Reply to “Karkinos in ancient medicine: More than just fatal cancer”

Ancient Greek and Roman physicians regarded cancer as a disease that was in the majority of cases incurable. Although there were occasions where cancers were treated successfully, the experience of ancient physicians was that most patients who had the disease died. This is why in my article¹ I stated that cancer (karkinos) was “very often” and “usually” thought to be deadly.

In the sixth century AD, for instance, the physician Aëtius, in summarizing previous medical thought, classified cancers as either curable or incurable. Aëtius said that cancers of the head, neck, back, armpit, and groin were incurable: patients would die either from the disease or from the surgery. Aëtius said that only cancers of the tip of the breast could be cured because patients were able to survive the operation.²

Some ancient physicians avoided surgery because they knew it could kill the patient more quickly than the disease. Stephanus (seventh century AD) was one physician who believed that surgery would bring about a patient’s death more rapidly. He described the terrible experience of an ancient cancer surgeon cutting away one piece of cancerous flesh and finding new layers of cancerous flesh below it:

“If you want to use the knife, you will first cut away the veins that are intertwined with each other; then, because the adjoining veins underneath are also affected by the disease, you will have to cut away those as well, and thereupon the ones underneath these also. In short, as the disease has spread in depth and in breadth, the patient dies of the surgery.”³

Although ancient physicians used the words “benign” and “malignant” when describing tumors (onkoi) generally, the word karkinos and related “crab” terms were used to describe tumors that were diagnosed (rightly or wrongly—misdiagnosis was common) as being potentially deadly.⁴ Ancient physicians usually preferred to use the words “incurable” and “curable” when discussing karkinoi. Ancient physicians also classified karkinoi with the term “hidden” (kryptos) for a tumor below the skin, as distinguished from a tumor protruding from the surface of the skin. Hidden cancers were thought to be untreatable, whereas drugs and surgery were used on “visible” cancers such as those on the tip of the breast. Ancient physicians called cancers that had broken through the skin “ulcerated,” and those that had not broken through the skin “unulcerated.”

Regrettably, I must point out that my colleague has used faulty translations when supplying evidence to support his argument that karkinos could refer to both benign and malignant swellings. For example, my colleague cites the ancient physician Paulus for a quotation about karkinoi that says: “The veins around the affected part stretch and become filled, resembling the legs of a crab, and hence the disease is called karkinos. However, not all such swellings are fatal.” Unfortunately, this is a misquotation. The words “however, not all such swellings are fatal” appear nowhere. Paulus actually says the opposite to what my colleague claims, for in this passage Paulus states that “cancer [karkinos] is an incurable disease.”⁵

There are also problems with my colleague’s interpretations of ancient texts. For instance, he claims the words “the one whose karkinos in the pharynx was cauterized was cured by me” in the Hippocratic Epidemics ⁶ indicate conditions “that modern medicine would likely classify as benign tumors.” However, this interpretation is doubtful. There is no reason to think that the karkinos was not malignant; but it is also possible that the physician misdiagnosed a benign tumor as a malignant one.

To finish on a positive note, I want to emphasize that I agree with my colleague that the ancient terminology for cancer is complicated and needs to be approached in a nuanced way. The main terms for cancer in antiquity were karkinos and karkinōma but these seem to have been used interchangeably. We also find terms such as “cancerous swelling” (karkinōdēs onkos), which also seems to have been equivalent in sense to karkinos and karkinōma. Unlike today, there was no single, universally agreed-upon term that referred to the disease.

The author declares no conflicts of interest.