CANCER: Emperor of All Maladies
How many of you saw the television version of Cancer: Emperor of All Maladies? Hmmm. Well, let me tell those of you who didn’t see the documentary just a bit about it.
As you might know, both Valerie and Stacy, our only children, were caught in the web of cancer. Valerie was diagnosed with Ewing’s sarcoma, a bone cancer, at three and gone from us in 1976 at nine. Thirteen years after Valerie’s death, our surviving child, Stacy, at 25, was diagnosed with breast cancer and lost to us in 2001 when she was 37.
So, needless to say, I take umbrage with cancer.
But this post is not about our girls’ cancer at the time. It is about cancer over time.
And that brings us to Cancer: Emperor of All Maladies and the three-night special on PBS. The documentary, based on the Pulitzer prize-winning book by Mukherjee, an oncologist, researcher and author, was produced by Ken Burns, directed by Barak Goodman and shown on PBS from 3/30/2015 to 4/1/2015.
The film describes cancer from its very beginnings, around 400 BC, when the Greek word for the disease first arose: Karkinos, or crab.
Some have said the book is too long (it’s 470 pages plus acknowledgements, notes, glossary, photograph credits, selected bibliography and index!). It is long but it’s also very good and I liked it somewhat better than the film. Unlike an academic textbook, the language is clear and easily absorbed. It explains cancer through the doctors who worked in the field, from then to now, along with the accompanying research, the devastating failures and the remarkable breakthroughs. Interspersed throughout are the patients’ stories.
In 1898, for example, surgeons performed a distinctive type of radical breast cancer surgery: they cut deep into the chest, removed lymph nodes and enough other tissue so that the shoulder caved in making it impossible to move the arm forward or sideways. The process was terribly painful, miserably disfiguring and often fatal.
Over time, however, we’ve seen the changes. One specific development took place with the discovery of the gene Her-2 in a small subset of breast cancer. Soon after the discovery of Her-2 came the targeted drug Herceptin along with its ability to kill cancer cells. And that opened up the path to further achievement and successes for other types of breast cancer. Today, there is surgery, radiation, chemotherapy, hormonal therapy and various targeted therapies. Individually or in combination, they are likely to increase a person’s survival rate from approximately 17 to 30 years.
For childhood cancers, the survival rate has increased as well. There is now an over 80% chance of cure for ALL (acute lymphoblastic leukemia), Hodgkin’s disease and some large-cell aggressive lymphomas.
Progress has, indeed, been made.
Yet Mukherjee writes that this monstrous disease might be impossible to permanently erradicate since cancer has the ability for endless cell division. We know that cancer travels throughout the body; it assaults the various organs, damages the tissues and flouts countless drugs.
Still, toward the end of his last chapter Mukherjee gives us a credible way to look at this ancient adversary. He writes that cancer might not be cured but, instead, would be constrained by longer and longer remissions, through “treatment, resistance, recurrence and more treatment” (Mukherjee, 462). This would represent a different kind of win. No longer would it be an early death but instead a prolongation of life: in other words, death as it should be, in old age.
But let’s go further. It’s also possible that the scenario Mukherjee finally proposes is not quite right. After all, he’s talking about the future and we all know how the future changes with each passing year, or month or even a day. Today, we have in our labs (www.cinj.org/treatment/breast_oncology.html) a process which drills down to the tiniest details of molecular and genomic information personalized to each patient: it’s called precision medicine. So, perhaps there is a cure for cancer. I certainly want to believe that. Wouldn’t you?
I’m not fussy, though. I’ll take it either way, whether it’s Mukherjee’s reflections or my hopes.