Gastrointestinal Oncology: Principles and Practice

Reviewed by:


D Kelsen et al
Published by Lippincott Williams & Wilkins (2002)
ISBN: 0-7817-2230-6.
934 pages plus index.
RRP: A$442.20

This multi-authored textbook is written by experts mainly from the US but with some contribution from co-authors from Europe, Canada, South Africa and Japan. It aims to provide a comprehensive review of the common GI malignancies encountered in both developed and developing countries. The emphasis is on a clear understanding and update on the essentials of the biology, natural history, prevention, diagnosis and multidisciplinary care of patients. The text covers in detail these aspects for cancer of the oesophagus, stomach, hepatobiliary system, large bowel, anal canal, and perianal skin and GI neuroendocrine tumours.

The book is presented in eight sections. The first half of the book reviews the principles and application of epidemiology, pathology, and molecular biology as relevant to GI tumours, together with chapters on principles of medical and radiation oncology and surgery. There are also chapters dealing with organ imaging, nutrition and quality of life issues. The second half of the book deals with organ-specific chapters, and there are two chapters devoted to GI lymphomas and stomal tumours.

Each section follows a common theme with a discussion of relevant information on epidemiology, screening and early diagnosis, pathology, staging and multidisciplinary care. The book is largely non-surgical but there is sufficient surgical emphasis, and operative technique is not overlooked.

Overall, this is a well-produced textbook printed on non-reflective paper and amply illustrated with clear line diagrams, summary tables and good quality black and white photography. Some of the latter key photomicrographs of surgical specimens, laparoscopic and endoscopic views and light microscopy are reproduced in colour as a separate composite atlas at the commencement of the book. In future, it would be better to intersperse these throughout the body of the text. Not surprisingly with a book of this size (some 934 pages plus index) there is some repetition. However, this does not detract from the overall impact, and each chapter largely stands alone yet fits into the overall scheme.

This book has something for everyone interested in GI malignancies. There is sufficient surgery to be instructive to non-surgical readers and still be valuable to trainees. Overall, it is pitched at senior students and especially advanced trainees in both medical and radiation oncology, but non-specialists will also find it useful for revision and update. A big appeal is the comprehensive bibliography at the end of each chapter, with most references drawn from the English language literature over the past 10 years.

It is impossible for one reader to give an authoritative resumé of all chapters. This reviewer read the section on large bowel cancer with interest, which in part was disappointing and one-sided. For example, there was no discussion on the subject of minimal invasion of an adenomatous polyp. The chapter on the classification and staging of bowel cancer made no reference to ICAT (International Comprehensive Anatomical Terminology) and attempts made to standardise staging as promoted by the international working party report commissioned by the World Congresses of Gastroenterology in Sydney in 1990. Indeed in this section, there is failure to draw distinction on the extent of tumour spread at diagnosis and treatment in a manner that has a clinically useful correlation with prognosis and simply defining tumour spread preoperatively. It needs to be stressed that to date, there is no reliable preoperative staging system that correlates accurately with survival. This needs to be clarified and reference to preoperative staging remains speculative at this time. Also, TNM staging although widely used in North America includes only an optional “R” classification to signify “local residual tumour” and does not assign a stage in such cases. This needs to be changed if there is to be consensus and the adoption of one internationally agreed to staging system.

The chapter dealing with laparoscopic surgery is somewhat hypothetical, and the perceived advantages of this technique still await confirmation from randomised controlled trials. Currently there are many cohort studies that would suggest that although this technique is feasible in expert hands and comparable to open surgery in terms of achieving clear margins and an adequate lymphovascular clearance, it is expensive and the potential for port-site recurrence remains a concern. There is still no long-term data on survival using this type of surgery. The use of radiotherapy for colon cancer is interesting, but remains controversial. There is little information on the use of laser technology for palliation of locally advanced tumours perhaps combined with endoluminal brachytherapy, or the use of stenting for obstructing tumours. A discussion on the use of selective chemotherapy in colon cancer would have been welcomed. TME surgery in rectal cancer is somewhat one-sided. No attempt is made to address issues of case selection and other confounding variables when discussing the place of this operation. What is important in TME is the precise mobilisation of the rectum along strict anatomical planes using either sharp or diathermy dissection. In this regard, the surgical importance of recognising the perirectal fascia and the retrorectal plane is clear. Also, more could have been said of the importance of methodological differences when reporting local recurrence after curative excision of rectal cancer.

Overall, these are fine points of controversy, which in no way distract from what is an excellent first edition on an important subject. This book belongs on the shelf of hospital libraries.

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