Glossary

Ablation

Destruction of tissue

Adjuvant therapy

Treatment given in addition to surgery to improve outcome. This may be radiotherapy, chemotherapy, hormonal therapy or treatment with new biological agents such as Herceptin.

Atypical hyperplasia

Excess cell growth including some cells with unusual shapes and sizes.

Augmentation

Increasing the size of the breast by inserting an implant

Axilla

The armpit

Benign

A change in the tissue that does not pose a danger as it does not spread abnormal cells around the body

Bilateral

Both sides

Biopsy

A sample of tissue from the body taken for examination under the microscope

Bone scan

See isotope scan

Ca 125

A tumour marker used to screen for ovarian cancer

Ca 153

A tumour marker.This substance is present in small quantities in the blood. Cancer cells sometimes produce large ammounts and this raised level can be measured with a blood test. It is not used as a primary screening test but can be useful for monitoring response to treatment or for detecting an early recurrence of a cancer after treatment

Calcification

Deposits of calcium in the tissue.These show up as white spots on a mammogram. Calcifications can be caused by benign conditions such as previous surgery, aging and fibroadenomas. The radiologist will try to classify them as benign, indeterminate (uncertain origin) or obviously malignant. Any indeterminate or malignant calcifications will require a biopsy.

Cancer

A growth of abnormal cells that can spread around the body

Carcinoma

A cancer arising from an epithelial surface - see cancer

Cell

The basic building blocks of the body. Each cell is a small sac of specialised fluid contained in a cell membrane. In the centre is the nucleus containing the genetic material.

Contracture

Hardening of scar tissue can occur around an implant or in other breast tissue after surgery.

Core biopsy

A needle with a small groove is fired into the lump by a spring loaded device after injecting local anaesthetic.A small cylinder of tissue is remioved for examination.This method gives more tissue than a fine needle aspiration biopsy and the pathologist can issue a more detailed report.

CT Scan

Computerised axial tomography is an x-ray technique that takes hundreds of cross sectional images through the tissue and uses a fast computer to combine the data to produce a cross sectional view of the area.You will need to lie in a narrow chamber for a few minutes.THis method is useful in assessing possible spread of breast cancer to other areas such as the liver and lungs. It may also be useful in assessing the armpit and shoulder area looking for enlarged lymph nodes.

Cyst

A fluid-filled lump

Cytology

Examination of individual cells under the microscope

DCIS

Ductal carcinoma in situ. Cancer cells are confined within the lining of the duct and have not spread.

Duct

A small tube. In the breast small milk ducts connect the milk sacs to the nipple.

Ductal cancer

A cancer arising in one of the breast ducts

Ectasia

Dilated ducts

Excision biopsy

Occasionally percutaneous needle biopsy will not provide enough tissue to make a precise diagnosis. In these cases surgical removal of the lump is recommended.

Fat necrosis

Fat necrosis is a process that can occur if the fatty tissue in the breast is injured either as a result of surgery,radiotherapy or trauma. The blood supply to the fat is damaged and the tissue dies. This can cause a dramatic inflammatory reaction under the skin. There is redness, swelling and pain and the features look very similar to mastits. This condition does not respond to antibiotics. With time the inflammation settles down. There may be a residual hard lump and eventually the damaged tissue can break down to form an oil cyst.

Fibroadenoma

A common benign breast lump

Fistula

An abnormal connection between two surfaces of the body. In the breast this is usually a connection between a milk duct and the skin. THis can result in milk or duct secretions oozing onto the skin

FNA

Fine needle aspiration biopsy. A thin needle attached to a syringe is passed through the lump with suction applied to the syringe. Individual cells are sucked up into the syringe and then sprayed onto a slide for examination under the microscope

Galactocoele

A cyst filled with milk. this appears as a lump in the breast. It occurs during or shortly after a woman has been lactating. The diagnsis is made with ultrasound. The fliud can be aspirated under local anaesthetic if the lump is causing discomfort or concern.Fluid may reaccumulate. Occaionally a galactocoele may need to be excised if it does not resolve.

Galactorrhoea

Abnormal production of milk when not pregnant or breast-feeding. May be due to a pituitary tumour producing the hormone prolactin. Can also be caused by some drugs

HER2

Human epidermal growth factor receptor 2

Herceptin

A monoclonal antibody that can block the HER2 receptor.

Histology

Study of tissue under the microscope

Hormone

A chemical messenger

Hormone receptor

Chemical site located on some cells that can bind with a particular hormone such as oestrogen allowing the hormone to stimulate the cell

Hyperplasia

Excess cell growth

Impalpable

Cannot be felt

Implant

A silicone bag filled with saline or silicone jel - used to increase size of breast or to replace breast after mastectomy.

Invasive cancer

A cancer in which malignant cells have spread from their normal location into the surrounding tissue

Involution

Shrinking or dying back

Isotope scan

You are given an injection of a radioactive substance that is selectively taken up by areas where cells are more active. A scanner then shows up these areas as hot spots. This technique is useful in looking for bone metastases.

Latissimus dorsi flap

A tissue flap based on this muscle used to reconstruct the breast after mastectomy.

LCIS

Lobular carcinoma in situ. Cancer cells are confined within the lining of the lobule and have not spread.

Liver scan

An imaging study to show the structure of the liver. May refre to ultrasound liver scan, CT Scan or isotope scan. Usually refes to ultrasound. Used to look for metastases.

Lobular cancer

A cancer arising from one of the breast lobules

Lymph nodes

Small filters connected to the lymph channels. They enlarge in response to infection or cancer.

Lymphoedema

Swelling of tissue caused by a build-up of lymph fluid. After breast cancer treatment this may be the result of damage to the axillary lymph-nodes caused by surgery or radiotherapy. Cancer cells can also obstruct the lymph vessels.

Malignant

A tumour that has the ability to spread around the body.

Mammogram

An x-ray of the breast. The breast is carefully positioned and gently compressed between two plates to spread out the tissue evenly. An x-ray beam passes through the tissue and creates an image that is stored on a photographic plate. In conventional mammography the images are stored on photographic film. New digital machines can now store the images electronically. A mammogram produces less radiation than a standard chest x-ray. Diagnostic mammography is an important component of triple assessment - the safe method that has evolved for investigating a breast problem. Screening mammography is the use of routine mammograms in well women to try to detect abnormal changes at an early stage.

Mastectomy

Operation to remove the breast

Mastitis

Infection of the breast tissue

Metastasis

A cancer that has spread from the original cancer and grown at a distant site in the body

Microcalcification

Very small calcifications - see calcification

Milk sacs

The structures within the breast that produce milk

MRI scan

Nuclear magnetic imaging is not an x-ray. It is an imaging technique that uses a strong magnetic field and radiofrequency pulses to creare cross-sectional images of the body.The strong magnet in the machine means that there are some situations where MRI is not safe. These include people with cardiac pacemakers and defibrillators, as well as those with ferromagnetic(metal) clips or other introduced metallic foreign bodies in the brain or orbit. It is useful for assessing problems with breast implants such as possible rupture. It is also useful for looking for multifocal cancer in the breast.

Neo-adjuvant chemotherapy

Chemotherapy given before surgery to shrink the cancer

Oestrogen receptor

See hormone receptor

Oncology

Study of cancer

Ovary

The female reproductive glands containing the eggs and also producing oestrogen and progesterone

Paget's Disease

Paget's Disease of the nipple is an uncommon type of cancer that develops around the nipple. It causes redness and scaling of the nipple skin and can be mistaken for eczema. The diagnosis is made by performing a biopsy of the abnormal area.

Palliative

Treatment to control symptoms of cancer rather than to cure it.

Partial mastectomy

Operation to remove part of the breast including the cancerous area

Peau d' orange

Characteristic dimpling of the skin caused when there is swelling of the breast. The small Coopers ligaments thether the skin. Can be a sign of large cancer but also seen after radiotherpay or infection of the breast

PET Scan

Positron emission tomography is one of the newest imaging techniques. You are injected with a small ammount of radioactive material that is taken up by active cells. A scan of the body then shows areas of increased activity. These may show areas of cancer growth. PET scanning is most useful in assessing whether cancer has spread to the lymph-nodes or beyond. IT is also useful in assesslng response to chemotherapy. It is not very good at detecting small cancer changes within the breast. PET scanning may be combined with other imaging methods such as CTscan to evaluate areas of increased uptake more precisely. PET scanning is only available in a few centres and is expensive. It is currently used selectively to sort out complex diagnostic problems.

Primary

A cancer that has developed in the breast

Progesterone receptor

See hormone receptor

Prosthesis

An artificial breast worn in the bra

Radiologist

Specialist in breast imaging

Receptor

A site on the surface or interior of the cell that can bind a specific molecule such as oestrogen, progesterone or HER2. Binding activates the receptor and signals the cell to perform an activity.

Recurrence

When a cancer comes back after treatment. In breast cancer this may be a local recurrence within the breast, a regional recurrence involving the draining lymph-nodes or a distant recurrence if cancer cells have spread to another site such as the liver, lungs or bones

Secondary

A cancer that has spread to another site such as the bone or liver.

Sentinel node

The first lymph-node to which cancer cells have spread

Sestimibi imaging

You are given an injection of a radioactive substance called Technetium 99 which circulates around the body and is picked up by active cells including cancer cells. A scanner can then detect areas of increased activity. It is not a good method for picking up small tumours. This technique is not widely used in breast cancer diagnosis and treatment in New Zealand at present.

Stereotactic biopsy

Screening results in the detection of many small abnormalities that cannot be felt. Biopsy of these small areas requires image guidance. This may be ultrasound or x-ray guided. Steretactic biopsy is a technique that uses the mammogram machine to position a core biopsy needle correctly so that samples can be taken. This is done under local anaesthetic.

Thermography

Is an imaging technique that records temperature differences in the breast. It has been promoted as a screening method for early detection of breast cancer. The problem is that this investigation is neithwer sensitive or specific. This means that some cancers will not be detected and on the other hand many non-cancer changes such as inflammation may show up. Any abnormal area seen on thermography requires standard assessment with clincial exam, ultrasound, mammography and biopsy. The Cancer Society of New Zealand issued a position statement on Thermography in January 2005.

TRAM

Transverse rectus abdominus myocutaneous flap

Triple assessment

Complete breast assessment may include: 1.Clinical examination 2.Ultrasound and mammography 3.Biopsy This combination of tests is called Triple Assessment and provides a high level of accuracy

Tumour

"A swelling" - term usually refers to an abnormal growth of cells. Benign tumours increase in size but do not spread. Malignant tumours can spread around the body.

Ultrasound

Ultrasound uses sound waves to produce an image of the breast. It is quick, painless and does not involve any radiation. Warm jelly is applied to the skin to provide a good contact for the probe. The probe is then moved over the breast tissue producing an image on the screen. We can very quickly identify most lumps and get a good idea as to whether it is a fluid-filled cyst or a solid lump. We can also obtain an impression of as to whether the lump looks benign or malignant. Needle biopsy is required to confirm the diagnosis and can be performed with ultrasound guidance to improve accuracy and minimise discomfort.

 
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Trevor Smith MBChB FCS

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