Malignant Disease

MALIGNANT DISEASE Malignianit Disease anzd its Treatment by Radiuiimi. By Stanford Cade, F.R.C.S. (Pp. 1,280; with 623 illustrations, many in colour. 75s. net.) Bristol: John Wright and Sons, Ltd.; London: Simpkin Marshall, Ltd. 1940. This book fills a long-felt want and is assured of a hearty welcome. Any one man might well shrink from the attempt to draw the picture of cancer as a whole, for the subject demands at the very least full knowledge of the pathology and natural history of cancer, the wisdom of the experienced general surgeon, and a detailed understanding of the physics and biophysics of radiant energy. Everyone concerned in the treatment of cancer will be under a great debt to Mr. Stanford Cade for succeeding in so immense an undertaking. The first part of the book contains in a hundred pages a full, accurate, and readable account of radio-activity and radium dosimetry. H. T. Flint, C. W. Wilson, and L. H. Gray have contributed chapters which will enable the clinician to understand the physical principles governing the use of radium, and so, in full co-operation with the physicist, be so much better equipped to treat the patient with cancer. In the second part of nearly 200 pages the biological effects of radiation are presented in clear and connected detail, and the wealth of references is never allowed to interfere with the continuity and the clinical significance of the facts described. Where all is so good the account of the much-neglected radium burn is outstanding: " It is neither inevitable nor is it of any therapeutic value. It denotes as a rule errors of technique or errors of judgment." The quotation well illustrates the author's vigorous and easy style, which makes the reading of the book as pleasurable as it is profitable. The third part starts with a succinct account of the limitations of surgery and of the value of radiotherapy, and the author pays his tribute to the pioneer work of the Paris Radium Institute, the Stockholm Radiumhemmet, and the New York Memorial Hospital. If the soundness of their principles had been earlier recognized in England the years spent in using radium for clinical research in general hospitals by methods of trial and error might well have been avoided. Malignant disease is then considered in every site of the body, a chapter to each: its natural history, clinical. types, symptoms (with particular emphasis on the early symptoms as distinct from the textbook descriptions of established disease), histology, local and distant metastases, course, and termination. Next the diagnosis and differential diagnosis are discussed, and then the choice of the method or methods of treatment. The emphasis is always on the value of combined methods of treatment-surgery, surgical diathermy, x rays, and the various kinds of radium treatment ; the right sequence as shown -by experience is indicated, and the technique of radium treatment is given in detail, with illustrative case histories and physical measurements of dosage. The causes of failure are discussed, and the five-year results of the author's cases are set out together with statistics from other cancer centres. Operative details are not as a rule given, but the author lays stress on such points as he has found of importance, such as the removal of the posterior belly of the digastric in a block dissection of the neck. In this connexion, incidentally, he brings the weight of his experience against the so-called prophylactic irradiation of the neck, the value of which is questioned by many radiotherapists. The value of a book written by one man over that compiled by many specialists is particularly well seen in the chapter on the breast: having, as Mr. Cade says, confused his own mind by the voluminous literature, he comes to clear and fundamental conclusions from the study of his own cases, and the indications for the various methods of treatment are set out with such logic as must command general acceptance. There are naturally many examples in radiotherapy where opinions will differ, and not everyone will support the author's preference for the interstitial treatment of rodent ulcer to surface application ; but the case is always fairly presented, and adequate references are given so that the reader may judge for himself. The chapter on cancer of the lung is written by C. Price Thomas, and those on the oesophagus, stomach, and rectum by E. Stanley Lee; these sites are the Cinderellas of radiotherapy, but the reasons for failure and the lines along which advance may be possible are adequately discussed. With over 600 illustratjons, most of them original and many in colour, and a liberal use of charts and tables, the book is an outstanding contribution to radium therapy and a worthy tribute to the Westminster and Mount Vernon Hospital Centres. It summarizes the work of the past twenty years, and will, it is to be hoped, influence the treatment of cancer for another twenty years to come.