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00:00I'm extremely determined and I just don't give up I'm a detective in the
00:12cancer world trying to outfox cancer it's giving us clues if we know where to
00:22look we'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
00:40grains of sand the answers are there we just have to find them and that's my
00:48mission for generations a cancer diagnosis left almost no hope it's a
01:00terrifying disease that has stalked us for millennia I didn't expect I had
01:06cancer because all the tests were coming back negative I don't think my body can
01:10take any more science has fought hard against it and now the tide is finally
01:16turning one of our key goals is to transform this idea of cancer as a
01:22death sentence a group of trailblazing scientists are making new breakthroughs
01:28we now need to take those discoveries and make them work for patients this is the
01:35world's first lung cancer prevention vaccine discovering cures and finding
01:41ways to stop cancer before it even starts the tumor seems to be shrinking your
01:46scan shows no active disease creating a future where cancer doesn't win we're
01:54getting very close to defeating cancer once and for all what's not curable today
02:00could be curable too long
02:02yeah
02:04yeah
02:06yeah
02:08yeah
02:10yeah
02:12yeah
02:14yeah
02:16yeah
02:20yeah
02:24yeah
02:26yeah
02:28yeah
02:34I love working
02:36I've worked since we were 15 years old
02:38but at school I didn't want to be a mechanic
02:42I wanted to be a jockey
02:44but when you go and work experience at school you couldn't find me a stable
02:49but they didn't want to find me so I got I went in to be a mechanic and I loved it
02:53I always loved getting my hands dirty as a kid
02:56my mum didn't like it but I had to go home dirty
02:58I just love cars
03:02but a doctor told me I should have a few months off
03:06I was off four days
03:08I couldn't handle it because this is normal for me and if I'm normal I haven't got cancer
03:14and that's a thing
03:18four years ago
03:2458-year-old Lee experienced pain in his back after playing golf
03:28but soon discovered
03:30but soon discovered it was more than a sports injury
03:32so I had two lumps in my back of my rib cage
03:34but I had pain around my kidney area
03:38I couldn't sleep at night
03:40I couldn't walk
03:42I couldn't move because of the pain
03:44a doctor sent me for an MRI scan
03:46and they scanned the tumour
03:50it was ten centimetres round
03:54so we had a biopsy
03:56and they come back and said
03:58it's cancer
04:00but it's a weird, it's a strange cancer
04:02because it's called something called cancer unknown primary
04:06never heard of it
04:08and I thought well
04:10what do you mean cancer unknown primary?
04:12cancer is cancer
04:13we can't find the primary source
04:17so I've got a tumour in my back which I know about
04:20but if you can't find out where it's originate
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
04:28so hopefully one day it'll pop its head out
04:31and then we'll kill it
04:33hopefully
04:34you still don't know?
04:36no one knows
04:37no, no one knows
04:39I'm a mystery
04:47in 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
05:00hiya
05:01checked in
05:02sorted, thank you
05:07leading the initiative
05:08is Professor Caroline Dive
05:10I've been thinking about how we fight cancer
05:14ever since I was 25 years old
05:17because cancer has always been
05:20one of the largest medical challenges for the human race
05:24cancer 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 to develop cancer
05:33we live with them
05:35cancer is a rogue ball of cells
05:38growing somewhere in a body
05:40and it's taking over those normal body processes
05:43and they have all these really lethal traits
05:47they move about around the body when they shouldn't
05:51they don't die when they should
05:54and that mutation that sat there
05:57suddenly now becomes very dangerous indeed
05:59I think about it as a very malevolent alien
06:04an alien within
06:06and really hard to beat
06:10At the Cancer Research UK National Biomarker Centre
06:19Caroline is looking at cancer much closer than ever before
06:22by investigating the fluid that links everything
06:25blood
06:27Hi guys, how's your day going?
06:33Hi Chris
06:34Can we have a look at the organoids?
06:36I know the data sounded really exciting
06:38so I'd like just to have a look
06:40Yes
06:41Alright
06:45We're looking at the molecular level
06:48with the new technologies we have at our fingertips
06:51we can detect vanishingly small amounts
06:54of cancer cell DNA in a tube of blood
07:01The answers are there in the blood
07:04we just have to find them
07:08and to sort of give you an idea of the scale of the challenge
07:13when we think about thousands of cells
07:16can fit on the head of a pin
07:18and we're looking for clues
07:20which tell us how a cancer cell is behaving now
07:24and how that cancer cell may behave in the future
07:31Only by knowing those details
07:32can we really solve the mysteries of cancer
07:34We are discovering what makes cancer tick
07:37We are discovering what makes cancer tick
07:39My mission is to take those discoveries
07:43and translate them into useful, impactful tests
07:49Because if we can catch cancers in the bloodstream
07:52we should be able to certainly give patients
07:55a much longer lifespan
07:57but in some cases cure
08:04Caroline and her team work closely with one of Europe's leading cancer centres
08:09The Christie
08:11Hi Lee, good morning, how are you today?
08:23All right, thank you
08:24Oh good, I'm just setting up for your bloods
08:26OK
08:27Again
08:28Again
08:29Lee has been undergoing a series of conventional cancer treatments
08:34to slow down his cancer's growth
08:36I think I've treated you a couple of times
08:38Yeah, you have, yeah, yeah
08:39I think everyone has now
08:40Yeah
08:41When you're talking to other cancer patients
08:45it's like a game of top trumps
08:47What cancer have you got then?
08:48And what have you got?
08:50And then they all say
08:51Oh, I've got prostate cancer
08:52I've got bowel cancer
08:53Well, what have you got?
08:54And I go cancer unknown primary
08:56What's that then?
08:57Other cancer patient hadn't heard of it
09:00I hadn't heard of it until
09:01I got to the Christie and said
09:03this is what you've got
09:05What I do before though
09:06is just do your pulse
09:09At first it was daunting
09:10because
09:11the general
09:12life expectancy
09:13from cancer unknown primary
09:15is about nine months
09:17Nearly nine months isn't a lot
09:19So I think, right
09:20what do I cram in in nine months?
09:22and then
09:24coming here and thinking
09:25well
09:26I'm coming here to
09:27pass me time
09:31Can I just have a look at you?
09:32Yeah, sure
09:33But when you come
09:34and you find out
09:35all the fantastic work
09:36the doctors, the nurses
09:37they're doing
09:38everyone's fighting your corner
09:40in every cancer
09:41not just mine
09:43they want to find a cure
09:45We are learning more every day
09:52and I am actually very optimistic
09:54that significant improvements are coming
09:57but at the same time
09:58you've got to have your motivation
10:00and what better motivation can there be
10:02than walking through the corridors
10:04seeing people with cancer
10:06It's very fulfilling for me
10:11having the National Biomarker Centre
10:13in the same building
10:14as 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
10:21to bring us all together
10:22in that same environment
10:23the clinicians
10:24the scientists
10:25Hi Natalie
10:27We develop new laboratory tests
10:32and then we test them
10:34in patients on clinical trials
10:38In Lee's case
10:39we want to find out
10:40where his cancer started
10:42because blood is circulating
10:44around the whole body
10:45bathing
10:46wherever that tumour is
10:47there's going to be blood flow
10:50Let me just clean the area now
10:57because my veins now are
11:00starting to close
11:01because of all the treatments
11:02I've had
11:03they put now
11:04a port into my vein there
11:06you see it
11:07and it's like a little valve there
11:09that you can access
11:11to get your blood
11:12rather than try and find a vein
11:14You've had a lot of chemotherapy haven't you?
11:16Yeah so
11:17So your veins have had enough
11:18Yeah, they give up the gulf, yeah
11:20We couldn't do research
11:22without people like Lee
11:24donating his blood samples
11:26It's like a dart board isn't it?
11:29Well 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
11:39The 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
11:48anything to try and find a cure quicker
11:51There we go
11:52That's what I've donated for
11:54I'm coming now
11:56I'll have a pint left
11:57what's a sick anyway?
12:00It's precious isn't it?
12:01The blood
12:02In Manchester, Caroline Dive is developing a series of revolutionary blood tests that can detect cancer at the molecular level
12:20We're making momentous discoveries about the biology of cancer from a tube of blood
12:27We take samples from patients, just maybe a tablespoon of their blood, it comes to the lab
12:35and 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 to 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
13:03And the real question is, can we detect cancer even earlier before cells transition into a cancerous state, that pre-cancerous state, when it's more treatable?
13:15And that's a huge challenge
13:23Come on through
13:27Pop your key on that chair for me
13:29And then I need you to come and have a lie down for me
13:31Yeah
13:35Another patient hoping to take part in the 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
13:47They did say it's quite aggressive, luckily we caught it quite soon
13:51But you're thinking the worst
13:56When 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
14:10This was the start of it all basically
14:1423rd of July I think it was, 2024
14:18Yeah, it's funny to see how small it was at the time
14:21It seemed so insignificant, but obviously ended up not being
14:28I wouldn't have even known it were there
14:31It 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?
14:38And I looked in the mirror and it looked a bit like a cocoa pop
14:42After that period, it really grown quick
14:46It went from, obviously what you've seen there, to that
14:52Cancer's like an ugly thing that looks like it does harm and damage
14:56That's what you pick up in your head and looking at the picture
14:59It looks like cancer
15:04Soon 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
15:14I just felt sick
15:16You'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
15:33I just can remember driving to work
15:36Really heartbroken thinking
15:38I 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?
15:45Has it spread?
15:47So yeah, the whole thing implodes
15:48I pray
15:52Love one
15:56They give you like a 25% chance that it could come back in the first year
16:01Go on
16:03You start reading up on the type of skin cancer, it's fast growing
16:06It likes to travel, it 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
16:16You try not to but you always think of how long are you going to be here?
16:21Can I afford to keep the house? Can I keep my job?
16:24How can I look after the kids?
16:26You've never got that all clear, you never know
16:29That's the scary thing
16:30That's the scary thing
16:39Today, 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, I'm all clear at the moment
16:53But it's weird, little aches and pains
16:56Normally you wouldn't even think twice about it
16:58You think, could that be cancer back again?
17:00A little lich, where my wounds, bingenitis
17:02All the little things that you don't really think of until you've got cancer
17:06In the UK, around 18,000 new cases of melanoma are diagnosed every year
17:16Okay, so local anaesthetic, 20 mils, 0.25 with adrenaline
17:21It'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
17:361.5 millimetres in thickness
17:39Whilst we have incredibly talented people doing sophisticated surgery
17:44What we don't know when the tumour is removed
17:48Is whether every cancer cell in the body is gone
17:51And those little tiny tumour cells that were in that original cancer
17:55Had already moved around the body
17:57And landed in another organ
18:00But haven't yet grown into big masses that can be seen with an imaging scan
18:04If that's already happened, then there's a real chance that tumour might come back
18:13Rather than detecting melanoma with a conventional CT scan
18:17Caroline is proposing a groundbreaking new approach
18:20So a tissue biopsy can 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 called a liquid biopsy
18:39Unlike a tumour biopsy
18:43Unlike a tumour biopsy
18:46Blood 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 at the molecular level
18:58From a tube of blood
19:00So we diagnose cancer earlier
19:04Before it evolves
19:05Is there something that these tumour cells are putting into the blood stream
19:11That we can pick up?
19:16Your blood contains millions of cells and molecules floating around in a liquid called plasma
19:23If you have cancer, there may also be cancer cells and dead bits of them hidden in your blood
19:29That have been shed from your tumour
19:31Dead cancer cells can leak fragments of tumour DNA into the blood
19:36But your blood also has millions of other fragments from your normal healthy DNA
19:43So finding a few fragments of circulating tumour DNA is like trying to find a needle in a haystack
19:53Because the burden of cancer in a human being is very low at this point
20:01There are very few molecules that we'll be able to measure
20:04So the test has to be very sensitive
20:08You know, and when we first studied it, I don't know, 15 years ago
20:13Everybody was very, very doubtful that that would ever be a good thing to do
20:18And the problem is not one I alone could solve
20:23Dr Becky Lee is one of the clinical investigators working with the National Biomarker Centre
20:31I've had, you know, a few eureka moments along the way
20:37And actually the detection trial is based off one of those eureka moments
20:41Where you suddenly realise that actually you're seeing some data that no-one else has seen
20:47When I was a PhD student, I was really inspired by what Caroline was doing in her lab
20:56We were looking at patients with advanced melanoma
21:02I knew that we could detect cancer in patients with lots of cancer present
21:08So then I just thought, can we bring this 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
21:31Becky used some blood samples from melanoma patients
21:34Whose tumour had been removed by surgery
21:37And spent months analysing them
21:40To see if she could identify whether cancer DNA was still present
21:44She sent her results to statisticians
21:47To check whether they matched with the patients whose melanoma later returned
21:53That was a eureka moment when we suddenly knew that actually we had to
21:57We were able to detect the CT DNA and it was able to predict this relapse
22:01And that was the moment that detection was really born
22:07It was incredible because it just came over on an email and there it was
22:11And just was like, oh wow, this is amazing
22:14And I was like, everyone come and see
22:17So yeah, it was cool
22:22We started with liquid biopsy in the early 2000s
22:26I think the first mutations that we measured in liquid biopsy were in breast cancer
22:30And then lung cancer
22:32But it was really early days
22:34We were just finding our way
22:36We didn't use them at that point in clinical trials at all
22:40It must be really incredible to kind of watch a field from its early existence
22:46To actually then making that difference to the patients
22:49That's the advantage of being old
22:51You can look back, you can look back
22:53After ten years of refining the process in the lab
22:57The liquid biopsy test is now ready to roll out into the clinic
23:04If I can get on this trial, it takes away that worry
23:08For a simple blood test which is non-invasive
23:10It takes about two minutes to have
23:13And have a team of brilliant people check you that thoroughly
23:17Would be fantastic
23:21So obviously you've now had your surgery
23:24You've had the scan result which hasn't shown any evidence that the melanoma is there
23:30Which is really good
23:32So I'm pleased to say that you're eligible to go on the trial
23:37That's brilliant
23:39Thank you
23:41And one piece of the puzzle really
23:44Because anything that reduces the risk was good
23:47But as soon as I heard there was trial
23:49I'm definitely up for that one if I can get it
23:51That's brilliant that
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 which would be amazing
24:02Yeah
24:04But even if we did find the DNA present
24:07We would be treating it at a really early stage where it's much more likely to respond
24:12Yeah
24:14But hopefully we'll never need to do that
24:16And we'll just monitor you very, very carefully with this blood test
24:18Fingers crossed
24:19Yeah
24:27Right, let's have a look at your veins
24:30Oh, I can see some
24:32Beautiful
24:34Really big news to know that I've got the clinical trial today
24:38Gives me a big hope, not just for me, for my family as well
24:41It eases their mind because it's not just me worried, it's everyone else in my family
24:44It's going to sound really random but all I've had in my head all morning is the Strictly theme tune
24:50And that's all that's going round in my head
24:54I get that sometimes, you 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
25:02Yes
25:03It's not just another blood test, it's to say that your cancer clear
25:08Not only that, if they do find it, you're catching it as early as you possibly ever could
25:13And it's immediate treatment, which is phenomenal
25:17Scans can only pick up so much, whereas if you go into the depths of DNA in your blood
25:22You can't get any more minute scale than that, can you?
25:27There we are
25:29Well done
25:30Perfect
25:33Damien's blood will be tested along with the other patient's blood samples
25:37To see if they can see any signs of cancer DNA present
25:44This blood test is really moving things forward
25:49Samples for you
25:50Thank you very much
25:51In our current standard of care
25:53Patients will be offered regular scan follow-up
25:57But generally, that's at least every three to six months
26:03So, this blood test is getting that result back within ten days
26:09We don't want to hang around where cancer is concerned
26:13We want to get ahead of it
26:14Once the samples are in the lab, the meticulous analysis begins
26:27To find the circulating tumour DNA, first everything else in the blood that's not DNA is removed
26:33Then all the fragments in the sample are compared with the patient's own healthy DNA
26:38If scientists spot DNA fragments that don't match, it could mean the patient has cancer
26:48And what of course we're all hoping for, for Damien, is a negative test
26:54And there is no sign of tumour
26:55And with these blood tests, we can keep a really close eye on Damien
27:01And if his tumour comes back, we can pick it up quickly
27:04I think we can't over promise, it's really important that we don't
27:09From a patient perspective, this is a clinical trial
27:14This test is not yet available, for example, on the NHS
27:19So we're testing the test
27:21There's a lot more work to do, but I'm very hopeful
27:26Basically, you want peace of mind that I'm all clear for now
27:30Basically, you want peace of mind that I'm all clear for now
27:51Seagulls, Mum, look, see, there's the first one
27:54I reckon that bit goes there, though, I'll try that bit
27:57Yes, that bit goes there as well
27:59Good
28:01Cracking along nicely now
28:03Cooking on gas
28:05I just find it really therapeutic
28:07Well, it's nice to sit with Mum and do something we can both do together
28:10And I just find it very satisfying when the pieces go in
28:13Because most of the time, the tasks that I perform are very long-term
28:18And not often completed in a day
28:20So, it's nice just to have something you can get done
28:23She was a terrible baby, she would not sleep
28:28In the end, I got so frustrated, I took her to the doctor
28:32And the doctor examined her, looked at her ears, looked at her eyes, looked at everything
28:37And he said, I can't think anything's wrong with her, he said
28:40I think she's got an overactive brain
28:42There you go
28:43And she will do very well in life
28:44I had a fantastic childhood
28:50We lived in a public school in Sussex
28:54Because my father was the head porter
28:59Didn't have any money, and I went to a state school
29:02But yeah, I saw, if you like, how the other half live
29:04But I never felt hard done by, I just thought I lived in a really nice place
29:09With parents who really cared about what happened next in terms of my life
29:14My dad, one of his top tips in my youth was, you know, every time you go to bed
29:19Just think about what did I learn today
29:22He loved learning and knowledge
29:24And he didn't get a very good education himself
29:27I think he left school at something like 13 years old
29:29Oh, and he was quite clever
29:31I mean, he could have had a, he could have done very well
29:34He was clever, he was a smart guy
29:36And I think, you know, he just wanted you to be the best you could possibly be
29:39At everything you tried to do
29:41And I think, you know, this, this, the need to achieve
29:44I think is sort of hardwired
29:47He was, he was just a lovely man
29:49We miss him dreadfully, it's, I wish he was here
29:50He died two years ago now, almost
30:00His liver was filled with masses of tumours on the scan
30:07He became so ill
30:10And seeing him that ill
30:12Yeah, it was difficult because his last three months were pretty miserable
30:15But up until that point, he was strong and resilient
30:19And, and fought his way through it with great, great dignity, actually
30:24Every time I saw him, the last thing he said was, I love you
30:27You know, it was emotional
30:32You know, you never did know when was the last time
30:37And on his death certificate, it 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 for many years to try and solve that problem
30:54And it will be a special moment for me to see the work we're doing now
30:59That could help patients with cancer of unknown primary in the future
31:03Because it must be awful knowing you've got cancer but not knowing where it's come from
31:07With perhaps not a great chance of improvement
31:19In 2021, I found two little lumps on my ribcage at the back
31:23So I weren't really concerned about the lumps, it was the pain
31:26The pain was more towards my kidney
31:29And over the weeks, the pain got worse
31:31I understand how people with pain could take their own life because I honestly thought about it
31:42Because the pain was that bad
31:44I'm glad it didn't
31:48But yeah, it was dark
31:54Lee was diagnosed with cancer of unknown primary after a mass of tumours were discovered in his kidney
32:00When I got the cancer, I thought, cancer's cancer, that's it
32:04But then to be told, cancer's unknown primary
32:07I didn't understand what that meant
32:09You think to yourself, why? Why can't you find it?
32:12How I look at this and it's dead simple
32:15I woke up one morning and the little cancer gremlin's gone, it'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
32:26Doctors find patients like Lee so mysterious
32:29Because unlike all other cancer patients, nobody knows where their cancer first began
32:39When a cancer starts, it's called a primary cancer
32:42And its type is determined by its location
32:45Over time, cancer cells can break off and spread to other organs forming secondary cancers
32:53This is called metastasis
32:57When doctors don't know where the cancer started, it's called cancer of unknown primary
33:02This is a perplexing type of cancer because patients have advanced disease
33:19Only when you know where the tumour started can you have a really rational discussion about what the right treatment would be
33:26Why does that matter for treatment?
33:28Because it has a different biology
33:30So it requires a different sort of treatment
33:35At the moment, there is no personalised treatment for patients with cancer of unknown primary
33:41I think there's an idea that if you have a cancer in the brain, it must be brain cancer
33:47That's not true
33:49If you sequence the DNA of a primary lung cancer
33:52And let's say that primary lung cancer moves and starts to grow in the brain
33:57And then you took that metastatic secondary lesion in the brain and sequenced it
34:01It would look more like the lung cancer than it would like anything that comes from the brain
34:08Okay Lee, this is going to be 30 minutes
34:10Yeah, perfect
34:12Have you had any reaction in the past?
34:14No
34:16Because Lee's cancer was discovered so late, it's spread and it's inoperable
34:20So Lee began a series of traditional treatments
34:24I had my first chemo session and they scanned me and it shrunk to half
34:29So the chemo, it was doing somewhat
34:32So they gave me another three sessions of chemotherapy
34:37They said they're bringing this new drug out called immunotherapy
34:40So that's going to be 30 minutes, any problem, just let me know
34:44I will do
34:45I also had 10 sessions of radiotherapy which pinpoints the cancer
34:51So it's like lasers I think and 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 but luckily it didn't
35:02So I had more chemo than the immunotherapy which is, it's keeping me here
35:06It's keeping me here, Torchwood
35:09Despite being given just nine months to live, Lee has been receiving treatment at the Christie Hospital for three years
35:18He's been under the care of Dr Natalie Cook, a leading expert in cancer of unknown primary
35:24We had multiple different investigations, ultrasound scans, CT scans, MRI scans, biopsies
35:32And after all of that we did not find out anything that would help personalise his treatment options
35:38Unfortunately prognosis remains quite poor for 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
35:50We don't know exactly why he's responded to immunotherapy but it's under control
35:55So he remains a true cancer of unknown primary
35:58Which is annoying to me because 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
36:09Right, how are you feeling today?
36:12All right
36:14Since we last saw you here, has there been any changes?
36:17Nothing, no
36:18So feeling generally okay on yourself?
36:19Brilliant, yeah, no pain
36:21Okay, no I think you're definitely one of the kind of lucky ones
36:25Because the chemotherapy worked really well
36:27Yeah
36:28And that seems to be keeping things under control, doesn't it?
36:30Yeah, I've done like 53 or 54 treatments
36:33Yeah, let me just go back to when you first started was on, was February 2022
36:40Right
36:41So over three years now, so that's amazing
36:42I understand but if you can't find the primary source of a cancer, you're not going to cure it
36:48You can't, you can generally look after it
36:51But I'm not holding out because you, 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
36:59Yes
37:00I'd probably like to see it in long, may it continue basically
37:03Yeah, I feel really good at the moment
37:05Yeah, she's my guardian angel
37:07No, don't put that on camera
37:14Natalie'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 that we call CUPID
37:28Cancer of Our Unknown Primary Identification, or 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
37:39This blood test is a little different in as much as we look at the fragments of cancer cell DNA
37:52Shed into the bloodstream
37:54But we can also look for the pattern of molecules which are on it
38:00And 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
38:13Guess what? It'll have a liver postcode
38:16We can measure those postcodes in the DNA
38:20And we can tell you where the tumour started from
38:25In order to isolate this data
38:28They use metal beads coated in a protein which the tumour DNA will bind to
38:33A magnetic strip then attracts the DNA-coated beads
38:36Enabling them to extract the molecules
38:40Millions of pieces of DNA are then analysed, allowing their codes to be read
38:46We can now be fairly confident that we can predict a 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
39:07But also the opportunity to direct a better treatment to your particular cancer
39:12So it's new pioneering work that we really feel we can do something to fix
39:19Caroline 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
39:35But with over 200 different types of cancer, there's still a long way to go
39:45I know it's incurable
39:47But hopefully it's manageable with all these treatments
39:51Now I know they're not going to last forever
39:53I know at a time they're going to say
39:57We've either got a cure for you
40:02And we've found it
40:04Or they're going to say
40:06There's not a lot more we can do
40:10It does bother me why I've got cancer
40:13Because I don't know why I've got cancer
40:15No 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 would be nice to be told
40:27Right
40:29We've found where the cancer has come from
40:31Hopefully
40:33It will be sooner than later
40:54That's the life that we strive for
40:57Sat there with a glass of whiskey watching the day go by
41:00Definitely look forward to her reaching 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
41:15No 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
42:03Hi Damien, it's Becky Lee the consultant
42:20Are 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
42:49Bye-bye
42:58Couldn't be any better
43:00Bank holiday on the horizon
43:01Spend time with my family
43:03With the all clear for now
43:05Fantastic
43:11How's it gone?
43:12Yeah, just got the phone call
43:14And we've got the all clear
43:16Hope it's gone forever now
43:17Yep
43:18Onwards, we can plan the weekend now
43:21I'll see you later, darling
43:23See you back, bye
43:24Bye
43:32I think it's becoming very clear that biomarker tests in blood
43:37Are changing how we even think about the early detection of cancer
43:42They really are changing the game
43:44I think it's the golden age of cancer research, it's massively exciting
43:49You know, and at the moment patients are giving blood in the hospital
43:54But 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
44:11You know, we're not there yet
44:13But it's it's a nice future to think about
44:16Because you know, it is doable
44:18And I think we'll get there
44:19And I think we'll get there
44:25Hi boys
44:27Hi son
44:29Three years on from his diagnosis
44:31The mystery of where Lee's cancer started
44:34Remains unsolved
44:35How many?
44:36You alright Lee?
44:37Fellas?
44:38You alright?
44:40Oh shit
44:42Stop swearing
44:44Don't think these lot drink in a catholic club would you?
44:50Who's on next?
44:52I've decided now
44:54Cancer won't meet me
44:56It's not going to get me down
44:58Oh lucky mate
45:00Because there's nothing I can do about it
45:02So why worry?
45:03Why sit at home and go
45:05Why me? Why me? It's me
45:07And now we're three and a half years in
45:10I'm still here now
45:12Still enjoying myself so
45:14You know, Dr Cook said to me
45:19And this gives you hope
45:22And she said what's not curable today
45:24Could be curable tomorrow
45:25The lads will pull us through
45:29The lads will pull us through
45:32You can't give up life
45:34It's too precious
45:37You've got to maintain that up
45:41Listen, I'll go to heaven mate
45:43Yeah
45:45Only if gates are locked downstairs
45:47I'll tell you
45:49I'm going to heaven
45:51I'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
46:24Let me open the gate for love
46:26Let's come to heaven
46:28Pet opens the gate as we enter seven
46:31I'll أوzt youfully
46:32I'll set you up in the gate for me
46:34And the gate is always over
46:37And the gate has a chance to escape
46:39The door and try to open the gate for you
46:41Because the gate is upper seat
46:44It will name only human being
46:46Now there's nothing we all can't turn
46:49Sleep is displayed
46:50And we're going to do
46:52You
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