Biography of Cancer — summary of a book
“Emperor of all Maladies: A Biography of Cancer” is a Pulitzer-winning non-fiction book by Siddhartha Mukherjee describing the evolution of the medical understanding of Cancer and various approaches to treating it. I’ve fallen in love with Mukherjee writing after reading his other book: Gene: An Intimate History. Besides being a great read to familiarize oneself with the topic, both of these books help understand how winding is the path from mystery to knowledge. Furthermore, both books are deeply personal as Mukherjee weaves in captivating and first-hand experiences. Altogether, this is a great read — both educational and entertaining.
The first, and most important narrative in the book, is that of cancer. In the recent decades, as people live healthier and longer, cancer has ascended to be the 2nd most frequent cause of death in the US and becomes increasingly common worldwide. It is a genetic disease, characterized by rapid and abnormal growth of mutated cells, which very often spreads and disrupts organs beyond the tissue it originally developed in. As Mukherjee states, cancer is very humane and evolutional, as, after its genesis, cancer continues to evolve faster than the normal human tissue and occupies the human body defying its normal ecosystem, much like humans, shortly after the birth of our species, started to dominate Earth and subjugated most of the planet for their needs.
Cancer is defined by essential changes in normal cells biology:
- cancer acquires an autonomous drive to grow and inactivates suppressor genes
- it disables pathways and genes that enable cells to die
- acquires the capacity to draw its own supply of blood and grow blood vessels around the malignant tissue
- acquires the capacity to migrate and colonize other organs
Most cancers are caused by multiple genetic mutations (and sometimes viruses). Typically mutations are rare, however, if a mutation accelerates cell division, or prevents a malformed cell from stopping to divide/clone itself, it increases the probability of further mutations. Some proteins produced in cancerous cells result in an additional draw of blood to the malignant tissue. More mutations block the natural defenses of organs against foreign cells, which results in the ability of cancer to spread beyond the originating body part. Natural body defenses against malignant mutations and cells, as well as the necessity for multiple mutations for cancer to proliferate, results in cancer becoming more frequent with age, since cells in our bodies can accumulate mutations over time.
Cancer is not just one disease. While it has a limited number of underlying mechanisms, it is many diseases, each requiring precise diagnosis and a personalized approach. There are cancers growing within the same organ, where the same treatment can completely cure or be absolutely fruitless.
Knowing this, the history of cancer treatment is scary in many ways. Lack of understanding of the underlying mechanisms of the disease has resulted in both misguided solutions affecting the lives of millions of people and desperate experimentation with bizarre approaches when million more human lives were sacrificed for the sake of progress. A number of surgeons in the late 19th century and the beginning of the 20th century practiced radical surgery to treat cancer patients. As cancer metastases into other organs, surgeons were encouraged to remove as much of the surrounding tissue (including muscles, bones, and unaffected organs) around the cancerous growth as possible. When chemotherapy showed promise, scientists seemed to try every known poison (and multiple combinations of poisons) as a cure — cancer is characterized by rapid growth, so anything that would stop cell growth/killed malignant cells was a step in the right direction. Doctors and scientists treated cancer for over 150 years without confidence in the underlying mechanism, and after the 1960s the scale of fruitless experimentation and depths involved hundreds of thousands of people.
While the biography of cancer is still evolving (being written), it proved once again how important fundamental research and science are for human progress. Fundamental research, an inquiry into the foundations of life, the universe, a search with no obvious application, is often undervalued as it is often impossible to write a business plan for it (and justify large investment which is often necessary). Genetics, Particle Physics, and Probability theory are some of the examples of such research. While cancer research has attracted large publicity and political attention, a large number of funds, hundreds of researchers, and millions of patients & lives under experimentation, the underlying mechanisms of cancer came no sooner than our understanding of genetics and methods of genetics research.