Zviratidzo, Zvinokonzera, Kuongororwa, uye Kurapa
Muchirwere weEntometraine mukenza unobata rwonzi rwechibereko uye unowanzoonekwa kune vakadzi mushure mokunge apera. Zvinonetsa ndezvokuti rudzi urwu rwekenza rwuri kuwedzera muNorth America neEurope. Chii chaunofanira kuziva pamusoro pezviratidzo, kuongororwa, uye kurapwa kwekenza iyi?
Endometrial Cancer-Definition
Kenza yemakemetrial, iyo inozivikanwawo sekenza yeuketini, ine kenza inowanikwa mumasero akavhara chibereko ( endometrium ) uye ndiyo inowanzosiyana yekenza inobata muviri wechibereko.
Iyo endometrium inoshanda zvikuru mumukadzi pakuenda kumwedzi uye pamuviri. Pakati pehafu yekutanga yekuenda kumwedzi, isrogen inokonzera kuti endometrium ivakwe mukugadzirira kuiswa kwekuzvimba. Kana mimba isingaiti, progesterone inotungamirira pakuputsika kwezvivara izvi, izvo zvinodururwa panguva yemwedzi wegore.
Imwe kenza isingasvikiki yechibereko, uterine sarcoma, inotanga muhutatu hwehutsika pasi pe endometrium inonzi myometrium (musumbu wechibereko).
Pane huwandu hwemazana emukenza wepametric, zvakadai seadenocarcinoma, adenosquamous, carcinoma, clear cell carcinoma, nevamwe. Mazhinji emaronda aya anowanikwa kare, padanho apo chirwere chinopa mukana wakanaka wekuporesa. Izvozvo zvakati, zviitiko zvinopisa zvinokonzera njodzi yekuvandudza makondomu aya akawedzerwa sezvo ane nhamba yezvirwere gore rimwe nerimwe munyika dzakabudirira.
Endometrial vs. Cervical Cancer
Kusiyana kwekenza yemakemikari uye chirwere chemukemikari kunogona kuvhiringidza kubvira apo chibereko chechivharo chaicho chiri chikamu chezasi chechibereko. Kunyange zvazvo iyo imwe nhengo ichibatwa, pane zvakawanda zvakasiyana zvakasiyana zvinobva pakucherechedza kune zvikonzero zvinonyanya kukosha zvekenza.
Chikamu chepamusoro chechibereko chinosanganisira muviri kana mari, asi chibereko chechivharo chikamu chepakati chechibereko, chinobatanidza kumudzimai.
Nharaunda yeAtometerrial Cancer
Muchirwere weEntometrial wakarongedzwa kuchinja vakadzi 61,380 muna 2017, zvichiguma nekufa kwe10,920 yevakadzi ava. Zvakawanikwa kuti kenza yemapendometri iri kuwedzera mumakore achangopfuura, kunyanya muNorth America neEurope. Zvinofungidzirwa kuti izvi zvinogona kunge zvakabatana nekuwedzera kwezvipingamupinyi mumakore achangopfuura, zvakadai sekuneta, vakadzi vane vana vashoma, uye vanonoka kubereka. Kunyange zvazvo chirwere chepametometrial chakanga chisingawanzwisisiki muvakadzi veAfrica kuAmerica kupfuura vatsvene muUnited States, chiitiko chacho zvino chakafanana.
Zviratidzo nezviratidzo
Pakutanga, mukadzi angave asina zviratidzo zvekenza yemapendometri. Apo zviratidzo zvinokura, zvinowanzoitika ndezvekuchinja kwehutachiza ropa. Izvi zvingave zvichibuda ropa mushure mokunge mukadzi apfuura nepamuviri uye haasisina nguva. Mukubuda ropa, chirwere chemendometri chinogona kukonzera kushaya muviri kusina kuchena , kwakadai sekubuda ropa uye kutarisa pakati penguva. Vamwe vakadzi havana ropa rakasiyana asi asi vanoona zvakajeka kana kuti zvishoma neropa remvura. Vamwe vakadzi vanogona kukura anemia (aine tsvuku tsvuku yeropa kuverenga) sechikonzero chekubuda ropa.
Zvimwe zviratidzo zvinogona kuitika zvinosanganisira kurwadziwa kweplavic kana kuti masimbi. Kana kenza ichifambira mberi, zviratidzo zvakadai sokurasikirwa kwekurema kwechisimba , kuneta, kana dumbu uye kushanduka kwechangu zvinogona kuonekwa.
Zvinokonzera uye Zviitiko Zvengozi
Kunyange zvazvo tisingazivi nezvechikonzero chinokonzera kenza yemapendometri, pane zvimwe zvinhu zvinowanzoisa njodzi. Zinozivikanwa uye zvinogona kuitika panjodzi zvinosanganisira:
- Zera: Muchirwere weEntometrial unozivikanwa zvikuru kuvakadzi vasati vava nemakore ekumisa kwemwedzi.
- Yakakura isrogen mazinga (pasina kukwirira kunoenderana neprogesterone): Chero mamiriro ezvinhu anowedzera maitiro eesrogen pasina kuwedzera kwakadaro muprogesterone kunowedzera dambudziko.
- Kushandiswa kwemakemikari omumuromo: Kushandiswa kwemishonga inononoka kwemuromo kwegore rimwe chete kunoderedza ngozi. Kuderedzwa kwengozi ndiko kwakanyanya kune vakadzi vanoshandisa mapiritsi ekuberekwa kwepanguva yakareba uye vanoramba vachideredza njodzi kwemakore akawanda mushure mokunge mapiritsi achirambidzwa.
- Hormone replacement therapy (HRT): HRT ine estrogen asi pasina progesterone (isina kuvhiringidzika isrogen therapy) inowedzera ngozi yekenza yemapemetri.
- Kubereka zvinokonzera: Vakadzi vane makore akawanda ekuberekwa, vakadai sevaya vanotanga kuenda kumwedzi mangwanani kana avo vanopedzisira vaenda kumwedzi vari pangozi huru. Vakadzi vasina vana vane njodzi huru kune avo vane vana.
- Nhoroondo yekusabereka
- Nhoroondo ye endometrial hyperplasia
- Kuwedzera muviri: Kuve wakanyanyisa katatu.
- Polycystic ovarian syndrome (PCOS): PCOS inowedzera mukana wekudzivirira kenza yemapendometri asi mamwe emishonga yePCOS, yakadai semetformin, inogona kuderedza ngozi.
- Chirwere cheshuga: Kenza yemukondomu yeEndometrial kanowedzera kupfuura vakadzi vari nechirwere cheshuga.
- IUD kushandiswa: Kushandisa IUD kunoderedza dambudziko remukadzi wekenza yemapemetra.
- Tamoxifen: Kushandiswa kwetamoxifen kuderedza dambudziko rekudzoka kana kuderedzera njodzi yekudzidzira kenza yemazamu kunogona kuwedzera mungozi yekurapa kenza yemapendometri.
- Zvimwe zvipembenene zvinokonzera mavari zvakadai se granulosa cell tumor secrete estrogen uye inogona kukonzera njodzi yekenza yemakemikari.
- Nhoroondo yekuve nekenza yekenza yakadai sekenza yemazamu kana kenza yemaawa
- Kuva nemhuri yehupenyu hwekenza yemapendometri kana chirwere chekoloni
- Vanhu vane chirwere chinokonzerwa nekenza yakadai saLynch syndrome (kanowanikwa nhaka yekrispolyposis kanzira yakanyanya kana HNPCC)
- Nhoroondo yemazuva ano kusvika kumapapiro sechikamu chekenza kurapwa
- Kuva nemararamiro ehupenyu
- Kudya zvokudya zvakakosha-mafuta
Kuchengetedza / Kuongorora Kwokutanga
Kusiyana nekenza yemukomana, hapana chiitiko chekuongorora kuongorora kenza yemapendometri. Vakadzi vari mukana wakawanda wekuvandudza chirwere ichi, chakadai sevaya vane nhoroondo yemhuri, chirwere chinokonzerwa nekenza yakadai seLynch syndrome, kana kuti vave vachishandisa tamoxifen kurapa kana kuderedza dambudziko rekenza yepamu vanofanira kutaura nachiremba wavo pamusoro pekuongorora. Kune vamwe vakadzi, kuongororwa kwakafanana ne-endometrial biopsy uye / kana uterine ultrasound kunogona kufungidzirwa kuwedzera mukana wekuona chirwere ichi pakarepo.
Kuongororwa kweKinometometrial Cancer
Kuongorora kunogona kunge kunofungidzirwa kubva muPap smear, asi Pap smear haisi inobudirira yekugadzira chirwere chechirwere. Kuongororwa kunowanzotanga nekuongorora kwepilvic, kunyange zvazvo kanzira dzekenza dzisinganzwisisiki.
Kana iwe wakanga usina chirwere chisina kuchena chekubuda ropa kune mimwe miedzo inogona kuonekwa nachiremba wako. A transvaginal ultrasound (an ultrasound inoshandiswa nokuisa svondo ye ultrasound mumudzimai wako) inogona kuitwa kutarisa kuwanda kwe endometrium yako. Sarine solution inogonawo kuiswa mukati mechibereko chako (sonohysterogram) musati maitiro ekuvandudza kutaridzika kwezvimwe zvinhu zvisina kunaka.
A hysteroscopy ndiyo nzira iyo "teresikopu" inowanikwa kuburikidza nemukati mutsara mukati momuviri wako kuitira kufungidzira kuti uterine yakagadzirwa.
Chidzidzo chinowanzoitwa biopsy ye endometrial. Munzira iyi yehofisi, chigadzirwa chinowanikwa kuburikidza nemudzimai wako kuti uwane kupora mukati memukuchi wako kuti uongorore mubasa. Chiremba wako anogonawo kukurudzira kuderedza uye kugadziriswa (D naC) iyo inowanzoitwa muimba yekushandira pasi pehuwandu hwehutachiona. Uine anesthesia uye kuputika kwechirwere chako, samu iri nani yeganda yako ye uterine inogona kuwanikwa.
Kana chirwere chemakemikari inenge ichifungidzirwa, biopsy inodiwa kuti ivimbise kuongororwa uye zvakare kujekesa maitiro echiremera.
Staging
Kuti uone kusarudzwa kwakanakisisa kwekurapa, kurongeka kwakarurama danho rakakosha mushure mekunge uongororwa. Kutarisa kunoitwa nekuona hukuru hwechirwere, kushungurudza kunobva pakuonekwa kwahwo pasi pe microscope (mamota makirasi kubva pa1 kusvika ku3), uye kuedza kuona kana kenza yakapinda kana kupararira kune chero mishonga kunze kwechibereko.
Kufanana nedzimwe kenza, izvi zvinowanzopiwa "TNM" iyo iyo T inomiririra hukuru hwechirwere (uye dzimwe nguva dzimwe mamiriro), N inomirira kubatanidzwa kwemakiromodhi ari pedyo kana kure, uye M inomiririra mastases, kana kupararira kune nhengo dziri kure.
Kana pane mukana wekuti kenza yakapinda kana kupararira kune dzimwe nhengo, zvimwe zviedzo zvinogona kusanganisira cystoscopy uye / kana proctoscopy kutsvaga humwe humwe uchapupu hwakapararira kumucheto kana rectum, uye CT, MRI, uye / kana PET kuongorora kutarisa kure nekupararira kwemarara.
Kufanana nemamwe mimwe mishonga yakasimba, mutanho wekupedzisira wepametriyo inoputsika muzvikamu zvitanhatu (saJanuary 2018 hapasisiri gadziriro 0). Izvi zvinosanganisira:
- Nhanho 1: Kanzera inongopfurikidza nechibereko, uye haina kupararira kumuromo wechibereko, dzimwe nzvimbo dzemawere, kana kuti nhengo dziri kure.
- Nhanho 2: Chirwere chakapararira kumuviri wechibereko, asi kwete kune dzimwe nhengo dzomuviri.
- Chikamu chechitatu: Chirwere chakapararira kupfuura chibereko, asi nzvimbo dzose dzekupararira dzichiri munharaunda.
- Chikamu chechina: Kenza yakapararira kune bladder, rectum, kana kuti kure kure kwemuviri.
Iyi nhanho inowedzera kuputsika muzvikamu (zvakadai seyero 2A uye 2B) zvichienderana nemamwe maitiro echiremera.
Zvirwere Zvokurapa Kwemakemikari Kanzera
Nzira dzakanakisisa dzokurapa mutsara wepometriyo dzinotarisana nechikamu chechirwere, zviratidzo, pamwe nezvimwe zvinhu zvakadai sehutano hwehutano. Zvimwe zvinosanganisira:
Kuvhiya: Kuvhiya ndiyo nzira inowanzoshandiswa pakurapa kenza yemapendometri. Mune chirwere ichi chibereko chinobviswa ( hysterectomy ), kazhinji pamwe chete nema tubes uye mavari (salpingo-ophorectomy). Kune vakadzi vakapedzisa kubereka, izvi hazviwanzovhiringidza dambudziko rakawanda kunze kwekuda kwekuvhiyiwa. Kune avo vari vaduku uye vakange vachishuva kuva nemwana kana vana, zvisinei, izvi zvinogona kunge zvichiodza mwoyo.
Radiation therapy: Radiation therapy inorapwa inogona kushandiswa kana pane imwe nguva mamwe masero emukenza akapararira kunze kwenharaunda kubviswa nekuvhiyiwa.
Hormone therapy: Hormone therapy inogona kushandiswa kuderedza uwandu hwewesrogen kana kuwedzera huwandu hweprogesterone mumuviri. Mishonga inowanzozivikanwa inosanganisira imwe yemhando dze progesterone. Pamakumbo anenge aripamusoro kana kuti akadzoka, mamwe marapirwo angangodaro anosanganisira tamoxifen, luteinizing kurega hormone agonists, uye aromatase inhibitors.
Chemotherapy: Chemotherapy haisi inowanzodiwa kuti utange mararamiro ekupedzisira endometrial. Nokuda kwekenza yakapararira kana yakadzoka, zvakadaro, chemotherapy inowanzoshandiswa.
Mishonga yemakiriniki: Zvose zvinorapwa nekenza yemapendometri iyo ikozvino yawanikwa yakamboongororwa mumakiriniki epirini. Kune hurumende inopfuurira yekuedza kwekenza yemapendometri iri kutsvaga nzira dzekuti zvose dzivandudze kupona uye kuderedza migumisiro yemigumisiro uye kusagadzikana kwemishonga.
Kutsungirira
Kuwana kuongororwa kwekenza pasinei nokuti mhando kana chikwata chinotyisa. Dzidzo iri kupa simba, uye kudzidza nezvekenza yako kunogona kukubatsira iwe kuva mutongi wako pabasa rako. Tora nguva yekudzidza nezvenzira yekuwana ruzivo rwakanaka rwekenza paIndaneti . Kutsigira kunokosha zvakare. Kuongororwa kwekenza inguva yakanaka yekuunganidza rubatsiro rwako rwakakupoteredza. Vanhu vazhinji vanozviona zvichibatsira kubatana neboka rinotsigira munharaunda yavo kana kutora chikamu mune rimwe remapoka ekutsigira paIndaneti kana masangano ekutsigira kwekenza yemapendometria.
Prognosis
Kunyanya kufungidzira kwekenza yemaprotometri muUnited States kwakanaka, sezvo vazhinji vekenza iyi inowanikwa kare. Mimwe mitauro isinganzwisisiki yekenza yemakemetari yakadai sekujekesa kemenjini carcinoma inonyanya kurwisa uye ine urombo hunofadza.
Ikozvino makore mashanu ekupukunyuka mazana ari 75-88 muzana yehutachiona I chirwere, 69 muzana yechitambo II, 47-58 muzana yechitambo III, uye 15-17 muzana yechitambo IV. Zvakakosha kucherechedza kuti nhamba dzinowanzova nemakore akawanda uye hadziratidzi zviratidzo zvitsva uye zvinobudirira zvakagamuchirwa kubvira panguva iyoyo.
Shoko Rinobva
Muchirwere weEntometrial chirwere chemubereki chinosuruvarisa chiri kuwedzera muUnited States neEurope. Chiratidzo chinowanzoonekwa (nokuda kwevanenge makumi mapfumbamwe nezana kubva muzana yevakadzi) chisina kuchena uterine kubuda ropa. Nenzira inofadza vakadzi vakawanda vanotsvaka kurapwa kana vane nguva dzisina kujairika kana kubuda mushure mokunge apedza kubuda, uye dzakawanda zvezviremara izvi zvinowanikwa muzvikamu zvekutanga. Kurapa kwakanakisisa kunoenderana nesiteji rekuongororwa.
Kana wakamboonekwa kuti une kenza yemapendometri, chinhu chakakosha iwe unogona kuita ndechokuti iwe uve mutongi wako mukutarisira kwako. Bvunza mibvunzo yakawanda. Funga kuwana pfungwa yechipiri. Uye dzidza nezvehutano hwako.
> Sources:
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> National Cancer Institute. Endometrial Cancer Treatment (PDQ) -Health Professional Version. Kuvandudzwa 08/18/17. https://www.cancer.gov/types/uterine/hp/endometrial-treatment-pdq
> Tang, Y., Zhu, L., Li, Y. et al. Metformin Use is Associated with Increasing Incidence and Improved Survival of Endometrial Cancer: A Meta-Analysis. BioMed Research International . 2017. 2017: 5905384.