Ua ʻike anei ʻoe i kahi loli i kou ʻano ʻōpū, ʻeha ʻōpū, a i ʻole ke koko i loko o kou ʻōpala i kēia mau lā? Mai hoʻowahāwahā i kēia mau hōʻailona, me ka manaʻo he mea maʻamau lākou. Hiki iā lākou ke lilo i mau hōʻailona o ka maʻi ʻaʻai kolona. I kēia lā, ke kamaʻilio nei mākou e pili ana i kahi ʻano maʻi ʻaʻai kolona i ʻoi aku ka kūikawā, akā ʻoi aku ka pōmaikaʻi. Ua kapa ʻia ʻo MSI-H.
I ka ʻōlelo maʻalahi, he aha kēia maʻi ʻaʻai kolona MSI-H?
I mea e hoʻomaopopo ai i kēia, e nānā mua kākou i ka DNA i loko o nā ʻāpana o ko kākou kino. E noʻonoʻo i kā kākou DNA he kaulahao lōʻihi. Loaʻa i kēia kaulahao nā ʻano like i hoʻopili ʻia iā ia i nā manawa he nui. Ua kapa ʻia kēia mau ʻāpana DNA i hana hou ʻia he microsatellites.
I kēia manawa, ke māhele ʻia nā ʻāpana o ko kākou kino a hoʻokumu ʻia nā ʻāpana hou, hana ʻia nā kope o kēia kaulahao DNA. I kekahi manawa hiki ke hana ʻia nā hewa (nā hoʻololi ʻana) ke hana ʻia kēia mau kope. Akā, mai hopohopo, he ʻōnaehana ko ko kākou kino e like me ka 'mākaʻi e ʻike ana i nā hewa'. Ua kapa ʻia ʻo ia ka ʻōnaehana Mismatch Repair (MMR) . Nānā ia i nā hewa i loko o kēlā mau kope DNA a hoʻoponopono koke iā lākou.
Eia nō naʻe, i loko o kekahi mau hunaola kanesa, ʻaʻole hana pono kēia ʻōnaehana MMR. Kāhea mākou iā ia he dMMR (deficient DNA Mismatch Repair). A laila, no ka mea, ʻaʻohe mea nāna e hoʻoponopono i nā hewa i loko o kēlā mau kope DNA, hōʻiliʻili nā hewa a lilo ka DNA i mea paʻa ʻole loa. ʻO ia ke kūlana me nā microsatellites paʻa ʻole loa, a mākou e kapa nei ʻo MSI-H (Microsatellite Instability-High) .
ʻO ka mea kupanaha, ʻo kēia "paʻa ʻole" o ka DNA he mea maikaʻi ia i kekahi manawa. ʻOi aku ka maikaʻi o ka pane ʻana o nā maʻi kanesa MSI-H i kahi lāʻau i kapa ʻia ʻo immunotherapy ma mua o nā ʻano maʻi kanesa ʻē aʻe. Eia kekahi, maikaʻi ko lākou nānā ʻana.
He aha nā hōʻailona kūpono o ke kanesa MSI-H?
ʻAʻole paha e ʻike mau ʻia nā hōʻailona, akā inā ʻike ʻia nā hōʻailona, ua like lākou me nā maʻi kanesa colon maʻamau.
| Māhele hōʻailona | Nā mea e ʻike ai |
|---|---|
| Nā loli i nā neʻe ʻana o ka ʻōpū | Ka maʻi kahe, ka paʻa ʻana o ka ʻōpū, a i ʻole ka manaʻo o ka piha ma hope o ka neʻe ʻana o ka ʻōpū. |
| Koko i loko o ka ʻōpala | Nā ʻōpala ʻeleʻele a ʻeleʻele paha, a i ʻole ke kahe ʻana o ke koko mai ka rectum. |
| ʻO ka ʻeha o ka ʻōpū | ʻEha ka ʻōpū, pehu. |
| Nā hiʻohiʻona kino ʻē aʻe | Luhi i wehewehe ʻole ʻia, pohō kaumaha, nalowale o ka makemake. |
He mea nui: ʻAʻole loaʻa i nā kānaka a pau me kēia mau hōʻailona ke kanesa. Eia nō naʻe , inā he koko kou i loko o kou ʻōpala a i ʻole ka ʻeha nui o ka ʻōpū, e ʻike koke i ke kauka. Inā mau nā hōʻailona ʻē aʻe no nā pule ʻelua a ʻoi, pono ʻoe e ʻimi i ke kōkua lapaʻau.
I kekahi manawa, ʻo ka hōʻailona mua o kēia maʻi ʻaʻai he hoʻāʻo koko e hōʻike ana i ka helu haʻahaʻa o nā hunaola koko ʻulaʻula (anemia). Ma muli kēia o ke kahe ʻana o ke koko i loko o nā ʻōpū.
Nā kumu a me nā kumu pilikia no ka hoʻomohala ʻana i ka maʻi kanesa MSI-H
ʻO ke kumu nui o ka maʻi ʻaʻai MSI-H ʻo ia nā kīnā i loko o nā genes MMR a mākou i kamaʻilio ai ma mua. Loaʻa pinepine kēia mau mea i ka wā o ke ola o kekahi, me ke kumu ʻole.
Akā ma kahi o 5% o ka poʻe e loaʻa ana i ka maʻi ʻaʻai kolona, ua hoʻoili ʻia kēia kīnā genetic i nā hanauna. Kāhea mākou i kēia ʻo Lynch syndrome . Inā loaʻa i kekahi o kou ʻohana kēia maʻi, ʻoi aku kou pilikia o ka loaʻa ʻana o ka maʻi ʻaʻai kolona.
Eia kekahi, aia kekahi mau mea i ko mākou nohona e hoʻonui ai i ka pilikia o ka maʻi kanesa.
| Nā mea pilikia hiki ʻole iā mākou ke kaohi | Nā mea pilikia hiki iā mākou ke kaohi |
|---|---|
| ʻOi aku ma mua o 50 mau makahiki | Momona |
| Loaʻa kahi moʻolelo ʻohana o ka maʻi ʻaʻai colon | ʻAno 2 diabetes |
| Nā maʻi hoʻoilina e like me ka Lynch syndrome | Puhipaka |
| Loaʻa nā maʻi e like me ka maʻi a Crohn | ʻO ka inu nui ʻana |
| Loaʻa nā polyps i loko o ka colon | ʻAi nui ʻana i ka ʻiʻo ʻulaʻula a me ka ʻiʻo i hana ʻia |
Pehea e ʻike ai i ka maʻi?
Inā kānalua kāu kauka i ka maʻi kanesa ma muli o kāu mau hōʻailona, e kuhikuhi ʻo ia iā ʻoe no kekahi mau hoʻokolohua.
1. Colonoscopy: Hoʻokomo ʻia kahi ʻōmole palupalu me kahi kāmela i hoʻopili ʻia ma o ka anus e nānā i ka kolona holoʻokoʻa. I kēia manawa, lawe ʻia kahi ʻāpana liʻiliʻi o ka ʻiʻo mai kahi wahi kānalua no ka nānā ʻana. Ua kapa ʻia kēia he biopsy .
2. Nā hoʻāʻo molekala: Hana ʻia nā hoʻāʻo kūikawā e ʻike i nā loli genetic, ʻo ia hoʻi ke kūlana MSI-H, i loko o ka hāpana ʻiʻo i lawe ʻia mai ka biopsy. Hoʻohana ʻia nā ʻenehana e like me IHC , PCR , a me NGS no kēia.
3. Nā hoʻāʻo kiʻi: Hana ʻia nā scan e like me CT a me MRI e ʻike inā ua laha ke kanesa i nā ʻōpū ʻē aʻe.
He aha nā lāʻau lapaʻau no ka maʻi ʻaʻai MSI-H?
Aia ka lāʻau lapaʻau ma ke kahua o ke kanesa a me ka mamao o kona laha ʻana. ʻElua mau koho lapaʻau nui.
ʻoki kino
Inā ʻaʻole i laha ka maʻi ʻaʻai i nā wahi ʻē aʻe, ʻo ka hana mua, ʻo ia ka wehe ʻana i ka puʻupuʻu ma o ke ʻoki ʻana. Hiki ke ʻokoʻa ke ʻano o ke ʻoki ʻana ma muli o ka nui o ke kanesa.
Lāʻau lapaʻau
ʻO kēia kahi e komo mai ai ke ʻano kūikawā o ka maʻi ʻaʻai MSI-H.
- Immunotherapy: ʻO kēia ka lāʻau lapaʻau koʻikoʻi a holomua hoʻi no ka maʻi ʻaʻai MSI-H.. E noʻonoʻo i ko kākou mau pūnaewele pale maʻi me he mea lā he kuapo 'on'/'off'. I kekahi manawa, hoʻopau akamai nā pūnaewele maʻi kanesa i kēia kuapo a peʻe mai nā pale o ko kākou kino. Hoʻohuli hou nā lāʻau immunotherapy (nā mea pale checkpoint) i kēlā kuapo 'off', e kōkua ana i ka ʻōnaehana pale maʻi e ʻimi a luku i nā pūnaewele maʻi kanesa.
- Kemoterapi: Ke hāʻawi ʻana i nā lāʻau ikaika e pepehi i nā hunaola kanesa. I kekahi manawa hoʻohana ʻia ma mua a ma hope paha o ke ʻoki ʻana.
- Lapaʻau i hoʻolālā ʻia: Ke hāʻawi ʻana i nā lāʻau lapaʻau e hoʻolālā a hoʻōki i nā protein a i ʻole nā kaʻina hana e kōkua ai i ka ulu ʻana o nā hunaola kanesa.
Ke noho nei me ka maʻi ʻaʻai MSI-H
He mea nui loa ka mālama ʻana i ke olakino kino a me ka noʻonoʻo maikaʻi i ka wā o ka mālama ʻana i ka maʻi kanesa.
- ʻAi: Ma hope o ke ʻoki ʻana, e hahai i nā ʻōlelo a kāu kauka a ʻai i kahi meaʻai maʻalahi ke hoʻoheheʻe ʻia a kiʻekiʻe i ka protein. ʻOi aku ka maikaʻi o ka hōʻemi ʻana i ka ʻai ʻana i nā meaʻai e hana ana i ke kinoea (e.g., kāpeti, pī) a me nā ʻiʻo i hana ʻia.
- Hoʻoikaika Kino: ʻO nā hoʻomaʻamaʻa maʻalahi e like me ka hele wāwae ʻana i ka nui hiki iā ʻoe ke lilo i mea maikaʻi loa no kou kino a me kou noʻonoʻo. Akā e nīnau i kāu kauka ma mua o ka hoʻomaka ʻana i kekahi papa hana hoʻoikaika kino.
- Ola kino: He mea maʻamau ka hopohopo a me ka makaʻu i nā manawa e like me kēia. Mai hūnā i kou mau manaʻo i loko. E kamaʻilio me kahi mea āu e hilinaʻi ai, kou ʻohana, a e ʻimi i ke kōkua mai kahi kākāʻōlelo olakino noʻonoʻo inā pono.
He kiʻekiʻe ka nui o ka ho'ōla ʻana o ke kanesa MSI-H i hoʻohālikelike ʻia me nā ʻano maʻi kanesa colon ʻē aʻe, ʻoiai inā ʻike mua ʻia, a hiki i nā lāʻau lapaʻau e like me ka immunotherapy ke loaʻa nā hopena maikaʻi loa.
Leka Lawe-Home
- ʻO MSI-H kahi ʻano maʻi ʻaʻai kolona kikoʻī kahi i loaʻa ai i nā hunaola kanesa kahi kīnā i kā lākou ʻōnaehana hoʻoponopono DNA (MMR).
- Ma muli o kēia "kūpaʻa ʻole", pane maikaʻi loa kēia mau maʻi ʻaʻai i ka immunotherapy.
- Inā loaʻa iā ʻoe nā hōʻailona e pili ana i ka maʻi ʻaʻai colon (nā loli i ka ʻōpala, ka ʻeha o ka ʻōpū, ke kahe ʻana o ke koko), mai hoʻowahāwahā iā lākou a e ʻike koke i kāu kauka.
- Loaʻa i nā maʻi ʻaʻai MSI-H kahi manawa kūpono e ho'ōla ʻia inā ʻike mua ʻia. No laila, he mea nui e pale aku i ka hopohopo a e ʻimi i ka ʻōlelo aʻoaʻo lapaʻau kūpono a me ka lāʻau lapaʻau.
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