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

譯者: Conway Ye 審譯者: Timothy Lee

"We're declaring war against cancer,

「我們已經和癌症宣布戰爭了，

and we will win this war by 2015."

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

這是美國國會 和國家癌症協會聲稱的，

just a few years ago, in 2003.

就在幾年前，2003 年。

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

現在，我不知道妳， 但是我並不相信。

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

我不認我們已經贏得這場戰鬥了，

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

而且我不認為在場的人會質疑我。

Now, I will argue that a primary reason

現在我會告訴你們一個 最基本的原因，

why we're not winning this war against cancer

為什麽我們不會贏得和癌症的戰爭，

is because we're fighting blindly.

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.

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，

His name is Ehud,

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

幾年前，他被診斷出有腦癌。

And not just any type of brain cancer:

而且還不是普通的腦癌，

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

他被診斷出患有最致命的腦癌。

In fact, it was so deadly

事實上，這個癌癥致命到

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

醫生告訴他，他只有 12 個月，

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

而且在這個 12 個月裡， 他們還要找到一個治療的方法。

They have to find a cure,

他們一定要找到一個治療方法，

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

而且如果找不到，他將會死亡。

Now, the good news, they said,

現在，好消息是，他們說，

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

有無數種治療方法可以選擇，

but the bad news is

但是壞消息是，

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

如果要檢測治療是否有效果，

well, that takes them about three months or so.

需要大約三個月的時間。

So they cannot try that many things.

所以他們嘗試不了那麽多療程。

Well, Ehud is now going into his first treatment,

埃胡德正在準備進行 他的第一次治療，

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

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。

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."

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？」

他說：「嗯，我感覺身體很難受。

And he says, "Well, I feel so terrible inside.

Something's gotta be working up there.

一定有什麽東西在裡面運作，

It just has to."

一定是的。」

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

好吧，不幸的是，三個月後， 我們得到消息，療程沒有起效果。

And so Ehud goes into his second treatment.

所以埃胡德進入第二次治療。

And again, the same story.

事情的發展又和上次一樣。

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

「我感覺很糟， 一定有什麽東西在裡面運作。」

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

三個月後，我們又接到了壞消息。

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

埃胡德接受了第三次 和第四次的治療。

And then, as predicted, Ehud dies.

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,

當身邊親近的人飽受巨大的折磨，

you get really swamped with emotions.

你的內心五味雜陳。

A lot of things are going through your head.

你的腦海中充斥著雜亂的事情。

For me, it was mostly outrage.

對於我來說，我的腦海充滿了憤怒。

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

我就是憤怒，我們只能提供這樣嗎？

And I started looking more and more into this.

然後我開始研究這件事，

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

結果是，這不僅僅是醫生能夠 提供給埃胡德最好的，

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

而且這是醫生能夠提供給 所有腦癌病人最好的。

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

我們其實並沒有在 解決癌症上做的很好。

I picked up one of those statistics,

我挑選了一些調查數據，

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

我保證你們中的一些人 曾經看過這些數據。

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

這將要告訴你多少人死於癌症，

in this case females in the United States,

多少美國女性，

ever since the 1930s.

自 1930 年代後。

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

你會發現並沒有什麽改變。

It's still a huge issue.

這依舊是一個巨大的問題。

You'll see a few changes, though.

不過你還是能看到一些改變，

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

比如你會發現肺癌在升高。

Thank you, cigarettes.

感謝香煙。

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

而且你還能看到，比如說，胃癌，

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

曾經癌症中最大的殺手之一，

is essentially eliminated.

已經大大地減少。

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

好，為什麽會這樣？有人知道嗎？

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

為什麽人類不再受胃癌折磨？

What was the huge, huge medical technology breakthrough

是哪個巨大的醫療技術突破

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

誕生在世界上，從胃癌中拯救人類？

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

可能是一種新藥或者 是一種更好的診斷方式？

You guys are right, yeah.

你們是對的。

It's the invention of the refrigerator,

是冰箱的發明，

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

還有我們不再吃腐爛食物的事實。

So the best thing that happened to us so far

所以至今發生最好的事情，

in the medical arena in cancer research

在癌症研究的醫療領域，

is the fact that the refrigerator was invented.

是冰箱的發明。

(Laughter)

（笑聲）

And so -- yeah, I know.

我知道。

We're not doing so well here.

我們並沒有做的很好。

I don't want to miniaturize the progress

我不想貶低

我們在癌症研究方面的付出。

and everything that's been done in cancer research.

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

聽著，五十多年來癌症研究很有用，

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

發現了有關癌症的重要東西。

But all that said,

但是，儘管這樣，

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

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,

我會闡述為什麼事情會發展成這樣，

why we have not done that remarkably well,

為什麼我們沒有做的非常好，

is really we're fighting blindly here.

是因為我們在盲目地鬥爭。

And this is where medical imaging comes in.

這和醫療影像有關，

This is where my own work comes in.

這是我研究的地方。

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

為了告訴你們今天最好的

that's offered today to brain cancer patients,

腦癌患者的醫療影像，

or actually generally to all cancer patients,

或者給所有癌症患者的，

take a look at this PET scan right here.

看一看這個 PET 掃描 （正子掃描），

Let's see. There we go.

So this is a PET/CT scan,

好，這是一個 PET/CT 掃描 （正子電腦掃描儀），

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

你能從這個 PET/CT 掃描中看出，

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

CT 斷層掃描能夠告訴你骨頭的位置，

and the PET scan will show you where tumors are.

PET 掃描能夠告訴你腫瘤的位置。

Now, what you can see here

現在，你可以看到，

is essentially a sugar molecule

一個糖分子

that was added a small little tag

被添加了一個小小的標簽，

that is signaling to us outside of the body,

並給在體外的我們打信號，

"Hey, I'm here."

「嘿，我在這。」

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

而且上億那樣的糖分子 被注射進病人體內，

and they're going all over the body

並散布至全身，

looking for cells that are hungry for sugar.

尋找需要糖分的細胞。

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

你會發現，比如說， 心臟部位是亮的，

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

那是因為心臟需要很多糖分。

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

你還會發現膀胱也是亮的。

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

那是因為膀胱負責清除

the sugar away from our body.

體內的糖分。

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

而且你會發現其他亮點，

and these are in fact the tumors.

這些事實上都是腫瘤。

Now, this is a really a wonderful technology.

現在，這是一個很棒的科技。

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

第一次能夠讓我們觀察人體內部，

without picking up each and every one of the cells

不需要挑出其中的細胞，

and putting them under the microscope,

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，

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

and ask, "Hey, has the cancer metastasized?

並問：「嘿，癌癥有擴散嗎？

Where is it?"

它在哪裡？」

And the PET scans here are showing you very clearly

而且 PET 掃描很清晰的展示

where are these hot spots, where is the tumor.

這些亮點在哪裡，那些腫瘤在哪裡。

So as miraculous as this might seem,

這看起來很奇妙，

unfortunately, well, it's not that great.

不幸的是，這並沒有那麽棒。

You see, those small little hot spots there.

那些小小的亮點，

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

有人能猜猜在其中一個腫瘤裡 有多少癌細胞嗎？

So it's about 100 million cancer cells,

大概有 1 億個癌細胞，

and let me make sure that this number sunk in.

我要解釋這個數據確定你們聽懂了。

In each and every one of these small little blips

每一個小小的亮點，

that you're seeing on the image,

你能在圖片中看到的，

there needs to be at least 100 million cancer cells

都需要至少 1 億個癌細胞

in order for it to be detected.

才能被檢測到。

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

如果那對你來說是個很大的數字，

it is a very large number.

沒錯，那的確是一個很大的數字。

This is in fact an incredibly large number,

事實上，這是一個非常龐大的數字，

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

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，

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

我們需要找到 一千個癌細胞大小的腫瘤，

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

但是理想來說， 只需要很少癌細胞的腫瘤，

and ideally just a handful of cells in size.

所以我們很明顯離這個還很遠。

So we're clearly pretty far away from this.

所以我們要做一個小實驗。

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

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

我要你們每一個人扮演和想像

that you are brain surgeons.

你們是腦外科醫師。

And you guys are now at an operating room,

你們現在在一間手術室裡，

and there's a patient in front of you,

面前有一個病人，

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

你的任務就是確定清除腫瘤。

So you're looking down at the patient,

所以你低頭看著病人，

the skin and the skull have already been removed,

皮膚和頭骨都已經被移除了，

so you're looking at the brain.

所以你正在看著大腦。

And all you know about this patient

關於這個病人，你只知道

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

有一個大概高爾夫球大小的腫瘤

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

在這個病人的右額葉。

And that's more or less it.

情景大概就是這樣。

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

所以你往下看，不幸的是， 所有東西都看起來是一樣的，

because brain cancer tissue and healthy brain tissue

因為腦癌組織和健康的腦組織

really just look the same.

看起來是一樣的。

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,

開始輕輕地在大腦上按壓，

because tumors tend to be a little harder, stiffer,

因為腫瘤相對更硬，

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

所以妳一遍一遍做這樣的事情，

"It seems like the tumor is right there."

「看起來腫瘤在這。」

Then you take out your knife and start cutting the tumor

然後你拿出刀，開始切割腫瘤，

piece by piece by piece.

一塊一塊地，

And as you're taking the tumor out,

你在摘除腫瘤的時候，

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

到一個階段你會想，

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

「好，我把所有的腫瘤都拿出來了。」

And at this stage, if that's --

到了這個時候，

so far everything sounded, like, pretty crazy --

一切看起來都有點瘋狂，

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

你現在要面臨人生中 最具挑戰的決定，

Because now you need to decide,

因為現在你要決定

should I stop here and let this patient go,

我應該停下，讓病人出院，

risking that there might be some leftover cancer cells behind

承擔有遺留癌細胞的風險，

that I just couldn't see,

因為你看不出來；

or should I take away some extra margins,

或者我應該多摘除一些邊緣物質，

typically about an inch or so around the tumor

經常是腫瘤邊緣一英寸，

just to be sure that I removed everything?

為了保證移除了所有腫瘤？

So this is not a simple decision to make,

所以這不是一個簡單的決定，

and unfortunately this is the decision

而且不幸的是，這個決定

that brain cancer surgeons have to take every single day

腦癌手術醫師每天都要做，

as they're seeing their patients.

因為他們要見到病人。

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

所以我記得我跟 我的幾個朋友在實驗室聊天，

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

「哇，還有更好的方式吧。」

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

不是你安慰別人的方式，

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

真的，應該要有更好的方式。

This is just incredible.

這太不可思議了。

And so we looked back.

所以我們回頭看，

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

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，

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

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

我們可以用很小很小 由金構成的粒子，

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

然後在它們旁邊附上一些 有趣的化學物質，

Let's program them to look for cancer cells.

讓它們去尋找癌細胞。

And then we will inject these gold particles

然後我們會注射這些金粒子，

into these patients by the billions again,

以上十億的數量注入病人體內，

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

讓它們散布全身，

and just like secret agents, if you will,

你可以把他們想像成特工，

go and walk by every single cell in our body

潛伏在我們體內的每一個細胞，

and knock on the door of that cell,

並敲開細胞的門，

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

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，

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

如果你是癌細胞， 我們就原地不動，並發出亮光，

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

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

並跟我們說， 「嘿，看看我，我在這。」

通過一些特殊的攝像頭，

And they'll do it through some interesting cameras

是我們在實驗室裡研究出來的，

that we developed in the lab.

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

一旦我們看到癌細胞， 可能就可以帶領腦癌手術醫師，

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

只摘除腫瘤，留下健康的腦細胞。

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

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.

我現在要給你們展示一個實驗，

What you're looking at here

你現在看到的，

is an image of a mouse's brain,

是一張老鼠大腦的照片，

and we've implanted into this mouse's brain

我們已經在這隻老鼠的大腦裡，

種植了一個小腫瘤。

a small little tumor.

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

所以這個腫瘤現在 正在老鼠大腦裡成長，

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

我們已經請求過一個醫生，

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

讓他把這隻老鼠當病人動手術，

and take out piece by piece out of the tumor.

一片一片地取出腫瘤。

And while he's doing that,

當他在做這個的時候，

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

我們準備給金粒子的位置拍照，

And so we're going to first start

所以首先我們要

給這隻老鼠注射金粒子，

by injecting these gold particles into this mouse,

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

所以我們可以看到，在最左邊，

that image at the bottom

底部的那張圖片，

is the image that shows where the gold particles are.

展示金粒子的位置，

金粒子的好處就是

The nice thing is that these gold particles

它們能夠成功找到腫瘤，

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."

發光，並告訴我們 「嘿，我們在這，腫瘤在這。」

所以我們可以看到腫瘤，

So now we can see the tumor,

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

但是我們還沒有把這個展示給醫生。

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

我們要求醫生開始切除腫瘤，

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。

and you see that first quadrant is now missing.

醫生然後移除了第二個 和第三個四分之一，

The doctor then took the second quadrant, the third,

現在看起來腫瘤已經被摘除乾凈了，

and now it appears to be everything.

到了這個階段，醫生告訴我們說：

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

「好了，我做完了。 現在你們還要我做什麽？

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

Should I keep things as they are

留下剩下的不動，

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

還是要我摘除多一點邊緣？」

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

然後我們說：「等等。」

我們告訴醫生你遺漏了這兩處，

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

與其要切除大量的邊緣，

so rather than taking huge margins around,

還不如把這些小型的部分切除。

only take out those tiny little areas.

把它們摘除，然後我們再看看。

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

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

然後醫生把它們摘除了，

the cancer is now completely gone.

癌細胞現在是完全乾淨了。

Now, the important thing

現在，重要的不僅僅是

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

癌症細胞已經從這個人 或說是老鼠的大腦裡摘除了，

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

我不需要摘除大量的健康腦細胞，

在手術過程中。

in the process.

And so now we can actually imagine a world

所以現在我們可以想像一個世界，

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

醫生和手術醫師在摘除腫瘤的時候，

they actually know what to take out,

他們知道什麼是應該摘除的，

and they no longer have to guess with their thumb.

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.

為什麼取出那些 剩餘少量的腫瘤那麼重要？

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

那些剩下的腫瘤， 即使只有一點點細胞，

they will grow to recur the tumor,

它們會復發，

for the tumor to come back.

重新長成腫瘤。

In fact, the reason why 80 to 90 percent

事實上，這就是為什麼 80% 到 90% 的

of those brain cancer surgeries ultimately fail

腦癌手術最終都會失敗，

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

是因為那些我們留下的 少量邊緣物質，

those small little leftover tumors that were left there.

那些我們留下的少量剩餘腫瘤。

So this is clearly very nice,

這看起來很好，

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

我真的想分享給你們的是 我們該怎麼從這裡開始，

And so in my lab at Stanford,

所以我在史丹福的實驗室，

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

我的學生和我在問，現在該研究什麼？

And I think where medical imaging is heading to

我認為醫療影像的未來

is the ability to look into the human body

是查看人體的內部，

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

並能夠分別查看每一個細胞。

像這樣的能力，能夠讓我們

The ability like this would allow us

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

在早期看到腫瘤，

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

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

能夠查看單個細胞的能力，

能夠讓我們

to ask insightful questions.

提出深刻的問題。

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

所以在實驗室裡， 我們達到了一個臨界點，

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

我們可以開始真的問 有關癌細胞的問題，

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

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，

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

days into the treatment, not three months.

在治療開始幾天就做，不是三個月。

And so also for patients like Ehud

像埃胡德這樣的病人，

that are going through these nasty, nasty chemotherapy drugs,

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，

for them not to suffer

through those horrendous side effects of the drugs

when the drugs are in fact not even helping them.

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,

但是坦白來說，

我們距離贏得與癌症的鬥爭還很遠，

just to be realistic.

這就是現實。

But at least I am hopeful

但是，至少我是樂觀的，

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

我們能夠用更好的醫療影像來鬥爭，

in the way that is not blind.

那樣，我們就不會盲目了。

Thank you.

謝謝。

(Applause)

（鼓掌）