The Emperor of All Maladies (2010) (edit title/settings)

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• William Stewart Halsted: A 19th century surgeon from Baltimore, Maryland. He pioneered the “radical” mastectomy, a method in which not only the tumor was removed, but a large amount of the surrounding and underlying tissue as well.
• Sidney Farber: Pioneer of modern chemotherapy. He was one of the first to use chemicals to kill cancer cells, focusing at first on leukemia in children. His cancer clinic at the Children’s Hospital in Boston was a true innovation. In the 1970s, Farber joined forces with Mary Lasker to lead a national “War on Cancer.”
• Mary Lasker: An influential fundraiser and health activist. Together with Sidney Farber, she assisted in the launch of the government-backed “War on Cancer” by providing essential energy, direction, and funding. She is the founder of the Lasker Foundation.
• Carla Reed: A young woman the author treated for Leukemia. Mukherjee describes her as a "thirty-year-old kindergarten teacher from Ipswich, Massachusetts, a mother of three young children."
• Robert Weinberg: A MIT cancer biologist who was one of the first to isolate oncogenes (a gene that has the potential to cause cancer) directly out of tumor cells.
• Emil Freireich: A National Cancer Institute researcher who, along with Emil Frei and Gordon Zubrod, was one of the first to performed combination chemotherapy trials on children with lymphoblastic leukemia.
• Howard Temin: A virologist from the California Institute of Technology who discovered reverse transcription, the mechanism by which some RNA viruses can transcribe their genetic material into a DNA copy and integrate this copy into the DNA of host organisms.
• Dennis Salmon: A UCLA oncologist and Chief of the division of Hematology-Oncology. He worked with Axel Ullrich to develop Herceptin, an antibody that targets the breast cancer–inducing Her- 2 gene. This drug was one of the first instances of targeted therapy in cancer.
• Jimmy: A young patient of Sydney Farber’s, he became the face behind the “Jimmy” Fund and aided in the creation of a new public interest in the battle against cancer. His real name was Einar Gustafson.
• Claudius Galen: A Greek physician and philosopher who practiced among Romans. He theorized that diseases were a result of an imbalance in the body’s four “humors.” Cancer and depression were a result of the excesses of black bile. Galen’s ideas influenced medical thought, rightly or wrongly, for centuries after his death.
• Brian Druker: A important researcher who aided the creation of Gleevec, a kinase inhibitor extremely effective in the treatment of chronic myelogenous leukemia.
• William Stewart Halsted: Great surgeon at John Hopkins in the 1890s. He was a pioneer and early proponent of the “radical” mastectomy. With this method, not only the tumor was removed, but a large amount of the surrounding and underlying tissue as well.
• Henry Kaplan: An American radiologist who pioneered in radiation therapy and radiobiology. He was among the first to study the use of extended field radiation to treat Hodgkin’s disease. Kaplan launched serial and comprehensive clinical trials using X-​​rays, which resulted in the cure of localized Hodgkin’s disease by the mid-​​1960s.
• Thad Dryja: Professor of Radiology at Stanford. He was an ophthalmologist-​​turned-​​geneticist who discovered the Rb gene with the help of researchers in Robert Weinberg’s lab.
• Henry Virchow: Independent German Researcher. In 1847 he changed the name to the more academic-sounding "leukemia"- from "leukos", the Greek word for "white"
• Bradford Hill: An English epidemiologist and statistician, pioneered the randomized clinical trial and, together with Richard Doll, was the first to demonstrate the connection between cigarette smoking and lung cancer. Hill is widely known for pioneering the "Bradford Hill" criteria for determining a causal association.
• Atossa: Persian/​Achaemenid queen who suddenly was struc by an unusual illness. She develops a mysterious mass in her breast that might have been inflammatory breast cancer. Daughter of Cyrus, and the wife of Darius. She is briefly mentioned in Herodotus’ Histories.
• Harold Varmus: A virologist who, working with Michael Bishop at UCSF, discovered that homologues of the src gene were present in all cells. Bishop and Varmus would thus advance the hypothesis that viral cancer-​​causing genes (viral oncogenes) were, in fact, derived from precursor genes (proto-​​oncogenes) present in all cells. He was awarded with Bishop the Nobel Prize for the discovery of the cellular origin of retroviral oncogenes in 1989.
• Geoffrey Keynes: A British surgeon, Keynes doubted Halsted’s method of radical mastectomy. Keynes used a combination of local surgery and radiation to treat breast cancer. He worked at St. Bartholomew's Hospital in London. He was the brother of John Maynard Keynes.
• Axel Ullrich: A German researcher at Genentech whose work led to the development of Herceptin, an antibody that targets the breast cancer–promoting Her-​​2 gene.
• Alfred Knudson: A Caltech-trained geneticist who proposed the “two-​​hit” model of tumor suppressor genes. Since tumor suppressors need to be inactivated and since two copies of each such gene exist in every cell, two independent mutations are required for the development of cancer.
• Martin Vogelstein: Physician at John Hopkins Medical School
• Paul Ehrlich: A German biologist and chemist who put forward the notion of specific affinity. The notion suggests that biological molecules work by virtue of binding other molecules with specificity. Ehrlich work by synthesizing chemicals with specific affinities for certain microbes, including those that cause sleeping sickness and syphilis. This discovery opened the door for later advances in chemotherapy. Ehrlich also coined the phrase “magic bullet” to describe specific cancer therapy. He was a medical student in Leipzig, 1878. He earned the Nobel Prize for his discovery of the principle of specific affinity.
• Evarts Graham: Pioneered an operation to remove a lung afflicted with cancer at Hospital in St. Louis. He also coauthor with Ernst Wynder of an important early study linking lung cancer and smoking. A long-​​time smoker, he died of lung cancer himself.
• John Bailar: With Elaine Smith, from Harvard, made improvements in analysis regarding survival rates
• Barbara Bradfield: A cancer survivor
• Vera Peters: Canadian surgeon who furthered Gilbert's studies by broadening the radiation field even farther- delivering X-rays not to a single swollen node.....
• John Bennett: Scottish Physician, 1845
• Gordon Zubrod: Director of the National Cancer Institute’s Clinical Center. Zubrod helped direct important early research for childhood leukemia.
• Charles Huggins: Born in Nova Scotia in 1901, attended Harvard Medical School in the early 1920s an traines as a general surgeon in Michigan. He became an urological surgeon and established a link between prostate cancer and testosterone. This laid the groundwork for hormonal therapy for breast and prostate cancer.
• George Papanicolaou: He was the inventor of the Pap smear, one of the first tests able to detect cancer in its earliest stages, where it could be excised with relatively simple surgery.
• Germaine Berne: Cancer patient at Baptist Hospital in Montgomery
• Ernst Wynder: An American epidemiology and public health researcher who, along with Evarts Graham, produced one of the first studies finding a correlation between smoking and lung cancer.
• Donald Pinkel: An American medical doctor who specializes in pediatric hematology and oncology. Protégé of Sidney Farber, Pinkel advanced leukemia chemotherapy by using combinations of drugs, X-​​ray therapy, and direct injection of chemotherapy into the spinal fluid to obtain striking response rates and cures in children.
• Baruch Blumberg: A biologist who discovered the hepatitis B virus, which proved to be a cause of liver cancer. This was one of the viral carcinogens that the NCI had fruitlessly searched for. He is the co-recipient of the 1976 Nobel Prize in Physiology or Medicine (with Daniel Carleton Gajdusek), and the President of the American Philosophical Society from 2005 until his death.
• Andreas Vesalius: An anatomist, physician, and author of one of the most influential books on human anatomy, De humani corporis fabrica (On the Fabric of the Human Body). Vesalius is often referred to as the founder of modern human anatomy. His detailed maps of the human body advanced medical understanding and challenged the Galenic theory that cancer was caused by black bile.
• Richard Doll: A British epidemiologist who became the foremost epidemiologist of the 20th century, turning the subject into a rigorous science. Doll, along with Bradford Hill, produced an influential study linking smoking and lung cancer. Doll and Hill devised the “prospective” study, in which a control and test population (e.g., smokers versus non smokers) is studied forward in time.
• Theodor Boveri: A German scientist and former assistant of Rudolf Virchow, he put forth a chromosomal theory of cancer, in which abnormalities in chromosomes caused normal cells to become malignant.
• Oscar Auerbach: An American lung pathologist famous for being one of the first to link cigarette smoking with cancer. Auerbach studied the progression of lung cancer through its various stages. His results suggested that cancer develops through multiple stages in a step-​​wise progression.
• Gregor Mendel: An Austrian scientist and Augustinian friar who gained posthumous fame as the founder of the new science of genetics. Mendel demonstrated that the inheritance of certain traits in pea plants follows particular patterns, now referred to as the laws of Mendelian inheritance. Although the significance of Mendel's work was not recognized until the turn of the 20th century, the independent rediscovery of these laws formed the foundation of the modern science of genetics.
• George Barney Crile: A surgeon who was one of the most fervent criticals of radical surgery. With the help of data from Geoffrey Keynes, cast doubt on Halsted’s theory of radical surgery. Crile found that local surgery, even without radiation, was just as effective as radical surgery.
• Marc Edell: The New Jersey attorney who plead Rose Cipollone’s Supreme Court case. Even though he only won a relatively small damage settlement, the case opened the door to very similar lawsuits and a settlement agreement between the cigarette manufacturers and forty-​​seven states.
• Sol Spiegelman: A Columbia University virologist who, inspired by Temin’s and Baltimore’s discovery of reverse transcription, launched an effort to find cancer-​​causing viruses in the 1970s. He developed the technique of nucleic acid hybridization, which helped to lay the groundwork for advances in recombinant DNA technology.
• Rose Cipollone: A lifelong smoker whose death from lung cancer urge forward a Supreme Court case over the liability of cigarette manufacturers. While her widower gained only a small settlement, the case opened the door for other lawsuits.
• Nick Lydon: Biochemist from Leeds
• Janet Rowley: An American human geneticist and the first scientist to identify a chromosomal translocation as the cause of leukemia and other cancers. She used chromosome staining techniques to discover that cancer cells often contain translocated chromosomes.
• Peyton Rous: A researcher at the Rockefeller Institute, New York, who discovered the first cancer-​​causing virus. His work laid part of the foundation for the modern genetic understanding of cancer. He focused in chicken virology. He was awarded the Nobel Prize for physiology and medicine in 1966.

Quotes edit see section history

• “Cell division allows us as organisms to grow, to adapt, to recover, to repair—to live.”

• “It was a project born of frustration. Virchow entered medicine in the early 1840s, when nearly every disease was attributed to the workings of some invisible force: miasmas, neuroses, bad humors, and hysterias.”

• “Science begins with counting. To understand a phenomenon, a scientist must first describe it; to describe it objectively, he must first measure it.”

• “Single-celled organisms such as bacteria would reveal the workings of massive, multicellular animals such as humans. What is true for E. coli <a microscopic bacterium>, the French biochemist Jacques Monod would grandly declare in 1954, must also be true for elephants.”

• “Cancer is an expansionist disease; it invades through tissues, sets up colonies in hostile landscapes, seeking “sanctuary” in one organ and then immigrating to another. It lives desperately, inventively, fiercely, territorially, cannily, and defensively—at times, as if teaching us how to survive.”

• “Perhaps there is only one cardinal sin: impatience. Because of impatience we were driven out of Paradise, because of impatience we cannot return.”

  Franz Kafka

• “Basic research is the pacemaker of technological progress. In the nineteenth century, Yankee mechanical ingenuity, building largely upon the basic discoveries of European scientists, could greatly advance the technical arts. Now the situation is different. A nation which depends upon others for its new basic scientific knowledge will be slow in its industrial progress and weak in its competitive position in world trade, regardless of its mechanical skill.””

• “A model is a lie that helps you see the truth.”

  Howard Skipper

• “She lost sleep, her hair, and her appetite and then something more important and ineffable—her animus, her drive, her will.”

• “Religious movements and cults are often founded on a tetrad of elements: a prophet, a prophecy, a book, and a revelation.”

• “How many of us have asked the question, ‘If this great country of ours can put a man on the moon why can’t we find a cure for cancer?’””

• “In science, ideology tends to corrupt; absolute ideology, <corrupts> absolutely.”

• “To enter the ward was to acquire automatic citizenship—as Susan Sontag might have put it—into the kingdom of the ill.”

  Susan Sontag

• “It is said that if you know your enemies and know yourself, you will not be imperiled in a hundred battles; if you do not know your enemies but do know yourself, you will win one and lose one; if you do not know your enemies nor yourself, you will be imperiled in every single battle.”

  Sun-Tzu

• “As Cairns had already pointed out, the only intervention ever known to reduce the aggregate mortality for a disease—any disease—at a population level was prevention.”

  Cairns

• “Terry had thus spent his childhood in the penumbra of tobacco and his academic life in the penumbra of cancer.”

• ““Multinational cigarette companies act as a vector that spreads disease and death throughout the world. This is largely because the tobacco industry uses its wealth to influence politicians to create a favourable environment to promote smoking. The industry does so by minimising restrictions on advertising and promotion and by preventing effective public policies for tobacco control such as high taxes, strong graphic warning labels on packets, smoke-free workplaces and public places, aggressive countermarketing media campaigns, and advertising bans. Unlike mosquitoes, another vector of worldwide disease, the tobacco companies quickly transfer the information and strategies they learn in one part of the world to others.””

• “Cancer therapy is like beating the dog with a stick to get rid of his fleas. —, Let Me Down Easy”

  Anna Deavere Smith

• “I do not wish to achieve immortality through my works. I wish to achieve immortality by not dying.”

  Woody Allen

• “Cancer is not a concentration camp, but it shares the quality of annihilation: it negates the possibility of life outside and beyond itself; it subsumes all living. The daily life of a patient becomes so intensely preoccupied with his or her illness that the world fades away.”

• ““Death in old age is inevitable, but death before old age is not.””

• ““There are far more good historians than there are good prophets,””

• “"Incremental advances can add up to transformative changes."”

• “"Src thus forcibly induced a cell to change its state from nondividing to dividing, ultimately inducing accelerated mitosis, the hallmark of cancer." pg. 359”

• “"In genetic terms, our cells were not sitting on the edge of of the abyss of cancer. They were dragged toward that abyss in graded, discrete steps." pg. 386.”

• “"Down to their innate molecular core, cancer cells are hyperactive, survival-endowed, scrappy, fecund, inventive copies of our ourselves." pg. 388”

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• civilization did not cause cancer, but by extending human life spans—civilization unveiled it.

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• Cancer, we now know, is a disease caused by the uncontrolled growth of a single cell. This growth is unleashed by mutations—changes in DNA that specifically affect genes that incite unlimited cell growth. In a normal cell, powerful genetic circuits regulate cell division and cell death. In a cancer cell, these circuits have been broken, unleashing a cell that cannot stop growing.

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• Cancer cells grow faster, adapt better. They are more perfect versions of ourselves.

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• Down to their innate molecular core, cancer cells are hyperactive, survival-endowed, scrappy, fecund, inventive copies of ourselves.

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• Cancer is an expansionist disease; it invades through tissues, sets up colonies in hostile landscapes, seeking “sanctuary” in one organ and then immigrating to another. It lives desperately, inventively, fiercely, territorially, cannily, and defensively—at times, as if teaching us how to survive. To confront cancer is to encounter a parallel species, one perhaps more adapted to survival than even we are.

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• Cancer thus exploits the fundamental logic of evolution unlike any other illness. If we, as a species, are the ultimate product of Darwinian selection, then so, too, is this incredible disease that lurks inside us.

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• Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of whom they know nothing. —Voltaire

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• “In God we trust,” he brusquely told a journalist. “All others [must] have data.”

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• Cancer is built into our genomes: the genes that unmoor normal cell division are not foreign to our bodies, but rather mutated, distorted versions of the very genes that perform vital cellular functions. And cancer is imprinted in our society: as we extend our life span as a species, we inevitably unleash malignant growth (mutations in cancer genes accumulate with aging; cancer is thus intrinsically related to age). If we seek immortality, then so, too, in a rather perverse sense, does the cancer cell.

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• This second version of the disease, called acute leukemia, came in two further subtypes, based on the type of cancer cell involved. Normal white cells in the blood can be broadly divided into two types of cells—myeloid cells or lymphoid cells. Acute myeloid leukemia (AML) was a cancer of the myeloid cells. Acute lymphoblastic leukemia (ALL) was cancer of immature lymphoid cells. (Cancers of more mature lymphoid cells are called lymphomas.)

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Setting & Locations edit see section history

• New York
• Boston
• America
• Washington
• London
• Europe
• Baltimore
• Chicago
• San Francisco
• United States
• England
• Germany
• Minot
• Bezwoda
• California
• Paris
• Houston
• St. Louis
• Massachusetts General Hospital
• Columbia
• Bethesda
• Texas
• Gleevec
• Memphis
• Children’s Hospital
• Berlin
• Philadelphia
• Basel
• Los Angeles
• New Jersey
• Stanford
• Memorial Hospital
• Framingham
• Bombay
• Africa
• Alabama
• Shanghai
• Johannesburg
• China
• Britain
• Harvard
• Egypt
• Vienna
• Herceptin
• Witwatersrand
• Frankfurt
• Hopkins

Organizations edit see section history

• The Jimmy Fund: Add a description of this organization.
• St. Jude's Children's Research Hospital

First Sentence edit see section history

Table of Contents edit see section history

Glossary edit see section history

• Acute lymphoblastic leukemia: a variant of white blood cell cancer that affects the lymphoid lineage of blood cells
• Acute myeloid leukemia: a variant of white blood cell cancer that affects the myeloid lineage of blood cells
• Apoptosis: the regulated process of cell death hat occurs in most cells, involving specific cascades of genes and proteins
• Carcinogen: a cancer-causing or cancer-inducing agent
• Chimeric gene: A gene created by the mixing together of two genes. A chimeric gene might be the product of a natural translocation, or might be engineered in the lab.
• Chromosome: a structure within a cell comprised of DNA and proteins that stores genetic information
• Cytotoxic: Cell-killing. Usually refers to chemotherapy that works by killing cells, particularly rapidly dividing cells.
• DNA: Deoxyribonucleic acid, a chemical that carries genetic information in all cellular organisms. It is usually present in the cell as two paired, complementary strands. Each strand is a chemical chain made up of four chemical units - abbreviated A, C, T, and G. Genes are carried in the form of a genetic "code" in the strand and the sequence is converted (transcribed) into RNA and then translated into proteins.
• Enzyme: a protein that accelerates a biochemical reaction
• Gene: a unit of inheritance, normally comprised of a stretch of DNA that codes for a protein or for an RNA chain (in special cases, genes might be carried in the RNA form)
• Genetic engineering: the capacity to manipulate genes in organisms to create new genes, or introduce genes into heterologous organisms (e.g. a human gene in a bacterial cell)
• Genome: the full complement of all genes within the organism
• Incidence: In epidemiology, the number (or fraction) of patients who are diagnosed with a disease in a given period of time. It differs from prevalence because incidence reflects the rate of new diagnosis.
• Kinase: a protein enzyme that attaches phosphate groups to other proteins
• Metastatic: cancer that has spread beyond its local site of origin
• Mitosis: the division of one cell to from two cells that occurs in most adult tissues of the body (as opposed to meiosis, which generates germ cells in the ovary and the testes)
• Mutation: An alteration in the chemical structure of DNA. Mutations can be silent - i.e., the change might not affect any function of the organism - or can result in a change in the function or structure of an organism.
• Neoplasm, neoplasia: an alternative name for cancer
• Oncogene: A cancer-causing or cancer-promoting gene. Activation or overexpression of a proto-oncogene (see below) promotes the transformation of a cell from normal to a cancer cell.
• Prevalence: in epidemiology, the number (or fraction) of affected patients in any given period of time.
• Primary prevention: prevention aimed at avoiding the development of a disease, typically by attacking the cause of the disease.
• Prospective trial: a trial in which a cohort of patients is followed forward in time (as opposed as retrospective, in which a cohort of patients is followed backward).
• Protein: A chemical comprised, at its core, of a chain of amino acids that is created when a gene is translated. Proteins carry out the bulk of cellular functions, including relaying signals, providing structural support, and accelerating biochemical reactions. Genes usually "work" by providing the blueprint for proteins (see DNA). Proteins can be modified chemically by the addition of small chemicals such as phosphates or sugars or lipids.
• Proto-oncogene: A precursor to an oncogene. Typically, proto-oncogenes are normal cellular genes that, when activated by mutation or overexpression, promote cancer. Proto-oncogenes typically code for proteins that are associated with cell growth and differentiation. Examples of proto-oncogenes include ras and myc.
• Randomized trial: a trial in which treatment and control groups are randomly assigned.
• Retrovirus: an RNA virus that keeps its genes in the form of RNA and is capable, by virtue of an enzyme, reverse transcriptase, to convert its genes from the RNA form into a DNA form.
• Reverse transcriptase: An enzyme that converts a chain of RNA into a chain of DNA. Reverse transcription is a property of retroviruses.
• RNA: Ribonucleic acid, a chemical that performs several functions in the cells, including acting as an "intermediate" message for a gene to become a protein. Certain viruses also use RNA, not DNA, to maintain their genes (see Retrovirus, above).
• Secondary prevention: Prevention strategies that are aimed at early detection of a disease, typically by screening asymptomatic men and women. Typically, secondary prevention strategies attack early, pre-symptomatic stages of the disease.
• Transfection: the introduction of DNA into a cell.
• Transgenic mice: mice in which a genetic change has been artificially introduced.
• Translocation (of a gene): the physical reattachment of a gene from one chromosome to another.
• Tumor suppressor gene (also called anti-oncogene): A gene that, when inactivated fully, promotes the progression of a cell into a cancer cell. Tumor suppressors usually protect a cell from one step on the progression toward cancer. When this gene is mutated to cause a loss or reduction in its function, the cell can progress to cancer. Typically, this occurs in combination with other genetic changes.
• Two-hit hypothesis: the notion that for tumor suppressor genes, both functionally intact copies of the gene must be inactivated in order for a cell to progress toward cancer.
• Virus: A microorganism that is incapable of reproducing by itself, but capable of creating progeny once it has infected a cell. Viruses come in diverse forms, including DNA viruses and RNA viruses. Viruses possess a core of either DNA or RNA, coated with proteins, and can be bound by an outer membrane made of lipids and proteins.

Series & Lists edit see section history

Authors & Contributors edit see section history

1. Siddhartha Mukherjee (Author)

First Edition edit see section history

Awards edit see section history

• Pulitzer Prize (April 2011: General Nonfiction)
• Publishers Weekly's Best Books of the Year (2010: Nonfiction)
• National Book Critics Circle Award (Finalist, 2010: General Nonfiction)
• Guardian First Book Award (Finalist, 2011, Longlist)
• Duff Cooper Prize (Finalist, 2011)

Classification edit see section history

• Library of Congress: Add the Library of Congress Classification.
• Dewey: 909

Notes for Parents edit see section history

Contains vivid descriptions of diseases and deaths.

Subjects edit see section history

• Books › Professional & Technical › Medical › Medicine › Internal Medicine › Oncology
• Books › History › Ancient › Early Civilization
• Books › Nonfiction › Social Sciences
• Books › Science › Biological Sciences › Biochemistry
• Books › Biographies & Memoirs › Professionals & Academics › Medical

Links to Supplemental Material edit see section history

• The Emperor of All Maladies: A Timeline of Cancer

More Books Like This edit see section history

Books with Additional Background Information edit see section history

Books Cited by This Book edit see section history