Bhiri isiri yakagadzirwa nechiropa uye yakachengetwa mu gallbladder. Bhiri inobatsira kuputsa mafuta anowanikwa mune zvokudya. Iyo duct duct inobatanidza gallbladder uye chiropa kumucheche muduku. Iyo duct duct inoshandiswa senzira yebheka kuti inopinda mumukomana muduku , uko bile inobatsira kugadzira zvokudya.
Bhiariary tract (kana biliary system) inoreva zvose zvinogadzira uye kuchengetedza bile, kusanganisira bile inobvisa mukati uye kunze kwechiropa uye gallbladder.
B bile inopinda mukati memuropa inonzi intrahepatic, uye bile inobvisa kunze kwechiropa inonzi inonzi extrahepatic.
Iyo miviri mikuru yekenza yebriary iri mukenza yemukenza (ie ie, cholangiocarcinoma) uye kenza yegolbladder. Kana akabatwa nekukurumidza, kenza yeguruva uye yekenza yekenza yekenza inogona kubudirira kurapwa nekubvisa zvivako izvi. Zvisinei, vanhu vakawanda vanouya nekenza iyi vanoita kudaro mushure mokunge marariya apararira, kana kuti kusvibiswa . Zvose izvi zvinokonzera zvinogona kukonzera chiropa, zvimwe zvikamu zvepamuviri, kana zvimwe zvikamu zvemuviri.
Ngatitarisei zvakanyanya nezvekenza yengarave yebhati.
Statistics
Maererano neAmerican Cancer Society, gore rega rega muUnited States, vanhu vanosvika 8000 vanoongororwa vane chirwere chinonzi bile duct chirwere. Iyi nhamba inosanganisira vanhu vanoongororwa vane intrahepatic bile duct chirwere uye extrahepatic bile duct chirwere. Uyezve, kunyange zvazvo chirwere chebhepidhi chinogona kukanganisa vanhu vaduku, mavhareji emakore ekuongororwa kwekenza inonzi intrahepatic ndeye 70 uye iyo yeexhepatic ndiyo 72.
Nzvimbo yekenza yehuro yekenza inogona kuiswa muimwe nzira nhatu:
- Kenza yeIntrahepatic : zvinokonzera mvere mukati mechiropa
- Kenza yeperihilar : pakati pemakumbo anenge ari muzinga wechiropa umo kurudyi uye kuruboshwe hepatic ducts vanobatana kuti vagadzire bile duct
- Kuparara kweBeng Duct Cancer : mishonga iri kure kure nechiropa mukati memucheto wezasi we bile duct
Zvirwere zveperihilar ndiyo inowanzosvibisa tumor-type-accounting kune anenge 65 muzana yebriary tract cancers. Izvozvo zvinowedzera makumi matatu muzana. Intuhepatic tumor is not the most common and account for about five percent of tumors.
Zvirwere zveperihilar zvinonziwo zvipembenene zvemukoko kana klatskin tumor. Perihilar uye distal bile marital cancers akabatanidzwa pamwe chete sevana vanonyangarika kanzira.
Makore mashanu ekupona ndeye metric yakawanda inoshandiswa navanachiremba kutsanangura chirwere chekenza kana kufungidzira. Kugara kwemakore mashanu kunoreva chiyero chevarwere vanorarama makore mashanu mushure mekunge vaongororwa. Mazuva mashanu ekupona kwemararamiro evanhu vane chirwere chendaneti akaparadzana nehuwandu hwekupararira kwekenza-nzvimbo, nzvimbo, kana kure-uye kana chirwere ichi chiri intrahepatic kana chechi.
Heanoi makore mashanu ehupenyu hwehupenyu hwemhando dzakasiyana dzekemukari inonzi intrahepatic inokonzerwa nedumbu rinopararira:
| Localized | 15% |
| Regional | 6% |
| Distant | 2% |
Heanoi aya emukenza wokuwedzera:
| Localized | 30% |
| Regional | 24% |
| Distant | 2% |
Risk Factors
Chinhu chinogona kuisa mungozi chinhu chipi zvacho chinowedzera ngozi yako yekenza. Mhando dzakasiyana dzekenza dzine maitiro akasiyana-siyana ematambudziko.
Kune zvirwere zvakasiyana zvechiropa zvinoshanda sezvipingamupinyi zvinokonzerwa nekenza ye-bile duct:
- Primary sclerosing cholangitis
- Cirrhosis
- Bile duct mabwe
- Choledochal cysts
- Hepatitis B
- Hepatitis C
- Ulcerative cholitis
- Chirwere cheCrohn
- Pancreatitis
- HIV utachiona
- Congenital anomalies ye pancreatic kana bile duct
- Polycystic chiropa chirwere
Heano zvimwe zvimwe zvipingamupinyi zvinokonzerwa nekenza ye-bile duct:
- Nhoroondo yemhuri
- Age akwegura
- Rudzi rwevanhu (semuenzaniso, veMasipanishe, vekuAmerica, uye veAsia)
- Kuwedzera muviri
- Chirwere cheshuga
- Kusvuta
- Pancreatitis
Ndapota ramba uchifunga kuti zvimwe zviitiko zvinopisa zvinogona kuchinja; asi, dzimwe dzisiri dzisingashanduki. Zvinogona kugadziriswa ngozi zvinogona kuchinjwa-unogona kuita chimwe chinhu kuti uchinje. Somuenzaniso, kuputa nekurema kunogona kushandiswa nokuti munhu anogona kumira kusvuta kana kurasikirwa nemutoro, maererano.
Uyezve, njodzi yehumwe zvirwere inogona kuchinjwa, zvakare. Semuenzaniso, kune chirwere chekushaya hepatitis B. Zvisingaitiki zvinokonzerwa nematambudziko, zvakadai semakore uye nhoroondo yemhuri, hazvigone kuchinjwa.
Kana iwe uchida kuderedza dambudziko rako rekenza nedzimwe zvirwere, tapota taurai izvi zvingasarudzwa nachiremba wako. Pane zvinhu zvakawanda zvaunogona kuita mukusimudzira mararamiro akanaka.
Zviratidzo nezviratidzo
Chirwere cheBiliary chepatri chinopa jaundice, ganda rinopisa (kureva, pruritis), uye kuora muviri. Apo murwere anopa izvi zviratidzo nezviratidzo, ropa rinokonzerwa nemakemikari uye kuongororwa kwemuviri zvinokonzerwa kutarisa mazinga akakwirira emamwe zvinhu muropa.
High mazinga e alkaline phosphatase uye bilirubin akaongororwa panguva yeropa chemistry test rinoratidza bile duct dysfunction. Uyezve, chirwere chemarara chinokonzera kukanganisa chinogona kukonzera kukwirira kwechirwere checarccerembryonic antigen (CEA), CA19-9, uye CA-125.
Kubva pane zvabuda kubva kuropa chemhemikari test uye mutsara wekuongorora zviratidzo, nyanzvi inogona kuronga bhidhiyo yeB bile duct kuti ione kana iri kenza. Nyuchi dzinoreva kubviswa kwechidimbu chezvinyorwa zvekuongorora kwake pasi pe microscope.
Kurapa
Mushure mekunge murwere aonekwa kuti ane kenza yemuviri webiliary, kufungidzira (zvakadai sa ultrasound neE ERCP) kunoitwa kutarisa danho, kana kupararira, kwechirwere uye kuderedza chiremera.
Kunyange zvazvo yakawanda yakawanda yakazara bile duct tumor is inoperable, hafu yezvinhu zvose distal bile duct tumors inogona kubviswa, kana kubviswa. Kuparara kwemakumbo, resection inosanganisira pancreaticoduodenectomy kana Whipple nzira. Iyo Whipple chirongwa chirongwa chakakura uye chinonyanya kuoma kuita izvi zvinosanganisira kubviswa kwe musoro wepascreas, gallbladder, bile duct uye duodenum, iyo ndiyo chikamu chokutanga chemukati mudumbu. The Whipple utano hunoitwa nekuvhiya oncologist.
Zvinosuruvarisa, kunyange kuvarwere vanozvitsvaga kugadziriswa uye vane bhiariary tract yakabviswa, makore mashanu ekupona kwemazana ari pasi: pakati pe20 ne25 muzana. Kune avo varwere vane kenza isingakwanisi, kupona kunogona kuyerwa mumavhiki kana mwedzi.
Nzvimbo inonyanya kunzwisisika yeB bile duct inoita kuti kuvhiyiwa kunetseke. Kuvhiya kunogumira kuburikidza nehutera zvakakura sei uye hukuru hwayo. Mishonga yakagadziriswa, kana kupararira, haigoni kushandiswa. Zvichienderana nemamiriro ezvinhu chaiwo eB bile duct tumor, mamwe mavhivhi anogona kuitwa zvinosanganisira:
- Partial hepatectomy (kureva, kubviswa kwechikamu chechiropa)
- Kugadziriswa kubviswa kweB bile duct
- Liver transplantation
Kurapa kwakagadziriswa kwekenza yemarariya yakadai sechemotherapy uye radiotherapy inopa zvishoma kubatsirwa. Zvisinei, radiotherapi inogona kushandiswa kuuraya masero emukenza anovhara bhati duct kana kushandura pamitsipa-chirwere chinopisa.
Chirwere chinopfurikidza chinoshandiswa kuti kuderedze kurwadziwa nekudzivirira kwezviratidzo zvekupedzisira kwechirwere. Mukuwedzera kune radiotherapi inopinza, pane dzimwe nzira dzakasiyana-siyana dzekunamatira.
- Mishonga yemishonga yakadai seypioid mishonga
- Kuiswa kwe stent biliary kana catheter kuchengetedza bile duct kuzaruka uye kutonga kwe jaundice
- Biliary inpass umo chiremba anovhiya anogadzira zvakapoteredza chiremera chinodzivirira bile duct
- Kushandiswa kwemuviri kunoshandisa kupisa uye simba remagetsi kuuraya masero emukenza
- Doro injini inouraya mitsipa inotora marwadzo mukati meB bile duct uye musikana muduku
- Photodynamic therapy inoshandisa mishonga inonzwisisika kune chiedza chemazwi chaiwo kuparadza kenza masero
Bhiriary Tract Cancer vs. Liver Cell Carcinoma
Kunyange zvazvo turakiti rebiariary rakanyatsobatanidzwa nechiropa, kanzira yebhuku rebhaariary yakasiyana zvikuru neyechiropa.
Sezvo zita racho rinoreva, chiropa che cell carcinomas chinobva pamasero eropa kana hepatocytes. Biriary tract cancers inomuka kubva kune epithelial masero ebazi rebhaariary uye inowanikwa adenocarcinomas. Adenocarcinomas inotaura nezvechirwere chinotyisa chinotangira epithelium glandular, kana masero anokonzera bile duct.
Isa mune mamwe mazwi, kunyange zvazvo bhiariary tract inotaridzika pedyo nechiropa, iyo yakagadzirwa nemasero akasiyana-siyana. Tumhesi inomuka kubva mumasero aya akasiyana.
> Sources:
> America Cancer Society. Chinonzi Chii Chirwere Chekenza? www.cancer.org
> American Society of Clinical Oncology. Cancer.Net. Bile Kubvisa Kanzera (Cholangiocarcinoma) Kutanga. www.cancer.net
> Carr BI. Tumha yeChiropa neBiliary Tree. Muna: Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 19e New York, NY: McGraw-Hill; 2014.
> Matheny SC, Long K, Roth J. Hepatobiliary Disorders. Mu: South-Paul JE, Matheny SC, Lewis EL. eds. KUCHENGA KUZIVA KUZIVA NOKUTAURWA: Mhuri Mhuri, 4e New York, NY: McGraw-Hill.