We can start winning the war against cancer | Adam de la Zerda

翻译人员: Conway Ye 校对人员: QI YU

"We're declaring war against cancer,

“我们已经和癌症宣战了，

and we will win this war by 2015."

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

这是美国国会和国家癌症协会

just a few years ago, in 2003.

在几年前，即2003年宣布的。

Now, I don't know about you, but I don't buy that.

现在，我不知道你们对这事儿怎么看， 但是我并不相信。

I don't think we quite won this war yet,

我不认为我们已经赢得这场战争了，

and I don't think anyone here will question that.

而且我不认为在场的人会质疑我。

Now, I will argue that a primary reason

现在我会告诉你们一个最基本的原因，

why we're not winning this war against cancer

为什么我们不会赢得和癌症的战争:

is because we're fighting blindly.

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.

我要给你们分享一个我的好朋友的故事。

His name is Ehud,

他的名字是埃胡德，

and a few years ago, Ehud was diagnosed with brain cancer.

几年前，他被诊断出有脑癌。

And not just any type of brain cancer:

而且还不是普通的脑癌，

he was diagnosed with one of the most deadly forms of brain cancer.

他被诊断出患有最致命的一种脑癌。

In fact, it was so deadly

事实上，这个癌症致命到

that the doctors told him that they only have 12 months,

医生告诉他，他只有12个月，

and during those 12 months, they have to find a treatment.

在这个12个月里， 他们必须要找到一种治疗方法。

They have to find a cure,

他们必须要找到一种有效的治疗方法，

and if they cannot find a cure, he will die.

而且如果找不到，他将会死亡。

Now, the good news, they said,

现在，好消息是，他们说，

is that there are tons of different treatments to choose from,

有无数种治疗方法可以选择，

but the bad news is

而坏消息是，

that in order for them to tell if a treatment is even working or not,

如果要检测一种治疗方法是否有效，

well, that takes them about three months or so.

好吧，需要大约三个月的时间。

So they cannot try that many things.

所以他们尝试不了几种方法。

Well, Ehud is now going into his first treatment,

现在， 埃胡德正在进行他的第一次治疗，

and during that first treatment, just a few days into that treatment,

在第一次治疗开始几天的时候，

I'm meeting with him, and he tells me, "Adam, I think this is working.

我见到他，他告诉我说 “亚当，我觉得疗程有效果。

I think we really lucked out here. Something is happening."

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.

他说， “因为，我感觉身体十分难受。

Something's gotta be working up there.

一定有什么东西在里面起作用，

It just has to."

一定是的。”

Well, unfortunately, three months later, we got the news, it didn't work.

然而，不幸的是，三个月后， 我们得到消息，治疗没有效果。

And so Ehud goes into his second treatment.

所以埃胡德尝试第二种治疗方法。

And again, the same story.

跟第一次一样，

"It feels so bad, something's gotta be working there."

他说“我感觉很糟， 一定有什么东西在里面起作用。”

And then three months later, again we get bad news.

三个月后，我们又接到了坏消息。

Ehud is going into his third treatment, and then his fourth treatment.

然后埃胡德接受了第三次治疗，第四次治疗，

And then, as predicted, Ehud dies.

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,

当你身边亲近的人经受这种巨大的折磨时，

you get really swamped with emotions.

你会感觉尤其强烈。

A lot of things are going through your head.

你的脑海中会充斥着各种想法。

For me, it was mostly outrage.

对于我来说， 我感觉很愤怒。

I was just outraged that, how come this is the best that we can offer?

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？

And I started looking more and more into this.

然后我开始深入地研究这件事，

As it turns out, this is not just the best that doctors could offer Ehud.

我发现，这并不是是医生能够 提供给埃胡德最好的办法，

It's not just the best doctors could offer patients with brain cancer generally.

而且这也不是医生能够提供给一般 脑癌病人最好的办法。

We're actually not doing that well all across the board with cancer.

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,

我挑选了一些统计数据，

and I'm sure some of you have seen those statistics before.

我相信你们可能有人曾经 看过这些数据。

This is going to show you here how many patients actually died of cancer,

这组数据统计了死于癌症的病人数量，

in this case females in the United States,

确切的说是有多少美国女性，

ever since the 1930s.

自从20世纪30年代以来死于癌症。

You'll notice that there aren't that many things that have changed.

你会发现从那儿以来事情并没有什么大的改变。

It's still a huge issue.

这依旧是一个巨大的问题。

You'll see a few changes, though.

当然，你能看到一些改变，

You'll see lung cancer, for example, on the rise.

你会发现，比如，肺癌的比例在升高。

Thank you, cigarettes.

拜香烟所赐。

And you'll also see that, for example, stomach cancer

你还能看到，比如说，胃癌，

once used to be one of the biggest killers of all cancers,

曾经癌症中最大的杀手之一，

is essentially eliminated.

已经几乎绝迹了。

Now, why is that? Anyone knows, by the way?

好，为什么会这样呢？ 有人知道吗？

Why is it that humanity is no longer struck by stomach cancer?

为什么人类不再受胃癌折磨？

What was the huge, huge medical technology breakthrough

是哪个巨大的医疗技术突破

that came to our world that saved humanity from stomach cancer?

于胃癌中拯救了人类？

Was it maybe a new drug, or a better diagnostic?

是一种新药或者 一种更好的诊断吗？

You guys are right, yeah.

你们答对啦！（笑）

It's the invention of the refrigerator,

是因为我们发明的了冰箱，

and the fact that we're no longer eating spoiled meats.

于是我们不再吃变质的食物。

So the best thing that happened to us so far

所以至今，

in the medical arena in cancer research

我们在癌症研究的医疗领域取得的最大的成就，

is the fact that the refrigerator was invented.

是冰箱的发明。

(Laughter)

（笑声）

And so -- yeah, I know.

所以，是的。

We're not doing so well here.

我们并没有做的很好。

I don't want to miniaturize the progress

我不想贬低

我们在癌症研究方面取得的进步。

and everything that's been done in cancer research.

Look, there is like 50-plus years of good cancer research

你看， 我们做了五十多年的癌症研究，

that discovered major, major things that taught us about cancer.

发现了有关癌症的很多重要的知识。

But all that said,

这些年研究的结果就是，

we have a lot of heavy lifting to still do ahead of us.

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,

我认为，之所以我们进展缓慢，

why we have not done that remarkably well,

之所以我们并没有取得突破性的成绩

is really we're fighting blindly here.

是因为我们一直在盲目地斗争。

And this is where medical imaging comes in.

所以我们发明了医疗影像，

This is where my own work comes in.

这就是我的工作成果。

And so to give you a sense of the best medical imaging

下面我给大家演示一下

that's offered today to brain cancer patients,

当前我们能给脑癌患者提供的最好的医疗影像，

or actually generally to all cancer patients,

或者应该说是给所以癌症患者提供的最好的医疗影像

take a look at this PET scan right here.

看一看这个PET扫描，

Let's see. There we go.

So this is a PET/CT scan,

好，这是一个PET/CT扫描，

and what you'll see in this PET/CT scan

你能从这个PET／CT扫描中看到什么呢？

is the CT scan will show you where the bones are,

CT扫描能够告诉你骨头的位置，

and the PET scan will show you where tumors are.

PET扫描则能告诉你肿瘤的位置。

Now, what you can see here

现在，你可以看到，

is essentially a sugar molecule

一个糖分子

that was added a small little tag

被添加了一个小小的标签，

that is signaling to us outside of the body,

在给我们发信号，

"Hey, I'm here."

“嗨，我在这。”

And those sugar molecules are injected into these patients by the billions,

上十亿那样的糖分子被 注射进病人体内，

and they're going all over the body

并散布至全身，

looking for cells that are hungry for sugar.

寻找需要糖分的细胞。

You'll see that the heart, for example, lights up there.

你会看到，比如说， 心脏部位是亮的，

That's because the heart needs a lot of sugar.

那是因为心脏需要很多糖。

You'll also see that the bladder lights up there.

你还会看到膀胱也是亮的。

That's because the bladder is the thing that's clearing

那是因为膀胱负责清除

the sugar away from our body.

体内的糖分。

And then you'll see a few other hot spots,

然后你会发现其他亮点，

and these are in fact the tumors.

这些事实上都是肿瘤。

Now, this is a really a wonderful technology.

这真的是一个很棒的科技。

For the first time it allowed us to look into someone's body

这是第一次，我们能够观察身体内部，

without picking up each and every one of the cells

不需要取出细胞，

and putting them under the microscope,

并把它们放在显微镜下来观察，

but in a noninvasive way allowing us to look into someone's body

而是无侵入性地观察人体内部，

and ask, "Hey, has the cancer metastasized?

并问，“嘿，癌症有扩散吗？

Where is it?"

它在哪里？”

And the PET scans here are showing you very clearly

PET扫描很清晰的告诉我们

where are these hot spots, where is the tumor.

亮点在哪里， 肿瘤在哪里。

So as miraculous as this might seem,

这看起来很奇妙，

unfortunately, well, it's not that great.

然而，这并没有那么棒。

You see, those small little hot spots there.

那些小小的亮点，

Can anyone guess how many cancer cells are in any one of these tumors?

有人能猜猜在其中一个肿瘤里 有多少癌细胞吗？

So it's about 100 million cancer cells,

大概有1亿个癌细胞，

and let me make sure that this number sunk in.

让我解释一下这个数字。

In each and every one of these small little blips

每一个小小的亮点，

that you're seeing on the image,

你能在图片中看到的，

there needs to be at least 100 million cancer cells

都需要至少1亿个癌细胞

in order for it to be detected.

才能被检测到。

Now, if that seemed to you like a very large number,

如果那对你来说是个很大的数字，

it is a very large number.

没错，那就是一个很大的数字。

This is in fact an incredibly large number,

事实上， 这就是一个非常巨大的数字，

because what we really need in order to pick up something early enough

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，

to do something about it, to do something meaningful about it,

我们需要能发现有一千个癌细胞大小的肿瘤，

well, we need to pick up tumors that are a thousand cells in size,

理想来说， 我们需要能发现只有很少癌细胞的肿瘤，

and ideally just a handful of cells in size.

所以我们很明显离这个目标还很远。

So we're clearly pretty far away from this.

所以我们要做一个小实验。

So we're going to play a little experiment here.

I'm going to ask each of you to now play and imagine

我要你们每一个人扮演和想象

that you are brain surgeons.

你是一个脑部手术医师。

And you guys are now at an operating room,

你们现在在一间手术室里，

and there's a patient in front of you,

面前有一个病人，

and your task is to make sure that the tumor is out.

你的任务就是保证清除肿瘤。

So you're looking down at the patient,

所以你低头看着病人，

the skin and the skull have already been removed,

皮肤和头骨都已经被拆除了，

so you're looking at the brain.

所以你正在看着大脑。

And all you know about this patient

你知道的所有关于这个病人的，

is that there's a tumor about the size of a golf ball or so

就是有一个大概高尔夫球大小的肿瘤

in the right frontal lobe of this person's brain.

在这个病人的右额叶。

And that's more or less it.

情景大概就是这样。

So you're looking down, and unfortunately everything looks the same,

所以你往下看，不幸的是， 所有东西都看起来是一样的，

because brain cancer tissue and healthy brain tissue

因为脑癌组织和健康的脑组织

really just look the same.

看起来是一样的。

And so you're going in with your thumb,

所以你要用你的拇指，

and you start to press a little bit on the brain,

开始轻轻地在大脑上按压，

because tumors tend to be a little harder, stiffer,

因为肿瘤相对更硬，

and so you go in and go a little bit like this and say,

所以你一遍一遍做这样的事情，

"It seems like the tumor is right there."

“看起来肿瘤在这。”

Then you take out your knife and start cutting the tumor

然后你拿出刀，开始切割肿瘤，

piece by piece by piece.

一块一块地，

And as you're taking the tumor out,

当你正在摘除肿瘤的时候，

then you're getting to a stage where you think,

然后你会想，

"Alright, I'm done. I took out everything."

“好，我把所有的肿瘤都拿出来了。”

And at this stage, if that's --

到了这个时候，

so far everything sounded, like, pretty crazy --

一切看起来都有点疯狂，

you're now about to face the most challenging decision of your life here.

你现在要面临人生中最具挑战的决定，

Because now you need to decide,

因为你要决定：

should I stop here and let this patient go,

我应该停下，让病人出院吗？

risking that there might be some leftover cancer cells behind

有可能还有一些癌细胞我并没有清除掉

that I just couldn't see,

因为我看不出来。

or should I take away some extra margins,

或者我应该多摘除一些边缘组织，

typically about an inch or so around the tumor

比如把肿瘤边缘一英寸的区域都清除掉，

just to be sure that I removed everything?

以保证移除了所有肿瘤？

So this is not a simple decision to make,

所以这不是一个简单的决定，

and unfortunately this is the decision

而且不幸的是，这是一个

that brain cancer surgeons have to take every single day

脑癌手术医师每一场手术都要做的决定，

as they're seeing their patients.

And so I remember talking to a few friends of mine in the lab,

所以我记得我跟 我的几个朋友在实验室聊天，

and we say, "Boy, there's got to be a better way."

我们说 “伙计们，我们必须要有更好的方式。”

But not just like you tell a friend that there's got to be a better way.

这不是说说而已

There's just got to be a better way here.

而是，真的，我们必须要有一个更好的方式。

This is just incredible.

这太不可思议了。

And so we looked back.

所以我们回头看，

Remember those PET scans I told you about, the sugar and so on.

想起了我告诉你们的那个PET扫描， 糖分子啊等等。

We said, hey, how about instead of using sugar molecules,

我们说，嘿，如果不用糖分子，

let's maybe take tiny, tiny little particles made of gold,

我们可以用很小很小的由金构成的粒子，

and let's program them with some interesting chemistry around them.

然后在它们旁边附上一些 有趣的化学物质，

Let's program them to look for cancer cells.

让它们去寻找癌细胞。

And then we will inject these gold particles

然后我们会注射这些金粒子，

into these patients by the billions again,

同样以上十亿的数量注入病人体内，

and we'll have them go all over the body,

让它们散布全身，

and just like secret agents, if you will,

你可以把他们想象成秘密特工，

go and walk by every single cell in our body

潜伏在我们体内的每一个细胞，

and knock on the door of that cell,

并敲开细胞的门，

and ask, "Are you a cancer cell or are you a healthy cell?

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，

If you're a healthy cell, we're moving on.

如果你是一个癌细胞， 我们就潜入进去，并发出亮光，

If you're a cancer cell, we're sticking in and shining out

and telling us, "Hey, look at me, I'm here."

给出信号说， “嘿，看看我，我在这。”

And they'll do it through some interesting cameras

他们可以通过一些特殊的摄像头来完成这些任务

that we developed in the lab.

（我们在实验室里研发出来的）

And once we see that, maybe we can guide brain cancer surgeons

一旦我们可以看到癌细胞， 我们就可以指导脑癌手术医师，

towards taking only the tumor and leaving the healthy brain alone.

只摘除肿瘤，留下健康的脑细胞。

And so we've tested that, and boy, this works well.

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.

我现在要给你们展示一个实验，

What you're looking at here

你现在看到的，

is an image of a mouse's brain,

是一张老鼠大脑的照片，

and we've implanted into this mouse's brain

我们已经在这只老鼠的大脑里，

a small little tumor.

种植了一个小肿瘤。

And so this tumor is now growing in this mouse's brain,

所以这个肿瘤现在正在老鼠大脑里扩散，

and then we've taken a doctor and asked the doctor

我们已经请求过一个医生，

to please operate on the mouse as if that was a patient,

让他来这只“病人”老鼠动手术，

and take out piece by piece out of the tumor.

一片一片地取出肿瘤。

And while he's doing that,

当他在做这个的时候，

we're going to take images to see where the gold particles are.

我们准备给金粒子的位置拍照，

And so we're going to first start

所以首先我们要

by injecting these gold particles into this mouse,

给这只老鼠注射金粒子，

and we're going to see right here at the very left there

所以我们可以看到，在最左边，

that image at the bottom

底部的那张图片，

is the image that shows where the gold particles are.

展示金粒子的位置，

The nice thing is that these gold particles

金粒子的好处就是

actually made it all the way to the tumor,

它们能够成功找到肿瘤，

and then they shine out and tell us, "Hey, we're here. Here's the tumor."

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,

所以我们可以看到肿瘤，

but we're not showing this to the doctor yet.

但是我们还没有把这个展示给医生。

We're asking the doctor, now please start cutting away the tumor,

我们要求医生开始切除肿瘤，

and you'll see here the doctor just took the first quadrant of the tumor

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。

and you see that first quadrant is now missing.

医生然后移除了第二个和 第三个四分之一，

The doctor then took the second quadrant, the third,

and now it appears to be everything.

现在看起来肿瘤已经被清除干净了，

And so at this stage, the doctor came back to us and said,

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？

"Alright, I'm done. What do you want me to do?

Should I keep things as they are

留下剩下的不动，

or do you want me to take some extra margins around?"

还是要我摘除多余的边缘？“

And then we said, "Well, hang on."

然后我们说：”等等。“

We told the doctor, "You've missed those two spots,

我们告诉医生 “你已经遗漏了这两处，

so rather than taking huge margins around,

与其要切除大量的边缘，

only take out those tiny little areas.

还不如把这些小型的部分切除。

Take them out, and then let's take a look."

把它们摘除，然后我们再看看。“

And so the doctor took them away, and lo and behold,

然后医生把它们摘除了，

the cancer is now completely gone.

癌细胞现在是完全的没了。

Now, the important thing

现在，重要的不仅仅是

is that it's not just that the cancer is completely gone

癌症细胞已经从这个人或者 是老鼠的大脑里摘除了，

from this person's brain,

or from this mouse's brain.

The most important thing

最重要的是，

is that we did not have to take huge amounts of healthy brain

我不需要在手术过程中摘除大量的健康脑细胞，

in the process.

And so now we can actually imagine a world

所以现在我们可以想象一个世界，

where doctors and surgeons, as they take away a tumor,

医生和手术医师在摘除肿瘤的时候，

they actually know what to take out,

他们知道什么是应该摘除了，

他们不再需要用拇指来猜测。

and they no longer have to guess with their thumb.

Now, here's why it's extremely important to take those tiny little leftover tumors.

现在，这是为什么取出那些 剩余少量的肿瘤那么重要，

Those leftover tumors, even if it's just a handful of cells,

那些剩下的肿瘤， 即使只有一点点细胞，

它们会复发，

they will grow to recur the tumor,

重新长成肿瘤。

for the tumor to come back.

In fact, the reason why 80 to 90 percent

事实上， 这就是为什么80%到90%的

of those brain cancer surgeries ultimately fail

脑癌手术医师最终都会失败，

is because of those small little extra margins that were left positive,

是因为那些我们乐观地 留下少量的边缘物质，

those small little leftover tumors that were left there.

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,

所以，这当然非常好。

but what I really want to share with you is where I think we're heading from here.

然而我最想分享给你们的是 由此开始，我们还可以做什么

And so in my lab at Stanford,

在我的斯坦福实验室，

my students and I are asking, what should we be working on now?

我和我的学生都在想：接下来我们可以做什么？

And I think where medical imaging is heading to

我认为医疗影像的未来

is the ability to look into the human body

是能够探查人体的内部，

and actually see each and every one of these cells separately.

并能够分别查看每一个细胞。

The ability like this would allow us

像这样的能力，能够让我们

to actually pick up tumors way, way earlier in the process,

在早期移除肿瘤，

way before it's 100 million cells inside, so we can actually do something about it.

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

一种能够查看单个细胞的能力， 能够让我们

to ask insightful questions.

提出更深刻的问题。

So in the lab, we are now getting to a point

所以在实验室里， 我们正在尝试，

where we can actually start asking these cancer cells real questions,

给癌细胞提出更具体的问题，

like, for example, are you responding to the treatment we are giving you or not?

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

So if you're not responding, we'll know to stop the treatment right away,

days into the treatment, not three months.

而不是要等到三个月以后

And so also for patients like Ehud

像埃胡德这样的病人，

that are going through these nasty, nasty chemotherapy drugs,

正在经受这些残酷治疗的病人

for them not to suffer

当药物并不能帮助他们的时候

through those horrendous side effects of the drugs

when the drugs are in fact not even helping them.

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,

但是坦白来说，

我们距离赢得与癌症的斗争还很远，

just to be realistic.

这就是现实。

But at least I am hopeful

但是，至少我是乐观的，

that we should be able to fight this war with better medical imaging techniques

我们能够用更好的医疗影像来做斗争，

in the way that is not blind.

那样，我们就不会是在盲目斗争了。

Thank you.

谢谢。

(Applause)

（鼓掌）