__WT
`
`Coming to
`Terms With
`
`Cancer
`
`A Glossary of Cancer-Related Terms
`
`
`
`Edward H. Laughlin, MD
`
`
` 2m erin: an
`ancer
`.'
`
`
`.
`? Society-J
`l
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`
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`Published by
`American Cancer Society
`Health Content Products
`1599 Clifton Road NE
`Atlanta, GA 30329, USA
`800-ACS-2345
`http://www.cancer.org
`
`Copyright ©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 system, or transmitted, in
`any form or by any means (electronic, mechanical, photocopying, recording, or otherwise) without
`the prior written permission of the publisher.
`
`Printed in the United States of America
`
`54321
`
`0102030405
`
`Library of Congress Cataloging-in-Publication Data
`
`Laughlin, Edward H.
`Coming to terms with cancer : a glossary of cancer-related terminology
`/ Edward H. Laughlin.
`p. ; cm.
`Includes index.
`ISBN 0-944235-36-0
`1. Cancer--Dictionaries.
`
`[DNLM1 1. Neoplasms--Popular Works. 2.
`Neoplasms--Terminology--English. Q2 15 L374c 2001] I. Title.
`RC262 .L35 2001
`616.99'4'003udc21
`
`2001000346
`
`A Note to the Reader
`The information contained in this book is not intended as medical advice 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 health require the
`supervision of a physician who is familiar with your medical needs. For more information, contact
`your American Cancer Society at 1-800-ACS-2345 (www.cancer.org).
`
`Book design by Mouse Design Studio, Atlanta, GA
`Cover design by Jill Dible, Atlanta, GA
`Illustrations (pages 1, 3, 10, 17, 35, 46, 63, 66, 110, 126, 127, 129, 136, 144, 165) by
`Angela Myrick
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`adrenalectomy
`
`adrenalectomy Surgical removal of one or both adrenal glands. Removal of one
`
`adrenal gland (unilateral) is used to treat a tumor that has started in the gland
`
`or, less often, has spread there from a cancer elsewhere in the body.
`
`adrenaline This is the potent hormone epinephrine, produced in the inner
`
`portion (medulla) of both adrenal glands, whose actions include increased pulse
`
`(heart rate) and blood pressure. Epinephrine when mixed with local anesthetic
`
`drugs, such as lidocaine, prolongs anesthesia. See Epinephrine.
`
`E51 Adl'iamycin® See Doxorubicin.
`
`advance directives Legal documents that tell the physician and family what a
`
`person wants for future medical care, including whether to start or when to stop
`life-sustaining treatment.
`
`advanced cancer A general term describing the stages of cancer in which the
`
`disease has spread from the primary site to other parts of the body. When the
`
`cancer has spread only to the surrounding areas, it is called locally advanced. If
`
`it has spread further by traveling through the bloodstream or lymph system, it
`is called metastatic.
`
`2;: Advil® See Ibuprofen.
`
`aflatoxin A carcinogen (cancer—causing substance) from fungi (Alpergz'llm) con—
`taminating grain and peanuts raised in warm, wet climates, and stored in hot,
`
`damp surroundings. Aflatoxin, together with viral hepatitis, appears responsi-
`
`ble for the large numbers of cases of liver cancer (hepatocellular carcinoma or
`
`liver cell cancer) found in Equatorial Africa.
`
`afterbirth See Placenta.
`
`afterloading A type of treatment used in cancer radiation therapy (called
`brachytherapy) in which the radiation source is placed in tubes or in, a device
`previously positioned in or near a tumor. After the calculated radiation dose is
`
`given, the tubes and radioactive sources are usually removed. However, in some
`
`types of treatment, such as for prostate cancer, the radioactive seeds may be left
`
`permanently in place. The technique is used to treat a variety of malignant
`
`tumors that include breast, prostate, and head and neck cancers.
`
`agent Any substance or force able to affect the body.
`
`. AG3340 Also known by the trade name Prinomastat®, this drug is a matrix
`metalloproteinase (MMP) inhibitor. MMPs are enzymes that help tumor cells to
`
`grow, invade surrounding tissue, and develop blood vessels that help cancer cells
`
`to spread to distant tissues. This drug prevents the action of these enzymes so
`
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`
`
`snuff 1
`
`this rapidly spreading cancer most often arises in the lungs, it can affect the
`esophagus, prostate, and vagina. About 20% of all primary lung malignancies are
`small cell (SCLC), which occurs more often in women than men. Unfortunately,
`
`SCLC is seldom curable. See 4110 Lung Cancer (pages 180—182).
`
`snuff Finely-powdered, cured tobacco placed between the gum and cheek
`(dipped); associated with cancer of the mouth and gum. In the past, snuff-
`related oral cancer was seen most often in older women in the South; but today,
`
`due to the promotion of smokeless tobacco, it is seen most often in young males.
`
`soft tissue sarcoma See Soft Tissue Cancer (pages 202—204).
`
`solid tumor Any cancer that begins as a distinct mass or lump in tissue other
`than lymph tissue, lymph nodes, and bone marrow. These include the following
`common cancers: lung, colon, breast, prostate, ovary, pancreas, etc.
`
`sonogram See Sonography.
`
`__
`'I'
`
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`__.JI. ,
`[‘44 '
`
`".I
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`=
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`'—
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`Li: J
`'_ _- _-
`fl'fll'fr
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`1-_
`_
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`
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`1
`
`I sonography
`
`sonography A study using high frequency sound
`waves to detect, evaluate, and measure structures and
`tumors deep within the body. A transducer (a small
`instrument that generates and collects reflected sound
`waves) is moved over the body, and the collected waves
`are entered into a computer to produce two-dimen—
`sional images or sonograms. The procedure is widely
`available, safe, and completely painless. Small trans-
`
`ducers contained in endoscopes allow examination and
`
`staging of tumors of the esophagus and rectum.
`Sonography is also used to guide needles to biopsy
`tumors of the breast. Also called ultrasonography.
`
`sorbitol This is a sugar known as a hyperosmotic laxative. It is used to treat
`
`constipation.
`
`spinal cord compression Increased pressure on the spinal cord or nerves in the
`spine most often caused by cancer that has spread to the bone marrow in a back
`bone or vertebra, and sometimes by the spread of a tumor to the tissue around
`
`the spinal cord. It occurs in up to 5% of people with cancer, and it is second only
`to brain metastasis as a complication of cancer that has spread to the brain and
`spinal cord (central nervous system). In a cancer patient, back pain, leg weakness
`or numbness, or loss of bladder or bowel control indicate a medical emergency
`
`requiring prompt treatment. Either immediate surgery to relieve the pressure or
`irradiation to the spine is needed to prevent permanent paralysis and loss of
`bladder and bowel control.
`
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`tumor
`
`tumor Literally a swollen area; most often used to indicate a new growth, par-
`ticularly a solid cancer that is causing a lump or mass. See Neoplasm; Malignancy.
`
`tumor board A group of physicians and health care professionals in a hospital or
`cancer center who meet regularly to discuss and make treatment recommendations
`regarding cancer patients presented to them. The board usually is comprised of
`medical, radiation, and surgical oncologists, radiologists, pathologists, and nurses.
`
`tumor dose The cumulative amount of radiation delivered in fractional (divided)
`
`doses to cancer during radiation therapy; measured in either grays (Gys) or rads
`(1 Gy = 100 rads).
`
`tumor marker Any one of a number of different, chemical substances in the
`blood and other body fluids used to detect and identify different cancers. These
`substances, produced either by a cancer or the body’s response to a malignancy,
`are also used to indicate tumor burden (size of tumor) before treatment, monitor
`
`response to therapy, and identify early recurrence. The ideal tumor marker
`should be 100% specific (occurs only with a particular cancer) and 100% sensi-
`tive (present in every case of the cancer). Although markers are neither totally
`specific nor sensitive, they are useful in gauging the effect of therapy and in
`indicating recurrent cancer before symptoms occur. Prostate-specific antigen
`(PSA) is used widely as a screening procedure to detect early prostate cancer
`before it causes symptoms, whenit is more likely to be controlled.
`Among the most common tumor markers are PSA—prostate; CEA (carcino-
`embryonic antigen)——colon, rectum; CA 125 (cancer antigen 125)—ovary; CA
`19-9 (cancer antigen 19—9)—pancreas; AFP (alpha-fetoprotein)—liver, testicle;
`hCG (human chorionic gonadotropin)—ovary, testicle, mediastinum.
`It is important to realize the shortcomings of many common markers used to
`detect cancer or to predict a likelihood of difficulty at a later date. PSA may be ele-
`vated very slightly following a simple finger rectal examination or up to 48 hours
`following sexual activity. CEA (which is usually used to follow a patient with
`cancer, rather than as a screening test) is often increased in cigarette smokers.
`BRCA indicates a likelihood of breast cancer and ovarian cancer in only a small
`
`number (5%) of women. In light of this, anyone having a having a blood test for
`a marker to detect or predict the likelihood of cancer should have the possible
`results and implications of the test carefully explained before the test is done.
`
`tumor necrosis factor A naturally occurring hormone produced in minute
`amounts by macrophages (large cells produced in bone marrow) that surround
`and destroy bacteria in tissue. Because tumor necrosis factor can kill tumor cells,
`it is being evaluated as cancer immunotherapy.
`
`J
`‘
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`_ I“
`
`KIDNEY CANCER
`
`
`Diagnosis
`Biopsy of involved lymph node(s), including the capsule (outer part) of the node,
`is necessary to diagnose Hodgkin’s disease. Although needle biopsy does not
`provide enough tissue from lymph nodes to make an accurate initial diagnosis,
`it can identify the presence or absence of disease in the bone marrow.
`
`Determining Stage
`I A detailed history and careful physical examination precede laboratory studies.
`Blood tests include a complete blood count as well as kidney and liver function
`tests. Imaging studies include chest x—rays, CT of the chest and abdomen.
`Surgery (staging laparotomy) to biopsy the liver and abdominal lymph nodes
`and remove the spleen was often performed in the past, however it is now rarely
`recommended.
`
`Considerations
`
`Treatment of Hodgkin’s disease has been extremely successful and represents one
`of medicine’s greatest advances. Almost 90% ofpeople diagnosed with Hodgkin’s
`disease are cured with chemotherapy that is often combined with radiation
`therapy. Research continues for safer and more effective means of controlling
`this cancer. Immunotherapy may improve the possibility of curing an aggressive
`form of Hodgkin’s disease that spreads rapidly.
`See also Epstein-Barr Virus.
`
`KIDNEY CANCER
`
`Overview
`
`The kidneys are paired organs that produce urine, and they are located on each
`side of the lower spine in the retroperitoneum, which is the area behind the
`abdominal cavity. Each consists of two parts: the outer portion in which urine is
`produced, and the renal pelvis, the collecting system in which urine is channeled
`into the ureter and conveyed to the bladder. The kidneys also produce erythro-
`poietin, a hormone that enhances the formation of red blood cells. Attached to
`the upper pole (upper part) of each kidney is the adrenal gland, a small gland
`that produces several hormones, including cortisol, aldosterone, and epineph-
`rine. Each kidney and adjacent adrenal is enclosed in a tough layer of tissue called
`Gerota’s fascia. Renal cell carcinoma (cancer of the kidney) occurs most often
`between the ages of 50 and 70, and men are twice as likely to develop the tumor.
`It is estimated that almost 51,000 Americans (adults and children) develop
`kidney cancer each year and approximately 12,100 die of it.
`
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`I
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`
`
` KIDNEY CANCER
`
`Type of Tumor and Spread
`Ninety percent of kidney cancers are renal cell carcinomas (hypernephromas)
`that arise in the urine—producing cells, and most of the remaining are transi-
`tional cell carcinomas, which begin in the renal pelvis. Wilms’ tumor is an
`uncommon cancer of infants and young children. Renal cell cancer often
`involves the inferior vena cava, the large vein that drains blood from the lower
`body, which results in early metastasis (spread) to the lungs and other organs.
`
`Risk Factors
`Environmental factors and chronic (persistent) kidney disease are both implicated
`as risk factors. Cigarette smoking increases the risk of developing renal cell carci-
`noma by 30% to 100%. Workers in the aniline dye industry, and possibly those in
`petroleum refining, are at an increased risk. Phenacetin, once widely prescribed as
`a pain reliever, has been linked to renal cell cancer, although this medication has
`not been available in the United States in over 20 years. End-stage kidney disease
`that requires dialysis with the artificial kidney makes people more at risk for devel-
`oping this cancer. Renal cell cancer is known to occur repeatedly in some families.
`
`Symptoms
`There are few indications until cancer is in an advanced stage, when it causes three
`common symptoms: pain in the lower back, bloody urine, and a lump or mass in
`the side below the ribs. Some individuals develop paraneoplastic syndrome (symp-
`toms that appear to have nothing to do with the cancer), which include marked
`weight loss, fatigue, fever, and polycythemia (increased numbers of red blood cells).
`
`Diagnosis
`A mass in the side of an individual who is experiencing both low back pain and
`passing blood is very suggestive. Cancer is usually confirmed with kidney x-rays
`(IVP) and possibly with ultrasonography.
`
`Determining Stage
`Following a detailed history and complete physical examination, blood tests
`include kidney function studies, liver function studies, and complete blood count.
`A chest x-ray, and often, a CT and MRI of the chest and abdomen are advised.
`
`Considerations
`The use of CT and ultrasonography to diagnose abdominal problems, such as gall—
`bladder disease, has resulted in some renal cell cancers being discovered at a very
`early stage before they cause symptoms, when they are likely to be cured. The only
`curative treatment is surgery. Neither radiation nor chemotherapy is very effective
`for renal cell carcinoma. Immunotherapy is often used in advanced cancer.
`See also Kidney Function Study; Retroperitoneum; Wilms’ Tumor (pages
`212—213).
`
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`NON-HODGKlN’S LYMPHOMA
`__________________'__—————’——
`
`Determining Stage
`Following complete blood count (CBC), urinalysis, liver and kidney function
`tests, imaging studies include x—rays of chest and skeleton, and bone scan. Bone
`marrow biopsy is necessary in every case. Evaluation includes genetic and bio-
`logic traits (biologic markers) exhibited by the cancer that show it to be
`favorable or unfavorable (how rapidly it will grow and spread).
`
`Considerations
`Although small infants with early-stage disease may be cured, most children
`(about 70%) have advanced-stage disease when diagnosed and are less likely to
`survive. Because widespread neuroblastoma seldom responds to present—day
`chemotherapy, newer techniques such as stem cell transplant following high-
`dose chemotherapy, and immunotherapy, are needed to improve the results of
`today’s treatment.
`See also Childhood Cancer.
`
`NON-HODGKIN’S LYMPHOMA
`
`Overview
`Non-Hodgkin’s lymphoma, usually referred to simply as lymphoma, is a cancer
`of the lymph nodes and lymphatic tissue. It is seven to eight times more
`common than Hodgkin’s disease, the next most common lymphatic cancer.
`Although some types of non-Hodgkin’s lymphoma are among the most
`common childhood cancers, over 95% of non-Hodgkin’s lymphoma cases occur
`in adults. The average age at diagnosis is in the early 40s.
`In the last 25 years, there has been a greater than 50% increase in the
`number of cases in the United States; and although this may be due, in part, to
`the association of lymphoma with AIDS and to better diagnostic techniques,
`there has been a real overall increase in the incidence of the disease. Unlike
`Hodgkin’s disease, which has become more curable with new treatment
`methods over the last two decades, some forms of lymphoma have shown little
`improvement in being permanently controlled. It is estimated that almost
`56,200 Americans develop non-Hodgkin’s lymphoma each year and about
`26,300 die from the disease.
`
`Type of Tumor and Spread
`Non-Hodgkin’s lymphoma is a disease of the immune system, usually involving
`B lymphocytes and, much less often, T lymphocytes. Most cases begin in lymph
`nodes, but some (extranodal lymphomas) can start in organs other than lymph
`nodes, such as in the skin, stomach, intestines, lungs, brain, and other organs.
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`NON-HODGKIN’S LYMPHOMA
`
`W L
`
`ymphoma is classified into a number of varieties, which help predict its
`course and indicate probable response to treatment. The classification system is
`confusing because there are so many types of the disease and several different
`systems of classification. The Working Formulation method of classifying lymph-
`oma categorizes disease as low grade, intermediate grade, or high grade, based
`upon expected survival of patients. A newer method of classification, called the
`REAL system, categorizes the types into four classes according to clinical behav-
`ior and prognosis afier treatment and is now, considered to be more accurate.
`
`Risk Factors
`
`Most patients with this disease do not have any known risk factors. Defects in
`the immune system seen in patients with AIDS and with suppressed immune
`systems following organ transplant are highly susceptible to developing lym-
`phoma. Viral infection is suspected, particularly in African Burkitt’s lymphoma
`and some forms of T cell lymphoma.
`
`Symptoms
`
`They vary greatly and are often confused with nonmalignant conditions, particu—
`larly infectious mononucleosis. Painless swelling of the lymph nodes, which at
`first may wax and wane, is the most common symptom. Abdominal complaints
`include stomach pain, vomiting, and/or passing blood. Skin problems that mimic
`skin disease (eczema) may be the first indication in some cases (mycosis fungoides).
`Weight loss, fever, and malaise (feeling poorly) occur as the disease progresses.
`
`Diagnosis
`
`Although excisional biopsy (lymph node biopsy that removes the entire node)
`usually is necessary to identify lymphoma, needle biopsy of bone marrow and
`lymph nodes may reveal lymphoma cells. Biopsy of the stomach and duodenum
`(using gastroscopy) is used to diagnose lymphoma of these organs. Newer labo-
`ratory methods, including flow cytometry and molecular genetic testing, further
`classify lymphomas into many subtypes, which help predict their behavior and
`indicate more precise treatment.
`
`Determining Stage
`A careful history taking and physical examination are followed by laboratory
`studies that include CBC as well as liver and kidney function tests. Imaging
`studies include chest x—ray, and CT of chest, abdomen, and pelvic area. Bone
`marrow biopsy is necessary in most cases.
`
`Considerations
`
`Research continues to develop newer chemotherapy to improve results and cause
`less adverse effects, especially to the bone marrow. Immunotherapy with the
`
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`OVARlAN CANCER
`
`monoclonal antibody rituximab (Rituxan®) is used for low-grade B cell lymph-
`omas that recur or persist after usual therapy. Bone marrow transplant and the
`use of cytokines to stimulate bone marrow enable high-dose chemotherapy to be
`used for intermediate- and high-grade lymphomas.
`
`See also Burkitt’s Lymphoma.
`
`OVARIAN CANCER
`
`Overview
`
`The ovaries are a pair of small organs in the female pelvic area. They are the
`
`main source of estrogen, and in the nonpregnant state, progesterone. These hor-
`mones are responsible for female characteristics including breast and uterine
`development and regulation of the menstrual cycle. During a woman’s repro-
`ductive life, between menarche (onset of regular menstrual periods) and
`
`menopause (cessation of regular menstruation), the ovaries usually produce a
`single ovum (egg) approximately every 28 days. Cancer of the ovary is a serious
`malignancy that most often affects women after menopause, although it may
`occur earlier. Today, it is the fifth leading cause of cancer deaths in American
`women. It is estimated that about 23,400 American women are diagnosed with
`
`the malignancy each year and almost 14,000 die of it.
`
`Type of Tumor and Spread
`Ninety percent are epithelial ovarian cancer, a variety of adenocarcinoma (gland-
`forming cancer) that
`tends to shed cancer cells throughout
`the pelvis and
`abdomen. Metastasis (spread) can involve the lymph nodes, but tends to spread to
`organs such as the liver, lung, and brain late in the course of the disease. However,
`it often spreads to the surface of the liver and lung. A cancer that resembles ovarian
`cancer, called primary peritoneal carcinomatosis, can begin in the abdominal
`cavity even in women who have had their ovaries removed by surgery.
`
`Risk Factors
`
`Most women with ovarian cancer do not have any known risk factors. However,
`
`women with a family history of ovarian cancer are at greater risk for developing
`ovarian cancer. Also, women with breast cancer are twice as likely to subse-
`
`quently develop cancer of the ovary. Recently, an inherited mutation (change) in
`either of two genes (BRCA1 and BRCA2) has been identified in some women
`
`with a family history of ovarian and/or breast cancers.
`
`Symptoms
`Unfortunately, there are few symptoms in early-stage disease. Mild abdominal
`discomfort or pressure, and other digestive disturbances are often so vague as to
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