The Emperor of All Maladies

1

Mukherjee stated that the first known breast cancer patient was the Persian Queen Atossa in 500BC. She received the most primitive form of mastectomy by her Greek slave. In 2500 BC, the cancer had another name, but there was no treatment. However, someone could perform a primitive form of surgery 2000 years after the first discovery of cancer. Two hundred years later, Hippocrates called cancer by the Latin name “karkinos.” In AD 168, Claudius Galen hypothesized the cause of cancer to be black bile. In 1778, John Hunter’s clinic in London figured out that Queen Atossa had localized breast cancer. Cancer has changed name and treatments throughout history. In 1986, BRCA-1 and BRCA-2 mutations were found from Atossa’s cancer. Cancer treatment has been improving and death rates from cancer had been reduced. However, still the best treatment is surgery if the cancer does not metastasize. In the future, Cancer-gene analysis and customized treatments will be available. However, most cancer is considered sporadic. People did not inherit cancer-causing mutations from their parents. Instead, cells in our body develop mutations and lead to cancer. These mutations can be caused by sun, radiation, chemicals or random events within the cell. Therefore, the fight for cancer will be continue forever as long as cancer exists. In other way, Mukherjee said that we are successful in the focus on prolonging life rather than eliminating death. He is optimistic about modern cancer treatments because they prolong cancer patients’ lives longer than in the past.

2

A biography is a detailed description or account of someone's life. It includes a history of one’s entire life and his most outstanding achievements. This book describes the history of cancer through the lens of Mukherjee’s eyes- a biography of cancer and the stories of cancer patients who suffered primitive treatments, advanced chemotherapy, or survived from cancer and radical treatments. The Emperor of All Maladies is a “biography of cancer.” According to this book, the first cancer was diagnosed in 1990 by a paleopathologist who found cancer marks from a Peruvian mummy. The first form of chemotherapy was developed from textile dyes and saved many cancer patients at that time. Now doctors could tell to the patients, “Your cancer can be treated.” Discovery of new treatments or causes of cancer might be small, but they can add up to transformative changes. Cholera, Asthma, and AIDS are diseases that also have biographies of their own.

3

When we look at the history of cancer causes or treatments, we can see that history does repeat itself. First, a scientist figured out that Atossa’s illness was that a swelling appeared on her breast that continued to spread and proliferated until a swelling was cut out by a knife. She had breast cancer in 500BC. Her cancer appeared and reappeared in one generation after the next. Her cancer has been moving through history because her tumor was frozen in its stage and remained the same now. Atossa’s case reminds us about the past and modern practice of cancer therapy as well as the future. Cancer happened in history and is happening in the present. Cancer comes into human lives again and again without exception. I cannot accept that something happens again and again without exception and it does it the exact same as the time before. Our medical technology has been changing and it can never be exactly like the previous time. The date, the time and the things involved are always changing. But complete banishing cancer is only one way that it is to be cut them off. If we cannot cut them off completely, cancer comes back in the past and now, maybe in future, too. We have to relive the past in order to move forward in the present, and achieve a solution in the future.

4.

We know now that all cancers are not the same. In the past, cancer had no treatments and it means that all cancer patients had to die. It is a reason why we tend to make a strong connection between cancer and death. Now, as long as we find them in its early stage, cancers are curable. “The War on Cancer” had so many sad stories about cancer patients. We all know that cancer causes death in general ignoring all of the medical scientists’ efforts because we don’t know exactly where cancer comes from. Determining what causes cancer is multifaceted challenge. All I know are the risk of cancer, including tobacco use, certain viruses, radiation, and damaged genes. Can we blame our ancestors because five to ten percent of cancers are entirely hereditary? Mukherjee points out those cancers are the most brutal of problems because mutated cells grow without normal regulation. and that it is the body’s own resources turned against us.

Early treatments focused on radical excision and chemotherapy. Doctors hoped to kill the cancer before it killed the patient. Chemotherapy has improved a lot within the last fifty years, and it has helped prolong the lifespan of cancer patients. Cancer survival rate has increased statistically. But I wonder whether scientists can also give cancer patients a productive lifestyle.

Rejected flies turn to booze

Fourth set of questions

1. in the final chapter of the book, the author creates a fictional journey for Queen Atossa through time to demonstrate how cancer treatment has changed over the centuries. How might you have summarized this book? What image or metaphor, emerges most powerfully at the end of this book?

2. The author calls this book a biography. Can a biography be written of an illness? Are there other diseases that demand biographies?

3. IN what sense does history "repeat itself" in cancer research? In science, where new discoveries keep altering the landscape, what is the worth of reliving the past?

4. At the end of the book do you come away with optimism about science's efforts to combat cancer? Why or why not?

The Emperor of All Maladies

1.

So many of the scientific breakthroughs have impacted cancer research such as Wilhelm Röntgen's discovery of the X-Ray in 1895, and it occurred by accident as well as folic acid discovery. Sidney Farber thought that anemia is deficiency of red blood cells because of lack of iron. Farber investigated the way of treating anemia with various things. Farber had been working for vitamins and bone marrow. Lucy Wills found that folic acid could help the blood in malnourished patients. Farber started to think the same thing with leukemia. However, folic acid actually accelerated the progression of leukemia. Then he happened to think about that maybe an "anti-folate" could work something to stop the growth of white blood cells. Folic acid, discovered in 1941 in green leafy vegetables, derives its name from the Latin word for leaf, folium. It was called folacin or folate, too. Folic acid is important in preventing spina bifida, so it prevents birth defects of the neural tube. Pregnant women are recommended to take folic acid during their pregnancy. He thought about “anti-folate” as anti-cancer treatment. It is just miracle.

2.

The war on cancer is successful. In the past, people didn’t want to face the cancer, especially a breast cancer. As a result, women had to suffer a lot. Now women don’t need to die for the breast cancer. 1969, Dr. Sidney Farber, past President of the American Cancer Society, stated “We are so close to a cure for cancer. We lack only the will and the kind of money and comprehensive planning that went into putting a man on the moon.”

President Richard M. Nixon signed for the National Cancer Act on December 23, 1971. The law earmarked $1.5 million for cancer research over a 3-year period. Now we understand the biological and molecular bases of cancer including cancer genes. Cancer-related mortality rates have declined such as lung, breast, colon, and prostate cancer. We are winner!!!

3.

The 1980 Canadian mammography trial was possibly faulty because technicians disproportionately chose women who might have breast cancer for mammograms, likely out of concern. It means that some patients who have cancer could not get mammograms. I could not believe that it happened just 30 years ago.

4.

Multi-pronged chemotherapy, radiation, and surgery are modern treatments for cancer. Now preventative care is an important method to fight back to cancer. But it is a long journey to reach this point of treatment. This book tells me that the history of science to fight against cancer. Everybody hopes to go over cancer and survive. Nelene Fox was refused in 1991 to get pay for an expensive bone marrow transplant to treat her diagnosis of advanced breast cancer. Honestly speaking, advanced cancer has nothing to do even though by modern technologies. One of my friends spent over $200,000 to save her husband as the doctors promised her to save him. It is impossible to save anyone from the advanced cancer. So I feel that the doctors ripped off her for money. She should use all money to have wonderful time with her husband until he passed away. Any experimental treatments would not to extend survival if the cancer is advanced stages.

3rd set of questions

1. So many of the scientific breakthrough that impacted cancer research such as the discovery of X-rays occurred by accident. What other chance discoveries appear in the text.

2. Was the war on cancer a failure? why or why not?

3. The 1980 Canadian mammography trail was possibly flawed because technicians steered women with suspected breast cancer to get mammograms, likely out of compassion. Put yourself in the technician's lab coat. Would you have allocated your friend to the mammogram group? If so, how can trials ever be randomized?

4. Review the case of Nelene Fox. In your view was it appropriate for the HMO to refuse to pay for the expensive bone marrow transplant?

The AEmperor of All Maladies

3 In the 1950s, people were terrified of cancer and did not want to talk about let alone face them. The New York Times refused to print the word “cancer” or “breast” for advertisement of cancer support-group. People have been terrified of cancer even though heart disease kills more people than cancer. In 1958, Science Digest reported that there were 450,000 new cases of cancer diagnosed each year and seven hundred thousand cases of cancer were being treated in America. In 1958, according to Patterns of Disease, one woman in four under the age of thirty-five could expect to get cancer, and one in seven would die from it; one man in five under the age of fifty would be afflicted, and one in eight would die. People tend to connect cancer to death immediately because cancers come out again and again after the doctors treated them. It is like the dead people come out again from the grave and eat people’s lives. I think that people’s feeling towards cancer and zombies are same. In 1950s, many doctors believed that cancer was not curable. Now people started to believe that cancer is curable. However, cancer’s nature of proliferation and invasion of nearby tissue in the body still scares people. Today, doctors and scientists believe that cancer is a genetic disease. For instance BRCA 1 and BRCA 2 genes cause breast cancer. In the future, people go to the oncologist’s clinic to check cancer genome for early prevention of these dreadful diseases.

4 Sidney Farber used anti-folate for leukemia treatment in 1947. Dr. Faber utilized folate analogues, which are chemical compounds that should reduce the growth of leukemia cells, and he tested his anti-folates on leukemia patients. It was a new treatment and first used by Sidney Farber to treat acute childhood leukemia. This finding encouraged other researchers to discover drugs that blocked different functions involved in cell growth and replication. This is the era of chemotherapy history. Siddhartha Mukherjee explains, “cancer as not one but many diseases.”

Sidney Farber devoted his life to save his cancer patients. He predicted that folic acid antagonists would inhibit or stop the proliferation of cancer cells. His research was used to find other chemotherapeutic agents. Under his influence and leadership, he founded the “Jimmy Fund”, which was one of the first comprehensive pediatric oncology treatment center, and the Children’s Cancer Research Foundation. Later this foundation became the Dana-Farber Cancer Institute.

5

Min Chiu Li was accused of using his patients for his experiments. He was not an American, but Chinese. So he was called an outsider. I feel that there are some cultural differences between Chinese and American. American people tend to put value about people’s feelings. Chiu Li had been studying cancer, therefore he knew the nature of recurrent cancer and he could recognize the sign of life for them. He cared about numbers and obsessed over the number “0” in order to reach an hcg level of 0. Therefore, he continued to treat chemotherapy drugs long after the patient looked well. It looked cold and heartless to care more about numbers for some doctors. I understand them because chemotherapy is horrible toxins to the body. Min Chiu Li lost his job for that, but he turned out to be right. Any trace of cancer was detected by indicators such as hcg level, where cancer relapsed some months later. What is worse, this relapse becomes more resistant to chemotherapy. When I had herpies because of stress, some American people believes that HIV causes these diseases. In Japan, it is very common in hihgly stressed people. I had to do many tests to prove that I did not have HIV. When I took medication, one doctor told me that if I took excess of drugs, I didn’t have any side-effects of disease like headache. I did not want to have a headache, so I took excess of medicines to fight back to this virus even through this doctor was reluctant to give me excess medications because of ethical issues. As a result, I am headache free my entire my life. So many people complain headache after this disease. Sometimes we need to take a risk to fight back against diseases. It is very difficult to deal with human bodies because we have exceptionally complicated bodies.

Cannibalistic cancer?

Cannibalistic cancer?

Cancer’s got a new enemy—drugs that block autophagy, the process of cellular cannibalism that is increased in many cancer cells. Presenting at AAAS, Ravi K. Amaravadi, an assistant professor of Medicine at the Perelman School of Medicine and Abramson Cancer Center at the University of Pennsylvania, argues that blocking the cell’s ability to degrade and recycle proteins can enhance a variety of cancer treatments.

Amaravadi and others have shown that hydroxychloroquine (HCQ), an approved malaria and rheumatoid arthritis treatment, can do just that. Laboratory models of treatment-resistant cancers and ongoing clinical trials have demonstrated that HCQ can enhance antitumor activity when combined with chemotherapy, targeted therapy, radiation, and immunotherapy.

“Our assays performed on human blood and tissue samples indicate that high doses of HCQ are required to block autophagy in patients, and in some cases, such as in a brain tumor trial, these high doses, in combination with specific anticancer agents, can lead to toxicity for the tumor,” Amaravadisaid in a press release. “While our knowledge of the role of autophagy in cancer is still in its infancy, the opportunity to learn about autophagy, both at the bench and the bedside, could accelerate the translation of basic advances in this field into clinical benefit for patients with cancer.”