Kutseka ndi madzi opangidwa ndi chiwindi ndi kusungidwa mu ndulu. Mtsinje umathandiza kuchepetsa mafuta omwe amapezeka mu chakudya. Datani ya bile imagwirizanitsa ndulu ndi chiwindi mpaka m'mimba. Mankhwalawa amakhala ngati njira yopangira bile kuti alowe mumatumbo aang'ono , komwe bile amathandiza kudyetsa chakudya.
Tsamba la biliary (kapena biliary system) limatanthauza zonse zomwe zimapanga ndi kusunga bile, kuphatikizapo bile imatulutsa mkati ndi kunja kwa chiwindi ndi ndulu.
Nyama imalowa m'chiwindi imatchedwa intrahepatic, ndipo bile imatulutsa kunja kwa chiwindi amatchedwa extrahepatic.
Mitundu ikuluikulu ya khansa ya biliary ndi khansa ya khansa (ie, cholangiocarcinoma) ndi khansara ya ndulu. Ngati atagwidwa mofulumira, kansa ya ndondomeko ya khansa ndi khansa ya khansa ikhoza kuthandizidwa mwa kuchotsa izi. Komabe, anthu ambiri omwe ali ndi khansa imeneyi amatero atatha kale kufalitsa khansa. Ma khansa onsewa akhoza kuthana ndi chiwindi, mbali zina za m'mimba, kapena mbali zina za thupi.
Tiyeni tione bwinobwino khansa ya khansa.
Ziwerengero
Malingana ndi American Cancer Society, chaka chilichonse ku United States, pafupifupi anthu 8000 amapezeka ndi khansa ya khansa. Nambalayi ikuphatikizapo anthu omwe amapezeka ndi khansa ya intrahepatic bile ndi kansa ya extrahepatic bile. Komanso, ngakhale kuti kansa ya khansa ingakhudze achinyamata, pafupifupi zaka zambiri za matenda a kansa ya intrahepatic ndi 70 ndipo ya extrahepatic ndi 72.
Malo a khansa ya khansa nthawi zambiri amatha kusankhidwa mwa njira imodzi:
- Khansara yotchedwa Intrahepatic : Matenda oopsa mkati mwa chiwindi
- Khansara ya perihila : zotupa zazikulu zomwe zili pamlingo wa chiwindi kumene mazira amodzi akumanzere ndi kumanzere akugwirizana kuti apange kanjira ka bile
- Khansara ya khansa ya m'thupi : Matendawa ali kutali kwambiri ndi chiwindi m'munsi mwa biling
Ziphuphu zowopsa ndizofala kwambiri pamtundu wa makoswe oposa 65 peresenti ya khansa ya biliary. Ziphuphu za extrahepatic zili ndi 30 peresenti. Matenda otchedwa Intrahepatic matumbo ndi ochepa kwambiri ndipo amawerengera pafupifupi matenda asanu mwa magawo asanu.
Ziphuphu zamtunduwu zimatchedwanso matumbo a hila kapena zotupa za Klatskin. Mankhwala a khansa ya perihilar ndi distal bile amasonkhanitsidwa pamodzi ngati khansa ya extrahepatic.
Kupulumuka kwa zaka zisanu ndilo mzere wamba umene amagwiritsidwa ntchito ndi madokotala kufotokozera za khansara kapena mawonekedwe. Kupulumuka kwa zaka zisanu kumatanthauza chiwerengero cha odwala omwe ali ndi moyo zaka zosachepera zisanu ataphunzira. Zomwe zimakhalapo zaka zisanu za khansa ya khansa ya bongo zimathyoledwa ndi momwe khansara yafalikira-kumadera, m'dera, kapena kutali-komanso ngati chotupacho ndi intrahepatic kapena extrahepatic.
Nazi zaka zisanu zomwe zimapulumuka pa matenda a khansa ya intrahepatic yochokera ku chifuwa chofalikira:
| Amapezeka | 15% |
| Chigawo | 6% |
| Kutalika | 2% |
Nazi zotsatira za khansa ya extrahepatic:
| Amapezeka | 30% |
| Chigawo | 24% |
| Kutalika | 2% |
Zowopsa
Chowopsa ndi chinthu china chimene chimaonjezera chiopsezo cha khansa. Mitundu yosiyanasiyana ya khansa ili ndi zifukwa zosiyanasiyana zoopsa.
Pali matenda angapo a chiwindi omwe amagwiritsa ntchito ngati chiwopsezo cha khansa ya khansa:
- Primary sclerosing cholangitis
- Cirrhosis
- Miyala yamatope
- Choledochal cysts
- Hepatitis B
- Chiwindi cha chiwindi C
- Cholitis yolonda
- Matenda a Crohn
- Pancreatitis
- HIV
- Congenital anomalies wa pancreatic kapena bile tray
- Matenda a chiwindi a Polycystic
Nazi zina mwazifukwa zomwe zimayambitsa kansa ya khansa:
- Mbiri ya banja
- Ukalamba
- Kusiyana kwa mitundu (mwachitsanzo, ku Puerto Rico, ku America, ndi ku Asia)
- Kunenepa kwambiri
- Matenda a shuga
- Kusuta
- Pancreatitis
Chonde kumbukirani kuti zifukwa zina zoopsa zimasinthika; pamene, zina sizosasinthika. Zosintha zomwe zingasinthike zingasinthidwe-mukhoza kuchita chinachake kusintha. Mwachitsanzo, kusuta ndi kunenepa kwambiri kumasintha chifukwa munthu akhoza kusiya kusuta kapena kulemera, motero.
Komanso, chiopsezo cha matenda ena akhoza kusintha, nayenso. Mwachitsanzo, pali katemera wodwala matenda a chiwindi B. Zosasinthika, monga mbiri zakale ndi banja, sizingasinthe.
Ngati mukufuna kuchepetsa zifukwa zanu zoopsa za khansa ndi matenda ena, chonde kambiranani ndi njirazi ndi dokotala wanu. Pali zinthu zambiri zimene mungachite kuti mukhale ndi moyo wathanzi.
Zizindikiro ndi Zizindikiro
Khansara ya mabiliyali imakhala ngati jaundice, khungu lofewa (ie, pruritis), ndi kulemera kwake. Pamene wodwala akupereka zizindikirozi, kuyezetsa magazi ndi zowonongeka zimayesedwa pofuna kuyang'ana zigawo zapamwamba za zinthu zina m'magazi.
MaseĊµera apamwamba a alkaline phosphatase ndi bilirubin omwe amayesedwa pa kafukufuku wamagazi amawonetsa kuti thupi limakhala lopweteka kwambiri. Komanso, kansa ya khansa ingayambitse chiwerengero cha zotupa za carcinoembryonic antigen (CEA), CA19-9, ndi CA-125.
Malinga ndi zotsatira zochokera kuyezetsa magazi ndi zowonongeka, katswiri angayambe chiwonongeko cha mankhwalawa kuti aone ngati ndi khansa. Chiwopsezo chimatanthawuza kuchotsedwa kwa minofu yaing'ono yowonongeka kwake pogwiritsa ntchito microscope.
Chithandizo
Pambuyo pa wodwala atapezeka ndi kansa ya biliyara, kujambulira (monga ultrasound ndi ERCP) kumachitika kuti mudziwe malo, kapena kufalikira, kwa chotupacho ndi kufotokoza chotupacho.
Ngakhale kuti matumbo ambiri omwe amatha kupitilirapo amakhala osagwiritsidwa ntchito, hafu ya zonse zotupa za khansa zingathe kukhazikitsidwa, kapena kuchotsedwa. Kwa zotupa zakutali, resection ikuphatikizapo njira ya pancreaticoduodenectomy kapena njira ya Whipple. Njira ya Whipple ndi opaleshoni yovuta kwambiri komanso yovuta kwambiri yomwe imaphatikizapo kuchotsedwa kwa mutu wa makoswe, ndulu, ndowe ndi duodenum, yomwe ndi gawo loyamba la m'mimba. Njira ya Whipple imachitidwa ndi opaleshoni ya opaleshoni ya opaleshoni.
Mwamwayi, ngakhale kwa odwala omwe akufuna kupatsidwa resection ndikuchotseratu chidutswa cha biliary, zaka zisanu zapakati pafupipafupi ndizochepa: pakati pa 20 ndi 25 peresenti. Kwa odwala omwe ali ndi kansa yosagwiritsidwa ntchito, kupulumuka kungakhoze kuwerengedwa mu masabata kapena miyezi.
Malo ovuta kwambiri a dala la bile amachita opaleshoni yonyenga. Opaleshoni ndi yoperewera ndi momwe chifuwa chafalikira ndi kukula kwake. Ziphuphu zomwe zasintha, kapena kufalikira, sizikutheka. Malingana ndi maonekedwe enieni a tumatope a bile, ma opaleshoni ena angathe kuchitidwa kuphatikizapo:
- Nthenda yotchedwa hepatectomy (mwachitsanzo, kuchotsa mbali ya chiwindi)
- Kuchotsa opaleshoni ya ndondomeko ya bile
- Kupatsa chiwindi
Mankhwala othandizira khansa ya biliary monga chemotherapy ndi radiotherapy zimapindulitsa pang'ono. Komabe, radiotherapy ikhoza kugwiritsidwa ntchito kupha maselo a kansa omwe amaletsa batire kapena kukhala ndi mitsempha yothandizira.
Mankhwala opatsirana amaperekedwa kuti athetse ululu ndi kuchepetsa zizindikiro za matendawa. Kuphatikiza pa radiotherapy palliative, pali njira zingapo zosamalirako zosamalira.
- Mankhwala opweteka monga mankhwala opioid
- Kuyika kwa stent biliary kapena catheter kuti chitetezo cha bile chikhale chotsegula ndi kulamulira kwa jaundice
- Biliary akudutsa kumene dokotalayo akupanga kudutsa pozungulira chotupa chimene chimatseketsa ndondomeko ya bile
- Kupuma kwa phokoso kumagwiritsa ntchito mphamvu yotentha ndi magetsi kuti aphe khansa
- Mankhwala opangira mowa amachititsa kuti mitsempha iwononge ululu pamatope a bile ndi m'mimba
- Thandizo la Photodynamic limagwiritsa ntchito mankhwala omwe amamvetsetsa kuunika kwina kochepa kuti awononge maselo a kansa
Kansa ya Biliary Tract Cancer vs. Chilonda Cell Carcinoma
Ngakhale pepala la biliary likugwirizana kwambiri ndi chiwindi, khansa ya tsamba la biliary ndi yosiyana kwambiri ndi chiwindi.
Monga dzina limatanthawuzira, chiwindi cha cell carcinomas chimachokera ku maselo a chiwindi kapena hepatocytes. Mankhwala a khansa ya biliary amachokera ku maselo achilendo a tsamba la biliary ndipo makamaka adenocarcinomas. Adenocarcinomas amatchula chotupa choopsa chomwe chimachokera ku epithelium, kapena maselo omwe amatsitsa njira ya bile.
Lembani mawu ena, ngakhale kuti tsamba la biliary liri pafupi ndi chiwindi, limapangidwa ndi mitundu yosiyanasiyana ya maselo. Ziphuphu zimachokera ku mitundu yosiyanasiyana ya selo.
> Zotsatira:
> American Cancer Society. Kodi Ndibwino Kuti Mukhale ndi Magulu a Khansa? www.cancer.org
> American Society of Clinical Oncology. Cancer.Net. Zomwe Zimayambitsa Khansa (Cholangiocarcinoma). www.cancer.net
> Carr BI. Ziphuphu za Chiwindi ndi Biliary Tree. Mu: Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. eds. Mfundo za Harrison za Internal Medicine, 19e New York, NY: McGraw-Hill; 2014.
> Matheny SC, Long K, Roth J. Hepatobiliary Disorders. Mu: South-Paul JE, Matheny SC, Lewis EL. eds. Kufufuza Koyamba ndi Kuchiza: Family Medicine, 4e New York, NY: McGraw-Hill.