"We're declaring war against cancer, and we will win this war by 2015."
“我们已经和癌症宣战了, 而且我们能在2015年前赢得这场战争。”
This is what the US Congress and the National Cancer Institute declared just a few years ago, in 2003. Now, I don't know about you, but I don't buy that. I don't think we quite won this war yet, and I don't think anyone here will question that. Now, I will argue that a primary reason why we're not winning this war against cancer is because we're fighting blindly.
这是美国国会和国家癌症协会 在几年前,即2003年宣布的。 现在,我不知道你们对这事儿怎么看, 但是我并不相信。 我不认为我们已经赢得这场战争了, 而且我不认为在场的人会质疑我。 现在我会告诉你们一个最基本的原因, 为什么我们不会赢得和癌症的战争: 是因为我们在盲目地斗争。
I'm going to start by sharing with you a story about a good friend of mine. His name is Ehud, and a few years ago, Ehud was diagnosed with brain cancer. And not just any type of brain cancer: he was diagnosed with one of the most deadly forms of brain cancer. In fact, it was so deadly that the doctors told him that they only have 12 months, and during those 12 months, they have to find a treatment. They have to find a cure, and if they cannot find a cure, he will die.
我要给你们分享一个我的好朋友的故事。 他的名字是埃胡德, 几年前,他被诊断出有脑癌。 而且还不是普通的脑癌, 他被诊断出患有最致命的一种脑癌。 事实上,这个癌症致命到 医生告诉他,他只有12个月, 在这个12个月里, 他们必须要找到一种治疗方法。 他们必须要找到一种有效的治疗方法, 而且如果找不到,他将会死亡。
Now, the good news, they said, is that there are tons of different treatments to choose from, but the bad news is that in order for them to tell if a treatment is even working or not, well, that takes them about three months or so. So they cannot try that many things.
现在,好消息是,他们说, 有无数种治疗方法可以选择, 而坏消息是, 如果要检测一种治疗方法是否有效, 好吧,需要大约三个月的时间。 所以他们尝试不了几种方法。
Well, Ehud is now going into his first treatment, and during that first treatment, just a few days into that treatment, I'm meeting with him, and he tells me, "Adam, I think this is working. I think we really lucked out here. Something is happening."
现在, 埃胡德正在进行他的第一次治疗, 在第一次治疗开始几天的时候, 我见到他,他告诉我说 “亚当,我觉得疗程有效果。 我觉得我们挺走运的。 事情正在改变。”
And I ask him, "Really? How do you know that, Ehud?"
我问他: “真的吗,你是怎么知道,埃胡德?”
And he says, "Well, I feel so terrible inside. Something's gotta be working up there. It just has to."
他说, “因为,我感觉身体十分难受。 一定有什么东西在里面起作用, 一定是的。”
Well, unfortunately, three months later, we got the news, it didn't work. And so Ehud goes into his second treatment. And again, the same story. "It feels so bad, something's gotta be working there." And then three months later, again we get bad news. Ehud is going into his third treatment, and then his fourth treatment. And then, as predicted, Ehud dies.
然而,不幸的是,三个月后, 我们得到消息,治疗没有效果。 所以埃胡德尝试第二种治疗方法。 跟第一次一样, 他说“我感觉很糟, 一定有什么东西在里面起作用。” 三个月后,我们又接到了坏消息。 然后埃胡德接受了第三次治疗,第四次治疗, 然后正如预测的一样,埃胡德去世了。
Now, when someone really close to you is going through such a huge struggle, you get really swamped with emotions. A lot of things are going through your head. For me, it was mostly outrage. I was just outraged that, how come this is the best that we can offer? And I started looking more and more into this. As it turns out, this is not just the best that doctors could offer Ehud. It's not just the best doctors could offer patients with brain cancer generally. We're actually not doing that well all across the board with cancer.
当你身边亲近的人经受这种巨大的折磨时, 你会感觉尤其强烈。 你的脑海中会充斥着各种想法。 对于我来说, 我感觉很愤怒。 我愤怒的是, 难道这就是我们能为病人提供的最好的办法吗? 然后我开始深入地研究这件事, 我发现,这并不是是医生能够 提供给埃胡德最好的办法, 而且这也不是医生能够提供给一般 脑癌病人最好的办法。 我们在治疗癌症这件事情上并没有做得很好。
I picked up one of those statistics, and I'm sure some of you have seen those statistics before. This is going to show you here how many patients actually died of cancer, in this case females in the United States, ever since the 1930s. You'll notice that there aren't that many things that have changed. It's still a huge issue. You'll see a few changes, though. You'll see lung cancer, for example, on the rise. Thank you, cigarettes. And you'll also see that, for example, stomach cancer once used to be one of the biggest killers of all cancers, is essentially eliminated. Now, why is that? Anyone knows, by the way? Why is it that humanity is no longer struck by stomach cancer? What was the huge, huge medical technology breakthrough that came to our world that saved humanity from stomach cancer? Was it maybe a new drug, or a better diagnostic? You guys are right, yeah. It's the invention of the refrigerator, and the fact that we're no longer eating spoiled meats. So the best thing that happened to us so far in the medical arena in cancer research is the fact that the refrigerator was invented.
我挑选了一些统计数据, 我相信你们可能有人曾经 看过这些数据。 这组数据统计了死于癌症的病人数量, 确切的说是有多少美国女性, 自从20世纪30年代以来死于癌症。 你会发现从那儿以来事情并没有什么大的改变。 这依旧是一个巨大的问题。 当然,你能看到一些改变, 你会发现,比如,肺癌的比例在升高。 拜香烟所赐。 你还能看到,比如说,胃癌, 曾经癌症中最大的杀手之一, 已经几乎绝迹了。 好,为什么会这样呢? 有人知道吗? 为什么人类不再受胃癌折磨? 是哪个巨大的医疗技术突破 于胃癌中拯救了人类? 是一种新药或者 一种更好的诊断吗? 你们答对啦!(笑) 是因为我们发明的了冰箱, 于是我们不再吃变质的食物。 所以至今, 我们在癌症研究的医疗领域取得的最大的成就, 是冰箱的发明。
(Laughter)
(笑声)
And so -- yeah, I know. We're not doing so well here. I don't want to miniaturize the progress and everything that's been done in cancer research. Look, there is like 50-plus years of good cancer research that discovered major, major things that taught us about cancer. But all that said, we have a lot of heavy lifting to still do ahead of us.
所以,是的。 我们并没有做的很好。 我不想贬低 我们在癌症研究方面取得的进步。 你看, 我们做了五十多年的癌症研究, 发现了有关癌症的很多重要的知识。 这些年研究的结果就是, 关于治疗癌症我们依然任重道远。
Again, I will argue that the primary reason why this is the case, why we have not done that remarkably well, is really we're fighting blindly here. And this is where medical imaging comes in. This is where my own work comes in.
我认为,之所以我们进展缓慢, 之所以我们并没有取得突破性的成绩 是因为我们一直在盲目地斗争。 所以我们发明了医疗影像, 这就是我的工作成果。
And so to give you a sense of the best medical imaging that's offered today to brain cancer patients, or actually generally to all cancer patients, take a look at this PET scan right here. Let's see. There we go.
下面我给大家演示一下 当前我们能给脑癌患者提供的最好的医疗影像, 或者应该说是给所以癌症患者提供的最好的医疗影像 看一看这个PET扫描,
So this is a PET/CT scan, and what you'll see in this PET/CT scan is the CT scan will show you where the bones are, and the PET scan will show you where tumors are. Now, what you can see here is essentially a sugar molecule that was added a small little tag that is signaling to us outside of the body, "Hey, I'm here." And those sugar molecules are injected into these patients by the billions, and they're going all over the body looking for cells that are hungry for sugar. You'll see that the heart, for example, lights up there. That's because the heart needs a lot of sugar. You'll also see that the bladder lights up there. That's because the bladder is the thing that's clearing the sugar away from our body. And then you'll see a few other hot spots, and these are in fact the tumors.
好,这是一个PET/CT扫描, 你能从这个PET/CT扫描中看到什么呢? CT扫描能够告诉你骨头的位置, PET扫描则能告诉你肿瘤的位置。 现在,你可以看到, 一个糖分子 被添加了一个小小的标签, 在给我们发信号, “嗨,我在这。” 上十亿那样的糖分子被 注射进病人体内, 并散布至全身, 寻找需要糖分的细胞。 你会看到,比如说, 心脏部位是亮的, 那是因为心脏需要很多糖。 你还会看到膀胱也是亮的。 那是因为膀胱负责清除 体内的糖分。 然后你会发现其他亮点, 这些事实上都是肿瘤。
Now, this is a really a wonderful technology. For the first time it allowed us to look into someone's body without picking up each and every one of the cells and putting them under the microscope, but in a noninvasive way allowing us to look into someone's body and ask, "Hey, has the cancer metastasized? Where is it?" And the PET scans here are showing you very clearly where are these hot spots, where is the tumor.
这真的是一个很棒的科技。 这是第一次,我们能够观察身体内部, 不需要取出细胞, 并把它们放在显微镜下来观察, 而是无侵入性地观察人体内部, 并问,“嘿,癌症有扩散吗? 它在哪里?” PET扫描很清晰的告诉我们 亮点在哪里, 肿瘤在哪里。
So as miraculous as this might seem, unfortunately, well, it's not that great. You see, those small little hot spots there. Can anyone guess how many cancer cells are in any one of these tumors? So it's about 100 million cancer cells, and let me make sure that this number sunk in. In each and every one of these small little blips that you're seeing on the image, there needs to be at least 100 million cancer cells in order for it to be detected. Now, if that seemed to you like a very large number, it is a very large number. This is in fact an incredibly large number, because what we really need in order to pick up something early enough to do something about it, to do something meaningful about it, well, we need to pick up tumors that are a thousand cells in size, and ideally just a handful of cells in size. So we're clearly pretty far away from this.
这看起来很奇妙, 然而,这并没有那么棒。 那些小小的亮点, 有人能猜猜在其中一个肿瘤里 有多少癌细胞吗? 大概有1亿个癌细胞, 让我解释一下这个数字。 每一个小小的亮点, 你能在图片中看到的, 都需要至少1亿个癌细胞 才能被检测到。 如果那对你来说是个很大的数字, 没错,那就是一个很大的数字。 事实上, 这就是一个非常巨大的数字, 我们需要的是能够尽早发现一些东西, 并能够采取有意义的行动, 我们需要能发现有一千个癌细胞大小的肿瘤, 理想来说, 我们需要能发现只有很少癌细胞的肿瘤, 所以我们很明显离这个目标还很远。
So we're going to play a little experiment here. I'm going to ask each of you to now play and imagine that you are brain surgeons. And you guys are now at an operating room, and there's a patient in front of you, and your task is to make sure that the tumor is out. So you're looking down at the patient, the skin and the skull have already been removed, so you're looking at the brain. And all you know about this patient is that there's a tumor about the size of a golf ball or so in the right frontal lobe of this person's brain. And that's more or less it. So you're looking down, and unfortunately everything looks the same, because brain cancer tissue and healthy brain tissue really just look the same. And so you're going in with your thumb, and you start to press a little bit on the brain, because tumors tend to be a little harder, stiffer, and so you go in and go a little bit like this and say, "It seems like the tumor is right there." Then you take out your knife and start cutting the tumor piece by piece by piece. And as you're taking the tumor out, then you're getting to a stage where you think, "Alright, I'm done. I took out everything." And at this stage, if that's -- so far everything sounded, like, pretty crazy -- you're now about to face the most challenging decision of your life here. Because now you need to decide, should I stop here and let this patient go, risking that there might be some leftover cancer cells behind that I just couldn't see, or should I take away some extra margins, typically about an inch or so around the tumor just to be sure that I removed everything?
所以我们要做一个小实验。 我要你们每一个人扮演和想象 你是一个脑部手术医师。 你们现在在一间手术室里, 面前有一个病人, 你的任务就是保证清除肿瘤。 所以你低头看着病人, 皮肤和头骨都已经被拆除了, 所以你正在看着大脑。 你知道的所有关于这个病人的, 就是有一个大概高尔夫球大小的肿瘤 在这个病人的右额叶。 情景大概就是这样。 所以你往下看,不幸的是, 所有东西都看起来是一样的, 因为脑癌组织和健康的脑组织 看起来是一样的。 所以你要用你的拇指, 开始轻轻地在大脑上按压, 因为肿瘤相对更硬, 所以你一遍一遍做这样的事情, “看起来肿瘤在这。” 然后你拿出刀,开始切割肿瘤, 一块一块地, 当你正在摘除肿瘤的时候, 然后你会想, “好,我把所有的肿瘤都拿出来了。” 到了这个时候, 一切看起来都有点疯狂, 你现在要面临人生中最具挑战的决定, 因为你要决定: 我应该停下,让病人出院吗? 有可能还有一些癌细胞我并没有清除掉 因为我看不出来。 或者我应该多摘除一些边缘组织, 比如把肿瘤边缘一英寸的区域都清除掉, 以保证移除了所有肿瘤?
So this is not a simple decision to make, and unfortunately this is the decision that brain cancer surgeons have to take every single day as they're seeing their patients.
所以这不是一个简单的决定, 而且不幸的是,这是一个 脑癌手术医师每一场手术都要做的决定,
And so I remember talking to a few friends of mine in the lab, and we say, "Boy, there's got to be a better way." But not just like you tell a friend that there's got to be a better way. There's just got to be a better way here. This is just incredible.
所以我记得我跟 我的几个朋友在实验室聊天, 我们说 “伙计们,我们必须要有更好的方式。” 这不是说说而已 而是,真的,我们必须要有一个更好的方式。 这太不可思议了。
And so we looked back. Remember those PET scans I told you about, the sugar and so on. We said, hey, how about instead of using sugar molecules, let's maybe take tiny, tiny little particles made of gold, and let's program them with some interesting chemistry around them. Let's program them to look for cancer cells. And then we will inject these gold particles into these patients by the billions again, and we'll have them go all over the body, and just like secret agents, if you will, go and walk by every single cell in our body and knock on the door of that cell, and ask, "Are you a cancer cell or are you a healthy cell? If you're a healthy cell, we're moving on. If you're a cancer cell, we're sticking in and shining out and telling us, "Hey, look at me, I'm here." And they'll do it through some interesting cameras that we developed in the lab. And once we see that, maybe we can guide brain cancer surgeons towards taking only the tumor and leaving the healthy brain alone. And so we've tested that, and boy, this works well.
所以我们回头看, 想起了我告诉你们的那个PET扫描, 糖分子啊等等。 我们说,嘿,如果不用糖分子, 我们可以用很小很小的由金构成的粒子, 然后在它们旁边附上一些 有趣的化学物质, 让它们去寻找癌细胞。 然后我们会注射这些金粒子, 同样以上十亿的数量注入病人体内, 让它们散布全身, 你可以把他们想象成秘密特工, 潜伏在我们体内的每一个细胞, 并敲开细胞的门, 并问: “你是一个癌细胞,还是健康的细胞?” 如果你是一个健康的细胞,那就继续去敲下一家门, 如果你是一个癌细胞, 我们就潜入进去,并发出亮光, 给出信号说, “嘿,看看我,我在这。” 他们可以通过一些特殊的摄像头来完成这些任务 (我们在实验室里研发出来的) 一旦我们可以看到癌细胞, 我们就可以指导脑癌手术医师, 只摘除肿瘤,留下健康的脑细胞。 所以我们尝试了这个办法, 它的运作很成功。
So I'm going to show you an example now. What you're looking at here is an image of a mouse's brain, and we've implanted into this mouse's brain a small little tumor. And so this tumor is now growing in this mouse's brain, and then we've taken a doctor and asked the doctor to please operate on the mouse as if that was a patient, and take out piece by piece out of the tumor. And while he's doing that, we're going to take images to see where the gold particles are. And so we're going to first start by injecting these gold particles into this mouse, and we're going to see right here at the very left there that image at the bottom is the image that shows where the gold particles are. The nice thing is that these gold particles actually made it all the way to the tumor, and then they shine out and tell us, "Hey, we're here. Here's the tumor."
我现在要给你们展示一个实验, 你现在看到的, 是一张老鼠大脑的照片, 我们已经在这只老鼠的大脑里, 种植了一个小肿瘤。 所以这个肿瘤现在正在老鼠大脑里扩散, 我们已经请求过一个医生, 让他来这只“病人”老鼠动手术, 一片一片地取出肿瘤。 当他在做这个的时候, 我们准备给金粒子的位置拍照, 所以首先我们要 给这只老鼠注射金粒子, 所以我们可以看到,在最左边, 底部的那张图片, 展示金粒子的位置, 金粒子的好处就是 它们能够成功找到肿瘤, 发光,并告诉我们 “嘿,我们在这儿,肿瘤在这儿。”
So now we can see the tumor, but we're not showing this to the doctor yet. We're asking the doctor, now please start cutting away the tumor, and you'll see here the doctor just took the first quadrant of the tumor and you see that first quadrant is now missing. The doctor then took the second quadrant, the third, and now it appears to be everything. And so at this stage, the doctor came back to us and said, "Alright, I'm done. What do you want me to do? Should I keep things as they are or do you want me to take some extra margins around?"
所以我们可以看到肿瘤, 但是我们还没有把这个展示给医生。 我们要求医生开始切除肿瘤, 你能看到四分之一的肿瘤 已经被医生摘除了, 你已经看不到四分之一的肿瘤了。 医生然后移除了第二个和 第三个四分之一, 现在看起来肿瘤已经被清除干净了, 到了这个阶段, 医生告诉我们说: “好了,我做完了。 现在你们要我干什么? 留下剩下的不动, 还是要我摘除多余的边缘?“
And then we said, "Well, hang on." We told the doctor, "You've missed those two spots, so rather than taking huge margins around, only take out those tiny little areas. Take them out, and then let's take a look."
然后我们说:”等等。“ 我们告诉医生 “你已经遗漏了这两处, 与其要切除大量的边缘, 还不如把这些小型的部分切除。 把它们摘除,然后我们再看看。“
And so the doctor took them away, and lo and behold, the cancer is now completely gone. Now, the important thing is that it's not just that the cancer is completely gone from this person's brain, or from this mouse's brain. The most important thing is that we did not have to take huge amounts of healthy brain in the process. And so now we can actually imagine a world where doctors and surgeons, as they take away a tumor, they actually know what to take out, and they no longer have to guess with their thumb.
然后医生把它们摘除了, 癌细胞现在是完全的没了。 现在,重要的不仅仅是 癌症细胞已经从这个人或者 是老鼠的大脑里摘除了, 最重要的是, 我不需要在手术过程中摘除大量的健康脑细胞, 所以现在我们可以想象一个世界, 医生和手术医师在摘除肿瘤的时候, 他们知道什么是应该摘除了, 他们不再需要用拇指来猜测。
Now, here's why it's extremely important to take those tiny little leftover tumors. Those leftover tumors, even if it's just a handful of cells, they will grow to recur the tumor, for the tumor to come back. In fact, the reason why 80 to 90 percent of those brain cancer surgeries ultimately fail is because of those small little extra margins that were left positive, those small little leftover tumors that were left there.
现在,这是为什么取出那些 剩余少量的肿瘤那么重要, 那些剩下的肿瘤, 即使只有一点点细胞, 它们会复发, 重新长成肿瘤。 事实上, 这就是为什么80%到90%的 脑癌手术医师最终都会失败, 是因为那些我们乐观地 留下少量的边缘物质, 那些我们遗漏的没有能够清除的少量剩余物质。
So this is clearly very nice, but what I really want to share with you is where I think we're heading from here. And so in my lab at Stanford, my students and I are asking, what should we be working on now? And I think where medical imaging is heading to is the ability to look into the human body and actually see each and every one of these cells separately. The ability like this would allow us to actually pick up tumors way, way earlier in the process, way before it's 100 million cells inside, so we can actually do something about it.
所以,这当然非常好。 然而我最想分享给你们的是 由此开始,我们还可以做什么 在我的斯坦福实验室, 我和我的学生都在想:接下来我们可以做什么? 我认为医疗影像的未来 是能够探查人体的内部, 并能够分别查看每一个细胞。 像这样的能力,能够让我们 在早期移除肿瘤, 远远在达到1亿个癌细胞之前, 我们就可以采取行动。
An ability to see each and every one of the cells might also allow us to ask insightful questions. So in the lab, we are now getting to a point where we can actually start asking these cancer cells real questions, like, for example, are you responding to the treatment we are giving you or not? So if you're not responding, we'll know to stop the treatment right away, days into the treatment, not three months. And so also for patients like Ehud that are going through these nasty, nasty chemotherapy drugs, for them not to suffer through those horrendous side effects of the drugs when the drugs are in fact not even helping them.
一种能够查看单个细胞的能力, 能够让我们 提出更深刻的问题。 所以在实验室里, 我们正在尝试, 给癌细胞提出更具体的问题, 比如说,我们给你的治疗有效果吗? 如果没有效果, 我们就会知道要立即停止治疗 而不是要等到三个月以后 像埃胡德这样的病人, 正在经受这些残酷治疗的病人 当药物并不能帮助他们的时候 让他们免受这些可怕的药物副作用,
So to be frank here, we're pretty far away from winning the war against cancer, just to be realistic. But at least I am hopeful that we should be able to fight this war with better medical imaging techniques in the way that is not blind.
但是坦白来说, 我们距离赢得与癌症的斗争还很远, 这就是现实。 但是,至少我是乐观的, 我们能够用更好的医疗影像来做斗争, 那样,我们就不会是在盲目斗争了。
Thank you.
谢谢。
(Applause)
(鼓掌)