Review by P J Bradley
This volume provides a comprehensive in-depth commentary and review of each phase of the survivorship trajectory of a patient with oral cancer, edited by the Senior Staff of the Department of Otolaryngology – Head and Neck Surgery, Oncology and Radiation Oncology and Molecular Radiation Sciences at Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. They and their contributing authors present the evidence of current treatment within 10 sections, in 52 chapters, covering 441 pages.
The text commences with the patient’s journey, in chapters with titles covering topics such as: epidemiology of oral cancer and the at-risk patients, premalignant conditions, the diagnostic process, pre-treatment evaluation and assessment, surgical management of the oral cavity by subsites, the role of adjuvant therapy, the management of non-squamous cell carcinoma lesions, review of post-treatment outcomes and sequelae, considerations for treatment options of recurrence and metastatic status, and ending with comments on the future perspectives. More than 100 authors are listed, of whom 90 per cent are North America-based (USA and Canada) (one-third are employed at Johns Hopkins University). Two chapters on subsite oral tumour excision have been authored by surgeons based in Mumbai, India and Hong Kong. Of note, one contributing author has been omitted or overlooked from the list of contributors!
Section V, titled ‘Evaluation and Surgical Management of Subsite-specific Oral Squamous Cell Cancers’ (Chapters 13–34, 181 pages, accounting for more than 45 per cent of the volume), presents information in a standard manner: epidemiology, clinical presentation, diagnostic methods, anatomical and treatment considerations, and sequelae of therapy, summarised by key points with or without ‘pearls’ which are highlighted. I am unsure why epidemiology commences each oral cavity subsite in Section V, when Chapter 1 of the book is already titled ‘Epidemiology’, but which in reality should have been titled ‘An Introduction to Oral Cavity Cancer’. Each of the oral cavity primary tumour subsites discussed (nine in total), has an accompanying chapter that details the options available for reconstruction, and it comments on advances, rehabilitation, sequelae and other relevant issues. Two chapters (33 and 34) discuss the use of definitive external beam radiotherapy and brachytherapy. There is in addition Section VI (‘Adjuvant Therapeutic Considerations’ – Chapters 35 and 36), which discusses current practice in radiotherapy and chemoradiotherapy, and which includes novel therapies.
Discussion of excision surgery of oral cavity subsites has been sequenced by a partner chapter discussing surgical reconstruction. The latter tends to be repetitive, listing the available local, regional (cutaneous and myocutaneous) and free-tissue flaps, rather than presenting the authors’ preferences for their reconstructive methods, citing advantages and disadvantages. Most US departments have the staff expertise and facilities to enable a separate team to undertake the excision and another to carry out the reconstruction. The use of surgical drawings, coloured preferably, or black and white, should be sourced and presented uniformly throughout the volume. The addition of a figure illustrating the classification of upper and lower alveolar bony defects might have reduced some of the wordage in the relevant reconstructive chapters.
This Thieme publication is a comprehensive work comprising 384 clinical, surgical, histopathological and radiological images, 29 tables, a flow-chart, and a box, with the text systematically laid out for ‘easy’ reading. It is comprehensively supported by many up-to-date citations and publications up to and including the early part of 2018 (mean number of 60 references per chapter). There is also an Index, using key words, which extends to 14 pages. A major difficulty, when reading, was that most chapters were best read singly, as the contents appeared to have been composed as such. In the reading of chapters in sequence, a significant portion of the factual information was repeated or duplicated. There was one reconstructive figure that I identified as duplicated (Figures 20.2 and 22.2; no others were noted). Such duplication could be minimised by more stringent editing between chapters and across the sections.
The patient’s journey as it progresses through each phase of the survivorship trajectory has been themed for this project, and is welcomed, as the editors acknowledge. The need for a ‘team approach’ or a ‘village’, as has been described elsewhere, is required for the management and support of patients diagnosed with head and neck cancer. In summary, there are chapters that cover topics such as: the pre-treatment dental evaluation, speech and swallowing assessment, nutritional evaluation, post-treatment use of oral prosthetics (labelled ‘oral rehabilitation’), voice and swallowing, dental considerations, as well as surgery and radiotherapy complications, and finally post-treatment surveillance. Notably, complications of oral cancer surgery were covered in 7 pages with 43 references, whereas radiotherapy related side effects merited 10 pages and 131 references – maybe this reflects the excellence of surgical practice! In Chapter 37, titled ‘Salivary Gland Malignancies’, sublingual (and minor) gland neoplasms got a ‘short shrift’, with a 10-line paragraph and no references. Chapter 38, titled ‘Uncommon Malignancies,’ covered three very dissimilar pathologies: mucosal melanoma, sarcoma and lymphoma. The commentary was, however, amalgamated into paragraphs, leaving an impression that they were somehow similar but the treatment was different! Two chapters, ‘Psychological Rehabilitation’ (Chapter 42) and ‘Trismus’ (Chapter 47) were informative and refreshing to read. A smile was generated on reading that clinicians in the USA have the availability of ‘Behavioural Health Specialists’ as team members to support the rehabilitation of head and neck patients; maybe sometime soon such expertise will be available internationally!
I was disappointed in Sections XI and X, which focus on tumour recurrence, metastatic disease and future direction. Five of the six chapters were authored by clinicians not from Johns Hopkins University, and the presentation was in the format of a literature review, with little or no details of patient selection, outcome or management success. It was also disappointing that the efforts of the World Health Organization regarding the prevention of environmental factors that cause oral cancer (Chapter 52) were not mentioned.
This book, despite my few criticisms and comments, has much to offer surgical and oncological residents and young clinicians, but also dentists, prosthodontists, oral and maxillofacial surgical residents and trainees, residents and trainees in oncology, students and clinicians in speech and language therapy, dietetics, psychologists, and other members of the head and neck multidisciplinary cancer team. There have been similar books covering oral cancer and a more expanded version covering topics of head and neck cancer that have included similar clinical scenarios on oral cancer. This publication and its contents are most comprehensive. However, given that this book has been commissioned and written by US-based clinicians, surgeons and oncologists, the market and sales are most likely to be confined locally, to North America.
Amazon Link: Oral Cancer: Evaluation, Therapy, and Rehabilitation
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