Bridging the Gap. James Eugene Munson
the century that followed, until the 1970s, when surgeons were able to modify the mastectomy using more sophisticated techniques and making it less disfiguring with fewer side effects.51
During this same time period (late 19th – early 20th century) another physician, Stephen Paget, determined that cancer cells could spread from the primary tumor through the bloodstream to another location in the body.52 This unique and significant concept was eventually proven in modern day medical research because of technological advances that explain cellular biology and the process of metastasis. As Paget’s findings became more readily acknowledged in the medical community, physicians recognized the limitations of cancer surgery, in that, full excision of a tumor and the surrounding area did not equate with a curative outcome. In addition, systemic treatments after surgery were developed to enhance the rate of survival by continuing to destroy malignant cells; this also lessened the extent to which surgery was performed, thereby decreasing the surgical mutilation. Exploratory surgery was often required to make a complete diagnosis of cancer, but with the advances of ultrasound and imaging, invasive surgeries are quite limited. This has occurred due to the development of chemotherapy and radiation, both of which have a more recent history and continue to be a mainstream approach to combating a cancer diagnosis.
Radiation therapy
Radiation therapy, also known as radiation oncology or radiotherapy was discovered after the advent of the X-ray. In 1896, a German physics professor by the name of Wilhem Conrad Roentgen presented a lecture entitled “Concerning A New Kind of Ray” and within months, the scientific community had designed systemic approaches and X-ray machines for identifying broken bones or locating foreign objects.53 Further research on the element radium proved quite successful, as scientists found that radium also killed diseased cells, targeting damaged DNA. There began a new and instrumental era of medical oncology.
Currently, at least half of all cancer patients are prescribed some form of radiation therapy.54 Scientific advancements in the field of radiation therapy have improved greatly. The precision of radiotherapy has been refined to offset unnecessary exposures. There are several methods of radiation therapy, which include: proton beam therapy (targets tumor cells directly), stereotactic surgery and therapy (gamma knife used for brain tumor), and intra-operative radiation therapy (applied after surgical removal of tumor to adjacent tissue). These advanced surgical techniques have allowed oncologists to truly refine their practice, thus providing patients with enhanced quality of life and potential for better outcomes.
Chemotherapy
About the same time that radiation therapy was discovered in the early 1900s, a German chemist by the name of Paul Ehrlich began developing drugs to treat illnesses.55 The concept of chemotherapy as systemic medicine came from this research, and the term chemotherapy was born defined as the use of chemicals to treat disease. It appeared to be a natural progression to use chemical compositions in order to create a drug for the treatment of cancer. However, the evolution of chemotherapy agents has been constantly challenged by the concept of specificity. Specificity refers to a medicine’s ability to differentiate between its intended target and its host. “The trouble lies in finding a selective poison, a drug that will kill cancer without annihilating the patient. Systemic therapy without specificity is an indiscriminate bomb.”56
It wasn’t until World War II, when researchers observed United States Navy sailors who were exposed to mustard gas during military activity and who experienced changes in bone marrow cells. As a result, scientists began to examine nitrogen mustard and its effects on white blood cells in the bloodstream or bone marrow when dosed in a controlled setting. After animal studies confirmed that malignant cells in blood and bone marrow disappeared without the negative effects of nitrogen mustard, doctors prescribed the chemical agent on humans with lymphoma. Almost immediately, swollen glands decreased in size, and it appeared as though remission was inevitable. Unfortunately, relapses were imminent and patients’ tumors would grow, harden, and the cancer would return. Nonetheless, nitrogen mustard inspired scientists and chemotherapists to continue research on chemical agents that might effectively destroy rapidly growing cancer cells by damaging their DNA.
In 1954, The National Cancer Institute (NCI) was authorized by the Senate to create cancer research-based programs. This led to the development of the Cancer Chemotherapy National Service Center (CCNSC), which allowed scientists to test chemotherapeutic drugs in controlled targeted settings. From 1954–1964, over 82,000 synthetic chemicals were tested, including 115,000 fermented products and 17,200 plant derivatives.57 The significant amount of research on chemical formulations reflected the fervent hope of finding curative substances for cancer. However, the decades that followed included many challenges for the chemotherapist.
Medical oncology was not a designated specialty in the 1960s. Those who administered chemotherapy were not regarded as specialists of cancer, but rather, referred to with less reputable names. For example, Louis K. Albert, who was involved in initial studies on nitrogen mustard and early lymphoma cases was known as “Louis the Hawk and his poisons” simply because he was often present during chemotherapy infusions. Quite simply, anti-cancer drugs in the 1960s were predominantly considered to be poison and not medicine. This sentiment has not completely disappeared in modern day cancer treatment.
Nonetheless, research continued and was led by those with utmost commitment to finding a cure for cancer through effective safe chemotherapy. The discovery of aminopterin, a compound related to folic acid, proved successful through its ability to promote remission in children with Acute Lymphoblastic Leukemia (ALL). This drug was the predecessor of methotrexate, one of the oldest chemotherapy drugs frequently used in treatment today. The evolution of chemotherapy continued rapidly and by the 1970s, adjuvant chemotherapy was introduced. Adjuvant chemotherapy is employed after surgery to kill any micrometastatic disease that may remain, thus preventing a recurrence. This is similar to the approach of administering radiation post-operatively to lessen the degree of growth for small tumors unable to be surgically removed.
By 1971 the “war on cancer” had formally begun as a result of the National Cancer Act. This act instituted a substantial amount of funding, which allocated billions of dollars for research specific to drug development and clinical trials. The momentum from this increase in funding escalated research in cancer pathology and more refined chemotherapy treatments. Additional systemic treatments were extrapolated including hormone therapies, targeted therapies, immunotherapies and biologic therapies. These categories of drugs would not exist without the dedication and courage of early oncologists who participated in the advancement of chemotherapy. From the mid 19th century to present day, this research has been integral to the development of successful, therapeutic outcomes in a cancer diagnosis.
The history and evolution of Chinese medical oncology proceeds without much deviation from its historical findings. The classical references to tumors date back over 2,000 years, and astonishingly, the theoretical applications remain the same. Chinese medicine’s methods of zang-fu pattern differentiation, as well as addressing the individual’s constitution, were aspects to oncology evolution that were not included in the Western medical paradigm. In current practice, Chinese medicine continues to adhere to the foundations of diagnosis through examination of the following: zang-fu, yin-yang theory, five elements, meridians and collaterals, qi and blood, body fluid, six excesses and five emotions. Within TCM, a continuity exists. The diagnostic methods are based on principles that reflect nature; these principles evolve with nature as they were intended to do. In modern day China, the practice of TCM and Western medicine, which was brought in during the 1900s Cultural Revolution as a means to modernize the country, are blended as a hybrid model of medicine.
It is evident through its historical evolution, that the aggressive nature of cancer has existed for thousands of years. Although it persists, statistics indicate that there is a downward trend of the disease with overall improved outcomes. It requires a certain hypervigilance by those who choose to practice in the field of oncology, and even more so by individuals diagnosed with cancer.
References
American Cancer Society. (2012).