In 2004, Dr Richard Ellenbogen spent almost 20 hours operating on a 17-year-old girl with a brain tumour. He ended up leaving a big piece of the tumour behind, mistaking it for normal brain tissue. Less than a year after the surgery, the cancer hit back and the young girl died.<\/p>\n
The week the girl died, Ellenbogen presented the case at his team\u2019s weekly meeting at Seattle Children\u2019s Hospital. \u201cThere\u2019s got to be a way to take more of the tumour out and leave more of the normal brain intact,\u201d he sighed in frustration. The nagging feeling that he could\u2019ve taken more tumour out wouldn\u2019t leave him alone. Ellenbogen had faced a dilemma: if he had removed more, he would probably have removed more tumour but might also have removed normal brain tissue, with the risk that the girl would have been left severely disabled. Neurosurgeons have to be aggressive and sometimes push themselves to go further and deeper than they feel comfortable going, but they all operate under the adage \u2018first, do no harm\u2019.<\/p>\n
The first recorded cases of cancer show how the Ancient Egyptians used cauterisation (using red-hot instruments to burn off tissue and seal off wounds) to destroy tumours and to treat a variety of infections, diseases and bleeding lesions. Until the mid-18th century, surgery was the only effective option for addressing several conditions. But it was difficult and painful, as shown by the case of Madame Frances d\u2019Arblay, an English novelist living in Paris.<\/p>\n
Before operating in 1811, d\u2019Arblay\u2019s doctor didn\u2019t shield her from the gruelling pain she would encounter during the treatment for her advanced breast cancer \u2013 a mastectomy, without anaesthetic. \u201cYou must expect to suffer, I do not want to deceive you\u2014you will suffer\u2014you will suffer very much!\u201d d\u2019Arblay later wrote that \u201cwhen the dreadful steel was plunged into the breast\u2014cutting through veins, arteries, flesh, nerves\u2014I needed no injunctions not to restrain my cries. I began a scream that lasted unintermittingly the whole time of the incision\u2026 the air felt like a mass of minute but sharp and forked poniards [daggers] that were tearing the edges of the wound.\u201d Yet the operation was a success, and d\u2019Arblay lived for another 29 years.<\/p>\n