Book Review

Clinical Endocrine Oncology

N Engl J Med 1997; 337:1479November 13, 1997

Article

Clinical Endocrine Oncology
Edited by Richard Sheaves, Paul J. Jenkins, and John A.H. Wass. 559 pp., illustrated. Cambridge, Mass., Blackwell Science, 1997. $199.95. ISBN: 0-86542-862-X

Malignant tumors in endocrine organs are rare, but when taken together account for more than 2 percent of all cancers. Their treatment is dispersed among specialized departments (endocrinology, gastroenterology, pneumology, hypertension, neurology, surgery, and general oncology), where each specialist treats the aspect he or she has been trained for. Most malignant endocrine tumors are slow growing. However, some patients will die of tumor progression or its metabolic consequences. Adequate management of such lesions must include treatment of the tumor and the metabolic consequences of any endocrine hypersecretion. For this reason, patients with endocrine tumors should be referred to specialized units with experts from multiple fields.

In addition, many patients with malignant disease have endocrine or metabolic disturbances such as hypercalcemia. Some may report endocrine disorders induced by cancer treatment. The interrelations between oncology and other medical specialties are such that only a multidisciplinary team can ensure the all-embracing care of these patients.

Clinical Endocrine Oncology, a comprehensive textbook on this subject, provides a solid clinical framework within which physicians of all specialties can diagnose and treat endocrine tumors. The editors have divided the book into seven sections, all written by internationally recognized specialists. Methods of treatment are reviewed in the first section, with emphasis on recent and future therapeutic options, such as gene therapy, tumor targeting, chemotherapy, and interventional radiology. Tumors of the endocrine glands (thyroid, parathyroid, pituitary, hypothalamic, adrenal, gonadal, and neuroendocrine) are dealt with in the following four sections. The molecular abnormalities, pathology, diagnosis, and treatment of each tumor are reviewed extensively. Some of these neoplasms have already been the subject of reviews or books, but others, such as neuroendocrine tumors, are given detailed descriptions based on current understanding and refined classifications, which should dispel uncertainty and clarify the knowledge of many physicians. A detailed description of predisposing syndromes highlights the importance of genetics in this field. Paraneoplastic syndromes, which occur frequently and are often difficult to treat, offer a model of gene expression in human tumors. The endocrine consequences of cancer treatments are also reviewed. Their incidence has increased as the results of cancer therapy improve. The last section deals with immunoendocrine-responsive tumors.

Certain sections may appear too short, such as that devoted to patients with metastases. Decision trees would have clarified the practical therapeutic options. Also, since the efficacy of systemic treatments is poor, prospective trials should have been encouraged, and the rarity of these tumors dictates that they be studied in multicenter trials. Moreover, in this rapidly evolving field, the most recent references are already two to three years old, and the text will soon need to be updated. Nevertheless, this book will be an essential reference for units engaged in the care of patients with endocrine tumors.

Martin Schlumberger, M.D.
Institut Gustave-Roussy, 94805 Villejuif, France