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Evolution of Surgery as a Cancer Treatment

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Image is courtesy of The Science Museum.


Cancer care has had its ups and downs throughout history, not only due to treatment ineffectiveness and side effects but also due to high ambition and the reality of complete recovery and cure in many cases. Antitumour medications and radiation have been the treatment choice in some cases and are part of the clinical arsenal, alongside surgery in the case of solid tumours. Nanotechnology is a relatively new therapeutic choice, with nanostructures being used for controlled drug delivery, integrating imaging and treatment, applying hyperthermia, and providing guided target therapy, among other applications. And of course, immunotherapy that increased in popularity as a treatment method in recent years, and it is now the first choice in many cases. However, this article is specifically to look at the evolution of surgery in cancer treatments.


The Roman physician Celsus along with many other ancient surgeons knew that even after the removal of tumors, the disease still, in many cases, comes back. They understood that once cancer had spread, there was no remedy. They even figure that interfering could be more dangerous than not intervening at all. Back then, however, surgery was rudimentary, with various problems including blood loss. Galen, a surgeon, and philosopher in the Roman Empire explored surgical cures for breast cancer. He wrote that the tumour could be removed entirely at an early stage.


William Stewart Halsted, Courtesy of The Lancet

Towards the end of the nineteenth and twentieth centuries, there were some major advances that were made in general and cancer surgery. During the last decade of the nineteenth century, William Stewart Halsted, a professor of surgery at Johns Hopkins University, invented the technique known as radical mastectomy. His study was inspired by W. Sampson Handley, a surgeon from London who believed that cancer cells spread outward from the original tumour. Though, Halsted did not believe that cancer could spread through the bloodstream and he assumed that eliminating the cancer locally would cure it; if the cancer resurfaced elsewhere, it would be a new method. Thus, he created the radical mastectomy for breast cancer as a result of this conviction.


For nearly a century, this was the cornerstone of cancer surgery. Then, in the 1970s, modern clinical trials found that for most breast cancer patients, less invasive surgery is equally successful. A radical mastectomy is often not performed today, and the "modified radical mastectomy" is performed relatively less frequently than it used to be. The primary tumour is removed (lumpectomy) and then radiation therapy is given to most women with breast cancer.

Surgeons strengthened their technological skills in minimizing the amount of normal tissue removed during cancer operations during the last decades of the twentieth century. Until then, cancer diagnosis often needed "exploratory surgery" to open the abdomen or chest so that the surgeon could take samples of tissue to be tested for cancer. Starting in the 1970s, advances in imaging tests such as ultrasound (sonography), computed tomography (CT scans), magnetic resonance imaging (MRI scans), and positron emission tomography (PET scans) have substituted many exploratory operations. CT scans and ultrasound may also be used to direct biopsy needles to tumours.


Doctors today use fibre optic technology instruments and miniature video cameras to look inside the body. Surgeons can operate with special surgical instruments through narrow tubes placed in minor incisions in the skin. Such tools can be used to look and work inside the abdomen (laparoscopic surgery) or the chest (thorascopic surgery). There are many studies currently being researched and used. For example, cryosurgery, also known as cryotherapy or cryoablation, which requires liquid nitrogen spray to freeze and kill abnormal cells.

Cancer surgery has flourished and is driven by groundbreaking research and innovation. In the past 50 years, there has been a prodigious shift in the way we treat cancer that enhanced cure rates using minimally invasive techniques that reduce the need for or the effects of radical surgery. Fortunately, today’s surgeons, along with other medical professionals have been thoroughly trained and have made cancer surgeries a safe and highly effective way to treat cancer.


References


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

Evolution of cancer treatments: Surgery. (Last revised: 2014). Retrieved February 28, 2021, from

https://www.cancer.org/cancer/cancer-basics/history-of-cancer/cancer-treatment-surgery.htm

Wyld, L., Audisio, R. A., & Poston, G. J. (2015). The evolution of cancer surgery and future perspectives. Nature Reviews Clinical Oncology, 12(2), 115–124. https://doi.org/10.1038/nrclinonc.2014.191



Article Author: Celine Guirguis

Article Editors: Edie Whittington, Sherilyn Wen