The Cancer Episode

This is an iHeart Podcast, Guaranteed Human. Welcome to Stuff You Should Know, a production of iHeart Radio. Hey and welcome to the podcast. I'm Josh and there's Chuck and Jerry's here too and this is a little fashioned episode of Stuff You Should Know. I guess one that we hope helps people understand things better is the clumsiest way I can put it. That's pretty clumsy. Thanks. Nice. You did well then. Did you already know a lot about cancer before you started researching this? Yeah. I mean I feel like I knew most of this stuff, generally, like obviously you know that we're going to go over a lot of statistics and stuff early on so I didn't, wasn't super dialed in but yeah, I mean we got, we have cancer in our family on my mom's side, like my mom had breast cancer, my her sister had some kind of cancer, one of her brothers had some kind of cancer so it's sort of been around and I've lost a couple of friends to cancer. Yeah. So it's popped up here and there. Yeah. I would say that's more than your fair share based on some of these statistics. Yeah. And you know I was, I mean not to spoil anything but I did see that only 5 to 10 percent of all cancer cases could be attributed to genetic defects. Yeah. I saw something like that too. So that made me feel better as far as you know knowing that I'm going to die of heart disease. Right. You know, I mean that is all American though, isn't it? Oh baby. It is. They give you a little American flag to hold in your casket when you die of heart disease. Yeah. But yeah, I mean those are the two leading causes, you know, especially if you're an American. So you know that's one of the two is probably going to take me out. Well, that's the thing. It sucks to think about this kind of stuff but you're going to, there's a hundred percent chance you're going to go somehow some way. That's right. And I think 40 percent of men and women in the United States will get a cancer diagnosis at some point. That's a lot. Yeah. One in every 2.5 Americans. Yeah. That's a sobering stat. And I feel bad for that 0.5 American because they already have it hard enough. Right. I need you to find a way to get a little humor in here. So let me kind of tell you what I learned about cancer that I just did not understand. Okay. Which is kind of like the overview of what cancer is. Cancer is not just one disease. It's a kind of new but I'd heard that I had no idea what people are talking about. What they're talking about is it's actually nowadays an umbrella term for a collection of more than 200 different diseases. And they all share two important things in common one, they are they come from genetic defects. Not just inherited genetic defects like you were talking about. And then two, the mechanism of the disease is uncontrolled cell growth. That's cancer. But the reason it's so insidious and difficult to treat and you know, kills so many people is because it comes from your own body. It's not like a foreign invader. So your body doing what it normally does, which is cells divide and they don't do it quite right sometimes and they can turn cancerous. And your body has ways to handle that stuff and get rid of it. But if your body starts to get overwhelmed or your immune system starts to get depleted as you age, then the cancer can take hold and then it goes from a normal byproduct of cell division to disease. It didn't really understand cancer in those terms until I researched this. Yeah. Well, that's good. I mean, that probably means you haven't faced it a lot in your immediate surroundings. Yeah. Yumi's brother, her older brother, Bobby, has aged for cancer right now. He's been hanging in there for a really long time. He's been living his best life and everything, but it's just kind of as constant in our lives. Yeah, for sure. Yeah. So if five to 10% are attributed to genetic defects, then the other 90 to 95% are rooted in environment and lifestyle. Obviously, if it was lifestyle, we're talking about some obvious things like smoking and diet, alcohol, the sun exposure, stuff like that, stress is one that's kind of scary to think about. Yeah. Obesity. But then, you know, 15 to whatever, 20% are due to stuff like, you know, environmental pollutants and just radiation that you can experience, maybe in your workplace or where you live or something like that. And that's all super, super sad. It's all sad. But, you know, the stuff that you have no control over, but you live near a thing, that's just super scary. Yeah. Yeah. For sure. Yumi radiation also can just come from being out in the sun over the course of your life, which I think is the reason why skin cancers are the most common type of cancer. Yeah. I think you're right. The name cancer is Latin for crab, so, you know, just like the zodiac sign. So in the early days, doctors describing tumors that had like veins or extensions coming out of them, said they were crab like in the way they said that was, they called them cancers. Yeah. So there you go. That's the end of the episode. Should we go over some of these other stats? Yeah. This is largely American stats, but we tried to extend them where we could to the UK, Australia, Canada. Yeah. Places where people listen to us. Exactly. So, and make sure everybody could share in this depressiveness. No, I agree. At any point, about 17 million Americans are living with cancer and about 5,800 new cases are diagnosed every day in the US, about 1,100 in the UK, and just 450 in Australia. 696 in Canada, I saw it to later. Oh, so 450 to 696? It's a range, I guess. No, no. That's Australia. 696 is Canada's. Oh, it's Canada. It's Australia. Yeah. No. Uh, and every year, about 600,000 Americans die of cancer, which accounts for about 17% of all deaths in the United States, with far and away with lung cancer being the leader there. Yeah. The UK is flipped to December 5 in Australia, number 3 in Canada, but it's definitely up there. Right? Yeah. And lung cancer, not just in the US, but worldwide, is the, is most responsible for deaths from cancer. It's really prevalent because smoking was really prevalent and still is. And like, you can chalk the vast majority of cancer deaths every year up to smoking, people who smoke make up the vast majority of people who die from lung cancer. And in the US, it's like 130,000 people every year and something like a hundred thousand of those people smoked. So every decade, a million people die because they smoke cigarettes. And then every year, about 7,300 Americans die from second-hand smoke exposure, which is even worse. Yeah. Colorectal cancer is number two at about 55,380 deaths expected this year in 2026, but sort of the sobering part of colorectal cancer is that it's really, really, I mean, you could even say skyrocketing in young adults. It's up 51 percent since 1994 in people between 20 and 49 and they don't, I mean, you should go get colonoscopies in your 40s and I would even say by the age 40, but your insurance may not cover it. So there's a lot of work obviously in the insurance world when it comes to covering things like this because as you'll see, getting ahead of the game and cancer is the name of the game with beating cancer. Yeah, for sure. And that is actually a reason why deaths from cancer in the West are on their way down and have declined precipitously in some cases. It depends on the type of cancer, but like cancer death rates for all cancers declined by almost 30 percent in the US over the past 20 years. That's amazing. Right. In the five-year survival rate, which as we'll see is pretty much for most cancers synonymous with cured, like your cancer, that's that past 70 percent in 2025. So like the numbers are pretty good and there's other kinds of cancers that have like eye-poppingly positive survival rates. Yeah, breast cancer for sure is one. One of the highest at about 90.5 percent thyroid is really up there, 98 percent, prostate is 46 percent, testicular cancer at 95 percent, and skin cancer at almost 94 percent. So those are really, really encouraging numbers. It's one of the scariest words I imagine you can hear from a doctor, but if you look at the numbers, unless it's just sort of one of those rare worst-case scenarios where you get some kind of news that something is stage four and metastasized. Right. You know, that just that doesn't happen very often, thankfully. - No, typically pancreatic cancer is pointed to you as kind of like the poster child for that. - Yeah. - And the reason why is because you don't show symptoms until it's metastasized. And that means you're diagnosed typically at stage four, which is last stage cancer, which means that I think it has a five year survival rate of 11.5% in the United States. Long cancers is only 22%. So, I'm going to get screened, hopefully this month 'cause I just turned 50. - Oh good. - So I'm now eligible for a lung CT because I smoked when I was younger and now I'm 50. So, cross your fingers 'cause I don't want cancer. - I don't want you to have cancer either, buddy. - Thanks, man. That's like, maybe the nicest thing you've ever seen. (laughing) - Well, especially when you've done the right thing and improved your health so much, and anytime somebody works really hard to do something really, really hard like quitting smoking, you hope that there's a real great payoff for that. Emily smoked for a long time too, so she's always just sort of worried and she has cancer in her family. So, she has always getting tons of screenings for things. - Good, it's smart. - Yeah. So, I think one out of every six deaths globally every year are from cancer, and the rates are really boosted by lower income countries because they don't have a lot of access like we do in the West to services, to screenings, even HPV vaccinations. That's a huge preventative for a whole suite of cancers. - Yeah. - And in the United States, it's very prevalent and it can save your sexual partner's life years down the road. And they don't necessarily have access to that. And by the way, HPV hepatitis, other viruses that can cause cancer are called oncoviruses, like oncology. - That's right. Should we talk about cells for a little while? - I mean, I don't see how we can talk about cancer and not talking about cells. - Yeah, so I think it would help if we talked a little bit about how cell division and like healthy cells are supposed to work, which is cells divide and reproduce. And they, you know, they do that when they should generally and they do that where they need to do that generally and they locate themselves in the body where they're supposed to go after they mature into a specialized cell. So a cell will divide and then once it matures it gets an assignment basically to go perform a role. And you know, it generally does that pretty well. And when it gets to the, and it's pretty miraculous when you think of just normal cell life. - Yeah. - How like, kind of wonderful it is to look at like when they get to the end of their life, they know that and they self-destruct and they say, we've done our job, it's time for us to exit the scene. And with cancer, all of that almost is flip-flopped. - It is. And again, like cancer just sells in your body that have become damaged or you inherited them with damage and like they just happen. But your body has all sorts of defenses to get rid of them as like waste and it handles it, right? So this isn't just like tumors we're talking about. This actually applies to any kind of cancer cell. They never stop dividing, which is one of the things we said at the beginning. Uncontrolled cell division and growth is essentially how you die from cancer, right? Either they cells accumulate into a tumor that crowds out the healthy cells and keeps them from doing their things. So if it's liver cancer, your liver can't filter enough stuff out anymore and that you die from organ or systemic failure 'cause the cancer cells have just crowded out the healthy cells. - Yeah, so like we said, it's a genetic mutation that's going on. And some DNA changes are gonna raise the levels of proteins to keep the cell growing. Others might lower levels of a protein that tells it when to stop growing. Sometimes it'll, you know, the ones that we talked about, it'll not have, and we'll talk about the specific protein. I guess we can, why wait? It's P53. - That was gonna be suspenseful for us. - I know. P53 is the one that basically is like the switch that tells us like, "Hey, it's done our job, it's time to go." So one DNA mutation might not tell that P53 gene to express itself. And they think, scientists think that more than one DNA change has to occur for a healthy cell to turn cancerous. So if you have an inherited genetic related change or something, you might need fewer additional changes to develop that cancer. - Yeah, because it's not like when you develop a carcinoma skin cancer, like that's the first time you've ever developed cancer right there, or a potentially cancerous cell, like it's not like you were just touched by the sun once and all of a sudden you have cancers, just how it works. Instead, you have those cells happening all the time, but they have built-in mechanisms to reprogram themselves, to basically take care of the damaged genes and turn them off or on. Or like you said, the wrong genes are offer on ones that have nothing to do with cell turning cancerous. Or again, if it does turn cancerous, the body's immune system can come take care of it, right? And that's why you have to have more than one genetic mutation because it sells pretty good at repairing itself. And if it's not, P53 comes up like a boxing manager and like, you know, smacks your face and wants to see if they need to throw in the towel. And if you have too many genetic mutations, it's gonna throw in the towel for you and you're gonna have to undergo a poptosis. That's right, you know, we talked about tumors, we're gonna be talking more about that obviously, but there's also something like leukemia. There are cancers of the blood where you don't form a tumor, but the blood cells, again, they just replicate such, they crowd out the healthy ones. And it's all doing this because they express, how would you say that, telomerase? Yeah, okay. And that keeps the telomere's lengthened. The telomere is what allows the cell to divide and they, you know, kind of dwindle down over time. But if they're expressing that telomerase, it's lengthened and that wears out a little more slowly so that tumor can just keep dividing and growing basically. Yeah, one of the other reasons they're so quick to divide is that they don't stick around long enough or they don't wait to divide long enough to mature. And like you said, healthy cells divide mature and then become specialized, they get their assignment. And tumor cells or cancer cells just don't, they just divide too quickly to ever mature. And so as they're doing that, they pick up all sorts of new genetic mutations. So the cells of a tumor can have a bunch of different, genetically different cells because it just starts getting so out of hand. Like I guess at the very beginning of a tumor, the cells are probably still relatively similar, but by the time you have a big old tumor, it's just this big mass of a bunch of weirdo cells that kind of like multiplicity with Michael Keaton. Right, that's right. And this is, I mean, cancer can really be insidious when you think about what's going on. Cancer cells can also recruit normal cells near a tumor to like develop new blood vessels and stuff to help keep the tumor alive and like help it kind of thrive and help it grow. It's like, hey, here's some more oxygen and more nutrients because cancer cells are recruiting other cells and like turning them to the dark side. Yeah, and there's one other thing that they found recently is not only can they recruit cells to create new blood vessels for them, they can recruit neurons nearby. And they send phony messages to the brain, which then in turn sends out this, I can't remember the name of it, but it's an immune cell whose job is to basically tell all the other immune cells like, hey, you can just relax, everything's all clear. So the brain sends those to where the tumor is and the tumor recruits them and surrounds itself with a bunch of immune cells that tell the body nothing to see here, keep moving on. That's what cancer cells do. That's insane that like something can evolve and adapt that quickly because we're talking about it doing this on the order of like months or a few years, maybe. It's just crazy what cancer is. Yeah, for sure. All right, I think maybe we should take a break. Yeah, I'm certain to get worked up. Yeah, that was a good table setting and we'll come back and talk about types of cancer right after this. (upbeat music) All right, so we're back to talk about types of cancer. Like you mentioned from the jump, there are more than 200 types of cancer because there are more than 200 types of cells in the body and that's no coincidence obviously. They're basically classified according to where they start in the body, But that also means that, you know, you can get cancer. are almost anything anywhere in the body. - Yeah, and again, I said the most common one is a carcinoma. I think 85% of all cancers are carcinomas and those start with epithelial tissue or cells, which are like the outside layer of your organs and make up tissue, the skin. And again, it's just because all of us are exposed to the sun over the course of our lifetimes and eventually, I guess it's just a game of odds that can, you know, some of those cancer cells that can just overwhelm the immune system as we get older because our immune system declines, which is one of the joys of aging and it turns out. - That's right, lymphoma, it makes up about 5% of cases that starts obviously in the lymph glands, in the lymphatic system and the lymphatic system obviously runs throughout your entire body. So a lymphoma can start almost anywhere. - Yeah. - If you've ever heard of non-Hodgkin lymphoma, which is the most common, or Hodgkin lymphoma, which is Hodgkin's disease, those are the two major subtytes of lymphoma. And, you know, there are some irony here for sure because the lymph systems clears out cancer cells from your body as waste. So that's definitely a cruel one. - There's also leukemia, which is cancer of white blood cells that begins in the bone marrow. And that's where white blood cells are formed along with red blood cells. And strangely, no one has any idea why, but this is the most common type of cancer in children. Adults can get it too. But if you are a child with cancer, it's most likely leukemia and they don't, they just don't understand what the problem is there. - Yeah, brain and spinal cord cancers, probably one of the scariest kinds when you just sort of hear those words by brain tumor. But, you know, I have known people who have had brain tumors and who are doing just fine. - Yeah. - They are central nervous system cancers. And then at, I think that's 3% of all cancers, right? - Yeah. - And then what do we have at 1%? - Myeloma is another one that starts in the bone marrow. This is plasma cells, which make up the liquid part of your blood, but it's also a type of white blood cell. So it's created in the bone marrow. And I was like, wait, that's two types of bone marrow cancers. And it turns out the bone marrow is called a metatastic niche because it's a magnet for some types of cancer cells that go to the bone marrow and just set up shop there. This is like an embarrassment of riches for all the stuff the cancer can use to recruit and protect itself. - Yeah. And then also 1% we have sarcoma. That begins in the connected tissue or the supportive tissue, like maybe in your muscle and your blood vessels and your fat or cartilage or even bone. - Chuck, because there's so many different kinds of cancers and they do all sorts of different stuff, I've read that essentially every case of cancer is totally unique because of your person's body is totally unique. And so they stage them. They basically describe them in different terms. And the two things that they base, the descriptions are most are size and growth. And the whole thing starts with stage zero cancer. It goes from stage zero to stage four. And stage zero is like you technically don't have cancer. It can be pre-cancer cells. You just have a spot that's acting a little weird and it's mostly curable because the cancer has an undergone one of the things that makes cancer so hard to treat. It hasn't spread to the surrounding tissues. So you can just go in, cut out the little growth and you just got all the cancer. You're not leaving anything behind. - Yeah, here at Stuff You Should Know, we love stage zero cancer. - Yes, our favorite kind of cancer. - As far as cancers go, this is the one we're behind. - For sure. - And we're not afraid to say it. - For sure, it even looks pretty. It's got that nice round O in the middle. - Yeah, but nothing in the center of that thing. - Right. - Of course, you have stage one next. They go stage one, two, three, and four. Stage one is, you know, it's a little bit more cancer. It's smaller, obviously not smaller than zero, but smaller than two. It's contained to one area, has not spread to the lymph nodes or other areas, which is basically where you get to and stage two as the tumor is gonna be larger and it may have spread to the lymph nodes at this point. - Yeah, and it's almost certainly spread to the surrounding tissue too, but it's kind of invisible. The tumor's quite obvious, but the spread around the tumor is not quite visible, so it makes it harder to get rid of through surgery. Stage three, it's grown even bigger and into deeper into the surrounding tissues. And it also has probably spread to nearby lymph nodes. And then once it's spread, once it metastasizes what it's called, you have entered stage four. - That's right. That means it's definitely spread outside. It's original place, probably to other organs or anywhere in your body, really. And that is metastatic cancer. You may also hear a letter sometimes in a diagnosis like stage two A and the letter will describe an aggressiveness with A being the least aggressive all the way up to D being the most aggressive. - Right, and then words like remission and cure also used, remission is where the cancer is, it basically describes how the cancer's responding to the treatment, right? If the cancer's on its heels and it's shrinking and it's doing all the stuff you wanted to do through treatment, it's in remission. That would be partial remission. Complete remission is where you've treated the cancer and it can no longer be detected in the body, but that doesn't mean that it's cured. That's like a whole different term. - Yeah, I mean, cure is sort of a dicey word when it comes to cancer. That's basically complete remission, meaning there's no evidence of the disease. And even though there may be a risk of reoccurrence if you're cured, basically like five years is what you said. If you're in complete remission for five years, you can kind of stamp that cure on your forehead proudly. - I think that doctors are kind of like, I don't like to use that word. They're just nervous about it coming back, you know? - Yeah, I mean, I don't know any doctors first. Well, I do know some doctors actually, but I haven't asked them like, how they feel about the language around it, you know? - Yeah. - We'll wait if you want to get in touch with them. - No, but we'll hear from doctors, I'm sure. - Yeah, I hope so. - In patients. I'm looking forward to getting emails from all kinds of people on this. - For sure. - So the history is, you know, we're not gonna get to in the weeds because it's basically a situation where they thought black bile was what, you know, caused death and disease for many hundreds of years, probably thousands. And then there was a Dutch scientist, the father of anatomy, Andreas Vesaleus, who finally said, you know what? I've looked at a lot of dead bodies, but even Stolson corpses to make it happen. And guess what, everyone? There's no black bile in the body. And everyone was like, well, why are people dying? That took a little bit longer. I think in 1793 there was an anatomist in London named Matthew Bailey. - That's what I'm going with. - Yeah, who was like, all right, here's a real proof everyone that cancer isn't black bile. It's, you know, we found out that tumors can grow in the body really fast. And for a long, long time, it was, let's cut that stuff out of the body and see what happens. - Yeah, because surgeons were like, "Oh, it's a tumor, we can get rid of that." And I think at first they thought, this is around 1850 when it really kicked off. They initially thought like, we can totally take care of cancer from now on. But what they figured out over time, because some of their patients that they treated would come down with cancer again, like a year later or something like that, was that that cancer would spread kind of invisibly deeper into the tissue, and that just getting rid of the tumor wasn't enough because it left too much of the cancerous cells to re-proliferate and grow again. - Yeah, and, you know, very sadly, they were like, you know, because I think they were so thrilled by the advent of successful surgery that they were a little scalpel happy. And we're like, we'll just keep removing stuff then, because that's how you cure this thing. And that left, you know, some disfiguration a lot of times when they just kept like getting rid of, you know, pieces of your body. - Yeah. - And it took a long time. It took decades before they finally figured out that it was a systemic thing, and finally understood what metastasization is. And then they came up with better treatments, starting with X-rays in 1895, right? - That's where they were discovered and as little as a year later, an American medical student named Emil Gruba, he was like, I'm gonna try to use those to treat cancer. And he was successful. He did a successfully treated a patient with breast cancer using X-rays. So now you got radiation, which can, you can go in and cut the tumor out, and then you can irradiate what's left. And now things are starting to cook. - Yeah, things are starting to cook a little bit. Chemotherapy enters the scene. Thanks to kind of a weird story, but in the US Army, doctors were conducting autopsies on soldiers who died from mustard gas exposure, and they're like, hey, this gas is attacking white blood cells. So they got a developed a derivative of mustard gas called mechlorethamine and that became the first chemo drug in the 1940s and they still use that sometimes for some types of lymphoma, I think. Yeah, because it's a disease of your white blood cells, right? Yeah. There's a guy who is basically synonymous with chemotherapy, his name is Sidney Farber. He, the Dana Farber Cancer Institute is named after him and it is world-renowned and it's also, I found a really great resource for info, really understandable but detailed info on cancer. Yeah. He came up with a cancer drug for treating leukemia in children, Aminopterin, I think is what it was called and that was back in 1947. So if you see photos of him after 1947, he usually has a little halo over his head. The thing is, and we're going to see this after we take a break, but chemotherapy is a very blunt instrument, right? I've heard a kind of an oncological gallows humor before that basically says, with chemotherapy, you're trying to kill the tumor before you kill the patient. Yeah. Because it just goes in and it wipes out so much stuff that you don't want to wipe out. It's just not very targeted, but again, as we'll see, it's gotten a lot better over time. Yeah, and a lot better to take thanks to some great new nausea drugs because nausea and fatigue are two of the biggest rough parts of chemotherapy. Yeah. I've heard that for sure. All right. Should we take our second break? Yes, please. All right. We're going to come back and we're going to talk about treatment because there's a lot of great stuff going on you guys. We'll be right back. So, check two things. The first one is, I always wondered if cancer was actually a relatively recent thing, like maybe from the industrial revolution on. Right. Yeah, I used to wonder that too. Absolutely not. I mean, I think Imhotep described it 40, 700 years ago, a breast cancer. So, it's been around a really long time. The reason it's only kind of recently come under investigation and study is because we used to die from a bunch of other stuff, mostly communicable diseases rather than cancer. It was pretty low on the list. And then as we started to take care of those other communicable diseases, then cancer suddenly became a much bigger problem than it happened before. Yeah, for sure. And the reason that we haven't developed like a complete just cure for cancer is because that no two cancers are the same. They all develop in different ways. They're doing a lot of, we'll talk about some of the more breakthrough stuff they're doing, but right now, what the standard practice still is, if you have a malignant tumor, is to shrink that tumor with targeted radiation and then remove that tumor and then prescribe a course of chemotherapy, which is probably like more than one chemotherapy drug, to eradicate what cancer is remaining in your body and to hopefully stave off metastasis. Yeah. And you'll do that round of chemotherapy, wait a little while, and then they'll test you and see what effects it had. And then if it's still there, you do another round and another round and test after each time until eventually, they're like, we can't detect cancer anymore. And now you're in full remission. Hopefully forever. Yeah. If you don't have a tumor, like you said earlier, if it's like a cancer of the blood, a chemotherapy is your main defense there and probably radiation as well. And also, you've probably heard of like a bone marrow transplant or stem cell transplant. That's also used in cases like leukemia. I was looking into that and it's apparently not nearly as bad as it's been made out to be. Everyone's like, it's the most painful thing you can possibly do. And also, apparently only 10% of people who apply to be donors actually end up donating marrow, most of the others and their plasma will do instead. So you end up basically donating blood. Chemotherapy, like I mentioned before, the break is a lot better than it was even like 10 or 15 years ago, because this serotonin antagonist, which is a new class of anti nausea drugs, really can help block the nausea receptors in the brain. And I know, just from like family and stuff, that was one of the worst parts. And I'm sure it's still no picnic, but those have really helped. Yeah. I mean, just what a horrible thing going in to get chemotherapy, knowing that you're going to get horribly nauseated for a while. The dread has to be really serious, you know? Yeah, I mean, one of one of our friends, like of you and me, have recently underwent cancer, the jaw surgery. And boy, the way he described just the pain of that surgery and what he felt like the next day was brutal. I don't think I have the exact words here on my text. I don't know if I'd read him anyway, but he basically was like, he felt like he'd gotten run over by a truck. And that was just like post post op. I mean, geez, that was just after the surgery, you say? Yeah, for sure. But he's doing great. Good. Good. I'm glad. So yeah, surgery is a big part of it. If it's a tumor, obviously, if it's a cancer of the blood, and there's no tumor, they're not doing that, like you said. But you promised cutting edge stuff, right? And something that is still, you can kind of call it cutting edge, just because it's so G was, but it's starting to become much more prevalent and available throughout the west. It's a form of immunotherapy, which is basically training your immune system to target cancer cells in the same way that it targets foreign invaders. Because again, cancer is not a foreign invader, and it's very, very clever at using the body's own immune system to prevent it from being attacked. Right? I was thinking about this. Cancer is like one of those rogue agents in a movie that was trained by the very agency that now seeks to kill it. Yeah. Yeah. It's good metaphor. Thanks, man. I've been working on it for a couple of weeks now. So yeah, you know, your body generally does a pretty good job of doing that kind of thing, but not in the case of cancer. So they're working on therapies that, like you said, can train your body to do that. And I guess the leading, or I guess one of the leading methods is called CAR T cell therapy. In this case, the CAR stands for chimeric antigen receptor, which is a targeted receptor for the type of cancer cells that invade your body. Right. So they basically just take some of your blood. They separate the T cells, your immune cells out of it. And they use CRISPR. Did we do a whole episode on CRISPR, the gene editing technology? I feel like we did. It was either a whole episode or it was came up pretty heavily and more than one back in the day. Okay. But it's a tool for basically use, you use a virus that has the gene G1 in it in the viruses, whatever disease it spreads is turned off. And you insert that into like a T cell. And now the T cell has the genes you want. And those genes get the T cell to express the same proteins that are in that kind of cancer. So now you put the T cells back in, you have to proliferate them for a while. And there's a bunch of T cells running around telling the rest of your immune system, look for this. Do you see this protein right here? This is what we're looking for. And in other cases, it can cause T cells to grow the kind of receptors that need that needs to attack and latch on to cancer just like it would any foreign invader. So I have a neighbor friend who underwent CAR T cell therapy. Yeah, that's amazing. Some other gene therapy techniques that are, I guess still in the testing stage, they, you know, we mentioned that P53 protein. That's the one that says like, Hey, it's, we've done our job. It's time to self-destruct. And that's the one, cancer cells don't have. So some gene therapy techniques include turning on that P53 protein in cancer cells. So they either self-destruct or at least stop dividing. Right. It's amazing. Yeah, there's others that there's genes that basically turn the cells into magnets for immune cells. And then I saw another one where they can turn the, they can make the cancer cell mature finally, right? And so it will have a job basically and get this. They found that the vast majority of those cells basically pull the plug. They undergo a poptosis. They self-destruct. So they'd rather die than have a job. The cancer cells would. Isn't that crazy? Cancer cells are genetics in other words. Pretty much. Wow, that's, that's incredible. I didn't know about that one. They also have on the horizon personalized cancer vaccines. Right. That's a new treatment designed to basically prime your immune system to target cancer cells to reduce recurrence risk. And, you know, obviously, hopefully, like kind of fewer side effects than something like chemotherapy. And it's not good that they use the word vaccines because it suggests that you can go get the vaccine before you have cancer and they'll keep you from having cancer. And that's not the case. It's vaccine in the sense that it primes your immune system to fight cancer better, but they're, but it's personalized, right? So they take your cancer and examine it and then figure out what treatment will best defeat your specific cancer. And that's part of a larger kind of push that's going on now. It's called precision oncology, which is you're studying the individual patient patient's cancer to defeat it. Like, and now that we have genomic scans that you can really kind of go through the DNA of a cell pretty quickly and find the mutations and then figure out how to use those mutations against the cancer. That's, I mean, this is, it's a really great frontier that that we're on right now. It's very hopeful. Yeah, for sure. You know, we do have done a lot of AI poo pooing on the show, but one of the great benefits of AI is that it's already kind of stepped up in cancer treatment and in sort of cancer diagnoses, it seems like like maybe having along with the human radiologist having AI looking at radiology scans to detect tumors that maybe a radiologist doesn't notice, maybe also to help predict a risk. I know there's an AI MIT model that's able to predict a person's risk of developing lung cancer six years in advance. And that's amazing, because you know, as we've kind of hammered home already, like the whole trick to cancer is getting an early diagnosis and start going at it right away. Yeah. And that's the, I mean, that's the big money part right there is detecting it early. And because of things like screening and other kinds of detection that we have and routinely used in the West, that's why cancer rates are going down. But like I said before, the developing world is pushing cancer rates up so much so that the World Health Organization is expecting cancer diagnoses to increase 77% by 2050 over 2023. So in just over 25 years, almost, well, almost 100% increase, I'm just going to say 77% is close enough to 100% where we're talking about that level of increase of cancer diagnoses. Yeah, for sure. You know, we talked a little bit about risk factors already. Things that you can control like, you know, alcohol obesity to certainly tobacco and sun exposure, things like that. There is an interesting emerging field called psycho neuro immunology, which is a branch of Western medicine that acknowledges the effect of the brain, right? Or your mind really on the systems of the body. And you know, it's, I don't think it's like a woo woo stuff to say that a real, real deep will to live can make a difference if you're, you know, up against cancer. And it can work the other way too. And I've seen this as well when someone is like, you know what, this isn't the life I want. And I'm, I'm, I'm done because it's just, it's time for me. And I've seen people go very quickly after someone has sort of made that decision. So there's something to it for sure. Yeah, they, they definitely started to research that more and more. It seems kind of thin, the amount of it that's out now, but this investigation into what the will to live is. And then, yeah, like how to primer in people is, is it's definitely being investigated now. And it does seem to be a thing for sure. Yeah. And you know, on that sort of last note, around the language when someone has chosen to not continue treatment, the way people talk about it is changing, I think, probably for the better, because, you know, you shouldn't say like someone has given up the fight, because it indicates that they're like quitting something or surrendering. And that, in fact, is like one of the bravest things you can do, I think. Yeah, that's, yeah, I mean, it's definitely, because you're just saying like, OK, I'm accepting my fate. And that is incredibly brave. Yeah, and not just saying like giving up the battle of cancer, just using framing cancer treatment and cancer disease in terms of fighting and battling implies things like that, that, you know, you don't have the guts to keep fighting, you know, or you're you're quitting or you're surrendering is another way to put it. And for some people, yes, like battle fighting, it definitely inspires them. So no one's saying like, don't use those terms anymore. Right. It's just that for other people, they're like, I don't like, this is making me feel bad. Like I'm responsible for my own death. And those people, they're like, you know, call it your journey with cancer, living with cancer, treating your cancer, more neutral terms, less fighting terms. And they're, they just say researchers say, follow the patient's lead on which way, like how you frame the terms of cancer, living with cancer and treating cancer. And I mean, that's super valid. For sure. And if you know someone in your life that is is accepted, that it's, it's time for them, like, that's when they need like your, your support and love more than ever, I think it's in, I mean, I would just recommend to not not like be devastated in front of them, at least, right? And to try and try and support that decision, you know, because that's a, that's a brave thing to accept. That's going to be tough for a kid to understand and accept too, you know? Yeah. There was a member that, that episode of the pit that really dealt with that. Oh, yeah, that was Lord got wrenching. I've got one quick soap box PSA. That's okay. Yeah, let's do it. So in the United States mammograms are covered by insurance. The problem is, is that you very often need a follow up because they're like, this mammogram is good enough, but not quite. There's this thing in here I want to see closer. Let's take a look. And it's probably nothing. In the most cases, it is nothing. But they do that because they're like, we don't want to miss something that's really important. The follow up imaging is not covered by insurance. So there's a, you know, plenty of women out there who are like, I don't have the money to pay out a pocket for a CT scan. So I'm just not going to go get the follow up imaging and cross my fingers. So there's bills floating around there basically like insurance companies, you have to cover all follow up imaging as well. Like you can't just, just do the bare minimum. It's just not going to work for people anymore. Hopefully. Yeah. And mammograms suck. Yeah, it's an awful process that's like already, there's an incentive to avoid something like that. So insurance companies, you know, we've ranted before, but they need to step it up in a lot of ways that certainly one of them. And also as we mentioned before, with the increased rate of colorectal cancer and younger adults, make them available to be covered in your 30s. You know, there's probably not a lot of 30 year olds that have the gumption to be like, you know, I'm going to go ahead and get a colonoscopy at 35 years old. But if they want to, then it should well be covered, you know, for sure. Wow. That was a good one, Chuck. Nicely done. We made it. I would say, do you have anything else about cancer? But I know you do. So we're just going to say this one's wrapped up. That's right. Since we just wrap this episode on cancer up, that means it's time for listener mail, of course. That's right. I'm going to finish with the very heartwarming story, which is a good way to end this one. Awesome. This was from our phone books short stuff when we talked about sort of randomly calling the wrong person with the same name. Hey, guys, when I was 15, I tried to call someone in our friend group, I looked up the last name, found a long list of entries and put a small dot and pin next to each name of someone I thought lived in our school district. I still have that phone book with the markings. And you'll see why. Thankfully, two towns in our area had similar names, but went to different school districts. I didn't know that at the time. So I called over a dozen numbers asking for my friend, who I never found, but one guy answered. And when I asked, can I please speak to name redacted? He answered, well, he isn't here, but this is that name. And I answered, well, this is Amanda, which is actually a fake name, guys, because the Boston song Amanda was out at the time. And it was all I could think of on the spot. The story's getting good. We, I think you see where it's headed. We spoke for 30, 30 minutes on the phone about the met to just one the world series and hung up. I then called back that guy once a week for five months. And we eventually decided to meet under a street light on the corner. And dudes, we've been married for 33 years. Awesome. Together for 39. And in December, our daughter is going to get married. He is my person, my soulmate, my everything. I'm a weirdo. And he gets me and always has all because of the phone book. That is so great, man. To answer your question, yes, the other guy knows the story and that he is the reason that I found my husband, I don't think he could believe it. And I sort of still can't really believe it myself. After all these years, nowadays, it would be so unlikely to even pick up a call from an unknown number. So thank Thank you again for coming. consistently creating such polished, elite entertainment. - Polished. - And I know, elite. - Wow. - Not two words we usually associate with ourselves. - No, I think she's talking about the daily. - I think so. But that is from Laura, and Laura sent picks of her and her huts in 1987, 1993, and won from this year. And it is adorable. He had quite the mustache. - I saw that subject line. I haven't looked at the email yet. So I have to run over and do that. That's what a great story, man. - Yeah, I love it. - That was Laura? - That was Laura. - Thank you, Laura. That was, I don't know. That's a contender for number one, maybe. - That's right. You and name redacted husband. So glad you're still together. - Seriously, one of the best ever. So thank you for sending that email, Laura. And if you want to take your shot at the number one email spot, we love that. You can send it off to [email protected]. Stuff you should know is a production of iHeartRadio. For more podcasts, my heart radio, visit the iHeartRadio app. Apple podcasts are wherever you listen to your favorite shows. - This is an iHeart podcast. Guaranteed human.