Chinthu chenichenicho chochititsa khansa yofooka sichikudziwika, koma zimaoneka kuti majini amathandiza. Pali zifukwa zingapo zomwe zimayambitsa matendawa. Izi zimadalira mtundu wa khansara, ndi asidi reflux (GERD), kapangidwe ka Barrett, ndi kunenepa kwambiri komwe kumagwirizana ndi adenocarcinoma, kuphatikizapo kusuta ndi kumwa mowa mwauchidakwa zomwe zimagwirizanitsidwa ndi ambiri a squamous cell carcinomas.
Palinso kusiyana kwakukulu kwa chiwerengero cha matenda a khansa, ndipo zizindikiro zosiyana zimakhala zofunikira m'madera osiyanasiyana a dziko lapansi.
Popeza kuti matendawa amapezeka kawirikawiri, m'zigawo zochepetsetsa, pozindikira za ziwopsezo, komanso kudziŵa zizindikiro za khansa yofooka , ndikofunika kuti azindikire matendawa mwamsanga. Pazifukwa zosadziwika, chiŵerengero cha adenocarcinoma cha mthempha posachedwapa chawonetsa kuwonjezeka kochuluka m'mayiko otukuka.
Genetics
Mofanana ndi khansa zambiri, majeremusi amachititsa kuti chitukuko cha khansa yatha, komanso magulu a khansa m'mabanja apezeka m'madera ena padziko lapansi. Genetics mwina imathandiza kwambiri mu squamous cell carcinoma kusiyana ndi adenocarcinoma, makamaka ponena za matenda enaake omwe amamangiriridwa ku matendawa. Matenda ena a chibadwa, tylosis, amawoneka ndi chiopsezo chachikulu cha esophageal squamous cell carcinoma.
Matendawa amadziwika ndi kuphulika kwa khungu pazitsamba ndi matumbo chifukwa chosowa vitamini A.
Genetics yokha siyimayambitsa khansara yowopsa, koma ikhonza kuonjezera pangozi yomwe imayambitsa matenda ena.
Kumvetsa Kuopsa
Chiwopsezo cha matenda chimatanthawuza chinthu chomwe chikukhudzana ndi mwayi wochulukitsa matendawa koma sizikutanthauza kuti zimayambitsa matendawa.
Kansera ya Esophageal imayamba pamene DNA imawonongeka (kusintha kwa majini) kumakhala maselo ozoloŵera operewera kuti maselo amere mosavuta. Kukhala ndi chiopsezo sikutanthauza kuti mudzakhala ndi khansa yowopsya, ndipo anthu omwe alibe zifukwa zomwe zingayambitse matendawa angathe ndipo nthawi zina amakhala ndi matendawa.
Zina mwazifukwa zomwe zimayambitsa khansara yowopsa ndi zinthu zomwe zimayambitsa kukwiya ndi kuwonongeka kwa chigawo cha mimba, ndipo tikuphunzira kuti kutupa kosatha kumapangitsa kusintha kwa minofu yomwe pamapeto pake kumabweretsa khansa. Zina mwaziopsezo, monga fodya, zili ndi khansa (zinthu zopangitsa khansa) zomwe zingathe kuwononga DNA.
Squamous Cell Carcinoma
Maselo a squamous amayamba m'zigawo zam'kati (maselo osakanikirana) omwe amatsitsa mimba . Mankhwalawa amapezeka kwambiri kumtunda ndipo ndi omwe amapezeka kwambiri padziko lapansi.
Zowopsa za mtundu uwu wa khansa yowopsya ndizo:
Zaka
Magulu ambiri a squamous cell carcinomas amapezeka pakati pa zaka zapakati pa 45 ndi 70, ndipo khansa izi si zachilendo kwa achinyamata.
Kugonana
Ngakhale khansa ya m'mimba imakhala yowonjezereka mwa amuna kusiyana ndi amayi onse, chotsutsana ndi zoona kwa squamous cell carcinoma ku United States.
Mpikisano
Ku United States, magulu akuluakulu a carcinomasi amavomereza kwambiri anthu akuda kuposa azungu, koma zosiyana ndi adenocarcinomas.
Geography
Chiŵerengero cha mitundu yonse ya khansa yofooka imasiyana kwambiri padziko lonse lapansi. Nthendayi yapamwamba kwambiri ya squamous cell carcinoma ya emophagus ili mkati mwa zomwe zagwiritsidwa ntchito ku "Asia Esophageal Cancer Belt." Dera ili likuphatikizapo madera monga Turkey, Iran, Kazakhstan, ndi pakati ndi kumpoto kwa China. Chiwerengerochi chimakhalanso chapamwamba kwambiri kum'mwera chakum'mawa kwa Africa.
Kusuta
Sagamous cell carcinomas ya epopus ndi pafupifupi kasanu ndi kawiri kuposa anthu omwe amasuta. Kusuta sikunayambitsa matenda a khansa ya m'mimba m'madera onse padziko lapansi. Mwachitsanzo, ku China, zikuwoneka kuti kusuta kumawathandiza chabe; Zinthu zofunikira zimawoneka zofunikira kwambiri.
Kugwiritsa Ntchito Mowa Mopitirira Muyeso
Mofanana ndi kusuta fodya, kumwa mowa ndi chiopsezo chachikulu cha squamous cell carcinoma m'madera ena a dziko lapansi koma osati ena. Kuledzera mowa kwambiri kumakhudzana ndi kuwonjezeka kwa pangozi ya 1.8 mpaka 7.4. Malingana ndi kafukufuku wa 2018, kuchepetsa kumwa mowa mopitirira malire, kwenikweni kumagwirizanitsidwa ndi chiopsezo chochepa cha matendawa kusiyana ndi omwe amaletsa.
Kusuta Kowonjezera Kumwa Mowa Wambiri
Kuphatikiza ndi kusuta ndi kumwa ndizoopsa kwambiri kwa squamous cell carcinoma ndipo zimalingalira kuti pafupifupi 90 peresenti ya milandu padziko lonse lapansi. Ngozi ndi yayikulu kuposa momwe mungayembekezere ngati muwonjezera kuopsa kwa kusuta komanso kumwa mowa kwambiri (m'malo mowonjezera, chiopsezo chikuwonjezeka).
Zochitika Zachilengedwe
Kuwonetsetsa kwa mankhwala ena-tetrachlorethylene yogwiritsidwa ntchito poyeretsa kauma, mwachitsanzo-angapangitse chiopsezo cha khansa yofooketsa.
Kumwa Madzi (Kuyeretsa Mafuta)
Lye amapezeka m'nyumba akutsuka oyeretsa ndipo ndi wothandizira. Chaka chilichonse ana ambiri mwachangu amamwa mankhwalawa mwachangu. Khansara ya Esophageal ikhoza kuchitika patapita zaka zambiri pambuyo pakupha mwangozi.
Achalasia
Achalasia ndi mkhalidwe umene gulu lopweteka kumbali yomwe ili pansipa ( lowona zapopugeal sphincter) silimasuka bwino kuti alole chakudya kuti chichoke m'mimba ndi kulowa mmimba. Izi zimabweretsa chakudya chotsalira ndi kutambasula pansi. Achalasia ikukhudzidwa ndi chiopsezo chachikulu cha khansa yofooka, ndi khansa nthawi zambiri imachitika zaka 15 mpaka 20 mutatha kuchipatala.
Chithandizo cha ma Radiation ku Chifuwa ndi Kumtunda Kwambiri
Thandizo la ma ARV pa chifuwa cha zinthu monga khansa ya m'mawere kapena matenda a Hodgkin angapangitse ngozi. Ngakhale kuti amayi omwe ali ndi ma radiation pambuyo poyambitsa matendawa ali ndi chiopsezo chokwanira, izi sizikuwoneka ngati zili choncho kwa amayi omwe ali ndi ma radiation kuti apitirire minofu pambuyo pa lumpectomy.
Mbiri ya Mutu ndi Nkhumba kapena Khansa Yam'mimba
Mbiri yake ya khansa imakhudzidwa ndi chiopsezo chachikulu cha khansa yochepa kwambiri, makamaka magulu oopsa a khansa ya mutu, khosi, ndi mapapo.
Kumwa Zakumwa Zotentha
Kumwa mowa wotentha kwambiri (kutentha kwambiri kuposa kapu ya khofi) kwakhala kwa nthawi yaitali kuti kuganiza kuti kumawopsa kwambiri. Phunziro la 2018 linagwirizanitsa chikhulupiliro ichi, ngakhale kuti kumwa zakumwa pa kutentha kunali pangozi pokhapokha ngati kuledzeretsa mowa kwambiri kapena kusuta fodya.
Kunena za zakumwa, mwina mwamvapo kuti soda ikhoza kuyambitsa khansara yowopsya pogwiritsa ntchito kupweteka kwa mtima. Kulumikizana kotheka kumeneku kunayambitsidwa ndi kafukufuku ku National Cancer Institute ndi maphunziro omwe anapeza kuti sanapeze kowopsa kowopsa kwa squamous cell carcinoma kapena adenocarcinoma koma zomwe zingakhale zosiyana.
Zakudya
Zakudya-makamaka zakudya zosadya zipatso ndi ndiwo zamasamba, ndi zazikulu zofiira ndi / kapena zogwiritsidwa ntchito-zimagwirizanitsidwa ndi chiopsezo chachikulu cha mitundu yonse ya khansa yofooka, koma mgwirizano ndi wamphamvu ndi squamous cell carcinoma. Pokhala ndi zakudya, njira yophika imawoneka kuti ndi yofunika, ndipo kuphika kapena kuphika pa kutentha kumakhudzidwa ndi chiopsezo chachikulu. Betel ndi mtedza wa areca zakhala zikugwirizana ndi chitukuko cha khansa yofooka.
Ku China, zakudya zopangidwa ndi nitrates zingakhale zoopsa kawiri. Ngozi imakhalanso yowonjezereka kwa iwo omwe ali ndi zofooka za vitamini ndi mineral (makamaka folate, vitamini C, ndi molybdenum) m'mayiko osauka.
Mankhwala a Papillomavirus (HPV)
Mankhwala a papillomavirus (HPV), kachilombo kamene kamayambitsa chiberekero komanso khansa zina, mwina akhoza kugwirizana ndi kukula kwa squamous cell carcinoma. Ngakhale ofufuza sakudziwa ngati kachilombo kameneka kamayambitsa matendawa, amapezeka mwa magawo atatu a khansa ya operewera ku Asia ndi madera ena a Africa. Pakalipano, HPV sichikuwoneka kuti ikugwirizana ndi khansa yowopsya ku United States.
Adenocarcinoma
Adenocarcinomas zimachitika kawirikawiri m'munsi mwachithunzi chachitatu ndikuyamba m'maselo osasangalatsa. Kawirikawiri, m'munsi mwa maselo ochepa amakhala ndi maselo osakanikirana, koma kuwonongeka kwapadera (monga chronic acid reflux) kumapangitsa kusintha kwa maselowa kuti awoneke ngati maselo omwe amayendetsa m'mimba ndi m'matumbo. Patapita nthawi, maselowa angakhale maselo osakanikirana komanso maselo a khansa. Adenocarcinomas tsopano yoposa magulu a squamous cell carcinomas ku United States, United Kingdom, Australia, ndi Western Europe.
Zowopsa za mtundu uwu wa khansa yowopsya ndizo:
Zaka
Mofanana ndi khansa ya squamous, adenocarcinomas amapezeka kwambiri pakati pa anthu a zaka zapakati pa 50 ndi 70.
Kugonana
Ku United States, adenocarcinomas ndi oposa asanu ndi atatu kuposa amuna.
Mpikisano
Mosiyana ndi khansa yapakhungu, adenocarcinomas ya epopus ndi yowonjezeka kwambiri (ndi chinthu cha 5) oyera kuposa akuda.
Geography
Chiŵerengero cha adenocarcinoma cha m'mimba ndi chachikulu kumadzulo kwa Ulaya, North America (makamaka United States), ndi Australia.
Matenda a Reflux a Gastroesophageal (GERD)
Matenda a reflux, kapena matenda a reflux a gastroesophageal ( GERD ), ndi chiwopsezo chachikulu cha matenda osokoneza bongo adenocarcinoma, ndipo pafupifupi 30 peresenti ya khansa imeneyi imaganiziridwa kuti ikugwirizana ndi chikhalidwecho. Zikuganiza kuti pakati pa 0,5 peresenti ndi 1 peresenti ya anthu omwe ali ndi GERD adzakhala ndi khansa yowopsa.
Zovuta za Barrett
Mitsempha ya Barrett ndi mkhalidwe umene maselo achibadwa a m'munsi mwa maselo (squamous cells) amaloledwa ndi maselo osakanikirana ngati omwe ali pamimba ndi m'matumbo. Kawirikawiri amapezeka mwa anthu omwe ali ndi nthawi yayitali ya reflux acid ndipo amapezeka 6 peresenti mpaka 14 peresenti ya anthu omwe ali ndi GERD osatha. Ngakhale kuti chiwerengerochi chimasiyanasiyana, pafupifupi 1 mwa 100 mpaka 1 mwa anthu 200 omwe ali ndi vuto la Barrett adzakhala ndi khansa yowopsya chaka chilichonse. Monga adenocarcinoma, mayendedwe a Barrett akuwonjezeka ku United States.
Kafukufuku wina (koma osati onse) asonyeza kuchepa kwa chiopsezo cha adenocarcinoma kwa anthu omwe ali ndi vuto la Barrett omwe atenga mankhwala osagwiritsidwa ntchito poletsa kutupa (Advil, ibuprofen, proton pump inhibitors (monga Prilosec, omeprazole) , kapena mankhwala a statin (monga Lipitor, atorvastatin).
Hatalia ya Hiatal
Nthenda yotereyi ikufooketsa mimba yomwe imalola kuti mimba iwonjezeke m'chifuwa kuchokera m'mimba ndipo nthawi zambiri imayambitsa zizindikiro za kupweteka kwa mtima. Kukhala ndi chilakolako chotha msinkhu kungapangitse kuti chiopsezo chiwonjezeke chifukwa cha 2 mpaka 6.
Kunenepa kwambiri / kunenepa kwambiri
Kukhala wonenepa kwambiri kapena owonjezera kumawonjezera ngozi ya adenocarcinoma ya mimba. Malinga ndi kafukufuku wa 2015, anthu omwe ali olemera kwambiri (chiwerengero cha masentimita 25 mpaka 29) ali pafupifupi 50 peresenti kuti athe kukhala ndi khansa, pamene iwo omwe ali ochepa (chiwerengero cha thupi la 30 kapena kuposa) ali ndi mwayi wokha khansara yokhayokha. Kukhala ndi matenda a shuga a mtundu wa 2 kungapangitse kuti chiwopsezo chiwonjezeke, koma sichidziwika ngati izi zikugwirizana ndi matenda a shuga kapena chokwanira.
Kusuta
Kusuta kumagwirizanitsa ndi chitukuko cha adenocarcinoma cha mimba, koma osachepera kuposa khansa ya squamous cell. Kusuta kumadzetsa chiopsezo cha adenocarcinoma ndi chinthu choposa 2.7.
Mankhwala
Mankhwala ena amagwiritsidwa ntchito ndi kuwonjezeka kapena kuchepa kwa chiopsezo cha adenocarcinoma cha mimba. Kugwiritsiridwa ntchito kwa bisphosphonates (kugwiritsidwa ntchito kwa osteoporosis) kungapangitse ngozi, monga momwe kugwiritsira ntchito estrogen-yekha yokha mankhwala othandizira. Mosiyana ndi zimenezi, kugwiritsa ntchito aspirin kumagwirizana ndi kuchepa kwake.
> Zotsatira:
> Arnal, M., Arenas, A., ndi A. Arbeloa. Kansa ya Esophageal: Zowopsa, Kuchepetsa ndi Kupirira Kwambiri M'mayiko a Kumadzulo ndi Kum'mawa. World Journal of Gastroenterology . 2015; 21 (26): 7933.
> Bast, Robert C., et al. Holland-Free Cancer Medicine. Wiley Blackwell, 2017.
> Castro, C., Peleteiro, B., ndi N. Lunet. Zinthu Zosinthika ndi Khansa ya Esophageal: Kusanthula Mwachidule kwa Meta-Analyzes yofalitsidwa. Journal of Gastroenterology . 2018; 53 (1): 37-51.
> Mayne, Susan T., et. al. Kugwiritsa Ntchito Mowa Mopaka Mbaka ndi Kuopsa kwa Esophageal Adenocarcinoma. Journal of National Cancer Institute. 2006; 98 (1) 72-75.
> Sardana, R., Chhikara, N., Tanwar, B, .ndi A. Panghal. Zotsatira za Zakudya pa Khansa Yophatikizira Anthu: Kufotokozera. Chakudya ndi Ntchito . 2018 Apr 4. (Epub patsogolo pa kusindikiza).
> Yu, C., Tang, H., Guo, Y. et al. Kugwiritsa Ntchito Tea Yamtundu ndi Kuyanjana Kwake ndi Mowa ndi Kusuta Fodya pa Ngozi ya Kansa ya Esophageal. Annals of Internal Medicine . 2015; 168 (7): 489.