Cancer

The term cancer derives from the Latin cancer, which in turn derives from the Greek xaexi/uoco both originally meaning a crab. Other medical terms used in classical antiquity derive from the same root. These terms, however, do not necessarily mean or refer to a neoplastic growth or malignant lesion. There is some evidence, in fact, that ulcers and lesions associated with other diseases (e.g., erysipelas and gangrene) were not always distinguished from malignancies.

As a medical term, xaexiuoco first appears in Hippocrates but in contexts that only suggest what is meant today by cancer. Later uses of the term by Galen and his followers were similar to the medical and clinical uses that prevailed up to the time of Rudolph Virchow. In the same way, the more restricted term carcinoma might have denoted a malignant condition, especially when the condition terminated fatally as, for example, in Hippocrates, Caelius Aurelianus, and Cassius Felix. The most extended account of cancer, next to Galen's, was that of Celsus, who attempted to distinguish a variety of swellings (tumors). He gave special names (e.g., atheroma, steatoma, and therioma) to some of these -probably not the malignant ones. However, he also described certain, more serious conditions, perhaps complications of erysipelas and gangrene, and these he likened to cancer. He reserved the term carcinoma or carcinode for other tumors that, when they did not appear to have been the result of another, antecedent disease, may have been malignant.

The terms just noted and other Greco-Roman cognates such as cancroma are not as common in the medical literature as one might expect and are even rarer in the nonmedical literature. Instead, there developed an elaborate taxonomy, with corresponding names, for a wide range of conditions that are reproduced in English by the nonspecific, generic term swellings. Celsus's distinctions were carried further by Galen, who distinguished among a wide range of diseases, localized morbid conditions, and various dermatological complaints. But Galen introduced one important improvement: He identified as malignant only those oyxoi (tumor[s]) that most closely resemble our concept of malignant neoplasms and called them xaxoySy.

The large amount of space devoted to recipes and other therapeutic forms for "swellings" and abscesses (e.g., by Cato, Paul of Aegina, Pliny, and Hippocrates) strongly suggests that malignant, often fatal, conditions were not uncommon, despite the lack of consensus on signs and symptoms and the equally obvious lack of a standardized nomenclature. Slightly more certain to have involved cancer is a series of inoperable, incurable, or fatal conditions of specific organs or bodily parts that were, more or less, amenable to examination, such as the breast, testicles, nose, and throat. It is even more problematic that neoplastic growths of internal organs were recognized, but perhaps it was to these that Hippocrates was referring by the phrase xeujitol xaexicooi (hidden cancers).

Reflecting the uncertainties in the diagnosis and therapy of what Galen called "swellings contrary to nature," their etiology was equally uncertain. Galen, however, twice explicitly stated that black bile was the cause of cancers. A hint of another, not necessarily incompatible etiology is contained in Celsus's statement that, whereas some ulcers arise from an external cause, carcinomata and the like "arise from within, from some part of the body which has been corrupted."

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