Kokoram Cachexia: So yɛbɛka eyi ho asɛm?

Sɛ wo anaa obi a wunim no wɔ kokoram a, ebia woahyɛ no nsow sɛ bere kɔ so no, wɔn nipadua ayɛ teateaa na mpo ɛsono sɛnea ɛte. Nnipa pii susuw sɛ eyi yɛ kokoram no fã bi anaasɛ ayaresa no mu nsunsuanso bɔne bi kɛkɛ. Ebia ɛno bɛyɛ nokware akodu baabi. Nanso, ɛtɔ mmere bi a saa tebea yi betumi ayɛ biribi a emu dɔ, tebea a wɔfrɛ no kokoram cachexia . Momma yɛnka eyi ho asɛm nkɔ akyiri nnɛ, efisɛ ɛka kokoram ayarefo asetra ne sɛnea wɔyɛ wɔn ade wɔ ayaresa ho.

Dɛn ne Kokoram Cachexia?

Sɛ yɛbɛka no tiawa a, kokoram cachexia yɛ adesɛe a emu yɛ den a kokoram de ba. Eyi ne bere a wohwere nnompe mu ntini ne nipadua mu srade dodow bi a ɛho hia . Ɛnyɛ sɛ wobɛtew wo mu duru so nko, na mmom ntini a ɛma ahoɔden nso. Saa mu duru a ɛso tew yi betumi asesa wo honam ani hwɛbea, ama wo nkate mu ayɛ wo yaw, na ama ayɛ den mpo sɛ wubegyina kokoram ayaresa ano. Ebetumi aka w’asetra pa nso na ɛtɔ mmere bi a asiw sɛnea wutumi gyina kokoram ano.

Abenfoɔ ka sɛ saa tebea yi ka kokoram ayarefoɔ bɛyɛ 50% . Afei nso, wobetumi ahu wɔ nnipa bɛyɛ 75% a wɔn kokoram atrɛw, kyerɛ sɛ, wɔ Stage IV kokoram mu. Awerɛhosɛm ne sɛ, saa tebea yi na ɛma kokoram a wowuwu no mu 25% .

Ɛwom sɛ tebea yi betumi aba wɔ kokoram biara mu de, nanso ɛtaa ba nnipa a wɔwɔ kokoram ahorow yi mu titiriw:

• Kokoram a ɛwɔ akyi berɛmo mu
• Ahurututu mu kokoram
• Melanoma, honam ani kokoram bi
• Kokoram a ɛwɔ dwensɔtwaa mu

Ɛwom sɛ nnuruyɛfo ntumi nsa kokoram cachexia koraa de, nanso ayaresa ahorow bɔ mmɔden sɛ ɛbɛma aduan dodow a wudi no akɔ soro, titiriw na wɔde wɔn adwene si nnuan a protein pii wom na ahoɔdennuru pii wom so .

Dɛn ne kokoram cachexia ho sɛnkyerɛnne ahorow?

Saa tebea yi ho sɛnkyerɛnne titiriw a ɛda adi kɛse ne sɛ wobɛtew wo nipadua mu duru nyinaa mu bɛboro 10% wɔ asram 6 kosi 12 a atwam no mu . Nea ɛka eyi ho ne ntini ne srade nyinaa. Sɛ ɛno da nkyɛn a, ebia sɛnkyerɛnne afoforo pii wɔ hɔ:

• Ɔbrɛ ne mmerɛwyɛ a ɛtra so: Ebia wobɛte nka sɛ wunni ahoɔden a ɛdɔɔso a wode bɛyɛ wo da biara da nnwuma, ahwɛ w’abusua, anaa mpo wobɛyɛ w’ankasa nnwuma. Ɛte sɛ nea wo nni nkwa.
• Ntini a wɔsɛe no: Nnuruyɛfo nso frɛ eyi ntini a wɔsɛe no anaa ntini a ɛyɛ mmerɛw . Eyi ne ntini a ɛyera ne ntini a wɔsɛe no.
• Anorexia: Eyi ne bere a wohwere ɔpɛ a wowɔ sɛ wubedidi nyinaa, wonte nka sɛ ɔkɔm de wo. Ɛtɔ da a, wompɛ sɛ wususuw aduan ho mpo. Nanso eyi yɛ soronko wɔ adidi mu haw a wɔfrɛ no anorexia nervosa a yɛate ho asɛm no ho.
• Mogya a ɛtɔ kɔ nipadua mu: Ebia wubenya mogya a ɛtɔ wo mu efisɛ wo nipadua no, sɛnea ɛyɛ ɔfe ho biribi no, ɛma protein bi a ɛka mogya mu nkwammoaa kɔkɔɔ a wɔyɛ no.
• Nyarewa a ɛtaa ba: Kokoram cachexia betumi ama wo nipadua mu ahoɔden a ɛko tia nyarewa no ayɛ mmerɛw, na ama entumi nko ntia nyarewa. Eyi betumi ama woanya ɔyare mmoawa kɛse.

Dɛn nti na kokoram cachexia yi ba?

Nneɛma pii nti na ɛte saa. Kokoram ma wo nipadua mu nneɛma a ɛsakra ntɛmntɛm . Eyi kyerɛ sɛ wo nipadua hia ahoɔden pii fi aduan mu. Bere koro no ara mu no, kokoram ne kokoram ayaresa nso betumi atew w’akɔnnɔ so. Nea efi mu ba ne sɛ wunnidi kakraa bi bere a wo nipadua hia aduannuru pii no.

Ntease ahorow bi a ɛka tebea yi pɔtee ni:

• Cytokines ahorow bi: Cytokines yɛ nnuru a ɛhwɛ sɛnea yɛn nipadua no mu tumi a ɛko tia nyarewa no yɛ n’ade wɔ ntuafo te sɛ mmoawa ho ne bere a ɛyɛ. Wɔ kokoram cachexia mu no, wo nipadua mu tumi a ɛko tia nyarewa no ma cytokines ahorow bi fi hɔ. Eyinom ma ɔfe, na ɛma wo nipadua no mu paapae srade ne ntini mu ntɛmntɛm. Kokoram nso ma ɔfe, na saa cytokines yi betumi ama saa ɔfe no ayɛ kɛse.
• Kokoram ho sɛnkyerɛnne ne nea efi mu ba: Ɛyaw, akisikuru, ne ɔfe a kokoram de ba no betumi ama woadidi kakraa bi. Afei nso, kokoram a wubenya no betumi ama woate adwenemhaw nka na w’ani nnye aduan ho.
• Kokoram ayaresa mu nsunsuanso bɔne: Nneɛma te sɛ oprehyɛn, mframa a wɔde sa yare , nnuru a wɔde sa yare , ne opioid nnuru bi a wɔde kum ɛyaw betumi ama ayɛ den sɛ ɔbɛmene anaasɛ asiw nipadua no kwan sɛ ɛbɛtwetwe aduannuru.
• Insulin a ɛko tia: Eyi kyerɛ sɛ wo ntini ne srade nkwammoaa ntumi nyɛ insulin ho adwuma yiye. Saa insulin a ɛko tia yi a ɛba wɔ cachexia mu no betumi ama ntini asɛe kɛse.
• Protein a ɛkɔ soro: Protein a ɛsakra ne ɔkwan a wɔfa so de protein foforo si protein dedaw a ɛwɔ wo nkwammoaa mu ananmu. Eyi nam protein a ɛsɛe so na ɛba . Wɔ kokoram cachexia mu no, protein ahorow a ɛwɔ nkwammoaa mu no sɛe ntɛmntɛm dodo sɛ protein foforo besi ananmu. Eyi nso ma ntini sɛe.

Dɛn ne nsɛnnennen a ɛwɔ kokoram cachexia mu?

Saa tebea yi betumi de nkwa ato asiane mu mpo. Sɛ nhwɛso no, susuw cachexia a ɛyɛ ade titiriw a ɛde owu ba ayarefo a wɔwɔ akisikuru a ɛyɛ den a ɛkɔ mmeae afoforo te sɛ ahurututu anaa prostate kokoram mu, bere a kokoram no trɛw kɔ nipadua no afã afoforo no ho hwɛ.

Nsɛnnennen afoforo betumi ayɛ:

• Nkɛntɛnso a ɛwɔ kokoram ayaresa so: Wo nipadua hia ntini ne srade na ama ne ho atɔ wo wɔ kokoram ayaresa mu. Eyinom a wobɛhwere no betumi aka sɛnea wubetumi anya kokoram ayaresa. Ebia wobɛhwere ahoɔden a wode begyina ayaresa no ano mpo.
• Adwene mu akwahosan ho nsɛm: Sɛ wohu sɛ wowɔ kokoram cachexia a, ebetumi akyerɛ sɛ aka asram kakraa bi pɛ a wode bɛtra ase. Saa nimdeɛ yi betumi ama woate dadwen ne adwenemhaw kɛse nka.
• Nkɛntɛnso a enya wɔ abusuafo ne nnamfo so: Tebea yi nso betumi ama wo ne w’abusuafo ne wo nnamfo ntam abusuabɔ ayɛ basaa. Ɛnyɛ sɛ wuhu nsakrae wɔ wo nipadua mu a, wubetumi ate awerɛhow nka, na mmom ebia wɔn a wɔhwɛ wo no nso bedwen w’akwahosan ho kɛse. Nhwehwɛmu ahorow ada no adi sɛ, sɛ abusua no mufo hu saa sɛnkyerɛnne ahorow yi a, ebia wɔbɛhyɛ ɔyarefo no ma wadidi, esiane ɔdɔ nti mpo, na ɛno betumi ama ntawntawdi a ɛho nhia aba na ama tebea a ɛyɛ den dedaw no ayɛ kɛse.

Fa no sɛ, sɛ abusua muni bi yɛ teateaa esiane kokoram nti na ontumi nnidi a, ɛyɛ ade a ɛfata sɛ wosi so dua sɛ, "Mesrɛ wo di kakra bio, mesrɛ wo di eyi nso." Nanso ɛno betumi ahaw ɔyarefo no kɛse mpo.

Ɔkwan bɛn so na nnuruyɛfo hu kokoram cachexia?

Wo oncologist ne/anaasɛ palliative care kuw no bɛhwehwɛ wo nipadua mu. Ebia wɔbɛka akyerɛ wo sɛ hyehyɛ nsɛmmisa kratasin bi a ɛfa w’adidi ho, na wobetumi nso ayɛ sɔhwɛ ahorow de asusuw wo ahoɔden ne wo ntini ahoɔden nyinaa.

Nea ɛka ho no, wobetumi akamfo akyerɛ sɛ wɔnyɛ CT scan anaa DXA scan . Saa DXA scan yi susuw ntini a ɛyɛ mmerɛw dodow a ɛwɔ wo nsa ne wo nan mu. Ebetumi ama oncologist no anya wo ntini mu duru ho adwene. Nea ebefi nhwehwɛmu ahorow yi mu aba no bɛboa oduruyɛfo no ma wahu baabi a yare no akɔ.

Dɛn ne kokoram cachexia no fã ahorow?

Kokoram cachexia no afã atitiriw abiɛsa na ɛwɔ hɔ:

• Pre-cachexia: Wɔ saa bere yi mu no, wo mu duru so retew ɛmfa ho sɛ wudidi yiye no. Nanso, woanhwere wo nipadua mu duru nyinaa mu bɛboro 5% wɔ asram 6-12 a atwam no mu. Sɛ woyɛ kɛse mmoroso a, ebia wɔrenhu saa mu duru a ɛso tew yi, nanso nhwehwɛmu ahorow kyerɛ sɛ nsakrae aba wɔ nipadua mu nneɛma a ɛsakra mu na wo ntini mu srade ka ho.
• Cachexia a ɛwɔ nipadua no mu:Seesei, wo nipadua mu duru so atew bɛboro 5% wɔ asram 6-12 a atwam no mu, anaasɛ wo mu duru so atew bɛboro 2%, na wo nipadua mu duru (BMI) nnu 20kg/m2. Ebia sɔhwɛ ahorow bɛkyerɛ sɛnkyerɛnne ahorow a ɛkyerɛ sɛ ntini ahorow no sɛe na ɛho ayɛ hyew.
• Refractory cachexia: Saa bere yi de, wo mu duru so atew bɛboro 20% na wo BMI nnu 27 kg/m2 (eyi betumi ayɛ te sɛ nea ɛkorɔn, nanso ɛyɛ den bere a wɔde ka ho ne wo mu duru a ɛso tew kɛse no). Wo mu duru a ɛso tew no betumi ama wo ho atɔ wo koraa na ama ayɛ den ama wo sɛ wubegyina kokoram ayaresa ano. Wɔ tebea horow bi mu no, kokoram ayaresa betumi agyae adwumayɛ.

Dɛn ne ayaresa ahorow a wɔde sa kokoram cachexia?

W'ayaresa no bɛtwe adwene asi akwan a wobɛfa so ama aduannuru atu mpɔn so titiriw . Sɛ nhwɛso no, ebia wo kokoram kuw ne kuw a wɔhwɛ wɔn a wɔyare a ɛma obi ho tɔ no bɛkamfo nneɛma te sɛ:

• Didi yiye: Fa w’adwene si nnuan nketenkete ne nnuan nketenkete a ahoɔdennuru, srade, ne protein pii wom a wubedi so . Sɛ wudi nnuan nketenkete a, ɛbɛboa wo ma woadi calories pii. Wo ne wo aduan ho ɔbenfo nkasa mfa nnuan a ɛbɛboa wo ma woanya mfaso kɛse afi aduan biara a wubedi mu ho. Ebia wɔbɛhyɛ nyansa sɛ fa nneɛma te sɛ kyiisi, bɔta, nnuaba, ne nufusu a wɔayam no yiye ka w’aduan ho.
• Sɔ nnuru a wɔde ka aduan ho hwɛ: Bisa wo oncologist anaa aduannuru ho ɔbenfo fa aduannuru a wubetumi anom anaa adi wɔ adidi ntam ho. Eyinom betumi ama wɔanya aduannuru foforo.
• Nya apɔw-mu-teɛteɛ kakra: Apɔw-mu-teɛteɛ a emu nyɛ den betumi aboa ma ntini a ɛyera no ayɛ brɛoo, nanso ɛsɛ sɛ wɔyɛ eyi wɔ nnuruyɛfo afotu ase nkutoo.
• Fa wo ho to w’aduruyɛfo kuw no so: Wo kuw a wɔhwɛ wɔn a wɔde wɔn ho to wɔn so no betumi aboa wo wɔ nneɛma te sɛ adwenemyare ne honhom fam mmoa mu. Saa mmoa no som bo kɛse saa bere yi.

So nnuru bi wɔ hɔ a wɔde sa cachexia?

Ɛnyɛ saa bere yi. Ɛwom sɛ nhwehwɛmu kyerɛ sɛ aduru bi a wɔfrɛ no megestrol acetate betumi ama aduan ho akɔnnɔ ayɛ kɛse na aboa wo ma wo mu duru ayɛ kɛse de, nanso U.S. Aduan ne Nnuru Dwumadibea (FDA) mpene so sɛ wɔmfa nsa kokoram cachexia. Wɔ tebea horow bi mu no, wo duruyɛfo betumi akyerɛw wo bere tiaa bi a wode bɛnom corticosteroid .

Dɛn na obi a ɔwɔ kokoram cachexia betumi ahwɛ kwan?

Egyina wo tebea no so ankasa. Ɛne sɛ, cachexia fã bɛn na wowɔ, kokoram fã bɛn na wowɔ Sɛ nhwɛso no, sɛ wowɔ pre-cachexia a, nsakrae a wobɛyɛ wɔ nea wudi mu no betumi ama srade ne ntini a wobɛtew no ayɛ brɛoo. Nanso, awerɛhosɛm ne sɛ, sɛ woma dodow a wudi no yɛ kɛse mpo a, wuntumi nsiw nea woahwere no ano koraa anaasɛ wunnya ntini ne srade a ayera no bio.

Sɛ wowɔ kokoram ne cachexia a akɔ anim, anaasɛ cachexia a ɛnyɛ ayaresa (refractory cachexia) a, ebia wo kokoram ho ɔyaresafo bɛka sɛ worebɛn w’asetra awiei. Sɛ wɔresa wo yare wɔ cachexia ho a, w’aduruyɛfo kuw no betumi ama wo nsɛm a eye sen biara a ɛfa nea wobɛhwɛ kwan ho.

Dɛn ne obi a ɔwɔ kokoram cachexia nkwa nna?

Nkwa nna gu ahorow wɔ onipa biara mu. Ɛwom sɛ kokoram cachexia taa ka nnipa a wɔwɔ kokoram a emu yɛ den de, nanso wubetumi anya sɛnkyerɛnne ahorow a edi cachexia anim wɔ wo kokoram no fã biara mu. Sɛ ɛba saa a, wubetumi de nsɛnnennen te sɛ kokoram ne cachexia atra ase mfe pii. Nanso, nhwehwɛmu kyerɛ sɛ sɛ wowɔ refractory cancer cachexia, a ɛyɛ kokoram bi a ɛnyɛ ayaresa ho biribi a, ɛtew hokwan a wowɔ sɛ wubenya kokoram no so bɛyɛ 30%.

Kokoram cachexia ba efisɛ yare no ma wo nipadua mu nneɛma a ɛsakra no de ahoɔden a efi aduan mu di dwuma ntɛmntɛm sen sɛnea ɛte daa. Nea ɛka ho no, kokoram ne kokoram ayaresa betumi asiw wo kwan sɛ wubedidi yiye. Ne saa nti, wo mu duru ne wo ntini mu duru betumi atew kɛse, na aka wo honam ani hwɛbea (ne sɛnea wubu wo ho), w’ahoɔden, ne w’asetra pa.

Ɛwom sɛ wonni aduruyɛ pɔtee biara a wɔde sa kokoram cachexia de, nanso nneɛma bi wɔ hɔ a wubetumi ayɛ de aboa ma woadi ne sɛnkyerɛnne ahorow ho dwuma. Sɛ worehyia eyi a, bisa wo kokoram hwɛ kuw no ma wɔmmoa wo. Wɔte nsɛnnennen a ɛwɔ kokoram cachexia asetra mu ase na wɔbɛyɛ nea wobetumi biara de aboa wo ma woadi ho dwuma.

Nneɛma a ɛho hia sen biara a ɛsɛ sɛ wokae (Take-Home Message) .

• Kokoram cachexia nyɛ kokoram no ankasa fã, na mmom ɛyɛ tebea soronko a ɛsɛ sɛ wodi ho dwuma. Sɛ wo anaa wo dɔfo bi mu duru so tew, aduan ho akɔnnɔ reyera, anaa ɔbrɛ kɛse a, wo ne wo duruyɛfo nka ho asɛm.
• Aduan pa ho hia paa. Aduan nketenkete a wɔtaa di a calories ne protein pii wom, ne nnuruyɛfo afotu a wobɛhwehwɛ wɔ aduannuru a wɔde ma ho no betumi aboa ma wɔadi tebea yi ho dwuma.
• Ɛnyɛ wo nko ara. Oncologists, ayarehwɛfo, aduannuru ho abenfo, ne palliative care akuw wɔ hɔ a wɔbɛboa wo wɔ akwantu yi mu. Nya wɔn mmoa.
• Adwene mu akwahosan nso ho hia paa. Nea ɛka nipadua mu nsakrae ho no, adwenemhaw nso betumi aba. Wo ne w’aduruyɛ kuw no nkasa mfa eyi ho na nya mmoa a ɛho hia.

Kokoram a wɔbɛko atia no nyɛ mmerɛw. Ɛyɛ den sɛ wubegyina nsɛnnennen afoforo te sɛ eyinom ano. Nanso, sɛ wonya nhumu na wɔboa no yiye a, wobetumi adi nsɛnnennen yi so.

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