Coming to
`Terms with
`
`ancer
`
`A Glossary of Cancer-Related Terms
`
`Edward H. Laughhn, MD
`
`American
`Cancer
`Society‘
`
`NOVARTIS EXHIBIT 2060
`Par v. Novam's, IPR 2016-01479
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`NOVARTIS EXHIBIT 2060
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`I
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`|
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`l
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`Published by
`American Cancer Society
`Health Coorem l’roducrs
`1599 Ciifron Road NE
`Atlanta. GA 30329. USA
`800-ACS-2345
`httpiflwwwxancernrg
`
`Capytight @2002 by Edward H. Laughlin. MD
`
`All rights reserved. Without limiting the rights under copyright reserved above. no part of this
`publication may be reproduced, stored in or introduced into a retrieval sysrcm. or transmitted. in
`any form or by any means (electronic. mechanical. photocopying, recording. or otherwise) without
`the prior written permission of the pubiisher.
`
`Printed in the United States of Ametica
`
`54521
`
`0102030405
`
`Library of Congress Cataloglng-ln-Puhlltetlon Data
`
`Laughlin, Edward H.
`Coming to terms wirh cancer : a glossary of cancer—related terminoiogy
`{Edward H. Laughljn.
`p. :cm.
`Inciudes index.
`ISBN 0—944235-36-0
`l. Cancer-Dictionaries.
`
`[DNLMz l. Neoplasms—Popular Works. 2.
`Neoplasms--Terminology--Engiish. QZ 15 LET-1c 9.001} I. Title.
`RC262 135 2001
`616.99'4'003ndc21
`
`2001000346
`
`A Note to the Reader
`The information contained in this book is not intended as medical odvrce and should not be relied
`upon as a substitute for consulting with your physician. This information may not address all pos-
`sible actions. precautions. side effects, or interactions. All matters regarding your heairh require the
`supervision of: physician who is Emilia: with your medical needs. For more information. contact
`your American Cancer Society at 1-800-ACS—2345 (www.carttetbffi).
`
`Book design by Moose Design Studio. Atlanta, GA
`Cover design byjill Dible. Atlanta. GA
`Illustrations (pages 1, 3. 10. 1?. 35. 46, 63. 66. MO. [26, 12?, 129, 156, 144. 165) by
`Angela Myrick
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`F—_——-—-—_—-—-——-—i———_— 1
`
`BRAIN TUMOR
`
`Diagnosis
`To distinguish cancer from a benign growth, a biopsy is necessary, which must
`be done carefully to prevent the spread of cancer cells that could interfere with
`future surgery. Although needle biopsy may be sufficient for diagnosis, inci-
`sional biopsy that provides a larger tissue specimenis usually needed.
`
`Determining Stage
`A thorough history taking and physical examination are followed by x—rays, CT,
`and possibly MRI of the involved area, which is then followed by a bone scan.
`Chest x—ray and chest CT are also needed. Blood tests include liver function
`studies.
`
`Considerations
`
`Chemotherapy with multiple drugs has greatly increased life expectancy for
`most types of cancer. Chemotherapy can usually shrink the cancer before surgery
`and has enabled limb-sparing procedures, in many instances, to give results
`equal to amputation. Research continues to devise treatment methods that will
`improve results while shortening the time needed to complete therapy.
`See also Childhood Cancer; Ewing’s Sarcoma; Paget’s Disease.
`
`BRAIN TUMOR
`
`Overview
`
`The brain and spinal cord make up the central nervous system (CNS), the site of
`tumors that arise inside the skull and spinal column as well as those spread from
`other cancers. However, the term “brain tumor" is used to describe only those
`
`originating within the skull, called primary brain cancers, rather than those that
`have metastasized (spread) to the brain from other parts of the body. They most
`often affect two age groups: children and older adults (average age = 70 years). It
`is estimated that approximately 17,200 Americans develop CNS tumors each year
`and about 13,100 die from them. For unknown reasons, primary brain tumors are
`becoming more common in all age groups and are second only to acute leukemia
`as the leading cause of cancer deaths in American children. Metastatic cancer to
`the central nervous system results from advanced-stage malignancies that usually
`are fatal.
`
`Type of Tumor and Spread
`Central nervous system tumors of adults and children often form in different
`areas and from different cell types and may have a different prognosis and treat-
`ment. Although some tumors grow so slowly as to be considered benign, nearly
`all that originate in the brain may prove fatal unless removed. They are divided
`
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`BRAIN TUMOR
`
`M i
`
`nto two broad categories: gliomas and nongliomas. The former arises in glial
`cells that support neurons, which are the cells responsible for brain function.
`Although some gliomas develop slowly, many are glioblastoma multiforme that
`grow rapidly and always recur following treatment. All gliomas can cause death.
`Among tumors classified as gliomas are astrocytomas, oligodendrogliomas, and
`ependymomas. Nongliomas are a diverse group of tumors, which include
`meningiomas that arise in the meninges (covering of the brain) and are rarely
`malignant; medulloblastomas; primitive neuroectodermal tumors; nerve tumors,
`including acoustic neuromas, optic neuromas, neuroflbromas—all of which are
`seldom malignant; craniopharyngioma; and pituitary tumors.
`
`Risk Factors
`
`The large majority of brain cancers are not associated with any risk factors. Brain
`lymphoma, however, is associated with HIV infection.
`
`Symptoms
`
`All CNS tumors cause symptoms either from growing into and destroying nerve
`tissue or from increasing pressure within the skull or spine. Symptoms vary
`widely, depending on tumor location and size. Headache, seizures, gradual
`paralysis, and personality change are common symptoms. Other symptoms
`include change in senses (sight, hearing, smell, touch, taste); nausea, vomiting,
`weakness; difficulty in speaking or walking; and mental deterioration, resulting
`from destruction of central nervous tissue. Difficulty with bladder or bowel
`control occurs from tumors involving the spinal cord.
`
`Diagnosis
`
`Findings on physical examination of the nervous system (neurological examina-
`tion) usually indicate a tumor’s location, and CT and MRI are imaging studies
`that identify the exact site. MRI can sometimes help determine tumor type
`(glioblastoma multiforme), but biopsy is usually necessary to identify the growth.
`In cases where surgical removal is not planned, needle biopsy through a butt
`hole (small opening) in the skull is used to accurately diagnose the tumor. In cases
`of metastatic cancer, detailed laboratory and x-ray studies are often necessary to
`determine tumor origin and other sites of spread.
`
`Determining Sta'ge
`There currently is no staging system for brain tumors. The most important
`factors in determining outcome are cell type (astrocytoma) and grade (aggres-
`siveness of the tumor cells).
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`BREAST CANCER
`H—xfi
`
`Considerations
`
`Although the outlook for most malignant brain tumors is poor, surgery, radia-
`tion, and chemotherapy can prolong and improve the lives of many patients.
`The prognosis for children with brain tumors tends to be more favorable.
`
`Because the blood-brain barrier prevents most chemotherapy from entering the
`CNS, newer methods of drug delivery are needed to enable anticancer drugs to
`pass from the blood into brain tissue.
`
`lobularceus II
`
`lobules -
`
`
`
`I collecting ducts
`
`fatty connective
`tissue
`
`BREAST CANCER
`
`_
`Overview
`The growth and development of the breasts
`are influenced by estrogen,
`the primary
`female hormone produced in the ovaries.
`
`During pregnancy, mammary (breast) tissue
`
`enlarges in preparation for nursing. In males,
`breast tissue remains in an immature, child-
`
`like state. Although breast cancer is uncom—
`
`mon in young women, it is becoming more
`
`prevalent in older females. It affects approxi—
`mately 10% to 11% of American women, and
`the number of women who survive has
`
`increased over the last decade. It is estimated
`
`that
`
`approximately
`
`192,200 American
`
`women develop breast cancer each year and
`about 40,200 die from it. African Americans
`
`are more likely to die from this cancer because they are often diagnosed at an
`advanced stage when breast cancer is harder to treat and cure \and because the
`cancer is often more aggressive. Although male breast cancer is rare, with only
`1,500 cases estimated each year, 400 men (27%) die from the disease. For both
`men and women, the likelihood of survival decreases as cancer involves the axil—
`
`lary (underarm) lymph nodes; In those without spread to lymph nodes, the
`possibility of survival depends mainly on the size of the cancer. Ten years after
`starting treatment, 80% of women without axillary lymph node metastasis and
`50% of those with lymph node metastasis are alive without cancer. Nine out of
`
`ten women with a cancer % inch or smaller are usually cured.
`
`Type of Tumor and Spread
`Almost all breast cancers are adenocarcinomas that arise either in the milk—
`
`producing lobules (glands) or, more commonly, in the ducts through which milk
`
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