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00:00I'm extremely determined, and I just don't give up.
00:09I'm a detective in the cancer world, trying to outfox cancer.
00:18It's giving us clues if we know where to look.
00:22We're trying to find tiny, tiny amounts of cancer DNA in the bloodstream,
00:32which is like finding a single grain of sand that matters amongst all the other grains of sand.
00:43The answers are there. We just have to find them, and that's my mission.
00:52For generations, a cancer diagnosis left almost no hope.
01:00It's a terrifying disease that has stalked us for millennia.
01:05I didn't expect I had cancer because all the tests were coming back negative.
01:09I don't think my body can take any more.
01:12Science has fought hard against it, and now the tide is finally turning.
01:17One of our key goals is to transform this idea of cancer as a death sentence.
01:24A group of trailblazing scientists are making new breakthroughs.
01:29We now need to take those discoveries and make them work for patients.
01:34This is the world's first lung cancer prevention vaccine.
01:39Discovering cures and finding ways to stop cancer before it even starts.
01:44The tumour seems to be shrinking.
01:46Your scan shows no active disease.
01:49Creating a future...
01:51Where cancer doesn't win.
01:54We're getting very close to defeating cancer once and for all.
01:59What's not curable today could be curable tomorrow.
02:02What should we소 and by the 29th maybe?
02:04What should I do?
02:06Just go past everything.
02:06What should I do?
02:07What should I do?
02:08What should I do?
02:09What should I do?
02:12What should I do?
02:17What should I do?
02:18What should I do?
02:24What should I do, Julia?
02:25Oh, my…
02:27I love working
02:34I've worked since we were 15 years old
02:37But at school
02:40I didn't want to be a mechanic
02:41I wanted to be a jockey
02:44But when you go and work
02:46Experience at school
02:47You couldn't find me a stable
02:49So I went in to be a mechanic
02:52And I loved it
02:53I always loved getting my hands dirty as a kid
02:56My mum didn't like it
02:57But I had to go home dirty
02:58I just love cars
03:01But a doctor told me
03:04I should have a few months off
03:06I was off four days
03:08I couldn't handle it
03:09Because this is normal for me
03:11And if I'm normal
03:13I haven't got cancer
03:14And that's the thing
03:17Four years ago
03:2358-year-old Lee
03:25He experienced pain in his back
03:27After playing golf
03:28But soon discovered
03:29It was more than a sports injury
03:31So I had two lumps in my back
03:34And my ribcage
03:35But I had pain
03:37Around my kidney area
03:38I couldn't sleep at night
03:40I couldn't walk
03:41I couldn't move
03:42Because of the pain
03:42A doctor sent me for an MRI scan
03:47And they scanned the tumour
03:49It was ten centimetres round
03:53So we had a biopsy
03:55And they come back and said
03:58It's cancer
03:59But it's a weird
04:01It's a strange cancer
04:02Because it's called something
04:03Called cancer unknown primary
04:05Never heard of it
04:08And I thought
04:09Well what do you mean
04:11Cancer unknown primary
04:12Cancer's cancer
04:13We can't find the primary source
04:15So I've got a tumour in my back
04:19Which I know about
04:19But if you can't find out
04:21Where it's originating
04:22How do you kill it?
04:23You can't
04:24So until it pops its head out
04:26It's like playing hide and seek
04:27So hopefully one day
04:30It'll pop its head out
04:31And then we'll kill it
04:33Hopefully
04:33You still don't know?
04:36No one knows
04:37No, no one knows
04:39I'm a mystery
04:41In Manchester
04:48Lee has joined a pioneering new project
04:51That seeks to solve his mysterious case
04:53By analysing the blood
04:55To unlock cancer's secrets
04:57Hiya
05:01Checked it
05:02Started, thank you
05:03Leading the initiative
05:08Is Professor Caroline Dive
05:10I've been thinking about
05:12How we fight cancer
05:14Ever since I was 25 years old
05:17Because cancer has always been
05:20One of the largest medical challenges
05:22For the human race
05:23Cancer is a disease of mutations
05:27And we all carry some gene mutations
05:30But for the most part
05:31For those of us who don't go on
05:33To develop cancer
05:34We live with them
05:35Cancer is a rogue ball of cells
05:39Growing somewhere in a body
05:41And it's taking over
05:42Those normal body processes
05:44And they have all these really lethal traits
05:48They move about around the body
05:50When they shouldn't
05:52They don't die when they should
05:55And that mutation
05:57And that mutation that sat there
05:57Suddenly now becomes very dangerous indeed
06:00I think about it
06:03I think about it as a very malevolent alien
06:05An alien within
06:07And really hard to beat
06:11At the Cancer Research
06:17UK National Biomarker Centre
06:19Caroline is looking at cancer
06:21Much closer than ever before
06:22By investigating the fluid
06:24That links everything
06:25Blood
06:26Hi guys
06:28How's your day going?
06:33Oh hi Chris
06:34Can we have a look at the organoids?
06:37I know the data sounded really exciting
06:39So I'd like just to have a look
06:40Yes
06:40Alright
06:41We're looking at the molecular level
06:47With the new technologies
06:49We have at our fingertips
06:51We can detect
06:52Vanishingly small amounts
06:54Of cancer cell DNA
06:57In a tube of blood
06:58The answers are there
07:03In the blood
07:04We just have to find them
07:06And to sort of give you
07:11An idea of the scale of the challenge
07:13When we think about
07:14Thousands of cells
07:16Can fit on the head of a pin
07:18And we're looking for clues
07:20Which tell us
07:21How a cancer cell is behaving now
07:24And how that cancer cell
07:26May behave in the future
07:27Only by knowing those details
07:32Can we really solve
07:33The mysteries of cancer
07:35We are discovering
07:37What makes cancer tick
07:39My mission
07:41Is to take those discoveries
07:43And translate them
07:45Into useful
07:46Impactful tests
07:47Because if we can catch cancers
07:51In the bloodstream
07:52We should be able to
07:54Certainly give patients
07:56A much longer lifespan
07:58But in some cases
07:59Cure
07:59Caroline and her team
08:06Work closely
08:07With one of Europe's
08:08Leading cancer centres
08:10The Christie
08:11Hi Leigh
08:22Good morning
08:23How are you today?
08:23Alright thank you
08:24Oh good
08:24I'm just setting up
08:25For your bloods
08:26Okay
08:27Again
08:28Again
08:29Leigh has been undergoing
08:32A series of conventional
08:33Cancer treatments
08:34To slow down
08:35And his cancer's growth
08:36I think I've treated you
08:38A couple of times
08:38Yeah you have
08:38Yeah yeah
08:39I think everyone has now
08:40Yeah
08:41When you're talking
08:44To other cancer patients
08:45It's like a game of
08:47Top trumps
08:47What cancer have you got then
08:49And what have you got
08:50And then they all
08:51So I've got prostate cancer
08:52I've got bowel cancer
08:53Well what have you got
08:55And I go
08:55Cancer unknown primary
08:56What's that then?
08:58Other cancer patient
08:59I hadn't heard of it
09:00I hadn't heard of it
09:02Until I got to the Christie
09:03And said this is
09:04What you've got
09:05What I do before though
09:06Is just do your pulse
09:08At first it was daunting
09:11Because the general
09:12Life expectancy
09:14For cancer unknown primary
09:16Is about nine months
09:17Nearly nine months
09:19Isn't a lot
09:19So I think right
09:20What do I cram in
09:21In nine months?
09:23And then coming here
09:25And thinking well
09:25I'm coming here
09:26To pass me time
09:28But when you come
09:34And you find out
09:35All the fantastic work
09:36The doctors
09:36The nurses
09:37They're doing
09:37Everyone's fighting
09:39Your corner
09:39In every cancer
09:41Not just mine
09:42They want to find a cure
09:44We are learning more
09:52Every day
09:53And I am actually
09:54Very optimistic
09:55That significant improvements
09:57Are coming
09:57But at the same time
09:59You've got to have
09:59Your motivation
10:00And what better motivation
10:02Can there be
10:03Than walking through
10:04The corridors
10:05Seeing people with cancer
10:07It's very fulfilling for me
10:11Having the National Biomarker Centre
10:14In the same building
10:15As the Christie Hospital
10:16Let me just make sure
10:18That I've got all the pictures
10:19That I need
10:20The idea is just to bring us
10:22All together
10:22In that same environment
10:24The clinicians
10:25The scientists
10:26Hi Natalie
10:27We develop new laboratory tests
10:32And then we test them
10:35In patients on clinical trials
10:36In Lee's case
10:39We want to find out
10:40Where his cancer started
10:42Because blood is circulating
10:44Around the whole body
10:46Bathing wherever that tumour is
10:48There's going to be blood flow
10:49So we just clean the area now
10:52Because my veins now are
10:59Starting to close
11:01Because of all the treatments
11:02I've had
11:02They put now
11:04A port into my vein
11:05There you see
11:06And it's like a little valve
11:09There you can access
11:10To get your blood
11:12Rather than try and find a vein
11:13You've had a lot of chemotherapy
11:16Haven't you?
11:16Yeah, so
11:17So your veins have had enough
11:18Yeah, they give up the gulsh
11:19Yeah
11:20We couldn't do research
11:22Without people like Lee
11:24Donating his blood samples
11:26It's like a dartboard, isn't it?
11:29Oh, I'm good at darts
11:30For Lee to benefit from their findings
11:32It's a race against the clock
11:34Right, one, two, three
11:35Nice deep breath in
11:36The more blood they take off me
11:41To try and find it
11:42Hopefully I can find
11:44Where the cancer has come from
11:46And then create a drug
11:49Anything to try and find a cure quicker
11:50There we go
11:52That's what I've donated for
11:54I'm coming now
11:55I'll have a pint left
11:57Watch a second anyway
11:58It's precious, isn't it?
12:01Your blood
12:12In Manchester, Caroline Dive is developing a series of revolutionary blood tests
12:18That can detect cancer at the molecular level
12:21We're making momentous discoveries about the biology of cancer from a tube of blood
12:28We take samples from patients
12:31Just maybe a tablespoon of their blood
12:34It comes to the lab
12:36And then the real challenge is to see how much we can learn from that tube of blood
12:41One of these blood tests aims to detect cancer early enough to try and stop it before it can even get started
12:48You have to know your enemy to have a good fight and stand a chance of winning
12:52And in this case, with cancer as the enemy, the younger you know that enemy, the better
12:58It's critical that we detect cancers at their earliest stage
13:02And the real question is, can we detect cancer even earlier before cells transition into a cancerous state
13:12That pre-cancerous state, when it's more treatable
13:15And that's a huge challenge
13:18Come on through
13:24Pop your key on that chair for me
13:28And then I need you to come and have a lie down for me
13:31Yeah
13:32Another patient hoping to take part in a clinical trial is 49-year-old Damien
13:40He's having a check-up following surgery a year ago that removed a melanoma skin cancer from his back
13:46They did say it's quite aggressive, luckily we caught it quite soon
13:50But you're thinking the worst
13:54When I went to the specialist and they measure you up and how much they're going to take
14:00They draw it on your back and it was like, Jesus, that's quite big that
14:04This was the start of it all basically
14:1323rd of July I think it was, 2024
14:16Yeah, it's funny to see how small it was at the time
14:20It seemed so insignificant, but obviously ended up not being
14:25I wouldn't have even known it were there
14:30It was my son that's seen it
14:32I'd got out of the shower and she said, what's that on your back, Dad?
14:37I looked in the mirror and it looked a bit like a cocoa pop
14:41After that period, it really grown quick
14:46It went from, obviously, what you're seeing there to that
14:50Cancer's like an ugly thing that looks like it does harm and damage
14:57That's what you pick up in your head and looking at the page
14:59It looks like cancer
15:01Soon after first spotting the growth, Damien went to get it checked
15:08And then had to break the news to his family that it was skin cancer
15:11I just felt sick
15:15You're scared to death, you know, ultimately I could potentially lose
15:19My best friend, love of my life
15:21We've been together 25 years
15:22And that's not the plan
15:24We're going to grow old together
15:26I cannot imagine him not being by my side
15:29For all that he drives me mad
15:31I just can remember driving to work
15:36Really heartbroken thinking
15:37I don't know how this is going to impact us as a family now
15:41Will Damien need a certain level of care or treatment?
15:46Has it spread?
15:47So, yeah, the whole thing implodes
15:49I pray
15:52Love one
15:53They give you, like, a 25% chance that it could come back in the first year
16:00God, God
16:02You start reading up on the type of skin cancer
16:04It's fast-growing, it likes to travel
16:07It likes to travel to your brain
16:08And that was, like, the eye-opener for me
16:12Jesus, it's not good
16:14Well, I saw myself
16:15You try not to, but you always think of
16:20How long are you going to be here?
16:22Can I afford to keep the house?
16:23Can I keep my job?
16:24How can I look after the kids?
16:27You've never got that all clear
16:29You never know
16:29That's the scary thing
16:31Today, Damien will find out if he is eligible for the detection trial
16:43That tests melanoma patients after surgery
16:46To try and determine if their cancer has recurred
16:49Basically, they're more clear at the moment
16:53But it's weird
16:54Little aches and pains
16:55Normally, you wouldn't even think twice about
16:58You think, could that be cancer back again?
17:00A little itch
17:01Where my wounds
17:01Bingenitis
17:02All the little things
17:03That you don't really think of
17:05Until you've got cancer
17:06In the UK, around 18,000 new cases of melanoma are diagnosed every year
17:16Okay, so local anaesthetic
17:1820 mils, 0.25 with adrenaline
17:20It's extraordinary, the progress that has been made
17:24In understanding how tumours behave
17:26But there are limitations to all of our conventional types of treatment
17:31And detection of cancers
17:33Know that this is a melanoma
17:351.5 millimetres in thickness
17:38Whilst we have incredibly talented people
17:42Doing sophisticated surgery
17:44What we don't know when the tumour is removed
17:47Is whether every cancer cell in the body is gone
17:50And those little tiny tumour cells
17:53That were in that original cancer
17:55Had already moved around the body
17:57And landed in another organ
17:59But haven't yet grown into big masses
18:01That can be seen with an imaging scan
18:03If that's already happened
18:05Then there's a real chance that tumour might come back
18:08Rather than detecting melanoma
18:15With a conventional CT scan
18:16Caroline is proposing a groundbreaking new approach
18:20So a tissue biopsy
18:25Can tell you a lot about that tumour
18:27However, accessing the tumour in the patient
18:30Particularly if that tumour is in a fairly inaccessible place
18:33Is very invasive for patients
18:35And this has given rise to a whole new type of test
18:39Called a liquid biopsy
18:40Unlike a tumour biopsy
18:45Blood can be taken from a patient
18:48Again and again and again
18:50Without too much discomfort for the patient
18:53And can we find everything we can
18:57At the molecular level
18:58From a tube of blood
19:00So we diagnose cancer earlier
19:04Before it evolves
19:06Is there something that these tumour cells are
19:09Are putting into the bloodstream
19:11That we can pick up
19:12Your blood contains millions of cells
19:19And molecules floating around
19:21In a liquid called plasma
19:22If you have cancer
19:25There may also be cancer cells
19:27And dead bits of them
19:28Hidden in your blood
19:29That have been shed from your tumour
19:31Dead cancer cells can leak fragments
19:34Of tumour DNA into the blood
19:36But your blood also has millions of other fragments
19:41From your normal healthy DNA
19:43So finding a few fragments of circulating tumour DNA
19:49Is like trying to find a needle
19:52In a haystack
19:53Because the burden of cancer in a human being
19:58Is very low at this point
20:00There are very few molecules
20:02That we'll be able to measure
20:03So the test has to be very sensitive
20:08You know, and when we first studied it
20:12I don't know, 15 years ago
20:14Everybody was very, very doubtful
20:17That that would ever be a good thing to do
20:18And the problem is not one I alone could solve
20:23Dr. Becky Lee
20:28Is one of the clinical investigators
20:30Working with the National Biomarker Centre
20:32I've had, you know, a few eureka moments along the way
20:37And actually the detection trial
20:39Is based off one of those eureka moments
20:42Where you suddenly realise
20:44That actually you're seeing some data
20:46That no one else has seen
20:48When I was a PhD student
20:51I was really inspired by what Caroline was doing
20:55In her lab
20:56We were looking at patients with advanced melanoma
21:01I knew that we could detect cancer in patients with lots of cancer present
21:08So then I just thought
21:12Can we bring the cancer detection test to an earlier stage
21:18Where there wasn't any evidence of disease on the scan of patients
21:23To see if we could still see whether the melanoma was present
21:27And that would be a signal of melanoma coming back
21:30Becky used some blood samples from melanoma patients
21:34Whose tumour had been removed by surgery
21:37And spent months analysing them
21:39To see if she could identify whether cancer DNA was still present
21:43She sent her results to statisticians
21:46To check whether they matched with the patients
21:49Whose melanoma later returned
21:50That was a eureka moment
21:54When we suddenly knew that actually we were able to detect the ctDNA
21:59And it was able to predict this relapse
22:02And that was the moment that detection was really born
22:07It was incredible because it just came over on an email
22:10And there it was
22:11And just was like, oh wow, this is amazing
22:14And I was like, everyone come and see
22:16So yeah, it was cool
22:20We started with liquid biopsy in the early 2000s
22:27I think the first mutations that we measured in liquid biopsy
22:30Were in breast cancer and then lung cancer
22:32But it was really early days
22:33We were just finding our way
22:36We didn't use them at that point in clinical trials at all
22:39It must be really incredible to kind of watch a field
22:43From its early existence
22:46To actually then making that difference to the patients
22:49The advantage of being old
22:50You can look back
22:52You can look back
22:54After ten years of refining the process in the lab
23:00The liquid biopsy test is now ready
23:02To roll out into the clinic
23:04If I can get on this trial
23:06It takes away that worry
23:08For a simple blood test which is non-invasive
23:11It's taken about two minutes to have
23:13And have a team of brilliant people
23:15Check you that thoroughly
23:17Would be fantastic
23:18So obviously you've now had your surgery
23:24You've had the scan result
23:27Which hasn't shown any evidence that the melanoma's there
23:30Which is really good
23:31So I'm pleased to say that you're eligible to go on the trial
23:36That's brilliant
23:37Yeah
23:38Thank you
23:39And one piece of the puzzle really
23:43Yeah
23:44Because anything that reduces the risk was good
23:47But as soon as I heard there was trial
23:48I was there
23:49I'm definitely up for that one if I can get it
23:51That's brilliant
23:52Now we hope that we won't see any evidence of DNA coming from cancer cells
23:58And then you don't need any further treatment
24:00Which would be amazing
24:01Yeah
24:02But even if we did find the DNA present
24:06We would be treating it at a really early stage
24:10Where it's much more likely to respond
24:12Yeah
24:12But hopefully we'll never need to do that
24:15And we'll just monitor you very, very carefully with this blood test
24:18Fingers crossed
24:19Yeah
24:19Right, let's have a look at your veins
24:29Oh, I can see some
24:31Beautiful
24:32Really big news to know that I've got the clinical trial today
24:37Gives me a big hope
24:39Not just for me, for my family as well
24:41It eases their mind
24:42Because it's not just me worried
24:43It's everyone else in my family
24:44It's going to sound really random
24:47But all I've had in my head all morning
24:49Is the Strictly theme tune
24:50And that's all that's going round in my head
24:54I get that sometimes
24:55You have no idea where it's come from
24:56Be careful or else I'll start dancing to the Strictly theme tune
24:59Anything to break up the day
25:01Exactly
25:02It's not just another blood test
25:05It's to say that your cancer clear
25:08Not only that, if they do find it
25:10You're catching it as early as you possibly ever could
25:12And it's immediate treatment
25:15Which is phenomenal
25:16Scans can only pick up so much
25:19Whereas if you go in
25:20Into the depths of DNA in your blood
25:22You can't get any more minute scale than that, can you?
25:27There we are
25:28All done
25:29Perfect
25:30Damien's blood will be tested
25:35Along with the other patient's blood samples
25:36To see if they can see any signs of cancer DNA present
25:40This blood test is really moving things forward
25:47Samples for you
25:50Thank you very much
25:51In our current standard of care
25:52Patients will be offered regular scan follow-up
25:57But generally that's at least every three to six months
26:01So this blood test is getting that result back within ten days
26:09We don't want to hang around where cancer's concerned
26:13We want to get ahead of it
26:15Once the samples are in the lab
26:21The meticulous analysis begins
26:23To find the circulating tumour DNA
26:30First everything else in the blood that's not DNA is removed
26:33Then all the fragments in the sample
26:37Are compared with the patient's own healthy DNA
26:39If scientists spot DNA fragments that don't match
26:44It could mean the patient has cancer
26:47And what of course we're all hoping for
26:51For Damien
26:52Is a negative test
26:54And there is no sign of tumour
26:56And with these blood tests
26:58We can keep a really close eye on Damien
27:00And if his tumour comes back
27:02We can pick it up quickly
27:04I think we can't overpromise
27:13It's really important that we don't
27:14From a patient perspective
27:16This is a clinical trial
27:18This test is not yet available
27:20For example on the NHS
27:21So we're testing the test
27:23There's a lot more work to do
27:26But I'm very hopeful
27:26Basically you want peace of mind
27:32That I'm all clear
27:33For now
27:35Seagulls mum
27:52Look see there's the first one
27:53I reckon that bit goes there though
27:56I'll try that bit
27:57Yes that bit goes there as well
27:59Good
27:59We're cracking along nicely now
28:02Cooking on gas
28:04I just find it really therapeutic
28:07Well it's nice to sit with mum
28:08And do something we can both do together
28:09And I just find it very satisfying
28:12When the pieces go in
28:13Because most of the time
28:14The tasks that I perform
28:16Are very long term
28:18And not often completed in a day
28:20So it's nice just to have something
28:22You can get done
28:23She was a terrible baby
28:26She would not sleep
28:27In the end I got so frustrated
28:30I took her to the doctor
28:31And the doctor examined her
28:34Looked at her ears
28:35Looked at her eyes
28:36Looked at everything
28:36And he said
28:38I can't think anything's wrong with her
28:40He said
28:40I think she's got an overactive brain
28:42There you go
28:43And she will do very well in life
28:45I had a fantastic childhood
28:50We lived in a public school in Sussex
28:54Because my father was the head porter
28:56Didn't have any money
29:00And I went to a state school
29:02But yeah I saw if you like
29:03How the other half live
29:04But I never felt hard done by
29:07I just thought I lived in a really nice place
29:09With parents who really cared
29:11About what happened next
29:12In terms of my life
29:13My dad
29:15One of his top tips in my youth
29:17Was you know
29:18Every time you go to bed
29:19Just think about
29:20What did I learn today
29:21He loved learning and knowledge
29:24And he didn't get
29:26A very good education himself
29:27I think he left school
29:28At something like 13 years old
29:30And he was quite clever
29:31I mean he could have had
29:32He could have done very well
29:34He was clever
29:34He's a smart guy
29:36And I think you know
29:37He just wanted you to be
29:38The best you could possibly be
29:39At everything you tried to do
29:40And I think you know
29:42The need to achieve
29:44I think is sort of hardwired
29:45He was just a lovely man
29:49We miss him dreadfully
29:50I wish he was here
29:51He died two years ago now almost
30:00His liver was filled with masses
30:05Of tumours on the scan
30:07He became so ill
30:10And seeing him that ill
30:12Yeah it was difficult
30:14Because his last three months
30:15Were pretty miserable
30:16But up until that point
30:17He was strong and resilient
30:19And fought his way through it
30:20With great dignity actually
30:22Every time I saw him
30:25The last thing he said
30:26Was I love you
30:26You know
30:27It was emotional
30:29You know you never did know
30:33When was the last time
30:34And on his death certificate
30:39It said cancer of unknown primary
30:40Which is an intriguing type of cancer
30:44That has a very personal importance to me now
30:49And we've been working together now
30:51For many years
30:52To try and solve that problem
30:54And it will be a special moment for me
30:57To see the work we're doing now
30:59That could help patients
31:01With cancer of unknown primary
31:02In the future
31:03Because it must be awful
31:05Knowing you've got cancer
31:06But not knowing where it's come from
31:08With perhaps not a great chance
31:10Of improvement
31:11In 2021
31:20I found two little lumps
31:21On my ribcage at the back
31:23So I weren't really concerned
31:25About the lumps
31:25It was the pain
31:26The pain was more towards my kidney
31:29And over the weeks
31:31The pain got worse
31:32I understand how people
31:36With pain
31:38Could take their own life
31:40Because I honestly thought about it
31:41Because the pain was that bad
31:43I'm glad it didn't
31:46But yeah
31:49It was dark
31:50Lee was diagnosed with cancer
31:56Of unknown primary
31:57After a mass of tumours
31:59Were discovered in his kidney
32:00When I got the cancer
32:02I thought cancer's cancer
32:03That's it
32:04But I then to be told
32:05Cancer unknown primary
32:07I didn't understand
32:08What that meant
32:09You think to yourself
32:10Why?
32:10Why can't you find it?
32:12How I look at this
32:14And it's dead simple
32:14I woke up one morning
32:16And the little cancer gremlin's gone
32:18It's your turn today
32:19But you're having this special one
32:21You're having one we can't find
32:22And that's what the doctors say
32:24Doctors find patients like Lee
32:28So mysterious
32:29Because unlike all other cancer patients
32:31Nobody knows where their cancer first began
32:34When a cancer starts
32:40It's called a primary cancer
32:42And its type
32:43Is determined by its location
32:45Over time
32:49Cancer cells can break off
32:50And spread to other organs
32:52Forming secondary cancers
32:53This is called metastasis
32:57When doctors don't know where the cancer started
33:01It's called cancer of a known primary
33:03This is a perplexing type of cancer
33:13Because patients have advanced disease
33:16Only when you know where the tumour started
33:21Can you have a really rational discussion
33:24About what the right treatment would be
33:26Why does that matter for treatment?
33:27Because it has a different biology
33:29So it requires a different sort of treatment
33:33At the moment
33:36There is no personalised treatment
33:38For patients with cancer of unknown primary
33:40I think there's an idea
33:43That if you have a cancer in the brain
33:45It must be brain cancer
33:47That's not true
33:49If you sequence the DNA
33:50Of a primary lung cancer
33:52And let's say that primary lung cancer
33:55Moves and starts to grow in the brain
33:57And then you took that metastatic
33:59Secondary lesion in the brain
34:00And sequenced it
34:01It would look more like the lung cancer
34:03Than it would like anything
34:04That comes from the brain
34:05Okay Lee
34:08This is going to be 30 minutes
34:10Yeah
34:10Perfect
34:11Have you had any reaction in the past?
34:14No
34:14Because Lee's cancer was discovered so late
34:18It's spread
34:19And it's inoperable
34:21So Lee began a series of traditional treatments
34:24I had my first chemo session
34:26And they scanned me
34:27And it shrunk to half
34:29So the chemo was doing something
34:32So they gave me another three sessions of chemotherapy
34:37And said they're bringing this new drug out
34:39Called immunotherapy
34:40So that's going to be 30 minutes
34:43Any problem?
34:44Just let me know
34:45I will do
34:45I also had 10 sessions of radial therapy
34:50Which pinpoints the cancer
34:51So it's like lasers I think
34:53And it burns it
34:54But it can cause other side effects
34:57Like because it was so close to my kidney
34:59It could have destroyed my kidney
35:00But luckily it didn't
35:01So I had more chemo than the immunotherapy
35:05Which is
35:06It's keeping me here
35:07Touch wood
35:08Despite being given just nine months to live
35:14Lee has been receiving treatment
35:16At the Christie Hospital for three years
35:18He's been under the care of Dr Natalie Cook
35:21A leading expert in cancer of unknown primary
35:24We had multiple different investigations
35:28Ultrasound scans
35:29CT scans
35:30MRI scans
35:31Biopsies
35:32And after all of that
35:33We did not find out
35:35Anything that would help personalise his treatment options
35:38Unfortunately prognosis remains quite poor
35:43For most patients diagnosed with cancer of unknown primary
35:45Often it's around about three to six months
35:48But obviously Lee's done significantly better than that
35:51We don't know exactly why he's responded to immunotherapy
35:53But it's under control
35:55So he remains a true cancer of unknown primary
35:58Which is annoying to me
36:00Because I do like to try and find out where the cancer started
36:03And in his case it truly is still a mystery
36:05Have a seat Lee
36:07Thank you
36:08Right, how are you feeling today?
36:12Alright
36:13Yes?
36:14Since we last saw you here
36:15Has there been any changes?
36:17Nothing, no
36:18No, so feeling generally okay in yourself?
36:20Brilliant, yeah, no pain
36:21Okay
36:21No, I think you're definitely one of the kind of lucky ones
36:25Because the chemotherapy worked really well
36:26Yeah
36:27And that seems to be keeping things under control, doesn't it?
36:30Yeah, I've done like 53 or 54 treatments now
36:33Yeah, let me just go back to when you first started
36:36Was on, was February 2022
36:39Right
36:41So over three years now
36:42So that's amazing
36:43I understand, but if you can't find the primary source of a cancer
36:47You're not going to cure it
36:48You can't, you can generally look after it
36:50But I'm not holding out
36:52Because if you can't find it after three years now
36:56I think it's hidden itself
36:57But I'm still here and fighting the corner
36:59Yes, I'd probably like to see it in long
37:01May it continue basically
37:02Yeah, I feel really good at the moment
37:04Yeah, she's my guardian angel
37:06No, don't put that on camera
37:09Natalie's investigations uncovered that little research had been done in this particular field
37:19So she got in touch with Caroline to get her help
37:23Together we've been able to develop this test
37:26That we call CUPID
37:28Cancer of Our Unknown Primary Identification
37:31Or CUPID
37:32And we're hoping that by taking a blood sample from a patient
37:36We can have a pretty good idea of where that tumour started
37:40This blood test is a little different
37:48In as much as we look at the fragments of cancer cell DNA
37:52Shed into the bloodstream
37:53But we can also look for the pattern of molecules which are on it
37:59And those patterns, it's a bit like a postcode
38:04They can tell us which organ in the body the tumour started off in
38:09So if you have a tumour that starts in the liver
38:12Guess what?
38:14It'll have a liver postcode
38:15We can measure those postcodes in the DNA
38:19And we can tell you where the tumour started from
38:22In order to isolate this data
38:27They use metal beads coated in a protein
38:30Which the tumour DNA will bind to
38:33A magnetic strip then attracts the DNA coated beads
38:37Enabling them to extract the molecules
38:40Millions of pieces of DNA are then analysed
38:44Allowing their codes to be read
38:45We can now be fairly confident that we can predict
38:49A cancer of unknown primary started in the lung
38:52Or it started in the colon, in the gut
38:54And I think for those common cancers of unknown primary
38:59Within two weeks of the patient arriving in clinic
39:03I think we'll be able to make a diagnosis of where their cancer started
39:06But also the opportunity to direct a better treatment to your particular cancer
39:13So it's new pioneering work that we really feel we can do something to fix
39:20Caroline and Natalie have collected hundreds of blood samples from people with known cancers
39:25And are building an atlas of postcodes to map out where the cancer comes from
39:30So far the test can match unknown primaries to 29 common cancers
39:36But with over 200 different types of cancer there's still a long way to go
39:42I know it's incurable
39:47But hopefully it's manageable
39:50With all these treatments
39:51Now I know they're not going to last forever
39:53I know
39:55At a time they're going to say
39:57We've either got
40:00A cure for you
40:01And we've found it
40:04Or they're going to say
40:06There's not a lot more we can do
40:08It does bother me why I've got cancer
40:13Because I don't know why I've got cancer
40:16No one in my family has had it
40:18So why me?
40:20That's the answer that I think most cancer patients want
40:23Why?
40:24What have I done?
40:26It'd be nice to be told
40:27Right
40:29We've found where the cancer has come from
40:32Hopefully
40:33It'll be sooner than later
40:38That's the life that we strive for
40:57Sat there with a glass of whiskey watching the day go by
41:02Definitely look forward to her
41:04Reaching retirement age
41:05Damien is waiting to get the results from the trial
41:11To find out if any cancer DNA is still present in his blood
41:16No one ever looks forward to finding out if they've still got cancer or not
41:20Obviously everything runs through your mind
41:23I don't want to get ill
41:24I don't want my family to see me getting ill
41:27Obviously I want to be here
41:28I want to see my grandkids grow up
41:30I want to enjoy life with them
41:32So, yeah, it certainly plays on your mind a fair bit
41:43After analysing all the data from the trial
41:46Becky must also bring those results back to the patients taking part
41:50We have a job where things can be fantastic for one patient
41:55And then go to another patient and it's awful
41:59And you're about to tell them something that's really going to change their life again
42:03PHONE RINGS
42:16Hi
42:17Hi Damien, it's Becky Lee, the consultant
42:20Hi, are you okay?
42:22Just to let you know that your result is negative
42:27So, great news
42:34Brilliant, thank you, that's fantastic news
42:38Fantastic
42:40No, that's lovely, the sun's shining so
42:43Couldn't have been a better day
42:45Okay, well I'll speak to you soon
42:48Brilliant, bye
42:48Thank you, bye-bye
42:58Couldn't be any better
42:59Bank holiday on the horizon
43:01Spend time with my family
43:03With the all clear for now
43:04Fantastic
43:10Hiya, Dal
43:11How's it gone?
43:12Yeah, just got the phone call and we've got the all clear
43:15Oh, brilliant
43:16Hope it's gone forever now
43:17Yep
43:18Onwards, we can plan the weekend now
43:22I'll see you later, Dal
43:23See you, bye-bye
43:24Bye
43:33I think it's becoming very clear that biomarker tests in blood
43:37are changing how we even think about the early detection of cancer
43:43They really are changing the game
43:46I think it's the golden age of cancer research
43:48It's massively exciting
43:51You know, and at the moment the patients are giving blood in the hospital
43:55But you might like to think in the years to come
43:57We'll wear a wearable device
43:59Your smart watch or whatever it is you're wearing will say
44:02Beep, beep, beep, it's the first Tuesday in the month
44:05Pop down to your pharmacy to give your blood in
44:08It's your routine blood test for cancer
44:10You know, we're not there yet
44:14But it's a nice future to think about
44:16Because, you know, it is doable
44:19And I think we'll get there
44:25My voice
44:26How's it going?
44:27All right
44:27All right
44:27All right
44:28All right
44:28Cheap
44:29Three years on from his diagnosis
44:31The mystery of where Lee's cancer started remains unsolved
44:35All right, Marie
44:35All right, Lee
44:36Fellas
44:37You all right?
44:40Oh, shit
44:41Stop swearing
44:44Don't think these lot drink in a Catholic club, would you?
44:50Who's on next?
44:51I've decided now
44:53Cancer won't meet me
44:55It's not going to get me down
44:57Oh, lucky mate
44:59Because there's nothing I can do about it
45:02So why worry?
45:03Why sit at home and go
45:04Why me?
45:05Why me?
45:06It's me
45:06And now we're three and a half years in
45:10I'm still here now
45:12Still enjoying myself
45:17You know, Dr Cook said to me
45:20And this gives you hope
45:22And she said, what's not curable today
45:24Could be curable tomorrow
45:29The lads will pull us through
45:32You can't give up life
45:34It's too precious
45:35You've got to maintain that up
45:41Listen, I'll go to heaven, mate
45:44Yeah
45:45Only if gates are locked downstairs
45:48I'll tell you
45:49I'm going to heaven
45:53I'll let you open the gate for me
46:05Thank you
46:07Gracias por ver el video.
46:37Gracias por ver el video.
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