Mayesero omwe amagwiritsidwa ntchito kuti azindikire khansa yodwalayo imakhala ndi chimbudzi cha Barium, endoscopy, ndi endoscopic ultrasound, ndipo nthawi zambiri amalamulidwa kwa anthu omwe ali ndi vuto lomeza, chifuwa chokhazikika, kapena ziwopsezo za matenda monga nthawi yayitali ya reflux acid. Njira zina ndi mayesero ojambula monga CT, PET, ndi bronchoscopy zingakhale zothandiza pakukhazikitsa siteji ya matendawa.
Kuchita masewera olimbitsa thupi kumafunikanso kuti musankhe njira zabwino zothandizira.
Mapulogalamu ndi Mayesero
Palibe kuyesa kwapakhomo kwa khansara yotopetsa. Ndizothandiza kudziwa zonse zomwe zingayambitse matendawa komanso zizindikiro zowononga khansa , kuti muthe kukambirana ndi dokotala wanu ndikuyesa kuyezetsa bwino, ngati pakufunikira.
Kuyezetsa ma labata sikunali koyenera ndi khansa yowopsya, koma amagwiritsidwa ntchito pamodzi ndi kujambula, kufufuza mosamala mbiri ya umoyo wa banja komanso zaumwini, komanso kuyezetsa thupi kuti apeze matendawa. Kuchuluka kwa magazi (CBC) kungasonyeze umboni wa kuchepa kwa magazi (kuchepa kwa maselo ofiira ochepa magazi) ngati khansayo imatuluka. Matenda a ntchito ya chiwindi angakhale okwezeka ngati khansara yayamba ku chiwindi.
Ndondomeko
Ndondomeko ndizofunika kwambiri poyambitsa matenda opatsirana khansa ndipo imaphatikizapo:
Endoscopy
Kumapeto kwa mapepala osakanikirana (esophagoscopy kapena esophagus-gastric-duodenoscopy) ndiyo njira yapadera yozindikiritsira khansa yosakanikirana lero.
Mu njirayi, phukusi losavuta, lopotoka limalowetsedwa kupyolera pakamwa ndi pansi kupyola m'mimba. Phukusi lili ndi kamera pamapeto omwe amalola madokotala kuti awonetsetse bwino momwe akugwirira ntchito. Ngati kusadziwika kwatchulidwa, chiwonetsero chingathe kuchitidwa panthawi yomweyo.
Asanayambe, anthu amapatsidwa chiwerewere chomwe chimayambitsa kugona, ndipo ndondomekoyi imalekerera.
Endoscopic Ultrasound (EUS)
Izi ndizochitidwa kuti mupeze zithunzi zothandiza. Pachikhalidwe chapamwamba chotchedwa endoscopy, kafukufuku wa ultrasound kumapeto kwa chiwerengerocho amagwiritsidwa ntchito kuti awononge mafunde amphamvu kwambiri kuchokera m'magulu amkati a m'mimba. Zolembazo zimapanga sonogram, chithunzi cha matendawa. EUS imathandiza kwambiri pakuzindikira kukula kwake kwa chotupacho, chomwe chili chofunika kwambiri pakuyikapo. Ndizothandiza kwambiri poyesa mitsempha yapafupi yomwe ili pafupi ndi zochitika zina zolakwika. Mayesero ena angaganizidwe (onani m'munsimu), ngakhale izi ndizovuta kwambiri.
Chimake
Kafukufuku amatha kutengedwa nthawi yosungirako zinthu, koma akhoza kupangidwa kudzera mu bronchoscopy kapena thoracoscopy. Akatswiri a zachipatala amawona minofuyi pansi pa microscope kuti aone ngati minofu ili ndi khansa ndipo, ngati zili choncho, kaya ndi squamous cell carcinoma kapena adenocarcinoma. Chitsanzocho chimaperekanso chiwerengero cha chotupa, nambala yomwe ikufotokoza momwe chiwombankhanga chimawonekera.
Zina zimayesedwa kuti ziwone mawonekedwe a maselo, monga maonekedwe a HER2 (monga khansa ya m'mawere yomwe ingakhale HER2 yabwino , khansa yosakanikirana ikhoza kukhala HER2 zabwino).
Bronchoscopy
Bronchoscopy imachitidwa kuti zikhale zotupa zomwe zili pakati mpaka chapamwamba chachitatu.
Bronchoscope (phokoso lopopera, lopindika) limaphatikizidwa kudzera m'mphuno kapena pakamwa pamatope (chubu yomwe imagwirizanitsa kamwa ndi mapapo) ndi bronchi (njira yaikulu) m'mapapo. Ndondomekoyi imalola dokotala kuti awonetsetse zovuta zilizonse m'maderawa ndikutenga zitsanzo zake (biopsy) ngati alipo.
Bronchoscopy yachitidwa pansi pamtunda, kawirikawiri monga njira yopuma.
Thoracoscopy
Pa thoracoscopy, kupaka kapena kudula kumapangidwa pakati pa nthiti ziwiri ndi thoracoscope, yomwe ndi kachigawo kakang'ono, kamene kali kofiira, kamalowetsedwa m'chifuwa. Madokotala amagwiritsa ntchito izi kuti ayang'ane ziwalo mkati mwa chifuwa ndikuyang'ana malo osayenera a khansa.
Zitsanzo za minofu ndi ma lymph nodes zimachotsedwera. Nthaŵi zina, njirayi ingagwiritsidwe ntchito kuchotsa mbali za m'mimba kapena m'mapapo.
Laparoscopy
Mu laparoscopy, kupota pang'ono kapena kudula kumapangidwa pakhoma la mimba. Laparoscope, kachigawo kena kamene kali kofiira, kamene kamaloledwa kameneka, kamalowetsedwa m'thupi mwa njira imodzi yowonetsera ziwalo mkati mwa mimba ndikuyang'ana zizindikiro za matenda. Zida zina zingalowetsedwe pogwiritsa ntchito zofanana kapena zofunikira zina monga kuchotsa ziwalo kapena kutenga zizindikiro zazing'ono.
Laryngoscopy
Kapepala kakang'ono kakang'ono kameneka kamayikidwa pansi pammero kuti ayang'ane pa larynx kapena bokosi la mawu. Mayesowa angathe kuona umboni uliwonse wa kufalikira kwa khansara kwa khungu kapena pharynx (khosi).
Kujambula
Mayesero ojambula angayambe poyamba ngati gawo la matenda opatsirana khansa ya osopha, koma nthawi zambiri amachitidwa kuti ayambe khansa yomwe yapezeka. Mayesero omwe angachitike ndi awa:
Barium Swallow
Chiyeso choyambirira chomwe anachitapo kuti aone ngati khansa yowopsya ingatheke kawirikawiri imakhala yayake kapena chimbudzi cham'mwamba, ngakhale kuti kupitilira kumalo osungirako mapepala kumakhala kosavuta ngati khansa yodwala matenda opatsirana imakhala ikudziwika.
Mujekesti ya Barium (yomwe imatchedwanso ma GI mndandanda wa pamwamba), munthu amamwa madzi oyera omwe ali ndi barium ndiyeno amakhala ndi ma X-ray. The barium imayambitsa mimba ndi m'mimba, kulola radiologist kuona zosaoneka pakhoma pa chithunzi pa zithunzi zatengedwa.
Katemera wa barium angakhale wothandiza pakupeza zilembo (zofiira m'mimba mwake), koma amagwiritsidwa ntchito mochepa kuposa kale chifukwa biopsy silingakhoze kuchitidwa panthawi yomweyo.
CT Scan
A CT scan (computerized tomography) amagwiritsa ntchito gawo la X-rays kuti apange chithunzi cha 3D cha ziwalo zamkati. Ndi khansa yochepa kwambiri, kawirikawiri mayeso samagwiritsidwa ntchito monga mbali ya matenda, koma ndizofunikira poyambitsa matendawa. CT ndi yabwino kwambiri kufunafuna umboni wa mavitamini omwe amapezeka m'magazi kapena m'madera ena a thupi, monga mapapo kapena chiwindi.
PET Scan
Kufufuza kwa PET kuli kothandiza kwambiri pakufunafuna umboni wa kufalikira ndi khansa yowopsya. Kufufuza kwa PET kumasiyana ndi kufufuza kwina kojambula m'maganizo poyesa ntchito zamagetsi m'madera a thupi. Kagulu ka shuga ka radioactive kakaloledwa m'magazi ndipo amaloledwa kutengedwa ndi maselo. Maselo omwe ali otanganidwa kwambiri, monga maselo a kansa, amasonyeza bwino kuposa malo omwe sagwira ntchito kwambiri.
X Ray
Kuphatikiza pa mayesero omwe ali pamwambawa kuti apeze khansa yowopsa kwambiri, chifuwa cha X-ray chofuna kufalitsa kufalikira chikhoza kuchitidwa.
Kusanthula Kusiyanasiyana
Pali zifukwa zingapo zomwe zingayambitse zizindikiro zofanana ndi za khansa yowopsya, monga vuto lomeza. Ena mwa awa ndi awa:
- Kuthamangitsidwa kwazomwekusowa : Chiguduli chimakhala ndi minofu yofiira yomwe imapangika m'mimba yomwe imayambitsa kuchepa. Nthawi zambiri zimachitika chifukwa cha kupsinjika mtima, mwachitsanzo, chifukwa cha zovuta za endoscopy kuti zikhale zochepa kwambiri (mitsempha ya varicose yomwe imagwirizanitsidwa ndi uchidakwa), munthu atakhala ndi chubu ( NG tube ) m'malo mwake , kapena chifukwa cha kuyamwa mwangozi koyeretsa ngati mwana.
- Khansara ya m'mimba ( kansa ya m'mimba): Khansa m'mimba ingayambitse zizindikiro zofanana ndi za khansara yokha.
- Ziphuphu zam'thupi zomwe zimatuluka m'mimba (monga esophageal leiomyoma): Matenda ambiri a m'mimba (pafupifupi 99 peresenti) ali ndi khansa. Matenda a Benign amatha kuchitika, ndipo ambiri mwa iwo ndi leiomyomas.
- Achalasia : Achalasia ndizovuta kwambiri kuti gulu la minofu pakati pa m'mimba ndi m'mimba (m'munsi mwa esophageal sphincter) lisamasuke bwino, zomwe zimapangitsa kuti zikhale zovuta kuti chakudya chisadutse kuchokera m'mimba mpaka m'mimba.
Kusinthana
Kutsimikiza malo omwe ali ndi khansa n'kofunika posankha njira zabwino zothandizira chithandizo, kuphatikizapo kusankha ngati opaleshoniyo ndi yosankha. Kuphatikiza zoyesera zamaganizo ndi zotsatira za biopsy nthawi zambiri amagwiritsidwa ntchito kuti adziwe malo.
Madokotala amagwiritsa ntchito njira ya TNM staging kuti awononge chotupa chachikulu. Njirayi imagwiritsidwanso ntchito kwa khansa zina. Koma ali ndi khansa yofooka, madokotala amalembanso kalata yowonjezera-G-kuwerengera kwa kalasi yoyamba. Mafotokozedwe a ma stage ndi ovuta, koma kuphunzira za iwo kungakuthandizeni kumvetsa bwino matenda anu.
T imaimira chotupa: Chiwerengero cha T chimadalira momwe chimbudzi chimayambira. Mkati mwa mkati (pafupi kwambiri ndi chakudya chodutsa pamimba) ndi lamina propria. Mizere iwiri yotsatira imadziwika kuti submucosa. Kupitirira apo ndilo lamina propria, ndipo pomalizira pake adventitia, malo ozama kwambiri.
- Tis: Izi zimayimira carcinoma mu situ, chotupa chomwe chimangokhala ndi maselo okwera pamwamba pa maselo.
- T1: Chotupacho chikudutsa kudzera mu lamina propria ndi submucosa.
- T2: Chotupacho chafalikira ku lamina propria, koma sichidutsa mu minofu ya mimba.
- T3: Chotupa chafalikira kwa adventitia. Tsopano yayendetsa njira yonse kupyolera mu minofu kupita ku zinyama zozungulira.
- T4: T4a amatanthawuza kuti chotupacho chafalikira kupyola phokoso kuti chiphatikizepo zida monga pleura (mapaipi a mapapo), piricardium (chigoba cha mtima), mitsempha yambiri, mimba , ndi peritoneum (chikhomo cha mimba ). T4b amatanthauza kuti chotupa chafalikira ku aorta, vertebrae, kapena trachea .
N imayimira ma lymph nodes:
- N0: Palibe mankhwala amphamvu omwe ali nawo.
- N1: Chotupacho chafalikira ku 1 kapena 2 pafupi ndi (m'madera).
- N2: Chotupacho chafalikira ku 3 mpaka 6 pafupi ndi maselo amphongo.
- N3: Chotupachi chafalikira ku 7 kapena kuposa.
M akuimira masastasis (kufalikira kwina) kwa khansa:
- M0: Metastases salipo.
- M1 : Metastases alipo.
G akuyimira kalasi:
- G1: Ma maselo amawoneka ngati maselo wamba (amasiyanitsa bwino).
- G2: maselo amawoneka mosiyana kwambiri ndi maselo achibadwa (omwe amasiyanitsa)
- G3 : Ma maselo amawoneka mosiyana kwambiri ndi maselo abwino (osadziwika bwino).
- G4: Ma maselo sakuwoneka ngati maselo osakanikirana omwe ali ndi thanzi labwino ndipo ndizosatheka kufotokoza chiwalo chomwe adachokera mu (undifferentiated).
Pogwiritsa ntchito zotsatira za TNM ndi G pamwambapa, oncologists ndiye amapereka siteji .
Gawo 0: Khansara imapezeka kokha m'kati mwa maselo omwe akugwiritsidwa ntchito poyambira (Tis, N0, M0). Izi zimatchedwanso kuti carcinoma in situ .
Gawo I: Gawo ili likhoza kuthyoledwa kulowa mu stage IA ndi IB.
- Gawo IA: Chotupacho chimaphatikizapo zigawo zenizeni zamkati (T1, N0, M0, G1).
- Gawo IB: Pali zifukwa ziwiri zomwe zimakhala zovuta kwambiri mu ntchentche IB. Mmodzi ali ofanana ndi siteji IA, kupatula maselo akuwonekera mwachilendo (T1, N0, M0, G2 mpaka G3). Mulimonsemo, chotupacho chiri m'munsi mwake ndipo chikufalikira kupyola chigawo choyamba cha minofu (T2 kapena T3, N0, M0, G1).
Gawo lachiwiri: Mogwirizana ndi kumene kansa yafalikira, khansa yachiwiri yothetsera chiwopsezo imagawidwa mu siteji ya IIA ndi siteji ya IIB.
- Gawo IIA: Pali zinthu zikuluzikulu ziwiri zomwe zikuchitika pa siteji ya IIA. Chotupacho chingakhale ndi mbali yapamwamba kapena yapakati ya phokoso ndipo ikhale T2 kapena T3 ndi G1 (koma N0 ndi M0), kapena chotupacho chikhoza kuphatikizapo gawo la pansi ndi kukhala T2 kapena T3 ndi G2 kapena G3, koma pali palibe umboni wokhudzana ndi mitsempha yam'mimba kapena metastases (N0, M0).
- Gawo IIB: Pa siteji ya IIB pali zinthu ziwiri zofunika. Mmodziwo, chotupacho chimaphatikizapo mbali yapamwamba kapena yapakati ya phokoso, koma mosiyana ndi siteji IIA, maselo amasiyana kwambiri (G2 kapena G3). Kapena, khansara ili mkati mwake (T1 kapena T2) koma yafalikira ku maselo amodzi kapena awiri (N1). Palibe zovuta.
Gawo lachitatu: Pali magawo atatu a gawo lachitatu.
- Gawo IIIA: Gawo ili liri ndi njira zitatu. Chotupachi chingakhale ndi maselo amkati ndi maselo atatu mpaka asanu ndi limodzi (T1 mpaka T2, N2, M0, G). Mwinanso, chotupacho chikhoza kufalikira kumtundu wakunja wa minofu, koma mitsempha imodzi kapena ziwiri yokha (T3, N1, M0, G iliyonse). Potsirizira pake, chotupacho chikhoza kufalikira ku minofu yoyandikana nayo, koma palibe maselo am'mimba (T4a, N0, M0, kapena G).
- Gawo la IIIB: Khansara yayamba kufalikira kunja kwa malo, komanso maselo atatu mpaka asanu (T3, N2, M0, G).
- Gawo III: Pali njira zitatu zomwe zingatheke pa gawo ili. Chotupacho chikhoza kufalikira ku minofu yapafupi, koma maselo ochepa kapena asanu ndi awiri (T4a, N1 kapena N2, M0, G). Kapena, chotupacho chafalikira ku minofu yoyandikana monga aorta, thupi lofewa, kapena trachea, kotero kuti sangathe kuchotsedwa ndi opaleshoni (T4b, iliyonse N, M0, G iliyonse). Pomaliza, chotupacho chafalikira ku maselo asanu ndi awiri kapena kuposerapo, koma osati kumadera akutali a thupi (chilichonse T, N3, M0, G).
Gawo IV: Chotupacho chafalikira kumadera akutali a thupi (T iliyonse, N, M1, G).
Kuwunika
Kuyezetsa kansa ndizo zomwe zimachitika kwa anthu omwe alibe zizindikiro za matenda. (Ngati zizindikiro zilipo, mayesero a chidziwitso amachitika.) Pakadali pano, palibe mayeso owonetsetsa a khansa yofooka yomwe imapezeka kwa anthu onse.
Popeza chiopsezo cha khansa yowopsya imakula kwambiri kwa anthu omwe ali ndi mayina a Barrett, madokotala ena adandaulira nthawi zonse kufufuza ndi endoscopy. Lingaliro la izi ndilokuti kupeza dysplasia (maselo osadziwika), makamaka kulandira milandu yoopsa kumayambiriro, kungalolere mankhwala kuti achotse maselo osadziwika mu sitepe yoyenera .
Izi zati, pakalipano, palibe umboni uliwonse wosonyeza kuti kuwonetsetsa kumeneku kumachepetsa chiŵerengero cha imfa kuchokera ku khansa yowopsya. Pa nthawi yomweyi, kuwonetsetsa kumatha kuvulaza, monga kutaya mwazi, kuchepa kwa pang'onopang'ono, kapena mavuto ena. Pali chiyembekezo kuti tsogolo lidzabweretsa umboni womwe udzakuthandizireni kudziwa ngati kuwonetsetsa anthu omwe ali ndi chiopsezo chachikulu ndi kotheka.
> Zotsatira:
> American Society of Clinical Oncology. Kansa ya Esophageal: Kuzindikira. Kusinthidwa 12/2016.
> Bast, R., Croce, C., Hait, W. ndi al. Holland-Free Cancer Medicine. Wiley Blackwell, 2017.
> National Cancer Institute. Kuchokera kwa kansa yapamwamba (PDQ) -Health Professional Version. Kusinthidwa 04/06/18.
> Rice, T., Patil, D., Blackstone, E. et al. Kukonzekera kwa 8: AJCC / UICC Kukhazikitsa Zokhazoka za Kugonjetsedwa ndi Kugonjetsedwa kwa Mgwirizano: Kugwiritsa Ntchito Kachitidwe Chachipatala. Annals of Surgery Surgery . 2017. 6 (2): 119-130.