Orientador: Mariângela Esther Alencar Marques / Banca: Gilberto Uemura / Banca: Sérgio Vicente Serrano / Banca: José Roberto Figaro Caldeira / Banca: Cleverson Teixeira Soares / Resumo: O câncer de mama (CM) representa um importante problema de saúde pública no mundo, com aproximadamente 1.400.000 casos diagnosticados e 460.000 mortes por ano. É considerada uma doença heterogênea, com alterações em diversas vias de sinalização molecular. Tanto os marcadores prognósticos quanto os preditivos são de grande importância para a tomada de decisões terapêuticas. No caso do CM operado, os marcadores prognósticos ajudam a determinar se a paciente necessita de tratamento adicional e os marcadores preditivos auxiliam o clínico a decidir qual tratamento a ser utilizado. Desta forma, o melhor conhecimento dos marcadores prognósticos e preditivos conhecidos e a identificação de novos marcadores, poderão auxiliar o tratamento de pacientes com CM de forma mais adequada. Dois marcadores tumorais com possíveis implicações clínicas são o TGF-β1 e o seu receptor TGF-βRII. Em relação ao impacto preditor de resposta a quimioterapia, os referidos marcadores ainda não foram devidamente estudados. Quanto ao papel prognóstico, os estudos em literatura são contraditórios. Acredita-se que o TGF-β atue de forma diferente em função do tipo celular e do contexto biológico envolvido. Assim, é supressor tumoral nos estágios iniciais da carcinogenese e promotor tumoral nos estágios tardios. O momento da troca de papéis não está estabelecido, porém, sabe-se que, em um mesmo tumor, o TGF-β pode atuar tanto como supressor quanto como promotor tumoral simultaneamente. Em face da complexidade biológica do TGF-β, optou-se por estudar um grupo homogêneo de mulheres com CM em estádio TNM III, com longo período de seguimento clínico, submetidas à quimioterapia neoadjuvante (QtNeo) baseada em doxorrubicina e também à quimioterapia adjuvante. Desta forma, o objetivo deste... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Breast cancer (BC) represents an important public heatlh problem worldwide, with approximately 1.4 million new cases and 460,000 deaths per year. It is considered a heterogeneous disease with changes in several molecular signalling pathways. Both the predictive and prognostic markers are important for making therapeutic decisions. In the case of operated BC, prognostic markers help to determine if the patient needs additional treatment and predictive markers help the clinician to decide which treatment to use. Thus, a better knowledge of known predictive and prognostic markers and the identification of new markers, may improve the treatment of BC patients. Two tumor markers with potential clinical implications are TGF-β1 and its receptor TGF-βRII. Regarding the prediction of response to cancer chemotherapy, these markers have not been adequately studied. Considering its prognostic value, published studies are contradictory. It is believed that the TGF-β acts differently depending on the cell type and the biological context involved. Thus, it acts as a tumor suppressor in the early stages of carcinogenesis and as a tumor promoter in later stages. The moment of role switch is not established, however, it is known that in the same tumor, TGF-β can act as both tumor suppressor and promoter simultaneously. Given the biological complexity of TGF-β, we chose to study a homogeneous group of women with TNM stage III BCs comprising tumors with long follow-up period, submitted to doxorubicinbased neoadjuvant chemotherapy (NAC) and adjuvant chemotherapy as well. Thus, the aim of this study was to evaluate the protein expression of TGF-β1 and TGF-βRII in a sample of BCs and to correlate it with clinical and pathological response rates, occurrence of distant metastasis, and survival analysis. To this end... (Complete abstract click electronic access below) / Doutor

People with intellectual disabilities are increasingly being diagnosed with cancer due, in part, to increases in life expectancy for this population. Despite the growing number of people with cancer and intellectual disabilities, the cancer-related experiences of people with intellectual disabilities are under-researched. Person-centred approaches to research are needed to better understand the needs and psychosocial outcomes of people with cancer and intellectual disabilities. This thesis aims to better understand the cancer-related experiences of people with intellectual disabilities, and the impact on the people who support them. The thesis comprises four related studies: (1) a systematic review of psychosocial experiences of cancer in people with intellectual disabilities; (2) a qualitative study of cancer experiences in people with intellectual disabilities using thematic analysis informed by grounded theory; (3) a survey of UK oncology nurses' attitudes and care perceptions towards people with intellectual disabilities; and (4) a feasibility study of an intervention to improve healthcare professionals' perceptions of communicating with people with cancer and intellectual disabilities. Five themes emerged from the ten papers included in the systematic review: delayed diagnosis; information, communication, and understanding; negative psychological consequences; negative physical consequences; and social support. Six of the ten papers included data from the same ethnographic study of 13 people, highlighting a paucity of empirical research regarding the psychosocial cancer experiences of people with intellectual disabilities. The qualitative study indicated that people with intellectual disabilities were often excluded from conversations about their diagnosis, treatment, and ongoing care, and expressed confusion and anxiety about their cancer. Attempts to protect them from distress inhibited communication, but where additional support was offered, participants engaged more meaningfully in their experience and this should, therefore, be encouraged. In the qualitative study, oncology nurses were reported to be important figures in the care of patients with intellectual disabilities. The survey of oncology nurses highlighted that caring for cancer patients with intellectual disabilities may intensify their already difficult role; however, previous experience may ameliorate negative consequences. This sample identified their need for training about communicating with people with intellectual disabilities. The first three studies informed the development of a novel, brief, online, video-based intervention for healthcare professionals working with people with intellectual disabilities and cancer. The feasibility trial of this intervention indicated that there were problems with recruitment, high attrition, and intervention adherence. These problems were, most likely due to participants finding the content and delivery method to be unacceptable. It is clear that the intervention is not feasible in its current format, and that further theoretical and modelling work is needed before the intervention is feasibility tested again ahead of a definitive trial. This body of work has demonstrated that people with intellectual disabilities and cancer face multiple barriers to accessing cancer care, including informative and understandable communication with healthcare professionals. With appropriate support, psychological and physical outcomes can be improved for people with intellectual disabilities and cancer, but caring for people with cancer and intellectual disabilities can be challenging for paid and informal carers, and oncology staff. Difficulties with communication are bi-directional, and improving communication might be an appropriate first step to improving cancer experiences for this population, but developing effective interventions presents numerous feasibility challenges.

Pancreatic adenocarcinoma (PDAC) is the fourth leading cause of cancer death in Western countries. The PDAC tumour microenvironment (TME) is characterized by a dense stromal reaction, consisting of many cell types including fibroblasts and immune cells. The chemokine receptor, CX3CR1 forms a high-affinity axis with its unique ligand CX3CL1 and is expressed on monocytes, macrophages and T cells. CX3CR1 is also present on pancreatic malignant cells, where it has been associated with metastasis formation. The aim of my project is to investigate the role of CX3CR1 in the progression and development of pancreatic cancer in a genetically engineered mouse model of PDAC, the CX3CR1GFP/GFPLSL-KRASG12D/+LSL-Trp53R172H/+Pdx1-Cre (CKPC) mouse. In these mice, the CX3CR1 protein is not functional but they express GFP. I have found that the absence of CX3CR1 in KPC mice has no effect in their lifespan and response to chemotherapy. Comparison of the immune infiltrate of the tumours revealed that the lack of CX3CR1 causes a significant decrease in T cells and a possible increase in myeloid cells in CKPC mice compared to KPC mice. Expression analysis of several inflammatory cytokines in the TME showed a significant difference in IL-10 between KPC and CKPC mice. There was also a significant increase in levels of, CX3CL1, both locally and in the plasma. Finally, we performed RNA-seq on KPC and CKPC tumours. My analysis revealed 607 differentially-expressed genes, some of which encoded other chemokines or protein regulating the immune system. In particular, I observed the upregulation of Cxcl10 and Cxcl12, and the downregulation of Gata3 and S100a4, which could explain the decrease in T cells in the TME of CKPC mice. In conclusion, although the lack of CX3CR1 modifies the TME in this genetic model of PDAC, these changes do not affect the lifespan or the response to chemotherapy.

Mammographic density (MD), created predominantly by increased stromal tissue, is a major breast cancer risk factor, though little is known about the biological mechanisms mediating it. Tamoxifen prevents breast cancer in a subset of high risk women via mechanisms that appear dependent on reduction of MD. Animal models suggest tamoxifen remodels the mammary stroma to a tumour-inhibitory phenotype. This study aims to analyse the effect of tamoxifen on human breast fibroblast function and identify pro-tumourigenic pathways contributing to density-associated risk. Methods Primary human breast fibroblasts from normal, high risk or breast cancer patients were treated with hydroxytamoxifen (100nM-5μM). Fibroblast function was analysed by measuring: proliferation, expression of stromal proteins fibronectin and collagen 1; effects on TGF-β signalling and up-regulation of myofibroblast marker SMA. Genome wide analysis was performed using RNA-Seq. Significantly deregulated pathways were validated by PCR, western blotting and mass spectrometry. Results Fibroblasts from 23 patients were treated with hydroxytamoxifen. All patients showed reduced proliferation with treatment. 62% of patients showed reduced fibronectin expression. TGF- β-mediated up-regulation of SMA and fibronectin were consistently inhibited by tamoxifen. RNA-Seq analysis revealed down-regulation of Wnt signalling, an established profibrogenic and pro-tumourigenic pathway. In addition, there was significant modulation of many metabolic pathways, including components of the microsomal anti-oestrogen binding site (AEBS). Binding of tamoxifen to the AEBS inhibits cholesterol epoxide hydrolase (ChEH) enzyme activity, promoting an anti-tumourigenic phenotype. The effects of tamoxifen on fibroblasts could be partly replicated using tesmilifene, a commercially available 5 inhibitor of ChEH. Mass spectrometry analysis confirmed an altered cholesterol metabolite profile in tamoxifen treated fibroblasts. Conclusion These data indicate that tamoxifen can directly remodel the mammary stromal microenvironment, generating a less 'reactive' stroma. Thus, tamoxifen impacts on multiple pathways, many independent of the oestrogen receptor, to create a tumourinhibitory microenvironment. This offers exciting potential for patient monitoring and alternative breast cancer prevention strategies.

Cancer is a highly complex disease that evolved in response to a wide range of biological and molecular changes that impact disease behaviour, treatment efficacy and clinical outcomes. Studying this diversity in human tumours is essential for gaining insights that will ultimately improve the survival rates of cancer patients. Cancer stem-like cells (CSCs) are believed to be responsible for invasive and metastatic features in tumours and can contribute to chemotherapy resistance and subsequent tumour relapses. There is an increasing need to identify the molecular mechanisms involved in tumour cells, particularly in CSCs. Cancer testis antigens (CTAs) are a subclass of germline proteins normally produced in immune-privileged sites, such as the testis, ovary and placenta of somatic tissues, and the presence of these antigens is increased in a variety of cancers. These characteristics make CTAs highly important immunotherapeutic targets, since they do not harness the immune response in the testes but encode immunogenic proteins that can induce a specific response in cancerous tissues. CTA genes are potentially very importance in clinical applications, including cancer diagnosis, vaccination and immunotherapy. This current study focused on the investigation of two CTAs, TDRD12 and LKAAEAR1, that may have an enhanced presence in cancer and the potential to be immunogenic. TDRD12 is linked to stemness features and enables the proliferation of germ line tumour cells. It appears to act as a possible transcriptional regulator for germline factors that are essential to cell cycle proliferation, germ cell maintenance and stem marker expression. TDRD12 may have the potential to drive oncogenesis and CSC targets. LKAAEAR1 was validated as a CTA at the protein level, showing its production was restricted to germ cells and the central nervous system from normal tissues and showed aberrant production in a wide range of tumours. This protein has been shown to be produced in germ cells undergoing spermatogenesis with strong nuclei staining, suggesting its potential role in this process. LKAAEAR1 potentially acts as a regulator for transposable elements, thereby increasing its contributions to cancer development. This study demonstrated that LKAAEAR1 could potentially be used as a cancer biomarker and therapeutic target.

Inflammatory Breast Cancer (IBC) is a rare, lethal, and understudied form of breast cancer. Although affecting 1-2% of the population, the remission rate is half that of the spectrum of other breast cancers, and most cases present in the advanced stages due to rapid undetectable development. Of the diagnosed cases, systemic chemotherapeutics are relatively ineffective in comparison to non-IBC breast cancer cases, indicating other unique mechanisms driving IBC progression. Historically, the specific sensitivities of a particular tumor type or subtype have been linked to genetic alterations that represent addiction hubs, such as hyperactivation of oncogenes due to mutation. Although some efforts have been made to characterize the molecular fingerprint of inflammatory breast cancers (IBCs), unfortunately, no clinical application has emerged from these studies. Thus, we decided to utilize a different strategy to identify the Achilles' heel of IBC cells. Using shRNA libraries, we performed an unbiased genome-wide loss-of-function screen comparing the gene functions required for survival of IBC and non-IBC cells. Histone deacetylase 6 (HDAC6) emerged as one of the top genes required for IBC cell survival and was further validated. HDAC6 is vital in the cell's unfolded protein response (UPR) to clear misfolded or toxic protein, and IBC cells proved to be preferentially sensitive to this aspect of HDAC6 inhibition, displaying increased protein accumulation, ER stress indicators, and subsequent apoptosis upon failure to clear or refold accumulated proteins. These data indicate HDAC6 is a crucial gene required for IBC cell line survival, in part due to its function in IBC cell UPR. Furthermore, emerging orally bioavailable agents for HDAC6 inhibition make it a promising candidate towards tailored therapeutic implementation in IBC patient trials.

Photocopy of typescript. / Digitized by Kansas Correctional Industries

Thesis (M.Sc. (Medical Laboratory Sciences)) -- University of the North, 1986 / Refer to the document

Thesis (MPH.) -- University of Limpopo, 2015 / Cervical cancer is a serious public health problem in both developed and developing countries. It is said to be the leading cause of death for women from developing countries as compared to other types of cancers. The aim of the study was to determine the initial clinical presentation of cervical cancer patients at the Pietersburg Hospital, Limpopo Province in South Africa. The objectives were to establish the demographic profile of cervical cancer patients, to identify the stage at initial clinical presentation, and to describe the factors that led to initial clinical presentation of cervical cancer patients at the Pietersburg Hospital in Limpopo Province, South Africa.The researcher conducted a quantitative retrospective cross-sectional survey by examining the records of cervical cancer patients seen for a period of three years from January 2012 to December 2014 at the Pietersburg. The results indicated that most patients, particularly the elderly, presented for the first time at the hospital with advanced stages of cervical cancer. Factors, such as age and place of residence contributed to this late presentation. There is a need for improved data capturing of information about marital status and parity to further assess the influence these two elements might have on the clinical presentation of cervical cancer. Furthermore, availability and facilities for screening should be improved because early detection of cervical cancer prevents progression to advanced stage of the disease. More awareness campaigns about risk factors of cervical cancer have to be implemented and a study is needed to establish why most patients with advanced stage cervical cancer are from Sekhukhune and Vhembe Districts, particularly the former Venda and Gazankulu Regions.

Cancer-related fatigue (CRF) is a persistent and debilitating problem for many breast cancer survivors. Although many CRF measurement tools are available, no consensus exists on the most appropriate tool to use for breast cancer survivors. The purpose of this project was to identify the best method of assessing CRF in breast cancer survivors. The practice-focused question inquired about the most appropriate way to assess fatigue in breast cancer survivors. The central concepts of the project were CRF and cancer survivorship. This project was informed by the theory of health as expanding consciousness and Mishel's theory of uncertainty in illness. The sources of evidence included multi-database searches and literature from professional organizations. Results were tracked using preferred reporting items for systematic reviews and metasystems and a literature review matrix. The search identified 14 sources, which were assessed for quality using the grading of recommendations, assessment, development, and evaluation process. The results of this systematic review did not support the use of any particular assessment tool; however, 2 clinical practice guidelines recommended screening using a numerical severity scale followed by detailed assessment of clinically significant fatigue using available assessment tools. Screening can be implemented into the survivorship clinic, allowing nurses to identify potentially clinically significant fatigue so that further workup is done and interventions are implemented. Identifying, assessing, and intervening for clinically significant fatigue can improve the quality of life for breast cancer survivors, contributing to positive social change.