BBC.地平线.2022.认识癌症（2022）

没有任何东西 完全空了
and my bowels. It’s completely empty.
盆腔淋巴结也全被清扫了
And all of the pelvic lymph nodes.
我想和有类似经历的人聊聊
I wanted to talk to someone who’s been in this position before.
我第一个想到的是我朋友戴维·施皮格哈尔特
The first person I thought of was my friend David Spiegelhalter.
他曾患前列腺癌
He’s had prostate cancer,
一直致力于医学统计学
and he’s spent a lifetime working in medical statistics.
我有点 怎么说呢
I’m just like, I don’t know,
试着用我一贯的方式处理
trying to tackle it in the same way that I do with everything.
我身边垒着一堆书
I’ve got, like, this massive stack of books next
都是关于我要克服的困难
to me of things that I’m trying to get through.
你觉得 那些数据有用吗
Do you think… I don’t know. Did the numbers help you?
跟其他人一样
I think, like everyone else,
这对情绪的打击是巨大的
it came as a huge emotional hit.
我也深受所有这些情绪的影响
You know, I’m not immune to any of those kind of feelings,
戴维·施皮格哈尔特爵士N统计学家
但我确实尝试
but I suppose I did try to take
以某种数学的角度审视它
a kind of mathematical view to it
并开始调查
and start doing some research on what
我有哪些选择 结果会如何
the options might be and what the outcomes might be.
当然 其中一方面就是
And, you know, one aspect of it, of course,
会有这样一种感觉 “我患了癌症”
is the feeling that, um, “Oh, you know, I’ve got cancer”,
“弄掉它 直接切除”
“let’s get it out, you know, just cut it out.”
而如今我会劝人们
Now I would say to people to
尽量控制 保持冷静
try to keep that under control, just keep calm,
保持冷静 切除或许不是最佳方案
keep calm. That may not be the best policy.
你也需要考虑这些治疗有弊端
You have to think that these treatments have harms attached
长♥期♥短期都有
to them, both short-term and long-term,
弊也许大于利
and the benefits just may not be worth it.
所以有时要怎么
Sometimes you should, what?
克服摆脱它的冲动
Fight the urge to want to get rid of it?
我指的是轻度阶段
I’m talking about the mild case of the disease.
将来会有许多人患癌症
Many more people will be living with cancer in the future.
那你是轻度的吗
Is that what happened in your case, then?
-不考虑做手术吗 -不
– Was not having surgery an option? – No,
考虑到我前列腺癌的严重程度
I was quite strongly recommended to have surgery due to
医生强烈建议我做手术
the particular severity of my prostate cancer.
目前为止 我已经五年没有复发
And, so far, I’m clear five years out,
所以先就这样
so we’ll see, you know…
由此看来 我应该心存感激了
I… In that sense, I’m not going to complain.
跟戴维的案例一样 我的医生明确表示p
Like David’s, my doctors have made it clear that
手术是我唯一选择
surgery is the only option for me.
子♥宫♥切除意味着我再无法生育
The hysterectomy will mean I can’t have another baby,
可是我还想要孩子
which is something I’d hoped for,
但我决定 这个代价我愿意付出
but I decided it was a price I was willing to pay.
这只是第一步
I’m, like, only at the beginning.
希望这只是个小插曲
Hopefully, this is just a little blip,
临时调整
a moment of reset
临时的暂停
and, kind of, a moment of pause.
癌症部还是综合部
The cancer unit or normal?
请开到癌症部 谢谢
Yes, please, the cancer unit, yeah, thank you.
我下一周的家
My home for the next…week.
今天做什么手术
What procedure are you having today?
根治性子♥宫♥切除
A radical hysterectomy.
还挺时髦呢
Well, this, is quite the thing.
医生会切除我的盆腹淋巴结
The surgeons are going to remove my pelvic lymph nodes.
他们担心它们可能有癌细胞
They’re worried there might be cancer in them,
但并不确定
but they’re not sure.
最大的问题
The biggest question
和最大的不确定因素是
and the most difficult uncertainty is whether or not
癌症是否已经转移到淋巴结
the cancer had got into the lymph nodes.
若没有进入淋巴结
If the cancer hadn’t got into the lymph nodes,
那就是一♥期♥癌症
then it was stage one cancer.
一般来说 生存率非常高
Basically, your chances of survival are really good.
大约有百分之九十五 手术有效
About 95%. The surgery works.
情况会非常非常好
You’re in a really, really good position.
但哪怕癌症转入任何一个淋巴
But if it had got into just one lymph node,
你便一下从一♥期♥癌症进入三♥期♥
you jump from stage one cancer straight to stage three cancer.
就非常严重
It becomes very, very serious.
手术观察室
所有进入手术室的人员
一律需在前台进行登记
会诊医师刚才过来
So the consultant just came in.
五小时后
我问他淋巴结有没有发现什么
And I asked him if he saw anything in the lymph nodes.
他说一边有四个
And he said that there was four on one side
有一点点肿大
that were a bit enlarged.
另一边有一个
And one on the other side.
不是好消息 对吧
Not great news, though, is it?
四或五个淋巴肿大
Four or five of them were enlarged,
但也可能只是
and that could be just
身体在对抗感染
your body’s fighting infection,
或者肿大是因为癌变
or they could be enlarged because they’re cancerous.
我来之前读过所有文献
I’d read all of this literature before going in
我知道如果是一个淋巴
and I knew that if it was in one lymph node,
生存率是百分之六十
it was 60% chance of survival,
两个淋巴就直接下降至百分之五十
two lymph nodes it dropped below 50%.
而他说我有四个或五个
And here he was saying four or five
可能癌变
could potentially be cancerous.
我想说…
I mean…
我已经没救了 不是吗
Well, then, you’re a goner, aren’t you, really?
妈咪
Mummy!
六天之后 我回家了
After six days, I’m home,
但我需要等待后续会诊
but I have to wait for a follow-up appointment
确定淋巴结是否有癌变
to find out if there’s cancer in my lymph nodes.
在英国 医生经常推荐
In the UK, doctors often recommend
一种术后治疗
further treatment after surgery,
叫做辅助疗法
called adjuvant therapy.
一般是化学治疗或放射治疗
It’s often chemotherapy or radiotherapy.
有点像保险
It’s a bit like an insurance policy.
尽管癌变部位已经移除
Although the cancer has been removed,
但是复发的可能性仍然存在
there’s a chance it might come back.
这种治疗旨在减少复发风险
The treatment aims to reduce that risk.
我想要理解医生如何
I want to understand how doctors
决定哪些病人应该进行这些额外治疗
decide which patients should have these extra treatments,
尤其是因为它们有副作用
especially as they come with side-effects.
朱迪·金是北伦敦的一位肿瘤学专家
Judy King is a medical oncologist in North London.
我们有许多临床病人
So we have a range of people in clinic,
但我们治疗的大部分人都进行着
but a number of the people that we’ll be seeing are having
名叫辅助化疗的治疗
what’s called adjuvant chemotherapy.
他们都经历过手术
So they’ve had their surgery,
他们或许进行了扫描检查 就目前而言
they may have had scans. And, as far as we can see,
没有癌症 但是如果不接受治疗
there is no cancer. However, we know that, untreated,
那些病人中大部分会患一种病
a number of those patients will have what we call
我们称之为微转移
micro-metastatic disease,
即非常微型的细胞将随处漂离
so there will be tiny cells that will have floated off
朱迪·金医生
肿瘤学会诊医师
到达危险部位
and ended up in the wrong place, which,
如果不检查 可能返回并导致癌症复发
if left unchecked, could come back and cause a cancer recurrence.
这就是我们努力治疗的疾病
And so those are the things that we’re trying to treat.
如何界定”对你有效”
Where do you set that boundary of, “It’s worth it for you,
-“对你无效” -对于乳癌
– “and it’s not worth it for you”? – So, in breast cancer,
可以说我们考虑的问题是
we would say that what we’re looking at is what is,
“今后十年 你彻底摆脱癌症的概率是多少”
“What is the chance of you being cancer-free ten years from now?”
如果化疗将这个存活概率
And if chemotherapy improves your chance
提高百分之五或更多
of being alive by about 5% or more,
那么我们通常就会和病人讨论
then chemotherapy is something that we would usually discuss
-化学疗法 -我确认一下
– with a patient. – Let me make sure I understand that, though,
同样概率 换一种说法就是
because another way to say the same thing is that,
如果一百位女性
if you’ve got 100 women,
所有人都接受化疗
all of them have chemo,
并治疗好其中的五位
and chemo will save the lives of five of them,
就是推荐与否的门槛
that’s the threshold?
是的 这是相对低风险的案例