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00:00And I just don't give up.
00:05I'm a detective in the cancer world.
00:09Trying to outfox cancer.
00:14It's giving us clues if we know where to look.
00:21We're trying to find tiny, tiny amounts of cancer DNA in the bloodstream,
00:28which is like finding a single grain of sand that matters amongst all the other grains of sand.
00:39The answers are there. We just have to find them. And that's my mission.
00:50For generations, a cancer diagnosis left almost no hope.
00:55It's a terrifying disease that has stalked us for millennia.
01:00I didn't expect I had cancer because all the tests were coming back negative.
01:04I don't think my body can take any more.
01:07Science has fought hard against it. And now the tide is finally turning.
01:12One of our key goals is to transform this idea of cancer as a death sentence.
01:17A group of trailblazing scientists are making new breakthroughs.
01:24We now need to take those discoveries and make them work for patients.
01:29This is the world's first lung cancer prevention vaccine.
01:34Discovering cures and finding ways to stop cancer before it even starts.
01:38The tumor seems to be shrinking.
01:41Your scan shows no active disease.
01:45Creating a future where cancer doesn't win.
01:49We're getting very close to defeating cancer once and for all.
01:53What's not curable today could be curable tomorrow.
01:56her culture alone.
01:58I'm gonna be here anyway.
01:59I'm gonna be here.
02:01Ohhehe...
02:03There are so manycji there...
02:04là her children's narrow way...
02:05Frざemisko...
02:07Frざemisko...
02:09Frange Roactic...
02:13Frno Mae...
02:15That I'm so sorry...
02:17Right now...
02:19That I'm so sorry...
02:20What are you doing?
02:21Let's try to communicate you this.
02:22I love working.
02:30I've worked since I was 15 years old.
02:34But at school, I didn't want to be a mechanic.
02:37I wanted to be a jockey.
02:40But when you go and work experience at school,
02:43you couldn't find me a stable.
02:44I didn't want to find me, so I went in to be a mechanic and I loved it.
02:49I always loved getting my hands dirty as a kid.
02:51My mum didn't like it, but I had to go home dirty.
02:55I just love cars.
02:57But a doctor told me I should have a few months off.
03:02I was off four days.
03:03I couldn't handle it because this is normal for me.
03:07And if I'm normal, I haven't got cancer.
03:11And that's the thing.
03:12Four years ago, 58-year-old Lee experienced pain in his back after playing golf,
03:23but soon discovered it was more than a sports injury.
03:26So I had two lumps in my back and my ribcage,
03:31but I had pain around my kidney area.
03:34I couldn't sleep at night.
03:35I couldn't walk.
03:36I couldn't move because of the pain.
03:37A doctor sent me for an MRI scan and they scanned the tumour.
03:45It was 10 centimetres round.
03:47So we had a biopsy and they come back and said,
03:53it's cancer.
03:55But it's a weird, it's a strange cancer because it's called something called cancer unknown primary.
04:00Never heard of it.
04:04And I thought, well, what do you mean cancer unknown primary?
04:07Cancer's cancer.
04:08We can't find the primary source.
04:12So I've got a tumour in my back, which I know about.
04:15But if you can't find out where it's originate, how do you kill it?
04:19You can't.
04:19So until it pops its head out, it's like playing hide and seek.
04:23So hopefully one day it'll pop its head out and then we'll kill it.
04:28Hopefully.
04:28So you still don't know?
04:31No one knows.
04:33No, no one knows.
04:35I'm a mystery.
04:41In Manchester, Lee has joined a pioneering new project that seeks to solve his mysterious case
04:48by analysing the blood to unlock cancer's secrets.
04:55Hiya.
04:56Checked it?
04:57Sorted, thank you.
04:58Leading the initiative is Professor Caroline Dive.
05:06I've been thinking about how we fight cancer ever since I was 25 years old.
05:12Because cancer has always been one of the largest medical challenges for the human race.
05:20Cancer is a disease of mutations.
05:22And 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.
05:31Cancer is a rogue ball of cells growing somewhere in a body and it's taking over those normal body processes.
05:39And they have all of us who don't die.
05:40And they have all these really lethal traits.
05:43They move about around the body when they shouldn't.
05:45They don't die when they should.
05:47They don't die when they should.
05:49And that mutation that sat there suddenly now becomes very dangerous indeed.
05:54I think about it as a very malevolent alien, an alien within and really hard to beat.
06:06At 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.
06:21Hi, guys. How's your day going?
06:28Oh, hi, Chris.
06:29Hi, Dan.
06:30Yeah, can we have a look at the organoids?
06:32I know the data sounded really exciting, so I'd quite like just to have a look.
06:35Yes.
06:36Right.
06:40We're looking at the molecular level.
06:42With the new technologies we have at our fingertips, we can detect vanishingly small amounts of cancer cell DNA in a tube of blood.
06:56The answers are there in the blood.
06:59We just have to find them.
07:01And to sort of give you an idea of the scale of the challenge, when we think about, you know, thousands of cells can fit on the head of a pin.
07:13And 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.
07:26Only by knowing those details can we really solve the mysteries of cancer.
07:31We are discovering what makes cancer tick.
07:35My mission is to take those discoveries and translate them into useful, impactful tests.
07:44Because 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.
07:54Caroline and her team work closely with one of Europe's leading cancer centres, the Christy.
08:16Hi, Lee. Good morning. How are you today?
08:18All right. Thank you.
08:19Oh, good. I'm just setting up for your bloods, OK?
08:22OK. Again.
08:23Again.
08:26Lee has been undergoing a series of conventional cancer treatments to slow down his cancer's growth.
08:31I think I've treated you a couple of times.
08:33Yeah, you have, yeah, yeah.
08:34I think everyone has now.
08:35Yeah.
08:36When you're talking to other cancer patients, it's like a game of top trumps.
08:43What cancer have you got then? And what have you got?
08:45And then they all say, oh, I've got prostate cancer, I've got bowel cancer.
08:49Well, what have you got? And I go, cancer unknown primary.
08:52What's that then?
08:53Other cancer patient hadn't heard of it.
08:54I hadn't heard of it until I got to the Christy and said, this is what you've got.
09:00What I do before, though, is just do your pulse.
09:04At first, it was daunting because the general life expectancy for cancer unknown primary is about nine months.
09:13Really, nine months isn't a lot.
09:15So I think, right, what do I cram in in nine months?
09:17And then coming here and thinking, well, I'm coming here to pass me time.
09:25Can I just have a look at you?
09:27Yeah, sure.
09:28But when you come and you find out all the fantastic work, the doctors, the nurses, they're doing, everyone's fighting your corner.
09:35In every cancer, not just mine, they want to find a cure.
09:39We are learning more every day, and I am actually very optimistic that significant improvements are coming.
09:53But at the same time, you've got to have your motivation.
09:56And what better motivation can there be than walking through the corridors, seeing people with cancer?
10:02It's very fulfilling for me, having the National Biomarker Centre in the same building as the Christy Hospital.
10:12Let me just make sure that I've got all the pictures that I need.
10:15The idea is just to bring us all together in that same environment, the clinicians, the scientists.
10:21Hi, Natalie.
10:25We develop new laboratory tests, and then we test them in patients on clinical trials.
10:33In Lee's case, we want to find out where his cancer started.
10:37Because blood is circulating around the whole body, bathing, wherever that tumour is, there's going to be blood flow.
10:45So we just clean the area now.
10:52Because my veins now are starting to close because of all the treatments I've had,
10:58they put now a port into my vein there, you see it?
11:02And it's like a little valve there they can access to get your blood, rather than try and find a vein.
11:09So you've had a lot of chemotherapy, haven't you?
11:11Yeah, so...
11:12So your veins have had enough.
11:13Yeah, they give up the gulch, yeah.
11:15We couldn't do research without people like Lee donating his blood samples.
11:22It's like a dart board, isn't it?
11:24Oh, I'm good at darts.
11:25For Lee to benefit from their findings, it's a race against the clock.
11:29Right, one, two, three, nice deep breath in.
11:31The more blood they take off me to try and find it, hopefully I can find where the cancer has come from,
11:41and then create a drug, anything to try and find a cure quicker.
11:46There we go.
11:47That's what I've donated for.
11:49I'm coming now.
11:51I'll have a pint left, what's a sec anyway?
11:53It's precious, isn't it, the blood?
12:08In Manchester, Caroline Dive is developing a series of revolutionary blood tests
12:13that can detect cancer at the molecular level.
12:17We're making momentous discoveries about the biology of cancer from a tube of blood
12:23We take samples from patients, just maybe a tablespoon of their blood.
12:29It comes to the lab, and then the real challenge is to see how much we can learn from that tube of blood.
12:37One of these blood tests aims to detect cancer early enough to try and stop it before it can even get started.
12:44You have to know your enemy to have a good fight and to stand a chance of winning,
12:48and in this case, with cancer as the enemy, the younger you know that enemy, the better.
12:53It's critical that we detect cancers at their earliest stage.
12:58And the real question is, can we detect cancer even earlier, before cells transition into a cancerous state,
13:07that pre-cancerous state, when it's more treatable?
13:11And that's a huge challenge.
13:13Come on through.
13:22Pop your key on that chair for me.
13:24And then I need you to come and have a lie down for me.
13:27Yeah.
13:30Another patient hoping to take part in a clinical trial is 49-year-old Damien.
13:35He's having a check-up following surgery a year ago that removed a melanoma skin cancer from his back.
13:42They did say it's quite aggressive.
13:44Luckily, we caught it quite soon.
13:46But you're thinking the worst.
13:49When I went to the specialist and they measure you up and how much they're going to take,
13:55they draw it on your back and it was like, Jesus, that's quite big, that.
13:59This was the start of it all, basically.
14:0923rd of July, I think it was, 2024.
14:13Yeah, it's funny to see how small it was at the time.
14:16It seemed so insignificant, but obviously ended up not being.
14:23I wouldn't have even known it were there.
14:26It was my son that's seen it.
14:27I'd got out of the shower and she said, what's that on your back, Dad?
14:34And I looked in the mirror and it looked a bit like a cocoa pop.
14:38After that period, it really grown quick.
14:42It went from, obviously, what you're seeing there to that.
14:48Cancer's like an ugly thing that looks like it does harm and damage.
14:52That's why you pick up in your head and looking at the picture, it looks like cancer.
14:57Soon after first spotting the growth, Damien went to get it checked and then had to break
15:04the news to his family that it was skin cancer.
15:06I just felt sick.
15:09You're scared to death, you know, ultimately, I could potentially lose my best friend, love of my life.
15:16We've been together 25 years and that's not the plan.
15:19We're going to grow old together.
15:22I cannot imagine him not being by my side for all that he drives me mad.
15:26I just can remember driving to work, really heartbroken, thinking, I don't know how this is going to impact us as a family now.
15:37Will Damien need a certain level of care or treatment?
15:41Has it spread?
15:42So, yeah, the whole thing implodes.
15:47I pray.
15:48Love one.
15:48They give you, like, a 25% chance that it could come back in the first year.
15:57God.
15:57You start reading up on the type of skin cancer, it's fast growing, it likes to travel, it likes to travel to your brain.
16:05And that was, like, the eye-opener for me.
16:07Jesus, it's not good.
16:10Well, I saw myself.
16:12You try not to, but you always think of how long are you going to be here?
16:16Can I afford to keep the house?
16:18Can I keep the house?
16:18Can I keep my job?
16:19How can I look after the kids?
16:22You've never got that all clear.
16:24You never know.
16:25That's the scary thing.
16:34Today, 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, I'm all clear at the moment.
16:48But it's weird, little aches and pains.
16:50Normally, you wouldn't even think twice about.
16:53You'd think, could that be cancer back again?
16:55A little itch where my wounds, bingenitis.
16:57All the little things that you don't really think of until you've got cancer.
17:01In the UK, around 18,000 new cases of melanoma are diagnosed every year.
17:11Okay, so local anesthetic, 20 mils, 0.25 with adrenaline.
17:15It'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.
17:28We know that this is a melanoma, 1.5 millimetres in thickness.
17:33Whilst 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.
17:45And 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.
17:58If 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.
18:18So a tissue biopsy can tell you a lot about that tumour.
18:22However, accessing the tumour in the patient, particularly if that tumour is in a fairly inaccessible place, is very invasive for patients.
18:31And this has given rise to a whole new type of test called a liquid biopsy.
18:38Unlike a tumour biopsy, blood can be taken from a patient again and again and again, without too much discomfort for the patient.
18:48And can we find everything we can at the molecular level from a tube of blood?
18:56So we diagnose cancer earlier, before it evolves.
19:02Is 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.
19:18If 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.
19:28Dead cancer cells can leak fragments of tumour DNA into the blood.
19:33But your blood also has millions of other fragments from your normal, healthy DNA.
19:38So finding a few fragments of circulating tumour DNA is like trying to find a needle in a haystack.
19:51Because 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.
19:58So the test has to be very sensitive.
20:05You 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.
20:15And the problem is not one I alone could solve.
20:18I've had 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.
20:43When I was a PhD student, I was really inspired by what Caroline was doing in her lab.
20:52We were looking at patients with advanced melanoma.
20:58I knew that we could detect cancer in patients with lots of cancer present.
21:03So then, I just thought, can we bring the cancer detection test to an earlier stage where there wasn't any evidence of disease on the scan of patients?
21:18To see if we could still see whether the melanoma was present, and that would be a signal of melanoma coming back.
21:25Becky 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.
21:39She sent her results to statisticians to check whether they matched with the patients whose melanoma later returned.
21:45That was a eureka moment when we suddenly knew that actually we were able to detect the CTDNA, and it was able to predict this relapse.
21:57And that was the moment that detection was really born.
22:02It was incredible, because it just came over on an email, and there it was.
22:06It just was like, oh wow, this is amazing.
22:10I was like, everyone come and see.
22:13So yeah, it was cool.
22:15We started with liquid biopsy in the early 2000s.
22:22I think the first mutations that we measured in liquid biopsy were in breast cancer and then lung cancer.
22:27But it was really early days.
22:29We were just finding our way.
22:32We didn't use them at that point in clinical trials at all.
22:34It must be really incredible to kind of watch a field from its early existence to actually then making that difference to the patients.
22:44The advantage of being old.
22:46You can look back.
22:48You can look back.
22:49After ten years of refining the process in the lab.
22:55The liquid biopsy test is now ready to roll out into the clinic.
22:59If I can get on this trial, it takes away that worry.
23:03For a simple blood test, which is non-invasive, it's taken about two minutes to have, and have a team of brilliant people check you that thoroughly would be fantastic.
23:13So obviously you've now had your surgery, you've had the scan result, which hasn't shown any evidence that the melanoma's there, which is really good.
23:26So I'm pleased to say that you're eligible to go on the trial.
23:32That's brilliant.
23:32Yeah.
23:34Oh, and one piece of the puzzle, really.
23:38Yeah.
23:39Because anything that reduces the risk was good.
23:42But as soon as I heard there was trial, I was, I'm definitely up for that one if I can get it.
23:46That's brilliant, that.
23:47Now 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.
23:56Yeah.
23:57But 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.
24:07Yeah.
24:08But hopefully we'll never need to do that, and we'll just monitor you very, very carefully with this blood test.
24:13Fingers crossed.
24:14Yeah.
24:14Yeah.
24:15All right, let's have a look at your veins.
24:25Oh, I can see some.
24:27Beautiful.
24:30Really big news to know that I've got the clinical trial today.
24:33Gives me big hope, not just for me, for my family as well.
24:36It eases their mind, because it's not just me worried, it's everyone else in my family.
24:39It's going to sound really random, but all I've had in my head all morning is the Strictly theme tune.
24:46Okay.
24:47And that's all that's going around in my head.
24:49I get that sometimes.
24:50You've no idea where it's come from.
24:51Be careful, or else I'll start dancing to the Strictly theme tune.
24:54Anything to break up the day.
24:56Exactly.
24:58It's not just another blood test.
25:00It's to say that your cancer clear.
25:03Not only that, if they do find it, you're catching it as early as you possibly ever could.
25:08And it's immediate treatment, which is phenomenal.
25:12Scans can only pick up so much, whereas if you go into the depths of DNA in your blood,
25:17you can't get any more minute scale than that, can you?
25:22There we are.
25:24All done.
25:25Perfect.
25:28Damien's blood will be tested along with the other patient's blood samples
25:31to see if they can see any signs of cancer DNA present.
25:39This blood test is really moving things forward.
25:44Samples for you.
25:45Thank you very much.
25:46In our current standard of care, patients will be offered regular scan follow-up.
25:52But generally, that's at least every three to six months.
25:58So, this blood test is getting that result back within 10 days.
26:05We don't want to hang around where cancer's concerned.
26:09We want to get ahead of it.
26:10Once the samples are in the lab, the meticulous analysis begins.
26:18To find the circulating tumour DNA, first everything else in the blood that's not DNA is removed.
26:30Then all the fragments in the sample are compared with the patient's own healthy DNA.
26:34If scientists spot DNA fragments that don't match, it could mean the patient has cancer.
26:42And what, of course, we're all hoping for, for Damien, is a negative test.
26:49And there is no sign of tumour.
26:52And with these blood tests, we can keep a really close eye on Damien.
26:56And if his tumour comes back, we can pick it up quickly.
26:58I think we can't overpromise.
27:08It's really important that we don't.
27:10From a patient perspective, this is a clinical trial.
27:13This test is not yet available, for example, on the NHS.
27:17So, we're testing the test.
27:19There's a lot more work to do, but I'm very hopeful.
27:21Basically, you want peace of mind that I'm all clear, for now.
27:46Seagulls, Mum.
27:47Look, see, there's the first one.
27:49I reckon that bit goes there, though.
27:51I'll try that bit.
27:52Yes, that bit goes there, as well.
27:54Good.
27:56We're cracking along nicely now.
27:58Cooking on gas.
28:00I just find it really therapeutic.
28:02Well, it's nice to sit with Mum and do something we can both do together.
28:05And I just find it very satisfying when the pieces go in,
28:08because most of the time, the tasks that I perform are very long-term
28:13and not often completed in a day.
28:15So, it's nice just to have something you can get done.
28:18She was a terrible baby.
28:21She would not sleep.
28:24In the end, I got so frustrated, I took her to the doctor.
28:27And the doctor examined her, looked at her ears, looked at her eyes,
28:31looked at everything.
28:32And he said,
28:33I can't think anything's wrong with her, he said.
28:35I think she's just got an overactive brain.
28:37There you go.
28:38And she will do very well in life.
28:40I had a fantastic childhood.
28:46We lived in a public school in Sussex,
28:49because my father was the head porter.
28:54Didn't have any money, and I went to a state school.
28:57But, yeah, I saw, if you like, how the other half live.
29:00But I never felt hard done by.
29:02I just thought I lived in a really nice place,
29:04with parents who really cared about what happened next in terms of my life.
29:09My dad, one of his top tips in my youth was, you know,
29:13every time you go to bed,
29:14just think about what did I learn today.
29:17He loved learning and knowledge.
29:20And he didn't get a very good education himself.
29:22I think he left school at something like 13 years old.
29:25Oh, and he was quite clever.
29:26I mean, he could have done very well if he'd had a good education.
29:29He was clever.
29:30He's a smart guy.
29:31And I think, you know, he just wanted you to be the best you could possibly be
29:34at everything you tried to do.
29:36And I think, you know, the need to achieve, I think, is sort of hardwired.
29:42He was just a lovely man.
29:44We miss him dreadfully.
29:45I wish he was here.
29:52He died two years ago now, almost.
29:55His liver was filled with masses of tumours on the scan.
30:04He became so ill.
30:05And seeing him that ill,
30:08yeah, it was difficult because his last three months were pretty miserable.
30:11But up until that point, he was strong and resilient
30:14and fought his way through it with great, great dignity, actually.
30:17Every time I saw him, the last thing he said was, I love you.
30:22You know, it was emotional.
30:27You know, you never did know when was the last time.
30:32And on his death certificate, it said cancer of unknown primary,
30:35which is an intriguing type of cancer.
30:39That has a very personal importance to me now.
30:45And we've been working together now for many years
30:47to try and solve that problem.
30:50And it will be a special moment for me
30:52to see the work we're doing now
30:54that could help patients with cancer of unknown primary in the future.
30:59Because it must be awful knowing you've got cancer
31:01but not knowing where it's come from,
31:03with perhaps not a great chance of improvement.
31:09In 2021, I found two little lumps on my ribcage at the back.
31:18So I weren't really concerned about the lumps, it was the pain.
31:22The pain was more towards my kidney.
31:25And over the weeks, the pain got worse.
31:30I understand how people with pain could take their own life
31:35because I honestly thought about it
31:36because the pain was that bad.
31:39I'm glad it didn't.
31:43But, yeah, it must act.
31:49Lee was diagnosed with cancer of unknown primary
31:52after a mass of tumours were discovered in his kidney.
31:55When I got the cancer, I thought, cancer's cancer, that's it.
31:59But then to be told, cancer's unknown primary,
32:02I didn't understand what that meant.
32:04You think to yourself, why? Why can't you find it?
32:06How I look at this, and it's dead simple.
32:10I woke up one morning, and the little cancer gremlin's gone,
32:13it's your turn today, but you're having this special one.
32:16You're having one we can't find.
32:18And that's what the doctors say.
32:21Doctors find patients like Lee so mysterious
32:24because, unlike all other cancer patients,
32:27nobody knows where their cancer first began.
32:34When a cancer starts, it's called a primary cancer,
32:37and its type is determined by its location.
32:40Over time, cancer cells can break off
32:45and spread to other organs forming secondary cancers.
32:50This is called metastasis.
32:53When doctors don't know where the cancer started,
32:56it's called cancer of a known primary.
32:58This is a perplexing type of cancer
33:08because patients have advanced disease.
33:14Only when you know where the tumour started
33:16can you have a really rational discussion
33:19about what the right treatment would be.
33:21Why does that matter for treatment?
33:22Because it has a different biology.
33:24So it requires a different sort of treatment.
33:30At the moment, there is no personalised treatment
33:33for patients with cancer of unknown primary.
33:37I think there's an idea that, you know,
33:38if you have a cancer in the brain,
33:41it must be brain cancer.
33:43That's not true.
33:44If you sequence the DNA of a primary lung cancer,
33:48and let's say that primary lung cancer moves
33:50and starts to grow in the brain,
33:52and then you took that metastatic secondary lesion
33:55in the brain and sequenced it,
33:56it would look more like the lung cancer
33:58than it would like anything that comes from the brain.
34:03OK, Lee, this is going to be 30 minutes.
34:05Yeah. Perfect.
34:07Have you had any reaction in the past?
34:09No.
34:11Because Lee's cancer was discovered so late,
34:14it's spread and it's inoperable.
34:16So Lee began a series of traditional treatments.
34:19I had my first chemo session and they scanned me
34:22and it shrunk to half.
34:25So the chemo, it was doing something.
34:29So they gave me another three sessions of chemotherapy
34:32and said they're bringing this new drug out
34:34called immunotherapy.
34:37So that's going to be 30 minutes.
34:38Any problem? Just let me know.
34:40I will do.
34:40I also had 10 sessions of radial therapy,
34:45which pinpoints the cancer.
34:47So it's like lasers, I think, and it burns it.
34:50But it can cause other side effects.
34:52Like, because it was so close to my kidney,
34:54it could have destroyed my kidney,
34:55but luckily it didn't.
34:57So I had more chemo and then the immunotherapy,
35:00which is, it's keeping me here.
35:03Touch wood.
35:03Despite being given just nine months to live,
35:09Lee has been receiving treatment
35:11at the Christie Hospital for three years.
35:14He's been under the care of Dr. Natalie Cook,
35:16a leading expert in cancer of unknown primary.
35:21We had multiple different investigations,
35:23ultrasound scans, CT scans, MRI scans, biopsies.
35:27And after all of that,
35:28we did not find out anything
35:31that would help personalise his treatment options.
35:33Unfortunately, prognosis remains quite poor
35:38for most patients diagnosed
35:39with cancer of unknown primary.
35:41Often it's around about three to six months.
35:43But obviously Lee's done significantly better than that.
35:46We don't know exactly why he's responded to immunotherapy,
35:49but it's under control.
35:51So he remains a true cancer of unknown primary,
35:54which is annoying to me
35:55because I do like to try and find out
35:57where the cancer started.
35:58In his case, it truly is still a mystery.
36:01Have a seat, Lee.
36:04Oh.
36:05Right, how are you feeling today?
36:07All right.
36:08Yes?
36:09Since we last saw you here,
36:11has there been any changes?
36:12Nothing, no.
36:13No?
36:13So feeling generally okay in yourself?
36:15Brilliant, yeah.
36:15No pain.
36:16Okay.
36:17No, I think you're definitely one of the kind of lucky ones
36:20because the chemotherapy worked really well.
36:22Yeah.
36:22And that seems to be keeping things under control, doesn't it?
36:25Yeah, I've done like 53 or 54 treatments now.
36:28Yeah, let me just go back to when you first started was on,
36:32was February 2022.
36:35Right.
36:36So over three years now, so that's amazing.
36:38I understand, but if you can't find the primary source of a cancer,
36:42you're not going to cure it.
36:43You can't.
36:44You can generally look after it.
36:46But I'm not holding out because if you can't find it after three years now,
36:50I think it's in itself, but I'm still here and fighting the corner.
36:55I'd probably like to see it along.
36:56May it continue, basically.
36:58Yeah, I feel really good at the moment.
37:00Yeah, she's my guardian angel.
37:03No, don't put that in camera.
37:09Natalie's investigations uncovered that little research had been done
37:13in this particular field.
37:15So she got in touch with Caroline to get her help.
37:18Together, we've been able to develop this test
37:21that we call CUPID,
37:23Cancer of Unknown Primary Identification, or CUPID.
37:28And we're hoping that by taking a blood sample from a patient,
37:31we can have a pretty good idea of where that tumour started.
37:41This blood test is a little different
37:43in as much as we look at the fragments of cancer cell DNA
37:47shed into the bloodstream.
37:49But we can also look for the pattern of molecules which are on it.
37:56And those patterns, it's a bit like a postcode.
37:59They can tell us which organ in the body the tumour started off in.
38:03So if you have a tumour that starts in the liver, guess what?
38:08It'll have a liver postcode.
38:11We can measure those postcodes in the DNA
38:14and we can tell you where the tumour started from.
38:17In order to isolate this data,
38:23they use metal beads coated in a protein
38:25which the tumour DNA will bind to.
38:28A magnetic strip then attracts the DNA-coated beads,
38:33enabling them to extract the molecules.
38:36Millions of pieces of DNA are then analysed,
38:39allowing their codes to be read.
38:40We can now be fairly confident that we can predict
38:44a cancer of unknown primary started in the lung
38:47or it started in the colon, in the gut.
38:50And I think for those common cancers of unknown primary,
38:54within two weeks of the patient arriving in clinic,
38:58I think we'll be able to make a diagnosis
39:00of where their cancer started.
39:02But also the opportunity to direct a better treatment
39:07to your particular cancer.
39:09So it's new pioneering work
39:11that we really feel we can do something to fix.
39:15Caroline and Natalie have collected hundreds of blood samples
39:18from people with known cancers
39:20and are building an atlas of postcodes
39:22to map out where the cancer comes from.
39:25So far, the test can match unknown primaries
39:29to 29 common cancers.
39:31But with over 200 different types of cancer,
39:34there's still a long way to go.
39:37I know it's incurable,
39:43but hopefully it's manageable with all these treatments.
39:47Now, I know they're not going to last forever.
39:49I know at a time they're going to say,
39:53we've either got a cure for you
39:56and we've found it,
39:59or they're going to say,
40:01there's not a lot more we can do.
40:03It does bother me why I've got cancer,
40:08because I don't know why I've got cancer.
40:11No-one in my family has had it,
40:13so why me?
40:15That's the answer that I think most cancer patients want.
40:18Why?
40:19What have I done?
40:21It would be nice to be told,
40:22oh, right,
40:23we've found where the cancer has come from.
40:27Hopefully,
40:28it'll be sooner than later.
40:29That's the life that we strive for.
40:53Sat there with a glass of whiskey watching the day go by.
40:55Definitely look forward to her reaching retirement age.
41:04Damien is waiting to get the results from the trial
41:06to find out if any cancer DNA is still present in his blood.
41:11No-one ever looks forward to finding out
41:13if they've still got cancer or not.
41:15Obviously, everything runs through your mind.
41:18I don't want to get ill.
41:19I don't want my family to see me getting ill.
41:22Obviously, I want to be here.
41:23I want to see my grandkids grow up.
41:24I want to enjoy life with them.
41:28So, yeah, it certainly plays on your mind a fair bit.
41:38After analysing all the data from the trial,
41:41Becky must also bring those results back
41:43to the patients taking part.
41:45We have a job where things can be fantastic for one patient
41:50and then go to another patient and it's awful.
41:54And you're about to tell them something
41:56that's really going to change their life again.
41:58BELL RINGS
42:02BELL RINGS
42:06BELL RINGS
42:07BELL RINGS
42:07BELL RINGS
42:09BELL RINGS
42:09BELL RINGS
42:11Hi.
42:12Hi, Damien.
42:13It's Becky Lee, the consultant.
42:15Hi. You OK?
42:17Just to let you know
42:19that your result
42:21is negative.
42:22BELL RINGS
42:22So, great news.
42:29Brilliant.
42:30That's fantastic news.
42:34Fantastic.
42:35No, that's lovely.
42:37The sun's shining,
42:38so couldn't have been a better day.
42:40OK, well, I'll speak to you soon.
42:43Brilliant.
42:43Bye.
42:44Bye-bye.
42:53Couldn't be any better.
42:54Bank holiday on the horizon.
42:56Spend time with my family.
42:58With the all clear for now.
43:00Fantastic.
43:05Hi, Dal.
43:06How's it, Dal?
43:07Yeah, just got the phone call
43:08and we've got the all clear.
43:10Oh, brilliant.
43:11Hope it's gone forever now.
43:13Yep.
43:13Onwards, we can plan the weekend now.
43:17I'll see you later, Dal.
43:18See you, babe.
43:19Bye.
43:19Bye.
43:27I think it's becoming very clear
43:29that biomarker tests in blood
43:31are changing
43:34how we even think about
43:35the early detection of cancer.
43:37They really are changing the game.
43:41I think it's the golden age
43:42of cancer research.
43:43It's massively exciting.
43:46You know, and at the moment,
43:48patients are giving blood
43:49in the hospital,
43:50but you might like to think
43:51in the years to come,
43:52we'll wear a wearable device,
43:54your smartwatch
43:56or whatever it is you're wearing
43:57will say,
43:57beep, beep, beep,
43:58it's the first Tuesday
43:59in the month.
44:01Pop down to your pharmacy
44:02to give your blood in.
44:03It's your routine blood test
44:05for cancer.
44:07You know, we're not there yet,
44:09but it's a nice future
44:11to think about
44:12because, you know,
44:12it is doable.
44:14And I think we'll get there.
44:20Hi, boys.
44:21All right, son?
44:23You all right?
44:23See?
44:24Three years on from his diagnosis,
44:26the mystery of where
44:27Lee's cancer started
44:28remains unsolved.
44:30All right, Marie?
44:30All right, Lee.
44:31Fellas?
44:32You all right?
44:35Oh, shit.
44:37Stop swearing.
44:39Don't think these lot
44:40drink in a Catholic club,
44:41would you?
44:45Who's on next?
44:46I've decided now
44:48cancer won't meet me.
44:51It's not going to get me down.
44:53Oh, looky, mate.
44:55Because there's nothing
44:56I can do about it,
44:57so why worry?
44:59Why sit at home and go,
45:00why me, why me?
45:01It's me.
45:03And now we're
45:04three and a half years in.
45:05I'm still here now.
45:07Still enjoying myself, so...
45:08You know, Dr. Cook said to me,
45:15and this gives you hope,
45:17and she said,
45:18what's not curable today
45:19could be curable tomorrow.
45:23The lads will pull us through.
45:27You can't give up life.
45:29It's too precious.
45:32You've got to maintain that hope.
45:36Listen, I'll go to heaven, mate.
45:39Yeah.
45:40Only if gates are locked downstairs.
45:43I tell you,
45:44I'm going to heaven.
45:48I'll let you
45:48open the gate for me.
45:49LAUGHTER
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46:20support information for the issues raised can be found online at channel 4.com forward slash
46:33support kicking it to the curb we've a whole night of standing up to cancer fundraising fun
46:39and celeb goggling adam hills and hannah fry get things going from 7 30 next friday
46:50you
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