A Look Back at Julia Sneden's Review of The Emperor of All Maladies

We repeat Julia's 2011 review as this coming week the Ken Burns televised series based on the Dr. Siddhartha Mulherjee book is being presented on PBS: Mukherjee portrait "Cancer: The Emperor of All Maladies tells the complete story of cancer, from its first description in an ancient Egyptian scroll to the gleaming laboratories of modern research institutions. At six hours, the film interweaves a sweeping historical narrative; with intimate stories about contemporary patients; and an investigation into the latest scientific breakthroughs that may have brought us, at long last, to the brink of lasting cures."

Emperor of All Maladies

Published by Scribner Division of Simon & Schuster, Paperback: 470 pp

Reviewed by Julia Sneden; photo © Deborah Feingold

The author of this Pulitzer Prize-winning book is an Assistant Professor of Medicine, Department of Medicine and Division of Hematology and Oncology at Columbia University Medical Center. It is therefore quite stunning to find that Dr. Mukherjee is also a writer of extraordinary talent, who has produced a remarkable book.

Billed as "A History of Cancer", the book is all that and a great deal more. Dr. Mukherjee goes well beyond a mere re-telling of the known record of the disease and of mankind’s efforts to control and/or eradicate it. He explains with great clarity just exactly what cancer is, how much we know about it at this point, and possible new directions in which the world of science might proceed to deal with it.

Not only does Dr. Mukerjee give us facts and history: he also tells us a number of very human stories of the doctors and scientists and researchers who have struggled to define and explain and treat the disease, as well as stories of patients who have battled cancer. Some of the latter are stories of survivors; some are of those who lost the fight. Oncologists have learned, and continued to learn, from both.

Cancer is defined as "a clonal disease," i.e. a disease of limitless, uncontrolled cell division, an entity that keeps growing "… cell and cell and cell ad infinitum." In each generation of its cells, a few of the clones are slightly different from their parent cells, so that when a drug or immune system attacks and kills the parent cells, a few mutant cells can resist the "cure" and continue to grow, a true example, as Dr. Mukerjee says, of "survival of the fittest."

The doctor describes cancer as "a distorted version of our normal selves," i.e. an enemy that is a perversion of what makes the human body able to grow and resist and repair itself during its lifetime. Cancer, however, is in a sense immortal where we are not. Given the proper conditions in a laboratory, cancer cells can live on, reproducing indefinitely long after their host body (a person) is dead.

The first recorded description of cancer comes from Egypt, in a text written in 2500 BC. It describes "a bulging tumor in the breast," with the further note that there is no treatment for it. In medieval times, cancer treatment was surgical, without anesthesia or sanitary conditions, and with appalling after-care that included "caustics, fire, and leather bindings." By the 1800's, anesthesia accompanied the surgeries, but those radical surgeries were extremely aggressive and extensive, with what we today would call dismal results which included massive disfigurement, as well as less-than-impressive statistics for longevity.

From the earliest times, doctors have searched for the cause of cancer, and some of them realized early-on that what we now call carcinogens were involved. As early as the 1700’s, a doctor in England made the connection between a high rate of scrotal cancer in young boys who served as chimney sweeps, and the soot they encountered. The children were lowered, often naked and greased well, into chimneys to sweep down the soot, and their incidence of cancer was, as we say today, off the charts.

Near the end of the 1700's, another British doctor noted a high level of cancer of the throat, lips, tongue and esophagus among people who used tobacco, be it pipe, cigarettes, or snuff. Dr. Mukhergee notes the unpopularity of this view, led by the entire business end of the tobacco industry, long before modern times.

In the early 1900's, however, a virologist announced that he had found a cancer gene infected with a virus, and for many years, researchers chased this viral chimera. An anti-viral drug was developed, and it seemed to work for some leukemic patients. Only quite recently has that theorem been adjusted, a matter of observing and charting the chromosomes and genes that is far too complicated to explain in this space, but I assure you, Dr. Mukherjee makes it very easy to understand.

During the last century, a crusade to involve the government in finding a cancer cure was led by cancer researchers and prominent socialites and politicians. Under President Nixon, 'The War On Cancer' was launched with much fanfare. Unfortunately, that war has proven a great deal more difficult to win than our other wars. The search for some sort of vaccine for all types of cancer has been fruitless, and looking for a cure before learning about the nature of the beast itself has led science down many dead-end alleys.

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A Look Back at Julia Sneden's Review of The Emperor of All Maladies

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