Cancer Glossary

Cancer, Health, and Medicine Glossary Page 1 of 22
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Acute affects of stereotactic radiosurgery - Very few complications commonly

occur in the first week after stereotactic radiosurgery and if they do occur they are
usually minor. These can include some minor bleeding or pain from the pin sites
where the head frame was attached, headache, nausea and vomiting, or seizures.
Adjuvant therapy - Cancer treatment given following the primary treatment that aids
or assists in the effectiveness of the primary therapy. Adjuvant therapy is usually
given to increase the chances of curing the cancer or keeping it controlled.
Allergic reaction to anesthesia - A systemic (affecting the entire body) reaction to

the general anesthesia used during surgery can occur. This is usually an allergic
type of reaction and is treated with medication, which in most cases effectively
reverses the reaction and symptoms.
Allergic reaction to chemotherapy - Some chemotherapy medications can cause

allergic reactions such as itching of the skin, rash, hives, shortness of breath,
wheezing, fevers, chills, blood pressure changes, or an abnormal heart rate. This is
not always predictable and usually, though not always, occurs within the first 15 to
30 minutes of the drug administration. During the infusion of the medication, you will
be monitored closely for any signs or symptoms of an allergic reaction. Should a
reaction occur, the chemotherapy drug will be stopped and medication given to
effectively relieve the symptoms and reverse the reaction.
Some chemotherapy medications require premedications, which are given before

the chemotherapy to reduce or prevent an allergic reaction.
Alopecia - Alopecia is the medical term for hair loss. Cells in the hair follicle, or hair
root, that are in their growing phase are vulnerable to chemotherapy drugs, because,
like cancer cells, they are rapidly dividing. When cells in the follicle are damaged, the
hair strands become very weak and within a few weeks will break off or be shed from
the follicle. Since 90% of hair follicles are in the growing phase at any one time, the
hair thinning can be abrupt and so pervasive that the hair may appear to fall out in
clumps. Most of the active follicles are on the head, so that is where alopecia is most
noticeable, but hair follicles anywhere on the body can be affected.
Whether or not alopecia occurs depends on the chemotherapy drug and the dose
given. Hair will usually re-grow a few months after chemotherapy is completed. It
may be different in color, texture, and curliness than it was prior to treatment, but
eventually it will return to normal.
Anemia - An abnormally low level of red blood cells or hemoglobin. Hemoglobin is a

protein found inside the red blood cell. Hemoglobin contains iron, which is necessary
to transport oxygen and carbon dioxide. When the hemoglobin level is decreased,
the blood cannot carry enough oxygen to meet the needs of the body tissues. As a
result, the person becomes tired physically and mentally. Other symptoms include
feeling cold, lightheaded, dizzy or faint, pale skin, headache, shortness of breath,
and heart palpitations.
Some causes of anemia include: cancer, treatments for cancer that lead to bone
marrow depression (chemotherapy, radiation therapy), diet (lack of iron, vitamin B12,
and folic acid), and blood loss from an injury.
Anesthesia - The usage of medications to prevent the ability to feel pain.
l General-The use of medications to cause a temporary state of

unconsciousness and the absence of pain over the entire body. The
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medications may be given as injections, inhalants or as rectal suppositories.

l Regional-The use of medications to block sensations in one part of the body.
These are typically administered as injections.
l Local-The use of medications to block sensations at the particular site of
administration. These may be given as injections or placed on the skin (such
as patches or gels).
Angiogenesis - Process of new blood vessel growth. Angiogenesis naturally helps
body tissues repair, but also helps tumor cells grow. Clinical trials are being
conducted to test drugs that can prevent blood vessel formation to keep tumor cells
from growing.
Antigen - A protein found on a foreign substance (such as a virus, bacteria, or

cancer cells) that stimulates the body's immune system to produce antibodies to help
protect the body.
Benign - Usually refers to non-cancerous tumors or lesions that do not invade other
tissues. When they are removed, they seldom return. A benign tumor can still be a
danger if located in an area that interferes with normal body function. For example, a
benign tumor in the brain can cause pressure on brain tissue and can cause serious
symptoms if not removed.
Best supportive care - Best supportive care refers to medical care provided by
doctors and other members of the health care team that is aimed at providing
maximum relief of disease symptoms and achieves the best quality of life. The focus
of care is not on treatment of the cancer with aggressive therapies, but rather
determining what medical support or therapies will provide relief of symptoms and
support the patient’s health and quality of life.
Biopsy - The process of removing either a collection of cells or a piece of tissue for
microscopic laboratory evaluation to determine the presence of cancer. Microscopic
evaluation is the only way to determine with certainty if cancer is present.
Bone marrow - The soft, spongy material or tissue inside the large bones that
produces all the blood cells of the body. These cells include the red blood cells,
white blood cells and platelets.
Bone marrow depression - Bone marrow depression (also called bone marrow
suppression or myelosuppression) is a decrease in the cells produced in the bone
marrow (inside the bones). It commonly occurs with many chemotherapy drugs. It
may also occur with radiation treatments if there is significant bone marrow in the
radiation treatment field. With chest radiation, the bones and ribs of the chest are in
the radiation field, but they do not usually cause significant bone marrow depression.
The cells inside the bone marrow include red blood cells, white blood cells, and
platelets. Red blood cells carry oxygen, white blood cells fight infection, and platelets
help clot the blood when there is an injury. When the red blood cells are decreased,
anemia is possible. When the white blood cells are decreased, the risk of infection is
increased. A decrease in the platelets may increase the risk of easy bruising or
bleeding from an injury. The doctor does a blood test called a CBC (complete blood
count), to determine the level of red blood cells, white blood cells, and platelets. If
the blood levels are decreased, special precautions may need to be followed until
the body makes new cells and the blood levels return to normal. Sometimes special
medications may be used to help increase the blood cells if low counts are due to
chemotherapy, or a blood transfusion may be necessary for anemia.
Bone scan - A procedure that creates images of the bones after an injection of a
radioisotope into the veins. It is used to find out if cancer has spread to the bones.
Boost - A boost of radiation therapy is given to increase the dose of radiation given
specifically to the tumor. It is usually given in a smaller area than the original
radiation therapy. For example, in brain radiation therapy a boost can be given to
specific tumor location after the whole brain has been treated with radiation.
Brain metastasis - Metastasis is the term used to describe cancer that has spread
to other organs or areas of the body from where it originally started. If cancer has
metastasized to the brain, there may be one, or more than one, separate places of
metastasis inside the brain. The treatment recommendation may be different
depending upon the number of areas.
Brain radiation long term effects - Long term effects are difficult to assess and
quantify, but can include loss of memory and analytic ability. For most patients, if this
occurs, it is minor and minimally noticeable, but for those whose work involves a lot
of analytical reasoning, this potential side effect may be unacceptable. The side
effects of radiation treatment to the brain must be weighed against long-term survival
goals and quality of life.
Bronchi - The two branches of the trachea (windpipe) that lead to each lung. The
right bronchus (singular of bronchi) leads to the right lung, the left bronchus leads to
the left lung.
Bronchoscopy - A diagnostic test that is used to view the inside of the trachea,
bronchi, and lungs. It also provides a way to obtain samples of the sputum or other
fluid within the airway for examination, or to biopsy these tissues. When this test is
performed, the patient is usually given medication to sedate them before the
instrument, called a bronchoscope, is passed through their mouth or nose down into
their lungs. As it passes to the lungs, the larynx (voicebox), trachea (windpipe), and
bronchi (two separate branches of the trachea that each enter one of the two lungs)
are visualized and evaluated. Once all areas of interest have been evaluated, the
bronchoscope is removed.
Cancer - A general term for tumors or abnormal growths characterized by abnormal,

out of control growth. This abnormal growth (malignancy) can grow into nearby
tissues and spread to other areas of the body. Cancer cells continue to divide and
change whereas normal cells reproduce when new cells are needed. Cancer cells
can invade and destroy nearby tissues. Cancer cells may separate from the original
malignant tumor and travel (metastasize) to other sites in the body where they begin
new tumors. Also see malignant for more information.
Cancer
Cancer Close-up View
Cancer growth - Normal cell growth, a cell's division and eventual death, is an
orderly controlled process, where cells reproduce only when needed. Cancer cells
continue to divide and change unchecked, they don't stop dividing and die at a
certain point (called programmed cell death or "apoptosis") as normal cells do. The
abnormal cells continue to grow out of control in a disorderly fashion.
Cancer stage - The cancer stage, or stage of disease, is a determination of the size
and extent of the cancer. It is an indication of how widespread or involved the cancer
is. There are two basic stages for small cell lung cancer. Limited stage includes
cancers located only in one lung and in the lymph nodes on the same side of the
chest. Extensive stage cancer has spread to the other lung, to lymph nodes on the
other side of the chest, or to distant organs.
A determination of the cancer stage is based on the results of the doctor’s physical
examination, laboratory blood tests, and radiologic tests such as chest x-ray tests
and CT or MRI scans. Knowing the precise cancer stage is critically important in
determining treatment and prognosis.
Cancer vaccines - The immune system is the body's first line of defense against
disease. Research has shown that the immune system has the ability to respond to
abnormal and cancerous cells as well as toxic invaders, such as germs and viruses.
Cancer cells like invading organisms display protein features that trigger an immune
response. Unlike foreign invaders, however, cancer cells also display proteins that
identify them as belonging to the body. As a result, the immune response to cancer
often is not aggressive enough to eliminate all the cancerous cells. Researchers
have long sought methods to stimulate or alter the immune system to destroy cancer
cells.
Types of Vaccines
Researchers are pursuing two strategies for creating anti-cancer vaccines. One aims
to prevent cancer from developing, the other aims to halt or cure cancer that has
already developed.
The prevention or prophylactic vaccines work much like common vaccines now
administered to healthy people to prevent such diseases as smallpox, polio,
influenza, mumps, measles, chickenpox, and other common diseases. The second
strategy, or therapeutic vaccines, involves altering the cancer cells to make them
more clearly recognized by the immune system as cells to be destroyed.
Two prophylactic vaccines have been shown effective in preventing infection by

viruses associated with cancer. The first is the hepatitis B vaccine (Recombivax
HB®, Engerix-B®) that can prevent infections linked to some forms of liver cancer.
The second prevents infection from the strains of human papillomavirus (HPV) that
cause most cervical, vaginal and vulvar cancers. These viruses are identified as
HPV 16 and HPV 18. Two such vaccines, Cervarix® [bivalent human papillomavirus
(types 16, 18) recombinant vaccine] and Gardasil® [quadrivalent human
papillomavirus (types 6, 11, 16, 18) recombinant vaccine], have been FDA-
approved.
No therapeutic vaccines for cancer have been approved by the FDA but research is
underway to evaluate the effectiveness, safety, and long term effects of these
vaccines. Some promising phase III clinical trial results have been reported in
kidney, prostate, follicular lymphoma, melanoma and breast cancer.
How is a cancer vaccine administered?

Prophylactic cancer vaccines are usually administered in a series of injections in the
skin. Most therapeutic cancer vaccines are given intravenously, and currently are
only given within a clinical trial.
What are the known side effects?

The prophylactic cancer vaccines cause few adverse side effects, with the most
common being redness and swelling at the injection site. Side effects of therapeutic
vaccines vary by the type of vaccine, but none have been FDA-approved yet. In
clinical trials some adverse effects have been reported ranging from soreness at the
injection site together with mild flu-like symptoms to autoimmune problems such as
inflammation of the thyroid gland, skin disorders, and inflammation of the colon and
rectum (colitis).
CAT scan or CT scan - refers to computed axial tomograph (CAT), a diagnostic

imaging test that is done in a diagnostic clinic, radiology lab, or hospital. CT
combines a revolving scanner (camera) and an x-ray with a computer to produce
highly detailed cross-sectional, three-dimensional pictures of the area being studied.
The entire body can also be scanned. CT scans are performed by a radiology
technician and is interpreted by a radiologist (a doctor who specializes in using x-
rays, ultrasound, CT, MRI and other scans to aid in diagnosis).
CT scans are generally far more sensitive than x-rays and provide a painless,
noninvasive method of obtaining a detailed view of internal organs. The test takes
about 30-45 minutes. Some patients may find it uncomfortable to remain still on the
narrow examination table during the procedure. There is a slight risk from radiation
exposure or an allergic reaction to contrast dye, which is used in some CT scans.
CBC (complete blood count) - A blood test to evaluate the cells in the blood. It
includes the WBC (white blood cell count), RBC (red blood cell count), platelet count,
hematocrit, hemoglobin, differential count (detailed information about the specific
WBCs), and other information about the RBCs. These cells are produced in the bone
marrow and may be decreased by anti-tumor therapies, such as chemotherapy or
radiation.
Chemoradiation - Chemoradiation combines chemotherapy and radiation therapy

for the treatment of cancer. The two treatments are given at or near the same period
of time. This combining of treatments is the current standard of care recommended
for limited stage small cell lung cancer.
Chemotherapy - Chemotherapy is the use of drugs (often called "anticancer drugs")

to treat cancer. Chemotherapy drugs destroy cancer cells by interfering with the
cell's ability to grow and multiply. The therapy is considered "systemic" because it
affects the whole body, including both normal and cancerous cells. Two or more
anticancer drugs are often used to treat cancer, this is called combination therapy.
Depending on the type of cancer and the stage of disease, chemotherapy can be
used to cure cancer, to keep cancer from spreading, to slow the growth of cancer
and to relieve cancer symptoms. In small cell lung cancer chemotherapy is the
primary and most important therapy.
Most chemotherapy is given intravenously (IV) but some may be given by mouth, by
injection with a needle or by infusion into a body part. In most cases, chemotherapy
is administered on an outpatient basis. Treatments are usually given followed by a
rest period so the body can build healthy new cells and gain strength. After the rest
period, the cycle begins again. Treatment cycles and schedules vary from patient to
patient. Your doctor will provide your specific treatment schedule.
Chemotherapy and radiation therapy - The combination of chemotherapy and

radiation therapy to the chest used in limited stage disease with the goal of cure or
control of the cancer. Chemotherapy is the use of drugs (often called "anticancer
drugs") to treat cancer. Chemotherapy drugs destroy cancer cells by interfering with
the cell's ability to grow and multiply. The therapy is considered "systemic" because
it affects the whole body, including both normal and cancerous cells. Radiation
therapy, also called radiotherapy, is the use of high energy radiation to treat cancer.
Chemotherapy for relapsed or progressive disease - Chemotherapy that is used

to treat cancer that has failed first-line therapy (the first chemotherapy given after
diagnosis) and is often referred to as second-line chemotherapy. Chemotherapy is
the use of medicines, or anticancer drugs to destroy cancer cells. Chemotherapy
drugs work by interfering with the cell’s ability to grow and multiply and are
considered a “systemic” therapy, meaning it is carried by the bloodstream throughout
the body and works on all cells, whether they are cancer cells or healthy cells.
Chest tube - A tube that is temporarily left in place between the chest wall and the
lung after a thoracotomy. It exits the body from a small incision. It is connected to a
suction bottle outside of the body. Its purpose is to keep the lung inflated, drain small
of amounts of fluid, and evacuate air leaking from the lung. It is usually removed
within 48 hours of the operation, once healing has begun. Before it can be removed,
however, the lung must maintain inflation on its own, the amount of fluid drainage
must be minimal, and there cannot be an ongoing air leak.
Clinical trial phases - Clinical trials are usually conducted in a series of steps,
called phases. Treatment clinical trials listed in the National Cancer Institute (NCI)
comprehensive cancer information database, are always assigned a phase.
However, screening, prevention, diagnostic, and quality-of-life studies do not always
have a phase. Genetics clinical trials generally do not have a phase.
l Phase I trials are the first step in testing a new agent. In these studies,
researchers evaluate what dose is safe, how a new agent should be given (by
mouth, injected into a vein, or injected into the muscle), and how often.
Researchers watch closely for any harmful side effects. Phase I trials usually
enroll a small number of patients and take place at only a few locations. The
dose of the new therapy or technique is increased a little at a time. The
highest dose with an acceptable level of side effects is determined to be
appropriate for further testing.
l Phase II trials study the safety and effectiveness of an agent or intervention,
and evaluate how it affects the human body. Phase II studies usually focus on
a particular type of cancer, and include fewer than 100 patients.
l Phase III trials compare a new agent or intervention (or new use of a
standard one) with the current standard therapy. Participants are randomly
assigned to the standard group or the new group, usually by computer. This
method, called randomization, helps to avoid bias and ensures that human
choices or other factors do not affect the study's results. In most cases,
studies move into phase III testing only after they have shown promise in
phases I and II. Phase III trials often include large numbers of people across
the country.
l Phase IV trials are conducted to further evaluate the long-term safety and
effectiveness of a treatment. They usually take place after the treatment has
been approved for standard use. Several hundred to several thousand people
may take part in a phase IV study. These studies are less common than
phase I, II, or III trials.
SOURCE: National Cancer Institute's Fact Sheet on Clinical Trials rev. 05/19/2006
Clinical trials - Clinical trials, also called cancer treatment or research studies, test
new treatments in people with cancer. The goal of this medical research is to find
better ways to treat cancer and help cancer patients. Clinical trials have been
responsible for the many advances in cancer treatment. Clinical trials test many
types of treatments such as new drugs, new approaches to surgery or radiation
therapy, new combinations of treatments, or new methods such as biological
therapy. Many of today's most effective standard treatments are based on previous
study results. Clinical trials may also answer important scientific questions and
suggest future research directions. Because of progress made through clinical trials,
many people treated for cancer are now living longer (National Cancer Institute,
2007).
You are encouraged to discuss available clinical trials with your health care team to
see if participation in such a trial might be appropriate for you.
Clinical trials side effects - Side effects (undesirable effects of a treatment) occur
with most cancer treatments. The specific side effects that you may experience will
depend on the type of treatment you receive in the clinical trial. Many small cell lung
cancer clinical trials involve chemotherapy, especially those for patients whose
cancer has recurred. Common side effects of standard chemotherapy treatments are
fatigue, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.
New treatments being studied may have these or other side effects.
There are very effective medications available today to prevent or reduce the
severity of many chemotherapy side effects, especially nausea and vomiting. The
study doctor and oncology nurse will explain in detail what possible side effects you
may experience while participating in the clinical trial. A written informed consent
form will also be given to you as you consider your decision to participate in a clinical
trial. This will have all the known side effects clearly written down for you to review.
Remember that side effects are highly individualized and each patient will
experience them differently with varying degrees of frequency and severity. Your
doctor will discuss this with you, as well as strategies for managing any other side
effect you may experience.
Combination chemotherapy - More than one (usually 2 to 4) different anticancer

drugs used together to treat cancer. Each drug in the combination is carefully
selected to increase the cancer cell kill through a different mechanism for attacking
the cancer cell. For most cancers (but not all), combination chemotherapy is more
effective than single agent chemotherapy.
Common postoperative effects of surgery - Normal and expected postoperative

effects of surgery may include pain at the incision site, headache, nausea and/or
vomiting, fatigue and anxiety. Each individual will vary in their experience and
recovery process. Generally, these effects can be due to the general anesthesia
used during surgery and brain swelling, along with the stress of the surgical
procedure on the body. Your doctor will prescribe medication to relieve pain, nausea
and vomiting as needed. Fatigue and anxiety usually resolve with recovery from
surgery.
Common side effects of chemotherapy - Side effects (undesirable effects of a

treatment) occur with chemotherapy because anticancer drugs destroy normal,
healthy cells as well as cancer cells. The effects on the normal cells are usually
temporary as new, healthy cells are made by the body to replace those that are
damaged. These side effects are common to many chemotherapy drugs including
the drugs commonly used to treat small cell lung cancer, they include: hair loss
(alopecia); loss of appetite (anorexia); low blood counts (bone marrow depression);
nausea and/or vomiting; diarrhea and fatigue. Cisplatin commonly causes abnormal
kidney function. Not all chemotherapy agents cause all of these side effects. Side
effects are highly individualized and each patient will experience them differently with
varying degrees of frequency and severity. The side effects experienced also
depend on the specific drugs and doses as well as the method of administration, e.g.
by mouth or intravenous (IV).
There very effective medications and other approaches that can prevent or reduce
the severity of chemotherapy side effects. If one approach doesn't work well, there
are others to try. The timing of the approaches may also make a difference, such as
giving anti-nausea medications before, during, or after the actual chemotherapy
treatment. Your doctor and oncology nurse will discuss the expected side effects
with you as well as strategies for managing those you may experience.
Complete blood count (CBC) - A blood test to evaluate the cells in the blood. It
includes the WBC (white blood cell count), RBC (red blood cell count), platelet count,
hematocrit, hemoglobin, differential count (detailed information about the specific
WBCs), and other information about the RBCs. These cells are produced in the bone
marrow and may be decreased by anti-tumor therapies, such as chemotherapy or
radiation.
Corticosteroids - A large family of chemical substances, comprising many

hormones. Examples of corticosteroids (steroids) used in the treatment of brain
tumors include dexamethasone and prednisone.
Steroids are given to reduce fluid or inflammation of tissues and control swelling of
the brain that occurs as result of a tumor or treatment. They may be used when a
patient complains of these symptoms or in some cases used prophylactically. They
are used for as short of period of time as needed and then the dosage is tapered. If
used for only a few days to a week, steroids generally cause no side effects, but
used over a long time or withdrawn without monitoring, steroids may produce several
side effects.
In some cancers corticosteroids are used for their antitumor activity also (i.e.,
lymphomas and lymphoid leukemias).
Cough, sore throat and swallowing problems - Patients may experience a cough,
a dry or sore throat and difficulty swallowing as a result of radiation therapy to the
chest area. These problems may occur if the esophagus becomes inflamed (this is
called esophagitis). This is because when radiation is directed at the center of the
chest it will include the esophagus. This is generally a minor, temporary side effect
that may occur within a few days to 2 weeks after treatment has started. There may
be a need to adjust diet by eating soft foods and liquids, like soups, milkshakes, or
commercial liquid supplements. Sometimes cough suppressants, pain medications
or topical anesthetics are advised to alleviate the discomfort. Occasionally, tube
feeding (a tube is placed in the nose and advanced into the stomach for feeding or a
tube is placed directly into the stomach during a minor surgical procedure), or
intravenous fluids are needed until the symptoms resolve.
Craniotomy - Surgical removal of a brain tumor. This is one of the options to treat
brain metastasis from lung cancer. The goal of this surgery for a patient with lung
cancer is to remove the tumor in order to prolong life, relieve symptoms, and
improve quality of life. It is indicated for patients who have a brain tumor in an area
of the brain that can be operated on without a high risk of neurological damage. With
this form of treatment, a neurosurgeon performs the surgery to remove the tumor.
Damage to healthy lung tissue - When radiation therapy is given to the chest area,
very careful and exact measurements are taken to deliver the radiation to the tumor
only. In spite of these precautions, radiation can affect healthy tissue near the tumor.
The toxic effects of the radiation are cumulative, meaning they increase as the total
dose of radiation increases.
The acute side effects of radiation within the lung may include temporary swelling of
the healthy tissue, which may result in difficulty breathing. This is usually relieved
with steroid therapy and a short interruption of radiation.
There may be permanent damage to the lungs called radiation pneumonitis and
pulmonary fibrosis. Radiation pneumonitis usually occurs about 1-3 months after
radiation and may be mild or severe. The symptoms may include shortness of breath
a dry cough, low-grade fever, and chest pain. Radiation pneumonitis usually gets
better. Some patients with radiation pneumonitis develop scarring in their lungs from
this process, which is called pulmonary fibrosis. They may have shortness of breath
of varying severity.
There may be clinical trials using medications or other approaches to decrease the
toxicity of radiation therapy to the lungs. Discuss this with your physician.
Delayed effects of stereotactic radiosurgery - The tumor tissue that remains after
the radiation treatment will typically shrink and became necrotic. This necrotic or
dead tissue usually does not cause symptoms. In a small percentage of cases
symptoms occur, in which case medications are used or surgery may be required to
remove the necrotic tissue. A determination for this is made by your neurosurgeon.
Diagnosis - The procedure(s) by which a disease is identified.
Erythropoietin - Erythropoietin (eh-rith-ro-POH-ee-tin) is a naturally occurring

human hormone produced by the kidneys that stimulates the bone marrow to
produce red blood cells.
Synthetic forms of erythropoietin, drugs that stimulate production of red blood cells,
are called erythropoiesis stimulating agents (ESAs). These include epoetin alpha
(Procrit®) and darbepoetin (Aranesp®). They are given to selected patients with
anemia due to kidney failure or chemotherapy in order to improve their quality of life,
decrease the need for transfusion, and possibly improve their outcomes. ESAs raise
the hemoglobin level over the course of several weeks or months, as opposed to
transfusions, which raise it almost immediately. ESAs are advantageous when the
patient is opposed to having or is unable to tolerate transfusions or when access to
transfusion is not readily available.
Combined guidelines from the American Society of Hematology (ASH), the American
Society of Clinical Oncology (ASCO), the Federal Drug Administration (FDA), and
the National Cancer Care Network (NCCN) specify the following:
l Epoetin alpha and darbepoetin are indicated for chemotherapy-related

anemia in cancers other than certain leukemias (AML and CML)
l The goal of treatment is to decrease the need for transfusions and reduce
symptoms
l The anemia should be causing symptoms
l Other correctable causes should be ruled out or treated
l They should be used only for anemia due to kidney failure or chemotherapy,
not for anemia caused by other therapies or associated with the cancer itself
l They should be started only when the hemoglobin level is less than 10 g/dL
(although use can be considered for hemoglobin 10-11 g/dL when
"significant" anemia symptoms are present)
l They should not be used in someone who has uncontrolled high blood
pressure
l It is recommended that their use be avoided when cancer cure is possible,
but this remains controversial
l They should be used with caution when the risk of abnormal blood clotting
(thromboembolism) is high
l Iron supplementation should be given since ESAs are effective only when
adequate iron is available (guided by blood tests called transferrin saturation
[to at least 20%] and serum ferritin [at least 100 ng/mL])
l Transfusion should be considered if it is a reasonable alternative
l The ESA dose should be adjusted to maintain the lowest hemoglobin level to
avoid transfusions, with a suggested target hemoglobin level of 11-12 g/dL
In addition, ASH recommends caution in application of risks to hematologic

malignancies in which ESAs have shown benefit (such as certain lymphocytic
leukemias and lymphomas), since the risk reports are based on studies of kidney
disease and solid tumors.
ESAs do not increase survival time. Some studies have shown improved quality of
life (QOL) with ESA therapy, while others have shown no improvement. Studies in
patients with solid tumors have shown an increased incidence of blood clots in the
veins (venous thromboembolic events), higher rates of cancer recurrence near the
original site, and increased mortality. This is especially true in patients treated for
anemia not caused by chemotherapy and in those who received ESA treatment
when their hemoglobin levels were above 12 g/dL.
For any patient with anemia due to chemotherapy, there should be careful
consideration and discussion between patient and physician of all the possible
benefits and risks of ESA therapy before it is started.
Esophagitis - Inflammation of the esophagus from radiation therapy. The symptoms

are variable, although can include chest pain or pain with swallowing.
Extensive stage - The staging system used for small cell lung cancer is the
Veteran's Administration Lung Group system. It classifies small cell lung cancer into
2 groups, limited stage disease and extensive stage disease. Cancer that has
spread from one side of the chest to the lung or lymph nodes on the opposite side of
the chest, or to any other area in the body, is classified as extensive stage disease.
Approximately two-thirds of people with small cell lung cancer have extensive stage
disease at the time of diagnosis.
Fatigue - Fatigue is a feeling of being tired, exhausted, weary, or energy depleted.

Patients may also feel weak and dizzy. It is associated with a desire for rest or sleep.
Some patients report difficulty thinking, forgetfulness, and an inability to concentrate.
There are no medical tests to measure fatigue.
Fatigue can be a common side effect of cancer, cancer therapy (surgery,

chemotherapy, radiation therapy), and anemia. No one knows the exact cause of
cancer-related fatigue, but causes are usually multiple. Any physical or emotional
change can deplete energy. Varying levels of fatigue may be experienced depending
on the individual patient situation and treatment(s). Patients experiencing persistent
and more severe fatigue may have a diminished quality of life because they are just
too tired to participate in the activities of daily living or work. Fatigue related to
cancer treatment is usually temporary, and the energy level improves over time
when treatment is completed. For patients with severe fatigue due to anemia caused
by the cancer treatment, there is an effective medication that can be given to
improve the anemia, which in turn improves the fatigue and quality of life. Talk with
your doctor or oncology nurse about your fatigue. Ask whether there are things you
can do to help you feel better. Your fatigue is often related to your treatment.
Understanding more about your fatigue can help you better plan your activity and
rest periods. This can help you feel more in control of your life.
First line chemotherapy - A group of chemotherapy drugs that are first used to
treat a cancer. These drugs are referred to as "first-line chemotherapy." First line
therapy drugs are considered to be the best and most effective in treating a cancer.
If first line therapy drugs quit working, then "second-line chemotherapy" drugs are
used.
Food and Drug Administration (FDA) - The Food and Drug Administration (FDA)
is an agency within the U.S. Public Health Service, which is a part of the Department
of Health and Human Services. It is the FDA's job to see that food is safe and
wholesome, cosmetics won't hurt people, and medicines and medical devices are
safe and effective. See also glossary term Labeled indications.
Growth factors - One of the important advances in treatment of cancer has been
the development of "growth factors." Growth factors are not anticancer medicines
(drugs); they are specially designed drugs used to prevent or minimize the bone
marrow suppressive effects of chemotherapy and, in some cases, radiation therapy.
Bone marrow is the soft, sponge-like tissue found inside the center of bones.
Bone marrow is responsible for the production of all blood cells, including red blood
cells (RBCs), white blood cells (WBCs), and platelets. Red blood cells carry oxygen
to the body tissues. White blood cells (there are actually five different types of white
blood cells) fight infections. The most important WBC for fighting infections is the
neutrophil. Platelets are small cells that travel to injured parts of the body to help
form blood clots and stop bleeding or bruising after cuts or injuries.
The bone marrow is highly sensitive to the effects of chemotherapy and radiation
therapy. It is easily damaged or destroyed as part of the cancer treatment process,
resulting in "bone marrow suppression." Bone marrow suppression, also called bone
marrow depression or myelosuppression, leads to a decrease in the number of red
blood cells, white blood cells (especially neutrophils), and platelets. The term "low
blood counts" is often used to refer to this fall in the number of blood cells.
A blood test called a CBC (complete blood count) is often used to detect low blood
counts. When low blood counts occur with cancer treatment (due to bone marrow
suppression), anemia, infection, and bleeding can result.
Growth factors were developed to promote the bone marrow's production of blood
cells to bring them back to normal levels quickly. Three types of growth factors are
available for cancer patients experiencing bone marrow suppression, especially if
associated symptoms are present such as fatigue (from anemia), a major or
persistent infection with fever, or bleeding or bruising. These include synthetic forms
of erythropoietin to promote red blood cell growth, called erythropoiesis stimulating
agents (Epogen®, Procrit®, or Aranesp®); one for neutrophils (Neupogen® or
Neulasta®); and one for platelets (Neumega®).
These special medicines help minimize the consequences of low blood counts
including hospitalization, the need for IV (intravenous) antibiotics or blood cell
transfusions, or a delay or decrease in cancer treatment. This is important, as delays
in cancer treatment or reductions in the planned dose can affect the overall
effectiveness of the chemotherapy or radiation therapy.
Growth factors are given by an injection (a shot) into the subcutaneous tissue (the
tissue underneath the top layer of skin). They are well tolerated by most patients with
few side effects.
It is important to note that not all patients need growth factors during cancer
treatment. Your doctor will decide if growth factors are appropriate for you based on
your personal situation, cancer therapies, expected toxicities, and your response to
treatment. The use of drugs to stimulate the production of red blood cells is generally
restricted to patients who develop anemia after chemotherapy if their hemoglobin
(the protein in RBCs) falls below 10 g/dl. This limited use is based on the results of 2
clinical studies that showed increased risks of death and locoregional cancer
recurrence in patients who had received these drugs to treat anemia that was not
caused by chemotherapy.
Hair loss and scalp irritation - Radiation therapy affects the rapidly dividing cells of
the body such as the hair follicles. So radiation therapy to the head can cause hair
loss. Alopecia is the medical term for hair loss. After approximately two weeks of
radiation therapy, the hair will gradually thin. It may take three to six months for the
hair to regrow. Depending on the dose of radiation to the scalp, permanent hair loss
or thinning may occur. Because hair loss can effect a person’s feelings about
themselves and is sometimes a visible and public reminder their cancer, hair loss
can be emotionally upsetting regardless of the amount of mental preparation done
before it happens.
Irritation of the scalp can also occur. Radiation therapy may irritate the skin in the
treatment area causing redness, warmth, swelling, tenderness, dry or moist skin
("weepy") peeling, itching, or irritation of the hair pores in the treatment area. These
changes may cause some temporary, mild discomfort but will resolve once treatment
is completed and the skin has time to heal. The radiation doctor or nurse will provide
special scalp care instructions. It is important to discuss scalp care with your doctor
or nurse even before skin irritation develops since some everyday shampoos and
conditioners may contribute to skin irritation when combined with radiation therapy.
Hearing loss - Cisplatin or carboplatin (platinum drugs), chemotherapy drugs used

to treat small cell lung cancer, can cause damage to the nerves that supply the inner
ear. This can result in ringing in the ears (called tinnitus), loss of balance and
possible hearing loss that involves the high frequency range of sounds. Usually,
normal conversation tones are not affected. The risk for hearing loss is cumulative,
meaning that the risk of experiencing this complication increases over time as more
drug is received. In rare cases, hearing changes can occur after the first dose of
cisplatin. Hearing loss may be temporary or permanent and may affect one or both
ears. Cisplatin is more likely to cause hearing changes than carboplatin. You should
report any ringing or decreased ability to hear normal conversation to your doctor
promptly.
Histology - The study of the structure and function of tissues of the body.
Kidney dysfunction - Cisplatin and carboplatin, chemotherapy drugs used to treat

small cell lung cancer, can cause temporary or permanent kidney damage resulting
in abnormal kidney function tests and changes in the kidney’s ability to filter body
wastes and regulate important blood chemicals such as sodium, potassium, calcium,
and magnesium. Cisplatin more commonly causes kidney changes than carboplatin.
There are usually no symptoms. Kidney function is evaluated by blood tests. The
doctor will order these tests before therapy begins and will periodically recheck them
to monitor for changes in kidney function.
To help prevent kidney damage, intravenous (IV) fluids are given before and after
cisplatin therapy, along with special medication if necessary. For some patients,
dose adjustments are made or the drug may need to be discontinued. Because
carboplatin is much less toxic to the kidney, it does not require additional IV fluids or
special medication.
Labeled indications - FDA approval for a drug or device is based on clinical trials
that prove its safety and effectiveness. The approval is for use of the drug or device
specifically as it was used in those trials and only for patients with similar diagnoses
as those who participated in the trials. This indicated use is called "on-label" use.
Once approved, however, doctors often prescribe the drug or device for similar
patients who do not have the specific clinical characteristics of those for whom the
drug or device was approved. This is called "off-label" use.
It is important to note that some well-accepted and effective treatments are based on
"off-label" use of drugs or devices. At the same time, however, some off-label uses
are ultimately abandoned when further research or observation suggests that they
are not as safe or effective as once thought.
Likelihood of overall survival - The likelihood that people with small cell lung
cancer survived all causes of death, including their cancer, at a specific point in time.
This probability is reported as a percentage.
Likelihood of surviving small cell lung cancer - The likelihood that people with
small cell lung cancer survived their cancer at a specific point in time.
Likely freedom from brain metastases - The likelihood that small cell lung cancer
has not spread to the brain.
Likely freedom from disease progression - The likelihood that at a particular time,
there are no signs that the small cell lung cancer has grown larger, extended into
nearby tissues, or spread to distant sites, based on various tests to detect
metastases.
Likely freedom from distant metastases - The likelihood that patients with
localized small cell lung cancer does not have signs, symptoms, or test results that
indicate the disease spread to other parts of the body at a specific point in time.
Likely freedom from recurrence - The likelihood that a patient with small cell lung
cancer does not have signs, symptoms, or test results that indicate the disease
returned at a specific point in time following treatment.
Limited stage - The staging system used for small cell lung cancer is the Veteran's
Administration Lung Group system. It classifies small cell lung cancer into 2 groups,
limited stage disease and extensive stage disease. Patients who have limited stage
disease have cancer located only in one lung and in lymph nodes on the same side
of the chest. Approximately one-third of patients diagnosed with small cell lung
cancer have limited stage disease at the time of diagnosis. Cancer that has spread
to the other lung, to lymph nodes on the other side of the chest, or to any other area
is classified as extensive stage disease.
Lobectomy - Lobectomy is a surgery to remove one lobe of a lung. There are 3

lobes in the right lung, called the upper, middle and lower lobes. The left lung
contains only 2 lobes, the upper and lower. In this illustration, the darker area
represents the lobe that has been removed. In this drawing it is an upper lobe, but
any lobe can be removed surgically, depending upon which lobe contains the
cancer.
Lung cancer types - Lung cancer is divided into two major classes: small cell lung
and non-small cell lung cancer. Treatments are specific to each category of lung
cancer.
The treatment of other more rare types of lung cancer including mesothelioma are
not included in this Cancer Profiler tool. Some cancers that have begun elsewhere in
the body can spread to the lungs in later stages of the disease, such as in breast
cancer or melanoma. Treatment of this spread to the lungs is described in those

separate Cancer Profiler tools.
Small cell lung cancer (SCLC) is also called "oat cell" because the cells have the
appearance of oat grains. SCLC accounts for about 20% of all lung cancers. It starts
in the hormonal cells and is a more aggressive type of lung cancer than NSCLC
spreading to lymph nodes and other organs more quickly. SCLC most commonly
starts in the central part of the chest (95%). It is very responsive to chemotherapy
and radiation treatments.
Non-small cell lung cancer (NSCLC) is the most common type of lung cancer,
accounting for almost 80% of lung cancers. NSCLC has three major subtypes:
l adenocarcinomas (40%) which usually develops in the outer regions of the

lungs,
l squamous cell carcinomas (30%) which tend to begin in the center of the
lungs and
l large cell carcinomas (10-15%) which often are large tumors and begin in the
outer regions of the lungs.
When found early NSCLC is treated with surgery. More advanced disease is treated
with radiation and chemotherapy.
Lymph nodes - One of numerous round, oval or bean-shaped glands located along
the course of lymphatic vessels throughout the body. Lymph nodes vary in size (1 to
25 mm in diameter) and are part of the body's immune system. Lymph nodes
function as filters, capturing and destroying bacteria. Lymph nodes can also collect
cancer cells. Lymph nodes are also referred to as lymph glands.
Malignant - Cancerous cells that divide and grow without order. Cancer cells can
invade and take over nearby tissues and can spread (metastasize) to other parts of
the body by traveling through the bloodstream and lymphatic system.
Normal cell growth, division to make new cells, and death is an orderly process
controlled by genes that direct replacement of cells as needed. Changes in these
genes can cause abnormal, uncontrolled growth and result in a benign or malignant
tumor.
Benign tumors are made up of cells that appear similar to normal cells but grow in an
abnormal way. Cancer cells have genetic changes that cause unchecked cell
division, invasion of normal tissues, and the ability to metastasize (distant spread) to
other areas of the body.
Characteristics of Normal Tissues, Benign Tumors, and Malignant Tumors

Normal Tissues Benign Tumors Malignant Tumors
(Cancer)
Growth Rate Controlled Abnormal growth- Abnormal growth-
growth- cells are often grow slowly may grow rapidly
replaced as
needed
Patterns of Grow, multiply, May press on Tumors often invade
Growth and die in orderly nearby tissues but and destroy nearby
patterns do not invade tissues
them
Spread to Do not spread Do not spread Cancer cells may
Other Areas (metastasize) to (metastasize) to detach from the tumor
(Metastasis) other areas of the other areas of the and spread to other
body body areas of the body
Blood Supply Malignant tumors
grow their own blood
vessels
-- --
(angiogenesis)
Appearance Normal in size Similar to normal May appear very
and shape cells different than cells of
origin- irregular
shapes
Malignant pleural effusion - An abnormal collection of cancerous fluid building up

in the pleural space (the space between the two separate layers of the pleura, which
is the protective membrane that surrounds the lungs).
Mediastinoscopy - Using a special visualization instrument to view the inside of the

mediastinum (the center of the chest between the lungs) to perform biopsy
procedures of lymph nodes and/or tumors within the mediastinum. It is inserted
through a small incision at the top of the chest.
Medical oncologist - A physician trained in internal medicine who specializes in the

treatment of cancer.
Metastasis - Spread of cancer to other organs or areas of the body from where it
originally started. The original site of cancer (the organ in which it started) is called
the primary tumor or primary cancer/site. Cancer cells in the metastatic sites are the
same type as the cells in the original cancer. They are not different cancers but the
same type of cancer in different areas of the body. Cancer cells may metastasize by
way of the bloodstream or the lymphatic system. Lung cancers can spread to other
organs such as the brain, bones or liver. X-ray studies, CT scans or other scans may
be completed as part of the evaluation to determine the presence of cancer in other
parts of the body.
MRI (magnetic resonance imaging) - Magnetic Resonance Imaging (MRI or MR) is

a sophisticated imaging technique to examine the body using powerful magnetic
fields and radio waves and a computer to produce internal pictures of the body. MRI
offers better visualization of soft tissues and highly detailed information without
exposing the body to radiation. In many instances, it provides more useful images
than CT scanning and ultrasound.
MRI is done in a diagnostic clinic or radiology department of a hospital. A radiologist

(a doctor who specializes in using x-rays, ultrasound, CT, MRI, and other scans to
aid in diagnosis) or qualified radiology technician performs the procedure. The
radiologist or other medical specialist will interpret the results. It takes about 30-90
minutes and is a painless, noninvasive test. Some people may find the noise and
being still and confined in a narrow space upsetting.
Muscle/joint aches, pain - Some chemotherapy drugs cause muscle and joint
aches, pains, weakness and soreness. This is usually felt in the large joints of the
arms or legs, but any joint area of the body can be affected. Muscle and joint pain is
a temporary reaction beginning several days after receiving the drug and resolving
on its own within a few days. If these symptoms become bothersome or interfere
with your daily activities, notify your doctor or oncology nurse so they can advise you
on management.
National Comprehensive Cancer Network (NCCN) Guidelines - The National

Comprehensive Cancer Network or NCCN is an alliance of 21 leading cancer
centers in the United States. The Network was started in 1995 to develop a set of
professional guidelines for cancer care. Step-by-step guidelines have been
developed for diagnosis, treatment and supportive care of the 30 most common
cancer types.
Physicians and researchers who are experts in their fields from the 21 member
institutions develop and update the guidelines based on their evaluation of the best
scientific evidence available. That evidence includes results from clinical trials. The
guidelines are updated regularly as new information becomes available. Guidelines
are available for use by both health care providers and patients. For more
information go to www.nccn.org.
The NCCN and its member institutions are non-profit organizations.
Neurological side effects - The risk of neurological complications will depend on

the area of the brain involved in the surgery and whether normal brain structures and
tissue are affected. If complications occur, they may resolve quickly as brain swelling
decreases, or sometimes they is a prolonged recovery or even permanent disability.
Examples of complications are memory loss, concentration problems, balance
problems, weakness, and mood or personality changes. Your neurosurgeon will
explain what risks are involved with your specific surgery.
Neutropenia - Neutropenia is a decrease in the number of neutrophils that are

circulating in the bloodstream. Neutrophils are one type of white blood cell (WBC),
and are produced in the bone marrow with other blood cells. Neutrophils fight
infection. Many types of treatment for cancer temporarily suppress the bone
marrow's ability to make blood cells, resulting in low numbers of these cells
circulating around the body, including the infection-fighting neutrophils. This
increases the patient's risk of developing an infection, which can be a serious
complication to anti-tumor therapy. The number of these cells is usually checked
between doses of therapy to make sure that the bone marrow has fully recovered
before proceeding with additional therapy.
The neutrophil count is part of a CBC (complete blood count). This is a simple blood
test.
Non-small cell lung cancer - Lung cancer is divided into two major classes: small
cell lung (SCLC) and non-small cell lung cancer (NSCLC). Treatments are specific to
each category of lung cancer. Non-small cell lung cancer is the most common type
of lung cancer, accounting for almost 80% of lung cancers. NSCLC has three major
subtypes: adenocarcinomas (40%) which usually develops in the outer regions of the
lungs, squamous cell carcinomas (30%) which tend to begin in the center of the
lungs and large cell carcinomas (10-15%) which often are large tumors and begin in
the outer regions of the lungs. When found early NSCLC is treated with surgery.
More advanced disease is treated with radiation and chemotherapy.
Oncologist - A doctor who specializes in the diagnosis and treatment of cancer.
Outcome - The term outcome is used in a variety of ways in cancer. The outcome of
a therapy is how effective the therapy seems to be. The term outcome can also be a
predictive term. For example, the outcome of some therapies is not to cure the
cancer but to diminish the effect the cancer has on the patient's quality of life. On a
grand scale, outcomes research will look at many patients who are similar to you
and what happened to them to try and give you a better idea of what each therapy
might mean to your particular case of lung cancer. It is important that the patient and
the physician have a clear understanding of the desired outcome for the patient.
Palliative care - Palliative care as defined by the World Health Organization (WHO)
is the active total care of patients whose disease is not responsive to curative
treatment. Control of pain, of other symptoms, and of psychological, social, and
spiritual problems, is the primary focus. The goal of palliative care is achievement of
the best quality of life of patients and their families. Palliative care affirms life and
regards dying as a normal process, neither hastens nor postpones death, provides
relief from pain and other distressing symptoms, integrates the psychological and the
spiritual aspects of care, offers a support system to help patients live as actively as
possible until death, offers a support system to help the family cope during the
patient's illness and in their own bereavement.
Performance status - An evaluation of an individual's daily activity level and ability

to care for themselves (able to walk, bathe, dress, participate in activities of daily
living, etc.) without the assistance of others. In medical terminology, this functional
level is referred to as an individual's "performance status." Performance status is
often used as criteria for eligibility in a clinical trial or to receive a specific cancer
treatment. Some clinical trials or cancer treatments require a patient to be fully
ambulatory and able to perform self-care to safely receive the treatment.
Peripheral neuropathy - This is a condition where the nerves in the body are
irritated or damaged by some chemotherapy drugs. This is experienced as
numbness, tingling ("pins and needles"), burning and/or weakness in the hands
and/or feet, called "stocking-and-glove distribution". It may feel like your hands or
feet are asleep. Another problem may be constipation or other changes in your
bowel or bladder function. You may have difficulty picking up a coin or buttoning your
shirt or blouse. Symptoms usually begin after multiple treatments over several
months, although symptoms can occur after a single dose. Symptoms can range
from mild to severe in the individual patient. They normally go away after completing
treatment and usually require no medication. In rare cases, symptoms may continue
or worsen after therapy has been stopped. However, if you experience any of these
symptoms and they interfere with your comfort or daily activities, let your doctor or
oncology nurse know so they can advise you on management.
PET scan (positron emission tomography) - This test is a highly specialized

diagnostic study that provides information about the extent of cancer spread based
on certain activities of the cells. It records the activity of cells with high metabolic
activity, such as cancer cells. It is a painless procedure that can last anywhere from
15 minutes to 2 hours depending on the area of the body being scanned.
A PET scan uses a small dose of a radioactive chemical, called radionuclide,

combined with a sugar that is more readily taken up by active cells. Cancer cells
grow at a faster rate compared to healthy tissue, so the tumor cells will use up more
of the sugar which has the radionuclide attached to it. When injected into the patient,
the radionuclide emits a specific type of radiation called positrons. A PET scanner
will rotate around the part of the body being studied to detect the positron emissions
and a computer records the measurements of glucose used to produce a picture
which is color-coded.
Other imaging studies used in cancer like the CT scan and MRI scan produce
images of internal organs or other structures. A PET scan assesses chemical and
physiological changes related to metabolism. This is important because these
chemical and physiological functional changes often occur before structural changes
in tissues. Therefore PET images may demonstrate pathological changes before
they would be revealed by CT and MRI scans. PET scans are being used in cancer
to:
l Distinguish benign from malignant tumors

l Stage cancer by showing cancer spread (metastasis) anywhere in the body
l Measure whether or not treatment therapies are working
Currently PET scans are used in some cases for breast, colorectal, ovarian,
lymphoma, lung, melanoma, and head & neck cancer.
Studies are in progress to determine additional usefulness of the PET scan in these
and other cancers. PET scan can also give physicians information about neurologic
conditions and heart disease.
Platelets - Platelets are the cells that circulate in the blood that help clot blood. If
there are low numbers of platelets, clotting will be delayed. Platelets are created in
the bone marrow, which is very sensitive to certain types of cancer treatment. The
bone marrow is frequently temporarily suppressed from either chemotherapy or
radiation therapy. In that case, the number of platelets will be decreased, thereby
increasing the patient's risk of major bleeding from lack of clotting ability.
The platelet count is easily checked as part of a simple blood test, the CBC
(complete blood count). It is important that the blood counts have recovered after
therapy before the next dose of treatment is given.
Pleura - The two layered membrane that lines the outside of the lungs and is
between the lungs and the chest wall. The inside layer closest to the lungs is called
the visceral pleura. The outside layer closest to the chest wall is called the parietal
pleura. There is a very thin space between the two layers of pleura, called the
pleural space. The pleural space contains liquid that acts as a lubricant so the two
layers can move against each other normally as breathing occurs.
Pleural effusion - The pleura is a two layer membrane that covers and protects the
lungs. The outer layer is attached to the chest wall and is called the parietal pleura.
The inner layer is called the visceral pleura. Between the two layers, there is a
potential very thin space, called the pleural space. In many disease states, both
malignant and non-malignant, extra fluid can cause a build-up of fluid in the pleural
cavity. The fluid is called a pleural effusion.
Small amounts of fluid can be tolerated in some people without any symptoms,
although as it grows larger, most people develop symptoms. The symptoms
frequently include pain in the chest, increasing coughing and breathing difficulty. A
pleural effusion can be seen on a chest x-ray or CT scan.
Primary therapy - The primary or main treatment (therapy) for a given cancer. Other
therapies may be added to the primary treatment. In this case, these therapies are
called "adjuvant therapy." The decision for adjuvant therapy depends on the
individual patient’s situation.
Prognosis - A prediction about the possible outcome of a disease.
Prophylactic cranial irradiation - (proh-fih-LAK-tik KRAY-nee-ul ir-RAY-dee-AY-

shun) – Prophylactic cranial irradiation (PCI), just like radiation to other parts of the
body, is the use of high-energy radiation. Radiation works by directly damaging the
DNA in the cancer cells. Normal brain tolerates small, daily doses of radiation
relatively well in comparison to tumor cells. This radiation is directed at the whole
brain. PCI is recommended for patients with limited stage small cell lung cancer who
are in complete remission after chemotherapy and chest radiation therapy.
Radiation oncologist - A cancer physician who specializes in using radiation to

treat cancer.
Radiation skin reactions - Skin changes can occur with external beam radiation
therapy. Radiation therapy may irritate the skin in the treatment area causing
redness, warmth, swelling, tenderness, dry or moist skin ("weepy") peeling, itching,
or irritation of the hair pores in the treatment area. Hair loss on the chest may also
occur. These changes may cause some temporary mild discomfort but will resolve
once treatment is completed and the skin has time to heal. The radiation doctor or
nurse will provide special skin care instructions. It is important to discuss skin care
with your doctor or nurse even before skin irritation develops, since some everyday
skin-care products may contribute to skin changes when combined with radiation
therapy.
Radiation Therapy - Radiation therapy (or radiotherapy) is the use of high-energy

radiation. This high-energy radiation is used because it concentrates the radiation
dose on the tumor while “sparing” the tissues that are not likely to contain cancer
cells. Radiation works by damaging the DNA in the cancer cells making it difficult or
impossible to repair radiation-induced injury with the goal that these cancer cells will
then die. It is considered "local" therapy as it only affects a small area of the body—
the tumor and surrounding area.
RBC (red blood cell) - RBC (red blood cell) is a blood cell that is produced in the
bone marrow and circulates around the body. Its purpose is to carry oxygen. Some
therapies for cancer cause temporary suppression of the bone marrow, resulting in
low numbers of the cells in the blood. A low number of RBCs is called anemia and
may have symptoms such as low energy, paleness, and shortness of breath (in
severe cases).
Checking the RBC count is part of a CBC (complete blood count), which is a simple
blood test that is usually performed between treatments for cancer. It is important
that the bone marrow suppression caused by the treatment be resolved before
giving the next dose of therapy.
Recurrence - Refers to cancer that has come back or returned after being treated.
The time to cancer recurrence, measured in months to years, is an important factor
when considering the best and most appropriate treatment of the recurrence.
Relapse - Refers to cancer that has come back or returned after being treated. Also
called a recurrence. Patients who experience relapse may be able to have additional
treatment.
Remission - The decrease or disappearance of disease. When the signs and

symptoms of cancer go away, the disease is said to be "in remission." A remission
can be partial, meaning that some but not all signs and symptoms go away, or
complete meaning that all signs and symptoms of cancer go away. A remission can
also be temporary or permanent.
Response to treatment - Refers to the effectiveness of the cancer treatment. A

complete response means that there has been a complete disappearance of cancer
cells as measured by physical exam, laboratory values and/or x-ray studies. This is
also referred to as remission. A partial response means that there has been some
shrinkage of the cancer as measured by physical exam, laboratory values or x-ray
studies. Response to treatment will affect further treatment recommendations.
Risk - Relative risk refers to a difference between two things expressed as a ratio.
Relative risk, relative rate, rate ratios, and odds ratios are all examples of relative
differences. By itself, the relative risk of something happening only gives you half the
picture. To understand the actual, or absolute risk you must know the starting point.
In the representation below, the starting risk or absolute risk of contracting disease x
is 1 chance in 50.
When exposed to substance y, the absolute risk doubled from 1 in 50 to 2 in 50.
When you compare the two risks, however, it is said that the exposure doubled the
risk, or increased the relative risk by 100% for those exposed to the substance
compared to or relative to those not exposed to the substance.
Even with the exposure, however, it is important to know that the actual or absolute
risk remains quite small at 2 in 50 or 4%.
Second-line chemotherapy - Chemotherapy given when cancer recurs or returns

and has failed first-line chemotherapy, which is the first chemotherapy given after
diagnosis.
Side effects - An undesirable effect or problem that occurs when a treatment

(surgery, chemotherapy, radiation therapy) affects normal, healthy cells. Common
side effects of standard cancer treatments are fatigue, nausea, vomiting, decreased
blood cell counts, hair loss, decreased appetite and mouth sores. New treatments
being tested may have these or other unknown side effects.
Side effects of best supportive care - Side effects (undesirable effects of a

treatment) can occur with most cancer treatments, even treatment aimed at
providing comfort or relieving symptoms of the disease. The side effects that you
may experience will depend on the specific medical treatment. Treatments for
cancer symptoms may include medicines, radiation, and/or non-surgical procedures.
Your doctor and nurses will review the pros, cons, and potential side
effects/complications of the treatment with you, as well as strategies for managing
the side effect.
Size of brain metastasis - Refers to the size in centimeters of the largest brain
tumor. This measurement is indicated on your CT or MRI brain scan report. Some
brain tumors less than 4 centimeters (1.5 inches) in size may be appropriate for
radiosurgery as a treatment option.
Small cell lung cancer - Lung cancer is divided into two major classes: small cell
lung (SCLC) and non-small cell lung cancer (NSCLC). Treatments are specific to
each category of lung cancer. Small cell lung cancer (also called "oat cell" because
the cells have the appearance of oat grains) accounts for about 20% of all lung
cancers. It starts in the hormonal cells and is a more aggressive type of lung cancer
than NSCLC spreading to lymph nodes and other organs more quickly. SCLC most
commonly starts in the central part of the chest (95%). It is very responsive to
chemotherapy and radiation treatments.
Standard treatment - The best treatment currently known for a cancer based on
results of past clinical research studies.
Stereotactic radiosurgery - Stereotactic radiosurgery is a non-invasive technique

that delivers a single high dose of radiation to a small, well-defined area in a one-day
session. The radiation dose falls off very sharply outside the target so nearby critical
structures and normal brain tissues around the tumor receive a minimal amount of
radiation. This is a treatment option for lung cancer patients who have a single brain
metastasis or in some cases up to three tumors.
Surgery for small cell lung cancer - Surgery to remove the cancer involves
removing the portion of lung that contains the cancer. The standard procedure is
either a lobectomy (removal of a lobe of the lung) or a pneumonectomy (removal of
the entire lung). The surgeon will determine how much of the lung should be
removed based on the size of the tumor, the patient's lung function, and overall
fitness. Surgery is not a standard treatment for small cell lung cancer since the
cancer has frequently already spread beyond the chest and surgery has not been
shown to be of benefit in that case. Surgery for small cell lung cancer may be
performed when the tumor is small and peripheral, or away from the center of the
chest and an accurate diagnosis is not easily obtained unless surgery is done.
Surgical wound infection - Infection of the surgical wound or incision may occur
after the operation. An infection may delay the wound healing and overall recovery
and increase the scarring of the incision. Signs and symptoms of an infection may
include new or increased pain, tenderness, redness, swelling, and warmth in the
area, yellow-green drainage, or fever. If any of these occur, contact your physician
promptly for evaluation and management.
Swelling (edema) of the brain - Swelling (edema) of the brain can be caused by
the tumor itself or from inflammation of the brain tissue as a result of the radiation
therapy or surgery. Surgery can cause fluid from surrounding vessels and tissue to
leak into the area where the tumor was removed and nearby brain tissue. The fluid
from inflammation after radiation or surgery causes increased pressure in the brain
because the skull is a fixed “box” and does not expand with this swelling. This
swelling can cause headache, blurred vision, visual sensitivity to light, nausea,
vomiting and other neurological affects. Steroids are given to reduce this fluid or
inflammation of tissues and control swelling of the brain. They may be used when a
patient complains of these symptoms from the brain swelling. They are used for as
short of period of time as needed and then the dosage is tapered. If used for only a
few days to a week, steroids generally cause no side effects, but used over a long
time or withdrawn without monitoring, steroids may produce several side effects. You
should discuss monitoring of the steroid and all possible side effects with you doctor.
Symptoms of lung cancer - A symptom is a change in normal body function or

sensation that indicates the presence of a medical problem. For example when lung
cancer is in the chest, symptoms can include coughing, wheezing, chest pain,
shortness of breath or hoarseness. If lung cancer has spread beyond the chest, a
patient may experience an abnormality in that body area, like bone pain if cancer
has spread to the bones.
Systemic - Refers to anything that affects the entire body. Chemotherapy is a

systemic treatment for cancer as the medication is administered through a vein into
the blood circulation and is dispensed throughout the body.
Thoracentesis - A procedure that removes fluid from the pleural space (the space
between the lungs and the chest wall). Thoracentesis can also be used to instill
medication in the pleural space. A local anesthetic is injected before a surgical
puncture of the chest wall is done with a large-bore needle to remove the fluid.
Toxicity grades - Side effects or adverse effects of treatments are key components
in evaluating the relative risk and benefit of a given treatment. In an effort to
standardize the evaluation of side effects, researchers have developed several
scales used to grade the severity of side effects. The most commonly used scales
are National Cancer Institute Common Toxicity Criteria version 3.0, and the World
Health Organization Standard Toxicity Scale. On both scales the higher the number,
the more toxic the side-effects of the treatment. Although they differ somewhat in
degree the two are similar in respect to their grades classifications. The scales are
generally:
Grade 1 = Mild side-effects

Grade 2 = Moderate side-effects
Grade 3 = Severe side-effects
Grade 4 = Life threatening or disabling side-effects
Grade 5 = Fatal
Tumor - An abnormal growth of cells that can be benign (non-cancerous) or

malignant (cancer).
Tumor marker - A substance that may be detected in higher-than-normal amounts

in the tissues, blood, or urine of patients with certain types of benign conditions or
cancers. Tumor markers can be produced by a tumor or by the body in response to
the presence of a tumor. However, since tumor markers can also be increased in
some non-cancerous conditions, an increase in a tumor marker is not enough to
diagnose a cancer. If it turns out that the tumor marker increase is related to cancer,
its level may be one of the tests used to monitor response to treatment; it will often
decrease when the tumor is going away and may increase if the tumor has returned
or is progressing.
Small cell lung cancer does not currently have any specific tumor markers.
Evaluation of response to treatment consists of a history and physical examination,
laboratory studies, and imaging studies such a CT scan or PET scan.
Whole brain radiation therapy - Whole brain radiation therapy, just like radiation to
other parts of the body, is the use of high-energy radiation. Radiation works by
directly damaging the DNA in the cancer cells. Normal brain cells tolerate small daily
doses of radiation relatively well in comparison to tumor cells. This type of radiation
is called “external beam radiation” because a beam of energy is directed at the
tumor from outside the body. Whole brain radiation therapy provides effective
palliation and can even provide long term tumor control for small cell lung cancer
(SCLC) patients who are diagnosed with one or more brain metastasis.
X-ray - High-energy electromagnetic waves of very short length that can penetrate
the body and produce pictures.

Cancer Glossary

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Cancer, Health, and Medicine Glossary Page 1 of 22

Acute affects of stereotactic radiosurgery - Very few complications commonly

Allergic reaction to anesthesia - A systemic (affecting the entire body) reaction to

Allergic reaction to chemotherapy - Some chemotherapy medications can cause

Some chemotherapy medications require premedications, which are given before

Anemia - An abnormally low level of red blood cells or hemoglobin. Hemoglobin is a

Anesthesia - The usage of medications to prevent the ability to feel pain.

l General-The use of medications to cause a temporary state of

medications may be given as injections, inhalants or as rectal suppositories.

Antigen - A protein found on a foreign substance (such as a virus, bacteria, or

Cancer - A general term for tumors or abnormal growths characterized by abnormal,

Cancer Close-up View

Two prophylactic vaccines have been shown effective in preventing infection by

How is a cancer vaccine administered?

What are the known side effects?

CAT scan or CT scan - refers to computed axial tomograph (CAT), a diagnostic

Chemoradiation - Chemoradiation combines chemotherapy and radiation therapy

Chemotherapy - Chemotherapy is the use of drugs (often called "anticancer drugs")

Chemotherapy and radiation therapy - The combination of chemotherapy and

Chemotherapy for relapsed or progressive disease - Chemotherapy that is used

Combination chemotherapy - More than one (usually 2 to 4) different anticancer

Common postoperative effects of surgery - Normal and expected postoperative

Common side effects of chemotherapy - Side effects (undesirable effects of a

Corticosteroids - A large family of chemical substances, comprising many

with steroid therapy and a short interruption of radiation.

Diagnosis - The procedure(s) by which a disease is identified.

Erythropoietin - Erythropoietin (eh-rith-ro-POH-ee-tin) is a naturally occurring

l Epoetin alpha and darbepoetin are indicated for chemotherapy-related

In addition, ASH recommends caution in application of risks to hematologic

Esophagitis - Inflammation of the esophagus from radiation therapy. The symptoms

Fatigue - Fatigue is a feeling of being tired, exhausted, weary, or energy depleted.

Fatigue can be a common side effect of cancer, cancer therapy (surgery,

Hearing loss - Cisplatin or carboplatin (platinum drugs), chemotherapy drugs used

Kidney dysfunction - Cisplatin and carboplatin, chemotherapy drugs used to treat

Lobectomy - Lobectomy is a surgery to remove one lobe of a lung. There are 3

cancer or melanoma. Treatment of this spread to the lungs is described in those

l adenocarcinomas (40%) which usually develops in the outer regions of the

Characteristics of Normal Tissues, Benign Tumors, and Malignant Tumors

Malignant pleural effusion - An abnormal collection of cancerous fluid building up

Mediastinoscopy - Using a special visualization instrument to view the inside of the

Medical oncologist - A physician trained in internal medicine who specializes in the

MRI (magnetic resonance imaging) - Magnetic Resonance Imaging (MRI or MR) is

MRI is done in a diagnostic clinic or radiology department of a hospital. A radiologist

National Comprehensive Cancer Network (NCCN) Guidelines - The National

The NCCN and its member institutions are non-profit organizations.

Neurological side effects - The risk of neurological complications will depend on

Neutropenia - Neutropenia is a decrease in the number of neutrophils that are

Oncologist - A doctor who specializes in the diagnosis and treatment of cancer.

Performance status - An evaluation of an individual's daily activity level and ability

ambulatory and able to perform self-care to safely receive the treatment.

PET scan (positron emission tomography) - This test is a highly specialized

A PET scan uses a small dose of a radioactive chemical, called radionuclide,

l Distinguish benign from malignant tumors

Prognosis - A prediction about the possible outcome of a disease.

Prophylactic cranial irradiation - (proh-fih-LAK-tik KRAY-nee-ul ir-RAY-dee-AY-

Radiation oncologist - A cancer physician who specializes in using radiation to

Radiation Therapy - Radiation therapy (or radiotherapy) is the use of high-energy

Remission - The decrease or disappearance of disease. When the signs and

Response to treatment - Refers to the effectiveness of the cancer treatment. A

When exposed to substance y, the absolute risk doubled from 1 in 50 to 2 in 50.

Second-line chemotherapy - Chemotherapy given when cancer recurs or returns

Side effects - An undesirable effect or problem that occurs when a treatment

Side effects of best supportive care - Side effects (undesirable effects of a