The Emperor Of All Maladies

Image of The Emperor Of All Maladies (Thorndike Biography)
Release Date: 
April 6, 2012
Publisher/Imprint: 
Thorndike Press
Pages: 
944
Reviewed by: 

Few books deftly yet thoroughly cover a wide range of topics in a single volume; The Emperor of All Maladies is undoubtedly one of these rare books. The topics in this articulate book progress from the earliest written records of cancer to the development of the newest targeted cancer chemotherapeutics. Sandwiched in between are such discussions on the seminal lawsuits against Big Tobacco, the development of the clinical trial process, the AIDS virus, and the author’s own valuable, often vulnerably so, clinical experience as an oncologist and researcher.

In addition, Dr. Mukherjee gracefully discusses the development of early chemotherapeutic agents, the first clinical trials, and the changing standards of surgical care for women with breast cancer. Paralleling the increasing importance of understanding cancer cell characterization in research, Dr. Mukherjee describes the discovery of the key cancer cell properties that many researchers may now take for granted. Critical connections and conclusions are carefully described, and each discovery is treated with care and respect. No part of this book is boring or dry; Dr. Mukherjee leads the reader through a masterful discussion using engaging, interesting language, which often borders on the poetic.

An important section of The Emperor of All Maladies unites the hallmarks of cancer, which were described in the now-classic paper “The Hallmarks of Cancer,” by Doug Hanahan and Robert Weinberg (Cell, 2000):

• Self-sufficiency in growth signals: Cancer cells survive by producing their own signals that tell them to keep growing and reproducing. • Insensitivity to growth-inhibitory signals: Cancer cells learn to ignore normal regulatory signals.

• Evasion of programmed cell death (apoptosis): Cancer cells are unable to “self-destruct,” in contrast to normal cells, which do so to avoid cancer, inflammation, and other unsavory ends.

• Limitless replicative potential: Cancer cells are literally immortal, given very basic growth conditions. Normal cells can only reproduce a limited number of times, but cancer cells can keep on reproducing.

• Sustained angiogenesis: Cancer cells can make blood vessels grow to reach them and therefore obtain food (glucose) and oxygen. Furthermore, these new blood vessels are very poorly disorganized and leaky.

• Tissue invasion and metastasis: Cancer cells can spill into the surrounding tissues (muscle, lymph nodes) and can also invade the blood stream and travel to distant sites in the body, or metastasize (lungs, brain, bone). Just as a cancer cell displays these key characteristics, the resulting tumor has serious implications on various aspects of the patient’s life.

Sociopsychologic, economic, and even political aspects are affected, and these factors are essential considerations for the patient and his or her family and team of health care professionals. Dr. Siddhartha Mukherjee is a gifted author, and every section and topic in this book is interesting, beautifully researched and referenced, and extremely compelling.

Every reader may benefit from reading The Emperor of All Maladies; readers will feel what can be imagined to be only a fraction of the pain and hope/hopelessness of cancer patients and their families, and will feel excitement, amazement, and respect at the lengths that cancer research has taken over the past few decades. Despite the frustration that cancer rates do not appear to have gone down compared to previous years, it is also important to note that the methods to detect cancers are improving, which can cause overestimation of cancer rates compared to past years.

Due to the increasing number of clinical tools and the advancing understanding of cancer development, clinical oncologists and researchers together will continue to improve the outcome of cancer patients. Dr. Mukherjee has brought these two fields together and forged an amazing, definitive, intelligent book.