Abstract
An attempt to capture the entire field of colorectal cancer in a single work is ambitious. Advances are rapidly occurring in many fields directly related to colorectal cancer, including prevention, radiology, surgery, and chemotherapy with both traditional cytotoxic and novel agents. The goal of this book is to provide a concise, focused, and current review of these and other advances, of which it does an admirable job. The book is split into 6 sections: Epidemiology/Prevention, Diagnostic and Therapeutic Radiology, Surgery of Colorectal Cancer, Medical Oncology, Supportive Management, and New Agents. This format is well conceived and provides the reader with a logical flow of information from start to finish. The Epidemiology/Prevention section builds from an opening discussion of the biology and molecular genetics of colorectal carcinogenesis. This thoughtful review includes information about established mechanisms as well as emerging concepts, such as DNA methylation. Risk factors for colorectal cancer are covered in multiple chapters, which allows the casual reader quick access to pertinent data. Rationales for current early detection and other management guidelines are presented in a user-friendly manner, although some topics, such as fecal occult blood testing, are described fairly briefly. An entire chapter is devoted to chemoprevention and, unlike some other resources, this chapter provides a nice overview regarding the basic premises for chemoprevention, as well as descriptions of the most promising agents. Essential concepts in Diagnostic and Therapeutic Radiology are carefully examined, with key points emphasized by well-chosen visual images. Comments included in the chapter on nuclear medicine challenge existing paradigms in colorectal cancer management. The discussion of radiation therapy for hepatic metastases is, although succinct, particularly instructive for nonexperts in the field. In the section on Surgery of Colorectal Cancer, basic elements of surgical pathology are reviewed in detail, allowing this chapter to serve as a single, informative reference for practicing clinicians. Surgeons who are actively involved in researching the role of laparoscopy in colorectal cancer management provide a broad review of the salient issues. Other wide-ranging topics, including conservative management of early-stage rectal cancer, surgical approaches for distant spread of disease (liver, lungs, and peritoneal surface), and combined operative/ablative interventions for hepatic metastases are covered using a mix of objective data and expert opinions. Medical Oncology is addressed fairly comprehensively, with chapters on 5-Fluorouracil, oral Fluoropyridines, Irinotecan, and Oxaliplatin. A relative omission in this section is the adjuvant therapy of rectal cancer, which has multiple nuances (some of which are discussed in the earlier section on radiation therapy for rectal cancer). The discussion of oral Fluoropyridines is well balanced, with appropriate caution against the use of these agents in the adjuvant setting given the lack of clinical trial data demonstrating their efficacy in that setting. The adjuvant therapy chapter has an excellent discussion of the evolution of the current standard of care, and of the issues of value of therapy for stage II disease. It would have benefited from further discussion of issues regarding bolus versus infusional delivery of 5-Fluorouracil. The discussion of markers deals mainly with markers of 5-FU sensitivity. Section 5, on supportive management, covers pain syndromes and pain management, sexuality and fertility, as well as complementary and alternative management strategies. Each topic is addressed thoroughly, with discussion and references to relevant literature within and outside of the colorectal field. This material is difficult to find, and this comprehensive review is a notable strength. The closing section on new agents is again comprehensive but somewhat encyclopedic, with many agents and approaches presented and briefly described, but limited opinion expressed as to what the most promising one or two areas might be. One area of omission is the role of Cox-2 inhibitors in colorectal cancer treatment (though they are discussed in an earlier section in respect to their possible chemopreventitive role). For a compilation of chapters from many different authors, the book reads well, with good uniformity and integration across most sections. The overall style could be favorably described as “dense,” since the chapters are typically packed with information that is current, comprehensive, and detailed. The text is complemented by figures and tables that are clear, helpful, and appropriate in quantity. Bottom Line: In our opinion, this book provides a valuable general reference resource on colorectal cancer for clinicians, researchers, or trainees.
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