Table Of Content_ International Union Against Cancer
Manual of
Clinical Oncology
Fifth Edition
With 88 Figures
Edited by
D. K. Hossfeld (Chairman)
C. D. Sherman R. R. Love F. X. Bosch
Springer-Verlag Berlin Heidelberg New York
London Paris Tokyo Hong Kong Barcelona
DICC
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ISBN-I3: 978-3-540-52769-5 e-ISBN-I3: 978-3-642-97267-6
DOl: 10.1007/978-3-642-97267-6
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© Springer-Verlag Berlin Heidelberg 1973, 1978, 1982, and VICC Geneva 1987, 1990
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The DICC wishes to express its particular gratitude
to the Swiss Cancer League and to Yeslam Binladin
on behalf of Knutstorp Corporation for their financial
assistance in the revision of this Fifth Edition.
Members of the UICC Manual Revision Committee for the Fifth Edition
Charles D. Sherman, Jr., MD, Chairman, UICC Professional Education
Program
Dieter K. Hossfeld, MD, Chairman, Manual Revision Project
Richard R. Love, MD, Senior Editor, Part I, MCO
F. X. Bosch, MD
Sandor Eckhardt, MD
I. W.F. Hanham, MD
J.Gordon McVie, MD
P.A. Voute, MD
Committees Members for Previou$ Editions
Umberto Veronesi, MD (Italy)
Chairman, First Edition
Charles D. Sherman, Jr., MD, (USA)
Chairman, Second, Third, and Fourth Editions
Felipe Alva-Ortega, MD (Mexico)
Kenneth C. CaIman, MD (UK)
Marcel Dargent, MD (France)
Sandor Eckhardt, MD (Hungary)
Ismail Elsebai, MD (Egypt)
Fran'fois Eschwege, MD (France)
Dincer Firat, MD (Turkey)
Dieter K. Hossfeld, MD (FRG)
Arthur Jones, MD (UK)
Ha~na Kolodziejska, MD (Poland)
Ivo Padovan, MD (Yugoslavia)
Jean-Pierre Paunier, MD (Switzerland)
Boris Peterson, MD (USSR)
Bruno Salvadori, MD (Italy)
Moacyr Santos-Silva, MD (Brazil)
Carl G. Schmidt, MD (FRG)
Kenneth W. Starr, MD (Australia)
Richard J. Walton, MD (Canada)
VI
Contributors to the Fifth Edition - U/CC MOC
E. C. Borden, MD, Professor of Human Oncology and Medicine,
University of Wisconsin, 600 Highland Ave, Madison, WI 53742, USA
F.X. Bosch, MD, Unit of Field and Intervention Studies, International
Agency for Research on Cancer (IARC) , 150 Cours Albert-Thomas,
69372 Lyon Cedex 08, France
R.J. Campbell, MD, Professor of Pathology, Mayo Clinic,
Mayo Medical School, Rochester, MN 55902, USA
M.P. Coleman, MD, Unit of Descriptive Epidemiology,
International Agency for Research on Cancer, Lyon, France
N.R. Drinkwater, PhD, Associate Professor of Oncology, University of
Wisconsin, McArdle Laboratory for Cancer Research, Madison, WI 53706,
USA
S. Eckhardt, MD, Director, National Cancer Institute, Rath Gyorgy, u. 7/9,
H-1525 Budapest, Hungary
R. Greenberg, MD, Assistant Professor of Physical Medicine and
Rehabilitation, State University of New York at Syracuse, NY, USA
I. W.F. Hanham, MD, St. Mary Abots Terrace 12, Kensington,
London W14, UK
H.D. Herrmann, MD, Professor of Neurosurgery,
Medical University Clinic, Martinistrasse 52, D-2000 Hamburg 20, FRG
D.K. Hossfeld, MD, Professor of Internal Medicine, Oncology
and Hematology, Medical University Clinic, Martinistrasse 52,
D-2000 Hamburg 20, FRG
R.R. Love, MD, Associate Professor of Human Oncology, University of
Wisconsin, 1300 University Ave., Room 7615, Madison, WI 53706, USA
B.L. Reyes, MD, Dept. of Radiation Oncology, Highland Hospital,
1000 South Avenue, Rochester, NY 14620, USA
C.D. Sherman, Jr., MD, Clinical Professor of Surgery, Highland Hospital,
1000 South Avenue, Rochester, NY 14620, USA
W. Sugden, PhD, Associate Professor of Oncology, University of Wiscon
sin, McArdle Laboratory for Cancer Research, Madison, WI 53706, USA
J.G. McVie, MD, Cancer Research Campaign, 2 Carlton House Terrace,
London SWI Y 5AR, UK
P. A. Voute, MD, Professor of Pediatric Surgery, Emma Kinderziekenhuis,
Dept. of Pediatric Oncology, Meibergdreef 9,1105 Amsterdam,
The Netherlands
VII
Preface to the Fifth Edition
The continuing success of the DICC's Manual of Clinical Oncology, a book
designed for medical students and practitioners, and the continuing refine
ment of our educational objectives in cancer, coupled with significant addi
tional knowledge in the field have led to the decision to publish a fifth
edition. Collaboration with the World Health Organization (WHO) and the
Pan-American Health Organization (PAHO) in international and regional
conferences in cancer education, and the development of courses using the
manual as a basic resource have aided further in establishing the DICC's role
in cancer education throughout the world. In addition, the recent formation
of "Coordinating Councils in Cancer Education" in Europe, Latin America,
and the Asian-Pacific region should encourage the use of the manual as a
basic resource in developing improved cancer education programs every
where.
The revision committee believes that most of the knowledge about cancer
which is essential for all students and practitioners has been incorporated in
this small volume. A large proportion of the material is devoted to the
basics, yet presented such that the clinical implications are clear. Although
we do not feel that general physicians need to know minor details about all
cancers, we did think it particularly important to be somewhat thorough in
the discussions of the more common cancers. We have omitted discussion of
rare cancers and limited ourselves here to presenting major concepts and
principles.
The table of contents, then, outlines our "educational objectives." The
text is concise, clear, not encyclopedic, and it should be read and taken in its
entirety. The whole of Part I is especially important and should be read
carefully before beginning with Part II.
The Manual of Clinical Oncology has been translated into many lan
guages and the central DICC committee continues to work with those who
are translating and adapting the book for local use in different parts of the
world. Although the most common cancers in one part of the world may be
quite different from those in another, the basic concepts and principles are
much the same.
A Note to Deans
More than any other area of medicine, oncology demands the integration of
basic and clinical sciences, since the clinical oncologist of today must know
IX
and use a great deal of basic science - carcinogenesis, epidemiology, screen
ing principles, cell biology and metabolism, cytokinetics, pharmacology of
cancer chemotherapy, basic principles of kinetics, and basic principles of
surgery and radiation therapy. In order to avoid gaps, fragmentation, and
unnecessary duplication and also to develop appropriate teaching materials
and learning experiences, it is essential to prepare a broad-based educa
tional plan. With good planning and careful execution, an integrated cancer
program can reduce the curriculum time necessary to accomplish this objec
tive and yet do a better job. Indeed, the integrated cancer committee can be
a driving force in improving a medical schools' educational program, also
stimulating interest and serving as a model for other departments. It is
hoped that this manual will be an important resource in many medical
schools.
1990 The Manual Revision Committee
of the UICC
x
Acknowledgements for the Fifth Edition
For numerous contributions in the field of epidemiology, we owe special
thanks to Dr. F. X. Bosch, who coordinated the efforts of many members of
the International Agency for Research in Cancer (Lyon) and Ms. Helene
Biehe. Others who commented on or reviewed material for the fifth edition
include: Dr. W. lonat, Hamburg, Dr. Frank Lucente, New York.
We wish to thank the American Cancer Society again for allowing us to
use several graphs and photographs. The tables and figures pertaining to
TNM staging have been reproduced from the most recent editions of the
TNM Classification of Malignant Tumours! and the TNM Atlas2• We also
thank Springer-Verlag for granting us permission to use these illustrations
and others from various UICC publications.
The committee would also like to express our appreciation to the UICC
staff: Ms. Isabel Mortara (Head, Education Dept.); Ms. Carmen Esparza
and Ms. Brigitte Utech for devotion and patience in the face of many and
diverse demands which were placed on their time and resources; Ms. K.
Mulliger (Rochester), Ms. A. Seibel (Hamburg), and Ms. Carrie Fassil
(Madison) gave outstanding editorial, computer, and secretarial services.
Finally, gratitude is extended to the publishers for once again being
extremely helpful in the development and publication of this edition.
1 Hermanek P, Sobin LH (eds) (1987) TNM Classification of Malignant Tumours, 4th
edn. Springer, Berlin Heidelberg New York
2 Spiessl B, Beahrs OH, Hermanek P, Hutter RVP, Scheibe 0, Sobin LH, Wagner G
(eds) (1989) TNM Atlas, 3rd edn. Springer, Berlin Heidelberg New York
XI
Acknowledgements for Previous Editions
Although the previous editions of the Manual of Clinical Oncology were
written as a collegial effort without assigning credit for the individual chap
ters to anyone person, the revision committee decided to delegate the
responsibility (and the credit) for each chapter to specific individuals, hop
ing thereby to improve the quality of the contributions. Some chapters have
only been revised, building on the work of numerous previous contributors;
others have been rewritten. We have tried to make these distinctions fairly.
Without specifically naming the author of each chapter in previous editions,
we would simply like to acknowledge our tremendous debt to previous
members of our manual revision committees. Those who aided our commit
tee in the previous editions include: Dr.!. Bross, Dr. R. J. Campbell, Dr. L.
Denis, Dr. S. Gordon-Firing, Dr. N. Gray, Dr. A. Kopf, Dr. M. Krant, Dr.
H. Lynch, Dr. V. McKusick, Dr. S. Mellette, Dr. J. Minton, Dr. M. Mott,
Dr. J. Mulvihill, Dr. M. Riveros, Dr. B. Sishcy, Dr. L. Sobin, and Dr. J.
Stjernsward, Dr. R. Saracci, Dr. D. M. Parkin, Dr. G. O'Connor, Dr. A.
Linsell, Dr. C. S. Muir and Dr. N. E. Day.
XII
