The Emperor of All Maladies: A Biography of Cancer

This Pulitzer prize winning expansive history of the disease(s) known as cancer is a pretty epic reading challenge, but well worth the effort. Mukherjee dives into his subject chronologically (from ancient and medieval treatises on the disease up through current genetic discoveries), thematically (by treatment -- surgery, radiation, chemotherapy, targeted agents; political advocacy and funding; research and clinical trials; prevention -- particularly in the context of anti-smoking campaigns), and personally with stories of his own medical training and experiences with cancer patients. The scope is so broad that you would think the approach would feel scattered, but Mukherjee has an ability to control the many threads of his narrative show more and dig deep into the background of individual researchers, discoveries, and treatments which grounds the reader in a narrative foundation and keeps the whole thing from running off the rails. As a breast cancer patient I was particularly fascinated with the history of the embrace and then rejection of ever more radical mastectomy surgeries, the dashed promise of scorched-earth chemo followed by a bone marrow transplant as a treatment for metastatic breast cancer, and the fascinating history of patient advocacy clashing (and then cooperating) with the pharmaceutical industry in the development of Herceptin, a wildly successful targeted treatment for Her-2 positive breast cancer. The book also helped me get my head around how clinical trials are designed and how the medical profession approaches oncology. And he FINALLY explained what kinases are and how they work in a way that clicked with my brain (as a person on her second flavor of a cyclin-dependent kinase inhibitor, this is news I could use). While his prose can sometimes be a bit florid and I didn't love every one of his patient characterizations, this was still a great read and I am very interested in reading his new book, The Song of the Cell. Human bodies are so complicated, and cancer uniquely harnesses this complexity to do its thing. Mukherjee really brings this all home in an understandable and comprehensive way. show less

I can only stand cancer in fiction to a very limited degree. Too many childhood memories of my grandmother on my mom’s side and the lung cancer and treatments that eventually killed her. However, nonfiction books about diseases interest me, and I figured that nonfiction might have more distance and be less emotional than fiction. I needed an audiobook to listen to while I worked, and this one was long enough to keep me occupied for quite a while.

Considering my requirements, the beginning of this book was not promising. Mukherjee started off with the story of a patient of his, Carla - her initial odd illness and eventual cancer diagnosis. This was not the emotional distance I was looking for, and I ended up connecting to this first show more portion of the book more personally and painfully than I expected to. Almost a year and a half ago, I was diagnosed with chronic hepatitis C, and this early bit about Carla reminded me strongly of sitting with my hepatitis doctor and discussing what that diagnosis meant and what my choices were.

Thankfully, although he continued to touch on Carla and other patients’ stories throughout the book, Mukherjee soon turned to the overall science and history of cancer. It was fascinating and often horrifying. Since I listened to the audiobook version and didn’t take more than a couple scribbled notes while I was listening, I can’t give too many details about the sorts of topics he covered. What I'll do instead is write about the things that stuck with me.

In the back of my mind, I think I had the idea that cancer was a modern disease. Mukherjee discussed many of the misconceptions people have about cancer, and this was one of them. Just because people didn’t have the vocabulary to discuss it didn’t mean it didn’t exist. And, just because we call all sorts of cancers “cancer” doesn’t mean they’re all one monolithic disease.

The sections on attempts to cure cancer were often cringe-inducing. Although Mukherjee wrote about cancer treatment history from a physician’s perspective, my mind kept interjecting “patient’s perspective” horror. Early mastectomies performed without anesthesia. Radical mastectomies that seemed like a contest between surgeons, to see who could successfully remove the most tissue (and, in some cases, bone). I had to stop the book a few times, so that the images in my mind could dissipate.

And none of those horrors even guaranteed that the patients would remain cancer-free. Mukherjee discussed the discoveries that allowed scientists to better understand various cancers and try to develop treatments that could destroy cancer cells more directly and, hopefully, cause less lasting damage to the patients. One of the things I marveled at was how interconnected diseases and their treatments can be. Lessons learned from the treatment of cancer were applied to the treatment of AIDS and hepatitis B. I remembered seeing some of those same connections when I researched the drugs I was going to be on to treat my hepatitis C.

It felt like Mukherjee covered some of just about everything related to cancer: its history, its science, its treatment, the people who studied it and raised money to research it, the politics surrounding it. For the most part, he explained things in a clear and easy-to-understand way, although I admit I got a little lost during some of the parts near the end on proteins and genetics. I was only really aware of how long the book was during the last three or so discs, which I felt dragged a little.

I’m not sure I could call this a reassuring read, but it was, overall, fascinating and incredibly informative.

(Original review, with read-alikes, posted on A Library Girl's Familiar Diversions.) show less

Amazing. A very tough subject, Mukherjee covers research for both cancer’s origins and its treatment. You’d think it would be a synergistic effort, but the history of cancer is full of fights, personality conflicts, larger than life egos, drive, dissapointment, grief and pain. Many decades have passed when doctors so singlemindedly focused on a cure that they dramatically cut or poisoned their patients, with a treatmeant meant to kill the cancer just before it killed the patient.

The biological cause of cancer was only discovered in the nineties, and even so, what we know is a general outline only. A series of mutations, each adding another ability to the cancer cell (growing, self-feeding, immortality, mobility, etc) is necessary show more for a cancer to develop, and each cancer is unique, with a unique combination of activated or deactivated genes and mutated genes. Targeted treatment has been developed for a few variants, but we still have a long way to go.

Mukherjee is an excellent writer. While much of the material is either harrowing or technically detailed, he manages to turn it all into an exciting page-turner, a story with turns and twists. I especially loved hus ability to bring both patients, doctors and researchers to life. Everyone had personality, anecdotal stories, and he himself brings a chock full of emotion to the story, taking one of his patients, Carla, through the story of her treatment, the stages of hope, despair, and remission.

I have listened on audio. Narrator Stephen Hoye was excellent. show less

Hmm. My friend told me earlier today that I wasn't gonna like Don Delillo because he was "more style than substance," or something like that. I can honestly say that I took one star off this book because it was more substance than style.

What I mean is, I liked this book a whole lot. Information frothed over the top of pages like high tide; I learned so much. I understood almost everything. The humanity of it all really burst through. But I also zoned out some parts of the book, mostly because the writing was so clear, so straightforward, that I just got lost in the history and the science and couldn’t help but gaze down at the page numbers, flip through to see when the next chapter was coming up, then return wearily to the passage show more I’d found a tad tiresome.

The writing was so clear. It was too clear. The author (who I must say is some divine all-powerful creature, regardless of my momentary criticism) took the tons of research he’d complied and fitted it into a writing canvas that riveted at times, but also seemed repetitive at others. I can’t really blame him that much though, because the history of cancer IS quite repetitive: Scientist sees cancer, scientist studies cancer, scientist thinks of solution, scientist experiments with solution, solution becomes universal, etc. Obviously with some exceptions.

I loved the human anecdotes sprayed throughout. I loved the ending. I loved the tone. This book is so important. I’m basically bound to get cancer someday, I think, with my family history, my perpetual sunburns, my Ashkenazi Jewness. I remember I used to fret about the disease back in middle school ever since this boy a grade above me died from brain cancer. The thought of it haunted me for a while, and there was a period where I’d just walk up to my mom and tell her I felt scared. At least now I know that cancer is not entirely a mystery, and that we’re on the road to uncover the part that remains so. show less

The book starts out rooted firmly in the human experience, told through the stories of patients, doctors, and discoverers from the ancients up through the modern era. I found these stories fascinating and often incredibly sad; I could relate to them. Around the 1960s the book shifts into a more technical vein, which makes sense because this is when so many innovations in cancer research and treatment began, but I found myself disengaging from the story. The author does a laudable job of keeping the human experience a part of the story, but this is a biography of cancer - not humans - and at some point the story becomes less about "us" and more about "it". Or rather, "them", because one of the most fascinating parts of the book was show more seeing how heterogenous cancer is in the human body. Lymphomas are completely different from breast cancer, which is completely different from sarcoma, etc. I truly had no idea.

Also fascinating was how breast cancer was the focus of cancer research for literally hundreds of years. This seems like a woman-positive situation until you discover the devastating surgeries and experiments that doctors inflicted on the female body. Would they have been so quick to carve out literal pounds of flesh if these were male bodies? Would male patients have had more authority over their own care, and been fully informed about what was about to be done to their bodies? Kudos to the author for explicitly calling out the medical industry on its historically cavalier treatment of women, and acknowledging the women of the 1970s who refused to be sidelined in their own treatment, and thus forged the patients' rights movement out of the second-wave feminist movement. show less

Summary: A biography of the disease, our understanding of its nature, and approaches to treating it.

Excuse my bluntness. Cancer sucks. I’ve watched friends and beloved relatives die cruel deaths from it. The survivors I know, including those in my own family, while grateful to be alive, bear the marks of their experience. The fear of recurrence is never far away. I’ve had my own brushes with cancer with skin lesions and precancerous polyps. Early detection and treatment made these just brushes. The truth is, all of us will have some form cancer or know someone close to us who does. And for anyone with a serious cancer diagnosis, life changes irrevocably on the day they receive that diagnosis.

The marvel of Siddhartha Mukherjee’s show more The Emperor of All Maladies is to write beautifully, elegantly, clearly, and honestly about this ugly fearsome disease. The title recognizes the powerful adversary cancer is. It arises when the normal cellular mechanisms that check growth and multiplication go haywire. Also, additional changes allow it to spread and resist our own defenses as well as external agents.

Mukherjee also calls this a biography of cancer. He chronicles a four thousand year history of the disease from the Egyptian physician Imhotep, who first described it to the Persian Queen Atossa, who had a slave remove a breast to fight breast cancer in 440 BC, futilely as it turned out because the cancer had spread. He traces that history down to the present discussing both our slowly growing understanding of the disease and key figures in the history of its treatment. Mukherjee also personalizes it with Carla, one of his patients, whose journey he traces at various points of the book.

He begins with when cancer was thought to be “black bile.” Yet doctors found no such substance, even in cadavers. Early on, a cancer diagnosis simply was a death sentence. Apart from quack remedies, there was no treatment. Only palliative care was possible. With the advent of antiseptic measures, surgeries were used to remove cancers, such as William Halsted’s radical mastectomies, often quite extensive and disfiguring. But quickly, doctors learned that if cancer was not local, surgery was futile. Another blunt instrument was radiation, again effective with local cancers (although it could also cause cancer).

Mukherjee introduces us to Sidney Farber, who moved from the laboratory to the clinic to fight childhood leukemia and other cancers. Antifolates and other early chemotherapies extended the lives of children. Farber teamed up with Mary Lasker to lead an effort to secure funding for research into other chemotherapies. They created the Jimmy Fund, named after a young boy, Einar Gusfson, with leukemia who was dubbed “Jimmy.” A baseball fan, he won the hearts of Boston’s baseball teams, and money poured in.

From the 1950’s to the 1970’s, Mukherjee chronicles burgeoning, hubristic efforts to win the “war on cancer” with chemotherapy. More and more extreme combinations of drugs resulted in both victories and a lot of failures. But something was missing. While throwing all these therapies at cancer, clinicians gave little time to understanding how cancer worked. Not only that, but those who researched the cellular mechanisms of cancer weren’t talking to the clinicians who treated it.

Then, beginning in the 1980’s, there was an explosion in understanding the nature of cancer, and the genetic mechanisms behind its uncontrolled multiplication and spread. Just as the human genome has been sequenced, so are cancer genomes, tracing pathways by which normal cells turn cancerous. This has been accompanied by advances in both prevention and therapeutics, including identifications of mutations like the BRCA gene that leads to some breast cancers.

Since 2010, there have been an avalanche of advances in cancer biology, prevention, and treatment. So in 2025, Mukherjee released an updated edition of the book with four new chapters detailing these advances.

Despite the heartbreaks and latent fears I’ve known, I found Mukherjee’s account fascinating. Mukherjee weaves into the history and the science real people, both those who die and those who survive. His book stands as a warning against hubris in announcing “cures for cancer.” He helps us understand why cancer is such a difficult to conquer emperor and what has been and is being done. He reflects the realistic hope of every cancer survivor who speaks, not of cures, but of “no evidence of disease” that allows one to live another day. Mukherjee also reminds us of the army of people working to prevent cancer and treat it, not giving up on conquering the emperor. show less

I've had this on my tbr since before my 3 year old was diagnosed with cancer. I'm glad I waited to read this till I was on the other side of her treatment.
This is an immense chronicle of what we know of cancer and how it's been treated over the decades. It's crazy that we haven't improved cancer treatment in any meaningful way since chemotherapy regimens were first discovered. The cocktail of drugs they started with is largely what was used in 2020.
I hate that new drugs targeting more specific cancers aren't funded because they aren't profitable. We experienced a shortage of a vital drug due to it not remaining profitable during her treatment. For profit healthcare is evil.
Despite pediatric cancer receiving very little funding, it was a show more large focus of this book. I am thankful for all the oncologists and patients who have come before. As the Green brothers have just said, this is the best time in history to be diagnosed with cancer. Though a year from now would be better. (John & Hank Green). show less