Glossary of Terms

A

Abdomen:

The part of the body that contains the pancreas, stomach, intestines, kidneys, urinary bladder, liver, gallbladder, and other organs.

Adenocarcinoma:

Cancer that originates from cells lining certain internal organs and has gland-like (secretory) properties.

Androgen receptor (AR):

The receptor (the molecule inside or on the surface of a cell that binds to a specific substance and causes a specific effect in the cell) which may mediate the effects of sex hormones (such as testosterone) in the development and progression of bladder cancer may explain why bladder cancer affects men more often than women. Therapies that target AR activity and signaling present a promising focus for novel therapeutic interventions for both men and women.

Adjuvant:

Additional cancer treatment administered following the primary treatment (often surgery or radiation) to reduce the risk of cancer recurrence. Adjuvant therapy may include chemotherapy, radiation therapy, hormone therapy, targeted therapy, or biological therapy.

Anesthesia:

Loss of sensation or awareness administered by the injection of drugs or via gases. General anesthetics put the person to sleep, while local anesthetics cause numbness in a specific part of the body.

Anterior exenteration:

The standard operation to remove bladder cancer in female patients, typically involving the removal of the bladder, urethra, uterus, cervix, ovaries, and the anterior or front wall of the vagina. In some cases, the patient’s urethra can be preserved. Patients may wish to discuss techniques for preserving reproductive organs with their surgeon prior to their cystectomy.

Arms:

An arm of a clinical trial is a group of patients receiving a specific treatment (or no treatment). Trials involving several arms, or randomized trials, treat randomly selected groups of patients with different therapies to compare their medical outcomes.

Arsenic:

A poisonous chemical used to kill weeds and pests. It has been associated with an increased risk of developing bladder cancer.

Avelumab:

A type of immunotherapy that works by targeting a protein called PD-L1 found on some cancer cells. By blocking PD-L1, avelumab helps the immune system recognize and destroy cancer cells. It is used in treating various cancers, including bladder cancer. It is known by the brand name Bavencio.

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B

Bacteria:

Single-cell microorganisms, some of which can cause infections and disease in animals and humans. The singular of bacteria is bacterium.

BCG (Bacillus Calmette-Guerin):

A form of immunotherapy for non-muscle invasive bladder cancer, in which the solution is introduced directly into the bladder via catheter. The solution contains live, weakened bacteria (Bacillus Calmette-Guerin) that activate the immune system. It is notable that while derived from the BCG vaccine for tuberculosis, a different BCG solution is used to treat bladder cancer. Typically, six weekly treatments are given, followed by BCG maintenance. These treatments are usually a series of 3 treatments given every 3-6 months for a 3-year period (Lamm protocol).

Benign:

Non-cancerous; does not spread to nearby tissue or other parts of the body.

Biological therapy:

Treatment that uses substances made from living organisms to treat disease and is used to mitigate potential side effects resulting from certain cancer treatments. This approach is also referred to as immunotherapy, biotherapy, or biological response modifier (BRM) therapy.

Biopsy:

The removal of cells or tissues for microscopic examination. An incision or core biopsy is when only a portion of tissue is removed for examination, whereas an excisional biopsy involves the complete removal of a tumor or lesion. Tissue or fluid may also be removed using a fine needle, called a needle biopsy or fine needle aspiration.

Bladder:

The body’s organ which stores urine.

Bladder Cancer:

Cancer originating in the tissues of the bladder. Most bladder cancers are urothelial carcinomas (previously referred to as transitional cell carcinomas), arising from cells forming the bladder’s inner lining. Other types include squamous cell carcinoma and adenocarcinoma, both of which are often associated with chronic irritation and inflammation of the bladder.

Blue Light Cystoscopy:

A form of cystoscopy in which a fluorescent light, which is blue, is used to enhance the appearance and detection of tumours in the bladder after prior instillation of a substance into the bladder that makes cancer cells appear pink.

Bone scan:

A nuclear medicine test for detecting bone metastases. After injection of a small amount of radioactive material into a blood vessel, increased uptake in bone can be detected by a dedicated scanner.

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C

Cancer:

A classification of diseases in which abnormal cells divide without control. These cancerous cells can spread to nearby tissues as well as to other parts of the body through the bloodstream and lymphatic system.

Carcinogen:

A cancer-causing substance.

Carcinoma in situ (CIS):

Cancer cells confined to the lining of an organ without any penetration into the wall of that organ.

Catheter:

A tube placed in the bladder with the purpose of draining urine.

Chemotherapy:

Treatment with anticancer drugs. Neoadjuvant chemotherapy is delivered before surgery with the goal of shrinking a tumour or stopping the spread of cancer to help make surgery/radiation more effective and improve survival. Adjuvant chemotherapy is administered after surgery to kill any remaining cancer cells with the goal of reducing the chances of recurrence. Chemotherapy is also used as the primary treatment in patients with metastatic bladder cancer.

Chlorine:

A chemical used to kill bacteria in water. Chlorine is the active agent in many household bleaches.

Clinical trial:

A research study used to evaluate the effectiveness of new medical treatments or interventions, assessing new approaches to screening, prevention, diagnosis, or treatment of a specific disease.

Continence (urinary):

The ability for one to control the flow of urine from the bladder. Muscular structures called sphincters, which wrap around the base of the bladder and urethra, assist with this capability. Therefore, disruption to or loss of these sphincters can affect one’s ability to control their urine flow.

Continent cutaneous catheterizable reconstruction:

A form of urinary diversion in which a constructed reservoir is attached to the skin rather than the urethra and requires emptying through catheterization. A channel is created to the skin with an opening at the skin that is smaller than the stoma one might have with an ileal conduit. The reservoir is formed using a portion of the large and/or small intestine to hold urine following bladder removal. The most common example is the Indiana Pouch.

CT scan:

A computed tomography scan in which a sequence of images is captured of the internal body from various angles. The images are generated by a computer linked to an X-ray machine. This form of medical imaging is also called a computerized axial tomography (CAT) scan.

Cutaneous ureterostomy:

A form of urinary diversion in which the ureters are brought up to the skin directly without any intervening bowel. This is rarely used in Canada. Typically, chronic ureteral stents are required in cutaneous ureterostomies.

Cystectomy:

Radical cystectomy is surgery to remove all of the bladder. Partial cystectomy is used in a small subset of patients to remove only part of the bladder.

Cystoscope:

A thin, lighted instrument inserted into the urethra to look inside the bladder. Can also remove tissue samples or small tumours, if needed.

Cystoscopy:

Examination of the bladder and urethra using a cystoscope inserted into the urethra. During the scope, tissue samples may be removed for examination under a microscope to determine whether cancer is present

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D

Docetaxel:

A type of chemotherapy that helps stop cancer cells from dividing by interfering with their internal structure, particularly by stabilizing structures called microtubules. This action prevents cancer cells from growing and spreading, making it useful for treating cancers such as bladder cancer. It is known by the brand names Taxotere and Docefrez.

Durvalumab:

A type of immunotherapy that works by targeting a protein called PD-L1 found on some cancer cells. By blocking PD-L1, durvalumab helps the immune system recognize and destroy cancer cells. It is used in treating certain cancers, including bladder cancer. It is known by the brand name Infinzi.

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E

Enfortumab vedotin (EV):

EV is an antibody-drug conjugate used in the treatment of advanced bladder cancer. The antibody portion of the drug (enfortumab) binds to Nectin-4, which is a protein present on almost all bladder cancer cells. Vedotin is a chemotherapy that is delivered specifically to the cancer cells by binding enfortumab to Nectin-4. EV is sold under the brand name PACDEV.

Enterostomal therapist:

A health professional with specialized training in the care of patients with urostomies and other stomas.

Epirubicin:

A type of chemotherapy that works by entering the cancer cells and attaching to their DNA, which stops the cells from making more copies of themselves. It helps to slow down or stop the growth of cancer cells and is used in treating different types of cancer, including bladder cancer. It is known by the brand names Pharmorubicin and Ellence.

Erdafitinib:

A targeted therapy that specifically inhibits certain proteins called FGFRs, which are involved in cell growth. By blocking these proteins, erdafitinib can help stop or slow the growth of bladder cancer cells that have certain genetic changes. It is known by the brand name Balversa.

Erectile dysfunction (ED):

A sexual dysfunction characterized by the inability to develop or maintain an erection of the penis during sexual performance.

External radiation:

A form of radiation therapy, also called external-beam radiation, in which high-energy beams are aimed at the cancer from outside the body.

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F

Fallopian tubes:

Part of the female reproductive tract, these tubes carry eggs from the ovaries to the uterus.

FGFR:

FGFR stands for fibroblast growth factor receptor. FGFR helps cells grow, survive, and multiply. In some cases of bladder cancer, the gene that controls FGFR is altered or mutated (known as FGFR alterations). FGFR alterations can contribute to cancer growth and spread, which can be exploited as a target for treatment.

Fulguration:

A procedure in which tissues are destroyed using an electric current.

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G

Gemcitabine:

A type of chemotherapy that works by interfering with the DNA of cancer cells, stopping them from growing and dividing. It is commonly used to treat various types of cancer, including bladder cancer, by targeting cells that are in a specific phase of their growth cycle. It is known by the brand name Gemzar.

Gene:

The fundamental unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for producing a specific protein.

Grade:

The grade of a tumour describes how abnormal the cancer cells look under a microscope, usually from 1 to 4. The grade helps predict how fast the tumour may grow and spread.

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H

Hematuria:

Blood in the urine – the most common symptom of bladder cancer. Hematuria can be considered “gross”, meaning that the blood can be seen with the naked eye, or “microscopic”, meaning that it can only be detected when urine is examined under a microscope.

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I

Ileal conduit:

A form of urinary diversion that commonly follows a radical cystectomy. In this urinary tract reconstruction procedure, a piece of the small intestine (ileum) is used to create a new passage for urine to leave the body. The ureters are implanted into this segment of intestine at one end and the other end is brought up to the skin to create a small opening called a stoma. A small pouch is attached to the skin externally with an adhesive to collect the urine.

Imaging:

Medical technologies used to view and produce internal pictures of the body, such as ultrasound, x-ray, MRI and CT scans.

Immune system:

The complex network of organs and cells that aids the body in fighting against infection or disease.

Immunotherapy:

A form of treatment which uses the body’s immune system to fight cancer cells.

Immunogenicity:

The ability of a substance to stimulate an immune response, or a term used to refer to the intensity of the response.

Impotent:

Incapable of having an erection sufficient for sexual intercourse.

Incision:

A surgical cut.

Indiana Pouch:

One form of continent cutaneous diversion.

Intermittent catheterization:

Also known as self-catheterization. The insertion of a catheter to empty the bladder followed by immediate removal of the catheter. This can be performed several times daily or less frequently.

Internal radiation:

A treatment technique which involves needles, seeds, wires or catheters containing radioactive material being placed into or near a tumour. This treatment is also called brachytherapy, implant radiation, or interstitial radiation therapy.

Intravenous (IV):

Intravenous means “within a vein.” Most often it refers to giving medicines or fluids through a needle or tube inserted into a vein. This allows the medicine or fluid to enter your bloodstream right away.

Intravenous pyelogram (IVP):

A series of x-rays of the kidneys, ureters and bladder taken after a dye is injected into a blood vessel. The dye is concentrated in the urine, causing the kidneys, ureters and bladder to be outlined on the x-rays.

Intravesical:

Within the bladder.

Invasive bladder cancer:

A bladder cancer that grows into the bladder wall. Invasive bladder cancer, especially when it invades the muscle layer (muscle-invasive bladder cancer) can spread to other parts of the body.

Interferon:

Interferon alpha2b is a natural compound that can affect the immune system. It was previously used to enhance the effect of BCG but is no longer available for use in patients.

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K

Kidneys:

A pair of organs in the abdomen that remove waste from the blood (as urine), stimulate red blood cell production, and contribute to blood pressure regulation.

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L

Lamina propria:

A specialized layer of connective tissue that separates the inner lining of the bladder (urothelium) from the underlying muscle wall.

Local therapy:

Therapy that targets a specific tumor site (e.g. tumor in the bladder or a specific metastasis). This differs from “systemic therapy” which targets the whole body.

Lymph node:

A small, rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue and is part of the immune system. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes. Lymph nodes filter substances from the lymphatic fluid (lymph) to help the body fight infection and disease. Your lymph nodes can swell or get bigger, which is a sign that your body is fighting an infection or an illness. Cancer spread to lymph nodes can also cause them to get bigger.

Lymphatic system:

The lymphatic system contains organs, vessels, and tissues which help protect the body from infection and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes, and a network of lymph vessels that carry lymph fluid back to the blood stream. Like blood vessels, lymph vessels branch into all the tissues of the body.

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M

Magnetic resonance imaging (MRI):

An imaging technique which uses a magnet connected to a computer to generate detailed images of the internal body.

Malignant:

Cancerous; a growth with the ability to invade and destroy nearby tissue and spread to other parts of the body.

Medical oncologist:

A physician specialized in the treatment of cancer with chemotherapy, hormonal therapy, immunotherapy, and targeted therapy. With respect to bladder cancer, medical oncologists are the primary caretaker of patients with advanced cancer, and they administer neoadjuvant and adjuvant therapy to patients with muscle-invasive bladder cancer.

Metastasis:

The spread of cancer cells from one part of the body to another. The resultant tumours that arise at distant sites are also called secondary tumours. Under the microscope they have the same appearance as the original (primary) tumour.

Mitomycin:

A type of chemotherapy that works by directly attacking the DNA in cancer cells, preventing them from growing and dividing. It can be used to treat bladder cancer and is often administered directly into the bladder to target the cancer cells more effectively. It is known by the brand name Mutamycin.

Mitrofanoff:

An alternative route for catheterization when the urethra is unable to be used, which employs the appendix as a channel, connecting the bladder to the skin.

Monotherapy:

Treatment involving only one drug.

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N

Neoadjuvant therapy:

Treatment administered as the initial step before the primary treatment (such as surgery) is used. Examples include chemotherapy, radiation therapy, and hormone therapy. The goal of neoadjuvant therapy is to kill any microscopic spread of the cancer and to shrink the primary tumour.

Neobladder (Orthotopic):

A new, reconstructed bladder made from a segment of intestine that is attached to the urethra. This new bladder takes up the anatomic position of the original bladder.

Nivolumab:

A type of immunotherapy that boosts the body’s immune system to help it recognize and attack cancer cells. It works by blocking a protein called PD-1, which normally stops the immune system from attacking cells, thus enhancing the immune response against cancer cells. It is known by the brand name Opdivo.

Non-Muscle Invasive Bladder Cancer (NMIBC):

Tumours that originate from the lining of the bladder and do not penetrate the muscle wall. Most bladder cancers are non-muscle invasive. They mostly have a low risk of progression, but recurrence is common. Formerly called superficial bladder cancer.

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O

Oncogene:

A specific cancer-causing gene which leads to abnormal stimulation of cell growth once altered.

Ostomy:

A surgical procedure in which an opening (stoma) is created, connecting an internal area of the body to the outside. Types of ostomies include colostomy for stool and urostomy for urine.

Ovaries:

The pair of female reproductive glands located in the pelvis on each side of the uterus that are responsible for the formation and release of ova, or eggs.

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P

P53:

A gene that regulates normal cell growth. Its function is lost in approximately 40% of bladder cancer due to gene mutation.

Pathologist:

A doctor who studies cells and tissues under a microscope to identify diseases.

PD-L1:

A protein that acts as a kind of “brake” to keep the body’s immune responses under control. PD-L1 may be found on some normal cells and in higher-than-normal amounts on some types of cancer cells. When PD-L1 binds to another protein called PD-1 (a protein found on T cells), it keeps T cells from killing the PD-L1-containing cells, including the cancer cells. Anticancer drugs called immune checkpoint inhibitors bind to PD-L1 or PD-1 to block their binding. This releases the “brakes” on the immune system and leaves T cells free to kill cancer cells.

Pelvis:

The lower part of the abdomen, located between the hip bones.

Pembrolizumab:

A type of immunotherapy that works by helping your immune system to kill cancer cells. It is used to treat a number of cancers. It is known by the brand name Keytruda.

Pharmacokinetics:

Measurement of the process by which a drug is moved into, through and out of the body, used to determine the onset, duration and intensity of the drug’s effect.

Photodynamic therapy:

Treatment with cancer-killing drugs that become active when exposed to light.

Primary tumour:

A term used to describe the original, or first, tumor in the body. Cancer cells from a primary tumour may spread to other parts of the body and form new, or secondary tumours. This is called metastasis. These secondary tumours are the same type of cancer as the primary tumour. Also called primary cancer.

Prostate:

A gland positioned below the bladder, surrounding part of the urethra. The prostate contributes to the male reproductive system by producing a large part of the semen.

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Q

Quality of life:

The overall enjoyment and satisfaction of life. Usually investigated in clinical trials to assess the effects of cancer and its treatments in relation to one’s overall sense of well-being and ability to perform tasks.

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R

Radiation oncologist:

A physician specialized in treating cancer using radiation.

Radiation therapy:

A treatment for killing cancer cells and shrinking tumours using high-energy radiation from x-rays, gamma rays, neutrons, and other sources. The radiation can be administered externally using a machine (external-beam radiation therapy), or internally by placing radioactive material near the cancer cells (internal radiation therapy, implant radiation, brachytherapy). Systemic radiation therapy (radiotherapy) involves injecting a radioactive substance to circulate throughout the body.

Radical cystectomy:

A surgical procedure in which the entire bladder and nearby tissues and organs are removed.

Radioactive:

Giving off radiation.

Rectal:

By or associated with the rectum, which is the final 8-10 inches of the large intestine, ending at the anus.

Recur:

To occur again. Recurrence refers to the return of cancer, either at the same site as the original (primary) tumour or in another location, after prior complete treatment of the tumour.

Refractory:

A disease that does not respond to treatment.

Resectoscope:

A lighted instrument like a cystoscope that is inserted into the bladder through the urethra to scrape away tumors using electric current.

Risk factor:

A habit, exposure, trait, condition, or genetic alteration that increases a person’s chance of developing a disease.

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S

Side effects:

Complications that can arise from the treatment of diseases. Common side effects of cancer treatments include nausea, vomiting, fatigue, hair loss, mouth sores, and decreased blood cell counts.

Small intestine:

The part of the digestive tract between the stomach and the large intestine.

Sonogram:

A form of medical imaging used to examine internal areas of the body using sound or vibrations with an ultrasonic frequency. Also called ultrasound.

Sphincter muscle:

A specialized circular muscle responsible for stopping the flow of urine when contracted. In males, two sphincter mechanisms exist: one located at the junction of the prostate and bladder, and one just below the prostrate in the upper segment of the urethra. It is believed that the second sphincter, which wraps around the urethra, is responsible for continence in females.

Squamous cell carcinoma:

Cancer originating from squamous cells, which can be found in the skin or the inner lining of most body organs including the bladder. Approximately 5% of all bladder cancer is squamous cell carcinoma.

Squamous cells:

Flat, thin cells resembling fish scales found in surface tissue of the skin and the lining of the body’s hollow organs, including the respiratory and digestive tracts.

Stage:

The extent of cancer, indicating how deep the primary tumour has invaded into the organ in which it originates and whether it has spread to other areas of the body.

Staging:

The use of medical tests (especially MRI and CT scans) and exams to determine the extent of the cancer within the body, particularly investigating whether it has spread to other areas.

Stoma:

An artificial opening, connecting the inside of the body to the skin.

Superficial:

Affecting cells on the surface; non-invasive.

Suprapubic tube:

A hollow flexible tube that is used to drain urine from the bladder, inserted through a small abdominal incision.

Surgeon:

A doctor who operates on patients to remove or repair parts of the body.

Surgery:

A procedure to treat or investigate diseases and injuries, including the removal or repair of parts of the body.

Symptom:

A sign or indication that a person may have a condition or disease. Some examples of symptoms include headaches, fever, fatigue, nausea, vomiting, and pain.

Systemic therapy:

A form of treatment that uses substances that circulate through the bloodstream, to reach and affect cells throughout the body.

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T

Tissue:

A group or layer of cells that collaborate to carry out a specific function.

Transurethral resection of bladder tumour (TURBT):

Surgery performed by inserting a resectoscope (lighted instrument like a cystoscope) through the urethra.

Trigone:

The bladder floor from where the ureters insert into the bladder to where the urethra exits the bladder.

Trimodal therapy (TMT):

Treatment that involves surgery to remove the tumour from the bladder (TURBT) with radiation therapy and chemotherapy to destroy remaining cancer cells. People who are not fit enough for chemotherapy will have radiation therapy on its own. TMT is an effective treatment approach as an alternative to radical cystectomy for selected patients with muscle invasive bladder cancer (MIBC).

Tumour:

An abnormal mass of tissue formed as a result of excessive cell growth and division. They may be either benign (non-cancerous) or malignant (cancerous).

Tumour suppressor gene:

A gene which contributes to cancer growth when its function is lost. This is the opposite of an oncogene, which causes cancer when it is activated. P53 is a commonly mutated tumor suppressor gene in bladder cancer.

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U

Ultrasound:

A form of medical imaging used to examine internal areas of the body using sound or vibrations with an ultrasonic frequency.

Ureter:

The tube that carries urine from the kidney to the bladder.

Urethra:

The tube through which urine exits the body, responsible for emptying urine from the bladder.

Urinary diversion:

A surgical procedure which reroutes the flow of urine from its normal pathway.

Urine:

Fluid containing water and waste products which is made by the kidneys, stored in the bladder, and exits the body via the urethra.

Urine Cytology:

Urine cytology evaluates the urine sediment for the presence of cancerous cells.

Urologic oncologist:

A surgeon specialized in treating urinary system cancers.

Urologist:

A surgeon specialized in diseases of the urinary organs in females and the urinary and sex organs in males.

Urostomy:

An artificial opening of the urinary tract to the skin, allowing urine to leave the body via a stoma in the abdomen.

Urothelium

The lining of the urinary tract, including the renal pelvis, ureters, bladder, and urethra.

Urothelial carcinoma:

Cancer that begins in the urothelial cells, which line the urethra, bladder, ureters, and renal pelvis. It was previously referred to as transitional cell carcinoma.

Uterus:

The small, hollow, pear-shaped organ in a woman’s pelvis, where a fetus develops during pregnancy. Also called the womb.

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V

Vagina:

The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal.

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Abbreviations

BCa – Medical Term for Bladder Cancer

BCG – Bacillus Calmette-Guérin

BMI – Body Mass Index

CADTH – Canadian Agency for Drugs and Technologies

CBCIS – Canadian Bladder Cancer Information System

CBCRN – Canadian Bladder Cancer Research Network

CCRA – Canadian Cancer Research Alliance

CT – Computerized Tomography

CUA – Canadian Urological Association

FGFR – Fibroblast Growth Factor Receptors

GP – General Practitioner

HCP – Health Care Provider

MIBC – Muscle Invasive Bladder Cancer

MRI – Magnetic Resonance Imaging

NMIBC – Non-Muscle Invasive Bladder Cancer

NSWOC – Nurse Specialized in Wound, Ostomy and Continence

NSWOCC – Nurse Specialized in Wound, Ostomy and Continence Canada

PD-1 – Checkpoint Inhibitor

PDL-1 – Checkpoint Inhibitor

RC – Radical Cystectomy

RN – Registered Nurse

UNC – Urology Nurses Canada

UTI – Urinary Tract Infection