As our population ages, the question is not if we  will encounter this illness in our lives, but when. Is it time we stopped fighting and learned to live with it?

當我們年紀變老時，遇到這樣的疾病，我們是要和它奮戰還是和它和平相處。

On the morning of 19 May 2004, Carla Reed, a  30-year-old nursery teacher and mother of three young children, woke up in bed with a headache. "Not just any headache," she says, "but the kind of numbness that instantly tells you that something is terribly wrong."

2004年五月十九日的早晨卡拉．理徳一位30歲的托兒所老師有一個三歲大的孩子，帶著頭痛從床上醒來，她說︰那不是一般的頭痛，它瞬間告訴你身體某部分出了很糟糕的問題。

Late in April, Carla had discovered a few bruises  on her back. They had suddenly appeared  one morning, like strange stigmata, then grown and vanished over the next month, leaving large, map-shaped marks on her back. Almost indiscernibly, her gums had begun to turn white. By early May, Carla, a vivacious, energetic woman, could barely walk up a flight of stairs. Some mornings, exhausted and unable to stand up, she crawled down the hallways of her house on all fours to get from one room to another. She slept fitfully for 12 or 14 hours a day, then woke up feeling so overwhelmingly tired that she needed to haul herself back to the couch again to sleep.

四月下旬卡拉發現有少許瘀傷在自己的背上，它們忽然出現，像似奇異的傷痕，一早長大成像地圖般，然後在次月消失。莫名其妙的她的齒齦轉成白色。五月初的時候卡拉還是個活潑精力十足的女人健步如飛的上樓梯，到了某天早晨她發現自己精疲力竭舉步維艱，必須四肢並用爬的到自己家的各房間，她斷斷續續的每天睡了大約12~14小時，但是醒來的時候仍然感到全身倦怠，要拖著身體到沙發上躺下來再繼續睡。

Carla and her husband saw a general physician and a nurse twice during those four weeks, but she returned each time with no tests and without  a diagnosis. Ghostly pains appeared and disappeared in her bones. The doctor fumbled about for some explanation. Perhaps it was a  migraine, she suggested, and asked Carla to try  some aspirin. The aspirin simply worsened the bleeding in Carla's white gums.

在發病的四個星期中卡拉由丈夫陪同去看了兩次普通醫生，醫生也沒有為她檢驗身體和詳細診斷，當卡拉感覺骨頭裏出現幽靈般來去的陣痛，醫生卻疏忽的診斷為偏頭痛並建議卡拉服用阿司匹靈，可是阿司匹靈惡化了卡拉的牙齦出血。

On the afternoon of 19 May, Carla dropped her three children with a neighbour and drove back to  the clinic, demanding to have some blood tests. Her doctor ordered a routine test to check her blood counts. As the technician drew a tube of blood from her vein, he looked closely at the blood's colour, obviously intrigued. Watery and pale, the liquid that welled out of Carla's veins hardly resembled blood. She waited the rest of the day without any news. At a market the next morning, she received a call.

五月十九日的下午卡拉把她三歲大的孩子託鄰居照顧，開車到診所要求作血液檢驗，醫生爲她做了例行性血球檢驗，很令人好奇的，她的血液呈蒼白色的、水水的。卡拉等了一天沒有檢驗消息，次日在市場時她收到一通電話；

"We need to draw some blood again," the nurse from the clinic said.

護士從診所打來說︰「我們必須再抽一管血」

"When should I come?" Carla asked. She remembers looking up at  the clock on the wall. In  the end, commonplace particulars make up her  memories of illness: the clock, the children, a  tube of pale blood, the tightening tone of a voice on the phone. "Come now," she thinks the nurse said. "Come now."

「什麼時候呢？」卡拉邊問邊看著牆上的鐘，以後她記憶裏只記得「病、鐘、孩子、一管血和電話裏的繃緊聲音」護士回答︰「馬上來！」

I heard about Carla's case at 7am on 21 May. The  sentence that flickered on my beeper had the  staccato and deadpan force of a true medical emergency: "Carla Reed/New patient with leukaemia/14th floor/Please see as soon as you  arrive."

我聽到關於卡拉的病案是在五月21日上午七點。BB扣機的句子無情的閃爍顯示著急診狀況︰「卡拉．理得／白血症新病人／14樓／請盡快來診斷」

Leukaemia is cancer of the white blood cells – cancer in one of its most explosive, violent incarnations. Its pace, its acuity, its breathtaking, inexorable arc of growth forces rapid, often drastic decisions; it is terrifying to experience, terrifying to observe and terrifying to treat. The  body invaded by leukaemia is pushed to its  brittle physiological limit – every system, heart, lung, blood, working at the knife-edge of its performance. Blood tests performed by Carla's doctor had revealed that her red cell count was critically low, less than a third of normal. Instead of normal white cells, her blood was packed with millions of large, malignant white cells – blasts, in  the vocabulary of cancer.

白血症就是血球細胞的癌症，它是癌症裏最具爆炸和暴力的化身之一，它的殘暴無情捉摸不定讓人很難搞定。身體一旦遭遇白血症每種系統心、肺、血液都像運作在刀鋒上，血液檢驗發現卡拉的紅血球數只有正常人的三分之一，白血球數卻是百萬計爆炸性的惡性成長，換句話說就是血癌。

When I arrived, Carla was sitting with peculiar calm on her bed, a schoolteacher jotting notes. ("But what notes?" she would later recall. "I  just  wrote and rewrote the same thoughts.") Her mother, red-eyed and tearful, sat silently in  a  chair by  the window, rocking forcefully. The din of activity around Carla had  become almost a  blur: nurses shuttling fluids in and out, interns donning masks and gowns, antibiotics being hung on IV poles to be dripped into her veins.

當我抵達的時候，卡拉睡在病床上出奇的平靜，有一本教師用的小筆記本在旁（記載些啥呢？之後她告訴我只是重複寫著一些相同的想法而已）她的母親紅著眼，含著淚，沉默著坐在靠窗的一張椅子上呆若木雞，環繞著卡拉週遭的騷動︰打進血管的點滴，護士的進進出出，穿著白袍帶著口罩的實習生，變成一個模糊的景像。

I explained the situation as best I  could. Her day ahead would be full of tests, a hurtle from one lab to another. I would draw a bone marrow sample. More tests would be run by pathologists. But the preliminary tests suggested that Carla had acute lymphoblastic leukaemia (ALL) – one of  the most common forms of cancer in children, but rare in adults.

我盡可能的解釋病情，往後她將面臨一個又一個的檢驗；我將抽一些骨髓樣本，病理師會做更多的檢驗，但是初期檢驗判斷卡拉得的是大多數發生在孩童，成人比較罕見的急性淋巴白血症。

I laid out the odds. Once the diagnosis had been confirmed, chemotherapy would begin immediately and last more than a year. Carla's chances of being cured were  about 30%.

我盤算著一旦診斷確定，卡拉將持續一年的化療，只有30%機會痊癒，

"Thirty per cent – I would repeat that number to  myself at night," she says. "Not even a third. If  someone gave me 30% odds in a game, would I  take the odds?"

卡拉晚上心裏一直重複著30%的數字，她說三分之一都不到，假如某人只提供我30%赢的機會，我會去賭它嗎？

The morning after Carla arrived at the hospital, I took her consent forms for chemotherapy that would allow us instantly to start pumping poisons into her body to kill cancer cells. Chemotherapy would come in three phases. The first would last about a month. The drugs – given in  rapid-fire succession – would hopefully send the leukaemia into a  sustained remission. They would certainly kill her normal white blood cells as well. Her white cell count would drop in freefall, all the way to zero. For a few critical days, she would inhabit one of the most vulnerable states modern medicine can produce: a body with no immune system, defenceless against the environment around it.

卡拉住院後的次日早晨，我拿著她的化療同意書，它允許我立刻把毒藥打進她體內去殺死癌細胞。化療分成三個階段︰第一階段持續一個月，迅速的下重藥希望讓白血病情獲得緩解，當然它也殺死正常白血球。卡拉的白血球數會像自由落體似的降到零，在某些嚴酷的日子裏她會處在極度脆弱的狀況下，所幸現代醫學允許人體在無免疫能力下抵抗它週遭環境存活。

If the leukaemia did go into remission, then we would "consolidate" and intensify that remission over several months. That would mean more chemotherapy, but at lower doses, given over longer intervals. She would be able to leave the hospital and return home, coming back every week for more chemotherapy. Consolidation and intensification would last for eight additional weeks, perhaps longer.

第二階段；假使白血症狀已經獲得緩解，我們將「鞏固」和「強化」病情的緩解幾個月。那就是用較低的劑量，更多次的化療，更長期的治療。病人可以回家每週來院做化療持續八週或更久

The worst part I kept for last. ALL has  an ugly propensity for hiding in the brain. The intravenous chemotherapy that we would give Carla, no  matter how potent, simply couldn't break into the cisterns and ventricles that bathed her brain. The blood-brain barrier essentially made the brain into a "sanctuary" for the leukaemia cells. To send drugs directly into that sanctuary, the medicines would need to be injected directly into  Carla's spinal fluid, through a series of spinal taps. Whole-brain radiation treatment – highly penetrant x-rays dosed directly through her skull – would also be used against leukaemia growth in  her brain. And there would be even more chemotherapy to follow, spanning two years, to "maintain" the remission, if we achieved it.

最艱難的階段我留到最後，急性淋巴白血病有一個不佳的傾向，就是癌細胞會躲藏在腦子裏。靜脈注射化療不管藥品多麼有效就是無法越過腦腔(腦子浸潤在腦腔的脊髓液中)，於是腦腔變成了白血症癌細胞的避難所。為了要把藥品進入避難所，藥必須由卡拉的脊髓某處注射入脊髓液中。全腦子的放射性治療—用高穿透性的X射線直接照射腦殼用來消滅癌細胞在腦子中成長，假如以上都完成了，甚至會視情況再多加兩年的化療來維持病況的穩定。

Cancer is not one disease but many diseases – more than 100 different types and subtypes, an  illness so impossibly multifarious that it defies the very limits of classification. And yet Carla's leukaemia – cancer of white blood cells – shares a  deep biological commonality with breast, stomach or lung cancer. In all cases, the fundamental aberration is the same: cancer originates in a cell that cannot stop dividing. That this seemingly simple mechanism – cell growth without barriers – can lie at the heart of this multifaceted disease is a testament to the unfathomable power of cell growth. Cell division allows us as organisms to grow, to adapt, to recover, to repair – to live. And, distorted and unleashed, it allows cancer cells to grow, to flourish, to adapt, to recover and to  repair: to live  at the cost of our living. Cancer cells grow faster, adapt better. They are more perfect versions of ourselves.

癌症超過一百多種型態，病人不可能忽視這些五花八門的癌症的各種限制。卡拉的血癌—白血球的癌症和乳癌、胃癌、肺癌病理上非常相似，基本病理就是癌細胞無法停止分裂，看似簡單的機構—細胞生長無障礙—許多癌症的中心病理證據，不可解的細胞成長。正常細胞在器官內成長被採用、使恢復、被修復、生存、被摧毀、被放棄，癌細胞生長過程和正常細胞一樣卻是生命中的損失負擔，但是長得更快、更容易被採用，它是我們自己身體的更完美版本。

How did Carla's body create such a cell? What, more generally speaking, causes any normal cell to lose control and begin to grow uncontrollably? Until the mid-1970s, very little was known about this process. Researchers knew that exposure to certain chemicals (such as benzene or cigarette smoke) could increase the chances of developing cancer. In  the 1770s, an English surgeon, Percivall Pott, had noted that adolescent chimney sweeps chronically exposed to chimney soot  could develop cancers of the scrotum, where minuscule particles of tar and soot were often trapped. These agents were called "carcinogens", but there  was little knowledge about how such agents  might work or how they might elicit uncontrolled growth.

卡拉的身體為什麼會長出癌細胞？更通俗的說什麼原因讓正常細胞失去控制變成無限分裂成長的癌細胞？直到1970年代中旬，大家都還搞不清楚。研究者知道曝露在某種化學物質下羅患癌症的機率會增加﹙如苯、抽煙﹚。遠在1770年就有一位英國外科醫生名叫波西魏爾．波特注意到長期從事煙囪打掃的青少年暴露在煤灰之下可能較容易得到陰囊癌。焦油和煤灰的細小粒子時常粘附其上，這些東西稱之為「致癌物」但是仍然不甚明白這些東西為何會引發細胞的失控成長。

Many scientists, on the other hand, argued that  cancer was caused by viruses – particularly retroviruses. Retroviruses are unique in the sense that the genes of these viruses can physically attach themselves to the DNA of the cell. Genes control the growth of cells. And so cancer, it was thought, was unleashed when a retrovirus gene attached itself to the cell's DNA, thereby delivering a genetic signal to alter cellular growth.

許多科學家另一方面爭論癌細胞是由病毒引起的特別是逆轉綠病毒，逆轉綠病毒是唯一被察覺它的基因會攻擊細胞的DNA，基因控制著細胞的成長，癌細胞被臆測成是逆轉綠病毒的基因附在正常細胞的基因下衍生出一個讓細胞生長的信號。

In the winter of 1976, a lanky, self-possessed scientist named Harold Varmus, along with J  Michael Bishop, a virologist originally from Pennsylvania, both working in San  Francisco, proposed a startling theory of cancer's genesis that reconciled the virus and chemical theories. Varmus and Bishop discovered that the genes that unleash cancer are typically already present in every normal cell. Retroviruses cause cancer, Varmus and Bishop found, by forcing a growth-inducing gene into the DNA of a cell. Chemical carcinogens, on the other hand, activate or inactivate genes by  mutating DNA, and thus distort growth-controlling genes. Thus lung cancer occurs when a chemical in cigarette smoke  mutates a gene that controls the growth of  a lung cell, thereby eliciting uncontrolled growth. But, notably, lung cancer can also occur in a man or woman who has never smoked: a lung cell, reproducing itself, might make a  random error in copying its genes, thus generating the same mutant gene that eventually  unleashes uncontrolled growth.

1976年冬天一位瘦長自我鞭策的的科學家名叫哈洛徳‧魏幕斯偕同J‧麥可‧比司霍普(兩位是1989諾貝爾醫學獎得主)，原先在賓夕凡尼亞州，後來在舊金山工作，不甘心於病毒和化學物理論，他們提出了令人意想不到的癌症基因接合理論。魏幕斯和比司霍普發現引發癌症的基因通常以經存在於每一個正常細胞裏，他們發現逆轉綠病毒是藉由迫使一個成長誘發基因進入正常細胞的DNA引發癌症，化學致癌物則是因為啟發或關閉某基因使DNA產生變異所以干擾了成長控制基因。肺癌的發生是因為香菸的化學物質變異了肺臟裏控制成長的細胞基因而啟動了不可控制的成長。但是那些從來不抽煙的人怎麼又會得肺癌呢？那是因為肺臟細胞在分裂複製自己幾次後，可能產生了隨機錯誤造成基因變異逐漸啟動了不可控制的成長。

Most normal cells, even rapidly growing normal cells, will proliferate over several generations and then exhaust their capacity to keep dividing. What allows a cancer cell to keep dividing endlessly, without exhaustion or depletion?

多數正常的細胞即使快速的長出正常細胞，幾次分裂後會耗盡能量不再分裂，什麼可以使癌細胞無止盡的分裂不致匱乏？

An emerging, although highly controversial, answer to this question is that cancer's immortality, too, is borrowed from normal physiology. The human embryo and many of our adult organs possess a tiny population of stem cells that are capable of immortal regeneration. Stem cells are the body's reservoir of renewal. The entirety of  human blood, for instance, can arise from a  single, highly potent blood-forming stem cell (called a haematopoietic stem cell), which typically lives buried inside the bone marrow. Under normal conditions, only a fraction of these blood-forming stem cells are active; the rest are deeply quiescent – asleep. But if blood is suddenly depleted, by injury or chemotherapy, say, then the stem cells awaken and begin to divide with awe-inspiring fecundity, generating cells that generate thousands upon thousands of blood cells. In weeks, a single haematopoietic stem cell can replenish the entire human organism with new blood - and then, through yet unknown mechanisms, lull itself back to sleep.

有一個新的仍充滿爭議性的解釋回答這個問題；癌細胞的永續分裂能量乃是借自正常的生理，人類胎兒期和成人的很多器官裏仍然有小量的幹細胞，他們具有永續再生的能力，幹細胞就像人體的再生水庫。人體的全部血液是由一個有力的通常埋藏在骨髓裡面的造血幹細胞產生。在正常情況下僅有一小部分的幹細胞會造血，其他的幹細胞處於休眠狀態，但是當因為受傷或化療時血液忽然缺乏，造血幹細胞會甦醒過來大量繁殖血球細胞，在幾週內單一個造血幹細胞就能夠補充人體器官所需要的新血，之後透過某種未知的機制幹細胞解除活力再度進入休眠。

Something akin to this process, a few researchers believe, is constantly occurring in cancer – or at least in leukaemia. In the mid-1990s, John Dick, a  Canadian biologist working in Toronto, postulated that a small population of cells in human leukaemias also possess this infinite self-renewing behaviour. These "cancer stem cells" act as the persistent reservoir of cancer – generating and regenerating cancer infinitely. When chemotherapy kills the bulk of cancer cells, a small remnant population of these stem cells, thought to be intrinsically more resistant to death, regenerate and renew the cancer, thus precipitating the common relapses of cancer after chemotherapy. Indeed, cancer stem cells have acquired the behaviour of normal stem cells by activating the same genes and pathways that make normal stem cells immortal – except, unlike normal stem cells, they cannot be lulled back into physiological sleep. Cancer, then, is quite literally trying to emulate a regenerating organ – or perhaps, more disturbingly, the regenerating organism. Its quest for immortality mirrors our own.

類似這種程序，少數研究者相信此種狀況經常發生於癌症，或至少是在白血症。1990年代中期，在加拿大多倫多工作的病理學家約翰‧迪克假設血癌的少數細胞也具有無限自我複製的行為。癌幹細胞就像癌症永久性水庫一樣無限制的再複製產生癌細胞。所以當化療殺死了一堆癌細胞後，殘餘份子本質上變得更頑強，再生更多的癌細胞所以化療後復發的機率很普遍。癌幹細胞就像正常幹細胞產生一堆補充細胞只是任務完成後正常幹細胞會進入休眠而癌幹細胞不會。

In July 2009, exactly five years after I had looked down the microscope into Carla's bone marrow and confirmed her first remission, I went to visit her. Just before I left the hospital, I glanced quickly at the first note I had written on her admission in 2004. As I had written that note, I  recalled with embarrassment, I had guessed that  Carla would not survive even the induction phase of chemotherapy.

2009年7月正好是我從顯微鏡下檢視卡拉的骨髓是否獲得初步緩解的五年之後。離開醫院之前我去訪視她，我快速的瞥了一下在2004年我為她寫下的筆記，心裏感到慚愧，因為那時我預測她活不過第一階段化療。

But she had made it; a charring, private war had just ended. In acute leukaemia, the passage of five years without a relapse is nearly synonymous with a cure. I handed her the flowers I had brought and she stood looking at them speechlessly, almost numb to the sheer scale of her victory.

但是她成功了，她打贏了自己的第一戰，以急性白血症來說，五年之內沒有復發等同痊癒。我送給她一束花，她默默的注視著花，對自己的勝利沒有一絲喜悅。

I asked Carla how she thought she had survived. How  had she managed, through the long days of that dismal summer, to drive to the hospital, wait in for hours as her blood tests were run, and then, told that her blood counts were too low for her to  be given chemotherapy safely, turn back and return the next day for the same pattern to be repeated?

我問卡拉對她能活下來有何想法。她如何度過那年悲慘的夏天，自己開車去醫院，等待數小時看血液檢驗報告，然後被告之血球數太低要作化療，回家後隔天又被要求來醫院重驗。

"There was no choice," she said, motioning to  the room where her children were playing. "My  friends often asked whether I felt as if my life  was somehow made abnormal by my disease. I would tell them the same thing: for someone who is sick, this is their new normal."

「沒有選擇」她說時深情的看著在房間裡玩耍的小孩「我的朋友經常問我的感覺好像我的生命因為我的病變得不正常，我始終回答他們，人要是生病了那就是他們新的平常生活的開始」

Taken to its logical extreme, the cancer cell's capacity consistently to imitate, corrupt and pervert normal physiology raises the ominous question of what "normality" is. If  the genes that unleash many forms of cancer are already present in every cell, then these cancers can  no longer be imagined as "exogenous" or "unnatural" phenomena. Cancer is inherently stitched into our genetic being. Quite possibly, as it has been for Carla, cancer is our "new normal". The question then will not be if we will encounter this immortal illness in our lives, but when.

把這邏輯推到極致，癌細胞一直冒充、腐蝕、打擊正常生理，它引起了一個疑問「什麼才是正常呢？」如果癌症基因已經呈現在每一個細胞上，那麼它還能稱是「外來的」或「不自然的」嗎？癌可能天生就附在我們的基因裏，正如卡拉所說癌是我們的新的平常生活，問題就不再是是否我們會罹患，只是何時而已。

It is important not to be too glib about this idea. Certain cancers are  caused largely by preventable exposures to carcinogens or viruses. Lung cancer is directly linked to smoking. Liver cancer has been long associated with inflammation and repair in liver cells caused by hepatitis B and C virus. Cervical cancer is often caused by a  sexually transmitted papilloma virus. These cancers do not arise accidentally or "naturally", but are caused by particular behaviours or exposures that can be modified and changed.

很重要的是不要太去強辯這個主意，某些癌症的引起是因大量暴露於致癌物或病毒。肺癌與抽煙相關，肝癌是和長期B或C型肝炎引起的經常性肝細胞發炎和修復相關，子宮頸癌時常由性行為傳染乳突病毒引起，這個癌症並非意外或自然感染而是由行為和接觸所以是可以改變和預防的。

But for many other cancers – many types of breast or prostate cancer, for example – there is no identifiable or modifiable risk aside from age itself. These cancers seem to arise not because we have exposed ourselves to a known chemical or behaviour, but because our genes themselves are vulnerable. Our cells divide as we age, and there are errors in copying genes from one division to the next. As mutant genes encrust upon mutant genes in our bodies, our cells are inevitably tugged towards uncontrollable growth – cancer.

還有很多其他的癌症如乳癌、前列腺癌沒有辦法避開風險主要是因為年齡關係。這種癌症不是因為化學物接觸或行為而是因為基因的弱化，我們的細胞隨著年齡分裂不知凡幾後，基因的複製出現了錯誤一代又一代突變的基因累積在身體內不可避免的引起細胞無法控制的生長而變成癌。

Indeed, in the developed world – where many other diseases have been eliminated, and thus men and women are living longer and longer – the  rise of cancer incidence has paralleled the rise  in life expectancy. In the US, for instance, life  expectancy grew over the last century, from the late-40s in 1900 to the mid-70s in 2000. Cancer incidence grew in parallel as well: in 2010, one in  two men and one in three women will be  diagnosed with cancer in America. If half of all  men and one-third of all women face this disease during their lives, then in what sense is a  person who develops cancer "abnormal"? Might  the growing spectre of  cancer force us to rethink the metaphors and images that surround this illness?

事實上在開發國家中很多其他的疾病已經被消除了。癌症的增加和壽命的增長成正比，以美國舉例，上一世紀1900年平均壽命是四十幾歲，到了2000年是七十五歲左右，所以癌症也跟著滋長。二分之一的男性，三分之一的女性在其一生中被診斷出罹癌，那麼如何認為癌是不正常的東西呢？又這個幽靈般的癌症迫使我們重新思考環繞著這個病的隱喻和面像。

One way we imagine cancer, at least, is changing. In the past, cancer was typically imagined as an acute disease, treated with surgery, radiation and chemotherapy. And the trifecta of assaults led to only two possible outcomes. Either cancer was eradicated from the  body – in other words "cured" – or it remained  recalcitrant to treatment, and was "incurable". The metaphors attached to cancer followed this binary outcome. Patients fought a "battle" with cancer. If cancer was defeated, then patients "won" the war. If patients lost the battle, the cancer was victorious. There was no intermediate outcome – no truce.

我們想像癌症的方式正在改變中。過去癌症被想成是急症，用開刀、輻射線和化學治療處理，這種三連砲出擊僅導致兩種結果︰要不癌症被徹底根除痊癒了，要不癌症仍在頑強抵抗就是無藥可救，那暗示只有輸贏兩種結局沒有中間妥協的可能。

But for many forms of cancer, this binary description no longer captures the truth. Take, for instance, a young woman with breast cancer. She may initially have surgery to remove the primary tumour from her breast. But we now know that surgical removal of the tumour may not cure such a patient outright. Microscopic deposits of cancer cells may be left behind after  surgery that can be eradicated only with  chemotherapy and radiation, typically administered over several months. And more drugs and treatments might follow. If her cancer is of a particular subtype, she may receive  anti-oestrogen therapy for several years. During this time, and for decades after, she may  be tested with mammography to detect early  breast cancer in her other breast. Her daughters may be tested for carrying genes that  predispose to  breast cancer. Indeed, her course of therapy might stretch into five or  even 10 years, perhaps even to the next generation. Suspended in limbo, she will be neither cured, nor deemed incurable – neither cancer-free nor  cancer-afflicted. Rather, cancer will become a  chronic condition for her; she will live in its immediate shadow for decades, never quite certain about her outcome. The combination of  surgery, chemo and radiation will likely extend her survival – but, having entered the world of cancer, her life will be permanently altered. As it did for Carla, for her, cancer will become the new "normal".

但是就許多癌症而言，這樣的二分法是不正確的。舉例一位年輕女性罹患乳癌，她可能起初開刀從乳房去除腫瘤，我們現在知道外科開刀無法完全治瘉病人，極小的潛伏癌細胞唯有用化療和放射線治療經過幾個月之後才能根除，假如她的癌細胞是特別的亞種，她可能要用抗雌激素治療好幾年。在這段幾十年的時間裡，她可能要用乳房X光機去檢測另一側的乳房有無早期癌細胞。她的女兒可能帶有乳癌基因要早期篩檢。她的治療期可能從五到十年甚至延伸到下一代。七上八下的折磨，她既不像治好又不像不能治好，癌症不像沒有了，癌症也不像沒有折磨她。癌症變成慢性病，她將在癌的陰影下幾十年沒有確定結果。外科、化療、放射線的結合治療延長了生命，但是一旦癌進入了她的世界，她的生命也永久的改變了，就像卡拉所說的她進入了一個「新的平常生活」。

Such cases are not rare in cancer. A disease called chronic myelogenous leukaemia (CML) once carried dismal survival figures: most patients died within three to five years. But a  new  drug called Glivec has transformed this  form  of cancer. CML patients who respond to  Glivec appear to live nearly as long as patients  without any form of cancer; their life expectancy is virtually identical to age-matched men and women. And yet, notably, Glivec does  not cure CML; it converts this leukaemia into a chronic disease. The leukaemia cells remain  abated as long as treatment continues. If  the drug is stopped, even for a few weeks, the  leukaemia cells return in the bone marrow and blood. For CML patients on Glivec, then, leukaemia defines their normal state of living. They live, age, bear children, work, travel and  celebrate holidays in the shadow of  CML, and  in the company of an orange pill that keeps  them alive.

如此情形在癌症上並不罕見，有一種病叫慢性骨髓白血症(CML)患者通常在三至五年內死亡。但是有一種新藥叫Glivece改變了型態，CML患者服用了它可以活得和正常男女平均壽命一樣久。但是CML並沒有治癒癌症只是把它轉為慢性病，只要治療持續會使癌細胞威力減弱潛伏起來，一旦停止服藥只要幾個星期癌細胞就又回到血液和骨髓裏。所以慢性骨髓白血症(CML)患者不論任何年齡、工作、旅行和度假都要帶著這個橘色藥片讓他們活下去。

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. Cancer is stitched into our genome, it ， is a flaw in our growth, but this flaw is ultimately deeply entrenched in ourselves. We  can rid ourselves of  cancer, then, only as much as we  can rid ourselves of the processes in  our physiology that  depend on growth – ageing, regeneration, healing, reproduction.

或許癌症定義了我們生命的大限，當我們身體老化時，細胞的分裂造成突變，累積形成癌症，它就是我們器官們的終站。癌滲透入我們的基因組，它是我們生長的缺陷，最後盤據我們的生命。要逃避癌症就像要免除我們生理的成長歷程︰老化、新生、恢復、再生。

Is the end of cancer conceivable in the future? Is it possible to eradicate this disease from our bodies and our societies for ever? Or should our goals be more modest?

未來可以終止癌症？它有可能從我們的身體或社會根除嗎？或者我們的目標要更謙卑一點？

The English epidemiologist Richard Doll liked  to  say that "death in old age is inevitable, but death before old age is not". Perhaps Doll's  favourite aphorism represents a more reasonable proximal goal to define success in  the  war on cancer. It is possible that we are fatally conjoined to this illness, forced to play  its  cat-and-mouse game for the foreseeable future of  our species. But if cancer deaths can be  prevented before old  age, if the terrifying game of treatment, resistance, recurrence and  more treatment can be  stretched out longer  and longer, then it will transform the way  we imagine this ancient illness. Given what  we know  about cancer, even  this would represent a technological victory unlike any other  in our history. It  would be a  victory over  our  own inevitability – a victory over  our  genomes.

英國病理學家理查‧杜爾喜歡說「死亡對老年人來說是無法避免的，但是對非老年人說不是」。或許杜爾的格言對癌症的戰爭短期目標來說表現得更合理。我們命中注定要和癌症盤旋，在我們這個物種可見的未來是個貓捉老鼠的遊戲。但是假如癌症之死亡可以在老化之前預防，假如這個治療、對抗、復發和再治療的可怕遊戲可以延展的更久，那麼它將轉換我們對這個古老疾病的看法。認清我們所知的癌症，即使它非過去般在技術上的勝利，它也是一個讓我們認清我們自己的宿命，在基因組上的勝利。

• This is an edited extract from The Emperor Of All Maladies: A Biography Of Cancer, by Siddhartha Mukherjee, published by Fourth Estate at £25. To order a copy for £20 (including UK mainland p&p), call 0330 333 6846 begin_of_the_skype_highlighting              0330 333 6846      end_of_the_skype_highlighting, or go to guardian.co.uk/bookshop.

本文取材自「疾病帝王；癌症的自傳」Siddhartha Mukherjee著，第四版