Osteosarcoma in Paleopathology

Joanna K. SucklingAnth 5374 · Paleopathology

April 20, 2011

Outline• What is cancer?

o History• What is osteosarcoma?

o 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.

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 cancero When cancer starts in the bone.

Cancer in Antiquity• Greeks first to identify

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

• Greeceo Surgical treatmentso 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 Proposed genetic basis of cancer (1902)

• Marie Curie (1867-1934)o First non-surgical treatment for cancer (~1910)

What causes cancer?• Genetics• Environment

o Radiationo Viruseso Chemicals and toxinso 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

osteosarcomao 7% of adolescent cancerso 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

o “Osteoblast-like” tumor cells

• “Sunburst”o Codman’s Triangle

• Swelling over a bone• Pain• Pathological fracture

Differential Diagnosis

Modern Treatment• Four standard options:

o Surgeryo Chemotherapyo Radiation therapyo 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

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 ~176 total? Mostly metastatic (not primary sarcoma)

o 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 Produces bone Likely to survive!

o 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 we’re seeing in recent decades is more due to our environment rather than solely living longer.

But wait…• Explanations for rarity:

o Osteosarcoma is rare in generalo Lack of sufficient diagnostic methods in the pasto Insufficient datao 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 BUT it was most likely really rare (Can’t know that for sure!)

o Osteosarcoma is rarely found• Increase in cancer rates is most likely a new concern,

resulting from increases in life expectancy and changes in our environmento 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.

References1. 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.

6. 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.

7. Capasso LL. 2005. Antiquity of cancer. International journal of cancer Journal international du cancer 113(1):2-13.

8. Dorfman HD, and Czerniak B. 1998. Bone tumors. St. Louis: Mosby.

9. Halperin EC. 2004. Paleo-Oncology: The Role of Ancient Remains in the Study of Cancer. Perspectives in Biology and Medicine 47(1):1-14.

10.Mirabello L, Troisi RJ, and Savage SA. 2009. Osteosarcoma incidence and survival rates from 1973 to 2004. Cancer 115(7):1531-1543.

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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). INTERNATIONAL JOURNAL OF OSTEOARCHAEOLOGY 7(1):82-90.

6. Suzuki T. 1987. Paleopathological study on a case of osteosarcoma. American journal of physical anthropology 74(3):309-318.

7. http://www.cancer.gov/cancertopics/pdq/treatment/osteosarcoma/patient

Images• http://www.cancer.gov/cancertopics/cancerlibrary/what-is-

cancer• http://ak47boyz90.files.wordpress.com/2010/09/34.png• http://upload.wikimedia.org/wikipedia/commons/3/32/

Hippocrates_rubens.jpg• http://upload.wikimedia.org/wikipedia/commons/8/8b/

Ebers7766.jpg• http://www.mlahanas.de/Greeks/images/

AchillesPatroclos.jpg• http://benefitsofhoneyblog.com/wp-content/uploads/

2011/03/honey.jpg• http://upload.wikimedia.org/wikipedia/en/c/c4/

GHS_carcinogen_sign.svg• http://www.rsc.org/images/b514317a-250_tcm18-48745.jpg• http://www.foodchannel.com/gallery/french%20fries.jpg• http://static.howstuffworks.com/gif/carcinogens-cause-

cancer1.jpg• http://upload.wikimedia.org/wikipedia/commons/thumb/

5/5d/WVSOM_Osteoblast.JPG/800px-WVSOM_Osteoblast.JPG

• http://orthoinfo.aaos.org/figures/A00040F01.jpg• http://www.sciencesway.com/vb/t9961-p2.html• http://www.nrc.gov/reading-rm/basic-ref/teachers/images/

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134711/840a4d1c5181499ad4ad78f8b72874.png• http://www.gsdhelp.info/cancer/osteosarcoma1.gif

o http://www.medic.usm.my/~pathology/bonepath/bonepath/Ostsac1.jpg

o http://images.radiopaedia.org/images/141917/ae078b640009823890876ea1e72510_gallery.png

• http://1.bp.blogspot.com/_FYzmMSSuvWc/TI8otppx-7I/AAAAAAAAF-M/jW6FWpnuRaY/s1600/4bd460824d898TEK-bone-tumor3.jpg

• http://www.cancer.iu.edu/research/programs/cancer_control/Cancer_Continuum2.jpg

• http://sarcomahelp.org/osteosarcoma.html• http://www.ccs.k12.in.us/chsBS/kons/kons/age%20and

%20cancer%20graph.jpg• http://kpbs.media.clients.ellingtoncms.com/img/photos/

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