The treatment of cancer

The first recorded reference to cancer was in the Edwin Smith Papyrus of 3000 BC, in which eight women with breast cancer are described. The writings of Hippocrates in 400 BC contain several descriptions of cancer in different sites. But our understanding of the disease really began in the nine­teenth century with the advent of cellular pathology.

Successful treatment by radical surgery became possi­ble in the later part of that century thanks to advances in

MCSthetks and antiseptics. Radical surgery involved the icrnoval of the tumour-containing organ and the drain­ing of its lymph nodes in one block. Halstead in lohns Hopkins was the main protagonist of the radical mastec­tomy, Wcrtheim of the hysterectomy. Trotter of the pharyn-gectomy and Miles of abdomino-perineal resection of the rectum. These diverse surgical procedures all followed the same principles. The twentieth century ended with the conservation of organs by minimizing the destruction caused by surgery and replacing it with radiotherapy and, for some sites, effective adjuvant therapy with drugs.

Radiotherapy has come a long way since the first patient with a nasal tumour was treated in 1899, only a year after the discovery of radium by Marie Curie. Although radiobiology developed as a research discipline, it has really con­tributed little to clinical practice. The rationale behind modern fractionated radiotherapy comes as much from empirical trial and error as from experimental results. Radio­therapy is remarkably successful tor certain areas of the body. Increasing sophistication in equipment coupled with dramatic strides in imaging have led to great precision in the planning and execution of treatment, thus sparing critical normal tissues and increasing the dose to the tumour.

The sinking of the US battleship John B Harvey in Bari Harbour in Italy by the Germans in 1942 led to the devel­opment ot effective chemotherapy.

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Most currently used drugs were found serendipitously from plants or fungi – paclitaxel, vjn-cristine, doxorubicin – and not by rational drug design. Although very successfully used in combination for lym­phoma, leukaemia, choriocarcinoma, testicular cancer and several childhood cancers, results in metastatic common solid tumours have been disappointing, with little more than palliative benefit . The advent of molecu­larly targeted drugs promises to change this dramatically.

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