Kodi Transitional Cell Carcinoma (TCC) N'chiyani?

Urothelial carcinoma, mtundu wochuluka wa khansa ya chikhodzodzo, yogwirizana ndi kusuta

Ngakhale khansara ya chikhodzodzo si mtundu wa khansara timayankhula za, monga kansa ya m'mapapo, khansara ya m'mawere, kapena khansa ya khansa ya khansa, ndiyo kwenikweni khansa yachinayi yomwe ikufala kwambiri ku America komanso yachisanu ndi chinayi ku America. Malingana ndi deta kuchokera ku Centers for Disease Control and Prevention, amuna opitirira 55,000 ndi akazi 17,000 amapeza khansa ya chikhodzodzo ku US chaka chilichonse.

Mwa awa, pafupifupi 16,000-kuposa mmodzi mwa anai-adzafa chifukwa cha matenda.

Mtundu wambiri wa kansa ya chikhodzodzo imatchedwa transitional cell carcinoma (TCC). Amadziwika ndi dzina lakuti urothelial carcinoma (UCC), TCC imachokera m'katikati mwazitsulo zamakono zotchedwa, mwachangu, urothelium.

TCC ikhoza kukhala minofu kuchokera paliponse pamphepete, kuphatikizapo:

• Sinus ya renal (chingwe mkati mwa impso)
• Ureter (ma tubes akugwirizanitsa impso ndi chikhodzodzo)
• Mkanda wamkati wa chikhodzodzo
• Urethra (chubu yomwe mtsuko umathamangitsidwa mu thupi)
• Urachus (otsalira a fetal channel pakati pa chikhodzodzo ndi nsanja)

TCC imaonedwa kuti ndi yachiwiri chifukwa cha khansa ya impso pamene ikukhudzana ndi sinus yamphongo.

Zizindikiro ndi Zizindikiro

Zizindikiro za TCC zidzasiyana ndi malo a chotupa. Nthaŵi zambiri amafanana ndi zizindikiro za matenda aakulu a impso momwe munthu angakumane ndi kupweteka kwam'mimba ndi kupweteka kumbuyo / impso.

Chifukwa chakuti matendawa amatsanzira zovuta zambiri (kuphatikizapo cystitis , matenda a prostate, ndi chikhodzodzo chopitirira mavitamini), matendawa amayamba kupangidwa pamene khansara imakula kwambiri.

Panthawi imodzimodziyo, TCC ndi khansara yopitirira pang'onopang'ono yomwe ili ndi latency nthawi iliyonse mpaka 14.5 zaka, malinga ndi National Cancer Institute.

Poyambirira, pang'onopang'ono, zizindikiro zimakhala zosavuta kuti zisakhaleko. Nthawi zambiri zimangokhalapo pamene chithunzithunzi chapita patsogolo kuti zambiri zowonjezera zimawonekera.

Ndi chifukwa chake kuti 89 peresenti ya ma diagnosti imapangidwa mwa amuna 50 ndi kupitirira. Mwa awa, 20 peresenti adzapezeka ndi khansara ya stage III, pamene pafupifupi mmodzi mwa anayi adzakhala ndi matenda a masastastra (kumene khansara yafalikira kumbali zina za thupi).

Malingana ndi siteji ya matenda, zizindikiro za TCC zingaphatikizepo:

• Magazi owoneka mu mkodzo ( gross hematuria )
• Kupweteka kovuta kapena kovuta ( dysuria )
• Kuthamanga mobwerezabwereza
• Cholinga champhamvu chokodza koma osakwanitsa kuchita zimenezi
• Kupweteka kwa flank kumbali imodzi kumbuyo kumunsi kwa nthiti
• Kutopa
• Kutaya thupi
• Kutaya njala
• Kutentha kwakukulu komwe kumatuluka thukuta kwambiri
• Kutupa kumapeto kwenikweni ( edema ), kawirikawiri pamatenda otsiriza

Zifukwa ndi Zoopsa

Nthawi zambiri anthu amaganiza kuti khansara ya chikhodzodzo kapena impso imayamba chifukwa cha poizoni ife timadya, kaya ndi madzi kapena mankhwala omwe ali nawo. Kwa mbali zambiri, izi siziri choncho. Ngakhale kuti poizoni zimagwirizana ndi chitukuko cha TCC, kaŵirikaŵiri zimakhala mtundu umene timapanga nthawi yaitali.

Mmodzi mwa iwo ndi utsi wa ndudu .

Ndipotu, oposa theka la onse omwe ali ndi matenda a TCC amuna ndi opitirira atatu mwa amayi amayamba kusuta fodya. Komanso, chiopsezo ndi msinkhu wa matendawa zikuwonekera molumikizana ndi chiwerengero cha zaka zomwe munthu akusuta komanso nthawi zambiri kusuta.

Malinga ndi kafukufuku wochokera ku Memorial Sloane-Kettering Cancer Center ku New York, khansara ya chikhodzodzo mu fodya si yowonjezereka koma kawirikawiri imakhala yowonjezereka kusiyana ndi osasamala.

Chifukwa cha mgwirizanowu ndizosamveka bwino, koma ena asokoneza kuti kusuta fodya kwa nthawi yaitali kumayambitsa kusintha kwa chromosomal m'mapisitiki omwe amachititsa zilonda ndi khansa.

Mavuto amaoneka kuti ali apamwamba kuposa onse omwe amasuta ndudu 15 pa tsiku.

Zina mwazidziwitso kwa TCC ndizo:

• Ukalamba, ndipo pafupifupi 90 peresenti ya milandu ikuchitika mwa anthu opitirira 55
• Kukhala wamwamuna, makamaka chifukwa cha atrogen yogwira ntchito (abambo amuna ogonana) omwe amathandiza kwambiri pakukula kwa TCC
• Kukhala woyera, komwe kumakhala koopsa kawiri poyerekeza ndi African American and Latinos
• Ma genetics, makamaka za kusintha kwa matenda a Cowden (PTEN gene), Lynch syndrome (HPNCC gene), kapena retinoblastoma (RB1 gene)
• Kunenepa kwambiri, chiopsezo chowonjezeka cha 10 mpaka 20 peresenti
• Malo ogwira ntchito kumalo odzola amines ankagwiritsidwa ntchito m'mafakitale ndi magetsi osindikizira komanso popanga nsalu, zikopa, utoto, ndi zovala
• Asanayambe kugwiritsa ntchito chemotherapy mankhwala Cytoxan (cyclophosphamide)
• Kugwiritsa ntchito mankhwala a shuga Actos (pioglitazone) kwa zoposa chaka
• Kugwiritsa ntchito mankhwala owonjezera omwe amapezeka ndi aristolochic acid (amadziwikanso kuti pin Yin mu mankhwala achi China)

Kudziwa

Kawirikawiri, chizindikiro choyamba cha matenda a TCC chidzakhala magazi mu mkodzo. Nthawi zina sizingatheke koma zimawoneka mosavuta mu urinalysis (kuyesa mkodzo) .

Mitsempha ya mkodzo ingagwiritsenso ntchito kuyang'ana maselo a khansa mu mkodzo, ngakhale kuti izi ndi njira yodalirika yofufuza. Mosiyana, mateknoloji atsopano amatha kuzindikira mapuloteni ndi zinthu zina mumkodzo wokhudzana ndi TCC. Izi zikuphatikizapo mayesero odziwika bwino otchedwa Urovysion ndi Immunocyt. Pali ngakhale mayeso a kunyumba omwe amadziwika kuti Bladderchek omwe amatha kuzindikira puloteni yotchedwa NMP22 yomwe imapezeka pamapamwamba kuposa anthu omwe ali ndi kansa ya chikhodzodzo.

Miyezo yamakono ya golidi yowunikira ndi yodabwitsa yomwe imapezeka ndi cystoscopy. Cystoscope ndi kansalu kakang'ono kamene kamakhala ndi kamera kamene kamalowetsedwa mu urethra kuti muwone chikhodzodzo. Chiwopsezo chimaphatikizapo kuchotsedwa kwa minofu yokayikira kuti afufuzidwe ndi wodwalayo.

Malinga ndi mtundu wa cystoscope umene wagwiritsidwa ntchito, njirayi ingagwiridwe ndi anesthesia wamba kapena wamba. Si zachilendo kugwiritsa ntchito anesthesia ambiri mwa amuna momwe njirayi ingakhalire yopweteka kwambiri chifukwa chakuti urethra wamwamuna ndi wautali ndi wocheperapo kusiyana ndi akazi.

Kansa Staging

Ngati matenda opatsirana khansa apangidwa, a oncologist amachititsa malignancy pang'onopang'ono. Dokotala adzachita zimenezi pogwiritsa ntchito njira ya TNM yomwe ikufotokoza kukula kwa chotupa choyamba ("T"), kulowerera kwa khansa kumalo osungira mafupa omwe ali pafupi ("N"), komanso kukula kwa metastasis ("M").

Cholinga cha mndandanda ndi kudziwa njira yoyenera yogwirira ntchito ndi cholinga chosafuna kapena kupitirira khansa. Malingana ndi zomwe apezazi, adokotala adzayambitsa matendawa motere:

• Gawo 0 ndi pamene pali umboni wodzitetezera koma osagwiritsa ntchito lymph node kapena masastasis.
• Gawo Woyamba limafotokozedwa ndi kufalikira kwa khansa kuchokera ku chipinda cha epithelial lining mpaka minofu yomwe imagwiritsidwa ntchito pansipa koma popanda kugwiritsira ntchito mitsempha ya mitsempha kapena ma metastasis.
• Gawo lachiwiri ndi pamene khansara yayamba kufalikiranso ku minofu pansipa koma sanadutse muzenera. Komabe, palibe kutengeka kwa ma lymph node kapena metastasis.
• Gawo lachitatu ndi pamene khansara yakula kupitirira linga la ziwalo koma sinafalikira ku maselo am'mbali.
• Gawo lachinayi ndi pamene khansara imafalikira ku ziwalo zakutali, kufalikira ku maselo amphongo oyandikira, kapena onse awiri.

Maphunzirowa amaperekanso dokotala komanso munthu wina kukhala ndi moyo wabwino kwambiri. Ziwerengerozi sizinayikidwa pamwala, ndipo anthu ena omwe ali ndi khansa yapamwamba akhoza kukwaniritsa chikhululukiro chonse mosasamala za matendawa.

Ndikunena kuti, kale matenda odwala matendawa nthawi zonse amathandizidwa ndi zotsatira zabwino. Anthu omwe ali ndi siteti 0, siteji I, kapena stage II TCC ali ndi 90 peresenti ya mankhwala. Amene ali ndi gawo lachitatu ali ndi mwayi wokwana 50 peresenti. Ngakhale omwe ali ndi kansa ya kanayi ya IV amakhala ndi 10 peresenti ndipo 15 peresenti amakhala ndi mwayi wokhululukidwa, malinga ndi National Cancer Society.

Chithandizo Chakumayendedwe

Kuchiza kwa TCC kumadalira makamaka pa siteji ya matenda, momwe khansa yafalikira, ndi mtundu wa ziwalo zomwe zikuphatikizidwa. Zina mwa mankhwalawa ndi ophweka ndi mankhwala apamwamba. Zina zimakhala zowonjezereka ndipo zikhoza kufunika kuchipatala chachikulu komanso chachilendo. Mwa iwo:

• Gawo lachiwiri ndi zithunzithunzi zomwe sindinayambe kuziyika minofu zimatha "kumeta" ndi chipangizo cha electrocautery chomwe chili pamapeto a cystoscope. Ndondomekoyi ikhoza kutsatiridwa ndi kafukufuku wamfupi wa chemotherapy. Mankhwala opatsirana pogonana pogwiritsa ntchito katemera wotchedwa Bacillus Calmette-Guérin (BCG) angachepetsenso chiopsezo cha kubwereza m'mabuku awiri mwa atatu.
• Matenda a khansa ya II ndi atatu ndi ovuta kuchiza . Afunika kuchotsa minofu iliyonse. Pankhani ya chikhodzodzo, zikhoza kuchitidwa opaleshoni yotchedwa cystectomy kwambiri yomwe chikhodzodzo chonsecho chimachotsedwa. Kachilombo kameneka kamatha kuchitidwa pang'onopang'ono kakang'ono ka magawo awiri, koma palibe gawo lachitatu. Chemotherapy angaperekedwe opaleshoni isanayambe kapena itatha, malinga ndi kukula kwa chotupacho. Mafuta angagwiritsidwe ntchito ngati mankhwala a adjuvant koma sagwiritsidwa ntchito pokhapokha.
• Matenda a khansa ya IV ndi ovuta kwambiri kuchotsa. Chemotherapy kapena popanda ma radiation nthawi zambiri ndi mankhwala oyamba omwe ali ndi cholinga chochepetsa kukula kwa zotupa. Kawirikawiri, opaleshoni sangathe kuchotsa khansa yonse koma ingagwiritsidwe ntchito ngati ikhoza kuwonjezera moyo wa munthu komanso umoyo wake .

Mankhwala Osokoneza Bongo

Mankhwala amtundu wa mankhwala monga methotrexate , vinblastine, doxorubicin, ndi cisplatin amagwiritsidwa ntchito pophatikizapo mankhwala. Ndi cytotoxic (kutanthauzira zowononga kwa maselo amoyo) ndipo amagwira ntchito pogwiritsa ntchito maselo ofotokoza mofulumira monga khansara. Chifukwa cha zotsatirazi, amatha kupha maselo wathanzi omwe ali mofulumira-kubwereza zomwe zimapezeka m'mafupa, tsitsi, ndi matumbo.

Mibadwo yatsopano monga mankhwala a Opdivo (nivolumab) , Yervoy (ipilimumab), ndi Tecentriq (atezolizumab) amagwira ntchito mosiyana ndi kuyambitsa chitetezo cha mthupi kuteteza khansa. Mankhwala otchedwa monoclonal antibodies amalowetsedwa m'thupi ndipo nthawi yomweyo amafufuza maselo a khansa, amawakakamiza ndi kusonyeza maselo ena omwe amateteza mthupi.

Mtundu uwu wa immunotherapy ukhoza kufoola zotupa ndikuletsa khansayo kuti isapitirire. Zimagwiritsidwa ntchito makamaka kuwonjezera moyo wa anthu omwe ali opambana, osagwira ntchito, kapena TCC yamtundu. Zotsatira zofala kwambiri za mankhwalawa opangitsa chitetezo cha mthupi ndi awa:

• Kutopa
• Kupuma pang'ono
• Zowawa zofanana kapena zowawa
• Kuchepetsa kudya
• Rash
• Kutsekula m'mimba
• Kukuda
• Kutsekedwa
• Chikopa kapena khungu lenileni
• Nausea

Kugwirizanitsa kwa Opdivo ndi Yervoy kwakhala kotchuka muzaka zaposachedwapa mu nkhani za TCC yapitayi. Chithandizo chimaperekedwa mwachangu m'mphindi 60, kawirikawiri milungu iwiri iliyonse. Mlingo ndi kawirikawiri zimakhudza kwambiri momwe khansara imachitira ndi mankhwala ndi kuopsa kwa zotsatira zake.

Kupewa

Kupewa TCC kumayambira ndi zinthu zomwe mungathe kuzilamulira. Mwa izi, ndudu zimakhalabe zofunikira kwambiri. Zoona ndi zophweka: Khansa ya chikhodzodzo ndiyi yachiwiri yowononga kusuta fodya kumbuyo kwa khansara yamapapo. Kusiya sikuti kumachepetsa kwambiri chiopsezo cha munthu cha TCC koma kumatha kuteteza kachilombo ka khansa mwa iwo omwe amachiritsidwa bwino.

Kusiya kungakhale kovuta ndipo kawirikawiri kumafuna mayesero angapo, koma mapulani ambiri a inshuwalansi lero akuphimba zina kapena zonse zomwe zimawonongeka ndi mankhwala osuta fodya.

Zinthu zina zosinthika zingathandizenso kuchepetsa ngozi. Kafukufuku wina wa zaka 10 okhudza amuna 48,000 anapeza kuti omwe amamwa madzi okwana 1.44 (magalasi pafupifupi asanu ndi atatu) tsiku ndi tsiku amakhala ndi khansa ya chikhodzodzo yochepa poyerekeza ndi omwe ankamwa mochepa. Ngakhale kuti zotsalirazo zakhala zikuchepa (chifukwa chakuti zinthu zina, monga kusuta ndi zaka, sizidaphatikizidwe), kafukufuku wa 2012 adawonetsa kuti kudya kwa madzi okwanira kunapereka chitetezo, makamaka kwa anyamata.

Ngakhale kumwa madzi okha sikungathetse zotsatira za kusuta fodya, kumapindulitsa phindu la njira zabwino zamoyo zotsatila zomwe zimaphatikizapo bwino hydration ndi pulogalamu yolemetsa yolemera ngati yayamba.

> Zotsatira:

> American Cancer Society. "Chithandizo cha Khansa Yachikhodzodzo, ndi Gawo." Atlanta, Georgia; Ndemanga pa 18, 2017.

> Burger, M .; Catto, J .; Dalbagni, G ;; et al. "Zomwe zimayambitsa matenda komanso matenda a kansa ya chikhodzodzo." Eur Urol. 2013; 63 (2): 34-41. DOI: 10.1016 / j.eureo.2012.7.033.

> Zolinga za Kuletsa ndi Kuteteza Matenda. "" Khansa Yachikhodzodzo. " Atlanta, Georgia; zasinthidwa pa June 6, 2017.

> Jiang, X .; Castaleo, J ;; Yuan, J. et al. "Kusuta Fodya ndi Zambiri za Khansa Yachikhodzodzo." Int J Khansa. 2012; 130 (4): 896-901. DOI: 10.1002 / ijc.26068.

> National Cancer Institute: Ma Institutes of Health. "Chikhodzodzo ndi Zina Zowononga Khansa Yogonana (PDQ) -Health Professional Version." Washington, DC; zasinthidwa pa February 22, 2017.