Zvirwere zvepachirwere chepancreatic zvinogona kusanganisira kuvhiyiwa, chemotherapy, kurapwa kwakagadziriswa, uye kukanganiswa kwekliniki kunongororwa mushonga mutsva, wakadai seunopunotherapy. Pamusana pekugadzirisa kusarudzwa kunowedzera hupenyu kune imwe nguva iyo chirwere hachibviri, National Cancer Institute inokurudzira kufunga nezvekuongorora kliniki.
Mishonga yekurapa ikozvino inowanikwa inogona kuiswa se:
- Kururamisa: Aya maitiro anoitwa netariro yekuwana nguva refu yekurarama nechirwere ichi.
- Kuratidzira: Mishonga iyi inogona kusapfuurira kupona, asi inovandudza hupenyu hwevaya vanorarama nehosha.
Mishonga inotarisana nekenza pachayo inogona kuiswa zvakare se:
- Mishonga yemunharaunda: Aya ndiwo marapirwo anobata kenza apo yakatanga, uye anosanganisira chirwere uye chirwere chemaawa.
- Kurapa kwakarongeka: Mishonga iyi yakagadzirirwa kugadzirisa masero emukenza kupi zvako mumuviri (kusanganisira metastases) uye inosanganisira chemotherapy uye mamwe emishonga mitsva iripo mumakiriniki ekuedza.
Pano, mhedziso yezvasarudzo zviripo panguva ino yekurapa kwekutanga uye yakakura yepancreatic cancers.
Surgery
Kuvhiya ndiyo chete nzira yekurapa iyo inopa mukana we "kurapa" kenza, kana kuti kuwedzera mukana wekugara kwenguva refu. Izvozvo zvakati, chete inenge 15 kubva muzana kusvika 20 kubva muzana yevanhu vane kenza yepancreatic ndivo vanoda kuvhiyiwa.
Zvinosuruvarisa, zvinogona kuva zvakaoma, kunyange nemuedzo wekufungidzira watinayo, kuziva kana kenza yakapararira kusvika pakananga kuvhiyiwa kusati kwaitika mushure mekuvhiyiwa pachako kwaitwa. (Kurapa kancreatic kankere dzakapararira, kusanganisira danho rechitatu uye chikwata chezvikamu 4, hazviwedzere kupona asi zvinonyanya kuderedza hupenyu hwehupenyu.) Panguva yokuvhiya, vanachiremba vanoona kuti kenza yakapararira zvakanyanya kuti nzira ione sekanaka dzinenge 20 muzana yenguva.
Vamwe vanachiremba vanokurudzira kuita laparoscopic biopsy (muedzo umo maitiro mashomanana mashoma anoiswa mudumbu uye shanduro inoiswa kuitira kuti abvise chiduku chiduku chepancreas nekuongorora nzvimbo dzakapoteredza) vasati vambovhiyiwa. Kuita izvi kunogona kuderedza mukana wekuvhiyiwa kusina basa uye marwadzo anotevera uye matambudziko aro.
Matambudziko uye Mafungiro
Iyo panikresi inongova shure kwepamuviri uye iri pedyo nezviverengeka zvakakosha zvinovakwa. Pamberi pepascreas inounganidza mishonga yakanyanya yeropa. Kana chirwere chinorondedzerwa se "chinowanikwa munzvimbo," zvinoreva kuti chirwere ichi chinogona kunge chichifukidzira midzi mikuru yeropa, zvichiita kubviswa kwechirwere chose pasina kutyisa midziyo iri pedyo-isingabviri. Kana izvi zvichiitika, munhu angave kana angave asina kubvumirwa kwekuvhiyiwa. Zvimwe zvizere zvepamusoro-soro zvinogona kukwanisa kubvisa uye kuvakazve midzi yeropa kumadhigirii akasiyana, zvisinei, saka mamwe kanzura aimbofungidzirwa kuti haasakwanisi iye zvino anogona kushandiswa.
Kunzwisisa hutachiona kunobatsirawo kune avo vanodzidza kuti vane chirwere chinogadzirisa zvirwere . Izvi zvinosanganisira vanhu vane kenza iyo inofukidza 50 kubva muzana kana iri pasi pechirwere cheropa.
Hapana hutano hwakanaka hwemamiriro ezvinhu aya, asi vamwe vanachiremba vanotenda kuti kupa chemotherapy (kana kuti pasina remirasi yehutachiona) kukonzera tsvina inogona kuita zvakakwana zvokuti inogona kubviswa chirwere.
Maitiro
Kana iwe uchifunga kuti unobvumirwa kurapwa, zvinotevera zvinogona kuitwa:
- Whipple Procedure (Pancreaticoduodenectomy): Inonzi Whipple nzira inowanzoitwa yakakonzerwa nekenza yepancreatic uye inosarudzwa kune vanhu vane kenza yemusoro wepancreas uye yechirwere chekutanga. Mukuvhiyiwa uku, gorofu, iyo yakazara bile duct, chikamu chikuru chepancreas (kusanganisira musoro), chikamu che duodenum, chikamu chemuviri, spleen, uye lymph node dziri pedyo zvakabviswa. Chikamu chemuviri nemuswe wepakreas yasara kumashure kuitira kuchengetedza basa rayo (kugadzirwa kwezvinyamusi zvekudya uye mahomoni).
- Whipple Procedure Variations: Kune misiyano yakasiyana-siyana yeCypple nzira yakachengetedza yakawanda yemudumbu uye chikamu chokutanga chemukati mudumbu, kazhinji inowanzozivikanwa se pylorus-kuchengetedza pancreaticoduodenectomy. Aya maitiro anoitwa kuti abatsire kuderedza mamwe matambudziko anotevera postoperative.
- Pakati Pancreatectomy: Kanza mumuviri kana muswe wepakreas haigoni kushandiswa, asi kana iine, muswe wepancreas unogona kubviswa kana kuti pasina spleen.
- Zvose Pancreatectomy: Total pancreatectomy inonyanya kufanana ne Whipple nzira, asi yakasiyana pakuti iyo yose pancreas inobviswa. Izvi zvinoitwa kana zvichidiwa kubvisa tumarara yose inooneka.
Migumisiro Yechiri uye Matambudziko
Zvose zvinoshandiswa pakushandurwa kwekenza pancreatic ndezvekuvhiya kukuru, uye zvinetso kana rufu hazviwanzozivikanwa. Njodzi dzinowanzoitika dzinosanganisira njodzi dzinowanzobatana neaneshesia, kubuda ropa, zvirwere, nekuvandudzwa kweropa rinopera mushure mekuvhiyiwa. Ngozi yekuvhara ropa yakakwirira kwazvo kune vanhu vane kenza yepancreatic, uye chirwere chinowedzera kune ngozi iyi. Kushandisa kushandiswa kwemakumbo pamakumbo panguva uye mushure mekuvhiyiwa, pamwe chete nevanocheka ropa vanogona kuderedza izvi kusvika pane imwe nguva.
Kunyanya kushandiswa kwenguva refu kwenguva refu kwekuvhiya ndezvekudzoka kwekenza, uye izvi, zvinosuruvarisa, zvakajairika. Mukana wekuti kenza yepancreatic ichadzoka mushure mekuvhiyiwa inobva pane zvinhu zvakawanda, uye muroyi wako chete achakwanisa kuenzanisa kuti izvi zvinorevei kwauri.
Nzira imwe neimwe inogona kuitawo dzimwe nyaya. Somuenzaniso, mu-pylorus-kuchengetedza pancreaticoduodenectomy, kubviswa kwechikamu chemuviri uye chikamu chokutanga chemukati mudumbu chinogona kukonzera dumping syndrome , chirwere chinogona kukonzera kuora kwemashure nguva pfupi mushure mekudya. Iyo inogonawo kuwedzera mukana we bile reflux, mamiriro apo iyo bile inoenda nenzira isina kururama uye inopinda mudumbu inokonzerwa nekuputika uye kusagadzikana.
Apo pancreatectomy yakazara inogadzirwa, zvose pancreatic work, zvirokwazvo, yakarasika zvachose. Hakuchina kugadzirwa kwe insulini, glucagon, kana kuti michemine enzymes. Chirwere cheshuga hachidziviriki uye insulin therapy uye kushandiswa kwe enzyme zvinodiwa mushure mekuvhiyiwa.
Zvichida iwe uchada kuwedzera mamwe enzymes kana mahomoni mushure mekunge chikamu chepancreas chibviswa chinoenderana nezvimwe zvinhu, kusanganisira kuwandisa kwepascreas kubva mumarara pamberi pokuvhiyiwa. Nenzira yakanaka, vanhu havadi pancreas yavo yose kuti vawane yakawanda ye insulini, uye kurarama hupenyu huripo hunoita mushure mekuvhiyiwa.
Palliative Surgery
Kuvhiya kunogonawo kuitirwa vanhu vane kenza yepancreatic kuti vadzivise zviratidzo asi kwete kurapa chirwere chacho. Izvo zvakajairika zvekuti bundu yevanhu yakawanda inodzivirirwa nemamota aya. Kana izvi zvikaitika, stent inogona kuiswa (kuburikidza ne endoscopy) kana kuti chirwere chinopfuura chikwata chingaitwa.
Kusarudza Chipatara
Kana iwe uri mukana wokuvhiya, zvakakosha zvikuru kuti iwe utsvake kuchipatara chinotakura bhuku guru rezvivhiya izvi. Izvozvo zvinoreva kusarudza nzvimbo inobata chirwere chepancreatic kanopfuura chegore gore negore uye inogona kurondedzera njodzi yakaderera yekufa uye chipfupi chipatara chinogara.
Chemotherapy
Chemotherapy inogona kushandiswa nenzira shomanana yevanhu vane kenza yepancreatic.
Neoadjuvant chemotherapy: Neoadjuvant chemotherapy inoreva kushandiswa kwekemotherapy mushure mekuvhiyiwa kuitira kuti tibvise tumarara kuitira kuti kuvhiya kunobvira (sezvakakurukurwa pamusoro).
Adjuvant chemotherapy: Adjuvant chemotherapy inoreva chemotherapy inoshandiswa kuwedzera pakuvhiya. Mishonga yepancreatic inowanzodzoka shure kwekuvhiyiwa, zvinoreva kuti masero emukenza anowanzosiyiwa kumashure (asi angave akareruka kuti asaonekwe pamifananidzo yekufungidzira). Apo chemotherapy inoshandiswa mushure mekuvhiyiwa, inofungidzirwa kuti inovandudza kupona kwemwedzi mitatu kusvika mina.
Kurapa chemotherapy: Nguva yakawanda apo chemotherapy inotorwa nekenza yepancreatic, inopiwa netariro yokuti ichawedzera hupenyu, asi kwete kurapa kenza. Kakawanda, chemotherapy inobata zviduku, asi kuchinja kunokosha kwehurefu hwekupona.
Zvinodhaka zvinowanzoshandiswa zvinosanganisira:
- Abraxane (albumin-bound paclitaxel)
- Gemzar (gemcitabine)
- 5-FU (fluorouracil)
- Onivyac (irinotecan liposome injection)
Iyi mishonga inowanzopiwa pamwe chete uye inogona kupiwa pamwe chete nechirwere chinotarisirwa, immunotherapy, kana dzimwe nguva, remishonga inonzi radiation. Mishonga iyi inopiwa intravenously pane dzimwe nguva (yakadai kamwe kamwe pavhiki kwevhiki nhatu, kuteverwa nevhiki imwe kubva) kwezviitiko zvakawanda.
Imwe mitatu inosanganiswa nemishonga, Folfirinex (5-FU / leucovorin, irinotecan, uye oxaliplatin) inoratidzika kushanda zvakajeka, asi inonyanyisa kudarika zvimwe zvingasarudzwa uye inoshandiswa zvikuru kune vanhu vane hutano hwakanaka (avo vane maitiro akanaka ). Chirongwa che 2018 chekuongorora kwakatarisa kusanganiswa kwakasiyana-siyana kwezvinodhaka kwakawanikwa kuti Folfirinex yakava nemigumisiro yakakura pakuwedzerwa kupona.
Migumisiro Yechechi Chemotherapy
Izvozvo zvinokonzerwa nekemotherapy zvinogona kuva zvakakosha uye zvinosanganisira bvudzi rinorasikirwa; kushungurudza uye kurutsira (kunyange zvazvo kurapwa kuderedza zviratidzo izvi kwakagadzikana zvikuru mumakore achangopfuura); pfupa remapfupa ekuderedza zvichiita kuti kuderedzwa kuwanda kwehuchena ropa, masero matsvuku eropa (anemia), uye maplatelet, nezvimwewo.
Targeted Therapy
Targeted therapies mishonga inotarisa nzira dzinoenderana nekukura kwekenza masero. Sezvo zvirwere izvi zvinongororwa zvakananga nekenza masero anowanzo (asi kwete nguva dzose) ane zvishoma zvinokonzera kupfuura chemotherapy.
Chirwere chemuromo chinowanzoshandiswa kune vanhu vane kenza yepancreatic, Tarceva (erlotinib) inoshanda nekuvhara nzira mukukura kwemasero ekenza. Pane kuuraya masero emukenza, inowanzovapa nzara uye inodzivisa kudzokorora kwavo. Tarceva inowanzoshandiswa pamwe chete naGemzar. Zvipembenene zvakanyanya kuwanikwa zveTarceva zvinosanganisira rheya-soro rehash and diarrhea.
Clinical Trials
Kune huwandu hwemakiriniki emakiriniki anoenderera mberi kwepancreatic kanhi yekuedza kuongororwa kwakasiyana-siyana kwemishonga inopfuura apa, pamwe chete nemishonga mitsva yakadai semaminisitiri . Kunyange zvazvo dzimwe nzira dzekurapa dzichangotanga kuongororwa nekenza yepancreatic, dzimwe nguva dzakatungamirira kukurudzira kukuru kwekenza, dzakadai sekenza yemapapu, uye inounza tariro yokuti kurapa kwakanakisisa kwekenza yepancreatic ichawanikwa mune ramangwana.
Complementary Medicine (CAM)
Penguva ino, hapana mishonga inoratidzira iyo inoratidza kushanda kupi mukurapa kenza yepancreatic. Dzimwe nzira dzokurapa dzakasiyana-siyana , zvisinei, dzinogona kubatsira vanhu kukunda zviratidzo zvinokonzerwa nekenza uye kurapwa kwekenza, uye mazhinji emakirini makuru emukenza iye zvino anopa maitiro ekubatanidza. Mienzaniso inosanganisira kugadziriswa, kufungisisa, kuporesa, uye yoga.
Zvigadzirwa
Vanhu vazhinji vanotsvaka kudya uye mishonga inowedzera apo pavanodzidza nezvehuwandu hwekenza yepancreatic. Zvakakosha kucherechedza kuti mamwe mavitamini uye zvinovaka muviri zvinogona kuderedza kushanda kwemishonga yekenza .
Tsvakurudzo mubazi yakatarisa mishonga shomanana inoshandiswa muAyurveda, yakadai sa triphala, uye nigella sativa (black caraway). Nepo pave pane zvivimbiso zvinoratidzira zvichiratidza kuvharwa kwekukura kwevanhu pancreatic masero akakurira mu test tube, hatizivi kana zvimiti izvi zvingava nemigumisiro yevanhu pachavo. Mukuwedzera, izvi zvinowedzera zvisingabhadharwi muUnited States uye zvinogona kupindira mune dzimwe mishonga. Ichi chiyeuchidzo chakanaka, zvisinei, kutaura neoncologist yako pamusoro pevhitamine chero ipi zvayo, zvicherwa, kana zvekudya zvinowedzera iwe uri / uri kufunga nezvekutora.
Zvinofadza, kutsvakurudza kutarisa kenza yecachexia (chirwere chekureruka, kurasikirwa kwechido, uye kurasikirwa kwemasamu mashoma anokanganisa vanhu vakawanda vane kenza yepancreatic) akawana kuti omega-3 mafuta akawanda anokwanisa kuva anobatsira-anokosha, sezvo pane zvishoma chaizvo izvo zvinonyatsoita mutsauko mune chirwere ichi. Sezvo cachexia inofungidzirwa kuti ndiyo inokonzera rufu mu 20 muzana yevanhu vane kenza, izvi zvakakosha kutaura nemumwe wako oncologist pamusoro. Kune zvakawanda zvinobva kune omega-3s yezvokudya, uye kazhinji nguva ye oncologist inokurudzira kuwana michero kuburikidza nekudya panzvimbo yekuwedzera.
Kuchengetedza kwepakati
Kunyatsotarisirwa hazvifananidzi nehutachiona, uye zvinogona kushandiswa kunyange kune vanhu vane zvipembenene zvinorapwa zvikuru. Inotarisa kuhutano uye hutano hwevanhu vanogara nekenza, panzvimbo pokurapa kenza pachayo. Kunyatsotarisa ndezvechokwadi chekuita kurapwa kwevakawanda vevanhu vanoonekwa kuti vane kenza yepancreatic. Izvi zvinogona kusanganisira kuvhiyiwa kana chemotherapy, sezvataurwa pamusoro apa, asiwo mamwewo maitiro.
Mienzaniso inosanganisira kutarisira zvakanaka kurwadziwa; kutarisa zvimwe zviratidzo zvepanyama, zvakadai sezvirwere zvekudya; utsi hwekudya; uye kutsigira mupfungwa kunetseka, kuzvidya mwoyo, uye kuora mwoyo. Kunyatsotarisirwa kunogona kubatsirawo pakugadzirisa zvinetso zvemuMweya, mutarisiri wekuda nekukurukurirana, uye nyaya dzinobatsira kubva ku inshuwarisi kusvika mune zvemari uye kutsigirwa kwemutemo.
Kanzira dzakawanda dzinowanikwa iye zvino dzinobvunzurudzwa neboka rinotarisira kutarisira kuti zviratidzo zvirongedzwe pamwe chete.
Mishonga yeMusha uye Upenyu
Sezvo hupenyu hwehupenyu nekenza yepancreatic inokosha zvikuru, zviyero zvinovandudza iyo inokosha. Kudya kudya kwakagadzikana hakugone kuita mutsauko nekenza yako, asi vanhu vazhinji vanofunga zviri nani kana vachidya kudya kunowanikwa muzvibereko nemiriwo. Kudzidzira muviri kunobatsira uye, zvichida zvinokonzera, zvinogona kubatsira kuderedza chirwere checachexia.
Vamwe vanhu vanoshamisika kana zvakakosha kurega kusvuta mushure mekunge vaongororwa, kunyanya nekenza yepancreatic yakakura. Mhinduro ndeyekuti hongu. Pane zvikonzero zvakasimba zvakakonzerwa nei kuregera mushure mekuonekwa kwekenza kunogona kubatsira zvikuru.
> Sources:
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> De la Cruz, M., Young, A., naMr Ruffin. Kuongororwa uye Kutungamirirwa kweCancreatic Cancer. American Family Physician . 2014. 89 (8): 626-632.
> National Cancer Institute. Pancreatic Cancer Treatment (PDQ) -Health Professional Version. Updated 01/26/18. https://www.cancer.gov/types/pancreatic/hp/pancreatic-treatment-pdq
> Zhang, S., Liu, G., Li, X., Liu, L., uye S. Yu. Kubudirira kweMakomotherapy Akasiyana-siyana Anoshandiswa Mukurapa Kwekuwedzera kana Metastatic Pancreatic Cancer: A Network Meta-Analysis. Nhamba yeCellular Physiology . 2018. 233 (4): 3352-3374.