Research & Trials > Glossary of Terms
The Colorectal Cancer Association of Canada has compiled an online glossary of colorectal cancer-related terms to help you familiarize yourself with the language used on this site or used by your doctor. The Glossary is designed to help promote awareness and facilitate your understanding of the disease as much as possible.
Click on the letter below to bring you to the desired listing of the alphabet containing the term in question or scroll down to the term you wish to have defined.
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Abdomen: The part of the body between the chest and the pelvis.
Abdominoperineal Resection (APR): Surgical procedure in which some of the organs of the abdomen and pelvis (i.e. sigmoid colon, rectum and anus) are removed through an incision made in the abdomen to prevent further spreading of the cancer. The end of the intestine is attached to an opening in the surface of the abdomen and body waste is collected in a disposable bag outside of the body. This opening is called a colostomy. Lymph nodes that contain cancer may also be removed during this operation. It may be performed for the treatment of rectal cancer.
Acupuncture: The technique of inserting thin needles through the skin at specific points on the body to control pain and other symptoms. It is a type of complementary and alternative medicine.
Adhesion: Scar tissue that binds connecting surfaces; often causes complications, such as pain or constipation, in a post surgical patient.
Adenocarcinoma: Cancer that begins in cells that line certain internal organs and that have glandular (secretory) properties. 90% of all colorectal cancers are adenocarcinoma.
Adenoma: A pre-cancerous (benign) growth that may occur in the colon of glandular tissue that can lead to colon cancer if left untreated. If an adenoma becomes cancerous, it is called an adenocarcinoma. Fortunately, adenomas are easily removed during routine screening tests such as colonoscopy.
Adenopathy: Large or swollen lymph glands.
Adjunct Therapy: Another treatment used together with the primary treatment. Its purpose is to assist the primary treatment. Also called adjunctive therapy.
Adjuvant Therapy: Medical treatment provided to a patient in addition to surgery (or primary treatment) to aid in the killing of cancer cells; adjuvant (meaning one that helps) chemotherapy, biological therapy and radiation therapy are used in colorectal cancer treatment in an effort to eliminate all cancerous cells from the body, increasing the chances for a cure.
Adverse Effect: An unexpected medical problem that happens during treatment with a drug or other therapy. Adverse effects do not have to be caused by the drug or therapy, and they may be mild, moderate, or severe. Also called adverse event.
Aerobic Respiration: A chemical process in which oxygen is used to make energy from carbohydrates (sugars). It is also referred to as aerobic metabolism, cell respiration, and oxidative metabolism.
Alkylating Agents: Alkylating agents inhibit cell division by reacting with DNA and are used as anti-cancer agents.
Alopecia: Loss of hair or baldness, usually temporary, hair may re grow after treatment is finished.
Alternative Treatment: Treatments used in the place of standard mainstream treatments; scientifically unproven therapies.
Anastomosis: Surgically connecting two ends of bowel after resection, may be done at the time of resection or during an ostomy reversal.
Anemia: A condition in which there is a decrease in the number of red blood cell (RBC’s) or hemoglobin (Hg), may occur with chemotherapy or post-operatively, symptoms may include shortness of breath, pale skin (pallor), pale mucus membranes (gums etc.), heart palpitations and tiredness or fatigue.
Angiogenesis: Development of new blood vessels usually feeding a tumor; anti-angiogenesis drugs attempt to block the formation of these blood vessels.
Angiogenesis Inhibitor: A substance that may prevent the formation of blood vessels. In anticancer therapy, an angiogenesis inhibitor may prevent the growth of new blood vessels that tumors need to grow. An example of an angiogenesis inhibitor in colorectal cancer is avastin (bevacizumab).
Anti-angiogenesis: The blockage of the formation of new blood vessels needed for tumor growth and spread through the use of drugs known as anti-angiogenics. An example of such drugs: avastin (bevacizumab).
Antifolate: A substance that blocks the activity of folic acid. Antifolates are used to treat cancer. Also called folate antagonist.
Antioxidant: A substance that protects cells from the damage caused by free radicals (unstable molecules made by the process of oxidation during normal metabolism). Free radicals may play a part in cancer. Antioxidants include beta-carotene, lycopene, vitamins A, C, D and E, and other natural and manufactured substances.
Antibody: A protein in the blood produced by immune cells to fight off diseases.
Antiemetic Remedies intended to control or reduce nausea and vomiting. An example is gravol.
Antigen: A substance that induces antibody production.
Apoptosis: Programmed self-destruction of cells (cell death).
Arterial Access Device: Semi permanent device that allows a doctor or nurse direct access to an artery without having to put a needle in the artery (IV) every time treatment is given. Examples include chemo-port, port or pic-line.
Anus: External opening of the digestive system through which stools are evacuated.
Anxiety: State of intense apprehension, uncertainty, and fear resulting from the anticipation of a threatening event or situation.
Arms (Clinical Trials): Clinical trials can include multiple "arms." Each arm is a study group of patients receiving a specific treatment or combination of treatments that is being compared to other treatment arms as well as to the control arm. The "control arm" is the best available standard treatment.
Ascending Colon: It is the portion of the colon extending from the cecum to the right colic flexure (first bend) or hepatic flexure near the liver. It is approximately 20 cm in length.
Ascites: Abnormal build-up of fluid in the abdomen that may cause swelling or bloating. In late-stage cancer, tumor cells may be found in the fluid in the abdomen. Ascites also occurs in patients with liver disease.
Avastin (Bevacizumab): A biological therapy designed to target the Vascular Endothelial Growth Factor Receptor (VEGFR) on the surface of colorectal cancer cells so that no new blood vessels will be formed for the spread and growth of existing tumors. Known as an anti-angiogenic agent or anti-VEGF.
AZD 2171: A substance being studied in the treatment of some types of cancer such as colorectal. AZD2171 may prevent the growth of new blood vessels that tumors need to grow and may kill cancer cells. It is a type of antiangiogenesis agent and a type of vascular endothelial growth factor (VEGF) receptor tyrosine kinase inhibitor. Also called cediranib and Recentin
Barium X-ray (Barium Enema): Practice of using the metal barium in liquid form, in combination with x-rays, to create a picture of the colon.
Benign: Not cancerous. Benign tumors do not spread to tissues around them or to other parts of the body.
Bevacizumab (Avastin): A biological therapy designed to target Vascular Endothelial Growth Factor Receptors (VEGFRs) on the surface of colorectal cancer cells so that no new blood vessels will be formed for the spread and growth of existing tumors. Known as an anti-angiogenic agent or anti-VEGF.
Best Available Standard Treatment: Also known as the control treatment, the best available standard treatment is the current treatment that has shown the best results in past trials. The standard is evolving as clinical trials identify new treatments with better results. If a patient is in a Phase 3 clinical trial (below), he will get either an ‘experimental’ treatment or the best available standard treatment (control treatment).
Bilirubin: A reddish-yellow pigment that is a constituent of bile and gives it its color and also causes the skin discoloration seen in jaundice when it is elevated.
Biological Therapy: The use of substances that normally occur in the body in small amounts; used in larger doses to treat disease.
Biopsy: Removal of a tissue sample to see if it is cancerous so a to diagnose colorectal cancer.
Bolus Infusion: A single dose of drug usually injected into a blood vessel over a short period of time. Also called a bolus.
Bowel Obstruction: Blockage or clogging of the intestine.
Brachytherapy: A type of radiation therapy in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near a tumor. Also called implant radiation therapy, internal radiation therapy, and radiation brachytherapy.
BRAT Diet: Bananas, Rice, Apple sauce, and Toast diet; this combination of foods can sometimes be used to stop or slow down diarrhea.
Cachexia: General weight loss and muscle wasting that may occur during the course of a chronic illness such as cancer.
Calorie: A unit of measure that reflects how much energy is present in a food.
Camptosar (Irinotecan): A chemotherapy drug sometimes known as CPT-11, interferes with DNA replication. It is administered in first and second line therapy in the treatment of colorectal cancer.
Cancer: A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is cancer that begins in the skin or in tissues that line or cover internal organs, such as colon or rectum. Sarcoma is cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord.
Carcinomatosis: A condition in which cancer is spread widely throughout the body, or, in some cases, to a relatively large region of the body. Also called carcinosis
Capecitabine (Xeloda): An oral drug used to treat colon cancer. It is taken up by cancer cells and breaks down into 5-fluorouracil, a substance that kills tumor cells. Xeloda is a type of antimetabolite.
Carcinoembryonic Antigen (CEA): A protein marker in the blood that may be present with some cancers and other diseases; may be used in some cases of colorectal cancer to monitor response to treatment or disease recurrence.
Carcinogen: Cancer-causing agent.
Carcinoma: Cancer derived from the cells lining organs or epithelial tissue.
CAT Scan (CT Scan): A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized axial tomography, computed tomography (CT scan), or computerized tomography.
CEA: Carcinoembryonic antigen. A substance (protein) that is sometimes found in an increased amount in the blood of people with certain cancers, such as colorectal cancer, that may assist in the monitoring of treatment response and with disease recurrence.
Cecum: The first part of the large intestine, located on the right side of the abdomen that is attached to the small intestine. The appendix lies at the lowest portion of the cecum.
Cell: The smallest living unit capable of independent existence. Humans are made up of billions and billions of cells.
Cell Proliferation: An increase in the number of cells as a result of cell growth and cell division
Cetuximab (Erbitux): Monoclonal antibody that binds to the Epidermal growth Factor Receptor (EGFR) inhibiting cell proliferation (growth), metabolism and angiogenesis. Known as an anti-EGFR therapy.
Chelating Agent: A chemical compound that binds tightly to metal ions. In medicine, chelating agents are used to remove toxic metals from the body. They are also being studied in the treatment of cancer.
Chemoembolization: A procedure in which the blood supply to the tumor is
blocked surgically or mechanically and anticancer agents are administered
directly into the tumor. This permits a higher concentration of drug to be
in contact with the tumor for a longer period of time, while depriving the tumour of oxygen and nutrients. The procedure is used to treat primary liver cancer or cancer that has metastasized to the liver from colorectal cancer for example.
Chemotherapy: The treatment of disease by chemical agents.
Clinical Study: A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis, or treatment of a disease. Also called clinical trial.
Colectomy: An operation to remove all or part of the colon. When only part of the colon is removed, it is called a partial colectomy. In an open colectomy, one long incision is made in the wall of the abdomen and doctors can see the colon directly. In a laparoscopic-assisted colectomy, several small incisions are made and a thin, lighted tube attached to a video camera is inserted through one opening to guide the surgery. Surgical instruments are inserted through the other openings to perform the surgery.
Colitis: Inflammation of the colon.
Colon: The part of the large intestine that extends from the end of the small intestine (cecum) to the rectum.
Colonoscope: Flexible, elongated tube that can be inserted through the anus and passed through the colon allowing visualization of the inside of the colon.
Colonoscopy: Visual examination of the inner surface of the colon by means of a colonoscope.
Colostomy: Procedure to create an opening of the colon through the skin of the abdomen to allow for the passage of feces; also the opening itself.
Compassionate Use Trial: A way to provide an investigational therapy to a patient who is not eligible to receive that therapy in a clinical trial, but who has a serious for life-threatening illness such as cancer for which other treatments are not available. Also called expanded access trial.
Complimentary Therapy: Treatments used along with standard mainstream treatments usually to help relieve symptoms or to help the patient feel better.
Constipation: A condition in which stool becomes hard, dry, and difficult to pass, and bowel movements don’t happen very often. Other symptoms may include painful bowel movements, and feeling bloated, uncomfortable, and sluggish.
Continuous Infusion: The administration of a fluid into a blood vessel, usually over a prolonged period of time.
Conventional Therapy: A currently accepted and widely used treatment for a certain type of disease, based on the results of past research. Also called conventional treatment.
CT Scan: Computed tomography scan; special type of x-ray that uses a computer to give the doctor a more detailed look at the internal organs than a regular x-ray.
Curative Treatment: Treatment for a disease that is intended to cure the patient of the disease. Also called adjuvant therapy.
Cytoreductive Surgery: Surgical removal of the major portion of the material composing a lesion. Also called debulking.
Debulking: Surgical removal of the major portion of the material composing a lesion. Also known as Cytoreduction.
Decadron (Dexamethasone): Is a steroid drug used to treat allergies or inflammation. It is administered with chemotherapy to help treat the nausea that may result from the treatment.
Dehydration: The loss of total body water; in colorectal cancer, this can occur because of vomiting, diarrhea, or low fluid intake.
Depression: A psychological disorder with symptoms such as sadness, inactivity, difficulty in thinking and concentration, significant increase or decrease in appetite and time spent sleeping, feelings of dejection and hopelessness, and sometimes thoughts of suicide.
Descending Colon: It is the portion of the colon on the left side of the abdomen that extends from the bend below the spleen (splenic flexure) to the sigmoid flexure. It is approximately 30 cm in length.
Dexamethasone (Decadron): Is a steroid drug used to treat allergies or inflammation. It is administered with chemotherapy to help treat the nausea that may result from the treatment.
Differentiated: Refers to how specialized a cell is to perform a specific function; in cancer, the more specialized or differentiated the cancer cell is, the closer to normal it is.
Distal Colon: Left side of the colon including the descending colon, sigmoid colon and rectum up to the splenic flexure.
Diverticulitis: A lower gastrointestinal condition characterized by the inflammation of a diverticulum (pouch), especially of diverticula (plural) occurring in the colon, which may undergo perforation with abscess formation. The condition may be relieved by resecting the affected bowel section.
Diverticulum: A pouch or sac branching out from a hollow organ or structure, such as the large intestine.
EGFR (Epidermal Growth Factor Receptor): A protein on the surface of some tumor cells, which may increase growth and spread of the cancer.
Electrolyte: Any of various ions, such as sodium, potassium, or chloride, required by cells to regulate the electric charge and flow of water across the cell membranes.
Eloxatin (Oxaliplatin): A platinum-based chemotherapeutic drug belonging to a class of drugs known as alkylating agents which stops the growth of cancer cells. It is administered in first and second line therapy in the treatment of colorectal cancer together with 5FU and folinic acid known as the regimen folfox.
Enterostomal Therapist: Nurse or therapist who specializes in the care and maintenance of a stoma or an ostomy.
Epidermal Growth Factor Receptor (EGFR): A protein on the surface of some tumor cells, which may increase growth and spread of the cancer.
Erbitux (Cetuximab): A biological chemo agent (monoclonal antibody) that targets cells that express EGFR which increases cell growth, metabolism and angiogenesis.
Erythema: Redness of the skin.
External Beam Radiation Therapy (EBRT): The sending of radiation from outside the body toward a tumor or potential tumor site inside the body.
Fat Soluble Vitamin: A vitamin that can dissolve in fats and oils. Fat-soluble vitamins are absorbed along with fats in the diet and can be stored in the body’s fatty tissue. They come from plant and animal foods or dietary supplements. Vitamins A, D, E, and K are fat-soluble.
Familial Adenomatous Polyposis (FAP): This is a hereditary condition caused by a faulty gene. Most people discover that they have it at a young age. People with FAP grow many polyps in the bowel. These are mostly benign, but because there are so many, it is really a question of time before one becomes cancerous. Since people with FAP have a very high risk of developing bowel cancer, bowel resection is thus often indicated.
Feces: The matter discharged from the bowel during bowel movements consisting mostly of the waste material from food.
Fellow: Doctor who has completed his or her residency (general training), but is specializing in a field such as medical oncology or radiation oncology. A fellow is under the supervision of a senior physician.
Fiberoptic: Thin fibers of glass or plastic inside an instrument that allow the inside of the body to be seen.
Fistula: An abnormal opening or passage between two organs or between an organ and the surface of the body. Fistulas may be caused by injury, infection, or inflammation, or may be created during surgery.
FIT (Fecal Immunochemical Test): There is a new class of occult blood tests called Fecal Immunochemical Tests. These tests detect the globin in feces rather than heme. Globin is the protein constituent of hemoglobin. By detecting globin, the tests are both more sensitive and specific for lower gastrointestinal bleeding.
Fluoropyrimidine: One of a group of substances used to treat cancer. A fluoropyrimidine is a type of antimetabolite. Examples are capecitabine, floxuridine, and fluorouracil (5-FU).
5-FU (Fluorouracil): A drug that is used in the treatment of cancer. It belongs to the family of drugs called anti-metabolites. Also called fluorouracil. It interferes with DNA and RNA replication in cells.
FOBT (Fecal Occult Blood Test): is a screening test that is performed on samples of stool in order to detect occult blood (blood that is not visible to the naked eye) in otherwise normal-colored stool.
Folate: Synthetic form of the vitamin Folic Acid (Vitamin B9).
FOLFOX: An abbreviation for a type of combination chemotherapy that is used to treat colorectal cancer. It includes fluorouracil, leucovorin, and oxaliplatin.
Folinic Acid (Leucovorin): A drug used to increase the effectiveness of 5FU in treating colorectal cancer. It is related to vitamin B9 (folic acid) and can help protect normal cells in the digestive tract from chemo-induced damage.
Food and Drug Administration (FDA): A regulatory agency whose role it is to oversee the pharmaceutical research conducted by drug companies, university research centers and physicians to ensure that federal regulations governing this research are followed in the U.S.
FOLFIRI: An abbreviation for a type of combination chemotherapy that is used to treat colorectal cancer. It includes fluorouracil, leucovorin and irinotecan.
Free Radical: A highly reactive chemical that often contains oxygen and is produced when molecules are split to give products that have unpaired electrons (a process called oxidation). Free radicals can damage important cellular molecules such as DNA or lipids or other parts of the cell.
Genetic Material: Material that gives us heredity from our parents; genes are made up of DNA (deoxyribonucleic acid).
Globin: The protein component of hemoglobin.
Gluten: Wheat gum; the protein part of wheat and some other grains.
Glycemic Index: A ranking (1-100) assigned to carbohydrates according to their effect on the body’s blood sugar levels two hours after a meal has been ingested. A low GI meal takes longer to digest and releases sugar into the bloodstream more slowly than a high GI meal.
Glycolysis: The generation of energy from glucose (sugar) without requiring oxygen.
Gray: Unit of measure used by radiation oncologists to calculate the amount of radiation used in cancer treatments.
Hematochezia: Bloody stools.
Heme: The deep red, iron component of hemoglobin.
Hemoglobin: The iron-containing respiratory pigment in red blood cells that carry oxygen throughout the body, consisting of about 6% heme (iron component) and 94% globin (protein component).
Hepatic Arterial Infusion (HAI): The delivery of chemotherapeutic agents to the liver through a catheter placed in the hepatic artery. This is most often done in the operating room with general anesthesia and an open procedure. A pump is implanted percutaneously (under the skin) for delivery of chemotherapy. The type and the schedule of chemotherapy delivered via the pump will depend on the physician. Generally, the pump is filled with chemotherapy once a month. Body temperature and the mechanism of the pump allow chemotherapy to be delivered continuously at a slow rate directly to the liver. The physician may choose to also give systemic chemotherapy in conjunction with HAI.
Hepatic Flexure: The bend or turn in the colon where the ascending colon joins the transverse colon.
Hereditary Non-Polyposis Colon Cancer (HNPCC): An inherited disorder in which affected individuals have a higher-than-normal chance of developing colorectal cancer and certain other types of cancer, often before the age of 50. It is also referred to as Lynch Syndrome.
Histologic Grade: A microscopic measure of how aggressive a tumor is. Grade I-well differentiated, which represents the least aggressive type of cancer. Grade II-moderately differentiated, Grade III-poorly differentiated and Grade IV-undifferentiated which represents the most aggressive type of cancer.
Hospice: A special kind of care for people in the final phase of illness; the care may take place in the patient’s home or in a homelike facility.
Hyperbilirubinemia: Elevated bilirubin levels.
Hypertension: Elevated blood pressure.
Hyperthermic Intraperitoneal Chemotherapy (HIPEC): the bathing of the abdominal organs with conventional chemotherapeutic drugs heated to such a high temperature as to kill cancer cells immediately following peritoneal surgery. A higher dose of medication can be used than would normally be tolerated by a patient if given intravenously. It is employed in the treatment of peritoneal mets arising from colorectal cancer.
Hypoxia: Deprived of an adequate oxygen supply.
Ileostomy: Surgical creation of an artificial opening through which the last segment of the small intestine discharges digestive waste material directly to the outside of the body through the skin.
Immune System: System of the body that is responsible for fighting off disease, which include B-cells that produce antibodies and T-cells which destroy invaders.
Immunomodulator: Drug that alters, suppresses, or strengthens the body’s immune system.
Informed Consent: The principle of informed consent means that patients have the right to be fully informed about a trial before agreeing to participate in that trial. The patient receives complete trial information, including treatment specifics, potential risks, benefits and side effects. The patient must sign an "informed consent form" before he or she is allowed to participate. If the protocol changes during the trial, the informed consent process is repeated.
Infusion: Introduction of fluid or medicines (such as saline solution or chemotherapy drugs) into an artery or vein. The infusion may be given over several hours or days.
Institutional Review Board (IRB): Each research institution has an Institutional Review Board. The IRB, which includes non-medical and medical people, reviews all protocols for patient safety. The board also reviews the consent information given to patients who are thinking about participating in the trial, to make sure that it is written in clear, understandable language.
Insulin-like Growth Factor -1 Receptor (IGF-1R): A growth factor that plays an important role in cell proliferation (growth) and survival. The IGF-1 receptor is highly over expressed in many malignant tissues.
Intern: Doctor in his or her first year of training after graduating from medical school; an intern is under the supervision of other doctors.
Intraoperative Radiotherapy (IORT): Radiation treatment given during an operation that takes place inside the body.
Irinotecan (Camptosar): A chemotherapy drug, sometimes known as CPT-11, that interferes with DNA replication. It is administered in first and second line therapy in the treatment of colorectal cancer.
Kinase: A type of enzyme that activates or inactivates one or more specific substrates (compounds – often other enzymes) by phosphorylating them (transferring phosphate groups to them).
Kras Status: Refers to either the presence of a mutation in the Kras gene which occurs in 30-40% of the colorectal cancer population or lack of mutation which is referred to as Kras wild type, occurring in approximately 60-70% of the population. Kras mutation status is predictive of response to anti-EGFR therapies such as erbitux and vectibix. Only the wild type population will demonstrate a positive response to these therapies.
Laparotomy: A surgical incision made in the wall of the abdomen.
Large Intestine: Refers to the last part of the digestive tract; it is divided into sections: ascending beginning at the cecum on the right side also known as proximal colon; transverse which is horizontal; descending which is on the left side also known as the distal colon; and ends with the sigmoid and the rectum. The primary function is the absorption of water and vitamins and the formation and collection of feces. It is also responsible for bacterial production. Cancer can occur anywhere in the large intestine with 39% occurring in the proximal colon, 25% occurring in the distal colon and 36% in the rectum. (Data Source: National Cancer Incidence Reporting System  – Canadian Cancer Registry 1992-1996)
Leucovorin (Folinic Acid): A drug used to increase the effectiveness of 5FU in treating colorectal cancer. It is related to vitamin B9 (folic acid) and can help protect normal cells in the digestive tract from chemo-induced damage.
Local Excision: Act or procedure of removing a diseased part by surgical means; local excision is the removal of the diseased tissue close to the affected organ.
Low Anterior Resection (LAR): Surgical procedure used to remove the cancerous tissue associated with colorectal cancer.
Lymph Nodes: Bean-like structures throughout the body that are part of the immune system that help the body fight off infection by producing white blood cells (lymphocytes).
Mammalian Target of Rapamycin (mTOR): A kinase protein found predominantly in the cytoplasm of the cell that acts as a central regulator of many biological processes that are essential for cell proliferation (growth), angiogenesis (blood vessel formation), and cell metabolism. mTOR is deregulated in many types of cancer.
Medical Oncologist: A doctor who specializes in diagnosing and treating cancer using chemotherapy, hormonal therapy, and biological therapy. A medical oncologist often is the main health care provider for someone who has cancer. A medical oncologist also gives supportive care and may coordinate treatment given by other specialists.
Metabolism: The total of all chemical changes that take place in a cell or an organism. These changes make energy and the materials needed for growth, reproduction, and maintaining health. They also help get rid of toxic substances
Metachronous Colorectal Cancer Tumours: Are second primary colorectal tumours that are discovered in the colon or rectum some time after the diagnosis of the first primary tumour.
Metastasis: Spread of a disease from the part of the body where it started (primary) to another part of the body beyond the regional lymph nodes.
Metastasize: To pass into or invade by metastasis. (see above)
Methotrexate: a chemotherapy drug used to treat cancer. It acts as an antimetabolite (inhibitor of normal metabolic processes) and specifically as a folic acid antagonist that inhibits the production of DNA, RNA and protein.
Microspheres: Are resin (Sirspheres) or glass (Theraspheres) beads containing Yttrium-90 (radiation) that is used for the treatment of unresectable metastatic liver tumours arising from primary colorectal cancer. They are injected via a catheter through the groin’s femoral artery into the hepatic artery delivering millions of microspheres directly into either the right or left lobe of the liver, where the beads break down to allow beta radiation to be released so as to target the liver tumours while sparing healthy liver tissue.
Microsatellite Instability: A change that occurs in the DNA of certain cells (such as tumor cells) in which the number of repeats of microsatellites (short, repeated sequences of DNA) is different than the number of repeats that was in the DNA when it was inherited. The cause of microsatellite instability may be a defect in the ability to repair mistakes made when DNA is copied in the cell. Also called MSI.
Microwave Therapy: A type of treatment in which body tissue is exposed to high temperatures to damage and kill cancer cells or to make cancer cells more sensitive to the effects of radiation and certain anticancer drugs. Also called microwave thermotherapy.
Milk Thistle: A plant that has been used in some cultures to treat certain medical problems, including stomach, liver, and gallbladder disorders. The active extract of milk thistle seeds is called silymarin. It is being studied in the prevention of liver damage caused by some cancer treatments. Also called Silybum marianum.
Mismatch Repair Status: Refers to the system within the cell responsible for correcting errors in DNA that works by detecting and replacing bases in the DNA that are wrongly paired (mismatched bases). The system repairs the mismatch. Tumours are either classified as either MMR deficient (loss of tumour mismatch repair function) or MMR competent (possessing tumour mismatch repair function).
Mitomycin C: A chemo drug known as an antibiotic, but acts as an alkylating agent. It stops cells from making DNA, which results in cell death. It is used to treat colorectal cancer.
Monoclonal Antibody: A laboratory-produced substance that can locate and bind to cancer cells wherever they are in the body. Many monoclonal antibodies are used in cancer detection or therapy; each one recognizes a different protein on certain cancer cells. Monoclonal antibodies can be used alone, or they can be used to deliver drugs, toxins, or radioactive material directly to a tumor. Examples in the treatment of colorectal cancer are avastin, erbitux and vectibix.
MRI: Magnetic Resonance Imaging – specialized way to look at the organs of the body using magnetic energy and a computer.
Mucosa: The wall of the colon is composed of four layers. The first layer is the mucosa which consists of a single layer of cell lining which is flat and regenerates itself every three to eight days. Small glands lie beneath the surface of this layer.
Mucositis: A complication of some cancer therapies in which the lining of the digestive system becomes inflamed. It is often seen as sores in the mouth.
Multimodality Treatment: Therapy that combines more than one method of treatment.
Muscularis Propia: The wall of the colon is composed of four layers. The third layer consists of the muscularis propria, which consists of an inner circular and outer longitudinal muscle layer.
Mutation: Any change in the DNA of a cell. Mutations may be caused by mistakes during cell division, or they may be caused by exposure to DNA-damaging agents in the environment. Mutations can be harmful, beneficial, or have no effect. If they occur in cells that make eggs or sperm, they can be inherited; if mutations occur in other types of cells, they are not inherited. Certain mutations may lead to cancer or other diseases.
Nasogastric (NG) tube: A tube that is passed through the nose and down through the nasopharynx and esophagus into the stomach. It is a flexible tube made of rubber or plastic, and it has bidirectional potential. It can be used to remove the contents of the stomach, including air, to decompress the stomach, or to remove small solid objects and fluid, such as poison, from the stomach. An NG tube can also be used to put substances into the stomach, and so it may be used to place nutrients directly into the stomach when a patient cannot take food or drink by mouth.
National Cancer Institute (NCI): NCI is a U.S. federal agency that oversees the nation’s cancer research programs. Many clinical trials are funded by and/or conducted with NCI. There are also NCI Cancer Centers around the country in the U.S.; these are clinical and research facilities that meet NCI criteria and standards for cancer research. The criteria and list of the centers can be found at http://cancercenters.cancer.gov.
Nausea: A symptom resulting from the inclination to vomit.
Necrosis: Refers to the death of living tissues
NED: No evidence of disease.
Needle Biopsy: The removal of tissue or fluid with a needle for examination under a microscope. When a wide needle is used, the procedure is called a core biopsy. When a thin needle is used, the procedure is called a fine-needle aspiration biopsy.
Neoadjuvant Therapy: A treatment given before the primary therapy. Chemotherapy and radiotherapy are often given before surgery to reduce the size of a tumour or to render surgery less complicated. Hence, the chemotherapy and radiotherapy would in this case be considered the neoadjuvant therapy.
Neoplasm: An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Neoplasms may be benign (not cancer), or malignant (cancer). Also called tumor.
Neuroendocrine Tumour (NET): Rare tumours that originate from the neuroendocrine cells throughout the body and are capable of producing various peptides (proteins).
Neuropathy: a problem with the nerves that carry information to and from the brain and spinal cord. This can produce pain, loss of sensation, tingling and numbness. Chemo-induced neuropathy can occur with the administration of the chemotherapeutic agent oxaliplatin which has a tendency to inflict neuropathy in the hands and feet through a cumulative effect.
Neutropenia: Presence of abnormally low numbers of white blood cells (neutrophils) in the circulating blood lowering the body’s ability to fight off infection.
Nodule: A growth or lump that may be malignant (cancer) or benign (not cancer).
NSAID: Non-steroidal anti-inflammatory drug. Examples are aspirin, ibuprofen, naproxen, sulindac and celebrex. Some research suggests that NSAIDs reduce the risk of precancerous lesions in the colon.
Nurse Practitioner (NP): A nurse who has a Master’s or Doctorate degree who is able to diagnose, prescribe medications and order diagnostic tests.
Nutritional Supplement: A product that is added to the diet. A nutritional supplement is taken by mouth, and usually contains one or more dietary ingredients (such as vitamins, minerals, herbs, amino acids, and enzymes). Also called dietary supplement.
Octreotide: A drug similar to the naturally occurring growth hormone inhibitor somatostatin. Octreotide is used to treat diarrhea and flushing associated with certain types of tumors.
Off-Label: Use of a drug for a disease or condition other than the indication for which it was approved by the FDA or Health Canada.
Open Label Study: A type of study in which both the health providers and the patients are aware of the drug or treatment being given.
Ostomy: Artificial stoma, or opening, from the digestive system to the skin, may be permanent or reversible. See anastomosis. Examples are colostomy (colon) and ileostomy (small bowel).
Overall Survival (OS): Refers to the period of time cancer patients are alive after they were diagnosed with or treated for their disease. Overall survival is often referred to in a study or treatment group. The overall survival rate is often stated as a five year survival rate, which is the percentage of people in a study or treatment group who are alive five years after diagnosis or treatment.
Oxaliplatin (Eloxatin): A platinum-based chemotherapeutic drug belonging to a class of drugs known as alkylating agents which stops the growth of cancer cells. It is administered in first and second line therapy in the treatment of colorectal cancer together with 5FU and folinic acid (folfox).
Oxidative Phosphorylation: The generation of energy utilizing oxygen. It is significantly more efficient than glycolysis.
Oxidative Stress: The creation of free radicals (reactive oxygen species) which are oxygen molecules containing unpaired electrons that have a tendency to reek havoc within the interior of the cell thereby possibly contributing to the onset of degenerative diseases over a long period of time. Consequently, it is a condition in which antioxidant levels are lower than normal. Antioxidant levels are usually measured in blood plasma.
Palliative Treatment: Treatment that relieves symptoms, such as pain, but is not expected to cure the disease. The main purpose is to improve the patient’s quality of life. Also called palliative care; supportive care.
Panitumumab (Vectibix): Monoclonal antibody used to treat colorectal cancer that has the Epidermal Growth Factor Receptor. Monoclonal antibodies are a manmade version of an immune system protein that fits like a lock and key with a certain protein on the surface of cancer cells. This drug stops colorectal cancer cells from growing and dividing and it may also help by tagging the cancer cells for destruction by the body’s immune system cells.
Parametrium: Area around the uterus or womb in women.
Partial Response (PR): A result of cancer treatment that was not able to completely rid the body of the cancer, but did result in either stopping the growth of tumor(s) or caused shrinkage in the tumor(s).
Pathologist: A doctor who examines the cells and tissues removed during surgery.
Pelvic Exenteration: Surgical removal of all of the organs of the pelvis; performed to treat cancers of the rectum or other pelvic organs.
Pelvis: Area of the body surrounded by the hips; includes for example the bladder, prostate, and uterus.
Performance Status: A measure of how well a patient is able to perform ordinary tasks and carry out daily activities. A scale of 0-4 is used when assessing patients’ performance status, zero being optimal and four being poorest.
Peritoneum: The part of the body that is a thin membrane lining the organs of the abdomen.
Peritonitis: Inflammation of the lining of the abdomen.
PET Scan: Positron emission tomography – specialized way to look at the organs of the body according to how fast they metabolize (use up) sugar; can be used to detect cancerous cells. Cancer cells have a high metabolism and absorb sugar faster than non-cancerous cells.
Phases for Cancer Trials: A trial’s phase defines the type of testing occurring at a specific point. Clinical trials for anti-cancer drugs are conducted in three phases:
- Phase 1 trials: 10 - 80 patients are enrolled to test dosage levels and the best way to apply the treatment (pills or injections; daily, hourly, weekly or continuously); side effects are monitored and used to determine the appropriate dosage levels for Phase 2 testing
- Phase 2 trials: 40 - 300 patients to examine the effectiveness and safety of the treatment for selected types of cancers
- Phase 3 trials: 300 - 5,000 patients, systematically compares the outcomes — the effectiveness and side effects — of the current standard of care treatment to the experimental treatment(s).
The phase of the trial is not necessarily related to the stage of the cancer being studied. There are Phase 1 trials for all stages of cancer.
Phosphatase & Tensin Homolog (PTEN): An enzyme that acts as a tumour suppressor. Defective PTEN plays a role in many cancers, including colorectal cancer.
Placebo: Compound with no real effect on the body (usually sugar) that is identical in appearance to the drug that is undergoing experimental research.
Polyp: Mass of tissue that bulges or projects outward or upward from the epithelial lining of the digestive tract. Adenomatous polyps are the most common and most likely to become cancerous in the colon.
Polypectomy: Surgical removal of a polyp.
Port: Small, semi-permanent device that allows for the introduction of drugs (like chemotherapy) into a patient’s artery or vein without the need for repeated IVs.
Portal Vein Embolization (PVE): Treatment of liver metastases arising from primary colorectal cancer causing the atrophy or shrinkage of a part of the liver and the hypertrophy or extra growth of the remaining liver so that surgical removal of the diseased site of the liver can be facilitated once shrunk.
Progression Free Survival (PFS): The length of time during and after treatment in which a cancer patient is living with their disease that does not get worse. Progression free survival is often used in a clinical study or trial to help find out how well a new treatment works. It is also referred to as “disease free survival”. Progression Free Survival Rate is often stated as a five year rate, which is the percentage of people in a study or treatment group who are disease free five years after diagnosis or treatment.
Prophylactic: A preventive measure.
Proximal Colon: Right side of the colon including the ascending colon.
Protocols (Clinical Trial Protocol): A protocol is a blueprint for the trial, which describes how the trial will proceed, what types of patients will be eligible for the trial, the number of patients required, and the type of care they will receive and so on. All protocols are reviewed by the sponsoring group (for example, the NCI, Health Canada, FDA or pharmaceutical company etc.) and the IRB (Institutional Review Board) of the institution where the research is being conducted to ensure patients are fully informed and that risks are minimized. See phases above.
Radiofrequency Ablation (RFA): causes the cellular destruction of soft tissue by destroying them with heat. Heat is generated through agitation caused by alternating electrical current (radiofrequency energy) moving through tissue. The heat results in local cell coagulation: coagulated cells die and cannot continue to grow. The patient undergoing radiofrequency ablation receives local anesthetic for pain control. A thin needle is inserted into the tumor, visualized by CT scan or MRI, and electrical current is passed through the tip of the needle which becomes very hot and destroys the tumor. The procedure lasts 10 - 15 minutes and the patient goes home on the same day. The majority of patients do not experience side effects and resume normal activity the following day. RFA can be administered as a therapy for colorectal cancer that has metastasized to the liver, provided size and number of lesions do not exceed certain parameters.
Radiation Oncologist: Doctor who specializes in the treatment of cancer using radiation therapy.
Radiation Pneumonitis: Inflammation of the lungs as a result of radiation therapy administered.
Radiation Therapist: Person who assists the radiation oncologist and who usually delivers the daily radiation treatments.
Radiation Therapy: Use of radiation (high energy x-rays) to eliminate or alleviate symptoms associated with tumors by shrinking or eliminating the tumors. In some cases, it is used prior to surgery for rectal cancer as neoadjuvant therapy.
Radioisotope: An unstable form of a chemical element that releases radiation as it breaks down and becomes more stable. Radioisotopes may occur in nature or be made in a laboratory. In medicine, they are used in imaging tests and in treatment. Also called radionuclide.
Randomize: To arrange into a grouping by chance; usually associated with clinical trials.
Rectum: The last part of the large intestine where stool is stored prior to evacuation through the anus (external opening of the digestive system).
Recurrence: Cancer that has come back after treatment. Local recurrence means that the cancer has come back at the same place as the original cancer. Regional recurrence means that the cancer has come back in the lymph nodes near the first site. Distant recurrence is when cancer metastasizes after treatment to organs or tissues (such as the lungs, liver, peritoneum, or brain) farther from the original site than the regional lymph nodes.
Remission: In oncology, a period of time during which there is an apparent absence of cancer in the body.
Resection (colectomy): Surgical removal of diseased tissue of the colon with a margin of normal tissue and regional (nearby) lymph nodes. Resections may be partial or limited depending on the extent of the disease. Resections may also occur in the liver (hepatic) and lungs (pulmonary) as well as in other organs of the body.
Resident: Doctor who has completed his or her first year of training (internship) after graduating medical school, but who is still in the process of his or her general training; residents are supervised by other doctors.
Response Rate: the percentage of patients in a trial or study whose cancer shrinks or disappears after treatment is administered.
Screening: The search for disease, such as cancer, in people without symptoms.
Serosa: The wall of the colon is composed of four layers. The fourth layer consists of the serosa, which is the outer, single-cell, thick covering of the bowel. It is similar to the peritoneum, the layer of cells that line the abdomen.
Sessile Polyp: Flat polyp
Sigmoid Colon: That portion of the left colon situated in the pelvis and extending from the descending colon to the rectum. It is an S-shaped segment that measures approximately 46 cm in length.
Sigmoidoscopy: Inspection, through a fiber optic scope, of the inside of the sigmoid colon which is the part of the large intestine that empties into the rectum.
Signaling Pathway: An ordered sequence of biochemical reactions carried out within a cell that is controlled by specific enzymes. They enable the cell to perform key functions and respond to its environment.
Simulation: Process before radiation therapy in which the doctor and therapists measure the patient and decide how to direct the radiation.
Situational Anxiety: A painful or apprehensive uneasiness due to a stressful situation such as a long-term illness.
Splenic Flexure: The bend in the colon where the transverse colon merges into the descending colon.
SRT (Stereotactic Radiation Therapy): Specialized type of external beam radiation therapy that uses focused radiation beams to target a well defined tumour, through the use of computerized three dimensional treatment planning and precise treatment set up enabling the radiation dose to be delivered with extreme accuracy. It is may be administered to treat liver metastases that arise from colorectal cancer with parameter restrictions.
Stage: Period in the course of a disease. In cancer, a description of the extent of cancer involvement of the various parts of the body represents the stage. See TNM below.
Standardized Uptake Value (SUV): When undergoing a PET scan, the utilization of FDG (radioactive sugar) by the body’s cells can be reflected in a numerical assignment called the SUV. The greater the SUV, the greater the glucose utilization because the more metabolically active the lesion is in the body. An SUV of 5 means that region has an intensity of FDG 5 times greater than the average cell in the body.
Stoma: Artificial opening between a body cavity or canal (such as the colon) and the skin.
Stomatitis: Refers to redness or irritation around the stoma of an ostomy site.
Stool: Discharge of the bowels; the digestive waste matter discharged in a movement of the bowels; may also be referred to as feces.
Submucosa: The wall of the colon is composed of four layers. The second layer consists of the submucosa. This is the area between the mucosa and circular muscle layer that is separated from the mucosa by a thin layer of muscle, the muscularis mucosa.
Support Network: Friends, family, coworkers, and others who provide care during a person’s lifetime, but particularly when illness strikes.
Survivor: An individual is considered a cancer survivor from the time of diagnosis, through the balance of his or her life. Family members, friends, and caregivers are also impacted by the survivorship experience and are therefore included in this definition.
Synchronous Tumours: Metastatic tumours discovered elsewhere in the body at the same time as the primary tumour in the colon or rectum.
T Cell: A type of immune cell that can attack foreign cells, cancer cells, and cells infected with a virus. T cells can also help control immune responses. A T cell is a type of white blood cell. Also called T lymphocyte and thymocyte.
Tegafur-Uracil: A substance being studied in the treatment of some types of cancer. It is a combination of tegafur and uracil. The tegafur is taken up by the cancer cells and breaks down into 5-FU, a substance that kills tumor cells. The uracil causes higher amounts of 5-FU to stay inside the cells and kill them. Tegafur-uracil is a type of antimetabolite. Also called Ftorafur, UFT, and Uftoral.
Thoracic Surgeon: A surgeon who specializes in operating on organs inside the chest, including the heart and lungs.
Thoracoscopy: Examination of the inside of the chest, using a thoracoscope. A thoracoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease.
Thrombocytopenia: A condition in which there is a lower-than-normal number of platelets in the blood. It may result in easy bruising and excessive bleeding from wounds or bleeding in mucous membranes and other tissues
TNM (Tumor Node Metastasis) Classification: System to evaluate cancer based on the T - extent of tumor invasion, N - lymph node involvement, and M - metastasis observed (other than regional lymph nodes); the number following each letter represents the extent to which each area is involved. The numbers can extend between 0 and 4.
Tomotherapy: A type of therapy in which radiation is aimed at a tumor from many different directions. The patient lies on a table and is moved through a donut-shaped machine. The radiation source in the machine rotates around the patient in a spiral pattern. Before radiation, a 3-dimensional (3-D) image of the tumor is taken. This helps doctors find the highest dose of radiation that can be used to kill tumor cells while causing less damage to nearby tissue. Tomotherapy is a type of intensity-modulated radiation therapy (IMRT). Also called helical tomotherapy.
Total Mesorectal Excision (TME): The sharp dissection of the mesorectum (tissue behind the rectum) under direct vision, permitting enbloc resection (as a whole) of an intact rectal tumour together with its lymph vessels and support structures. Evidence supports superior treatment outcomes with this new surgical standard of rectal tumour removal.
Total Parenteral Nutrition (TPN): Nutrition for the body that is infused directly into the veins, bypassing the digestive system. It is used for patients who cannot or should not get their nutrition through eating. TPN may include a combination of sugar and carbohydrates (for energy), proteins (for muscle strength), lipids (fat), electrolytes, and trace elements. An individual’s solution may contain all or some of these substances, depending on their condition.
Transabdominal Ultrasound: A procedure used to examine the organs in the abdomen. The ultrasound device is pressed firmly against the skin of the abdomen. Sound waves from the device bounce off tissues and create echoes. A computer uses the echoes to make a picture called a sonogram
Transanal Endoscopic Microsurgery: Minimal invasive surgery for early stage rectal cancer in which the surgeon removes the tumour while looking through a tube into the rectum of the patient.
Trans Fat: A type of fat that has certain chemical properties and is usually found in processed foods such as baked goods, snack foods, fried foods, shortening, margarine, and certain vegetable oils. Eating trans fats increases blood cholesterol levels and the risk of heart disease.
Trauma: Injury to the body, or an event that causes long-lasting mental or emotional damage.
Transverse Colon: The portion of the large intestine passing transversely across the upper part of the abdomen, between the right and left colic flexures (turns) also known as the hepatic and splenic flexures. It is approximately 46 cm in length.
Tumor Board Review: A treatment planning approach in which a number of doctors who are experts in different specialties (disciplines) review and discuss the medical condition and treatment options of a patient. In cancer treatment, a tumor board review may include that of a medical oncologist (who provides cancer treatment with drugs), a surgical oncologist (who provides cancer treatment with surgery), and a radiation oncologist (who provides cancer treatment with radiation). Also called multidisciplinary opinion.
Tumor Burden: Refers to the number of cancer cells, the size of a tumor, or the amount of cancer in the body. Also called tumor load.
Tumor Debulking: Surgical removal of as much of a tumor as possible. Tumor debulking may increase the chance that chemotherapy or radiation therapy will kill all the tumor cells. It may also be done to relieve symptoms or help the patient live longer. Also called debulking.
Tumor Marker: A substance that may be found in tumor tissue or released from a tumor into the blood or other body fluids. A high level of a tumor marker may mean that a certain type of cancer is in the body. Examples of tumor markers include CA 125 (in ovarian cancer), CA 15-3 (in breast cancer), CEA (in colorectal, ovarian, lung, breast, pancreas, and other gastrointestinal tract cancers), and PSA (in prostate cancer).
Turmeric: An East Indian plant that is a member of the ginger family and is used as a spice and food color. The underground stems are used in some cultures to treat certain stomach problems. The substance in turmeric that gives it a yellow color (curcumin) is being studied in the treatment of cancer, Alzheimer disease, cystic fibrosis, and psoriasis. The scientific name is Curcuma longa. Also called Indian saffron and jiang huang.
Tyrosine Kinase Inhibitor: A drug that interferes with cell communication and growth and may prevent tumor growth. Some tyrosine kinase inhibitors are used to treat cancer.
Urologist: A physician who specializes in urinary or urogenital tract diseases and disorders.
Ulcerative Colitis: This lower gastrointestinal condition is characterized by chronic inflammation of the large intestine and rectum resulting in bloody diarrhea. Surgery may be indicated when medical therapy does not improve the condition. Removal of the colon is curative and also removes the risk of colon cancer.
Vascular Endothelial Growth Factor Receptor (VEGFR): A growth factor receptor that plays a role in both angiogenesis (blood vessel formation) and lymph angiogenesis by attracting and organizing vascular endothelial cells. VEGFR is a key therapeutic target in colorectal cancer. An Anti-VEGF agent in the treatment of colorectal cancer is Avastin (Bevacizumab).
Vectibix (Panitumumab): Monoclonal antibody used to treat colorectal cancer that targets the Epidermal Growth Factor Receptor. (Monoclonal antibodies are a manmade version of an immune system protein that fits like a lock and key with a certain protein on the surface of cancer cells.) This drug stops colorectal cancer cells from growing and dividing and it may also help by tagging the cancer cells for destruction by the body’s immune system cells.
Venous Access Device: Semi-permanent device that allows direct access to a vein without having to place a needle in the vein each time an infusion is given.
Virtual Colonoscopy: Virtual Colonoscopy is a recently developed technique that uses a CT scanner and computer virtual reality software to look inside the body without having to insert a long tube (Conventional Colonoscopy) into the colon or without having to fill the colon with liquid barium (Barium Enema).
Wide Surgical Resection: Surgical procedure used to treat colorectal cancer in which the cancerous colon and an area of normal colon and lymph nodes are removed in an attempt to cure the patient of his or her cancer.
Xeliri: The combination of the two chemotherapeutic drugs irinotecan and xeloda.
Xeloda (Capecitabine): An oral drug used to treat colon cancer. It is taken up by cancer cells and breaks down into 5-fluorouracil, a substance that kills tumor cells. Xeloda is a type of antimetabolite. It is also referred to as capecitabine.
Xelox: The combination of the two chemotherapeutic drugs oxaliplatin and xeloda.
Yttrium 90: An artificial radioactive isotope with a physical half-life of 2.67 days which decays with the emission of beta particles used in radiotherapy in the treatment of such cancers as colorectal cancer (see “Microspheres”)