Progress in Cancer Surgery
This timeline of advances in cancer surgery was developed by the American Society of Clinical Oncology (ASCO),
which represents nearly 30,000 physicians who treat people with cancer and research new cures. An interactive
version, which includes timelines of advances against a range of common cancers, is available online at
www.CancerProgress.Net.
Overview
Early surgical techniques were radical, removing both the cancer and surrounding healthy tissue. This often
resulted in long recovery times, life-changing disability and, in some cases, severe cosmetic disfigurement. Today’s
surgical techniques and technologies are more precise, less disfiguring and produce fewer complications, without
sacrificing effectiveness.
Millions of patients have benefited from these refinements. For example, women with early-stage breast cancer
can now avoid the disfiguring mastectomies that were once standard. People with colon and rectal cancer can
maintain their bowel function, and men with prostate cancer can often avoid incontinence and loss of sexual
function.
Patients with many common cancers now undergo laparoscopic surgery, in which tumors are removed through
small incisions with telescoping equipment – offering faster recovery and fewer complications than traditional
“open” surgery. Robotic surgery is also being studied as a way to improve results and minimize complications even
further.
Timeline
1846 Advent of general anesthesia opens the door for modern cancer surgery
In October 1846, a Boston dentist named William T.G. Morton provides the first public demonstration
of ether as a general anesthetic, allowing surgeons to remove a tumor from a patient’s jaw without
pain. This advance gains immediate and widespread attention, ultimately eliminating the excruciating
pain experienced by surgical patients until that time, and making the modern era of surgery possible.
1880s Radical mastectomy ushers in more aggressive surgical approaches for cancer
Baltimore surgeon William Halsted pioneers a new approach to removing breast tumors, radical
mastectomy, in which the entire breast and the surrounding lymph nodes and chest muscles are
removed. This helps reduce recurrences of the disease, which was previously nearly always fatal.
Halsted’s work also leads to similar approaches for other cancers, in which both the tumor and
surrounding tissue are removed. These techniques are still an important part of treatment for some
cancers today. For breast cancer, however, surgeries have become far more conservative and effective,
enabling many women to avoid mastectomy altogether.
Progress in Cancer Surgery
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1905 Cervical Cancer
Radical hysterectomy used to treat early cervical cancers
British surgeon Ernst Wertheim introduces a new surgical technique, the ‘Wertheim radical
hysterectomy,’ reporting that more than 30 percent of cervical cancer patients who underwent the
surgery remained free of cancer after five years. This result is considered a monumental feat for the
time, despite the fact that about 15 percent of women died during the procedure. The surgery, which
involves the removal of the uterus, cervix and surrounding lymph nodes through an abdominal
incision, soon becomes the standard treatment for uterine and cervical cancers. Over the following
decades, however, it is refined to dramatically reduce the risk of complications, improve outcomes and
leave more healthy tissue intact. The highly refined approach is still used today for patients with earlystage
cervical cancer.
Late 1940s-
1960s
Kidney Cancer
First evidence that surgical removal of kidney is effective for early-stage cancer
For the first time, surgeons report that they have cured patients with early-stage renal cancers by
removing their kidneys. Studies conducted over the next two decades reveal a 65 percent 5-year
survival rate for patients who undergo the procedure.
1971 Breast Cancer
More limited mastectomy proven effective for early-stage breast cancer
While radical surgery had been routinely used to treat breast cancer, a more limited surgical procedure
called total mastectomy (removing just the breast tissue instead of removing the breast, chest wall
muscle and underarm lymph nodes) is confirmed to be as effective for women with early-stage breast
cancer. The procedure reduces pain after surgery and speeds recovery for patients. This advance paves
the way for future breast-conserving surgeries.
1977 Breast Cancer
Many women can opt for breast-conserving surgery
Studies show that a procedure called lumpectomy – involving the removal of only the tumor, and not
the entire breast – followed by radiation therapy is as effective as mastectomy for women with earlystage
breast cancer. The finding helps dramatically reduce the physical and cosmetic side effects of
breast cancer treatment and enables women to recover more quickly after surgery and return to their
normal lives.
1977 Kidney Cancer
Removing just part of the cancerous kidney is proven safe and effective
Studies indicate that some patients with early-stage malignant tumors in one or both kidneys are
candidates for partial nephrectomy – surgery in which the tumor and only part of the kidney is
removed, as opposed to removing the whole kidney. This refined approach revolutionizes treatment of
such tumors, preserving patients’ kidney function and helping many to avoid the difficult experience of
long-term dialysis.
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1978 Pancreatic Cancer
Modification of standard surgical technique leads to fewer complications for
patients with early-stage pancreatic cancer
Surgeons refine the standard surgical approach for removing pancreatic tumors, called the “Whipple”
procedure. The modified pylorus (stomach)-preserving approach takes less time to perform, requires a
shorter hospital stay, and results in similar survival outcomes. Patients treated with this new approach
also have a lower risk of long-term side effects, which can include gastrointestinal distress, ulcers,
cramping and dizziness.
1982 Colorectal Cancer
Limited surgery helps rectal cancer patients avoid colostomies
A new procedure called total mesorectal excision emerges as a new standard surgical treatment for
many patients with rectal cancer. The procedure involves removing only the cancerous region of the
rectum and surrounding tissues, while preserving the anal sphincter, an approach that allows patients
to maintain normal use of their bowels. Previously, nearly all patients with rectal cancer underwent
permanent colostomies (elimination of waste through an opening in the abdomen connected to a
colostomy bag).
1982 Prostate Cancer
New surgical approach helps preserve sexual and urinary function
A new, nerve-sparing approach to prostate removal surgery (prostatectomy) is introduced. For the first
time, some men are able to maintain sexual potency and urinary continence after their prostates are
removed.
Mid-1980s Melanoma
Less extensive surgery found effective for removing melanoma tumors
Instead of the traditional practice of surgically removing up to two inches of skin and tissue
surrounding a melanoma tumor, clinical trials show that margins of three-quarters of an inch or less
around the tumor are sufficient. This refinement makes recovery easier and helps reduce the cosmetic
impact of surgery.
1985 Colorectal Cancer
Minimally invasive approach useful for some rectal cancers
Surgeons develop and refine transanal endoscopic microsurgery (TEM) – surgery performed via a scope
inserted into the anus to remove early-stage rectal cancers less invasively. This approach is especially
important as an option for patients who are too ill or elderly to undergo an open abdominal
operation.
Progress in Cancer Surgery
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1990 Testicular Cancer
New surgical technique allows most men to maintain their sexual function,
fertility
After identifying the lymph nodes where testicular cancer is most likely to spread, surgeons begin
using a new surgical technique – called nerve-sparing or modified retroperitoneal lymph node
dissection – to remove the cancerous testicle and the affected nodes. Whereas previous surgical
techniques generally left men unable to ejaculate following surgery, this new approach spares key
nerves and tissue. Over time, refinements to the approach enable 95 percent of men with testicular
cancer to maintain their sexual function and fertility.
Early 1990s Laparoscopic surgery minimizes pain, recovery time for several cancers
Beginning in the 1990s, laparoscopic surgery – in which a surgeon makes several small incisions and
uses telescoping equipment to remove tumors – emerges as an alternative to traditional open surgery
for some cancers, including kidney, prostate and colorectal cancer. This new approach allows patients
to recover faster and experience less pain, without sacrificing effectiveness.
1992 Melanoma
Sentinel lymph node biopsy introduced to assess the spread of melanoma to
nearby lymph nodes
A surgical technique called sentinel lymph node biopsy becomes a less invasive way to assess whether
early-stage melanoma has spread to surrounding lymph nodes. The procedure involves surgically
removing the lymph node(s) that receives lymph drainage from the primary tumor – the “sentinel”
node – and then examining it under a microscope for evidence of cancer. If the sentinel node is cancerfree,
no further lymph nodes are removed and the patient is spared the previous practice of removing
multiple lymph nodes. This more conservative approach is easier on patients and reduces the risk of
post-operative side effects such as lymphedema. Later studies show that results of sentinel lymph node
biopsy are one of the most important predictors of risk for melanoma recurrence. This information
helps doctors determine which patients should be treated more aggressively to prevent their cancer
from returning.
1996 Breast Cancer
Sentinel lymph node biopsy introduced to assess breast cancer spread
An important study establishes a technique called sentinel lymph node biopsy as a standard part of
breast cancer surgery. The procedure involves removing the lymph node closest to the primary tumor –
the “sentinel” node – and examining it under a microscope for evidence of cancer. If the sentinel node
is cancer-free, no further lymph nodes are removed and the patient is spared the previous practice of
removing a large number of nodes and possibly larger sections of the breast. This more conservative
approach allows for easier recovery and reduces the risk of postoperative side effects such as
lymphedema, a painful swelling of the arm. If cancer is found, additional nearby lymph nodes are
assessed, and often removed, and the patient is treated with additional chemotherapy after surgery.
Recently, studies have shown that for some women, removing just the sentinel node may be sufficient.
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1997 Colorectal Cancer
Surgery found to cure some patients with advanced colorectal cancer
In general, metastatic cancer is difficult or impossible to treat with surgery because tumor cells have
spread throughout the body. But in a 1997 study, researchers find that some colon cancer patients
with tumors that have spread to the liver alone can be cured with surgery. In a study of nearly 300
such patients who underwent surgery between 1960 and 1987, about one in four were still alive five
years later, and nearly of all of these patients were found to have been essentially cured. A later study
finds that use of positron emission tomography, or PET scanning, can identify some liver metastases
that would have gone unnoticed before, helping surgeons in the study to achieve a cure rate above 50
percent for patients with metastatic disease.
2000 Kidney Cancer
Combination of kidney removal and immunotherapy extends life
Removing a cancerous kidney and delivering immunotherapy (interferon alfa 2b) is found to increase
survival time by 50 percent in patients with advanced renal cancer, compared to patients who received
only immunotherapy.
2003 Brain Cancer
Chemotherapy “wafer” active against malignant gliomas
Use of a surgically implanted biodegradable wafer containing the anticancer medication carmustine
(BCNU) is found to delay tumor growth and improve overall survival in some patients with gliomas. The
wafer provides continuous chemotherapy directly to the tumor site to kill remaining cancer cells and to
prevent or slow regrowth of the cancer. Today it is used in patients with recurrent malignant glioma
and newly diagnosed glioblastoma, a highly aggressive form of glioma.
2004 Colorectal Cancer
Laparoscopic colon cancer surgery effective, better tolerated
A study by researchers at multiple cancer centers finds that laparoscopic surgery to remove colon
tumors was as effective as conventional open abdominal surgery, and was associated with shorter
hospital stays and less pain after surgery. Laparoscopic surgery involves removing the tumor through
multiple small incisions and a telescoping camera device. This less-invasive approach is now widely
used.
2006 Brain Cancer
Chemically “illuminating” glioma tumors during surgery postpones recurrence
The use of 5-aminolevulinic acid, a substance that reacts with and illuminates malignant glioma cells, is
shown to improve surgeons’ ability to remove tumor tissue. Patients treated with this technique during
surgery were significantly less likely to have any tumor growth after six months, compared to those
who underwent conventional surgery.
Progress in Cancer Surgery
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2007 Colorectal Cancer
Lymph node sampling for staging is refined
Researchers determine that at least 12 abdominal lymph nodes need to be removed and analyzed
during colon cancer surgery to accurately determine the stage of the tumor. This study finds that the
more lymph nodes that were sampled, the longer a patient lived on average following therapy.
Accurate staging is necessary to identify which patients are at high risk of recurrence and are therefore
candidates for adjuvant chemotherapy following surgery.
2008 Cervical Cancer
Minimally invasive surgery shown to be effective for cervical cancer
In a small study, researchers find that two minimally invasive techniques – laparoscopic and robotic
radical hysterectomy (removal of the uterus) with radical pelvic lymphadenectomy (removal of
surrounding pelvic lymph nodes) – are as effective as traditional radical hysterectomy and
lymphadenectomy in women with cervical cancer. The procedures, which are performed through small
incisions, are associated with less blood loss and shorter hospital stays than traditional, open surgery.
While both of the new techniques had already been put into limited practice, this study provided
evidence to support their widespread use.
2009 Breast and Ovarian Cancer
Preventive surgery confirmed to reduce breast and ovarian cancer risk in women
with BRCA gene mutations
A major review of previously published studies confirms that surgical removal of the ovaries and
fallopian tubes in healthy premenopausal women with BRCA gene mutations reduces the risk of breast
cancer by 51 percent and the risk of ovarian and fallopian tube cancers by 79 percent. Among
postmenopausal women with BRCA gene mutations, this surgery is found to significantly reduce the
incidence of ovarian cancer but not breast cancer.
Without the surgery, women with inherited mutations in the two BRCA genes have up to an 84
percent lifetime risk of breast cancer and up to a 46 percent risk of ovarian and fallopian tube cancers.
These data give women with these mutations a proven option for reducing their cancer risk, although
it is comes with many side effects (including early-onset menopause) and prevents women of childbearing
age from having children.
2010 Breast Cancer
Removing fewer lymph nodes for some breast cancer patients does not impair
survival
Two large clinical trials confirm that less extensive lymph node surgery in women with early-stage
disease does not reduce their likelihood of survival. Specifically, researchers find that removing
additional underarm lymph nodes to look for breast cancer in women with limited or no disease
spread in the “sentinel” node – where cancer is most likely to spread – does not make a significant
difference in survival, compared to removing fewer nodes. Removing fewer nodes decreases the risk of
side effects, such as pain and swelling in the affected arm.
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2010 Ovarian Cancer
Pre-surgery chemotherapy proven an effective option for women with advanced
ovarian cancer
Major European trial reports that giving chemotherapy prior to surgery (called neo-adjuvant
chemotherapy) or after surgery (called adjuvant chemotherapy) is equally effective in women with
advanced ovarian cancer. These results resolve long-standing debate and provide an important
treatment alternative, particularly for women with larger tumors. In this group, giving chemotherapy
first can shrink the tumors so that less extensive surgery is needed later on in the course of therapy.
http://www.cancerprogress.net/downloads/timelines/progress_in_cancer_surgery_timeline.pdf