The art of diagnosing tumors—A brief history
The first clues to the disease that would later be known as cancer probably came from observing skin ulcers that didn't heal with standard treatments. An account of such a condition, written on an Egyptian papyrus in the 15th century B.C., constitutes one of the first known references to the disease.
By the time of Hippocrates — the fourth century B.C. — physicians already knew that cancer was a chameleon, taking different forms in different organs. They were familiar with cancer of the stomach and the uterus, and were able to describe the symptoms of each. Beyond that, however, they were mostly guessing. There was little sense of how cancer differed from other conditions, what caused it, or what, in essence, it actually was.
The Greek physician Galen, in the second century A.D., came up with a classification system that is in many ways still valid. He recognized "tumors according to nature," such as the enlargement of the breasts that occurs during puberty; "tumors exceeding nature," such as the thick mass of tissue that sometimes forms around a bone break; and "tumors contrary to nature," which today would be considered benign or malignant cancers.
The French physician Marie-Francois Xavier Bichat made an important contribution when he proposed in the early 19th century that all organs are made of basic structures called tissues, and that cancer represents an accidental growth of such tissue. What made his theory noteworthy was not just its accuracy, but the fact that he made it without using a microscope (a gadget he felt would never be useful for studying cancer).
Bichat's views notwithstanding, it was the development of the microscope that revolutionized cancer diagnosis. For the first time, scientists could observe individual cells and detect the subtle and not-so-subtle differences between normal cells and cancerous ones. To this day, the microscopic examination by a skilled pathologist is the primary method for determining if tissue is cancerous.
Even that, however, is being changed by technology. Today, the pathologist's microscope is being supplemented by other techniques that probe some of the cell's smallest parts. Immunophenotyping, for example, analyzes specific structures on the surface of cells, while cytogenetics examines the chromosomes in cells to determine their genetic makeup. Advances like these are bringing ever-more precision to the diagnosis of an ancient disease.
SOURCES:
Freddy Homburger, M.D., Biologic Basis of Cancer Management
(New York: Harper & Brothers, 1957)
Charles Oberling, M.D., The Riddle of Cancer
(New Haven: Yale University Press, 1944)
Channing C. Simmons, M.D., ed., Cancer: A Manual for Practitioners (Boston: Rumford Press, 1940)
University of Virginia Health System Web Site.
