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INTRODUCTION

A medical student reading about lung cancer notices that the number of lung cancer deaths has steadily increased worldwide.

She asks when lung cancer was first described in the medical literature and how it was treated in the past. She wonders, how the frequency of deaths due to lung cancer compares to the frequency of deaths due to other cancers.

Learning Objectives

  1. Who described cancers within the chest for the first time?

  2. How was lung cancer diagnosed and treated in the last 200 years?

  3. For how long has lung cancer been the most common cause of cancer deaths globally?

FIRST DESCRIPTION OF LUNG CANCER

In 1912, Isaac Adler published the first literature review about lung cancer.1 He listed the known 374 cases mentioned in several European registries over the preceding 50 years. Most physicians at the time thought of lung cancer as an extremely rare disease, and Dr. Adler suspected that lung cancer was underdiagnosed. Not all cases were diagnosed by microscopy, but the number of reported cases had been rising since the mid-1800s.2

The concept of cancers arising in the lung has been a rather recent development in medical history. In the 1800s, Dr. René Laennec at the Hopital Necar in Paris started a new practice of combining postmortem pathology with clinical observation. Dr. Laennec also is known for his invention of the stethoscope. He was a keen clinical observer and well-published writer. The lesions that Dr. Laennec described based on his autopsies were unlike the well-known tuberculosis cases in the 1800s. He described these lesions as encephaloid (cerebral) or medullary tumors due to the visual appearance, which was similar to brain tissue. Dr. Laennec was the first author to describe them as cancers arising from the lung. Dr. Laennec’s work was soon translated into English by John Forbes in 1821 and reached a wider audience, who became aware of this new entity of cancer arising in the chest.3 New medical journals, such as the Lancet Journal (launched in 1823), promoted the practice of autopsies and helped their readers identify lung cancer as a diagnosis apart from the widespread tuberculosis.2

The paradigm of cancer’s cellular origin was slowly evolving in the middle of the 1800s based on microscopic work by Theodor Schwann, Johannes Mueller, and Matthias Schleiden.4 Microscopes, as well as new histological staining and fixing techniques, helped decipher the nature of cell growth. In 1858, Dr. Rudolf Virchow published his book on cellular pathology.5 He lectured on cellular pathology in the 1860s and the new cellular pathology replaced the theory of humoral imbalances which has been the pathological concept explaining diseases since ancient times.

LUNG CANCER IN THE NINETEENTH CENTURY

The lung cancers in the 19th century were often called fungiform and encephaloid tumors following Laennec’s terminology. The diagnosis was mainly ...

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