He mea paʻakikī ke hoʻopuka i kou manaʻo i ka wā e ʻike ai ʻoe ua loaʻa iā ʻoe a i ʻole kekahi āu e aloha ai ka maʻi kanesa. He mea maʻamau ka makaʻu a me ka hoihoi i ka wā e haʻi aku ai kāu kauka iā ʻoe e pili ana i kahi lāʻau hou, e like me PRRT, he huaʻōlelo i kamaʻāina ʻole ʻia. Akā, mai hopohopo. ʻOiai he kumuhana paʻakikī kēia, i kēia lā e kamaʻilio mākou e pili ana i ke ʻano o PRRT, kāna hana, a me kona mau pono a me nā hemahema, ma ke ʻano maʻalahi loa e hiki ai iā ʻoe ke hoʻomaopopo.
He aha ka manaʻo maʻalahi o ka PRRT?
I ka ʻōlelo maʻalahi, he lāʻau lapaʻau holomua loa ka PRRT e kuhikuhi ana, ʻimi, a luku i nā hunaola kanesa, e like me ka 'missile alakaʻi' . Hoʻohana kūikawā ʻia ia e mālama i kahi ʻano kanesa i kapa ʻia ʻo 'Neuroendocrine Tumors (NETs).'
ʻO ke ʻano kūikawā o kēia lāʻau lapaʻau, ʻo ia ka mea radioactive (radioactivity) i hoʻokuʻu ʻia e ia e hele pololei i loko o nā hunaola kanesa a luku iā lākou. No laila, ʻoi aku ka liʻiliʻi o ka hōʻino ʻana i nā hunaola olakino ma mua o ka radiation therapy maʻamau.
Pehea e hana ai kēia lāʻau lapaʻau i loko o ke kino?
No ka hoʻomaopopo ʻana i kēia, e hoʻohana kākou i kahi laʻana maʻalahi. E noʻonoʻo ʻoe he mau puka kou mau hunaola kanesa me nā 'puka kī' kūikawā he nui ('nā mea hoʻokipa'). Hoʻokomo wale kēlā me kēia puka i kahi kī me kahi ʻano kikoʻī.
Hana ʻia kēia lāʻau lapaʻau, i kapa ʻia ʻo PRRT, ma ka hui pū ʻana i ʻelua mau ʻāpana:
1. Ke Kī: He protein kēia. Hiki i kēia kī ke komo i loko o ka 'puka kī' o nā hunaola kanesa. ʻAʻole ia e komo i loko o nā hunaola olakino.
2. Ka Mea Holo Leka Uila: He mea leka uila liʻiliʻi loa kēia (`radionuclide`) i hoʻopili ʻia i kēia kī.
No laila, ke hāʻawi ʻoe i kēia lāʻau i kou kino, hele kēia 'kī' ma ke kino holoʻokoʻa, loaʻa nā 'puka kī' i loko o nā hunaola kanesa, a hoʻopili iā ia iho iā lākou. A laila, komo ka 'mea holo radioactive' ma ke kī i loko o ke hunaola kanesa, hōʻino i ka DNA o kēlā hunaola, a luku i ke hunaola mai loko mai.
ʻO kēia ʻano hana e ʻae ai i ka luku koho ʻana i nā hunaola kanesa wale nō, me ka ʻole o ka hōʻino nui ʻana i nā hunaola olakino. ʻO kēia ka pōmaikaʻi nui loa o kēia lāʻau lapaʻau.
ʻO ka lāʻau PRRT i hoʻohana nui ʻia i kēia lā ʻo ia ka `lutetium Lu 177 dotatate (LUTATHERA®)`.
No wai ka lāʻau PRRT i ʻōlelo ʻia?
ʻAʻole kūpono kēia lāʻau lapaʻau no nā poʻe maʻi kanesa āpau. I kēia manawa, ua ʻōlelo nui ʻia no nā maʻi kanesa i kapa ʻia ʻo 'gastroenteropancreatic NETs', ʻo ia hoʻi nā maʻi kanesa o ke ala ʻai (nā ʻōpū, ka ʻōpū, ka rectum) a me ka pancreas. Aia kekahi mau kūlana e kūpono ai kēia lāʻau lapaʻau iā ʻoe.
| Kūlana | Wehewehena |
|---|---|
| ʻAʻole kūpono no ke ʻoki kino | Inā ua pālahalaha ke kanesa ( metastasized ) i nā ʻāpana he nui o ke kino, ʻaʻole paha e hāʻawi ka ʻoki kino wale i kahi lāʻau lapaʻau piha. Nui ka poʻe me NETs i hoʻolaha mua i ke kanesa i ka wā i ʻike ʻia ai lākou. |
| ʻAʻole i holomua nā lāʻau lapaʻau ʻē aʻe | I nā hihia kahi hiki ʻole ai ke ʻoki kino, hāʻawi ʻia nā mea e like me ka lāʻau lapaʻau hormone. Akā i kekahi manawa, ʻo kēlā mau lāʻau lapaʻau ke kumu o ka ulu ʻana o nā hunaola kanesa me ka ʻole o ke kāohi ʻia. No kēlā poʻe, he koho maikaʻi ʻo PRRT. |
| Loaʻa i nā pūnaewele kanesa kēlā 'kī puka' | ʻO kēia ka mea nui loa. I mea e hiki ai i ka lāʻau PRRT ke hōʻea i ke 'kī' a hoʻopili, pono nā 'puka kī' i kapa ʻia ʻo nā mea loaʻa somatostatin ma luna o ka ʻili o nā hunaola kanesa. E hana kāu kauka i kahi scan kūikawā, e like me ka scan octreotide a i ʻole ka scan PET , e ʻike inā loaʻa i kāu mau hunaola kanesa kēia mau mea. |
He aha ka mea e hana ʻia ma mua a i ka wā o ka mālama ʻana?
Ma mua o ka mālama ʻana
Inā ʻoe e lawe ana i nā lāʻau lapaʻau ʻē aʻe no NETs (ʻoi aku hoʻi nā analog somatostatin), e aʻo aku paha kāu kauka iā ʻoe e hoʻōki i ka lawe ʻana iā lākou i kekahi mau pule ma mua o PRRT. E hana paha kāu kauka i nā hoʻokolohua koko ma kahi o hoʻokahi pule ma mua o kāu lāʻau lapaʻau e nānā i kāu hana puʻupaʻa a me ka helu o nā cell koko e hōʻoia i kou kino i ke kūlana maikaʻi e loaʻa ai ka lāʻau lapaʻau.
I ka lā o ka mālama ʻana
ʻO ka maʻamau, hāʻawi ʻia kēia lāʻau lapaʻau i kēlā me kēia ʻelua mahina no 4 mau kau ma luna o 8 mau mahina. He hana outpatient kēia, me ka ʻole o ka noho ʻana i ka haukapila. ʻO ka lōʻihi o ke kaʻina hana holoʻokoʻa ma kahi o 5-6 mau hola.
- ʻO ka mea mua, hoʻokomo ʻia kahi ʻōmole liʻiliʻi (cannula) i loko o kahi aʻa i loko o kou lima a hana ʻia kahi laina saline.
- Ma kahi o hoʻokahi hola ma mua o ka hoʻomaka ʻana o ka lāʻau lapaʻau, hāʻawi ʻia ka lāʻau lapaʻau e pale ai i ka nausea a me ka luaʻi.
- A laila, e hāʻawi ʻia ʻoe i kahi wai saline e loaʻa ana nā waikawa amino e pale i kou mau puʻupaʻa no kahi o 4 mau hola. He mea nui loa kēia.
- Ma kahi o 30 mau minuke ma hope o ka hoʻomaka ʻana o ka lawelawe ʻana i nā waikawa amino, hoʻokomo ʻia ka lāʻau PRRT i ke kino ma o ka saline ma kahi o 30-45 mau minuke.
- Ke hoʻokomo ʻia ka saline a pau, e wehe ʻia ka ʻōmole ma ka lima.
I ka lā ma hope o ka lāʻau lapaʻau, e loaʻa hou iā ʻoe kahi scan e nānā i kahi i hele ai ka lāʻau radioactive i loko o kou kino, ʻoiai ma kahi o nā puʻupuʻu kanesa.
He aha nā hopena ʻaoʻao a me nā pilikia?
E like me nā lāʻau lapaʻau āpau, aia paha kekahi mau hopena ʻaoʻao.
Nā hopena ʻaoʻao maʻamau:
ʻO nā hopena ʻaoʻao maʻamau ka nausea a me ka luaʻi ʻana , akā hiki ke hoʻomalu nui ʻia kēia mau mea e ka mālama mua ʻana.
Nā pilikia ʻē aʻe e hiki ke hana ʻia:
- ʻO kekahi hopena i ka hana o nā puʻupaʻa a i ʻole ke akepaʻa.
- Ka emi ʻana o ka helu o nā hunaola koko (nā hunaola koko keʻokeʻo, nā hunaola koko ʻulaʻula, nā platelets). Hiki i kēia ke hoʻopilikia i ka hanu ʻana, hoʻonui i ka maʻalahi i nā maʻi, a me ka hoʻonui ʻia o ka pilikia o ke kahe ʻana o ke koko a i ʻole ka palapū.
- He mea kākaʻikahi loa, aia kahi pilikia liʻiliʻi loa o ka hoʻomohala ʻana i nā maʻi kanesa koko ʻē aʻe e like me ka myelodysplastic syndrome a i ʻole ka leukemia.
E nānā mau ana kāu kauka i kou pae koko i loko o kāu lāʻau lapaʻau. Inā kū mai kekahi pilikia, hiki iā lākou ke hoʻoholo e hoʻololi i ka nui o ka lāʻau a hoʻōki paha i kāu lāʻau lapaʻau.
He kūlana koʻikoʻi loa e pono ai ka nānā koke ʻana!
He kūlana kakaikahi ka pilikia carcinoid akā he mea hoʻoweliweli paha i ke ola e hiki ke hana ʻia i ka wā o kēia mālama ʻana. Hoʻokumu ʻia ia e ka hoʻokuʻu koke ʻana o ka nui o nā hormones mai nā hunaola kanesa i loko o ke koko. Hiki ke ʻike ʻia nā hōʻailona i loko o nā hola 48 mua o ka loaʻa ʻana o ka mālama ʻana.
Inā loaʻa iā ʻoe kekahi o kēia mau hōʻailona, e hele koke i ka haukapila Emergency Department (ETU) kokoke loa a kāhea aku paha i ka 1990:
* Paʻakikī ka hanu ʻana
* ʻUlaʻula o ka maka a i ʻole ka ʻāʻī, me ka wela a i ʻole ke kuni ʻana o ke kino (Flushing)
* Ka hāʻule koke ʻana o ke koko (manaʻo poniuniu)
* Nā palpitations o ka puʻuwai
* Ka maʻi pākī nui
Ke ola o kēlā me kēia lā ma hope o ka mālama ʻana
Hoʻomanawanui maikaʻi ka hapa nui o ka poʻe i kēia lāʻau a hoʻōla koke.
Ka hana radioactive a me ka palekana:
Hoʻohana ka lāʻau lapaʻau i kahi liʻiliʻi loa o ka radiation. E hoʻokuʻu ʻia kēia mai kou kino i loko o kou mimi a me ka ʻōpala i nā lā e hiki mai ana. I loko o kēia manawa, e hāʻawi kāu kauka iā ʻoe i nā ʻōlelo aʻoaʻo e pale aku i nā poʻe ʻē aʻe mai ka hoʻopili ʻia ʻana i ka radiation.
- He mea nui loa ia e noho mamao aku mai nā wahine hāpai a me nā keiki ʻōpio no kekahi mau lā.
- E holoi pono i kou mau lima me ke kopa ma hope o ka hoʻohana ʻana i ka lua.
Ka huakaʻi ʻana:
Aia paha he liʻiliʻi loa ka nui o ka radiation i loko o kou kino a hiki i 3 mau mahina ma hope o kāu mālama ʻana. Hiki i kēia ke hoʻāla i nā mea ʻike radiation ma nā kahua mokulele a i ʻole nā palena. No laila, e mālama mau i ke kāleka kūikawā āu i loaʻa mai ka haukapila a me kāu mau kikoʻī mālama me ʻoe. He mea nui loa kēia e pale aku i nā pilikia i ka wā e hele ai.
Leka Lawe-Home
- He lāʻau lapaʻau holomua ka PRRT e hāʻawi ana i ka radiation i kuhikuhi pono ʻia i nā hunaola kanesa. Hoʻohana kūikawā ʻia ia no nā Neuroendocrine Tumors (NETs).
- ʻOiai ʻaʻole kēia he lāʻau e hoʻōla loa ai i ka maʻi kanesa, kōkua ia i ka hoʻēmi ʻana a i ʻole ka hoʻōki ʻana i ka ulu ʻana o nā puʻupuʻu, kaohi i nā hōʻailona, a hoʻomaikaʻi i ke ʻano o ke ola ma ka hoʻonui ʻana i ka manawa ola.
- No kekahi mau lā ma hope o ka lāʻau lapaʻau, e hahai i nā ʻōlelo kuhikuhi i hāʻawi ʻia e pale aku i nā poʻe ʻē aʻe mai ka radiation (ʻoi aku ka noho mamao aku mai nā keiki ʻōpio a me nā wahine hāpai).
- E makaʻala i nā hōʻailona o ka pilikia carcinoid (paʻakikī ka hanu ʻana, ka ʻulaʻula, ka maʻi diarrhea nui, ka piʻi ʻana o ka puʻuwai). Inā ʻike ʻoe i kekahi o kēia mau hōʻailona, e hele koke i ka ETU o ka haukapila.
- Mai kānalua e kamaʻilio me kāu kauka e pili ana i nā hopena ʻaoʻao a i ʻole nā pilikia āu e ʻike ai.
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