This class of diseases is among the most important in industrialized societies. Benign tumors grow slowly, remain localized, and cause only cosmetic or, occasionally, pressure effects. Malignant tumors, or cancers, grow rapidly and have the ability to invade locally and to spread throughout the body, metastasize, causing the death of the individual. The progression of such tumors can be erratic, but, if unchecked by medical or surgical intervention, cancers will metastasize to vital organs via lymphatics or blood vessels, destroying the function of organs such as the liver, lung, or brain and causing death.
There have been a number of studies indicating that cancer is a relatively modern disease. Comparative evidence shows that tumors are rare in nonhuman primates. One very early tumor is most likely not a cancer but a benign proliferation of bone of the femur of Homo erectus, the immediate predecessor of Homo sapiens, discovered in Java in the early 20th century. This lesion has been diagnosed as either myositis ossificans, a reaction to trauma, or an example of fluorosis. Identical lesions have been seen in modern patients suffering from excess ingestion of fluorine and similar lesions are noted in sheep grazing in volcanic areas, such as Java. Tumors are mentioned in the Egyptian medical papyri but have been interpreted by modern readers as simply swellings or perhaps varicose veins. Cancer's crab-like nature was noted by the Greeks about 200 AD, but the first reports in the scientific literature of a number of distinctive tumors have only been over the past 200 years. Examples include scrotal cancer in chimney sweeps in 1775, nasal cancer in snuff-users in 1761, and Hodgkin's disease in 1832. Only one diagnosis of a soft tissue tumor has been reported in a mummy—rectal carcinoma in an Egyptian of the 3rd century AD.
Tens of thousands of skeletons have been examined and only a few tumor diagnoses made. Osteomas of the skull have been described in several different skeletal populations. Osteochondromas have been diagnosed in skeletons from Scandinavia, Egypt, and in the New World. A medieval skeleton from the Swedish island of Gotland showed multiple exostoses, some of which occluded the pelvic outlet, with death in labor. The unborn fetus showed evidence of the same disease. Tumors described by Elliot-Smith and Ruffer in Egyptian skeletons as osteosarcoma, primary malignancy of bone, are unlikely to be so, based on the gross morphology. Some more likely cases have been reported from Europe and Peru, although these could be reactive processes, secondary to infection. Osteosarcoma is not an exceptionally rare tumor now and, as it usually produces bone, one might expect it more frequently in archeological material than we do, especially as this is a tumor of young people. Bone is notorious for trapping radioactive minerals and one can speculate on the role of radiation in our modern world in causing bone tumors.
Bone can be invaded by local tumors, and bone metastases are common in the modern world but have been diagnosed only rarely in ancient material. Meta-static carcinoma and postmortem erosion can produce similar changes, namely the formation of multiple round defects in the bone.
It has been suggested that the short life span of individuals in antiquity precluded the development of cancer. Although this statistical construct is true, many persons did live to a sufficiently advanced age to develop other degenerative diseases, such as atherosclerosis, Paget's disease of bone, and arthritis. It must also be remembered that, in modern populations, bone tumors primarily affect the young.
Another explanation for the rarity of tumors in ancient remains is that tumors might not be well preserved, but experimental studies show that mummification preserves the features of malignancy. In an ancient society lacking surgical intervention, evidence of cancer should remain in all cases. The virtual absence of malignancies must be interpreted as indicating their rarity in antiquity. The majority of human cancers are believed to be related to environmental factors, and studies indicating a rarity of cancer in antiquity suggest that such factors are limited to societies affected by modern industrialization.
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