The Emperor Of All Maladies: A Biography Of Cancer
A historical account of arguably medicine's most challenging adversary.
“Cancer is an expansionist disease; it invades through tissues, sets up colonies in hostile landscapes, seeking “sanctuary” in one organ and then immigrating to another. It lives desperately, inventively, fiercely, territorially, cannily, and defensively—at times, as if teaching us how to survive. To confront cancer is to encounter a parallel species, one perhaps more adapted to survival than even we are.” - Dr. Siddhartha Mukherjee portraying the qualities and behaviors that make cancer a deadly assassin.
The Great Predicament
It’s never easy losing a loved one, nor witnessing them struggle through medical distress, but there is something particularly cruel about when either of these occurs due to cancer. Maybe it is the traitorous aspect of cancer, marked by your own cells going rogue and turning against you. Maybe it’s the way that cancer attacks your identity, forcing you to choose between your hair and your life. Or maybe its cancer’s stealth, with which it can lay under the radar until it induces a life expectancy of only months. Regardless of the mechanism, it is evident that cancer strikes an emotional blow unlike any other disease pathway, and it is this emotional blow that drives us to pink walks, Locks of Love, and bone marrow drives; yet, it seems that no matter how hard we push to relieve cancer’s burden on patients, their families, and the world, it seems to evade us. Why is this? Some would pose radical conspiracy theories, exclaiming that, “it’s the government man, they’re hiding the cure to keep making money off of it,” but this doesn’t pass the weakest of sniff tests, considering the incredible amount of money that the government loses to cancer research and treatment efforts every year. So what is it about cancer that makes it one of the more difficult medical puzzles to solve?
“In Lewis Carroll’s Through the Looking-Glass, the Red Queen tells Alice that the world keeps shifting so quickly under her feet that she has to keep running just to keep her position. This is our predicament with cancer: we are forced to keep running merely to keep still.” - Mukherjee outlining the demanding nature of combatting cancer.
Retracing the Enemy’s Steps
In his book, The Emperor of All Maladies: A Biography Of Cancer, Dr. Siddhartha Mukherjee, oncologist and cancer researcher, explains the history of this category of diseases, dating from Ancient Egyptian times all the way to the present era, and unravels the qualities that make providing its cures such a quandary. Touching on pivotal points along humanity’s journey fighting cancer, such as the discovery of the first chemotherapies and the connection between cancer and genetic mutation, Mukherjee takes you through the minds of the scientists and physicians that have pursued and continue to pursue an end to cancer’s cruelty. In addition, he shares his own journey through oncology, providing personal anecdotes of dealing with the sorrow of losing patients to cancer. If you’re looking for a deep dive into the nuances of cancer, covering its emotional aspects as much as its genetic, physiologic, and historical components, then this is the book for you.
“In those ten indescribably poignant and difficult months, dozens of patients in my care had died. I felt as if I was slowly becoming inured to the deaths and the desolation - vaccinated against the constant emotional brunt.” - Mukherjee describing the mental toll of working in the oncology field.
The War Goes On
The famous Chinese general Sun Tzu once said, “Know thy enemy and know thyself and you will win a hundred battles.” Reading The Emperor of All Maladies opened my eyes to the incredible complexity in the battles against cancer, in that it portrayed the multi-faceted nature of a cancer’s development and preservation. In particular, my view on cancer was significantly impacted by three realizations I gained from the book: 1. Cancer is not a disease, rather it is a spectrum of diseases, each containing its own unique signatures and qualities; 2. A successful cancer cell is the result of extremely scrutinized evolution, in which only the most pervasive and exceptional mutated cells survive, and from which extremely resilient cells arise ; 3. It is not difficult to destroy a cancer cell, rather the difficulty lies in destroying the cancerous cells without destroying the healthy cells in the process, as these two types of cells are more genetically similar than they are different. After understanding these few concepts, I immediately found the answer to the question from above. Cancer is such a difficult medical problem to solve because its process of development is erratic and ever-changing, producing cells that were selected for their abilities to evade your immune system, resist treatments, survive, and spread — all of which they can do while at least partially blending in with the rest of the cells in your body. This is only part of the story, which you will discover on your journey through the book, as cancerous pathology contains far more intricacies than these 3 nuances. As I mentioned before, one of the reasons that cancer might hit so hard to home is that it involves our own cells seemingly turning against us. In this regard, we truly must know both our enemy and ourselves if we are to win our war against the “Emperor Of All Maladies.”
“Killing a cancer cell in a test tube is not a particularly difficult task...The trouble lies in finding a selective poison...a fantastically nimble knife: sharp enough to kill cancer yet selective enough to spare the patient.” - Mukherjee explaining the delicate precision required to successfully defeat cancer.
Find more of Dr. Mukherjee’s work here.