Muroti weiyo (renal cell carcinoma) inowanzoongororwa uchishandiswa kusanganiswa kwe-ultrasound, CT, uye MRI inoongorora, pamwe nekunyatsocherechedza, kuongorora muviri, kuongorora ropa, uye kuongorora urinhi. Kamwe kana kenza inowanikwa, chirwere ichi chinoda kunyatsogadziriswa kuitira kuti chiongorore mishonga yakakodzera.
Kuenda kuburikidza nehutano hwekutsvaga kazhinji kunonetsa-iwe unganzwa uchitya uye unetseka.
Kuziva kuti chii chaunotarisira uye kuti ungagadzirisa sei nguva yekumirira nemigumisiro inogona kubatsira kubvisa mamwe manzwiro.
Kuongorora Chekuita uye Kuedzwa Kwepamba
Murefu wepoyi haugoni kuonekwa kumba, asi sezvo pasina ikozvino kuongororwa kwekuongorora, kuva nekuziva kwezviratidzo zvinogona kuitika uye zviratidzo zvechirwere chinhu icho munhu wese anogona kuita.
Kunyanya, kana iwe uchicherechedza kuti iwe une ropa mumuguta wako (chero chiyero), marwadzo erumupfudze, ruzivo rwemanzi, unonzwa wakaneta kana wakarasikirwa nechido chako, kana uremerwa uremu pasina kuedza, iva nechokwadi chekuona chiremba wako.
Labs uye Miedzo
Kuongororwa kwemukembudzi wepvo kazhinji kunotanga nekunyatsocherechedza, kutarisa mungozi dzechirwere, kuongorora muviri, uye kuongororwa kwebhroreta.
Kuongorora Panyama
Chirwere chemuviri chakaitwa nekunyatsotariswa kunotarirwa kuongororwa nehumuviri mudumbu, kumativi, kana kumashure, pamwe nekuongorora ropa. Iyo itsvo inobatanidzwa basa rinokosha pakutevedzera ropa, uye zvipuka zvinogona kuita kuti munhu arambe achiwedzera simba reropa iro dzimwe nguva rinokuvadza zvikuru (rakaipa kwazvo rekuwedzera kwehutano).
Muongorori unosanganisira kuongororwa kwema genitalia muvarume. Chirwere chepemhi chakasiyana nechokuti chinogona kukonzera varicocele, mutsara wakawedzerwa (varicose vein) mu scrotum kana testicle. Kusiyana nehuwandu hunokonzera varicocele, iyo inokonzerwa nekenza yepfungwa haifaniri kuenda apo murume akarara (anotora supine position).
Dhiyabhorosi Miedzo
Basa rekuongororwa-kamuti yemukenza wepimbudzi inowanzotanga ne urinalysis , muedzo unoitwa kwete kungoona ropa mumuguta wako, asi zviratidzo zvehutachiona, mapuroteni, nezvimwe. Zvinenge hafu yevanhu vane mutsara weutsvo vachave nehuwandu hweropa mumuviri wavo.
Ropa rakazara ropa (CBC) chirongwa chakakosha, seanemia (aine tsvuku dzeropa rekuyera nhamba) iye zvino ndiyo inonyanya kuratidza chiratidzo chechirwere. Kuongorora maitiro epyiki kunokosha zvakare, kunyange izvi zvingave zvakasikwa.
Chirwere chepoyi chakasiyanawo mune zvekuti chinogona kukonzera kukura muropa chiedza chekuedza, kunyange pasina kenza inopararira kuchiropa. Chiratidzo ichi ndechimwe chezviratidzo zvepaneentiki zvinogona kuitika kana majekiseni aya akabudisa zvinhu kana mahomoni. Paraneoplastic zviratidzo zvingavewo zvinosanganisira calcium yakakwirira muropa ( hypercalcemia ), kunyange izvi zvingaitikawo kana kenza inopararira kumapfupa.
Imaging
Mhando dzakasiyana dzakasiyana-siyana dzekufungidzira zvingashandiswa kune zvose kuongororwa uye kugadzirwa kwekenza yempfungwa.
Ultrasound
Ultrasound inoshandisa mazaya akajeka kuti ape mufananidzo wezvivako mudumbu. Inowanzotanga kuedzwa kwekutanga uye inonyanya kubatsira mukuparadzanisa krissts (iyo inenge iri nguva dzose inobata), kubva pamakumbo akaoma kana mvere dzakasimba ne cystic.
CT Scan
CT inoshandisa shanduro ye-x-ray kuti ipe chinyamupinyi chechikamu chemuviri wemuviri wakadai semafuta. Mukuwedzera pakutsanangura chirwere chepfungwa, CT scan inogona kupa ruzivo rwakakosha pakugadzirisa nekuongorora kana zvichionekwa kuti kenza yakapararira kunze kweinso kana kuti lymph nodes.
A CT scan inowanzoitwa pakutanga pasina kupikisa, uye ipapo neirai reraocontrast. Dhayi dzimwe nguva inogona kushungurudza vanhu vane mafungiro asingabatsiri, pane imwe nguva mimwe mienzaniso yekuenzanisa inogona kushandiswa.
CT ndeyedzidzo yakanakisisa yekuenzanisa zvirwere zveperesi asi kazhinji haigone kuziva kana kenza yakapararira mumhino yezvokudya, mhangura huru inobva kuinso inobatana neine inferior vena cava (mutezi mukuru unounza ropa kubva muviri pasi kusvika pamwoyo).
MRI Scan
MRI scan inoshandisa maginetic imaging pane x-ray teknolojia yekuumba mufananidzo wezvivako mudumbu. Mune iyo inonyanya kubatsira pakutsanangura "zvinyoro zvishoma" zvisingaiti. Nenzira yakawanda, CT scan ndiyo mhinduro yakanakisisa yekuongorora chirwere chepfungwa, asi MRI inogona kudiwa kune avo vane zvirwere zvisina kuoma zvepfungwa dzepfungwa kana vane vane mitoo yekusiyanisa dhayi.
MRI inogona kuonekwawo kana chirwere chepfungwa chinofungidzirwa kuti chakapararira mumhino yezvokudya uye pasi pevena cava, sezvo nzira dzakakosha dzinogona kudiwa panguva yekuvhiyiwa. MRI haigone kushandiswa nevanhu vane tsvina mumuviri wavo, zvakadai se pacemaker, shrapnel, kana kuti zvimedu, sezvo magetsi akasimba angatungamirira kufamba kwezvinhu izvi.
MRI yeuropi inogona kuitwa kuti iongorore humwe hutano hwehutachiona (kupararira) kwekenza kuuropi, chechitatu chinowanzosvika kune iyo inopararira nekenza yepoyo.
PET Scan
PET inoongorora inoshandiswa kakawanda mukenza kuongororwa, asi zvishoma nezvishoma mukuongororwa kwekenza yempfungwa. Munguva yePET scan, shoma shoma inokonzerwa nehutachiona inoshandiswa mumuviri uye mifananidzo (kazhinji inosanganiswa neTT) inotorwa mushure mekunge shuga yava nenguva yekugadzirisa.
Kusiyana neTCT uye MRI, inonzi inoshandiswa kuongorora pane kushanda kwekugadzirisa uye inogona kubatsira mukusiyanisa nzvimbo dzekushanda kwechirwere kukura kubva munzvimbo dzakadai sedare.
Intravenous Pyelogram (IVP)
An IVP chiratidzo umo dhayi inopindwa muvhein. Itsvo dzinotora dhayi iyi, ichibvumira radiologists kuti ione itsvo, kunyanya renal pelvis.
IVPs inopedzisira isati yasvika pakuonekwa kwekenza yempfungwa asi inogona kushandiswa kuti urothelial cell cancers (mishonga inokonzera keseti yakadai sekenza yekanda uye ureter pane dzimwe nguva inogona kusanganisira chikamu chikuru chetsvo, renal pelvis).
Renal Angiography
Angiography inowanzoitwa pamwe chete neC CT scan uye inosanganisira kuisa dhayi mumushonga weupfumi kunotsanangura midziyo yeropa yeputsvo. Uyu muedzo dzimwe nguva unoshandiswa kubatsira kubatsira kuronga kwechirwere.
Cystoscopy uye Nephro-Ureteroscopy
Iyi miedzo yaisanganisira kuisa catheter inopenya mumukanda, kuburikidza neverereter, uye kusvika kune renal pelvis (iyo "centre" yeinso). Inoshandiswa kunyanya kana kunewo uwandu huri mubhanhire kana ureter, zvakadai sa transitional cell carcinoma.
Biopsy
Kunyange zvazvo bhiopsy inokosha pakutsvaga huwandu hwekenza, hazviwanzodiwa kuti uongorore chirwere chepenyo. Uyezve, pane ngozi ine nheyo yakanaka yealopsies (biopsies yakaitwa neine tsono ine tsvina inowanikwa kuburikidza neganda uye muinso) iyo nzira inokwanisa "kudzvara" chirwere (kuparadzira tumarara chete nzira yetsono).
Zviratidzo zvemuviri zvakakosha mukuronga kurapwa, zvakadai sekurapa kunorapwa, asi kazhinji kunowanikwa panguva yekuvhiyiwa panzvimbo yehupi.
Miedzo yeMetastases
Mukembudzi wepoyi unogona kupararira kuburikidza neropa kana kuti nemidziyo ye lymphatic, uye nzvimbo dzakawanda kwazvo dzemasastases ndiwo mapapu, mapfupa, uye uropi, nenzira iyoyo. Bhokisi re x-ray (kana chifu CT) rinogona kuitwa kutarisa mapapu emagetsi .
Pamwe pfupa rekupona kana PET scan rinogona kuziva kana masastases e bone aripo. MRI yeuropi ndiyo yakanakisisa kuedza kutarisa maitiro europi.
Kusiyanisa Kuziva
Kusiyana nekuwanda kwekenza, kune zvishomanana zvinokonzera mashoma muinso. Izvo zvakasiyana-siyana zvinowanikwa, zvinogona kuva zvakaoma kana huwandu hudiki hunowanikwa muhvo, kazhinji kana chiitiko chikaitwa kune chimwe chikonzero.
Zvimwe zvinokonzera kukanganisa kwemasimba zvinosanganisira:
- Renal (itsvo) cysts: Cysts dzinogona kugoverwa ne ultrasound uye dzinowanzowanika nechirwere chinonzi polycystic .
- Angiomyolipomas: An angiomyolipoma inogona kusiyaniswa nemukenza wepfungwa panguva yeT CT scan (nemhaka yekuvapo kwamafuta). Idzi idzi dzine uturu hwakanaka.
- Oncocytomas: Oncocytomas inowanzosiyaniswa maererano neCCT yekuwana. Izvi zvipembenene zvinorwara zvinogona dzimwe nguva kufanana nemararamiro empfungwa pamapfungwa ekufungidzira.
- Renal adenomas: Idzi idzi dzine hutachiona hunopisa hunowanzowanikwa mukufungidzira pamagetsi ekufungidzira.
- Urothelial kanzira (transitional cell cancers yebhanyi, ureters, uye dzimwe nguva renal pelvis): Aya kanzura inoumba anenge 15 muzana yekenza yepoyo uye inowanzowanikwa mukati mepfungwa uye inosanganisira kuunganidza nzira. Cancers masero anogona kunge aripo mumuginalysis.
- Zvirwere zvepamusoro: Zvinonzi adrenal glands zvinogara kumusoro kweivo uye zvinowanzosiyaniswa pamifananidzo. Izvo zvipembenene zvinowanzozivikanwa zvinowanzoitwa metrenasis adrenal metastases kubva kumarariya ane kenza yemapapu.
- Nyofu yeRenal: An abscess igadziriswa nehutachiona.
- Iropi metastases: Mhando dzakawanda dzekenza dzinogona kupararira kune itsvo. Izvi zvinowanzokonzera mashoma maduku maduku panzvimbo pane tumarara yakakura. Cancers inogona kupararira kune itsvo dzinosanganisira mutsa wemapapu, kenza yemazamu, kenza yemudumbu, melanoma, uye kanzura dzeimwe tsvete.
- Hodgkin's lymphoma uye isiri Hodgkin's lymphoma: Zvose izvi zvine chokuita neropa zvinogonawo kusanganisira itsvo, asi dzinowanzobatanidzwa nemakumbo (pamwe nemakondomu akawedzerwa) kune dzimwe nzvimbo dzomuviri pamwe chete.
- Renal inoparara: An infarct inoreva kusakwana kweropa. Izvi zvakafanana ne "mwoyo yekushungurudza" kwetsvo, uye mhuka dzakafa (necrotic tissue) dzimwe nguva dzinogona kuonekwa sehukuru pamifananidzo.
- Sarcomas: Izvozvi ndezvirwere zvekenza zvisingawanzo zvinotanga muzvinyama zvinyoro zvakapoteredza mafungiro.
Inorwara Kidyo Kanzera
Kuisa kenza yeminyo inowanzoitwa mushure mekuvhiyiwa uye inobatanidza migumisiro yekufungidzira miedzo pamwe nehutachiona hwechirwere chinotumirwa kuhutano mushure mekuvhiyiwa, pamwe nekuwana zviitiko panguva yekuvhiyiwa.
Tumor Grade
Ipi kansari inopiwa chikamu che 1 kusvika ku4, chinonzi grade Fuhrman, ichocho chiyero chekutsamwa kwemarara.
Chikamu chekutanga chinoshandiswa kurondedzera zvipembenene izvo zvisinganyanyi kurwisa uye zvine masero akaparadzaniswa zvikuru (tarisa zvakanyanya kufanana nemasero emagetsi matsva). Kusiyana neizvi, chikamu chechina chinopiwa kurondedzera zvinotyisa zvinoratidzika semakumbo, izvo zvisingaverengeki uye zvinotarisa zvakasiyana zvikuru nemaitiro ezvitsidzo zvepfungwa.
TNM Staging
Tsitsi dzomukomana dzinoshandiswa zvakare uchishandisa chimwe chinhu chinonzi TNM system. Izvi zvinogona kuvhiringidza pakutanga asi zviri nyore kunzwisisa zvakanyanya kana tikatsanangura tsamba idzi uye kuti nhamba dzinorevei.
- T inomirira tumor. Nhamba dzinotevera T dzinoratidza hukuru hwechirwere. T1 matumbu ane pasi pemasendimita manomwe. T2 matamu ane masendimita manomwe kusvika ku10 muhupamhi. T3 mapfupa akakura kunze kweinso kana kupinda mune mutsinga, asi kwete mumadzinza adrenal kana kuti kunze kweGerota's fascia (yakasara yezvisikwa zvinopoteredza tsori). T4 mapfupa akakura kunze kweGerota's fascia kana kuti muchengeti wegadrenal.
- N inomirira nodes. Tsanangudzo yeN0 ingareva kuti kenza haina kupararira chero ipi zvayo yemaitiro. N1 zvinoreva kuti kenza yakapararira kune lymph nodes pedyo.
- M inomirira mitastases uye inenge 0 kana 1 zvichienderana nemasitosita aripo (ingave kenza yakapararira kumapapu, mapfupa, uropi, kana dzimwe nzvimbo). M0 zvinoreva kwete metastases aripo. M1 zvinoreva metastases aripo.
Tx (kana Nx kana Mx) zvinoreva kuti tumarara (kana nodes kana metastases) haigone kuongororwa. T0 zvinoreva kuti hakuna humwe hupupuriro hwemuviri wekutanga uye hunoshandiswa kana mafungiro emassosa eesvini anowanikwa, asi chiremera chikuru hachigoni kuwanikwa.
Nhanho
Kushandisa tsamba dziri pamusoro, kanzira dzeperesi dzinobva dzakakamurwa kuva zvikamu zvina:
- Nhanho 1: Mutsara 1 kanzira dzepfungwa (T1, N0, M0) dzisingasviki masendimita manomwe uye dziri muinso (hadzina kupararira kune lymph nodes kana chero imwe nzvimbo dzomuviri).
- Chikamu chechipiri: Muchitsauko ichi (chinotsanangurwa seT2, N0, M0) kenza inogona kuva yakareba kupfuura masendimita manomwe kana kuti yakapararira kune imwe mheto yakakura yakadai seyoya yemuviri kana kuti inferior vena cava. Izvo hazvina, zvakadaro, zvakapararira kune chero nhengo dzenzou, nhengo dzegrenti, Gerota's fascia, kana nzvimbo dziri kure.
- Chikamu chechitatu: Matanho matatu (zvikamu zvinogona kuva T1 kana T2, N1, M0, kana T3, chero ipi zvayo N, M0) ingave yakakura asi haina kupararira mberi kweGerota's fascia. Ichi chikamu chinosanganisira matumire asina kukura kunze kweevo, asi akapararira kune lymph nodes iri pedyo.
- Nhanho 4: Chikamu chechina chinotsanangurwa nenzira mbiri dzinokosha. Mune imwe nzvimbo, chirwere ichi chingave chakapararira mberi kweGerota's fascia uye kune lymph nodes dziri pedyo, asi kwete kune dzimwe nzvimbo dzomuviri. Kana kuti inogona kunge yakakura, yakapararira kune chero nodes, uye yakapararira kune dzimwe nzvimbo dzomuviri (chero T, chero N, M1).
Kakawanda keminyo kanza
Kenza mutsva yenguruve inongoreva chero kenza ipi yakadzoka, ingava mukati meimpvo, mumakumbo akapoteredza, mumakirinikodhi, kana munzvimbo dziri kure.
Zvose zvinongororwa zvirwere zvinoitwa zvichabatsira chiremba wako kunyatsoronga denda rako. Kubva pamigumisiro, iye achave akakwanisa kunyanya kusarudza mushonga wakakonzerwa nemamiriro ako.
> Sources:
> American Society of Clinical Oncology. Cancer.Net. Iropi Kanzera: Kuziva. Yashandurwa 08/17. https://www.cancer.net/cancer-types/kidney-cancer/diagnosis
> Lara, Primo N., naEric Jonasch. Kwenyi Kanzira Mitemo uye Maitiro. Springer International Publishing, 2015.
> Pieroazio, P., uye S. Campbell. Nzira yekuongorora, Kusiyanisa kwekusiyanisa, uye Kutungamirirwa kweMisa Mashoma. UpToDate . Updated 03/02/18.