Full size book cover of The Emperor of All Maladies: A Biography of Cancer}

The Emperor of All Maladies: A Biography of Cancer

Siddhartha Mukherjee

4.34(107755 readers)
"The Emperor of All Maladies "is a magnificent, profoundly humane "biography" of cancer--from its first documented appearances thousands of years ago through the epic battles in the twentieth century to cure, control, and conquer it to a radical new understanding of its essence. Physician, researcher, and award-winning science writer, Siddhartha Mukherjee examines cancer with a cellular biologist's precision, a historian's perspective, and a biographer's passion. The result is an astonishingly lucid and eloquent chronicle of a disease humans have lived with--and perished from--for more than five thousand years.

The story of cancer is a story of human ingenuity, resilience, and perseverance, but also of hubris, paternalism, and misperception. Mukherjee recounts centuries of discoveries, setbacks, victories, and deaths, told through the eyes of his predecessors and peers, training their wits against an infinitely resourceful adversary that, just three decades ago, was thought to be easily vanquished in an all-out "war against cancer." The book reads like a literary thriller with cancer as the protagonist.

From the Persian Queen Atossa, whose Greek slave may have cut off her diseased breast, to the nineteenth-century recipients of primitive radiation and chemotherapy to Mukherjee's own leukemia patient, Carla, "The Emperor of All Maladies "is about the people who have soldiered through fiercely demanding regimens in order to survive--and to increase our understanding of this iconic disease.

Riveting, urgent, and surprising, "The Emperor of All Maladies "provides a fascinating glimpse into the future of cancer treatments. It is an illuminating book that provides hope and clarity to those seeking to demystify cancer.

Publisher

Thorndike Press

Publication Date

4/6/2012

ISBN

9781410447159

Pages

944

Categories

History

About the Author

Portrait of author Siddhartha Mukherjee
Siddhartha Mukherjee
Siddhartha Mukherjee (Bengali: সিদ্ধার্থ মুখার্জী) is a cancer physician and researcher. He is an assistant professor of medicine at Columbia University and a staff cancer physician at Columbia University Medical Center. A Rhodes scholar, he graduated from Stanford University, University of Oxford, Harvard Medical School. He has published articles in Nature, The New England Journal of Medicine, The New York Times, and The New Republic. He lives in New York with his wife and daughters.

His book The Emperor of All Maladies: A Biography of Cancer won the 2011 Pulitzer Prize for General Non-Fiction.

Questions & Answers

Over centuries, the understanding and treatment of cancer have evolved significantly. Initially, cancer was attributed to imbalances in bodily fluids, like the Galenic theory of black bile. Surgery was considered ineffective due to the belief that the problem was systemic. In the 19th century, Virchow identified cancer as a disease of uncontrolled cell growth, leading to the development of radical surgery. The 20th century saw advancements like chemotherapy, radiation, and hormonal therapy. More recently, the focus shifted to understanding the genetic and molecular basis of cancer, leading to targeted therapies and personalized medicine. Despite these advancements, challenges remain, including cancer's heterogeneity and the need for more effective prevention and treatment strategies.

The fight against cancer has been shaped by several key scientific breakthroughs:

  1. Chemotherapy Development: Sidney Farber's discovery of antifolates and the development of chemotherapy marked a significant shift in cancer treatment, offering a new approach to combating the disease.

  2. Understanding of Cancer Genes: The identification of genes like Rb, p53, and oncogenes like ras and myc has provided insights into the genetic basis of cancer, leading to targeted therapies.

  3. Cancer Genomics: The mapping of the cancer genome by scientists like Bert Vogelstein has revealed the complexity of cancer and the presence of driver and passenger mutations, which are crucial for understanding and treating the disease.

  4. Targeted Therapies: The development of targeted therapies, such as Herceptin for breast cancer, has allowed for more specific and effective treatment by targeting specific cancer cells.

  5. Immunotherapy: Advances in immunotherapy, including checkpoint inhibitors, have unlocked the body's own immune system to fight cancer, offering new hope for patients.

These breakthroughs have significantly improved cancer treatment and survival rates, transforming the landscape of cancer research and care.

Public policies have significantly influenced the pace and direction of cancer research. Early on, the lack of funding and public awareness led to slow progress. The establishment of the National Cancer Institute (NCI) and the passage of the National Cancer Act in 1971 marked a turning point, providing substantial funding and a coordinated national effort. This led to significant advancements, including the development of chemotherapy and radiation therapy. However, the focus on a "War on Cancer" led to a period of over-optimism and a search for a universal cure, which later shifted to a more nuanced understanding of cancer's complexity. Recent policies emphasizing personalized medicine, prevention, and targeted therapies have accelerated research and improved patient outcomes.

Personalized medicine and targeted therapies address cancer's diverse nature by focusing on the unique characteristics of individual patients and their tumors. By analyzing genetic, molecular, and other patient-specific factors, these approaches identify the specific vulnerabilities within a cancer cell, allowing for more precise and effective treatment. This contrasts with traditional treatments that often target broad groups of cells, including healthy ones. Personalized medicine can tailor treatments to the specific cancer type, stage, and genetic makeup, potentially leading to better outcomes with fewer side effects. Targeted therapies specifically target cancer-related molecules or pathways, minimizing damage to normal cells. This precision not only increases the effectiveness of treatment but also helps in managing resistance, which is a significant challenge in cancer treatment.

The potential future directions for cancer research include integrating traditional epidemiology with molecular biology and cancer genetics to better understand and prevent cancer. This could involve identifying subtle risk factors and carcinogens through a more integrated approach. Additionally, personalized medicine, using genetic information to tailor treatments, and targeted therapies that attack specific vulnerabilities in cancer cells are promising. However, eradicating cancer entirely may not be feasible due to its deep roots in our genome and the inherent growth processes in our bodies, like aging and reproduction. The focus may shift to prolonging life and improving quality of life for cancer patients.

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