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