Iko kune marudzi anopfuura makumi mashanu emasarcas anocheka
Sarcomas yakasimba yeboka rekenza rinokonzerwa nemafuta, musimba, tendon, cartilage, tyminiid tishu, midziyo nezvimwewo. Iko kune marudzi anopfuura makumi mashanu emhando dzakashata sarcoma. Kunyange zvazvo sarcomas dzakawanda dziri dzakapfava sarcomas, nenzira yakawanda, sarcomas inogonawo kukanganisa pfupa.
Kuongororwa uye kurapwa kwemavara emhando dzakapinza zvinosanganiswa uye zvakasiyana-siyana, zvinoda rubatsiro rwewe oncologists , chirwere chinonzi oncologists, radiologists, interventional radiologists nezvimwe.
Mishonga inosanganisira kuvhiyiwa, radiotherapy uye, mune dzimwe nguva, chemotherapy.
Chii Chine Utano Hwakadzikama Sarcomas?
Sarcomas mhando dzakakoshesa ndeyechirwere chisingawanzocheki chekodopu uye nhoroondo yepasi pepfumbamwe muzana yekenza muvanhu vakuru. IAmerican Cancer Society inofungidzira kuti 12,310 mamiriro matsva emhando dzakashata sarcoma dzichaonekwa muna 2016 (6 980 mhosva dzevarume uye madzimai 5,330 kuvakadzi). Muvana, sarcomas dzakaderera dzinomirira 15 muzana yekenza.
Chikonzero chaicho chemasarcas akawanda akanyanya hachizivikanwi, uye izvi zvipembenene zvinowanzoitika pasina chikonzero chakajeka. Zvisinei, mune zvimwe zviitiko zve-tissue sarcoma, kuchinja kweDNA kwakawanikwa pashure pokunge aberekwa uye yechipiri kune majekesheni kana kuti maitiro evanhu vanogona kuita basa mumapathogenesis.
Mhando dzakanyanya kufanana nemasarcas muvanhu vakuru hazvina kufanirwa sarcoma (inonzi inonzi malignant fibrous histiocytoma), liposarcoma uye leiomyosarcoma . Liposarcomas uye zvisingaverengeki sarcomas zvinowanzovapo mumakumbo, uye leiomyosarcomas ndiyo inowanzoita sarcomas yemimba.
Muvana, rudzi rwakakurumbira rwezvinyama zvinyoro sarcoma rhabdomyosarcoma, iyo inokanganisa maronda emakumbo.
Sarcomas yakasimba inogona kutyisa upenyu, iine 50 kusvika 60 kubva muzana yevanhu vapenyu makore mashanu mushure mekunge vatanga kuonekwa kana kurapwa, chiyero chinonzi makore mashanu ekupona. Pakati pevanhu ivavo vanofa nemaronda akaoma sarcoma, metastasis, kana kupararira, kumapapu ndicho chikonzero chinowanzoita rufu.
Muna 80 kubva muzana yevarwere vane hutachiona, hutachiona hunopisa hutachiona hunoitika pakati pemakore maviri nematatu mushure mekutanga kuongorora.
Chirongwa cheKliniki yeChinofu Chine Sarcomas
Kazhinji, sarcoma inonyorera inoratidzika semhomho isingabvi zviratidzo (kureva, kushaya muviri). Vanogona kufanana nemapomas, kana kuti ane urombo, asingasviki maronda anoita mafuta. Kutaura zvazviri, lipomas inowanikwa ka100 pane yakawanda kupfuura zvinyoro zvinyoro zvinyuchi uye inofanira kuonekwa sechikamu chekusiyanisa kuonekwa. Mune mamwe mazwi, ganda reganda riri paruoko rwako kana gumbo zvinowanzoita kuti uve nechirwere chinotapira kupfuura sarcoma yakaoma.
Inenge zvikamu zviviri kubva muzvitatu zvemashizha emhando dzakadzika dzinomuka pamaoko nemakumbo. Iyo imwe yechitatu inomuka mumusoro, mudumbu, mutsi, mutsi, uye retroperitoneum. Iro retroperitoneum inzvimbo iri seri kwemasvingo emimba ane mafyvo uye makanda uyewo chikamu che aorta uye pasi pasi vena cava.
Nemhaka yokuti sarcomas dzakapfava dzinowanzokonzera zviratidzo, dzinowanzoonekwa chete zvichiitika mushure mechiitiko chinotambudza chinoda kurapwa kunounza munhu kuchipatara. Sarcomas yakasimba yemasarcasi emakona ari kure (zvikamu zvemuoko uye gumbo rakapfurikidza nemhepo) zvinowanzova duku kana zvichisarudzwa.
Kunyange zvazvo sarcomas dzakapfava dzinowanikwa mune retroperitoneum kana zvimwe zvikamu zvemugumo (izvo zviri pedo nemhepo) zvinogona kukura zvakakura zvisati zvaonekwa.
Kana sarcoma inotapira yakava yakawanda zvakakwana, inogona kuisa mazamu pane zvivako zvakapoteredza, zvakadai sefupa, nerve uye mutezo weropa, uye zvinokonzera zviratidzo, kusanganisira kurwadziwa, kuzvimba, uye edema. Zvichienderana nenzvimbo, ma sarcomas makuru anogona kudzivisa chirwere chemuviri uye kuita kuti zviratidzo zvepamuviri zviratidzo, zvakadai semakumbo, kubatwa, uye kurasikirwa kwechido. Sarcomas yakakura inogonawo kufungidzira mutsara uye mitsetse yakasvibiswa kuitira kuti zvive nematambudziko emagetsi.
Pakupedzisira, sarcomas iri mumigumo (maoko nemakumbo) zvinogona kupa semvura yakadzika inopisa.
Kuongororwa uye Kurongeka kweSaft Tissue Sarcomas
Zviduku zvinyoro zvinyoro zvitsva izvo zvitsva, zvisina kuwedzera, zvisingasviki uye zvishoma zvishoma masendimita mashanu muhukuru zvinogona kuonekwa nechiremba asina kunyatsokurapa. Kuwedzera masasa anenge akadzika kana akareba kupfuura masentimita mashanu anoda kubhadhara zvakakwana: nhoroondo, kufungidzira, uye biopsy .
Pamberi pebhizimusi, kuongororwa kunoshandiswa kunoshandiswa kuongorora sarcoma. Magnetic resonance imaging (MRI) inonyanya kubatsira kana kuongorora maziso emhando dzakashata dziri mumagumo. Nekuremekedza zviremera izvo zvinonzi retroperitoneal, intra-mimba (mukati memimba) kana truncal, computed tomography (CT) inobatsira zvikuru. Zvimwe kuongororwa kwemaitiro zvinogona kuita basa mukufungidzirwa ndezvipi positron emission tomography (PET) uye ultrasound. Radiography (x-rays) haibatsiri kana uchitarisa zvipembenene zvine uturu.
Mushure mokunge kuongororwa kuongororwa, bhiopsy inoitwa kuti iongorore hutachiona husina simba hwemuviri. Nhoroondo, yakazarura incisional biopsies , iyo inoberekwa inoda kuti aneshehesia yakawanda, ave yakaenzana yegoridhe paanowana zvigadzirwa zvakakwana zvemashoko ekuzivikanwa kwake. Munguva pfupi yapfuura, zvakadaro, nheyo yechipfuti yebiopsy , iyo isingakonzwiki uye yakachengeteka, yakarurama uye inodhura, yakagadzirirwa rudzi rwehupopi. Chakanaka-sindano chishuvo chimwe chigadzirwa chebiopsy. Pakupedzisira, kana chironda chiri chiduku uye chiri pedo nepamusoro pepanyika, kusanganisa biopsy kunogona kuitwa.
Kunyange zvazvo zviputi zvezviremera zvepamusoro zvakanyanya zvinogona kuitika mune imwe nzvimbo kana kunze kwemahofisi, zviputi zvakadzika zvinoda kuiswa muchipatara nehupindira redhiologist uchishandisa ultrasound kana CT kuti atungamirire.
Nyaya inoshandiswa kuongorora michina yakaita sarcomas yakaoma, uye kunyange nyanzvi sarcoma pathologists haibvumirani ne histologic diagnosis uye tumor grade kubva pakati pe25 ne40 muzana yenguva. Kunyange zvakadaro, histologic diagnosis ndiyo inonyanya kukosha paanongorodza chirwere chacho nekugadzirisa chirwere chekurwadza uye kurwara kwechiremba, kana kutarisira chibereko chemakiriniki. Zvimwe zvinhu zvinokosha pakugadzirisa chiremera chemuviri wekukura uye nzvimbo. Kutarisa kunoshandiswa nenyanzvi kuronga kurapwa.
Zvine mitsetse yakanyorova, metastases kana kupararira kune lymph nodes haigoni. Pane kudaro, zviputi zvinowanzopararira kumapapu. Dzimwe nzvimbo dzemasimasi dzinosanganisira bone, chiropa, uye uropi.
Kurapa kweSoft Tissue Sarcoma
Kuvhiya kubvisa tsvina iyi ndiyo inowanzoshandiswa kurapwa kwemasvini akaoma. Dzimwe nguva, kuvhiyiwa ndiko zvose zvinodiwa.
Kamwe pane imwe nguva, kubudiswa kwaiwanzoitwa kuitira kuporesa sarcomas yemakumbo nemakumbo. Nemafaro, mazuva ano, chirwere chekuvhara-gumbo chinowanikwa.
Paunenge uchibvisa sarcoma inotapira, kukwirira kwepamunharaunda kunowanikwa umo bundu racho pamwe chete nedzimwe nhengo dzakapoteredza, kana margin, rinobviswa. Kana matumbo abviswa kubva mumusoro, mumutsipa, pamimba kana padombo, oncologist yekuvhiya inoedza kuderedza ukuru hwemashure uye kuchengetedza hutano hwakawanda hune utano hwakakwana sezvinobvira. Kunyange zvakadaro, hapana maonero ekubvumirana aripo pamusoro pehukuru hwe "zvakanaka" margin.
Mukuwedzera pakuvhiya, radiotherapy, iyo inoshandisa simba-ray x-ray kana mamwe mavara emirairo, inogona kushandiswa kuuraya masero emuviri kana kupedza kukura kwavo. Radiotherapy inowanzobatanidzwa nekuvhiyiwa uye inogona kupiwa vasati vambovhiyiwa (kureva, neoadjuvant therapy) kuti inopera kukura kwechirwere kana mushure mekuvhiyiwa (kureva, adjuvant therapy) kuderedza dambudziko rekudzoka kwekenza. Vose neoadjuvant uye adjuvant therapy vane zvikwereti uye zvinokanganisa, uye pane mhirizhonga seyo nguva yakanakisisa yekurapa sarcomas dzakashata dzakashandisa radiotherapy.
Iyo miviri miviri mikuru ye radiotherapy iri kunze kwemishonga inonzi radiation uye inonzi radiation therapy . Neine kunze kwehutachiona hwemishonga, mishonga iri kunze kwemuviri inounza kupenya kwemuviri. Nekati mukati mehutachiona hwemaawa, radioactive zvinhu zvakasimbiswa mumatare, masayeri, catheter kana mbeu inowanikwa mukati kana pedyo nechomuviri.
Rudzi rutsva rwe radiotherapy inowedzera -modulated radiotherapy (IMRT). IMRT inoshandisa kombiyuta kutora mifananidzo uye inovandudza maitiro chaiwo uye kukura kwechirwere. Miti yemirairo yehutano hwakasiyana-siyana inobva ichitarirwa nechirwere kubva mumakumbo akawanda. Rudzi urwu rwehutachiona hunoita kuti urege kukuvadzwa kune mishonga yakapoteredza uye inoisa murwere ari pangozi yakaderera yemigumisiro yakaipa, yakadai semuromo wakaoma, dambudziko rinomedza uye kuora kweganda.
Kuwedzera kune radiotherapy, chemotherapy inogona kushandiswawo kuuraya masero emukenza kana kuvadzivisa kukura. Chemotherapy inosanganisira kutungamirirwa kwemakemikarirapeutic agents kana madhiragi zvichibva mumuromo kana nemuviri kana musuru (parenteral administration). Nhoroondo, kushandiswa kwemakemikrasi ekurapa sarcomas dzakashata zvinopesanawo.
Mishonga yakasiyana-siyana inogamuchirwa kuti iite sarcoma ine mhando dzakanaka kusanganisira zvinotevera:
- doxorubicin hydrochloride
- dactinomycin (Cosmegen)
- imatinib mesylate (Gleevec)
- eribulin mesylate (Halaven)
- olaratumab (Lartruvo)
- trabectedin
Pakupedzisira, kazhinji kacho nyuchi dzakapfava sarcoma ndiyo nyuchi dzakasununguka sarcoma inodzoka mushure mokurapa. Inogona kudzoka mune imwe mhando yakanyorova kana kuti zvinyoronyoro zviri mune imwe chikamu chemuviri.
Pasi Pasi
Ndapota fungai murangariro kuti mavara emhando dzakashata haawanzoitiki. Zvimwe zvose zvakaenzana, mukana wekuti chero bundu kana bump pamuviri wako chirwere chakanyanya. Zvisinei, iwe unofanirwa kunzwa wakasununguka kurongedza kusangana nechiremba wako kuti uongorore chero chipi nechipi pamusoro peganda kana bump-kunyanya kana chiri kukonzera kurwadziwa, kusimba kana zvimwe.
Kana iwe kana munhu waunoda watoona kuti ane sarcoma yakanyorova, tapota nyatsoteerera kutungamirirwa kwevanyori vako. Kunyange zvazvo upenyu huri kutyisidzira munenge hafu yeavo vanoongororwa, kune vakawanda, zvinyoro zvinyoro zvinyuchi zvinogona kurapwa.
Pakupedzisira, mishonga mitsva yemapapu etukutu inonzi sarcoma iri kubuda. Somuenzaniso, chemotherapy yemakero , iyo chemotherapy iyo inoshandisa zvikamu zvemuviri zvakadai semakumbo kana makumbo, inzvimbo inoshingaira yekutsvakurudza. Iwe kana munhu waunoda angave akakodzera kubatanidzwa muchipatara chekuedza. Unogona kuwana miedzo yekliniki inotsigirwa neNational Cancer Institute (NCI) iri pedyo newe.
> Sources:
> Mukuru weSoft Tissue Sarcoma Treatment (PDQ®) -Patient Version. National Cancer Institute. https://www.cancer.gov/about-cancer/treatment/clinical-trials/search.
> Cormier JN, Gronchi A, Pollock RE. Soft Tissue Sarcomas. Mu: Brunicardi F, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, Pollock RE. eds. Schwartz's Principles of Surgery, 10e . New York, NY: McGraw-Hill; 2014.
> Hoefkens F, et al. Sarcoma mutsvuku yemigumo: kumirira mibvunzo pakuvhiyiwa uye radiotherapy. Radiation Oncology. 2016; 11: 136.
> Sabel MS. Oncology. Mu: Doherty GM. eds. KUBATSIRA KUTAURIRWA & KUKURWA: Kuvhiya, 14e . New York, NY: McGraw-Hill; 2015.