Book Review

Colorectal Cancer

N Engl J Med 1994; 330:1163-1164April 21, 1994

Article

Colorectal Cancer
Edited by Harold J. Wanebo. 608 pp., illustrated. St. Louis, Mosby-Year Book, 1993. $85. ISBN: 0-8016-6554-X

This is an excellent book. It is aimed at the clinical oncologist, but since the editor is a surgeon, there is a bias toward surgical treatment. This is no bad thing, because most colorectal cancers are first treated surgically. The book is not only about surgery, however; it is a truly comprehensive discussion of the problem of colorectal cancer from a meeting on the subject in Newport, Rhode Island, in 1990. However, one does not get the impression, so common in publications prepared after a meeting, of tired contributors sending in just enough to keep the editor satisfied. Many sections are of the highest quality, written by major players and with exemplary illustrations and line drawings. The book contains sections on the molecular biology and pathology of colorectal cancer, screening, early detection and polyposis, management of primary tumors, adjuvant therapy and clinical trials, surgical management of recurrent and metastatic disease, systemic management of advanced disease, and finally colorectal tumors other than adenocarcinomas. Within each part the surgical and nonsurgical contributions are interspersed to emphasize the importance of a team approach.

Surgical developments evolve slowly, but in molecular biology the advances are so rapid that any book is likely to be overtaken by events. The recent work on sporadic colorectal cancer and chromosome 2 appeared after the book had gone to press. Nevertheless, the first part is a very readable summary of the molecular genetics, biology, pathogenesis, and staging of colorectal cancer. There is a good review of controversies in pathological staging, and a stimulating account of the known factors in the development of metastases. Perhaps the one area in which surgery has made some progress recently is in the use of laparoscopic techniques to remove colorectal tumors. This is included in the book, but as something of an afterthought, since it is dealt with in the last chapter in a rather uncritical way and without any particular emphasis on the specifically oncologic implications of laparoscopic bowel resections.

The second part deals with screening, the treatment of polyps, and the polyposis syndromes. The logistical and economic issues involved in mass screening are sensibly discussed, and the evidence for the polyp-to-carcinoma sequence is presented for each histologic type of polyp. The chapter on endoscopic management of polyps is, refreshingly, discussed by a surgeon rather than a physician-colonoscopist, with the advantage that the subject can be handled in the context of the appropriateness of open as compared with endoscopic surgery. The pictures of polypectomy are also excellent. The late David Jagelman wrote the section on familial adenomatous polyposis, and he examines the surgical options with wisdom and common sense.

It can be galling for British surgeons to read American books that do not refer to or cite work done in other countries. The part on the surgical management of colorectal cancers includes contributions from Japan and England, and the bibliographies are international. The section on surgical judgment and technique contains lots of good advice and superb line drawings. There is a review of local excision and a chapter on the specific issue of extended resections when a tumor may involve other organs; this is rounded off nicely by a chapter on the treatment of urologic complications.

All the published and proposed clinical trials of adjuvant therapy are then presented, but the conclusions are necessarily vague, because most of the trials are still in progress or are being vigorously debated. Perhaps there could have been more critical discussion of the recommendations made after the Intergroup trial that all patients with nodal involvement should have adjuvant therapy for one year.

It was a good idea to include a section on surgery for recurrent or metastatic disease, and I especially liked the chapter on pelvic recurrence, which is so often seen as a hopeless nonsurgical problem. There is an omission here, though -- no mention of laser or transanal resectoscopic procedures to debulk recurrent or large primary tumors in elderly patients. Also, it is pleasing to see a chapter on pain control, but it could have been better focused. This is followed by a useful section on systemic therapy for advanced disease, including discussion of the action of fluorouracil and some newer drug combinations, with a look to the future and immunotherapy.

Not only will this book be read and enjoyed by surgeons, radiotherapists, and medical oncologists, but it should also be a great starting point for students and researchers who want access to the literature on colorectal cancer. Your library should certainly have one, and I would suggest you acquire a copy, too.

Neil Mortensen
John Radcliffe Hospital, Oxford OX3 9DU, England