Cancer typifies unmoored instability: Pulitzer winner

New Delhi, April 19 (IANS) Cancer is often described as a 'modern' illness because its metaphors are so modern. It is a disease of overproduction, of fulminant growth tipped into the abyss of no control, says Pulitzer Prize winning writer and oncologist Siddhartha Mukherjee in his book, 'The Emperor of Maladies: A Biography of Cancer'.

'The notion of cancer as an affliction that belongs paradigmatically to the 20th century is reminiscent, as Susan Sontag argued so powerfully in her book, 'Illness as Metaphor', of another disease once considered emblematic of another era: Tuberculosis in the 19th century,' Mukherjee compares.

'Both drain vitality, both stretch out the encounter with death, in both cases 'dying', even more than death, defines the illness,' Mukherjee says.

According to the specialist, 'cancer is an expansionist disease'.

It invades the tissue; 'sets up colonies in hostile landscapes, seeking sanctuary in one organ and then migrating to another.

'It lives dangerously, inventively, fiercely, territorially, cannily, and defensively - at times as if teaching us how to survive. To confront cancer is to confront another species, one perhaps more adapted to survive then even we are,' Mukherjee says.

In writing this book, he started off by imagining the project as a 'history' of cancer.

'But it felt inescapably as if I were not writing about something but about someone. My subject daily morphed into something that resembled an individual - an enigmatic, if somewhat deranged, image in a mirror. This was not so much a medical history of an illness, but something more personal, more visceral in biography,' he writes.

To begin with, every biographer must confront the birth of his subject, the writer says. 'Where was cancer born?' 'How old is cancer?'

In 1862, Edwin Smith, part scholar and part huckster, antique forger and Egyptologist, bought (some say stole) a 15-foot-long papyrus from an antique seller in Luxor in Egypt.

'The papyrus was in dreadful condition, still crumbling, yellow pages filled with cursive Egyptian writing. It is now thought to have been written in the 17th century BC, a transcription of a manuscript dating back to 2500 BC,' Mukherjee says.

Translated in 1930, the papyrus was thought to contain the collected teachings of Imhotep, a great Egyptian physician who lived around 2625 BC. The physician listed 48 cases of illnesses found during his time.

'Describing case forty-three, Imhotep advises, 'if you examine having bulging masses on breast; if you place your hand upon breast and find them to be cool, there being no fever, they have no granulations, contain no fluid, yet they feel protuberant to your touch, you should say (concerning him): This is a case of bulging masses I have to contend with',' Mukherjee says in his book.

Imhotep was referring to breast tumours.

And under the section therapy, he offered only a single sentence: 'There is none.'

Mukherjee says: 'In 500 BC, Persian Queen Atossa self-prescribes the most primitive form of mastectomy (for breast cancer) which was performed by her Greek slave.'

Atossa's disease and her war against it serves as the cornerstone for cancer research over the centuries - evolving with time.

The book is divided into seven chapters.

In the summer of 2003, after having completed his residency in medicine and graduate work in cancer immunology, Mukherjee began an advanced training in cancer medicine at the Dana Faber Institute and Massachusetts General Hospital in Boston.

'I had initially envisioned writing a journal of that year - a view from the trenches of cancer treatment. But the quest soon grew into a large exploratory journey that carried me into the depths not only of science and medicine, but of culture, history, literature and politics - into cancer's past and its future,' the writer says.

The book, published in India by Harper-Collins, is priced at Rs.499.