• Michael Misialek, MD

Taking the Emperor's Throne: Pathologists Battle of Cancer

Cancer, a word that strikes fear, is one of the oldest diseases known to man. As a pathologist, I know the chain of events that is put into motion each time I make the diagnosis. It is not only the patient, but the countless loved ones, family members and friends that are impacted. Cancer has touched all of our lives in some way.


In 2010 Dr. Siddhartha Mukherjee released The Emperor of All Maladies: A Biography of Cancer. It quickly became a best seller and Pulitzer Prize winner. It documents the history of cancer research and treatment from the earliest recorded events in human history to the present day. On March 30, 31 and April 1, PBS will air Cancer: The Emperor of All Maladies, in which the award winning historical film-maker Ken Burns recounts Mukherjee’s book.

All treatment begins with a diagnosis. Pathologists make these diagnoses and have been a major player battling “The Emperor”. According to one of modern day’s most famous pathologists, Dr. Juan Rosai, “Pathology, the parent discipline, started with physicians doing autopsies during the Renaissance in Italy to try to understand the reasons for the symptoms and the signs that they had been monitoring.” However, I contend that pathology started in ancient Egyptian times. The film documents this story.

The world’s oldest documented cases of cancer can be found on papyrus scrolls dating back to 3000 BC in which the Egyptians described tumors of the breast. They recognized the fact that removal was a mainstay of treatment, and did so using what they termed “the fire drill”. The Egyptians certainly had an in depth knowledge of anatomy, as evidenced by their mummification skills.

Around 400 BC the Greek doctor Hippocrates, considered the Father of Medicine, described a woman with breast cancer. He was the first to identify various stages of the disease. He coined the terms carcinos and carcinoma, which in Greek refers to a crab, and certainly was attributed to the appearance of cancer, that often grows and spreads in projections like the claws of a crab. He felt that is was a disturbance in the body’s humors (or fluids) that caused cancer. This theory was later promoted by the Roman doctor Celsus and then the Greek doctor Galen, and remained unchanged for over a thousand years. Treatment of cancer was directed towards purging the body of these evil humors.

It wasn’t until the Middle Ages and the scientific revolution of the Renaissance that our understanding of cancer advanced. It was Leeuwenhoek that popularized the use of the microscope in the 1670s. In 1761, Morgagni was the first to do autopsies to determine cause of death. This was instrumental in our understanding of cancer. The German pathologist Muller in 1838 identified that cancer was made up of cells and not the “humors” of ancient times. Rudolph Virchow, Muller’s student, correlated microscopic findings of cancer with the patient’s disease and laid the foundation for cancer research and surgery. This allowed the pathologist to inform a surgeon intraoperatively of tumor characteristics and even whether it had all been removed, just as is done today.

When Watson and Crick discovered the double helix structure of DNA in 1953, this set the stage for a molecular understanding of cancer that continues to this day. Using new sequencing technologies, the mysteries of cancer are being solved today. The Achilles heel of cancer is exploited in new treatments, so called “precision medicine”. Recognizing this quantum leap, President Obama pledged $215 million as part of the Precision Medicine Initiative.

Mukherjee, now a hematologist-oncologist at Columbia, has strong Boston connections. He received his medical degree from Harvard and did his residency and fellowship at Massachusetts General Hospital. Much of the advances highlighted by Mukherjee have roots in Boston.

Dr. Sidney Farber, a pediatric pathologist in Boston, made several groundbreaking discoveries in the treatment of childhood leukemia. As such, he is considered the father of modern chemotherapy. Dana Farber Cancer Institute is named after him. The film explores these and other breakthroughs, right up to modern day advances such as immunotherapy where the body’s immune system is harnessed to fight cancer. Pathologists have played a key role along the way and promise to do so in the years ahead.

The National Cancer Institute will host a Twitter chat each evening of the film using the hashtag, #CancerFilm. Leading cancer institutions (including Dana Farber Cancer Institute) across the country will be live Tweeting during the film. Join the conversation. Check your local listings for the time and station in your area. I’ll be there and hope you will too. Send a question to me @DrMisialek.

#cancer #pathology #Mukherjee #EmperorofAllMaladies

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