A brief history of cancer and its treatment

Cancer refers to a group of diseases characterized by the uncontrolled growth and spread of abnormal cells within the body. These cells originate from normal tissue cells and form a local tumor, the primary tumor, which at later stages invade nearby tissues and organs forming secondary tumors or metastases.

4000-year-old Egyptian fire drill kit by David Morningstar, taken in the Manchester Museum.

The earliest known mention of cancer dates back to ancient Egypt (around 3000 BC). In papyrus documents, reports were found of tumors in the breast. Treatment involved a technique where tissue was destroyed using a hot instrument known as “the fire drill.”

The term cancer was coined by the ‘father of medicine’, Hippocrates (460 BC – c. 370 BC). It refers to “καρκινος” (carcinos), the Greek word for ‘crab’ or ‘crayfish,’ due to the appearance of malignant tumors. Treatment involved diet, blood-letting, and laxatives.

Galen (2nd century AD), a prominent Greek physician, made significant contributions to various fields of medicine, including anatomy, physiology, and pathology. Galen used the term “oncos”, meaning swelling or mass, to describe tumors. Galen recognized that tumors were characterized by abnormal growths; he observed various types of tumors in his patients and wrote extensively about their clinical manifestations, characteristics, and treatments. Treatment was still based on the humoral theory inherited from Hippocrates. According to this theory, diseases were caused by imbalances in the body’s four humors (blood, phlegm, yellow bile, and black bile).

During the following centuries the knowledge of the causes of cancer and treatment did not show a lot of improvement. Medical knowledge stagnated during the Middle Ages, and cancer was often considered a fatal condition with few treatment options.

Surgery as a treatment of cancer

Van Leewenhoek microscope (source: Utrecht University Museum)

A major breakthrough was the introduction of surgery as a treatment for cancer, introduced by Wilhelm Fabry, a prominent German surgeon who lived during the 16th and 17th centuries. He made significant contributions to the field of surgery and is often considered one of the founding figures of modern surgery. He documented cases of both benign and malignant tumors, noting their different appearances and behaviors. Fabry was one of the first surgeons to advocate for the complete excision of tumors whenever possible, rather than simply draining or cauterizing them as was common at the time.

In the 17th to 19th century, advances in microscopy allowed for more detailed examination of cancer cells and tissues. Antonie van Leeuwenhoek, a Dutch scientist who lived in the 17th century, made his own handcrafted microscopes and is often referred to as the “father of microbiology” for his pioneering work. In the 19th century, the development of the cell theory by scientists like Matthias Schleiden and Theodor Schwann laid the foundation for understanding cancer as a disease of cellular dysfunction.

In the late 19th to Early 20th century, radiation therapy emerged as a treatment option for certain types of cancer, following the discovery of X-rays by Wilhelm Roentgen in 1895. Radiation was used to shrink tumors and alleviate symptoms, but its efficacy was limited by the crude technology available at the time.

Cancer as a genetic disorder

Theodor Boveri (source: Wikipedia)

The early 20th century saw significant advancements in the understanding and treatment of cancer. The hypothesis that cancer is a genetic disease was proposed by Theodor Boveri, a German biologist. His work laid the groundwork for the understanding of cancer as a genetic disorder. In 1914, Boveri published a seminal paper titled “Concerning the Origin of Malignant Tumors,” in which he put forward his theory that cancer arises from abnormalities in the cell’s chromosomes. He proposed that cancer cells have abnormal numbers or arrangements of chromosomes, which lead to uncontrolled growth and proliferation.

Boveri’s work was ahead of its time and his ideas were not widely accepted initially. However, today Boveri is recognized as one of the founders of modern cancer genetics, and his hypothesis has been validated by decades of scientific research. Back to the early 1900s, other researchers such as the American virologist Peyton Rous discovered that certain viruses could cause cancer in animals, laying the groundwork for the study of viral carcinogenesis. This discovery challenged the prevailing notion at the time that cancer was solely caused by environmental factors or genetic predisposition.

In the mid-20th century, researchers discovered by accident chemotherapy for treating cancer. During World War II, a chemical compound called mustard gas was used as a poison gas on the battlefield. In a gas accident, it was found that soldiers exposed to this gas experienced damage to their white blood cells (leukocytes). This observation inspired scientists to explore the potential of nitrogen mustard derivatives for cancer treatment and indeed such chemical compounds could shrink tumors. In the 1940s, mechlorethamine was used to treat malignant lymphoma—a type of cancer affecting the lymphatic system. This breakthrough paved the way for further research into chemotherapy.

In the 1950s, the elucidation of the DNA structure by James Watson, Francis Crick, along with contributions from Rosalind Franklin and Maurice Wilkins, provided a breakthrough for studying the genetic basis of cancer.

Overall, the history of cancer spans millennia, with gradual progress in understanding the disease and developing treatments. These developments, however, accelerated immensely from the 1960s onward driven by discoveries of underlying molecular causes of cancer and technological innovations. These new insights were driven by the discovery of underlying genetic causes of cancer, which will be addressed in the next part, Cancer, a genetic disease.

Suggested extra reading:

History of cancer: Siddhartha Mukherjee, The emperor of all maladies Wikipedia