Kune huwandu hwakanaka uye hune hutachiona hwemaitiro ekurapa maranoma.
Kana melanoma iri paganda, inogona kubudirira nekugadziriswa zvachose mumatambudziko mazhinji. Dzimwe nguva, kunyange zvakadaro, inopararira ( metastasizes ) kune dzimwe nzvimbo dzomuviri, kazhinji dzinotanga kuenda kumakirini emunharaunda ari pedyo mukati mako, mutsipa, kana kugomera. Kana chiremba wako achifungidzira kuti izvi zvaitika, chirwere chinonzi sentinel node biopsy chichaitwa kuti chicherechere uye kubvisa lymph node iyo kenza inogona kunge yakapararira kubva pachirwere chekutanga.
Kana yako sentinel node biopsy yakanaka (ine kenza kenza), zvino ndiyo nguva yekuita. Iwe unofanirwa here kuva nemamwe mishonga yemaitiro munharaunda ino yabviswa, mune chirongwa chinonzi chirongwa chekugadzirira lymph node dissection (CLND, kana lymphadenectomy)? Mhedziso ndeyokuti CLND inochengetedza kuti masero e-melanoma mune mamwe ose eine lymph nodes abviswa, izvo zvino zvinogona kudzivirira chirwere kuti chisapararire mberi.
Zvinosuruvarisa, uchapupu hahuna kukwana, saka sarudzo iyi haisi yakananga, kunyange kuvanachiremba. Heano mamwe mazano uye ane njere yekufunga.
Zvimwe zveLymph Node Dissection
1. CLND inobatsira kunyatsonzwisisa danho remaranoma, iyo inobatsira chiremba mukugadzira mazano ekugadzirwa kweperi-adjuvant.
2. Nhamba yakawanda yezvipfigira zvinoshandiswa nemaserooma zvinongoraramisa zvekuchengetedza varwere vane chirwere chechitatu, uye chete CLND inokwanisa kupa ruzivo urwu.
3. Zvimwe zvidzidzo zvinoratidza kuti 20 muzana yevarwere vanoenda kune CLND pakarepo mushure mekunge vaona kuti vakatora sentinel lymph node uzoefu vakavandudza kupona. Izvi zvinonyanya kuitika kuvarwere vaiva nemakumbo ekuputika mukati meganda ravo (1.2 kusvika ku 3.5 mm).
4. Nokumisa kupararira kwemalaoma kumakirinikodhi, a CLND anowedzera mukana wekurapa.
Kunyange huwandu hwemaranoma mune lymph nodes inogona kuenderera mberi nekufamba kwenguva kuti ive yakakosha uye inotyisa.
Cons Lymph Node Dissection
1. Matambudziko eCLND anokosha uye anoitika kusvika 67 kubva muzana yevarwere, kunyanya kune avo vanopfuura 60. Izvi zvinosanganisira:
- Buildup yemvura inzvimbo yekuvhiyiwa ( seroma )
- Kurwara
- Kufuridzira kwechikwata chakakanganiswa nekubviswa kwe-lymph nodes ( lymphedema )
- Unhu, kurira, kana kurwadziwa munzvimbo yekuvhiya
- Kuparara (kutsvaira) kweganda panzvimbo iyo
Kunyangwe kuzvimba shure kwekuvhiyiwa kunogona kudzivirirwa kana kudzorwa nekushandiswa kwemishonga inorwisa mabhakitiriya, kusungira zvisikwa, kushambadza, uye maharauretics, inogona kunge iri dambudziko rinokanganisa.
2. Kubudirira kweCCLND kunogona kutarisana nehukuru hwechirwere chemalaoma. Zvidumbu zviduku (0,1 mm kana zvishoma muhupamhi) mumutambo weininelin node zvinogona kunge zvisati zvambotungamirira kumastastisitiri zvachose, saka kuita CLND kunogona kusakosha. Chirongwa chegore ra2009 chakaratidza kuti kupona nekudzoka kwemitambo yevarwere vane zvipukanana izvi zviduku zvakafanana neavo vakanga vasina melanoma mune yavo sentinel lymph node. Nokudaro, ava "vane pangozi" varwere vangave vakakwanisa kudzivisa CLND uye vanova nemigumisiro yakafanana.
The Bottom Line
Kusarudza kuti uite chirongwa chakakura chokuvhiya chakadai seCCLND haisi chisarudzo chaunofanira kutora zvishoma, kunyanya kana biopsy yako inongoratidzira shomanoma shoma chete mumakirini ako.
Zvinhu zvakawanda zvinobatanidzwa, kusanganisira ukuru uye nzvimbo yako yepamusoro melanoma, zvinokonzerwa ne-sentinel lymph node biopsy nezvimwe zviedzo, uye makore ako. Unogona kuona zvichibatsira kutsvaga pfungwa yechipiri.
References:
Boughton B (2009). Ko lymphadenectomy inofanira kunge yakananga yekuchengetedza mumaranoma metastasis kune lymph nodes? Oncology News Intl. 18 (5).
Morton DL, Thompson JF, Cochran A, et al (2006). Sentinel-node biopsy kana kuti nodal kuona mu melanoma. N Engl J Med. 2006 Sep 28; 355 (13): 1307-17.
Thomas JM (2005). Nguva yekudzokororazve Sentinel Node Biopsy muMelanoma Post-Multicenter Yakasarudza Lymphadenectomy Trial. J Clin Oncol. 2005 Dec 20; 23 (36): 9443-4.
van Akkooi AC, Rutkowski P, van der Ploeg IM, uye al (2009). Nguva yakareba yekutevedzwa kwevarwere vane hutachiona husinel node tumor burden (<0.1mm) maererano nemitemo ye Rotterdam: Kuongorora kweEORTC Melanoma Group. J Clin Oncol 27:15, 2009 (suppl; abstr 9005).