Glossary

Here is a list of terms that are used throughout the book or that you may hear during your treatment:

Adenocarcinoma: a cancer that develops in a gland forming tissue similar to that in the breast. This term is not in general use but it may appear on your pathology report.

Adjuvant systemic therapy: treatment given after surgery and/or radiotherapy to reduce the chance of cancer returning; includes treatments such as chemotherapy or hormonal therapy that affect the whole body.

Advanced breast cancer: cancer that has spread (metastasised) to other parts of the body through the bloodstream.

Amenorrhoea: absence or stoppage of menstrual periods.

Anorexia: loss of appetite.

Anthracyclines: group of chemotherapy drugs including doxorubicin (Adriamycin) and epirubicin. These are the most commonly used drugs in breast cancer. Mitozantrone is another type of anthracycline that is used occasionally to treat breast cancer.

Anti-inflammatory drugs: these are used to treat breast and bone pain or areas of inflammation and include paracetamol and ibuprofen.

Areola: the pigmented area of skin around the nipple.

Aromatase: the enzyme that converts male hormones to oestrogen.

Aromatase inhibitors: drugs that block the aromatase enzyme and stop the production of oestrogen. Effective only in postmenopausal women.

Aspiration: removal of fluid or cells from a collection of fluid such as a cyst or a breast lump.

Asymmetry: difference in appearance of two sides of the body, usually used when comparing the two breasts.

Atypical hyperplasia: abnormal cells within the breast lobule that have increased in number and expand the lobule but do not fill all the spaces in the

lobule; part of what is now called lobular neoplasia.

Axilla: the armpit.

Axillary clearance: removal of all lymph nodes from underneath the axilla.

Axillary dissection: removal of some or all the lymph glands from under the armpit.

Axillary nodes: lymph glands in the armpit that drain the lymph from the breast.

Axillary sampling: removal of a few lymph glands, usually four, from the armpit.

Benign: not cancerous.

Bilateral: both sides of the body.

Bilateral prophylactic mastectomy: surgical removal of both breasts to reduce the risk of development of breast cancer.

Biopsy: removal of a sample of tissue which is then examined under the microscope to check cause of a lump. Bone scan: test to check for cancer in the bones.

BRCA-1 gene: the first gene to be identified which is associated with breast cancer in some families; abnormalities in this gene are linked to breast cancer in certain families. Women with an abnormal BRCA-1 gene are also at increased risk of ovarian cancer.

BRCA-2 gene: the second gene abnormalities in this gene have been linked to breast cancer in certain families. There is also an increased risk of ovarian cancer in women with an abnormal BRCA-2 gene. Men with abnormal BRCA-2 genes may also develop breast cancer.

Breast-conserving surgery: an operation that removes the cancer and some surrounding normal tissue with the intention of maintaining the breast shape. Breast reconstruction: an operation to rebuild the breast to match the other side.

Calcification: small calcium deposits in the breast that can be seen on a mammogram.

Cancer: a growth of abnormal tissue, the growth of which is uncontrolled. Cancer cells invade surrounding tissues and can also spread through the bloodstream and lymphatic system to other parts of the body. Capsule: the fibrous tissue that forms around foreign material such as an implant.

Capsular contraction: contraction of the fibrous capsule that develops around an implant, which can cause the implant to feel hard and alter in shape.

Cellulitis: infection of the skin or tissues under the skin of the breast.

Chemotherapy: treatment with drugs aimed at destroying cancer cells.

Clear margin: a rim of normal tissue around a cancer that is essential when performing breast-conserving surgery.

Clinical oncologist: a doctor who specialises in treatment of cancer with radiotherapy. Some clinical oncologists also give chemotherapy.

Clinical trial: research studies that involve patients. These studies are designed to find better ways to prevent, detect or treat cancer.

Combination chemotherapy: a combination of drugs as compared with a single drug chemotherapy.

Contralateral tumour: a cancer in the opposite breast to the one affected by breast cancer.

Core biopsy: removal of a thin sliver of tissue from the breast using a needle. CT: computed tomography – a type of X-ray where a computer is used to produce detailed pictures. It is particularly useful for looking at the liver, bone and brain, to tell whether cancer is present.

Cyst: a collection of fluid within the breast usually seen around the menopause. Cytology: examination of cells removed with a needle from a breast lump under the microscope. This requires an expert pathologist or cytologist. Diagnostic radiographer: a person trained in the taking of X-ray pictures. A therapeutic radiographer is one who is involved in giving radiotherapy.

DIEP flap: deep inferior epigastric artery perforator flap used for breast reconstruction.

DNA: deoxyribonucleic acid – the material that contains the genetic code. Drain: a tube placed at the end of an operation to remove any fluids that collect under the wound.

Ducts: hollow tubes that either connect the breast lobule to the nipple or take fluid from one part of the body to another, such as from the breast to the lymph nodes.

Ductal carcinoma in situ (DCIS): non-invasive cancer arising in the terminal duct lobular unit of the breast. Endocrine therapy: drugs that interfere with hormones and are used to treat the breast cancer.

Expander: an inflatable implant. Flap: a portion of tissue that is moved from one part of the body to another. Free flap: a flap that is detached from one part of the body and moved to another part where the blood vessels are reconnected.

Gene: sequence of DNA required to make a particular protein. Grade: describes how closely a cancer resembles normal tissue of the same type and also reflects the cancer’s rate of growth. Low-grade or grade 1 cancers closely resemble normal tissue whereas grade 3 cancers least resemble normal tissue and grow faster.

Gynaecomastia: male breast enlargement.

Haematoma: collection of blood beneath the skin.

Haemorrhage: bleeding.

HER2: there are four human epidermal growth factor receptors. This was the second to be described and in 15 to 20 per cent of cancer there is more HER2 protein on the surface on the cell than in normal breast cells and this causes the cell to grow faster. This HER2 protein can be targeted by the drug trastuzumab (Herceptin).

Herceptin: a drug also known as trastuzumab that is effective against cancers that are HER2 (human epidermal growth factor receptor 2) positive.

Hodgkin’s disease: a type of cancer that involves the lymph nodes.

Hormone: a chemical substance produced by glands that enters the bloodstream and affects other organs.

Hormone receptor test: a test to measure the amount of proteins known as hormone receptors in breast cancer tissue. A high level of hormone receptors means that hormones are important to help the cancer grow and therefore removal or blockage of the hormones is likely to be effective at stopping the cancer growing. Hormone replacement therapy

(HRT): drugs that usually contain oestrogen with or without a progesterone-like substance, which are used to treat the symptoms of the menopause.

Hormone treatment: treatment of cancer by removing, blocking or adding hormones. Hyperplasia: an increase in the number of normal cells in a tissue.

Hysterectomy: an operation in which the uterus (womb) and cervix are removed. Imaging: tests such as X-rays or ultrasound used to produce pictures of certain areas of the body. Implant: used for breast reconstruction, usually filled with silicone gel and occasionally with saline.

Infertility: inability to produce children. Infiltrating cancer: cancer that invades surrounding tissue.

Inflammatory breast cancer: a rare type of breast cancer in which the cancer cells block the lymph channels in the skin under the breast. The breast is characteristically swollen, red and warm, and the skin of the breast may appear pitted and have ridges. It produces an orange peel-like appearance – skin thickening – peau d’orange.

In situ: these cancers do not invade beyond the tissue in which they arise so a ductal carcinoma in situ is limited within the terminal duct lobular unit and draining ducts.

Internal mammary nodes: nodes behind the edge of the breastbone.

Intraductal: within a duct. Intraductal cancer: this is the same as DCIS, that is non-invasive cancer in the ducts and lobule. Intravenous: injection into a vein. Invasive cancer: invasive cancers have the ability to spread beyond the lobules and ducts in which they formed into the surrounding breast tissue. They can also spread to other parts of the body.

Latissimus dorsi muscle: a large broad muscle just under the skin of the upper back. LHRH agonist: a drug that mimics luteinising hormone-releasing hormone (LHRH) and results in reduction of production of oestrogen from the ovary.

Lobular carcinoma in situ (LCIS): abnormal cells that fill and expand the terminal duct lobular unit. These are round cells and LCIS looks different under the microscope from DCIS. Lobular neoplasia: a term for the two conditions previously known as lobular carcinoma in situ and atypical lobular hyperplasia. Local: affecting the breast and chest wall.

Local therapy: treatment that is directed to the cancer in the breast and the area close to it.

Locally advanced breast cancer: a cancer that is large and involves the skin or muscles of the chest wall but has not necessarily spread elsewhere.

Lumpectomy: removal of the cancer with a rim of normal tissue.

Lymph: the colourless fluid that leaks out of blood and then travels back through the lymphatic system to lymph nodes. It can carry cells from cancers to the lymph glands.

Lymph nodes: small and bean shaped, these are located along the channels of the lymphatic system. Lymph nodes store special cells that fight off bacteria. They can be affected by cancer cells. Clusters of lymph glands are found under the arm, under the breastbone and in the groin, neck, chest and abdomen.

Lymphoedema: a condition in which excess fluid builds up in tissues and causes swelling. This can affect both the arms and the legs.

Lymphovascular invasion: cancer cells that have spread into lymph channels or blood vessels.

Magnetic resonance imaging (MRI): uses strong magnets linked to a computer to create detailed pictures of areas inside the body.

Malignant: a tumour that is able to spread to other parts of the body.

Mammography: use of X-rays to create a picture of the breast.

Mastectomy: surgical removal of the whole breast.

Mastopexy: surgical uplift of the breast.

Medical oncologist: a doctor who specialises in treatment of cancers with drugs.

Menarche: age at which a woman’s periods begin.

Menopause: the change of life (climacteric), the time when a woman’s periods stop.

Menstrual cycle: the hormonal changes that take place every month.

Metastasis: spread of cancer to other parts of the body. Breast cancers commonly spread or metastasise to the lungs, liver, bone or brain.

Microcalcification: a tiny deposit of calcium in the breast that cannot be felt but is detected by a mammogram. A cluster of microcalcification may indicate that a cancer is present.

Micrometastasis: very small group of cancer cells that have spread to another part of the body such as the lymph node.

Multicentric tumour: more than one area of tumour in the same breast but widely apart.

Multidisciplinary care: management by a team of doctors usually involving a surgeon, oncologists, radiologists and pathologists.

Multifocal disease: disease affecting more than one area in the breast but close together.

Multimodality treatment: use of a combination of different types of treatment for breast cancer, usually a combination of surgery, radiotherapy and drug therapy.

Neoadjuvant therapy: drug treatments that are given before surgery.

Neoplasm: abnormal growth of tissue; can be benign or malignant.

Oncologist: a doctor who specialises in treating cancer. Some oncologists specialise in a particular type of cancer treatment – for example, a medical or a clinical oncologist.

Oncology: study of cancers. Oncoplastic technique: surgical technique combining the specialities of cancer surgery to excise the cancer (onco-) and plastic surgery to reconstruct after removal of the cancer (plastic).

Osteoporosis: softening of the bones and bone loss that occur with increasing age or secondary to drug treatment that lowers the oestrogen level in the body.

Ovarian suppression or ablation: suppression of oestrogen production from the ovaries or surgical removal of the ovaries.

p53: a gene involved in controlling the growth of cells. An abnormal p53 gene can result in development of multiple cancers including breast cancer. This occurs as part of a rare syndrome known as the Li–Fraumeni syndrome.

Palliation: the activity of relieving a symptom without affecting the cause.

Palliative treatment: treatment that does not alter the course of the disease but improves the quality of life.

Pathologist: a doctor who specialises in diagnosis of disease using a microscope.

Pedicled flap: a flap of tissue, usually skin, muscle and fat, that is left attached to its blood supply and is moved to another part of the body. Pedicled flaps are a common method of breast reconstruction.

Port of an expander/implant: a reservoir that is attached to an expander. It allows the injection of saline into the expander.

Postmenopausal: after the menopause.

Pre-cancerous: a term used to describe a condition that occurs before cancer develops.

Progesterone: one of the two female hormones; the other is oestrogen.

Prognosis: the probable outcome of the course of disease.

Prosthesis: artificial replacement for a body part.

Radioactive: giving off radiation.

Radiologist: a doctor who specialises in imaging and interpreting images of areas inside the body. The images are produced by X-rays, sound waves or other types of energy such as magnetism.

Radiotherapy: treatment with high-energy X-rays to kill cancer cells.

Recurrence: a cancer that returns or re-grows either in the area around the site of initial surgery (local recurrence) or somewhere else in the body (systemic recurrence).

Relapse: the return of signs and symptoms of disease after apparently successful treatment.

Remission: successful treatment and control of a disease.

Risk factors: something that increases the chances of developing a disease.

Screening: identifying disease at a stage before it has caused symptoms.

Sentinel lymph node biopsy: removal of one or more nodes that are the first nodes that drain a particular organ such as the breast.

Sentinel node of the breast: the first node receiving lymphatic drainage from the breast. This is usually in the lower part of the armpit. There is rarely one sentinel node. The average is three.

Seroma: collection of fluid underneath the skin.

Side effects: undesirable effects of treatment.

Silicone: synthetic material used to fill breast implants.

Stage: the extent of cancer spread in the body.

Staging: performing tests and examinations to determine the extent of cancer spread.

Stereotactic guidance: using two X-rays from different angles to pinpoint the exact location of a lesion in the breast that cannot be felt to allow a biopsy to be performed. Stereotactic guidance is also used to place a ‘wire’ in the breast to guide the surgeon when excising an area of calcifications or other abnormality.

Supraclavicular: the area above the collarbone. This usually refers to lymph glands in this area.

Systemic therapy: treatment that uses drugs that travel through the bloodstream to reach all cells throughout the body.

Tamoxifen: a drug that blocks the oestrogen receptors found on the surface of normal and cancerous cells in the breast. Terminal duct lobular unit: the milk-producing part of the breast where cancer starts.

TRAM flap: transverse rectus abdominis myocutaneous flap – a flap of tissue taken from the patient’s lower abdomen that includes muscle.

Ultrasonography: ultrasound is a test that uses sound waves. These are bounced off tissues and the echoes are converted into a picture.

Wide excision: surgical removal of a lump with a margin of normal tissue surrounding the tumour.

X-ray: high-energy radiation used in low doses to diagnose disease and in high doses to treat cancer.