Siddhartha Mukherjee - The Emperor of All Maladies

The Emperor of all Maladies

A BIOGRAPHY OF CANCER

SIDDHARTHA MUKHERJEE

Copyright

Fourth Estate

An imprint of HarperCollins Publishers Ltd. 1 London Bridge Street London SE1 9GF

www.harpercollins.co.uk

Copyright © Siddhartha Mukherjee 2011

The right of Siddhartha Mukherjee to be identified as the author of this work has been asserted by him in accordance with the Copyright, Designs and Patents Act 1988

A catalogue record for this book is available from the British Library

All rights reserved under International and Pan-American Copyright Conventions. By payment of the required fees, you have been granted the non-exclusive, non-transferable right to access and read the text of this ebook on-screen. No part of this text may be reproduced, transmitted, down-loaded, decompiled, reverse engineered, or stored in or introduced into any information storage and retrieval system, in any form or by any means, whether electronic or mechanical, now known or hereinafter invented, without the express written permission of HarperCollins ebooks

HarperCollins Publishers has made every reasonable effort to ensure that any picture content and written content in this ebook has been included or removed in accordance with the contractual and technological constraints in operation at the time of publication

Source ISBN: 9780007250912

Ebook Edition © FEBRUARY 2011 ISBN: 9780007435814

Version: 2017-09-20

To ROBERT SANDLER (1945–1948), and to those who came before and after him.

Illness is the night-side of life, a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.

—Susan Sontag 1

Contents

Cover

Title Page The Emperor of all Maladies A BIOGRAPHY OF CANCER SIDDHARTHA MUKHERJEE

Copyright

Dedication To ROBERT SANDLER (1945–1948), and to those who came before and after him.

Epigraph Illness is the night-side of life, a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place. —Susan Sontag 1

Prologue

Part One - “Of blacke cholor, without boyling”

“A suppuration of blood”

“A monster more insatiable than the guillotine”

Farber’s Gauntlet

A Private Plague

Onkos

Vanishing Humors

“Remote Sympathy”

A Radical Idea

The Hard Tube and the Weak Light

Dyeing and Dying

Poisoning the Atmosphere

The Goodness of Show Business

The House That Jimmy Built

Part Two - An Impatient War

“They form a society”

“These new friends of chemotherapy”

“The butcher shop”

An Early Victory

Mice and Men

VAMP

An Anatomist’s Tumor

An Army on the March

The Cart and the Horse

“A moon shot for cancer”

Part Three - “Will you turn me out if I can’t get better?”

“In God we trust. All others [must] have data”

“The smiling oncologist”

Knowing the Enemy

Halsted’s Ashes

Counting Cancer

Part Four - Prevention Is the Cure

“Coffins of black”

The Emperor’s Nylon Stockings

“A thief in the night”

“A statement of warning”

Photographic Insert

“Curiouser and curiouser”

“A spider’s web”

STAMP

The Map and the Parachute

Part Five - “A Distorted Version of Our Normal Selves”

“A unitary cause”

Under the Lamps of Viruses

“The hunting of the sarc”

The Wind in the Trees

A Risky Prediction

The Hallmarks of Cancer

Part Six - The Fruits of Long Endeavors

“No one had labored in vain”

New Drugs for Old Cancers

A City of Strings

Drugs, Bodies, and Proof

A Four-Minute Mile

The Red Queen’s Race

Thirteen Mountains

Atossa’s War

Footnotes

Notes

Glossary

Selected Bibliography

Index

Acknowledgments

Author’s Note

About the Author

About the Publisher

In 2010, about six hundred thousand Americans, and more than 7 million humans around the world, will die of cancer. In the United States, one in three women and one in two men will develop cancer during their lifetime. A quarter of all American deaths, and about 15 percent of all deaths worldwide, will be attributed to cancer. In some nations, cancer will surpass heart disease to become the most common cause of death.

Prologue

Diseases desperate grown 2

By desperate appliance are relieved,

Or not at all.

—William Shakespeare, Hamlet

Cancer begins and ends with people 3. In the midst of scientific abstraction, it is sometimes possible to forget this one basic fact. . . . Doctors treat diseases, but they also treat people, and this precondition of their professional existence sometimes pulls them in two directions at once.

—June Goodfield

On the morning of May 19, 2004, Carla Reed, a thirty-year-old kindergarten teacher from Ipswich, Massachusetts, a mother of three young children, woke up in bed with a headache. “Not just any headache,” she would recall later, “but a sort of numbness in my head. The kind of numbness that instantly tells you that something is terribly wrong.”

Something had been terribly wrong for nearly a month. Late in April, Carla had discovered a few bruises on her back. They had suddenly appeared one morning, like strange stigmata, then grown and vanished over the next month, leaving large map-shaped marks on her back. Almost indiscernibly, her gums had begun to turn white. By early May, Carla, a vivacious, energetic woman accustomed to spending hours in the classroom chasing down five- and six-year-olds, could barely walk up a flight of stairs. Some mornings, exhausted and unable to stand up, she crawled down the hallways of her house on all fours to get from one room to another. She slept fitfully for twelve or fourteen hours a day, then woke up feeling so overwhelmingly tired that she needed to haul herself back to the couch again to sleep.

Carla and her husband saw a general physician and a nurse twice during those four weeks, but she returned each time with no tests and without a diagnosis. Ghostly pains appeared and disappeared in her bones. The doctor fumbled about for some explanation. Perhaps it was a migraine, she suggested, and asked Carla to try some aspirin. The aspirin simply worsened the bleeding in Carla’s white gums.

Outgoing, gregarious, and ebullient, Carla was more puzzled than worried about her waxing and waning illness. She had never been seriously ill in her life. The hospital was an abstract place for her; she had never met or consulted a medical specialist, let alone an oncologist. She imagined and concocted various causes to explain her symptoms—overwork, depression, dyspepsia, neuroses, insomnia. But in the end, something visceral arose inside her—a seventh sense—that told Carla something acute and catastrophic was brewing within her body.