Bakgrund: Urinblåsecancer finns i olika former och vid muskelinvasiv cancer är radikal operation den vanligaste behandlingen. Förutsatt att cancern inte spridit sig, då görs en cystektomi. Många människor har en naturlig förmåga att hantera kriser och skapar ny balans i tillvaron efter en påfrestande händelse i livet. Sjuksköterskan kan ge råd och stöd i situationen och bör då ha kunskap om förändringar i personens fysiska och psykiska tillstånd. Syfte: Syftet var att belysa hur personer som genomgått cystektomi på grund av urinblåsecancer upplevde att det dagliga livet påverkades. Metod: En litteraturstudie har gjorts där 15 vetenskapliga artiklar har granskats. Resultat: Personerna drabbades av olika problem efter cystektomin. Urinproblem, buk- och avföringsproblem och livsförändring var tydliga, men även problem med en förändrad kroppsuppfattning och problem med det sociala stödet kom fram. Slutsats: Det är olika faktorer som påverkar det dagliga livet efter en cystektomi. Kunskap i hur personerna kan reagera är viktig för sjuksköterskan, för att kunna bemöta problemen och ge råd och stöd om olika copingstrategier för att hantera situationen. Då kan individuell omvårdnad ges, utifrån varje persons behov. / Background: Bladder cancer exists in different forms and in muscle invasive cancer, radical surgery is the standard treatment. Assuming that the cancer has not spread, then, a cystectomy is done. Many people have a natural ability to handle crises and generate a new personal balance. A nurse can offer advice and support in the situation and should have knowledge of changes in the person's physical and mental condition. Aim: The aim was to illustrate how people who have undergone cystectomy because of bladder cancer felt that their daily lives were affected. Methods: A literature review has been done where 15 scientific papers have been reviewed. Results: The subjects suffered from various problems after cystectomy. Urinary Problems, abdominal and stool problems, and change in life were common, but also problems with an altered body image and problems with social support occurred. Conclusion: There are different factors that affect the daily lives after a cystectomy. Knowledge of how people might react is important for nurses, in order to address the problems and provide advice and support on various coping strategies to deal with the situation. When that is the case, individual care can be given, based on each person's needs.

Bakgrund: Urinblåsecancer är den elfte vanligaste cancerformen globalt. Sjukdomen angriper urinblåsans slemhinna och kan växa in i muskellager. Vid muskelinvasiv cancer genomgår patienten cystektomi, och erhåller urostomi. Patients egenvårdsförmåga är av stor betydelse efter operationen. Vårdpersonalen behöver därför arbeta personcentrerat för att stödja patienten att klara sin egenvård. Informationen som ges behöver anpassas för optimal individualisering, så att patienten förstår och blir delaktig.  Syfte: Undersöka upplevelser av informationsbehov hos patienter med urinblåsecancer som genomgår cystektomi.  Metod: Kvalitativ litteraturstudie med tematisk syntetisering.  Resultat: Resultatet baseras på 14 peer-review och kvalitetsgranskade originalartiklar och presenteras utifrån fyra analytiska teman: Dimensioner av information, känslomässig berg-och dalbana genom sjukdomsförloppet, den förändrade kroppen och egenvårdensbetydelse till ett fortsatt liv. Resultatet visar att patienternas informationsbehov i det perioperativa förloppet inte blir uppfyllt. De upplevde alltför sparsam information om sexuellt- och psykologiskt stöd. Utökad information om fysisk aktivitet efterfrågades även information som underlättade att patienten fördes framåt i sin process för att förstå sitt nya jag saknades.  Konklusion: Information är nödvändigt, men behöver anpassas och personcenteras utifrån patientens önskemål och behov. Om informationsbehoven inte tillgodoses kan detta bidra till missförstånd och otrygghet vilket behöver fångas upp i omvårdnaden. / Background: Worldwide, bladder cancer is the eleventh most common cancer. Tumors that invade the detrusor muscle are referred to as muscle-invasive bladder cancer and are treated with radical cystectomy, the patient gets an urostomy. Self-care is significant after the surgery. The care provider needs a person-centered approach to facilitate self-care. Optimal information needs to be individualized. This will help the patient to understand and become involved.  Aim: To investigate experiences of information needs in patients with bladder cancer undergoing cystectomy. Method: Qualitative literature study with a thematic synthesis. Results: In the result fourteen peer-reviewed and quality-reviewed original articles are included. The review highlighted that patient experienced unmet information needs. Patients also experienced receiving too much information in a limited time. This led to difficulties to understand and process the information. Patients also experienced limited information about sexual and psychological support and requested more information about physical activity. Conclusion: Information is essential but needs to be adapted and based on person-centered care principles related to the patients’ needs and wishes. Unmet needs impacts patients’ life and are associated with misunderstandings and insecurity which need to be considered in nursing.

Urinary bladder cancer is a heterogeneous disease appearing in different forms, e.g. non-muscle invasive and muscle invasive. For all variants, the expression of proteins is interesting to analyze for diagnostic, predictive, prognostic and drug targeting purposes, since it reflects the altered gene expression causing the cancer. Since urothelial cells of the bladder are in direct contact with urine it is likely that this body fluid contains cancer-related proteins. In Paper I, unbiased analysis of proteins in urine from urinary bladder cancer patients and controls, using label-free quantification by mass spectrometry, was applied and four interesting proteins APOE, FGB, LRG and SERPINA1 were selected and further analyzed with western and dot blot. In Paper II, two more proteins, POLR1E and TOP2A, were validated as relevant proteins in bladder cancer urine. In Paper III and IV, the proteins GAL1 and STMN1 were investigated for their prognostic and therapeutic target potential in bladder cancer. In Paper II, III and IV, the expression of seven of the proteins were analyzed on tissue microarrays representing tumour tissue from 360 patients with different tumour stages. For the proteins identified by the urine screening approach, their protein expressions were confirmed in bladder cancer tissue. The expression level in tissue of five of the proteins, APOE, FGB, POLR1E (Paper II), GAL1 (Paper III) and STMN1 (Paper IV), increased with tumour stage, showing diagnostic relevance and three of the proteins, SERPINA1 (Paper II), STMN1 (Paper IV) and GAL1 (Paper III) had prognostic potential in urinary bladder cancer. In addition, GAL1 and STMN1 were demonstrated to be highly expressed in metastatic disease and inhibition of STMN1 reduced cell growth (Paper III and IV), indicating that these proteins are promising drug targets in urinary bladder cancer. In conclusion, the approach of this thesis has generated several candidate protein biomarkers in urine and tissue, validated with independent methods, which have the potential to improve the care for bladder cancer patients.