In general, application of direct 
current between a tumour and its surrounding s will 
induce two kinds of transports: ions of the supporting 
electrolytes and electrolytic products from the surfaces 
of the electrodes. These transportS thereby modify the 
conditions for survival of neoplastic cells. The tra.ns­
ports also lead to the development of recombination 
products and the appearance of true "biological reac­
tions", such as anodic accumulation of leukocytes, for­
mation of capillary thromboses and scar tissue, water 
transport and changes of individual cells. In this way 
possibilities may exist for local treatment of regions of 
tissue larger than the tumour tissue primarily de­
stroyed around the anode. To date many possibilities 
remain for optimizing the conditions of treatment, 
Treatment of cancer 271 e.g., with regard to elect:rode technique, suitable volt­
age, fluctuation of voltage, current-density and dura­
tion of treatment. When direct current of "low" energy is used, the 
local destructive effects are low. Nevertheless , consid­
erable effects on surrounding tissue can be expected 
when the current is allowed to flow over a long period 
of time, e.g., several hours. When direct current of 
"high" energy is used, local destruction close to the 
electrodes becomes pronounced . A large number of 
variables as yet undefined will influence these effects 
in individual tissues in vivo. Only extensive experi­
mental and empirical testing will tell us how the treat­
ment technique can be optimized. Alternatives to pres­
ently available clinical techniques of treating cancer 
are desirable. This need applies particularly for treat­
ing primary neoplasms in the most surgically inaccessi­
ble locations, e.g., brain, pancreas, liver, spine and 
prostate. Electrochemical treatments should offer 
promising results in these organs as well as for meta­
static disease in various parts of the body. A. Spontaneous and induced 
healing of cancers 
Tbe spontaneous disappearance of verified cancers is 
very rare, but well documented (20, 28, 63). Everson 
(18) and Everson and Cole (19) reviewed the subject 
extensively. Initially they considered 600 cases of re­
ported spontaneous regressions but finally accepted 
only 47 as sufficiently documented by microscopic 
fmdings to justify inclusion in their series. Later they 
extended the study to include 120 authenticated cases. The authors admit that many of the discarded cases 
may also have been true expressions of spontaneous 
regression. Dunphy (16), Shimkin (62), Stewart (67) 
and others have also emphasized both the existence of 
spontaneous healing of cancers and the importance of 
recognizing such occurrences as a means of adding to 
our knowledge of environmental variations in the rela­
tionship of tumour and host. The mechanism of spontaneous healing of a malig­
nant tumour is still obscure. Presumabl y immunolog ic 
or hormonal, the mechanism has been thought to be a 
change in the environment of the tumour. For exam­
ple, Smithers (64) noted that after three of his patients 
with breast cancer experienced a natural menopause , 
their tumours regressed for as long as seventeen years. In most cases, however, the process of spontaneous 
regression remains obscure. Seen in the light of BCEC mechanisms, the thera­
peutic problem now is bow best to support spontane-
272 Treatment of cancer ous tendencies toward healing of a growing tumour, 
when its foci of internal injury release energy only 
intermittently and often weakly. The energy released 
in spontaneous injury may be sufficient to induce ionic 
exchange by diffusion and migration over a BCEC, 
e.g., in healing ordinary wounds and fractures. Such 
conditions should perhaps be called nonprogres sive in­
juries. Conversions of energy in biology usually take 
place with remarkably little loss of energy. The possi­
bility is worth serious consideration that most of the 
energy necessary for ionic transports in healing a non­
progressive injury may be provided by the injury it­
self. In this view, infectious injuries or locally degrad­
ing injuries in cancers may be called progressive injuries. The critical point is that the healing induced in pro­
gressive injuries either temporarily or permanently 
lags behind the advancing primary pathologic process. Logically, extensive local destruction might release 
enough energy for the healing also of progressive inju­
ries. Obviously enough, this solution is possible only 
in selected instances, usually most "elegantly" by sur­
gical removal of the diseased tissue (and sometimes 
unfortunately also a large quantity of normal tissue). The ideal solution would be selectively to depress the 
disease by supporting physiologic healing mechanisms 
while preserving normal tissue. How electric current 
can be suitably used toward these goals is, of course, 
not easily answered. It will, however, be seen that 
direct current can offer beneficial effects on malignan t 
tumours regarded as unsuitable for more traditional 
types of therapy. B. Diathermic production 
of local tissue injury in 
lung tumours 
I. Dry electrodes 
A technique for local electrocoagulation of small soli­
tary rumours in the lung has previously been described 
by the author, based on an experience of 30 patients 
(39, 40). As much as possible of the centre of each of these 
solitary and relatively small tumours was electrocoagu­
lated with an ordinary surgical electrocoagulation ap­
paratus. The neutral large electrode was applied to the 
patient's skin. The active electrode consisted of a thin, 
Tenon-coated , stainless steel string, electrically insu­
lated except at its tip. This elect:rode, 0.5 mm in diameter was introduced 
percutaneously under biplane fluoroscopic control. A 
thermoelectric detector needle (0.9 mm in diameter) Fig. XVII: Z. Electrodes for "wet" diathermic electrOCOagu­
lation of pulmonary tumours. (a) Spiral screw soldered to a 
cannula. The exterior of the cannula is insulated with Tef­
lon. This electrode is inserted through a Teflon rube (b) and 
anchored in the tumour tissue by the spira.l part, which is 
screwed into the tumour. High frequency current applied 
between the tumour elecuode and a.n indifferent , large, skin 
(Fig. XVII: 2 c) for recording of the generated tem­
peratures was then similarly introduced and positioned 
at the edge of the lesion. Injured bronchial arteries 
inside the tumour sometimes bled, appearing fluoro­
scopically as a local blurring of the surroundings of the 
tumour. The bleedings stopped spontaneously. No 
serious complications occurred in any of these pa­
tients. This technique proved to be successful in caus­
ing necrosis of small neoplasms, usually small metasta­
ses less than I em in diameter. A drawback of this technique has been that much 
heat is generated in the tumour ncar the electrode. Nearby tissues desiccate easily, interrupting the elec­
tric current. Tumours larger than 1 em in diameter 
were therefore usually unsuitable for this type of treat­
ment. In order to overcome these difficulties , a Teflon 
tube (1.5 mm in diameter, of the type shown in Fig. XVII: 2 b) was frrst inserted into the tumour. A 1.2 
mm diameter needle served as stylet. After removal of 
the stylet, a Teflon-coated needle electrode, 1.0 mm in 
diameter (Fig. XVII: 2 a), was insened through the 
Teflon tube. This modification made it possible to 
remove the electrode for occasional cleaning, which 
improved the efficiency of the electrocoagulation pro­
cedure. 2. Electrodes perfused with liquid 
This technique presents certain advantages compared 
with the dry electrode technique. The active electrode consists of a stainless steel can­
nula, I mm thick and insulated by Teflon. A spiral 
screw, I em long, is soldered to the tip of the cannula 
(Fig. XVII: 2a). The hub of the cannula is connected 
both to a surgical diathermia apparatus and via a electrode produces heat in the tumour. Saline solution in­
fused through the electrode maintains moisture and in­
creases the quantity of sodium chloride in the tumour, en­
hancing conductivity. The transmitted heat is measured by 
an electrothermometer (c), which is placed at the edge of the 
tumour. Teflon tube (50 em long and 2 mm wide) to a lympho­
graphy syringe. This syringe is filled with saline solu­
tion, which is slowly and evenly injected through the 
electrode during treatment. A large metal plate at­
tached to the patient's arm is used as an indifferent 
electrode. In order to avoid a large pneumothorax, 
which might easily displace an electrode, it was found 
useful to place percutaneously an ordinary pleural 
drainage tube in the pleural space two days before 
implantation of the electrode. Twenty minutes before the procedure the patient is 
administered a tranquilizer, such as Valium '~>, intra­
muscularly. Under local anaesthesia and biplane 
fluoroscopic control, the thin Teflon tube (Fig. XVII: 2 b) is inserted percutaneously into the tumour. Material for cytologic study is obtained via the cannula 
by means of a small screw needle inStrument (44, 45). The material is stained immediately and examined 
microscopically. In the meantime the electrode is in­
serted through the Teflon tube, screwed into the tu­
mour tissue and connected to the electrocoagulation 
apparatus and the lymphographic syringe. A forceful 
aspiration with the syringe must precede these ma­
noeuvres in order to make sure that the tip of the 
Teflon tube is not positioned in a pulmonary vein, 
which might possibly introduce spontaneous inflow of 
air into the left side of the heart. The tip of the 
electrothermometer needle (Fig. XVII: 2c) is placed in 
the tumour close to the surface. Accuracy is required for implanting the electrodes . This requirement led to cooperative work with repre­
sentatives of the x-ray industry, resulting in the devel­
opment of the so-called BINO and SINO' units (42). 1 Manufac:lured b)' Siemcns·Eicma, Stockhobn, under the trade 
name of Angioscope. Treatment of cancer 273 Fig. XV/1:4. Piece of meat (moosesteak ) after local diather­
mic production of heat over an electrode perfused with saline 
~1ution. ~rhe cut surface through the bolted tissue is ap­
proximately 2.5 x 1.5 em and grey-white . Dia:hcrmia over a 
dry electrode produces a small, black region cf dry tissue, 
which easily breaks conductivity of the circuit. 274 Treatment of cancer Fig. XVII: 3. Biplane flu­
oroscopic unit, designed for 
separate positioning of two 
arch-suspended x-ray tubes 
and image intensifiers in any 
direction in relation to the 
subject. The patient table, 
suspended in a coordinate 
S)"tcm from 1he ceiling, al­
lows positioning of the pa­
tient independent of the 
arch construction. Elevation 
of the table top, rotation of 
the patient and movements 
of the arches are controlled 
by servo motors from a con· 
trol panel. This biplane equipment (Fig. XVII: 3) allows individ­
ual placements of two arch-suspended radiographic 
tubes and image intensifiers . The patient is examined 
on a roll sheet table suspended from the ceiling by 
telescopic stands, which are movable in a coordinate 
system. Nearly all the movements of the arches and of 
the patient table are performed remotely via servo 
motors from a control panel. About 2-3 drops of saline solution per second are 
injected during the electrocoagulat ion. In this way the 
tissue close ro rhe electrode tip is kept wet, securing a 
continued complete circuit over a prolonged time com­
pared with the use of dry electrodes. Evaporated water 
escapes as steam between the wall of the cannula and 
the inner wall of the Teflon rube. At the same time the 
amount of salt increases in the tumour tissue, enhanc­
ing conductivity. Usually the recorded temperature at the edge of the 
tumour was elevated to about 60"C for 4 to 5 minutes 
during each of these treatments. This level of heat 
means that the tissue is "boiled" rather than "fried", 
as with the dry electrode technique. The result of such 
a boiling of a piece of moosesteak is shown in Fig. XVII: 4. The tissue is opaque only in the coagulated area. The effe<:t in a lung tumour in vivo is difficult to 
predict, because it depends to a large extent on circula· 
tion of blood and ventilation, cooling the tissues. 3. Resuhs 
Twelve pulmonary metastaS(. 'S in eight patients as well 
as primary carcinoma of the breast in two patients 
have been treated by ele<:trodes perfused with liquid. Table XVII: I surveys relevant clinical data of these 
teo patients. Seven of the patiems were women and three men. Ages varied between nineteen and sixty-four years. The size of each tumour at the time of treatment 
varied between 6 and 37 (mean 18) mm in diameter. Eight of the rumours regressed after treatment , five 
showed progression and one was indeterminate. The 
Fig. XVII: 5. Electrocoa· 
gulation followed by de· 
crease in size of a metastatic 
fibroliposarcoma in lhe right 
lung. (a) ~fore treatment. (c) After 485 days. (d) After 
1490 days. (b) Cytologic 
specimen obtained by per· 
cutaneous needle biopsy of 
lhe rumour before treat· 
ment. May-Grunewald· 
Giemsa stain. a two largest tumours showing regression had initial 
diameters of 29 to 30 mm. Longest observation time 
with persistent regression has been four years and 
eight months in one patient. No serious complications 
have occurred. In !our patients small to moderate 
asymptomatic pneumothoraces developed . Before 
electrocoagulation was performed , ten of the tumours 
had continued to grow in spite of cytostatic therapy. The courses of two patients with lung metastases 
and the rwo with breast rumours will now be described 
and illustrated in de~ail. Case /. A fibroliposarcoma of the uterus was excised 
from a 19-year-old woman. One year after operation a 
tumour 2 em in dianneter was found in the right lung 
(Fig. XVU: 5 a). The diagnosis of metastasis from the 
primary tumour was confirmed (Fig. XVII: 5 b) by a 
screw needle biopsy (44, 45) obtained under local 
anaesthesia. The Tef1lon tube (Fig. XVII: 2 b) was then 
. . ·;.v_~SO).Im 
fltia ...,.._,......._,.._ 
Treatment of cancer 275 Table XVII: I. Rtsults of trtatmnrt by electrocoagu lation (liquid-perfused electrodes) of metastatic cancer in the lungs in eighr patinr 
(no. I~) and primary carcinoma of tht breasr in two patients (no. 9, /0) 
Date of electro· Obsen"'ltion 
coagulation time (da)~) Effecc on 
P2fit"nl l,rimary Si:r.e of TUmour Siu of tu· rreated 
No. Age tumour (mm) mour (mm) tumour Commenrs 
I. B.K. 'i' Fibroliposar· 912 1978 I 490 Regression ContinuQus growth of four pulmonary 
19 coma of uterus 19XI9X 19 7xSx2 metastases during cytostatic therapy 
ReS«tion 1977 before electrocoagulation of one, and 
later elecuoehemical treatmen t of 
three of the metastases (set Table 
XVII: 2). 2. G.B. 'i' At.alignant 2714 1977 240 Regression Prt\·ious cytoStatic lhe-rapy, followed 
32 melanoma of 29X29X30 nxzox2z by tumour srowth until elecrroooagula · 
s!Un tion. lXath from haemorrhage in one of 
Resection 1976 sen:ral cerebral mctastaSC$ . Small 
pneumothorax during electrocoagulat ion. 3. A.T. 'i' Carcinoma of Ia 31/S 197i IH Progi"C$sion Tumours I and II initiaJJy o( approxi~ 
59 uterus 26X27X31 34X34X37 m:ni,•ely the same size. After t\\"'1> treat-
ReS«tion 1974 I b ll/10 1977 S83 l)rogression ments, growth of tumour I acctlerated 
Hx34x37 68x68x73 <:ompan:<l to growth of the untreated 
II 3115 1977 134 Progression tumour II. 29x3~x38 36x43x·U 
(untreated) S83 Progression 
62><S8x6S 
4. G.P. 'i' Carcinoma of 18111 1976 I 480 Regression Pre,rious cytostatic and antioestrogen 
S2 breast llxi9XI9 14x 12X 14 therapy followed b)' growth of multiple 
Resection 1969 II 8112 1977 I 0110 Regression pulmonary metastases. Af1er electro-
16XI4X 12 2x2x2 coagulatio n, regression of the two 
heated tumours. Small pneumothorax and 
small hat'rnoptysis during electro-
coagulatio n. Progression of untreated 
metastases in lung and skeleton. 5. J.D. d Hypernephroma 8110 1976 I 145 Rc:gn:ssion Multiple pulmonary metastases increased 
S2 Resection 1974 13x lOx 12 9XIIx9 in size after previous cytostatic treat-
II 26110 1976 630 Initial reg- ment. Small pneumothorax each time of 
16XI3XIS 8x8x8 ressjon dectrOC03gulation. NonCQagulatcd tumours 
I 127 ProgrC$sion progre$$00 rapidl)'. Death of widespread 
49xS2x60 metastases. 111 9/1 I 1976 315 Progression 
16>< 15X IS 23><22X23 
830 ProgNSsion 
S6X 10SX67 
IV 17/2 1977 I 010 Progmsion 
9XI0X9 30X42X40 
6. U.L. 9 "Malignant 3111 1976 60 Cytostatic therapy failed. Twc:l\'e months 
37 adenoma'' of 6><1Sx7 16x lOx 10 after electrocoagulation, death of 
parathyroid (cavity) widespread metastases . Resection 1972 455 Regression 
10x6x6 
(scar) 
7. B.R. d Carcinoma of IS/2 1977 415 Progn-:ssion Fourteen months after dectrocoagu la· 
50 thyroid 30x30x30 4SX42X47 tion, death of widespread , rapidly 
Rese-ction 1967 growing melllSIIISe S. 
8. L.V. d Hypernephroma 14112 1977 zoo Regression Cywstatic therapy failed. Se\•c:n 
42 RC$CCtion 1977 18><18XI8 17XI5XI5 months after electrocoagu lation, death 
of widespread metastases. Small 
pneumothorax . 9. M.O. 'i' Adenocarcinoma 2/11 1976 8SO Progression Failed cytostatic and hormone treat· 
S8 of breast 13x 13x 10 ments. Oisrant metastase s at the time 
of electrocoagulatio n. Death of wide· 
spread mera.stue s. 
10. M.B. 9 Adenocarcin oma IZ/10 1977 sso Regression Failed cytostatic and honnone treatments. 64 of breast 29xl6x26 19x.8x 13 Distant mct·aslascs at the time o( 
dc:cuocoagulation. Death of widespread 
mctastas.t.-s. Fig. XV II: 6. Screw-<:annula-e lectrode at !he .edge of the tu· 
mourshown in Fig. XVII: 5o, just before the screw was 
placed in the tumour. Thermoelectric electrode positioned at 
!he anteromedial aspect ofthc surface of the tumour. (a) An· 
teropostcri or view. (b) Lateral view. introduced into the tumour and the needle was re· 
moved. The electrode , with a metal spiral at the tip, 
was then passed through the Teflon tube and screwed 
into the tissue of the tumour, and thereby secured in a 
ftxed position. Fig. XVU: 6a and b illustrate postero· 
anterior and lateral projections of the electrothermo · 
meter needle at the surface of the tumour and the 
tumour electrode just before placement into the tissue 
of the tumour. The indifferent electrode was then applied to the 
patient's right arm and saline solution infused slowly 
under diathermy. The temperature at the tumour sur· 
face was maintained at about 60"C for 5 minutes, as 
seen in Fig. XVII: 7. No pain, bleeding or other complications occurred 
but the patient experienced "a sensation of heat some· 
where inside" during the treatment. Fig. XVII: 7. Temperature of about 
60'C for 5 minutes at the edge of the tu· 
mour shown in Fig. XVU: Sa. Tracing 
obtained from electrOthermometer 
placed at the surface of the tumour. 'c 
TO When a treatment is successful by this method, the 
tumour regresses slowly but apparently continuously. The diminished size of the residual tumour in this 
patient can be seen after one year, four months in Fig. XVII: 5 c. Four years and one month after treatment 
only a minimal scar remained (Fig. XVII: 50). Case 2. This 32-year-old woman, who six years 
earlier had had a malignant melanoma excised from 
the skin of a breast, had another malignant melanoma 
excised from her right leg. Shortly thereafter, a large 
metastasis (40x30x30 mm) was excised from the right 
frontal lobe of the brain. One month later a tumour, 2 
em in diameter and of very low radiographic opacity, 
was found in the lower lobe of the left lung (Fig. XVII: 8 a). This tumour grew during two months of 
treatment with different cytostatic agents (Dacarba· 
zinum, OTIC, Vincristinum, and Oncovin). Tbis solitary pulmonary metastasi s was then treated 
with electrocoagulation. The screw electrode cannula 
was secured to the tumour, as in the previous case. Diathermy was applied and temperature at the surface 
of the tumour was monitored (Fig. XVII: 8d) during 
the continuous infusion of saline solution. A small 
pneumothorax was found after the treatment but no 
bleeding occurred . After 2 months, the regressing tumour (Fig. XVII: 8 b) is clearly more radiopaque than before elec­
trocoagulation . The increase in density is most likely 
caused by intratumoural accumulation of calcium. The 
size of the tumour decreased further, as shown 8 
months after the treatment (Fig. XVII: 8c). Six weeks later, cerebral symptoms recurred as met· 
astatic disease reappeared in the brain. She died short· 
ly thereafter. In the two patients with breast carci11oma and distant 
Treatment of cancer 277 Fig. XV II: 8. Electrocoagulation (liquid-perfused electrode) 
of metastatic melanoma of low radiopacity (a) is followed by 
a considerable increase in opacity of the tumour 60 days later 
(b). 180 da)"' later(c), the tumour has clearly decreased in 
metastases (Cases 9 and 10 in Table XVII: 1), the 
breast rumours were treated with local electrocoagula· 
tion. The diagnosis of each cancer was made by screw 
needle biopsy. The cell sampling for cytologic diagnosis and the 
placement of the active electrode and temperature 
probe in the mammary tumours were performed by 
means of the stereot:ucic instrument previousl y de· 
scribed (9, 43). The biopsies and treatment were c-•ch 
performed under local anaesthesia. The indifferent 
electrode was placed on the arm of the patient. The 
treatments, each of which lasted about 30 minutes, 
were well tolerated. Fig. XVII: 9a shows one of the breast cancers (case 
9) before treatment, when it measured l3x 13x 10 
mm. Fig. XVII: 9 b shows the liquid electrode in the 
centre of <he tumour and <he thermometer at its edge. During the treatment, vapour escaped through the 
Teflon tube as well as through the electrode cannula. No bleeding or general reactions were produced by the 
treatment. The tumour is seen immediately after treat· 
ment in Fig. XVII: 9c, and II months later in Fig. 278 Treatment of cancer ~!o=:::~~.r-----~ ,~0-------~~------~ W~m-.n----
size. The increased radiopacity probably represents an in~ 
flow of calcium into the injured rumour tissue. (d) T empcra~ 
mre measured at the surface of the tumour during electro· 
coagulation. XVII: 9d. The cancer appeared to have increased in 
size but showed internal accumulation of calcium and 
some radiatil\g, fibrous structures in the surrounding 
breast. Fig. XVII: 9 e shows the tumour enlarged and 
differentl y shaped 2 years, 4 months after <he treat· 
mc.nt. The second patient with breast cancer (case 10) is 
shown before treatment in Fig. XVII: toe. Numerous 
radiating , fibrous structures surround the tumour. Fig. XVII: lOa, b shows stereoradiographs (± 15°) of 
the position of the electrode perfused with liquid and 
of the electrothermometer in relation to the tumour. The temperature was elevated at the tumour edge to 
600C for six minutes. This carcinoma appeared to stop 
growing after treatment. It is shown I year, 6 months 
after treatment in Fig. XVII: !Od, shonly before the 
patient died from widespread metastases , which were 
already established before the treatment. In both of the two patients with breast cancer rreat· 
M in this way, the clinical course and initial radiogra­
phic appearance s were almost identical. They both 
suffered from many distant skeletal metastases, which Fig. XV II: 9. Electrocoagulation of a brOllSt carcinoma. The 
diagnosis was established in this 59-year-old woman by 
stereotaxic screw needle biopsy. Many disrant metastases 
precluded local surgical excision. Local electrocoagu lation, 
1976, (a) immediately before, (b) during, (c) immediately 
after electrocoagulation (stereotaxic equipment, liquid·per· 
fused electrode ). (d) Radiograph 330 days later shows nu-
Zt 1-824586 N~Wdtmll'6m me.rous, thin_, radiating, fibrous structures einanating from 
the enlarged tumour. (e) 850 days after ltOlltment and shortly 
before the patient died. The !tOll ted tumour has enlarged and 
changed its shape the last 520 days. Radiating fibrous sltUc­
tures have increased in number. Subareolar radiopacities and 
re.traction of the nippJe have increased. New infiltrations lat· 
eral to the treated tumour are seen. Treatment of cancer 279 c 
d 
made it impossible to obtain follow-up biopsies after 
the treatments. One tumour progressed, one re­
gressed. Unfortunately, necroPSies were not obtained 
for these two patients. In swnmary, th.e small number of patients and short 
observation time allow little conclusion about the long 
term effects of electrocoagulation of lung and breast 
cancers, except to observe that the procedure is feasi­
ble and may be beneficial in certain patients. The 
treatments are relatively easy to perform and are nN 
very distressing to the patients. 4. ComplJcations 
Complications have been limited to the occasional de­
velopment of a small pneumothorax in the pulmonary 
280 Treatment of cancer Fig. XVII: 10. Elecuocoa ­
gulation of breast cancer by 
liquid-perfused electrode. The tumour is surrounded 
by radiating, fibrous struc­
rures before treatment (c). Stercoradiographs (a, b) of 
tbe tumour and electrodes 
inserted by means of stereo­
taxic instrument. (d) SSO 
<hys after treatment, shortly 
before tbe patient died. The 
rumour is slightly smaller 
tban before treatment. cases, which is easily managed by a pleural suction 
drain. No serious bleedings or cardiac arrhythmias 
have been encountered. On two occasions the spiral 
part of the electrode was lost in the twnour tissue after 
the electric current corroded the stainless material. It 
should therefore be made of a more corrosion-resistant 
metal, which still must allow the electrode to be se­
cured in some way in the tumour tissue. Occasionally 
duri.ng treatment the patients reported a sensation of 
pain, coinciding with too little saline solution per­
fused, which can result in sudden disconnections and 
reconnections of the electric circuit. Pain is also easily 
produced when the electrode is located close to the 
pleura, which in such cases should be anaesthetized . The treatment can be repeated. Histologically, the 
distance after electrocoagulation between completely 
destroyed, necrotic tissue and normal tissue is only 2-3 
mm. 5. Discussion 
Considerable evidence (47, 52, 76) indicates that ma· 
lignant cells are more sensitive to beat than are most 
normal cells. Electrocoagulation with large external 
electrodes has also been practiced in the treatment of 
n~p lasms of skin and mucous membranes , e.g., carci­
noma of the vulva (8). For deeply situated tumours, technical control dur­
ing treatment is considerably more complicated, but 
not at all impossible (39). Introducing irrigation of the 
active electrode has been an improvement in such 
cases. Compared to electrocoagulation with dry elec­
trodes, the volume of destroyed tissue can be in­
creased. The risks of cutting a vessel or depositing 
material on the electrode, leading to interruption of 
the current, are also almost completely excluded. The drawback of the technique is the uncertainty 
about the transmission of heat to different parts of the 
tumour. Loeal variations in vascularity may interfere 
uncontrollably with the transmission of heat. In retrospect , it now seems evident (see Table 
XVII: I) that the electroeoagulations of the rumours of 
patient no. S (perhaps excepting tumour l) were not 
performed with sufficient transmission of the genera­
ted beat to devitalize all malignant cells of-tumours II, 
Ill and IV. Only part of the tissue of these tumours 
was destroyed. These electroeoagulations were per­
formed at an early stage in the development of the 
technique. A minimum of 6Q•C measured at the edge 
of a tumour for at least five minutes bas therefore been 
introduced as the standard "dose" in these treatments. The treatments appear to have been effec-tive only in 
tumours smaller than 2 em in diameter. The mechanism of healing of tissue injured by heat, 
as described in this section, must be considered in 
comparison with previously described results. Several 
of the phenomena of healing described in this section 
can be recognized as requiring the mechanism of a 
Ouctuating potential over a BCEC. The decrease in 
size of these tumours can in a traditional way be 
explained as a result of resorPtion of destroyed materi­
al. Certain details in the transformations of the tissues 
are, however, not easily explained in a traditional way. Increase in radiographic density in a coagulated metas· 
tasis (Fig. XVII: 8 b), the development of an "A" zone 
around a tumour, and late signs of fibrous tissue pro­
duction (Fig. XVII: 9d, e) suggest that the proposed 
mechanism of healing of injury over BCEC channels 
has been activated in these transformations. C. Induction of healing 
reactions in tumours by 
direct current 
I. Introduction 
Once the background of results was al'ailable from the 
in vitro and in vivo studies of the effects of direct 
current on tissues (Chapters XIV and XVI), a tech­
nique was developed for applying direct current to 
treatment of tumours. The technique proved accept· 
able. A brief first report on electrochemical treatments 
in five patients with otherwise untreatable pulmonary 
metastases was given in 1978 (41). Complete primary destruction of a malignant tu­
mour in lung was not attempted for cancers which arc 
large and positioned centrally, i.e., close to large ves­
sels. The evident reason is the risk of producing seri­
ous vascular injury. The present method is based on the assumptio n that 
the primary destruction of tissue around the anode is 
supplemented by the ability of direct current to induce 
specific biological healing reactions in surrounding tis­
sues. Some of the mechanisms of healing, as discussed 
in previous chapters, can now be induced and en· 
banced by a method which appears to support tenden· 
cies toward spontaneous healing. Some general aspects 
of the mechanism of tumour healing after ionization of 
tissue will now be considered. Direct current ionizes tissue, as does ionizing radi­
ation. In radiotherapy, selective destruction is pro­
duced in malignant tumours (IS, 17, 34). Several fac­
tors, e.g., the degree of oxygenation of the tissue, 
influence the destructive effects. Ionizing radiation is 
known to be far more destructive to intracellular nu­
clei than tO cytoplasm (II). It is also believed that the 
biochemica l constiruent most sensitive to the effects of 
ionizing radiation is DNA (49). When quanta of radi­
ation bombard DNA in a solution, free radicals are 
generated from the DNA and the medium. The free 
radicals then react with the DNA. A few protons 
administered to the chromosomes produce consider­
able damage, such as chromosomal ruptures, while 
more than I 000 protons do not affect the cytoplasm 
(71). Effects similar to the damage by ionizing radiation 
in rumour therapy can also be anticipated to occur 
when direct current ionizes tissue. Certain observa· 
tions in this study indicate that ionization vf tissue via 
electrodes appears to affect normal and malignant tis· 
sues differently. At the same time, considerable differ­
ences exist between these two ways to ionize tissue. In 
electrochemical treatment, electric energy can be se· 
lectively applied to obtain ionization .. New materials 
Treatment of cancer 281 develop at the electrode surfaces. These materials and 
those of the supporting medium migrate and diffuse in 
the electric field. Furthermore, direct current induces 
in tissue many structural modifications which appear 
indistinguishable from those of ordinary wound heal­
ing. Resistivity and capacitance vary in different biologic 
tissues. An electric current in tissue therefore encoun­
ters local barriers which wiJJ change its directions. Air~ 
bone, fat, matrices of ceUular membranes and walls of 
vessels present relatively higher resistivity than blood 
plasma and interstitial fluid. Panerns of different pref­
erential pathways for current in tissue can therefore be 
expected, as can different intensities of transport and· 
electrochemical reactions. Varyingly differentiated 
flow patterns can be expected to develop as functions 
of energies (potential differences ) and densities of cur­
rent (amount of current per cross-sectional area of the 
path of flow). It has long been known that elevation of electrode 
ovcrpotential increases current logarithmically (69). Moreover, one can also predict that the patterns of 
current flow must be modified by local variations in 
electric capacitance and resistivity of tissues at differ­
ent overpotentials. These local variations indicate that 
an equal amount of current which has passed between 
electrodes at different voltage differences should mean 
a different spatial distribution of current in the tissues 
and hence different regional biologic effects. It is apparent that the amount of energy delivered to 
tissue by direct current can not be expressed in the 
same terms as are used for radiotherapy. Radiation 
treatment of deeply situated cancers is limited to the 
use of high energy photons. Therefore in radiotherapy 
the factor of minimum ionizing energy is indiscrimi­
nate for different k.imJs of mauer. Ionization by direct 
current, on the other band, can be prcduccd over a 
large range of "low" to "high" energy levels. Low 
energy levels appear feasible, because they can be used 
to build up the therapeutic dose of energy from the 
inside of a tumour. In this way the use of ~irect 
current may theoreticaUy induce a large range of dif­
ferent biological ionizing effects. At "low" electrode voltages, only outer electrons 
with low binding energies arc likely to be affected, 
which may suffice for interference with important bio­
logic tissue and cell functions. When current densities 
are kept low' the extent or destruction of tissue by heat 
is also ~ept low. At "very high" electrode voltages, electrons of low­
er kinetic energy will also be removed, resulting in 
different qualitative changes of the ionized tissue com­
pared with the changes induced by low voltage ioniza­
tion. Increased destruction around the electrodes will 
then become evident and the preferential pathways for 
current in different tissues will become less differcnti-
282 Treabnent of cancer ated (see also Fig. XVII: 14). Increasing heat will 
evaporate water, resulting in elevation of pressure·in 
the tissues. Thermic and electrically induced precipi­
tation of protein will become prominent. Direct current will also produce different biologic 
effects in the anodic and cathodic fields. Since the begintting of the century, it has been well 
known (31) that the destructive effect around the an­
ode is caused by diffusion and migration of protons, 
which make the tissue black. The cellular components 
of blood also turn black around the anode. Erythro­
cytes are known to produce electropositive haemin in 
the acidic surroundings of the anode, while electrone­
gative haemin is produced in the basic surroundings of 
the cathode (36). Haematin is the electroneutral com­
ponent (36). The central part of the brown-black mate­
rial around the anode will be grey-white, due to 
bleaching by liberated chlorine gas (see Fig. XIV: 21). This focal discolouration of the black tissue has no 
effect whatsoever on the devitalization of the anodic 
tissues. The anodic tissues have already been de­
stroyed by an abundance of easily diffusing and elec­
trophoretically migrating protons. This point needs 
stress because the production of chlorine gas has re­
cently and erroneously been suggested (53-57) as re­
sponsible for the destruction of tissue around the an­
ode. The destructive effect around the cathode is 
caused by production of hydroxyl ions. In addition to the migration and diffusion of ionized 
products at the electrode surfaces, other charged com­
pounds will move throughout the electric field. Leu­
kocytes, which are negatively charged, will at proper 
electrode voltages accumulate massively in the anodic 
tissue. Microthromboses also will be induced. They 
are probably mediated by electrophoretic accumula­
tion of thrombocylcs. Complex ions of proteins, fat 
and carbohydrate s will be transported. Their charges 
will become modified under the influence of the actual 
acidic or alkaline surroundings in the electrical field. The water pressure of tissue will decrease around the 
anode (Chapter IX). This drying of tissue around the 
anode looks like dry gangrene. Around the cathode the 
interstitial oedema will to a large extent compress the 
vessels. Extremely complex modifications of tissue compo­
nents, cells and ceUular contents are still further modi­
fied by matrix interference in the electric field, includ­
ing tissue and blood circulation and convection fac­
tors. The size, shape and location of electrodes in 
relation to the structures of affected tissues wiU influ­
ence the shape and size of the anodic and cathodic 
fields. Of particular importance also is the fact that 
tissue cells, including cancer cells, carry a surplus of 
fiXed negative charges. An anode in a tumour will 
therefore tend to keep the malignant cells together. Consequently an electrode should not, at least as a ftrst en? 30 
20 
0 6 0 coulomb 
Fig. XVII: II. Volume of necrotic shoulder muscle in a dog 
as a function of quantity of dir«t current P"ssed between the 
anode, percutaneously insated in the mu!ICic, and tbc ath· 
ode in thcthoncic aorta (10 volts potential). Destruction of 
musdc was deftned as both white and black n«rosis. step in a treatment procedure, be placed in a tumour 
and be made cathodic. An intratumoura l cathode can 
be expected to repel tumour cells and therefore in· 
crease the risks of producing distant metastases. All these factors, and probably still unknown ones, 
Fig. XVII: IZ. Section through perianodic tissue in the 
shoulder of a dog subjected to 150 ooulombs direct current 
in vivo. Cathode in the aorta (10 volts). make it desirable to define the conditions of treatment 
as carefully as possible, e.g., applied voltage, total 
amount of current, ionized tissue volumes and "dec· 
trodc technique". This last factor includes definition 
of size, shape, material, polarity and position of c:lcc­
trodes. It is, however, appa.rent that a fully meaningful 
definition of electrode "position" is often difficult to 
obtain. In a strict sense it should require derailed 
knowledge of topography, resistivity and circulatory 
conditions of all compone nts of the tissues. 2. ~limioary tec.hoique 
In dog experiments a technique was developed after 
initial testing of different voltages and amounts of 
current on lung, skin, fat, liver and muscle tissue. The 
intention was to use the reaction to anodic injury as a 
preliminary indication of the effect of treatment. A 
platinum string 0.2 nun thick and 20 mm long was 
used as the anode in each of eight dogs. The active 
surface of the anode was L2.6 mm2• The strings were 
introduced percutaneously into the skin, subcutis or 
muscle tissue of the side of the neck. The cathode was 
a stainless steel arteriographic guide wire in the thorac­
ic aorta. The active surface of the cathode was 190 
mm2• Ten volts of DC current were then applied 
between the electrodes. Initial levels of current were about 10 rnA, which 
increaSed gradually to about 30 mA during one hour. As the amount of current at 10 volts increased, the 
volume of the black, destroyed tissue increased (Fig. XVII: II). Fig. XVll:l2 shows a section through a 
lesion produced with 150 coulombs. The volume of 
destroyed tissue around the anode was in this case 
about 8 cm3• 
A cavity will be produced around the anode as gas is 
produced and the tissue dehydrates. When the anode is placed in subcutaneous fat tissue, 
the tissue shrinks and becomes dehydrated and 
greyish. In muscle (or lung tissue) the destroyed area 
consists of amorphous material without visible cells. Fig. XVII: 13 illustrates (a) a completely destroyed, 
(b) an intermediate and (c) a normal z.one in muscle 
around the anode. The width of the intermed iate zone 
is approxima tely 0.3 mm. The tissue (c) adjacent to 
such lesions contains cells characterized by various 
degrees of cloudy swelling. Extensive capillary throm· 
hoses are also present in "normal" tissue around the 
lesions. In vivo such thromboses should eventually 
lead to circulatory disturbances peripheral to the tissue 
which has been primarily destroyed. A massive accu­
mulation of lcukocyt.es can also be induced in the 
vessels and tissue around the destroyed zone. The 
destroyed and intermediate z.ones also are dehydrated, 
due to electroosmosis. These extensive changes are 
Treatment of cancer 283 1mm 
easily observable field effects, clearly indicating that 
possibilities e.xist for modifying the environment of a 
lesion outside the region of primary destruction . It is 
evident that field effects are capable of modifying 
normal as well as abnormal components of tissue. Only 
empirical tests of electrochemical treatment with di­
rect current will be able to supply conclusive informa­
tion about possible selective effects on neoplastic tis­
sue. Preliminary technical tests have showed that circu­
lar or point-sbapcxl electrodes produce circular or 
spherical primary lesions and that long string elec­
trodes produce cylindrical or ovoid lesions. These re­
sults require that the anode and cathode must also be 
separated by a distance of at least the expected diame­
ter of the primary, proton induced, black anodic lesion 
at a potential difference between the electrodes of less 
than IS volts. Forty volts applied between one subcu­
taneous electrode (anode) in the left thoracic wall and 
one (cathode) in the right abdominal wall in a dog 
produced cylindrical interelectrode damage in the 
skin, ribs, lung, diaphragm, stomach, liver and the 
abdominal wall as an effect of an electric short circuit 
between the electrodes (Fig. XVII: 14). The current 
through this dog was allowed to cross the tissues for 
over four hours. Coagulation necrosis appeared in a 
cylindrical core through the different interpositioned 
tissues, without any regard to their morphologic 
boundaries. The diameter of this core was about 4-5 
284 Treatment of cancer Fig. XVJ/: 13. Perianodic 
necrosis of muscle after 10 
volts, ISO coulombs, direct 
current in a dog. Histologic 
section from edge of necro­
tic zone shows (a) complete 
CO<Iglllation necrosis, (h) a 
transition zone to (c) nor­
mal-appearing tissue. Hae­
matoxylin·tm in stain. em and the border with surrounding tissues rather well 
demarcated. The application of an electric field over the heart is 
generally to be avoided (72). It was, however, fouod 
that transpulmonary direct current at 20 volts in the 
dog produced no disturbances of rhythm or any other 
evidence of cardiac injury. The current was led 
through an arteriograpbic guide wire (cathode) in a 
plastic catheter introduced intravenously through the 
heart and placed with its tip in a pulmonary artery. The anode was placed in the pulmonary parenchyma . Cardiac arrhythmias caused by direct current have 
been previously studied in experiments by Phillips 
(48). In two experiments in dogs he tried to induce 
cardiac arrhythmias via a grounded electrode (cathode) 
over the left upper chest and the anode in the coeliac 
axis. Current flow as much as 10 mA produced no 
cardiac irregularities. When the anode was placed in 
the aortic arch and the grounded plate was placed 
against the buttocks, no irregular bean beats were 
observed (current. ;; 10 rnA). Even when the anode was 
placed in the left ventricle, currents below 2-3 mA had 
no effect on the myocardium . Above this level, howev­
er, premature contractions were produced. At 6 mA 
the cardiac rhythm became very irregular. Fibrillation 
was induced at levels of 8 rnA or higher. Whenever current is applied, voltage must be in­
creased slowly, e.g., from no current to 10 V in one 
minute. Whenever a treatment is concluded, voltage Fig. XVII: 14. Direct cur­
rent at high voltage(40 volts 
in this example) shon-cir­
cuits most physiological, 
preferential pathways for 
current in different tissues. An indiscriminate mass of 
coagulation necrosis is the 
result. Anodic electrode in 
the left thoracic wall of a 
dog, cathodic electrode in 
the right abdominal waU. (a) Chest wall. (b) Ribs. (c) Diaphragm. (d) Stomach. (t) Liver edge. (/) Abdomi­
nal waU. must be decreased slowly to zero. Otherwise, rapid 
changes of current produce undesirable effects, e.g., 
pain or muscle contractiuns. When electrodes were 
placed 4-10 em apart in the lungs, no apparent side 
effects were observed in dogs given "'IS coulombs of 
current per kg bodyweight, either immecliately or dur­
ing an observation time of 3 weeks following each 
experiment of treatment with direct current. 3. Prelimiruu-y conclusions 
At the interfaces of electrode and tissue, easily detect­
able morphologic changes can be seen in animal ex­
periments. At these interfaces a primary ionization 
takes place. A secondary ionizarion is, however, also suggested in living material at electrode~uivalent 
sites (Chapter XII, XIII, XIV) as a function of field­
induced migraticm and diffusicm of primarily icmized mate­
rials from the regions of the active surfaces of the 
electrodes. These rrtigrations and diffusions (e.g., of 
protons from the anode and hydroxyl ions from the 
cathode) will interfere with the functions of living 
cells, wwcb thereby become injured and will conse­
quently deliver ionized material. Further ccUular and 
tissue clisturbances will ensue from e.lectric field 
forces, leading to sequences of injury reactions. The supporting e.lectrolytes and their associated var­
iously charged materials (e.g., thrombocytes, leuko­
cytes, red blood cells, charged metabolites and cell 
debris) will be transported in the electric field under 
the influence of the tissue matrix. Dielectric materials 
Treatment of cancer 285 sucb. as water will also be transported in tb.e electric 
field, a process depending to a large extent on the 
tissue matrix (Chapter IX). Tissue acidity and alkalin­
ity in the anodic and cathodic fields, respectively, will 
also influence the chemical composition of transported 
materials. Distinction should also be made between 
the influence of a tissue matrix in vitro and in vivo. The living tissue provides a variety of active effects, 
such as buffering capacity and effects of tissue circula­
tion. Altered physicochemical properties of matrices of 
tissue, e.g., their surface charges, are also part of the 
secondary injury of tissue. In order to direct attention 
to such important, extremely complex discrepancies 
between electrophoresis in vitro and in vivo, the au­
thor deliberately chose a somewhat provocative term 
for direct current treatment of tumours in the prelimi­
naty report, "Electrophoretic ionization in the treat­
ment of malignant tumours" (41). The damage to the 
tissue by induced "cascades" of injuty reactions are, 
however, only a portion of all the biologic effects, i.e., 
the many complicated biologic reactions connected 
with healing of an injured tissue. It seems appropriate 
to conclude that "direct current trearmmt" or "electro­
chemical treatment" should be more adequate terms. They include aU possible technical variations and ef­
fects, e.g., electrolysis, electrophoresis, electroosmosis 
and other known and still unknown interferences with 
biologic processes in the electric field. The goal of direct current treatment of malignant 
tumours is of course to try selectively to suppress 
neoplastic growth. Presumably , both primary injury 
and secondary induction of biological processes in the 
electric field form the basis of the suppression. More­
over, DC treatment may be recognized as enhancing 
physiologic mechanisms of spontaneous healing, in­
duced by energy supplied over electrodes from an 
external source of DC power. This initial, anificial 
phase of "simulated healing" is then anticipated to 
continue after a treatment is concluded, as a process of 
spontaneous "true" healing of the injured tissue over 
BCEC channels. These channels are probably pre­
dominantly the vascular-interstitial closed circuits. The initially driven system is turned into a self-driving 
system over these channels. We will now consider techrtical problems of the 
electrodes and application of direct current in the 
planning of electric treatment of patients with pulm<>­
naty cancers. 4. Electrodes 
Different electrodes serve different purposes. Four 
types of electrodes have been constructed: 
Type I. A 300 mm long, 0.25 mm thick, solid 
platinum-iridium string is coated with layers of 
286 Treatment of cancer Teflon, except for a length of 1-2 em ending O.S-1 em 
from the tip. The string is bent ISO". The tip as far as 
the bend is inserted into the tip of a 172 mm long, 
I mm thick, Rotex biopsy cannula (44, 45). The can­
nula contains the usual indwelling screw needle for 
sampling of cellular material. The construction and 
insertion of this electrode, as well as cell sampling, are 
shown in Fig. XVII: 15. The electrode and cannula are introduced under 
local anaesthesia through a small incision in the skin. Under fluoroscopic television conrrol, the cannula and 
electrode are passed through the pleura into the tu­
mour in the lung (Fig. XVII: 15a). The electrode is 
released from the cannula by retracting the cannula to 
the edge of the tumour (b). A cytologic sample is then 
taken in the usual way with the instrument. The screw 
needle is in this procedure driven by rotation into the 
tumour tissue (c), whereupon the hub of the cannula is 
rotated until it is advanced over the screw (d). The 
cannula and screw are then retracted together with 
cytologic material protected in the grooves of the screw 
needle. The material is then smeared on a glass slide 
and examined after suitable staining (44, 45). Cellular 
material may, of course, be collected as a separate 
procedure before insertion of the electrode, when 
doubts exist as to the character of the lesion. This platinum electrode is suitable as an anode in 
small tumours (about 2 em diameter or less). It is also 
suitable as a tissue cathode. Because mechanical strain 
rather easily breaks this electrode during treatments of 
tumours larger than 2 em (which require about2 hours 
of treatment), a second and stronger type of electrode 
was devised: 
Type 2. This electrode (Fig. XVII: 16) may serve as 
an anode or a cathode in direct current treatment. Two 
or more platinum strings arc twisted together to mini­
mize points of local strain. The electrode is insened 
and cell material obtained in the same way as de­
scribed above for the simple platinum string electrode. The increased thickness of the combined electrode 
strings makes them suitable for use as a guide wire over 
which a plastic tube is inserted (Fig. XVII: 16b). The 
hooked end of each string then helps to anchor the 
electrode in direct contact with tumour tissue. The 
plastic tube also allows aspiration of gas produced 
along the surface of the electrode. The plastic tube is 
kept in place by slightly stretching the indwelling 
platinum strings against the plastic tube. The strings 
are then fixed in place by plugging the hub of the tube 
with a small stopper. Type 3. This e.lectrode (Fig. XVII: 17) has been 
designed to maximize the area of the electrically active 
surface. The electrode also is suitable for percutaneous 
insenion and biopsy, in principle as described for 
Types I and 2. ln addition, it provides a canal for 
direct access to the internal part of the active electrode a 
b 
c 
d 
Fig. XVII: IS. Direct cum:nt treal:ment. Insertion of a 
Type I platinum string electrode in10 a tumour, followed by 
sampling of tumour cells for cytology. (a) The lip of the elec­
trode is bent, insened into the tip of a 1 mm thick Rotex bi· 
opsy cannula, and placed in the tumour. (b) The cannula is 
retracted. The hook helps to anchor the electrode. (<} Before lhe cannula is removed, a biopsy may be obta.ined, when 
necessary, by rotation of the indwelling screw needle into the 
tissue and (d) advancement of the cannula over the screw so 
that cellular material is secured inside the cannula and pro­
tected in the grooves of the screw before the instrument is re­
moved. Treatment of cancer 287 b 
Fig. XVII: 16. Direct current treatment. A Type 2 electrode 
or twisted platinum strings surrounded by a plastic tube. The hooked ends of the strings (a) arc inserted as shown in 
Fig. XVII; 15. (b) After the cannula is removed, a Teflon 
area. This electrode is intended primarily to be used in 
c.largc" tumours. The electrode contains four layers. An inner screw 
needle resides in a Rorex steel cannula, surrounded by 
a Teflon tube. Outermost are platinum electrode 
rings, which can be varied in number or length accord­
ing to the size of the lesion. As it enters the rings, the 
Teflon tube tapers and becomes thin-walled. The most 
distal electrode ring has a tapered tip and is welded to 
three platinum strings. These strings run outside the 
thin part of the Teflon tube and are tightly pressed 
against the other electrode rings so as to make electri­
cal contact with them. Proximal to the electrode rings, 
ihe Teflon tube widens, which helps hold the rings i.n 
place in situ. The strings run inside the wide part of 
the Teflon tube and pass outside the tube through a 
hole at the beginning of the thin part. Proximally the 
strings emerge from the plastic hub, where they arc 
accessible for connection to the source of direct cur­
rent. The active electrode surface can be varied by the 
number and size of the platinum rings. The length of 
the thin pan of the Teflon tube is adjusted according­
ly. Slots in the Teflon tube make it possible to aspirate 
gas and to inject pharmacological agents or saline solu-
288 Treatment of cancer tube with stopcock is passed over rhe twisted platinum 
strings to the edge of the tumour. The tube serves both as an 
insulator of adjustable length and as a channel for removal of 
gas produced along the electrode during the treatment. tion through the electrode canal. The screw needle is 
O.SS mm thick at its base and tapered to the tip over a 
distance of 16 mm. The steel cannula is I mm thick. The external diameter of the electrode rings is 1.9 
mm. The purposes of the screw needle are twofold: to 
obtain cellular material for cytologic examination from 
the site of the electrode and 10 control placement of the 
electrode by stabilizing its position in the tumour. When the cannula and the larger platinum electrode 
are introduced, the position of the screw needle deter­
mines their positions. Type 4. Some tumours are not solid, but semisolid 
or cavitary inside. Gas produced at the electrode sur­
faces causes or enlarges cavitation in the tumour. Therefore, it may be difficult to keep an electrode in 
place for longer than a few minutes. Gas also jeopar­
dizes contact between electrode and tissue, and can 
disconnect the current. The Type 4 "winged" electrode shown in Fig. XVII: 18 is designed to overcome these drawbacks. The platinum electrode is tapered distally and grooved 
proximally. Three platinum strings are soldered to the 
most proximal groove. A sling of nylon thread runs 
through two holes in the electrode and passes proxi­
mally the length of the Teflon tube and out the stop-• 
b 
c 
Fig. XV II: 17. Direct current treatment . Construction and 
insertion of a platinum electrode (Type 3) with a relatively 
large surface area. (a) The active electrode surface consists of 
one ro several segments of platinum rubes, as indicated by 
diagonal lines in cross section. Three platinum strings are 
here welded to the distal platinum tube, which has a conical 
tip. The strings run between the cylindrical platinum rubes 
and a thin-walled Teflon tube. At the base of the proximal 
platinum tube, the Teflon tube widens. There the platinum 
strings pass through a hole into the proximal larger part of 
the Teflon tube. (b) The electrode is advanced to the edge of 
the tumour by means of a Rotex biopsy instrumen t. (c) The 
cock. The platinum strings emerge close to the stop· 
cock connection. The Teflon tube is provided distally 
with 4 slots, which allow the segments between the 
slots to fold outward when the nylon string is pulled. The electrode is inserted the same way as is electrode 
Type 3, above, using a screw needle and cannula. The 
folded, slotted Teflon section anchors the electrode tip 
in place, even if gas pressure and dehydration happen 
to produce an anodic intratumoural cavity. The nylon 
threads arc maintained taut by a small stopper plugged 
into the stopcock. The opened wings also permit easy 
communication between the Teflon tube and the inner 
part of the tumour. In this way, gas can be removed 
and pharmacological agents or saline solution infused 
into the tumour. This electrode is intended for usc as 
an anode. Given the principle that vascular branches of the 
VICC selectively conduct current, selective positioning 
of the cathode in a vessel merits consideration. For 
that purpose, a specifically cathodic electrode has been e 
screw needle is introduced to serve as a guide for advancing 
the cannula and platinum rings. (d) The cannula and the 
platinum tube are introduced into the tumour. The cannula 
and indwelling screw needle are then removed. The grooves 
of the screw hold material for cytologic examination . (t) The 
platinum sections can be varied in number and length ac· 
cording to the size of the tumour. The inrratumoural part of 
the Teflon rube is thin and slotted lengthwise. Gas produced 
at the surface of the electrode can be aspinted from the rube. Saline solution or pharmacologic agents, e.g., cytostatic 
compounds, can also be infused through the rube. developed (Fig. XVII: 19). This electrode consists of a 
plastic radiopaque catheter, curved at the tip and per· 
forated by a row of side holes along the inner curva· 
ture. The perforations permit electrochemical contact 
between ·blood and the metal. After percutaneous in· 
sertion by Seldinger technique, the catheter is placed 
in the chosen vessel, e.g., a pulmonary artery. A metal 
electrode is placed inside the catheter. To date, an 
ordinary stainless steel guide wire has been accepted 
for this purpose. The guide wire is positioned along 
the whole length of the catheter but does not protrude 
beyond the tip of the catheter. The distal part of the 
catheter is curved, to further minimize the risk of 
injury to the vessel wall by contact with the metal of 
the cathode. To use direct current for treatment of a cancer an 
important principle must be noted: 
Cells of mammals, including cancer cells, carry a net 
surplus of fixed electronegative charges (I, 4, 26, 27, 
70, 75). This surplus means that those cells which are 
Treatment of cancer 289 b 
c 
Fig. XV II: 18. Direct current treatment. Electrode of 
Type 4, designed to remain ftx:ed in a cavitary tumour. (c) A 
tapered platinum tube is screwed proximally into a plastic 
tube. The distal end of the tube contains four longitudinal 
slots. A nylon nring runs through holes (thin arrows) in the 
platinum tube and passes through the plastic tube. Three 
platinum strings are welded on the most proximal groov( (ar· 
row-heads ). (b) By pulling the nylon thread (oblique arrow), 
290 Treatment of cancer retracting the biopsy screw needle (horizontal arrow) and 
pushing rhe plastic tube (c) into dte tumour, four wings fold 
out, securing the electrode in the cavitary tumour. The tube 
is also available for removal of gas and infusion of liquid so· 
lotions, e.g., saline or cytostatic compounds. This electrode 
is introduced in the same way as is the electrode shown in 
Fig. XVII: 17. Fig. XVII: 19. Direct cur· 
rent treatment: intravascular 
cathodic electrode in a cath· 
e~er. Multiple side holes 
along the concavity of a plas­
tic catheter prevent the met­
al in the catheter from di· 
rectly contacting the wall of 
a vessel. The metal string of 
the elec-t.rode is provided 
with a stopper. The three· 
way stopcock allows intra· 
vascular infusion through 
tbe holes in the catheter. easily detached, such as malignant cells, will move in a 
superimposed electric field from the cathode toward 
the anode. The electropositive field around the intra­
tumoural anode will, therefore, tend to keep all mov­
able cancer cells in place during the direct current 
treatment. The application of an electronegative po­
tential in a cancer, on the other hand, can be expected 
to tend to repel the neoplasti c cells away from the 
tumour and therefore increase the risk of producing 
metastases. The tumQur electrode must initially be anodic. The 
cathode must be kept away from malignant cells. Because 
cancer cells are electronegatively charged, they will be kept 
wgether araund the anodtl but be tramparted away from 
the cathode. If an intratu.moural electrode is cathodic, the 
subsequent spread of tumour cells is very likely. 5. Application of electrodes 
Direct current treatmen 1 can easily be performed in a 
patient treated with a tranquilizer (e.g., morphine­
scopolamine, S-10 mg, i.m.) and local anaesthesia 
(Xylocaine ®) in the skin and pleura. In this way it is 
possible to communicate with the patient during the 
treat.ment. The insertion of electrodes is performed percutane ­
ously as described above after careful radiologic local­
ization of the lesion wirh plain films, biplane nuoro-
Fig. XVII: 20. Compu1erized tomography as an aid 10 per­
curaneous insertion of electrodes in direct current treatment 
of a metastasis in the lungs. Blackness represent s air in lung. The patient is supine and viewed as a transverse section seen 
as if the viewer were looking from 1he direc1ion of 1he pa­
tient's feet toward the patient's head. The carcinoma , ap­
proximately 2 em in djamere-r, is situated anterolalerally in 
the periphery of the right lung. Reconstructions optimize scopy, and, if necessary , computerized tomograms. Computerized tomograms are in many cases indis­
pensable. In biplane televised fluoroscopy, one select· 
ed projection may be optimal while the perpendicular 
view is insufficient 10 localize a small lesion. In such 
cases a computerized tomogr.tm makes it possible to 
determine the exact distance between the planned site 
of pleural puncture and the margin of the lesion. An 
electrode can then be introduced to the predetermined 
position by means of a suitable projection at fluoro­
scopy. Fig. XVII: 20 illustrates the role of computer­
ized tomography in determining the most suitable di­
rection and depth for percutaneous .insertion of elec­
trodes. ParaUel white lines indicate planned introduc­
tion of the anode into the carcinoma and the cathode 
into the lung parenchyma between th.e tumour and the 
bjlum. The placement of electrodes can in theory be widely 
v.aried for DC treatment of pulmonary neoplasms (Fig. XVII: 21). Electrod.cs can (theoreticaU y) be placed on 
the skin, or inserted directly through the chest wall. Electrode s can also be inserted via a catheter into the 
pulmonary artery, a syste.ruc artery, a systenUc vein, a 
bronchus or in the pleural space. The venous routes 
and the pleural space are of particular interest because 
they provide pathways for current which include the 
lymphatics. A large skin cathode is not very suitable 
for treating pulmonary lesions because of the risk of 
eddy currents between the skin and the anodic tumour 
imaging detail of(a) margins of the cancer, (b) sof1 tissues of 
the chest waU. Biplane fluoroscopy besl v;sualized 1he lesion 
when one of the planes was as marked by the while lines. In 
this plane the centre of the lesion was 8.5 .em from 1he sur­
face of the skin (measured distance of the shorter strnighl 
white line). The longer white line marks the anticipated posi­
tion of the cathodic electrode . Treatment of cancer 291 Fig. XV II: 22. Position of electrodes for direct current treat­
ment ora lung tumour. The tumour electrode should beano· 
die. (a) The cathodic electrode is ideally positioned. It is out­
side the tumour and proximally placed in the &arne segment 
to maximize intcrcJcctrode flow of current over the conduct­
ing interstitiJII Ouid and intravascular plasma. (b) Unsuitable 
position of the cathode, positioned in an adjacxnt pulmonary 
lobe or segment. When interlobar pleura (dashed line) or any 
o<her poorly conducting membrane is interposed between 
the anode (in the tumour) and the cathode, now of cum:nt 
will take an unpredictable roundabout way, perhaps via the 
hilum. b 
292 T"'atment of cancer Fig. XVII: 21. Different (theoreti­
cal) possibilities for placement of 
clectrodea in D.C. therapy of cancers 
in the lung. T • transthoracic; Pa ~ 
via a catheter in the pulmonary ar­
tery; Br • throuaJ> the tracheobron­
chial tree; Ao • via a catheter in th~ 
aorta or bronchial artery; S ~ large 
electrode on the skin; V e via a cath· 
ctcr in a vein. electrod~ in th~ lung.
631928626-Biologically-Closed-Electric-Ci-Bjorn-Nordenstrom-pdf.txt
Summarize the following text section accurately and concisely. Maintain specific details and numerical information, and use anti-repetition mechanisms:

        In general, application of direct 
current between a tumour and its surrounding s will 
induce two kinds of transports: ions of the supporting 
electrolytes and electrolytic products from the surfaces 
of the electrodes. These transportS thereby modify the 
conditions for survival of neoplastic cells. The tra. ns­
ports also lead to the development of recombination 
products and the appearance of true "biological reac­
tions", such as anodic accumulation of leukocytes, for­
mation of capillary thromboses and scar tissue, water 
transport and changes of individual cells. In this way 
possibilities may exist for local treatment of regions of 
tissue larger than the tumour tissue primarily de­
stroyed around the anode. To date many possibilities 
remain for optimizing the conditions of treatment, 
Treatment of cancer 271 e. g. , with regard to elect:rode technique, suitable volt­
age, fluctuation of voltage, current-density and dura­
tion of treatment. When direct current of "low" energy is used, the 
local destructive effects are low. Nevertheless, consid­
erable effects on surrounding tissue can be expected 
when the current is allowed to flow over a long period 
of time, e.
To support spontaneous tendencies toward healing of a growing tumour.
What is the goal of the treatment technique?
The generation of a large amount of heat near the electrode, which can cause nearby tissues to desiccate and interrupt the electric current.
What is the main drawback of the dry electrode technique?
The liquid-perfused electrode technique generates less heat and is more suitable for larger tumours.
What is the main difference between the dry and liquid-perfused electrode techniques?
To monitor the temperature at the surface of the tumour during treatment.
What is the purpose of the thermoelectric detector needle?
The risk of producing serious vascular injury.
What is the main challenge in using direct current to treat deeply situated tumours?