Loaʻa iā ʻoe ke kanesa i loko o kou ʻōpū? E aʻo kākou e pili ana i ke Kanesa ʻŌpū.

Ua manaʻo paha ʻoe ʻoiai ʻo ke kino liʻiliʻi loa o ko kākou kino, ka mea a kākou e nānā ʻole ai i kekahi manawa, hiki ke loaʻa i kahi maʻi koʻikoʻi loa? Pēlā nō ia me ka gallbladder. Hiki ke ulu kēia ʻano i kapa ʻia ʻo ke kanesa gallbladder. ʻOiai he mea kakaikahi kēia, he mea nui loa ia e makaʻala. No laila, i kēia lā e kamaʻilio maʻalahi mākou e pili ana i ke kanesa gallbladder, ma ke ʻano hiki iā ʻoe ke hoʻomaopopo.

He aha ke Kanesa ʻAʻai Gallbladder?

I ka ʻōlelo maʻalahi, ʻo ke kanesa o ka ʻōpū ka wā e hoʻomaka ai nā pūnaewele i loko o kou ʻōpū e ulu me ka ʻano ʻē a me ka wikiwiki, me ke kāohi ʻole ʻia. ʻO kēia mau pūnaewele ka mea a mākou e kapa nei he mau pūnaewele malignant.

I kēia manawa, he nīnau kāu, he aha kēia ʻōpū a he aha kāna hana? He ʻōkana liʻiliʻi ka ʻōpū e waiho ana ma ka ʻaoʻao ʻākau o ko kākou ʻōpū, ma lalo o ke akepaʻa, a ua like kona ʻano me ka pea liʻiliʻi. ʻO kāna hana nui, ʻo ia ka hōʻiliʻili a me ka mālama ʻana i ka bile, kahi wai i hana ʻia e ke akepaʻa, a e kōkua iā kākou e hoʻoheheʻe i nā meaʻai momona a kākou e ʻai ai. Ua like ia me kahi pahu wai.

Hoʻomaka pinepine kēia maʻi kanesa ma ka papa lahilahi i loko o ka gallbladder. Kāhea nā kauka i kēia ʻo ka 'mucosal layer '. I ka hala ʻana o ka manawa, hiki i kēia mau hunaola kanesa ke laha ma waena o nā paia o ka gallbladder a puka i waho.

ʻO ka mea kaumaha, ʻaʻole hōʻike pinepine kēia maʻi kanesa i kekahi mau hōʻailona i kona mau pae mua. No laila, ʻike ʻia i kekahi manawa ma hope o ke ʻoki ʻana e wehe i ka gallbladder no kekahi kumu ʻē aʻe.

Eia nō naʻe, inā ʻike mua ʻia a hoʻopau loa ʻia me ke ʻoki ʻana, he kiʻekiʻe loa ka manawa e ho'ōla ʻia ai kēia maʻi kanesa. Eia nō naʻe, i ka manawa e ʻike ʻia ai ka hapa nui o ka poʻe, ua pālahalaha mua ke kanesa ma ʻō aku o ka ʻōpū. I kēlā manawa, lilo ka mālama ʻana i mea paʻakikī iki.

Pehea ka maʻamau o kēia maʻi kanesa?

Ke hoʻohālikelike ʻia me nā ʻāina e like me ʻAmelika Hui Pū ʻIa, he mea paʻakikī iki ka loaʻa ʻana o nā helu pololei e pili ana i kēia maʻi kanesa ma Sri Lanka. Eia nō naʻe, ma kekahi mau ʻāina o ka honua, no ka laʻana, ma nā ʻāina e like me India, Iapana, a me Korea, ʻike iki ʻia. Malia paha kēia no ka mea ʻoi aku ka maʻamau o ka hoʻokumu ʻia ʻana o nā pōhaku gallstones a me nā kūlana ʻē aʻe e hoʻonui ai i ka pilikia o kēia maʻi kanesa ma ia mau ʻāina.

He aha nā hōʻailona? He paʻakikī anei ke ʻike mua?

E like me kā mākou i ʻōlelo ai ma mua, ʻaʻole hōʻike pinepine ʻia nā hōʻailona o ke kanesa o ka ʻōpū i kona mau pae mua. ʻOiai ke ʻike ʻia nā hōʻailona, ​​​​ua like pinepine lākou me nā mea i hoʻokumu ʻia e nā pōhaku ʻōpū a i ʻole ka paʻa ʻana o ke aʻa bile, no laila hiki ke huikau maʻalahi.

ʻO nā hōʻailona nui e ʻike ʻia:

• ʻEha nui ma ka ʻaoʻao ʻākau o luna o ka ʻōpū .
• Melemele o ka ʻili a me nā keʻokeʻo o nā maka. Ua kapa ʻia kēia he jaundice .
• Manaʻo e like me kahi puʻu i loko o ka ʻōpū.
• Ka lilo ʻana o ke kaumaha me ke kumu ʻole.
• Ka luaʻi a me ka luaʻi.
• Manaʻo ua piha kou ʻōpū (pehu).
• Ka wela pinepine.

Inā loaʻa iā ʻoe kekahi a ʻoi aku paha o kēia mau hōʻailona, ​​ʻaʻole ia he manaʻo he maʻi kanesa kou. Eia nō naʻe, inā hoʻomau kēia mau hōʻailona, ​​ʻoi aku ka maikaʻi o ke ʻike ʻana i ke kauka no ka ʻōlelo aʻo.

No ke aha e ulu ai kēia ʻano maʻi kanesa?

Hoʻomaka ka maʻi ʻaʻai ʻōpū ke lilo nā ʻāpana olakino i mau ʻāpana maʻi ʻaʻai a hoʻomaka e ulu ma waho o ke kaohi. Hana ʻia kēia i ka wā e loaʻa ai nā loli, i kapa ʻia ʻo 'mutations' , i loko o nā mea genetic i loko o kā mākou mau cell. Hoʻomohala kēia mau mutations genetic i ka hala ʻana o ka manawa, ʻaʻole mai ko mākou mau mākua.

ʻAʻole maopopo loa i nā kānaka ʻepekema ke kumu e lilo koke ai nā hunaola olakino i mau hunaola kanesa. Eia nō naʻe, ua ʻike lākou i kekahi mau mea pilikia e hoʻonui ai i ka pilikia o ka loaʻa ʻana o kēia kanesa.

He aha nā kumu pilikia?

Aia kekahi mau hui a me nā kūlana e hoʻonui ai i ka pilikia o ka hoʻomohala ʻana i kēia maʻi kanesa:

• ʻOi aku ka nui o ka pilikia o nā wāhine ma mua o nā kāne.
• ʻOi aku ka nui o ka pilikia o ka poʻe ma luna o 65 mau makahiki . (ʻO ka awelika o ka makahiki i ka wā i ʻike ʻia ai ka maʻi ma kahi o 72.)
• Ma ʻAmelika Hui Pū ʻIa, ua ʻike ʻia he pinepine ka loaʻa ʻana i nā poʻe o nā ʻAmelika ʻĪnia, nā ʻōiwi Alaskan, a me nā lāhui Mekiko-ʻAmelika.

Nā kumu pilikia ʻē aʻe:

• ʻO ke alo a i ʻole ka mōʻaukala o nā gallstones i hala.
• Loaʻa nā polyps o ka gallbladder ( nā ulu liʻiliʻi e like me ka ʻōpū).
• Ka mumū mau loa o ka gallbladder (cholecystitis) .
• ʻO ka maʻi lōʻihi me ka bacteria Salmonella typhi, ka mea e hoʻoulu ai i ka maʻi typhoid.
• Nā waihona kalipuna i loko o nā paia o ka ʻōpū o ka ʻōpū (ua kapa ʻia kēia ʻo 'porcelain gallbladder ').
• Ka mumū lōʻihi o nā ʻauwai bile ( cholangitis sclerosing mua ).
• ʻO ke kūkulu ʻia ʻana o nā cysts i loko o ke kahawai bile nui ( choledochal cysts ).
• Ka momona nui .

Eia kekahi, ua manaʻo ʻia hoʻi e hoʻonui ka puhipaka a me ka ʻike ʻana i kekahi mau kemika i hoʻohana ʻia i ka hana lole a me ka rubber e hoʻonui i ka pilikia.

Pehea ʻoe e ʻike ai i kēia?

E like me kā mākou i kūkākūkā ai ma mua, ʻike pinepine ʻia ka maʻi ʻaʻai ʻōpū ma hope o ka wā ma muli o ka palupalu o kona mau hōʻailona mua a ua like kona mau hōʻailona me nā maʻi ʻē aʻe. I kekahi manawa ʻike ʻia ia ma ke ʻano ulia pōpilikia, ma muli paha o nā pōhaku ʻōpū a i ʻole i ka wā o ke ʻoki ʻana e wehe i ka ʻōpū.

Inā kānalua kāu kauka he maʻi ʻaʻai gallbladder kou, e nānā ʻo ia iā ʻoe, e nīnau e pili ana i kou mōʻaukala olakino, a laila e kauoha i kekahi mau hoʻokolohua.

He aha nā hoʻokolohua e hana ʻia?

Hiki i kēia mau hoʻokolohua ke komo pū me nā hoʻokolohua koko, nā ʻano scan like ʻole, a me nā ʻoki kino liʻiliʻi.

• Nā hoʻāʻo koko (nā hoʻāʻo lab):
• Hoʻāʻo hana akepaʻa: Ke ana kēia i nā pae o kekahi mau mea i hoʻokuʻu ʻia e ke akepaʻa. Hiki i kēia ke hāʻawi i kahi manaʻo inā ua hoʻopilikia ka maʻi ʻaʻai gallbladder i ke akepaʻa.
• Hoʻāʻo CEA (Carcinoembryonic antigen): ʻO ka CEA kahi māka puʻupuʻu i hoʻokuʻu ʻia e nā hunaola olakino a me nā hunaola kanesa. ʻO nā pae kiʻekiʻe o kēia hiki ke lilo i hōʻailona o ke kanesa ʻōpū.
• Hoʻāʻo CA 19-9: He hōʻailona puʻupuʻu nō hoʻi kēia. ʻO nā pae kiʻekiʻe o kēia hiki ke lilo i hōʻailona o ke kanesa gallbladder a i ʻole ka maʻi pancreatic.

• Nā hoʻokolohua kiʻi: Hiki i kēia ke kōkua i nā kauka e ʻike inā loaʻa ke kanesa a inā ua pālahalaha.
• ʻO ke kani ultrasound ʻōpū: Hoʻohana kēia i nā nalu kani e kiʻi i nā kiʻi o nā ʻōpū o ka ʻōpū. Inā hōʻike kēia i kahi mea e like me ka puʻupuʻu gallbladder, e noi ʻia paha ʻoe e hana i kahi CT scan a i ʻole MRI scan.
• CT scan (computed tomography scan): Hoʻohana ʻia kekahi ʻano X-ray e kiʻi i nā kiʻi kikoʻī o nā ʻōpū o loko.
• MRI scan (magnetic resonance imaging): Hoʻohana i kahi magnet, nā nalu lekiō, a me ke kamepiula e kiʻi i nā kiʻi o loko o ke kino.
• ʻO ka ultrasound Endoscopic: Lawe ʻia nā kiʻi o ke ala ʻai me ka hoʻohana ʻana i kahi mea like me ka paipu i kapa ʻia he endoscope.
• ERCP (Endoscopic retrograde cholangiopancreatography): He kaʻina hana e lawe i nā kiʻi X-ray o nā ʻauwai bile. Hiki i ke kanesa Gallbladder ke hoʻohaiki i kēia mau ʻauwai.

• Nā ʻoki kino liʻiliʻi:
• Biopsy: Pili kēia i ka lawe ʻana i kahi laʻana liʻiliʻi o nā ʻiʻo kānalua a nānā iā ia ma lalo o kahi microscope e ʻike inā he mau hunaola kanesa. ʻO ka biopsy wale nō ke ala e hōʻoia pono ai i ka maʻi kanesa o ka ʻōpū.
• Laparoscopy: Ma kēia kaʻina hana, ua hoʻokomo ʻia kahi ʻōmole lahilahi me kahi kāmela (i kapa ʻia he laparoscope) i loko o ka ʻōpū ma o kahi ʻoki liʻiliʻi e nānā i ka gallbladder a me nā ʻiʻo a puni. Kōkua kēia i ka hoʻoholo ʻana i ka mamao o ka laha ʻana o ke kanesa.

He aha nā pae o ka maʻi kanesa?

ʻO ke ana ʻana i ke kanesa kahi ala no kāu kauka e hoʻoholo ai inā ua laha ke kanesa (metastasized) ma mua o kahi i hoʻomaka mua ai. Ma muli o ka mamao o ka laha ʻana o ke kanesa, e hāʻawi kāu kauka i kāu kanesa i kahi helu (mai ka ʻole a i ka ʻehā). ʻO nā helu kiʻekiʻe aʻe ke ʻano o ka laha ʻana o ke kanesa i nā wahi hou aʻe o kou kino.

Eia nā pae o ka maʻi ʻaʻai gallbladder:

• Pae 0 (Pae 0 - `carcinoma in situ`): Loaʻa nā ʻano ʻē aʻe, hiki ke lilo i kanesa ma ka papa o loko loa (mucosa) o ka gallbladder.
• Pae 1: Aia nā hunaola kanesa i loko o ka ʻōpū o ka gallbladder a ua pālahalaha paha i ka papa ʻiʻo o ka gallbladder.
• Pae 2:Ua pālahalaha ke kanesa ma ʻō aku o ka papa ʻiʻo a i loko o nā papa pili o ka ʻōpū gallbladder.
• Pae 3: Ua pālahalaha ke kanesa i ke akepaʻa a i ʻole nā ​​​​​​kikowaena kokoke, a i ʻole i ka papa waho loa (papa serosal) o ka gallbladder. Ua pālahalaha paha i nā lymph nodes.
• Pae 4: Ua pālahalaha ke kanesa i ʻoi aku ma mua o ʻekolu mau lymph node kokoke, nā kīʻaha koko, a/a i ʻole nā ​​​​​​ʻōpū mamao loa mai ka gallbladder.

Ua kapa nā kauka i ke kanesa ʻōpū pae 1 he "kūloko." ʻO ke ʻano kēia, ʻaʻole i laha ke kanesa ma waho o ka ʻōpū. ʻOi aku ka maʻalahi o ka ho'ōla ʻia ʻana o nā kanesa pae 1. ʻOi aku ka paʻakikī o ka mālama ʻana i nā pae 2, 3, a me 4.

Pehea e laha ai kēia maʻi ʻaʻai?

Hoʻomaka ka maʻi ʻaʻai ʻōpū ma ka papa o loko o ka ʻōpū a pālahalaha aku i nā papa o waho. I ka hala ʻana o ka manawa, hiki iā ia ke pālahalaha aku i nā lymph node kokoke, ke akepaʻa, a me nā ʻōpū ʻē aʻe, e like me nā ʻauwai bile. Hiki i ka maʻi ʻaʻai metastatic gallbladder ke pālahalaha aku ma o ka ʻōnaehana lymphatic, ke kahe koko, a i ʻole i nā ʻōpū mamao o ke kino.

He aha nā lāʻau lapaʻau?

ʻO ke kahua o ke kanesa e hoʻoholo ai i nā ʻano lapaʻau a me nā pahuhopu o ka mālama ʻana. I ke kanesa mua, ʻo ka pahuhopu nui ka wehe loa ʻana i ke kanesa a kāohi iā ia mai ka hoʻi hou ʻana mai. Inā ua pālahalaha ke kanesa, ʻo ka pahuhopu o ka mālama ʻana, ʻo ia ka hoʻolōʻihi ʻana i ke ola a me ka kaohi ʻana i nā hōʻailona.

Ka mālama ʻana i nā maʻi ʻaʻai mua

ʻO ke kanesa ʻōpū i ke kahua mua, hiki ke wehe ʻia me ke ʻoki ʻana, ʻo ia ka hopena lapaʻau maikaʻi loa.

• ʻOki kino: E wehe ke kauka lapaʻau (oncologist ʻoki kino) i kou gallbladder a me nā ʻiʻo i hoʻopilikia ʻia a puni. Ua kapa ʻia kēia he cholecystectomy . I kekahi manawa ʻo ka gallbladder wale nō ka mea e wehe ʻia (simple cholecystectomy), akā i kekahi manawa hiki ke wehe ʻia nā lymph node i loaʻa nā cell cancer a i ʻole kekahi hapa o ke ake, e like me ka gallbladder, (extended cholecystectomy).
• Lapaʻau radiation: Ma kēia, kuhikuhi kahi mīkini ma waho o ke kino (EBRT - external beam radiation therapy) i nā kukuna radiation i kahi maʻi kanesa. Pepehi kēia radiation i nā hunaola kanesa a hoʻolohi paha i ka ulu ʻana o ka puʻupuʻu. Hana ʻia kēia ma ke ʻano e hōʻemi ai i ka hōʻino ʻana i nā hunaola olakino. Hiki ke hāʻawi ʻia kēia lāʻau lapaʻau e pepehi i nā hunaola kanesa i koe ma hope o ke ʻoki ʻana. Hiki i ka radiation therapy ke kōkua i ka hōʻoluʻolu ʻana i nā hōʻailona.
• Kemoterapia: Hoʻohana kēia i nā lāʻau lapaʻau e pepehi i nā hunaola kanesa a i ʻole e hoʻōki iā lākou mai ka hoʻonui ʻana. E like me ka radiation therapy, kōkua ka chemotherapy i ka pepehi ʻana i nā hunaola kanesa i koe ma hope o ke ʻoki ʻana. I kekahi manawa, paipai paha kāu kauka i ka chemotherapy me ka radiation therapy.

Lapaʻau no nā maʻi kanesa hiki ʻole ke hana ʻia, hoʻi hou, a metastatic paha

ʻO nā maʻi kanesa hiki ʻole ke wehe ʻia me ke ʻoki kino (`unresectable`), i hoʻi hou mai ma hope o ka mālama ʻana (`recurrent`), a i ʻole i pālahalaha i nā ʻāpana ʻē aʻe o ke kino (`metastatic`) he mea paʻakikī ke ho'ōla loa. ʻOiai ʻaʻole hiki i nā lāʻau lapaʻau e like me ka radiation therapy a me ka `chemotherapy` ke hoʻopau loa i ke kanesa, hiki iā lākou ke kōkua i ka hōʻemi ʻana i kāu mau hōʻailona a hoʻolōʻihi i kou ola. Eia kekahi, inā e ālai ana ke kanesa i kāu paipu meaʻai, hiki ke hana ʻia ke ʻoki kino e hōʻoluʻolu i kēlā mau hōʻailona.

I kēia mau hihia, loaʻa paha iā ʻoe ka manawa kūpono e komo i kahi hoʻokolohua lapaʻau . ʻO nā hoʻokolohua lapaʻau he mau haʻawina e hoʻāʻo ai i nā lāʻau lapaʻau hou a me nā ʻano hou i nā lāʻau lapaʻau e kū nei. ʻO kekahi o nā lāʻau lapaʻau e hoʻāʻo ʻia nei i nā hoʻokolohua lapaʻau no ka maʻi ʻaʻai gallbladder:

• Lapaʻau i hoʻolālā ʻia: Lapaʻau e pili ana i nā hunaola kanesa wale nō i loaʻa kekahi mau hoʻololi hoʻoilina.
• Immunotherapy: Nā lāʻau lapaʻau e hoʻoikaika i kāu ʻōnaehana pale ponoʻī e kōkua iā ia e ʻike a luku i nā hunaola kanesa.
• Nā Radiosensitizers: Nā lāʻau lapaʻau e hoʻonui ai i ka maʻalahi o nā hunaola kanesa i ka radiation therapy.

E nīnau i kāu kauka inā kūpono ʻoe no kahi hoʻokolohua lapaʻau.

Aia kekahi mau hopena ʻaoʻao o ka lāʻau lapaʻau?

E like me nā ʻoki kino āpau, aia nā pilikia o ka maʻi, nā pilikia mai ka anesthesia, a me nā ʻūpā koko. Pono ʻoe e kūkākūkā i kēia mau mea āpau me kāu kauka ma mua o ka hoʻomaka ʻana i ka lāʻau lapaʻau.

He mea nui hoʻi e makaʻala i nā hopena ʻaoʻao hiki ke loaʻa mai ka chemotherapy a me ka radiation therapy. ʻAʻole like ka ʻike ʻana o nā kānaka a pau i nā hopena ʻaoʻao. Eia nō naʻe, hiki i kāu kauka ke wehewehe iā ʻoe i nā hopena ʻaoʻao e hiki mai ana ma muli o kāu hoʻolālā lapaʻau.

Aia kekahi ala e pale aku ai i kēia?

ʻAʻohe ala maopopo e pale loa ai i ke kanesa o ka ʻōpū. Eia nō naʻe, hiki iā ʻoe ke hoʻāʻo e hōʻemi i nā kumu pilikia a mākou i kūkākūkā ai ma mua e like me ka hiki. No ka laʻana, hiki iā ʻoe ke kamaʻilio me kāu kauka a mālama i kahi kaumaha olakino e kūpono iā ʻoe. Eia naʻe, ʻoiai ke hana ʻana pēlā, ʻaʻole hiki ke hōʻoia 100% ʻaʻole ʻoe e loaʻa i ka maʻi kanesa.

Pehea ka hiki ke hoʻōla hou ʻia?

ʻIke pinepine ʻia ke kanesa ʻōpū ma hope o ka laha ʻana o ka maʻi, no laila ʻaʻole maikaʻi ka wānana. Ma kahi o 20% wale nō o nā kanesa ʻōpū i ʻike ʻia i ka wā mua. ʻO ka helu ola ʻelima makahiki no ka poʻe i laha ka maʻi kanesa i nā ʻāpana ʻē aʻe o ke kino (metastasized) he haʻahaʻa e like me 2%. Eia nō naʻe, i ka wā e pili ana ka maʻi kanesa i ka gallbladder, ʻo ia hoʻi, i ka wā mua, piʻi ka helu ola ʻelima makahiki i 66%.

ʻO ia hoʻi, inā ʻike mua ʻia, nui ka manaʻolana no ka hoʻōla ʻana!

He aha kāu e hana ai i ka wā e noho ana me ka maʻi kanesa?

He mea paʻakikī ke ʻike ʻana ua loaʻa iā ʻoe ka maʻi ʻaʻai ʻōpū. Akā he mea nui e hoʻomaopopo i kāu hōʻailona, ​​​​nā pono a me nā pōʻino o kāu mau koho lapaʻau, a me kāu hoʻolālā hoʻōla. ʻO kāu hui mālama maʻi ʻaʻai kahi kūpono loa e wehewehe i kēia mau mea āpau iā ʻoe.

ʻO ka launa pū ʻana me nā poʻe loea e hāʻawi ana i ka mālama palliative hiki ke kōkua iā ʻoe e hoʻokele i kāu mau hōʻailona. ʻO ka mālama palliative kahi lawelawe e kālele ana i kou ʻoluʻolu a me nā pono, me ka nānā ʻole i kou kūlana. E nīnau i kāu kauka inā makemake ʻoe i ka mālama palliative.

He aha kāu e nīnau ai i ke kauka?

Ke hele ʻoe e ʻike i kāu kauka, e hana i kahi papa inoa o kāu mau nīnau e pili ana i ka maʻi ʻaʻai gallbladder. Eia kekahi laʻana, hiki iā ʻoe ke nīnau i nā nīnau e like me:

• He aha nā hoʻokolohua e pono iaʻu e hana e ʻike ai i ke kahua kikoʻī o koʻu maʻi kanesa?
• I ke kahua hea koʻu maʻi ʻaʻai ʻōpū?
• He aha ke ʻano lapaʻau kūpono loa iaʻu?
• He aha nā pōmaikaʻi a me nā pilikia kūpono o kēia mau lāʻau lapaʻau?
• He aha nā kumuwaiwai e loaʻa ana e kākoʻo iaʻu i kēia manawa?

Leka Lawe-Home

He maʻi laha ʻole akā he maʻi koʻikoʻi loa ke kanesa ʻōpū. Inā manaʻo ʻoe he mau hōʻailona paha kāu o ke kanesa ʻōpū, e ʻike koke i ke kauka. E hoʻomanaʻo ʻoiai ʻoiai e hōʻike mua nā ʻano kanesa ʻē aʻe i nā hōʻailona, ​​ʻaʻole paha e hōʻike maopopo ke kanesa ʻōpū a hiki i ka wā lohi o ka maʻi. No laila, he mea nui loa ka ʻimi ʻana i ka lāʻau lapaʻau i ka wā mua.

Inā ʻike mua ʻia kēia maʻi, hiki ke ho'ōla koke ʻia. No laila, mai hoʻowahāwahā i nā hōʻailona. E mālama i kou kino a e ʻimi i ke kōkua lapaʻau i ka wā e pono ai.

ʻO ke kanesa ʻōpū, ke kanesa ʻōpū, nā hōʻailona o ke kanesa, ʻōpū, ʻōpū, nā pae o ke kanesa, ka mālama ʻana i ke kanesa, CEA, CA 19-9