Urothelial carcinoma, iyo inowanzojairika yekenza yemukaka, yakabatana nekusvuta
Kunyange zvazvo kenza yemukomana isiri yomuti wekenza tinotaura pamusoro pezvakawanda, sekuti, kenza yemapapu, kenza yepazamu, kana kuti melanoma, ndeyechokwadi, kane kenza kanowanikwa muAmerica uye yepfumbamwe inonyanya kuwanikwa muAmerica vakadzi. Maererano nemashoko kubva kuCenters for Disease Control nekudzivirira, varume vanopfuura 55 000 nevakadzi 17 000 vanowana kenza yekemura muUnited States gore negore.
Pakati idzi, inenge 16 000-kupfuura imwe muzvina-ichafa nekuda kwekushaya marwadzo.
Rudzi rwakawanda kwazvo rwekenza yemukaka inonzi transitional cell carcinoma (TCC). Iyo inozivikanwawo se urothelial carcinoma (UCC), TCC inobuda kubva mukati mekamuri yemugwagwa unonzi, aptly, urothelium yemazuva ano.
TCC inogona kukura muzvivara kubva kune imwe nzvimbo iri pamutsamba, kusanganisira:
- Iyo sinal sinus (chivara mukati meitsvo)
- Iverere (iyo tubes inobatanidza itsvo kusvika kumusha)
- Icho chiri mukati-kati mutsara wechidimbu
- Irethra (iyo tube inobva mumuguta inodzingwa kubva mumuviri)
- Irohus (iyo yakasara ye fetal channel pakati pechikwata nehova)
TCC inoonekwa sechipiri chinowanzokonzera chirwere chepfungwa pachinosanganisira sinus renal.
Zviratidzo nezviratidzo
Zviratidzo zveTCC zvichasiyana nekusara kwemarara. Vanowanzowanzoita sezviratidzo zvehutano hwakakomba hwepimpowo umo munhu achabatwa nekurwadza kunorwadza uye kuderedza kuchera shure / kurwadziwa kwepvo.
Nemhaka yokuti chirwere chacho chinoshandisa zvimwe zvinokonzera zvinokonzera (kusanganisira cystitis , prostate chirwere, uye chikwata chisina simba), kuongororwa kunowanzoitwa kana kenza yakanyanyisa.
Panguva imwecheteyo, TCC inomhanya-mhanya inononoka uye ine latency nguva yepamwe kusvika pamakore 14.5, maererano neNational Cancer Institute.
Mune imwe yapakutanga, nzvimbo yekunonoka, zviratidzo zvinogona kunge zvisinganzwisisiki kuti hazvipo. Iro inowanzoitika chete apo kuora kwekufambisa kwave kuchipfuurira zvokuti mazhinji emashoko akawanda anooneka.
Izvi ndezvikonzero zvekuti 89 muzana yehuongorori hunoitwa mumarume makumi mashanu uye kupfuura. Pakati idzi, 20 muzana ichaonekwa kuti ine kenza yepamuti III, asi inenge imwe yechina ichave nechirwere chemasastatic (apo kenza yakapararira kune dzimwe nhengo dzomuviri).
Zvichienderana nechikamu chechirwere, zviratidzo zveTCC zvinogona kusanganisira:
- Visible ropa mumuguta ( gross hematuria )
- Kunorwadza kana kuoma kuoma ( dysuria )
- Kuramba uchidzoka
- Chikumbiro chakasimba chokuramba asi kusakwanisa kuita kudaro
- Huru rinorwadza kune rumwe rutivi rwemashure nechezasi pemabvu
- Kuneta
- Kuonda
- Kufirwa kwechido
- High fever ine sweating yakawanda
- Kudzora pasi kumativi ekupedzisira ( edema ), kazhinji muchechi-gare gare chirwere
Zvinokonzera uye Zviitiko Zvengozi
Vanhu vanowanzofunga kuti kenza yemukaka kana tsvina inokonzerwa nekusvibiswa nehupfu hwedu tinodya, pasinei nemvura yakasvibiswa kana makemikari mune zvokudya zvedu. Kune chikamu chikuru, izvi hazvisizvo. Nepo uturu hwakanyatsobatanidzwa nekukudziridza kweTCC, inowanzowanzo maitiro atinoshandisa kwenguva refu.
Mukuru pakati peiyi utsi hwefodya .
Zvechokwadi, inopfuura hafu yezvose TCC inowanikwa mune varume uye kupfuura chikamu chechitatu muvakadzi inosanganiswa nekurema kusvuta. Uyezve, njodzi uye danho rechirwere rinoonekwa zvakananga nehuwandu hwemakore munhu ari kusvuta uye zuva rega rekufuta.
Maererano nekutsvakurudza kunobva kuChemberero Sloane-Kettering Cancer Centre muNew York, kenza yekramha inoputira haisi yega yakawanda asi inowanzova yakawanda kupfuura inopisa.
Chinokonzera kushamwaridzana uku hachisi pachena zvachose, asi vamwe vanofunga kuti nguva yakareba yekusvuta fodya inokonzera chromosomal kuchinja mune epithelial tissue izvo zvinokonzera zvipembenene uye kanzira.
Ngozi inowanikwa kuva yakakwirira kune vanhu vanosvuta fodya kupfuura 15 pazuva.
Zvimwe zvinokonzera ngozi kune TCC dzinosanganisira:
- Zera rakwegura, rine inenge 90 muzana yezviitiko zvinowanikwa kune vanhu vanopfuura 55
- Kuva murume, zvichienderana nekushanda uyerogen (varumekadzi sex hormone) receptors inoita basa rinokosha pakuvandudzwa kweTCC
- Kuva wakachena, iwe unowedzera kaviri pangozi kana uchienzaniswa neAfrica America uye Latinos
- Mhuri genetics, zvikurukuru inosanganisira kuchinja kwechirwere ichi chinokonzerwa nechirwere cheCowden (PTEN gene), Lynch syndrome (HPNCC gene), kana retinoblastoma (RB1 gene)
- Kuwedzera muviri, kuwedzera kwengozi kubva 10 kusvika ku20 muzana
- Kunzvimbo yekushanda kune amine inonhuhwirira inoshandiswa mune dae uye mabhizimisi ekunyora uyewo mukugadzira raibha, ganda, pende, uye mavara
- Usati washandisa chemotherapy drug Cytoxan (cyclophosphamide)
- Kushandiswa kwemishonga yetshuga yeAictos (pioglitazone) kweinopfuura gore
- Kushandiswa kwemishonga yemishonga inosanganisira aristolochic acid (inozivikanwawo sePin Yin mumutauro weChina mushonga)
Kuziva
Kazhinji kutaura, chiratidzo chekutanga chekuongorora chirwere cheTCC chichava neropa mumugini. Dzimwe nguva hazvizooneki asi zvinogona kuonekwa nyore nyore mu urinalysis (urine test) .
Muti urtolo cytology inogona kushandiswawo kutarisa kenza masero mumuginho, kunyange ichi ichi chimiro chisina kuvimbika chekuongororwa. Kusiyana neizvi, inyanzvi itsva inogona kugadzirisa mapuroteni nemamwe zvinhu mumuguta unobatana neTCC. Izvi zvinosanganisira maitiro anozivikanwa anonzi Urovysion uye Immunocyt. Kune imomo yemuongorori wemuzinda unozivikanwa seBladderchek unogona kuona chipuroteni chinonzi NMP22 chinowanikwa panzvimbo dzakakwirira kune vanhu vane kenza yeropa.
Ikozvino yegoridhe yepamusoro yekuongororwa ndeye biopsy inowanikwa ne cystoscopy. Inonzi cystoscope ndeyeiyo yakareba inogadziriswa inogadziriswa ine micro-kamera iyo inopindirwa muchirwere ichi kuti uone bhiza. Bhiopsy inosanganisira kubviswa kwemashutu anonyunyuta kwekuongororwa nechiremba.
Zvichienderana nemhando ye cystoscope inoshandiswa, iyo nzira inogona kuitwa pasi pemunharaunda kana yeaneshesia. Hazvisi zvisingawanzoshandisi kushandisa aneshesia mukati mevarume sezvo nzira yacho inogona kuva inorwadza zvakapiwa sezvo mumiriri wemurume ari kure uye akapfupika kudarika vakadzi.
Cancer Kuronga
Kana kenza kuongororwa inogadzirwa, an oncologist achaisa kuipa kwechikwata. Chiremba achaita saizvozvo achishandisa chirongwa cheTM staging chinorondedzera ukuru hwechirwere chepakutanga ("T"), kupindira kwekenza kuine lymph nodes dziri pedyo ("N"), uye huwandu hwemasastasis ("M").
Chinangwa chekutsanangurira ndekutsanangura nzira yakakodzera yekuita nechinangwa chekusaiti kana kutora kenza. Kubva pane izvi zvakawanikwa, chiremba achagadzirisa chirwere ichi nenzira inotevera:
- Chikamu chechipiri ndechekuti kune uchapupu hwekudzivirira asi asiri nekodhi node yekubatanidza kana metastasis.
- Nhanho I inotsanangurwa nekupararira kwekenza kubva kune epithelial lining kusvika kune zvigunwe zvinobatanidza zviri pasi apa asi pasina lymph node kupinda kana metastasis.
- Nhanho II ndiyo apo kenza yakapararira kunyanya kumusana wepamusoro pasi asi hauna kupfuura napamadziro echikwata. Kunyange zvakadaro, hapana kuvepa lymph node kana metastasis inoonekwa.
- Nhanho yechitatu ndiyo apo kenza yakakura kupfuura yerinhiro asi haina kupararira kune lymph nodes iri pedyo.
- Nhanho IV ndiyo apo kenza inopararira kune nhengo dziri kure, inopararira kune lymph nodes iri pedo, kana maviri.
Nharaunda yacho inopawo chiremba uye mumwe munhu pfungwa yakanaka yekupona nguva. Aya mafananidzo haana kuiswa mumatombo, uye vamwe vanhu vane kenza yakakura vanogona kubudirira kuregererwa kwakakwana pasinei nehutachiona.
Nezvo zvichitaurirwa, kutanga kuongororwa kunenge nguva dzose inobatanidzwa nemigumisiro iri nani. Vanhu vanowanikwa vane shanho 0, nhanho I, kana shanho II TCC ine 90 muzana yemukana wekurapa. Avo vane chitubu chechitatu vane 50 muzana mukana. Kunyange avo vane kenza yemukana wechitanhatu vane 10 muzana uye 15 muzana mukana wekuregererwa kwakasimba, maererano neNational Cancer Society.
Treatment Approaches
Kurapa kweTCC kunonyanya kutarisana nechikamu chechirwere, chiyero icho kenza yakapararira, uye rudzi rwezvikamu zvakabatanidzwa. Mimwe yemishonga iyi isiri nyore uye yakakura kurapa mazinga. Mimwe yakawanda uye inogona kusanganisira zvose zvidzidzo uye zvidzidzo (yechipiri). Pakati pavo:
- Nhanho 0 uye ini matumire ayo asati asvika pamusana wechipfuva anowanzo "kuveurwa" nechokugadzirisa electrocautery yakagadzirirwa kusvika pakuguma kwe cystoscope. Iyi nzira inogona kuteverwa nekanguva kemikemikirasi. Immunotherapy treatments kushandisa chirwere chinonzi Bacillus Calmette-Guérin (BCG) chinogonawo kuderedza ngozi yekudzoka mune zviviri kubva mumatatu matatu.
- Chikamu II uye III kanzira zvinorema kubata . Vaizoda kubviswa kwakakura kwezvisikwa zvipi zvayo. Muchiitiko chechirwere, zvinogona kuda kuti chirongwa chinoparidzirwa sechirwere chinonzi cystectomy umo chishuvo chose chibviswa. Chikwangwani chechikamu chinokonzerwa chinyorwa chinogona kuitwa muchikamu chiduku chechigamba chechipiri II asi kwete nhanho III. Chemotherapy inogona kupiwa kana isati yambovhiyiwa kana mushure mekuvhiyiwa, zvichienderana zvichienderana nekukura kwechirwere. Mishonga inogonawo kushandiswa sehutachiona hweAdjuvant asi inenge isina kumboshandiswa payo pachayo.
- Matanho emakemikari emuchina akaoma kwazvo kubvisa. Chemotherapy kana kuti pasina mihizha inowanzoita mushonga wekutanga-chinangwa nechinangwa chokuderedza ukuru hwemakumbo. Muzviitiko zvakawanda, chirwere hachikwanise kubvisa kese yese asi inogona kushandiswa kana ichikwanisa kuwedzera hupenyu hwomunhu pamwe nehupenyu hwehupenyu .
Mishonga yeMishonga
Chimiro chemotherapi yemishonga yakadai se methotrexate , vinblastine, doxorubicin, uye cisplatin zvinowanzoshandiswa muhutano hubatanidzwa. Icho cytotoxic (zvinoreva chekisi kune masero mhenyu) uye inoshanda nekutsvaga zvakasimba-kudzokorora masero sekenza. Somugumisiro wechiito ichi, vanogonawo kuuraya masero ane utano anokurumidza-kudzokorora zvakadai mumapfupa emvere, bvudzi, uye mumatumbu maduku.
Zvizvarwa zvitsva zvinodhaka zvakadai seOpdivo (nivolumab) , Yervoy (ipilimumab), uye Tecentriq (atezolizumab) inoshanda zvakasiyana nekukurudzira maitiro ezvirwere zvekudzivirira zvirwere zvekenza. Izvo zvinonzi zvinonzi monoclonal antibodies zvinorohwa mumuviri uye dzinotsvaga masero emukenza, kusunga kwavari uye kuratidza mamwe masero ezvirwere zvekudzivirira.
Izvi zvinongororwa maitiro e immunotherapy zvinogona kuderedza mishonga uye kudzivirira kenza kuti irege kufambira mberi. Iyo inoshandiswa kunyanya kufambisa hupenyu hwevanhu vane hukuru, vasingakwanisi, kana tastc metastatic. Zvinowanzovhiringidzika zvinowanzoitwa nemishonga iyi yekudzivirira muviri inosanganisira:
- Kuneta
- Kupfupika kwemhepo
- Utano hwakakwana kana hutumbu
- Kuderedza kudya mwoyo
- Mapundu
- Diarrhea
- Kukosora
- Constipation
- Rash kana ruvara rweganda
- Nausea
Kubatana kweOpdivo neJervoy kwave kwakakurumbira mumakore achangopfuura mumatambudziko eTCC yakapfuura. Mishonga inopiwa mukati memaawa makumi matanhatu, kazhinji vhiki mbiri. Muyero uye huwandu hunoenderana zvikuru nemanzwisisiro ekuti kenza inopindura sei kurapwa uye kuoma kwemigumisiro.
Kudzivirira
Kudzivirira kweTCC kunotanga nezvinhu zvaunokwanisa kuzvidzora. Pakati idzi, fodya inoramba ichinyanya kukosha. Ichokwadi chiri nyore: kenza yemukaka ndiyo nhasi yechipiri inowanzobatwa nekusvuta-yakasangana nehupenzi shure kwekenza yemapapu. Kurega kwete chete kunoderedza ngozi yomunhu yeTCC asi kunogona kudzivirira kereke yekudzoka kune avo vanobudirira kubata.
Kusiya kunogona kuva kwakaoma uye kazhinji kunoda kuedza kakawanda, asi zvirongwa zvizhinji zvehushuwarisi nhasi zvinotakura zvimwe kana kuti zvose zvinodhura zvekusvuta kupedza mushonga.
Zvimwe zvinogadziriswa zvinogona kuitawo kuti kuderedzwa kwengozi. Chimwe chekudzidza kwemakore gumi pakubatanidza varume makumi maviri nemazana makumi mashanu vakawana kuti avo vanonwa 1.44 litre emvura (magirasi masere) zuva rimwe nerimwe vaine kamukira kenza yekramera kana vachienzanisa nevaya vanonwa zvishoma. Nepo zvichiripo zvakakosha zvisingakwanisi maererano nezvakawanikwa (zvichipiwa kuti zvimwe zvimwe zvinhu, zvakadai sokusvuta uye makore, hazvina kubatanidzwa), meta-analysis yakabuda muna 2012 yakaratidza kuti kudya kwechirwere kunopa rubatsiro runodzivirira, zvikurukuru kuvarume vaduku.
Kunyange zvazvo kunwa mvura chete hakugoni kuvhara migumisiro yekusvuta, inogadzirisa zvinobatsira zvekusarudzwa kwehupenyu hwehupenyu hunosanganisira yakakodzera hydration uye chirongwa chekureruka kwekureruka kana zvakanyanya.
> Sources:
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> Centres for Disease Control and Prevention. "" Chirwere chekanyara. " Atlanta, Georgia; yakarongedzwa naJune 6, 2017.
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