Clinical Oncology: A Multidisciplinary Approach for Physicians and Students, 8th Edition

I had the pleasure of reviewing the 8th edition ofPhilip Rubin’s Clinical Oncology: A Multidisciplinary Approach for Physiciansand Students. This is another in a long line of excellent clinical textbooksedited by Dr. Rubin and associate editor Jacqueline P. Williams, PhD. Dr. Rubinis a pioneer in oncology and, in particular, radiation oncology. The currentedition consists of 34 chapters authored by 95 contributors spanning alloncologic specialties and numerous institutions.

The original edition of this textbook, entitled Clinical Oncology for MedicalStudents, was published by Dr. Rubin in 1963. This early text emphasizedradiation therapy, with a second edition published in 1965. In 1967, the titlewas changed to Clinical Oncology for Medical Students: A MultidisciplinaryApproach, with updates appearing in 1970 and 1971. The next three editions weresponsored by the American Cancer Society and authored by members of theUniversity of Rochester Cancer Center Faculty. For those of us who were medicalstudents at that time, these textbooks proved to be valuable educational tools.Unique to the current 8th edition is the multi-institutional authorship.

The textbook is divided into general chapters and site-specific chapters. Thefirst 15 chapters provide both the medical student and the practicing physicianwith a solid foundation for understanding the principles of cancer and cancertherapy. The first chapter, with Dr. Rubin as the lead author, is entitled"Statement of the Clinical Oncologic Problem." It contains generalinformation on cancer, for example, reviewing the epidemiologic aspects ofcancer, as well as the principles of detection, staging, and treatment.

The second chapter, entitled "The Biology of Cancer," describes themolecular basis of tumor development. The chapter discusses the particularlyrelevant principles of cancer development in this era of molecularly targetedtherapies. Chapter 3 reviews the pathology of cancer, and chapter 4 reviews theprinciples of surgical oncology. Chapters 5 through 7 reflect Dr. Rubin’sexpertise in radiotherapy in their discussion of the principles of this field.These three chapters provide a solid background on all aspects of radiationinvolved in the treatment of cancer, including radiobiology, physics, and basicradiation principles.

The next chapter explores chemotherapy and medical oncology, and this isfollowed by a discussion of the basic concepts guiding drug development andclinical trials, which will be especially useful for medical students. Textbooksoften report the results of clinical trials, but they rarely describe theprocess behind trial development and reporting. I frequently ask students thedifference between phase I, II, III, and IV trials and, more often than not,receive an incorrect response. This chapter provides a concise, complete summaryof relevant information.

The non-site-specific chapters include discussions of gene therapy andimmunologic therapy. Also included are chapters on HIV-related malignancies andoncologic emergencies. The latter chapter is divided into different types ofemergencies. Each section begins with a background paragraph, which is followedby a consideration of diagnosis and therapy. I found this to be a useful,straightforward presentation of the data.

Another chapter is devoted to the principles of psychosocial oncology. Thoseof us involved in the care of oncology patients understand the importance ofthis aspect of management, which can be a large part of day-to-day practice.This section of the book does a good job of reviewing an often underappreciatedfield.

The final non-site-specific chapter addresses oncologic and tumor imagingstrategies, providing background on various imaging modalities. However, thediscussion on positron-emission tomography (PET) imaging is somewhat lacking,given current clinical indications for the technique. This probably relates tothe speed at which the indications for PET imaging in oncology are developingand the time it takes to publish a textbook.

The site-specific chapters are divided into general malignancies, eg,gynecologic cancers, alimentary cancers, and so forth. These chapters, in turn,are organized into sections discussing epidemiology and etiology, detection anddiagnosis, classification and staging, principles of treatment, and results.They also contain separate subsections on the neoplasms classified within eachof these tumor groups. I found these chapters to be well-written and concise.The book is particularly well suited as an introduction to the whole continuumof issues that are important when treating a particular malignancy.

The first section of each site-specific chapter, on epidemiology andetiology, provides basic cancer statistics and primary etiologic factors. Thenext section, on detection and diagnosis, describes clinical detection anddiagnostic procedures, providing good background information for practicalapplications. For example, the breast cancer chapter introduces the BreastImaging Reporting and Data System (BIRADS) and discusses the controversysurrounding screening mammography in women aged 40 to 50 years. Specificradiologic and other diagnostic procedures appropriate for the malignancy arereviewed in this section.

The section entitled Classification and Staging discusses the histopathologyof cancer and currently accepted staging systems. The section on principles oftreatment describes the main recommended therapies while emphasizing themultidisciplinary nature of current oncologic management. The final section,Results and Prognosis, reviews expected outcomes with an emphasis on clinicaltrials. The result section is supported by an extensive bibliography in each ofthe site-specific chapters.

In summary, Dr. Rubin and colleagues should be congratulated for anotheroutstanding edition of Clinical Oncology. This should be a staple for allmedical students and an excellent general textbook for all physicians interestedin oncology.