Dissertations / Theses on the topic 'Colorectal Cancer Diagnosis'
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1
Wood, Emma McIntosh. "Delays in the diagnosis of colorectal cancer." Thesis, University of Leeds, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.445952.
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Boone, D. J. "Facilitating colorectal cancer diagnosis with computed tomographic colonography." Thesis, University College London (University of London), 2013. http://discovery.ucl.ac.uk/1413011/.
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Computed tomographic colonography (CTC) is a diagnostic technique involving helical volume acquisition of the cleansed, distended colorectum to detect colorectal cancer or potentially premalignant polyps. This Thesis summarises the evidence base, identifies areas in need of further research, quantifies sources of bias and presents novel techniques to facilitate colorectal cancer diagnosis using CTC. CTC literature is reviewed to justify the rationale for current implementation and to identify fruitful areas for research. This confirms excellent diagnostic performance can be attained providing CTC is interpreted by trained, experienced observers employing state-of-the-art implementation. The technique is superior to barium enema and consequently, it has been embraced by radiologists, clinicians and health policy-makers. Factors influencing generalisability of CTC research are investigated, firstly with a survey of European educational workshop participants which revealed limited CTC experience and training, followed by a systematic review exploring bias in research studies of diagnostic test accuracy which established that studies focussing on these aspects were lacking. Experiments to address these sources of bias are presented, using novel methodology: Conjoint analysis is used to ascertain patients‘ and clinicians’ attitudes to false-positive screening diagnoses, showing that both groups overwhelmingly value sensitivity over specificity. The results inform a weighted statistical analysis for CAD which is applied to the results of two previous studies showing the incremental benefit is significantly higher for novices than experienced readers. We have employed eye-tracking technology to establish the visual search patterns of observers reading CTC, demonstrated feasibility and developed metrics for analysis. We also describe development and validation of computer software to register prone and supine endoluminal surface locations demonstrating accurate matching of corresponding points when applied to a phantom and a generalisable, publically available, CTC database. Finally, areas in need of future development are suggested.
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Loukola, Anu-Maria. "Molecular diagnosis of hereditary nonpolyposis colorectal cancer (HNPCC)." Helsinki : University of Helsinki, 2000. http://ethesis.helsinki.fi/julkaisut/laa/haart/vk/loukola/.
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Abu, Sharour Lo'ai Mohammad Jumah. "Psychosocial Predictors of Quality of Life among Jordanian Colorectal Cancer Patients: A Mixed-Method Study." Thesis, Griffith University, 2011. http://hdl.handle.net/10072/366759.
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Colorectal Cancer (CRC) is one of the most common forms of cancer worldwide (National Cancer Institute [NCI], 2007); its prevalence is also reflected in the Jordanian population (Jordanian Ministry of Health & Jordan Cancer Registry [MOH & JCR], 2008). It appears that CRC diagnosis and treatment modalities have a negative impact on patients’ physical, social, and emotional well-being and their quality of life (QOL). Alarmingly, up to 35% of CRC patients have clinically significant levels of psychological distress. Accordingly, better understanding of QOL and its psychosocial predictors will assist health professionals, especially oncology nurses, to recognize the effects of CRC and its treatment modalities on patients and to plan appropriate interventions to ameliorate these effects.
This study was conducted in two phases using mixed methods in a sequentional-explanatory design to: (1) explore the relationships between hope, coping, psychological distress (depression and anxiety), age, gender, marital status, income, time since diagnosis and QOL among Jordanian CRC patients; (2) identify to what extent hope, coping, psychological distress (depression and anxiety), age, gender, marital status, income and time since diagnosis predicts QOL among Jordanian CRC patients; and (3) describe Jordanian CRC patients’ experiences and perceptions about QOL during their treatment period.Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Nursing and Midwifery
Griffith Health
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Olsson, Louise. "Early detection of colorectal cancer /." Stockholm, 2004. http://diss.kib.ki.se/2004/91-7349-841-6/.
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Oda, Masahiro, Takayuki Kitasaka, Kensaku Mori, and Yasuhito Suenaga. "DEVELOPMENT OF A COMPUTER AIDED DIAGNOSIS SYSTEM FOR COLORECTAL CANCER BASED ON NAVIGATION DIAGNOSIS." INTELLIGENT MEDIA INTEGRATION NAGOYA UNIVERSITY / COE, 2006. http://hdl.handle.net/2237/10473.
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Fong, Yuen, and 方圓. "A systematic review of factors influencing the uptake of screening for colorectal cancer using a faecal occult blood test." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193837.
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Background
Colorectal cancer (CRC) is one of the most common cancers with high morbidity and mortality among both genders and yet it carries a better prognosis when detected early. Colorectal cancer screening using faecal occult blood test (FOBT) is proven to be cost-effective, however worldwide FOBT uptake rate is suboptimal which directly affects the cost-effectiveness of the screening program. Identifying those factors that influence the uptake of colorectal cancer screening using FOBT will allow implementation of relevant measures when planning a population based screening program.
Methods
A structured electronic search using PubMed and Medline was conducted in order to identify studies that included factors influencing the uptake of CRC screening by using FOBT. Qualities of included studies were assessed by quality assessment checklist STROBE.
Results
Factors that contributed to the low uptake rate of CRC screening by FOBT were identified and summarized. They were broadly divided into 3 groups.
Demographic factors: age, gender, social economic status, insurance status and education, for ethnicity, employment status and obesity further studies in the future may be needed.
Subject factors: subject’s attitudes and knowledge towards CRC screening, type of FOBT screening, health concerned behavior, frequency of clinical visit and physiciancomment.
Provider factors: health care system factor and physicians’ factors.
Conclusion
Different factors, in particular those factors that were associated with low FOBT uptake rate in CRC screening, were reviewed and summarized in this paper. With the continuous effort from worldwide as well as local investigators, timely measures can be implemented to tackle this deathly disease and to ensure cost effectiveness of a screening program.published_or_final_version
Public Health
Master
Master of Public Health
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Weller, David P. "Colorectal cancer in the Australian population : prospects for prevention through screening /." Title page, contents and abstract only, 1994. http://web4.library.adelaide.edu.au/theses/09PH/09phw4478.pdf.
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Ward, Nicholas. "Serum protein profiling using a proteomics approach in the diagnosis of colorectal cancer." Thesis, University of Essex, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.510507.
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Chen, Dan Chary. "Pathological image processing and geometric modelling for improved management of colorectal cancer." Thesis, University of Oxford, 2015. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.711813.
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Ho, Yuen-chi, and 何婉姿. "Potential utility of colorectal cancer screening with computed tomographic colonography in Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2014. http://hdl.handle.net/10722/206940.
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Background
Colorectal cancer is becoming the commonest cancer in Hong Kong in 2011. Colorectal cancer screening is becoming a hot topic of discussion after the proposal of a local pilot screening program of colorectal cancer in the Policy Address 2014. Colorectal screening is traditionally performed by faecal occult blood test and optical colonoscopy. Computed tomographic colonography is a new imaging technology, with high sensitivity and specificity for clinically significant colonic lesions and polyps. It is therefore emerging as a new method for the colorectal cancer screening.
Method
This project aims to systemically review the literature, try to explore the potential utility and cost effectiveness of using computed tomographic colonography as one of the screening modality for asymptomatic patients aged 50 years or older.
Results and Conclusion
The results of the review are presented and conclusion is made. The limitation of the systematic review and its implications of local policy making are also discussed.published_or_final_version
Public Health
Master
Master of Public Health
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Morgan, Sarah Louise. "Towards the molecular diagnosis of bladder and colorectal cancer : analysis of CD44 exon splicing." Thesis, Cranfield University, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.269524.
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Kontoyannis, Angeliki. "Development of the NICE clinical guideline on the diagnosis and management of colorectal cancer." Thesis, Cardiff University, 2014. http://orca.cf.ac.uk/71966/.
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This thesis examines the evidence base on which the NICE guideline for colorectal cancer was developed. The information supporting guidelines varies. Six separate studies researching the availability and quality of different types of such information were carried out. Methodology, epidemiology, clinical practice, diagnostic accuracy, therapeutic, and internationally sourced data was examined. The information was sourced by online data mining, national database queries, systematic reviewing of literature databases, and the observation of the NICE guideline development process through both membership of the guideline development group established to produce the recommendations, and the technical development team supporting its production. Results show that : • NICE methodology data is available publicly, is easily accessible online, and has been developed following an internationally accepted guideline quality assessment and development tool. • Epidemiology data on colorectal cancer is easily accessible and of good quality. • Data regarding current clinical practice on colorectal cancer collected by national databases has methodological challenges and is not easily accessible. • Diagnostic accuracy studies are less robustly developed comapared to therapeutic studies. Their design is heterogeneous making the results subject to bias and reporting is inconsistent. Quality assessment when evaluating diagnostic evidence for a guideline ensures clarity with regard to the strength of the recommendations. • Systematic reviews of therapeutic studies can be inappropriately considered high quality evidence using traditional quality appraisal and evidence classification methods. All outcomes of a study should be considered when assesing study quality and recommendations based on a more holistic grading of the evidence are a more accurate reflection of the evidence. • Evidence considered for guideline development is international in its nature and the national setting of a study does influence guideline recommendations. Overall, NICE methodology is of high quality. The research helps identify challenges that the evidence can present as a platform for future improvements.
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Pawa, Nikhil. "Identification and validation of new biomarkers for the diagnosis and management of colorectal cancer." Thesis, University of Essex, 2015. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.654422.
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Colorectal cancer is one of the most prevalent malignancies worldwide with approximately 1 million cases diagnosed each year, and 500 000 deaths. If diagnosed early over 95% of patients would benefit from curative surgery. Large scale randomised studies have demonstrated a reduction in mortality with mass screening programmes. Current methods employed for screening for colorectal cancer involved the faecal occult blood test. This investigation maintains an average sensitivity for the diagnosis of colorectal cancer with poor compliance from the population. This study aimed to investigate and validate new biomarkers for the diagnosis of colorectal cancer. BORIS is a paralogue of the transcription factor CTCF. BORIS is found to be expressed normally in spermatocytes in the testis, however aberrant expression has been found to play a part in tumour development. This study set out to analyse the role of BORIS as a potential biomarker for colorectal cancer. BORIS expression in the leukocytes of colorectal cancer patients was assessed via both Western blotting and immunocytochemistry. Furthermore its expression was compared III colorectal cancer tissue and matched normal tissue by immunohistochemistry. Minimal positive expression was demonstrated for BORIS in A the leukocytes, with only two out of sixty patients showing positive expression by both methods. Similar findings were noted in the analysis of tissue samples, although significantly higher immunoreactivity was identified in the colorectal cancer tissue in comparison with the normal group. This study concluded BORIS has a limited role as a biomarker for colorectal cancer. A smaller further study set out to identify significant proteins as possible biomarkers in the leukocytes of colorectal cancer patients via two dimensional gel electrophoresis.
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Almeida, Maria do RosaÌrio. "Molecular diagnosis of hereditary non polyposis colon cancer and sporadic mismatch repair deficient colorectal tumours." Thesis, University of Newcastle Upon Tyne, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.248470.
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Thomas, Kamilah B. "Exploring Colorectal Cancer Diagnosis Disclosure to First-Degree Relatives: An African American Family Case Series." Scholar Commons, 2010. https://scholarcommons.usf.edu/etd/1789.
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Colorectal cancer (CRC) is the second leading cancer killer in the United States and the third most common cancer in African American men and women. Though the overall death rates have declined, this reduction in mortality is smaller for African Americans than for Whites. Factors that are protective against colorectal cancer include occupational or recreational physical activity, a diet high in fruits and vegetables, and colorectal cancer screening with removal of polyps (polypectomy) before they progress to cancer. Compliance with CRC screening recommendations requires people to know if a first-degree relative (parent, sibling, and child) or second-degree relative (aunt, uncle, niece, nephew, and grandparent) has been diagnosed with colorectal cancer. Little is known about how patients disclose this information to their relatives and what type of information is disclosed when disclosure takes place. The role of the family has long been overlooked in research on African American health screening behavior despite the fact that family interventions have been known to produce favorable outcomes in diet, nutrition, and exercise. This qualitative study explored the disclosure process among African American colorectal cancer survivors and FDRs with whom they shared their diagnosis. Of special interest was the role of social support in the disclosure process and the criteria used to decide which relatives to tell. Findings from this study will be used to advance the knowledge about the dynamics of CRC disclosure to first-degree relatives in African American families and ultimately increase CRC screening in relatives.
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Ali, Sumaira. "Development and characterisation of novel monoclonal antibodies against colorectal tumour cells for use in cancer diagnosis and therapy." Thesis, Kingston University, 2013. http://eprints.kingston.ac.uk/40725/.
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Colorectal cancer is a major public health problem and a leading cuase of cancer deaths in the western world. At present, three monoclonal antibodies (mAbs) namely anti-epidermal growth factor receptor (EGFR) cetuximab and panitumumab and anti-vascular endothelial growth factor mAb bevacizumab have been approved for the treatment of patients with metastatic colorectal cancer. However, many patients simply do not respond, or the cancer aquires resistance following a short course of therapy. The aim of this study was to develop a new panel of mouse monoclonal antibodies directed against other cell surface antigens which are over-exoressed on human colorectal tumour cells using hybridoma technology and to investigate their potential as diagnostic and therapetic agents. A panel of human colorectal cancer cell lines, established from colorectal cancer patients at different stages of the disease, were employed as the source of immunogen for immunisation of a group of mice. Seven novel mouse hybridomas were developed, secreting seven novel mAbs named KU2.77, KU2.90, KU3.39, KU3.47, KU3.61, KU4.76 and KU4.94. Following purification, the binding efficacy of each purified mAb to a large panel of colorectal tumor cells, human foreskin fibroblast (DE532) and human immortalized keratinocyte (HACAT) cells was determined using ELISA and flow cytometry. All seven mAbs are directed against cell surface antigens which are over-expressed on human colorectal cancer cells. The differential binding of these mAbs to the various human colorectal tumour cells and to the other cells suggests that these antibodies may be directed against at least three distinct over-expressed cell surface antigens. Interestingly, of the seven mAbs examined, KU3.47 and KU4.94 did not bind to DE532 and HACAT cells suggesting that the antigen recognised by these two antibidies may be tumour specific antigens. at 300nM, with the exception of mAb KU3.39 which induced slight growth inhibition of CCL-228 and Colo2 cells, the growth of other colorectal cancer cells were not inhibited by the any of the antibodies while only two mAbs (KU2.77 and KU2.90) inhibited the migration of CCL-228 cells. Out of the seven novel mAbs, KU3.47, KU4.94 and KU3.61 stained their respective antigens in formalin-fixed, paraffin-embedded, colorectal tumour cell pellets, suggesting that these antibodies are directed against a sequential determinant on the antigen and could therefore have potential for use as tools for investigating the expression pattern, prognostic significance and predictive value of such antigens in cancer patients. The preliminary results of immunoprecipitation followed by mass spectroscropy revealed that three newly developed mAbsKU2.77, KU3.39 and KU4.94 may recognise or cross react with integrin alpha-3, Large neutral amino acid transporter small subunit1 (LAT-1) and apo-lipoprotein A-IV respectively. Since all seven novel mAbs are directed against over-expressed cell surface antigens, they could form excellent tools for use in basic research for investigating the role of such antigens in the progression of human cancers. Further investigations are warranted to identify the target antigens recognised by each of the novel antibodies and to determine their full potential as diagnostic agents and therapeutic agents when conjugated to various toxins, drugs or radioisotopes.
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Yamaura, Tadayoshi. "Accurate diagnosis of mismatch repair deficiency in colorectal cancer using high-quality DNA samples from cultured stem cells." Kyoto University, 2019. http://hdl.handle.net/2433/242418.
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Williet, Nicolas. "Diagnostic et prise en charge précoce des cancers du pancréas et des cancers colorectaux." Thesis, Lyon, 2020. http://www.theses.fr/2020LYSES043.
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Introduction. les cancers colorectaux (CCR) et les cancers du pancréas (CP) sont les cancers digestifs les plus fréquents. Ils occupent le 2ème et 3ème rang en termes de mortalité du fait d’un diagnostic souvent tardif ; Des progrès doivent être faits pour améliorer le diagnostic précoce de ces cancers. Méthode. Nos travaux ont porté sur l’amélioration d’un critère qualité majeure dans le dépistage du CCR qui est le taux de détection d’adénome (TAD), correspondant à la proportion de patients chez qui l’on découvre au moins un adénome au cours d’une coloscopie. La première partie de nos travaux concerne le développement d’une nanoparticule fonctionnalisée (Ac antiEGFR) qui serait administrée au cours d’une coloscopie et capable de se fixer sur les lésions précancéreuses adénomateuses exprimant le récepteur à l’EGF (Étude COLOREC). La 1ère étape in vitro est exposée ici à partir d’une série de lésions découvertes au cours de coloscopies réalisées prospectivement au CHU de Saint-Étienne. Le 2ème travail concerne l’évaluation d’un dispositif nommé Endocuff-Vision® disposé à l’extrémité du coloscope permettant d’effacer les plis et les haustrations coliques lors de la coloscopie dans le but d’améliorer le taux de détection des adénomes. Nous avons réalisé la 1ère méta-analyse publiée d’essais randomisés sur ce sujet. Enfin, concernant le cancer du pancréas nous avons constitué une plasmathèque à partir d’une vaste cohorte unicentrique cas-témoin (SERPAN) de tous les cancers du pancréas pris en charge dans notre centre dans le but de déterminer les facteurs biologiques corrélé au diagnostic positif. Nous avons isolé un marqueur candidat (Adiponectine) qui apparait très corrélé à la survenue d’un CP dans la population de patients diabétique (étude ADIPAN). Résultats. A travers l’étude COLOREC, nous montrons qu’il existe une surexpression des EGFRs dès le stade d’adénome, suivant un gradient d’expression corrélé au stade de la dysplasie. Cette surexpression est particulièrement marquée en cas de dysplasie de haut grade, indépendamment de la taille de la lésion. Concernant l’évaluation de l’Endocuff-Vision®, la méta-analyse réalisée suggère un gain relatif de 20% du TAD en particulier chez les opérateurs les moins expérimentés (+51%). Enfin nous montrons des preuves de concept de l’intérêt potentiel du dosage de l’Adiponectine dans le diagnostic précoce du cancer du pancréas chez les diabétiques de plus de 50 ans. Le dosage de ce marqueur nécessite de tenir compte de cofacteurs jusque là sous estimés dans les précédentes publications. Ainsi, les performances diagnostiques seraient de 100% si l’ensemble de ces critères sont vérifiés. Ces résultats préliminaires doivent être confirmés à partir d’une plus large cohorte. S’ils sont confirmés, nous projetons de réaliser une étude prospective Nationale à partir des nouveaux cas de diabètes diagnostiqués après 50 ans. Conclusion. Les projets COLOREC et ADIPAN sont prometteurs et méritent d’être poursuivis pour avancer dans l’amélioration de la détection précoce des CCR et des CPIntroduction. colorectal cancers (CRC) and pancreatic cancers (PC) are the most common digestive cancers. They occupy the 2nd and 3rd place in terms of mortality due to an often late diagnosis; Progress should be made to improve the early diagnosis of these cancers. Method. Our work focused on improving a major quality criterion in CRC screening, which is the adenoma detection rate (ADR), corresponding to the proportion of patients in whom at least one adenoma is discovered during colonoscopy. The first part of our work concerns the development of a functionalized nanoparticle (antiEGFR Ab) which would be admitted during colonoscopy and capable of biding precancerous adenomatous lesions expressing the EGF receptor (COLOREC study). The 1st in vitro study is presented here from a series of lesions discovered during colonoscopies performed prospectively at the Saint-Etienne University Hospital. The second work concerns the evaluation of a device called Endocuff-Vision® placed at the tip of the colonoscope to erase colonic folds in order to improve the ADR. We performed the 1st published meta-analysis of randomized trials on this topic. Finally, concerning pancreatic cancer, we have carried out a plasma bank from a large unicentric case-control cohort (SERPAN) including all pancreatic cancers treated in our center in the goal of identifying the biological factors correlated with the positive diagnosis. We identified a candidate marker (Adiponectin) which appears to be highly correlated with the occurrence of PC in the population of diabetic patients (ADIPAN study). Results. Through the COLOREC study, we show that there is an overexpression of EGFRs in colorectal adenoma, following an expression gradient correlated with the stage of dysplasia. This overexpression is particularly marked in high grade dysplasia, regardless of the size of the lesion. Regarding the evaluation of Endocuff-Vision®, the meta-analysis carried out suggests a relative gain of 20% for the ADR, especially among less experienced operators (+ 51%). Finally, we show proof of concept of the potential interest of the adiponectin assay in the early diagnosis of pancreatic cancer in diabetics over 50 years of age. Assaying this marker requires taking into account cofactors underestimated in previous publications. Thus, the diagnostic performance would be 100% if all of these criteria are verified. These preliminary results need to be confirmed from a larger cohort. If they are confirmed, we plan to carry out a national prospective study based on new cases of diabetes diagnosed after 50 years. Conclusion. The COLOREC and ADIPAN projects are promising and deserve to be continued to move forward in improving the early detection of CRCs and CPs
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Strohkamp, Sarah [Verfasser]. "Identification of protein markers in tissue & liquid biopsies for improving early diagnosis & prognosis of sporadic colorectal cancer / Sarah Strohkamp." Lübeck : Zentrale Hochschulbibliothek Lübeck, 2017. http://d-nb.info/1137193573/34.
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Tänzer, Marc [Verfasser], Angelika [Akademischer Betreuer] Schnieke, and Roland M. [Akademischer Betreuer] Schmid. "Novel epigenetic biomarkers for diagnosis, prognosis and response prediction in colorectal cancer / Marc Tänzer. Gutachter: Roland M. Schmid. Betreuer: Angelika Schnieke." München : Universitätsbibliothek der TU München, 2012. http://d-nb.info/1020057084/34.
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Aissaoui, Souria. "Elaboration d'un outil pour l'évaluation et l'amélioration de la qualité de la prise de décision lors du Comité d'Onco-Génétique multidisciplinaire dans le cadre de prédisposition héréditaire au cancer colorectal. : une expérience française." Thesis, Aix-Marseille, 2013. http://www.theses.fr/2013AIXM5020.
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Les maladies les plus fréquentes prédisposant au cancer colorectal sont le Syndrome de Lynch et la Polypose Adénomateuse Familiale. Les gènes du système MMR, le gène APC et le gène MUTYH sont respectivement responsables. Le conseil génétique est primordial pour une prise en charge optimale des patients et des familles. Les Comités d'Oncogénétique aident les professionnels de santé à décider d'une indication d'analyse génétique et au suivi des familles. Nous souhaitons évaluer et améliorer a qualité décision prise pour une famille à risque. Des décisions très disparates d'un cas familial à un autre équivalent ont été suspectées. A Lyon, nous avons créé une base de données pour analyser et contribuer cela. Résultat : 100% (33/33) des centres français de consultations principales d'oncogénétique ont décrit l'organisation de leurs COG: 76% développent un COG spécifique, 24% utilisent une concertation standard. Environ 3.75 spécialités médicales sont rassemblées par COG, dont des oncogénéticiens (100%), gastro-entérologues (76%), conseillers en génétiques (84%), chirurgiens (32%), et biologistes/anatomopathologistes (36%). Vingt pourcent des centres ayant une COG spécifique discutent tous leurs cas familiaux, 80% sélectionnent leurs dossiers. Dans notre région, un outil informatique a été élaboré et sera largement diffusé. Notre but étant de standardiser nos décisions et, catégoriser des groupes de patients/familles, pour standardiser la surveillance proposée chez les familles équivalentes. Une meilleure rationalisation de la prise en charge, du suivi des familles, et de la prévention est ici cibléeThe most common diseases that predispose for colorectal cancers are Lynch Syndrome and Familial Adenomatous Polyposis. The genes of MMR system, the APC gene and the MUTYH gene are respectively responsible. Genetic counselling is imperative for an optimal care making for patients and at-risk families. Multidisciplinary committees (MDC) are organized so as to help healthcare professionals for gene analysis decision and families' follow-up. Our aim is evaluation and improvement of quality decision-making for at-risk families. A disparate distribution of decisions from one familial case to another equivalent one has been suspected and observed. In Lyon region we created a database to analyse that and contribute to harmonize the different participants' work in MDC. Results: the 33 French oncogenetic main consultation centers described the organization of their MDC. Answering rate reached 100%. Among these centers, 76% developed a specific MDC, whereas 24% used standard consultation. About 3.75 different medical specialities are gathered by MDC. Among them, there are oncogeneticists (100%), gastroenterologists (76%), genetic counsellors (84%), surgeons (32%), and biologists (36%). Twenty percent of centers having a specific MDC evaluate all their patient cases, whereas 80% select them. In Lyon region, a computerized tool has been elaborated and will be widely disseminated to every collaborating partners of our MDC. It will enable us to standardize our decision-making and, by comparing decisions through quality criteria, to differentiate and categorize some patients/families groups. A better rationalization of care management, families' follow-up and prevention is targeted
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Mitchell, Gary. "A critical ethnography of communication processes involving the management of oral chemotherapeutic agents by patients with a primary diagnosis of colorectal cancer." Thesis, Queen's University Belfast, 2017. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.728191.
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Communication about medications can be one-sided, leaving the patient to take a passive role in discussions about medications. In relation to oral chemotherapy, there is a paucity of research in this area, which is surprising given the extremely narrow therapeutic index of oral chemotherapy and subsequent high risk of toxicity. The aim of this ethnographic study was to illuminate the processes of communication between healthcare professionals, patients and informal carers during oral cancer drug therapy in order to identify factors that promote or inhibit concordance and appropriate medication administration. Observations were conducted on interactions between healthcare professionals and eight patients. These observations occurred over a period of six months, in outpatient departments where prescriptions were explained and supplied, and on follow-up consultations where treatment regimens were monitored and assessed. Semi-structured interviews were conducted with patients and their informal carers during and after their six-month treatment. Focus-groups were carried out with healthcare professionals at the conclusion of the study. These data were analysed using thematic analysis. The results of this study are divided into two sections. The first relates to the patient journey to their first consultation appointment, which includes two broad themes of the shock of the lifeworld and the waiting room experience. The second explores the patient’s six-month journey of receiving communication about oral chemotherapy and this includes the three broad themes of colonization of the lifeworld, mutual system lifeworld and detachment of the system. Communication processes within oncology are complex. This study found that the main communication priority for patients, their family members and healthcare professionals, was medical management of side-effects. Importantly, communication about oral chemotherapy is not an isolated event. It occurs over a long period, is preceded by important communication processes through the diagnosis period and succeeded by supportive communication in the period after treatment.
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El, Messaoudi Safia. "Evaluation de l'analyse de l'ADN circulant dans le contexte de la tumorogenèse et comme outil diagnostique." Thesis, Montpellier, 2015. http://www.theses.fr/2015MONT3501.
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L’analyse de l’ADN circulant dans le contexte de la tumorogenèse et comme outil diagnostic Le projet de thèse ici décrit est fondé sur la découverte remarquable qu'une quantité importante d’ADN circule dans le sang de patients atteints de cancer [1-5]. Le développement d'une technologie basée sur la détection de l'ADN circulant représente une avancée scientifique et médicale pour le diagnostic et le suivi dans la prise en charge thérapeutique des patients atteints de cancer. Malgré de nombreuses études menées au cours des dix dernières années [4,5] sur l'ADN circulant, les origines de la libération de l'ADN circulant dans les liquides biologiques sont hypothétiques et sa structure n'est pas élucidée. Ces données ne valident pas jusqu'à présent l'ADN circulant en tant que biomarqueur. Pour cette raison, les objectifs du groupe dirigé par Alain Thierry sont axés sur l'élucidation des formes structurelles de l'ADN circulant. Ainsi, en utilisant des souris nude xénogreffées avec des lignées cellulaires tumorales humaines de cancer colorectal ainsi que des échantillons sanguins cliniques provenant de patients atteints de cancer colorectal, l'équipe a montré que la concentration en ADN circulant était corrélée positivement avec la taille de la tumeur [6, 7] et ces résultats se sont révélés optimaux pour des tailles inférieures à 100 pb. Une discrimination significative entre les individus sains et les patients du cancer a été observée grâce à l'analyse de la fragmentation de l'ADN circulant. L'originalité de ces découvertes a donné naissance à la technologie Intplex récemment breveté par le CNRS [8]. L'objectif de la thèse est de valider la quantification et la fragmentation de l'ADN circulant comme un outil de diagnostic et de suivi de la maladie dans la prise en charge du cancer en analysant de près les facteurs qui peuvent influencer la quantification et la fragmentation de l'ADN circulant. Grâce au modèle animal développé par l’équipe et l’étroite collaboration avec les centres anti-cancéreux, différents paramètres seront analysés. Une partie de la thèse se concentrera sur la comparaison et la standardisation des résultats en fonction de nombreux facteurs spécifiques à la tumeur, comme son type, sa progression, sa différenciation et sa localisation tissulaire. Le travail de thèse portera également sur l'influence de facteurs individuels pouvant affecter la quantité et la fragmentation de l'ADN circulant: âge, sexe, antécédents médicaux, états physiologiques spécifiques, situations physiopathologiques. L'influence du traitement sera également explorée. Des études seront menées afin de standardiser l'analyse biologique: influence du rythme circadien, prise de nourriture .... Techniquement, la variation analytique et l'influence des facteurs pré-analytiques seront déterminées afin d’établir un guide de bonnes pratiques analytiques pour éliminer tout artefact susceptible d’affecter la quantité et l'intégrité de l'ADN circulant dans les échantillons. Ces deux paramètres seront testés dans une évaluation clinique prospective multicentrique sur une cohorte de 450 patients atteints de cancer colorectal. Ce travail garantit un impact considérable dans la littérature et dans la pratique clinique comme test non invasif de diagnostic et de suivi et comme un outil pour améliorer les connaissances de base sur l'ADN circulant et le cancerAnalysis of circulating DNA circulating in the context of tumorigenesis and as a diagnostic tool The thesis project described here is based on the remarkable discovery that a significant amount of DNA circulates in blood of cancer patients [1-5]. The development of a technology based on the detection of circulating DNA represents a scientific and medical breakthrough for diagnosis and follow up in therapeutic care of cancer patients. Despite numerous studies conducted over the last decade [4,5] on circulating DNA, origins of release of circulating DNA in biological fluids are hypothetical and its structure is unclear. These data do not validate so far circulating DNA as a biomarker. For this reason, objectives of the group led by Alain Thierry are focused on elucidating structural forms of circulating DNA. Thus, using nude mice xenografted with human tumor cell lines of colorectal cancer as clinical samples from colorectal cancer patients, the team showed that the concentration was positively correlated with tumor size [6 , 7] and these results were optimal for sizes below 100 bp. A significative discrimination between healthy individuals and cancer patients was found by the analysis of circulating DNA fragmentation. The originality of these discoveries gave rise to the Intplex technology recently patented by the CNRS [8]. The aim of the thesis is to validate quantification and fragmentation of circulating DNA as a diagnostic and follow-up test in the management of cancer by closely analyzing the factors that may influence quantification and fragmentation of circulating DNA. Thanks to mouse model developed by the team and close collaboration with clinical cancer centers, different parameters will be analyzed. One part of the thesis will be focused on comparison and standardization of the different results depending on many factors specific to the tumor, such as its type, its progression, its differentiation and its tissue localization. The thesis work will also focus on the influence of individual factors that may affect the quantity and the fragmentation of circulating DNA: age, sex, medical history, specific physiological states, pathophysiological situations. The influence of treatment will also be explored. Studies will be undertaken in order to standardize the biological analysis: influence of circadian rhythm, food intake.... Technically, the analytical variation and the influence of pre-analytical factors will be determined to establish a good practice guide to eliminate any artifacts altering the amount and integrity of circulating DNA in the samples. These two parameters will be tested in a prospective multicentric clinical evaluation on a cohort including 450 patients with colorectal cancer. This work warrants a significant impact in the literature and in cancer clinical practice as a non invasive diagnostic and follow-up test and as a tool to improve the basic knowledge on circulating DNA and cancer
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Malagón, Rodríguez Marta. "Development of new, non-invasive tools based on faecal bacterial signatures for the early detection of colorectal cancer." Doctoral thesis, Universitat de Girona, 2019. http://hdl.handle.net/10803/669281.
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This thesis aims to develop a new non-invasive tool based on faecal bacterial markers for the early detection of colorectal cancer, which is capable of detecting precancerous lesions before the onset of clinical signs. In this work three tools have been developed: (1) RAID-CRC, based on the combination of four bacterial species with FIT, capable of reducing FIT false positive results in a 50% in a population with symptoms compatible with CRC; (2) RAID-CRC Screen, based on the combination of six bacterial species, capable of reducing I a 20% FIT false positive results in an asymptomatic population aged between 50 and 69 (current CRC screening population); and finally, (3) RAID-LS, based on the combination of three bacterial species, capable of detecting colorectal neoplastic lesions absence in Lynch syndrome carriers (subjects with CRC genetic predisposition) with a 100% sensitivity.Aquesta tesi té l’objectiu principal de desenvolupar una nova eina no invasiva basada en marcadors bacterians fecals per a la detecció precoç del càncer colorectal, que sigui capaç també de detectar lesions precanceroses abans que apareguin signes clínics. En aquest treball s’ha aconseguit desenvolupar tres eines: (1) RAID-CRC, basada en la combinació de quatre espècies bacterianes amb el TSOF, capaç de reduir el nombre de falsos positius del TSOF en un 50% en una població amb símptomes compatibles amb el CCR; (2) RAID-CRC Screen, basada en la combinació de sis espècies bacterianes, capaç de reduir en un 20% els falsos positius del TSOF en una població sense símptomes d’entre 50 i 69 anys d’edat (població actual de cribratge de CCR); i per últim, (3) RAID-LS, basada en la combinació de tres espècies bacterianes, capaç de detectar l’absència de lesions neoplàsiques colorectals en portadors de la síndrome de Lynch (persones amb predisposició genètica a patir CCR) amb una sensibilitat del 100%.
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Ramgolam, Anoop. "Conception, caractérisation et validation d'une sonde endoluminale bimodale couplant l'imagerie par résonance magnétique et la spectroscopie optique en vue du diagnostic du cancer colorectal." Thesis, Lyon 1, 2012. http://www.theses.fr/2012LYO10105.
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Ce travail porte sur le développement d’une nouvelle technique de diagnostic associant la résonance magnétique à haute résolution spatiale à la spectroscopie optique d’autofluorescence et de réflectance. La mise au point d’une telle sonde endoluminale bimodale s’inscrit dans les recherches de méthodes complémentaires ou alternatives à l’endoscopie conventionnelle pour le diagnostic précoce des pathologies du tube digestif. En effet le cancer colorectal représente aujourd’hui un enjeu majeur de santé publique avec plus de 1,2 millions de cas diagnostiqués dans le monde sachant que le taux de survie à 5 ans d’un patient est actuellement de 94% dans le cas de lésions détectées à un stade précoce (stade I) et seulement de 8% à un stade tardif (stade IV). Dans la première partie du manuscrit, nous abordons les différentes modalités d’imagerie et d’analyse spectrale en cours de développement ou d’évaluation, en mettant l’accent sur les principes physiques utilisés en RMN et spectroscopie optique. Dans une deuxième partie, nous détaillons la conception et la réalisation de prototypes de sondes endoluminales ainsi que les bancs optiques associés. Nous traitons également de la mise en oeuvre de dispositifs d’acquisition ainsi que des méthodes d’analyse de données au moyen de programmes informatiques dédiés. Dans une dernière partie, le système bimodal est caractérisé et validé lors d’études sur fantômes et une étude in vivo sur lapin. Les images obtenues par RM, fournissant l’information morphologique des échantillons ou du tissu, et les spectres optiques liés à leur composition sont corrélésThe main aim of this work is the development of a new diagnostic technique combining high spatial resolution MRI to autofluorescence and reflectance spectroscopy through the conception of a bimodal endoluminal probe. Such a technique falls within the framework of alternative innovative techniques to conventional colonoscopy that would allow better sensitivity to early stage digestive pathologies. Colorectal cancer is today a major health issue worldwide with more than 1.2 million cases diagnosed each year bearing the fact that the 5 year survival rate is 94% when precancerous lesions are diagnosed at an early stage (stage I) and only 8% when diagnosed at an advanced stage (stage IV). The promising imaging and spectral analysis techniques under investigation or undergoing clinical evaluation in different parts of the world are presented in the first chapter of this manuscript along with the basic physics involved in magnetic resonance imaging and optical spectroscopy. Chapter 2 gives a detailed description of the work carried out in devising and conceiving different endoluminal bimodal probe prototypes along with the dedicated optical test benches. Dedicated data processing and visualisation programmes developed are also presented within this chapter. The final chapter of this work deals with the different studies carried out in-vitro on different phantoms and in-vivo on a rabbit. Morphological information obtained through the MR images are also correlated to the biochemical information through the autofluorescence and reflectance spectra
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Alsheh, Ali Maya. "Analyse statistique de populations pour l'interprétation d'images histologiques." Thesis, Sorbonne Paris Cité, 2015. http://www.theses.fr/2015PA05S001/document.
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Au cours de la dernière décennie, la pathologie numérique a été améliorée grâce aux avancées des algorithmes d'analyse d'images et de la puissance de calcul. Néanmoins, le diagnostic par un expert à partir d'images histopathologiques reste le gold standard pour un nombre considérable de maladies notamment le cancer. Ce type d'images préserve la structure des tissus aussi proches que possible de leur état vivant. Ainsi, cela permet de quantifier les objets biologiques et de décrire leur organisation spatiale afin de fournir une description plus précise des tissus malades. L'analyse automatique des images histopathologiques peut avoir trois objectifs: le diagnostic assisté par ordinateur, l'évaluation de la sévérité des maladies et enfin l'étude et l'interprétation des mécanismes sous-jacents des maladies et leurs impacts sur les objets biologiques. L'objectif principal de cette thèse est en premier lieu de comprendre et relever les défis associés à l'analyse automatisée des images histologiques. Ensuite, ces travaux visent à décrire les populations d'objets biologiques présents dans les images et leurs relations et interactions à l'aide des statistiques spatiales et également à évaluer la significativité de leurs différences en fonction de la maladie par des tests statistiques. Après une étape de séparation des populations d'objets biologiques basée sur la couleur des marqueurs, une extraction automatique de leurs emplacements est effectuée en fonction de leur type, qui peut être ponctuel ou surfacique. Les statistiques spatiales, basées sur la distance pour les données ponctuelles, sont étudiées et une fonction originale afin de mesurer les interactions entre deux types de données est proposée. Puisqu'il a été montré dans la littérature que la texture d'un tissu est altérée par la présence d'une maladie, les méthodes fondées sur les motifs binaires locaux sont discutées et une approche basée sur une modification de la résolution de l'image afin d'améliorer leur description est introduite. Enfin, les statistiques descriptives et déductives sont appliquées afin d'interpréter les caractéristiques extraites et d'étudier leur pouvoir discriminant dans le cadre de l'étude des modèles animaux de cancer colorectal. Ce travail préconise la mesure des associations entre différents types d'objets biologiques pour mieux comprendre et comparer les mécanismes sous-jacents des maladies et leurs impacts sur la structure des tissus. En outre, nos expériences confirment que l'information de texture joue un rôle important dans la différenciation des deux modèles d'implantation d'une même maladieDuring the last decade, digital pathology has been improved thanks to the advance of image analysis algorithms and calculus power. However, the diagnosis from histopathology images by an expert remains the gold standard in a considerable number of diseases especially cancer. This type of images preserves the tissue structures as close as possible to their living state. Thus, it allows to quantify the biological objects and to describe their spatial organization in order to provide a more specific characterization of diseased tissues. The automated analysis of histopathological images can have three objectives: computer-aided diagnosis, disease grading, and the study and interpretation of the underlying disease mechanisms and their impact on biological objects. The main goal of this dissertation is first to understand and address the challenges associated with the automated analysis of histology images. Then it aims at describing the populations of biological objects present in histology images and their relationships using spatial statistics and also at assessing the significance of their differences according to the disease through statistical tests. After a color-based separation of the biological object populations, an automated extraction of their locations is performed according to their types, which can be point or areal data. Distance-based spatial statistics for point data are reviewed and an original function to measure the interactions between point and areal data is proposed. Since it has been shown that the tissue texture is altered by the presence of a disease, local binary patterns methods are discussed and an approach based on a modification of the image resolution to enhance their description is introduced. Finally, descriptive and inferential statistics are applied in order to interpret the extracted features and to study their discriminative power in the application context of animal models of colorectal cancer. This work advocates the measure of associations between different types of biological objects to better understand and compare the underlying mechanisms of diseases and their impact on the tissue structure. Besides, our experiments confirm that the texture information plays an important part in the differentiation of two implemented models of the same disease
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Deleau, Céline Buecher Bruno. "Diagnostic de récidive de cancer colorectal par PET-Scan." [S.l.] : [s.n.], 2007. http://castore.univ-nantes.fr/castore/GetOAIRef?idDoc=21566.
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Bodle, Sarah J. "Adhesion Based Early Detection of Colorectal Cancer." Ohio University / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1503486302129822.
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Liao, Christopher C. L. "Mass Spectrometry Based Protein Expression Profiling in Colorectal Cancer Diagnostics." Thesis, University of Essex, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.520129.
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Des, Guetz Gaëtan. "Nouveaux facteurs pronostiques et prédictifs dans les cancers colorectaux." Paris 13, 2007. http://www.theses.fr/2007PA132014.
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L’évaluation des facteurs pronostiques biologiques dans le traitement du cancer colorectal est fondamentale. Dans notre méta-analyse, l’augmentation des valeurs de densité vasculaire et d’expression du VEGF était associée à une faible survie sans rechute, respectivement RR à 2,32 (95% CI : 1. 39-3. 90 ; p < 0. 001) et 2,84 (95% CI :1. 95-4. 16 ; p <0. 001). Dans une seconde méta-analyse, la technique du ganglion sentinelle (SLN) était évaluée. Le DAOR était de 10,7 (95% CI 7,0-16,5). Ainsi, pour un patient SLN+ le risque d’être N+ est 10,7 fois plus élevé. Enfin, nous avons recherché l’implication du statut MSI dans la réponse à la chimiothérapie standard FOLFOX. Le taux de réponse globale et de survie sans progression apparaît similaire statistiquement: 22% (MSI) versus 37 % (MSS) et 8. 6 mois (3-10. 1) versus 8. 3 mois (2-73. 6) respectivement. De hautes doses de chimiothérapie, apparaissaient efficaces. Il est apparaît désormais nécessaire d’évaluer prospectivement ces facteurs lors de traitements adjuvantsThe evaluation of the biological prognostic factors will be necessary for colorectal cancer. In our meta-analysis, increased MVD and VEGF expression significantly predicted poor RFS (RR = 2. 94 ; 95% CI : 1. 93-4. 47) and OS (RR = 1. 65 ; 95% CI : 1. 27-2. 14). Technics of Sentinel Lymph Node (SLN) should also be evaluated. In our second study, the pooled DAOR was 10. 7 (95% confidence interval 7. 0-16. 5). That means that a patient whose SLN is invaded has 10. 7 times more risk to be node-positive than an SLN-negative patient. Thirdly, we aimed to determine whether or not MSI status play a role in the response to usual chemotherapy ie FOLFOX. Overall response rates 22% versus 37 % and median progression-free survival 8. 6 months (3-10. 1 months) versus 8. 3 months (2-73. 6 months) were similar in the 2 groups, MSI and MSS patients. It is now necessary and essential to continue the evaluation of prognostic factors in colorectal cancer, in randomised controlled trials of adjuvant treatments
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Li, Wai-yee, and 李蔚宜. "Trajectories of psychological distress and Chinese patients newly diagnosed with colorectal cancer : a longitudinal study." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2014. http://hdl.handle.net/10722/208006.
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Substantial studies have investigated homogeneity of psychological distress level among cancer patients by using cross-sectional and longitudinal study design. Nonetheless, as proposed by Bonnano (2004), heterogeneity characteristics of psychological distress following stressful event could not be neglected and he further suggested that the majority of individuals were resilient in response to stressful events. To test this postulation, recent studies employed growth mixture modelling method to examine the heterogeneity characteristics of psychological distress trajectory among cancer patients. Furthermore, identifying relevant factors differentiate the psychological distress trajectories is an integral part for developing effective interventions for cancer patients in dealing with illness demands. However, only a few studies have examined these issues among Chinese colorectal cancer patients, a second most common cancer in Hong Kong. Therefore, it is of important need to address this knowledge gap.
This study had two major aims: 1) to explore the patterns of psychological distress among Chinese patients with colorectal cancer from shortly after diagnosis but before surgery (i.e. 1-day prior operation) to 1-year post-surgery and to testify Bonnano’s theory on resilience; 2) to identify the effects of cancer-related intrusive thoughts, physical symptom intrusiveness and dispositional optimism on differentiating psychological distress trajectories.
A total of 246 Chinese patients with colorectal cancer were recruited for the current study. Altogether, 5 consecutive face-to-face interviews were conducted on one day prior to surgery (baseline), 1-, 4-, 8- and 12-month post-surgery (T2-T5). Patients’ psychological distress (i.e. anxiety and depression), physical symptom intrusiveness, cancer-related intrusive thoughts, dispositional optimism, demographic and medical information were assessed by a standardised questionnaire with valid and reliable psychometric instruments. Growth mixture modelling was used to estimate and specify the psychological distress trajectories. Multinomial logistic regression was adopted to assess the proposed factors in relation to differentiate the trajectory patterns.
Growth mixture modelling suggested three distinct trajectories were identified for both anxiety and depression model. The majority of patients with colorectal cancer were identified as resilient (i.e. maintaining low and stable distress level across time) for both models (anxiety: 82.3%, depression: 82.7%). Additionally, for anxiety trajectory model, the remaining 12.3% and 5.4% of patients were classified as moderately-low anxiety group (i.e. maintaining moderate to low distress level) and increasing anxiety group (i.e. increased from moderate level of distress at initial to subsequently high distress level) respectively. For depression trajectory model, the remaining 12.6% and 4.7% of the patients were grouped as delayed depression (i.e. delayed level of distress over time) and recovery depression (i.e. recovered from high distress level to low across time). Multinomial logistic regression showed that cancer-related negative intrusive thoughts, physical symptom intrusiveness and dispositional optimism were significant factors to differentiate anxiety and depression trajectories respectively.
This study highlighted the heterogeneous feature of psychological distress among Chinese patients with colorectal cancer. Physical symptom intrusiveness, cancer-related negative intrusive thoughts and dispositional optimism played important role on predicting cancer patient’s psychological distress respectively. Nonetheless, further investigations are much needed to clarify the underlying mechanism.published_or_final_version
Public Health
Master
Master of Philosophy
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Mahadavan, L. "Diagnostic accuracy of colonic cellular DNA sampling (colonix) in the detection of colorectal cancer." Thesis, Exeter and Plymouth Peninsula Medical School, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.700630.
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Morel, Corinne. "Les marqueurs moléculaires de progression tumorale dans les cancers colorectaux et les applications possibles à partir des cellules desquamées dans les selles de patients à risque." Paris 5, 1998. http://www.theses.fr/1998PA05P043.
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Mahadavan, Lalitha. "Diagnostic accuracy of colonic cellular DNA sampling (colonix R) in the detection of colorectal cancer)." Thesis, Exeter and Plymouth Peninsula Medical School, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.526939.
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Gokhale, Priyanka G. "DEVELOPMENT AND COMMERCIALIZATION OF A FECAL DNA BASED MOLECULAR DIAGNOSTIC ASSAY FOR COLORECTAL CANCER SCREENING." Case Western Reserve University School of Graduate Studies / OhioLINK, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=case1275440415.
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Högberg, Cecilia. "Diagnosing colorectal cancer in primary care : the value of symptoms, faecal immunochemical tests, faecal calprotectin and anaemia." Doctoral thesis, Umeå universitet, Allmänmedicin, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-133628.
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Background: Colorectal cancer (CRC) is the third most common cancer in men and the second most common in women worldwide. Adenomas can be precursors to CRC, and inflammatory bowel disease (IBD) can present with the same symptoms as CRC. The majority of patients with CRC initially consult primary care. Symptoms associated with CRC are also common among primary care patients, but seldom caused by any significant disease. Reliable diagnostic aids would be helpful in deciding which patients to refer. Faecal immunochemical tests (FITs) are commonly used for this purpose in primary care in Sweden, but there is little evidence to support this use. Faecal calprotectin (FC) has been suggested as an additional test. Aim: To explore how doctors in primary care investigate patients with suspected CRC, the value of FITs, symptoms and presence of anaemia in diagnosing CRC and adenomas in primary care, and whether FC tests could contribute to diagnosis. Methods: Three studies (1-3) were carried out in Region Jämtland Härjedalen, Sweden. There was no screening programme for CRC. We used a point of care qualitative dip-stick 3-sample FIT with a cut-off of 25-50μg haemoglobin/g faeces, and a calprotectin enzyme-linked immunosorbent assay (ELISA) test with a cut-off of 100 μg/g faeces. 1: A retrospective, population-based study including all patients diagnosed with CRC or adenomas with high-grade dysplasia (HGD) during the period 2005-2009 that initially consulted primary care. Symptoms, FIT results, anaemia and time to diagnosis were retrieved from medical records. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated from FIT results at the region’s health centres 2008- 2009. (Paper I.) 2: A prospective cohort study including consecutive patients where primary care doctors requested FITs and/or FC tests, at four health centres, from 30 Jan 2013 to 31 May 2014. FITs, FC tests, haemoglobin and iron deficiency tests were analysed; patients and doctors answered questionnaires about symptoms. Patients were examined with bowel imaging or followed for two years. Findings of CRC, adenomas with HGD, adenomas with low grade dysplasia (LGD) ≥1 cm and IBD were registered. (Papers II and III.) 3: A qualitative study of interviews with eleven primary care doctors. We explored what made them suspect CRC, and their practices regarding investigation and referral with particular attention to their use of FITs. Qualitative content analysis with an inductive approach was used for the analysis. (Paper IV.) Results: 1: Paper I: Of 495 patients 323 (65.3%) started the investigation in primary care. FITs were analysed in 215. In 23 cases with CRC, FITs were negative; 15 (65.2%) had anaemia. In 33 cases with CRC, FITs were performed due to asymptomatic anaemia; 10 (30.3%) had negative FITs. The time from start of investigation, to the diagnosis of CRC or adenomas with HGD, was significantly longer for patients with negative FITs. 2: 377 patients (9 diagnosed with CRC, 10 with IBD) were included. Paper II: Concordance of positive answers about symptoms from patients and doctors was generally low. Rectal bleeding (recorded by 43.5% of patients and 25.6% of doctors) was the only symptom related to CRC and IBD. The FIT showed a better PPV than rectal bleeding for CRC and IBD. When patients recorded rectal bleeding, the FIT had a PPV of 22.6% and a NPV of 98.9% for CRC and IBD. Paper III: The best test for detecting CRC and IBD was the combination of a positive FIT and/or anaemia with a sensitivity, specificity, PPV and NPV of 100%, 61.7%, 11.7% and 100% respectively. The FC test had no additional value to the FIT alone. The sensitivity, specificity, PPV and NPV of the FIT for CRC in study 1 was estimated at 88.4%, 73.3%, 6.2% and 99.7% respectively. In study 2, corresponding figures were 88.9%, 67.4%, 6.3% and 99.6% respectively. 3: Paper IV: We identified four categories: “Careful listening – with awareness of the pit-falls”, “tests can help – the FIT can also complicate the diagnosis”, “to refer or not to refer – safety margins are necessary”, and “growing more confident – but also more humble”. All doctors had found their own way to handle FIT results in the absence of guidelines. Conclusion: The diagnostic process when suspecting CRC can be described as navigating uncertain waters with safety margins. FITs were often used by primary care doctors but with considerable variations in interpretation and handling of results. Rectal bleeding was the only symptom related to CRC and IBD, but the FIT showed a better PPV than rectal bleeding. The combination of a negative FIT and no anaemia may be useful as a rule-out test when CRC is suspected in primary care, and this potentially also applies when patients present with rectal bleeding. Further studies are needed to confirm this and to determine the optimal FIT cut-off value for this use.
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Milot, Laurent. "Imagerie des métastases hépatiques colorectales à l’ère des résections chirurgicales complexes : peut-on en améliorer la spécificité ?" Thesis, Lyon, 2019. http://www.theses.fr/2019LYSE1040.
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Les métastases hépatiques du cancer colorectal (MHCR) sont fréquentes et sont associées à une mortalité significative. Ces dernières décennies, des progrès thérapeutiques importants ont permis d'en améliorer le pronostic. Plus particulièrement, le rôle des résections hépatiques s'est considérablement élargi dans la maladie métastatique limitée au foie, conduisant à un changement radical dans la prise en charge. Ceci a naturellement eu des répercussions sur l'imagerie, qui doit être très performante au niveau lésionnel, nécessitant des sensibilité et spécificité très élevées. Si les techniques modernes ont permis une amélioration très nette en termes de sensibilité, en particulier grâce aux produits de contraste hépatospécifiques et de l'imagerie pondérée en diffusion, l'amélioration de la spécificité est moins claire et moins bien évaluée. Pourtant, la spécificité est tout aussi importante dans ce contexte, où les erreurs diagnostiques sont coûteuses, avec des chirurgies inutiles en cas de faux positifs, et des résections incomplètes en cas de faux négatifs. Ces deux situations sont accompagnées d'une morbi-mortalité très importante. Le présent travail de thèse va donc explorer de nouvelles pistes dont l'objectif ultime serait d'améliorer la spécificité de l'imagerie des MHCR. La première étude confronte l'apparence des métastases d'origine colorectale en IRM de haute résolution et leur histologie sous-jacente. Cette étude originale démontre que la fibrose tumorale apparait en hypersignal T2 et la nécrose tumorale en hyposignal T2 et hypersignal T1, ce qui va à l'encontre du dogme classique. La seconde étude explore la faisabilité de la fusion d'images IRM/échographie dans l'exploration de lésions hépatiques focales chez des patients ayant un cancer colorectal. Cette étude montre qu'un nombre significatif de lésions ne peuvent être visualisées à l'échographie qu'en utilisant la fusion, ouvrant la voie à une meilleure caractérisation lésionnelle en combinant les atouts de l'échographie et de l'IRM. Enfin, la troisième étude, complétée d'une revue iconographique, analyse le comportement IRM des lésions hépatiques après injection d'un produit de contraste intravasculaire. Elle montre une accumulation progressive du contraste au sein des angiomes, mais pas dans les métastases, conduisant à des apparences très différentes sur la phase tardive. Ceci était aussi observé dans les lésions de petites tailles, ce qui devrait permettre une meilleure spécificité dans les cas difficilesColorectal cancer liver metastases (CRCLM) are common and result in significant mortality. During the past decades, important therapeutic advances have improved the prognosis signficantly, especially through a marked expansion of the role of hepatic resections in liverlimited metastatic disease, leading to a radical change in management. This was naturally accompanied by an equally radical change in the imaging paradigm, now centered at the lesion level and not at the patient level, requiring very high sensitivity and specificity. While modern techniques have allowed a significant improvement in terms of sensitivity, especially through the use of hepatospecific contrast agents and diffusion imaging, the benefits in term of specificity are less clear, with only few studies focusing on and reporting the specificity of the techniques. However, specificity is equally important in this context, where diagnostic errors are costly, resulting either in unnecessary surgeries in case of false positives or in incomplete resections in case of false negatives. In this setting, our thesis will examine the results of three studies, which objective is to offer possible solutions to better understand the imaging of metastases and improve the specificity of liver imaging of CRCLM. The first study analyzes the association between high resolution MRI appearance of CRCLM and their underlying histology, showing that tumor fibrosis was in hypersignal on T2 Weighted Imaging while tumor necrosis was in hyposignal on T2 Weighted Imaging and hypersignal on T1 Weighted Imaging, which goes against the classical teaching about these lesions. The second study assesses the feasibility of using an MRI/Ultrasound fusion system in the exploration of liver lesions in patients with colorectal cancer. This study shows that more lesions were detected with ultrasound when using the fusion system, suggesting that a fusion system may allow a better characterization of lesions by combining the complementary information of MRI and ultrasound. Finally, the third study and its accompanying pictorial essay, explored the behavior of liver lesions after injection of an intravascular contrast agent. The main finding of this study was that hemangioma were accumulating the contrast over time while metastases were not, a key differentiating feature. This finding was found even in small lesions, often difficult to diagnose, suggesting that using such contrast in the exploration of liver lesions in patients with CRCLM would result in a higher specificity of the method
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Lambert, Sylvie. "[An] in depth exploration of health information-seeking behavior among individuals diagnosed with prostate, breast, or colorectal cancer." Thesis, McGill University, 2008. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=92690.
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Seeking cancer information is key in coping with the feelings (e.g., fear, uncertainty) and other challenges (e.g., treatment decision-making) confronting individuals diagnosed with cancer. Despite recognition of a variation in why, when, how, and where individuals diagnosed with cancer seek information, few efforts have been made to systematically document patterns in information-seeking. Aim: To explore individuals' patterns of health information-seeking behaviors (HIS B) including the type, amount, and sources ofinforn1ation and the strategies used to process and/or manage cancer information.La recherche d'information sur Ie cancer est d'une importance determinante pour les personnes atteintes de cette maladie dans Ie contexte OU elles ont gerer des emotions intenses (p. ex. : peur, incertitude) et font face plusieurs defis (p. ex. : processus de decision relatif au traitement). Des variations concernant la recherche d'information par les individus diagnostiques avec un cancer ont ete observees et reconnues notamment en termes des raisons qui motivent la recherche d'information et des moyens utilises pour obtenir l'infomlation desiree. Cependant, a ce jour, peu d'efforts ont ete deployes pour documenter de maniere systematique les differents types de comportements de recherche d'information.
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O'Brien, Brian D. "Estimation of the first three years of hospital costs for colorectal cancer cases diagnosed in Nova Scotia in 1990." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp04/mq24982.pdf.
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Kloor, Matthias Johannes [Verfasser]. "The pathogenesis of microsatellite unstable colorectal cancer and the evaluation of novel diagnostic and therapeutic options / Matthias Johannes Kloor." Aachen : Shaker, 2012. http://d-nb.info/1066198004/34.
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Kloor, Matthias [Verfasser]. "The pathogenesis of microsatellite unstable colorectal cancer and the evaluation of novel diagnostic and therapeutic options / Matthias Johannes Kloor." Aachen : Shaker, 2012. http://nbn-resolving.de/urn:nbn:de:101:1-2015020112463.
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Tournier, Isabelle. "Mécanismes d'inactivation des gènes impliqués dans les deux formes majeures de prédisposition héréditaire aux cancers : la prédisposition aux cancers du sein et de l'ovaire et le cancer colorectal héréditaire non polyposique (HNPCC) ou syndrome de Lynch." Rouen, 2007. http://www.theses.fr/2007ROUE04NR.
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Le, Bonniec Alice. "Les déterminants psychosociaux de la participation au dépistage du cancer colorectal : enjeux de l’arrivée du nouveau test immunologique." Thesis, Montpellier 3, 2018. http://www.theses.fr/2018MON30014/document.
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IntroductionLe cancer colorectal est la 2ème cause de mortalité par cancer en France (HAS, 2013) mais aussi le 3ème cancer le plus fréquent (INCa, 2014). Un dépistage organisé existe depuis 2008, pourtant, les taux de participation restent faibles : 33,5% en France (Santé Publique France, 20018). D’après la littérature, les principaux freins à la participation au dépistage sont le manque de confiance envers le système de soins (Clavarino et al, 2004) ; l’embarras, l’inconfort et le déplaisir accompagnant les procédures des tests (Varela et al, 2010) ; ou encore le manque de temps. Enfin, le manque de recommandations de la part du médecin représente l’un des freins les plus importants (Walsh et al, 2010 ; Powell et al, 2009). Le test Hémoccult II, utilisé dans le cadre du dépistage organisé jusqu’en mars 2015, a été remplacé par un nouveau test immunologique, jugé plus sensible, plus spécifique et plus fiable par la communauté médicale (INCa, 2014).Objectifs et méthodeAu regard des faibles taux de dépistage et des principaux freins identifiés dans la littérature, ce travail de thèse a pour but d’analyser les déterminants de la participation au dépistage à la fois du point de vue des patients mais aussi des médecins généralistes. De plus, il apparaît nécessaire d’évaluer les enjeux de l’arrivée du nouveau test immunologique.Ce travail doctoral est basé sur la technique de la triangulation (théorique, méthodologique et des données). Plus précisément, deux cadres théoriques validés et reconnus en psychologie sociale de la santé ont été mobilisés, à savoir la Théorie des Représentations Sociales (Moscovici, 1984), et la Théorie du Comportement Planifié (Ajzen et al, 1991), permettant l’adoption d’une approche compréhensive aussi bien que prédictive du dépistage. Trois études ont ainsi été développées :- Une étude qualitative par entretiens semi-directifs, menée auprès de 17 médecins généralistes, ayant pour but d’appréhender leurs représentations sociales du dépistage du cancer colorectal ainsi que la manière dont celui-ci peut s’ancrer dans leur pratique de recommandation ;- Une étude qualitative par focus groups, menée auprès de 29 participants issus de la population générale dont l’objectif était d’appréhender leurs représentations sociales du dépistage du cancer colorectal ainsi que les freins et facilitateurs à son adhésion.- Une étude quantitative par questionnaires, menée auprès de 160 participants issus de la population générale, visant à identifier les principaux prédicteurs de l’intention et du comportement de dépistage du cancer colorectal.Principaux résultatsL’analyse des entretiens a révélé une incohérence entre le rôle que les médecins pensent devoir jouer auprès des patients dans la prévention et le dépistage, et la réalité de leur pratique qui ne leur laisse que peu de temps à y consacrer. L’analyse des focus groups a révélé que les principaux freins à la participation au dépistage sont : le manque d’accessibilité du test (nécessité de consulter le médecin généraliste pour obtenir le kit de dépistage), une faible préoccupation pour la prévention, mais aussi le fait que le cancer colorectal se réfère à une partie du corps liée à un tabou, et considérée comme sale. Enfin, l’analyse des questionnaires a permis d’identifier plusieurs variables ayant une influence sur l’intention et le comportement de dépistage, à savoir : le comportement antérieur de dépistage, la fréquence de dépistage, le déni, la proximité sociale, les normes sociales et le contrôle comportemental perçu. Les analyses ont particulièrement mis en avant l’importance du contrôle comportemental perçu, pouvant agir directement sur le comportement sans passer par l’intention.ConclusionLes conclusions révèlent la pertinence d’allier une approche compréhensive à une approche prédictive. Nos perspectives proposent la mise en place d’interventions visant à améliorer le niveau de contrôle perçu de la population générale face à ce dépistageIntroductionColorectal cancer is the second leading cause of cancer deaths in France (HAS, 2013) but also the third most common cancer (INCa, 2014). An organized screening programme has been put in place since 2008, but participation rates remain low: 33.5% in France (Santé Publique France, 2018). According to the literature, the main barriers to participation in screening are the lack of confidence in the health care system (Clavarino et al, 2004) ; embarrassment, discomfort and dissatisfaction accompanying testing procedures (Varela et al, 2010); or lack of time. Finally, the lack of general practitioners’ recommendations is one of the most significant obstacles (Walsh et al, 2010, Powell et al, 2009). The Hemoccult II test, used as part of organized screening until March 2015, was replaced by a new immunological test, considered more sensitive, more specific and more reliable by the medical community (INCa, 2014).Objectives and methodFaced with the low screening rates and main obstacles identified in the literature, this thesis aims at analyzing the determinants of screening participation, with both patient and general practitioner points of view. Moreover, it appears necessary to evaluate issues with the arrival of the new immunological test.This doctoral work is based on the technique of triangulation (theoretical, methodological and data triangulation). More precisely, two validated and recognized theoretical frameworks in health and social psychology were employed, namely the Theory of Social Representations (Moscovici, 1984), and the Theory of Planned Behaviour (Ajzen et al, 1991), allowing the adoption of a comprehensive approach as well as a predictive approach to studying screening participation. Three studies have been set up:- A qualitative study through semi-structured interviews, conducted with 17 general practitioners, aimed at understanding their social representations of colorectal cancer screening and how it can be anchored in their practice of recommendation;- A qualitative study by focus groups, conducted with 29 participants from the general population. The objective was to apprehend their social representations of colorectal cancer screening as well as the obstacles and facilitators to screening participation.- A quantitative study by questionnaire, including 160 participants from the general population, endeavours to identify the key predictors of colorectal cancer screening intention and behaviour.Main resultsThe analysis of interviews revealed an inconsistency between the role general practitioners think they should play with patients in prevention and screening, and the reality of their practice which leaves them insufficient time to devote to it. The focus group analysis revealed that the main barriers to participation in screening are: the lack of accessibility of the test (needing to consult the general practitioner in order to obtain the screening kit), a low concern for prevention, but also the fact that colorectal cancer refers to a body part that is deemed taboo, and considered “dirty”. Finally, the analysis of questionnaires allowed the identification of several variables influencing intention and behaviour of screening, namely: previous screening behaviour, frequency of screening, denial, social proximity, social norms and perceived behavioural control. Analysis particularly emphasized the value of perceived behavioural control, which can directly influence behaviour without going through intention.ConclusionResults reveal the relevance of combining a comprehensive approach with a predictive approach. Our perspectives suggest the implementation of interventions aimed at improving the perceived level of control of the general population faced with this screening
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Rivoire, Michel. "Stratégies diagnostique et thérapeutique des métastases hépatiques des cancers colorectaux par les anticorps monoclonaux radiomarqués : développement d'un modèle expérimental chez la souris Nude." Lyon 1, 1995. http://www.theses.fr/1995LYO1T214.
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Gaifulina, Riana. "A study of Raman spectroscopy as a clinical diagnostic tool for the detection of lynch syndrome/hereditary nonpolyposis colorectal cancer (HNPCC)." Thesis, University College London (University of London), 2017. http://discovery.ucl.ac.uk/10024847/.
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Lynch syndrome also known as hereditary non-polyposis colorectal cancer (HNPCC) is a highly penetrant hereditary form of colorectal cancer that accounts for approximately 3% of all cases. It is caused by mutations in DNA mismatch repair resulting in accelerated adenoma to carcinoma progression. The current clinical guidelines used to identify Lynch Syndrome (LS) are known to be too stringent resulting in overall underdiagnoses. Raman spectroscopy is a powerful analytical tool used to probe the molecular vibrations of a sample to provide a unique chemical fingerprint. The potential of using Raman as a diagnostic tool for discriminating LS from sporadic adenocarcinoma is explored within this thesis. A number of experimental parameters were initially optimized for use with formalin fixed paraffin embedded colonic tissue (FFPE). This has resulted in the development of a novel cost-effective backing substrate shown to be superior to the conventionally used calcium fluoride (CaF2). This substrate is a form of silanized super mirror stainless steel that was found to have a much lower Raman background, enhanced Raman signal and complete paraffin removal from FFPE tissues. Performance of the novel substrate was compared against CaF2 by acquiring large high resolution Raman maps from FFPE rat and human colonic tissue. All of the major histological features were discerned from steel mounted tissue with the benefit of clear lipid signals without paraffin obstruction. Biochemical signals were comparable to those obtained on CaF2 with no detectable irregularities. By using principal component analysis to reduce the dimensionality of the dataset it was then possible to use linear discriminant analysis to build a classification model for the discrimination of normal colonic tissue (n=10) from two pathological groups: LS (n=10) and sporadic adenocarcinoma (n=10). Using leaveone-map-out cross-validation of the model classifier has shown that LS was predicted with a sensitivity of 63% and a specificity of 89% - values that are competitive with classification techniques applied routinely in clinical practice.
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López, Siles Mireia. "Ecophysiology and philogeny of Faecalibacterium prausnitzii in healthy and diseased gut. Application in Inflamatory Bowel Disease diagnostics." Doctoral thesis, Universitat de Girona, 2016. http://hdl.handle.net/10803/369044.
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In this PhD thesis Faecalibacterium prausnitzii populations of patients with gut disease and healthy individuals have been characterized.
First, isolates from healthy volunteers have been phenotypically characterised, which has allowed to gain insight into the physiology of this species. A possible link between F. prausnitzii sensitivity to changes in gut physicochemical conditions and its disappearance in a diseased gut has been revealed.
Second, molecular studies on F. prausnitzii populations have allowed to define two phylogroups within this species, and to describe the diversity of phylotypes in healthy individuals and in patients with intestinal disease. The phylotypes specifically compromised in patients suffering some gut disorders have been identified.
Finally, new molecular tools for the detection and quantification of this species and its phylogroups have been designed. Their usefulness to be implemented as complementary molecular tools for the diagnosis and prognosis of intestinal diseases has been determined.En aquesta tesi doctoral s'ha estudiat la població de Faecalibacterium prausnitzii de pacients amb malalties intestinals i individus sans. En primer lloc, es va realitzar una caracterització fenotípica d'aíllats d'aqueta espècie obtinguts d'individus sans, el que ha permès adquirir coneixement sobre la fisiologia d'aquesta espècie. S'ha evidenciat una possible relació entre la sensibilitat de F.prausnitzii a canvis en les condicions fisicoquímiques de l'intestí i la seva desaparició en un intestí malalt. En segon lloc, s'han realitzat estudis moleculars de les poblacions de F. prausnitzii. Això ha permès definir dos filogrups dins d'aquesta espècie, i descriure la diversitat de filotips en individus sans i pacients amb malalties intestinals.Per primera vegada, s'han identificat els filotips especificament compromesos en pacients que pateixen determinades malalties intestinals. Per últim, s’han dissenyat eines moleculars per a la detecció i quantificació d'aquesta espècie i els seus filogrups. S’ha determinat la utilitat d’aquestes eines moleculars per al suport al diagnòstic o prognòstic de malalties intestinals.
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Thoresen, Lene. "Nutrition Care in Cancer Patients : Nutrition assessment: diagnostic criteria and theassociation to survival and health-related quality oflife in patients with advanced colorectal carcinoma." Doctoral thesis, Norges teknisk-naturvitenskapelige universitet, Institutt for kreftforskning og molekylær medisin, 2012. http://urn.kb.se/resolve?urn=urn:nbn:no:ntnu:diva-16470.
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God ernæringspraksis for kreftpasienter. Ernæringsutredning; diagnostiske kriterier og sammenheng med overlevelse og helserelatert livskvalitet hos pasienter med avansert tykk- og endetarmskreft. Avhandlingen bygger på fire studier. Artikkel 1. Denne studien undersøker meninger til 2759 sykepleiere, 1753 sykehusleger og 359 kliniske ernæringsfysiologer (kef) fra Skandinaviske sykehus om bruk av kef’enes fagkompetanse i sykehus. Sykepleiere og leger som ser kef to eller flere ganger per uke i motsetning til de som ser kef sjeldnere enn to ganger per uke prioriterte klinisk ernæring høyere i avdeling, hadde oftere internundervisning om ernæring, fant det enklere å identifisere underernærte pasienter og pasienter som trengte ernæringsstøtte. Studien viser at sykepleiere og leger som ser kef oftere enn to ganger per uke har større fokus på ernæring. Artikkel 2. I denne studien ble ernæringsstatus til 46 kreftpasienter som ble innlagt i en palliativ enhet undersøkt med hjelp av objektive kriterier og skjemaet ”Subjective Global Assessment” (SGA). I følge de objektive kriteriene; vekttap, BMI, hudfoldtykkelse, armmuskelomkrets, S-Albumin og S-Pre-albumin var 28 pasienter underernært. Med SGA var 30 pasienter vurdert som underernært. SGA hadde en sensitivitet på 96% for å påvise underernæring. Underernærte pasienter hadde flere spiserelaterte symptomer og spiste mindre matporsjoner. Vi fant at to tredjedeler av pasientene var underernært og at SGA var valid som metode for å undersøke ernæringsstatus blant kreftpasienter med avansert sykdom. Artikkel 3. Her er ulike metoder for å måle nedgang i ernæringsstatus hos 77 pasienter med avansert tykk- og endetarmskreft undersøkt. Videre ble metodenes evne til å predikere pasientenes overlevelse studert. 28 pasienter hadde sarkopeni, 32 hadde ernæringsrisiko, 26 var underernært og 16 hadde kakeksi (CCSG) mens 41 hadde kakeksi (EPCRC). De ulike metodene overlappet hverandre ufullstendig. Studien viste at en stor andel av pasientene hadde dårlig ernæringsstatus. Det å ha kakeksi (CCSG) eller å være underernært predikerte kortere overlevelse. Artikkel 4. I denne studien ble ernæringsstatus og livskvalitet undersøkt hos 50 nyhenviste pasienter til Kreftavdelingen for vurdering av kjemoterapi for avansert tykk- og endetarmskreft. Pasientene hadde lavere livskvalitet sammenliknet med normalbefolkningen. De som var underernærte eller hadde kakeksi (EPCRC-SGA) hadde både statistisk og klinisk signifikant dårligere livskvalitet enn de øvrige pasientene. Etter 3 måneder økte 13 pasienter vekt og de forbedret flere livskvalitetsparametre. Syv pasienter tapte vekt og de forverret livskvaliteten signifikant, mens de pasientene som var vektstabile hadde uendret livskvalitet. Tolking. Den høye andelen av underernæring blant pasientene indikerer at mer bør gjøres for å forebygge underernæring tidligere i pasientforløpet. Underernæring og kakeksi kunne ikke holdes i fra hverandre med de metodene som ble undersøkt. Vekttap som kriterium er for uspesifikt til å diagnostisere kakeksi. Det er behov for å utvikle metoder for å påvise nedbrytning av muskulatur som kjennetegner kakeksi. En undersøkelse av ernæringsstatus gjennom et pasientforløp vil kunne avdekke tidspunkter for når intervensjoner bør settes inn mot underernæring.
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Lurkin, Antoine. "Pratiques médicales et référentiels en cancérologie, différentes méthodes d’évaluation : exemples du cancer du sein, du colon et des sarcomes." Thesis, Lyon 1, 2009. http://www.theses.fr/2009LYO10329.
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La base de la pratique médicale est l’observation : observation clinique du patient, observation épidémiologique d’une population, etc… L’analyse des pratiques observe la pluralité des attitudes adoptées par les praticiens face à une situation clinique. A un fait scientifique reconnu correspond une multitude d’attitudes pratiques. L’analyse de ces pratiques décrit la répartition et les variations de ces pratiques, et tente d’en expliquer les raisons. En France, la pratique clinique quotidienne reste encore un secteur peu étudié. Si les variations ne s’expliquent pas par les caractéristiques des patients, les raisons des variations sont peut-être à rechercher du côté médical. L’un des domaines étudié, où il peut y avoir également des variations de pratiques médicales est la cancérologie. Dans ce domaine les raisons de variations des pratiques peuvent être nombreuses et liées aux médecins, à leur structure ou à la politique d’hospitalisation de la région. Le postulat de départ est que l’harmonisation des prises en charge et des traitements des patients peut influencer leur survie. C’est pourquoi ce travail c’est intéressé à comparer la prise en charge des patients atteints de cancers fréquents (cancer du sein et du colon) à un cancer rare (les sarcomes) dans la région Rhône-Alpes. Nous avons montré, à travers des études prospectives et rétrospectives, le rôle du thesaurus et de son implémentation dans les pratiques médicales et leurs modifications. Nous avons également développé un outil informatique sous forme d’algorithmes décisionnels permettant de montrer le cas échéant si certaines étapes de l’audit clinique pouvaient être automatisées. La comparaison entre l’évaluation des pratiques médicales par un évaluateur et les algorithmes nous ont permis de conclure sur l’importance de la reproductibilité des décisions et sur les apports, de l’informatisation de ces procédés. Nous avons également montré l’importance d’une relecture des blocs de tumeurs par un expert dans une pathologie cancéreuse rare et complexe. Cela nous a permis de spécifier la nouvelle incidence des sarcomes en région Rhône-AlpesObservation is the basis of medical practice: clinical observation of the patient, epidemiological observation of a population, and so on… the analysis of practices observes the plurality of attitudes physicians take when they face a clinical situation. An acknowledged scientific fact given meets dozen of practical attitudes. The analysis of these practices describes their distribution and variations and try to explain the causes. In France, the daily clinical practice is still a sector on which few studied have been realized. If patients' characteristics can't explain variations, the causes of these variations may be found on the medical side. Medical practice variations can also be found in oncology, one of the studied domains. Causes of variations of practices in this domain can be numerous and linked to physicians, to their structures or to the region hospital care .policy. The postulate is that the harmonization of management and treatment of patients can act up on their survival. That is the reason why this work get interested in comparing the management of patients with frequent cancers (breast and colon) to rare cancers (sarcomas) in the Rhône-Alpes region. We showed, through prospective and retrospective studies, the role of a thesaurus and of its implementation in medical practices and their modifications. We have also developed a computing tool in decision-making algorithm form which could show if need be if some steps of clinical audit could be automated. The comparison between the assessment of medical practice made by an assessor or made thanks to the algorithms allowed us to conclude on the importance of reproducibility of decisions and on the contribution of the computerization of these processes. We also showed the necessity for tumours samples to be reviewed by an expert in a rare and difficult cancerous pathology. We could therefore specify the new incidence of sarcomas in the Rhône-Alpes region
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Hamade, Hussein. "Analyse des mécanismes moléculaires et cellulaires conduisant à une inflammation dans l'intestin et une progression tumorale induits par la perte de la sous-unité d'intégrine Alpha6 chez la souris." Thesis, Strasbourg, 2014. http://www.theses.fr/2014STRAJ062/document.
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Le laboratoire a établi un modèle de souris α6ΔIEC qui développe une inflammation chronique intestinale associée à la formation d’adénocarcinomes colorectaux. Ce modèle correspond à une délétion ciblée à l’épithélium intestinal de l’intégrine α6β4. Mon projet de thèse a consisté à définir les mécanismes qui influencent la transformation de lésions inflammatoires en adénocarcinomes. La caractérisation du modèle α6ΔIEC a permis de mettre en évidence plusieurs altérations : détachement de l’épithélium, régénération du tissu, prolifération, augmentation de la perméabilité intestinale, hypersécrétion du mucus, ségrégation anormale des bactéries, inflammation chronique et formation de tumeurs.Pour étudier la séquence et la cinétique des mécanismes, j’ai développé un modèle de souris inductible (α6ΔIECTAM). Cette lignée présente, deux semaines après l’invalidation de l’intégrine α6,les mêmes signes d’inflammation que les souris α6ΔIEC. Mon approche a consisté à dissocier les processus impliqués dans chacune des étapes-clés de la pathologie afin de définir la contribution respective de l’infection par les bactéries et du stress mécaniqueWe generated a new mouse model, α6ΔIEC, in which the genetic ablation of α6 integrin from intestinal epithelial cells triggered the development of spontaneous colitis and colorectal cancer. My main goal was to define the mechanisms by which inflamed lesions degenerate into infiltrating adenocarcinomas. Loss of α6 integrin in this model resulted in epithelial barrier damage, enhanced permeability, altered mucus layers, abnormal bacterial segregation, chronic inflammation and tumor development.In order to define the sequence of events and the mechanisms involved at each stage of the disease, from inflamed to tumor lesions, I developed an inducible mouse model, α6ΔIECTAM, in which α6 integrin ablation was induced by tamoxifen treatment. This line recapitulates all aspects of inflammation observed in the α6ΔIEC model, as early as two weeks after tamoxifen treatment. In particular, I tried to define the respective contribution of infection by bacteria and mechanical stress during disease progression