Zizindikiro, Kuchiza, ndi Kugonjetsa kwa Neuroblastoma
Ngati mwana wanu kapena mwana wa mnzanu atapezeka kuti ali ndi neuroblastoma, kodi muyenera kudziwa chiyani? Kodi ndi khansa yotani ya ubwana? Kodi amachiritsidwa bwanji ndi chiyani?
Kodi Neuroblastoma N'chiyani?
Monga imodzi mwa mitundu yofala kwambiri ya khansara ali wakhanda, neuroblastoma ndi khansara yomwe imapezeka mwa ana aang'ono. Chotupacho chimayambira m'magazi a m'mitsempha (maselo ammimba amphamvu) a m'katikati mwa mitsempha.
Makamaka, neuroblastoma imaphatikizapo maselo a mitsempha omwe ali mbali ya mchitidwe wamanjenje wachifundo. Machitidwe achifundo ndi omvetsa chisoni ndi magawo onse a dongosolo la mantha, lomwe limayendetsa njira mu thupi lomwe sitimayenera kuganiza mofanana ndi kupuma ndi chimbudzi. Mchitidwe wamanjenje wachifundo umayambitsa "nkhondo kapena kuthawa" zomwe zimachitika tikakakamizidwa kapena kuopa.
Mchitidwe wamanjenje wachifundo uli ndi malo omwe amatchedwa ganglia, omwe ali pamagulu osiyanasiyana a thupi. Malinga ndi kumene khunyu kamayambitsa ntheroblastoma, ikhoza kuyamba m'zinthu za adrenal (pafupifupi gawo limodzi mwa magawo atatu a matendawo), mimba, pelvis, chifuwa, kapena khosi.
Ziwerengero Zokhudza Neuroblastoma
Neuroblastoma ndi khansa yamba ya ubwana , yowerengera 7 peresenti ya khansa pansi pa zaka 15, ndipo 25 peresenti ya khansa yomwe imakula m'chaka choyamba cha moyo.
Momwemo, ndi mtundu wochuluka kwambiri wa khansara m'mwana. Ndilofala kwambiri mwa amuna kuposa akazi. Pafupifupi 65 peresenti ya mauroblastomas amapezeka asanafike miyezi isanu ndi umodzi, ndipo mtundu uwu wa khansa ndi wochepa pambuyo pa zaka 10. Neuroblastoma imayambitsa pafupifupi 15 peresenti ya imfa zokhudzana ndi khansa ana.
Zizindikiro ndi Zizindikiro za Neuroblastoma
Zizindikiro za neuroblastoma zimasiyana malinga ndi momwe zimayambira mthupi komanso ngati khansara yayamba kufalikira kumadera ena.
Chizindikiro chofala kwambiri chopezeka ndi cha mimba yaikulu ya m'mimba. Ambiri amatha kupezeka m'madera ena komwe amapezeka ngati chifuwa, pelvis, kapena khosi. Pangakhale malungo ndipo ana angakhale akuvutika ndi kulemera kapena "kusapindula."
Khansara ikafalikira (yomwe imapezeka ku mafupa, chiwindi, kapena mafupa) zizindikiro zina zikhoza kukhalapo. Mavitamini kumbuyo ndi kuzungulira maso (periorbital metastases) angayambitse maso a mwanayo kuti asatuluke ( mavitamini ) ndi mdima wakuda pansi pake. Mavitamini ku khungu amatha kuyambitsa mabala a mabulosi akuda (omwe amawoneka) omwe amachititsa mawu akuti "buluu muffin baby". Kupsinjika pa msana pamatumbo a metastases kungayambitse zizindikiro za m'mimba kapena chikhodzodzo. Mavitamini amateteza mafupa nthawi zambiri amachititsa ululu ndipo amatha kupweteketsa mafupa (kupasuka kwa fupa lomwe lafooka chifukwa cha kukhalapo kwa khansara mumphongo).
Kodi Mazira a Neuroblastomas Amafalikira (Metastasize)?
Neuroblastomas ikhoza kufalikira kuchokera kumalo oyambirira kudzera m'magazi kapena ma lymphatic system.
Mbali za thupi zomwe zimafalikira kwambiri zimaphatikizapo:
- Mitsempha (yochititsa kupweteka kwa mafupa ndi kutupa)
- Chiwindi
- Mapuloteni (kupangitsa kupuma pang'ono kapena kupuma kovuta)
- Mafupa a mafupa (omwe amachititsa kufooka ndi kufooka chifukwa cha kuchepa kwa magazi)
- Dera la Periorbital (kuzungulira maso akuchititsa bulging)
- Khungu (kuyambitsa maonekedwe a mufini muffin)
Kusanthula kwa Neuroblastoma
Kafukufuku wa neuroblastoma kawirikawiri amaphatikizapo mayesero a magazi onse kufunafuna zizindikiro (zinthu zomwe maselo a kansa amatseketsa) ndi maphunziro olingalira.
Monga mbali ya mchitidwe wamanjenje wachifundo, maselo a neuroblastoma amatulutsa mahomoni otchedwa catecholamines. Izi zimaphatikizapo mahomoni monga epinephrine, norepinephrine, ndi dopamine.
Zinthu zomwe zimagwiritsidwa ntchito popanga matenda a neuroblastoma zimaphatikizapo homovanillic acid (HVA) ndi vanillylmandelic acid (VMA). HVA ndi VMA ndi metabolites (mankhwala owonongeka) a norepinephrine ndi dopamine.
Mayesero ojambula omwe anayesedwa kuti aone chotupa (ndi kuyang'ana metastases) angaphatikizepo CT scans, MRIs ndi PET . Mosiyana ndi CT ndi MRI zomwe ndi "maphunziro", PET amawunika ndi "maphunziro". Pachiyeso ichi, shuga pang'ono ya radioactive imalowetsedwa m'magazi. Maselo okula mofulumira, monga maselo a zotupa, amatenga shuga kwambiri ndipo akhoza kuwoneka ndi mafano.
Mphuno wa mafupa umagwiritsidwa ntchito bwino kuyambira pamene ziphuphuzi zimafalikira ku fupa la mafupa.
Chitsanzo chokhachokha cha neuroblastomas ndi MIBG scan. MIBG imaimira meta-iodobenzylguanidine. Maselo a Neuroblastoma amatenga MIBG yomwe imaphatikizidwa ndi ayodini ya radioactive. Maphunzirowa ndi othandiza pofufuza mavitamini a mfupa komanso kutenga nawo mbali kwa mafupa.
Chiyeso china chimene nthawi zambiri chimapangidwa ndi kuphunzira kwa MYCN. MYCN ndi jini lofunika kwambiri pa kukula kwa maselo. Mazira ena a mphutsi ali ndi mavokosi owonjezera a jini (zoposera 10), zomwe zimatchedwa "MYCH amplification." Neuroblastomas ndi MYCN amplification sizitha kuchitapo kanthu pochiza matenda a neuroblastoma ndipo zimakhala zovuta kuti ziwonongeke kumadera ena a thupi.
Neuroblastoma Screening
Popeza kuti mchere wa vanillylmandelic acid ndi homovanillic acid ndi osavuta kupeza komanso zosawerengeka zilipo 75 mpaka 90 peresenti ya mphutsi za mphutsi, kuthekera kwa kuwonetsetsa ana onse za matendawa kumakangana.
Kafukufuku ayang'ana kuyesa ndi mayesero awa, kawirikawiri ali ndi miyezi isanu ndi umodzi. Pamene kuyang'ana kumatenga ana ambiri ali ndi sitepe yoyambirira ya neuroblastoma, sizikuwoneka kukhala ndi zotsatirapo pa chiwerengero cha kufa kwa matendawa ndipo sichikulimbikitsidwa pakalipano.
Kusinthana kwa Neuroblastoma
Monga ndi khansa zambiri, neuroblastoma imagawanika pakati pa magawo I ndi IV malingana ndi kukula kwa khansara. Masitepe ndi awa:
- Gawo I - Pa matenda a stade I chifuwacho chimapezeka, ngakhale kuti chimafalikira ku maseŵera olimbitsa thupi. Pachigawo chino, chotupacho chingachotsedwe mwathunthu pakapita opaleshoni.
- Gawo lachiwiri - Chotupacho chimangokhala kumalo kumene chinayambira komanso ma lymph nodes pafupi akhoza kuthandizidwa, koma chotupacho sichitha kuchotsedwa kwathunthu ndi opaleshoni.
- Gawo III - Chotupacho sichikhoza kuchotsedwa opaleshoni (chiri chosadalirika). Zingakhale zitafalikira kumalo ozungulira kapena kumadera ena, koma osati ku zigawo zina za thupi.
- Gawo lachinayi - Gawo lachinayi limaphatikizapo chotupa chilichonse cha kukula kwake kapena kosapanga mafupa omwe afalikira ku fupa, fupa, chiwindi, kapena khungu.
- Gawo la IV-S - Maphunziro a masewero a IV-S amapangidwa chifukwa cha zotupa zomwe zimapezeka m'madera, koma ngakhale izi zafalikira m'mafupa, khungu kapena chiwindi mwa ana osakwana chaka chimodzi. Mafupa amatha kukhala nawo, koma chotupacho chiripo pansi pa 10 peresenti ya mafupa.
Pafupifupi 60 mpaka 80 peresenti ya ana amapezeka ngati khansara ili pazenera IV.
Gulu la International Neuroblastoma Risk Staging System (INRGSS)
Gulu la International Neuroblastoma Risk Staging System ndi njira ina yomwe mauroblastomas amafotokozera ndikupereka zowonjezera za "chiopsezo" cha khansa, mwa kuyankhula kwina, kuti chotupacho chiyenera kuchiritsidwa bwanji.
Pogwiritsa ntchito dongosolo lino, zotupa zimakhala ngati chiopsezo chachikulu kapena choopsa, chomwe chimathandiza kutsogolera chithandizo.
Zifukwa ndi Zoopsa za Neuroblastoma
Ana ambiri omwe ali ndi neuroblastoma alibe mbiri ya banja lawo. Izi zinati, kusintha kwa maselo kumaganiziridwa kuti ndi amene amachititsa pafupifupi 10 peresenti ya tizilombo toyambitsa matenda.
Zosintha za ALK (amaplastic lymphoma kinase) jini ndizo zimayambitsa matenda a neuroblastoma. Kusinthika kwa Germine ku PHOX2B kwapezeka mu chigawo cha nthenda yotchedwa neuroblastoma.
Zina mwazidzidzidzi zomwe zimaphatikizidwa ndi kusuta fodya, kugwiritsa ntchito mowa, mankhwala ena pa nthawi yomwe ali ndi pakati komanso mankhwala ena, koma panthawiyi sadziwa ngati awa ali ndi gawo kapena ayi.
Mankhwala a Neuroblastoma
Pali njira zingapo zothandizira mankhwala a neuroblastoma. Kusankha kwa izi kudzadalira ngati opaleshoni ndi yotheka ndi zina. Kaya chotupacho ndi "chiopsezo chachikulu" malingana ndi INCRSS imathandizanso kusankha chisamaliro, ndipo zosankha zimapangidwa malinga ndi kuti chotupacho ndi chiopsezo chachikulu kapena chiopsezo chachikulu. Zosankha zikuphatikizapo:
- Kuchita Opaleshoni - Kupatula kuti neuroblastoma yakula (siteji IV), opaleshoni imachitidwa pofuna kuchotsa chotupa chachikulu ngati n'kotheka. Ngati opareshoni sangathe kuchotsa chotupa chonse, mankhwala owonjezereka ndi chemotherapy ndi ma radiation nthawi zambiri amalimbikitsa.
- Chemotherapy - Chemotherapy imaphatikizapo kugwiritsira ntchito mankhwala osokoneza bongo omwe amachititsa kuti azigawanika mofulumira maselo. Zotsatira zake zimakhala zowawa chifukwa cha zotsatira zake pa maselo omwe ali m'thupi lomwe limagawanika mofulumira monga mafupa, tsitsi la misozi, ndi matenda. Mankhwala am'madzi omwe amagwiritsidwa ntchito popanga neuroblastoma ndi Cytoxan (cyclophosphamide), Adriamycin (doxorubicin), Platinol (cisplatin), ndi etoposide. Zakudya zina zowonjezereka zimagwiritsidwa ntchito ngati chotupachi chimaonedwa kuti ndi choopsa.
- Kulowetsa maselo a tsinde - Mankhwala apamwamba a mankhwala ndi ma radiation otsatiridwa ndi tsinde lopatsirana ndi njira ina yothandizira. Mapuloteni amenewa akhoza kukhala autologous (pogwiritsa ntchito maselo a mwana omwe amachotsedwa asanafike chemotherapy) kapena allogeneic (pogwiritsa ntchito maselo kuchokera kwa wopereka monga kholo kapena wopereka osagwirizana).
- Mankhwala ena - Chifukwa cha zotupa zomwe zimabwereranso, mitundu ina ya mankhwala omwe angaganizidwe ndi monga retinoid therapy, immunotherapy , ndi mankhwala omwe amathandizidwa ndi ALK inhibitors ndi mankhwala ena, monga kugwiritsa ntchito mankhwala omwe amatengedwa ndi maselo a neuroblastoma omwe amagwiritsidwa ntchito ndi radioactive particles.
Kukhululukidwa kwadzidzidzi kwa Neuroblastoma
Chodabwitsa chomwe chimatchulidwa kuti chikhululukiro chadzidzidzi chikhoza kuchitika, makamaka kwa ana omwe ali ndi zotupa zosachepera masentimita awiri ndi awiri, ndi siteji I kapena siteji yachiwiri, ndipo ali osakwana chaka chimodzi.
Kutulutsa modzidzimutsa kumachitika pamene matenda "amatha" okha popanda mankhwala. Ngakhale chodabwitsa ichi ndi chosowa ndi ena ambiri khansa, si zachilendo ndi neuroblastoma, kaya ndi zotupa zoyambirira kapena metastases. Sitikudziwa chomwe chimayambitsa zina zoterezi, komabe zimakhudzana ndi chitetezo cha mthupi m'njira ina.
Matenda a Neuroblastoma
Nthenda ya neuroblastoma imasiyana mosiyana pakati pa ana osiyana. Zaka zodziŵika bwino ndi nambala imodzi yomwe imakhudza matenda. Ana amene amapezeka kuti asanakwanitse zaka chimodzi amakhala ndi chithunzithunzi chabwino kwambiri, ngakhale ndi njira zapamwamba za neuroblastoma.
Zinthu zomwe zimagwirizanitsidwa ndi matenda a neuroblastoma ndi awa:
- Zaka zakubadwa
- Gawo la matendawa
- Zotsatira za mafupa monga ploidy ndi amplification
- Mawuwa ndi chotupa cha mapuloteni ena
Kupeza Thandizo
Winawake adanena kuti chinthu choyipa kwambiri kuposa kukhala ndi khansa ndikuti mwana wanu akumane ndi khansara, ndipo pali choonadi chochuluka ku mawu amenewa. Monga makolo, timafuna kupepesa ana athu ululu. Mwamwayi, zosowa za makolo a ana omwe ali ndi khansara zakhudzidwa kwambiri m'zaka zaposachedwapa. Pali mabungwe ambiri okonzedwa kuti athandize makolo omwe ali ndi ana omwe ali ndi khansara, ndipo pali ambiri mwa-munthu komanso magulu othandizira pa intaneti ndi midzi. Magulu awa amakulolani kulankhula ndi makolo ena omwe akukumana ndi mavuto omwewo ndikupeza chithandizo chomwe chimabwera chifukwa chodziwa kuti simuli nokha. Tengani kamphindi kuti muwone mabungwe omwe amathandiza makolo omwe ali ndi khansara.
Ndikofunika kutchula abale ndi alongo omwe akulimbana ndi maganizo a kukhala ndi mchimwene wawo ali ndi khansara komabe nthawi zambiri amakhala ndi nthawi yochepa ndi makolo awo. Pali mabungwe othandizira komanso makampu omwe amakonzedwa kuti akwaniritse zosowa za ana omwe abwenzi awo ambiri sangathe kumvetsa. CancerCare ili ndi zinthu zothandizira abale a mwana ndi khansa. SuperSibs ikudzipereka kuti itonthoze ndi kuwapatsa mphamvu ana omwe ali ndi mchimwene wawo ali ndi khansara ndipo ali ndi mapulogalamu osiyanasiyana kuti akwaniritse zosowa za ana awa. Mwinanso mutha kuyang'ana kumisasa ndi kubwerera kwa mabanja ndi ana omwe akudwala khansa.
Mawu Ochokera
Neuroblastoma ndi mtundu wochuluka kwambiri wa khansara kwa ana pa chaka choyamba cha moyo koma siwowonjezereka m'zaka zaunyamata kapena akuluakulu. Zizindikiro zambiri zimaphatikizapo kupeza mimba m'mimba, kapena zizindikiro monga "buluu la muffin" kuthamanga.
Njira zambiri zamankhwala zothandizira amatha kupezeka ndi matenda a neuroblastomas amene atulukira kale kapena omwe adabwereranso. Izi zimadalira zifukwa zambiri, koma kupulumuka ndipamwamba kwambiri pamene matendawa amapezeka m'chaka choyamba cha moyo, ngakhale atakula kwambiri. Ndipotu, matenda ena a mphuno, makamaka aang'ono, amatha kupezeka popanda mankhwala.
Ngakhale pamene matendawa ali abwino, neuroblastoma ndi matenda oopsa kwa makolo, omwe angafune kuti adziwonetse okha kusiyana ndi kuti ana awo azikhala ndi khansa. Mwamwayi, pakhala kufufuza kwakukulu ndi kupita patsogolo pakuchiza khansa ya ana m'zaka zaposachedwa, ndipo njira zatsopano zothandizira mankhwala zikupangidwa chaka chilichonse.
> Zotsatira:
> Berlanga, P., Canete, A., ndi V. Castel. Kupita Patsogolo pa Mankhwala Osokoneza Bongo Omwe Akuthandizira Kuchiza Mankhwala a Neuroblastoma. Malingaliro Amaganizo pa Zotsatira Zogwiritsa Ntchito Mankhwala Osokoneza Bongo . 2017. 22 (1): 63-75.
> Esposito, M., Aveic, S., Seydel, A., ndi G. Tonini. Neuroblastoma Chithandizo pa Post-Genomic Era. Journal of Biomedical Science . 2017. 24 (1): 14.
> National Cancer Institute. Chithandizo cha Neuroblastoma (PDQ) - Health Professional Version. Kusinthidwa 06/21/17. https://www.cancer.gov/types/neuroblastoma/hp/neuroblastoma-treatment-pdq