One hundred years ago, primary lung cancer was considered a rarity, with only a few hundred cases acknowledged in the world literature. Until the middle of the 1920s, medical textbooks by noted authors continued to label the disease “rare,” although metastatic lung disease was recognized and associated with an array of neoplasms. However, in the past 80 years, there have been more drastic changes in the position and understanding of primary lung cancer and its impact on society than for any other disease. It is now the most frequently diagnosed malignant neoplasm in the world.
In 1924, Arthur C. Christie, MD, Professor of Roentgenology at George Washington University Hospital in Washington, DC, published Roentgen Diagnosis and Therapy. In this book, as in others of the era, lung cancer is noted to be a difficult diagnosis to make. Bronchoscopy with biopsy, if feasible, is the most important diagnostic tool. Dr. Christie gives his differential of the x-ray appearances and possibilities. He notes, “benign tumors appear smooth on x-rays” (and slow growth is its distinguishing characteristic).
An x-ray of a syphilitic gumma mimics that of a malignant tumor. Positive syphilitic tests, such as the Wassermann and, of the upmost importance, the disappearance of the lesion under anti-syphilitic treatment will help distinguish it from cancer. Caseous pneumonia is also easily confused with primary carcinoma.
Metastatic tumors of the lung, as seen in this photograph, are usually carcinoma, sarcoma, or hypernephroma. Early metastasis is characterized by small circular shadows. Sarcoma often grows as one large smooth mass involving an entire lung. Sarcoma metastasis can be distinguished from metastatic carcinoma, as the carcinoma metastasis usually has multiple lesions with irregular edges. Only metastatic carcinoma of the prostate resembles lung sarcoma, as its metastasis may be a solitary round lesion. Many times the metastases are so numerous that their appearance simulates that of extensive tuberculosis.
Excerpted from Oncology: Tumors & Treatment, A Photographic History, The Radium Era 1916-1945 by Stanley B. Burns, MD, FACS. Photograph courtesy of Stanley B. Burns, MD, and The Burns Archive. ■