History of Surgical Oncology

 Drastic changes in cancer treatment over the past few centuries led to the introduction of a term called surgery. Role of surgeon in treating cancer is referred as cancer surgeon and /or Surgical Oncologist. History of cancer therapy states that surgery is the first line of defense mechanism. Later, as non adjuvant therapy was introduced, surgery came down to second or third line of defense.

Treating superficial cancers with surgery is not a new technique. Old historical records show that surgery was practiced in Egyptian Papyri in the year 1700 B.C. to cautery destruction of breast. First and second century A.D.  Roman physician namely, Celsus and Galen made a note on breast cancer surgical operation. Lenoidas, a Greek physician described breast cancer therapy as mastectomy and cautery for homeostasis. During the 5^th century, surgical operation was done with Dark Age of medicines. Modern medicines  began  after the invention of humoral theories of diseases of white and black bile, blood and phlegm.

John Hunter  (1728 – 1793) was referred as Father of Surgery. He introduced the surgical principles and concepts for curing cancer patients. Before the proposal of Halsted’s theory, Hunter stressed that cancerous cells should be removed completely. He described that cancer cells spread throughout the lymphatic system. Better understanding of fields like pathology and anatomy lead to the development of general anesthesia in the year 1842. Lister proposed the principles of antisepsis in the year 1867. With this invention surgical oncology broke the limitation of treating superficial tumors of breast cancer to treat abdominal malignancies.

The first surgical oncologist was Theodore Billroth, Vienna. He was famous as

• First partial gastrectomy of cancer in the year 1881
• First total laryngectomy in the year 1873
• First hemipelvectomy in the year 1891
• First to remove suprapubic bladder tumor

Resection of colon cancer was done by Weir in the year 1885. Halsted treated breast cancer with radical mastectomy in the year 1891. Kelly introduced radical hysterectomy for cancer in the year 1895. Crile was the first to the first to perform radical neck dissection in the year 1906. W. Ernest Miles was the first to treat the rectal cancer by abdominoperineal resection in the year 1908. Theodore Kocher was the first to describe  thyroid surgery in the year 1909. Surgery was in practice till the first half of twentieth century. Cancer surgeons’ terminology was introduced when surgery raised curative symptoms and palliative symptoms.

Cancer treatment centers like American College of Surgeons and American Association for the Advancement of Cancer or American Cancer Society were constructed in the year 1913. Multidisciplinary concept of treating cancer was published in Neoplastic diseases by James Ewing in the year 1919. Pulmonary metases was first resectioned by George Divis in the year 1927. Pancreaticduodenectomy was developed to treat pancreatic cancer in the year 1935 by Allen O. Whipple. Jamed Ewing society was established in the year 1940. Chemotherapeutic drugs like nitrogen mustards and folic acid antagonists was developed in the 1940s. National Surgical Adjuvant Breast Project (NAABP) was first initiated in the year 1957. Division of surgical oncology was established by Dr. Walter Lawrence in Medical College of Virginia. Society of Surgical Oncology (SSO) was established in the year 1975. Surgical Oncologist was defined by SSO and NCI (National Cancer Institute) in the year 1978. Advisory Council for Surgical Oncology as The American College of Surgeons Oncology Group was established in the year 1998. In view of multidisciplinary advances in oncology, role of surgical oncologists  became significant and remarkable in the field of surgical oncology.          

Questions:

• How surgery is practiced in ancient times to treat cancer?
• What is the role of an oncology surgeon?
• Give a brief description about the Father of Surgery.