We can start winning the war against cancer
-
0:01 - 0:03"We're declaring war against cancer,
-
0:03 - 0:05and we will win this war by 2015."
-
0:06 - 0:10This is what the US Congress
and the National Cancer Institute declared -
0:10 - 0:13just a few years ago, in 2003.
-
0:14 - 0:17Now, I don't know about you,
but I don't buy that. -
0:17 - 0:19I don't think we quite won this war yet,
-
0:19 - 0:21and I don't think
anyone here will question that. -
0:22 - 0:24Now, I will argue that a primary reason
-
0:24 - 0:26why we're not winning
this war against cancer -
0:26 - 0:29is because we're fighting blindly.
-
0:29 - 0:32I'm going to start by sharing with you
a story about a good friend of mine. -
0:32 - 0:34His name is Ehud,
-
0:34 - 0:37and a few years ago,
Ehud was diagnosed with brain cancer. -
0:37 - 0:39And not just any type of brain cancer:
-
0:39 - 0:42he was diagnosed with one
of the most deadly forms of brain cancer. -
0:42 - 0:43In fact, it was so deadly
-
0:43 - 0:46that the doctors told him
that they only have 12 months, -
0:46 - 0:49and during those 12 months,
they have to find a treatment. -
0:49 - 0:51They have to find a cure,
-
0:51 - 0:53and if they cannot
find a cure, he will die. -
0:54 - 0:55Now, the good news, they said,
-
0:55 - 0:58is that there are tons
of different treatments to choose from, -
0:58 - 0:59but the bad news is
-
0:59 - 1:03that in order for them to tell
if a treatment is even working or not, -
1:03 - 1:06well, that takes them
about three months or so. -
1:06 - 1:08So they cannot try that many things.
-
1:08 - 1:11Well, Ehud is now going
into his first treatment, -
1:11 - 1:14and during that first treatment,
just a few days into that treatment, -
1:14 - 1:18I'm meeting with him, and he tells me,
"Adam, I think this is working. -
1:18 - 1:21I think we really lucked out here.
Something is happening." -
1:21 - 1:23And I ask him, "Really?
How do you know that, Ehud?" -
1:23 - 1:25And he says, "Well,
I feel so terrible inside. -
1:25 - 1:27Something's gotta be working up there.
-
1:27 - 1:28It just has to."
-
1:28 - 1:33Well, unfortunately, three months later,
we got the news, it didn't work. -
1:34 - 1:36And so Ehud goes
into his second treatment. -
1:36 - 1:37And again, the same story.
-
1:37 - 1:40"It feels so bad, something's
gotta be working there." -
1:40 - 1:43And then three months later,
again we get bad news. -
1:43 - 1:47Ehud is going into his third treatment,
and then his fourth treatment. -
1:47 - 1:49And then, as predicted, Ehud dies.
-
1:50 - 1:54Now, when someone really close to you
is going through such a huge struggle, -
1:54 - 1:56you get really swamped with emotions.
-
1:56 - 1:58A lot of things
are going through your head. -
1:58 - 2:00For me, it was mostly outrage.
-
2:00 - 2:05I was just outraged that, how come
this is the best that we can offer? -
2:05 - 2:07And I started looking
more and more into this. -
2:07 - 2:10As it turns out, this is not just
the best that doctors could offer Ehud. -
2:10 - 2:14It's not just the best doctors could offer
patients with brain cancer generally. -
2:14 - 2:17We're actually not doing that well
all across the board with cancer. -
2:18 - 2:20I picked up one of those statistics,
-
2:20 - 2:23and I'm sure some of you
have seen those statistics before. -
2:23 - 2:26This is going to show you here
how many patients actually died of cancer, -
2:26 - 2:28in this case females in the United States,
-
2:28 - 2:30ever since the 1930s.
-
2:30 - 2:33You'll notice that there aren't
that many things that have changed. -
2:33 - 2:34It's still a huge issue.
-
2:34 - 2:36You'll see a few changes, though.
-
2:36 - 2:39You'll see lung cancer,
for example, on the rise. -
2:39 - 2:40Thank you, cigarettes.
-
2:40 - 2:43And you'll also see that,
for example, stomach cancer -
2:43 - 2:46once used to be one
of the biggest killers of all cancers, -
2:46 - 2:48is essentially eliminated.
-
2:48 - 2:51Now, why is that?
Anyone knows, by the way? -
2:51 - 2:54Why is it that humanity is no longer
struck by stomach cancer? -
2:54 - 2:59What was the huge, huge
medical technology breakthrough -
2:59 - 3:02that came to our world
that saved humanity from stomach cancer? -
3:03 - 3:07Was it maybe a new drug,
or a better diagnostic? -
3:07 - 3:08You guys are right, yeah.
-
3:08 - 3:11It's the invention of the refrigerator,
-
3:11 - 3:14and the fact that we're
no longer eating spoiled meats. -
3:14 - 3:16So the best thing
that happened to us so far -
3:16 - 3:18in the medical arena in cancer research
-
3:18 - 3:20is the fact that
the refrigerator was invented. -
3:20 - 3:21(Laughter)
-
3:21 - 3:23And so -- yeah, I know.
-
3:23 - 3:24We're not doing so well here.
-
3:24 - 3:26I don't want to miniaturize the progress
-
3:26 - 3:30and everything that's been done
in cancer research. -
3:30 - 3:33Look, there is like 50-plus years
of good cancer research -
3:33 - 3:37that discovered major, major things
that taught us about cancer. -
3:37 - 3:38But all that said,
-
3:39 - 3:41we have a lot of heavy lifting
to still do ahead of us. -
3:43 - 3:46Again, I will argue that the primary
reason why this is the case, -
3:46 - 3:48why we have not done that remarkably well,
-
3:48 - 3:50is really we're fighting blindly here.
-
3:50 - 3:52And this is where
medical imaging comes in. -
3:52 - 3:54This is where my own work comes in.
-
3:54 - 3:57And so to give you a sense
of the best medical imaging -
3:57 - 4:00that's offered today
to brain cancer patients, -
4:00 - 4:02or actually generally
to all cancer patients, -
4:02 - 4:04take a look at this PET scan right here.
-
4:04 - 4:05Let's see. There we go.
-
4:06 - 4:07So this is a PET/CT scan,
-
4:07 - 4:10and what you'll see in this PET/CT scan
-
4:10 - 4:13is the CT scan will show you
where the bones are, -
4:13 - 4:15and the PET scan will show you
where tumors are. -
4:16 - 4:18Now, what you can see here
-
4:18 - 4:21is essentially a sugar molecule
-
4:21 - 4:22that was added a small little tag
-
4:22 - 4:25that is signaling to us
outside of the body, -
4:25 - 4:26"Hey, I'm here."
-
4:26 - 4:30And those sugar molecules are injected
into these patients by the billions, -
4:30 - 4:31and they're going all over the body
-
4:31 - 4:34looking for cells
that are hungry for sugar. -
4:34 - 4:37You'll see that the heart,
for example, lights up there. -
4:37 - 4:39That's because the heart
needs a lot of sugar. -
4:39 - 4:42You'll also see that the bladder
lights up there. -
4:42 - 4:44That's because the bladder
is the thing that's clearing -
4:44 - 4:46the sugar away from our body.
-
4:46 - 4:48And then you'll see a few other hot spots,
-
4:48 - 4:50and these are in fact the tumors.
-
4:50 - 4:52Now, this is a really
a wonderful technology. -
4:52 - 4:55For the first time it allowed us
to look into someone's body -
4:55 - 4:57without picking up
each and every one of the cells -
4:57 - 4:59and putting them under the microscope,
-
4:59 - 5:02but in a noninvasive way
allowing us to look into someone's body -
5:02 - 5:05and ask, "Hey,
has the cancer metastasized? -
5:05 - 5:06Where is it?"
-
5:06 - 5:08And the PET scans here
are showing you very clearly -
5:08 - 5:11where are these hot spots,
where is the tumor. -
5:11 - 5:15So as miraculous as this might seem,
-
5:15 - 5:18unfortunately, well, it's not that great.
-
5:18 - 5:20You see, those
small little hot spots there. -
5:21 - 5:25Can anyone guess how many cancer cells
are in any one of these tumors? -
5:27 - 5:29So it's about 100 million cancer cells,
-
5:29 - 5:32and let me make sure
that this number sunk in. -
5:32 - 5:34In each and every one
of these small little blips -
5:34 - 5:36that you're seeing on the image,
-
5:36 - 5:40there needs to be
at least 100 million cancer cells -
5:40 - 5:41in order for it to be detected.
-
5:41 - 5:44Now, if that seemed to you
like a very large number, -
5:44 - 5:45it is a very large number.
-
5:47 - 5:49This is in fact
an incredibly large number, -
5:49 - 5:52because what we really need
in order to pick up something early enough -
5:52 - 5:55to do something about it,
to do something meaningful about it, -
5:55 - 5:58well, we need to pick up tumors
that are a thousand cells in size, -
5:58 - 6:00and ideally just
a handful of cells in size. -
6:00 - 6:02So we're clearly
pretty far away from this. -
6:02 - 6:05So we're going to play
a little experiment here. -
6:05 - 6:07I'm going to ask each of you
to now play and imagine -
6:07 - 6:09that you are brain surgeons.
-
6:09 - 6:13And you guys are now at an operating room,
-
6:13 - 6:15and there's a patient in front of you,
-
6:15 - 6:19and your task is to make sure
that the tumor is out. -
6:19 - 6:23So you're looking down at the patient,
-
6:23 - 6:25the skin and the skull
have already been removed, -
6:25 - 6:27so you're looking at the brain.
-
6:27 - 6:28And all you know about this patient
-
6:28 - 6:31is that there's a tumor
about the size of a golf ball or so -
6:31 - 6:34in the right frontal lobe
of this person's brain. -
6:34 - 6:35And that's more or less it.
-
6:35 - 6:39So you're looking down, and unfortunately
everything looks the same, -
6:39 - 6:42because brain cancer tissue
and healthy brain tissue -
6:42 - 6:43really just look the same.
-
6:43 - 6:45And so you're going in with your thumb,
-
6:45 - 6:48and you start to press
a little bit on the brain, -
6:48 - 6:50because tumors tend to be
a little harder, stiffer, -
6:50 - 6:53and so you go in and go
a little bit like this and say, -
6:53 - 6:55"It seems like the tumor is right there."
-
6:55 - 6:57Then you take out your knife
and start cutting the tumor -
6:57 - 6:59piece by piece by piece.
-
6:59 - 7:00And as you're taking the tumor out,
-
7:00 - 7:03then you're getting
to a stage where you think, -
7:03 - 7:05"Alright, I'm done.
I took out everything." -
7:05 - 7:06And at this stage, if that's --
-
7:06 - 7:09so far everything sounded,
like, pretty crazy -- -
7:09 - 7:13you're now about to face the most
challenging decision of your life here. -
7:13 - 7:14Because now you need to decide,
-
7:14 - 7:17should I stop here
and let this patient go, -
7:17 - 7:20risking that there might be
some leftover cancer cells behind -
7:20 - 7:22that I just couldn't see,
-
7:22 - 7:25or should I take away some extra margins,
-
7:25 - 7:27typically about an inch or so
around the tumor -
7:28 - 7:30just to be sure that I removed everything?
-
7:31 - 7:35So this is not a simple decision to make,
-
7:36 - 7:38and unfortunately this is the decision
-
7:38 - 7:41that brain cancer surgeons
have to take every single day -
7:41 - 7:43as they're seeing their patients.
-
7:43 - 7:46And so I remember talking
to a few friends of mine in the lab, -
7:46 - 7:49and we say, "Boy,
there's got to be a better way." -
7:49 - 7:52But not just like you tell a friend
that there's got to be a better way. -
7:52 - 7:54There's just got to be a better way here.
-
7:54 - 7:56This is just incredible.
-
7:56 - 7:57And so we looked back.
-
7:57 - 8:00Remember those PET scans I told you about,
the sugar and so on. -
8:00 - 8:03We said, hey, how about
instead of using sugar molecules, -
8:03 - 8:06let's maybe take tiny, tiny
little particles made of gold, -
8:06 - 8:10and let's program them with some
interesting chemistry around them. -
8:10 - 8:12Let's program them
to look for cancer cells. -
8:12 - 8:14And then we will inject
these gold particles -
8:14 - 8:17into these patients by the billions again,
-
8:17 - 8:19and we'll have them go all over the body,
-
8:19 - 8:21and just like secret agents, if you will,
-
8:21 - 8:24go and walk by
every single cell in our body -
8:24 - 8:25and knock on the door of that cell,
-
8:25 - 8:28and ask, "Are you a cancer cell
or are you a healthy cell? -
8:28 - 8:30If you're a healthy cell, we're moving on.
-
8:30 - 8:33If you're a cancer cell,
we're sticking in and shining out -
8:33 - 8:35and telling us,
"Hey, look at me, I'm here." -
8:35 - 8:37And they'll do it
through some interesting cameras -
8:37 - 8:39that we developed in the lab.
-
8:39 - 8:42And once we see that,
maybe we can guide brain cancer surgeons -
8:42 - 8:45towards taking only the tumor
and leaving the healthy brain alone. -
8:46 - 8:49And so we've tested that,
and boy, this works well. -
8:49 - 8:51So I'm going to show you an example now.
-
8:51 - 8:53What you're looking at here
-
8:53 - 8:57is an image of a mouse's brain,
-
8:57 - 9:00and we've implanted
into this mouse's brain -
9:00 - 9:01a small little tumor.
-
9:01 - 9:04And so this tumor is now
growing in this mouse's brain, -
9:04 - 9:06and then we've taken a doctor
and asked the doctor -
9:06 - 9:09to please operate on the mouse
as if that was a patient, -
9:09 - 9:12and take out piece by piece
out of the tumor. -
9:12 - 9:13And while he's doing that,
-
9:13 - 9:16we're going to take images
to see where the gold particles are. -
9:16 - 9:18And so we're going to first start
-
9:18 - 9:20by injecting these gold particles
into this mouse, -
9:20 - 9:23and we're going to see
right here at the very left there -
9:23 - 9:25that image at the bottom
-
9:25 - 9:27is the image that shows
where the gold particles are. -
9:27 - 9:29The nice thing
is that these gold particles -
9:29 - 9:31actually made it all the way to the tumor,
-
9:31 - 9:35and then they shine out and tell us,
"Hey, we're here. Here's the tumor." -
9:35 - 9:36So now we can see the tumor,
-
9:36 - 9:39but we're not showing this
to the doctor yet. -
9:39 - 9:42We're asking the doctor,
now please start cutting away the tumor, -
9:42 - 9:45and you'll see here the doctor
just took the first quadrant of the tumor -
9:45 - 9:47and you see that first quadrant
is now missing. -
9:47 - 9:50The doctor then took
the second quadrant, the third, -
9:50 - 9:52and now it appears to be everything.
-
9:52 - 9:54And so at this stage,
the doctor came back to us and said, -
9:54 - 9:57"Alright, I'm done.
What do you want me to do? -
9:57 - 9:58Should I keep things as they are
-
9:58 - 10:01or do you want me to take
some extra margins around?" -
10:01 - 10:02And then we said, "Well, hang on."
-
10:02 - 10:05We told the doctor,
"You've missed those two spots, -
10:05 - 10:07so rather than taking huge margins around,
-
10:07 - 10:09only take out those tiny little areas.
-
10:09 - 10:11Take them out,
and then let's take a look." -
10:11 - 10:14And so the doctor took them away,
and lo and behold, -
10:14 - 10:16the cancer is now completely gone.
-
10:16 - 10:17Now, the important thing
-
10:17 - 10:20is that it's not just
that the cancer is completely gone -
10:20 - 10:21from this person's brain,
-
10:21 - 10:22or from this mouse's brain.
-
10:23 - 10:24The most important thing
-
10:24 - 10:27is that we did not have to take
huge amounts of healthy brain -
10:27 - 10:29in the process.
-
10:29 - 10:31And so now we can actually imagine a world
-
10:31 - 10:35where doctors and surgeons,
as they take away a tumor, -
10:35 - 10:36they actually know what to take out,
-
10:36 - 10:38and they no longer
have to guess with their thumb. -
10:40 - 10:43Now, here's why it's extremely important
to take those tiny little leftover tumors. -
10:43 - 10:46Those leftover tumors,
even if it's just a handful of cells, -
10:46 - 10:49they will grow to recur the tumor,
-
10:49 - 10:51for the tumor to come back.
-
10:51 - 10:53In fact, the reason why 80 to 90 percent
-
10:53 - 10:55of those brain cancer surgeries
ultimately fail -
10:55 - 10:59is because of those small little
extra margins that were left positive, -
10:59 - 11:02those small little leftover tumors
that were left there. -
11:03 - 11:06So this is clearly very nice,
-
11:06 - 11:10but what I really want to share with you
is where I think we're heading from here. -
11:10 - 11:12And so in my lab at Stanford,
-
11:12 - 11:17my students and I are asking,
what should we be working on now? -
11:18 - 11:20And I think where
medical imaging is heading to -
11:20 - 11:23is the ability to look into the human body
-
11:23 - 11:26and actually see each and every one
of these cells separately. -
11:27 - 11:29The ability like this would allow us
-
11:29 - 11:32to actually pick up tumors
way, way earlier in the process, -
11:32 - 11:36way before it's 100 million cells inside,
so we can actually do something about it. -
11:36 - 11:40An ability to see each and every one
of the cells might also allow us -
11:40 - 11:41to ask insightful questions.
-
11:41 - 11:43So in the lab,
we are now getting to a point -
11:43 - 11:46where we can actually start asking
these cancer cells real questions, -
11:46 - 11:50like, for example, are you responding
to the treatment we are giving you or not? -
11:50 - 11:54So if you're not responding, we'll know
to stop the treatment right away, -
11:54 - 11:56days into the treatment, not three months.
-
11:56 - 11:59And so also for patients like Ehud
-
11:59 - 12:03that are going through these
nasty, nasty chemotherapy drugs, -
12:03 - 12:04for them not to suffer
-
12:04 - 12:07through those horrendous
side effects of the drugs -
12:07 - 12:10when the drugs are
in fact not even helping them. -
12:10 - 12:13So to be frank here,
-
12:13 - 12:16we're pretty far away
from winning the war against cancer, -
12:16 - 12:18just to be realistic.
-
12:18 - 12:20But at least I am hopeful
-
12:20 - 12:24that we should be able to fight this war
with better medical imaging techniques -
12:24 - 12:26in the way that is not blind.
-
12:26 - 12:27Thank you.
-
12:27 - 12:29(Applause)
- Title:
- We can start winning the war against cancer
- Speaker:
- Adam de la Zerda
- Description:
-
Learn about the latest advances in the war against cancer from Stanford researcher Adam de la Zerda, who's working on some cutting-edge techniques of his own. Using a remarkable imaging technology that illuminates cancer-seeking gold particles injected into the body, de la Zerda's lab hopes to light the way for surgeons to remove even the tiniest trace of deadly tumors.
- Video Language:
- English
- Team:
- closed TED
- Project:
- TEDTalks
- Duration:
- 12:42
Brian Greene edited English subtitles for How we can start winning the war against cancer | ||
Brian Greene approved English subtitles for How we can start winning the war against cancer | ||
Brian Greene edited English subtitles for How we can start winning the war against cancer | ||
Brian Greene edited English subtitles for How we can start winning the war against cancer | ||
Joanna Pietrulewicz accepted English subtitles for How we can start winning the war against cancer | ||
Joanna Pietrulewicz edited English subtitles for How we can start winning the war against cancer | ||
Joanna Pietrulewicz edited English subtitles for How we can start winning the war against cancer | ||
Joseph Geni edited English subtitles for How we can start winning the war against cancer |