Cancer is a devastating illness that has aroused dread throughout history. Today, it is the second leading cause of death in the United States, exceeded only by heart disease.
Cancer mortality rates peaked in 1991. Since then, according to recent reports in the “Journal of the American Medical Association” and from the American Cancer Society, there has been a 27 percent decline in deaths from the most common tumors: lung, colon-rectal, breast and prostate.
A reduction in tobacco use, greater awareness of risk factors, better early detection and new therapies are responsible for the enhanced outcomes. While the mortality toll has decreased for some types of the disorder, there remains far too many afflicted individuals where malignancy is still winning.
Cancer is a complex group of diseases that defies every rule of biologic sensibilities. There is no one single cause that is responsible for the condition. Many factors interact to produce mutations within cells. These alterations stimulates rapid growth.
Groups of abnormal cells join together in a pact of destruction. They proliferate uncontrollably and spread to distant parts of the body, along the way eroding blood vessels and destroying vital centers.
Cancer does not affect people equally. The difference in impact occurs because of genetics, hormonal factors, environmental exposure, and unhealthy lifestyles. But for most tumors, increasing age is the single most important risk factor. Eighty percent of all malignancies in the United States are diagnosed in people 55 years of age or older.
Cancer is the prototypical modern disease that is also one of the oldest on record. It has been recognized in the bones of the prehistoric cave dwellers and the Egyptian mummies. The ancient Greeks and Romans designated the signature swellings as carcinos, or crablike. Hippocrates, the “Father of Modern Medicine,” said, “Just as a crab’s feet extend from every part of its body so in this disease the veins are distended forming a similar figure.”
For most of medical history the treatment of cancer was within the exclusive province of surgeons. They frequently removed superficial tumors visible on the surface. For many centuries the scalpel could not battle malignancies inside the body. With the introduction of anesthesia, improved methods to control shock, blood replacement and antibiotics, more radical and safer surgery evolved.
At the start of the 20th century, clinicians began using radiation to reduce the size of tumors. For decades surgery and radiation were the principal treatments for cancer. In 1947 chemotherapy was discovered and joined the medical armamentarium to subdue malignancies.
More recently oncology, the branch of medicine that deals with tumors, has undergone a revolution. The catalyst for this change has been the advancement in the comprehension of cancer’s cellular biology.
This knowledge has generated a shift from the classic therapies that are based on the tumor’s anatomic site of origin to innovative medications that attack malignant changes at the molecular level. These new agents can sometimes be combined with traditional regimens to improve outcomes.
One advance is immunotherapy.
It utilizes the body’s own existing arsenal of natural defenses to stop or slow the growth of malignant cells. Based on this concept, researchers in New York recently announced preliminary success in a small clinical trial of an experimental cancer “vaccine” for lymphoma. It is used in patients who already have the cancer, but it is not preventative like a flu shot. Further study is necessary.
Another treatment category is monoclonal antibodies that target particular kinds of tumors. It has already become a standard component of care for patients with non-small cell lung cancer. Unfortunately, not all malignancies are responsive to this class of pharmaceuticals.
Cancer is a tough disease for scientists to harness, but emerging cutting-edge research holds promise for the future. As novel treatments become available, some will continue to improve the odds of survival while other discoveries hopefully may unearth the heretofore elusive cure for all forms of this dreaded ancient malady.
Stolz is a retired physician and author of the book “Medicine from Cave Dwellers to Millennials.”