Iko kuongororwa kwakawanda uye nzira dzinogona kushandiswa kuongororwa nekenza yevarivha, kusanganisira kuongorora kweplavic; miedzo yekufungidzira, yakadai se transvaginal ultrasound, CT, MRI, kana PET scan; uye kuongororwa ropa, zvakadai seC CA-125. Kuti zviongororwe, bhiopsy inowanzodiwa kuti zvose zvigadzirise kuti uwandu hwakaipa (kanzira) uye hunoziva rudzi rwechirwere chechirwere chacho.
Kana kuongororwa kuchiitwa, izvi zvinowedzera uye mimwe miedzo inoshandiswa kugadzirisa danho rechirwere, izvo zvichabatsira kutsanangura nzira yakanakisisa yekurapa.
Self Checks / At-Home Testing
Zvinosuruvarisa, hakuna huno-checks chekenza yevana. Uyezve, pa-kumusha maitiro ezve genetic haigone kunyatsoona mungozi yako yekuvandudza chirwere chacho. Zvakakosha kuti vakadzi vose vazive zviratidzo uye zviratidzo uye vataure navanachiremba kana vane chero njodzi dzinokonzera chirwere chacho.
Kuongorora Panyama
Hapana mazano ekuongorora maitiro ekenza yevana. Zvisinei, chirongwa chepilvic chinowanzoitwa nachiremba wako (kana chimwe chakaitwa nekuda kwekuvapo kwezviratidzo) chinogona kuona huwandu munharaunda yako yenyuchi, inozivikanwa seadnexal mass. Zvisinei, cheki iyi ine zvisingakwanisi.
Kuongorora kunoitwa bimanually neruoko rumwe mumudzimai wako uye imwe pamimba yako. Sezvo chiremba ari kunzwa nekuda kwechirwere chako pasi pemafuta ane mafuta, kuongorora hakusi kwakarurama pakutsvaga uwandu hwevanhu vari kuwandisa kana kuoma.
Kunyange mumadzimai akaonda, kuongorora kwepachiviki kunogona nyore nyore kupotsa zvipembenene zviduku.
Zvakakosha kucherechedza kuti Pap smear chete (pasina bimanual kuongorora), neinobatsira pakutsvaga kenza yemukomana, haibatsiri pakuwana kenza yevana.
Imaging
Kufungidzira kuongororwa kunodiwa zvose zvinowanikwa mauto mashoma ovarian uye kuti uwedzere kunzwisisa masasa anokwanisa kunzwika pakuongorora.
Zvimwe zvinosanganisira:
Transvaginal Ultrasound
Muchengetedzwa inonzi ultravicound isu inoshandisa mazai ezwi kuti aumbe mifananidzo yezviputi. Inowanzotanga kuedzwa kwakaitwa kuti iongorore uwandu hwemapurisa uye hahudzidzise vanhu kumasana. Nzira yacho inogona kuitwa kana mudumbu (iyo probe yakagadzirirwa pamusoro peganda rako) kana kuti transvaginally (probe inowanikwa mumudzimai kuti iswedere pedyo neavary). Zvisinei, iyo yekare haina kufanana neyekupedzisira pakujekesa mashizha evhavha, kunyanya iyo iduku.
An ultrasound inogona kupa chiyero chehukuru hwehukuru, pamwe nekugadzirisa kana iri krisst iri nyore, cyst yakaoma, kana yakasimba. Zvisi nyore cysts zvinowanzoshaya bhendi. Kirasi yakaoma inogona kunge ine simba, asi inomutsa kunetseka pamusoro pekuve nekenza kana ine mutsara kana kuti zvinokonzera (kusagadzikana kukura). An ultrasound inogonawo kutarisa kusununguka kwemvura mukati memapapiro, chimwe chinhu chinowanzoonekwa nemakumbo akapfuura.
Mimba uye / kana Pelvic CT Scan
A CT scan inoshandisa mifananidzo ye X-rays kuti igadzire mufananidzo wemuviri kana mapfupa. Inogona kushandiswa kubatsira pakunorwara, asi inowanzoshandiswa mumutsara wepakati. Iko muedzo wakanaka kuongorora lymph nodes, utumbo, chiropa, nemapapu (chifuva CT scan) chero humwe uchapupu hwekuti kenza yakapararira (inoshandiswa mastasi ).
Mitemo yaunogona kuona pamushumo wako inosanganisira ascites (fluid build-up mudumbu); metastases (nzvimbo dzekupararira); carcinomatosis (yakawanda nzvimbo dzomukaka); omental cake (thickening ye omentum, mafuta anowira pamusoro pemitezo yemimba); mafuta anokwidza (kurira mumimba mishonga mishonga); uye kupisa (fluid kuvaka). Uyewo, lymph nodes inogona kurondedzerwa seyakakuriswa. Nhengo dzakakura dzakapetwa dzinowanzove dzakakura kudarika 2 cm (inenge inenge 1 inch) muhupamhi uye inogona kuva nenzvimbo dzepakati necrosis (sero rufu) kana kenza iripo.
MRI
MRI (magnetic resonance imaging) inogona kushandiswa nenzira yakafanana neC CT scan asi haina kusanganisira mashizha, zvichiita kuti ive yakachengeteka kuedza panguva yekuzvitakura.
MRI inofanirwa kuva nani pane CT pakujekesa mhando dzisina kunaka uye dzinogona kushandiswa kujekesa kutsvaga kune dzimwe mimwe miedzo.
PET Scan
Kunyange zvazvo CT, MRI, uye ultrasound zvirongwa zvekufungidzira zvinyorwa (zvinotarisa kusaremara kwepanyama), PET scan ndiyo chirongwa chinoshanda, icho chiyero chemuitiro. Chiyero ichi chakaoma chinotsvaka humwe hwehutachiona (hunopararira) kupi zvako mumuviri uye hunobatsira mukusarudza pakati pehutachivara uye kenza.
Ne PET scan, shoma shoma yehuyoya inopindwa muropa. Iko kunotorwa kunoitwa mushure mokunge shuga yave nenguva yekugadziriswa nemasero. Mamwe masero anokura achikurumidza, akadai sekenza masero, achavhenekera pamifananidzo iyi, iyo inowanzobatanidzwa neC CT.
Labs uye Miedzo
Mukuwedzera kune zvidzidzo zvekufungidzira uye kuongorora, basa reropa rinoitwa kuti utsvake humwe uchapupu hwokuti kusina kuwanikwa kunowanikwa mukuongororwa uye / kana kufungidzira kune kenza kana kwete. Miedzo inogona kusanganisira:
Ropa Kushanda Kunetseka Kuonekwa Kwekucherechedza
Zvimwe ropa rinogona kuongororwa rinogona kuona mapuroteni anozivikanwa semaror markers. Zvimwe zvacho zvinokonzerwa nemasero ose evanhu vane kenza uye mahara, saka kenza yemaawa inotaridzika inoratidzirwa kana yakawanda iri muropa yakakwirira pane yakasarudzwa. Zvimwe zvipembenene zvinokonzerwa nemakumbo zvinongororwa nemasero evhavhaya anenge ava nekenza uye haaoneki kune vanhu vasina kenza yevana, saka kuvapo kwavo chete ndiko chiratidzo chechirwere.
Kuziva izvi zvinokonzera marara muenzanisi yeropa haisi nzira inobatsira yekuratidza kenza yevana, asi inogona kubatsira mukugadzirisa uye nekuteerera mhinduro dzeaikonzera pakurapa.
- CA-125: CA-125 chiyero chinowanzoitwa apo pane kunetseka pamusoro pemukenza unogona kubuda. Kunyange zvazvo uwandu hwacho hwakakwiridzirwa muhuwandu hwemapumviri e epithelial ovarian, kune zvikonzero zvakawanda nei chiyero ichi chisingazosimudzirwe (zvisiri zvenhema) uye zvikonzero zvakawanda nei zvichigona kunge zvakakwirira pasina kenza yemaawa inenge iripo (nhema dzenhema). Mamwe mashoma emamwe mamiriro ezvinhu anogona kuwedzera CA-125 anosanganisira kuberekwa, polycystic ovarian syndrome, chirwere chepachivi chinoputira, pancreatitis, cirrhosis, uye lupus.
Nekenza yeAvari, CA-125 inowanzove yakakwirira mune serous uye endometrioid subtypes. Kunyange zvazvo pane zvakawanda zvinokonzera kukanganisa kunokanganisa, mhedzisiro yakakwirira (yakadai seC CA-125 kune 1000) inowedzera mukana wekuti kenza yevarivha ndiyo inokonzera. Nhamba yeCA-125 panguva yekuongororwa ingabatsirawo kufanotaura kufungidzira. - Human epididymis protein 4 (HE4): HE4 inogona kubatsira kana inosanganiswa neA CA-125 uye inogona kunge yakakwiridzwa nemararamiro e-serous uye endometrioid epithelial ovarian. Uyu muedzo haubatsiri kuvakadzi vaduku, nekuda kwechirwere chevana vanopinda mahara kanowanikwa kazhinji mumadzimai ekutanga.
- CA 72-4: CA 72-4 inogona kukwidziridzwa mune dzimwe dzakawanda (kanowanzogadzirisa mafungiro) nemamiriro ezvinhu panguva yekufungidzirwa zvinogona kubatsira kufanotaura kufungidzira kune vamwe vanhu.
- CA-19-9: Ichi chirwere chinoputika chinonyanya kuonekwa muzvipembenene mucinous epithelial ovarian.
- CEA (carcinoembryonic antigen): CEA haisi mumiririri uye inogona kukwidziridzwa mune dzimwe mimwe makondombera, pamwe chete nemigumisiro yematumbo.
- Alpha-fetoprotein (AFP) uye chorionic gonadotropin (HCG) yevanhu: Vanhu vanonyatsoziva neHCG ndivo vanoita kuti vawane pamuviri mutsva, uye AFP ichienzaniswa panguva yekuzvitakura, asi zvose izvi zvinokonzerwa zvinogona kukwidziridzwa mumakumbo emakumbo.
- Estradiol uye inhibin: Zvose isradiol uye inhibin zvinowanzokwidziridzwa mumusikana kana vakadzi vane chirume chepabonde-stromal tumor or germ cells tumor, uye inhibin kazhinji inoputirwa ne granulosa cell tumor in vakadzi vechidiki (rudzi rwechiremera chetsika).
Mimwe Miedzo Yeropa
Mimwe miedzo yeropa inogona kubatsira mukugadziriswa inosanganisira ropa rakazara kuverenga (CBC), LDH, alkaline phosphatase, uye sed sed kana C-reactive protein test (iyo inotarisa kuvhiringidzika).
Kutsvakurudza kwakawana kuti kusanganiswa kweimwe tsvuku yeropa dzemaoko , iyo inonzi red red cell rekupararira yakareba (RDW), uye inoreva hove yeplatelet (MPV) inogona kubatsira mukufanotaura kuti zvipembenene zvipi zvinokonzera kenza uye izvo zvisiri. (RDW inowedzera kuva yakakwirira uye MPV yakasuruvara nekenza yevana.)
Ovarian Risk Index
Dambudziko rakasiyana-siyana rekurwara mahara rinotarisa kusanganiswa kwezvakawanikwa pazviedzo uye kufungidzira kufanotaura kana dambudziko rinogona kuva kenza yepamusoro uye kana chidimbu ichidiwa. Kunyange zvazvo izvi zvingave zvichibatsira, zvinangwa zvekufungidzira njodzi zvinonyatsojeka kana zvichishandiswa pamwe chete nehutano hwekuzvidzivirira weimwe nyanzvi, yakadai sechirwere chezvemagetsi.
Kuvhiyiwa Bhuku
Bhiopsy yechirungu chinoshungurudza inowanzoitwa kuburikidza nekuvhiyiwa. Dzimwe nguva, nenyuchi inonzi biopsy (iyo inoshandiswa nenyuchi iri mukati meganda) inogona kufungwa, asi inofungidzirwa kuti kana kenza yevarivha iripo, izvi zvinogona kuguma kune izvo zvinonzi mbeu (kupararira kwemarara).
Bhiopsy yokuvhiya inogona kuitwa pamwe ne laparoscopy, chirwere umo maitiro mashomanana mashoma anoitwa mudumbu uye purogiramu ine kamera uye zvigadzirwa zvinoshandiswa, kana kuti laparotomy, uko kushandiswa kwetsika kunoitwa mudumbu. Bhiopsy (sampuli) inotorwa uye inotumirwa kune chiremba kuti aone kana iri kenza, uye kana zvakadaro, rudzi.
Kana iwe uine biopsy, muchengeti wezvirwere anotarisa muenzanisi sezvakadzorerwa uye zvikamu zvechando kuti zvive nehutachiona huri mberi. Pamushumo wako, samuenzaniso icharondedzerwa seine bhendi (kwete-kanzira) kana yakaipa (isina kenza). Ona pasi apa kuti uwane mamwe mashoko pamusoro pekuongorora maitiro emapurisa mushure mekuvhiyiwa kwekenza yevana.
Kusiyanisa Kuongorora
Chiyero chinonzwika munharaunda ye ovary uye fallopian tube pamubvunzo kana kuongorora mifananidzo inonzi inonzi adnexal mass . Zvishomanana zvezvinokonzera (pane zvakawanda) zvinogona kusanganisira zvinotevera, izvo zvese zvingafungidzirwa kunze kwekenza yevana:
- Ovarian cysts: Ovarian cysts yakajairika, asi inogona kuve yakasiyana nemasimba akaoma kana maitiro akakomba e ultrasound
- Chirwere chechipembenene chinoputira (PID): NePID, nhengo inogona kuitika inokonzera kuti mashoma anzwe kana kuonekwa.
- Endometriosis: Endometriosis inzvimbo umo hutachiona hunokura kunze kwechibereko.
- Zvironda zveBenign ovarian: Kazhinji, zviputi zvinowanikwa mumadzimai e-premenopausal zvinowanzoita kuti zvive zvakanaka kana izvo zvinowanikwa mumadzimai emasimopaopausal zvinowanzova zvakaipa.
- Polycystic ovarian syndrome (PCOS): PCOS inowanzoita kuti vakadzi vape majekiti akawanda mavari mavari.
- Corpus luteal cyst: Hazvishamisi kuti vakadzi vave ne corpus luteum cyst pakuzvitakura.
- Ectopic (tubal) pamuviri: Tubal pamuviri ungakonzera kuwanikwa kwakafanana nekenza yevana, uye pavanenge vachiitika pakutanga kwepamuviri, vakadzi dzimwe nguva havazivi kuti vane pamuviri.
- Ovarian torsion : Izvi zvinogona kutungamirira mukuputira uye kubuda ropa uye zvinogona kuitika pachayo kana kuti yechipiri kune chiremera chemavhiri.
- Appendiceal abscess: Kana appendix rupture, inogona kukonzera abscess pedyo nenharaunda yakakodzera.
- Tsitsi dzepelvic: Izvi zvinosanganisira mafungiro anoramba ari mumapapiro panguva yekukura kwekuberekwa uye angatanga kutanga aonekwa sehuwandu mumapanga.
Kuongorora miedzo
Kana kuongororwa kwekenza yemaawa inenge yashandiswa, danho rinotevera riri kutarisa chirwere chacho. Zvimwe zvemashoko anodiwa pakugadzirisa zvinogona kuunganidzwa kubva kumifananidzo yekufungidzira uye bhiopsy, asi kazhinji kuvhiyiwa (kubvisa mazai ezvo uye kazhinji mamwe maviri) kunodiwa kuti unyatsoronga kenza. Kuenzanisira kunze kwemukati wekenza kunokosha mukusarudza nzira dzakanakisisa dzokurapa.
Mushure mekuvhiyiwa, chiremba wako anokwanisa kutumira chero mhuka dzakabviswa kune chiremba. Izvi zvinogona kusanganisira mavha mavari, fallopian tubes, chiberekero, uye mhuka uye maikirwo akatorwa kubva kune dzimwe nzvimbo dzedumbu rako. Pasi pema microscope, iye achasimbisa kuongororwa kwekenza yemuvhari uye oonawo kuti zvipi zviduku zvine kenza masero.
Maviri ekufungidzira uye kuvhiyiwa kunogona kubatsira kuziva kana kenza yakapararira kune lymph nodes kana dzimwe nzvimbo dzomuviri. Pamakemikari anopfuura ovarian, biopsies inowanzotorwa kubva kuma-lymph nodes, omentum (mafuta, chigadziro-chakafanana nechepamusoro pemukumbo), uye kazhinji nzvimbo dzakawanda dze peritoneum (iyo micheche inotarisa mimba yemimba). Mumwe chiremba anovhiya achabvisa kana kutora mutsara wezvinyorwa zvinotyisa zvinotyisa kana mamwe mashoma. Kana kenza yaiva mucinous, zvinyorwa zvichabviswa.
Kushambidza kunogonawo kuitika, umo chirwere chinopinda chirwere chinokonzera saline mudumbu uye zvino chinodzosera mvura inotarisa kutsvaga uchapupu hwekenza masero.
Zviwanikwa zvinobatsira kutsanangura nzvimbo yacho zvinosanganisira:
Tsika uye subtype: Kuziva rudzi rwechirwere chekenza yevana vanokwanisa kupa ruzivo pamusoro pekutarisirwa kwekutsvaga kwechirwere uye kana kuchikurumidza kana kukura zvishoma.
Tumorire giredhi: Ichi chiyero chekurwisa kwechiremera. Ne cancers endometrioid ovarian, kenza inopiwa bhomba yepamusoro pakati pe1 ne3:
- Bhuku 1: Maseji anowanzoonekwa achionekwa (akaparadzaniswa) uye anowanzove asina kunyanyisa.
- Bhuku 2: Maseji anowa pakati pezviri pamusoro apa uye pasi pezvikamu.
- Bhuku 3: Maseji anotarisa zvikuru (asingabatsiri) uye anowanzova nehasha.
Simba remhonje inopiwa chimwe chezvikwereti zviviri: panzvimbo yepamusoro kana yepamusoro.
Nhanho
Kenza yeOvarian inoshandiswa kushandiswa kana nzira dzakakwana kana dzakakwana FIGO yekugadzira. Zvitsva zvinogona zvakare kutsanangurwa sekenza yemukati. Kunyange zvazvo pasi apa inonyanya kukanganisa chiremba wako, zvinogona kubatsira kana iwe uchiedza kunzwisisa kuti ndezvipi zvirongwa zvekurapa zvingave zvakakodzera kwauri.
Borderline Ovarian Cancer
Makondombera e-ovarian e-boundary ndeaya ane hutachiona hwakakosha. Izvi zvinowanzotanga matanho epakutanga uye kazhinji hazvikure shure mushure mekuvhiyiwa. Izvi zvinogona kupiwa mukana kana chiremba wako asina chokwadi paanovhiyiwa kana kanhi yepamusoro yekenza iripo, kana kana ichionekwa pane yakapararira kwechirwere.
Yakareruka Kutaura
Kuti uwane mufananidzo wakajeka wekusiyana pakati pezvikamu, izvi zvinogona kuputsika kusvika:
- Nhanho 1: Mucheche unongowanikwa kune ovary.
- Chikamu chechipiri: Chirwere chakapararira kune nhengo dzepachiviri (zvakadai sechibereko uye chetatupi), asi kwete mumimba yemimba.
- Chikamu chechitatu: Chirwere chakapararira kune nhengo dzepamuviri (somuenzaniso, pamusoro pechiropa kana maronda) kana lymph nodes (pelvic kana mimba dzomukati).
- Nhanho yechina: Chirwere chakapararira kune nzvimbo dziri kure, dzakadai semapapu, chiropa (mukati kwete kwete kumusoro), uropi, kana kuti nhengo dzakare kure.
- Kudzokorora: Kanzera inowanzobuda mahara inotaura nezvekenza inodzoka panguva kana mushure mekurapa. Kana kenza inodzoka mumwedzi mitatu yokutanga, inowanzoonekwa sekufambira mberi panzvimbo pokudzoka zvakare.
FIGO Yakazara
IFIGO yakazara, yakatumidzwa kuti International Federation of Gynecology uye Obstetrics, ishanduro yekutsvakurudza inoshandiswa inoshandisa maRoma nhamba dzezvikamu (kufungidzira kushambadzira) uye tsamba dzezvikamu (izvo zvinobatsira kutungamirira kurapa kurapa).
- Nhanho IA: Mucheche unopera kune imwe ovary uye kunze kwekuvhara mutsva haisi kuputika. Hakuchina mutezo uri panze wekunze uye hapana yakwira uye / kana kushambidzwa kusina kunaka.
- Chikamu IB: Chirwere chinowanikwa mune mazai maviri, asi iyo kapule yekunze haina kusimba uye hapana maronda kune imwe kunze. Iko pasina ascites uye kushambidzwa hakuna kunaka.
- Chikamu IC: Mucheche unove danho IA kana IB yezinga, asi capsule inoputika, pane chiremera chiri pamusoro pevhiriji, kana kuti masero anonyangadza aripo ku ascites kana kushamba.
- Nhanho IIA: Mucheche unosanganisira imwe kana mavari mavari uye inowedzera kumucheche uye / kana fallopian tube. Kushambidzwa kusina kushambidza uye hakune ascites.
- Nhanho IIB: Mucheche unosanganisira imwe kana mavari mavari uye inowedzera kune mamwe maviri eplavic kupfuura chibereko uye fallopian tube. Kushambidzwa kusina kunaka uye hakune ascites.
- Nhanho IIC: Mucheche unosanganisira imwe kana mavari mavari uye inowedzera kumapukisi emaPlavic seGadhe IIA kana IIB, asi nehutachiona hwakashambidzwa.
- Chikamu IIIA: Kanzera yakapararira kune lymph nodes. Dumbu racho rakazara (kune ziso rakashama) rakavharirwa kumapapiro asi ne microscopic peritoneal metastases (inopararira inowanikwa pasi pe microscope) kunze kwemapapiro kusvika pamimba pecononeal surfaces kana omentum. Iomentum ndiyo inoratima yakaora iyo inoputika mumatumbo uye dzimwe nhengo dzepamuviri.
- Chikamu IIB: Kanzera yakapararira kune lymph nodes. Chikamu ichi chakafanana nechitambo IIIA, asi nekupararira kukuru (kupararira kunogona kuonekwa pachena) ku peritoneum kana omentum. Panguva ino, nzvimbo dzekenza dzakapararira dzinopfuura 2 cm (zvishomanana kudarika masendimita) muhukuru.
- Chikamu IIIC: Kanzera yakapararira kune lymph nodes. Iyi nharaunda inofananidzwawo nechitambo IIIA, asi ne peritoneal kana omental metastases (yakapararira) kune imwe nzvimbo yemapapiro uye nzvimbo dzakakura kudarika 2 cm (inch) mamita muhukuru, kana kuti inopararira kune lymph nodes muzvinyoro (inguinal nodes) , pelvis (pelvic nodes), kana para-aortic (para-aortic nodes).
- Nhanho IV: Kanzera yakapararira kumuviri wechiropa kana kune dzimwe nzvimbo dzisingasviki mudumbu (peritoneal cavity) kune dzimwe nzvimbo dzakadai sebhokisi kana uropi.
> Sources:
> American Society of Clinical Oncology. Ovarian, Fallopian, uye Peritoneal Cancer: Matanho uye maBhuku. Cancer.Net. Yashandurwa 08/16. https://www.cancer.net/cancer-types/ovarian-fallopian-tube-and-peritoneal-cancer/stages-and-grades
> Henderson, J., Webber, E., naG. Sawaya. Kuchengetedza kweAvarian Cancer: Mharidzo yeEvidence Report uye Ongororo Yakarongeka yeUnited States Preventive Services Task Force. JAMA . 2018. 319 (6): 595-606.
> National Cancer Institute. Ovarian Epithelial, Fallopian Tube, uye Primary Peritoneal Cancer Treatment (PDQ) -Health Professional Version. Updated 01/19/18. https://www.cancer.gov/types/ovarian/hp/ovarian-epithelial-treatment-pdq
> Qin, Y., Wu, Y., Xian, X. et al. Kusarudzwa uye kushandiswa kwakaitwa Red Cell Distribution Width, Zvinoreva Platelet volume, uye Cancer Antigen 125 yeKutsvaga kwakasiyana-siyana kweAvarian Cancer neBenign Ovarian Tumors. Zvinyorwa zveOvarian Research . 2018. 11 (1): 10.
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