Interstitial laser thermal therapy is a novel local approach to treating prostate cancer. During treatment, thermal ablation may occur on the adjacent rectal wall. The aim of this thesis was therefore twofold: to study the effects of rectal cooling on lesion formation, and secondly, to engineer a computer controlled rectal cooling unit. To study the effects of the coolant temperatures and flow rate, thermal simulations were executed, followed by testing the phenomenon using agar gel phantoms which thermally mimic prostate tissue. Further simulations were run using a treatment planning software, which predicted the required coolant temperatures to protect the outer rectal wall while subsequently determining the shape and size of the resulting coagulated lesion at various laser settings. Results suggest that low coolant temperatures and low flow rates cause maximum cooling rates. Furthermore, the shape and size of the coagulated region is affected by coolant temperatures at specific laser powers and positions within the prostate.

This descriptive, comparative, correlational study explored the relationships among demographic characteristics, health histories, disease characteristics, body image, anxiety and depression, sexual relationship power, female sexual function, and sexual satisfaction; examined sexual self-schema as a moderator or mediator on female sexual function and sexual satisfaction; and compared the differences in female sexual function and sexual satisfaction between women with gynecological or rectal cancer and women without any cancer. Fifty-five females with gynecological or rectal cancer in the study group and 72 females without any cancer in the comparison group completed seven structured questionnaires. For females in the study group, a significant negative relationship existed between time since surgery and anxiety and depression, between the number of cancer treatments and female sexual function, and between performance status and anxiety and depression. In addition, a significant positive relationship existed between performance status and sexual relationship power and between the number of cancer treatments and sexual satisfaction. Further, body image was significantly related to anxiety and depression, sexual relationship power, sexual self-schema, and sexual satisfaction. The anxiety and depression factor was significantly linked with sexual relationship power, female sexual function, and sexual satisfaction. There was a significant negative relationship between sexual satisfaction and sexual relationship power and between sexual satisfaction and female sexual function. Also, females in the study group reported significantly worse sexual function and sexual satisfaction than females in the comparison group. A hierarchical multiple regression model accounted for 40% of the variance in female sexual function, and gynecological/rectal cancer, body image, and the interaction between sexual relationship power and sexual self-schema were three significant predictors. After controlling for gynecological/rectal cancer, body image, sexual relationship power, sexual self-schema, and the interaction term between sexual relationship power and sexual self-schema, female sexual function accounted for 17% of the variance in sexual satisfaction. In unsolicited comments, females in the study group described the changes in their sexual lives after surgery and treatments, emphasizing that sexual information should be provided promptly and effectively by health care providers. The study findings led to implications and recommendations for the conceptual framework, nursing practice, research, and education. / text

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Introducción: Se estima que en el año 2000 se diagnosticaron más de 10 millones de cánceres colorectales en el mundo y más de 6 millones murieron por esta causa. En Europa se ha observado un aumento de la incidencia desde los años 60 así como una mejora de la supervivencia. En su etiología, además de una causa genética, se ha evidenciado el estilo de vida occidentalizado y, dentro de él, la dieta como principal factor ambiental. Está en debate la mejor estrategia de cribado a nivel poblacional para este cáncer. El tratamiento de elección es la cirugía. Desde 1990 está demostrado el beneficio de la quimioterapia y radioterapia adyuvantes. Asimismo, la poliquimioterapia en la enfermedad avanzada aumenta la supervivencia. Objetivo:Conocer la incidencia y la supervivencia poblacional del cáncer colorectal en Tarragona por género, edad, sublocalización, histología y estadio.Estudiar la evolución temporal de estos indicadores.Comparar los resultados obtenidos con los de otros registros de cáncer de base poblacional.Construir un patrón epidemiológico del cáncer colorectal para la provinvia de Tarragona.Material y métodos:Se trata de un estudio epidemiológico poblacional descriptivo del cáncer colorectal a partir de la información del Registro de Cáncer de Tarragona desde el año 1980 al 1998. Se estiman las tasas de incidencia brutas, ajustadas por edad a la población mundial estándar, truncadas y acumuladas así como las tasas específicas por edad, global y por género, edad, sublocalización, histología y estadio. Se realiza un análisis de la tendencia temporal utilizando los modelos de regresión de Poisson y de Join Point, y se estiman los porcentajes anuales de cambio y su significación estadística.En cuanto a la supervivencia, se calcula la supervivencia observada global (método no paramétrico de Kaplan y Meier) y la supervivencia relativa global (método de Ederer) por género, edad, sublocalización, histología y estadio. Se determina la asociación de diversas variables con el tiempo de supervivencia utilizando el método de riesgos proporcionales de Cox, y se estudia la evolución de la supervivencia desde 1985 hasta 1998 por períodos. Los resultados de incidencia se han comparado con los publicados por diferentes registros de cáncer de todo el mundo y los de supervivencia con los de registros europeos.Resultados:La tasa bruta de incidencia es de 56,5 para ambos géneros juntos. Las tasas ajustadas son de 61,7 en hombres y 51,3 en mujeres. Las sublocalizaciones por orden de frecuencia son: recto, colon izquierdo y colon derecho en hombres, y colon izquierdo, colon derecho y recto en mujeres. La distribución porcentual por estadios (clasificación de Dukes) es: A 13%, B 27%, C 27% y D 22%. La incidencia ha aumentado un 3,3% anual en hombres y un 2,5% anual en mujeres de forma constante a lo largo de todo en período. El cáncer de colon derecho es el que más aumenta en hombres (6,5% anual) y en mujeres (5,2% anual).La supervivencia observada a 5 años es de 40,4% y la relativa de 49,0% (47,6% en hombres y 50,7% en mujeres). Por edades, las supervivencias relativas a 5 años son: 60% entre los de 35 y 54 años, 53% entre los de 55 y 74 años, y 45% en los mayores de 74 años. Por estadios, la supervivencia a 5 años es: A 90%, B 68%, C 47% y D 3%. El estadio es el factor pronóstico más importante, delante de la edad. La supervivencia relativa a 5 años pasó de 42% entre los casos diagnosticados en el periodo 1985-89 a 49% en el periodo 1990-94.Conclusiones:En Tarragona el cáncer colorectal es el cáncer más frecuente en ambos géneros juntos y presenta una incidencia media-baja con respecto a otros registros de Europa pero con una tendencia rápidamente ascendente y continua, muy probablemente debida a la adopción de un estilo de vida occidentalizado y, sobre todo, al cambio de la dieta. Las tasas de supervivencia alcanzadas se pueden considerar medio-altas en el contexto europeo, y han aumentado de forma similar a la de la mayoría de países de Europa. / Introduction: It was estimated, for year 2000, that more than ten million people would be diagnosed of colorectal cancers in the world and more than six million people would die of it. In Europe, the incidence of colorectal cancer has been growing since 1960 and the survival has also improved. In its etiology, next to a genetic base, is the westernized way of life the most important factor (mainly a diet rich in proteins and fats and poor in fruits and vegetables). The adenoma is the precancerous lesion. There's controversy about the best population screening strategy for this cancer. The standard treatment is surgery. Since 1990, is the benefit of adjuvant therapies (chemotherapy and radiotherapie) confirmed. Also, the polichemotherapie has shown a survival benefit for the patients with advanced disease. Objetives:To know the incidence and survival, at a population level, of colorectal cancer in Tarragona according to gender, age, subsite of origin, histology and stage. To study the temporal trends of these sanitary indicators: incidence and survival.To compare our results with the results of other population-based cancer registries of the world.To describe an epidemiological pattern for colorectal cancer in Tarragona.Methods:Descriptive epidemiological study of colorectal cancer in Tarragona between 1980 and 1998. The data come from the population-based Cancer Registry of Tarragona. Incidence rates: normal, rates and standard rates, adjusted to the world population (Segi, 1950) have been calculated, according to gender, age, subsite of origin, histology and stage. For the temporal trends study (1980-1998) we used the Poisson model and the joinpoint model and calculated the anual percentage of change for each category. The data have been compared with the data of other registries published in Cancer Incidence Five Continents.Survival rates: observed survival rate (Kaplan and Meier model) and relative survival rate (Ederer model) have been calculated, according to gender, age, subsite of origin, histology and stage. The Cox model was uded to study the association between the different variables and the time of survival for the years 1996 and 1997. A study of the evolution of survival rates was also made (1985-1998). The data have been compared with the data of other registries published in EUROCARE-3 and the data of the SEER Programm in USA..Resultados:The normal incidence rate is 56,5 cases/100.000 inhabitants*year for both genders together. The adjusted incidence rate is 61,7 for men and 51,3 for women. The most frequent subsite of origin is left colon cancer. After this comes rectal cancer and right colon cancer. The distribution according to stages (Dukes classification) is: A (13%), B (27%), C (27%), D (22%). The incidence rates have grown 3,3% each year in men and 2,5% in women. The trend is constant between 1980 and 1998. The subsite of origin with a fastest growth is right colon cancer (6,5% in men and 5,2% in women). The 5-years observed survival rate is 40,4% and the 5-year relative survival rate is 49%. According to age-groups, the 5-year relative survival rates are: 60% for people between 35-55 years old; 53% for the ones between 55-75 years old and 45% for the people older than 74 years old. According to stages, the 5-year relative survival rates are: A (90%), B (68%), C (47%) and D (3%). The stage is the most important prognostic factor, next to the age. Between 1985 and 1994 the 5-year relative survival rate has improved from 42% to 49%.Conclusions:Colorectal cancer is the most frequent cancer in Tarragona for both genders together and the incidence rates are in the average in comparison to other European countries. The incidence has grown fast and constant. The cause of this change is probably the most westernized way of life with the time (for example: the changes in the diet). The survival rates are also in the average of the European countries and have grow from 1985 till 1994, like in the other countries, probably because of improvements in the therapies.

ABSTRACT Background: People with colorectal cancer undergoing rectum amputation get a permanent colostomy, which affects the social life. It may be valuable for health care what these people experience living with colostomy in order to provide the greatest possible support. Objective: The aim of this study is to describe how people who received a colostomy experience their daily lives and the support they have received from the health services.Method: Qualitative interview study with six people, with a descriptive phenomenological approach.Results: The analysis of the interviews about how it's like to live with a colostomy resulted in three themes: 1) Living with a colostomy gives an uncertainty that affect the social life, 2) Physical and psychological impact of getting a colostomy and 3) Support for health care and relatives.Conclusion: Subjects had a positive attitude towards life, which contributed to that they could adjust to living with a colostomy and feel a meaningfulness of life. The study shows that all the interviewed people overall were satisfied with the information provided by the healthcare personnel. It was good with both oral and written information and very appreciated with repeated information. One aspect that could be improved was the information given aboute the closure of anus during surgery and the following complications. This was the most painful experience among the interviewed people. Special nurses in surgery should take more responsibility for that the information reaches the patients and also that a follow-up take place.

Purpose: To describe patient & tumor characteristics among rectal cancer patients in Nova Scotia, to determine factors associated with permanent colostomy and oncologic outcomes and to determine the relationship between surgeon knowledge and oncologic outcomes.Methods:The Provincial cancer registry identified new rectal cancer patients from in Nova Scotia. A comprehensive review of inpatient, outpatient and cancer center medical records was used to assemble the cohort. Surgeon knowledge was assessed using a survey with questions pertaining to rectal cancer care.Results: Patient & tumor characteristics were similar between hospitals providing rectal cancer care. Patients treated by high volume cancer center surgeons are less likely to undergo a permanent colostomy or have a local recurrence compared to patients treated elsewhere. Patients treated by surgeons with a high survey score have improved clinical and oncologic outcomes.Conclusions: There is an opportunity to improve rectal cancer care in Nova Scotia.

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2006. / Härtill 5 uppsatser.

Diss. (sammanfattning) Uppsala : Uppsala universitet, 2006. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.