Pali mitundu yoposa 50 ya mitsempha yofewa
Mitsempha yofewa ndi gulu losiyanasiyana la khansa limene limachokera ku mafuta, minofu, tendon, cartilage, tissue lymphoid, zotengera ndi zina zotero. Pali mitundu yoposa 50 ya sarcoma yofewa. Ngakhale kuti nsomba zambiri ndi minofu yofewa, mozama kwambiri, mitsempha imatha kugwiranso fupa.
Kufufuza ndi kuchiritsidwa kwa mitsempha yofewa kumaphatikizapo komanso kumaphatikizapo mitundu yosiyanasiyana, yofuna kuthandizira ovomerezeka , opaleshoni ya opaleshoni, akatswiri a radiologists, othandizana ndi ma radiologist ndi zina zambiri.
Chithandizo chimaphatikizapo opaleshoni, radiotherapy komanso, nthawi zina, chemotherapy.
Kodi Sarcomas Ndi Zosakaniza Zotani?
Mphuno yofewa ndizosawerengeka ndipo zimakhala zochepa zochepa za khansa akuluakulu. American Cancer Society ikuganiza kuti zida zatsopano zokwana 12,310 za sarcoma zofewa zidzapezeka mu 2016 (amtundu 6,980 amuna ndi 5,330 milandu kwa akazi). Kwa ana, mitsempha yofewa imaphatikizapo 15 peresenti ya khansa.
Chifukwa chenicheni cha mitsempha yofewa kwambiri sichidziwika, ndipo zilonda izi zimachitika popanda chifukwa chomveka. Komabe, nthawi zina minofu yofewa ya sarcoma, kusintha kwa DNA kunayambika pambuyo pa kubadwa ndipo yachiwiri mpaka kuika kwa dzuwa kapena khansa kumathandiza kukhala ndi tizilombo toyambitsa matenda.
Zomwe zimakhala zofewa kwambiri m'thupi la anthu akuluakulu ndizosavomerezeka kwambiri (zomwe poyamba zimatchedwa malignant fibrous histiocytoma), liposarcoma ndi leiomyosarcoma . Liposarcomas ndi mitsempha yopanda malire nthawi zambiri imapezeka pamilingo, ndipo leiomyosarcomas ndi mitsempha yambiri yamimba.
Kwa ana, mtundu wambiri wa minofu ya sarcoma ndi rhabdomyosarcoma, yomwe imakhudza mitsempha ya chigoba.
Mphuno yofewa ikhoza kuopseza moyo, ndipo anthu 50 mpaka 60 peresenti ya anthu omwe amakhala ndi moyo zaka zisanu atangoyamba kupeza kapena kuchiritsidwa, chiwerengero chokhala ndi zaka zisanu zapakati pa moyo wawo. Mwa anthu omwe amafa ndi minofu yofewa, masastasis, kapena kufalikira, m'mapapo ndi omwe amachititsa anthu kufa.
Pa 80 peresenti ya odwala odwala, matendawa amatha kukhala pakati pa zaka ziwiri ndi zitatu atangoyamba kugonana.
Kufotokozera zachipatala za Sarcomas Zosakaniza
Kawirikawiri, minofu yofewa imaoneka ngati misa yomwe siimayambitsa zizindikiro (ie, asymptomatic). Zingathe kufanana ndi lipomas, kapena zoopsa, zopanda mafuta zakufa zopangidwa ndi mafuta. Ndipotu, lipomas ndizoposa 100 zomwe zimakhala zofala kuposa minofu yofewa ndipo imayenera kuonedwa kuti ndi mbali ya kusiyana kwake. Mwa kuyankhula kwina, khungu la khungu lomwe lili pampono kapena mwendo mwako ndilovuta kuti likhale lipoma lopweteka kwambiri kusiyana ndi minofu yofewa ya sarcoma.
Pafupifupi magawo awiri pa atatu aliwonse a mitsempha yofewa imayamba pamanja ndi miyendo. Gawo lina lachitatu likuyimira mutu, mimba, thunthu, khosi, ndi retroperitoneum. Retroperitoneum ndi malo omwe ali kumbuyo kwa khoma la m'mimba lomwe lili ndi impso ndi mapasitiki komanso mbali ya aorta ndi low low vena cava.
Chifukwa chakuti mitsempha yofewa imapangitsa kuti asamangokhala ndi zizindikiro, nthawi zambiri amangozindikira kokha pokhapokha chochitika choopsa chimene chimafuna kuti munthu azitha kuchipatala. Mphuno yofewa ya m'madera otalikirana kwambiri (mbali za mkono ndi mwendo kutali kwambiri ndi chifuwa) nthawi zambiri zimakhala zochepa ngati zimapezeka.
Ngakhale, mitsempha yofewa yofewa yomwe imapezeka mu retroperitoneum kapena mbali zochepa za mapeto (omwe ali pafupi kwambiri ndi chifuwa) amatha kukulirakulira asanazindikire.
Ngati minofu yofewa imakhala yayikulu mokwanira, imatha kumangirira pambali, monga fupa, mitsempha ndi mitsempha ya magazi, ndipo zimayambitsa zizindikiro, kuphatikizapo ululu, kutupa, ndi edema. Malingana ndi malo, mitsempha yayikulu imatha kulepheretsa m'mimba zizindikiro za m'mimba ndikuyambitsa zizindikiro za m'mimba, monga ziphuphu, kudzimbidwa, ndi kusowa kwa njala. Sarcomas akuluakulu angathenso kugwedeza mitsempha ya mitsempha yomwe imayambitsa mavuto a ubongo.
Potsiriza, mitsempha yomwe ili pamapeto (mikono ndi miyendo) ikhoza kupereka ngati thrombosis yakuya kwambiri.
Kusanthula ndi Kusinthana kwa Sarcomas Zosakaniza
Mitundu yaing'ono yofewa yomwe ili yatsopano, yosakulitsa, yongopeka ndi yosakwana masentimita asanu mu kukula ingakhoze kuwonedwa ndi dokotala yemwe alibe mankhwala. Kukulitsa mabala omwe akuya kwambiri kapena aakulu kuposa masentimita asanu amafunika kubwezeretsa kwathunthu: mbiri, chithunzi, ndi chidziwitso .
Asanayambe kugwiritsidwa ntchito, kuyezetsa magazi kumagwiritsidwa ntchito pofufuza minofu yofewa ya sarcoma. Kujambula kwamaginito (MRI) kumathandiza kwambiri poona zithunzi zofewa zofewa zili pamapeto. Ponena za zotupa zomwe ziri retroperitoneal, intra-m'mimba (mkati mwa mimba) kapena truncal, computed tomography (CT) ndi yothandiza kwambiri. Njira zina zochizira zomwe zingathandize kuti mupeze matendawa ndi positron emission tomography (PET) ndi ultrasound. Mafilimu (x-rays) si othandiza pamene mukupeza zotupa zofewa.
Pambuyo poyezetsa matenda, chidziwitso chimachitidwa kuti chifufuze kutengera kwapang'ono kwambiri kwa chotupacho. Zakale, kutsegulidwa kosavuta , zomwe ndizochita opaleshoni zomwe zimafuna kuti aesthesia ambiri, akhala akuyimira golidi pamene akupeza zowonongeka zowonongeka. Posachedwapa, chida chachikulu cha singano , chomwe chiri chosawonongeka pang'ono komanso chitetezo, cholondola ndi chosagwiritsidwa ntchito, chakhala mtundu wamakono wokometsetsa. Chovala chabwino cha singano ndi njira ina yotsalira. Potsirizira pake, pamene zilonda zing'onozing'ono komanso pafupi, pamwamba pake phokoso limatha.
Ngakhale kuti ziphuphu zowonjezereka zingathe kuchitidwa pamtunda kapena kunja kwa ofesi, ziwalo zazikulu ziyenera kukhala zogwiritsidwa ntchito m'chipatala ndi katswiri wa radiologist yemwe amagwiritsa ntchito ultrasound kapena CT kuti awatsogolere.
Kuyeza kwa tizilombo tosaoneka timeneti ndi kovuta, ndipo ngakhale akatswiri a sarcoma pathologists sagwirizana pa zamtheradi matenda ndi chifuwa kalasi pakati 25 ndi 40 peresenti ya nthawi. Komabe, kuyerekezera kwake ndi chinthu chofunika kwambiri pakukhazikitsa chotupa ndi kuwonetsa kuti chotupacho ndi chiwawa ndi matenda odwala, kapena kuyembekezera zotsatira zachipatala. Zinthu zina zofunika pakuzindikira chotupacho ndi kukula ndi malo. Kugwiritsira ntchito kumagwiritsidwa ntchito ndi katswiri kuti akonze chithandizo.
Ndi mitsempha yofewa, metastases kapena kufalikira ku maselo am'mimba ndi osowa. M'malo mwake, zotupa zimakonda kufalikira m'mapapo. Malo ena a metastases ndi mafupa, chiwindi, ndi ubongo.
Kuchiza kwa Sarcoma Soft
Kuchita opaleshoni kuchotsa chotupacho ndi njira yowonjezera yowonjezera ya mitsempha yofewa. Nthawi zina, opaleshoni ndizofunikira.
Kamodzi pa nthawi, amwedwe kawiri kaŵirikaŵiri kuti athetse mitsempha ya manja ndi miyendo. Mwamwayi, masiku ano, kupha opaleshoni yambakukhala kofala.
Pochotsa minofu yofewa ya sarcoma, kuthamanga kwakukulu kwapadera kumapangidwira kumene chifuwacho pamodzi ndi minofu yathanzi, kapena m'mphepete mwachangu, imachotsedwa. Pamene zotupa zimachotsedwa pamutu, pamutu, pamimba kapena thunthu, oncologist opaleshoni amayesera kuchepetsa kukula kwa mitsinje ndikusunga minofu yathanzi kwambiri. Komabe, palibe lingaliro lovomerezeka lomwe liripo pa kukula kwake kwa "zabwino" mmphepete.
Kuphatikiza pa opaleshoni, radiotherapy, yomwe imagwiritsa ntchito mphamvu zamagetsi x-ray kapena mitundu ina ya ma radiation, ingagwiritsidwe ntchito kupha maselo a ziwalo kapena kuchepetsa kukula kwawo. Radiotherapy nthawi zambiri imaphatikizapo opaleshoni ndipo ingaperekedwe opaleshoni (ie, neoadjuvant therapy) kuchepetsa kukula kwa chotupa kapena opaleshoni (mwachitsanzo, adjuvant therapy) kuchepetsa chiopsezo cha khansa kubwerera. Matenda awiri a neoadjuvant ndi adjuvant mankhwalawa ali ndi ubwino ndi zopinga zawo, ndipo pali kutsutsana kwa nthawi yabwino yothetsera mitsempha yofewa pogwiritsira ntchito radiotherapy.
Mitundu ikuluikulu ikuluikulu ya radiotherapy ndi mankhwala omwe amachokera ku mazira ndi ma radiation mkati . Ndi mankhwala omwe amachokera kunja kwa thupi, makina omwe ali kunja kwa thupi amapereka mpweya wabwino kwa thumba. Ndi mankhwala opangidwa ndi ma radiation, zinthu zowonongeka zowindikizidwa mu mawaya, singano, catheters kapena mbewu zimayikidwa mkati kapena pafupi ndi chotupacho.
Mtundu watsopano wa radiotherapy ndi radiotherapy (IMRT). IMRT imagwiritsa ntchito makompyuta kuti imvetse zithunzi ndikugwirizanitsa mawonekedwe ndi kukula kwa chotupacho. Mitsinje ya miyendo yamtundu wosiyanasiyana imayang'ana phokoso lochokera kuzingwe zambiri. Mankhwalawa amachititsa kuti wodwalayo asakhale ndi vuto loopsa, monga ngati pakamwa, khungu kumame ndi kuwonongeka khungu.
Kuwonjezera pa radiotherapy, chemotherapy ikhoza kugwiritsidwa ntchito kupha maselo a kansa kapena kuwaletsa kuti asakule. Chemotherapy imaphatikizapo kayendetsedwe ka chemotherapeutic wothandizira kapena mankhwala osokoneza bongo, kapena pakamwa kapena pamtenda kapena minofu (parenteral administration). Tawonani, kugwiritsa ntchito mankhwala a chemotherapy pofuna kutulutsa mitsempha yofewa kumatsutsaninso.
Mankhwala ovomerezeka amavomerezedwa kuti apeze mankhwala osakanizika a sarcoma kuphatikizapo zotsatirazi:
- doxorubicin hydrochloride
- dactinomycin (Cosmegen)
- imatinib mesylate (Gleevec)
- eribulin mesylate
- olaratumab (Lartruvo)
- trabectedin
Potsirizira pake, minofu yowonongeka ya sarcoma ndi minofu yofewa ya sarcoma imene imabwerera pambuyo chithandizo. Zitha kubwereranso minofu yofewa kapena minofu yofewa yomwe ili mbali ina ya thupi.
Pansi
Chonde kumbukirani kuti mitsempha yofewa ndi yosavuta. Zonse ziri zofanana, mwayi woti chilichonse chotupa kapena chifuwa m'thupi lanu ndi khansa ndi yochepa. Komabe, muyenera kukhala omasuka kukonzekera zokambirana ndi dokotala wanu kuti muyese zokhudzana ndi mtanda kapena kupuma-makamaka ngati zikupweteka, zofooka kapena zina zotero.
Ngati inu kapena wokondedwa wanu mwapezeka kale ndi minofu yofewa ya sarcoma, chonde mverani chitsogozo cha akatswiri anu. Ngakhale kuti pangozi pafupifupi theka la omwe amapezeka, pamatenda ambiri amatha kupatsidwa mankhwala.
Pomalizira, mankhwala atsopano a minofu yofewa amawonekera. Mwachitsanzo, chigawo cha chemotherapy , chomwe chiri chemotherapy chomwe chimafuna ziwalo zina za thupi monga mikono kapena miyendo, ndi gawo lochita kafukufuku. Inu kapena wokondedwa mukhoza kulandira nawo mbali mu kuyesedwa kwachipatala. Mukhoza kupeza mayesero a chipatala omwe amathandizidwa ndi National Cancer Institute (NCI) omwe ali pafupi ndi inu.
> Zotsatira:
> Kuchiza Mankhwala Akale Kwambiri (PDQ®) -Patient Version. National Cancer Institute. https://www.cancer.gov/about-cancer/treatment/clinical-trials/search.
> Cormier JN, Gronchi A, Pollock RE. Sarcomas Wofewa. Mu: Brunicardi F, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, Pollock RE. eds. Mfundo za Schwartz za Opaleshoni, 10e . New York, NY: Hill ya McGraw; 2014.
> Mafupafe F, et al. Masewera owongoka a m'mphepete: Akuyembekezera mafunso opaleshoni ndi radiotherapy. Mafilimu a Oncology. 2016; 11: 136.
> Sabel MS. Oncology. Mu: Doherty GM. eds. Kufufuza Koyamba ndi Kuchiza: Opaleshoni, 14e . New York, NY: Hill ya McGraw; 2015.