Guest Columnist Dr. Roy Sessions: Demystifying Cancer Jargon

RoySessionsCancer patients and their families enter a world that can be overwhelming. For starters, the mere word cancer evokes fear and anxiety, and often in the older population, a sense of hopelessness. The cancer topic for study or discussion is frequently avoided in the lay population (especially in the elderly), and ignorance concerning control and/or cure results. Truth be known, today we actually do cure a lot of people – over 60%; and in early stage cancers, the cure rates can be dramatically better. In years past, paternalistic physicians compounded patient ignorance with secrecy in this and other diseases. This shielding was a practice based on the attitude that patients were best left in the dark – protected from hard facts. This is somewhat understandable, given the meager state of knowledge; there frequently wasn’t much to offer – hence, the blind optimism. Thankfully, times have changed, and not only are contemporary doctors armed and ready, but the educated patient is the norm, rather than the exception. In today’s world of information technology, there is little proprietary information, and furthermore, doctors in general, and oncologist especially, prefer to deal with a realistic and educated patient. Essentially, patient information, self–advocacy, and substantive discussion between doctors and patients have become the ideal, and when not present, the relationship should be questioned. As the younger generation advances in this environment of full disclosure and patient awareness, secretiveness will become a thing of the past. I touched on this concept in my August blog.

For patients to take advantage of information, however, they must wade through a vocabulary that has historically mystified lay people. That’s not to say that this “medical language” is inappropriate, merely that it shouldn’t be proprietary, and unfortunately, some doctors not being good communicators, have a tendency to talk in the language of the profession. Since some doctors have always done this and undoubtedly some always will, the patient should be prepared. In this blog, my goal is to simplify some of the lingo, and making it more understandable for the readership. As future blogs are written, I will discuss a variety of these issues as I delve into the whole subject of patient comprehension, and communication capabilities of physicians (or lack of)- more on this later. For now, the following is a glossary of terms (in no particular order) that swirl through the cancer lexicon; there are many, many more, but this will get you started:

Tumor is the general word for a growth, either benign or malignant. Cells are always growing, and often changing. Doctors throw this term around a bit, and the reader should remember that it is not specific – good or bad. A wart, for instance is a tumor.

Mass is an even more non-specific term denoting a lump or bump. For example a pimple can be referred to as a mass. A breast mass can be a tumor (benign or malignant), a cyst, or even scar tissue. The word raises fear, but in itself does not have an ominous connotation.

The word Malignant refers to a state of cellular derangement that has the capacity to spread to different parts of the body, and in doing so, destroy the host tissues, as well as the function of the particular organ(s) in which is lodges. Some malignancies are low grade, some high grade, and some are intermediate in nature. Generally, high grade is worse that the low.

A malignancy is a generic word that can refer to a malignant tumor of any site, as well as a systemic cancer such as leukemia, multiple myeloma, lymphomas and others classified as malignancies.

Pre-malignant is a general word that applies to certain deteriorating cellular changes that are part of the cascade that ultimately leads to malignancy. Some skin growths, certain benign tumors of salivary glands, intestinal polyps and other growths have the capacity to evolve from benign to malignant, and with biopsy the cellular derangement shows the tell-tale changes. Most, but not all pre-malignancies become malignant; hence the reluctance to observe any mass that is growing.

Dysplasia refers to the state of cellular derangement within a given growth; mild dysplasia, intermittent dysplasia, and high- grade dysplasia represents the stairway to malignancy. These cellular changes can occur within or on the surface of any tumor or growth. Generally, the high grade is on the brink of or just becoming malignant. Conversely, low grade bears watching, but is generally not threatening.

Benign refers to the state of non-malignancy. Even though there are rare exceptions, a benign growth (tumor) does not have the capacity to spread to other sites, but instead can grow and destroy locally – pushing aside what is adjacent, and in that capacity, be harmful, depending the location.

Cancer is the formal name for malignancy. The terms are synonymous. The word, cancer takes is origin from Latin, “crab or creeping ulcer”. The Romans had translated it from the Greek word, karkinos, which was applied too such tumors because the swollen veins surrounding the growth resembled the limbs of a crab.

A carcinoma is a cancer that originates in or on the surface tissue of the body, such as the squamous or pavement cells of the skin, or other surfaces, in which case it would be called a squamous cell carcinoma. The word squamous is from Latin, squamosus and from squama or “scale”. A carcinoma that originates in the glandular cells in structures such as the salivary glands, the colon, the pancreas, the breast, the lungs, the prostate, skin, or the intestinal tract are called adeno-carcinomas. Because certain organs harbor both types of cells – squamous and glandular, they are vulnerable to both squamous and adenocarcinomas. Lung and breast cancer, for instance can be either be adeno or squamous carcinomas. The word adeno always refers to a gland, and is indirectly from Greek – acorn. They are the most common of cancers.

The term, adenoma refers to a benign tumor of a gland of any type, in any location where there are glands. For example, most polyps in the colon are adenomas. Such adenomatous polyps can be pre-malignant, and when they mature, they are adenocarcinomas. Hence the indication for regular colonoscopies, a safe procedure that allows detection and removal of polyps with potential for malignant transformation. This is the quintessential example of preventative medicine.

Adenopathy is a generic word referring to an abnormality of a lymph gland. It reflects enlargement, and is not necessarily secondary to cancer within the lymph gland. As is stated above, “adeno” refers to a gland, and the “pathy” element (Greek) indicates a morbid condition or disease; therefore, it can merely mean swollen glands. Adenopathy can be seen as a result of an adjacent inflammation, such as tonsillitis, or an infected arm or leg. If there is adenopathy in conjunction with a malignancy e.g. breast, the biopsy may show malignant adenopathy representing spread (metastasis) from the primary site.

When persistent after a period of observation, adenopathy is a potential danger, and usually warrants further investigation. There are thousands of lymph nodes throughout the body, and most are less than 1.5 cm (2.5 cm = one inch). Many are easily felt e.g. neck, groin, axilla (armpit). When they become a cause for concern depends on a physician’s clinical judgment.

Sarcoma is a cancer that originates in the connective tissues of the body, such as muscle, bone, fascia, and others. The sub-classification of sarcomas is complicated, but the bottom line is that all of them are malignant.

Melanoma … a skin cancer that originates in the melanocyte – a particular cell within the skin architecture. They are always malignant, and are generally related to sun exposure. Certain melanotic moles or freckles are pre-malignant and should be removed.

Squamous cell carcinoma is a common skin cancer. These are generally less aggressive than melanomas. They originate in (on) the surface of the skin, and generally relate to sun damage; hence the need to wear sun block and avoid tanning salons.

Basal cell carcinomas come from the deeper part of the skin, and are generally the least aggressive of the skin cancers. These are very common, and are also related to sun i.e. ultraviolet exposure.

Leukemia is a “blood” cancer that originates in one of the types of blood cells, such as lymphocytes, or monocytes. Contrary to common belief, many leukemias are curable today.

Lymphoma is a cancer that originates in the lymphoid tissue i.e., the lymphocytes. Since the lymph nodes consist of lymphocytes, previously discussed adenopathy i.e. lymphadenopathy can be caused by lymphomas. As with leukemia, many lymphomas are cured.

Lesion is a non-specific term that refers to any growth or mass, either benign or malignant.

Nodule is another non-specific term that generally refers to benign enlargements, although there is no assurance that it is so. It’s like saying “a bump”.

Metastasis refers to spread of a cancer. With rare exception, benign tumors do not metastasize. Malignancies, by definition have the capacity for metastasis.

Metastases is the pleural form of metastasis and generally refers to multiple sites of metastasis. An example would be a breast tumor has metastasized to both the bone and the lungs.

To metastasize is to use metastasis as the verb.

Distant metastasis refers to spread to another part of the body, such as lung, liver, or bone from a source such as oral cavity.

Regional metastasis depicts spread to an immediate area, such as oral cavity spreading to the glands in the neck. Different tumors have fairly consistent patterns of metastasis. Colon cancers typically spread to the lymph nodes within the abdomen and then on to the liver. Throat cancers almost always spread first to the glands of the neck. Breast cancer usually first goes to the lymph glands in the axilla (armpit).

Recurrence is the reappearance of a tumor that had disappeared after treatment. The time of recurrence varies greatly, but after a number of years, a tumor in the same spot usually represents the development of a new cancer, as opposed to recurrence of the original one. There are exceptions, but in most cancers, the majority of recurrences occur within the first 2-3 years.

Five-Year Survival is a phrase commonly recognized by the lay public. It is, however, an arbitrary time of disease freedom that is generally used for statistical analysis. Even though the majority of cases are cured by the 5-year mark, there are exceptions.

Recrudescence is a non-specific word referring to re-growth of a tumor after dormancy, and although it is usually used in discussing cancers, can apply to benign tumors.

The word Margins refers to the edge of a tumor resection when studied under the microscope. This method helps determine if the tumor has been adequately circumvented by surgical excision. The word applies to malignant as well as benign tumors.

Positive margins means there is evidence of tumor cells in the edge of the excision site. If nothing further is done, positive margins generally (but not always) lead to recurrence at that particular site.

Remission refers to the regression of a tumor – generally as a result of treatment, but occasionally it occurs spontaneously.

Partial Remission, also known as a PR, indicates at least a 50% reduction in tumor volume. This is much more accurately defined with modern technology, such as CT scans. Prior to these methods, it was merely a clinical estimate.

Complete remission, also known as CR, indicates disappearance of the gross tumor or overall disease if it has metastasized. Although this is a very favorable sign, it does not always indicate a cure. PR and CR are terms frequently used by medical and radiation oncologists (chemo and radiation oncologists, respectively).

Control is a general word that refers to dormancy of a treated tumor, but does not necessarily indicate cure.

The word Cure is used when there is no evidence of tumor after a prescribed time frame. This varies with different tumors. Certain tumors e.g. some salivary gland, some breast, some thyroid can have late recurrences, and in those, the use of the word cure must be used judiciously. The phrase 5- year survival is not synonymous with cure. The former merely represents a data point in time, and the latter being a definitive state.

Oncology is a general word that denotes the study of tumors, malignant as well as benign. Those doctors who manage these patients are referred to as oncologists.

Oncology is subdivided into:

. medical oncology

. radiation oncology

. pschooncology

. surgical oncology

Medical oncologists are often referred to as chemotherapists. These individuals underwent residency training in internal medicine, and went on to post residency fellowships in medical oncology.

Chemotherapy has become a casually and often inaccurately used word. It can include a variety of cytotoxic (toxic to cancer cells) drugs, and in the strict definition of words, should not include other medical tools to fight cancer. Newer methods include, for instance, immune modulators, gene therapy, hormonal therapy, and others. All of these medical treatments, including (cytotoxic drugs) fall within the domain of medical oncology; thus the preferred label for these doctors is medical oncologists, rather than chemotherapist.

Radiation oncology is synonymous with radiation therapy, and the individuals administering it are radiation oncologists, or radiation therapists. Patients sometimes mistakenly refer to these oncologists as radiologists. These latter doctors are diagnosticians, interpreting x-rays, various scans, and MRI (magnetic resonance imaging), and their training is drastically different from radiation oncologists.

Psycho-oncology is a relatively new branch of psychiatry, and consists of a limited number of doctors who deal mainly with and treat cancer victims and their families. Because of supply and demand, general psychiatrists care for most cancer patients who require help.

Surgical oncologists are further divided into urologic, gynecologic, orthopedic, neurologic, head and neck, dermatologic, colon-rectal, breast, thoracic and general surgical oncology. All of these have in common the fact that these surgeons have undergone extra training (fellowship) after their basic surgical training, and also, each generally limits their practice to surgery of tumors (malignant and benign), in their respective areas of interest. The general surgical oncologists has followed general surgical residency with one or two additional fellowship years in which the fellow rotates through all of the different disciplines listed above. These surgeons usually gravitate to one specific area once in practice, such as breast, colon-rectal, or others.

In the final analysis, cancer patients and their families should be informed, and very importantly, should understand the words confronting them. I hope this helps!

Roy B. Sessions, MD, FACS

Seabrook Island, SC

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