5/14/08 - cancer

In today's excerpt - from Nathan Myhrvold's Intellectual Ventures LLC -- the idea that cancer can be detected long before a tumor is formed. Myhrvold, one of Microsoft's pioneers, brings intellectuals from different disciplines together to brainstorm new ideas -- in this case, physicist Lowell Wood meets with a group of doctors:

" 'Lowell came in looking like the Cheshire Cat', Myhrvold recalled. 'He said 'I have a question for everyone. You have a tumor and the tumor becomes metastatic, and it sheds metastatic cancer cells. How long do those circulate in the bloodstream before they land?' And we all said, 'We don't know. Ten times?' 'No,' he said, 'As many as a million times.' Isn't that amazing? If you had no time, you'd be screwed. But it turns out that these cells are in your blood for as long as a year before they land somewhere. What that says is that you've got a chance to intercept them.'

"How did Wood come to this conclusion? He had run across a stray fact in a recent issue of The New England Journal of Medicine. 'It was an article that talked about, at one point, the number of cancer cells per millilitre of blood,' he said. 'And I looked at that figure and said, 'Something's wrong here. That can't possibly be true.' The number was incredibly high. Too high. It has to be one cell in a hundred litres, not what they were saying -- one cell in a millilitre. Yet, they spoke of it so confidently. I clicked through to the references. It was a commonplace. There really were that many cancer cells.'

"Wood did some arithmetic. He knew that human beings have only about five litres of blood. He knew that the heart pumps close to a hundred millilitres of blood per beat, which means that all of our blood circulates through our bloodstream in a matter of minutes. ... 'It turns out that some small per cent of tumor cells are actually the deadly ones', he went on. 'Tumor stem cells are what really initiate metastases. And isn't it astonishing that they have to turn over at least ten thousand times before they can find a happy home? You naively think it's once or twice or three times. Maybe five times at most. It isn't. In other words, metastatic cancer -- the brand of cancer that kills us -- is an amazingly hard thing to initiate. Which strongly suggests that, if you tip things just a little bit, you essentially turn off the process.'

"That was the idea that Wood presented to the room in St. Louis. From there, the discussion raced ahead. Myhrvold and his inventors had already done a lot of thinking about using tiny optical filters capable of identifying and zapping microscopic particles. They also knew that finding cancer cells in blood is not hard. They're often the wrong size or the wrong shape. So, what if you slid a tiny filter into a blood vessel of a cancer patient? 'You don't have to intercept very much of the blood for it to work', Wood went on. 'Maybe one ten-thousandth of it. The filter could be put in a little tiny vein in the back of the hand, because that's all you need. Or maybe I intercept all of the blood, but then it doesn't have to be a particularly efficient filter.' "


Malcolm Gladwell


'In the Air'


The New Yorker


May 12, 2008


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