Sunday, July 10, 2016

The Evolution of Cancer Treatment

From:, 10-23-10

Mammography is most likely the most important technological advancement in the area of breast cancer detection.

Treatment for breast cancer no longer involves cauterization with hot instruments or surgeries without anesthesia. While surgery is still an option, modern-day treatments for breast cancer also include the use of radiation, chemotherapy, hormone therapy, biological therapy or a combination of them.

Here's a look at the evolution of breast cancer treatment.

— 1600 B.C.: The Edwin Smith Papyrus describes eight cases of tumors or ulcers of the breast that were treated by cauterization, using a hot tool called the fire drill.

— 460-370 B.C.: Greek physician Hippocrates used the terms "carcinos" and "carcinoma" to describe non-ulcer-forming and ulcer-forming tumors. The words refer to a crab and mostly likely described the spreading nature of the disease.

— 1713: Italian doctor Bernardino Ramazzini reported a relatively high incidence of breast cancer and absence of cervical cancer in nuns. The observation was instrumental in the later identification and understanding of hormones and cancer risk.

— 1761: Italian Giovanni Morgagni did autopsies to relate the patient's illness to pathological findings after death. This laid the foundation for scientific oncology, or the study of cancer.

— Mid-1760s: Scottish surgeon John Hunter suggested some cancers might be cured by surgery if the tumor hadn't invaded nearby tissue and was movable. At that time, surgeries were done without anesthesia. Hunter believed cancer spread through the lymphatic system.

— 1840: German surgeon Karl Thiersch showed that cancer metastasizes through the spread of malignant cells, not through fluid.

— 1846: Anesthesia was discovered, and surgeries to remove cancer increased.

— 1860s: Prussian-born Rudolf Virchow provided the scientific basis for the modern pathological study of cancer. Body tissues removed by a surgeon now could be examined, a precise diagnosis made and a determination made whether the surgery had removed all of the cancer. He determined that all cells, including cancer cells, were derived from other cells, not lymph.

— 1882-90s: William Halsted, a professor of surgery at Johns Hopkins University, developed the radical mastectomy, which called for the removal of the breast, lymph nodes and the muscle connecting the breast to the chest wall. He believed local removal of the cancer would cure it. If cancer appeared elsewhere, it was considered a new process. Radical mastectomy was used until the 1970s, when clinical trials demonstrated less extensive surgery was equally effective for most women with breast cancer.

— 1889: English surgeon Stephen Paget concluded cancer cells spread by way of the bloodstream to all organs but were only able to grow in a few organs. This idea eventually led to the development of systemic treatments that could be used before or after surgery to destroy cells.

— Late 1895-96: Scottish surgeon Thomas Beatson discovered that removal of the ovaries often resulted in improvement of breast cancer and believed the ovaries could be a cause of breast cancer. His work provided the foundation for the use of hormone therapy to treat and prevent breast cancer.

— Early 1900s: The use of radiation therapy to treat cancer, administered in daily doses over several weeks, increases.

— Mid-1940s: The U.S. Army found that nitrogen mustard, which is related to mustard gas, worked against cancer in the lymph nodes. The discovery led to other agents that killed rapidly growing cancer cells by damaging their DNA.

— 1956: Metastatic cancer is first cured by methotrexate, a cancer treatment drug still used today.

— 1962: Tamoxifen is discovered. Some breast cancer cells require estrogen to grow. The drug prevents estrogen from binding to the estrogen receptor in breast tissue.

— 1960-90s: Mammography methods were developed. Partial mastectomies, called lumpectomies, replaced radical mastectomies and allowed less normal tissue to be removed during breast cancer surgery. Exploratory operations were replaced by ultrasound, computed tomography (CT scans), magnetic resonance imaging (MRI scans) and positron emission tomography (PET scans). Advances in radiation therapy allowed beams to better target the disease or large doses of radiation be directed to a small tumor. Adjuvant therapy was first tested in breast cancer and indicated chemotherapy after surgery could destroy remaining cancer cells. Combinations of chemotherapy drugs were used to treat cancer.

— 1994-95: BRCA 1 and BRCA 2, the gene mutations that cause breast cancer, were discovered. Herceptin, a monoclonal antibody that blocks the growth of cancer, was approved.

— 2008: Avastin, an angiogenesis inhibitor, was approved to treat metastatic breast cancer. The drug stops tumors from making new blood vessels, which the tumors need to continue growing.

Sources: American Cancer Society; "Bathsheba's Breast: Women, Cancer & History," by James S. Olson


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