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‘Emperor of All Maladies’ Author Mukherjee Answers Your Questions

After our conversation with Dr. Siddhartha Mukherjee about his new book, “The Emperor of All Maladies: A Biography of Cancer,” Dr. Mukherjee offered to answer some questions submitted by NewsHour viewers.

We received many questions on a variety of issues – his research, the disease and his hopes for his patients and a cancer cure. Dr. Mukherjee answers a few of those queries below.

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Carrie (Kensington, Md.): When a patient that was “in remission” has “recurrence” of cancer(same form), did the cancer actually return, or was it more likely really never totally cured?

Dr. Siddhartha Mukherjee: Typically, when cancer recurs in patients with a prior remission, it is because the original cancer was never cured. Occasionally, there can be really late recurrences, even up to a decade. Once in a while, though, a “recurrence” can be a truly new cancer, unrelated to the original cancer.

Jane (Germantown, Md.): You mentioned that when treated, many cancer survivors live more like those with chronic disease … what does that look like? What should we think about/listen to/act on if this is the case?

Dr. Siddhartha Mukherjee: For some cancers, such as breast cancer, prostate cancer, and some leukemias, patients can survive a prolonged period of time with the disease, even with advanced stage disease. This phenomenon is not merely restricted to breast, prostate and leukemias; there are patients with lung cancer, or even melanomas, that survive for decades without their disease being fully “cured.” Many of these patients return to their normal lives, although, of course, cancer remains very much a part of their lives.

Kathleen B: I have had 3 types of cancer, melanoma, papillary carcinoma (I think that is correct. Thyroid cancer)and invasive ductal carcinoma. Is it my immune system that isn’t functioning correctly and allowing these cancers to grow? Is there some relationship between these cancers that I had all three? Now that they’ve all been treated and seemingly in remission, what’s next? Some other form of cancer?

Dr. Siddhartha Mukherjee: It is difficult to tell whether a genetic link lurks behind these three types of cancer in your case. However, three cancers occurring in the same patient does raise the question of an unusual genetic predisposition or an unusual carcinogenic exposure. A genetic counselor might be able to advise you, in particular, by taking a careful family history. I hope that you don’t have another form of malignancy in the future.

Krista (Baton Rouge, La.): Has there been any success against the more aggressive leukemias, like acute myelogenous leukemia?

Dr. Siddhartha Mukherjee: Absolutely. We are using a variety of new drugs against acute leukemias, and many clinical trials are in advanced stages. Of particularly interest are drugs that are used to treat pre-leukemic diseases, such as certain forms of myelodysplastic syndrome.

Carol F.: You spoke of cancer as a disease, and if you interpret disease as “lack of ease,” it surely can be. However in the current medical usage of the word, does cancer strike you as more of a failure of the immune system? This would seem in keeping with your idea of a genetic origin.

Dr. Siddhartha Mukherjee: The relationship between cancer and the immune system is very complex, and only recently being discovered. Rather, I should say “rediscovered.” Scientists and doctors have known for a long time that certain cancers, such as melanomas, interact with the immune system. But recently, we have begun to understand this relationship in molecular terms, and to create medicines that activate the immune system. One such medicine happens to work against melanomas – a truly exciting advance. The notion of using the immune system to attack cancers will doubtless be a major focus of future research. I am very optimistic about this area.

Jennifer: Dr. Mukherjee, thank you for writing your book. As a breast cancer survivor diagnosed at age 31, my question is: why does it seem like younger and younger women are being diagnosed with breast cancer? Is it solely that we have more accurate diagnostic tools, or is there something else at work here?

Dr. Siddhartha Mukherjee: Some of the increased incidence of breast cancer is due to increased screening. Some of it, unfortunately, is the result of the usage of hormone replacement therapy – a practice that has mostly stopped. Some of it might be related to increased obesity, although this link is being investigated. A large part of this, though, is related to the overall aging of the population: breast cancer is very tightly linked to age.

No Name Provided: Does the doctor talk about Bone Marrow/Stem Cell Transplants, its history, and its future for treating blood type cancers and maybe other cancers in future?

Dr. Siddhartha Mukherjee: I cover some of this in my book. However, it is not possible to cover all aspects of BMT. I believe that BMT is a rich area of research, and is particularly successful at curing certain blood cancers. But it is a complex, toxic and expensive procedure that must be performed very carefully to get optimal results.

Jane (Germantown, Md.): If you could wave a magic wand, what would you tell us survivors not to worry about (or to keep in perspective) in order to live with confidence and joy?

Dr. Siddhartha Mukherjee: I would advise survivors to embrace everything that is positive in their lives. I would ask them to look to their loved ones, their families, their children, their friends for support and joy. I think it is impossible to “forget” the diagnosis of cancer; that would be asking too much. But it is also important to not let cancer invade every aspect of survivorship. I would tell survivors to try to restore the sanctity and dignity of their lives – to live beyond cancer as much as possible.

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