Jul 15 2011

The Emperor of All Maladies – A Biography of Cancer

Published by at 8:26 am under Books

By Siddhartha Mukherjee
The subtitle of this very popular book from the fall of 2010 is an accurate description of its contents, and if the ‘hold queue’ at the SF public library is a good indication, it is still very popular. It seems that a lot of people are interested in either a better understanding of cancer or just appearing to have read the book.
The author who is an oncologist chronologically traces human understanding of cancer and the corresponding treatments from earliest reports in antiquity to the latest knowledge based on a partial understanding of the key role played by changes to genes. Chapters are organized around important steps in diagnosing, treating, and understanding cancers, and often focus on the key individuals or groups. Most of the book deals with the 20 th. century and its ‘War On Cancer’ period.
Overall, it was a very informative book, but it did get a bit tedious and slow in the middle chapters which dealt with a period of limited knowledge, failed treatments, and the selling of the “War on Cancer”. The earlier historical material and the later genetics based improvement in understanding of the variety of cancers and their causes were more engrossing.
Cancer is a category of diseases with many sometimes subtle and sometimes complex distinctions which can be critical to the success of potential treatments. Currently, some types of cancer or some subtypes of specific cancers can be treated and controlled with a high degree of success. Others varieties and forms remain mostly deadly. All cancers seem to be caused by mutations in normally benign human genetic processes. One or more genetic mutations occur to enable uncontrolled cell division and in some cases migration around the body(metastasis). Many of the key genes involved in enabling cancerous growth have been identified and in some cases their identification has led to effective treatments.
The book’s stories often follow a common form: understand the anatomy of the disease, then the function of parts of that anatomy, and finally use that understanding to develop a treatment. Seems like progress almost has to follow such a path, but serendipity and the doggedness of specific individuals were also needed to make progress. While there must have been many equally fanatical and self assured researchers who failed and possibly hurt patients in the attempt, such stories are not told here.
Overall, the message is that cancer is a malfunctioning of normal live giving processes. Not an external agent (even the types which involve transmission by viruses). Progress has been made but cancer is subtle, robust, varied, and by no means on the way out.

2 responses so far

2 Responses to “The Emperor of All Maladies – A Biography of Cancer”

  1. hdomkeon 18 Jul 2011 at 3:32 am

    “Progress has been made but cancer is subtle, robust, varied, and by no means on the way out.”
    That is for sure!
    The way cancer is covered in the media you would think great progress has been made in the search for cures for cancer. In fact progress has been minimal at best. If you compare death rates now with 1930 you will see that there are only two dramatic changes: Stomach cancer has declined and lung cancer has increased.

    http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-026208.pdf

  2. Chicagoon 18 Jul 2011 at 7:39 am

    I think the author would agree with you; as I do. The book makes the case that a “cure” for cancer is very unlikely. Progress is being made in understanding the course of some of the various cancers and in a few cases good treatments have been found. The biggest corrective step has been the reduction in smoking which is gradually reducing incidence of lung cancer.

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