Head and Neck Oncology: A Concise Guide

Review by L Flood
Middlesborough, UK

I did find it hard to review this book, based solely on my reading off a desktop monitor, but, at a time when new texts are few and far between, this beggar will not be too choosy. Although only an e book is available to reviewers, it seems there is at least a soft back version out there and, from this publisher, I am sure it is well presented.

This “Concise Guide” does not follow the usual practice of an international multi-authorship, supervised by a couple of eminent editors. Instead it is all the work of just two authors (even though the title page still calls them “editors”). That has obvious advantages for consistency of style throughout and adherence to deadlines, but equally, it does place demands on the authors to cover such a wide field comprehensively.

The Preface suggests that this is aimed at the vast Indian market and that it is best seen as an introduction to the subject for trainees. It explains that all management recommendations are based on the guidelines of the National Comprehensive Cancer Network (NCCN) and that certainly does prove to be the case. Most chapters draw heavily on the guidance, quoted word for word, but also on the internationally recognised TNM classification of tumour staging (Union for International Cancer Control, UICC) and for many chapters these two are the sole content. Notably the work of John Watkinson in “Stell and Maran’s Textbook of Head and Neck Surgery” (CRC Press 2011) is very widely referenced in many. This must raise doubts about the novelty of the book content. Having these two on-line resources printed out, ready to hand (and frankly far more readable here than in the NCCN site, which is murder to navigate and read) may well be of advantage to trainees, although again such content is freely available, if you can read off a monitor of course.

Randomly scanning through the content I was struck by some errors and omissions. In the chapter on laryngeal cancer, I was surprised to see Fig 13.1 telling me that a T3 tumour meant a “paralyzed” vocal cord, very different to a fixed cord of course. I confess an obvious personal interest in the “Occult Primary” chapter but read with persisting incomprehension “The exact incidence of epidemiology is unknown, but the occult primary of the head and neck has an incidence of 3-7% presenting with squamous cell carcinoma of the neck”. Fine needle aspiration cytology (FNAC) is recommended, but most of would now consider ultrasound guided needle biopsy, especially as it checks the Human Papilloma Virus (HPV) status, with obvious clues as to the site of the primary tumour. Curiously, HPV receives but a single mention throughout the book, in a chapter on oncogenes and then purely in a list of the culprits. In the oropharyngeal cancer chapter the brief coverage is limited to the NCCN guidelines for p16 negative tumours, without reproducing their guidance on p16 positive tumours!

I turned to a chapter on imaging and saw that ultrasound is dismissed in one and one half lines. Much of the illustration is based on photography of transparent films (those were the days) on the illuminated viewing screens that now gather dust on our hospital walls in the UK. The problem here is reflection of the room lighting and, in one remarkable image, we clearly see the photographer reflected, holding a tablet device

Proof reading missed some errors in the text e.g. “and depends considerably depends on…” In a chapter on radiotherapy I was amused to read a bullet point “Mold and Mold room. Patient mold is prepared in a mold room” as the sole content.

There is praiseworthy content e.g. chapters on carotid blowout, sentinel node biopsy and the orbit. These are imaginative topics and well covered. Colour diagrams of anatomy are quite superb throughout, but the artist responsible is not clarified in the acknowledgements. I have a suspicion I might have favoured a hard copy more than the e-version and better appreciated its value.

This is, indeed then, a concise introductory text, suitable for trainees in head and neck oncology and there is a value in having easy access, in a hard copy that one can read without eye strain, to the TNM classification system and NCCN guidance as to management for many primary sites. Despite the claims in the two forewords, what seems lacking here is “added value”, the personal experience, the tips, the pearls of wisdom, the review controversies that come with decades of experience. A second edition will surely add that.

Amazon Link: Head and Neck Oncology: A Concise Guide
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