Ke hopohopo nei hoʻi ʻoe no kou ʻōpū? E kamaʻilio kākou e pili ana i kēia maʻi kanesa laha ʻole (ʻO ke Kanesa ʻo Appendix)!

Ke lohe ʻoe i ka huaʻōlelo kanesa appendix, makaʻu iki paha ʻoe, ʻeā? He maʻi laha ʻole ia. Akā, he mea nui e makaʻala iki i ia mea. E nānā kākou i ke ʻano o ka kanesa appendix, pehea e ulu ai, he aha nā hōʻailona, ​​a he aha nā lāʻau lapaʻau.

I ka ʻōlelo maʻalahi, ʻo ke kanesa appendix ka wā e loli ai nā pūnaewele i loko o kāu appendix a hoʻomaka e ulu wikiwiki a me ke kāohi ʻole ʻia. Ua kapa ʻia hoʻi kēia he kanesa appendix .

I kēia manawa, ke noʻonoʻo nei paha ʻoe i ke ʻano o ka appendix. He ʻāpana ia o kāu ʻōnaehana hoʻoheheʻe . ʻO ka pololei, he ʻeke liʻiliʻi ia e like me ka paipu ma ka ʻaoʻao ʻākau o kou ʻōpū, kokoke i kahi e hui ai ka ʻōpū liʻiliʻi a me ka ʻōpū nui. ʻAʻole maopopo loa i nā kānaka ʻepekema ka hana a ka appendix. Manaʻo kekahi he kōkua ia i kā mākou ʻōnaehana pale . Wahi a kekahi he ʻano kino wale nō ia ʻaʻole e lawelawe maikaʻi iā mākou.

He aha nā ʻano maʻi ʻaʻai appendix?

ʻAe, i kēia manawa e nānā kākou i nā ʻano maʻi kanesa e hiki ke ulu i loko o ka appendix. ʻOiaʻiʻo, aia kekahi mau ʻano o nā puʻupuʻu e hiki ke ulu i loko o ka appendix, ʻo nā benign a me nā malignant . ʻO kēia mau puʻupuʻu kanesa ka mea weliweli loa no ka mea hiki iā lākou ke ulu a laha ma ke kino. Hoʻokaʻawale nā ​​​​kauka i kēia mau maʻi kanesa appendix ma muli o ke ʻano o nā cell mai kahi e hoʻomaka ai ke kanesa. ʻElua mau ʻano nui:

• ʻO ka adenocarcinoma appendiceal
• Nā puʻupuʻu neuroendocrine

ʻO ka Adenocarcinoma Appendiceal (Nā Tumor Epithelial)

ʻO ka hapa nui o nā maʻi ʻaʻai appendix he ʻano adenocarcinoma . Hoʻomaka kēia mau mea i loko o ka ʻiʻo glandular e uhi ana i ko kākou kino. Aia kekahi mau ʻano ʻē aʻe o kēia ʻano:

• ʻAdenocarcinoma mucinous: Hoʻomaka kēia ʻano ma ka papa o loko o ka appendix. Hoʻopuka lākou i kahi mea mānoanoa i kapa ʻia ʻo mucin , i loaʻa i loko o ka mucus. ʻOiai hiki i kēia mau puʻupuʻu ke pālahalaha, ʻaʻole lākou e pālahalaha ma waho o ka ʻōpū.
• ʻO ka adenocarcinoma ʻano colonic (nonmucinous): Hoʻomohala kēia mau puʻupuʻu ma kahi kokoke i ka ʻaoʻao haʻahaʻa o ka appendix. Hana lākou e like me ke kanesa colon, a ua like loa nā hōʻailona.
• ʻO ka adenocarcinoma o ke kelepona apo hōʻailona:He mea kākaʻikahi loa kēia, akā hiki ke ulu i kekahi manawa ma ka appendix. Hoʻopuka kēia mau hunaola kanesa a mālama i ka nui o ka mucin. Loaʻa iā lākou ko lākou inoa no ka mea ke nānā ʻia ma lalo o kahi microscope, ua like kēia mau hunaola me nā apo.
• ʻO ka adenocarcinoma cell goblet: He ʻano adenocarcinoma kakaikahi loa kēia. Loaʻa iā ia kekahi mau hiʻohiʻona o nā tumors neuroendocrine.

Nā Puʻupuʻu Neuroendocrine Appendiceal (Nā Puʻupuʻu Carcinoid)

Hoʻomohala nā ʻōpū neuroendocrine i loko o kahi ʻano cell kūikawā i kapa ʻia ʻo neuroendocrine cells . Loaʻa i kēia mau cell nā hōʻailona mai kā mākou ʻōnaehana nerve a hoʻokuʻu i nā hormones. ʻO ka hapa nui o ka manawa, ulu mālie loa kēia ʻano ʻōpū.

Pehea ka maʻamau o ke kanesa o ka ʻāpiki?

ʻO ka ʻoiaʻiʻo, he maʻi laha ʻole loa ka maʻi ʻaʻai appendix. No ka laʻana, ma ʻAmelika Hui Pū ʻIa, loaʻa ka maʻi i hoʻokahi a ʻelua paha mau kānaka i hoʻokahi miliona i kēlā me kēia makahiki. ʻOi aku ka liʻiliʻi o ia ma mua o 1% o ka heluna kanaka.

He aha nā hōʻailona o ke kanesa o ka ʻāpiki?

I kekahi manawa, hiki iā ʻoe ke loaʻa i ka maʻi ʻaʻai appendix me ka ʻole o nā hōʻailona. A i ʻole, ʻaʻole paha ʻoe e ʻike i kekahi mau hōʻailona a hiki i ka laha ʻana o ka puʻupuʻu. Hiki ke ʻokoʻa kēia mau hōʻailona mai kēlā kanaka a kēia kanaka. E nānā e ʻike inā loaʻa iā ʻoe kekahi o kēia mau mea:

• ʻO ka appendicitis (ʻo ia hoʻi ka mumū a i ʻole ka maʻi o ka appendix)
• ʻO ka pehu ʻana , ka manaʻo o ka piha i loko o ka ʻōpū
• Nā ʻūlū
• Hoʻonui ʻia ke anapuni o ka pūhaka
• ʻEha ma ka ʻōpū a i ʻole ke pelvis
• Nā loli i ka hana ʻōpū (ʻoi aku ka maʻi diarrhea )
• Ka luaʻi a me ka luaʻi
• Manaʻo piha i ka wā e hoʻomaka ai ʻoe e ʻai ( māʻona mua )

I kekahi manawa, hiki ke hele pū me ke kanesa o ka ʻāpiki me kahi maʻi kakaikahi loa i kapa ʻia ʻo Pseudomyxoma peritonei (PMP) . I ka PMP, hoʻopuka nā hunaola kanesa i kahi mea like me ka jelly i kapa ʻia ʻo mucin, hiki ke hoʻoulu i ka ʻāpiki e pehu. I ka hala ʻana o ka manawa, hiki ke loaʻa nā hōʻailona e like me ka pehu a me ka ʻeha o ka ʻōpū.

He aha ke kumu o ka maʻi ʻaʻai appendix?

Hoʻomaka ka maʻi ʻaʻai ʻāpiki i ka wā e loli ai nā pūnaewele i loko o ka ʻāpiki a hoʻomaka e ulu me ke kāohi ʻole. Eia nō naʻe, ʻaʻole maopopo i nā loea ka mea e hoʻoulu ai i kēia kaʻina hana.

Nā kumu pilikia

Eia nō naʻe, hiki i kekahi mau mea ke hoʻonui i ka pilikia o ka loaʻa ʻana o ka maʻi ʻaʻai appendix. ʻO kēia mau mea:

• Makahiki:ʻOiai hiki ke loaʻa ka maʻi ʻaʻai appendix i kēlā me kēia makahiki, ʻoi aku ka maʻamau i nā poʻe ma waena o 40 a me 60 mau makahiki. ʻIke pinepine ʻia ka maʻi i nā poʻe ma ko lākou mau makahiki 50.
• Kāne: ʻOi aku ka nui o ka hiki i nā wahine ke hoʻomohala i nā tumors neuroendocrine o ka appendix.
• ʻO ka puhipaka a i ʻole ka hoʻohana ʻana i nā huahana paka: Hoʻonui ka hoʻohana ʻana i ka paka i ka pilikia o ka hoʻomohala ʻana i nā ʻano maʻi kanesa āpau, me ke kanesa o ka appendix.
• Mōʻaukala lapaʻau: ʻO kekahi mau kūlana olakino, e like me ka atrophic gastritis , ka anemia pernicious, a me ka Zollinger-Ellison syndrome, hiki ke hoʻonui i ka pilikia o ka maʻi ʻaʻai appendix.
• Moʻolelo ʻohana o ke kanesa: Ua hōʻike ʻia kahi noiʻi hou e hiki i kekahi poʻe me ke kanesa o ka ʻāpiki ke hoʻoilina i nā genes e hoʻonui ai i ko lākou pilikia o ka maʻi kanesa. Eia nō naʻe, pono ka noiʻi hou aku e hoʻoholo ai inā he hoʻoilina kēia.

Pehea e ʻike ʻia ai ke kanesa o ka ʻāpiki?

ʻO ka hapa pinepine, hele ka poʻe me ke kanesa appendix i ke kauka me nā hōʻailona o ka appendixitis. Hana pinepine ʻia ka ʻike ma hope o ka appendectomy , ʻo ia hoʻi ka wehe ʻana i ka appendix. I kekahi manawa, ʻike ʻia kēia mau puʻupuʻu ma ka hanana i ka wā o nā hoʻokolohua no kekahi kūlana ʻē aʻe a i ʻole i ka wā o ke ʻoki ʻana.

Inā kānalua kāu kauka i ka maʻi ʻaʻai appendix, e kauoha ʻo ia i kekahi mau hoʻokolohua hou aʻe. Hiki i kēia mau mea ke komo pū me:

• Nā hoʻāʻo kiʻi: Hiki i kāu kauka ke kauoha i kahi scan CT a i ʻole kahi scan MRI (magnetic resonance imaging) . Lawe kēia mau hoʻāʻo i nā kiʻi o nā ʻiʻo i loko o kou kino. Hiki iā lākou ke hōʻike i nā hōʻailona o nā puʻupuʻu a inā ua laha ka maʻi ʻaʻai. Ke laha ka maʻi ʻaʻai appendix, hiki iā ia ke laha i nā ʻōpū kokoke a i ʻole nā ​​​​ʻiʻo e uhi ana iā lākou ( peritoneum ).
• Laparoscopy: Ma kēia kaʻina hana, hoʻokomo ke kauka i kahi mea lōʻihi a lahilahi i kapa ʻia he laparoscope ma o kahi ʻoki liʻiliʻi i loko o kou ʻōpū. Lawe kahi kāmela liʻiliʻi ma luna o ia i nā kiʻi o ka appendix a hōʻike iā lākou ma kahi pale.
• Biopsy: Ma kēia kaʻina hana, lawe ke kauka i kahi hāpana ʻiʻo a hoʻouna iā ia i kahi keʻena hoʻokolohua pathology e nānā i nā hunaola kanesa. He mea paʻakikī iki ka lawe ʻana i kahi biopsy mai ka appendix. No laila, inā ua pālahalaha paha ke kanesa i kahi ʻāpana ʻē aʻe, e lawe ke kauka i kahi hāpana mai ia wahi.
• Nā hoʻāʻo koko:Inā maikaʻi nā hopena o kāu biopsy no ke kanesa o ka ʻāpiki, e kauoha kāu kauka i nā hoʻokolohua lab e nānā i kāu mau pae protein. Hiki i nā pae o kekahi mau protein ke kōkua i ka hoʻoholo ʻana i ka mamao o ka laha ʻana o ke kanesa.

Nā pae o ke kanesa appendix

ʻO ka ʻike ʻana i ke kahua o ka maʻi ʻaʻai e kōkua i nā kauka e hoʻoholo i ke koʻikoʻi o ke kanesa, he aha ka hoʻolālā lapaʻau maikaʻi loa, a me nā hopena o ka lāʻau lapaʻau.

Hoʻohana nā kauka i nā pae hoʻohālikelike like ʻole ma muli o ke ʻano o ka maʻi puʻupuʻu:

• ʻO nā adenocarcinomas appendiceal: Hoʻohana nā kauka i ka ʻōnaehana hoʻonohonoho TNM e hoʻonohonoho i nā adenocarcinomas appendiceal. Manaʻo kēia ʻōnaehana i ka nui o ka puʻupuʻu (T), inā ua pālahalaha ke kanesa i nā lymph nodes (N), a inā ua pālahalaha i nā ʻōpū mamao (M). ʻO ke kanesa i pālahalaha ma kēia ʻano ua kapa ʻia ʻo ia he kanesa metastatic . Lawe pū ʻia kēia mau mea āpau a ua hoʻokaʻawale ʻia kahi kahua mai ka hoʻokahi a i ka ʻehā. ʻO ke kahua hoʻokahi ka kanesa mua, a ʻo ke kahua ʻehā ka kanesa holomua.
• ʻO nā puʻupuʻu neuroendocrine appendiceal: Hoʻoholo ʻia ke kahua o kēia mau puʻupuʻu e ka hiki ke wehe loa ʻia me ke ʻoki ʻana. Nānā pū lākou i ke ʻano o ka puʻupuʻu (pehea ke ʻano ʻē o nā cell ma lalo o kahi microscope). Inā he puʻupuʻu haʻahaʻa kou (ʻo ia hoʻi, he kakaikahi nā cell ʻē) a hiki i ke kauka ke wehe iā ia me ke ʻoki ʻana, maikaʻi kāu prognosis.

ʻOiaʻiʻo, he mea paʻakikī iki ka hoʻoholo ʻana i ke kahua o ka maʻi ʻaʻai appendix no ka mea he nui nā ʻano puʻupuʻu like ʻole. Loaʻa i kēlā me kēia ʻano kona mau ʻano ponoʻī, ka mea e hoʻoholo ai i kāu mau koho lapaʻau a me ka prognosis.

Akā, mai hopohopo. E noi i kāu kauka e wehewehe pehea e hoʻopilikia ai kou ʻano a me ke kahua o kou maʻi kanesa iā ʻoe.

Pehea e mālama ʻia ai ke kanesa o ka ʻāpiki?

Aia kekahi mau lāʻau lapaʻau no ke kanesa ʻāpiki. ʻO nā mea nui, ʻo ia ke ʻoki kino a me nā lāʻau lapaʻau. E noʻonoʻo kāu kauka i kekahi mau mea ma mua o ka hoʻolālā ʻana i kāu lāʻau lapaʻau. ʻO kēia mau mea ka nui a me ke kahua o ka puʻupuʻu, kou olakino holoʻokoʻa, a me kāu mau makemake pilikino.

ʻoki kino

ʻO ke ʻoki kino ke ʻano nui o ka lāʻau lapaʻau no ka maʻi ʻaʻai appendix . Aia kekahi mau ʻano ʻoki kino:

• Appendectomy: No nā ʻōpū i liʻiliʻi ma mua o 1 a i ʻole 2 kenimika (ʻoi aku ka liʻiliʻi ma mua o hoʻokahi ʻīniha), ʻo ka wehe ʻana i ka appendix wale nō paha ka lawa.
• Hemicolectomy: No nā ʻōpū nui a ʻoi aku ka koʻikoʻi, ʻo ka hemicolectomy kaPono paha ke ʻoki kino hou aʻe, e like me ka laparotomy. Ma kēia kaʻina hana, ma waho aʻe o ka wehe ʻana i ka appendix, ua wehe ʻia kekahi hapa o ka colon a me kekahi mau lymph nodes.
• ʻO ke ʻoki kino Cytoreductive (debulking): Inā ua pālahalaha ke kanesa ma loko o ka ʻōpū, pono paha kahi ʻoki kino nui aʻe. Ma kēia, wehe ke kauka ʻoki kino i ka nui o ka puʻupuʻu e like me ka hiki, ʻo ia hoʻi ka wehe ʻana i nā ʻāpana o nā ʻōpū kahi i pālahalaha ai ke kanesa.

Nā lāʻau lapaʻau

Inā ʻaʻole hiki i ke ʻoki kino ke hoʻopau loa i ke kanesa, pono paha ʻoe i ka lāʻau lapaʻau. Hiki i kēia ke komo pū me:

• Kemoterapi: Hoʻohana ʻia kēia lāʻau lapaʻau e pepehi i nā hunaola kanesa i pālahalaha ma ʻō aku o ka appendix. Pepehi pū ia i nā hunaola kanesa i koe ma hope o ke ʻoki ʻana. Hiki ke hāʻawi ʻia kēia lāʻau lapaʻau ma ke ʻano he inikini a i ʻole he pila.
• ʻO Hyperthermic Intraperitoneal Chemotherapy (HIPEC): He ʻano kūikawā ka HIPEC o ka lāʻau chemotherapy. Hana pinepine ʻia ia i ka wā o ke ʻoki kino. Pili ia i ka hoʻomehana ʻana i nā lāʻau chemotherapy a me ka hoʻolaha ʻana iā lākou i loko o ka lua ʻōpū. ʻO kēia wela a me ka hoʻopili pololei ʻana o nā lāʻau lapaʻau e ʻoi aku ka ikaika a me ka maikaʻi o ka chemotherapy.
• Lapaʻau lāʻau i kuhikuhi ʻia: ʻO ka pahuhopu o kēia lāʻau lapaʻau, ʻo ia ke kuhikuhi wale i nā hunaola kanesa me ka hoʻēmi ʻana i ka hōʻino ʻana i nā hunaola olakino. Hoʻohana ʻia nā lāʻau lapaʻau kūikawā e kuhikuhi i kekahi mau genes a i ʻole nā ​​protein e kōkua ana i ka ulu ʻana o ka kanesa. Hoʻohana ʻia nā lāʻau lapaʻau e like me cetuximab , bevacizumab , ramucirumab, a me panitumumab i kēia ʻano lāʻau lapaʻau no ka maʻi kanesa appendix.

He aha kāu e manaʻo ai inā loaʻa iā ʻoe ka maʻi ʻaʻai appendix?

E hilinaʻi ʻia kou ʻike ma nā kumu he nui, me ke ʻano, ka nui, a me ke ʻano o ka puʻupuʻu. He mea nui nō hoʻi kou olakino holoʻokoʻa a me ke ʻano o kāu pane ʻana i ka lāʻau lapaʻau.

Hiki ke ho'ōla piha ʻia kekahi mau ʻano maʻi ʻaʻai appendix. No ka laʻana, hiki ke ho'ōla pinepine ʻia nā ʻōpū neuroendocrine appendix haʻahaʻa me ke ʻoki ʻana. Ma keʻano laulā, ʻo ka liʻiliʻi o ka ʻōpū, ʻo ka nui o ka hiki ke ho'ōla piha ʻia ke kanesa me ka lāʻau lapaʻau. Hohola koke nā ʻōpū nui a ʻaʻole paha e pane maikaʻi i ka lāʻau lapaʻau.

Hiki i kāu kauka ke alakaʻi iā ʻoe i ka mea e manaʻo ai ma muli o kāu hōʻailona.

He aha ka nui o ke ola no ka maʻi ʻaʻai appendix?

ʻO ka helu ola ʻelima makahiki no ka maʻi ʻaʻai appendix haʻahaʻa ma waena o 67% a me 97%. ʻO ke ʻano kēia ma waena o 67% a me 97% o ka poʻe me ka maʻi e ola mau ana ma hope o ʻelima mau makahiki. Hiki ke haʻahaʻa loa kēia helu ola no nā puʻupuʻu holomua a i ʻole no ka maʻi ʻaʻai appendix i ʻike ʻia ma kahi pae ma hope.

E hoʻomanaʻo, ʻaʻole i wānana nā helu ola i ka maikaʻi o kāu pane ʻana i ka lāʻau lapaʻau a i ʻole pehea ka lōʻihi o kou ola ʻana. Hōʻike kēia mau helu i nā ʻike o ka poʻe i loaʻa i ka maʻi ʻaʻai appendix i ka wā ma mua. No ka mea he mea kakaikahi loa ka maʻi ʻaʻai appendix, ʻaʻole paha pololei ka ʻike e pili ana i ka manaʻolana o ke ola. Inā he mau nīnau kāu e pili ana i nā helu ola, e kamaʻilio me kāu kauka.

Āhea wau e ʻike ai i ke kauka?

Inā ʻike ʻoe i nā hōʻailona o ke kanesa appendix, e like me ka appendicitis, ka pehu ʻana, a i ʻole ka ʻeha o ka ʻōpū , e ʻike koke i kāu kauka .

Inā ua ʻike ʻia ʻoe me ka maʻi ʻaʻai appendix, e kamaʻilio me kāu kauka inā loli a ʻoi aku ka ʻino o kāu mau hōʻailona. E haʻi iā ia e pili ana i nā hopena ʻaoʻao āu e loaʻa nei mai kāu lāʻau lapaʻau. Hiki iā ia ke hāʻawi i nā ala e kōkua iā ʻoe e hoʻomanawanui i kāu mau hōʻailona. Hiki iā ia ke kuhikuhi iā ʻoe i nā lawelawe mālama palliative . Kōkua nā loea mālama palliative i nā poʻe me nā ʻano maʻi like ʻole (me nā maʻi ʻaʻole e hoʻoweliweli i ke ola) e hoʻokele i kā lākou mau hōʻailona.

He aha nā nīnau e pono iaʻu e nīnau aku i kaʻu kauka?

ʻO ka ʻike i ka nui e hiki ai iā ʻoe e pili ana i kou kūlana e kōkua iā ʻoe e hoʻoholo i nā hoʻoholo e pili ana i kou olakino. Eia kekahi mau nīnau e nīnau aku ai i kāu kauka:

• He aha ke ʻano o ka appendix i loaʻa iaʻu?
• Pehea ka nui o ka puʻupuʻu?
• He aha ke kahua a me ke ʻano o koʻu maʻi ʻaʻai appendix?
• He aha nā koho lapaʻau e loaʻa iaʻu?
• Āhea wau e hoʻomaka ai i ka lāʻau lapaʻau?
• E hiki anei iaʻu ke hana i ka wā e mālama ʻia ai no ka maʻi kanesa?
• Aia kekahi mau kumuwaiwai a i ʻole nā ​​​​hui kākoʻo e kōkua iaʻu?

He mea maʻamau ka makaʻu a me ka kānalua ke ʻike ʻoe he maʻi ʻaʻai appendix kou. E kamaʻilio me kāu kauka e pili ana i kou manaʻo. Hiki iā ia ke pane i kāu mau nīnau e pili ana i kou kūlana a haʻi iā ʻoe i kahi e hiki ai iā ʻoe ke loaʻa ke kākoʻo. No ka mea, he mea kakaikahi loa ka maʻi ʻaʻai appendix, hiki iā ʻoe ke manaʻo mehameha me kēia hōʻailona. Akā, ʻaʻole ʻoe hoʻokahi. Hiki iā ʻoe ke hoʻopili me nā poʻe ʻē aʻe i loaʻa nā ʻike like. Hiki iā ʻoe ke kōkua kekahi i kekahi ma o ka mālama ʻana a me ka mālama ʻana i ka maʻi ʻaʻai appendix.

ʻO ka ʻōlelo lawe home koʻikoʻi loa mai kēia ʻatikala

ʻAe, ua kamaʻilio nui kākou e pili ana i ke kanesa o ka ʻāpiki, ʻeā? ʻOiai he ʻano kanesa kakaikahi loa kēia, he mea kūpono ke makaʻala i ia mea.

• He maʻi laha ʻole ka maʻi ʻaʻai ʻāpiki. Eia nō naʻe, inā ʻike ʻoe i nā hōʻailona e like me ka appendicitis, ʻeha ʻōpū ʻē, a i ʻole ka pehu ʻana, pono ʻoe e ʻike i ke kauka.
• Aia nā ʻano maʻi ʻaʻai appendix like ʻole, kēlā me kēia me nā ʻano lapaʻau like ʻole a me nā helu hoʻōla.
• He mea nui loa ka ʻike mua ʻana, no ka mea, ʻoi aku ka holomua o ka lāʻau lapaʻau.
• Aia nā lāʻau lapaʻau i loaʻa. Hoʻōla ʻia kēia maʻi me nā mea e like me ke ʻoki kino, ka chemotherapy, a me ka lāʻau lapaʻau i hoʻolālā ʻia.
• Mai makaʻu e nīnau. E nīnau i kāu kauka i nā nīnau āu e loaʻa ai. ʻAʻole ʻoe hoʻokahi, aia nā wahi e loaʻa ai ke kōkua.

ʻO ka mea nui loa, ʻo ia ka hoʻolohe ʻana i nā loli i kou kino. Inā ʻike ʻoe i kekahi mea ʻē, he mea naʻauao ke ʻimi i ka ʻōlelo aʻo lapaʻau ma mua o ka hoʻowahāwahā ʻana.

ʻO ke kanesa ʻāpiki, appendicitis, nā hōʻailona o ke kanesa, ka mālama ʻana i ke kanesa, adenocarcinoma, nā maʻi neuroendocrine, ʻoki kino