Clinical Guidelines for the Treatment of Various Head and Neck Cancer
Kushandiswa kwedheta kutungamira zvisarudzo zvinokosha kwakaratidza leitmotif munguva yezana remakore rechi21. Muitiro wekurapa hausi wakasiyana uye unowedzerwa nedhesi; zvakakodzera, kurapwa kunofanira kutungamirirwa neuchapupu kwete nemukana, intuition kana kungocherechedza. Masangano mazhinji anobatanidzwa mukusimbisa hutungamiri hunotungamirirwa nemakiriniki ehutano kusanganisira Scottish Intercollegiate Guidelines Network (SIGN).
Maererano newebsite yeSIGN:
"NZIRA dzekutsvaga dzinotorwa kubva pakugadziriswa kwezvinyorwa zvezvesayenzi uye dzakagadzirirwa semotokari yekusimudzira kushandurwa kwechivo chitsva muchiito kuti zvigadzirise chinangwa chedu chokuderedza kusiyanisa mukuita, nekuvandudza zvirwere zvinokosha-zvinokosha."
Ndapota cherechedza kuti SIGN inongova sangano rimwechete rinopa uchapupu-based guidelines, uye kune mamwe masangano akakurumbira anoita zvakafanana. Semuenzaniso, United States Preventive Service Task Force (USPSTF) inopawo mazano maererano neuchapupu hwezvehutano.
Muchikamu chino, tichaongorora uchapupu hunobva mumakiriniki emitambo yekurapa mutsauko wepamusoro uye wemutsipa maererano nekenza yekenza. Izvi zvinorapwa zvinobva pane zvinorayirirwa zveSIGN kana mazano anonzi European Society for Medical Oncology (ESMO). Uyezve, mukuremekedza mazera ekukwegura-epakati akarongwa pasi apa, tapota cherechedza kuti tiri kutaura nezvekurapa mazano ekurapa kwepakutanga-uye yakakura-mberi kwekenza iyo inowanikwa mumutsipa, isina maitiro ekure.
Pasi pose, musoro nemutsipa makondombera iri boka rezvirwere zvakasiyana-siyana, uye kurapa kwakananga kunobva pane nzvimbo yekenza nechikwata. Vasati vasarudzwa zvirongwa zvinoshandiswa, lymph nodes mumutsipa inoongororwa nokuda kweuchapupu hwekenza, uye kuvapo kwemasimba akare kure kunoratidzwa kunze.
Pakupedzisira, munyaya ino tinotaura nezvekenza kuongorora (TNM).
Kuti uwane mamwe tsanangudzo yakazara yekutema, tapota tevera mazano ari munyaya ino.
Kurapa Kwepakutanga-Kwenzira Mumuviri weKenza
Heino zviratidzo zveSIGN zvinyorwa-based based on the treatment of early stages (Stage I uye Stage II) kenza yemuromo:
- kubvisa kushandiswa (resection) yepamukira guru
- selective neck dissection ku N0 lymph nodes
- kana zviitiko zvishoma zvidhi nodes zvinoratidza uchapupu hwekenza kana kupararira kwakanyanyisa, saka remishonga inonzi radiation inokurudzirwa
Kusarura mutsipa kusagadzikana kunosanganisira kuchengetedzwa kwemapoka emapoka e-lymphatic. Sarudza mapoka emakirini anokonzerwa nekymph node anobviswa zvichienderana nezvinofanotaurwa mapepa emagetsi.
Zvimwe humwe uchapupu-hwakatungamirirwa hutano hwekurapa kwekutanga-gwara sarudzo yemuromo inotarisa kushandiswa kwemutsipa weutsi kana kubviswa kwemuviri wecymphatic mumutsipa. Kutanga, kune vanhu vasati vava kugamuchira kurapwa kwekenza yemuromo (kurapa-naïve) pamwe neduku duku kana kuti duku duku guru (T1 neT2, zvichienderana) ye squamous cell origin, kusarudza (voluntary) kuputsika kwemutsipa kunogona kupedzera kupona. Chechipiri, kuputika kwemitsipa kunogona kuderedza dambudziko rekudzoka uye kufa-kanangwana (kufa) kune vanhu vane lymph nodes vasingarati uchapupu hwekenza.
Kurapa Kwekuwedzera-Stage Oral Cancer
Maererano nechiratidzo, kenza yemuromo inokurudzirwa inofanirawo kubviswa.
Uyezve, kugadziriswa radical neck dissection inokurudzirwa. Ne modified radical neck dissection, lymph nodes yose mumutsipa inobviswa uye imwe kana kupfuura zvivako zve lymphatic zvinodzivirirwa.
Kana munhu ane kenza yemuromo yakakosha isingagoni kushandiswa pane (haisi mukana wokuvhiya), chemoradiation ne cisplatin regimen uye irradiation yakafanana yemutsipa (kureva, kurapa kwemazuva kumativi ose emutsipa) kunorumbidzwa.
Kurapa Kwekutanga-Stage Nasopharyngeal Cancer
Pano pane mazano eEMO ekurapwa kwekenza yenguva yekutanga yeanopharyngeal:
- chirwere chemazuva ano chete chinoshandiswa kurapa kenza yesero
- makorediation yakakwana (cisplatin uye therapy radiation) ingashandiswa kurapa kenza yechipiri II
- kunyanya modulated rayation therapy (IMRT) ndiyo inoratidzirwa rudzi rwehutachiona hwehutachiona hwepakutanga-danho rekurapa kanopharyngeal
Kurapa kweE-Advanced-Stage Nasopharyngeal Cancer
Hezvino maEMM mazano ekurapwa kwekenza yepamusasa ya nasopharyngeal:
- ganhuro III, IVA uye IVA kanzira inobatwa nekodoradiation yakakwana (cisplatin ndiyo chemotherapy inoshandiswa)
- IMRT ndiyo nzira inofanirwa yehutachiona hwemaawa
Kurapa Kwokutanga-Gwara Oropharyngeal Cancer
CHIKAMU chinokurudzira kuti kenza yekutanga yerororyngeal inorapwa pamwe nekuvhiyiwa uye kuputika kwemitsipa kana kuti kunze kwemishonga inonzi radiation yechirwere uye lymph nodes mumutsipa.
Kurapa kweE-Advanced-Stage Oropharyngeal Cancer
Maererano neSIGN, vanhu vane kenza yemuromo yakakura vanogona kurapwa mune imwe yenzira mbiri: kuvhiyiwa kwokutanga kana kuchengetedzwa kwemuviri. Nekuvhiyiwa kukuru, chiremera chekutanga chinobviswa uye kushandiswa kwe radical neck dissection kunoitwa. Nechirongwa chekuchengetedzwa kweganda, chemoradiation ne cisplatin inoshandiswa, uye lymph nodes kumativi ose emutsipa (pamwe chete) inogadziriswa.
Pashure pekuvhiya kukuru kana kuti kuchengetedzwa kweganda, chemoradiation ne cisplatin inoitwa kuvarwere vanoona extracapsular (yakawedzerwa zvakapararira) kupararira uye maitiro akanaka ekuvhiya. Chirwere chinoshandiswa chakanaka chiripo apo mumwe munhu anoona kuti masero ari pamuganhu wezvisikwa zvakabviswa achiri chirwere.
Kurapa Kwekutanga-Stage Hypopharyngeal Cancer
CHIKAMU chinopa mazano matatu ekurapa kwevanhu vane chepopharyngeal cancer kare. Kutanga, cisplatin chemoradiation pamwe chete neprophylactic radiation therapy inogona kushandiswa. Chechipiri, kuvhiyiwa kwekuchengetedza pamwe chete nemagetsi emutsipa kusagadzikana kunogona kuitwa. Chechitatu, kune vanhu vasina kuroorwa uye vasingakwanisi kupinda chemoradiation, kurapwa kwemaawa chete kunogona kushandiswa.
Kurapa kweE-Advanced-Stage Hypopharyngeal Cancer
Maererano nechiratidzo, kana bundu racho richigadziriswa (kureva, rinogona kubviswa), saka imwe nzira mbiri inogona kuedzwa: kana kuvhiyiwa kubvisa tsvina kana kuchengetedzwa kwechigadziko. Nekuchengetedzwa kwomuviri, kunze kwemuti wehutachiona hwehutachiona uye chemoradiation yakafanana inoshandiswa. Neck lymph nodes iyo yakanaka kune kenza inogona kurapwa kushandiswa kwemutsipa kumutsipa kana kana pasina chemoradiation.
Kana zvinoregererwa kumurwere, avo vane mishonga dzisingakwanisi kubviswa kana kubviswa zvinogona kurapwa ne cisplatin chemoradiation.
Kurapa Kwepakutanga-Nhanho Dzakanyanya Kenza
Maererano nechiratidzo, kenza yekare inogona kurapwa pamwe nekuvhiyiwa kwekuchengetedza kana kuti kunze kwechirwere chemaawa. Uyezve, chirwere chekare chinoshandiswa chinogona kunge chakabudirira semishonga inonzi radiation
Ne transoral laser microsurgery, chiremba anovhiya anotungamirira laser pasi pe microscope saka kuwedzera kunowedzera zvakakwana. Iyi nzira inobvumira chirwere ichi kuti chibvise chete masero anokonzera mishonga kubva kumativi akakomberedzwa akaenzana uye anoshandiswa apo kuchengetwa kwechimiro kunokosha munguva yemuromo, larynx uye chirwere chinonzi pharynx. Kuvhiyiwa kwakadaro kunogona kutungamirira kuhutano hwakanaka hwehupenyu. Semuenzaniso, achishandisa transoral laser microsurgery, chiremba anovhiya anogona kuchengeta larynx kana izwi rebhokisi basa kune avo vane kenza yakaoma kana kanzura iri mumutsipa wakadzika.
Kurapa Kwekutanga-Stage Supraglottic Cancer
Maererano nechiratidzo, kurapwa kwekenza yepamusoro yepamusoro kune yakafanana neyekutanga kwekenza yeglottis, pamwe nekuvhiyiwa kwekuchengetedza kana kuti kunze kwemishonga inonzi radiation therapy inoshandiswa. Kuvhiyiwa kunochengetedza kunogona kuteverwa nekusagadzikana kwehuro. Aya maitiro ekurapa anotarisa lymph nodes pakati pezinga II uye nhamba III yemutsipa.
Kurapa kweE-Advanced-Stage Laryngeal Cancer
Maererano neSIGN, iyi ndiyo nzira yekukwanisa kurapwa nayo kanhi-yekupedzisira-kenza yemarara.
- kubviswa zvachose kwelarynx (laryngectomy) kana nehana isina (conjuitant) adhivant
- iyo nzira yekuchengetedza nhengo inosanganisira kushandiswa kwekambani cisplatin chemoradiation yakateverwa nekuvhiyiwa chirwere kana zvichidikanwa
- sezvinoitwa nhengo-kuchengetedza nhengo, kana chirwere chisingaverengeki, vatungamiri vanobatanidzawo zvakafanana cisplatin chemoradiation inotevera chirwere chesavage kana zvichidikanwa
- lymph nodes yekenza inobviswa nenzira yekuputika kwemitsipa kana kana pasina chemoradiation
General Chemotherapy Mazano
Heano humwe humwe huwandu hunoratidza hutungamiri-hwakatungamirirwa kubva paZVIMWE nezvekurapa mutsa wemusoro nemutsipa:
- chiitiko chekugadzirisa chemotherapy mushure mekudzivirira kwemaawa (ie, neoadjuvant therapy) hakurudzirwi
- chiitiko chekuita chemotherapy pashure pemishonga inonzi radiation (adjuvant therapy) haina kukurudzirwa
- neoadjuvant kana adjuvant chemotherapy haisi nguva dzose inokurudzirwa pamwe chete nekurapwa kwekuvhiya
Zvinonyanya kukosha, mazano e chemotherapy anokurudzira kuti vanhu vane muromo wemuromo, oropharyngeal kana kenza yearyine havangogamuchirwi kana makorediation mushure mekunge kana mushure mekurapwa nekuvhiyiwa kana kuti kurapwa kwemaawa. Mune mamwe mazwi, chirwere chemaawa kana chirwere chinogona kuve kurapa kwakakwana pachavo.
Mhedziso
Ndapota zivai kuti kunyange humwe humwe huri pamusoro apa hurudziro hukuru-bhuku hunosimbiswa nehutano hunogutsa hwehupupu, maitiro anongorongedzwa anoromised, meta-analysis nezvakadaro, kwete zvose izvi zvinokurudzirwa ndezvokukwirira kwepamusoro uye zvimwe zvinotsigirwa zvisinganyatsonzwisisiki uchapupu. Kukurukurirana zvikamu zvakasiyana zvehupupuriro kune umwe neumwe zvinorayira ndezvekunze kwenyaya ino.
Kunyange zvakadaro, kana uine mibvunzo pamusoro pemakero kana zvimwe zvinetso pamusoro pemukati nemusoro wemutsipa, tapota taura nezvezvinetso izvi nechiremba wako wehutano. Kurapa mutsava wemusoro uye wemutsipa kwakaomeswa, uye mazano akasimba kubva kunechiremba wako chinhu chinokosha munguva yekuita sarudzo.
> Sources:
> Musoro uye Neck Cancer Treatment. Dynamed Plus. www.dynamed.com
> NCI Dictionary yeCancer Terms. www.cancer.gov
> SIGNI website. http://sign.ac.uk/about/index.html
> Kurapa Kwemusoro uye Neck Cancer: Neck Dissection. Dynamed Plus. www.dynamed.com.