From The New England Journal of Medicine
The past three decades have witnessed substantial advances in our knowledge of the pathogenesis, diagnosis, and treatment of colorectal cancer. Despite these developments, colorectal cancer remains a considerable public health problem, with an estimated 150,000 new cases diagnosed in the United States yearly. There are still many challenges in the areas of screening, prevention, and treatment. This book offers an overview, from one author's perspective, of the pathology and clinical features of colorectal cancer. Organized into 14 chapters, the book begins with a description of the causes of colorectal cancer and continues with chapters devoted to pathogenesis, pathology, diagnosis and clinical features, screening and surveillance, prevention, treatment, and follow-up. Specific sections deal with anal cancer, hereditary nonpolyposis colorectal cancer, familial adenomatous polyposis, other polyposes, and carcinoid tumors. Ponz de Leon concludes with a chapter entitled "Colorectal Cancer at the Beginning of the New Millennium," which forecasts the role of genetic testing in the determination of the risk of cancer and the spread of the colorectal cancer "epidemic" to emerging countries because of changes in diet and lifestyle. The author's attempt to cover pathogenesis, screening, prevention, and treatment in a single book is laudable. A particular strength of the book is its success in providing insights into pathogenesis through the demonstration of links between epidemiology, histology, and molecular biology. This strong point is most apparent in the discussion of familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer. The controversies surrounding the relative contributions of environmental and genetic factors to the disease process are explained in a clear and concise fashion. There are some deficiencies in the coverage of clinical aspects of colorectal cancer. In the chapter on screening and surveillance, clear recommendations are provided for colonoscopic surveillance in persons who are at risk because of previous surgery or polypectomy or known hereditary cancer syndrome. In contrast, the recommendations regarding screening for persons with average risk are somewhat cursory, despite detailed descriptions of the potential benefits and limitations of sigmoidoscopy, colonoscopy, and fecal occult-blood testing. The discussion of chemotherapy does not address some new developments in the treatment of advanced colorectal cancer that have occurred during the past three years. One example of an important issue omitted here is the controversy surrounding potentially increased toxicity associated with regimens including fluorouracil and irinotecan. Another is the recent acceptance of oxaliplatin in combination with fluorouracil for initial and salvage treatment. Capecitabine is discussed only briefly, but it was approved in the United States in April 2001 for use as first-line treatment of metastatic colorectal cancer. Despite these limitations, Colorectal Cancer is a valuable overview, especially in the areas of pathogenesis and hereditary cancer syndromes. Richard Pazdur, M.D.
Copyright © 2002 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.