Njira Zothandizira Mankhwala a Mutu Wambiri Wam'mutu ndi Khansa
Kugwiritsira ntchito deta kuyendetsa zosankha zofunika kunatsimikizira leitmotif m'zaka za zana la 21. Mchitidwe wa mankhwala ndi wosiyana komanso umadalira deta; Choyenera, chithandizo chiyenera kutsogoleredwa ndi umboni osati mwadzidzidzi, chidziwitso kapena kungowona. Mabungwe angapo akugwira ntchito yopanga malangizo othandizira okhudzana ndi umboni kuphatikizapo Scottish Intercollegiate Guidelines Network (SIGN).
Malingana ndi webusaiti ya SIGN:
"Zitsogozo za SIGN zimachokera ku ndondomeko yovomerezeka ya zolemba za sayansi ndipo zapangidwa monga galimoto yofulumizitsa kumasuliridwa kwa chidziwitso chatsopano kuti zithetse cholinga chathu chochepetsera kusintha kwa ntchito, ndikukwaniritsa zotsatira za odwala."
Chonde dziwani kuti SIGN ndi bungwe limodzi lokha limene limapereka malangizo othandizira umboni, ndipo pali mabungwe ena otchuka omwe amachitanso chimodzimodzi. Mwachitsanzo, United States Preventive Service Task Force (USPSTF) imaperekanso malingaliro pogwiritsa ntchito umboni wa zachipatala.
M'nkhani ino, tipenda malangizo othandizira okhudzana ndi matenda a khansa ya mutu ndi khosi malinga ndi mtundu wa khansa. Mankhwalawa amachokera pazotsatidwa za chizindikiro kapena zovomerezedwa ndi European Society ku Medical Oncology (ESMO). Kuwonjezera apo, ponena za khansa yapamwamba yomwe ili pamunsimu, chonde onani kuti tikupereka malangizo othandizira odwala khansa yoyambirira komanso yapamwamba kwambiri yomwe ili pamtunda, popanda masitima apatali.
Zonsezi, khansa ya mutu ndi khosi ndi magulu osiyanasiyana a matenda, ndipo mankhwala enieni amachokera kumalo a khansa ndi siteji. Musanayambe kusankha njira zamankhwala, mankhwala opatsirana m'mitsempha amakafufuzidwa chifukwa cha khansara, ndipo kukhalapo kwa metastase kutali kumachotsedwa.
Pomaliza, m'nkhani ino tikukamba za khansa yowonjezera (TNM).
Kuti mudziwe zambiri za staging, chonde tsatirani zowonjezera m'nkhaniyi.
Kuchiza kwa Khansa Yam'mimba Yoyamba
Pano pali zizindikiro zokhudzana ndi umboni wa SIGN za mankhwala oyambirira (Gawo I ndi Gawo II) khansa ya m'kamwa:
- kuchotsa opaleshoni (resection) ya chotupa chachikulu
- Kusankha khosi kumtundu wa N0
- ngati mitsempha yambiri imasonyeza umboni wa khansa kapena kufalikira kwakula kwambiri, ndiye kuti mankhwala othandizidwa ndi ma radiation akulimbikitsidwa
Kusokoneza mitsempha yosasamala kumaphatikizapo kusungira magulu oposa amodzi ochepa. Sankhani magulu a lymph node achotsedwa pogwiritsa ntchito machitidwe omwe amadziwika.
Mfundo zina zowonjezera umboni wothandizira kansalu ya m'kamwa koyambirira zimagwiritsa ntchito mitsempha yotulutsa khosi kapena kuchotsa minofu m'khosi. Choyamba, mwa anthu omwe sanalandire chithandizo cha khansa ya m'kamwa (mankhwala-naïve) ndi chotupa chaching'ono kapena chachikulu chofunika kwambiri (T1 ndi T2, mwachindunji) cha squamous cell, chotsatira (mwadzidzidzi) kusweka kwa khosi kungapitirize kukhala ndi moyo. Chachiwiri, kusokonezeka kwa khosi kungachepetse chiopsezo cha kufala ndi imfa yeniyeni yomwe imakhala ndi anthu omwe ali ndi mafupa omwe sasonyeza umboni wa khansa.
Kuchiza kwa Khansa Yoyamba Kumayendedwe
Malinga ndi CHIZINDIKIRO, khansa yapakamwa yomwe ili patsogolo ikuyenera kuchotsedwanso.
Kuwonjezera apo, kusinthidwa kwazitsitsimutso kupindika kwa khosi kukulimbikitsidwa. Pogwiritsa ntchito njira yowonongeka ya khosi, zitsulo zonse zamphongo zimachotsedwa pamtambo ndipo chimodzi kapena zingapo zimakhala zosungidwa.
Ngati munthu amene ali ndi khansara ya m'kamwa sangagwiritsidwe ntchito (siochita opaleshoni), mankhwalawa ndi cisplatin regimen ndi irradiation zamtundu wa khosi (mwachitsanzo, mankhwala opangira mazira kumbali zonse za khosi) akulimbikitsidwa.
Kuchiza kwa Khwerero Yoyamba ya Canopharyngeal Cancer
Nazi malangizo a ESMO ochiza khansa yoyambirira ya nasopharyngeal:
- Chithandizo cha ma radiation chokha chimagwiritsidwa ntchito pochiza khansa yapakati
- makinadiation (cisplatin ndi mankhwala opatsirana pogwiritsa ntchito mankhwala) angagwiritsidwe ntchito pochiza khansa yachigawo ya II
- Matenda amphamvu a ma radiation (IMRT) ndi mtundu wokondedwa wa mankhwala ochizira mazira pa khansa yoyambirira ya nasopharyngeal
Kuchiza kwa khansa yapamwamba yotchedwa Nasopharyngeal Cancer
Nazi malingaliro a ESMO ochiza khansa yapamwamba ya nasopharyngeal:
- siteji ya III, IVA ndi IVA khansa imachiritsidwa ndi mankhwala amodzimodzi (cisplatin ndi chemotherapy yogwiritsira ntchito)
- IMRT ndiyo njira yamakono yothandizira ma radiation
Kuchiza kwa Khwerero Loyambira Oropharyngeal Cancer
CHIZINDIKIRO chimalimbikitsa kuti khansa yoyamba ya oropharynge imathandizidwa ndi opaleshoni ndi kupotuka kwa khosi kapena mankhwala omwe amachotsa mazira a kunja kwa mimba ndi minofu m'khosi.
Kuchiza kwa Khansa yapamwamba ya Oropharyngeal Cancer
Malinga ndi CHIZINDIKIRO, anthu omwe ali ndi khansara ya m'kamwa amatha kuchiritsidwa chimodzi mwa njira ziwiri: opaleshoni yoyamba kapena kusungidwa kwa ziwalo. Ndi opaleshoni yapadera, chotupa chachikulu chikuchotsedwa ndipo kusinthika kwa mitsempha yowonongeka kwapangidwe kumachitidwa. Ndi njira yotetezera ziwalo, chimoradiation ndi cisplatin imagwiritsidwa ntchito, ndipo maselo a m'mphepete mwa mbali zonse za khosi (m'magulu awiri) amatsitsidwa.
Pambuyo pa opaleshoni yaikulu kapena kusungidwa kwa ziwalo, chimoradiation ndi cisplatin imaperekedwa kwa odwala omwe amatha kufalikira kwambiri (kufalikira kwina) ndi mapulogalamu abwino opaleshoni. Pali njira yabwino yochitira opaleshoni pamene wodwalayo akuwona kuti maselo omwe ali pamalire a minofu imene achotsedwa amakhala akadali ndi khansa.
Kuchiza kwa Khansa Yoyamba Yamakono Opatsirana
CHIZINDIKIRO chimapereka malingaliro atatu a chithandizo kwa anthu omwe ali ndi khansara yoyamba. Choyamba, mankhwalawa amatha kugwiritsa ntchito cisplatin chemoradiation ndi prophylactic radiation. Chachiwiri, opaleshoni yokhazikika yokhala ndi mapepala osakanikirana a khosi angapangidwe. Chachitatu, kwa anthu omwe sali opaleshoni ndipo sangathe kulowa mu chemoradiation, mankhwala opangidwa ndi mazira okhawo angagwiritsidwe ntchito.
Kuchiza kwa Khansa yapamwamba ya Stopopharyngeal Cancer
Malinga ndi CHIZINDIKIRO, ngati chotupacho chikuchotsedwa (mwachitsanzo, chingachotsedwe), ndiye njira ziwiri zingayesedwe: kapena opaleshoni kuchotsa chotupa kapena kusungidwa kwa ziwalo. Ndi chitetezo chamagulu, chithandizo chamankhwala chotsitsimutsa chazitali ndi mankhwala omwe amagwiritsidwa ntchito nthawi zonse amathandizidwa. Matenda a mitsempha omwe ali othandiza kwa khansara amatha kuchiritsidwa pogwiritsira ntchito mitsempha ya khosi kapena popanda mankhwala.
Ngati ololedwa kwa wodwala, omwe ali ndi ziwalo zotere zomwe sangathe kuzichotsa kapena kuchotsedwa angathe kuchiritsidwa ndi cisplatin chemoradiation.
Kuchiza kwa Khansa Yoyamba Kwambiri
Malinga ndi CHIZINDIKIRO, khansa yoyambirira ingapangidwe ndi opaleshoni yosamalidwa bwino kapena mankhwala opangira mazira. Kuwonjezera pamenepo, opaleshoni ya opaleshoni ya transoral ingakhale yogwira mtima monga mankhwala opangira mazira
Pogwiritsa ntchito microsurgery ya transoral, dokotala wochita opaleshoni amatsogolera laser pansi pa microscope, motero kuwonjezereka kwachuluka kwambiri. Njirayi imathandiza dokotalayo kuchotsa maselo omwe ali ndi khansa kuchokera kumatenda ozungulira omwe amagwiritsidwa ntchito pamene chitetezo cha m'thupi n'chofunika pakamwa, m'kamwa komanso pa opaleshoni. Kuchita opaleshoni imeneyi kungachititse kuti moyo ukhale wabwino. Mwachitsanzo, pogwiritsa ntchito transorse laser microsurgery, dokotalayo amatha kusunga khungu kapena mawu a bokosi omwe ali ndi khansara kapena khansa yomwe ili pansi pake.
Kuchiza kwa Khansa Yoyamba Yopambana Ndikatswiri
Malinga ndi CHIZINDIKIRO, chithandizo cha khansa yoyamba yapamwamba ndi yofanana ndi khansa yoyambirira ya glottis, mwina opaleshoni yachipatala kapena mankhwala opangidwa ndi mazira a kunja omwe amathandizidwa. Kuchita opaleshoni yowonongeka ikhoza kutsatiridwa ndi kusweka kwa khosi. Njira zamankhwalazi zimagwiritsidwa ntchito pa ma lymph node pakati pa chigawo chachiwiri ndi gawo III la khosi.
Kuchiza kwa Khansa Yoyambira-Stage Laryngeal Cancer
Malinga ndi CHIZINDIKIRO, apa ndi momwe kansa ya khansa yapakhungu imatha kuchiritsidwa:
- Kuchotsa kwa khungu (laryngectomy) ndi mankhwala osokoneza bongo (adjuvant)
- Njira yotetezera ziwalo imaphatikizapo kugwiritsira ntchito cisplatin chemoradiation potsatira opaleshoni ya salvage ngati pakufunika
- monga momwe zimakhalira ndi chitetezo cha thupi, ngati chotupacho sichingatheke, oyang'anira akuphatikizanso nthawi yomweyo cisplatin chemoradiation yotsatira opaleshoni ya salvage ngati pakufunika
- Khansa ya khansa ya khansa imachotsedwa ndi kupotola khosi kumbali kapena popanda mankhwala
General Chemotherapy Malingaliro
Nazi zina zowonjezera zowonetsera umboni kuchokera ku CHIZINDIKIRO chokhudza chithandizo cha khansa ya mutu ndi khosi:
- Kusamalidwa kwa mankhwala a chemotherapy musanayambe kutentha kwa dzuwa (ie, neoadjuvant therapy) sikunakonzedwe
- Kugwiritsa ntchito mankhwala a chemotherapy pambuyo pa radiation therapy (adjuvant therapy) sikuvomerezedwa
- Neoadjuvant kapena adjuvant chemotherapy sichikulimbikitsidwa nthawi zonse pamodzi ndi mankhwala opaleshoni
Momwemonso, malangizo a chemotherapywa amavomereza kuti anthu omwe ali ndi chitseko chamlomo, oropharyngeal kapena khansa yowonongeka sazilandira mankhwala amodzi asanayambe kapena atatha opaleshoni kapena mankhwala opatsirana. Mwa kuyankhula kwina, mankhwala opangira mazira kapena opaleshoni angakhale ndi mankhwala okwanira okha.
Kutsiliza
Chonde mvetserani kuti ngakhale malangizidwe omwe ali pamwambawa ndi malangizidwe apamwamba kwambiri othandizidwa ndi umboni wokhutiritsa, mayesero olamuliridwa mosavuta, kusanthula mndandanda ndi zina zotero, sizinthu zonsezi zomwe zimayamikiridwa ndizopambana ndipo zina zimathandizidwa ndi zosakwanira umboni. Kulongosola za umboni wapadera pazovomerezedwa zilizonse sizikupezeka pa nkhaniyi.
Komabe, ngati muli ndi mafunso okhudza sukulu kapena mavuto ena okhudzana ndi khansa ya mutu ndi khosi, chonde kambiranani zodandaulazi ndi dokotala wanu. Chithandizo cha kansa ya mutu ndi khosi ndi yovuta, ndipo malangizo othandiza kuchokera kwa dokotala wanu ndi chinthu chamtengo wapatali panthawi yopanga zisankho.
> Zotsatira:
> Chithandizo cha khansa ya mutu ndi khansa. Zowonjezera Mwamphamvu. www.dynamed.com
> NCI Dictionary ya Migwirizano ya Khansa. www.cancer.gov
> LOWANI webusaitiyi. http://sign.ac.uk/about/index.html
> Chithandizo cha Mutu ndi Khansa: Khanda Kutaya. Zowonjezera Mwamphamvu. www.dynamed.com.