Surgical Oncology

This book is one in the series of Bailliere's Clinical Gas-troenterology. The books in this series are reviews of specific subjects, with chapters written by acknowledged experts and a guest editor. Inevitably, there is a variety of styles of writing and some repetition. The chapters are all written by enthusiasts for their own area of work and can be less than objective. In this volume, however, the editor has produced a book with few of these faults. He has not allowed his authors to be too abstruse, the chapters have been written with the practising clinician in mind; all try to be objective, setting their particular field in its overall context. The book begins with an informative and descriptive account of the pathology of cancer of the pancreas. There is a good review of the results of diagnosis via pancreatic biopsy and a preliminary classification of tumours into subgroups suggesting a good or bad prognosis-a worthwhile development for the assessment of various therapeutic modalities. This chapter is followed by one describing recent developments in the cell biology of pancreatic cancer. There is a good synopsis of the facts in this new area concerning growth factors and oncogenes. Many gaps in our knowledge are pointed out, queries are posed and future research areas are outlined. The authors assume a fair degree of knowledge and the text is somewhat fragmented, reflecting the gaps in this area. Chapter three gives a good account of serum diagnostic tests. Such tests are set in context and their limited usefulness is recognised. Various clinical subgroups may be recognised using such tests, and they may further our understanding of tumour biology. There is a lot of emphasis on the authors' own work but it is set in its correct perspective. There follows a chapter on radioimmunolocalisation of tumours which gives a good explanation of the theory and potential of this technique. The technique has limited usefulness however, being somewhat nonspecific and insensitive. Endoluminal ultrasound in diagnosis is then reviewed. This chapter gives a clear account of its role and use. The technique is a step forward in anatomical diagnosis but it requires considerable expertise and further clinical evaluation. There follow three chapters on surgery for pancreatic cancer. There is a good didactic overview from the British standpoint. Surgical results are reviewed with the right note of caution. There are well written descriptions of the procedures even a …

This book is one in the series of Bailliere's Clinical Gastroenterology. The books in this series are reviews of specific subjects, with chapters written by acknowledged experts and a guest editor. Inevitably, there is a variety of styles of writing and some repetition. The chapters are all written by enthusiasts for their own area of work and can be less than objective. In this volume, however, the editor has produced a book with few of these faults. He has not allowed his authors to be too abstruse, the chapters have been written with the practising clinician in mind; all try to be objective, setting their particular field in its overall context. The book begins with an informative and descriptive account of the pathology of cancer of the pancreas. There is a good review of the results of diagnosis via pancreatic biopsy and a preliminary classification of tumours into subgroups suggesting a good or bad prognosisa worthwhile development for the assessment of various therapeutic modalities.
This chapter is followed by one describing recent developments in the cell biology of pancreatic cancer. There is a good synopsis of the facts in this new area concerning growth factors and oncogenes. Many gaps in our knowledge are pointed out, queries are posed and future research areas are outlined. The authors assume a fair degree of knowledge and the text is somewhat fragmented, reflecting the gaps in this area.
Chapter three gives a good account of serum diagnostic tests. Such tests are set in context and their limited usefulness is recognised. Various clinical subgroups may be recognised using such tests, and they may further our understanding of tumour biology. There is a lot of emphasis on the authors' own work but it is set in its correct perspective.
There follows a chapter on radioimmunolocalisation of tumours which gives a good explanation of the theory and potential of this technique. The technique has limited usefulness however, being somewhat nonspecific and insensitive. Endoluminal ultrasound in diagnosis is then reviewed. This chapter gives a clear account of its role and use. The technique is a step forward in anatomical diagnosis but it requires considerable expertise and further clinical evaluation.
There follow three chapters on surgery for pancreatic cancer. There is a good didactic overview from the British standpoint. Surgical results are reviewed with the right note of caution. There are well written descriptions of the procedureseven a physician can understand! Some diagrams would have been helpful. Despite the author's extensive surgical experience he is notably cautious in his claims for surgical cure. There is an American view of pylorus-saving surgery. This seems to be a real surgical advance. The chapter is well written and attempts to be critical. The message is to wait and see but that it is in specialist centres that pancreatic operations should be performed. The Japanese surgical experience is then described, with better results for survival after radical resection for small tumours than would be expected in the UK. This is an encouragement for further detailed study of resection in subgroups of patients. This chapter is a bald account of surgical findings, with little opinion or discussion.
Chapter nine gives a comprehensive review of the evidence relating sex hormones and their receptors to pancreatic function and pancreatic cancer. This is obviously an area of great interest for further study, particularly via molecular biology techniques. An attempt at an overall summary with a unified hypothesis would have been helpful.
Three further chapters on therapy follow: there is an excel-lent chapter on chemotherapy for pancreatic cancer. This is an authoritative and well written review. The requirements of good clinical trials in this difficult area are clearly summarised. The overall poor results are well documented with tabular summaries. The result is a clear picture of the role (and possible way forward) for chemotherapy. Radiotherapy for pancreatic cancer is then adequately reviewed. The enthusiast is naturally optimistic, but the summary describes accurately the present limited role of radiotherapy. Further areas for research and development are suggested. Despite being somewhat technical for the nonspecialist, the message of the chapter is clear. Extensive radiotherapy combined with radical surgery in Japan is then described. Once again the Japanese, with their boldness in approach, appear to be producing improved results. This is a well written account of a combined aggressive approach, with impressive results. The technique obviously needs further evaluation. It is dependent upon local expertise, the number of patients is small and comparisons are with historical controls. The extensive therapy is not without severe nutritional complications. The approach is of interest in the context of the treatment of this disease where so often treatment is inadequate.
The final chapter is concerned with nonoperative palliation of pancreatic cancer. It gives a good account of the palliation of biliary obstruction by nonsurgical means but there is no discussion of pain relief or other complications of the disease. The advantages and disadvantages of the techniques of biliary drainage are well described.
This multi-author book has been well edited and maintains a high standard throughout. The range of topics reviewed is wide and the volume provides a good up to date account of pancreatic cancer for the practising clinician. Obviously it is not intended to be the authoritative text on this disease, but the ample references allow one to read further. It is a worthy addition to the series in Baillieire's Clinical Gastroenterology.
The place of surgical oncology as a sub-specialty has become well established in the United States, but in the United Kingdom its place is still uncertain. A surgical oncologist may be defined as a trained surgeon with a committed interest in cancer research, expertise in the care of patients with malignant disease and familiarity with the principles and potential applications of surgery, radiotherapy, chemotherapy, immunotherapy and other new treatment modalities. This multi-authored book aims to give an up to date overview of these concepts in surgical oncology as practised in the UK, where the surgical care of patients with malignant disease is usually undertaken by general surgeons with a regional interest. There are sixteen chapters of similar length, which are divided on a regional basis and written by specialists in their field, with most chapters containing extensive bibliographies.
The chapters on carcinoma of the oesophagus and the pancreas and biliary tree provide up to date overviews of the aetiology, pathology, diagnosis and multimodality treatments of these tumours. The chapter on oesophageal cancer could have benefited with some illustrations and the contentious issue of parenteral nutrition is only touched upon. The principals of surgical resection are well summarised as are the place of irradiation and chemotherapy. The section on carcinoma of the pancreas and biliary tree also provides an excellent summary of the more common tumours presenting to the surgeon and their appropriate form of management. Whilst not aiming to give the surgical detail of a Wipple resection, some very useful key points to bear in mind whilst undertaking this demanding operation are stressed. I was surprised to read the recommendation of temporary biliary drainage prior to undertaking this operation in jaundiced patients, as there is no evidence to recommend this practice routinely. Endocrine and cystic tumours of the pancreas and gall bladder carcinoma are not covered.
The management of gastric cancer is well summarised including the results of recent chemotherapy trials, but the detailed surgical techniques and their indications were by necessity omitted. Colorectal cancer surgery has traditionally been the domain of all general surgeons, but with the advent of pouch surgery and more sphincter-preserving operations has come an even greater need for specialist colorectal surgeons. The issue of population screening for colorectal cancer is well covered, as is the detection of liver metastases, although I disagreed with the recommendation that their presence or absence should be established pre-operatively in all cases. The surgical treatment of carcinoma of the rectum is given a separate section although there is no mention of transanal excision, resection or irradiation and carcinoma of the anal canal is not discussed. The management of hepatic metastases from colorectal cancer is controversial with the place of surgical resection, regional and systemic chemotherapy uncertain; unfortunately the section devoted to it does not clarify this contentious subject.
This book contains a good summary of the management of the more common endocrine tumours, but perhaps a section about the multiple endocrine neoplasia syndromes could have been included. The four chapters on urological oncology were of interest to me as a non-urologist, although possibly out of place in a book of this length and reading audience. Bone and soft tissue sarcomas are discussed together, with a bias towards the former which was not as one might expect in a book of this type. In the chapter on melanoma the importance of complete nodal clearance whenever this operation is performed for nodal disease is emphasised and whilst isolated limb perfusion is mentioned, there are no details of the technique or results of its use for recurrent disease.
It is in the management of breast cancer that the surgeon's role as a member of a multi-disciplinary team is probably best exemplified and the chapter related to this section gives a good basic overview. There is little information about the enormous advances in molecular biology and the use of prognostic factors. Surprisingly, breast reconstruction and the management of locally advanced disease are not discussed. The final sections on the principles of cancer chemotherapy and recent advances in cancer research provided succinct informative reviews of these interesting topics.
In conclusion, it is difficult to define the market at which this book is aimed, although it does succeed in its aim of providing an up to date review of the topics covered. This book lacks the detail necessary for the consultant general surgeon and the surgeon or senior registrar with a special interest in oncology. It is, however, a useful overview for those preparing for the second part FRCS, but is not, as is claimed by the publishers, essential reading. This slim volume is, in effect, the tabular part of the latest Cancer Incidence in Five Continents (Vol. 5) published in 1987 which incorporates incidence data from 36 countries, for all malignancies for the years 1978-82 or thereabouts. The plethora of tabulation in this volume make it difficult to digest, even for epidemiologists. The present book attempts to rectify this by reducing the tabular data in a variety of ways. A series of bar charts of incidence by cancer site is organised in sequences of highest to lowest rates, pie charts by country and selected cancer sites are given and fuller age specific incidence graphs are shown by site by country.
There is a brief chapter giving explanation detailswhich is adequatebut no further words of comment or explanation are given in the text.
Graphical data always have an attraction way beyond their tabular counterparts and this volume is very appealing. Its systematic approach makes this an immensely useful volume to turn to and it should provide material for comment, investigation and teaching throughout the world.
There is very little to criticisethe user should beware of the caveats regarding the accuracy of the companion volume in particular beware of over interpretation of data for some registries where small case numbers occur and where good census data are not always readily available. The diagrams occasionally become victims of their own logical scheme in that some of the pie diagrams do not shade consistently. Such comments are trivial compared with the overwhelming burden of good and interesting data, well presented in a clear fashion and understandable to all. In many ways this atlas is a far less satisfactory product than the previous work. It is also a companion volume to a previous publicationin this case an atlas on cancer mortality in US white populations. The authors are thus constrained by decisions made about that volume in the production of this one. Non-whites means the black, amerindian and asian members of the community. Numbers of the latter two groups are small and the data are dominated by the black population. The descriptive elements are not full or critical enough for the reader to acquire very much sense of the interpretability of the results. The geographic analysis is somewhat confused by the use of 'state economic areas' which are not fully explained in the text.
Perhaps the most useful parts of the results appear in the early pages where comparison of rates with whites are made followed by changes in the non-white rates with time. These reveal recent higher rates of male lung cancer in non-whites and the better known excesses of myeloma, prostate and oral cavity cancers in certain groups. Similarly there are lower rates of Hodgkin's Disease and melanoma.
The mapsfour for each sex by sitetake some while to appreciate fullygiving rates for each of the 3 decades and a time trend. However, only the extremes of the distribution are coloured. Because the numbers of non-whites is not evenly distributed around the country, for me, this makes interpretation very difficult indeed. The authors draw attention to some aspects of the geography about which they are confident but it is difficult to see what else can be gleaned from this compilation. This is thus very much a specialist volumeuseful to certain epidemiologists, geographers and public health specialists in the US but it is unlikely to have much general appeal.

R.A. Cartwright
Cancer: Causes, Occurrence and Control (IARC Scientific Pubs. No.  Epidemiology and prevention together form the principal focus of the activities of the International Agency for Research on Cancer, the autonomous cancer research arm of WHO. It is appropriate therefore that it should have chosen