From the New England Journal of Medicine, July 11, 2002
The Oxford Textbook of Oncology, weighing in at 7.9 kg, covers virtually the entire spectrum of malignant diseases in adults and children. It meets very high editorial and production standards: the organization, illustrations, and eye-pleasing typography are outstanding. With the exception of one vital element, I have high praise for this textbook. Since it is unlikely that these volumes will be read from cover to cover, the usefulness of the Oxford Textbook of Oncology depends heavily on how the individual sections (there are 20) and the chapters within them stand on their own. Will trainees find in these volumes satisfying overviews of non-Hodgkin's lymphoma in children, radiotherapy, and familial cancer? The answer is "yes" in all three cases. Indeed, most of the chapters I read are well-written, up-to-date, and useful reviews. (No reviewer could render an expert opinion on each section of this enormous work, and I am no exception.) The opening section, on the molecular and cell biology of cancer, is excellent. It mentions topics as new as DNA microarrays and covers almost all the recent advances concerning the basis of malignant transformation and the mechanisms whereby tumor cells invade and metastasize. Some chapters in the introductory sections are especially meritorious. Among them are chapters on radiation carcinogenesis, imaging in cancer management, and staging. The entire section on the assessment of the results of cancer treatment is good enough to be made required reading for all trainees and practicing oncologists. The 13 sections concerning site-specific or age-specific tumors, which take up all of volume 2, have been well thought out, and most of the chapters in these sections are well written. Not every chapter I sampled appealed to me. The chapters on cancer screening, prognostic factors, and the molecular and cellular pathology of cancer are too general to be useful. The chapter on the pathology of head and neck cancer is devoid of illustrations. The one on screening by mammography begs for editorial intervention and fails to come across with balanced, clinically useful advice (the downside of mammographic screening is not mentioned). Nowhere in the section on breast cancer could I find a comprehensive discussion of the care of women who carry a BRCA1 or BRCA2 mutation; the topic is briefly taken up in the chapter on familial cancer, but it deserves more than is offered. Surprisingly, this two-volume work arrived without a CD-ROM version, unlike many other large textbooks that have recently been published. Most of the contributors to the Oxford Textbook of Oncology are British, but there is good representation from the rest of Europe. Some Australians and a few North Americans and South Americans also wrote chapters. For readers from any country, however, most of the content is universal. Spot checks on the treatment of chronic lymphocytic leukemia, the staging of esophageal cancer, and the management of non-small-cell lung cancer revealed recommendations in widespread use. Screening for colorectal cancer remains an unsettled question everywhere, but in the United States the trend is toward colonoscopy; the position of the book is, "Colonoscopy as a primary screening tool is . . . unlikely to be acceptable . . . in the United Kingdom or continental Europe." There are undoubtedly other exceptions to current practice in the United States and elsewhere, but they won't be troubling. The chief problem with the book is its price: $445 exclusive of sales tax, shipping, and handling. The cost of the book puts it out of the reach of trainees, and only a small number of individual buyers will purchase it. I doubt that many divisions or departments of oncology will have the resources to buy the book. For some trainees, practitioners, and training units, the only way to acquire an expensive textbook is to receive it as a gift from a pharmaceutical company, a not-uncommon practice that undoubtedly engenders goodwill. Librarians, however, are not recipients of such benevolence, and their limited budgets may prevent them from making a large investment in a textbook that will be outdated within a few years. Surely, in this electronic age, there must be a better means of offering a valuable resource such as the Oxford Textbook of Oncology at an affordable price and in a way that will keep it up to date without the use of paper. Publishers and editors must have thought about the problem, and doubtless they have answers. On its Web site, Oxford University Press states that it originated "in the information technology revolution of the late fifteenth century." The revolution continues but no longer needs printing presses. It is strange to me that Oxford University Press has signified its recognition of the sweeping changes in publishing by offering online references to the public at reasonable subscription rates but continues to market huge medical textbooks at prices that few can afford. Surely the law of diminishing returns will force all publishers to consider whether the extravagantly priced textbook is in their own best interest. Robert S. Schwartz, M.D.
Copyright 2002 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

Book Description
The Oxford Textbook of Oncology provides the definitive, international reference on clinical cancer medicine. It combines the experience of the world's leading cancer experts, particularly from leading European centres of excellence, with an aproach that emphasizes the importance of the best clinical evidence: the guidelines to management are based on the sum of all the available evidence. For rare tumours, where clinical experience is the main guide to treatment, the editors have ensured that options and alternatives are discussed. There are major sections on all cancer sites, and in each section investigation, epidemiology, pathology, causes and treatment are covered in a consistent manner to aid reference. There is a new international team of editors for the second edition, representing oncology, radiotherapy and surgery. Two-thirds of the text has been entirely rewritten. The chapters have been carefully reviewed to ensure that they are clear and concise. Quality-of-life and psychosocial issues, palliation, and communication are given fuller treatment. Early chapters describe the processes underlying cancer; the information on the molecular and cellular biology of cancer and their practical impacton diagnosis and investigation procedures have been extensively revised and updated. The sections on the scientific basis of cancer treatment include the principles of the use of surgery, radiation, chemotherapy and biological therapies. There are substantial new sections on adolescent cancer, cancer as a genetic disease, and melanoma and skin cancer and the extensive section on breast cancer is now proporion to the importance and frequency of this disease. The many clear illustrations are prepared to a consistently high quality. The Oxford Textbook will be the reference work of choice for oncologists, both in practice and in training, all over the world. It will also be an important reference work for generalists who need to understand modern cancer management as part of their practice.

Synopsis
Provides an international reference on clinical cancer medicine. It combines the experience of the world's leading cancer experts, particularly from leading European centres of excellence, with an approach that emphasizes the importance of the best clinical evidence: the guidelines to management are based on the sum of all the available evidence. For rare tumours, where clinical experience is the main guide to treatment, the editors have ensured that options and alternatives are discussed. There are major sections on all cancer sites, and in each section investigation, epidemiology, pathology, causes and treatment are covered in a consistent manner to aid reference. Quality-of-life and psychosocial issues, palliation, and communication are included.

Book Info
Univ. College London, UK. Extensive reference for the practicing clinician. Early sections cover science and explain and illustrates the biology on which cancer treatment depends. Following sections describe the principles of cancer treatment in various forms and specific tumors. Previous edition: c1995.