c l i n i c a l f o l i o s : d i s c u s s i o n



Breast Cancer: Glossary

 

 

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z  

adenocarcinoma
A type of carcinoma arising from glandular tissue such as the breast.

adenoid cystic carcinoma
A very rare form of cancer found in the breast

adjuvant therapy
Treatment (radiation, chemotherapy, hormonal therapy) added to prevent recurrence in the absence of disseminated disease.

angiogenesis
The formation of new blood vessels. Necessary for the growth and survival of tissues and tumors. May be stimulated by tumor factors. Inhibition may slow tumor growth.

architectural distortion
Changes in the normal structure of tissues seen in mammographic abnormalities.

areola
The pigmented area around the nipple. Contains lubricating sebaceous glands which appear as small bumps.

aspiration
The process of withdrawing fluid with suction as in needle aspiration of a breast cyst.

asymmetry
An unbalanced distribution of tissue that should be equally dispersed. Often a sign of abnormality on a mammogram.

atypical hyperplasia
Unusual growth of the cells lining the breast ducts in which the cells appear microscopically abnormal in form.

abnormal
Different from the most common pattern found in a particular tissue.

axilla
The area between the chest wall, the collar bone (clavicle) and shoulder blade (scapula). Contains lymphatic channels and nodes which drain the breast.

axillary tail
Extension of glandular breast tissue up toward the axilla. More or less prominent in different women.

baseline mammogram
A first mammogram to which subsequent mammograms are compared. Usually done at age 35. Below 35 the glandular tissue is too dense to visualize and the cancer risk is low.

basement membrane
The sheath of connective tissue surrounding the ducts of the breast. An initial barrier to the spread of cancerous duct lining cells.

benign
Tissue that is not cancerous.

bilateral
On both sides in mirror-image structures such as the breasts.

biopsy
To remove tissue for pathologic examination.

biopsy needle
A fine or a special cutting needle used to remove tissue in a minimally invasive way.

bone
One of the preferred sites of implantation of metastatic breast cancer.

bone marrow transplant
Restoration of bone marrow previously harvested from a patient (autologous) or from a donor (allograft) after a patient's own vital blood element forming marrow has been wiped out by radical chemotherapy.

brain
A favored site of metastatic breast cancer implantation.

BRCA1 & 2
Genes that have been identified as protective against breast cancer. Mutations in these genes reduce or eliminate their protective function and predispose to breast cancer. Such mutated genes may be inherited, and specific mutations, out of many mutations possible, are tested for within family groups.

breast
The highly modified glandular tissue, fat, connective tissue and skin lying on the chest wall between the midline and the latissimus muscle, and between the clavicle and the rectus abdominus muscle.

breast conserving therapy (BCT)
Removal of a tumor with a safe margin of normal tissue, plus or minus axillary lymphatics instead of removal of the whole breast for breast cancer. Usually supplemented with radiation therapy to decrease the chance of recurrence.

breast examination
Yearly examination of the breasts and surrounding lymph node bearing areas by a physician or other trained health professional.

breast self-examination (BSE)
Monthly self-examination

cancer
The uncontrolled proliferation of abnormal cells that have the ability to invade surrounding tissue and spread to distant sites in the body.

carcinoma
One of the two categories of cancer (vs. sarcoma). A cancer that arises from tissue derived from the inner or outer layer of the embryo. Includes glandular tissue such as the breasts.

cardiovascular disease
Disease of the heart and blood vessels. By far the greatest cause of death in women.

chemotherapy
Drugs kill or slow the growth of cancer cells predominantly, but which also affect normal cells. Administered by specialized M.D.'s called medical oncologists (specialty of hematology/oncology).

clinical stage
The estimation of the extent of cancer by pre-operative examination and testing.

clinical trial
A highly regulated and standardized scientific test of therapy on groups of patients. The most rigorous and valid clinical trials are randomized, prospective (vs. retrospective analysis), and double blinded (neither doctor nor patient knows which alternate therapy is being used during the course of the trial).

cluster
A group, as a family group in which multiple members have gotten breast cancer.

clustered calcifications
Groupings of five or more calcifications in a very small area of the breast in contrast to the normal scattered calcifications.

colloid carcinoma (also called mucinous carcinoma)
A rare, bulky, slimy-surfaced, slow-growing variant of ductal breast cancer with a better prognosis than the common (75%) scirrhous infiltrating ductal carcinoma.

commedocarcinoma
A bulky variant of ductal cancer in which the channels of multiple tiny ducts are filled with toothpaste-like debris.

compression
Sometimes applied to questionable areas of the breast during a mammogram to thin out the tissue and see more precisely.

core needle
A specialized biopsy needle used to take a small tubular sample of tissue from a palpable tumor or from a mammographic abnormality (stereotactically/x-ray guided).

craniocaudal
An x-ray view from the head toward the toes. One of the two standard mammographic views, done by compressing the breast from top to bottom.

cyst
A lined cavity containing fluid. Stretching of a tensely distended cyst may cause pain. It may be relieved by aspirating the fluid. Most cysts are benign. If the contents are bloody or if a mass remains after aspiration, further tests are necessary.

cystosarcoma phyllodes
A rare sarcoma of the breast (but the most common sarcoma occurring in the breast), possibly related to a common benign growth, a fibroadenoma. Slow-growing and rarely metastasizing.

cytology
The examination of isolated cells for malignant characteristics. Cells from a bloody cyst aspirate or from fine needle aspiration for example. Highly accurate in expert hands.

DCIS
Ductal carcinoma in-situ, earliest form of breast cancer. Growth of cancerous breast ductal cells within the confines of the surrounding membrane. Non-invasive. Due to earlier detection, now constitutes 50% of new breast cancers. Highly curable, but increased risk of subsequent cancer (20%).

death rate (mortality)
The time-based demise of breast cancer patients by stage. Not equivalent to incidence of breast cancer which is the number of new cases per year.

desmoplastic reaction
A growth of fibrous tissue and inflammatory response caused by a tumor. Typical of infiltrating ductal carcinoma, forming the crab-like scirrhous tumor.

diagnostic mammogram
A mammogram done for the suspicion of an abnormality, in contrast to a screening mammogram.

dimpling
The skin retraction caused by tumor shortening the suspensory ligaments of the breast.

dissection
Surgical separation of tissue as done during a breast biopsy or mastectomy.

DNA
The genetic material in the nucleus of each cell. A few specific genes related to breast health (e.g.. BRCA1 and BRCA2) have been identified.

duct
A tubular structure. Breast ducts carry milk from the gland lobules to the nipple. Most (75%) of breast cancers arise in the ducts.

ductal carcinoma
The most common form of breast cancer.

early breast cancer
breast cancer less than 2 cm in size confined to the breast and having an excellent prognosis. Highly suitable for breast-conserving therapy.

edema
Swelling of tissue due to accumulation of undrained fluid. rarely seen in the arm after axillary dissection interrupts lymphatic channels.

environmental factors
Extrinsic influences such as smoking which may increase the incidence of cancer; as opposed to genetic factors.

epidermoid carcinoma
A very rare form of breast cancer thought to arise by transformation of cuboidal duct cells to flat (squamous) cells (metaplasia).

excise
To cut out.

fibroadenoma
A benign breast tumor commonly seen in teen-agers. Characteristic smooth, mobile (breast mouse), lobulated. Easily excised. If left over long periods may enlarge and transform into cystosarcoma phyllodes.

fibrocystic disease
A condition found to some degree in many, if not most, women, characterized by nodular, tender breasts. Waxes and wanes randomly and in response to hormone cycles. Not a risk factor for breast cancer, but very lumpy breasts and scar tissue from multiple biopsies make examination more difficult

fine needle aspiration
Minimally invasive way of obtaining cells from a lump for cytology.

frozen section
Freezing a surgical specimen to provide solidity for immediate cutting and quick microscopic examination. Less reliable than embedding specimen in paraffin for permanent sections. No longer used to guide definitive breast cancer surgery.

gene
A segment of DNA whose code guides the construction of specific proteins by the cell.

glands
Specialized cells which secrete substances to be excreted (such as milk from the breast glands) or to circulate in the blood stream (endocrine glands).

grade
The degree of abnormality of cancer cells. The higher the grade, the greater the abnormality, the more aggressive the tumor and the worst the prognosis.

growth rate
The capacity of a tumor to enlarge, often expressed in doubling time. Varies from tumor to tumor. The more rapid the doubling time, the worse the prognosis.

Herceptin
A new, targeted gene therapy drug.

histochemistry
The process of using labeled substances which target specific structures or cells and can be identified on a microscopic level. Estrogen and progesterone receptors are identified using labeled immune complexes (immunohistochemistry)

histology
The study of tissues under the microscope.

hormonal therapy
The use of estrogen-blocking substances to reduce stimulation of estrogen-sensitive tumors by endogenous hormone. Also to confer a protective effect on breast cells in patients at risk.

immune system
The complex mechanism by which the body recognizes foreign and abnormal cells and destroys them.

implant
Synthetic material placed in the body, such as a saline filled breast prosthesis.

incidence
The rate at which an event occurs, such as the number of new breast cancer cases per year.

Indian file
The single file arrangement of infiltrating cancer cells within the desmoplastic tissue of a scirrhous ductal or lobular breast cancer.

infiltrating ductal carcinoma
A ductal cancer that invades and grows into the surrounding tissue.

infiltrating lobular carcinoma
A cancer of lobular origin that invades and grows into the surrounding tissue. Often difficult to differentiate from infiltrating ductal.

inflammatory carcinoma
A rare deadly form of breast cancer in which poorly differentiated (anaplastic) cells infiltrate the skin and its lymphatics, causing a hot, red, painful breast with prominent pores (peau d'orange).

inspection
Looking at the part to be examined. The first step in any physical exam.

internal mammary artery
The blood vessel beneath the breast bone that supplies the medial part of the breast.

invasive cancer
cancer that has broken through its initial limiting membrane, such as the basement membrane of the breast duct.

lateral thoracic artery
An accessory blood supply to the breast.

LCIS
An abnormal, but not cancerous, proliferation of lobular breast glandular cells. Significantly increases the risk (20-30%) of developing a subsequent invasive (usually ductal) cancer in either breast. Also called lobular neoplasia.

lesion
An abnormal area within a tissue.

liver
One of the favored sites of breast cancer metastasis.

lobular carcinoma
The rarer (5-10%) of the two common forms of breast cancer, arising from glandular elements rather than ducts. Difficult to differentiate from ductal carcinoma, often must see associated lobular nodules.

lobular neoplasia
See LCIS.

lobules
The terminal glandular clusters at the ends of breast ducts.

local anesthesia
Anesthetic agent directly infiltrated into the breast to perform most breast biopsies and lumpectomies today.

local therapy
Treatment of the breast and axilla directly with surgery and/or radiation

lumpectomy
Surgical removal of a tumor and its surrounding tissue.

lungs
A favored site of breast cancer metastasis.

lymph node
An aggregation of lymphoid cells along the course of lymphatic channels.

lymphatics
Tiny channels which drain fluid from the space between cells and carry lymphocytes and other material from place to place.

lymphedema
Engorgement of tissue with fluid due to the blockage or interruption of lymphatic channels.

magnification
sometimes used in mammography to get a detailed view of a questionable area.

malignant
Cancerous, growing out of control, infiltrating surrounding tissue, spreading to other areas of the body.

mammography
Low-dose x-ray technique to visualize early malignant changes in breast tissue.

mastectomy
Surgical removal of the breast tissue.

mediolateral
From side to side. One of the two standard views of mammography.

medullary carcinoma
A rare, bulky form of ductal carcinoma characterized by extensive lymphocytic infiltration. Slightly better prognosis than scirrhous carcinoma.

metastasis
Spread, implantation and growth of cancer in a part of the body separate from the primary tumor site.

microinvasion
The earliest stage of invasive breast cancer, seen in association with DCIS.

modified radical mastectomy
Surgical removal of the breast tissue, pectoral fascia and axillary lymph node sampling. The modified part is the sparing of the pectoralis major muscle compared to radical mastectomy.

mucinous carcinoma
See colloid carcinoma.

multicentric
Cancer that is present in more than one quadrant of the breast.

multifocal
Cancer that is in multiple sites within one quadrant of the breast.

musculocutaneous flap
Composite flap of skin and muscle that is transferred with its blood supply (or connected to a new blood supply) from the abdomen or back to the chest to reconstruct the breast mound with living tissue.

mutation
The alteration of the elements of a gene that may change its function to a greater or lesser degree. Mutation may be spontaneous in an individual, it may be inherited and it may be passed on to offspring.

National Institutes of Health (NIH)
The official United States health research institution which both conducts primary state-of-the-art health care research (basic science and clinical trials) and administers funding for academic institutional research across the country.

needle localization biopsy
Excision of a lesion that is visible only on mammogram with the aid of an x-ray guided needle placed to pinpoint its location for the surgeon.

neoadjuvant chemotherapy
Drug treatment of an advanced tumor to reduce its extent or stage prior to attempting surgical control.

nipple
The site of convergence of 15-20 terminal breast ducts.

NSABP
National Surgical Adjuvant Breast Project has run large scale, standardized multi-institutional clinical trials over the past twenty plus years.

oblique
Supplemental mammographic views are sometimes taken tangentially to visualize irregularities in difficult locations.

oncology
The specialty dealing with malignancy.

outpatient
Treatment done without hospital admission. Most breast biopsies are now done under local anesthesia as outpatient procedures either in a hospital or in a dedicated surgical center.

Paget's disease of the nipple
Infiltration of the skin of the nipple and areola by an underlying ductal cancer. Presents as a rash and thickening of the areolar skin with or with an underlying palpable mass. Slightly better prognosis because of early presentation.

palpate
To feel with the hands. The second component of physical examination after inspection.

papillary carcinoma A rare form of ductal carcinoma.

papilloma
A polypoid growth of the lining of a breast duct. sometimes the cause of a bloody nipple discharge.

pathological stage
The definitive stage of disease established after surgical specimens, particularly axillary lymph nodes, are examined.

pathologist
Physician specializing in the gross and microscopic evaluation of disease.

peau d'orange
Literally, orange skin. The edematous thickening of skin making pores prominent in the face of tumor cell blockage of lymphatics.

pectoral fascia
The fibrous covering of the large chest wall muscle on which the breast rests. The deep site of attachment of the ligamentous bands passing through the breast tissue to the skin.

pectoralis major
The large muscle of the chest that lies under the breast.

penetrance
The degree to which the manifestations of a gene or its mutation are expressed in an individual. A gene with low penetrance may be clinically insignificant while a gene with 100% penetrance is always expressed.

peripheral stem cell transplant
Preliminary separation, preservation and reinfusion of marrow stem cells from the peripheral blood after radical chemotherapy.

prognosis
The prospects for disease free survival from the time of treatment.

prophylactic
Preventive, such as bilateral mastectomy in a known carrier of an active BRCA mutation.

prosthesis
An external breast form worn in the bra for cosmesis after mastectomy.

ptosis
sagging of the breast with age due to relaxation of the suspensory ligaments.

quadrantectomy
Removal of a quadrantectomy as a breast conservation measure with a moderate size tumor.

radical chemotherapy
Highly toxic levels of chemotherapy in advanced, high-risk disease, followed by bone marrow transplant.

radical mastectomy
Classical Halsted procedure with removal of breast, pectoralis major and minor muscles and complete axillary dissection. Rarely done today except for direct invasion of pectoralis muscle.

radiologist
Physician trained in performing and reading x-rays, including mammograms and ultrasound; interventional procedures such as stereotactic biopsy and needle placement.

radiotherapist
Physician trained to administered radiation by external beam or by implantation, also called radiation oncologist.

Raloxifene
A new anti-estrogen drug.

reconstruction
Rebuilding of the breast with the patient's own tissue transplanted from another part of the body. Lower abdominal skin and muscle (TRAM flap) currently favored. May be done immediately if radiation is not required or may be staged. Performed by a plastic surgeon.

reduction mammoplasty
Reshaping a large opposite breast after mastectomy to match a reconstructed breast.

retraction
Drawing in of the breast skin (see dimpling) due to shortening of the suspensory ligaments by tumor.

risk
The chances of getting breast cancer during a particular interval in a woman's life. Best viewed in terms of decades, with the greatest increase in danger during the fifth decade (40-50) to a higher level of risk thereafter.

sampling
The removal of a portion of the axillary contents with enough (about 10 nodes out of about 30 total) to be reliably predictive of whether there is axillary spread.

sarcoma
A cancer arising from the middle layer (mesoderm) of the embryo, rarely seen in the breast.

scirrhous carcinoma
The form usually taken by infiltrating ductal (and lobular) carcinoma. Heavy reactive growth of connective tissue and inflammation (desmoplastic reaction) in response to the tumor.

screening mammogram
Mammogram done routinely without suspicion of a particular growth. Without strong family history, baseline at 35, every year 40-50, yearly after 50.

segmentectomy
Removal of a wedge of breast tissue containing a few glandular lobes. Theory being that initial spread remains within a given lobe.

sentinel lymph node
The lymph node (or nodes) to which a particular tumor spreads first, with rare skip lesions. Proven reliable in melanoma, being tried in breast. If sentinel node is negative, virtually rules out spread beyond, eliminating the need for axillary dissection in a majority of women.

solid lesion
A mass in the breast as opposed to a cyst.

stage
Standardized classification of the extent of breast disease, used for comparing treatment regimens, guiding therapy and assessing prognosis.

stains
Dyes used to highlight cellular structures for microscopic examination.

stereotactic
Localization of a point in a three-dimensional volume such as the breast using two views (orthogonal) at 90% angles to each other.

surgery
The manipulation of living tissue with the hands and instruments.

surveillance
Observation. In the context of breast cancer, the degree of surveillance is guided by the stage of disease and the risk of recurrence.

suspensory ligaments
Fibrous elements running through the breast connecting the pectoral fascia with the skin. May shorten and cause retraction with breast cancer. Laxity causes drooping (Ptosis).

suspicious lesion
A palpable or mammographic abnormality with malignant characteristics.

sweat gland carcinoma
A very rare cancer of the breast.

systemic therapy
Chemotherapy and hormonal therapy that act on the whole body, in contrast to local treatment of the breast (surgery and radiation).

Tamoxifen
An estrogen-like drug with lower estrogenic activity than the native hormone. Binds to estrogen receptors, blocking binding and stimulation by estrogen (competitive inhibition). Confers benefits against osteoporosis and heart disease.

thoracoacromial artery
The dominant blood vessel supplying the pectoralis major and the overlying breast.

tissue
The histologically varied substance of the body, e.g. breast tissue.

tissue expander
A silicone sac that is gradually inflated with saline to stretch the chest wall skin after mastectomy if it is too tight to accept immediate implantation of a breast prosthesis.

tissue transplant
The movement of muscle, fat and skin (composite flap) from one area of the body to another to fill a defect or reconstruct the breast, e.g. TRAM flap.

TNM system
The set of tumor, node and metastatic criteria used to establish the stage of cancer.

total mastectomy
Surgical removal of the breast, the pectoral fascia and a sampling of axillary lymph nodes.

TRAM flap
Transverse rectus abdominis muscle flap. Shifts lower abdominal skin and fat to the chest based on the blood supply through the rectus muscle. Blood supply may be divided and reconnected (free TRAM).

tubular carcinoma
A rare form of ductal breast cancer with a slightly better prognosis than scirrhous ductal cancer.

tumor
A mass of abnormal cells. May be benign or malignant.

tumor markers
Substances produced by tumors that can be measured to detect the presence of the tumor.

ultrasound
The use of reflected sound waves to non-invasively visualize abnormal growths and differentiate cystic from solid lesions.

vein
The low pressure vascular channel that returns blood from the tissues to the heart. May carry cancer cells to distant areas of the body.

well differentiated
How close tumor cells resemble the normal cells of the structure in which they arose. The less well differentiated the cells, the more aggressively the tumor tends to behave.


This page was last modified on 10-Jul-1999.