The Emperor of All Maladies: A Narrative of Cancer History and Ideas

This week I finished reading the Emperor of All Maladies, the 2010 “biography” of cancer by Dr. Siddhartha Mukherjee. The author, a medical oncologist and researcher now at Columbia University, provides a detailed account of malignancies – and how physicians and scientists have understood and approached a myriad of tumors – through history.

The encyclopedic, Pulitzer Prize-winning book is rich with details. In the first half, Mukherjee focuses on clinical aspects of malignancy. He works both ancient and modern stories into the narrative; the reader learns of Atossa, the Persian queen of the 6th Century BCE who covered her breast disease, and Thomas Hodgkin, who in the 19th Century dissected cadavers and noted a “peculiar” pattern of glandular swelling in some young men, and Einar Gustafson, aka Jimmy, who was among the first children cured of leukemia in the 1950s.

The second half is a tour-de force on cancer biology; the author winds distinct threads of cancer science. He moves from century-old observations of cells with abnormal chromatin, through viral theories and hard-to-prove carcinogens, to the brave new world of oncogenes, targeted therapies, and current cancer genomics. He narrates the rift between clinical oncologists who, primarily, treat patients empirically and think less about science, and cancer researchers, who generally attend separate conferences and concern themselves with mechanisms of tumor growth and theoretical ways of blocking them. He relates a gradual, albeit slow, coming together of those two fields – of clinical and molecular oncology.

Mukherjee leaves the reader with a sense of cancer as a vast, infinitely diverse group of diseases that can mutate and adapt while a person receives treatment. The oncologist’s new goal, he suggests, is not so much to eradicate the disease as to learn more about its nature and course, to monitor each patient’s tumor and adjust medications as the cancer – or burden, as the term implies – shifts and mutates within the person who carries it along, within, for years and even decades.

It takes a long time to understand the workings of cancer cells; this book offers insights for oncologists and patients alike.

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