Definition Of Terms

DEFINITION OF TERMS Hydronephrosis is distention and dilation of the renal pelvis and calyces, usually caused by obstruction of the free flow of urine from the kidney, leading to progressive atrophy of the kidney. www.wikipedia.com Cystoscopy: A procedure in which the doctor inserts a lighted instrument called a cystoscope into the urethra (the tube that carries urine from the bladder to the outside of the body) in order to look inside the urethra and bladder. Medicinenet.com Apoptosis (pronounced /ˌæpəpˈtoʊsɨs/,[1] ăpˈəp-tō'sĭs, ăpˈə-tō'sĭs[2]) is the process of programmed cell death (PCD) that may occur in multicellular organisms. http://en.wikipedia.org/wiki/Apoptosis Metastasis ∗ the transference of disease-producing organisms or of malignant or cancerous cells to other parts of the body by way of the blood or lymphatic vessels or membranous surfaces. ∗ the condition produced by this. http://dictionary.reference.com/browse/metastasis Angiogenesis is a physiological process involving the growth of new blood vessels from pre-existing vessels. Though there has been some debate over this, vasculogenesis is the term used for spontaneous blood-vessel formation, and intussusception is the term for new blood vessel formation by splitting off existing ones. Angiogenesis is a normal and vital process in growth and development, as well as in wound healing. However, it is also a fundamental step in the transition of tumors from a dormant state to a malignant one. The identification of an angiogenic diffusible factor derived from tumors was made initially by Greenblatt and Shubik in 1968. http://en.wikipedia.org/wiki/Angiogenesis mutation - a sudden departure from the parent type in one or more heritable characteristics, caused by a change in a gene or a chromosome. http://dictionary.reference.com/browse/mutation

Fibroblast growth factor receptor 3 (achondroplasia, thanatophoric dwarfism), also known as FGFR3, is a human gene. FGFR3 has also been designated as CD333 (cluster of differentiation 333). The protein encoded by this gene is a member of the fibroblast growth factor receptor family, where amino acid sequence is highly conserved between members and throughout evolution. FGFR family members differ from one another in their ligand affinities and tissue distribution. A full-length representative protein would consist of an extracellular region, composed of three immunoglobulin-like domains, a single hydrophobic membrane-spanning segment and a cytoplasmic tyrosine kinase domain. The extracellular portion of the protein interacts with fibroblast growth factors, setting in motion a cascade of downstream signals, ultimately influencing mitogenesis and differentiation. This particular family member binds acidic and basic fibroblast growth hormone and plays a role in bone development and maintenance. Mutations in this gene lead to craniosynostosis and multiple types of skeletal dysplasia. Alternative splicing occurs and additional variants have been described, including those utilizing alternate exon 8 rather than 9, but their full-length nature has not been determined.[1] http://en.wikipedia.org/wiki/FGFR3 Somatic cells are any cells forming the body of an organism, as opposed to germline cells. In mammals, germline cells (also known as "gametes") are the spermatozoa and ova which fuse during fertilization to produce a cell called a zygote, from which the entire mammalian embryo develops. Every other cell type in the mammalian body—apart from the sperm and ova, the cells from which they are made (gametocytes) and undifferentiated stem cells—is a somatic cell: internal organs, skin, bones, blood, and connective tissue are all made up of somatic cells. The word "somatic" is derived from the Greek word sōma, meaning "body". http://en.wikipedia.org/wiki/Somatic_cells

An oncogene is a gene that, when mutated or expressed at high levels, helps turn a normal cell into a tumor cell.[1] Many cells normally undergo a programmed form of death (apoptosis). Activated oncogenes can cause those cells to survive and proliferate instead.[2] Most oncogenes require an additional step, such as mutations in another gene, or environmental factors, such as viral infection, to cause cancer. Since the 1970s, dozens of oncogenes have been identified in human cancer. Many cancer drugs target those DNA sequences and their products.[ http://en.wikipedia.org/wiki/Oncogenes

A tumor suppressor gene, or antioncogene, is a gene that protects a cell from one step on the path to cancer. When this gene is mutated to cause a loss or reduction in its function, the cell can progress to cancer, usually in combination with other genetic changes. http://en.wikipedia.org/wiki/Tumor_suppressor_genes Clonal expansions One common feature of neoplastic progression is the expansion of a clone with a genetic or epigenetic alteration. This may be a matter of chance, but is more likely due to the expanding clone having a competitive advantage (either a reproductive or survival advantage) over other cells in the tissue. Since clones often have many genetic and epigenetic alterations in their genomes, it is often not clear which of those alterations cause a reproductive or survival advantage and which other alterations are simply hitchhikers or passenger mutations (see Glossary below) on the clonal expansion. Clonal expansions are most often associated with the loss of the p53 (TP53) or p16 (CDKN2A/INK4a) tumor suppressor genes. In lung cancer, a clone with a p53 mutation was observed to have spread over the surface of one entire lung and into the other lung[45].In bladder cancer, clones with loss of p16 were observed to have spread over the entire surface of the bladder[46][47]. Similarly, large expansions of clones with loss of p16 have been observed in the oral cavity [48] and in Barrett's esophagus[24]. Clonal expansions associated with inactivation of p53 have also appear in skin[22][49], Barrett's esophagus[24], brain[50], and kidney[51]. Further clonal expansions have been observed in the stomach[52], bladder[53], colon[54], lung[55], hematopoietic (blood) cells[56], and prostate[57]. These clonal expansions are important for at least two reasons. First, they generate a large target population of mutant cells and so increase the probability that the multiple mutations necessary to cause cancer will be acquired within that clone. Second, in at least one case, the size of the clone with loss of p53 has been associated with an increased risk of a pre-malignant tumor becoming cancerous[58]. It is thought that the process of developing cancer involves successive waves of clonal expansions within the tumor[59]. http://en.wikipedia.org/wiki/Somatic_evolution_in_cancer#Clonal_expansions

Transitional cell carcinoma (TCC, also urothelial cell carcinoma or UCC) is a type of cancer that typically occurs in the urinary system: the kidney, urinary bladder, and accessory organs. It is the most common type of bladder cancer and cancer of the ureter, urethra, and urachus; it is the second most common type of kidney cancer. TCC arises from the transitional epithelium, a tissue lining the inner surface of these hollow organs.[1]

When the term "urothelial" is used, it specifically refers to a carcinoma of the urothelium, meaning a TCC of the urinary system. http://en.wikipedia.org/wiki/Transitional_cell_carcinoma

What is a transurethral bladder tumor resection?A transurethral bladder tumor resection is surgery done to remove a tumor from the bladder. "Transurethral" means that it is done through the urethra. The urethra is the passageway that carries urine from the bladder to the outside of the body. When is it used? Tumors are removed because they are cancerous and can cause problems such as bleeding, infection, or blockage. Cancerous tumors may spread to other parts of your body. Examples of alternatives are: • having a radical cystectomy, which is removal of the bladder and surrounding lymph nodes and other nearby organs, such as the prostate gland or uterus, tubes, and ovaries • choosing not to have treatment while recognizing the risks of your condition. You should ask your healthcare provider about these choices. How do I prepare for a transurethral bladder tumor resection? Plan for your care and recovery after the operation, especially if you are to have general anesthesia. Find someone to drive you home after the surgery. Allow for time to rest and try to find people to help you with your day-to-day duties. Follow your healthcare provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery. If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during surgery. If you are taking daily aspirin for a medical condition, ask your provider if you need to stop

taking it before your surgery. Follow any other instructions your healthcare provider gives you. If you are to have general anesthesia, eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight on the day of the procedure. Do not even drink coffee, tea, or water. What happens during the procedure? You are given a regional or general anesthetic. A regional anesthetic numbs part of your body while you remain awake. It should keep you from feeling pain during the operation. A general anesthetic relaxes your muscles, puts you to sleep, and prevents you from feeling pain. Your healthcare provider will insert a scope through the urethra into your bladder. The scope is a thin, lighted tube with lenses like a microscope. Water will flow through the tube and into the bladder to fill and stretch it so that your provider has a better view. Your provider uses a heated wire or a laser to shave the tumor down a piece at a time. The pieces of tumor are flushed out of the bladder with water. Pieces of the tumor are sent to the lab for tests. What happens after the procedure? You may go home that day or may be in the hospital for a few days, depending on the extent of the operation. You will have a catheter, or tube, in the bladder to help it drain and to flush out any remaining pieces of tumor and any blood clots that have formed. Your healthcare provider will remove the catheter after the bleeding stops. While you are recovering from surgery, you may have trouble controlling your bladder. The scab inside the bladder may become loose and bleed. If this happens, you may notice blood in your urine or have trouble urinating because of blood clots. Rest in bed and call your provider if it continues more than 1 day or gets worse. Drink a lot of water. For 3 to 4 weeks avoid all heavy activity such as lifting and any unnecessary strain. Try to avoid getting constipated. Your provider will want to do a follow-up exam of your bladder. Ask your provider what other steps you should take and when you should come back for a checkup.

What are the benefits of this procedure? The tumor may be removed, and you may no longer have bladder pain or cancer. By having the tumor removed with a scope through the urethra, you will avoid the additional pain, discomfort, cost, and longer hospital stay of an operation performed with an open cut through your abdomen. What are the risks associated with this procedure? • There are some risks when you have general anesthesia. Discuss these risks with your provider. • A regional anesthetic may not numb the area enough and you may feel some minor discomfort. Also, in rare cases, you may have an allergic reaction to the drug used in this type of anesthesia. Regional anesthesia is considered safer than general anesthesia. • The tumor may grow again, and this operation may need to be repeated. • You may have infection or bleeding. • The bladder could be damaged and need to be repaired with more surgery. • If you are in a lot of discomfort, you may not be able to pass urine and may need a catheter to drain urine. • Rarely, a scar may form inside the urethra and cause it to become narrow. As a result, you may need to have the urethra stretched to widen the passage. You should ask your healthcare provider how these risks apply to you.