Khansa m'mapfupa nthawi zambiri imafalikira, kapena metastasis, kuchokera ku khansa yina yopanda mafupa- metastases ya mafupa a khansa yamapapu kapena khansa ya m'mawere. Kutenga chitsanzo cha malo okhudzidwa ndi mafupa kumathandiza kusiyanitsa pakati pa khansa yapafupa ndi ma metastasis kuchokera ku khansa zina komanso kumathandiza kudziwa mtundu wina wa khansa yapafupa.
Pozindikira kuti khansa ya pfupa, fupa lomwe limakhudzidwa-komanso malo a chotupa m'kati mwa mafupa ena-zonsezi ndizofunika kwambiri.
Osteosarcoma, chondrosarcoma, ndi Ewing sarcoma ndi zina mwa mitundu yambiri ya khansa ya mafupa. Komabe, khansara ya mfupa si khansa yamba, ngakhale: khansa yoyamba ya mafupa imakhala osachepera 0,2 peresenti ya khansa yonse.
Kuyesedwa / Kuyesedwa Kwapanyumba
Panthawiyi, mayesero apakhomo a matenda a kansa ya mafupa sanapangidwe. Kuwonjezera apo, zizindikiro zoyambirira za khansa ya mafupa zimatha kusokonezeka mosavuta chifukwa cha zochitika zina zomwe zimachitika monga masewera a masewera, kapena poyamba zikhoza kuoneka kuti zimakhala zowawa ndi zowawa.
Pambuyo pake, matenda ambiri a khansa ya mfupa amapita kuchipatala chifukwa cha zizindikiro zomwe zimaphatikizapo kupweteka kwa mafupa komwe kumakhala kovuta nthawi. Kupweteka kwa khansa ya fupa kumafala usiku ndipo nthawi zambiri kumakhala ndi kutupa kwa dera lomwe lakhudzidwa.
Mapulogalamu ndi Mayesero
Kufufuza Kwambiri
Panthawi ya khansa ya mfupa, kufufuza kumene dokotala amachita kumachitika mwachibadwa pokhapokha mwina chifukwa cha "minofu yofewa" imene ingamveke pamalo oyamba a khansa. Izi zikhoza kuoneka monga mtanda, chitunda, kapena kutupa komwe kumachokera ku fupa.
Ntchito Yagazi
Kuyeza kwa ma laboratory, kapena ntchito yamagazi , kungakhale kothandiza, ngakhale kuti sichidziŵika kawirikawiri matenda enaake. Maselo awiri a zamoyo zam'madzi makamaka-alkaline phosphatase ndi lactate dehydrogenase-ali pamwamba pa odwala ali ndi khansa yapafupa. Komabe, maguluwa samagwirizana bwino ndi momwe matendawa afalikira mthupi.
Chimake
Ngati phokoso la fupa limakhalapo, kachilombo kakang'ono kamene kakachotsedwa kamene kadzachotsedwa ndi kuyang'aniridwa pansi pang'onopang'ono. Amaonedwa kuti ndi opaleshoni yosavuta, yomwe imagwiritsidwa ntchito poyambitsa matenda amadzimadzi, ndipo mudzakambirananso mwa izo musanayambe kuchita. Chidutswachi chidzawulula ngati maselo a khansa alipo pamphongo.
Kujambula
X-ray
Chimodzimodzinso chifuwa cha osteosarcoma nthawi zambiri chimachokera ku mawonekedwe a fupa lakukhudzidwa pa mafano.
Osteosarcoma ingakhale ndi maonekedwe osiyana pa kujambula: kuchepa kapena "kudyedwa" komwe kumawoneka m'malo a fupa kumatchedwa chitsanzo cha lytic. Mwinanso, fupa lingawoneke ngati lakulimbidwa ndi simenti yowonjezera, ndipo izi zimatchedwa chitsanzo cha sclerotic. Khansara ya mafupa ingayambitsenso chitsanzo chophatikiza (lytic-sclerotic) pa kujambula.
Madokotala amadziwa za phokoso lamakono la "radiburst" 'la osteosarcoma, momwe minofu yoyandikana nayo imakhala ndi maonekedwe aakulu a fupa mumdima wodutsa, spokes-from-the-hub, sunburst pattern; komabe izi sizikutanthauza kuti osteosarcoma sizitsamba zonsezi.
CT ndi MRI
Kuchita opaleshoni kaŵirikaŵiri kumapanga chithandizo cha mankhwala, ndipo zimakhala zofunikira kudziwa momwe osteosarcoma imagwirira ntchito minofu ndi zofewa. Izi zimawoneka bwino kwambiri pogwiritsa ntchito njira zamaganizo zojambula pamtundu monga computed tomography (CT) kapena kujambula kwa magnetic resonance (MRI).
MRI ndi njira yomwe imagwiritsa ntchito maginito, mafunde a wailesi, ndi makompyuta kuti azipanga zithunzi zambiri za zigawo za thupi, kuphatikizapo malo otupa. Kugwiritsira ntchito MRI kufotokozera kukula kwa chifuwacho kwawonetsedwa kuti ndikulondola molondola zenizeni monga momwe zakhazikitsidwa pa nthawi ya opaleshoni.
Radionuclide Makhalidwe Abwino
Kafukufuku wosiyanasiyana wa ma radiographic amagwiritsidwa ntchito monga gawo la kafukufuku wa kansa ya mfupa kudziwa momwe matenda am'derali amachitira kutali komanso kutali.
Kujambula kwa pulogalamu ya radionuclide, pogwiritsa ntchito kachilombo koyambitsa technetium 99m kumayikidwa mu mitsempha, imagwiritsidwa ntchito kufotokoza kukula kwa chotupa chachikulu. Ndipo, popeza kuti nthawi zambiri zimakhala zochepa kwambiri, zimathandiza opaleshoni kukonzekera kuchotsa chotupacho.
Mankhwalawa amathandizanso kupeza malo ena a khansa m'matumbo omwewo (otchedwa skip lesions) komanso kutalika kwa mafupa a metastases. Mayesowa ndi othandiza chifukwa akhoza kusonyeza mafupa onse mwakamodzi. Kujambula kwa positron tomography (PET) kungapereke chithunzi chofanana, kotero kupyolera kwa fupa sikungakhale kofunikira ngati PET yowunika.
Positron Emission Tomography (PET) Fufuzani
PET scan, mtundu wa shuga wa radioactive (wotchedwa FDG ) umalowetsedwa m'magazi. Nthaŵi zambiri maselo a khansa m'thupi akukula mofulumira ndipo amamwa kwambiri shuga, kupanga chithunzi chomwe chikuwonetsetsa FDG mu thupi mmalo mwa chiopsezo cha khansa. Chithunzicho sichikufotokozedwa ngati CT kapena MRI scan, koma chimapereka chidziwitso chokhudza thupi lonse.
Kufufuza kwa PET kungathandize kusonyeza kufalitsa kwa osteosarcomas m'mapapu, mafupa ena, kapena ziwalo zina za thupi, komanso kungathandize kuona momwe khansara ikuyankhira mankhwala.
Kawirikawiri PET ndi CT zimayanjanitsidwa panthaŵi imodzimodziyo ( PET / CT scan ) kuti zitha kuwonetsa malo omwe ali ndi mphamvu yowonjezera mphamvu pa PET kufufuza poyerekeza ndi mawonekedwe a malowa pa CT scan.
Kusinthanitsa kwa Metastases
Ngakhale chifuwa chachizoloŵezi X-ray imalola kuti matenda a metastases amapezeke m'matenda ambiri, CT imakhala yovuta kwambiri pozindikira mapangidwe a mapapu ndipo imakhala njira yopangira zithunzi. Mwina pangakhale zonyenga, komabe makamaka ngati pali zochepa zochepa m'mapapu, kotero kuti chidziwitso chingakhale chofunikira.
Kusiyanitsa kusiyana
Kusiyanitsa kwa matenda a mafupa a mtundu umenewu ndi awa:
- Kutenga
- Ziphuphu zina:
- Aneurysmal bone cyst
- Kutulutsa sarcoma
- Chondrosarcoma
Malo a chotupa mu fupa ndi chigoba amathandizira kusiyanitsa osteosarcoma ndi Ewing sarcoma, yomwe ndi yachiwiri chotupa kwambiri mu msinkhu wachinyamata.
Zambiri zomwe zingatheke zingathenso kuthandizidwa ndi malo a chotupa chachikulu. Mwachitsanzo, kusiyanitsa kwa mitsempha ya nsagwada kumaphatikizapo mitundu yosiyanasiyana ya kupasuka kwa dzino, osteomyelitis (matenda) a fupa la nsagwada, ndi zina mwazirombo zosaoneka bwino (monga kutulutsa fibromas ndi zotupa zakuda za hyperparathyroidism).
Zowonongeka pazithunzi
Chimodzi mwa matenda a kansa ya mfupa chimaphatikizapo kuyendetsa. Kuphatikizira kumatanthauza kuyang'ana kukula ndi malo a chotupa chachikulu, ngati chikufalikira, ndi kumene chikufalikira. Kuphatikizira kumathandiza kusankha chisamaliro, ndipo madokotala amaganiziranso malo a kansa pamene akukambirana za ziwerengero za moyo.
Zomwe zimayendera motsutsana ndi Metastatic
Kukhazikitsa malo kumayambira pa mayeso, zojambula, ndi zochitika zilizonse zomwe zachitidwa. Osteosarcoma ikhoza kukhala gawo I, II, kapena II ndi magawo angapo.
Chinthu chimodzi chofunika kuganizira pazokambirana ndi kaya khansara ndi "malo okhala" kapena "metastatic." Ngati malowa, osteosarcoma amangooneka pokhapokha mafupa omwe amayamba mkati mwinamwake ndi minofu pafupi ndi fupa, monga minofu, tendon, kapena mafuta.
Malingana ndi American Cancer Society, pafupifupi 4 mwa asanu alionse osteosarcomas amawoneka kuti akupezeka pamene akupezeka koyamba. Komabe, ngakhale pamene zojambulazo siziwonetsa kuti khansara yafalikira kumadera akutali, odwala ambiri amakhala ndi malo ochepa kwambiri a kufalikira kwa khansa omwe sangazindikiridwe ndi mayesero.
Chotheka cha tizilombo tating'ono ting'onoting'ono ndi chimodzi mwa zifukwa zomwe mankhwala a chemotherapy ndi mbali yofunikira ya chithandizo cha ma osteosarcomas ambiri. Izi zikutanthauza kuti khansara ikhoza kubwereranso atatha opaleshoni ngati palibe mankhwala omwe amapatsidwa.
Mafupa osteosarcomas akupezeka m'magulu awiri:
- Khansa zowoneka ndizo zomwe zivomezi zonse zimawoneka ndi opaleshoni.
- Osaosarcomas osagwiritsidwa ntchito (kapena osakwanira) sangathe kuchotsedwa kwathunthu ndi opaleshoni.
Kulemba
Kulemba kungaphatikizepo ku staging ndipo kumatanthawuza maonekedwe a maselo a khansa pansi pa microscope. Kulemba kumapereka lingaliro la momwe kansa ingakhalire mwamsanga.
- Maselo a khansa yapamwamba amayamba kukula mofulumira komanso mochepa kufalikira.
- Ziphuphu zapamwamba zimakhala ndi maselo a khansa omwe amakula msanga ndipo amatha kufalikira.
Mafuta ambiri a osteosarcomas ndi apamwamba kwambiri, koma mtundu wotchedwa parosteal osteosarcoma nthawi zambiri umakhala wochepa.
Njira Zowonongeka
Njira yogwiritsidwa ntchito kwambiri popanga osteosarcoma imagwiritsira ntchito ziphuphu zam'nofu zomwe zimakhala zosavuta kwambiri.
Kalasi
Maphunziro apansi ndi apamwamba angasonyeze siteji.
- Kalasi yachepa = siteji I
- Maphunziro apamwamba = Gawo II
Chiwerengero cha Anatomic
- Malo am'deralo amatsimikiziridwa kuti kaya chotupacho chimachokera pamtunda, phokoso lakunja la mafupa limene limapanga malo otetezera kuzungulira mkatikati mwa khola
- Intracompartmental (palibe kutambasula kupyolera mu cortex) = A
- Zoonjezerapo (kutambasula kupyolera mu cortex) = B
M'dongosolo lino, zotsatirazi ndi zoona:
- Matenda ochepa kwambiri, omwe ndi ofunika kwambiri.
- Matenda apamwamba kwambiri, omwe ndi malo oyamba II.
- Matenda a mitsempha (mosasamala kalasi) ndi gawo lachitatu.
Pali zilonda zam'mimba zochepa kwambiri (stage IIA) chifukwa ma osteosarcomas ambiri amatha kupyola mu khungu la mafupa kumayambiriro kwa chitukuko chawo.
Ali aang'ono, magulu ambiri a osteosarcomas ndi apamwamba; Choncho, pafupifupi odwala onse ali pa siteji IIB kapena III, malinga ndi kupezeka kapena kupezeka kwa matenda osokonezeka.
Zitsanzo ndi Gawo
- Gawo IA: Khansara ndi yapamwamba kwambiri ndipo imapezeka pokhapokha kupindika kolimba kwa fupa.
- Gawo IB: Khansara ndi yochepa kwambiri, imatuluka kunja kwa fupa komanso m'mapiko ofewa omwe ali ndi mitsempha ndi mitsempha ya magazi.
- Gawo IIA: Khansara ilipamwamba kwambiri ndipo imakhala mkati mwa chofunda cholimba cha fupa.
- Gawo IIB: Khansara ili ndipamwamba kwambiri ndipo yafalikira kunja kwa fupa ndi m'zipinda zofewa zozungulira zomwe ziri ndi mitsempha ndi mitsempha ya magazi. Mafupa ambiri osteosarcomas ndi siteji 2B.
- Gawo lachitatu: Khansara ikhoza kukhala yochepa kapena yapamwamba kwambiri ndipo imapezeka mkati mwa fupa kapena imatuluka kunja kwa fupa. Khansara yayamba kufalikira kumbali zina za thupi, kapena mafupa ena osagwirizanitsidwa mwachindunji ndi fupa kumene chotupacho chinayamba.
Ngati khansara ikhoza kubwerera pambuyo pochiza chithandizo, izi zimatchedwa khansa yowonongeka kapena yobwereranso.
> Zotsatira:
> American Cancer Society. Mayesero a Osteosarcoma. Chiwongola dzanja
> Institute Cancer Institute. Osteosarcoma ndi Malignant Fibous Histiocytoma ya Matenda a Matenda (PDQ®) -Health Professional Version. https://www.cancer.gov/types/bone/hp/osteosarcoma-treatment-pdq.