The Emperor of All Maladies

The Pulitzer Prize-winning "biography of cancer" by Siddharta Mukherjee is surprising lucid, even for the layman, but I must admit there were sections where the succession of different doctors and treatments piled too high for me to comprehend. But I did come away with an understanding of how cancer was first discovered, what causes it, and how it might be cured.

Cancer was given a name by Hippocrates, based on the word karkinos, Greek for crab, because some of the tumors resembled the crustacean (and is why one of the signs of the Zodiac is so named). The first recorded mention of it is a papyrus from Ancient Egypt, where a queen named Atossa is described as having something removed from her breast. But then there is a long silence about it in the record.

The early physician Galen though it was caused by melancholy, or black bile, but eventually, through the study of anatomists like Vesalius, no such black bile was found in the body. Doctors began making connections--in 18th century England a doctor noticed a high incidence of scrotal cancer among boys used as chimney sweeps, and thus the idea of a cancer-causing agent, a carcinogen, was conceived. Marie Curie, who made great breakthroughs in the study of radium, contracted leukemia, and watchmakers, who painted watch dials with radium, had high incidents of tongue cancer, from licking their paintbrushes.

What is cancer? Basically it's our bodies working too well, a mutated division of cells that grows tumors. It is something of a modern disease, a symptom of civilization, as in past generations other diseases, such as tuberculosis, small pox, pneumonia or many others, killed people before they could ever get cancer. Mukherjee also adds: "We tend to think of cancer as a 'modern' illness because its metaphors are so modern. It is a disease of overproduction, of fulminant growth--growth unstoppable, growth tipped into the abyss of of no control. Modern biology encourages us to imagine the cell as a molecular machine. Cancer is the machine unable to quench its initial command (to grow) and thus transformed into an indestructible, self-propelled automaton.

Mukherjee covers the disease from all angles, from the evolution of treatment, with both chemotherapy (in which it was discovered that a drug and be a poison and a poison can be drug) and radiation (oddly, of course, radiation can stem and cause cancer), and methods of surgery. William Halsted pioneered the radical mastectomy in the 19th century, where he would not only remove the breast but most of the muscle around it, to keep the cancer from coming back. This was seen in later years as barbaric, and more precise lumpectomies became the thing to do.

He also covers the efforts to raise money and awareness for cancer research, such as the Jimmy Fund, founded in Boston around a little boy, a Braves' fan, who had cancer. The charity is now associated with the Red Sox (after the Braves left town), and the boy's name wasn't Jimmy at all--it was Einar Gustafson, a name far less marketable. He also talks about a socialite named Mary Lasker, who worked tirelessly for cancer research, and took out full page ads urging President Nixon to treat cancer as the U.S. treated landing on the moon.

Mukherjee is an oncologist, and interrupts his narrative every so often to talk about real cases he has dealt with, which puts a human face on the subject. He's also something of a lexicographer, outlining the derivation of certain words, such as oncology comes from the Greek word onkos, meaning "mass" or "burden," and palliative comes from the Latin for "cloak."

All of this is fascinating, but the best chapters were on the eventual linking of tobacco to lung cancer. It's been told before, but Mukherjee tells the tale in lively prose. Two studies came out in the mid-50s making the connection, when cigarette smoking was at its most popular--45% of Americans had the habit. Of course the tobacco industry fought hard, but they've been losing the battle ever since, especially when a court case proved that they withheld data that showed that they knew of the link and covered it up.

Cancer has declined precipitously in the last twenty years, mainly due to lower numbers of smokers and the development of cancer screening mechanisms, but Mukherjee doesn't see the possibility of a sure-fire cure on the horizon. But he certainly remains hopeful.