Seventy Years of Dunphys Puzzle Revisited

Abstract

Kangla Tsung

In 1950 Dr. J Englebert Dunphy published an essay titled “Some observations on the natural behavior of cancer in man” in the New England Journal of Medicine in which he challenged the main stream concept of cancer as a “steady and irrevocable growth” by describing four cancer cases with unpredictable outcome ranging from spontaneous regression to explosive metastases a er resection of primary tumor. His main point is to raise the awareness that there is a “local tissue resistance” that causing cancer to go through periodic arrest or even regression amid general trend of progression.  e question to be answered “is not what makes the cells suddenly grow, but what has held them in abeyance for long”. With this question answered, he hoped in the future, “it may be possible to determine the growth curves of a given tumor so as to plan extirpation at periods of quiescence rather than during periods of very active growth”. 70 years have passed since Dunphy’s original writing and we know that what he called “natural tissue resistance” in his essay is what we call antitumor immunity today. Yet even with this knowledge, today’s cancer surgeons still do not base their surgical decisions on the actual interaction between tumor and host antitumor immunity.  ey still do not plan the surgical timing based on tumor growth pro le.  is essay is a revisit of Dunphy’s view by analysing the cases in Dunphy’s original essay with today’s knowledge and by presenting a few more cases in which we followed his hypothesis and obtained desired outcomes.

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