Chirwere cheRopa Cancer Chinonyanya Kuonekwa muVakuru Vakuru
Chirwere chinonzi myeloid leukemia (AML) chirwere chekenza chinotangira pakutanga mumasese eropa apo masero eropa anobudiswa uye anobva aenda nokukurumidza kusvika kumasero eropa ivo pachavo. Kubvira ipapo, kenza inogona kupararira kune dzimwe nhengo dzomuviri, kusanganisira chiropa, spleen, ganda, uropi, uye musipinha.
AML inokanganisa vanhu vanosvika mamiriyoni gore roga roga uye inotungamirira kune vazhinji vanenge 150 000 vakafa.
MuUnited States chete, pakati pe10 000 ne18 000 matambudziko anoongororwa gore negore.
Kusiyana nedzimwe mhando dzeukama , iyo inowanzokonzera vechidiki, AML inowanzokonzera vanhu vakuru vanopfuura 65. Pakati peboka iri rezera, makore mashanu ekupukunyuka kwehupenyu anenge ari murombo, achienda kumativi anenge mashanu kubva muzana. Kurapa mahara pakati pevanhu vaduku vechidiki vanoita zviri nani kune chero ipi zvayo kubva pa25 kusvika ku70 muzana vachiwana kuregererwa kwakakwana mushure memakemikari.
Zvirwere Zviratidzo
Leukemia ikamu boka rakasiyana-siyana rekenza rinobata zvose zviviri zvinoita ropa uye masero eropa. Kunyange zvazvo chirwere chacho chinowanzokonzera masero emachena eropa , mamwe maitiro echirwere ichi kurwisa mamwe masero ezvitera.
Muchiitiko che AML, izwi rokuti "acute" rinoshandiswa nokuti kenza irikufambira mberi nokukurumidza, asi "myeloid" inoreva kumapfupa emapfupa uye mamwe masero eropa anopa marora anosika.
AML inotanga muine masero masero eropa anozivikanwa se myeloblast.
Aya ndiwo masero ayo, pasi pemamiriro ezvinhu akadai, aizokura mumasero matsvuku eropa zvakadai semaganulocytes kana monocytes . Zvisinei, ne AML, myeloblasts ichabudirira "inonaya" muhupenyu hwavo husina simba asi ramba richiwedzera kuregererwa.
Kusiyana nemasero anowanzoita ane mararamiro akasiyana-siyana, kenza dzemasero zvinoreva "kusingafi" uye dzicharamba dzichinyora pasina kupera.
NeAAML, masero eropa rekenza pakupedzisira anobuda kunze kwezvakanaka uye anotopesana nekukura kwemasero matsvuku eropa, masero matsvuku eropa (erythrocytes), uye platelets ( thrombocytes ).
AML haina kufanana nemukoma wake acute lymphocytic leukemia (ALL) iyo inobata imwe rudzi rwechichena chechizivo cheropa chinonzi lymphocyte . Kunyange zvazvo AML inonyanya kukanganisa vanhu vakwegura, KANA zvikuru inouraya vana pakati pemakore maviri ne mashanu.
Zviratidzo zvekare uye zviratidzo
Zviratidzo zve AML zvakabatana zvakananga nekuparadzanisa kwemasero eropa eropa nevanorwara nekenza. Kusavapo kwemasero eropa rega rega kunogona kusiya munhu anenge aine hutachiwana hwehutachiona uye zvimwe zvirwere izvo muviri unogona kudzivisa.
Nenzira yekuenzanisira, masero eropa ropa anonyanya kushandiswa mumuviri wemuviri. Masero matsvuku eropa, zvakasiyana, ane mutoro wekutakura okisijeni kuenda uye kubvisa carbon dioxide kubva mumasukisi, apo maplatelets ari chinhu chinokosha pakuvhara ropa.
Kuparara kweimwe yemasero aya kunogona kutungamirira kune kuitika kwezviratidzo, kazhinji zvisingaiti uye zvakaoma kuongorora. Mienzaniso inosanganisira:
- Kushayikwa kwemasero matsvuku eropa kunogona kuwedzera mungozi yehutachiona husingazoperi. Izvi zvinosanganisira zviratidzo zvine chokuita nekushayikwa kweeukocytes (leukopenia) kana neutrophils ( neutropenia ).
- Kushayikwa kwemasero matsvuku eropa kunogona kutungamirira kune hoemia iyo inogona kuratidza nezviratidzo zvekuneta, kupera, kuperevedza kwepfupa, misoro, dutu, uye kushaya simba.
- Kushayikwa kweplatelets kunogona kutungamirira ku thrombocytopenia uye kukura kweropa rinopa ropa, kunyanya kuputika kana kubuda ropa, kana kugara kakawanda kana kwakanyanya nosebleeds.
Gare gare Chiratidzo Chiratidzo
Sezvo chirwere chacho chichifambira mberi, zvimwe, zviratidzo zvinotaurira zvinogona kuwedzera kukura. Sezvo masero eukemia ari makuru pane masero evanhu vemazuva ese akachena, anowanzobatanidzwa mune zviduku zviduku zvehurongwa hwekufamba kana kuti kuunganidza nhengo dzakasiyana dzomuviri.
Zvichienderana nekuti kuvharwa kunowanikwa kupi, munhu angawana:
- Chloromas , yakasimba misero yemasero inogona kukura kuva, pamwe chete, muto-wakafanana nehunze huri kunze kwefupa remafupa, ruvara-rwakafanana, kana kubuda ropa kunorwadza nekuputika kwemasamu
- Leukostasis , chirwere chinokurumidzira mune zvehutano umo kuvhara kunogona kutungamirira kune zviratidzo zvakafanana nesitiroko
- Sweet's syndrome , rinorwadza ganda rinosuruvara rinowanzoonekwa pamusoro pezvombo, musoro, makumbo, uye trunk
- Izwi rakadzika rinonzi vein thrombosis (DVT) iyo inenge yakavharwa mutezo, kazhinji mumugumbo
- Pulmonary embolism (PE) , kuvharwa kwetari mumapapu
- Kuvhara pamuviri kubviswa pamusana pekuunganidza kwemasero mu spleen nechiropa
- Meningeal leukemia inoratidzira nehutano hwepfungwa dzakadai semusoro, kusvetuka, maonero asina kunaka, kugunun'una, kunetseka kunetseka, uye kushaya simba kwemaziso
Pashoma zvishoma, AML inogona kukanganisa itsvo, lymph nodes, meso, kana testicles.
Zvinokonzera uye Zviitiko Zvengozi
Pane huwandu hwezvipingamupinyi zvinokonzerwa ne AML. Zvisinei, kuva nechimwe kana kunyange zvimwe zvezvikonzero izvi hazvireve kuti iwe uchawana chirwere chemuropa. Kusvika iye zvino, isu hatichikwanise kunzwisisa kuti nei mamwe masero achangoerekana achinja kenza apo vamwe vasingaiti.
Izvo zvatinoziva ndezvokuti kanzira inokonzerwa nehutachiona hwekodhi yekodhi inogona kuitika dzimwe nguva apo sero rinoparadzanisa. Tinotarisa kune izvi sechishanduko. Nepo huwandu huzhinji hwekuchinja hunoita kuti uwane kenza, pane dzimwe nguva apo kukanganisa kuchangoerekana "kuvhara" chimwe chinhu chinonzi chirwere chekunyaradza gene chinotaridzira kuti nguva yakareba sei. Kana izvi zvikaitika, imwe sero isina kukwana inogona kuerekana ichinyora kunze kwekutonga.
Pane huwandu hwezvipingamupinyi zvinosanganiswa neizvi:
- Kusvuta
- Occupational kudzvinyirira makemikari, kunyanya ku benzene
- Mamwe kenza chemotherapy madawa anosanganisira cyclophosphamide , mechlorethamine, procarbazine, chlorambucil, melphalan, busulfan, carmustine, cisplatin, uye carboplatin
- Kuvhiringidzwa kwemazizi makuru, akadai nekenza radiotherapy
- Kuva nechirwere chisingaperi chine ropa chakadai se myeloproliferative chirwere (MPS) kana myelodysplastic syndromes (MDS)
- Kuva nehutano hwepabonde hwakafanana neArt syndrome , Fanconi anemia , uye neurofibromatosis rwiyo 1
Nokuda kwezvikonzero zvisingazivikanwi, varume 67 kubva muzana vanogona kuwana AML kupfuura vakadzi.
Kuziva
Kana AML ichifungidzirwa, kuongororwa kunowanzotanga nekuongorora kwepanyama nekudzokorora nhoroondo yezvokurapa uye yemhuri. Munguva yekuongorora, chiremba achabhadhara zvakanyanya zviratidzo zvakanyanyisa kupwanya, kubuda ropa, utachiona, kana humwe upi zvake hwemaziso, muromo, chiropa, spleen, kana lymph nodes. Ropa rakazara rinokonzerwa neropa (CBC) richaitwawo kuti rione chero kusakanganiswa kwekugadzirwa kweropa.
Kubva pane izvi zvakawanikwa, chiremba anogona kurayira mimwe miedzo yekusimbisa kuongororwa. Izvi zvinogona kusanganisira:
- Tora marora kushuva umo masero emasafu emapfupa akabudiswa nokuisa nheyo refu mufupa, kazhinji kakomberedza chiuno
- Bhuna marora rinoputira umo ine nhoyo huru inowanikwa mukati mefupa kuti ibudise masero
- Lumbar kuputika (mumutsara wepombi) umo kamutsana kadiki kakaiswa pakati pemapfupa o muromo wepasinini kubvisa cerebrospinal fluid (CSF )
- Kufungidzira miedzo yakadai seX-ray, ultrasound, kana kuti computed tomography (CT ) scan
- Peripheral blood smear umo ropa rinoongororwa pasi pe microscope, kazhinji nedhayi dzinosimbisa chete masero eukemia asi kubatsira kusiyanisa pakati pe AML uye ALL
- Purogiramu yerometetry umo mapurotete anodzivirira, anonzi AML antibodies, anowanikwa muropa kana CSF sampimo kusimbisa kuvapo kwe AML masero
- Cytogenetics umo masero eukemia "anokura" mubasa racho ndokuzoongororwa pasi pe electron microscope kuti aone kushanduka kwakasiyana-siyana nemaitiro avo echromosomal
Staging
Kanzura inogadziriswa inoitwa kuti inzwisise kuti kanaya yakapararira sei. Izvi, zvakare, zvinobatsira chiremba kutsanangura nzira yakakodzera yekurapa kuitira kuti munhu wacho arege kupfigirwa kana kuputirwa. Nharaunda yacho inobatsirawo kufanotaura kuti munhu angararama kwenguva yakadini mushure mekurapa.
Nokuti AML haina kusanganisira kuumbwa kwechirwere chinouraya chinoratidzwa mune dzimwe mhando dzekenza, haigoni kuve yakarongedzwa neklasi yeTMM (tumarara / lymph node / malignancy ) methodology.
Kune maitiro maviri akasiyana akashandiswa pakureba AML: French-American-British (FAB) kuenzanisa kweAmL uye World Health Organization (WHO) chikamu che AML.
FAB Chikwangwani
Chirongwa cheFrench-American-British (FAB) chakagadzirwa mumakore ekuma1970 uye zvikamu zvechirwere chirwere chinobva mumhando uye kukura kwekamuri rakakanganiswa.
Chikonzero chekutsvaga chiri nyore: AML inowanzoenderana nemuenzaniso umo myeloblasts isina kuchena ndiyo yekutanga masero ekugadziriswa. Sezvo chirwere chacho chichifambira mberi, chinotanga kukanganisa myeloblasts muzvikamu zvishoma zvekutsvaira uye zvinozofambira mberi kumasero matsvuku eropa (zvakadai se monocytes uye eosinophils) vasati vadzokera kumasero matsvuku eropa (erythrocytes) uye pakupedzisira megakaryoblasts (immature platelet cells).
Izvi zvinopa hutachiona ruzivo rwunoda kuziva kuti chiremba chiri nani sei.
FAB kugovera mabheji kubva kuM0 (kwekutanga AML) kuenda kuM7 (yepamusoro AML) nenzira inotevera:
- M0: zvisinafferentiated acute myeloblastic leukemia
- M1: achirwere myeloblastic leukemia nekunyorera kusakwana
- M2: achirwere myeloblastic leukemia nekukura
- M3: acute promyelocytic leukemia
- M4: aine myelomonocytic leukemia
- M4 eos: yakawanda myelomonocytic yeukemia ine eosinophilia
- M5: aine monocytic leukemia
- M6: yakaoma erythrocytic leukemia
- M7: achirwa megakaryoblastic leukemia
WHO Classification
IWorld Health Organization yakagadzira nzira itsva yekugadzirisa AML muna 2008. Kusiyana neFAB system, sangano re WHO rinotarisa zvakasiyana-siyana zvromosomal mutations zvakawanikwa panguva yekuongorora kwechitogenetic. Icho chinowedzerawo mune zvehutano zvinogona kuvandudza kana kuwedzeredza maonero (kufungidzira) kweavo vanobatwa.
Nzira ye WHO inowedzera simba pakuongorora kwayo chirwere ichi uye inogona kuparadzaniswa zvakaperera sezvinotevera:
- AML nemakadzo anowanzoita maitiro (zvinoreva zvakananga, unhu hunoshanduka hupenyu)
- AML ine myelodysplasia-yakasiyana-siyana (zvinoreva kuvapo kweMDC, MDP, kana zvimwe zvinetso zvemyeloblastic)
- Myeloid-related myeloid neoplasms (zvinoreva zvakabatana nechipatro chemotherapi kana remishonga inonzi radiation)
- Myeloid sarcoma (zvinoreva AML pamwe chete nekloroma)
- Kuwedzerwa kweMyeloid kwakabatana neA Down syndrome
- Blastic plasmacytoid dendritic cell neoplasm (hutsinye hutsinye hwekenza inozivikanwa nemakumbo eganda)
- AML haisi iyo yakasarudzwa (inonyanya kushandiswa kwemavara manomwe eFAB system nezvimwe zvirwere zviviri zvezvirwere)
Kurapa
Kana ukaongororwa neAAML, chimiro uye nguva yehutano ichave yakagadziriswa nechigarire chekenza uye hutano huripo hwomunhu oga.
Kazhinji kutaura, kurapa kunotanga ne chemotherapy. Izvi zvinogona kusanganisira zvizvarwa zvekare zvekare zvinodhaka zvinogona kukanganisa masero anokonzera uye asingasviki uye chizvarwa chitsva chinotarisirwa nemishonga iyo zero mune makero ekenza chete.
Izwi rinonzi chemotherapy regimen rinotumidzwa se "7 + 3" nokuti chemotherapy inodanwa se cytarabine inopiwa sechirwere chinoramba chichiwedzera (IV) kwemazuva manomwe chichiteverwa nemazuva matatu akatevedzana emumwe mushonga unonzi anthracycline . Kusvika makumi manomwe kubva muzana yevanhu vane AML vachawana kuregererwa kutevera "7 + 3" "therapy."
Nezvo zvataurwa, nhamba shomanana yemasero eukemia angangoramba ari kutevera chemotherapy, zvichiita kuti vadzokezve muzviitiko zvakawanda. Kuti urege izvi, vanachiremba vacharamba vachirapa kurapwa kunoenderana nemigumisiro yemunhu pashure pekurapa uye noutano hwehutano.
Muvanhu vane zviratidzo zvakanaka zvekuongororwa, kurapwa kunogona kungosanganisira zvidzidzo zvitatu kusvika kune zvishanu zvemakemikari yakasimba, inonzi yakasimbiswa chemotherapy.
Kune avo vari pangozi yakakura yekudzokazve, zvimwe, zvirwere zvinotyisa zvinogona kudiwa zvinosanganisira stem cell transplant kana mupiki anogona kuwanikwa. Zvishoma nezvishoma, kuvhiyiwa kana kurapwa kwemaawa kunogona kukurudzirwa.
Nemhaka yokuti AML chemotherapy inotungamirira kukurwisa kwakanyanya kwekudzivirira muviri, varwere vakwegura vangave vasingakwanisi kubvumira kurapwa uye vanogona kupiwa zvishoma kuderera chemo kana kutarisira kurapa .
Kupona
Mafungiro omurume akawana chirwere che AML chinogona kusiyana zvikuru kubva pachigamba chekenza panguva yekuongororwa. Asi, pane zvimwe zvinhu zvinogonawo kufanotaura zvingangoitika. Pakati pavo:
- Vanhu vanowanikwa vane MDS uye MPD vane nguva yokupona kubva pamwedzi mipfumbamwe kusvika ku11.8 makore zvichienderana nekuoma kwechirwere.
- Zvimwe chromosomal mutations zvakagadziriswa ne cytogenetics zvinogona kutungamirira kumakore mashanu ekupukunyuka kwehuwandu hwehutsika hwakaderera se 15 muzana kune yakakwirira se70 muzana.
- Vanhu vanopfuura makumi matanhatu avo vakasimudza maruva e- lactate dehydrogenase (kuratidza kukanganisa kwakakura kwemashu) zvinowanzova nemigumisiro yakaipa.
Kakawanda, chirongwa chepurasi chirwere che AML chiri pakati pe20 muzana uye 45 muzana. Kusimudzirwa kuregererwa kwemari kunowanzove yakakwirira kune vanhu vaduku vanogona kukwanisa kutsungirira kurapwa.
Shoko Rinobva
Kana wakamboonekwa kuti une AML, iwe uchasangana nematambudziko emagariro uye emuviri angave akaoma kukurira. Usaenda uri woga. Mikana yako yekubudirira ichave yakanyatsovandudzwa kana iwe ukavaka rutivi rutsigiro rwunoumbwa nevadikanwa, vashandi vezvehutano, uye vamwe vakambopfuura kana kuti vari kurwara nekenza mishonga.
Kunyangwe mushure mokunge maitwa kurapwa, kutya kwekudzokazve kunogona kugara kwenguva yakareba kwemwedzi kana kunyange makore. Nekutsigirwa, iwe pakupedzisira uchakurira zvinetso izvi uye udzidze kutarisa utano hwako nekugara kwachiremba kushanyira. Kazhinji kutaura, kana kudzokazve kusina kumboitika mukati memakore mashomanana, hazvigone kuti AML ichadzoka zvakare.
Kunyange zvazvo pasina chinhu chaunogona kutora kuti urege kudzokerazve, mararamiro ane hutano anogona kunyatsovandudza maitiro ako. Izvi zvinosanganisira kugovera tsika dzakanaka dzokudya, kudzidzira nguva dzose, kurega kusvuta, nekuwana zororo zvakawanda kuti usanyanya kunetseka uye kuneta.
Pakuguma, zvakakosha kutora zvinhu rimwe zuva panguva uye kuva nemumwe munhu waunokwanisa kutendeukira kana iwe unombove uchida kutsigirwa.
> Sources:
> America Cancer Society. "Kuponesa Nhamba dzeMyelodysplastic Syndromes." Washington, DC; yakarongedzwa naJanuary 22, 2018.
> De Kouchenovsky, I. naAbdul Hay, M. "Chirwere chinokonzerwa neukemia: kubvunzurudzwa kwakazara uye 2016 kushandurwa." Ropa Can J. 2016; 6; e441.
> Döhner, H .; Weisdorf, D .; uye Bloomfield, C. "Acute Myeloid Leukemia." New Engl J Med . 2015; 373 (12): 1136-52. DOI: 10.1056 / NEJMra1406184.