Haematological Oncology - Cambridge Medical Reviews Volume 3

253 curious that over 30 pages are allocated to insulinomas and virtually the same to all the other gastrointestinal and panc-reatic endocnne tumours. As I have already hinted, the only major omission that I can find is the limited reference to the use of octreoscan as a diagnostic agent, which in Europe has become an essential part of the modern diagnostic protocol for the investigation of neuroendocrine cancers. However, this can clearly be updated in future editions, as I am sure this will reach a second edition. Furthermore, in a future edition a little more emphasis could be included on the non-surgical therapies of these cancers. Who is going to buy this book? Reference libraries should consider this a must, and it will certainly be purchased by oncologists, endocrinologists and surgical oncologists with an interest in thyroid and endocrine cancers. However, the general oncologist is probably not going to have this on his shelf. It is also unfortunate that within the next year there is going to be a rival European book published which is likely to cover the same ground. However, it may well be that the volumes are complementary rather than directly rivalling each other. In conclusion, this is an excellent book which plugs a gap that needed filling. It is a must for the reference library and a must for those rare oncologists who have a particular interest in endocrine malignancies. The story of viruses and cancer is important for two distinct reasons. First, some 15% or more of human cancer incidence is linked with virus infection. Major malignancies in the world, such as cancer of the uterine cervix, primary liver cancer, nasopharyngeal carcinoma (NPC) and several forms of adult T-cell leukaemias and lymphomas, have viruses as an essential component of their aetiology and pathogenesis. Second, oncogenic viruses opened up cancer genetics. Oncogenes were first found in retroviruses long bef6re it was realised that the viruses had purloined cellular genes. Tumour-suppressor proteins were first identified through the study of DNA viruses, as viral proteins such as E6 and E7 of the human papillomaviruses sequester the Rb and p53 proteins , which is the phenotypic equivalent of a genetic knockout. Thus, studies of oncogenic viruses have had a significance far beyond that proportion of cancer actually caused by them. This volume on viruses and cancer represents papers given at the 51st Symposium of the British Society for General …

curious that over 30 pages are allocated to insulinomas and virtually the same to all the other gastrointestinal and pancreatic endocnne tumours.
As I have already hinted, the only major omission that I can find is the limited reference to the use of octreoscan as a diagnostic agent, which in Europe has become an essential part of the modern diagnostic protocol for the investigation of neuroendocrine cancers. However, this can clearly be updated in future editions, as I am sure this will reach a second edition. Furthermore, in a future edition a little more emphasis could be included on the non-surgical therapies of these cancers.
Who is going to buy this book? Reference libraries should consider this a must, and it will certainly be purchased by oncologists, endocrinologists and surgical oncologists with an interest in thyroid and endocrine cancers. However, the general oncologist is probably not going to have this on his shelf. It is also unfortunate that within the next year there is going to be a rival European book published which is likely to cover the same ground. However, it may well be that the volumes are complementary rather than directly rivalling each other.
In conclusion, this is an excellent book which plugs a gap that needed filling. It is a must for the reference library and a must for those rare oncologists who have a particular interest in endocrine malignancies. The story of viruses and cancer is important for two distinct reasons. First, some 15% or more of human cancer incidence is linked with virus infection. Major malignancies in the world, such as cancer of the uterine cervix, primary liver cancer, nasopharyngeal carcinoma (NPC) and several forms of adult T-cell leukaemias and lymphomas, have viruses as an essential component of their aetiology and pathogenesis. Second, oncogenic viruses opened up cancer genetics. Oncogenes were first found in retroviruses long bef6re it was realised that the viruses had purloined cellular genes. Tumour-suppressor proteins were first identified through the study of DNA viruses, as viral proteins such as E6 and E7 of the human papillomaviruses sequester the Rb and p53 proteins, which is the phenotypic equivalent of a genetic knockout. Thus, studies of oncogenic viruses have had a significance far beyond that proportion of cancer actually caused by them.

NS
This volume on viruses and cancer represents papers given at the 51st Symposium of the British Society for General Microbiology. It provides a useful overview of current research into oncogenic viruses. While some chapters are broad reviews, others are focused more narrowly on the authors' own research. I particularly enjoyed David Lane's chapter on tumoursuppressor genes and p53 and Karen Vousden's article on cell transformation by human papillomaviruses. More than 50 pages in the volume are devoted to Epsten-Barr virus (EBV) in relation to B-cell transformation and tumours, whereas only two pages discuss NPC. This is in inverse ratio to the prevalee of these tumours, and reveals the inclinations of EBV specialists: lymphomas are easier to study than carcinomas. Human adenoviruses, perhaps the most potent oncogenc viruses of all when experimentally inoculated into rodents, receive no mention at all, not even in George Klein's introductory article. Perhaps they are deemed uninteresting because they have not been associated with human cancer, and not for want of trying. Yet this very negation is fascinating and puzzling.
In the majority of well-studied viral cancers, the viral genome plays a direct role in cell transformation and the maintenance of the malignant phenotype. Integrated or episomal viral genes are found in the tumour cell clones. However, it is also becoming increasingly evident that viruses can predispose to cancer indirectly. In this volume Ian Weller illustrates HIV-related cancers with respect to immune deficiency, while Jan Butel and colleagues discuss hver cancer is relation to hepatitis B and C viruses, where chronic liver damage may promote the emergence of the premalignant clones of liver cells not infected by the virus. Viral carcinogenesis may be direct or indirect, but in both cases it can be prevented by immunisation against viral infection in the first place. Here, vaccination is discussed only in relation to human and bovine papillomaviruses and feline leukaemia virus. However, successful intervention studies against hepatitis B virus are already under way in West Africa, and time will tell if this leads to a significant drop in the incidence of liver cancer. There appears to be a synergistic relationship between virus and dietary carcinogens briefly mentioned by Butel et al. for liver cancer and by Saveria Campo for bovine papillomavirus type 4. A more thorough discussion of co-factors in viral oncogenesis and the prospects for prevention would not have come amiss. Nonetheless, for those intrested in the relation of viruses to cancer, this volume provides a useful introduction to the field. This is the third volume in the series of reviews highlighting growth areas in haematological oncology aimed at both clinicians and research workers. The editors set themselves a very difficult task in accepting such a wide remit and by and large achieve a lot. However, such review texts become rather piecemeal and lack the continuity of a monograph or text committed to a specific topic. Consequently, in this volume there is something for everyone but no topic is fully covered, e.g. the epidemiology and viral aetiology of lymphomas are included, but these are not put into the context of clinical manifestation, immunophenotyping or pathology. For the clinician reviewing a topic or for the hard-pressed examination candidate multiple texts are thus required, while the researcher is more likely to find value in the bibliographies and hence the original papers.
Those critical comments are applicable to all such texts and must not detract from the well-written individual contributions, all by respected authorities in their field. Cartwright and McNally's Epidemiology of Non-Hodgkin's Lymphomas is an excellent reference source, although so many large tables make it difficult for the reader. I was confused by the comment that 'no clear geographical associations emerged' in childhood NHL and then the discussion of Burkitt's lymphoma, for which there is a very characteristic geographical variation. There were many other intriguing items of interest which, as the authors suggest, do really warrant further research. Onions has produced a very fine and comprehensive overview of the viral aetiology of lymphoid malignancies, as has Myrtle Gordon on the stromal microenvironment. The stroma is a complex area to study but represents a real growing point of haematological research, and this is a timely review of the subject. The back-to-back chapters on myeloma therapy are especially helpful to the practitioner deciding on therapy for an individual patient, and in particular Diana Sampson's final recommendations are clear and very useful. Peripheral blood stem cell transplantation is very much the flavour of the month, for obvious reasons, but with the available growth factors changing so rapidly texts such as this one inevitably become dated no matter how well written, as here by Juttner and To. Alan Burnett's team's contribution to our understanding of MDS is not inconsiderable, although the chapter here really consists of a few laboratory titbits demonstrating pluripotential stem cell dysfunction. The brief French collaborative chapter on retinoids summai the situation in APML well, but holds little which most in the field do not already know. Lorna Secker-Walker's very comprehensive chapter on cytogenetics in ALL still leaves you with the feeling that we are reading about phenomena. Am I alone in wishing that the moleular geneticists, signales and protein experts would collaborate with the cytoneticists to try to collectively explain what we are observing and take our understanding forward? A joint article by a number of those experts would be a really useful contribution in a future volume. Rogers' article on fungi is excellent and very timely: as we intensify treatment, recognise and treat bacterial infection earlier and for longer we are facing increasngly the threat of fungal infection. The table on drug interactions, recommendations for prophylaxis and strategies is of special practical Importance.
In conclusion, this small tome is quite wide ranging in topics and authors and must be seen in the context of being one in a series. The editors must certainly be congratulated on bringing together in the three volumes a tr ndous array of individual talent.

Professor OB Eden
Practcl Approach to Head aud Neck Tmors Jack Gluckman, Patrick Gullane and Jonas Johnson. Raven Press: New York, 1994, 212 pp. ISBN 0-7817-0228-3. This is a somewhat unusual book. It is written by three ENT surgeons, two from USA and one from Canada. There are 15 chapters devoted to tumours at the various head and nwk sites, inchlding thyroid and skcin. Each chapter is written by one surgeon, who describes his own approach to management of the tumours at the site in question. Comments from the other two authors are in within the text In each chapter aetiology, cinical behaviour and staging is described very briefly and there is dikscussion of patient evahuation by clinical examination and imaging. The majority of each chapter is devoted to treatment. There is a list of 'suggested further reading' at the end of each chapter, but there are no references as such. The authors make no attempt to support their choice of treatment from published results.
Not surprisingly the emphasis is on surgical treatment. Radical radiotherapy is not recommended for carcinoma at any head and neck site except the nasopharynx or at any stage; the one exception is caranoma of the hypopharynx because the first author on this subject is the Canadian surgeon.
The American author of the chapters on tumours of the larynx and oropharynx decries the use of radical radiotherapy for any stage of disease at either of these sites. The Cnadinan author in his comments takes a diametricaly opposite view. Throughout the book the role of radiotherapy is regarded mainly as post-operative and there is little mention of chemotherapy. There is no mention of multidisciplinary collaboration, either between surgical specialties or between surgeons, radiation oncologists and cancer physicians. One of the American surgeons writes: 'Most patients will probably be treated in centres where facilities vary in quality. The presence or absence of surgical expertise, sophisicated radiotherapy and chemotherapy, and adequate prosthetic facility all will dictate the optimal [my italics] treatment of the patient in any given situation.' This is a state of affairs which he seems to accept. This book describes how ENT surgeons in the two countries approach head and neck cancer. However, it offers no explanation for the difference between them, which is mainly the differences in health care delivery systems between USA and Canada. It should be read in order to gain an insight into North American surgical practice. It does not purport to be a textbook of head and neck oncology and should not be regarded as such.