Osteosarcoma in Paleopathology

Joanna K. Suckling Anth 5374 Paleopathology April 20, 2011

Outline
What is cancer?
o o

History Diagnosis

What is osteosarcoma?

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.
o

Develop because of damage to DNA

What is Cancer?
Metastasis
o

When cancer cells travels to other parts of the body, grow, and replace normal tissue.

Primary bone cancer

o

When cancer starts in the bone.

Cancer in Antiquity
Greeks first to identify cancer
o

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
o

Greece
o o

Papyrus Ebers describe spells and fumigation to prevent eating of body tissues

Surgical treatments Topical treatments

History
Campbell Greig De Morgan (1811-1876)
o

Idea that cancer spreads from a tumor to other parts of the body (1871-1874)

Theodor Boveri (1862-1915)

o o

Proposed genetic basis of cancer (1902)

First non-surgical treatment for cancer (~1910)

Marie Curie (1867-1934)

What causes cancer?

Genetics Environment
o o o o

Radiation Viruses Chemicals and toxins Anything that can damage DNA!

What is osteosarcoma?
One of the most common malignant neoplasms of bone
o

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
o o

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 Pagets disease

Diagnosis
Production of osteoid
o

Osteoblast-like tumor cells

Codmans Triangle

Sunburst
o

Swelling over a bone Pain Pathological fracture

Differential Diagnosis

Modern Treatment
Four standard options:
o o o o

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

Image removed

Emergency above knee amputation Patient started on chemotherapy

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
o

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
o o

~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:
o o

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?

Osteosarcoma affects young individuals
Should show up in the record despite differences in life expectancy!

Perhaps the increase of cancer that were seeing in recent decades is more due to our environment rather than solely living longer.

But wait
Explanations for rarity:
o o o o

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
o o

BUT it was most likely really rare

(Cant 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
o

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
1. American Cancer S. 2008. Bone metastasis : what you need to know-- now. Atlanta, Ga.: American Cancer Society. 2. 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. 3. Aufderheide AC. 2003. The scientific study of mummies. Cambridge, UK; New York: Cambridge University Press. 4. 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. 5. Bronner F, and Farach-Carson MC. 2009. Bone and cancer. London: Springer.

References
1. Mould RF. 1998. The discovery of radium in 1898 by Maria Sklodowska-Curie (1867-1934) and Pierre Curie (18591906) with commentary on their life and times. The British journal of radiology 71(852):1229-1254. 2. Ortner DJ. 2003. Identification of pathological disorders in human skeletal remains. Amsterdam; London: Academic. 3. Pinhasi R, and Mays S. 2008. Advances in human palaeopathology. Chichester, England; Hoboken, NJ: John Wiley & Sons. 4. Roberts CA, and Manchester K. 2007. The archaeology of disease. Ithaca, N.Y.: Cornell University Press. 5. 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).

Images
http://www.cancer.gov/cancertopics/cancerlibrary/what-iscancer http://ak47boyz90.files.wordpress.com/2010/09/34.png http://upload.wikimedia.org/wikipedia/commons/3/32/Hippoc rates_rubens.jpg http://upload.wikimedia.org/wikipedia/commons/8/8b/Ebers7 766.jpg http://www.mlahanas.de/Greeks/images/AchillesPatroclos.jp g http://benefitsofhoneyblog.com/wpcontent/uploads/2011/03/honey.jpg http://upload.wikimedia.org/wikipedia/en/c/c4/GHS_carcinog en_sign.svg http://www.rsc.org/images/b514317a-250_tcm18-48745.jpg