The Emperor of All Maladies: A Biography of Cancer

The author uses car parts to describe the way in which cancer develops in cells. In proto-oncogenes, mutations cause the cells to divide endlessly, as if they were a car with a jammed accelerator. Tumor suppressor genes that don’t work are like brakes that fail. They are supposed to curb growth, but they do not do so in cancerous cells. This description helps the reader understand the mechanism by which cancers can develop in the body.

However, the author emphasizes that these events do not happen with regularity and that mutations after mutations must occur before cancer grows in the body. Jammed accelerators and failed brakes are rare occurrences: “In genetic terms, our cells were not sitting on the edge of the abyss of cancer. They were dragged toward that abyss in graded, discrete steps” (386). Although genes can develop into proto-oncogenes and tumor suppressors can fail, these are rare events. Our bodies do not poise on the brink of disaster. Instead, genes must go through several different mutations before cancer develops. These mutations, including jammed accelerators and failed brakes, are possible, but they do not always happen.

At the end of the book, Mukherjee compares developing cancer treatments to the “Red Queen’s Race” (440), an allusion to Lewis Carroll’s Through the Looking-Glass, in which Alice runs but still stays in the same place. Cancer treatment is ever-evolving, and sometimes even targeted therapies, such as Gleevec, do not work on drug-resistant forms of cancer. Therefore, the quest to find cures is ever-evolving: As cancer cells mutate constantly, so must our treatments for cancer.

Mukherjee predicts that this “Red Queen syndrome” (444) will continue to characterize the future of cancer: We will always be marching just to stand still. As new treatments evolve, the disease itself will change, and therefore, we will need to be ever-changing ourselves. The author writes that “the relentlessness, the inventiveness, the resilience, the queasy pivoting between defeatism and hope” (466) will always mark our battle against cancer. He believes that human hubris, the belief that we can somehow master the movement of our own cells, will constantly be frustrated. Instead, science will always be playing a game of catch-up with our biology.