The Emperor of All Maladies Book Summary - The Emperor of All Maladies Book explained in key points

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The Emperor of All Maladies summary

Name: The Emperor of All Maladies
Rating: 4.5 (94 reviews)
Author: Siddhartha Mukherjee

Siddhartha Mukherjee

A Biography of Cancer

4.5 (94 ratings)

22 mins

Table of Contents

The Emperor of All Maladies
summarized in 9 key ideas

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Key idea 1 of 9

What’s in it for me? Gain a fuller understanding of the greatest medical challenge of human history.

It’s highly likely that you or someone you know has been touched by cancer in some way. Though cancer and its many forms are more prevalent in our lives than ever, few of us have a solid understanding of the disease. Cancer is not a new phenomenon – descriptions of the illness date from as far back as Egypt in 2500 BCE. Since then, numerous theories have altered the way we look at cancer, ultimately leading us to what we know of it today. This book explains the two biological factors that make cancer cells so deadly. It reveals the internal processes and external agents that induce cancer. Moreover, it guides us through the milestone events in cancer treatment and research that point to the future of our battle with the disease.

In the following blinks, you’ll also learn

how eternal youth is actually a bad thing for our cells;
why young women’s jaws began to crumble after painting watches; and
how the unlikely team of a pathologist and a New York socialite changed the face of cancer research.

We’ve known about cancer since ancient times – but our understanding of it is very different today.

Ever heard the expression “balanced personality?” Today it might be a way to describe one of your level-headed friends, but around 400 BCE it was closely linked to the ideas of Hippocrates, the “Father of Medicine.” He was convinced that the human body was composed of four cardinal fluids or humors: Blood, phlegm, yellow bile, and black bile. When one of these fluids was out of balance with the other, then an illness or personality problem would result. For example, a short-tempered person would be diagnosed by Hippocrates as having an excess of yellow bile.

How does cancer fit into this four-part physical system? The first known theory of cancer held that tumors were caused by an entrapment of black bile. This understanding, first developed by Greco-Roman physician Galen in CE 160, informed mainstream theory about cancer for centuries.

But, because autopsies were forbidden for religious reasons, there was no opportunity to prove Galen’s theory until the sixteenth century. At this time, the physician Vesalius autopsied cancer-riddled corpses, and was surprised to find that neither the tumors nor the bodies contained black bile. The late eighteenth-century physician Baillie was equally unsuccessful in his investigation.

With Galen’s black bile theory refuted, many scientists turned to a substance that was both external to the body, and invisible. Until 1850, scientists suspected that parasitic and inscrutable poisonous vapors called miasmas led to tumors. Worms, fungal spores and protozoa were also thought to cause cancer. Scientists falsely believed they had found them after examining “cancerous tissues” under microscopes, and in 1926 physician Johannes Fibiger was even awarded the Nobel Prize for “proving” that roundworms cause stomach cancer (he was wrong!)

So humanity first thought cancer’s cause was located in the body’s own substance. Our second theory was concerned with external agents. But what do we think of cancer today?

Cancer develops from our own cells, but unlike normal cells, cancerous cells multiply endlessly and never die.

Today, the idea that cancer is caused by invisible miasmas that emerge out of nowhere seems a little absurd. That’s what pathologist Rudolf Virchow may have thought in 1840, when he decided to investigate cancer only using what he could view under a microscope. This approach laid the foundations of our modern understanding of cancer.

Virchow’s cellular theory explained that every cell arises from another existing cell. By investigating tumor tissue under a microscope, he discovered that it was in fact composed of a vast number of the body’s own cells. This is how he concluded that cancer tissue arises from and is made up of our own cells.

Certain chemicals not only cause cancer, but also prevent our body from fighting it.

In eighteenth-century Georgian England, scores of young boys were dying from an otherwise rare scrotal cancer. What exactly was going on?

The surgeon Percival Pott investigated the mysterious case of the disease-stricken boys and found that they were all chimney sweeps. From as young as four years old, these boys were forced to climb naked into narrow, sooty chimneys. As they sweated, the soot ran down to their scrotums, coating the skin and ultimately causing their sickness.

Infections increase the risk of cancerous mutations as our tissue attempts to recover itself.

What comes to mind when you think about infections? A runny nose, or that cough you always get at the start of winter?

In fact, not all infections are so benign – some of them can lead to cancer. This connection was first discovered in poultry, when chicken virologist Peyton Rous experimented with a rare chicken carcinoma. Transplanting these carcinoma cells into a healthy chicken, he found that they kickstarted tumors. Rous then prepared another piece of the tumor, filtering out all its cancerous cells and injecting it into healthy hens. Once again, these hens developed cancer.

Radiation, hormones and hereditary influences all increase your cancer risk.

Have you ever heard of the Radium Girls? No, they’re not a new pop band, but a group of young women in the 1910s who were employed to paint glow-in-the-dark watch dials using highly radioactive paint infused with radium. Unfortunately, this work proved lethal a few years later, when their jaws began to disintegrate and they suffered cancerous lesions of the mouth, neck and bones – worse, they developed leukemia.

Radiation was later scientifically proven to cause mutations that lead to cancer.

Since antiquity, cancer has been fought by surgical means, often with terrible consequences.

If cancer treatment today seems a complicated process, imagine trying to treat it back in 500 BCE! It was at this time that the proud Persian queen Atossa discovered a lump in her breast. Horrified, she locked herself away in her chambers, isolating herself from everyone but her beloved slave Democedes. He eventually convinced her to let him cut out the lump, thereby healing her.

In theory, what Democedes did matches the first of three approaches to fighting cancer with surgery. The first goal is to remove the primary tumor, and ideally before the cancer spreads to other areas of the body. If those cells have already spread and new tumors are forming, surgery can be used to hinder the cancer by removing those new tumors. Finally, surgery can also prevent cancer by removing tissues such as colon polyps and certain moles, before they become malignant.

Chemotherapy curbs the rapid replication of cancer cells.

Surgery is a vital tool in fighting cancer, but its use is still limited. It’s simply not possible to cut out blood cancers like leukemia or to eliminate all rapidly spreading tumor cells. In order to eliminate fast-growing cells that are elusive to the knife, we need chemotherapy.

The first thing to understand about chemotherapy is that it damages the parts of DNA that govern cell multiplication. It cuts off the growth of every cell in the affected population, but especially cancer cells, as they multiply the most and can’t repair DNA damage. In this way, chemotherapy attacks all cells, but normal cells will regenerate while cancer cells die.

When surgery and chemotherapy don’t work, radiation is the best option.

Remember the Radium Girls and their crumbling jaws, and how we found out that radiation can cause cancer? Well, surprisingly enough it can fight cancer too, for the same reason – radiation damages DNA.

So how exactly can we make use of radiation’s destructiveness? Radiation treatment uses highly controlled and intense rays to eradicate cancer cells that have spread over a limited area.

In the twentieth century, an unlikely couple joined forces to fight cancer.

In the 1940s, a pathologist named Sidney Farber was spending his days shut away in a small subterranean laboratory in Boston. Meanwhile, a woman named Mary Lasker lived the glittering life of a New York socialite and businesswoman. An unlikely couple to lead the fight against cancer, wouldn’t you say?

In 1947, Farber discovered that antifolates (which we heard about earlier) could be used to treat leukemia. Indeed, he is considered the father of modern chemotherapy.

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What is The Emperor of All Maladies about?

The Emperor of All Maladies is an informative look at the deadly disease that has affected millions. Cancer is one of the greatest challenges facing medical science today, and this book gives us a rare opportunity to learn about every aspect of it – its causes, its astonishing biological processes and our ever-changing fight against it, from the past to the present day.

Best quote from The Emperor of All Maladies

It is hard to look at the tumor and not come away with the feeling that one has encountered a powerful monster in its infancy.

—Siddhartha Mukherjee

Who should read The Emperor of All Maladies?

Anyone who has been diagnosed with cancer and wants a fuller picture of the illness
Anyone interested in the history of cancer therapy
Anyone interested in the biology of cancer

About the Author

Siddhartha Mukherjee is an Indian-born cancer physician and pioneering researcher. A Rhodes scholar, he graduated from the University of Oxford, Stanford University and Harvard Medical School, has published numerous scientific papers and is the recipient of the prestigious NIH Challenge Grant for his research on stem cells. The Emperor of All Maladies is his first book, and won several major awards in 2011, including the Pulitzer Prize for Nonfiction and the Guardian First Book Award. Recently, Mukherjee was awarded the Padma Shri – one of the highest civilian awards given the Indian government.

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