Kulimbana ndi Adrenal Metastase Kuchokera ku Khansa ya M'mimba
Ngati mwauzidwa kuti khansara yanu yamapapu (kapena khansara ina) yafalitsidwa ku adrenal glands (adrenal metastases) mukhoza kukhala osokonezeka. Mosiyana ndi kufalikira kwa khansa kumadera ena, monga chiwindi, kufalikira kwa adrenal glands sikukambidwa mobwerezabwereza. Izi zinati, adrenal metastases ndizofala kwambiri ndi khansara yamapapo. Kodi ma gland adrenal ali kuti, nanga amatanthauzanji ngati khansa yanu yamapapu ikufalikira kumalo ano?
Phunzirani chifukwa chake metastases ku matenda a adrenal angakhale ndi chithunzithunzi chabwino kuposa malo ena a metastases, makamaka pamene amachitika pambali imodzi ya thupi ngati khansara.
Mwachidule
Zilonda za adrenal ndi glands zooneka ngati zitatu zomwe zili pamwamba pa impso. Matenda oterewa amachititsa kuti mahomoni asungidwe, kuphatikizapo "mahomoni opweteka" monga cortisol, epinephrine (adrenaline), ndi norepinephrine.
Khansa Zomwe Zimapangitsa Kuti Zidzakhala Zovuta Kwambiri Glands
Pafupi khansara iliyonse ikhoza kufalikira ku mazira a adrenal, koma zotupa zimakhala zosavuta kuposa zina kuti zitheke ku dera lino. Pa kafukufuku wina, khansayo yowonongeka ya adrenal metastases inali mapapu (35 peresenti) yotsatira khansara ya m'mimba (14 peresenti) khansa yowopsya (12 peresenti) ndi khansa ya chiwindi / bile (10%). Ma khansa ena omwe amapezeka kuderali amapezeka ndi khansa ya impso, khansa ya khansa, khansa ya m'mawere, khansara yamtundu, ndi lymphoma.
Ngati khansara yamapapu yafalikira kumatenda a adrenal, imaonedwa ngati sitiroko 4 ya khansa ya m'mapapo ya m'mapapo (kapena kansa ya kansa ya m'mapapo). M'mbuyomu, kunali kochepa koti kansa yamapapo yamapiko itatha. Komabe, zaka zaposachedwapa, zakhala zikudziwika kuti kwa anthu ena-makamaka omwe ali ndi adrenal metastasis yodzipatula-mankhwala opanga opaleshoni opaleshoni ya metastasis angapangitse kukhala ndi moyo kwa nthawi yaitali.
Monga tafotokozera pansipa, Chizindikiro cha adrenal metastases kuchokera ku khansa ya m'mapapo ikhoza kukhala bwino kusiyana ndi zizindikiro zina za metastases - monga chiwindi, ubongo, ndi mafupa.
Chikoka cha Adrenal Metastases
Kufikira 40 peresenti ya anthu omwe ali ndi khansa ya m'mapapo adzayamba kukhala ndi mavitamini ambiri pa nthawi ina, ndipo pa 10 peresenti ya anthu omwe ali ndi khansa ya m'mapapo yopanda mapira, matendawa amafalikira ku ziwalo zonse za adrenal. Mankhwalawa amapezeka pakati pa 2 ndi 3 peresenti ya anthu pa nthawi ya matenda, ndipo pafupipafupi pali chizindikiro choyamba cha khansa ya m'mapapo.
Zizindikiro
Nthawi zambiri pamene khansara imafalikira kumatenda a adrenal palibe zizindikiro zirizonse. Ndipotu, mu phunziro limodzi 5 peresenti ya anthu okhala ndi adrenal metastases anali ndi zizindikiro. Anthu nthawi zambiri amangodziwa za masastases chifukwa cha maphunziro a radiology monga CT scan, MRI, kapena PET scan.
Ngati zizindikiro zilipo, zingakhalepo:
- Ululu wammbuyo (m'dera lakumbuyo).
- Kupweteka m'mimba.
- Kutaya magazi m'mimba (kutaya magazi).
- Matenda a Addison : Zizindikiro za matenda a Addison zikhoza kuphatikizapo kufooka, kuthamanga kwa magazi (hypotension), shuga yambiri ya magazi ( hypoglycemia ), msinkhu wochepa wa sodium m'magazi (hyponatremia), ndi mlingo wapamwamba wa potassium ( hyperkalemia ).
Kudziwa
Ngati muli ndi malingaliro a sitirojekiti a adrenal metastases, simukusowa kupitiliza kuunika, makamaka ngati muli ndi metastases ku zigawo zina za thupi lanu. Nthaŵi zina, dokotala wanu angafune kutsimikiza kuti misala yanu ya adrenal imayamba chifukwa cha khansa yamtenda, ndipo imapereka chithunzithunzi cha CT chotsogolera.
Chithandizo
Mankhwala operekedwa kuti adrenal metastases akhoza kusintha malinga ndi zinthu zingapo. Kwa anthu onse ochirikiza chithandizo ndikofunikira. Kwa anthu omwe ali ndi zizindikiro monga kuchepa kwa magazi, mankhwala monga opaleshoni angafunikire kuchepetsa zizindikiro. Kwa anthu ena, mankhwala ndi cholinga chochiza khansa akhoza kukhala kotheka.
Thandizo Lothandizira: Kaya inuyo ndi dokotala wanu mukuganiza kuti mungapitirizebe kuchiza khansa kapena adrenal metastases, kusamalira zizindikiro zanu kumakhalabe kofunika kwambiri. Anthu omwe ali ndi khansa amayenerera kupweteka kwabwino ndi kulamulira zizindikiro zina zokhudzana ndi khansa.
Kuchiza Zizindikiro: Monga taonera kale, adrenal metastases sichimachititsa zizindikiro. Ngati mavitamini akumwa (kutaya magazi) kapena ali pa chiopsezo chachikulu chotuluka mwazi, opaleshoni kuchotsa chotupa ndi adrenal gland (adrenalectomy) angakonzedwe. Ngati mankhwala a metastasis awonetsa kuti sangakwanitse, mankhwala ndi steroid angafunike. Ngati ululu wa m'mimba kapena ululu wamkati umapezeka, izi ziyenera kuchiritsidwa.
Chithandizo cha Matenda Oyamba ndi Mavitamini Ena: Kuchiza khansa ya m'mapapo 4 ya mapapo kungaphatikizepo mankhwala a chemotherapy, mankhwala othandizira, immunotherapy, ndi / kapena mankhwala ochizira. Anthu ena amatengapo mbali m'mayesero a kachipatala pophunzira mankhwala atsopano ndi njira zatsopano. Kuwonjezereka kwa mankhwala ochiritsidwa ndi immunotherapy, zasintha nkhope ya khansa yamapapu yapamwamba kwa anthu ambiri m'zaka zaposachedwapa. Zomwe zimayambitsa kusintha, mankhwala osokoneza bongo angalole kuti madokotala asamalire khansa ya m'mapapo 4, ngati matenda aakulu. Ngakhale kuti mankhwalawa amapezeka pakapita nthawi, nthawi zina mbadwo wachiwiri komanso mankhwala omwe amapezeka m'badwo wachitatu akupezeka. Nthawi zina, nthawi yambiri imakhala ndi "yankho lokhazikika," lomwe limakhala ndi kansa ya m'mapapo poyang'ana nthawi yaitali. Popeza kuti mankhwala oyamba m'deralo amavomerezedwa mu 2015, sitiyenera kudziwa ngati zotsatira zomwe timawawona nthawi zina zidzatha, kapena zomwe zotsatira za nthawi yaitali zingakhalepo.
Chithandizo Ndi Cholinga Chokhwima: Kwa anthu omwe ali ndi adrenal metastasis okhaokha, mankhwala angapangitse kukhala ndi moyo kwa nthawi yaitali. Zosankha zikuphatikizapo:
- Opaleshoni: Onse otseguka ndi laparoscopic adrenalectomy (kuchotsedwa kwa chiberekero cha adrenal) angakhoze kuchitidwa ndi cholinga chowongolera kwa anthu ena.
- SBRT: Ngati opaleshoni sizingatheke, kafukufuku amasonyeza kuti thupi la stereotactic radiotherapy (SBRT) lingakhale lothandiza ndi lolekerera. SBRT imaphatikizapo kugwiritsa ntchito miyeso yapamwamba kwambiri ya mazira ndi malo ochepa, ndipo nthawi zina zotsatira zimakhala zofanana ndi opaleshoni.
- Ablation: Chithunzi chotsogoleredwa mwachangu ndi njira ina. Kafukufuku wa 2018 anapeza kuti, ngakhale kuti kupulumuka kunali kosauka kwa anthu omwe ali ndi kansa yaing'ono ya m'mapapo ya maselo omwe anachitapo kanthu kusiyana ndi ena khansa, kupatsirana kwachithunzithunzi kowonongeka kwa adrenal metastases kungapangitse kupititsa patsogolo kwaumwini-kopanda moyo komanso moyo wonse. Phunziroli, pafupifupi kupulumuka kwathunthu (kwa mitundu yonse ya ziphuphu pamodzi) pa 1, 3, ndi zaka zisanu kunali 82, 44, ndi 34% potsatira njirayi.
Kuthamangitsani
Popanda chithandizo, kupulumuka kwapakati podziwa matenda a adrenal metastases kunali miyezi itatu mu phunziro limodzi. Izi zinati, ndipo mosiyana ndi metastases ku zigawo zina za thupi, mankhwala a metastases awa mwa osankhidwa omwe ali ndi kansa yaing'ono ya mapapu ya m'mapapo yakhala ndi moyo wamuyaya. Ziŵerengero zimenezi zapulumuka zinakonzedwanso pamaso pa mankhwala atsopano monga immunotherapy, ndipo ambiri mwa mankhwala omwe takhala nawo tsopano, anavomerezedwa ku khansa ya m'mapapo.
Kafukufuku angapo ang'onoang'ono akuyesa kulandira chithandizo cha adrenal metastases akhala akulimbikitsa. Mwachitsanzo, pa kafukufuku wina wa odwala 37, kupulumuka kwa anthu ambiri kunali 34 peresenti kwa odwala amene anachitidwa opaleshoni, koma 0 peresenti kwa iwo omwe sanachite opaleshoni. Kafukufuku wina waposachedwapa adapeza kuti kupulumuka kwa nthawi yaitali kunali kotheka mwa 25 peresenti ya ophunzira amene anachiritsidwa ndi adrenal metastases.
Ndi khansa yaing'ono yamapapo ya m'mapapo , kafukufuku wina anapeza kuti, mosiyana ndi metastases ku chiwindi, ubongo, fupa, ndi chifuwa chamadzi, metastases ku adrenal gland sizinali zosavomerezeka.
Kodi N'chiyani Chimachititsa Kuti Matenda Akhale Osaphatikizapo Adrenal Metastases Kuposa Matenda Ena?
Yankho la funso loti n'chifukwa chiyani adrenal metastases ali ndi ubwino wambiri, akhoza kukhala momwe khansa ikufalikira kuti ifike pamatenda a adrenal. Khansara imafalikira mu njira zitatu zoyambirira. Mmodzi ali pafupi ndi chotupacho. Chimodzi chimachokera ku mafilimu. Ndipo lachitatu ndi kupyolera mu magazi. Pamene maselo a khansa alowa m'magazi amayenda mu thupi lonse. (Ofufuza ena amakhulupirira kuti khansara yamapapu ingafalikire mofulumira, kapena kupyolera mumlengalenga.)
Mu kafukufuku wina wofufuza momwe mphamvu ya adrenalectomy ikupulumutsira, inapezeka kuti ndi "matenda opatsirana" -ndiko kufalikira kwa khansa ku mbali imodzi ya thupi monga kansa ya m'mapapo-zaka zisanu zapakati pa moyo anali 83 peresenti. Mosiyana ndi zimenezi, zaka 5 zapakati pa anthu omwe ali ndi "metastases" -adrenal metastases kumbali yina ya thupi kuchokera ku khansa ya m'mapapo, zaka zisanu zapakati pa opaleshoni ndi opaleshoni zinali zero.
Zimaganizidwa kuti khansa yamapapu ikafalikira kumtundu wa adrenal pambali imodzi ya thupi, imatha kufika ku adrenal gland kudzera mwa njira yamagulu. Mosiyana ndi zimenezo, pamene chiwalo cha adrenal kumbali ina ya thupi chikukhudzidwa, chimayenda kudzera m'magazi (kufalikira kwa magazi) kufika pamatenda a adrenal ndipo zotsatira zake si zabwino.
Mawu Ochokera
Kutsegula ndi khansa ya m'mapapo (siteji ya 4) sizomwe tikufuna. Izi zikuti, malo onse a metastases, adrenal metastase nthawi zambiri amakhala ndi ubwino wambiri (monga momwe tawonetsera, zizindikiro zowonjezera bwino ndizosavuta ngati ziwalo za adrenal gland zili mbali imodzi ya thupi monga khansara yamapapu). Kuonjezera apo, njira zothandizira mankhwala ndi chiwopsezo cha khansa ya m'mapapo yapamwamba nthawi zambiri ikukula bwino, makamaka ngati mankhwala othandizidwa ndi kusintha kwa majini kapena mankhwala a immunotherapy angagwiritsidwe ntchito pofuna kuchiza chotupacho.
Ngati mwapezeka kuti muli ndi kansa ya mapapo 4 yamapapo ndi adrenal metastases, pitirizani kuphunzira za khansara yanu. Kutenga nawo kansa ya m'mapapo pa intaneti ndiwothandiza kwambiri. Mankhwala atsopanowa akukula bwino, koma chithandizo cha khansa ya m'mapapo chikusintha mofulumira kwambiri moti palibe chovuta kuti aliyense akhale pamwamba pa zomwe zapeza posachedwapa. Ngati mukuganiza kuti mungapeze bwanji anthu omwe ali pa "mapeto" a kafukufuku wa khansa yamapapo, kugwiritsa ntchito hashtag #lcsm kwa khansa ya m'mapapo ndizofunika kwambiri.
Mungakonde kulingalira lingaliro lachiwiri pa imodzi mwa zikuluzikulu za National Cancer Institute-malo opatsirana ndi khansa, kumene akatswiri odziwa za khansa ya m'mapapo amatha kupeza kafukufuku wamakono komanso mayesero a kachipatala omwe alipo. Chofunika koposa, chitani mbali yogwira ntchito yanu ndikukhala woyimilira . Tikuphunzira kuti kudzikonda (kapena kukhala ndi bwenzi kapena wokondedwa amene angakufufuzeni matenda ndikukulimbikitsani), sikungowonjezera nkhawa komanso kumakuthandizani kuti muzitha kulamulira matenda anu, koma kungakuthandizeninso zotsatira.
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