Colorectal Cancer: Multimodality Management


LB Saltz (ed)
Published by Humana Press (2002)
ISBN:  0-8690-3935-8.  835 pages plus index.
RRP:  A$195.00

This book is extensive in scope, aiming to provide a “well-balanced, authoritative, evidence-based review of the current approaches to the prevention, diagnosis and treatment of colorectal cancer” and is divided into six segments. These are epidemiology and prevention, diagnostic and therapeutic radiology, surgery, medical oncology, supportive management and new agents in colorectal cancer.

Each section has significant strengths. In the first section on epidemiology and prevention there is an excellent overview on the chemoprevention of colorectal cancer. The chapter on screening and surveillance is reasonable, but does not adequately address the role of the Bethesda criteria in identifying families who may require investigation for hereditary non-polyposis colorectal cancer. 

The section on diagnostic and therapeutic radiology provides excellent chapters on the role of virtual colonoscopy, nuclear medicine and preoperative staging of rectal cancer. Within the section on surgery, the chapter examining the role of laparoscopy in colorectal cancer is balanced by cautious concluding remarks, which rightly place the technique in the setting of research trials rather than routine clinical practice until long term outcomes and cost efficacies are known. The chapters on cryosurgical and radiofrequency ablation of hepatic metastases suffer from enthusiasm being weighted over evidence. Both techniques require better trials before their role can truly be assessed. The chapter on the surgical management of peritoneal surface spread is written by an obvious enthusiast, and is thinly referenced. Balancing this are solid chapters on surgery of the colon and rectum.  Furthermore the chapter on management of cancer in a polyp is concise and helpful to any budding colonoscopist.

The section on medical oncology provides an excellent, detailed overview to an area that is experiencing rapid change. As with any text in an evolving area, the chapters inevitably are unable to be completely up-to-date, and hence this reduces its utility to established oncologists in the field. However, for non-oncologists involved in the management of colorectal cancer and trainees to the field all the chapters are valuable. Similar comments apply to the section on new agents in colorectal cancer.

The section on supportive care is incomplete. One of the most distressing aspects of advanced colorectal cancer can be bowel obstruction due to recurrent disease and/or peritoneal spread. The medical management role of venting percutaneous gastrostomy and surgery is not covered in this section. Similarly, the role of radiotherapy in pain management is not covered, although the overview of analgesics used is not unreasonable.

This text would be useful for any health professional working in the area of colorectal cancer who wishes to have an accessible text covering other disciplines beyond his or hers in this field. It is relatively weak with respect to palliative management, but the sections on medical oncology and epidemiology and prevention are its greatest strengths.

P Bampton
Dept of Gastrointestinal Endoscopy
Flinders Medical Centre
Bedford Park, SA

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