The Cancer Episode

8:00Josh Clark: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 U.S., about 1 ,100 in the U.K., and just 450 in Australia.

8:15Chuck Bryant:696 in Canada, I saw it too, later.

8:19Josh Clark:Oh, so 450 to 696? It's a range, I guess?

8:22Chuck Bryant:No, no, that's Australia. 696 is Canada's.

8:25Josh Clark:Oh, it's Canada. I thought you said Australia.

8:27Chuck Bryant:Yeah. No, uh-uh.

8:28Josh Clark:And every year about 600 ,000 Americans die of cancer, which accounts for about 17 % of all deaths in the United States, far and away with lung cancer being the leader there.

8:42Chuck Bryant:Yeah. The U.K. has flipped. It's number five in Australia, number three in Canada. But it's definitely up there, right?

8:49Josh Clark:Yeah.

8:50Chuck Bryant:And lung cancer, not just in the U.S., but worldwide, is most responsible for deaths from cancer. It's really prevalent because smoking was really prevalent and still is. And, like, you can chalk the vast majority of cancer deaths every year up to smoking. People who smoked make up the vast majority of people who die from lung cancer. And in the U.S., 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.

9:35Josh Clark: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. Because as you'll see, getting ahead of the game and cancer is the name of the game with beating cancer.

10:24Chuck Bryant: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 U.S. over the past 20 years.

10:45Josh Clark:That's amazing.

10:46Chuck Bryant:Right. And the five-year survival rate, which as we'll see is pretty much for most cancers synonymous with cured, like you're cured of cancer, that passed 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.

11:06Josh Clark:Yeah, breast cancer for sure is one. One of the highest at about 90.5%. Thyroid is really up there, 98%. Prostate, 96%. uh, testicular cancer at 95 % and skin cancer at almost 94%. So those are really, really encouraging numbers. Uh, it's, you know, one of the scariest words I imagine you can hear, um, from a doctor, but, um, you know, if you look at the numbers, uh, unless it's just sort of a, one of those rare worst case scenarios, uh, where you get some kind of news that something is, you know, stage four and metastasized.

11:43Chuck Bryant:Right.

11:43Josh Clark:And, you know, that just, that doesn't happen very often, thankfully.

11:47Chuck Bryant:No, typically pancreatic cancer is pointed to as kind of like the poster child for that.

11:53Josh Clark:Yeah.

11:54Chuck Bryant:And the reason why is because you don't show symptoms until it's metastasized. And that means you're diagnosed typically at stage four, which is last stage cancer, which means that I think it has a five-year survival rate of 11.5 % in the United States. Lung cancers is only 22%. So I'm going to get screened hopefully this month because I just turned 50. Oh, good. Which means I'm now eligible for a lung CT because I smoked when I was younger and now I'm 50. So cross your fingers because I don't want cancer.

12:29Josh Clark:I don't want you to have cancer either, buddy. Thanks, man.

12:32Chuck Bryant:That's like maybe the nicest thing you've ever said.

12:36Josh Clark: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 is always getting tons of screenings for things.

12:59Chuck Bryant:Good. It's smart.

13:01Josh Clark:Yeah.

13:01Chuck Bryant:So I think one out of every six deaths globally every year are from cancer. And 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.

13:22Josh Clark:Yeah.

13:22Chuck Bryant:That's a huge preventative for a whole suite of cancers. Yeah. And 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 oncoviruses, 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 talk about cells.

13:54Josh Clark: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. And when it gets to the end, it's pretty miraculous when you think of just normal cell life, like how kind of wonderful it is to look at.

14:37Josh Clark: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-flopped.

14:49Chuck Bryant:It is. And again, like cancer are just cells 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 the cells accumulate into a tumor that crowds out the healthy cells and keeps them from doing their thing.

15:27Chuck Bryant:So 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.

15:40Josh Clark:So, you know, like we said, it's a genetic mutation that's going on. And some DNA changes are going to, like, 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, is why we can, why wait? It's P53.

16:08Chuck Bryant:That was going to be suspenseful for a second. I know.

16:10Josh Clark:So P53 is the one that basically is like the switch that tells a cell like, hey, 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. So if you have an inherited genetic related change or something, you might need fewer additional changes to develop that cancer.

16:42Chuck Bryant:Yeah, because it's not like when you develop a carcinoma, a 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 sun once and all of a sudden you have cancer. It's 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 off or on, ones that have nothing to do with a cell turning cancerous. Or again, if it does turn cancerous, the body's immune system can come take care of it, right?

17:23Chuck Bryant:And that's why you have to have more than one genetic mutation because a cell is pretty good at repairing itself. And if it's not, P53 comes up like a boxing manager and, like, you know, smacks your face and wants to see if they need to throw in the towel. Yeah. 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 apoptosis.

17:51Josh Clark: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 that they crowd out the healthy ones. And it's all doing this because they express, how would you say that, telomerase? 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 it wears out a little more slowly so that tumor can just keep dividing and growing, basically.

18:34Chuck Bryant: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. And 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.

19:16Chuck Bryant: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.

19:26Josh Clark: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. It'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.

19:54Chuck Bryant: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.

20:32Chuck Bryant:That's insane that like something can evolve and adapt that quickly because we're talking about doing this on the order of like months or a few years, maybe. It's just crazy what cancer is.

20:44Josh Clark:Yeah, for sure. All right. I think maybe we should take a break.

20:48Chuck Bryant:Yeah, I'm starting to get worked up.

20:50Josh Clark:Yeah, that was a good table setting. And we'll come back and talk about types of cancer right after this.

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22:38Josh Clark:That's right, and their slippers are everything you'd want for a cozy night in made with the softest, squishiest materials.

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23:37Josh Clark: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 because 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 know, you can get cancer of almost anything anywhere in the body. Yeah.

24:03Chuck Bryant:And again, I said the most common one is a carcinoma. I think 85 % of all cancers are carcinomas, and those start with epithelial tissue or cells, which are like the outside layer of your organs. They 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, it turns out.

24:36Josh Clark:That's right. Lymphoma 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. So a lymphoma can start almost anywhere. Yeah. 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 subtypes of lymphoma. And, you know, there is some irony here for sure because the lymph system clears out cancerous cells from your body as waste. So that's definitely a cruel one.

25:16Chuck Bryant: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.

25:44Josh Clark:Yeah. Brain and spinal cord cancer is probably one of the scariest kinds when you just sort of hear those words, like brain tumor. But, you know, I have known people who have had brain tumors who are doing just fine.

25:59Chuck Bryant:Yeah.

25:59Josh Clark: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 %?

26:10Chuck Bryant: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 niche because it's a magnet for some types of cancer cells that go to the bone marrow and just set up shop there. This is like an embarrassment of riches for all the stuff the cancer can use to recruit and protect itself. Yeah.

26:43Josh Clark:And then also 1%, we have sarcoma. That begins in the connective tissue or the supportive tissue, like maybe in your muscle and your blood vessels and your fat or cartilage or even bone.

26:56Chuck Bryant:Chuck, 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 every 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 on most are size and growth. And the whole thing starts with stage zero cancer. It goes from stage zero to stage four. And stage zero is like you technically don't have cancer. It can be precancerous cells. You just have a spot that's acting a little weird. and it's mostly curable because the cancer hasn't undergone one of the things that makes cancer so hard to treat.

27:39Chuck Bryant: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.

27:50Josh Clark:Here at Stuff You Should Know, we love stage zero cancer.

27:54Chuck Bryant:It's our favorite kind of cancer.

27:57Josh Clark:As far as cancers go, this is the one we're behind. For sure. And we're not afraid to say it.

28:01Chuck Bryant:For sure. It even looks pretty. It's got that nice round O in the middle.

28:04Josh Clark:Yeah, but nothing in the center of that thing.

28:06Chuck Bryant:Right.

28:08Josh Clark:Of course, you have stage 1 next. They go stage 1, 2, 3, and 4. Stage 1 is, you know, it's a little bit more cancer. It's smaller, obviously not smaller than 0, but smaller than 2. It's contained to one area, has not spread to the lymph nodes or other areas, which is basically where you get to in stage 2, is the tumor is going to be larger, and it may have spread to the lymph nodes at this point.

28:35Chuck Bryant: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, that 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.

29:08Josh Clark:That'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 may also hear a letter sometimes in a diagnosis, like stage 2A, and the letter will describe an aggressiveness with A being the least aggressive all the way up to D being the most aggressive.

29:31Chuck Bryant:Right. And then words like remission and cure are also used. Remission is where the cancer is, it basically describes how the cancer is responding to the treatment, right? If the cancer is on its heels and it's shrinking and it's doing all, it's all the stuff you want it 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 cured. That's like a whole different term.

30:05Josh Clark: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, and even though there may be a risk of reoccurrence 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.

30:29Chuck Bryant: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?

30:38Josh Clark:Yeah. I mean, I don't know any doctors. Well, I do know some doctors, actually. But I haven't asked them, like, how they feel about the language around it, you know?

30:48Chuck Bryant:Yeah. We'll wait if you want to get in touch with them. No, but we'll hear from doctors, I'm sure.

30:54Josh Clark:Yeah, I hope so. And patients. I'm looking forward to getting emails from all kinds of people on this. For sure. So the history is, you know, we're not going to get too 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. And then there was a Dutch scientist, the father of anatomy, Andreas Veselius, who finally said, you know what, I've looked at a lot of dead bodies, I even stole some corpses to make it happen. And guess what, everyone, there's no black bile in the body. And Evan was like, well, why are people dying?

31:35Josh Clark: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 cut that stuff out of the body and see what happens.

32:02Chuck Bryant: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. 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 cancer would spread kind of invisibly deeper into the tissue. And that just getting rid of the tumor wasn't enough because it left too much of the cancerous cells to re-proliferate and grow again.

32:37Yeah.

32:38Josh Clark: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.

33:01Chuck Bryant:Yeah.

33:01Josh Clark: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 treatment, starting with x-rays in 1895, right?

33:18Chuck Bryant:Mm-hmm. That's where they were discovered. And as little as a year later, an American medical student named Emil Gruba, he 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've 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.

33:46Josh Clark:Yeah, things are starting to cook a little bit. Chemotherapy enters the scene, thanks to kind of a weird story. But in the U.S. 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 developed a derivative of mustard gas called meclorethamine and that became the first chemo drug in the 1940s and they still use that sometimes for some types of lymphoma, I think.

34:17Chuck Bryant:Yeah, because it's a disease of your white blood cells, right?

34:20Josh Clark:Yeah.

34:20Chuck Bryant:There's a guy who is basically synonymous with chemotherapy. His name is Sidney Farber. he the Dana Farber Cancer Institute is named after him and it is world renowned and 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 aminopterin 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?

35:07Chuck Bryant: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.

35:17Josh Clark:Yeah.

35:18Chuck Bryant:Because it just goes in and it wipes out so much stuff that 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.

35:32Josh Clark:Yeah, and a lot better to take thanks to some great new nausea drugs because nausea and fatigue are two of the biggest rough parts of chemotherapy.

35:42Chuck Bryant:Yeah, I've heard that for sure.

35:45Josh Clark: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.

36:09Josh Clark:Hey, everybody. Cozy season is upon us. And that means crisp mornings. That means soft layers. And that means bombas.

36:16Chuck Bryant:Yeah, Bombas makes your comfiest fall staples so you can make the most out of one of the best seasons of the year. Bombas has new suede moccasins that are perfect for fall because they have cushy soles, a shearling lining, and they're made of water-resistant suede.

36:30Josh Clark:That's right, and their slippers are everything you'd want for a cozy night in made with the softest, squishiest materials.

36:35Chuck Bryant:And, of course, Bombas has socks. Not just any socks. Socks for every type of weather, every type of occasion, because fall can be fickle, and Bombas makes socks that can handle it all. And the best part about Bombas, for every item you purchase, they donate an essential clothing item to someone facing housing insecurity. One purchased equals one donated, with over 200 million donations and counting.

36:57Josh Clark:So head on over to Bombas.com slash S-Y-S-K and use code S-Y-S-K at checkout for 20 % off your first purchase. That's B-O-M-B-A-S dot com slash S-Y-S-K using code S-Y-S-K at checkout.

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37:34Josh Clark:And when your family and your friends bet on you, it hits a little differently. And the city of Atlanta took notice and decided to be a part of the change. But the city actually put dollars behind that change and said if the big box stores won't come, we'll build our own. One community-funded store became several, but eradicating food deserts across the country takes more than a village.

37:55Chuck Bryant:We won the AT &T Small Business Contest Grant, and that was what we needed to open the first AI-powered shipping container grocery store in the country. Having a powerhouse like AT &T stand behind you takes it to a whole new level.

38:10Josh Clark:Connecting changes everything. AT &T. Hey, everybody.

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39:07Josh Clark:Wayfair, every style, every home.

39:25Chuck Bryant:So Chuck, two things. The first one is I've always wondered if cancer was actually a relatively recent thing, like maybe from the Industrial Revolution on.

39:34Josh Clark:Right. Yeah, I used to wonder that too.

39:36Chuck Bryant:Absolutely not. I mean, I think Imhotep described it 4 ,700 years ago, 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 had been before.

40:08Josh Clark:Yeah, for sure. And the reason that we haven't, you know, developed like a complete just cure all for cancer is because that no two cancers are the same. They all develop in different ways. And they're doing a lot of, you know, we'll talk about some of the like 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.

40:53Chuck Bryant: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, another round, and test after each time until eventually they're like, we can't detect cancer anymore. And now you're in full remission, hopefully forever. Yeah.

41:14Josh Clark:If you don't have a tumor, like you said earlier, if 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. Yeah. That's also used in cases like leukemia.

41:33Chuck Bryant: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, their plasma will do instead. So you end up basically donating blood.

41:54Josh Clark:Chemotherapy, like I mentioned before the break, is a lot better than it was even like 10 or 15 years ago because this serotonin antagonist, which is a new class of anti-nausea drugs, really can help block the nausea receptors in the brain. Right. And I know, you know, just from like family and stuff that that was one of the worst parts. And I'm sure it's still no picnic, but those have really helped.

42:18Chuck Bryant:Yeah. I mean, just what a horrible thing going in to get chemotherapy knowing that you're going to get horribly nauseated for a while. The dread has to be really serious, you know?

42:30Josh Clark:Yeah. I mean, one of our friends of 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 brutal. I don't think I have the exact words here on my text. I don't know if I'd read them anyway. But he basically was like he felt like he'd gotten run over by a truck. And that was just like post-op.

43:00Chuck Bryant:I mean, geez, that was just after the surgery, you say?

43:04Josh Clark:Yeah, for sure. But he's doing great.

43:07Chuck Bryant:Good. Good. I'm glad. Okay. So, yeah, surgery is a big part of it. If it's a tumor, obviously, if it's a cancer of the blood and 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 gee whiz. 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?

43:56Chuck Bryant: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.

44:06Josh Clark:Yeah. It's a good metaphor.

44:08Chuck Bryant:Yeah. Thanks, man. I've been working on it for a couple of weeks now.

44:13Josh Clark:So, 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.

44:40Chuck Bryant: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.

44:51Josh Clark:It was either a whole episode or it came up pretty heavily in more than one back in the day.

44:56Chuck Bryant:Okay. But it's a tool for basically you use a virus that has the genes 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. So 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 that it needs to attack and latch on to cancer, just like it would any foreign invader.

45:42Chuck Bryant:So I have a neighbor friend who underwent CAR T cell therapy.

45:46Josh Clark:Yeah, that's amazing. Some other gene therapy techniques that are, I guess, still in the testing stage. We mentioned that P53 protein. That's the one that says, like, hey, we've done our job. It's time to self-destruct. And that's the one cancer cells don't have. So some gene therapy techniques include turning on that P53 protein in cancer cells. So they either self-destruct or at least stop dividing. Right. It's amazing.

46:14Chuck Bryant:Yeah, there's others that there's genes that basically turn the cells into magnets for immune cells. And then I saw another one where they can turn the they can make the cancer cell mature finally. Right. And so it will have a job basically. And get this. They found that the vast majority of those cells basically pull the plug. They undergo apoptosis. They self-destruct. So they'd rather die than have a job, the cancer cells would.

46:48Josh Clark:Isn't that crazy? Cancer cells are Gen X, 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. Right. That's a new treatment designed to basically prime your immune system to target cancer cells to reduce recurrence risk. and, you know, obviously, hopefully, like, kind of fewer side effects than something like chemotherapy.

47:15Chuck Bryant: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 keep 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, like, 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. 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.

48:03Chuck Bryant:That's, I mean, this is, it's a really great frontier that we're on right now. It's very hopeful.

48:10Josh Clark:Yeah, for sure. You know, we do have done a lot of AI poo-pooing on this show, but one of the great benefits of AI is that it's already kind of stepped up in cancer treatment and in sort of cancer diagnoses, it seems like, like maybe having, along with a human radiologist, having AI looking at radiology scans to detect tumors that maybe a radiologist doesn't notice, maybe also to help predict risk. 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. 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.

48:57Chuck Bryant:Yeah, and 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. But 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 2023. So in just over 25 years, 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.

49:43Josh Clark: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 psychoneuroimmunology, which is a branch of Western medicine that acknowledges the effect of the brain or your mind, really, on the systems of the body. And, you know, I don't think it's like woo-woo stuff to say that a real, real deep will to live can make a difference if you're, you know, 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.

50:31Josh Clark:And 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.

50:42Chuck Bryant: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 it in people is – it's definitely being investigated now. And it does seem to be a thing for sure. Yeah.

51:01Josh Clark:And, 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.

51:30Chuck Bryant:Yeah, that's, yeah. I mean, it's definitely, because you're just saying like, okay, I'm accepting my fate. And that is incredibly brave. Yeah, and not just saying like giving up the battle with 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.

52:13Chuck Bryant:Like I'm responsible for my own death. Those people, they're like, you know, call it your journey with cancer, living with cancer, treating your cancer, more neutral terms, less fighty 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. And I mean, that's super valid. For sure.

52:41Josh Clark:And if you know someone in your life that has accepted that it's time for them, like that's when they need like your support and love more than ever, I think. Like, it's in, I mean, I would just recommend to not, like, be devastated in front of them at least. Right. And to try and support that decision, you know, because that's a brave thing to accept.

53:06Chuck Bryant:That's got to be tough for a kid to understand and accept too, you know?

53:11Josh Clark:Yeah.

53:12Chuck Bryant:There was a, remember that episode of The Pit that really dealt with that?

53:18Josh Clark:Oh, yeah. That was gut-wrenching.

53:21Chuck Bryant:I've got one quick soapbox PSA, if that's okay.

53:25Josh Clark:Yeah, let's do it.

53:26Chuck Bryant:So in the United States, mammograms are covered by insurance. Here we go. The problem is that you very often need a follow-up because they're like, this mammogram's 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 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 plenty of women out there who are like, I don't have the money to pay out of pocket for a CT scan. So I'm just not going to go get the follow-up imaging and cross my fingers.

54:07Chuck Bryant: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 do the bare minimum. It's just not going to work for people anymore, hopefully.

54:21Josh Clark: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 in younger adults, make them available to be covered. in your 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?

55:00Chuck Bryant:Totally, 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.

55:13Josh Clark:That's right.

55:14Chuck Bryant:Since we just wrapped this episode on Cancer Up, That means it's time for listener mail, of course.

55:21Josh Clark:That's right. I'm going to finish with a very heartwarming story, which is a good way to end this one.

55:26Chuck Bryant:Awesome.

55:27Josh Clark:This was from our phone 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. I still have that phone book with the markings. and you'll see why. 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.

56:05Josh Clark:And I answered, well, this is Amanda, which was 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. This story's getting good. I think you see where it's headed. We spoke for 30 minutes on the phone about the Mets who had just won 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 streetlight on the corner. And dudes, we've been married for 33 years. Awesome. Together for 39. And in December, our daughter is going to get married. He is my person, my soulmate, my everything.

56:43Josh Clark:I'm a weirdo and he gets me and always has all because of a phone book

56:47Chuck Bryant:that is so great man

56:49Josh Clark: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 don't know. I think she's talking about the daily. I think so. But that is from Laura, and Laura sent pics of her and her huds in 1987, 1993, and one from this year.

57:21Josh Clark:And it is adorable. He had quite the mustache.

57:25Chuck Bryant:I saw that subject line. I haven't looked at the email yet, so I have to run over and do that. That's what a great story, man.

57:32Josh Clark:Yeah, I love it.

57:33Chuck Bryant:That was Laura? That was Laura. Thank you, Laura. That was, I don't know, that's a contender for number one, maybe.

57:41Josh Clark:That's right. You and name-redacted husband. I'm so glad you're still together.

57:45Chuck Bryant:Seriously, one of the best ever. So 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 Stuff Podcasts at iHeartRadio.com.

58:01Josh Clark:Stuff You Should Know is a production of iHeartRadio. For more podcasts from iHeartRadio, visit the iHeartRadio app, Apple Podcasts, or wherever you listen to your favorite shows.

58:35Chuck Bryant:The Voice of Vivgard From diagnosis to working with their care team on their treatment plan. Listen to Voices of Vivgard on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. Stuff at Sea is a five-night, adults-only sailing trip that brings the Stuff Podcast universe to life on board. This voyage is a culture-soaked escape where pink sand paradise meets curious minds. Sailing round trip from New York City to Bermuda on October 2nd to 7th, 2026, this voyage drops you straight into the iHeart Podcast Stuff universe. On top of the adults-only experience you already love, you'll get live podcast episode recordings, behind-the-scenes sessions, themed activations, and more unmissable onboard moments.

59:21Chuck Bryant:Learn more at virginvoyages.com slash stuff. With no fees or minimums on checking accounts, it's no wonder the Capital One bank guy is so passionate about banking with Capital One. If he were here, he wouldn't just tell you about no fees or minimums, He'd also tell you about how Capital One cafes are open seven days a week to assist with your banking needs. Yep, even on weekends. It's pretty much all he talks about. In a good way. What's in your wallet? Terms apply. See CapitalOne.com slash Bank Guy. Capital One N-A, member FDIC. This is an iHeart Podcast. Guaranteed human.