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00:00and I just don't give up I'm a detective in the cancer world trying to outfox cancer
00:11it's giving us clues if we know where to look
00:17we're trying to find tiny tiny amounts of cancer DNA in the bloodstream which is like
00:29finding a single grain of sand that matters amongst all the other grains of sand
00:36the answers are there we just have to find them and that's my mission
00:44for generations a cancer diagnosis left almost no hope it's a terrifying disease that has stalked
00:58us for millennia I didn't expect I had cancer because all the tests were coming back negative
01:04I don't think my body can take anymore science has fought hard against it and now the tide is
01:11finally turning one of our key goals is to transform this idea of cancer as a death sentence a group of
01:20trailblazing scientists are making new breakthroughs we now need to take those discoveries and make them
01:27work for patients this is the world's first lung cancer prevention vaccine discovering cures and
01:35finding ways to stop cancer before it even starts the tumor seems to be shrinking your scan shows no
01:43active disease creating a future where cancer doesn't win we're getting very close to defeating
01:51cancer once and for all what's not curable today could be curable tomorrow
01:58asIN
02:07it's a
02:21I love working.
02:30I've worked since we were 15 years old.
02:34But at school, I didn't want to be a mechanic.
02:37I wanted to be a jockey.
02:40But when you go and work experience at school,
02:43you couldn't find me a stable.
02:45They didn't want to find me.
02:45So I went in to be a mechanic and I loved it.
02:49I always loved getting my hands dirty as a kid.
02:51My mum didn't like it, but I had to go home dirty.
02:55I just love cars.
02:57But a doctor told me I should have a few months off.
03:02I was off four days.
03:03I couldn't handle it because this is normal for me.
03:07And if I'm normal, I haven't got cancer.
03:11And that's a thing.
03:12Four years ago, 58-year-old Lee experienced pain in his back after playing golf,
03:23but soon discovered it was more than a sports injury.
03:26So I had two lumps in my back and my ribcage,
03:31but I had pain around my kidney area.
03:34I couldn't sleep at night.
03:35I couldn't walk.
03:36I couldn't move because of the pain.
03:39A doctor sent me for an MRI scan,
03:42and they scanned the tumour.
03:45It was 10 centimetres round.
03:47So we had a biopsy,
03:51and they come back and said,
03:53it's cancer.
03:55But it's a weird, it's a strange cancer
03:57because it's called something called cancer unknown primary.
04:02Never heard of it.
04:04And I thought, well,
04:05what do you mean cancer unknown primary?
04:07Cancer's cancer.
04:08We can't find the primary source.
04:10So I've got a tumour in my back,
04:14which I know about.
04:15But if you can't find out where it's originated,
04:17how do you kill it?
04:18You can't.
04:19So until it pops its head out,
04:21it's like playing hide-and-seek.
04:23So hopefully one day it'll pop its head out,
04:26and then we'll kill it.
04:28Hopefully.
04:29You still don't know?
04:31No-one knows.
04:33No, no-one knows.
04:35I'm a mystery.
04:40In Manchester,
04:43Lee has joined a pioneering new project
04:46that seeks to solve his mysterious case
04:48by analysing the blood
04:50to unlock cancer's secrets.
04:55Hiya.
04:56Checked in?
04:57Started, thank you.
05:02Leading the initiative
05:03is Professor Caroline Dive.
05:06I've been thinking about
05:07how we fight cancer
05:09ever since I was 25 years old.
05:13Because cancer has always been
05:15one of the largest medical challenges
05:17for the human race.
05:20Cancer is a disease of mutations.
05:23And we all carry some gene mutations,
05:25but for the most part,
05:26for those of us who don't go on to develop cancer,
05:29we live with them.
05:31Cancer is a rogue ball of cells
05:34growing somewhere in a body,
05:36and it's taking over those normal body processes.
05:39And they have all these really lethal traits.
05:43They move about around the body
05:45when they shouldn't.
05:47They don't die when they should.
05:51And that mutation that sat there
05:52suddenly now becomes very dangerous indeed.
05:55I think about it as a very malevolent alien.
06:01An alien within.
06:03And really hard to beat.
06:11At the Cancer Research UK National Biomarker Centre,
06:14Caroline is looking at cancer
06:16much closer than ever before
06:17by investigating the fluid
06:19that links everything blood.
06:22Hi, guys.
06:23How's your day going?
06:28Hi, Chris.
06:30Can we have a look at the organoids?
06:32I know the data sounded really exciting,
06:34so I'd like just to have a look.
06:36All right.
06:36We're looking at the molecular level.
06:43With the new technologies we have at our fingertips,
06:46we can detect vanishingly small amounts
06:49of cancer cell DNA in a tube of blood.
06:56The answers are there in the blood.
06:59We just have to find them.
07:01And to sort of give you an idea
07:07of the scale of the challenge,
07:08when we think about, you know,
07:10thousands of cells can fit on the head of a pin,
07:13and we're looking for clues
07:15which tell us how a cancer cell is behaving now
07:19and how that cancer cell may behave in the future.
07:26Only by knowing those details
07:27can we really solve the mysteries of cancer.
07:31We are discovering what makes cancer tick.
07:35My mission is to take those discoveries
07:38and translate them into useful, impactful tests.
07:44Because if we can catch cancers in the bloodstream,
07:48we should be able to certainly give patients
07:51a much longer lifespan, but in some cases, cure.
07:54Caroline and her team work closely
08:02with one of Europe's leading cancer centres,
08:06the Christie.
08:06Hi, Lee, good morning.
08:18How are you today?
08:18All right, thank you.
08:19Oh, good.
08:20I'm just setting up for your bloods, OK?
08:22OK.
08:22Again.
08:23Again.
08:26Lee has been undergoing a series
08:27of conventional cancer treatments
08:29to slow down his cancer's growth.
08:31I think I've treated you a couple of times.
08:33Yeah, you have, yeah, yeah.
08:34I think everyone has now.
08:35Yeah.
08:38When you're talking to other cancer patients,
08:41it's like a game of top trumps.
08:43What cancer have you got then?
08:44And what have you got?
08:45And then they all say,
08:46oh, I've got prostate cancer,
08:47I've got bowel cancer.
08:49Well, what have you got?
08:50And I go, cancer unknown primary.
08:52What's that then?
08:53Other cancer patient, I haven't heard of it.
08:55I hadn't heard of it until I got to the Christy
08:58and said, this is what you've got.
09:00What I do before, though, is just do your pulse.
09:04At first, it was daunting
09:06because the general life expectancy
09:09for cancer unknown primary is about nine months.
09:13Nearly nine months isn't a lot.
09:15So I think, right, what do I cram in in nine months?
09:18And then coming here and thinking,
09:20well, I'm coming here to pass me time.
09:25Can I just have a look at your cancer?
09:27Yeah, sure.
09:28But when you come and you find out
09:30all the fantastic work,
09:31the doctors, the nurses, they're doing,
09:33everyone's fighting your corner.
09:35In every cancer, not just mine,
09:38they want to find a cure.
09:46We are learning more every day
09:48and I am actually very optimistic
09:50that significant improvements are coming.
09:53But at the same time,
09:54you've got to have your motivation.
09:56And what better motivation can there be
09:58than walking through the corridors
10:00seeing people with cancer?
10:05It's very fulfilling for me
10:06having the National Biomarker Centre
10:09in the same building as the Christy Hospital.
10:12Let me just make sure
10:13that I've got all the pictures that I need.
10:15The idea is just to bring us all together
10:17in that same environment,
10:19the clinicians, the scientists.
10:21Hi, Natalie.
10:22We develop new laboratory tests
10:27and then we test them
10:30in patients on clinical trials.
10:33In Lee's case,
10:34we want to find out
10:35where his cancer started
10:37because blood is circulating
10:39around the whole body,
10:41bathing wherever that tumour is,
10:43there's going to be blood flow.
10:44So we'll just clean the area now.
10:53Because my veins now are starting to close
10:56because of all the treatments I've had,
10:58they put now a port into my vein there,
11:01you see it.
11:02And it's like a little valve there
11:04that you can access
11:05to get your blood
11:07rather than try and find a vein.
11:08You've had a lot of chemotherapy, haven't you?
11:11Yeah, so...
11:12So your veins have had enough.
11:13Yeah, they give up the gulsh, yeah.
11:16We couldn't do research
11:17without people like Lee
11:19donating his blood samples.
11:22It's like a dart board, isn't it?
11:24Oh, I'm good at darts.
11:25For Lee to benefit from their findings,
11:27it's a race against the clock.
11:29Right, one, two, three,
11:30nice deep breath in.
11:34The more blood they take off me
11:36to try and find it,
11:38hopefully I can find
11:39where the cancer has come from
11:41and then create a drug,
11:44anything to try and find a cure quicker.
11:46There we go.
11:47That's what I've donated for.
11:49I'm coming now.
11:51I'll have a pint left,
11:52what's a sec anyway?
11:55It's precious, isn't it?
11:56Give a look.
11:59In Manchester,
12:10Caroline Dive is developing
12:11a series of revolutionary blood tests
12:13that can detect cancer
12:15at the molecular level.
12:17We're making momentous discoveries
12:19about the biology of cancer
12:22from a tube of blood.
12:24We take samples from patients,
12:26just maybe a tablespoon of their blood.
12:29It comes to the lab
12:31and then the real challenge
12:33is to see how much we can learn
12:35from that tube of blood.
12:37One of these blood tests
12:38aims to detect cancer early enough
12:40to try and stop it
12:42before it can even get started.
12:44You have to know your enemy
12:45to have a good fight
12:46and to stand a chance of winning.
12:47And in this case,
12:49with cancer as the enemy,
12:51the younger you know that enemy,
12:52the better.
12:53It's critical that we detect cancers
12:56at their earliest stage.
12:58And the real question is,
13:00can we detect cancer even earlier
13:02before cells transition
13:06into a cancerous state,
13:07that pre-cancerous state,
13:09when it's more treatable?
13:10And that's a huge challenge.
13:18Come on through.
13:22Pop your key on that chair for me.
13:24And then I need you to come
13:25and have a lie down for me.
13:27Yeah.
13:30Another patient hoping to take part
13:32in a clinical trial
13:33is 49-year-old Damien.
13:36He's having a check-up
13:37following surgery a year ago
13:39that removed a melanoma skin cancer
13:41from his back.
13:42They did say it's quite aggressive.
13:44Luckily, we caught it quite soon.
13:46But you're thinking the worst.
13:51When I went to the specialist
13:53and they measure you up
13:54and how much they're going to take,
13:56they draw it on your back
13:57and it was like,
13:58Jesus, that's quite big, that.
14:05This was the start of it all, basically.
14:0923rd of July, I think it was, 2024.
14:13Yeah, it's funny to see
14:14how small it was at the time.
14:16It seemed so insignificant,
14:18but obviously ended up not being.
14:23I wouldn't have even known
14:24it were there.
14:26It was my son that's seen it.
14:29I'd got out of the shower
14:30and she said,
14:31what's that on your back, Dad?
14:32And I looked in the mirror
14:35and it looked a bit like a cocoa pop.
14:38After that period,
14:40it really grown quick.
14:42It went from, obviously,
14:43what you're seeing there
14:44to that.
14:48Cancer's like an ugly thing
14:49that looks like it does harm and damage.
14:52That's what you pick up in your head
14:53and looking at the picture.
14:54It looks like cancer.
14:59Soon after first spotting the growth,
15:01Damien went to get it checked
15:03and then had to break the news
15:04to his family
15:05that it was skin cancer.
15:08I just felt sick.
15:11Well, you're scared to death.
15:12You know, ultimately,
15:12I could potentially lose
15:14my best friend,
15:15love of my life.
15:16We've been together 25 years
15:17and that's not the plan.
15:19We're going to grow old together.
15:22I cannot imagine him
15:23not being by my side
15:24for all that he drives me mad.
15:28I just can remember driving to work
15:31really heartbroken thinking,
15:33I don't know how this is going to impact
15:35us as a family now.
15:37Will Damien need a certain level of care
15:40or treatment?
15:41Has it spread?
15:42So, yeah, the whole thing implodes.
15:44I pray.
15:48Love one.
15:51They give you, like,
15:52a 25% chance
15:54that it could come back
15:54in the first year.
15:57Come on.
15:57You start reading up
15:58on the type of skin cancer,
16:00it's fast growing,
16:01it likes to travel,
16:02it likes to travel to your brain.
16:05And that was, like,
16:06the eye-opener for me.
16:07Jesus, it's not good.
16:09Well, I saw myself.
16:12You try not to,
16:13but you always think of
16:15how long are you going to be here?
16:16Can I afford to keep the house?
16:18Can I keep my job?
16:19How can I look after the kids?
16:22You've never got that all clear.
16:24You never know.
16:25That's the scary thing.
16:26Today, Damien will find out
16:36if he is eligible
16:37for the detection trial
16:38that tests melanoma patients
16:40after surgery
16:41to try and determine
16:42if their cancer has recurred.
16:46Basically,
16:47I'm all clear at the moment,
16:48but it's weird.
16:49Little aches and pains.
16:51Normally,
16:52you wouldn't even think twice about it.
16:53You think,
16:53could that be cancer back again?
16:55A little itch
16:56where my wound's bingenised.
16:57All the little things
16:58that you don't really think of
17:00until you've got cancer.
17:05In the UK,
17:06around 18,000 new cases
17:08of melanoma
17:09are diagnosed every year.
17:11It's a local anaesthetic,
17:1320 mils, 0.25 with adrenaline.
17:16It's extraordinary,
17:17the progress that has been made
17:19in understanding
17:20how tumours behave.
17:22But there are limitations
17:23to all of our conventional
17:25types of treatment
17:26and detection of cancers.
17:28Know that this is a melanoma,
17:311.5 millimetres in thickness.
17:33Whilst we have
17:35incredibly talented people
17:37doing sophisticated surgery,
17:39what we don't know
17:41when the tumour is removed
17:42is whether every cancer cell
17:44in the body is gone.
17:46And those little tiny tumour cells
17:48that were in that original cancer
17:50had already moved around the body
17:52and landed in another organ,
17:55but haven't yet grown into big masses
17:56that can be seen
17:57with an imaging scan.
17:59If that's already happened,
18:00then there's a real chance
18:02that tumour might come back.
18:07Rather than detecting melanoma
18:10with a conventional CT scan,
18:12Caroline is proposing
18:13a groundbreaking new approach.
18:18So a tissue biopsy
18:20can tell you a lot
18:21about that tumour.
18:23However, accessing the tumour
18:24in the patient,
18:25particularly if that tumour
18:26is in a fairly inaccessible place,
18:28is very invasive for patients.
18:31And this has given rise
18:32to a whole new type of test
18:34called a liquid biopsy.
18:38Unlike a tumour biopsy,
18:41blood can be taken
18:42from a patient
18:43again and again and again
18:45without too much discomfort
18:47for the patient.
18:48And can we find everything we can
18:52at the molecular level
18:53from a tube of blood?
18:56So we diagnose cancer earlier,
18:59before it evolves.
19:02Is there something
19:02that these tumour cells
19:04are putting into the bloodstream
19:06that we can pick up?
19:07Your blood contains millions of cells
19:14and molecules floating around
19:16in a liquid called plasma.
19:19If you have cancer,
19:20there may also be cancer cells
19:22and dead bits of them
19:23hidden in your blood
19:24that have been shed
19:25from your tumour.
19:27Dead cancer cells
19:28can leak fragments of tumour DNA
19:30into the blood.
19:33But your blood also has millions
19:35of other fragments
19:36from your normal, healthy DNA.
19:41So finding a few fragments
19:43of circulating tumour DNA
19:44is like trying to find a needle
19:47in a haystack.
19:48Because the burden of cancer
19:53in a human being
19:53is very low at this point,
19:56there are very few molecules
19:57that we'll be able to measure.
20:00So the test has to be
20:02very sensitive.
20:05You know, and when we first studied it,
20:08I don't know, 15 years ago,
20:10everybody was very, very doubtful
20:12that that would ever be
20:13a good thing to do.
20:15And the problem is not
20:16one I alone could solve.
20:18Dr. Becky Lee
20:23is one of the clinical investigators
20:25working with the
20:26National Biomarker Centre.
20:29I've had, you know,
20:30a few eureka moments
20:32along the way
20:32and actually the detection trial
20:34is based off
20:35one of those eureka moments
20:37where you suddenly realise
20:39that actually
20:39you're seeing some data
20:41that no-one else has seen.
20:44When I was a PhD student,
20:46I was really inspired
20:48by what Caroline was doing
20:50in her lab.
20:52We were looking at patients
20:54with advanced melanoma.
20:58I knew that we could detect
21:00cancer in patients
21:01with lots of cancer present.
21:03So then, I just thought,
21:07can we bring the cancer detection test
21:10to an earlier stage
21:13where there wasn't any evidence
21:15of disease on the scan of patients?
21:18To see if we could still see
21:20whether the melanoma was present
21:22and that would be a signal
21:23of melanoma coming back.
21:26Becky used some blood samples
21:28from melanoma patients
21:29whose tumour had been removed
21:31by surgery
21:32and spent months analysing them
21:34to see if she could identify
21:36whether cancer DNA
21:37was still present.
21:39She sent her results
21:40to statisticians
21:41to check whether they matched
21:43with the patients
21:44whose melanoma later returned.
21:48That was a eureka moment
21:49when we suddenly knew
21:51that actually we were able
21:53to detect the CT DNA
21:54and it was able to predict
21:55this relapse
21:57and that was the moment
21:59that detection was really born.
22:02It was incredible
22:03because it just came over
22:04on an email
22:05and there it was.
22:06It just was like,
22:07oh wow, this is amazing.
22:10I was like,
22:10everyone could see.
22:13So yeah, it was cool.
22:18We started with liquid biopsy
22:20in the early 2000s.
22:22I think the first mutations
22:23that we measured
22:24in liquid biopsy
22:25were in breast cancer
22:26and then lung cancer
22:27but it was really early days.
22:29We were just finding our way.
22:32We didn't use them
22:33at that point
22:33in clinical trials at all.
22:35It must be really incredible
22:36to kind of watch a field
22:38from its early existence
22:41to actually then making
22:43that difference to the patients.
22:44That's the advantage
22:44of being old.
22:46You can look back.
22:48People are there to look back.
22:49After 10 years
22:53of refining the process
22:54in the lab,
22:55the liquid biopsy test
22:57is now ready
22:57to roll out into the clinic.
23:00If I can get on this trial,
23:01it takes away that worry.
23:03For a simple blood test
23:04which is non-invasive,
23:06it's taken about
23:07two minutes to have
23:08and have a team
23:09of brilliant people
23:10check you that thoroughly,
23:12would be fantastic.
23:13So obviously you've now
23:18had your surgery.
23:20You've had the scan result
23:22which hasn't shown
23:23any evidence
23:24that the melanoma's there
23:25which is really good.
23:27So I'm pleased to say
23:29that you're eligible
23:30to go on the trial.
23:32That's brilliant.
23:33Yeah.
23:34Oh, and one piece
23:36of the puzzle really.
23:38Yeah.
23:39Because anything
23:40that reduces the risk
23:41was good.
23:42But as soon as I heard
23:43there was trial,
23:43I was, uh,
23:44I'm definitely up for that one
23:45if I can get it.
23:46That's brilliant, that.
23:47Now we hope
23:48that we won't see
23:50any evidence of DNA
23:51coming from cancer cells
23:53and then you don't need
23:54any further treatment
23:55which would be amazing.
23:57Yeah.
23:57But even if we did find
24:00the DNA present,
24:02we would be treating it
24:03at a really early stage
24:05where it's much more likely
24:06to respond.
24:07Yeah.
24:08But hopefully we'll never
24:09need to do that
24:10and we'll just monitor
24:11you very, very carefully.
24:12with this blood test.
24:13Fingers crossed.
24:14Yeah.
24:14Yeah.
24:22Right, let's have a look
24:23at your veins.
24:25Oh, I can see some.
24:27Beautiful.
24:30Really big news
24:31to know that I've got
24:31the clinical trial today.
24:33Gives me a big hope,
24:34not just for me,
24:35for my family as well.
24:36It eases their mind
24:37because it's not just me
24:38worried,
24:38it's everyone else
24:39in my family.
24:41It's going to sound
24:42really random,
24:43but all I've had
24:43in my head all morning
24:44is the Strictly theme tune.
24:48And that's all
24:48that's going around
24:49in my head.
24:49I get that sometimes.
24:50You have no idea
24:51where it's come from.
24:52Be careful,
24:52or else I'll start dancing
24:53to the Strictly theme tune.
24:55Anything to break up the day.
24:56Exactly.
24:57It's not just
24:59another blood test,
25:00it's to say
25:01that your cancer's clear.
25:03Not only that,
25:04if they do find it,
25:05you're catching it
25:06as early as you possibly
25:07ever could.
25:08And it's immediate treatment,
25:10which is phenomenal.
25:12Scans can only pick up
25:13so much,
25:14whereas if you go in
25:15into the depths
25:16of DNA in your blood,
25:18you can't get any more
25:19minute scale than that,
25:21can you?
25:22There we are.
25:24All done.
25:25Perfect.
25:27Damien's blood
25:29will be tested
25:30along with the other
25:30patient's blood samples
25:31to see if they can see
25:33any signs of cancer DNA present.
25:39This blood test
25:40is really moving things forward.
25:44Samples for you.
25:45In our current standard of care,
25:48patients will be offered
25:50regular scan follow-up,
25:52but generally,
25:53that's at least
25:54every three to six months.
25:56So this blood test
26:01is getting that result
26:02back within 10 days.
26:05We don't want to hang around
26:07where cancer's concerned.
26:08We want to get ahead of it.
26:14Once the samples are in the lab,
26:16the meticulous analysis begins.
26:18To find the circulating tumour DNA,
26:25first everything else in the blood
26:26that's not DNA is removed.
26:30Then all the fragments in the sample
26:32are compared with the patient's
26:33own healthy DNA.
26:36If scientists spot DNA fragments
26:38that don't match,
26:39it could mean the patient has cancer.
26:42And what, of course,
26:45we're all hoping for,
26:47for Damien,
26:47is a negative test,
26:49and there is no sign of tumour.
26:52And with these blood tests,
26:53we can keep a really close eye on Damien,
26:56and if his tumour comes back,
26:57we can pick it up quickly.
26:58I think we can't overpromise.
27:08It's really important that we don't.
27:10From a patient perspective,
27:11this is a clinical trial.
27:13This test is not yet available,
27:15for example, on the NHS.
27:17So we're testing the test.
27:19There's a lot more work to do,
27:21but I'm very hopeful.
27:21Basically, you want peace of mind
27:27that I'm all clear.
27:29For now.
27:46Seagulls, Mum.
27:47Look, see, there's the first one.
27:49I reckon that bit goes there, though.
27:51I'll try that bit.
27:52Yes, that bit goes there as well.
27:54Good.
27:56I'm cracking along nicely now.
27:58Cooking on gas.
28:00I just find it really therapeutic.
28:02Well, it's nice to sit with Mum
28:03and do something we can both do together,
28:05and I just find it very satisfying
28:07when the pieces go in,
28:08because most of the time,
28:10the tasks that I perform
28:11are very long-term
28:13and not often completed in a day,
28:15so it's nice just to have something
28:17you can get done.
28:18She was a terrible baby.
28:21She would not sleep.
28:24In the end, I got so frustrated,
28:26I took her to the doctor,
28:27and the doctor examined her,
28:29looked at her ears,
28:30looked at her eyes,
28:31looked at everything,
28:32and he said,
28:33I can't think anything's wrong with her,
28:35he said.
28:35I think she's got an overactive brain,
28:37and she will do very well in life.
28:44I had a fantastic childhood.
28:46We lived in a public school in Sussex
28:49because my father was the head porter.
28:54Didn't have any money,
28:55and I went to a state school.
28:57But yeah, I saw, if you like,
28:58how the other half live.
29:00But I never felt hard done by,
29:02I just thought I lived in a really nice place
29:04with parents who really cared about
29:06what happened next in terms of my life.
29:09My dad, one of his top tips in my youth
29:12was, you know,
29:13every time you go to bed,
29:14just think about what did I learn today.
29:17He loved learning and knowledge,
29:19and he didn't get a very good education himself.
29:22I think he left school
29:23at something like 13 years old.
29:25Oh, and he was quite clever.
29:26I mean, he could have done very well
29:29if he'd had a good education.
29:29He was clever.
29:30He's a smart guy.
29:31And I think, you know,
29:32he just wanted you to be the best
29:33you could possibly be
29:34at everything you tried to do.
29:36And I think, you know,
29:37the need to achieve,
29:39I think, is sort of hardwired.
29:42He was just a lovely man.
29:44We miss him dreadfully.
29:45I wish he was here.
29:52He died two years ago now, almost.
29:55His liver was filled with masses of tumours on the scan.
30:04He became so ill,
30:05and seeing him that ill,
30:08yeah, it was difficult
30:09because his last three months were pretty miserable,
30:11but up until that point,
30:12he was strong and resilient
30:14and fought his way through it
30:15with great, great dignity, actually.
30:19Every time I saw him,
30:20the last thing he said was,
30:21I love you.
30:22You know, it was emotional.
30:27You know, you never did know
30:28when was the last time.
30:32And on his death certificate,
30:34it said cancer of unknown primary,
30:36which is an intriguing type of cancer.
30:40That has a very personal importance to me now.
30:44And we've been working together now
30:46for many years
30:47to try and solve that problem.
30:50And it will be a special moment for me
30:52to see the work we're doing now
30:54that could help patients
30:56with cancer of unknown primary in the future.
30:59Because it must be awful
31:00knowing you've got cancer
31:01but not knowing where it's come from,
31:03with perhaps not a great chance of improvement.
31:09Yes.
31:09Yes.
31:09Yes.
31:09Yes.
31:14In 2021,
31:15I found two little lumps
31:16on my ribcage at the back.
31:18So I weren't really concerned
31:20about the lumps.
31:21It was the pain.
31:22The pain was more towards my kidney.
31:25And over the weeks,
31:26the pain got worse.
31:30I understand how people
31:32with pain
31:33could take their own life
31:35because I honestly thought about it
31:36because the pain was that bad.
31:39I'm glad it didn't.
31:40But, yeah,
31:44it was dark.
31:49Lee was diagnosed with cancer
31:51of unknown primary
31:52after a mass of tumours
31:54were discovered in his kidney.
31:56When I got the cancer,
31:57I thought,
31:58cancer's cancer,
31:58that's it.
31:59But then to be told,
32:01cancer's unknown primary,
32:02I didn't understand what that meant.
32:04You think to yourself,
32:05why?
32:05Why can't you find it?
32:07How I look at this,
32:09and it's dead simple.
32:10I woke up one morning
32:11and the little cancer gremlin's gone,
32:13it's your turn today,
32:14but you're having this special one.
32:16You're having one we can't find.
32:18And that's what the doctors say.
32:21Doctors find patients like Lee
32:23so mysterious
32:24because unlike all other cancer patients,
32:27nobody knows where their cancer first began.
32:29When a cancer starts,
32:35it's called a primary cancer
32:37and its type
32:38is determined by its location.
32:43Over time,
32:44cancer cells can break off
32:45and spread to other organs
32:47forming secondary cancers.
32:50This is called metastasis.
32:53When doctors don't know
32:55where the cancer started,
32:56it's called cancer of unknown primary.
32:59This is a perplexing type of cancer
33:08because patients have advanced disease.
33:14Only when you know
33:15where the tumour started
33:16can you have a really rational discussion
33:19about what the right treatment would be.
33:21Why does that matter for treatment?
33:22Because it has a different biology.
33:25So it requires a different sort of treatment.
33:28At the moment,
33:31there is no personalised treatment
33:33for patients with cancer of unknown primary.
33:35I think there's an idea that, you know,
33:38if you have a cancer in the brain,
33:41it must be brain cancer.
33:43That's not true.
33:44If you sequence the DNA
33:45of a primary lung cancer
33:47and let's say that primary lung cancer
33:50moves and starts to grow in the brain
33:52and then you took that metastatic
33:54secondary lesion in the brain
33:55and sequenced it,
33:56it would look more like the lung cancer
33:58than it would like anything
33:59that comes from the brain.
34:00OK, Lee, this is going to be 30 minutes.
34:05Yeah.
34:06Perfect.
34:07Have you had any reaction in the past?
34:09No.
34:11Because Lee's cancer was discovered so late,
34:14it's spread and it's inoperable.
34:16So Lee began a series of traditional treatments.
34:19I had my first chemo session
34:21and they scanned me
34:22and it had shrunk to half.
34:25So the chemo, it was doing something.
34:29So they gave me another three sessions of chemotherapy
34:32and said they're bringing this new drug out
34:34called immunotherapy.
34:37So that's going to be 30 minutes.
34:39Any problem?
34:39Just let me know.
34:40I will do.
34:40I also had 10 sessions of radial therapy
34:45which pinpoints the cancer.
34:47So it's like lasers, I think,
34:48and it burns it.
34:49But it can cause other side effects.
34:52Like, because it was so close to my kidney,
34:54it could have destroyed my kidney,
34:55but luckily it didn't.
34:57So I had more chemo than the immunotherapy,
35:00which is, it's keeping me here.
35:03Touch wood.
35:06Despite being given just nine months to live,
35:09Lee has been receiving treatment
35:11at the Christie Hospital for three years.
35:14He's been under the care of Dr. Natalie Cook,
35:16a leading expert in cancer of unknown primary.
35:21We had multiple different investigations,
35:23ultrasound scans, CT scans, MRI scans, biopsies.
35:27And after all of that,
35:29we did not find out anything
35:31that would help personalise his treatment options.
35:35Unfortunately, prognosis remains quite poor
35:38for most patients diagnosed
35:39with cancer of unknown primary.
35:41Often it's around about three to six months.
35:43But obviously Lee's done significantly better than that.
35:46We don't know exactly why he's responded
35:48to immunotherapy, but it's under control.
35:51So he remains a true cancer of unknown primary,
35:54which is annoying to me,
35:55because I do like to try and find out
35:57where the cancer started.
35:58In his case, it truly is still a mystery.
36:00Have a seat, Lee.
36:06Right, how are you feeling today?
36:07All right.
36:08Yes?
36:09Since we last saw you here,
36:11has there been any changes?
36:12Nothing, no.
36:13No?
36:13So feeling generally okay in yourself?
36:15Brilliant, yeah, no pain.
36:16Okay.
36:17No, I think you're definitely one of the kind of lucky ones,
36:20because the chemotherapy worked really well.
36:22Yeah.
36:22And that seems to be keeping things under control, doesn't it?
36:25Yeah, I've done, like, 53 or 54 treatments now.
36:28Yeah, let me just go back to when you first started
36:31was on, was February 2022.
36:35Right.
36:36So over three years now, so that's amazing.
36:38I understand, but if you can't find a primary source
36:41of a cancer, you're not going to cure it.
36:43You can't.
36:44You can generally look after it.
36:46But I'm not holding out,
36:47because if you can't find it after three years now,
36:50I think it's in itself,
36:53but I'm still here and fighting in the corner.
36:55I'd probably like to see it along.
36:56May it continue, basically.
36:58Yeah, I feel really good at the moment.
37:00Yeah, she's my guardian angel.
37:03No, don't put that in camera.
37:09Natalie's investigations uncovered that little research
37:12had been done in this particular field.
37:15So she got in touch with Caroline to get her help.
37:18Together, we've been able to develop this test
37:21that we call CUPID,
37:23Cancer of Our Unknown Primary Identification, or CUPID.
37:28And we're hoping that by taking a blood sample from a patient,
37:31we can have a pretty good idea of where that tumour started.
37:35This blood test is a little different
37:43in as much as we look at the fragments of cancer cell DNA
37:47shed into the bloodstream,
37:49but we can also look for the pattern of molecules which are on it.
37:56And those patterns, it's a bit like a postcode.
37:59They can tell us which organ in the body the tumour started off in.
38:04So if you have a tumour that starts in the liver,
38:08guess what?
38:09It'll have a liver postcode.
38:11We can measure those postcodes in the DNA
38:14and we can tell you where the tumour started from.
38:17In order to isolate this data,
38:23they use metal beads coated in a protein
38:25which the tumour DNA will bind to.
38:29A magnetic strip then attracts the DNA-coated beads,
38:33enabling them to extract the molecules.
38:36Millions of pieces of DNA are then analysed,
38:39allowing their codes to be read.
38:40We can now be fairly confident
38:43that we can predict a cancer of unknown primary
38:46started in the lung
38:47or it started in the colon, in the gut.
38:50And I think for those common cancers of unknown primary,
38:54within two weeks of the patient arriving in clinic,
38:58I think we'll be able to make a diagnosis
39:00of where their cancer started.
39:01But also the opportunity to direct a better treatment
39:07to your particular cancer.
39:09So it's new pioneering work
39:11that we really feel we can do something to fix.
39:15Caroline and Natalie have collected hundreds of blood samples
39:18from people with known cancers
39:20and are building an atlas of postcodes
39:22to map out where the cancer comes from.
39:24So far, the test can match unknown primaries
39:29to 29 common cancers.
39:31But with over 200 different types of cancer,
39:34there's still a long way to go.
39:41I know it's incurable,
39:43but hopefully it's manageable with all these treatments.
39:47Now, I know they're not going to last forever.
39:49I know at a time they're going to say,
39:52we've either got a cure for you
39:56and we've found it,
40:00or they're going to say,
40:01there's not a lot more we can do.
40:06It does bother me why I've got cancer,
40:08because I don't know why I've got cancer.
40:11No-one in my family's had it,
40:13so why me?
40:15That's the answer that I think most cancer patients want.
40:18Why?
40:19What have I done?
40:20It'd be nice to be told,
40:22right, we've found where the cancer has come from.
40:27Hopefully, it'll be sooner than later.
40:29That's the life that we strive for.
40:53Sat there with a glass of whiskey watching the day go by.
40:55Definitely look forward to her reaching retirement age.
41:04Damien is waiting to get the results from the trial
41:06to find out if any cancer DNA is still present in his blood.
41:09No-one ever looks forward to finding out if they've still got cancer or not.
41:15Obviously, everything runs through your mind.
41:18I don't want to get ill.
41:19I don't want my family to see me getting ill.
41:22Obviously, I want to be here.
41:23I want to see my grandkids grow up.
41:25I want to enjoy life with them.
41:28So, yeah, it certainly plays on your mind a fair bit.
41:32After analysing all the data from the trial,
41:41Becky must also bring those results back to the patients taking part.
41:45We have a job where things can be fantastic for one patient
41:50and then go to another patient and it's awful.
41:53And you're about to tell them something
41:56that's really going to change their life again.
42:10Hi.
42:12Hi, Damien.
42:13It's Becky Lee, the consultant.
42:15Hi.
42:15Are you OK?
42:16Just to let you know that your result is negative.
42:26So, great news.
42:29Brilliant.
42:30That's fantastic news.
42:33Fantastic.
42:35No, that's lovely.
42:37The sun's shining, so couldn't have been a better day.
42:40OK, well, I'll speak to you soon.
42:43Brilliant.
42:43Bye.
42:44Bye-bye.
42:46Couldn't be any better.
42:54Bank holiday on the horizon.
42:56Spend time with my family.
42:58With the all clear for now.
42:59Fantastic.
43:05Hi, Dal.
43:06How's it gone?
43:07Yeah, just got the phone call and we've got the all clear.
43:10Brilliant.
43:11Hope it's gone forever now.
43:13Yep.
43:13Onwards.
43:14We can plan the weekend now.
43:16I'll see you later, Dal.
43:18See you later.
43:19Bye.
43:19Bye.
43:27I think it's becoming very clear that biomarker tests in blood are changing how we even think
43:35about the early detection of cancer.
43:37They really are changing the game.
43:41I think it's the golden age of cancer research.
43:43It's massively exciting.
43:44You know, and at the moment, patients are giving blood in the hospital, but you might like to
43:51think in the years to come, we'll wear a wearable device, your smart watch or whatever it is
43:56you're wearing will say, beep, beep, beep, it's the first Tuesday in the month, pop down
44:01to your pharmacy to give your blood in, it's your routine blood test for cancer.
44:05You know, we're not there yet, but it's a nice future to think about because, you know,
44:12it is doable.
44:14And I think we'll get there.
44:15Three years on from his diagnosis, the mystery of where Lee's cancer started remains unsolved.
44:30All right, my knee?
44:30All right, Lee.
44:31Fellas, you all right?
44:35Oh, shit.
44:37Stop swearing.
44:39Don't think these lot drink in a Catholic club, would you?
44:45Who's on next?
44:47I've decided now cancer won't meet me.
44:51It's not going to get me down.
44:53Oh, lucky, mate.
44:55Because there's nothing I can do about it, so why worry?
44:58Why sit at home and go?
45:00Why me?
45:00Why me?
45:01It's me.
45:03And now we're three and a half years in.
45:05I'm still here now.
45:07Still enjoying myself, so.
45:12You know, Dr Cook said to me, and this gives you hope, and she said, what's not curable today
45:19could be curable tomorrow.
45:23The lads will pull us through.
45:27You can't give up life.
45:29Too precious.
45:32You've got to maintain that up.
45:36Listen, I'll go to heaven, mate.
45:39Yeah.
45:40Only if gates are locked downstairs.
45:43Sorry.
45:44I'm going to heaven.
45:45I'll let you open the gate for me.
45:49I'll let you open the gate for me.
45:49I'll let you open the gate for me.
45:50I'll let you open the gate for me.
45:51I'll let you open the gate for me.
45:51I'll let you open the gate for me.
45:52I'll let you open the gate for me.
45:52I'll let you open the gate for me.
45:53I'll let you open the gate for me.
45:53I'll let you open the gate for me.
45:54I'll let you open the gate for me.
45:55I'll let you open the gate for me.
45:56I'll let you open the gate for me.
45:56I'll let you open the gate for me.
45:57I'll let you open the gate for me.
45:58I'll let you open the gate for me.
45:59I'll let you open the gate for me.
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