Is there a doctor in the house? Need help with cancer history (1 Viewer)

[Chad R]

I'm looking for information on how cancer was diagnosed in the early 1960's. I've tried the search engines for web sites but am having little luck. I can find the history of cancer, but nothing in the way we diagnosed and treated it for a specific time period.

I just need very general information for a new screenplay I'm writing.

Were X-Rays used? Did MRI's even exist back then? How major of a procedure was a biopsy? Were they even performed?

Any where I can be pointed or any info would be great.

Thanks!

 

[Tom Fynan]

I am not a cancer specialist on televison, but I play one in real life. I've been practicing medical oncology for 12 years, so I can't speak firsthand about diagnosis in the early 1960s, but I can give you some ideas.
Back then, cancer was diagnosed for the most part the way it is now, based on a patient's history and physical exam, followed by a biopsy. Regular X-rays were used when appropriate. CT scans did not come into use until the early 1970s, and MRIs were not in use until the mid 1980s (the first MRI picture I saw was in 1985). I think mammograms were used to diagnose breast cancers then, but were not used for screening, as they are today.
Several specialized X-ray techniques did exist, however. A brain tumor could be imaged then with a technique called a pneumoencephalogram, and spinal cord tumors with a technique called a myelogram. Lymphangiograms were used in the diagnosis of Hodgkin's Disease. None of these are still in use. Lung cancers were seen only with regular old chest X-rays. The treatment of cancer at that time is a much more fascinating story.
You might try looking for some old medical textbooks. Harrison's Internal Medicine is a standard text that was published back then. It would have recommendations on the tests used to diagnose various conditions.
Hope this helps,
Tom Fynan, MD

 

[Jack Briggs]

What about colbalt treatment, Dr. Fynan? My late mother (who died because of The Big C, by the way) had to endure cobalt treatments when she was diagnosed earlier in her life, back in 1971. Man, was she ever nauseated.

I have lots of questions to ask, but I'd be hijacking this thread. But one of them would be: In light of all the genetic research being done, do you see medical technology turning the corner on cancer treatment? Will cancer ever be a thing of the past?

 

[Chad R]

Dr. Fynan,

Thank you so much for the reply! If you could just quickly describe what entailed both a pneumoencephalogram and myelogram, I'd be eternally grateful!

Jack,

Feel free to hijack this thread, I got my answers!

 

[Cees Alons]

I was a medical student in the sixties, so I can try to tell you what we learned.

It wasn't that different, in a way, from today. The most striking difference was the absence of newer scanning techniques (like MRI), so invasive diagnostic methods were used earlier in the course of the diagnosis. But you should not underestimate how (relatively) easy you can get at almost all parts of the body.

Yes, X-rays where important, e.g. for tumors inside the skull and the chest.

But endoscopy, laparascopy, several techniques of taking biopsies were prominent. It still is, because the definitive diagnosis is still dependent on pathology: examination under a microscope.

Jack: cobalt implantation was a method of bringing a radiation source close to the tumor (without exposing other tissue too much - if possible). Nowadays, there are better methods of aiming radiation from outside the body, as well as newer and refined chemotherapy techniques. Do not underestimate the side-effects (especially nausea) of chemotherapy.

There are several studies trying to estimate the effects of modern cancer diagnosis and therapy. There are certainly big improvements, but in some fields the longer survival rate after discovery of a tumor, is mainly caused by the earlier diagnosis. Some people argue that that isn't an improvement of the quality of life.

One cannot be sure if cancer will ever disappear, but we know that it's mainly a fall-back of cells to an unregulated state (in a living organism cells and their growth have to obey to rules aimed at the integrity of the organism as a whole), more or less similar to the single cell situation. It's doubtful if an ever maturing organism can avoid those downfalls forever. And wathever happens - anything that lives, must die, one day.

Cees

 

[Tom Fynan]

Chad,

A pneumoencehalogram involved injecting air into the ventricles (the fluid filled cisterns inside the brain) and then taking X-rays. I think Bette Davis had one in Dark Victory. It's how George Gershwin's brain tumor was diagnosed. It all sounds pretty ghastly.

Myelograms are a variation on that theme. X-ray dye is injected into the spinal fluid, done via a spinal tap in the lower spine. The patient is then tipped in varying degrees to get the dye to travel up toward the brain. X-rays show if there is any blockage in the spinal canal, indicating a tumor.

Radiation was being used as a treatment for cancer in the 60's, and in fact had been since shortly after X-rays were discovered by Marie Curie in the early 1900s. Cobalt has been replaced by better radiation sources, and nausea is still an issue, but we have better drugs to treat it. Surgery was the mainstay of cancer treatment (and still is) if the tumor was resectable. Chemotherapy was first used to treat cancer in the mid 1940's (it grew out of chemical warfare research done during World War II. The first chemotherapy was given at Yale University (where I did my training) in 1942. It's a fascinating story that would make a great movie. Chemotherapy wasn't of much use until the late 1960's, when new drugs and new ideas made it more effective.

Jack, in some ways we have turned the corner in cancer treatment. We now understand at a molecular level what makes a cell turn cancerous, and we are beginning to develop the technology to turn that information into treatments. I can now use antibody treatments and other non-chemotherapies to treat some of my patients. New stuff is coming alon all the time, which is part of what makes oncology a great profession to be in. My educated guess is that in 10 or 15 years cancer will be a chronic disease, much like diabetes or high blood pressure, or even AIDS is these days. Part of the problem with cancer is that it is not one disease - each organ has its own type of cancer, and they're all different.

Tom Fynan

 

[Dome Vongvises]

Jack Briggs said

In light of all the genetic research being done, do you see medical technology turning the corner on cancer treatment?

Well, to be honest, everybody on this forum (even as young as little Matt Chmiel) will probably be dead before cancer treatment improves. But there is some hope. I'm doing a paper right now on the "common cold", but I happened upon research being done using adenoviruses (one of many viruses that causes the common cold) as vectors for gene therapy in cancer cases. I forgot what the logic or thinking behind it was, but I think it had something to do with the ease with which to manipulate the genome in an adenovirus.

As for the question in the thread, try PubMed or SilverPlatter. Since these are "licensed"? search engines, you might need to go to a college library.

 

[Don Black]

I really doubt that ... I'm speaking from basically 0 knowledge but I'm guessing that in 20-30 years (exactly when I start worrying about C) we will have cancer down to a manageable, livable illness. A cure might be decades off .. but successful treatments I think are certainly possible in 1-3 decades.

 

[Jack Briggs]

"My educated guess is that in 10 or 15 years cancer will be a chronic disease, much like diabetes or high blood pressure, or even AIDS is these days. Part of the problem with cancer is that it is not one disease - each organ has its own type of cancer, and they're all different.

Those are very encouraging words, Dr. Fynan. Very encouraging. Especially to this HTFer: from a genetic standpoint, the cards are stacked against me--both parents died from it (colon cancer in my mother, lung cancer in my father).

But I sure hope your projection of ten to fifteen years proves correct. I am hoping to live long enough to see the first humans walk on Mars!

Re each organ having its own type of carcinoma: I once heard, I think on PBS's NOVA, that the same forms of cancer are different in various individuals. That is, one person's lung cancer might not be the same as another's. If I understand correctly, this fact has been one of the major stumbling blocks to the conquest of this/these disease(s).

Very enlightening post, sir. Same for Cees's.

 

[Chad R]

Thank you again, Dr. Fynan and a big thank you goes out to Dr. Alons also! Excellent info which will be put to use!

 

[Cees Alons]

Jack,

Colon-cancer is indeed known for genetic factors in the etiology. However that isn't true at all for lung-cancer. As you know, there is indeed an important predestination factor for several types of cancer of the lung: smoking cigarettes.

But even if there's something in your genes to make you like that, you can avoid it by sheer willpower.

Cees

 

[Jack Briggs]

Which, alas, is a problem for me, Cees. And, at my baby-boomer age (trailing edge, that is), I wonder if it's too late for quitting to make any difference, that I've reached the point of no return. As I understand, lung cancers get started about ten years before they can be detected--and by the time they are detected, it's really too late for any sort of treatment to be effective other than to extend one's life by a few months.

I know I sound fatalistic here, but, man, I've seen up close what these diseases do to people--the wasting, the odors, the nausea, and, most of all, the pain. I would favor euthenasia over experiencing what my parents did.

 

[Rachael B]

Nobody has mentioned the role of the pathologist who looks at the tissue samples that have been removed and put on slides for viewing and diagnosis. That's what my late father did. Unfortuneatly, he was taken by a malignant brain tumour, a glieo blastoma. < I hope I spelled that right. Ironically, my dad's work proably led to his preature demise. One of the risk factors for glieo blastoma is expousure to formaldehyde.
In his labratory the tissue samples were in jars of formaldehyde. When he opened one the room reeked. He developed a cough from all the expousure too, as if he smoked. He was the youngest looking, srongest looking 73 year old imaginable when he got the tumour. He only lived about 7 months with it. Removing it nearly killed him. Chemo did little or nothing. Glieo blastomas are one of the worst malignancies you can get. this type of tumour devours the brain. Some other types grow between, around brain tissue. They're far more treatable. I can't imagine glieo blastoma being treatable anytime soon or ever. It's a death sentence.
Anyway, pathologists are present for biobsies frequently. They may tell the surgeon to get some of that over there. Then the samples are made into frozen sections (slides) for analysis. Then the onocologists take over the actual treatment process. Best wishes!

 

[Cees Alons]

Jack,
The bad news is: I can't help getting you off the hook, because...
The good news is, that quitting does make a difference. Several studies show that someone who totally quits smoking will have the quality of his lungs restored over time - to use a fast rule: about the time you have been smoking.
So, let's say (again: this is a very rough approximation, and there are several other factors): someone smokes heavily from his 15th - 30th year. Then his chances (statistically) to severe lung problems, including certain types of cancer, may be equal to someone who didn't smoke, but is much, much older (or even: worse than anyone who never smoked). But if that smoker quits smoking altogether at 30, his expectations at 45 can be about the same again as someone else of 45 who has never smoked.
Now this is a severe simplification of things, and a lot more can be said, but the main lesson is: yes it makes sense to quit smoking.
But if you feel it's wise to do it, do it properly: quit totally! And never do it again. That seems to be the only way that could really help achieving your goal. Tell anyone you know that you stopped. Make a big thing of it. It will help you look ridiculous if you light one .
Decide suddenly (not: "next week, Friday, I will quit smoking, when my last cigarette is gone") . Destroy every cigarette in your possession, the box in your pocket and on your table (under your foot, throw the rest in the fire ). Financially, that won't make any difference, of course: they were going to be burned anyway. Once you stopped, you will feel terrible for a while, but then for a good reason grow proud of yourself: you will find out that you can do it. Make sure you always remember why.
Ha, ha. I can easily say all this, I stopped at 16, before I ever really started (and tried cigars and a pipe for some time, but then decided it was not for me). Note that a former cigarette smoker should never switch to cigars or pipe (he would inhale).
I do hope I didn't make your life more miserable now, by suggesting a possible, in fact necessary, but terrible change .
Cees

 

[Jack Briggs]

The voice of logic and wisdom as always, Cees. I see what you're saying, and I agree. I really, really do want to quit. Think of all the DVDs I could then obtain--and still have a fighting chance to see the first manned landing on Mars!

 

[Cees Alons]

Rachael,
I mentioned pathology in my third little paragraph! How could I ever forget it: I worked for 9 years in a Pathology Department, doing research. And I met my wife there, who is a trained Pathologist herself!
It's sad to hear about your father's situation. BTW, there are several types of glioblastoma, generally denoted as grades (1-4). Not all are equally threatening, they also have different growth rates. I don't think the formaldehyde is seen as a major risk factor for this type of brain tumor, nowadays. I'm out of the field myself for many years now, but I just asked my wife (), who doesn't think so either. Perhaps he "just got it", and it wasn't caused by his profession after all.
Cees

 

[Cees Alons]

Jack,
If you want it - you can! And it makes sense!
And those are my final words to you about this matter (I know how boring it can be if someone goes on about it forever).
Cees