The A to Z of specialist medical terms

Adjuvant
The term "adjuvant therapy" refers to a therapy or medication that is given following surgery for breast cancer. The aim is to reduce the relapse rate and thus further increase the chances of a cure.

Amputation
Surgical removal of part of the body

Anti-oestrogen therapy
See: hormone therapy

Aromatase inhibitor (AI)
Aromatase inhibitors are anti-hormonal drugs. Some breast cancer cells require oestrogen in order to grow. Aromatase inhibitors suppress an enzyme known as aromatase. This enzyme is involved in the production of oestrogen.
See also: hormone therapy

Axillary
Belonging to the armpit

Axillary lymph node dissection (ALND)
Surgical removal of lymph nodes from the armpit (axilla)
See also: Lymphadenectomy

Benign tumour
Although these tumours are non-invasive, they can have a negative influence on health:

• Owing to their size, they may press against organs or blood vessels
  
• Endocrine tumours may cause excess hormone production.
  

Biopsy
Removal of tissue by means of an instrument (for example, a special cannula, forceps or a scalpel) for further examination under a microscope. A biopsy is termed depending on the removal technique (e.g. needle biopsy) or the part of the body from which the specimen is taken (e.g. mucous membrane biopsy).

BRCA genes
(BReast CAncer) genes containing certain mutations linked to hereditary forms of breast cancer. These genes are known as BRCA1 and BRCA2. Normally, they help to regulate cell growth. People with a mutation in these genes have an increased risk of contracting breast, ovarian, prostate and other types of cancer. People with a high family history of breast cancer or ovarian cancer should be tested for the BRCA gene by their doctor.

Breast cancer classification
Breast cancer is classified depending on the following criteria:

• Tumour size
  
• Spread to the lymph nodes in the armpit
  
• Spread to distant organs
  

Based on the classification, individual therapy approaches are planned by an interdisciplinary team of physicians.

Breast-conserving operation
A surgical operation to remove a breast tumour, involving only the removal of the cancerous tissue and a few millimetres of surrounding tissue (see also: resection margin). In most women, the previous appearance of the breast can be maintained.

Breast reconstruction
Breast reconstruction is an operation to restore the shape of the breast following a mastectomy or lumpectomy.

Breast ultrasound
High-frequency sound waves are used to produce an image of the internal breast tissue. An ultrasound image makes it possible to distinguish between dense lumps and fluid-filled cysts.

Cancer
See: malignant tumour

Cell cycle
During the cell cycle, a cell produces an exact replica of its genetic material and divides into two identical cells. If the cell cycle is defective, cells can divide uncontrollably. This can lead to serious diseases such as cancer.

Checkpoint inhibitors
Checkpoint inhibitors are so-called immune therapies. They increase the activity of the patient's immune system, which is inhibited by the tumor.

Chemotherapy
Treatment with chemical substances which inhibit the growth of tumour cells in the organism. The term is frequently used to mean cytostatic chemotherapy, i.e. the targeting of tumour cells with drugs which inhibit cell division (see also: cytostatics).

Classification
Assignment/allocation to classes

Curative
Serving to cure or heal; remedial

Cysts
Encapsulated sac-like growths containing one or more chambers filled with thin or viscous fluid.

Cytology
The study of cellular anatomy and functions

Cytostatics
Drugs which inhibit the growth of tumour cells, but can also cause a certain amount of damage to healthy cells. They work by preventing cell division (see also: chemotherapy).

Diagnostics
Umbrella term for all examinations that are necessary to identify and specify a disease.

Disease management programme (DMP)
A DMP is a structured treatment plan based on fixed guidelines and a fixed time frame.

Distant metastasis
See: metastasis

Ductal carcinoma in situ (DCIS)
DCIS is the earliest form of breast cancer in the milk ducts of the breast. This diagnosis means that abnormal cells are present in the walls of the milk ducts, but have not yet spread outside the milk ducts. In some cases, DCIS can develop into an invasive cancer which spreads to other parts of the breast.

Dysplasia
Abnormal cell development and differentiation, which is often a preliminary stage of neoplasia.

Endocrine therapy
See: hormone therapy

Epithelial
Belonging to the upper layer of cells in the skin or mucous membrane tissue

Ex vivo diagnostics
Examinations carried out on organs or cells removed from the organism but still in a functioning condition
See also: in vivo diagnostics

Fatigue
Fatigue is the medical term for chronic tiredness, which can be an accompanying symptom of various chronic diseases and also of tumor diseases.

Gestagen
Hormone produced by the female ovaries for the purpose of preparing the body for pregnancy and safeguarding pregnancy (see also: progesterone).

Gland
Multicellular organ which produces specific active substances (secretions) and releases them externally, for example in the oral cavity, or internally directly into the bloodstream or lymphatic system. The thyroid is an example of a hormonal gland.

Grading
Assessment of the degree of malignancy of tumours based on certain evaluation criteria. These criteria include the degree of similarity between the tumour cells and the cells of the affected organ, or the cell division rate of the tumour (see also: TNM classification).

HER2
Human epidermal growth factor 2, which is linked to an aggressive growth of breast cancer cells.

Histology/histological
Science and study of the fine structure of biological tissue. Examination of a fine, specially prepared tissue section under a microscope enables specialists to identify whether the tumour is benign or malignant and where it has originated from.

Hormones
Messenger substances produced in specialised cells and tissues of the body and transported to where they are needed via the bloodstream and the lymphatic system.

Hormone receptor
The identification of hormone receptors in breast cancer patients is an important factor in deciding whether to opt for a supportive (adjuvant) or a symptom-relieving (palliative) form of therapy. A distinction is made between oestrogen and progesterone receptors. Oestrogen receptors are found in around 50 to 60 per cent of premenopausal patients and in 70 to 80 per cent of postmenopausal patients. The expected course of the disease (prognosis) is more favourable in receptor-positive patients than in patients with receptor-negative tumours. Moreover, hormone (endocrine) therapy has better chances of success in receptor-positive patients.

Hormone therapy
In the case of hormone therapy, cancer cells with receptors for oestrogen and progesterone are directly targeted by drugs which block or stimulate these receptors (see also: Tamoxifen). A further aim of the treatment is to disrupt hormone metabolism. Drugs such as aromatase inhibitors are used for this purpose.

In vitro diagnostics
Examination of fluids or tissue in a test-tube.
See also: in vivo diagnostics
See also: ex vivo diagnostics

In vivo diagnostics
Examination of living organisms or organs and cells in their normal environment, i.e. within the body.
See also: in vitro diagnostics
See also: ex vivo diagnostics

Infiltrate
Penetrate, permeate

Inflammatory breast cancer
Inflammatory breast cancer is a rare but serious disease. It is caused by cancer cells blocking the lymphatic vessels through their growth.

Invasive
Surgical operations: penetrating organs or tissue. Tumours: spreading into the surrounding connective tissue.

Ki-67
Ki-67 is a protein involved in cell proliferation. Tumours with a high proportion of Ki-67-positive cells grow faster than other tumours.

Lobular carcinoma in situ (LCIS)
In the case of LCIS, there is a slight change in the cells on the inside of the gland lobules. This is associated with an increased risk of developing breast cancer. Although most women diagnosed with LCIS never contract breast cancer, they should be monitored by means of regular mammogram screening.

Lumpectomy
This term refers to a breast-conserving operation for breast cancer. Instead of removing the whole breast, the surgeon only removes the cancerous tumour tissue and a “resection margin” around the edge of the surrounding healthy tissue.

Lymph nodes
The lymph nodes filter tissue water (lymphatic fluid) from a particular area of the body at numerous different sites (lymph node stations). The lymph nodes constitute an important part of the immune system. The commonly used term “lymph glands” is confusing, as the lymph nodes have no gland function.

Lymph node dissection
The surgical removal of one or more lymph nodes which have tested positive for the presence of cancer cells.

Lymphatic drainage
Manual massage for the treatment and removal of lymphatic obstructions due to delayed drainage of lymphatic fluid following a mastectomy, for example. By means of gentle stroking movements and light pressure, fluids are directed to other areas of the body where they can drain off more easily.

Lymphatic system
Part of the immune system which protects the body against infections and other illnesses. The immune system is made up of the bone marrow, the thymus gland, the spleen and the lymph nodes.
The lymphatic system has two main purposes:
1. To protect the body from infection
2. To drain fluid from the tissue

Lymphoedema
Swelling in various parts of the body due to impaired lymphatic drainage.

Lymphoma
Malignant disease of the lymphatic system. Lymphomas are types of lymphatic cancer with differing biological characteristics which can be divided into two main groups: Hodgkin’s and non-Hodgkin’s lymphoma.

Magnetic resonance imaging (MRI)
Complex examination procedure which, unlike X-ray techniques, uses magnetic fields and delivers a high volume of imaging information. Magnetic resonance imaging is often used for examining the brain and the spinal cord and can also generate images of pathological changes in other organs. This method is not suitable for patients fitted with pacemakers, as the strong magnetic field can cause functional disturbances.

Malignancy grade
Term used to indicate the degree of malignancy of malignant cells

Malignant tumour
A synonym for cancer. Malignant tumours are characterised by uncontrolled growth, the ability to spread to distant organs (see also: metastasis) and defective cell differentiation.

Mammogram
X-ray image of the breast

Mastectomy
Breast amputation

Metastasis
A diseased area resulting from pathogenic material, such as tumour cells or bacteria, spreading from an existing diseased area to another part of the body. In its narrower sense, the term is used to designate a secondary malignant tumour (see also: metastisation). A distant metastasis is caused by cancer cells entering into the bloodstream or the lymphatic system and developing at a site far removed from the primary tumour.

Metastisation
Cancer cells can be transported to other parts of the body via the bloodstream (haematogenous metastasis) or the lymphatic system (lymphogenic metastasis).

Neoadjuvant (= preoperative) therapy
Chemotherapy, radiotherapy or hormone therapy aimed at reducing the size of the tumour prior to surgery.

Occupational therapy
All measures aimed at helping patients to recover physical and mental skills, reintegrate into working life and participate in social activities. These measures may include temporary aids, transitional welfare benefits, personal care assistance for the disabled, and vocational rehabilitation.

Oestrogen
Female sex hormone which triggers cell division and affects cell growth in the female reproductive organs, e.g. in the mucous membranes and muscles of the uterus or the mammary gland.

Ovarian ablation
Removal of the ovaries. This operation is mainly carried out in the case of hormone-receptive tumours, such as breast cancer, and has a positive effect on the course of the disease. The endocrine functions of the ovaries can be suppressed by means of drugs and restored after the end of treatment.

Palbociclib
A drug that is used in combination with anti-hormonal therapy to treat metastatic breast. It belongs to the group of so-called CDK 4/6 inhibitors (inhibitors of protein kinases. The drug combination results in a decrease of tumor growth and inhibits cell division.

Palliative treatment
Treatment designed to relieve symptoms. It alleviates certain effects of the illness without actually curing the underlying disease. Palliative medicine is of particular importance in cases where the cancer patient cannot be cured. The main purpose of the treatment is to provide intensive pain relief and keep other symptoms in check.

Physiotherapy
Treatment of illnesses by natural means, such as water, warmth, light and air.

Pigmentation
Accumulation of body pigments in the skin cells

Primary tumour
The first tumour to occur, capable of causing metastatic tumours

Progesterone
This yellow body hormone is the most important natural gestagen. Together with oestrogen, it regulates the functions of virtually all the female reproductive organs.

Prognosis
A prediction about the future course of the disease. Medical experts base their prognosis on a critical assessment of the patient’s current state of health.

Prosthesis
Artificial replacement for an amputated or missing part of the body

Psychological
Relating to the mind/mental state

Radiation treatment (radiotherapy)
Treatment using ionised beams. A special device – usually a linear accelerator – directs the beams at a specific area of the body. The treatment fields are planned and calculated in such a way that an adequate radiation dose is delivered to the target area to achieve the desired effect while sparing the surrounding healthy tissue as far as possible. A distinction is made between internal radiotherapy (afterloading of radioactive materials) and external radiotherapy.

Radiotherapy
Cancer cells are destroyed by means of high-energy X-ray beams. Normal cells are capable of repairing themselves, whereas cancer cells are not. There are a number of different approaches:
External radiotherapy: radiation is directed at the areas of the body in which the tumour is situated;
Internal radiotherapy: small rod-like radioactive pellets are implanted in the body in the vicinity of the tumour;
Radiotherapy during surgery.

Reconstruction
Rebuilding of the damaged tissue structure

Receptor for growth factors
A protein present in a cell or on the surface of a cell which binds a specific growth factor protein. Growth factors regulate a series of cellular processes, e.g. cell division, cell growth and differentiation.

Relapse
Recurrence of a tumour or another disease at the same site

Remission
Regression of the tumour. In clinical terminology, a distinction is made between complete and partial remission depending on whether the tumour has completely disappeared or merely become smaller. Complete remission does not necessarily mean that the disease has been permanently cured.

Resection
Surgical removal of diseased organ parts

Resection margin
The resection margin is the surrounding tissue removed together with the tumour during surgery. The resection margin is examined under a microscope to ensure that no tumour cells have been left behind in the body and that the tumour has been safely excised. If the resection margin contains tumour cells, the status is classed as “unclear” or “positive”, and it may be necessary to perform a second operation to remove further tissue.

Scintigraphy/scintigram
Method used for the imaging of internal organs by means of radioactively labelled substances. X-rays make these substances show up as luminous dots, allowing black-and-white images of organs to be produced. With the help of scintigrams, specialists can detect abnormal areas in organs and initiate further investigations.

Segment
Portion, section

Sentinel lymph node
The sentinel lymph node is the first lymph node to drain lymphatic fluid from the tumour. In some cases, there is more than one sentinel lymph node.

Sentinel lymph node biopsy (SLNB)
A sentinel lymph node biopsy involves removing the sentinel lymph node. This is the first lymph node to drain fluid from the tumour and is therefore the most likely to contain metastases. If no metastases are found in this lymph node, it is highly improbable that the tumour has spread to other lymph nodes. If the sentinel lymph node is positive and contains a macrometastasis measuring more than 2 mm, further lymph nodes in the axillary region need to be removed. This procedure is known as axillary lymph node dissection. In the case of a micrometastasis, the decision whether or not to remove further lymph nodes is dependent on additional factors.

Silicone
A gel-like substance often used in reconstructive surgery, for example breast reconstruction, owing to its plasticity and tolerability.

Sonography
See: ultrasound examination

Staging
Staging is a means of assessing the spread of malignant tumours to neighbouring and distant organs. Parameters taken into account in the staging process are the size of the original tumour (primary tumour), the number of lymph nodes affected and metastases (see also: TNM classification, grading).

Symptom
Sign of an illness

Tamoxifen
Tamoxifen is the most well-known anti-hormonal drug. Some breast cancer cells require oestrogen in order to grow. Tamoxifen prevents the female hormone oestrogen from binding to its receptor.
See also: hormone therapy

Targeted therapy
The latest anti-cancer drugs target specific parts of cancer cells.
See also: hormone therapy, HER2 therapy

TNM classification
The classification of malignant tumours into groups depending on the extent to which they have spread. The standard code is as follows: T = tumour, N = nodes (neighbouring lymph nodes), M = distant metastases. Indexing is used to designate the individual stages more precisely. An early-stage carcinoma with no metastases, for example, is denoted as T1 N0 M0.

Trastuzumab (Herceptin)
A biotechnological drug that binds to and blocks the growth factor receptor HER2. This drug is mainly used for patients whose cancer cells generate an overproduction of the HER2 receptor.

Triple-negative breast cancer
The term “triple-negative breast cancer” means that the tumour has none of the following surface receptors:

• Oestrogen receptors
  
• Progesterone receptors
  
• HER2 receptors
  

Tumour
A growth which is not necessarily malignant. A malignant tumour consists of cell proliferations which grow uncontrollably.

Tumour marker
Substances and cellular changes. The analysis of tumour markers can deliver information about the presence of malignant tumours, the prognosis and the course of the disease.

Ultrasound scan (sonography)
A diagnostic method whereby ultrasound waves are directed through the skin into the body and reflected at tissue and organ boundaries. A receiver captures the echoed sound waves and a computer converts them into images. This method allows the physician to monitor the functioning of moving organs such as the heart or intestines. The patient is not subjected to any radiation; the scan can be repeated if necessary.