The Emperor of All Maladies: A Biography of Cancer

Nursing Book Club

The Emperor of All Maladies: A Biography of Cancer

Under his pen in what he rightly terms a biography, cancer takes on the dark role of the shape-shifting main character

By By Siddhartha Mukherjee (Scribner, 2010)
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Reviewed By Christine Contillo, RN, BSN

It takes a special talent to write well and accurately about science. It is even more surprising when the author can take the subject matter and hold your interest intently until the very last page. That is exactly what Siddhartha Mukherjee accomplishes with The Emperor of all Maladies. Under his pen in what he rightly terms a biography, cancer takes on the dark role of the shape-shifting main character. It is a thriller of the best sort, forcing you to continually turn the pages to see exactly what will happen next.

Mukherjee practices oncology and conducts cancer research as an assistant professor at Columbia University. In his notes, he writes that the 500+ page book began as a personal journal he kept during his advanced training at the Dana Farber Institute. As he explored his topic and expanded his vision, the journal evolved into a study of cancer as an entity — a disease that may have been first described centuries B.C. by the Egyptian physician Imhoptop. Centuries later Herodotus describes what is surely breast cancer in the Persian Queen Atossi.

Interspersed with stories from history are tales of the author’s own patients as he traces the beginnings of treatment from the brutal disfiguring surgeries first used to eradicate tumors to the targeted pharmaceutical agent used today. If you thought you understood cancer and all its forms, you will probably be surprised to find that there is so much more to know.

Sweeps and Smokers

Slowly the role of the environment and its interaction at the cellular level becomes apparent to those studying medicine and public health. Chimney sweeps in London had testicular cancer in great numbers, and less than 50 years later the rates of lung cancer in smokers began to increase dramatically. Surprisingly, the connection to lifestyle or diet is ignored by the greater health community which gives the author an opportunity to describe the link behind research funding and politics. Again the cast of characters is fascinating.

Finally, it’s genetics that opens up a new door for treatment options and as he says, that “the tools that we will use to battle cancer in the future will doubtless alter so dramatically in 50 years that the geography of cancer prevention and therapy might be unrecognizable.” Our comprehension of what cancer is has changed, and with it treatment options. This allows the author to place that afflicted Queen of Persia through the ages and describe alternatives to her early death.

The Emperor of all Maladies is a wonderful book — engaging, honest, personal and thorough. It forced me to look at my own health promotion activities and the way I teach the importance of lifestyle changes to my patients. At the risk of sounding whiny (and I’m sure that my genetics professor would concur if he could hear me now), the RNA discussion and its importance to cell evolution still continues to elude me, but I found every other page in this long book engaging. I looked forward to reaching for it every day and will welcome further writing from this author.


Christine Contillo, RN, BSN is a public health nurse who suggests joining a book club as a reason to put down trashy magazines and look smart on the subway.

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