Tsanangudzo, Zviratidzo, Zvirwere uye Kuparara kweFollicular Lymphoma
Follicular lymphoma inowanzosiyana yevanhu vasiri Hodgkin Lymphoma (NHL) . Inowanzoita lymphoma inokura-inokura iyo inobva kuB-seli (B lymphocytes) , rudzi rwechichena cheropa.
Follicular lymphoma inonziwo indolent kana kuti yepamusoro-grade lymphoma nokuda kwechimiro chayo chinononoka, zvose maererano nemafambiro ayo-kukura zvishoma-uye kuti inotarisa sei pasi pe microscope-zvisiri izvo zvisinganzwisisiki (zvakanyatsosiyaniswa) kupfuura yepamusoro-grade malignancies.
Risk Factors
Nhoroondo inogona kuchinja chero ani zvake wezera ripi neripi, asi rinowanzoonekwa kune vakwegura vakuru. Ivhareji yemakore panguva yekuongororwa inenge inenge 55, uye inobata varume nevakadzi zvakaenzana.
Kuwanda
Follicular lymphoma ndiyo inowanzosiyana-siyana yekukurumidza-kukura lymphoma, ine vanhu vanosvika 15 000 muUnited States vanoongororwa gore negore.
Zviratidzo nezviratidzo
Chimiro che follicular lymphoma chinowanzosvibisa, uye ine zviratidzo zviduku zvinonyevera zvinogona kuenda zvisingaoneki kwenguva refu. Zviratidzo zvinogona kusanganisira:
- Kuwedzera kwe lymph nodes - Kufuridzira kwemakirini nhengo mune imwe nzvimbo yomuviri ndiyo chiratidzo chinowanzoonekwa che follicular lymphoma. Iyi node inogona kunzwa mumutsipa , armpit , kana kugomera, kana kuti inogona kuonekwa pamafungiro ekufungidzira mune dzimwe nzvimbo dzomuviri (zvakadai nemakirini emasikirini emidzimu mumapfupa kana retroperitoneal lymph nodes mudumbu). (I- lymph node learning centre inokurukura basa re lymph nodes uye nzvimbo dzakadzika zvakanyanya.)
- Furo yevasingazivikanwi yakabva (FUO) - Chipisa chakakwirira (kupfuura 100.4 degrees F kana 38 degrees C) iyo iripo kwemazuva matatu kana kupfuura akawanda anokonzera pasina chikonzero chaicho chingava chiratidzo che lymphoma. Panzvimbo pokuva nehukama nehutachiona husingazivikanwi, zvinofungidzirwa kuti FUO inokonzerwa nemakemikari ekuisa nzira dzinoenderana nekenza pachayo inowedzera kutonhora kwemuviri wepanyika.
- Kurasikirwa kwekurema kwekusazvipira - Kusarondedzera kurasikirwa kunotsanangurwa se kurasikirwa kwe5 kusvika ku10 muzana yehutatu hwemuviri (somuenzaniso, 7.5 kusvika ku15 mapaundi mu 150-pound munhu) pane imwe nguva mwedzi mitanhatu kana kupfuura.
- Usiku hunoputika - Usiku hunoputika hwakasiyana nekutsva kupisa nekuputika mune dzimwe nguva ivo vari kunyatsochera uye vanhu vanoda kuchinja mabhedha avo nekuvata, dzimwe nguva kakawanda munguva yeusiku.
- Kuneta - Kushanda kwekenza kakawanda kunowanzosiyana ne " kuneta kunowanzoitika" pakuti hazvivandudzi nehusiku hwakanaka hwekurara kana mukombe wekofi.
- Kupfupika kwemhepo
- Generalized Itching - Itching inotanga kuitika muviri wose uye inogona kuva yakanyanya.
I-B zviratidzo zve lymphoma zvinosanganisira zviratidzo zvitatu zvakakosha zvinogona kubatsira pakufanotaura kuti kenza ichapfuurira sei uye ichapindura kurapwa uye inosanganisira:
- Fever
- Unintentional kurasikirwa kwekurema
- Kuchengeta usiku kunopika
Kuziva
Follicular lymphoma inowanzoonekwa ine lymph node biopsy . Izvi zvinogona kuitwa sezvinoitwa bhiopsy yekuvhiya (ine nodes inogadziriswa yakadai seyomutsipa) kana senheyo yakakura yenyuchi (nokuda kwezvikamu zvakadzika mumuviri).
Chinyorwa chiduku chechidimbu chakakanganiswa chinotorwa uye chinongororwa pasi pe microscope nehutachiona. Zvikamu zvehutachiona hwakakanganiswa zvinoratidza kuvapo kwe-lymphoma.
Mukuwedzera kune chitarisiko chiri pasi pe microscope, immunohistochemistry miedzo inoitwa kuti iongorore lymphoma CD tumor markers uye inotarisa rudzi rweusingaiti Hodgkin lymphoma .
Nei Ichinzi 'Follicular' Lymphoma
Kungofanana nemaronda akawanda emakumbo, follicular lymphomas inowanzokonzera lymph nodes . Apo lymph nodes inobatwa ne lymphoma iyi inowanikwa pasi pe microscope, inoratidza zvikamu zvakakomberedza zvinonzi "follicles." I-lymphoma inonzi "follicular lymphoma".
Miedzo Mushure mekuona Utano
Mukuwedzera kune zviyero zvine chokuita ne biopsy pamusoro apa, dzimwe mimwe miedzo inowanzodiwa apo follicular lymphoma inotanga kuongororwa.
Izvi zvinobvumira chiremba kuti aone zvakaenzana zvechirwere uye nhengo dzipi dzinobata. Kuongorora ropa, CT scans uye mapfupa emapfupa anowanzodiwa.
Kutsvakurudza kutsva kwakaongorora zvakare kushandiswa kwePET / CT kuongorora kuongorora follicular lymphoma, somuenzaniso, kana zviitiko zveT CT scan zvisingazivikanwi. MuPET-CT, motokari inonzi radioactive (18F-fluorodeoxyglucose) inojowa mumurwere pamberi peT CT scan uye nzvimbo dzehutachiona hunovhenekera kana dzinotakura gasecheni inonzi radioactive. Izvi zvinobatsira kusiyanisa nzvimbo dzinoshanda dzekenza kune dzimwe nzvimbo dzemavara ane mutsara anogona kuoneka akafanana neC CT scans.
Nhanho
Chikamu che follicular lymphoma chinoratidza kuti chirwere chacho chakapararira sei uye chakakosha mukusarudza mishonga yakanakisisa uye mukufungidzira kusarudzwa kwechirwere chacho. Lymphoma inopararira kune lymph nodes pamwe chete nedzimwe nhengo mumuviri, kusanganisira bone marora. Kune zvikamu zvina zve lymphoma zvinosanganisira:
- Nhanho I - Imwe lymph node (kana lymph structure) inobatanidzwa.
- Chikamu II - Zviviri kana kupfuura zvinonzi lymph nodes (kana lymph structures) zvinosanganiswa asi kune rumwe rutivi (pamusoro kana pasi) dhifa.
- Gwara rechitatu - Lymph nodes (kana zvivako) kumativi ose echinyorwa chinobatanidzwa.
- Chikamu IV - I-lymphoma inowanikwa mumapfupa emapfupa uye / kana mishonga kana nhengo dzisiri kune lymph nodes kana lymph structures.
Mukuwedzera kune nhamba, lymphomas inopiwawo zita reA kana B, rine A zvinoreva kuti hakuna B zviratidzo uye B zvinoratidza kuvapo kweB zviratidzo zve lymphoma (yakanyorwa pamusoro pezviratidzo).
Kufambira mberi
Follicular lymphoma inowanzova chirwere chinokura uye chinowanzoramba chisingazivikanwi kwenguva refu mumuviri isati yaonekwa. Sezvo zviratidzo zvinyengeri, chirwere chacho chinowanzotanga kusati kwaonekwa chirwere, uye vanhu vazhinji vanorwara apo lymphoma iri danho rechitatu kana IV.
Kunyangwe mune zvikamu zvakatowedzera zvechirwere, zvisinei, kazhinji hazvive pangozi pakarepo kuhupenyu panguva yekuongororwa. Chirwere ichi chinowanzova ne "kumira uye kunonoka" nzira, zvinoreva kuti inopisa uye inowedzera kazhinji kakawanda kwemakore akawanda. Kunyange zvazvo pasina mishonga inoporesa mune zvishoma, varwere vazhinji vanogara kwemakore 8 kusvika ku10 kana kupfuura nekurapa.
Kuchinja
Follicular lymphoma inowanzotendeuka pane imwe nguva, kubva pane chirwere chinoputika kusvika kune chirwere chinoramba chichiwedzera. Izvi zvinotaurwa sekushandurwa. Kuchinja kunogona kuitika mumasero ose, kana mune imwe chete chikamu chekenza. Kuvapo kwezviratidzo zveB zvinowedzera mukana wekuti tumarara ichashanduka munguva yemberi iri mberi. Mushure mokunge follicular lymphoma "inoshanduka" inowanzobatwa nenzira yakafanana kune yakakura huru B-cell lymphoma .
Zvinokonzera
Hatizivi kuti chii chinokonzera lymphomas, kunyange kune zvimwe zvipingamupinyi zvinokonzerwa nehuwandu hwehutano. Zvimwe zvinokonzerwa nezvinokonzerwa ne lymphoma , uye follicular lymphoma (FL) zvakananga, inosanganisira:
- Zvokudya zvakaderera muzvibereko nemiriwo
- Zvikamu zvezasi zvekuita basa
- Kusvuta - Kusiyana nemamwe asiri Hodgkin's lymphoma, njodzi yeFF inowedzera kune vanhu vanobvuta.
- Doro inodya - Doro rekushandisa rinogona kukanganisa njodzi mune imwe nzira; huwandu hwewaini hunobatanidzwa nehuwandu huri pasi uye huwandu hwezuva rose hwehudha hunobatanidza nehuwandu hwehuwandu.
- Age (sezvakataurwa pamusoro apa, FL inowedzera nezera)
- Kuwedzera muviri
- Immunosuppression
- Kusununguka kwezvakatipoteredza kune zvinouraya mishonga inouraya, zvigadzirwa zvemabhizimisi, uye mahydrocarboni
- Kugadziriswa kweGenetic kunogona kubatsira kune dzimwe mamiriro.
- Kusiyana nemamwe marudzi evanhu vasiri Hodgkin's lymphoma, FL haina kubatana ne Epstein-Barr HIV mawere, H.pylori.
- UV chiedza chiedza chinosanganiswa nekunonoka kuderedzwa . (Vitamin D inogona kutora chikamu chekudzivirira kurwisa FL).
Kurapa
Pane mishonga yakasiyana-siyana inogona kuwanikwa ye follicular lymphoma , ine sarudzo dzakanakisisa dzine chokuita nesero rekenza, kushungurudza (gira), mamwe mararamiro aunayo, hutano hwako hwose, uye marapirwo awakave nawo munguva yakapfuura. Kukura kwechirwere chetachiona, kupisa kwemazuva oga kunogona kuva zvose zvinodiwa. Nehutachiona hwepamusoro, mishonga iri pasi apa inowanzoshandiswa pamwe chete (ona sangano rekubatanidza pasi apa). Zvimwe zvinogona kusanganisira:
Mira uye tarisa - Kana follicular lymphoma isingaiti zviratidzo, kurinda kumirira kungava "kurapa" kwekusarudza. Nekumirira kwakamirira, iwe uchanyatsotariswa nemuedzo nekufungidzirwa kuedza kuitira kuti mushonga unogona kutanga apo kenza inotanga kufambira mberi. Izvi zvinogona kutinhira zvinotyisa, kunyange zvakawanikwa kuti kuponeswa kwekuita hakushandisi kana nzira iyi inoshandiswa.
Radiation therapy - Kwechikwata, ini follicular lymphomas, kurapwa kwemaawa kungangova kurapwa chete kunoda, uye kunogona kuporesa chirwere chacho. Kushandiswa kwemajeri emishonga inonzi radiation therapy (IFRT) inowanzowanzo nzira yekushandiswa kwemaawa. Kusiyana nehuwandu hwemishonga inonzi radiation, IFRT inopa miviri kune miviri yakakanganiswa chete, kuisa mishonga ine utano. (Radiation therapy inokonzera ngozi yechirwere chechipiri uye izvi zvinoderedza ngozi.)
Chemotherapy - Chemotherapy inowanzoshandiswa nemhinduro dzakanaka. Inowanzoshandiswa sechikamu chekubatanidza chirwere (ona pasi apa).
Targeted therapy - Targeted therapy inoshandisa mishonga iyo inopararira zvakananga masero ekenza kana nzira yekuratidzira inobata mukurara kwekura. Iyo monoclonal antibody Rituxan (rituximab) inowanzoshandiswa (ona maitiro ekubatanidza pamwe chete) pamwe nechemotherapy uye yakaita musiyano mukuru muhupenyu hwehupenyu. Monoclonal antibodies yakadai se rituximab inorwisana nemunhu yakagadzirirwa kusungirirwa kune zvikwangwani zvinowanikwa pane lymphoma cells (CD markers). Vose rituximab neGazyva (obinutuzumab) vanorwisa CD 20 tumor marker .
Treanda (bendamustine) yakawanikwawo kuwedzera kukura-kusina kusununguka asi kune huwandu hwemigumisiro yakawanda. Gazyva (obinutuzumab) uye bendamustine inogona kushanda kune avo vasingateereri rituximab.
Radioimmunotherapy - Radioimmunotherapy inorapwa umo mushonga (kazhinji unopisa mumiririri) unobatanidzwa nezvikamu zvemazuva ano zvichibvumira mushonga wacho kuti ubudise mazai chaiwo zvakafanana nekenza masero. Mumwe muenzaniso ndeye Zevalin (yttrium-90 ibritumomab tiuxetan).
Mishonga yemakiriniki - Mishonga yakawanda nemitemo iri kuongororwa mumakiriniki ekuedzwa , kusanganisira immunotherapy drug Keytruda (pembrolizumab), stem cell transplants , nezvimwewo. Heano zvimwe zvezvinhu zvitsva zvakawanikwa mukutsvakurudza nezve lymphoma.
Mishonga yekurapa
Kune mishonga yakawanda yekubatanidza iyo inogona kushandiswa zvose pakutanga kana kana follicular lymphoma ichifambira mberi. Izvi zvinosanganisira
- R-Bendamustine (rituximab uye bendamustine) - Kubatana uku kunoratidzika kuva nezvakawandisa (zvishoma nezvirwere neuropathy uye kurasikirwa nevhudzi).
- Treanda (bendamustine) oga
- Rituximab chete
- R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, uye prednisone)
- R-CVP (rituximab, cyclophosphamide, vincristine, uye prednisone)
- Fludara (fludarabine) uye rituximab
- Zydelig (idelalisib) ine kana isina rituximab
- Revlimid (lenalidomide) ane kana asina rituximab
Maintenance Therapy - Apo follicular lymphoma inopindura, chirongwa chakadai se rituximab chinogona kupfuurirwa kwemakore mashomanana kubatsira nguva refu yekuregererwa .
Migumisiro Yechiri
Mimwe migumisiro yechirwere yako ichaenderana nemutano chaiwo waunogamuchira. Nechirwere chinotarirwa sezvakaitwa rituximab, iyo yakanyanya kufanana nayo yechirwere inokonzera kugadziriswa panguva ye rituximab infusions . Dzimwe mimwe migumisiro inogona kusanganisira kuderera kweropa uye kukoromora kana kubuda kwemvura.
Prognosis
Kana follicular lymphoma inowanika mumatanho ekutanga, inogona kurapwa nemishonga inonzi radiation. Asi kunyange nematanho epamusoro epachirwere ichi, vanhu vanogona kupona makore akawanda vachirapa. Chishandiso chinonzi Follicular Lymphoma International Prognostic Index kana FLIPI dzimwe nguva chinoshandiswa kuwana pfungwa pamusoro pekutsanangura kwako. Nhamba iyi inoona zvinhu zvakasiyana zvakasiyana uye inopa nhamba inofungidzira makore gumi ekupona kwechirwere ichi.
Ramba uchifunga kuti pane zvinhu zvakawanda zvakasiyana zvinokanganisa kufungidzira nekenza, uye dzimwe nguva vanhu vanorarama kwenguva yakareba kudarika zvakatarisirwa, kana zvimwewo. Tinoziva kuti kushandiswa kwefodya, kuneta, uye kunwa doro kunosanganiswa nekupona kwakashata, uye naizvozvo mararamiro akanaka anonyanya kukosha.
Kutsungirira
Mushonga we lymphoma uri kuchinja nokukurumidza. Zvakakosha kudzidza zvose zvaunogona nezvekenza yako. Tarisa mazano aya ekutsvakurudza kenza yako paIndaneti . Zvidzidzo zvinotitaurira kuti vanhu vakadzidziswa nezvekenza yavo havasi kunzwa chete mukugadzirisa uye kupiwa simba, asi vanogona kuva nemigumisiro yakanaka zvakare.
Kumbira kubatsirwa uye rega vamwe vakubatsire. Funga kuve mune chikamu chekutsigira uye / kana kuti paIndaneti chinyorwa chinotsigira rubatsiro. Hazvina mhosva kuti shamwari dzako nemhuri yako vane rudo sei, inogona kuva inokosha zvikuru kutaura nevamwe vari kutarisana nematambudziko akafanana.
Chikuru chezvose, yeuka kuti kufambira mberi kunokosha kuri kuitwa mukurapa kwekenza se follicular lymphoma. Iva iwe mupepeti wako semukwere wekenza uye dzidza nezvezviwanikwa izvi. Pane tariro yakawanda.
Caregiving
Kana iwe uri kunetseka kuti chii chaunoda iwe uchida kupinda, unogona kuda kuona kuti vanopukunyirwa nekenza vakati chii pavakabvunzwa mubvunzo: chii chaicho chaizvo kurarama nekenza ? Follicular lymphoma, pakuve kenza inononoka, inowanzovapo kwemakore mazhinji. Mune mamwe mazwi, iyo marathon uye kwete sprint. Tora nguva kuti udzidze nzira yekuzvichengeta iwe pachako sezvaunotarisira unodiwa nekenza.
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Ambinder, A., Shenoy, P., Malik, N. et al. Kutsvaga Nengozi dze Follicular Lymphoma. Kufambira mberi muHematology . 2012. 2012: 626035.
Burke, J., van der Jagt, R., Kahl, B. et al. Kusiyanisa muhutano hwehupenyu pakati peBendamustine-Rituximab uye R-CHOP / R-CVP mune varwere Nepakutanga Vasingazivikanwi Vakanyanyisa Kunetseka Vasina Hodgkin Lymphoma kana Mantle Cell Lymphoma. Clinical Lymphoma, Myeloma, uye Leukemia . 2016. 16 (4): 182-190.
Flinn, I., van der Jagt, R., Kahl, B. et al. Randomized Trial yeBendamustine-Rituximab kana R-CHOP / R-CVP mumutambo wekutanga-Kurapa kweIndolent NHL kana MCL: The BRIGHT Study. Ropa . 2014. 123 (19): 2944-52.
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