Submitted by Rosivalda Pereira (mrs.pereira@ufma.br) on 2017-09-12T19:35:08Z No. of bitstreams: 1 WalnaRamos.pdf: 1885249 bytes, checksum: a716015a5d512aaba735cf4af13d0e13 (MD5) / Made available in DSpace on 2017-09-12T19:35:08Z (GMT). No. of bitstreams: 1 WalnaRamos.pdf: 1885249 bytes, checksum: a716015a5d512aaba735cf4af13d0e13 (MD5) Previous issue date: 2017-04-28 / Human papillomavirus (HPV) is the etiologic agent of one of the most common sexually transmitted infections (STIs). According to the oncogenic potential, it is classified in low risk and high risk; high risk subtypes cause lesions that may progress to invasive carcinomas and has been recognized as a possible etiologic agent in penile carcinoma. Brazil has one of the highest incidences of penile cancer in the world. The general objective of this work is associate HPV infection with the histopathological profile of squamous cell carcinomas in patients from the State of Maranhão. This is a prospective analytical study of 29 samples of patients who underwent penectomy surgery at the Aldenora Bello Institute of Oncology of Maranhão. Sociodemographic data were collected through a questionnaire applied to the patients, clinical and histopathological data were collected from the medical records. Tumor samples were collected during penectomy surgeries, and the following steps were performed at the laboratory: DNA extraction and quantification, Nested PCR with PGMY and GP + primers for HPV detection, visualization of amplified products, purification of the PCR product and automated sequencing. The sequencing products were decoded through the BLAST program. Data were analyzed through the SPSS statistical program, with a 5% level of significance. It was observed that the majority of the men were over 60 years of age (69%), had stable marital union (75.9%), family income of up to one minimum wage (75.9%), were illiterate (55. 2%), lived in countryside towns (79.3%), reported using tobacco at some moment in their lives (62%). Regarding sexual habits, 62.1% reported not having performed circumcision, 41.4% had a previous STD, 72.4% had never used a condom, 48.3% had the first intercourse before age 18. The presence of HPV was detected in 69% of the cases, among the viral types, HPV 16 was the most prevalent (55.5%). Regarding to lesion, 51.7% of the cases presented more than one affected region, and the glans was affected in 93.1% of the cases. The most prevalent type of lesion was ulceration (51.7%). Among the histopathological classifications, 41.4% of the samples were classified in degree I of the Broders scale, 27.7% in stage T1 of the TNM staging and according to the Jackson classification, both stages I and II presented the same prevalence, 27.6% of samples. There was no statistically significant difference between the variables evaluated and the presence of HPV. Low education, low income and no circumcision were highly observed in the study, being possible to correlate such variables with the increase of the risk of penile cancer development. The presence of HPV in 69% of the samples and the prevalence of high risk subtypes suggest the need for more actions to prevent the spread of HPV over the population / O papilomavírus humano (HPV) é o agente etiológico de umas das infecções sexualmente transmissíveis (ISTs) mais comuns. É classificado de acordo com o potencial oncogênico em baixo risco e alto risco, os subtipos de alto risco causam lesões que podem progredir para carcinomas invasivos e vem sendo reconhecido como possível agente etiológico no carcinoma peniano. O Brasil tem uma das maiores incidências de câncer de pênis do mundo. O objetivo geral deste trabalho é associar a infecção do HPV com o perfil histopatológico de carcinomas epidermóides penianos em pacientes do Estado do Maranhão. Trata-se de um estudo analítico prospectivo de 29 amostras de pacientes que foram submetidos a cirurgia de penectomia no Instituto Maranhense de Oncologia Aldenora Bello. Dados sociodemográficos foram coletados através de um questionário aplicado aos paciente, os dados clínicos e histopatológicos foram coletados dos prontuários. As amostras tumorais foram coletadas durante as cirurgias de penectomia, e em laboratório foram realizadas as etapas de: extração e quantificação do DNA, PCR Nested com os primers PGMY e GP+ para detecção do HPV, visualização dos produtos amplificados, purificação do produto da PCR e sequenciamento automatizado. Os produtos do sequenciamento foram decodificados através do programa BLAST. Os dados foram analisados através do programa estatístico SPSS, o nível de significância foi de 5%. Foi observado que a maioria dos homens estava na faixa etária acima de 60 anos (69%), apresentavam união conjugal estável (75,9%), renda familiar de até um salário mínimo (75,9%), eram analfabetos (55,2%), residiam em municípios do interior do Estado (79,3%), relataram o uso de tabaco em algum momento da vida (62%). Em relação aos hábitos sexuais, 62,1% relataram não ter realizado circuncisão, 41,4 % a ocorrência de DST prévia, 72,4% nunca fizeram uso de preservativo, 48,3% tiveram o 1º coito antes dos 18 anos. A presença de HPV foi detectada em 69% dos casos, dentre os tipos virais, o HPV 16 foi o mais prevalente (55,5%). Em relação a lesão, 51,7% dos casos apresentou mais de uma região afetada, estando a glande afetada em 93,1% dos casos. O tipo de lesão mais prevalente foi a do tipo ulceração (51,7%). Dentre as classificações histopatológicas, 41,4% das amostras foram classificadas no grau I da escala de Broders, 27,7% no estágio T1 do estadiamento TNM e na classificação de Jackson, os estágios I e II apresentam a mesma prevalência, 27,6% das amostras. Não houve diferença estatisticamente significante entre as variáveis avaliadas e a presença de HPV. A baixa escolaridade, a baixa renda e a não circuncisão foram observados no estudo com um percentual elevado, sendo possível correlacionar tais variáveis com o aumento no risco de desenvolvimento do câncer de pênis. A presença de HPV em 69% das amostras e a prevalências dos subtipos de alto risco sugerem a necessidade de mais ações de prevenção da disseminação desse vírus na população.

Yes / Aim: To explore how men with penile cancer construct humour in relation to their diagnosis and treatment. Background: Functionalist, relief and incongruity theories attempt to account for humour but there is a dearth of empirical evidence in nursing care. This is particularly so in relation to a condition like penile cancer where some nurses think that humour in their interactions with patients would be inappropriate. Design: The study employed a participative, mixed-qualitative-methods design. Method: Focus groups and patient-conducted interviews were both used during a one-day ‘pilot workshop’ in March 2011. The data were initially analysed using framework analysis. This paper explores the theme of humour in depth. Findings: Humour helped participants make light of their condition, which meant that they could laugh about the consequences of treatment (‘laughing about urination’) and build rapport with health professionals (‘humour with health professionals’). Nevertheless, the use of humour was less important than the treatment of their cancer (‘humour discounted’) and there was a fear that they would be subject to ridicule because of their condition (‘fear of ridicule’). Conclusion: The findings suggest a combination of functionalist, relief and incongruity theories of humour; the emotions these men experience are contained (functionalist) and released (relief) through humorous interaction, and the potential for comedy lies in an incongruity between what is expected socially and the experiences of these men, for example around expectations that men use urinals in public toilets. Nurses should continue to use humour to build rapport with patients, should they judge this to be appropriate although they may want to avoid jokes about sexual and urinary functioning until after treatment. / National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0808-17158).

Yes / Aim To explore the challenges of engaging men with penile cancer in qualitative interview research. Background Qualitative interviewing offers an ideal tool for exploring men’s experiences of illness, complementing and providing context to gendered health inequalities identified in epidemiological research on men. But conducting interviews with men can be challenging and embarking on a qualitative interview study with males can feel like a daunting task, given the limited amount of practical, gender-sensitive guidance for researchers. Reflecting on a researcher’s experience of conducting qualitative research on men with penile cancer, this paper explores the potential challenges of interviewing this group, but also documents how engagement and data collection were achieved. Review methods This is a reflective paper, informed by the experiences of a male researcher (KW) with no nurse training, who conducted 28 interviews with men who had been treated for penile cancer. The researcher’s experiences are reported in chronological order, from the methodological challenges of recruitment to those of conducting the interview. Implications for practice/research The paper offers a resource for the novice researcher, highlighting some advantages and disadvantages of conducting qualitative interview research as a nurse researcher, as well as recommendations on how to overcome challenges. Conclusion Engaging men with penile cancer in qualitative interview raises practical, methodological, ethical and emotional challenges for the researcher. However, when these challenges are met, men will talk about their health. Methodological procedures must enable an open and ongoing dialogue with clinical gatekeepers and potential participants to promote engagement. Support from colleagues is essential for any interviewer, no matter how experienced the researcher is.

Made available in DSpace on 2016-08-10T10:39:24Z (GMT). No. of bitstreams: 1 Antoniella Fernanda Mendanha Sousa.pdf: 2903899 bytes, checksum: ec3428888f580d02453116414b41e866 (MD5) Previous issue date: 2008-04-11 / Cancer arises as a consequence of genetic or epigenetic alterations in genes that have a variety of different influences on the cell cycle, including cell growth, proliferation, differentiation, and apoptosis. Nowadays, cancer is among the most prevalent, costly, and preventable of all health problems. In Brazil, it represents the second cause of death of the adult population. Penile cancer is a rare disease, generally more prevalent in poor populations from developing countries, associated with precarious hygiene habits, especially of uncircumcised men. Penile cancer incidence varies across Brazilian geographical regions and it is more common on the North and Northeast regions. Penile cancer usually develops between the fourth and seventh decade of life and Squamous Cell Carcinoma accounts for up to 97% of all penile cancers. Molecular and epidemiological data has found strong evidence of the presence of HPV genome associated with penile carcinomas. The prevalence of HPV genome has been reported to be as high as 80%, depending on the sensitivity of the detection method and the selection of the tumor type. High-oncogenic-risk viral genotypes 16 and 18 are the most common types detected in association with penile tissue. The general objective of the current study was to detect and genotype HPV genome associated with penile cancer tissue using the polymerase chain reaction (PCR) assay. Furthermore, the potential association between the presence of HPV in the samples and the clinicopathological aspects of all cases was also investigated. The study group comprised of 29 cases diagnosed with penile carcinomas at the Urology Department/Hospital Araújo Jorge in Goiânia from 2001 to 2006. Total DNA was isolated from frozen tumor tissue and HPV DNA amplification was performed using GP5+/6+ primer pairs. Samples identified as positive for HPV DNA were genotyped with type-specific primer pairs. Appropriate positive and negative PCR controls were run with all reactions. As an internal control, a fragment of the GAPDH gene was also amplified. In our study, the mean age at the diagnosis was 61,5 years. With respect to tumor topography, 24% was present on the penile shaft, 28% on the glans, 16% on glans and foreskin as the three most frequent observations. Regarding Jackson s staging, 32% of the cases were J-I, 36% J-II, 24% JIII, and 8% J-IV. Partial penectomy was the most frequent surgical approach during treatment, 32% of all cases had metastasis and phimosis was present in 72% of the patients. HPV genome was amplified in 34,5% (10/29) of samples, and HPV-16 was the most prevalent. HPV role in penile cancer must be investigated and viral infection should be considered an import risk facto for penile cancer development, most likely to be implicated in tumor initiation, and should be investigated in association with the occurrence of phimosis, poor hygiene habits, chronic smoking, and individual promiscuity. / O Câncer é uma conseqüência de alterações genéticas ou epigenéticas em uma variedade dos genes que são fundamentais ao processo de crescimento, proliferação, diferenciação e morte programada da célula. Atualmente, essa doença, configura-se um dos principais problemas da saúde mundial, e no Brasil, representa a segunda causa de óbito na população adulta. O câncer de pênis é um tipo raro de neoplasia, que acomete indivíduos de países subdesenvolvidos com baixo nível social e precários hábitos de higiene associado à fimose e não circuncizados. No Brasil a incidência varia conforme a região estudada: 5,5% a 16% nas regiões Norte e Nordeste de 1 a 4% nas regiões Sul e Sudeste e 3,8% na região Centro-Oeste. Este tipo de câncer ocorre freqüentemente entre a quarta e sétima décadas de vida, com 97% dos casos representados pelo carcinoma epidermóide. No entanto, indivíduos jovens também podem ser afetados. Estudos epidemiológicos e moleculares têm identificado a associação entre o Papilomavírus Humano (HPV) e carcinoma de pênis. O genoma desse vírus já foi identificado em 15-80% dos casos desse tipo de tumor, sendo os subtipos de alto risco oncogênico (16 e 18), os mais freqüentes. Os objetivos do estudo foram detectar e genotipar HPV em espécimes biológicos de tumor de pênis e determinar as possíveis associações existentes entre a persença dos tipos virais e os aspectos clínico patológicos (ACP) dos pacientes diagnosticados com câncer de pênis no Serviço de Urologia do Hospital Araújo Jorge (SU-HAJ), no período de 2001 a 2006 e identificar o genoma do HPV pela Reação em Cadeia da Polimerase (PCR). Foram diagnosticados 29 pacientes no SU-HAJ e os ACP foram obtidos a partir dos prontuários e tabulados com estatística descritiva. As amostras de tecido com carcinoma peniano foram submetidas à extração de DNA e posteriormente realizada as reações de PCR. Nestas, utilizou-se os primers GAPDH, GP5+/6+ e tipo-específicos, como controle interno da reação, detecção de qualquer tipo de HPV e genotipagem, respectivamente. A média das idades foi de 61,5 anos. Para topografia, observou-se 24% para haste, 28% para glande, 16% para glande e prepúcio, 12% para glande e haste, 8% para prepúcio e 12% para outras especificações. A morfologia de maior prevalência foi carcinoma escamoso invasor variando do grau I ao IV. No estadiamento (classificação de Jackson), foi verificado 32% para Jackson I, 36% para Jackson II, 24% para Jackson III e 8% para Jackson IV. O tratamento de escolha para a maioria dos casos foi a penectomia parcial, sendo que 32% dos pacientes apresentaram metástases e 72% dos pacientes apresentaram fimose. Na avaliação molecular, o conjunto de primers GAPDH mostrou-se amplificado em todas as amostras analisadas, demonstrando eficácia na extração de DNA. A amplificação para o genoma viral com os primers GP5+/6+ foi observada em 34,48% (10/29) e o tipo mais freqüente de HPV foi o 16. Os estudos sobre a associação entre o HPV e os tumores de pênis são importantes, pois podem avaliar a relação desse vírus com o processo de iniciação e promoção de tumores, junto a outros fatores de risco, como a fimose, má higiene, o tabagismo e a promiscuidade.

Essa pesquisa resultou das inquietaÃÃes provocadas por nossa prÃtica clÃnico-hospitalar com homens portadores de cÃncer peniano submetidos à amputaÃÃo cirÃrgica do pÃnis. Percebemos, quanto a isso, a existÃncia de uma dissimetria entre o discurso desses homens e aquele sustentado pela medicina e pela psico-oncologia, o qual à centrado, sobretudo, no funcionamento sexual amparado na anatomia e fisiologia. Essa nÃo-coincidÃncia nos despertou o desejo de problematizar essa questÃo em uma pesquisa de mestrado, tendo em vista as possibilidades de favorecer em nosso trabalho, junto a essa equipe, uma maior coerÃncia entre o acompanhamento desses pacientes e suas experiÃncias para com esse dano real sofrido. Nosso objetivo geral foi investigar o impacto da penectomia na sexualidade masculina; e os especÃficos, identificar possÃveis saÃdas encontradas pelo sujeito para a satisfaÃÃo pulsional na ausÃncia do pÃnis e verificar os destinos desse impacto em relaÃÃo aos pontos de ancoragem da virilidade e seus respectivos deslocamentos. Para tanto, procuramos, na medida do possÃvel, escutar esses homens a partir da tÃcnica analÃtica, abstendo-nos de dirigirmos suas falas, embora nÃo se tratasse estritamente de uma psicanÃlise. Destarte, procuramos estabelecer uma maior coerÃncia entre a nossa pesquisa e a clÃnica psicanalÃtica, espaÃo privilegiado da pesquisa psicanalÃtica no sentido que lhe à dado por Freud e Lacan. Escutamos seis sujeitos, por ocasiÃo de suas revisÃes pÃs-cirÃrgicas, oriundos do ServiÃo de Urologia do Hospital do CÃncer do Cearà â ICC, local onde se deu a nossa prÃtica para com eles. O tempo decorrido desde a cirurgia atà o encontro conosco variou de dez meses a trÃs anos, e a mÃdia de idade das pessoas atendidas foi de 60,5 anos. ApÃs cada encontro, as falas dos sujeitos foram anotadas e, posteriormente, relatadas sob a forma de vinheta clinica. Assim, mantivemo-nos fiÃis aos significantes por eles produzidos, inerentes Ãs suas subjetividades e nÃo a um saber prÃvio a elas. Quanto aos resultados obtidos, destacamos: a dissociaÃÃo entre amor e desejo presente na vida amorosa dos sujeitos pesquisados; o confronto com a tarefa de reconstruir a imagem viril, perante a mulher e os outros homens, sem o sustentÃculo imaginÃrio fornecido pela anatomia; a tendÃncia de elaborar o sem sentido da doenÃa e da cirurgia atribuindo-as ao exercÃcio da virilidade junto a outras mulheres, que nÃo a esposa; e a ausÃncia de âvida sexualâ para os que ainda possuem o coto peniano, contrariando o que preconiza o saber mÃdico quanto à capacidade de gozo sexual dos pacientes parcialmente penectomizados. ConcluÃmos que atravÃs de uma escuta psicanalÃtica foi possÃvel perceber que, no discurso desses sujeitos, a sexualidade se mostra, de certo modo, refratÃria aos modelos reabilitadores restritos à dimensÃo funcional da sexualidade e, portanto, redutÃveis ao comportamento dos mesmos quando do ato sexual. Isso evidenciou a relevÃncia de um trabalho mais abrangente para com eles, nÃo restrito a intervenÃÃes pedagÃgicas, com o intuito de fazer com que eles elaborem a perda sofrida e possam lidar de forma simbÃlica com a sua nova realidade, inclusive corporal. / This research arises from our restlessness concerning clinical and hospital-related practice involving men suffering from penile cancer who underwent surgical removal of the penis. We perceived that there was dissonance between these men‟s discourse and that one advanced by medical community and psycho-oncologists, centered mainly on sexual functioning as supported by anatomy and physiology. That discrepancy aroused our desire to tackle the issue by means of a master‟s research considering the possibilities of improving with this work a more coherent design for the follow-up of the patients and their experiences related to a serious damage sustained. Our general objective was to evaluate the impact of penectomy on male sexuality; and, as specific objectives to identify possible alternatives found by patients to fulfill the satisfaction drive in face of penile absence, and ascertain where the reflecting impact would end considering virility anchorage points. Leaning on analytical techniques, we tried to listen to these men, avoiding directing their speeches, considering that this was not psychoanalytical sessions. We tried to establish a more coherent design between our research and psychoanalytical practice, a privileged tool adopted by psychoanalytical research if one considers the meaning of this tool as developed by Freud and Lacan. We heard six subjects during their post-surgical evaluation visits, all of them referred by the Urological Service from the Cancer Hospital of the State of CearÃ, where we developed our research. The time between surgical procedure and our encounter with subjects ranged from 10 to 36 months, mean age of them being 60.5 years. After each encounter, we took notes of the subjects‟ speeches, and later presented them as a clinical sketch. Thus, we kept ourselves tuned to major issues inherent to patients‟ subjectivities and not to previous knowledge that we could have about those values. As upshots of our investigative work, we can highlight the dissociation between love and desire in the amorous lives of subjects; the struggle of them to rebuild their virile image in face of female counterpart and other men, lacking as they were the strong imaginary force provided by anatomy; the trend to elaborate on life‟s meaninglessness as a result from disease and surgery preventing them from exerting their virility in relation to other women but the wife; the absence of âsexual lifeâ for those who maintain a penile stump, thus disputing the medical knowledge that propounds existence of a capability for sexual pleasure by patients who underwent partial penectomy. We concluded that by means of a psychoanalytical hearing technique it was possible to assess from the subjects‟ discourse that sexuality presents itself to a certain extent resistant to rehabilitating models based solely on its functional dimension, and, therefore, restricted to patient behavior in relation to the sexual act. This disclosed the importance of a more extensive work with those patients without restricting itself to pedagogical interventions, but aiming at making patients elaborate on their loss and help them tackle in a symbolic way their new reality, including bodily configuration.

Submitted by Maria Aparecida (cidazen@gmail.com) on 2017-11-27T18:12:10Z No. of bitstreams: 1 Juliana Macedo.pdf: 3843653 bytes, checksum: a40308c73af9a3d7ce2e665d6464831f (MD5) / Made available in DSpace on 2017-11-27T18:12:10Z (GMT). No. of bitstreams: 1 Juliana Macedo.pdf: 3843653 bytes, checksum: a40308c73af9a3d7ce2e665d6464831f (MD5) Previous issue date: 2017-08-28 / FAPEMA. / Penile cancer (PeCa) is a rare neoplasm with higher incidence in regions with low socioeconomic indexes. In Brazil, most of the men afflicted by this disease reside in the North and Northeast. Among the main risk factors are lack of hygiene, phimosis, high-risk human papillomavirus (HPV) infection and chronic inflammation. Although the role of inflammation and HPV infection is known in some cancers, the relationship between these two factors and the disruption of genes involved in the CaPe genesis is not yet well established. Thus, our main goal was to determine the expression of genes involved in the process of chronic inflammation and in the carcinogenesis mediated by HPV infection and the role of the deregulation of these genes in the establishment and progression of penile tumor. For this purpose, fresh and formalin-fixed paraffin-embedded (FFPE) tissues from 55 patients with penile cancer were evaluated. HPV detection and genotyping were carried out by nested PCR and direct sequencing in all samples. A subgroup (N = 37) was evaluated by qRT-PCR to determine COX-2, EGFR, MYC, RB and P53 gene expression. For this, sections of FFPE tissues containing more than 70% tumor cells were analyzed. Protein expression of these genes and PGE2 were determined by immunohistochemistry in the same tumor tissues. An analysis of the association between the clinical-histopathological parameters, presence of HPV, and gene and protein expression was performed. All tumors were classified as epidermoid squamous cell carcinoma. HPV DNA was detected in 80% of tumors, of which 95% had at least one high-risk subtype, and HPV16 was the most frequent subtype (63%). Among the HPV negative samples in the tumor tissue, 14% were positive in the tissue adjacent to the tumor, so that 94% of the patients, in total, were positive for the presence of HPV DNA.. Overexpression was identified in all genes involved in the inflammatory process. EGFR showed overexpression in 84% of the samples, while COX2 and PGE were overexpressed in 40% of the tumors, each. There was an associationbetween the levels of EGFR and COX2 expression, and between COX2 and PGE2. On the other hand, the genes related to HPV infection, MYC, RB and P53, were underexpressed in 97%, 85% and 81% of the samples, respectively. The gene expressions did not show any association with clinical-histopathological variables. This study describes the repression of RB and P53 activity in HPV + tumors, suggesting that there is a mechanism of control of these genes, possibly mediated by the virus. The high detection of HPV infection shows the importance of the immunization of boys in the prevention of penile cancer. Our data emphasize the need to expand the vaccine coverage to cover types of HPV present in penile cancer. The overexpression of EGFR / COX2 / PGE2, and the association found between them, support the possibility of therapeutic use of anti-EGFR and anti-COX drugs in penile tumors. / Câncer peniano (CaPe) é uma neoplasia rara com maior incidência em regiões com baixos índices socioeconômicos. No Brasil, a maior parte dos homens acometidos por essa doença residem nas regiões Norte e Nordeste. Entre os principais fatores de risco estão a falta de higiene, fimose, infecção por papilomavírus humano (HPV) de alto risco e inflamação crônica. Embora o papel d a inflamação e da infecção por HPV sejam conhecidas em alguns cânceres, ainda não é bem estabelecida a relação entre esses dois fatores e a disrupção de genes envolvidos na gênese de CaPe. Assim, neste estudo foi avaliada a expressão de genes envolvidos no processo de inflamação crônica e na infecção pelo HPV e o papel da desregulação desses genes no estabelecimento e progressão de tumor peniano. Para isto, foram avaliadas amostras teciduais frescas e fixadas em formalina embebidas em parafina (FFPE) de 55 pacientes com câncer de pênis. Foram realizadas detecção e genotipagem de HPV por nested PCR e sequenciamento direto em todas as amostras Um subgrupo amostral (N=37) foi avaliado por qRT-PCR para determinação da expressão dos genes COX-2, EGFR, MYC, RB e P53. Para isso, foram usadas secões de tecidos de FFPE contendo mais de 70% de células tumorais. A expressão proteica desses genes e de PGE2 foi determinada por imunohistoquímica em 42 amostras. Foi feita análise de associação entre os parâmetros clínico-histopatológicos, presença de HPV e expressão gênica e proteica. Todos os tumores foram classificados como carcinoma epidermóide de células escamosas. DNA de HPV foi detectado em 80% dos tumores (N=55), dos quais 95% apresentaram, pelo menos, um subtipo de alto risco, e destes, HPV16 foi o subtipo mais frequente (63%). Dentre as amostras negativas para HPV no tecido tumoral, 14% foram positivas no tecido adjacente ao tumor, de modo que 94% dos pacientes, no total, foram positivos para presença de DNA de HPV. Nas amostras nas quais foi feita análise de expressão gênica (N=37), detectou-se 94,4% de infecção, sendo 94% dos infectados possuem, pelo menos um, tipo de alto risco. Foi Identificada superexpressão em todos os genes envolvidos no processo inflamatório. EGFR mostrou superexpressão em 84% das amostras, enquanto COX2 e PGE mostraram-se, cada um, superexpressos em 40% dos tumores. Houve associação entre níveis de expressão de EGFR e COX2, e entre COX2 e PGE2. Por outro lado, os genes relacionados à infecção por HPV, MYC, RB e P53, mostraram-se subexpressos em 97%, 85% e 81% das amostras, respectivamente. A expressão dos genes estudados não mostrou associação com as variáveis clínico-histopatológicas. Este estudo descreve a repressão da atividade de RB e P53 em tumores HPV+, sugerindo que há um mecanismo de controle desses genes em câncer peniano, possivelmente mediado pelo vírus. A alta detecção de infecção por HPV mostra a importância da imunização de meninos na prevenção de câncer peniano, e ressalta-se a necessidade de ampliação da cobertura vacinal de modo a abranger tipos de vírus presentes em câncer peniano. A superexpressão de EGFR/COX2/PGE2, e a associação encontrada entre eles, sustenta a possibilidade de uso terapêutico de drogas anti-EGFR e anti-COX em tumores penianos.

This thesis is comprised of two parts. In the first part we study the influence of four frequently disputed genes on the susceptibility for developing prostate cancer, and in the second part we attempt to establish a basic understanding of the molecular genetic events in penile cancer. In a prostate cancer cohort we have investigated the relation of prostate cancer risk and single nucleotide polymorphisms (SNPs) in four different genes coding for the androgen receptor (AR), the vitamin D receptor (VDR), insulin (INS) and insulin receptor substrate 1 (IRS1). Despite strong biological indications of an involvement of these genes in prostate carcinogenesis, the results from different studies are contradictory and inconclusive. The action of the AR varies between individuals in part owing to a repetitive CAG sequence (polyglutamine) in the first exon of the AR gene. The results presented in this thesis show that in our cohort of prostate cancer patients the average number of repeats is 20.1, which is significantly (p<0.001) fewer repeats compared to healthy control individuals, where the average is 22.5 repeats. We find a 4.94 fold (p=0.00003) increased risk of developing prostate cancer associated with having short repeat lengths (≤19 repeats), compared with long repeats (≥23 repeats). In paper I we also study the TaqI polymorphism in the VDR gene, and find that it does not modify the risk of prostate cancer. In the INS gene we study the +1127 PstI polymorphism and find no overall effect on the risk of prostate cancer. However, we do find that the CC genotype is associated with low grade disease defined as having a Gleason score ≤6 (OR=1.46; p=0.018). In the IRS1 gene we study the G972R polymorphism and observe that the R allele is significantly associated with a 2.44 fold increased prostate cancer risk (p=0.010). The knowledge of molecular genetic events in penile cancer is very scarce and to date very few genes have been identified to be involved in penile carcinogenesis. We chose therefore to analyse the penile cancer samples using genome-wide high-density SNP arrays. We find major regions of frequent copy number gain in chromosome arms 3q, 5p and 8q, and slightly less frequent in 1p, 16q and 20q. The chromosomal regions of most frequent copy number losses are 3p, 4q, 11p and 13q. We suggest four candidate genes residing in these areas, the PIK3CA gene (3q26.32), the hTERT gene (5p15.33), the MYC gene (8q24.21) and the FHIT gene (3p14.2). The mutational status of the PIK3CA and PTEN genes in the PI3K/AKT pathway and the HRAS, KRAS, NRAS and BRAF genes in the RAS/MAPK pathway was assessed in the penile cancer samples. We find the PIK3CA, HRAS and KRAS genes to be mutated in 29%, 7% and 3% of the cases, respectively. All mutations are mutually exclusive. In total the PI3K/AKT and RAS/MAPK pathways were found to be activated through mutation or amplification in 64% of the cases, indicating the significance of these pathways in the aetiology of penile cancer.

Yes / Survival for penile cancer is high but treatment can have a long-term detrimental effect on urological function and quality of life. Owing to its rarity, it is difficult to include men with penile cancer in research about their condition.The aim of this study was to identify aspects of their diagnosis and treatment that they would want explored in penile cancer research. The study employed a participative, mixed qualitative methods design; it utilized focus groups and patient-conducted interviews, combined into a 1 day ‘pilot workshop’. The data were analysed using framework analysis. ‘Early signs and seeking help’, ‘disclosure of a ‘personal’ cancer’ and ‘urological (dys)function’ emerged as three key themes. Men with penile cancer want research about their condition to explore early signs and helping seeking, disclosure of a ‘personal’ cancer and urological (dys)function. Research could use methodologies that include consideration of the chronological narrative of the experiences of men with penile cancer, which could be applied in clinical practice by integrating opportunities to explore specific aspects of their experiences at appropriate times along the care pathway. / National Institute for Health Research (NIHR); Research for Patient Benefit (RfPB) Programme. Grant Number: PB‐PG‐0808‐17158

Yes / When used in routine clinical practice, Patient Reported Outcomes Measures (PROMS) can give patients tacit approval to discuss embarrassing topics, which could be particularly useful for urological nursing. The aim of this study was to assess whether it would be feasible to use two such measures for penile cancer; one for body image (the Male Genital Self-Image Scale; MGSIS-5) and another for lymphedema (the Groin and Lower Limb Lymphedema questionnaire; G3L-20). Study packs were posted to penile cancer patients who had received (i) sentinel node biopsy only, (ii) inguinal node dissection only, and (iii) inguinal node dissection with post-operative radiotherapy with or without chemotherapy. The two measures (MGSIS-5 and G3L-20) were complemented with those specific to sexual function (IIEF) and cancer (EORTC-QLQ-C30 version 3) and a modified Lymphoedema Genitourinary Cancer Questionnaire (mLGUCQ). Twenty patients returned questionnaires. Validity and reliability analyses are presented but low participant numbers mean that results need treating with caution. Results show sufficient feasibility for the MGSIS-5 and the G3L-20 to warrant another study to attract larger numbers of participants, either over a longer time frame or at multiple sites. In these further studies, we would recommend adding (1) more Likert responses, (2) the timeframe to the MGIS and (3) exploring either the use of sexual desire psychometric measures or the addition of sexual desire items to the MGSIS for this patient group.

Made available in DSpace on 2016-08-10T10:39:25Z (GMT). No. of bitstreams: 1 LARISSA FERNANDES DE CARVALHO.pdf: 2794684 bytes, checksum: a117224e860c989d8636ee7805cfc679 (MD5) Previous issue date: 2010-05-31 / Cancer has been a major public health problem both in developed and developing countries . Each year, cancer is responsible for more than six million deaths, imposing a population burden that claims about 12% of all causes of that worldwide. Under a genetic perspective, there are two major classes of gene that hold an important role on cancer development: the proto-oncogenes and the tumor suppress genes. Mutations in these genes are the underlying cause of uncontrolled cell proliferation. Under the spectrum of male urological tumors, penile carcinoma is the one that most resembles cervical carcinoma in women. Epidemiological studies have frequently implicated HPV genome as a potential initiator factor for carcinomas of different anatomical sites. HPV role in cancer induction is well documented for cervical carcinomas and a significant association has been found in up to 99,7% of all cases worldwide. The occurrence of HPV in both male and female genital areas has increased the scientific interest around the potential association of HPV genome and penile carcinomas. The HPV genome is mode of one copy of the double-stranded circular DNA molecule, organized in three distinct regions: a Long Control Region (LCR), an Early (E) and a Late (L) protein coding regions. Following viral insertion in a cell genome, the viral LCR becomes the target of an intracellular regulatory mechanism. When infected cells lose this control mechanism, tumor progression towards malignancy and increased viral gene expression occur. Penile cancer is a rare disease, however by far the most common type is the squamous cell carcinoma which is found in about 95% of the penile malignancies. As any other Sexually Transmitted Disease, men are the major link in the chain of infection of HPV. The Polimerase Chain Reactions is the most sensitive procedure to detect and genotype HPV DNA in human biological samples. The current study is a meta-analysis which comprised the result of several studies that using PCR detected and genotyped HPV genome in association with penile cancers. Herein we report on the results of 39 research articles published from 1989 to 2009. We found the published data had large heterogeneity, tending to significance when combined within the 95% confidence interval. The DermonSaimonian-Laird analysis indicated significance between HPV infection and penile cancer development. / O HPV atua como uma importante causa de câncer cervical, em cerca de 99,7% dos casos em todo mundo. Como ocorre em toda infecção de transmissão sexual, o homem é o principal elo na cadeia epidemiológica do HPV e tem sido bastante discutido a associação deste vírus aos carcinomas penianos. O câncer de pênis é uma doença rara, sendo o carcinoma de células escamosas responsável por 95% dos casos. Assim, a infecção por HPV em homens, promove modificações bioquímicas e moleculares, alterando significativamente a população de células, através da interação do genoma viral com o genoma da célula hospedeira ou de proteínas virais com proteínas celulares necessárias ao controle do ciclo celular, como as proteínas supressoras de tumor pRb e p53, podendo desencadear a progressão para o processo maligno. Dentre as técnicas moleculares para detecção de DNA do HPV, a PCR é a mais sensível, pois é capaz de identificar o tipo do HPV. Neste contexto, o presente estudo teve como objetivo, investigar a associação entre o HPV e os pacientes com câncer de pênis através de uma meta-análise. Um procedimento destinado a examinar, de modo simultâneo, os resultados de várias investigações sobre um mesmo tópico, de forma a gerar conclusões com maior segurança e confiabilidade. De um total de quarenta e quatro (44) artigos encontrados, foram incluídos na meta-análise, trinta e nove (39) artigos e duas (2) dissertações entre os anos de 1989 a 2009 que estabeleciam a co-relação e utilizavam as mesmas técnicas e primers para detecção e genotipagem do HPV. Na presente meta-análise, observou-se que os artigos analisados apresentaram heterogeneidade quando avaliados os tipos de HPV 16 e 18, em conjunto. O HPV do tipo 18 isolado não apresentou significância, enquanto o HPV 16 demonstrou estar significativamente relacionado ao carcinoma espinocelular de pênis. Pelo teste de DerSimonian-Laird os resultados dos estudos combinados demonstram que os mesmos são significativos e heterogêneos em relação a IC 95%. Assim, pode-se concluir que a associação entre câncer de pênis e HPV se confirma por meta-análise, demonstrando assim a importância da força estatística da meta-análise diante dos estudos isolados na tentativa de desenvolvimento de novas estratégias de prevenção do HPV.