(CNN) — Cancer is often considered a disease of the modern era. However, medical texts from ancient Egypt indicate that the healers of the time were aware of this disease. Now, new evidence from a skull more than 4,000 years old has revealed that ancient Egyptian doctors may have attempted to treat certain types of cancer with surgery.
The skull belonged to a man who was between 30 and 35 years old when he died, and is in the collection of the Duckworth Laboratory at the University of Cambridge (United Kingdom). Since the mid-19th century, scientists have studied the scarred surface of the skull, which includes multiple lesions believed to represent bone damage caused by malignant tumors. The skull, labeled 236 in the collection, is considered by archaeologists to be one of the oldest examples of malignant tumors in the ancient world, dating to between 2686 BC and 2345 BC.
But when researchers took a closer look at the tumor scars with a digital microscope and computed tomography (CT) scan, they detected signs of cuts around the tumors, suggesting that sharp metal instruments had been used to remove the tumors. The scientists published their findings Wednesday in the journal Frontiers in Medicine.
“It was the first time that humanity surgically treated what we call cancer today,” said the study’s lead author, Dr. Edgard Camarós, a professor in the history department at the University of Santiago de Compostela in Coruña, Spain.
However, it is unknown if the healers attempted to remove the tumors while the patient was still alive, or if the tumors were removed after death for analysis, Camarós told CNN.
“If those cut marks were made with the living person, we’re talking about some type of treatment directly related to the cancer,” he said. But if the cut marks were made posthumously, “it means that this is a medical autopsy examination in relation to that cancer.”
In any case, “it is surprising to think that they performed a surgical intervention,” Camarós added. “But we can’t really distinguish between treatment and an autopsy.”
Several of the metastatic skull lesions 236 show cut marks. (Credit: courtesy of Tondini, Isidro, Camarós)
Medical “knowledge and mastery”
Ancient Egyptian medicine, widely documented in medical texts such as the Ebers papyrus and the Kahun papyrus, was undoubtedly sophisticated, and the new finds offer important and direct evidence of this knowledge, said Dr. Ibrahem Badr, associate professor in the department of restoration and conservation of antiquities at the Misr University of Science and Technology in Giza, Egypt.
“We can see that ancient Egyptian medicine was not based solely on herbal remedies like the medicine of other ancient civilizations,” said Badr, who was not involved in the new research. “It was based directly on surgical practices.”
But while this ancient evidence was well studied during the 19th and 20th centuries, 21st-century technologies, like those used in the new study, are revealing previously unknown details about the medical arts of ancient Egypt, Badr added.
“The research provides a strong new direction for reassessing the history of medicine and pathology among the ancient Egyptians,” he said. The methods of the study’s authors “take their results from the realm of uncertainty and archaeological possibilities to that of scientific and medical certainty.”
The scientists also found cancerous lesions on a second skull in the Duckworth collection. Labeled E270 and dated between 664 BC and 343 BC, it belonged to an adult woman of at least 50 years old. The team identified three lesions in the specimen in which malignant tumors had damaged the bone.
Unlike skull 236, E270 showed no signs of surgical interventions related to the disease. But the woman’s skull did have long-healed fractures, demonstrating the success of prior medical intervention for head trauma.
“That person survived many years after that trauma,” Camarós said.
Writing the “biography” of cancer
The analysis of both skulls “is a remarkable investigation that provides new and clear scientific evidence on the field of pathology and the development of medicine among the ancient Egyptians,” Badr said.
Badr, who collaborates with scientists in Europe and the United States in the study of atherosclerosis (accumulation of plaques in the arterial walls) in ancient Egyptian mummies, explained that his work follows the same scientific direction as the research on the skulls. Through detailed examinations of the mummies with 21st-century technologies such as CT scanning and DNA sequencing, Badr and his colleagues hope to further illuminate the extent of medical knowledge in ancient Egyptian times.
“There is an urgent need to re-evaluate the history of Egyptian medicine using these scientific methodologies,” Badr said. “Using these modern techniques, we will be able to study and gain a more complete and accurate understanding of medicine in ancient Egypt.”
The new findings also help complete a part of the “dark biography” of cancer by adding a chapter that was written thousands of years ago, Camarós added.
“The more we look into our past, the more we know that cancer was much more widespread, much more present than we thought,” he said.
The research team examined skulls from the University of Cambridge’s Duckworth Laboratory collection using microscopic analysis and computed tomography. (Credit: courtesy of Tondini, Isidro, Camarós)
A medical milestone
The ancient Egyptians’ perception of cancer focused on the visible tumors produced by the disease. The first recorded observation of cancer is found in an ancient Egyptian medical text known as the Edwin Smith Surgical Papyrus, which dates from approximately 3000 BC to 2500 BC. This text contains 48 case studies covering various ailments, including a description of breast cancer.
Although the healers of ancient Egypt knew about cancer, treating it was another story. Most of the medical cases in the Edwin Smith papyrus mentioned medications or healing strategies. But there were none for the breast cancer patient’s tumors, Camarós said.
“It specifically says there is no treatment,” he said. “They realized this was a frontier in terms of their medical knowledge.”
However, incisions around skull tumors suggest that ancient Egyptian healers were trying to change that, surgically removing the tumors to cure the patient or to examine the tumors more closely.
“We have these two possibilities: they tried to treat it or they tried to understand it medically, in terms of probably treating it in the future,” Camarós said. “I think it’s a milestone in the history of medicine.”
Mindy Weisberger is a science writer and media producer whose work has appeared in Live Science, Scientific American, and How It Works magazine.