Molecular oncology, as it relates to cancer formation, growth,
metastasis, and treatment, is a rapidly progressing and exciting
field. Its forward movement is so fast that even scientific journals,
because of publication delays, are unable to keep readers informed
in a timely manner. What, therefore, is the role of a textbook
on molecular oncology?
The Molecular Basis of Cancer consists of contributions
from an accomplished array of molecular biologists and immunologists.
The editors' aim, as stated in the preface, is "...to explain,
rather than merely recount, the discoveries and observations that
form the basis for understanding a disease...." Such a text
is needed: a reference geared toward readers already versed in
molecular biology but who want to learn more about specific molecular
alterations leading to cancer formation, as well as novel therapies
based on molecular biology. Unfortunately, the first edition of
The Molecular Basis of Cancer does not fully succeed in accomplishing
its goal of providing a clear, concise overview of the molecular
basis of neoplasms.
The text is divided into four main sections: malignant transformation,
growth and spread of cancer, molecular abnormalities of specific
malignancies, and the molecular basis of cancer therapy. The first
section on malignant transformation is comprised of introductory
chapters on such topics as cell-cycle regulation, viral carcinogenesis,
tumor-suppressor genes, specific oncogenes, and signal transduction.
The chapters on viral carcinogenesis and tumor-suppressor genes
are well-written and comprehensive with extensive reference lists,
but the chapter on molecular genetics of hematopoietic malignancies
is inappropriate for the introductory section and is redundant,
since much of the information is repeated in two later chapters.
The second section, entitled "Growth and Spread of Cancer,"
includes chapters on cytokinetics, cell adhesion mechanisms, tumor
angiogenesis, and molecular mechanisms of metastasis. The chapters
on cell adhesion and angiogenesis are excellent; the text is clear
and well-written, and each chapter has over 340 references.
The third section is comprised of chapters on specific tumors,
including hematopoietic malignancies, childhood malignancies,
lung cancer, breast cancer, and colorectal cancer. Certain cancers
with well-defined molecularly based origins have been omitted,
such as genitourinary cancers (renal cell cancers, bladder cancers,
germ cell tumors), sarcomas, ovarian cancer, melanoma, and endocrine
cancers (eg, medullary thyroid cancer). All the omitted cancers
have fascinating, well-established molecular mechanisms, and the
textbook would be more complete with additional chapters on these
Cancer therapy is the main topic of the fourth and final section,
and chapters on chemotherapy, radiation therapy, growth factors,
monoclonal antibody therapy, cellular immunity, and gene therapy
are included. One chapter I was disappointed with was that on
cellular immunity, which consists of 18 pages of uninterrupted
text with no diagrams. Most of the chapter focuses on natural
killer and tumor-infiltrating leukocyte (TIL) cells with a rather
long historical description of past immunotherapy trials. I was
surprised to find no discussion of tumor antigens, T-cell costimulation,
or T-cell anergy, and how these concepts may relate to the escape
of cancers by the immune system. Importantly, manipulation of
the immune system may lead to novel anticancer therapies, which
was not discussed.
One significant shortcoming of the book as a whole is the paucity
and poor quality of the illustrations. Conceptual understanding
of the molecular biology discussed in the text would be facilitated
by clear diagrams, which should serve to confirm points described
more fully in the text. In The Molecular Basis of Cancer,
the text bears the full responsibility of explaining detailed,
complex concepts. Diagrams, when present, are often small, rudimentary,
and sometimes even appear hand-drawn. This textbook would benefit
from larger, clearer, computer-generated, and more frequent diagrams.
A textbook on molecular oncology should provide introductory chapters
on basic molecular mechanisms of cancer, include all cancers
with a known molecular basis, and be filled with clear, concise,
self-explanatory diagrams that reinforce concepts discussed in
the text. The text should also leave the reader excited about
molecular oncology and eager to read and regularly peruse scientific
journals. This first edition of The Molecular Basis of Cancer
falls short of achieving these objectives, but hopefully, in subsequent
editions, the editors and their highly accomplished contributors
will improve the text and eventually succeed in their mission.