Principles and Practice of Gastrointestinal Oncology

Book Preface

As a group, gastrointestinal malignancies are the most common cause of cancer in the world. A recent review indicated that, of the 10.8 million people in the world each year who develop cancer, approximately 3.3 million have gastrointestinal malignancies, including esophagogastric cancer, colorectal, hepatocellular, and pancreatic malignancies. In comparison, lung cancer occurs in approximately 1.4 million people each year and breast cancer in 1.2 million women per year. Furthermore, gastrointestinal malignancies are one of the most lethal malignancies. Twenty-nine percent of cancer-related deaths are caused by gastrointestinal cancers. Particularly for esophagogastric cancer, hepatocellular, and pancreatic cancer, the annual incidence and annual mortality are very similar. Prevention, early diagnosis, and improved therapy are urgently needed in gastrointestinal malignancies.

Although the incidence of gastrointestinal cancers varies substantially between different regions of the world, there is considerable overlap in their cause and in the strategies pursued for improvement in outcome. Some gastrointestinal malignancies should be nearly totally preventable, such as hepatocellular carcinoma secondary to cirrhosis from viral hepatitis or alcohol abuse and anal canal cancer secondary to infection with human papilloma virus. In both of these diseases, the development of vaccines against the infectious agent that leads eventually to the malignancy should markedly decrease the incidence of cancer. Proof of principle has already been demonstrated for hepatocellular cancer using vaccines against hepatitis B. In the case of colorectal cancer, removal of a premalignant lesion should prevent the development of subsequent cancer.

If the tumor cannot be prevented, finding it at an earlier stage also improves outcome. This has been demonstrated for colorectal cancer as well as for upper gastrointestinal tract malignancies such as gastric cancer. On the other hand, for some tumors, including pancreatic cancer, the etiology of the disease is less clear, although some progress has been made. Screening and surveillance programs have not yet been adequately developed, and the majority of patients with gastrointestinal malignancies present with extensive and frequently metastatic cancers.

Since the publication of the first edition of this book, there have been important advances in understanding the cause and pathogenesis of gastrointestinal malignancies, a far better understanding of the molecular events leading to the development of these cancers, some improvements in surveillance and screening, and improvements in therapy. From the pathogenesis point of view, colorectal cancer is a model for understanding the neoplastic process from the development of an adenoma through increasing degrees of dysplasia and carcinoma. Better preclinical models, such as genetically engineered mouse models, hold promise for an improved understanding of gastrointestinal malignancies, including such difficult-to-access tumors as pancreatic cancer. Rapid advances in molecular biology (including the sequencing of the human genome) and the development of high through-put systems hold promise for the development of better prognostic and predictive markers in the individual patient.

This second edition of Principles and Practices of Gastrointestinal Oncology is a comprehensive, in-depth review of the commonest group of human cancers. The editors and the chapter authors represent an international group of experts who are leaders in their respective fields. They have helped develop current standards of care and direct many important research initiatives. The book features an introductory section that reviews the principles of modern oncology, including both basic and translational science points of view. The principles underlying individual discipline —including surgery, radiation, medical oncology, diagnostic imaging, and epidemiology—are presented as they apply to gastrointestinal cancers.

The second portion of the book is an updated, in-depth review of gastrointestinal malignancies from the prospective of each individual organ. Each site-specific section features chapters that focus on epidemiology, molecular biology and pathology, prevention (including screening and surveillance), staging, and therapeutic options for that individual tumor site. The chapters are current and include the results of recent important clinical trials that may have either changed the standard of care or demonstrated that an important research initiative did not substantially change outcome. In general, the site-specific chapters dealing with clinical management are multi-authored by experts in appropriate disciplines, including medical, radiation, and surgical oncology.

We hope that this new edition of Principles and Practices of Gastrointestinal Oncology will be useful to all physicians, practitioners, and scientists who have an interest in gastrointestinal malignancies. Our understanding of gastrointestinal cancer is changing rapidly, and we hope that the book provides a readable and in-depth presentation of the most current information available to help our colleagues in the management of patients with cancer of the gastrointestinal tract.