“我们已经向癌症宣战
“We’re declaring war against cancer,
而且我们能在2015年前赢得这场战争”
and we will win this war by 2015.”
这是美国国会和国家癌症协会
This is what the US Congress and the National Cancer Institute declared
在几年前 即2003年宣布的
just a few years ago, in 2003.
现在 我不知道你们怎么看 但是我并不相信
Now, I don’t know about you, but I don’t buy that.
我不认为我们已经赢得这场战争了
I don’t think we quite won this war yet,
而且我不认为在场的人会质疑我
and I don’t think anyone here will question that.
现在我会提出一个最基本的原因
Now, I will argue that a primary reason
为什么我们不会赢得和癌症的战争
why we’re not winning this war against cancer
是因为我们在盲目地斗争
is because we’re fighting blindly.
我要给你们分享一个我好朋友的故事
I’m going to start by sharing with you a story about a good friend of mine.
他的名字是埃胡德
His name is Ehud,
几年前 他被诊断出有脑癌
and a few years ago, Ehud was diagnosed with brain cancer.
而且还不是普通的脑癌
And not just any type of brain cancer:
他被诊断出患有最致命的一种脑癌
he was diagnosed with one of the most deadly forms of brain cancer.
事实上 这个癌症致命到
In fact, it was so deadly
医生告诉他 他只剩12个月
that the doctors told him that they only have 12 months,
在这12个月里 他们必须找到一种方法
and during those 12 months, they have to find a treatment.
一种有效疗法
They have to find a cure,
而且如果找不到 他将会死亡
and if they cannot find a cure, he will die.
现在 好消息是 他们说
Now, the good news, they said,
有无数种治疗方法可以选择
is that there are tons of different treatments to choose from,
而坏消息是
but the bad news is
如果要检测一种治疗方法是否有效
that in order for them to tell if a treatment is even working or not,
好吧 需要大约三个月时间
well, that takes them about three months or so.
所以他们尝试不了几种方法
So they cannot try that many things.
现在 埃胡德正在进行他的第一次治疗
Well, Ehud is now going into his first treatment,
在第一次治疗开始几天的时候
and during that first treatment, just a few days into that treatment,
我见到他 他告诉我说 “亚当 我觉得疗程有效果
I’m meeting with him, and he tells me, “Adam, I think this is working.
我觉得我们挺走运的 事情正在改变”
I think we really lucked out here. Something is happening.”
我问他：“真的吗 你是怎么知道 埃胡德？”
And I ask him, “Really? How do you know that, Ehud?”
他说 “因为 我感觉身体十分难受
And he says, “Well, I feel so terrible inside.
一定有什么东西在里面起作用
Something’s gotta be working up there.
一定是的”
It just has to.”
然而 不幸的是 三个月后 我们得到消息 治疗无效
Well, unfortunately, three months later, we got the news, it didn’t work.
所以埃胡德尝试第二种治疗方法
And so Ehud goes into his second treatment.
跟第一次一样
And again, the same story.
他说 “我感觉很糟 一定有什么在里面起作用”
“It feels so bad, something’s gotta be working there.”
三个月后 我们又接到了坏消息
And then three months later, again we get bad news.
然后埃胡德接受了第三次治疗 第四次治疗
Ehud is going into his third treatment, and then his fourth treatment.
然后正如预测的一样 埃胡德去世了
And then, as predicted, Ehud dies.
当你身边亲近的人经受这种巨大折磨时
Now, when someone really close to you is going through such a huge struggle,
你会感觉尤其强烈
you get really swamped with emotions.
你的脑海中会充斥着各种想法
A lot of things are going through your head.
对于我来说 我感觉很愤怒
For me, it was mostly outrage.
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？
I was just outraged that, how come this is the best that we can offer?
然后我开始深入地研究这件事
And I started looking more and more into this.
我发现 这并非医生能够提供给埃胡德的最好办法
As it turns out, this is not just the best that doctors could offer Ehud.
而且这也不是医生能提供给脑癌病人最好办法
It’s not just the best doctors could offer patients with brain cancer generally.
我们在治疗癌症这件事上并没有做得很好
We’re actually not doing that well all across the board with cancer.
我挑选了一些统计数据
I picked up one of those statistics,
我相信你们可能有人曾经看过这些数据
and I’m sure some of you have seen those statistics before.
这组数据统计了死于癌症的病人数量
This is going to show you here how many patients actually died of cancer,
确切的说是有多少美国女性
in this case females in the United States,
自从20世纪30年代以来死于癌症
ever since the 1930s.
你会发现从那以后事情并没有什么改变
You’ll notice that there aren’t that many things that have changed.
这依旧是一个巨大的问题
It’s still a huge issue.
当然 你能看到一些改变
You’ll see a few changes, though.
你会发现 比如 肺癌的比例在升高
You’ll see lung cancer, for example, on the rise.
拜香烟所赐
Thank you, cigarettes.
你还能看到 比如说 胃癌
And you’ll also see that, for example, stomach cancer
曾经癌症中最大的杀手之一
once used to be one of the biggest killers of all cancers,
已经几乎绝迹了
is essentially eliminated.
好 为什么会这样呢？有人知道吗？
Now, why is that? Anyone knows, by the way?
为什么人类不再受胃癌折磨？
Why is it that humanity is no longer struck by stomach cancer?
是哪个巨大的医疗技术突破
What was the huge, huge medical technology breakthrough
于胃癌中拯救了人类？
that came to our world that saved humanity from stomach cancer?
是一种新药 或者一种更好的诊断吗？
Was it maybe a new drug, or a better diagnostic?
你们答对啦！
You guys are right, yeah.
是因为我们发明的了冰箱
It’s the invention of the refrigerator,
于是我们不再吃变质的食物
and the fact that we’re no longer eating spoiled meats.
所以至今
So the best thing that happened to us so far
我们在癌症医疗领域取得的最大成就
in the medical arena in cancer research
是冰箱的发明
is the fact that the refrigerator was invented.
[笑声]
[Laughter]
所以 是的
And so — yeah, I know.
我们并没有做的很好
We’re not doing so well here.
我不想贬低
I don’t want to miniaturize the progress
我们在癌症研究方面取得的进步
and everything that’s been done in cancer research.
你看 我们做了五十多年的癌症研究
Look, there is like 50-plus years of good cancer research
发现了有关癌症的很多重要知识
that discovered major, major things that taught us about cancer.
这些年研究的结果就是
But all that said,
治疗癌症我们依然任重道远
we have a lot of heavy lifting to still do ahead of us.
我认为 之所以我们进展缓慢
Again, I will argue that the primary reason why this is the case,
之所以我们并没有取得突破
why we have not done that remarkably well,
是因为我们一直在盲目地斗争
is really we’re fighting blindly here.
所以我们发明了医疗影像
And this is where medical imaging comes in.
这就是我的工作成果
This is where my own work comes in.
下面我给大家演示一下
And so to give you a sense of the best medical imaging
当前我们能给脑癌患者提供的最好的医疗影像
that’s offered today to brain cancer patients,
或者说是给所有癌症患者提供的最好的医疗影像
or actually generally to all cancer patients,
看一看这个PET扫描
take a look at this PET scan right here.
看一看这个PET扫描
Let’s see. There we go.
好 这是一个PET/CT扫描，
So this is a PET/CT scan,
你能从这个PET／CT扫描中看到什么呢？
and what you’ll see in this PET/CT scan
CT扫描能够告诉你骨头的位置
is the CT scan will show you where the bones are,
PET扫描则能告诉你肿瘤的位置
and the PET scan will show you where tumors are.
现在 你可以看到
Now, what you can see here
一个糖分子
is essentially a sugar molecule
被添加了一个小小的标签
that was added a small little tag
在给我们发信号
that is signaling to us outside of the body,
“嗨 我在这”
“Hey, I’m here.”
上十亿那样的糖分子被注射进病人体内
And those sugar molecules are injected into these patients by the billions,
并散布至全身
and they’re going all over the body
寻找需要糖分的细胞
looking for cells that are hungry for sugar.
你会看到 比如说 心脏部位是亮的
You’ll see that the heart, for example, lights up there.
那是因为心脏需要很多糖
That’s because the heart needs a lot of sugar.
你还会看到膀胱也是亮的
You’ll also see that the bladder lights up there.
那是因为膀胱负责清除
That’s because the bladder is the thing that’s clearing
体内的糖分
the sugar away from our body.
然后你会发现其他亮点
And then you’ll see a few other hot spots,
这些事实上都是肿瘤
and these are in fact the tumors.
这真的是一个很棒的科技
Now, this is a really a wonderful technology.
这是第一次 我们能够观察身体内部
For the first time it allowed us to look into someone’s body
不需要取出细胞
without picking up each and every one of the cells
并把它们放在显微镜下观察
and putting them under the microscope,
而是无侵入地观察人体内部
but in a noninvasive way allowing us to look into someone’s body
并问 “嘿 癌症有扩散吗？
and ask, “Hey, has the cancer metastasized?
它在哪里？”
Where is it?”
PET扫描很清晰地告诉我们
And the PET scans here are showing you very clearly
亮点在哪 肿瘤在哪
where are these hot spots, where is the tumor.
这看起来很奇妙
So as miraculous as this might seem,
然而 这并没有那么棒
unfortunately, well, it’s not that great.
那些小小的亮点
You see, those small little hot spots there.
有人能猜出 一个肿瘤里有多少癌细胞吗？
Can anyone guess how many cancer cells are in any one of these tumors?
大概有1亿个癌细胞
So it’s about 100 million cancer cells,
让我解释一下这个数字
and let me make sure that this number sunk in.
每一个小小的亮点
In each and every one of these small little blips
你能在图片中看到的
that you’re seeing on the image,
都需要至少1亿个癌细胞
there needs to be at least 100 million cancer cells
才能被检测到
in order for it to be detected.
如果那对你来说是个巨大的数字
Now, if that seemed to you like a very large number,
没错 那就是一个巨大的数字
it is a very large number.
事实上 这就是一个非常巨大的数字
This is in fact an incredibly large number,
我们需要的是能够尽早发现一些东西
because what we really need in order to pick up something early enough
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.
我要你们每一个人扮演和想象
I’m going to ask each of you to now play and imagine
你是一个脑部手术医师
that you are brain surgeons.
你们现在在一间手术室里
And you guys are now at an operating room,
面前有一个病人
and there’s a patient in front of you,
你的任务就是保证清除肿瘤
and your task is to make sure that the tumor is out.
所以你低头看着病人
So you’re looking down at the patient,
皮肤和头骨都已经被拆除了
the skin and the skull have already been removed,
所以你正在看着大脑
so you’re looking at the brain.
你知道所有关于这个病人的
And all you know about this patient
就是有一个大概高尔夫球大小的肿瘤
is that there’s a tumor about the size of a golf ball or so
在这个病人的右额叶
in the right frontal lobe of this person’s brain.
情形大概就是这样
And that’s more or less it.
所以你往下看 不幸的是 所有东西看起来都一样
So you’re looking down, and unfortunately everything looks the same,
因为脑癌组织和健康的脑组织
because brain cancer tissue and healthy brain tissue
看起来是一样的
really just look the same.
所以你要用你的拇指
And so you’re going in with your thumb,
开始轻轻地在大脑上按压
and you start to press a little bit on the brain,
因为肿瘤相对更硬
because tumors tend to be a little harder, stiffer,
所以你一遍一遍做这样的事情
and so you go in and go a little bit like this and say,
“看起来肿瘤在这”
“It seems like the tumor is right there.”
然后你拿出刀 开始切割肿瘤
Then you take out your knife and start cutting the tumor
一块一块地
piece by piece by piece.
当你正在摘除肿瘤的时候
And as you’re taking the tumor out,
然后你会想
then you’re getting to a stage where you think,
“好 我把所有肿瘤都拿出来了”
“Alright, I’m done. I took out everything.”
到了这个时候
And at this stage, if that’s —
一切看起来都有点疯狂
so far everything sounded, like, pretty crazy —
你现在要面临人生中最具挑战的决定
you’re now about to face the most challenging decision of your life here.
因为你要决定：
Because now you need to decide,
我应该停下 让病人出院吗？
should I stop here and let this patient go,
有可能还有一些癌细胞我并没有清除掉
risking that there might be some leftover cancer cells behind
因为我看不出来
that I just couldn’t see,
或者我应该多摘除一些边缘组织
or should I take away some extra margins,
比如把肿瘤边缘一英寸的区域都清除掉
typically about an inch or so around the tumor
以保证移除所有肿瘤？
just to be sure that I removed everything?
所以这不是一个简单的决定
So this is not a simple decision to make,
而且不幸的是 这是一个
and unfortunately this is the decision
脑癌手术医师每天面对病人时
that brain cancer surgeons have to take every single day
都必须做出的决定
as they’re seeing their patients.
所以我记得我跟我的几个朋友在实验室聊天
And so I remember talking to a few friends of mine in the lab,
我们说 “伙计们 我们必须要有更好的方式”
and we say, “Boy, there’s got to be a better way.”
这不是说说而已
But not just like you tell a friend that there’s got to be a better way.
而是 真的 我们必须要有一个更好的方式
There’s just got to be a better way here.
这太不可思议了
This is just incredible.
所以我们回头看
And so we looked back.
想想我说的那个PET扫描 糖分子啊等等
Remember those PET scans I told you about, the sugar and so on.
我们说 嘿 如果不用糖分子
We said, hey, how about instead of using sugar molecules,
我们可以用很小很小的由金构成的粒子
let’s maybe take tiny, tiny little particles made of gold,
然后在它们旁边附上一些有趣的化学物质
and let’s program them with some interesting chemistry around them.
让它们去寻找癌细胞
Let’s program them to look for cancer cells.
然后我们会注射这些金粒子
And then we will inject these gold particles
同样以上十亿的数量注入病人体内
into these patients by the billions again,
让它们散布全身
and we’ll have them go all over the body,
你可以把他们想象成秘密特工
and just like secret agents, if you will,
潜伏在我们体内的每一个细胞
go and walk by every single cell in our body
并敲开细胞的门
and knock on the door of that cell,
并问：“你是一个癌细胞 还是健康的细胞？”
and ask, “Are you a cancer cell or are you a healthy cell?
如果你是健康细胞 那就继续去敲下一家的门
If you’re a healthy cell, we’re moving on.
如果你是癌细胞 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
给出信号说 “嘿 看看我 我在这”
and telling us, “Hey, look at me, I’m here.”
这些可以用我们实验室研发的
And they’ll do it through some interesting cameras
特殊摄像头来实现
that we developed in the lab.
一旦能看到癌细胞 我们就能指导脑癌手术医师
And once we see that, maybe we can guide brain cancer surgeons
只摘除肿瘤 留下健康的脑细胞
towards taking only the tumor and leaving the healthy brain alone.
所以我们尝试了这个办法 它的运作很成功
And so we’ve tested that, and boy, this works well.
我现在要给你们展示一个实验
So I’m going to show you an example now.
你现在看到的
What you’re looking at here
是一张老鼠大脑的照片
is an image of a mouse’s brain,
我们已经在这只老鼠的大脑里
and we’ve implanted into this mouse’s brain
种植了一个小肿瘤
a small little tumor.
这个肿瘤现在正在老鼠大脑里扩散
And so this tumor is now growing in this mouse’s brain,
我们已经邀请一个医生
and then we’ve taken a doctor and asked the doctor
让他来对这只“病人”老鼠动手术
to please operate on the mouse as if that was a patient,
一片一片地取出肿瘤
and take out piece by piece out of the tumor.
当他在做这个的时候
And while he’s doing that,
我们准备给金粒子的位置拍照
we’re going to take images to see where the gold particles are.
所以首先我们要
And so we’re going to first start
给这只老鼠注射金粒子
by injecting these gold particles into this mouse,
所以我们可以看到 在最左边
and we’re going to see right here at the very left there
底部的那张图片
that image at the bottom
展示金粒子的位置
is the image that shows where the gold particles are.
金粒子的好处就是
The nice thing is that these gold particles
它们能够成功找到肿瘤
actually made it all the way to the tumor,
发光 并告诉我们 “嘿 在这儿 肿瘤在这儿”
and then they shine out and tell us, “Hey, we’re here. Here’s the tumor.”
所以我们可以看到肿瘤
So now we can see the tumor,
但是我们还没有把这个展示给医生
but we’re not showing this to the doctor yet.
我们要求医生开始切除肿瘤
We’re asking the doctor, now please start cutting away the tumor,
你能看到四分之一的肿瘤 已经被医生摘除了
and you’ll see here the doctor just took the first quadrant of the tumor
你看到四分之一的肿瘤已经消失了
and you see that first quadrant is now missing.
医生接着移除了第二个和第三个四分之一
The doctor then took the second quadrant, the third,
现在看起来肿瘤已经被清除干净了
and now it appears to be everything.
到了这个阶段 医生告诉我们说：
And so at this stage, the doctor came back to us and said,
“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?
留下剩下的不动
Should I keep things as they are
还是要我摘除多余的周边？“
or do you want me to take some extra margins around?”
然后我们说：”等等“
And then we said, “Well, hang on.”
我们告诉医生 “你已经遗漏了这两处
We told the doctor, “You’ve missed those two spots,
与其要切除大量的周边
so rather than taking huge margins around,
还不如把这些小型的部分切除
only take out those tiny little areas.
把它们摘除 然后我们再看看”
Take them out, and then let’s take a look.”
然后医生把它们摘除了
And so the doctor took them away, and lo and behold,
癌细胞现在是完全的没了
the cancer is now completely gone.
现在 重要的不仅仅是
Now, the important thing
癌症细胞已经
is that it’s not just that the cancer is completely gone
从这个人 或者是
from this person’s brain,
老鼠的大脑里摘除了
or from this mouse’s brain.
最重要的是
The most important thing
我们无需在手术中摘除大量的
is that we did not have to take huge amounts of healthy brain
健康脑细胞
in the process.
所以现在我们可以想象一下
And so now we can actually imagine a world
医生和手术医师在摘除肿瘤时
where doctors and surgeons, as they take away a tumor,
他们确实知道应该摘除哪个
they actually know what to take out,
他们不再需要用拇指来猜测
and they no longer have to guess with their thumb.
现在 这就是为何取出剩余的少量肿瘤那么重要
Now, here’s why it’s extremely important to take those tiny little leftover tumors.
那些剩下的肿瘤 即使只有一点点
Those leftover tumors, even if it’s just a handful of cells,
它们会复发
they will grow to recur the tumor,
重新长成肿瘤
for the tumor to come back.
事实上 这就是为什么80%到90%的
In fact, the reason why 80 to 90 percent
脑癌手术医师最终都会失败
of those brain cancer surgeries ultimately fail
是因为我们乐观地留下的少量边周边物质
is because of those small little extra margins that were left positive,
那些遗漏的没能清除的少量剩余物
those small little leftover tumors that were left there.
所以 这当然非常好
So this is clearly very nice,
然而我最想分享的是 由此我们还能做什么
but what I really want to share with you is where I think we’re heading from here.
在我的斯坦福实验室
And so in my lab at Stanford,
我和学生都在想：接下来我们能做什么？
my students and I are asking, what should we be working on now?
我认为医疗影像的未来
And I think where medical imaging is heading to
是能够探查人体的内部
is the ability to look into the human body
并能够分别查看每一个细胞
and actually see each and every one of these cells separately.
像这样的能力 能够让我们
The ability like this would allow us
在早期移除肿瘤
to actually pick up tumors way, way earlier in the process,
远未达到1亿个癌细胞之前 我们就能行动
way before it’s 100 million cells inside, so we can actually do something about it.
一种查看单个细胞的能力 能够让我们
An ability to see each and every one of the cells might also allow us
提出更深刻的问题
to ask insightful questions.
所以在实验室里 我们正在尝试
So in the lab, we are now getting to a point
给癌细胞提出更具体的问题
where we can actually start asking these cancer cells real questions,
比如说 我们给你的治疗有效果吗？
like, for example, are you responding to the treatment we are giving you or not?
如果没有效果 我们就会立即停止治疗
So if you’re not responding, we’ll know to stop the treatment right away,
而不是要等到三个月以后
days into the treatment, not three months.
像埃胡德这样的
And so also for patients like Ehud
经受这些残酷治疗的病人
that are going through these nasty, nasty chemotherapy drugs,
当药物治疗实际上不再起作用时
for them not to suffer through those horrendous side effects of the drugs
让他们免受可怕的药物副作用
when the drugs are in fact not even helping them.
但是坦白说
So to be frank here,
我们距离赢得对癌症的斗争还很远
we’re pretty far away from winning the war against cancer,
这就是现实
just to be realistic.
但是 至少我是乐观的
But at least I am hopeful
我们能用更好的医疗影像来做斗争
that we should be able to fight this war with better medical imaging techniques
那样 我们就不再是盲目斗争了
in the way that is not blind.
谢谢
Thank you.
[掌声]
[Applause]