Ultimately, the key to unlocking some of cancer's basic mysteries has come out of a better understanding of its complexity. Only in recent years have scientists mapped the key components that the different forms and facets of cancer share: a variety of physiological mechanisms at the cellular level (simplistically put, disabled on/off switches and stop-and-go traffic signals), which allow abnormal cells to proliferate, spread, and infiltrate the body. Similarly, it's only at the cellular level that all cancers can be said to possess a universal "cause" ("starting point" would be a better way to put it), in the form of an initial genetic mutation. As for what sets that initial process in motion: here, too, every form of cancer possesses its own set of suspects—a complex mix of genetics, environmental factors, lifestyle habits, pure chance, and other factors—that predispose or raise the risk of onset.
The practical applications of these insights have meant monumental clinical progress. The more specifics we know about the conditions under which normal cells turn cancerous, Mukherjee emphasizes, the better equipped physicians will become at targeting those aberrant cells and their fatally errant mechanisms. This explains why, today, each patient receives slightly different regimens or dosages of radiation or chemo. In sum, the days of the cookie-cutter approach—of using one type of radical surgery or radiation dosage for all patients—is past. "Viewing [cancer] as a single disease that will yield to a single approach is no more logical than viewing neuropsychiatric disease as a single entity that will respond to one strategy," wrote National Cancer Institute director Richard Klausner in 1997.
In retrospect, Klausner's statement seems obvious; but as Mukherjee demonstrates, that change of mindset took centuries. Even with today's hard-won advances, cancer remains an enigmatic realm, where medical conundrums (how and why did the nasty tumor cells surgically excised and irradiated at Point A still manage to pop up in an even more virulent form in Points B and C?) are oncologists' daily diets. Patients anxiously seek answers to questions whose resolution too often can only be guessed at. Is the remission real? or is it the calm before a metastasis? Are the benefits of the preventive treatment worth the risks of the side effects? Will I be better off going with an experimental regimen? or with a more traditional treatment? Such is the unstable roller-coaster land of dread, hope, and anxiety into which a cancer diagnosis can cast anyone, whether ourselves or those we care for, or care about.
Who isn't included in this group? Statistically speaking (statistics being the lingo on which most oncologists rely, explains Mukherjee), the odds in favor of the prevention, cure (especially for young people), and ever-longer survival rates for just about every type of cancer appear to be improving. Paradoxically, however, precisely because of our longer life spans and lower mortality rates from other causes, statistics also favor more of us being diagnosed with cancer. Indeed, epidemiological surveys predict that approximately 40 percent of all American men and women born today will be diagnosed with some form of cancer.
Mukherjee makes sense of these statistics, among cancer's many complexities, by structuring his narrative like a medical thriller that plays out through the millennia. The intractable enemy is cancer; the heroes are the scientists and doctors who hunt it down; the people in need of rescue are all of us. The story is ongoing and ultimately inconclusive.
"Perhaps cancer, the scrappy, fecund, invasive, adaptable twin to our own scrappy, fecund, invasive, adaptable cells and genes, is impossible to disconnect from our bodies," the author muses near the book's conclusion. "Perhaps cancer defines the inherent outer limit of our survival. As our cells divide and our bodies age, and as mutations accumulate inexorably upon mutations, cancer might well be the final terminus in our development as organisms."
Which takes us back to what "The Big C" also stands for: our Cells—and, of course, learning to Cope.
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