Great strides have been made in recent years in the treatment of many cancers. For most tumors, the best chance of cure remains early detection and surgical removal prior to the tumor spreading. This includes such cancers as skin cancers, especially melanoma, breast cancer, and colon cancer. New treatments that involve directing the immune system to attack the cancer or suppressing the cancer through hormonal manipulation also are showing some good outcomes and tend to have less side effects than traditional chemotherapy. Radiation remains an important option for some cancers, especially for relief of symptoms. In this first part of a two-part series, we will explore the interesting history of cancer treatments from ancient times to modern ones. In the second part, we will go into more detail about the current treatments that hold great promise and some exciting new things on the near horizon of science.
Our earliest Western writings regarding cancer pertain to breast cancer. This is probably due the fact that it was more easily observable than tumors that are more internal. The first writing is from Hippocrates, the renowned physician of Ancient Greece and author of the Hippocratic Oath, who in 460 BCE (before current epoch, aka BC) described breast cancer as being caused by an imbalance in body humors and that bloodletting to remove “black bile” might be a treatment. Incidentally, his writings also describe the technique of surgically opening an abscess to drain pus, which is still the preferred treatment today. Another renowned Greek physician and surgeon, Aelius Galenus, in 200 CE (current epoch, aka AD) proposed applying a salve to the breast made of sulphur and licorice in a castor oil base. This may have actually had some benefit. The first description of mastectomy was in 548 CE by the Byzantine surgeon, Aetius of Amida. Such surgeries must have been very difficult on the patient as this was before anesthetics or sterile techniques. Bleeding was controlled by applying a hot iron. It is likely that opium was given for pain control. Surgical management did not really improve much for the next two millennia.
The foundations of modern surgery are attributed to the Scottish surgeon John Hunter (1728-1793) who promoted techniques to prevent infection, better understanding of anatomy, pathologic examination of what was removed during a surgery as part of establishing the diagnosis and the tying off of bleeding arteries. Surgical technique significantly improved further with the development of ether and chloroform as anesthetics in the 1840’s and surgical sterility in the 1860’s. British surgeon Joseph Lister (1827-1912) heard about the work of French microbiologist Louis Pasteur (1822-1895) and based on Pasteur’s observations about infections being caused by microorganisms Lister developed the idea of changing gloves in-between cases, scrubbing the surgeon’s hands before surgery and soaking surgical instruments in a solution of carbolic acid. Lister also introduced the technique of steam sterilization. All of these advances in surgery moved cancer treatment forward so that by the beginning of the 20th century, there was for the first-time hope of curing cancer through early surgical removal.
The first effective chemotherapy treatment had an unusual discovery. During World War I, mustard gas from an attack drifted into a French hospital treating cancer patients. The gas had become diluted enough that most of the patients survived the attack. Some of the physicians noted that the patients with lymphoma, a cancer related to the immune system’s cells, showed improvement. However, this observation in 1918 did not get much attention at the time.
During World War II, on December 2nd, 1943, German dive bombers attacked the Italian port of Bari, sinking many Allied supply ships. One ship, the John Harvey, was carrying a secret stockpile of mustard gas that the Allies intended to use to stop a possible German advance. Many civilians in the town died from the gas, however, it was noted by British physicians that those people who survived suffered from very low white blood cell counts. This led several American physicians, including Sydney Farber (1903-1073) who was a renowned pediatric oncologist, to suggest using mustard agents intravenously as a treatment for leukemia and lymphoma. The drug was named mustine and has been further refined to modern carmustine. This showed significant benefit in treating lymphomas, including achieving cures of Hodgkin’s lymphoma. As the first effective chemotherapy agent, mustine replaced previous treatments which were based on arsenic and were highly poisonous and of dubious benefit. A related drug, estramustine has been used to treat prostate cancer.
The basic principle behind chemotherapy, which dominated cancer treatment from the early 1950’s until the development of more recent treatments is that cancer cells are dividing more rapidly than normal cells. While it turns out that this is not always true, the idea is to carefully introduce controlled amounts of chemotherapy drugs which, while potentially toxic, will be more so to the cancer cells and less so to the patient’s normal cells. These treatments effect all dividing cells in the body, which is why a patient may loose their hair or have their bone marrow, which makes blood and immune cells, suppressed. The development in the 1990’s of better drugs to control the side effects of chemotherapy, especially nausea, greatly improved a patient’s ability to tolerate the treatment. Still, there had to be a better way.
Much of the 1990’s and early 2000’s were spent in developing treatments that are more effective with less side effects. We will examine some of these in next week’s article including some that are coming soon that show promise.
“Over the past 30 years we have gained a deeper understanding of drives cancer cell growth. In addition, we discovered some of the mechanisms that malignant tumors use to evade a person’s own immune system. This knowledge has led to the development of ‘precision’ cancer treatment which can specifically target the cancer cells while not harming normal cells,” said Dr. Vandana Sharma, medical director of the oncology clinic at Adventist Health Mendocino Coast in Ft. Bragg. “These advances have improved survival and decreased the toxicity of cancer treatment.”
Miller Report for the Week of October 17th, 2022; by William Miller, MD
You can access all previous Miller Reports online at www.WMillerMD.com.
Dr. Miller is a practicing hospitalist and the Chief of Staff at Adventist Health Mendocino Coast hospital in Ft. Bragg, California. The views shared in this weekly column are those of the author and do not necessarily represent those of the publisher or of Adventist Health.