Pali zowonjezereka komanso zowonongeka za matenda opatsirana pogonana chifukwa cha matenda a khansa ya khansa.
Pamene khansa ya khansa imakhala pakhungu, ikhoza kuthetsedwa mosavuta komanso kosatha nthawi zambiri. Nthawi zina, zimatulutsa ( metastasizes ) m'madera ena a thupi, nthawi zambiri zimayenda kumalo am'katimbiri omwe ali pafupi, pamutu, kapena kubuula. Ngati dokotala akuganiza kuti izi zakhala zikuchitika, mayesero otchedwa sentinel node biopsy adzachitidwa kuti azindikire ndi kuchotsa mliri wa khansa yomwe khansayo ikhoza kufalikira ku chotupa chachikulu.
Ngati nthenda yanu yotchedwa reninel node biopsy ndi yabwino (ili ndi maselo a khansa), ndiye nthawi ya chisankho. Kodi mukuyenera kuti muli ndi mankhwala enaake omwe amachotsedwa m'dera lino, mu opaleshoni yotchedwa completion lymph node dissection (CLND, kapena lymphadenectomy)? Lingaliro ndilo kuti CLND ikuonetsetsa kuti maselo a melanoma m'magazi ena onse amachotsedwa, zomwe zingateteze matendawa kufalikira kutali.
Mwamwayi, umboniwo ndi wosakwanira, kotero chisankhochi sichiri cholunjika, ngakhale kwa madokotala. Pano pali zina zabwino ndi zofunikira kuziganizira.
Zotsatira za Kusokonezeka kwa Lymph Node Dissection
1. Bungwe la CLND limathandizira kudziwa molondola malo a melanoma, omwe amathandiza dokotala popereka malangizo kwa mankhwala opatsirana (adjuvant).
2. Chiwerengero cha nthendayi zomwe zili ndi maselo a melanoma ndizopangitsa kuti odwala omwe ali ndi matendawa athane ndi matendawa.
3. Kafukufuku wina amasonyeza kuti 20 peresenti ya odwala omwe amagwira ntchito ya CLND mwamsanga atapeza kuti ali ndi vuto lotha kupulumuka. Izi ndizowona makamaka kwa odwala omwe anali ndi zotupa zapakati pafupipafupi (1.2 mpaka 3.5 mm).
4. Poletsa kufalikira kwa melanoma pa maselo a mitsempha, CLND imapereka mpata wochiritsidwa.
Ng'onoting'ono kakang'ono ka khansa ya m'magazi ikhoza kukulirakulira pakapita nthawi kuti ikhale yoopsa komanso yoopsa.
Kusokonezeka kwa Lymph Node Dissection
1. Mavuto a CLND ndi ofunika kwambiri ndipo amapezeka mpaka 67 peresenti ya odwala, makamaka mwa iwo oposa 60. Izi zikuphatikizapo:
- Buildup wa madzi pa malo opaleshoni ( seroma )
- Kutenga
- Kutupa kwa mphuno yokhudzidwa ndi kuchotsedwa kwa mitsempha yam'mimba ( lymphedema )
- Kuwongolera, kupweteka, kapena kupweteka mu malo opaleshoni
- Khungu lakuwonongeka kwa khungu kudera lanu
Ngakhale kutupa pambuyo poti opaleshoni ikhoza kutetezedwa kapena kuyang'aniridwa ndi kugwiritsa ntchito mankhwala opha tizilombo, zotchinga zotsekemera, masisitala, ndi zodzoladzola, zingakhale zovuta zowonjezera.
2. Mphamvu ya CLND ikhoza kudalira kukula kwa chifuwa cha khansa ya khansa ya khansa. Ziphuphu zazing'ono (0.1 mm kapena zochepera m'mimba mwake) mu mitsempha ya mitsempha yazing'onoting'ono sizingayambitse konse masastasis, kotero kuchita CLND sikungakhale kofunikira. Kafukufuku wa 2009 adawonetsa kuti odwala omwe ali ndi zotupa zazing'ono ndizokhalanso zofanana ndi omwe analibe melanoma m'matumbo awo a fetinel. Choncho, odwalawa "omwe ali pangozi" akhoza kupewa CLND ndipo amakhala ndi zotsatira zomwezo.
Mfundo Yofunika Kwambiri
Kusankha kuti muchitidwe opaleshoni yayikulu monga CLND sizomwe muyenera kusamala, makamaka ngati chiwonetsero chanu chikuwonetsa kokha kansalu kakang'ono kamene kamakhala ndi mitsempha yanu.
Pali zinthu zambiri zomwe zikuphatikizidwapo, kuphatikizapo kukula ndi malo a chiwerengero chanu chachikulu cha khansa, zotsatira za mayendedwe a mitsempha ndi zovuta zina, ndi zaka zanu. Mungapeze kuti zothandiza kufunafuna lingaliro lachiwiri.
Zolemba:
Boughton B (2009). Kodi matenda a lymphadenectomy ayenera kukhala ofanana ndi mankhwala a melanoma metastasis kwa maselo a mitsempha? Oncology News Intl. 18 (5).
Morton DL, Thompson JF, Cochran A, et al (2006). Zolemba zamtundu wa Sentinel kapena zokopa zamtundu wa melanoma. N Engl J Med. 2006 Sep 28; 355 (13): 1307-17.
Thomas JM (2005). Nthawi Yoyambiranso Kuyeza Nthendayi Yamtundu wa Sentinel mu Mayendedwe a Melanoma Post-Multicenter Selective Lymphadenectomy Trial. J Clin Oncol. 2005 Dec 20; 23 (36): 9443-4.
Van Akkooi AC, Rutkowski P, van der Ploeg IM, ndi al (2009). Kutengera kwa nthawi yaitali kwa odwala omwe ali ndi vuto lochepa lakumtenda (<0.1mm) malinga ndi zofunikira za Rotterdam: Kafukufuku wa gulu la EORTC Melanoma. J Clin Oncol 27:15, 2009 (suppl, pansi 9005).