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START Patient hdbk cover 2B1009.indd 1
6/30/09 3:54:38 PM
Dear Patients, Family Members and Friends,
Welcome to The START Center for Cancer Care where you will find health care teams
dedicated to providing you with the highest quality of care.
At START our concept is one of comprehensive patient care. We offer expertise and
experience in the following areas: Medical Oncology, Radiation Oncology, Research,
Hematology, Gynecologic Oncology and Integrative Oncology Services. In keeping
with our commitment to treat the whole person we have dedicated 4,100 square feet
to the Spa and Wellness Center which will deliver our Integrative Oncology Services.
The Spa and Wellness Center, which opens the end of 2009, will offer acupuncture,
massage, nutrition classes, guided imagery, counseling and other spa and wellness
treatments. Our philosophy is to treat cancer patients with an inclusive, personalized
coordination of care. This comprehensive approach may include any of the services
mentioned above.
In START’s Phase I clinic, while the same concept exists, our research physicians and
their highly trained staff have also accomplished tremendous advances that have lead to
an improved understanding and treatment of cancer. Their mission is to accelerate the
development of new anti-cancer drugs with the purpose of improving quality of life and
survival for patients with cancer. Through this program we are bringing you access to
cutting edge therapy.
We are committed to providing the highest quality of medical care in a personal and
caring environment. You are the fundamental ingredient of your health care team and
our goal is to work with you to treat your disease while making you feel informed,
reassured and regarded with compassion. Soon after your initial registration you will be
met by one of our Patient Advocates who will assist you, alleviate some of your concerns
and help to reduce the stress of your experience.
We hope you will call upon any member of your healthcare team with any questions or
concerns because our promise is to provide you with the assistance, quality of care and
kindness that you deserve. If you have questions or suggestions, which we welcome,
please call our Patient Advocate department at 210-593-2652 or send an email to
[email protected]
Sincerely,
Your START Physicians
1
Queridos Pacientes, Familia y Amigos,
Bienvenidos a The START Center for Cancer Care (El Centro START Para El Cuidado del
Cáncer – mejor conocido como “START”) en donde encontrarán un equipo médico
dedicado a proveerles el mejor cuidado posible.
En START tenemos el concepto del cuidado total del paciente. Ofrecemos experiencia
médica en las siguientes áreas: Oncología y Radiación Oncológica, Investigación,
Hematología, Ginecología-Oncológica y otros servicios complementarios. De acuerdo
con nuestro compromiso de tratar a la persona completa, hemos dedicado 4,100 pies
cuadrados al Spa and Wellness Center (Spa y Centro de Bienestar), el cual abrirá sus puertas
a finales del 2009, y ofrecerá acupuntura, masajes, clases de nutrición, imaginación guiada,
consejería y otros tratamientos de spa y bienestar. Nuestra filosofía es tratar pacientes
con cáncer con un cuidado coordinado que es inclusivo y personalizado. Este enfoque
comprensivo podría incluir cualquiera de los servicios mencionados antes.
En la Clínica Fase I de START, aunque existe el mismo concepto, nuestro equipo de
investigación junto con su personal altamente entrenado también han logrado un tremendo
avance en cuanto al entendimiento y tratamiento del cáncer. La misión en este centro
es acelerar el desarrollo de nuevos medicamentos contra el cáncer con el propósito de
mejorar la calidad de vida y supervivencia de los pacientes con esta enfermedad. A través
de este programa estamos brindandoles acceso a una terapia de vanguardia.
Nos comprometemos a proveer la mas alta calidad de cuidado médico dentro de un
ambiente personal y humanitario. Ustedes son el ingrediente fundamental de nuestro
equipo médico y nuestra meta es poder trabajar con ustedes para tratar su enfermedad y al
mismo tiempo mantenerlos informados, hacerlos sentir tranquilos y siempre tratarlos con
compasión. Luego de la inscripción inicial, uno de nuestros intercesores lo asistirá para
aminorar sus preocupaciones y lo ayudara a reducir el estrés de esta experiencia.
Esperamos que contacte a cualquier miembro de su equipo de cuidado médico con
cualquier pregunta o inquietud, ya que nuestra promesa es proveerle la asistencia,
cuidado y amabilidad que usted se merece. Actualmente estamos diseñando una guía
para nuevos pacientes y esperamos poder ponerla a su disposición a la brevedad posible.
Mientras tanto, si usted tiene alguna pregunta o sugerencias, por favor comuníquese a
nuestro Departamento de Intercesores al (210) 593-2652 o a nuestro correo electrónico
[email protected]
Atentamente
Su Equipo Médico de START
3
GENERAL INFORMATION /
REGISTRATION
GENERAL
INFORMATION/
REGISTRATION
EMERGENCIES & PHONE CALLS
If you are experiencing a true, life-threatening emergency, call 911. Call our office
only after you have made arrangements to get to the Emergency Room.
Our nurses return calls during business hours as time permits. If the matter is urgent,
please tell our phone operator so that the nurse can confer with you in the timeliest
manner possible. Please understand that calls for test results and prescription refills
will be returned after urgent patient needs are met. We ask that you remember that
physicians’ schedules are long and demanding. It may be late in the afternoon after all
patients are seen, or sometimes the following day before non-emergency phone calls
are returned.
If you feel you need us, we want to hear from you. Please use this guide as to when you
should make your phone call:
Call anytime (210) 593-5700 – day or night – if:
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Fever 100.5 F. degrees or greater.
Uncontrollable nausea or diarrhea.
Pain medication is not working.
Chest pains or shortness of breath.
Severe shaking or chills.
Bleeding from the nose or gums.
Blood in the urine.
Black, tarry bowel movement.
Constipation with intense abdominal cramping.
Changes in your vision or hearing.
Increased bruising or pinpoint red or purple spots anywhere on the body.
Call During Regular Office Hours (8:00 a.m. - 4:30 p.m. Monday-Friday):
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If you have questions about your medication, treatment or side effects.
If you’re having nutrition problems.
If you need a prescription refilled.
Please call by 3 p.m. and have your pharmacy’s phone number.
For narcotics such as Percocet, MS Contin or Oxycontin, plan to either come into the office
for a written prescription or allow 5 days for the written prescription to be mailed. By law,
your pharmacy must have a written prescription. No narcotic prescriptions can be written on
weekends.
If you’ve heard about a new treatment.
If you notice new numbness or tingling of fingers or toes.
For lab tests or scans, please know that results usually take:
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Scans: 48-72 hours
Tumor markers: 72 hours
Bone marrow: 7-10 days
Pathology Reports: 3-5 days
Never hesitate to call us for any problem that is important to you. There is no need to be
miserable. If a certain medication is not working, call and let us know. Chances are, we
can prescribe or suggest something to make you more comfortable.
5
LOCATIONS
1. The START Center
210-593-5700
4383 Medical Drive
San Antoino, TX 78229
4. North Central
Radiation Center
6. Boerne
210-593-5800
134 Menger Springs Rd, Ste
1120
Boerne, TX 78006
The Atrium at NC Baptist
502 Madison Oak, Ste 120 & 160
San Antoino, TX 78258
2. Downtown
210-593-5900
7. Bandera
210-593-5200
5. Northeast
Santa Rosa Pavilion
315 N San Saba, Ste 1160
San Antoino, TX 78207
210-593-5600
Northease Baptist MOB
8715 Village Drive, Ste 116
San Antoino, TX 78217
3. Sonterra
210-593-5700
1300 Cedar Street
Bandera, TX 78003
8. Westover Hills
210-593-2503
210-593-5700
155 E Sonterra, Ste 200
San Antoino, TX 78258
11212 Hwy 151, Ste 290
San Antoino, TX 78251
PARKING AT THE START CENTER
For the convenience of the patients we have a parking garage located
behind The Start Center for Cancer Care location at 4383 Medical Drive.
The parking rates are:
00 – 30 minutes:
31 – 60 minutes;
61 – 90 minutes
91 – 120 minutes
121 – 150 minutes
151 – 180 minutes
181+ minutes
Free
$1.00
$2.00
$3.00
$4.00
$5.00
$6.00
We also have a $6.00 day pass for patients
or family members who must come and go
throughout the day.
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PRIVACY POLICY
Each time you visit our office, a record of your visit is made. Typically, this record
contains your symptoms, examination and test results, diagnosis, treatment, and a plan
for future care or treatment. This information, often referred to as your medical record,
serves as a:
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basis for planning your care and treatment
means of communication among the many health professionals who contribute to your care
legal document describing the care you received
means by which you or a third-party payer can verify that services billed were actually
provided
a tool in educating health professionals
a source of data for medical research
a source of information for public health officials charged with improving the health
of the nation
a source of data for facility planning and marketing
a tool with which we can assess and continually work to improve the care we render and the
outcomes we achieve
Understanding what is in your record and how your health information is used helps
you to:
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ensure its accuracy
better understand who, what, when, where, and why others may access your health
information
make more informed decisions when authorizing the disclosure of your health information to
others
Your Health Information Rights
Although your health record compiled by The START Center for Cancer Care is our
physical property, the information belongs to you. And under state and federal laws, you
have certain rights regarding that information. Specifically, you have the right to:
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Request restrictions on certain uses and disclosures of your health information. Your
request for restriction(s) must be submitted in writing to START Health Information Services.
(45 CFR 164.522) Review of the restriction request will be completed within 30 days and will
conclude with a written determination to you. START is not required to agree to the requested
restriction(s).
• Obtain a paper copy of the Notice of Information Practices upon request.
• Inspect and/or obtain a copy of your medical record. (45 CFR 164.524)
Requests to inspect or for copies of your health record must be submitted in writing to the
Health Services Department and must contain the following information:
° The signature of the patient or the patient’s legally authorized representative, along
with the date it was signed
° The identity of the information to be disclosed
° The dates of service to be disclosed
° The reason or purpose for the disclosure
° The identity of the person or entity to whom the information is to be disclosed
An appointment to inspect your records or to pick up your copies will be made. Records
will be inspected during START normal business hours. State law allows START 30 days to
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P R I VA C Y P O L I C Y, c o n t i n u e d
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provide you with copies of your record, and allows START to charge you for those copies. You
will be provided with an estimate of any charges before we make any copies for you.
Request information in your health record be amended or changed. (45 CFR 164.528)
Requests for changes or amendments to be made to your health information must be
submitted in writing to the Health Information Management Department. Review of the
change or amendment request will be completed within 30 days and will conclude with a
written determination to you. START is not required to agree to the requested change or
amendment.
Obtain an accounting of disclosures of your health information for purposes other than
Treatment, Payment, or Operations. (45 CFR 164.528)
Requests for accounting disclosures of your health information must be submitted in writing
to the Health Information Management Department.
Request communication of your health information by alternative means or at alternative
locations. (45 CFR 164.522)
Revoke your authorization to use or disclose health information except to the extent that
action has already been taken.
The START Center for Cancer Care Information Responsibilities
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START is required by law to:
° maintain the privacy of your health information
° provide you with a notice as to our legal duties and privacy practices with respect to
information we collect and maintain about you
abide
by the terms of this notice
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notify
you
if we are unable to agree to a requested restriction
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accommodate
reasonable request you may have to communicate health information by
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alternative means or at alternative locations
8
FINANCIAL & INSURANCE ISSUES
The START Center for Cancer Care Billing Department is located at 4383 Medical Drive,
on the fourth floor.
The business office is open from 8:00 - 5:00 p.m. or by appointment and can be reached
by calling 593-5711.
To offer you the highest level of service the business office has assigned specific insurance
companies to specific reimbursement specialists; thus maximizing the knowledge and
understanding required to navigate the insurance industry.
We believe that your active involvement with your Insurance Carrier is the key to
ensuring you receive all benefits afforded to you under your policy.
Please call the business office (210-593-5711) today to discuss your insurance
benefits.
Financial and Insurance Issues
Financial and insurance issues can be stressful and confusing for you and your caregivers.
It is important to create an organized system for managing this aspect of cancer care. By
educating yourself about insurance benefits and keeping organized financial records,
you may prevent financial dilemmas, thereby preventing unnecessary stress. Here are
some general tips on insurance, a glossary of common insurance terms and information
about medical costs and tax returns.
Consider using a binder as your filing system to organize your healthcare records and
financial information. Keep a record of all phone conversations with your insurance
provider. In addition, some patients find it helpful to designate a caregiver or family
member to keep track of all insurance/financial information.
Insurance Tips
Medical insurance and bill management can be one of the most frustrating aspects
of cancer care for you and your caregivers. Importantly, most hospitals and clinics
will provide a patient services representative to assist you. You should identify these
individuals and seek help from them whenever necessary.
Get the maximum benefit from your insurance policy!
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Get a copy of your policy and find out exactly what your coverage includes. Your employer or
insurance company can help you with this.
Call your health insurance provider to clarify any questions that you may have. Also, make sure
you are aware of any possible coverage issues before you start treatment.
Talk to your healthcare team to request that insurance coverage of any procedure, test or
treatment be verified prior to you receiving them. If you healthcare team is unable to provide this
service, they should be able to identify an alternative resource to assist you.
Keep careful records of all your covered expenses, claims, denials and appeals throughout the
claims process. Do not throw any correspondence away.
Copyright©2008 CancerConsultants.com. All Rights Reserved.
9
FINANCIAL & INSURANCE ISSUES, continued
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Take notes during your conversations with insurance representatives. Include their names and
job titles. Keep these notes with your records. If you think the representative is wrong, ask to
speak with his or her supervisor.
If you have a claim that has been denied, talk to your health insurance provider to find out what
steps you can take to appeal.
Understanding Insurance Terms
accreditation - An evaluative process in which a healthcare organization undergoes an examination
of its operating procedures to determine whether the procedures meet designated criteria as
defined by the accrediting body, and to ensure that the organization meets a specified level of
quality.
ancillary services - Auxiliary or supplemental services, such as diagnostic services, home health
services, physical therapy, and occupational therapy, used to support diagnosis and treatment of
a patient’s condition.
annual maximum benefit amount - The maximum dollar amount set by an MCO that limits the total
amount the plan must pay for all healthcare services provided to a subscriber in a year.
appropriateness review - An analysis of healthcare services with the goal of reviewing the extent to
which necessary care was provided and unnecessary care was avoided.
case management - A process of identifying plan members with special healthcare needs, developing
a health-care strategy that meets those needs, and coordinating and monitoring the care, with
the ultimate goal of achieving the optimum healthcare outcome in an efficient and cost-effective
manner. Also known as large case management (LCM).
claim - An itemized statement of healthcare services and their costs provided by a hospital, physician’s
office, or other provider facility. Claims are submitted to the insurer or managed care plan by
either the plan member or the provider for payment of the costs incurred.
claim form - An application for payment of benefits under a health plan.
claimant - The person or entity submitting a claim.
claims administration - The process of receiving, reviewing, adjudicating, and processing claims.
clinical practice guideline - A utilization and quality management mechanism designed to aid
providers in making decisions about the most appropriate course of treatment for a specific
clinical case.
coinsurance - A method of cost-sharing in a health insurance policy that requires a group member to
pay a stated percentage of all remaining eligible medical expenses after the deductible amount
has been paid.
Consolidated Omnibus Budget Reconciliation Act (COBRA) - A federal act which requires each group
health plan to allow employees and certain dependents to continue their group coverage for a
stated period of time following a qualifying event that causes the loss of group health coverage.
Qualifying events include reduced work hours, death or divorce of a covered employee, and
termination of employment.
copayment - A specified dollar amount that a member must pay out-of-pocket for a specified service
at the time the service is rendered.
credentialing - The process of obtaining, reviewing, and verifying a provider’s credentials—the
documentation related to licenses, certifications, training, and other qualifications—for the
purpose of determining whether the provider meets the MCO’s preestablished criteria for
participation in the network.
deductible - A flat amount a group member must pay before the insurer will make any benefit
payments.
diagnostic and treatment codes - Special codes that consist of a brief, specific description of each
diagnosis or treatment and a number used to identify each diagnosis and treatment.
Copyright©2008 CancerConsultants.com. All Rights Reserved.
10
FINANCIAL & INSURANCE ISSUES, continued
disease management (DM) - A coordinated system of preventive, diagnostic, and therapeutic
measures intended to provide cost-effective, quality healthcare for a patient population who have
or are at risk for a specific chronic illness or medical condition. Also known as disease state
management.
Employee Retirement Income Security Act (ERISA) - A broad-reaching law that establishes the
rights of pension plan participants, standards for the investment of pension plan assets, and
requirements for the disclosure of plan provisions and funding.
fee-for-service (FFS) payment system - A system in which the insurer will either reimburse the group
member or pay the provider directly for each covered medical expense after the expense has
been incurred.
fee schedule -The fee determined by an MCO to be acceptable for a procedure or service, which the
physician agrees to accept as payment in full. Also known as a fee allowance, fee maximum, or
capped fee.
formulary - A listing of drugs, classified by therapeutic category or disease class, that are considered
preferred therapy for a given managed population and that are to be used by an MCO’s providers
in prescribing medications.
generic substitution -The dispensing of a drug that is the generic equivalent of a drug listed on a
pharmacy benefit management plan’s formulary. In most cases, generic substitution can be
performed without physician approval.
Health Insurance Portability and Accountability Act (HIPAA) - A federal act that protects people who
change jobs, are self-employed, or who have pre-existing medical conditions. HIPAA standardizes
an approach to the continuation of healthcare benefits for individuals and members of small group
health plans and establishes parity between the benefits extended to these individuals and those
benefits offered to employees in large group plans. The act also contains provisions designed to
ensure that prospective or current enrollees in a group health plan are not discriminated against
based on health status.
Health Maintenance Organization (HMO) - A healthcare system that assumes or shares both the
financial risks and the delivery risks associated with providing comprehensive medical services
to a voluntarily enrolled population in a particular geographic area, usually in return for a fixed,
prepaid fee.
Indemnity Insurance - Traditional indemnity insurance is sometimes referred to as “fee for service.”
This type of insurance plan allows patients to go to any doctor or hospital that they select,
anywhere in the United States or abroad. Although insurance plans will vary, patients will generally
be responsible for a deductible and copayments.
lifetime maximum benefit amount - The maximum dollar amount set by an MCO that limits the total
amount the plan must pay for all healthcare services provided to a subscriber in the sub-scriber’s
lifetime.
managed care - The integration of both the financing and delivery of healthcare within a system that
seeks to manage the accessibility, cost, and quality of that care.
managed care organization (MCO) - Any entity that utilizes certain concepts or techniques to manage
the accessibility, cost, and quality of healthcare. Also known as a managed care plan.
Medicaid - A jointly funded federal and state program that provides hospital expense and medical
expense coverage to the low-income population and certain aged and disabled individuals.
medical advisory committee - Committee whose purpose is to review general medical management
issues brought to it by the medical director.
medical director - Manager in a healthcare organization responsible for provider relations, provider
recruiting, quality and utilization management, and medical policy.
Medicare - A federal government hospital expense and medical expense insurance plan primarily for
elderly and disabled persons. See also Medicare Part A, Medicare Part B, and Medicare Part C.
Medicare Part A - The part of Medicare that provides basic hospital insurance coverage automatically
for most eligible persons. See also Medicare.
Copyright©2008 CancerConsultants.com. All Rights Reserved.
11
FINANCIAL & INSURANCE ISSUES, continued
Medicare Part B - A voluntary program that is part of Medicare and provides benefits to cover the
costs of physicians’ services. See also Medicare.
Medicare Part C - The part of Medicare that expands the list of different types of entities allowed
to offer health plans to Medicare beneficiaries. Also known as Medicare+Choice. See also
Medicare.
Medicare supplement - A private medical expense insurance plan that supplements Medicare
coverage. Also known as a Medigap policy.
Omnibus Budget Reconciliation Act (OBRA) of 1990 - A federal act which established the Medicare
SELECT program, a Medicare supplement that uses a preferred provider organization to
supplement Medicare Part B coverage.
outcomes measures -Healthcare quality indicators that gauge the extent to which healthcare services
succeed in improving patient health.
Patient Bill of Rights - Refers to the Consumer Bill of Rights and Responsibilities, a report prepared
by the President’s Advisory Commission on Consumer Protection and Quality in the Health Care
Industry in an effort to ensure the security of patient information, promote healthcare quality, and
improve the availability of healthcare treatment and services. The report lists a number “rights,”
subdivided into eight general areas, that all healthcare consumers should be guaranteed and
describes responsibilities that consumers need to accept for the sake of their own health.
peer review -The analysis of a clinician’s care by a group of that clinician’s professional colleagues.
The provider’s care is generally compared to applicable standards of care, and the group’s analysis
is used as a learning tool for the members of the group.
pharmacy and therapeutics committee - Committee charged with developing a formulary, reviewing
changes to that formulary, and reviewing abnormal prescription utilization patterns by providers.
pharmacy benefit management (PBM) plan - A type of managed care specialty service organization
that seeks to contain the costs, while promoting safer and more efficient use, of prescription
drugs or pharmaceuticals. Also known as a prescription benefit management plan.
Preferred Provider Organization (PPO) - A PPO allows patients to see a doctor from the plan’s network
of physicians for a small copayment fee. Patients who choose to see a doctor out of the network
must pay the balance between the PPO’s scheduled fee and the billed amount.
premium - A prepaid payment or series of payments made to a health plan by purchasers, and often
plan members, for medical benefits.
prior authorization - In the context of a pharmacy benefit management (PBM) plan, a program that
requires physicians to obtain certification of medical necessity prior to drug dispensing. Also
known as a medical-necessity review.
therapeutic substitution - The dispensing of a different chemical entity within the same drug class
of a drug listed on a pharmacy benefit management plan’s formulary. Therapeutic substitution
always requires physician approval.
usual, customary, and reasonable (UCR) fee - The amount commonly charged for a particular medical
service by physicians within a particular geographic region. UCR fees are used by traditional
health insurance companies as the basis for physician reimbursement.
utilization management (UM) - Managing the use of medical services to ensure that a patient receives
necessary, appropriate, high-quality care in a cost-effective manner.
utilization review (UR) - The evaluation of the medical necessity, efficiency, and/or appropriateness
of healthcare services and treatment plans.
utilization review committee - Committee that reviews utilization issues brought to it by the
medical director, often approving or reviewing policy regarding coverage, reviewing utilization
patterns of providers, and approving or reviewing the sanctioning process against providers.
Copyright©2008 CancerConsultants.com. All Rights Reserved.
12
FINANCIAL & INSURANCE ISSUES, continued
Expensing Medical Costs on Your Tax Return
Even with good insurance, treatment and follow-up care for cancer can incur many outof-pocket expenses. One way to recoup some of these expenses is to do an itemized
deduction for your medical and dental expenses on your tax return. Note that you are
only allowed to deduct the amount of your medical and dental expenses that is greater
than a percentage of your income, currently 7.5% of your adjusted gross income (this
is subject to change). If your income is high or your expenses are low, you might not
benefit from an itemized deduction of medical expenses.
The obvious deductible expenses include any medical or dental care costs for you, your
spouse (if filing jointly), your child or dependent that were not covered by insurance.
Any out-of-pocket medical expense that was reimbursed by insurance is not deductible.
Other obscure expenses that are deductible include acupuncture, therapeutic massage,
chiropractic medicine, contact lenses, eye glasses and laser eye surgery. Cosmetic or
illegal surgeries are not deductible.
If your treatment requires travel, transportation costs for travel by bus, taxi, train or plane
are deductible. If traveling by car, you can expense the actual cost for oil and gas or allot
12 cents per mile. In either case, include parking fees and tolls. Lodging, but not meals,
can also be deducted while traveling for the explicit purpose of medical treatment.
Allowable lodging expenses may not exceed $50 per night per person.
Other miscellaneous expenses you should keep track of and are allowed to deduct
include medical conferences, prescription medication (including birth control pills),
artificial limbs, wigs and nursing services. Nutritional supplements and household help
other than nursing are not currently deductible.
By keeping track of expenses and deducting them on your tax returns, you may be able
to partially recover some of the out-of-pocket medical expenses not covered by your
insurance. For more information on deducting medical and dental expenses look at
Publication 502 and the instructions for Schedule A of form 1040 at www.irs.gov or see
your accountant.
Copyright©2008 CancerConsultants.com. All Rights Reserved.
13
ADMISSIONS
The START Center for Cancer Care’s Admissions Department is responsible for obtaining
complete and accurate demographic and personal information necessary for billing
purposes. It is our goal to obtain as much of this information in advance to ensure
a timely and expeditious check in and check out process. Patients may contact the
admissions department for any questions regarding their insurance benefits, payment
options, referrals, financial concerns they may have, or to report any changes in
insurance coverage or mailing address by contacting 210-593-5700 and requesting to
speak with any point of service representative at the appropriate site.
PATIENT ADVOCACY
Patient Advocacy
Through our Patient Advocacy department we hope to create a better environment for
our patients. A Patient Advocate will greet your during your first appointment, whenever
possible. The Advocate will provide information about resources and services available
to you and your representatives. This Advocate will also provide a confidential site for
you to voice a complaint, concern or request and assist you in resolving the issue. It is our
policy to resolve patient concerns and grievances in a timely, reasonable and consistent
manner. Our goal is to learn from patients and whenever possible and appropriate we
will take steps to improve the overall quality of patient care. We also welcome your
compliments when appropriate, and pledge to notify the staff member responsible for
assisting you.
We encourage patients and their representatives to communicate with the Patient
Advocacy office regarding any compliments, complaints, problems or concerns which
have not been resolved directly with the parties involved.
Contact Patient Advocacy at (210) 593-2652 or [email protected], MondayFriday 8:00 a.m. - 5:00 p.m.
ELECTRONIC MEDICAL RECORDS
The START Center for Cancer Care utilizes an electronic medical record system designed
specifically for oncologists. Physicians no longer flip through a patient’s chart page by
page. Instead, the physician’s use the computer to scroll through the chart.
Each exam room is equipped with a computer, so the patient’s information can be
entered directly into the computer during the patient’s visit. This may include information
such as vital signs, medications, allergies, past medical history, laboratory test results,
and the patient’s exam. The physician and patient may review labs, scans, etc. through
the computer.
Electronic medical records improve accuracy in treatment, improve efficiency, and
streamline communication among the medical team treating the patient. The records
provide a continuity of care from doctor to doctor and a faster response time, as
physicians can access patient records from wherever they are.
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CLINICAL
RESEARCH
CLINICAL RESEARCH
CLINICAL RESEARCH
Introduction
Clinical trials are studies that evaluate the effectiveness of new drugs or treatment
strategies. The development of more effective cancer treatments requires that new and
innovative therapies be evaluated with cancer patients. Each clinical trial is designed to
find new or better ways to treat cancer patients. In oncology, clinical trials are especially
important because, in the absence of high cure rates, nearly all therapeutic approaches
are developmental in nature.
Currently, there are hundreds of ongoing clinical trials in the United States. Although
clinical trials are an important component of cancer care and are crucial for improving
cancer treatment, fewer than 5% of cancer patients currently participate in clinical
trials because they are uninterested or unaware that they exist, have difficulty finding an
appropriate clinical trial that may be of benefit to them, or are ineligible to participate
in a clinical trial because of prior treatment interventions.
It is extremely important to decide whether or not to participate in a clinical trial before
receiving any treatment from a physician.
What are Clinical Trials?
A clinical trial is a research study designed to evaluate potential new treatment options.
These studies are the result of a long and deliberate cancer research process that often
takes years. Clinical trials test the safety and effectiveness of new or modified cancer
drugs, new drug doses, unique approaches to surgery or radiation therapy, and varied
combinations of treatments. Clinical trials are an integral component for improving
the treatment of medical conditions because they lead to higher standards of care. In
the United States all new cancer treatment products must proceed through an orderly
clinical trials evaluation process to ensure that they have an acceptable level of safety
and demonstrate benefit to helping patients with a specific cancer before they become
commercially available to other patients.
Clinical trials essentially fall into two general categories.
� The first general category of clinical trials are designed to evaluate new drugs, compounds, or
biologic agents that have not yet been approved by the Food and Drug Administration (FDA) for
administration to patients. All substances must go through several phases of clinical trials to
document their safety and effectiveness before the FDA approves them for routine use to treat
cancer patients. Prior to FDA approval, these substances are only available through clinical trials;
however, after FDA approval, they are commercially available.
� Clinical trials may also evaluate drugs, compounds, or biologic agents already approved by the FDA
for the treatment of one type of cancer. These substances have already been determined to be safe
by the FDA and they are now being evaluated in different doses, schedules, and combinations to
determine how to optimally use them for the treatment of a variety of cancers.
Copyright©2008 CancerConsultants.com. All Rights Reserved.
15
CLINICAL RESEARCH, continued
Phases of Clinical Trials
Development of new anticancer agents and treatment strategies occurs in four phases.
Each phase is designed to determine specific information about the potential new
treatment such as its risks, safety and effectiveness compared to standard therapy.
The hope is that the new therapy will be an improvement over the previous standard
therapy.
Phase I Trials:
This phase is probably the most important step in the development of a new drug or therapy.
These trials usually involve a small number of patients for whom other standard therapies
have failed or no known alternative therapy is available. Phase I therapy may produce anticancer effects and a small number of patients may benefit. However, the primary goals of
this phase are to determine anticancer activity in humans, the maximum tolerated dose of
the treatment, the manner in which the drug works in the body, the toxic side effects related
to different doses and whether toxic side effects are reversible. Upon completion of phase I
trials, the information that has been gathered is used to begin phase II trials.
Phase II Trials:
Once the information is gathered and analyzed from phase I trials, phase II trials are designed
to determine the effectiveness of the treatment in a specific patient population at the dose
and schedules determined in phase I. These trials usually require a slightly higher number of
patients than phase I trials. This number may increase depending on the number of responses
as the phase II trial progresses. Drugs or therapies that are shown to be active in phase II
trials may become standard treatment or be further evaluated for effectiveness in phase III
trials.
Phase III Trials:
Phase III trials compare a new drug or therapy with a standard therapy in a randomized and
controlled manner in order to determine proof of effectiveness. Phase III trials require a large
number of patients to measure the statistical validity of the results because patient age, sex,
race, and other unknown factors could affect the results. To obtain an adequate number of
patients, several physicians (investigators) from different institutions typically participate in
phase III clinical trials.
Phase IV Trials:
Once the drug or treatment becomes part of standard therapy, the manufacturer of the
drug may elect to initiate phase IV trials. This phase includes continued evaluation of the
treatment effectiveness and monitoring of side effects as well as implementing studies to
evaluate usefulness in different types of cancers.
Copyright©2008 CancerConsultants.com. All Rights Reserved.
16
CLINICAL RESEARCH, continued
How are Clinical Trials Conducted?
Clinical trials are designed to test treatments under very specific scientific and ethical
guidelines. Clinical trials use written protocols to define the purpose, design and
conduct of a specific clinical trial. All of the research centers participating in a particular
study use the same research protocol. The protocol is written by the sponsor of the
study and explains what the trial will do, how it will be conducted, where it will be
conducted, who may participate and how and when the participants will be evaluated.
Sponsors of clinical trials include, but are not limited to, the National Cancer Institute,
groups or networks of physicians, individuals within a single cancer institution and
manufacturers of biopharmaceutical products. In order to protect patients participating
in clinical trials, the sponsor reviews the protocol for safety and appropriateness and
then the protocol must undergo a second neutral review by an Institutional Review
Board (IRB). The Institutional Review Board is responsible for overseeing any clinical
trials that are performed in the specific healthcare institution where the clinical trial
is offered/conducted. An Institutional Review Board includes physicians, healthcare
providers and individuals not involved in healthcare, including the clergy or ordinary
citizens/consumers. Institutional Review Board members do not have any personal
interest in the results of the trial and, therefore, can ensure that the study is conducted
fairly and safely. Committee members serving on Institutional Review Boards address
the following questions in reviewing protocols:
•
•
•
•
•
•
•
•
•
•
Does this protocol have scientific value?
Does the protocol have scientific validity?
Does the study have a valid scientific design and yet pose an inappropriate risk for subjects?
Are risks to subjects minimized?
Are the risks to subjects reasonable in relation to anticipated benefits, if any, to subjects and
the importance of the knowledge that may reasonably be expected to result?
Is the selection of subjects equitable?
Are additional safeguards in place for subjects likely to be vulnerable to coercion or undue
influence?
Will informed consent be obtained from research subjects or their legally authorized
representatives?
Is there adequate provision for monitoring the data collected to ensure the safety of subjects?
Are there adequate provisions to protect the privacy of subjects and to maintain the
confidentiality of data?
The Institutional Review Board also reviews all informed consent documents to make
sure that they provide clear and complete information for those evaluating the merits of
enrolling in a specific clinical trial.
Clinical trials evaluating cancer treatments or strategies may be offered in large university
hospitals, local community hospitals and/or physician practices. The location where a
clinical trial is conducted depends on the specific resources required to conduct the
trial, the number of patients needed for enrollment in the trial to answer the question
and the individual or institution’s interest in performing clinical trials in general.
Copyright©2008 CancerConsultants.com. All Rights Reserved.
17
CLINICAL RESEARCH, continued
Clinical Trials Safeguards
Both standard care and clinical trials have risks, side effects and benefits that vary
depending on the individual. However, there are rigorous guidelines in place to protect
the well-being and safety of clinical trial participants. The physician and research nurse
conducting the study will explain any known or anticipated risks ahead of time. Once
a patient’s eligibility for a specific trial is established, the research nurse will explain the
informed consent process. Informed consent is one of the patient’s most important rights
in the research process, as it outlines the purpose of the study, the exact treatments
that will be administered, all possible side effects, and the patient’s right to withdraw
from the study at any point. Signing the consent form acknowledges that the trial was
explained and is understood. Also, clinical trial participants are constantly monitored to
identify any changes in their condition.
Participating in Clinical Trials
Clinical trials are designed to evaluate the effectiveness of new treatment interventions.
The objective of these clinical trials is to test new therapies in patients who have cancer.
Patients participate in clinical trials for several reasons, including:
•
•
•
The potential to benefit from a new drug or treatment procedure
Improved management of symptoms resulting from treatment or cancer
The opportunity to directly contribute to improving the understanding of how to
treat a cancer and ultimately, benefit other patients
Patients who participate in clinical trials receive either a promising new treatment or
the best available conventional treatment. If a new treatment option is proven to work,
patients who are participating in the clinical trial will be among the first to benefit.
While there is no guarantee that any treatment will be successful, clinical trials have
been proven to offer some of the most effective cancer treatments currently available
today.
Copyright©2008 CancerConsultants.com. All Rights Reserved.
18
CLINICAL RESEARCH, continued
The Cost of Clinical Trials
There are two types of costs associated with a trial:
•
•
Patient care costs; and
Research costs
Patient care costs: These are costs associated with providing medical goods and services
to each patient. Usual care costs include doctor visits, hospital stays, clinical laboratory
tests, x-rays, and any other medical costs that occur regardless of whether a patient is
participating in a clinical trial or receiving standard treatment. These costs are usually
covered by a third-party health plan, such as Medicare or private insurance.
Research costs: Research costs are costs that are associated with clinical trial participation,
such as data collection and management, research physician and nurse time, analysis of
results, and tests performed purely for research purposes. Such costs are usually covered
by the sponsoring organization, such as a pharmaceutical company. Be sure to consult
with your physician about the financial aspects of any trial you are evaluating.
Health insurance companies and managed care companies decide which health care
services they will pay for by developing coverage policies regarding the specific services.
In general, the most important factor determining whether something is covered is a
health plan’s judgment as to whether the service is established or investigational. Health
plans usually designate a service as established if there is a certain amount of scientific
data to show that it is safe and effective. If the health plan does not think that such data
exists in sufficient quantity, the plan may label the service as investigational.
Health care services delivered within the setting of a clinical trial are very often
categorized as investigational and are not covered. This is because the health plan
thinks that the major reason to perform the clinical trial is that there is not enough data
to establish the safety and effectiveness of the service being studied. Thus, for some
health plans, any mention of the fact that the patient is involved in a clinical trial results
in a denial of payment.
Health plans may define specific criteria that a trial must meet before extending coverage.
Some plans, especially smaller ones, will not cover any costs associated with a clinical
trial, while other, larger managed care plans have recently announced at least partial
coverage of costs associated with clinical research. Policies vary widely, but in most
cases the best strategy is to have a doctor initiate discussions with the health plans.
Medicare Coverage
For up-to-date information about Medicare coverage of clinical trials, visit the Web
site http://www.hcfa.gov/medlearn/refctmed.htm to view the Medicare Clinical Trials
Quick Reference Guide.
Copyright©2008 CancerConsultants.com. All Rights Reserved.
19
20
SUPPORT
SERVICES
SUPPORT SERVICES
SPA & WELLNESS CENTER
Located just inside our lobby on the first floor is the beautiful Spa and Wellness Center
which is due to open the end of 2009. The Start Center created the Spa and Wellness Center
in keeping with our mission to deliver comprehensive cancer care.
We believe that an integral part of comprehensive cancer care is addressing the needs
of the whole person. We recognize that a cancer diagnosis can be challenging and can
threaten your sense of well being and quality of life. The Spa and Wellness Center will
offer complementary modalities in an effort to support you in your treatment and recovery
process. Complementary modalities are evidence -based and are designed to complement
your existing traditional medical regimen. Our treatments and services help manage
chemotherapy side effects, pain, anxiety, stress, and depression. The spa services are
designed to promote relaxation, rejuvenation and stress relief. Each service and modality
is created with the special needs of a cancer patient in mind. The goal of the Spa and
Wellness Center is to offer supportive services that optimize wellness by addressing the
needs of body, mind, and spirit.
The Spa and Wellness center will offer the following:
•
•
•
•
•
•
•
•
•
•
•
Acupuncture
Massage
Facials
Nutritional Counseling
Energy Therapy
Reflexology
Aromatherapy
Psychological Counseling
Spiritual Counseling
Meditation
Guided Imagery
In addition to our treatments and services, the Spa and Wellness Center will have a specialty
shop that will offer cancer specific products. Skin care, oral care, wigs, and mastectomy
products are some of the items that will be found in our specialty shop.
Our Spa and Wellness Center is available to patients, family members, or anyone touched
by cancer seeking integrative oncology services. A full menu describing the services, prices,
and items offered can be found in the center when we open. For further information, please
contact the Director, Ginger Kemmy, RN, 593-5975.
21
VOLUNTEER AUXILIARY
By becoming a member of the Care Today, Cure Tomorrow Volunteer Auxiliary…
You will…
Share the moments
Share the benefits
Share the caring, and
Share the future.
Whatever your background may be, your talents
and skills can improve the lives of our patients.
Membership is open to anyone interested in giving
of themselves to help others. There are many areas
in need of assistance…some including patient
contact, while others consist of clerical assignments
or helping nurses with preparing patient handouts.
Before you volunteer, you will either need to attend
a training class or agree to accompany a “buddy”
for one shift.
The requirements to become a
Care Today, Cure Tomorrow Volunteer Auxiliary member are…
�
�
�
�
�
�
�
�
Complete an application
Meet with the Volunteer Coordinator
Pay the one-time auxiliary membership dues ($10.00)
Choose a specific day (Monday-Friday)
Choose a shift (9:00 AM-12:00 PM or 12:00 PM-3:00 PM)
Attend training session or choose a time to accompany a “buddy”
Get a TB test (there is no charge…test can be given any day except Thursday)
In order to remain an active volunteer, you must commit to a minimum of
fifty (50) hours annually.
In conjunction with the support of the START Center for Cancer Care administration,
any funds acquired by the Auxiliary will be granted to the ThriveWell Cancer Foundation
for patient assistance.
The START Center for Cancer Care
Patient Advocacy
4383 Medical Drive
San Antonio, Texas 78229
Phone: 210-593-2652
Fax: 210-593-5992
Email: [email protected]
22
CANCER SUPPORT GROUPS LISTING
Coping with Cancer
A support group designed to educate and provide support for patients and their families. FOR USAA
EMPLOYEES. Sponsored by American Cancer Society.
3rd Wed. from 12:30-1:00
USAA, Conference Room F-Fitness Area-Dugout
Contact Charlotte Hickman or Susan McEreath
210-498-1385
A program designed to help patients, their families and friends better understand and learn to live
with cancer. Several locations/times; see below. Sponsored by American Cancer Society.
University Health Center - Downtown (formerly Brady Green)
1st and last Thursday of the month at 11:00 a.m.
Bilingual Support Group
527 N. Leona, San Antonio, TX 78207
Contact Carmen Boudreau, LMSW
210-358-3620
St. Mathew’s Catholic Church
4th Monday at 7:30 p.m. except December
10703 Wurzbach Rd., San Antonio, TX 78230
Contact Norma Willet
210-561-0581
St. Philip of Jesus/UIW Health Ministry
3rd Sunday of every month, 10:30 - 11:30
Contact Jean Deliganis
210-224-7122
130 Bank Street , San Antonio, TX 78204
Northeast Baptist Hospital
First floor - Cancer Resource room next to Oncology Area
3rd Tuesday of every month, 6:00 - 7:30 p.m.
8811 Village Dr., San Antonio, TX 78217
Contact Irene Henry
210-297-2419
St. Thomas Catholic Church
Meet 4th Monday of the Month at 7:00PM
Contact Eleanor Freeman
830-899-3211 or 210-382-5889
180 St. Thomas Dr, Canyon Lake, TX 78133
I Can Cope
Support group for cancer survivors, family members or loved ones who are coping with cancer.
1st Tuesday of every month except public holidays
Northeast Baptist Hospital–Classroom 2, 1st Floor (East Wing)
Contact Northeast Baptist Hospital
210-297-7005
23
CANCER SUPPORT GROUPS LISTING, continued
Women With Cancer-Support Group
An educational program for women with cancer, their families and friends. This program includes
doctors, nurses, social workers, and other health professionals who discuss issues related to
cancer. Sponsored by American Cancer Society.
2nd Tuesday of every month, 6:30 p.m. - 7:30 p.m.
First Baptist Church
1401 Pat Booker Rd., Universal City, TX 78148
Contact Nancy Anthony
210-422-6880
Life After Loss
A bereavement support program for anyone who has experienced the loss of a loved one within the
past two years. Sponsored by American Cancer Society.
Please call the American Cancer Society for dates and locations.
Contact the American Cancer Society Patient Services Dept
210-614-4212
Look Good… Feel Better…
Provides information to women undergoing cancer treatments to help them look and feel more their
appearance. This program is offered in a group setting by licensed cosmetologists. Sponsored by
American Cancer Society.
Last Monday of every month, 9:00 - 11:00 a.m.
American Cancer Society office
8114 Datapoint Dr., San Antonio, TX 78229
Please contact the American Cancer Society to register or for information on other dates and
locations.
210-614-4212
Lost Chord Club
The American Cancer Society in cooperation with the International Association of Laryngectomees,
provides visitation and support to laryngectomees and their families. Sponsored by American Cancer
Society.
3rd Sunday of the month, 2:00 p.m.
American Cancer Society office
8115 Datapoint Dr., San Antonio, TX 78229
Contact Patient Services Dept or Robert VanWinkle Volunteer
210-614-4212 or 210-403-2659
Reach to Recovery
Volunteers who have been treated for breast cancer visit patients before and after surgery.
Patients receive gift items including literature and a temporary breast form. Exercises are
demonstrated at the request of the patient’s physician. Sponsored by American Cancer Society.
A physician referral is required. Please call the American Cancer Society Patient Services Dept.
for further details.
www.cancer.org
1-877-227-1618 or 210-614-4213
24
CANCER SUPPORT GROUPS LISTING, continued
United Ostomy Association of San Antonio
Volunteers provide one-on-one visitation and support for colostomy, ileostomy and urostomy
patients. This program is sponsored by American Cancer Society in partnership with the UOA.
Meetings are last Monday of the month except May and December, 7:00 p.m.
American Cancer Society Office
8114 Datapoint Dr., San Antonio, TX 78229
Contact Patient Services Dept–Diane Armstead
210-614-4212 or 210-684-2775
Brain Tumor Support Group
Sponsored by Bexar County Brain Tumor Support Group
Meet 2nd Tuesday of every month, 7:00 - 8:30 p.m.
Warm Springs, 1st Floor, Resource Room
5101 Medical Center Drive, San Antonio, TX
Contact Teresa Zdansky
830-779-3059 / cell: 210-386-5608 / [email protected]
Cancer Support Group
Sponsored by Boerne Cancer Support Group
2nd and 4th Monday of each month, 7:00 p.m. - 8:30 p.m.
St. Mark Presbyterian Church
208 W. Bandera St., Boerne, TX 78006
Contact St. Mark Presbyterian Church for more information–Larry Warren, PhD
830-816-3000
Make Today Count
Sponsored by Cancer Therapy & Research Center (CTRC)
2nd and 4th Thursdays, 6:00 p.m.
Cancer Therapy & Research Center
7979 Wurzbach Rd., San Antonio, TX 78229
Contact Patient & Family Services @ 210-616-5570 or Jenny Gonzalez @ 210-450-1565
Cancer Support
Counselors Available. Sponsored by Harvest Fellowship Community Church.
Harvest Fellowship Community Church
1270 North Loop 1604, San Antonio, TX 78232
Contact Maxine Klein
210-249-2400
Kathy’s Angels
Breast Cancer Support Group for Holy Trinity/St. Marks Church or anyone else who’d like to attend.
Sponsored by Holy Trinity Catholic Church.
Sonterra Country Club
Please contact Sherry Drury for more information and details
210-497-4200, Ext. 305
25
CANCER SUPPORT GROUPS LISTING, continued
Breast Cancer Support Group
Sponsored by Keep Abreast.
1st Monday of the month; 6:00-7:00 p.m. Metastatic; 7:00-9:00 p.m. All Breast Cancer
Cancer Therapy & Research Center
Grossman Library 1st Floor
7979 Wurzbach Rd, San Antonio, TX 78229
Contact Suzi Emanuel for more information
210-593-5748
Kerrville Cancer Support Group
Open to any patient receiving treatment, their caregiver or cancer survivor. Sponsored by Kerrville
Cancer Support Group.
2nd Wednesday of the month, 5:00 p.m. in Reception Area
Kerrville Cancer Center
218 Sidney Baker North, Kerrville, TX
Contact Patrice Doerries
830-257-7088 or 1-888-621-0047
Multiple Myeloma
Sponsored by Leukemia & Lymphoma Society
2nd Wed. of the month, 6:30-8:00 p.m.
Contact Nicole Bell for more information
210-377-1775, ext. 111
Children Cancer Support Group
For children with all types of cancer. Sponsored by Leukemia & Lymphoma Society Of America
Various locations–contact Nicole Bell for more information
210-377-1775, Ext. 111
Medina Area Cancer Support Group
For all types of cancers. Sponsored by Medina Area Cancer Support Group.
1st Monday of every month October through June, 7:00 p.m.
Medina Community Library
13948 St. HWY 16 N, Medina TX 78055
Contact Robert Gladden
830-589-7664
Survivors Offering Support
Breast cancer support group for the patient and family. Sponsored by Methodist Healthcare.
1st Tuesday of every month at 7:00 p.m.
Northeast Methodist Hospital
12412 Judson Rd. at the Community Center
Contact Libby Fleming
210-575-0355
26
CANCER SUPPORT GROUPS LISTING, continued
General Cancer Support Group
Support group for friends and families only of cancer patients. Program sponsored by Methodist
Hospital.
Thursdays, 2:00-3:00 pm
Methodist Hospital– 8th floor-Family Waiting Room
7700 Floyd Curl Drive, San Antonio, TX 78229
Contact Nikki Yuill
210-575-4558
Prayer Meeting
Service/Support Group. Program sponsored by Methodist Hospital.
Tuesdays, 6:00 p.m.
Methodist Hospital– 8th floor-Family Waiting Room
7700 Floyd Curl Drive, San Antonio, TX 78229
Contact Nikki Yuill
210-575-4558
Gynecologic Cancer Support Group
Cervical, Ovarian and Uterine cancer. Sponsored by National Ovarian Cancer Coalition
La Madeline
Contact Linda Tarver for more information
210-824-3496 or 830-227-5778
Gynecologic Cancer Support Group
Ovarian or other types of gynecologic cancer. Peer-to Peer Support through the NOCC. Sponsored
by National Ovarian Cancer Coalition.
Please contact Diedre J. Steele for more information
210-497-5259 / [email protected]
The Harbor GYN Center Support Group
Sponsored by Northwest Counseling Center.
Meetings: 2nd Tuesday of January, April, July and October
Sea Island Restaurant
1604 & Bandera, San Antonio, TX
Contact Barbara Fry @ 210-736-5053 or Ann Cavett @ 830-981-4676
New Braunfels Area Breast Cancer Support Group
Sponsored by St. Paul Lutheran Church New Braunfels
3rd Monday of the month, 9:30 a.m.
St. Paul Lutheran Church
181 South Santa Clara Ave., New Braunfels, TX 78130
Contact Becky Voges for more information
830-625-9191
Help and Hope for the Journey
Sponsored by University United Methodist Church.
2nd and 4th Wednesday of the month, 7:00 p.m. - 8:00 p.m.
5084 DeZavala #205
Contact Dorothy Phillips
210-292-3795
27
CANCER SUPPORT GROUPS LISTING, continued
Prostate Cancer Support Group
San Antonio Alamo Chapter Meetings. Sponsored by Us Too Partners.
1st Monday of the month at 5:30 p.m.
8310 Ewing Halsell Drive, San Antonio, TX 78229
For more information contact John Staha 24/7
Home 830-569-5516 or 830-570-7012
Prostate Cancer Survivor Support Group
Support group provides information by specialist in the various fields related to prostate cancer,
such as surgery, radiation and medicine. Sponsored by Us Too Partners.
Normally scheduled for the 1st Thursday of each month at 7:00 p.m.
South Texas Regional Medical Ctr. Chapter of Us Too
1905 Hwy. 97 East, Jourdanton, TX 78026
For more information contact John Staha 24/7
Home 830-569-5516 or 830-570-7012
Wilford Hall Medical Center General Cancer Support
Group for the patient and the family. Military and civilian.
Every Thursday of the month at 1:00-2:00 p.m.
Wilford Hall Medical Center
2200 Bergquist, Family Room 6 A35, San Antonio, TX 78236
Call Cindy Burke @ 210-292-6914 or Dorothy Phillips @ 210-292-3795 for information
28
RESOURCES
National Cancer Institute
1-800-4-CANCER or www.cancernet.com
American Cancer Society
(local offices throughout the U.S.)
1-800-ACS-2345 or www.cancer.org
www.cancerfatigue.org
www.chemocare.com
www.cancersymptoms.org
www.acor.org
www.oncochat.org
www.plwc.org
www.utmb.edu
www.cancerpatientcare.org
www.cancer.gov
www.planetcancer.org
www.activesurvivor.org
www.utmb.edu/nsights/18ways.htm
www.aapainmanage.org
www.patientcenters.com
www.webmd.com
www.preventcancer.org
www.painfoundation.org
www.texascancercouncil.org
29
AREA BUSINESSES
Hotels
Oak Hills Medical Center
Inn & Suites
7401 Wurzbach
210-614-9900
Homegate Studios & Suites
10950 Laureate Drive
210-691-1103
Hampton Inn
4803 Manitou Drive
210-684-9966
Country Hearth Inn
7500 Louis Pasteur
210-616-0030
Staybridge Suites
4320 Spectrum One
210-558-9009
Courtyard at Marriott
8585 Medical Drive
(off Fredericksburg @ Wurzbach)
210-614-7100
Residence Inn by Marriott
4041 Bluemel
210-561-9660
Omni San Antonio
9821 Colonnade Drive
210-691-8888
Motel 6
9400 Wurzbach
210-593-0013
Embassy Suites Hotel
7750 Briaridge
(IH-10 @ Callaghan)
210-340-5421
Studio 6
7719 Louis Pasteur Court
210-349-3100
Hampton Inn (Six Flags)
11010 IH-10 @ Huebner
210-561-9058
Super 8 Motel
5319 Casa Bella
(IH-10 @ DeZavala)
210-696-6916
Springhill Suites by Marriott
3636 NW Loop 410 @ Fredericksburg
210-737-6086
Drury Inn Northwest
9806 IH-10 West @ Wurzbach
210-561-2510
Hyatt Place
4325 Amerisuites Drive
210-561-0099
Homewood Suites
4323 Spectrum One
210-696-5400
Candlewood Suites
9350 IH-10 West
210-615-0550
Comfort Inn
1-877-727-8483
Complimentary Shuttle
Ronald McDonald House
4803 Sid Katz
210-614-2554
Drury Inn
9806 IH 10 West
210-561-2510
30
AREA BUSINESSES, continued
Grocery Stores
HEB
5803 Babcock @ Huebner
210-641-6403
HEB
9900 Wurbach @ IH-10
210-696-0794
Pharmacies
HEB
5803 Babcock @ Huebner
210-641-6405
Pill Box Pharmacy
7718 Louis Pasteur
210-614-3360
CVS Drugs
4805 Medical
210-616-0482
Oak Hills Pharmacy
7711 Louis Pasteur
210-614-4100
Walgreens
6393 Babcock
210-690-0825
Walgreens
5282 Medical Drive
210-614-3588
Long-Term Housing
CWS Corporate Housing
210-479-7231
Banks
Broadway National Bank
Fredericksburg @ Datapoint
210-283-6500
Bank of America
7333 Wurzbach
210-614-9910
McMullen County State Bank
8800 Huebner @ Floyd Curl
210-641-7000
Washington Mutual
4703 Medical Drive
210-614-3754
Frost Bank
Loop 410 @ Fredericksburg
210-220-6914 210-856-3315
Wells Fargo
4351 Medical Drive
210-856-5000
Compass Bank
7940 Floyd Curl @ Tower II Bldg.
210-592-5700
Wachovia
4727 Medical Drive
210-616-9486
Bank One
7954 Fredericksburg
210-617-6380
Compass Bank
7575 Wurzbach
210-592-5750
31
AREA BUSINESSES, continued
Restaurants
Chick-fil-A
4715 Medical Drive
210-615-5293
Black Eyed Pea
7959 Fredericksburg
210-614-3825
Big Apple Bagels
8434 Fredericksburg
210-614-3095
Quizno’s Italian Subs
8124 Fredericksburg
210-614-5577
Picnikins
8038 Wurzbach Road, Suite 140
210-616-0954
Dry Dock Oyster Bar
8522 Fredericksburg
210-692-3959
Jack In The Box
2465 Babcock
210-615-7328
Wendy’s
7727 Wurzbach
210-614-0540
Aldo’s Italian Restaurant
Fredericksburg @ Wurzbach
210-696-2536
Luby’s Cafeteria
9251 Floyd Curl @ Huebner
210-699-6652
Druthers Café
8637 Fredericksburg
210-691-2777
Jim’s
410 @ Fredericksburg
210-732-5491
Applebee’s
8224 Fredericksburg
210-614-3131
Jim’s
IH-10 @ Huebner
210-691-0665
Le Madeleine
Huebner Oaks Shopping Center
IH-10 access road @ Huebner
210-691-1227
Cha Cha’s Mexican Restaurant
2026 Babcock
210-681-2066
Sarika’s Thai Food
4319 Medical Drive
210-692-3200
California Pizza Kitchen
Huebner Oaks Shopping Center
IH-10 access road @ Huebner
210-699-4275
Cracker Barrel
11030 W. IH 10
(between Huebner & De Zavala)
210-690-3808
Mencius Chinese
Medical Drive @ Fredericksburg
210-615-1288
Bei Fang Chinese Restaurant
8637 Fredericksburg Road
210-697-8895
32
QUESTIONS
&
ANSWERS
CHEMOTHERAPY & RADIATION
CHEMOTHERAPY & RADIATION
QUESTIONS & ANSWERS
QUESTIONS TO ASK
Questions to Ask My Doctor about My Cancer
Before Treatment
Being diagnosed with cancer can be overwhelming. Learning on your own about the
disease, how it is treated, and how to apply this information to your situation is a
daunting task and you may feel you need some help. While we can give you general
information about your disease and its treatment, your doctor is the best source of
information about your particular situation.
It is important to have frank, open discussions with your cancer care team. They want
to answer all of your questions, no matter how trivial they might seem. But you need
to know what to ask. Getting answers to the questions below can help you understand
your cancer and your options, so that you can be an active participant in your cancer
treatment.
•
•
•
•
•
•
•
•
•
•
What kind of cancer do I have and where is it located?
Has my cancer spread beyond the primary site?
What is the stage of my cancer and what does that mean in my case?
What treatment choices do I have?
What do you recommend and why?
What risks or side effects are there to the treatments you suggest?
What are the chances my cancer will come back with these treatment plans? What is my
prognosis with these treatments?
What should I do to be ready for treatment?
Should I follow a special diet?
Will the treatment be painful? Will I have any scars?
During and After Treatment
Once you have decided on a course of treatment, you will need to know what to expect
and what to look out for. While all of the following questions may not apply to you,
asking the ones that do apply may be helpful.
•
•
•
•
•
•
•
•
•
•
How will you know if the treatment is working?
Is there anything more that I can do to manage side effects?
Are there any symptoms that I should notify you about immediately?
Will I need to be on a special diet during and after treatment?
Are there any limitations on my activities or amount of exercise?
How often will I need to have follow up exams?
How will I know if the cancer has returned? What symptoms should I watch for?
Will I have to have more imaging tests in the future such as CT scans or MRI scans?
What blood tests will be needed?
What are my options if the cancer comes back?
©2002 American Cancer Society
33
QUESTIONS TO ASK, continued
Other questions I need answered
In addition to the sample questions on the previous page, be sure to write down some of
your own. For instance, you might want more information about recovery times so you
can plan your work schedule. Or, you may want to ask about second opinions or about
clinical trials for which you may qualify. Write your questions below.
• _______________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
• _______________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
• _______________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
• _______________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
• _______________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
• _______________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
• _______________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
• _______________________________________________________________________
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_________________________________________________________________________
• _______________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
34
CHEMOTHERAPY QUESTIONS & ANSWERS
Chemotherapy
Chemotherapy is any treatment involving the use of drugs to kill cancer cells. Cancer
chemotherapy may consist of single drugs or combinations of drugs, and can be
administered through a vein, injected into a body cavity, or delivered orally in the form
of a pill. Chemotherapy is different from surgery or radiation therapy in that the cancerfighting drugs circulate in the blood to parts of the body where the cancer may have
spread and can kill or eliminate cancers cells at sites great distances from the original
cancer. As a result, chemotherapy is considered a systemic treatment.
More than half of all people diagnosed with cancer receive chemotherapy. For millions
of people who have cancers that respond well to chemotherapy, this approach helps
treat their cancer effectively, enabling them to enjoy full, productive lives. Furthermore,
many side effects once associated with chemotherapy are now easily prevented or
controlled, allowing many people to work, travel, and participate in many of their other
normal activities while receiving chemotherapy.
Being informed about chemotherapy and its potential side effects can help you to
proactively manage your own care and optimize your treatment and outcome. Things
you may need to know include the following topics:
•
•
•
•
•
•
How is chemotherapy delivered?
Managing Chemotherapy Side Effects
Understanding and Monitoring Your Blood Count
When to Call Your Doctor
Frequently Asked Questions
How is chemotherapy delivered?
Overview
There are a variety of schedules and techniques used to deliver chemotherapy and yours
will depend on which treatment your doctor prescribes. Cancer chemotherapy may
consist of a single drug or combinations of drugs that are delivered in cycles. A cycle
consists of treatment with one or more drugs followed by a period of rest.
Chemotherapy can be administered orally in the form of a pill, into a vein (intravenous),
injected into a body cavity (such as the bladder), into a muscle (intramuscular), or into the
spinal fluid (intrathecal). Currently, most chemotherapy is administered intravenously;
however, oral chemotherapy drugs are gaining wider use. In some cases, it may be
beneficial to administer IV chemotherapy through a venous access device (VAD), which
is inserted into a major vein in the body and can remain in place for a long period
of time. Not every chemotherapy patient requires a VAD. However, for those that are
undergoing frequent treatment, blood tests, and nutritional support, a VAD is beneficial
by reducing the number of needle sticks and associated discomfort.
Copyright©2008 CancerConsultants.com. All Rights Reserved.
35
CHEMOTHERAPY QUESTIONS & ANSWERS, continued
How often will I receive chemotherapy?
Chemotherapy drugs are typically given in cycles. The cycle consists of the day(s) the
drug is administered followed by a rest and recovery period. A cycle usually lasts one
to four weeks and is then repeated, which means a treatment is administered every one
to four weeks. Each course of chemotherapy is different, but generally consists of four
to six cycles. The actual administration of some chemotherapy drugs may take only
seconds or minutes, while others may take hours or even days.
What are the advantages and disadvantages of oral chemotherapy drugs?
In the past, chemotherapy drugs were mainly administered into a vein (intravenous).
Recently, oral chemotherapy drugs are being developed. Oral drugs may provide
greater ease of administration since patients can take them at home rather than going
to a clinic or hospital for treatments. Not all chemotherapy drugs are available in oral
form. Furthermore, intravenous (IV) administration is sometimes preferable because the
doctor can be more certain that the patient received the appropriate dose as scheduled
and they can monitor the patient during administration.
What is a venous access device (VAD) and what types are used for cancer patients?
A VAD is a surgically implanted device that provides long-term access to a major vein.
Although there are several different types of VADs, the two most commonly used for
cancer treatment and taking blood samples are:
•
•
Tunneled external catheters (Hickman® catheter), or
Subcutaneous implanted ports (port-a-cath).
Both a Hickman® catheter and a port-a-cath are surgically implanted into a major vein.
For the Hickman® catheter, the plastic tube or catheter is attached to a major vein and
then comes out of the body for external access. A port-a-cath is implanted completely
beneath the skin into a major vein under the collarbone. The port may then be accessed
by a special needle through the skin to deliver chemotherapy, hydration, transfusions,
and for taking blood samples.
The following are some key features that distinguish these two types of VADs:
Hickman® catheter
•
•
Easier insertion, removal, and access
Higher flow capacity due to single, double, or triple lumen (channel)
Port-a-cath
•
•
•
•
Fewer device-related infections
Fewer activity restrictions
Less day-to-day maintenance
Lower flow capacity due to only single or double lumen (channel)
Patients undergoing very demanding therapies that require frequent treatment, blood
transfusions, and nutritional support—such as a stem cell transplant—may be required
a Hickman® catheter instead of a port.
Copyright©2008 CancerConsultants.com. All Rights Reserved.
36
CHEMOTHERAPY QUESTIONS & ANSWERS, continued
Who needs a VAD?
Not every chemotherapy patient requires a VAD. For some chemotherapy treatment
plans, the inconvenience of implanting and accessing a VAD may outweigh the benefits.
You may wish to ask your doctor if a VAD is an appropriate option for you, especially if
you experience any of the following:
•
•
•
•
•
•
•
•
•
You are extremely anxious about having needles inserted.
Your veins are difficult to access or become inaccessible.
You must have alternative veins in your foot or hand accessed, which may be associated with
more discomfort.
You are undergoing continuous infusion chemotherapy (over an hour).
You anticipate many months of chemotherapy treatments.
You are receiving intravenous chemotherapy that requires multiple needle sticks.
Your treatment requires frequent drawing of blood samples.
Your treatment strategy involves chemotherapy agents that may cause “vein pain” when
administered through the arm.
You have a physician or nurse who recommend a vascular access device.
What special precautions are necessary with a VAD?
Your VAD must be flushed in order for it to work properly. Flushing your VAD requires
placing a needle in your port and flushing it out with heparin. Heparin is a blood
thinner prevents the catheter (plastic tube) from becoming occluded (clogged). While
you are on treatment, your VAD will be flushed after each treatment. When you are
no longer on treatment you must still remember to have your VAD flushed regularly.
This procedure needs to be done every 4-6 weeks. It is your responsibility to make the
appointment to have your VAD flushed.
Copyright©2008 CancerConsultants.com. All Rights Reserved.
37
CHEMOTHERAPY QUESTIONS & ANSWERS, continued
Managing Chemotherapy Side Effects
The treatment of cancer may include the use of chemotherapy, radiation therapy,
biological therapy, surgery or some combination of all of these therapeutic options. All of
these treatment options are directed at killing or eradicating the cancer that exists in the
patient’s body. Unfortunately, the delivery of cancer therapy, including chemotherapy,
often affects the body’s normal organs and tissues not affected by cancer. The undesired
consequence of damaging healthy cells is a complication of treatment, or a side effect.
Side effects may be acute (short-term), chronic (longer-term), or permanent. When
cancer treatments are evaluated, side effects are measured and reported as part of the
treatment evaluation. Examples of acute side effects include nausea and vomiting, and
mouth sores (mucositis).
Why do side effects occur?
Unfortunately, most chemotherapy drugs cannot tell the difference between a cancer
cell and a healthy cell. Therefore, chemotherapy often affects the body’s normal tissues
and organs which results in complication of treatments, or side effects.
Side effects cause inconvenience, discomfort, and may occasionally be fatal. Additionally
and perhaps more importantly, side effects may prevent doctors from delivering the
prescribed dose of therapy at the specific time and schedule of the treatment plan.
Because the expected outcome from therapy is based on delivering treatment at the dose
and schedule prescribed in the treatment plan, a change from the treatment plan may
reduce your chance of achieving an optimal outcome. This is extremely important to
understand. In other words, side effects not only cause discomfort and unpleasantness,
but may also compromise your chance of cure by preventing the delivery of therapy at
its optimal dose and time.
What are the most common side effects?
All chemotherapy is associated with a wide variety of side effects. However, some side
effects occur more frequently than others. Whether you will experience side effects,
which ones, and their severity depends on a variety of factors, including your type
of cancer, the type of chemotherapy drug or regimen you are taking, your physical
condition, your age, and others. However, the following side effects are typically
associated with chemotherapy:
•
•
•
•
•
•
•
•
•
•
•
•
Anemia
Depression
Fatigue
Hair Loss
Infection/Fever
Low Blood Counts
Mouth Sores
Nausea and Vomiting
Neutropenia
Pain
Reproduction/Sexuality
Thrombocytopenia
Copyright©2008 CancerConsultants.com. All Rights Reserved.
38
CHEMOTHERAPY QUESTIONS & ANSWERS, continued
Can anything be done about side effects?
Fortunately, in the last 20 years there has been a great deal of progress in the development
of treatments to help prevent and control the side effects of cancer therapy. These
developments have:
•
•
•
Led to vast improvements in the management of symptoms associated with
cancer treatment
Allowed chemotherapy to be delivered with greater accuracy and consistency,
Made many cancer treatments more widely available.
For example, modern anti-vomiting drugs, called antiemetics, have reduced the severity
of nausea and vomiting with chemotherapy. In addition, blood cell growth factors are
now available to protect patients from infection, to reduce the fatigue associated with
anemia, and to ensure that treatment can be delivered at the planned dose and schedule
for optimal outcomes.
Understanding and Monitoring Your Blood Counts
Overview
A reduced number of blood cells in circulation is a common side effect of chemotherapy.
Blood is composed of three basic blood cell types: red blood cells, white blood cells,
and platelets. Blood cells are produced in the bone marrow and regularly released into
circulation. Chemotherapy destroys rapidly dividing cells, a characteristic of cancer
cells. However, bone marrow cells also divide rapidly and are frequently damaged by
chemotherapy. Blood counts are monitored with a laboratory test called a Complete
Blood Count (CBC). The best way to treat low blood counts is to prevent them before
they occur. This can be accomplished with the administration of blood cell growth
factors. In some circumstances, blood transfusions may also be necessary.
•
•
•
•
•
•
What are low blood counts?
What causes low blood counts?
What are the symptoms of low blood counts?
Why is it important to monitor low blood counts?
How are low blood counts diagnosed?
What are the treatments for low blood counts?
What are low blood counts?
A blood count is a measurement of the number of blood cells an individual has in
circulation based on laboratory evaluation of a blood sample. Blood is composed of
three basic blood cell types: red blood cells, white blood cells, and platelets. You should
have billions of these blood cells circulating throughout your body. However, certain
circumstances may cause you to have fewer cells than is considered normal, a condition
which is called “low blood counts”. The laboratory test that is conducted to measure the
number of blood cells is called a complete blood count, or CBC.
Copyright©2008 CancerConsultants.com. All Rights Reserved.
39
CHEMOTHERAPY QUESTIONS & ANSWERS, continued
What causes low blood counts?
The most common reason cancer patients experience low blood counts is as a side
effect of chemotherapy. Chemotherapy involves the use of drugs to destroy cancer
cells. Chemotherapy works by destroying cells that grow rapidly, a characteristic of
cancer cells. Unfortunately, chemotherapy also affects normal cells that grow rapidly,
such as cells in the bone marrow that produce red blood cells, white blood cells, and
platelets.
What are the symptoms of low blood counts?
Your symptoms will depend on which types of blood cells are low. Common symptoms
of the different types of low blood cell counts are listed in table 1.
Table 1: Common symptoms of low blood counts
Low red blood cell
Fatigue or tiredness
Trouble breathing
Rapid heartrate
Difficulty staying warm
Pale skin
Dizziness
Lightheaded
Low white blood cell
Infection
Fever
Low platelets
Excessive bruising
Excessive bleeding
Nosebleeds
Why is it important to monitor blood counts?
It is important to monitor for low blood cell count because this condition may:
•
•
Increase your risk of unpleasant and sometimes life-threatening side effects, such as fatigue,
infection, and/or bleeding.
Disrupt delivery of your cancer treatment, resulting in a change to the planned dose and
time.
How are low blood counts diagnosed?
A test called the complete blood count (CBC) is used to determine whether your blood
counts are low. The CBC measures the levels of the three basic blood cells: red, white,
and platelets.
In the United States, the CBC is typically reported in the format shown below. If your
blood counts fall outside of the normal range, which is shown in the “Reference interval”
column, their values will be reported in the “Flag” column with an ‘L’ for low and an
‘H’ for high. The example CBC on the next page shows that white blood cells, red blood
cells, and platelets are all low.
Copyright©2008 CancerConsultants.com. All Rights Reserved.
40
CHEMOTHERAPY QUESTIONS & ANSWERS, continued
Table 2: CBC with Differential
Test
White Blood Count
Red Blood Count
Hemoglobin
Hematocrit
Platelets
Polys
Lymphs
Monocytes
Eos
Basos
Polys (absolute)
Lymphs (absolute)
Monocytes (absolute)
Eos (absolute)
Basos (absolute)
Result
Flag
1.5 L
3.50 L
10.8 L
31.1 L
302
23 L
68 H
7
2
>
.34 L
1.0
0.1
0.1
0.0
Units
x 10-3/mL
x 10-6/mL
g/dL
%
x 10-3/mL
%
%
%
%
%
x 10-3/mL
x 10-3/mL
x 10-3/mL
x 10-3/mL
x 10-3/mL
Reference Interval
4.0-10.5
4.70-6.10
14.0-18.0
42.0-52.0
140-415
45-76
17-44
3-10
0-4
0.2
1.8-7.8
0.7-4.5
0.1-1.0
0.0-0.4
0.0-0.2
Result column: The result column shows counts that fall within the normal range.
Flag column: The flag column shows counts that are lower (“L”) or higher (“H”) than the
normal range.
Reference interval (or reference range) column: The reference interval shows the
normal range for each measurement for the lab performing the test. Different labs may
use different reference intervals.
White blood cells: White blood cells help protect individuals from infections. The above
CBC report shows that the patient’s total white cell count is 1.5, which is lower than the
normal range of 4.0-10.5. The low white cell count increases the risk of infection.
Differential: This portion of the CBC shows the counts for the 5 main kinds of white
cells, either as percentages (the first 5 counts), or as the absolute number of cells (the
second 5 counts).
Absolute neutrophil count: Neutrophils are the main white blood cell for fighting or
preventing bacterial or fungal infections. In the CBC report, neutrophils may be referred
to as polymorphonuclear cells (polys or PMNs) or neutrophils. The absolute neutrophil
count (ANC) is a measure of the total number of neutrophils present in the blood. When
the ANC is less than 1,000, the risk of infection increases. The ANC can be calculated
by multiplying the total WBC by the percent of polymorphonuclear cells. For example,
this patient’s ANC is 0.34, which equals (WBC) 1.5 x 23%.
Copyright©2008 CancerConsultants.com. All Rights Reserved.
41
CHEMOTHERAPY QUESTIONS & ANSWERS, continued
Red blood cells: Red blood cells carry oxygen from the lungs to the rest of the body. The
above CBC report indicates that the patient has a red cell count of 3.5, which is lower
than the normal range of 4.70-6.10, and therefore, shown in the flag column.
Hemoglobin (Hb or Hgb): Hemoglobin is a protein in the red cell that carries oxygen.
The above CBC report indicates that the patient’s Hb count is 10.8, which is below
the normal range of 14.0-18.0. The hematocrit (HCT), another way of measuring the
amount of Hb, is also low. This means that the patient has mild anemia and may be
starting to notice symptoms.
These three ranges will vary depending on age and gender. For women, they will be
lower than those shown here. For example, the Hb reference interval for a woman is
12.0-16.0.
Platelets: Platelets are the cells that form blood clots that stop bleeding. The above CBC
report indicates that the platelet count for this patient is normal.
What are the treatments for low blood counts?
The best treatment for low blood counts is to prevent them before they occur. This can
be accomplished with the administration of blood cell growth factors. Blood cell growth
factors are substances produced by the body that stimulate the cells in the bone marrow
to produce more red blood cells, white blood cells, or platelets. These factors have also
been produced in a laboratory and are approved by the Food and Drug Administration
(FDA) for the treatment of cancer patients with low blood counts.
Low red blood cell counts: Erythropoietin is a blood cell growth factor that selectively
increases production of red blood cells. Clinical trials have demonstrated that
erythropoietin is safe and effective in reversing anemia in cancer patients. Erythropoietin
has been proven to effectively:
•
•
•
•
Increase hematocrit
Decrease the need for blood transfusions
Reverse fatigue
Improve overall sense of well-being
Erythropoietin is FDA-approved for the treatment of anemia in patients with nonmyeloid
cancers (cancers that do not involve blood cells), whose anemia is a result of
chemotherapy.
Treatment with erythropoietin causes a gradual increase in red blood cell production. The
body uses iron in red blood cell production. Thus, supplemental iron may be required
to adequately support erythropoietin-stimulated erythropoiesis. Virtually all patients
receiving erythropoietin therapy will eventually require supplemental iron therapy.
Copyright©2008 CancerConsultants.com. All Rights Reserved.
42
CHEMOTHERAPY QUESTIONS & ANSWERS, continued
Low white blood cell count: The blood cell growth factors approved by the FDA for
the prevention of chemotherapy-induced neutropenia are Neupogen® (filgrastim)
and Neulasta® (pegfilgrastim). Multiple clinical trials have shown that Neulasta® and
Neupogen® reduce the severity and duration of low white blood cell counts associated
with many kinds of chemotherapy regimens. By increasing white blood cell counts,
Neupogen® has been shown to decrease a patient’s risk of fever and admission to the
hospital. The drawback of Neupogen®, however, is that it must be administered daily.
In two clinical trials, a single dose of Neulasta® has been proven to be as effective as an
average of 11 daily injections of Neupogen® for the management of neutropenia. The
most common side effect you may experience with Neulasta® is aching in the bones.
If this happens, it can usually be relieved with a non-aspirin pain reliever, such as
acetaminophen. It is also possible to have an allergic reaction to Neulasta®.
Low platelet count: The blood cell growth factor approved by the FDA for the prevention
of low platelet count is called Neumega®. Clinical studies have shown that Neumega®
prevents thrombocytopenia and decreases the need for platelet transfusions in patients
at high risk for developing a low platelet count. Neumega® has been reported to cause
palpitations, fluid retention and diarrhea as well as other side effects in some patients.
Transfusions: In some cases, low blood counts may be so severe that you may need
to undergo a blood transfusion. Red blood cells and platelets are often transfused.
Sources for transfusional blood include blood banks or your own blood that you had
stored for future use before undergoing treatment. Transfusions may be associated with
complications, including allergic reactions that may range from mild to life-threatening.
In general, it is better to prevent low blood counts than to treat them once they occur.
References
1. Glaspy JA, Jadeja J, Justice G. Optimizing the management of anemia in patients with cancer: a randomized, active-controlled
study investigating the dosing of darbepoetin alfa [abstract]. Proceedings of the American Society of Clinical Oncology 38th
annual meeting; May 18-21, 2002. Abstract 1446.
2. Kotasek D, Albertson M, Mackey J. Randomized, double-blind, placebo-controlled, dose-finding study of darbepoetin alfa
administered once every 3 (Q3W) or 4 (Q4W) weeks in patients with solid tumors [abstract]. Proceedings of the American Society
of Clinical Oncology 38th annual meeting; May 18-21, 2002. Abstract 1421.
3. Vose J, Crump M, Lazarus H. Randomized, multicenter, open-label study of pegfilgrastim compared with daily filgrastim after
chemotherapy for lymphoma. Journal of Clinical Oncology. 2003;21: 514-519.
4. Green M, Koelbl H, Baselga J. A randomized double-blind multicenter phase III study of fixed-dose single-administration
pegfilgrastim versus daily filgrastim in patients receiving myelosuppressive chemotherapy. Annals of Oncology. 2003:14:29-35.
Copyright©2008 CancerConsultants.com. All Rights Reserved.
43
CHEMOTHERAPY QUESTIONS & ANSWERS, continued
When to Call Your Doctor
The development of any of the following symptoms during your chemotherapy treatment
may indicate a serious condition. If you experience any of the following throughout
your cancer treatment, please inform your doctor.
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Fever higher than 100.5º F
Shaking chills
Vomiting that continues 48 hours after treatment
Bleeding or bruising
Shortness of breath/chest pain
Severe constipation or diarrhea
Painful or frequent urination
Blood in the urine or stool
Soreness, redness, swelling, pus, or drainage at your VAD site
Irregular or rapid heart beat
Pain in a new place
Pain that is not relieved by your pain medication
Headache that is not relieved by Tylenol®
Inability to eat and continued weight loss
Mouth sores
Nasal congestion, drainage, cough
One or more of the following symptoms in conjunction with repetitive diarrhea or vomiting
(signs of dehydration):
° Dry, cracked lips
° Dry, sticky tongue
° Increased thirst
° Decreased urination
° Increased weakness
° Increased pulse rate
Dizziness/lightheadedness (especially when rising to a standing position)
Copyright©2008 CancerConsultants.com. All Rights Reserved.
44
CHEMOTHERAPY QUESTIONS & ANSWERS, continued
Most Frequently Asked Questions about Chemotherapy
How does chemotherapy work?
Chemotherapy kills rapidly-dividing cells in a variety of ways, depending on the
drug. Since there are many different types of cancers that all grow differently, many
chemotherapy drugs have been developed to target these various growth patterns. Each
drug has a different way of working and is effective at a specific time in the life cycle of
the cell it targets. For example, some chemotherapy drugs work by:
•
•
•
Damaging DNA,
Preventing cells from dividing, or
Disrupting cellular metabolism or other critical functions.
How is chemotherapy given?
Chemotherapy can be given:
•
•
•
•
Intravenously (IV),
By mouth in the form of a pill,
With a shot (injection), or
By intrathecal and intraventricular injection (meaning into the spinal fluid surrounding the
spinal cord or brain).
Many types of chemotherapy can be given at home. Through instruction, you and
your family members can learn how to administer chemotherapy in pill form or by
injection with small syringes and needles similar to those that people with diabetes
use to administer insulin. In some cases, a nurse will administer chemotherapy in an
outpatient clinic. In other cases, it may be necessary to go to the hospital to receive
treatment.
Chemotherapy is typically given in cycles, which is a treatment followed by a period
of rest. A cycle can last one or more days, but is usually one, two, three, or four
weeks long. A course of chemotherapy is comprised of multiple cycles. Each course is
different, but generally consists of four to six cycles. It may take a relatively short period
of time to receive some chemotherapy drugs, while others take hours. It all depends on
the treatment regimen that your doctor recommends.
If your chemotherapy is given through an IV, your doctor may suggest an implanted
venous access device (VAD) such as a Hickman® catheter or Port-a-Cath. VADs are
surgically placed in a large vein near the heart and can stay in place for long periods of
time. By using a VAD, you will not have to have smaller catheters repeatedly placed in
your arm veins.
How often will I receive chemotherapy?
Generally, treatments are given daily, weekly, or monthly. How often you receive
chemotherapy depends on the type of cancer and which drug or combination of drugs
you receive. Your doctor will help you determine the most effective treatment schedule
for you. Chemotherapy is usually given in cycles with rest periods between each
administration.
Copyright©2008 CancerConsultants.com. All Rights Reserved.
45
CHEMOTHERAPY QUESTIONS & ANSWERS, continued
Chemotherapy may be used in combination with surgery. When chemotherapy is given
before surgery it is referred to as neoadjuvant chemotherapy. The goal of neoadjuvant
chemotherapy is to shrink the cancer before it is surgically removed. If the chemotherapy
is given after surgery, it is referred to as adjuvant chemotherapy. The goal of adjuvant
chemotherapy is to kill any cancer cells left in the body after surgery. Regardless of
whether it is given before or after surgery, chemotherapy will still be administered in
cycles that depend on the type of cancer and which drug or combination of drugs.
What chemotherapy will I receive?
You will receive chemotherapy that is best suited to achieve your goals of therapy.
When selecting a treatment or treatments, your doctor will consider:
•
•
•
•
•
•
•
Your diagnosis
How far along your cancer is in its development
The expected behavior of the cancer
Where the cancer originated
Your age
Other medical problems you may have
Any potential side effects from the treatment.
How is my chemotherapy scheduled?
Chemotherapy is typically given in cycles, which is a treatment followed by a period of
rest. A cycle can last one or more days, but is usually one, two, three or four weeks long.
A course of chemotherapy is comprised of multiple cycles. Each course is different, but
generally consists of four to six cycles. The actual administration of the chemotherapy
drugs may take minutes to several hours, depending on the drug or drugs given.
If your chemotherapy is given through an IV, your doctor may suggest an implanted
venous access device (VAD) or Port-a-Cath. VADs are surgically placed in a large vein
near the heart and can stay in place for long periods of time. By using a VAD you will
not have to have smaller catheters repeatedly placed in arm veins.
What are the side effects of chemotherapy?
Chemotherapy works by destroying cancer cells; unfortunately, it cannot tell the
difference between a cancer cell and a healthy cell. The delivery of cancer therapy often
affects the body’s normal tissues or organs that are not affected by cancer. Side effects, or
complications of treatment are the undesired consequence of affecting normal cells.
Side effects of treatment may cause inconvenience, discomfort, and occasionally even
fatality to patients. Additionally and perhaps more importantly, side effects may prevent
delivery of the full dose of chemotherapy on schedule. This is extremely important to
understand since your expected outcome from chemotherapy is based on delivering
treatment at the full dose and schedule prescribed in the treatment plan. Because the
expected outcome from therapy is based on delivering treatment at the prescribed dose
and schedule, a change from the treatment plan may reduce your chance of achieving
an optimal outcome. This is extremely important to understand. In other words, side
effects not only cause discomfort and unpleasantness, but may also compromise your
chance of cure by preventing the delivery of therapy at its optimal dose and time.
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46
CHEMOTHERAPY QUESTIONS & ANSWERS, continued
The most common side effects of chemotherapy are low blood counts, nausea, vomiting,
hair loss, and fatigue. Some side effects may be temporary and merely annoying. Others,
such as infection or a low white blood count, can be life-threatening. For example, one
of the most serious potential side effects of chemotherapy is a low white blood cell
count – a condition called neutropenia (new-truh-pee-nee-ah) – which can put you at
risk for severe infections or treatment interruptions.
Fortunately, last 20 years has brought a great deal of progress in the development
of treatments to help prevent and control the side effects of cancer therapy. These
developments have
•
•
•
Led to vast improvements in the management of symptoms associated with
cancer treatment
Allowed for greater accuracy and consistency concerning the administration of
cancer treatment
Made many cancer treatments more widely available to patients throughout the world
Why am I so tired?
Many people who receive chemotherapy experience fatigue. Fatigue has many causes
but frequently occurs because of anemia caused by the chemotherapy. Your daily
activities should be planned according to how you feel, and you should take rest periods
throughout the day as often as you feel necessary. Anemia can be effectively treated. To
learn more, go to fatigue.
Will my chemotherapy make me sick?
Without receiving special anti-nausea medications, most patients will experience some
nausea after treatment with chemotherapy. Nausea and vomiting may last 24-48 hours.
The severity of nausea and vomiting mainly depends on which chemotherapy drugs were
used. A number of very effective medications called anti-emetics or anti-nausea drugs
are now available to help lessen or prevent nausea and vomiting. These medications
may be given to you intravenously during your chemotherapy, or you may be given a
prescription medication to take at home. To learn more, go to nausea and vomiting.
What tests will be performed?
Your doctor determines what kinds of tests are needed. If you are receiving chemotherapy,
you may have blood work done anywhere from the day of or up to 7 days before
your scheduled treatment. This blood work will include a complete blood count (CBC),
chemistry profile, and any necessary cancer markers. A blood sample for a complete
blood count (CBC) will also be collected seven to fourteen days following your
chemotherapy. It is important to be aware of possible symptoms of reduced red blood
cell (RBC), white blood cell (WBC), or platelet (PLT) production. Be sure to report any
of the following:
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•
•
Fever (over 100.5º F), congestion, or a cold. Earlier we’ve defined fever as 100.5
A rash, blister, easily bruised skin, signs of bleeding, an infected cut, itching or
burning in the genital area.
Weakness, fatigue, or shortness of breath.
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47
CHEMOTHERAPY QUESTIONS & ANSWERS, continued
Why is my complete blood count (CBC) tested after treatment?
Chemotherapy destroys rapidly dividing cells, a characteristic of cancer cells. However,
red blood cells, white blood cells, and platelets also divide rapidly and are frequently
damaged by chemotherapy. Your red blood cell count, white blood cell count, and
platelet count may all go down. Your doctor monitors these counts to determine the
toxicity of treatment and to predict your risk for complications, as well as to plan future
therapy. For more information, see section on Understanding and Monitoring Your
Blood Counts.
Will I lose my hair because of my treatment?
Hair loss occurs with some, but not all, chemotherapy drugs. The amount of hair loss
varies from a slight thinning to complete baldness and affects the scalp, eyelashes and
eyebrows, legs, armpits, and pubic area.
Hair loss will typically begin two or three weeks after your first treatment. The amount
of hair that you lose will depend on the type of chemotherapy drug you are taking.
Hair typically begins to grow back approximately 2-3 weeks after treatment is finished.
The hair may grow back differently than it was before treatment. For example color or
texture (curly or straight) may be different.
Remember that hair loss associated with chemotherapy is temporary and the hair WILL
grow back. In the meantime, here are a few tips to help you cope with the loss:
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•
You may wish to cut your hair before it starts falling out. The experience of losing the hair is
sometimes worse than dealing with it once it’s gone. If you expect to lose all or a lot of your
hair, cutting it first may be easier to cope with.
Plan ahead; shop for a wig before your hair is gone, especially if you wish to match your
natural color. Or, take this opportunity to try something different.
Try hats or head scarves; these are good alternatives or a compliment to a wig.
Remember to cover your head or use sunscreen on your scalp. Skin that has been covered
with hair may be particularly sensitive to UV rays of the sun.
Ask your insurance company if they cover the cost of the wig.
Treat your new hair gently once it grows back. Avoid chemicals, bleach, peroxide, or colors.
Copyright©2008 CancerConsultants.com. All Rights Reserved.
48
RADIATION THERAPY QUESTIONS & ANSWERS
Radiation Therapy
Cancer treatment may vary depending upon the type of cancer, the stage of cancer, and
the goal of treatment. Often, one or more treatment modalities may be used in order
to provide the most complete treatment for the patient. Increasingly, it is common to
use several treatment modalities concurrently (together) or in sequence. This is referred
to as multi-modality treatment of the cancer and the modalities may include surgery,
chemotherapy, biological therapy, and/or radiation therapy. For the majority of newly
diagnosed cancer patients, the optimal treatment may be a multi-modality approach
composed of standard therapies that have been established through extensive medical
research. For other patients, the most appropriate therapy may still be under investigation
and may be available only through a clinical trial.
Radiation therapy works by damaging the DNA in the cancer cell, thereby disabling the
cancer cells from reproducing and growing. The cancer cells then die and the cancer
shrinks. The objective of radiation therapy is to kill enough cancer cells to maximize the
probability of cure and minimize the side effects. Under some circumstances, radiation
therapy may also be used as palliation, or palliative care, which is aimed at reducing
symptoms but not curing the underlying disease.
Radiation is usually administered in the form of high-energy beams that deposit the
radiation dose in the body where cancer cells are located. Radiation therapy, unlike
chemotherapy, is considered a local treatment. This means that cancer cells are only
killed at the location in the body where the radiation is delivered, called the radiation
field. If cancer exists outside the radiation field, those cancer cells are not destroyed by
the radiation.
Techniques for Delivering Radiation Therapy
Radiation therapy may be delivered externally or internally. External radiation delivers
high-energy rays directly to the cancer from a machine outside the body. Internal
radiation, or brachytherapy, is the implantation of a small amount of radioactive material
(seeds) in or near the cancer.
External Beam Radiation Therapy (EBRT)
EBRT is given via machines called linear accelerators, which produce high-energy
external radiation beams that penetrate the tissues and deliver the radiation dose deep
in the areas where the cancer resides. These modern machines and other state-of-the-art
techniques have enabled radiation oncologists to significantly reduce side effects while
improving the ability to deliver radiation.
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RADIATION THERAPY QUESTIONS & ANSWERS, continued
EBRT is typically delivered on an outpatient basis for approximately 6 to 8 weeks. EBRT
begins with a planning session, or simulation, during which a special CT is performed
with the patient in the treatment position. Marks are placed on the surface of the patient.
This information is then used by the radiation oncologist to develop a patient specific
treatment plan. During treatment, the patient lies on a table and is treated with radiation
from multiple directions. The actual area receiving radiation treatment may be large or
small, depending on the features of the cancer. Radiation can be delivered specifically
to an organ or encompass the surrounding area, including the lymph nodes.
Intensity Modulated Radiation Therapy (IMRT)
IMRT is an advanced form of radiation therapy that allows doctors to customize the
radiation dose by modulating, or varying, the amount of radiation given to different parts
of the area being treated. The radiation intensity is adjusted with the use of computercontrolled, moveable “leaves” which either block or allow the passage of radiation from
the many beams that are aimed at the treatment area. The leaves are carefully adjusted
according to the shape, size, and location of the tumor. As a result, more radiation
can be delivered to the tumor cells while less is directed at the normal cells that are
nearby.
An analogy for IMRT is a shower nozzle that shoots many different streams of water
from different directions, except that each stream can be turned on or off, or set to
deliver different intensities. This is unlike standard radiation techniques that allow only
a constant flow of radiation from each beam.
Image-guided Radiation Therapy (IGRT)
IGRT is a new approach to delivering radiation therapy that allows for more accurate
delivery of radiation to the target tissue. IGRT involves imaging during the course of
radiation treatment. A computer compares images taken at the time of treatment to
images taken during the planning phase. Through this process, IGRT is able to account
for changes in the patient’s body or position that may shift the exact location of the
cancer. This allows increased accuracy of very complex treatment approaches. It also
provides documentation of the degree of accuracy. IGRT is used in conjunction with
EBRT or IMRT.
RAPIDARC
Rapidarc is a new, state of the art treatment technology that allows patients to be treated
much faster than standard radiation treatments. This technology treats patients while the
machine rotates which reduces treatment times from 20 minutes down to 2 minutes. This
can be used to treat pelvis, lung, and head and neck patients resulting in shorter, more
accurate treatments. This technology is used in conjunction with IMRT and IGRT.
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50
RADIATION THERAPY QUESTIONS & ANSWERS, continued
Brachytherapy
Internal radiation is known by a number of names, including “brachytherapy,” “seeds,”
or “implants.” These terms refer to treatment in which radioactive material is placed
directly into or near the cancer. Brachytherapy may be used to provide an additional
boost of radiation to an area also being treated with external radiation therapy, or may
be used as the only type of radiation therapy.
Brachytherapy may be permanent or temporary. In permanent brachytherapy, radioactive
seeds are inserted and permanently left in place. After the procedure, the patient will
temporarily contain a small amount of radiation from the seeds, although this amount
is not generally dangerous to most other people. Some physicians may advise patients
to avoid close contact with young children or pregnant women for several weeks. Over
time, the radioactivity diminishes.
In temporary brachytherapy, the radioactive material is inserted for a specified period
of time and then removed before the patient goes home. Temporary brachytherapy may
be administered at a lower dose over a longer period of time (low dose rate, or LDR)
or a higher dose over a shorter period of time (high dose rate, or HDR). During LDR
brachytherapy, patients are generally hospitalized for as long as the radioactive implants
are in place (often two to three days). In contrast, it may be possible to receive HDR
brachytherapy on an outpatient basis.
Brachytherapy has proven to be useful in the treatment of several different types of
cancer, including prostate, cervix, uterus, vagina, head and neck, and breast.
Stereotactic Radiosurgery (SRS)
Stereotactic Radiosurgery (SRS) allows non-invasive treatment of brain tumors,
arteriovenous malformation, and other selected conditions. It is an outpatient treatment
that delivers a high dose of radiation to a highly defined target. Treatments can be
prescribed to deliver the total dose of radiation in a single treatment or in a fractionated
manner up to 5 treatments.
Cyberknife
The latest most advanced technology in combating cancer with radiosurgery is now
offered by the physicians at The START Center for Cancer Care. It is the Cyberknife,
which gives patients a novel alternative in radiation. The Cyberknife delivers exact doses
of radiation to tumors anywhere in the body, even tumors that are out of reach of other
radiosurgery systems or traditional surgeries.
If deemed a candidate for Cyberknife, patients undergoing this state of the art
treatment:
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•
Benefit from a painless, non-invasive procedure.
Complete the treatments in fewer sessions than conventional radiotherapy.
Benefit from no recovery or rehabilitation time.
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RADIATION THERAPY QUESTIONS & ANSWERS, continued
•
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Have the advantage of the maximum dose of radiation with sub-millimeter accuracy to the
tumor without affecting healthy tissue.
Have the benefit of treating multiple tumors in different locations during a single session.
Have a reduction in infections, hemorrhage and loss of hearing and feeling, sometimes
associated with conventional surgeries.
Benefit from a convenient outpatient procedure.
Xsight Lung is a new non-invasive technique to treat lung cancer using Cyberknife
Radiosurgery. Lung tumors have been problematic for radiation oncologists because the
tumors move as the patient breathes making it difficult to localize the tumor. Previously,
Cyberknife has overcome this by following the location of a metal marker seed that is
surgically placed in the tumor. Cyberknife used imaging technology to determine the
location of the marker and then the Cyberknife machine would move as the marker seed
moved. However, the insertion of the marker seed has some inherent risks. Xsight Lung
is a significant advance in the treatment of lung cancer because it allows the Cyberknife
unit to follow the tumor without using a marker seed. This allows the physicians to spare
more of the healthy lung tissue without the additional risks inherent to the insertion of
the marker seed.
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52
RADIATION THERAPY QUESTIONS & ANSWERS, continued
What to Expect During Radiation Treatment
Radiation treatment must be individualized for each patient depending on the size and
location of their cancer. In order to tailor radiation treatment to meet the specific needs
of individual patients, the radiation process involves several components, including
consultation, simulation, treatment planning, and finally, the actual treatment.
Consultation: The consultation is an important visit that allows both you and the radiation
oncologist to gain more information. During the consultation, the radiation oncologist
will obtain a medical history and perform a physical examination. Many patients find
it helpful to prepare for the consultation by bringing x-rays, medical records, a list of
medications, insurance information, and referral forms.
During the consultation, the radiation oncologist may communicate a great deal of
information in a short period of time. You may find it useful to prepare a list of questions
prior to the consultation to assure they are all answered. You may also find it beneficial
to bring another person to the consultation to help understand the information from the
physician.
After the consultation, the radiation oncologist may order additional tests, await results
of other pending tests or consultations, or obtain additional records and reports.
Multidisciplinary care is increasingly important for optimal cancer care, therefore the
radiation oncologist will typically communicate with any other treating physicians to
determine the appropriate course of treatment. In addition, the radiation oncologist
will likely send a complete report of their evaluation to the referring physician and any
other physicians requested by the patient. Once all of the necessary information has
been gathered and the treatment team has communicated, a decision may be made to
use radiation treatment. At this point, the radiation oncologist will discuss the treatment
plan and alternatives with you and will present a consent form for you to sign prior to
treatment. It is important to read and understand the consent form prior to signing it.
CT Simulation: After the initial consultation and decision to use radiation treatment, the
next session is usually a planning session, which is called a simulation. Simulation is
used to determine the radiation treatment fields and most of the treatment planning.
The CT simulator does not deliver radiation treatment, but instead allows the radiation
oncologist and technologists to see the area to be treated. Images are obtained and
transferred to the planning system where a virtual 3-dimensional image of the patient is
created and the treatment delivery plan is developed.
For the simulation session, temporary marks are made on your skin with magic markers
to identify the treatment areas. The room is periodically darkened while the treatment
fields are being set. Alignment is critical during simulation and is facilitated by lasers
mounted on the wall and ceiling. Special individually constructed immobilization
devices may be used to help achieve this alignment. While you may see red lines of
light, the low energy lasers are for alignment purposes only and you will not feel burning
or anything else from the laser light.
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53
RADIATION THERAPY QUESTIONS & ANSWERS, continued
In most centers, the patient is given multiple “tattoos,” which mark the treatment fields
and replace the marks previously made with magic markers. These tattoos are not
elaborate and consist of no more than pinpricks followed by ink, appearing like a small
freckle. Tattoos enable the radiation technologists to set up the treatment fields each
day with precision, while allowing you to wash and bathe without worrying about
obscuring the marks that indicate where treatment will be delivered.
Sometimes several simulation sessions are necessary in order to optimize treatment and
are often performed prior to planned “boost” or “reduced field” treatments as part of
the overall treatment plan.
Treatment planning: Several steps occur after simulation and prior to treatment; however,
you do not need to be present during most of these procedures.
During treatment planning, the dosimetrists perform special calculations to help assure
that the proper radiation dose will be delivered. Computerized treatment planning
may facilitate these calculations. Computers have become extremely sophisticated in
planning radiation therapy delivery. Computers are even capable of extremely complex
three-dimensional representation of the treatment area and surrounding normal tissues.
It may take several days for treatment planning to be completed after simulation and
prior to treatment. After all treatment planning is complete, radiation therapy treatments
are ready to begin.
Radiation treatment: Radiation treatment is usually given in another room separate
from the simulation room. The treatment plans and treatment fields that result from the
simulation session are transferred over to the treatment room, which contains a linear
accelerator focused on a patient table similar to the one in the simulation room. The
treatment plan is verified and treatment started only after the radiation oncologist and
technologists have rechecked the treatment field and calculations, and are thoroughly
satisfied with the “setup”.
During radiation treatment, you must lie very still on the treatment table while the
radiation beam is targeted to the exact area of the tumor. The machine and treatment
table may rotate up to 360 degrees if the treatment requires the radiation to hit the
tumor from all angles. The technologists will not be in the room during the treatment,
but they will be monitoring the treatment via a video camera and an audio connection
with the treatment room. You will not feel the radiation as it is being delivered.
Radiation therapy is generally given once a day, five days a week, usually at the
same time each day. Occasionally, treatment is given less frequently or twice a day.
The number of treatments depends on multiple factors and varies from 5-10 to 40 or
more, which means that treatment may last anywhere from one to eight weeks or more.
Radiation treatments are generally given as outpatient treatments and involve relatively
little time each day. While the first few visits might last for an hour or more, typically
a daily radiation treatment will take about 15-30 minutes in the treatment room and
the actual treatment only lasts a few minutes. It is important not to miss treatments.
Extending treatments beyond the recommended time period may reduce the chance of
controlling the cancer.
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RADIATION THERAPY QUESTIONS & ANSWERS, continued
Side Effects of Radiation Therapy
Although patients do not feel anything during a radiation treatment, the effects of
radiation gradually build up over time. Most patients have very few initial side effects;
however, many patients experience fatigue as treatment continues.
The vast majority of patients are able to complete radiation therapy without significant
difficulty. Side effects and potential complications of radiation therapy are infrequent
and, when they do occur, are typically limited to the areas that are receiving treatment
with radiation. The chance of experiencing side effects, however, is highly variable.
A dose that causes some discomfort in one patient may cause no side effects in other
patients. If side effects occur, you should inform the technologists and radiation
oncologist, because treatment is almost always available and effective. Side effects are
usually temporary and resolve once the radiation is completed.
The most common side effect of radiation are:
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Skin reaction
Fatigue
Side effects that commonly occur with radiation to the head and neck are:
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Mucositis
Xerostomia
Changed sense of taste and/or smell
Hypothyroidism
Other less common side effects are:
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Hair loss
Nausea/Vomiting
Diarrhea
Loss of appetite
Low blood counts (myelosuppression)
While not as common with the advent of modern radiation delivery techniques, side
effects that may occur with radiation to the chest are:
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Lung fibrosis
Heart complications
In addition to the above temporary side effects, in certain cases, patients may develop
long-term side effects, also called “late complications”, such as:
•
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Secondary cancers
Hypothyroidism
These long-term side effects are also less common with the advent of modern radiation
techniques.
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RADIATION THERAPY QUESTIONS & ANSWERS, continued
Most Common Side Effects of Radiation Therapy
Skin reaction: A common side effect of radiation therapy is skin irritation in the area
of the body that is being treated. The skin reaction can range from mild redness and
dryness (similar to a sunburn) to severe peeling (desquamation) of the skin in some
patients. The majority of skin reactions to radiation therapy go away a few weeks after
treatment is completed. In some cases, the treated skin will remain slightly darker than
it was before and it may continue to be more sensitive to sun exposure.
It is important to notify your nurse or physician when your skin becomes irritated because
redness and dryness can eventually progress to peeling with oozing of fluid in the area.
They can suggest measures to relieve your discomfort and possibly minimize further
irritation. There are effective topical medications for treatment of radiation induced skin
irritation, as well as a number of precautions that may minimize skin irritation during
radiation therapy, such as:
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Keep the treated area dry and free from irritation. Cornstarch, gently patted on with a powder
puff, will keep the skin dry.
Wash the skin in the treatment area only with mild soaps.
Use a mild shampoo, such as baby shampoo, if the head is being treated.
When using a towel, pat the area dry instead of rubbing.
If you must shave in the treated area, use an electric razor to prevent cuts.
Avoid using shaving lotions or scented creams.
Do not use perfumes, deodorants, or makeup in the treated area.
Avoid using heating pads or ice packs on the skin in the treated area.
Wear loose-fitting clothing that does not rub on the skin in the treated area.
Avoid harsh fabrics over the treatment area, such as wool, corduroy, or starched cloth.
Lightweight cotton is recommended.
Avoid sun exposure in the treated area. If you expect to be in the sun for more than a few
minutes, wear protective clothing (such as a hat with a broad brim and shirt with long sleeves)
and use a sunscreen. Ask your doctor or nurse about using sunscreen lotions of SPF 15 or
higher.
Check with your nurse or physician regarding the use of creams or lotions. Usually, samples
of safe topical medications are available in the radiation clinic.
Unless necessary, do not use adhesive tape, including band aids and paper tape on the
treated area.
Breast cancer patients should not use deodorant if the axilla is in the treatment field. Create
your own non-irritating deodorant: 1/4 cup baking soda and 1/4 cup of corn starch mixed
together and applied with cotton balls.
Do not swim in salt water, lakes, pools, or ponds.
Always report any discomforts or concerns to your nurse or doctor.
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RADIATION THERAPY QUESTIONS & ANSWERS, continued
Fatigue: Fatigue is a feeling of tiredness, weariness, weakness, exhaustion, or a profound
lack of energy. Fatigue is one of the most common side effects of radiation therapy.
Patients are not restricted from normal activity during radiation therapy; however, they
should balance normal activity with periods of rest. Fatigue is typically more severe
2-4 hours after treatment. The feeling of fatigue should wear off several weeks after
the completion of radiation therapy. The following suggestions may help you manage
fatigue resulting from radiation therapy:
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Limit your activities, if possible.
Exercise each day to maintain your strength.
Prepare meals ahead of time and freeze them.
Use convenience foods that are ready to eat.
Accept offers of help from friends and relatives.
Drink three quarts of fluid each day to avoid the build-up of cellular waste products.
Increase rest by getting more sleep at night and taking naps during the day.
Try to eat even when you are tired. Sometimes a little food will increase energy.
Side Effects Associated with Radiation Therapy
to the Head and Neck
Mucositis (sore mouth or throat): Radiation therapy that is delivered to the head and
neck area may cause mucositis. Mucositis is inflammation of the lining of the mouth and
throat, called the mucus membranes. When radiation is administered directly to or near
the head and neck region, chest, abdomen, or anal-rectal regions, it may cause damage
to the mucosal lining of the entire gastrointestinal tract. This results in inflammation and
sloughing of the mucosal cells, causing pain and increasing the risk of infection.
Patients who have a sore mouth or gums need to take special care of their teeth, as they
are a primary site for infection and pain. These patients may need to utilize frequent
oral hygienic measures and antiseptic mouthwashes. In addition, some patients find it
helpful to rinse the mouth with water frequently in order to remove food and bacteria
and promote healing.
Patients with mucositis should also select foods that will not further irritate an already
tender mouth, for example:
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Choose soft foods that are easy to chew and swallow.
Avoid foods that irritate the mouth such as citrus fruits and foods that are spicy, salty, rough,
coarse, or dry.
Cook foods until they are soft and tender.
Cut foods into small pieces.
Mix food with butter, thin gravies or sauces to make it easier to swallow.
Puree food in a blender or food processor.
Use a straw to drink liquids.
Eat foods cold or at room temperature, as hot food can irritate a tender mouth.
Use anesthetic lozenges and sprays to numb the mouth and throat long enough to eat
meals.
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RADIATION THERAPY QUESTIONS & ANSWERS, continued
Xerostomia (dry mouth): Radiation therapy that is delivered to the head and neck area
may also result in xerostomia. Xerostomia is a chronic dry-mouth condition, which is
caused by damage to the salivary glands as a result of radiation therapy. Xerostomia can
have a negative effect on quality of life by greatly impairing a patient’s ability to speak,
chew, swallow, and taste. Coping with a dry mouth can be difficult, but the following
tips may help.
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Try consuming sweet or tart foods or beverages, such as lemonade, to help your mouth
produce saliva. (Avoid these, however, when experiencing a sore mouth or throat.)
Suck on sugar-free, hard candy or popsicles or chew sugar-free gum; this may also help to
produce more saliva.
Eat soft and pureed foods that are easier to swallow.
Keep lips moist with lip salves.
Eat foods with sauces, gravies, and salad dressings to make them moist and easier to
swallow.
Sip water every few minutes to make swallowing and talking easier.
If the dry mouth problem is severe, ask your physician or dentist about products that coat and
protect the mouth and throat.
Changed sense of taste and/or smell: Radiation therapy or cancer itself may cause a
change of taste or smell that typically goes away once treatment is complete. Foods may
have a bitter or metallic taste, or simply less taste. The following is a list of suggestions
that may help to make food taste better.
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Stop eating foods that cause an unpleasant taste and choose foods that look and smell good
to you.
Serve foods at room temperature.
Try using small amounts of flavorful seasonings.
Try tart foods such as oranges or lemons that may have more taste (unless you are
experiencing a sore mouth or throat).
Marinate meat, chicken, or fish in sweet sauces.
If red meat tastes or smells strange, switch to chicken, turkey, eggs, or dairy products.
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RADIATION THERAPY QUESTIONS & ANSWERS, continued
Less Common Side Effects of Radiation Therapy
Hair loss: Radiation therapy only causes hair loss in the area being treated. Hair loss
typically begins 2-4 weeks after the initiation of treatments. Some individuals experience
thinning of the hair, while others experience complete hair loss. Hair loss caused by
radiation is temporary. Typically, regrowth of hair begins 6-8 weeks after completion of
radiation therapy. The best way to deal with hair loss is to prepare for it before it happens.
Your physician will inform you of your chances for hair loss before your treatments
begin. Consider the following tips for coping with hair loss:
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Get a short, stylish haircut prior to beginning radiation in order to prepare yourself for the
change in your appearance.
If considering a wig, see a wig stylist before radiation treatment begins so that the stylist can
match a wig to your natural hair color and texture.
Ask your doctor for a prescription for a wig, as some insurance companies will cover this
cost.
Once radiation treatments begin, use a mild shampoo, pat the hair dry, and comb the hair
carefully, without tugging.
Only use a hairdryer if necessary and keep it on a low heat setting.
Avoid hair dyes, rollers, curling irons, or perms.
Sleep on a satin pillowcase to avoid friction between hair and scalp.
Consider scarves, turbans, or wigs.
Some patients feel more in control if they shave their head completely, rather than dealing
with the hair falling out.
Nausea/vomiting: Sometimes radiation therapy causes nausea (feeling queasy or sick to
your stomach) and/or vomiting (throwing up), especially when the radiation is delivered
to the abdominal area. Nausea/vomiting can happen immediately after radiation, can
be delayed, or can occur in anticipation of receiving treatment. Several drugs, called
antiemetics, are FDA approved for the prevention of nausea and vomiting.
If you do experience nausea immediately after radiation, you may find it helpful to
refrain from eating several hours prior to the treatment and for 1-2 hours afterward. In
contrast, if you experience anticipatory nausea, it might be helpful to eat a bland snack,
such as toast or crackers, before treatment. The following is a list of suggestions for
coping with nausea:
•
•
•
•
•
•
•
•
•
Eat small meals.
Eat and drink slowly.
Eat often.
Avoid foods that are fried or high in fat.
Drink cool liquids between meals.
Eat foods that have only a mild aroma and that can be served cool or at room temperature.
Stick to any special diet that your doctor or dietician gives you.
For a severely upset stomach, try a clear liquid diet (broth and juices) or bland foods that are
easy to digest, such as dry toast and gelatin.
If nausea/vomiting persists, your physician can prescribe an antiemetic to prevent nausea.
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RADIATION THERAPY QUESTIONS & ANSWERS, continued
Diarrhea: Radiation treatment that is delivered to the abdominal area can cause diarrhea,
which usually begins in the third or fourth week of radiation therapy. Your physician
may recommend that you change your diet and/or prescribe medicine to help with the
diarrhea. The following may help you manage diarrhea:
•
•
•
•
•
As soon as diarrhea starts, switch to a clear liquid diet.
Avoid foods that are high in fiber or can cause cramps or a gassy feeling (raw vegetables,
coffee, beans, cabbage, spicy food).
Eat small, frequent meals.
Avoid dairy products.
Eat foods that are high in potassium, such as bananas, potatoes, and apricots, because
diarrhea causes potassium loss.
Loss of appetite: Loss of appetite is a common factor with cancer and its treatment.
Nausea, vomiting, and depression can contribute to a loss of appetite. While you may
not want to eat, it is important to maintain proper nutrition throughout treatment. The
following suggestions may help you maintain your nutritional intake:
•
•
•
•
•
Eat whenever you are hungry. Several smaller meals throughout the day might be more
appropriate than three larger meals.
Eat often. Taking just a few bites of food every hour can ensure that you get more protein and
calories.
Have a calm, relaxed mealtime.
Add variety to your menu.
Create a calm and appealing ambiance with music, candles, and friends.
Low blood counts (myelosuppression): Blood counts, or the number of blood cells in
circulation, can be affected by radiation therapy. Many radiation therapy institutions
make it a policy to check the blood counts at least once during the radiation treatments.
Low blood counts may cause changes in sleep or rest patterns during the radiation
therapy period and some patients describe a sense of tiredness and fatigue. Notify your
nurse or doctor if you experience any of these symptoms because treatment is available
for low blood counts.
Other less common side effects may occur in certain situations and will be discussed
with you as appropriate.
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RADIATION THERAPY QUESTIONS & ANSWERS, continued
Possible Side Effects with Radiation to the Chest
Lung fibrosis: Lung fibrosis is scarring of the lung tissue and causes difficulty breathing.
Fibrosis can be a significant long-term (late) complication following radiation treatment
for Hodgkin’s disease and other cancers requiring radiation to the lungs. However,
this decrease in lung function appears to improve over time and is thought to be
reversible.
Heart complications: Heart disease is also a late complication of radiation to the middle
portion of the torso, called the mediastinum. The risk of heart disease increases with
higher radiation doses and larger field sizes.
Possible Long-Term Side Effects of Radiation Therapy
Secondary cancers: A second cancer can be induced by cancer treatment, including
radiation, chemotherapy, or the combination of radiation and chemotherapy. Treatment
for Hodgkin’s lymphoma at a young age will ultimately result in a higher incidence of
second cancers.
Hypothyroidism: Hypothyroidism (abnormally low levels of thyroid hormone) is one
of the more frequently encountered late complications of radiation therapy in patients
where the radiation field includes the neck. This may occur in up to one-third of patients
receiving radiation therapy. It is important for patients who have received radiation
therapy to be tested on a regular basis because signs and symptoms of hypothyroidism
occur very late and are subtle.
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RADIATION THERAPY QUESTIONS & ANSWERS, continued
Prevention and Management of Radiation Side Effects
There are several methods being utilized for the prevention of radiation therapy side
effects. These mainly include altering the manner in which radiation is delivered and
administering drugs that protect normal cells from radiation damage.
Radiation Delivery Methods
Two delivery methods that were originally used to reduce radiation side effects include
dose fractionation, or splitting the total dose of radiation therapy into multiple doses
and physical shielding with lead blocks to reduce the area of exposure.
Fractionation and hyperfractionation: Radiation therapy was originally given in one
large dose. More than a half-century ago it was found that it was less toxic and more
effective to administer radiation on a daily basis, a method called dose fractionation.
Fractionation allows the delivery of a larger total dose of radiation to the cancer than
would have been possible as a single dose. Currently, most radiation treatments are
administered daily, 5 days a week. The 5 days per week is strictly for the convenience
of maintaining a normal work week. The 24-hour interval and the two-day interval
between doses allows for recovery of normal tissues between doses while cancer cells,
in general, have less capability for recovery. There is no doubt that using fractionation
has reduced side effects compared to single-dose delivery.
While cancer cells tend to be less resilient than normal tissues, there is a chance that
the intervals between fractionated doses of radiation may allow cancer cells to recover.
Recent findings indicate that some cancers are best treated by reducing the 24-hour
interval between doses to 6-8 hours, in order to enhance the toxic effects on cancer cells,
while still preserving an adequate time interval for the recovery of normal cells. This
technique, called hyperfractionation, is being widely used to treat a variety of cancers.
Hyperfractionation requires sophisticated equipment and therefore it is important for
patients to be treated at specialty medical centers that have experience and staff trained
in this technique.
Intensity modulated radiation therapy (IMRT): IMRT delivers varying intensity of
radiation with a rotating device. The intensity is varied by the placement of “leaves,”
which either block or allow the passage of radiation. The rotating component of this
technique allows for more specific targeting of the cancer, sparing normal tissues from
damage due to radiation exposure. In conventional radiation therapy, the beam is usually
delivered from several different directions, possibly 5-10. The greater the number of
beam directions, the more the dose will be confined to the target cancer cells, sparing
normal cells from exposure. IMRT delivers radiation from every point on a helix, or
spiral, in contrast to only a few points.
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RADIATION THERAPY QUESTIONS & ANSWERS, continued
Three-dimensional conformal radiation: Three-dimensional conformal radiation therapy
is a promising approach for the treatment of some cancers with decreased toxicity to
normal tissues. Using computerized tomography (CT) scans and other scans, radiation
oncologists have developed methods for determining the tumor size and shape in 3
dimensions. This allows high-dose external beam radiation therapy to be delivered
primarily to the cancer with less damage to normal cells. For example, three-dimensional
conformal radiation has allowed radiation oncologists to reduce the amount of radiation
to the breast by 50%, which should decrease the risk of secondary breast cancer. It is
important for conformal radiation to be administered at special cancer centers with
sophisticated equipment and trained staff.
Drug Therapy
While preventing radiation side effects from occurring is the ideal approach to
management, sometimes side effects are inevitable. In these situations, several types of
drugs can be used to decrease the side effects of radiation. Drug therapies for radiationinduced side effects fall into two categories:
� Those that protect the non-cancerous tissue from radiation damage through
systemic administration.
� Those that are applied topically to mucus membranes to decrease or treat
radiation damage.
Radiation protectors: Radioprotectants are drugs that selectively protect normal cells,
but not cancer cells, from the effects of radiation. Over the past 50 years, many radiation
protectors have been tested in laboratories to determine their efficacy in preventing
radiation damage to normal cells and tissues.
Ethyol®: Ethyol® is a radiation protector and the only drug that has been approved by
the FDA for xerostomia (dry mouth) in patients receiving radiation therapy for cancers
of the head and neck. Xerostomia is a chronic dry-mouth condition, which is caused
by damage from radiation therapy to the salivary glands. Xerostomia can greatly
impair a patient’s ability to speak, chew, swallow and taste and therefore, can have a
negative effect on a patient’s quality of life. Results from a clinical trial indicated that
the incidence of severe xerostomia for patients receiving Ethyol® was 51%, compared to
78% for patients receiving radiation therapy alone. One year following completion of
radiation therapy, only 35% of patients who had received Ethyol® were still experiencing
symptoms of xerostomia, whereas 57% of patients who had received radiation therapy
alone were still experiencing symptoms.
Steroids: Steroids are naturally occurring hormones produced by the adrenal glands. As
part of your radiation therapy treatment, your physician may prescribe steroids such as
Prednisone® or Decadron® (generic name is dexamethasone). These drugs help decrease
swelling in body tissues. Dexamethasone has also been shown to prevent radiationinduced vomiting, especially in treatment of cancers of the abdomen.
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RADIATION THERAPY QUESTIONS & ANSWERS, continued
Topical agents: Some drugs can be applied topically to mucus membranes to decrease
or treat radiation damage. The topical agent sucralfate may protect mucus membranes
by several mechanisms and is often used during and after radiation therapy for the
prevention and treatment of mucositis (mouth sores).
Topical antiseptics, such as chlorhexidine or benzydamine, have been used for the
prevention of mucositis, but recent research indicates that these are not effective. In
a Mayo Clinic study involving 52 patients with head and neck cancers who received
radiation therapy, chlorhexidine was found to be more toxic, and no more effective than
placebo in the prevention of mucositis. German researchers reported that chlorhexidine
mouthwashes were not effective in treating mucositis in patients with a low white blood
cell count. Despite a significant decrease in the aerobic and anaerobic bacterial flora
on the oral mucous membranes, the risk of mucositis seemed to be enhanced. The
patients treated with chlorhexidine seemed to have more problems with inflammation,
resulting in mucositis.
Strategies to Improve Prevention and Management of
Radiation Side Effects
The development of more effective cancer treatments requires that new and innovative
therapies be evaluated with cancer patients. Clinical trials are studies that evaluate the
effectiveness of new drugs or treatment strategies. Future progress in the prevention
and management of radiation side effects will result from the continued evaluation
of new treatments in clinical trials. Participation in a clinical trial may offer patients
access to better treatments and advance the existing knowledge about treatment of this
cancer. Patients who are interested in participating in a clinical trial should discuss the
risks and benefits of clinical trials with their physician. Areas of active investigation
aimed at improving the prevention and management of radiation side effects include
the following:
•
•
•
•
Keratinocyte growth factor (KGF, palifermin)
Antioxidants
Interleukin 11
Prostaglandins
Keratinocyte growth factor (KGF, palifermin): This is a growth factor that has been shown
to stimulate growth of epithelial cells, which make up the mucus membrane and line
the mouth and throat. Keratinocyte growth factor is currently being tested in patients to
prevent chemotherapy damage to the mucus membranes of the gastrointestinal tract.
Antioxidants: The antioxidant agent Cu/Zn superoxide dismutase (SOD) has shown
promise in reducing early and late radiation-induced tissue injury. In one clinical trial,
448 patients with bladder cancer were randomly allocated to receive either SOD or
placebo after each radiation treatment. The patients who received SOD experienced
fewer rectal problems and less bladder inflammation and skin toxicity than those who
received placebo.
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RADIATION THERAPY QUESTIONS & ANSWERS, continued
Interleukin 11: Interleukin 11 is a growth factor that is similar but not identical to
what the body normally produces. Interleukin 11 has been approved by the FDA to
stimulate platelet recovery in patients with low platelet counts due to chemotherapy.
Clinical trials are currently underway to determine if Interleukin 11 will prevent side
effects, especially to the mucus membranes and gastrointestinal tract, associated with
chemotherapy and radiation therapy.
Prostaglandins: Prostoglandins are a group of compounds that affect the healing of
inflammation and wounds. Misoprostol is a prostaglandin that is effective in treating
complications that arise in patients with prostate cancer who receive radiation
treatment. Inflammation of the rectum (radiation proctitis) is a known complication
of radiation therapy in the treatment of prostate cancer. Available medical treatment is
usually ineffective and has focused on relieving symptoms after damage has occurred.
One clinical study evaluated the effects of misoprostol in patients undergoing radiation
therapy treatment for prostate cancer. In the study, nine patients received misoprostol
rectal suppositories and seven patients received placebo. The results indicated that
misoprostol rectal suppositories significantly reduced acute and chronic radiation
proctitis symptoms in patients receiving radiation therapy for prostate cancer.
References
1. Brizel DM, Wasserman TH, Henke M, et al. Phase III Randomized Trial of Amifostine as a Radioprotector in Head and Neck
Cancer. J Clin Oncol 2000;18:3339-3345.
2. Sanchiz F, Milla A, Artola N, Julia JC, et al. Prevention of radioinduced cystitis by orgotein: a randomized study. Anticancer Res
1996;16(4A):2025-8.
3. Foote RL, Loprinzi CL, Frank AR, et al. Randomized Trial of Chlorhexidine Mouthwash for Alleviation of Radiation InducedMucositis. J Clin Oncol 1994;12:2630-2633.
4. Pitten FA, Kiefer T, Buth C, et al. Do cancer patients with chemotherapy-induced leukopenia benefit from an antiseptic
chlorhexidine-based oral rinse? A double-blind, block-randomized, controlled study. J Hosp Infect 2003;53:283-91.
5. Khan AM, Birk JW, Anderson JC, Georgsson M, et al. A prospective randomized placebo-controlled double-blinded pilot
study of misoprostol rectal suppositories in the prevention of acute and chronic radiation proctitis symptoms in prostate cancer
patients. Am J Gastroenterol 2000;95(8):1961-6.
Copyright©2008 CancerConsultants.com. All Rights Reserved.
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RADIATION THERAPY QUESTIONS & ANSWERS, continued
Radiation Therapy FAQs
What is radiation therapy?
Radiation therapy, or radiotherapy, is the treatment of cancer and other diseases using
ionizing radiation. This radiation can be delivered externally or internally.
How does radiation work?
Radiation therapy works by damaging the DNA in the cancer cell, thereby disabling the
cancer cell from reproducing and growing. The cancer cells then die and the cancer
shrinks.
Will I feel the radiation or will it hurt?
No, external beam radiation treatments are painless, like having an x-ray taken. Although
radiation therapy is not painful, it can cause unwanted side effects. The skin where
radiation is aimed may feel like it has been sunburned and will need to be protected
from the sun.
Will I become radioactive?
External beam radiation does not cause you to become radioactive, and you pose no
risk of radiation exposure to people near you. If you have a radioactive implant in place,
some visitors, such as pregnant women and small children, will not be allowed to get
too close and visiting time may be limited or restricted until the implant is removed.
Your doctor or nurse will tell you when these precautions are necessary.
Are there risks involved with radiation therapy?
The radiation used to damage or destroy cancer cells can also damage normal cells.
When this happens, you may experience side effects. However, the risk of side effects
is usually outweighed by the benefits of killing cancer cells. Any side effects will be
carefully monitored by the radiation oncologist.
What should I know about the risks of radiation therapy?
The risks, problems, and side effects that can occur with radiation therapy depend on
the type and the dose and the part of the body that is being treated. Radiation that
involves the abdomen may cause diarrhea; radiation involving the head and neck can
cause mouth sores. The most common side effects of radiation are fatigue, mouth
sores, and skin problems. Before your treatments, your doctor will explain ways to help
prevent or reduce potential side effects.
What are the typical side effects of radiation therapy?
The most common side effects of radiation therapy reported by patients are fatigue and
skin irritation at the site of treatment. Other side effects depend on the area of the body
being treated and the dosage being given, such as:
•
•
•
Dry or sore mouth or throat may occur when treatment is being given in the mouth, throat or neck
area.
Some coughing and excess mucus production may occur if treatment is given to the lung area.
Mild nausea and/or diarrhea may occur if treatment involves the abdominal area.
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RADIATION THERAPY QUESTIONS & ANSWERS, continued
Most of these side effects will go away on their own within 4 to 6 weeks after treatment
is completed. Some long-term effects may include changes in the color and elasticity
of skin in the treatment area. Discuss any concerns you may have about side effects
and ask about medications to counteract them with the radiation oncologist before the
start of your treatment.
Will the radiation therapy make me sick?
Most patients do not experience any nausea with radiation therapy, unless the area
being treated with radiation is around the stomach. If you experience nausea, report
this and any other symptoms to your doctor. Effective medications exist to reduce and/
or prevent your symptoms.
Will I lose my hair?
No, you will not lose the hair on your head unless that is the area being treated. Hair
loss only occurs in the area that is being treated with radiation therapy. For instance, if
the area being treated is your arm, you can expect to lose the hair on that arm during
the treatment.
How long will my radiation treatment take?
Most of the time, external beam radiation is delivered in daily treatments, or fractions,
over a period of 5 to 7 weeks. The patient will generally receive these treatments Monday
through Friday, and then have the weekend off. A daily fraction will take about 15-30
minutes in the treatment room; however, the actual treatment only lasts a few minutes.
Who will administer my radiation treatments?
A doctor who specializes in radiation therapy is called a radiation oncologist. The
radiation oncologist will prescribe the type and amount of radiation treatment that is
appropriate and work closely with a team of healthcare professionals in determining
the best way to deliver that treatment. Those healthcare professionals may include the
following:
•
•
•
•
Radiation physicists are experts who make sure the machines are working properly and that they
deliver accurate radiation doses. The physicist also works closely with the doctor in planning
your treatment.
Dosimetrists are specialists who work with the doctor and physicist to create the treatment plan
and calculate the radiation dose delivered to the tumor and the surrounding normal tissues.
Radiation therapists are professionals who position you and operate the machines to deliver the
radiation treatment on the linear accelerator.
Radiation oncology nurses are caregivers who will help coordinate your care, manage side
effects, and help you and your family learn about your treatment.
Can someone come to my treatments with me?
Friends or family are welcome to accompany you to your treatments. However, federal
regulations prohibit anyone who is not a patient or a person wearing a film badge
monitor to be in the radiation controlled area during the time radiation equipment is
being operated. Those accompanying you will likely be asked to wait in the reception
area during the treatment. This also serves to protect the privacy of other patients. Only
patients and staff are allowed in the treatment area during treatment hours.
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RADIATION THERAPY QUESTIONS & ANSWERS, continued
Can I continue my regular routine/activities while undergoing radiation treatments?
You should continue with your normal routines. Most patients continue full-time
occupations or leisure activities through the course of treatments. When you feel tired,
do not over exert yourself; take time to rest when needed. Try to get plenty of sleep and
maintain a healthy diet.
Will I be alone during my treatments?
Because radiation effects are accumulated and radiation therapists treat many patients
each day, it would be a long-term health risk for them to be in the room during the
radiation treatments. To ensure that you are okay and your treatment delivery is going
well, you will be in voice contact with your radiation therapists and constantly monitored
by a video camera. If you should need assistance, simply tell the therapists and they
will terminate the treatment and immediately tend to your needs.
What cancers are treated with brachytherapy?
Brachytherapy is used predominantly to treat early stage prostate cancer; however, it
may also be used in breast, cervical, head and neck, and other cancers.
What is involved in the implantation of a radioactive seed into the prostate
(brachytherapy)?
For most of these patients, radioactive seed implantation into the prostate is a one-time,
non-surgical, low-impact procedure. Radioactive seed implantation into the prostate is
typically performed in an outpatient hospital setting by a team of physicians consisting of
a urologist, radiation oncologist, and a radiation physicist. Spinal anesthesia is typically
performed, but general anesthesia may occasionally be utilized. Some centers perform
this procedure in their hospital operating rooms. Both outpatient and inpatient settings
are acceptable. Most patients can return to normal activity, including work, within one
to three days, with little or no pain.
Will radioactive seeds be painful?
After the implantation of radioactive seeds into the prostate, there typically is some
soreness underneath the scrotum. Occasionally patients describe feeling like they
are “sitting on a golf ball”. This is due to the slight swelling and bleeding associated
with the surgery. It gradually resolves. Most patients require only mild analgesics like
acetaminophen (Tylenol®). Narcotic pain medications are rarely required.
How soon after implantation of radioactive seeds into the prostate can I resume
exercise or other vigorous activities?
The insertion of the needles causes some trauma to the vessels surrounding the prostate.
Therefore, immediately after the implant, any exercise or activity that puts pressure on
the prostate should be avoided. You should avoid lifting heavy objects or doing vigorous
exercise for at least three to four days after the implant. Very vigorous exercise after
this period may cause some minor bleeding in the bladder. This is not harmful, but
you should limit your exercise until the bleeding stops. Activities such as bike riding,
horseback riding, motorcycle riding in which there is pressure on the prostate should
be avoided for at least six months. The repetitious jarring of the prostate with these
activities can cause some swelling and impair urination.
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RADIATION THERAPY QUESTIONS & ANSWERS, continued
Will I be radioactive after the seed implantation?
Yes, but the radiation is confined to the area of the implant. Although the seeds are radioactive,
patients are not. Because the radioactivity is so low and the placement is so precise, virtually
all the radioactivity is absorbed into the prostate. However, special precautions should be
taken when a patient is in contact with small children and pregnant women in the first two
months after treatment. You nurse or doctor will advise you what precautions are necessary
and when.
Does the radiation from seed implants pose any danger to my sexual partner?
No, the seeds are of low energy and pose little risk to your partner. The semen is not
radioactive. You may resume sexual activity very soon after the procedure. Occasionally,
there may be blood in the semen or some slight pain at climax.
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70
GLOSSARY
GLOSSARY
GLOSSARY
Definitions & Phonetic Pronunciations
A
APC gene: a gene that slows the growth of cells in the body. Changes in this gene can cause
familial adenomatous polyposis (FAP) and Gardner syndrome. People who have a mutation in
this gene can develop hundreds of polyps in the colon. See also Gardner syndrome, familial
adenomatous polyposis.
abdomen (ab-duh-men): the part of the body between the chest and the pelvis. It contains the
stomach (with the lower part of the esophagus), small and large intestines, liver, gallbladder, spleen,
pancreas, and other organs. The abdomen is lined by a membrane called the peritoneum.
ablative (ab-lay-tive) therapy: treatment that removes or destroys the function of an organ. For
example, removing the ovaries or testicles or taking medicines that cause them to stop making
the hormones which help some types of cancer grow.
abscess (ab-ses): a collection of pus in tissues, organs, or other parts of the body.
adenocarcinoma (ad-no-kar-suh-NO-muh): cancer that starts in the glandular tissue, such as in
the ducts or lobules of the breast.
adenoma (add-no-muh): a benign (non-cancerous) growth starting in the glandular tissue.
adhesions (ad-hee-zhunz): scar tissue that forms after surgery. If it tightens, it may bind together
organs that are normally separate. This can sometimes cause partial or total blockage of the
intestine.
adjuvant (ad-juh-vunt) therapy: treatment used in addition to the main treatment. It usually
refers to hormonal therapy, chemotherapy, radiation therapy, or immunotherapy added after
surgery to increase the chances of curing the disease or keeping it in check.
adrenal gland (uh-dree-nul): one adrenal gland is located at the top of each kidney. Its main
function is to make hormones which control metabolism, fluid balance, and blood pressure. It
also makes small amounts of “male” hormones (androgens) and “female” hormones (estrogens
and progesterone).
advance directives: legal documents that tell the doctor and family what a person wants for
future medical care in the event that the patient becomes unable to make decisions for him or
herself. This may include whether to start or when to stop life-sustaining treatments. Another
type of advance directive lets you choose a person to make decisions for you later if you become
unable to do it for yourself. See living will and health care power of attorney.
advanced cancer: a general term describing stages of cancer in which the disease has spread
from where it started (the primary site) to other parts of the body. When the cancer has spread
only to the nearby areas, it is called locally advanced cancer. If it has spread to distant parts of
the body, it is called metastatic cancer.
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G L O S S A R Y, c o n t i n u e d
AJCC Staging System: American Joint Committee on Cancer staging system (also called the TNM
system), which describes the extent of a cancer’s spread in Roman numerals from 0 through IV.
See also staging.
allogeneic (al-o-jen-nay-ick) bone marrow transplant: uses marrow from a donor whose tissue
type closely matches the patient’s. This can be from a related donor or an unrelated donor. See
also stem cell transplant.
alopecia (al-o-PEE-shuh): hair loss. This often happens with chemotherapy treatment or radiation
therapy to the head. In most cases, the hair grows back after treatment ends.
alveoli (al-vee-o-lie): air sacs of the lungs.
alternative therapy: an unproven therapy that is recommended instead of standard (proven)
medical treatment. Some alternative therapies have dangerous or even life-threatening side
effects. With others, the main danger is that the patient may lose the chance to benefit from
standard treatment. The American Cancer Society recommends that patients thinking about
using any alternative or complementary therapy discuss it first with a member of their health
care team. See also complementary therapy.
Amsterdam criteria (am-stir-dam cry-teer-ee-uh): a set of conditions common in people with
hereditary non-polyposis colon cancer (HNPCC). Only about 60% of people who meet all
of the criteria actually have HNPCC, but people who meet the criteria may want to consider
genetic testing for it. Compare to Bethesda criteria. See also hereditary nonpolyposis colon
cancer.
anastomosis (uh-nas-tuh-MO-sis): the site where 2 structures are surgically joined together.
androgen (an-dro-jen): any male sex hormone. The major androgen is testosterone.
androgen blockade: use of drugs to disrupt the actions of male hormones.
anecdotal (an-neck-doe-tul): individual or personal report, an incomplete description from one
or more patients.
anemia (uh-neem-ee-uh): low red blood cell count.
anesthesia (an-es-thee-zhuh): the loss of feeling or sensation as a result of drugs or gases.
General anesthesia causes loss of consciousness (“puts you into a deep sleep”). Local or regional
anesthesia numbs only a certain area.
anesthesiologist (an-es-thee-zee-AHL-uh-jist): a doctor who specializes in giving medicines or
other agents that prevent or relieve pain, especially during surgery.
aneuploid (an-you-ploid): See ploidy.
angiogenesis (an-jee-o-JEN-uh-sis): the formation of new blood vessels. Some cancer treatments
work by blocking angiogenesis, thus preventing blood from reaching the tumor.
angiography (an-jee-AH-gruf fee): a test in which a contrast dye is injected directly into a blood
vessel that goes to the area that is being studied. A series of x-ray images are then taken to show
surgeons the location of blood vessels around a tumor.
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G L O S S A R Y, c o n t i n u e d
anorexia (an-uh-rek-see-uh): loss of appetite; may be caused by either the cancer itself or as a
side effect of treatments such as chemotherapy.
anterior (an-teer-ee-yer): at or near the front.
antibiotic: drugs used to kill micro-organisms that cause disease. Antibiotics may be made
naturally by living organisms or they may be created in the lab. Since some cancer treatments
can reduce the body’s ability to fight off infection, antibiotics may be used to treat or prevent
these infections.
antibody: a protein produced by immune system cells and released into the blood. Antibodies
defend the body against foreign agents, such as bacteria. These agents contain certain substances
called antigens. Each antibody works against a specific antigen. See also antigen.
anti-emetic (an-tie-eh-MEH-tik): a drug that prevents or relieves nausea and vomiting, common
side effects of chemotherapy.
anti-estrogen (an-tie-ess-tro-jen): a substance (for example, the drug tamoxifen) that blocks the
effects of estrogen on tumors. Antiestrogens are used to treat breast cancers that depend on
estrogen for growth.
antigen (an-tuh-jen): a substance that causes the body’s immune system to respond. This response
often involves making antibodies. For example, the immune system’s response to antigens that
are part of bacteria and viruses helps people resist infections. Cancer cells have certain antigens
that can be found by lab tests. They are important in cancer diagnosis and in watching response
to treatment. Other cancer cell antigens play a role in immune reactions that may help the
body’s resistance against cancer.
antimetabolites (an-tie-muh-TAB-o-lites): substances that interfere with the body’s chemical
processes, such as those that create proteins, DNA, and other chemicals needed for cell growth
and reproduction. In treating cancer, antimetabolite drugs disrupt DNA production, which in
turn prevents cell division and growth of tumors. See also DNA.
antioxidants (an-tie-OX-uh-dunts): compounds that hold back chemical reactions with oxygen
(oxidation). Some vitamins, such as vitamins C and E and beta-carotene are antioxidants.
Antioxidants that are found in foods are thought to reduce the risk of some cancers. However,
use of certain antioxidants supplements has been linked to higher cancer risk in some people.
apheresis (a-fur-REE-sis) or pheresis (fur-ree-sis): a procedure in which blood is taken, part
of the blood is removed, and the rest of the blood is infused back into the donor. May be
called plasmapheresis if plasma is removed, leukaphoresis if white blood cells are removed, or
plateletpheresis when platelets are removed.
apoptosis (a-pop-toe-sis): programmed cell death. Apoptosis is controlled by genes that cause
a cell to die at a specific time, for example, when DNA is damaged. This type of cell death
is different from the process of cell death by decay. Some drugs used to treat cancer cause
apoptosis.
aspiration (asp-er-A-shun): to draw out by suction. See also fine needle aspiration biopsy.
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asymptomatic (a-simp-tuh-MAT-ik): not having any symptoms of a disease. Many cancers can
develop and grow without producing symptoms, especially in the early stages. Screening tests
such as mammograms and colonoscopies help to find these early cancers before symptoms
start, when the chances for cure are usually highest. See also screening.
atypical (a-tip-uh-kul): not usual; abnormal. Also called atypia (a-tip-ee-yuh). Often refers to
the appearance of cancerous or pre-cancerous cells. See also hyperplasia.
autologous (aw-tahl-uh-gus) bone marrow transplant: a complex and sometimes risky treatment
that may be used when cancer is advanced or has recurred, or as the main treatment in some
types of leukemia or lymphoma. A portion of the patient’s bone marrow is removed, cleansed,
treated, and stored. The patient is given high doses of chemotherapy to kill the cancer cells. The
drugs also destroy the remaining bone marrow, thus robbing the body of its natural ability to fight
infection. The cleansed marrow is then given by transfusion (transplanted) to restore the patient’s
immune defenses. The best place to have a bone marrow transplant is at a comprehensive
cancer center or other facility that has the technical skill and experience to perform it safely.
Bone marrow transplants can also be received from a donor. See allogeneic bone marrow
transplant. See also stem cell transplant.
axilla (ax-ill-uh): the armpit.
axillary (ax-ill-air-ee) dissection: removal of the lymph nodes in the armpit (axillary nodes).
They are looked at under a microscope to see if they contain cancer.
B
BPH: see benign prostatic hyperplasia.
BRCA1: a gene which, when damaged (mutated), places a woman at much greater risk of
developing breast and/or ovarian cancer, compared with women who do not have the
mutation.
BRCA2: a gene which, when damaged or mutated, puts the woman at a much higher risk for
developing breast cancer and/or ovarian cancer than the general population.
barium enema (bear-ee-um en-uh-muh): a method used to help diagnose colorectal cancer.
Barium sulfate, a chalky substance, is used to enlarge and partly fill the colon. When the colon
is about half-full of barium, air is pushed in to cause the colon to expand further. This allows
good x-ray films to be taken. Also called a double contrast barium enema.
basal cell carcinoma: the most common type of skin cancer. It begins in the lowest layer of the
epidermis, called the basal cell layer. It usually develops on sun-exposed areas, especially the
head and neck. Basal cell cancer grows slowly and is not likely to spread to distant parts of the
body.
basic science: lab studies that are not aimed at specific problems, but that provide the knowledge
and background required for later applied research.
behavioral research: research into what motivates people to act as they do. The results of such
research can be used to help encourage people to adopt healthy lifestyles and follow life-saving
screening and treatment guidelines.
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benign (be-nine): not cancer; not malignant.
benign tumor: an abnormal growth that is not cancer and does not spread to other areas of the
body.
benign prostatic hyperplasia (be-nine pros-tat-tick hi-per-PLAY-zhuh): non-cancerous
enlargement of the prostate that may cause problems with urination such as trouble starting and
stopping the flow. Also referred to as BPH.
beta carotene: a form of vitamin A that is found mainly in yellow and orange vegetables and
fruits. It functions as an antioxidant and may play a role in cancer prevention. However, high
doses of beta carotene supplements in smokers may increase lung cancer risk.
Bethesda criteria (beth-ez-duh cry-teer-ree-yuh): a set of conditions that are common in people
with hereditary non-polyposis colon cancer (HNPCC). Most people who meet these criteria
actually do not have HNPCC, but may want to consider further testing for it. Compare to
Amsterdam criteria. See also hereditary non-polyposis colon cancer.
bilateral (bi-lat-er-ul): on both sides of the body; for example, bilateral breast cancer is cancer
in both breasts. Compare to unilateral.
biologic response modifiers: substances that boost the body’s immune system to fight against
cancer; interferon is one example. Also called biologic therapy.
biomarkers: see tumor markers.
biopsy (by-op-see): the removal of a sample of tissue to see whether cancer cells are present.
There are several kinds of biopsies. In some, a very thin needle is used to draw fluid and cells
from a lump. In a core biopsy, a larger needle is used to remove more tissue.
bladder: a hollow organ in the pelvis with flexible, muscular walls. The bladder stores urine as
it is produced by the kidneys.
blood count: a count of the number of red blood cells and white blood cells in a given sample
of blood.
B-lymphocytes (limf-o-sites) or B-cells: white blood cells that are help make antibodies.
bone marrow: the soft, spongy tissue in the hollow middle of flat bones of the body where new
blood cells are made.
bone marrow aspiration and biopsy: a procedure in which a needle is placed into the cavity of
a bone, usually the hip or breast bone, to remove a small amount of bone marrow so that it can
be looked at under a microscope.
bone marrow transplant: a treatment that restores blood-forming stem cells that have been
destroyed by high doses of chemotherapy and/or radiation therapy. The bone marrow may come
from the patient (autologous) or a donor (allogeneic.) See autologous bone marrow transplant,
allogeneic bone marrow transplant, and stem cell transplant.
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bone scan: an imaging method that gives important information about the bones, including the
location of cancer that may have spread to the bones. It can be done on an outpatient basis and
is painless, except for the needle stick when a low-dose radioactive substance is injected into a
vein. Pictures are taken to see where the radioactivity collects, pointing to an abnormality.
bone survey (skeletal): an x-ray of all the bones of the body; often done when looking for cancer
that has spread to the bones.
brain scan: an imaging method used to find anything not normal in the brain, including brain
cancer and cancer that has spread to the brain from other places in the body. This scan can
be done in an outpatient clinic. It is painless, except for the needle stick when a radioactive
substance is injected into a vein. The pictures taken will show where radioactivity collects,
indicating an abnormality.
brachytherapy (brake-ee-THER-uh-pee): internal radiation treatment given by placing radioactive
seeds or pellets directly into the tumor or close to it. Also called interstitial radiation therapy
or seed implantation.
breast cancer: cancer that starts in the breast. The main types of breast cancer are ductal
carcinoma in situ, invasive ductal carcinoma, lobular carcinoma in situ, invasive lobular
carcinoma, medullary carcinoma, and Paget disease of the nipple (see definitions under these
headings). Some breast specialists believe that lobular carcinoma in situ is not a true cancer.
breast conservation therapy or breast-conserving therapy: surgery to remove a breast cancer
and a small area of normal tissue around the cancer without removing any other part of the
breast. The lymph nodes under the arm may be removed, and radiation therapy is also often
given after the surgery. This method is also called lumpectomy, segmental excision, limited
breast surgery, or tylectomy.
breast implant: a sac used to increase breast size or restore the contour of a breast after
mastectomy. The sac is filled with silicone gel (a synthetic material) or sterile saltwater (saline).
breast reconstruction: surgery that rebuilds the breast contour after mastectomy. A breast implant
or the woman’s own tissue is used. If desired, the nipple and areola may also be recreated.
Reconstruction can be done at the time of mastectomy or any time later.
breast self-exam (BSE): a way to check one’s own breasts for lumps or suspicious changes.
Women over age 20 might choose to do BSE regularly, usually at a time other than the days
before, during, or immediately after her menstrual period.
bronchi (brong-ki): in the lungs, the 2 main air passages leading from the windpipe (trachea).
The bronchi provide a passage for air to move in and out of the lungs.
bronchiole (brong-key-ol): one of the smaller sub-divisions of the bronchi.
bronchoscopy (brong-kos-kuh-pee): looking at the bronchi using a flexible, lighted tube called
a bronchoscope.
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C
CA 19-9: a tumor marker sometimes produced by colorectal, stomach, bile duct, and pancreatic
cancers. It may also be produced in pancreatitis, liver disease, and other noncancer conditions.
See tumor markers.
CEA: see carcinoembryonic antigen.
CT-guided needle biopsy: a procedure that uses special x-rays to show a mass, while the
radiologist advances a biopsy needle toward it. The images are repeated until the doctor is sure
the needle is in the tumor or mass. A biopsy is then taken from it to be looked at under the
microscope.
CT scan or CAT scan: see computed tomography.
cachexia (ka-kek-see-uh): a profound state of general poor health and malnutrition (poor dietary
intake).
calcifications: (kals-if-ik-a-shuns) tiny calcium deposits within the breast, alone or in clusters,
often found by mammography. These are also called microcalcifications. They are a sign of
changes within the breast that may need to be followed by more mammograms, or by a biopsy.
They may be caused by breast cancer or by benign breast conditions.
cancer: cancer is not just one disease but a group of diseases. All forms of cancer cause cells
in the body to change and grow out of control. Most types of cancer cells form a lump or mass
called a tumor. The tumor can invade and destroy healthy tissue. Cells from the tumor can break
away and travel to other parts of the body. There they can continue to grow. This spreading
process is called metastasis. When cancer spreads, it is still named after the part of the body
where it started. For example, if breast cancer spreads to the lungs, it is still breast cancer, not
lung cancer.
Some cancers, such as blood cancers, do not form a tumor. Not all tumors are cancer. A tumor
that is not cancer is called benign. Benign tumors do not grow and spread the way cancer does.
They are usually not a threat to life. Another word for cancerous is malignant.
cancer care team: the group of health care professionals who work together to find, treat, and
care for people with cancer. The cancer care team may include any or all of the following
and others: primary care physicians, pathologists, oncology specialists (medical oncologist,
radiation oncologist), surgeons (including surgical specialists such as urologists, gynecologists,
neurosurgeons, etc.), nurses, oncology nurse specialists, and oncology social workers. Whether
the team is linked formally or informally, there is usually one person who takes the job of
coordinating the team.
cancer cell: a cell that divides and reproduces abnormally and can spread throughout the body,
crowding out normal cells and tissue.
cancer-related check-up: a routine health examination for cancer in persons without obvious
signs or symptoms of cancer. The goal of the cancer-related check-up is to find the disease, if it
exists, at an early stage, when chances for cure are greatest. Depending on the person’s sex and
age, this check-up may include a digital rectal examination, clinical breast examination, Pap
smear, PSA blood test, and skin examination. See also detection.
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cancer-related fatigue: an unusual and persistent sense of tiredness that can occur with cancer
or cancer treatments. It can be overwhelming, last a long time, and interfere with everyday life.
Rest does not always relieve it.
cancer screening tests: see screening.
cancer susceptibility genes: genes (the basic unit of heredity) inherited from one’s parents that
greatly increase the risk of a person’s developing cancer. About 5% to15% of all cancers are
caused by these genes.
cancer vaccine: a vaccine used in the treatment (not prevention) of some cancers. It is made
from pieces of tumors and works by causing the immune system to recognize and attack the
cancer cells.
carcinoembryonic antigen (car-sin-o-em-bre-ON-ic an-tuh-jin): a substance normally found in
fetal tissue. If found in an adult, it may suggest that a cancer, especially one starting in the
digestive system, may be present. Tests for this substance may help in finding out if a colorectal
cancer has come back after treatment. The test is not helpful for screening for colorectal cancer
because of the large number of false positives and false negatives. See tumor marker, screening,
false positive, and false negative.
carcinogen (car-sin-o-jin): any substance that causes cancer or helps cancer grow. For example,
tobacco smoke contains many carcinogens that greatly increase the risk of lung cancer.
carcinoid tumors or carcinoids: tumors that develop from neuroendocrine cells, usually in the
digestive tract, lung, or ovary. The cancer cells from these tumors release certain hormones into
the bloodstream. In about 10% of people, the hormone levels are high enough to cause facial
flushing, wheezing, diarrhea, a fast heartbeat, and other symptoms throughout the body.
carcinoid syndrome: A group of symptoms produced by cancer cells that release high amounts of
hormones, which cause facial flushing, wheezing, diarrhea, a fast heartbeat, and other symptoms.
carcinoma (car-sin-o-ma): a malignant tumor that begins in the lining layer (epithelial cells) of
organs. At least 80% of all cancers are carcinomas.
carcinoma in situ (car-sin-o-ma in sy-too): an early stage of cancer in which the tumor is confined
to the organ where it first developed. The disease has not invaded other parts of the organ or
spread to distant parts of the body. Most in situ carcinomas are highly curable.
case manager: the member of a cancer care team, usually a nurse or oncology nurse specialist,
who coordinates the patient’s care throughout diagnosis, treatment, and recovery. The case
manager acts as a guide through the complex system of health care by helping cut through red
tape, getting responses to questions, managing crises, and connecting the patient and family to
needed resources.
catheter (cath-it-ur): a thin, flexible tube through which fluids enter or leave the body; for
example, a tube to drain urine.
cell: the basic unit of which all living things are made. Cells replace themselves by splitting and
forming new cells (this process is called mitosis). The processes that control the formation of
new cells and the death of old cells are disrupted in cancer.
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cell cycle: the series of steps that a cell must go through to divide; some chemotherapy drugs
act by interfering with the cell cycle.
centigray: see radiation dose.
centimeter (sin-tuh-mee-ter): a metric measure of length. It takes about 2 1/2 centimeters to
equal 1 inch. Also, 1/100 of a meter.
cervix (ser-vix): the neck of the womb (uterus).
cGy: short for centigray, a unit of radiation equal to the rad, an older term.
chemoprevention (key-mo-pre-VEN-shun): prevention or reversal of disease using drugs,
chemicals, vitamins, or minerals. While this idea is not ready for widespread use, it is a very
promising area of study. The Breast Cancer Prevention Trial has shown that the drug tamoxifen
can prevent some cases of breast cancer among women with high risk of the disease. But the
drug may have some serious side effects.
chemotherapy (key-mo-THER-uh-pee): treatment with drugs to destroy cancer cells.
Chemotherapy is often used, either alone or with surgery or radiation, to treat cancer that has
spread or come back (recurred), or when there is a strong chance that it could recur. Often
called chemo.
chromosome (krom-uh-som): chromosomes carry genes, the basic units of heredity. Humans
have 23 pairs of chromosomes, one member of each pair from the mother, the other from the
father. Each chromosome can contain hundreds or thousands of individual genes.
chronic obstructive pulmonary (ob-struck-tiv pull-mun-err-ee) disease: lung disease, such as
emphysema or chronic bronchitis, that makes it harder to breathe. More common in smokers;
also known as COPD.
clinical breast examination: an examination of the breasts done by a health professional such
as a doctor or nurse.
clinical stage: see staging.
clinical trials: research studies to test new drugs or other treatments to compare current, standard
treatments with others that may be better. Before a new treatment is used on people, it is studied
in the lab. If lab studies suggest the treatment will work, the next step is to test its value in
patients. These human studies are called clinical trials. The main questions the researchers want
to answer are:
• Does this treatment work?
• Does it work better than what we’re now using?
• What side effects does it cause?
• Do the benefits outweigh the risks?
• Which patients are most likely to find this treatment helpful?
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colon: the large intestine. The colon is a muscular tube about 5 feet long. It is divided into 4
sections: the ascending, transverse, descending, and sigmoid colon. It continues the process of
absorbing water and mineral nutrients from food that was started in the small intestine.
colonoscope (co-lahn-uh-scope): a slender, flexible, hollow lighted tube about the thickness of
a finger. It is inserted through the rectum up into the colon. A colonoscope is much longer than a
sigmoidoscope, and allows the doctor to see much more of the colon’s lining. The colonoscope
is connected to a video camera and video display monitor so the doctor can look closely at the
inside of the entire colon. (This procedure is called a colonoscopy.)
colonoscopy (ko-lun-AH-skuh-pee): a procedure that allows a doctor to see inside the large
intestine to find polyps or cancer.
colony stimulating factors (CSF): types of growth factors that promote growth and division of
blood-producing cells in the bone marrow. CSFs are naturally produced in the body. But extra
amounts may be given as a treatment to reduce or prevent certain side effects of chemotherapy
that may be caused by not having enough blood cells.
colorectal cancer screening: testing done to detect abnormalities early, before signs and
symptoms start. This allows for earlier detection of cancer, when it is most curable. It also
allows doctors to find and remove polyps, which can prevent cancer from developing. See also
screening, fecal occult blood test, fecal immunochemical test, barium enema, sigmoidoscopy,
colonoscopy, and polyp.
colostomy (kuh-lahs-tuh-me): a procedure in which the end of the colon is attached to an
opening created in the abdominal wall to get rid of body waste (stool). A colostomy is sometimes
needed after surgery for cancer of the rectum. People with colon cancer sometimes have a
temporary colostomy but they rarely need a permanent one.
combined modality therapy: two or more types of treatment used alternately or together to get
the best results. For example, surgery for cancer is often followed by chemotherapy to destroy
any cancer cells that may have spread from the original site.
complementary therapy: treatment used along with standard medical treatment. Some
complementary therapies may help relieve certain symptoms of cancer, relieve side effects of
standard cancer therapy, or improve a patient’s sense of well-being. The ACS recommends that
patients thinking about using any alternative or complementary therapy discuss it first with a
member of their health care team, since many of these treatments are unproven and some can
be harmful. See also alternative therapy.
computed tomography (to-mahg-ruh-fee): an imaging test in which many x-rays are taken from
different angles of a part of the body. These images are combined by a computer to make crosssectional pictures of internal organs. Except for the injection of a dye (needed in some but not
all cases), this is a painless procedure that can be done in an outpatient clinic. It is often referred
to as a “CT” or “CAT” scan.
concurrent treatment: treatment or therapy that is given at the same time as another
treatment.
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Cone Beam Imaging (CBI): the first system in San Antonio with this advanced technology that
alllows high quality CT images that are taken on the treatment machine to improve the accuracy
of the radiation.
conformal proton beam therapy: a technique for giving radiation therapy that uses proton
beams rather than standard radiation. Protons are parts of atoms that cause little damage to the
tissues they pass through but are very effective in killing cells at the end of their path. Proton
beam therapy is still new and not offered in many treatment centers, but it may be able to
deliver more radiation to the cancer while reducing the damage to normal tissues. See also
conformal radiation therapy.
conformal radiation therapy: a newer type of radiation treatment that uses a special computer
which helps shape the beams of radiation to the shape of the tumor and delivers the beams from
different directions. This allows healthy tissue to be exposed to less radiation.
control group: in research or clinical trials, this is the group that does not receive the treatment
being tested. In cancer research, this group most often gets standard treatment (which has already
been tested and is in general use.) When no standard treatment exists, the control group may get
a placebo or sham treatment. Also called the comparison group. See also clinical trials.
conventional therapy or treatment: see standard therapy.
COPD: see chronic obstructive pulmonary disease.
corticosteroid: (kor-ti-ko-STEER-oid) any of a number of steroid substances that come from the
cortex of the adrenal glands. They are sometimes used as an anti-cancer treatment or to reduce
nausea
cryoablation (cry-o-ah-BLAY-shun): use of extreme cold to freeze and destroy cancer cells.
cryosurgery: see cryoablation.
curative treatment: treatment aimed at producing a cure. Compare with palliative treatment.
Cyberknife: this advanced technology in radiosurgery, uses robotics and image-guidance to
deliver exact doses of radiation. It is a non-invasive and painless procedure.
cyst (sist): a fluid-filled mass that is usually not cancer (benign). The fluid can be removed for
analysis. See needle aspiration.
cystoscopy (sis-tah-sko-pee): looking at the inside of the bladder with a thin, flexible, lighted
tube called a cystoscope.
cytogenetics (sy-toe-juh-net-icks): tests done to look for abnormal changes in chromosomes.
This is often done on bone marrow samples in patients with leukemia.
cytokine (sy-toe-kine): A substance that is produced by cells of the body’s immune system that
can affect the immune response. Cytokines can also be produced in the lab and given to people
to help the body’s immune responses against cancer.
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cytology (sy-tahl-uh-jee): the branch of science that deals with the structure and function of
cells. Also refers to tests to diagnose cancer and other diseases by looking at cells under the
microscope.
cytometry (sy-tahm-uh-tree): the counting and measuring of cells using a machine called a flow
cytometer.
cytotoxic (sy-toe-tok-sick): toxic to cells; cell-killing.
D
D & C or dilation and curettage (die-lay-shun and cure-uh-tazh): a test in which the cervix
is opened slightly so that a sample of tissue from the lining of the uterus can be removed and
studied.
DES: see diethylstilbestrol.
DNA: deoxyribonucleic (dee-ok-see-ri-bo-new-CLEE-ick) acid or DNA: the genetic “blueprint”
found in the nucleus of each cell. DNA holds genetic information on cell growth, division, and
function. See also mutation.
DNA repair: the process of correcting the genetic mistakes that are made each time a cell
divides. If the repair process does not go right, it can increase the chances of a person having
some forms of cancer.
DRE: see digital rectal exam.
dermatologist (der-muh-tahl-uh-jist): a doctor who specializes in skin diseases.
detection: finding disease. Early detection means that the disease is found at an early stage,
before it has grown large or spread to other sites. Note: many forms of cancer can reach an
advanced stage without causing symptoms. Mammography can help find breast cancer early,
and the prostate-specific antigen (PSA) blood test is useful in finding prostate cancer. See also
screening.
diagnosis: identifying a disease by its signs or symptoms, and by using imaging tests and
laboratory findings. For most types of cancer, the earlier a diagnosis of cancer is made, the
better the chance for long-term survival.
dietary supplement: a product, such as a vitamin, mineral, or herb, intended to improve health
but not to diagnose, treat, cure, or prevent disease. Because dietary supplements are not
considered “drugs,” their manufacturers do not have to prove they are effective, or even safe. In
many cases, studies have found that some do not contain what is listed on the label, and some
contain impurities or ingredients not listed.
diethylstilbestrol (die-ETH-ul-still-bes-trahl): a man-made form of estrogen.
dietitian/registered dietitian/nutritionist: an expert in the area of food and diet; a registered
dietitian (RD) has at least a bachelor’s degree and has passed a national competency exam. The
term nutritionist is also used, but there are no educational requirements associated with this
title.
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differentiation (dif-uhr-en-she-A-shun): the normal process through which cells mature so they
can carry out the jobs they were meant to do. Cancer cells are less differentiated than normal cells.
Pathologists grade the cells to evaluate and report the degree of a cancer’s differentiation.
digital mammography: a method of storing an x-ray image of the breast as a computer image
rather than on the usual x-ray film. Digital mammography can be combined with computerassisted diagnosis (CAD), a process in which the radiologist uses the computer to help interpret
or “read” the mammogram.
digital rectal exam (DRE): an exam in which the doctor inserts a lubricated, gloved finger into
the rectum to feel for anything not normal. This simple test, which is not painful, can detect
many rectal cancers and some prostate cancers.
disease-free survival rate: the percentage of people with a certain cancer who still have no
evidence of disease (cancer) at a certain period of time (usually 5 years) after treatment.
dissection (di-sek-shun): surgery to divide, separate, or remove tissues. See also axillary
dissection.
distant cancer: cancer that has spread far from its original location or primary site to distant
organs or lymph nodes. Sometimes called distant metastases. See also primary site; compare
to local or localized cancer.
dopamine (dope-uh-meen): a chemical messenger in the brain and nervous system. Dopamine
is thought to control balance, movement, and other body functions. It also affects the mood and
is linked to feelings of pleasure.
dosimetrist (do-sim-uh-trist): a person who plans and calculates the proper radiation dose for
cancer treatment.
doubling time: for cancer in general, the time it takes for a cell to divide or for a cancer to
double itself in size. Cancers vary in doubling time from 8 to 600 days, averaging 100 to 120
days. Thus, a cancer may be present for many years before it can be found.
drug resistance: refers to the ability of cancer cells to become resistant to the effects of the
chemotherapy drugs used to treat cancer.
duct ectasia (ek-ta-zhuh): widening of the ducts of the breast, often related to breast inflammation
called periductal mastitis. Duct ectasia is a benign (not cancerous) condition. Symptoms of this
condition are a nipple discharge, swelling, retraction of the nipple, or a lump that can be felt.
ductal carcinoma in situ or DCIS (ductal car-sin-o-ma in sy-too): cancer cells that start in the
milk passages (ducts) but have not grown through the duct walls into the surrounding tissue. This
is a highly curable form of breast cancer that is treated with surgery, or surgery plus radiation
therapy. Also called intraductal carcinoma.
durable power of attorney for health care: a legal document that allows you to appoint a
person to make medical decisions for you if you become unable to do so for yourself. This is a
type of advanced directive. See also advanced directive.
dysphagia (dis-fay-zhe-uh): having trouble swallowing or eating.
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dysplasia (dis-play-zhuh): abnormal changes of groups of cells that may lead to cancer.
E
edema (uh-deem-uh): build-up of fluid in the tissues, causing swelling. Edema of the arm or leg
can develop after surgery or radiation. Arm edema can also develop after radical mastectomy
or axillary dissection of lymph nodes. Leg edema can develop if lymph nodes in the groin are
removed. See also lymphedema.
efficacy (ef-i-kuh-see): effectiveness. The ability of a treatment to produce the desired result.
electrofulguration (e-lek-tro-ful-ger-A-shun): a type of treatment that destroys cancer cells by
burning with an electrical current. Also known as electrocautery.
embolization (em-bo-li-ZAY-shun): a type of treatment that reduces the blood supply to the
cancer by the injection of materials to plug up the artery that supplies blood to the tumor.
emesis (em-eh-sis): vomiting
endocrine (en-duh-krin) glands: glands that release hormones into the bloodstream. The ovaries
are one type of endocrine gland.
endocrine therapy: manipulation of hormones in order to treat a disease or condition. See also
hormone therapy.
endocrinologist (en-duh-kruh-NAHL-uh-jist): a doctor who specializes in diseases related to the
glands of the endocrine system, such as the thyroid, pancreas, and adrenal glands.
endometrium (en-do-mee-tree-um): the lining of the womb (uterus).
endoscopy (en-dahs-kuh-pee): inspection of body organs or cavities using a flexible, lighted
tube called an endoscope.
enterostomal therapist (en-ter-es-STO-mal ther-uh-pist): a health professional, often a nurse,
who teaches people how to care for ostomies (surgically created openings such as a colostomy)
and other wounds.
enucleation (ee-noo-klee-AY-shun): surgical removal of something without cutting into it.
Sometimes used to describe removal of a whole tumor; also may describe removing the whole
eyeball while leaving eye muscles and other contents of the eye socket.
enzyme (en-zime): proteins that increase the rate of chemical reactions in living cells.
epidemiology (ep-ih-deem-ee-AHL-uh-jee): the study of diseases in populations by collecting
and analyzing statistical data. In the field of cancer, epidemiologists look at how many people
have cancer; who gets specific types of cancer; and what factors (such as environment, job
hazards, family patterns, and personal habits, such as smoking and diet) play a part in the
development of cancer.
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esophageal (eh-sof-uh-JEE-uhl) speech: a special type of speech used by some people after
surgery for cancer of the voice box (larynx). Air is swallowed and a “belching” type of speech
can be produced. New devices, improved surgery, and the use of chemotherapy and radiation
therapy instead of surgery, have reduced the need for learning esophageal speech.
estrogen: a female sex hormone produced mostly by the ovaries, and in smaller amounts by the
adrenal cortex. In women, levels of estrogen fluctuate on nature’s carefully designed schedule,
regulating the development of secondary sex characteristics, including breasts; regulating the
monthly cycle of menstruation; and preparing the body for fertilization and reproduction. In
breast cancer, estrogen may promote the growth of cancer cells. See estrogen receptor assay,
estrogen replacement therapy, and hormone therapy.
estrogen replacement therapy: the use of estrogen from other sources after a woman’s body
no longer makes its own supply. This type of hormone therapy is used to relieve symptoms
of menopause. It can provide protective effects against bone thinning (osteoporosis) after
menopause. Since estrogen nourishes some types of breast cancer, scientists question whether
estrogen replacement therapy increases breast cancer risk. Some new drugs called selective
estrogen receptor modulators (SERMs) are being studied. They seem to have many of the helpful
effects of estrogen replacement without increasing breast cancer risk; in fact, recent studies
suggest that some SERMs may actually reduce breast cancer risk. See estrogen, menopause,
and osteoporosis.
estrogen receptor assay: the estrogen receptor assay is a laboratory test done on a sample of the
cancer in order to see whether estrogen receptors are present. The growth of normal breast cells
and some breast cancers is stimulated by estrogen. Estrogen receptors are molecules that function
as cells’ “welcome mat” for estrogen circulating in the blood. Breast cancer cells without these
receptors (called estrogen-receptor negative or ER negative) are unlikely to respond to hormonal
therapy. Estrogen-receptor positive cancers are more likely to respond to hormonal therapy.
etiology (ee-tee-ahl-uh-jee): the cause of a disease. In cancer, there are probably many causes.
Research is showing that both genetics and lifestyle are major factors in many cancers.
excision (ex-sih-zhun): removal by surgery. This can include a tumor or a body part.
external beam radiation therapy (EBRT): radiation that is focused from a source outside the
body on the area affected by the cancer. It is much like getting a diagnostic x-ray, but for a
longer time. Compare to brachytherapy.
F
false negative: test result implying a condition does not exist when in fact it does. false positive:
test result implying a condition exists when in fact it does not.
familial adenomatous polyposis or FAP: (fa-mil-e-uhl ad-no-muh-tus pa-lee-po-sis)FAP: an
inherited condition that is a risk factor for developing colorectal cancer at a young age. People
with this syndrome develop polyps in the colon and rectum. Usually one or more of these
polyps becomes cancerous if it is not removed. FAP is caused by changes in the APC gene. See
also APC gene.
fascia (fash-uh): a sheet or thin band of fibrous tissue that covers muscles and some organs of
the body.
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fatigue (fuh-teeg): a common symptom during cancer treatment, a bone-weary exhaustion that
doesn’t get better with rest. For some, this can last for some time after treatment.
fecal immunochemical test (fee-kuhl im-you-no-KIM-uh-kuhl test) (also called FIT): a newer
test to look for “hidden” blood in the stool, which could be a sign of cancer. The test is not
affected by vitamins or foods, though it still requires 2 or 3 specimens. See also fecal occult
blood test, false positive, and colorectal cancer screening.
fecal occult blood test: a test for “hidden” blood in the feces (stool). The presence of such
blood could be a sign of cancer. See also fecal immunochemical test and colorectal cancer
screening.
feces (fee-sees): solid waste matter; stool.
fibrocystic (fi-bro-sis-tick) changes: a term that describes certain benign changes in the breast.
Symptoms of this condition are breast swelling or pain. The doctor or nurse will also look for
the presence of nodules, lumpiness, or a discharge from the nipples. Because these symptoms
or other signs can look a lot like breast cancer, a mammogram or a biopsy of breast tissue may
be needed to show that there is no cancer.
fibrosis: formation of scar-like (fibrous) tissue. This can happen anywhere in the body.
fine needle aspiration (FNA) biopsy: a procedure in which a thin needle is used to draw up
(aspirate) samples to be looked at under a microscope. See also biopsy.
first-degree relative: a parent, sibling (brother or sister), or child.
FISH: short for fluorescent in situ hybridization; a cytogenetic blood test used to find specific
DNA sequences on chromosomes. It can be used to diagnose, to evaluate prognosis (disease
outlook), or to look at the remission of a disease, such as cancer. See also cytogenetics.
fistula (fist-chu-luh): an abnormal passage, opening, or connection between 2 internal organs
or from an internal organ to the surface of the body.
five (5)-year survival rate: the percentage of people with a given cancer who are expected to
survive 5 years or longer after diagnosis. Five-year survival rates are based on the most recent
information available, but they may include information from patients treated several years
earlier. These numbers do not take into account advances in treatment that have often occurred.
They are not helpful in predicting an individual case. They only paint a very general picture of
how people in the past have done with the same type of cancer. See also relative 5-year survival
rate.
flow cytometry (flow sy-tahm-uh-tree): a test of tumor tissue to see how fast the tumor cells are
reproducing and whether the tumor cells contain a normal or abnormal amount of DNA. This test
is used to help predict how aggressive a cancer is likely to be. See also ploidy, deoxyribonucleic
acid, and S-phase fraction.
focus (fo-kus): a point at which rays of light or radiation beams come together. Also used to
describe a region of disease in the body. The plural can be focuses or foci (fo-si).
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frozen section: a very thin slice of body tissue that has been quick-frozen and then looked at
under a microscope. This method is sometimes used during an operation because it gives a
quick diagnosis, and can tell a surgeon whether or not to continue with the procedure. The
diagnosis is confirmed in a few days by a more detailed study called a permanent section.
G
GI tract: see gastrointestinal tract.
Gardner syndrome: like familial adenomatous polyposis, Gardner syndrome is an inherited
condition in which polyps develop at a young age and often lead to cancer. It can also cause
benign (not cancerous) tumors of the skin, soft connective tissue, and bones. See APC gene,
familial adenomatous polyposis.
gastric (gas-trick): of or referring to the stomach.
gastroenterologist (gas-tro-en-ter-AHL-uh-jist): a doctor who specializes in diseases of the
digestive (gastrointestinal) tract, such as the esophagus, stomach, small intestine, colon, and
rectum.
gastrointestinal (gas-tro-in-TEST-uh-nul) tract: the digestive tract. It is made up of those organs
and structures that process and prepare food to be used for energy; for example, the stomach,
small intestine, and large intestine.
gene: a piece of DNA that has information on hereditary traits such as hair color, eye color, and
height, as well as susceptibility to certain diseases. See also deoxyribonucleic acid.
genetic counseling: the process of counseling people who may have a gene that makes them
more likely to develop cancer. The purpose of counseling is to explore what the genetic test
results might mean, help them decide whether or not they wish to be tested, and to support
them before and after the test.
genetic counselor: a specially trained health professional who helps people as they consider
genetic testing, as they adjust to the test results, and as they consider whatever screening and
preventive measures are best for them.
genetic testing: tests performed to see if a person has certain gene changes known to increase
cancer risk. Such testing is not recommended for everyone, but for people with specific types of
family history. Genetic counseling should be part of the genetic testing process.
gene therapy: a new type of treatment in which defective genes are replaced with normal ones.
The new genes are delivered into the cells by viruses or proteins.
genome (jee-nome): the total DNA in a single cell, representing all of the genetic information
of the organism.
germ cell: the reproductive cells of the body, that is, ova (eggs) or sperm.
glands: a cell or group of cells that produce and release substances used nearby or in another
part of the body.
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Gleason grade: the prostate cancer grading system used most often is called the Gleason system.
A pathologist assigns a Gleason grade ranging from 1 through 5 based on how much the cancer
cells under the microscope look like normal prostate cells. Those that look a lot like normal
cells are graded as 1, while those that look the least like normal cells are graded as 5. See also
Gleason score, and grade.
Gleason score: the combination of the two Gleason grades used in classifying each prostate
cancer based on how the cells look under the microscope. Because prostate cancers often
have areas with different grades, a grade is assigned to the two areas that make up most of the
cancer. These two grades are added to give a Gleason score between 2 and 10. The higher the
Gleason score, the faster the cancer is likely to grow and the more likely it is to spread beyond
the prostate. Also known as the Gleason sum.
grade: the grade of a cancer reflects how abnormal it looks under the microscope. There are
several grading systems for different types of cancers. Each grading system divides cancer into
those with the greatest abnormality, the least abnormality, and those in between. Grading is
done by a pathologist who looks at the tissue from the biopsy. It is important because cancers
with more abnormal-appearing cells tend to grow and spread more quickly and have a worse
prognosis (outlook).
gray (Gy): see radiation dose.
graft versus host disease (GVHD): the condition that results when the immune cells of a
transplant (usually a bone marrow transplant) from a donor attack the tissues of the person
receiving the transplant.
growth factors: naturally occurring proteins that cause cells to grow and divide. Too much
growth factor production by some cancer cells helps them grow quickly. New treatments to
block these growth factors are being tested in clinical trials. Other growth factors help normal
cells recover from side effects of chemotherapy.
guaiac (gwi-ack): substance used to test the stool to see if it contains blood.
gynecologic (guy-nuh-kuh-lah-jik) oncologist: a doctor who specializes in cancers of the female
reproductive organs.
gynecologist (guy-nuh-kahl-uh-jist): a doctor who specializes in women’s health.
H
health care power of attorney: see durable power of attorney for health care.
Health Insurance Protability and Accountability Act (HIPAA): a federal act that protects
people who change jobs, are self-employed, or who have pre-existing medical conditions.
HIPAA standardizes an approach to the continuation of healthcare benefits for individuals and
members of small group health plans and establishes parity between the benefits extended to
these individuals and those benefits offered to employees in large group plans. The act also
contains provisions designed to ensure that prospective or current enrollees in a group health
plan are not discriminated against based on health status.
hematologist (he-muh-TAHL-uh-jist): a doctor who specializes in diseases of the blood and
blood-forming tissues.
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hematoma (he-muh-TO-muh): a collection of blood outside a blood vessel caused by a leak or
an injury. A bruise is an example of a hematoma.
hematuria (he-muh-TUR-ee-uh): blood in the urine.
hemorrhoids (hem-uh-royds): large varicose veins inside the rectum or colon. They don’t cause
cancer or become cancerous, but they can cause pain, itching, and irritation. They can also cause
slight bleeding, which can result in a positive fecal occult blood test or fecal immunochemical
test even when no cancer is present. See fecal occult blood test, fecal immunochemical test,
and colorectal cancer screening.
hepatomegaly (hep-at-o-MEG-uh-lee): enlargement of the liver.
HER2 gene (sometimes called HER2/neu): this oncoprotein is present in very small amounts on
the outer surface of normal breast cells. About 25% to 30% of breast cancers have too much
of this protein. HER stimulates cell growth, and breast cancers that produce too much of this
protein tend to be more aggressive. A monoclonal antibody used to treat this type of breast
cancer attaches to the HER2 protein, slow the growth of the breast cancer cells, and may also
stimulate the immune system to more effectively attack the cancer. Some other types of cancer
also have too much HER2 protein. Studies of monoclonal antibody therapy for these cancers
are in progress.
hereditary cancer syndrome: conditions linked with cancers that occur in several family
members because of an inherited, mutated gene.
hereditary non-polyposis (huh-red-i-ter-ee non-pah-lee-PO-sis) colon cancer (HNPCC): an
inherited condition that greatly increases a person’s risk for developing colorectal cancer, as
well as endometrial cancer, ovarian cancer, small bowel cancer, or cancer of the lining of the
kidney or the ureters. People with this condition tend to develop cancer at a young age without
first having many polyps.
high risk: when the chance of developing cancer is greater than that normally seen in the
general population. People may be at high risk from many factors, including heredity (such as
a family history of breast cancer), personal habits (such as smoking), or the environment (such
as overexposure to sunlight).
HIPAA: Health Insurance Portability and Accountability Act of 1996. This act clarified and
modified elements of the Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA).
Among other provisions, HIPAA eliminates health insurance descrimination based on preexisting conditions, incorporating instead a waiting period of 12 to 18 months.
histology (hiss-tah-luh-jee): how cells or tissues look when studied under a microscope. The
histologic examination is done by a pathologist. See also pathologist.
Hodgkin disease: an often curable type of cancer that affects the lymphatic system. Named for
the doctor who first identified it; previously called Hodgkin’s disease.
home health nurse: a nurse who gives treatment or medicines in the home, teaches patients
how to care for themselves, and assesses their condition to see if further medical attention is
needed.
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homogeneous (home-uh-jee-ne-us): cells or tissue that look the same throughout. See also
histology.
hormone: a chemical substance released into the body by the endocrine glands such as the
thyroid, adrenal, or ovaries. Hormones travel through the bloodstream and set in motion various
body functions. Testosterone and estrogen are examples of male and female hormones.
hormone receptor: a protein located on a cell’s surface (or within the cell cytoplasm) that binds
to a hormone. Tumors can be tested for hormone receptors to see if they can be treated with
hormones or anti-hormones. See also hormone receptor assay.
hormone receptor assay: a test to see if a breast tumor is likely to be affected by hormones or if
it can be treated with hormones. See also estrogen receptor assay and progesterone receptor
assay.
hormone replacement therapy: the use of estrogen and progesterone from an outside source
after the body has stopped making its own supply because of natural or induced menopause.
This type of hormone therapy is often given to relieve symptoms of menopause and has
been shown to offer protection against thinning of the bones (osteoporosis) in women after
menopause. Recent studies have found that combined hormone replacement therapy (estrogen
plus progesterone) slightly increases breast cancer risk, as well as the risk of heart disease and
blood clots. See also estrogen replacement therapy.
hormone therapy: treatment with hormones, using drugs that interfere with hormone production
or hormone action, or the surgical removal of hormone-producing glands. Hormone therapy
may kill cancer cells or slow their growth.
hospice: a special kind of care for people in the final phase of illness, as well as their families
and caregivers. The care usually takes place in the patient’s home or in a home-like facility.
hot flush: sudden brief feeling of body warmth, along with flushing of the skin and sweating;
common during menopause. Also called hot flash.
hyperalimentation (hy-per-al-ih-men-TAY-shun): giving liquid nutrition into a vein (intravenously
or IV).
hyperplasia (hy-per-PLAY-zhuh): too much growth of cells or tissue in a specific area, such as
the lining of the prostate. See also benign prostatic hyperplasia.
hypertension (hy-per-TEN-shun): high blood pressure.
hyperthermia (hy-per-THERM-ee-uh) therapy: treatment of disease by raising body
temperature.
hypertrophy (hy-per-truh-fee): the enlargement of an organ or part due to an increase in the
size of its cells.
hysterectomy (hiss-ter-EK-tuh-me): an operation to remove the uterus through an incision in the
abdomen or through the vagina. Removal of the ovaries (oophorectomy) may be done at the
same time.
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I
IVP: see intravenous pyelogram
ileostomy (ill-ee-OSS-tuh-me): an operation in which the end of the small intestine, the ileum,
is brought out through an opening in the abdomen. Unformed, liquid stool leaves the intestine
through this opening into a bag called an appliance.
Image Guided Radiation Therapy (IGRT): diagnostic quality images increase the accuracty of
patient setups and improve the accuracy of radiation delivery.
imaging studies: methods used to make pictures of internal body structures. Some imaging
methods used to help diagnose or stage cancer are x-rays, CT scans, magnetic resonance
imaging (MRI), and ultrasound.
immune system: the complex system by which the body resists infection by germs, such as
bacteria or viruses, and rejects transplanted tissues or organs. The immune system may also help
the body fight some cancers.
immunocytochemistry (im-yuh-no-sy-toe-KEM-iss-tree) or immunohistochemistry ( im-yuh-nohis-toe-KEM-iss-tree): a laboratory test that uses antibodies to detect specific chemical antigens
in cells or tissue samples viewed under a microscope. This procedure can be used to help detect
and classify cancer cells. It is also one of the methods used for estrogen receptor assays and
progesterone receptor assays. See also monoclonal antibodies.
immunology (im-yuh-nahl-uh-jee): study of how the body resists infection and certain other
diseases. Knowledge gained in this field is important to those cancer treatments based on the
principles of immunology.
immunosuppression (im-yuh-no-suh-PREH-shun): a state in which the ability of the body’s
immune system to respond is decreased. This condition may be present at birth, or it may be
caused by certain infections (such as human immunodeficiency virus or HIV) or by certain
cancer therapies (such as cancer-cell killing (cytotoxic) drugs, radiation, and bone marrow
transplant).
immunotherapy (im-yuh-no-THER-uh-pee): treatments that promote or support the body’s
immune system response to a disease such as cancer.
implant: a small amount of radioactive material placed in or near a cancer. Also, an artificial
form used to restore the shape of an organ after surgery, for example, a breast implant.
impotence (im-puh-tense): not being able to have or keep an erection of the penis.
incidence (in-sih-dens): the number of new cases of a disease that occur in a group of people
each year. Compare to prevalence.
incision (in-sih-zhun): cut made during surgery.
incontinence (in-kon-tuh-nence): partial or complete loss of urinary or bowel control.
indigent (in-dij-ent): not having enough money to meet one’s needs.
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informed consent: a legal document that explains a course of treatment, the risks, benefits, and
possible alternatives; also the process by which patients agree to treatment.
infraclavicular (in-fruh-kluh-VICK-yuh-ler) nodes: lymph nodes located under the collar bone
(clavicle).
ingest (in-jest): to take in by mouth; to eat or drink.
inherited disease: illness to which a person is susceptible because of a gene passed from his
or her parents at birth. Examples of inherited diseases related to colorectal cancer include
hereditary non-polyposis colon cancer or familial adenomatous polyposis. See mutation.
in situ (in sy-too): in place; localized and confined to one area. A very early stage of cancer.
interferon (in-ter-fear-on): a protein produced by cells. Interferon helps regulate the body’s
immune system, boosting activity when a threat, such as a virus, is found. Scientists have learned
that interferon helps fight against cancer, so it is used to treat some types of cancer.
interleukins (in-ter-loo-kins): see cytokine.
internal radiation: treatment in which a radioactive substance is implanted in the body; see also
brachytherapy. Compare to external beam radiation therapy.
interstitial (in-ter-stih-shul) radiation therapy: a type of treatment in which a radioactive implant
is placed directly into the tissue (not in a body cavity).
intestines (in-test-ins): the part of the digestive tract from the end of the stomach (pylorus) to the
anus, which absorbs nutrients and water from food into the bloodstream. It includes the small
intestine, which is sometimes called the small bowel, and the large intestine, which is also
called the large bowel or colon.
intravenous (IV): a method of giving fluids and medicines using a needle or a thin tube that is
put into a vein.
intravenous pyelogram (in-tra-veen-us pile-uh-gram): a special kind of x-ray procedure. A dye is
injected into the bloodstream. It travels to the kidneys, ureters, and bladder and helps to clearly
outline these organs on the x-rays. Referred to as IVP.
invasive cancer: cancer that has spread beyond the layer of cells where it first developed and
has grown into nearby tissues.
invasive ductal carcinoma: a cancer that starts in the milk passages (ducts) of the breast and
then breaks through the duct wall, where it invades the fatty tissue of the breast. When it reaches
this point, it can spread (metastasize) elsewhere in the breast, as well as to other parts of the
body through the bloodstream and lymphatic system. Invasive ductal carcinoma is the most
common type of breast cancer, accounting for about 80% of breast malignancies. Also known
as infiltrating ductal carcinoma.
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invasive lobular carcinoma: a cancer that starts in the milk-producing glands (lobules) of the
breast and then breaks through the lobule walls and grows into the nearby fatty tissue. From
there, it may spread elsewhere in the breast. About 15% of invasive breast cancers are invasive
lobular carcinomas. It is often hard to detect by physical examination or even by mammography.
Also called infiltrating lobular carcinoma.
investigational: under study; often used to describe drugs used in clinical trials that are not yet
available to the general public.
L
LHRH (luteinizing hormone-releasing hormone) (loo-tee-uh-ny-zing): a hormone produced by
the hypothalamus, a tiny gland in the brain.
LHRH analogs: man-made hormones, chemically similar to LHRH. They block the production
of the male hormone testosterone and are sometimes used as a treatment for prostate cancer.
laparoscope (LAP-uh-ruh-scope): a long, flexible, slender tube inserted into the abdomen
through a very small incision. See also laparoscopic surgery.
laparoscopic (lap-uh-ruh-SKAH-pick) surgery: surgery done through a small incision through
which a narrow tube-like instrument called a laparoscope (see above) is inserted. Other tubes
are inserted in other nearby incisions to allow the surgeon to work inside the abdomen and
remove part of the colon or other organ, which is shown on a television monitor. The small
incisions led to the name “keyhole surgery.” This surgery is more difficult than open surgeries,
and requires a skilled surgeon who has done a lot of them.
laryngectomy (lair-en-jek-tuh-me): surgery to remove the voice box (larynx), usually because
of cancer.
leiomyoma (lie-o-my-o-muh): a benign (non-cancerous) fibrous tumor of the uterus. About 40%
of women have leiomyomas by age 40. Usually there are no symptoms, but the tumors can
cause abnormal uterine bleeding and other symptoms depending on their size and location in
the uterus. It is also called uterine fibroid tumor or fibroma.
lesion (lee-zhun): a change in body tissue; sometimes used as another word for tumor. May also
be used to describe a change in the appearance or texture of skin, such as an open sore, scab,
or discolored area.
leukemia (loo-key-me-uh): cancer of the blood or blood-forming organs. There are two major
classes of leukemia, myeloid and other, non-myeloid types. People with leukemia often have a
very high number of white blood cells (leukocytes). See leukocytosis, myeloid leukemia, and
non-myeloid cancers.
leukocytosis (loo-ko-sy-TOE-sis): having more than the usual number of white blood cells.
leukopenia: (loo-ko-PEE-nee-uh): decrease in the white blood cell count, often a side effect of
chemotherapy.
leukoplakia (loo-ko-PLAY-key-uh): white patches on the tongue or inside the cheeks. These are
often pre-malignant.
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limited breast surgery: also called lumpectomy, segmental excision, and tylectomy. This surgery
removes the breast cancer and a small amount of tissue around the cancer, but preserves most
of the breast. It is almost always combined with axillary lymph node removal and is usually
followed by radiation therapy.
linear accelerator: a machine used in radiation therapy to treat cancer. It gives off gamma rays
and electron beams. This is called external-beam radiation therapy.
living will: a legal document that allows a person to decide what should be done if he or she
becomes unable to make health care decisions; a type of advance directive. See also advance
directives.
lobectomy (lob-bek-tuh-me): surgery to remove a lobe of an organ -- usually the lung.
lobular carcinoma in situ (LCIS): a very early type of breast cancer that develops within the
milk-producing glands (lobules) of the breast and has not grown through the wall of the lobules.
Researchers think that most cases of lobular carcinoma in situ do not progress to invasive
lobular cancer. Still, having this type of cancer places a woman at increased risk of developing
an invasive breast cancer later in life. For this reason, it’s important for women with lobular
carcinoma in situ to have a physical examination 3 times a year and an annual mammogram.
lobules: the glands in a woman’s breasts that produce milk.
local excision (lo-kul eck-si-zhun): surgery to remove small superficial (surface) cancers or
polyps.
local or localized cancer: a cancer that is confined to the organ where it started; that is, it has
not spread to distant parts of the body.
lump: any kind of mass in the breast or elsewhere in the body.
lumpectomy (lum-peck-tuh-me): surgery to remove the breast tumor and a small amount of
surrounding normal tissue. See also breast conservation therapy.
lymph (limf): clear fluid that flows through the lymphatic vessels and has cells known as
lymphocytes. These cells are important in fighting infections and may also have a role in fighting
cancer. See also lymphatic system, lymph nodes, lymphocytes, and lymphadenectomy.
lymph nodes: small bean-shaped collections of immune system tissue, such as lymphocytes,
found along lymphatic vessels. They remove cell waste, germs, and other harmful substances
from lymph. They help fight infections and also have a role in fighting cancer, although cancers
sometimes spread through them. Also called lymph glands. See also lymph, lymph system, and
lymphadenectomy.
lymph node biopsy: a test in which all or part of a lymph node is removed and looked at under
a microscope to find out if cancer has reached the lymph nodes.
lymph node dissection: see lymphadenectomy.
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lymphadenectomy (limf-ad-uh-NECK-tuh-me): surgical removal of one or more lymph nodes.
After removal, the lymph nodes are looked at under a microscope to see if cancer has spread.
Also called lymph node dissection. See also lymphatic system, lymph, lymph nodes, and
lymphocytes.
lymphatic system: the tissues and organs (including lymph nodes, spleen, thymus, and bone
marrow) that produce and store lymphocytes (cells that fight infection) and the channels that carry
the lymph fluid. The entire lymphatic system is an important part of the body’s immune system.
Invasive cancers sometimes get into the lymphatic vessels (channels) and spread (metastasize)
to lymph nodes. See also lymph, lymph nodes, lymphocytes, and lymphadenectomy.
lymphedema (limf-uh-dee-muh): a complication in which excess fluid collects in the arms or
legs. This often happens after the lymph nodes and vessels are removed by surgery, or injured
from radiation or from a tumor that changes the normal drainage of the fluid. This can happen
even years after treatment and can be a life-long condition. See lymph, lymph nodes, and
lymphatic system.
lymphocytes: a type of white blood cell that helps the body fight infection.
lymphocytosis (limf-o-sy-TOE-sis): having an excess of lymphocytes.
lymphokines (limf-o-kines): see cytokine.
lymphoma (lim-foam-uh): a cancer of the lymphatic system, a network of thin vessels and
nodes throughout the body that helps to fight infection. Lymphoma involves the type of white
blood cells called lymphocytes. The 2 main types of lymphoma are Hodgkin disease and nonHodgkin lymphoma. The treatments for these 2 types of lymphomas are very different.
Lynch syndrome: an old term used to describe hereditary non-polyposis colorectal cancer
(HNPCC); an inherited tendency to develop certain cancers. See hereditary non-polyposis
colorectal cancer.
M
MRI: see magnetic resonance imaging.
macroglobulinemia (mack-row-glob-yuh-lin-EE-mee-uh): a condition with abnormally large
proteins in the blood, which may reduce or clog blood flow in the smaller blood vessels.
Waldenstrom macroglobulinemia is a type of non-Hodgkin lymphoma with such proteins. .
macrophage: (mack-row-faj): a type of white blood cell that engulfs and destroys foreign
materials.
magnetic resonance imaging (MRI): a method of taking pictures of the inside of the body.
Instead of using x-rays, MRI uses a powerful magnet to send radio waves through the body. The
images appear on a computer screen as well as on film. Like x-rays, the procedure is physically
painless, but some people may feel confined inside the MRI machine.
malignant (muh-lig-nunt) tumor: a mass of cancer cells that may invade surrounding tissues or
spread (metastasize) to distant areas of the body. See also tumor and metastasis.
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mammogram, mammography: an x-ray of the breast; a method of finding breast cancer that
can’t be felt. Mammograms are done with a special type of x-ray machine used only for this
purpose. A mammogram can show a developing breast tumor before it is large enough to be
felt by a woman or even by a highly skilled health care professional. Screening mammography
is used to help find breast cancer early in women who don’t have any symptoms. Diagnostic
mammography helps the doctor learn more about breast masses or the cause of other breast
symptoms.
margin: the edge of a tissue sample removed during surgery. A negative surgical margin means
that no cancer cells were found on the outer edge of the removed tissue, and is a sign that no
cancer was left behind. A positive surgical margin indicates that cancer cells are found at the
outer edge of the removed sample and is usually a sign that some cancer remains in the body.
mass: any sort of lump, which may or may not be cancer. See also tumor.
mastectomy (mas-tek-tuh-me): surgery to remove all or part of the breast and sometimes other
tissue. Modified radical mastectomy removes the breast, skin, nipple, areola, and most of the
axillary lymph nodes on the same side, leaving the chest muscles intact. Partial or segmental
mastectomy removes only the part of the breast that has the cancer and a margin of healthy
breast tissue surrounding the tumor. Prophylactic mastectomy is a mastectomy done before any
evidence of cancer can be found, for the purpose of preventing cancer. Quadrantectomy (quadrunt-EK-tuh-me) is a partial mastectomy in which the quarter of the breast that has a tumor is
removed. Simple mastectomy or total mastectomy removes only the breast and areola.
mediastinoscopy (me-dee-uh-stine-AH-skuh-pee): examination of the chest cavity using a
lighted, flexible tube inserted under the chest bone (sternum). This allows the doctor to see the
lymph nodes in this area and remove samples to check for cancer.
medical oncologist: a doctor who is specially trained to diagnose and treat cancer with
chemotherapy and other drugs.
medical power of attorney: see durable power of attorney for health care.
medullary (med-you-lair-ee) carcinoma: a special type of infiltrating ductal carcinoma with
especially sharp boundaries between tumor tissue and normal tissue. About 5% of breast
cancers are medullary carcinomas. The outlook (prognosis) for this kind of cancer is considered
to be better than average.
melanoma (mel-uh-no-muh): a cancerous (malignant) tumor that begins in the cells that
produce the skin coloring (melanocytes). Melanoma is almost always curable in its early stages.
However, it is likely to spread, and once it has spread to other parts of the body the chances for
a cure are much less.
menarche (men-ar-key): a woman’s first menstrual period. Early menarche (before age 12) is a
risk factor for breast cancer, possibly because the earlier a woman’s periods begin, the longer
her exposure to estrogen.
menopause (men-uh-paws): the time in a woman’s life when monthly cycles of menstruation stop
forever and the level of hormones produced by the ovaries decreases. Menopause usually takes
place in women in their late 40s or early 50s, but it can also be brought about by surgical removal
of both ovaries (oophorectomy), or by some chemotherapies that destroy ovarian function.
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messenger RNA: the molecule that carries the information from the DNA genetic code to areas
in the cytoplasm of the cell that make proteins.
metastasis (meh-tas-tuh-sis): cancer cells that have spread to one or more sites elsewhere in
the body, often by way of the lymph system or bloodstream. Regional or local metastasis is
cancer that has spread to the lymph nodes, tissues, or organs close to the primary site. Distant
metastasis is cancer that has spread to organs or tissues that are farther away (such as when
prostate cancer spreads to the bones, lungs, or liver).The plural of this word is metastases. See
also primary site, lymph nodes, and lymph system.
metastasize (meh-tas-tuh-size): the spread of cancer cells to one or more sites elsewhere in
the body, often by way of the lymph system or bloodstream. See also metastasis and lymph
system.
metastatic (met-uh-stat-ick): a way to describe cancer that has spread from the primary site
(where it started) to other structures or organs, nearby or far away (distant). See also primary site
and metastasis.
micrometastases (mike-row-muh-TAS-tuh-sis): the spread of cancer cells in groups so small that
they can only be seen under a microscope.
microsatellite instability (MSI) (my-crow-SAT-uh-lite in-stuh-BILL-uh-tee): a type of genetic
mutation often linked to hereditary non-polyposis colon cancer (HNPCC). This mutation causes
size differences in sections of DNA that are normally the same size in all a person’s cells. Testing
for MSI is done on tissue taken from the cancer to find out if this DNA is of different lengths; if
it is, HNPCC genetic testing is usually offered. See also hereditary non-polyposis colon cancer,
DNA, mutation, and genetic counseling.
microwave therapy: a way of treating cancer in a few sites, such as the liver, by applying heat
to destroy the cells.
millimeter: a metric measure of length. It takes about 25 millimeters to equal 1 inch. Also
1/1000 of a meter.
millirem: see radiation dose.
millisievert: see sievert.
modified radical mastectomy: see mastectomy.
monoclonal (ma-nuh-KLO-nuhl) antibodies: man-made antibodies that are designed to lock
onto specific antigens. Antigens are substances that can be recognized by the immune system.
Monoclonal antibodies that have been attached to chemotherapy drugs or radioactive substances
are being studied for their potential to seek out antigens unique to cancer cells and deliver these
treatments directly to the cancer, thus killing the cancer cell and not harming healthy tissue.
Monoclonal antibodies are also often used to help detect and classify cancer cells under a
microscope. Other studies are being done to see if radioactive atoms attached to monoclonal
antibodies can be used in imaging tests to detect and locate small groups of cancer cells. See
antibody, antigen, and immunocytochemistry.
morbidity: a measure of the new cases of a disease in a population; the number of people who
have a disease.
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mortality: a measure of the rate of death from a disease within a given group of people.
mucinous carcinoma (myoo-sin-us car-sin-o-ma): a type of carcinoma that is formed by mucusproducing cancer cells.
mucositis (myoo-ko-site-us): inflammation of a mucous membrane, such as the lining of the
mouth.
multidrug resistance (MDR): resistance of tumor cells to several unrelated drugs after being
exposed to a single chemotherapy drug. May also refer to infections that can no longer be cured
by the usual antibiotics.
mutation: a change in the DNA of a cell. Most mutations do not produce cancer, and a few may
even be helpful. However, all types of cancer are thought to be due to mutations that damage
a cell’s DNA. Some cancer-related mutations can be inherited, which means that the person
is born with the mutated DNA in all the body’s cells. But most mutations happen after the
person is born, and are called somatic mutations. This type of mutation happens in one cell at
a time, and only affects cells that arise from the single mutated cell. See also somatic mutation,
inherited mutation, deoxyribonucleic acid, gene, and cancer susceptibility gene.
myeloid (my-uh-loid) leukemia: Several kinds of leukemia that include chronic myelogenous
leukemia (CML) and acute myeloid leukemia (AML). There are 8 subtypes of acute myeloid
leukemia -- M0 (Undifferentiated AML), M1 (Myeloblastic leukemia with minimal maturation), M2
(Myeloblastic leukemia with maturation), M3 (Promyelocytic leukemia), M4 (Myelomonocytic
leukemia), M5 (Monocytic leukemia), M6 (Erythroid leukemia), and M7 (Megakaryoblastic
leukemia). See also leukemia and non-myeloid cancers.
N
necrosis (nuh-crow-sis): the death of living tissues. Necrotic refers to tissue that has died.
needle aspiration: a type of needle biopsy that removes fluid from a cyst or cells from a tumor. In
this procedure, a needle is used to reach the cyst or tumor, and with suction, draw up (aspirate)
samples to be looked at under a microscope. If the needle is thin, the procedure is called a fine
needle aspiration or FNA. See also biopsy.
needle biopsy: removal of fluid, cells, or tissue with a needle so that it can be looked at under
a microscope. There are 2 types: fine needle aspiration (FNA) and core biopsy. FNA uses a thin
needle to draw up (aspirate) fluid or small tissue fragments from a cyst or tumor. A core needle
biopsy uses a thicker needle to remove a cylindrical sample of tissue from a tumor.
needle localization: a procedure used to guide a surgical breast biopsy when the lump is hard
to locate or when there are areas that look suspicious on the x-ray but there is not a distinct
lump. A thin needle is placed into the breast. X-rays are taken and used to guide the needle to
the suspicious area. The surgeon then uses the path of the needle as a guide to find the abnormal
area to be removed.
neoadjuvant (nee-o-AD-juh-vunt) therapy: treatment given before the main treatment. Compare
to adjuvant therapy.
neonatologist (nee-o-nay-TAHL-uh-jist): a doctor who specializes in the care of the newborn
(until about 6 weeks of age).
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neoplasm (nee-o-plaz-um): an abnormal growth (tumor) that starts from a single altered cell; a
neoplasm may be benign or malignant. Cancer is a malignant neoplasm.
nephrologist (neh-frahl-uh-jist): a doctor who specializes in diseases of the kidneys.
neuropathy (nur-ah-puth-ee): nerve abnormality or damage which causes numbness, tingling,
pain, muscle weakness, or even swelling. It may be caused by injury, infection, disease (cancer,
diabetes, kidney failure, or poor nutrition, for example), or by drugs. Peripheral neuropathy is
a type of neuropathy that starts in nerves farthest away from the brain, such as the hands and
feet.
neurosurgeon (nur-o-SUR-jun): a doctor specializing in operations to treat nervous system
disorders.
neutropenia (new-trow-PEEN-ee-uh): a decrease in the number of neutrophils (white blood cells
that respond quickly to infection) in the blood. If a person has less than 1,500/mm3 neutrophils,
he or she is considered to be neutropenic and at risk for infection. With fewer than 500 cells/
mm3 the risk of infection is high.
neutrophils (new-trow-fills): white blood cells that fight bacterial infection.
nipple discharge: any fluid coming from the nipple. It may be clear, milky, bloody, tan, gray, or
green.
nodal status: indicates whether the cancer has spread to lymph nodes (node-positive) or has not
spread to lymph nodes (node-negative). See also lymph node and lymphatic system.
nodule: a small, solid lump that can be felt. This term is sometimes used to refer to a small tumor
seen on x-ray.
non-Hodgkin lymphoma: a cancer of the lymphatic system. The lymphatic system is a network of
thin vessels and nodes throughout the body that helps to fight infection. What distinguishes nonHodgkin lymphoma from Hodgkin lymphoma is the absence of a type of cell called the ReedSternberg cell. This cell is present only in Hodgkin lymphoma. The treatment methods for Hodgkin
and non-Hodgkin lymphomas are very different. Previously called non-Hodgkin’s lymphoma.
non-myeloid cancers: all cancers other than myeloid leukemias. These non-myeloid cancers
include all types of carcinoma, all types of sarcoma, melanoma, lymphomas, lymphocytic
leukemias (ALL and CLL), and multiple myeloma. See also leukemia and myeloid leukemia.
nuclear medicine scan: a method for finding diseases of internal organs such as the brain, liver,
or bone. Small amounts of a radioactive substance (isotope) are injected into the bloodstream.
The isotope collects in certain organs and a special camera called a scintillation camera is used
to produce an image of the organ and show areas of disease. See radioisotope.
nucleus (new-klee-us): the center of a cell where the DNA is found and where it reproduces.
Studying the size and shape of a cell’s nucleus under the microscope can help pathologists tell
cancer cells from benign cells.
nurse practitioner: a registered nurse with a master’s or doctoral degree. Licensed nurse
practitioners diagnose and manage illness and disease, usually working closely with doctors.
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O
occupational therapist: a specially trained therapist who works with people who have disabilities
to help them relearn how to perform daily activities.
off label: refers to the use of a drug to treat a condition other than that for which it was approved
by the Food and Drug Administration.
omentum: a large fatty sheet in the abdomen that drapes like an apron over the stomach,
intestines, and other organs.
oncogenes (on-kuh-jeenz): genes that promote cell growth and multiplication. These genes are
normally present in all cells. But oncogenes may undergo changes that activate them, causing
cells to grow too quickly and form tumors. Compare to tumor suppressor genes.
oncologist (on-call-uh-jist): a doctor with special training in the diagnosis and treatment of
cancer.
oncology (on-call-o-jee): the branch of medicine concerned with the diagnosis and treatment
of cancer.
oncology clinical nurse specialist: a registered nurse with a master’s degree in oncology nursing
who specializes in the care of cancer patients. Oncology nurse specialists may prepare and give
treatments, monitor patients, prescribe and provide supportive care, and teach and counsel
patients and their families.
oncology social worker: a person with a master’s degree in social work who is an expert in
coordinating and providing non-medical care to patients. The oncology social worker counsels
and assists people with cancer and their families, especially in dealing with the nonmedical
issues that can result from cancer, such as financial problems, housing (when treatments must
be taken at a facility away from home), and child care.
oophorectomy (oof-uh-rek-tuh-me): surgery to remove the ovaries.
ophthalmologist (off-thuhl-mal-uh-jist): a medical doctor who specializes in diseases of the
eye.
oral: refers to the mouth. For example, medicines that are taken orally are taken by mouth. Oral
cancer is cancer of the mouth.
oral and maxillofacial surgeon: a surgeon who specializes in surgery of the mouth, jaw, and
face.
orchiectomy (or-key-ek-tuh-me): surgery to remove the testicles; also called castration. See also
hormone therapy.
orthopedic (or-thuh-pee-dik) surgeon: a surgeon who specializes in diseases and injuries of the
bones.
osteoporosis (os-tee-o-puh-ROW-sis): thinning of bone tissue, causing less bone mass and
weaker bones. Osteoporosis can cause pain, deformity (especially of the spine), and broken
bones. This condition is common among postmenopausal women.
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ostomy (os-tuh-me): a general term meaning an opening, especially one made by surgery. See
also colostomy, ileostomy, urostomy, and tracheostomy.
otolaryngologist (o-toe-lair-in-gol-uh-jist): a doctor who specializes in diseases of the ear, nose,
and throat. Also called a head and neck surgeon.
ovary (o-vuh-ree): reproductive organ in the female pelvis. Normally a woman has two ovaries.
They contain the eggs (ova) that, when joined with sperm, result in pregnancy. Ovaries are also
the primary source of estrogen. See also estrogen.
P
p53: an important tumor suppressor gene that is not working properly in many cancers. The
protein that this gene makes (also called p53) normally causes damaged cells to die. Mutations,
or changes, in this gene can be inherited or they can happen during a person’s life. When they
do happen, they can increase risk of many types of cancer. See also mutation.
PET scan: see positron emission tomography.
PSA: see prostate-specific antigen.
Paget (paa-jet) disease of the nipple: a rare form of breast cancer that begins in the milk passages
(ducts) and spreads to the skin of the nipple and areola. This affected skin may look crusted,
scaly, red, or oozing. The prognosis is generally better if these nipple changes are the only sign
of breast disease and no lump can be felt. Named for the doctor, Paget, who first identified it;
also known as Paget’s disease.
pain specialist: oncologists, neurologists, anesthesiologists, neurosurgeons, and other doctors,
nurses, or pharmacists who are experts in pain control.
palliative (pal-ee-uh-tiv) treatment: treatment that relieves symptoms, such as pain, but is
not expected to cure the disease. Its main purpose is to improve the patient’s quality of life.
Sometimes chemotherapy and radiation are used in this way.
palpation (pal-pay-shun): using the hands to examine. A palpable mass is one that can be felt.
pancreatectomy (pan-cree-uh-TEK-tuh-me): surgery to remove the pancreas.
Pap test: this test involves scraping cells from a woman’s cervix and looking at them under a
microscope to see if abnormal cells are present. Also called a Pap smear.
papillary (pap-uh-lair-ee): having cancer cells arranged in tiny, finger-like projections. Used
to describe the appearance of some tumors of the ovaries, uterus, thyroid gland, and other
organs.
pathologic stage: see staging.
pathologist (path-all-uh-jist): a doctor who specializes in diagnosis and classification of diseases
by lab tests such as looking at cells under a microscope. The pathologist determines whether a
tumor is benign or cancerous, and if cancerous, the exact cell type and grade.
pediatric oncologist: a doctor who specializes in cancers of children
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pediatrician: a doctor who specializes in the care of children.
pelvic examination: an examination of a woman’s uterus and other pelvic organs. It is used to
help find cancers of the reproductive organs. The doctor will visually examine external structures
and palpate (feel) the internal organs such as the ovaries and cervix.
pelvic exenteration (ex-en-ter-A-shun): surgery to remove the organs that are in the pelvis.
pelvis (pell-vis): the part of the skeleton that forms a ring or basin of bones below the belly
(abdomen). Pelvis may also refer to the general area of the body between the hip bones, below
the abdomen. The pelvis contains the bladder, reproductive organs, and the rectum. In women,
it also contains the uterus and fallopian tubes; in men, the prostate.
peritoneum (pear-i-tuh-NEE-um): membrane that lines the abdomen and covers most of its
organs. Peritoneal cavity refers to the area enclosed by the peritoneum.
permanent section: a method of preparing tissue to be looked at under a microscope. The
tissue is soaked in formaldehyde, processed in various chemicals, surrounded by a block of
wax, sliced very thin, attached to a microscope slide, and stained. This process usually takes 1
to 2 days. It allows a clear view of the sample so that the presence or absence of cancer can be
determined.
pheresis (fuh-ree-sis): see apheresis.
Photodynamic (foe-toe-die-NAM-ick) therapy (PDT): a treatment sometimes used for cancers
of the skin, esophagus, lung, or bladder. PDT begins with the injection of a non-toxic chemical
into the blood. This chemical is allowed to collect in the tumor for a few days. A special type
of laser light is then focused on the cancer. This light causes the chemical to change so that it
can kill cancer cells. The advantage of PDT is that it can kill cancer cells with very little harm
to normal cells.
phyllodes tumor (fie-loads): rare breast tumor, usually benign, which grows quickly and can
become quite large. Also called phylloides tumor or cystosarcoma phyllodes.
physical therapist: a health professional who uses exercises and other methods to restore or
maintain the body’s strength, mobility, and function.
physiologic (fiz-ee-o-LA-jick): pertaining to the processes of the body or its systems. May be
used to describe a particular body function or organ as normal.
phytochemical (fie-toe-KEM-ih-kul): substance produced by plants that may produce health
benefits when eaten or ingested; for example, antioxidants. See antioxidants.
placebo (pluh-see-bo): an inert, inactive substance that may be used in studies (clinical trials) to
compare the effects of a given treatment with no treatment. Commonly called, a “sugar pill.”
plastic or reconstructive surgeon: a surgeon specializing in restoring appearance or in rebuilding
or replacing removed or injured body parts.
platelet (plate-let): a part of the blood that plugs up holes in blood vessels after an injury.
Chemotherapy can cause a drop in the platelet count, a condition called thrombocytopenia
that carries a risk of excessive bleeding.
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pleura (plur-uh): the membranes around the lungs and lining the chest cavity.
pleurodesis (plu-rod-is-sis): injection of a agent between the layers of the pleura that causes
them to fuse to seal off leaks. This procedure helps prevent fluid or air from building up in the
pleural cavity, the area between the pleura. See pleura.
pneumonectomy (new-muh-NECK-tuh-me): surgery to remove a lung.
ploidy (ploy-dee): a measure of the amount of DNA contained in a cell. Ploidy is a marker that
helps predict how quickly a cancer is likely to spread. Cancers with the same amount of DNA
as normal cells are called diploid (dip-loid) and those with either more or less than that amount
are aneuploid (an-you-ploid). About two-thirds of breast cancers are aneuploid.
polycythemia vera (pah-lee-sy-THEME-e-uh vair-uh): a chronic blood disorder of unknown
cause where the bone marrow makes too many red blood cells, white blood cells, and platelets.
This leads to a higher concentration of hemoglobin with larger amounts of red blood cells,
which is the main feature of this disease. But with time, the high platelet count may become
more of a problem and patients can suffer from problems with blood clots because of this
and their “thickened” blood. Often, the spleen is enlarged. Over time, the bone marrow is
replaced by fibrous tissue (myelofibrosis). Although it is not a true cancer, it often turns into
acute myelogenous leukemia (AML) after many years.
polyp (pah-lup): a growth from a mucous membrane commonly found in organs such as the
rectum, the uterus, and the nose.
polypectomy (pah-lup-eck-tuh-me): surgery to remove a polyp.
positron emission tomography (PET): (pahs-uh-trahn ee-mish-uhn tom-ahg-ruh-fee): a PET scan
creates an image of the body (or of biochemical events) after the injection of a very low dose of
a radioactive form of a substance such as glucose (sugar). The scan computes the rate at which
the tumor is using the sugar. In general, high-grade tumors use more sugar than normal and lowgrade tumors use less. PET scans are especially useful in taking images of the brain, although
they are becoming more widely used to find out if cancers of the breast, colon, rectum, ovary,
or lung have spread. PET scans may also be used to see how well a tumor is responding to
treatment.
posterior (post-eer-ee-uhr): the back or near the back of an organ or the body.
poultice (pole-tiss): soft paste or thick liquid that is usually heated, applied to a cloth, and
placed over an inflamed or painful area. Herbs, leaves, or foods are commonly used for this in
folk medicine and home remedies.
pre-cancerous: changes in cells that may, but do not always, become cancer. Also called premalignant.
predisposition: susceptibility to a disease that can be triggered under certain conditions. For
example, some women have a family history of breast cancer and are therefore more likely (but
not necessarily destined) to develop breast cancer.
pre-malignant: See pre-cancerous.
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prevalence (preh-vul-uns): a measure of the proportion of persons in the population with a
particular disease at a given time. Compare with incidence.
prevention: the reduction of cancer risk by eliminating or reducing contact with things known
to cause cancer, or by changing conditions that contribute to cancer (such as obesity or lack of
exercise.) A change in lifestyle, such as quitting smoking, for example, reduces the risk of lung
and other cancers.
primary care physician: the doctor a person would normally see first when a problem arises. A
primary care doctor could be a general practitioner, a family practice doctor, a gynecologist, a
pediatrician, or an internal medicine doctor (an internist).
primary site: the place where cancer begins. Primary cancer is usually named after the organ
in which it starts. For example, cancer that starts in the breast is always breast cancer, even if it
spreads (metastasizes) to other organs such as bones or lungs.
primary treatment: the first, and usually the most important, treatment.
progesterone (pro-jes-ter-own): a female sex hormone released by the ovaries during every
menstrual cycle to prepare the uterus for pregnancy and the breasts for milk production
(lactation).
progesterone receptor assay: a laboratory test done on a sample of the breast cancer that
shows whether the cancer depends on progesterone for growth. Progesterone and estrogen
receptor tests provide more complete information to help decide the best cancer treatment for
the patient.
prognosis (prog-no-sis): a prediction of the course of disease; the outlook for the chances of
survival.
progression: spreading or growing disease, with or without treatment.
prophylactic (pro-fuh-LACK-tik) mastectomy: see mastectomy.
prostate (pros-tate; note that there is no “r” in the second syllable): a gland found only in men.
It is just below the bladder and in front of the rectum. The prostate makes a fluid that is part of
semen. The tube that carries urine, the urethra, runs through the prostate.
prostatectomy: surgical removal of all or part of the prostate gland.
Prostate-specific antigen (PSA): a protein made by the prostate gland. Levels of PSA in the
blood often go up in men with prostate cancer as well as other conditions. The PSA test is used
to help screen for prostate cancer. It is also used to check the results of treatment.
prostatitis (pros-tuh-TIE-tus): inflammation of the prostate. Prostatitis is not cancer.
prosthesis (pros-thee-sis): an artificial replacement part of the body, such as a breast
prosthesis.
protein: a large molecule made up of a chain of smaller units called amino acids. Proteins serve
many vital functions within and outside of the cell.
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protocol (pro-tuh-call): a formal outline or plan, such as a description of what treatments a
patient will receive and exactly when each should be given. See also regimen.
proton beam therapy: see conformal proton beam therapy.
psychiatrist: a medical doctor specializing in mental health and behavioral disorders. Psychiatrists
provide counseling and can also prescribe medicines.
psychologist: a health professional who assesses a person’s mental and emotional status and
provides counseling.
psychosocial (sy-ko-so-shul): the psychological and/or social aspects of health, disease,
treatment, and/or rehabilitation.
pulmonologist: a doctor who has specialized experience and knowledge in the diagnosis and
treatment of pulmonary (lung) conditions and diseases.
Q
quality of life: overall enjoyment of life, which includes a person’s sense of well-being and
ability to do the things that are important to him or her.
R
RNA: see ribonucleic acid.
radiation dose: the amount of radiation an object (such as human tissue) receives. There are
several units used to describe radiation doses:
rad
(“radiation absorbed dose”): a basic unit of the amount of radiation transferred to an object. This
measurement does not take into account the type of radiation, which can influence the effect on
different body tissues. The rad has largely been replaced by the gray (see next).
gray (Gy): the newer, international unit of measurement of radiation transfer. One gray equals 100 rads.
(Therefore, one rad equals one centigray [cGy].)
rem (“roentgen equivalent man”): a basic unit of radiation exposure which is based on both the dose and
the type of radiation. Because of this, it is more commonly used to describe radiation exposure than
is the rad. Often reported in units of millirem (mrem), which is one-thousandth of a rem. The rem is
sometimes replaced by the sievert (see sievert).
radiation oncologist: a doctor who specializes in using radiation to treat cancer.
radiation therapist: a person with special training to work the equipment that delivers radiation
therapy.
radiation therapy: treatment with high-energy rays (such as x-rays) to kill or shrink cancer cells.
The radiation may come from outside the body (external radiation) or from radioactive materials
placed directly in the tumor (brachytherapy or internal radiation). Radiation therapy may be
used to shrink the cancer before surgery, to destroy any remaining cancer cells after surgery, or
as the main treatment. It may also be used as palliative treatment for advanced cancer.
radical prostatectomy: surgery to remove the entire prostate gland, the seminal vesicles, and
nearby tissue.
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radioactive implant: a source of high-dose radiation that is placed directly into or around a
tumor to kill the cancer cells. See also brachytherapy.
radiocontrast dye: any material used in imaging studies such as x-rays, MRIs, and CT scans to
help outline the body parts being examined. These may be injected or ingested (drunk). Also
called dye, contrast dye, radiocontrast medium. See also imaging studies.
radiofrequency ablation (ray-dee-oh-free-kwin-see uh-blay-shun): treatment that uses highenergy radio waves to heat and destroy abnormal tissues. A thin, needle-like probe is guided
into the tumor by ultrasound or CT scan. The probe releases a high-frequency current that
heats and destroys cancer cells. RFA is sometimes used to treat tumors in the liver, and is being
studied for use in several other areas of the body.
radioisotope (ray-dee-oh-EYE-suh-tope): a type of atom that is unstable and prone to break up
(decay). Decay releases small fragments of atoms and energy. Exposure to certain radioisotopes
can cause cancer. But radioisotopes are also used to find and treat cancer. In certain imaging
procedures, for example, radioisotopes are injected into the body where they then collect in
areas where the disease is active, showing up as brighter areas on the pictures. See also imaging
studies.
radiologic technologist: a health professional (not a doctor) trained to position patients for
x-rays, take the images, and then develop and check the images for quality. The films taken by
the technologist are sent to a radiologist to be read.
radiologist: a doctor with special training in diagnosis of diseases by interpreting or reading
x-rays and other types of diagnostic imaging studies; for example, CT and MRI scans.
radionuclide (ray-dee-oh-NOO-klide) bone scan: an imaging test which uses a small amount
of radioactive contrast material given in the vein. The radioactive material settles in areas of the
bone to which the cancer may have spread (“hot spots”), and shows up on the picture. See also
imaging studies.
randomized or randomization: a process in clinical trials that uses chance to assign participants
to different groups that compare treatments. Randomization means that each person has an
equal chance of being in the treatment and comparison groups. This helps reduce bias in the
results that might happen, if, for example, the healthiest people all were assigned to a particular
treatment group. See also control group and clinical trials.
recurrence: the return of cancer after treatment. Local recurrence means that the cancer has
come back at the same place as the original cancer. Regional recurrence means that the cancer
has come back after treatment in the lymph nodes near the primary site. Distant recurrence
is when cancer spreads (metastasizes) after treatment to distant organs or tissues (such as the
lungs, liver, bone marrow, or brain). See also primary site, metastasis, and metastasize.
red blood cells: blood cells that contain hemoglobin, the substance that carries oxygen to all of
the cells of the body. See also anemia.
regimen (reh-juh-men): a strict, regulated plan (such as diet, exercise, or medicine schedule)
designed to reach certain goals. In cancer treatment, a plan to treat cancer. See also protocol.
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regional involvement or regional spread: the spread of cancer from its original site to nearby
areas such as lymph nodes, but not to distant sites. See also metastasis.
rehabilitation: activities to help a person adjust, heal, and return to a full, productive life after
injury or illness. This may involve physical restoration (such as the use of prostheses, exercises,
and physical therapy), counseling, and emotional support.
relapse: reappearance of cancer after a disease-free period. See recurrence.
relative 5-year survival rate: the percentage of people with a certain cancer who have not died
from it within 5 years. This number is different from the 5-year survival rate in that the relative
5-year survival rate does not include people who have died from unrelated causes. See also
5-year survival rate.
rem: see radiation dose.
remission: complete or partial disappearance of the signs and symptoms of cancer in response
to treatment; the period during which a disease is under control. A remission may not be a
cure.
rescue treatment: procedures or treatments such as bone marrow transplantation that
“rescue” a patient’s immune system and blood-forming organs from the effects of high-dose
chemotherapy.
resection: surgery to remove part or all of an organ or other structure.
respiratory therapist: under the direction of a doctor, the respiratory therapist gives breathing
treatments and helps manage patients on ventilators.
retinoids: vitamin A and synthetic compounds similar to vitamin A.
ribonucleic acid (ri-bo-new-CLEE-ick acid): a nucleic acid found in all cells that transmits
genetic messages between structures in the cell. Usually referred to as RNA.
risk factor: anything that is related to a person’s chance of getting a disease such as cancer.
Different cancers have different risk factors. For example, unprotected exposure to strong
sunlight is a risk factor for skin cancer; smoking is a risk factor for lung, mouth, larynx, and
other cancers. Some risk factors, such as smoking, can be controlled. Others, like a person’s
age, can’t be changed.
S
sarcoma (sar-ko-muh): a malignant tumor growing from connective tissues, such as cartilage,
fat, muscle, or bone.
scan: a study using either x-rays or radioisotopes to produce images of internal body organs.
See radioisotope.
scintillation (sin-till-LAY-shun) camera: device used in nuclear medicine scans to detect
radioactivity and produce images that help diagnose cancer and other diseases. See nuclear
medicine scan.
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screening: the search for disease, such as cancer, in people without symptoms. For example,
screening measures for prostate cancer include digital rectal examination and the PSA blood
test. Screening may refer to coordinated programs in large groups of people. The same tests used
for screening may also be used as diagnostic tests, which look for cancer in a person after there
is some sign of a problem. For instance, a PSA test would be a diagnostic test if it was used in a
man who had a lump on his prostate or urinary symptoms.
secondary tumor: a tumor that forms as a result of spread (metastasis) of cancer from the place
where it started.
sedation (suh-day-shun): to make sleepy, calm, or relaxed. Drugs to cause sedation are often
used along with medicines to numb an area for a procedure or certain types of surgery. See also
anesthesia.
sentinel lymph node biopsy: a newer procedure that might replace standard lymph node
dissection. Blue dye and/or a radioisotope tracer is injected into the tumor site at the time of
surgery and the first (sentinel) node that picks up the dye is removed and biopsied. If the node is
cancer-free, fewer nodes are removed. See also lymph node and radioisotope.
sex therapist: a mental health professional with special training in counseling people about
sexual changes, problems, and communication (for example, after treatment for cancer).
side effects: unwanted effects of treatment such as hair loss caused by chemotherapy, and fatigue
caused by radiation therapy.
sievert (Sv): the newer, international unit of measurement of radiation exposure. One sievert
equals 100 rem. Often reported in millisieverts (mSv), which are thousandths of a sievert (or
about 1/10 of a rem). See also radiation dose.
sigmoidoscope (sig-moid-uh-scope): a slender, flexible, hollow, lighted tube about the thickness
of a finger. It is inserted through the rectum up into the colon. This allows the doctor to look at
the inside of the rectum and part of the colon for cancer or for polyps. The sigmoidoscope is
connected to a video camera and video display monitor so the doctor can look closely at the
inside of your colon. Polyps are small growths that can become cancerous. This test may be
somewhat uncomfortable, but it should not be painful.
sigmoidoscopy (sig-moid-AH-skuh-pee): a procedure in which a doctor can look into the rectum
and the descending portion of the colon for polyps or other abnormalities.
sign: a physical change you can see. Compare to symptom.
simulation: a process involving special x-ray pictures that are used to plan radiation treatment so
that the area to be treated is precisely located and marked for treatment. See also external beam
radiation therapy.
SKY: short for spectral karyotyping; a cytogenetic blood test used to see all the pairs of chromosomes
in a cell in different colors. Also called chromosome painting. See also cytogenetics.
social worker: a health professional who helps people find community resources and provides
counseling and guidance to help with issues such as insurance coverage and nursing home
placement.
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somatic mutation: a change in DNA that starts in one cell of the body after an embryo is
formed. All the cells that arise from it will have the same mutation, which in some cases can
form cancer. This kind of mutation is different from any inherited mutations that are present at
birth in all the cells of the body. Somatic mutations are not passed on to children. Compare to
inherited mutation. See also mutation and deoxyribonucleic acid.
speech therapist: a person specially trained to work with people to help them speak clearly.
Speech therapists help re-establish communication skills and also make sure that patients can
easily eat and drink.
sphincter (sfink-ter): a ring-like muscle that can open and close to control the passage of
substances in the body.
s-phase fraction: the percentage of cells that are replicating their DNA. DNA replication usually
means that a cell is getting ready to split into 2 new cells. A low s-phase fraction is a sign that a
tumor is slow-growing; a high s-phase fraction shows that the cells are dividing rapidly and the
tumor is growing quickly.
spinal tap: a procedure in which a thin needle is placed in the spinal canal to withdraw a small
amount of spinal fluid or to give medicine into the central nervous system through the spinal
fluid. Also called lumbar puncture or LP.
spindle cell: a cell that, when viewed under a microscope, looks like a long oval. Some types
of sarcomas, melanomas, and carcinomas have this type of cell. There are also normal cells of
the body that are shaped like spindles.
spiral CT: a special scanner that takes cross-sectional pictures around the body. See also
computerized tomography.
sputum cytology (spu-tum sy-tahl-uh-jee): a study of phlegm cells under a microscope to see if
they are normal or not.
squamous (skway-mus) cell carcinoma (car-sin-o-mah): cancer that begins in the flat,
nonglandular cells of the body, for example, the skin or the lining of the body’s organs.
staging: the process of finding out whether cancer has spread and if so, how far; that is, to learn
the stage of the cancer. There is more than one system for staging different types of cancer.
The TNM staging system, which is used most often, gives 3 key pieces of information:
•
•
•
T refers to the size of the tumor
N describes whether the cancer has spread to nearby lymph nodes, and if so, how many
M shows whether the cancer has spread (metastasized) to other organs of the body
Letters or numbers after the T, N, and M give more details about each of these factors. To make this
information clearer, the TNM descriptions can be grouped together into a simpler set of stages, labeled
with Roman numerals (usually from I to IV). In general, the lower the number, the less the cancer has
spread. A higher number means a more serious cancer.
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The 2 main types of staging are:
•
•
clinical staging: an estimate of the extent of cancer based on physical exam, biopsy results, and
imaging tests.
pathologic staging: an estimate of the extent of cancer by studying the samples removed during
surgery.
standard therapy: standard treatment. See therapy.
stem cells: any type of cell that may mature into different types of cells. In cancer treatment,
they usually are the immature blood cells found in the bone marrow and in the blood. Even
though they start out the same, these stem cells can mature into all types of blood cells.
stem cell transplant: procedure used to restock the bone marrow when it has been destroyed by
chemotherapy, radiation, or disease. Stem cells can be taken from bone marrow or circulating
blood to be transfused into the patient. Stem cells may be the patient’s own (autologous), or may
come from someone else (allogeneic). Bone marrow transplants (BMTs) were the first method
for replacing stem cells.
stenosis (steh-no-sis): a narrowing (stricture) of a duct or canal.
stent: a very small tube or “straw-like” device that is inserted to support and hold open a tubeshaped organ, such as a blood vessel or intestine.
stereotactic needle biopsy (steer-e-o-TACK-tick buy-op-see): a method of needle biopsy that is
useful in some cases in which calcifications or a mass can be seen on mammogram but cannot
be felt. A computer maps the location of the mass to guide the placement of the needle. See also
needle aspiration and needle biopsy.
stereotactic radiosurgery: this new treatment method focuses high doses of radiation at a tumor
while limiting the exposure that normal tissue receives. The treatment may be useful for tumors
that are in places where regular surgery would harm essential tissue, for example, in the brain
or spinal cord, or when the patient’s condition does not permit regular surgery.
sterility: the inability to have children, which can result from some types of cancer treatment.
Also known as infertility.
stoma: an opening, especially an opening made by surgery to allow elimination of body waste.
See also colostomy, ileostomy, and urostomy.
stomatitis (sto-muh-TIE-tus): inflammation or ulcers of mouth area. Stomatitis can be a side
effect of some kinds of chemotherapy.
supraclavicular (sue-pruh-clah-VICK-you-lar) lymph nodes: lymph nodes that are found just
above the collarbone (clavicle).
surgeon: a doctor who operates.
surgical biopsy: removal of tissues using open surgery so that the tissues can be looked at under
a microscope to find out if they contain cancer cells. Also called open surgical biopsy. Biopsies
may also be done laparoscopically, or with thin needles. See biopsy, laparoscope, and fine
needle aspiration biopsy.
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surgical oncologist: a doctor who specializes in using surgery to treat cancer.
survival rate: the percentage of people still alive within a certain period of time after diagnosis
or treatment. For cancer, a 5-year survival rate is often given. This does not mean that people
can’t live more than 5 years, or that those who live for 5 years are necessarily permanently
cured. See also relative 5-year survival rate.
survivor: not generally used as a medical word, survivor can have several different meanings
when applied to people with cancer. Some people use the word to refer to anyone who has been
diagnosed with cancer. For example, someone living with cancer may be considered a survivor.
Some people use the term when referring to one who has completed cancer treatment. And still
others call a person a survivor if he or she has lived several years past a cancer diagnosis. The
American Cancer Society believes that each individual has the right to define his or her own
experience with cancer and considers a cancer survivor to be anyone who defines himself or
herself this way, from the time of diagnosis throughout the balance of his or her life.
survivorship: the state of being a cancer survivor, that is, having been diagnosed with cancer.
See also survivor.
synchronous (sin-kruh-nus): at the same time; for example, cancer in both breasts at the same
time is synchronous.
symptom: a change in the body caused by an illness or condition, as described by the person
experiencing it. Compare to sign.
synergistic (sin-er-jis-tick): acting together. A synergistic agent can act together with other agents
to produce an effect greater than that of the sum of each one acting alone. Some chemotherapy
drugs act synergistically.
systemic (sis-tem-ick) disease: in cancer, this term means that a cancer that started in one place
has spread to distant organs or structures.
systemic therapy: treatment that reaches and affects cells throughout the body; for example,
chemotherapy.
T
TNM staging system: see staging.
tamoxifen (tuh-mok-si-fin): this drug blocks the effects of estrogen on many organs, such as the
breast. Estrogen promotes the growth of some breast cancers. Research suggests that tamoxifen
may lower the risk of breast cancer in women with certain risk factors.
targeted therapy: treatment that attacks some part of cancer cells that make them different from
normal cells. Targeted therapies tend to have fewer side effects than the general chemotherapy
drugs.
Taxol: a drug first made from the bark or needles of yew trees that can now be made in the
laboratory. It is used to treat breast, ovarian, and other types of cancer.
terminal: generally understood to mean that the cancer is no longer considered curable, and
the patient is dying.
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testicles (tess-tick-ulls): the male reproductive glands found in the scrotum. The testicles (or
testes) produce sperm and the male hormone testosterone.
testosterone (tes-toss-ter-own): the male hormone, made mostly in the testes. It stimulates blood
flow, growth in certain tissues, and the secondary sexual characteristics. In men with prostate
cancer, it can also make the tumor grow.
therapy: any of the measures taken to treat a disease, treatment. See also alternative therapy,
complementary therapy, and unproven therapy.
thoracic surgeon: a doctor who operates on organs in the chest cavity.
thrombocytopenia (throm-bo-sy-toe-PEEN-e-uh): a decrease in the number of platelets in the
blood; can be a side effect of chemotherapy. See platelets.
tissue: a collection of cells, united to perform a particular function.
T-lymphocytes (limf-o-sites) or T-cells: white blood cells made in the thymus gland. They produce
cytokines and play a large role in the immune response against viruses, transplanted organs and
tissues, and cancer cells. See cytokines.
toxicity (tock-sis-i-tee): in medical treatment, the harmful effects of a medicine or treatment,
especially at higher doses.trachea (tray-key-uh): the “windpipe.” The trachea connects the
larynx (voice box) with the bronchi (the 2 large air passages that lead into the lungs) and serves
as the main passage for air coming from the nose and mouth into the bronchi and lungs.
tracheostomy (tray-key-ah-stuh-me): surgery to create an opening of the trachea through the
neck. See trachea.
transrectal ultrasound (trans-rec-tul ull-truh-sound): the use of sound waves to create a picture
of the prostate on a screen to help detect tumors. Also called TRUS.
transverse rectus abdominus (trans-verse rek-tus ab-dom-in-us) muscle flap procedure: a
method of breast reconstruction in which tissue from the lower abdominal wall which receives
its blood supply from the rectus abdominus muscle is used. The tissue from this area is moved
up to the chest to create a breast mound. An implant is usually not needed. Moving muscle
and tissue from the lower abdomen to the chest results in flattening of the lower abdomen (a
“tummy tuck”). Also called a TRAM flap or rectus abdominus flap procedure.
tumor: an abnormal lump or mass of tissue. Tumors can be benign (non-cancerous) or malignant
(cancerous).
tumor bank: a collection of many hundreds of patients’ tumor specimens that are stored for
future use and research to understand the biology of cancer as well as research to identify new
targets for the development of new therapies.
tumor flare: short-term worsening of symptoms or cancer markers.
tumor markers: substance produced by cancer cells and sometimes normal cells. They are
not very useful for cancer screening because other body tissues not related to a cancer can
produce the substance, too. But tumor markers may be very useful in monitoring for response
to treatment when a cancer is diagnosed or for a recurrence. Tumor markers include CA 125
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(ovarian cancer), CEA (GI tract cancers), and PSA (prostate cancer).
tumor necrosis (neck-row-sis) factor (TNF): a substance given off by activated white blood cells
that can cause the death of tumor cells. See also necrosis.
tumor suppressor genes: genes that slow down cell division or cause cells to die at the right
time. Alterations of these genes can lead to too much cell growth and development of cancer.
U
ultrasound: an imaging method in which high-frequency sound waves are used to outline a part
of the body. The sound wave echoes are picked up and displayed on a television screen. Also
called ultrasonography.
umbilical cord blood transplant: the use of stem cells in blood removed from the umbilical
cords of newborns (a very rich source) to replace the blood-forming cells in patients whose own
blood-forming cells have been destroyed by radiation or chemotherapy.
unilateral: affecting one side of the body. For example, unilateral breast cancer occurs in one
breast only. Compare to bilateral.
unproven therapy: any therapy that has not been scientifically tested and approved.
unstaged cancer: cancer that has been diagnosed but has not yet been staged, so that the full
extent of the cancer is not yet known. See staging.
urethra (yoo-ree-thruh): the tube that carries urine from the bladder to the outside. In women,
this tube is fairly short; in men it is longer, passing through the penis, and it also carries the
semen.
urine cytology (yur-in sy-tahl-uh-jee): urine is examined under a microscope to look for
cancerous and precancerous cells. Cytology can also be done on bladder washings. Bladder
washing samples are taken by placing a salt solution into the bladder through a tube (catheter)
and then removing the solution for testing.
urologist (yur-ol-uh-jist): a doctor who specializes in treating problems of the urinary tract in
men and women, and of the genital area in men.
urostomy (yur-os-tuh-me): surgery to send urine through a new passage and then through an
opening in the abdomen. In a continent urostomy, the urine is stored inside the body and
drained a few times a day through a tube placed into an opening called a stoma.
uterine fibroid tumor (yew-ter-in fi-broyd too-mer): a non-cancerous tumor that is made of fibrous
or connective tissue. It is the most common tumor found in women. It can be in the uterine wall
or protrude into the lining of the uterus. Usually there are no symptoms but it can cause abnormal
bleeding and other symptoms depending on its size and location in the uterus. It is also called
fibroma.
uterus: the womb; the pear-shaped organ in women that holds and nourishes the growing
embryo and fetus. The uterus has 3 areas: the body or upper part; the isthmus or the narrowed
central area; and the cervix, the lower portion.
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V
vaccine: a modified version of a germ or other substance related to a disease, usually
given by injection. It is used to stimulate the immune system to resist that disease for a
period of time, or even permanently. Development of cancer vaccines is the subject of
intense research.
vagina (vuh-jie-nuh): the passage leading from the vulva (the female genital organs that
are on the outside of the body) to the uterus.
virtual colonoscopy: examination of the colon for polyps or masses using special
computerized tomography (CT) scans. The images are combined by a computer to
make a 3- dimensional (3-D) model of the colon, which doctors can “travel through”
on a computer screen. It is not yet clear if this new technique is as effective as other
screening methods for colon cancer. See computerized tomography and colonoscopy.
virus: very small organisms (micro-organisms) that cause infections. Viruses are too
small to be seen with a regular microscope. They reproduce only in living cells.
W
watchful waiting: in some cases of prostate cancer, close monitoring that is done instead
of starting active treatment right away. This may be a reasonable choice for older men
with small tumors that might grow very slowly. If the situation changes, active treatment
can be started. Also called expectant management.
white blood cells (WBCs): blood cells that help defend the body against infections. There
are many types of white blood cells. Certain cancer treatments such as chemotherapy
can reduce the number of these cells and make a person more likely to get infections.
wire localization: a method used during a surgical breast biopsy when the lump is hard
to find or when there is an area that looks suspicious on the x-ray. A thin, hollow needle
is placed into the breast and x-rays are taken to guide the needle to the area in question.
A fine wire is inserted through the center of the needle. A small hook at the end of the
wire keeps it in place. The hollow needle is then removed, and the surgeon uses the
path of the wire as a guide to find the abnormal area to be removed.
X
x-rays: one form of radiation that can be used at low levels to produce an image of the
body on film or at high levels to destroy cancer cells.
Last Medical Review: 3/25/2008
4/23/2008
Last
©2008 American Cancer Society
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PERSONAL RECORDS
& JOURNALS
PERSONAL
RECORDS &
JOURNALS
INFORMATION RECORD
Name: __________________________________________________________________________________
Telephone Number: ________________________________________________________________________
Hours: __________________________________________________________________________________
(if you need to, call and ask for your Nurse)
After hours, weekends, holidays: (210) 593-5700 — Ask for your Primary Doctor
Diagnosis: _______________________________________________________________________________
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QUESTIONS TO ASK YOUR DOCTOR
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NAMES OF MEDICATIONS AND DOSAGES
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Have available:
1. Record of your last blood count: WBC, platelets, ANC
2. Date of last chemotherapy treatment
3. Your doctor’s name
4. Your nurse’s name & telephone number
5. Emergency telephone number
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Date
Medication
Dosage
Given by
NAMES OF MEDICATIONS AND DOSAGES
Pre-Meds
Notes
MEDICATION ALLERGY RECORD
List Medication Allergies
Reaction
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TEMPERATURE & BLOOD PRESSURE RECORD
Date
Time
Temperature
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Date
Time
Blood Pressure
COMPLETE BLOOD COUNT (CBC) RECORD
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WBC
hgh
hct
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bands
AGC
SURGERIES & DIAGNOSTIC TESTS RECORD
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CALENDAR OF ACTIVITIES
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NOTES & JOURNAL
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ALL DOCTORS INVOLVED IN YOUR CARE
Doctor
Telephone Number
128
INDEX
INDEX
INDEX
Page
Addresses & Telephone Numbers-Local businesses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30-32
Admissions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Blank Calendar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123-124
CBC Record . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Chemotherapy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35-48
Clinical Cancer Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-19
Clinical Trials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-19
CyberKnife . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51, 52, 81
Diet, Nutrition & Complementary Therapies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Electronic Medical Records. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Explanation of Charges, Financial & Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-13
Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71-114
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
Information Record . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-13
Image Guided Radiation Therapy (IGRT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50, 91
Intensity Modulated Radiation Therapy (IMRT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50, 62
Introduction-English . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Introduction-Spanish. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Locations/Maps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Medication Allergy Record . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Names of Medications & Dosages. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Notes & Journal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125-128
Notice of Privacy Practices (HIPAA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-13
Parking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Patient Advocacy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Patient Rights & Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-8
Personal Records & Journals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115-128
Privacy Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-8
Questions & Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33-69
Questions Commonly Asked by Patients Taking Chemotherapy. . . . . . . . . . . . . . . . . . . . . . . . . 35-48
Questions Commonly Asked by Patients Taking Radiation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49-69
Questions to Ask your Doctor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33-34
Radiation Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49-69, 123
Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-19
Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Support Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21-32
Temperature Record . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
Volunteer Auxiliary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Wellness Center/Spa. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
129
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