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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
00:39grains 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 anymore 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
01:21death 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 cureable to mind
02:02Oh, my God.
02:32I 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 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. I just love cars.
03:02But 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.
03:14And 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.
03:52So 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.
04:07Never heard of it. And I thought, well, what do you mean cancer unknown primary? Cancer's cancer. We can't find the primary source.
04:15So I've got a tumour in my back, which I know about. But if you can't find out where it's originated, how do you kill it?
04:23You 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? No-one knows. No, no-one knows. I'm a mystery.
04:45In Manchester, Lee has joined a pioneering new project that seeks to solve his mysterious case
04:53by analysing the blood to unlock cancer's secrets.
05:00Hiya.
05:01Checked it?
05:02Started, thank you.
05:07Leading the initiative is Professor Caroline Dive.
05:10I've been thinking about how we fight cancer ever since I was 25 years old.
05:18Because cancer has always been one of the largest medical challenges for the human race.
05:25Cancer is a disease of mutations.
05:27And we all carry some gene mutations, but for the most part,
05:31for those of us who don't go on to develop cancer, we live with them.
05:35Cancer is a rogue ball of cells growing somewhere in a body,
05:41and it's taking over those normal body processes.
05:45And they have all these really lethal traits.
05:48They move about around the body when they shouldn't.
05:52They don't die when they should.
05:54And that mutation that sat there suddenly now becomes very dangerous indeed.
06:01I think about it as a very malevolent alien.
06:05An alien within.
06:08And really hard to beat.
06:11At 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, blood.
06:27Hi guys, how's your day going?
06:33Oh, hi Chris.
06:34Hi, Carol.
06:35Yeah, can we have a look at the organoids?
06:36I know the data sounded really exciting, so I'd like to just have a look.
06:40All right.
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 of cancer cell DNA in a tube of blood.
07:01The answers are there in the blood.
07:04We just have to find them.
07:06And to sort of give you an idea of the scale of the challenge,
07:13when 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
07:24and how that cancer cell may behave in the future.
07:30Only by knowing those details can we really solve the mysteries of cancer.
07:36We are discovering what makes cancer tick.
07:39My mission is to take those discoveries and 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 a much longer lifespan,
07:57but in some cases, cure.
08:05Caroline and her team work closely with one of Europe's leading cancer centres,
08:11the 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, OK?
08:26OK. Again.
08:28Again.
08:31Lee 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.
08:43When you're talking to other cancer patients,
08:45it's like a game of top trumps.
08:48What cancer have you got then?
08:49And what have you got?
08:50And then they all say, oh, I've got prostate cancer, I've got bowel cancer.
08:54Well, what have you got?
08:55And I go, cancer unknown primary.
08:57What's that then?
08:58Other cancer patient hadn't heard of it.
09:00I hadn't heard of it until I got to the Christie and said,
09:04this is what you've got.
09:05What I do before, though, is just do your pulse.
09:08At first it was daunting because the general life expectancy from cancer unknown primary is about nine months.
09:18Really, nine months isn't a lot.
09:20So I think, right, what do I cram in in nine months?
09:22And then coming here and thinking, well, I'm coming here to pass me time.
09:30Can I just have a look at you?
09:32Yeah, sure.
09:32But when you come and you find out, oh, the fantastic work, the doctors, the nurses, they're doing, everyone's fighting your corner.
09:40In every cancer, not just mine, they want to find a cure.
09:44We 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.
10:17Let 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.
10:27We 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.
10:50So we just clean the area now.
10:57Because my veins now are starting to close because of all the treatments I've had, they 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 dartboard, isn't it?
11:29Well, 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, hopefully I can find where the cancer has come from.
11:46And then create a drug, anything to try and find a cure quicker.
11:51There we go.
11:52That's what I've donated for.
11:54I'm coming now.
11:55Well, I'll have a pint left, what's a tick anyway?
12:00It's precious, isn't it, your blood?
12:02In Manchester, Caroline Dive is developing a series of revolutionary blood tests that 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, it comes to the lab, and 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, and in this case, with cancer as the enemy, the younger you know that enemy, the better.
12:58It's critical that we detect cancer, it's critical, it'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, that pre-cancerous state, when it's more treatable?
13:16And that's a huge challenge.
13:17Come on through.
13:19Pop your key on that chair for me.
13:20And then I need you to come and have a lie down for me.
13:21Yeah.
13:22Another 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.
13:46They did say it's quite aggressive, luckily we caught it quite soon, but 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, they draw it on your back and it was like, Jesus, that's quite big, that.
14:03This 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.
14:28I wouldn't have even known it were there.
14:30It was my son that had seen it.
14:33I'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.
14:45It 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 PJ.
14:59It looks like cancer.
15:00Soon after first spotting the growth, Damien went to get it checked and then had to break the news to his family that it was skin cancer.
15:13I just felt sick.
15:15Were you scared to death?
15:16You know, ultimately, I could potentially lose my best friend, love of my life.
15:20We've been together 25 years and that's not the plan.
15:24We're going to grow old together.
15:25I cannot imagine him not being by my side for all that he drives me mad.
15:33I just can remember driving to work really heartbroken thinking, I 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? Has it spread?
15:46So, yeah, the whole thing implodes.
15:51I pray.
15:52Love one.
15:55They give you like a 25% chance that it could come back in the first year.
16:00Come on.
16:02You start reading up on the type of skin cancer, it's fast growing, it likes to travel, it likes to travel to your brain.
16:09And 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, how long are you going to be here?
16:21Can I afford to keep the house? Can I keep my job? How can I look after the kids?
16:26You've never got that all clear, you never know.
16:28That's the scary thing.
16:29Today, 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.
16:46Basically, they're more clear at the moment, but it's weird, little aches and pains. Normally, you wouldn't even think twice about it. You think, could that be cancer back again? A little itch when my wounds binge and all these. All the little things that you don't really think of until you've got cancer.
17:05In the UK, around 18,000 new cases of melanoma are diagnosed every year.
17:16Okay, so local anaesthetic, 20 mils, 0.25 with adrenaline.
17:20It's extraordinary, the progress that has been made in understanding how tumours behave, but there are limitations to all of our conventional types of treatment and detection of cancers.
17:32Know that this is a melanoma, 1.5 millimetres in thickness.
17:38Whilst we have incredibly talented people doing sophisticated surgery, what we don't know when the tumour is removed is whether every cancer cell in the body is gone.
17:49And those little tiny tumour cells that were in that original cancer had already moved around the body and landed in another organ, but haven't yet grown into big masses that can be seen with an imaging scan.
18:03If that's already happened, then there's a real chance that tumour might come back.
18:07Rather than detecting melanoma with a conventional CT scan, Caroline is proposing a groundbreaking new approach.
18:19So a tissue biopsy can tell you a lot about that tumour.
18:27However, accessing the tumour in the patient, particularly if that tumour is in a fairly inaccessible place, is very invasive for patients.
18:34And this has given rise to a whole new type of test called a liquid biopsy.
18:42Unlike a tumour biopsy, blood can be taken from a patient again and again and again, without too much discomfort for the patient.
18:52And can we find everything we can at the molecular level from a tube of blood?
19:00So we diagnose cancer earlier, before it evolves.
19:06Is there something that these tumour cells are putting into the bloodstream that we can pick up?
19:11Your 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.
19:31Dead cancer cells can leak fragments of tumour DNA into the blood.
19:35But your blood also has millions of other fragments from your normal, healthy DNA.
19:45So finding a few fragments of circulating tumour DNA is like trying to find a needle in a haystack.
19:55Because the burden of cancer in a human being is very low at this point, there are very few molecules that we'll be able to measure.
20:02So the test has to be very sensitive.
20:07You know, and when we first studied it, I don't know, 15 years ago, everybody 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.
20:21Dr 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.
20:46When 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.
21:01I knew that we could detect cancer in patients with lots of cancer present.
21:07So 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.
21:29Becky used some blood samples from melanoma patients whose tumour had been removed by surgery and 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.
21:49That was a eureka moment when we suddenly knew that actually we were able to detect the CT DNA and it was able to predict this relapse and that was the moment that detection was really born.
22:06It was incredible because it just came over on an email and there it was.
22:11Just was like, oh wow, this is amazing.
22:14I was like, everyone could see you.
22:17So yeah, it was, it was, it was cool.
22:22We started with liquid biopsy in the early 2000s.
22:25I think the first mutations that we measured in liquid biopsy were in breast cancer and then lung cancer, but 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 from its early existence to actually then making that difference to the patients.
22:48That's the advantage of being old.
22:49You can look back, you've got further to look back.
22:56After 10 years of refining the process in the lab, the 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, it's taken about two minutes to have.
23:13And have a team of brilliant people check you that thoroughly would be fantastic.
23:17So obviously you've now had your surgery, you've had the scan result, which hasn't shown any evidence that the melanoma is there, which is really good.
23:31So I'm pleased to say that you're eligible to go on the trial.
23:36That's brilliant.
23:39And one piece of the puzzle, really.
23:43Yeah.
23:44Because anything that reduces the risk was good.
23:46But as soon as I heard there was trial, I was, I'm definitely up for that one if I can get it.
23:50That's brilliant, that.
23:51Now 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.
24:01Yeah.
24:02But 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.
24:11Yeah.
24:12But hopefully we'll never need to do that and we'll just monitor you very, very carefully with this blood test.
24:17Fingers crossed.
24:18Yeah.
24:19Yeah.
24:20Right, let's have a look at your veins.
24:29Oh, I can see some.
24:31Beautiful.
24:33Really big news to know that I've got the clinical trial today.
24:37Gives me a big hope, not just for me, for my family as well.
24:40It 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.
24:49And that's all that's going round in my head.
24:53I 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.
25:03It'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.
25:16Scans can only pick up so much, whereas if you go into the depths of DNA in your blood, you can't get any more minute scale than that, can you?
25:26There we are. All blood.
25:28Perfect.
25:29Damien's blood will be tested along with the other patients' blood samples to see if they can see any signs of cancer DNA present.
25:43This blood test is really moving things forward.
25:47Samples for you.
25:49Thank you very much.
25:50In our current standard of care, patients will be offered regular scan follow-up.
25:56But 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.
26:40If 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.
27:00And if his tumour comes back, we can pick it up quickly.
27:10I think we can't overpromise.
27:12It's really important that we don't.
27:14From a patient perspective, this is a clinical trial.
27:18This test is not yet available, for example, on the NHS.
27:21So, we're testing the test.
27:22There'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.
27:34Seagulls, Mum. Look, see, there's the first one.
27:38Ha-ha.
27:40I reckon that bit goes there, though. I'll try that bit.
27:43Yes, that bit goes there as well. Good.
27:44We're cracking along nicely now.
27:45Cooking on gas.
27:46I just find it really therapeutic.
27:47Well, it's nice to sit with Mum and do something we can both do together.
27:50And I just find it very satisfying when the pieces go in, because most of the time, the tasks that I perform are very long-term and not often completed in a day.
28:00So, it's nice to just have something you can get done.
28:01She was a terrible baby. She would not sleep.
28:02In the end, I got so frustrated, I took her to the doctor.
28:04And I was like, oh, I don't know.
28:05I don't know.
28:06I don't know.
28:07I don't know.
28:08I don't know.
28:09I don't know.
28:10I don't know.
28:11I don't know.
28:12I don't know.
28:13If I couldn't go out with the doctor, you wouldn't know.
28:14I m not.
28:15But I would say that, and Dr.
28:17Yeah.
28:18Well, I do have a lot of sleep that, I'm trying to find the patient.
28:20So, it's nice to just have something you can get done.
28:25She was a terrible baby.
28:26She would not sleep.
28:28In the end, I got so frustrated, I took her to the doctor.
28:32And the doctor examined her.
28:34Looked at her ears.
28:35Looked at her eyes.
28:36Looked at everything.
28:37And he said, I can't think anything is wrong with her, he said.
28:40I think she's just got an overactive brain
28:42and she will do very well in life.
28:49I had a fantastic childhood.
28:51We 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.
29:05But I never felt hard done by,
29:07I just thought I lived in a really nice place
29:09with parents who really cared about what happened next
29:12in terms of my life.
29:14My dad, one of his top tips in my youth was,
29:18you know, every time you go to bed,
29:19just think about what did I learn today?
29:22He loved learning and knowledge.
29:25And he didn't get a very good education himself.
29:27I think he left school at something like 13 years old.
29:30Oh, and he was quite clever.
29:31I mean, he could have done very well.
29:34He was clever. He's a smart guy.
29:36And I think, you know, he just wanted you to be the best
29:38you could possibly be at 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.
29:50It's, I wish he was here.
29:58He died two years ago now, almost.
30:00His liver was filled with masses of tumours on a scan.
30:09He became so ill.
30:10And seeing him that ill,
30:13yeah, it was difficult because his last three months were pretty miserable.
30:16But up until that point, he was strong and resilient
30:19and fought his way through it with great, great dignity, actually.
30:22Every 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.
30:34And on his death certificate, it said cancer of unknown primary,
30:40which is an intriguing type of cancer.
30:45That has a very personal importance to me now.
30:50And we've been working together now for 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 with cancer of unknown primary in the future.
31:04Because it must be awful
31:05knowing you've got cancer but not knowing where it's come from,
31:08with perhaps not a great chance of improvement.
31:19In 2021, I found two little lumps on my ribcage at the back.
31:22So I weren't really concerned about the lumps.
31:25It 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.
31:42Because the pain was that bad.
31:44I'm glad it didn't.
31:48But, yeah, it was dark.
31:52Lee was diagnosed with cancer of unknown primary
31:57after a mass of tumours were discovered in his kidney.
32:00When I got the cancer,
32:02I thought, cancer's cancer, that's it.
32:04But I then, to be told, cancer's unknown primary.
32:08I didn't understand what that meant.
32:09You think to yourself, why?
32:10Why can't you find it?
32:12How I look at this, and it's dead simple.
32:15I 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.
32:23And that's what the doctors say.
32:26Doctors find patients like Lee so mysterious
32:29because, unlike all other cancer patients,
32:32nobody knows where their cancer first began.
32:34When a cancer starts,
32:40it's called a primary cancer,
32:42and its type is determined by its location.
32:47Over time, cancer cells can break off
32:50and spread to other organs forming secondary cancers.
32:53This is called metastasis.
32:58When doctors don't know where the cancer started,
33:01it's called cancer of unknown primary.
33:10This is a perplexing type of cancer
33:13because patients have advanced disease.
33:19Only 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.
33:30So it requires a different sort of treatment.
33:35At the moment,
33:36there is no personalised treatment
33:38for patients with cancer of unknown primary.
33:41I think there's an idea that, you know,
33:43if you have a cancer in the brain,
33:46it must be brain cancer.
33:48That's not true.
33:49If you sequence the DNA of a primary lung cancer,
33:53and let's say that primary lung cancer moves
33:55and starts to grow in the brain,
33:57and then you took that metastatic secondary lesion
34:00in the brain and sequenced it,
34:01it would look more like the lung cancer
34:03than it would like anything that comes from the brain.
34:08Okay, Lee, this is going to be 30 minutes.
34:10Yeah.
34:11Perfect.
34:12Have you had any reaction in the past?
34:14No.
34:14Because Lee's cancer was discovered so late,
34:19it's spread, and it's inoperable.
34:21So Lee began a series of traditional treatments.
34:25I had my first chemo session,
34:27and they scanned me,
34:28and it shrunk to half.
34:29So the chemo, it was doing something.
34:34So they gave me another three sessions of chemotherapy,
34:38and said they'd bring in this new drug out,
34:39called immunotherapy.
34:42So 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 radiotherapy,
34:50which pinpoints the cancer.
34:51So it's like lasers, I think, and it burns it.
34:55But 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.
35:02So I had more chemo than the immunotherapy,
35:05which is, it's keeping me here.
35:08Touch wood.
35:08Despite being given just nine months to live,
35:14Lee has been receiving treatment
35:16at the Christie Hospital for three years.
35:19He's been under the care of Dr. Natalie Cook,
35:21a leading expert in cancer of unknown primary.
35:26We had multiple different investigations,
35:28ultrasound scans, CT scans, MRI scans, biopsies.
35:32And after all of that,
35:34we did not find out anything
35:36that would help personalise his treatment options.
35:38Unfortunately, prognosis remains quite poor
35:42for most patients diagnosed
35:44with cancer of unknown primary.
35:46Often 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,
35:54but it's under control.
35:56So he remains a true cancer of unknown primary,
35:59which is annoying to me
36:00because I do like to try and find out
36:02where the cancer started.
36:03In his case, it truly is still a mystery.
36:06How's Evely?
36:09Oh.
36:10Right, how are you feeling today?
36:12All right.
36:13Yes?
36:14Since we last saw you here,
36:15has there been any changes?
36:17Nothing, no.
36:18No?
36:18So feeling generally okay on yourself?
36:20Brilliant, yeah.
36:20No pain.
36:21Okay.
36:22No, 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 was on,
36:37was February 2022.
36:40Right.
36:41So over three years now, so 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.
36:49You can generally look after it.
36:50But I'm not holding out because 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 in the corner.
37:00I'll probably like to see it in long.
37:01May it continue, basically.
37:02Yeah, I feel really good at the moment.
37:05Yeah, she's my guardian angel.
37:08Now, don't put that in camera.
37:14Natalie's investigations uncovered that little research had been done
37:18in 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
37:26that we call CUPID,
37:28Cancer of Unknown Primary Identification, or CUPID.
37:33And 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.
37:46This 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
37:57which are on it.
38:01And those patterns, it's a bit like a postcode.
38:04They can tell us which organ in the body
38:06the tumour started off in.
38:09So if you have a tumour that starts in the liver,
38:13guess what?
38:13It'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.
38:25In order to isolate this data,
38:28they use metal beads coated in a protein
38:30which the tumour DNA will bind to.
38:34A magnetic strip then attracts the DNA-coated beads,
38:38enabling them to extract the molecules.
38:40Millions of pieces of DNA are then analysed,
38:44allowing their codes to be read.
38:46We can now be fairly confident
38:48that we can predict a cancer of unknown primary
38:51started in the lung
38:52or it started in the colon, in the gut.
38:55And 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
39:05of where their cancer started.
39:07But also the opportunity to direct a better treatment
39:12to your particular cancer.
39:14So it's new pioneering work
39:16that we really feel we can do something to fix.
39:20Caroline and Natalie have collected hundreds of blood samples
39:23from people with known cancers
39:25and are building an atlas of postcodes
39:27to map out where the cancer comes from.
39:29So far, the test can match unknown primaries
39:34to 29 common cancers.
39:36But with over 200 different types of cancer,
39:39there's still a long way to go.
39:46I know it's incurable,
39:48but 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,
39:57we've either got a cure for you
40:01and we've found it,
40:05or they're going to say,
40:06there's not a lot more we can do.
40:11It 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 would be nice to be told,
40:27right,
40:29we found where the cancer has come from.
40:32Hopefully,
40:33it will be sooner than later.
40:34That's the life that we strive for.
40:58Sat there with a glass of whiskey watching the day go by.
41:00Definitely look forward to her reaching retirement age.
41:09Damien 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
41:18if 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.
41:26Obviously, I want to be here.
41:28I want to see my grandkids grow up.
41:30I want to enjoy life with them.
41:33So,
41:33yeah,
41:35it 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
41:48to 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
42:01that's really going to change their life again.
42:03Hi.
42:17Hi, Damien.
42:18It's Becky Lee, the consultant.
42:20Hi, you OK?
42:22Just to let you know
42:24that your result is negative.
42:31So, great news.
42:33Brilliant.
42:35That's fantastic news.
42:39Fantastic.
42:40No, that's lovely.
42:42The sun's shining,
42:42so couldn't have been a better day.
42:45OK, well, I'll speak to you soon.
42:48Brilliant.
42:48Bye.
42:49Bye-bye.
42:49Bye.
42:58Couldn't be any better.
42:59Bank holiday on the horizon.
43:01Spend time with my family
43:02with the all-clear for now.
43:04Fantastic.
43:10Hi, Dal.
43:11How's it, Dal?
43:12Yeah, just got the phone call
43:13and we've got the all-clear.
43:15Oh, brilliant.
43:16Hope it's gone forever now.
43:18Yep.
43:18Onwards, we can plan the weekend now.
43:22I'll see you later, Dal.
43:23See you, babe.
43:24Bye.
43:24Bye.
43:25Bye.
43:25Bye.
43:25Bye.
43:25Bye.
43:25Bye.
43:25Bye.
43:25Bye.
43:25Bye.
43:27Bye.
43:27Bye.
43:29Bye.
43:29Bye.
43:29Bye.
43:29Bye.
43:29Bye.
43:29Bye.
43:29Bye.
43:29Bye.
43:29Bye.
43:29Bye.
43:29Bye.
43:29Bye.
43:29Bye.
43:29Bye.
43:31Bye.
43:32Bye.
43:33Bye.
43:34Bye.
43:35Bye.
43:36Bye.
43:37Bye.
43:38Bye.
43:39Bye.
43:40Bye.
43:41Bye.
43:42Bye.
43:43Bye.
43:44Bye.
43:45Bye.
43:46Bye.
43:47Bye.
43:48Bye.
43:49Bye.
43:50Bye.
43:51Bye.
43:52Bye.
43:53Bye.
43:54Bye.
43:55Bye.
43:56Bye.
43:57Bye.
43:58Your smart watch or whatever it is you're wearing will say beep beep beep it's the first Tuesday in the month
44:05Pop down to your pharmacy to give your blood in. It's your routine blood test for cancer
44:12You know we're not there yet, but it's it's a nice future to think about because you know it is doable and I think we'll get there
44:28Okay, three years on from his diagnosis the mystery of where Lee's cancer started remains unsolved
44:42Stop swearing don't think he's not drinking a Catholic club, would you?
44:50Who's on next?
44:52I've decided now cancer won't meet me. It's not gonna get me down
44:57Oh lucky mate
45:00Because there's nothing I can do about it. So why worry why sit at home and go why me why me it's me?
45:07And now we're three and a half years in I'm still here now still enjoying myself
45:17You know dr. Cook said to me and this gives you oh
45:22And she said what's not curable today could be curable tomorrow
45:27The lads up the lads up post room
45:32You can't give up life too precious
45:37You've got to maintain that
45:41They said I'll go to ever me yeah
45:45Only if gates are locked downstairs
45:48Sorry, I'm going to heaven
45:50I'll let you open the gate for me
45:52I'll let you open the gate for me
45:53open the gate for me.
46:23Support information for the issues raised can be found online at channel4.com forward
46:37slash support.
46:38Kicking it to the curb with a whole night of standing up to cancer, fundraising fun
46:43and celeb goggling.
46:44Adam Hills and Hannah Fry get things going from 7.30pm next Friday.
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