Kanzira mumapfupa kazhinji inokonzerwa nekupararira, kana metastasis, kubva kune imwe kenza isati yemafupa-bone metastases kubva mumukenza wemapapu kana kenza yemumuromo, somuenzaniso. Kutora sampu, kana biopsy , yenharaunda yakagadzikana yefupa haisi kungosiyanisa pakati pekenza yemapfupa uye metastasis kubva kune mamwe kanzira asiwo inobatsira kuziva rudzi rwakasiyana rwekenza yemapfupa.
Muchiziviso chekenza yemapfupa, iyo pfupa inoshandiswa-uye nzvimbo yechipfupa mukati mefupa-inogona kunge inokosha.
Osteosarcoma, chondrosarcoma, uye Ewing sarcoma ndevamwe vanowanzosangana nekenza yekenza. Zvisinei, kenza yemapfupa haisi kenza yakajairika, pane zvose: kanzira dzepakutanga dzemapfupa dzinoita zvishoma kudarika 0,2 muzana yevamwe kanzira.
Kudzika-Cheki / Pamba-Kuedzwa
Panguva ino, miedzo yepamusha yekuongororwa kwekenza yemapfupa haina kuumbwa. Uyezve, zviratidzo zvekutanga uye zviratidzo zvekenza yemapfupa zvinogona nyore nyore kuvhiringidzika kune mamwe mamiriro ezvinhu akajairika zvakadai sekukuvara kwemitambo, kana kuti pakutanga angangodaro anonzi muscular aches uye kurwadziwa.
Pakupedzisira, kazhinji kenza yemapfupa inoenda kurapwa nekuda kwezviratidzo uye zviratidzo zvinosanganisira kurwadziwa kwepfupa kunowedzera kuwedzerwa kwenguva. Marwadzo kubva kenza yemapfupa anowanzoipisisa usiku uye anowanzoperekedzwa nekuputika kwenharaunda.
Labs uye Miedzo
Kuongorora Panyama
Muzviitiko zvekenza yemapfupa, kuongororwa kwechiremba kunoitwa nachiremba kuchave kwakakosha kunze kwekuda kwe "mavara mashomanana" angave akanzwika panzvimbo yekutanga yekenza. Izvi zvinogona kuonekwa sezvinoitwa bundu, murwi, kana kupfugama zvichibuda kubva pfupa.
Ropa Rushanda
Kuongorora kwebhroreta, kana basa reropa , kunogona kubatsira, kunyange zvazvo kazhinji kusinganzwisisi kuongorora kumwe. Izvo zviyero zviviri zvebiomarkers kunyanya-alkaline phosphatase uye lactate dehydrogenase-zvakakwirira muhuwandu hwevarwere vane kenza yemapfupa. Zvisinei, mazinga aya haabatanisi zvakanyanya nehutachiona hunopararira sei mumuviri.
Biopsy
Muchiitiko chepfupa rinoputika, chiduku chiduku chechiremera chichabviswa uye kuongororwa pasi pekroscope. Zvinonzi kuvhiyiwa nyore, kunoitwa pasi pesarudzo yakawanda, uye iwe uchataurirwa kuburikidza nayo nguva isati yasvika uye panguva yekufamba. Icho chidimbu chicharatidza kana kenza dzemasero dziripo mufupa.
Imaging
X-ray
Kushungurudzika kweasteosarcoma kakawanda kunowanzobva pakuonekwa kwetsipa rakaputika pamifananidzo.
Osteosarcoma inogona kunge yakasiyana-siyana pamifananidzo yekufungidzira: thinned kana "kudyiwa" inoonekwa munzvimbo dzefupa inonzi inonzi lytic pattern. Zvimwewo, bone rinogona kuoneka rakaoma, sokunge rakasimbiswa nesimiti yakawedzerwa, uye izvi zvinonzi seyakashongedzwa. Kenza yemapfupa inogonawo kuumba mhando yakavhenganiswa (lytic-sclerotic) pamifananidzo.
Vanachiremba vanodzidza nezvenharaunda yakawanda yehuroal kana "sunburst" 'pattern ye osteosarcoma, iyo iyo mhuka inopoteredza inotarisa kuonekwa kwakaoma kwefupa mumhepo inopenya, spokes-kubva-the-hub, sunburst pattern; asi izvi zvisinganzwisisike kune osteosarcoma uye kwete ose osteosarcomas acharatidza muenzaniso iwoyo.
CT uye MRI
Kuvhiya kunowanzoratidzira mushonga, saka zvinova zvakakosha kuziva kuti osteosarcoma inobata sei mapfupa uye mapfupa akanyorova. Izvi zvinonyatsooneka nemagadzirirwo emagetsi ekugadzirwa kwepamusoro-soro akadai sekomusoro tomography (CT) kana magnetic resonance imaging (MRI).
MRI inzira inoshandisa maginiti, mafungu eredhiyo, uye kombiyuta kuti iite mutsara wemifananidzo yakajeka yezvikamu zvemuviri, kusanganisira nzvimbo yehutu hwekuumba. Kushandisa MRI kurondedzera kukwana kwechirwere kwakaratidzwa kuva chirevo chechokwadi chechirwere chaiyo sekusarudzwa panguva yekuvhiyiwa.
Radionuclide Bone Scan
Zvidzidzo zvakasiyana-siyana zvemasayenzi zvinoshandiswa sechikamu chekuongorora kuongororwa kwekenza yemapfupa kutarisa huwandu hwepakati uye hukuru hwezvirwere nenguva yekuongororwa.
A radionuclide bone scan, achishandisa zvishoma zvishoma zvemhepo inonzi techactive technetium 99m inopindwa muvheini, inoshandiswa kutsanangura kuwanda kwechiremera chikuru. Uye, sezvo kuwedzera kwayo kunowanzoenderera mberi zvishoma nezvisungo zvechirwere, kunobatsira vanachiremba kuti vagadzire kubviswa kwemarara.
Iro radionuclide bone scanning inobatsirawo pakuona zvimwe zvikamu zvekenza mukati mefupa rimwechete (iro rinonzi mapuropa eronda) pamwe chete nemasitoshe emakona ari kure. Uyu muedzo unobatsira nokuti unogona kuratidza skeleton yose kamwechete. A positron emission tomography (PET) scan ingawanzopa ruzivo rwakadaro, kuitira kuti pfupa ringave risina kudiwa kana PET scan yakaitwa.
Positron Emission Tomography (PET) Scan
Mune PET scan, chimiro cheshuga re radioactive (inozivikanwa seDGG ) inopindwa muropa. Kazhinji kese masero emukenza ari mumuviri ari kukura nokukurumidza uye anotora yakawanda yehuga, achigadzira chifananidzo chinoratidza FDG ichiwana mumuviri munzvimbo dzekubatwa nekenza. Mufananidzo wacho hauna kufanana neCCT kana MRI scan, asi inopa ruzivo runobatsira pamusoro pemuviri wose.
PET kuongorora kunogona kubatsira kuratidza kupararira kweasteosarcomas kumapapu, mamwe mapfupa, kana zvimwe zvikamu zvemuviri, uye zvinogona kubatsira pakuona kuti kenza inopindura sei kurapwa.
Kakawanda PET uye CT zvinowanikwa pamwe chete panguva imwechete ( PET / CT scan ) kuti zvibvumira nzvimbo dzepamusoro-soro inonzi PET scan kuti ienzaniswe nehuwandu hwakajeka hwemahara panzvimbo iyo CT scan.
Kuverenga maMetastases
Kunyange zvazvo chikwata chepurogiramu X-rays chichibvumira kuonekwa kwemapapu emapapu mune dzakawanda zvezvirwere, CT inonyanya kuonekwa pakucherechedza mapapu emapapu uye yava mifananidzo yekufungidzira yekusarudza. Ikoko kunogona kunge kune mafungiro emanyepo, zvisinei, zvikurukuru kana pane zvishoma zvitsva mumapapu, saka biopsy yekusimbisa inogona kudiwa.
Kusiyanisa Kuziva
Kusiyanisa kuongororwa kwezvirwere zvepfupa zvemuti uyu kunosanganisira zvinotevera:
- Kurwara
- Mamwe matumbo:
- Aneurysmal bone cyst
- Ewing sarcoma
- Chondrosarcoma
Nzvimbo yechipfupa mumapfupa uye nhengo dzemawere inobatsira kusiyanisa osteosarcoma uye Ewing sarcoma, iyo ndiyo yechipiri inonyanya kuora muboka duku.
Izvo huwandu hwezvimwe zvingangodarowo zvinokanganisa nenzvimbo yechipfuva chikuru. Semuenzaniso, kusiyana kwekutsvaga kwechirwere chechirasi ichi chinosanganisira maitiro akasiyana-siyana echipfuko chezino, osteomyelitis (hutachiona) hwechifuva, uye zvimwe zvezviremara zvisingasviki zvinokonzera (zvakadai sekushambadzira fibromas uye mvere dzemavara e hyperparathyroidism).
Staging Overview
Chikamu chekuongorora chirwere chepfu chinosanganisira kugadzirisa. Kufambisa kunoreva kutarisa ukuru uye nzvimbo yeronda guru, kana rakapararira, uye rave rakapararira. Kufambisa kunobatsira kusarudza kurapwa, uye vanachiremba vanofungawo nezvechirwere chekenza pavanenge vachitaura nezvehupenyu hwehuwandu.
Localized vs. Metastatic
Kudongororwa kwakavakirwa pakuongororwa kwepanyama, kuongororwa kwekufungidzira, uye chero zvipi zvayo zvakagadzirwa. Osteosarcoma inogona kuva danho I, II, kana II rine zvishoma.
Chimwe chikuru chinonyanya kuongororwa mumutsara ndechokuti kenza "inowanikwa" here kana kuti "metastatic." Kana iri nzvimbo, osteosarcoma inowanikwa mumapfupa ayo yakatanga mukati uye zvichida mapukisi ari pedyo nefupa, zvakadai semasumbu, tendon, kana mafuta.
Maererano neAmerican Cancer Society, inenge 4 kubva pa5 osteosarcomas inowanikwa inowanikwa kana ichiwanikwa. Zvisinei, kunyange kana kufungidzira kuongororwa hakuratidzi kuti kenza yakapararira kune nzvimbo dziri kure, varwere vazhinji vanogona kunge vane nzvimbo shomanana dzekupararira kwekenza dzisingagoni kuonekwa nekuedzwa.
Kubvira kwemasinasi akadai akadaro chimwe chezvikonzero zvinoita kuti chemotherapy ive chikamu chinokosha chekurapa kwemaosteosarcomas akawanda. Izvi zvinoreva kuti kenza inowanzodzoka mushure mekuvhiyiwa kana pasina chemotherapy inopiwa.
Maosteasarcomas anowanikwa munzvimbo ino anowanikwazve mumapoka maviri:
- Kanzira inogadziriswa ndeye iyo iyo yose inoratidzika kuora inogona kubviswa nekuvhiyiwa.
- Izvo zvisingawaniki (kana kuti zvisingaregi) osteosarcomas haigoni kubviswa zvachose nekuvhiyiwa.
Grading
Kuchengetedza kunogona kuiswa mukutarisa uye kunoreva kuonekwa kwemasero emukenza pasi pe microscope. Kuchengeta kunopa pfungwa yekukurumidza kukura kwekenza.
- Masero emukenza wepamusoro-soro anowanzotanga kukura uye zvishoma kudarika kupararira.
- Matumire epamusoro -grade anowanikwa nekenza masero anogona kukura nokukurumidza uye anowanzopararira.
Vazhinji maosteosarcomas vane hupamhi-grade, asi chimiro chinozivikanwa separosteal osteosarcoma kazhinji kacho chidiki.
Staging Systems
Inonyanya kushandiswa kushandiswa kwetsika ye osteosarcoma inoratidzira nzvimbo yakashata yemapfupa emapfupa nemazinga maviri neatomic.
Bhuku
Chikoro chakakwirira uye chakakwirira chinogona kuratidzira danga.
- Low grade = danho I
- High grade = danho II
Local Anatomic Extent
- Iyo nzvimbo yemagariro inotsanangurwa kana kana kwete iyo tumarara inopfuurira kuburikidza ne cortex, dense rekunze kwepamusoro kwepafu rinoumba chivharo chekudzivirira chakakomberedza cavity mukati
- Intracompartmental (hapana kuwedzera kuburikidza ne cortex) = A
- Extracompartmental (kuwedzera kuburikidza ne cortex) = B
Munyika ino, zvinotevera ndezvechokwadi:
- Gorosi yepamusoro, maitiro emunharaunda ndeyemutsara I.
- Yakakwirira-grade, mamiriro ekumunharaunda ari mukana wechipiri II.
- Zvirwere zveMetastatic (pasinei negorosi) iri danho rechitatu.
Iko kune vashomanana vemazinga emakwenzi emakirati emakwenzi (chirongwa cheIIA) nokuti vazhinji vepamusoro-grade osteosarcomas vanopinda nepakineti yepafu pakutanga kwekukura kwavo.
Mumapoka maduku, huwandu hwemaosteosarcomas hwakakwirira-grade; saka, vanenge vari varwere vose vari muchengeti weIIB kana III, zvichienderana nekuvapo kana kusavapo kwechirwere chetachiona chinowanikwa.
Mienzaniso neSiteji
- Nhanho IA: Mucheche unotsika-grade uye unongowanikwa mukati mekuoma kupfeka kwefupa.
- Chikamu IB: Chirwere chinoderedzwa, chinowedzera kunze kwefupa uye munzvimbo dzakapfava dzemuviri dzine mitsipa nemitsipa yeropa.
- Nhanho IIA: Mucheche unokwidzidza uye unowanikwa zvachose mukati mekutsvaira kwepfupa.
- Nhanho yeIIB: Mucheche unokwidziridzwa uye wakapararira kunze kwefupa uye kune nzvimbo dzakakomberedzwa dzakapoteredza dzine mitsipa nemidziyo yeropa. Mazhinji osteosarcomas inhanho 2B.
- Nhanho yechitatu: Kanza inogona kuva yakaderera kana yepamusoro-grade uye inowanikwa mukati memapfupa kana inowedzera kunze kwefupa. Kenza yakapararira kune dzimwe nhengo dzomuviri, kana kune mamwe mapfupa asingabatanidzi zvakananga kune pfupa iyo yakatanga.
Kana kenza inodzoka mushure mekutanga kurapwa, ichi chinozivikanwa sekenza yakadzoka kana kuti yakadzokazve.
> Sources:
> America Cancer Society. Miedzo yeOsteosarcoma. https://www.cancer.org/cancer/osteosarcoma/detection-diagnosis-staging/how-diagnosed.html.
> National Caner Institute. Osteosarcoma uye Malignant Fibrous Histiocytoma ye Bone Treatment (PDQ®) -Health Professional Version. https://www.cancer.gov/types/bone/hp/osteosarcoma-treatment-pdq.