Glossary / medical dictionary of words commonly associated with primary bone cancer and cancer in general.

If you know the letter that the word begins with, click on the following:

A-G    H-M    N-S    T-Z

Actinomycin D
A chemotherapy drug used in the treatment of sarcomas, such as Ewing's sarcoma. This drug stops cells from dividing properly by preventing a cell from reading its own DNA (a process called 'DNA transcription'). If a cell can't read its own DNA then it can't copy the DNA to make a new cell.

Actinomycin D is given directly into the vein as an infusion, via an Intra Venous drip.

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Adjuvant Treatment
A treatment given 'after' the main or first (primary) type of treatment to remove all the know tumour. For example, primary bone cancer patients will have an operation to remove the tumour, and they will be given chemotherapy treatment after the surgery.

Chemotherapy given after surgery is called 'adjuvant chemotherapy'. The aim of post-operative adjuvant chemotherapy is to kill any cancer cells that could have spread prior to the operation, and to prevent the tumour growing back in the original site.

Adjuvant radiotherapy can be given to the site of a primary bone tumour after an operation to remove it – it's aim is to prevent tumour growing back at the operation site.

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Adolescence, adolescents
The period between the onset of puberty and adulthood. Many physical and mental changes happen during this time.Young people in this age group are sometimes referred to as 'adolescents'. Back to top
Aggressive Cancer
This is the name given to cancer where the tumour cells grow quickly, or spread quickly to other organs in the body. Back to top
Alkaline phosphatase or ALP
ALP is an enzyme found in high levels in healthy bones and in the liver. ALP levels in the blood are an indicator of different things. To test for ALP levels, a blood sample is taken from a patient and sent to the laboratory for testing.

An ALP Test is sometimes carried out as part of a liver function test (LFT). However, in primary bone cancer patients (or people who doctors suspect might have primary bone cancer) ALP levels in the blood are measured because osteosarcoma causes high levels of ALP to be present in the blood.

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Alkylating Agent
Drugs or other substances that interfere with the cell's DNA and slow down or stop cell growth. Some chemotherapy drugs are alkylating agents and are used to inhibit cancer cell growth.

Alkylating chemotherapy drugs chemically alter DNA by adding an alkyl molecule. This changes the shape of the DNA and prevents the DNA being copied to make a new cancer cell.

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When we inherit traits (genes) from our parents we inherit one copy from each parent. This means that for each gene we can inherit two versions the same (e.g. both parents brown-eyed) or two different versions (e.g. one parent blue-eyed and the other parent brown-eyed). The scientific word for each of the two 'versions' of the gene is 'allele'. Back to top
An allograft is a transplantation of an organ or tissue donated by one person and given to another person. Back to top
Alternative Medicine
Alternative medicines or therapies, such as extract of mistletoe (iscador) and laetrile (bitter almonds) are used 'instead' of what are called conventional medicines.

It is important to remember that alternative medicines do not have to go through the very careful testing (trials) that conventional medicines do, and therefore may not be safe. Many alternative medicines are not backed up with scientific evidence that they work at all and therefore are a waste of money and time.

Alternative medicine is sometimes mistakenly included alongside complementary medicine under the name of CAMs (see entry for Complementary and Alternative Medicines) as if they were the same thing. They are not the same, there are important differences. Complementary medicines are taken alongside conventional treatments (to complement the conventional therapies) whereas alternative medicines are used instead of conventional therapies.

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Around 10% of primary bone cancer patients need to have an amputation as part of their treatment. An amputation is surgery to remove a part of the body.

Around 1 in 10 primary bone cancer patients, whose tumour is in an arm or leg, need to have all or part of that limb removed. This could be because the tumour has damaged a joint so badly that it cannot be mended by surgery. Alternatively it could be because the cancer has spread to the major blood vessels or nerves in the limb, and the limb wouldn't be able to work without these.

Patients who have an amputation will be supported by their medical team to make sure that they can live a normal life, and when possible patients may be given a prosthesis (artificial arm/leg) to replace the amputated limb.

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Anaemia is the term for unusually low levels of red blood cells (which contain haemoglobin the molecule that carries oxygen) in the blood. This means that the blood can't carry enough oxygen around the body, and so it can cause tiredness and fatigue. Back to top
The opposite of algesia, it means 'not' being able to feel pain, while awake. Some drugs called analgesics stop patients feeling pain. Back to top
Drugs (medicines) that help to stop patients feeling pain. Examples of analgesics include ibuprofen, paracetamol and codeine. Back to top
A group of drugs that fight infections caused by bacteria. Back to top
Antibody, Antibodies
Antibodies are an essential part of each person's immune system, which is the network of cells and molecules that protects the body against infections by germs (bacteria and viruses).

An antibody is a small molecule that recognises one particular a target on a virus or bacteria. When the antibody recognises its target it alerts other cells in the immune system, which kill the target bacteria or virus. After a person has had an infection (such as chicken pox) once, the body makes antibodies against the infection virus or bacteria that caused it, so usually the person won't ever get ill with the same infection twice.

Cancer is not caused by a bacteria or virus. Therefore it is difficult for a person's immune system to 'see' cancer cells, because the immune system can't recognise the cancer as a bacteria or virus.

A lot of research is being conducted to try to find ways to make cancer patients develop antibodies against their cancer by using vaccines to stimulate their immune system. Some early stage (phase 1) clinical trials are being carried out using these vaccines, but these treatments won't be widely available for patients for some time yet.

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Drugs that stop patients from feeling sick (nausea) or being sick (vomiting). Back to top
Antisense DNA
Antisense DNA is a new type of treatment that is being developed against cancer. This is a way of switching off key tumour-promoting genes and/or genes that are allowing cells to be resistant to chemotherapy or radiotherapy.

This type of therapy is still at an early stage and there are no antisense DNA therapies available for primary bone cancers at the present time.

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Apheresis is the term given to the collection of blood from a donor or patient, followed by the removal of specific parts of the collected blood, such as, red blood cells, white blood cells or plasma. The remaining blood is then returned to the patient or donor. Back to top
Apoptosis is a cell's "self-destruct" sequence. If a healthy cell starts to become cancerous or detects that it is infected or damaged, certain genes trigger apoptosis and the cell dies before it can cause wider problems. In many kinds of cancer the apoptosis genes are damaged (mutated) and so the trigger doesn't work.

The aim of cancer treatment is to kill or remove the cancer cells so that the no more tumour cells are left in the body. There are two main routes to causing cells to die: necrosis and apoptosis. Necrosis is when the cell is killed by physical damage or being starved of oxygen and/or nutrients.

A lot of research is being focussed on ways to activate apoptosis in cancer cells, to compensate for the damaged genes that prevent them from self-destructing.

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Askin tumour
Askin tumour is a kind of cancer called a primitive neuroectodermal tumour (PNET), which belongs to the Ewing's sarcoma family of tumours. Unlike the majority of Ewing’s sarcoma cases which start in the bone, Askin tumour starts in the soft tissue of the chest wall. It was first described in 1974 by an American doctor called Frederic Askin.

The treatment for Askin tumour (surgery/ radiotherapy/ type of chemotherapy drugs) are generally the same as those used to treat Ewing's sarcoma. Back to top
An audiogram is the medical term for a hearing test. One of the long term side-effects of chemotherapy is that some patients' hearing is damaged by the drugs, and so audiograms are used to detect whether the hearing has been damaged.

An audiogram usually involves a patient wearing headphones, which play different sounds at different volumes (loud and quiet) and different pitches (low and high) to tell whether the patient's hearing is in the normal range.

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Audiometry is the branch of medicine that deals with patients’ hearing and deafness. Back to top
Autologous means 'self-to-self'. Examples include an 'autologous stem cell transplant' where the patient's stem cells are taken out of their blood and then given back to the same patient later (after high-dose chemotherapy). Another example is an 'autologous bone graft', where a healthy bone (such as the tibia) is taken out and used to replace a damaged bone, elsewhere in the body. Back to top
The axial skeleton is the part of the skeleton that includes the bones of the centre of the body. This includes the bones of the skull, neck, spine, ribcage, sternum and sacrum. Back to top
A baseline reading is the starting point or healthy test result. For example, a patient might be given a hearing test before they start chemotherapy treatment. This test gives a baseline reading, which later test results can be compared to in order to measure whether the patient's hearing has changed over the course of chemotherapy treatment. Back to top
A benign tumour is a lump of cells that does not have the ability to spread into surrounding healthy tissues or to other parts of the body. This means that benign tumours are not a kind of cancer.

Benign tumours are much easier to treat than cancer and are much less of a risk to a patient's health.

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A drug used as a painkiller and local anaesthetic in the form of a spray. It is used for numbing a sore mouth (ulcers) or throat. This drug belongs to a group of drugs known as non-steroidal anti-inflammatory drugs (NSAIDs). Back to top
Biological Therapy
Biological therapies are a new kind of anti-cancer treatment. Instead of using very strong chemicals, biological therapies try to use a person’s own anti-cancer defences to kill the cancer. Biological therapies do this by stimulating specific cells or genes within cells that will help to defeat the cancer.

Cancer vaccine are a type of biological therapy. These vaccines stimulate a patient’s immune system to turn against the cancer cells and destroy them. These vaccines are being developed for different kinds of cancer but are not widely available for patients as yet.

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An investigation or test that can help a doctor called a pathologist (PATH-oll-OH-jist) to look closely at some of a patient's cells or a piece of tissue.

The process of taking a biopsy involves a surgeon taking a small amount of tissue (or sometimes the whole lump) from the patient's suspected tumour. The small piece of tissue that has been taken out is referred to as a biopsy.

The pathologist looks at the cells from the biopsy under a microscope, and decides what tests to perform to make a diagnosis. By looking closely at the cells of a patient's biopsy, doctors can discover whether a tumour is malignant or benign, and see whether the tumour has spread to nearby tissues.

Bone biopsies should only be performed by a specially trained orthopaedic (bone) surgeon or radiologist. English patients will have their biopsies taken at a Bone Cancer Treatment Centre.

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Bisphosphonates are a class of drugs that help to reduce damage to the bones caused by primary bone cancer, secondary cancers in the bone or osteoporosis.

Bisphosphonates are drugs that switch off a kind of cell called an osteoclast, which are found in all bones. Osteoclasts usually help to remove damaged bone by eating away at the damage so that healthy bone can be made to fill in the gap. In osteoporosis, primary bone cancer and secondary cancers in the bones osteoclasts are too active and cause a lot of damage to the bone. Bisphosphonates have been used to treat osteoporosis for a number of years and now clinical trials are running to see whether these drugs might improve the treatment of primary bone cancers as well.

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Blood Tests
A blood test involves taking a small sample of patient's blood from a vein using a needle (or from a central line, PICC or Portacath®; if a patient has one of these). The sample of blood is tested by laboratory scientists to monitor a patient's general health and check for levels of certain substances or chemicals in the blood.

Types of tests may include:

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Bones help to give the body shape, protect the internal organs, aid movement and help to fight disease.

Bones are hard but they are not solid or dead, they are living parts of the body just like muscles or eyes. Bones have lots of spaces and channels inside, filled with bone cells and blood vessels.

There are different types of bone cells that either 'make' or 'remove' bone to make sure only the right amount is produced. The word 'osteo' is the Ancient Greek word for bone; many medical words are Greek or Latin.

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Bone Cancer Treatment Centre; Bone Cancer Centre
Bone cancer centres are specialist hospital centres. They have a group of healthcare specialists who are experts in the diagnosis and treatment of primary bone cancer.

Most surgery for primary bone cancers in England and Wales is carried out at one the Bone Cancer Treatment Centres. These should also be the place where diagnostic tests, including bone biopsies, are carried out.

  • North of England Bone and Soft Tissue Tumour Service, Newcastle upon Tyne Hospitals NHS Foundation Trust
  • Nuffield Orthopaedic Centre NHS Trust, Oxford
  • Royal National Orthopaedic Hospital, Stanmore, Middlesex
  • The Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Oswestry
  • The Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham

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Bone marrow
Bone marrow is found at the centre of some of the long bones of the body such as the femur, ribs, skull and pelvis. It is a fatty spongy tissue, which holds the stem cells that can make new blood cells. Back to top
Bone Marrow Aspiration
A procedure in which a small sample of bone marrow is removed, usually from the hip bone, breastbone, or thigh bone. The bone marrow is sent to a laboratory to be looked at under a microscope. Back to top
Bone Scan
Bone scans are used to look for abnormalities in bones. Patients who have a suspected primary bone cancer will probably have a full body bone scan. A tiny amount of radioactive substance (radionuclide) is injected into the patient's blood, which is then taken up by the bones fairly quickly (~2-4 hours). During the scan the radioactivity is detected by a specialised camera called a gamma camera.

The radioactivity will collect more at areas of high activity (breakdown and repair) in the bone. This could be caused by a primary bone cancer or secondary bone cancer . The areas of high activity picked up by the gamma camera are known as 'hot spots.'

The scans are carried out in Radiology and Nuclear Medicine Departments. Patients will need to drink lots of fluids before the scan to help the radioactive substance travel to the bones quickly and to encourage the removal of the radionuclide from the system quickly. The results of the scan will be examined by a radiologist and a report will be produced. This may take a few days. Following the scan, the radionuclide will be passed completely from the body in the urine within 24 hours. Back to top
Cancer; cancerous
Cancer is a disease of the body's cells. Throughout a person's life but especially when they are developing and growing, their cells will divide (split in two) to make more cells. This helps to make new bone or muscle as a person grows up, and to replace old or damaged cells throughout life. Usually, cells only divide when the body sends them special signals and the cells 'know' when to stop dividing.

Sometimes, cells start to divide and grow when they should not and they may not stop dividing. When this happens, they may form a lump called a tumour, or a 'growth.' The doctor may alternatively use the word 'neoplasm' (NEE-oh-PLA-zum), this is a Latin word meaning 'new growth , and means the same as 'tumour'.

In primary bone cancer, a cell that lives inside the bone starts to divide and grow uncontrollably, making a bony lump. The tumour can be benign, meaning that it cannot spread and cause damage to the body. Alternatively it can be malignant, meaning that it can spread and therefore it is cancer. The tumour is described as 'cancerous'. Back to top
Cancer Research
Research means looking for or finding out new facts and information. Most medical research is carried out to firstly understand how our bodies function normally when people are well. This in turn helps us to understand what happens when things are not functioning normally (illness).

Cancer research helps us to learn, for example:

  • What causes people to get cancer,
  • How many people have it,
  • How it can be treated,
  • Ways doctors can discover that a patient has cancer and what sort of cancer they have (diagnosis).
Cancer research can be carried out by biologists, medical doctors, nurses, surgeons, mathematicians, chemists, physicists and many other people. Research is usually carried out in hospitals, universities or research institutes. Cancer research costs a lot of money to run, because of the expensive equipment that is necessary. This is paid for by research funding, which can come from research charities, government research councils, universities or from businesses such as pharmaceutical companies. The most common cancers, including lung, bowel, breast and prostate cancers, receive the most funding for research.

BCRT supporters raise money to fund research into primary bone cancers. This is an essential source of funding for this rare and under-funded type of cancer. You can learn more about BCRT's research projects here, in the BCRT Research Projects Section.

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Cancer Vaccine
There are two main types of cancer vaccine:
  • Preventative vaccines such as the HPV vaccine given to young women to help prevent cervical cancer
  • Treatment vaccines are used to treat patients who already have cancer.

Cancer treatment vaccines help the immune system to recognise and kill cancer cells; this is called 'immunotherapy.' Cancer prevention vaccines are targeted against viruses that can cause cancer.

It is difficult to develop cancer treatment vaccines because the immune system does not always recognise cancer cells, cancer cells can 'look' normal to the immune system. Cancer cells can also produce chemical messages to slow down an immune response against them.

Cancer treatment vaccines are undergoing trials, although none of these trials have yet looked at primary bone cancer. Back to top
Cannula , cannulae
A cannula is a thin, flexible tube that is inserted through a needle into a vein. Cannulae are commonly placed on a patient’s arm or the back of their hand. The tube is attached to a plastic port outside the skin, through which drugs can be given or a drip can be attached. The cannula should be changed after three days, and the cap on the outside should be kept closed to prevent bacteria getting into the cannula. Back to top
Cartilage is a connective tissue that acts as a shock-absorber between bones. Cartilage is found in the joints, where it prevents bones from rubbing together (which would cause damage) and absorbs some of the impact and physical pressure on the joint.

Chondrosarcoma is a type of cancer that starts from a cartilage cell.

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All living things are made up of cells. They are the building blocks of the body. Cells are very small, and can usually only be seen under a microscope.

Most animal cells including humans are between 10 and 30 micrometres in diameter. A micrometre (µm) is one millionth of a metre. That means as many as 100 cells could fit on the full stop at the end of this sentence.

Some living things are made up of one single cell, like bacteria or yeast. Humans, like plants and animals, are multi-cellular organisms. Each person is made up of about 100 trillion (100, 000,000,000,000) cells, which work together in a delicate balance to allow us to live and function. Back to top
Cell Cycle
The cell cycle is the name of the process of cell growth and division. The cell cycle is made up of three phases called interphase (inter-FAZE), mitosis (my-TOH-siss), and cytokinesis (sy-TOH-ki-NEE-siss).

During Interphase the cell 'gets ready' to divide by making a fresh copy of all of its DNA to give to a new cell, and making all the cell machinery necessary for division. Mitosis is the phase during which the cell nucleus (where the DNA is kept) divides into two, with each nucleus containing an exact copy of the cell's DNA. During Cytokinesis the rest of the cell splits into two cells, each cell getting one nucleus. The new cells are often called 'daughter cells'.

The process of the cell cycle is very tightly regulated. There are checkpoints between each stage of the cycle. For example, if the DNA isn't copied properly, the cell will not go into the mitosis stage until the mistakes are repaired. If the DNA mistakes can't be repaired then the cell sacrifices itself in a process known as apoptosis.

A good way to think of the cell cycle and its checkpoints is to compare it to a washing machine cycle. After washing, the machine will not go straight into the spin cycle until it has checked that the rinse cycle has been completed. A washing machine that goes straight from wash to spin is faulty. It's a similar situation with cells. If the regulation of the cell cycle is disrupted, it can cause problems such as cancer. Back to top
Central Line
Long, flexible, plastic tubes that go into a 'central' blood vessel in the chest near the heart; that is why they are called central lines. They are used to give fluids, nutrition, chemotherapy and other drugs directly into the blood, and to take blood samples. Central lines may also be referred to as a Hickman®;; this is a brand name of one type of central line.

The central line is put in using a local anaesthetic (or sometimes a general anaesthetic) to numb the area and the line runs under the skin and into a vein. There is a small piece of the line left hanging outside of the skin, to which a drip line can be attached. Unlike a cannula (Venflon), central lines can be in place for up to a few months. These lines enable the number of needles required during treatment to be minimised and more than one drug or treatment (such as fluids or nutrition) can be given at the same time because the lines can have multiple openings or 'lumens.'

Whether a central line will best suit the patient's needs, can be discussed with the nurses and the doctor. Other lines called PICCS and Portacaths® may be more suitable for some patients. Back to top
The treatment of cancer with medicines that stop the growth of, or kill cancer cells. Chemotherapy is quite often shortened to 'chemo' (KEY-mo).

Primary bone cancer patients are given (administered) more than one type of chemotherapy drug, this is called combination chemotherapy.

There are different ways patients can be given chemotherapy, tablets, liquid medicine, injection or directly into the blood through a cannula, central line, PICC or portacath.

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Chondroblastic Osteosarcoma
Chondroblastic osteosarcoma is the name given to an osteosarcoma that when looked at under a microscope, the cells can be seen to be producing cartilage. Cartilage is tissue that covers and cushions the ends of bones. Back to top
Chondromas are benign growths that start in the cartilage, the bone or the tendons around the bone. Chondroma is not a kind of cancer because it cannot spread into nearby tissues and has a much more limited ability to grow. Back to top
Chondrosarcoma is a cancer that starts in the cartilage cells. Cartilage is the tissue that cushions the ends of the bones and stops the bones from getting worn down or damaged at the joints.

Chondrosarcoma is the most common type of primary bone cancer, and is most often diagnosed in men and women over the age of 40.

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Chordomas are a very rare form of primary bone cancer. There are thought to be around 30 cases a year diagnosed in the UK and around 2 cases per year in Ireland. Chordoma is a cancer of the cells in the notochord (NO-tow-cord), a tissue that is found in the spine as it develops. Even though the spine takes over the function of the notochord, some cells remain in the spine in adulthood and very rarely these can become cancerous.

Although it can occur at any age, chordomas tend to develop in people over the age of 40, affecting men more than women. Chordomas are slow growing tumours and tend to develop in the skull, bones of the face and spine. Chordomas are treated using chemotherapy, surgery and proton therapy. Occasionally, it may be necessary to use radiotherapy when tumours cannot be fully removed by surgery.

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Chromosomes are structures found in the nucleus of cells, which contain all the instructions for growth, development and function of the cells. These instructions are known as genes and they are in the form of a chemical code contained within a very long molecule called DNA (which stands for DeoxyriboNucleic Acid). The DNA molecule is around 2 metres and has to be packaged into a cell nucleus which is around 2 micrometres in diameter (2 millionths of a metre).

The DNA is wound so tightly around special proteins, and around itself that it can be packaged into a cell's nucleus. The chromosomes are only visible under a microscope during a stage of the cell cycle known as mitosis.

Humans have 23 pairs of chromosomes, which each hold a different section of genetic information. Each chromosome pair is made up of one copy of the mother's chromosome and one copy of the father's, and this is how genetic information is inherited. Back to top
Chromosome Translocation
A chromosome translocation is the accidental rearrangement of parts of chromosomes. This kind of rearrangement can cause serious health problems such as cancer. In around 90% of Ewing's sarcomas part of chromosome 11 has joined onto chromosome 22 and a piece of chromosome 22 has moved to chromosome 11. You may see this written as t(11;22) when you are reading about Ewing's sarcoma. This means 't' for translocation and the numbers in the brackets tell us which chromosomes are involved.

This translocation forces two genes to be joined together. One of these genes is very powerful but rarely switched on, and the other gene is always switched on but less important in the cell. The result is a gene that is very powerful and always switched on, sending out incorrect signals to the rest of the cell. This can result in uncontrolled cell division, which causes cancer.

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Cisplatin is a platinum containing chemotherapy drug that is given as a treatment for osteosarcoma and for some other types of cancer. This drug works by binding or sticking to DNA and starting processes that will kill the cells, this process is called apoptosis (A-pop-TOH-sis).

Cisplatin is usually given straight into the blood, through a cannula, central line, PICC line or Portacath

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This is the medical name for the collar bone. Back to top
Clinical Trial
Clinical trials are used to test how well new drugs or treatments work in people. There are different types of clinical trial and these are known as 'phases'.

Phase 1 clinical trials are the first stage of testing a new drug on patients. Usually there are very few patients enrolled on Phase 1 trials and these are patients who have already tried every other type of treatment but are not getting better. These types of trial check to see whether the drug or treatment is safe for humans, rather than trying to cure the illness.

Phase 2 clinical trials enrol more patients and the aim is to find the best dose of the drug to treat the patients.

Phase 3 clinical trials are large studies involving patients in more than one hospital, often in different countries. This phase helps to build up evidence that the drug/treatment is effective in treating patients.

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Combination therapy
Chemotherapy treatment involves giving strong drugs that kill cancer cells. There are many different Chemotherapy drugs, and new drugs are being developed all the time. Different drugs work in different ways.

Combination therapy is when several different drugs are given to a patient over a period of time. This means that the cancer is faced with different kinds of drugs, and so even if the cancer doesn't respond to one of the drugs it will hopefully respond to the other drugs in the combination.

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Complementary and alternative medicines (CAM)
CAM is short for Complementary and Alternative Medicine. Although these two types of medicine are sometimes lumped together, there are big differences between them. Back to top
Complementary Medicines/therapies
Complementary medicines and therapies are used 'alongside' conventional medical treatment often to help with symptoms or to aid relaxation. These include acupuncture, meditation and nutritional supplements. Complementary therapies are sometimes lumped together with alternative medicines, under the bracket of Complementary and Alternative Medicines (CAM).

It is important to check with your doctor before taking any complementary therapy, just to make sure that they won't conflict with the conventional treatment.

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Connective Tissue
The connective tissues are the group of tissues in the body that helps to provide physical support for the body, keep certain parts of the body in the right place and connect different tissues and organs together. Bone, cartilage, fat and muscle are all types of connective tissue. Back to top
Contrast Agent/ Medium
In CT scans it can be difficult to tell one tissue from another and so contrast agents are used. Contrast agent is a substance that is opaque to x-rays, and so it shows up clearly in scans. It is used during CT scans and allows organs and blood vessels to show up much more clearly. Contrast agent can be injected into a vein prior to a scan or can be in the form of drink that the patient drinks prior to being scanned.

For MRI (Magnetic Resonance Imaging) scans, contrast agents can be injected and these are based on a metal called gadolinium (GAD-oh-LIN-ee-um). This metal affects particles called protons, which changes the properties of the scan. The contrast agent makes the blood vessels show up more clearly.

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Co-trimoxazole is an antibiotic containing two drugs, sulfamethoxazole (SUL-fa-meth-OX-ah-zole) and trimethoprim (try-METH-oh-prim). Co-trimoxazole is mainly used to treat bladder infections, pneumonia, bronchitis and ear infections.

Patients who are on chemotherapy for a long period of time, such as Ewing's Sarcoma patients, may be given this antibiotic to take continuously through treatment to prevent a certain infection called pneumocysitis carnii (PCP).

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Creatinine is a molecule that is a waste-product from muscle cells. The kidneys normally filter out the creatinine from the blood, but if the kidneys aren't working properly then creatinine levels rise. This means that creatinine levels can be used to measure how well the kidneys are working.

Some chemotherapy drugs can damage the kidneys so creatinine levels are monitored to check how well the kidneys are functioning.

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CT scan/scanner / CAT scan/scanner
A machine that uses X-rays to take very detailed pictures of the inside of the body. This helps doctors called radiologists to check if a patient's tumour has grown or whether the cancer has spread.

A CT scanner looks like a large 'doughnut' with a bed for the patient to lie on. The bed will move slowly through the hole while the machine takes the pictures.

Before the scan, patients may be given a contrast medium. The contrast medium is usually injected into a vein. This contrast medium helps to improve the image of particular tissues and it can also help the radiologist tell the difference between blood vessels and other structures.

CT stands for Computerised Tomography. Another name for this type of scan is CAT, which stands for Computerised Axial Tomography. Back to top
A cure is a treatment that leaves a patient completely free of cancer. A patient is cured when they are disease-free and their good health is restored. Back to top
A chemotherapy drug used to treat primary bone cancers and some other forms of cancer.

Cyclophosphamide can be given directly into the blood or in the form of tablets. The drug belongs to a class of drugs called alkylating (AL-kuh-LAY-ting) agents. Cyclophosphamide slows the growth of cancer cells by interfering with the actions of DNA. For the treatment of osteosarcoma the drug is given alongside other chemotherapy drugs, this is called combination chemotherapy.

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A scientist that specialises in the study of chromosomes and chromosomal abnormalities. During the diagnosis stage, cytogeneticists carry out tests to look for damage to chromosomes and genes that help control the cell. Back to top
Cytotoxic means 'toxic to cells '. Cytotoxic drugs are used in chemotherapy to kill cancer cells. Back to top
C reactive protein (CRP)
'C-Reactive Protein' levels in the blood are increased when the immune system is responding to an infection. This means that CRP levels can be used to monitor for signs of inflammation and infection. CRP can also be raised in response to cancer. Back to top
Dacarbazine is a chemotherapy drug that is used to kill primary bone cancer cells. Dacarbazine modifies DNA in a way that stops cells from copying their DNA so the cells cannot divide. Back to top
Dexamethasone is a type of drug called a corticosteroid (KOR-tih-koh-STEH-royd). The drug has an anti-inflammatory effect and is used to treat some of the side effects caused by chemotherapy. Back to top
The process of identifying exactly what condition/disease is causing a patient to be ill. Investigations or tests and physical examinations help doctors to make a specific diagnosis. Back to top
Also called the shaft is the main part of a bone between the epiphyses (epi-FEE-sees). See diagrams in 'What is osteosarcoma' and 'What is Ewing's sarcoma' sections. Back to top
A drug used as a painkiller, which belongs to a group of drugs known as non-steroidal anti-inflammatory drugs (NSAIDs). Diclofenac may be used to treat pain following an operation. Back to top
A dietician is a specialist who gives advice about the best things for a person to eat in order to improve their health. Some patients find it difficult to eat during chemotherapy and a dietician can advise them on what they need to be eating in order to help to beat the cancer. Back to top
Digestive system/ digestive tract
The digestive tract is the long pathway that food follows through the body. It starts with the mouth and includes the oesophagus, stomach, intestines, colon, rectum and anus. The digestive tract is also sometimes called the 'Gastro-intestinal Tract' or 'GI tract'.

The digestive tract is lined with healthy cells that divide very quickly. Because they divide quickly, they can be affected by chemotherapy drugs. This can cause side-effects of chemotherapy that include mouth ulcers, sickness and diarrhoea.

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This is a medical word to mean something far away. When used to describe the skeleton, distal means a position that is the furthest from the body. For example, the femur (thigh bone) is attached to the body at the hip; and so the distal part of the femur is the part of the bone furthest from the hip, which is the point nearest to the knee joint. The opposite of distal is 'proximal', which means the nearest point to the body. Back to top
DNA stands for deoxyribonucleic acid (dee-OK-see-RY-bow-new-KLAY-ick acid). DNA is a long molecule (as long as 2 metres) that is packaged into the nucleus (centre) of each cell. DNA holds the genetic information of a cell. Each separate piece of information is called a gene. Each time a cell divides the whole of the DNA is copied so that each new cell has an identical copy.

DNA is a bit like an information database that contains the information cells need to carry out their functions to build and maintain the body. The information in DNA is stored as a code made up of four chemicals called bases (called A, C, G and T).

Cancer occurs when there is some form of damage or change to the DNA and therefore the cell's instructionsare made un-readable. If the damaged DNA is in an important gene that is responsible for making sure cells only grow and divide when they need to, then the cell can escape the normal control and grow in an uncontrolled way.

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The amount of a drug (medicine) or treatment that will be given (administered) to a patient. For example, for chemotherapy the dose is based on body surface area, the amount could be in milligrams or grams per square metre per day (mg/m2/day). Radiation therapy doses are measured in grays (Gy); the total dose is spread out over time or 'fractionated.' Back to top
A chemotherapy drug that is given as a treatment for sarcomas and some other types of cancer. Doxorubicin is a red fluid and is given directly into a vein by infusion.

Doxorubicin works by interfering with the cancer cell's DNA at a time when the cell is getting ready to divide. This prevents the cell from dividing. Doxorubicin targets the rapidly-dividing cells in the body, which includes any cancer cells but can also affect the healthy cells that divide rapidly, such as the hair cells or the lining of the digestive tract. This causes the side effects that are associated with some cancer treatments.

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Test that measures the electrical activity of the heart. This test is usually carried out before and during chemotherapy treatment to see how well the heart is working. Special leads are attached to small sticky discs, which are stuck onto the skin across the chest. These leads pick up the electrical signals of the heart and record the results. It is completely painless. Back to top
This test is often referred to as an 'Echo' and it is used to examine how well the heart is working. The test uses high-energy sound waves, which are not detectable to the human ear. The sound waves are made by a special machine. This machine emits the sound waves then detects the sound waves as they bounce back off of the heart tissue. This allows the machine to build up a detailed picture of the heart on a monitor based on the sounds that echo back to the machine.

Patients who need chemotherapy will have echocardiograms before and during treatment. This is because some chemotherapy drugs can have effects on the heart. The test before treatment will show doctors how well your heart is working and give a baseline reading. This result can be compared to later tests during treatment to show doctors whether the chemotherapy is affecting the heart.

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Electrolytes are the levels of certain salts and chemicals within the blood. Electrolytes are important for many of the body's functions, including nerve and muscle functions. If the levels of electrolytes in the blood are too high or too low, this can be a sign that the kidneys are not working properly. Back to top
Endoprosthesis , endoprosthetics
E'Endo' means inside the body and a 'prosthesis' is an artificial body part. An endoprosthesis is an implant that acts as an artificial replacement for a body part.

Some primary bone cancer patients have metal endoprostheses that act to replace a part of a bone or a joint that has been damaged by cancer or removed by a surgeon as part of their cancer treatment.

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The epiphysis is the area at the end of the bone where growth happens to make the bones longer during childhood and adolescence. See diagrams in 'What is osteosarcoma' and 'What is Ewing's sarcoma' sections. Back to top
Erythrocyte Sedimentation Rate
ESR stands for 'Erythrocyte (eh-REETH-row-site) sedimentation rate.' Erythrocyte is the scientific name for a red blood cells. The ESR is a blood test, which measures the distance red blood cells travel in one hour as they settle to the bottom of a test tube. An increased ESR can be a sign of inflammation or infection. Back to top
A chemotherapy drug that is used to treat some types of cancer, including primary bone cancers . The drug is in the form of a white powder, which is then made into a colourless solution. Etoposide is usually given directly into a vein by infusion. It can also be given by mouth as it is available in capsule form.

Etoposide works by stopping an enzyme called topoisomerase II (TOH-poh-i-SOM-meh-rays), which helps the cell to copy its DNA DNA during cell division. When topoisomerase can't do its job, the cell cannot divide and so it will self-destruct (apoptosis).

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EURAMOS is the European and American Osteosarcoma Study Group. EURAMOS carries out clinical trials of treatments to help improve survival from Osteosarcoma. Back to top
EURO-EWING 99 is a large International study aimed at improving treatment and outcome of Ewing's Family of Tumours Euro-EWING 99 has now finished collecting data and now this information is being analysed. Back to top
Event Free Survival
The length of time after a treatment in which there is no appearance of the signs, symptoms or effects of the cancer. Back to top
Ewing's sarcoma
A rare malignant tumour found in bones or sometimes in muscles near to bone. This type of cancer was named after James Ewing, the doctor who first described it. Ewing's Sarcoma is the second most common primary bone cancer in children and young people; it is more common in boys than girls. Back to top
Ewing's Sarcoma Family of Tumours
This group of cancers are all thought to start in the same type of mesenchymal (me-zen-ky-mal) stem cell, and involve the same genetic mutations. Mesenchymal stem cell are the cells that can make any kind of connective tissue , including bone, cartilage, muscle and fat. The Ewing’s Sarcoma Family of Tumours or EFTs includes:

The treatment of Ewing's sarcomas whether they are found in soft tissues or bone is the same; chemotherapy, surgery and radiotherapy. Back to top
EWS-FLI1 fusion gene
This is the joining or fusion of two genes by a chromosome translocation found in more than 90% of Ewing's sarcomas. In this case a gene called FLI1 from chromosome 11 is joined to a gene called EWS on chromosome 22, this is sometimes referred to as ‘t(11;22)’ for short.

The instructions in this fusion gene code for a protein called the EWS-FLI1 fusion protein. This fusion protein is thought to affect many other genes in the cell by switching them on or off at the wrong times.

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Extraosseous Ewing's sarcoma
Extraosseous Ewing's sarcoma starts in soft tissue rather than bone. It is one of the Ewing's Family of Tumours. Extraosseous Ewing’s sarcoma is rare but is treated in the same way as Ewing’s sarcoma arising from the bone. Back to top
Extraosseous Osteosarcoma
A tumour that appears identical to osteosarcoma but sarts outside of the bone. It is very rare. Back to top
FBC; Full Blood Count
A blood test, which gives information about the numbers of the different cells of the blood:
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Febrile Neutropenia
This is a combination of fever (higher than normal temperature) and neutropenia. Neutropenia is when a patient has a lower than normal number neutrophils in their blood. Neutrophils are one kind of immune cell that helps to fight infections. Lower than normal levels of neutrophils increases the patient’s risk of infection and lessens the patient’s ability to fight infection.

Fever is an indication that a patient has an infection and so if the patient has neutropaenia as well as an infection then they will struggle to fight off the infection and so they will need extra care.

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The longest bone in the body. It is found in the leg between the hip and knee. Back to top
Fenretinide is a chemotherapy drug that has shown promising results in the laboratory, where it has been able to kill Ewing's sarcoma cells that are grown in dishes. Some early-stage clinical trials are planned to test whether this might be an effective treatment in patients. Back to top
Fibroblastic Osteosarcoma
Fibroblastic osteosarcoma is a kind of osteosarcoma, which is a kind of primary bone cancer that starts in a bone-making cell. This form looks unusual because unlike conventional osteosarcoma, the fibroblastic osteosarcoma tumour cells look like they have stopped making any bone. Back to top
This is a drug that treats infections caused by micro-organisms that belong to the fungus family. Patients whose immune system has been weakened by chemotherapy are more susceptible to these kind of infections. Fluconazole belongs to a group of drugs called anti-fungal agents. Back to top
A fracture is the medical term for when a bone is broken. bone fractures can be caused by accidents and injuries, but in very rare cases they can be caused by a tumour inside the bone.

A bone tumour can cause the healthy bone around the tumour to be destroyed by the growing tumour. The bone is left severely weakened and this makes it more likely to fracture, even by a minor knock or fall. Some cases of primary bone cancer are diagnosed when a patient goes to hospital with a fracture. A fracture caused by a disease (such as primary bone cancer or osteoporosis) is called a 'pathological fracture'.

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Full Blood Count
G-CSF; Granulocyte Colony Stimulating Factor
G-CSF is a kind of chemical signal called a growth factor. Growth factors are signals that are normally released by one kind of cell in the body, to tell a certain kind of cell to start dividing, in order to make more cells.

G-CSF targets a kind of cell called a granulocyte, which is one group of the white blood cells that work together to form the immune system. G-CSF is a signal that causes new granulocytes to be created, and this means that the immune system is given a boost.

Chemotherapy can reduce the numbers of white blood cells in the blood, leaving the patient at an increased risk of infection. Treatment with G-CSF after chemotherapy helps to restore the numbers of white blood cells, which speeds up the recovery of the immune system.

G-CSF may also sometimes be given before high dose chemotherapy to stimulate the production of stem cells, which are collected from the patient and stored until the chemotherapy course has been completed, then returned to the patient to help production of new blood cells. G-CSF is also sometimes given after high dose chemotherapy , to increase the numbers of stem cells.

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Genes are the instructions for how to make a living thing. Each individual gene is a single instruction to make one piece of a huge jigsaw of genes that work together to make a working cell, organ, or organism. Humans have around 30,000 genes in total.

Genes are made of a chemical called DNA (which stands for deoxy-ribonucleic acid). The DNA is arranged into letters that spell out a code, and the letters are A, G, T and C. The scientific word for these letters is ‘bases’. Inside the cell there are special molecular machines that can read the code and build molecules according to the exact code.

Our genes are inherited from our parents. For each gene we have one copy from each parent (these come together when a sperm fertilises an egg). This is how we inherit characteristics from our parents.

Every time a new cell is made, the DNA of an existing cell is copied, and the copy is given to the new cell. Sometimes during the process of copying the DNA, a mistake is made in the code. Any mistakes in the code (such as a missing letter or a wrong letter) cause a mistake to be made in the molecule that is built from the instructions in that gene. Sometimes these mistakes are harmless, but sometimes this kind of mistake (called a genetic mutation) can cause health problems.

DNA forms a long, twisted ladder structure (a double helix). Each of these long ladders is called a chromosome, and there are hundreds or thousands of genes, one after another, along each chromosome.

Two ‘official’ definitions of a gene are ‘the basic biological unit of heredity’ or ‘a segment of deoxyribonucleic acid (DNA) needed to contribute to a function.’

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Genetic Mutation
A genetic mutation is a mistake in the DNA code that spells out the instructions coded by genes (see Genes). These mistakes can be harmless but sometimes they can cause serious health problems. We know that cancer always starts because of genetic mutations. It is thought that around 5-10 different mutations in the DNA of one single cell, are necessary to cause cancer. It is very rare that this many mutations are able to happen without the cell being detected and killed.

Some genetic mutations are inherited. The scientific word for this is a 'germline mutation'. Some families have a condition called 'Li-Fraumeni syndrome' which is caused by an inherited mutation in a gene called p53.

In most cases of cancer the mutations are not inherited. Instead they happen during a person's life. These mutations are called 'somatic mutations'. In some cancers we know why these mutations happen, for example UV rays in sunlight can cause mutations that lead to melanoma, a type of skin cancer.

Currently we do not know what causes the gene mutations that cause primary bone cancer to start. Big research studies are underway to try to discover which genes are mutated in primary bone cancer, and this might lead to a better understanding of the diseases as well as giving us a clue as to which genes could be targeted to provide better treatments.

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Genetic predisposition
A genetic predisposition means that a person’s gene code has given them an increased chance of developing a certain disease. For example, people who inherit mistakes in their copy of a gene called ‘p53’ have an increased predisposition for developing osteosarcoma, and several other kinds of cancer.

A genetic predisposition does not mean that a person will definitely develop cancer; it means an increased chance of developing cancer.

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GFR, Glomerular Filtration Rate
GFR stands for glomerular (GLOM-eh-rue-lar) filtration rate. This rate is measured to test how well a patient’s kidneys are working.

The kidneys have many important functions, including: keeping the concentrations of various salts and other important blood chemicals constant, keeping the volume of water in the body constant, removing waste products from the body into the urine, keeping the acidity of the blood constant and helping to regulate the blood pressure.

Some drugs given in the treatment of primary bone cancers can affect the kidneys. A kidney test will be done before and during treatment. The test before treatment will show doctors how well the kidneys are working normally. This result can be compared to later tests during treatment, to show whether the drugs are affecting how well the kidneys are functioning.

A GFR test can sometimes involve injecting the patient with a tiny amount of a radioactive dye. Every 1 or 2 hours for the next 4 hours blood samples are taken from the patient and the amount of radioactive dye will be measured. This shows the rate (millilitres per minute) at which the original amount of dye has been removed from the blood by the kidneys and tells doctors how well the kidneys are working.

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Glomerular Filtration Rate
The grade of a cancer describes how different the cells look from normal cells when they are examined under a microscope. From this information, doctors can determine how quickly the cancer may grow or spread to other parts of the body.

Low grade tumours are slow growing and least likely to spread to other parts of the body. High grade tumours are fast growing tumours that can spread to other parts of the body. The type of treatment that a doctor recommends for a patient will depend on the grade of the cancer, amongst other factors.

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Granulocyte Colony Stimulating Factor
Growing Pains
The medical name for growing pains is 'recurrent nocturnal limb pains' or 'idiopathic limb pains'. Idiopathic means that nobody knows what causes it.

This night time pain of the legs (shins/ knees) and more rarely the arms is fairly common in children, usually seen between the ages of 3-12. Many theories have been put forward for the cause of 'growing pains' but the exact cause remains unknown.

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