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“All things change, and we change with them.”

Chinese Proverb

Despite cancer’s persistent and dominant presence in medicine today, its roots extend back thousands of years. This long history exemplifies the disease’s complex and resilient nature. Cancer has not been discriminatory through its course of medical evolution; just as the early societies of the West endured cancer’s pervasive character for thousands of years, so did the East. While the title of oncologist did not emerge until the late 1900s, the mention of benign and malignant tumors appears across ancient medical texts. Early physicians across the world were discovering the intricacies of this pervasive disease, many with similar theories to its roots. Although now the biomedical dynamics of cancer in modern medicine are well understood, it is important to explore the historical evolution of this aggressive illness to understand the power behind it.

The timeline of cancer begins quite early with evidence of cancerous cells existing in fossilized dinosaur bones approximately 80 million years ago.²⁶ In 3000 B.C., Egyptian mummies were found to have cancer in fossilized bone as well, suggestive of osteosarcoma or bone metastasis.²⁷ The first written record of cancer is from 1550 B.C. where descriptions of surgical procedures on tumors were illustrated on Ebers Papyrus, one of the oldest preserved Egyptian medical documents.²⁸ Within the 110 pages of the scroll, there are 700 remedies and formulas to address numerous health conditions. Specifically related to cancer, the scroll cites eight references to tumors on the breast. It was believed cancer was an illness caused by the gods. It’s described as a virulent disease, recounting “a tumor against the god Xenus” it recommends, “do thou nothing there against.”²⁹ Essentially stating that there was no remedy for cancer. It may be assumed that even in 1600 B.C. cancer was a powerful entity of unknown origin treated with uncertainty and poor outcome.

The Ebers Papyrus describes treatment of these tumors with a heated instrument called “the fire drill,” which was a form of cauterization to excise the cancer; the inscriptions suggest that treatment of this disease was only palliative. Other references to surgical procedures for ulcers and tumors are noted by “cutting out with a knife or burning with red-hot irons,” which also describes the excision of tumors through surgical means.³⁰ From 500–1500 A.D. similar procedures were employed mainly surgery and cautery for smaller tumors; pastes containing arsenic were applied to the skin as well for more severe cancers; phlebotomy (blood-letting), and references to powder of crab as well as magical/symbolic charms were used. Herbal and nutritional remedy was also an integral component to ancient medicine with certain recommendations for cancer. Medical manuscripts describe stomach cancer treated with boiled barley mixed with dates; uterine cancer was treated with a blend of pig’s brain mixed with fresh dates and inserted into the vagina.

In ancient China, the word, cancer (ai), itself was not referenced specifically until 1171, where it was stated in a text written by Dongxuan Jushi, entitled Wei Ji Bao Shu [A Treasury of Relief and Treatment]. Preceding this reference, there exists a long history of observation and treatment of tumors noted in classic medical texts. As early as the Shang Dynasty (16th–11th century B.C.), there is evidence found on bones and tortoise shells from where the word for tumor, liu, is identified.³¹ In the Qin Dynasty (221–207 B.C.), physicians documented their observations of tumors, sores, suppurations, as well as theories on the disease. There was, of course, no specialty for oncology during the early dynasties of the East. However, in the Qin Dynasty, doctors were classified with specialties such as internal disease, dietitians, and specialists of sores or wounds. Doctors of the latter condition treated sores with and without ulceration, termed “swollen sores.” Traditionally, tumors were not divided as benign or malignant, but rather, according to visual and palpable characteristics.

A remarkable observation discussed in ancient dictionaries from the early 2nd century of the Han Dynasty (206 B.C.–220 A.D.), Shuo Wen Jie Zi (Discussing Characters and Explaining Words) and Zheng Zi Tong (A Comprehensive Discussion on the Correct Use of Characters) also delineates the difference between zhong (swelling) and liu (tumor). An abscess that is swollen and ulcerating is described as zhong, and liu equates to its homophone meaning, “to flow.” Thus, the stagnation of qi and blood causes a swelling, or tumor: zhong liu. It is further explained that liu does not grow with the tissue but is rather the result of extended, chronic disease. It is remarkable that this concept is still applicable today and well understood in TCM diagnosis in two ways. First, the accumulation of qi and blood causes stagnation; and second, this accumulation may lead to acute or chronic disease, including cancer. In total, the diagnosis of qi and blood stagnation results from proliferation of tissue, inflammation and essentially, lack of flow.

In the West, a word for cancer, karkinos was first noted in medical literature during the time of Hippocrates.³² Hippocrates (460–370 B.C.), recognized as the “Father of Medicine,” is largely responsible for naming the disease. He noted that the structure of a tumor with its swellings, blood vessels and suppurations resembled a crab in the sand with legs spread in a circular fashion. This imagery influenced physicians, patients, and others affected by the disease who described the pain of cancer as being similar to the pain of being caught in a crab’s pincers; or the physical quality of a hard, matted tumor, resembling the shell of the crab body; and how the movement of a crab reflected the fluidity of a tumor’s growth under the skin.

Hippocrates’ initial analysis of the disease is remarkable given the lack of technology, microscopes, scientific method, or knowledge of basic cellular division. His awareness of karkinos was quite limited and specific to visible cancerous formations, such as breast tumors or skin cancers. Further, there was no way to differentiate malignant from benign, and many physical maladies fell under the umbrella of karkinos: general swellings, polyps, pustules, nodes and glands. Despite this limited scientific evidence and understanding of the disease, Hippocrates noted the aggressive nature of the disease, stating cancer was “best left untreated, since patients live longer that way.”³³

Hippocrates theorized the cause of disease as a result of an imbalance among four humors, or body fluids: blood, phlegm, yellow and black bile.³⁴ This is referred to as humoral theory, the first of many theories on the biology of cancer. When in excess, black bile was deemed to be the culprit of cancer, and this theory was accepted as the cause for over 1,300 years. Black bile was associated with melancholia, the medieval word for depression, and it was thought that this particular fluid congealed in the area where tumors formed. This theory is remarkably similar to those of the ancient Chinese physicians regarding stagnation of phlegm pathologies.

Five centuries later, a famous Greek physician, Claudius Galen, furthered Hippocrates’ humoral theory through his medical observations. Galen also differentiated disease by excess of body fluids, some of which are realistic metaphors of modern day medicine, such as his understanding of inflammation as red, hot, with distending pain as a result of excess blood.³⁵ Jaundice was perceived as a result of excess yellow bile and is now commonly associated with production and function of the liver; and pustules, tubercles and nodules of lymph that were often white and cool in temperature, reflected excess of phlegm. These conjectures maintain threads of similarity and truth in current medical diagnosis for liver disease or infections and viruses.

Hippocrates and Galen both determined of the four humors, black bile was most dangerous. It was believed one’s emotional health was inextricably linked with physical wellness within the scope of cancer pathology. Galen proposed that black bile was “trapped” cancer stating, “Of blacke cholor [bile], without boyling cometh cancer.”³⁶ Galenic theory identified cancer as a systemic problem due to an excess of black bile, which created outcroppings of tumors throughout the body. Galen surmised removing tumors surgically was impossible because of black bile being deeply internal and throughout the body. Surgeons could attempt to excise a tumor, but the body would put forth more black bile immediately, so surgery was not advised.

Galen primarily attempted treatment of cancer by systemic means to eradicate the black bile. Remedies for cancer included lead tinctures, arsenic extracts, fox lungs, boar’s tooth, ipecac and senna to name a few.³⁷ Pain was controlled with alcohol and opium tinctures. Rarely did Galen perform surgery, but some evidence suggests he did for palliative or cosmetic reasons. If the internal medical treatment was not effective, the most common method for treating cancer was a series of bleeding and purging techniques to literally extract the humors out of the body. This particular approach is an interesting comparison to an acupuncture technique used to resolve excess blood stagnation or heat referred to as bloodletting. Galen and Hippocrates’ early theorizing and attempt to understand the nature of cancer play an inherent role in the biology of cancer setting a foundation for the medical advances that followed.

Similar to Western physicians, Chinese doctors were making early attempts to identify tumors and treat them effectively. The Huang Di Nei Jing [The Yellow Emperor’s Internal Classic] is a core text of Chinese medicine; TCM would not exist without this comprehensive manuscript. In this classical literature, there are numerous descriptions of cancer-like formations, one may ascertain that the described masses, superficial sores or swollen areas of tissue could have been identified as early cancers. For example, early references to tumors include chang liu, identified as intestinal tumor and, xie ge, masses below the diaphragm due to blood stasis, and ge sai, an obstruction within the diaphragm.³⁸ The translations elucidate the type of mass, location and quality. Shi jia, is described as stone-like masses in the uterus. In modern medicine this could be diagnosed as ovarian cysts, fibroids, or gynecological tumor.

The Nei Jing created a foundation for developing theories related to etiology of tumors. The fundamental basis of Chinese medicine diagnosis is rooted in aspects of excess and deficiency, and the factors that play a role in this delicate dynamic are pertinent to good health. This is specifically discussed in the Nei Jing where emotions such as joy or anger may result in the accumulation of pathology, which may linger and cause imbalance.³⁹ It also states that environmental influences such as seasons that are excessively warm or cold, may perpetuate illness. Interestingly, in modern medicine there is recognition of environmental toxins and external influences that are linked to cancer formation. Also, significant to this assessment is the proper movement of ying qi (nutritive qi) and wei qi (defensive qi), both integral to upholding a strong immune system.

Tumor pathology is referenced throughout Qin and Han dynasties (221 B.C.–220 A.D.) and within classical texts such as the Nei Jing. Not only are the symptoms of the condition depicted, but also more importantly, they formulate TCM theory in order to understand the pathogenesis of the disease. For example, in the Nei Jing, in reference to intestinal tan, the famous physician Qi Bo states, “Pathogenic Cold settles outside the Intestines and struggles with Wei Qi (Defensive Qi). Qi cannot be nourished and will stagnate so that masses will form in the interior, pathogenic Qi will be aroused and polyps produced.”⁴⁰ This answer by Qi Bo suggests a pathogenic factor (like one of the six excesses) will lodge interiorly and effect proper movement of qi and blood. As a result, there is an accumulation of these substances that provide opportunity for disease to manifest, such as cancer. Further, if the person’s constitution is already deficient, the capacity of the pathogen to overtake what remains of the individual’s health becomes even more harmful.

The Chinese classics note that pathogens can invade deeply when there is a constitutional deficiency. This concept is reflected in the Ling Shu, Chapter 75, which is essentially saying that pathogens or “evils” in TCM, particularly cold and heat, but also wind and fire, will invade into the interior when there is deficiency. A constitutional deficiency allows for a deeper and perhaps more tenacious penetration of an evil. The evil struggles with the defensive qi and the qi and/or fluids around it eventually trapping them and forming knots. These knots become tumors. At first soft, they grow as they linger and become more dense and more recalcitrant. If the evil strikes into or at the level of the sinews, then a sinew tumor is formed, and if into the intestines, then an intestinal tumor is formed, and so on.⁴¹ These diagnostic elements to TCM theory are extremely important in clinical medicine. The practitioner must identify the constitutional deficiency and assess the strength of pathogenic factor with respect to the subject’s constitution in order to effectively treat with acupuncture and herbal therapy.

A more detailed analysis of the theories presented in the Nei Jing takes place in the Nan Jing (Classic on Medical Problems). This is where pattern differentiation evolves specifically pertaining to oncological theory and development in Chinese medicine. The description of benign versus malignant tumors is discussed in the 55th Problem stating, “Accumulations consist of yin influences...stay in the depth and are hidden…emerge in the five depots… Their upper and lower extensions are clearly marked by end and beginning; to the left and to the right are clearly defined locations where they subside.”⁴² The Nan Jing also states that illness that arises in the depots (zang organs) are difficult to cure. That is a patient is likely to die. In contrast, an illness that arises in the palaces (fu organs) can be difficult but is easy to cure. That means that a patient should live. This accumulation mass, related to yin and a disorder of the zang organs (five depots) has the same qualities of what is now perceived as a malignant tumor given the structure, definitive location and shape. By contrast, a concentration is described as being a problem with the fu organs (six palaces), thus related to yang, not maintaining a specific area or shape. In a clinical perspective, the concentrations were most likely assumed to be benign, perhaps that of a lipoma or fibroid. In essence, ancient TCM doctors could already classify cancer as a disease that affected the whole system, not merely limited to external causes. Further, one’s internal constitution and overall health determined, to some extent, the absolute strength of pathogenic factor.

Back in the West, by 1540, a physician named Andreas Vesalius unknowingly challenged the humoral theory made by Hippocrates. This occurred through Vesalius’ dedication to understanding human anatomy by way of autopsy on human cadavers, something Hippocrates was unable to perform for religious reasons during the Grecian era. Through detailed anatomical research Vesalius determined that the black bile referenced by Hippocrates and Galen did not physically exist.⁴³ Through autopsy he discovered the pale, watery fluid of the lymphatic system, the blood vessels holding blood, and the liver holding yellow bile.⁴⁴ Black bile was not found, which challenged Vesalius not only on a professional and academic level, but also on a personal level through his dedication to his predecessor, Galen. In his search, without realizing the outcome, he produced extensive diagrams of veins, nerve pathways, and the circulatory system, culminating in the first medical anatomy book, The Seven Books on the Structure of the Human Body. As a result, the humoral theory was cast aside and physicians began to search for another source of cancer, which lead to the lymph theory.

Lymph theory proposed that the cancer formation was caused by another body fluid, lymph. This idea was supported largely through the 17th century and suggested that the human body was formed of lymph, which was responsible for the ongoing movement of blood and fluids. Blood released tumors into the body’s circulatory system, eventually leading to cancer in that local region. Not long after this theory was introduced, the evolution of cancer biology made significant progression in the medical field with the discovery of cellular biology. As scientists could examine cellular structure in closer detail, it became evident that cancer is actually made up of cells derived from other cells. Thus, the observed character of the disease continued to become more illuminated, as science, technology, and physicians identified its mechanism.

This cellular discovery led to the blastema theory, developed by pathologist Johannes Muller in 1838 who recognized the cellular composition of cancer.⁴⁵ He proposed that cancer was cellular and not lymph fluid believing further that cancer cells were a separate entity from normal healthy cells. His student, Rudolf Virchow, became one of the foremost leaders in pathology. His scientific research led to the understanding that entire organisms do not get sick, but it is the cells or groups of cells within the organism that do.⁴⁶ Thus, cancer cells did not originate from body fluid but from other cells. Virchow played a significant role by initiating the field of cellular pathology following the advent of the microscope. As such, Virchow revolutionized the field based on two tenets: first, similar to the bodies of animals and plants, human bodies were made up of cells and second, cells arise from other cells.⁴⁷

This greatly influenced the practice of medicine as physicians began to recognize that disease progression occurred by pathological and anatomical changes not merely as a result of symptom changes. Physicians could then make more effective medical diagnoses and treatments, ideally with better outcomes. The similarity of animal’s anatomical structures shed light on the pathology and physiology of humans, which was the advent of harnessing animal research into human biology and medicine. Virchow proposed a hypothesis about the distinction of cellular human growth, which differentiated between hyperplasia and hypertrophy. Virchow defined the primary method of cell change, hyperplasia, as a growth of cells increasing in number, versus hypertrophy, where the number of cells did not change, but rather individual cells grew in size. It’s possible to delineate the structure of human tissue by hypertrophy and hyperplasia. For adult animals, fat and muscle grow through hypertrophy. By contrast, internal organ structures such as the liver, intestinal tract, blood and integumentary system all grow through hyperplasia.

As a result of Virchow’s knowledge and studies on cellular pathology, he proposed cancer was a result of pathological hyperplasia. With a microscope, Virchow examined abnormal cellular progression, identifying a significant aspect of uncontrolled cellular growth — hyperplasia. The structure of cancerous cells appeared more clearly through this process allowing a distinct point of view. Essentially, cellular division occurred autonomously in a different, new form; hence the term, neoplasia, “novel, inexplicable, distorted growth.”⁴⁸ As a consequence, these cells expanded into dense masses, invading normal tissue with the drive to metastasize to surrounding organs and other distant sites such as the brain, bones or spinal cord.

By the 19th century, the complexity of cancer was gaining momentum in the scientific community. The biology and evolution of the disease were more clearly delineated by scientists Watson and Crick who discovered the deoxyribonucleic acid (DNA) helical structure in 1953 and subsequently received the Nobel Prize in 1962. Following this discovery, geneticists were able to identify how genes worked, as well as how they were damaged by mutations causing cellular division. Encompassing this discovery was the integral component of carcinogens, like chemicals affecting DNA structure, as well as changes in cellular integrity by viruses, radiation, or genetics.

In 1970, the discovery of two gene families provided even more information on cancer cell biology. Proto-oncogenes are normally responsible for controlling the frequency to which a cell divides, and the degree to which it differentiates. When these genes mutate uncontrollably or abnormally, they become malignant, and an oncogene is created. Oncogenes are not always activated or turned on, but when triggered, it may lead to neoplasm. Tumor suppressor genes were also identified. Normally these genes control cell division, the repair of damaged DNA and instruct cells when to die off. If the tumor suppressor gene does not function, this impairs the control of cells causing overgrowth and division. Both oncogenes and tumor suppressor genes are negatively impacted by chemical exposure and radiation. In addition to these groups of specific gene families, scientists also found genetic predispositions to cancers such as those that affect the thyroid, pancreas, colon, kidney and ovary.

As modern medicine evolved, so did the ability to treat cancer more effectively, as illustrated by the various methods employed by oncologists today. The current treatment of cancer has fortunately extended beyond “the fire drill” procedure from ancient Egypt, to more modern and mainstream treatments like surgery, chemotherapy and radiation. The early administration of conventional medicine was far from flawless, requiring numerous attempts and many years to refine techniques in cancer care.

Allopathic Forms of Cancer Treatment

Surgery

Surgical removal of tumors was the first form of cancer treatment. In ancient medical approaches to cancer, physicians recognized that cancer would likely return even after surgery.⁴⁹ Due to limitations of sanitary surgical procedures, as well as proper tools and anesthesia, surgery was risky and complicated. There were higher rates of blood loss and often death. Once anesthesia was developed in 1846, surgeons were able to perform more complex surgeries to remove tumors. This era was referred to as the “century of the surgeon.”

The physician commonly identified with oncological surgery is Dr. William Halsted, a surgeon in the late 19th century. He is regarded as the doctor most responsible for developing the radical mastectomy. His assertion was that cancer could be eradicated through local removal of the tumor and surrounding tissue, which began with the removal of the pectoralis minor, then extended into the chest, collarbone, surrounding lymph nodes, anterior mediastinum, and for his disciples, there are records of removing ribs, amputating a shoulder and collarbone.⁵⁰ He determined, if there was a reoccurrence, it was due to a new neoplastic disease process and not related to the primary cancer that was eradicated. This radical mastectomy became the foundation for cancer surgery in the century that followed, until the 1970s, when surgeons were able to modify the mastectomy using more sophisticated techniques and making it less disfiguring with fewer side effects.⁵¹

During this same time period (late 19th – early 20th century) another physician, Stephen Paget, determined that cancer cells could spread from the primary tumor through the bloodstream to another location in the body.⁵² This unique and significant concept was eventually proven in modern day medical research because of technological advances that explain cellular biology and the process of metastasis. As Paget’s findings became more readily acknowledged in the medical community, physicians recognized the limitations of cancer surgery, in that, full excision of a tumor and the surrounding area did not equate with a curative outcome. In addition, systemic treatments after surgery were developed to enhance the rate of survival by continuing to destroy malignant cells; this also lessened the extent to which surgery was performed, thereby decreasing the surgical mutilation. Exploratory surgery was often required to make a complete diagnosis of cancer, but with the advances of ultrasound and imaging, invasive surgeries are quite limited. This has occurred due to the development of chemotherapy and radiation, both of which have a more recent history and continue to be a mainstream approach to combating a cancer diagnosis.

Radiation therapy

Radiation therapy, also known as radiation oncology or radiotherapy was discovered after the advent of the X-ray. In 1896, a German physics professor by the name of Wilhem Conrad Roentgen presented a lecture entitled “Concerning A New Kind of Ray” and within months, the scientific community had designed systemic approaches and X-ray machines for identifying broken bones or locating foreign objects.⁵³ Further research on the element radium proved quite successful, as scientists found that radium also killed diseased cells, targeting damaged DNA. There began a new and instrumental era of medical oncology.

Currently, at least half of all cancer patients are prescribed some form of radiation therapy.⁵⁴ Scientific advancements in the field of radiation therapy have improved greatly. The precision of radiotherapy has been refined to offset unnecessary exposures. There are several methods of radiation therapy, which include: proton beam therapy (targets tumor cells directly), stereotactic surgery and therapy (gamma knife used for brain tumor), and intra-operative radiation therapy (applied after surgical removal of tumor to adjacent tissue). These advanced surgical techniques have allowed oncologists to truly refine their practice, thus providing patients with enhanced quality of life and potential for better outcomes.

Chemotherapy

About the same time that radiation therapy was discovered in the early 1900s, a German chemist by the name of Paul Ehrlich began developing drugs to treat illnesses.⁵⁵ The concept of chemotherapy as systemic medicine came from this research, and the term chemotherapy was born defined as the use of chemicals to treat disease. It appeared to be a natural progression to use chemical compositions in order to create a drug for the treatment of cancer. However, the evolution of chemotherapy agents has been constantly challenged by the concept of specificity. Specificity refers to a medicine’s ability to differentiate between its intended target and its host. “The trouble lies in finding a selective poison, a drug that will kill cancer without annihilating the patient. Systemic therapy without specificity is an indiscriminate bomb.”⁵⁶

It wasn’t until World War II, when researchers observed United States Navy sailors who were exposed to mustard gas during military activity and who experienced changes in bone marrow cells. As a result, scientists began to examine nitrogen mustard and its effects on white blood cells in the bloodstream or bone marrow when dosed in a controlled setting. After animal studies confirmed that malignant cells in blood and bone marrow disappeared without the negative effects of nitrogen mustard, doctors prescribed the chemical agent on humans with lymphoma. Almost immediately, swollen glands decreased in size, and it appeared as though remission was inevitable. Unfortunately, relapses were imminent and patients’ tumors would grow, harden, and the cancer would return. Nonetheless, nitrogen mustard inspired scientists and chemotherapists to continue research on chemical agents that might effectively destroy rapidly growing cancer cells by damaging their DNA.

In 1954, The National Cancer Institute (NCI) was authorized by the Senate to create cancer research-based programs. This led to the development of the Cancer Chemotherapy National Service Center (CCNSC), which allowed scientists to test chemotherapeutic drugs in controlled targeted settings. From 1954–1964, over 82,000 synthetic chemicals were tested, including 115,000 fermented products and 17,200 plant derivatives.⁵⁷ The significant amount of research on chemical formulations reflected the fervent hope of finding curative substances for cancer. However, the decades that followed included many challenges for the chemotherapist.

Medical oncology was not a designated specialty in the 1960s. Those who administered chemotherapy were not regarded as specialists of cancer, but rather, referred to with less reputable names. For example, Louis K. Albert, who was involved in initial studies on nitrogen mustard and early lymphoma cases was known as “Louis the Hawk and his poisons” simply because he was often present during chemotherapy infusions. Quite simply, anti-cancer drugs in the 1960s were predominantly considered to be poison and not medicine. This sentiment has not completely disappeared in modern day cancer treatment.

Nonetheless, research continued and was led by those with utmost commitment to finding a cure for cancer through effective safe chemotherapy. The discovery of aminopterin, a compound related to folic acid, proved successful through its ability to promote remission in children with Acute Lymphoblastic Leukemia (ALL). This drug was the predecessor of methotrexate, one of the oldest chemotherapy drugs frequently used in treatment today. The evolution of chemotherapy continued rapidly and by the 1970s, adjuvant chemotherapy was introduced. Adjuvant chemotherapy is employed after surgery to kill any micrometastatic disease that may remain, thus preventing a recurrence. This is similar to the approach of administering radiation post-operatively to lessen the degree of growth for small tumors unable to be surgically removed.

By 1971 the “war on cancer” had formally begun as a result of the National Cancer Act. This act instituted a substantial amount of funding, which allocated billions of dollars for research specific to drug development and clinical trials. The momentum from this increase in funding escalated research in cancer pathology and more refined chemotherapy treatments. Additional systemic treatments were extrapolated including hormone therapies, targeted therapies, immunotherapies and biologic therapies. These categories of drugs would not exist without the dedication and courage of early oncologists who participated in the advancement of chemotherapy. From the mid 19th century to present day, this research has been integral to the development of successful, therapeutic outcomes in a cancer diagnosis.

The history and evolution of Chinese medical oncology proceeds without much deviation from its historical findings. The classical references to tumors date back over 2,000 years, and astonishingly, the theoretical applications remain the same. Chinese medicine’s methods of zang-fu pattern differentiation, as well as addressing the individual’s constitution, were aspects to oncology evolution that were not included in the Western medical paradigm. In current practice, Chinese medicine continues to adhere to the foundations of diagnosis through examination of the following: zang-fu, yin-yang theory, five elements, meridians and collaterals, qi and blood, body fluid, six excesses and five emotions. Within TCM, a continuity exists. The diagnostic methods are based on principles that reflect nature; these principles evolve with nature as they were intended to do. In modern day China, the practice of TCM and Western medicine, which was brought in during the 1900s Cultural Revolution as a means to modernize the country, are blended as a hybrid model of medicine.

It is evident through its historical evolution, that the aggressive nature of cancer has existed for thousands of years. Although it persists, statistics indicate that there is a downward trend of the disease with overall improved outcomes. It requires a certain hypervigilance by those who choose to practice in the field of oncology, and even more so by individuals diagnosed with cancer.

References

American Cancer Society. (2012). Evolution of Cancer Treatments: Radiation. Retrieved November 3, 2014, from American Cancer Society: http://www.cancer.org/cancer/cancerbasics/thehistoryofcancer/the-history-of-cancer-cancer-treatment-radiation

American Cancer Society. (2014). Evolution of Cancer Treatments: Surgery. Retrieved September 7, 2014, from www.cancer.org: http://www.cancer.org/cancer/cancerbasics/thehistoryofcancer/the-history-of-cancer-cancer-treatment-surgery

American Cancer Society. (2014). Early theories about cancer. Retrieved October 31, 2014, from American Cancer Society: http://www.cancer.org/cancer/cancerbasics/thehistoryofcancer/the-history-of-cancer-cancer-causes-theories-throughout-history

American Cancer Society. (2018). Early History of Cancer. Retrieved October 14, 2018, from https://www.cancer.org/cancer/cancer-basics/history-of-cancer/what-is-cancer.html

British Broadcasting Channel. (2014). History: Andreas Vesalius. Retrieved September 8, 2014, from bbc.co.uk: http://www.bbc.co.uk/history/historic_figures/vesalius_andreas.shtml

Cancer Council Victoria. (2013). Cancer Council Victoria. Retrieved September 14, 2014, from Cancer Council Victoria: www.cancervic.org

Devita, V. T., & Chu, E. (2008). A History of Cancer Chemotherapy. Retrieved November 3, 2014, from Cancer Research: http://cancerres.aacrjournals.org/content/68/21/8643.long

Krans, B. (2017). Radiation Therapy. Retrieved August 29, 2018, from https://www.healthline.com/health/radiation-therapy

Links, C. (1995). http://www.crystalinks.com/egyptmedicine.html. Retrieved August 7, 2014, from Crystalinks: www.crystalinks.com

Mukherjee, S. (2010). The Emperor of All Maladies. New York, NY: Scribner.

Peiwen, L. (2003). Management of Cancer with Chinese Medicine. St. Albans, Herts, UK: Donica Publishing Ltd.

Schultz, M. (2008). Rudolf Virchow. Retrieved September 7, 2014, from National Institute of Health: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2603088/#!po=10.0000

Sudhakar, A. (2009). History of Cancer, Ancient and Modern Treatment Methods. Retrieved September 7, 2014, from National Institute of Health: http://www.ncbi.nlm.nih.gov/pmc/article/PMC2927383/

Unschuld, P. U. Trans (1986). Nan-Ching, The Classic of Difficult Issues. Berkeley: University of California Press.

Unschuld, P. U. (2016). Huang Di Nei Jing Ling Shu — the ancient classic on needle therapy. Oakland, CA: University of California Press.

WebMD. (2014). Radical Mastectomy for Breast Cancer. Retrieved September 7, 2014, from Webmd.com: http://www.webmd.com/breast-cancer/radical-mastectomy

²⁶ Cancer Council Victoria, 2013

²⁷ American Cancer Society, 2018

²⁸ Links, 1995

²⁹ Cancer Council Victoria, 2013

³⁰ ibid

³¹ Peiwen, 2003

³² Mukherjee, 2010

³³ Mukherjee, 2010

³⁴ Sudhakar, 2009

³⁵ Mukherjee, 2010

³⁶ ibid

³⁷ Mukherjee, 2010

³⁸ Peiwen, 2003

³⁹ Peiwen, 2003

⁴⁰ ibid

⁴¹ Unschuld, 2016

⁴² Unschuld, 1986

⁴³ British Broadcasting Channel, 2014

⁴⁴ Mukherjee, 2010

⁴⁵ American Cancer Society, 2014

⁴⁶ Schultz, 2008

⁴⁷ Mukherjee, 2010

⁴⁸ Ibid

⁴⁹ American Cancer Society, 2014

⁵⁰ Mukherjee, 2010

⁵¹ WebMD, 2014

⁵² American Cancer Society, 2014

⁵³ American Cancer Society, 2012

⁵⁴ Krans, 2017

⁵⁵ Devita & Chu, 2008

⁵⁶ Mukherjee, 2010

⁵⁷ Murherjee, 2010