| 1. |
- Ekwall, Eva, 1950-
(författare)
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Women's experiences of gynecological cancer and interaction with the health care system through different phases of the disease
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis explores women’s experiences of being diagnosed with gynecological cancer, during different phases of the disease trajectory. The women were undergoing treatment for primary gynecological cancer (study I) and for recurring ovarian cancer (studies II–IV). The focus of studies I and III was the women’s interactions with the health care system, while the experience of recurring ovarian cancer was sought in studies II and IV. Interviews were made and the text was tape-recorded and transcribed. The women in studies I-III were interviewed at the end of their treatment periods. The method used in studies I and III was subjected to qualitative content analysis. The aim of study I was to illuminate what women, diagnosed with primary gynecological cancer, reported to be important in their interactions with the health care system. Fourteen women were interviewed. The results were described in three categories: optimal care, good communication, and maintained self-image and sexuality. The aim in study III was to explore what women with the first recurrence of ovarian cancer perceived as important in their interactions with the health care team. Twelve women were interviewed. The main finding was that the women needed help from the health care team to familiarize themselves with the disease. This theme was supported by the following sub-themes: being confirmed as a person, getting help in making sense of the information about the disease and its treatment, having the opportunity to be involved and to share responsibility, and feeling confident that medical expertise is good enough. A phenomenological method was used in studies II and IV. The aim of study II was to deepen the understanding of women’s experiences of the first recurrence of ovarian cancer. Twelve women were interviewed. The findings showed three key constituents: being denied one’s future while simultaneously hoping to be able to delay the cancer’s advancement; feeling alienated from both oneself and one’s surroundings; and being responsible. The key constituents was integrated into a structure: living in limbo, characteristic of an existential loneliness. In study IV, four of the women from studies II–III were interviewed twice, three and five years after the first recurrence. The aim was to illuminate the phenomenon of living with life-prolonging treatment of recurring ovarian cancer. The analysis started with creation of the situated structure for each woman. The situated structures were transformed into a general structure of living with life-prolonging treatment of recurring ovarian cancer that was formulated as follows: time was experienced as short, yet extendable; the body became increasingly fragile; strength proved itself to be unpredictable; and the wish to share the meaning of the disease with others was experienced as unattainable. The findings produced important knowledge that increases the understanding of the needs of women living with gynecological cancer. This knowledge provides a basis to shape health care delivery in accordance with the needs of the women.
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| 2. |
- Isaksson, Helena, 1978-
(författare)
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Clinical studies of RNA as a prognostic and diagnostic marker for disease
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Technologies for RNA detection are evolving rapidly and gives an op-portunity for discovery of new markers for early detection of complex diseases. Today in clinical work we rely on signs and symptoms in com-bination with the measurement of protein levels for diagnosis. The quick turnaround time of mRNA synthesis may provide an earlier diagnostic signal than protein-based biomarkers assays, in acute dramatic condi-tions such as acute mesenteric ischemia (AMI), for early detection of cancer, as prognostic tool in cancer treatment and as an aid in difficult diagnosis of unknown origin.The main goals of this thesis was to apply a whole genome approach to study different complex diseases to evaluate the applicability of RNA as a diagnostic or prognostic marker for disease, preferably from an easily accessible source such as peripheral blood. This was investigated in an animal model with induced AMI, a cohort of ovarian cancer patients and in a single-patient study of a girl with a severe inflammatory syn-drome.Through this thesis we have gained insight into how gene expression is regulated in ischemic intestinal tissue.We found that a peripheral blood test can distinguish between ovarian cancer patients with or without residual tumour mass after surgery with the help of expression analysis of six genes. We also found that gene expressions of three genes can predict overall survival in peripheral whole blood from ovarian cancer patients. And that gene expression profiles indeed can significantly distinguish between two groups of high and low risk ovarian cancer. In the single-patient study, we tried but failed to device a successful treatment before it was too late. Neverthe-less, the things we learned and the case studies that were published may serve as a diagnostic tool for clinicians facing similar syndromes.
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| 3. |
- Bohr Mordhorst, Louise, 1958-
(författare)
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Predictive and prognostic factors in cervical carcinomas treated with (chemo-) radiotherapy
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A series of 131 women with cervical carcinoma FIGO stage I-IV were treated with external radiotherapy and intracavitary brachytherapy. In 47 patients (36%) concomitant chemotherapy was given. One hundred and twenty-one tumors (92%) achieved complete remission. Addition of chemotherapy increased primary cure rate to 98%. Tumor stage, tumor size, and histology were significant predictive factors for primary cure. Treatment related factors were: brachytherapy dose and interruption of irradiation.Thirty-nine recurrences (30%) were recorded. Tumor stage, histology, and concomitant chemotherapy were significant predictive factors.The 5-year cancer-specific survival rate of the complete series was 65%. Tumor size was a strong prognostic factor in multivariate analysis.Serum samples from 44 patients were analyzed. Ten candidate biomarker proteins with regard to tumor recurrences were identified.Five Hedgehog proteins were analyzed with immunohistochemistry. Residual tumor, local and distant recurrences and survival rate were associated with PTCH, SMO and GLI2. In the Wnt-β-catenin study intense staining of the membranes and nuclear staining > 5% were of significant predictive and prognostic value. Intense nuclear APC staining was associated with recurrences and cancer-specific survival rate.Conclusion: Histology, tumor size and brachytherapy dose were important clinical predictive and prognostic factors. Multiprotein analysis identified ten biomarker proteins associated with tumor recurrences. Three proteins (PTCH, SMO, and GLI2) in the Hedgehog pathway were of predictive and prognostic value. In the Wnt-β-catenin pathway intensity of β-catenin membrane staining and accumulation in the nuclei as well as nuclear APC-expression were of predictive and prognostic value.
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