Background: Radiation therapy used for head and neck cancer patients cause many side effects in the oral cavity and above all affects the salivary glands. Complaint of dry mouth (xerostomia) and hyposalivation are common as well as swallowing difficulty (dysphagia) even after the cancer is remitted.  Aim: The aim of the study is to examine the correlation between hyposalivation and xerostomia in patients undergoing radiotherapy.   Methods: Six patients undergoing radiotherapy for head and neck cancer at Norrlands University Hospital participated in the study. A questionnaire regarding xerostomia was answered and a collection of stimulated as well as unstimulated saliva was taken.  Results: Regarding the stimulated salivary flowrate, one out six patients was below the limit of hyposalivation. Three out of six patients were below the limit of hyposalivation with reference to the unstimulated salivary output. The questionnaire regarding xerostomia showed that all patients experienced dry mouth symptoms to varying degrees. The questions concerning the dryness of the tongue and the amount of saliva in the mouth had the highest rating.  Conclusion: Regarding the patients that participated in this study, a correlation is shown between xerostomia and unstimulated salivary output. However, due to the lack of participants in the study, no firm conclusion can be drawn.

Bakgrund: Bröstcancer är idag den vanligaste cancerformen som drabbar kvinnor i världen. För unga kvinnor under 45 årsåldern riskerar endast 4-6% att drabbas av bröstcancer vilket utgör diagnosen till en ovanlig sjukdom. På grund av bröstcancerns svåra patologi och dess unika prognostik krävs särskild uppmärksamhet hos unga kvinnor då cancern påverkar flera aspekter på livet som fertilitet, familjeliv och karriär.  Syfte: Syftet med litteraturöversikten var att beskriva den unga kvinnans upplevelser av att leva med bröstcancer.  Metod: Studien är en kvalitativ litteraturstudie innefattande av tolv artiklar där en kvalitativ innehållsanalys tillämpats vid analysering av data.  Resultat: Olika upplevelser som identifierades i de inkluderade artiklarna kunde sammankopplas under följande huvudkategorier: 1) Den unga kvinnans sexuella hälsa, 2) Ångest och livskris, 3) Den sociala aspekten.  Slutsatser: Olika upplevelser identifierades hos unga kvinnor under deras bröstcancerdiagnos. För att öka sjuksköterskors förståelse för unga bröstcancerpatienter och möjliggöra implementationen av förbättrad vård bör sjuksköterskestudenter och nuvarande sjuksköterskor utbildas om omvårdnad vid unga bröstcancerpatienter. / Background: Breast cancer is today the most common form of cancer that affects women in the world. For young women under the age of 45, only 4-6% are at risk of suffering from breast cancer, which constitutes the diagnosis of an unusual disease. Due to the difficult pathology of breast cancer and its unique prognosis, special attention is required in young women as the cancer affects several aspects of life such as fertility, family life and career. Aim: The purpose of the literature review was to describe the young woman's experiences of living with breast cancer. Method: The study is a qualitative literature study comprising twelve articles where a qualitative content analysis is applied when analyzing the data. Results: Different experiences identified in the included articles could then be linked under the following main categories: 1) The young woman's sexual health, 2) Anxiety and lifecrisis, 3) The social aspect. Conclusion: Different experiences were identified in young women during their breast cancer diagnosis. In order to increase nurses' understanding of young breast cancer patients and enable the implementation of improved care, nursing students and current nurses should be educated about nursing care for young breast cancer patients.

A high expression of stromal PDGFRβ is known to be a poor prognosis marker in several solid tumor types. However, the role of stromal PDGFRβ for non-small cell lung cancer (NSCLC) patients remains unclear. Therefore, we investigated the activation status of PDGFRβ with proximity ligation assay (PLA) by studying the interaction between the receptor and GRB2, one of PDGFRβs downstream signaling molecules. The main aim is in this study is to investigate the activation status of stromal PDGFRβ in NSCLC tissues and look into its clinical relevance for lung cancer patients. Our data revealed that PDGFRβ activation status did not affect overall survival, and was not associated to smoking, sex, age or stage of cancer. PDGFRβ activation status was higher in the histological subgroup of squamous cell carcinoma-patients compared to the adenocarcinoma subgroup. The PDGFRβ activation status showed a clear correlation to the general expression level of PDGFRβ investigated by immunohistochemistry (IHC). The correlation also showed that a high activation status required a high general expression, indicating a specific pipeline.

Bakgrund: Under 2020 fick 7570 kvinnor i Sverige diagnosen bröstcancer. Under sjukdomsförloppet kommer behandling sättas in för att bota cancern och förebygga att den ska sprida sig och komma tillbaka i framtiden. De vanligaste behandlingarna vid bröstcancer är mastektomi, strålbehandling samt cytostatika. Det är viktigt att sjuksköterskan har rätt resurser, förutsättningar samt kunskap för att kunna möta kvinnan i sin sjukdom och förstå hur hennes sexualitet, självbild och identitet förändras under behandlingstiden vid bröstcancer. Syfte: Syftet var att beskriva hur kvinnans sexualitet, självbild och identitet förändras under behandlingstiden vid en bröstcancerdiagnos. Metod: Studien genomfördes med en kvalitativ design med induktiv ansats. Litteraturstudien utgick från tre patografier och analysen genomfördes i enlighet med Graneheim och Lundmans (2017) kvalitativa innehållsanalys. Resultat: Resultatet i denna studie baserades på två huvudkategorier/ teman och fyra underkategorier/ teman. De olika kategorierna/ teman beskriver hur tre kvinnor med en bröstcancerdiagnos upplever att deras självbild förändras under behandlingsperioden. Huvudkategorierna/ teman i studien är att inte känna igen sig själv, kroppsliga förändringar samt emotionella reaktioner. Under behandlingen förändras kvinnans självbild och identitet. Saker så som självständighet, kroppsuppfattning samt känsla av sexualitet omvärderas i relation till hur kvinnans liv var innan dess att hon fick bröstcancerdiagnosen  Slutsats: Slutsatsen som kan dras efter att ha studerat resultatet är att kvinnors självbild förändras under behandling av bröstcancer. I resultatet framkom det att flera aspekter av självbilden förändras. Bland dessa fanns förändrad identitet samt upplevelsen av kvinnans sexualitet. Resultatet i denna studie är riktat till den grundutbildade sjuksköterskan men kan med fördel också intressera övrig sjukvårdspersonal och bröstcancerdrabbade kvinnor.

Umeå University Hospital has acquired a new treatment planning system, RayStation, for radiotherapy. It has a different set of dose calculation algorithms that require new planning strategies for stereotactic lung cancer treatments. This \paper{} has two parts and the first investigates the Monte Carlo algorithm, recalculating doses for 21 historical treatments, and finds that it is slow but fast enough to be used and that it reports dose coverage that is usually lower than that of simpler algorithms, particularly for small tumours in low density lungs. The second part investigates the performance of four alternative planning methods: a straight forward PTV/ITV based method, a method using density override of the PTV, an ITV based semi-robust method and a fully robust method treating both setup margins and breathing motion robustly. The new methods are tested on 12 historical cases and are compared, using robust evaluation, to each other and the original plans. The first three are found to all be viable alternatives, while the fully robust method, while impressive, is found not to be a practical alternative at this time. / Norrlands Universitetssjukhus har skaffat ett nytt dosplaneringssystem, RayStation, till radioterapin. Det har en annan uppsättning dosberäkningsalgoritmer som kräver en ny planeringsstrategi för stereotaktisk lungcancerbehandling. Den här rapporten innehåller två delar och den första undersöker Monte Carlo-algoritmen genom att räkna om doserna för 21 tidigare behandlingar. Den visar sig vara långsam men snabb nog för att vara användbar och den rapporterar lägre dostäckning än enklare algoritmer, särskilt för små tumörer i lungor med låg densitet. Den andra delen undersöker fyra alternativa planeringsmetoder: en baserad på PTV och ITV utan krusiduller, en dito med s.k. override av PTVs densitet, en ITV-baserad med robust hantering av setup-marginaler och en helt robust metod med robust hantering av både marginaler och andningsrörelser. De nya metoderna testas på 12 tidigare behandlingar och jämförs, medelst robust utvärdering, med varandra och originalplanerna. De tre första visar sig alla vara goda alternativ medan den helt robusta, som visserligen är imponerande, inte är praktiskt användbar än.

The number of children and young adolescents diagnosed with cancer is increasing, leading to a need for new therapeutic strategies with diminished neurodegenerative side- effects. This report presents preliminary observations on glioma-initiating cells (GICs) in the way to develop a strategy that induces cell-cycle arrest or quiescence in neural stem cells (NSCs). To test how changes in membrane potential due to pharmacological treatments have effects on localization and levels of REV-ERBα protein, proneural (PN) and mesenchymal (MES) cells were treated with varying concentrations of REV-ERBα agonist SR9009 drug and T-type calcium channel blocker mibefradil. Treatments showed that both drugs do not relocalize REV-ERBα to the nucleus. However, SR9009 decreases the levels of REV-ERBα protein, whereas mibefradil does not have a similar effect.  Our preliminary data on mouse NSCs showed they engage with REV-ERBα protein while going into contact inhibition. Therefore, we investigated whether high confluency put PN and MES GICs into quiescence and the role of the main molecular clock protein REV-ERBα in this process. Cells were grown up to certain confluency, and following qPCR gene expression analysis revealed PN cells go into contact inhibition whereas MES cells continue proliferating even after they are grown to confluency. Moreover, REV-ERBα protein does not have any role in both outcomes.

Background: Neuroblastoma is the most common extracranial solid tumor in children. The survival rate in high-risk neuroblastoma is less than 50 % despite intensive multimodal therapy, and there is thus an immense need for new treatment options. In a previous preclinical study conducted at Uppsala University, treatment with sunitinib was found to inhibit tumor growth and angiogenesis in an orthotopic model of high-risk neuroblastoma.  Aim: The present study aimed to further explore the effect of sunitinib on tumor stroma, focusing on whether it was possible to detect and quantify tumor-associated neutrophils (TANs) in tumor sections from the above-mentioned study using immunohistochemistry (IHC). Methods: Tissue sections from formalin-fixated paraffin-embedded tumors were stained with anti-Ly-6G/Ly-6C, anti-ITGAM, or hematoxylin-eosin, and the number of granulocytes was quantified manually using a light microscope. An independent samples two-tailed t-test was used for statistical analysis. Results: The average number of granulocytes increased by 40 % in animals treated with sunitinib compared to control animals (p = 0.003) in hematoxylin-eosin stained tumor sections of orthotopic neuroblastomas. The results from the staining with anti-Ly-6G/Ly-6C or anti-ITGAM, on the other hand, were impossible to quantify due to the high background staining despite the concentration of antibody used. Conclusion: In conclusion, this report indicates that the density of TANs in an orthotopic murine neuroblastoma model is increased by treatment with sunitinib. However, to confirm this result, the study should be repeated once a reliable IHC method for the detection of TANs has been developed.

Background: Every year, hundreds of children are diagnosed with cancer. This affects the whole child's family, which means that the nurse during the child's cancer care must be there to support the whole family. The parent needs to feel involved in the child's care and have a trusting relationship with the nurse. As a parent, you have to go through a great deal of suffering, which requires the nurse to adapt her support to the needs of the parent and the child. Aim: The purpose of this study was to shed light on how a parent with a child with cancer experiences the nurse's support during and after cancer care. Method: A literature-based study was conducted. Ten qualitative articles were selected and analyzed, based on Friberg's analysis step model. This participates in three categories and a total of eight subcategories. Results: The results showed that the nurse's support was an important factor in an attempt to reduce the parent's suffering. This support could be divided into three categories: Cooperation between nurse and parent, parent's need for support and accessibility and communication. Conclusion: Pediatric cancer affects the whole child's family, and the parent is in great need of support to deal with their suffering and at the same time support their child. During their child’scancer care, the parent goes through many feelings of no longer recognizing their own child, as well as being helpless in their parenting role. By the nurse working in an empathetic and inclusive way where there is an opportunity to build meaningful and strengthening relationships between the parent and the nurse and that the parent's needs are also met, the parent's suffering can be reduced with the help of the nurse's support.

Prostate cancer (PCa) is the second most common cancer diagnosis for men and the fifth leading cause of cancer-related death worldwide. A common treatment strategy for PCa is external beam radiation therapy (EBRT), where high doses of radiation are used to kill cancer cells. Recent developments in RT include maintaining acceptable side effects during intensified treatment over fewer treatment occasions (hypofractionation) and boosting the level of radiation to the gross tumor volume (GTV) visible on multiparametric magnetic resonance imaging (mpMRI) and positron emission tomography (PET). Without a histopathological (HP) reference, the dose distribution cannot be compared to the varying grades of aggressivity within the cancer, known as ISUP grade groups (IGGs). The aim of this master thesis project was to explore the dose distribution over IGGs using a gold standard HP reference and investigate the mitigating effects of rectal spacers, following a hypofractionated RT schedule with focal boosts. The dataset consists of 15 patients, planned for radical prostatectomy. These patients harbored high-risk disease (IGG ≥ 4) in the GTV. HP evaluations following surgery resulted in physical slices of the prostate, showing the location and IGG of lesions. EBRT treatment plans that combined an ultra-hypofractionation strategy with a boost to the GTV were made. The dose distributions were evaluated by dose volume histograms (DVHs) over the target volumes, organs at risks (OARs) and the lesions. Robust evaluations of targets and OARs were performed by recalculating doses following translations of the patient by 2 mm in all directions. Similarly, lesions were shifted by 2 mm in all directions with respect to the nominal dose plan to estimate the sensitivity to motion. The effects of the translations were assessed by examining the impact on the DVHs and percentage of passed clinical goals. Two viable dose plans for each patient were produced, one for a 10 mm spacer and one for 8 mm. Both plans fulfill all rectum goals. For the 10 mm plan, the average median dose (D50) was greater than the prescribed prostate dose (42.7 Gy) for all IGGs by atleast 1.1 Gy. The D50 of the higher grades (IGG 3, 4 and 5) were 47.5, 46.4 and 48.7 Gy, meaning that they were closer to the desired GTV dose 49.0 Gy than the prescribed prostate dose. This thesis project showed that it is possible to reach high GTV doses while sparing the OARs and that the higher IGGs received a higher dose than the lower grades. Examining rectal dose depending on different spacer thicknesses allowed us to recommend a spacer thickness that is safe to use, which can provide increased patient comfort while saving time and resources.

Aim: To study the possibility of detecting lymph node metastasis in locally advanced urinary bladder cancer (UBC) treated with radical cystectomy (RC) by using preoperative positron emission tomography/computed tomography (PET/CT) and peroperative sentinel node biopsy (SNB) technique. We also investigate the clinical significance of macrophage traits expression by cancer cells, M2-macrophage infiltration (MI) in tumor stroma and the immunohistochemical expression of biomarkers in cancer cells in relation to clinicopathologic data. Patients and Methods: We studied prospectively 122 patients with UBC, pathological stage pT1–pT4 treated with RC and pelvic lymph node dissection (PLND) during 2005–2011 at the Department of Urology, Linköping University Hospital. In the first study, we compared the results of preoperative PET/CT and conventional CT with the findings of postoperative histopathological evaluation of lymph nodes (LNs). In the second study we investigated the value of SNB technique for detecting pathological LNs during RC in patients with UBC. W also examined the significance of the primary tumor location in the bladder in predicting the site of LN metastases, and the prognostic significance of lympho-vascular invasion (LVI) and lymph node metastasis density (LNMD) on survival. In the third study, we investigate the clinical significance of macrophage infiltration (MI) in tumor stroma and macrophage-traits expression by tumor cells. In the fourth study, we investigate the cell cycle suppression proteins p53, p21, pRb, p16, p14 ARF as well as tumors proliferative protein Ki67 and DNA repair protein ERCC1 expression in cancer cells. The results were compared with clinical and pathological characteristics and outcome. Results: Prior to RC, PET/CT was used to detect LN metastasis in 54 patients. PET/CT had 41% sensitivity, 86% specificity, 58% PPV, and 76% NPV, whereas the corresponding figures for conventional CT were 41%, 89%, 64%, and 77%. SNB was performed during RC in 103 patients. A median number of 29 (range 7–68) nodes per patient were examined. SNs were detected in 83 out of 103 patients (81%). The sensitivity and specificity for detecting metastatic disease by SNB varied among LN stations, with average values of 67% -90%. LNMD or ≥8% and LVI were significantly related to shorter survival. In 103 patients, MI was high in 33% of cases, while moderate and low infiltration occurred in 42% and 25% of tumors respectively. Patients with tumors containing high and moderate compared to low MI had low rate of LN metastases (P=0.06) and improved survival (P=0.06), although not at significant level. The expression of different tumor suppression proteins was altered in 47-91% of the patients. There were no significant association between cancer specific survival (CSS) and any of the studied biomarkers. In case of altered p14ARF, ERCC1 or p21, CSS was low in case of low p53 immunostaining but increased in case of p53 accumulation, although not at a significant level, indicating a possible protective effect of p53 accumulation in these cases. Conclusion: PET/ CT provided no improvement over conventional CT in detection and localization of regional LN metastases in bladder cancer. It is possible to detect the SN but the technique is not a reliable for perioperative localization of LN metastases; however, LVI and LNMD at a cut-off level of 8% had significant prognostic values. MI in the tumor microenvironment but not CD163 expression in tumor cells seems to be synergistic with the immune response against urinary bladder cancer. Our results further indicate that altered p53 might have protective effect on survival in case of altered p14ARF, p21, or ERCC1 indicating an interaction between these biomarkers.