Ovarian cancer, one of the most dreadful malignancies of the female reproductive system, poses a lethal threat to women worldwide. In this dissertation, the objective was to introduce a novel type of graphene quantum dots (GQDs) based nano-sized drug delivery systems (DDS) for ovarian cancer treatment. As a starting point, the facile synthesis method of the GQDs was established. Subsequently, the targeting ligand,folic acid (FA), was conjugated to GQDs. Next, a FDA approved chemotherapeutic drug, Doxorubicin (DOX), was loaded to form the GQDs-FA-DOX nano-conjugation as the DDS. Moreover, the uptake profile and anti-cancer effect of the GQDs-FA-DOX were validated in ovarian cancer cells. Finally, the immunotoxicity of GQDs and its mechanism were investigated and elucidated. Taken together, the findings described in this dissertation provide a novel and powerful strategy of targeted treatment for ovarian cancer.

Ovarian cancer is a fatal disease because of the lack of symptoms and markers for early detection. Most ovarian neoplasms resemble and are classified according to the complex characteristics of Mullerian duct epithelia. We tested the hypothesis that Mullerian epithelial characteristics influence early ovarian neoplastic progression. The most common type of ovarian cancer is the serous carcinoma which resembles Mullerian-derived oviductal epithelium. We discovered that oviduct-specific glycoprotein (OVGP1), a tubal differentiation marker, was present in inclusion cysts, which are the preferential sites for malignant transformation, and in most low grade serous tumors, but absent in ovarian surface epithelium and most high grade carcinomas. OVGP1 was almost entirely limited to ovarian neoplasms with the notable exception of endometrial hyperplasia and carcinoma. A new antibody against OVGP1 detected elevated serum levels from most women with low grade ovarian cancers compared to normal controls. OVGP1 also identified a subset of patients with high grade serous carcinomas who had a more favorable outcome. To examine whether the differentiated phenotype of early ovarian neoplasms alters invasiveness, we established the first permanent cell line for serous borderline ovarian tumors (SBOT), which are differentiated but noninvasive. The results revealed a striking phenotypic similarity between two lines regardless of their cytogenetic diversity. They retained Mullerian epithelial characteristics in vitro, as demonstrated by their morphologic appearance and the differentiation markers keratin, E-cadherin, CA125 and OVGP1. Neither disruption of the growth pattern nor manipulations of the cadherin profile induced invasivenesss. Induction of invasiveness by SV40 early genes was associated with a loss in morphologic differentiation and of differentiation markers but increased motility. MMP secretion was independent of the invasion status. Our findings indicate that OVGP1 is an indicator of early ovarian epithelial neoplasia. It can be detected in the sera from women with early ovarian cancer, and thus, may be a new promising diagnostic marker for the early detection of ovarian cancer. In addition, the results show that Mullerian differentiation does not directly prevent invasiveness, but it diminishes in parallel with invasion caused by other factors. The lack of invasiveness by SBOT cells may depend on factors that regulate motility. / Medicine, Faculty of / Obstetrics and Gynaecology, Department of / Graduate

Les cancers de l’ovaire constituent la cinquième cause de cancer chez la femme et la principale cause de décès pour cancer gynécologique. Ce mauvais pronostique est lié à un diagnostic tardif de la maladie et à l’acquisition de la résistance au sel de platine. L’individualisation thérapeutique est nécessaire compte tenu de l’évolution très clinique hétérogène malgré une histologie et un stade similaire. Les facteurs pronostiques classiques comme l’âge, le stade FIGO, le type histologique, le grade et le résultat chirurgical, ne sont pas suffisants pour prédire la réponse thérapeutique et le pronostique. Cette hétérogénéité clinique est probablement expliqué par l’existence des formes biologiques différentes. La réponse clinique initiale à la chimiothérapie chez la plupart des patientes suivi d’une récidive dans plus de la moitié des cas suggère l’existence d’une subpopulation des cellules qui développe des mécanismes de résistance et survivent. Le TGCA a retrouvé des mutations au niveau de TP53 dans plus de 95% des patientes avec un cancer séreux de l’ovaire à haut grade. Ils ont trouvé une prévalence élevé de mutations somatiques mais peu récurrentes, avec un nombre important des variations du nombre de copies. La recombinaison homologue est défectueuse dans la moitié des tumeurs analysées et les voies de signalisation NOTCH et FOXM1 sont également impliqués. La mutation TP53 et les défets de réparation d’ADN provoquent une instabilité génétique et favorisent une diversité génétique. Il y a des données dans la littérature sur l’hétérogénéité existante entre différentes localisations des cancers de l’ovaire en fonction du moment de la maladie chez la même patiente et chez des patientes différentes avec la même histologie. Nous avons centré notre étude sur la caractérisation de l´expression génique des métastases péritonéales sur une série de patientes avec un cancer sereux de haut grade de l’ovaire en carcinose péritonéale. Nous avons montré des profils géniques différents entre les localisations péritonéales et la tumeur primitive. Nous avons mis en évidence que les gènes présentant des variations d’expression génique les plus marquées au niveau du péritoine codaient pour des protéines impliquées dans les voies de signalisation des principales cytokines intervenant dans l’oncogenèse dont la voie JAK/STAT. Ces voies de signalisation sont probablement impliquées dans la réponse des tumeurs à leur microenvironnement au niveau du péritoine (J Translational medicine 2012). Nous avons réalisé une deuxième étude pour combiner le séquençage génomique et transcriptomique au niveau des prelevements multi-site des patientes avec un cancer de haut grade de l´ovaire afin d’évaluer s’il existe des différences d’expression allélique. 43 gènes montrent des variants alléliques communs à tous les patients. La majorité des gènes presentent une expresión preferentielle par site mais les voies de sigalisation sont similaires pour les localisations peritoneales et pour les tumeurs primitives. Ces produits codent des protéines impliquées dans les voies de signalisation impliquées dans l’adhésion, la migration cellulaire, la réparation de l’ADN ou la croissance cellulaire et peuvent être des cibles thérapeutiques éventuelles (PLOS Genetics under final review). / Ovarian cancer is the fifth most common cause of cancer in women and the leading cause of death in gynaecological cancer. This low survival rate is due to the frequent diagnosis of epithelial ovarian cancer at an advanced stage, and to intrinsic and acquired resistance to platinum-based chemotherapy. Individualisation of treatment is necessary since EOC is a heterogeneous disease. Patients with morphologically similar, advanced-stage tumours display a broad range of clinical outcomes. Prognostic features, including patient’s age, performance status, FIGO stage, histological tumour grade and subtype, and initial surgery results, are insufficient to capture the important individual variations in response to chemotherapy and survival. This heterogeneous outcome suggests the existence of biologically different forms. The Cancer Genome Atlas (TCGA) found that TP53 mutations are present in more than 95% of HGSOC. They found a high prevalence of somatic mutations, but there is a low prevalence of recur¬rent mutations; and there are large-scale copy number aberrations. Initial analyses also suggest that homologous recombination is defective in about half of the tumours analysed, and that NOTCH and FOXM1 signalling are involved in ovarian cancer pathogenesis. However, TP53 mutation and frequent germline and somatic DNA repair defects lead to genetic instability with the potential to generate genetic diversity. Indeed, genetic heterogeneity by different mutational profiles throughout time among different tumor localisations within the same patient, and between patients have been reported.We have focused our research on the charecterisation of peritoneal gene expression profiles compared to primary ovarian lesions. High-density gene expression arrays demonstrate significant different gene expression profiles compared to theirs matched ovarian primary tumors. Differentially expressed genes are enriched in specific pathways, including cell adhésion, cytokine signaling and specifically JAK-STAT pathway. Underlying copy number variation significantly affect gene expression, and patients with copy number alterations displayed greater gene expression différences between their peritoneal and matched primary ovarian lesions (J Translational medicine 2012). In a second study, we performed a combined genome and transcriptome analysis form multi-site samples form ovarian cancer patients to identify preferentially expressed alleles. 43 genes shared across all patients presented significant allele variants. Patients clustered together but every sample and site clustered independently at the variant level. Most genes seemed site-specific but there were similar pathways in the primary and metastatic sites. Preferentially expressed alleles could act as cancer drivers and therefore they can constitute a new therapeutic target (PLOS Genetics under final review).

Ovarian cancer is a malignancy characterized by poor prognosis, high levels of distress, and impaired quality of life (QOL). Investigation into the contributors to QOL is of psychological and prognostic significance in cancer. Contemporary stress theories and empirical accounts identify early life adversity and recent life stress as those sources which exert significant impact on physical and psychological health. To date, life stress research in cancer has yielded few designs which operationalize both indices of early life and recent life stress exposures. Moreover, despite the high-resolution stress data provided by the Life Events and Difficulties Schedule (LEDS) system, no studies to date comprehensively operationalize the early life adversity data obtained during each interview. Therefore, the proposed study is the first of its kind to comprehensively obtain ratings and examine effects of early life adversity data collected as part of the LEDS interview. It is also the first to examine independent influences of differentially timed life stress indices on psychological variables important to psychosocial functioning in ovarian cancer. Early life adversity was experienced by 43.1% of the sample. Adversity varied in content, number of occurrences, and severity. Ongoing difficulties, but not recent life events or early life adversity, were significantly associated with pre-surgical depression and QOL. Ongoing difficulties were also associated with lower depression, sleep, and QOL scores at all time-points. Early life adversity was associated with a poorer trajectory of sleep and QOL over the first year post-diagnosis. Findings are discussed with attention to behavioral and biological mechanisms. Applications to generative and cumulative theories of life stress are proposed. These findings lend support to the potential benefit of interventions aimed toward practical support and stress management in patients with ovarian cancer, as well as provide guidelines for use of early life adversity data obtained through the LEDS interview.

L’amélioration de la prise en charge personnalisée des cancers de l’ovaire nécessite le développement de nouvelles approches thérapeutiques et d’outils capables de prédire la réponse au traitement et la récidive. L’étude des miARNs cellulaires et circulants représente un champ d’investigation prometteur en oncologie, et ils pourraient rapidement constituer de nouveaux outils diagnostiques, pronostiques, voire thérapeutiques. Suite à la réalisation d’un criblage fonctionnel haut débit d’une banque de miARNs sur des lignées cancéreuses ovariennes, nous avons identifié plusieurs miARNs d’intérêt. Alors que l’utilisation des miARNs en tant qu’agents thérapeutiques n’est pas aujourd’hui envisageable, la caractérisation des cibles «pas-à-pas» de l’un de ces candidats, le miR-3622b-5p, en lien avec son action anti-tumorale au sens large (pro-apoptique, sensibilisation au cisplatine et anti-invasive) sur un panel de lignées cancéreuses ovariennes, a permis de renforcer l’intérêt de l’approche que nous développons qui consiste à reproduire l’effet de miARNs en ciblant les déterminants de leur action à l’aide de molécules inhibitrices, potentiellement utilisables en clinique. En parallèle, afin d’identifier globalement les cibles (leur aspect direct ou indirect vis-à-vis d’un miARN devenant alors secondaire) et réseaux associés des miARNs les plus prometteurs, identifiés lors du du screening, et en se basant initialement sur le premier apoptomiR identifié au laboratoire, le miR-491-5p, pour en faire la preuve de concept, une évaluation de l’approche méthodologique combinant des données d’approches multi-omiques a permis de conclure quant à l’intérêt de coupler les analyses trancriptomique et protéomique pour identifier de nouvelles cibles/voies en lien avec son action pro-apoptotique et ainsi proposer des associations pharmacologiques pertinentes et innovantes pour les cancers de l’ovaire. Par ailleurs, nous avons identifié une signature de miARN sérique capable d’identifier les patients susceptibles de présenter une résistance aux sels de platine et potentiellement aux inhibiteurs de PARP, préalablement à toute chimiothérapie et au moment de la récidive avant la seconde ligne de traitement. En résumé, ces résulats offrent de grandes promesses et placent les miARNs au coeur la médecine de précision de demain dans les cancers de l’ovaire. / Improving the personalized management of ovarian cancer requires the development of new therapeutic approaches and tools able to predict treatment response and recurrence. The study of cellular and circulating miRNAs represents a promising field of investigation in oncology, and they could quickly constitute new diagnostic, prognostic and even therapeutic tools. Following a high-throughput functional screening of a miRNA library on ovarian cancer lines, we identified several miRNAs of interest. While the use of miRNAs as therapeutic agents is not currently possible, the characterization of the targets «step-by-step»of one of these candidates, the miR-3622b-5p, with its broad anti-tumoral activity (pro-apoptic, sensibilisation to cisplatin and anti-invasive) on a panel of ovarian cancer lines, made it possible to reinforce the interest of the approach which we develop which consists in reproducing the effect of miRNAs by targeting the determinants of their action using inhibitory molecules, potentially usable in the clinic. In parallel, in order to globally identify the targets (their direct and indirect aspect next to a miRNA then becoming secondary) and associated networks of the most promising miRNAs, identified during the screening, and initially based on the first laboratory-identified apoptomiR, the miR-491-5p, to provide a proof of concept, an evaluation of the methodological approach combining data from multi-omic strategies led to the conclusion that it is useful to combine the trancriptomic and proteomic analyses to identify new targets/pathways related to its pro-apoptotic action and thus propose relevant and innovative pharmacological associations for ovarian cancers. In addition, we have identified a serum miRNA signature capable of identifying patients who may be resistant to platinum-based chemotherapy and potentially PARP inhibitors, prior to any chemotherapy and at the time of recurrence before the second line of treatment. In summary, these results offer great promise and place miRNAs at the heart of tomorrow's precision medicine in ovarian cancer.

Ces dernières années le rôle du stroma tumoral (microenvironnement) dans la progression tumorale. De même le rôle des cellules endothéliales et de la néo-angiogenèse a été illustré dans de multiples études conduisant à la mise en place des thérapeutiques anti-angiogéniques. Cependant il est possible qu’au delà de leur simple rôle comme transporteur d’oxygène et de nutriments les cellules endothéliales jouent un véritable rôle dans la biologie tumorale en sécrétant des substances bioactives (cytokines, microparticules…). Ces médiateurs sont les acteurs actifs d’un dialogue entre cellules tumorales et cellules du stroma. Dans ce travail de thèse nous nous sommes intéressés au rôle particulier des microparticules. Nous avons pu montrer que les microparticules des cellules endothéliales avaient un effet pro-tumoral sur les cellules des cancers de l’ovaire et du sein. Elles étaient capable d’induire une tradition epithélio-mésenchymateuse. Dans la seconde étude nous avons montré que les cellules tumorales sécrétaient des microparticules capable d’activer la voie de signalisation ont/beta-catenin dans les cellules endothéliales par le recrutement de Rac1 et PAK. / In our study, we showed that microparticles participate to a complex dialogue between cancer and ECs. Our main finding showed the ability of MPs mediated cross-talk between cancer and ECs to functionalize an activated angiocrine pro-tumoral endothelial niche. Using endothelial Akt activation as a readout, we were able to differentiate MPs from cells with mesenchymal from cells with epithelial traits. Our data showed that MPs from mesenchymal-like cell lines were able to promote an activation of ECs through Akt phosphorylation, compared to MPs from epithelial-like cell lines. The overexpression of Arf6 in activated ECs is associated with quantitative changes of EC-MPs. Additionally, we were interested in determining the mechanisms that derive the activation of ECs toward supporting tumor growth and expansion. Here we showed that ovarian cancer MPs trigger β-catenin activation in ECs by inducing the upregulation of Wnt/bcatenin target genes and increasing the angiogenic proprieties. Interestingly, the activation of bcatenin in ECs was Wnt/Frizzled independent; but dependent on VE-cadherin localization disruption, bcatenin integrin activation and MMP activity.

Cette thèse de doctorat est une étude de la biologie et de la dynamique des microARN circulants, démontrant leur potentiel comme biomarqueurs pour l’amélioration de la surveillance et de l’évaluation pronostique dans le cancer. Il s’agit des ARN non codants simple-brin, d'environ 19-25 nt de longueur. Ils jouent un rôle clé dans la régulation de l'expression génomique au niveau post-transcriptionnel, en ciblant et réprimant la traduction des ARNm par complémentarité partielle avec leur 3'-UTR. Ils sont également libérés dans le milieu extracellulaire, la circulation et les liquides biologiques. Leur stabilité remarquable et leur diversité dans la circulation, ainsi que leur provenance maligne ou normale, en font des candidats biomarqueurs intéressants, reflétant potentiellement l'état et la dynamique d’une tumeur. Nous nous sommes focalisés sur les carcinomes ovariens (OvCa) et nasopharyngés (NPC), essayant d'élucider la relation entre les miARN plasmatiques et le pronostique des OvCa après une première ligne de traitement, ainsi que d’évaluer leur utilité dans la détection d’une réponse précoce des NPC au traitement. Le carcinome ovarien séreux est la malignité gynécologique la plus agressive. L'absence de symptômes précoces et l'insuffisance des moyens modernes pour détecter la maladie résiduelle et évaluer les résultats du traitement signalent le besoin de nouveaux biomarqueurs diagnostiques et pronostiques. En utilisant des prélèvements plasmatiques séquentiels OvCa avant et après traitement, nous avons étudié un groupe de miARN, en comparaison à des lésions pelviennes bénignes et des femmes en bonne santé. MiR-200b avait une concentration nettement plus élevée dans les échantillons malins avant traitement par rapport aux deux groupes non cancéreux. L'analyse pré- et post-traitement de miR-200b en parallèle avec le biomarqueur standard CA125 a révélé des variations distinctes et une corrélation significative de la variation de miR-200b avec le temps de rémission (PFS). Nous concluons que miR-200b pourrait éventuellement être utilisé comme biomarqueur supplémentaire pour l'estimation de la rémission à la fin du traitement. Le carcinome nasopharyngé (NPC) d'autre part est une tumeur constamment associée à une infection latente des cellules malignes par le virus d’Epstein-Barr (EBV), présentant une distribution géographique particulière. La position de la tumeur rend difficile l'approche chirurgicale, les biomarqueurs évaluant différentes approches thérapeutiques étant de grande importance. Etudiant une nouvelle forme orale de l'agent démethylant 5-azacytidine, démontrée prometteuse pour un tiers des patients NPC qui l’ont reçue, nous avons essayé d'évaluer son impact sur l'expression des miARN et des protéines virales. Malgré l'infection virale latente, les miARN viraux sont abondamment exprimés. En traitant pendant deux semaines quatre modèles de tumeur NPC développés in vivo, nous avons observé une réponse nette dose-dépendante dans les deux. L'analyse protéique a montré une induction de la protéine activatrice du cycle lytique BZLF1, renforçant les preuves antérieures d'induction partielle du cycle lytique viral par la 5-azacytidine. L'analyse des miARN a confirmé l'expression robuste des miARN BART et l'absence des miARN BHRF1 dans les NPC sans traitement. Lors du traitement, nous avons détecté les miR-BHRF1 à la fois dans la tumeur et le plasma des souris traitées. Cette induction a été validée par un traitement ultérieur d'une semaine qui a aussi mis en évidence l'induction de l’expression de l'ARNm de BHRF1, transcrit par le locus situé parmi les miARN BHRF1. Une induction de ces miARN a été observée après traitement par des agents de chimiothérapie, suggérant une utilité clinique potentielle des miR-BHRF1 comme biomarqueurs pour l’évaluation précoce de l’efficacité du traitement. Notre objectif actuel est de valider cette induction par chimiothérapie et étendre nos études au plasma humain. / This doctorate thesis provides an insight into the biology and dynamics of circulating microRNAs, demonstrating their potential to become crucial biomarkers for a better surveillance and prognosis of cancer. MicroRNAs (miRNAs) are small, single-stranded non-coding RNAs, 19-25 nt long, with a key role in the post-transcriptional regulation of gene expression, repressing the translation of target mRNAs through partial base-pair complementarity with their 3’-UTR. They can be released in the extracellular medium, being protected from RNases by association with various transporters and reach body fluids and circulation, participating in intercellular communication. Their remarkable stability and manageable diversity in circulation, as well as the fact that they derive from both malignant and normal cells make them very attractive biomarker candidates, potentially reflecting tumor state and dynamics. We have been focusing on ovarian (OvCa) and nasopharyngeal (NPC) carcinomas, attempting to elucidate the relation between plasma miRNAs and the prognosis of OvCa after first-line treatment, as well as to evaluate their use in the detection of early response of NPC tumors to treatment. Serous epithelial ovarian carcinoma is the most frequent ovarian and the most aggressive gynecologic malignancy. The absence of early symptoms and the insufficiency of modern means to accurately map residual disease and assess treatment outcome highlight the need for new diagnostic and prognostic biomarkers. Using sequential plasma samples from OvCa patients before and after first-line treatment, we studied a pre-selection of miRNAs, comparing them to samples from benign pelvic lesions and healthy women. MiR-200b exhibited a distinct higher concentration in malignant samples before treatment compared to both non-cancerous groups. Pre- and post-treatment assessment of miR-200b in parallel with the standard biomarker CA125 revealed distinct variations and a significant correlation of miR-200b variation with the progression-free survival (PFS) of the patient. We suggest that miR-200b could eventually be used as a supplementary biomarker for estimation of the remission upon treatment completion. Nasopharyngeal carcinoma (NPC) on the other hand is a tumor consistently associated to latent Epstein-Barr virus (EBV) infection of the malignant cells, presenting a unique geographical incidence pattern. The deep position of the tumor makes it tough to access surgically, with biomarkers assessing different therapeutic approaches being greatly needed. Studying a new oral form of the demethylating agent 5-azacytidine, proven to be promising for one third of NPC patients receiving it as a monodrug, we attempted to identify impact of the drug on the expression of viral miRNAs and proteins. Despite the latent viral infection, viral miRNAs are abundantly expressed, attracting interest in EBV-associated malignancies. Treating four in vivo developed NPC tumor models for two weeks, we observed clear response in two of them, in a dose-dependent manner. Protein analysis showed an induction of the immediate-early lytic protein BZLF1, solidifying previous evidence of partial activation of the viral lytic cycle by 5-azacytidine. MiRNA analysis confirmed robust expression of BART and absence of BHRF1 miRNAs at baseline status of NPC. Upon treatment, we observed an induction of BHRF1 miRNAs in both tumor and plasma of treated mice. This induction was successfully validated in a following one-week treatment and completed by a recorder de novo expression of the BHRF1 mRNA, transcribed within the BHRF1 miRNA loci. A weaker induction of BHRF1 miRNAs was also recorded after treatment with standard chemotherapeutic agents, suggesting a potential clinical utility of these miRNAs as circulating biomarkers for detection of early response to treatment. We are further working to confirm this induction by chemotherapy and extend our study to plasma samples derived from treated patients.

Background: Ovarian cancer is the second most common female form of cancer and is considered to be the most aggressive form of gynecological cancer with the highest mortality. This is due to the difficulties in identifying the disease at an early stageWomen who are diagnosed with ovarian cancer face anxiety, feel great uncertainty for the future, fear of relapse and death. They also feel that family relationshipsand other contacts deteriorate, leading to social isolation. Objective: The purpose was to elucidate women's experiences of nursing in ovarian cancer. Method: A literature study with a qualitative approach that is based on ten qualitative articles and an article with a mixed method where the focus is on the qualitative analysis has been used to compile the result. Result: The women's experience of nursing in ovarian cancer resulted in three main categories: communication, support and knowledge, and seven subcategories which are: the need to create a relationship with caregivers, the need for confirmation, the need for individually adapted information, the experience in lack of follow up, the experience in lack of coordination, the experience in lack of competence and understanding of the healthcare staff as well as the need for self-care training. Conclusion: Byhighlighting women's experiences, nurses can create a better understanding of the nursing need that exists to address and manage it by applying patient-centered nursing. / Bakgrund: Ovarialcancer är den näst vanligaste kvinnliga cancerformen och anses vara den aggressivaste formen av gynekologisk cancer med högst mortalitet. Detta beror påsvårigheterna att identifiera sjukdomen i ett tidigt skede. Kvinnor som diagnostiserats med ovarialcancer möter ångest, känner stor osäkerhet inför framtiden, har rädsla för återfall och dödsfall. De upplever även att familjerelationer, samt övriga kontakter försämras vilket leder till social isolering. Syfte: Syftet var att belysa kvinnors upplevelser av omvårdnad vid ovarialcancer. Metod: En litteraturstudie med kvalitativ ansats som baseras på tio kvalitativa artiklar samt en artikel med blandad metod där fokus läggs på den kvalitativa analysen har använts för att sammanställa resultatet. Resultat: Kvinnornas upplevelse av omvårdnad vid ovarialcancer resulterade i tre huvudkategorier: kommunikation, stöd ochkunskapsamt sju subkategorier vilka är: behov av att skapa en relation till vårdgivaren, behovet av bekräftelse, behovet av individuellt anpassad information, upplevelsen av bristande uppföljning, upplevelsen av bristande samordning, upplevelsen av bristande kompetens och förståelse hos vårdpersonalensamt behovet av utbildning i egenvård. Slutsats: Genom att lyfta fram kvinnornas upplevelser kan sjuksköterskor skapa bättre förståelse för det omvårdnadsbehovet som finns för att kunna bemöta och hantera det genom att tillämpa personcentrerad omvårdnad.

Ovarian cancer is the most common cause of death from gynecological malignancy. Taxanes and platinum derivatives are most used therapeutics for its treatment. Development of multi drug resistance to chemotherapy represents a serious complication of the treatment. Therefore, new chemotherapeutic and therapeutic targets are investigated, which could help to overcome tumor cell resistance. The main objectives of the thesis were to study: i) the efficiency of new derivatives of conventional taxanes in vitro with the aim to determine the potentially most effective taxane derivatives in resistant tumor ovarian cells and, ii) the gene expression profile of the Notch signaling pathway, as a possible therapeutic target for the treatment of ovarian cancer. Specifically, the thesis focused on the relationship between levels of Notch signaling gene expression in patients with ovarian carcinoma and their prognosis, progression and survival. This thesis revealed that Stony Brook Taxanes - "SB-T"; SB-T-121402, SB-T-121605, and SB-T-121606 derivatives are very effective in NCI/ADR-RES tumor carcinoma cells resistant to conventional taxane - paclitaxel, and should be further studied in more advanced models, e.g. in vivo patient derived xenografts. In a study of the importance of the Notch signaling pathway in...

Bakgrund: Äggstockscancer är den sjunde vanligaste cancern i världen och den dödligaste av alla gynekologiska cancertyper. I en sjukdomsprocess har sjuksköterskan ett ansvar att vara lyhörd och visa medkänsla, genom att vara ett stöd och ge tröst åt kvinnor vilket kan öka välbefinnandet. Syfte: Syftet var att belysa kvinnors upplevelser av att leva med äggstockscancer. Metod: Studien utfördes som en litteraturstudie med en induktiv ansats. Nio resultatartiklar inhämtades från två olika vetenskapliga databaser, och bearbetades genom en innehållsanalys. Resultat: Innehållsanalysen resulterade i tre övergripande kategorier: Att uppleva rädsla och oro, att ta kontrollen och att uppleva förhoppningar och stöd. Kvinnorna beskrev upplevelsen av diagnosen äggstockscancer som en stor omställning i livet och med en inverkan på fysisk, psykisk och social hälsa. Gemensamt upplevde kvinnorna att bristen på information och kunskap om sjukdomen korrelerade med lidande. Konklusion: I litteraturstudien framgår det att kvinnornas livsvärld påverkas i stora drag och leder till en lägre livskvalitet och ett lidande. Livssituationen förändrades varav kvinnorna upplevde ett behov av stöd och tröst för att kunna hantera sin vardag. / Background: Ovarian cancer is the seventh most common cancer in the world and the deadliest of all gynecological cancers. In process of disease the nurse has a responsibility to be responsive and show sympathy, by comforting and supporting women which can increase well-being. Aim: The aim was to clarify women's experiences of living with ovarian cancer. Method: The study was conducted as a literature study with an inductive approach. The results of nine articles were obtained from two different scientific databases and processed through a content analysis. Results: The content analysis resulted in three categories: Experience of fear and anxiety, taking control and experience of hope and support. The women described the experience of the diagnosis of ovarian cancer as a major adjustment in life with an affect of the physical, psychological and social health. In common the women experienced that the lack of information and knowledge about the disease correlated with suffering. Conclusion: The literature study shows that women's life overall is affected and leads to a low quality of life and suffering. The situation of life changes and the women experienced a need for support and care to handle the daily life.