"We're declaring war against cancer, and we will win this war by 2015."
「我們已經和癌症宣布戰爭了, 而且我們能在 2015 年前 贏得這場戰爭。」
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.
這是美國國會 和國家癌症協會聲稱的, 就在幾年前,2003 年。 現在,我不知道妳, 但是我並不相信。 我不認我們已經贏得這場戰鬥了, 而且我不認為在場的人會質疑我。 現在我會告訴你們一個 最基本的原因, 為什麽我們不會贏得和癌症的戰爭, 是因為我們盲目地鬥爭。
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.
我要跟你們分享一個 我的好朋友的故事。 他的名字是埃胡德, 幾年前,他被診斷出有腦癌。 而且還不是普通的腦癌, 他被診斷出患有最致命的腦癌。 事實上,這個癌癥致命到 醫生告訴他,他只有 12 個月, 而且在這個 12 個月裡, 他們還要找到一個治療的方法。 他們一定要找到一個治療方法, 而且如果找不到,他將會死亡。
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.
現在,好消息是,他們說, 有無數種治療方法可以選擇, 但是壞消息是, 如果要檢測治療是否有效果, 需要大約三個月的時間。 所以他們嘗試不了那麽多療程。
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."
埃胡德正在準備進行 他的第一次治療, 在第一次治療開始幾天的時候, 我見到他,他告訴我: 「亞當,我覺得療程有效果。 我覺得我們還是挺走運的。 事情正在改變。」
And I ask him, "Really? How do you know that, Ehud?"
我問他:「真的嗎, 你怎麽知道,埃胡德?」
And he says, "Well, I feel so terrible inside. Something's gotta be working up there. It just has to."
他說:「嗯,我感覺身體很難受。 一定有什麽東西在裡面運作, 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.
好吧,不幸的是,三個月後, 我們得到消息,療程沒有起效果。 所以埃胡德進入第二次治療。 事情的發展又和上次一樣。 「我感覺很糟, 一定有什麽東西在裡面運作。」 三個月後,我們又接到了壞消息。 埃胡德接受了第三次 和第四次的治療。 正如預測的一樣,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.
當身邊親近的人飽受巨大的折磨, 你的內心五味雜陳。 你的腦海中充斥著雜亂的事情。 對於我來說,我的腦海充滿了憤怒。 我就是憤怒,我們只能提供這樣嗎? 然後我開始研究這件事, 結果是,這不僅僅是醫生能夠 提供給埃胡德最好的, 而且這是醫生能夠提供給 所有腦癌病人最好的。 我們其實並沒有在 解決癌症上做的很好。
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.
我挑選了一些調查數據, 我保證你們中的一些人 曾經看過這些數據。 這將要告訴你多少人死於癌症, 多少美國女性, 自 1930 年代後。 你會發現並沒有什麽改變。 這依舊是一個巨大的問題。 不過你還是能看到一些改變, 比如你會發現肺癌在升高。 感謝香煙。 而且你還能看到,比如說,胃癌, 曾經癌症中最大的殺手之一, 已經大大地減少。 好,為什麽會這樣?有人知道嗎? 為什麽人類不再受胃癌折磨? 是哪個巨大的醫療技術突破 誕生在世界上,從胃癌中拯救人類? 可能是一種新藥或者 是一種更好的診斷方式? 你們是對的。 是冰箱的發明, 還有我們不再吃腐爛食物的事實。 所以至今發生最好的事情, 在癌症研究的醫療領域, 是冰箱的發明。
(Laughter)
(笑聲)
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.
我知道。 我們並沒有做的很好。 我不想貶低 我們在癌症研究方面的付出。 聽著,五十多年來癌症研究很有用, 發現了有關癌症的重要東西。 但是,儘管這樣, 我們還有很多重要的事情需要解決。
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.
我會闡述為什麼事情會發展成這樣, 為什麼我們沒有做的非常好, 是因為我們在盲目地鬥爭。 這和醫療影像有關, 這是我研究的地方。
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.
為了告訴你們今天最好的 腦癌患者的醫療影像, 或者給所有癌症患者的, 看一看這個 PET 掃描 (正子掃描),
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,這是一個 PET/CT 掃描 (正子電腦掃描儀), 你能從這個 PET/CT 掃描中看出, CT 斷層掃描能夠告訴你骨頭的位置, PET 掃描能夠告訴你腫瘤的位置。 現在,你可以看到, 一個糖分子 被添加了一個小小的標簽, 並給在體外的我們打信號, 「嘿,我在這。」 而且上億那樣的糖分子 被注射進病人體內, 並散布至全身, 尋找需要糖分的細胞。 你會發現,比如說, 心臟部位是亮的, 那是因為心臟需要很多糖分。 你還會發現膀胱也是亮的。 那是因為膀胱負責清除 體內的糖分。 而且你會發現其他亮點, 這些事實上都是腫瘤。
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.
現在,這是一個很棒的科技。 第一次能夠讓我們觀察人體內部, 不需要挑出其中的細胞, 並把它們放在顯微鏡下, 而且無侵入性地 讓我們觀察人體內部, 並問:「嘿,癌癥有擴散嗎? 它在哪裡?」 而且 PET 掃描很清晰的展示 這些亮點在哪裡,那些腫瘤在哪裡。
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.
這看起來很奇妙, 不幸的是,這並沒有那麽棒。 那些小小的亮點, 有人能猜猜在其中一個腫瘤裡 有多少癌細胞嗎? 大概有 1 億個癌細胞, 我要解釋這個數據確定你們聽懂了。 每一個小小的亮點, 你能在圖片中看到的, 都需要至少 1 億個癌細胞 才能被檢測到。 如果那對你來說是個很大的數字, 沒錯,那的確是一個很大的數字。 事實上,這是一個非常龐大的數字, 因為為了能夠盡早發現一些東西, 並能夠採取有意義的行動, 我們需要找到 一千個癌細胞大小的腫瘤, 但是理想來說, 只需要很少癌細胞的腫瘤, 所以我們很明顯離這個還很遠。
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?
所以我們要做一個小實驗。 我要你們每一個人扮演和想像 你們是腦外科醫師。 你們現在在一間手術室裡, 面前有一個病人, 你的任務就是確定清除腫瘤。 所以你低頭看著病人, 皮膚和頭骨都已經被移除了, 所以你正在看著大腦。 關於這個病人,你只知道 有一個大概高爾夫球大小的腫瘤 在這個病人的右額葉。 情景大概就是這樣。 所以你往下看,不幸的是, 所有東西都看起來是一樣的, 因為腦癌組織和健康的腦組織 看起來是一樣的。 所以你要用你的拇指, 開始輕輕地在大腦上按壓, 因為腫瘤相對更硬, 所以妳一遍一遍做這樣的事情, 「看起來腫瘤在這。」 然後你拿出刀,開始切割腫瘤, 一塊一塊地, 你在摘除腫瘤的時候, 到一個階段你會想, 「好,我把所有的腫瘤都拿出來了。」 到了這個時候, 一切看起來都有點瘋狂, 你現在要面臨人生中 最具挑戰的決定, 因為現在你要決定 我應該停下,讓病人出院, 承擔有遺留癌細胞的風險, 因為你看不出來; 或者我應該多摘除一些邊緣物質, 經常是腫瘤邊緣一英寸, 為了保證移除了所有腫瘤?
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.
所以這不是一個簡單的決定, 而且不幸的是,這個決定 腦癌手術醫師每天都要做, 因為他們要見到病人。
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.
所以我記得我跟 我的幾個朋友在實驗室聊天, 「哇,還有更好的方式吧。」 不是你安慰別人的方式, 真的,應該要有更好的方式。 這太不可思議了。
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.
所以我們回頭看, 記得我告訴你們的那個 PET掃描, 糖分子啊等等? 我們說,嘿,如果不用糖分子, 我們可以用很小很小 由金構成的粒子, 然後在它們旁邊附上一些 有趣的化學物質, 讓它們去尋找癌細胞。 然後我們會注射這些金粒子, 以上十億的數量注入病人體內, 讓它們散布全身, 你可以把他們想像成特工, 潛伏在我們體內的每一個細胞, 並敲開細胞的門, 並問:「你是一個癌細胞, 還是健康的細胞?」 如果你是健康的細胞,那就繼續, 如果你是癌細胞, 我們就原地不動,並發出亮光, 並跟我們說, 「嘿,看看我,我在這。」 通過一些特殊的攝像頭, 是我們在實驗室裡研究出來的, 一旦我們看到癌細胞, 可能就可以帶領腦癌手術醫師, 只摘除腫瘤,留下健康的腦細胞。 所以我們檢測了這個主意, 它的運作很成功。
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."
我現在要給你們展示一個實驗, 你現在看到的, 是一張老鼠大腦的照片, 我們已經在這隻老鼠的大腦裡, 種植了一個小腫瘤。 所以這個腫瘤現在 正在老鼠大腦裡成長, 我們已經請求過一個醫生, 讓他把這隻老鼠當病人動手術, 一片一片地取出腫瘤。 當他在做這個的時候, 我們準備給金粒子的位置拍照, 所以首先我們要 給這隻老鼠注射金粒子, 所以我們可以看到,在最左邊, 底部的那張圖片, 展示金粒子的位置, 金粒子的好處就是 它們能夠成功找到腫瘤, 發光,並告訴我們 「嘿,我們在這,腫瘤在這。」
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?"
所以我們可以看到腫瘤, 但是我們還沒有把這個展示給醫生。 我們要求醫生開始切除腫瘤, 你能看到四分之一的腫瘤 已經被醫生摘除了, 你已經看不到那四分之一的腫瘤了。 醫生然後移除了第二個 和第三個四分之一, 現在看起來腫瘤已經被摘除乾凈了, 到了這個階段,醫生告訴我們說: 「好了,我做完了。 現在你們還要我做什麽? 留下剩下的不動, 還是要我摘除多一點邊緣?」
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."
然後我們說:「等等。」 我們告訴醫生你遺漏了這兩處, 與其要切除大量的邊緣, 還不如把這些小型的部分切除。 把它們摘除,然後我們再看看。
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.
然後醫生把它們摘除了, 癌細胞現在是完全乾淨了。 現在,重要的不僅僅是 癌症細胞已經從這個人 或說是老鼠的大腦裡摘除了, 最重要的是, 我不需要摘除大量的健康腦細胞, 在手術過程中。 所以現在我們可以想像一個世界, 醫生和手術醫師在摘除腫瘤的時候, 他們知道什麼是應該摘除的, 他們不再需要用拇指來猜測。
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.
為什麼取出那些 剩餘少量的腫瘤那麼重要? 那些剩下的腫瘤, 即使只有一點點細胞, 它們會復發, 重新長成腫瘤。 事實上,這就是為什麼 80% 到 90% 的 腦癌手術最終都會失敗, 是因為那些我們留下的 少量邊緣物質, 那些我們留下的少量剩餘腫瘤。
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.
這看起來很好, 我真的想分享給你們的是 我們該怎麼從這裡開始, 所以我在史丹福的實驗室, 我的學生和我在問,現在該研究什麼? 我認為醫療影像的未來 是查看人體的內部, 並能夠分別查看每一個細胞。 像這樣的能力,能夠讓我們 在早期看到腫瘤, 遠遠在 1 億個細胞之前, 所以我們可以採取行動。
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.
能夠查看單個細胞的能力, 能夠讓我們 提出深刻的問題。 所以在實驗室裡, 我們達到了一個臨界點, 我們可以開始真的問 有關癌細胞的問題, 比如說,我們給你的治療有效果嗎? 如果沒有效果, 我們就會知道要立即停止治療, 在治療開始幾天就做,不是三個月。 像埃胡德這樣的病人, 正在經受這些殘酷治療的病人, 讓他們免受可怕的藥物副作用, 如果藥物對他們沒有幫助。
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.
但是坦白來說, 我們距離贏得與癌症的鬥爭還很遠, 這就是現實。 但是,至少我是樂觀的, 我們能夠用更好的醫療影像來鬥爭, 那樣,我們就不會盲目了。
Thank you.
謝謝。
(Applause)
(鼓掌)