Understanding Cancer: Origins and Impact

What’s cancer got to do with crabs, artist Jackson Pollock, and artificial intelligence? It’s not a riddle; these are some of the things we’ll explore with surgeon Grant Stewart, computer scientist Mateja Jamnik and radiologist Evis Sala from the Mark Foundation Institute for Integrated Cancer Medicine.

In this episode, we’ll discover how artificial intelligence is making it easier for doctors to diagnose and treat cancer and we’ll share some cancer facts that are both amazing and disturbing. We also learn about the WIRE clinical trial for kidney cancer. WIRE evaluates the effectiveness of giving a short course of drug treatment to patients in the one-month “window of opportunity” between diagnosis and surgery. Patients on the WIRE trial also undergo a suite of new imaging techniques that have been brought together for the first time globally in this clinical trial.

This episode was produced by Nick Saffell, James Dolan, Naomi Clements-Brod and Annie Thwaite. 

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Timestamps: 

[00:00] - Introductions

[01:15] - A bit about the guests’ research

[02:45] - The origins of cancer.  Why Hippocrates is known as the father of medicine. 

[04:00] - How cancer starts 

[05:05] - How many types of cancer are there? What are the most common types of cancer? 

[06:10] - How do cancers develop? The lifecycle of cancer. 

[09:00] - How early in the lifecycle can we see or detect cancer? What size does the cancer cell need to be for us to see it?

[10:15] - What improved machines and AI help with detection and characterisation? 

[11:00] - Can we turn imaging into a virtual biopsy?

[12:20] - Defining Artificial Integiilence (AI) 

[14:20] - AI and machine learning and how they interlink. 

[15:10] - Deep learning and statistical learning. 

[16:10] - Origins of AI in medicine and healthcare. 

[17:15] - Intro to AI and cancer imagery 

[18:30] - How the AI algorithm assists the radiologist

[20:10] - AI and prepared models. How the data is trained to understand what cancer looks like. 

[21:20] - The importance of sharing the data set. 

[22:00] - Time for a recap!

[28:40] - Ai and surgical robots

[29:30] - AI and screening kidney cancer. Grant’s and Evis’s work using models, imagery, automation to screen for kidney cancer  

[31:50] - Explaining the types of imaging in oncology  

[33:10] - How Evis uses AI in her imagery 

[34:10] - How to scan for ovarian cancer 

[35:20] - Comparing images of tumours to paintings. Comparing Jackson to a Mark Rothko painting. Homogeneous or heterogeneous 

[37:40] - Describing what the images actually look like from a non-radiologist perspective. Grades of grey. What CT scans and MRI scans look like. 

[41:10] - How AI is used throughout the imagery process, not just for clarification. 

[42:30] - Comparing the AI in oncology imagery to an Instagram filter. Do we lose any information when we use AI?

[43:15] - Time for another recap! 

[48:15] - How do we create and ensure a high quality of data in a healthcare context? 

[50:50] - Is there any governance for introducing AI into clinical practice. GDPR and how it impacts AI decisions around the care of a human being. A huge area of research around explainability.  

[53:20] - The typical process (modality of data) What Evis, Grant and Matejia are doing with Integrated Cancer Medicine. The techniques 

[56:30] - The time has come for integrated care and shared streams of data. Increase the involvement of the patient in their care. 

[58:15] - Grant explains the WIRE trial (WIndow-of-opportunity clinical trial platform for evaluation of novel treatment strategies in renal cell cancer). 

[1:02:40] - Is it possible to do a holistic analysis? The goal of AI is to help clinicians with personalised medicine. 

[1:03:20] - Why it is so important for patients to be involved in oncology AI-based studies.  

[1:04:10] - Let's break this episode down and close this thing out.

Guests

Professor Mateja Jamnik 

Professor of Artificial Intelligence in the Department of Computer Science and Technology (Computer Laboratory) at the University of Cambridge, UK. I am also an associate fellow at the Leverhulme Centre for the Future of Intelligence. Recently I served as Specialist Adviser to the House of Lords Select Committee on Artificial Intelligence. I founded the women@CL initiative.

I am interested in human intuitive reasoning and want to make computers think intuitively too. I build computational models that capture human informal reasoning - I am essentially trying to humanise computer thinking. I combine AI reasoning with machine learning techniques, and apply them to personalise medicine and tutoring systems.

Broadly, my research is in the areas of artificial intelligence, human-like computation, machine learning, automated reasoning, diagrammatic reasoning, knowledge representation, theorem proving, cognitive science, human-computer interaction.

Professor Evis Sala @EvisSala 

Dr Sala is an academic radiologist with a special interest in Cancer Imaging. She is the Professor of Oncological Imaging at the University of Cambridge, UK. She leads the Radiogenomics and Quantitative Imaging Group in the Department of Radiology.  Her current research focuses on integrated diagnostics, through the clinical development and validation of functional imaging biomarkers to rapidly evaluate treatment response using physiologic and metabolic tumour habitat imaging. Her research in the new field of “radio genomics” has focused on understanding the molecular basis of cancer by demonstrating the phenotypic patterns which occur as a result of multiple genetic alterations that interact with the tumour microenvironment to drive the disease in several tumours types. Her work integrates quantitative imaging methods for evaluation of spatial and temporal tumour heterogeneity with genomics, proteomics and metabolomics. She is also working on development and clinical translation of several novel PET tracers.

Professor Grant Stewart  @grantissimus 

As Professor Surgical Oncology, Professor Stewart aims to leverage the strengths of academic surgical oncology (clinical surgery, trials and biosampling/translational research) to enhance the cure rate following surgical treatment of cancer. He has a specific interest in optimising management of patients with initially localised renal cancer, an area of great need within the disease. Clinically, Professor Stewart undertakes a full range of treatments for renal cancer at Addenbrooke’s Hospital, from robotic partial nephrectomy for small renal cancers to multi-speciality surgery for locally advanced disease. In order to make practice changing developments in this area, Professor Stewart has developed a range of interlinked clinical trials and translational research, which are all underpinned by clinical excellence in managing renal cancer at Addenbrooke’s Hospital, Cambridge. To deliver on the above goals, he coordinates the Cambridge Renal Cancer Collaboration (CamRenCan) a group of over 40 clinicians, translational researchers and basic scientists across the Cambridge Biomedical Campus with a shared interest in renal cancer research. His research is focused on the key clinical questions in initially localised RCC, namely: early detection/screening, early diagnosis approaches, optimal follow-up strategies, neoadjuvant and adjuvant therapies.