Cancer in History -- Ancient to Modern Times

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It's been a long road from the ancient world to today's chemotherapy and targeted anti-cancer drugs, and the road still winds off into the horizon.

Despite the absence of microscopes and CT scanners, ancient peoples did recognize cancer, at some level. The physician Hippocrates (460–370 B.C) used the Greek word karkinos to describe carcinoma tumors, but his was not the first historical reference to cancer.

According to the American Cancer Society, our oldest description of cancer dates back to about 3000 B.C. in Ancient Egypt. It is found in the Edwin Smith Papyrus, and is a copy of part of an ancient Egyptian textbook on trauma surgery. It describes 8 cases of breast tumors that were removed by cauterization with a tool called the fire drill. The writing says about the disease, “There is no treatment.”

Discovery of Anesthesia, Metastasis

Ancient surgeons knew that cancer would usually come back after it was removed by surgery.

After anesthesia was invented in 1846, surgeons Bilroth, Handley and Halsted took to surgery to try to treat cancer, removing entire tumors, together with involved lymph nodes. Later, Paget, a surgeon, reported on the sad discovery that you couldn't always 'cut it out'...that cancer cells were spread from the primary tumor to other places through the blood stream, or what’s known as metastasis.

These were times that preceded any modern notion of diagnostic imaging like plain films or CT scans. Surgeries were performed to find out what the problem was, to see inside. Roentgen discovered X-rays 50 years after anesthesia was discovered.

Invention of Computerized Imaging

In the beginning of 1970s, the science of imaging with the assistance of computers was beginning to boom.

Progress in ultrasound (sonography), computed tomography (CT scans), magnetic resonance imaging (MRI scans) and positron emission tomography (PET scans) made many, but not all, exploratory operations unnecessary.

Accidental Discovery of Chemotherapy

Nitrogen mustard gas was used in WWI. These compounds, called alkylating agents, had potential in cancer treatment, but that discovery would not come for some years. According to Andrew D. Smith, a writer for OncLive, it was not until World War II that scientists discovered the agent’s promise as a treatment for lymphoid malignancies. The US government had asked researchers at Yale School of Medicine in New Haven, Connecticut, to study potential antidotes to mustard gas as a weapon, which fueled further discovery.

During the 20th century, surgeons developed new methods for cancer treatment by combining surgery with chemotherapy, radiation and sometimes both. Over the years, use of many different chemotherapy drugs has resulted in the successful treatment of many types of cancers.

Melphalan is an alkylating agent still used today. According to the American Cancer Society, melphalan is used to treat multiple myelomas, as well as ovarian, breast, and prostate cancer and sometimes for non-cancerous conditions.

Realizing Hormonal Therapy

It’s a relatively recent development that hormones are being used to treat certain cancers, but the link between hormones and cancer was known far in advance of hormone-based treatment. Thomas Beatson discovered in 1878 removing the ovaries in rabbits caused the breasts to stop producing milk. Scientists later observed in some case that metastatic prostate cancer miraculously shrunk after surgical removal of the testes.

Today, doctors use a variety of drugs to block hormones to treat prostate and breast cancers, and the role of hormones in the risk of cancer development is an active area of investigation.

Radiation Therapy, Adjuvant Therapy, Immunotherapy and More

Early in the 20th century, researchers saw that radiation could cause cancer as well as treat it. Today, there are a variety of different cancer therapies that use radiation, and the push has been to make these treatments more specific and targeted to cancer, and less apt to result in collateral damage. Chemotherapy also began to be been used in new ways, such as after surgery, to destroy the few remaining cancer cells in the body.

With increasing knowledge of biology at the molecular level, and marked improvement in the ability to manufacture biologic molecules, the so-called targeted, biologic and/or immunotherapies are now more important than ever before. In 1990s scientists produced the therapeutic monoclonal antibodies rituximab and trastuzumab that specifically targeted lymphoma and breast cancer cells. And currently, vaccines against cancer cells and many other frontiers are being explored.

Sources

American cancer Society. Early history of Cancer. http://www.cancer.org/cancer/cancerbasics/thehistoryofcancer/the-history-of-cancer-what-is-cancer. Accessed February 2015.

OncLive. From Warfare to Mainstay: Mustard Derivatives Play Evolving Role in Cancer Therapy. Accessed February 2015.

Sudhakar A. History of Cancer, Ancient and Modern Treatment Methods. J Cancer Sci Ther.  2009;1(2):1-4.

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