The King Of Terrors

I had a little taste of terror when I opened the paper and saw the number of pages there. I was sure the book I reviewed was not "400 pages long".

Then I remembered a colleague had e-mailed The Star, to publish the details for Fourth Estate's edition of the book. The original review was based on a 571-page edition from Scribner (Simon & Schuster).

And I was so relieved to complete the review in the midst of a hectic week, I forgot to nominate a title and standfirst for The Star's overworked editors. Nor did I confirm whether Dr Mukherjee still holds all the posts listed in the profile. My bad.

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The king of terrors

The Emperor of All Maladies is written by a cancer specialist. It might be 400 pages long but it makes for very effective encouragement to live healthier.

first published in The Star, 27 February 2011


Sales of cigarettes in Malaysia still appear to be brisk, despite the redesigned packaging with the awful images of diseased lungs. As a better deterrent to smokers, may I recommend The Emperor of All Maladies? This book written by a cancer specialist might be 400 pages long but it makes for very effective encouragement to live healthier. I don’t smoke, so I’m changing my eating habits instead.

Why, of all the books written about the disease, read this one? Well, not only is it among the latest, it’s also written in an accessible way. Yes, it’s dry in places, with loads of medical jargon, history, and references to genetics, virology and such, but it is also, as the author notes, “a personal journey of my coming-of-age as an oncologist (a specialist on tumours and by extension, cancer).” This is what makes the book different.

For oncologist Dr Siddharta Mukherjee, associate professor of medicine at New York’s Columbia University and staff physician at the university’s medical centre, this book had modest beginnings. What started as just a journal grew into a more in-depth journey into the realm of cancer, and an attempt to answer some questions about it. When did it first appear, and when did the fight against cancer start? Is there an end? Can we win?

The story begins in 2004 when, behind the doors of a Massachusetts General Hospital ward, a leukaemia patient waits for the author – one of the patients we will read about that helps to give the disease a face. The disease is also profiled through a historical examination of some major cancers, including leukaemia (cancer of the blood), lymphoma, and cancers of the breast and lungs.

Among the many characters that appear, two are prominently featured: Sidney Farber, considered to be the father of modern chemotherapy, and Mary Lasker, a Manhattan socialite widowed by the illness she would spend her life fighting.

Ancient Egyptian wise man Imhotep (2667BCE-2648BCE) was the first to diagnose breast cancer, according to this book. The treatment? “There is none,” wrote the physician and part-time architect.

Since then, there have been numerous causes proposed as the cause of cancer, almost as many as the epithets it has been given, some of which demonstrate the hidden literary talents within the medical and scientific professions. An unnamed 19th century surgeon called it, rather poetically, “the emperor of all maladies, the king of terrors”.

Inspired by a revelation about how cancer starts in our bodies, one researcher compares it to Grendel in the 8th century Old English epic Beowulf – “a distorted version of our normal selves”. Why? “Cancer was intrinsically ‘loaded’ in our genome, awaiting activation,” the author laments. “We were destined to carry this fatal burden in our genes.”

It was also compared to a crab during the time of the “father of modern medicine”, Hippocrates (c 460BCE-c 370BCE): thick, with something that seems almost carapace-like, burrowing deep into the afflicted. That explains the seemingly unrelated crustacean on the cover of some editions of The Emperor of All Maladies.

After the discoveries, came the fight. But what and how much can one do against one’s own rebel genes?

Man’s hubris in this area is well-documented in the book, from Mary Lasker’s apparently quixotic anti-cancer campaign, to the tobacco lobby’s efforts in denying links between tobacco use and lung cancer.

The accounts about the latter will shock, given what we know today and how most people feel about corporate whitewashing. Within and without, it seems the human race is its own worst enemy.

The glimpses into the lives of cancer patients add some humanity into an otherwise weighty read.

Like the biography of someone still alive, there is no clear ending. Nor is there always a happy ending for patients. The last one profiled in this book dies, driving home the point about the terror of cancer.

Overall, the book is a good balance of the clinical and human. There aren’t enough books like this written about cancer, its myriad forms, the pain it inflicts, and the urgent need to end its scourge.

After the table of contents in The Emperor is this chilling note:

“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.”

Whoever it was that crowned cancer “the emperor of all maladies” had genius and foresight. No epithet is more suitable for this disease that marks our times.

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The Emperor of All Maladies

A Biography of Cancer

Siddhartha Mukherjee
Fourth Estate (2011)
400 pages
Non-fiction
ISBN: 978-0007367481