Foundations of colorectal cancer

Colorectal cancer (CRC) is the third most common cancer and the second most common cause of cancer related deaths worldwide as per the Globocan 2020. Although CRC is more prevalent in developed countries, there has been an increasing trend of CRC cases in developing countries including India. The last decade has seen many advances in the management of CRC which have contributed to better outcomes for patients. This has resulted in an explosion of the literature on CRC in recent years. This book entitled Foundations of colorectal cancer, edited by Alejandro Pazos Sierra is a new addition to the plethora of literature on CRC.

This book is an in-depth review and consists of eight sections divided into 56 chapters focusing on the various aspects of CRC. It is a collaborative effort by experts working with the REGICC (Galician Network of Research in Colorectal Cancer) and has a European and especially Spanish perspective.

The first section covers epidemiological studies on CRC and includes chapters on incidence and mortality, prognosis and follow up, with a focus on European and Spanish data. The next section on clinical manifestations and disease detection also includes the chapters on primary prevention and screening which could have been a part of the epidemiology section. The chapter on early-onset CRC is brief and could have been more detailed to include data published in the last few years on this topic. The chapters on primary care in early referrals and rapid diagnostic pathways for patients with suspected CRC have a regional focus.

The section on diagnosis and staging surprisingly starts with colon capsule which is a rarely used modality in CRC and also features on the cover illustration of the book. This section covers detailed chapters on endoscopic ultrasound, computed tomography colonography and positron emission tomography before focussing on the main investigations such as magnetic resonance imaging, histopathology and colonoscopy. In addition, there are chapters on oligo metastatic disease and hereditary CRC syndromes. The sub-section on the new tools of diagnosis in CRC covers molecular biomarkers, bioinformatics (including artificial intelligence in imaging) and omics based biomarkers. This is an interesting, concise update on trending topics in CRC.

The section on treatment includes chapters on the different modalities of treatment in CRC including endoscopic treatment (which again has a section on surveillance), surgery, radiotherapy, chemotherapy and their use in various settings such as neoadjuvant, adjuvant and oligo metastatic disease. The chapter on immunology and immunotherapy in CRC is an exhaustive and updated review of a contemporary topic. A novel addition here is a sub-section that includes chapters on enhanced recovery after surgery (ERAS), pre-operative optimization, rehabilitation and post-operative care and management of complications, acute post-operative pain and chronic pain management. These are important topics often not covered in books on CRC and help in making the book comprehensive.

The sections on microbiota, molecular and biological mechanisms of CRC and on biobanks are detailed and up to date. An important section focuses on an approach to the sequelae and consequences of CRC. There are chapters on psychological approach and emotional management in CRC, faecal incontinence, stoma care and sexual dysfunction in CRC which are all important patient-centric topics and add value to the book. The final section on ethical and legal aspects in CRC has some general chapters on ethical principles and rules covering biomedical research but also some topical and relevant topics such as personal data protection and new technologies and research with health data although from a European perspective.

A detailed chapter on palliative care would have made the book complete, although parts of it are touched upon in the chapters on surgery, endoscopy and pain management. There is also some overlap in the topics covered across the book. The sections could have been better organized for a smoother flow of topics from the reader’s perspective. To conclude, this is an exhaustive and updated review on CRC covering all related allied topics which will be useful to clinicians treating patients with CRC.