The Emperor of All Maladies [Paperback]

Cancer is an enormous subject: its influence on the history of medicine, on society, on politics... can't be over-estimated. Somebody was bound to take the risk of trying to capture all of this in one book. `I started off by imagining my project as a "history" of cancer. But it felt, inescapably, as if I were writing not about something but about someone. My subject daily morphed into something that resembled an individual - an enigmatic, if somewhat deranged, image in a mirror.' So Siddhartha Mukherjee, cancer physician and researcher, redefined his project: it became `a biography of cancer' - although `a thrilling piece of sublime literary non-fiction' captures the book just as well.

Mukherjee starts off the book on familiar ground: a woman being asked to return to the hospital as soon as possible, because something has shown up in the tests she underwent. This something is leukemia, a liquid cancer, and it catapults us back in time: to 1847, when the term leukemia was coined.
The first chapter is dedicated to the earliest known cases of cancer. We consider cancer a "modern" illness (and it is, because only in the last two centuries have we started to grow old enough for cancer to become the second most common cause of death) but there are some freakishly ancient occurrences. Atossa (550 > 475 BC), queen of Persia, had her breast cut off - a breast cancer that even made an army change direction. (I'm not going to explain this: it's one of the mesmerizing anecdotes you have to read for yourself.) And then there's the Peruvian mummy with a thousand year old preserved cancer. `It is hard to look at the [mummy] tumor and not come away with the feeling that one has encountered a powerful monster in its infancy', Mukherjee observes.
This same chapter also introduces one of the book's "heroes": the pediatric pathologist Sidney Farber, whose research produced the first-ever remission in a leukemia patient. He was the man who realised that, to get the funding for large-scale cancer research, the disease, any disease `needed to be marketed, just as a political campaign needed marketing. A disease needed to be transformed politically before it could be transformed scientifically.'

The second chapter, `An impatient war', focuses on a double war. First battlefield: the political struggle, the perception of science by politicians and the public. Second battlefield: the first attempts at chemotherapy, `near-complete devastation' of a patient, in an attempt to stamp out any trace of the evil.
In the subsequent chapters, Mukherjee writes about patients demanding visibility - as late as the 1950s, the New York Times refused to take an ad for a support group for women with breast cancer, claiming neither the word "breast" nor "cancer" were suitable for print - and a more humane form of care. About the influence of feminism and HIV on cancer treatments. About the slow process of finding the correlation between smoking and lung cancer and the even slower process of accepting this scientific fact.

Finally, we return to cellular level and learn more about the nature and origin of cancer. These last two chapters are a more difficult read, because the more one discovers about the workings of cancer, the more complex it all becomes.

In passing, we learn more about the working of DNA, about the medical definition of the word `cause', about the discovery of X-rays (first thought to be a cure for cancer, but turning out to be a major catalyst of the disease), and much, much more. The emperor of all maladies is an unputdownable piece of medical history, with breakthroughs, competition, pipe dreams and disappointments, Eureka!-moments and the odd incidence of deceit. Reading this book is a rewarding as well as a highly enjoyable experience: here is some excellent non-fiction, with elements of horror, adventure novel and science fiction. Muhkerjee's exploration of cancer - from a factual, historical, biological and poetic point of view - changes your way of thinking about the disease.

The struggle to understand and to cure cancer has consumed medical researchers throughout the twentieth and beginning of the twenty-first centuries. Mukherjee takes a deeply in-depth look at the illness throughout history in this biography of an illness, where cancer is often visualized as a crab scurrying and burrowing away from all reach of therapy. The author adds his own experience to a years-long study of cancer to provide a definitive, insightful book on the way this illness has gripped our modern day lives.

I think almost everyone I know has lost someone near and dear to them to cancer. I have; my brother died at only eighteen from non-Hodgkin's lymphoma. If anything, the fact that we've all been touched by this horrible illness in its many incarnations makes a book like The Emperor of All Maladies an even more important read. Reading this book was always going to be difficult, but it is on a subject I wanted to understand. After it won the Pulitzer Prize, and unending praise from many of my favorite bloggers, I simply had to read it, no matter how uncomfortable the subject matter.

I'm really glad I made that choice, because this book was excellent in so many ways. Mukherjee skilfully weaves together his own years treating cancer patients, ensuring that we get an up close and personal view of what it's like to fight cancer today, with a thorough history of the illness, including its ancient manifestations, early treatments, and continuing right up to the medicines and techniques used to treat various kinds of cancer today. I learned so much from this book, certainly things I never even thought about, like how the War on Cancer got started in the first place, what the Jimmy Fund is, and so on.

I'd also never really understood anything about the biology of cancer. I knew the disease was basically uncontrollable cell division, but Mukherjee goes into depth without becoming confusing or using any jargon that an ordinary reader can't understand.

While doing all this, he also succeeds in matching the struggle against cancer alongside current events, explaining how certain developments happened and why. I felt like I was getting the full story from all possible angles, which I so appreciated, and so thorough a look that I don't think I really need to read another book. Adding in the perspectives of his modern patients just demonstrated the strength of the human spirit and the difficulties of treatment.

This truly is a biography; in many ways Mukherjee makes cancer itself a visible part of the book. In many ways, it is our normal body functions turned inside out and made virulent - and immortal. It's a surprisingly fascinating read which has really enhanced my understanding of everything to do with cancer. I'd highly recommend The Emperor of All Maladies to almost anyone.

First, I have to declare an interest in the subject - I have been diagnosed with leukemia since 2003, have gone through five chemotherapy regimes and remission for me only seems to last months rather than years. However I am (morbidly) fascinated by the subject and here is a book written by a doctor and researcher in a plain English literary style that does not confuse the general reader with too many scientific names or jargon. Dr Mukherjee is certainly to be congratulated for producing such a lucid and understandable account of the disease. Starting from records of cancer in early history, the book concentrates on the developments of detecting and understanding cancer and its treatment, with special emphasis on the stirling work performed by Sid Farber after the Second World War and the rapid development of treatments to first try to control the disease, up until the last twenty years with the development of specialised monoclonal antibodies to actually target specific types of cancer.

The subject itself is fascinating with such topics as how discoveries of scrotal cancer among boy chimney sweeps in the 19th Century have led to the cause of lung cancer being convincingly stated in the 1950's and the adverse reaction this would have on the powerful tobacco industry. Everyone has probably heard of a "Pap-smear" but who knows where the word "Pap" originated? The book describes the work of George Papanicolaou, over many decades in developing the smear technique but only realised in 1950 that it could not detect cancer - but could find its precursor so allowing cervical cancer to be treated in a preventative manner before the disease took hold. There are far too many highlights to mention in this brief review. However, one particular item that makes this book stand head and shoulder above anything else are the human stories recounted, from the author's own diagnosis of his patient Carla with acute lymphoblastic leukemia and her successful treatment to the description of treatment that Maggie Jencks, a Scottish landscape artist, received for acute myeloid leukemia which she described as being woken up mid-flight on a jumbo-jet and thrown out of the plane with no parachute into a landscape without a map. The author does not overlook the experiences of the patients but keeps them prominently throughout the text.

This book really is a pleasure to read (macabre as that may sound), an unsentimental yet humane book of the worst of all diseases one might suffer.