Pali njira zingapo zomwe zingagwiritsidwe ntchito kuti zitha kudziwa khansa ya ovari, kuphatikizapo kuyesa pamimba; mayesero ojambula, monga transvaginal ultrasound, CT, MRI, kapena PET scan; ndi kuyezetsa magazi, monga CA-125. Pofuna kuti apeze matendawa, kawirikawiri zimakhala zofunikira kuti onse awiri atsimikizire kuti misala ndi yowopsya (khansa) komanso kuti adziwe mtundu ndi kachilombo ka matendawa.
Ngati matendawa atengedwa, zotsatira zake ndi zowonjezereka zimagwiritsidwa ntchito kuti adziwe momwe matendawa angakhalire, zomwe zingakuthandizeni kupeza njira yabwino kwambiri yothandizira.
Kudziyesa / Kuyezetsa Pakhomo
Mwamwayi, palibe zofufuza za khansara ya ovari. Kuwonjezera apo, kuyesa kwapakhomo kwapakhomo sikungatsimikizire kuti muli ndi chiopsezo chotenga matendawa. Ndikofunika kuti amayi onse adziŵe zizindikiro ndi zizindikiro komanso akalankhule ndi madokotala ngati ali ndi zifukwa zilizonse zoopsya za matendawa.
Kufufuza Kwambiri
Palibe njira zowunikira za khansa ya ovari. Komabe, kafukufuku wa piritsi wochitidwa ndi dokotala wanu (kapena wochitidwa chifukwa cha kukhalapo kwa zizindikiro) amatha kuzindikira misala m'dera lanu la ovary, wotchedwa adnexal mass. Komabe, cheke ichi chili ndi malire.
Kuyezetsa kumeneku kumachitidwa bimanually ndi dzanja limodzi mu chiberekero chanu ndi m'mimba mwanu. Popeza dokotala akukumana ndi chifuwa chanu pansi pa minofu yambiri, kuyesa sikuli koyenera pozindikira misala mwa anthu omwe ali olemera kwambiri kapena olemera kwambiri.
Ngakhale amayi oonda kwambiri, mayeso ochepa amatha kuphonya mosavuta ziwalo zazing'ono zamkati.
Ndikofunika kuzindikira kuti mapepala a Pap okhaokha (popanda kuyeza kwa bimanual), ngakhale zothandiza pakuzindikira khansa ya pachibelekero, sizothandiza kwambiri kupeza khansa ya ovari.
Kujambula
Mayesero ojambula amafunikira onse omwe amapeza masewera ochepa a ovari ndi kumvetsetsanso masses omwe angamveke pamayesero.
Zosankha zikuphatikizapo:
Transvaginal Ultrasound
Nthendayi yotchedwa ultrasound ndiyeso yomwe imagwiritsa ntchito mafunde amphamvu kuti apange chithunzithunzi cha ziwalo. Kawirikawiri ndi mayeso oyambirira omwe amachitidwa kuti awonetsere masewera olimbitsa thupi. Ndondomekoyi ikhoza kuchitidwa pamimba (pulojekitiyi ili pamwamba pa khungu lanu) kapena transvaginally (kafukufukuyo amalowetsedwa mu chikazi kuti ayandikire pafupi). Komabe, poyamba sikunali kofanana ndi kumapeto kwa masewerawa, makamaka omwe ali ochepa.
An ultrasound amatha kulingalira kukula kwake kwa misa, komanso kudziwa ngati ndi chinthu chophweka, chovuta kwambiri, kapena cholimba. Zambiri zosavuta nthawi zambiri zimakhala zonyozeka. Chida chowopsya chikhoza kukhala choipa, koma chimadzutsa nkhaŵa za kukhala ndi khansa ngati ili ndi mitsempha yam'mimba kapena yowonjezera. An ultrasound angathenso kuyang'ana kwaulere madzimadzi m'matumbo, chinthu chomwe nthawi zambiri amachiwona ndi zotupa kwambiri.
Mimba ndi / kapena Pelvic CT Scan
A CT scan amagwiritsa ntchito ma X-ray kuti apange chithunzi cha mimba kapena pelvis. Angagwiritsidwe ntchito kuthandiza kuthandizira, koma nthawi zambiri amagwiritsidwa ntchito pa khansa ya stage. Ndiyeso yabwino kuyesa ma lymph nodes, matumbo, chiwindi, ndi mapapo (chifuwa cha CT scan) chifukwa cha umboni uliwonse umene khansara wafalitsidwa.
Malingaliro omwe mungawone pa lipoti lanu ndi monga ascites (kumanga madzi mumimba); metastases (malo ofalitsidwa); carcinomatosis (malo ambiri otupa); omental keke (kuwonjezeka kwa mafuta olemera, mafuta omwe amapezeka pamimba); mafuta onunkhira (kutupa m'mimba minofu); ndi kuwonongeka (kumadzimadzi kumanga). Komanso, maselo am'mimba amatha kufotokozedwa ngati akufutukuka. Zilonda zowonjezereka zimakhala zazikulu kuposa 2 cm (pafupifupi 1 inchi) m'mimba mwake ndipo zingakhale ndi mbali ya pakatikati ya necrosis (imfa ya selo) ngati khansa ilipo.
MRI
Chithunzi cha MRI (magnetic resonance imaging) chingagwiritsidwe ntchito mofanana ndi kanema ka CT koma sichikhudza ma radiation, kuti apange mayeso otetezeka pa nthawi ya mimba.
MRI imakhala yabwino kuposa CT pakufotokozera zovuta zosaoneka bwino ndipo zingagwiritsidwe ntchito pofotokozera zotsatira za mayesero ena.
PET Scan
Ngakhale CT, MRI, ndi ultrasound ndizoyesedwa zamaganizo (zimayang'ana zolakwika zathupi), kuyesa PET ndiyeso yothandiza, yomwe ndiyeso ya ntchito. Mayeso ovutawa amafufuza umboni wa masastases (kufalitsa) paliponse m'thupi ndipo zimathandiza posiyanitsa pakati pa minofu ndi khansa.
Ndi kupopera kwa PET, shuga pang'ono ya radioactive imayikidwa mu magazi. Kuwongolera kumachitika pambuyo poti shuga yakhala nayo nthawi yogwiritsidwa ntchito ndi maselo. Maselo ochulukirapo ochulukirapo, monga maselo a khansa, adzatsegula zithunzi izi, zomwe nthawi zambiri zimakhala ndi CT.
Mapulogalamu ndi Mayesero
Kuphatikiza pa maphunziro a kujambula ndi kuyesa, ntchito ya magazi imayesedwa kuti ayang'ane umboni wakuti chinthu chosavomerezeka chomwe chimapezeka pamayesero ndi / kapena kujambula ndi khansa kapena ayi. Mayesero angaphatikizepo:
Magazi Gwiritsani Ntchito Kumva Kuzindikira Kuzindikira
Mayeso ena a magazi amatha kuzindikira mapuloteni otchedwa tumor markers. Zina mwa izo zimapangidwa ndi maselo ochizira komanso ochotsa khansa, choncho khansara ya ovari imasonyezedwa ngati ilipo m'magazi ndi apamwamba kusiyana ndi yachibadwa. Matenda ena amtunduwu amangopangidwa ndi maselo oyamba omwe amakhala odwala khansa ndipo sapezeka m'matenda omwe alibe khansara, choncho kupezeka kwawo kokha ndi chizindikiro cha matendawa.
Kuzindikiritsa izi zotupa m'magazi si njira yabwino yowonera khansara ya ovari, koma zingakhale zothandiza poyeza matendawa ndikutsata mayankho a khansa kuchipatala.
- CA-125: CA-125 ndi kafukufuku omwe amachitika nthawi zambiri pamene akudandaula za khansa yowopsa ya ovari. Ngakhale kuti msinkhuwu ukukwera kwambiri pamatenda a m'mimba, pali zifukwa zambiri zomwe zingatheke kuti msinkhu usapitirire (zonyenga) ndi zifukwa zambiri zomwe zingakhale zopanda khansara zowonongeka (zabodza). Zina mwazimene zingathe kuwonjezera CA-125 zimaphatikizapo mimba, matenda a polycystic ovarian, matenda a kutupa kwapakhosi, chiwombankhanga, chiwindi, ndi lupus.
Ndi khansara ya ovari, CA-125 imakhala yowonjezeka mu serous ndi endometrioid subtypes. Ngakhale pali zifukwa zambiri zomwe zingayambitse zotsatira zabwino zabodza, zotsatira zabwino (monga CA-125 pa 1000) zimapangitsa mwayi kuti khansara ya ovari ndi yomwe imayambitsa. Mpata wa CA-125 pa nthawi ya matendawa ingathandizenso kutanthauzira zazomwezo. - Mankhwala a epididymis 4 (HE4): HE4 angakhale othandiza pamene akuphatikizidwa ndi CA-125 ndipo akhoza kukhala okwera ndi khansa ya serous ndi endometrioid epithelial ovarian cancers. Mayesowa sapindulitsa kwambiri kwa atsikana achichepere, chifukwa cha mtundu wa khansa ya mazira opezeka m'mimba mwa amayi omwe amapezeka nthawi zambiri.
- CA 72-4: CA 72-4 ikhoza kukwezedwa m'magulu angapo (kawirikawiri chigawo cha kugaya) ndi msinkhu pa nthawi ya kuchidziwitso kungathandize kulongosola kwa anthu ena.
- CA-19-9: Choyimira chotupachi chikufala kwambiri m'matumbo a mucinous epithelial ovarian.
- CEA (carcinoembryonic antigen): CEA ndi chizindikiro chosadziwika bwino ndipo imatha kukwera m'matenda ambiri, komanso m'mimba.
- Alpha-fetoprotein (AFP) ndi chorionic gonadotropin (HCG): Anthu amadziwika bwino ndi HCG chifukwa choyesa kuyesa mimba, ndipo AFP ikuyesedwa panthawi yomwe ali ndi mimba, koma zizindikiro zonsezi zingakwezeke m'mimba.
- Estradiol ndi inhibin: Onse estradiol ndi inhibin amatha kukwezedwa kwambiri kwa atsikana kapena amayi omwe ali ndi zotupa zogonana zogonana kapena ziwalo zotupa za majeremusi, ndi ma inhibin omwe nthawi zambiri amavomerezedwa ndi mitsempha ya granulosa m'mimba mwa atsikana (mtundu wa chotupa cha stromal).
Mayesero Ena a Magazi
Mayeso ena a magazi omwe angathandize popanga matenda akuphatikizapo kuchuluka kwa magazi (CBC), LDH, phosphatase ya alkaline, ndi mlingo wa sed kapena C-yogwira ntchito yapuloteni (yomwe imawoneka kutupa).
Kafukufuku anapeza kuti kuphatikizapo imodzi ya maselo ofiira a magazi , omwe amadziwika kuti red red cell distribution distribution (RDW), ndipo amatanthauza kuti mapuloteni apamwamba (MPV) angakhale othandiza pofotokoza kuti zivomezi zomwe zimakhala ndi khansa ndi zomwe siziri. (RDW nthawi zambiri imakhala yapamwamba komanso MPV ili ndi khansa ya ovari.)
Mndandanda wa ngozi ya ovari
Zowopsya zosiyana siyana za nyerere zoopsa zimayang'ana zochitika zosiyana siyana pa mayesero ndi masomphenya kuti adziwe ngati vuto likhoza kukhala khansara loyambitsa matenda ndipo ngati chiwopsezo chikufunika. Ngakhale izi zingakhale zothandiza, zolinga zowonetsera chiopsezo ndizo zolondola pamene zimagwiritsidwa ntchito pamodzi ndi kuwunika kovomerezeka kwa katswiri wina, yemwe ali ndi matenda odziwa za umoyo.
Opaleshoni Yopangira Opaleshoni
Chidziwitso cha zilonda zokayikitsa nthawi zambiri zimachitidwa opaleshoni. Nthawi zina, singano ya singano (yomwe singano imayikidwa kudzera pakhungu) ikhoza kuganiziridwa, koma amaganiza kuti ngati khansara ilipo, izi zingachititse zomwe zimatchedwa seeding (kufalikira kwa chotupa).
Chiopsezo chochita opaleshoni chikhoza kuchitidwa mwina ndi laparoscopy, opaleshoni yomwe imagwiritsidwa ntchito pang'onopang'ono m'mimba komanso pulojekiti ndi makamera ndi zida zowonjezera, kapena laparotomy, komwe kumapangidwira mimba. Chitsanzo (sampuli) chimatengedwa ndi kutumizidwa kwa odwala matenda kuti aone ngati ndi khansa, ndipo ngati ndi choncho, mtunduwo.
Ngati muli ndi biopsy, katswiriyu adzayang'ana chitsanzocho monga magawo omwe adatulutsidwa ndi mazira ake kuti awonetsere chotupacho. Pa lipoti lanu, chitsanzochi chidzanenedwa kukhala choipa (osati khansa) kapena choipa (osati cha khansa). Onani pansipa kuti mudziwe zambiri pa kufufuza malipoti odwala matenda opatsirana pogonana.
Kusanthula Kusiyanasiyana
Misa yomwe imamveka m'dera la ovary ndi fallopian tube pamayesero oyezetsa kapena kujambulira amatchulidwa ngati misala ya adnexal . Zina mwa zifukwa zomwe zingatheke (pali zambiri) zingakhalepo zotsatirazi, zomwe zingaganizidwe kuwonjezera pa khansa ya ovari:
- Ovarian cysts: Ovarian cysts ndi ofanana kwambiri, koma nthawi zambiri amasiyana ndi magulu olimba kapena zovuta kwambiri pa ultrasound
- Matenda a kutupa thupi (PID): Ndi PID, chifuwa chitha kuchitika chomwe chimayambitsa misa kuti imveke kapena kuwonedwa.
- Endometriosis: Endometriosis ndi chikhalidwe chimene chimakhala chiberekero chimakula kunja kwa chiberekero.
- Zilonda za m'mimba za Benin: Kawirikawiri, zotupa zomwe zimapezeka m'mabambo azimayi ambiri zimakhala zosautsa pamene amayi omwe amapezeka m'mbuyo mwa amayiwa amakhala oopsa.
- Matenda a Polycystic ovarian (PCOS): PCOS ndi chizoloŵezi chomwe amai amapanga mazira ambiri m'mimba mwawo.
- Corpus luteal cyst: Si zachilendo kuti amayi azikhala ndi corpus luteum cyst mu mimba.
- Mimba ya Ectopic (tubal): Kutenga pakati pa Tubal kungayambitse kupeza ngati khansara ya ovari, ndipo ikachitika msinkhu, amayi nthawi zina sadziwa kuti ali ndi pakati.
- Ovarian torsion : Izi zingachititse kutupa ndi kutuluka magazi ndipo zikhoza kuchitika payekha kapena pachikondwerero ku chotupa cha m'mimba.
- Kupumula kwapadera: Ngati zowonjezereka, zikhoza kuchititsa abscess pafupi ndi dera la ovari yoyenera.
- Impso zapakhosi: Matendawa amachititsa kuti impso zatsalira m'mimba mwa pathupi panthawi ya kukula kwa mwana ndipo zitha kuzindikirika ngati misala.
Mayesero Ozengereza
Ngati matenda a khansa ya m'mimba yowonongeka imapangidwa, sitepe yotsatira imayambitsa chotupacho. Zina mwazidziwitso zomwe zimayenera kuyendetsa masitepe zimatha kusonkhanitsidwa kuchokera ku zojambula zojambula ndi zojambula, koma kawirikawiri opaleshoni (kuchotsa mazira ndi mafupipafupi owonjezera) ndizofunikira kuti zitha kukhazikitsa khansa. Kuzindikira malo omwe ali ndi khansa ndizofunika posankha njira zabwino zothandizira.
Pambuyo pa opaleshoni, dokotala wanu amatha kutumiza minofu iliyonse yomwe imachotsedwa kwa wodwalayo. Izi zingaphatikizepo mazira, mazira, chiberekero, ndi minofu ndi zida zomwe zimatengedwa kuchokera kumadera ena a mimba. Pansi pa microscope, iye adzatsimikizira kuti mukudwala khansa ya ovari komanso mumadzi omwe ali ndi khansa.
Mayesero onse ndi opaleshoni angathandize kudziwa ngati khansara yayamba kufalikira ku ziwalo za thupi kapena m'madera ena a thupi. Kwa khansa yapamwamba ya ovarian, biopsies nthawi zambiri imatengedwa kuchokera ku mitsempha yam'mimba, omentum (mafuta, mapepala onga mawonekedwe a m'matumbo), ndipo nthawi zambiri malo amodzi a peritoneum (zidutswa zomwe zimayendera mimba). Dokotala wa opaleshoni adzachotsanso kapena kulemba zolemba zamtundu uliwonse zomwe zikuwoneka ngati zokayikitsa. Ngati khansa inali mucinous, zowonjezereka zichotsedwa.
Kusamba kungapangidwenso, kumene opaleshoni imayambitsa saline m'mimba ndikuchotsa madziwo kuti ayang'ane umboni wa maselo a kansa.
Zomwe zikuthandizira kupeza siteji ndizo:
Mtundu ndi subtype: Kudziwa mtundu ndi kagawo ka khansara ya ovari kungapereke chidziwitso pa chizunzo choyembekezeka cha chotupa ndipo ngati chikukula mofulumira kapena pang'onopang'ono.
Gulu lakumimba: Ichi ndi chiyeso cha chotupacho. Ndi khansa yotchedwa endometrioid ovarian, khansa amapatsidwa kalasi yoyambira pakati pa 1 ndi 3:
- Kalasi 1: Maselo ndiwowoneka bwino (amasiyanitsidwa) ndipo samakonda kukhala ovuta.
- Kalasi 2: Maselo amagwera pakati pa pamwambapa ndi pansipa.
- Kalasi 3: Maselo amawoneka osalimba (opandafferentiated) ndipo amayamba kukhala okwiya kwambiri.
Ziphuphu zotupa zimaperekedwa chimodzi mwaziwiri mmalo mwake: kalasi yochepa kapena yapamwamba.
Miyendo
Khansara ya ovariya imagwiritsidwa ntchito pogwiritsa ntchito njira zosavuta kapena zonse za FIGO. Zowonjezera zingathenso kutanthauzidwa ngati khansa ya m'magazi. Ngakhale kuti m'munsimu mumakhudza dokotala wanu, zingakhale zothandiza pamene mukugwira ntchito kuti mudziwe zomwe mungachite kuti mupeze mankhwala.
Mzere wamtundu wa Ovarian khansa
Khansa ya m'magazi yamagazi ndi omwe ali ndi mphamvu zochepa. Izi kawirikawiri zimatuluka pachifuwa chakumayambiriro ndipo nthawi zambiri sizingabwerere pakapita opaleshoni. Ziphuphuzi zingaperekedwe siteji ngati dokotala wanu sakudziwa bwinobwino pamene akuchitidwa opaleshoni ngati kansa yapamwamba imakhalapo, kapena ngati ikuwoneka kuti yayamba kufalikira.
Zosavuta Zosintha
Kuti mupeze chithunzi chachikulu cha kusiyana pakati pa magawo, izi zikhoza kuthyoledwa:
- Gawo 1: Khansara imangokhala pa ovary.
- Gawo 2: Chotupacho chafalikira ku ziwalo zamkati (monga chiberekero ndi mazira olakwika), koma osati m'mimba.
- Gawo 3: Chotupacho chafalikira kumimba za m'mimba (mwachitsanzo, pamwamba pa chiwindi kapena matumbo) kapena maselo am'mimba (kumimba kapena m'mimba).
- Gawo 4: Chotupacho chafalikira kumadera akutali, monga mapapo, chiwindi (mkati osati pamwamba), ubongo, kapena kutalika kwake.
- Zowonongeka: Khansa yowonongeka yowonongeka imatchula khansa imene imabweranso panthawi yomwe yaperekedwa kapena itatha. Ngati khansara ikhoza kubweranso miyezi itatu yoyamba, nthawi zambiri imaoneka kuti ikupita patsogolo m'malo mobwerezabwereza.
FIGO Yoyera
FIGO yathunthu, yotchedwa International Federation of Gynecology ndi Obstetrics, ndiyo njira yopangira opaleshoni yomwe imagwiritsa ntchito ziwerengero za Aroma pa magawo.
- Gawo IA: Khansara ili yokwanira ku ovary imodzi ndipo capsule ya kunja yamagazi siinatuluke. Palibe chotupa pamtunda kunja kwa ovary ndipo palibe ascites ndi / kapena kusamba ndizolakwika.
- Gawo IB: Khansara imapezeka m'matumbo onse awiri, koma kapule yakunja imatha ndipo palibe chotupa pamtunda. Palibe ma ascites ndi kusamba ndizolakwika.
- Gawo la IC: Khansara ndi Stage IA kapena IB level, koma kapsule imatuluka, pali chotupa pamtunda pamwamba pake, kapena maselo owopsa alipo ku ascites kapena kusamba.
- Gawo IIA: Khansara imaphatikizapo amodzi kapena mazira awiri onse ndipo yapitirira ku chiberekero ndi / kapena kugwa. Kusamba ndi kusamba kosayenera ndipo palibe ascites.
- Gawo IIB: Khansara imaphatikizapo imodzi kapena mazira ochulukirapo ndipo imayambira ku zida zina zapachiwisi kupyola chiberekero ndi khola lamagulu. Kusamba ndi kolakwika ndipo palibe ascites.
- Gawo IIC: Khansara imaphatikizapo imodzi kapena mazira ochulukirapo ndipo yayamba kufika kumatenda a m'mimba monga Stage IIA kapena IIB, koma ndi mavitamini abwino.
- Gawo IIIA: Khansara yafalikira ku maselo am'mimba. Chotupacho chimakhala chachikulu kwambiri (kumaso osasunthika) chosemedwa m'mimba mwa pelvis koma ndi microscopic peritoneal metastases (kufalikira kumawonedwa kokha pansi pa microscope) kupyola m'mimba mwa mimba mpaka pamimba pamimba kapena pa omentum. Mafutawa ndi mafuta omwe amatulutsa matumbo ndi ziwalo zina za m'mimba.
- Gawo la IIIB: Khansa yafalikira ku maselo am'mimba. Gawo ili likufanana ndi gawo la IIIA, koma ndi kufalikira kwakukulu (kufalikira komwe kungawonekere kumaso) kwa peritoneum kapena omentum. Panthawi iyi, malo omwe ali ndi khansa omwe afalikira ndi osachepera 2 cm (pang'ono pang'ono kuposa inchi) kukula kwake.
- Gawo lachiwiri: Khansa yafalikira ku maselo am'mimba. Gawoli lilinso lofanana ndi siteji IIIA, koma ndi peritoneal kapena omental metastases (kufalikira) kupyola pakhosi ndi malo omwe ali aakulu kuposa 2 cm (inchi) kukula kwake, kapena kufalikira ku maselo am'mimba m'mimba (inguinal nodes) , pelvis (nkhono zam'mimba), kapena para-aortic (para-aortic nodes).
- Gawo lachinayi: Khansara yayamba kufalikira ku thupi la chiwindi kapena kumadera ena kunja kwa m'mimba (peritoneal cavity) kumadera monga chifuwa kapena ubongo.
> Zotsatira:
> American Society of Clinical Oncology. Ovariya, Fallopian, ndi Khansa ya Peritoneal: Maphunziro ndi Maphunziro. Cancer.Net. Kusinthidwa 08/16. https://www.cancer.net/cancer-types/ovarian-fallopian-tube-and-peritoneal-cancer/stages-and-grades
> Henderson, J., Webber, E., ndi G. Sawaya. Kuwunika kwa Khansa ya Ovarian: Ndemanga Yopereka Umboni ndi Kukonzekera Mwatsatanetsatane kwa gulu la US Preventive Services Task Force. JAMA . 2018. 319 (6): 595-606.
> National Cancer Institute. Ovarian epithelial, Tube Fallopian, ndi Primary Primary Peritoneal Treatment Treatment (PDQ) -Achilengedwe Professional Version. Kusinthidwa 01/19/18. https://www.cancer.gov/types/ovarian/hp/ovarian-epithelial-treatment-pdq
> Qin, Y., Wu, Y., Xian, X. et al. Kugwiritsira ntchito kopanda malire komanso kofanana kwa Red Cell Distribution Width, Ponena za Volume Platelet, ndi Cancer Antigen 125 kwa Kusiyana Kwambiri kwa Khansa ya Ovarian ndi Matenda a Benign Ovarian. Journal of Ovarian Research . 2018. 11 (1): 10.
> Soletormos, G., Duffy, M., Othman, S. ndi al. Kugwiritsa Ntchito Kachilombo ka khansa mu Epithelial Cancer Ovarian: Zosinthidwa Malangizo Ochokera ku European Group pa Tumor Markers. International Journal of Gynecological Cancer . 2016. 26 (1): 43-51.