How we can start winning the war against cancer | Adam de la Zerda | TEDxStanford
-
0:11 - 0:13"We're declaring war against cancer,
-
0:13 - 0:16and we will win this war by 2015."
-
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.
-
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,
-
0:29 - 0:32and I don't think
anyone here will question that. -
0:32 - 0:35Now, I will argue that a primary reason
-
0:35 - 0:37why we're not winning
this war against cancer -
0:37 - 0:39is because we're fighting blindly.
-
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,
-
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:
-
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
-
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,
-
1:01 - 1:03and if they cannot
find a cure, he will die. -
1:04 - 1:06Now, the good news, they said,
-
1:06 - 1:09is that there are tons
of different treatments to choose from, -
1:09 - 1:10but the bad news is
-
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.
-
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.
-
1:37 - 1:39It just has to."
-
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.
-
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.
-
2:07 - 2:09A lot of things
are going through your head. -
2:09 - 2:10For me, it was mostly outrage.
-
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,
-
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,
-
2:39 - 2:40ever since the 1930s.
-
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.
-
2:45 - 2:46You'll see a few changes though.
-
2:46 - 2:49You'll see lung cancer,
for example, on the rise. -
2:49 - 2:50Thank you, cigarettes.
-
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.
-
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.
-
3:19 - 3:21It's the invention of the refrigerator,
-
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
-
3:28 - 3:31is the fact that
the refrigerator was invented. -
3:31 - 3:32(Laughter)
-
3:32 - 3:33And so -- yeah, I know.
-
3:33 - 3:34We're not doing so well here.
-
3:34 - 3:37I don't want to miniaturize the progress
-
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,
-
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,
-
3:58 - 4:00is really we're fighting blindly here.
-
4:00 - 4:03And this is where
medical imaging comes in. -
4:03 - 4:04This is where my own work comes in.
-
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.
-
4:14 - 4:16Let's see. There we go.
-
4:16 - 4:18So this is a PET/CT scan,
-
4:18 - 4:20and what you'll see in this PET/CT scan
-
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
-
4:29 - 4:31is essentially a sugar molecule
-
4:31 - 4:33that was added a small little tag
-
4:33 - 4:35that is signaling to us
outside of the body, -
4:35 - 4:36"Hey, I'm here."
-
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
-
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.
-
4:57 - 4:59And then you'll see a few other hot spots,
-
4:59 - 5:00and these are in fact the tumors.
-
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,
-
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,
-
5:25 - 5:28unfortunately, well, it's not that great.
-
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,
-
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,
-
5:46 - 5:50there needs to be
at least 100 million cancer cells -
5:50 - 5:52in order for it to be detected.
-
5:52 - 5:54Now, if that seemed to you
like a very large number, -
5:54 - 5:56it is a very large number.
-
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
-
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
-
6:32 - 6:34that deal with brain cancer patients,
-
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.
-
6:53 - 6:57And you guys are now at an operating room,
-
6:57 - 6:59and there's a patient in front of you,
-
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,
-
7:07 - 7:09the skin and the skull
have already been removed, -
7:09 - 7:10so you're looking at the brain.
-
7:11 - 7:12And all you know about this patient
-
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.
-
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.
-
7:27 - 7:29And so you're going in with your thumb,
-
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."
-
7:39 - 7:41Then you take out your knife
and start cutting the tumor -
7:41 - 7:42piece by piece by piece,
-
7:43 - 7:44and as you're taking the tumor out,
-
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,
-
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,
-
8:06 - 8:08or should I take away some extra margins,
-
8:08 - 8:11typically about an inch or so
around the tumor -
8:11 - 8:14just to be sure that I removed everything?
-
8:15 - 8:19So this is not a simple decision to make,
-
8:20 - 8:22and unfortunately this is the decision
-
8:22 - 8:25that brain cancer surgeons
have to take every single day -
8:25 - 8:27as they're seeing their patients.
-
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.
-
8:38 - 8:39This is just incredible.
-
8:39 - 8:41And so we looked back.
-
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,
-
9:01 - 9:03and we'll have them go all over the body,
-
9:03 - 9:05and just like secret agents, if you will,
-
9:05 - 9:07go and walk by
every single cell in our body -
9:07 - 9:09and knock on the door of that cell,
-
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.
-
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.
-
9:35 - 9:36What you're looking at here
-
9:37 - 9:40is an image of a mouse's brain.
-
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,
-
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,
-
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.
-
10:54 - 10:56You've missed those two spots."
-
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
-
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,
-
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
-
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
horrendous 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:
-
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.
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 |