Tanthauzo, Zizindikiro, Machiritso ndi Mafupa a Follicular Lymphoma
Follicular lymphoma ndi mtundu wamba wa non-Hodgkin Lymphoma (NHL) . Kawirikawiri zimakhala zochepa kwambiri zomwe zimabwera kuchokera ku B-maselo (B lymphocytes) , mtundu wa selo loyera la magazi.
Follicular lymphoma imatchedwanso lymphoma yamadzimadzi kapena yochepa kwambiri, chifukwa cha khalidwe lake-kukula mofulumira-komanso momwe imawonekera pansi pa microscope-yochepa kwambiri (yosiyana kwambiri) kusiyana ndi malinkhulidwe apamwamba.
Zowopsa
Zolembera zingakhudze aliyense wa msinkhu uliwonse, komabe zimakhala zofala kwa akuluakulu. Ambiri a zaka za nthawi ya matendawa ali pafupi 55, ndipo zimakhudza amuna ndi akazi mofanana.
Kukula
Follicular lymphoma ndi mtundu wofala kwambiri wa lymphoma, womwe uli ndi anthu pafupifupi 15,000 ku United States omwe amapezeka chaka chilichonse.
Zizindikiro ndi Zizindikiro
Maonekedwe a follicular lymphoma nthawi zambiri amakhala osabisa, ndi zizindikiro zochepa zazing'onoting'ono zomwe zingathe kuziwoneka kwa nthawi yaitali. Zizindikiro zingakhalepo:
- Kukula kwa ma lymph node - Kutupa kwa ma lymph nodes m'dera lina la thupi ndi chizindikiro chofala kwambiri cha follicular lymphoma. Ziphuphuzi zingamveke m'khosi , pamphuno , kapena m'mimba, kapena kuziwoneka pamayesero ojambula m'madera ena a thupi (monga mankhwala opatsirana pogonana m'mimba kapena minofu ya retroperitoneal m'mimba). ( Lymph node learning center ikukambirana za ntchito zamagulu ndi malo mozama kwambiri.)
- Chiwombankhanga chosadziwika (FUO) - Kutentha kwamtali (madigiri oposa 100.4 kapena 38 ° C) komwe kulipo kwa masiku atatu kapena ochuluka motsatizana popanda chifukwa choonekeratu kungakhale chizindikiro cha lymphoma. M'malo mogwirizana ndi matenda osadziwika, amaganiza kuti FUO imayambitsidwa ndi njira zowonetsera mankhwala zokhudzana ndi khansa yokha yomwe imapangitsa kutentha kwa thupi.
- Kuwonongeka kosayembekezereka - Kutayika kosawerengeka kumatanthauzidwa ngati kutayika kwa 5 mpaka 10 peresenti ya kulemera kwa thupi (mwachitsanzo, mapaundi 7.5 mpaka 15 peresenti ya 150-pounds) pa nthawi ya miyezi isanu kapena umodzi.
- Kuthupa kwa usiku - Kujuka kwajoro gutandukanye no kubara kwinshi no kuruka mugihe kenshi iwo akung'onongeka kwenikweni ndipo anthu amafunika kusintha zovala zawo ndi zogona, nthawi zina kangapo usiku.
- Kutopa - Khansa yofooketsa kawirikawiri imasiyana ndi "kutopa kwamba" muzomwe sizikuyenda bwino ndi usiku wabwino wokhala tulo kapena khofi.
- Kupuma pang'ono
- Kuyamwa Kwachibadwa - Kuyabwa kumawoneka kuti kumachitika thupi lonse ndipo kungakhale kolimba kwambiri.
B zizindikiro za lymphoma zikuphatikizapo zizindikiro zitatu zikuluzikulu zomwe zingathandize kufotokoza momwe khansara idzalimbikitsidwire ndikuyankhira mankhwala.
- Fever
- Kutayika kosayembekezereka
- Kutseka usiku kukuwombera
Kudziwa
Follicular lymphoma kawirikawiri amapezeka ndi matenda a mitsempha . Izi zikhoza kuchitika ngati chiopsezo chochita opaleshoni (omwe ali ndi nthiti zomwe zingatheke ngati khosi) kapena ngati chingwe chachikulu cha singano (chifukwa cha nthenda zakuya m'thupi).
Chinthu chochepa cha nthendayi yomwe imakhudzidwayo imatengedwa ndikuyang'anitsidwa pansi pa microscope ndi katswiri wamagulu. Zomwe zimakhudza nthendayi zimasonyeza kukhalapo kwa lymphoma.
Kuphatikiza pa maonekedwe a microscope, mayesero a immunohistochemistry amachitika kuti aone ngati ali ndi kachilombo koyambitsa matenda a CD komanso amadziwa mtundu wa non-Hodgkin lymphoma .
Chifukwa Chimene Ilo limatchedwa 'Follicular' Lymphoma
Mofanana ndi ma lymphomas ambiri, mapuloteni a follicular amakhudza kwambiri ma lymph nodes . Pamene maselo am'mimba amakhudzidwa ndi lymphomayi amapezeka pansi pa microscope, amasonyeza nyumba zozungulira zomwe zimatchedwa "follicles". Lymphoma amatchedwa follicular lymphoma.
Mayeso Atatha Kudziwa
Kuphatikiza pa mayesero okhudzana ndi biopsy pamwamba, mayesero ena angapo amafunika pamene follicular lymphoma imapezeka poyamba.
Izi zimalola dokotala kuona momwe matendawa alili komanso zomwe ziwalo zimakhudzidwa. Mayeso a magazi, katemera wa CT komanso mafupa a fupa amafunika.
Kafukufuku watsopano wayambanso kufufuza momwe PET / CT angagwiritsire ntchito kuwunika follicular lymphoma, mwachitsanzo, ngati zotsatira za CT sizimveka bwino. Mu PET-CT, timapepala ta radio (18F-fluorodeoxyglucose) imayikidwa mkati mwa wodwalayo pamaso pa CT scan ndi malo omwe ali ndi matenda omwe amawoneka ngati akudwala shuga. Izi zimathandiza kusiyanitsa zigawo zogwira ntchito za khansa m'madera a minofu yowopsya yomwe ingawonekere ngati ya CT.
Miyendo
Gawo la follicular lymphoma limasonyeza kuti matendawa afalikira motani ndipo ndizofunika posankha mankhwala abwino komanso kulingalira momwe matendawa akuyendera. Lymphoma imafalikira ku maselo am'mimba komanso ziwalo zina m'thupi kuphatikizapo mafupa. Pali magawo anayi a lymphoma omwe ndi awa:
- Gawo I - Lymph node imodzi yokha (kapena maselo amphamvu) imakhudzidwa.
- Gawo lachiwiri - Mitsempha iwiri kapena yambiri (kapena maselo amphongo) amagwira ntchito koma pambali imodzi (pamwamba kapena pansipa).
- Gawo Lachitatu - Limulo (kapena zigawo) mbali zonse ziwiri za phokoso zimakhudzidwa.
- Gawo lachinayi - Lymphoma imapezeka m'mafupa komanso / kapena ziwalo kapena ziwalo zina osati ma lymph nodes kapena ma lymph.
Kuphatikiza pa chiwerengero, maimfimasi amaperekedwanso kutchulidwa kwa A kapena B, ndi A kutanthawuza kuti palibe zizindikiro B ndi B kusonyeza kukhalapo kwa B zizindikiro za lymphoma (zolembedwa pamwambapa).
Kupititsa patsogolo
Follicular lymphoma kawirikawiri ndi matenda opitirira pang'onopang'ono ndipo nthawi zambiri imakhala yosadziwika kwa nthawi yaitali thupi lisanatuluke. Pamene zizindikirozo ndizobisika, matendawa amayamba nthawi zambiri asanatuluke, ndipo anthu ambiri amapezeka kuti lymphoma ndi gawo lachitatu kapena IV.
Ngakhale m'zaka zapitazo matendawa, nthawi zambiri sizikhala zoopsa pamoyo panthaŵi ya matenda. Nthendayi imakhala ndi "kuyendetsa ndi kuyendetsa" njira, kutanthauza kuti imatuluka ndipo imawonjezereka kangapo pazaka zingapo. Ngakhale kuti palibe mankhwala omwe akuwongolera pakapita patsogolo, odwala ambiri amakhala ndi moyo zaka 8 kapena 10 kapena kuposa.
Kusintha
Follicular lymphoma nthawi zambiri amatha kusintha nthawi zina, kuchokera ku matenda opsereza mpaka matenda opitirira. Izi zimatchedwa kusintha. Kusandulika kungabwereke m'maselo onse, kapena mu gawo limodzi la khansara. Kukhalapo kwa zizindikiro za B kumawonjezera mwayi kuti chotupacho chimasintha posachedwa. Pambuyo pa follicular lymphoma "imasintha" nthawi zambiri imathandizidwa mofanana ndi B-cell lymphoma yaikulu .
Zimayambitsa
Sitikudziwa chomwe chimayambitsa lymphomas, ngakhale pali zifukwa zina zomwe zimayambitsa ngozi. Zina mwaziopsezo zokhudzana ndi lymphoma , ndi follicular lymphoma (FL) makamaka, ndizo:
- Zakudya zochepa mu zipatso ndi ndiwo zamasamba
- Zotsatira zochepa zochitidwa
- Kusuta - Mosiyana ndi ena omwe si a Hodgkin's lymphoma, chiopsezo cha FL chikuwonjezeka mwa anthu omwe amasuta.
- Mowa umamwa - Mowa umagwiritsidwa ntchito ungakhudze chiopsezo mu njira iliyonse; vinyo wochepa amakhala ndi chiwopsezo chochepa kwambiri komanso chakumwa choledzeretsa tsiku ndi tsiku chimakhala ndi chiopsezo chowonjezeka.
- Zaka (monga taonera pamwambapa, FL imakula ndi zaka)
- Kunenepa kwambiri
- Kugonjetsa
- Kuwonetsa zachilengedwe kwa mankhwala ophera tizilombo, mafakitale a mafakitale, ndi ma hydrocarboni
- Kutengera kwa majeremusi kungapangitse zifukwa zina.
- Mosiyana ndi mitundu ina ya anthu omwe si a Hodgkin's lymphoma, FL sagwirizana ndi matenda a Epstein-Barr, H.pylori.
- Kuunika kwa kuwala kwa UV kumagwirizanitsa ndi kuchepa kwake . Vitamini D ikhoza kuteteza ku FL).
Chithandizo
Pali mankhwala ambiri omwe angapangidwe ndi follicular lymphoma , ndizosankha zabwino zogwirizana ndi sitepe ya khansa, kuipa kwake (kalasi), matenda ena omwe muli nawo, thanzi lanu lonse, ndi mankhwala omwe mudali nawo kale. Matenda oyambirira, matendawa ndi omwe amafunikira. Ndi matenda opatsirana, mankhwala omwe ali pansipa amagwiritsidwa ntchito palimodzi (onani mankhwala osakaniza pansipa). Zosankha zingakhalepo:
Yembekezerani ndi kuwonerera - Ngati follicular lymphoma sichizindikiro, kuyembekezera kudikira kungakhale "mankhwala" osankha. Mukamadikirira, mumayang'anitsitsa mayesero ndi mayesero kuti mankhwala athe kuyamba pamene khansara ikuyamba kukula. Izi zikhoza kuwopsya, ngakhale kuti zapeza kuti kusintha kwake sikusintha pamene njirayi ikugwiritsidwa ntchito.
Mankhwala othandizira mazira - Pa malo oyamba, ine follicular lymphomas, mankhwala a radiation angakhale okhawo othandizira, ndipo amachiza matenda. Njira yothandizira ma ARV (IFRT) kawirikawiri ndiyo njira yomwe imagwiritsidwa ntchito poizoni. Mosiyana ndi mankhwala opatsirana kwambiri a m'midzi, IFRT imapereka ma radiation kumatenda okhawo okhudzidwa, popereka minofu yathanzi. (Mankhwalawa amaika khansa yachiwiri ndipo izi zimachepetsa chiopsezo.)
Chemotherapy - Chemotherapy imagwiritsidwa ntchito pogwiritsa ntchito mayankho abwino. Kaŵirikaŵiri amagwiritsidwa ntchito monga gawo la mankhwala othandizira (onani m'munsimu).
Thandizo lachidule - Njira yochiritsira imagwiritsira ntchito mankhwala omwe amatsogolerera mwachindunji maselo a khansa kapena njira zozindikiritsira zomwe zikukhudzana ndi kukula kwa zotupa. Mankhwala a monoclonal Rituxan (rituximab) amagwiritsidwa ntchito nthawi zambiri (onani mankhwala ochiritsira) pamodzi ndi chemotherapy ndipo wapanga kusiyana kwakukulu m'magulu opulumuka. Mankhwala a monoclonal monga rituximab ndi ma antibodies opangidwa ndi anthu opangidwa kuti agwirizane ndi zizindikiro zina zomwe zilipo pa maselo a Lymphoma (CD). Onse a rituximab ndi Gazyva (obinutuzumab) amayambitsa khungu la CD 20 .
Treanda (bendamustine) yapezedwanso kuonjezera kupulumuka kwapanda phindu koma kuli ndi zotsatira zambiri. Gazyva (obinutuzumab) kuphatikizapo bendamustine ikhoza kugwira ntchito kwa iwo omwe samayankha ku rituximab.
Radioimmunotherapy - Radioimmunotherapy ndi mankhwala omwe mankhwala ambiri (omwe amachititsa kuti azikhala ndi mankhwala osokoneza bongo) amagwiritsidwa ntchito ndi ma particles of radiation omwe amalola kuti mankhwalawa apereke mankhwala omwe amawathira khansa. Chitsanzo ndi Zevalin (yttrium-90 ibritumomab tiuxetan).
Zilonda zam'chipatala - Mankhwala ambiri ndi njira zamakono zimaphunziridwa m'mayesero a zachipatala , kuphatikizapo immunotherapy mankhwala Keytruda (pembrolizumab), stem cell transplants , ndi zina zambiri. Nazi zina mwazomwe zapeza posachedwapa pa kafukufuku pa lymphoma.
Njira Zothandizira
Pali mankhwala ambiri omwe angagwiritsidwe ntchito poyamba kapena pamene follicular lymphoma ikupita. Izi zikuphatikizapo
- R-Bendamustine (rituximab ndi bendamustine) - Kuphatikiza uku kumawoneka kukhala ndi zotsatira zochepetsetsa (zochepetsetsa za m'mimba ndi ubweya wa tsitsi).
- Treanda (bendamustine) yekha
- Rituximab yekha
- R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, ndi prednisone)
- R-CVP (rituximab, cyclophosphamide, vincristine, ndi prednisone)
- Fludara (fludarabine) ndi rituximab
- Zydelig (idelalisib) ndi kapena popanda rituximab
- Revlimid (lenalidomide) ndi wopanda kapena rituximab
Thandizo la Maintenance - Pamene follicular lymphoma ikuyankhidwa, chithandizo cha mankhwala monga rituximab chikhoza kupitilizidwa kwa zaka zochepa kuti chithandizire kutaya nthawi yaitali.
Zotsatira Zotsatira
Zotsatira za mankhwala anu zimadalira chithandizo chomwe mumalandira. Ndi mankhwala othandizira monga rituximab, zotsatira zofala kwambiri ndi zotsatira zowopsa pa rituximab infusions . Zotsatira zina zingaphatikizepo kuchepa kwa magazi ndi chifuwa kapena kutuluka kwa nasal.
Kuthamangitsani
Ngati follicular lymphoma imapezeka kumayambiriro, ikhoza kuchiritsidwa ndi mankhwala opatsirana. Komabe ngakhale ndi matenda oyamba kwambiri, anthu amatha kupulumuka zaka zambiri akuchiritsidwa. Chida chotchedwa Follicular Lymphoma International Prognostic Index kapena FLIPI nthawi zina chimagwiritsidwa ntchito kuti chidziwe zokhudzana ndi zomwe mumanena. Ndondomekoyi imayang'ana zinthu zosiyanasiyana ndipo imapereka chiwerengero chomwe chimawerengera zaka 10 zomwe zimakhalapo.
Kumbukirani kuti pali zinthu zambiri zomwe zimakhudza kusalidwa ndi khansa, ndipo nthawi zina anthu amakhala motalika kwambiri kuposa momwe amayembekezera, kapena mosiyana. Tikudziwa kuti kugwiritsa ntchito fodya, kunenepa kwambiri, ndi kumwa mowa kumakhudzana ndi kupulumuka kosauka, choncho moyo wathanzi ndi wofunika kwambiri.
Kulimbana
Mankhwala a lymphoma akusintha mofulumira. Ndikofunika kuphunzira zonse zomwe mungathe pa khansara yanu. Onani malangizo awa kuti mufufuze khansa yanu pa intaneti . Kafukufuku amatiuza kuti anthu omwe amaphunzira za khansayo samangokhala olamulira komanso amphamvu, koma angakhale ndi zotsatira zabwino.
Funsani thandizo ndikulola ena akuthandizeni. Ganizirani kukhala nawo pagulu lothandizira komanso / kapena pa intaneti pa lymphoma. Ziribe kanthu kuti anzanu ndi achibale anu achikondi, zingakhale zamtengo wapatali kulankhula ndi ena omwe akukumana ndi mavuto omwe muli nawo.
Koposa zonse, kumbukirani kuti kupita patsogolo kwakukulu kumachitidwa pochiza khansa monga follicular lymphoma. Khalani wochonderera wanu ngati wodwala khansara ndikuphunzirani za zopezeka izi. Pali chiyembekezo chambiri.
Kusamalira
Ngati mukudabwa zomwe wokondedwa wanu akukumana nazo, mungafune kufufuza zomwe anthu opulumutsidwa ndi khansa adanena pofunsidwa funso: Kodi ndibwino bwanji kukhala ndi khansa ? Follicular lymphoma, pokhala khansara yofulumira, imakhalapo kwa zaka zambiri. Mwa kuyankhula kwina, ndi marathon ndipo osati sprint. Tengani kamphindi kuti mudziwe momwe mungadzisamalire nokha pamene mumasamalira wokondedwa ndi khansa.
Zotsatira
Adams, H., ndi T. Kwee. Kuyeza kwapakati kwa FDG-PET yapakati pa R-CHOP-Yotayidwa Yopambana Kwambiri B-Cell Lymphoma: Kukonzekera Mwadongosolo ndi Meta-Analysis. Zofufuza Zovuta pa Oncology ndi Hematology . 2016. 106: 55-63.
Ambinder, A., Shenoy, P., Malik, N. et al. Kufufuza Zowopsa kwa Lymphoma ya Follicular. Kupititsa patsogolo mu Hematology . 2012. 2012: 626035.
Burke, J., van der Jagt, R., Kahl, B. ndi al. Kusiyanasiyana kwa Moyo wa Pakati pa Bendamustine-Rituximab ndi R-CHOP / R-CVP kwa Odwala Amene Kale Anali Wosadziwika Osadziwika Osadziwika Hodgkin Lymphoma kapena Mantle Cell Lymphoma. Clinical Lymphoma, Myeloma, ndi Leukemia . 2016. 16 (4): 182-190.
Ine, ine, van der Jagt, R., Kahl, B. ndi al. Kuwongolera kwa Bendamustine-Rituximab kapena R-CHOP / R-CVP mu Njira Yoyamba Yothandizira NHL Yachiwawa kapena MCL: Study BRIGHT. Magazi . 2014. 123 (19): 2944-52.
Gascoyne, R., Nadel, B., Pasqualucci, L. et al. Lymphoma ya Follicular: State-of-the-Art ICML Workshop ku Lugano 2015. Mafilimu Othandiza Kwambiri pa Zamoyo . 2017 Apr 4. (Epub patsogolo pa kusindikiza).