Pali madokotala angapo odziwa zambiri omwe amafufuza kuti apeze khansa ya pancreatic . Mayesero ojambula angaphatikizepo njira yapadera ya CT scan, endoscopic ultrasound, MRI, kapena ERCP. Mayeso a magazi angayang'ane zifukwa za jaundice komanso zizindikiro zamatenda. Ndipo mbiri yakale yokhudza zachipatala yokhudzana ndi zoopsa, pamodzi ndi kuunika kwa thupi, ndizofunikira.
Chiwopsezo chimatha kapena sichifunika, malingana ndi zina zomwe zapeza. Pambuyo poyezetsa matenda, ma stage amapangidwa kuti apeze mankhwala oyenera kwambiri pa matendawa.
Aliyense ayenera kudziwa za zizindikiro zowononga za khansa ya pancreatic , kotero kuti athe kupeza kafukufuku wamankhwala mwamsanga.
Mapulogalamu ndi Mayesero
Kufufuza kwa khansara yotchedwa pancreatic kawirikawiri kumayambira ndi mbiri yosamala komanso kuunika kwa thupi. Dokotala wanu adzakufunsani mafunso pazifukwa zomwe mungakhale nazo, kuphatikizapo mbiri ya banja la matendawa, ndipo mudzafunsanso za zizindikiro zanu. Adzachita kafukufuku ndikuyang'anitsitsa khungu lanu ndi maso kuti apeze umboni wa chifuwa ; Kufufuza mimba yanu kuti mukhale ndi misa kapena kukulitsa chiwindi chanu, kapena umboni uliwonse wa ascites (kumanga madzi mumimba), ndi kufufuza zolemba zanu kuti muwone ngati mwataya thupi.
Kuyesedwa kwa magazi kosaopsa ndi kansa ya pancreatic ndi yosayenera, koma nthawi zina kumathandiza popanga matenda pogwiritsa ntchito mayesero.
Mayesero angaphatikizepo:
- Mayendedwe a chiwindi, omwe nthawi zina amawonjezeka
- Kuchuluka kwa magazi (CBC), kuyang'ana chiwerengero chokwanira chaplatelet (thrombocytosis) makamaka
- Mayeso a bilirubin: Pali mitundu yosiyanasiyana ya bilirubin, ndipo malinga ndi mtundu woyesedwa, madokotala angapeze zizindikiro monga magwero a jaundice aliwonse omwe muli nawo. Ndi zotsekemera zowopsya (chifukwa cha chifuwa chosokoneza bongo chimene chimapangitsa kuti anthu azikhala ndi mankhwala ambiri), pali zowonjezereka m'magwiridwe onse ndi bilirubin.
Magazi a shuga amayamba kukwera, monga pafupifupi 80 peresenti ya anthu omwe ali ndi khansa ya pancreatic adzakhala ndi insulin kukana kapena shuga. Pafupifupi theka la anthu amakhala ndi serum amylase ndi serum lipase kumayambiriro kwa matendawa, koma matenda ochepa kwambiri.
Zolemba Zosokoneza
Zizindikiro zamatenda ndi mapuloteni omwe amachitidwa ndi khansa ndipo amatha kupezeka mwa kuyesa magazi. Mmodzi mwa zizindikirozi, carcinoembryonic antigen (CEA), wakwera kwambiri pafupifupi theka la anthu omwe amapezeka ndi matendawa komanso amadzikweza m'mitambo yambiri. Maseŵera a CA 19-9 akhoza kuyesedwa, koma popeza kuti nthawi zonse sakhala okwera komanso amakula amatha kusonyeza zina zachipatala, izi sizothandiza kwambiri pakupeza khansa ya pancreatic. Chotsatira ichi, komabe, ndi chothandiza posankha ngati chotupa cha pancreatic chingachotsedwe opaleshoni, ndi kutsatira njira ya chithandizo.
Matenda Akumagazi a Neuroendocrine
Mayeso ena a magazi angathandizenso pozindikira kuti mitundu yosawerengeka ya khansa ya pancreatic yotchedwa neuroendocrine tumors. Mosiyana ndi zotupa zambiri zapascreatic, zomwe zimapangidwa ndi maselo omwe amapanga mavitamini a m'mimba, zotupazi zimaphatikizapo maselo a endocrine omwe amapanga mahomoni monga insulini, glucagon, ndi somatostatin.
Kuyeza kuchuluka kwa mahomoniwa, komanso kuyesera magazi ena, kungakhale kothandiza pozindikira zotupazi.
Kujambula
Mayesero ojambula kawirikawiri ndi njira yoyamba yotsimikizira kapena kukana kukhalapo kwa misala m'zipinda. Zosankha zingakhalepo:
CT Scan
Tomography yamagetsi (CT) amagwiritsira ntchito X-ray kupanga chigawo cha chigawo cha thupi ndipo kawirikawiri ndipamene amadziwika. Ngati dokotala akukayikira kansa ya pancreatic makamaka, khungu lapadera la CT lotchedwa multiphase helical CT scan kapena pancreatic protocol CT scan nthawi zambiri limalimbikitsidwa.
Kansalu ya CT ingathandize kwambiri kuti muzindikire chifuwacho (kuwonetsa kukula kwake ndi malo ake operewera) ndi kuyang'ana umboni uliwonse wa kufalikira ku maselo a mitsempha kapena m'madera ena.
CT ingakhale yothandiza kwambiri kusiyana ndi endoscopic ultrasound pofuna kudziwa ngati khansa yafalikira kwa mitsementi yapamwamba ya mesenteric (yofunika posankha chithandizo).
Endoscopic Ultrasound (EUS)
Ultrasound imagwiritsa ntchito mafunde omveka kuti apange chithunzi cha mkati mwa thupi. Kawirikawiri (transcutaneous) ultrasound samachitidwa ngati dokotala akukayikira khansa ya pancreatic, monga matumbo a m'mimba amatha kuwonetsa zovuta zapascito. Koma zingakhale zothandiza pakufufuza mavuto ena a m'mimba.
An endoscopic ultrasound ingakhale yamtengo wapatali pochidziwitsa. Zimagwiritsidwa ntchito pogwiritsa ntchito zipangizo zamakono zotchedwa endoscopy, phukusi lokhala ndi tizilombo toyambitsa matenda lomwe lili ndi mapulogalamu a ultrasound pamapeto pake limalowetsedwa kudzera m'kamwa ndikugwera m'mimba kapena m'mimba, kuti kanthini ichitike kuchokera mkati. Popeza kuti maderawa ali pafupi ndi kapangidwe kameneka, mayesero amalola madokotala kuti ayang'ane bwino chiwalo.
Pogwiritsira ntchito mankhwala (consciousness sedation), anthu amalekerera njirayi bwino. Chiyesochi chikhoza kukhala cholondola kuposa CT pofuna kuyesa kukula ndi kukula kwa chotupa koma si bwino kupeza kufalikira kwina kwina (metastases) kapena kudziwa ngati chotupacho chimakhudza mitsempha ya magazi.
Endoscopic Kubwezeretsanso Cholangiopancreatography (ERCP)
Kachilombo kameneka kowonjezera (ERCP) ndi mayesero omwe amatenga mapuloteni ndi ma X-ray kuti awoneke ma date. ERCP ingakhale yankho lovuta la kupeza kansa ya pancreatic koma si yolondola posiyanitsa matendawa ndi mavuto ena, monga chiwopsezo. Ndi njira yowonjezera yowonjezereka yokhudzana ndi mayesero pamwambapa.
MRI
Chithunzi cha maginito (MRI) chimagwiritsa ntchito magetsi mmalo mwa X-rays kuti apange chithunzi cha zipangizo zamkati. MRI imagwiritsidwa ntchito mobwerezabwereza kuposa CT ndi khansa ya pancreatic koma ingagwiritsidwe ntchito panthawi zina. Mofanana ndi CT, pali mitundu yapadera ya MRI, kuphatikizapo MR cholangiopancreatography (MRCP). Popeza sizinaphunzirepo mofanana ndi mayesero omwe ali pamwambawa, amagwiritsidwa ntchito makamaka kwa anthu omwe matenda awo sadziwa bwinobwino malingana ndi maphunziro ena, kapena ngati munthu ali ndi zovuta zosiyana ndi dye yosiyanasiyana yomwe imagwiritsidwa ntchito pa CT.
Octreoscan
Chiyeso chotchedwa octreoscan kapena somatostatin receptor scintigraphy (SRC) chikhoza kuchitidwa ngati chotupa cha neuroendocrine cha pancreas chikuwoneka. Mu octreoscan, puloteni ya radioactive (yotchedwa tracer) imayikidwa mu mitsempha. Ngati chotupa cha neuroendocrine chiripo, wojambulayo amamanga maselo mu chotupacho. Maola angapo pambuyo pake, kujambulidwa kumapangidwe komwe kumatulutsa miyendo yonse yomwe imatulutsa (zotupa za neuroendocrine zidzatuluka, ngati zilipo).
PET Scan
PET imawunikira, nthawi zambiri kuphatikizapo CT (PET / CT), nthawi zina ikhoza kuchitidwa, koma imagwiritsidwa ntchito mobwerezabwereza ndi kansa ya pancreatic kuposa ena khansa. Pachiyeso ichi, shuga yochepa ya radioactive imayikidwa mu mitsempha ndipo sewero lachitidwa pambuyo poti shuga yakhala nayo nthawi yogwiritsidwa ntchito ndi maselo. Maselo akukula kwambiri, monga maselo a kansa, "adzawunika," mosiyana ndi malo a maselo abwino kapena minofu yofiira.
Chimake
Chitsanzo cha minofu (biopsy) nthawi zina amafunika kutsimikizira kuti matendawa ndi otani, komanso kuyang'ana maonekedwe a maselo.
Chingwe chabwino cha singano (njira yomwe singano yopyapyala imayendetsedwa kudzera mu khungu m'mimba ndi mumphuno kuti muchotse minofu) nthawi zambiri imagwiritsidwa ntchito pogwiritsa ntchito malangizo omwe ali ndi ultrasound kapena CT. Pali zodetsa nkhaŵa kuti mtundu uwu wa biopsy ukhoza "kubzala" chotupa, kapena kupangitsa kufala kwa khansa pamzere kumene singano imayambira. Sikudziwika kuti kuchuluka kwa mbeu kumachitika kangati, koma malinga ndi kafukufuku wa 2017, chiwerengero cha zochitika za mbeu chifukwa cha mapulogalamu osungira bwino a singano omwe amatsogoleredwa ndi ultrasound akuwonjezeka mofulumira.
Popeza kuti zochitika zapadera zimapangidwa makamaka kuti aone ngati opaleshoni ikhoza kuchitidwa (chithandizo chokha chomwe chimapangitsa kuti pakhale moyo wa nthawi yayitali), izi ndizofunika kuti muziyankhula ndi dokotala wanu.
Monga njira ina, laparoscopy ingagwiritsidwe ntchito, makamaka ngati chotupa chingathe kuchotsedwa (resectable). Mu laparoscopy, zochitika zingapo zing'onozing'ono zimapangidwa m'mimba ndi chida chochepa chimaphatikizidwa kuti chikwaniritse. Popeza, pafupifupi 20 peresenti ya nthawiyi, anthu amawoneka kuti ali ndi matenda omwe satha kuchitidwa opaleshoni atayamba kale kudwala khansa ya pancreatic, ena madokotala amalimbikitsa kuti ayesere kuyesa aliyense amene adzachitidwa opaleshoni (kuti asamamuchitire opaleshoni yaikulu).
Kusanthula Kusiyanasiyana
Pali zifukwa zingapo zomwe zingafanane ndi zizindikiro za khansa ya pancreatic kapena zimapanganso zotsatira zofanana pa kuyesa magazi ndi kujambula. Madokotala adzagwira ntchito kuti athetse zotsatirazi asanadziwe:
- Zokhazikika zamatope: Njira yokhala ndi bile yodabwitsa ndi kupopera kwachilendo kwa ndondomeko ya bile. Zingayambitsidwe ndi gallstones kapena opaleshoni kuti zichotse, koma zingayambitsenso khansa ya pancreatic.
- Kupweteka kwapadera kapena kwachilendo: Pancreatitis , kutukusira kwa kapangidwe, kungayambitse zizindikiro zofanana, koma sizimayambitsa misala. Pafupifupi anthu 1 pa 20 alionse, kupweteka koopsa kwapachilendo kulipo panthawi ya matenda a khansa ya pancreatic.
- Zojambula zamatope: Miyala yomwe ili m'kati mwa njirayi imayambitsa zizindikiro za obstructive jaundice ndipo imatha kuwonedwa pa ultrasound. Mofanana ndi bile duct strictures, komabe, akhoza kukhala limodzi ndi khansa ya pancreatic.
- Ampullary carcinoma
- Khansara ya Gallbladder : Khansa ya Gallbladder ikhoza kuoneka ngati yofanana ndi khansa yapakhungu, koma ingakhale yosiyana ndi CT kapena MRI.
- Mitsinje (cholelithiasis)
- Zilonda zam'mimba kapena zam'mimba
- Mimba ya aortic aneurysm
- Pancreatic lymphoma
- Gastric lymphoma
- Kansa ya chiwindi
- Matenda a khansa yamatope
Kusinthana
Kuzindikira malo odwala khansa ya pancreatic n'kofunika kwambiri pankhani yothetsa ngati khansa ikhoza kuchitidwa opaleshoni kapena ayi. Ngati kusinthana kuli kolakwika, kungachititse opaleshoni yosafunikira. Kuphatikizanso kungathandizenso kulingalira momwe matendawa akuyendera.
TNM Staging
Madokotala amagwiritsa ntchito dongosolo lotchedwa TNM staging kuti adziwe siteji ya chotupa. Izi zikhoza kusokoneza kwambiri poyamba koma zimakhala zosavuta kumvetsa ngati mukudziwa zilembo izi.
T amaimira chotupa. Chotupa chimapatsidwa nambala kuchokera ku T1 mpaka T4 kuchokera ku kukula kwa chotupacho, komanso ziwalo zina zotupa zikhoza kukhala zabwera.
| T1 | Kutupa kotsekedwa kumapangidwe ndi osachepera 2 cm |
| T2 | Kutupa kumangidwe kumapangidwe ndi oposa 2 cm |
| T3 | Kutupa kumadutsa mopitirira phokoso (mpaka ku duodenum, bile, ma portal kapena mesenteric mitsempha), koma sizimaphatikizapo mzere wa celiac kapena ambuye opambana a mesenteric |
| T4 | Kutupa kumaphatikizapo mitsempha yotchedwa laliac kapena mitsempha yopambana ya mesenteric |
N imayimira ma lymph nodes. N0 zikutanthawuza kuti chotupa sichinayambe kufalikira ku minofu iliyonse. N1 imatanthauza kuti chotupacho chafalikira ku maselo amphongo oyandikira.
| N0 | Palibe kukhudzidwa kwa maselo am'deralo |
| N1 | Zilonda zam'deralo zimakhala zabwino kwa khansa |
M imayimira metastases. Ngati chotupa sichinayambe kufalikira, chikhoza kufotokozedwa ngati M0. Ngati zafalikira kumadera akutali (kupyola pamphuno) zikanatchedwa M1.
| M0 | Palibe metastasis yayitali |
| M1 | Matenda aakulu a metastasis |
Malinga ndi TNM, zotupa zimapatsidwa gawo pakati pa 0 ndi 4. Palinso magawo ena.
Gawo 0: Gawo 0 limatchedwanso carcinoma in situ ndipo limatanthawuza khansa yomwe siinafalikirepo pamtunda. Ziphuphuzi sizowonongeka (ngakhale magawo amodzi akutsatira) ndipo ziyenera kukhala zochiritsidwa kwathunthu.
Gawo 1: Gawo 1 (T1 kapena T2, N0, M0) khansa ya pancreatic imangokhala pamphuno ndipo ili osachepera masentimita awiri.
Gawo lachiwiri: Zovunda zachigawo 2 (mwina T3, N0, M0 kapena T1-3, N1, M0) zikhoza kupitirira kupyola pamphuno (popanda kuphatikizana ndi mitsempha yotchedwa celiac kapena minofu ya mesenteric yapamwamba) ndipo sinafalikire ku maselo a mitsempha, kapena kuti ziphuphu koma zafalikira ku minofu.
Gawo lachitatu: Zovunda 3 (T4, iliyonse N, M0) ikufutukula kupyola pamphepete ndipo zimaphatikizapo mitsempha yotchedwa celiac kapena minofu ya mesenteric yopambana. Zikhoza kapena sizifalikira ku maselo a mitsempha, koma sinafalikire kumadera akutali a thupi.
Gawo 4: Zovunda zapakati pa 4 (T iliyonse, iliyonse N, M1) ikhoza kukula. Ngakhale zikhoza kufalikira kapena zopanda kufalikira ku maselo, zimayambira kumalo akutali monga chiwindi, peritoneum (zibulu zomwe zimayika pamimba), mafupa, kapena mapapo.
> Zotsatira:
> American Society of Clinical Oncology. Cancer.Net. Kusinthidwa 12/2016. https://www.cancer.net/cancer-types/pancreatic-cancer/diagnosis
> 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.
> Kikuyama, M., Kamisawa, T., Kuruma, S. et al. Kusanthula koyambirira koyambitsa matenda oopsa a khansa ya ku Canada. Khansa . 2018. 10 (2) :. pii: E48.
> Minaga, K., Takenaka, M., Katanuma, A. et al. Seeding Tract Tract: Kusagwedezeka kawirikawiri Kuthana ndi Endoscopic-Kutsogoleredwa Kwambiri-Nkhono Yopuma. Oncology . 2017. 93 Suppl 1: 107-112.