Cancer Treatment in Turkey Through Questions – A Brief History and the Current State

In Turkey, oncology (the science of cancer) has been an important field since the early years of the Republic. The first cancer laboratories and clinics were established during this period, and important steps were taken in the fight against cancer. Today, it has achieved remarkable progress.

A Brief History of Cancer Treatment in Turkey

Information about the history of cancer in the Ottoman Empire is quite limited. This is because cancer diagnosis and treatment methods had not yet developed at that time. Although symptoms related to cancer appear in medical works in Ottoman sources, it is not fully understood what these symptoms indicate.

One of the early studies related to cancer in the Ottoman Empire is the work "Kitabü'l-Menafi" by Ebubekir bin Muhammed el-Halici, who lived in the 17th century. This work contains some information about the symptoms and treatment of cancer.

The first modern studies related to cancer in the Ottoman Empire began with breast cancer surgeries performed by Dr. Cemil Topuzlu in the 1890s. Dr. Cemil Topuzlu, who holds an important place in the history of Turkish surgery, developed an important technique in breast cancer surgery. During breast cancer operations he performed in the late 1890s, Dr. Topuzlu injured the artery in the armpit and introduced a technical innovation by suturing the severed artery end to end. This method was considered an important development in breast cancer surgery at the time.

Cancer research and the fight against cancer in Turkey were pursued intensively by many physicians during the early years of the Republic. The first books on cancer diagnosis and treatment were published in translation in the 1920s. In addition, cancer was addressed in a special session at Turkey's third national medical congress, where many physicians from different disciplines related to cancer came together and exchanged ideas.

The pathology laboratory established by Hamdi Suat Aknar in 1925 became an important center for cancer research. The article Aknar published in 1927 entered the international medical literature. Kazım İsmail Gürkan's work "Kanserin Esbâb ve Tedavisi" was published in 1926 and paved the way for an increase in scientific studies on cancer. 

Prof. Dr. İbrahim Türe, the founder of Istanbul University Cerrahpaşa Faculty of Medicine, opened the first cancer clinic in Turkey in 1935. This clinic began applying modern treatment methods to cancer patients. At the same time, the first cancer classification and cancer statistics in our country were established at this clinic.

As studies related to cancer increased in our country, institutions for cancer treatment began to be established in Turkey in the 1930s. The "Cancer Institute" was established at Istanbul University in 1933, and cancer research began there. A "Radiotherapy Clinic" was opened at Ankara University Faculty of Medicine in 1940.

From the 1950s onward, the fight against cancer accelerated in Turkey. The "Cancer Control Association" was established in 1953, and awareness-raising activities related to cancer began. The "Cancer Research Institute" was established at Ankara University in 1956, and scientific studies related to cancer continued to increase.

New methods for cancer treatment were developed in Turkey in the 1960s. A "Cancer Outpatient Clinic" was opened at Istanbul University in 1960. Turkey's first radiotherapy device began to be used in 1962. In the same year, a "Cancer Treatment Center" was opened at Ankara University Faculty of Medicine.

Today, significant progress has been made in cancer diagnosis and treatment in Turkey. Many hospitals in our country are equipped with modern medical devices and treatment methods. In addition, cancer research and studies continue without slowing down. In this way, important steps are being taken in the fight against cancer and awareness of cancer is being increased.

Modern Cancer Treatment in Turkey

In the remainder of the article, we share the current state of cancer treatment in our country in a question-and-answer format.

Is there a difference between the cancer treatments provided in our country and those provided in other developed countries? What are the developments in personalized treatment, smart treatment applications, and cancer imaging and treatment? Are they being implemented in our country? Do we have advantages over other countries in cancer treatment?

Is there a difference between the cancer treatments provided in our country and those provided in Europe or America?

Today, access to information is so rapid that it can almost be measured in minutes. The most important factor in cancer treatment is access to changing and updated treatment strategies, following clinical studies that contribute to the development of these strategies, and transferring expert opinions into routine practice. Since information is not the monopoly of any institution or person, oncologists who can access and assimilate current information are able to quickly share the newest treatments with their patients. As for technological requirements and comfortable facilities, our country is also undergoing rapid change in this area. What our people need to know is that we now provide cancer treatment services as good as those in the Western world, and that we are ahead in some areas. When it comes to valuing patients and their relatives, which is the most important part of cancer treatment, and to a compassionate and caring approach, no physician or group of healthcare professionals anywhere in the world can surpass our country.

What is personalized treatment? Can it be provided in our country?

"Personalized Treatment" and "Precision Oncology" are concepts that have developed in recent years. This approach aims to provide the most appropriate treatment for an individual based on scientific evidence by simultaneously analyzing the genetic structure of the patient's cancer and the individual's non-cancer-related characteristics. The model that "a single treatment method benefits all patients" has now been abandoned and replaced by "personalized treatments." In this way, more effective treatments are administered to patients and unwanted side effects are avoided. This approach is being successfully applied in many types of cancer, including breast cancer and lung cancer.

What are smart treatment and immunotherapy applications in cancer? Are they being implemented in our country?

Since the 2000s, smart therapies or targeted therapies in cancer have become a source of hope for cancer patients by achieving success in many cancer treatment strategies. In many types of cancer where successful results could not be obtained with conventional chemotherapy drugs, targeted drugs used alone or together with chemotherapy provided benefits beyond expectations. It was observed that these drugs affected cancerous cells while having no or very little effect on normal cells. Developed to target tumor-specific proliferation pathways located inside or outside the cell, these drugs create selectivity in treatment and are moving the perception of cancer toward that of a chronic disease. For example, while the life expectancy of a female patient with advanced-stage lung cancer, who had not smoked before 2000 and whose cancer was adenocarcinoma, was limited to months, it is extremely gratifying for physicians today to witness such patients quickly leading a healthy life with a single pill. Today, we successfully use smart drugs for many types of cancer in our country.

Immunotherapy in cancer, is a treatment method designed to support the immune system in fighting cancer cells. Immunotherapy targets cancer cells by enabling them to be recognized and destroyed by the immune system or by activating the body's own defense mechanisms by increasing the interaction of immune system cells with cancer cells.

This treatment has been regarded as a major development in cancer treatment in recent years. Immunotherapy is used in different types of cancer and, in some types of cancer, is administered as an alternative to chemotherapy and radiation therapy. Immunotherapy can also be effective in advanced-stage cancer and may play an important role in prolonging the lives of cancer patients.

The contribution of immunotherapy to patients is demonstrated by its adoption of a more direct strategy for fighting cancer cells. Other cancer treatments, particularly chemotherapy, can cause undesirable side effects because they may target healthy cells as well as cancer cells. Immunotherapy, on the other hand, generally offers patients a more effective treatment option with fewer side effects.

What are the new technologies in cancer imaging and treatment, and does our country have access to these technologies?

Cancer treatment has undergone a major evolution thanks to developments in medical technology. The most important development was the routine use of PET-CT' among cancer imaging devices. Thanks to this device, tumor spread in the body can be detected more accurately and the success of treatment can be determined at an early stage. However, PET-CT is not an imaging method specific only to cancer. The device measures the metabolic activity of cells that are more active than normal cells and determines whether these areas have an abnormal structure. PET-CT is not suitable for routine cancer screening but is useful for individuals with suspected cancer. Today, patients can easily access this device in many provinces of our country. In addition, clinics also provide services to their patients with PET-MRI, an improved version of PET-CT.

Technological developments have also taken place in breast cancer imaging and follow-up. Digital breast imaging devices have improved image quality of the breast and increased patient comfort. Thanks to these devices, called tomosynthesis, patients' previous information can be stored, new findings can be compared with older images, and it can easily be monitored whether a problem has developed in the patient's breast. This method is readily accessible in our country.

There have also been significant developments in the field of radiotherapy. New devices and application methods have increased the rates of controlling cancer and reduced the risk of damage to normal tissues. The previously used "Cobalt" devices have been replaced by "LINAC" devices, and treatment times have been shortened, particularly with fast and modern devices, thereby increasing patient comfort. Almost all cancer centers in our country now have these types of new technologies.

Smart radiotherapy applications are methods that are needed extremely rarely. Methods such as Gamma Knife and CyberKnife, known as the "Space Scalpel," are preferred for patients who are not suitable for surgery and for tumors located close to critical tissues such as the brain. These types of devices are available in our country

Do we have advantages over other countries in cancer treatment?

Innovations in cancer treatment are not limited solely to technology and knowledge. Thanks to our physicians and healthcare workers who serve day and night with loving hearts, we have adopted a philosophy of life and treatment in cancer care. With this philosophy, we aim to improve our patients' quality of life. By transforming our treatment areas into art houses, we welcome our patients with art teachers and many artistic activities, keeping them engaged in life rather than disconnecting them from it. We are pleased that this approach, which began in Antalya, has spread throughout almost the entire country. We also show sensitivity to the rehabilitation, nutrition, sexual problems, and psychosocial problems of cancer patients. Failing to assess these issues as part of routine practice may make it more difficult to achieve success in cancer treatment. The presence of physicians who have adopted this philosophy and incorporated it into their daily lives is one of our most important advantages.

What deficiencies exist in our country that patients may need?

One of our important problems in the field of cancer treatment is the lack of palliative care clinics and end-of-life care. While “Hospice” clinics managed by healthcare professionals focused on this issue provide widespread services in developed countries, there are not yet enough of them in our country. Dedicated treatment areas should be established with trained physicians and healthcare workers providing services in this field, and a service befitting human dignity should be provided. We should have a respectful perspective toward the dying process, and the comfort and quality of life of our patients in the final stages of life should be a priority. I hope our relevant institutions accelerate their work on this issue and that palliative care clinics become widespread in our country as well.

Another issue is the development of new drugs for cancer treatment and the difficulties patients experience in accessing these drugs. Clinical research, plays a critical role in the development of new cancer treatments. I would like research in this area to become more widespread and receive greater support in our country.

What are Mustafa Özdoğan's expectations for the future regarding cancer treatment? What kind of organization would he like to be involved in?

My dear friend, esteemed teacher, and elder brother whom I lost to cancer, Prof. Dr. Mustafa Samur, and I have a promise I made to him years ago. One day, we will establish such a cancer center in Antalya that people from all over the world will come to this center for treatment. When I made this promise to him, he said to me, "Can we really achieve this"?

Cancer is a disease that can affect people of any age and, unfortunately, it is still one of the most common causes of death today. For this reason, our greatest desire and expectation in the fight against cancer is to increase the number of centers that provide healthcare services where patients and their families can feel safe and have access to the highest-quality treatments. Therefore, the leading healthcare institutions, nongovernmental organizations, and private hospitals of Antalya and our country need to come together in an organization focused on cancer treatment and work together to achieve the goal of making the Middle East’s cancer treatment city. In line with this goal, we must make an intensive effort to provide the best service to patients with cancer in every period and under every circumstance of life. Thus, we believe that not only Antalya but also our entire country will become a leading country in cancer treatment. Please let us all strive together to make this dream a reality and support the fight against cancer.