Thursday, December 08, 2022

“Whoever wishes to foresee the future must consult the past.”—Machiavelli

Cancer has been primarily a major disease of the latter half of the 20th century and onwards. Nonetheless, it was present and observed back to ancient times. There dates from about 1500 BCE an ancient papyrus called the Edwin Smith Papyrus. It is apparently part of a textbook on trauma surgery and describes eight cases of tumors or ulcers of the breast that were treated by Egyptian physicians with cauterization. The text goes on to say that there is no curative treatment for this disease. This is the earliest written description of cancer that is known.

To orient the reader to the time frame here, it is estimated that Abraham left Ur around 1730 BCE and that the Exodus from Egypt took place around 1400-1500 BCE.

The earliest malignant tumors were found in Egyptian mummies that date back to this time period, around 1500 BCE, as well. A cadaver has been discovered frozen in Siberia that was dated to the same time period also that contains prostate cancer metastatic to bone.

Somewhat later, there is a study of about 1,100 skeletons that were unearthed at an Egyptian cemetery between 1,500 and 3,000 years ago. In these bodies were found six cancers—two women had cervical cancer, a man had testicular cancer, another showed colorectal cancer, there was a metastatic cancer of unknown origin in a woman, and leukemia in a child. But note that six cancers among 1,000 bodies is a remarkably low prevalence of cancer.

Hippocrates is known as the Father of Medicine and practiced in the 4th century BCE in Greece. Among his many contributions, he is probably best known for his Oath, still used at many medical schools today. His writings describe masses (onkos) and describe treatments, especially surgery, for various serious diseases including karkinomas (carcinoma). He wrote that occult karkinomas could remain dormant for a long time and it was frequently best to leave them unmolested. A later Roman physician, Aulus Celsus (25 BCE-50 CE), wrote that many carcinomas, if resected, could later return and cause death.

This brings us to Rome. Archigenes of Apamea (75-129 CE) practiced in Rome at the time of the emperor Trajan and advised that surgery would be more successful if diagnosis were made at an earlier stage. He also recommended surgery for advanced cancers, only in those who were physically fit and able to survive surgery.

Galen, a Roman born in Greece, was probably the most prominent physician prior to the Middle Ages. He is well known for utilizing autopsies extensively to learn about anatomy and disease processes. He became physician to the emperor Marcus Aurelius at one point and to some degree relied on empirical observations to guide his medical practices. For our purposes, he understood and classified the differences between benign and malignant tumors, though he did not introduce any new treatments.

After the fall of the Roman Empire, the Arab world became preeminent in medicine. They made major contributions in understanding the physiology of various systems, like the lungs and heart. In the 14th century, Avenzoar described gastric and esophageal cancer in great detail. Ultimately the Catholic revival led to the building of monasteries and hospitals where medicine became practiced in the early Middle Ages in Christian Europe.

Gabriele Fallopius (1523-1562) described multiple visual and clinical signs for distinguishing benign from malignant tumors. The writings of Rene Descartes (1590-1650), while not specifically addressing medicine or cancer, did have a profound influence in encouraging an empirical experimental approach to the acquisition of knowledge. As an example, there had been a very dominant theory dating back to Galen that black bile was a major cause of cancer. Jean Pecquet, a French physician, could not find any black bile in connection with cancer while lymph was present frequently and thus this led to skepticism regarding the black bile theory. In 1759, Jean Astruc, a French physician, conducted an experiment in which he compared the flavor of slices of cooked beef to slices of cooked breast cancer and found that they tasted the same; his conclusion was that there was no bile in the breast cancer (another incredible example of self experimentation?). In part because of this, a French surgeon, Henri Le Dran, a great surgeon of the era, suggested that cancer developed locally and then spread through the lymphatics; this led to the development of total mastectomy, including axillary node resection, as treatment for breast cancer, an approach which persisted in one form or another into the 20th century and till today.

I could cite numerous other anecdotes and discoveries but would be remiss if I did not mention the groundbreaking work of John Hill who, in 1761, warned that the use of snuff would lead to cancer; snuff, of course, is a form of tobacco. And finally the discovery of Percival Pott, who in 1775 published on the fact that chimney sweeps were at increased risk of scrotal cancer. He attributed this to the soot that collects on their skin.

Alfred I. Neugut, MD, PhD, is a medical oncologist and cancer epidemiologist at Columbia University Irving Medical Center/New York Presbyterian and Mailman School of Public Health in New York.

This article is for educational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment, and does not constitute medical or other professional advice. Always seek the advice of your qualified health provider with any questions you may have regarding a medical condition or treatment.

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