The Cancer Journey

A Glossary of Cancer Terms

Adjuvant therapy: This is a treatment that is given after completion of curative surgery. Even though the main tumour has been surgically removed, microscopic cancer cells may be left behind which adjuvant therapy aims to destroy. Common situations where adjuvant therapy is given include adjuvant systemic therapy (including chemotherapy, hormonal therapy and targeted therapy) after surgery for breast cancer or chemotherapy for stage 2 or 3 colorectal cancer. Adjuvant radiotherapy to the breast and lymph nodes after breast conserving surgery or head and neck surgery.

Associated costs: These costs that are not specifically related to medical costs such as medication, hospital fees. This can include childcare, food, transportation, unpaid leave. This has to be factored into calculating the financial burden of therapy.

Benign: A benign tumour is one that is non-cancerous. They are very unlikely to metastasize. Benign tumours if not treated or removed may grow over time and affect surrounding organs, or become cancerous for example a pituitary tumour in the brain.

Biopsy: A biopsy is the removal of tissue (a small portion of the tumour) in order to examine it under a microscope in more detail. This is often the most definitive method in which to confirm a cancer diagnosis (benign versus malignant tumor) and determine the origin of a tumour eg. whether it is a breast, lung, colon cancer.

Bone marrow: Found at the center of all large bones, bone marrow is a soft tissue that is located where blood cells are created including red blood cells, white blood cells, platelets.

Cancer: Characterized by abnormal cell growth in almost any part of a person’s body, cancer is the term given to a group of more than 100 diseases. Cancers have the ability to spread to other parts of the body (metastasize).

Carcinoma: are the most commonly found cancer. These cells originate from tissues that cover internal organs. Common examples are breast, colorectal, lung cancer.

Cells: The basic building blocks that make up the human body. Too small to be seen with the naked eye, too small to be seen by.

Chemotherapy: Drugs that are toxic to cells that are used to kill cancer cells. They normally prefer to kill cancer cells compared to normal cells in the body, therefore they can be used as medicines.

Chronic: Refers to a persistent disease or symptoms that lingers over a long period of time, often many months to many years.

Clinical trial: Testing new treatments to determine their safety levels and effectiveness. A lot of research is normally done before the drug can even be introduced into humans, and there is a reasonably high expectation it will be better than the current “standard of care”. It usually takes hundred of millions of ringgit and years to perfect a drug that can be safely used in human beings.

Clinical Oncologist: A doctor who has undergone further training to specialize in oncology. A clinical oncologist is licensed to deliver both systemic therapy and radiation oncology. A medical oncologist is only licensed to deliver systemic therapy and need to work with a clinical oncologist to deliver cancer treatment.

Cure: Someone who is completely clear of the cancer, no cells left in the body.

Evidence-based medicine (EBM): is the process of systematically reviewing, appraising and using clinical research findings to aid the delivery of optimum clinical care to patients.

Follow-up care: The continuous monitoring of a patient usually for a minimum of 5 years after cancer treatment. During this time the patient returns to clinic at regular intervals to have check-ups, blood tests and scans to detect recurrence.

Guidelines: are medical recommendations describing the current best available treatments. Reputable guidelines include the American NCCN (National Comprehensive Cancer Network), ESMO (European Society for Medical Oncology) and so forth.

Hormone therapy: A treatment that is designed to reduce hormones levels in the body or block the hormones from being used by cancer cells to grow. It is usually done in cancers that feed on hormones such as prostate cancer feeding on testosterone and breast cancer feeding on oestrogen. By starving the cancer cells of hormones they eventually die or are unable to grow further.

Imaging test: Scans are useful to visualize the cancers – to determine their size, whether they have spread to other parts of the body, whether they are causing damage to our organs. Examples are PET-CT, CT, MRI, ultrasound, mammogram.

Immunotherapy: A cancer treatment that works to boost the natural defenses of the boy.

Late effects: The side-effects of treatment such as surgery or radiation therapy that appear after months or years after the treatment.

Leukemia: known as the cancer of the blood. Acute lymphocytic leukemia, chronic lymphocytic leukemia, acute myeloid leukemia and chronic myeloid leukemia are the four most common types of leukeima.

Locally Advanced Cancer: A cancer that is usually large and has invaded surrounding tissue or lymph nodes but has not metastasized (spread to other parts of the body). For example a prostate cancer that has invaded seminal vesicles, or a lung cancer that has spread to lymph nodes in the chest (mediastinum), or a large breast cancer more than 5cm. Locally advanced cancers usually require neoadjuvant systemic therapy or radiotherapy to shrink them first before an operation can be performed safely.

Local Therapy: Treatment that is focused on one part of the body (as opposed to systemic therapy). Examples are surgery, radiotherapy, cryoablation (freezing a tumour to death), microwave ablation (burning a tumour to death).

Lymphatic system and lymph nodes: The system of small vessels and small organs (lymph nodes) that carry lymphatic fluid throughout the body. They contain white blood cells and function to ward off infections. However this system of vessels can be the route by which cancer cells spread in the body.

Lymphoma: Lymphoma is a cancer that affects cells in the lymphatic system. They can be B Cell or T cell lymphoma .

Medical Oncologist: A doctor that is licensed to deliver systemic therapy and will work with a clinical oncologist or radiation oncologist to deliver complete cancer care.

Metastasis: When cancer cells break away from the initial tumour and travels/spreads to other organs, for example a lung cancer that has spread to the lung, liver or brain. They can either use the bloodstream or lymphatic system to spread. Some types of tumour prefer to spread to certain organs for example prostate cancers like to spread to bones but rarely to liver or lungs.

Neoadjuvant therapy: A treatment (either systemic therapy or radiotherapy) that is given before curative surgery to shrink the tumour to enable the surgeon to successfully remove the cancer. For example radiotherapy to a rectal improves the chances of successful surgery. If the radiotherapy is given after surgery the effectiveness is much less. For breast cancers that are above 2-3cm in size which are triple negative or HER2 positive, chemotherapy before operation can help to improve survival. In this situation early chemotherapy before surgery also helps to kill the cancer cells which have metastasized to other parts of the body early. If given after surgery, which could be several weeks later, the cells would have even more opportunity to spread and multiply endanger the life of the patient.

Oncology A branch of medicine that specializes in the treatment of cancer.

Palliative: Any form of treatment that aims to improve quality of life and help to reduce the troubling symptoms a patient may be experiencing such as pain, breathlessness, swelling. The aim of palliative treatment is not to cure the patient but may allow prolongation of life

Placebo Effect: A “treatment” that does not have any actual effect or benefit, however if the patient is convinced the treatment will work, they may experience relief of symptoms. But in actual fact the cancer continues to grow

Polyp: A growth that sticks out from the lining of an organ.

Pre-existing condition: A known condition that a person has had for a length of time.

Precancerous: The cells that may have the potential to later become cancerous. Examples are DCIS (Ductal Carcinoma In Situ) of the breast which eventually turns into breast cancer.

Predisposition: The likelihood of which a person may be susceptible to a disease which may be triggered under certain circumstances.

Primary cancer: The site of the original cancer, or where the cancer first formed. Oncologists will base treatment on the primary cancer. For example if a lung cancer metastasizes to the liver, the treatment for both the liver and lung tumours is lung cancer treatment. Using liver cancer treatment for the tumour in the liver will not be effective

Prognosis: How long a patient is expected to live or whether we expect the cancer to respond to treatment

Radiotherapy (@Radiation therapy): The method of destroying cancer cells through the use of high-energy x-rays.

Recurrence: A cancer reemerging after a period of time where no cancer could be detected. “Local recurrence” refers to cancer that has returned to the original area. “Regional recurrence” relates to cancer that has returned to the area adjacent to the original cancer site. “Distant recurrence” indicates the spread of cancer through the lymphatic system or bloodstream into a new organ of the body which means the cancer is now stage 4.

Regimen: The plan of treatment, including expected treatments, procedures, listed medications and their corresponding dosages, treatment schedules and all relative time frames.

Rehabilitation: The services that help patients with cancer regain their best physical, psychological, social and work-related abilities both during and after their treatment.

Remission: The temporary or permanent disappearance in the signs and symptoms of cancer, but not the entire disease.

Sarcoma: originates in the supporting tissue of the body such as muscles, blood vessels, fat tissue or bone.

Screening: Doing tests in people with the purpose of detecting cancer early before they develop symptoms.

Standard of care: The best available treatment for a particular stage of cancer, for that particular type of tumour. The standard of care has usually been determined by many oncologists working for many years to perfect a particular regimen.

Surgery: An operation that involves the removal of cancerous tissue.

Survivorship: Living with or through cancer or being rid of cancer all together.

Systemic Therapy: Any drug which is delivered that uses the bloodstream to travel around the whole body to target cancer cells wherever they may be hiding. It includes drugs which are taken as a tablet or injected. Systemic therapy encompasses chemotherapy, hormonal therapy, immunotherapy and targeted therapy.

Targeted therapy: Drugs which are designed to specifically target specific genes, proteins or other molecules in the cancer cell. This is meant to be a more “bull’s eye” approach compared to chemotherapy which is less specific for cancer cells.

TNM Staging: T – tumour size and how much it has invaded the tissues around the primary, N – the degree of spread of the cancer to lymph nodes, metastases – whether the cancer has spread to other organs in the body. Taking into account T, N and M, we then assign the cancer stage be it from 1 to 4.

Tumor: When normal cells begin to grow and change, they become a mass called a tumor. A tumour can be either benign or malignant. Tumour just means an abnormal growth, not necessarily a cancer.