The Emperor of All Maladies: A Biography of Cancer

The Emperor of All Maladies: A Biography of Cancer

Paperback | August 9, 2011

bySiddhartha Mukherjee

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Winner of the Pulitzer Prize, and now a documentary from Ken Burns on PBS, 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.

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The Emperor of All Maladies: A Biography of Cancer

Paperback | August 9, 2011
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From the Publisher

Winner of the Pulitzer Prize, and now a documentary from Ken Burns on PBS, 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 o...

Siddhartha Mukherjee was born in 1970 in New Delhi, India. He received an undergraduate degree in biology from Stanford University, a DPhil in immunology from Magdalen College, Oxford University, and a M.D. from Harvard Medical School. He is known for his work on the formation of blood, and the interactions between the micro-environmen...

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Format:PaperbackDimensions:608 pages, 9.25 × 6.12 × 1.5 inPublished:August 9, 2011Publisher:ScribnerLanguage:English

The following ISBNs are associated with this title:

ISBN - 10:1439170916

ISBN - 13:9781439170915

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Reviews

Rated 5 out of 5 by from Cancer Very interesting look into cancer. Many interesting and captivating stories. Enjoyed how the book was laid out.
Date published: 2015-08-09
Rated 4 out of 5 by from The Emperor of All Maladies Good read with a history of cancer discovery-research. Gets a little dry in spots but interesting.
Date published: 2014-05-03
Rated 4 out of 5 by from A Historian With A Time Machine All I'm gonna say is: "you will experience a glorious moments of revelation", however, he tries in futility, to Hijack the history of "surgical oncology" and to discredit "The Great Founding Father Of Modern Surgery", William Stewart Halsted, but you can not blame the author for that, after all he is a "medical diplomat" who tries to convince others that he fought at the front lines of cancer therapy, when in fact , it is the Great "Surgical Warriors" that fight and die and the front line of war on cancer, then it becomes clear why a diplomat would try to take the credit for winning the war, that was won by the great warriors and martyrs, Surgery , always have been, always will be, the most effective preventive, diagnostic, therapeutic, prognostic, palliative, modality, And "Visceral Surgeons", will always lead the fight , and one day, they will win the war, Do not be fooled by the author "nihilistic" outlook on the war on cancer, for he is a "physician", not a " Surgeon", When was the last time that physicians won any war? They are mere observers of that war, and that us the best they could be, just "historians", no matter how good at it, that 's just about it, a good story tellers, Leave the fighting and the winning, to the Surgical Warriors, definitely we have lost so many battles, but make no mistake, we will win that war, the term cancer itself, will be one day, obsolete, archaic term, for an eradicated disease , just like small pox, and polio, and this is not a mere wishful thinking, this is "The Doctrine" of our "Founding Fathers", We leave the "chronicling" for them, For we are busy fighting
Date published: 2014-02-15
Rated out of 5 by from Amazing book!!!! Not only does he discuss the patients point of view as well as the doctor treating them, he also touches apon the genetic structure of genes that may have led to translocation of chromosomes (he explains what translocation is) that in turn lead to cancer. I have never recomended a book as much as i have this one! No wonder it won the Pulitzer Prize.
Date published: 2013-04-10
Rated 5 out of 5 by from Well written and interesting The subject matter of this book is not light, but it's written in a way that is engaging and personable. A great chronicle of humanity's fight against a most pernicious foe.
Date published: 2013-02-21
Rated 4 out of 5 by from Everyone Should Read This! For such a depressing but all important topic as cancer, this book was a fantastic read. Smooth writing about the toughest disease to overcome in layperson terms from the history of the disease to the most current treatments. Mr. Mukherjee emphasizes that uncontrolled cell division (cancer) is a challenge to cure but that continued human progress in research and clinical trials will lead us to a better medical future. I was pleasantly surprised on how absorving this book was - now I know why it won the Pultizer Prize.
Date published: 2011-11-14
Rated 5 out of 5 by from Fabulous and easy to understand history of cancer The Good Stuff * I won't lie, when I opened up the mail and saw this my first thought was WTF - pulizter prize winner, hello this is not my thing. I am not an overly intelligent women and well quite frankly was thinking dullsville. Well, I was very, very wrong! * This is brilliantly written and relatively easy to understand -- even for me * I was so fascinated and learned so much I actually found it difficult to put down * Medical information is in depth, interesting and written in more layman terms - which very much surprising * Incredibly well researched & some fantastic notes and detailed index (yes I know its geeky but I am an anal Library Technician * Fascinating to see the denial through history of the connection between tobacco and cancer -- especially from educated medical personal * Horrified and disgusted at times of all the research done on unsuspecting patients, even knowing the benefits it had in the medical field * Actually teared up a couple of times which very much surprised me * The author has a very honest, sensitive and personal manner which is a rarity in a Dr (Trust me I have spent my whole life surrounded by those in the medical profession) * The writing is almost lyrical which again surprised me * Cancer really does suck a** & hopefully one day we will kick its a** The Not so Good Stuff * At times it jumps from time frame to time frame which was a little disconcerting * Some noticeable repetition - better editing would have made it a tighter piece of writing Favorite Quotes/Passages "As a doctor learning to tend cancer patients, I had only a partial glimpse of this confinement. But even skirting its periphery, I could still feel its power-the dense, insistent gravitational tug that pulls everything and everyone into the orbit of cancer." "When Wynder presented his preliminary ideas at a conference on lung biology in Memphis, not a singles question or comment came from the members of the audience, most of whom had apparently slept through the talk or cared too little about the topic to be roused. IN contrast, the presentation that followed Wynder's, on an obscure disease called pulmonary adenomatosis in sheep, generated a lively, half hour debate." "Germaine fought cancer obsessively, cannily, desperately, fiercely, madly, brilliantly, and zealously - as if channeling all the fierce, inventive energy of generations of men and women who had fought cancer in the past and would fight it in the future." Who should/shouldn't read * Anyone who has been affected in any way by Cancer * All medical professional dealing with Cancer * So yeah, its pretty much required reading for everyone over the age of 16 (Terminology and subject matter might be hard to deal with by those younger than 16) 4.5 Dewey's I received this from Simon and Schuster in exchange for an honest review
Date published: 2011-09-11
Rated 4 out of 5 by from The Emperor of all Maladies “The Emperor of all Maladies a Biography of Cancer” by Siddhartha Mukherjee is a well put together book. It is organized and well thought out. It starts at the beginning of recorded history of cancer and ends with our present day knowledge of cancer. The book covers how humans have treated cancer from the beginning to the present. The book terrified me in some parts; reading how they treated breast cancer, performing mastectomies without anesthetic and how crippled the women would be after the procedure if they survived. “The Emperor of all Maladies” is a frightening reminder of how little we do know about cancer. One thing I have learned over the years is that knowledge and how we apply our knowledge is always changing. What we believe is true today will most likely be false tomorrow and this applies to the medical field and from reading this book you will see how it applies to cancer. Cancer is part of our society and as our population ages it well become an even greater part of who we are...with the majority of us living a long life...the majority of us well encounter some form of cancer. What is the best way to beat cancer? More money, it really is that simple...with the money available to the many intelligent individuals out there willing to do research, I truly believe we could have better survival rates and less toxic, less side effect ridden medications. Will we ever beat cancer? I doubt it, but we sure could treat it in a more patient friendly way. I have always had a love for the field of genetics and this book feeds that passion. The book is informative and interesting and involving...it contains enough science to teach the reader about what is the cause of cancer and how can we treat it. I always love a book that teaches me new things and this one succeeds on many levels.
Date published: 2011-04-19
Rated 4 out of 5 by from A silver lining perhaps... It must have been difficult to write the history of a disease that has decimated so many families and created such fear and anxiety. Mukherjee manages to do this with great ability, giving us the critical information whilst not bogging us down with too many details. The book has a few dry spots but, overall, for a science history, it is quite intriguing. I certainly learned a lot about cancer while reading this and I was surprised to find how brutal the treatments were up to very recently. Mukherjee also gives us a little more hope at the very end with his chapter on gene therapy. A great read for those interested in medical science or for those who want to know more about cancer specifically. The book is very approachable and you can easily navigate its terms and concepts with a minimum of science background.
Date published: 2011-02-24
Rated 5 out of 5 by from This man can write! There are times his writing has a poetical character to it. How cancer and poetry can be in the same sentence is hard to imagine but it is something Mukherjee achieves.
Date published: 2011-01-20

Extra Content

Read from the Book

The Emperor of all Maladies Prologue Diseases desperate grown By desperate appliance are relieved, Or not at all. —William Shakespeare, Hamlet Cancer begins and ends with people. In the midst of scientific abstraction, it is sometimes possible to forget this one basic fact.… Doctors treat diseases, but they also treat people, and this precondition of their professional existence sometimes pulls them in two directions at once. —June Goodfield On the morning of May 19, 2004, Carla Reed, a thirty-year-old kindergarten teacher from Ipswich, Massachusetts, a mother of three young children, woke up in bed with a headache. “Not just any headache,” she would recall later, “but a sort of numbness in my head. The kind of numbness that instantly tells you that something is terribly wrong.” Something had been terribly wrong for nearly a month. Late in April, Carla had discovered a few bruises on her back. They had suddenly appeared one morning, like strange stigmata, then grown and vanished over the next month, leaving large map-shaped marks on her back. Almost indiscernibly, her gums had begun to turn white. By early May, Carla, a vivacious, energetic woman accustomed to spending hours in the classroom chasing down five- and six-year-olds, could barely walk up a flight of stairs. Some mornings, exhausted and unable to stand up, she crawled down the hallways of her house on all fours to get from one room to another. She slept fitfully for twelve or fourteen hours a day, then woke up feeling so overwhelmingly tired that she needed to haul herself back to the couch again to sleep. Carla and her husband saw a general physician and a nurse twice during those four weeks, but she returned each time with no tests and without a diagnosis. Ghostly pains appeared and disappeared in her bones. The doctor fumbled about for some explanation. Perhaps it was a migraine, she suggested, and asked Carla to try some aspirin. The aspirin simply worsened the bleeding in Carla’s white gums. Outgoing, gregarious, and ebullient, Carla was more puzzled than worried about her waxing and waning illness. She had never been seriously ill in her life. The hospital was an abstract place for her; she had never met or consulted a medical specialist, let alone an oncologist. She imagined and concocted various causes to explain her symptoms—overwork, depression, dyspepsia, neuroses, insomnia. But in the end, something visceral arose inside her—a seventh sense—that told Carla something acute and catastrophic was brewing within her body. On the afternoon of May 19, Carla dropped her three children with a neighbor and drove herself back to the clinic, demanding to have some blood tests. Her doctor ordered a routine test to check her blood counts. As the technician drew a tube of blood from her vein, he looked closely at the blood’s color, obviously intrigued. Watery, pale, and dilute, the liquid that welled out of Carla’s veins hardly resembled blood. Carla waited the rest of the day without any news. At a fish market the next morning, she received a call. “We need to draw some blood again,” the nurse from the clinic said. “When should I come?” Carla asked, planning her hectic day. She remembers looking up at the clock on the wall. A half-pound steak of salmon was warming in her shopping basket, threatening to spoil if she left it out too long. In the end, commonplace particulars make up Carla’s memories of illness: the clock, the car pool, the children, a tube of pale blood, a missed shower, the fish in the sun, the tightening tone of a voice on the phone. Carla cannot recall much of what the nurse said, only a general sense of urgency. “Come now,” she thinks the nurse said. “Come now.” I heard about Carla’s case at seven o’clock on the morning of May 21, on a train speeding between Kendall Square and Charles Street in Boston. The sentence that flickered on my beeper had the staccato and deadpan force of a true medical emergency: Carla Reed/New patient with leukemia/14th Floor/Please see as soon as you arrive. As the train shot out of a long, dark tunnel, the glass towers of the Massachusetts General Hospital suddenly loomed into view, and I could see the windows of the fourteenth floor rooms. Carla, I guessed, was sitting in one of those rooms by herself, terrifyingly alone. Outside the room, a buzz of frantic activity had probably begun. Tubes of blood were shuttling between the ward and the laboratories on the second floor. Nurses were moving about with specimens, interns collecting data for morning reports, alarms beeping, pages being sent out. Somewhere in the depths of the hospital, a microscope was flickering on, with the cells in Carla’s blood coming into focus under its lens. I can feel relatively certain about all of this because the arrival of a patient with acute leukemia still sends a shiver down the hospital’s spine—all the way from the cancer wards on its upper floors to the clinical laboratories buried deep in the basement. Leukemia is cancer of the white blood cells—cancer in one of its most explosive, violent incarnations. As one nurse on the wards often liked to remind her patients, with this disease “even a paper cut is an emergency.” For an oncologist in training, too, leukemia represents a special incarnation of cancer. Its pace, its acuity, its breathtaking, inexorable arc of growth forces rapid, often drastic decisions; it is terrifying to experience, terrifying to observe, and terrifying to treat. The body invaded by leukemia is pushed to its brittle physiological limit—every system, heart, lung, blood, working at the knife-edge of its performance. The nurses filled me in on the gaps in the story. Blood tests performed by Carla’s doctor had revealed that her red cell count was critically low, less than a third of normal. Instead of normal white cells, her blood was packed with millions of large, malignant white cells—blasts, in the vocabulary of cancer. Her doctor, having finally stumbled upon the real diagnosis, had sent her to the Massachusetts General Hospital. In the long, bare hall outside Carla’s room, in the antiseptic gleam of the floor just mopped with diluted bleach, I ran through the list of tests that would be needed on her blood and mentally rehearsed the conversation I would have with her. There was, I noted ruefully, something rehearsed and robotic even about my sympathy. This was the tenth month of my “fellowship” in oncology—a two-year immersive medical program to train cancer specialists—and I felt as if I had gravitated to my lowest point. In those ten indescribably poignant and difficult months, dozens of patients in my care had died. I felt I was slowly becoming inured to the deaths and the desolation—vaccinated against the constant emotional brunt. There were seven such cancer fellows at this hospital. On paper, we seemed like a formidable force: graduates of five medical schools and four teaching hospitals, sixty-six years of medical and scientific training, and twelve postgraduate degrees among us. But none of those years or degrees could possibly have prepared us for this training program. Medical school, internship, and residency had been physically and emotionally grueling, but the first months of the fellowship flicked away those memories as if all of that had been child’s play, the kindergarten of medical training. Cancer was an all-consuming presence in our lives. It invaded our imaginations; it occupied our memories; it infiltrated every conversation, every thought. And if we, as physicians, found ourselves immersed in cancer, then our patients found their lives virtually obliterated by the disease. In Aleksandr Solzhenitsyn’s novel Cancer Ward, Pavel Nikolayevich Rusanov, a youthful Russian in his midforties, discovers that he has a tumor in his neck and is immediately whisked away into a cancer ward in some nameless hospital in the frigid north. The diagnosis of cancer—not the disease, but the mere stigma of its presence—becomes a death sentence for Rusanov. The illness strips him of his identity. It dresses him in a patient’s smock (a tragicomically cruel costume, no less blighting than a prisoner’s jumpsuit) and assumes absolute control of his actions. To be diagnosed with cancer, Rusanov discovers, is to enter a borderless medical gulag, a state even more invasive and paralyzing than the one that he has left behind. (Solzhenitsyn may have intended his absurdly totalitarian cancer hospital to parallel the absurdly totalitarian state outside it, yet when I once asked a woman with invasive cervical cancer about the parallel, she said sardonically, “Unfortunately, I did not need any metaphors to read the book. The cancer ward was my confining state, my prison.”) As a doctor learning to tend cancer patients, I had only a partial glimpse of this confinement. But even skirting its periphery, I could still feel its power—the dense, insistent gravitational tug that pulls everything and everyone into the orbit of cancer. A colleague, freshly out of his fellowship, pulled me aside on my first week to offer some advice. “It’s called an immersive training program,” he said, lowering his voice. “But by immersive, they really mean drowning. Don’t let it work its way into everything you do. Have a life outside the hospital. You’ll need it, or you’ll get swallowed.” But it was impossible not to be swallowed. In the parking lot of the hospital, a chilly, concrete box lit by neon floodlights, I spent the end of every evening after rounds in stunned incoherence, the car radio crackling vacantly in the background, as I compulsively tried to reconstruct the events of the day. The stories of my patients consumed me, and the decisions that I made haunted me. Was it worthwhile continuing yet another round of chemotherapy on a sixty-six-year-old pharmacist with lung cancer who had failed all other drugs? Was is better to try a tested and potent combination of drugs on a twenty-six-year-old woman with Hodgkin’s disease and risk losing her fertility, or to choose a more experimental combination that might spare it? Should a Spanish-speaking mother of three with colon cancer be enrolled in a new clinical trial when she can barely read the formal and inscrutable language of the consent forms? Immersed in the day-to-day management of cancer, I could only see the lives and fates of my patients played out in color-saturated detail, like a television with the contrast turned too high. I could not pan back from the screen. I knew instinctively that these experiences were part of a much larger battle against cancer, but its contours lay far outside my reach. I had a novice’s hunger for history, but also a novice’s inability to envision it. But as I emerged from the strange desolation of those two fellowship years, the questions about the larger story of cancer emerged with urgency: How old is cancer? What are the roots of our battle against this disease? Or, as patients often asked me: Where are we in the “war” on cancer? How did we get here? Is there an end? Can this war even be won? This book grew out of the attempt to answer these questions. I delved into the history of cancer to give shape to the shape-shifting illness that I was confronting. I used the past to explain the present. The isolation and rage of a thirty-six-year-old woman with stage III breast cancer had ancient echoes in Atossa, the Persian queen who swaddled her diseased breast in cloth to hide it and then, in a fit of nihilistic and prescient fury, possibly had a slave cut it off with a knife. A patient’s desire to amputate her stomach, ridden with cancer—“sparing nothing,” as she put it to me—carried the memory of the perfection-obsessed nineteenth-century surgeon William Halsted, who had chiseled away at cancer with larger and more disfiguring surgeries, all in the hopes that cutting more would mean curing more. Roiling underneath these medical, cultural, and metaphorical interceptions of cancer over the centuries was the biological understanding of the illness—an understanding that had morphed, often radically, from decade to decade. Cancer, we now know, is a disease caused by the uncontrolled growth of a single cell. This growth is unleashed by mutations—changes in DNA that specifically affect genes that incite unlimited cell growth. In a normal cell, powerful genetic circuits regulate cell division and cell death. In a cancer cell, these circuits have been broken, unleashing a cell that cannot stop growing. That this seemingly simple mechanism—cell growth without barriers—can lie at the heart of this grotesque and multifaceted illness is a testament to the unfathomable power of cell growth. Cell division allows us as organisms to grow, to adapt, to recover, to repair—to live. And distorted and unleashed, it allows cancer cells to grow, to flourish, to adapt, to recover, and to repair—to live at the cost of our living. Cancer cells can grow faster, adapt better. They are more perfect versions of ourselves. The secret to battling cancer, then, is to find means to prevent these mutations from occurring in susceptible cells, or to find means to eliminate the mutated cells without compromising normal growth. The conciseness of that statement belies the enormity of the task. Malignant growth and normal growth are so genetically intertwined that unbraiding the two might be one of the most significant scientific challenges faced by our species. Cancer is built into our genomes: the genes that unmoor normal cell division are not foreign to our bodies, but rather mutated, distorted versions of the very genes that perform vital cellular functions. And cancer is imprinted in our society: as we extend our life span as a species, we inevitably unleash malignant growth (mutations in cancer genes accumulate with aging; cancer is thus intrinsically related to age). If we seek immortality, then so, too, in a rather perverse sense, does the cancer cell. How, precisely, a future generation might learn to separate the entwined strands of normal growth from malignant growth remains a mystery. (“The universe,” the twentieth-century biologist J. B. S. Haldane liked to say, “is not only queerer than we suppose, but queerer than we can suppose”—and so is the trajectory of science.) But this much is certain: the story, however it plays out, will contain indelible kernels of the past. It will be a story of inventiveness, resilience, and perseverance against what one writer called the most “relentless and insidious enemy” among human diseases. But it will also be a story of hubris, arrogance, paternalism, misperception, false hope, and hype, all leveraged against an illness that was just three decades ago widely touted as being “curable” within a few years. In the bare hospital room ventilated by sterilized air, Carla was fighting her own war on cancer. When I arrived, she was sitting with peculiar calm on her bed, a schoolteacher jotting notes. (“But what notes?” she would later recall. “I just wrote and rewrote the same thoughts.”) Her mother, red-eyed and tearful, just off an overnight flight, burst into the room and then sat silently in a chair by the window, rocking forcefully. The din of activity around Carla had become almost a blur: nurses shuttling fluids in and out, interns donning masks and gowns, antibiotics being hung on IV poles to be dripped into her veins. I explained the situation as best I could. Her day ahead would be full of tests, a hurtle from one lab to another. I would draw a bone marrow sample. More tests would be run by pathologists. But the preliminary tests suggested that Carla had acute lymphoblastic leukemia. It is one of the most common forms of cancer in children, but rare in adults. And it is—I paused here for emphasis, lifting my eyes up—often curable. Curable. Carla nodded at that word, her eyes sharpening. Inevitable questions hung in the room: How curable? What were the chances that she would survive? How long would the treatment take? I laid out the odds. Once the diagnosis had been confirmed, chemotherapy would begin immediately and last more than one year. Her chances of being cured were about 30 percent, a little less than one in three. We spoke for an hour, perhaps longer. It was now nine thirty in the morning. The city below us had stirred fully awake. The door shut behind me as I left, and a whoosh of air blew me outward and sealed Carla in.

Editorial Reviews

“This volume should earn Mukherjee a rightful place alongside Carl Sagan, Stephen Jay Gould, and Stephen Hawking in the pantheon of our epoch's great explicators.”—Boston Globe