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Gastrointestinal tract malignancies encompass a spectrum of diseases with marked differences in etiology, incidence, biological behavior, and treatment outcome. The incidence of new gastrointestinal cases recorded yearly for patients residing in the United States is approximately 230,000, representing nearly 20% of all cancer cases. Worldwide, gastrointestinal malignancies are responsible for the largest number of cancer deaths, particularly because of the high incidence of hepatocellular and gastric cancer in other countries.
Gastrointestinal Oncology is directed to those most involved in the multidisciplinary approach to the gastrointestinal cancer patient, including medical, radiation and surgical oncologists; gastroenterologists; interventional radiologists; pathologists; oncology nurses; and oncology physicians-in-training.
- Sales Rank: #2915590 in eBooks
- Published on: 2012-12-06
- Released on: 2012-12-06
- Format: Kindle eBook
From The New England Journal of Medicine
Cancer of the gastrointestinal tract is the leading cause of death from cancer worldwide. In the United States, it is second only to lung cancer as a cause of death and accounts for almost 150,000 deaths per year. Because it is so common, all clinicians need some familiarity with the usual presentation and diagnostic evaluation of patients in whom this type of cancer is suspected. Patients with established gastrointestinal cancer require integrated care from physicians in multiple subspecialties. Traditionally, surgeons, radiation oncologists, and medical oncologists assumed primary responsibility for discrete phases of the disease process. Usually, a patient's first stop was a surgeon. If the surgeon could not eradicate the tumor with the scalpel, the patient was referred to a medical oncologist, who coordinated all subsequent care.
Over the past decade, this pattern has shifted. It is no longer the case that surgeons direct initial care of cancer and medical oncologists provide subsequent care. For example, neoadjuvant chemotherapy and irradiation are now often administered before surgical resection of gastroesophageal and rectal tumors is performed, and patients with advanced colon cancer are treated with an array of surgical techniques to destroy liver metastases. Because cancer therapy has increasingly become an interdisciplinary endeavor, surgical, medical, and radiation oncologists must understand the indications for and risks and benefits of each approach if they are to help patients make decisions about various treatment strategies.
Gastrointestinal Oncology reviews the important developments in treating patients with this common form of cancer and underscores the multidisciplinary approach and the need for ongoing, close collaboration among physicians from the various oncology subspecialties. In a slim, readable book, Benson has assembled the work of experts in this field and has highlighted the most controversial and difficult aspects of treatment, many of which involve multimodal therapy.
Gastroenterologists, medical, surgical, and radiation oncologists, and diagnostic radiologists will find that the chapters in this book synthesize huge amounts of information and explain the rationale for current treatment practices. Because the chapters are concise and well written, basic scientists and others who are not directly involved in making therapeutic recommendations will also find this book accessible.
Each of the first eight chapters reviews one of the gastrointestinal tumors. The focus is generally on treatment rather than on epidemiologic features, causes, or diagnosis. Unlike some review articles and textbooks about oncology, these chapters do not read like laundry lists of clinical trials. Rather, they take a historical perspective, describe the evolution of care for gastrointestinal neoplasms over the past two decades, and justify the use of current therapies. Throughout the book, an effort is made to distinguish between conventional approaches to treatment and those that have become obsolete or remain controversial. This makes the book an especially good source for students. Some chapters, such as those on pancreatic, esophageal, and anal cancer, provide a comprehensive review of therapy. Others highlight a particular aspect of treatment, such as that for metastatic liver disease. The chapter on gastric cancer critically evaluates the role of adjuvant therapy, and the one on rectal cancer compares preoperative and postoperative adjuvant chemoradiation.
The final chapters focus on understanding gastrointestinal tumors at the molecular level. They include explanations of biologic therapies, the basis of disease resistance to chemotherapy, and the genetics of pancreatic and colon cancers. The molecular events leading to colorectal cancer are better understood than those for any other solid tumor and have established an important example for cancer research. The final chapter, which summarizes the genetics of colorectal cancer at a level that is both sophisticated and accessible to the clinician, is especially valuable.
In the on-line era, when more and more practitioners can gain access to abstracts from recent meetings and journal articles with a few keystrokes, one can question whether books remain a vital source of information about cancer therapeutics. Indeed, the amount of time required to edit and publish a book means that results from very recently reported clinical trials are not included in Gastrointestinal Oncology. For example, irinotecan and oxaliplatin, which have emerged as effective treatments for colorectal cancer, receive less attention than they would have had the chapter on this subject been written in 1999. Despite this limitation, a well-edited book such as this, with contributions from recognized leaders in the field, fills an especially important niche when the results of every clinical trial are but a few mouse clicks away. It provides a tangible way for clinicians who are inundated with information to gain perspective on the relative importance of research studies and to find out how and why some therapies have become standard whereas others have remained controversial.
Reviewed by Deborah Schrag, M.D.
Copyright © 1999 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
Review
` ...a well-edited book such as this, with contributions from recognized leaders in the field, fills an especially important niche when the results of every clinical trial are but a few mouse clicks away. It provides a tangible way for clinicians who are inundated with information to gain perspective on the relative importance of research studies and to find out how and why some therapies have become standard whereas others have remained controversial.'
Deborah Schrag in The New England Journal of Medicine, 341:16 (1999)
`...For these reasons, it can be recommended to both an audience of general oncologists and specialists in the field.'
P. Saletti in Annals of Oncology, 10: (1999)
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