Evolution of Cancer Treatment

The advancements in the treatment of cancer have taken many decades to impact survival.  The once sought-after common cause and common cure proved elusive.  The medical community began to focus on prevention and early detection.  Early stage cancer was more and more frequently identified, thereby slightly improving the overall mortality.  Research began to prove that although a cancerous tumor was removed, the cancer may still be growing undetected.  With that concept at the forefront, oncology began prolonging the use chemotherapy and/or the adding of x-ray therapy (XRT).  Early detection and prolonged treatment combined to very slowly improve mortality.  

The evolution of chemotherapy was long and arduous.  As so often happens, many of the early agents were discovered “accidentally”.  Early chemo was cytotoxic, that is toxic to the cells.  It killed the cells in the body that divided the fastest, affecting not only the tumor but also the hair, blood formation and entire GI tract.  The drugs and the dosing schedules were so toxic that often the cancer patient did not survive.  Decades of trial and error gradually refined both to an improved, but still difficult to tolerate, level.  Despite the advances in treatment, as recent as the 2000’s, the cancer patient frequently elected to discontinue treatment for an improved quality of life.  Patients with advanced nodal involvement (T2N3) or distant metastases (T2N2M1) had very short life expectancies, generally 24 months or less.  With current advancements and knowledge as to cell type, tumor grades, differentiation and cytogenetics these predictably low life expectancies have been extended.  Astonishingly, even Stage IV cancers are being significantly impacted.  It is not unheard of to witness the life expectancies of Stage IV colon cancer and melanoma extended by years.  

Next week tumor grades and differentiation, cytogenetics and tumor markers