The Emperor of All Maladies, A biography of cancer, reviewed

We look at The Emperor of All Maladies, A biography of cancer, by Siddhartha Mukherjee, see more about the book here. 

The Emperor of All Maladies, A biography of cancer, reviewed

Originally published in 2011, this updated version came out in 2025 with another 100 pages added to cover developments and new insights learned in the last 15 to 20 years. This book by Siddhartha Mukherjee is a labour of love, passion, sadness, frustration and rapidly, scrambling, evolving wisdom too. Cancer has risen over the centuries in terms of it’s ranking for the number of people it has killed. Once barely in the top ten, over time this has risen only higher and higher. In some ways this is a demonstration of humanity’s success in removing the mortality impact of other diseases which used to kill many more people. TB, dysentery, cholera, malaria, small pox and many other lethal diseases now kill less people due to improvements in sanitation, water quality and immunisation programs. Therefore, in one respect cancer is an indication of humanity’s progress, and also increasing longevity.

Previously many people had cancer, but died of other illnesses. Now, as we live longer, cancer has more time to grow, spread and become a greater killer. As Mukherjee is quick to highlight however, things are not quite that simple. As well as longevity enabling some cancers to come to the fore, there are other types of cancer emerging, which were not prevalent before. As we tug at the string from the complex ball of causes, triggers, environmental factors, it quickly becomes clear that cancer, while one word, covers a multitude of different types of cell mutation, attacks to the body, and types of progression. Mukherjee often expresses sadness and frustration at the number of times, as a practising cancer doctor, as well as a great documenter of the wider field, that he has had to answer patient’s questions with a reluctant, we don’t know why…

This book is well written as it takes the general reader on a journey with someone who has been close to the bleeding edge of innovations and developments. At the same time, there have also been periods of stagnation, interesting insights ridiculed by the wider community, or connections supposed, but without the tools to confirm theoretical breakthroughs. In this way cancer treatment has evolved in a stop start way. Declaring war on cancer, as Nixon did in the 70s was always going to be problematic approach. There have been some fantastic breakthroughs for some types of cancer, for some types of people. Some have then gone into remission for decades, and lived out longer lives than could have been hoped for. In other cases there have been temporary improvements, sometimes for three to nine months, before the symptoms return again, oftentimes causing the death of the patient.

As Mukherjee is only too aware, especially with the early forms of treatment, while the cure might have been a success, the survival of the patient was not always the case. Chemo was, and can still be, brutally harsh on the patient, treatments have improved, but it can radically vary depending on which type of cancer is being treated. Mukherjee also points out some interesting thought experiments in terms of identical twins, who take different paths in terms of dealing with breast cancer. These quickly point out some of the absurdities, or at least challenges when calculating mortality and cancer survival, or rather extended life expectancy, before succumbing to the disease. All of this is important and thought provoking. With a close family member who has survived two different types of cancer, and is now battling a third one, a book like this can helpful in a variety of ways.

In the conclusion to his book Mukherjee points out that, as cancer rates more beyond one in three, towards one in two, in is probably a case of when, not if. Therefore how we look at cancer, understand it, and approach it, will only become more and more important for all of us and those in our lives. This is a long book, but it is well worth the time spent reading it.

More about the book

In The Emperor of All Maladies, Siddhartha Mukherjee, doctor, researcher and award-winning science writer, examines cancer with a cellular biologist’s precision, a historian’s perspective, and a biographer’s passion. The result is an astonishingly lucid and eloquent chronicle of a disease humans have lived with – and perished from – for more than five thousand years.

The story of cancer is a story of human ingenuity, resilience and perseverance, but also of hubris, arrogance and misperception, all leveraged against a disease that, just three decades ago, was thought to be easily vanquished in an all-out ‘war against cancer’. Mukherjee recounts centuries of discoveries, setbacks, victories and deaths, told through the eyes of predecessors and peers, training their wits against an infinitely resourceful adversary.

From the Persian Queen Atossa, whose Greek slave cut off her malignant breast, to the nineteeth-century recipient of primitive radiation and chemotherapy and Mukherjee’s own leukemia patient, Carla, The Emperor of All Maladies is about the people who have soldiered through toxic, bruising, and draining regimes to survive and to increase the store of human knowledge.

Riveting and magesterial, The Emperor of All Maladies provides a fascinating glimpse into the future of cancer treatments and a brilliant new perspective on the way doctors, scientists, philosophers and lay people have observed and understood the human body for millennia.

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