Care or Cure?

By Andreyev, Jervoise | The Spectator, February 5, 2011 | Go to article overview

Care or Cure?


Andreyev, Jervoise, The Spectator


The Emperor of All Maladies: A Biography of Cancer

by Siddhartha Mukherjee

Fourth Estate, £25, pp. 571,

ISBN 9780007250912

Cancer is usually associated with death.

For the cancer specialist, however, cancer is more about life: not just patients' lives; the cancer itself often lives the life of Riley. If it has a life, then, it is entitled to a biography. Here, Siddhartha Mukherjee, an obviously compassionate oncologist, provides that biography.

The basis of any biography is the story.

In this book, there are four interwoven stories; that of people with cancer, full of fear, but increasingly often, surviving; that of scientists and doctors: stories of genius, per - severance, integrity, serendipity but also arrogance and fraud; the statistical story which tells us that the global burden of cancer doubled (thank you tobacco) in the last 25 years, 13 million people will be diagnosed this year but five million will survive and cancer specific death rates are falling by one per cent per year; and finally, the story of cancer itself, a major health burden after public hygiene measures eradicated infectious causes of death.

When cancer was first described almost four millennia ago, it had no name. Without a name, no one takes a disease seriously.

Two millenia pass, it was named karkinos , and now could be classified, initially by semi-religious concepts of invisible forces - imbalance in the red, green, white and black humours, later miasmas, neuroses, hysterias - wrong in detail, but right in that from the beginning, cancer often affects the whole body.

Sixteenth-century developments in anatomy, 18th-century understanding that cancer passed through developmental stages and 19th-century invention of anaesthesia and anti-sepsis were critical milestones permitting a century-long, surgically led assault.

Surgery carried out by master craftsmen, in their operating 'theatres', truly became a performance.

For inoperable tumours, 100 years ago radiotherapy became available; from the 1950s chemotherapy drugs emerged, indiscriminate inhibitors of cell growth with devastating effects on healthy and malignant tissues alike. Much too slowly oncologists started to understand that you need to combine systemic and local treatments to impact on cancer outcomes.

Yet it was the failure of these drugs even when combined with surgery and radiotherapy to improve death rates which led to the modern realisation that to achieve progress it was necessary to target the cause for cancer, namely, the accumulation of genetic defects in normal cells. The last 30 years has taught us that almost every individual cancer is genetically unique but they all contain a dozen or so critically transformed molecular pathways which virtually immortalise cells, empower them to ignore normal control signals and spread through the body. …

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