Zizindikiro, Zimayambitsa, Kuzindikira, ndi Kuchiza
Khansara ya endometrial ndi khansara yomwe imakhudza chiberekero cha chiberekero ndipo imafala kwambiri kwa amayi atatha msinkhu. Chodabwitsa ndi chakuti mtundu uwu wa khansara ukuwonjezeka ku North America ndi Europe. Kodi muyenera kudziwa chiyani za matenda, khansa, ndi chithandizo cha khansa iyi?
Kansa ya Endometrial-Tanthauzo
Khansara ya endometrial, yomwe imatchedwanso khansa ya uterine, ndi khansa yomwe imayamba mu maselo omwe amalowa m'chiberekero ( endometrium ) ndipo ndiyo khansa yowononga kwambiri chiberekero.
Endometrium imakhala yogwira kwambiri pa nthawi ya kusamba kwa mzimayi komanso mimba. Pa theka loyamba la kusamba, estrogen imapangitsa endometrium kumanga pokonzekera kukhazikitsidwa kwa mimba. Ngati mimba sichikuchitika, progesterone imayambitsa kusokonezeka kwa minofuyi, yomwe imatsanulidwa pa nthawi ya mkazi.
Khansara ina yochepa kwambiri ya chiberekero, uterine sarcoma, imayamba m'kati mwa minofu pansi pa endometrium yotchedwa myometrium (minofu ya chiberekero).
Pali magawo angapo a khansa ya m'mimba, monga adenocarcinoma, adenosquamous, carcinoma, bwino cell cell carcinoma, ndi ena. Ambiri mwa khansawa amapezeka mofulumira, pa siteji pamene opaleshoni imapereka chithandizo chabwino. Izi zati, zifukwa zomwe zimayambitsa chiopsezo chotenga khansa zimenezi zawonjezeka monga momwe zilili ndi chiwerengero cha chaka chilichonse m'mayiko otukuka.
Matenda opatsirana pogonana ndi khansa yachiberekero
Kusiyanitsa pakati pa khansa ya m'mimba ndi khansara ya chiberekero kungakhale kusokoneza kuyambira pamene chiberekero kwenikweni ndi chiberekero cha chiberekero. Ngakhale chiwalo chomwecho chikukhudzidwa, pali kusiyana kwakukulu kosiyana komwe kumachokera ku kuyang'ana ku zifukwa zofunika kwambiri za khansa.
Chigawo chapamwamba cha chiberekero chimaphatikizapo thupi kapena ndalama, pamene kachilombo ka HIV ndi kachigawo ka m'munsi mwa chiberekero, chomwe chimafikira kumaliseche.
Chikoka cha Khansa ya Endometrial
Kafukufuku wa khansa ya endometrial imakhudza akazi okwana 61,380 mu 2017, zomwe zimachititsa kuti amayi 10,920 afa. Zapezeka kuti khansa ya m'magazi ikuwonjezeka m'zaka zaposachedwapa, makamaka kumpoto kwa America ndi ku Ulaya. Zikuganiza kuti izi zokhudzana ndi kuwonjezeka kwa zoopsa m'zaka zaposachedwa, monga kunenepa kwambiri, amayi ocheperapo ana, ndi kubwezeretsa kubereka. Ngakhale kansa ya m'magazi inali yosazolowereka kwambiri mu amai a ku Africa kuno kuposa azungu ku United States, chiwerengerochi chimafanana.
Zizindikiro ndi Zizindikiro
Poyambirira, mkazi sangakhale ndi zizindikiro zilizonse ndi khansa ya endometrial. Pamene zizindikiro zimayamba, chofala kwambiri ndi kusintha kwa magazi. Izi zikhoza kukhala zowuluka pambuyo poti mkazi wadutsa kusamba kwa nthawi ndipo alibe nthawi. Kupha magazi kumtenda, khansa ya m'magazi ingayambitse magazi ochuluka , monga kutuluka m'magazi ndi kupenya pakati pa nthawi. Azimayi ena alibe magazi osiyana koma m'malo mwake amadziwa kuti madzi amadzi azimayi amadziwika bwino. Azimayi ena akhoza kukhala ndi vuto la kuchepa kwa magazi.
Zizindikiro zina zotheka ndizopweteka pamimba kapena masana. Khansayo ikakula, zizindikiro monga kuchepa kwadzidzidzi , kutopa, kapena kusintha kwa chikhodzodzo ndi chikhodzodzo zikhoza kuzindikiridwa.
Zifukwa ndi Zoopsa
Ngakhale sitikudziŵa zenizeni zomwe zimayambitsa kansa ya m'magazi, pali zifukwa zingapo zoopsa zomwe zapezeka. Zomwe zimadziwika komanso zomwe zingatheke ndizo:
- Zaka: Khansara ya endometrial imakhala yowonongeka kwambiri kwa amayi osapitirira msinkhu wa kusamba.
- Mapiri a estrogen apamwamba (opanda mapiri a progesterone): Chikhalidwe chilichonse chomwe chimapangitsa mazinga a estrogen popanda kuchuluka kwa progesterone kungapangitse ngozi.
- Kugwiritsa ntchito mankhwala ovomerezeka mwachindunji: Kugwiritsa ntchito mankhwala opatsirana pakamwa pakatha chaka chimodzi kumachepetsa chiopsezo. Kuperewera kwa chiopsezo ndi kwakukulu kwa amayi omwe amagwiritsa ntchito mapiritsi oletsa kubereka kwa nthawi yaitali ndipo akupitiriza kuchepetsa chiopsezo kwa zaka zingapo mapiritsi achotsedwa.
- Mankhwala othandizira odwala otchedwa hormone (HRT): HRT ndi estrogen koma popanda progesterone (mankhwala osatetezedwa a estrogen) amachititsa ngozi ya khansa ya m'mimba.
- Zotsatira zoberekera: Amayi omwe ali ndi zaka zambiri zobereka, monga omwe amayamba kusamba msanga kapena omwe amatha kusamba nthawi yayitali ali pangozi yaikulu. Akazi omwe alibe ana ali pangozi yaikulu kuposa omwe ali ndi ana.
- Mbiri ya kusabereka
- Mbiri ya endometrial hyperplasia
- Kunenepa kwambiri: Kukhala wochulukirapo katatu kukhala ndi chiopsezo chotenga matendawa.
- Matenda a Polycystic ovarian (PCOS): PCOS imayambitsa chiopsezo chokhala ndi kansa ya endometrial ngakhale zina mwa mankhwala a PCOS, monga metformin, zingachepetse ngozi.
- Matenda a shuga: Matenda a khansa ya endometrial ndi ochuluka kwambiri kuposa amayi omwe ali ndi shuga.
- Gwiritsani ntchito mankhwalawa: Kugwiritsa ntchito IUD kumachepetsa chiopsezo cha amayi cha khansa ya m'magazi.
- Tamoxifen: Kugwiritsidwa ntchito kwa tamoxifen kuchepetsa chiopsezo cha kubwereza kapena kuchepetsa chiopsezo cha khansa ya m'mawere kungapangitse chiopsezo chokhala ndi khansa ya m'magazi.
- Ziphuphu zina za m'mimba monga khungu la granulosa serete secrete estrogen ndipo ikhoza kupha khansa ya m'mimba.
- Mbiri ya kukhala ndi khansa monga khansa ya m'mawere kapena khansara ya ovari
- Kukhala ndi mbiri ya banja la khansa ya m'magazi kapena khansa yamtundu
- Anthu omwe ali ndi matenda a khansa yachilendo monga Lynch syndrome (khansa yopanda malire ya nonpolyposis yosalala kapena HNPCC)
- Mbiri ya miyendo ya m'magazi monga gawo la chithandizo cha khansa
- Kukhala ndi moyo wokhazikika
- Kudya zakudya zamtengo wapatali
Kuwunika / Kutulukira Kwambiri
Mosiyana ndi khansara ya chiberekero, palibe njira yowonetsera kachitidwe ka kansa ya endometrial. Azimayi omwe ali pangozi yowonjezera matendawa, monga omwe ali ndi mbiri ya banja, matenda a khansa monga Lynch, kapena omwe akhala akugwiritsa ntchito tamoxifen kuti athetse kapena kuchepetsa chiopsezo cha khansa ya m'mawere ayenera kulankhula ndi dokotala wawo za kuyang'ana. Kwa amayi ena, mayesero monga endometrial biopsy ndi / kapena uterine ultrasound angaoneke ngati akuwonjezera mwayi wowunikira matenda mwamsanga.
Kuzindikira kwa khansa ya m'mimba
Matendawa amatha kuganiza kuti ali ndi mapepala a Pap, koma mapuloteni a Pap sali chida chowunika bwino cha matendawa. Kudziwa kawirikawiri kumayambira ndi kuyeza kwa msana, ngakhale kuti khansa yoyambirira sichitha.
Ngati mwakhala ndi magazi osakanizidwa, pali mayesero ambiri omwe dokotala angaganizire. A ultrasound transvaginal (ultrasound yomwe imachitidwa poika kafukufuku wa ultrasound mu umaliseche wanu) ikhoza kuchitidwa kuti muwone kukula kwa endometrium yanu. Yankho la saline lingathenso kulowa mu chiberekero chanu (sonohysterogram) musanayambe njira yowonjezeramo kuyang'ana kwa zovuta zilizonse.
Kachilombo kameneka ndi njira yomwe "telescope" imayikidwa kudzera mu chiberekero chanu mu chiberekero chanu kuti muwone ngati chiberekero cha uterine.
Phunziro lapadera ndi biopsy ya endometrial. Mu ndondomekoyi yaofesiyi, chida chimayikidwa kudzera mumaliseche anu kuti mupeze chiberekero cha mkati mwa chiberekero kuti muyese mu labu. Dokotala wanu angalimbikitsenso kuchepetsa ndi kuyeretsa (D ndi C) komwe kawirikawiri imachitidwa m'chipinda chogwiritsira ntchito pansi pa mankhwala osokoneza bongo. Ndi mchere wokhala ndi kachilombo koyambitsa matenda a chiberekero chanu, mungapezeke chitsanzo chabwino cha uterine.
Ngati khansa ya m'magazi imaganiziridwa, chidziwitso n'chofunika kuti zitsimikizidwe kuti zimapezeka komanso kuti zifotokoze momwe zimakhalira.
Kusinthana
Kuti mudziwe njira zabwino zothandizira chithandizo, kulumikiza molondola ndi sitepe yovuta mutaphunzira. Kuwongolera kumachitika poyang'ana kukula kwa chotupacho, ndiko kupsa mtima kochokera ku maonekedwe ake pansi pa microscope (sukulu yoyambitsa chotupa kuyambira 1 mpaka 3), ndi kuyezetsa kuti aone ngati khansara yayenda kapena kufalikira ku zida zilizonse kunja kwa chiberekero.
Mofanana ndi khansa zina, zotupazi zimaperekedwa ndi "TNM" momwe T imayimira kukula kwa chotupa (ndipo nthawi zina zizindikiro zina), N imayimira kukhudza ma lymph nodes kapena pafupi, ndipo M amaimira metastases, kapena kufalikira ku ziwalo zakutali.
Ngati pali mwayi kuti khansara yadutsa kapena kufalikira kwa ziwalo zina, mayesero ena angaphatikizepo cystoscopy ndi / kapena proctoscopy kuyang'ana umboni uliwonse wa kufalikira kwa chikhodzodzo kapena kachilombo, ndi CT, MRI, ndi / kapena PET kuyang'ana kufalikira kwina kwa chotupacho.
Mofanana ndi zotupa zambiri zamphamvu, khansara ya endometri yathyoledwa mu magawo anayi (kuyambira mu January 2018 palibe siteji 0). Izi zikuphatikizapo:
- Gawo 1: Khansara imangokhala pachiberekero, ndipo sinafalikira ku chiberekero, mbali zina za m'mimba, kapena ziwalo zakutali.
- Gawo 2: Chotupa chafalikira ku chiberekero, koma osati ku mbali zina za thupi.
- Gawo 3: Chotupacho chafalikira kupyola chiberekero, koma malo onse kufalikira akadali kumidzi.
- Gawo lachinayi: Khansara yafalikira ku chikhodzodzo, kachilomboka, kapena kutalika kwa thupi.
Zigawozi zikuphatikizidwanso kukhala zidutswa (monga siteji 2A ndi 2B) malingana ndi zina za chifuwacho.
Njira Zothandizira Mankhwala a Kachilombo ka M'thupi
Njira zabwino zothandizira khansa ya m'magazi zimadalira pazigawo za matenda, zizindikiro, komanso zinthu zina monga thanzi labwino. Zosankha zikuphatikizapo:
Opaleshoni: Opaleshoni ndiyo njira yodziwika kwambiri yothandizira khansa ya endometrial. Pa opaleshoni imeneyi chiberekero chachotsedwa ( hysterectomy ), nthawi zambiri pamodzi ndi ma tubes ndi mazira (Salpingo-ophorectomy). Kwa amayi omwe atha kubereka, izi sizimakhala zovuta zambiri kupatulapo chiopsezo cha opaleshoni. Kwa iwo omwe ali aang'ono ndipo akufuna kukhala ndi mwana kapena ana ambiri, komabe izi zingakhale zowawa mtima.
Mankhwala othandizira ma ARV: Mankhwalawa ndi mankhwala omwe angagwiritsidwe ntchito ngati kuli kotheka kuti maselo ena a khansa afalikira kudutsa dera lachotsedwa ndi opaleshoni.
Thandizo la mahomoni: Mankhwala otchedwa hormone angagwiritsidwe ntchito kuchepetsa kuchuluka kwa estrogen kapena kuwonjezera kuchuluka kwa progesterone m'thupi. Mankhwala omwe amapezeka kawirikawiri amaphatikizapo mtundu wina wa progesterone. Kwa zotupa zomwe ziri patali kwambiri kapena zakhala zikubwereranso, zochiritsira zina zotheka zimaphatikizapo tamoxifen, luteinizing kumasula agonists a hormone, ndi aromatase inhibitors.
Chemotherapy: Chemotherapy sichifunika nthawi zambiri kuti matenda a khansa ya endometrial ayambe. Koma khansa yomwe yafalitsidwa kapena yobwereza, komotherapy imagwiritsidwa ntchito nthawi zambiri.
Zilonda zam'chipatala: Zonse za mankhwala a kansa ya m'magazi yomwe ilipo tsopano idaphunzitsidwapo m'mayesero a zamankhwala. Pali mayesero omwe amapita ku khansa ya m'magazi kufunafuna njira zothandizira kuti apulumuke komanso kuchepetsa zotsatirapo za mankhwala komanso kupweteka kwa mankhwala.
Kulimbana
Kupeza chidziwitso cha khansara mosasamala kanthu za mtundu kapena siteji. Maphunziro alimbikitsa, ndipo kuphunzira za khansara kungakuthandizeni kukhala wothandizira anu pa chisamaliro chanu. Tengani kamphindi kuti mudziwe momwe mungapezere uthenga wabwino wa khansa pa intaneti . Thandizo ndilofunikanso. Kuzindikira kwa khansara ndi nthawi yabwino yosonkhanitsa dongosolo lanu lothandizira kuzungulira iwe. Anthu ambiri amaona kuti zimathandiza kuti agwirizane ndi gulu lothandizira m'mudzi mwawo kapena kutenga nawo mbali m'magulu othandizira pa intaneti kapena kuthandizira anthu a khansa ya m'magazi.
Kuthamangitsani
Chidziwitso cha khansa ya m'magazi ku United States ndi yabwino, ndipo ambiri mwa khansawa amapezeka msanga. Mitundu ina yosadziwika ya kansa ya m'magazi monga clear cell carcinoma ndi yamphamvu komanso imakhala yoipa kwambiri.
Mavuto a zaka zisanu ndi zisanu ndi zisanu ndi zisanu ndi zisanu ndi zitatu ndi 75-88 peresenti ya matenda a matenda, 69 peresenti pa gawo la II, 47-58 peresenti pa gawo lachitatu, ndi 15-17 peresenti pa gawo la IV. Ndikofunika kuzindikira kuti mawerengero nthawi zambiri amakhala ndi zaka zambiri ndipo samasonyeza mankhwala atsopano komanso othandiza omwe avomerezedwa kuyambira nthawi imeneyo.
Mawu Ochokera
Khansara ya endometrial ndi khansara ya chiberekero yomwe mwatsoka ikuwonjezeka ku United States ndi Europe. Chizindikiro chofala kwambiri (kwa akazi oposa 90%) ndikumayambitsa magazi osadziwika. Mwamwayi amayi ambiri amafufuza chithandizo ngati ali ndi nthawi zochepa kapena amasiya magazi atatha kusamba, ndipo ambiri mwa zotupazi amapezeka m'zigawo zoyambirira. Njira yabwino yothandizira imadalira gawo la matenda.
Ngati mwapezeka kuti muli ndi khansara ya endometrial chinthu chofunika kwambiri mungachite ndikumulankhulira nokha. Funsani mafunso ambiri. Taganizirani kupeza lingaliro lachiwiri. Ndipo phunzirani za matenda anu.
> Zotsatira:
> Lortet-Tiuelent, J., Ferlay, J., Bray, F. et al. Zitsanzo za Mayiko ndi Zotsatira za Kachilombo ka Khansa ya Endometrial, 1978-2013. Journal of National Cancer Institute . 16 October 2017.
> National Cancer Institute. Endometrial Cancer Treatment (PDQ) -Health Professional Version. Kusinthidwa 08/18/17. https://www.cancer.gov/types/uterine/hp/endometrial-treatment-pdq
> Tang, Y., Zhu, L., Li, Y. et al. Kugwiritsa ntchito Metformin kumayenderana ndi kuchepa kwa chiopsezo komanso kupulumutsidwa kwa khansa ya m'magazi: A Meta-Analysis. BioMed Research International . 2017. 2017: 5905384.