- 3 months ago
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Short filmTranscript
00:00I'm extremely determined and I just don't give up.
00:10I'm a detective in the cancer world, trying to outfox cancer.
00:19It'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,
00:33which 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.
01:01It's a terrifying disease that has stalked us for millennia.
01:06I didn't expect I had cancer because all the tests were coming back negative.
01:10I don't think my body can take any more.
01:13Science 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.
01:47Your scan shows no active disease.
01:50Creating a future where 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.
02:02To learn.
02:03Oh, my God.
02:33I love working. I've worked since I was 15 years old. But at school, I didn't want to be a mechanic. I wanted to be a jockey. But when you go and work experience at school, you couldn't find me a stable. They didn't want to find me. So I got, I went in to be a mechanic and I loved it. I always loved getting my hands dirty as a kid. My mum didn't like it, but I had to go home dirty.
02:59I just love cars. But a doctor told me I should have a few months off. I was off four days. I couldn't handle it because this is normal for me. And if I'm normal, I haven't got cancer.
03:15And that's a thing.
03:17Four years ago, 58-year-old Lee experienced pain in his back after playing golf, but soon discovered it was more than a sports injury.
03:31So I had two lumps in my back and my rib cage, but I had pain around my kidney area. I couldn't sleep at night. I couldn't walk. I couldn't move because of the pain.
03:42A doctor sent me for an MRI scan. And they scanned the tumour. It was 10 centimetres round.
03:54So we had a biopsy and they come back and said, it's cancer. But it's a weird, it's a strange cancer because it's called something called cancer unknown primary.
04:05Never heard of it. And I thought, well, what do you mean cancer unknown primary? Cancer's cancer. We can't find the primary source.
04:17So I've got a tumour in my back, which I know about. But if you can't find out where it's originate, how do you kill it?
04:24You can't. So until it pops its head out, it's like playing hide and seek.
04:28So hopefully one day it'll pop its head out and then we'll kill it. Hopefully.
04:34You still don't know?
04:36No one knows. No, no one knows. I'm a mystery.
04:47In Manchester, Lee has joined a pioneering new project that seeks to solve his mysterious case by analysing the blood to unlock cancer's secrets.
04:58I've been thinking about how we fight cancer ever since I was 25 years old, because cancer has always been one of the largest medical challenges for the human race.
05:10Cancer is a disease of mutations. And we all carry some gene mutations, but for the most part, for those of us who don't go on to develop cancer, we live with them.
05:22Cancer is a rogue ball of cells growing somewhere in a body, and it's taking over those normal body processes.
05:27And they have all these really lethal traits. They move about around the body when they shouldn't. They don't die when they should.
05:34And that mutation that sat there suddenly now becomes very dangerous indeed.
05:41I think about it as a very malevolent alien. An alien within. And really hard.
05:48to beat.
06:01I think about it as a very malevolent alien, an alien within, and really hard to beat.
06:16At the Cancer Research UK National Biomarker Centre, Caroline is looking at cancer much closer than ever before by investigating the fluid that links everything, blood.
06:27Hi guys, how's your day going?
06:31Oh, hi Chris. Can we have a look at the organoids? I know the data sounded really exciting, so I'd like just to have a look.
06:45We're looking at the molecular level. With the new technologies we have at our fingertips, we can detect vanishingly small amounts of cancer cell DNA in a tube of blood.
06:58The answers are there, in the blood. We just have to find them.
07:06And to sort of give you an idea of the scale of the challenge, when we think about, you know, thousands of cells can fit on the head of a pin.
07:18And we're looking for clues, which tell us how a cancer cell is behaving now, and how that cancer cell may behave in the future.
07:28Only by knowing those details can we really solve the mysteries of cancer.
07:35We are discovering what makes cancer tick.
07:40My mission is to take those discoveries and translate them into useful, impactful tests.
07:50Because if we can catch cancers in the bloodstream, we should be able to certainly give patients a much longer lifespan, but in some cases cure.
08:00Caroline and her team work closely with one of Europe's leading cancer centres, the Christie.
08:12Hi, Lee, good morning. How are you today?
08:24All right, thank you.
08:25Oh, good. I'm just setting up for your bloods, OK?
08:27OK. Again.
08:28Again.
08:29Lee has been undergoing a series of conventional cancer treatments to 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, it's like a game of Top Trumps.
08:47What cancer have you got, then? And what have you got?
08:50And then they all say, oh, I've got prostate cancer, I've got bowel cancer.
08:53Well, what have you got? And I go, cancer unknown primary.
08:56What's that, then? Other cancer patient hadn't heard of it.
09:00I hadn't heard of it until I got to the Christie and said, this is what you've got.
09:05What I do before, though, is just do your pulse.
09:10At first, it was daunting, because the general life expectancy
09:15from cancer unknown primary is about nine months.
09:18Nearly nine months isn't a lot.
09:20So I think, right, what do I cram in in nine months?
09:24And then coming here and thinking, well, I'm coming here to pass me time.
09:32Yeah, sure.
09:33But when you come and you find out all the fantastic work, the doctors, the nurses, they're doing,
09:38everyone's fighting your corner.
09:40In every cancer, not just mine, they want to find a cure.
09:45We are learning more every day, and I am actually very optimistic that significant improvements are coming.
09:58But at the same time, you've got to have your motivation.
10:01And what better motivation can there be than walking through the corridors, seeing people with cancer?
10:07It's very fulfilling for me, having the National Biomarker Centre in the same building as the Christie Hospital.
10:16Let me just make sure that I've got all the pictures that I need.
10:20The idea is just to bring us all together in that same environment, the clinicians, the scientists.
10:26Hi, Natalie.
10:31We develop new laboratory tests, and then we test them in patients on clinical trials.
10:38In Lee's case, we want to find out where his cancer started.
10:42Because blood is circulating around the whole body, bathing, wherever that tumour is, there's going to be blood flow.
10:51Let me just clean the area now.
10:53Because my veins now are starting to close because of all the treatments I've had,
11:03they put now a port into my vein there, you see it?
11:07And it's like a little valve there that you can access to get your blood rather 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 without people like Lee donating his blood samples.
11:27It's like a dart board, isn't it?
11:29Oh, I'm good at darts.
11:30For Lee to benefit from their findings, it's a race against the clock.
11:34Right, one, two, three, nice deep breath in.
11:39The more blood they take off me to try and find it,
11:43hopefully I can find where the cancer has come from
11:46and then create a drug, anything to try and find a cure quicker.
11:52There we go.
11:53That's what I've donated for.
11:55Coming now.
11:56Well, I'll have a pint left, what's a second anyway?
12:00It's precious, isn't it? Your blood.
12:02In 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.
12:29We take samples from patients, just maybe a tablespoon of their blood.
12:35It 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.
12:49You have to know your enemy to have a good fight and to stand a chance of winning.
12:53And 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.
13:04And the real question is, can we detect cancer even earlier, before cells transition into a cancerous state,
13:13that pre-cancerous state, when it's more treatable?
13:17And that's a huge challenge.
13:23Come on through.
13:24Pop your key on that chair for me.
13:29And then I need you to come and have a lie down for me.
13:32Yeah.
13:36Another patient hoping to take part in the clinical trial is 49-year-old Damien.
13:41He'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.
13:50But 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.
14:04This was the start of it all basically. 23rd of July, I think it was, 2024.
14:18Yeah, it's funny to see how small it was at the time.
14:20It seemed so insignificant, but obviously ended up not being.
14:26I 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?
14:37And 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're seeing there to that.
14:50Cancer's like an ugly thing that looks like it, it does harm and damage.
14:57That's what you pick up in your head and looking at the PJ.
15:00It 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.
15:11I just felt sick.
15:14Well, you're scared to death. You know, ultimately, I could potentially lose my best friend, love of my life.
15:21We've been together 25 years and that's not the plan.
15:25We're going to grow old together.
15:27I cannot imagine him not being by my side for all that drives me mad.
15:34I just can remember driving to work really heartbroken thinking,
15:37I don't know how this is going to impact us as a family now.
15:42Will Damien need a certain level of care or treatment?
15:46Has it spread?
15:47So, yeah, the whole thing implodes.
15:52I pray.
15:53Love one.
15:56They give you, like, a 25% chance that it could come back in the first year.
16:02Come 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.
16:10And that was, like, the eye-opener for me.
16:13Jesus, it's not good.
16:15Well, I saw myself.
16:17You try not to, but you always think of, how long are you going to be here?
16:22Can I afford to keep the house? Can I keep my job?
16:25How can I look after the kids?
16:27You've never got that all clear, you never know.
16:30That's the scary thing.
16:31Today, Damien will find out if he is eligible for the detection trial that tests melanoma patients after surgery to try and determine if their cancer has recurred.
16:48Basically, they're more clear at the moment, but it's weird.
16:54Little 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 itch, where my wounds, bingenite.
17:03All the little things that you don't really think of until you've got cancer.
17:06You've got cancer.
17:10In the UK, around 18,000 new cases of melanoma are diagnosed every year.
17:17Okay, so local anaesthetic, 20 mils, 0.25 with adrenaline.
17:21It's extraordinary, the progress that has been made in understanding how tumours behave.
17:27But there are limitations to all of our conventional types of treatment and detection of cancers.
17:33Know that this is a melanoma, 1.5 millimetres in thickness.
17:39Whilst we have incredibly talented people doing sophisticated surgery,
17:45what we don't know when the tumour is removed is whether every cancer cell in the body is gone,
17:51and those little tiny tumour cells that were in that original cancer had already moved around the body
17:57and landed in another organ but 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.
18:12Rather than detecting melanoma with a conventional CT scan, Caroline is proposing a groundbreaking new approach.
18:21So a tissue biopsy can tell you a lot about that tumour.
18:28However, accessing the tumour in the patient, particularly if that tumour is in a fairly inaccessible place,
18:34is very invasive for patients.
18:36And this has given rise to a whole new type of test called a liquid biopsy.
18:40Unlike a tumour biopsy, blood can be taken from a patient again and again and again,
18:51without too much discomfort for the patient.
18:55And can we find everything we can at the molecular level from a tube of blood?
19:00So we diagnose cancer earlier, before it evolves.
19:07Is there something that these tumour cells are putting into the bloodstream that we can pick up?
19:17Your blood contains millions of cells and molecules floating around in a liquid called plasma.
19:22If you have cancer, there may also be cancer cells and dead bits of them hidden in your blood that have been shed from your tumour.
19:32Dead cancer cells can leak fragments of tumour DNA into the blood.
19:37But 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.
19:56Because 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.
20:05So the test has to be very sensitive.
20:08You know, and when we first studied it, I don't know, 15 years ago,
20:15everybody was very, very doubtful that that would ever be a good thing to do.
20:20And the problem is not one I alone could solve.
20:27Dr Becky Lee is one of the clinical investigators working with the National Biomarker Centre.
20:32I've had, you know, a few eureka moments along the way and actually the detection trial is based off one of those eureka moments where you suddenly realise that actually you're seeing some data that no one else has seen.
20:49When 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.
21:03I knew that we could detect cancer in patients with lots of cancer present.
21:11So then I just thought, can we bring this cancer detection test to an earlier stage where 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 and that would be a signal of melanoma coming back.
21:31Becky used some blood samples from melanoma patients whose tumour had been removed by surgery.
21:38And spent months analysing them to see if she could identify whether cancer DNA was still present.
21:43She sent her results to statisticians to check whether they matched with the patients whose melanoma later returned.
21:51That was a eureka moment when we suddenly knew that actually we had to, we were able to detect the CTDNA and it was able to predict this relapse.
22:01And that was the moment that detection was really born.
22:08It was incredible because it just came over on an email and there it was.
22:12Just was like, oh wow, this is amazing.
22:15I was like, everyone come and see.
22:17So yeah, it was, it was, 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 were in breast cancer and then lung cancer.
22:33But it was really early days.
22:35We were just finding our way.
22:37We didn't use them at that point in clinical trials at all.
22:39It must be really incredible to kind of watch a field from its early existence to 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.
22:57After 10 years of refining the process in the lab, the liquid biopsy test is now ready to roll out into the clinic.
23:05If I can get on this trial, it takes away that worry.
23:09For a simple blood test, which is non-invasive, it's taken about two minutes to have.
23:14And have a team of brilliant people check you that thoroughly would be fantastic.
23:23So obviously you've now had your surgery.
23:25You've had the scan result, which hasn't shown any evidence that the melanoma is there, which is really good.
23:31Yeah.
23:33So I'm pleased to say that you're eligible to go on the trial.
23:37That's brilliant.
23:38Yeah.
23:41And one piece of the puzzle, really.
23:44Yeah.
23:45Because anything that reduces the risk was good.
23:48But as soon as I heard there was trial, I was, I'm definitely up for that one if I can get it.
23:52That's brilliant, that.
23:53Now we hope that we won't see any evidence of DNA coming from cancer cells and then you don't need any further treatment, which would be amazing.
24:02Yeah.
24:03But even if we did find the DNA present, we would be treating it at a really early stage where it's much more likely to respond.
24:12Yeah.
24:13But hopefully we'll never need to do that and we'll just monitor you very, very carefully with this blood test.
24:18Fingers crossed.
24:19Yeah.
24:20Yeah.
24:21Right, let's have a look at your veins.
24:30Oh, I can see some.
24:33Beautiful.
24:35Really big news to know that I've got the clinical trial today.
24:39Gives 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.
24:45It's going to sound really random, but all I've had in my head all morning is the Strictly theme tune.
24:51OK.
24:53And that's all that's going round in my head.
24:55I get that sometimes, you have no idea where it's come from.
24:57Be careful or else I'll start dancing to the Strictly theme tune.
25:00Anything to break up the day.
25:02Exactly.
25:04It's not just another blood test, it's to say that your cancer clear.
25:09Not 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.
25:18Scans can only pick up so much, whereas if you go into the depths of DNA in your blood,
25:24you can't get any more minute scale than that, can you?
25:27There we are.
25:29All done?
25:30Perfect.
25:34Damien's blood will be tested along with the other patients' blood samples
25:38to see if they can see any signs of cancer DNA present.
25:40This blood test is really moving things forward.
25:48Samples for you?
25:50Thank you very much.
25:52In our current standard of care, patients will be offered regular scan follow-up.
25:58But generally, that's at least every three to six months.
26:01So, this blood test is getting that result back within ten days.
26:10We don't want to hang around where cancer's concerned.
26:14We want to get ahead of it.
26:15Once the samples are in the lab, the meticulous analysis begins.
26:28To 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.
26:40If scientists spot DNA fragments that don't match, it could mean the patient has cancer.
26:46And what, of course, we're all hoping for, for Damien, is a negative test.
26:54And there is no sign of tumour.
26:57And with these blood tests, we can keep a really close eye on Damien.
27:00And if his tumour comes back, we can pick it up quickly.
27:12I think we can't overpromise. It's really important that we don't.
27:15From a patient perspective, this is a clinical trial.
27:19This test is not yet available, for example, on the NHS.
27:23So we're testing the test.
27:25There's a lot more work to do, but I'm very hopeful.
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.
27:58Yes, that bit goes there as well.
28:00Good.
28:02Cracking along nicely now.
28:04Cooking on gas.
28:06I just find it really therapeutic.
28:08Well, it's nice to sit with Mum and do something we can both do together.
28:11And I just find it very satisfying when the pieces go in,
28:14because most of the time, the tasks that I perform are very long-term
28:19and not often completed in a day.
28:21So it's nice to just have something you can get done.
28:24She 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 just got an overactive brain.
28:42There you go.
28:43There you go.
28:44I think she would do very well in life.
28:45I had a fantastic childhood.
28:51We lived in a public school in Sussex because my father was the head porter.
28:57Didn't have any money and I went to a state school.
29:02But yeah, I saw, if you like, how the other half live.
29:05But 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,
29:20just think about what did I learn today?
29:22He loved learning and knowledge.
29:25And he didn't get a very good education himself.
29:28I think he left school at something like 13 years old.
29:30And he was quite clever.
29:32I mean, he could have done very well if he had a good education.
29:35He was clever. He was a smart guy.
29:37And I think, you know, he just wanted you to be the best you could possibly be
29:40at everything you tried to do.
29:42And I think, you know, the need to achieve, I think, is sort of hardwired.
29:47He was just a lovely man. We miss him dreadfully.
29:50It's, I wish he was here.
29:58He died two years ago now, almost.
30:03His liver was filled with masses of tumours on a scan.
30:08He became so ill. And seeing him that ill, yeah, it was difficult because his last three months were pretty miserable.
30:16But up until that point, he was strong and resilient and fought his way through it with great, great dignity, actually.
30:23Every time I saw him, the last thing he said was, I love you.
30:27You know, it was emotional.
30:30You know, you never did know when was the last time.
30:34And on his death certificate, it said cancer of unknown primary, which 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 that 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, with perhaps not a great chance of improvement.
31:11In 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.
31:27The pain was more towards my kidney.
31:30And over the weeks, the pain got worse.
31:35I understand how people with pain could take their own life,
31:40because I honestly thought about it, because the pain was that bad.
31:45I'm glad it didn't.
31:48But, yeah, it was dark.
31:55Lee was diagnosed with cancer of unknown primary after a mass of tumours were discovered in his kidney.
32:01When I got the cancer, I thought, cancer's cancer, that's it.
32:05But then to be told, cancer's unknown primary.
32:08I 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. You're having one we can't find.
32:23And that's what the doctors say.
32:24Doctors find patients like Lee so mysterious, because unlike all other cancer patients, nobody knows where their cancer first began.
32:34When a cancer starts, it's called a primary cancer, and its type is determined by its location.
32:45Over time, cancer cells can break off and spread to other organs forming secondary cancers.
32:52This is called metastasis.
32:53When doctors don't know where the cancer started, it's called cancer of unknown primary.
33:05This is a perplexing type of cancer, because patients have advanced disease.
33:19Only when you know where the tumor started can you have a really rational discussion about what the right treatment would be.
33:25Why does that matter for treatment?
33:28Because it has a different biology.
33:31So it requires a different sort of treatment.
33:36At the moment, there is no personalised treatment for patients with cancer of unknown primary.
33:42I think there's an idea that, you know, if you have a cancer in the brain, it must be brain cancer.
33:47That's not true.
33:48If you sequence the DNA of a primary lung cancer, and 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,
34:02it would look more like the lung cancer than it would like anything that comes from the brain.
34:08OK, Lee, this is going to be 30 minutes?
34:10Yeah.
34:11Perfect.
34:13Have 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.
34:22So Lee began a series of traditional treatments.
34:25I had my first chemo session, and they scanned me, and it shrunk to half.
34:30So the chemo, it was doing something.
34:35So they gave me another three sessions of chemotherapy, and said they're bringing this new drug out called immunotherapy.
34:40So that's going to be 30 minutes.
34:41Any problem?
34:42Just let me know.
34:43I will do.
34:44I also had 10 sessions of radiotherapy, which pinpoints the cancer.
34:50So it's like lasers, I think, and it burns it.
34:54But it can cause other side effects.
34:56Like, because it was so close to my kidney, it 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.
35:08Touch wood.
35:10Despite being given just nine months to live, Lee has been receiving treatment at the Christie Hospital for three years.
35:19He'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, and after all of that, we did not find out anything that would help personalise his treatment options.
35:39Unfortunately, prognosis remains quite poor for most patients diagnosed with cancer of unknown primary.
35:45Often it's around about three to six months, but obviously Lee's done significantly better than that.
35:52We don't know exactly why he's responded to immunotherapy, but it's under control.
35:56So he remains a true cancer of unknown primary, which is annoying to me, because I do like to try and find out where the cancer started, and in his case it truly is still a mystery.
36:06Have a seat, Lee.
36:10Right, how are you feeling today?
36:12All right.
36:13Yes?
36:14Since we last saw you here, has there been any changes?
36:17Nothing, no.
36:18No, so feeling generally okay on yourself?
36:20Brilliant, yeah, no pain.
36:21Okay.
36:22No, I think you're definitely one of the kind of lucky ones, because 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 now.
36:33Yeah, let me just go back to when you first started, was February 2022.
36:40Right.
36:41So over three years now, so that's amazing.
36:43That's amazing.
36:44I understand, but if you can't find the primary source of a cancer, you're not going to cure it.
36:48You can't.
36:49You can generally look after it, but I'm not holding out, because if you can't find it after three years now, I think it's hidden itself.
36:57But I'm still here and fighting in the corner.
37:00Yes.
37:01I'd probably like to see it in long.
37:02May it continue, basically.
37:03Yeah, I feel really good at the moment.
37:05Yeah, she's my guardian angel.
37:06No, don't put that in camera.
37:07Natalie's investigations uncovered that little research had been done in this particular field.
37:20So, she got in touch with Caroline to get her help.
37:24Together we've been able to develop this test that we call CUPID, Cancer of Unknown Primary Identification, or CUPID.
37:33And we're hoping that by taking a blood sample from a patient, we can have a pretty good idea of where that tumour started.
37:40This blood test is a little different in as much as we look at the fragments of cancer cell DNA shed 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, guess what?
38:14It'll have a liver postcode.
38:16We can measure those postcodes in the DNA and we can tell you where the tumour started from.
38:26In order to isolate this data, they use metal beads coated in a protein which the tumour DNA will bind to.
38:34A magnetic strip then attracts the DNA coated beads, enabling them to extract the molecules.
38:41Millions 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 or it started in the colon, in the gut.
38:55And I think for those common cancers of unknown primary, within two weeks of the patient arriving in clinic,
39:03I think we'll be able to make a diagnosis of where their cancer started.
39:08But also the opportunity to direct a better treatment to your particular cancer.
39:14So 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,
39:26and are building an atlas of postcodes to map out where the cancer comes from.
39:31So far the test can match unknown primaries to 29 common cancers.
39:37But with over 200 different types of cancer, there's still a long way to go.
39:41I know it's incurable, but hopefully it's manageable with all these treatments.
39:52Now I know they're not going to last forever.
39:54I know at a time they're going to say,
39:58we've either got a cure for you and we've found it,
40:04or they're going to say, there's not a lot more we can do.
40:11It does bother me why I've got cancer, because I don't know why I've got cancer.
40:16No-one in my family has had it, so why me?
40:20That's the answer that I think most cancer patients want.
40:23Why? What have I done?
40:26It would be nice to be told, right, we've found where the cancer has come from.
40:32Hopefully, it'll be sooner than later.
40:41That'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.
41:14No-one ever looks forward to finding out if they've still got cancer or not.
41:19Obviously, everything runs through your mind.
41:22I don't want to get ill. I don't want my family to see me getting ill.
41:26Obviously, I want to be here. I want to see my grandkids grow up.
41:29I want to enjoy life with them.
41:33So, 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.
42:04Hi.
42:17Hi, Damien. It's Becky Lee, the consultant.
42:20Hi. Are you OK?
42:23Just to let you know that your result is negative.
42:31So, great news.
42:34Brilliant. Thank you. That's fantastic news.
42:39Fantastic.
42:41No, that's lovely. The sun's shining, so...
42:44Couldn't have been a better day.
42:46OK, well, I'll speak to you soon.
42:48Brilliant. Bye.
42:49Thank 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.
43:11Hi, Dal.
43:12How's it, Dal?
43:13Yeah, just got the phone call and we've got the all clear.
43:15Oh, brilliant.
43:16Hope it's gone forever now.
43:18Yep.
43:19Onwards.
43:20We can plan the weekend now.
43:21I'll see you later, Dal.
43:22See you later.
43:23Bye.
43:24Bye.
43:25Bye.
43:26I think it's becoming very clear that biomarker tests in blood are changing how we even think about the early detection of cancer.
43:42They really are changing the game.
43:46I think it's the golden age of cancer research. It's massively exciting.
43:51You know, and at the moment, 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, beep, beep, beep.
44:03It's the first Tuesday in the month.
44:06Pop down to your pharmacy to give your blood in.
44:08It's your routine blood test for cancer.
44:12You know, we're not there yet.
44:14But it's it's a nice future to think about because, you know, it is doable.
44:19And I think we'll get there.
44:25Hi, boys.
44:27Hi, son.
44:28You all right?
44:29See?
44:30Three years on from his diagnosis, the mystery of where Lee's cancer started remains unsolved.
44:35Right, Marie?
44:36You all right, Lee?
44:37Fellas?
44:38You all right?
44:41Oh, shit.
44:42Stop swearing.
44:43You don't think these lot drink in a Catholic club, would you?
44:50Who's on next?
44:52I've decided now cancer won't meet me.
44:56It's not going to get me down.
44:59Oh, lucky, mate.
45:00Because there's nothing I can do about it.
45:02So why worry?
45:03Why sit at home and go, why me, why me?
45:06It's me.
45:08And now we're three and a half years in.
45:10I'm still here now.
45:12I'm still enjoying myself, so...
45:13You know, Dr Cook said to me, and this gives you hope, and she said, what's not curable today could be curable tomorrow.
45:26The lads up, the lads will pull us through.
45:31You can't give up life.
45:33It's too precious.
45:35You've got to maintain that up.
45:38Listen, I'll go to heaven, mate.
45:43Yeah.
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.
45:55Things.
45:56We'll walk forward.
45:57Yeah, it's okay.
45:58I see.
45:59I'll never do this outside.
46:00The room for me.
46:01ller
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