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Colorectal Cancer: Current Concepts in Diagnosis and Treatment
845
BOOK REVIEWS
Mayo Clin Proc, October 1986, Vol 61
to demonstrate proper stomal placement and techniques but also to illustrate the potential complications. Most physicians are not knowledgeable about the management of stomas and their complications, and they may be unfamiliar with the difficulties that can occur. The outstanding illustrations and the readable text provide ample information about the manifestations and management of complications of intestinal stomas. The book is clearly and concisely written; the verbiage is minimized, yet the necessary points are aptly made. The volume is sufficiently brief to be a useful resource for quick answers to questions, and it is also well referenced. Tables are incorporated infrequently but appropriately. When applicable, statistics, complication rates, and alternative methods of management are presented. Complications of Kock ileostomies and different types of stomas are discussed. This excellent book should be useful for all physicians. For the first time, many surgeons will be exposed to the details of stomal therapy. Residents should appreciate this thorough review of stomal problems, which are generally inadequately taught during training. Physicians can refer to this text when patients complain of herniation, difficulty with irrigation, stenosis, or prolapse of stomas. This text will help determine the diagnosis and outline appropriate alternatives of management. Robert W. Beart, Jr., M.D. Department of Surgery
Colorectal Cancer: Current Concepts in D i a g n o s i s and Treatment (Science and Practice of Surgery, Vol 5), edited by Glenn Steele, Jr., and Robert T. Osteen, 366 pp, with illus, $59.50, New York, Marcel Dekker, 1986 A well-conceived, eminently readable, and authoritative review of the difficult and potentially confusing subject of colorectal cancer has been produced by editors Steele and Osteen. They carefully construct their work about a central aim: to provide the reader with complete, concise information. In so doing, the editors manage to make the multiauthored text read as though it were single authored—no simple task. For this effort, students of colorectal cancer will be most appreciative.
The topic of colorectal cancer is indeed vast. The text is organized logically, beginning with a short but complete and accurate review of colon and rectal anatomy and physiologic mechanisms. Next, characteristics of patients who have been identified as being at risk for development of colorectal cancer are described. Moreover, environmental and demographic risks are detailed. Chapter 3 discusses the theory, controversy, and practice of screening asymptomatic patients for colorectal cancer, whereas chapter 4 evaluates all the available methods for diagnosing colorectal cancer in symptomatic patients (ranging from the physical examination to intrarectal ultrasonography). Chapter 5 is a particularly well-done effort; Richard Wilson analyzes prognostic factors in patients with colorectal cancer. These factors include age and sex, histologic features, tumor size and location, tumor markers, obstruction, adhesions, stage of disease, and patient performance status. He concludes the chapter with an important review of the natural history of colorectal cancer. Chapters 6 and 7 describe the surgical management of colonic, rectal, and anal cancer in an exemplary fashion; the topics are large but efficiently and completely covered. Numerous controversies in surgical management are presented fairly (such as "radical" versus "standard" resection, preoperative radiation therapy, and prophylactic oophorectomy). Chapters 8 and 9 present the current status of irradiation and chemotherapy in the management of patients after resection for colorectal cancer. These topics can indeed be confusing; but practical, clear, comprehensive, and fair presentations by Rich and Gunderson and by Mayer render these chapters focused and, therefore, understandable. Rational yet practical plans for postoperative follow-up, based on the biologic features of colorectal cancer and other considerations, such as the philosophy of the physician and the availability of resources, are presented in chapter 10. A particularly well-executed discussion of carcinoembryonic antigen based on second-look exploration is included. Chapter 11 explores treatment options for recurrent disease. The natural history of metastatic disease, sites of recurrence, histologic features, and disease-free interval are described. Systemic and regional treatment regimens are thoroughly
Mayo Clin Proc, October 1986, Vol 61
yet succinctly detailed. The role of palliative operations, such as pelvic exenteration, sacral resection, and urinary diversion, is described. A thoughtful and complete discussion of palliation in general follows. The chapter ends with a thorough description of the operative and nonoperative treatment of hepatic metastatic lesions. Chapter 12 details the role of nutrition in the management of colorectal cancer. The text ends appropriately with reports on the current status of two major research efforts based on the cell biology of colorectal cancer. These research areas are tumor models and tumorassociated markers. Importantly, the authors' speculation on the future applicability of these areas of research is fascinating reading. This work is outstanding. It is at once complete (more than 800 references) and yet comfortable to read. Obviously, it will be required reading for surgeons who operate on patients with colorectal cancer. The secret of this book's undoubted success is that it can be read, understood, and enjoyed by any surgeon, senior surgical resident, gastroenterologist, or general internist who deals with patients who have colorectal cancer, yet it can be studied with equal reward by even the most ardent student of the topic. The editors state in the preface that they "...hope the life span of this edition will be limited." Although clinical and bench research may rapidly outdate their observations, the data, opposing arguments, and recommendations presented are solid. Thus, the text will be durable— there is no safer "investment" in the literature. John H. Pemberton, M.D. Section of Colon and Rectal Surgery
Trauma Management: For Civilian and Military Physicians, by Stanley L. Wiener and John Barrett, 582 pp, with illus, $65, Philadelphia, W. B. Saunders Company, 1986 It was with some skepticism that I embarked on a review of a trauma text coauthored by a nonsurgeon, but once I had an opportunity to delve into the volume, I was pleasantly surprised. Dr. Wiener, a professor of medicine at the University of Illinois and a colonel in the Medical Corps,
BOOK REVIEWS
84C
United States Army Reserve, has special interest and expertise in the medical aspects of war. His surgeon-coauthor, Dr. Barrett, is director of the trauma unit at the University of Illinois. Together, they strike a balance that has resulted in perhaps the most unusual text on trauma available to date. As anticipated, initial assessment, resuscitation, and management of both blunt and penetrating injuries are appropriately presented and discussed in an organ-system format. Likewise, environmental injuries are covered in detail, including hypothermia, hyperthermia, frostbite, snake, insect, and marine-animal bites, lightning injuries, and drowning. Thereafter, the authors deviate from the usual prescription for standard textbooks on trauma care and present information not available elsewhere in a single source. The devastating effects of high-velocity missies are addressed generally in the first two chapters on wound ballistics and explosive device-related injury and specifically throughout the text by organ system. As pointed out by the authors in the preface, infectious disease and other nontraumatic illnesses accounted for 70% of all hospital admissions during the Vietnam conflict. Therefore, the inclusion of fever of unknown origin, which may be encountered in possible deployment areas around the world, as well as its differential diagnosis according to geographic region, is appropriate. Unsettling, but nevertheless necessary to such a volume, are chapters on casualties due to unconventional warfare: chemical agents (nerve gases), biological and toxin warfare, and thermonuclear weapons. The text is generously supplemented with wellreproduced photographs of injuries under consideration, line drawings, and, for rapid reference, management algorithms. The algorithms are included to summarize pertinent points related to regional injuries and resuscitation. I have found that algorithms are often cumbersome; however, the system used by the authors—simple questions with "yes" or "no" answers at each branch point— is particularly easy to follow. Although this book is ideally suited—in fact, a must—for military physicians or surgeons charged with caring for soldiers during a time of armed conflict, the ever-increasing use of highvelocity weapons by terrorist groups and the urban criminal element, as well as the occasional injury resulting from high-velocity sporting firearms, makes this text an excellent reference
BOOK REVIEWS
Mayo Clin Proc, October 1986, Vol 61
to demonstrate proper stomal placement and techniques but also to illustrate the potential complications. Most physicians are not knowledgeable about the management of stomas and their complications, and they may be unfamiliar with the difficulties that can occur. The outstanding illustrations and the readable text provide ample information about the manifestations and management of complications of intestinal stomas. The book is clearly and concisely written; the verbiage is minimized, yet the necessary points are aptly made. The volume is sufficiently brief to be a useful resource for quick answers to questions, and it is also well referenced. Tables are incorporated infrequently but appropriately. When applicable, statistics, complication rates, and alternative methods of management are presented. Complications of Kock ileostomies and different types of stomas are discussed. This excellent book should be useful for all physicians. For the first time, many surgeons will be exposed to the details of stomal therapy. Residents should appreciate this thorough review of stomal problems, which are generally inadequately taught during training. Physicians can refer to this text when patients complain of herniation, difficulty with irrigation, stenosis, or prolapse of stomas. This text will help determine the diagnosis and outline appropriate alternatives of management. Robert W. Beart, Jr., M.D. Department of Surgery
Colorectal Cancer: Current Concepts in D i a g n o s i s and Treatment (Science and Practice of Surgery, Vol 5), edited by Glenn Steele, Jr., and Robert T. Osteen, 366 pp, with illus, $59.50, New York, Marcel Dekker, 1986 A well-conceived, eminently readable, and authoritative review of the difficult and potentially confusing subject of colorectal cancer has been produced by editors Steele and Osteen. They carefully construct their work about a central aim: to provide the reader with complete, concise information. In so doing, the editors manage to make the multiauthored text read as though it were single authored—no simple task. For this effort, students of colorectal cancer will be most appreciative.
The topic of colorectal cancer is indeed vast. The text is organized logically, beginning with a short but complete and accurate review of colon and rectal anatomy and physiologic mechanisms. Next, characteristics of patients who have been identified as being at risk for development of colorectal cancer are described. Moreover, environmental and demographic risks are detailed. Chapter 3 discusses the theory, controversy, and practice of screening asymptomatic patients for colorectal cancer, whereas chapter 4 evaluates all the available methods for diagnosing colorectal cancer in symptomatic patients (ranging from the physical examination to intrarectal ultrasonography). Chapter 5 is a particularly well-done effort; Richard Wilson analyzes prognostic factors in patients with colorectal cancer. These factors include age and sex, histologic features, tumor size and location, tumor markers, obstruction, adhesions, stage of disease, and patient performance status. He concludes the chapter with an important review of the natural history of colorectal cancer. Chapters 6 and 7 describe the surgical management of colonic, rectal, and anal cancer in an exemplary fashion; the topics are large but efficiently and completely covered. Numerous controversies in surgical management are presented fairly (such as "radical" versus "standard" resection, preoperative radiation therapy, and prophylactic oophorectomy). Chapters 8 and 9 present the current status of irradiation and chemotherapy in the management of patients after resection for colorectal cancer. These topics can indeed be confusing; but practical, clear, comprehensive, and fair presentations by Rich and Gunderson and by Mayer render these chapters focused and, therefore, understandable. Rational yet practical plans for postoperative follow-up, based on the biologic features of colorectal cancer and other considerations, such as the philosophy of the physician and the availability of resources, are presented in chapter 10. A particularly well-executed discussion of carcinoembryonic antigen based on second-look exploration is included. Chapter 11 explores treatment options for recurrent disease. The natural history of metastatic disease, sites of recurrence, histologic features, and disease-free interval are described. Systemic and regional treatment regimens are thoroughly
Mayo Clin Proc, October 1986, Vol 61
yet succinctly detailed. The role of palliative operations, such as pelvic exenteration, sacral resection, and urinary diversion, is described. A thoughtful and complete discussion of palliation in general follows. The chapter ends with a thorough description of the operative and nonoperative treatment of hepatic metastatic lesions. Chapter 12 details the role of nutrition in the management of colorectal cancer. The text ends appropriately with reports on the current status of two major research efforts based on the cell biology of colorectal cancer. These research areas are tumor models and tumorassociated markers. Importantly, the authors' speculation on the future applicability of these areas of research is fascinating reading. This work is outstanding. It is at once complete (more than 800 references) and yet comfortable to read. Obviously, it will be required reading for surgeons who operate on patients with colorectal cancer. The secret of this book's undoubted success is that it can be read, understood, and enjoyed by any surgeon, senior surgical resident, gastroenterologist, or general internist who deals with patients who have colorectal cancer, yet it can be studied with equal reward by even the most ardent student of the topic. The editors state in the preface that they "...hope the life span of this edition will be limited." Although clinical and bench research may rapidly outdate their observations, the data, opposing arguments, and recommendations presented are solid. Thus, the text will be durable— there is no safer "investment" in the literature. John H. Pemberton, M.D. Section of Colon and Rectal Surgery
Trauma Management: For Civilian and Military Physicians, by Stanley L. Wiener and John Barrett, 582 pp, with illus, $65, Philadelphia, W. B. Saunders Company, 1986 It was with some skepticism that I embarked on a review of a trauma text coauthored by a nonsurgeon, but once I had an opportunity to delve into the volume, I was pleasantly surprised. Dr. Wiener, a professor of medicine at the University of Illinois and a colonel in the Medical Corps,
BOOK REVIEWS
84C
United States Army Reserve, has special interest and expertise in the medical aspects of war. His surgeon-coauthor, Dr. Barrett, is director of the trauma unit at the University of Illinois. Together, they strike a balance that has resulted in perhaps the most unusual text on trauma available to date. As anticipated, initial assessment, resuscitation, and management of both blunt and penetrating injuries are appropriately presented and discussed in an organ-system format. Likewise, environmental injuries are covered in detail, including hypothermia, hyperthermia, frostbite, snake, insect, and marine-animal bites, lightning injuries, and drowning. Thereafter, the authors deviate from the usual prescription for standard textbooks on trauma care and present information not available elsewhere in a single source. The devastating effects of high-velocity missies are addressed generally in the first two chapters on wound ballistics and explosive device-related injury and specifically throughout the text by organ system. As pointed out by the authors in the preface, infectious disease and other nontraumatic illnesses accounted for 70% of all hospital admissions during the Vietnam conflict. Therefore, the inclusion of fever of unknown origin, which may be encountered in possible deployment areas around the world, as well as its differential diagnosis according to geographic region, is appropriate. Unsettling, but nevertheless necessary to such a volume, are chapters on casualties due to unconventional warfare: chemical agents (nerve gases), biological and toxin warfare, and thermonuclear weapons. The text is generously supplemented with wellreproduced photographs of injuries under consideration, line drawings, and, for rapid reference, management algorithms. The algorithms are included to summarize pertinent points related to regional injuries and resuscitation. I have found that algorithms are often cumbersome; however, the system used by the authors—simple questions with "yes" or "no" answers at each branch point— is particularly easy to follow. Although this book is ideally suited—in fact, a must—for military physicians or surgeons charged with caring for soldiers during a time of armed conflict, the ever-increasing use of highvelocity weapons by terrorist groups and the urban criminal element, as well as the occasional injury resulting from high-velocity sporting firearms, makes this text an excellent reference