A laymanâs dictionary to Breast cancer
Adjuvant chemotherapy - Adjuvant therapy is therapy that is added to a primary or main therapy to increase the effectiveness of treatment. It usually refers to hormonal therapy, chemotherapy, or radiation therapy added after surgery to increase the chance of curing the disease or keeping it from returning.
Adjuvant ovarian ablation - A hormone therapy procedure to remove, destroy, or inactivate the ovaries and prevent their ability to produce estrogen. In hormone dependent breast cancers, estrogen serves to support the growth of the cancer. By removing the source of estrogen, the growth of the cancer can be slowed or stopped. In early stage breast cancer, ovarian ablation is performed after surgical removal of the tumor and is referred to as "adjuvant" therapy. Ovarian ablation is a treatment option only for premenopausal women who are still menstruating .
Adjuvant radiation therapy - Adjuvant radiation therapy is the use of radiation therapy to the breast/chest following mastectomy surgery for breast cancer. The axillary (underarm or armpit) lymph nodes may or may not in included in the treatment. Adjuvant radiation is given to decrease the chance of cancer recurrence (returning).
Adjuvant tamoxifen therapy - The use of tamoxifen), a hormone altering drug following surgery and/or radiation therapy to reduce the risk of the cancer returning or the formation of a new cancer in the opposite breast. Tamoxifen is an anti-estrogen drug that blocks the cancer cell from using estrogen for stimulation and growth. Tamoxifen is used in both early and advanced stages of breast cancer.
Adjuvant Therapy - Cancer treatment given following the primary treatment (usually surgery in the case of breast cancer)which aids or assists in the effectiveness of the primary therapy. Adjuvant therapy generally refers to chemotherapy, hormone therapy, biological (immunotherapy) therapy, or radiation therapy that is added after surgery. Adjuvant therapy is given to increase the chances of curing the cancer or keeping it in check.
Aggressive - A term used to describe breast cancer cells that tend to multiply rapidly and which may be linked to poor outcomes
allergic reaction to chemotherapy - Some chemotherapy drugs can cause allergic reactions (hypersensitivity reactions) which may result in any of the following symptoms: high or low blood pressure, shortness of breath or tightness in the chest, wheezing, chills, fever, itching, facial flushing or swelling, especially the eyelids or area around the eyes, dizziness, rapid heart beat, back pain, and skin rash or hives. This is not always predictable and usually occurs within the first hour (often within the first 15 to 30 minutes) of the first chemotherapy infusion. In some patients, reactions may not occur until the second or third dose. Reactions can be minor and do not require interruption of therapy; or they may be severe requiring immediate discontinuation and treatment of symptoms with IV medication. Treatment of hypersensitivity reactions varies depending on the individual symptoms and severity of the reaction. During the infusion, the nurse will monitor your blood pressure, temperature, pulse, and breathing for any signs of an allergic reaction.
Paclitaxel and docetaxel are two chemotherapy drugs commonly used to treat breast cancer that can cause allergic reactions. Special medications, called âpremedication(s)â are given before paclitaxel or docetaxel to decrease the risk of an allergic reaction.
There are usually no long-term effects from this complication; however, future administration of the same drug may not be possible. Your doctor will discuss other drug therapy options with you, if necessary.
Alopecia - The medical term for hair loss. Hair loss is a common side effect of many chemotherapy drugs, but not all. This occurs because anticancer drugs can also affect normal cells, including the cells responsible for hair growth. This effect, however, is not permanent, and healthy cells grow back normally once chemotherapy is completed.
Hair loss can occur suddenly after treatment but usually begins 14 to 21 days after a course of chemotherapy and peaks several weeks later. Hair may become thinner, or it may fall out completely. Hair on the head is most commonly affected, but hair loss may also occur on the face (eyebrows and eyelashes), arms, legs, underarms, and pubic area. The scalp may become tender, and hair that is till growing may become dull and dry. Fortunately, for virtually all patients, hair will grow back once chemotherapy is completed. The new hair may be different in color, texture, and curliness than it was prior to treatment.
The type and amount of hair loss due to chemotherapy varies from person to person and also depends on the type and dosage of the chemotherapy drugs used.
Anemia - An abnormally low level of red blood cells or hemoglobin. Hemoglobin is a protein found inside the red blood cell. Hemoglobin contains iron, which is necessary to transport oxygen and carbon dioxide. When the hemoglobin level is decreased, the blood cannot carry enough oxygen to meet the needs of the body tissues. As a result, the person becomes tired physically and mentally. Other symptoms include feeling cold, lightheaded, dizzy or faint, pale skin, headache, shortness of breath, and heart palpitations. Some causes of anemia include: cancer, treatments for cancer (surgery, chemotherapy, radiation therapy), diet (lack of iron, vitamin B12, and folic acid), and blood loss from an injury. If the red blood cells remain depressed and the resulting anemia begins to impact the patient's quality of life, a new medication can be given to help the body boost it's production of red blood cells and improve anemia symptoms.
Aneuploid - A cell with an abnormal number of chromosomes.
Anorexia - Loss of appetite or the desire to eat which commonly occurs with cancer and/or cancer treatment. Taste changes (such as a change in the sensation of sweet, salty, sour, or bitter) may also occur due to taste buds affected by the cancer or its treatment. Not eating can lead to weight loss. Weight loss can cause weakness and fatigue, which influence your ability to perform normal activities. Proper nutrition also helps your body prevent and fight infection. This is highly variable among individuals and is usually temporary. Once chemotherapy is completed, the appetite usually returns to normal.
anthracycline-based chemotherapy - Chemotherapy that includes a drug from the class of chemotherapy agents called anthracyclines, which includes doxorubicin (Adriamycin), daunorubicin , epirubicine HCL, or mitozantrone .
A common example of an anthracycline-based chemotherapy regimen for breast cancer is CAF (cyclophosphamide, doxorubicin, 5-fluorouracil), CEF (cyclophosphamide, epirubicin, 5-fluorouracil),or AC (doxorubicin, cyclophosphamide).
Chemotherapy for newly diagnosed breast cancer usually includes 2 to 3 drugs from different types or classifications of agents. Chemotherapy for recurrent breast cancer may also include several drugs from different classifications or may simply be a single drug depending on the individual circumstances, medical history, and doctor's evaluation and treatment decision.
Antibodies - Proteins that are usually present in the blood and are made by cells for the immune system to fight infections---either normally or in response to a foreign substance.
Antigens - Various substances, such as toxins, bacteria, and cells of foreign bodies, that stimulate the production of antibodies when entering the human body
Anxiety - It is common and very normal to feel stress or anxiety when you have a diagnosis of breast cancer. There are many factors that bring about feelings of anxiety and apprehension, such as doctor's appointments, understanding treatment options, potential surgery, and fears about your cancer and its affect on your life. Anxiety may cause significant psychological distress and impact quality of life for some women. Symptoms of anxiety include a vague, uneasy feeling of distress, trouble sleeping and concentrating, feeling restless and tense, tiring easily, and feelings of depression.
Areola - The area of dark-colored or tanned skin surrounding the nipple of the breast.
aromatase inhibitor side effects - Most women receiving an aromatase inhibitor (anastrozole, letrozole, or exemestane have few or no side effects. The following symptoms have been observed in some patients receiving these drugs:
nausea, usually mild to moderate
headaches and/or dizziness, most often mild
decreased energy and weakness, usually mild and does not interfere with normal daily activities
hot flashes and increased sweating, common but mild
diarrhea, usually mild to moderate
vaginal dryness, usually mild and does not interfere with normal activitiesâthis may also be due to natural menopause
swelling of the arms and/or legs, usually mild and uncommon in most patients
musculoskeletal pain, bone or back pain
joint pain and stiffness; the most commonly affected areas are the hands, knees, hips, lower back and shoulders; early morning stiffness has also been observed; the cause of joint pain is not clear at this time
shortness of breath and cough
A more serious complication is an increased risk of blood clots (thrombophlebitis), which is very rare. Symptoms of a potential blood clot that should be reported to your doctor immediately include: pain, redness, swelling in the legs or arms, shortness of breath, or dizziness. Heart effects and strokes can also occur but are rare.
Special Note Do not get pregnant while taking one of these medications as fetal harm may occur. Use appropriate contraceptive measures. Breast feeding is not recommended.
The side effects listed above are possible with any of the aromatase inhibitor drugs, but others may occur. Symptoms can vary in each individual. It is important that you report any persistent, bothersome, unusual, or new symptom to your doctor promptly.
Aspiration - The removal of fluid from a lump, often from a cyst, using a needle and a syringe.
Aspiration biopsy - Removal of cells in fluid or tissue from a cyst or mass using a needle and syringe for microscopic examination and diagnosis.
Autoimmune disease - Any disease arising from and directed against (attacking) the individual's own normal tissues/body. Examples of common autoimmune diseases include: inflammatory bowel disease, Crohnâs disease (chronic inflammation of the bowels, systemic lupus erythematosus, SLE (chronic inflammatory disease affecting many tissues of the body), scleroderma (chronic hardening of the skin and other body tissues), multiple sclerosis (a chronic inflammation of the central nervous system), HIV (human immunodeficiency virus-a virus that attacks part of the patient's immune system), AIDS (acquired immune deficiency syndrome that is caused by the HIV virus), rheumatoid arthritis (a chronic disease involving inflammation, stiffness, and swelling of the joints), myasthenia gravis (a chronic disorder involving the nerves and muscles), Addison's disease (a disease of the adrenal glands), or thyroid diseases such as Graves' disease. Active autoimmune diseases such as those listed may affect a personâs eligibility to participate in a clinical trial.
Axilla - The underarm or armpit area of the body. Lymph nodes are located in this area and are referred to as axillary lymph nodes. The axillary lymph nodes are frequently the first area of breast cancer spread or metastasis.
Axillary - The underarm or armpit area, known as the axilla. Lymph nodes are located in this area and are referred to as axillary lymph nodes. The axillary lymph nodes are frequently the first area of breast cancer spread or metastasis.
Axillary lymph node dissection - Axillary lymph node dissection is a surgical procedure to remove the axillary (underarm or armpit)lymph nodes for examination under the microscope for breast cancer spread. If there is cancer present in the lymph nodes, the lymph node evaluation is called "lymph node positive". If there is no cancer present, then it is called "lymph node negative". Axillary lymph node dissection can cause postoperative complications such as infection, swelling (lymphedema), numbness, tingling, weakness or restricted arm mobility in the affected arm. The presence and extent of these complications are influenced by the extent of surgery in the axilla, the number of lymph nodes removed, the amount of tumor in the lymph nodes and if post-operative radiation therapy will be given.
Benign - Not cancerous or malignant, meaning not invading nearby tissue or spreading to other parts of the body. A benign lesion or tumor is a non-cancerous tumor.
Biologic therapy - Biological therapy (also known as immunotherapy, biotherapy, or biological response modifier-BRM-therapy) uses biological agents (drugs) to stimulate, enhance, modify, repair, or manipulate the immune system to fight infection, cancer, or other diseases.
One type of biologic therapy that has evolved in breast cancer is monoclonal antibody therapy. Monoclonal antibody therapy is a type of biologic therapy that has been found to be effective in fighting certain types of cancer. Antibodies are proteins made by the body's own immune system that are directed against foreign and infectious agents, called antigens. Monoclonal antibodies are antibodies developed in a laboratory as medicines to provide specific anticancer action in humans. The new drug, Herceptin (trastuzumab), is a monoclonal antibody now available for breast cancer patients with recurrent or metastatic disease.
Biopsy - The removal of suspicious cells or tissues for microscopic examination and diagnosis. When only a sample or small piece of tissue is removed, the procedure is called an incisional or core biopsy. When the whole tumor or suspicious area is removed, the procedure is called an excisional biopsy. When a sample of fluid or tissue is removed with a needle and syringe, the procedure is called a fine needle aspiration biopsy.
Biotechnology - The application of the principles of engineering and technology to the life sciences, for example, using biological substances to develop new medicines (drugs)
Bisphosphonate Therapy - Bisphosphonate therapy is the use of special medicines (drugs) to treat bone metastasis from breast cancer. Bone is the most common site of breast cancer spread (metastasis) and the majority of women with metastatic disease develop bone metastasis. Bisphosphonate therapy is not anticancer medicine but instead is therapy that effectively reduces the number of skeletal complications associated with breast cancer. It also delays the time to the first skeletal complication for some patients.
Blood clots (thromboembolic events) - A blood clot is a solid or semisolid mass of blood that forms from a thickening process in the body. Blood clots may form in the legs following surgery due to blood pooling in the extremities with inactivity following a major abdominal surgery.
Occasionally, the blood clot can break free, called a "thromboembolic event", from where it formed and travel through the bloodstream to another part of the body, often the lungs. Blood clots in the lungs cause shortness of breath, difficulty breathing and chest pain.
Resuming leg and foot exercises and walking as soon as possible after surgery, once your doctor has granted permission, can decrease the risk of this complication. Many surgeons have their patients wear special elastic stockings after surgery to help avoid postoperative thromboembolic events. For patients at high risk for blood clots, special blood thinning medication may be given preoperatively to help minimize or prevent this complication.
Blood count - A blood count is a blood joe to measure the number of red blood cells, white blood cells and platelets circulating in the blood. This test is also called a CBC or a complete blood count.
Bloom Richardson Score - The Bloom Richardson Score is an evaluation of the degree of malignancy of breast cancer cells. The pathologist who receives and studies the breast cancer specimen performs this evaluation. The evaluation uses a scoring system from three to nine, depending on the degree of abnormality or malignancy of the cancer cell. Scores of three (the lowest and best possible score), four, or five are categorized as Grade 1, or low grade, and considered a good prognosis. Scores of six or seven are categorized as Grade 2 or intermediate grade. Scores of eight or nine (the highest and worst possible score) as Grade 3, or high grade, and considered a poor prognosis. This malignancy score is helpful in determining prognosis and treatment. The Bloom Richardson score is not used alone but is considered along with other breast cancer prognostic factors and test results.
Bone marrow - The soft, spongy material or tissue inside the large bones that produces all the blood cells of the body. These cells include the red blood cells, white blood cells and platelets.
bone marrow or peripheral stem cell transplant - A procedure to replace bone marrow destroyed by treatment with high doses of anticancer drugs or radiation. Transplantation may be autologous (an individual's own marrow or stem cells saved before treatment), allogeneic (marrow or stem cells donated by someone else), or syngeneic (marrow or stem cells donated by an identical twin). Before chemotherapy, doctors remove some of the patient's (or a donor's) stem cells from either the peripheral (circulating) blood or bone marrow. After chemotherapy, the bone marrow or stem cells are re-infused back into the patient, which helps restore the body's ability to produce healthy blood cells (white blood cells, red blood cells, platelets).
Bone marrow suppression - Suppression of the activity of bone marrow that commonly occurs with chemotherapy and radiation therapy (if there is significant bone marrow in the treatment field, e.g., ribs, pelvic bones, spine). Bone marrow suppression is also called bone marrow depression or myelosuppression. The bone marrow is the soft, sponge-like tissue found inside the bones. The bone marrow is responsible for the production of all blood cells, which includes red blood cells (RBCs), white blood cells (WBCs), and platelets. When the productive activity of the bone marrow is suppressed, as with chemotherapy or radiation, there is a decrease in the number of RBCs, WBCs, and platelets.
Red blood cells carry oxygen, white blood cells fight infections, and platelets help clot the blood when there is an injury. When the red cells are decreased, anemia is possible. When the white blood cells are decreased, the risk of infection is increased. Common signs of infection are swelling, redness, pain, or fever (especially sustained fever). It is very important that fevers are reported to your doctor right away so that a prompt evaluation can be done and treatment begun, if indicated.
A decrease in the platelets may increase the risk of easy bruising or bleeding from an injury. A blood test called a CBC (complete blood count) is ordered by the doctor to determine the level of each blood cell. If the blood levels are decreased, special precautions need to be followed until the bone marrow makes new cells and the blood levels return to normal. Sometimes special medications, called growth factors, may be used to help increase the blood cell production and minimize complications of low blood counts. In some cases, a blood transfusion may be necessary for anemia.
bone pain from bisphosphonate therapy - Increased pain in the bones may occur with aredia therapy. This usually only occurs with the first or second treatment and gradually goes away within a few days. Pain medicines can be used during this time to relieve discomfort. If the pain does not improve or worsens, the doctor should be consulted for evaluation and additional medicine, if indicated.
Brachial plexopathy - Brachial nerves are nerves from the lower neck and upper chest area that help provide motor and nerve function to the arm and hand. When breast cancer is treated with radiation, the nerves in this area may get irritated or damaged by the radiation, causing mild discomfort in the shoulder and arm. This condition is called brachial (referring to the arm) plexopathy (referring to an abnormality of a group of nerves). Patient factors that may increase the risk of developing brachial plexopathy include a higher dose of radiation or a larger treatment area, young age, and CMF chemotherapy (cyclophosphamide, methotrexate, 5-FU) given at the same time as radiation. Other symptoms include numbness, tingling, or burning sensation as well as weakness of the arm and hand. Higher doses of radiation may increase the risk of brachial plexopathy. This is a rare complication.
Brachytherapy (interstitial radiation) - Brachytherapy (also called interstitial radiation or implant therapy) may be used as part of the treatment plan to deliver radiation to a highly localized (specific) area of the breast. Brachytherapy is radiation delivered by an implanted or injected radioactive source. This procedure is usually used as a âboostâ to external-beam radiation therapy. In most situations, catheters or thin wires (needles) are placed through the tumor, or the area where the tumor was removed, under general anesthesia. Once the patient returns to the hospital room, the radioactive material is then placed through the catheters or hollow needles to deliver the treatment. The person is hospitalized for the duration (a few hours to a few days) of this procedure and may require isolation because of the radioactivity.
Clinical research studies (clinical trials) are underway investigating the use of brachytherapy alone (without external beam radiation therapy) after breast conserving therapy (lumpectomy), e.g., brachytherapy as the sole radiation treatment following lumpectomy and instead of external beam radiation. Results of recent clinical trials are promising and offer the advantage of a shortened treatment time. External beam radiation involves a 6 to 7 week course of treatment. In contrast, brachytherapy can be completed in a 4 to 5 day treatment course. This treatment alternative is only appropriate for patients who are candidates for breast conserving surgery.
Brachytherapy as the sole radiation treatment following lumpectomy is currently considered investigational and its' use is restricted to a very small group of early stage patients with a very low risk of cancer recurrence elsewhere in the breast. Brachytherapy alone should only be performed in the setting of a clinical research trial.
BRCA 1 & BRCA 2 - Human genes which, when present in a mutated form, increase a woman's risk of developing breast and ovarian cancer. About 90-95% of women who get breast cancer DO NOT have an inherited form of breast cancer, or a mutated BRCA 1 or BRCA 2 gene. This means that only 5-10% of all cases of breast cancer develop from inherited gene mutations in BRCA 1 or BRCA 2. (National Cancer Institute 1998).
Breast Cancer Staging - Please note that the numbers (0, 1, 2, 3, 4) associated with each T, N, M stage represent increasing size and extent of the cancer.
STAGE GROUPING for BREAST CANCER
Stage 0
Tis
N0
M0
Stage I
T1
N0
M0
Stage IIA
T0T1T2
N1N1N0
M0M0M0
Stage IIB
T2T3
N1N0
M0M0
Stage IIIA
T0T1T2T3T3
N2N2N2N1N2
M0M0M0M0M0
Stage IIIB
T4Any T
Any NN3
M0M0
Stage IV
Any T
Any N
M1
Breast conserving surgery - Surgery to remove a breast cancer and a small amount of normal, healthy tissue surrounding the cancer, without removing any other part of the breast. This procedure is also called lumpectomy, segmental excision, limited breast surgery, or breast preserving surgery. Axillary (underarm or armpit) lymph node surgery may or may not be performed depending on the individual patient situation.
Breast conserving surgery + radiation therapy - Surgery to remove a breast cancer and a small amount of normal, healthy tissue surrounding the cancer, without removing any other part of the breast. This procedure is also called lumpectomy, segmental excision, limited breast surgery, or breast preserving surgery. Axillary (underarm or armpit) lymph node surgery may or may not be performed depending on the individual patient situation. Radiation therapy is given to the breast following surgery to decrease the risk of cancer recurrence (cancer returning).
Breast reconstruction - Surgery done after a mastectomy to rebuild or restore the breast and may also include rebuilding the nipple and areola as well.
Calcium deposits (calcifications) - Calcium deposits (calcifications) in the breast are very common and are due to benign processes. Most women have one or more calcifications visible on a mammogram. When a mammogram is magnified, calcifications are seen even more frequently. Calcifications found on a mammogram are also called âmicrocalcificationsâ and appear as white spots. Although readily seen on a mammogram, breast calcifications cannot be felt on examination unless they are associated with a breast lump.
Calcifications can develop due to secretion from cells, cellular debris, inflammation, trauma, prior radiation, or foreign bodies. It is important to know that breast calcifications are not related to dietary calcium supplements that many women take.
The size, shape, and pattern of calcifications vary and it is this variance that aids radiologists (doctors specializing in interpreting mammograms) in the early recognition of many breast cancers. Calcifications due to a possible cancer have a different appearance than those of normal breast tissue. If calcifications appear changed, worrisome, or suspicious, the radiologist may order additional mammograms called âmagnification viewsâ and/or a biopsy to determine if the abnormality is cancer or not. Calcifications that are benign in appearance and are unchanged from year to year do not need further investigation.
Cancer - A general term for tumors or abnormal growths characterized by abnormal, out of control growth. Cancers can invade and destroy surrounding normal tissue and spread to other parts of the body by the blood or lymph fluid to start new cancers. These new cancers are called "metastases". There are over 100 known types of cancer in mankind. Each type of cancer is a different disease and begins or originates in specific cells or tissues of a body system. Moreover, each cancer is unique in its prognosis and required treatment.
Cancer grade - A measure of how abnormal cancer cells look under a microscope. This is also called the "histologic or histopathologic grade". The pathologist determines the histologic grade of the cancer cell by examining actual cancer cells under the microscope obtained from the tumor biopsy specimen. Pathologists study how abnormal the cancer cells appear when compared with normal cells of the same tissue.
In breast cancer, tumors are graded on a scale of 1 to 3 (sometimes 1-4) with grade 1 tumors looking most like normal tissue (called well differentiated) and grade 3 (or 4) tumors looking very abnormal (called poorly differentiated or undifferentiated). Grade 1 cancers are not as rapidly growing as Grade 3 cancers are. Cancer grading may also be designated using Roman numerals from I-IV, like cancer staging.
The histologic grade may predict the aggressiveness of cancer by analyzing the features of individual cells, as well as the arrangement of tumor cells in relation to each other. In general, the histologic grade increases with tumor size and advancing stage of the disease. Grading gives doctors important information about the patient's prognosis and helps them figure out what treatment options to recommend.
Cancer operable - An evaluation by the surgeon as to whether the tumor can be safely and completely removed by surgery. Surgical options for breast cancer include breast conserving surgery (also called breast preserving surgery or lumpectomy) or mastectomy.
Cancer Stage - The stage of cancer, or stage of disease, is a determination of the size and extent of the cancer. The cancer stage is an indication of how far a cancer has spread--it is a "picture" of the disease. The current staging system used in the United States is an international classification system from the American Joint Committee on Cancer, 1998. In this system the letters T, N, M are used to measure the extent of the cancer. T stands of the size of the primary tumor, N for the absence or presence and extent of regional lymph node metastasis and M for the absence or presence of distant metastasis. The T, N, M system is then incorporated into Stages 0-IV for breast cancer. Stage 0 is the very lowest stage and includes "in-situ" cancers that are not invasive. Stage I-IV includes invasive cancers, which progress in the size of the primary tumor, number of lymph node sites, and metastatic sites.
The process for determining the stage of a cancer is called the "staging procedure(s)". It is important to understand that there are two kinds of staging. The first is "clinical staging". This occurs when you first receive your diagnosis, before treatment begins. Clinical staging requires a combination of the doctor's physical examination, various tests, and diagnostic exams such as chest x-rays, CT scans, MRI, etc. The second type of staging is "pathologic staging", which only occurs when actual tissue samples from the cancer is studied under the microscope by the pathologist. The pathology report may not be available for a week after surgery or biopsy but it provides the most reliable information.
The cancer stage provides critically important information for treatment planning and prognosis of an individual cancer. Sometimes when doctors get more precise information from the pathological staging, it changes the way the cancer was previously classified.
Carcinoma - A cancer that originates in the skin or in tissue of the body that lines or covers major organs. In breast cancer, carcinoma refers to cancer, which originates in the lining or covering of the lobules or ducts of the breast.
Carcinoma in situ (CIS) - A very early cancer that has not invaded (infiltrated) or spread from where it started into normal, healthy surrounding tissue or other areas of the body. The term in situ means "in place". In breast cancer there are two kinds of CIS: lobular carcinoma in situ (LCIS) and ductal carcinoma in situ (DCIS). LCIS is confined to the lubules (area of the breast where milk is made). DCIS is confined to the ducts (ducts that carry the milk from the lobules to the nipple of the breast). Most in situ carcinomas are very curable. Ductal or lobular carcinoma in situ is classified as a Stage 0 cancer. Cancer that has spread to the surrounding breast tissue from the ducts or lobules is referred to as invasive, infiltrating.
Cardiotoxicity - Most chemotherapy drugs do not affect the heart. However, some chemotherapy drugs can irritate or interfere with heart function and damage the heart resulting in a condition called cardiomyopathy. This may result in changes in the heart rate and rhythm, and the blood pressure. An electrocardiogram (ECG) or heart function test (MUGA scan) may be performed before starting therapy. Paclitaxel (Taxol), doxorubicin (Adriamycin) epirubicin (Ellence), and trastuzumab (Herceptin) are chemotherapy drugs used to treat breast cancer and can affect the heart.
Heart effects are usually dependent on the dose, method of administration and duration of treatment. Risk factors for cardiac toxicity include older age, preexisting heart disease, a higher dose of adriamycin or epirubicin, coadministration of paclitaxel or trastuzumab, and radiation of the heart. Symptoms usually develop within several months after chemotherapy, although they may develop later (sometimes years later).
The nurse administering the drug will be monitoring your pulse and blood pressure. If any irregularities occur during the infusion, another ECG may be taken. If you have a history of heart disease or experience any unusual or new symptoms (such as shortness of breath at rest or with exertion, having to sit up to breathe, chest palpitations, swelling of the lower legs and feet, or unusual weight gain)promptly notify your nurse or doctor.
CBC (complete blood count) - A blood joe to evaluate the cells in the blood. It includes the WBC (white blood cell count), RBC (red blood cell count), platelet count, hematocrit, hemoglobin, differential count (detailed information about the specific WBCs), and other information about the RBCs. These cells are produced in the bone marrow and may be decreased by anti-tumor therapies, such as chemotherapy or radiation.
Cell - A cell is the basic unit of structure of all human, animal and plant species.
Cellulitis - Cellulitis of the arm or axillary (underarm or armpit) area may occur after axillary lymph node surgery (dissection). Cellulitis is an inflammation or irritation of the tissue in an area of the body. Signs and symptoms of cellulitis include redness, swelling, pain or tenderness in the area, skin warmth or heat, and fever. These signs and symptoms may indicate an infection and require antibiotic medication. Warm, moist compresses to the area are helpful and provide comfort. Promptly report these signs and symptoms to your doctor if this occurs so that evaluation and treatment can be started, if indicated.
changes in reproductive function - Chemotherapy affects ovarian function in women who are still menstruating, resulting in changes in the menstrual cycle and flow, as well as decreased estrogen levels. Approximately 20-30% of premenstrual women experience menstrual irregularities, which may include amenorrhea or having no periods. These effects are related to the drug(s) given (ovarian failure is lower with CMF chemotherapy vs. AC), dose(s), and duration of treatment and may be permanent in women over 40 years of age. The older a woman is when she receives chemotherapy, the more likely she will stop menstruating or lose her ability to become pregnant (infertility). The time to the onset of ovarian failure is also shorter in older women than in younger women. The age of the woman at the time of therapy is an important factor in future fertility, with women under 30 having the best chance of becoming pregnant after cancer treatment.
When estrogen levels drop or cease due to chemotherapy (or natural menopause), early or premature menopause occurs. Common symptoms include hot flashes/flushes, sweats, vaginal dryness, fatigue, nervousness, insomnia, and mood changes such as irritability, loss of concentration, and depression. A decrease in sexual desire (called libido) may also occur. Some women may experience uncomfortable or painful intercourse due to vaginal dryness or irritation, which also results from deceased estrogen levels with menopause.
Premature menopause may also result in accelerated bone density loss and risk for osteoporosis and possibly cardiovascular disease (due to the decreased estrogen effect on cholesterol and lipids). Women who have chemotherapy-induced ovarian failure should have adequate dietary intakes of calcium and vitamin D and should perform weight-bearing exercise regularly and have their bone density evaluated.
Chemotherapy side effects - Chemotherapy causes side effects because normal, healthy cells are damaged or destroyed in the process of destroying cancer cells. The side effects of chemotherapy depend on the drugs used, the dose, and the length of therapy. The normal cells most likely to be affected are blood cells in the bone marrow (spongy substance inside the bones), cells in the mouth, digestive tract, reproductive system and the hair follicles. Some chemotherapy drugs can also damage cells of the heart, lungs, liver, bladder or nervous system. Some drugs have special medication which can be used to protect the normal cells from the damaging effects of the drug.
The most common side effects of chemotherapy include nausea and vomiting, hair loss (alopecia), loss of appetite (anorexia), fatigue, bone marrow depression, and changes in the menstrual cycle. Premenopausal women can experience premature menopause and infertility. Most side effects are temporary and manageable. Keep in mind that every person doesn't get every side effect--some have few and others may have many. Each patient will vary in the frequency and severity of side effects.
Chromosome - A linear thread in the nucleus of a cell. It contains the DNA (genes) which transmits genetic information. Normal cells have 46 chromosomes.
Clinical cancer stage - Clinical cancer (tumor) stage refers to a system description of the anatomic extent of disease, and in most cases, is directly linked to prognosis. The cancer stage is an indication of how far a cancer has spread. The current staging system used in the United States is an international classification system from the American Joint Committee on Cancer (AJCC Cancer Staging System), 1997. This staging method, called the "TNM" system, is based on the assessment of three components. The T = the extent (size) of the primary tumor measured in centimeters (cm); N = the absence or presence and extent of regional lymph node metastasis; M = the absence or presence of distant metastasis. The higher the stage, the greater the degree of spread and the worse the prognosis.
The clinical tumor stage is determined by a combination of the physician's physical examination (with careful evaluation of the skin, the breast, and lymph nodes) and any x-ray studies such as the mammogram, ultrasound, CT scan, etc.
In some cases of breast cancer, there may be more than one tumor (multiple tumors). In this situation, the largest of the tumors is used to designate the T size and the clinical stage. If the patient has bilateral cancers (cancers in both breasts), each tumor will be staged separately.
Clinical node stage - Clinical node stage is the determination of axillary (underarm) lymph node involvement from breast cancer. This determination is based on the result of the doctor's physical examination. The axillary lymph nodes are often the first site of breast cancer spread. If the breast cancer has spread to the lymph nodes, they can often be felt during the doctor's examination and may even be stuck or matted together.
Clinical trials - Clinical trials, also called cancer treatment or research studies test new treatments in people with cancer. The goal of this research is to find better ways to treat cancer and help cancer patients. Clinical trials have been responsible for the many advances in cancer treatment. Clinical trials test many types of treatment such as new drugs, new approaches to surgery or radiation therapy, new combinations of treatments, or new methods such as biological therapy. Many of today's most effective standard treatments are based on previous study results. Clinical trials may also answer important scientific questions and suggest future research directions. Because of progress made through clinical trials, many people treated for cancer are now living longer. (US National Cancer Institute, 1998).
Clinical trials side effects - Side effects (undesirable effects of a treatment) occur with most cancer treatments. The specific side effects that you may experience will depend on the type of treatment you receive in the clinical trial. Many ovarian cancer clinical trials involve chemotherapy. Common side effects of standard chemotherapy are fatigue, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores. Side effects from surgery and/or radiation may also occur if these treatments are part of the clinical trial. New treatments being studied may have these or other side effects. There are very effective medications available today to prevent or reduce the severity of many chemotherapy side effects, especially nausea and vomiting and low blood counts. The research doctor and oncology nurse will explain in detail what possible side effects you may experience while participating in the clinical trial. An informed consent form will also be given to you as you consider your decision. The consent form will have all the known side effects clearly written for your review. Remember that side effects are highly individualized and each patient will experience them differently with varying degrees of frequency and severity. Your doctor will discuss this with you, as well as strategies for managing any other side effect you may experience.
Cobalt machine - A machine containing a radioactive cobalt-60 source that emits high-energy gamma radiation that can deeply penetrate tissues.
Cognitive - The mental process of knowing, thinking, learning and judging
Comedo - A pattern of ductal cancer where the cells filling the duct look very abnormal; cancers in this pattern tend to be aggressive
common tamoxifen side effects - Most side effects from tamoxifen therapy are mild and can be managed easily. Side effects relate to its hormonal mode of action. The most common side effects from tamoxifen are hot flashes and vaginal discharge. Other side effects may include: sweats, vaginal dryness, irritation, or itching, and menstrual irregularity. The extent of these symptoms may vary among women. These are similar to symptoms commonly experienced during menopause. But, tamoxifen does not cause menopause itself.
Tamoxifen can also cause a "flare reaction" (bone or tumor pain or increase in tumor size). This reaction is usually mild and occurs shortly after initiation of therapy and resolves with continued tamoxifen treatment. Pain medicines may be required during this time.
Other common symptoms associated with aging and the menopause, such as joint pains, mood swings, weight gain, and difficulty concentrating, cannot be directly ascribed to tamoxifen therapy. These symptoms are more likely the result of the estrogen deficiency associated with menopause.
Men with breast cancer who take tamoxifen may experience headaches, nausea and/or vomiting, skin rash, impotence, or a decrease in sexual interest.
Complication(s) - A secondary medical problem (disease, accident, or a negative reaction) that develops following a medical procedure, treatment, or illness. Complications are usually related, directly or indirectly to a procedure (risk of the procedure), treatment (side effect or toxicity), or illness. Because cancer therapies are aimed at cancer cells that still have a lot in common with normal body cells, the therapy can often harm other parts of the body not affected by the cancer. For instance, chemotherapy often causes diarrhea, because the cells in the intestines are injured by the drugs that are directed at the patient's cancer.
complications from surgical oophorectomy - Complications from surgical oophorectomy include damage to internal organs such as the bladder blood vessels and nerves. The ureter (the drainage tube from the kidney to the bladder), which is close to the ovary, may also be damaged during the procedure. Anesthesia risks are basically the same as in any surgical procedure and include reaction to the anesthesia (medication) used, chipped teeth, and tears in the trachea (due to the breathing tube placed down the throat during the anesthesia process) etc. Occasionally, women may experience irregular uterine bleeding due to the loss of estrogen from the ovaries.
Each patient will vary in their risk level for developing these complications. Your doctor will discuss the specific complications that may occur with your procedure as well as the medical management.
Congestive heart failure - Congestive heart failure, CHF, is a medical condition resulting from undue stress upon the heart. Essentially, it represents failure of the heart muscle to pump sufficient blood to meet the body's metabolic needs. CHF can be acute, meaning that symptoms develop suddenly with serious effects on the body's circulatory system. Chronic CHF develops slowly and has mild symptoms including fatigue, increased heart rate, shortness of breath, inability to lie flat due to difficulty breathing, cough, wheezing, and weight gain. Weight gain occurs because of fluid build-up in the lungs, hands/fingers, feet/ankles, and possibly other body areas. The underlying cause of CHF must be determined. Therapy is then directed at treating both the cause and the symptoms of CHF.
Connective tissue disease - History of a connective tissue disease involving the joints or the connective tissue, which includes muscles, cartilage, ligaments, and tendons. Connective tissue supports and connects other tissues and body parts. Connective tissue diseases include all the different forms of arthritis, scleroderma, systemic lupus erythematosus, and many other diseases. Connective tissue diseases are also referred to as collagen vascular disease. If you are under the care of a specialized doctor called a rheumatologist, you probably have a connective tissue disease.
CT or CAT scan - CT scan refers to computed axial tomograph (CAT), a diagnostic imaging test that is done in a diagnostic clinic, radiology lab, or hospital. CT combines a revolving scanner (camera) and an x-ray with a computer to produce highly detailed cross-sectional, three-dimensional pictures of the area being studied. The entire body can also be scanned. CT scans are performed by a radiologist (a doctor who specializes in using x-rays, ultrasound, CT, MRI and other scans to aid in diagnosis) or radiology technician. The radiologist will interpret the scans.
CT scans are generally far more sensitive than x-rays and provide a painless, noninvasive method of obtaining a detailed view of internal organs. The test takes about 30-45 minutes. Some patients may find it uncomfortable to remain still on the narrow examination table during the procedure. There is a slight risk from radiation exposure or an allergic reaction to contrast dye, which is used in some CT scans.
CT scans are used in breast cancer to help identify potential areas of cancer spread or metastases. CT scans usually are not done as part of the routine diagnostic process for breast cancer unless there is suspicion of metastatic disease, such as symptoms, abnormal blood test, abnormal x-ray, etc.
Cyst - A fluid-filled sac or mass that is usually harmless. The fluid can be removed by aspiration with a needle and syringe and then sent to the pathologist for analysis.
Cystitis - Cystitis is an inflammation of the bladder. Symptoms of cystitis include painful, frequent urination and/or blood in the urine (which may vary from microscopic to frank bleeding). Cyclophosphamide and ifosfamide, two chemotherapy drugs, can cause cystitis. It is a rare complication but should be reported to the doctor promptly if it occurs.
To prevent this complication, additional IV (intravenous) fluids are given during administration of the chemotherapy to help flush the bladder. Patients should increase their oral fluids the day of treatment and for 2 or 3 days afterwards. Special medication called mesna may also be given to decrease the chance of cystitis. Your doctor will advise you if mesna is indicated.
Decreased Arm And Shoulder Movement - Decreased movement (range of motion) and strength of the arm and shoulder can occur following axillary (underarm or armpit) lymph node surgery (dissection) and/or mastectomy. Radiation therapy may also cause this complication. This is due to the surgical/radiation affects and/or injury to the motor nerves of the arm and chest on the affected side. Loss of strength (arm weakness) and movement is usually temporary but some women may have some permanent changes. Additionally, skin in the breast area may be tight or hard and muscles of the arm and shoulder may feel stiff or have a pulling sensation. Factors that may increase the risk of this complication include older age, non-participation in physical exercise programs, and development of scar tissue in the axillary area from surgery. A greater extent of surgery or radiation can also affect the risk.
Full range of motion or movement can be maintained by starting arm and shoulder exercises promptly after surgery. Talk with your doctor about an exercise program and when it is safe to begin. A Physical Therapist is available through most hospitals for consultation and assistance with regaining arm and shoulder movement, if needed or desired.
Decreased Sexual Desire (Libido) - When estrogen levels drop or cease due to natural menopause or menopause caused by chemotherapy, a decrease in sexual desire (called libido) may also occur.
Diarrhea - Diarrhea is a condition of loose, frequent stools. Cancer treatment (chemotherapy or radiation therapy to the abdomen or pelvis) may cause diarrhea by affecting the cells lining the intestine. Changes in diet, medications, and infections may also cause diarrhea. Diarrhea caused by chemotherapy or radiation therapy is usually temporary and is managed by fluid replacement, dietary alterations, and medication. If you have diarrhea lasting longer than 24 hours or have pain and cramping along with it, call your doctor.
Difficult Future Mammograms - Due to the tissue changes in the breast that normally occurs with radiation, future mammograms may be more difficult to read and evaluate. If you change doctors after your breast cancer treatment, it will be important to inform your new doctor, as well as the radiologist (doctor whom views and evaluates your mammogram), that you have had prior radiation therapy to the affected breast.
Diploid - A cell with a normal number of paired chromosomes, i.e., 46
Dissection - A surgical procedure that cuts and separates tissue. In breast cancer, this term refers to the surgical removal of the axillary (underarm or armpit) lymph nodes and lymph vessels.
DNA - The hereditary structure and carrier of genetic information for all human cells, both normal and cancer cells. DNA is deoxyribonucleic acid and is found inside the nucleus of each cell.
DNA ploidy - Ploidy refers to the amount of DNA contained in the nucleus of a cell. The DNA ploidy test is a laboratory test performed on the breast cancer specimen to measure the amount of DNA in the nucleus of cancer cells. DNA (deoxyribonucleic acid) is the hereditary structure and carrier of genetic information for all human cells, both normal and cancerous. Cells are categorized as either diploid (made up of normal amounts of DNA) or aneuploid (made up of abnormal amounts of DNA).
DNA ploidy is used to evaluate how malignant or aggressive a breast cancer may behave. Diploid tumors tend to be less aggressive than aneuploid tumors. It is not a routine breast cancer test, like estrogen/progesterone receptor testing, but may be done by some laboratories or ordered by the doctor. DNA ploidy is not used alone, but is considered along with other breast cancer prognostic factors.
duct(s) - A passageway or tubelike structure in the breast designed to transport milk or fluid from the lobule, where milk is made, to the nipple.
Ductal carcinoma in situ (DCIS) - A very early breast cancer that is confined to the breast ducts and has not invaded into surrounding tissues (non-invasive) such as connective tissue, fatty tissue, and lymph nodes. This early form of breast cancer is highly curable and is usually discovered on a routine mammogram. The DCIS appears as "calcifications" on the mammogram and is an early clue to a potential cancer.
Dysfunction - A disturbance, impairment or abnormality of the functioning of an organ
early menopause - Early or premature menopause occurs when the ovaries are removed or inactivated by ovarian ablation, resulting in an immediate and abrupt decline in the body's estrogen levels. Menopause is the term used to refer to the time of life when a woman stops menstruating (having periods) and the female sex hormone production decreases rapidly, bringing an end to fertility. Menopause is also called the "change of life". Postmenopause is all the years after menopause.
Symptoms of menopause include cessation of menses, hot flashes/flushes, sweats, nervousness, mood changes (such as irritability, loss of concentration, depression), insomnia, painful urination, incontinence, vaginal dryness and itching, pain during sex, and reduced height and curved spine due to osteoporosis (bone loss due to decreased estrogen levels). The number and severity of symptoms can vary among women experiencing early menopause.
emotional effects from mastectomy - A diagnosis of breast cancer and loss of the breast can evoke a wide range of emotions, from denial to guilt, helplessness, anxiety, depression, and fear. It is truly a stressful time for many women and their families. Feelings of sexuality and intimacy may be impacted as well. For many women, this is not a problem and their self-image and feelings of attractiveness are unchanged. For other women, losing the breast is a tremendous emotional adjustment and greatly affects how they feel about themselves and their body image. Sometimes these feelings interfere with sexual intimacy and relationships. These feelings are very normal reactions as a woman's breast symbolize so many positive things--motherhood, sexuality, and being a woman. Most women and their partners will need to take time to grieve the loss of a breast and heal. There is no right or wrong reaction or response--it is highly individualized. Given time, every woman with breast cancer becomes more comfortable with her body and accepting of the changes. If these feelings continue or worsen and begin to interfere with activities of daily living or quality of life, consult your doctor to discuss counseling. Joining a support group may also help.
Endocrine therapy - Endocrine therapy is the use of hormone altering medications (drugs) used to treat breast cancer. Endocrine therapy is also referred to as hormone therapy or hormone treatment.
Endometrial cancer - Tamoxifen therapy affects the lining of the uterus and over time, may cause cellular changes that result in endometrial cancer (cancer of the lining of the uterus). Although a serious and potentially life-threatening complication, the actual incidence is quite rare (2 of every 1000 women treated). This is more common in women over the age of 50 years and the risk is similar to women taking estrogen replacement therapy. Endometrial cancer in this situation tends to be of a low grade and stage and is very treatable. Women on tamoxifen therapy should have regular pelvic examinations on an annual basis and report any new or different vaginal discharge, especially bleeding, to the doctor promptly.
Estrogen - A female hormone produced by the ovaries and to a smaller extent in the adrenal glands that is responsible for the development and maintenance of female sex characteristics. Scientists have proven a strong relationship between estrogen and breast cancer. Estrogen may promote the growth of breast cancer. The main source of estrogen in the premenopausal female is the ovaries. In the postmenopausal female the main source of estrogen is the adrenal glands, fat tissue, and muscle.
Estrogen receptor (ER) status - Estrogen receptor (ER) testing (and progesterone receptor testing) is performed on all newly diagnosed invasive breast cancers to measure the amount of estrogen receptors present in the breast cancer tissue. The result of this test is called the "estrogen receptor status". Receptors are proteins on the surface of breast cancer cells, which allow estrogen to attach to the cell and support cancer growth. Estrogen (or progesterone receptors) are also referred to as a tumor marker or biologic marker. Estrogen is a female hormone produced by the ovaries. Some breast cancers are hormone dependent and require estrogen and progesterone for growth. If estrogen receptors are detectable, it is called an estrogen receptor-positive breast cancer.
Please note: ER/PR receptor testing is not routinely performed on non-invasive tumors (in situ tumors, e.g., ductal carcinoma in situ, DCIS, or lobular carcinoma in situ, LCIS--stage 0).
Extensive intraductal component (EIC) - An evaluation by the pathologist of the extent of noninvasive (in-situ) ductal cancer within the invasive tumor area and in nearby tissue. The presence of EIC (more than 25%) is associated with an increased risk of breast cancer recurrence in the same breast following breast conserving surgery. Re-excision of the primary tumor bed may be necessary if EIC is present in the biopsy or tumor specimen.
External beam radiation thearpy - Radiation therapy that uses a machine outside the body to aim high-energy rays at a cancer. Also called external radiation or teletherapy. Radiation therapy is the use of high-energy radiation from x-rays, neutrons, and other sources to damage or kill cancer cells and shrink tumors.
Fatigue - Many breast cancer patients receiving adjuvant chemotherapy have fatigue. About two thirds of these patients rate the level of fatigue as moderate or severe. Fatigue is a feeling of being tired, exhausted, weary, or energy depleted and is a common medical condition for cancer patients. For the majority of patients, it is only a temporary condition that resolves over time when treatment is completed; but, for others it may be chronic (meaning it doesn't go away).
The cause of fatigue is poorly understood but contributing factors may include anemia, sleep disturbances, depression, the disease itself or the treatment(s). Patients may feel weak and dizzy with a desire for rest and sleep. Other symptoms include pain in the legs, or difficulty climbing stairs or walking short distances, being short of breath after only light activity, like cooking a meal or taking a shower. Some patients report difficulty thinking, forgetfulness, and an inability to concentrate.
There are no medical tests to measure fatigue. No one knows the exact cause of cancer-related fatigue, but causes are usually multiple. Any physical or emotional change can deplete energy. Varying levels of fatigue may be experienced, depending on the individual patient situation and cancer treatment(s).
Patients experiencing persistent and more severe fatigue may have a diminished quality of life because they are just too tired to participate in the activities of daily living or work. In this case, interventions including conserving energy, resting, establishing priorities for daily activities, and delegating tasks, must be considered.
For patients with severe fatigue due to anemia (caused by the cancer or treatment), there is an effective synthetic drug called "human erythropoietin" (a growth factor, Epogen, Procrit) that can be given to improve the anemia. This growth factor drug helps the body make new red blood cells to resolve the anemia, which in turn relieves the symptoms of anemia and improves quality of life. Talk with your doctor or oncology nurse about your fatigue and if you have symptoms of anemia, ask if human erythropoietin is appropriate for you. Ask whether there are things you can do to help you feel better. Understanding more about your fatigue can help you better plan your activity and rest periods. This can help you feel more in control of your life.
fluid retention - Some chemotherapy and hormone therapy can cause fluid retention. Fluid retention is a condition in which the body retains fluids. The individual will notice swelling or puffiness in the face, hands, feet, or abdomen as well as weight gain (called "peripheral edema"). Patients may experience tight-feeling rings or shoes or ankle swelling as the day progresses that may not be relieved by elevating the feet. In some cases, it may become generalized and, less frequently, lead to fluid in the lining of the lung, heart or abdomen. This can result in shortness of breath and difficulty breathing, even at rest. Salt and foods high in sodium content may need to be restricted or avoided, as they can contribute to fluid retention. If the problem is severe, your doctor may prescribe a diuretic (a "water pill"), a medicine to help your body get rid of the excess fluid.
Docetaxel is a chemotherapy drug frequently used to treat breast cancer that can cause a cumulative fluid retention problem. Fluid retention develops over time in relation to the docetaxel dose, typically after three to five cycles. It is not life threatening, but it can result in treatment delay or discontinuation. Once docetaxel is discontinued, the fluid retention resolves and body weight slowly returns to normal. To help minimize or prevent this complication, pre-medication with dexamethasone (a steroid) is given before treatment.
Gene - The basic unit of heredity (genetic material). Genes are made out of DNA (deoxyribonucleic acid), and genes make up our chromosomes. Each gene occupies a certain location on a chromosome. Genes determine which traits we inherit from our parents. Genes are also responsible for directing cellular activity and telling the cell which chemicals or proteins to manufacture, when to divide, etc.
gene alteration - Any change or difference in the usual makeup or function of a gene, including a change in the formation of essential body proteins
General health - Your general or overall health condition at the present time. For example, do you have other health problems or conditions besides breast cancer such as heart disease, lung disease, diabetes, etc.
Gray - A measurement of radiation. In 1985, the word Gray replaced the term "rad" (1 Gray = 100 rad).
Growth factors - Today, chemotherapy is used in the treatment of nearly all types of cancer and usually includes the use of multiple chemotherapy drugs (two or more). Additionally, over 50% of cancer patients receive radiation therapy sometime during the course of their disease. Although important and significant advances have occurred in the treatment of cancer, side effects or complications of treatment still occur and can significantly impact a patient's quality of life.
The good news is that, along with improvements in cancer therapy and patient survival, advances in the management of treatment related side effects have also been achieved. These medical advances are enabling many patients to successfully complete their treatment with fewer complications and an improved quality of life.
One of these important advances has been the development of "growth factors". Growth factors are not anticancer medicines (drugs), but instead are specially designed drugs used to prevent or minimize the bone marrow suppressive effects of chemotherapy and in some cases, radiation therapy. Chemotherapy and radiation therapy can damage the blood-producing cells of the bone marrow. Use of growth factors not only minimizes treatment complications but also helps treatment to be successfully completed without delays or reduction in the drug dose.
Bone marrow is the soft, sponge-like tissue found inside the center of bones. It is the organ responsible for the production of all blood cells, which includes red blood cells (RBCs), white blood cells (WBCs), and platelets. Red blood cells carry oxygen to the body tissues. White blood cells (there are actually five different types of white blood cells) fight infections and the most important one is the neutrophil. Platelets are cells that travel to injured parts of the body to help form blood clots and stop bleeding or bruising after cuts or injuries.
These important blood cells are highly sensitive to the effects of chemotherapy and radiation therapy. Thus, they are easily damaged or destroyed as part of the cancer treatment process, resulting in "bone marrow suppression". Bone marrow suppression, also called bone marrow depression or myelosuppression, is a decrease in the number of red blood cells, white blood cells (especially neutrophils) and platelets, referred to as "low blood counts". The doctor routinely measures the blood levels of these bone marrow cells using the CBC (complete blood count) laboratory test. When low blood counts occur with cancer treatment (due to bone marrow suppression), anemia, infection, and/or bleeding can result.
Growth factors were developed to prevent or minimize these damaging effects on the bone marrow. Today, there are three types of growth factors available for cancer patients experiencing bone marrow suppression, especially if associated symptoms are present such as fatigue (from anemia), a major or persistent infection with fever, or bleeding/bruising. There is a specific growth factor for red blood cells (Procrit®), two for neutrophils (Neupogen® and Neulasta®), and one for platelets (Neumega®). These special medicines help the body make new cells and return the blood cell levels back to normal more quickly, minimizing the consequences of low blood counts that may include hospitalization and IV (intravenous) antibiotics or a red blood cell transfusion. This is an important factor in cancer therapy as delays in treatment or reductions in the planned dose can impact overall effectiveness of the chemotherapy or radiation therapy. Growth factors are given by an injection (a shot) into the subcutaneous tissue (tissue underneath the top layer of skin). They are well tolerated by most patients with few side effects.
It is important to note, however, that not all patients need growth factors during cancer treatment. Your doctor will decide if growth factors are appropriate for you based on your personal situation, type of cancer, cancer therapies, expected toxicities, and your response to treatment. But, these "supportive therapies" are readily available if you do need them.
hand-foot syndrome - Hand-foot syndrome, also known as "palmar-plantar erythrodysesthesia" (PPE) can occur in some patients receiving continuous infusion 5-fluorouracil (or its derivatives), liposomal doxorubicin, or capecitabine chemotherapy. These drugs are used as second-line chemotherapy for recurrent breast cancer. Symptoms of this side effect include tingling, burning, itchiness, pain or tenderness, swelling or signs of redness on skin surfaces. Typically, only the hands and feet are affected but it may occur in any areas of skin friction and pressure, such as behind the knees or in the groin. In its early stage, patients first notice a tingling sensation in their palms, followed by redness. Hand-foot syndrome is usually seen after 2 or 3 cycles of treatment but may occur earlier. In most patients, the reaction is mild and resolves on its own in one to two weeks. However, in some patients a dose modification may be necessary or in severe cases of skin peeling and shedding, the drug may be discontinued.
Hand-foot syndrome is not life threatening, but it can cause pain and discomfort. It is a reversible, easily managed complication of some chemotherapy.
Health permit surgery - An evaluation by the doctor as to whether a patient is medically safe to have surgery and considered a good surgical risk. A patient's general health and any chronic medical conditions (diabetes, heart disease, lung disease, kidney disease, etc.) can affect the decision for surgery as well as the risk of surgical complications.
Hematoma - A swelling or mass of blood (usually clotted) confined to an organ, tissue, or space and caused by a break in a blood vessel. Hematomas may occur following breast surgery. They may resolve on their own or may need to be drained by the surgeon.
HER2 positivity - A phrase used to describe the presence of HER2/neu protein overexpression or gene amplification in a cell or tissue. HER2/neu positivity occurs in 25-30/% of breast cancers.
HER2 protein overexpression - The excess production of the HER2 growth factor receptor protein (cell-surface receptor) that results from a change or mutation in the HER2 gene in cancerous cells.
HER2 receptor - One of the many proteins on the surface of a cell (both normal and cancerous) that signals the cell to divide. This protein is also called HER2 growth factor receptor.
Histologic cell type - The specific type of cell forming a specific type of tissue of the body.
Histology - The study of the structure and function of tissues of the body; histology describes the type and arrangement of normal and malignant cells.
Histopathologic cancer grade - A measure of how abnormal cancer cells look under a microscope. This is also called the histologic or histopathologic grade. The pathologist determines the histologic grade of the cancer cell when examining the tumor biopsy specimen under the microscope. In breast cancer, tumors are graded on a scale of 1 to 3, with grade 1 tumors looking most like normal tissue (called well differentiated) while grade 3 tumors looking very abnormal (called poorly differentiated or undifferentiated). The histologic grade may predict the aggressiveness of cancer by analyzing the features of individual cells, as well as the arrangement of tumor cells in relation to each other. In general, the histologic grade increases with tumor size and advancing stage of the disease.
Hormone receptor assay (test) - A joe performed on breast cancer tissue to see whether a breast tumor is likely to be affected by hormones or if it can be treated with hormones. The hormones that are tested are estrogen and progesterone. If the tumor is positive for hormone receptors, it is called "hormone receptor or ER/Pgr positive". Conversely, if the tumor is negative for hormone receptors, it is called ""hormone receptor or ER/Pgr negative".The use of medicines (drugs) or medical procedures to treat cancer by changing the hormone environment in the body. Hormone therapy drugs interfere with hormone production or hormone action. Hormone therapy may also include surgical removal of hormone-producing glands to kill cancer cells or slow their growth. Hormone therapy is also called "endocrine therapy".
Hormone therapy is considered a systemic therapy as it goes into the bloodstream and affects the entire body as compared to surgery or radiation therapy, which are local therapies affecting only a small area of the body. Hormone therapy is used for breast cancers that are dependent on hormones for growth (usually estrogen). These cancers are referred to as hormone sensitive or hormone responsive cancers. Hormone therapy can be accomplished by adding, removing or blocking specific hormones (especially estrogen) a cancer may need to grow.
The most common hormonal therapy for breast cancer is the drug tamoxifen. Other hormonal therapies include megestrol, aromatase inhibitors, androgens, and surgical removal of the ovaries (oophorectomy).
Hormone(s) - A chemical substance produced in the body and released into the circulation to promote and regulate body functions. The substance travels through the bloodstream and sets in motion various body functions. Some of the body organs, or glands, that produce hormones are the ovaries, thyroid, and the adrenal glands.
Hot Flashes - Hot flashes or hot flushes, can be a side effect of hormone therapy for breast cancer. This is one of the most common side effects of tamoxifen therapy. A sudden feeling of warmth spreads throughout the upper torso, which can last for up to an hour. The face may become red, followed by sweating. This occurs because the hormones change the way the body controls temperature. Hot flashes can be treated several ways, including identifying and avoiding certain triggers for them and possibly taking small amounts of medication to prevent or reduce the severity of the hot flashes.
in situ - Refers to abnormal cells that have not spread beyond their site of origin. In the case of breast cancer, ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS) are early forms of breast cancer that is highly curable. DCIS begins in the milk ducts or passageways of the breast. LCIS begins in the lobes of the breast that produce milk.
Infertility - The inability to produce children
infusion - Administration of a solution, such as various anticancer medicines (chemotherapy, biological therapy), into the body through a needle in a vein. This method of drug or solution delivery is called "intravenous" or IV.
infusion-associated reaction - Herceptin (trastuzumab) is a new anticancer drug used to treat advanced, metastatic breast cancer. Herceptin can cause an infusion-associated symptoms during the first treatment (while the IV is running) including chills and/or fever. This occurs in about 40% of patients. The symptoms are usually mild to moderate and successfully treated with medicines. Few patients have to discontinue their treatment because of this side effect. Other signs and/or symptoms may include nausea, vomiting, pain (often at the tumor site), shaking, headache, dizziness, shortness of breath, rash, low blood pressure, or fatigue. This reaction rarely occurs with subsequent infusions.
Injection - Injection is a shot into the body using a needle and syringe to administer drug(s) or fluids.
injection (IV) site reactions - Some chemotherapy drugs can cause irritation at the IV (intravenous--into the vein) site of infusion. Reactions may include tenderness or pain, redness, swelling, red streaking or discoloration along the course of the vein, inflammation of the surrounding skin, and ulceration. Leaking of the chemotherapy drugs and IV fluid into the surrounding tissue usually causes this reaction. For some drugs a special IV catheter may be inserted to prevent or minimize this complication. Symptoms are usually temporary but can be severe in some cases. If you notice any discomfort or pain, stinging, or burning during or after the infusion, contact your oncology nurse or doctor promptly.
Intramuscular - Intramuscular means into a muscle of the body. An intramuscular injection would be a shot using a needle and syringe of a drug into the muscle.
Intravenous (IV) - Intravenous is the injection of medicines (drugs) or fluids into a vein of the body.
Invasive (infiltrating) cancer - Cancer (carcinoma) that has invaded (infiltrated) or spread from where it started into surrounding normal, health tissue or other areas of the body. Invasive cancer is more serious than non-invasive cancer called "carcinoma in situ". Breast cancer that has started in a duct is called invasive or infiltrating ductal carcinoma. Breast cancer that started in a lobule is called invasive or infiltrating lobular carcinoma.
Ki-67 - In the 80's and early 90's, "flow cytometry" was the standard laboratory test used to measure the number of cancer cells making DNA , as well as the amount of DNA (called "ploidy"). Flow cytometry is also called S-phase fraction or SPF. DNA (deoxyribonucleic acid) is the hereditary structure and carrier of genetic information for all human cells, both normal and cancerous.
Flow cytometry, or SPF, is gradually being replaced by an easier test called Ki-67.
Ki-67 is a cell cycle related protein located in the nucleus of tumor cells. The Ki-67 test uses a special technique to identify cells that are actively making DNA and are not in the "resting" phase. Test results are reported as a percentage. A low percentage (less than 10%) indicates a slow-growing tumor. A high percentage (>20%) indicates a more rapidly growing tumor which may behave more aggressively with a higher risk of recurrence (cancer returning) and distant metastasis (cancer spread to distant organs). Some pathology laboratories prefer one test to the other.
Lesion - An abnormal mass of cells or a nodule. In the case of breast cancer, a lesion seen on a mammogram could represent a benign or malignant tumor or condition. Or a lesion seen on x-rays of bone could represent breast cancer spread to the bone.
Leukopenia - Leukocytes are white blood cells. A decrease in the number of white blood cells is called leukopenia. White blood cells fight bacteria that enter the body and are the body's main defense against infection. White blood cells are made inside the bones in the soft, spongy material called bone marrow. When the white blood cells are decreased, due to the cell damaging effects of chemotherapy or radiation therapy, the risk of infection increases.
LHRH drug side effects - Medicines that are used for medical (chemical) ovarian ablation (castration) are called lutenizing hormone-releasing hormone (LHRH) drugs. This group of drugs can cause the following adverse reactions or side effects: gastrointestinal: infrequent nausea, vomiting, loss of appetite, diarrhea, and/or constipationdermatological : discomfort lasting up to 30 minutes at the skin injection site, skin rash, sweating, acne, seborrhea, increased facial hair, or deepening of voiceneurological : dizziness, insomnia, depression, mood changes, sluggishness, nervousnessendocrine (hormone): hot flashes, increased sexual desire (libido), light or irregular vaginal bleeding, stopping of menstrual periods, painful intercourse, burning/dryness/or itching of the vaginacardiac (heart): fast or irregular heart beattumor flare: increased bone pain or other symptoms of the disease; this applies only to women with advanced or metastatic breast cancerother: headache, increased blood cholesterol levels, muscle weakness (rare), fatigue, allergic reaction (rare), weight gain, blurred vision, swelling and increased tenderness of breasts, swelling of feet or lower legs
It is important to remember that not all of these side effects may occur. Side effects are highly individualized and vary among patients. You should notify your doctor or oncology nurse of any that you do experience so they can help you with symptom management or dose adjustments that may be necessary.
Life Expectancy - A statistical prediction of the average years that a person of a certain age can expect to live considering other causes of death such as heart disease, complications of diabetes, lung disease, etc., and not breast cancer. In studies comparing the effectiveness of treatments, researchers may eliminate people who are known to have life-threatening conditions other than breast cancer, or comorbid disease, so that the results over time will more accurately reflect survival as a result of the cancer treatment. This restriction is a problem, however, because it is difficult to recruit large groups of people with breast cancer and no comorbid disease. Also, the results cannot be applied to the general population. The ages of the patients the time the study begins also affects the results, particularly since evaluating the effectiveness of a breast cancer treatment requires a long-term follow-up period of five or ten years. Therefore, an elderly person who has already achieved a normal life expectancy may not survive ten years even if the treatment of cancer is successful.
Likelihood of Overall Survival - The likelihood that people with breast cancer survived all causes of death, including their cancer, at a specific point in time. This probability is reported as a percentage.
Likelihood of Surviving Breast Cancer - The likelihood that people with breast cancer survived death due to the breast cancer at a specific point in time. This probability is reported as a percentage.
Likely Freedom From Disease Progression - The likelihood, that at a particular time, there are no signs that the cancer has grown larger, extended into nearby tissues, or spread to distant sites, based on various tests to detect metastases. This category is often used for evaluating the effectiveness of treatment among patients with advanced breast cancer. This probability is reported as a percentage.
Likely Freedom From Distant Metastases - The likelihood that patients with localized breast cancer does not have signs, symptoms, or test results that indicate the disease spread to other parts of the body at a specific point in time. This probability is reported as a percentage.
Likely Freedom From Recurrence - The likelihood that a patient with breast cancer does not have signs, symptoms, or test results that indicate the disease returned at a specific point in time following treatment. This probability is reported as a percentage.
Linear accelerator - Most commonly used equipment worldwide for teletherapy. Generates electromagnetic waves that convert electrons into radioactive photons, which are directed in a beam toward the tumor. Can treat superficial or deeper cancers.
Liver And Kidney Dysfunction - Some chemotherapy drugs may irritate the liver or kidneys and cause temporary or permanent damage. Damage to the liver or kidney cells results in the inability of the body to effectively process body wastes and regulates blood chemicals.
Liver and kidney dysfunction can be determined by liver and kidney blood tests. If you are receiving a drug that may cause this complication, your doctor will likely order these blood tests (liver and kidney function tests) from time to time to check for any abnormalities. Dose adjustments may have to be made or the drug discontinued, if necessary.
Lobule - A part of a breast lobe. A woman's breast contains 15-20 lobes where milk is produced and then passed through the ducts to the nipple.
Local cancer recurrence - A return or recurrence of the cancer (cancer that comes back) at or near the original breast cancer site, which may include the breast, the chest wall (ribs, muscles between or around the ribs, excluding the pectoral muscle), underarm (axilla) lymph nodes, or skin overlying the chest wall. A cancer recurrence that is confined to the breast or chest area is called a "local or locoregional recurrence".
A recurrence in another body organ or site, such as the lung, liver, bone, etc. is referred to as a "systemic or distant cancer recurrence". The specific location(s) and extent of cancer recurrence is an important factor when considering treatment options for recurrent breast cancer. A local recurrence can often be treated with local therapies such as surgery or radiation therapy, whereas a systemic or distant recurrence requires a systemic therapy such as hormone therapy and/or chemotherapy.
loss of estrogen protective effects - Estrogen has positive, protective effects on the bones and heart. Estrogen increases bone density and lowers blood cholesterol levels. When estrogen levels decrease due to natural or early menopause, this protective effect is lost or diminished. This results in an increased risk of osteoporosis (and bone fractures) and cardiac disease, especially in women who are postmenopausal.
Lumpectomy - A surgical procedure to remove a breast cancer and a rim of surrounding normal tissue while preserving the breast. This procedure is referred to as breast conserving surgery. When radiation therapy is given after surgery, then it is called breast conserving therapy.
Lymph fluid - The colorless fluid that travels throughout the many lymph vessels and lymph nodes of the body, carrying special infection fighting cells.
Lymph node - One of numerous round, oval or bean-shaped glands located along the course of lymphatic vessels throughout the body. Lymph nodes vary in size (1 to 25 mm in diameter) and are part of the body's immune system. Lymph nodes function as filters, capturing and destroying bacteria, as well as filtering the lymphatic fluid (lymph) Lymph nodes can also collect cancer cells. Lymph nodes are also referred to as lymph glands.
Lymphatic (lymph) system - The network of tissues, organs and channels (vessels) throughout the body that produce and store cells crucial to the immune system. These highly specialized tissues produce, store, and carry white blood cells that fight infection and other diseases. The lymphatic system is made up of the bone marrow, spleen, thymus, lymph nodes, and a network of thin tubes that carry lymph and white blood cells (lymphatic channels).
Lymphatic/Vascular Invasion - Lymphatic and/or vascular invasion refers to breast cancer cells that have invaded or infiltrated through the lining of the breast duct wall (where most breast cancers begin) into surrounding blood vessels or lymphatic vessels. This determination is done by the pathologist (a doctor who identifies and diagnoses disease by examining cells and tissue under the microscope) who examines the breast cancer specimen. The presence of lymphatic or vascular invasion provides important prognostic information and may indicate a more aggressive cancer with a higher risk of cancer recurrence in the breast, chest region, or elsewhere in the body. Lymphatic or vascular invasion may also influence treatment decisions after surgery.
Lymphedema - Lymphedema is a swelling of the hand and/or arm. When axillary (armpit) lymph node surgery is done for breast cancer, the lymphatic vessels or channels are interrupted resulting in an inability to transport lymph fluid normally. Radiation therapy to the breast and axillary can also cause lymphedema. Fluid then builds up in the tissues. Lymphedema may never occur but is a possibility anytime after lymph node surgery. You may notice some swelling right after surgery. This is normal and will subside as the tissues heal. Infection and stress (i.e., lifting heavy items) can also cause swelling to occur.
Malignant - A cancer or growth of cancer cells.
Mammogram - An x-ray of the breast to detect tumors or other breast changes
Mastectomy - Mastectomy is a surgical procedure for breast cancer in which the entire breast and some of the axillary (underarm) lymph nodes are removed. In some cases of mastectomy, removal of axillary lymph nodes is unnecessary. There are actually several mastectomy procedures all of which vary depending on the amount of breast tissue removed. Mastectomy options include a modified radical mastectomy (the most common mastectomy procedure performed in the U.S.), a total mastectomy, and a skin-sparing mastectomy (minimal skin removal for purposes of immediate reconstructive surgery). Breast reconstruction is usually an option for all women having a mastectomy for breast cancer.
Menopausal status - Menopause is the time of life when a woman stops menstruating (having periods) and her female sex hormone production decreases rapidly, bringing an end to fertility. Menopause can be gauged by laboratory tests, but otherwise a woman has to go 12 continuous months without a period before she can conclude she was in menopause. Menopause is also called the "change of life". Menopause usually occurs in the late 40s or early 50s in most women. Post-menopause is all the years after menopause. The average duration of the menopause transition is about 4 years.
menstruation - The periodic discharge of a bloody fluid from the uterus, occurring at more or less regular intervals during the life of a woman from age of puberty (9 to 17 years of age) to menopause. Length of flow varies from 3 to 7 days (average of 4 to 5 days). It occurs on an average every 27 to 28 days, although time may vary from 18 to 40 days. Menstruation ceases during pregnancy; may or may not cease during lactation; and ceases permanently with the completion of menopause.
Menstrual Irregularity - Changes in the menstrual cycle and flow may occur in premenopausal women, including amenorrhea or having no menstrual periods. Approximately 20-30% of premenstrual women experience menstrual irregularities. These effects are related to the drug(s) and dose(s) used in treatment and may be permanent in women over 40 years of age.
Metastasis to distant organs - Metastasis is the term used to describe the spread of cancer to other organs or areas of the body. In breast cancer, common areas of cancer spread include the bone, soft tissue (skin or lymph nodes other than those in the underarm or armpit), lung, liver and brain. Clinical evidence of metastasis is determined by radiologic tests such as chest x-ray, bone scan, CT scan, MRI, etc.
metastasis to the brain or spinal cord (CNS) - Breast cancer that has spread/traveled to the brain and/or spinal cord (the central nervous system, CNS). When this occurs, the new site of cancer is not "brain cancer". This secondary (metastatic) tumor is an extension of the original cancer in the breast and contains cells like those found in the original tumor of the breast. The brain is one of the major sites of breast cancer metastasis. X-ray studies, CT or MRI scans, or other scans may be completed as part of your evaluation to determine the presence of cancer in other parts of your body.
metastasis to the liver - Breast cancer that has spread to the liver. The liver is a large, glandular organ in the upper abdomen that cleanses the blood and helps digestion by secreting bile. The liver is a common organ or site of cancer spread (metastasis) from breast cancer. The secondary (metastatic) tumor(s) in the liver is not a new cancer or type (it is not "liver cancer"); this secondary (metastatic) tumor has cells like those found in the original breast cancer. X-ray studies, CT scans or other scans may be completed as part of your evaluation to determine the presence of cancer in other parts of your body.
metastasis to the lung(s) or pleura - Breast cancer that has spread (called metastasis) to one or both lungs or the lining of the lungs. The lung is a common organ for cancer spread from breast cancer. The secondary (metastatic) tumor in the lung(s) is not "lung cancer" but is the same cancer that is now present in the lung and contains cells like those found in the primary breast (original) tumor. X-ray studies, CT scans or other scans may be completed as part of your evaluation to determine the presence of cancer in other parts of your body.
Metastasis/metastasized - The spread of cancer cells from the organ/site of origin to distant areas or organs of the body, usually by way of the nearby lymph vessels or bloodstream. When a cancer spreads to another distant site, it is said to have "metastasized" and is a "metastatic cancer". The most common areas for metastasis in breast cancer include the bone, liver, lung, and brain. When cancer originates in the breast and spreads to other organs, it is still considered breast cancer, not liver, lung, or bone cancer. Doctors commonly use special scans (such as CT scans or MRI) and x-rays to help locate and diagnose these distant cancer growths.
Microcalcifications - Microcalcifications are tiny deposits of calcium made by early breast cancers. These small clusters of abnormal calcium cannot be felt, but can be seen on a mammogram and facilitate the early detection of breast cancer. Calcium deposits are also present in normal breast tissue and are due to benign processes; but, they have a different look compared with the calcifications associated with breast cancer. In fact, most women have one or more areas of calcifications but the vast majority of these are harmless and remain unchanged from year to year. It is helpful to know that breast calcifications are unrelated to calcium supplements you may be taking.
Radiologists, doctors who specialize in identifying abnormalities and disease on x-rays, are trained to recognize the difference between calcifications of normal tissue versus those of a cancer. Whenever worrisome or suspicious calcifications are seen on a mammogram, additional mammograms and/or a biopsy may be recommended to determine whether the calcifications are from normal tissue or a new cancer.
Microcalcifications on the post-biopsy mammogram - Microcalcifications are tiny deposits of calcium made by early breast cancers. These small clusters of abnormal calcium cannot be felt, but can be seen on a mammogram and allow for early detection of breast cancer. In some cases, a repeat mammogram is done after the initial surgical excision (surgical removal) to assure that all cancer cells have been removed. If the repeat mammogram shows any signs of cancer, then additional surgery or a re-excision of the primary tumor bed is done to remove any remaining cancer cells. This is an important step in breast conserving surgery, as any cancer cells left in the breast are a source of cancer recurrence (cancer returning).
Monoclonal antibody therapy - A type of biologic therapy that has been found to be effective in fighting certain types of cancer. Antibodies are proteins made by the body's own immune system that are directed against foreign and infectious agents (called antigens) or to abnormal cells such as cancer cells. Monoclonal antibodies are antibodies developed in a laboratory as a medical therapy drug to provide specific antitumor action within the human body. Herceptin (trastuzumab) is a new monoclonal antibody used to treat advanced, metastatic breast cancer.
MRI (MR) or magnetic resonance imaging - Magnetic Resonance Imaging (MRI or MR) is a new sophisticated imaging technique to examine the body using powerful magnetic fields and radio waves, and a computer to produce internal pictures of the body. MRI offers better visualization of soft tissues and highly detailed information without exposing the body to radiation. In many instances, it provides more useful images than CT scanning and ultrasound.
MRI is done in a diagnostic clinic, radiology lab, or hospital. A radiologist (a doctor who specializes in using x-rays, ultrasound, CT, MRI, and other scans to aid in diagnosis) or qualified radiology technician performs the procedure. The radiologist or other medical specialist will interpret the results. It takes about 30-90 minutes and is a painless, noninvasive test. Some people may find the noise and being still and confined in a narrow space upsetting.
Research studies are showing that MRI is very sensitive in visualizing both invasive and noninvasive (in-situ) ductal breast cancers. It can detect cancers that are unable to be felt by physician examination or clearly seen on mammogram, offering the potential for more accurate breast cancer staging and better treatment planning. MRI is emerging as an important diagnostic tool in breast cancer. However, MRI as a method to detect, diagnose, and stage breast cancer remains in the investigational stage. Further research is needed to precisely define its place in the diagnosis of breast cancer.
Multiple tumors within the same quadrant - The presence of multiple tumor nodules in the same area or quadrant of the affected breast, e.g., 2 or more areas of cancer in the same breast. The "quadrants" of the breast refers to four separate areas of the breast. In most cases, these are not separate, independent tumors but are multiple areas of involvement of the primary tumor in a single ductal unit. This situation is called "multifocal" breast cancer.
Using the hands of a clock to demonstrate this concept, imagine that twelve to three would be one quadrant, three to six would be another quadrant, six to nine another quadrant, and nine to twelve the fourth quadrant. For example, if there were several tumors in the twelve to three area, this would be described as multiple cancers within the same quadrant, whereas a tumor in the three to nine quadrant and another tumor in the nine to twelve quadrant would be considered cancers in two or more quadrants of the breast or multicentric disease. These abnormal findings can usually be identified on the mammogram.
Multifocal breast cancer is an important factor when considering surgical options. If multifocal disease is present, even though it is confined to one quadrant, breast conserving surgery may not be possible. In this case, too much breast tissue may have to be removed (the tumors may be too far apart to be removed with one incision) resulting in significant disfiguration and unacceptable cosmetic results.
Muscle/Joint Aches, Pains - Some chemotherapy drugs cause muscle and joint aches, pains, weakness, and soreness. This is usually felt in the large joints of the arms or legs (weight-bearing bones are usually the most affected) but any joint area of the body can be affected. Muscle and joint pain is a temporary reaction beginning 48 to 72 hours after receiving the drug and last about 3 to 5 days. Symptoms vary among patients and range from mild lower back cramping to incapacitating pain in the lower back and legs.
Patients receiving paclitaxel (taxol) may experience "restless leg syndrome". Associated symptoms include cramping and feelings of "crawling" in the muscles. Symptoms usually occur at night, when the patient is at rest, and go away with ambulation (walking). The cause for this reaction is unknown.
If you experience any of the above symptoms and they become bothersome or interfere with your daily activities, notify your doctor or oncology nurse so they can advise you on home remedies, such as heat therapy (to the area of discomfort) or medicines for relief and comfort.
Mutation - An error in one or more genes. Gene mutations result in the gene not working like it should. Mutations may be inherited or spontaneous. Inherited mutations are those you were born with--a defective gene that one of your parents passed on to you at birth. Spontaneous mutations are those that may occur during the course of your life.
Myocardial infarction (MI or heart attack) - Severe or uncontrolled diseases of the heart or circulatory (blood circulating) system. Diseases such as congestive heart failure (problems with the muscle action of the heart leading to breathing difficulties), coronary artery disease (diseases of the heart vessels), peripheral vascular disease (problems of the circulation of blood throughout the body), myocardial infarction (heart attack), severe or uncontrolled high blood pressure, heart rate or rhythm problems, and bleeding or clotting problems are important factors which may affect a personâs eligibility to participate in a clinical trial. Many heart and circulatory problems limit physical activities and people with these problems may have difficulty walking 50 feet without stopping.
Nausea And Vomiting - Nausea and vomiting are common and frequent side effects of chemotherapy. Radiation therapy may also cause nausea and vomiting if the brain, stomach or some areas of the abdomen are treated. Frequency and severity vary, depending on the drug(s), doses, administration schedule and the person. Nausea and vomiting usually starts within a few hours after treatment and resolves with 12 to 24 hours. With some drugs, nausea and vomiting may not begin for 12 to 24 or more hours and may last for several days. Today, there are very effective medications (antiemetics) available to lessen or prevent this symptom. Staying well hydrated with fluids and changes in eating habits before and after a treatment may also help.
Neoadjuvant chemotherapy - Chemotherapy given before surgery to shrink a tumor so that surgery can then be attempted with a greater chance of success and less complications. Surgical options following neoadjuvant chemotherapy will depend on the amount of tumor shrinkage and the individual patient situation. Surgical procedures for breast cancer include mastectomy or breast conserving (breast preserving) surgery. Breast conserving surgery is also called lumpectomy.
Neutropenia - Neutropenia is a decrease in the number of neutrophil cells in the blood. There are different types of white blood cells. One very important type of white blood cell is the neutrophil. Neutrophils are the body's main defense against infection-causing bacteria. When bacteria invade the body, neutrophils rush to the site of infection and destroy them. Normally, millions of these white blood cells live in the blood and bone marrow. Chemotherapy and sometimes radiation therapy destroys normal, healthy neutrophils in the process of destroying cancer cells. When you do not have enough neutrophils, you have a condition called neutropenia. Without enough neutrophils, you are at risk for a bacterial infection. Infection can be serious, but it can be treated effectively with antibiotics. There are also special medications available to help the body increase the neutrophil count. Your doctor may order these, if indicated.
Nodule - A small mass or group of cells which is solid and can be felt by touch.
Nuclear grade (if no Bloom Richardson Score) - Nuclear grade is an evaluation of the degree of abnormality of the cancer cell's nucleus as compared to normal breast cells. Nuclear grade is an indication of how fast the cancer cell is growing and affects prognosis. Breast cancer cells that appear only slightly changed from normal breast cells are called "well differentiated" or grade one (1). Those that are very abnormal, primitive and no longer resemble normal breast cells are called "poorly differentiated" or grade three (3). Cancer cells appearing somewhere in between are termed "moderately differentiated" or grade two (2).
The pathologist (the doctor who identifies or diagnoses a disease by examining cells and tissues under a microscope) determines the nuclear grade during examination of the cancer specimen. This information is then included on the pathology report that is sent to the doctor. Nuclear grade is used as a prognostic factor (information that indicates a likely outcome or course of a disease) to estimate the aggressiveness of a cancer and the risk of possible recurrence. The more differentiated (grade 1) tumors are less aggressive and carry a better prognosis than less differentiated tumors (grade 2 or 3). Nuclear grade is not used alone, but is considered along with other prognostic factors and test results.
Number of metastatic sites - The number of organs or sites in the body with cancer that has spread from the primary tumor in the breast. For example, metastasis to the bone only would be one site; metastasis to the bone and the liver would be two sites, and so on. The doctor uses this important clinical information when determining the most effective treatment(s) for the patient.
number of previous chemotherapy regimens - The number of previous chemotherapy regimens (also called "regimes") that a patient has received for treatment of their cancer. This number would include the first chemotherapy regimen given when initially diagnosed and treated as well as any subsequent regimens given for a recurrence of the cancer.
A regimen is a treatment plan that specifies the drug(s), dosage, route of administration (e.g., by mouth or IV, etc.), treatment schedule (e.g., how often such as weekly, monthly, etc.), and the duration of treatment (e.g., how long, usually measured in weeks or months).
For example, a common chemotherapy regimen used in breast cancer is CMF (cyclophosphamide, methotrexate, 5-fluorouracil) for 6 treatment cycles. Another common regimen is CAF (cyclophosphamide, doxorubicin, 5-fluorouracil) for 3 treatment cycles. In these examples, CMF would be considered one chemotherapy regimen and CAF another regimen and so on.
When breast cancer recurs after completing the first chemotherapy regimen, a second or third regimen, (if necessary) will be given to treat the cancer in an attempt to control the disease and achieve another remission. It is not unusual for breast cancer patients with recurrent disease to receive multiple chemotherapy regimens. It is important to know the number of previous chemotherapy regimens a patient has received as this factor can directly influence future drug therapy and tolerance.
Oncogene - A cancer causing gene. Oncogene comes from the Greek word "oncos", meaning tumor. Oncogenes have been identified in human tumors. In addition to genes that can induce tumors (a malignancy), there are anti-oncogenes that suppress tumors.
Oncologist - A doctor who specializes in the diagnosis and treatment of cancer. There are several types of oncologists. A surgeon who specializes in cancer surgery is called a "surgical oncologist". A doctor who specializes in using chemotherapy or hormone therapy to treat cancer is called a "medical oncologist". A doctor who specializes in treating cancer with radiation is called a "radiation oncologist" or radiotherapist. Because most cancers require a combination of treatments, a patient may have all three types of cancer specialist involved in his/her care.
Oophorectomy - The surgical removal of an ovary. If only one ovary is removed, the procedure is called a unilateral oophorectomy, meaning only one side (unilateral) is affected. If both ovaries are removed, the procedure is called a bilateral oophorectomy, meaning both sides (bilateral) are affected.
Other serious medical condition - Any other major or serious medical disease or condition not mentioned in the above list that is uncontrolled and/or requires regular medical therapy and physician management. Examples would include diabetes, a major psychiatric illness such as manic-depressive disorder or schizophrenia, bleeding or other blood disorders such as severe anemia, or adrenal diseases such as Cushing's syndrome, or an addictive disorder such as a drug addiction. Serious medical illnesses may affect a personâs eligibility to participate in a clinical trial.
Outcome - The term outcome is used in a variety of ways in breast cancer. The outcome of a therapy is how effective the therapy seems to be. The term outcome can also be a predictive term. For example, the outcome of some therapies is not to cure the breast cancer, but to diminish the effect the cancer has on the patient's quality of life. On a grand scale, outcomes research will look at many patients who are similar to you, and what happened to them, to try and give you a better idea of what each therapy might mean to your particular case of breast cancer. It is important that the patient and the physician have a clear understanding of the desired outcome for the patient.
Ovarian ablation - Ovarian ablation or castration refers to a medical procedure to remove, destroy, or inactivate the ovaries and prevent their ability to produce estrogen. Ovarian ablation can be accomplished by surgery (called oophorectomy), radiation therapy, or by the administration of estrogen reducing medicines (drugs). Ovarian ablation is a hormone treatment option for premenopausal women with estrogen receptor positive or unknown status breast cancer.
Ovaries - The ovaries are two small, solid almond-sized organs in the pelvis that sit on either side of a woman's uterus. Some of the cells in the ovary produce and store eggs (ova) until they are released into the uterus during the menstrual cycle (ovulation). Other cells in the ovary make the female hormones estrogen and progesterone. The plural of ovary is ovaries.
Overexpression - The excess production of growth factor receptors (cell-surface receptors or proteins) that results from alteration of a gene in cancerous cells.
Pain from metastasis to the bone - Pain is the most common symptom of cancer spread to the bone (metastasis). The pain of bone metastasis is caused by the fact that cancer cells disrupt the normal structure of the bone. Pain from bone metastasis usually is confined to the specific area of bone involved. In this case, the pain is referred to as "localized pain". Bone metastasis can be determined by visible evidence on x-rays, bone scans, CT or MRI scans.
Pain, tenderness - Postoperative pain and tenderness at the surgical site is common and temporary (short-term). It will resolve and lesson each day as healing occurs. It is important to remain optimally comfortable during this time and pain medicines should be taken to relieve pain. Remaining as pain free as possible is important to hasten tissue healing and recovery. When you have no to minimal pain, you are more active and ambulatory, which improves circulation and healing of tissue. If you are getting inadequate pain relief, consult your doctor promptly for changes in your pain medication.
Palliative care - Palliative care refers to any treatment whose goal is symptom relief and comfort to improve quality of life rather than to cure.
Palpation - Examination of the skin and the tissue beneath the skin with the hands. A "palpable" breast lump is one that can be felt with the hands by pressing on the breast tissue.
Pathologist - A doctor who identifies and diagnoses disease by examining cells and tissues under a microscope.
Pathology - The study of the nature and cause of disease, which involves changes in structure and function
Pathology report - A report from the pathologist describing the results of the breast tissue biopsy or surgical specimen. The report includes information about the biology and size of the tumor, which enables the doctor (medical oncologist) to draw conclusions about the patients' condition. A pathology report includes information about 3 key factors: a description of what the cancer tissue looks like with the naked eye, a description of the actual features of the tissue under the microscope, and the diagnosis.
The first part of the report will explain if the tissue is a cluster of cells or a lump of tissue as well as the size, texture, and shape of the tissue specimen--how the cancer cells look individually and how they are arranged in relation to each other. The second part will explain how the cells and surrounding tissue appear under a microscope. The report will also include the results of any biologic markers, if present, and to what degree. Biologic markers for breast cancer include estrogen and progesterone receptors (ER/PgR) and the HER2 protein. Calcifications, if present in the tissue, will also be described and whether they are benign or cancerous.
Performance status - Performance status is an evaluation of an individual's daily activity level and ability to care for themselves without the assistance of others. Performance status is often used as criteria for eligibility in a clinical trial or to receive a specific cancer treatment. Some clinical trials or cancer treatments require a patient to be fully ambulatory and able to perform self-care to safely receive the treatment.
Peripheral neuropathy - A condition in which the nerves in the body are irritated or damaged by some chemotherapy drugs. It is usually mild to moderate, and the severity is related to the individual dose, total dose received over time, and schedule of administration.
Peripheral neuropathy is experienced as numbness, tingling ("pins and needles"), burning and/or weakness in the hands and/or soles of the feet, called "stocking-and-glove distribution". It may feel like your hands or feet are asleep. Another problem may be constipation or other changes in your bowel or bladder function. You may have difficulty picking up a coin or buttoning your shirt or blouse. Symptoms usually begin after multiple treatments over several months, although symptoms can occur after a single dose.
These symptoms typically last 3 to 6 months following completion of therapy but may last longer. In rare cases, symptoms may continue or worsen after therapy has been stopped. There are currently no effective means to prevent or treat peripheral neuropathy, but early recognition and sometimes a delay or reduction in the dose can improve symptoms in most cases. If you experience any of these symptoms and they interfere with your comfort or daily activities, consult your doctor or oncology nurse so they can advise you on management.
Phantom breast syndrome - After mastectomy, many women experience feelings or sensations of the breast still remaining or being present on the chest wall. This is why it is called, "phantom breast syndrome". As many as 50% of patients who undergo mastectomy experience some sensation of a remaining breast after mastectomy. The most common complaint is pain (but may also be painless), but itching, nipple sensation, erotic sensations, and premenstrual-type breast soreness also are described. These symptoms may be fairly constant over time. The cause of this syndrome is unknown.
Phlebitis - Irritation or inflammation of the vein caused by some chemotherapy drugs. This is usually a temporary reaction and will resolve on its own or may require treatment with warm or cold compresses or discontinuing use of the affected vein.
photosensitivity - Some chemotherapy drugs make the skin and scalp more sensitive to sun exposure. This reaction is called photosensitivity and may develop after a short exposure to the sun. The skin appears like acute sunburn, with redness, swelling, and blisters followed by darkening of the skin color and peeling. The following instructions will help prevent this reaction. When outdoors, protect the skin from direct sun exposure between the hours of 10 AM and 3 PM (the sun is strongest during this time). Wear protective clothing, such as a wide-brimmed hat or a long-sleeved cotton shirt. Use an effective sunscreen (sun protection factor, SPF, of 15 or greater) on the exposed skin. Sunscreens should be applied 15 to 30 minutes before sun exposure and reapplied according to product directions.
Additionally, previously irradiated skin is at increased risk of additional damage from ultraviolet (UV) radiation. Cancer survivors should be aware of increased skin sensitivity to UV radiation and should be examined carefully and regularly for skin damage and skin cancers. Preventive strategies will remain important, e.g., adequate sun screen and shielding exposed skin from direct sunlight.
Plastic surgeon - A plastic surgeon is a doctor who specializes in reconstructive and cosmetic surgery. These doctors also perform surgery to repair or correct disfigurement that has resulted from an accident, birth defects or a disease.
Platelets - Platelets are blood cells that help to clot the blood and stop bleeding when there is an injury to the body. Platelets are made in the bone marrow, along with red blood cells and white blood cells. When there are not enough platelets, as in some diseases, or as a result of cancer treatment (chemotherapy or radiation therapy) easy bruising or bleeding can occur.
Ploidy - The number of chromosomes in a cell. "Aneuploid" cells have an abnormal number of chromosomes. Cancer cells are often aneuploid. "Diploid" cells have a normal number of chromosomes (i.e., 46).
Positive axillary lymph nodes - Lymph nodes are small bean-shaped structures scattered along vessels of the lymphatic channels or vessels. The lymphatic vessels and lymph nodes are commonly referred to as the "lymphatic system". The lymph nodes act as filters, collecting bacteria or cancer cells that may travel through the lymph vessels. The axillary lymph nodes are located in the underarm or armpit and are commonly the first site of cancer spread (metastasis) from the breast. Although a site of metastasis, axillary lymph nodes are not considered "distant" metastasis, but instead an extension of the primary tumor in the breast.
Other lymph nodes that can be a potential site of cancer spread include: the internal mammary lymph nodes which lie on the outer edge of each side of the breast bone; the supraclavicular lymph nodes which lie above the collar bone; and the infraclavicular lymph nodes which lie beneath the collar bone. Lymph nodes and lymph vessels are also found in many other parts of the body. They are often the sites of cancer spread from other types of cancers.
postoperative sensory changes - Sensory changes, such as numbness, tingling, prickling, or burning can occur at the surgical site (the affected arm, underarm, breast, chest wall, or back) following mastectomy or breast conserving surgery (lumpectomy). Axillary lymph node surgery is usually performed with mastectomy or breast conserving surgery (lumpectomy) for invasive breast cancer. Other sensations of discomfort experienced by patients include: throbbing, soreness, aching, tenderness, pain, sharp or shooting twinges, pulling, or tightness. Not all patients experience the same sensations. Sensory changes may be worsened by various activities that involve movement.
Sensory changes are most likely the result of injury or disruption of the nerves and tissues in the surgical area during the procedure. The nerves are often cut as part of the lymph node removal. A greater extent of surgery can also increase this risk. For some patients, sensory changes may be severe and distressing. These changes are usually temporary and resolve over time as nerve cells regenerate. However, some women may experience permanent changes such as numbness or tenderness.
Pregnant - Pregnant or pregnancy is the condition of carrying a developing embryo (human life or child) in the uterus.
Previous breast conserving surgery (lumpectomy) - Surgical removal of the breast cancer and a small amount of normal tissue around the cancer, without removing any other part of the breast. Breast conserving surgery is also called breast sparing surgery, lumpectomy, segmental excision, or limited breast surgery.
Primary therapy - The primary or main treatment (therapy) for a given cancer. Other therapies may be added to the primary treatment. In this case, these therapies are called "adjuvant therapy". The decision for adjuvant therapy depends on the individual patient and specific tumor characteristics. The physician will make this determination after a careful patient evaluation and review of the final surgical and pathology reports.
prior tam therapy - Hormone (endocrine) therapy with tamoxifen (Nolvadex) that was taken for treatment of the first, initial breast cancer. Tamoxifen is usually given following breast cancer surgery, radiation therapy, and chemotherapy. In some cases, tamoxifen may be given at the same time as chemotherapy.
Progesterone - A female sex hormone produced by the ovaries during every menstrual cycle to prepare the uterus for pregnancy. Menstruation begins when the production of progesterone stops.
Progesterone receptor (PgR) status - Progesterone receptor(PgR) testing (and estrogen receptor testing) is performed on all newly diagnosed breast cancers to measure the amount of progesterone receptors present in the breast cancer tissue. The result of this test is called the "progesterone receptor status". Receptors are proteins on the surface of breast cancer cells, which allows progesterone to attach to the cell and support cancer growth. Progesterone receptors (and estrogen receptors) are also referred to as tumor markers or biologic markers. Progesterone is a female hormone produced by the ovaries. Some breast cancers are hormone dependent and require estrogen and progesterone for growth. If progesterone receptors are detectable, it is called a progesterone receptor positive breast cancer.
Prognosis - The likely or expected outcome of a disease or a prediction of the course of a disease. Usually refers to the outlook for the cure of a patient. For example, a woman with breast cancer that was diagnosed early and received treatment promptly would have a good prognosis.
Prognostic factors - Prognostic factors or indicators are test results or specific medical information that is used to predict an outcome or the likelihood of a cancer recurrence. In breast cancer, some examples of commonly used prognostic factors include the number of positive axillary lymph nodes, the tumor size, estrogen/progesterone receptor status, HER-2 neu status, nuclear grade, etc.
Prosthesis - Replacement of a missing body part or organ. If breast reconstruction is not desired, a breast prosthesis may be worn instead. A prosthesis is an artificial, pliable breast form that can be put on or taken off as desired. Prostheses come in many shapes, sizes, materials, and colors. Many specialty stores that sell medical supplies carry them as well as larger department stores. The lingerie areas of some department stores employ professional fitters who will help you find a comfortable and suitable prosthesis, and a bra to wear with it. Smaller lingerie boutiques in major cities may also provide this service. Bathing suits and lingerie are usually also available in these specialty shops or department stores.
A member of your health care team can suggest nearby places to buy prostheses. You can also consult the yellow pages under "Lingerie" or "Brassieres", or in larger cities, under "Breast Prostheses". Temporary prostheses can often be ordered by mail. Most insurance companies will provide some level of reimbursement for a prosthesis and bra. You should contact your insurance company to find out what your plan will cover.
QOL - Quality of life involves how satisfied the patient is with the total situation of their lives. This includes the things directly related to the patient's cancer, as well as everything else that determines the level of satisfaction the patient experiences. Discussing the quality of life is very complex, and can involve personal judgments that differ from patient to patient. A common quality of life issue for breast cancer patients is weighing the probability that a treatment will cure the cancer against the issue that the treatment is very uncomfortable. Another aspect of quality of life is whether a cancer treatment that could potentially cure the cancer has side effects that would make the patient so uncomfortable that their quality of life would be significantly reduced. All of these issues should be thoroughly discussed by the physician, the patient, and any desired family members before treatment decisions are made.
Race - A distinct ethnic group characterized by traits that are transmitted through the offspring; a group of individuals with the same characteristics who originated from a common ancestor.
radiation effects of ovarian ablation - The dose of radiation used for ablation or castration of the ovary is very low. There are no acute (severe, rapid onset) side effects other than brief, mild nausea and possibly a short bout of diarrhea. The long-term effects are premature onset of menopause, which is the intended effect of this treatment.
Radiation heart effects - When radiation is given to the chest region or area, irritation or inflammation of the heart muscle and/or heart blood vessels (arterial insufficiency, coronary artery disease) can occur, but is uncommon with modern treatment techniques (where radiation exposure to the heart is limited) and represents only a small long-term increase in this complication. Left-sided radiation with older techniques or anthracycline-based chemotherapy (e.g., doxorubicin) can increase the risk of heart disease. Personal risk factors include obesity, smoking, high blood pressure, pre-existing heart conditions, and age greater than 55 years. If this complication occurs, it usually is months to years after the completion of radiation therapy. Symptoms include chest pain, shortness of breath, or swelling in the lower legs or ankles. Radiation cardiotoxicity is a function of the total radiation dose, volume of tissue treated, other cancer therapies (such as chemotherapy that also may cause cardiotoxicity) and personal risk factors.
radiation lung effects - If the lung or parts of the lung are included in the radiation treatment field, as is the case with breast cancer, the radiation can cause inflammation of the lung tissue, called radiation pneumonitis. Risk factors for pneumonitis include a larger radiation treatment area, older age, and chemotherapy. Although the incidence of pneumonitis is rare (less than 1 percent of women who undergo radiation to the breast or chest wall), changes in the lung tissue that are seen on chest x-rays are actually common.
This complication usually occurs about two to nine months after the completion of radiation therapy. The incidence is higher when chemotherapy and radiation therapy are given at the same time or when lymph nodes above the collar bone or a full axillary (underarm) field is included in the treatment area. Symptoms include a dry cough, low-grade fever, chest pain, and shortness of breath. These same symptoms are also seen in lung infections or pneumonia. Thus, these symptoms could represent a lung infection, such as pneumonia, or a lung reaction to the radiation. The symptoms of radiation pneumonitis usually resolve without treatment in a few weeks or months, and most patients do not require steroid therapy.
Pulmonary fibrosis, or scarring of the lungs, can also occur with radiation therapy. This is considered a late effect or complication of radiation and is related to the total radiation dose and treatment schedule. Some chemotherapy drugs can also cause pulmonary fibrosis but is an uncommon complication. Scarring of the lung causes the lung to lose its flexibility in moving air in and out. This results in shortness of breath and difficulty breathing with exercise or at rest in more severe cases.
Radiation pneumonitis - If the lung or parts of the lung are included in the radiation treatment field, as is the case with breast cancer, the radiation can cause on inflammation or irritation of the lung tissue, which is called radiation pneumonitis. This potential complication usually occurs about six months or longer after the completion of radiation therapy. Symptoms include a dry cough, low-grade fever and shortness of breath. These same symptoms are also seen in lung infections or pneumonia. Hence, if they develop, report to your doctor promptly for evaluation and treatment, if indicated.
radiation sensory changes in the breast or chest - Intermittent aches, pains, and twinges may occur in the breast, chest wall, or axilla (underarm or armpit) during radiation therapy to the breast. This may occur about one week after the start of radiation and persist for months after radiation is completed. These aches and pains are a common, normal part of the treatment and will decrease in frequency and resolve over time. Occasionally, some women experience twinges for years following radiation. Radiation therapy also may cause the breast to develop slight to moderate swelling. The breast may feel full or heavy. This may occur about one week after the start of radiation and may persist for weeks to months after therapy is completed.
radiation skin and soft tissue reactions - Skin and soft tissue changes can occur with external beam radiation therapy. People with fair complexions may be more sensitive than those with darker complexions. Radiation therapy may irritate the skin in the treatment area causing redness, warmth, swelling, dry or moist peeling, itching, irritation of the hair pores in the treatment area, and ulceration or blistering (uncommon). Infections in the skin tissue (cellulitis) can occur or a small pocket/collection of tissue fluid (seroma) may form, but these are uncommon. Hair loss around the nipple and the axilla (underarm or armpit) may also occur. These changes may cause temporary mild discomfort that will resolve once treatment is completed and the skin has healed. The radiation oncologist (doctor) or radiation oncology nurse will provide special skin care instructions, which will include approved skin care creams or ointments to use, if needed.
A tanning, darkening or increased color of the skin over the breast may occur with radiation therapy. This change begins about two weeks after the start of treatment and slowly resolves after treatment is completed, but may be permanent in some women. Skin tanning may be more noticeable in darker skinned women.
The soft tissue of the breast and/or chest wall can be affected by radiation, resulting in scarring of this tissue. The skin and tissue underneath (sub-cutaneous) may feel thickened, firm, and tight. The breast may become smaller. Spidery, thin, purple-red blood vessels also may develop in the affected area, as well as increased skin sensitivity. Because of these changes, the skin should be protected from sun exposure and injury to this area. The degrees of soft tissue fibrosis and skin changes are related to the total radiation dose and treatment schedule. This complication is considered a long term and rare effect of radiation. It can occur six months or longer after radiation therapy has been completed.
Radiation soft tissue fibrosis - Radiation therapy can cause changes in the soft tissue of the breast and/or chest wall resulting in scarring of the tissue. The skin and tissue underneath (sub-cutaneous) may feel thickened, firm, tight and spidery purple-red blood vessels may develop in the area. These tissue changes may result in the breast becoming smaller. The skin in this area will be more sensitive and should be protected from sun exposure and injury. The degree of soft tissue fibrosis is related to the total radiation dose and treatment schedule. This is considered a long term and rare effect of radiation, occurring six months or longer after radiation therapy has been completed.
Radiation therapy - Radiation therapy is the use of high-energy particles or waves, such as x-rays, gamma rays, electrons and protons, to destroy or damage cancer cells. Other names for radiation therapy include radiotherapy, x-ray therapy, cobalt therapy (actually an outdated name), and irradiation. Radiation therapy is one of the most common treatments for cancer and is used in more than half of all cancer cases. The goals of radiation therapy may be cure, control of the disease, or palliation (therapy used to relieve symptoms rather than to treat the disease), depending on the individual patient situation. Radiation may be used as the only treatment in some cancers, but more commonly it is used in combination with other cancer therapies such as surgery and/or chemotherapy.
Radiation may come from a machine outside the body (external-beam radiation therapy or teletherapy) or from radioactive (giving off radiation) substances called radioisotopes. Radioisotopes produce radiation and can be placed inside the body in or near the tumor or in the area near cancer cells. This type of radiation has many names to describe it: internal radiation therapy, implant radiation, interstitial radiation, or brachytherapy.
When radiation therapy is used after surgery, it is called "adjuvant radiation therapy". Adjuvant radiation therapy is most often used with breast conserving surgery, but may also be recommended after a mastectomy. When radiation therapy is used as the main therapy instead of surgery, or before surgery to shrink the tumor, it is called "primary radiation therapy". Radiation therapy is also very effective in treating breast cancer recurrences in the breast or chest wall, as well as cancer spread (metastasis) to bone or other areas of the body.
Radiologic evidence of bone damage from metastasis - Visible signs of bone damage or destruction from cancer on radiologic tests such as plain x-rays, bone scans, CT scans, etc. These visible signs are called "lytic lesions" and can be identified by the radiologist (a doctor who specializes in reading and interpreting x-rays and performing specialized x-ray procedures). Bone is the most common site for breast cancer spread.
Radiologist - A radiologist is a doctor who specializes in identifying abnormalities and diseases using x-rays or other imaging tests such as CT scans, MRI, ultrasound, etc.
Reaction To Anesthesia - A generalized systemic (affecting the entire body) reaction to anesthetic drugs used during surgery. This usually is an allergic type of reaction and is treated with medication, which effectively reverses the reaction in most cases.
Recurrence - The return of the original, primary cancer. The recurrence may be close to the original area of the cancer and called a "local" recurrence. Or the cancer may recur in distant organs or areas of the body and is called a "systemic" recurrence or metastasis. Examples of a systemic recurrence is cancer that has spread to the liver, lung, brain, etc.
Recurrent type of breast cancer (histology type) - Recurrent type of breast cancer refers to the type of breast cancer found in the recurrent cancer (the cancer that has returned). This is called the tumor histology or histopathology. In most cases, the type of recurrent breast cancer is the same type as the original or first breast cancer. Sometimes, the recurrent tumor can change form the first or initial breast cancer. Knowing the precise histological type (the tissue of origin or tissue where the cancer began) is important information when determining treatment and prognosis.
Red blood cells (RBC) - Red blood cells are the cells of the body that carry oxygen to the body organs and tissues. Red blood cells are made in the bone marrow, along with white blood cells and platelets. Red blood cells also contain a protein called hemoglobin. Hemoglobin is bright red and is what gives these cells their red color. Hemoglobin contains iron which is an excellent transporter of oxygen. When there is not enough hemoglobin, a condition called anemia results. Anemia can result from the affects of cancer on the body or from cancer treatment, especially chemotherapy or radiation therapy.
Remission - The disappearance of the signs and symptoms of a cancer. When some, but not all signs and symptoms disappear, it is called a "partial remission." When all signs and symptoms disappear, it is called a "complete remission." A remission may be temporary or permanent. When a remission is permanent and is sustained over time, it may be referred to as a "cure."
Rib Fracture - Rib fractures can occur from radiation therapy due to a slight weakening of the ribs underlying the treated breast. A higher dose of radiation or a larger treatment area can increase the risk of rib fracture. This most often occurs if the patient has an accident or injury in the affected area. Rib fracture due to radiation is not an indication of cancer spread to the bone. There may be no symptoms or only mild discomfort. The fracture usually will heal on its own over time. Pain medications or over the counter anti-inflammatory medicines can be helpful in treating any discomfort and should be discussed with the doctor.
Risk factor - Any factor that increases the chance or risk of developing a disease, such as breast cancer. A family history of breast cancer is a risk factor. Smoking is a risk factor for developing lung cancer. Excessive sun exposure is a risk factor for developing skin cancer.
Risk Of Endometrial Cancer - Tamoxifen therapy affects the lining of the uterus and over time, may cause endometrial cancer (cancer of the lining of the uterus) to develop. This is more common in women over the age of 50 years and the risk is similar to women taking estrogen replacement therapy. Endometrial cancer in this situation tend to be a low grade and stage and are very treatable. Women on tamoxifen therapy should have regular pelvic examinations on an annual basis and report any new or different vaginal discharge, especially bleeding, to the doctor promptly.
S-phase - The biochemical phase of the cell cycle in which DNA synthesis (producing) occurs.
S-phase fraction (SPF) - S-phase fraction (SPF) is a laboratory test performed on the breast cancer tissue specimen. S-Phase fraction measures the growth rate (the "proliferation rate") of the cancer, determining how quickly it is making new cells and multiplying (dividing). The test result is expressed in a percentage. Breast cancers with a high S-phase fraction indicates a more aggressive and rapidly growing cancer with a higher risk of recurrence (cancer returning). A low S-phase fraction indicates a slower growing tumor. S-phase fraction is not used alone, but is considered along with other prognostic factors. S-Phase fraction is similar to another test called Ki-67, which also measures the cancer cell proliferation rate. Ki-67 may be done in lieu of S-phase fraction in some laboratories or hospitals.Unit of Reference: (%)
Screening - Screening refers to performing a test to check for a disease when there are no signs or symptoms. Mammograms are routinely recommended for women on an annual basis to screen for breast cancer. The goal of a screening test is to be able to identify and diagnose a disease at a very early stage to achieve the best chance of cure.
Second cancer (malignancy) - Second or secondary cancer (malignancy) refers to a new cancer that develops as a result of the initial chemotherapy and/or radiation therapy received to treat the first cancer. This is a rare complication, affecting less than 1% of patients. Chemotherapy and radiation therapy can cause changes in the DNA of normal cells. Sometimes these changes cannot be repaired and over time the damaged cells undergo more changes, eventually transforming into a cancer cell that continues multiplying and growing into a new tumor. The risk of developing a second cancer depends on the specific chemotherapy drug(s), the total dose received, and the duration of treatment. These same factors apply to radiation therapy as well, e.g., the risk depends on the total dose of radiation and the volume of bone marrow irradiated. The risk may be higher for women who receive both chemotherapy and radiation therapy, especially when alkylating agents (such as cyclophosphamide, Cytoxan ®) are used.
In the case of radiation therapy, there is a slight risk of developing a second breast cancer in the opposite breast (called contralateral breast cancer) and is most likely due to the small dose of "scatter" radiation to the other breast. The increased risk seems to be confined to women younger than 40 to 45 years of age at the time of treatment. The dose of radiation to the opposite breast can be reduced with modern technical measures.
Secondary cancers caused by cancer treatment usually occur five or six years after therapy is completed. But, some may develop as early as several years or as late as 10 to 12 years and even up to 30 years later. Some of the second cancers that can develop include angiosarcoma of the skin (radiation), sarcoma (very rare with radiation), skin cancer, esophageal cancer, and acute leukemias or myelodysplasia (an abnormal alteration in bone marrow cells).
It is important to keep in mind that although a second cancer is a serious complication, it is actually quite rare with modern treatment and the improvement in survival may outweigh the increased risk of a second cancer. This issue should be carefully discussed with the doctor.
Sentinel lymph node biopsy - A sentinel lymph node biopsy is a new surgical procedure used to determine if axillary (underarm or armpit) lymph nodes contain cancer. During surgery, a blue dye or a radioactive substance is injected into the area around the tumor. The dye or the radioactive substance is carried to the sentinel lymph node by the lymphatic vessels surrounding the tumor. The sentinel lymph node is the first lymph node to which the cancer is most likely to drain and spread. The surgeon can see the blue dye or use a scanner (Geiger counter) to detect the radioactivity in the sentinel node. The sentinel node is cut out and examined to see if cancer cells are present. If the sentinel lymph node(s) contains cancer, then more axillary lymph nodes are removed. If the sentinel lymph node(s) does not contain cancer, no further lymph nodes are removed and the patient is spared more axillary surgery and its potential complications.
Seroma - A pocket of clear fluid that accumulates in or around the surgical incision area after surgery. The fluid is removed by inserting a needle into the pocket of fluid and draining it. Seromas may recur and require additional draining by the surgeon until the wound is completely healed and all fluid in the area is completely absorbed by the body.
Sexuality and intimacy effects - Feelings of sexual attractiveness and intimacy may change after mastectomy due to the loss of the breast and changes in body image. For many women, this is not a problem and their self-esteem and feelings of attractiveness are not changed with losing the breast. For other women, losing the breast is a significant emotional adjustment and greatly affects how they feel about themselves and their self-image. This is a very normal emotional reaction, especially when combined with a new breast cancer diagnosis. Sometimes these feelings interfere with sexual intimacy and relationships. There is no right or wrong reaction or response---it is highly individualized. Most women and their partners will need to take time to grieve the loss of a breast. However, if these feelings continue to be a problem and interfere with quality of life and relationships, your doctor should be consulted to discuss counseling. Joining a support group may also help.
Side Effect - Any undesirable or unwanted secondary effect of a drug or therapy. Side effects or problems occur when a treatment/therapy affects healthy, normal cells. Common side effects of cancer treatment are fatigue, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.
Skin Flap Necrosis - The skin over the incision site and surgical area may not get enough blood supply after surgery. When this happens, the "skin flap" in the incision area may develop areas where the tissue dies and turns dusky or dark in color. This is an uncommon problem today and can usually be avoided with good surgical technique. If skin flap necrosis occurs, it is usually managed with additional surgical intervention and wound care.
skin rash and nail changes - Skin rashes, with or without itching, and nail changes can occur with some chemotherapy drugs. Rashes are usually mild to moderate in severity and consist of flat, blotchy, round to raised bumps on the feet and hands, and sometimes on the arms, face, or body. Redness, swelling, scaling or peeling may accompany some rashes. In most cases, these reactions are benign, temporary, and will resolve on their own either before or after chemotherapy is completed. If you develop a skin rash that becomes bothersome or is worsening, consult your doctor for evaluation and treatment, if indicated.
Nail changes can also occur and include: peeling, color changes (darkening), thinning, softening, peeling, cracking, stripes or bands across the nail and in severe cases, loss of the nail. Like skin reactions, most nail reactions are benign and resolve on their own after chemotherapy is completed. Keeping your nails clean and trimmed during treatment may help prevent nail problems.
With some chemotherapy drugs, the skin over the veins used for IV administration may darken in color and look tanned. This, too, is a benign skin change. The darkened color usually fades overtime, but the color change may persist in some cases.
Stem cells - The immature cells of the bone marrow that are responsible for the production of all blood cells--red blood cells (RBCs), white blood cells (WBCs), and platelets. Stem cells are also located in the circulating blood and may be withdrawn and stored for later use in a stem cell transplant procedure.
Stomatitis - Inflammation of the lining of the mouth caused by some chemotherapy drugs. Chemotherapy damages the cells and tissues that line the mouth and throat. The can result in mouth sores, tender gums, mild to moderate redness and swelling, a sore throat, or esophagus. Stomatitis may also be called oral (referring to the mouth) mucositis.
Subcutaneous (SQ or SC) - Subcutaneous is under or beneath the skin. A subcutaneous injection of medicine is a shot given with a needle and syringe under or beneath the skin.
Supportive Therapy - Therapy or treatment to relieve, rather than cure, symptoms caused by advanced, metastatic cancer. Supportive therapy is also called palliative care. Supportive therapy or palliative care can help people live more comfortably and improve quality of live.
Surgery - Surgery is a medical procedure to remove or repair a part of the body or to get tissue to evaluate for disease.
Surgical Margin Clearance - The amount, in millimeters (mm), of the surrounding normal tissue, measured from the edge of the tumor to the rim or edge of the biopsy specimen. Some pathology reports will list the surgical margin clearance in centimeters (cm) rather than millimeters. This is perfectly acceptable--there is no right or wrong and simply depends on the custom of the particular pathology laboratory.
You can convert your margin clearance easily from centimeters to millimeters by multiplying the reported centimeter (cm) margin by 10 to get the equivalent millimeter (mm) value. For example, if your pathology report reads "a margin of 0.5 cm", you would multiply 0.5 x 10, which is 5 or a 5 millimeter margin.Unit of Reference: (millimeters, mm)
Surgical margins - The edge or rim of normal surrounding tissue (boundary) that is removed with the tumor at the time of the excisional biopsy or lumpectomy. When the tumor specimen is sent to the laboratory, the margins of the specimen are examined by the pathologist to see if there are any cancer cells present in the boundary around the tumor and if so, how close the cancer cells are to the edge of the margin.
It is important that the surgical margins be free of cancer cells to reduce the risk of cancer recurrence in the breast. If cancer cells are present in the margins (positive surgical margins), additional surgery (a re-excision of the primary tumor bed) is recommended to remove the remaining cancer. When the margins are clear (clear surgical margins), the cancer is considered to be successfully removed with no cancerous tissue remaining.
Surgical resection for local recurrence - Surgical removal of a breast cancer recurrence in the breast tissue or chest area. The tumor is removed with a small amount of surrounding normal tissue.
Systemic therapy only - Systemic therapy is medical treatment that affects the entire body as compared to "local therapy" such as surgery or radiation therapy, which is limited to one area of the body. Systemic therapy refers to chemotherapy, hormone therapy, or biologic therapy (also called biotherapy, immunotherapy, or biological response modifier-BRM-therapy), which enters the bloodstream and travels throughout the body to attack cancer cells. Most systemic therapies for cancer are given by intravenous (IV) injection through a needle in the vein.
Tamoxifen response - Tamoxifen response refers to the time (in months to years) between the completion of tamoxifen therapy and the date of cancer recurrence. This information is important for the doctor in determining whether tamoxifen can be used again to treat the recurrence. If the time between completion and return of the cancer has been at least a year or more, there is a good chance that the cancer will respond (cancer shrinkage or regression) again if tamoxifen is resumed.
Tamoxifen Side Effects - Most side effects from tamoxifen therapy are mild, tolerable, and can be managed easily. Side effects relate to tamoxifen's hormonal mode of action. The most common side effects are hot flashes and vaginal discharge. Other side effects may include vaginal dryness, irritation, or itching, and menstrual irregularity. These are similar to symptoms commonly experienced during menopause; but, tamoxifen does not cause menopause itself. There is also an increased risk of developing cataracts (a clouding of the lens inside the eye), particularly for women over age 50. Hence, yearly eye exams are encouraged. As is the case with menopause, not all women who take tamoxifen have these symptoms and the presence of symptoms and their extent vary among women. Men who take tamoxifen may experience headaches, nausea and/or vomiting, skin rash, impotence, or a decrease in sexual interest.
Tamoxifen therapy is associated with a small, increased risk of endometrial cancer (about 2 cases for every 1000 women treated per year). Endometrial cancer is cancer of the lining of the uterus. The risk of uterine cancer is in the same range as (or less than) the risk in postmenopausal women taking single-agent estrogen replacement therapy. Endometrial cancers are seen mainly in women over 50 years of age. Women receiving tamoxifen therapy should have annual gynecologic (pelvic) examinations and should report any unusual vaginal bleeding or abdominal pain to the doctor immediately.
It is important to remember that the benefits of tamoxifen therapy as a treatment for breast cancer are firmly established and far outweigh the potential risks.
taxane-based chemotherapy - Chemotherapy that includes a drug from the class of chemotherapy agents called taxanes (also referred to as antimicrotubule agents), which includes paclitaxel (Taxol) and docetaxel (Taxotere).
For example, a common taxane-based chemotherapy regimen available for breast cancer is AC (doxorubicin and cyclophosphamide) followed by paclitaxel (T).
Chemotherapy for newly diagnosed breast cancer usually includes 2 to 3 drugs from different types or classifications of agents. Chemotherapy for recurrent breast cancer may also include several drugs from different classifications or may simply be a single drug depending on the individual circumstances, medical history, and doctor's evaluation and treatment decision.
Teletherapy - Also called external beam therapy. The most common method of delivering radiation therapy. Radiation is delivered from a machine that is external to the patient.
Thrombocytopenia - A decrease in the level of platelets in the blood. Platelets are special blood cells that plug up damaged blood vessels and help form blood clots to stop bleeding. Platelets are made in the bone marrow, the soft, spongy tissue inside the bones. Chemotherapy and radiation therapy can damage these cells and result in a decrease in the blood level. When the platelet count is low, easy bruising or bleeding may occur even from a minor injury.
Time between first cancer treatment and recurrence - The time between the completion of the first breast cancer treatment and the first cancer recurrence (when the cancer returns) is referred to as the disease-free interval or DFI. This is usually measured in months to years. The disease-free interval is important information for the doctor to consider when determining the best treatment for the cancer recurrence.
Tissue - Tissue is a group or collection of cells that act together to perform a particular function. The tissues of the body form the various body organs, which have specific body functions.
Tumor - A tumor is an abnormal mass (lump or nodule) or growth of cells or tissue. A tumor can be benign (not cancerous) or malignant (cancerous). The only way to know for sure if a tumor is benign or malignant is to obtain a biopsy of the abnormal tissue and examine it under a microscope. A pathologist performs the examination and makes the final determination of the tissue.
Tumor Flare - Tumor "flare" may occur in the first month of therapy. Symptoms of this would include an increase in tumor-related symptoms, such as bone pain which is sometimes accompanied by an increased blood calcium level. Other symptoms might include an increase in tumor size or redness in the skin over the tumor site. This reaction usually subsides quickly.
Tumor size - The size of the invasive component of the tumor in centimeters (cm) or millimeters (mm), depending on the pathology report. This measurement is done by the pathologist (the doctor who identifies or diagnoses disease by examining cells and tissue under the microscope) upon receipt of the tumor specimen. This information is included in the pathology report which is sent to the doctor. In some cases of breast cancer, there may be more than one tumor (multiple tumors) in the breast. In this situation the largest of the tumors is used as the "primary" tumor and its' size used to determine the clinical cancer stage, i.e., T1, T2, T3. Additionally, some breast cancers contain both invasive and non-invasive (ductal carcinoma in situ, DCIS) components in the tumor. In this situation, only the invasive component is measured for determination of tumor size. Unit of Reference: (centimeters, cm)
Tumors in two or more quadrants of the breast - Different, independent primary tumors in two or more quadrants of the breast is called "multicentric" breast cancer. "Quadrants" of the breast refers to the four separate areas of the breast.
Using the hands of a clock to demonstrate this concept, imagine that twelve to three would be one quadrant, three to six would be another quadrant, six to nine another quadrant, and nine to twelve the fourth quadrant. A tumor in the twelve to three quadrant and another tumor in the nine to twelve quadrant would be described as cancer in two or more quadrants of the breast. If there were several tumors, but they were all within the same quadrant, say the three to six area, then it would be considered multifocal breast cancer. These abnormal findings can usually be identified on the mammogram.
Multicentric breast cancer is an important factor when considering surgical options. When multicentric disease is present, two separate surgical incisions are usually required to remove the different tumors. They cannot be removed with one incision because of the distance between them. This factor can influence whether breast conserving surgery is possible.
Type of breast cancer (histolopathologic type) - The type of breast cancer refers to the cells and tissue of origin from which the cancer originated or began. This is called the tumor histology or histopathologic type. There are over 100 different types of cancer in mankind. Each type of cancer begins or originates in specific cells or tissues of a body organ. Histology is the study or science of cells and tissue. Thus, the histology of the cancer is critical information as it tells the doctor where the cancer began and also provides prognostic information about treatment and survival.
In some cases of breast cancer, there may be a mix of both invasive and non-invasive (in-situ) in the breast tumor. This is called "invasive with predominant intraductal component". The intraductal component refers to the non-invasive or in-situ part of the tumor. In this situation, the size of the tumor, as well as the treatment and prognosis, will be based on the size of the invasive component of the tumor.
uncommon (rare) tamoxifen side effects - Uncommon (rare) but potentially serious side effects of tamoxifen include:
blood clots
cataracts, and
endometrial cancer
Tamoxifen therapy is associated with a very small increased risk of developing a blood clot (thrombosis) in the lungs. This is called a pulmonary embolism, or "PE", and means that a blood clot that formed in a major vein of the leg or groin (referred to as a deep vein thrombosis or DVT) broke loose and traveled through the blood to the lungs. Blood clots may also travel to the brain and result in a stroke. The risk of having a blood clot develop from tamoxifen is similar to the risk of a blood clot when taking estrogen replacement therapy. Women receiving chemotherapy and tamoxifen therapy at the same time may have a higher incidence of thrombosis than either treatment alone.
There is also a slight increased risk of developing cataracts (a clouding of the lens inside the eye), particularly for women over the age of 50. Cataracts may require eye surgery. Women receiving tamoxifen are encouraged to have annual eye examinations.
Endometrial cancer can develop in a very small number of women taking tamoxifen--about 2 cases for every 1000 women treated per year. Endometrial cancer is cancer of the lining of the uterus. The risk of uterine cancer is in the same range as (or less than) the risk in postmenopausal women taking single-agent estrogen replacement therapy. Endometrial cancers occur primarily in women over the age of 50 and tend to be an early-stage cancer that is curable with surgery alone. There is no evidence that tamoxifen increases the risk of other cancers. Women receiving tamoxifen therapy should have annual gynecologic (pelvic) examinations and should report any unusual vaginal bleeding or abdominal pain to their doctor immediately. For women who have not received routine gynecologic care, a pelvic examination should be performed before treatment with tamoxifen is started.
It is important to remember that the benefits of tamoxifen therapy as a treatment for breast cancer are firmly established and far outweigh the potential risks.
Urine discoloration - Some chemotherapy drugs turn the urine a reddish-orange color for the first 24 to 48 hours after receiving the drug. This is a harmless drug effect and the urine will clear on its own in a few days. Urine discoloration occurs because the drug itself is colored and in turn colors the urine. Doxorubicin or liposomal doxorubicin is a drug used to treat breast cancer and is a reddish-orange color when prepared for administration. Hence, the urine will turn a reddish-orange color when receiving doxorubicin.
Vaginal Discharge - Vaginal discharge may occur when first starting tamoxifen therapy. Although a vaginal discharge may be a nuisance and bothersome, it is usually harmless and will go away on its own over time. Any change in the type of vaginal discharge, or any other vaginal or abdominal symptom (such as vaginal bleeding or pelvic or abdominal pain, a woman is experiencing should be reported to her doctor promptly for evaluation.
vinca alkaloid-based chemotherapy - Chemotherapy that includes a drug from the vinca alkaloid class of chemotherapy agents, which includes vincristine (Oncovin), vinblastine (velban), and vinorelbine (Navelbine).
For example, one of the chemotherapy regimens available for treatment of breast cancer is CMFVP, a combination which includes cyclophosphamide, methotrexate, 5-fluorouracil, vincristine, and prednisone. Another vinca alkaloid-based regimen is vinorelbine plus doxorubicin.
Chemotherapy for newly diagnosed breast cancer usually includes 2 to 3 drugs from different types or classifications of agents. Chemotherapy for recurrent breast cancer may also include several drugs from different classifications or may simply be a single drug depending on the individual circumstances, medical history, and doctor's evaluation and treatment decision.
Weight changes - Weight changes can occur with chemotherapy or hormone therapy. Hormone therapies, including tamoxifen, often cause weight gain. Some women put on weight during chemotherapy although the reasons are unclear. The average weight gain from chemotherapy is about seven pounds, but greater gains are not unusual. On the other hand, there can be weight loss from chemotherapy due to a decrease in appetite, especially when nausea or vomiting occurs. Weight loss and decreased appetite due to chemotherapy are usually temporary changes and resolve when chemotherapy is completed.
weight gain - Weight gain is a common problem among breast cancer patients who receive adjuvant chemotherapy, particularly treatment with CMF chemotherapy(cyclophosphamide, methotrexate, and fluorouracil/5-FU). Studies suggest that weight gain is especially pronounced among premenopausal women, those who are treated for a longer period of time (12 months vs. 6 months) and those who are also receiving prednisone. Women treated with doxorubicin and cyclophosphamide gain less weight that those treated with CMF.
The exact cause of weight gain remains unknown. Decreased physical activity (energy expenditure) appears to be an important contributing factor in research studies; but increases in caloric intake do not seem to play a significant role. Other factors that may contribute to weight gain include ovarian failure and a reduced basal metabolic rate. The amount of weight gain is reported to range from 2 1/2 to 18 pounds (1.2 to 8.3 kg--the average is 2 to 6 kg.) and is predominately found in the legs and lower trunk.
Research studies have suggested that a regular physical activity program, tailored to the individual patient, be included in the overall treatment plan to curb significant weight gain and the deleterious health effects it can have. This should be discussed with your doctor.
Weight loss - Decrease in the body weight
Weight shift And imbalance - Loss of the breast organ with mastectomy may cause a woman's weight to shift and be out of balance, especially if she has large breasts. Not all women notice or experience this change. Over time, this imbalance resolves as the body adjusts to the body change.
White blood cells (WBC) - White blood cells are blood cells that fight infection. White blood cells are made in the bone marrow, along with red blood cells and platelets. There are actually five different types of white blood cells and each performs a different function or job to protect the body from infection. The most important white blood cell for fighting bacterial infection is the neutrophil. When there are not enough white blood cells and especially neutrophils, due to disease or the effects of cancer treatment such as chemotherapy or radiation therapy, there is an increased risk of developing an infection.
Workup - A thorough medical evaluation to diagnose a condition
# posted by Dr.Sanjeev Chhiber @
Thu, 15 December 2005 23:42 
