Book Review

Cancer of the Colon, Rectum, and Anus

N Engl J Med 1995; 332:1656June 15, 1995

Article

Cancer of the Colon, Rectum, and Anus
Edited by Alfred M. Cohen and Sidney J. Winawer, with Michael A. Friedman and Leonard L. Gunderson. 1154 pp., illustrated. New York, McGraw-Hill, 1994. $125. ISBN: 0-07-011601-6

Dear Uncle,

Thank you very much for the wonderful book on elephants you sent me for my birthday. It told me more than I ever wanted to know about elephants.

Your niece

While settling down on many occasions to the task of reviewing this large book on neoplasia of the large intestine, I thought of that apocryphal little girl. But after completing the review, I had feelings quite the opposite of hers, although words such as “tome,” “comprehensive,” and even “exhaustive” kept coming to mind as I read through 109 chapters and a total of 1154 pages.

This is not an elementary textbook. I would describe it as a state-of-the-art review of the areas of special interest and expertise of 140 authorities, including the editors. The subject matter includes epidemiology, causation, genetics (including a discussion of the polyposis syndromes and their molecular basis), pathogenesis and oncogenesis (including precursor lesions and molecular biology); metastasis, pathology, diagnosis, staging, surveillance, and prevention; and the treatment of primary and metastatic disease, including surgery, radiotherapy, chemotherapy, and pain control. Anal cancers and rarer tumors are also well addressed. Necessarily, there is some redundancy and even contradiction that at times I wished the editors had highlighted and not left standing without some comment by themselves or the authors. Examples of truly outstanding chapters include that by Fidler on the biology of invasion and metastasis, that by Lennard-Jones and Connell on surveillance in inflammatory bowel disease, that by the Lynches on the Lynch syndromes, and that by Minsky on clinicopathological selection criteria for local therapy of rectal carcinoma.

Reading the book made me feel as though I was attending an up-to-date and comprehensive postgraduate course. I still wished, however, that there had been a way to bring the reader up to speed on such (to me) arcane areas as molecular biology and genetics. Other readers may have different “knowledge deficits” and would benefit from a more basic perspective in some of the chapters. Since the book is designed to be state of the art, there is a built-in difficulty. The clock is ticking on its being completely current. Most of the references were no more recent than 1992, although I found some from 1993 and a very few from 1994.

The editors had the authors eschew summary abstracts but instructed them instead to preface their chapters with (it was hoped) pithy “Highlights,” “Controversies,” and “Future Directions.” I found this feature very helpful when well done or done at all. The lack of uniformity left me mildly frustrated, but one can imagine the chagrin of the editors, although they ducked the question of uniformity in the preface by stating that this feature would be used “when appropriate.”

From a technical point of view, the book is of high quality and easily readable. The tables and illustrations are helpful, and the index appears quite complete. I found remarkably few production errors other than an embarrassing grammatical mistake in one of the dedications at the very front of the book. Although I understand the economic reasons, I did not find it helpful to have eight pages of colored illustrations sandwiched into the middle of the book. Black-and-white versions of these pictures usually appeared in the appropriate places in the text.

The editors and authors have accomplished their goal of providing us with a “timely, critical analysis of our knowledge concerning the biology and therapy of cancer of the colon, rectum and anus.” Although some of the material has been covered in recent textbooks, this is not another “me too” book. It would be a useful reference book for every medical library and for surgeons, oncologists, gastroenterologists, and perhaps basic scientists working in the field.

Donald J. Glotzer, M.D.
Beth Israel Hospital, Boston, MA 02215