Biography of malignancy

In 1947, a Boston shipyard worker’s child fell sick. Examining the twoyear- old’s blood through the microscope, Sydney Farber, a city doctor, saw billions of malignant white cells “dividing in frenzy, their chromosomes condensing and uncondensing, like tiny clenched and unclenched fists.”

The child was suffering from leukaemia and by yearend he was near death.

Farber injected him with an experimental drug, aminopterin. In two weeks the kid was back on his feet. The drug gave temporary respite, but for Farber it was the beginning of a dream for what one researcher called “a penicillin for cancer.”

The Boston paediatrician plunged himself into cancer research and is today known as the father of chemotherapy. But Farber was not the only pioneer. In the 1950s, two other US physicians, Min Chiu Li and Roy Hertz, demonstrated that systemic chemotherapy could cure a widely malignant disease.

Chiu Li, in fact, lost his job at the National Cancer Institute for providing chemotherapy to patients whose symptoms had receded. This is among the interesting bits of information in Siddhartha Mukherjee’s The Emperor of All Maladies.

Mukherjee works at a cancer-treatment institute in Boston named after Farber and by his own admission began work on the book to relieve the stress of treating morbid patients. The book is at its most compelling in the story of how cancer research has progressed. Scenes from the early days of cancer diagnosis and treatment make for grim reading. For example, in the fifth century BC Persian Queen Atossa asked her Greek slave to cut off her malignant breast.

Doctors in 18th century England believed that chimney sweeps’ exposure to soot made them more likely to develop scrotal cancer. That was one of the first times a link was established between a carcinogen and cancer. But, as Mukherjee notes, well into the 20th century there was little understanding of cancer’s basic biology.

Doctors had only two treatment strategies: removing tumours surgically or incinerating them with radiation. It was only with Farber, Hertz and Chiu Li’s research that doctors began to understand that some cancers could be cured with chemicals.

Since the 1970s, the US has led cancer research, with the government pouring money into 20 major research centres, but Mukherjee shows a lot of the research in US labs draws on work in European Institutes.

For example, the Greek cytologist Georgios Papinikolaou did a lot of his early work on pap smear in Greece and Germany before moving to the US. The smear made it possible to catch cells at a pre-cancerous stage. Mukherjee emphasises why cancer treatment is dauntingly complex.

Those who study the causes of cancer in labs and those who treat it in the clinics do not always talk to each other. As Mukherjee puts it, “The two conversations occur in sealed and separate universes.”

Arpan Basu is a physician in New York

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