Handbook of Gynecologic Oncology

Handbook of Gynecologic Oncology, edited by Drs.Barakat, Bevers, Gershenson, and Hoskins, is a first-edition clinical handbookformulated primarily for fellows in gynecologic oncology as well as forinterested fellows in medical oncology and radiation oncology. The textbookpresents concise summaries of the critical issues in the care of gynecologiccancer patients and would also be of interest to residents preparing for theirgynecologic oncology rotations, obstetrician/gynecologists, other physicians whocare for gynecologic cancer patients, and practicing gynecologic oncologists.

Handbook of Gynecologic Oncology is the result of a collaborationbetween the faculties of M. D. Anderson Cancer Center and MemorialSloan-Kettering Cancer Center—considered the birthplaces of the gynecologiconcology subspecialty and fellowship training. The editors and the 29 additionalauthors, many of whom are recognized experts in their field, are exclusivelyaffiliated with these two large cancer centers, and in this text, they pass onpearls of wisdom concerning gynecologic cancer care gleaned over the past 40years in addition to information from the current literature.

The organizational scheme of the book closely follows the standard curriculumfor the gynecologic oncology fellowship. The first chapter presents an overviewof statistics in understandable terms using specific examples from the field ofgynecologic oncology. The concepts and facts relevant to the interpretation ofclinical literature and manuscript preparation are the focus of the chapter,making it a good quick reference for young physicians early in their academiccareer.

Subsequent chapters present additional gynecologic oncology-related topics,including pharmacology, critical care, perioperative care, nutrition, supportivecare, and minor surgical procedures. These chapters remain true to the aim ofthe text, providing the information needed by busy clinical fellows.

The pharmacology section comprehensively and effectively outlines themanagement of multiple common clinical problems such as pain management, bonemarrow suppression, neutropenic fever, chemotherapy-induced nausea, and fluidand electrolyte management. Utilizing multiple easy-to-read tables, the dosingand potential side effects of the various medications used to treat thegynecologic oncology patient are clearly outlined.

The illustrations in the chapter on procedures are clear and simple, pointingout important anatomic landmarks. One potential area for improvement would bethe addition of a chapter that briefly describes and illustrates major surgicalprocedures such as urinary conduit formation and bowel reanastamosis—interventionsthat often require a quick review by the trainee before stepping into theoperating room.

The chapter on nutrition provides a good overview of broad issues but wouldhave been more helpful to the trainee if a step-by-step algorithm forcalculating and ordering total parenteral nutrition (TPN) solutions had beenincluded. The critical care chapter is especially succinct and complete. Withtables defining and explaining ventilator modes, types of shock, and otherimportant concepts, this chapter could serve both as a quick clinical referenceand concise study guide for the boards.

The remaining chapters present the principles of radiation therapy andchemotherapy followed by chapters individually dedicated to gynecologic cancerdisease sites, including preinvasive disease as well as breast and colon cancer.The various chemotherapies commonly used in gynecologic oncology aresystematically described by their mechanism of action, route of elimination,dosing and schedules, administration, expected side effects, and druginteractions. The radiation chapter begins with the basic principles and endswith a discussion of the important issues involved in planning radiation therapyfor cervical, endometrial, and vulvar cancer. Illustrations showing dosimetrydiagrams would be a welcome addition for future editions.

The disease site chapters comprise brief but clinically relevant discussionsof the diagnosis, treatment, and surveillance of the various malignancies. Ingeneral, the illustrations are of excellent quality. The few treatment guidelinealgorithms are comprehensive and provide excellent summations. Becausegynecologic oncologists frequently care for patients with breast and coloncancer, the basic but complete chapters on these two cancers are welcomeadditions to a clinical handbook.

The textbook ends with nine appendices totaling 146 pages. In contrast toappendices in other handbooks, these are especially useful with respect to theirchosen topics and format. Appendix 1 concisely summarizes the American CancerSociety recommendations for general cancer screening, and screening for breast,colorectal, gynecologic, and skin cancer. Appendix 2 presents the InternationalFederation of Gynecology and Obstetrics (FIGO) staging classifications instandard table format and in illustrations depicting not only gross anatomy butrelevant microscopic/histologic anatomy as well—both unique and especiallyhelpful features.

Appendices 3 and 4 contain summaries of the common combination-chemotherapyregimens used in gynecologic oncology and clinical research definitions,respectively, while the 93-page Appendix 5 exhaustively defines toxicitycriteria. Appendices 6 through 8 provide quick-reference tables of laboratoryvalues, critical care formulas, and advanced cardiac life support algorithms.The text ends with an appendix of useful Web addresses—a necessity for anoncologist in the 21st century.

In summary, Handbook of Gynecologic Oncology achieves its statedobjectives and should become an important resource for fellows, residents, andphysicians caring for patients with gynecologic cancers. The text is well editedand uses innovative strategies to present this overview. Having these topics,tables, formulas, and algorithms presented concisely in one user-friendlyclinical handbook will be a blessing for the busy trainee caring for patients ina hospital or in the office, evaluating patients enrolled in protocols, writingmanuscripts, or preparing for boards. Downscaling the size of the book so thatit could fit into the pocket of a lab coat would only further enhance its value.

The editors promise to update this text every 2 years. Thus, Handbook ofGynecologic Oncology has the potential to continually improve and remaincurrent in its excellent presentation of the care of the gynecologic oncologypatient.