Book Review

Neoplasms of the Digestive Tract: Imaging, staging, and management

N Engl J Med 1998; 339:708-709September 3, 1998

Article

Neoplasms of the Digestive Tract: Imaging, staging, and management
Edited by Morton A. Meyers. 587 pp., illustrated. Philadelphia, Lippincott-Raven, 1998. $165. ISBN: 0-397-51757-2

The tools for the clinical diagnosis of tumors of the gastrointestinal tract are no longer limited to a physical examination, rigid endoscopy, and barium contrast radiography but also include fiberoptic endoscopy, ultrasonography, endoscopic ultrasonography, computed tomography, and magnetic resonance imaging. These techniques continue to find new applications, such as assessment of the pancreatic and common bile ducts by magnetic resonance imaging with high-quality T₂-weighted images. Additional methods, such as positron-emission tomography, spiral three-dimensional computed tomography, and virtual endoscopy, are being studied. All these procedures are used for the initial diagnosis and staging, monitoring the response to treatment, and the detection of recurrent disease. Clinicians in the field of gastrointestinal oncology have to understand the indications and pitfalls of each technique to make the best choices for their patients.

Neoplasms of the Digestive Tract: Imaging, Staging, and Management uniquely serves that purpose. Most of the 46 detailed chapters discuss individual techniques for the imaging of specific organs; for example, chapters 3, 4, 5, and 6, respectively, focus on barium studies, computed tomography, magnetic resonance imaging, and endoscopic ultrasonography in the diagnosis of esophageal cancer. Each organ-specific section ends with a chapter on the management of cancer of that organ. Only for less common tumors, such as gastric lymphoma and small-bowel neoplasms, are the various diagnostic and management issues bundled into one chapter. This consistent framework and the good index make the book useful as a study tool and a reference. It contains hundreds of excellent illustrations and covers the newest techniques. For these reasons, it will appeal to many physicians as a guide to planning strategy for patients with neoplasms of the digestive tract.

The book has only a few shortcomings. The most important one is that little attention is paid to the role of endoscopy in the diagnosis and management of gastrointestinal tumors. The title suggests that the book will provide an overview of the imaging, staging, and management of gastrointestinal tumors, but this goal cannot be accomplished unless the role of diagnostic and therapeutic endoscopy in this field is covered. For example, the book does not contain a separate review of endoscopic retrograde cholangiopancreatography in the diagnosis and management of carcinomas of the pancreas and common bile duct. The focus on radiology is illustrated in chapter 7, “Management of Esophageal Cancer,” by the suggestion that a barium swallow should be the first step in the evaluation of a patient in whom esophageal cancer is suspected, “to serve as a roadmap for endoscopy.” Most endoscopists, however, dislike performing barium tests before endoscopy in a potentially stenotic organ.

In summary, Neoplasms of the Digestive Tract is an excellent book for all physicians involved in gastrointestinal oncology. The editor has managed to produce a very well organized book containing chapters by experts in the field.

Ernst J. Kuipers, M.D., Ph.D.
Free University Hospital, 1007 MB Amsterdam, the Netherlands