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25 BCE
Celus Discovers Surgical Removal of Cancer
Ancient physicians and surgeons knew that cancer would usually come back after it was surgically removed. The Roman physician Celsus wrote, “After excision, even when a scar has formed, none the less the disease has returned.” -
183
Galen
Galen was a 2nd-century Greek doctor whose books were preserved for centuries. He was the highest medical authority for over a thousand years. Galen viewed cancer much as Hippocrates had, and considered the patient incurable after a diagnosis of cancer had been made. His views set the pattern for cancer management for centuries. -
Autopsies
Autopsies, done by Harvey (1628), led to an understanding of the circulation of blood through the heart and body that had until then been a mystery. -
John Hunter
The famous Scottish surgeon John Hunter (1728-1793) suggested that some cancers might be cured by surgery and described how the surgeon might decide which cancers to operate on. If the tumor had not invaded nearby tissue and was “moveable,” he said, “There is no impropriety in removing it.” -
Surgery has Major Advancements
There were great surgeons before the discovery of anesthesia. John Hunter, Astley Cooper, and John Warren achieved lasting acclaim for their swift and precise surgery. But when anesthesia became available in 1846, the work advanced so rapidly that the next hundred years became known as “the century of the surgeon.” -
Exploratory Surgery
Until near the end of the 20th century, diagnosing cancer often required “exploratory surgery” to open the abdomen (belly) or chest so the surgeon could take tissue samples to be tested for cancer. -
William Stewart Halsted
William Stewart Halsted, a surgeon at Johns Hopkins University, developed the radical mastectomy during the last decade of the 19th century. His work was based in part on that of W. Sampson Handley, the London surgeon who believed that cancer spread outward by invasion from the original growth. (The general concept of the radical mastectomy can be traced all the way back to Lorenz Heister, a German writing his ideas for mastectomy and lumpectomy in his book, Chirurgie, published in 1719.) -
Creation of the X-ray
In 1896 a German physics professor, Wilhelm Conrad Roentgen, presented a remarkable lecture entitled “Concerning a New Kind of Ray.” Roentgen called it the “X-ray”, with “x” being the algebraic symbol for an unknown quantity. There was immediate worldwide excitement. Within months, systems were being devised to use x-rays for diagnosis, and within 3 years radiation was used in to treat cancer. -
Surgical Removal of Cancer in the Early to Mid 1900s
He believed that adequate local removal of the cancer would cure it – if the cancer later appeared elsewhere, it was a new process. That belief led him to develop the radical mastectomy for breast cancer. This became the basis of cancer surgery for almost a century. -
Daily Doses of Radiation Comes with Better Results
Radiation therapy began with radium and with relatively low-voltage diagnostic machines. In France, a major breakthrough took place when it was discovered that daily doses of radiation over several weeks greatly improved the patient’s chance for a cure. The methods and the machines that deliver radiation therapy have steadily improved since then. -
Radiation Can be Harmful With Repeated Exposure
At the beginning of the 20th century, shortly after radiation began to be used for diagnosis and therapy, it was discovered that radiation could cause cancer as well as cure it. Many early radiologists used the skin of their arms to test the strength of radiation from their radiotherapy machines, looking for a dose that would produce a pink reaction (erythema) which looked like sunburn. -
Doctors and Researches Get Leukemia
They called this the “erythema dose,” and this was considered an estimate of the proper daily fraction of radiation. It’s no surprise that many of them developed leukemia from regularly exposing themselves to radiation. -
Mustard Gas is Used to Treat Cancer
In the 1940s, two prominent Yale pharmacologists, Alfred Gilman and Louis Goodman examined the therapeutic effects of mustard agents in treating lymphoma. First, they established lymphomas in mice and showed that the tumors could be treated with mustard agents. Then, together with a thoracic surgeon called Gustav Lindskog, they injected a less volatile form of mustard gas called mustine (nitrogen mustard) into a patient who had nonHodgkin's lymphoma. -
Cancer is Cured With Chemotherapy for the First Time
Metastatic cancer was first cured in 1956 when methotrexate was used to treat a rare tumor called choriocarcinoma. Over the years, chemotherapy drugs (chemo) have successfully treated many people with cancer. Long-term remissions and even cures of many patients with Hodgkin disease and childhood ALL (acute lymphoblastic leukemia) treated with chemo were first reported during the 1960s. -
Exploratory Surgeries are No Longer Needed
Starting in the 1970s, progress in imaging tests such as ultrasound (sonography), computed tomography (CT scans), magnetic resonance imaging (MRI scans), and positron emission tomography (PET scans) have replaced many exploratory operations. CT scans and ultrasound can also be used to guide biopsy needles into tumors. -
Radiation Can be Aimed
Advances in radiation physics and computer technology during the last quarter of the 20th century made it possible to aim radiation more precisely. Conformal radiation therapy (CRT) uses CT images and special computers to very precisely map the location of a cancer in 3 dimensions. -
Process for Safer Radiation Exposure is Discovered
The patient is fitted with a plastic mold or cast to keep the body part still and in the same position for each treatment. The radiation beams are matched to the shape of the tumor and delivered to the tumor from several directions. Intensity-modulated radiation therapy (IMRT) is like CRT, but along with aiming photon beams from several directions, the intensity of the beams can be adjusted. This allows doctors to reduce exposure to normal cells while delivering a high dose to the cancer. -
New Techniques are Created for Surgical Removal
During the final decades of the 20th century, surgeons developed greater technical expertise in minimizing the amounts of normal tissue removed during cancer operations. Like the trend from radical mastectomy to lumpectomy, progress was also made in removing bone and soft tissue tumors of the arms and legs without the need for amputation in most cases, and in avoiding a colostomy for most patients with rectal cancer. -
Radiation, Chemotherapy, and Surgery are combined to Create Better Surgical Results
This progress depended not only on understanding cancer better as a disease and on better surgical instruments, but also on combining surgery with chemotherapy and/or radiation. -
Modern Chemotherapy Delivery Methods
New drugs, new combinations of drugs, and new delivery techniques
Novel approaches that target drugs more specifically at the cancer cells (such as monoclonal antibody therapy) to produce fewer side effects
Drugs to reduce side effects, like colony-stimulating factors, chemoprotective agents (such as dexrazoxane and amifostine), and anti-emetics (to reduce nausea and vomiting)
Agents that overcome multi-drug resistance (when the cancer doesn’t respond to the usual treatment drugs) -
Modern Radiation Research
Chemical modifiers or radiosensitizers are substances that make cancer more sensitive to radiation. The goal of research into these types of substances is to develop agents that will make the tumor more sensitive without affecting normal tissues. Researchers are also looking for substances that may help protect normal cells from radiation. -
Modern Cancer Surgery
Today, doctors use instruments with fiberoptic technology and micro video cameras to look inside the body. Surgeons can operate using special surgical instruments through narrow tubes put into small cuts in the skin. These instruments can be used to look and work inside the abdomen (laparoscopic surgery) or chest (thorascopic surgery). A similar instrument, the endoscope, can be used to remove some tumors in the colon, esophagus, or bladder by entering through natural openings such as the mouth.