The Evolution of Cancer Biology

Cancer is characterized by the uncontrolled growth of cells in the body. This disease remains one of the most significant medical challenges in the modern day;  however, humans have been aware of this condition for thousands of years. Ancient physicians all over the world have, for centuries, described cancerous growths in their patients. Analyzing the progression of cancer treatments throughout history will help us understand how medicine evolved over time.

Many sources dating back to thousands of years ago have detailed instances of cancerous growths in humans, the earliest, describing tumors in the breasts, was found in the Edwin Smith Papyrus from around 3000 BCE (Hajdu 2011). Similarly, the Ebers Papyrus, from around 1500 BCE, discussed cancers of the skin, uterus, and stomach (Hajdu 2011). Both documents stated that no available treatments could effectively combat this condition (Hajdu 2004).

Figure 1. The Edwin Smith Papyrus from about 3000 BCE detailing the earliest mention of any type of cancerous growth.

Hippocrates, a Greek physician from the 4th century BCE, developed treatments for cancer based on the humoral theory. Aside from providing detailed descriptions of tumors, Hippocrates theorized that the imbalance of four humoral fluids within a patient’s body —  blood, phlegm, yellow bile, and black bile —  caused cancer (American Cancer Society 2014a; Hajdu 2004). By applying his theory, Hippocrates treated his patients by prescribing a specific diet which would help reestablish the balance of fluids in the human body (Bujalkova 2001). During that same time period, Indian physician Sushruta also published his cancer treatments in the Sushruta Samhita, a medical treatise detailing a variety of ailments, from cancer to ulcers, and surgical procedures, such as  plastic surgery and eye surgery. After studying various types of tumors and the bodies of cancer patients, Sushruta concluded that unstable mental states and unhealthy diets could cause imbalances in the human body that would lead to cancer (Balachandran 2004). He initially prescribed natural Ayurvedic treatments, an ancient system of holistic medicine dating back thousands of years, to help ease his patients’ ailments. In cases where Ayurvedic treatments failed, he turned to surgical interventions, including cutting out the tumor and cauterizing the wound to prevent recurrences (Balachandran 2004). It seems that before the advent of modern science, humans were already amassing a considerable amount of knowledge about cancer and its treatments.


Surprisingly enough, it wasn’t until the early 1900s that scientists were able to develop systematic approaches to effectively treat cancer and their efforts eventually resulted in the creation of chemotherapy. During World War II in the early 1900s, doctors studying leukemia noticed that soldiers exposed to nitrogen mustard gas on the battlefield had decreased bone marrow levels and lymph nodes in their bodies (DeVita 2008). This observation led physicians to hypothesize whether exposure to mustard gas could suppress cancer cell growth. Leukemia is characterized by an increase in white blood cells and the soldiers exposed to mustard gas had decreased levels of bone marrow, and therefore lower levels of white blood cells which are stored in the bone marrow. What resulted from these experiments was the development of methotrexate: the first drug targeted against metastatic cancer (American Cancer Society 2014b). Chemotherapy drugs, like methotrexate and many others, are injected into a patient’s bloodstream and attack unhealthy or cancerous cells. However, these drugs are not targeted on one point in the body, meaning they may damage other cells while killing the cancerous cells.  This creates risks associated with chemotherapy like fatigue, hair loss, effects on cognitive power, and many others.

A variation of chemotherapy known as combination chemotherapy is still widely practiced in contemporary medical treatments. Like the name suggests, doctors will use a combination of many treatments to target one disease or ailment. This strategy has proven to be more effective than simply utilizing one drug or treatment alone. Cancer cells, however, can develop multi-drug resistance to the medicines used in combination chemotherapy, creating a need for other types of treatments that don’t depend as heavily on a cocktail of medications. (Frei 2003). One promising alternative is immunotherapy which utilizes the patient’s own immune cells to attack cancerous growths (National Cancer Institute 2019). Although originally developed as a tool to locate tumors in the body, researchers later realized that immunotherapy could be applied instead to directly attack tumors. This treatment is more precise and efficient while posing fewer side effects associated with chemotherapy (Arruebo 2011). These advancements in oncology are providing us the hope of permanently “curing” this deadly condition.  

When we look back at the history of cancer treatments, it is remarkable to observe how therapies have morphed from Ayurvedic medicine and crude surgery to immunotherapy. No matter how our perspectives differ from the past, understanding the wisdom of predecessors will help those on the forefront of medicine to illuminate the path to clearer and more effective solutions in the future.

Edited by Edward Xue

References

Ahn, B. (2019). The Evolution of Cancer Research. Scientific American. https://www.scientificamerican.com/custom-media/the-evolution-of-cancer-research/

American Cancer Society A, (2014, June). Early Theories about Cancer Causes. American Cancer Society. https://www.cancer.org/cancer/cancer-basics/history-of-cancer/cancer-causes-theories-throughout-history.html

American Cancer Society B, (2014, June). Evolution of Cancer Treatments: Chemotherapy. American Cancer Society. https://www.cancer.org/cancer/cancer-basics/history-of-cancer/cancer-treatment-chemo.html

Arruebo, M., Vilaboa, N., Sáez-Gutierrez, B., Lambea, J., Tres, A., Valladares, M., & González-Fernández, A. (2011). Assessment of the evolution of cancer treatment therapies. Cancers, 3(3), 3279–3330. https://doi.org/10.3390/cancers3033279

Balachandran, P., & Govindarajan, R. (2004, June 07). Cancer-an ayurvedic perspective. Pharmacological Research. https://www.sciencedirect.com/science/article/pii/S1043661804001094

Bujalkova, Maria & Straka, S & Jureckova, A. (2001). Hippocrates’ humoral pathology in nowaday’s reflections. Bratislavské lekárske listy. 102. 489-92. https://www.researchgate.net/profile/Maria_Bujalkova/publication/11557294_Hipp ocrates’_humoral_pathology_in_nowaday’s_reflections/links/58455bfb08ae2d217 567c361.pdf

DeVita, V. T., & Chu, E. (2008). A History of Cancer Chemotherapy. AACR Centennial Series https://cancerres.aacrjournals.org/lens/canres/68/21/8643

Frei E III, Eder JP (2003). Combination Chemotherapy. In: Kufe DW, Pollock RE, Weichselbaum RR, et al., editors. Holland-Frei Cancer Medicine. 6th edition. Hamilton (ON): BC Decker. Available from: https://www.ncbi.nlm.nih.gov/books/NBK13955/

Hajdu, S.I. (2004), Greco‐Roman thought about cancer. Cancer, 100: 2048-2051. doi:10.1002/cncr.20198

Hajdu, S.I. (2011), A note from history: Landmarks in history of cancer, part 1. Cancer, 117: 1097-1102. doi:10.1002/cncr.25553

National Cancer Institute. (2019, September). Immunotherapy for Cancer. National Cancer Institute. https://www.cancer.gov/about-cancer/treatment/types/immunotherapy

Image References

Hajdu, S.I. (2004), Greco‐Roman thought about cancer. Cancer, 100: 2048-2051. doi:10.1002/cncr.20198

Hajdu, S.I. (2011), A note from history: Landmarks in history of cancer, part 1. Cancer, 117: 1097-1102. doi:10.1002/cncr.25553

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