Khansa yapakansa

Kupezeka kwa khansa ya kapamba kumachitika chifukwa cha magawano osagwirizana komanso osokoneza ma cell a kapamba mothandizidwa ndi zinthu zingapo. Matendawa amatchedwa "chete", chifukwa kwa zaka zambiri samatha kudziwonetsa.

Njira yaposachedwa ya matendawa imafotokozedwa ndi zodabwitsa za malo a ziwalozo, zomwe zimazunguliridwa ndi m'mimba, duodenum, gren adrenal ndulu. Chifukwa chake, mawonetseredwe a khansa ya pancreatic amadziwika kale kumapeto, chotupa chikakhala chachikulu.

Zambiri

Mwa matenda onse a kapamba, kapamba (kutupa) ndi oncology nthawi zambiri amapezeka ndi matenda. Kuchuluka kwa milandu kumachuluka chaka chilichonse, osati chifukwa cha zovuta zoyipa. Izi zikuchitika chifukwa cha kusintha kwa njira zodziwonera, zomwe zimaloleza kusokonezeka komwe kumayambitsa matenda a gland kumayambiriro kwa khansa.

Maselo atayamba kugawikana mosiyana ndi chilengedwe, chotupa cha khansa chimayamba. Maselo oopsa amatha kulowa m'matumba apafupi ndikuwawononga. Kuphatikiza apo, ndikukula kwa chotupa, amalekanitsidwa ndi ma neoplasm ndikulowa kufalikira kapena dongosolo. Izi zimabweretsa metastasis, ndiye kuti kufalikira kwa khansa kwa ziwalo zina ndi machitidwe ena. Zowonongeka kwambiri za kapamba zimadziwika ndi metastasis yoyambirira koyambirira.

Zikondazo zimagwira ntchito ziwiri mthupi: zimatulutsa timadzi tam'mimba ndi mahomoni. Kuchita kwamphamvu kotereku komanso kuthamanga kwa magazi m'ziwalo zimapangitsa kuti pasakhale zotupa zosiyanasiyana. Adenocarcinoma wodziwika bwino, yemwe amapangidwa kuchokera ku glandular epithelium. Ndikofunika kudziwa kuti azimayi amtundu wamtunduwu amakhala ndi kawiri kawiri kuposa amuna.

Cystadenocarcinoma ndi yachiwiri pakufalikira: chotupa ichi nthawi zambiri chimakhala ndi zizindikiro zazikulu, zomwe zimathandizira kuzindikira koyambirira. Carcinoma imachitika makamaka kumbuyo kwa kapamba kapena matenda a shuga ndipo amatha kukhudza gawo lililonse la thupi - mutu, thupi ndi mchira.

Khansa ya mchirala ya kapamba imachitika mwachangu pakupanga ma metastases, komabe, imakhala yothandiza nthawi zonse pochita opareshoni. Pa nthawi ya opareshoni, mchira wonse ndi ndulu, zomwe zimakhala ndimitsempha yamafupa wamba ndi kapamba, zimachotsedwa.

Ngati chotupa chija chikukula, ndiye kuti kuwonongeka kwa ziwalo zapafupi - m'mimba ndi matumbo - ndikotheka. Maselo olekanitsidwa ndi khansa amatha kuyenda ndi zotuluka za m'mimba ndikupanga metastases mu chiwindi ndi mapapu.

Zoyambitsa ndi Zoopsa

Zomwe zimayambitsa khansa ya pancreatic sizinakhazikitsidwe, ngakhale patadutsa zaka zambiri. Amakhulupirira kuti kufalikira kwa matenda oyipa pakati pa anthu kumalumikizidwa ndi kuwonongeka kwa zochitika zachilengedwe padziko lonse lapansi, kuchuluka kwa mowa, makamaka mowa wotsika, kadyedwe kosagwirizana ndi kuchepa kwa kuchuluka kwa moyo.

Pogwira ntchito ndi asbestos, kusamala kwa chitetezo kuyenera kuonedwa, popeza mankhwalawa amachititsa kuti pakhale ma carcinogenic omwe amapangitsa khansa.

Pakadali pano pali malingaliro angapo asayansi ofotokoza zomwe zimayambitsa khansa. Zonsezi ndizokhazikitsidwa ndikuwonongeka kwa kapangidwe ka DNA, chifukwa chomwe oncogene adayambitsa. Izi zimapangitsa kuti maselo osakhazikika omwe amapanga chotupa.

Pali zinthu zakunja ndi zamkati zomwe zikuthandizira kuyambika kwa khansa. Choyamba, ndikudziwika za kubadwa kwa chibadwa, pamene thupi lachepetsa mphamvu yobwezeretsanso DNA kapena chitetezo chokwanira pa oncology.

Zina mwangozi zakunja ndizophatikizira izi:

• irradiation, kuphatikizapo ultraviolet;
• anasamutsa opareshoni yam'mimba;
• kuledzera ndi zinthu zovulaza - mafuta, asbesto, ndi ena;
• shuga mellitus, makamaka mtundu 1;
• chakudya chopanda malire ndi kuchuluka kwa nyama yofiira ndi mafuta m'zakudya.

Ndizofunikiranso kudziwa kuti pali ubale ndi mtundu wa anthu: azungu ndi aku Asia amadwala khansa ya kapamba nthawi zambiri kuposa anthu aku Africa. Nthawi zambiri, zomwe zimayambitsa mkati ndi kunja zimakhala zosamveka bwino kwambiri kotero kuti sizingatheke kudziwa kutsogola kwawo.

Zizindikiro

Zizindikiro za khansa ya pancreatic koyambirira ndikosowa kwambiri. Nthawi zina pokhapokha wodwala amatha kuwona kupweteka kwapakati pamimba komanso kuwonjezeka pang'ono kwa kutentha kwa thupi. Nthawi zina, chizindikiro choyamba ndi chikaso pakhungu.

Zizindikiro zoyambirira za khansa ya pancreatic zimawoneka ngati chotupa chikakamiza ziwalo zoyandikana nawo kapena chikamera mwa icho. Nthawi zina, motsutsana ndi maziko azaumoyo wathunthu, kukula kwa kapamba kapamba kapena chifuwa chachikulu cha shuga kumadziwika. Pa nthawi yowunikira, kupezeka kwa chotupa kwapezeka, kukula komwe kunayambitsa kuphwanya kutulutsa kwa pancreatic madzi. Zomwe zimayambitsa matenda a shuga pamenepa ndi kugonjetsedwa kwa zisumbu za Langerans, kupanga insulin ya mahomoni.

Kutengera gawo lomwe gawo la chotupacho chilimo, Zizindikiro zimasiyana. Chifukwa chake, mutu wa nduluyo ukawonongeka, chimbudzi chachikulu cha kapamba chimatsekeka, ndipo bile simalowa m'matumbo kwathunthu. Chifukwa chake, chikaso cha sclera cha maso ndi khungu chimawonedwa, ndipo mkodzo umakhala ndi mtundu wakuda.

Ngati chotupacho chapezeka m'thupi kapena mchira, zizindikiro zoyambirira zimawonekera pambuyo pa metastasis. Chizindikiro chachikulu ndi kupweteka pamimba, pansi pa nthiti, zomwe zimabweza. Matenda a ululu amayamba kuchuluka mukatha kudya komanso kugona. Ndikothekanso kutsitsa ululu pamene thupi lazungulira.

Carcinoma yopita patsogolo imawonetsedwa ndi nseru, kufooka, kusowa chilimbikitso ndi kunenepa. Chifukwa cha zowonongeka zazing'onoting'ono za Langerans, kupanga mahomoni mu kapamba kumawonjezeka, kotero wodwalayo amatha kusokonezeka ndi kukokana kwa minyewa, chizungulire komanso chopondapo.

Masiteji

Pali magawo anayi a khansa ya pancreatic, iliyonse yomwe imadziwika ndi mawonekedwe ake achipatala komanso njira zamankhwala:

Matenda a insulinoma

• Gawo loyamba. Chotupa sichidutsa masentimita awiri ndipo sichitha kupitirira malire a gland;
• 2 siteji. Maselo owopsa ayamba kufalikira ndikusokoneza mucous membrane wa ziwalo zapafupi ndi makapisozi am'malo am'mimba;
• 3 siteji. Ma metastases amalowa mkati mwa ziwalo zomwe zimakhudzidwa;
• 4 siteji. Chotupacho chimafika pamlingo waukulu, kuchuluka kwa ma metastase kumawonjezeka kwambiri kotero kuti ziwalo zakutali zimakhudzidwa ndi njira yothandizira, ndipo ubongo umavutika.

Palinso gawo lotchedwa zero, lowongolera kwambiri. Sizigwirizana ndi oncology, chifukwa maselo owonongeka ali kokha kumtunda wapamwamba wa epithelial. Komabe, mothandizidwa ndi zinthu zoyipa, maselo amenewa amatha kudzilimbitsa.

Gawo lachinayi, kudwala khansa kumadziwika ndi ma metastases angapo, ndipo chiwindi chimakhala chimakhudzidwa nthawi zonse

Kuzindikira chotupa cha digiri yoyamba ndikosiyana ndipo sikupanga oposa 5% a milandu. Komabe, kudalirika kwa khansa ya kapamba, komwe kumakhudza gawo laling'ono la chiwalo, ndikabwino kwambiri. Ndi chithandizo chokwanira komanso chokwanira, ndikotheka kukwaniritsa kupulumuka kwa odwala azaka zisanu.

Kuyambira gawo lachiwiri, chithunzi cha chipatala chimakhala chowoneka bwino komanso chatsatanetsatane. Nthawi zambiri, amafanana ndi matenda a shuga.

Pamagawo a 2-3, zizindikiro zingapo zamakhalidwe zimawonedwa:

• mbali zonse zitatu, kukula kwa m'mimba kumawonjezeka;
• Kuchepetsa thupi ndi chakudya chokhazikika kumapezeka pafupifupi odwala onse omwe amapezeka ndi khansa;
• 5 mwa odwala 10 ali ndi mseru komanso ammiyendo;
• kutopa, ulesi zimachitika 25% milandu.

Chotupa cha thupi kapena mchira wa chithokomiro chikuwonetsedwa ndi zizindikiro izi:

• kumverera kwa ludzu losatha ndi pakamwa lowuma;
• kuchepa kwakukonda;
• pallor ndi zotupa pakhungu;
• red lilime;
• kusuntha kwa kusamba ndi kuchepa kwa kugonana;
• kuwoneka kwa mikwingwirima pakhungu popanda chifukwa chodziwika bwino komanso kuchiritsa kwa mabala kwa nthawi yayitali.

Gawo lachinayi, zizindikirozi zimatchulidwanso, chifukwa matendawa amafalikira ku ziwalo zina. Odwala amatha kudandaula za kuyaka khungu ndi kupuma movutikira. Chifukwa cha kuchuluka kwa madzi am'madzi, m'mimba mumachulukanso, mkodzo womwe umatulutsidwa umakhala mumdima, ndipo chopondacho chimapeza mtundu wowala bwino.

Insulinoma imatha kukhala yopanda pake kapena yoyipa, kubisa insulin mosalamulirika

Kuphatikiza apo, tint yachikasu sichiwoneka pakhungu pokha, komanso zimagwira pakamwa. Nthawi zambiri pamakhala magazi amkamwa, omwe sanali m'mbuyomu. Mapapu akamagwira ntchito yoyipa, kupuma movutikira ndi chifuwa kuoneka - poyamba zizindikirazi zimavutitsa munthuyo atachita masewera olimbitsa thupi, koma kenako amadzuka ndikupuma.

Zotsatira zoyipa kwambiri zimakhala ndi metastases ya ubongo. Pankhaniyi, zithunzi zowoneka bwino komanso kumva zimatha kuchepa, mgwirizano ungasokonekere. Khalidwe losakwanira ndi chisokonezo nthawi zina zimawonedwa.

Ngati chithandizo cha khansa ya kapamba sichinachitike, ndiye kuti pa 4th mavuto monga aimpso ndi chiwindi kulephera, magazi, kutsekeka kwamatumbo ndikuwonda kwambiri, mpaka kutopa kwathunthu, kumatha. Ngati zovuta zingapo zimawonekera, kuthekera kwa kumwalira kwa wodwalayo kumachulukana kangapo.

Kodi ndikhala nthawi yayitali bwanji nditazindikira kuti ndimadwala khansa 4? Funsoli limayamba kufunsidwa ndi wodwala. Yankho lake limatengera kufalikira kwa metastase komanso komwe ziwalo zimakhudzidwira. Pafupifupi, anthu amakhala miyezi inanso isanu ndi umodzi, koma nthawi imeneyi imatha kupitilizidwa kawiri, chifukwa cha kuthekera kwa thupi kulimbana ndi matendawa. Mutha kudziwa za njira zamankhwala ndi zakudya za odwala omwe ali ndi khansa ya 4th degree pano.

Zizindikiro

Kuzindikira khansa ya pancreatic kumayamba ndi kuwunika komanso kufufuza mwatsatanetsatane wodwala. Magazi, mkodzo ndi ndowe zimayesedwa, komanso mayeso amodzi kapena angapo otsatirawa:

• radiograph of the kumtunda kwam'mimba thirakiti, kapena njira ya barium porridge. Imachitika pambuyo poti wodwala amwa madzi am'madzi a barium sulfate, omwe amawonetsa mizere ya ziwalo pansi pa radiation ya x-ray;
• MRI kapena CT. Ma tomography ophatikizidwa amatha kuthandizidwanso pogwiritsa ntchito njira ina yosiyana ndi yomwe imaperekedwa kwa wodwala musanayankhe;
• Ultrasound imakhala yothandiza kwambiri pofufuza anthu ocheperako, chifukwa mafuta omwe ali ndi mafuta onenepa amatha kusintha zolakwika;
• ERCP, endoscopic retrograde cholangiopancreatography imayikidwa pokhapokha njira zakale sizothandiza. Izi ndichifukwa chazovuta komanso zowononga za njirayi, zomwe zimatha kuchitika kuchipatala pansi pa opaleshoni yam'nyumba;
• PTCA, percutaneous translate coronary angioplasty ndikofunikira kudziwa malo omwe kutsekeka kwa chiwonetsero cha chiwindi;
• angiography imagwiritsidwa ntchito kuti iwone kukula kwa neoplasm, kuchuluka kwa kuchuluka kwake, mkati mwa njirayi, kulumikizana kwa chotupa ndi zombo zazikulu kumakhazikitsidwa;
• biopsy ya mdera lomwe lakhudzidwa kuti liwunikenso.

Oncology yowerengedwa tomography imagwiritsidwa ntchito nthawi zambiri kuposa MRI, chifukwa imapereka zotsatira zolondola kwambiri kuwunika kuchuluka kwa njira ya pathological pamisempha yoyandikana ndi ma lymph node. Njira imeneyi ndi yofunika kwambiri ngati chotupa chapezeka mchira wa chiwalo.

Chithandizo

Momwe angachitire ndi kapamba zimatengera zotsatira za mayeso, mtundu wa khansa komanso mkhalidwe waumoyo wodwala. Ngati chotupa sichikulitsa kupitirira chiwalo, ndiye kuti chitha kuchithetsa. Monga lamulo, chithandizo chotere nthawi zambiri chimaphatikizidwa ndi chemotherapy ndi radiation.

Kodi khansa ya kapamba ingachiritsidwe ndi njira yokhazikika monga kuchotsedwa kwa opaleshoni? Pancreatoduodenal resection, kapena opaleshoni ya Whipple, ndiye muyeso wa golide pochiza matenda a oncology ndikubwezeretsanso chiyembekezo chakuchira odwala omwe m'mbuyomu amadziwika kuti sangathe.

Chemotherapy ikhoza kuchitika pang'onopang'ono komanso kuchipatala. Zimatengera momwe wodwalayo alili komanso kulolera kwake mankhwala omwe amagwiritsidwa ntchito.

Kutalika kwa ntchito ndi pafupifupi maola 4-5, pomwe mutu wa m'mimba ndi chotupa chachikulu umachotsedwa. Gawo la ndulu ya bile, chikhodzodzo, ndi gawo la duodenum lomwe limakhala ndimitsempha yamagazi yodziwika bwino ndi mutu wa kapamba limapangidwanso.

Malinga ndi umboni, madokotala a opaleshoni amasankha pakuchotsa mbali ina yam'mimba, omentum ndi lymph node. Ngati chotupa chafalikira kumitsempha ya chiwindi, ndikofunikira kuchita gawo limodzi latsopanolo ndikumanganso ziwiya pambuyo pake.

Gawo lomaliza la PDR ndikupanga mafupa amkati am'mimba kapamba ndi matumbo ang'onoang'ono, matumbo otsala a bile ndi matumbo, komanso matumbo ndi m'mimba. Pomaliza, machubu apadera amabweretsedwa m'matumbo a wodwalayo kuti atuluze zotulutsa pakukonzanso koyambirira.

Ngati kuwonongeka kwa thupi kapena mchira wa chithokomiro, kupindika kwathunthu kumachitika - kuchotsedwa kwathunthu kwa kapamba ndi gawo la duodenum 12. Ngati chotupa sichitha kuchotsedwa, ndiye kuti ntchito yodutsa kapena yoluma imachitika, pomwe matumbo kapena ndulu za bile zimatsekeka.

Njira ya chemotherapy imagwiritsidwa ntchito mosinthana, pomwe thupi limabwezeretseka. Mankhwala ambiri amalowetsedwa mu mtsempha, koma ena amawapangira pakamwa.

Tramadol ndi imodzi mwama mankhwala othandizika kupweteka, omwe amakhudza kwambiri malingaliro ndi thanzi la wodwalayo

Pali njira zambiri "zopewera" kupweteka kwa khansa ya kapamba. Mankhwala osagwiritsa ntchito mankhwala ochepetsa mphamvu ya anti-yotupa komanso ma opioids amathandiza odwala ena (Tramadol, Tramal). Nthawi zina, sizingatheke kuchotsa mikwingwirima yopweteka mothandizidwa ndi mankhwala, kenako madokotala amatengera njira zina.

Mwachitsanzo, kudzera mu singano yayitali yomwe imalowetsedwa m'matumbo am'mimba, jekeseni wa mowa amapangidwa pafupi ndi ena a mitsempha. Kuledzera kotereku nthawi zambiri kumapereka zotsatira zake ndipo sikuyambitsa mavuto.

Kuchotsa pang'ono kwa mitsempha ya peritoneal ndikothekanso kotchinga kupweteka. Mukachiza ndi poizoniyu womwe umachepetsa kukula kwa chotupacho, ululu umachepa.

Nthawi zina, kuyikapo catheter wochita kufunikira ndikofunikira, komwe kumatsimikizira kuti mankhwalawa amapezeka mosavuta.

Kupulumuka ndi kufa

Momwe matendawa amathandizira pancreatic malignancies amakhala opanda vuto, chifukwa matendawa amayambiranso. Kukwaniritsidwa kwamankhwala amakono ndi matekinoloje aposachedwa sanalole kuchiritsa khansa kwathunthu. Ichi ndichifukwa chake simuyenera kuzengereza kukaonana ndi dokotala ngati mukukayikira kuti vuto la m'mimba lothandiza kugaya. Kuyang'ana kapamba kumalimbikitsidwa ndikuwoneka pafupipafupi kwa kupweteka kwa chapamwamba cha hypochondrium ndi zina zodziwika.

Oposa 80% ya odwala omwe amafunafuna chithandizo pambuyo pake a oncology amafa m'chaka choyamba atazindikira. Pafupifupi kotala la odwala onse amakhala ndi moyo mpaka chaka chimodzi. Khansa ikapezeka koyambirira, kupulumuka kumaposa 20%.

Zaka zisanu atatha kuzindikira, kuchuluka kwa kupulumuka kumatsitsidwa pang'onopang'ono, ndipo ndi 1-2% yokha ya odwala omwe amakhala ndi zaka 10. Kuyembekeza moyo kumachitika chifukwa cha zaka, thanzi komanso mawonekedwe amunthu. Odwala omwe ali ndi zotupa zosagwira, kufa kumachitika pakadutsa miyezi 6 mpaka 12, ndipo kupezeka kwa kuchuluka kwa metastases kumachepetsa kutalika kwa moyo pafupifupi miyezi isanu ndi umodzi.

Njira zabwino kwambiri zopewera kupewa matenda a kapamba ndichakudya choyenera, kusapezeka kwa zizolowezi zoyipa (kusuta, mowa) komanso maphunziro akuthupi mwadongosolo. Ndipo ngati pali zovuta zina, ndikulimbikitsidwa kukayezetsa. Khalani athanzi!