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"We're declaring war against cancer,

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and we will win this war by 2015."

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This is what the US Congress
and the National Cancer Institute declared

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just a few years ago, in 2003.

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Now, I don't know about you,
but I don't buy that.

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I don't think we quite won this war yet,

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and I don't think
anyone here will question that.

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Now, I will argue that a primary reason

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why we're not winning
this war against cancer

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is because we're fighting blindly.

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I'm going to start by sharing with you
a story about a good friend of mine.

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His name is Ehud,

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and a few years ago,
Ehud was diagnosed with brain cancer.

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And not just any type of brain cancer:

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he was diagnosed with one
of the most deadly forms of brain cancer.

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In fact, it was so deadly

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that the doctors told him
that they only have 12 months,

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and during those 12 months,
they have to find a treatment.

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They have to find a cure,

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and if they cannot
find a cure, he will die.

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Now, the good news, they said,

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is that there are tons
of different treatments to choose from,

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but the bad news is

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that in order for them to tell
if a treatment is even working or not,

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well, that takes them
about three months or so.

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So they cannot try that many things.

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Well, Ehud is now going
into his first treatment,

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and during that first treatment,
just a few days into that treatment,

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I'm meeting with him, and he tells me,
"Adam, I think this is working.

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I think we really lucked out here.
Something is happening."

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And I ask him, "Really?
How do you know that, Ehud?"

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And he says, "Well,
I feel so terrible inside.

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Something's gotta be working up there.

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It just has to."

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Well, unfortunately, three months later,
we got the news, it didn't work.

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And so Ehud goes
into his second treatment.

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And again, the same story.

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"It feels so bad, something's
gotta be working there."

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And then three months later,
again we get bad news.

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Ehud is going into his third treatment,
and then his fourth treatment.

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And then, as predicted, Ehud dies.

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Now, when someone really close to you
is going through such a huge struggle,

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you get really swamped with emotions.

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A lot of things
are going through your head.

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For me, it was mostly outrage.

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I was just outraged that, how come
this is the best that we can offer?

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And I started looking
more and more into this.

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As it turns out, this is not just
the best that doctors could offer Ehud.

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It's not just the best doctors could offer
patients with brain cancer generally.

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We're actually not doing that well
all across the board with cancer.

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I picked up one of those statistics,

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and I'm sure some of you
have seen those statistics before.

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This is going to show you here
how many patients actually died of cancer,

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in this case females in the United States,

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ever since the 1930s.

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You'll notice that there aren't
that many things that have changed.

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It's still a huge issue.

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You'll see a few changes though.

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You'll see lung cancer,
for example, on the rise.

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Thank you, cigarettes.

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And you'll also see that,
for example, stomach cancer

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once used to be one
of the biggest killers of all cancers,

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is essentially eliminated.

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Now, why is that?
Anyone knows, by the way?

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Why is it that humanity is no longer
struck by stomach cancer?

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What was the huge, huge
medical technology breakthrough

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that came to our world
that saved humanity from stomach cancer?

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Was it maybe a new drug,
or a better diagnostic?

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You guys are right, yeah.

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It's the invention of the refrigerator,

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and the fact that we're
no longer eating spoiled meats.

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So the best thing
that happened to us so far

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in the medical arena in cancer research

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is the fact that
the refrigerator was invented.

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(Laughter)

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And so -- yeah, I know.

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We're not doing so well here.

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I don't want to miniaturize the progress

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and everything that's been done
in cancer research.

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Look, there is like 50-plus years
of good cancer research

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that discovered major, major things
that taught us about cancer.

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But all that said,

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we have a lot of heavy lifting
to still do ahead of us.

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Again, I will argue that the primary
reason why this is the case,

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why we have not done that remarkably well,

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is really we're fighting blindly here.

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And this is where
medical imaging comes in.

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This is where my own work comes in.

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And so to give you a sense
of the best medical imaging

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that's offered today
to brain cancer patients,

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or actually generally
to all cancer patients,

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take a look at this PET scan right here.

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Let's see. There we go.

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So this is a PET/CT scan,

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and what you'll see in this PET/CT scan

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is the CT scan will show you
where the bones are,

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and the PET scan will show you
where tumors are.

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Now, what you can see here

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is essentially a sugar molecule

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that was added a small little tag

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that is signaling to us
outside of the body,

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"Hey, I'm here."

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And those sugar molecules are injected
into these patients by the billions,

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and they're going all over the body

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looking for cells
that are hungry for sugar.

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You'll see that the heart,
for example, lights up there.

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That's because the heart
needs a lot of sugar.

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You'll also see that the bladder
lights up there.

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That's because the bladder
is the thing that's clearing

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the sugar away from our body.

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And then you'll see a few other hot spots,

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and these are in fact the tumors.

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Now, this is a really
a wonderful technology.

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For the first time it allowed us
to look into someone's body

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without picking up
each and every one of the cells

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and putting them under the microscope,

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but in a noninvasive way
allowing us to look into someone's body

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and ask, "Hey,
has the cancer metastasized?

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Where is it?"

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And the PET scans here
are showing you very clearly

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where are these hot spots,
where is the tumor.

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So as miraculous as this might seem,

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unfortunately, well, it's not that great.

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You see, those
small little hot spots there.

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Can anyone guess how many cancer cells
are in any one of these tumors?

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So it's about 100 million cancer cells,

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and let me make sure
that this number sunk in.

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In each and every one
of these small little blips

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that you're seeing on the image,

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there needs to be
at least 100 million cancer cells

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in order for it to be detected.

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Now, if that seemed to you
like a very large number,

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it is a very large number.

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This is in fact
an incredibly large number,

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because what we really need
in order to pick up something early enough

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to do something about it,
to do something meaningful about it,

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well, we need to pick up tumors
that are a thousand cells in size,

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and ideally just
a handful of cells in size.

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So we're clearly
pretty far away from this.

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So we're going to play
a little experiment here.

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I'm going to ask each of you
to now play and imagine

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that you are brain surgeons.

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And you guys are now at an operating room,

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and there's a patient in front of you,

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and your task is to make sure
that the tumor is out.

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So you're looking down at the patient,

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the skin and the skull
have already been removed,

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so you're looking at the brain.

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And all you know about this patient

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is that there's a tumor
about the size of a golf ball or so

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in the right frontal lobe
of this person's brain.

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And that's more or less it.

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So you're looking down, and unfortunately
everything looks the same,

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because brain cancer tissue
and healthy brain tissue

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really just look the same.

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And so you're going in with your thumb,

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and you start to press
a little bit on the brain,

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because tumors tend to be
a little harder, stiffer,

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and so you go in and go
a little bit like this and say,

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"It seems like the tumor is right there."

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Then you take out your knife
and start cutting the tumor

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piece by piece by piece,

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and as you're taking the tumor out,

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then you're getting
to a stage where you think,

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"All right, I'm done.
I took out everything."

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And at this stage, if that's --

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so far everything sounded,
like, pretty crazy --

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you're now about to face the most
challenging decision of your life here.

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Because now you need to decide,

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should I stop here
and let this patient go,

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risking that there might be
some leftover cancer cells behind

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that I just couldn't see,

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or should I take away some extra margins,

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typically about an inch or so
around the tumor

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just to be sure that I removed everything?

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So this is not a simple decision to make,

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and unfortunately this is the decision

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that brain cancer surgeons
have to take every single day

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as they're seeing their patients.

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And so I remember talking
to a few friends of mine in the lab,

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and we say, "Boy,
there's got to be a better way."

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But not just like you tell a friend
that there's got to be a better way.

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There's just got to be a better way here.

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This is just incredible.

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And so we looked back.

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Remember those PET scans I told you about,
the sugar and so on.

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We said, hey, how about
instead of using sugar molecules,

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let's maybe take tiny, tiny
little particles made of gold

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and let's program them with some
interesting chemistry around them.

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Let's program them
to look for cancer cells.

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And then we will inject
these gold particles

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into these patients by the billions again,

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and we'll have them go all over the body,

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and just like secret agents, if you will,

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go and walk by
every single cell in our body

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and knock on the door of that cell,

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and ask, "Are you a cancer cell
or are you a healthy cell?

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If you're a healthy cell, we're moving on.

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If you're a cancer cell,
we're sticking in and shining out

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and telling us,
"Hey, look at me, I'm here."

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And they'll do it
through some interesting cameras

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that we developed in the lab.

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And once we see that,
maybe we can guide brain cancer surgeons

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towards taking only the tumor
and leaving the healthy brain alone.

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And so we've tested that,
and boy, this works well.

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So I'm going to show you an example now.

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What you're looking at here

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is an image of a mouse's brain,

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and we've implanted
into this mouse's brain

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a small little tumor.

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And so this tumor is now
growing in this mouse's brain,

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and then we've taken a doctor
and just asked this doctor

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00:09:17,320 --> 00:09:20,136
to please operate on the mouse
as if that was a patient,

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and take out piece by piece
out of the tumor,

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and while he's doing that,

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00:09:24,400 --> 00:09:27,376
we're going to take images
to see where the gold particles are.

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And so we're going to first start

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00:09:29,040 --> 00:09:31,456
by injecting these gold particles
into this mouse,

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and we're going to see
right here at the very left there

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00:09:34,400 --> 00:09:35,656
that image at the bottom

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is the image that shows
where the gold particles are.

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The nice thing
is that these gold particles

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00:09:40,280 --> 00:09:42,296
actually made it all the way to the tumor,

224
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and then they shine out and tell us,
"Hey, we're here. Here's the tumor."

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So now we can see the tumor,

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but we're not showing this
to the doctor yet.

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We're asking the doctor,
now please start cutting away the tumor,

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and you'll see here the doctor
just took the first quadrant of the tumor

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and you see that first quadrant
is now missing.

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The doctor then took
the second quadrant, the third,

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and now it appears to be everything.

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And so at this stage,
the doctor came back to us and said,

233
00:10:05,320 --> 00:10:07,576
"All right, I'm done.
What do you want me to do?

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00:10:07,600 --> 00:10:09,176
Should I keep things as they are

235
00:10:09,200 --> 00:10:11,696
or do you want me to take
some extra margins around?"

236
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And then we said, "Well, hang on."

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We told the doctor,
"You've missed those two spots,

238
00:10:15,840 --> 00:10:17,840
so rather than taking huge margins around,

239
00:10:17,864 --> 00:10:19,696
only take out those tiny little areas.

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Take them out,
and then let's take a look."

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00:10:21,760 --> 00:10:24,616
And so the doctor took them away,
and lo and behold,

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the cancer is now completely gone.

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Now, the important thing

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is that it's not just
that the cancer is completely gone

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from this person's brain,

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or from this mouse's brain.

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The most important thing

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is that we did not have to take
huge amounts of healthy brain

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in the process.

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And so now we can actually imagine a world

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where doctors and surgeons,
as they take away a tumor,

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they actually know what to take out,
and they no longer have to guess.

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Now, here's why it's extremely important
to take those tiny little leftover tumors.

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Those leftover tumors,
even if it's just a handful of cells,

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they will grow to recur the tumor,

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for the tumor to come back.

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In fact, the reason why 80 to 90 percent

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of those brain cancer surgeries
ultimately fail

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is because of those small little
extra margins that were left positive,

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those small little leftover tumors
that were left there.

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So this is clearly very nice,

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but what I really want to share with you
is where I think we're heading from here.

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And so in my lab at Stanford,

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my students and I are asking,
what should we be working on now?

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And I think where
medical imaging is heading to

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is the ability to look into the human body

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and actually see each and every one
of these cells separately.

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The ability like this would allow us

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to actually pick up tumors
way, way earlier in the process,

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way before it's 100 million cells inside,
so we can actually do something about it.

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An ability to see each and every one
of the cells might also allow us

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to ask insightful questions.

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So in the lab,
we are now getting to a point

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where we can actually start asking
these cancer cells real questions,

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like, for example, are you responding
to the treatment we are giving you or not?

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So if you're not responding, we'll know
to stop the treatment right away,

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days into the treatment, not three months.

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And so also for patients like Ehud

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that are going through these
nasty, nasty chemotherapy drugs,

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for them not to suffer

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through those horrendous
side effects of the drugs

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when the drugs are
in fact not even helping them.

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So to be frank here,

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we're pretty far away
from winning the war against cancer,

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just to be realistic.

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But at least I am hopeful

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that we should be able to fight this war
with better medical imaging techniques

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in the way that is not blind.

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Thank you.

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(Applause)