and more aggressively was the answer to freeing the patient from the
invader.
The ancient Greek word for cancer was karkinos, or crab. In 400 B.C.E.,
Hippocrates observed a tumor mass as a “clutch of swollen blood vessels
around it, [reminding] Hippocrates of a crab dug in the sand with its legs
spread in a circle.”^26 Later writers would further embellish upon the idea
of cancer as an alien invader, the crab outfitted with a tough carapace and
bellicose pincers. With this mindset, the Halstedian concept of the
surgeon’s role as liberator, the chief function was to separate the patient
from her disease. Unlike the Greeks, who had no microscopes and no
conception of the cellular basis of disease, Halsted understood that cancers
were comprised of abnormal cells. What he and other dauntless surgeons
were missing was the pathologic process of vascular metastases, where the
cancer cells spread through the bloodstream and not just through
contiguous, centrifugal growth.
Only decades since the discovery of what cancer really was—the
pathologic transformation and growth of cells—and decades before
chemotherapy and radiation would become available, Halsted perceived
his heroic task was to lacerate, harrow, and extirpate (and disfigure and
dismember, if need be). In the few years between the launch of the
hospital and the opening of the medical school in 1893, Halsted would
enlarge the zone of excision, eventually removing the entire pectoralis,
and occasionally ribs, the collarbone, and all the lymph nodes. He wanted
to get at the root of the cancer, naming the operation radical mastectomy,
from the Latin word for root, radix. We misconstrue the meaning of
radical in this context when we assume it means “severe” or “profound.”
Clearly, radical mastectomy, in Halsted’s hands, was severe and
uncompromising, but he was conceptually digging deeper.
In the end, the radical mastectomy would lose its favored position
among cancer surgeons. A few brave surgeons, like Geoffrey Keynes,
George Crile Jr., and Bernard Fisher, bucked tradition, believing that
simple, less aggressive surgery was just as effective, and certainly less
morbid, than radical mastectomy. (This transformation is elegantly
reported by Siddhartha Mukherjee in The Emperor of All Maladies.) While
the technique itself is no longer performed, we can certainly understand
why Halsted posited that it might work. Wide resection is still a mainstay
in solid tissue oncology, where shockingly wide swathes of muscles, skin,