Miedzo inoshandiswa kuongororwa nekemukari inophageal inogona kusanganisira chirume che barium, endoscopy, uye endoscopic ultrasound, uye inowanzorairwa kuvanhu vane dambudziko rokumedza, kuramba vachikanganiswa, kana kuti zvipingamupinyi zvechirwere chakadai sekugara kwenguva yakareba acid reflux. Mamwe maitiro uye maitiro ekufungidzira akadai seTCT, PET, uye bronchoscopy zvinogona kubatsira mukugadzirisa danho rechirwere.
Kunyatsotarisa, zvakare, kunoda kuitira kuti usarudze nzira dzakanakisisa dzokurapa.
Labs uye Miedzo
Hapano pamba-kuedzwa kwemusha kwekenza yekusaphageal. Zvinobatsira kuziva zvose zviri zviviri zvinokonzerwa nechirwere uye zviratidzo zvinogona kuchenesa uye zviratidzo zvekenza yekushaya simba , kuitira kuti iwe ugone kusangana newachiremba wako uye kutsvaka kuongororwa kwakanaka kwezvesayenzi, kana zvichidikanwa.
Dhiyabhorosi miedzo haisati yakananga nekenza yepayedal, asi inoshandiswa pamwe chete nekufungidzira, kunyatsoongorora zvemhuri uye nhoroondo yehutano hwehupenyu, uye kuongorora mumuviri kuti uongorore chirwere chacho. Ropa rakazara rega (CBC) rinogona kuratidza uchapupu hwehutachiwana hwehutachiona (hutsika hwemasero matsvuku emuropa) kana kenza ichibuda ropa. Chiropa basa chekuita zvinogona kunge zvakakwirira kana kenza yakapararira kuchiropa.
Maitiro
Nzira dzakakosha zvikuru pakuita kuti kuongororwa kwekenza yemajoka uye kunosanganisira:
Endoscopy
Endoscopy yepamusoro (esophagoscopy kana esophagus-gastric-duodenoscopy) ndiyo nzira inonyanya kuongorora yekuongorora kemukari nhasi.
Mune nzira iyi, chimiro chinoshandiswa, chinopenya chinowanikwa mumuromo uye pasi kuburikidza nesophagus. Iyo tube ine kamera pamagumo iyo inobvumira vanachiremba kuti vaone zvakajeka kubatana kwepopu. Kana kusakanganiswa kuchionekwa, bhiopsy inogona kuitwa panguva imwe chete.
Pamberi penzira yacho, vanhu vanopiwa kugadzirisa kunokonzera kurara, uye nzira inowanzochengetedzwa zvakanaka.
Endoscopic Ultrasound (EUS)
Iyi ndiyo nzira inoitwa kuti iwane imaging inobatsira. Munguva yemagariro ekupedzisira endoscopy, shanduro ye ultrasound pamugumo wehuwandu inoshandiswa kukonzera simba-guru remhepo inoputika kubva mukati memaviri emukati. Izvo zvinokwana zvinoumba sonogram, mufananidzo weavo tishu. EUS inonyanya kubatsira pakugadzirisa nekudzika kwemarara, iyo inonyanya kukosha pakutsvaga. Izvo zvinobatsirawo pakuongorora nhengo dzeropa dzinoswedera pedyo uye kutungamirira biopsies chero zvipi zvisiri izvo. Zvimwe zviitiko zvekufungidzira zvinogonawo kufungidzirwa (ona pasi apa), kunyange ichi ndicho chakanyanya kuparadza.
Biopsy
Bhiopsy inowanzotorwa munguva yekupedzisira, asi inogona kuitwawo ne-bronchoscopy kana thoracoscopy. Vanachipatara vanotarisa hutachiona pasi pe microscope kuti vaone kana mhuka yacho ine kenza uye, kana zvakadaro, ingave squamous cell carcinoma kana adenocarcinoma. Muenzaniso wacho unopiwawo chikwata chebundu, nhamba inotsanangura kusuruvara kwechiremara chinowoneka.
Mimwe miviri yechirwere inogona kuitwa iyo inotarisa ma molecular maitiro echiremera, chakadai seHER2 chimiro (sekuita mazamu emukomana anokwanisa kuva HER2 akanaka , kenza yemasikirwo anogona kunge ari HER2 akanaka).
Bronchoscopy
A bronchoscopy inowanzoitwa nokuda kwezvipembenene zvisingagoni kuwanikwa zviri pakati nepakati chetatu chesophagus.
Braconchoscope (tsvuku, yakanyungudutswa tube) inowanikwa mumhino kana mumuromo mumatchea (iyo tube inobatanidza muromo nemapapu) uye bronchi (iyo huru mhepo) yemapapu. Iyo nzira inobvumira chiremba kuti anonyatsocherechedza chero kusakosha kwezvinhu izvi uye kuunganidza zvigunwe zvemuviri wavo (biopsy) kana zviripo.
Bronchoscopy iri kuitwa pasi pekudzivirira, kazhinji sechirongwa chekubuda kunze.
Thoracoscopy
Munguva ye thoracoscopy, kusungurudzwa kana kutemwa kunoitwa pakati pembabvu mbiri uye thoracoscope, iyo ine tsvuku, inopenya, inoiswa mubhokisi. Vanachiremba vanoshandisa izvi kutarisa nhengo dziri mukati mebhokisi uye chengetedza nzvimbo dzisina kukwana dzekenza.
Zvinyorwa zvemasumbu uye lymph nodes zvinogona kubviswa nokuda kwebiopsy. Mune zvimwe zviitiko, nzira iyi inogona kushandiswa kubvisa zvikamu zveeophagus kana mapapu.
Laparoscopy
Mune laparoscopy, zviduku zviduku kana zvigurwa zvinogadzirwa murusvingo rwemuviri. A laparoscope, imwe imwe tsvuku, yakajeka, inoiswa mumuviri kuburikidza nechimwe chezvinhu zvinotaridzika kutarisa nhengo mukati memimba uye kutarisa zviratidzo zvezvirwere. Zvimwe zviridzwa zvinogona kuiswa kuburikidza nemamwechete kana zvimwe zvakasarudzwa kuti zviite zvakadai sokubvisa nhengo kana kutora zviduku zvemuviri zvebiopsy.
Laryngoscopy
Chinhu chiduku chinotungidzirwa chinosungirirwa pasi pasi pomutsipa kuti utarise larynx kana izwi bhokisi. Uyu muedzo unogona kuona hupi hupi uchapupu hwokupararira kwekenza kumarara kana pharynx (throat).
Imaging
Kuenzanisa miedzo kunogona kuitwa pakutanga sechikamu chekuongorora kurapwa kwekenza yemajoka, asi zvinowanzoitwa pakugadzira kenza yakawanikwa. Miedzo inogona kuitwa inosanganisira:
Barium Swallow
Chiyero chekutanga chakaitwa kuti chiongorore chinogona kuve nekenza yenguva yakawanda inowanzova inguyo yeBabum kana yepamusoro endoscopy, kunyange zvazvo kuenderera mberi kune endoscopy kunoshandiswa kana kenza yekusophageal inofungidzirwa.
Mune chirume chinonzi Barium (iyo inonziwo yakakwirira yeGI series), munhu anonwa mvura yakajeka ine bhayoum uye anoteerera ma-X-rays. Iyo bharum inotenderera inophagus uye mudumbu, zvichibvumira radiologist kuti aone kusakanganiswa mumadziro ehupenyu pamifananidzo yakatorwa.
Chimiro chinonzi barium chinogona kubatsira mukuongorora zvirwere (zvisikwa zvitsvuku mukati memaoko), asi zvinoshandiswa zvishoma kupfuura munguva yakapfuura nokuti biopsy haigoni kuitwa panguva imwe chete.
CT Scan
A CT scan (computerized tomography) anoshandisa chikamu chemuchinjikwa we X-rays kuti aite 3D image yemukati. Nekenza yekusaphageal, muedzo hauwanzoshandiswa sechikamu chekuongororwa, asi zvinokosha mukugadzira chirwere ichi. CT inonyanya kunaka pakutsvaga uchapupu hwehupi hunopararira ( metastasis ) yechiremera kune lymph nodes kana dzimwe nzvimbo dzomuviri, dzakadai semapapu kana chiropa.
PET Scan
PET kuongorora kunobatsira chaizvo pakutsvaka uchapupu hwekupararira nehupachiona chekushaya simba. PET scan inopesana nedzimwe dzidzo dzekufungidzira munazvo dzinoshandisa basa rekuita zvemagetsi munharaunda yemuviri. Chimwe cheshuga inokonzerwa neRacactive injected into bloodstream uye inobvumirwa nguva yekutorwa nemasero. Maseji ayo anoshanda zvakanyanya, akadai sekenza masero, anoratidza kujeka kudarika nzvimbo dzisinganyanyi kushandiswa kwemagetsi.
X-Ray
Mukuwedzera kune miedzo iri pamusoro apa yekuongorora uye yekugadzirisa chirwere chepachirwere chepakati, chirwere che X-ray chekutsvaga kupararira kumapapu chinogona kuitwa.
Kusiyanisa Kuongorora
Pane huwandu hwemamiriro ezvinhu angaita kuti zviratidzo zvakafanana neyekushaya chepaygeal, zvakadai sekuoma kuedza. Zvimwe zvezvi zvinosanganisira:
- Esophageal stricture : Chidimbu chikafu mutsvuku chinowanikwa mumusango unokonzera kuderedza. Inowanzoitika nekuda kwekutambudzika, somuenzaniso, nekuda kwezvinetso zvekupedzisira kwemasimba evhapic (varicose veins of the epopu often associated with alcohol), mushure mekunge munhu ave neruzhinji rweganda ( NG tube ) panzvimbo yakareba kwenguva yakareba , kana nekuda kwekukurumidza kusanganisa kwekuchenesa semucheche.
- Kenza yemukondomu (kenza yemukaka): Cancers mudumbu inogona kukonzera zviratidzo zvakafanana neyekushaya chepaygeal.
- Bhenign esophageal tumors (yakadai seesophageal leiomyoma): Zviremara zvakawanda zvepamu (inenge 99 peresenti) zvinokonzera kenza. Zvinotyisa zvinogona, zvisinei, zvinoitika, uye ruzhinji rweiyi ndeyeiiomyomas.
- Achalasia : Achalasia isingawanzoitiki iyo maitiro ezvinyorwa pakati pepasi nechepamuch (pasi re esophageal sphincter) hazviregi zvakanaka, zvichiita kuti zvive nyore kuti zvokudya zvipfuure kubva mudumbu kusvika mudumbu.
Staging
Kusarudza nzvimbo yekenza kunokosha mukusarudza nzira dzakanakisisa dzokurapa, kusanganisira kusarudza kana kusambovhiya iko kusarudza. Kubatanidzwa kwezvifananidzo zvekufungidzira nemigumisiro yebiopsy zvinowanzoshandiswa kusarudza danho.
Vanachiremba vanoshandisa nzira yeTMM yokugadzirisa kuisa tumoropu. Iyi nzira inoshandiswa kune dzimwe kenza pamwe chete. Nekenza yekusaphageal, zvisinei, vanachiremba vanowedzera tsamba yakawedzerwa kune chinyorwa-G-kuverengera chechirwere chemaitiro. Izvo zvakananga zvekutema zvakaoma, asi kudzidza pamusoro pavo kunogona kukubatsira kuti unzwisise zviri nani chirwere chako.
T inomirira tumarara: Nhamba ye T inobva pakudzika mukati mechidzitiro chesophagus tumarara inowedzera. Iko mukati-kati (yakapedzisira kune zvokudya zvinopfuura nepamuviri) ndiyo lamina propria. Mimwe miviri miviri inotevera inozivikanwa se submucosa. Kunze kweiyo inonzi lamina propria, uye pakupedzisira iyo adventitia, yakadzika yakadzika yechipupuriro.
- Tis: Izvi zvinomirira carcinoma in situ, tumorori inosanganisira chete yakatsetseka masero mumasophagus.
- T1: Chirwere ichi chinopfuurira nemamina propria uye submucosa.
- T2: Tsvina yakapararira kune lamina propria, asi haina kupindira kuburikidza nemisungo yepopu.
- T3: Chirwere chakapararira kune adventitia. Iko ikozvino yakapinda munzira yose kuburikidza nemisumbu iri kupinda mukati maviri.
- T4: T4a zvinoreva kuti tumarara yakapararira mberi kwehutano kubatanidza zvivako zvakadai se pleura (girafu yemapapu), pericardium (rwonzi rwemwoyo), mutsara weayeza, chidimbu , uye peritoneum (chidzitiro chemuviri ). T4b zvinoreva kuti tumarara yakapararira kune aorta, vertebrae, kana trachea .
Nini inomirira lymph nodes:
- N0: Hapana lymph nodes inobatanidzwa.
- N1: Chirwere ichi chakapararira kune 1 kana 2 pedyo (nharaunda) lymph nodes.
- N2: Chirwere ichi chakapararira kusvika kune 3 kusvika ku 6 nhengo dzenzou dziri pedyo.
- N3: Chirwere chakapararira kune 7 kana kupfuura.
M inomirira masastasis (kupararira kure) kwekenza:
- M0: Metastases haisipo.
- M1 : Metastases aripo.
G inomirira gorosi:
- G1: Masero anotarisa semasero akajairika (zvakanyatsosiyaniswa).
- G2: Masero anotarisa zvisiyana zvishoma pane masero mashoma (mamwe akasiyana)
- G3 : Masero anotarisa zvakasiyana nemasero ane hutano (asingatauriki zvakasiyana).
- G4: Masero haataridzi chinhu semasero ane utano hwakanaka uye hazvibviri kutaurira chinhengo chavakatanga (zvisinafferentiated).
Uchishandisa zvigumisiro zveTMM neG kumusoro, oncologists zvino inopa danho .
Nhanho 0: Chirwere chinowanikwa mukati memukatikati memasero akavhara sophagus (Tis, N0, M0). Izvi zvinozivikanwawo secarcinoma in situ .
Chikamu I: Chikamu ichi chinogona kuputsika kusvika muchengeti IA uye IB.
- Nhanho IA: Chirwere chinosanganisira kungova mukati-kati meshonga (T1, N0, M0, G1).
- Chikamu IB: Kune mamiriro maviri maitiro umo chirwere chinogona kuva danho IB. Imwe yakafanana nesiteji IA, kunze kwekuti masero anenge achioneka asingaoneki (T1, N0, M0, G2 kusvika kuG3). Mune rimwe divi, tumarara iri mudenga rezasi uye yakapararira mberi kwepakati pekutanga kwezvisikwa (T2 kana T3, N0, M0, G1).
Nhanho II: Maererano nekenza kuti kenza yakapararira, chirwere chechipiri chekushaiwa kwekenza chinopatsanurwa kuva danho reIIA nechitambo IIB.
- Nhanho IIA: Pane mamiriro maviri ezvinyorwa zvinosanganisira chirongwa cheIIA. Dumbu racho rinogona kusanganisira chikamu chepamusoro kana chepakati chesophagus uye kuva T2 kana T3 uye G1 (asi N0 uye M0), kana bundu racho rinogona kusanganisira chikamu chezasi chesophagus uye kuva T2 kana T3 uye G2 kana G3, asi pane hapana uchapupu hwekuita lymph node kupinda kana metastases (N0, M0).
- Nhanho IIB: Muchitambo IIB panewo zvinhu zviviri zvinokosha. Mune imwe, chironda chinosanganisira chikamu chepamusoro kana chepakati chesophagus, asi kusiyana nechikamu cheIIA, masero haana kusiyaniswa zvakanyanya (G2 kana G3). Kana, kenza inongowanikwa mukati-kati (T1 kana T2) asi yakapararira kune rimwe kana maviri lymph nodes (N1). Iko hakuna maitiro.
Chikamu III: Pane zvikamu zvitatu zvechikamu chechitatu.
- Chikamu IIIA: Chikamu ichi chine mikana mitatu. Dumbu racho rinogona kusanganisira zvikamu zvemukati zvemasero uye zvitatu kusvika kumatanhatu lymph nodes (T1 kusvika T2, N2, M0, chero G). Zvimwe, chirwere chinogona kunge chakapararira kune chekunze chemashuga, asi chikamu chimwe chete kusvika kune zviviri zvinonzi lymph nodes (T3, N1, M0, chero G). Pakupedzisira, bundu racho ringave rakapararira kune zvisikwa zviri pedyo, asi hapana lymph nodes (T4a, N0, M0, chero G).
- Chikamu IIB: Kanzera yakapararira kune zvinyorwa zvekunze kweeophagus, pamwe chete nhatu kusvika kumatanhatu lymph nodes (T3, N2, M0, chero G).
- Chikamu IIIC: Pane zviitiko zvitatu zvechikamu ichi zvakare. Dumbu racho ringave rakapararira kune mishonga iri pedyo, asi lymph nodes matanhatu kana zvishoma (T4a, N1 kana N2, M0, chero G). Kana kuti, chirwere chacho chakapararira kune zvisikwa zviri pedyo zvakadai se-aorta, muviri wechechi, kana trachea, zvokuti haikwanise kubviswa nekuvhiyiwa (T4b, chero N, M0, chero G). Pakupedzisira, bundu racho rakapararira kune zvinomwe zvinopfurikidza, asi kwete kune nzvimbo dziri kure dzomuviri (chero T, N3, M0, chero G).
Nhanho IV: Chirwere chakapararira kune imwe nzvimbo iri kure yemuviri (chero T, chero ipi zvayo N, M1, chero G).
Kuongorora
Kanzira yekuongorora miedzo ndeye iyo inoitwa kune vanhu vasina zviratidzo zvehosha. (Kana zviratidzo zviripo, kuongororwa kunowanikwa.) Parizvino, hapana kuongorora kuongorora kwekenza yekushaya simba iyo inowanikwa kuvanhu vose.
Sezvo njodzi yekenza yekusaphageal yakakwirira kune vanhu vane chirwere cheBarrett, vamwe vanachiremba vakurudzira nguva nenguva kuongororwa ne endoscopy. Pfungwa iri shure kweiyo ndeyokuti kuwana dysplasia (masero asina kukwana), kunyanya kubata maitiro akaoma kare kare, inogona kubvumira kurapwa kubvisa masero asina kukwana munzvimbo yakatarisa.
Izvozvo zvakati, kusvika ikozvino, pane zvisinganyatsooneki kuti hakuna uchapupu hwokuti kuongorora uku kunoita kuti kuderedza kufa kwechirwere kubva kune kenza yemajoka. Panguva imwecheteyo, kuongorora kunogona kukuvadza, zvakadai sokubuda ropa, kusangana kwepfungwa, kana zvimwe zvinetso. Pane tariro yokuti ramangwana richaunza huchapupu huchabatsira kuziva kana kuongorora vanhu vane ngozi yakawanda kunofanirwa.
> Sources:
> American Society of Clinical Oncology. Esophageal Cancer: Kuziva. Updated 12/2016.
> Bast, R., Croce, C., Hait, W. et al. Holland-Free Cancer Medicine. Wiley Blackwell, 2017.
> National Cancer Institute. Esophageal Cancer Screening (PDQ) -Health Professional Version. Updated 04/06/18.
> Rice, T., Patil, D., Blackstone, E. et al. 8th Edition AJCC / UICC Kutarisa Kanzera dzeEsophagus uye Esophagogastric Junction: Kushanda kuKliniki Practice. Annals of Cardiothoracic Surgery . 2017. 6 (2): 119-130.