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Pancreatic Cancer Pathogenesis Diagnosis and Treatment

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Pancreatic Cancer Pathogenesis Diagnosis and Treatment. Edited by Reber HA. (Pp 352; illustrated; £125.00.) Human Press, 1998. ISBN 0-89603-466-6.

It seems a week does not go by without another book about the pancreas. This is not to suggest that there is no room for this particular publication, rather it reflects the rapidly changing nature of current knowledge, both clinical and non-clinical, as it relates to pancreatic disease. The editor is Howard A Reber from the UCLA School of Medicine. He has culled chapters from a number of acknowledged experts in the United States, Europe and the Far East. The resulting mixture is a multicultural blend of basic science and clinical data that succinctly encapsulates carcinoma of the pancreas.

This book is divided into three parts. The first section, which given recent advances is somewhat smaller than it might have been, describes the aetiology and mechanisms of malignant transformation particularly as they relate to pancreatic cancer. There are chapters on molecular genetics, growth factors, their receptors and experimental models. An entire chapter is devoted to TGF-β justifiably reflecting the important role of this negative regulator of cell proliferation and its downstream signalling pathways in the development of carcinoma of the pancreas.

Part two deals with staging and diagnosis with chapters on screening for genetic mutations, tumour antigens and laparoscopy, as well as a chapter on more conventional diagnostic methods. The third section describes current management. After a chapter describing the standard Whipple resection there are two chapters from Japan describing the technique and results of more radical surgery. The juxtaposition of these different surgical approaches allows the reader to assess their relevance to their own clinical practice. Chapters on radiotherapy and chemotherapy follow and given the rather dismal conclusions a welcome inclusion is a chapter on quality of life and its evaluation in patients with pancreatic carcinoma. Gene therapy has yet to make any real impact in this condition but quite rightly there is a chapter describing its principles and potential application.

In the main the text is well written, easy to read and avoids becoming overly complex, making it fairly easy for a clinician to digest and understand. It is always difficult to get the balance between clinical results and basic scientific research right but I must say I think this book succeeds admirably. Most importantly, this book highlights the areas that will be important over the next decade if we are to improve the results of treatment; these include adjuvant chemotherapy, surgical standardisation and early diagnosis. I can thoroughly recommend this book and suggest that it has a place on the shelf of pancreatic surgeons as well as scientists with an interest in this area.

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