Khansara ya Esophageal si yachilendo, koma ndi imodzi mwa zifukwa khumi zomwe zimayambitsa kufala kwa khansa ku United States, chifukwa kawirikawiri zimapezeka pamtunda pamene sichichira. M'mbuyomu, squamous cell carcinoma ya mimba-yogwirizana ndi kusuta ndi kumwa mowa mopitirira muyeso-inali yofala kwambiri. Koma m'zaka zaposachedwapa, yapambana ndi adenocarcinoma, yomwe nthawi zambiri imagwirizanitsidwa ndi nthawi yayitali ya asidi reflux ndi kunenepa kwambiri.
Kuvuta ndi kumeza nthawi zambiri ndi chizindikiro choyamba cha khansa yofooka, ndipo mayesero monga endoscopy amathandiza kutsimikizira kuti akudwala matendawa. Akagwidwa msanga, opaleshoni ikhoza kuchiza matendawa, koma nthawi zambiri matendawa amapita patsogolo, ndipo chemotherapy ndi mankhwala omwe amachititsa kuti tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda.
Khansara ya Esophageal imasiyanasiyana kwambiri padziko lonse lapansi, ponseponse m'zochitika komanso pazifukwa zomwe zimakhala zoopsa. Pakali pano, esophageal adenocarcinoma ikuwonjezeka ku United States ndi mayiko ena otukuka, ngakhale zifukwa zenizeni sizikudziwika.
Kumvetsa Esophagus
Matendawa ndi minofu yomwe imagwirizanitsa pakamwa ndi mmimba. Icho chiri kumbuyo kwa mfupa ndi trachea (chubu yomwe mpweya umadutsa panjira yopita kumapapo), ndi kutsogolo kwa msana wa thoracic. Malo omwe ali pakati pa chifuwacho amatha kutchulidwa kuti mediastinum , malo omwe ali ndi ziwalo zina monga mtima, mitsempha yambiri ya magazi (aorta), ndi mitsempha yambiri.
Pakatikatikatikati, pali zinthu zochepa zomwe zimayendetsa momwe zowonjezera ndi zakumwa zimachokera mkamwa mwako mpaka kumimba mwakumeza. Mphuno yapamwamba ya sphincter ndi gulu la minofu pafupi ndi pamwamba pa mitsempha yomwe imalepheretsa kubwereka chakudya kuchokera pakamwa mpaka pakamwa, komanso kumathandiza kupewa kutentha (kupuma chakudya mu trachea).
Mankhwala otsika otchedwa sophageal sphincter ndi gulu la minofu pafupi ndi mpangidwe wa mimba ndi m'mimba. Pamene kamvekedwe ka sphincter kamakhala kotsika kapena kotsika (chifukwa cha mankhwala kapena mankhwala), zingakhudze momwe chakudya chimachokera kumimba mpaka m'mimba. Asanafike m'mimba, mimba imadutsamo. Ngati nthendayi ili yofooka, chifuwa chimatha kupita kumtunda.
Zambiri za kutalika kwake zimakhala ndi maselo odziwika ngati maselo a squamous, maselo ofanana omwe amapezeka pakamwa, pamtunda wautali, komanso pakhungu. Ngati chotupa chimayamba m'dera lino amadziwika kuti squamous cell carcinoma . Dera lomwe lili pansi pa chigwacho, ndipo pamene mimba imayanjana m'mimba, ili ndi maselo amtunduwu. Ngati chotupa choopsa chiyamba m'derali, chimatchedwa adenocarcinoma .
Magulu a squamous cell carcinomas adagwirizananso ku United States, ndipo amakhala mtundu wochuluka kwambiri wa khansa yapachilendo padziko lonse lapansi. Pakalipano, adenocarcinomas ndizofala ku United States ndi mayiko ena otukuka.
Zizindikiro
Zizindikiro za khansa yochepa kwambiri zimakhala zoonekeratu kokha pamene khansara ili patsogolo kwambiri.
Izi zikuti, mobwerezabwereza, anthu ambiri amapeza kuti akhala akukhala ndi zizindikiro kwa nthawi ndithu, koma akhala akudziŵa bwinobwino zizindikiro izi (mwa kudya zakudya zosavuta, mwachitsanzo).
Zizindikiro zowonjezerapo zikuphatikizapo:
- Zovuta kumeza (dysphagia): Chizindikiro chofala kwambiri, izi zimayambira ndi zakudya zolimba ndipo pamapeto pake zimaphatikizapo kuphatikizapo zakumwa. Ululu ukhoza kupezeka ndi kumeza, komanso kumverera kwa chakudya chogwiritsidwa ntchito.
- Kusadziwika kolemetsa (kulemera kopanda popanda kuyesera)
- Kubwezeretsanso chakudya chosagwiritsidwa ntchito
- Kutentha kwa moto (kuyaka kapena kuthamanga kuseri kwa bere)
- Kuwombera magazi kapena kupitilira magazi akale ndi matumbo ( zakuda )
- Chifuwa chosatha
- Kumva ululu pakati pa mapewa a mapewa
- Kusokonezeka kapena kutaya mawu
Popeza zina mwazizindikirozi zimachitika ndi acid reflux, ndipo popeza asidi reflux ndi chiwopsezo cha khansa yochepa kwambiri, ndikofunika kuti anthu asadziwe za zizindikiro zatsopano zomwe amaziwona, koma za kusintha kulikonse mu zizindikiro zawo zachilendo.
Zifukwa ndi Zoopsa
Sitikudziwa zomwe zimayambitsa, ngakhale kuti majini amachititsa chidwi. Pali zifukwa zingapo zomwe zimayambitsa khansara yotchedwa sophageal ndipo zimasiyana malinga ndi mtundu wina wa khansa yowopsya.
Squamous cell carcinoma ya emophagus nthawi zambiri imagwirizanitsidwa ndi kusuta fodya ndi kumwa mowa mopitirira muyeso, ngakhale pali zifukwa zinanso zoopsya. Padziko lonse, khansa yowopsya imakhala yowonjezereka kwa amuna kusiyana ndi akazi, koma squamous cell carcinoma imapezeka kwambiri kwa amayi ku United States. Ndimodziwikiranso kwa anthu akuda kuposa azungu. Zakudya zokhutira ndi zipatso ndi ndiwo zamasamba komanso zofiira kwambiri ndipo zowonongeka zimakhala ndi zotetezera.
Adenocarcinoma ya emophagus nthawi zambiri imagwirizanitsidwa ndi matenda osakaniza aclux (matenda a reflux a gastroesophageal, kapena GERD ), komanso matenda a Barrett ndi kunenepa kwambiri. Ku United States, zimakhala zofala kwambiri kwa amuna kusiyana ndi akazi, komanso zofala kwambiri kuposa azungu.
Kudziwa
Mayesero osiyanasiyana angagwiritsidwe ntchito kuti azindikire khansa yodwalayo . Kawirikawiri, mayeso oyambirira amalamulira ndi swallowum swallow . Koma ngati khansa ikugwiritsidwa ntchito, komatu phokoso lapamwamba la endoscopy (esophago-gastric-duodenoscopy) ndilo mayesero oyambirira omwe amagwiritsidwa ntchito kuti apeze matendawa. Mwa njirayi, chubu imayikidwa kupyolera pakamwa ndi mkati. Kamera pamapeto pa chubu imathandiza madotolo kuti aziwoneka bwinobwino mkati mwa chithunzicho ndipo amatenga kachidutswa, ngati kuli kofunikira.
Kuyika masitepe n'kofunika kwambiri pakusankha mankhwala abwino pa matendawa. Mayesero omwe amagwiritsidwa ntchito popangira masewerowa ndi CT, PET, ndipo nthawi zina maphunziro ena monga bronchoscopy , thoracoscopy, ndi ena.
Chithandizo
Njira zomwe mungapangire khansa yofooka zimadalira pa siteji ya khansa, kumene ilipo, ndi zina mwazifukwa zina.
Kwa matenda oyambirira, opaleshoni (esophagectomy) ikhoza kupereka mpata wochiritsidwa. Izi zinati, ndizochita opaleshoni yaikulu zomwe zimatulutsa gawo la mimba ndi kubwezeretsa m'mimba zomwe zatsala pamtunda (kapena kuwonjezera gawo la m'matumbo pamene gawo lalikulu la mimba likuchotsedwa). Chemotherapy ndi mankhwala opatsirana pogwiritsa ntchito mazira amayamba kachitidwe opaleshoni (neoadjuvant chemotherapy) kuti achepetse chotupa, koma angagwiritsenso ntchito atatha opaleshoni kuti atsimikizidwe kuti maselo aliwonse a khansa amatha.
Kwa iwo omwe sali ovomerezeka ku opaleshoni, palinso zosankha. Chemotherapy ndi mankhwala osokoneza bongo angapitirize moyo. Mankhwalawa amagwiritsidwa ntchito nthaŵi zambiri pamodzi ndi mankhwala a chemotherapy, mwina asanachitidwe opaleshoni, atachita opaleshoni, kapenanso mankhwala enaake pamene opaleshoni sizingatheke.
Zovuta zothandizidwa zingathandizenso kulamulira matendawa, mwachitsanzo, mwa anthu omwe ali ndi zotupa zomwe zili zabwino kwa HER2 (zofanana ndi khansa ya m'mawere). Immunotherapy imaphatikizapo njira zosiyanasiyana zochizira zomwe zimaphatikizapo kupanga thupi la chitetezo cha thupi kuti limenyane ndi khansa, ndipo nthawi zina amatha kuwongolera ngakhale khansa yapamwamba. Palinso mankhwala ambiri omwe akuphunziridwa m'mayesero a kachipatala omwe amapereka chiyembekezo kuti mankhwala abwino adzakhalapo mtsogolo.
Kwa omwe ali ndi khansa yapamwamba, chithandizo chothandizira kuti akhale ndi moyo wabwino ngakhale kuti akudwala khansa silingatheke, ndipo nthawi zambiri chisamaliro cha palliative ndicho cholinga cha mankhwala. Kusamalidwa sikunali kofanana ndi chipatala (chingagwiritsidwe ntchito ngakhale kwa anthu omwe ali ndi zotupa zomwe zingathe kuchiritsidwa), ndipo cholinga chake ndi kuyang'anira zizindikiro zakuthupi ndi zamaganizo zokhala ndi khansa. Tikuphunziranso kuti chisamaliro chosamalidwa chimangowonjezera khalidwe la moyo, koma lingapangitse kupulumuka kwa anthu omwe ali ndi khansa yapamwamba.
Kulimbana
Kulimbana ndi khansa yochepa kwambiri kungakhale kovuta kwambiri. Pachikhalidwe, kuvutika ndi kumeza sikungokhala kovuta koma kungasokoneze kwambiri ndi zakudya. Mwakhumudwa, mbiri ya khansara yotopa kwambiri monga chiwombankhanza choopsa ndi matenda olakwika amachititsa nkhani zambiri, kuphatikizapo mapeto a moyo. Pakati pa anthu, matenda odwala matenda a khunyu amatha kusokoneza maudindo omwe ali nawo m'banja. Ndipo nkhani zothandiza kuchokera ku inshuwalansi kuti ndalama ziwonjezere kulemetsa.
Kulimbana ndi matenda opatsirana pogonana kumatengera mudzi, ndipo ndikofunikira kusonkhanitsa dongosolo lanu lothandizira. Kupeza chithandizo pakati pa anthu odwala matenda opatsirana khansa pa intaneti kungakhalenso kopindulitsa kwambiri, chifukwa kumabweretsa mwayi wokambirana ndi anthu ena komanso osamalira mabanja omwe akukumana ndi vuto lomweli.
Kuchita nawo mbali mwachithandizo chanu pokhala wothandizira nokha pa chisamaliro chanu cha khansa sikungangowonjezera nkhaŵa zina pa zosadziwika, koma nthawi zina zingasokoneze zotsatirapo.
Mawu Ochokera
Khansara yotchedwa Esophageal nthawi zambiri imatha kupewa matenda mpaka patapita nthawi, koma anthu ambiri amavomereza kuti ali ndi zizindikiro zisanafike. Kudziwa zizindikiro ndi kudziwa ngati muli ndi zifukwa zingakhale zothandiza kupeza matendawa mwamsanga. Ndikofunika kuzindikira kuti ngakhale kuti matendawa sakugwidwa msanga ndi opaleshoni sizingatheke, pakadalipo mankhwala omwe angachepetse zizindikiro ndipo nthawi zambiri amatambasula moyo.
> Zotsatira:
> American Society of Clinical Oncology. Kansa ya Esophageal: Zizindikiro ndi Zizindikiro. Kusinthidwa 12/2016.
> Bast, R., Croce, C., Hait, W. ndi al. Holland-Free Cancer Medicine. Wiley Blackwell, 2017.
> National Cancer Institute. Matenda a Esophageal Cancer Treatment (PDQ) -Health Professional Version. Kusinthidwa 02/06/18.