Cancer Bang Goes the Theory

Cancer is a condition we all know about.

Here in the UK, a third of a million people

are diagnosed with it every single year.

And as we live longer, that number is set to rise.

Currently, cancer is the country's second-biggest killer.

Tonight on Bang, we reveal it's not all bad news

as serious progress has been made in our fight against it.

Over the last 40 years, our chances of surviving some cancers

have more than doubled and we're much better at preventing them too.

From the latest approach to screening...

It saved Chris's life. I am convinced of it.

..to cutting-edge technology being used in theatre...

For brain surgery, I think it's going to be revolutionary.

..and the new wave of designer drugs

that aim to cure some cancers altogether.

Tonight on Bang, we confront cancer

and explore how we're planning to defeat it.

According to this nationwide survey,

more doctors smoke Camels than any other cigarette.

This ad from 1949 shows how we used to view smoking.

A year later, British scientists discovered the link

between tobacco and cancer

and it was a finding that would save millions of lives.

It's still responsible for a quarter of our cancer deaths

and we've since found other things that pose a risk.

In fact, it's been estimated that two out of every five cancer cases

are caused by our own lifestyle choices.

Too much exposure to the sun's UV rays has been linked to skin cancer.

Poor diet, inactivity and excessive boozing,

they've all repeatedly been shown to significantly increase

your risk of cancer.

But if you listen to the press, you might think

lots of other things were a risk too,

things like deodorant,

grapefruit

and even wearing your belt too tight.

These are just a few of the things the press have linked to cancer

in recent years.

So, is every story in the paper worth worrying about?

Sir Richard Peto has spent decades studying the causes of cancer.

It's easy to say that anything might be dangerous.

Biscuits might be dangerous. Coffee might be dangerous.

Sitting in chairs all day might be dangerous.

But I think we shouldn't let worrying about possible hazards

divert attention from dealing with the main things.

And the main things in this country would be, number one, tobacco,

and number two would be having too much fat around your tummy.

So, some things are worth worrying about, others are not.

But unfortunately, when it comes to cancer,

some things are out of your control.

And what makes all this a game of chance comes down

to how cancer occurs in the body and why.

Here's Liz to explain.

Cancer isn't just one disease,

it's a whole range of different diseases,

but they all share some common features.

Cancer starts in our bodies, within our own cells,

and it happens when our very biology malfunctions.

Our bodies are made up of cells programmed to do specific jobs,

from carrying oxygen around your blood

to transmitting signals in your brain.

The instructions that tell a cell how to behave are held in its DNA,

in sections of chemical code known as genes.

This is just one gene and a fairly small one at that.

Now, each cell follows its own set of instructions that dictate

how it must function to stay healthy and act normally within the body.

Imagine this bubble is behaving like most cells.

If it's healthy, it's programmed to grow and divide and so multiply.

But this multiplication needs to be done in a controlled way.

This cell division is known as mitosis.

And of course, each of these cells may go on to divide further.

But there is a predetermined limit to how many times

division will occur from that first cell.

Another set of instructions control when a cell should die.

This is important for cells in a number of different circumstances.

They can stop being useful to the body

or they can start behaving abnormally,

so it's vital that a cell is able to self-destruct.

Cell death is essential for maintaining order within the body.

It happens up to 70 billion times every day in a healthy adult.

But it's possible for our biological instructions to go wrong.

The chemical coding within the DNA can be changed or damaged

by outside influences, altering how the cell behaves.

As a result of these chemical changes,

cells start to behave in ways they shouldn't.

They may grow too fast and multiply too often

and they may no longer listen to the body's signals to stop

or refuse to die when they're instructed to.

When cells become cancerous,

they no longer obey the normal rules of cell life and cell death.

All cancers start out as a growing population of too many cells

in the wrong place, doing the wrong job.

And in most cases, they start growing as a mass, a tumour.

Now, not all tumours are cancerous, in which case,

they're called benign.

But if a tumour invades surrounding tissue or spreads

to other parts of the body, it is cancerous or malignant.

Between 5% and 10% of cancers are caused by genetic errors

inherited at birth.

And some dangerous mutations and damage to DNA

are caused by substances like cigarette smoke,

radiation from the sun, viruses like HPV

and also by a number of other unavoidable environmental factors.

And the longer we live, the more chance we have

of collecting a bad combination of mutations.

It's the fact that we're all living longer that means that

an increasing number of people will get cancer.

We're much, much less likely to die from heart disease and stroke

and infection than we were 40 years ago

and so an increasing proportion

of the deaths that are left are due to cancer.

Cancer only became a serious problem in the modern world

as people started to live longer.

But our understanding of cancer has grown too

and we've applied science and technology

to find ways to overcome it.

One of the biggest success stories is radiotherapy.

Back in 1895, a German scientist, Wilhelm Rontgen,

discovered a new type of light, invisible to the human eye,

yet of an energy and nature that allowed it

to pass straight through the human body,

only being preferentially blocked by the denser parts like bone.

Shone into a photographic plate,

it gave extraordinary images like these.

These mysterious rays that could pass through our flesh

like light through glass became known as X-rays.

Quite soon after their discovery, it was noted that just because

most of the X-rays passed through living tissue,

they didn't necessarily leave it unaffected.

And within weeks, Victorian doctors were using X-rays

to try and cure all sorts of ailments, including cancer.

Taking photos like these uses a very small dose of X-rays.

But it was found that if the dosage was thousands of times bigger,

it could damage living tissue inside the body.

Now, in here I've got some real, live cancer cells,

growing and dividing as I speak.

Placed under a microscope, the cells themselves are clearly visible.

At the other end of this lab,

they've got a source of high-energy radiation like X-rays.

Let's see what happens to our cancer cells

when they get a quick blast of that.

The energy from the beams of radiation damages the DNA,

shown here in red.

This stops cells replicating or kills them outright.

The use of high-energy radiation to attack cancerous growths

is known as radiotherapy. But as with most things in medicine,

there's a lot more to take into account as you leave the lab

with the intention of trying the process on real people.

X-rays aren't the only sort of radiation used to treat cancer,

but they are the most common, and different types of radiotherapy

can be administered from outside or inside the human body.

But whatever method is used, the big problem is that healthy cells

are made from the same stuff as cancerous growths,

so they can also suffer from intense radiation exposure.

Now, imagine this is a section through a patient.

These bits here represent all the healthy tissue that should be there,

and this, that's been discovered through careful scanning,

is a cancerous tumour.

Now, with a further leap of the imagination, this is my X-ray gun,

capable of firing a stream of highly energetic photons into the body.

Firing a beam straight on like this

not only heavily damages the cancerous tissue

but also the healthy areas in front of and behind it.

But if we set the gun firing

whilst it moves on a circular path centred around the cancer,

let's see what happens.

With this setup, any damage to the healthy tissue is spread out,

whilst the cancer receives a concentrated dose.

With actual radiotherapy, the doses are carefully split up over time.

By giving smaller doses on different days,

the body has a chance to repair the limited damage it's received.

The tumour can't repair itself nearly so well.

Now it's time to give the cancer another blast.

Obviously, with real treatment,

programmes of radiotherapy and recovery are uniquely planned

to maximise damage to the cancer, avoid vital organs

and keep the patient as safe as possible.

Now, obviously, this isn't real radiotherapy,

but it's this ever-increasing planning

and precision of the doses

and building in the correct recovery time that's making

what's always been a very powerful treatment for some cancers

increasingly safe and effective.

The real technology and the way we use it

is getting more sophisticated all the time.

Every tumour is a unique, complex shape,

and one of the most advanced new treatments follows it in 3D

and then changes the shape of the X-ray beam

to concentrate the dose on the cancer.

By increasing our precision,

we've made major breakthroughs in fighting tumours with radiotherapy.

And it's not the only kind of treatment where this is the case.

When it comes to cancer surgery,

pioneering technology is also helping to increase

our chance of survival,

especially with operations to remove brain tumours.

Operations like this one are incredibly delicate procedures.

Removing cancerous cells from healthy tissue

in the most complex organ of the body

requires extreme precision down to a microscopic level.

Here at Charing Cross Hospital,

Mr O'Neill carries out operations like this one every week.

And while every case poses its own individual problems,

the goals are always the same.

The thing that we do know here and now

is that we can give the patient a much better outlook

if we can get as much of this tumour out as accurately as possible.

-We have to be very, very precise.

-Right.

And we use as much technology as we can.

We take pre-operative MRI scans and we convert them into a 3D volume

so when we point to the head

we can point to the exact point on the image

so we can see exactly where we're heading and where the tumour is.

We use ultrasound to update that volume.

And of course then you have your experience, your naked eye

or using the microscope to identify what looks abnormal.

But even with all the current technology,

surgeons often have to send a sample

from what they believe to be the edge of the tumour

to the biopsy lab.

There they run tests to see if the job is complete.

But this can take up to half an hour,

and the patient has to remain under anaesthetic.

The more cells that can be removed while keeping healthy tissue intact,

the smaller the chance of the cancer coming back.

But even with biopsies, the process isn't 100% accurate.

If we can improve our accuracy even more,

I think we can improve these patients' outlook incredibly.

Surgeons here are working with Imperial College

on a new device that will bring the biopsy into the theatre.

They're enhancing a tool that's already commonly used,

a knife that cauterises the tissue with electricity as it cuts.

It's a very precise tool,

and what's really good about this is it stops bleeding immediately.

Dr Takats and his team have taken a workhorse of the operating theatre

and combined it with a common piece of equipment from the chemistry lab,

a mass spectrometer.

Electrosurgery, as it works, produces smoke.

Using this tubing, we can introduce this smoke into the instrument

and we can perform almost real-time chemical analysis.

And as an example of how this technology works,

I'm using it to analyse two very different samples of animal tissue.

-Oh, wow, look at that. Lamb liver chemical signature.

-Exactly.

That is pretty impressive.

And not only are we getting a good old whiff of that,

but some of that smoke, of course, has been filtered through this tube,

but it's letting you know in real time

the chemical signature of the cells or the tissue you're cutting through.

Exactly.

Cancer has a unique metabolism,

quite different from any other tissues,

which means that just by looking at

those molecules which electrosurgery liberates from the tissue,

we can easily differentiate between healthy and cancerous tissues.

And it can give a warning signal

whenever the wrong type of tissue is hit.

This technology could help surgeons define more precisely

where the tumour boundaries are

and ultimately help to safely remove more of the cancer.

This intelligent knife could be used in the removal of tumours

from any part of the body.

The surgeons here will be starting to test it in the next few months.

For brain surgery, I think it's going to be revolutionary,

because the whole point is to try and avoid removing normal brain

and get to a point where you can

very accurately identify tumour versus normal brain,

and how more accurate could you get

than a molecular fingerprint of the tissue you're looking at?

Improving the precision of tumour removal is especially important,

as it helps to limit one of cancer's deadliest characteristics,

its ability to spread.

As a malignant tumour grows, cancer cells can invade surrounding tissue,

like a weed spreading through a garden.

But they also have the potential to take root in other parts of the body

in a process known as "metastasis".

With metastasis, individual cancer cells break off from a growth

and travel in the body's vessels to other organs.

Only about one in 10,000 cancer cells take hold in other tissues,

but once there they can lie dormant for months or even years

before conditions are right for them to start multiplying again.

What metastasis means is that cancer can spread,

so you could get a breast cancer that moves to the brain

or a lung cancer appearing in the liver.

But even if a cancer has metastasised,

there are ways of fighting back.

One of the most commonly used techniques uses medicines,

and it's known as chemotherapy.

Chemotherapy drugs are a bit like the selective weedkillers

you might use in your garden

so you can rid your lawn of weeds but leave the grass untouched.

Chemo agents target fast-growing cells in the body,

like cancer cells, killing them,

leaving the slower-growing, healthy cells unharmed.

But cancer cells aren't the only ones that multiply fast.

Our blood cells, made in our bone marrow,

and cells in our gut do, too.

So chemo can also affect these.

And this is what leads to side effects,

like tiredness, susceptibility to illness, and hair loss.

Nevertheless, chemotherapy has helped to save millions of lives

and remains a very effective treatment for cancer.

Unfortunately, if any diseased cells are left behind,

they can mutate further or undergo other chemical changes.

So they can evolve to become resistant to chemotherapy,

like some weeds are resistant to weedkiller.

The Institute of Cancer Research

are working with the Royal Marsden hospital

to develop new drugs that target specific cancers.

We might refer to them by body part - brain, lung, breast etc -

but it would be more accurate to refer to them by genetic coding.

And so far, we've identified over 200 different types of cancer,

each one of them capable of changing or mutating within the body.

A lot of work is currently being done to develop medicines

based on the specific genetic make-up and character

of particular diseases.

Dr Udai Banerji is currently overseeing 31 trials of new drugs.

The cancer is very smart,

and it actually evolves with every treatment that you get.

What we have to do is almost play chess with the cancer

and try and predict what it's going to do next.

-Good morning, Karen.

-Good morning, Maria.

-How are you?

-I'm fine.

-And you?

-Yeah, very well, thank you.

Once a drug is found to be effective in the lab,

it has to be tested

with real patients already undergoing treatment.

Karen is on one of Dr Banerji's phase one trials.

She was diagnosed with cancer three years ago.

-Looks all right, doesn't it?

-Everything OK. I'll turn it off.

When I was actually told, the first thing I said to my consultant was,

"Am I going to die?"

And she said to me, "I don't know".

So that was like, "Oh, OK, then," and so it was a shock,

but I took it much better than I thought I would.

I thought if you got cancer you'd be laying in bed

and you'd never get up. That's how I imagined cancer to be!

But, you know, you just get on with it, and it's made me feel

a lot better about myself, and here I am, three years later.

By the time Karen had been diagnosed,

her cancer had already spread.

She responded to traditional chemotherapy at first,

but it stopped working soon after.

My consultant at St Richard's said, "The Marsden are really fantastic

"and they have trials and you can be a guinea pig and you can see..."

And I just said, "Yep, bring it on. Anything.

"Anything to get me better so I can have time with my grandson."

In the last few months,

Karen's become one of the first six people in the world

to try out a new treatment

as part of a trial which combines chemotherapy with a targeted drug.

We are so eternally grateful

to patients who volunteer for these studies.

There are no guarantees the drug will work.

There is a possibility that you'll have side effects

which have never been seen before.

I think they are the true heroes of drug development that we have.

Only about 10% of drugs used on these kind of trials

make it to market.

But for Karen, the results so far have been promising.

How did the last week go in itself?

I'm back at work full time Thursdays and Fridays.

Had a little grandchild this weekend,

-so that's been very exciting.

-Excellent news!

-Yes!

But, no, healthwise I've felt really well, so, yes, long may it continue.

At the moment, Karen's tumours have stopped growing,

and she plans to continue to take part in the trial

as long as the drugs keep working.

I think the final goal would be

to predict exactly where the cancer cell is going to evolve to

and so almost back it into a corner with different treatments

to be able to then deliver the final blow

to try and kill all the cancer cells.

Not everyone having this treatment has responded as well as Karen,

and it's impossible to know

if it will be found safe and effective long term.

But these kind of trials play a key part in overcoming cancer.

The work being done here is really exciting,

but it only underlines how much more there is to know

about this complex set of diseases.

It's vital that we completely understand the enemy,

because then we can better predict what it will do next,

because that will give us the best possible chance

of developing the drugs to defeat it.

New treatments offer up hope where previously there was none.

And if you catch them early, certain cancers are a lot easier to treat.

TV presenter Tommy Walsh knows this all too well,

and he believes screening for some cancers is very important.

Both my mum and my sister had breast-cancer operations,

and I had a few scares meself,

the first of which, unusually for a man, was a lump in my breast.

And most recently, I was screened for bowel cancer.

But thankfully it turned out to be negative.

But my experience has shown me that cancer really is a game of chance.

Even though it seems unlikely, it can happen to anyone.

The NHS has introduced

several national screening programmes over the years

to try and catch cancer in its early stages.

The latest involves bowel cancer testing kits,

which have been hitting the doormats of everyone over 60

in the last few years.

Sandy Gallagher's husband Chris received one just six months ago.

This came through the post, and I thought,

"Nah, I don't feel unwell

"and I don't fancy the idea of anything wrong".

And when I read the instructions of what you had to do,

I thought, "No, this isn't my ball game at all".

Did you have to pressure him?

Gently persuade him, Tommy, and I just said to him, "Look, just do it.

"It's not a problem. It only takes minutes. And you never know."

The kits can be completed discreetly and hygienically in your loo at home.

Using the cardboard spatulas provided,

you take six tiny samples of poo and seal them away under these flaps

and send the kit back in the envelope provided.

Chris's kit was analysed at this screening hub

run by Professor Stephen Halloran.

So, what we now need to do is to see

if we can identify the presence of blood

in any of those six samples.

Why blood? Why is that important?

We've known for many years that if people have colon cancer,

those lesions inside the colon bleed.

So if you see blood in your poo, then you need to act on it,

you need to go and see the doctor, see your GP,

and they will take appropriate action.

But the blood doesn't always show up in the toilet bowl,

and the kits contain a special ingredient

that helps indicate if there's any hidden in the samples.

Extracted from a South American tree,

guaiac resin reacts in the presence of oxygen.

If there's blood in a sample, it will release the oxygen

from a few drops of hydrogen peroxide added to the mixture.

So what we're going to do is just add it...

and what we'll see is that it changes colour to blue.

Oh, look at it! Yeah! That's a really rich blue, isn't it?

And what's happening is the oxygen is reacting with the guaiac.

-So that tells us there's blood in it.

-Absolutely.

In the kits, the guaiac is already absorbed into the sample panels,

so all the team here have to do is open up the back of the kit,

add some drops of hydrogen peroxide,

and if there's any blood there to release the oxygen,

the window turns blue.

If we find blood in one, two, three or four,

then we refer you to have a second and potentially a third kit.

If we have five or six spots that are positive,

that's sufficient evidence for us to refer directly for colonoscopy.

A colonoscopy is a minor procedure

where doctors use a camera to examine the bowel in more detail.

Finding blood in your poo doesn't necessarily mean cancer,

but after Chris got a positive result

the doctors found a six-centimetre tumour,

which they were able to remove in surgery.

The thing that they told Chris

was apparently you've got four walls to your bowel

and the size of the tumour had gone through three of the walls,

so if this hadn't been found when it was,

it would have grown through the bowel wall completely,

through the fourth wall,

and then the likelihood is

it would have spread to other organs of the body.

How lucky were you that you actually managed to persuade him

to actually take that test?

Getting that test unsolicited through the post was a miracle.

Frankly, it saved Chris's life. I am convinced of it.

Most kits come back negative, but in England alone

over 70,000 cancers and pre-cancers have been detected so far.

In cases where it's caught early,

around 90% of people diagnosed with bowel cancer

live for at least five years.

Of those who find out late, it's under 10%.

Another stage of bowel screening is in the process of being rolled out

for all 55-year-olds in England

that could reduce your chance of getting bowel cancer by a third.

It involves a minor inspection with a camera

with added potential to painlessly lasso out any small growths

before they even become cancerous.

By making bowel screening available for anyone of a given age,

these programmes have the potential

to save thousands of lives every year.

Let's face it, cancer screening isn't a particularly glamorous activity.

But for me, it's a no-brainer.

It may be worrying, but remember, early diagnosis could save your life.

Smarter knives...

more precise radiotherapy...

specifically targeted drugs...

and improved screening...

we've come a long way since a link was first made

between cancer and smoking,

and today, we're better positioned to deal with it than ever before.

But in fact, most major breakthroughs in cancer research

happen because patients are willing to volunteer

to take part in trials and programmes

whilst dealing with their own illness

alongside the doctors and medical researchers

who have dedicated their lives to medical science -

they, too, are helping us to detect, prevent, treat and cure cancer.

Next week on Bang,

we find out how big data is going to change our lives

in ways we could never imagine.

Join us to find out exactly what big data is

and the good and the not-so-good of this brave new world.

In the meantime, if you're interested in a career in biomedical research,

check out our website, /bang, for our very own careers guide.

And if you'd like to learn more about cancer,

follow the links to the Open University.