+ BISPHOSPHONATES:
The bisphosphonates are drugs that reduced the bone problems in breast cancer women with metastasis. Bone pain, fractures of bone with metastasis and the need of bone irradiation are reduced by bisphosphonates. The side effects of bisphosphonates are few. Some patients show fever, conjunctivitis and bone pain.

+ BODY SURFACE AREA :
The body surface area (BSA) is calculated from patient height (metres) and weight (kilograms) and it is expressed in m2. The BSA is used for know the chemotherapy drug doses.

+ BONE GAMMAGRAPHY :
Gammagraphy is a testing method with previous injection of radioactive substance (in dose and materials no danger for the patient and people around). Gammagraphy is used to see all skeleton and detect metastasis in bones.

+ BRACHYTHERAPY:
Brachtytherapy is one type of radiation therapy. Unlike external radiotherapy, in which high-energy ray beams are generated from outside the body (80-100 centimetre to the patient), brachytherapy involves placing a radioactive material directly inside the body. In conservative treatment of breast cancer, brachytherapy is used to “reinforce” the radiotherapy dose where the tumour was before its remove (localization with more risk of recidivist).

+ BRCA1:
Long and complex gene located on chromosome 17. More than 500 mutations have been detected along this gene. BRCA1 mutations are hereditary and they are associated with an increased risk of breast and ovarian cancer. BRCA 1 mutations are associated too with an increased risk of prostate cancer but to a lesser degree than breast and ovarian cancer. People with BRCA1 mutation have 56% to 85% chance of getting breast cancer sometime during their life. People with BRCA1 mutation have 15% to 45% chance of getting ovarian cancer sometime during their life.

+ BRCA2:
Complex gene located on chromosome 13. The BRCA2 gene is two times longer than BRCA1 gene. The BRCA2 gene is associated with an increased risk of breast cancer in women (similar to BRCA1) and men (the risk is 6% along the life of men). An increased risk of ovarian, pancreas cancer and melanoma has been reported. The BRCA1 and BRCA2 genes have showed in the most breast and ovarian hereditary cancers and approximately in half of breast hereditary family cancers.

+ BREAST BIOPSY :
A biopsy is a medical test involving the removal of suspect tissue. The tissue is examined by a phatologist to determine a diagnostic.

+ BREAST CANCER :
Breast cancer starts in breast cells.

+ BREAST CANCER, SYMPTOMS:
The symptoms of breast cancer depend on disease extension. Early breast cancer (non palpable cancer only detected by mamography) usually does not cause symptoms. When tumour is palpable, the first manifestation is a lump in the breast (greater or smaller size). Sometimes the lump appears in the armpit (lymph node). Other possible manifestations of breast cancer are: breast pain, thickening of skin and fluid coming from the nipple.

+ BREAST RECONSTRUCTION :
Breast reconstruction is surgery to rebuild a breast’s shape after total or partial mastectomy.

+ CAPECITABINE:
Drug used to the treatment of local advanced and metastatic breast cancer after the patient has failed anthracycline-based treatment or another. Some side effects of capecitabine are: skin and subcutaneous tissue alterations and intestinal problems (diarrhea, nausea, vomits).

+ CARCINOMA, in situ:
The cancer growth inside ducts or lobules so there aren’t external invasion.

+ CATHETER:
The catheter is a thin and flexible tube that allows liquid drainage. Sometimes, after the breast surgery, develops a seroma (a pocket of fluid) that it must be drained.

+ CHEMOTHERAPY:
Chemotherapy, in its most general sense, refers to treatment by drugs (not hormonal) that kill cancer cells.

+ CHEMOTHERAPY, high doses:
The role of high doses chemotherapy in treatment of metastatic breast cancer is controversial. Some alkylating drugs (cysplatin or carboplatin, cyclophosphamide, etc.) are combined and they are applied to almost lethal doses (with autotransplant support) to destroy whatever more cancerous cells are possible. However, the results obtained until now don’t be better than traditional schemes (CMF, FAC).

+ CLINICAL TRIAL :
A clinical trial is a study made in humans to establish by scientific way if one treatment is superior to another. Specially, it must value the repercussion on survival and quality of life.

+ CLINICAL TRIAL, phases:
The experimental phase is the study of a new drug or a new modality of treatment in experimentation animals. The next step is the Phase I that it designed to asses maximum tolerated dose of the new drug or the new treatment modality in human subjects. When the Phase I is superseded begin the Phase II that it asses the possible activity of the new drug or the new treatment modality on different tumours. Finally, the Phase III is aimed at being the definitive assessment of how effective the new drug or treatment is, in comparison with current 'gold standard' treatment. When the Phase III is superseded begin the Phase IV that involves the safety and ongoing technical support of a drug after it receives permission to be sold.

+ CMF:
Classical association of three anticancerous drugs: cyclophosphamide (C), metotrexate (M) and 5-Fluorouracil (F). It’s lot of used as adjuvant chemotherapy or complementary chemotherapy.

+ COMPLETE HEMOGRAM AND PLATELETS :
A complete hemogram of patient blood sample inform about red blood cells (erytrocites), haemoglobin (iron content of erytrocites), white blood cells (leucocytes) and platelets (essential cells to blood coagulation) counts.

+ COMPUTED TOMOGRAPHY (CT): :
Computed tomography is a medical imaging method that it combined a revolving X-ray machine with a computer. Digital geometry processing is used to generate a three-dimensional image of the inside of an object from a large series of two-dimensional X-ray images taken around a single axis rotation. CT to make possible the detection of nodes bigger than normal nodes and metastasis.

+ CONSERVATIVE TREATMENT:
In the conservative treatment, the tumor is removed based on it size and anatomical site by tumorectomy, segmentectomy or quadrantectomy. The all breast never is removed. After surgery, breast radiotherapy is always applied.

+ CORTICOSTEROIDS:
These drugs are used sometimes to diminish the risks of some anticancerous drugs and to improve the condition, mainly in advanced patients. The corticosteroids improve the appetite. The risks of corticosteroid treatment are insomnia, anxiety, high blood pressure, osteoporosis, and stomach ulcer.

+ CUADRANTECTOMY:
The cuadrantectomy is the removal of a breast quadrant (fourth part) as conservative treatment. After this intervention, the total breast is treated by radiotherapy.

+ CYCLOPHOSPHAMIDE :
A lot of used alkylating group drug in oncology. It is used to treat breast cancer in various regimens.

+ DEFENCELESS:
Defenceless is the reaction of that patient who is totally sunk by her disease and live based on it. The patient used to processing the given information in negative way. Defenceless is also known as resignation. See “facing strategy” in this glossary.

+ DEPRESSION :
The depression is a reaction of sadness, pessimism and apathy. There are diverse degrees of depression. The depression can appear in the middle of the chemotherapy and radiotherapy or at the end of these treatments (see “psychological support” section). Remember that FEFOC help you to value depression level (see home page).

+ DOCETAXEL:
Docetaxel is a semisynthetic derivate obtained by yew tree. It is used in the treatment of the advanced breast cancer.

+ DUCTAL CARCINOMA, in situ:
Ductal carcinoma is the most common type of non invasive breast cancers. It starts in the ducts.

+ EARLY DIAGNOSIS:
The cancer is diagnosed in its initial stages. It is located in the breast. The cancer hasn’t disseminated neither to lymphatic nodes nor sanguineous route.

+ ECHOGRAPHY :
The echography is an image diagnosis obtained by ultrasounds and sound waves that create an image of the breast in a screen. It’s used to distinguish between benign cyst (liquid contain) and suspicious solid mass.

+ EPIRRUBICINE:
Epirrubicine is a drug similar to adriamicine but with less heart toxicity. It is used in breast cancer as complementary chemotherapy associated with other drugs.

+ EXTERNAL RADIOTHERAPY :
The patient sits or lies on a couch and an external source of radiation is pointed at a part of the body where the cancer is. The machines more used are cobalt “bomb” and lineal accelerators.

+ FAC:
FAC is the chemotherapy association of 5-Fluorouracil (f), Adriamicine (A) and Cyclophosphamide (C), for post surgery treatment and treatment of patients with metastasis.

+ FACING STRATEGY :
Way in which the patient reacts to the cancer diagnosis and treatment. It depends on several factors like personality, psychopathologic alterations antecedents, social and familiar support, as well as the age. In general, five facing strategies have been identified (see definitions in this glossary): fighting spirit, negation, hopelessness, defencelessness and anxious preoccupation. Each facing strategies will influence in the quality of life of the patients and its relatives. Remember that FEFOC help us to evaluate your facing strategy (see home page).

+ FAMILIAR UNIT :
Familiar unit is a concept used to define the approach of the psychological problems caused by the cancer and its treatment, from a familiar perspective. That is the alterations are conceived and treated by the idea that the patient is the implied person but its environment people too.

+ FIBROSIS :
Fibrosis is the formation or development of excess fibrous connective tissue in an organ. The breast fibrosis is benign and frequent, especially after menopause. The fibrous connective tissue is the support tissue of breast structures.

+ FIGHTING SPIRIT :
The patient with fighting spirit reacts to disease with desire to fight. The cancer represents a challenge for her. She request information and scrupulously follows the indications of the doctor. This attitude is good for her familiar environment and her medical team because she is a combative patient that to fall to pieces few times and in concrete facts. See “facing strategy” in this glossary.

+ GRADING:
Pathology grading systems are used to classify cancer in terms of how abnormal the cells appear microscopically and what may be the outcome in terms of rate of growth, invasiveness, and dissemination. Cancer is a disorder of excessive cell growth, hence cancer cells often are poorly differentiated. The grade reflects the degree of cellular differentiation and refers to how much the tumor cells resemble or differ from the normal cells of the same tissue type.

+ GRANISETRON :
Granisetron is a drug used as an antiemetic to treat nausea and vomiting following chemotherapy.

+ HEIGHT:
The height is a length of a person from the feet at the top. Usually it’s expressed in meters and it’s used to the calculation of the body area.

+ HER-2/neu :
HER-2/neu is a protein giving higher aggressiveness in breast cancer. Trastuzumab (see in this glossary) associated or not to paclitaxel can effective in breast cancer where the HER-2/neu receptor is overexpressed.

+ HOPELESSNESS :
The hopelessness is a facing strategy of that patient who reacts with desperation in front of cancer diagnosis. It’s difficult to give her consolation and lightening.

+ HORMONE:
A hormone is a chemical substance produced and released from endocrine glands (testicles, ovaries, thyroids, adrenals, etc.) in the body. The hormones are secreted to the bloodstream and influence in body functions. Estrogens and progesterone are interest hormones in this context.

+ HORMONE RECEPTORS :
A hormone receptor is a receptor protein on the surface of a cell or in its interior (citoplasm) that binds to a specific hormone. The hormone causes many changes to take place in the cell. Binding of hormones to hormone receptors often trigger the sats a biophysical signal that can lead to further signal transduction pathways or trigger the activation or inhibition of genes. The receptors can be blocked by some drugs like tamoxifen.

+ HORMONE TREATMENT:
The therapy with hormone drugs change patient hormone environment. The objective of hormone treatment is to stop the tumor growth.

+ HORMONE TREATMENT, adjuvant :
The adjuvant hormone treatment is applied after surgery or radiotherapy when therapeutic reinforcement is necessary by the initial tumor area.

+ HYPERPLASIA:
Hyperplasia is referring to the benign proliferation of cells within an organ or tissue beyond that which is ordinarily seen.

+ IMMUNITY :
Resistance of the body in front of certain substances or micro organisms.

+ IMMUNODEFICIENCY:
State in with the immune system’s ability to fight infectious disease is compromised or entirely absent. Some chemotherapy drugs can cause certain immunodeficiency by reduction of white blood cells count.

+ INTERNAL RADIOTHERAPY :
See brachytherapy.

+ IPOS :
International Psycho-Oncology Society created in 1984. The mission of IPOS is to be the international multi-disciplinary organization dedicated to fostering the science of psychosocial and behavioral oncology and improving the care of cancer patients and their families throughout the world. IPOS has experienced an important growth so the importance of this subject is crucial.

+ JUDGEMENT, of control :
Patient perception respect to its capacity to control the situation in front of cancer diagnosis. Because the breast cancer and its treatment can cause in the patient and his family the sensation of no longer controls their lives, it’s good to strengthen their control judgement by clear and adapted information to the circumstances of each case.

+ KILOGRAM:
Base unit of mass. The patient weight in kilograms is used to calculate the body area.

+ LAPAROSCOPY :
Laparoscopy is a modern surgical technique in which operations in the abdomen are performed through small incisions. The key element in laparoscopic surgery is the use of a laparoscope, a long and little thick tube.

+ LETROZOLE :
Letrozole is more used in patients with resistance to tamoxifen but some studies show similar efficacy between letrozole and tamoxifen as first line of hormonal treatment. Letrozole blocks production of estrogens. A third part of the patients show hot flushes, nauseas and weakened hair. Letrozole is associated to a higher risk of blood circulation problems (trhombophlebitis), cephalea, dizziness, bone and muscle pain, vaginal bleeding, increment or loss of weight. Letrozole is not associated to a higher risk of uterus cancer.

+ LIBIDO :
Sexual impulse. The libido can be altered in front of cancer diagnosis or by the treatment.

+ LIVER TESTS :
Because the treatment cans injury the liver, the liver tests are made frequency at the diagnostic time and in the patients under hormonal treatment or chemotherapy. In addition, the liver tests are made to detect early possible metastasis.

+ LOBULAR CARCINOMA, in situ: :
The lobular carcinoma is less frequent than the ductal in situ. Many authors think that it isn’t an authentic cancer but it’s a risk maker. The cells are only in the linning of the lobules or lobes of the breast.

+ LYMPH NODES :
Human lymph nodes are bean-shaped. Lymphocytes (essential cells of immune system) are located within lymph nodes. Sometimes, cancerous cells penetrate into lymph nodes.

+ LYMPHEDEMA :
Lymphedema is a condition of localized fluid retention caused by a compromised lymphatic system. It causes upper limb swollen, usually chronic, in the same side of breast cancer appeared. It is most frequently seen after lymph node dissection, surgery and/or radiation therapy, in which damage to the lymphatic system is caused during the treatment of cancer, most notably breast cancer.

+ MASTECTOMY :
Surgical removal of the breast. There are a variety of types of mastectomy. In the simple mastectomy, the entire breast tissue is removed, but armpit lymph nodes and pectoral muscles are undisturbed. The entire breast tissue with the armpit lymph nodes and sometimes pectoral minor muscle are removed in modified radical mastectomy. In the radical mastectomy, the entire breast tissue, armpit lymph nodes and minor and major pectoral muscles are removed. The radical mastectomy is little frequent nowadays.

+ MEDROXYPROGESTERONE :
Progesterone derivate used in advanced breast cancer and in the treatment of decreased appetite (anorexia) seen in a lot of patients.

+ METHOTREXATE:
This drug works well for breast cancer. It is used as part of CMF.

+ MITOXANTRONE:
This drug works well for advancer breast cancer alone or combined with cyclophosphamide, 5-fluorouracil, methotrexate and another drugs.

+ MULTIDISCIPLINARY UNIT :
The multidisciplinary unit is an oncologic patient assistance team that includes different health professionals like oncologist, another related doctors, psychologist, nurse, social assistant, physiotherapist and nutritionist. The health team works together to give high quality attention to the patient and its relatives.

+ NEGATION :
The negation is a defence mechanism that humans used to avoid that painful facts affect us. Some cancer patients show this reaction in the presence of cancer. The patient avoids to speak and even to think about cancer and in some cases, the patient acts like the cancer doesn’t exist. In extreme cases, the patient doesn’t follow the correct treatment (see “adherence treatment” in this glossary) or doesn’t go to control visits. It’s necessary to act cautiously front negation patient because the patient can obtain psychological benefices from her behaviour. However, a lot of patients show partial negation and that can be cause of disagreement in her relatives. Visit to a specialized professional can be recommended.

+ NEOADYUVANT OR PRE SURGERY CHEMOTHERAPY :
This chemotherapy is applied before local treatment. Its main objective is to reduce the excess size of certain tumours and after to apply local treatment. Another use of this chemotherapy is to evaluate if a chemotherapy scheme is or not efficient because their effect is observed day by day.

+ NEOPLASIA :
Neoplasia is equivalent to cancer.

+ NERVOUS :
Nervous makes reference to a discomfort which the physical cause is not known. In patients with breast cancer is habitual use this term for some discomforts. However, if the discomfort persists, a detailed analysis must be done. In addition, if the discomfort is nervous type also it’s necessary to consult a professional.

+ NODE :
Lymph node.

+ NUCLEAR MAGNETIC RESONANCE (NMR) :
The NMR produce images like CT (see) but NMR uses magnetic fields and CT uses x-ray. The NMR allows to see the affectation of ganglia and metastasis.

+ ONDANSETRON :
This drug works well for control of chemotherapy and radiotherapy vomits.

+ PACLITAXEL :
Semisynthetic derivate of the yew tree. This drug works well for breast cancer, in post surgical quemotherapy as much advanced cases. Four sittings of paclitaxel, after four sittings of FAC, are considered the best post surgical treatment in patient with positive axillary lymph nodes.

+ PALIATIVE TREATMENTS :
The pursuit of paliative treatments is to improve quality of life when quantity of life it isn’t guaranteed. The objective of these treatments is to improve the symptoms especially, the pain.

+ PATHOLOGIST :
The pathologist is the doctor specializing in the diagnosis by microscopic visual examination of tissues.

+ PHASES :
Cellular division phase in which many anticancerous drugs inhibit the cellular multiplication. The phase is also a prognosis factor, since the tumours with low phase S have minor growth degree than tumours with very active phases.

+ POLICHEMOTHERAPY :
Combination of anticancerous drugs to strengthen the effects of each one of them used independently.

+ PROGESTERONE :
Female hormone.

+ PROGNOSIS :
The most important factors are: age, genetic antecedents, stage (TNM) and state of hormonal receptors.

+ PSYCHOLOGICAL DISTRESS :
The psychological distress is an emotional reaction in front of stress situation. Term very used to define the psychological alterations of the patient with cancer, to indicate a mixture of anxiety and depression, when there aren’t elements for one or another diagnosis but there are characteristics of both.

+ PSYCO ONCOLOGYST :
Psychologist specialized in the detection and the treatment of the possible psycho-social, emotional and sexual alterations that they can arise as a result of the diagnosis and treatment of breast cancer. The psycho oncologist also gives support to the patient familiar environment.

+ QUALITY OF LIFE :
Quality of life is a descriptive term that refers to patient’s satisfaction about some life areas. It involves a global approach of cancer: the cure (quantity of life) is not only important but the life of the patient after diagnoses and treatments is important too (quality of life).

+ RALOXIFENE :
Antiestrogenic drug with similar efficiency than tamoxifen in chemoprevention. Raloxifene contribute in osteoporosis prevention and it doesn’t rise uterus cancer risk.

+ RELAPSE :
A relapse occurs when a person is affected again by a condition that affected them in the past.

+ RESCUE TREATMENTS:
The patient is treated by rescue treatments when it is apparently be cured but the disease reappears or extends.

+ SEGMENTECTOMY :
Excision of a breast segment. Breast radiotherapy must be applied after segmentectomy.

+ SENTINEL LYMPH NODE:
The sentinel lymph node (SLN) is the first lymph node located between the tumour and the armpit. If SLN is negative, the armpit lymph nodes usually not affected. If SLN is positive, the armpit lymph nodes must be removed because they can be affected.

+ SENTINEL NODE BIOPSY :
The sentinel node biopsy is a relative new technique where first lymph node located between tumour and armpit is removed. If the lymph node is negative, it’s not necessary to remove the aixllary lymph nodes.

+ SIDE EFFECTS OF CHEMOTHERAPY :
The side effects are very different according to the type of used drug. The most common side effects are nausea, vomiting, anorexia (diminution or loss of appetite) and alopecia (loss of hair that it recovers when chemotherapy finish).

+ SIDE EFFECTS OF HORMONAL TREATMENT :
See drugs used in breast cancer treatment.

+ SIDE EFFECTS OF RADIOTHERAPY:
The modern radiotherapy usually causes few problems. Some people suffer a process call “ray disease” that consists in fatigue, nausea and sometimes vomiting. The skin of the radiated zone is reddened (erythema). This local reaction depends on the colour of patient skin (more white, more reaction). Some people can develop pneumonitis (lung inflammation with cough and fever). See lymphedema as possible complication of radiotherapy.

+ SIDE EFFECTS OF SURGERY :
Aside from normal problems to healing and pain of surgery wounds, some patients develop fluid retention (seroma). The seroma is usually resolved some weeks after surgery. The lymphedema can be a complication of the armpit surgery.

+ SIDE EFFECTS OF TREATMENTS :
They are the problems that arise parallel to therapeutic means. The side effects can be important in breast cancer and to affect the quality of life of the patient.

+ SILICONE :
Inert material used for breast reconstruction.

+ STAGES :
Synthesis of TNM that value the extensión of the tumor in the breast, the affectation or not of the nodes and the presence or not of metastasis.

+ TAMOXIFEN :
Drug which compete with estrogen and progesterone for binding hormone receptors. Therefore, cancerous cell colonies deaths because reproduction isn’t take place. Tamoxifen is currently used for the treatment of both early and advanced estrogen receptor positive breast cancer. Side effects of tamoxifen are increase of weight, increase of uterus cancer risk and cardiovascular problems (varicose veins, embolism, etc.).

+ TISSUE EXPANDER :
Breast reconstruction technique that surgeon placed saline tissue expander under chest muscle. The tissue expander creates a new breast-shaped pocket for a breast implant.

+ TNM :
The TNM classification is a cancer staging system for describing the extent of breast cancer. T describes the size of the tumor and whether it has invaded nearby tissue, N describes any lymph nodes that are envolved, and M describes metastasis (spread of cancer from breast to another body part).

+ TRASTUZUMAB :
Trastuzumab is a humanized monoclonal antibody that acts on the HER2/neu receptor. Trastuzumab’s principal use is as an anti-cancer therapy in breast cancer in patients whose tumors over express (produce more than the usual amount of) this receptor and have metastasis. This drug can be combined with paclitaxel as first line treatment in patients with this condition. Trastuzumab cause heart toxicity so it’s must not to be associated with adriamicine.

+ TREATMENT ADHERENCE :
Adherence refers how to closely the patient follows a treatment regimen prescribed and recommended by the physician. The adherence can be related to psychological factors (for example, a depressed patient can have a low adherence to the treatment).

+ TUMORECTOMY :
Tumorectomy is the remove of a tumor located in the breast. After tumorectomy radiotherapy always must be applied.

+ VINORELBINE :
An anticancer drug that belongs to the family of plant drugs called vinca alkaloids. Vinorelbine is active for advanced breast cancer.

+ WEB:
Internet page. Nowadays, you can see several webs dedicated to the breast cancer. These webs contain information about disease, treatments and ways to confront the disease. As reference page you can consult the FEFOC web: www.fefoc.org