TEDxStanford
Adam de la Zerda: We can start winning the war against cancer
Adam de la Zerda: Como podemos começar a vencer a guerra contra o cancro
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Conheça os avanços mais recentes na guerra contra o cancro com Adam de la Zerda, investigador da Universidade de Stanford, criador de algumas técnicas de ponta. Usando uma tecnologia de imagiologia notável, para iluminar partículas de ouro que são injetadas no corpo e atraídas pelas células cancerígenas, o laboratório de Adam espera iluminar um caminho que permita que os cirurgiões extraiam até mesmo os mais pequenos vestígios dos tumores mortais.
Adam de la Zerda - Biologist, electrical engineer
Adam de la Zerda develops new medical imaging technologies to detect and destroy cancer. Full bio
Adam de la Zerda develops new medical imaging technologies to detect and destroy cancer. Full bio
Double-click the English transcript below to play the video.
00:12
"We're declaring war against cancer,
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"Declaramos guerra ao cancro,
00:14
and we will win this war by 2015."
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"e vamos vencer esta guerra até 2015."
00:18
This is what the US Congress
and the National Cancer Institute declared
and the National Cancer Institute declared
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Foi esta a declaração do Congresso e do
Instituto Nacional do Cancro dos EUA,
Instituto Nacional do Cancro dos EUA,
00:22
just a few years ago, in 2003.
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há poucos anos, em 2003.
00:25
Now, I don't know about you,
but I don't buy that.
but I don't buy that.
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Quanto a vós não sei,
mas a mim não me convence.
mas a mim não me convence.
00:28
I don't think we quite won this war yet,
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Não me parece que a guerra
esteja ganha,
esteja ganha,
00:30
and I don't think
anyone here will question that.
anyone here will question that.
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e creio que ninguém duvida.
00:33
Now, I will argue that a primary reason
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Vou defender que a principal razão
00:36
why we're not winning
this war against cancer
this war against cancer
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para não estarmos a vencer
a guerra conta o cancro
a guerra conta o cancro
00:38
is because we're fighting blindly.
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é estarmos a lutar vendados.
00:40
I'm going to start by sharing with you
a story about a good friend of mine.
a story about a good friend of mine.
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Vou começar por partilhar convosco
a história de um amigo, chamado Ehud.
a história de um amigo, chamado Ehud.
00:44
His name is Ehud,
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00:45
and a few years ago,
Ehud was diagnosed with brain cancer.
Ehud was diagnosed with brain cancer.
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Há uns anos foi-lhe diagnosticado
um tumor cerebral.
um tumor cerebral.
00:48
And not just any type of brain cancer:
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Não era um tumor qualquer.
00:50
he was diagnosed with one
of the most deadly forms of brain cancer.
of the most deadly forms of brain cancer.
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Diagnosticaram-lhe um tumor cerebral
dos mais mortais.
dos mais mortais.
Na verdade, era tão mortal
00:53
In fact, it was so deadly
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00:55
that the doctors told him
that they only have 12 months,
that they only have 12 months,
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que os médicos lhe disseram
que só tinham 12 meses,
que só tinham 12 meses,
00:57
and during those 12 months,
they have to find a treatment.
they have to find a treatment.
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e durante esses 12 meses,
teriam de descobrir um tratamento.
teriam de descobrir um tratamento.
01:01
They have to find a cure,
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Teriam de descobrir uma cura.
01:02
and if they cannot
find a cure, he will die.
find a cure, he will die.
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Se não descobrissem a cura,
ele morreria.
ele morreria.
01:05
Now, the good news, they said,
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As boas notícias, disseram,
01:07
is that there are tons
of different treatments to choose from,
of different treatments to choose from,
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é que se pode escolher entre
muitos tratamentos diferentes,
muitos tratamentos diferentes,
01:10
but the bad news is
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mas as más notícias
01:11
that in order for them to tell
if a treatment is even working or not,
if a treatment is even working or not,
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é que, para se saber se um tratamento
está a funcionar ou não,
está a funcionar ou não,
01:15
well, that takes them
about three months or so.
about three months or so.
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leva cerca de três meses.
01:17
So they cannot try that many things.
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Portanto, não podem tentar muitos.
01:19
Well, Ehud is now going
into his first treatment,
into his first treatment,
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Bem, o Ehud começa
o primeiro tratamento,
o primeiro tratamento,
01:23
and during that first treatment,
just a few days into that treatment,
just a few days into that treatment,
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e durante o tratamento,
pouco depois de começar
pouco depois de começar
01:26
I'm meeting with him, and he tells me,
"Adam, I think this is working.
"Adam, I think this is working.
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encontro-o e ele diz:
"Adam, acho que funciona.
"Adam, acho que funciona.
"Creio que tive sorte,
que está a funcionar".
que está a funcionar".
01:29
I think we really lucked out here.
Something is happening."
Something is happening."
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01:32
And I ask him, "Really?
How do you know that, Ehud?"
How do you know that, Ehud?"
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Perguntei-lhe: "Como sabes"?
E ele diz: "Bem,
sinto-me tão mal por dentro.
sinto-me tão mal por dentro.
01:35
And he says, "Well,
I feel so terrible inside.
I feel so terrible inside.
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01:37
Something's gotta be working up there.
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"Alguma coisa deve estar a funcionar.
Tem de estar".
Tem de estar".
01:39
It just has to."
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01:40
Well, unfortunately, three months later,
we got the news, it didn't work.
we got the news, it didn't work.
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Infelizmente, três meses depois,
chega a notícia, não funcionou.
chega a notícia, não funcionou.
Portanto, o Ehud começou
o segundo tratamento.
o segundo tratamento.
01:45
And so Ehud goes
into his second treatment.
into his second treatment.
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01:47
And again, the same story.
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E outra vez o mesmo.
01:48
"It feels so bad, something's
gotta be working there."
gotta be working there."
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"Sinto-me tão mal, alguma coisa
deve estar a funcionar".
deve estar a funcionar".
01:51
And then three months later,
again we get bad news.
again we get bad news.
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E três meses depois,
novamente a má notícia.
novamente a má notícia.
01:54
Ehud is going into his third treatment,
and then his fourth treatment.
and then his fourth treatment.
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O Ehud passa ao terceiro tratamento,
e depois ao quarto.
e depois ao quarto.
01:58
And then, as predicted, Ehud dies.
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Depois, tal como previsto, o Ehud morre.
02:01
Now, when someone really close to you
is going through such a huge struggle,
is going through such a huge struggle,
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Quando alguém próximo
passa por uma luta tão grande,
passa por uma luta tão grande,
02:06
you get really swamped with emotions.
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sentimos um turbilhão de emoções.
02:08
A lot of things
are going through your head.
are going through your head.
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Passa-nos muita coisa pela cabeça.
Eu, senti ultraje.
Eu, senti ultraje.
02:10
For me, it was mostly outrage.
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02:11
I was just outraged that, how come
this is the best that we can offer?
this is the best that we can offer?
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Era escandaloso. Isto é o melhor
que temos para oferecer?
que temos para oferecer?
02:16
And I started looking
more and more into this.
more and more into this.
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E comecei a dedicar
atenção ao tema.
atenção ao tema.
02:18
As it turns out, this is not just
the best that doctors could offer Ehud.
the best that doctors could offer Ehud.
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Não só era o melhor que os médicos
tinham para oferecer ao Ehud,
tinham para oferecer ao Ehud,
02:22
It's not just the best doctors could offer
patients with brain cancer generally.
patients with brain cancer generally.
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não só era o melhor para
quem tem um tumor cerebral,
quem tem um tumor cerebral,
02:26
We're actually not doing that well
all across the board with cancer.
all across the board with cancer.
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como não nos estamos a sair muito bem
para todos os cancros em geral.
para todos os cancros em geral.
02:30
I picked up one of those statistics,
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Trouxe uma daquelas estatísticas,
02:32
and I'm sure some of you
have seen those statistics before.
have seen those statistics before.
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e creio que já as terão visto antes.
02:34
This is going to show you here
how many patients actually died of cancer,
how many patients actually died of cancer,
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Isto mostra quantos doentes
morreram de cancro,
morreram de cancro,
02:38
in this case females in the United States,
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neste caso mulheres nos EUA,
02:40
ever since the 1930s.
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desde a década de 1930.
02:41
You'll notice that there aren't
that many things that have changed.
that many things that have changed.
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Nota-se que pouca coisa mudou.
Ainda é um problema.
Ainda é um problema.
02:44
It's still a huge issue.
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02:46
You'll see a few changes, though.
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Mas vêem-se alterações.
02:48
You'll see lung cancer,
for example, on the rise.
for example, on the rise.
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O cancro do pulmão [Lung & bronchus],
a aumentar,
a aumentar,
02:50
Thank you, cigarettes.
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graças aos cigarros.
02:52
And you'll also see that,
for example, stomach cancer
for example, stomach cancer
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E o cancro do estômago [Stomach],
02:54
once used to be one
of the biggest killers of all cancers,
of the biggest killers of all cancers,
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que já foi um dos cancros mais mortais,
02:58
is essentially eliminated.
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foi praticamente eliminado.
03:00
Now, why is that?
Anyone knows, by the way?
Anyone knows, by the way?
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Porque é que isto acontece?
03:02
Why is it that humanity is no longer
struck by stomach cancer?
struck by stomach cancer?
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Porque somos menos afetados
pelo cancro do estômago?
pelo cancro do estômago?
03:05
What was the huge, huge
medical technology breakthrough
medical technology breakthrough
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Qual foi o enorme, enorme
desenvolvimento na tecnologia médica
desenvolvimento na tecnologia médica
03:10
that came to our world
that saved humanity from stomach cancer?
that saved humanity from stomach cancer?
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que apareceu e salvou a humanidade
do cancro do estômago?
do cancro do estômago?
03:15
Was it maybe a new drug,
or a better diagnostic?
or a better diagnostic?
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Um medicamento novo,
um diagnóstico melhor?
um diagnóstico melhor?
03:19
You guys are right, yeah.
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Sim...
03:20
It's the invention of the refrigerator,
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foi a invenção do frigorífico,
03:23
and the fact that we're
no longer eating spoiled meats.
no longer eating spoiled meats.
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e o facto de já não comermos
carnes estragadas.
carnes estragadas.
03:25
So the best thing
that happened to us so far
that happened to us so far
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Portanto, o melhor desenvolvimento
03:28
in the medical arena in cancer research
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na pesquisa do cancro
03:29
is the fact that
the refrigerator was invented.
the refrigerator was invented.
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foi a invenção do frigorífico.
03:32
(Laughter)
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(Risos)
03:33
And so -- yeah, I know.
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Pois, não nos estamos a sair bem.
03:34
We're not doing so well here.
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03:36
I don't want to miniaturize the progress
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Não pretendo menorizar o progresso,
03:38
and everything that's been done
in cancer research.
in cancer research.
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e tudo o que foi feito
na pesquisa do cancro.
na pesquisa do cancro.
03:41
Look, there is like 50-plus years
of good cancer research
of good cancer research
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Existem mais de 50 anos
de boa pesquisa sobre o cancro.
de boa pesquisa sobre o cancro.
03:45
that discovered major, major things
that taught us about cancer.
that taught us about cancer.
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Descobriram-se muitas coisas importantes,
e aprendemos muito sobre o cancro.
e aprendemos muito sobre o cancro.
03:48
But all that said,
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Apesar de tudo isso, ainda
temos um grande esforço pela frente.
temos um grande esforço pela frente.
03:50
we have a lot of heavy lifting
to still do ahead of us.
to still do ahead of us.
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03:54
Again, I will argue that the primary
reason why this is the case,
reason why this is the case,
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Novamente, vou defender que
a principal razão para isto,
a principal razão para isto,
03:58
why we have not done that remarkably well,
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de não nos termos saído muito bem,
04:00
is really we're fighting blindly here.
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é que estamos a lutar vendados.
04:01
And this is where
medical imaging comes in.
medical imaging comes in.
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É aqui que entra
a imagiologia médica e o meu trabalho.
a imagiologia médica e o meu trabalho.
04:04
This is where my own work comes in.
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04:06
And so to give you a sense
of the best medical imaging
of the best medical imaging
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Para vos dar uma ideia
da melhor imagiologia médica
da melhor imagiologia médica
04:09
that's offered today
to brain cancer patients,
to brain cancer patients,
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hoje oferecida
a doentes com tumores cerebrais,
a doentes com tumores cerebrais,
04:11
or actually generally
to all cancer patients,
to all cancer patients,
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e doentes de
todos os cancros em geral,
todos os cancros em geral,
04:13
take a look at this PET scan right here.
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observem esta tomografia.
04:15
Let's see. There we go.
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Cá está.
04:17
So this is a PET/CT scan,
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É uma tomografia PET/CT,
04:19
and what you'll see in this PET/CT scan
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e o que podem ver na tomografia PET/CT
04:21
is the CT scan will show you
where the bones are,
where the bones are,
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é que o CT mostra onde estão os ossos,
04:25
and the PET scan will show you
where tumors are.
where tumors are.
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e o PET mostra onde estão os tumores.
04:27
Now, what you can see here
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O que estão a ver aqui
04:30
is essentially a sugar molecule
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é essencialmente uma molécula de açúcar
04:32
that was added a small little tag
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com uma pequena marca
que nos sinaliza, no exterior:
que nos sinaliza, no exterior:
04:34
that is signaling to us
outside of the body,
outside of the body,
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04:36
"Hey, I'm here."
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"Estou aqui".
04:37
And those sugar molecules are injected
into these patients by the billions,
into these patients by the billions,
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Estas moléculas são injetadas
nos doentes, aos milhares de milhões
nos doentes, aos milhares de milhões
04:41
and they're going all over the body
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e percorrem o corpo à procura de
células que consomem açúcar.
células que consomem açúcar.
04:43
looking for cells
that are hungry for sugar.
that are hungry for sugar.
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04:46
You'll see that the heart,
for example, lights up there.
for example, lights up there.
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Podem ver que o coração [heart]
tem muitas.
tem muitas.
04:49
That's because the heart
needs a lot of sugar.
needs a lot of sugar.
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O coração precisa de muito açúcar.
04:51
You'll also see that the bladder
lights up there.
lights up there.
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Também veem a bexiga [bladder].
04:53
That's because the bladder
is the thing that's clearing
is the thing that's clearing
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É a bexiga que está a retirar
o açúcar do corpo.
o açúcar do corpo.
04:56
the sugar away from our body.
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04:58
And then you'll see a few other hot spots,
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E veem vários pontos assinalados,
que são os tumores.
que são os tumores.
05:00
and these are in fact the tumors.
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05:01
Now, this is a really
a wonderful technology.
a wonderful technology.
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Esta tecnologia é realmente maravilhosa.
05:03
For the first time it allowed us
to look into someone's body
to look into someone's body
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Pela primeira vez, permitiu-nos
ver o interior do corpo
ver o interior do corpo
05:07
without picking up
each and every one of the cells
each and every one of the cells
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sem pegar em cada célula
05:09
and putting them under the microscope,
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e observá-la ao microscópio.
05:11
but in a noninvasive way
allowing us to look into someone's body
allowing us to look into someone's body
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Mas de forma não invasiva,
podendo ver o interior do corpo
podendo ver o interior do corpo
05:14
and ask, "Hey,
has the cancer metastasized?
has the cancer metastasized?
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e perguntar: "O cancro metastizou?
05:16
Where is it?"
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"Onde está a metástase"?
05:17
And the PET scans here
are showing you very clearly
are showing you very clearly
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E este PET está a mostrar claramente
05:20
where are these hot spots,
where is the tumor.
where is the tumor.
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onde estão os pontos, onde está o tumor.
05:23
So as miraculous as this might seem,
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Embora pareça miraculoso,
05:26
unfortunately, well, it's not that great.
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isto, infelizmente, não é muito bom.
05:30
You see, those
small little hot spots there.
small little hot spots there.
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Veem aqueles pontinhos ali?
05:33
Can anyone guess how many cancer cells
are in any one of these tumors?
are in any one of these tumors?
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Adivinham quantas células tem
um daqueles tumores?
um daqueles tumores?
05:38
So it's about 100 million cancer cells,
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Cerca de 100 milhões de
células cancerígenas.
células cancerígenas.
05:40
and let me make sure
that this number sunk in.
that this number sunk in.
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E deixem-me repetir:
05:43
In each and every one
of these small little blips
of these small little blips
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em cada um dos pontinhos
que veem na imagem,
que veem na imagem,
05:46
that you're seeing on the image,
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05:47
there needs to be
at least 100 million cancer cells
at least 100 million cancer cells
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têm de estar pelo menos
100 milhões de células cancerígenas
100 milhões de células cancerígenas
05:51
in order for it to be detected.
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para o pontinho ser detetado.
05:53
Now, if that seemed to you
like a very large number,
like a very large number,
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Se parece ser um número enorme,
é porque é mesmo muito grande.
é porque é mesmo muito grande.
05:55
it is a very large number.
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05:58
This is in fact
an incredibly large number,
an incredibly large number,
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É um número incrivelmente grande,
06:00
because what we really need
in order to pick up something early enough
in order to pick up something early enough
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porque o que precisamos,
para detetar estas coisas a tempo,
para detetar estas coisas a tempo,
06:04
to do something about it,
to do something meaningful about it,
to do something meaningful about it,
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e agir, com impacto,
precisamos de detetar tumores
que tenham só mil células,
que tenham só mil células,
06:07
well, we need to pick up tumors
that are a thousand cells in size,
that are a thousand cells in size,
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e idealmente, muitas menos.
06:10
and ideally just
a handful of cells in size.
a handful of cells in size.
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Portanto, estamos muito longe disso.
06:12
So we're clearly
pretty far away from this.
pretty far away from this.
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06:14
So we're going to play
a little experiment here.
a little experiment here.
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Vamos fazer uma pequena experiência.
06:16
I'm going to ask each of you
to now play and imagine
to now play and imagine
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Vou pedir que cada um imagine
06:19
that you are brain surgeons.
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que é neurocirurgião.
06:21
And you guys are now at an operating room,
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Estão numa sala de operações,
e têm um doente à vossa frente,
06:25
and there's a patient in front of you,
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06:27
and your task is to make sure
that the tumor is out.
that the tumor is out.
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e o vosso trabalho é extrair o tumor.
06:31
So you're looking down at the patient,
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Olham para o doente,
06:34
the skin and the skull
have already been removed,
have already been removed,
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a pele e o crânio já foram afastados,
06:37
so you're looking at the brain.
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e estão a ver o cérebro.
06:38
And all you know about this patient
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Aquilo que sabem
06:40
is that there's a tumor
about the size of a golf ball or so
about the size of a golf ball or so
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é que o tumor tem o tamanho
aproximado de uma bola de golfe
aproximado de uma bola de golfe
06:43
in the right frontal lobe
of this person's brain.
of this person's brain.
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no lobo frontal direito do cérebro.
06:46
And that's more or less it.
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É mais ou menos isto.
06:47
So you're looking down, and unfortunately
everything looks the same,
everything looks the same,
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Estão a olhar para baixo,
e tudo é semelhante,
e tudo é semelhante,
06:50
because brain cancer tissue
and healthy brain tissue
and healthy brain tissue
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porque o tecido cerebral cancerígeno
e o tecido saudável têm o mesmo aspeto.
e o tecido saudável têm o mesmo aspeto.
06:53
really just look the same.
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06:55
And so you're going in with your thumb,
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Inserem o polegar,
06:57
and you start to press
a little bit on the brain,
a little bit on the brain,
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e pressionam ligeiramente o cérebro,
porque os tumores tendem
a ser mais duros e rígidos,
a ser mais duros e rígidos,
06:59
because tumors tend to be
a little harder, stiffer,
a little harder, stiffer,
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07:02
and so you go in and go
a little bit like this and say,
a little bit like this and say,
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e então fazem assim e dizem,
07:04
"It seems like the tumor is right there."
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"Parece que o tumor está aqui".
07:06
Then you take out your knife
and start cutting the tumor
and start cutting the tumor
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Pegam no bisturi e começam
a cortar o tumor
a cortar o tumor
07:09
piece by piece by piece.
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pedaço a pedaço a pedaço.
07:10
And as you're taking the tumor out,
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Durante este processo,
07:12
then you're getting
to a stage where you think,
to a stage where you think,
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chegam a uma fase em que pensam,
07:14
"Alright, I'm done.
I took out everything."
I took out everything."
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"Acabei, já extraí tudo."
07:16
And at this stage, if that's --
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E aqui chegados,
se até aqui isto pareceu de doidos,
07:18
so far everything sounded,
like, pretty crazy --
like, pretty crazy --
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07:21
you're now about to face the most
challenging decision of your life here.
challenging decision of your life here.
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estão prestes a tomar a decisão
mais difícil da vossa vida.
mais difícil da vossa vida.
07:24
Because now you need to decide,
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Porque agora têm de decidir:
"Paro aqui e termino,
"Paro aqui e termino,
07:26
should I stop here
and let this patient go,
and let this patient go,
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07:29
risking that there might be
some leftover cancer cells behind
some leftover cancer cells behind
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"arriscando ter deixado
células cancerígenas para trás
células cancerígenas para trás
07:32
that I just couldn't see,
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"que simplesmente não vi,
07:33
or should I take away some extra margins,
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"ou retiro mais alguma margem,
07:36
typically about an inch or so
around the tumor
around the tumor
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"normalmente uns dois centímetros
em redor do tumor
em redor do tumor
07:39
just to be sure that I removed everything?
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"só para ter a certeza que removi tudo?"
07:43
So this is not a simple decision to make,
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Tomar esta decisão não é simples,
07:47
and unfortunately this is the decision
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e infelizmente é uma decisão
07:49
that brain cancer surgeons
have to take every single day
have to take every single day
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que os neurocirurgiões
têm de tomar todos os dias
têm de tomar todos os dias
07:53
as they're seeing their patients.
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pelos seus doentes.
07:55
And so I remember talking
to a few friends of mine in the lab,
to a few friends of mine in the lab,
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Recordo-me de conversar
com amigos no laboratório,
com amigos no laboratório,
07:58
and we say, "Boy,
there's got to be a better way."
there's got to be a better way."
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e dizíamos: "Tem de haver
uma maneira melhor".
uma maneira melhor".
08:00
But not just like you tell a friend
that there's got to be a better way.
that there's got to be a better way.
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Mas não era só conversa...
Tem mesmo de haver
uma maneira melhor.
uma maneira melhor.
08:04
There's just got to be a better way here.
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08:06
This is just incredible.
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Porque é inacreditável.
08:07
And so we looked back.
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Fomos rever o tema.
08:09
Remember those PET scans I told you about,
the sugar and so on.
the sugar and so on.
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Recordam-se do PET que mostrei,
do açúcar e isso?
do açúcar e isso?
08:12
We said, hey, how about
instead of using sugar molecules,
instead of using sugar molecules,
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Dissemos: "Se, em vez de usar
moléculas de açúcar,
moléculas de açúcar,
08:15
let's maybe take tiny, tiny
little particles made of gold,
little particles made of gold,
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"pegarmos em partículas
muito pequenas de ouro,
muito pequenas de ouro,
08:18
and let's program them with some
interesting chemistry around them.
interesting chemistry around them.
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"e as envolvermos, com
alguma química interessante?
alguma química interessante?
08:21
Let's program them
to look for cancer cells.
to look for cancer cells.
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"Programá-las para procurarem
células cancerígenas."
células cancerígenas."
08:24
And then we will inject
these gold particles
these gold particles
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Injetamos estas partículas de ouro
08:26
into these patients by the billions again,
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nos doentes, aos milhares de milhões
08:28
and we'll have them go all over the body,
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e elas vão percorrer todo o corpo,
08:30
and just like secret agents, if you will,
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1976
como agentes secretos, se me permitem,
08:32
go and walk by
every single cell in our body
every single cell in our body
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vão calcorrear cada célula do corpo
08:35
and knock on the door of that cell,
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e bater-lhe à porta e perguntar:
08:37
and ask, "Are you a cancer cell
or are you a healthy cell?
or are you a healthy cell?
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"És uma célula cancerígena ou saudável?
08:40
If you're a healthy cell, we're moving on.
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2016
"Se fores saudável, vamos embora.
"Se fores cancerígena,
vamos entrar e brilhar".
vamos entrar e brilhar".
08:42
If you're a cancer cell,
we're sticking in and shining out
we're sticking in and shining out
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08:44
and telling us,
"Hey, look at me, I'm here."
"Hey, look at me, I'm here."
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Elas dizem-nos: "Estou aqui".
08:47
And they'll do it
through some interesting cameras
through some interesting cameras
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E dizem-no através
de umas câmaras interessantes
de umas câmaras interessantes
08:49
that we developed in the lab.
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que criámos no laboratório.
08:50
And once we see that,
maybe we can guide brain cancer surgeons
maybe we can guide brain cancer surgeons
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E quando as vemos,
talvez possamos guiar os neurocirurgiões
talvez possamos guiar os neurocirurgiões
08:53
towards taking only the tumor
and leaving the healthy brain alone.
and leaving the healthy brain alone.
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para retirarem só o tumor
e deixar o tecido saudável.
e deixar o tecido saudável.
08:57
And so we've tested that,
and boy, this works well.
and boy, this works well.
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Fizemos testes e funciona bem.
09:00
So I'm going to show you an example now.
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Vou mostrar-lhes um exemplo.
09:02
What you're looking at here
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Aquilo que estão a ver
09:04
is an image of a mouse's brain,
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é a imagem do cérebro de um rato,
09:08
and we've implanted
into this mouse's brain
into this mouse's brain
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e implantámos no cérebro deste rato
um pequeno tumor.
um pequeno tumor.
09:11
a small little tumor.
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09:13
And so this tumor is now
growing in this mouse's brain,
growing in this mouse's brain,
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O tumor está agora a crescer
no cérebro do rato,
no cérebro do rato,
09:15
and then we've taken a doctor
and asked the doctor
and asked the doctor
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e fomos ter com um médico
e pedimos-lhe
e pedimos-lhe
09:18
to please operate on the mouse
as if that was a patient,
as if that was a patient,
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para operar o rato
como se fosse um doente,
como se fosse um doente,
09:21
and take out piece by piece
out of the tumor.
out of the tumor.
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e extrair o tumor, pedaço a pedaço.
09:23
And while he's doing that,
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Enquanto ele faz isso,
09:25
we're going to take images
to see where the gold particles are.
to see where the gold particles are.
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nós tiramos imagens
para ver onde estão as partículas.
para ver onde estão as partículas.
09:28
And so we're going to first start
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Vamos começar
09:30
by injecting these gold particles
into this mouse,
into this mouse,
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por injetar as partículas
de ouro no rato,
de ouro no rato,
09:32
and we're going to see
right here at the very left there
right here at the very left there
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e vamos ver aqui à esquerda
a imagem de baixo
a imagem de baixo
09:35
that image at the bottom
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09:36
is the image that shows
where the gold particles are.
where the gold particles are.
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mostra onde estão
as partículas de ouro.
as partículas de ouro.
09:39
The nice thing
is that these gold particles
is that these gold particles
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É interessante que
estas partículas de ouro
estas partículas de ouro
09:41
actually made it all the way to the tumor,
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2016
chegaram mesmo ao tumor,
09:43
and then they shine out and tell us,
"Hey, we're here. Here's the tumor."
"Hey, we're here. Here's the tumor."
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e depois brilham e dizem,
"Estamos aqui. O tumor está aqui".
"Estamos aqui. O tumor está aqui".
09:47
So now we can see the tumor,
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Agora podemos ver o tumor,
09:48
but we're not showing this
to the doctor yet.
to the doctor yet.
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mas ainda não o mostramos ao médico.
09:50
We're asking the doctor,
now please start cutting away the tumor,
now please start cutting away the tumor,
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Pedimos ao médico para
começar a extrair o tumor,
começar a extrair o tumor,
09:53
and you'll see here the doctor
just took the first quadrant of the tumor
just took the first quadrant of the tumor
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e podem ver que o médico
tirou o primeiro quadrante do tumor
tirou o primeiro quadrante do tumor
09:57
and you see that first quadrant
is now missing.
is now missing.
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e agora falta o primeiro quadrante.
O médico tirou
o segundo quadrante, o terceiro,
o segundo quadrante, o terceiro,
09:59
The doctor then took
the second quadrant, the third,
the second quadrant, the third,
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e agora parece estar tudo.
10:01
and now it appears to be everything.
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Nessa altura, o médico disse:
"Acabei. O que querem que faça?
"Acabei. O que querem que faça?
10:03
And so at this stage,
the doctor came back to us and said,
the doctor came back to us and said,
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10:06
"Alright, I'm done.
What do you want me to do?
What do you want me to do?
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10:08
Should I keep things as they are
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"Deixo como está,
ou querem que retire uma margem"?
ou querem que retire uma margem"?
10:10
or do you want me to take
some extra margins around?"
some extra margins around?"
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Dissemos-lhe: "Espere,
não extraiu estes dois pontos.
não extraiu estes dois pontos.
10:12
And then we said, "Well, hang on."
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10:14
We told the doctor,
"You've missed those two spots,
"You've missed those two spots,
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"Em vez de retirar uma margem grande,
extraia só estas pequeninas.
extraia só estas pequeninas.
10:16
so rather than taking huge margins around,
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10:18
only take out those tiny little areas.
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"Extraia-as e depois vemos".
10:20
Take them out,
and then let's take a look."
and then let's take a look."
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2016
O médico extraiu-as e, pasme-se,
10:22
And so the doctor took them away,
and lo and behold,
and lo and behold,
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10:25
the cancer is now completely gone.
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2016
o cancro desapareceu por completo.
10:27
Now, the important thing
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O que é importante,
10:29
is that it's not just
that the cancer is completely gone
that the cancer is completely gone
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não é só o cancro ter desaparecido
do cérebro desta pessoa,
do cérebro desta pessoa,
10:31
from this person's brain,
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10:33
or from this mouse's brain.
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ou do cérebro deste rato.
10:35
The most important thing
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A coisa mais importante
foi que não removemos
foi que não removemos
10:36
is that we did not have to take
huge amounts of healthy brain
huge amounts of healthy brain
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grandes quantidades de tecido saudável
neste processo.
neste processo.
10:39
in the process.
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10:40
And so now we can actually imagine a world
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Agora podemos imaginar um mundo
10:42
where doctors and surgeons,
as they take away a tumor,
as they take away a tumor,
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onde médicos e cirurgiões,
ao remover um tumor,
ao remover um tumor,
10:46
they actually know what to take out,
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sabem o que devem retirar,
não precisam de adivinhar com o polegar.
não precisam de adivinhar com o polegar.
10:48
and they no longer
have to guess with their thumb.
have to guess with their thumb.
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10:51
Now, here's why it's extremely important
to take those tiny little leftover tumors.
to take those tiny little leftover tumors.
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É muito importante extrair
aqueles pequenos tumores restantes.
aqueles pequenos tumores restantes.
10:55
Those leftover tumors,
even if it's just a handful of cells,
even if it's just a handful of cells,
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Aqueles tumores restantes,
sendo só um punhado de células,
sendo só um punhado de células,
10:58
they will grow to recur the tumor,
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vão crescer,
e fazer reincidir o tumor.
e fazer reincidir o tumor.
11:01
for the tumor to come back.
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11:03
In fact, the reason why 80 to 90 percent
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80 a 90 % das operações
11:05
of those brain cancer surgeries
ultimately fail
ultimately fail
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a tumores cerebrais não têm sucesso
11:07
is because of those small little
extra margins that were left positive,
extra margins that were left positive,
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devido às camadas marginais
deixadas ainda positivas,
deixadas ainda positivas,
11:11
those small little leftover tumors
that were left there.
that were left there.
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os tumores minúsculos
deixados para trás.
deixados para trás.
11:15
So this is clearly very nice,
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Isto é claramente muito bom,
11:17
but what I really want to share with you
is where I think we're heading from here.
is where I think we're heading from here.
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mas o que quero partilhar
é a minha visão do caminho futuro.
é a minha visão do caminho futuro.
11:21
And so in my lab at Stanford,
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No meu laboratório em Stanford,
11:23
my students and I are asking,
what should we be working on now?
what should we be working on now?
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estamos a questionar-nos:
"Em que devíamos trabalhar agora?"
"Em que devíamos trabalhar agora?"
11:29
And I think where
medical imaging is heading to
medical imaging is heading to
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E penso que o futuro da imagiologia médica
11:32
is the ability to look into the human body
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está na capacidade de ver o interior
do corpo humano, cada célula.
do corpo humano, cada célula.
11:34
and actually see each and every one
of these cells separately.
of these cells separately.
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11:39
The ability like this would allow us
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A capacidade de fazê-lo
11:40
to actually pick up tumors
way, way earlier in the process,
way, way earlier in the process,
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permite detetar tumores muito mais cedo,
11:43
way before it's 100 million cells inside,
so we can actually do something about it.
so we can actually do something about it.
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antes de terem 100 milhões de células,
e podemos agir.
e podemos agir.
11:48
An ability to see each and every one
of the cells might also allow us
of the cells might also allow us
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A capacidade de ver cada célula,
poderá permitir perguntas perspicazes.
poderá permitir perguntas perspicazes.
11:51
to ask insightful questions.
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11:53
So in the lab,
we are now getting to a point
we are now getting to a point
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Estamos a chegar ao ponto de conseguir
fazer perguntas às células cancerígenas,
fazer perguntas às células cancerígenas,
11:55
where we can actually start asking
these cancer cells real questions,
these cancer cells real questions,
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11:58
like, for example, are you responding
to the treatment we are giving you or not?
to the treatment we are giving you or not?
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como, por exemplo: "Estás a
responder ao tratamento ou não?"
responder ao tratamento ou não?"
Se não respondem, podemos interromper
logo o tratamento,
logo o tratamento,
12:02
So if you're not responding, we'll know
to stop the treatment right away,
to stop the treatment right away,
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numa questão de dias,
em vez de três meses.
em vez de três meses.
12:05
days into the treatment, not three months.
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12:08
And so also for patients like Ehud
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E também para doentes como o Ehud,
12:10
that are going through these
nasty, nasty chemotherapy drugs,
nasty, nasty chemotherapy drugs,
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submetidos a quimioterapias
extremamente desagradáveis,
extremamente desagradáveis,
12:15
for them not to suffer
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para que não sofram
com os horríveis efeitos secundários,
com os horríveis efeitos secundários,
12:16
through those horrendous
side effects of the drugs
side effects of the drugs
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12:19
when the drugs are
in fact not even helping them.
in fact not even helping them.
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quando as substâncias não estão a ajudar.
12:22
So to be frank here,
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Para ser franco,
12:24
we're pretty far away
from winning the war against cancer,
from winning the war against cancer,
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estamos bastante longe
de ganhar a "guerra" contra o cancro,
de ganhar a "guerra" contra o cancro,
12:28
just to be realistic.
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só para ser realista.
12:29
But at least I am hopeful
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Mas, tenho a esperança de que
poderemos combater nesta guerra
poderemos combater nesta guerra
12:31
that we should be able to fight this war
with better medical imaging techniques
with better medical imaging techniques
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com melhor imagiologia médica,
e sem estarmos vendados.
e sem estarmos vendados.
12:35
in the way that is not blind.
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12:37
Thank you.
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Obrigado.
12:38
(Applause)
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(Aplausos)
ABOUT THE SPEAKER
Adam de la Zerda - Biologist, electrical engineerAdam de la Zerda develops new medical imaging technologies to detect and destroy cancer.
Why you should listen
Adam de la Zerda is an assistant professor at the Departments of Structural Biology and Electrical Engineering (courtesy) at Stanford University – School of Medicine. He completed his undergraduate degree in computer engineering and physics from the Technion – Israel Institute of Technology in 2005 Summa Cum Laude. He received his Ph.D. in Electrical Engineering from Stanford University in 2011, where he developed the Photoacoustic Molecular Imaging technique with Sanjiv Sam Gambhir. He was then a postdoctoral fellow at the lab of Carolyn Bertozzi at UC Berkeley – Chemistry Department, before joining the Stanford faculty in 2012.
de la Zerda's research interests span the broad field of molecular imaging. His lab focuses on developing new optical imaging instrumentation and chemistry tools to study the complex spatiotemporal behavior of biomolecules in living subjects. The lab uses animal models for cancer and ophthalmic diseases such as age-related macular degeneration. His research efforts span both basic science and clinically translatable work.
de la Zerda has received many awards and honors for his work, including the Pew-Stewart Scholar for Cancer Research, the AFOSR Young Investigator Award, Baxter Faculty Scholar Award, Dale F. Frey Award, Forbes Magazine 30 Under 30 in Science and Healthcare for 2012 and 2014, NIH Director’s Early Independence Award, Damon Runyon Cancer Research Foundation Postdoctoral Fellowship, Era of Hope Distinguished Predoctoral Poster Award, Best Poster Presentation at SPIE Photonics West, the Young Investigator Award at the World Molecular Imaging Congress, the Department of Defense Breast Cancer Research Program Award for Predoctoral researchers, the Bio-X Graduate Student Fellowship and first place at the Bay Area Entrepreneurship Contest. He has published papers in leading journals including Nature Medicine, Nature Nanotechnology and PNAS. He holds a number of patents and is the founder of a medical device company, Click Diagnostics.
Adam de la Zerda | Speaker | TED.com