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Challenges in Colorectal Cancer
  1. M ALLEN

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Challenges in Colorectal Cancer. Edited by J H Scholefield (Pp230; illustrated; £69.50). Oxford, UK: Blackwell Science, 2000. ISBN 0 63205 116 7.

If asked to supply a subtitle for this excellent eminently readable book, I would suggest “All you ever wanted to know about the basics of colorectal cancer but were afraid to ask because you assumed that people would expect you to know already”. The chapters are written by experts renowned in their field and each topic is dealt with comprehensively and clearly with the reader being led from one line of argument to the next in a satisfyingly logical way. Although aimed at the clinician rather than the scientist, where necessary the scientific evidence is given in sufficient detail without overwhelming the non-expert with technical jargon. Similarly, in this era of evidence based medicine, the authors are to be congratulated on choosing judiciously the most relevant clinical trials which help explain the development of currently accepted clinical practice. Areas of controversy (such as the use of total mesorectal excision (TME) in rectal cancer) are presented in a fair and (largely) unbiased way.

Perhaps a few more figures or diagrams might have been useful, although the easily readable text makes this less of a problem than it might have been (I assume the labelling of the first two figures in the chapter on adjuvant chemotherapy which does not correspond with the text will have been corrected by the time the book is published).

There are a few minor quibbles concerning details of individual chapters. The statement that in rectal cancer the use of TME to reduce local recurrence rates to less than 10% precludes the need for adjuvant therapy should have read adjuvantradiotherapy—adjuvant chemotherapy is still indicated in these patients. The chapter on surgery for recurrent and metastatic disease deals mainly with local recurrence: it would have been interesting to have greater discussion of the role of surgery for hepatic and pulmonary metastases. A short historical introduction to the Dukes' staging system (although well known) and its modifications (perhaps not so well known) would have been appreciated in the chapter on pathology. Some readers may find a little too much technical detail in the otherwise excellent chapter on radiotherapy.

The authors of the chapter on adjuvant chemotherapy may have changed their emphasis on radiotherapy as the “prime adjuvant weapon” in rectal cancer if they had known the results of the recently published NSABP-R02 trial which showed that radiotherapy seems to be more useful at reducing local recurrence rates (which is probably more of a problem in the subgroup of patients with positive circumferential margins or who undergo suboptimal surgery) rather than improving overall survival: the clinical choice for adjuvant treatment in these patients is probably between chemotherapy alone or combined chemoradiation.

The chapter on future directions misses the opportunity to discuss in greater detail the potential of the new drugs irinotecan, oxaliplatin, and the oral fluoropyrimidines. A separate chapter on imaging techniques might be considered for the next edition, considering the increasing interest in virtual colonoscopy and the value of MRI in helping to determine the resectability of rectal tumours.

I am somewhat loath to mention these points as they are probably a reflection of individual opinion and certainly should not detract from this valuable book, which would be an excellent introduction for a registrar or SHO plunged into the field and expected to be a knowledgeable expert from the outset. Likewise, as the relevance of a multidisciplinary approach to colorectal cancer becomes increasingly important, it is essential that the specialist in one discipline keeps up to date with the current thinking in related specialties: a function which this books serves admirably.

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