The Cancer Episode

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2:07Hey and welcome to the podcast. I'm Josh and there's Chuck and Jerry's here too. And this is a little fashion 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. Yeah, pretty clumpy. Thanks. Nice. You did well then. Did you already know a lot about cancer before 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, uh, 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. My, 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.

3:07Yeah. 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, uh, I mean, not to spoil anything, but I did see that only five to 10% of all cancer cases could be attributed to genetic defects. Yeah, I saw something like that too. So that, 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, um, they give you a little American flag to hold in your casket when you die of heart disease. Yeah. But, uh, you know, 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, uh, 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.

4:09That's right. Uh, and I think 40% 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 fun away to get a little humor in here. Um, so let me, 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. It's, it, 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. Yeah. 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.

5:10And 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, and you know, kills so many people is because it comes from your own body. It's not like a foreign invader. It's 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 with it, handle that stuff and get rid of it. But if you, 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. And Yumi's brother, her older brother, Bobby has aged four cancer right now. And he's been hanging in there for a really long time.

6:11He's been living his best life and everything. But you know, it's, it's just kind of as constant in our lives. Yeah, for sure. Yeah. So if five to ten percent are attributed to genetic defects, then the other 90 to 95 percent 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 scared to think about. Yeah. Obesity. But then, you know, 15 to whatever, 20 percent 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 like super, super sad. It's all sad. But, you know, the stuff that like you have no control over, but you live near a thing.

7:11That's just super scary. Yeah. Yeah. For sure. That UV 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. With 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 1100 in the UK.

8:19And just 450 in Australia. And we're 96 in Canada. I saw it too 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. Yeah. Yeah. Uh-huh. 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 most responsible for deaths from cancer. It's really prevalent because smoking was really prevalent and still is. Mm-hmm. And like you can talk the vast majority of cancer deaths every year up to smoking. Like people who smoked make up the vast majority of people who die from lung cancer.

9:21And in the US, it's like 130,000 people every year. And something like 100,000 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 secondhand 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% 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.

10:25Because 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% in the US over the past 20 years. That's amazing. Right. And the five year survival rate, which as we'll see is pretty much for most cancers synonymous with cured, like your turtle cancer. That's that past 70% 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%. Thyroid is really up there 98% prostate 96% testicular cancer at 95% in skin cancer at almost 94%.

11:29So those are really, really encouraging numbers. It's one of the scariest words I imagine you can hear from a doctor. But you know, 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, you know, stage 4. And metastasized. Right. And 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 4, 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 because I just turned 50. Oh, good. I'm now eligible for a lung CT because I smoked when I was younger and now I'm 50.

12:32So cross your fingers because I don't want cancer. I want you to have cancer either, buddy. Thanks, man. That's like maybe the nicest thing you've ever seen. Well, you know, 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. You know, Emily smoked for a long time too. So she's 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. So I think one out of every six deaths globally every year or from cancer. And it's 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. Yeah. That's a huge preventative for a whole suite of cancers.

13:34And in the United States, it's very prevalent and it can save your sexual partner's life years down the road. And like they don't necessarily have access to that. And by the way, HPV hepatitis, other viruses that can cause cancer are called onco viruses 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.

14:34And when it gets to the, and it's pretty miraculous when you think of just normal cell life. Like how, 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-flop. 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 sell accumulate into a tumor that crowds out the healthy cells and keeps them from doing their things.

15:35So if it's liver cancer, your liver can't filter enough stuff out anymore. And that you die from organ or systemic failure because 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 going to 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 going to be suspension for us. P53 is the one that basically is like the switch that tells us, like, hey, it's, we've 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.

16:39So 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 sudden once and all of a sudden you have cancers, just not how it works. Yeah, 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, 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, like a boxing manager and like, you know, smex your face and wants to see if you, if they need to throw in the towel.

17:49Yeah. And if you have too many genetic mutations, it's going to throw in the towel for you and you're going to have to undergo a poptosis. That's right. You know, we talked about tumors, we're going to 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? Telemerase? Yeah. Okay. And that keeps the telomeres 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.

18:50And 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.

19:52It's like, hey, here's 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. Yeah. It's just crazy what cancer is. Yeah, for sure. All right, I think maybe we should take a break.

20:55Yeah, I'm starting 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. This message comes from Apple business. Now you can control how your business shows up across Apple apps and with ads on maps, you now have a new way to show up to an even wider audience of potential customers available in the US and Canada. Cleaning starts with one small task and suddenly it's the whole house. Luckily, there's AirTasker. Post your task, set your budget and choose a tasker to help from carpet cleaning to finally tackling the junk door. Go to airtasker.com or download the app. AirTasker, get anything done. Hey everybody, YouTube Premium takes something you already love, YouTube, and makes it even better. The content, the creators, the feeling of finding exactly what you're into for every mood and moment of your day.

21:58Like for example, let's say you want to learn to cook, but you don't have time to go take cooking classes across town. Well, you can find tons of instructional cooking videos all without ads on YouTube Premium. That's right, Premium transforms that experience into a more supercharged, enhanced way to enjoy YouTube. A YouTube Premium subscription gives you access to exclusive YouTube features and benefits, including but not limited to add free. So we're talking about uninterrupted videos, background play, so background play lets you keep listening with your screen locked and offline downloads. You can download your videos to watch anywhere, even without Wi-Fi connection. That's pretty awesome. And smart downloads automatically downloads videos by your favorite creators. So even if you forget to download it ahead of time, Premium has you covered. If you like YouTube, you'll love Premium. Sign up now for your free trial, terms and conditions apply. 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.

23:16Because 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 can get cancer 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. So let's 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 can just overwhelm the immune system as we get older because our immune system declines, which is one of the joys of aging. That's right. Limfoma 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.

24:17So a lymphoma can start almost anywhere. 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 cancerous cells from your body is waste. That's definitely a cruel one. And 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 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.

25:24But, you know, I have known people who have had brain tumors who are doing just fine. 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, yeah, 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. And then there's just 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.

26:26Chuck, 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. In 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. Yeah, it's our favorite kind of cancer as far as cancers go. This is the one we're behind for sure. We're not afraid to say it for sure. It even looks pretty. It's got that nice round. Oh, in the middle.

27:34Yeah, 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 to contain to one area has not spread to the lymph nodes or other areas, which is basically where you get to in stage two is the tumor is going to 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 not like it's kind of invisible. The tumor is 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 spreads once it metastasizes what it's called you have entered stage four.

28:38That's right. That means it's definitely spread outside its original place, probably to other organs or anywhere in your body really. And that is metastatic cancer. You now 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. And then words like remission and cure also used remission is where the cancer is it basically describes how the cancer is responding to the treatment right if the the cancers on its heels and it's shrinking and it's doing all it's 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 cure that's like a whole different term. Yeah, I mean, cure is a sort of a dicey word when it comes to cancer. That's basically complete remission meaning there's no evidence of the disease.

29:44And even though there may be a risk of reoccurrence if you're 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, well, wait if you want to get in touch with them. No, but we'll we'll hear from doctors. I'm sure. Yeah, I hope so. In patients. I'm looking forward to to getting emails from all kinds of people on this for sure. So the history is, you know, we're not going to 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.

30:45And then there was a Dutch scientist, the father of anatomy, Andreas, Vezaleus, who finally said, you know what, I've looked at a lot of dead bodies, even stolen 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 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, 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. Yeah. 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.

31:58And that just getting rid of the tumor wasn't enough because it left too much of the cancerous cells to reproliferate 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.

32:58He was like, I'm going to try to use those to treat cancer and he was successful. He treated 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. Kima therapy and intersacine. 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 sometimes 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 chemo therapy, his name is Sydney Farber. He, the Dana Farber Cancer Institute is named after him. And it is world renowned.

34:01And 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, ammonopterin, 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, it wipes out so much stuff that is 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.

35:01Yeah, and a lot better to take thanks to some 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. Summer me, let's host people outside more reality. The patio furniture is still in the box. The AC just started making a weird noise and the pool flamingo still needs to be inflated. So I open airtasker, post the task, set my budget and pick a tasker to help. Suddenly, the furniture is assembled, the AC is fixed, and the flamingo is floating. Which means I am too. Go to airtasker.com or download the app.

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38:08Wi-Fir every style, every home. 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. Yeah, I used to wonder that too. Absolutely not. I mean, I think Imhotep described it 4700 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.

39:09Yeah, for sure. And the reason that we haven't developed like a complete cure all for cancer is because no two cancers are the same. They all develop in different ways. And 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 kind of 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.

40:09And now you're in full remission. Hopefully forever. Yeah, if you don't have a tumor, like you said earlier, it's like a cancer of the blood, 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 could 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 there's serotonin antagonists, which is a new class of anti nausea drugs really can help block block the nausea receptors in the brain.

41:10And I know, you know, just from like family and stuff that that's 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 what a horrible thing going into get chemotherapy knowing that you're going to get horribly nauseated for a while. It's kind of the dread has to be really serious, you know. Yeah, I mean, one of one of our friends like 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 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 that 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.

42:11So yeah, surgery is a big part of it. If it's a tumor, obviously, if it's a cancer, the blood, there's no tumor, they're not doing that like you said, but you promise 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 Chuck. 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, it's good metaphor. Thanks, man. I've been working on it for a couple of weeks now.

43:13So 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 you want in it and the virus is 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.

44:20So now you put the T cells back in you after you 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 to be used. I mean, it's just like a receptor 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, That's the one that says like, hey, we've done our job. It's time to self-destruct. And that's when cancer cells don't have. So some gene therapy techniques include turning on that P53 protein and 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

45:20immune cells. And then I saw another one where they can make the cancer cell mature finally. And so they 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? Your cells are genetics in other words. Pretty much. Wow, that's incredible. I didn't know about that one. They also have on the horizon personalized cancer vaccines. That's a new treatment designed to basically prime your immune system to target cancer cells to reduce recurrence risk. And obviously, hopefully, fewer side effects than something like chemotherapy. Yeah, 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

46:22keep 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 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'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 we're on right now. It's very hopeful. Yeah, for sure. You know, we do have done a lot of AI pooping on the show, but one of the great benefits of AI is that it's already kind of stepped up in cancer treatment and sort of cancer

47:24diagnoses that it seems like, like maybe having along with the human radiologists, having AI looking at radiology scans to detect tumors that maybe a radiologist doesn't notice, maybe also to help predict a risk. Right. 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. Yeah. 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 use in the West, that's why cancer rates are going down. And 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

48:292023. So in just over 25 years, almost, well, almost 100% increase. I'm just going to say 77% is close enough to 100% when 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, 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 or your mind really on the systems of the body. You know, 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 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.

49:32And 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 definitely have 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 prime in people is, it's definitely being investigated now. And it does seem to be a thing for sure. Yeah. 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, okay, I'm accepting

50:36my 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 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. 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 death. 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 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.

51:38And I mean, that's super valid. For sure. And if you know someone in your life that is accepted, that it's time for them, like, that's when they need like 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 support that decision, you know, because that's a, that's a brave thing to accept. That's got 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 soapbox PSA. That's okay. Yeah, let's do it. So in the United States, mammograms are covered by insurance. There we go. The problem is, is that you very often need a follow up because they're like, this mammogram

52:39is 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's certainly one of them. And also as we mentioned before, with the increased rate of colorectal cancer and younger

53:43adults, make them available to be covered. And you're 30s. You know, there's probably not a lot of 30 year olds that have the gumption to be like, you know what, 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. And 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 bone 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.

54:45I still have that phone book with the markings. And you'll see why. Uh, 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. I think you see where it's headed. We spoke for 30, uh, 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. Uh, together for 39 and in December, our daughter is going to get married. Uh, 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.

55:47That 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 you again for consistently creating such polished elite entertainment. Polished. 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 pics of her and her hud's in 1987, 1993 and one from this year. And it is adorable. He had quite the mustache. I saw that, uh, subject line. I haven't looked at the email yet. So I have to run over and do that. What a great story, man. Yeah. I love it. That was Laura. That was Laura. Thank you, Laura. That was, I don't know. It's a contender for number one, maybe. Yeah. That's right. You and name redacted husband. Yeah. So glad you're still together. Seriously, one of the best ever.

56:48So 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 stuffpodcast.iHeartRadio.com. 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. Moving days going great. Until the couch won't fit through the door. Tilt it. It is tilted. So I post a task on air tasker, set my budget, and choose a local tasker to help. Suddenly, the couch is inside the new place, the TV's melted, and my drone has been retrieved from my neighbor's tree. Big tasks, small tasks, even the weird ones. Go to airtasker.com or download the app. Airtasker. Get anything done.

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