Mankhwala opatsirana khansa ya pancreatic angaphatikize opaleshoni, chemotherapy, mankhwala opatsirana, ndi mayesero a zachipatala akugwiritsidwa ntchito pa mankhwala atsopano monga immunotherapy. Chifukwa cha zosankha zochepa zomwe zimapangitsa moyo kukhala wovuta kwambiri pamene opaleshoni sizingatheke, National Cancer Institute ikuvomereza kukambirana kayezetsa kachipatala.
Njira zothandizira pakali pano zingathe kusankhidwa monga:
- Zopweteka: Mankhwalawa amachitika ndi chiyembekezo chokhala ndi moyo wautali ndi matendawa.
- Kulimbitsa thupi: Mankhwalawa omwe sangapitirize kukhala ndi moyo, koma amathandiza kuti anthu omwe ali ndi matendawa akhale ndi moyo wabwino.
Mankhwala omwe amakhudza khansa yokha akhoza kugawidwa kwambiri monga:
- Zochitika zapanyumba: Awa ndi mankhwala omwe amachiza khansara kumene adayambira, ndipo amaphatikizapo opaleshoni komanso mankhwala opatsirana.
- Mankhwala othandiza: Mankhwalawa amapangidwa kuti athetsere maselo a khansa kulikonse mu thupi (kuphatikizapo metastases) komanso kuphatikizapo chemotherapy ndi zina mwa mankhwala atsopano omwe akupezeka m'mayesero a zamankhwala.
Pano, mwachidule za zosankha zomwe zilipo pakadalire khansa yapakhungu komanso yapamwamba.
Opaleshoni
Kuchita opaleshoni ndiyo njira yokhayo yothandizira yomwe imapereka mpata woti "kuchiritsa" khansara, kapena kuonjezera mwayi wa kupulumuka kwa nthawi yaitali. Izi zinati, pafupi 15 peresenti mpaka 20 peresenti ya anthu omwe ali ndi khansa ya pancreatic ndi oyenerera opaleshoni.
Mwamwayi, zikhoza kukhala zovuta, ngakhale ndi mayesero olingalira omwe tili nawo, kudziwa ngati khansa yafalikira mpaka pamene opaleshoniyo silingatheke opaleshoniyo itatha. (Kuchiza khansa ya pancreatic yomwe yafalikira, kuphatikizapo gawo lachitatu ndi zotupa 4 zapakati, sizingaonjezere kupulumuka koma kumachepetsa kwambiri umoyo wa moyo.) Pa opaleshoni, madokotala amapeza kuti khansa yafalikira kwambiri kuti njirayi ikhale yabwino pafupifupi 20 peresenti ya nthawiyo.
Madokotala ena amalimbikitsa kupanga laparoscopic chiopsezo (mayesero omwe amachitiramo ziwerengero zing'onozing'ono m'mimba ndi pulojekiti amayikidwa kuti achotse kachigawo kakang'ono ka phokoso ndi kufufuza malo oyandikana nawo) asanachite opaleshoni. Kuchita zimenezo kungachepetse mwayi wa opaleshoni yosafunikira ndi ululu wotsatira ndi mavuto ake.
Mavuto ndi Maganizidwe
Nkhanzazi zili kumbuyo kwa m'mimba ndipo zili pafupi ndi zofunikira zambiri. Mwachindunji kuseri kwa kapangidwe ndi mndandanda wa mitsempha yambiri ya magazi. Ngati chotupa chikufotokozedwa kuti "chakupita kwanuko," zikutanthawuza kuti chotupacho chikhoza kukumba mitsempha yambiri yamagazi, kuchotsa kuchotsa chivundi chonse popanda kuwononga zitsulo kukhala pafupi-kosatheka. Izi zikachitika, munthu akhoza kukhala kapena woyenera kuchita opaleshoni. Malo ena apamwamba kwambiri amatha kuchotsa ndi kubwezeretsa mitsempha ya mthupi mosiyanasiyana, komabe, kotero khansa zina zomwe poyamba zinkaganiza kuti sizingatheke tsopano zitha kugwira ntchito.
Kumvetsetsa kutuluka kwa thupi kumathandizanso kwa iwo omwe amaphunzira kuti ali ndi matenda omwe amatha kukhala ndi matenda . Izi zikuphatikizapo anthu omwe ali ndi khansara omwe amapanga ma envulopu 50 peresenti kapena osachepera mwazi.
Palibe mankhwala ochiritsira a izi, koma madokotala ena amakhulupirira kuti kupatsa chemotherapy (popanda mankhwala a radiation) kuchepetsa chotupacho kungathe kuchitidwa opaleshoni.
Ndondomeko
Ngati mukuganiziridwa kuti ndinu woyenera opaleshoni, zotsatirazi zikutsatidwa:
- Njira ya Whipple (Pancreaticoduodenectomy): Njira ya Whipple ndiyo njira yowonjezera yowononga khansa ya pancreatic ndipo ndi mwayi kwa anthu omwe ali ndi khansara pamutu wa ziphuphu komanso nthawi yoyamba. Pa opaleshoni imeneyi, ndulu, yomwe imakhala yotchuka kwambiri, imakhala ndi mbali yaikulu ya kapangidwe (kuphatikizapo mutu), mbali ya duodenum, mbali ya m'mimba, ntchentche, ndi minofu yapafupi imachotsedwa. Mbali imodzi ya thupi ndi mchira wa kapangidwe zimasiyidwa kuti zisunge ntchito yake (kupanga mavitamini a mavitamini ndi mahomoni).
- Kusintha kwa njira ya Whipple Kusiyana: Pali kusiyana kosiyanasiyana pa njira ya classic Whipple yomwe imateteza mimba ndi gawo loyamba la matumbo aang'ono, omwe amadziwika kuti pylorus-kusunga pancreaticoduodenectomy. Njirazi zimachitidwa kuti zithandize kuchepetsa mavuto ena obwera pambuyo pake.
- Pansi Pancreatectomy: Khansa m'thupi kapena mchira wa kapangidwe kawirikawiri sichitha kugwira ntchito, koma pamene ili, mchira wa pansalu ikhoza kuchotsedwa kapena popanda ndulu.
- Chiwerengero cha Pancreatectomy: Chiwerengero cha pancreatectomy chimafanana ndi Whipple ndondomeko, koma zimasiyana ndi kuti pancreas onse achotsedwa. Izi zimachitika pamene pakufunika kuchotsa chotupa chonse chowonekera.
Zotsatira Zotsatira ndi Zovuta
Zonse zopangira opaleshoni ya khansa ya pancreatic ndi opaleshoni yaikulu, ndipo zovuta kapena imfa si zachilendo. Zoopsa zomwe zimakhalapo ndizoopsa zomwe zimachitika ndi anesthesia, kutuluka m'magazi, matenda, ndi chitukuko cha magazi pambuyo pa opaleshoni. Kuopsa kwa kupha magazi kumakhala kwakukulu kwambiri kwa anthu okhala ndi kansa ya pancreatic, ndipo opaleshoni imapangitsa kuti pakhale ngozi. Kugwiritsira ntchito kupanikizika pamilingo nthawi ndi pambuyo poti opaleshoni, komanso ochepa magazi amatha kuchepetsa izi.
Kufala kwa nthawi yaitali kwa opaleshoni ndi kubwereza kwa khansa, ndipo izi, mwatsoka, ndizofala kwambiri. Mpata kuti khansara yapakreati idzabwerenso pambuyo pochita opaleshoni imadalira pazifukwa zambiri, ndipo dokotala wanu yekha adzayesa kulingalira zomwe izi zikutanthauza kwa inu.
Ndondomeko iliyonse ikhoza kubweretsa zina. Mwachitsanzo, mu pylorus-kuteteza pancreaticoduodenectomy, kuchotsa mbali ya m'mimba ndipo gawo loyambirira la m'mimba mwachinyamatayo kungayambitse matenda otupa , vuto limene lingayambitse matenda otsegula m'mimba posakhalitsa. Ikhoza kuonjezera mwayi wa bile reflux, vuto pamene bile amapita njira yolakwika ndipo imalowa m'mimba chifukwa kutupa ndi zovuta.
Pamene pancreatectomy yochuluka imayendetsedwa, zonse zopangira pancreatic ndi, ndithudi, zitayika kwathunthu. Palibe kupanga insulini, glucagon, kapena michere ya m'mimba. Matenda a shuga ndi otetezeka komanso mankhwala a insulini ndi othandizira mavitamini ndizofunikira pakuchita opaleshoni.
Kaya mungafunike mavitamini ena kapena mahomoni pambuyo poti mbali ina ya kapangidwe imachotsedwa zimadalira zifukwa zingapo, kuphatikizapo kuchuluka kwa zowonongeka kuchokera ku chotupa chisanachitike opaleshoni. Mwamwayi, anthu samasowa zoperekera zonse kuti athe kupanga insulini yokwanira, ndipo kukhala ndi moyo wabwinobwino ndi kotheka pambuyo pa opaleshoni.
Kupanga Opaleshoni
Kuchitanso opaleshoni kwa anthu omwe ali ndi kansa ya pancreatic kuchepetsa zizindikiro koma samachiza matenda. Ndizofala kwambiri kuti njira yodziwika ya bile yomwe imatsekedwa ndi zotupazi. Izi zikachitika, zimatha kuikidwa (pogwiritsa ntchito endoscopy) kapena opaleshoni kupitirira njira yomwe ingayendetsedwe.
Kusankha Chipatala
Ngati ndinu oyenerera opaleshoni, ndikofunikira kwambiri kuti mupeze chisamaliro kuchipatala chomwe chimakhala ndi buku lalikulu la opaleshoniyi. Izi zikutanthawuza kusankha malo omwe amachititsa opaleshoni ya opaleshoni ya khansa yapakati pa 15 chaka chilichonse ndipo akhoza kupereka chiopsezo chochepa cha imfa komanso chipatala chofupika.
Chemotherapy
Chemotherapy ingagwiritsidwe ntchito m'njira zingapo kwa anthu omwe ali ndi kansa ya pancreatic.
Neoadjuvant chemotherapy: Neoadjuvant chemotherapy amatanthauza kugwiritsa ntchito mankhwala a chemotherapy asanayambe opaleshoni kuti achepetse chotupa kuti opaleshoni ichitike (monga momwe tafotokozera pamwambapa).
Mankhwala a Adjuvant: Adjuvant chemotherapy amatanthauza chemotherapy yomwe imagwiritsidwa ntchito kuwonjezera pa opaleshoni. Khansa yapancreatic kawirikawiri imabwereranso pakutsata opaleshoni, kutanthauza kuti maselo a khansa nthawi zambiri amasiyidwa (koma angakhale ochepa kwambiri kuti asawoneke pazithunzi zojambula). Pamene chemotherapy imagwiritsidwa ntchito pambuyo pochita opaleshoni, zimaganiziridwa kuti zikhale ndi moyo miyezi itatu kapena inayi.
Mankhwala othandizira ena: Nthawi zambiri pamene mankhwala a chemotherapy amatengedwa ndi khansa ya pancreatic, amaperekedwa ndi chiyembekezo chakuti chidzawonjezera moyo, koma osati kuchiritsa khansa. Kachilendo, mankhwala a chemotherapy amachititsa kusintha kwazing'ono, koma kwakukulu kwa kutalika kwa moyo.
Mankhwala omwe amagwiritsidwa ntchito kwambiri ndi awa:
- Abraxane (albumin-bound paclitaxel)
- Gemzar (gemcitabine)
- 5-FU (fluorouracil)
- Onivyac (irinotecan liposome injection)
Mankhwalawa amaperekedwa mophatikizana ndipo angaperekedwe limodzi ndi mankhwala opatsirana, immunotherapy, kapena nthawi zina, mankhwala opatsirana pogwiritsa ntchito mankhwala. Mankhwalawa amaperekedwa mwachangu nthawi zina (monga kamodzi pa sabata kwa masabata atatu, otsatiridwa ndi sabata imodzi kuchoka) kwa maulendo angapo.
Kuphatikiza mankhwala osokoneza bongo, Folfirinex (5-FU / leucovorin, irinotecan, ndi oxaliplatin) amawoneka kuti amagwira ntchito bwino, koma ali ndi poizoni kuposa njira zina ndipo amagwiritsidwa ntchito makamaka kwa anthu omwe ali ndi thanzi labwino (omwe ali ndi vuto labwino ). Kupenda kwa 2018 kafukufuku akuyang'ana mankhwala osiyanasiyana omwe anapeza kuti Folfirinex anali ndi zotsatira zowonjezereka pakukhalitsa.
Zotsatira Zotsatira za Chemotherapy
Zotsatira za mankhwala a chemotherapy zingakhale zofunikira komanso kuphatikiza tsitsi; kunyozetsa ndi kusanza (ngakhale mankhwala ochepetsera zizindikirozi asintha bwino kwambiri m'zaka zaposachedwa); kupwetekedwa kwa mafupa a mafupa omwe amachititsa kuchepa kwakukulu kwa magazi oyera, maselo ofiira a magazi (magazi a magazi), ndi mapaleletti, ndi zina zambiri.
Thandizo Lolinga
Njira zochiritsira ndizo mankhwala omwe amawunikira njira zenizeni mu kukula kwa maselo a khansa. Popeza kuti mankhwalawa akugwiritsidwa ntchito makamaka pa maselo a khansa nthawi zambiri (koma osati nthawi zonse) amakhala ndi zotsatira zochepa kusiyana ndi mankhwala a chemotherapy.
Mankhwala osokoneza bongo omwe nthaŵi zina amagwiritsidwa ntchito kwa anthu omwe ali ndi kansa ya pancreatic, Tarceva (erlotinib) amagwira ntchito potseka njira pakukula kwa maselo a kansa. M'malo mopha maselo a khansa, amawapha ndipo amasiya kubwereza. Tarceva nthawi zambiri imagwiritsidwa ntchito pamodzi ndi Gemzar. Zotsatira zofala kwambiri za Tarceva zikuphatikizapo kutupa kwa mphuno ndi kutsekula m'mimba.
Mayesero Amakono
Pali mayesero angapo a kachipatala omwe akuyambitsa kansa ya pancreatic kanthana ndi mankhwala omwe ali pamwambapa, komanso mankhwala atsopano monga immunotherapy . Ngakhale kuti mankhwala ena ayamba kuphunziridwa ndi khansara ya pancreatic, nthawi zina amachititsa kuti azitha khansa yapakhungu, monga khansa ya m'mapapo, ndi kubweretsa chiyembekezo kuti mankhwala opatsirana khansa yapakhungu adzapezeka m'tsogolomu.
Mankhwala Ophatikiza (CAM)
Pakalipano, palibe njira zina zochiritsira zosonyeza kuti kuli ndi mphamvu yothetsera khansa ya pancreatic. Njira zina zothandizira ena , zingathandize anthu kuthana ndi zizindikiro za khansa ndi mankhwala a kansa, ndipo malo ambiri omwe ali ndi khansa tsopano akupereka zowonjezereka. Zitsanzo zimaphatikizapo kugwira ntchito, kusinkhasinkha, kupatsira misala, ndi yoga.
Zakudya
Anthu ambiri amafunafuna zakudya zowonjezera zakudya komanso zitsamba akamaphunzira za momwe matenda a khansa ya pancreatic imayendera. Ndikofunika kuzindikira kuti vitamini ndi zakudya zina zowonjezereka zimachepetsanso mphamvu zothandizira khansa .
Kafukufuku mububu wakhala akuyang'ana mankhwala ochepa omwe amagwiritsidwa ntchito ku Ayurveda, monga triphala, ndi nigella sativa (black caraway). Ngakhale kuti pakhala pali zotsatira zowonjezera zomwe zikuwonetsa kukula kwa maselo osokoneza bongo omwe akukula mu pulogalamu yamayeso, sitidziwa ngati mankhwalawa angakhudze anthu okha. Kuonjezera apo, mavitaminiwa amapezeka kwambiri ku United States ndipo amatha kusokoneza mankhwala ena. Ichi ndi chikumbutso chabwino, komabe, kuyankhula ndi wanu oncologist za ma vitamini, minerals, kapena zakudya zowonjezera zomwe muli / akuganiza zowatenga.
Chochititsa chidwi n'chakuti kafukufuku akuyang'ana kachexia ya khansa (matenda a kuchepa kwa thupi, kusowa kwa kudya, ndi kutayika kwa minofu yomwe imakhudza anthu ambiri omwe ali ndi kansa ya pancreatic) yapeza kuti omega-3 fatty acids angakhale ofunika kwambiri, monga pali chochepa kwambiri chomwe chimapangitsa kusiyana pakati pa matendawa. Popeza cachexia imalingalira kuti ndiyo imfa yeniyeni mwa 20 peresenti ya anthu omwe ali ndi khansara, izi ndi zoyenera kuyankhula ndi oncologist wanu. Pali mitundu yambiri ya omega-3s, ndipo nthawi zambiri ovomerezeka amalimbikitsa kupeza zakudya kudzera mu zakudya m'malo mopatsirana.
Chisamaliro chosakanikirana
Kusamalidwa sikunali kofanana ndi hospice, ndipo kungagwiritsidwe ntchito ngakhale kwa anthu omwe ali ndi zotupa kwambiri. Amaganizira za thanzi labwino la munthu amene ali ndi khansara m'malo mochiza khansa yokha. Kusamalidwa kwenikweni ndi njira yothandizira anthu ambiri omwe amapezeka ndi khansa ya pancreatic. Izi zingaphatikize opaleshoni kapena chemotherapy, monga taonera pamwamba, komanso zina zomwe mungachite.
Zitsanzo zimaphatikizapo kuyang'anira bwino kupweteka; Kugonjetsa zizindikiro zina zakuthupi, monga vuto lakumadya; thandizo la zakudya; komanso kulimbikitsa maganizo pa nkhawa, nkhawa, ndi kuvutika maganizo. Kusamalidwa kungathandizenso kuthana ndi mavuto a uzimu, zosamalira komanso zosamalirana, komanso zofunikira kuchokera ku inshuwalansi kupita ku ndalama ndi thandizo lalamulo.
Ambiri omwe ali ndi khansa tsopano akuyendera gulu lothandizira kuti atsimikizire kuti zizindikiro zimayankhidwa komanso momwe zingathere.
Zothetsera Pakhomo ndi Moyo Wamoyo
Popeza khalidwe la moyo ndi khansa ya pancreatic ndi yofunikira kwambiri, njira zomwe zimapangidwira ndizofunika kwambiri. Kudya zakudya zathanzi sikungapangitse kusiyana ndi khansara yanu, koma anthu ambiri amamva bwino akamadya chakudya chokhala ndi zipatso ndi ndiwo zamasamba. Kuchita masewera olimbitsa thupi ndiwothandiza, mwinamwake molakwika, kungathandize kuchepetsa khansa ya khansa.
Anthu ena amadzifunsa kuti ndibwino kuti asiye kusuta atapezeka, makamaka ndi khansa yapakhungu yoopsa. Yankho ndilo inde. Pali zifukwa zingapo zomwe zimapangitsa kuti munthu asatenge matenda a khansa angakhale othandiza kwambiri.
> Zotsatira:
> Zochitika Zamakono Komanso Zowoneka M'matenda a Pancreatic, Springer Verlag, 2017.
> De la Cruz, M., Young, A., ndi M. Ruffin. Kuzindikira ndi Kusamalira Khansa ya Pancretic. American Family Physician . 2014. 89 (8): 626-632.
> National Cancer Institute. Chithandizo cha khansa ya Pancreatic (PDQ) -Health Professional Version. Kusinthidwa 01/26/18. https://www.cancer.gov/types/pancreatic/hp/pancreatic-treatment-pdq
> Zhang, S., Liu, G., Li, X., Liu, L., ndi S. Yu. Kuthana ndi Matenda Osiyanasiyana a Chemotherapy Amagwiritsidwa Ntchito pa Chithandizo Chapafupi kapena Metastatic Pancreatic Cancer: A Network Meta-Analysis. Journal of Physiology . 2018. 233 (4): 3352-3374.