Speaker 1: Throughout this series, we'll be discussing many aspects of cancer
Speaker 1: diagnosis and treatment, and we will be sharing several personal
Speaker 1: stories related to cancer. Some listeners might find this content upsetting.
Speaker 1: Please listen with discretion.
Speaker 2: Do you know that you can live without a jugular vein?
Speaker 2: Those were the first words my surgeon told us after
Speaker 2: he removed sed vein during my second excigen surgery for
Speaker 2: sway MISSL carcinoma six months earlier. The newly discovered cancer
Speaker 2: was isolated to my tongue and lymph. Notes the cancer
Speaker 2: was brought on by the human papaloma virus HPV. As
Speaker 2: a gen xer, I probably got it long ago. However,
Speaker 2: my children are likely to be spared HPV and this
Speaker 2: kind of cancer because of the gardess of vaccine. The
Speaker 2: cancer was removed with good margins me and that I've
Speaker 2: probably gotten at all. Then came the radiation to sweep
Speaker 2: up any stray cells hanging around. I received the largest
Speaker 2: dost possible, thirty sessions directed in my neck and mouth.
Speaker 2: Before radiation began, I was told there was a deterioration
Speaker 2: risk to surrounding bone structures. I brushed it off, thinking
Speaker 2: save my life. Nothing else matters. However, the radiation did
Speaker 2: not stop an immediate recurrence. That's when it was drapped
Speaker 2: around my jug of the rain. Then I began chemotherapy.
Speaker 2: This required me to mask after each treatment so as
Speaker 2: not to contaminate the air with chemo. I was only
Speaker 2: a few treatments in when the world shut down due
Speaker 2: to the cod pandemic. Because the public was buying up
Speaker 2: medical protection, supplies on cology ran short and I had
Speaker 2: to source my own masks. Chemo worked where radiation had not.
Speaker 2: I'm in a remission, but cancer is still a part
Speaker 2: of my life. As predicted, the large radiation dose ravage
Speaker 2: the bones of my jaw. It's been seven years since cancer,
Speaker 2: and I still faced an extensive eight hour surgery just
Speaker 2: to refer the damage from treatment itself. The inevitability is
Speaker 2: that without this procedure, it's only a matter of time
Speaker 2: before my jaw simply breaks. There was no saving my teeth.
Speaker 2: Eating without them and with a partial scarred tongue is
Speaker 2: difficult and limited. I needed physical therapy to learn to
Speaker 2: swallow again. Since Stentser's a contraindicated I'll be living with
Speaker 2: the stigma and drawbacks associated with toothlessness. For the rest
Speaker 2: of my life. Still beats being dead.
Speaker 3: My name's Louise Baines and I have stage four triple
Speaker 3: negative breast cancer. I was first diagnosed stage three eight
Speaker 3: years ago at the age of thirty nine. I have
Speaker 3: the standard treatment chemotherapy, surgery, radiotherapy was eventually back to
Speaker 3: some semblance of then in twenty twenty three, I found
Speaker 3: a suspicious lump in my armpit, a new lymph no tumor.
Speaker 3: I had more surgery, more chemo, but at the end
Speaker 3: of that year, sadly, a ct scam found widespread bone
Speaker 3: mets and lymph no tumors in my chest. My world
Speaker 3: fell apart for the third and most ominous time. I
Speaker 3: was told I'd need to be on treatment for whatever
Speaker 3: time I had left, thought to be around two years,
Speaker 3: treatable to a point, but not curable. Seeing palliative chemo
Speaker 3: on my notes was a bit of a shock. Triple
Speaker 3: negative is aggressive and can become resistant to treatment. My
Speaker 3: first line of therapy, chemotherapy and immune therapy got me stable,
Speaker 3: pretty much obliterated all my bone mets, but I had
Speaker 3: progression after a year, so I moved on to a
Speaker 3: new drug. This was a targeted chemotherapy that I had
Speaker 3: only been around for a few years. It gave me
Speaker 3: hope to find some of the ladies on that original
Speaker 3: trial were still stable or no evidence of active disease
Speaker 3: even after five years. I took part in a clinical
Speaker 3: trial with my primary chemo which added an extra trial
Speaker 3: drug into the standard treatment, and I became fascinated with
Speaker 3: the science behind the treatment. Researching the history and development
Speaker 3: of each drug became really interesting to me. That first
Speaker 3: study didn't show any better outcomes than standard treatment, sadly,
Speaker 3: but being part of the research made me feel like
Speaker 3: I was helping in some small way. After my second
Speaker 3: line of treatment started to show resistance after another year,
Speaker 3: I decided to look for another clinical trial. I only
Speaker 3: have a few options left for suitable chemos, and while
Speaker 3: I'm still pretty fit and well, I don't want to
Speaker 3: use them all up too fast. I was approved for
Speaker 3: a trial at the Royal Marsden in the UK, and
Speaker 3: I'm being really well looked after. I'm on my second
Speaker 3: cycle of a targeted immune therapy plus a standard immune
Speaker 3: therapy similar to what I had as my first line.
Speaker 3: It's a phase one expansion trial, so the drug has
Speaker 3: shown someone promising results in one type of cancer and
Speaker 3: is being expanded to include other difficult to treat cancers
Speaker 3: like mine. I'm quietly hopeful. I'm now two years into
Speaker 3: my diagnosis, and I didn't expect to still be here.
Speaker 3: Research is very important to me, and I will be
Speaker 3: forever grateful for the extra time I've been given with
Speaker 3: my son, my husband, and my friends. Statistics haven't quite
Speaker 3: caught up with the current treatment, so I wouldn't recommend
Speaker 3: googling for a prognosis. According to that, I should be
Speaker 3: in the ground long ago. But right now I'm living
Speaker 3: well and hopefully we'll continue to do so for as
Speaker 3: long as I can thanks to science.
Speaker 1: Thank you so so much for sharing your story with us,
Speaker 1: and a huge thank you to everyone who has written
Speaker 1: in with their experiences. It is, I mean, it is
Speaker 1: so incredibly meaningful that so many of you are willing
Speaker 1: to put yourselves out there and share such an intimate
Speaker 1: part of your lives. These first hand accounts are truly,
Speaker 1: truly are the backbone of this podcast.
Speaker 4: They really are, Like this podcast would not be the
Speaker 4: same without all of you and all of your stories.
Speaker 4: And we have a lot more that we're going to
Speaker 4: be sharing throughout this episode and throughout this series that
Speaker 4: we're putting together. So truly, thank you so much to
Speaker 4: everybody who took the time to submit your story, to
Speaker 4: write in to record yourselves. We really wish that we
Speaker 4: could have included every single story because they all mean
Speaker 4: so much to us, So thank you.
Speaker 1: Yeah. Hi, I'm Aaron Welsh.
Speaker 4: And I'm Erin Alman Updike and.
Speaker 1: This is this podcast will kill you.
Speaker 4: Welcome to our series on cancer.
Speaker 1: On cancer. Yeah, well I don't know this, I mean
Speaker 1: such a big topic. I mean, we may the decision
Speaker 1: because it is. It is a checked so many people.
Speaker 1: It is such a big topic and if we ever
Speaker 1: want to go into certain cancer episodes in the future,
Speaker 1: we need to lay a foundation.
Speaker 4: And that's what we're doing. That's to today.
Speaker 1: Right right, We have got four absolutely info packed episodes
Speaker 1: ahead of us where we're going to be covering this
Speaker 1: tremendously huge, monumental.
Speaker 4: Topic and only four episodes.
Speaker 1: In only four episodes, Oh, there's like a lot of
Speaker 1: material here.
Speaker 4: Oh yeah, we'll yeah, you can't see our folders, but
Speaker 4: this is.
Speaker 1: One episode's worth. Yeah. But when we first decided that
Speaker 1: we wanted to do these episodes, we immediately kind of okay,
Speaker 1: we asked ourselves what do we want to cover, how
Speaker 1: do we want to approach this, what aspects to focus on,
Speaker 1: and how to organize them in a way that made
Speaker 1: sense so that we could just like again, lay a foundation.
Speaker 1: So our goal with this series is to do that,
Speaker 1: is to kind of give you the background information about
Speaker 1: what cancer is, how we treat it, and also where
Speaker 1: do we go from here? And so with that in
Speaker 1: mind are our first episode The one today explores what
Speaker 1: cancer is, both conceptually and clinically, and how we came
Speaker 1: by that knowledge. The second delves into what's happening inside
Speaker 1: and outside of our bodies to make cancer so prevalent,
Speaker 1: and the third is all about treatment, which.
Speaker 4: Is a lot big it's a big top.
Speaker 1: And the fourth and final episode surveys the current landscape
Speaker 1: of cancer around the world and asks what can we
Speaker 1: do about this?
Speaker 4: Where do we go from here? So it's a lot
Speaker 4: there's a lot of ground that we're going to be covering,
Speaker 4: but as much as we are covering, there is a
Speaker 4: lot that will necessarily remain unexplored in this first of
Speaker 4: our cancer series. So please everyone listening and watching, No.
Speaker 4: Two things Number One, we have a really huge list
Speaker 4: of sources for these episodes that we put together, so
Speaker 4: if you want to read more, there is tons that
Speaker 4: you can look up and read just as a starting point.
Speaker 4: And number two, these are not the only cancer episodes
Speaker 4: that we've ever done that we ever will do. We
Speaker 4: have a lot of plans to cover a lot of
Speaker 4: the individual cancers that we'll be talking about and touching
Speaker 4: on in this episode. So we also would love to
Speaker 4: hear from you if you have particular cancers or particular
Speaker 4: topics that you want to hear a lot more about.
Speaker 4: I know, just like we know that we'll need to
Speaker 4: do callon Cancer very soon.
Speaker 1: Yeah, and we will be doing it. Let's tell your thoughts.
Speaker 1: Like again, we always ask for thoughts, but like especially
Speaker 1: in this what do you want to hear more about
Speaker 1: exactly exactly and as you'll hear you know, know to
Speaker 1: cancers or experiences with cancer are alike. And so we
Speaker 1: are again so grateful to our first hand account providers
Speaker 1: for showing us just a sample really like a sample
Speaker 1: of the diversity of ways that cancer can touch our lives.
Speaker 1: You know, in these episodes, what we focus on is
Speaker 1: primarily cancer as like a biological phenomenon, not necessarily the
Speaker 1: experience of cancer. And so we are again eternally grateful
Speaker 1: to all of you who have provided this important context
Speaker 1: and sharing your experience from of someone who has been
Speaker 1: diagnosed with cancer, who's undergoing cancer treatment, who's has a
Speaker 1: loved one who has cancer, who is a caregiver, you know,
Speaker 1: all all of these different facets that are so integral
Speaker 1: to the experience.
Speaker 4: We really like can't say enough I know how much
Speaker 4: these first hand accounts mean absolutely everything to us, and
Speaker 4: in this cancer series especially, it's been so meaningful to
Speaker 4: get to hear from so many of you, So thank
Speaker 4: you again.
Speaker 1: Okay, one more piece of business, just a little bit,
Speaker 1: and that is quarantine time. Quarantiny time, actually though it's
Speaker 1: play and that's.
Speaker 4: Plassy Berita time. I guess this is an announcement.
Speaker 1: That we're making kind of is we've.
Speaker 4: Been doing this quarantiny business since we started the podcast,
Speaker 4: and it's actually one of the things that really clinched
Speaker 4: the idea of doing this podcast. Would kill you, because
Speaker 4: Aaron came up with the name Quarantini and it was
Speaker 4: too good to pass up. But we thought that as
Speaker 4: we'll learn, so we've talked about alcohol before and the
Speaker 4: problems with alcohol in the past, and so we thought
Speaker 4: that this series today, starting today, would be a fitting
Speaker 4: time to no longer include alcohol in our quarantini recipes.
Speaker 4: So they're technically all going to be plassy burritas.
Speaker 1: They are they are. I mean, we're still going to
Speaker 1: use the term quarantini because it's really good. I can't
Speaker 1: let it go. I can't let it go.
Speaker 4: But I'm also quite proud of plassy burrita. That's really good.
Speaker 1: And I remember when that we came up with that. Yeah,
Speaker 1: it was on the It was on the fly.
Speaker 4: Yeah again, it was I think while we were recording,
Speaker 4: wasn't it. Yes, Yeah, that was good.
Speaker 1: Yeah, yeah, Okay, So what is our quarantining? What is
Speaker 1: it for the series?
Speaker 5: Aron?
Speaker 4: We're drinking the crab, the crab because cancer. Yeah, that's
Speaker 4: what it is. Yeah, it's basically an aphagado. Yes, I
Speaker 4: actually really wish that we had one. That would be
Speaker 4: so much.
Speaker 1: I could use a little caffeine at a little boost.
Speaker 4: Yeah, yeah, but you can. You know, we'll still post
Speaker 4: on our Instagram or whatever.
Speaker 1: Wow, we'll bringing endorsement of our social media listen, still post.
Speaker 4: Our social media game could probably use some work at
Speaker 4: this point, but I know.
Speaker 1: We will post it there and you know it's fine.
Speaker 1: You can look it up the recipe, but also look
Speaker 1: up the crab because you know we did make the effort.
Speaker 4: You mean our version of ye yeah, yeah, yeah, exactly. Yeah.
Speaker 4: So follow us on social media if you're not, is
Speaker 4: what we're saying to media.
Speaker 1: That's one way you can find what we're doing. It's
Speaker 1: one of the best ways. Another great way is through
Speaker 1: our website web podcast will Kill You dot Com. On
Speaker 1: our website, you can find all sorts of things like transcripts.
Speaker 1: You can find the sources for each and every one
Speaker 1: of our episodes. You can find a first hand account form,
Speaker 1: you can find a contact us form, other things. That's
Speaker 1: all i'm gonna say. Well, links to Patreon and merch
Speaker 1: and other things.
Speaker 4: All kinds of things. Thank you for rating, reviewing, and
Speaker 4: subscribing on your favorite podcatcher or on you Tube. If
Speaker 4: you're watching this, yes we're hearing the exactly right studios.
Speaker 4: Thank you to everyone. Thank you working right now.
Speaker 1: This is the longest intro of all time.
Speaker 4: Are we done yet? Yes?
Speaker 1: Okay, great, we're done. Let's take a break. Okay, and
Speaker 1: then and then get in get into it.
Speaker 4: Thanks great.
Speaker 6: Bye.
Speaker 7: My name is Amanda. In twenty nineteen, at fifty two,
Speaker 7: I was diagnosed with stage three triple negative breast cancer.
Speaker 7: The diagnosis was a shock, not only because of its severity,
Speaker 7: but because I truly believed I was doing everything right.
Speaker 7: For years, I followed a clean alternative wellness lifestyle. I
Speaker 7: it organic, avoided plastics, used non toxic products, took supplements,
Speaker 7: exercise regularly, maintained a healthy weight on a low carb diet,
Speaker 7: and didn't smoke. One pivotal decision was replacing annual mammograms
Speaker 7: with thermal imaging. Felt empowering in hindsight, it was a
Speaker 7: serious mistake. When I found a lump in my left breast,
Speaker 7: I turned to thermal imaging. The scan came back low
Speaker 7: risk for cancer. The practitioner diagnosed it as a cyst,
Speaker 7: suggested rebounding exercises and cost oil robes, and confidently told
Speaker 7: me it was far too large to be cancer. That
Speaker 7: reassurance was dangerously wrong. The lump didn't shrink, It grew
Speaker 7: quickly and painfully. When I finally saw a breast radiologist
Speaker 7: to aspirate what I believed was a cyst. My cancer
Speaker 7: journey began. I was thrust into aggressive treatment because my
Speaker 7: cancer demanded it. I underwent six cycles of chemotherapy, including
Speaker 7: the so called Red Devil. I tolerated it well and
Speaker 7: the results were remarkable. The tumor disappeared completely. Surgery followed,
Speaker 7: first to lumpectomy, then a unilateral mistectomy due to residial disease.
Speaker 7: Losing my breast was and remains a profound loss. I
Speaker 7: still wondered whether the earlier medical or intervention might have
Speaker 7: changed that outcome. Radiation and oral chemotherapy followed during South
Speaker 7: Africa's COVID lockdown. The treatments were challenging, but manageable cancer
Speaker 7: forced me to re evaluate everything I thought I knew
Speaker 7: about health. Over time, I stopped trusting methods that offered
Speaker 7: certainty without evidence, and learned to hold space for both
Speaker 7: intuition and science. My version of health today is far
Speaker 7: less rigid, less fear based, and more informed. I have
Speaker 7: seen how vulnerable people are to misinformation, wrapped in hope
Speaker 7: and sold as wellness. And if there's one message I
Speaker 7: hope people take from my story is that there's strength
Speaker 7: in questioning our beliefs and in choosing evidence based care.
Speaker 5: Hi. My name is mccannaugh Elvin ORMMBT, Florida, and when
Speaker 5: I was fifteen years old, I was diagnosed with stage
Speaker 5: three uing circoma aware from my bone cancer. My aud's
Speaker 5: survival were about fifty thirfty. I underwent countless runs a
Speaker 5: chemotherapy and had a serious to remove my left fibula.
Speaker 5: Because of how aggressive the type of cancer I had was,
Speaker 5: cancer immediately became my entire life. I was pulled from
Speaker 5: school and spent most of my time in the hospital.
Speaker 5: It felt like I didn't exist outside of my disease.
Speaker 5: There was also just this chance I wasn't going to
Speaker 5: Chemotherapy is also pretty violent in nature. It felt like
Speaker 5: every part of me had to be stripped away in
Speaker 5: order to get rid of the tumor. I lost my hair,
Speaker 5: my tone as will turn black and fall off. I
Speaker 5: had horrible mouse words that kept me from eating. I
Speaker 5: had chronic insomnia. Felt like I kept giving and giving
Speaker 5: until by the end I was just a shadow of
Speaker 5: a person with really only my life left. I ended
Speaker 5: up responding well to treatment, though, and I was able
Speaker 5: to go back to school for my senior year of
Speaker 5: high school.
Speaker 4: Two years after my initial diagnosis.
Speaker 5: At first, I was excited to go back and built
Speaker 5: it'd be a new chapter for me, we where I'd
Speaker 5: be a normal kid again. Instead, I began a whole
Speaker 5: different type of suffering. Sitting in a desk, I felt
Speaker 5: like I didn't know how to exist as a person anymore.
Speaker 5: I'd gone from being fifteen so coming into my own
Speaker 5: to cancer becoming my entire life. I now couldn't claim
Speaker 5: the cancer identity, but also physically and mentally, I didn't
Speaker 5: resemble the person I was before. Looking in the mirror,
Speaker 5: I followed disassociation to that person and couldn't grasp who
Speaker 5: I was the same time I was suffering from PTSD,
Speaker 5: I was continuously having panic attacks and took myself to
Speaker 5: the emergency room on a couple of different occasions, convinced
Speaker 5: my cancer had returned and I was going not to
Speaker 5: start the process all over again. I ended up becoming
Speaker 5: severely depressed and got to the point where I really
Speaker 5: didn't want to be alive anymore, which brought on a
Speaker 5: deep survivor's guilt for even having these feelings. People weren't
Speaker 5: very understanding of. This ended up being a really isolating
Speaker 5: and lonely time in my life, and I just wish
Speaker 5: someone had told me that what I was feeling was
Speaker 5: completely normal. One in five people ended up with PTSD
Speaker 5: after cancer treatment. It took me years to find a
Speaker 5: sense of self and peace again. This past July was
Speaker 5: my ten years cancer free. I'm eternally grateful for all
Speaker 5: the moments and experiences and things I've been able to
Speaker 5: accomplish since I was at fifteen year old. I am
Speaker 5: truly so happy for my life. But I also want
Speaker 5: to go back to tell myself that what I was
Speaker 5: feeling was okay. I didn't need to feel grateful for
Speaker 5: something that should have never happened in the first place.
Speaker 5: No matter what, I was always deserving of my life.
Speaker 1: Forty percent of us will develop cancer at some point
Speaker 1: in our lives. Seventeen percent of us will die from cancer.
Speaker 4: Gosh, those are such sobering statistics, Aaron.
Speaker 1: Really, yeah, I know the number of times I double
Speaker 1: checked it and was like, confirm other sources. Is this right?
Speaker 1: It is? And again you know these are estimates, they
Speaker 1: are not destinies. Our knowledge is always evolving, treatments are
Speaker 1: always improving, We're putting more fun into prevention and so
Speaker 1: we might see those numbers shift in the upcoming decades
Speaker 1: or for future generations. And neither are these numbers globally consistent.
Speaker 1: You know, diagnosis, access to treatments, and screening, and demographics
Speaker 1: vary dramatically across countries. But no matter how much you
Speaker 1: hedge or qualify these estimates with well technically, the undeniable
Speaker 1: reality is that cancer is extremely common and quite deadly.
Speaker 1: Why Why Why? That one word question has inspired countless
Speaker 1: research articles, medical foundations, textbooks, hospitals, memoirs, documentaries, podcasts. It
Speaker 1: has shaped lives, careers, relationships, perspectives. It holds the key
Speaker 1: to understanding not just this disease, but multicellular life itself.
Speaker 1: Over these four episodes, we might not fully answer this
Speaker 1: question of why why, Yeah, but we are going to
Speaker 1: explore many different aspects, many dimensions of it, like why
Speaker 1: cancer is so prevalent, why it's so challenging to treat
Speaker 1: and prevent, why each cancer is unique, and why despite
Speaker 1: all these whys, we should still be optimistic about the
Speaker 1: future of cancer research. I like that part, yeah, But
Speaker 1: before we approach any of these individual questions, we need
Speaker 1: to start at the beginning. What is cancer?
Speaker 4: What is cancer.
Speaker 1: Drawing the bounds around what cancer is and what it
Speaker 1: isn't is trickier than it sounds like. Just ask our
Speaker 1: immune systems, and those boundaries have changed substantially over history,
Speaker 1: and so for my part of this first episode, I'm
Speaker 1: going to explore how our understanding of cancer has changed
Speaker 1: over time and how that has influenced the noise or
Speaker 1: the silence surrounding it.
Speaker 4: Okay, okay.
Speaker 1: In the early decades of the twentieth century, after the
Speaker 1: dust had settled from that vaccines, pasturization, sanitation and a
Speaker 1: septic technique and antibiotics, much of the world was surprised
Speaker 1: to find that a health revolution had taken place. Infectious disease,
Speaker 1: which had for millennia made an early, gravely expected norm,
Speaker 1: no longer held the power that it once held. Children
Speaker 1: drinking pasteurized milk and vaccinated against smallpox could now more
Speaker 1: reliably expect to live long enough to experience the joys
Speaker 1: and disappointments of adulthood, and adults drinking clean water and
Speaker 1: operated on by a surgeon with a clean blade were
Speaker 1: now more likely to feel the mixed blessing that came
Speaker 1: with the aches and ailments of old age.
Speaker 4: Well this is so interesting already, Aaron like, I just okay,
Speaker 4: keep going, keep going. I just want to know more.
Speaker 1: Is this cliffhanger? Yeah, you're just like, what is something
Speaker 1: on the horizon?
Speaker 4: It's cancer.
Speaker 1: It's cancer. Yeah. As infectious disease stole less of the spotlight,
Speaker 1: other diseases became more visible. We've talked about this phenomenon
Speaker 1: many times on the podcast, and among these diseases is cancer.
Speaker 1: Cancer was not a new disease, of course, but at
Speaker 1: the beginning of the twentieth century, cancer was not even
Speaker 1: in the top five leading causes of death in the
Speaker 1: United States. Really. Yeah, it was eighth on the list. Wow.
Speaker 4: Yeah, sorry, remind me of the year because my brain is.
Speaker 1: Like nineteen hundred okay, yeah, yeah, not even in the
Speaker 1: top not even in the top five. Wow.
Speaker 2: Okay.
Speaker 1: Life expectancy was forty nine years wow, which is a
Speaker 1: flawed metric. It doesn't take into account the effect that
Speaker 1: of infant and childhood mortality would have on those numbers,
Speaker 1: which was primarily from infectious disease. But overall, people were
Speaker 1: not living as long as they do today, and cancer
Speaker 1: was less prevalent, partly because people were dying before developing cancer.
Speaker 1: Cancer happens to be a disease later in life. Life
Speaker 1: most commonly partly because our relative lack of knowledge about
Speaker 1: cancer meant that many people had cancer but never realized it,
Speaker 1: and partly because certain cancer risk factors, such as smoking,
Speaker 1: were lower than in the following decades. Okay, So, for instance,
Speaker 1: at the turn of the century, a case of lung
Speaker 1: cancer was rare enough to point out to med students
Speaker 1: so that they saw it at least once in their careers.
Speaker 4: Really, that's depressing.
Speaker 1: Yeah, over the first half of the twentieth century, all
Speaker 1: that would change. Yeah, all of it.
Speaker 4: That's quite actually particularly disappointing with regards to lung cancer
Speaker 4: because we're people just not smoking. We need to do
Speaker 4: tobacco as like an actual episode Aarin.
Speaker 1: I have that written in here multiple times. Yeah, there
Speaker 1: are some really interesting trends about like smoking, and of
Speaker 1: course it's very different country to country and by age
Speaker 1: group and stuff like that. But yeah, I mean cigarettes
Speaker 1: were really became popular, especially after the World Wars.
Speaker 4: Got it, ok Okay, that makes sense.
Speaker 1: Over the course the twentieth century, life expectancy rose. Cancer
Speaker 1: research began to shed light on the disease, so that
Speaker 1: more cancers were diagnosed and then lumped into this rapidly
Speaker 1: growing umbrella term of cancer. And certain cancers increased in
Speaker 1: incidents as exposure to carcinogens increased, like with lung cancer
Speaker 1: and cigarettes. Even though cancer was not a new disease,
Speaker 1: even though this rise was driven primarily by growing awareness
Speaker 1: and life expectancy, cancer became labeled as a disease of
Speaker 1: the twentieth century. It represented corruption, consumerism and excess, the
Speaker 1: uncontrolled population growth happening within cities, the danger of nonconformity, oh,
Speaker 1: and the threat of invasion.
Speaker 4: Okay, yeah wow.
Speaker 1: While microbiology had demystified many long feared infectious diseases, cancer
Speaker 1: remained one big question mark that scientists could not answer.
Speaker 1: If cancer cells were part of us, why were they harmful?
Speaker 1: Why did cancer strike one person but not another? Why
Speaker 1: does cancer happen at all? Science couldn't yet provide any
Speaker 1: satisfying answers to these questions, and so people did what
Speaker 1: they so often do, They invented their own. Broadly speaking,
Speaker 1: the explanations, or rather blame, really fell into two main categories,
Speaker 1: modern civilization or yourself. Of course, you are to blame.
Speaker 4: It's your fault. It's your fault.
Speaker 1: Yeah. Throughout much of the late eighteen hundreds and into
Speaker 1: the nineteen seventies, really all the way through that whole time,
Speaker 1: that vast amount of time, people diagnosed with cancer were
Speaker 1: told that they had brought it on themselves by bottling
Speaker 1: up their feelings, that it was the result of depression,
Speaker 1: and a quote unquote cancer prone personality type was constructed.
Speaker 4: Is this just Freud who was diagnosing cancer?
Speaker 1: No, oh my god, this was this is before Freud,
Speaker 1: after Freud. I can't blame Freud for this. I know,
Speaker 1: it's too bad. We do like to do that, we do.
Speaker 1: I'm sure he had a hand in it.
Speaker 4: He was a proponent.
Speaker 1: Yeah, yeah, yeah. So in her book Illness as Metaphor,
Speaker 1: Susan Sontag describes this cancer prone personality type quote the forlorn,
Speaker 1: self hating, emotionally inert creature. She had been diagnosed with cancer,
Speaker 1: and so this is what a lot of people would
Speaker 1: That's like how you were talked about, like, oh, well,
Speaker 1: this creature, this creature. Yeah. At that point, So this
Speaker 1: Illness as Metaphor came out in nineteen seventy seven, and
Speaker 1: at that point cancer had been a subject of intense
Speaker 1: scientific scrutiny for decades, and yet this blame language persisted.
Speaker 1: People are afraid of what they don't understand, and our
Speaker 1: understanding of cancer is relatively new, incomplete, and constantly evolving.
Speaker 1: That imperfect knowledge has resulted in blame. It has resulted
Speaker 1: in fear, and it has resulted in silence and euphemisms.
Speaker 1: When Ulysses S. Grant developed throat cancer in eighteen eighty four,
Speaker 1: his doctor acknowledged that cigars they might have been to blame,
Speaker 1: but added that quote depression and distress of mind was
Speaker 1: a more important factor end quote.
Speaker 4: In the development of throat cancer. Okay, yeah.
Speaker 1: Obituaries in the early twentieth century alluded to quote unquote
Speaker 1: lingering illness as the cause of death rather than print
Speaker 1: the word cancer.
Speaker 4: Really, so they don't want to call it cancer.
Speaker 1: They don't want to call it cancer. And then even
Speaker 1: when the taboo on cancer kind of lifted and there
Speaker 1: was an outcry for more research, there were there was
Speaker 1: like an organization that was like, oh, we want to
Speaker 1: meet to talk about breast cancer, and they were like,
Speaker 1: we can't print that.
Speaker 4: Okay, yeah, great, great, great great, yeah cool.
Speaker 1: When cancer was mentioned during that period, it was often
Speaker 1: in like lurid terms, like Senator Matthew Neely used in
Speaker 1: nineteen twenty eight during a speech demanding funds for cancer research. Quote,
Speaker 1: I proposed to speak a monster that is more insatiable
Speaker 1: than the guillotine. It has prayed and still praise upon
Speaker 1: every nation. It has fed and feasted and fattened on
Speaker 1: the flesh and blood and brains and bones of men
Speaker 1: and women and children in every land. The name of
Speaker 1: this loathsome deadly and insatiate monster is cancer. End quote.
Speaker 4: So interesting, Aaron to go back and look at these
Speaker 4: kinds of ways that we describe cancer and like compare
Speaker 4: that to what how we fighting against cancer today?
Speaker 5: Oh?
Speaker 1: Yeah, I mean there are there are entire books written
Speaker 1: about like the language that we use when we talk
Speaker 1: about cancer. And you know, more recently or since since
Speaker 1: the nineteen seventies, I guess the language is much more
Speaker 1: likely to be military code of yes, right, the war
Speaker 1: on cancer and all out of tack, defeating the enemy,
Speaker 1: and aggressive aggressive, aggressive aggressive, And that shift to this
Speaker 1: military language, it has not eradicated victim blaming, which can
Speaker 1: come in more indirect ways. Right, you know, healthy mind,
Speaker 1: healthy body, The implication that cancer will defeat you if
Speaker 1: you don't fight hard enough.
Speaker 8: Yes.
Speaker 1: And also I think there's this tendency that we all have.
Speaker 1: I think it's human of us that when we hear
Speaker 1: that someone has cancer, we want to know what kind
Speaker 1: of cancer is it?
Speaker 5: Oh?
Speaker 1: Were they a smoker? So that we try to find
Speaker 1: ourselves in that well, well we won't be that won't
Speaker 1: happen to us.
Speaker 4: Trying to understand I didn't do this, what was different
Speaker 4: about you? What's different about me? Why does this not.
Speaker 1: A Why do I want to make sense of this diagnosis?
Speaker 1: And I want to I don't want this to happen
Speaker 1: to me. Yeah, And so we try to find that reason.
Speaker 1: We try to find a cause and effect.
Speaker 6: Yeah.
Speaker 1: And today the fear of cancer and the blame is
Speaker 1: as real and as palpable as ever. Surveys looking at
Speaker 1: fear of chronic diseases show that people fear cancer more
Speaker 1: than any other chronic disease, even though heart disease kills
Speaker 1: warm people one killer.
Speaker 4: That's actually really interesting. I did not know that, Aaron.
Speaker 4: That doesn't surprise me at all, No, because it's the
Speaker 4: thing I mean, I know, like when you have if
Speaker 4: you're concerned about it, everyone wants to tiptoe around do
Speaker 4: we even say that we're concerned about cancer? Or do
Speaker 4: we not even say the word cancer yet? Kind of
Speaker 4: thing that still happens in medicine todays.
Speaker 1: Yeah, I mean that's a whole I know, I have
Speaker 1: a lot of I know, I know, but yeah, I mean, why, Like,
Speaker 1: what is it about cancer that elicits such dread? And
Speaker 1: I don't think that it's an unreasonable fear? Yeah, I
Speaker 1: would not say it at all. I'm I have that fear.
Speaker 1: Forty percent of us will develop cancer at some point
Speaker 1: in our lives. But what that looks like or when
Speaker 1: it might happen, we have no idea. It could mean
Speaker 1: a diagnosis in childhood, in middle age, or later in
Speaker 1: our lives, all of the above, all of the above.
Speaker 1: It could mean a simple curative surgery or a marathon
Speaker 1: of expensive and tortuous treatments. It could mean delayed plans,
Speaker 1: canceled plans, or new plans. It could mean becoming a
Speaker 1: caretaker or being taken care of. It could mean hope, despair, clarity,
Speaker 1: a new knowing. It could mean every one of those things,
Speaker 1: some of those things, or none of those things. Cancer
Speaker 1: is unpredictable by nature, which is part of why it
Speaker 1: inspires such fear. It has touched every one of us,
Speaker 1: ourselves directly or through our family, our friends, our neighbors,
Speaker 1: our colleagues. But we can't necessarily look to others' experiences
Speaker 1: to predict how our own story will unfold. We want answers,
Speaker 1: what's my prognosis, will this treatment work, how long do
Speaker 1: I have? What side effects will I experience? What happens next?
Speaker 1: But most answers are best guesses, formed by decades of
Speaker 1: research and always qualified with it's likely that, but we
Speaker 1: can't know for certain. And that doesn't represent a failure
Speaker 1: on the part of the research community, which has produced
Speaker 1: a true wealth of information when it comes to cancer,
Speaker 1: what it is and how to treat it. Will more
Speaker 1: research helped to fill in those knowledge gaps and shorten
Speaker 1: those error bars in some situations. Yes, but the fact
Speaker 1: remains that cancer is so unpredictable because it is so variable.
Speaker 1: Cancer has many causes, many origins, many pathways, many outcomes,
Speaker 1: and each cancer is distinct. And I don't mean that
Speaker 1: breast cancer is just distinct from prostate cancer. Each individual
Speaker 1: case of breast cancer is unique and as we'll discover
Speaker 1: more next week. When we talk about like the cellular
Speaker 1: biology of cancer, oftentimes that uniqueness goes all the way
Speaker 1: down to the cellular level, with tumors made up of
Speaker 1: a diversity of cancer cells. The more we've discovered about cancer,
Speaker 1: the bigger this term gets. So let's go back to
Speaker 1: the beginning and see if we can trace its growth
Speaker 1: over time, just like.
Speaker 4: A cancer cell.
Speaker 1: Sure, cancer might be a defining disease of our time,
Speaker 1: but that doesn't mean it's only of our time. Fossil
Speaker 1: remains of humans and our hominid relatives show us that
Speaker 1: cancer has been a part of us for millennia and beyond.
Speaker 4: Forever and ever forever.
Speaker 1: A million year old jaw bone found in East Africa
Speaker 1: with evidence of lymphoma A million.
Speaker 4: Yeah, wow, Yeah, what kind of jow bone?
Speaker 1: What like a homind job? Sorry? I was like, no,
Speaker 1: I don't think I wrote the species down because I
Speaker 1: think it was like, we're not really sure anyway.
Speaker 4: Wow, fascinating but yes, okay.
Speaker 1: A growth in a Neanderthal skeleton from one hundred and
Speaker 1: twenty thousand years ago. An ancient Egyptian mummy from four
Speaker 1: hundred CE with abdominal cancer and that's just to name
Speaker 1: a few. I literally cut out so many more examples
Speaker 1: where I was like, there are papers, find them in
Speaker 1: our show.
Speaker 4: Lots of examples.
Speaker 1: Yeah, but looking beyond present absence to prevalence, cancer does
Speaker 1: seem more common today than in centuries or millennia past.
Speaker 1: And that's due to the mix of factors that I
Speaker 1: already mentioned. But it's kind of hard to be more
Speaker 1: specific than that, like how much more prevalent considering that
Speaker 1: cancer doesn't always leave its mark on bone, and that
Speaker 1: we've you know, we've examined only a tiny fraction of
Speaker 1: the fossils or remains that have been left behind. Yeah, okay,
Speaker 1: so what about the written record? Oh so, starting in
Speaker 1: ancient Egypt, naturally, we've got the Edwin Smith papyrus from
Speaker 1: about thirty six hundred years ago, which describes what sounds
Speaker 1: like a case of breast cancer. This is paraphrasing a
Speaker 1: little bit quote. If you put your hand upon his breast,
Speaker 1: upon those tumors, and you find them very cool, there
Speaker 1: being no fever at all. They have no granulation, they
Speaker 1: form no fluid, they do not generate secretions of fluid,
Speaker 1: and they are bulging to your hand.
Speaker 4: End quote, Okay, yeah, could be, could be, could be,
Speaker 4: could be.
Speaker 1: Yeah. And although this papyrus contains many remedies for all
Speaker 1: the other ailments that it has listed in there, there
Speaker 1: is no treatment for this disease. Interesting basically says there's nothing. Yeah.
Speaker 1: So following this, there was a relatively long period of
Speaker 1: silence when it comes to writings about cancer, until we
Speaker 1: get to ancient Greece, where cancer again makes an appearance.
Speaker 1: Not in a medical context this time though, but a
Speaker 1: storytelling one. So the Greek historian Herodotus, writing around four
Speaker 1: hundred and forty BCE, briefly tells the story of Atosa,
Speaker 1: the queen of Persia, who developed a swelling on her
Speaker 1: breast and ultimately headed excised. Was it cancer? Was it
Speaker 1: an ulcer or fiber adnoma?
Speaker 4: Yeah, lots of benign tumors.
Speaker 1: We don't know, We don't know. And it's in the
Speaker 1: Hippocratic texts written in Greece in the fourth and fifth
Speaker 1: centuries BCE, which I still have to look up every time,
Speaker 1: Like if I were to go to trivia and that
Speaker 1: was one of the questions, I would not know. But
Speaker 1: this in the Hippocratic text is when we first find
Speaker 1: the words for cancer and carcinoma or their origins.
Speaker 4: Okay, that's that was gonna be one of my big questions. Yeah,
Speaker 4: so that's a long time ago, time ago.
Speaker 1: So carkinos, carcinos, and carcinoma.
Speaker 4: Okay with ks.
Speaker 1: Carcunose was used to refer to any non healing, swelling
Speaker 1: or ulcerous formation, including things like hemorrhoids or cysts. Okay, interesting,
Speaker 1: while carcunoma was generally reserved for a non healing growth.
Speaker 4: Okay, yeah, non healing growth. This is so interesting.
Speaker 1: M Both words come from the ancient Greek for crab. Ah,
Speaker 1: this is where crab comes from. Okay, So apparently the
Speaker 1: appearance of a tumor surrounded by blood vessels branching out
Speaker 1: reminded Hippocrates and then later Galen of a crab in
Speaker 1: sand with its legs all spread out.
Speaker 4: Interesting. Yeah, so that's how they Okay.
Speaker 1: Yeah. Hippocrates also used the word methistemi for metastasis.
Speaker 6: Oh.
Speaker 4: Interesting.
Speaker 1: Methisdemi means to remove or set free, and he thought
Speaker 1: that quote metastatic affectation are those which travel from one
Speaker 1: to another part of the body.
Speaker 4: Yeah, end quote.
Speaker 1: It's not wrong, Yes, I mean he's not wrong. I
Speaker 1: don't think that, like, I mean, given sort of the
Speaker 1: leading ideas about disease, right, his word, the hit metastasist
Speaker 1: to him is not the same metastasist to us. But
Speaker 1: it is interesting, yeah, the roots of that.
Speaker 4: Yeah.
Speaker 1: Yeah. So then after Hippocrates we run into Galen, whose
Speaker 1: humoral explanation of cancer dominated Western medicine for centuries, a
Speaker 1: build up of black bile, also known as melancholy.
Speaker 4: Oh that's interesting. Yeah, that that's just persistent without people
Speaker 4: probably realizing they were doing that. But so sorry, so
Speaker 4: they were like, cancer is black bile. That's the that's
Speaker 4: the that's there. Yeah, done, done, okay, Yeah. God must
Speaker 4: be nice just to have an explanation for something, huh.
Speaker 1: I mean.
Speaker 4: We wouldn't know.
Speaker 1: No, yeah, we can't all yeah, yeah, yeah we are.
Speaker 1: That's that's that's how we do it on this podcast.
Speaker 1: Will kill you. But so yeah, according to Galen, I mean,
Speaker 1: what you can what you can do with black bile
Speaker 1: is you can maybe like drain a little bit of it,
Speaker 1: but it's really difficult to do. Also black so black
Speaker 1: bile is melancholy, and it's like depression and repeat.
Speaker 4: I don't know about this in your which episode was
Speaker 4: that that you did all of the humors ball bladder?
Speaker 4: And we were like, what is black bile?
Speaker 1: No, so, I mean I didn't put this in here,
Speaker 1: but like this is like and black bile not just
Speaker 1: specific any of the humors, right, people knew what blood,
Speaker 1: people knew whatever, slam, but black bile was this mysterious
Speaker 1: thing that no one could find. And then I think
Speaker 1: it was like visalias. I hope that's right, was trying
Speaker 1: to find he was trying to like confirm Galen's black
Speaker 1: bile and the humoral theory and was like doing auto
Speaker 1: and he was like, I don't find anything where it is.
Speaker 2: What is this?
Speaker 1: And so it was kind of like the beginning of
Speaker 1: the end which had already been under question. Blah blah
Speaker 1: blah blah. Medicine was not stagnant for that long, et cetera.
Speaker 1: So but Galen for the most part was like, I
Speaker 1: don't think that we should treat this. I don't think
Speaker 1: that surgery is the way to go. It's only going
Speaker 1: to speed up progression. And so unless it was like
Speaker 1: very small, he tended to opt to just do nothing, okay,
Speaker 1: And later physicians kind of did the same thing. It
Speaker 1: was very much like some did surgery, some didn't, and
Speaker 1: many other many other, many other surgeons physicians contributed to
Speaker 1: this body of knowledge about cancer, but like it was
Speaker 1: incremental and none of it really moved the needle, yeah,
Speaker 1: in terms of like what does this do for the patient? Right,
Speaker 1: or even like our understanding to then try to develop something.
Speaker 1: And so even though so Galen's black bile concept of
Speaker 1: cancer came uter scrutiny as early as the fourteenth century,
Speaker 1: it overstayd It's welcome, though for much much longer than that,
Speaker 1: no central hypothesis of cancer took its place, and physicians
Speaker 1: remained largely helpless to treat or even just understand this
Speaker 1: disease of many faces. That's so interesting, And things started
Speaker 1: to change around the eighteenth and nineteenth centuries. Okay, all right,
Speaker 1: So science and medicine during this period is marked by
Speaker 1: the invention of tools and techniques that allowed physicians and
Speaker 1: scientists to observe for themselves what had previously been invisible.
Speaker 1: The thermometer that indicated a fever, the stethoscope that detected
Speaker 1: a heart murmur, the microscope that revealed the cells that
Speaker 1: formed us and all of life, the taboo against autopsies
Speaker 1: had been declining for a couple of centuries, which allowed
Speaker 1: people to map out not only how the body worked,
Speaker 1: but also like when things went awry. With this new toolkit,
Speaker 1: patients were more likely to find confirmation and explanation of
Speaker 1: their vague symptoms. Surgery back on the rise, especially once
Speaker 1: antiseptic technique and anesthesia were introduced in the later half
Speaker 1: of the nineteenth century. Surgery revealed that the exhaustion and
Speaker 1: the aches that you had been feeling were likely tied
Speaker 1: to the tumor in your breast that had spread to
Speaker 1: your bone. A slide of your blood cells viewed under
Speaker 1: the microscope pointed towards a proliferation of white blood cells
Speaker 1: as a contributor to the listlessness and abdominal pain you
Speaker 1: had been experiencing. As a medical topic, cancer was not
Speaker 1: unknown to the physicians of this era, but it evaded explanation.
Speaker 1: These new tools surgery, microscope, anatomy, chemistry gave them the
Speaker 1: opportunity to pin down this disease, focusing on two main questions,
Speaker 1: what is cancer and why does it happen?
Speaker 4: This is so interesting erin because I don't think that
Speaker 4: I expected for there to be a kind of unified
Speaker 4: idea that cancer is cancer from that far back, like
Speaker 4: I thought that this was going to be you being
Speaker 4: like and then they thought that this was some weird
Speaker 4: disease and it turned out that was also cancer.
Speaker 1: Like, yes, that is kind of what it. I mean,
Speaker 1: this is things are still coal.
Speaker 4: Yeah.
Speaker 1: So it's just like now we have in the starting
Speaker 1: in the nineteenth century, we have these tools, we have
Speaker 1: this idea of like, Okay, now we're going to throw
Speaker 1: out this black bile theory which had been around for
Speaker 1: a really long time and kind of lingers still, and
Speaker 1: we're going to kind of see like what this individual
Speaker 1: one is. And so breast cancer was still viewed as
Speaker 1: a distinct thing. Okay, and it is, I mean, and
Speaker 1: you can see why because like there are commonalities between
Speaker 1: some and not between others. Yeah, exactly so. But it's
Speaker 1: what happens now. The story I'm about to tell you
Speaker 1: is how we form the idea of cancer itself, like
Speaker 1: the mechanism, the recognition of it.
Speaker 4: Especially because you're like blood cancers versus solid tumors like this,
Speaker 4: they all can look so different.
Speaker 1: They all can look so different. So how do we
Speaker 1: come up with cancer?
Speaker 4: Cancer okay, okay.
Speaker 1: In eighteen forty five, German physician Rudolph Virchow aka the
Speaker 1: father of modern pathology, published a case report on a
Speaker 1: fifty year old woman who had been admitted to the
Speaker 1: hospital with edema in her legs, a swollen spleen, diarrhea,
Speaker 1: and nose bleeds. Okay, she was treated according to the
Speaker 1: standard of the day, which was like leeches, bleeding, purgatives,
Speaker 1: et cetera, but she passed away. Three months later. Virtue
Speaker 1: conducted an autopsy and found that some of her organs
Speaker 1: were teeming with white blood cells, with hardly a red
Speaker 1: blood cell to be found. Yeah, and it was like,
Speaker 1: like he noted that it was like the normal ratio
Speaker 1: of white blood cells to red blood cells had just
Speaker 1: been reversed, and it was like the white blood cells
Speaker 1: were so they were so numerous that they were preventing
Speaker 1: the production of red blood cells. So to Virtue, he
Speaker 1: was like, Okay, I've seen many white blood cells before
Speaker 1: in like, you know, infections, but this doesn't look like that.
Speaker 1: This is not like the thick you know, pus whatever
Speaker 1: yellowish that happens after an injury or a festering wound.
Speaker 1: It's just too many white blood cells that looked slightly off.
Speaker 1: They looked mostly like normal white blood cells, but they
Speaker 1: were not a little bit off, And so he gave
Speaker 1: it a name, leukemia.
Speaker 4: He named it.
Speaker 1: He named it. It's Greek for white blood. Yeah, yeah.
Speaker 1: And this name is was revelatory because it didn't imply
Speaker 1: a process or a cause. It simply described what he
Speaker 1: saw interesting white blood. And over the following years, Virtue
Speaker 1: continued to examine and describe cases of leukemia as well
Speaker 1: as solid tumors, and he found a common thread. Uncontrolled
Speaker 1: cell proliferation seemed to be at the root too, many
Speaker 1: of whatever type of cells a little bit odd, okay, yeah, okay.
Speaker 1: And so since our bodies are made up entirely of cells,
Speaker 1: which was kind of a relatively new concept at the time,
Speaker 1: like cell theory had really just formalized in the early
Speaker 1: eighteen hundreds, like eighteen thirties, Yeah, then that meant that
Speaker 1: these malignant growths could start anywhere within our bodies neoplasia
Speaker 1: which is what he called it, also, and that cancerous
Speaker 1: cells could travel anywhere throughout our bodies. Virtua's framework of
Speaker 1: uncontrolled cell proliferation, articulated in the mid nineteenth century became
Speaker 1: the leading concept of cancer. It displaced the plethora of vague,
Speaker 1: non mechanistic hypotheses like it's a buildup of lymph, or
Speaker 1: it's poisons from the soil, or it's an excess of
Speaker 1: black bile. And it still really provides the foundation for
Speaker 1: our current understanding of this disease. It didn't explain why
Speaker 1: cancer happened, but it gave people an image to search
Speaker 1: for and a way to diagnose. Just too many of
Speaker 1: one thing and it's a little bit odd.
Speaker 4: Yeah.
Speaker 1: With this, the field of cancer research had broken open.
Speaker 1: Three primary, though overlapping avenues emerged. Mechanism, what's causing this, epidemiology,
Speaker 1: who's getting it? And treatment? What do we do about it?
Speaker 1: And Since at least the late seventeen hundreds, scientists had
Speaker 1: identified patterns of cancer and populations, whether through environmental or
Speaker 1: occupational exposure, like scrotal cancer and young chimney sweeps. Huh,
Speaker 1: you don't know this story, Okay, wait for the fourth episode.
Speaker 1: I cannot wait. It's great or familial clusters like Pierre
Speaker 1: Broca's research on hereditary breast cancer, but these proved to
Speaker 1: be exceptions. In the majority of cases, there was no
Speaker 1: family history or known or distinct environmental exposure. So the
Speaker 1: other big scientific and medical revolution at the time, microbiology
Speaker 1: wasn't providing many answers either. While different fevers began to
Speaker 1: be divvied up among different bacterial pathogens or microbes, they
Speaker 1: didn't seem to be at the root of cancer, at
Speaker 1: least not obviously. So it was our own selves causing
Speaker 1: the problem, Just as Virtue observed in the late eighteen
Speaker 1: hundreds and early nineteen hundred, it's improved microscopes and staining
Speaker 1: techniques began to shed light on what it was about
Speaker 1: our cells that was causing these issues. They look slightly off,
Speaker 1: but what is that offness?
Speaker 2: Right?
Speaker 4: What is off about them?
Speaker 1: Yeah? Yeah, our chromosomes was one thing that they observed. Basically,
Speaker 1: something happens to the genetic markup of a cancer cell
Speaker 1: that causes it to replicate uncontrollably, and the resulting cells
Speaker 1: inherit that faulty genetic material, continuing this pathological cycle of
Speaker 1: growth and metastasis. So this is when they started to
Speaker 1: also realize that not only are we all made up
Speaker 1: of cells, but that each cell then divides and creates
Speaker 1: more cells, and then what is what are the instructions
Speaker 1: that are inherited chromosomes. If it's inheriting faulty chromosomes.
Speaker 4: Then it's going to be a faulty cell yep.
Speaker 1: Yeah, yeah, this is how cancer grows.
Speaker 4: Right, Yeah, what a time in research, My goodness.
Speaker 1: But like, still, what was the initial trigger? What happened
Speaker 1: to at the beginning to then lead to that abnormal chromosomes?
Speaker 1: There didn't seem to be a consistent answer. There was
Speaker 1: radiation in cancer, chimney soot and cancer cancer that ran
Speaker 1: in families. But these diverse explanations were unsatisfying. How is
Speaker 1: it possible that these disparate things were all resulting in
Speaker 1: the same disease process? How then a beacon of hope.
Speaker 1: In nineteen ten, Peyton Rouse discovered that he could transmit
Speaker 1: cancer from one chicken to another. Oh yes. The discovery
Speaker 1: of the Rouse sarcoma virus, which is the first cancer
Speaker 1: virus to be discovered, kicked off a frenzy of research.
Speaker 1: Maybe there's a virus for every cancer if we just
Speaker 1: look hard.
Speaker 4: Enough, just look and find it.
Speaker 1: And for some time that seemed like it might pan out.
Speaker 1: There was the chop Peppelloma virus was identified in nineteen
Speaker 1: thirty three, which is that cancer causing viruses that causes
Speaker 1: tumors and rabbits. We talk about it all the time
Speaker 1: in our talks, but it may have led to the
Speaker 1: jacalobe myths, these likeny growths.
Speaker 4: Yeah, rabbits.
Speaker 1: There were mouse viruses that caused cancer, cat viruses, and
Speaker 1: the first human cancer virus to epstein bar virus associated
Speaker 1: with Burkett's lymphoma, that was described in nineteen sixty four,
Speaker 1: and so over these decades, Over this fifty years or so,
Speaker 1: a handful of people were still working on environmental and
Speaker 1: hereditary causes of cancer, but the majority of research funds
Speaker 1: for basic cancer biology, which was a smaller portion of
Speaker 1: the pie overall for cancer funding, was geared towards this
Speaker 1: viral hypothesis of cancer sting.
Speaker 4: Yeah, that's really really interesting to think about.
Speaker 1: Right, And given the huge strides made in the first
Speaker 1: half of the twentieth century when it came to the
Speaker 1: control and prevention of infectious diseases, especially when it came
Speaker 1: to vaccines, it makes sense that viruses were an appealing
Speaker 1: answer to the question of why does cancer happen? Because
Speaker 1: if you could just come up with a vaccine.
Speaker 4: Then then that's it. Then we can be done with it.
Speaker 1: It can be done. Yeah, well yeah, there's still you know,
Speaker 1: you can get people to take the public buy in
Speaker 1: and all of that. Yes, But after decades of research,
Speaker 1: it became increasingly clear that viruses held the answer in
Speaker 1: only a small proportion of cancers, about ten to twenty percent,
Speaker 1: and by the mid nineteen seventies, research took on a
Speaker 1: more balanced approach, also investigating environmental and hereditary causes of cancer.
Speaker 1: But that era of research where like the viral hypothesis
Speaker 1: ruled all people were also had other people were like yeah,
Speaker 1: I know, sorry, hedging hed hedgelah. But it led to
Speaker 1: the discovery of oncogenes. And this is a really fascinating
Speaker 1: story which you should find out, but it's too long
Speaker 1: to include here. But these onco genes essentially in trying
Speaker 1: to find out what it was about this virus that
Speaker 1: led to cancer, of what were they doing to charge themselves. Yeah,
Speaker 1: they were like, there's this different version of a gene
Speaker 1: that's causing it's like a mutated version of a gene
Speaker 1: that we have, but it's causing the cell to proliferate
Speaker 1: with no often keep growing, just go go go go go. Yeah,
Speaker 1: and so onco genes and then later tumor suppressor genes.
Speaker 1: That the finding of these you know, mutated forms of
Speaker 1: normal genes that then either you know, gas pedal to
Speaker 1: the floor or the brake is broken.
Speaker 4: Yeah.
Speaker 1: Yeah, they helped to unite the three main drivers thought
Speaker 1: to cause cancer. Right, there's environmental, viral, and genetic, and
Speaker 1: so an environmental exposure could cause mutation in a normal gene,
Speaker 1: turning it into an oncogene. Right, gas to the floor.
Speaker 1: A virus could insert its oncogene into the host cell's genome.
Speaker 1: Gas to the floor. Someone could inherit a predisposition where
Speaker 1: oncogene development is more likely, or they inherit faulty tumor
Speaker 1: suppressor genes either gas to the floor or no break.
Speaker 4: And we'll talk about those. Talks are about those. Yeah.
Speaker 1: So this is how this unifying. Okay, cancer is this
Speaker 1: thing that can happen through many different roots.
Speaker 4: All these different mechanisms, same end result.
Speaker 1: Same end results. Yeah, yep. But so many questions remained.
Speaker 1: How do these mutations happen, what are the pathways? How
Speaker 1: predictable is this process? What are the genes are involved?
Speaker 1: Can we harness any of this information to prevent or
Speaker 1: treat cancer. Up through the nineteen seventies, research on cancer
Speaker 1: biology and cancer treatment was happening almost entirely separately, really
Speaker 1: really okay, So even at a cancer conference you wouldn't
Speaker 1: really find like a cancer geneticist attending a clinical oncologist
Speaker 1: talk and vice versa. Just wasn't really something that could
Speaker 1: and very siloed. And after the initial promise that chemotherapy
Speaker 1: had shown more on that in the third episode, clinical
Speaker 1: oncologists grew frustrated as they discovered that what worked for
Speaker 1: one type of cancer, or even just one person's case,
Speaker 1: you know, did work for another. This dream of a
Speaker 1: magic bullet for cancer was slipping out of reach. Cancer
Speaker 1: biologists validated this with their research as genetic sequencing revealed
Speaker 1: the complex and unique pathways that drove each individual cancer
Speaker 1: and how those pathways evolved over time. And so when
Speaker 1: Nixon announced the War on Cancer in nineteen seventy one,
Speaker 1: it was useful. It was really quite useful from a
Speaker 1: funding an awareness viewpoint. It was like, you know what,
Speaker 1: this is a thing. We're going to fight this, this
Speaker 1: is a priority. This is a priority. We are going
Speaker 1: to Cancer is an.
Speaker 4: Under fund it the way that we fund war.
Speaker 1: That is the idea. That was the idea, Yeah, but
Speaker 1: it also had the effect of distilling this incredibly diverse
Speaker 1: process into one disease with one mechanism, one pathway, and
Speaker 1: thus one mythical cure. And when that cure failed to materialize,
Speaker 1: the public grew disillusioned. There was the sense that if
Speaker 1: we could just form a task force, we could just
Speaker 1: task force our way through this, just throw enough resources
Speaker 1: and expertise at this problem, then we could come up
Speaker 1: with a solution in no time, because this is what
Speaker 1: the Manhattan Project had done during World War Two, right, Like,
Speaker 1: why can't we just do this? But reality didn't quite
Speaker 1: align with these high expectations, and in nineteen ninety seven,
Speaker 1: a controversial study came out in the New England Journal
Speaker 1: of Medicine with the jarring title Cancer Undefeated. So this
Speaker 1: was about, you know, twenty five, twenty six years after
Speaker 1: Nixon's War on cancer. What was inside was even more shocking.
Speaker 1: The report demonstrated that from nineteen seventy to nineteen ninety four,
Speaker 1: cancer deaths had either plateaued or increased for most cancers.
Speaker 1: In the few cases where cancer mortality had declined, it
Speaker 1: was mostly attributed to screening and prevention. The paper was criticized,
Speaker 1: reasonably so, because it seemed to call into question the
Speaker 1: decades of cancer research and the millions in cancer funding.
Speaker 1: Friend it showed was real cancer remained deadly. But what
Speaker 1: it didn't articulate were two very important things about cancer.
Speaker 1: Number One, cancer is not one disease, but many. A
Speaker 1: paper like that falls into the same trap of coalescing,
Speaker 1: this distilling into one thing. It shaves off all of
Speaker 1: the nuance, any of the color around this thing. So
Speaker 1: lumping all cancers together does not allow us to see
Speaker 1: the nuance where substantial progress has absolutely been made or
Speaker 1: where we still have a ways to go. And number two,
Speaker 1: the other thing that it didn't really articulate about cancer
Speaker 1: was that cancer is a disease years in the making,
Speaker 1: both in terms of its pathology as well as our understanding.
Speaker 1: The cigarettes that you smoked in your youth might lead
Speaker 1: to cancer decades later, just as the cancer biology we're
Speaker 1: uncovering now will give us insights into treatment that will
Speaker 1: take years to develop, tests, approve, and become a standard
Speaker 1: of care.
Speaker 4: I think that's one of the hardest things about how
Speaker 4: fast things feel like they're moving right now now is
Speaker 4: that they still aren't fast enough for people today? You know,
Speaker 4: and they are reality.
Speaker 1: It is, it is yeah, and you know these it
Speaker 1: will take a while for these things, these headlines to
Speaker 1: actually become reality that people can access if you know,
Speaker 1: there are other issues with access and but for some
Speaker 1: treatments it has already happened. Some cancers have been completely
Speaker 1: transformed because of our understanding and treatment development. Over its history,
Speaker 1: cancer has been assigned so many meanings and definitions. It's
Speaker 1: been a disease of black bile, a cellular pathology, a monster,
Speaker 1: a genetic mutation, an enemy, a curse. In cancer's metaphors,
Speaker 1: we see the fear and the blame that is so
Speaker 1: human of us. In our narratives of cancer history, we
Speaker 1: may emphasize scientific progress over failure, and in our personal
Speaker 1: stories of cancer, we may assign villains and heroes, cause
Speaker 1: and effect. We want cancer to be one thing, but
Speaker 1: it isn't. It has many causes, many mechanisms, many pathways,
Speaker 1: many beginnings, and many endings. Each time we try to
Speaker 1: draw hard boundaries around it, cancer resists them. It demands
Speaker 1: that we look again and reconsider, and when we do,
Speaker 1: we find something that for me has been perspective shifting.
Speaker 1: We find that the same cellular mechanisms that allow a
Speaker 1: cancer to proliferate and metastasize are those that underlie our
Speaker 1: ability to heal wounds or develop from infancy into adulthood. Yep,
Speaker 1: we find ourselves. We find what it is to be
Speaker 1: a multicellular being. Cancer is not a failure of ourselves.
Speaker 1: It is a consequence of multicellular life. To understand why
Speaker 1: cancer arises in the first place and why it's so
Speaker 1: difficult to prevent and treat, we have to explore cancer
Speaker 1: in an evolutionary framework. Yes we do, which is what
Speaker 1: we'll be doing next week. But before we get there,
Speaker 1: I'll actually have to define, like what cancer is?
Speaker 4: What is it today?
Speaker 1: Today? So, Aaron, what is cancer?
Speaker 4: I would love to tell you what I can.
Speaker 9: Hi. My name is Kara Ringstorf. I was diagnosed with
Speaker 9: stage four colon cancer in late twenty twenty four, right
Speaker 9: before my thirty third birthday. I had been experiencing blood
Speaker 9: in my stool for a few years, and around three
Speaker 9: to four doctors dismissed it as fishers or like hemorrhoids.
Speaker 9: I was very anemic at one point and was sent
Speaker 9: to an oncologist who was also a blood specialist, and
Speaker 9: he told me I was just like knemic because I
Speaker 9: was a menstruating female. About a year and a half later,
Speaker 9: it am like there was more blood, so I told
Speaker 9: my primary care physician that I wanted a specialist. I
Speaker 9: had my colonoscopy and they found a four centimeter tumor
Speaker 9: in my sigmoid colon. So I had my sigmoid colon
Speaker 9: reception pretty soon after, and while I was in recovery,
Speaker 9: they biopsied my liver and it turns out it had
Speaker 9: metastasized to my liver, meaning I was Stage four. About
Speaker 9: a month later, I had my first round of chemo. Unfortunately,
Speaker 9: the pump they sent me home with with the five FU,
Speaker 9: which is what my treatment plan was, gave me a
Speaker 9: stress induced heart attack, which only happens about one to
Speaker 9: two percent of patients. So I started back up and
Speaker 9: switched chemo to a different schedule than what the traditional
Speaker 9: five FU regiment is, and a couple of weeks later,
Speaker 9: I had a liverysection in early March of twenty twenty five,
Speaker 9: so now I'm in remission. Since then, I have of
Speaker 9: sea tea scans and blood work done every three months.
Speaker 9: I know that I'm in mr mission, but also with
Speaker 9: the reoccurrence rate and everything, it still kind of feels
Speaker 9: like a death sentence for me.
Speaker 10: Hi. My name is Rachel, and today I would like
Speaker 10: to share my twin sister, Leslie's story. We had a
Speaker 10: standard sibling relationship growing up and she was my best
Speaker 10: friend as we entered into early adulthood. The summer we
Speaker 10: turned twenty one, she was diagnosed with uvula melanoma, a
Speaker 10: rare tumor growing in her eye. She had almost none
Speaker 10: of the risk factors, was young, healthy, and active, but
Speaker 10: cancer doesn't care about those things. Initial treatment included radiation
Speaker 10: black therapy to kill the blood supply and shrink the tumor,
Speaker 10: and she had successful treatment. We were thankful to live
Speaker 10: in an area with access to excellent medical care, including
Speaker 10: her ophthalmologist, doctor Oliver. Follow Up included yearly scans that
Speaker 10: she went to diligently. Leslie went on to graduate with
Speaker 10: her Bachelor of Science and Kinesiology and health promotion, and
Speaker 10: she became a doctor or physical therapy. She got married
Speaker 10: and lived life to the fulls for the next ten years.
Speaker 10: In her free time, she loved skiing and hiking, which
Speaker 10: are typical of a Colorado native. For skiing, she gravitated
Speaker 10: towards the most technical runs like Christmas Tree Bowl and Steamboat.
Speaker 10: For hikings, she also gravitated towards technical routes and was
Speaker 10: able to summit over forty of Colorado's fourteen ers, including
Speaker 10: some of the most challenging Class four routes like Beer Peak.
Speaker 10: I haven't summitted nearly that many, but she, my dad,
Speaker 10: and her husband slowly kept knocking peak after Peak off
Speaker 10: the list. Then shortly after our thirty first birthday, she
Speaker 10: had her son, and in early summer, the unimaginable happened,
Speaker 10: and she was diagnosed with metastatic y vi la melanoma
Speaker 10: in her liver after having a clear scan the fall prior.
Speaker 10: While doctors were again able to act quickly, the cancer
Speaker 10: was growing too rapidly for successful treatment, and she passed
Speaker 10: away less than eight weeks after this diagnosis. I just
Speaker 10: celebrated my seventh birthday without her, surrounded by family skiing
Speaker 10: in the mountains. Her husband has since remarried, and I
Speaker 10: am thankful her son has a mother to grow up with.
Speaker 10: I'm now a mom to three, including a set of twins.
Speaker 10: There's no roadmap to grief, and I've learned a lot
Speaker 10: about giving others grace and understanding because we don't know
Speaker 10: what they might be working through. I also think of
Speaker 10: friends and family navigating their own journeys with cancer, and
Speaker 10: as a biomedical engineer, I use my sister's story as
Speaker 10: motivation to continue to engineer medical devices that allow surgeons
Speaker 10: to have better patient outcomes. I'm also choosing to live
Speaker 10: life to the fullest, just like Leslie, and I'm thankful
Speaker 10: to have a supportive husband and family. Leslie didn't want
Speaker 10: to be defined by her diagnosis. She wanted to be
Speaker 10: defined by the things she did and the patient she
Speaker 10: interacted with. She was a wife, mother, sister, daughter, avid
Speaker 10: skier and hiker, and a doctor. Leslie, I love you
Speaker 10: and miss you.
Speaker 4: So Erin. Obviously, you covered a lot of ground in
Speaker 4: that history section. Thank you very much. I really enjoyed it.
Speaker 4: But we do still have quite a bit to cover
Speaker 4: in terms of what we mean when we talk about
Speaker 4: cancers today, and so that's what I'm going to try
Speaker 4: and get into right now. And there are actually quite
Speaker 4: a number of different definitions depending on what organization you're
Speaker 4: looking at. But they do all boil down to this
Speaker 4: same general concept, which is abnormal growth. Right, cancer is
Speaker 4: an aberition of some kind. It is abnormal, it's atypical,
Speaker 4: it's out of control, it's uncontrollable growth in some way.
Speaker 4: So one technical definition that I will put forth comes
Speaker 4: from the National Cancer Institute, which says, quote, cancer is
Speaker 4: a disease in which some of the body's cells grow
Speaker 4: uncontrollably and spread to other parts of the body. Now,
Speaker 4: I just like side note here because some of the
Speaker 4: definitions of cancer very explicitly say cancer is a group
Speaker 4: of diseases, which and other definitions say cancer is a disease.
Speaker 4: And I just think that that's a really interesting like
Speaker 4: that that is still something that I wouldn't say is
Speaker 4: like up for debate, but is just like a part
Speaker 4: of how we define cancer where some groups are going
Speaker 4: to define it more as multiple different diseases and some
Speaker 4: are going to say, like we're lumping all of cancer
Speaker 4: as one thing, right, with many different pathways and many
Speaker 4: different like ways that it's going to turn out. Essentially
Speaker 4: it's interesting, well.
Speaker 1: And it's like there's a deliberate choice there, Yes, exactly
Speaker 1: what does that.
Speaker 4: Mean, what does that mean? I also read it really interesting.
Speaker 4: I'm so off script right now, but I read a
Speaker 4: really interesting paper from twenty twenty three that was like
Speaker 4: a we're proposing a new definition for cancer. That was
Speaker 4: much and it was an int higher paper that was
Speaker 4: an explanation for their one sentence definition, like word by word,
Speaker 4: this is why we chose of instead of buy and
Speaker 4: stuff like that that you would love it.
Speaker 1: I would love that.
Speaker 4: But they really focused a lot on the evolution concept,
Speaker 4: which we're going to talk more about next week. But
Speaker 4: it's a great paper. I'll link to it, please. So
Speaker 4: the point is the point is that uncontrollable cell growth, yes,
Speaker 4: that spreads to other parts of our bodies. Okay, just
Speaker 4: pause and don't ask me any questions, sure, because I
Speaker 4: will tell you that. A big question that arises when
Speaker 4: I hear that particular definition is like how why? How?
Speaker 4: How are cells growing uncontrollably? How are they spreading to
Speaker 4: other parts of our body? I'm not going to answer
Speaker 4: that question this week.
Speaker 1: Can I ask a question?
Speaker 4: Yeah, but I just want you to know if it's
Speaker 4: that I won't answer it.
Speaker 1: No, No, No, I kind of know some of that.
Speaker 4: Yes, I know you do.
Speaker 1: But spread spread is that?
Speaker 4: So that is obviously that is a big I'll talk
Speaker 4: a lot about that this week. Yes, Okay, that is
Speaker 4: a big part of cancer and that I will talk
Speaker 4: about this week. Okay, spreads to other part is.
Speaker 1: A necessary inclusion in that definition. H fascinating.
Speaker 4: We'll get there, we'll get there. But the question of
Speaker 4: how this happens is what I'm going to focus more
Speaker 4: on next week's episode. But this week I'm gonna just
Speaker 4: kind of take for granted that we all understand the
Speaker 4: idea of a cancer because we've known someone who has
Speaker 4: had cancer, et cetera. And what I want to dig
Speaker 4: a little bit deeper into is what I would call
Speaker 4: maybe the kind of clinical aspects of how we deal
Speaker 4: with cancers today, how we define them, how we classify them,
Speaker 4: and then broad strokes on sort of how we're diagnosing
Speaker 4: and you know, grouping different kinds of cancers. Okay, and
Speaker 4: then next week is more the biology of what's happening. Cool.
Speaker 1: Great.
Speaker 4: So the first way that we have to classify cancers,
Speaker 4: and I think that we do this kind of almost
Speaker 4: intuitively when we talk about cancers, is what organ is
Speaker 4: your cancer coming from? And that is actually the first
Speaker 4: way that medicine has to classify a cancer too, it's
Speaker 4: primary side of origin. So where did those cells initially
Speaker 4: come from? Where they lung cells, where they breast cells,
Speaker 4: where they liver cells, Where in the body did this
Speaker 4: tumor first begin? Oh, I have so many questions already, Okay, okay,
Speaker 4: And we do this for a lot of different reasons,
Speaker 4: but it's in part to figure out where it first started. Yeah,
Speaker 4: and also because pancreatic cancer acts very differently than breast cancer,
Speaker 4: and so we need to know what we're dealing with, right,
Speaker 4: which also act differently, by the way, than blood cancers
Speaker 4: like leukemias and lymphomas. These are all very distinct types
Speaker 4: of cancers. Once we have figured out the organ, like
Speaker 4: the tissue that it came from, that is not the
Speaker 4: end because not all breast cancers are the same, not
Speaker 4: all lung cancers are the same. And so the next
Speaker 4: part that we have to do is figure out what
Speaker 4: tissue type it came from within that organ.
Speaker 1: Okay, what part of the lung?
Speaker 4: What part? Yeah, So cancers that come from our epithelial cells,
Speaker 4: and we've talked a lot about epithelial cells on this podcast,
Speaker 4: but they're the cells that line all of our body surfaces.
Speaker 4: So they're like the inside of ducts in your breast.
Speaker 4: They are the insides of all of our blood vessels.
Speaker 4: They are the cells that are like lining and making
Speaker 4: up the inner parts of our body surfaces. These are
Speaker 4: called carcinomas. And so if you ever hear carcinoma, that
Speaker 4: means that it came from epithelial cells. This accounts for
Speaker 4: like over ninety percent of solid cancers we'll get there, okay,
Speaker 4: of humans, And you further can divide it from there
Speaker 4: because there are many different types of epithelial cells. So
Speaker 4: you might have a squamous cell carcinoma that came from
Speaker 4: these flat like diski shaped cells, or you might have
Speaker 4: an adinocarcinoma, which comes from these glandular cells. And some cancers,
Speaker 4: like breast cancer, for example, most are all adno carcinomas.
Speaker 4: But we don't necessarily call them that. We distinct them
Speaker 4: by did it come from the duct, did it come
Speaker 4: from the lapule. There's a lot of different types. We
Speaker 4: get really specific.
Speaker 1: Okay, it's wild. I know how many different sub small.
Speaker 4: Cell non small cells, squamous cell. I don't know, like
Speaker 4: there's so many different types of these, even just within
Speaker 4: the carcinoma category. Aside from that, cancers can also arise
Speaker 4: from non epithelial tissues, and these would be our connective
Speaker 4: tissue cancers. Okay, so sarcomas, bone cancers, those kinds of
Speaker 4: things are called sarcomas, and those are actually a really
Speaker 4: wide range as well. So for example, a mesothelioma which
Speaker 4: listened to our asbestos episode for more detail. But a
Speaker 4: mesothelioma we think of as a lung cancer, it's not
Speaker 4: a lung cancer. It's a cancer of the lining of
Speaker 4: the lung, which is a connective tissue. So even though
Speaker 4: it gets a special name mesothelioma, it is technically a sarcoma. Whoa,
Speaker 4: I know, I'm getting technical, but it's fun for me.
Speaker 1: I think it well, I mean, I think it's helpful
Speaker 1: to understand that it truly can arise anywhere anywhere, and
Speaker 1: the side of origin and the type of origin and
Speaker 1: blah blah blah all influences the path that the cancer
Speaker 1: could take.
Speaker 4: Exactly, because it all means that these cells initially were
Speaker 4: acting in one particular way, and so that's going to
Speaker 4: tell us something about how they might act as they
Speaker 4: become cancer cells. Then there's also cancers that originate in
Speaker 4: our bones, like our blood based cancers rather right and
Speaker 4: bone marrow yes, thank you whoa aaron? So that would
Speaker 4: be like a leukemias, lymphomas, myelomas, which are all different
Speaker 4: types of blood cell cancers. Okay. Then there's also more
Speaker 4: specific ones you can get like retino blastoma which is
Speaker 4: in the retina of your eye, glioblastomas which are in
Speaker 4: your brain, which I think technically might fall under sarcoma,
Speaker 4: but they're so specialized that there I don't know if
Speaker 4: they actually technically count as a sarcoma because they again
Speaker 4: are just so specialized that it's your brain cells. So
Speaker 4: there's a lot of different ways that we have to
Speaker 4: classify it at the beginning. But if we then go back,
Speaker 4: so knowing that if we go back to our definition
Speaker 4: of cancer of these cells that are growing in an
Speaker 4: uncontrolled way, that are then spreading to part of our body,
Speaker 4: part of this definition is that it's abnormal growth. So
Speaker 4: what is it that makes these abnormal?
Speaker 1: It's a great question, It's a really great question.
Speaker 4: And mechanistically we'll get a little bit more into detail
Speaker 4: on that next week. But one thing to know is
Speaker 4: that cancers grow in these like disorganized masses, especially when
Speaker 4: we're talking about solid tumors, right, so everything but the
Speaker 4: blood cancers, and we call these tumors like that's the
Speaker 4: name that we call these clumps of cells. But not
Speaker 4: all tumors are cancer, right. In medicine, we call non
Speaker 4: cancerous tumors benign. And it's not a great word.
Speaker 1: It's not a great word. We talked about this in
Speaker 1: enemage for you.
Speaker 4: We did, yeah, we did, because in medicine, benign does
Speaker 4: not mean good. It does not mean chill, it doesn't
Speaker 4: mean don't worry about it. It means that this tumor
Speaker 4: is not going to metastasize. And that is really the
Speaker 4: key that makes cancers cancers. It's not just that they're
Speaker 4: growing these disorganized clumps of cells. It's not just all
Speaker 4: these things. It's also that they are spreading, and they
Speaker 4: spread in a lot of different ways. The thing that
Speaker 4: makes cancer so deadly is this ability to invade our bodies. First,
Speaker 4: they're invading past what we would call tissue level barriers,
Speaker 4: which means that a cancer might start within the duct
Speaker 4: cells of your breast. But then it's going to invade
Speaker 4: through the lining of those ducks and into the surrounding tissue,
Speaker 4: and then it will break off pieces of itself and
Speaker 4: it will travel whether through your lymph system into your
Speaker 4: lymph nodes or through your bloodstream to distant organs and
Speaker 4: set up shop there. And that is what we call metastases,
Speaker 4: those little bits of pieces that travel and make new
Speaker 4: tumors at distant sites.
Speaker 1: So, yeah, uh, spread or potential to spread? And what
Speaker 1: is that quality or characteristic that allows for mobility.
Speaker 4: That's a great question. I don't know, Okay, I don't
Speaker 4: know if we fully understand that.
Speaker 1: But like so if you're trying to say, is this
Speaker 1: a benign growth or a cancerous growth? Yeah, has what
Speaker 1: how do you distinguish?
Speaker 4: That's a great question. They're looking at the We'll talk
Speaker 4: a lot more about all of the other like cell
Speaker 4: markers and things that we see on how these cells
Speaker 4: behave in cancer. Yeah, if that makes sense a little
Speaker 4: bit next weeks exactly the hallmarks of like how cancer
Speaker 4: cells all behave. But and so a lot of it
Speaker 4: is that it's looking at all of these things, and
Speaker 4: I think it's also looking at the disorganization of the
Speaker 4: structure where benign tumors are less likely to be super disorganized,
Speaker 4: though they might be a little bit disorganized, okay, compared
Speaker 4: to malignant tumors. So things that are going to be spreading.
Speaker 4: And I think too, it's I think that most of
Speaker 4: these growths now we have well characterized, so we know
Speaker 4: if you look at this type of tumor, it is
Speaker 4: not likely to spread, Whereas if you look at this
Speaker 4: type of tumor, it is likely to spread. And there
Speaker 4: are some that can sometimes hedge that line where they
Speaker 4: are not cancerous, but they might have the potential to
Speaker 4: become cancerous. Okay.
Speaker 1: Another question from the class endometriosis.
Speaker 4: Oh, I knew you were going to ask. I know,
Speaker 4: I know, I have to.
Speaker 1: I mean, you can find cells anywhere in the body
Speaker 1: and it can form tishoe, it could grow to shoe anywhere. Yeah,
Speaker 1: so how is that not it's just as a cancer.
Speaker 4: It's no we talked to question. But it's a really
Speaker 4: good question. And I think honestly, doing this research for
Speaker 4: this episode made me go back and ask that question
Speaker 4: myself because I was like, it doesn't kind of make sense.
Speaker 4: This is one of the biggest hallmarks and it's because
Speaker 4: the endometrial tissue that we find in endometriosis doesn't meet
Speaker 4: all of the other hallmarks of cancer. It's not necessarily disorganized,
Speaker 4: it's not replicating indefinitely. It's replicating in a way that
Speaker 4: is in sync with a menstrual cycle and things like that, Like,
Speaker 4: it's not just going wild. I would say, it's a
Speaker 4: valid question to think, where is this line blurrier than
Speaker 4: we think, right? And I think maybe, But I'm just
Speaker 4: going with what.
Speaker 1: I guessh in the boundaries again.
Speaker 4: Yeah, Yeah, endometrosis is a wild beast. It is, especially
Speaker 4: in the context of this. Yeah, because yeah, they spread everywhere.
Speaker 4: M but that's what cancers do. And because of this,
Speaker 4: metastases are the reason why. The next step in defining
Speaker 4: our cancers is figuring out how far it has already spread.
Speaker 4: And so we do this through a process called cancer staging.
Speaker 4: So once someone has a cancer and we know where
Speaker 4: it came from, we know what kinds of cells it
Speaker 4: came from, we need to figure out how far it
Speaker 4: has gone, and so we do this through staging is
Speaker 4: often called like TNM staging, which I'll tell you what
Speaker 4: it all stands for. And so first, the first way
Speaker 4: asterisk on this. But the first way that cancers tend
Speaker 4: to spread is locally, so from like the inner lining
Speaker 4: of your bladder, through the muscle wall or something like that. Okay,
Speaker 4: So how far a cancer has invaded within the tissue
Speaker 4: that it's from is the first component of that cancer,
Speaker 4: and that's the t in the TNM framework.
Speaker 1: Okay.
Speaker 4: So for example, you could have something called ductyl carcinoma insto,
Speaker 4: These are cancer cells, but they have not yet left
Speaker 4: that duct, right, So that's like a stage zero cancer. Okay,
Speaker 4: same thing with bladder cancer. You might have and this
Speaker 4: is true for any cancer, but bladder cancer. You might
Speaker 4: have it that's just within the lining of the bladder
Speaker 4: and hasn't yet invaded into the muscle. Or you might
Speaker 4: have what's considered muscle invasive bladder cancer. So now it's
Speaker 4: made it through the muscle, Okay, have the bladder wall.
Speaker 1: How how much variation is there in terms of like
Speaker 1: the thickness of these different layers.
Speaker 4: Oh that's a great question, huge amounts.
Speaker 1: Okay.
Speaker 2: Yeah.
Speaker 4: You think of like the duct of a breast, Like
Speaker 4: a breast duct is going to be like a couple
Speaker 4: sells thick, whereas the lining of your bladder is quite thick.
Speaker 1: Right, yeah, And so how does like, does that have
Speaker 1: any bearing on staging?
Speaker 4: It's all I mean, it's all part of the staging process,
Speaker 4: but like does what does it mean for prognosis and things?
Speaker 4: That's such a I know, I can't answer that question,
Speaker 4: I know, I know. So then the next part of
Speaker 4: staging is n which stands for node. Because one of
Speaker 4: the first ways that many cancer spread is via our
Speaker 4: lymphatic systems, and our lymph system drains into lymph nodes
Speaker 4: in specific patterns, and so we know, like your breast
Speaker 4: tissue is going to drain towards a cluster of lymph
Speaker 4: nodes in your armpit and other you know, your liver
Speaker 4: is going to train to specific lymph nodes, et cetera.
Speaker 4: And so by sampling the lymph nodes in the areas
Speaker 4: where that original tumor is draining, we can figure out
Speaker 4: how far the cancer has spread what we consider regionally
Speaker 4: within the body.
Speaker 1: So you would expect to find cancer cells within that
Speaker 1: lymph node.
Speaker 4: Potentially that could be that could be a first place
Speaker 4: where they may spread.
Speaker 1: And is there a possibility that it has spread but
Speaker 1: not not? No evidence in the lymph node.
Speaker 4: Absolutely, because the next step is m from atastases. Okay,
Speaker 4: because the other way that cancer spread is via the bloodstream,
Speaker 4: which means they can go anywhere. Very commonly, we see
Speaker 4: places like the liver or the bones where cancers tend
Speaker 4: to spread, and part of that is because we have
Speaker 4: good blood flow to those areas, and also maybe that
Speaker 4: those are just particularly conducive tissues to grow cancer cells.
Speaker 4: Why who knows. But metastases can be literally anywhere. And
Speaker 4: I said asterisk on the fact that cancers are going
Speaker 4: to first spread locally. That's not always true. Some cancers
Speaker 4: have these, especially what we call micrometastases, that might spread
Speaker 4: very early in the course of disease, and we might
Speaker 4: not even be able to pick those up if they're
Speaker 4: very small. Because the ways that we tend to look
Speaker 4: for metastatic growth is by doing imaging tests, so that
Speaker 4: might be CT scans or MRIs or what are called
Speaker 4: PET scans, and that is to look for evidence of
Speaker 4: cancer in distant sites, far from that place where we
Speaker 4: first identify a tumor. Okay, So by using all of
Speaker 4: this information, we then can stage a cancer. And that's
Speaker 4: where we think of like was it stage one? Stage two,
Speaker 4: stage three, stage one, Like you, what stage was your cancer?
Speaker 4: They don't all mean the same thing. And there's a
Speaker 4: lot of nuance to this. So I'm not gonna like
Speaker 4: get detailed into how we stage these cancers because some
Speaker 4: get like to ab CD and things like that.
Speaker 1: So many very yeah, so many variations.
Speaker 4: And especially for some cancers that we have now done
Speaker 4: a lot more research on and we understand much better,
Speaker 4: breast cancer as one example, there might be a lot
Speaker 4: more to staging than just this. There might be testing
Speaker 4: for hormone receptors. There might be testing for particular antigens
Speaker 4: that we see on the cancer that we happen to
Speaker 4: have treatment for so we could then treat it with
Speaker 4: specific medications. And so there's more to the staging process.
Speaker 4: But this is the like broad strokes picture of it
Speaker 4: that can give us a sense of I won't say prognosis,
Speaker 4: because that's not quite true. Like it, how bad is
Speaker 4: this going to be? Is not quite the point of it,
Speaker 4: but it's part of it, right. It's being able to
Speaker 4: group different types of cancers together, both for like clinical speak,
Speaker 4: to be able to talk to somebody about their cancer
Speaker 4: and have them understand this framework and also to be
Speaker 4: able to do clinical trials so that people with similar
Speaker 4: types of cancers with similar distributions in terms of nodes
Speaker 4: and metastases and things, are going to be participating in
Speaker 4: trials for different medications. And it also, I think creates
Speaker 4: this language that allows us to say stage four means
Speaker 4: that your cancer is metastatic, Stage zero means it has
Speaker 4: not spread outside at all, and everything in between is
Speaker 4: a lot more gray area.
Speaker 1: Sort of like, Okay, how how long has this been
Speaker 1: going on? How fast did we get here? And where
Speaker 1: might this go from here?
Speaker 4: Kind of except that every cancer moves differently in terms
Speaker 4: of speed, so not so much on the how fast
Speaker 4: did we get here necessarily, but like where are we not?
Speaker 4: Where are we starting from?
Speaker 1: Starting from?
Speaker 4: And what does that mean for them? What the treatment
Speaker 4: options are and things like that.
Speaker 1: So okay, so let's say that you are you go
Speaker 1: in because you suspect you have a suspicious growth, and
Speaker 1: you're like, I want to get this checked out. Yeah,
Speaker 1: what are the steps for staging? Like what does that
Speaker 1: look like for someone?
Speaker 4: I was hoping that you would ask me that question, Elsetair,
Speaker 4: because it's like the question is like, how are we
Speaker 4: diagnosing cancer, How are we doing this right? And it
Speaker 4: can start with a really wide range of things, depending
Speaker 4: on if you come in saying, you know, I have
Speaker 4: a lump that I'm worried about, or if it's like
Speaker 4: I've been losing weight and I'm not I'm nauseous, or
Speaker 4: if it's I'm fatigued, and so like, the how you
Speaker 4: get exactly to that initial diagnosis can really really vary
Speaker 4: depending on the type of cancer that we're talking about.
Speaker 4: A cervical cancer we might pick up on a pap smear,
Speaker 4: a breast cancer we might pick up on a mammogram.
Speaker 4: Something like a blood cancer. You might have to have
Speaker 4: blood work done and it just be abnormal for someone
Speaker 4: to be able to recognize that. So there's a huge
Speaker 4: range of how we get to that initial one. But
Speaker 4: then the next step is actually a tissue diagnosis, which
Speaker 4: means getting a biopsy to be able to do all
Speaker 4: those things we said, where did this come from, what
Speaker 4: kind of cells are are they, et cetera. And then
Speaker 4: the staging process is going to be usually a relatively
Speaker 4: long process of many, many appointments, but it might include
Speaker 4: in addition to that biopsy, it might include node biopsies, so,
Speaker 4: especially for something like breast cancer, you might get node
Speaker 4: biopsies at the same time that you get an initial
Speaker 4: biopsy because we know those nodes very well, we know
Speaker 4: which ones to sample for in what quadrants, et cetera.
Speaker 4: For others, it might not. There might not be a
Speaker 4: nodal biopsy until there's maybe an exploratory surgery or some
Speaker 4: kind of surgery to remove the cancer, and then you
Speaker 4: would sample lymph nodes at that same time.
Speaker 1: What is it tell me walk me through a node biopsy?
Speaker 4: Oh, I mean, I'm not a surgeon or an interventional radiologist,
Speaker 4: but you are an MD.
Speaker 1: So just hoping for some broad strokes subscription.
Speaker 4: It depends on It depends on the type of cancer
Speaker 4: and things. For breast cancer, you could do it without
Speaker 4: necessarily needing to do like an open surgery or anything.
Speaker 4: So you might be able to do a lymph node
Speaker 4: biopsy with just like an in interventional radiology type of procedure.
Speaker 4: The same thing might be true for a lot of
Speaker 4: biopsies of things like maybe your liver or even lungs.
Speaker 4: You could do with like a broncoscopy. You could do
Speaker 4: a lot of different biopsies in multiple different ways of
Speaker 4: both lymph noodes and the tumor itself, whereas for others
Speaker 4: you might not, like in your guts, it's very hard
Speaker 4: to sample some of those lymph nodes, and so you
Speaker 4: might not be able to do a lymph noode biopsy
Speaker 4: until you're doing a surgery, and then you might take
Speaker 4: the whole entire lymph node rather than just us samample. Okay,
Speaker 4: And there's obviously pros and cons to doing both and right, right,
Speaker 4: but hopefully that was a good answer.
Speaker 1: It was great, Thank you so much.
Speaker 4: And then and then after we have all of that,
Speaker 4: then you're also going to get images tests as well too,
Speaker 4: and that's to look for distant metastases. And you know,
Speaker 4: depending on the types of cancer, there could be a lot.
Speaker 1: How well does imaging what what is the imaging and
Speaker 1: then like are there cancers that are missed by imaging
Speaker 1: or yeah.
Speaker 4: Yes, yes, definitely okay, especially I mean, I would say
Speaker 4: especially micrometastases, Like we're not going to be able to
Speaker 4: pick up a handful of cells somewhere, right, which is
Speaker 4: why a lot of times chemotherapy is still recommended. Even
Speaker 4: if you think we had a surgery, we got good
Speaker 4: margins we didn't see any metastases. There still might be
Speaker 4: a recommendation for chemotherapy because we just don't know if
Speaker 4: there's other cells hanging out locally or more broadly. But yeah,
Speaker 4: MRI is sometimes used. CT scans are sometimes used, and
Speaker 4: then PET scans, which are this like weird and fancy
Speaker 4: way to look at metabolism.
Speaker 1: Basically, it's really cool. It is really cool.
Speaker 4: There's still like a mystery for me, but you basically
Speaker 4: are looking at like glucose uptake and metabolism so that
Speaker 4: you can see if cells are looking like they're growing
Speaker 4: more than they ought to.
Speaker 1: And you can do fancy scans you can do if
Speaker 1: you can find specific targeted cell cancer cells exactly. But okay, okay,
Speaker 1: I just didn't know how well imaging captures.
Speaker 4: Yeah, it all just depends like it just depends on
Speaker 4: the size. And that's why most people with cancer are
Speaker 4: going to have many scans. It's not going to be
Speaker 4: just the one. It's going to be that first one
Speaker 4: for staging, and then they're going to have scans to
Speaker 4: look for evidence of recurrence or new metastases that we
Speaker 4: didn't know about. Because things can change, you know, very rapidly, right,
Speaker 4: when it comes to how cancer is affecting our body's
Speaker 4: big picture, most cancer deaths are due to metastasis, meaning
Speaker 4: because of the way that this cancer has spread through
Speaker 4: our bodies, and like what is the exact mechanism of that.
Speaker 4: Who knows, Like it can really really depend. Like it
Speaker 4: could be that you have metastases to your liver, and
Speaker 4: so now your liver is failing because it can't function
Speaker 4: anymore because it's full of cancer. It could be that
Speaker 4: you have brain metastases again your brain or your kidney
Speaker 4: or whatever it is. Sometimes also we can see that,
Speaker 4: like if tumors grow large or very numerous, they might
Speaker 4: start to lice themselves or sometimes that can happen as
Speaker 4: a result of treatment, and that can be very very
Speaker 4: dangerous because you're basically releasing a bunch of things that
Speaker 4: are supposed to be inside cells, and that trigger is
Speaker 4: a really strong immune response, Yeah, exactly. There's also though,
Speaker 4: cancer requires a lot from our bodies in terms of
Speaker 4: our metabolic load, and so it ends up just weakening
Speaker 4: our bodies until they really can't function anymore. And so
Speaker 4: this can result in something called cancer associated cachexia, which
Speaker 4: is really really awful and it's just this depletion of
Speaker 4: skeletal muscle mass, especially skeletal muscle mass, that cannot be
Speaker 4: entirely reversed no matter how much nutritional support you give someone.
Speaker 4: And it's ever yeah, it's it's I mean, it's not
Speaker 4: like no one can recover from this, but you until
Speaker 4: you get that cancer under control, right right, right, Okay,
Speaker 4: the cancer itself is doing this, and so you can't
Speaker 4: completely reverse it.
Speaker 1: It's just diverting all the resources.
Speaker 4: Exactly. It's exactly that. And it's a very multifactorial thing
Speaker 4: because a lot of times we do see like people
Speaker 4: having either food aversions or nausea, whether it's from the
Speaker 4: medications or from the cancer itself, or if you're talking
Speaker 4: about like a head of net cancer or an upper
Speaker 4: GI cancer, you might not be able to eat physically,
Speaker 4: and so then it's very difficult to get nutrients answers
Speaker 4: it comes. There's a lot that goes into a kaxia
Speaker 4: associated with cancer, but that is a really big cause
Speaker 4: of death. One estimate that I saw was that cancer
Speaker 4: associated kakexia accounts for nearly half of all the deaths
Speaker 4: associated with cancer worldwide, which is which is really huge.
Speaker 4: And then there's also the fact that cancer dysregulates our
Speaker 4: immune system in a very profound way, especially when it
Speaker 4: gets to be metastatic, and so it can end up
Speaker 4: causing things like blood clots and thrumba embolism or blood
Speaker 4: clots are a really big cause of death for people
Speaker 4: with cancer as well. So there's just a lot of
Speaker 4: ways that cancer dysregulates our body and then can end
Speaker 4: up leading to death, like in a lot of different ways.
Speaker 1: Why are I know, I know that we're not going
Speaker 1: to talk about specific cancers, but why is there such
Speaker 1: very you know, looking at different organ system or like
Speaker 1: point of origin, organ of origin, Why is there such
Speaker 1: a difference tends to be such a difference in you know,
Speaker 1: metastasis and fatal you know, fatality and treatment receptibility. What
Speaker 1: is it being able to be treated? I can't think
Speaker 1: of the word.
Speaker 4: It's hard, Aaron, because it's so many different things. I
Speaker 4: think that play into that. Some of it is our
Speaker 4: ability to screen for things, and so we are able
Speaker 4: to catch some cancers a lot earlier than we can
Speaker 4: catch other cancers, and therefore we can treat them more
Speaker 4: effectively with the same treatments that we would use for
Speaker 4: another cancer. Pancreatic cancer is a really good example of that,
Speaker 4: like and ovarian cancer is another one where a lot
Speaker 4: of times these are completely asymptomatic until it's really bad, bad,
Speaker 4: until it's already spread at least regionally, if not widespread.
Speaker 4: And so that's part of it, whereas breast cancer, prostate
Speaker 4: cancer like things that we can screen for, we can
Speaker 4: potentially catch earlier. And some of it is just cancer
Speaker 4: specific that I don't know the answer to. I'd have
Speaker 4: to dig on each specific cancer of like why pancreatic
Speaker 4: cancer is so so And some of it too, is
Speaker 4: that we research cancers that are more common, and there's
Speaker 4: more funding for cancers that are more common, which is logical,
Speaker 4: which means that cancers that are more rare are going
Speaker 4: to have a lot less treatment options. They're going to
Speaker 4: be harder for us to detect, harder for us to
Speaker 4: even think about checking for, and then harder for us
Speaker 4: to treat because we don't have as many treatment options
Speaker 4: available for those kinds of cancers. And that's a really
Speaker 4: huge issue.
Speaker 1: Right And then if they're if they're rarer, then it's
Speaker 1: harder to have clinical trials that then you know, show
Speaker 1: the performance of this treatment versus another.
Speaker 4: So you're relying on a lot less data to guide
Speaker 4: your therapy to begin with. So there's there's so much that.
Speaker 1: So many factors.
Speaker 4: Yeah, but obviously cancer can and does end up affecting
Speaker 4: our entire body system. But I haven't even told you
Speaker 4: at all. How does this actually apply?
Speaker 1: It happen?
Speaker 4: How does a cell in our body just up and
Speaker 4: decide to go rogue? Is that really what happens? Why
Speaker 4: is tobacco, smoke and genetics? Like, how do all these
Speaker 4: virus environment genetics play a role. That is where we'll
Speaker 4: pick up next week here, Cliffanger, Cliffhangers, we love them,
Speaker 4: we do, we do. Gosh, I know it was a lot.
Speaker 1: I feel like. I mean, yeah, we've we've covered a
Speaker 1: lot of grond already.
Speaker 4: And I have so many more questions.
Speaker 1: I know. I feel like we've also barely scratched the surface.
Speaker 4: Yeah, that's true.
Speaker 1: This is an iceberg of a top.
Speaker 4: And if you want more below the surface, boy do
Speaker 4: we have very well?
Speaker 1: Then we planned that, we did not plan that. We
Speaker 1: have a lot of sources. I have so many, And
Speaker 1: then I just wrote a few here to shout.
Speaker 4: Out so long y'all, like please go to our website
Speaker 4: this podcast will kay you dot Com, click on the
Speaker 4: episode's tab and it.
Speaker 1: Is such a long list it was really hard to stop. Yeah,
Speaker 1: and there are some really great sources. Okay, So for
Speaker 1: this episode, A few of the sources that I found
Speaker 1: the most helpful are The Emperor of All Maladies, A
Speaker 1: biography of cancer. It's classic, it's Pulser Prize winning. It
Speaker 1: is yes, by sid Arthur Mukerjee, published in twenty ten.
Speaker 1: Then there's another book called Terratologies, A Cultural Study of
Speaker 1: Cancer by Jackie Stacy, which I think this is twenty thirteen,
Speaker 1: but I think it came out earlier than that. I'm
Speaker 1: not sure. That was a really interesting perspective on our
Speaker 1: perception of cancer today and how that's shifted. Then there's
Speaker 1: a series by had You from twenty eleven going all
Speaker 1: the way through like twenty sixteen or something like that,
Speaker 1: seven part series called A Note from History, Landmarks and
Speaker 1: History of Cancer one through seven. Hugely informative.
Speaker 4: Okay, I love yeah.
Speaker 1: And then also more about sort of the historical perception
Speaker 1: of cancer is a dread disease. Cancer in modern American
Speaker 1: culture by James Patterson nineteen eighty eight.
Speaker 4: Not the same James Patterson that my dad reads.
Speaker 1: I don't believe, so I'd have to double check on that.
Speaker 4: I have a number of papers as well too. I
Speaker 4: also just want to shout out the National Cancer Institute
Speaker 4: has like a cancer classification. They have these like training
Speaker 4: modules that anyone can access.
Speaker 1: There's a wealth of information there.
Speaker 4: Yeah, it's really great. So I have a link to that.
Speaker 4: That paper that I mentioned that was like updating the
Speaker 4: definitions of cancer was by Brown at All from twenty
Speaker 4: twenty three, called Updating the Definition of Cancer. I thought
Speaker 4: that was just an interesting read. And then if you
Speaker 4: want more about the staging of cancer, there's a paper
Speaker 4: it's kind of old from two thousand and eight by
Speaker 4: Green and Sobin called the Staging of Cancer a retrospective
Speaker 4: and perspective appraisate.
Speaker 1: Early twenty first century. I don't know.
Speaker 4: And then there's so much more. Go to our website,
Speaker 4: check it out, you can see it at all. I'm done.
Speaker 1: Thank you again. I mean so deeply, so deeply to
Speaker 1: the providers of our Fritan accounts. It means the world.
Speaker 4: Everyone, everyone who wrote in, everyone who sent in your story,
Speaker 4: thank you, thank you so much.
Speaker 1: Thank you to Bloodmobile for providing the music for this
Speaker 1: episode in all of our episodes.
Speaker 4: Thank you to everyone here, Thanks after WAT Studios.
Speaker 1: Yes, thank you, thank you.
Speaker 4: And Tom and Leanna and so many Pete, Pete, Oh
Speaker 4: my gosh, I'm going to forget everyone's name. Oh dear.
Speaker 1: Yes, thank you you make this happen. Also, I want
Speaker 1: to shout out my husband John for listening to me
Speaker 1: re all of these and go through all of these
Speaker 1: notes and talk incessantly about cancer for weeks on end
Speaker 1: and really every other topic. Yea.
Speaker 4: I should also say thank you to Brat. I were
Speaker 4: listening to you. I mean him, It's like you can't
Speaker 4: do any fun things right now. I need to talk
Speaker 4: to you.
Speaker 1: I want to talk to you about two hours about cancer.
Speaker 1: Your guys are good sports, very good sports. We appreciate
Speaker 1: your support. We also appreciate the support of listeners.
Speaker 4: Good transition.
Speaker 1: That's great. Damn. Really you think you you allow us
Speaker 1: to make this happen and your ideas are always appreciated.
Speaker 1: Everything like you mean the world.
Speaker 4: Thank you. Yeah, especially shout out to our patrons. Thank
Speaker 4: you for your support over on Patreon. We really, we
Speaker 4: really it means a lot to us.
Speaker 1: Yes, it's the end.
Speaker 4: It is of episode one. Of episode one, We've got
Speaker 4: three more coming to you, So wash your hands.
Speaker 8: Fealthy animals, bum bumba, bumbo
Speaker 1: Ombu.