Review by L Flood
The opening sentence of this book’s Preface did surprise me. Hypopharyngeal cancer, however much feared by the patient or as potentially missed by the clinician, is officially an ‘orphan disease’ in the developed world, affecting fewer than 5 cases per 100 000 of the population. If anything, the prevalence here may actually be decreasing. Sadly, however, in the developing world and especially Asia, varying epidemiological factors result in the reverse and, indeed, increasing rates in women. This is very nicely illustrated in a pair of world maps (disease risks for men and for women) in the opening chapter. Throughout the book, preservation of function, as much as survival, is stressed, but the challenge is that cancer in this site shows the highest risk of any in the head and neck for a second primary tumour elsewhere. (One of several times in this book when I found myself saying ‘I did not know that’.)
The format of Advances in Oto-Rhino-Laryngology will be familiar to most readers, with the last 12 months seeing publications on sleep-related breathing disorders, hearing rehabilitation and vestibular disorders. Again, there is a multi-author and international contribution, although the two editors have certainly not been idle.
Prof Bradley’s opening chapter on epidemiology exploits many a national register, but notes the surprising lack of such in countries including Italy, Spain and France (a country where hypopharyngeal cancer proves worryingly common). Risk factors, even the unlikely link of viral infection, as is seen with cancer so close by in the oropharynx, are presented, and the references do pass my reviewer’s test for topicality and recent publication. A chapter on ‘Symptoms, Signs, Staging and Co-Morbidity’ reproduces a nice algorithm for the evaluation of a new presentation, and manages to cite the eighth edition of the tumour–node–metastasis (TNM) classification, as recent as 2017. Discussion of the evolution and indeed limitations of TNM ‘staging’ is particularly well done. It seems that volumetric staging, made possible by modern imaging, may yet prove superior (another ‘I did not know that’ moment).
Chapter titles that follow are self-explanatory; for example, ‘Natural History’, ‘Radiologic Evaluation’ (with very nice endoscopic and radiological illustrations) and ‘Treatment Options’. A chapter on changing paradigms in the treatment of an early presenting tumour shows how technological advances, such as laser surgery and transoral robotic surgery, have evolved. ‘Surgical Treatment of Advanced Disease’ has particularly sharp illustrations of procedures all too familiar to the more senior amongst us. The text then moves on to indications for non-surgical management, outcomes to be expected, rehabilitation and complications of treatment (or rather their avoidance). Unsurprisingly, salvage after failed primary treatment is still best achieved with radical surgery, but a recurring message is that of patient selection.
A particularly thought-provoking chapter is on the treatment options in developing countries, where of course the disease is commonest, but facilities limited. My ‘prize chapter’ has to be the final ‘Future Perspectives in …’. With references as recent as 2018, this chapter discusses gene therapy, molecular biology and biomarkers, as one would expect. Cleverly though, it includes coverage of funding of services and drugs, centralisation of treatment, and surgical research topics. I was fascinated to read of something I have long suspected, but which now has a scientific evidence base: any one biopsy of a tumour may well not represent the molecular behaviour and characteristics of other parts of the same primary. (I did not know that.)
This book will have an obvious appeal to all involved in head and neck oncology, especially when so many publications concentrate instead on laryngeal cancer and voice. Our currently precarious UK economy means this is a significant investment for the departmental library, but it has a novelty that makes it well worth it, and exchange rates will hardly improve in the near future!
Amazon Link: Advances in Oto-Rhino-Laryngology, Vol. 83: Hypopharyngeal Cancer
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