Glossary of Gynecological Oncology Terms

ABDOMEN - Often mistakenly called the stomach, it is the large space that contains the stomach, all the intestines, the liver, gall bladder, spleen and in women, the uterus, tubes and ovaries. The abdominal cavity is lined with the peritoneum

ADENOCARCINOMA (ad deno carcinoma) - A cancer of glandular linings. (see Epithelium).

ANTIBODY - A chemical produced by specialized lymphocytes when that lymphocyte encounters a foreign substance. The antibody identifies the invader as being foreign. The antibody is part of the immune system that helps rid the body of foreign substances that are usually a virus or bacteria.

ANTIGEN - The chemical on a foreign agent such as an infectious bacterium or virus. Specialized lymphocytes recognize this chemical as being foreign and produce antibodies against that antigen. Cancer cells are thought to be weakly antigenic and thus should cause an immune response leading to their destruction.

ASCITES (a sy tees) - Fluid that has accumulated in the abdomen. Usually due to cancer that has spread throughout the abdomen, Other reasons for ascites are cirrhosis of the liver, heart failure and kidney diseases.

BENIGN - Not a cancer

BIOPSY - A piece of tissue removed and examined microscopically to determine if there is a cancer.

BONE MARROW - The substance inside certain bones that contains the stem cells which are responsible for the manufacture of the blood elements: red blood cells, white blood cells, platelets (see Stem Cells). An autologous bone marrow transplant means that some of the bone marrow, with these stem cells, was removed prior to chemotherapy and then returned after chemotherapy. Cancers such as leukemia, which is a cancer of an element of the bone marrow, are treated to destroy all of the bone marrow. A marrow transplant from a matched donor is then used to reconstitute the bone marrow elements.

BRACHYTHERAPY (brakey therapy) - Slow therapy. Refers to irradiation techniques in which a radioactive substance is placed into the cancer and allowed to remain several hours to several days. Also called implant.

Ca-125 - A cancer associated antigen that can be tested for by a blood test. If the test is positive(greater than 35), then the antigen is present in the blood and a cancer may be present. The test is usually done for ovarian cancers. Unfortunately, it is not specific and many other benign conditions can also cause a positive test. It is a good test to use to monitor the results of treatment for a known ovarian cancer. If it was initially elevated and does not revert to less than 35, then the cancer is still present. If it reverts to normal with chemotherapy, it is good but still about one half of these patients have persistent cancer. So, a normal value is meaningless. A positive value in a person with no known cancer, no symptoms of cancer and no findings suggestive of cancer on examination, will be wrong 99 out of a hundred times. This is why it cannot be used to screen for ovarian cancers.

CANCER - An abnormal, uninhibited proliferation of cells that can invade into adjacent tissue and spread to distant sites.

CANCER SCREENING - Tests performed on people who have no symptoms or findings suggestive of a cancer. A screening test is done on "normal" people to find hidden disease. If the person has symptoms or findings that could be due to a cancer then diagnostic tests have to be done. Screening tests are not diagnostic tests. Abnormal screening tests indicate a potential problem that must be resolved by diagnostic tests.

CARCINOMA - A cancer of epithelium, such as skin or the lining of the intestinal tract. (see Epithelium).

CARCINOMA-IN-SITU (sy two) - A premalignant condition usually of squamous epithelium. This is not a cancer, but the change that precedes a cancer. Since it is not a cancer, treatment is usually simple and usually completely effective.

CHROMOSOME - The material in the nucleus of cells that contains the genetic information. There are 23 pairs of chromosomes, one of each pair was contributed by the father and one of each pair by the mother. The chromosomes are made of long chains of molecules which in the aggregate is called DNA. The specific sequence of molecules in a specific segment of the chain specifies a gene.

CIN - Cervical Intraepithelial Neoplasia. (see Dysplasia).

CONE BIOPSY - A cone shaped piece of tissue removed from the cervix, usually requires a general anesthetic.

CURE - A cancer is considered to have been cured if, after treatment, it is no longer detectable and remains undetectable for a long period of time. For many cancers this means it has not reappeared in five years. For other types of cancer, five years is not a reliable time span.

CYST - A fluid filled structure. A simple cyst is essentially a bag of fluid. A complex cyst has internal structures. May or may not be malignant.

DNA - Deoxyribonucleic acid. The genetic material in the nucleus of a cell. Composed of long chains of molecules called nucleotides. The specific sequence of a segment of these nucleotides codes for a specific cell function. This segment is a gene.

DYSPLASIA - Usually refers to a disorder in the maturation process of squamous epithelium. If the disorder is limited to the lowest 1/3 of the thickness, it is referred to as a mild dysplasia, if 2/3 then moderate dysplasia, if 3/3 or full thickness then severe dysplasia, also called carcinoma-in-situ. These changes are also referred to as intraepithelial neoplasia Grade I, II, and III. A grade III intraepithelial neoplasia, or a carcinoma-in-situ is considered a premalignant change that can progress to a squamous cell cancer. Dysplasias are diagnosed by microscopic examination of a biopsy specimen. (see Squamous Epithelium).

EPITHELIUM (ep i thee lium) - A covering or lining either external or internal. Skin is an external lining. The lining of the intestinal tract is a glandular lining. Epithelial linings are often exposed to the environment. You can trace a path from the skin through the mouth to the esophagus, stomach, small intestine, large intestine and then out the anus and back to the skin. Another example would be from the skin through the vagina, cervix, uterus, fallopian tubes to the surface of the ovary and into the lining of the abdominal cavity. Or, skin, nipple, milk duct into a milk gland of the breast. Cancers of epithelium are called carcinomas. Cancers of glandular linings are called adenocarcinomas. (see Squamous Epithelium).

EXPERIMENTAL TRIAL - When a new cancer drug is developed and first tested in humans, it is referred to as a Phase I Trial. The purpose is to determine what an appropriate dose is and incidentally whether it has any specific antitumor activity. When an appropriate dose is determined, then it is used in a Phase II Trial. In a Phase II Trial the object is to determine if the drug has any activity against a variety of different types of cancer. If it does, then a Phase III Trial is done in which this new drug is tested against what is currently thought to be the best treatment. Usually, Phase III trials are randomized, which means that the treatment, new drug Vs old drug, is determined by chance. This prevents any bias from influencing the outcome. All of the current major chemotherapy drugs have gone through this type of testing. Not all experimental trials involve chemotherapy.

GENE - A specific segment on a chromosome that determines a specific cell function. Genes control such individual characteristics as eye color, height and size. Some genes control the growth of a cell and its ability to repair itself if changed by a mutation. If a gene that limits a cells growth mutates and is no longer able to stop the cell from uncontrolled growth then that cell may give rise to a cancer. Genes are passed down to successive generations. There may be as many as 100,000 genes in every nucleus.

GESTATIONAL CHORIOCARCINOMA(korio carcinoma) - (see Mole).

GLANDULAR EPITHELIUM - The lining epithelium of many internal organs is composed of a single layer of cuboidal cells side-to-side. This surface forms a complex, convoluted folded shape similar to the surface of a shag rug. This provides for a huge three dimensional surface area for a very small two dimensional surface area. The lining of the stomach, intestine, colon, endocervix, uterus and fallopian tube, as well as other internal organs have this type of glandular lining. Cancers that originate from cells of a glandular lining are called adenocarcinomas.

GRADE - Many cancers are assigned a grade according to their microscopic appearance. If the cancer retains the appearance of the normal structure from which it arose, then it is called well differentiated, or Grade I. If it is difficult to determine the structure of origin, then poorly differentiated or Grade III. Moderately differentiated or Grade II cancers are intermediate in appearance. Grade I cancers are expected to behave the best, Grade III the worst.

HYDATIDIFORM MOLE(hy da tidi form) - (see Mole).

HYPERPLASIA - Excessive growth, usually of glandular epithelium. May be a premalignant change.

INCIDENCE - The number of cancers diagnosed in a given population. Usually on an annual basis.(see Prevalence).

INCIDENCE RATE - The number of new cancers diagnosed annually per 100,000 population.

INTRAEPITHELIA NEOPLASIA - (see Dysplasia).

INTRAPERITONEAL - Within the peritoneum. The abdomen is like a big bag which contains the intestines, liver, spleen, gall bladder and in the female, the reproductive organs. The lining of this space is called the peritoneum. Intraperitoneal is within the abdominal cavity. Fluid that has accumulated in this space is called ascites. There can be several gallons of ascitic fluid in the abdomen.

LAPAROSCOPY - Looking into the abdomen with a scope.

LAPAROTOMY - Cutting into the abdomen with an incision through the abdominal wall.

LEEP - Loop electrosurgical excision procedure. A technique for removing portions of the cervix with an electrified thin wire loop. Usually performed for both diagnosis and treatment of premalignant and benign cervical problems.

LESION - A nonspecific term for an abnormal area.

LYMPH NODE, LYMPHATIC SYSTEM - Just as there is the blood circulatory system in which the arteries deliver blood to the tissues throughout the body and the veins return it to the heart, there is a lymphatic system in which tissue fluid is drained from all areas of the body. These lymphatic vessels drain into regional centers where there are clusters of lymph nodes that strain the lymphatic fluid. The fluid is eventually returned to the blood system. The lymphatic system is a major part of the immune system and is responsible for the initial response to combat infections. Cancer can spread by way of the lymphatic system. Success or failure of treatment often depends on whether the regional lymph nodes are involved with the cancer.

LYMPHADENECTOMY - Surgical removal of the lymph nodes

LYMPHOCYTE - A major category of white blood cell that initiates the immune response. Collections of lymphocytes are organized into lymph nodes. When stimulated by an antigen the lymphocyte produces a variety of chemicals called lymphokines that perform immune response functions.

MALIGNANT - A cancer.

MASS - A tumor. May or may not be malignant.

METAPLASIA - The normal process by which cervical glandular epithelium changes into cervical squamous epithelium.

METASTASIS (ma tas ta sis)(metastases plural) - A cancer that has spread beyond its site of origin is said to have metastasized. A cancer that originated in the lining of the colon and is subsequently found in the liver is not a liver cancer, but is metastatic colon cancer. Some types of cancer are indolent and seldom spread. Other cancers are notorious for their predilection for widespread metastases early in their development.

MITOSIS, MITOTIC(my toe sis) - Mitosis is the method by which a dividing cell gives a full complement of the chromosomes to each daughter cell. Cancers have increased mitotic rates, which is why they grow fast. A mitotically active neoplasm is a cancer.

MOLE - Molar pregnancy. An early pregnancy gone awry. There usually is no fetus and the placental elements continue to grow. These placental elements have the ability to invade into the wall of the uterus and to metastasize to distant sites. Behaves as a cancer. Also referred to as gestational trophoblastic disease, includes gestational choriocarcinoma.

NECROSIS - Dead tissue. Tissue that has lost its blood supply dies and becomes necrotic. Parts of cancers outgrow their blood supply and become necrotic. Radiation can cause a loss of blood supply to a tissue and it will become necrotic. Necrotic tissue is usually infected and has an odor.

NEGATIVE PREDICTIVE VALUE - The probability that the disease is not present when the test is negative.

NEOPLASM - A new growth. May be benign or malignant.

OMENTUM - A large fatty structure in the abdomen that drapes over the intestines like an apron. It is often the site of massive involvement by metastatic ovarian cancer.

ONCOGENE - A gene that, when changed by an injury or mutation, can result in the cell becoming a cancer cell. An inherited oncogene abnormality may cause cancers to run in families. (see Chromosome).

PALLIATION - Treatment given for symptoms caused by a cancer, not necessarily to try to treat the cancer.

PERITONEUM - The lining of the abdominal cavity, which covers all the intraperitoneal organs such as the liver, intestines and in the female the reproductive organs

PLATELETS - A blood element that is part of the mechanism to stop bleeding. When a blood vessel is cut or ruptured, platelets plug the leak.

POSITIVE PREDICTIVE VALUE - The probability that the disease is really present when the test is positive. (see Sensitivity, Specificity and Negative predictive value).

PRECANCER - A change that occurs that can turn into a cancer. Precancerous changes, if detectable, can usually be treated with simple methods with excellent results. Some cancers have well defined precancer precursors, others do not.

PREVALENCE - The number of cancers that exist in a given population. Prevalence is usually unknown because not all of the cancers have been diagnosed. (see Incidence).

RAD - A unit of radiation delivered to tissue. Means radiation absorbed dose. Has been superseded by the Gray(Gy). 100 rads = 1 Gy. 1rad = 1 cGy (centigray).

RED BLOOD CELL - The cell circulating in the blood responsible for carrying oxygen. If the red blood cell count is low, then that is called anemia. Weakness and fatigue are symptoms of anemia.

REMISSION - The cancer, after treatment, is not detectable or not progressing.

RESPONSE - A determination of the effectiveness of treatment, usually requires a measurable amount of cancer. A complete clinical response means that a previously measurable cancer has gone away with treatment. It cannot be detected by examination, x-ray or scan. A complete surgical response means that even with a surgical exploration there is no trace of a cancer previously known to be present. A partial response means that the measurable amount of cancer has decreased by 50%.

SARCOMA - A cancer of supporting structures such as bone, muscle, cartilage and fat. A major category of solid cancers along with carcinomas.

SCREENING - see cancer screening.

SENSITIVITY - Refers to the probability that a test will be positive when the disease is present. (see Specificity, Positive Predictive Value and Negative Predictive Value).

SPECIFICITY - Refers to the probability that a test will be negative when the disease is not present. (see Sensitivity, Positive Predictive Value and Negative Predictive Value.

SQUAMOUS CELL CANCER - A cancer of squamous epithelium.

SQUAMOUS EPITHELIUM (Squay-mus) - The outermost layer of skin, which is 12-24 cell layers thick, located on a basement membrane. The cells closest to the basement membrane are large, round and have a large nucleus. The cells closest to the surface are flattened and have a small dense nucleus. On exposed skin the outermost layer of cells have lost their nucleus and are filled with keratin to form a protective keratin layer. The word squamous means flattened and refers to these flattened cells.

In normal squamous epithelium, there is a regular progression of the shape of the cells from large and round at the basement membrane to flattened at the surface. There is also a progression in nuclear change from large at the basal layer to small and dense toward the surface and absent at the outermost layer of exposed skin. A dysplasia is a disorder of this maturation progression. (see dysplasia).

STAGE - A determination of the extent of a newly diagnosed cancer. Each type of cancer has its own staging criteria. A common staging system assigns the cancer to one of four stages. Stage I refers to a cancer localized to the site of origin. Stage II is a cancer that has spread into adjacent tissue. Stage III cancers have spread within the region. Stage IV indicates distant spread or involvement of another organ system. There are usually substages for each of the four common stages.

The official staging system used by cancer registries is the TNM system. T indicates the status of the primary tumor and is subdivided into T1, T2, T3 and T4, depending on the size and extent of the primary tumor. N indicates the status of the regional lymph nodes and is subdivided into Nx, No, N1, and N2. M indicates distant metastases, Mo-none, M1, - present. Some cancers are assigned a stage by examination and x-ray tests. Others require a surgical exploration. Staging is important because it indicates the appropriate treatment, allows evaluation of treatment results, and can compare results from different types of treatment.

STEM CELL - The cell in the bone marrow that gives rise to the blood cells. The stem cells produce both red and white blood cells. If the stem cells are destroyed during chemotherapy then there will be no white blood cells to combat infection, which may be fatal. If some stem cells can be removed prior to chemotherapy, then huge doses of chemotherapy, that would otherwise be fatal, can be given and the stem cells replaced after the chemotherapy. It is called a stem cell because it has the ability to become any of the blood elements. The other cells in the bone marrow have lost this ability and can make only a specific type of blood cell element.

STOMACH - The organ that receives the swallowed food. It is the beginning structure of the digestive system. Sometimes incorrectly used to refer to the abdomen in general.

STROMA(stro ma) - The supporting tissue around or beneath an epithelium. The skin is an epithelium supported by the fibrous fatty stroma beneath it.

TELETHERAPY - Therapy from a distance. Refers to radiation therapy given by a radiation machine, which is several feet from that part of the body being exposed to the x-ray beam. Usually given one dose per day for several weeks. (see brachytherapy).

TERMINAL - When an irreversible failure of a critical organ system develops. People who are living with their cancer, even though the cancer is not curable, are not terminal.

TUMOR - A lump, implies a growth, can be either benign or malignant.

VAIN - Vaginal Intraepithelial Neoplasia. (see Dysplasia).

VIN - Vulvar Intraepithelial Neoplasia. (see Dysplasia).

WHITE BLOOD CELL - Cells in the blood that are responsible for performing immune functions particularly to combat infections. If the white blood cell count is too low, you are at risk for an infection. The white cells include the lymphocytes, and neutrophiles.

References:

William M. Rich, M.D.

Clinical Professor of Obstetrics and Gynecology

University of California, San Francisco

Director of Gynecologic Oncology

University Medical Center

Fresno, California