Tuesday, January 18, 2011

Siddhartha Mukherjee: The Emperor of All Maladies: A Biography of Cancer

In November 2010, NPR’s Fresh Air featured a story, “An Oncologist Writes a Biography of Cancer.” Oncologist Siddhartha Mukherjee was treating one of his patients, a woman with advanced abdominal cancer who had relapsed multiple times, when she asked him what seemed like a simple question. "She said, 'I'm willing to go on, but before I go on, I need to know what it is I'm battling,' " Mukherjee tells NPR's Terry Gross. But, as Mukherjee explains, describing his patient's illness wasn't so simple. Defining cancer, he says, is something doctors and scientists have been struggling to do since the disease's first documented appearance thousands of years ago. Mukherjee's new book, The Emperor of All Maladies: A Biography of Cancer, grew out of his desire to better understand the disease he treats, through examining the way cancer has been described and treated throughout history. He chronicles the ways therapies evolved, particularly in the 20th century, as more treatment options became available and scientists worked to understand the underlying genetic mutations that caused the disease.
“A breast cancer might turn out to have a close resemblance to a gastric cancer. And this kind of reorganization of cancer in terms of its internal genetic anatomy has really changed the way we treat and approach cancer in general.”

- Siddhartha Mukherjee, author of the book: The Emperor of All Maladies: A Biography of Cancer

“What does it mean to be an oncologist? It means that you get to sit in at a moment of another person’s life that is so hyper-acute, and not just because they’re medically ill. It’s also a moment of hope and expectation and concern. It’s a moment when you get to erase everything that’s irrelevant and ask the most elemental questions — about survival, family, children, legacy.”

- Siddhartha Mukherjee, author of the book: The Emperor of All Maladies: A Biography of Cancer

In November 2010, The Economist published “With hope, farewell fear: The long struggle to understand cancer.” It is said that when the good burghers of Amsterdam were first presented with a rhinoceros—armored, horned, three-toed, with a prehensile lip—spectators shook their heads in disbelief. Cancer provokes a similar bafflement. So protean are its forms and so varied its features that even specialist prognoses of aggressiveness, invasion and response to treatment have typically generated more exceptions than rules. Apparently, identical cancers in two patients may behave so unlike as to appear utterly different diseases. Siddhartha Mukherjee’s “The Emperor of All Maladies” tells of the search for a “unifying theory” of cancer, the common attribute of all types of malignant cell growth that might reveal its cure. The arc of this rich and engrossing book matches Mr. Mukherjee’s personal evolution as an oncologist, beginning on the first day of his hospital residency. It seems that the diversity of this implacable, shape-shifting foe will defeat him. He is faced with dead-end discoveries, therapeutic disasters and revelations that lead only to more mysteries. But with the perceptiveness and patience of a true scientist he begins to weave these individual threads into a coherent and engrossing narrative.
“If there's a seminal discovery in oncology in the last 20 years, it's that idea that cancer genes are often mutated versions of normal genes. And the arrival of that moment really sent a chill down the spine of cancer biologists. Because here we were hoping that cancer would turn out to be some kind of exogenous event — a virus or something that could then be removed from our environment and our bodies and we could be rid of it — but as it turns out, cancer genes are sitting inside each and every one of our chromosomes, waiting to be corrupted or activated.”

- Siddhartha Mukherjee, author of the book: The Emperor of All Maladies: A Biography of Cancer

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