On April 1st, my wife and I celebrated our twenty-fifth wedding anniversary. We stayed home and enjoyed a simple meal of green salad, goat cheese and sesame crackers. Then we poured ourselves some wine and smuggled up on the couch to watch Ken Burns' documentary, "Cancer: The Emperor of All Maladies." Not terribly romantic, I know, but we are big Ken Burns fans. And my wife's breast cancer has recently returned.


She was first diagnosed seven years ago, had a lumpectomy and underwent radiation treatment. At that time, she never suffered much from cancer symptoms. Now that it's in her lungs, she's had shortness of breath, but fortunately that has been cured by chemo. During these ups and downs, I've never been able to form a clear image in my mind as to what cancer is, and how treatments work against it. I hoped that Ken Burns' documentary would teach us about the science and history behind cancer treatment and give us an image of the disease that would help us cope.


The first thing we learned is that we are very very extremely happy to have missed the last fifty years of cancer treatment. During the early days, treatment methods followed the dictum: "if something is good, then more must be better." In chemotherapy, this lead to mega-dose regimes that brought patients to the brink of death. In breast cancer surgery, it lead first to the radical, then the super-radical, and ultimately the ultra-radical mastectomy, with each procedure removing more tissue. The images of cancer associated with these treatments are horrifying: a vermin that must be poisoned; a spreading decay that must be carved and scraped out.


Fortunately, doctors no longer use these extreme methods. And over that last 20 years, researchers have developed a more sophisticated understanding of cancer. They now believe that the difference between normal cell growth and cancer cell growth is found in our genes. This genetic understanding has given us an image of the disease that is complex and mysterious.


Normal cell growth is coded by genes that produce control mechanisms similar to a car's gas pedal and breaks. The control mechanisms regulate the pace of cell division to ensure steady and organized growth. But if certain genes mutate, the instructions become scrambled and the controls fail. The result is cancer cell growth.


For example, when "oncogenes" mutate and become active, the result is like a stuck gas pedal; cells do not die as they normally would, but replicate out of control. When "tumor suppressor genes" mutate and become inactive, the result is like weak brakes; cells cannot stop and continue to divide incessantly.


Once cancer cell growth tips out control, it upsets the delicate and balanced organization of a healthy human body. Normally, cells of a similar type grow in an ordered fashion to function together as tissue. Tissues organize to function together as an organ. Organs function together as an organ system. Organ systems function together to make a whole organism—a whole husband or a whole wife.


Cancer disrupts the order and follows a chaotic rhythm, fatally out of step with the whole. I find this to be a profound image: the exuberant dynamism of life spinning out of balance. While I dread it, this is an image I can at least cope with, an image that helps me appreciate the fleeting, exquisite balance that makes possible the life my wife and I share.