Table Of ContentEUROPEAN SOCIETY OF SURGICAL ONCOLOGY
U. Veronesi (Editor-in-Chief)
Surgical Oncology
A European Handbook
B. Arnesj0, I. Burn, L. Denis and F. Mazzeo (Co-Editors)
Foreword by I. Burn
With 222 Figures and 227 Tables
Springer-Verlag Berlin Heidelberg New York
London Paris Tokyo Hong Kong
Professor Dr. UMBERW VERONESI
Direttore Generale
Istituto Nazionale per 10 Studio e la Cura dei Tumori
Via Venezian, 1, 20133 Milano, Italy
Professor Dr. Bo ARNESJ0
Department of Surgery, Haukeland University Hospital
University of Bergen
5021 Bergen, Norway
Professor Dr. IAN BURN
Charing Cross Hospital
Fulham Palace Road
London W6 8RF, United Kingdom
Professor Dr. LOUIS DENIS
Department of Urology
A. Z. Middelheim, Vrue Universiteit Brussel
Lindendreef 1, 2020 Antwerpen, Belgium
Professor Dr. FRANCESCO MAZZEO
Universita di Napoli
Cattedra di Chirurgia Generale, II facolta'
Via Pansini, 5, 80131 Napoli, Italy
Editorial Secretariat
Scientific Secretaries: Dr. Vittorio Quagliuolo, Dr. Alberto Azzarelli
Editorial Secretary: Ms. Sheila McGrath
ISBN-13:978-3-642-72648-4 e-ISBN-13:978-3-642-72646-0
DOl: 10.1007/978-3-642-72646-0
Library of Congress Cataloging-in-Publication Data
Surgical oncology: a European handbook / U. Veronesi (editor-in-chief) ; B. Arnesjo ... let al.],
co-editors. p. cm. Includes bibliographies and index.
ISBN-13:978-3-642-72648-4 (U.S.):l.Cancer-Surgery-Handbooks, manuals, etc. I. Veronesi, Umberto.
II. Arnesjo, B. (Bo) [DNLM: 1. Neoplasms - surgery. QZ 268 S96113] RD651.S933 1989 616.99'4059
- dc20 DNLM/DLC for Library of Congress
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Foreword
The concept of the surgical oncologist is a strange one. Surgeons are a special
breed of human beings, whose work requires a degree of pragmatism which is
almost unique. Cancer would seem to be altogether too diffuse a subject to con
tain within the usual surgical boundaries and almost foreign to the traditional
precision of surgical thinking. And yet, the responsibility for initial diagnosis and
primary management of the vast majority of patients with malignant disease has
always been vested in the surgeon.
For some forms of cancer, there is reason to be fairly satisfied with what has
been achieved. Apart from the natural distaste of anyone to submit him- or her
self to the surgeon's knife, there would seem to be little cause to seek a change
of therapy. Why change a winning horse? It is true that for other forms of malig
nant disease, however, surgical endeavour has seen little reward in terms of cure
of the disease. The analysis of such results, about which the literature is volumi
nous, frequently shows that ultimate failure is due to the advanced stage of the
cancer at the time of first diagnosis, rather than to an integral fault of the proce
dure. In other words, given an earlier cancer, the same procedure will effect cure.
But perhaps the argument is too facile, certainly for the patient with advanced
cancer. We can never expect that all cancers will be diagnosed early enough for
the surgeon, with his or her present techniques, to cure the majority. Patients
will continue to present to the doctor with varying stages of malignant disease.
The therapist must adapt to allow for this.
Here then lies the challenge for the surgical oncologist. Patients with cancer
need to be studied before vital decisions on therapy are made. This study will be
possible only if there is complete familiarity with the natural history of the dis
ease and with the true potential of all available methods of treatment. Above all,
knowledge must incorporate the disadvantages of these methods so as to ensure
that the situation is not made worse.
Where is the knowledge to come from to enable surgeons to be more com
pletely equipped to deal with cancer in the modem era? The "surgical oncolo
gist" may be defined as a trained surgeon with a committed interest in the study
of cancer and in the care of patients with malignant disease. Such individuals
must have the opportunity and facilities to study cancer, and this is going to re
quire some radical re-thinking in the corridors of surgical power.
Hopefully those responsible for surgical decision-making throughout the
world will recognise the need for surgical oncology and will support the concept
in a positive way. Trainee surgeons with a declared interest in the topic must be
given the encouragement and support to pursue their interest. Their educational
needs must be provided. Posts must be created in hospitals and institutes within
which the surgical oncologists can ply their trade alongside other specialist on
cologists. To date, this has happened only to a small degree in a few enlightened
areas in the world.
VI Foreword
Fortunately, there have been some positive moves on behalf of surgical onco
logy, which have at least made a start in the creation of educational facilities.
Notable has been the emergence of a number of surgical oncology societies and
journals. Some of these are now well established and provide a continuing excit
ing forum for debate and the exchange of information. Also, the last few years
have seen the production of a number of text books on surgical oncology, which
will undoubtedly help to foster interest in the subject.
The European Handbook of Surgical Oncology was spawned out of discus
sions which took place between members of the European Society of Surgical
Oncology shortly after its formation 5 years ago. The book contains contribu
tions from oncologists from all over Europe. It is truly comprehensive in its ap
proach to the subject. To practise cancer surgery confidently requires a depth of
knowledge about the disease which goes far beyond the simple attributes of
diagnosis and dissection. This book provides that knowledge, donated by some
of the most experienced oncologists of this century. It is also, notably, an interna
tional effort, which is the only logical way to deal with a disease which is a mas
sive threat to the whole human race.
IAN BURN
President, European
Society of Surgical Oncology
Table of Contents
Introduction: The Role of Surgery in Cancer Treatment (U. VERONESI) . . .. 1
Biology of Cancer. . . . . . . . . . . . . . . . 7
The Cancer Cell (N. S. E. SARGENT and M. M. BURGER) 9
Biology of Cancer Invasion and Metastasis (P. SmAuLI) 20
Cancer Epidemiology (c. S. MUIR and M.-C. GRAN) ... 31
Detection and Diagnosis . 45
Cancer Staging (I. BESZNYAK) . .. . . . . . . . . . . . . . . . . . . . . . 47
Cancer Detection and Screening: High-Risk Groups (D. M. PARKIN) . . 55
A Modern View of Histopathological Diagnosis and Classification of
Cancer (F. RILKE) ............................. 62
Modern Imaging Techniques in Diagnosis Staging and Follow-up of Cancer
(P. HAEHNEL, M. DREYFUS, and D. JAECK) . . . . . . . . . . . . . . . . . .. 84
Endoscopy in the Diagnosis and Treatment of Cancer (P. SPINELLI) . . . .. 97
Monoclonal Antibodies in the Diagnosis and Management of Colorectal
Carcinomas (J. P. MACH, F. BUCHEGGER, J. PETIA VEL, A. BISCHOF-DELALOYE,
and B. DELALOYE) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
General Concepts in Cancer Treatment ......... . 121
Principles of Surgery in the Primary Treatment of Cancer (I. BURN) ..... 123
Surgery in the Treatment of Recurrent and Metastatic Cancer (J. PETIAVEL,
1. COSTA, P. DOUGLAS, A. BESSON, M. SAVARY, and N. DE TRIBOLET) 131
Irradiation in Cancer Treatment (M. TuBIANA) . . . . . . . . . . . . . . . 142
Intraoperative Radiotherapy (H. J. HOEKsmA and F. A. CALVO) ...... 150
The Biologic Basis of Cancer Chemotherapy (M. BROWER and D. CARNEY) 162
Chemotherapy in Cancer Treatment (E. BOVEN and H. M. PINEDO) .. 174
Liver Infusion Chemotherapy (P. SCHLAG and C. HERFARTH) . . . . . . 188
Adjuvant Systemic Therapy (G. BONADONNA, F. FOSSATI-BELLANI, and
P. VALAGUSSA) . . . . . . . . . . . . . . . . . 200
Hormones in Cancer Treatment (F. CAVALLI) . . . . . . . . . . . . . . 218
VIII Table of Contents
Immunotherapy of Cancer (P. ROMKE) . . . . . . . . . . . . . . . . . . .. 228
Transplantation and Cancer (H. PICHLMAIER and R GRUND MANN) . . . . .. 237
Wound Healing and Cancer (B. ZEDERFELDT, P. BLOMQUIST, H. JIBORN, and
P. UDEN) . . . . . . . . . . . . . . . . . . . . . . . . . . . 246
Nutrition and Cancer (L. L. MOLDAWER and T. SCHERSTEN) . 254
Infection in Cancer Patients (P. DEJACE and J. KLASTERSKY) 260
Psychological Aspects of Surgical Oncology (P. MAGUIRE) 272
Pain Treatment in Cancer (Y. VENTAFRIDDA and A. SBANOTfO) 282
Terminal Care (R TwYCROSS) . . . . . . . . . . . . . . . . . 296
Emergencies in Cancer Disease . . . . . . . . . . . . . . . . . . . . 307
Increased Intracranial Pressure and Spinal Cord Compression
(E.-O. BACKLUND) . . . . . . . . . . . . . . . . . . . . . . 309
Vascular Emergencies (D. BERGQVIST and S.-E. BERGENlZ) . . . . 315
Metabolic Disorders (K. LUNDHOLM) . . . . . . . . . . . . . . . 320
Haemorrhage, Obstruction, Perforation, and Infection in Head and Neck
Cancer (I. A. McGREGOR) . . . . . . . . . . . . . . . . . . . . . . . . . .. 327
Obstruction, Perforation, Infection, and Haemorrhage in Thoracic Cancer
(T. M. SCHEININ and P. J. ROBERTS) . . . . . . . . . . . . . . . . . . . . . .. 331
Emergencies in Gastrointestinal Cancer (G. WILLEMS) . . . . . . . . . . .. 337
Obstruction, Perforation, Inflammation, and Haemorrhage in Urological
Cancer (RRHALL) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 341
Hemorrhage, Obstruction, Perforation, and Inflammation in Gynecological
Cancer (w. H. MATTHEIEM). . . . . . . . . . . . . . . . . . . . . . . . . 345
Early and Late Complications of Oncological Treatment (G. C. DAVIES) ... 348
Rehabilitation Procedures . . . . . . . . . . . . . . . . . . . . . . . 363
Plastic and Reconstructive Surgery in Breast Cancer Patients (H. BOHMERT) . 365
Microsurgical Reconstruction of Large Defects after Tumor Surgery in the
Head and Neck Region (RG.H.BAUMEISTER and H.BOHMERT) ........ 383
Orthopaedic Procedures in the Rehabilitation of Cancer Patients (R KOlZ
and A. AZZARELLI) . . . . . . . . . . . . . . 386
Stoma Construction and Care (L. HULTEN) . . . . . . . . . . . . . . . . . . . 399
Planning and Evaluation of Cancer Treatment 413
Regional Treatment Programmes and Cancer Registration (T. R MOLLER and
T. LANDBERG). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 415
Follow-up of Surgical Cancer Patients (H. WHITE and M. C. PARKER) . . . 424
Clinical Trials (M. STAQUET) . . . . . . . . . . . . . . . . . . . . . . . . . 446
Statistical Analysis of Survival and Disease Recurrence Data (M. BUYSE) 451
Measurement of Quality of Life in Cancer Research (N. K. AARONSON and
F.CALAISDASILVA) .......................... 458
Controlled Clinical Trials 1988: Ethical Considerations (H. TAGNoN) . . .. 467
Table of Contents IX
Treatment of Cancer of Different Organs . . . 473
Cancer of the Head and Neck Region (G. B. SNOW) . . . . . . . . . . . .. 475
Cancer of the Respiratory Tract, Pleural Cavity, Mediastinum, and Chest
Wall (P. GOLDSlRA w) ............................ 495
Cancer of the Oesophagus (R. GIULi) . . . . . . . . . . . . . . . . . . . . 514
Cancer of the Cardia: Extended Esophagogastrectomy (E. M. GONZALEZ,
M. GOMEZ, J. M. JOYER, J. CALLEJA, I. LANDA, J. ARIAS, F. ESCUDERO, and
I. GARCIA) ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 537
Cancer of the Stomach (F. MAZZEO, N. MOZZILLO and P. FORESllERI) . . . 544
Pancreatic and Periampullar Carcinoma (W. HOHENBERGER, H. ZIRNGIBL and
F. P. GALL) . . . . . . . . . . . . . . . . . . . . . . . . . . . 578
Cancer of the Liver (0. J. GARDEN and H. BISMUlH) ..... 622
Cancer of the Biliary Tract (0. S0REIDE and L. H. BLUMGART) 636
Small Bowel Cancer (U. METZGER) . . . . . . . . . . . . . . 653
Cancer of the Colon and Rectum (B. ARNESJ0, J. F. HALVORSEN and
AO.MYKING) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 657
Tumours of the Anal Region 0. M. A NORlHOYER and J. P. S. THOMSON) . 675
Cancer of the Kidneys (w. VAHLENSIECK and N.JAEGER) . . . . . . . . . 683
Cancers of the Urinary Bladder, Ureters and Urethra (L. DENIS, R. HALL and
G. JAKSE) . . . . . . . . . . . . . . . . . . . . 705
Carcinoma of the Prostate (F. H. SCHROEDER) 720
Carcinoma of the Penis 0. P. BLANDY) .... 746
Cancer of the Testis (G. PIZZOCARO) ..... 756
Cancer of the Ovary (F. DI RE and R. FONTANELLI) 768
Cancer of the Uterus 0. P. WOLFF) ........ 783
Primary Adult Vaginal Cancer (G. MICHEL and A GERBAULET) . 809
Cancer of the Vulva (G. MICHEL and A GERBAULET) . . . . . . 817
Cancer of the Breast (U. VERONESI, A COSTA and P. VERONESI) 827
Thyroid and Parathyroid Carcinoma (P.-O. GRANBERG, M. BACKDAHL,
B. CEDER MARK, B. HAMBERGER, G. LUNDELL, T. LbWHAGEN, and G. WALLIN) 879
Gastrointestinal and Adrenal Tumours (F. STADIL and H. KEHLET) . 897
Melanoma of the Skin (N. CASCINELLI and C. CLEMENTE) . 900
Cancer in Childhood-Solid Tumours 0. PLASCHKES) 930
Soft-Tissue Sarcomas (A KULAKOWSKI) . . . . . . . 955
Bone Sarcomas (N. TRAPEZNIKOV) ......... 962
Surgery in Hematologic Malignancies (K. SOLHEIM) 970
Metastatic Cancer from Unknown Primary Site (K. LOTE) . 976
Subject Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 985
List of Contributors
AARONSON, N. K. BERGQVIST, D.
E. O. R. T. C. Study Group Department of Surgery
on Quality of Life University of Lund
The Netherlands Cancer Institute General Hospital
Plesmanlaan 121 Malmo, Sweden
1066 CX Amsterdam, The Netherlands
BESSON, A.
J. Facuite de Medecine
ARIAS,
Instituto Nacional de la Salud Service de Chirurgie A du CHUV
Servicio de Chirurgia de 1011 Lausanne, Switzerland
Aparato Digestivo II
Hospital 1. Octubre BESZNYA K, 1.
Carretera de Andalucia, km 5 National Cancer Institute
28041 Madrid, Spain Department of Surgery
1125 Rath Gy. u. 7-9
Budapest, Hungary
ARNESJ0, B.
Department of Surgery
Haukeland University Hospital BISCHOF-DELALOYE, A.
5021 Bergen, Norway CHUV
Division of Nuclear Medicine
BACKLUND, E. O. 1011 Lausanne, Switzerland
Department of Neurosurgery
University of Bergen BISMUTH, H.
Unite de Chirurgie Hepato-Biliaire
Haukeland Hospital
Hopital Paul Brousse
5016 Bergen, Norway
94800 Villejuif, France
BA-CKDAHL, M. BLANDY, J. P.
Karolinska Hospital
The London Hospital Medical College
10401 Stockholm 60, Sweden
Turner Street
London E1 2AD, UK
BAUMEISTER, R. G. H.
Abteilung Plastische Chirurgie der
BLOMQUIST, P.
Chirurgischen Klinik und Poliklinik
Malmo General Hospital
Klinikum Grosshadern
Department of Surgery
Marchioninistrasse 15
University of Lund
8000 Munchen 70, FRG
21401 Malmo, Sweden
BERGENTZ, S.-E. BLUMGART, 1. H.
Department of Surgery Klinik fUr Viszerale und
University of Lund Transplantationschirurgie
General Hospital Inselspital
Malmo, Sweden 3010 Bern, Switzerland
