The Molecular Basis of Cancer

Molecular oncology, as it relates to cancer formation, growth,metastasis, and treatment, is a rapidly progressing and excitingfield. Its forward movement is so fast that even scientific journals,because of publication delays, are unable to keep readers informedin a timely manner. What, therefore, is the role of a textbookon molecular oncology?

The Molecular Basis of Cancer consists of contributionsfrom an accomplished array of molecular biologists and immunologists.The editors' aim, as stated in the preface, is "...to explain,rather than merely recount, the discoveries and observations thatform the basis for understanding a disease...." Such a textis needed: a reference geared toward readers already versed inmolecular biology but who want to learn more about specific molecularalterations leading to cancer formation, as well as novel therapiesbased on molecular biology. Unfortunately, the first edition ofThe Molecular Basis of Cancer does not fully succeed in accomplishingits goal of providing a clear, concise overview of the molecularbasis of neoplasms.

The text is divided into four main sections: malignant transformation,growth and spread of cancer, molecular abnormalities of specificmalignancies, and the molecular basis of cancer therapy. The firstsection on malignant transformation is comprised of introductorychapters on such topics as cell-cycle regulation, viral carcinogenesis,tumor-suppressor genes, specific oncogenes, and signal transduction.The chapters on viral carcinogenesis and tumor-suppressor genesare well-written and comprehensive with extensive reference lists,but the chapter on molecular genetics of hematopoietic malignanciesis inappropriate for the introductory section and is redundant,since much of the information is repeated in two later chapters.

The second section, entitled "Growth and Spread of Cancer,"includes chapters on cytokinetics, cell adhesion mechanisms, tumorangiogenesis, and molecular mechanisms of metastasis. The chapterson cell adhesion and angiogenesis are excellent; the text is clearand well-written, and each chapter has over 340 references.

The third section is comprised of chapters on specific tumors,including hematopoietic malignancies, childhood malignancies,lung cancer, breast cancer, and colorectal cancer. Certain cancerswith well-defined molecularly based origins have been omitted,such as genitourinary cancers (renal cell cancers, bladder cancers,germ cell tumors), sarcomas, ovarian cancer, melanoma, and endocrinecancers (eg, medullary thyroid cancer). All the omitted cancershave fascinating, well-established molecular mechanisms, and thetextbook would be more complete with additional chapters on thesecancers.

Cancer therapy is the main topic of the fourth and final section,and chapters on chemotherapy, radiation therapy, growth factors,monoclonal antibody therapy, cellular immunity, and gene therapyare included. One chapter I was disappointed with was that oncellular immunity, which consists of 18 pages of uninterruptedtext with no diagrams. Most of the chapter focuses on naturalkiller and tumor-infiltrating leukocyte (TIL) cells with a ratherlong historical description of past immunotherapy trials. I wassurprised to find no discussion of tumor antigens, T-cell costimulation,or T-cell anergy, and how these concepts may relate to the escapeof cancers by the immune system. Importantly, manipulation ofthe immune system may lead to novel anticancer therapies, whichwas not discussed.

One significant shortcoming of the book as a whole is the paucityand poor quality of the illustrations. Conceptual understandingof the molecular biology discussed in the text would be facilitatedby clear diagrams, which should serve to confirm points describedmore fully in the text. In The Molecular Basis of Cancer,the text bears the full responsibility of explaining detailed,complex concepts. Diagrams, when present, are often small, rudimentary,and sometimes even appear hand-drawn. This textbook would benefitfrom larger, clearer, computer-generated, and more frequent diagrams.

A textbook on molecular oncology should provide introductory chapterson basic molecular mechanisms of cancer, include all cancerswith a known molecular basis, and be filled with clear, concise,self-explanatory diagrams that reinforce concepts discussed inthe text. The text should also leave the reader excited aboutmolecular oncology and eager to read and regularly peruse scientificjournals. This first edition of The Molecular Basis of Cancerfalls short of achieving these objectives, but hopefully, in subsequenteditions, the editors and their highly accomplished contributorswill improve the text and eventually succeed in their mission.