Khansa ya impso (renal cell carcinoma) kawirikawiri imapezeka kuti ikugwiritsidwa ntchito pogwiritsa ntchito ultrasound, CT, ndi MRI, pamodzi ndi mbiri yosamala, kuyeza thupi, kuyesa magazi, ndi kuyesa mkodzo. Kamodzi kansana ikapezeka, chotupacho chiyenera kuikidwa mosamala kuti chidziwitse chithandizo choyenera kwambiri.
Kupyolera mu ndondomeko yoyezetsa matenda nthawi zambiri kumawopsyeza-mukhoza kumva mantha ndi nkhawa.
Kudziwa zomwe muyenera kuyembekezera ndi momwe mungapirire nthawi yodikira ndi zotsatira zingathandize kuchepetsa maganizo ena.
Kufufuza Chekha ndi Kuyesedwa Kwapanyumba
Khansara ya impso sangapezeke pakhomo, koma popeza palibe pakali pano kuyezetsa kuyesa, kuzindikira kuti zizindikiro ndi matenda omwe alipo ndizomwe aliyense angathe kuchita.
Makamaka, ngati muwona kuti muli ndi magazi m'mkodzo (chiwerengero chilichonse), kupweteka kwa flank, phokoso, kumverera wotopa kapena kutaya chilakolako chanu, kapena kutaya thupi popanda kuyesera, onetsetsani kuti muwone dokotala wanu.
Mapulogalamu ndi Mayesero
Kufufuza kwa khansa ya impso nthawi zambiri kumayamba ndi mbiri yosamala, kuyang'ana zoopsa za matendawa, kuyerekezera thupi, ndi mayeso a ma laboratory.
Kufufuza Kwambiri
Kuyezetsa thupi kumaperekedwa mwatsatanetsatane poyang'anira mimba m'mimba, kumbali, kapena kumbuyo, komanso kuyang'ana kuthamanga kwa magazi. Impso zimathandiza kwambiri pakuletsa kuthamanga kwa magazi, ndipo zotupa zingayambitse kupanikizika kwa magazi komwe nthawi zina kumakhala koopsa kwambiri.
Kafukufuku umaphatikizaponso kuyesa ma genitalia mwa amuna. Khansara ya impso ndi yodabwitsa chifukwa imatha kuyambitsa mitsempha (varicose vein) mu scrotum kapena nyamayi. Mosiyana ndi zifukwa zambiri zomwe zimayambitsa matendawa, khansa ya impso sizimachoka pamene mwamuna agona (akulandira udindo wa supine).
Mayesero a Lab
Kafukufuku wothandizira khansa ya impso ingayambike ndi urinalysis , mayesero omwe sanagwiritse ntchito kuyang'ana magazi mu mkodzo wanu, koma zizindikiro za matenda, mapuloteni, ndi zina. Pafupifupi theka la anthu omwe ali ndi khansa ya impso adzakhala ndi magazi ambiri mumtsuko.
Kuchuluka kwa magazi (CBC) ndi kuyesayesa kofunikira, monga kuchepa kwa magazi m'thupi (chiwerengero chochepa cha maselo ofiira magazi) panopa ndi chizindikiro choyamba cha matendawa. Mayeso a ntchito za impso ndi ofunika, ngakhale kuti izi zingakhale zachilendo.
Khansara ya impso ndi yodabwitsa kwambiri chifukwa ingayambitse kuchuluka kwa matenda a chiwindi, ngakhale popanda khansa yofalitsa chiwindi. Chizindikiro ichi ndi chimodzi mwa zizindikiro zomwe zimatha kuchitika pamene maselo otupawa amatulutsa zinthu kapena mahomoni. Zizindikiro zapanoplastiki zingaphatikizepo mlingo wokwanira wa calcium m'magazi ( hypercalcemia ), ngakhale izi zikhoza kuchitika pamene kansa imafalitsa mafupa.
Kujambula
Njira zosiyanasiyana zojambula zingagwiritsidwe ntchito pa matenda a khansa ya impso.
Ultrasound
Ultrasound amagwiritsa ntchito mafunde omveka kuti apereke chithunzi cha ziwalo m'mimba. Kaŵirikaŵiri mayeso oyambirira amachitika ndipo amathandiza kwambiri kusiyanitsa zosavuta zowononga (zomwe zimakhala zowononga nthawi zonse), kuchokera ku ziwalo zolimba kapena zotupa zolimba ndi ziwalo zina.
CT Scan
Mankhwala a CT amagwiritsira ntchito mndandanda wa x-ray kuti afotokoze chithunzi cha chigawo cha thupi monga impso. Kuwonjezera pa kufotokoza khansara ya impso, CT scan ingapereke uthenga wofunika kuti ikhale yofufuza pofufuza ngati zikuwoneka kuti khansara yayamba kufalikira kunja kwa impso kapena zam'mimba.
Kafukufuku wa CT amagwiritsidwa ntchito moyamba popanda kusiyana, kenako ndi dzira la radiocontrast. Dayi nthawi zina ingayambe kudera nkhaŵa anthu omwe ali ndi vuto la impso, panthawiyi mayesero osiyanasiyana angagwiritsidwe ntchito.
CT ndi mayeso abwino kwambiri okhudza khansa ya impso koma nthawi zambiri satha kudziwa ngati khansara yayamba kufalikira mu mitsempha yamphongo, mitsempha yaikulu yomwe imachokera mu impso yomwe ikuphatikizana ndi otsika vena cava (mitsempha yaikulu imene imabweretsa magazi kuchokera kumtunda. kumtima).
MRI Scan
Kujambula kwa MRI kumagwiritsa ntchito maginito imaging m'malo mwa teknoloji ya X-ray kupanga chithunzi cha nyumba m'mimba. Mmenemo zimathandiza kwambiri kufotokoza "zofewa zofewa" zopanda pake. Kawirikawiri, CT scan ndiyeso yabwino kuti ayese kansa ya impso, koma MRI ingafunikire kwa iwo omwe ali ndi mayesero opatsirana a impso kapena omwe ali ndi zovuta zosiyanitsa utoto.
MRI ingathenso kuganiziridwa ngati khansara ya impso ikuganiziridwa kuti yafalikira mu mitsempha yamtambo ndi yotsika mtengo wa vena cava, monga njira yapadera yomwe mungafunike pakuchita opaleshoni. MRI sangagwiritsidwe ntchito ndi anthu omwe ali ndi zitsulo m'thupi lawo, monga pacemaker, shrapnel, kapena zidutswa za zipolopolo, monga maginito amphamvu angayambitse kuyenda kwa zinthu izi.
MRI ya ubongo ingathe kuchitidwa pofunafuna umboni wokhudzana ndi matenda a khansa ku ubongo, malo atatu omwe makamaka khansa ya impso ikufalikira.
PET Scan
Kafukufuku wa PET amagwiritsidwa ntchito kawirikawiri pa matenda a khansa, koma mochepa kwambiri pakudziwika kwa khansa ya impso. PET scan, kachilombo ka shuga kamene kamayikidwa mu thupi ndi mafano (nthawi zambiri kuphatikizapo CT) amatengedwa pambuyo poti shuga imakhala nayo nthawi.
Mosiyana ndi CT ndi MRI, imaonedwa kuti ndiyeso yogwira ntchito m'malo moyesera ndipo ingakhale yofunikira posiyanitsa madera okhudzidwa kukula kuchokera kumadera monga minofu yambiri.
Pyelogramme Yosakaniza (IVP)
IVP ndi mayeso omwe jekeseni umayikidwa mu mitsempha. Kenako impso zimatenga utoto umenewu, zomwe zimathandiza kuti akatswiri a radiologist aone impso, makamaka nswala yamphongo.
IVPs yachitidwa mobwerezabwereza mu matenda a kansa ya impso koma ingagwiritsidwe ntchito kwa khansa yambiri ya maselo (khansa yapakati ya maselo monga khansa ya chikhodzodzo ndi ureter kuposa momwe nthawi zina mungafunire gawo lalikulu la impso, renal pelvis).
Renal Angiography
Angiography nthawi zambiri imagwiridwa ndi CT scan ndipo imayambitsa jekeseni m'kati mwa mitsempha yamoto kuti imveke mitsempha ya magazi ya impso. Nthawi zina mayeserowa amagwiritsidwa ntchito kuthandizira kukonza opaleshoni.
Cystoscopy ndi Nephro-Ureteroscopy
Mayeserowa ankaphatikizapo kuika kathete yonyezimira mu chikhodzodzo, kupyolera mu ureter, mpaka ku renal pelvis ("pakati" ya impso). Amagwiritsidwa ntchito makamaka ngati palinso misa mu chikhodzodzo kapena ureter, monga transitional cell carcinoma.
Chimake
Ngakhale kuti chiwopsezo n'chofunika kwambiri pozindikira kuti pali khansa yambiri, sikofunika kuti munthu apeze khansa ya impso. Kuonjezerapo, pali chiopsezo cha biopsies yabwino (biopsies yopangidwa ndi singano yopyapyala yomwe imayikidwa kudzera mu khungu ndi impso) kuti njirayi ikhonza "kubzala" chifuwa (kufalitsa chotupa yekha njira ya singano).
Zitsanzo za chotupa ndi zofunika pakukonza chithandizo, monga chithandizo chowongolera, koma nthawi zambiri amapezeka pa opaleshoni m'malo mwa opaleshoni.
Mayeso a Metastases
Khansara ya impso ingathe kufalikira kudzera m'magazi kapena kudzera m'zombo zamakono, ndipo malo omwe amapezeka kwambiri a metastases ndi mapapo, mafupa, ndi ubongo, motere. Chifuwa cha x-ray (kapena chifuwa CT) chikhoza kuchitidwa pofuna kuyang'ana mapangidwe a mapapo .
Mwina kuthandizira fupa kapena PET kufufuza kungadziwe ngati masastases a mafupa alipo. MRI ya ubongo ndiyeso yabwino kuyang'ana ubongo metastases.
Kusiyanitsa kusiyana
Mosiyana ndi khansa zambiri, pali zochepa zomwe zimayambitsa misa mu impso. Komabe, kusiyana kwa matendawa kungakhale kovuta kwambiri pamene kachilombo kakang'ono kamapezeka mu impso, kawirikawiri pamakhala pamene mayesero amachitikira chifukwa china.
Zina zomwe zimayambitsa misala ndizo:
- Mphuno yamphongo (impso): Nsabwe zimatha kusiyanitsidwa ndi ultrasound ndipo zimapezeka ndi matenda a impso ambiri .
- Angiomyolipomas: Angiomyolipoma ikhoza kusiyanitsidwa ndi khansa ya impso panthawi ya CT scan (chifukwa cha kukhalapo kwa mafuta). Izi ndi zotupa zabwino.
- Oncocytomas: Oncocytomas amakhalanso osiyana ndi zofufuza za CT. Ziphuphu zoterezi nthawi zina zimafanana kwambiri ndi khansa ya impso pa maphunziro a kujambula.
- Manyowa adenomas: Awa ndiwo matenda oopsa omwe kaŵirikaŵiri amapezeka pamasewero ojambula.
- Mankhwala osokoneza bongo ( khansa yapakati ya maselo a chikhodzodzo, mazira, ndipo nthawi zina amachotsa pakhosi): Khansa imeneyi imakhala pafupifupi 15 peresenti ya khansa ya impso ndipo nthawi zambiri imakhala mkatikati mwa impso ndikuphatikizapo kusonkhanitsa. Maselo a Khansa akhoza kukhalapo pamtunda.
- Zilonda za m'mimba: Zilonda za adrenal zimakhala pamwamba pa impso ndipo zimatha kusiyanitsidwa pamaganizo. Matenda ambiri omwe amapezeka m'mimba mwawo ndi amtenda omwe amatha kudwala khansa ya m'mapapo.
- Chifuwa cha manjenje: Chosowa chimakhala ndi matenda.
- Impso metastases: Mitundu ingapo ya khansara ikhoza kufalikira ku impso. Izi nthawi zambiri zimayambitsa mawanga ang'onoang'ono m'malo mwa chotupa chachikulu. Khansa yomwe ingafalikire ku impso ndi khansa yamapapo, khansa ya m'mawere, khansa ya m'mimba, khansa ya khansa, ndi khansa ya impso zina.
- Hodgkin's lymphoma ndi osakhala Hodgkin's lymphoma: Zonsezi zokhudzana ndi mwazi zikhonza kuphatikiza impso, koma nthawi zambiri zimagwirizanitsidwa ndi zotupa (komanso ziwalo zina za thupi).
- Manyowa osasokonezeka: Wophazikika amatanthauza kusowa kwa magazi. Izi ziri ngati "matenda a mtima" a impso, ndipo minofu yakufa (minofu yamphongo) nthawi zina imatha kuwonekera ngati misala pa mafano.
- Sarcomas: Awa ndi ochepa khansa omwe amayamba mu minofu yofewa yomwe ili ndi impso.
Kupha Khansa ya Impso
Kuthana ndi khansa ya impso imachitika pambuyo pochita opaleshoni ndipo imaphatikiza zotsatira za kuyesa zojambula pamodzi ndi zizindikiro za chifuwa chomwe chimatumizidwa ku matenda pambuyo pa opaleshoni, komanso zomwe zimachitika pa opaleshoni.
Ziphuphu
Khansa ya impso imapatsidwa kalasi ya 1 mpaka 4, yotchedwa grade Fuhrman, yomwe ndiyeso ya chiwawa cha chotupa.
Kalasi ya 1 imagwiritsidwa ntchito pofotokoza zolasa zomwe zimakhala zosautsa kwambiri ndipo zimakhala ndi maselo omwe amasiyana kwambiri (ayang'anitse maselo ambiri a impso). Mosiyana ndi izi, kalasi ya 4 imapatsidwa kufotokozera zovuta zowonongeka kwambiri, zomwe sizili bwino komanso zimawoneka mosiyana kwambiri ndi maselo a impso.
TNM Staging
Ziphuphu za impso zimayesedwa pogwiritsira ntchito chinachake chotchedwa TNM dongosolo. Izi zingakhale zosokoneza poyamba koma zimakhala zosavuta kumvetsa ngati tifotokozera makalata awa ndi zomwe ziwerengero zimatanthauza.
- T amaimira chotupa. Manambala akutsatira T amasonyeza kukula kwa chotupacho. Matenda a T1 ndi osachepera masentimita 7. Matenda a T2 ndiwo masentimita 7 mpaka 10 m'mimba mwake. Matenda a T3 awonjezeka kuposa impso kapena m'mitsempha, koma osati m'matenda a adrenal kapena kupitirira kwa Gerota's fascia (minofu yambiri yomwe ili pafupi ndi impso). Matenda a T4 awonjezeka kuposa Gerota's fascia kapena adrenal gland.
- N imaimira node. Kufotokozera za N0 kungatanthawuze kuti khansara sinafalikire ku maselo amodzi. N1 zikutanthawuza kuti khansara yayamba kufalikira ku maselo am'mimba pafupi.
- M imayimira metastase ndipo ili 0 kapena 1 malingana ndi momwe masastases alipo (kaya khansara yayamba kufalikira m'mapapo, mafupa, ubongo, kapena madera ena). M0 amatanthauza palibe metastases alipo. M1 amatanthauza metastases alipo.
Tx (kapena Nx kapena Mx) zikutanthauza kuti chotupa (kapena nodes kapena metastases) sichikhoza kuyesedwa. T0 amatanthauza kuti palibe umboni wa chotupa chachikulu ndipo amagwiritsidwa ntchito ngati metastases ya impso ikupezeka, koma chotupa chachikulu sichipezeka.
Miyendo
Pogwiritsira ntchito makalata pamwambapa, khansa ya impso imagawidwa mu magawo anayi:
- Gawo 1: Gawo 1 la khansa ya impso (T1, N0, M0) ndi osachepera masentimita 7 ndipo ili mu impso (iwo sanafalikire ku maselo am'mimba kapena mbali zina za thupi).
- Gawo 2: Pakadali pano (kutanthauzidwa ngati T2, N0, M0) khansara ikhoza kukhala yaikulu kuposa masentimita 7 kapena kufalikira ku mitsempha yayikulu yoyandikana nayo monga mitsempha yamtchire kapena yotsika mtengo wa vena cava. Komabe, sizinafalikire ku maselo ena amodzi, malonda a adrenal, Gerota's fascia, kapena malo akutali.
- Gawo lachitatu: Matenda atatu (omwe angakhale T1 kapena T2, N1, M0, kapena T3, iliyonse N, M0) akhoza kukula koma alibe kufalikira kupitirira Gerota's fascia. Mbaliyi imaphatikizansopo zotupa zomwe sizinapitirire kupyola impso, koma zafalikira ku maselo am'mbali omwe ali pafupi.
- Gawo 4: Gawo 4 limafotokozedwa m'njira zikuluzikulu ziwiri. Panthawi imodzi, chotupacho chikhoza kufalikira kupyola kwa Gerota's fascia ndi kwa mafupa apamtima pafupi, koma osati ku zigawo zina za thupi. Kapena mwina akhoza kukula, kufalikira ku nambala iliyonse, komanso kufalikira kumadera ena a thupi (T iliyonse, N, M,).
Kansa ya Kanso Yowonongeka
Khansara ya impso yatsopano imatanthawuza khansa yomwe yabwerera, kaya mkati mwa impso, m'matenda ozungulira, m'matenda a mitsempha, kapena kumalo akutali.
Mayesero onse opatsirana amachitidwa angathandize dokotala wanu kuti adziwe bwinobwino vuto lanu. Malinga ndi zotsatira, iye adzatha kusankha bwino chithandizo chomwe chikugwirizana ndi zomwe zikuchitika.
> Zotsatira:
> American Society of Clinical Oncology. Cancer.Net. Khansa ya Impso: Kuzindikira. Kusinthidwa 08/17. https://www.cancer.net/cancer-types/kidney-cancer/diagnosis
> Lara, Primo N., ndi Eric Jonasch. Mfundo za Khansa ya Impso. Kusindikiza kwa International Springer, 2015.
> Pieroazio, P., ndi S. Campbell. Njira Yodziwiratu, Kuzindikira Kusiyanitsa, ndi Kulamulira Misa Yaikulu Yambiri. Kupititsa patsogolo . Kusinthidwa 03/02/18.