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I first met Susan Sontag in spring 1976 when she was recovering from cancer surgery and needed someone to help type her correspondence. I had been recommended by the editors of 'The New York Review of Books,' where I'd worked as an editorial assistant.
If you take 100 breast-cancer samples, 100 types of cancer have 100 different hallmarks of mutated genes. You could be nihilistic and say, 'Oh, God, we'll never be able to tackle this!' But there are deep, systematic, organizational principles at work in all that diversity.
Nearly every one of the genes that turns out to be a key player in cancer has a vital role in the normal physiology of an organism. The genes that enable our brains and blood cells to develop are implicated in cancer.
Unlike other diseases, the vulnerability to cancer lies in ourselves. We always thought of disease as exogenous, but research into cancer has turned that idea on its head - as long as we live, grow, age, there will be cancer.
I think you would have to be a nihilist to say that we are not making progress on cancer, just like you'd have to be hubristically optimistic to say that we have conquered cancer.
Cancer is not just a dividing cell. It's a complex disease: It invades, it metastasizes, it evades the immune system.
There is a very moving and ancient connection between cancer and depression.
I had seen cancer at a more cellular level as a researcher. The first time I entered the cancer ward, my first instinct was to withdraw from what was going on - the complexity, the death. It was a very bleak time.
I think the way we think about cancer, the way we treat cancer, has dramatically changed in the last century. There is an enormous amount of options that a physician can provide today, right down from curing patients, treating patients or providing patients with psychic solace or pain relief.
A breast cancer might turn out to have a close resemblance to a gastric cancer. And this kind of reorganization of cancer in terms of its internal genetic anatomy has really changed the way we treat and approach cancer in general.
We know cancer is caused ultimately via a link between the environment and genes. There are genes inside cells that tell cells to grow and the same genes tell cells to stop growing. When you deregulate these genes, you unleash cancer. Now, what disrupts these genes? Mutations.
Cancer is not one disease but many diseases.
What we do in the laboratory is we try to design drugs that will not just eradicate cancer cells but will eradicate their homes.
It turns out that the very genes that turn on in cancer cells perform vital functions in normal cells. In other words, the very genes that allow our embryos to grow or our brains to grow, our bodies to grow, if you mutate them, if you distort them, then you unleash cancer.
Because I work on leukemia, the image of cancer I carry in my mind is that of blood. I imagine that doctors who work on breast cancer or pancreatic cancer have very different visualizations.
We may have to learn to live with cancer rather than die of it. It means a big change in our mindset and how we do research. We haven't quite reached there yet.
Every era casts cancer in its own image.
I began wondering, can one really write a biography of an illness? But I found myself thinking of cancer as this character that has lived for 4,000 years, and I wanted to know what was its birth, what is its mind, its personality, its psyche?
If there's a seminal discovery in oncology in the last 20 years, it's that idea that cancer genes are often mutated versions of normal genes.
The idea that cancer genes are sitting inside each and every one of our chromosomes, just waiting to be corrupted or inactivated and thereby unleashing cancer, is, of course, one of the seminal ideas of oncology.
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