How we can start winning the war against cancer | Adam de la Zerda | TEDxStanford
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0:01 - 0:03"We're declaring war against cancer,
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0:03 - 0:05and we will win this war by 2015."
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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.
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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,
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0:19 - 0:21and I don't think
anyone here will question that. -
0:22 - 0:24Now, I will argue that a primary reason
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0:24 - 0:26why we're not winning
this war against cancer -
0:26 - 0:29is because we're fighting blindly.
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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,
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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:
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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
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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,
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0:51 - 0:53and if they cannot
find a cure, he will die. -
0:54 - 0:55Now, the good news, they said,
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0:55 - 0:58is that there are tons
of different treatments to choose from, -
0:58 - 0:59but the bad news is
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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.
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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.
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1:27 - 1:28It just has to."
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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.
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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.
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1:56 - 1:58A lot of things
are going through your head. -
1:58 - 2:00For me, it was mostly outrage.
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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,
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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,
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2:28 - 2:30ever since the 1930s.
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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.
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2:34 - 2:36You'll see a few changes though.
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2:36 - 2:39You'll see lung cancer,
for example, on the rise. -
2:39 - 2:40Thank you, cigarettes.
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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.
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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,
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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
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3:18 - 3:20is the fact that
the refrigerator was invented. -
3:20 - 3:21(Laughter)
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3:21 - 3:23And so -- yeah, I know.
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3:23 - 3:24We're not doing so well here.
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3:24 - 3:26I don't want to miniaturize the progress
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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,
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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,
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3:48 - 3:50is really we're fighting blindly here.
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3:50 - 3:52And this is where
medical imaging comes in. -
3:52 - 3:54This is where my own work comes in.
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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.
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4:04 - 4:05Let's see. There we go.
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4:06 - 4:07So this is a PET/CT scan,
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4:07 - 4:10and what you'll see in this PET/CT scan
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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
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4:18 - 4:21is essentially a sugar molecule
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4:21 - 4:22that was added a small little tag
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4:22 - 4:25that is signaling to us
outside of the body, -
4:25 - 4:26"Hey, I'm here."
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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
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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.
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4:46 - 4:48And then you'll see a few other hot spots,
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4:48 - 4:50and these are in fact the tumors.
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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,
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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.
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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,
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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,
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5:36 - 5:40there needs to be
at least 100 million cancer cells -
5:40 - 5:41in order for it to be detected.
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5:41 - 5:44Now, if that seemed to you
like a very large number, -
5:44 - 5:45it is a very large number.
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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.
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6:09 - 6:13And you guys are now at an operating room,
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6:13 - 6:15and there's a patient in front of you,
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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,
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6:23 - 6:25the skin and the skull
have already been removed, -
6:25 - 6:27so you're looking at the brain.
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6:27 - 6:28And all you know about this patient
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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.
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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."
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6:55 - 6:57Then you take out your knife
and start cutting the tumor -
6:57 - 6:59piece by piece by piece,
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6:59 - 7:00and as you're taking the tumor out,
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7:00 - 7:03then you're getting
to a stage where you think, -
7:03 - 7:05"All right, 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,
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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,
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7:22 - 7:25or should I take away some extra margins,
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7:25 - 7:27typically about an inch or so
around the tumor -
7:28 - 7:30just to be sure that I removed everything?
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7:31 - 7:35So this is not a simple decision to make,
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7:36 - 7:38and unfortunately this is the decision
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7:38 - 7:41that brain cancer surgeons
have to take every single day -
7:41 - 7:43as they're seeing their patients.
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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.
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7:54 - 7:56This is just incredible.
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7:56 - 7:57And so we looked back.
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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,
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8:17 - 8:19and we'll have them go all over the body,
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8:19 - 8:21and just like secret agents, if you will,
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8:21 - 8:24go and walk by
every single cell in our body -
8:24 - 8:25and knock on the door of that cell,
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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.
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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.
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8:51 - 8:53What you're looking at here
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8:53 - 8:57is an image of a mouse's brain,
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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 just asked this 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,
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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
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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,
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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"All right, 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,
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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.
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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 - 10:38they actually know what to take out,
and they no longer have to guess. -
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
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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:
- How we can start winning the war against cancer | Adam de la Zerda | TEDxStanford
- Description:
-
What if brain surgeons could actually see what they were doing so that they didn’t have to “fight blind” when they are removing a tumor? That’s what biologist and electrical engineer Adam de la Zerda wanted to know after his close friend died of the disease. Using remarkable new imaging techniques that illuminate injected gold particles throughout the body, de la Zerda’s lab can identify and thus light the way for a surgeon to remove the tiniest deadly cells. In his talk, he shows us how this new technology has the promise to alter the prognosis for a cancer that is today almost always a death sentence and talks about the key ingredient that will make us succeed in the "war against cancer".
Featured in the Forbes 30 Under 30 lists twice in science and healthcare, Adam de la Zerda is an assistant professor of structural biology and (by courtesy) of electrical engineering at Stanford. In his lab, he develops new medical imaging technologies to detect cancer at an early stage and guide physicians towards optimal treatment of the cancer. He received over 15 awards for his research, authored over 20 papers in leading journals and founded two companies, OcuBell Inc. and Click Diagnostics.
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 |