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Glossary of Terms

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Adjuvant Chemotherapy – sometimes referred to as “preventative chemotherapy,” refers to systemic chemotherapy that is given after a complete CRS. The purpose is to delay or reduce the risk of recurrence, especially in patients with aggressive pathology or positive lymph nodes.

 

Appendectomy – a surgical procedure to remove the appendix, usually associated with treatment for appendicitis (or inflammation of the appendix).

 

Appendix – a small organ connected to the colon (also called the large intestine or large bowel) in the lower right side of the abdomen. It is also referred to as the vermiform appendix.

 

Ascites – refers to the abnormal accumulation of fluid within the abdominal cavity and can be caused by both benign and cancerous conditions. Normally, there is a balance between fluid absorption and secretion in the abdominal cavity. However, when this is disrupted, the buildup of ascites can cause abdominal bloating, swelling, and discomfort. This may be relieved or controlled using outpatient procedures, such as paracentesis, or more definitive treatments, such as chemotherapy or CRS/HIPEC.

 

Bevacizumab (Avastin) – an antiangiogenic agent that prevents the formation of new blood vessels. It is used in combination with systemic chemotherapy to treat a variety of cancers including, colon, ovarian, and appendix. Of note, you should not receive this drug within 8 weeks of undergoing major surgery to minimize the risk of complications related to wound healing.

 

BRCA 1/2 – BRCA1 and BRCA2 are two genes that are important for fighting cancer. Mutations in either of these genes impairs their function and is associated with breast, ovarian, and pancreatic cancers. BRCA mutations can be inherited or random. Certain treatments, such as PARP inhibitors, are designed specifically to treat tumors with BRCA mutations.

 

Capecitabine (Xeloda) – an oral chemotherapy medication used to treat several types of cancer, including colon and appendix. It also has anti-inflammatory properties.

 

Carcinoid Syndrome – refers to a collection of symptoms that occur in patients with neuroendocrine or carcinoid tumors. It occurs rarely in patients with appendix carcinoid tumors and more commonly in patients with small bowel neuroendocrine tumors. Symptoms include diarrhea, flushing, rapid heartbeat, and difficulty breathing. Most symptoms can be managed using a somatostatin analog, such as octreotide.

 

Carcinoid Tumor (also Neuroendocrine Tumor) – refers to rare tumors that develop in cells of the neuroendocrine system, which includes nerve and gland cells. These tumors usually begin in various organs of the gastrointestinal tract.

 

Cecectomy – also referred to as an extended appendectomy, it is the surgical removal of the appendix and cecum, part of the colon that the appendix is attached to. It may be recommended for low-grade appendix tumors that are pushing close to the cecum in order to achieve negative surgical margins.

 

Cecum – the first part of the colon (also called the large intestines or large bowel) that connects to the small intestines. The appendix is also attached to the colon at the cecum.

 

Central Line – an intravenous (IV) catheter that is placed in a large vein leading to the heart to provide long-term access for medications and nutrition.

 

Chemoradiation – a treatment for cancer that combines chemotherapy and radiation therapy. It is commonly used in rectal cancers and for certain types of recurrence for colon cancers. This combination therapy is meant to increase the effectiveness of both treatments and minimize side effects.

 

Chest Tube – tubes placed through the skin into the chest cavity to drain fluid and air from around the lungs.  These are necessary if a patient’s surgery includes the removal of tumors from around the diaphragm, the breathing muscle that separates the abdominal cavity from the chest cavity.

 

Colonoscopy – refers to a non-invasive procedure that allows doctors to examine the inside of the colon and rectum using a flexible tube/camera called a colonoscope. It is not only a way to screen for colon cancer, but also prevent colon cancer from developing through the removal of precancerous polyps. A colonoscopy may also be recommended as part of the preoperative workup before a CRS/HIPEC procedure. 

 

Colostomy – refers to the re-routing of the large intestine by surgically making an opening in the abdominal wall and creating an outlet with a portion of the large intestine in order for the body to pass stool. A colostomy is sometimes required after surgery involving the intestines, such as a hemicolectomy, and may be permanent or temporary.

 

Cytoreductive Surgery (CRS) – refers to the aggressive surgical removal or destruction of cancer. It is performed through an incision down the midline of the abdomen and may include removal of the omentum, spleen, colon, bowel, ovaries, uterus, appendix, liver, gallbladder, peritoneum, lymph nodes, and other abdominal structures. The amount and length of surgery and specific resections required depend on the location and amount of involvement by tumors. Cytoreductive surgery aims to remove all visible disease or, in some cases, to achieve palliation of symptoms.

 

Completeness of Cytoreduction Score (CC-Score) – is a measure from 0-3 of the quality of cytoreduction that was performed. CC-0 and CC-1 are considered to be complete cytoreductions and are associated with the best survival outcomes. CC-2 and CC-3 are called incomplete cytoreductions. In high-grade tumors, CC-0 has better outcomes than CC-1 cytoreduction.

 

Cystic Mesothelioma – very rare non-invasive, likely reactive condition characterized by the presence of mesothelial cysts in the peritoneum. The are commonly called benign cystic mesothelioma or peritoneal inclusion cysts. While considered “benign,” they can cause significant morbidity and are at high risk for recurrence, despite complete surgical removal.

 

Diagnostic Laparoscopy – a minimally invasive procedure that allows your surgeon to look inside your abdomen without a larger operation. In this procedure, a camera is inserted through a small incision in your abdomen. This can help your CRS/HIPEC surgeons better assess the extent of disease, as well as obtain a biopsy to clarify your diagnosis.

 

Endotracheal (ET) Tube – also referred to as a “breathing tube,” this tube is inserted through a patient’s mouth and throat to the trachea, also known as the windpipe, and is connected to a ventilator, or breathing machine, to help a patient breathe.

 

Exploratory Laparotomy – a surgical procedure that involves making an incision on your abdomen so a surgeon can better examine your organs. It is the first step of performing CRS.

 

FOLFIRI – a chemotherapy regimen commonly used to treat colon cancers consisting of the combination of 5-FU, folinic acid, and irinotecan. It can also be given with or without Avastin.

 

FOLFOX – a chemotherapy regimen commonly used to treat colon cancers. It consists of a combination of 5-FU, folinic acid, and oxaliplatin. It is usually the first-choice regimen. However, the oxaliplatin can cause neuropathy so your oncologist may elect to use FOLFIRI if symptoms occur.

 

Germline Mutation – a gene mutation that is inherited and present in all of the cells of your body. You may be recommended to undergo germline genetic testing (usually a blood or saliva test) based on your family history of cancers. The presence of a germline mutation can make you at greater risk for developing cancer and additional regular screening tests may be recommended.

 

Grade – refers to how aggressive a cancer is, which is determined based on how much cancer cells look like normal healthy cells when viewed with a microscope. A less aggressive cancer would be considered low-grade, and a more aggressive cancer would be considered high-grade.

 

Goblet Cell Carcinoma – an aggressive type of mucinous appendix cancer that is commonly mistaken for less aggressive carcinoid/neuroendocrine tumors. It may be mixed with signet ring cells, which results in a poorer prognosis.

 

HAMN – stands for high-grade appendiceal mucinous neoplasm, which is a mucin-producing growth in the appendix that is likely to cause PMP or LGMCP. It is similar to LAMN, but the cells have a slightly more complex architecture, increasing the likelihood of PMP development.

 

Hemicolectomy – refers to the surgical removal of part of the colon and surrounding lymph nodes. A right hemicolectomy is recommended for patients with invasive appendix cancers.

 

HGMCP (PMCA) – stands for high-grade mucinous carcinoma peritonei, formerly known as PMCA (peritoneal mucinous adenocarcinoma), and refers to the spread of mucin and invasive cancer cells throughout the abdominal cavity. It most commonly originates from a mucinous adenocarcinoma of the appendix.

 

Hyperthermic Intraperitoneal Chemotherapy (HIPEC) – refers to the infusion of heated chemotherapy throughout the abdominal cavity. It is performed immediately following cytoreductive surgery and the goal is to treat any microscopic tumor cells that may be left behind. Heating chemotherapy drugs increases the penetration into tissues and potentiates the effects of some chemotherapy drugs. Heat alone can also kill cancer cells.

 

Ileostomy - refers to the re-routing of the small intestine by surgically making an opening in the abdominal wall, and creating an outlet with the very end portion of the small intestine. An ileostomy is sometimes required after surgery involving the intestines and may be permanent or temporary.

 

Intraperitoneal Chemotherapy (IP) – a type of chemotherapy that is infused directly into your abdomen through a port. IP chemotherapy is different from HIPEC because repeated doses at pre-defined intervals and is not heated. IP chemotherapy is most commonly used in ovarian cancer, but it is associated with more port-related complications compared to traditional systemic chemotherapy.

 

Interval Surgery – also referred to as a “sandwich procedure,” it is a treatment approach that involves having systemic chemotherapy before and after CRS. CRS can be performed with or without HIPEC depending on the institution. This approach is reserved for patients who are not candidates for upfront surgery and require a neoadjuvant chemotherapy to shrink tumors and improve performance status.

 

Iterative CRS/HIPEC – also referred to as a repeated CRS/HIPEC, which describes an additional CRS/HIPEC procedure performed for disease recurrence. Each additional CRS/HIPEC poses more challenges for the surgeon given the development of adhesions and scar tissue. However, if the location of the recurrence allows for an additional CRS/HIPEC, this treatment option is likely to provide better survival compared to systemic chemotherapy alone.

 

Jackson-Pratt (JP) Drain – a device that uses gentle suction to drain blood, body fluids, and medicines such as chemotherapies used in treatment out of the abdomen or other surgical areas.

 

LAMN – stands for low-grade appendiceal mucinous neoplasm, which is a mucin-producing growth in the appendix that is likely to cause PMP or LGMCP.

 

LGMCP (DPAM) – stands for low-grade mucinous carcinoma peritonei, formerly known as DPAM (disseminated peritoneal adenomucinosis), and refers to the spread of mucin and scant bland epithelial cells throughout the abdominal cavity. It most commonly originates from LAMN or HAMNs.

 

Lymph Node – a small structure that is part of the immune system. The body contains hundreds of lymph nodes that are connected by lymph vessels.

 

Malignant Peritoneal Mesothelioma – refers to an aggressive form of cancer that originates in the mesothelial cells that line the peritoneal cavity. It has been linked to past asbestos exposure and includes 3 pathologic subtypes, epithelioid, sarcomatoid, and biphasic (mixed epithelioid and sarcomatoid).

 

Mesothelium – a membrane made up of epithelial cells that lines internal organs and body cavities, including the peritoneal cavity.

 

Metastasis – refers to the spread of cancer cells from the area or organ where they first formed to other organs or other parts of the body.  Cancer cells can travel from the original tumor (also referred to as “primary tumor”) through the blood vessels or lymphatic system and form a new, metastatic tumor in a different area.  When this happens, the metastatic tumor is made of the same cancer cells as the primary tumor.  You may also see references to “metastases,” or “metastasize.”

 

Mucin – a jelly-like substance that the body produces to protect the lining of the stomach, intestines, and the appendix.  Certain types of cancer cells produce mucin that may cause organs to rupture, such as the appendix, and build up in the abdomen. This leads to a condition called pseudomyxoma peritonei, or PMP.

 

Neoadjuvant Chemotherapy (NACT) – refers to the cycles of chemotherapy that are given before interval surgery to shrink tumors and help to make them more amenable to be surgically removed.

 

Nasogastric (NG) Tube – a tube placed in a patient’s nose that runs down into the stomach to drain the stomach of any contents until the intestines regain function.

 

Ostomy (Colostomy / Ileostomy) – An ostomy is a surgical procedure where a part of the colon or small bowel is diverted through an opening in the abdominal wall. It can be reversible (temporary) or permanent. It may be required depending on the location of the tumor and the extent of involvement of the colon. The purpose is to allow for complete tumor removal, prevent high-risk postoperative complications, and maintain quality of life.

 

Overall Survival – is used to measure the length of time until death. In cancer research, it is often measured from the time of a certain treatment or diagnosis until death from any cause and helps to provide an expected survival in certain groups of patients. The median overall survival is the amount of time (usually in months) and helps to define the “average” survival time.

 

Palliative Treatment – refers to a treatment that is performed with the purpose to improve or alleviate symptoms rather than for the goal of achieving a cure.

 

Paracentesis – an outpatient procedure usually performed by interventional radiology that is used to drain ascites. This may be repeated as needed to alleviate symptoms.

 

PARP Inhibitor – stands for poly-ADP-ribose polymerase (PARP) and is a special class of drugs used to treat ovarian cancers. They are oral medications, such as Olaparib or Niraparib, that can be used in combination with systemic chemotherapy or alone as maintenance therapy.

 

Patient Controlled Analgesic (PCA) Pump – a device that delivers a prescribed amount of pain medication at a continuous rate via IV and allows a patient to initiate additional medication as needed.

 

Peritoneal Cancer Index (PCI) – a score from 0-39 that surgeons and researchers use to quantify the amount of tumor in the abdominal cavity. This score divides the abdominal cavity into 13 regions and each region is given a score of 0-3 depending on the amount of tumor in that location. While some may try to estimate this on a CT scan or diagnostic laparoscopy, the only accurate way to know this value is at the time of exploratory laparotomy.

 

Peritoneal Carcinomatosis / Peritoneal Metastases – refers to the spread of tumors throughout the abdominal cavity. This can originate from a wide variety of tumors, including the appendix, colon, ovaries, and many other abdominal organs.

 

Peritoneum and Peritoneal Cavity – the smooth, thin membrane that lines the abdominal cavity.  The peritoneum provides a frictionless surface such that internal organs of the abdomen and pelvis may move freely.  The space lined by the peritoneum and containing the abdominal and pelvic organs is also referred to as the peritoneal cavity. 

 

Platinum Resistant – refers to tumors that do not respond to platinum-based chemotherapy agents, such as carboplatin or cisplatin. Tumors that recur within 6 months – 1 year from the date of the last platinum-based treatment are considered to be platinum resistant, limiting the available treatment options.

 

Polypectomy – a procedure in which a polyp is removed from the inside of the colon. Polyps can be cancerous or pre-cancerous. Removing polyps during a colonoscopy is one way to prevent advanced colorectal cancer from developing.

 

Progression Free Survival – also referred to as recurrence-free survival, is the period of time without tumor recurrence or progression. In cancer research, it is often measured from the start of a treatment or diagnosis.  

 

Pseudomyxoma Peritonei (PMP) – the clinical syndrome of a mucinous tumor that has spread throughout the abdominal cavity. It is most commonly caused by mucinous tumors of the appendix and is categorized into LGMCP or HGMCP depending on the architecture of the cancer cells in the mucin.

 

Signet Ring Cell Carcinoma – an aggressive type of mucinous appendix cancer characterized by ring-shaped cells in the mucin. It has a propensity to metastasize to the lymph nodes and may require systemic chemotherapy in addition to CRS/HIPEC.

 

Somatic Mutation – a type of gene mutation that is acquired from environmental triggers or random chance. It is not passed on to or inherited from family members. Cancers develop from somatic mutations and testing on a sample of the tumor can help decipher what is driving your tumor growth and qualify you for targeted treatments or certain clinical trials.

 

Systemic Chemotherapy – also referred to as intravenous (IV) chemotherapy, it is traditional chemotherapy that is given directly into a vein. In this method, the treatment can reach all cells in the body. However, systemic chemotherapy has poor penetration into the peritoneal cavity and localized treatments, such as HIPEC or IP chemotherapy, are more successful at treating this type of metastases.

 

Thoracentesis – an outpatient procedure usually performed by interventional radiology to drain pleural effusions or fluid accumulated around the lungs (pleural cavity). This may be repeated as needed to alleviate symptoms, such as shortness of breath.

 

Total Parenteral Nutrition (TPN) and Intralipids – nutrition that is administered directly into a patient’s vein to provide the body with nutrients (including intralipids, or “liquid fat”) needed to heal until they are able to eat food again.

Adjuvant Chemotherapy
Appendectomy
Appendix
Ascites
TPN
Thoracentesis
Systemic Chemotherapy
Somatic Mutation
Signet Ring Cell Carcinoma
Pseudomyxoma Peritonei
Progression Free Survival
Polypectomy
Platinum Resistant
Peritoneum and Peritoneal Cavity
Peritoneal Carcinomatosis
Peritoneal Cancer Index
Patient Controlled Analgesic
PARP Inhibitor
Paracentesis
Palliative Treatment
Overall Survival
Ostomy
Nasogastric
Neoadjuvant Chemotherapy
Mucin
Metastasis
Mesothelium
Malignant Peritoneal Mesothelioma
Lymph Node
LGMCP
LAMN
Jackson-Pratt
Iterative CRS/HIPEC
Interval Surgery
Intraperitoneal Chemotherapy
Ileostomy
Hyperthermic Intraperitoneal Chemotherapy
HGMCP
Hemicolectomy
HAMN
Goblet Cell Carcinoma
Grade
Germline Mutation
FOLFOX
FOLFIRI
Exploratory Laparotomy
Endotracheal (ET) Tube
Cystic Mesothelioma
Completeness of Cytoreduction Score
Cytoreductive Surgery
Colostomy
Colonoscopy
Chest Tube
Chemoradiation
Central Line
Cecum
Cecectomy
Carcinoid Tumor
Carcinoid Syndrome
Capecitabine
BRCA 1/2
Bevacizumab
Diagnostic Lap

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