Terminology
Mammotome - Device used to perform vacuum
assisted out patient breast biopsies under the guidance of ultra sound imaging
or stereotactic imaging.
SAVI - 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.
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 - An 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. 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.
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).
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) - Invasion 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 areas.
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.
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.
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