Kurapa kwekenza yekushaiwa simba kunobva pachigarire chekenza uye kunogona kusanganisira kuvhiyiwa (kubvisa chikamu kana kuti chese chinokonzera), chemotherapy, remishonga inonzi radiation, inorapwa, kana kuti kliniki kuongororwa kuongororwa kwezvinhu izvi kana mushonga mutsva.
Kurapa, zvisinei, kunongopfuura kungoita kurapa kenza, uye kurapa kana kurapa-kurapa-kurapa kwakarongeka kunobatsira vanhu kurarama nemigumisiro yepanyama, yepfungwa, uye yemweya-inokosha zvakaenzana.
Kusarudza Chirapa Centre
Kunyangwe iwe uchange uchivhiyiwa kana zvimwe zvirwere, kuwana kenza yakanaka yepakati inokosha. Chidzidzo che 2017 muna Annals of Surgery chakasimbisa izvo zvidzidzo zvekare zvaratidza. Vatsvakurudzi vakaona kuti vanhu vane kenza yekushushikana vanofamba marefu marefu kusvika kune-high-volume yekenza nzvimbo vanowana marapirwo akasiyana zvakasiyana uye vanove nemigumisiro yakanaka kune avo vanogara pedyo neimba pamakirini ekenza inobata vanhu vashomanana vane chirwere.
Iwe unogona kufunga kusarudza kutsvaga maonero pane imwe yepamusoro National Cancer Institute-mahara emagariro emukenza; nzvimbo dzinobata huwandu hwevanhu vane kenza yemazino (uye kune avo vanovhiyiwa, vanoita mamwe mavhivhi aya).
Kuchengetedzwa Kwekutsvaga neSiteji
Usati wapinda mune zvakasarudzwa zvinoshandiswa kurapwa, zvinobatsira kukurukura mishonga inowanzoshandiswa pamatanho akasiyana echirwere.
Zvinogona kusiyana zvakasiyana-siyana.
Vanhu vaviri vane chirwere chakafanana chechirwere, somuenzaniso, vanogona kuva nekenza munzvimbo dzakasiyana-siyana dzinoda kurapa kwakasiyana. Kunyangwe nekenza ine yakafanana munzvimbo, nzvimbo, uye kune vanhu vane utano hwakanaka hwakafanana, zvakakosha kuziva kuti hapana kanzura mbiri yakafanana.
Izvozvo zvakati, nzira huru ndeyotevera.
Nhanho 0
Nhanho 0 ( carcinoma in situ ) kana chirwere chiduku zvikuru 1A kanzira dzimwe nguva dzinogona kubviswa kuburikidza ne endoscopy. MuUnited States (kusiyana nedzimwe nzvimbo dzenyika), kenza yemazino isingawanzoitiki uye haigoni kuwanikwa pachigamba zvishoma zvakakwana kuti kubviswa kwekusingaperi kunogona. Kuvhiya kunogona kushandiswawo kune matamu aya.
Nhanho 1
Kuvhiya kunowanzoitwa kurapwa kwesarudzo yekamuti 1 kanzira uye inogona kuva ndiyo chete kurapwa inoda mune dzimwe nguva.
Nhanho 2 ne3
Chemotherapy uye radiation (kana chemotherapy oga) inotevera nekuvhiyiwa ndiyo nzira yakakurumbira, kunyange zvazvo dzimwe nguva chirwere choga, kana chemotherapy chete, inogona kushandiswa. Ikozvino pane mhirizhonga pamusoro pekuti vanhu vane squamous cell carcinomas eopopus vane mhinduro yakakwana (hapana uchapupu hwemuviri) mushure mekunge chemotherapy inoda kuvhiyiwa.
Nhanho 4
Zvine chirwere chepaneji 4A, chemotherapy uye remishonga inonzi radiation dzimwe nguva inofanira kuteverwa nekuvhiyiwa (kana chironda chacho chinopindura zvakanaka kwazvo). Kune chikwata 4B kanzira, chemotherapy dzimwe nguva zvinogona kuita kuti zvisizvo zviite.
Vamwe vanhu vanonetseka kuti, nekuda kwezera, kurapwa kuchava nehasha, asi vanhu vakwegura (vanopfuura makore makumi masere) vane hutano hwakanaka hunoita sokuti vanoregerera kurapwa kwemajoka uye vanove nehupenyu hwehutano hwakafanana nehwevaduku.
Surgery
Kana uchinge uongororwa muzvikamu zvekare zvechirwere, chirwere chinogona kupa mukana wekurapa. Usati watarisa kuvhiyiwa, kunyatsotarisa kunokosha zvikuru. Zvinosuruvarisa, kana kenza yakapararira mberi kwemasimba, chirwere hachigadziri kuponesa asi chinoderedza hupenyu hwehupenyu. Saka zvakakosha kuziva kuti ndiani achabatsirwa nekuvhiyiwa.
Zvakakosha kufanana nekuwana chiremba anovhiya uyo ane ruzivo rwakanyanya pakuita kuvhiyiwa. Kunyange zvazvo chirwere chikuru chekenza chichikwanisa kuva nechiremba chiremba ane ruzivo rwakakura, zvinokosha kutora nguva yeku "kubvunzurudza" mushandi anovhiya pamusoro pezvaanosangana nazvo nekuvhiyiwa kwekushaya mano.
Maitiro
An esophagectomy, chirwere chakaitwa kubvisa kenza yemasophageal, rinoreva kubviswa kwezvose kana chikamu chesophagus. Kune mamwe kanzura, kunyanya avo vari pasi pepasi, chikamu chemuviri chakabviswa zvakare. Mukuwedzera, lymph node dziri pedyo dzinowanzobviswa uye dzinotumirwa kubasa rehutano kuti dziongorore hupi hupi hupi hwekenza.
Mushure mokunge chikamu chesophagus chibviswa, chironda chinosanganiswa kusvika kumusoro (izwi rinorondedzera kusunanisa pamwe chete "anastomosis"). Kana chikamu chikuru chesophagus chibviswa kuitira kuti kusungirirwa kuve kwakaoma kana kusakundikana, chikamu chemukati chinogona kubviswa ndokuiswa pakati pepamusoro nepamuviri uye mudumbu.
An esophagectomy inogona kuitwa nenzira mbiri dzakasiyana:
- Zarura esophagectomy: Munzira yakasununguka, tsvina yakawanda inowanzoitwa mumutsipa, pachipfuva, kana mumimba (kana dzimwe nguva inosanganisira dzose zvitatu) kuburikidza iyo inophagus inowanikwa.
- Minimally invasive esophagectomy: Nenzira shomanana inoputika, tsvina dzakawanda dzinoiswa mumutsipa nepfupa. Chiyero (nekhamera) chinowanikwa kuburikidza nezviitiko izvi uye kuvhiyiwa kunoitwa kuburikidza nehuwandu. Kuvhiyiwa kwemadiki kusinganzwisisiki kunongowanikwa chete nemavhudzi maduku.
Migumisiro Yechiri uye Matambudziko
Kubvisa chikamu chepopu chinhu chikuru chekuvhiya uye zvinetso hazvishamisi. Panguva yekuvhiyiwa, njodzi dzakawanda dzinosanganisira kubuda ropa uye anesthesia zvinosanganisira sekusava nemwoyo kwemaitiro nemapapu emapapu.
Mumazuva anotevera kuvhiyiwa, ropa rinoputika rakawanda kwazvo ( zvakadzika mumasipiresi emvura ) uye dzimwe nguva rinogona kubvisa uye kuenda kumaapapu ( mapaimoni anoitwa ). Zvirwere zvakadai sepneumonia zvinowanzoonekwa munguva yekudzima uye kuparara (uye hutachiona hunotevera uye kuputika) dzimwe nguva zvinowanzoitika apo dhiyo rakasanganiswa zvakare.
Nenguva refu, vamwe vanhu vanoramba vachitsvaga nokuda kwekukuvadza kwemitsipa mubhokisi panguva yekuvhiyiwa. Nharaunda inogona kukanganisawo kuchinja kwemaitiro mumugwagwa wepamusoro wekudya unogona kutungamirira kumushushi nekutura. Kubvira pakaderera esophageal sphincter (boka remaviri pasi pepopu inodzivirira dumbu mukati maro kupinda musimba) inowanzobviswa kana kuora, kupisa kwepfungwa kunowanzoitika, uye vanhu vazhinji vanoda mishonga ye acid asiri.
Chemotherapy
Chemotherapy inoshanda nekurwisa masero mashoma anokamura uye inogona kupiwa mune imwe yenzira dzinoverengeka nekenza yemajoka. Izvi zvinosanganisira:
- Neoadjuvant chemotherapy: Neoadjuvant chemotherapy inoreva kushandiswa kwekemotherapy mushure mekuvhiyiwa kuderedza ukuru hwechirwere.
- Adjuvant chemotherapy: Adjuvant chemotherapy inoreva chemotherapy inopiwa mushure mekuvhiyiwa. Kunyange kana pasina kuonekwa seine kenza yakasara mushure mekuvhiyiwa, masumbu mashoma emasero emukenza anogona kuramba achiita kuti zvive zvakare zvakare. Chemotherapy mushure mekuvhiyiwa kunogona kuderedza dambudziko rekudzoka nekuvandudza kupona kune vamwe vanhu.
- Kurapa chemotherapy: Palliative chemotherapy inoreva kushandisa chemotherapy kuronga zviratidzo uye kuwedzera upenyu nechirongwa chechina zvirwere, asi kwete kuporesa chirwere chacho. Penguva ino, chemotherapy (kunyange kana yakabatanidzwa nemirairo) inogona kuwedzera urefu hwekupona asi haigoni kuporesa chirwere chacho.
Kana kuvhiyiwa kuri kuonekwa, nzira yakakurumbira ndeyokupa chemotherapy (kana kuti pasina remirasi yehutachiona) vasati vavhiyiwa (adjuvant chemotherapy kana chemoradiation). Pane zvikonzero zvakawanda zveizvi.
- Chiremba wako anogona kujekesa kuti chemotherapy inoshanda pane kudzidzira mushure mekuvhiyiwa kana isiri.
- Chemotherapy inowanzoremeswa zviri nani kupfuura kuvhiyiwa mushure mekuvhiyiwa.
- Neoadjuvant chemotheropi inogona kuderedza chirwere (ita kuti ive duku) kuitira kuti kuvhiya zvive nyore kuita.
- Pakupedzisira, kune vamwe vanhu (kunyanya avo vane squamous cell carcinomas), tsvina inogona kuparara kuitira kuti kuvhiyiwa hakudi.
Chemotherapy mishonga inowanzoshandiswa inosanganisira kusanganiswa kweParaplatin (carboplatin) uye Taxol (paclitaxel) kana Platinol (cisplatin) uye Camptosar (irinotecan). Munguva yakapfuura, mishonga 5-FU (5 fluorouracil) yaiwanzoshandiswa, asi inowedzera kuva yakanyanyisa.
Chemotherapy Side Effects
Sezvo nemishonga yakawanda yekenza, zvakakosha kuchengeta mupfungwa kuti zvakaipa zvinokonzerwa nemishonga shamwari kana mhuri inogona kunge yakamboitika kare, haisi iyo inoshandiswa pakurapa kwechirwere chemazuva ano. Chemotherapy madzimai anowanzopiwa mumakumbo (semuenzaniso, vhiki nhatu dzose), kwemwedzi mina kusvika kumatanhatu.
Zvakawanda zvemigumisiro inokonzerwa nemishonga inouraya pamasero evanhu vanowanzoparadzanisa nokukurumidza pamwe chete nekenza masero. Migumisiro yakajairika inosanganisira:
- Ropa rakashandurwa rinoreva: Kuderera kweropa kunokonzera ( bone marrow kuderedza ) zvichiita kuti mucheche weropa rekuyera ropa ( neutropenia ), aine red red cell count ( anemia ), uye pasi peteletti yakawanda ( thrombocytopenia ).
- Kurashirwa kwebvudzi : Mishonga inonyanya kukonzera bvudzi haisati ishandiswa nekenza yemajoka (kunze kweCamptosar) asi kazhinji inokonzera bvudzi kudonha.
Nausea uye kurutsa : Ona pasi apa.
- Peripheral neuropathy: Kubata, kupera, uye kurwadziwa, kazhinji mu "kugovera uye kugadzira gorove" kugoverwa.
- Mucherechedzo wemuromo uye kugadzira kuchinja
- Kuneta
Kungofanana nemishonga yemakemikrasi inoshandiswa mazuva ano isiri yanyanyisa, kutungamirirwa kwemigumisiro yakagadzirisa zvakanyanya. Vanhu vazhinji vane zvishoma kana zvisingambofungi uye kurutsa nemishonga inodzivirira. Kunewo majekiseni anowanikwa kuwedzerwa ropa rekuyera ropa kana zvichidikanwa (kunyange zvakadaro zvichiri kukosha kudzidza pamusoro penzira dzekudzivirira hutachiwana hwehutachiwana panguva yechikemikari ).
Peripheral neuropathy (PN), ndeimwe yezviratidzo zvinoshungurudza zvekemotherapy nokuda kwekenza yecheophage uye inowanzoramba iripo. Mishonga inobatana zvikuru pamwe nePN inosanganisira taxanes (yakadai seTareol), nemishonga yeplatinum (yakadai sePlatinol neParaplatin). Sezvo kusanganiswa kweizvi kunowanzoshandiswa, zvinoitika zvinogona kukudzwa.
Kune dzidzo dzakawanda dziri kuramba dzichitsvaga nzira dzekudzikisa chiratidzo ichi (sekushandisa L-glutamine munguva yekurapa), uye vanhu vanofanira kutaura nevanongori vavo pamusoro pekutsvakurudza kwemazuva masati vasati vatanga chemotherapy.
Radiation Therapy
Radiation therapy inoshandisa mashizha ane simba ekurapa masero emukenza uye inowanzoshandiswa pamwe chete nechemotherapy. Radiation therapy inogonawo kushandiswa pakutsamwa (ona pasi apa). Inopiwa nenzira mbiri dzinokosha:
- Dhiyabhorosi yekunze kwekunze: Kupisa kwemavira kunze kwemafomu vanhu vakawanda vanoziva, uye vanogona kupiwa zuva nezuva kwemazuva mashomanana kana vhiki.
- Brachytherapy (mukati) chirwere chemaawa: Ne brachytherapy, endoscopy inogadzirwa kuitira kuti miviri inogona kuiswa pedo nechirwere chiri mukati memoyo. Inowanzoitwa kakawanda sechirwere chinopisa kubatsira kubatsira nekumedza.
Radiation Side Effects
Zvipembenene zvinowanzoitika zvehutachiona hwehutachiona kumapfupa ndezvekugadzirisa ganda uye kuputika panzvimbo yehutachiona (yakafanana nekupisa kwezuva) uye kuneta . Kupiswa kwechifuva kuchipfuva kunogona kukonzera kupisa kwemapapu ( rayation pneumonitis ). Kana isina kutorwa iyo inogona kutungamirira ku fibrosis yemapapu. Kuvhiringidza kwesophagus ( pulmonary fibrosis ) kunogonawo kuitika.
Targeted Therapy
Targeted therapy inoshandisa zvinodhaka sezvinonzi chemotherapy, asi mishonga "inotarisirwa" kune imwe nzira iyo mukukura kwekenza masero. Nekuda kwechikonzero ichi vanowanzova nemigumisiro shomanana kudarika mhemberero dzemakemikari.
Cyramza (ramucirumab)
Cyramza inonzi monoclonal antibody inonzi ingiogenesis inhibitor. Kuti zviremera zvikure, zvinoda kuumba misha midzi yeropa ( angiogenesis ). Mishonga inovhara danho rinodiwa kuti rigadzirire midziyo mitsva.
Cyramza inowanzoshandiswa kana mamwe maitiro asingashandisi uye anogona kushandiswa kana asina chemotherapy. Migumisiro inogona kusanganisira kuora musoro uye kuwedzerwa kweropa asi pane imwe nguva zviratidzo zvakakomba, zvakadai sokubuda ropa zvakanyanya kana mumukati mutsvuku, zvinogona kuitika.
Maererano nekudzidza muna 2017, kubva mune chemotherapy uye zvakarongwa nemishonga inogona kuwanikwa, Cyramza yakanyatsoratidza zvakajeka kukwanisa kuvandudza zvose zvakasununguka-kusasununguka kwekusununguka uye kurarama kwevanhu vari mberi (danho 4) esophageal adenocarcinoma.
Herceptin (trastuzumab)
Herceptin inoshandiswa pane dzimwe nguva yekufambira mberi kweesophageal adenocarcinomas iyo inonzi HER2 positive (yakafanana neHER2 yakanaka yepamu kanzera).
Kuongororwa kweHER2 kunoitwa pamuenzaniso webundu rakagadzikwa panguva yebiopsy kana chirwere. Aya kanzura ane protein HER2 pamusoro pekamuri, uko kukura kwezvinhu kunosunga uye kunokonzera kukura. Herceptin inosungira kune izvi zvinogamuchirwa kuitira kuti kuwedzera zvinhu zvisingakwanise, kunyanya kushaya kenza yenzara.
Migumisiro inowanzova yenyoro, yakadai senyoka uye fever, uye kazhinji inovandudza munguva. Iyo mishonga inogona, pane dzimwe nguva, inokonzera mwoyo kukanganisa. Chiremba wako achakurukura nezvekuda kweizvi.
Clinical Trials
Iko kune ikozvino kuongororwa kwemakiriniki inoenderera mberi kutarisa kusanganiswa kwezvirapa zvataurwa pamusoro apa, pamwe chete nemishonga mitsva yakadai semishonga yemajoini .
Kunyange zvazvo kupinda muchikwata chekutsvakurudza kunogona kutyisa kune vamwe vanhu, zvinobatsira kuchengeta mupfungwa kuti kurapa kwose kwatinoita iye zvino kwekenza yechegeal yakave yakadzidza mumutambo wekliniki.
Complementary Medicine (CAM)
Penguva ino, hapana "nzira" dzokurapa dzinowedzera kupona kana kuunza mushonga wevanhu vane kenza yemaitiro. Izvozvo zvakati, dzimwe mishonga inogona kubatsira nezviratidzo zvekenza uye mishonga yekenza apo inosanganiswa nemishonga inowanikwa.
Mazhinji emakirini makuru emukenza iye zvino anopa idzi dzimwe nzira dzokurapa kenza pamwe chete nemishonga inokonzerwa nekenza. Mishonga yakadai sokufungisisa, yoga, kugadziriswa, kurapa kurapa, nezvimwe dzimwe nguva zvinogona kubatsira vanhu kuti vatsungirire zvose zvinetso zvenyama uye zvepfungwa zvinoenda pamwe nekuongororwa kwekenza.
Kuchengetedza kwepakati
Kunyatsotarisa kunopesana nekuchengetwa kwekuchengetedza mukuti inogona kushandiswa kunyange kune vanhu vanotarisira kuporeswa kubva kune kenza yavo. Iko kunetseka kunotarisa kubatsira vanhu kutarisa zviratidzo zvepanyama uye zvepfungwa zvine chokuita nekenza uye kurapa kwekenza, kubva pakurwadziwa kwekenza kune kuora mwoyo.
Dambudziko rinomedza nekuda kwekuvharwa kwehutachiona nehutachiona hunojairika nekenza yechirwere uye inopindira chirongwa chakakodzera. Kana chirwere chakanyanya kunyanya kuvhiyiwa (esophagectomy) kune zvimwe zvingasarudzwa zvokuderedza zvinetso nekugwinya. Zvimwe zvezvi zvinosanganisira:
- Kuisa stent munharaunda (kuburikidza ne endoscopy) kuchengetedza sopu.
- Brachytherapy (mukati memirasiyo) yakataurwa pamusoro apa.
- Dhiyabhorosi iri kunze kwemahara.
- Electrocoagulation (inopisa nzvimbo yechipfuva ichikonzera kuvhiringidzika).
- Laser therapy.
Makanzura mazhinji emunharaunda zvino anopa kubvunzurudzwa neboka rinotarisira kutarisira. Kushanda neruzivo rwehutano hwakanaka nguva dzose kunowedzera mukana wekuti zviratidzo zvako zvichabatwa zvakanaka uye kuti hupenyu hwako hunogona kuva hwakanaka sezvaunokwanisa kana uchirarama nekenza.
> Sources:
> Bast, R., Croce, C., Hait, W. et al. Holland-Free Cancer Medicine. Wiley Blackwell, 2017.
> Janmaat, V., Steverberg, E., van der Gaast, A. et al. Palliative Chemotherapy uye Targeted Mishonga yeEsophageal uye Gastroesophageal Junction Kanzera. Cochrane Database yekuongorora kwakarongeka . 2017. 11: CD004063.
> National Cancer Institute. Esophageal Cancer Treatment (PDQ) -Health Professional Version. Yashandurwa 02/06/18.
> Speicher, P., Englum, B., Ganapathi, A. et al. Kufamba kuBhuku Rakakwirira-Bhuku rinosanganiswa neKuponesa Kuvandudzika Kwevarwere NeEsophageal Cancer. Annals of Surgery . 2017. 265 (4): 743-749.