TERMINOLOGY

Mammotome - Device used to perform vacuum assisted out patient breast biopsies under the guidance of ultra sound imaging or stereotactic imaging.

Mammosite - Catheter placed in lumpectomy cavity, used to deliver radiation “seeds” over a 5 day treatment period. Not all patients meet the clinical criteria for this treatment method.

Oncovue - New risk test still in trial study. We are the only site approved in Central Indiana.  This is the first genetic-based breast cancer risk test which is relevant to all women.  For more information, visit www.oncovuetest.com

Oncotype - Risk test performed on the actual tissue specimen that was positive for cancer. It is a very individualized test which helps greatly with the cancer patient treatment plan.

Breast Lump/Mass - Something found in the breast either on Self-Breast Exam (SBE) or Clinical Breast Exam (CBE). A new lump may be benign or malignant. Possibilities include: Cyst (a benign, fluid-filled structure), benign tumor (fibroadenoma, papilloma, lipoma), prominent glandular tissue, fibrocystic changes, or cancer. If mass persists beyond a menstrual cycle it will need to be further evaluated. Sometimes an important mass cannot be identified on mammogram, so a “negative” mammogram does not necessarily mean that any particular lump is “ok”.

Breast Pain/Mastalgia - Usually a benign condition where one or both breasts cause pain. Often the pain varies with the menstrual cycle. Once important pathology is ruled out by undergoing a Clinical Breast Exam (CBE) and a mammogram, the symptoms of Mastalgia are usually treated clinically. Caffeine reduction and getting fitted for a good supportive bra are the mainstays of treatment. If no relief is obtained from these manipulations, vitamin E and sometimes Evening Primrose Oil can offer benefit if taken on a regular basis. Sometimes reassurance that there is no sign of cancer is all that is required in mild cases.

Abnormal Mammogram - Mammograms undergo a standardized rating which all Radiologists use in their readings. The American College of Radiology (ACR) has devised the BI-RADS (Breast Imaging Reporting and Data System) score which assigns a number value to every mammogram:


BI-RADS # Interpretation

0 -  Incomplete exam, additional imaging is needed

1 -  Normal

2 -  Benign Finding

3 -  Probably benign, short-term follow-up is required

4 -  Suspicious finding. Biopsy is suggested.

5 -  Highly suggestive of malignancy.

Categories 3,4, and 5 are considered “abnormal” and require further action. Many times what can be seen on a mammogram cannot be felt either on SBE or on CBE.
Examples of findings on a mammogram which may be “abnormal” include: microcalcifications, a density, a spiculated density, an area of architectural distortion, or asymmetry.

Microcalcifications/ Calcifications -  A finding on mammography. Calcium deposits in the tissues appear as very bright spots on the x-ray film. Calcium may be formed in tissues for a variety of reasons, only one of which is cancer. Many of these calcifications are obviously benign (to a Radiologist), but some are “indeterminant” and therefore suspicious. These would require a biopsy. Some of the criteria which suggest that calcifications might be suspicious include: clustering, being of varying shapes (“pleiomorphic”), or showing “branching” shapes. There have to be greater than a certain number of calcifications to be considered suspicious, so if the number increases from one year to the next, then these would require biopsy.

Heredity/ Family history of Breast Cancer/ Relatives with Breast Cancer  - Having a “first degree” relative with breast cancer increases one’s own risk to develop the disease by a factor of two. A first degree relative would be: mother/father, sister/brother, daughter/son. More removed relations do not have nearly the risk impact. Having no relatives with breast cancer does not guarantee that cancer will not develop: most women diagnosed with breast cancer are not related to someone with it.
“High risk” women need to begin mammogram screening at an age which is ten years younger than the youngest relative with the disease. They should have yearly (or sometimes more frequent) CBEs done by a physician who is skilled at breast diagnosis.
10% of breast cancer cases are found to be “genetic”. Families who have this genetic mutation ( BRCA-1 or BRCA-2) have very high risk for developing Breast, Ovarian, Prostate, and Colon cancer.

Genetic Testing / Familial Breast Cancer / BRCA -1 and BRCA -2 mutations  - Families in whom multiple members have developed Breast or Ovarian Cancer can undergo genetic testing to determine whether or not they have an inherited gene mutation. There have been two genes identified, on two different chromosomes whose mutations can be found on DNA testing. The presence of either of these mutations imparts a 50% - 80% lifetime risk of developing breast cancer, and there is an increased risk of developing ovarian, prostate, and colon cancer in these families as well.
If a person is found to have the mutation, not only is her risk of developing cancer elevated, but there is a 50% chance that each of her offspring will also have the gene mutation. Genetic Counseling must always precede genetic testing in order for the patient to make informed decisions, and to better understand the implications of the results.

Ultrasound -  An imaging study which is useful in evaluating a breast mass or specific mammogram abnormality. Sound waves are sent from a transducer against the skin through the breast tissue, and then bounce back. The reflected waves produce an image which shows characteristic findings for cysts, fibroadenomas, lymph nodes, or cancer. Ultrasound can be used to increase accuracy in biopsy. Ultrasound-guided core biopsy or fine needle aspiration can often be done in the office setting under local anesthesia for more rapid diagnosis.

MRI / Magnetic Resonance Imaging -  A type of imaging study which is just beginning to be used in Breast Diagnosis. Cancers will readily show up on MRI that might be missed on CBE, Ultrasound, or Mammogram. Being such a sensitive exam, often benign lesions will appear suspicious on MRI which often leads to more diagnostic testing. MRI is a very expensive exam, and so insurers strictly regulate its use. Currently MRI is being used on patients who have already had a Breast Cancer diagnosed, in order to make sure that the cancer is not present in unsuspected areas in the same breast (“multifocal disease”), and that the other breast is not affected (“bilateral” or “contralateral” disease). It is also sometimes used to evaluate very high risk women, or women with very dense breast tissue in whom Mammography is difficult to interpret.

Mammogram / Mammography -  An examination using x-rays to visualize the breast tissue. The breast is compressed between plastic plates in order to thin the tissue to allow penetration of the x-rays, and to splay the tissue out for accurate diagnosis. Allows diagnosis of very early stage Breast Cancer, often before a lump has had time to develop. Can also be used to guide biopsy, using fine needle aspiration, core biopsy, or mammotome biopsy. Recent technological advance has been to use “digital” mammography, where the image is stored digitally on a computer. This allows more manipulation of the image by the Radiologist, and better ability to share images with other specialists. Image acquisition is also faster, as there is no film to develop, so the patient’s mammogram does not take as long to complete.

Nipple discharge  - May be a “physiologic” phenomenon – the breasts, after all, are designed to produce and discharge fluid. May also be “pathologic” (a symptom of disease), but most often not a sign of cancer. If the discharge comes from both breasts, out of multiple ducts, and only with nipple stimulation, then this might be normal lactation, an effect of medication, or a symptom of a pituitary gland problem. If the discharge is only from one nipple, a solitary duct, or spontaneous, then there is more likely to be an explanation to be found within that breast. Nipple discharges can be watery, creamy, greenish, amber, bluish, rusty-colored, or frankly bloody. Bloody nipple discharges must always be further evaluated for 15% of these are associated with a cancer, often within the ductal system of the breast. A common benign lesion that causes nipple discharge is a Papilloma. Evaluation of a nipple discharge may include: CBE, mammogram, ultrasound, ductogram, biopsy.

Prevention of breast cancer -  Breast cancer is not a cancer that can be prevented by avoiding the things that are known to cause it, as can happen for lung cancer and smoking, cervical cancer and Human Papilloma Virus, etc. Many of the things that are associated with general good health have been shown to lower the risk for breast cancer. Obesity is associated with a higher risk. High fat diet may increase a woman’s risk. Smoking increases breast cancer risk. Excessive alcohol use elevates risk. Use of exogenous hormones (even the “herbal” ones, the phytoestrogens) is known to increase breast cancer risk.
For the BRCA-1 and BRCA-2 patients, consideration may be given to “prophylactic” (preventive) mastectomy, and to prophylactic “oophorectomy” (removal of the ovaries) once a woman’s family is complete. These measures have been shown to have a significant effect in reducing breast and ovarian cancer risk.

Breast redness / Erythema  - Redness of the skin of the breast can signify infection (mastitis) or rarely cancer. Redness (“erythema”) is a sign of inflammation. It is usually accompanied by a feeling of warmth to the touch, sometimes by tenderness. If the skin is swollen or “edematous”, it can sometimes look like an orange peel with little dimples where the hair follicles are. If the problem is mastitis, the patient will eventually develop a fever and become ill. Any breast condition that causes erythema will need to have a doctor’s evaluation. If there is mastitis it will require antibiotics, and sometimes surgical drainage of an abcess. If there is any concern that there might be a cancer responsible, a biopsy is necessary. Erythema (if benign) often takes several weeks to completely resolve, even after adequate treatment.

Paget’s Disease of the Nipple  - This is a condition where the nipple becomes eroded. Early on there is crusting of the nipple which heals then breaks open again. Eventually the entire nipple and areola will become involved in an open sore. This disease is a cancer of the nipple, and is often associated with an underlying cancer elsewhere in the breast. Sometimes the cancer is not invasive (in situ disease). It must be treated by removing the nipple-areolar complex, and historically has been treated by removing the entire breast (mastectomy).

Inflammatory Breast Cancer  - A very aggressive form of breast cancer. Symptoms usually include erythema (redness) of the skin, and edema within the skin which gives the appearance of an orange peel (“peau d’orange”) Very important to distinguish this from mastitis. Diagnosis is usually made with a skin biopsy in the office. First line of treatment is usually chemotherapy followed by surgery, then chest wall radiation. This form of breast cancer is sometimes seen in a neglected cancer, but has also been thought to develop very rapidly in other cases.

Lumpectomy / Partial Mastectomy -  An operation to remove a breast cancer. Combined with post-operative Radiation Therapy, this is an acceptable treatment for Breast Cancer which is known as Breast Conservation. The operation removes the tumor with a surrounding area of normal breast tissue. It is essential for the Surgeon and the Pathologist to confirm that the margin of the lumpectomy is clear of cancerous cells.

Mastectomy -  A breast cancer operation which removes the entire breast, nipple, and areola, but largely preserves the overlying skin and underlying muscle. This is an acceptable treatment for Breast Cancer. It is necessary if the tumor is too large for a lumpectomy, if the tumor is multifocal, or by patient request.

Radiation Therapy -  Used to complete breast cancer treatment to the remaining breast once lumpectomy or partial mastectomy has been done. Conventionally administered by exposing the breast to a beam of electrons from an external source. All other body parts are shielded from the radiation. Total dose of radiation to be used is calculated for each patient, and then administered in daily treatments over a period of weeks. The addition of Radiation to breast cancer treatment has allowed the choice of Breast Conservation. Without Radiation, local recurrence of breast cancer is unacceptably high.

Chemotherapy Cancer  -  treatment overseen by a Medical Oncologist. Usually denotes treatment with intravenous medications, but with Breast Cancer chemotherapeutic agents include some oral medications which counteract hormone effects on tumor cells. Can be administered before or after surgery, before or after radiation.

Child-bearing  -  Pregnancy definitely needs to be avoided during breast cancer treatment, and should be prevented until the patient has been disease-free for a period of time to make sure that survival is likely. Becoming pregnant after being successfully treated for breast cancer does not pose any additional risk for recurrence or development of new disease.

Abortion  - There is no data that show that termination of pregnancy confers any risk to a woman of developing breast cancer.

Male Breast Cancer  -  Approximately 1 out of 100 breast cancer cases are in men. Males in BRCA-1 or -2 kindreds have highest risk. Treatment most often consists of Mastectomy.

Gynecomastia  -  The presence of breast tissue in a man. Often related to use of certain medications; can be associated with liver disease; most often no cause can be identified. Gynecomastia does not elevate a man’s risk for breast cancer, and is considered to be a cosmetic issue. If desired, the breast tissue may be surgically removed.

Breast Cancer Abnormal  -  cells which develop in the breast out of either “lobular” or “ductal” tissue. These will divide abnormally and eventually develop into a mass or “tumor”. Cancerous cells invade into adjacent normal breast tissue, and can spread or “metastasize” to distant organs. Affects 1 out of every 8 women in the U.S. Breast cancer is the most common cancer in American women, and the second deadliest (behind lung cancer).

Male breast cancer -  1% of breast cancer cases are diagnosed in men. It usually presents as a mass or lump which is noticed by the patient. Treatment is most often a mastectomy plus lymph node sampling. Chemotherapy and radiation might be necessary, just as in female breast cancer.

Self breast exams / SBEs -  Usually practiced either while in the shower, or lying down in bed, the woman extends her arm over her head and examines the breast with the opposite hand. The entire breast and chest wall from the collar bone down to the crease beneath the breast, and the underarm area to the breast bone should be “palpated” (or felt) in a systematic way looking for a lump or area that feels different compared to the surrounding tissue. Any question of an abnormality should be evaluated by the doctor. SBEs should be done monthly, and are best performed just following the menses.

DCIS / Ductal carcinoma in situ -  A very early breast cancer that is still completely contained within the ducts of the breast, and has not yet invaded into the deeper breast tissue. Usually found through mammography, most have not yet grown into a mass. Most always curable, although sometimes the entire breast must be removed if the DCIS is extensive. Otherwise may treat with lumpectomy and radiation.

Atypia / Atypical Ductal Hyperplasia / ADH  -  A condition found on biopsy where breast cells are abnormal appearing under the microscope, but not cancerous. Possibly a “pre-cancerous” condition. Raises a woman’s risk of developing breast cancer in her lifetime by a factor of 4. Usually treated by removing entire abnormal area, but this does not reduce the woman’s risk.

Cyst  - A fluid-filled structure that can be present in the breast. May be solitary or multiple. Sometimes symptomatic; may be felt as a tender lump. These are considered a benign and common manifestation of breast development and aging. If a cyst is bothersome, it can be treated by removing the fluid with a needle and syringe. The presence of breast cysts do not affect breast cancer risk.

Fibrocystic disease -  A condition of the breast tissue which is now thought of as a common and benign “ aberration” rather than a “disease”. The breast tissue contains more than the normal amount of fibrous tissue with multiple tiny cysts imbedded within it. Fibrocystic breasts can be painful, particularly in the pre-menstrual phase. On SBE, fibrocystic breasts may feel very lumpy, firm, and tender. Breast exams in the fibrocystic patient may be confusing, and mammography may be less sensitive due to dense tissue. Fibrocystic disease does not increase a woman’s risk of developing breast cancer.

Fibroadenoma  -  A benign mass in the breast. Most commonly found in young women. Felt to be an “aberration” of normal breast development. Most often these are not painful, or otherwise symptomatic. May be left alone if the diagnosis is certain, and growth does not continue. If bothersome to the patient, or if the fibroadenoma continues to grow, they are treated by surgical removal. Usually diagnosed by a combination of clinical examination and ultrasound; may be biopsied. Fibroadenomas do not increase a woman’s risk of developing breast cancer.

Biopsy -  Removal of a piece of tissue in order for the Pathologist to examine it under the microscope. Can be performed with a needle and syringe, a “coring” needle, or by surgically removing all or a portion of a mass. Breast biopsy is often combined with mammography or ultrasound in order to target a lesion that cannot be felt by examination.

Lymph nodes - Tiny structures which are present in large numbers throughout the body, and are involved in the immune system. Cancers will often spread to lymph nodes, and so lymph nodes are examined in order to help determine the stage of the cancer. The lymph nodes which are related to the breast are located under the arm on the same side of the body. They are surgically removed during breast cancer surgery in order to examine them under the microscope.

Sentinel lymph node biopsy  -  A method of identifying and removing the lymph nodes for Pathologic examination. Using radioactive tracer material and injectable dye, the first lymph nodes in the chain of nodes are identified and then surgically removed through a small incision under the arm. If there are no metastases found in the sentinel nodes it is highly unlikely that any lymph nodes at all are involved.

Metastasis (pleural: metastases) -  Implants of cancer at a site distant from the original tumor. Breast cancer most commonly metastasizes to lymph nodes, bones, lungs, liver, and brain. Metastatic disease is usually treated with chemotherapy or radiation, or both. Cancer travels by shedding cells into lymph or blood vessels, which then lodge and begin to grow in other organs.

Port-a-cath / Infusaport / Port -  An intravenous device which is implanted surgically, and can remain in for months to years. It is used for administering chemotherapy. May also be used for drawing blood tests. A port is usually placed under the skin on the front of the chest. It is attached to some tubing that lies in a large vein under the collar bone. Rarely associated with complications such as lung puncture, bleeding, infection, or blood clots. A port is much more comfortable for the patient who is having frequent IV meds and blood draws, compared to using the small veins in the arm or hand.

Breast Reconstruction / Implants -  Following a mastectomy, a patient may elect to have Plastic Surgery for reconstruction of the breast mound. This can be performed sometimes immediately following the mastectomy, during the same surgical procedure. Some patients elect to have the reconstruction performed at a later date. A new contour can be fabricated by placing a fluid-containing implant behind the chest muscle, or by transferring the patient’s own muscle tissue onto the chest wall as a mound under the skin. Reconstruction allows the patient to wear a normal bra without a prosthesis.

Prophylactic mastectomy -  A mastectomy done on a breast that does not have cancer. Usually offered to women who are at excessive risk of developing a breast cancer. This operation does not reduce the risk of breast cancer to zero, but significantly reduces it.

Estrogen receptors  -  Breast cancer cells may be responsive to the effects of hormones if they have receptors on their surface. There are receptors for both, estrogen and progesterone that may be identified in the lab. All breast cancers are tested for receptors. Women with hormone “sensitive” tumors are sometimes offered a chemotherapy pill (Tamoxifen, Arimidex…) in addition to their other treatments. These pills block the effect of hormones on the tumor cells.

Tumor grade -  A scoring system used by the Pathologist to characterize a breast cancer based on features seen under the microscope. There are 3 grades, with Grade 1 being most favorable, and Grade 3 being most aggressive. This information is used by the Oncologist to help make decisions regarding treatment.

Tumor stage -  The stage of a cancer helps determine the treatment regimen, and also determines the prognosis. For breast cancer, the stage is determined using information on the tumor size (“T”), the presence of involved lymph nodes (“N”), and the presence of distant metastases (“M”). There are 5 stages: Stage 0 denotes in situ (or non-invasive) disease, Stage 4 denotes the presence of distant metastases. A lower stage signifies more favorable disease, therefore a better prognosis.

Lymphedema -  Swelling of the arm on the side of a breast cancer. This is a known complication of lymph node removal from under the arm, which is performed to determine the stage of the cancer. Much less frequently occurring now since Sentinel Lymph Node Biopsy has become the method of choice for examining lymph nodes, although it still may occur. If diagnosed and treated early, lymphedema can be manageable and not so troubling. If neglected, lymphedema can cause severe deformity and loss of use of the limb. Treatment usually involves Physical Therapy, massage, and use of elastic sleeve garment.

Clinical Breast Exam / CBE -  Performed by a Health Care Professional, a manual examination of the breasts and axilla (underarms) looking for masses, skin changes, asymmetry, nipple discharge, abnormal lymph nodes. CBE should be part of an annual physical exam. In high risk women, CBE is sometimes necessary every 6 months.

Papilloma -  A benign growth of cells within a milk duct. Often will cause production of a nipple discharge, sometimes bloody. Can occasionally become large enough to show up on the mammogram as a density or nodule. Historically considered not to increase a woman’s risk of developing breast cancer, but this is under some debate. Usually removed surgically.

Lipoma  -  A benign tumor composed of fat cells, lipomas can occur anywhere in the body, including in the breast. May be felt as a soft mass. Of no consequence in regard to breast cancer risk. Only removed if diagnosis is unclear.

Density / Neodensity - A finding on mammography of a new spot . Because of the possibility of the density representing a cancer, these need to be evaluated with additional mammogram views and ultrasound. If benignity cannot be proven with imaging, a biopsy will be necessary.

Spiculated -  The radiologic term for a finding on mammogram of a density that has fine lines radiating out of it, giving the appearance of an irregular starburst on the film. This is a suspicious finding, and as a general rule will require biopsy. A spiculated density confers approximately 15% - 20% risk of a breast cancer being present.

Architectural distortion -  A mammogram finding where the tissue in a focal area appears abnormal compared to surrounding areas, as though the normal shadows are being drawn in, “folded”, or “tented”. This finding may represent a breast cancer, but also can be due to scarring from previous surgery, injury, or infection. A biopsy is often necessary to rule out malignancy.

Asymmetry  -  A finding on mammography or CBE where a place in the breast is different from the corresponding place in the opposite breast. May not represent a pathologic condition, but may require biopsy to rule out malignancy if the asymmetry is new.

Cancer / malignant / malignancy  -  A condition which occurs when dividing cells lose the ability to stop dividing. Uncontrolled cell division produces new generations of similarly abnormal cells. Malignant cells also possess the ability to invade into surrounding tissues and disrupt the function of the organ in which they are present. They can also travel within the bloodstream or lymphatic vessels, lodge in other organs, and disrupt and damage that organ’s functions. The phenomenon of traveling to distant organs is known as metastasizing.

Core biopsy -  A method of obtaining a tissue sample whereby one or more slivers of tissue is obtained using a large bore needle. Usually no attempt is made to completely remove the lesion being sampled. The biopsy is performed under local anesthesia, and can be directed by imaging or by simply “palpating” (feeling) the lesion.

Mammotome -  A specialized form of core biopsy using a larger needle attached to suction. Very large cores of tissue are removed, which may sometimes improve the accuracy of diagnosis. Always used in conjunction with mammography (“stereotactic” biopsy) or ultrasound.

Fine Needle Aspiration / FNA  -  A method of biopsy in which a small needle is directed into the lesion and a sampling of cells is obtained. This is the least accurate of the “non-invasive” biopsy methods.

Ductogram -  An xray during which some dye is injected into a milk duct. Usually done in the evaluation of an abnormal nipple discharge.

Abscess  -  A localized infection in the breast in which a pocket of pus has formed. Usually quite painful, and often accompanied by fever and general illness. Abscesses usually require a surgical drainage procedure, followed by open packing of the wound with regular dressing changes until healing occurs. Antibiotics are also used in treatment, but must be used in conjunction with surgical drainage.

Breast conservation  -  The term used to describe the combination of lumpectomy and radiation therapy for treatment of breast cancer.

Prognosis  -  The long term expectation in relation to a disease. Usually determined by the stage of cancer, the odds of cure or remission or death are based on the observation of the experience of other patients with a similar stage.