosis of diverse cancer types, including breast, colorectal, lung, ovarian, and prostate cancers. We systematically cover the fundamental design principles governing plasmonic nanostructures, quantum dot-based sensors, nanophotonic waveguides, SERS-active substrates, and lab-on-chip integrated devices. Special emphasis is placed on the clinical translation challenges, including selectivity in complex biomatrices, reproducibility, stability, and regulatory pathways. We also discuss emerging strategies such as machine learning-assisted signal processing, multiplexed biomarker detection, and CRISPR-coupled optical readouts. Comparative performance metrics across platforms are presented through structured tables, and representative fabrication and sensing mechanisms are illustrated. The review concludes with a critical assessment of future directions and unmet needs in the field, aiming to provide a comprehensive resource for researchers and clinicians working at the interface of nanophotonics and oncology.