The key ideas

The Emperor of All Maladies: A Biography of Cancer

Siddhartha Mukherjee, 2010

Four thousand years ago an Egyptian physician described a tumor and wrote, honestly: there is no treatment. The oncologist Siddhartha Mukherjee tells the story of cancer as the biography of a living adversary: from ancient papyri and brutal operations to the first drugs, the fight with the tobacco companies, and a pill that turned a deadly leukemia into a disease people live with for years. This book shows where we have already won, where we have not yet, and why every victory was paid for with mistakes.

Who it is for

For anyone curious about how medicine learned to understand humanity's most stubborn disease. And for everyone tired of loud headlines about a “cure for cancer” who wants to know what really lies behind them.

Down to their innate molecular core, cancer cells are hyperactive, survival-endowed, scrappy, fecund, inventive copies of ourselves.

What the book is about

On the morning of May 19, 2004, Carla Reid, a thirty-year-old kindergarten teacher, woke up with a headache so bad that her head felt numb. Two days later a young oncologist, Siddhartha Mukherjee, a doctor who treats cancer, read a message on his pager: new patient with leukemia, see her at once. Leukemia is a cancer of the blood. You will find out how Carla's story ends at the very end of the book.

While Mukherjee was treating Carla, he began to keep a journal, and this book grew out of it. He tells the story of cancer as a biography: the disease has a birth in ancient times, a character, habits and adversaries. The author puts the book's central question like this: can this disease ever be brought to an end?

Ahead of you are a surgeon who believed that the more you cut away, the better; a children's doctor who dared to give sick children a substance no one had tested; a society lady who declared war on cancer in a newspaper; and a pill that changed what treatment could mean. You will see what has already been achieved, and what has not yet.

Idea 1. Cancer is not a new disease, people just did not live long enough to get it

Cancer seems like a disease of our time. Yet the first known description of a tumor of the breast was written in Egypt more than four thousand years ago. It is attributed to the physician Imhotep, and it survives on papyrus, an ancient manuscript made of reed. Having described the tumor, the author offers no remedy and writes: there is none.

Two thousand years later Herodotus tells of a Persian queen named Atossa. A tumor grew in her breast, and a Greek slave cut it out. The Greek physician Hippocrates called the disease karkinos, the crab: the swollen vessels around a tumor reminded him of claws.

So why did cancer seem rare for so long? Mukherjee explains: cancer is mostly a disease of aging. While people died young of infection, hunger and war, they simply did not live long enough to meet it. When lives grew longer, cancer moved to the front.

What this means for you: a rising number of cancer cases partly tells you that people live longer, not only that the world has grown more dangerous.

A granddaughter leafs through the family album and asks her grandmother why almost nobody in the old stories had cancer. The grandmother counts them off: the war took the girl's great-grandfather, typhus took her great-grandmother, tuberculosis took her own brother. Back then few people reached the old age where cancer waits.

A disease that looks like a sign of modern times is in fact very old. What is new is not the disease but the length of a human life.

Read in Livria

About the author

Siddhartha Mukherjee is an American oncologist and researcher of Indian origin who teaches at Columbia University. This book won him the 2011 Pulitzer Prize.

All books by this author: Siddhartha Mukherjee

Terms from the book

  • Leukemia
  • Nixon
  • Fisher
  • remission
  • Wright
  • chemotherapy
  • Carroll
  • Gene
  • Hippocrates
  • Hill
  • bishop
  • Papyrus
  • Oncologist: A doctor who treats tumors and cancer. This field of medicine is called oncology.
  • Reid: Carla Reid, a kindergarten teacher from Massachusetts and one of the author's patients. Her treatment for leukemia runs through the whole book.
  • Imhotep: An Egyptian physician and architect who lived around 2600 BC. An ancient medical text describing a tumor of the breast is attributed to him.
  • Herodotus: An ancient Greek historian of the fifth century BC, author of the Histories, which describe the wars between the Greeks and the Persians.
  • Atossa: A Persian queen who lived around 500 BC. The Greek historian Herodotus tells how a tumor appeared in her breast.
  • Halsted: William Halsted, an American surgeon at Johns Hopkins Hospital in the late nineteenth century. He invented the radical mastectomy.
  • Mastectomy: Surgery to remove the breast. Halsted's radical mastectomy removed the chest muscles and the lymph nodes along with the breast.
  • Lymph nodes: Small structures that lymph, the fluid of the body's tissues, passes through. Cancer cells often reach them first.
  • Randomized trial: A trial in which patients are assigned to different treatments by lot. That makes the groups alike, so a difference in outcome can be credited to the treatment itself.
  • Farber: Sidney Farber, a pathologist at a children's hospital in Boston. In 1947 he began treating children with leukemia with aminopterin. He is called the father of modern chemotherapy.
  • Aminopterin: A substance that stops cells from using folic acid. One of the first drugs to halt leukemia in children, if only for a while.
  • Folic acid: A B vitamin that cells need in order to divide and build new DNA.
  • Sandler: Robert Sandler, a boy with leukemia and one of Farber's first patients. He died in 1948, and the book is dedicated to him.
  • Lasker: Mary Lasker, a New York philanthropist and activist. For decades she pushed for public money to fight cancer.
  • Pott: Percivall Pott, an eighteenth-century London surgeon. In 1775 he linked skin cancer in chimney sweeps to soot.
  • Carcinogen: A substance or exposure that raises the risk of cancer. Tobacco smoke, for example.
  • Doll: Richard Doll, a British epidemiologist. Together with Austin Bradford Hill he proved the link between smoking and lung cancer.
  • Screening: Testing people who have no complaints, to find a disease or its early signs before symptoms appear.
  • Papanicolaou: George Papanicolaou, a Greek-born American physician. He devised the smear that finds changed cells in the cervix.
  • Mutation: A change in the DNA record. Many mutations are harmless, while some break the way a gene works.
  • Oncogene: A gene that, once mutated, pushes a cell to divide without stopping. In their normal form such genes help cells grow when growth is needed.
  • Varmus: Harold Varmus, an American biologist. With Michael Bishop he showed that cancer genes are altered versions of the cell's own genes. Nobel Prize, 1989.
  • Chromosome: A strand into which the DNA inside a cell is packed. Each human cell has 46 chromosomes.
  • Chronic myeloid leukemia: A slowly developing cancer of the blood caused by one specific break in the chromosomes. It is often shortened to CML.
  • Gleevec: The drug imatinib, which precisely switches off the protein made by the break behind chronic myeloid leukemia. Approved in the United States in 2001.
  • Ciba-Geigy: A Swiss pharmaceutical company that later became part of Novartis. Its chemists created the molecule that became Gleevec.
  • Druker: Brian Druker, an American oncologist. He brought Gleevec to trials in people.
  • Herceptin: The drug trastuzumab, an antibody that targets breast cancer cells carrying too much of the protein HER2. Approved in the United States in 1998.
  • Slamon: Dennis Slamon, an American oncologist. He linked an excess of the protein HER2 to aggressive breast cancer and ran the trials of Herceptin.
  • Red Queen: An image the book borrows from Lewis Carroll: a character who has to run as fast as she can just to stay in the same place. Not a scientific term.

All terms

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