In this day of encyclopedic oncology texts, frequently updated online reference sites, and literature searches at the click of a button, is there a place for a basic medical oncology textbook? The second edition of the Textbook of Medical Oncology, edited by Drs. Cavalli, Hansen, and Kaye, is approximately 50% longer than the first edition, due in large part to the inclusion of newer therapeutic approaches.
The book differs from many other general oncology texts in two ways. First, the information is presented from a medical oncology viewpoint, eschewing details of surgical and radiation techniques in favor of a focus on systemic therapy issues. Second, because the editors and many of the contributors are European, studies coordinated by the European Organization for Research and Treatment of Cancer (EORTC) and other regional or national European cooperative groups figure more prominently in discussions of the evolution of various treatments than they do in most US texts.
The text opens with a well-written chapter on the molecular biology of cancer that uses easy-to-follow text and illustrations to explore topics ranging from the somatic mutation theory of cancer through oncogenes, tumor-suppressor genes, signal transduction, and cell-cycle control to the possible role of gene therapy in reversing the malignant phenotype. It features an extremely useful glossary of molecular biology terms that may be unfamiliar to clinicians. This chapter is followed by one on the principles of systemic therapy. Detailed descriptions of approved antineoplastics are supplied in an appendix, allowing this chapter to focus on concepts and to include discussions of novel approaches such as tumor-specific immunotherapy, gene therapy, and the identification of new biologic targets (signal transduction pathways and tumor-induced angiogenesis).
The third chapter is an excellent introduction to clinical trial design and interpretation. It takes a would-be investigator through the major issues associated with designing a study, including the selection of appropriate end points, from tumor response and survival through toxicity, impact on quality of life, and cost-effectiveness analysis. It also addresses timely issues such as the challenge of choosing appropriate end points for studies of noncytotoxic therapies, the risks of subgroup analysis, and the strengths and weaknesses of meta-analysis.
The next 15 chapters address malignancies by organ system, and although they focus on the most common cancers affecting that organ system, they also address many less common malignancies. In general, the discussions achieve a balance between historical and current data to support general treatment recommendations and important research questions going forward. Extensive bibliographies include many of the pivotal papers in each area.
Many of the individual chapters are excellent and short enough to be digested in one sitting, but with sufficient detail to provide a good base of information from which to approach most common clinical situations or to assess newly presented or published data. One notable exception is the chapter on breast cancer, which presents lists of potential prognostic factors and treatment options without sufficient guidance on the relative value of each. In that same chapter, the author asserts that ductal carcinoma in situ (DCIS) is "usually treated by some form of radical surgery"; in fact, breast-conserving surgery has become the treatment of choice for many women with DCIS.
Given the lead time required to produce a textbook, it is not surprising that certain novel therapies—such as the potential of BCR-ABL tyrosine kinase inhibition in chronic myelogenous leukemia—are mentioned only briefly, if at all. Other omissions are more puzzling—for example, the absence of a discussion of the influence of BRCA1/BRCA2 mutations on the incidence of ovarian cancer, the treatment and screening options available to women identified as being at high risk, and the passing mention of interleukin-2 (Proleukin) and biochemotherapy as systemic therapy for advanced melanoma.
A 52-year-old man presented with an erythematous lesion in the axilla of unknown duration. Surgical excision was performed. What is your diagnosis?
