All About Stage 1 Breast Cancer and Treatment Options

 

Overview 

Stage 1 breast cancer is the earliest stage of invasive breast cancer. If treated, it has a positive outlook.

Regular breast cancer screening is an important factor in the detection of stage 1 breast cancer. Like most types of cancer, the earlier stage 1 breast cancer is detected and treated, the better the outcome will likely be.

Your diagnosis, type of breast cancer, and medical history are all factors that will determine what type of treatment plan your doctor will develop with you.

Read on to find out how stage 1 breast cancer is staged and what you can expect from treatment. Also included are some helpful resources for support and help as you navigate your breast cancer journey.

What is stage 1 breast cancer?

Stage 1 breast cancer is the earliest stage of breast cancer. Experts divide it into stages 1A and 1B, based on tumor size and spread to lymph nodes.

To understand how these subcategories are defined, it’s helpful to break down the TNM system of classification.

TNM classification

T measures tumor size:

• TX. Nothing about the primary tumor is known, or its size cannot be measured.
• T0. Primary tumor cannot be found.
• Tis. Cancer cells are in their original location, or in situ.
• T1 to T4. Tumor size from small to large.

N measures lymph node spread:

• NX. No information on lymph nodes can be accessed.
• N0. No cancer cells are found within nearby lymph nodes.
• N1 to N3. Refers to the location, size, or number of nodes with cancer cells.

M measures metastasis or spread to other body parts:

• M0. Cancer cells have not spread.
• M1. Cancer cells have spread to distant sites.

IN STAGE 1 BREAST CANCER

• The tumor size is T0 or T1.
• The lymph node spread is N0 or N1.
• The metastasis is M0.

The reason for this classification is that the tumor remains small in stage 1. If there is any lymph node spread, it is microscopic.

Also, because the tumor is small and localized, there won’t be any metastasis, or spread to other parts of the body.

Stage 1 breast cancer is then further subdivided into stages 1A and 1B.

Stage 1A	The tumor is about 2 centimeters or smaller in size and has not spread outside the breast.
Stage 1B	Either the tumor is smaller than 2 centimeters, or no tumor is found within the breast (less common). Small clusters of breast cancer cells no more than 2 millimeters in size are present in the lymph nodes.

Other considerations

Your doctor and healthcare team will consider many different factors before deciding on the best type of treatment for your stage 1 breast cancer. Besides knowing the TNM classification of your cancer, they will also test a sample of cancer cells for:

• tumor grading
• the presence of specific receptors

Knowing more about the tumor grade and the types of receptors that are on the surface of the cancer cells will be especially helpful in determining the right type of treatment for you.

About tumor grading

Tumor grading gives an indication of how fast the cancer cells are likely to grow and spread beyond the breast. A higher grade is considered to be more aggressive.

How breast cancer cells are graded

• G1. Cells are well differentiated — this is considered low grade.
• G2. Cells are moderately differentiated — this is considered intermediate grade.
• G3. Cells are poorly differentiated — this is considered high grade.

About breast cancer receptors

Your healthcare team will also test the cancer cells for receptors that are located on the outside of the cells. Knowing which receptors are present can help determine what type of treatment is likely to be more effective.

Receptor status of breast cancer cells

Breast cancer cells are tested to determine whether they have any of the following receptors:

• Estrogen receptors: estrogen receptor-positive (ER+) or estrogen receptor-negative (ER-) status
• Progesterone receptors: progesterone receptor-positive (PR+) or progesterone receptor-negative (PR-) status
• HER2 (a growth-promoting protein): human epidermal growth factor receptor 2-positive (HER2+) or human epidermal growth factor receptor 2-negative (HER2-) status

What type of treatment can you expect?

The type of treatment that’s recommended for stage 1 breast cancer will depend on a variety of factors, such as:

• the tumor size
• lymph node involvement
• the tumor grade
• receptor status
• gene mutations

Local treatment: surgery and radiation

If you receive a diagnosis of stage 1 breast cancer, your doctor may recommend local treatments such as surgery and radiation therapy to treat your breast cancer at the site.

Both lumpectomy and mastectomy are options for stage 1 breast cancer. Your doctor will help determine what is right for you based on the tumor size, grade, and level of spread.

• Lumpectomy. Also known as breast-conserving surgery, a lumpectomy is the least invasive surgery for breast cancer. With this procedure, a surgeon will remove the tumor and some surrounding tissue, but will leave as much of your breast as possible so that it looks a lot like the original breast.
• Mastectomy. A mastectomy involves the removal of the entire breast. There are different types of mastectomies. Some types of mastectomies involve the removal of the lymph nodes. Other types can preserve the breast skin or the nipple and areola, especially with early stage breast cancer.

Doctors typically recommend radiation therapy after a lumpectomy for stage 1 breast cancer treatment. Radiation therapy helps destroy any cancer cells that may have been left behind after the surgery. This helps lower the chance of the breast cancer coming back.

Radiation is less often needed after a mastectomy with stage 1 breast cancer.

Beyond local treatments, your doctor might recommend systemic treatments for stage 1 breast cancer.

Systemic treatments for stage 1 breast cancer

Systemic treatments, often termed add-on or adjuvant treatments, treat breast cancer throughout your body and not just at the site of the tumor.

These treatments help destroy cancer cells that have spread beyond your breast but are still too small to be spotted. They include the therapies outlined below.

Chemotherapy

Doctors may recommend chemotherapy, also called chemo, after surgery to help destroy any undetected cancer cells. Chemotherapy may also lower your risk of the cancer coming back at a later stage.

Chemotherapy may be recommended for a smaller tumor if:

• Any cancer cells were found in the lymph nodes.
• You score high on a gene test such as Oncotype DX, which shows whether chemotherapy could help treat your breast cancer and if it’s likely to come back after surgery.
• The cancer cells are progesterone receptor- and estrogen receptor-negative.
• The breast cancer cells are positive for human epidermal growth factor receptor 2 (HER2) — various therapies can target these receptors.

Hormone therapy

Hormone therapy can be used to help slow down the growth of cancer cells in people with estrogen receptor-positive (ER+) or progesterone receptor-positive (PR+) cancer cells. Hormone therapy works by blocking hormone receptors on the cancer cells or by lowering the amount of estrogen produced in your body.

Your doctor may prescribe tamoxifen if you’re still having your menstrual period. If you’ve reached menopause, they may prescribe an aromatase inhibitor such as anastrozole (Arimidex), letrozole (Femara), or exemestane (Aromasin).

You may also be prescribed a medication such as leuprolide (Lupron) or goserelin (Zoladex) to stop the production of estrogen. Or, you could opt to have your ovaries removed. This can prevent the production of hormones that fuel cancer growth.

It’s important to ask your doctor about the potential side effects of hormone therapy before you begin this treatment, so can you know what to expect.

Targeted therapy

Targeted therapies can be used to treat HER2-positive breast cancer. These targeted drugs can help block the HER2 proteins that the cancer cells need to grow.

Targeted therapies may also help boost the effects of chemotherapy. Examples of targeted therapy drugs include trastuzumab and pertuzumab.

Breast cancer terminology

To better understand breast cancer terminology and prepare for meeting with your doctor, Here are 60+ terminologies used in breast cancer

What happens after treatment?

A 2020 review

that was published in the Journal of Cancer Survivorship found that a long-term care plan was key to curbing the impact of cancer treatment and improving the overall wellness of cancer survivors.

But, according to a 2019 study, approximately 21 percent of breast cancer patients stop seeing their doctor for follow-up care within 5 years of being diagnosed with breast cancer.

To maximize your long-term health and wellness, it’s important to stick to the follow-up care plan that your doctor recommends for you. This will likely involve:

• Doctor visits. These may occur every few months at first and then gradually scale down to once a year after 5 years.
• Hormone therapy. You may take hormone therapy for 5 years or longer if you had estrogen receptor- or progesterone receptor-positive breast cancer.
• Taking bone strengthening agents. These include treatments such as zoledronic acid (Zometa) or denosumab (Prolia) if you’re at increased risk of bone fractures or osteoporosis due to certain cancer treatments.
• Breast imaging. If you had breast-conserving surgery or lumpectomy, you may need imaging 6 to 12 months after surgery and radiation treatment. You may have imaging at least once a year after that.
• Pelvic exams. If you took hormonal drugs such as tamoxifen, these drugs can raise your risk of uterine cancer. Annual pelvic exams are also recommended even if you’re not taking tamoxifen.
• Bone density tests. These tests are recommended if you took an aromatase inhibitor or went through menopause as a result of treatment.
• Other tests. You may have imaging and blood tests, bone scans, or biopsies if you have symptoms or findings that suggest your breast cancer might have returned.

What’s the survival rate?

The outlook for stage 1 breast cancer is good. This is because it’s an early stage of breast cancer and hasn’t yet spread to the lymph nodes or to other parts of the body.

A 2018 study

supports previous reports that show the 5-year survival rate among people with stage 1 breast cancer to be greater than 90 percent in most cases.

Breast cancer support and resources

If you’ve received a diagnosis of breast cancer, you may be feeling fearful and anxious. But you are not alone. You may want to consider reaching out to a breast cancer support group or online community for help, advice, and resources.

Many other people are dealing with exactly the same questions and concerns that you are. And many people have also survived breast cancer and can provide invaluable advice and support.

You may want to:

• Join an online community to connect with other people affected by breast cancer. The Healthline Breast Cancer app may be a good place to find emotional support and connect with others who are on the same journey as you.
• Check out the Community Discussion Boards
  at breastcancer.org.
• Get in-person, online, or phone support at Living Beyond Breast Cancer.
• Connect with young breast cancer survivors through the Young Survival Coalition.
• Browse titles of the more than 400 podcast episodes of Breast Cancer Update, featuring oncologist Dr. Neil Love.
• Listen to many breast cancer topics on the Breastcancer.org Podcast
  page.
• Get important health information and listen to personal stories on the Breast Cancer Podcasts
  page from the Centers for Disease Control and Prevention (CDC).
• Reach out to the many other organizations that also offer resources for people living with breast cancer. These include the National Breast Cancer Foundation
  , the American Cancer Society
  , and CancerCare.

The bottom line

Stage 1 breast cancer is the first stage of invasive breast cancer. It’s characterized by a small tumor or microscopic spread to the lymph nodes. Understanding the classification of stage 1 breast cancer and what to expect from your treatment plan can help you feel more in control of your health.
The first line of treatment for stage 1 breast cancer often involves surgery followed by radiation. Your doctor can also add systemic therapy such as chemotherapy and hormone or targeted therapy to your care plan if they believe these treatments are necessary.
With 5-year survival rates above 90 percent, the outlook for stage 1 breast cancer is very positive. The earlier breast cancer is detected and treated, the better the outcomes tend to be. Cancer of the breast or breast cancer one and same.

JPeei Clinic

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Understanding Metastatic Breast Cancer in the Colon

 What is metastatic breast cancer?

When breast cancer spreads, or metastasizes, to other parts of the body, it normally moves to one or more of the following areas:

• bones
• lungs
• liver
• brain

Only rarely does it spread to the colon.

Slightly more than 12 out of every 100Trusted Source women will get breast cancer in their lifetime. Of these cases, research estimates about 20 to 30 percent will become metastatic.

If the cancer metastasizes, treatment becomes focused on preserving your quality of life and slowing the spread of the disease. There isn’t a cure for metastatic breast cancer yet, but medical advancements are helping people live longer lives.

Symptoms of metastasis to the colon

Symptoms associated with breast cancer that’s spread to the colon include:

• nausea
• vomiting
• cramping
• pain
• diarrhea
• changes in the stool
• bloating
• abdominal swelling
• a loss of appetite

A review of cases treated at the Mayo Clinic also found that 26 percent of women who had colon metastases experienced blockage of the intestine.

It’s worth noting that in the review, colon metastases are broken down to cover eight other sites, including the:

• stomach
• esophagus
• small bowel
• rectum

In other words, this percentage is covering more than just women with metastasis in the colon.

What causes metastasis?

Breast cancer usually starts in the cells of the lobules, which are glands that produce milk. It can also start in the ducts that carry milk to the nipple. If the cancer stays in these areas, it’s considered noninvasive.

If breast cancer cells break off the original tumor and travel via blood or the lymphatic system to another part of your body, it’s referred to as metastatic breast cancer.

When breast cancer cells travel to the lungs or bones and form tumors there, these new tumors are still made of breast cancer cells.

These tumors or groups of cells are considered breast cancer metastases and not lung cancer or bone cancer.

Almost all types of cancer have the potential to spread anywhere in the body. Still, most follow certain pathways to specific organs. It’s not fully understood why this happens.

Breast cancer can spread to the colon, but it’s not likely to do so. It’s even uncommon for it to spread to the digestive tract.

When this does happen, cancer is more often found in the peritoneal tissue that lines the abdominal cavity, stomach, or small intestine instead of the large intestine, which includes the colon.

A studyTrusted Source of people who had breast cancer metastases lists the sites breast cancer is most likely to spread to first.

This study also lists the top four locations for breast cancer to spread:

• to the bone 41.1 percent of the time
• to the lung 22.4 percent of the time
• to the liver 7.3 percent of the time
• to the brain 7.3 percent of the time

Colon metastases are so uncommon that they don’t make the list.

When breast cancer spreads to the colon, it usually does so as invasive lobular carcinoma. This is a type of cancer that originates in the milk-producing lobes of the breast.

Diagnosing metastasis to the colon

If you’re experiencing any of these symptoms, especially if you’ve previously received a breast cancer diagnosis, speak with your doctor.

Your doctor may order one or more tests to determine whether cancer has spread to your colon.

When examining your colon, your doctor will look for polyps. Polyps are small growths of abnormal tissue that can form in the colon. Although most of them are harmless, polyps can become cancerous.

When you have a colonoscopy or sigmoidoscopy, your doctor will snip off any polyps they find. These polyps will then be tested for cancer.

If cancer is found, this testing will show whether the cancer is breast cancer that’s spread to the colon or if it’s a new cancer that originated in the colon.

Colonoscopy

A colonoscopy is a test that allows your doctor to look at the inner lining of your large intestine, which includes the rectum and colon.

They use a thin, flexible tube with a tiny camera on the end called a colonoscope. This tube is inserted into your anus and up through your colon. A colonoscopy helps your doctor find:

• ulcers
• colon polyps
• tumors
• inflammation
• areas that are bleeding

The camera then sends images to a video screen, which will enable your doctor to make a diagnosis. Normally, you’ll be given medication to help you sleep through the exam.

Flexible sigmoidoscopy

A flexible sigmoidoscopy is similar to a colonoscopy, but the tube for a sigmoidoscopy is shorter than a colonoscope. Only the rectum and lower part of the colon are examined.

Medication usually isn’t needed for this examination.

CT colonoscopy

Sometimes called a virtual colonoscopy, a CT colonoscopy uses sophisticated X-ray technology to take two-dimensional images of your colon. This is a painless, noninvasive procedure.

Treating metastatic breast cancer

If you receive a diagnosis of breast cancer that’s spread to your colon, your doctor will likely order additional tests to see whether the cancer has spread to other parts of your body.

Once you know exactly what’s going on, you and your doctor can discuss the best options for treatment. This may include one or more of the following therapies.

Chemotherapy

Chemotherapy drugs kill cells, especially cancer cells, that are dividing and reproducing quickly. Common side effects of chemotherapy include:

• hair loss
• sores in the mouth
• fatigue
• nausea
• vomiting
• increased risk of infection

Every person responds differently to chemotherapy. For many, the side effects of chemotherapy can be very manageable.

Hormone therapy

Most breast cancers that have spread to the colon are estrogen receptor-positive. This means the growth of breast cancer cells is triggered at least in part by the hormone estrogen.

Hormone therapy either reduces the amount of estrogen in the body or prevents estrogen from binding to the breast cancer cells and promoting their growth.

Hormone therapy is more often used to reduce further spread of the cancer cells after initial treatment with chemotherapy, surgery, or radiation.

The more severe side effects that people may have with chemotherapy rarely occur with hormone therapy. The side effects of hormone therapy may include:

• fatigue
• insomnia
• hot flashes
• vaginal dryness
• mood changes
• blood clots
• bone thinning in premenopausal women
• increased risk of uterine cancer for postmenopausal women

Targeted therapy

Targeted therapy, often called molecular therapy, uses drugs that block the growth of cancer cells.

It normally has fewer side effects than chemotherapy, but the side effects may include:

• rashes and other skin problems
• high blood pressure
• bruising
• bleeding

Some drugs used in targeted therapy can damage the heart, interfere with the body’s immune system, or cause serious damage to parts of the body. Your doctor will monitor you to avoid any complications.

Surgery

Surgery may be performed to remove bowel obstructions or portions of the colon that are cancerous.

Radiation therapy

If you have bleeding from the bowel, radiation therapy may treat it. Radiation therapy uses X-rays, gamma rays, or charged particles to shrink tumors and kill cancer cells. Side effects may include:

• skin changes at the site of the radiation
• nausea
• diarrhea
• increased urination
• fatigue

What’s the outlook for people with metastatic breast cancer?

Although cancer that’s metastasized can’t be cured, advancements in medicine are helping people with metastatic breast cancer lead longer lives.

These advances are also improving the quality of life for people living with the disease.

According to the American Cancer Society, people with metastatic breast cancer have a 27 percentTrusted Source chance of living at least 5 years after their diagnosis.

It’s important to remember that this is a general figure. It doesn’t account for your individual circumstances.

Your doctor can provide you with the most accurate outlook based on your individual diagnosis, medical history, and treatment plan.

JPeei Clinic

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Breast Cancer Glossary, All Words Used In The Condition

Breast cancer glossary is here to make you fully understand the condition: diagnosis terms, treatment options and drugs used.

 AC chemotherapy: Two drugs, adriamycin and cytoxan, commonly used to treat breast cancer patients.

accrual: The process of getting patients onto a clinical trial, or the number of patients planned for a given trial.

acquired resistance: The ability of a tumor to resist chemotherapy treatment following an initial response.

adenoma: A benign tumor made up of glandular tissue.

adenocarcinoma: A cancer that develops in gland-forming tissue. Most breast cancers are adenocarcinomas.

adjuvant chemotherapy: Anti-cancer drugs used in combination with surgery and/or radiation to destroy residual cancer cells to prevent or delay recurrence.

adjuvant therapy: Treatment that is given before there is any indication that the cancer has spread to prevent or delay the development of metastatic breast cancer administered after surgery and/or radiation.

AFP: Alpha fetoprotein, a tumor marker.

alopecia: Hair loss or thinning.

amenorrhea: Loss of menstrual periods.

anastrazole: Generic name for Arimidex, a hormone therapy for advanced breast cancer.

anemia: Condition in which a decreased number of red blood cells may cause symptoms including tiredness, shortness of breath, and weakness.

aneuploid: Abnormal amount of DNA in a cell, can correlate with a worse cancer.

angiogenesis: The process of development of new blood vessels. In cancer, the development of blood vessels can feed tumors and allow them to grow, and drugs that block angiogenesis are being tested as cancer treatment.

anorexia: The loss of appetite.

antibody: Substance formed by the body to help defend it against infection.

antiemetic agent: A drug that prevents or controls nausea and vomiting.

antigen: A substance that causes the body to produce natural antibodies.

apoptosis: A genetically mediated series of events by means of which cells actively trigger their own destruction.

areola: The circular area around the nipple on the breast, typically darker than the rest of the breast.

Arimidex: Brand name for anastrazole a hormone therapy for advanced breast cancer.

arm: Any of the treatment groups in a randomized trial. Most randomized trials have two arms, but some have three or more.

aspiration: A technique for removing fluid from a cyst or cells from a mass, using a needle and syringe.

asymptomatic: Medical condition which is silent, has no symptoms.

atypical cell: Mild to moderately abnormal cell when viewed under the microscope, not malignant.

atypical hyperplasia: Cells that are both abnormal (atypical) and increased in number. Benign microscopic breast changes known as atypical hyperplasia may increase a woman's risk of developing breast cancer.

autologous transplant: The reintroduction of cells, tissue or organ previously removed from an individual, back into the same individual with continued function after reintroduction.

axillary lymph nodes: Lymph nodes found in the armpit. Tumor in these nodes portends a high risk of recurrence.

basement membrane: A layer of cells that separate the epithelial cells and other tissue cells. Cancer invades this membrane and grows into adjacent tissue.

benign: Not cancerous.

bilateral: Involving both sides, such as both breasts.

biomarkers: Any of various biological or biochemical indicators that serve to detect exposures to carcinogenic processes or to predict carcinogenic disposition.

biopsy: The removal of a sample of abnormal tissue that is microscopically examined for cancer cells.

blind: A randomized trial is blind if the patient is not told which arm of the trial she is on.

blood cells: Minute structures produced in the bone marrow that circulate in the veins and arteries; they consist of red blood cells, white blood cells and platelets.

blood count: The number of red blood cells, white blood cells and platelets in a sample of blood.

bone density scan: Scan which measures the mineral content of bone and is used to detect osteoporosis.

bone marrow: The soft, sponge-like material inside some bones. Blood cells are produced in the bone marrow.

bone marrow transplant: A procedure in which physicians replace marrow destroyed by high doses of anti-cancer drugs or radiation. The replacement marrow may be taken from the patient before treatment or may be donated by another person. When the patient's own marrow is used the procedure is called autologous bone marrow transplant.

bone scan: A picture of the bones using a radioactive dye that shows any injury, disease, or healing. This is a valuable test to determine if cancer has spread to the bone, if anticancer therapy has been successful, and if affected bony areas are healing.

BRCA1 and BRCA2: The principal genes that, when abnormal, or mutated, indicate an inherited susceptibility to breast and ovarian cancers; accounting for 80-90% of all inherited cases of breast and the majority of inherited ovarian cancers.

breast-conserving therapy: A treatment for breast cancer in which the breast is preserved, it usually consists of segmental mastectomy , lumpectomy and radiation therapy.

breast density: Term describing the proportion of fat to fibrous tissue. Mammography is more effective when screening breasts of less density.

breast implant: Special type of prosthesis filled with saline or silicone. It is surgically placed on the chest wall to form a breast mound after mastectomy.

BSE: Breast self-exam, manual self examination of the breast.

calcifications: Calcium deposits in the breast which can be either benign or malignant.

cancer: General term for a large group of diseases in which abnormal cells divide without control.

capecitabine: Generic name for Xeloda, immunotherapy for advanced breast cancer.

carcinoma: Cancer that begins from cells that line glands and in the lining of internal organs.

CEA: Carcinoembryonic antigen, a blood tumor marker that, when elevated, can indicate the presence of cancer.

cardiomyopathy: A general diagnostic term designating primary noninfammmatory disease of the heart.

cervical nodes: Lymph nodes in the neck.

chemoprevention: The use of drugs or vitamins to prevent cancer in people who have precancerous conditions or a high risk of cancer, or to prevent the recurrence of cancer in people who already have been treated for it.

chemotherapy: A treatment for cancer that works by killing all rapidly reproducing cells, but also has side effects on normal cells.

chronic: Persisting over a long period of time.

clean margin: A boundary of normal tissue surrounding the cancer in a surgically excised tissue.

clinical trials: Randomized and controlled research studies involving large groups of patients. Designed to answer questions regarding the optimal treatment of disease.

CMF chemotherapy: Three drugs, cyclophosphamide, methotrexate, and 5 fluorouracil, commonly used to treat breast cancer.

comedo: Type of DCIS where dead cells and debris fill the duct. This type of DCIS has a higher recurrence risk.

complementary and alternative medicine (CAM): Treatment of health care problems with the use of acupuncture, homeopathy and herbal therapy. These treatments can include guided imagery, meditation, massage, therapeutic touch, etc., and are often combined with standard therapy.

complete response: All detectable cancer is gone after treatment. This is not the same as a cure, as there may still remain some cancer too small to detect.

contracture: Formation of a thick scar tissue; in the breast a contracture can form around an implant.

control group: The arm of a randomized trial which gets the standard treatment or no treatment.

core biopsy: Removal of a sample of tissue, using a wide needle, to see if cancer cells are present.

CT scan: "Computed tomography scan" in which X-rays are used to create cross-sectional pictures of the body.

cyclophosphamide: Generic equivalent of cytoxan

cyst: A fluid-filled sac, usually benign.

cytoxan: A chemotherapy drug commonly used in breast and other cancers.

DNA (deoxyribonucleic acid): A large molecule that carries the genetic information that cells need to replicate and to produce proteins.

differentiated: Clearly defined. Differentiated tumor cells are similar in appearance to normal cells, and usually carry a better prognosis.

diploid: Normal amount of DNA in a cell, can correlate with a better prognosis.

disease free survival: Time the patient survives without any detectable cancer after initial treatment.

dissection: Removal of specific tissue (breast lump), leaving surrounding tissues in place.

distant recurrence: Reappearance of cancer at another site.

docetaxol: Generic equivalent of taxotere.

dose limiting toxicity: Side effects that are severe enough to prevent giving more of the treatment in a clinical trial.

double-blind: A research design in which neither the investigator or the patient knows whether the patient is given a new drug or current standard of care until it is time to analyze the results.

doxorubicin: Generic equivalent of Adriamycin, a chemotherapy drug commonly used for breast cancer.

ductal carcinoma in situ (DCIS): Cancer cells that develop from the lining of the milk duct but are confined to the ducts of the breast. DCIS is considered to be a precursor to invasive cancer, and almost never spreads beyond the breast.

ECOG status: The Eastern Cooperative Oncology Group scale for measuring patient performance status on a scale from 0 (no symptoms) to 4 (completely bedridden).

end point: The goal of a clinical trial, what it is trying to measure.

endometrial carcinoma: Cancer of the lining of the uterus (endometrium).

enzyme: A protein molecule that accelerates chemical reactions in cells or organisms.

erythema: Redness of the skin.

estrogen: A type of female sex hormone produced by ovaries, adrenal glands, placenta, and fat.

estrogen receptor (ER) test: test done on tumor tissue to determine if a tumor is sensitive to estrogen (ER positive), and thus whether hormone therapy may be effective.

evaluable disease: A tumor or tumors which cannot be measured accurately but are definitely present on an x-ray or by examination.

excisional biopsy: Tumor or mass is removed from the breast, and cut into thin sections that are microscopically studied to see if cancer cells are present.

experimental group: The arm of a randomized trial which gets the new or experimental treatment.

fibroadenoma: A benign tumor composed of fibrous tissue.

fibrocystic breast disease: Term used to describe a benign breast condition.

5-FU: A chemotherapy commonly used in breast cancer.

fixation: Attachment of tumors to deeper tissues. Associated with more advanced disease.

fluorouracil: Generic equivalent of 5-FU.

FNA (fine needle aspiration): Biopsy in which cells are removed from a lump by needle and syringe, and then tested to see if cancer cells are present.

frozen section: A sliver of frozen biopsy tissue, used for immediate diagnosis at the time of surgery.

gene: Segment of the DNA molecule and the fundamental biological unit of heredity. They contain chemical information to make proteins, control inherited traits, and influence the activity of other genes.

gene markers: Landmarks for a target gene, either detectable traits that are inherited along with the gene or distinctive segments of DNA.

genotype: The entire genetic makeup of an organism.

gluteal musculocutaneous free flap: One of the techniques for breast reconstruction which uses the patient's own tissues rather than an implant.

grade: In the context of clinical trials, refers to a numeric scale rating the severity of toxicity from treatment. Also see histologic grade below.

hepatic: Pertaining to the liver.

Herceptin: One of a biological class of drugs known as monoclonal antibodies. Treatment for women with advanced breast cancer who overexpress HER2/neu.

HER2/neu: Human oncogene found to be in elevated amounts in some women with breast cancer.

histologic grade: Subjective microscopic assessment of degree of departure from normal tissue structure. High grade implies a more aggressive tumor.

hormone: Any one of a group of chemicals produced by the body's glandular tissues. They are transported by the blood stream. These substances interact with one another and are an essential part of the control of vital bodily functions.

hormone receptors: Proteins on the cell surface which admit substances to that cell. These substances may be hormones, drugs, or toxins similar in structure to the receptor's target hormone.

hormone therapy: A treatment for cancer that works by removing, blocking or adding hormones.

hyperplasia: Condition in which there is an abnormal increase in the number of cells in a tissue.

immunotherapy: Genetically reengineered genes are used to boost the immune system.It is designed to act only on the cancer cells, so there is no adverse effect on normal cells, thus there are no adverse side effects.

implant: A silicone bag filled with either saline or silicone gel used in reconstructive surgery to create a breast shape.

incisional biopsy: Removes only a portion of the tumor for pathology to examine, generally reserved for larger tumors.

infiltrating cancer: Cancer that has grown beyond its site of origin into neighboring tissue. Does not imply that the cancer has spread outside the breast.

inflammatory breast cancer: Uncommon type of cancer in which cancer cells block the lymph vessels of the breast. Blockage causes the breast to become red, swollen and warm with a dimpled (like an orange) appearance to the skin.

informed consent: The process by which a person learns about and understands the purpose and aspects of a clinical trial before voluntarily deciding whether or not to participate.

infusion: Delivering fluids or medications into the bloodstream (usually by vein) over a period of time.

in situ: A term that refers to cancers that have not grown beyond their original site. This usually implies non-invasive tumor.

Institutional Review Board (IRB): A committee of medical specialists, lawyers, ethicists, community representatives, and clergy approved by the federal government to review, modify, approve, or disapprove the research trial. All clinical trials must be approved by an IRB.

intraductal papilloma: A small benign growth that projects into a breast duct and can cause bleeding from the nipple.

invasive: Tumor which grows into and destroys healthy tissue; same as infiltrating.

Karnofsky status: A performance status scale which rates the severity of symptoms and degree of disability from 100% (no symptoms) to 0% (dead).

La Femara: Brand name for letrozole, a hormone therapy for advanced breast cancer.

latissimus flap: Flap of skin and muscle taken from the back and used for reconstruction after mastectomy or partial mastectomy.

lesion: Any focal abnormal area in the body. Can be used to describe a benign or malignant growth.

letrozole: Generic name for La Femara, a hormone therapy for advanced breast cancer.

leukopenia: A drop in the number of circulating white cells in the body, making the individual more susceptible to infection.

linkage: Genes are said to be linked when they reside close together on the same chromosome.

lipoma: A benign fatty tumor which forms a lump.

lobules: Working units of the breast capable of producing milk.

lobular carcinoma in situ (LCIS): Cancer cells that develop from the lining of the lobules in the breast. LCIS is not considered to be a precursor to cancer, but it is a marker of high risk.

local recurrence: The return of breast cancer in or near the primary site.

local therapy: Radiation therapy or topical therapy (like 5FU), only the area of involvement is affected by the treatment.

localized biopsy (wire or needle): Uses mammography or ultrasound to aid in the biopsy of abnormalities that can be seen on a mammogram or ultrasound, but cannot be felt by the surgeon.

lumpectomy: The surgical removal of the breast lump and a margin of healthy breast tissue.

lymphatic system: The tissues and organs (including the bone marrow, spleen, thymus and lymph nodes) that produce and store cells that fight infection and diseases. The channels that carry the lymph fluid are also part of this system.

lymphedema: Swelling of the arm or hand caused by buildup of lymph usually after an axillary lymph node dissection.

lymph node: Glands found throughout the body along lymphatic channels which defend the body from bacteria or other foreign invaders. If cancer cells are found in the lymph nodes, they are an indication that the cancer may have spread beyond the breast.

lymphoma: A cancer of the lymphatic system. Lymphomas are differentiated by the type of cell that is involved in the makeup of the tumor.

magnetic resonance imaging (MRI): A technique that uses a powerful magnet linked to a computer to create detailed pictures of areas inside the body.

malignant: Cancerous.

mammogram: A low dose x-ray of the breast.

mastectomy: The surgical removal of the breast. Simple mastectomy involves the removal of the entire breast; radical mastectomy involves the removal of the entire breast along with underlying muscle and lymph nodes of the armpit.

mastitis: Infection of the breast, sometimes used loosely to refer to any inflammation in the breast.

mastodynia: Pain in the breast.

maximum tolerated dose (MTD): The highest dose of a drug or other treatment that most people can safely withstand.

measurable disease: Tumors whose size can be clearly measured in two dimensions. Some clinical trials require measurable disease.

mediastinum: The space in the chest between the pleural sacs of the lungs that contains all the viscera of the chest except the lungs and pleurae.

medical oncologist: Physician who treats cancer with the use of drugs and hormones.

Megace: Brand name for megesterol acetate, a hormonal therapy for advanced breast cancer.

megesterol acetate: Generic name for the hormone therapy for advanced breast cancer, Megace.

melanoma: A cancer of the pigment-forming cells of the skin or the retina of the eye.

menopause: Time when a woman's ovaries cease producing estrogen and progesterone. One of the many symptoms is the cessation of menstruation.

menstruation: The monthly discharge, during a woman's reproductive years, of blood and tissue from the uterus.

metastasis: The spread of cancer beyond the primary site of the cancer, and beyond the axillary nodes.

microcalcifications: Small deposits of calcium in the breast, which can show up on a mammogram. Certain patterns of microcalcifications are sometimes a sign of breast cancer.

micrometastases: Microscopic and as yet undetectable but presumed spread of tumor cells to other organs.

mitotic rate: Rate at which cell division occurs.

modified radical mastectomy: Surgery to remove the entire breast, nipple and axillary lymph nodes.

morbidity: Symptoms of illness produced by disease or treatment.

mucositis, gastritis: Inflammation of the mucous membrane, especially that of the stomach.

myeloma: A malignant tumor of the bone marrow associated with the production of abnormal proteins.

myocutaneous flap: Skin, muscle and other tissue surgically moved from one part of the body to reconstruct the breast which has been removed due to cancer.

navelbine: A chemotherapy drug commonly used in advanced breast cancer.

neoadjuvant therapy: Chemotherapy given before surgery to shrink a cancer.

neuropathy: Disease or abnormality of the nervous system.

noninvasive: Self contained, not growing into or destroying healthy tissue.

Nolvadex: Brand name for the hormonal drug tamoxifen.

OCN: Oncology certified nurse.

oncology: The study and treatment of cancer. Doctors who specialize in oncology are called oncologists.

oncogene: A gene that promotes the growth of cancer.

oophorectomy: Surgical removal of the ovaries.

osteoporosis: Softening of the bones, or loss of mineral content, that occurs with age in some people.

paclitaxel: Generic equivalent of taxol.

palliative: An alleviating treatment that can give relief from symptoms, but is not a cure for a disease.

Pap smear: A test to detect cancer of the cervix.

partial response: A decrease in the total cross sectional area of all measurable tumors of at least 50% but less that 100%.

pathologist: Physician who identifies diseases by studying tissue or cells under a microscope.

pedigree: A family history in diagram form showing the family members (males as squares, females as circles) and their relationships to individuals with a certain disease.

peripheral neuropathy: A disease or degenerative state of the peripheral nerves in which motor, sensory, or vasomotor nerve fibers may be affected and which is marked by muscle weakness and atrophy, pain, and numbness.

phase: Clinical trials are carried out in these sequential steps. Phases I, II, and III are designed to find out different information. Patients may be eligible for studies in different phases depending on their condition, type and stage of cancer, and what therapy they have already had.

phenotype: The observable physical or biochemical characteristics of an organism, determined by both genetic makeup and environmental influences.

photosensitivity: Extreme sensitivity to the sun, leaving the patient prone to sunburns. This can be a side effect of some cancer drugs and radiation.

placebo: An inactive substance or treatment given to patients in a study which has been created to resemble the active treatment.

ploidy: Degree of repetition of the basic number of chromosomes.

predictive gene tests: Gene testing to identify abnormalities that may cause a person to be vulnerable to certain diseases or disorders.

primary tumor: The original site of a cancer. Breast cancer that has spread to the bone is still called breast cancer.

progesterone: One of the female hormones produced by the ovaries.

progesterone receptor (PR) test: A test that determines if breast cancer is sensitive to hormonal therapy.

prognosis: A prediction about the possible outcome of a disease.

progressive disease: Disease is getting worse as documented by tests showing that tumors are growing or that new tumors are appearing.

protocol: Research designed to answer a hypothesis; often involve testing a specific new treatment under controlled conditions.

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radiation oncologist: Physician who uses radiation to treat cancer or its symptoms.

radiologist: Physician who uses X-rays, ultrasound, MRI, etc. to aid in diagnosis.

Raloxifene: Hormone treatment for osteoporosis which may protect against breast cancer in the same manner as tamoxifen in low risk postmenopausal women, but without the complication of uterine cancer. Currently in clinical trials.

randomized: Assignment to a clinical treatment arm by chance.

recurrence: Return of cancer after its apparent complete disappearance.

RBC: Red blood count or number of red blood cells seen in a blood sample.

regional recurrence: Reappearance of cancer near the original site.

remission: Complete or partial disappearance of the signs and symptoms of disease (cancer).

risk factor: Anything that increases a person's chances of developing cancer, for example, smoking and lung cancer.

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S-phase: Measure of number of cells dividing DNA at any one time. A higher number usually indicates a more aggressive tumor.

sarcoma: A malignant tumor of muscles or connective tissue such as bone and cartilage.

sentinel node: First node to which cancer cells migrate. Tumor cells on the node can be visualized by the use of dyes or radiographic techniques, and this experimental technique can eliminate the need for a complete axillary node dissection.

side effects: Symptoms or medical problems due to drugs used for disease treatment.

stage: Refers to the extent of cancer and is determined by the tumor size and whether it has spread to lymph nodes or other distant sites around the body.

surgical oncologist: Surgeon who specializes in treating cancer.

systemic therapy: Taken intravenously or orally, goes through the body to attack cancer cells, or to lower the risk of recurrence after surgery.

TNM system: Classification based on T (tumor size), N (lymph node involvement), and M (presence or absence of metastatic spread). Various TNM combinations are collected onto staging groups based on similar clinical performance.

tamoxifen: Anti-estrogenic agent used worldwide as an adjuvant hormonal therapy against breast cancer, and for advanced breast cancer.

taxol: A chemotherapy commonly used to treat breast cancer.

taxotere: A chemotherapy used to treat advanced breast cancer.

total mastectomy: Surgery to remove the entire breast including the nipple, but not the axillary lymph nodes.

toxicity: Side effects.

trastuzumab: Generic name for Herceptin.

tumor: an abnormal mass of tissue.

tumor suppressor genes: Normally, these genes restrict cell growth, but when missing or inactivated by mutation, they permit cells to grow without restraint.

ultrasound: The use of sound waves to confirm the presence or absence of a mass and to tell whether it is solid or fluid filled.

vinorelbine: Generic equivalent of navelbine.

WBC: White blood count; the number of white blood cells seen in a blood sample. These are important in resistance to infections.

Xeloda: Brand name for capecitabine, hormone therapy for advanced breast cancer.

x-ray: Low doses of this type of radiation that penetrates tissue, are used to diagnose disease, high doses are used to treat cancer.

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