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Cancer and Clinical Biochemistry. Peter Pannall and Dusan Kotasek. London, UK: ACB Venture Publications, 1997, 132 pp., $36. ISBN 0-902429-09-4.

Core Laboratory, St. Joseph's Health Centre, 30 The Queensway, Toronto, Ontario M6R 185, Canada

With a title that is broad in scope, this small, soft-covered 132-page book tries to cover a wide range of topics related to clinical biochemistry and cancer. The book is written by a clinical biochemist and a practicing medical oncologist, and its approach is somewhat eclectic, rather basic, and lacking in depth for the reader who is seeking more than the fundamentals. Despite this, the book contains many interesting, pertinent, and current facts. It is easy to read and would be beneficial to the clinical biochemist with a rudimentary knowledge of the subject and the clinician who would gain much insight from the appropriate use and limitations of tumor markers.

The first two chapters are dedicated to the fundamentals of tumor biology, with an overview of cell growth cycles, oncogenes, and the effects of tumor growth on organ dysfunction. The second chapter gives a full range of possible disorders of the normal biochemical state brought about directly and indirectly by tumor growth. Illustrations, including case vignettes, are clear and effective in showing how biochemical indicators change with disease progression and response to therapy, although some figures have incomplete legends. The five pictures of bone scans and x-rays occupying five pages could be eliminated altogether without loss of information.

Chapters 3 and 4 deal with the all-important subject of tumor markers. This topic is divided into two separate parts, namely general considerations and clinical applications of tumor markers. The general considerations section gives an overview of the production and secretion of some of the common tumor markers (CEA, AFP, hCG, and the CA-series), with a brief mention of the lesser-known mucins, ß-2 microglobulin, and cytokeratins. This section also describes the general principles of interpretation and basic concepts of sensitivity, specificity, assay variability, and ROC curves to determine optimum cutoff points. There is little discussion of predictive values or their limitations, although these terms are used in the subsequent chapter on the applications of tumor markers. An appendix at the end of the book lists the equations for the derivation of these terms; the equation for the efficiency of a test is incorrect and obviously a typographical error. I was disappointed to find no focused discussion on the controversies of screening for cancer with biochemical markers. Chapter 4 is perhaps the most informative and useful section of the book. It discusses the clinical applications of various tumor markers, with solid tumors as the main focus. Apart from a few confusing statements, the information is factual, current, and clearly imparts the important message, to quote from an earlier chapter, that "the ability to measure something does not, however, mean that it should be measured". There are many current and pertinent references in the reading list at the end of this chapter.

Chapter 5, entitled "Paraneoplastic Syndromes", describes some clinical conditions that are indirectly associated with malignancy. These conditions, such as hypercalcemia, hyponatremia, and hypoglycemia, although in themselves not diagnostic of malignancy, may serve as important clues to its possible existence. Finally, Chapter 6 provides the basic principles of treatment of cancer, with a nice section on chemotherapeutic agents and their toxicity.

In summary, this book contains many pertinent facts that laboratorians, clinicians, and students with an interest in cancer would find very useful. Its modest price makes it a handy reference text for the shelves of the personal as well the reference library.

Acknowledgments

I thank Donald Sutherland, Medical Director, Oncology Patient Services, Toronto-Sunnybrook Regional Cancer Centre, for his useful contributions to this review.

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