Slash, poison and burn

The story of cancer is a story about treatment and mutation, hope and despair, life and death

Five decades since an all-time classic Anand hit the screen, cancer has become the emperor of all maladies with an estimated 18 million new cases diagnosed each year. A decade from now, however, the global burden is projected to grow to 21 million new cancer cases with no less than 13 million succumbing to it. Tragically, Anand’s inspiring tale of celebrating life amidst brutal certainty remains perhaps the only mantra for all those who may have to traverse their own journeys through the dreaded illness, then and now.  

The First Cell by Azra Raza
Harper Collins, New Delhi
353 pages, Rs 599.

The subject matter is pretty grim, as Rebel Cell unravels the evolutionary inevitability and The First Cell its discontented treatment in highlighting our brutal stalemate with the Big C. Cancer has come to rule over the host with despotic autocracy, and the fatal aspect is that a patient with cancer is as likely to die of it today as one was fifty years ago. Unlike other human ailments, when it comes to cancer we are literally in relationship with death. ‘We get cancer because we can't avoid it’, writes award-winning science journalist Kat Arney, ‘because there is bug in the system of life itself’. Noted oncologist Azra Raza is in agreement that cancer isn’t anybody’s fault, it exists because multi-cellularity exists. Cancer cell is not a foreign invader but a double agent, hardwired into the fundamental processes of life to outsmart our existence. Literally, it is one cell that wants to live longer than the entire human body. Why is it, and how to change it? 

There are no easy answers. But these two books ask the same question that you’re asking, hopefully, that we’re all asking. But that’s the conundrum, isn’t it? However, the authors manage to pack in an awful lot: there’s a heart-wrenching portrayal of the loss of the loved ones, exquisitely detailed descriptions of failed prescriptions, and gloomy narratives on excruciating side effects that leave the cancer patients dangling between life and death. The story of cancer is a story about treatment and mutation, hope and despair, life and death. With cancer too often evolving its way out of trouble, Arney argues that everything we know about cancer may be wrong. Having lost her husband to cancer, Raza laments the pharma industry dogged insistence on slash, poison, and burn (surgery, chemo, and radiation therapies) as the magic strategies.   

Rebel Cell offers insights on a new way of thinking about what cancer really is, where it came from, where it's heading, and how we can stop it. Though mortality is ever-present, this is a book that investigates life in its messy glory. The First Cell takes a step further, by exploring cancer from medical, scientific, and cultural lens. Told through the disoriented lives of those whom the treatment failed, the book questions the unshakable hubris of modern science claim to curing as complex a disease as cancer. The cancer landscape is much worse in reality, as only 5 per cent of the successful drugs extend life of patients by a few months at the cost of millions of dollars, Die from the disease or die from the treatment, the choice is indeed limited.        

Rebel Cell by Kat Arney
Weidenfeld & Nicolson, London
416 pages, Rs 1,747.

With exquisite subtlety and insight, Raza navigates the twin poles of failed treatment and unfathomable grief with poetic resilience. As a clinical researcher, a treating oncologist and a cancer widow, Raza’s indicts the cancer industry and fellow oncologists for under-reporting failure with treatment therapies. Why both are shying away to tell the stories of majority who die? With failure outnumbering success, cancer stories need no exaggeration to depict the drama of pain and grueling decisions. Knowing well that every bit of criticism applies as much to her as to fellow colleagues, Raza minces no words to conclude that unless research on identifying the earlier markers of the first cancer cells are found the cancer paradigm will soon reach a grotesque, unrecognizable, and destabilized end point.     

Science journal Nature considers The First Cell an incisive critique-cum-memoir. Indeed, it is. Written with empathy and anguish, deeply personalized interactions with patients and families make it a must read treatise on a disease that every one of us has a fifty-fifty chance of getting into. While there is an improvement in cancer mortality due to early detection, significant advances in the treatment of metastatic cancers hasn’t kept pace. A Columbia University professor of medicine and practicing oncologist, Raza gives a voice to our collective anxieties as a species as well as to our growing vulnerabilities. It is responsible writing at its best.    

There is little denying that we need to be a lot smarter to defeat such a wily foe. The traditional strategy of treating cancer has already reached its maximum potential, as every cancer evolves its unique way out of trouble. If a British advocacy group ‘Dying for a Cure’ is to be believed: ‘at the current rate of progress it would take 1,778 years at least before we saw a 20-year survival improvement for all 200 types of known cancer.’ Not to be let down, the need of the hour in cancer research would be to shift from studying animals to studying humans, and a shift from chasing after the last cancer cell to developing the means to detect the first cancer cell.  

The First Cell is no ordinary book of science and medicine. Written with the sensibilities of a poet (Raza’s first book was on Ghalib: Epistemologies of Elegance) and a deep compassion for fellow beings, Raza questions the profiteering that has come to rule our lives by first flooding our environment with carcinogens and then making profit from treating it. The world need to escape from this vicious cycle, and only by placing prevention and early detection on priority will we be able to outsmart the dreaded enigma. The writing on the wall is clear.

First published in Hindustan Times on Feb 2, 2022.