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Prognostic value of telomerase activity as an adjunct modality to diagnose and monitor bladder cancers

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dc.contributor.advisor Pretorius GHJ, Prof en
dc.contributor.advisor Van Den Heever WMJ, Dr en
dc.contributor.advisor Beukes CA, Prof en
dc.contributor.author Schemel MN en
dc.date.accessioned 2016-09-22T06:14:03Z
dc.date.available 2016-09-22T06:14:03Z
dc.date.created 2002 en
dc.date.submitted 2004 en
dc.identifier.uri http://hdl.handle.net/20.500.11892/4075
dc.description.abstract Transitional cell carcinoma of the bladder is the second most prevalent tumour of the genitourinary tract and is rated the second most common cause of death due to urinary tract malignancies.<br><br> Cystoscopy in conjunction with exfoliative cytology is the mainstay for diagnosing and monitoring of patients with bladder cancer, however, the traditional prognostic examinations are not sufficiently predicative in the individual patient. Regardless of their undisputable diagnostic value, both modalities have inconveniences and limitations that render them far from the ideal tests for bladder cancer screening.<br><br> Urine cytology can provide a useful tool in the detection of high-grade tumours but has a poor overall sensitivity and is quite examiner-dependent. Cystoscopy, on the other hand, remains the cornerstone for detection and monitoring of bladder tumours. However, this invasive procedure is uncomfortable for patients, especially in follow-up examinations. This procedure may be inconclusive at times especially in cases of inflammatory disease or when the tumour growth does not extend above the mucosal surface.<br><br> This coupled with the goal to circumvent the need for frequent cystoscopy to detect recurrent bladder tumours, has led to the investigations of new urine-based bladder cancer tests and various tumour biomarkers to aid in the detection and monitoring of bladder cancers. The availability of such a marker would permit selective use of aggressive treatment in patients at risk of recurrences and progression, while sparing low-risk individuals from unnecessary procedures.<br><br> Several urine-based markers are being investigated both for diagnostic and prognostic purposes. Because of the frequent multifocal nature of bladder carcinoma, recurrences are common despite early detection and treatment. Only prospective studies, which include unscreened comparison groups, can determine whether screening is effective in reducing the morbidity or mortality from bladder cancer (or other urologic cancers), and whether the benefits justify the costs and risks of screening and treatment. In the absence of such disease, routine screening cannot be recommended, because of the high incidence of false-positives and the possibility to harm asymptomatic patients. Primary prevention may offer a safer and more effective strategy than screening to reduce mortality from urologic cancer.<br><br> Among the most beneficial tools available in the combat against malignant disease are biological tumour markers. These markers may also be useful in monitoring therapeutic results and as a method of surveillance of recurrent disease.<br><br> Most biomarkers appear to have some advantages over urine cytology in terms of sensitivity, particularly for flagging low-grade superficial tumours. However, these markers tend to be less specific than cytology, yielding more false-positive results. This synopsis is most common in patients with concurrent bladder infections or other benign bladder conditions.<br><br> In the present study investigations had been conducted whereby telomerase activity was evaluated in spontaneously exfoliated transitional cells from patients being assessed for the presence of urologic pathology. The statistical data derived from the ROC curve showed that a RTA value of <6% incorporates the majority of patients who are free from malignant disease. Although we could not distinguish between the different grades of TCC purely on the relative telomerase activity values, a ROC curve reading of >6% included most of the individuals with active bladder cancer.<br><br> It is important to note that telomerase activity should be cautiously interpreted for diagnostic purposes, bearing in mind that it is expressed in various disease conditions and by diverse types of cells.<br><br> In the clinical assessment of bladder cancer, the detection of occult and low-grade bladder tumours and uncovering new molecular markers for patient follow-up remain the most challenging objective as non-invasive investigations. en
dc.language English en
dc.subject Medical sciences: Diseases en
dc.subject Other diseases en
dc.title Prognostic value of telomerase activity as an adjunct modality to diagnose and monitor bladder cancers en
dc.title.alternative Prognostiese waarde van telomerase aktiwiteit as 'n toegevoegde modaliteit vir diagnose en kontrolering van blaaskankers en
dc.type Masters degree en
dc.description.degree MTech en


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