Book Review

Principles and Practice of Gastrointestinal Oncology

N Engl J Med 2008; 359:771August 14, 2008

Article

Principles and Practice of Gastrointestinal Oncology
Second edition. Edited by David P. Kelsen, John M. Daly, Scott E. Kern, Bernard Levin, Joel E. Tepper, and Eric Van Cutsem. 749 pp., illustrated. Philadelphia, Lippincott Williams & Wilkins, 2008. $199. ISBN: 978-0-7817-7617-2

This textbook is an informative resource concerning core principles and practices in gastrointestinal oncology. It covers a wide range of practice areas, with good examples of pathology and radiologic images and useful chapters on epidemiology, genetics, staging, and pathology for each primary tumor site.

The production lead time for textbooks can result in content that is outdated by the time of publication. This problem is evident in some areas of this book, particularly in relation to the management of specific tumor types for which therapeutic developments have led to changes in best practice that are not wholly represented. However, the comprehensive coverage makes this book a useful resource for the practitioner wishing to gain a greater understanding of the principles of managing malignant gastrointestinal disease.

The book opens with a well-structured chapter on epidemiology, followed in the next chapter with a useful summary table of immunohistochemical patterns for different tumor types. Screening and surveillance recommendations are well presented and clearly written throughout the book. The inclusion of a chapter devoted to complementary therapies is welcome; this is a topic that is often of interest to patients but in which most oncologists have had little formal training. The chapter on medical imaging in the management of gastrointestinal cancers is valuable to the reader, as it describes the basis of each imaging technique as well as its application in staging and evaluation of responses to treatment. The next chapter addresses endoscopy. It includes guidance on endoscopic screening of patients at high risk for cancer and informative sections on the role of endoscopic ultrasonography and endoscopic interventions for Barrett's esophagus and high-grade dysplasia, including photodynamic therapy, argon plasma coagulation therapy, and endoscopic mucosal resection.

The treatments discussed do not always reflect practice outside North America, most likely because the majority of the contributing authors are from the United States. The transatlantic differences in treatment are particularly apparent in the recommended management of upper gastrointestinal tumors, where the emphasis in the book is predominantly on chemoradiation rather than on neoadjuvant, perioperative, or postoperative chemotherapy. In contrast, there is an informative discussion on the shift in the United States from postoperative to preoperative chemoradiation for rectal cancer, although it is acknowledged that postoperative chemoradiation is still often regarded as the standard of care. Comprehensive and detailed discussion of both the molecular biology of colorectal cancer and screening and surveillance is provided. There is also an excellent chapter dedicated to the treatment of colorectal liver metastases, an important area in which the best management strategies are still under investigation.

The final chapters of the book cover the uncommon gastrointestinal tract cancers, including anal cancer, neuroendocrine tumors, gastrointestinal stromal tumors, and malignant peritoneal mesothelioma. Treatments are discussed along with epidemiology, histopathology, and the diagnostic workup for these tumors. Importantly, a strong theme throughout these chapters encourages participation in clinical trials to facilitate the development of more effective treatments.

Principles and Practice of Gastrointestinal Oncology is a comprehensive overview of the multidisciplinary management of gastrointestinal cancers and will be a valuable resource. In common with most textbooks, it should not be used as the sole resource to guide management decisions for patients with gastrointestinal cancers but should instead be used in conjunction with data from current clinical trials.

David Cunningham, M.D.
Royal Marsden Hospital, Sutton SM2 5PT, United Kingdom