Glossary of Terms

Ablation: Using surgery or radiation to remove or stop the function of an organ or tissue in the body.

Adjuvant therapy: In the case of adjuvant chemotherapy, it is treatment given to lower the chance of cancer coming back. Adjuvant chemotherapy is given after surgery in breast cancer.

Algorithm: In clinical medicine, this term refers to a step- by-step protocol for managing a healthcare problem.

Amenorrhea: The absence or halting of the menstrual cycle in premenopausal women.

Aneuploidy: A condition involving a genetic imbalance in which some cells have a normal number of chromosomes and others have an abnormal number of chromosomes.

Angiogenesis: The formation of new blood vessels that cancer cells need to grow.

Anthracyclines: A type of chemotherapy that comes from certain types of Streptomyces bacteria. Anthracyclines are used to treat many types of cancer. Anthracyclines damage the DNA in cancer cells, causing them to die.

Antiemetics: Medications that reduce nausea and vomiting.

Aromatase inhibitor: A drug that prevents the formation of estradiol, a female hormone, by interfering with an aromatase enzyme. Aromatase inhibitors are used as a type of hormone therapy for postmenopausal women who have hormone-dependent breast cancer.

Atypical cells: Cells that are not typical, are abnormal. Atypical is often used to refer to the appearance of precancerous or cancerous cells.

Autologous bone-marrow transplantation: A procedure in which healthy bone marrow is removed from a patient, stored, and then replaced following cancer treatment (chemo or radiation therapy). This is done in order to preserve the marrow from the damaging effects of the therapy, as in the case of high-dose chemotherapy.

Axillary lymph node involvement: The spread of cancer from the primary tumor to the axillary lymph nodes, which are located in the arm pit area. The axilla is typically the first site of spread (metastasis) in breast cancer.

Benign: Not cancerous.

Bilateral: Affecting both sides of the body.

Biological therapy: Also known as immunotherapy or biotherapy, this term refers to treatments designed to use the body's immune system (either directly or indirectly) to fight cancer or reduced side effects of cancer treatment. Cancer vaccines, now in development, are a type of biological therapy.

Biopsy: The removal of a sample of tissue for examination under a microscope to check for cancer cells. Physical exam and imaging can show that something abnormal is present in the breast, but a biopsy is the only sure way to know whether the problem is cancer. In a biopsy, the doctor removes a sample of tissue from the abnormal area, or may even remove the whole tumor. A specialist trained to examine such tissues is called a pathologist. A pathologist examines the tissue under a microscope. If cancer is present, the pathologist can usually tell what kind of cancer it is and may be able to judge whether the cells are likely to grow slowly or quickly.

Bisphosphonates: A group of drugs routinely used in the treatment of osteoporosis. In cancer, bisphosphonates may reduce the incidence of metastasis to the bones and, when cancer has spread to the bones, they have been shown to prevent fractures, promote healing, and reduce pain.

Boost dose: An extra dose of radiation administered in additional to the regular dose.

BRCA1 and BRCA2: Genes located on chromosome 17 and 13, respectively, that help to suppress cell growth under normal circumstances. An altered version of this gene predisposes the carrier to breast, ovarian, or prostate cancer.

Breast parenchyma: The complete essential elements of the breast, the complete breast, not including the supportive framework.

Breast-conservation therapy: A treatment modality for early-stage breast cancer involving surgery, in which the tumor and a portion of the surrounding breast tissue are removed (amount varies), followed by postoperative radiation therapy. Lumpectomy (also called excisional biopsy, or wide or wide-local excision), partial/segemental mastectomy, and modified radical mastectomy (MRM) are all types of breast-conserving surgery, each designating the removal of an increasingly large portion of the breast. BCT usually involves the removal of some of the axillary lymph nodes. If nodes are found to be clinically positive for disease, a complete axillary lymph node dissection is usually performed. For many women with small tumors, BCT represents an effective and appealing alternative to mastectomy, allowing good disease control and improved cosmetic results.

Chemosensitivity: A favorable response to chemotherapy indicating that the chemo is working and is killing cancer cells/shrinking the tumor mass.

Chemotherapy: Often referred to simply as chemo. The use of drugs to kill cancer cells. Chemotherapy can be taken orally or by needle into a vein or muscle. Chemotherapy is called a systemic therapy because the drugs enter the blood stream and travel throughout the body. Chemotherapy can therefore kill cancer cells outside of the breast.

Chest-wall recurrences: The subsequent reappearance within the chest wall of a breast cancer in a patient who underwent treatment and was found to be disease-free. This is a particularly serious occurrence.

Clinically significant findings: Findings considered important on clinical evaluation.

Comorbid: The presence of additional or coexisting disease. Comorbidity may be considered a factor in prognosis.

Contralateral: Affecting or located on the opposite side of the body. The opposite of ipsilateral.

CT Scan: A series of detailed pictures of areas inside the body taken from different angles. The pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography scan, computerized axial tomography scan and computerized tomography.

Cyst: A closed sac or capsule, usually filled with fluid or semisolid material.

DCIS: Ductal carcinoma in situ. Often referred to as pre-cancer, DCIS is the term for a type of cancer consisting of cancer cells that remain where they originated, in the ducts of the breast.

DIEP Flap: A type of breast reconstruction in which blood vessels called deep inferior epigastric perforators (DIEP), and the skin and fat connected to them are removed from the lower abdomen and used for reconstruction. Muscle is left in place. For more information about breast reconstruction procedures, contact YSC.

Dominant masses: A prominent, suspicious mass requiring further clinical evaluation.

Dysplasia: Cells that look abnormal under a microscope but are not cancer.

EIC: Extensive intraductal component. The term used to describe situations in which 25% or more of the primary tumor consists of DCIS and in which DCIS is seen in ducts extending beyond the primary mass. EIC is more common in young patients and is associated with a higher incidence of positive margins and residual tumor in the surrounding breast.

Endocrine therapy: Treatment that adds, blocks or removes hormones. To slow or stop the growth of certain cancers (such as prostate and breast cancer), synthetic hormones or other drugs may be given to block the body's natural hormones. Sometimes surgery is needed to remove the gland that makes a certain hormone. Also called hormonal therapy, hormone therapy and hormone treatment.

ER-negative: See ER-positive.

ER-positive: This is an indication of whether the individual cancer cells in the tumor express an estrogen receptor, which means that they are receptive and sensitive to estrogen. In general, tumors that are sensitive to hormones, such as ER+ tumors, are slower growing and are thought to have a slightly better prognosis than tumors that are not sensitive to hormones, such as ER- tumors. Young women are more likely to have ER- tumors; older, postmenopausal women are more likely to have ER+ tumors. Many breast cancer treatments include the use of drugs such as tamoxifen that block the receptors in the breast cancer and metastatic cancer cells and prevent estrogen from getting to them.

Estrogen-receptor status: This refers to whether the tumor is ER-positive or ER-negative.

Excision: The act of cutting out; the surgical removal of part or all of a structure, such as a breast mass, or organ.

False-positive rate: The rate at which a test produces results that are mistakenly positive for cancer when in fact no cancer is actually present.

Fibroadenoma: Benign fibrous tissue of the breast. Such tissue is most commonly found in young women.

FISH: A laboratory technique used to look at genes or chromosomes in cells and tissues. Pieces of DNA that contain a fluorescent dye are made in the laboratory and added to cells or tissues on a glass slide. When these pieces of DNA bind to specific genes or areas of chromosomes on the slide, they light up when viewed under a microscope with a special light. Also called fluorescence in situ hybridization.

FNA: Fine-needle aspiration. Aspiration of a suspicious lump using a small-gauge hypodermic needle in order to remove a sample of tissue (from the abnormal area) for pathological evaluation.

Follicular phase: The phase of the menstrual cycle prior to ovulation, approximately days 3-12. During the follicular phase, high estrogen levels cause the uterine lining to grow.

HER2/neu: A protein involved in normal cell growth. It is found on some types of cancer cells, including breast and ovarian. Cancer cells removed from the body may be tested for the presence of HER2/neu to help decide the best type of treatment.

Highly proliferative tumors: The proliferative capacity of a tumor refers to the rate at which the cancer cells within the tumor are dividing (increasing in number). The higher the rate of proliferation, the more aggressive the tumor is considered to be. In highly proliferative tumors, the cells are multiplying relatively quickly. This proliferative capacity is measured using a number of indicators, including S-phase fraction and flow cytometry, which evaluate cell-division behavior and the amount and type of DNA in the tumor cells, respectively. The proliferative capacity of a tumor is considered to be a predictor of risk of relapse.

Histopathological features: The features related to changes in and progress of the cancer. In breast cancer, these include pathologic tumor size, pathologic axillary status, number of metastatic lymph nodes, pathologic stage, lymphatic vascular invasion, estrogen-receptor status, and histologic grade. The histopathologic features of a breast cancer tumor are those characteristics determined by the pathologist under microscopic examination and using a variety of methods of pathologic analysis.

Hormone Receptor: A protein on the surface of a cell to which a specific hormone binds. The hormone causes many changes to take place in the cell.

IHC: See Immunohistochemistry.

Imaging: Any one of a variety of radiologic techniques, including x-ray, mammography, and MRI, used to produce a clinical image. Imaging is used to visualize the breast tissue in order to detect any visible, suspicious masses.

Immunohistochemistry: A sophisticated pathologic test in which cancer cells are stained with either fluorescent dyes or enzymes in order to reveal specific antigens.

IMRT: A type of 3-dimensional radiation therapy that uses computer-generated images to show the size and shape of the tumor. Thin beams of radiation of different intensities are aimed at the tumor from many angles. This type of radiation therapy reduces the damage to healthy tissue near the tumor. Also called intensity-modulated radiation therapy.

Incidental findings: Findings made while looking for something else; findings that are found by accident.

Invasive/infiltrating ductal carcinoma: One of several specific patterns of breast cancer. It begins in the cells of the breast ducts and spreads into the surrounding breast tissue. An estimated 65% to 85% of all breast cancers are of this type.

Ipsilateral: Affecting or located on the same side of the body. The opposite of contralateral (the other or opposite side).

LCIS: Lobular carcinoma in situ. Also see DCIS.

Lobular carcinoma: Cancer that begins in the lobules (the glands that make milk) of the breast. Lobular carcinoma in situ (LCIS) is a condition in which abnormal cells are found only in the lobules. When cancer has spread from the lobules to surrounding tissues, it is invasive lobular carcinoma.

Local-regional recurrence rate: The rate at which cancer cells from the primary tumor are detected in the same location and/or region following the primary treatment for the cancer.

Lumpectomy: see breast-conservation therapy.

Luteal phase: The postovulatory phase of the menstrual cycle (day ~13-15 onward). The luteal phase is often considered to include the first couple of days of the following cycle. During the luteal phase, the woman?s body produces progesterone that assists with preparation of the uterus to support the implantation and growth of an embryo.

Lymphatic invasion: Sometimes called lymphovascular invasion; is one of the many factors that the pathologist looks for when evaluating tissue from the primary tumor obtained by biopsy. If cancer cells are seen (under the microscope) in the middle of a blood vessel or a lymphatic vessel, this is called vascular invasion or lymphatic invasion. Such invasion in the primary tumor suggests that the cancer is potentially more dangerous than if there is no such invasion, as there is a greater likelihood of it metastasizing, via the lymphatics, to the lymph nodes in the axilla.

Lymphedema: A condition involving swelling of the arm that can follow surgery to the axillary lymph nodes. It can be temporary or permanent and may occur soon after surgery or at a much later date.

Margins: This term refers to the area of normal, noncancerous breast tissue between the tumor and the surgeon's knife. Tumor margins are pathologically assessed following excision of the tumor to see whether they are free of cancer cells. The role of margins as a predictor of local recurrence is an important and controversial issue.

Mastectomy: Removal of the breast for the purpose of removing breast cancer.

Matched cohort: An observational or comparison group matched as closely as possible with the main study group for all extraneous factors by individually pairing its members with members of the study group. (Extraneous factors are those that may affect outcome, but which are not the factor under investigation.) While all members of the study group will have the risk factor (or have had exposure to the agent) under investigation, members of the matched cohort will not. Outcomes of the two groups are then compared in order to draw conclusions about the factor or agent in question.

Mean: In statistics, the average value in a set or range of values. The mean value is calculated by taking the sum of all values and dividing by the total number of values.

Median: The middle value in a range of values.

Mediastinum: The area between the lungs. The organs in this area include the heart and its large blood vessels, the trachea, the esophagus, the bronchi and lymph nodes.

Metastases: Plural of Metastasis.

Metastasis: The transfer of disease from one organ or part to another not directly connected with it. In malignant tumors, metastasis is due to the transfer of cells. The capacity to metastasize is a characteristic of all malignant tumors.

Metastatic seeding: Surgery-induced tumor cell dissemination. The spread of cancer cells at the time of tumor excision.

Multicentric disease: The meaning of this term, along with that of multifocal disease, is subject to variation. In general terms, multicentric disease involves two or more distinct primary tumors found within the breast, usually in different quadrants of the breast.

Multicentricity: Breast cancers with two or more centers (foci) of disease appearing in different areas of the same breast.

Multifocal disease: The meaning of this term, along with that of multicentric disease, is subject to variation. In general terms, multifocal disease refers to breast tumors with more than one focus or area of disease within the breast.

Necrosis: Dead tissue.

Negative: Not abnormal, not affirmative of a specific finding, response, presence, condition, etc. For example, negative margins means surgical margins that are found to be free of cancer cells on pathologic evaluation.

Neoadjuvant chemotherapy: Chemotherapy taken before surgery.

Neuropathy: A nerve problem that causes pain, numbness, tingling, swelling, or muscle weakness in different parts of the body. It usually begins in the hands or feet and gets worse over time. Neuropathy may be caused by physical injury, infection, toxic substances, disease (such as cancer, diabetes, kidney failure or malnutrition) or drugs, including anticancer drugs. Also called peripheral neuropathy.

Neutropenia: A condition in which there is a lower-than-normal number of neutrophils (a type of white blood cell).

Node positivity: A finding of cancer cells in the lymph nodes indicating that the cancer has metastasized.

Occult metastases: Hidden metastases. Occult metastases are those metastases not seen during routine examination.

Oncologist: A doctor who specializes in treating cancer. Some oncologists specialize in a particular type of cancer treatment. For example, a radiation oncologist specializes in treating cancer with radiation.

Oophorectomy: Removal of the ovaries.

Ovarian ablation: The use of surgery, chemicals, or radiation on the ovaries to halt their functioning and thereby "shut off" the menstrual cycle.

Ovarian suppression: The use of chemicals on the ovaries to halt their functioning and thereby "shut off" the menstrual cycle.

Overexpression: The excess of a particular protein on the surface of a cell. Overexpression of certain proteins is associated with the growth of cancer cells.

Paget's Disease: A form of breast cancer in which the tumor grows from ducts beneath the nipple onto the surface of the nipple. Symptoms commonly include itching and burning and an eczema-like condition around the nipple, sometimes accompanied by oozing or bleeding.

Palliative therapy: Treatment given to relieve the symptoms and reduce the suffering caused by cancer and other life-threatening diseases. Palliative cancer therapies are given together with other cancer treatments, from the time of diagnosis, through treatment, survivorship, recurrent or advanced disease, and at the end of life.

Parity: The state of having given birth to an infant or infants. Each childbirth is considered a single parous experience, regardless of whether it involves a single or multiple birth or whether the baby is born dead or alive.

Pathologic confirmation: Confirmation of clinical findings by the pathologist, who conducts a microscopic examination of tissue/cell samples.

PET scan: A procedure in which a small amount of radioactive glucose (sugar) is injected into a vein, and a scanner is used to make detailed, computerized pictures of areas inside the body where the glucose is used. Because cancer cells often use more glucose than normal cells, the pictures can be used to find cancer cells in the body. Also called positron emission tomography scan.

Phase 0 Trials: Are "first in human trials" and have been recently developed to shorten the timeline for taking anticancer drugs from the laboratory to the clinic. Iin a Phase 0 trial, a limited number of doses, and much lower doses of the drug are administered, therefore there is less risk to the participant. Also, fewer patients (around 10 to 12 persons) are needed. By studying pharmacodynamics and pharmacokinetics , researchers can weed out the drugs that aren't producing the desired effects much more quickly, and they can avoid moving those drugs onto Phase I, II, and III trials.

Phase I Trials: Clinical trials attempt to determine the appropriate dose of drug to be administered. Phase I trials typically include patients with the most advanced stages of disease, which might be resistant to standard treatments. The dose is typically increased as additional patients are added into the study to determine the maximum tolerated dose. Phase I trials primarily test the safety of an experimental drug in very few patients.

Phase II Trials: Test some short-term effectiveness but mainly test the drug's safety and identify effective dosages using greater numbers of patients. They attempt to measure the biologic response of a particular tumor to a specific treatment. Typically patients with a tumor for which there is not an effective therapy are included in phase II trials of single agents. Combination regimens may also be evaluated in phase II trials. The goal of a combination regimen phase II trial is to ensure that the treatment is feasible, safe, and promising enough before expanding to the next phase.

Phase III Trials: Are designed to compare an experimental treatment to an accepted standard of care and evaluate endpoints such as survival and symptom control. These trials typically are performed in multi-institutional settings that include physicians from the community. They test the safety, effectiveness and dosage in a large number of patients. Only after a successful Phase III trial will the Federal Drug Administration (FDA) consider the approval of a drug for use in certain populations.

Phases of Clinical Trials: Clinical trials are research studies that are divided into four phases. Each phase is designed to find out certain information, building on information from the earlier phase.

Ploidy: The number of sets of chromosomes within an organism or cell.

Polychemotherapy: Chemotherapy regimens involving the use of more than one chemotherapeutic agent; multidrug chemotherapy.

Port: An implanted device through which blood may be withdrawn and drugs may be infused without repeated needle sticks. Also called port-a-cath.

Positive: Abnormal, affirmative of a specific finding, response, presence, condition, etc.

Positive predictive value: In screening and diagnostic tests, the probability that a person with a positive test/finding is a true positive (i.e., has the disease). Predictive value is related to the sensitivity and specificity of the test or screening method.

Prognosis: A forecast of the probable outcome of an attack or disease, the prospect of recovery from a disease as indicated by the nature and symptoms of the case.

Prophylactic mastectomy: Surgery to reduce the risk of developing breast cancer by removing one or both breasts before disease develops. Also called preventive mastectomy.

Prospective study: Studies in which people meeting the study criteria are enrolled and then followed over a period of time in order to gain data on events or outcome in the time following enrollment. In prospective breast cancer trials, patients are generally enrolled at time of diagnosis. Prospective studies are generally expensive undertakings, requiring large numbers of study participants and use of extensive resources for their planning and execution. They are considered very reliable studies, in part because potentially confounding variables can be controlled for from the start.

Quadrant: The breast is spoken of in clinical terms as having four quarters, known as quadrants: the upper-outer, the upper-inner, the lower-outer, and the lower-inner quadrants.

Re-excision: A follow-up surgical excision at the primary excision site for the purpose of excising any residual tumor cells left behind during the initial surgery.

Recurrence: Cancer that has recurred (come back), usually after a period of time during which the cancer could not be detected. The cancer may come back to the same place as the original (primary) tumor or to another place in the body. Also called recurrent cancer.

Relative Risk: A measure of risk based on a comparison of disease incidence in two populations. For relative risk measures, the group used as the reference is given a relative risk of 1.0.

Resection volume: The overall volume of tissue, including disease- free tissue, removed during lumpectomy.

Residual Tumor: Tumor cells that remain behind, uneradicated, after an initial attempt has been made to remove the cancer.

Retrospective review: A review in which patient data are evaluated at a subsequent time within the context of a study designed to answer a specific etiologic question (a question concerned with the cause or causes of something) or to confirm an etiologic hypothesis. In retrospective reviews, researchers review patient records and consider patient exposure to various supposed causal factors. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons.

Retrospective study: Retrospective studies involve going back in time. These studies look at the histories of a group of subjects who have been selected because they have the condition (e.g., breast cancer) of interest. The presence or absence or level of one or more possible risk factors is determined for each study subject and evaluated in relation to outcome. A retrospective study is one in which a review of data is undertaken in order to learn about the possible causes leading to a condition. In case-control retrospective studies, the histories of study subjects with the condition of interest are compared with the histories of study subjects who do not have the condition in order to determine the association between the risk factor being studied and the condition in question and to determine if it occurs more frequently or at a higher average level among cases of the condition than among the control cases. [Note: There can be variations in the design of studies. For instance, it is possible to use a group of subjects who were originally prospectively enrolled in a study to retrospectively study the group for a related but different purpose at a future date. In such a case, the researchers would be able to refer to the data collected prospectively and may choose to supplement it with new retrospective data collected at the time of the study to round out their data (such as posing new questions to the original subjects). A good example of where this may occur in breast cancer research is in the study of lymphedema at a distant follow-up point, such as 20 years post-treatment.]

RT: Contraction of Radiation Therapy. Treatment with high-energy rays (e.g., x-rays) to the affected area to kill cancer cells and/or to shrink the tumor. Also called radiotherapy.

Salvage mastectomy: Mastectomy performed in response to failure of prior treatment (i.e., local recurrence after breast-conservation therapy).

Second-line treatment: The term used to describe treatment undertaken at the time of recurrence of disease.

Sentinel lymph node biopsy: A staging and therapeutic technique use in breast cancer to determine the presence and extent of metastatic disease in the axilla. It is based on the basic concept that the first lymph node in the axillary basin to receive drainage of lymph from the primary tumor will be the first node to harbor cancer cells. If no cancer cells are found in this "sentinel" node, that basin is considered to be free of cancer. This technique is most successful for staging of early-stage breast cancers and for suitable candidates, offers a less invasive alternative to axillary lymph node dissection.

Supraclavicular lymph nodes: A lymph node located above the clavicle (collarbone).

Tamoxifen: An antiestrogen, tamoxifen is an anticancer drug that works by blocking the effect of the body's natural estrogen. In breast cancer treatment, tamoxifen can be used as a preventive agent to prevent the onset of breast cancer, or as adjuvant therapy to control the spread of breast cancer or delay its return.

Taxanes: A type of drug that blocks cell growth by stopping mitosis (cell division). Taxanes interfere with microtubules (cellular structures that help move chromosomes during mitosis). They are used to treat cancer. A taxane is a type of mitotic inhibitor and antimicrotubule agent.

Tylectomy: another name for lumpectomy (see Breast- conservation therapy).

Unilateral: Having to do with one side of the body.

Vascular invasion: See Lymphatic invasion.

Whole-breast ultrasound: Ultrasound imaging in which the entire breast is imaged instead of a smaller portion only.

Wide excision: also called wide-local excision. In breast cancer, this refers to the surgical removal of an area of breast tissue containing cancer cells, along with a rim (~1-cm in width) of normal tissue around the cancer cells (see margins). When referring to treatment of invasive breast cancers, wide excision is also commonly called lumpectomy (see Breast-conservation therapy). When referring to treatment of DCIS, the term wide excision is more commonly used, since there is usually no palpable lump per se.