Complete Guide to Colorectal Cancer

Nearly 150,000 people will be diagnosed with colorectal cancer in the United States in 2006. The impact of this diagnosis will be felt by countless family members, coworkers, and friends. Although screening tests for colorectal cancer have been available and encouraged by medical associations such as the American Cancer Society (ACS) and others, public awareness and compliance has been dismal. The past 10 years have seen advances in the research laboratory and drug development, which have led to improvements in cure rate and survival. Advocacy groups have played a major role in educating the medical community and the general public about colorectal cancer and, as a result, have taken some of the embarrassment and stigma out of the diagnosis. The foreword written by Katie Couric clearly illustrates the need for a condensed and comprehensive resource.

The ACS's Complete Guide to Colorectal Cancer is a timely and practical reference written by experts in the field who are not only at the forefront of research but also treat patients in their daily practice. It is written for patients and caregivers, in language that is easy to understand, accompanied by constructive illustrations and tables, with a comprehensive glossary, index, and 16 pages of national resource references. Valuable insights from people with colorectal cancer are included throughout the book, as are suggested questions to ask the medical provider and clearly labeled techniques and concepts that are on the horizon. This guide is divided into seven sections that cover everything from prevention, screening, diagnosis, and treatment to understanding alternative therapies, side effects of treatment, building a health-care team, and coping with practical matters not always addressed in the doctor's office.

The first three sections focus on the diagnosis. Section I gives an overview of colorectal cancer, including the adenoma-to-carcinoma sequence. It provides a comprehensive review of risk factors and prevention. Genetics and the role of genetic testing are addressed, as well as lifestyle modifications, diet, and the controversial role of statins and nonsteroidal anti-inflammatory drugs. This section imparts an element of control to the reader that can be shared with family members and friends.

Section II deals with diagnosis of the disease. Early detection is thoroughly covered, including detailed explanations and pictures of the different screening techniques, description of a bowel preparation, and the ACS guidelines for screening initiation and intervals. The authors address the underutilization of screening and provide practical reasons as to why it is avoided. Those with newly diagnosed colorectal cancer will find the discussion of staging tests, pathologic staging, and interpreting a pathology report particularly helpful. A straightforward and practical guide to understanding prognosis and statistics is unique and logical.

Section III, covering the time after the diagnosis, guides the patient through the health-care system. It is very current, introducing all members of a team in today's health-care environment. This section provides tools for accessing support services and communicating with the health-care team, and provides examples of logs that can help to empower patients in their care.

Treatment options are covered in section IV. A separate and detailed chapter each on surgery, radiation, and chemotherapy are up to date. The nuances of different surgical approaches and radiation techniques introduce a new vocabulary to the reader. The chapter on chemotherapy not only addresses drug regimens but also common misconceptions about chemotherapy, as well as the administration process. Another chapter is dedicated to the importance and role of clinical trials. It clearly describes the different phases of studies and novel therapies being pursued, such as monoclonal antibodies, vaccines, and viral vectors. These strategies are presented in a nonintimidating and demystifying way. Complementary and alternative strategies are presented objectively, discouraging patients from pursuing therapy that is either inappropriately studied or potentially harmful. This discussion fosters communication with the health-care provider for full disclosure regarding any alternative therapies that might be of interest to the individual.

The final three sections address physical, practical, and emotional issues that are faced during and after treatment. The chapter on coping with symptoms and side effects empowers the patient by offering tangible strategies for dealing with these therapy- and disease-related reactions, which often go unaddressed and can have a profound impact on quality of life. A separate chapter addresses specifics for living with a colostomy. The comprehensive and unambiguous information provided will be invaluable to those undergoing this sudden physical change. Practical matters such as finances and work provide a framework that will be reassuring and productive. The goals and strategies for follow-up care and surveillance as well as survivorship put into context the fear of recurrence and the process of establishing a new normal life after cancer. A special section directed to caregivers provides tools that will benefit both patient and caregiver.

This book is clearly written with the needs of the patient in mind. It is comprehensive and provides a spectrum of information in a user-friendly format. The resource guide (including organizations, publications, and corporations) is, by itself, worth the price of the book. The quotes from patients strewn throughout the text are inspirational without being pretentious. The one limitation of the book is a general lack of information directed toward the patient with incurable cancer and advanced disease. People in this situation may still find much of the volume quite useful, but treatment failure and end-of-life issues are not prominently addressed in this resource.

As a health-care provider, I found the information provided to be thought-provoking and enlightening. The text offers a framework with which to address both often-ignored topics and procedures that can be difficult to explain. This book should be prominently displayed where patients and families with colorectal cancer are likely to benefit from its practicality and grasp.

—Mary F. Mulcahy, MD