Glossary

Allogeneic bone marrow transplant: An infusion of bone marrow or stem cells that were obtained from an HLA compatible donor. This differs from an autologous bone marrow transplant in which marrow or stem cells are obtained from the same patient into which they are later reinfused.

Alopecia: Alopecia means hair loss. Cells responsible for hair growth divide more frequently than many other types of cells in the body. Many anti-cancer drugs work by targeting rapidly dividing cells. This is because it is during cell division that cells of all kinds are the most vulnerable to injury. The extent of hair loss is related to the type and dosage of the drug or drugs used and the number of cycles received. Hair that is lost due to exposure to chemotherapy drugs generally grows back at a normal pace once chemotherapy is stopped.

Anemia: This is another case of rapidly dividing cells being the most vulnerable to some types of anti-cancer drugs. Many types of anti-cancer drugs work by targeting cells that divide rapidly. Anemia means that fewer red blood cells are available to carry oxygen throughout the body. A person with anemia often feels fatigued. Anemia can also be caused by suppression of stem cells in the bone marrow caused by other types of cells such as leukemia cells, which divide and reproduce themselves out of control.

Antiemetic: An anti-emetic is a drug that is prescribed to help control nausea, which can be caused by certain chemotherapy drugs.

Autologous bone marrow transplant: A small quantity of a patient's own bone marrow or stem cells are removed before receiving high-dose chemotherapy, which is intended to kill cancer cells in the patient’s body. The marrow or stem cells are then reinfused into the patient after the chemotherapy drugs are cleared from the body. This allows the bone marrow to replenish itself.

Biopsy: Removal of a sample of tissue from a patient in order to examine it under a microscope or to perform laboratory testing. There are several types of biopsies. Three of the most common types are: Fine needle aspiration (FNA) - a small gauge needle is inserted into the tumor, often guided by CT scan or ultrasound, and cells are withdrawn. If a larger gauge needle is used, the procedure is called a needle core biopsy. An excisional biopsy is a procedure in which a surgeon makes an incision into the skin and removes the whole tumor mass. This differs from an incisional biopsy in which only a small portion of the tumor is removed.

Blind studies: In a single-blind study, patients are assigned to a study group (also called an “arm”) in which all members receive either a research treatment, a "standard-of-care" treatment, or, in some cases, a placebo – however the patient does not know to which group (or arm) of the study they have been assigned. In a double-blind study, neither the patient nor the doctor knows which study group the patient is in. The intent is to minimize the chance of bias in judging the effects of the treatment. Most patients enter clinical trials hoping that they will receive the new, investigational treatments but in single and double-blind studies this often is not the case.

Blood Transfusion: A transfusion is the replacement of blood or a blood component. A needle is inserted into a vein and a tube carries replacement blood into the body. A transfusion might be required to replace red blood cells or some other blood component lost due to surgery, cancer treatment, or due to the illness itself.

Bone marrow aspiration: Removal of cells from the bone marrow. Bone marrow is located inside of some of the larger bones of the body. Red blood cells, white blood cells, and platelets are produced in the bone marrow. In a bone marrow aspiration, a doctor usually numbs the skin with a local anesthetic and inserts a small gauge needle into the hip or, in some cases, the sternum. The doctor then draws back on a syringe to remove a small quantity of cells, which are examined for abnormalities. A bone marrow aspiration is performed to diagnose illness, perform laboratory tests, or to monitor response to therapy.

Bone Marrow Biopsy: A bone marrow biopsy is similar to a bone marrow aspiration (see above) except that a larger gauge needle is used to obtain a small disk of bone along with a sample of bone marrow.

Bone Scan: This is a test that is used to see if cancer has spread to the bones. A harmless radioactive tracer is injected and concentrates in abnormal cells that are present in bones. These areas can then be detected. Cancer cells are not the only abnormal cells that might be found in bones. For example, arthritis and infections are among other types of cells that can also cause the tracer to concentrate.

Brachytherapy. Brachytherapy is a form of radiation treatment in which radioactive “seeds” are placed inside the body, as close to the cancer as possible. Brachytherapy allows for continual exposure of cancer cells to radiation and also spares overlying tissues from radioactive beams which must pass through to reach the tumor site.

Bronchoscopy: A bronchoscopy involves the use of a pliable fiber-optic filament which is attached to a camera to allow viewing of the throat and lungs. If a suspicious mass is found, a small biopsy can also be obtained during the bronchoscopy.

Cancer: The term cancer encompasses literally hundreds of different illnesses which involve abnormal cells. The three principal defining features of a cancer cell that make it different from other types of normal and abnormal cells are that 1.) cancer cells have the ability to grow out of control, 2.) to spread to other parts of the body (metastasize) and 3.) to erode through membranes and thereby invade into other tissues. In contrast, a benign tumor has only one of these three properties. A benign tumor certainly can grow in an uncontrolled fashion but it does not travel to other parts of the body and, although it can crowd other tissues and even damage them in the process, a benign tumor does not actually invade into the other tissues or organs.

Carcinoma in situ: A name given to a cancer that has not spread to other parts of the body or invaded nearby tissue.

Cardiac Toxicity: Some chemotherapy drugs, principally those in a class of drugs called anthracyclines, can cause permanent damage to the heart. Therefore, these drugs are given in carefully planned dosages and the patient’s heart is monitored for signs of change.

Chemotherapy: A type of cancer treatment that involves the use of drugs to kill cancer cells or to stop them from growing. Chemotherapy generally is used for cancers that have spread locally or to distant sites in the body. Adjuvant chemotherapy is used in certain cases where no additional cancer is visible after surgery but chemotherapy is given anyway, just in case the cancer has spread or some cancer cells have been left behind but have not been detected. Neoadjuvant chemotherapy is sometimes used prior to surgery in order to shrink a tumor mass to the point where a less extensive surgical procedure can be used. Drugs used for adjuvant chemotherapy are often the same drugs that are used for primary chemotherapy.

Clinical trials: Clinical trials are used to test the effectiveness of new treatments. In Phase I trials of chemotherapy drugs, maximum drug safe dosages for humans are established and short term side effects are noted. Most frequently, healthy volunteers are recruited into Phase I trials but sometimes cancer patients are also accepted into the studies. In Phase II trials, a small number of patients participate – perhaps one or two hundred - and drug effectiveness and a therapeutic range of drug dosages are noted. Phase III clinical trials are large-scale, multi-institutional studies in which a new drug must prove that it is more effective than existing treatments or at least equally effective, with acceptable toxicities. Phase IV trials are conducted after a drug has already received FDA approval for use in a certain group of patients. The idea is to see if the drug is effective for patients in other clinical settings or to see how combining the drug with other drugs affects the drug’s therapeutic benefit. Additional information about side effects also is collected.

Colony Stimulating Factors: These are drugs that boost the production of various blood components in order to replace those which are depleted by illness or by treatment with certain chemotherapy drugs.

Creatinine: Creatine is excreted in urine where it can be easily measured as an indicator of kidney function. Creatinine “clearance” is measured to determine if a patient has underlying kidney problems or to monitor a patient for potential damage to the kidneys from chemotherapy.

CT Scan (Computerized Tomography): The CT scan is an x-ray procedure that works by taking a series of cross-section photos of the body. A CT scanner rotates around the patient taking dozens of pictures. A computer then knits the photos together to produce a detailed image that simulates a slice of the body. Many such slices will be created to allow for thorough analysis of the specific part of the body that is being studied.

Cycle: Most chemotherapy drugs are administered only once every two or three weeks in order to allow the body to recover from harmful side effects such as the depletion of red and white blood cells, although some drugs are given in an oral daily dose. Each separate drug administration combined with it’s recovery period is called a cycle

Edema: Swelling caused by an abnormal accumulation of fluid in a limb, organ, or other body tissue.

EGFR: Epidermal Growth Factor Receptor. A protein molecule involved in normal and abnormal cell growth. In a healthy cell, EGFR signaling helps to perform a variety of useful functions such as regulating normal cell growth, facilitating wound healing, and helping to resist damage from toxins. However, abnormal signaling along the EGFR pathway has been associated with numerous dangerous cell behaviors such as tumor growth and progression, metastasis, resistance to chemotherapy, and generally poorer patient prognosis. A promising area of chemotherapy research involves developing drugs that interfere with EGFR activity and therefore prevent the type of abnormal cell growth that is associated with cancer cells.

Endoscopy: A small incision is made through the skin and a flexible tube containing a video camera is inserted. The doctor then can visualize a nodule or mass and perform a biopsy if necessary while viewing the procedure on a video monitor.

Endothelial Cell: Endothelial cells form capillaries in a process called angiogenesis. Capillaries carry oxygen and nutrients to tumor cells. A new class of drugs, called angiogenesis inhibitors, targets these endothelial cells. This starves tumor cells of oxygen and nutrients, interferes with the elimination of cellular wastes, shuts-down routes of tumor metastasis, and potentially aids in the delivery of other types of anti-cancer drugs to the tumor mass.

Extravasation: This describes a condition which occurs during infusional chemotherapy when a chemotherapy agent leaks from a vein into local tissue, causing damage to the vein and potentially also to the surrounding tissues.

Functional Tumor Cell Profiling: This is a laboratory method in which living tumor cells are obtained from individual cancer patients and are exposed to different chemotherapy drugs in order to see which of the drugs are effective at killing or stopping the growth of the cancer cells and which of the drugs are not effective. The purpose of Functional Tumor Cell Profiling is to personalize therapy design by identifying chemotherapy drug treatments that have the greatest likelihood of helping each patient as an individual. This is the opposite of empirical therapy selection in which patients are treated blindly with drugs that worked in the past for some percentage of patients who received them. Functional Tumor Cell Profiling is based upon the principle that no cancer patient is "average" but rather that each patient's illness is unique in its response to treatment. This is supported by the clinical observation that different cancer patients often respond very differently to the same treatments

Gallium Scan: A method for detecting cancer in which a radioactive tracer is injected into a vein and is then visualized to see if the tracer accumulates in a certain area of the body, potentially indicating the presence of a tumor in that area.

Informed consent: A legal document that outlines the aims, methods, and risks of a procedure or research study. A patient who signs an informed consent is indicating that he or she agrees to participate in a study or to undergo a procedure in spite of possible risks.

Infusion: Delivering drugs or other fluids into the body by means of a needle which is inserted into a vein. The needle may be attached to a syringe or to a tube which leads to plastic bag in which the fluid is contained.

Institutional review board (IRB): A panel of persons who must first approve and then monitor any clinical trial which includes human subjects in order to ensure the safety and privacy of patients who participate.

Intravenous (IV): The introduction of fluids into the body by means of injection into a vein.

Lymph nodes: These are small glands or sacks that are scattered throughout the body. Lymph fluid passes through the lymph nodes carrying infections and impurities, which are then trapped in the lymph node where they can be attacked by white blood cells. Cancer cells are often carried in lymph fluid and spread to other parts of the body through the lymphatic system. Therefore, doctors often examine lymph nodes for signs of cancer.

Lymphedema: An accumulation of lymphatic fluid in tissues, resulting in swelling.

Malignant: A term used to indicate the presence of cancer, such as a malignant tumor. The term “malignancy” can refer to a tumor mass, a cancerous cell, or a general or specific type of cancer.

Mediastinoscopy: An flexible tube is passed through a small incision at the base of the neck and directed behind the sternum into the chest cavity. This allows for visualization of a suspicious mass and the taking of a biopsy for study.

Metastasis: A cancer which has spread from the point of origin to another part of the body. A cancer may spread “locally”, generally meaning into surrounding tissues, “regionally”, generally meaning to not-too-distant structures such as lymph nodes, or else the spread may be “distant,” meaning to remote parts of the body.

MRI (Magnetic Resonance Imaging): MRI is similar to a CT scan but uses magnetic fields instead of radiation to visualize internal body structures. MRI scans can take longer to perform but provide greater detail than CT scans.

Mucositis: Occurs when chemotherapy damages epithelial cells which line the mouth and esophagus. The feeling is one of general soreness to these surfaces. Topical anesthetics may be given, including a viscous liquid which is gargled and produces temporary relief. Mucositis is a temporary condition. The cells usually replenish themselves and the soreness goes away within a few days.

MUGA Scan: A MUGA Scan is performed to assess heart function. It might be performed prior to starting chemotherapy or while therapy is in progress, to monitor heart function and see if changes are occurring. MUGA scanning involves injecting a radioactive tracer that is tracked with a special scanner as it passes through the heart.

Nadir: The lowest point in the white blood cell count reached after chemotherapy. Generally, it occurs around 7-14 days following drug administration, depending on the drugs and dosages given. Patients generally are most susceptible to infections when white counts are near their nadir.

Neoadjuvant Chemotherapy: See the definition under Chemotherapy.

Neoplasm: An abnormal, usually unregulated, proliferation of cells. A neoplasm can be malignant or benign. Cancer is often described as a “malignant neoplasm”.

Neutropenia: An abnormally low neutrophil count. A neutrophil is a type of while blood cell that helps to fight infections. Neutrophils are often depleted by cancer chemotherapy drugs and must be monitored throughout treatment.

Oncologist: A doctor who specializes in cancer treatment. A medical oncologist specializes in planning and administering chemotherapy treatments. A radiation oncologist treats tumors by exposing them to x-rays. A surgical oncologist specializes in removing tumors surgically. A gynecologic oncologist specializes in women’s reproductive cancers and combines certain attributes of both a surgical oncologist and a medical oncologist.

Oncology: A medical discipline that focuses on the study and treatment of cancer.

Performance Status: A relative scale doctors often use to describe a patient's overall physical well-being, based upon his or her ability to do everyday tasks such as sitting upright for long periods, walking, and performing other normal activities. Clinical trials often specify a minimum performance status level for entry in order to make sure that patients are well enough to receive certain chemotherapy drugs given at necessary dosages.

PET Scan (Positron Emission Tomography Scan): In a PET scan, a radioactive tracer which has been chemically bound to glucose - a form of sugar - is injected into a vein. Cells use higher amounts of glucose when they are actively dividing and reproducing themselves. Because a tumor contains large numbers of actively dividing cells, much of the glucose is absorbed by cells clustered in a small area. A PET scan looks for tumors by detecting areas in organs, lymph nodes and other parts of the body where the radioactive glucose has concentrated.

Port-A-Catheter: A port-a-catheter makes it easier to give chemotherapy when multiple drug infusions, spread over several weeks or months, are anticipated. The small plastic or steel port is inserted just under the skin of the chest or arm by a simple, outpatient procedure. The port-a-catheter has a small tube that remains connected to a nearby vein. Then, instead of repeatedly having to locate and puncture a vein in order to administer each cycle of chemotherapy, the drugs are introduced into the catheter with less discomfort to the patient.

Prognosis: A patient’s most likely clinical outcome based upon a variety of factors specific to the patient combined with what is generally known about the usual behavior of a certain type of cancer.

Protocol: A formal study plan consisting of guidelines and rules that must be strictly followed in the course of a clinical trial.

Randomized trial: A type of clinical trial in which patients are randomly assigned to receive different treatment regimens.

Recurrence: The return of a cancer that previously was in remission.

Red blood cell: Red blood cells are produced in the bone marrow. They circulate in the blood and carry oxygen to cells throughout the body.

Refractory: A disease which is not responsive to treatment.

Regimen: A chemotherapy plan - it includes drugs, dosages, and treatment scheduling.

Relapse: A disease recurrence following initial treatment success.

Remission: Similar to response (see below). It refers to a partial or complete disappearance of detectable cancer or the reduction or disappearance of disease symptoms.

Response: This has a very specific meaning in cancer treatment. In order to say that a response has occurred, a tumor mass must have shrunk by at least 30% in its perpendicular dimensions (height and width) in comparison with it's original size, when measured by some objective means, such as x-ray. If a tumor has shrunk by less than 50% it is called a partial response. If there is no evidence of disease following treatment it is called a complete response. A less technical but still measurable way of evaluating response is to detect proteins circulating in the blood, called tumor markers, that correlate with improving or worsening illness. An imprecise but highly practical method of evaluating treatment response is to note if there is an improvement in symptoms of disease. Response does not mean the same thing as a cure and, in fact, response is not even a reliable predictor of overall survival time. However, response to treatment clearly is a good thing and it is the first criterion upon which a physician determines whether or not a treatment is working. A treatment that does not produce a response in a specific patient will be discontinued.

Single agent: Single-agent chemotherapy is the use of a single chemotherapy drug for the treatment of cancer.

Splenomegaly: An enlarged spleen.

Stable Disease: A condition in which a cancer is becoming neither better or worse. For a solid tumor type it may mean that a tumor is neither shrinking nor growing. For a leukemia or other hematologic cancer it may mean that the circulating cancer cell population is neither increasing nor decreasing.

Stage: Staging is a method of determining the extent of the cancer, or how far the disease has spread. The stage is determined after performing a series of diagnostic tests, which may include x-rays, scans, and sometimes surgery.

Stem cell: An immature cell that has the ability to develop into any of several other types of cells, notably red or white blood cells or platelets. Most stem cells are found in the bone marrow, but a small number, called peripheral stem cells, circulate in the blood.

Thrombocytopenia: Some anti-cancer drugs and also some cancers themselves can suppress the bone marrow, in which platelet cells are produced. Platelets are necessary for blood clotting. Platelets have a fairly short life span and must be replaced about every 10 days. Thrombocytopenia is a condition in which platelet levels are reduced because platelets have died and cannot be replaced owing to bone marrow suppression.

Toxicity: Toxicity refers to the potential of a drug to produce harmful side effects. Most drugs have known toxicities. That is, they are known to produce specific types of side effects. When combining chemotherapy drugs, care must be taken to avoid administering two or more drugs with severe overlapping toxicity profiles.

Tumor markers: Proteins circulating in the blood that that are known to be produced by specific types of cancer. These can be detected and measured using laboratory techniques. More meaningful than static measurements of tumor markers are serial measurements over time which might indicate that the number of cancer cells in the body are increasing or decreasing. This can be useful as an indicator of whether a cancer is responding or not responding to therapy.

Tyrosine Kinase: An enzyme involved in communication within cells, or signaling pathways. Abnormal tyrosine kinase signaling can cause dangerous cell behaviors such as unregulated cell growth.

Tumor: A tissue mass generally containing a mixture of both mutated and normal cells. Some cells in the tumor may be necrotic (dead) and others may be viable (living). A tumor, also sometimes called a "lesion" a "mass" or a "neoplasm," may be malignant or benign. It takes about one billion cells to form a tumor mass that is one centimeter in diameter.

Ultrasound: An imaging technique in which high-frequency sound waves are used to create pictures of internal structures.

Vesicant: A chemotherapy drug that could potentially cause serious tissue damage if it leaked from the a vein into surrounding tissues. A drug that is capable of causing a somewhat less severe reaction if leaked is called an irritant.

White blood cell: White blood cells are immune cells, so-called because they are instrumental in fighting infections. When white blood cells are depleted, such as by certain chemotherapy drugs, or are not functioning properly, as in some cancers of the blood, the body is highly susceptible to infectious illnesses.