Osteosarcomain Paleopathology Joanna K. Suckling Anth5374 · Paleopathology April 20, 2011
Outline What is cancer? History What is osteosarcoma? Diagnosis Why look for osteosarcoma in the archaeological record? Conclusions
What is Cancer? The uncontrolled growth of abnormal cells in the body. Normal cells Grow, divide, and die. Cancer cells Grow and divide. Develop because of damage to DNA
What is Cancer? Metastasis When cancer cells travels to other parts of the body, grow, and replace normal tissue. Primary bone cancer When cancer starts in the bone.
Cancer in Antiquity Greeks first to identify cancer Hippocrates “Father of Medicine” Descriptions of disease that may be cancer exist in several cultures (Egypt, Peru, etc.) Little understanding until the past 200 years
Ancient Treatments Egypt Papyrus Ebers describe spells and fumigation to prevent “eating” of body tissues Greece Surgical treatments Topical treatments
History Campbell Greig De Morgan (1811-1876) Idea that cancer spreads from a tumor to other parts of the body (1871-1874) Theodor Boveri (1862-1915) Proposed genetic basis of cancer (1902) Marie Curie (1867-1934) First non-surgical treatment for cancer (~1910)
What causes cancer? Genetics Environment Radiation Viruses Chemicals and toxins Anything that can damage DNA!
What is osteosarcoma? One of the most common malignant neoplasms of bone But one of the more uncommon types of cancer ~1500 reported each year in the US Sometimes known as “osteogenic sarcoma” 40-60% of primary malignant tumors in bone are osteosarcoma 7% of adolescent cancers 19% of all tumors in bone
What is osteosarcoma? Develops from the metaphyseal growth plate and extends into the bone cortex Usually starts in osteoblasts
What is osteosarcoma? Usually affects juvenile individuals (< 20) Occurs during growth periods Males more often affected
Other Risk Factors Radiation therapy Medications Genetics Paget’s disease
Diagnosis Production of osteoid “Osteoblast-like” tumor cells “Sunburst” Codman’s Triangle Swelling over a bone Pain Pathological fracture
Modern Treatment Four standard options: Surgery Chemotherapy Radiation therapy Samarium
Modern Case Study 17 year old male Growing mass on the leg Pain
X-ray and biopsy confirm osteosarcoma
Modern Case Study Emergency above knee amputation Patient started on chemotherapy Image removed
Survival? Malignant Early death Bone cells can release hormone-like factors that cause cancer cells to grow faster (American Cancer Society 2008) Rate depends on treatment plan and metastasis 20% survival with only surgery
Is cancer a “new” disease? Popular theory that age at death, diet, and environment contributed to a substantial rise in the incidence of cancer
Is cancer a “new” disease? Industrialized nations: 2nd leading cause of death Very few references to cancer in antiquity Few definite examples in archaeology ~176 total? Mostly metastatic (not primary sarcoma) Evidence of cancer does exist in animal fossils, non-human primates, possibly Neanderthal, and modern humans.
Why look for osteosarcoma in the archaeological record? Important to paleopathology: Produces bone Likely to survive! Occurs most often in young individuals Should appear in populations despite shorter life expectancy
Physical Evidence of Osteosarcoma Femur found in Peru(Aufderheide et al. 1997) Hawaii (Suzuki 1987) Europe (Brothwell 1967; Strouhal et al. 1997) Possibly Egypt, Spain, Germany, Poland, and France Very few cases!
The Increase of Cancer Incidence? Osteosarcomaaffects young individuals Should show up in the record despite differences in life expectancy! Perhaps the increase of cancer that we’re seeing in recent decades is more due to our environment rather than solely living longer.
But wait… Explanations for rarity: Osteosarcoma is rare in general Lack of sufficient diagnostic methods in the past Insufficient data In past societies not all social classes may have had equal access to care Not all cases recorded or recognized
Conclusions Cancer has always affected humans BUT it was most likely really rare (Can’t know that for sure!) Osteosarcoma is rarely found Increase in cancer rates is most likely a new concern, resulting from increases in life expectancy and changes in our environment Historical accounts in this century support this conclusion
Conclusions … But the debate continues. Need more data! Better diagnoses Paleopathology has the potential to contribute to the study of cancer.
References American Cancer S. 2008. Bone metastasis : what you need to know-- now. Atlanta, Ga.: American Cancer Society. Aufderheide A, Ragsdale B, Buikstra J, Ekberg F, and Vinh TN. 1997. Structure of the radiological "sunburst" pattern as revealed in an ancient osteosarcoma. JOURNAL OF PALEOPATHOLOGY 9:101-106. Aufderheide AC. 2003. The scientific study of mummies. Cambridge, UK; New York: Cambridge University Press. Boveri T. 2008. Concerning the Origin of Malignant Tumours by Theodor Boveri. Translated and annotated by Henry Harris. J Cell Sci 121(Supplement_1):1-84. Bronner F, and Farach-Carson MC. 2009. Bone and cancer. London: Springer. Brothwell DR, and Sandison AT. 1967. Diseases in antiquity; a survey of the diseases, injuries, and surgery of early populations. Springfield, Ill.: C.C. Thomas. Capasso LL. 2005. Antiquity of cancer. International journal of cancer Journal international du cancer 113(1):2-13. Dorfman HD, and Czerniak B. 1998. Bone tumors. St. Louis: Mosby. Halperin EC. 2004. Paleo-Oncology: The Role of Ancient Remains in the Study of Cancer. Perspectives in Biology and Medicine 47(1):1-14. Mirabello L, Troisi RJ, and Savage SA. 2009. Osteosarcoma incidence and survival rates from 1973 to 2004. Cancer 115(7):1531-1543.
References Mould RF. 1998. The discovery of radium in 1898 by Maria Sklodowska-Curie (1867-1934) and Pierre Curie (1859-1906) with commentary on their life and times. The British journal of radiology 71(852):1229-1254. Ortner DJ. 2003. Identification of pathological disorders in human skeletal remains. Amsterdam; London: Academic. Pinhasi R, and Mays S. 2008. Advances in human palaeopathology. Chichester, England; Hoboken, NJ: John Wiley & Sons. Roberts CA, and Manchester K. 2007. The archaeology of disease. Ithaca, N.Y.: Cornell University Press. Strouhal E, Vyhnanek L, Horackova L, Benesova L, and Nemeckova A. 1997. A Case of Osteosarcoma in a Late Medieval-Early Modern Skull from Kyjov (Czech Republic). INTERNATIONAL JOURNAL OF OSTEOARCHAEOLOGY 7(1):82-90. Suzuki T. 1987. Paleopathological study on a case of osteosarcoma. American journal of physical anthropology 74(3):309-318. http://www.cancer.gov/cancertopics/pdq/treatment/osteosarcoma/patient