Light bulb moments in oncology

In October 1846, William T.G. Morton first demonstrated how ether could be used as an anaesthetic when he removed a tumour from a patient's jaw without pain. Prior to this, surgical patients experienced excruciating pain during procedures.

In the 1870s, English surgeon Campbell De Morgan formulated the hypothesis that ‘cancer poison’ spreads from the primary tumour through the lymph nodes to other sites, causing metastasis.

Following Marie Curie’s discovery of radium in 1898, doctors reported the first use of the radioactive element to treat cancer in 1903. Radiotherapy is now a mainstay of modern cancer treatment.

Criticised at the time by his peers, Paul Ehrlich suggested that tumour development was usually suppressed by our own immune system. However, immunotherapy which uses the body's immune system to fight cancer is now a growing field in cancer treatment.

Now commonly used throughout the developed world, the PAP test (named after inventor George Papanicolaou) allows doctors to detect and treat cervical cancer or pre-cancer before they have a chance to spread. The test has dramatically reduced cervical cancer death rates, though they remain high in developing countries where access to screening is limited.

The first approved drug used for cancer chemotherapy was initially used as a chemical warfare agent during WWII. Following clinical trials which showed remarkable results for people with an advanced type of blood cancer, nitrogen mustard (mustard gas) was approved by US regulators in 1949.

The U.S. Surgeon General and the U.K. Royal College of Physicians both issued reports in the 1950s–1960s that demonstrated the link between smoking and cancer, particularly lung cancer. Tobacco control and smoking cessation campaigns to discourage smoking soon became a priority in a bid to reduce the rising numbers of people with lung cancer.

In 1966, the Nobel Prize was awarded to Charles Huggins for his research showing that hormonal treatment of prostate cancer was feasible. This pioneering work led to the development of treatments for both prostate and breast cancer.

Judah Folkman first demonstrated the role of angiogenesis in tumour growth and spread; this important discovery led to the development of angiogenesis inhibitors which have significantly changed the outlook for many patients with many common forms of advanced cancer.

Georges Kohler and Cesar Milstein published a paper outlining their experiment into the principle for the production of monoclonal antibodies – a type of biological therapy now commonly used in the treatment of cancer.

Computed Tomography, or CT scanning, was first seen in the 1970s when researchers performed the first human scan on a woman with a suspected brain tumour. The technology uses X-rays to create images of the tumour within the body, allowing doctors to carefully target the correct location with surgery or radiotherapy without harming healthy tissue.

In 1997, the first molecularly targeted drug was approved for the treatment of people with a type of lymphoma that no longer responds to other treatments. The drug was the first in a new class of drugs called monoclonal antibodies – 20 years after the discovery of the principle by Kohler and Milstein.

In 2003, the code for the human genome was published; the culmination of 13 years’ research. This major breakthrough has paved the way for extensive genetic investigations including the identification of genetic defects in specific cancers. In 2009, researchers unlocked the entire genetic code of two of the most common cancers – skin and lung.

Used for the treatment of metastatic prostate cancer, the first cancer treatment vaccine was approved by US regulators in 2010. Vaccines to prevent cancer caused by the human papilloma virus (cervical and throat) and hepatitis B virus (liver) are also approved for use.

A breakthrough therapy designation allows drugs which show substantial improvement over existing therapies to undergo a ‘fast track’ review by authorities in order for the treatment to be made available to patients faster. The first drug granted this designation was approved for the treatment of chronic lymphocytic leukaemia in 2013.