Fluctuations in the Growth Energy of Malignant Tumors in Man, with Especial Reference to Spontaneous Recession

Abstract

Spontaneous regression or remission (SR) of cancers has been defined as the disappearance of the malignancies without any treatment or with obviously inadequate treatment. Four case reports are presented. These include a case of pleomorphic liposarcoma with bilateral lung metastases, a case of recurrent squamous cell carcinoma of the esophagus following esophagectomy a year earlier, a case of a squamous cell carcinoma of the scalp, and a case of a ruptured hepatocellular carcinoma with an emergency right hepatic lobectomy but with some gross cancer remaining in the left hepatic lobe. The literature of SR of cancers was reviewed and various mechanisms possibly involved in the disappearance of the cancers were discussed. Although immune modulation has been stated to be the most likely process causing SR, other mechanisms, such as genetic therapy, withdrawal of carcinogens, infection, fever and vaccine roles, apoptosis, antibody, antiangiogenesis and maturation mechanisms, withdrawal of therapy, natural killer activity, endocrine, hormonal, and pregnancy factors, and prayers or psychoneuro-religious participation were also mentioned. Induction and inhibition of malignant protein expression and repair of gene damage may prove to be the more important processes in cancer regression. It was also pointed out that the pulmonary metastases of the liposarcoma and the recurrent squamous cell carcinoma of the esophagus may be the very first cases of their kind to be described and that it is rare indeed to find 4 cases of SR's in a solo practice. Finally, it is likely that SR is rarer than previously believed and that the incidence may be one in every 140,000 cases of cancer rather the one per 60,000 to 100,000 cancer cases as earlier thought.

Case Details

Clinical Characteristics

The greatest number of spontaneous regressions have occurred following incomplete surgical removal of the tumor; next in order of frequency during some acute febrile process; and least frequently, in connection with some profound alteration in the metabolic processes of the organism such as extreme cachexia, artificial menopause, or the puerperium.

Remission Characteristics

The observation that a neoplasm may be absorbed subsequent to, or during, an acute infection, opens a most interesting field for speculation. The greater number of cases in this group have occurred after an attack of erysipelas, an observation which has led to the use of toxins of the causative organism as a therapeutic measure. However, further observation shows that recession has also occurred after smallpox, pneumonia, malaria, and acute tuberculosis. No one organism is, therefore, specific in causing regression. In the histories of those cases that are given in detail, there is a common symptom, namely, high temperature, sustained without remission for several days.

Treatment & Mechanisms

Proposed Remission Mechanisms

Injections of bacterial toxins, while they do give rise to violent febrile reactions, are not characterized by the continuance of fever in full violence and without remission over a period of forty-eight hours.

Clinical Treatment

Incomplete surgical removal of the tumor

Additional Notes

In those cases of spontaneous recession reported in the literature where a cause for the recession was reported by the author or inferred from the case report, 64 recessions were attributed to heat, 27 of which were attributed to acute general infection, and the remainder to other forms of heat including heat applied externally.