History of Cancer Treatment

The Ebers Papyrus, an Egyptian medical text compiled around 1550 BCE, contains references to tumors and their treatment. In Greece, Hippocrates (c. 460–370 BCE) is credited with using the term karkinos (Greek for "crab") to describe tumors, and the Roman physician Galen (c. 131–201 CE) used the term carcinoma and described the appearance and behavior of tumors. These early accounts show that cancer was recognized as a distinct condition, but they offered no reliable way to treat it.

For most of this period, treatment was local and often brutal: cutting out tumors, burning them with cautery, or applying potions and minerals. These approaches were shaped by humoral theory, which held that disease resulted from an imbalance of the body's four humors. Without a way to see inside the body or to understand what a tumor actually was, practitioners could only guess.

The German pathologist Rudolf Virchow (1821–1902) developed the theory of cellular pathology, published in Cellularpathologie in 1858. Virchow argued that disease, including cancer, originates in the cell. This was a decisive shift: it made it possible to classify tumors by their cellular structure and to distinguish cancers that behaved differently. The development of microscopy in medicine and pathology was essential to this change.

Examination of removed tissue connected surgery to diagnosis, margins, prognosis, and decisions about additional treatment. Pathology defined the target: it told surgeons what they were removing and whether the removal was complete. This connection between the operating table and the laboratory became a defining feature of modern cancer care.

The American surgeon William Stewart Halsted (1852–1922) developed his radical mastectomy at Johns Hopkins, beginning in the 1880s, and published his results in 1894. The operation removed the breast, the underlying muscles, and the lymph nodes. The operation became the standard treatment for breast cancer from the 1890s through the 1970s. It was based on the belief that cancer spread in an orderly, step-by-step fashion, and that removing a wide margin of tissue would prevent it from returning. The history of surgery provides the broader context for this era.

In the 1970s and 1980s, randomized trials, notably those led by Bernard Fisher and the National Surgical Adjuvant Breast and Bowel Project (NSABP), showed that breast-conserving surgery plus radiation could be as effective as radical mastectomy for early-stage breast cancer. This was a turning point: it showed that more extensive surgery was not always more effective, and it strengthened less destructive approaches when outcomes were equivalent. The history of clinical trials explains how these comparisons were made.

In 1896, the French physicist Henri Becquerel discovered spontaneous radioactivity while studying uranium salts. Marie and Pierre Curie discovered the elements polonium and radium in 1898, and early radiation burns experienced by researchers demonstrated that the emissions could damage living tissue. Becquerel and the Curies shared the 1903 Nobel Prize in Physics. Marie Curie received a second Nobel Prize, in Chemistry, in 1911, after she and André-Louis Debierne had isolated radium metal in 1910. See the profile of Marie Curie.

In the early 1900s, physicians in Paris and elsewhere began experimenting with radium sources placed directly on or near tumors, and it could shrink them. X-rays, discovered by Wilhelm Röntgen in 1895, were also used to treat cancer from 1896. The history of radiology and medical imaging provide the broader context for these developments.

Radiation therapy required careful planning: the dose had to be high enough to damage the tumor but low enough to spare healthy tissue. This led to the development of fractionated doses, shielding, and long-term follow-up. Radiation remains a central part of cancer treatment today, often combined with surgery or chemotherapy.

The first chemotherapy drugs came from an unexpected source: mustard gas. Earlier observations that mustard agents damaged bone marrow led wartime researchers to test related compounds against cancer. In 1942, nitrogen mustard was used experimentally to treat a patient with lymphoma; wartime secrecy delayed publication of the work until 1946. This was the beginning of chemotherapy: the use of chemicals to treat cancer.

In the late 1940s, the American pediatrician Sidney Farber (1903–1973) used aminopterin, a folate antagonist, to treat childhood acute lymphoblastic leukemia (ALL). In 1948, he and his colleagues reported temporary remissions in childhood leukemia. This was a landmark: it showed that a drug could shrink a cancer, even if the remissions were often temporary. The development of methotrexate in the 1950s and the work of Gertrude Elion and George Hitchings on antimetabolites further advanced the field. See the profile of Gertrude Elion.

In the 1960s and 1970s, combination chemotherapy, which used several drugs with different mechanisms, dramatically improved survival. The 5-year survival rate for childhood leukemia rose from about 10% in the 1960s to over 80% by the 1990s. Combination regimens for Hodgkin's lymphoma, such as MOPP, also showed that some cancers could be cured with drugs alone. Chemotherapy demanded careful management of infection, bleeding, nausea, and organ toxicity.

In the 1970s, researchers began to explore the possibility of using the immune system, including antibodies, to target cancer cells. This was an early step toward what would later become immunotherapy. Decades later, in 2011, the first immune checkpoint inhibitor, ipilimumab, was approved for melanoma. In 2014, pembrolizumab, another checkpoint inhibitor, was approved. These drugs work by releasing the brakes on the immune system, allowing it to attack cancer cells.

Targeted therapy, which targets the specific changes in cancer cells that help them grow, also emerged in this period. In 1998, Herceptin (trastuzumab) was approved for HER2-positive breast cancer, one of the first targeted therapies. In 2001, imatinib (Gleevec) was approved for chronic myeloid leukemia (CML). Imatinib inhibits the BCR-ABL fusion protein that drives CML, and it transformed CML from a fatal disease into a manageable chronic condition. These successes showed that understanding the biology of a specific cancer could lead to effective, targeted treatments.

George Papanicolaou reported the diagnostic potential of cervical-cell sampling in 1928; a 1943 monograph with Herbert Traut helped establish the method later known as the Pap test. It uses cervical cells to detect precancerous changes and cancer. It became one of the most successful screening tests in history, dramatically reducing the incidence and mortality of cervical cancer in countries where it is widely used.

Mammography, the use of X-rays to image the breast, was developed in the 1930s and used for breast cancer screening from the 1960s and 1970s. Randomized trials in the 1970s and 1980s showed that mammographic screening could reduce breast cancer mortality, although the benefits and harms of screening remain a subject of ongoing debate.

In 1951, cells were taken from the cervical tumor of Henrietta Lacks, a Black woman from Virginia, without her knowledge or consent. These cells, known as HeLa, became the first immortal human cell line and are used in research worldwide. Lacks died in 1951, and her family was not told about the cells for decades. Her story raised important ethical questions about consent, ownership, and the use of human tissue in research. See the profile of Henrietta Lacks and the history of medical ethics.

Screening and treatment remain unequal because specialist centers, pathology, imaging, medicines, travel, and continuing follow-up are not distributed evenly. Technical progress becomes public benefit only when health systems can deliver it safely and affordably. The history of cancer treatment is therefore also a history of who had access to treatment, and who did not.

Today, most people with cancer receive a combination of treatments, such as surgery with chemotherapy and radiation therapy. The National Cancer Institute (NCI) recognizes several types of treatment, including surgery, radiation therapy, chemotherapy, hormone therapy, immunotherapy, targeted therapy, blood stem cell transplant, and biomarker testing. The NCI's overview of cancer treatment types shows how these approaches now combine.

Survival also made late effects, fertility, pain, disability, recurrence, employment, and psychological support central to care. Patients and advocacy groups pressed institutions to measure quality of life and to communicate uncertainty rather than treating tumor response as the only outcome.