Mukamaganizira momwe mukudziwira, kupita patsogolo ndi chithandizo n'kofunika kwambiri kuti mukwaniritse thanzi lanu ndi kuchiza. Mapulani a kansa ya kansalu ya kansalu ya chikhodzodzo adzadalira zifukwa zingapo, makamaka siteji ya khansa (momwe ikufalikira) ndi kalasi ya khansa (momwe maselo a kansa amavomerekera).
Opaleshoni
Tiyeni tiyambe mwa kukambirana za njira zothandizira khansa ya chikhodzodzo.
Chikhodzodzo Chotsatira Chitetezo (TURBT)
Njira yoyamba yothandizira khansa yopanda chiwopsezo yopanda chifuwa-kutanthauza kuti chotupacho chiri mkati mwa chikhodzodzo ndipo sichilowetsa muyeso wake wosanjikiza-ndi mtundu wa opaleshoni wotchedwa transurethral resection chifuwa cha chikhodzodzo, kapena TURBT. Njirayi imachotsa chotupacho m'chikhodzodzo.
Pakati pa TURBT, katswiri wamagetsi amaika chida cholimba, chochepa chokhala ndi kuwala ndi kamera pa iyo (resectoscope) kupyolera mwa chiberekero cha munthu mu chikhodzodzo chake. The resectoscope ili ndi chingwe chamtundu chomwe chimalola dokotala kuchotsa chotupacho.
Njirayi imagwiritsidwa ntchito m'chipinda chogwiritsira ntchito ndipo nthawi zina yachiwiri ya TURBT imafunika masabata pambuyo poyambirira kuti asaphonyeke. Uthenga wabwino ndi wakuti anthu ambiri amatha kupita kunyumba tsiku lomwelo kapena tsiku lotsatira. Ndiponso, zotsatirapo, monga kutaya mwazi kapena kusokonezeka pamene mukukodza, kawirikawiri zimakhalitsa ndi zochepa.
Zamwano Cystectomy
Mankhwala oyenera a khansara yowonongeka ndi minofu-kutanthauza kuti chotupacho sichipezekapo ndipo chalowetsa chikhodzodzo chachikulu cha minofu-ndi opaleshoni yotchedwa cystectomy yovuta kwambiri. Njirayi ikuphatikizapo kuchotsa chikhodzodzo ndi ziwalo zozungulira - prostate ndi masinic vesicles mwa amuna; chiberekero, kachilombo ka HIV, mazira, mazira, ndi gawo lakumtunda kwa amayi .
Nthawi zina zimakhala zovuta kwambiri kuti khansa ya chikhodzodzo iwonongeke. Izi zimalangizidwanso kwa anthu omwe ali ndi khansara ya chikhodzodzo chosatsutsika kapena yowonongeka pambuyo pa mankhwala ndi intravesical immunotherapy (onani m'munsimu).
Kusokonezeka kwa Urinary ndi Kumangidwanso
Chikhodzodzo chitachotsedwa, dotolo ayenera kupanga malo atsopano a mkodzo kuti asungidwe. Pali zochepa zomwe mungachite:
- Chikhodzodzo chatsopano chikhoza kulengedwa kuchokera kumbali ya m'mimba (neobladder) yomwe imagwirizanitsidwa ndi munthu wa urethra kotero kuti akhoza kukodza monga kale.
- Thumba likhoza kulengedwa mkati mwa thupi pogwiritsira ntchito minofu m'mimba kapena matumbo. Mapeto amodzi akugwirizanitsidwa ndi otupa ndipo ena amatsegula pakhungu pamimba pamimba (stoma). Catheter ikhoza kugwiritsidwa ntchito kupukuta mkodzo kupyolera mu stoma masana, koma thumba lakumapeto limasunga mkodzo, ngati chikhodzodzo chikanakhala.
- M'malo mwa thumba, chidutswa cha m'matumbo chikugwirizanitsidwa ndi odwala. Ndi opaleshoni yamtundu uwu, mkodzo umatuluka kuchokera mu impso kupita ku ureters kudzera m'matumbo ndi kulowa mu stoma. Pomalizira pake, imalowa m'thumba laching'ono lomwe limatuluka kunja kwa thupi.
Zoopsa Zopaleshoni
Kusokoneza kwambiri khungu komanso kupanga chikhodzodzo chatsopano ndi opaleshoni yovuta. Mwa kuyankhula kwina, ndi chinthu chachikulu. Choncho, ndikofunikira kuti mumvetse mavuto ndi zopindulitsa zomwe zimakhudzidwa-zabwino ndi zoipa, kunena.
Ndipotu, mwayi wochita opaleshoni umadalira pazinthu zingapo, monga momwe dokotala akuchitira, msinkhu wake, komanso ngati wodwala ali ndi vuto lililonse la mankhwala. Komabe, zitsanzo za mavuto omwe angapangitse opaleshoni ndi awa:
- Kusuta
- Kutenga
- Magazi akumira m'mapapu
Nkhani inanso yomwe mungayankhe ndi dokotala wanu ndizo zowononga zakugonana, monga kupweteka kwa erectile kapena kukakamiza kugonana, ndi momwe mungapiririre.
Chemotherapy Asanafike Opaleshoni
Ngati munthu ali ndi thanzi labwino, adzalandira mankhwala a chemotherapy asanayambe opaleshoni kuti athe kupulumuka. Cholinga cha chemotherapy ndi kupha maselo a khansa omwe ali m'thupi koma sakuwonekeranso.
Mankhwala awiri omwe amagwiritsidwa ntchito kwambiri asanayambe opaleshoni ya khansa yowononga chikhodzodzo ndi:
- MVAC (methotrexate, vinblastine, doxorubicin, ndi cisplatin)
- GC (cisplatin ndi gemcitabine)
Wachikulire wanu, kapena dokotala wa khansa, adzawongolera izi chemotherapies mu zozungulira. Izi zikutanthauza, kuti mutatha kuchipatala, mudzapumula ndikuyang'aniridwa ndi zotsatira zovuta. Zitsanzo za zotsatira zoyipa zomwe zingathe kuwonedwa ndizimenezi zikuphatikizapo:
- Kutopa
- Kuwonjezeka kwa chiopsezo cha matenda
- Kupuma kapena kupweteka mosavuta
- Kutaya tsitsi
- Zilonda zamkati
- Nsowa ndi kusanza
- Kumva kutayika
- Kunjenjemera ndi kugwedeza m'manja kapena mapazi
- Magazi mu mkodzo
Ulendo uliwonse umatha kwa masabata angapo ndipo, mobwerezabwereza, maulendo atatu amalangizidwa asanachite opaleshoni ya chikhodzodzo.
Tizilombo toyambitsa matenda
Ngakhale kuti chiwerengero cha opulumuka chikuthandizidwa ndi anthu omwe alibe khansa yowonongeka ya chikhodzodzo, sizingatheke, madokotala akuluakulu awiri ngakhale atachotsa chotupa ndi awa:
- Kubwereza (khansa imabwerera)
- Kupitirira (kansa imafalikira mu minofu kapena kupitirira mu thupi)
Choncho, tiyeni tiwone njira zosankha zopanda opaleshoni.
Intravesical Chemotherapy
Zomwe zili pamwambazi ndi chifukwa chake odwala ambiri amapatsidwa chithandizo chowonjezereka pambuyo pa kuchotsedwa kwa mankhwalawa ndi mankhwala omwe amatchedwa intravesical chemotherapy. Ndi mankhwala awa, mankhwala amaperekedwa mwachindunji mu chikhodzodzo kupyolera mu kathete. Cholinga cha mankhwala a chemotherapy ndicho kuwononga maselo onse a khansa omwe sali owoneka.
Malingana ndi chiopsezo cha munthu cha khansa yansabwe ya chikhodzodzo (zomwe dokotala amayesa monga otsika, apakati, kapena apamwamba), iye adzalandira mlingo umodzi pa nthawi yoyamba ya TURBT kapena mlingo wambiri pa nthawi ya sabata sikisi intravesical chemotherapy.
Mitomycin kawirikawiri ndi mankhwala a chemotherapy omwe amasankhidwa. Zingayambitse zina zotentha m'chikhodzodzo komanso kukodza mobwerezabwereza komanso / kapena kupweteka.
Intravesical Immunotherapy
Nthaŵi zina, m'malo mwa mankhwala a chemthrapa, munthu amatha kulandira chithandizo chamagetsi chotchedwa Bacillus Calmette-Guerin (BCG). Mankhwalawa amachititsa chitetezo cha mthupi kuti chithe maselo a kansa.
N'zochititsa chidwi kuti Bacillus Calmette-Guerin (BCG) anayamba kupangidwa ngati katemera wa chifuwa chachikulu. Koma, m'zaka za m'ma 1970 ndi 1980, anapezeka kuti akupha maselo a khansa ya chikhodzodzo, nayenso.
Ngakhale zogwira mtima, intravesical BCG ingachititse zotsatirapo kwa masiku awiri omwe angaphatikizepo:
- Fever, chills, ndi thupi zimawononga
- Kutopa
- Kuthamanga kwambiri
- Magazi mu mkodzo
- Ululu mukakodza
- Kutentha mkati mwa chikhodzodzo
Kawirikawiri, BCG ikhoza kufalikira ku thupi. Izi zingachititse kuti thupi lonse likhale ndi matenda, omwe angatuluke ndi malungo omwe amapezeka masiku oposa awiri kapena malungo omwe samasintha ndi mankhwala. Matenda a thupi lonse ndi ovuta kwambiri azachipatala ndipo amafunika kuchipatala mwamsanga.
Kusungidwa kwa Chikhodzodzo
Ngakhale kuti mankhwalawa ndi ovuta kwambiri, ndiye kuti munthu amene ali ndi khansara yoteteza chikhodzodzo sangakhale ndi chikhodzodzo chonse. M'malo mwake, amatha kuchotsa chikhodzodzo kapena pang'ono. Monga mtundu uliwonse wamachiritso, panthawi zosiyanazi, zoopsa ndi zopindulitsa ziyenera kufufuzidwa mosamalitsa.
Mankhwala Opanga Mafuta
Mankhwala othandizira mazira, omwe amaperekedwa ndi a radiation oncologist, nthawi zambiri amaphatikizidwa ndi chemotherapy ndi TURBT m'zinthu zoteteza chikhodzodzo, chifukwa sizingakhale ngati njira yokha yokha ya mankhwala. Mafunde akupha maselo a khansa komanso nthawi zamachiritso amatha masiku asanu pa sabata kwa milungu ingapo.
Kuwunika Patatha Chithandizo
Pafupifupi miyezi itatu mutatha kuchipatala ndi mankhwala opatsirana (ndipo pakapita nthawi), adokotala adzachita kansalu kuti asamawonongeke. Kwa odwala omwe ali pamsinkhu woopsa, mkodzo wa cytology kuyang'ana maselo a khansa ndi kujambulidwa kwa njira yapamwamba yamakina (ie CT scan) idzachitanso nthawi ndi nthawi ngati njira yowunika.
Ngati malo okayikira a chikhodzodzo akuwoneka, adzalumikizidwa ndi kuchotsedwa ndi TURBT. Ngati khansa yayamba kubwerera, munthu nthawi zambiri amatha kuchipatala kwambiri kapena amachotsedwa chikhodzodzo ndi opaleshoni ya cystectomy.
Ngati palibe umboni wa kubwereza, munthu akhoza kuchipatala ndi BCG kuti apitirize kuteteza khansara iliyonse. Nthawi yokonza mankhwala (mwachitsanzo, chaka chimodzi motsutsana ndi zaka zitatu) zimadalira chiopsezo cha munthu, chomwe chikuwonetsedwa ndi gulu lake la khansa.
Khansara Yamatenda Yamatenda
Khansara ya chikhodzodzo yomwe imafalikira kumbali zina za thupi, ngati maselo amphamvu kapena ziwalo zina (mapapu, chiwindi, ndi mafupa), chemotherapy ikhoza kukhala njira yothetsera kukula kwa khansa. Kafufuzidwe kafukufuku wa matenda a khansa yapakhungu yapamwamba ikufufuzidwa.
Nthaŵi zina, kupatsidwa mankhwala kapena kupaleshoni (TURBT kapena cystectomy) kumachitika pa munthu yemwe ali ndi khansara yamatenda, nayonso. Ndikofunika kumvetsetsa kuti, mankhwalawa amachitidwa ngati njira yothandizira kuperewera-njira yochepetsera zizindikiro zovuta zokhudzana ndi khansa.
Izi zinati, ngati zili ndi khansa ya chikhodzodzo, ndikofunikira kuti muzitha kuwona ngati mankhwala osiyanasiyana akusowa kwambiri kusiyana ndi kusintha moyo wanu. Pachifukwa ichi, dziwani kuti ndi bwino kutumiza maganizo anu kwa banja lanu ndi oncologist .
Mwa kuyankhula kwina, nthawi yayitali ingakhale yokhutiritsa kuposa nthawi yayitali ya mankhwala osasangalatsa. Izi, ndithudi, ndi chisankho chapadera kwambiri.
> Zotsatira:
> Abt D, Bywater M, Engeler DS, Schmid HP. Njira zochiritsira zosokoneza hematuria mu khansara yothamanga kwambiri. Int J Urol. 2013 Jul; 20 (7): 651-60.
> American Cancer Society. May6, 2016. Kuchiza Cancer Yachikhodzodzo.
> Babjuk et al. EAU Malangizo pa osalimba-osadziwika orothelial carcinoma wa chikhodzodzo: Yambani 2016. Eur Urol. 2017 Mar; 71 (3): 447-61.
> Chang et al. Kuzindikira ndi chithandizo cha khansa yopanda chiwopsezo yopanda chifuwa: khansa ya AUA / SUO. J Urol. 2016 Oct; 196 (4): 1021-9.
> Stephenson AJ. December 2016. Zambiri za njira yoyamba yothetsera khansa ya chikhodzodzo. Mu: UpToDate, Lerner SP, Ross ME (Eds), UpToDate, Waltham, MA.