Because obviously, you and I can take so much of this for granted.

因為很顯然，你我都會認為這一切是理所當然的。

But let's start with some basics about cancer.

不過，讓我們先來了解一下癌症的基本知識。

How does one define cancer?

如何定義癌症？

What separates a cancer cell from a non-cancer cell?

是什麼將癌細胞與非癌細胞區分開來？

Well, if you look at the broadest properties, there are two properties that separate cancer from other cells in the body.

那麼，如果從最廣泛的特性來看，有兩種特性可以將癌症與人體內的其他細胞區分開來。

The first is uncontrolled growth.

首先是增長失控。

Virtually all of the tissues we have, be it fingernails or eyebrows or you name it, they'll grow to a given amount.

實際上，我們擁有的所有組織，無論是指甲還是眉毛，都會生長到一定數量。

And then they'll stop.

然後他們就會停下來。

Well, cancers don't have that signal to stop.

癌症患者沒有停止的信號。

They'll keep growing.

他們會繼續成長。

And the second is it's the only cell that can arise in one part of the body and spread and live and divide and grow in another part of the body.

其次，它是唯一一種可以在身體的一個部位出現，並在身體的另一個部位擴散、存活、分裂和生長的細胞。

And that's not true of virtually any other kind of cell.

而幾乎所有其他種類的細胞都不是這樣。

So cells with uncontrolled growth that can spread and grow elsewhere are the biologic properties.

是以，細胞不受控制地生長，可以擴散到其他地方生長，這就是生物特性。

Now, we can dig down layer by layer by layer and get to the point of, well, why does a normal cell ultimately become a cancer cell?

現在，我們可以一層一層地往下挖掘，最終找到一個問題：為什麼正常細胞最終會變成癌細胞？

And we now understand that that's due to the accumulation of mutations in DNA of these cells divide, which explains why it's the common organs of the body, all of which have ducts.

我們現在明白，這是因為這些細胞分裂時 DNA 變異積累所致，這也解釋了為什麼人體的常見器官都有導管。

The lining of those ducts are constantly turning over.

這些管道的內壁不斷翻轉。

And as that DNA is turning over, mistakes are made called mutations.

在 DNA 翻轉的過程中，會出現被稱為突變的錯誤。

And it's that accumulation of mutations that results in the cancer itself.

正是這種突變的積累導致了癌症本身。

So we can take it all the way from the biology of uncontrolled growth, but down to the very molecules that are involved.

是以，我們可以從失控生長的生物學角度出發，深入到相關的分子。

We can describe it.

我們可以描述一下。

It doesn't mean we really understand it all, but we can describe it.

這並不意味著我們真的理解了一切，但我們可以描述它。

And let's also explain to people the difference between the epithelial tumors, the hematologic tumors, and even let's frame it as it was in 1974 in terms of what was a person's odds of surviving.

我們還要向人們解釋上皮腫瘤和血液腫瘤之間的區別，甚至讓我們按照 1974 年的標準來衡量一個人的存活機率。

So maybe tell folks what the common epithelial tumors are and explain a little bit about the, we're not going to go into staging in great detail, but what's the difference between local tumor versus metastatic tumor?

那麼，也許可以告訴大家常見的上皮腫瘤有哪些，並解釋一下分期，我們不會詳細討論分期，但局部腫瘤與轉移性腫瘤之間有什麼區別？

And what's the impact that has on a person's survival at the time you arrived at NCI?

在你來到NCI的時候，這對一個人的生存有什麼影響？

So the hematologic cancers, of course, are the blood cancers, and they start from progenitors in the hematopoietic system.

是以，血液系統癌症當然就是血癌，它們都是從造血系統中的祖細胞開始的。

Because after all, the hematopoietic system starts from an individual stem cell that then divides into multiple different characteristics, much as we all grow from a single fertilized egg from one cell that makes us what we are.

因為造血系統畢竟是從一個單獨的幹細胞開始，然後分裂成多種不同特性的細胞，就像我們都是從一個受精卵中生長出來的一個細胞，而正是這個細胞造就了我們。

So even back then, and a little more so now, if you developed a cancer of the bloodstream, which were about 10% of all cancer deaths are due to those, 90% of cancer deaths are due to the epithelial cancers.

是以，即使在當時，現在也是如此，如果你患上了血癌，大約有 10%的癌症死亡是由於血癌，90%的癌症死亡是由於上皮癌。

So these start in the solid organs of the body, and that's all the way from the rectum up through the GI tract, through the stomach, through the esophagus, the pancreas, the GU organs, the testis, the ovary, the prostate.

是以，這些都是從人體的實體器官開始的，從直腸一直到消化道、胃、食道、胰腺、GU 器官、睪丸、卵巢、前列腺。

All of these solid organs have ducts.

所有這些實體器官都有導管。

And as I've mentioned, it's the epithelial lining of the ducts that are turning over that become the cancer.

正如我所提到的，是導管的上皮內膜發生了變化，從而引發癌症。

In blood cancers, it's the more primordial cells that develop into neutrophils and lymphocytes and other types of cells.

在血癌中，更原始的細胞會發展成中性粒細胞、淋巴細胞和其他類型的細胞。

So let's talk about the solid tumors, which are 90% of all cancer deaths.

讓我們來談談實體瘤，它佔所有癌症死亡的 90%。

Last year in the United States, there were about 600,000 deaths due to cancer. 550,000 were due to the solid epithelial cancers.

去年，美國約有 60 萬人死於癌症。其中 55 萬人死於實體上皮癌。

If you operate on a patient who develops a cancer, to remove that cancer, then well over half the time, that patient will be cured.

如果你為一名罹患癌症的病人做手術，切除癌症，那麼一半以上的時間裡，這名病人都會痊癒。

That is, go on and live their normal lifespan.

也就是說，繼續過著正常的生活。

But the half, the little less than half of patients that cannot be cured result in this enormous tragedy of 600,000 innocent people dying of cancer every year.

但這一半，不到一半的病人無法治癒，導致每年有 60 萬人無辜死於癌症的巨大悲劇。

Once the cancer spreads, however, and this in my view is the dirty little secret of oncology.

然而，一旦癌症擴散，這在我看來就是腫瘤學中骯髒的小祕密。

And that is that if a cancer spreads from its local site and cannot be surgically removed, then the death rate in that patient is 100%.

這就是，如果癌症從局部擴散，無法通過手術切除，那麼病人的死亡率就是 100%。

That is, we have virtually no treatments that can cure, systemic treatments that can cure a patient with a metastatic solid cancer, that is one that is spread to a different site that can't be surgically resected.

也就是說，我們幾乎沒有任何治療方法可以治癒轉移性實體癌，即擴散到不同部位且無法手術切除的癌症。

Now there are a couple of exceptions to that.

但也有幾個例外。

There are two solid tumor exceptions that have existed for several decades.

有兩種實體瘤例外，它們已經存在了幾十年。

One is choriocarcinoma.

一種是絨毛膜癌。

These are cancers that start in the placenta of pregnant women that then spread and you can have 90% of the lung replaced by that tumor, receive methotrexate, a chemotherapy drug, and it will all disappear.

這些癌症始於孕婦的胎盤，然後擴散，你可以讓 90% 的肺部被腫瘤取代，接受甲氨蝶呤（一種化療藥物）治療，腫瘤就會全部消失。

Still don't understand exactly how.

還是不明白到底是怎麼做到的。

Germ cell tumors in the male, tumors of the testis like Lance Armstrong who had brain mets and lung mets, no matter how much they've spread, if you give patients platinum-derived chemotherapy regimens, you can cause complete durable regression of that metastatic disease.

男性生殖細胞腫瘤、睪丸腫瘤，如蘭斯-阿姆斯特朗（Lance Armstrong）的腦轉移瘤和肺轉移瘤，無論擴散到什麼程度，只要給患者使用鉑類化療方案，就能使轉移性疾病完全持久地消退。

Up until 1985, those were the only cancers that could be cured.

直到 1985 年，只有這些癌症可以治癒。

We can now add to that list solid cancers.

現在，我們可以在這個名單上再加上固體癌症。

We can now add to that list melanoma and renal cancer because interleukin-2 administered to patients back in the mid-80s caused complete regressions of widely metastatic cancer in patients that are still alive today.

現在，我們可以把黑色素瘤和腎癌也列入這個名單，因為早在上世紀 80 年代中期，白細胞介素-2 就曾給病人注射，導致廣泛轉移的癌症完全消退，這些病人至今仍然健在。

But that's it.

但僅此而已。

Choriocarcinoma, germ cell tumors, melanoma, renal cancer.

絨毛膜癌、生殖細胞瘤、黑色素瘤、腎癌。

Other than those four, everyone who develops a spread cancer will die of it despite all the best treatments that we have.

除了這四種癌症之外，所有患上擴散性癌症的人都會死於癌症，儘管我們有最好的治療方法。

We read in the paper that this celebrity has cancer and they're gonna fight it and they're gonna beat it, but nobody beats it.

我們在報紙上看到，某某名人得了癌症，他們要與癌症抗爭，他們要戰勝它，但沒人能戰勝它。

We're in such desperate need of better treatments for patients with metastatic cancers because we just, we can beat them back a little bit, we can improve survival by months, and for some cancers, maybe a few years, like breast cancer and colon cancer, but everybody ultimately will succumb to the disease.

我們亟需為轉移性癌症患者提供更好的治療方法，因為我們可以將他們打回原形，我們可以提高几個月的生存率，對於某些癌症來說，也許可以提高几年的生存率，比如乳腺癌和結腸癌，但每個人最終都會死於這種疾病。