When we first envisioned The MD Anderson Manual of Medical Oncology,
we hoped it would fill an important void in oncology reference material by
serving as a hands-on resource for the practicing oncologist. The first
edition, published in 2006, was written exclusively by our faculty and
fellows with the idea of giving a bird's eye view of how multidisciplinary
care was practiced at our institution. We were proud of that initial effort
and pleased that the book received very positive reviews from several
high-impact journals, including the JAMA, Lancet, and the New
England Journal of Medicine. In addition, feedback from our broad
multinational readership inspired us to move forward with an enhanced second
In the second edition, we have remained
faithful to the guiding principles of our first effort, providing a visually
stimulating, practice-oriented reference which articulates our unique
multidisciplinary approach to cancer care. We have also continued the
tradition of including evidence-based management algorithms in the form of
flowcharts and diagrams shaped by the clinical experience of our world-class
faculty to provide readers with a practical guide to the diagnostic and
therapeutic strategies used at MD Anderson.
Importantly, our new version is not merely an update of the first, but
contains new chapters on myelodysplastic syndrome, myeloproliferative
neoplasms, T-cell lymphomas, small bowel and appendiceal cancers,
inflammatory breast cancer, and penile cancer. In addition, some chapters
now provide embedded comments sharing the perspective of other experts at MD
Anderson, including our colleagues in surgical oncology, radiotherapy,
pulmonology, and pathology. Also in this edition, we have asked our authors
to discuss future directions with special emphasis on personalized cancer
We hope this edition serves to help
oncologists everywhere provide high-quality, state-of-the-art cancer care to
their patients, who deserve nothing less.
M. Kantarjian, MD
Robert A. Wolff, MD
Charles A. Koller, MD
The MD Anderson Manual of Medical Oncology, Second Edition
articulates the personalized, multidisciplinary approach to cancer
management pioneered by The University of Texas MD Anderson Cancer Center.
This approach has contributed to our ranking as number one in cancer care in
8 of the past 10 years in the U.S. News & World Report's
"America's Best Hospitals" survey. Our unique perspective has evolved from
decades of clinical practice and research with more than 800,000 patients
treated. This volume is designed to bring a pragmatic approach to cancer
management that may serve as a guide for oncologists around the world. The
text reflects how MD Anderson currently operates, including many patient
care practices that would not have been recognized by practitioners just a
decade ago. In a single year, 96,500 people with cancer—33,200 of them
new patients—seek care at MD Anderson. Many of them participate in the
largest clinical research program in the nation exploring novel therapies as
well as our personalized approach to treatment evident in the nearly 12,000
patients enrolled in therapeutic clinical trials. Since the first edition,
we have improved our ability to identify biomarkers that are predictive for
survival, a major triumph in medical oncology that is demonstrated
throughout the text.
The current edition
emphasizes and discusses recent developments in diagnostic procedures, which
include the incorporation of new molecular markers and revised staging
systems. This edition also emphasizes how imaging and molecular profiling
can prevent administration of overly aggressive, toxic treatment regimens,
or invasive surgery to treat superficial or indolent tumors.
Two major advances in therapeutic approaches over the past
decades are emphasized in The MD Anderson Manual of Medical Oncology,
Second Edition: (1) better timing of therapeutic modalities to enhance
response and (2) a growing capacity to individualize treatment to
target-specific patterns of genomics, proteomics, growth factors, and cell
signaling pathways identifiable today through high-throughput microarray and
other advanced technologies. Most chapters offer a thorough review of
relevant signaling pathways as well as major clinical studies of potential
therapeutic agents that target components of these pathways.
The Manual emphasizes new therapies that have emerged from
progress in our understanding of the biology of various cancers. As the
genetic and epigenetic events driving carcinogenesis, invasion, metastasis,
and the interaction of the tumor cells with host's microenvironment are
elucidated, the development and testing of targeted molecules have
mushroomed, resulting in a wider selection of therapeutic drug combinations.
Discussion of new therapeutic agents used alone or in combination with
preexisting therapies is expanded in the new edition. Case examples
illustrate successful treatment strategies throughout the text, often using
a personalized approach to selecting appropriate targeted therapies.
Reflecting new advances in our approach to cancer
management, the second edition of The MD Anderson Manual of Medical
Oncology features several new chapters. For example, special chapters on
myelodysplastic syndromes and Philadelphia chromosome-myeloproliferative
neoplasms have been added to be based on the 2008 changes in the WHO
classification of these disorders as neoplasms, as well as significant new
advances in their diagnosis, risk assessment, and management. In the new
edition, aggressive B-cell and peripheral T-cell lymphomas now warrant
separate focused chapters to enable greater attention to novel treatment
strategies for T-cell lymphomas. Likewise, pancreatic cancer and
hepatobiliary malignancies are now covered separately to devote more
attention to promising novel strategies that have the potential to improve
the prognosis for pancreatic cancer. A new chapter on neoplasms of the small
bowel and appendix has also been added. Inflammatory breast cancer,
previously mentioned briefly alongside locally advanced breast cancers, now
has its own expanded chapter. In addition, this edition now contains a
chapter on penile cancer.
Also new to the second
edition are special commentaries invited from other subspecialists from
fields such as pulmonary medicine, radiation oncology, and surgery to
discuss other perspectives on management:
A radiation oncologist discusses new strategies to reduce the long-term
toxic effects of treatment of the Hodgkin lymphoma such as the risk of
future secondary cancers.
• A new, minimally invasive technology
for tissue sampling is recommended to improve the diagnostic accuracy of
mediastinal lymph node staging in non–small cell lung cancer.
• Surgical perspectives are added to the chapter on appendiceal
carcinoma, including how the surgical plan is individualized for patients
whose cancer treatment began outside of MD Anderson.
pathologist contributes discussion of immunohistochemical markers shared by
all neuroendocrine carcinomas regardless of their anatomic location.
• A special discussion of surgical options after neoadjuvant
chemotherapy is embedded within the chapter on early-stage and locally
advanced breast cancer.
• A research scientist adds his assessment
of how a personalized medicine approach to the management of urothelial
cancers would dramatically improve patient outcomes.
commentaries on the role of radiation therapy and surgical management of
brain tumors are introduced in the chapter on tumors of the central nervous
• A microbiologist comments on specific adaptations,
laboratories need to make to provide adequate microbiological diagnosis of
mold and viral infections in cancer patients.
• A surgeon adds his
perspective on how he integrated referral to palliative care services into
management of his patient with pancreatic cancer.
While the Manual discusses special considerations in the treatment of
populations such as the elderly and those with comorbidities, the book
stresses the many ways that recent progress in reducing treatment-associated
toxicity has made advanced age less of a contraindication to many effective
therapeutic regimens. Morbidity associated with surgery and radiation
therapy has greatly decreased over the past decade, and many of the new,
targeted oral agents have little or no toxicity.
To help clinicians quickly assess cancer management options, every chapter
includes abundant tables, diagrams, and imaging photos. These include, for
example, treatment algorithms and decision trees developed at MD Anderson
for specific cancers or disease subtypes; promising novel therapy targets
and the latest clinical trial phase of drugs targeting them; and new
molecular therapies recommended to overcome resistance to previously
The new era of novel
personalized, targeted therapeutics has also sparked the recent evolution of
another crucial advancement in management of metastatic disease: the
transition from sequential care culminating in the sole delivery of
palliative care, to integration of ongoing active disease treatment with
simultaneous interdisciplinary symptom control, palliative care, and
rehabilitation to improve quality of life. Clinicians at MD Anderson no
longer approach advanced metastatic disease management with palliative care
goals alone; now these patients are often offered frontline cancer treatment
and the opportunity to participate in clinical trials for investigational
drugs. The chapter on defining palliative care in oncology starts with a
traditional case vignette of a patient with metastatic pancreatic cancer who
did not receive palliative care until he/she had discontinued chemotherapy,
then explains the various ways in which integration of palliative and
symptom care earlier in the treatment could have benefited him/her and
In recognition of the growing
pool of patients who are surviving their cancer, MD Anderson has greatly
expanded programs for cancer survivors since publication of the first
edition. Chapters on long-term survival and follow-up demonstrate the
additional utility of this book for clinicians outside the specialty of
oncology, as a high proportion of the growing number of cancer survivors
will be followed by a primary care physician, cardiologist, or other
specialist in their home community. The text's description of the results
from MD Anderson's survey of cancer survivors serves as an essential guide
to typical long-term health problems both physicians and rehabilitation
specialists can expect to manage.
Over the past
decade, the practice of medical oncology at MD Anderson has truly evolved to
epitomize the translational research concept of "bench to bedside and back,"
along with an increasingly personalized approach that considers the
"molecular fingerprint" of the patient's cancer in treatment decisions—a
paradigm shift that this volume pertinently exhibits.
Waun Ki Hong, MD
American Cancer Society Professor
Samsung Distinguished University Chair in Cancer Medicine
Head, Cancer Medicine
Professor, Thoracic/Head and Neck Medical
The University of Texas MD Anderson Cancer Center