Hiki iā ʻoe ke loaʻa i ke kanesa e like me kēia i loko o kou ʻōpū? E kamaʻilio kākou e pili ana i ke Kanesa Peritoneal Mua

Ua lohe paha ʻoe i kēia inoa ʻo 'primary peritoneal cancer'? ʻAʻole paha. No ka mea, he ʻano maʻi kanesa kakaikahi ia. Akā, he mea nui loa ia e ʻike e pili ana i ia mea, ʻoiai hoʻi no nā wāhine. I kēia lā, e kamaʻilio maʻalahi mākou e pili ana i ia mea, ma ke ʻano hiki iā ʻoe ke hoʻomaopopo.

He aha ke Kanesa Peritoneal Mua?

I ka ʻōlelo maʻalahi, ʻo ke kanesa peritoneal mua ka maʻi kanesa e hoʻomaka ana ma ka uhi o kou ʻōpū, ka membrane lahilahi e uhi ana i loko o kou lua ʻōpū. Ua kapa ʻia kēia membrane ʻo ka peritoneum . E noʻonoʻo e like me ka uhi o kahi pōpō.

Uhi pū kēia peritoneum i kekahi mau ʻōkana koʻikoʻi i loko o kou ʻōpū. Eia kekahi laʻana:

• ʻŌpū mimi
• Nā ʻōpū
• ʻUmiʻumi
• ʻUterus (wahine)

Ua ʻike anei ʻoe ua hana ʻia kēia peritoneum me kahi ʻano cell kūikawā i kapa ʻia ʻo epithelial cells . Mālama kēia mau cell i nā ʻili like ʻole o ko mākou kino. Eia kekahi, hoʻopuka kēia peritoneum i kahi wai kūikawā. ʻO kēia wai ka mea e ʻae ai i nā ʻōpū i loko o ka ʻōpū e neʻe manuahi me ka ʻole o ke kuʻi ʻana kekahi i kekahi.

No laila, ulu ka maʻi ʻaʻai peritoneal mua i ka wā e hoʻomaka ai nā pūnaewele i loko o ka peritoneum e ulu ma ke ʻano ʻē a me ke kāohi ʻole ʻia.

I kēia manawa, e nānā kākou i nā ʻano o ke kanesa peritoneal. Ua hoʻokaʻawale nā ​​kauka iā ia i ʻelua ʻano, ma muli o kahi e hoʻomaka mua ai ke kanesa:

1. Ka maʻi ʻaʻai peritoneal mua: I kēia ʻano maʻi ʻaʻai, hoʻomaka ke kanesa i loko o nā pūnaewele e hana ana i ka peritoneum. Ke kamaʻilio nui nei mākou e pili ana i kēia ʻano i kēia lā.

2. Ka maʻi ʻaʻai peritoneal lua: ʻO kēia ka wā e hoʻomaka ai ke kanesa ma kahi ʻē aʻe o ke kino (no ka laʻana, nā ovaries, ka ʻōpū, nā ʻōpū) a laha i ka peritoneum. ʻO ke ʻano kēia, ʻaʻole ia i hoʻomaka ma ka peritoneum.

Pehea ka maʻamau o kēia maʻi ʻaʻai peritoneal mua?

ʻO ka ʻoiaʻiʻo, he ʻano maʻi ʻaʻai kakaʻikahi loa ka maʻi ʻaʻai peritoneal mua. E noʻonoʻo e pili ana i ia mea, ua ʻike ʻia ka maʻi ma lalo o 7 mai ka miliona o ka poʻe i kēlā me kēia makahiki. Eia naʻe, ʻaʻole hōʻike kēia mau helu i ke kiʻi holoʻokoʻa. Wahi a kekahi poʻe noiʻi, ma kahi o 15% o nā wahine i ʻike ʻia me ka maʻi ʻaʻai ovarian holomua e loaʻa paha i ka maʻi ʻaʻai peritoneal. No ka mea, ua like loa nā hōʻailona o nā mea ʻelua.

ʻO wai ka mea i ʻoi aku ka nui o ka pilikia o ka hoʻomohala ʻana i kēia?

ʻOi aku ka nui o ka hiki i nā wāhine ke loaʻa i ka maʻi ʻaʻai peritoneal mua ma mua o nā kāne. Ua like loa nā kumu pilikia no kēia me nā mea no ka maʻi ʻaʻai ovarian. E nānā kākou i ko lākou ʻano:

• Makahiki: ʻIke pinepine ʻia kēia maʻi i nā poʻe he 60 makahiki a ʻoi paha.
• ʻO ka endometriosis:Inā loaʻa iā ʻoe ka endometriosis (kahi ʻano e ulu ai nā pūnaewele e like me nā mea i loaʻa i loko o ka ʻili o ka uterus ma waho o ka uterus), e hoʻonui ʻia paha kou pilikia.
• Nā mana hoʻoilina (hoʻoilina): Inā ua loaʻa i kahi lālā o ka ʻohana pili (makuahine, kaikuahine, kaikamahine) ka maʻi ʻaʻai peritoneal, ka maʻi ʻaʻai tuba fallopian, a i ʻole ka maʻi ʻaʻai ovarian, ʻoi aku ka nui o kou pilikia. ʻOi aku ka nui o ka pilikia o nā wahine me nā hoʻololi ʻana o ka gene BRCA1 a i ʻole BRCA2 . ʻOi aku ka nui o ka pilikia o ka poʻe me nā genes no ka Lynch syndrome (kahi maʻi hoʻoilina e hoʻonui ai i ka pilikia o kekahi mau ʻano maʻi ʻaʻai).
• Kiʻekiʻe: ʻO ka poʻe i ʻoi aku ke kiʻekiʻe ma mua o ka awelika, ʻike ʻia lākou he kiʻekiʻe iki aʻe ka pilikia o ka loaʻa ʻana o kēia maʻi kanesa.
• Lapaʻau hoʻololi hormone: ʻO nā wahine e lawe ana i ka lāʻau lapaʻau hormone ma hope o ka menopause e piʻi aʻe paha ka pilikia.
• Momona: ʻO ka poʻe me ka momona o ke kino kiʻekiʻe e loaʻa pū kekahi i ka pilikia nui.
• Mōʻaukala hānau: Hiki ke hoʻonui iki ʻia kēia pilikia i ka poʻe i pilikia i ka loaʻa ʻana o nā keiki (infertility) a/a i ʻole ʻaʻole i loaʻa nā keiki.

He aha ka ʻokoʻa ma waena o ke kanesa peritoneal a me ke kanesa ovarian?

ʻO kēia kahi e huikau ai ka poʻe he nui. Hoʻomaka ka maʻi ʻaʻai peritoneal ma kahi ʻokoʻa ma mua o ke kanesa ovarian. Hoʻomaka pinepine ka maʻi ʻaʻai ovarian i loko o nā ovaries, a i ʻole i loko o nā cell ma nā wēlau o nā fallopian tubes. Eia nō naʻe, ʻo ke kanesa peritoneal, e like me kaʻu i ʻōlelo ai ma mua, hoʻomaka i loko o nā cell o ka peritoneum, ka membrane e uhi ana i loko o ka ʻōpū a uhi i nā ʻōpū i loko o ka ʻōpū.

Hiki ke huikau maʻalahi kēia mau maʻi ʻaʻai ʻelua kekahi i kekahi. ʻO kēia no ka mea ua hana ʻia ka peritoneum a me ka uhi o nā ovaries i nā ʻano cell like (epithelial cells). Eia kekahi, no ka mea ua pālahalaha nā maʻi ʻaʻai ʻelua ma ka uhi o ka ʻōpū, he mea paʻakikī i kekahi manawa ke kuhikuhi pololei i kahi i hoʻomaka mua ai ke kanesa.

ʻO ka maʻamau, ʻoi aku ka ʻelemakule o ka poʻe i ʻike ʻia me ka maʻi ʻaʻai peritoneal ma mua o ka poʻe i ʻike ʻia me ka maʻi ʻaʻai ovarian. Ua ʻōlelo ʻia hoʻi ʻoi aku ka ʻino o ka wānana no ka maʻi ʻaʻai peritoneal ma mua o ka maʻi ʻaʻai ovarian.

No ke aha e ulu ai kēia maʻi ʻaʻai peritoneal mua?

ʻO kaʻoiaʻiʻo, ʻaʻole maopopo i nā kānaka noiʻi ke kumu e loaʻa ai i kekahi poʻe ka maʻi ʻaʻai peritoneal mua. Eia nō naʻe, e like me ka mea i ʻōlelo ʻia ma mua, ua ʻike ʻia he kiʻekiʻe ka pilikia o ka poʻe i hānau ʻia me kekahi mau hoʻololi gene i ka loaʻa ʻana o ka maʻi.

He aha nā hōʻailona o kēia?

E like me ke kanesa ovarian, ʻaʻole hōʻike pinepine kēia maʻi i nā hōʻailona i kona mau pae mua . ʻOiai inā he mau hōʻailona, ​​pinepine lākou i ka maopopo ʻole a like paha me nā maʻi maʻamau ʻē aʻe. ʻIke ka hapa nui o ka poʻe i nā hōʻailona ke ʻoi aku ka holomua o ke kanesa, ʻo ia hoʻi ua laha.

Eia nō naʻe, inā loaʻa i kekahi kanaka nā hōʻailona mua, penei paha lākou:

• ʻEha ma ka ʻōpū a/a i ʻole ka ʻōpū lalo.
• Ke kahe koko ʻana a i ʻole ke kahe ʻana o ka ʻōpū ma ke ʻano ʻē.
• Manaʻo piha, he manaʻo kaumaha ma ka ʻōpū a i ʻole ka ʻōpū lalo.
• Nā loli o ka ʻōpū (ka paʻa ʻana o ka ʻōpū a me/a i ʻole ka hoʻonui ʻia ʻana o ka pahū ʻana o ka ʻōpū) a i ʻole ke kahe ʻana o ke koko i ka rectum.
• Pono e mimi pinepine.
• Nā pilikia hoʻoheheʻe ʻana, nalowale o ka makemake e ʻai, a i ʻole ka manaʻo piha ma hope o ka ʻai ʻana i kahi meaʻai liʻiliʻi wale nō.
• Ka piʻi a i ʻole ka pohō kaumaha i manaʻo ʻole ʻia.

I ka holomua ʻana o ke kanesa peritoneal, hiki ke ʻike ʻia nā hōʻailona ʻē aʻe. ʻO kēia mau mea:

• Luhi.
• Ka hōʻiliʻili ʻana o ka wai i loko o ka ʻōpū (ua kapa ʻia kēia ʻo 'ascites' ).
• Ka luaʻi a i ʻole ka luaʻi ʻana.
• Ka paʻakikī o ka hanu ʻana (dyspnea).
• Ka pehu ʻana o nā wāwae.

He aha nā hopena ʻaoʻao (nā pilikia) e hiki mai ana o kēia?

Hiki i nā poʻe me ke kanesa peritoneal holomua ke loaʻa i nā pilikia e like me:

• ʻEha nui o ka ʻōpū.
• ʻAʻole hiki ke ʻai a inu paha.
• Ka luaʻi nui a i ʻole ka luaʻi ʻana.
• ʻŌpū liʻiliʻi, ʻōpū nui, a i ʻole ke ālai ʻana o ke ala mimi.

Pehea ʻoe e ʻike pololei ai i kēia maʻi?

Ke ʻike ʻoe i ke kauka, e nīnau mua lākou iā ʻoe e pili ana i kāu mau hōʻailona a hana i kahi hoʻokolokolo kino. Inā hōʻike kāu mau hōʻailona i ka maʻi ʻaʻai peritoneal, hiki iā lākou ke kauoha i nā hoʻokolohua e like me:

• Nā hoʻāʻo koko: Ke nānā nei kēia mau hoʻāʻo koko i kahi kemika i kapa ʻia ʻo CA-125, i hana ʻia e kekahi mau hunaola kanesa. Hiki i ka poʻe me ka maʻi kanesa peritoneal ke loaʻa i nā pae kiʻekiʻe o kēia mea. Hiki iā lākou ke nānā i ka hoʻonui ʻia o kahi protein i kapa ʻia ʻo HE4 (hiki ke hana ʻia e nā hunaola kanesa peritoneal).
• Nā hoʻāʻo kiʻi: Hiki i nā hoʻāʻo e like me ka ultrasound, MRI, a i ʻole CT scan ke nānā i nā ulu ʻana o ka maʻi kanesa. Eia nō naʻe, hiki i kēia mau hoʻāʻo ke paʻakikī ke ʻike i nā hihia o ka maʻi ʻaʻai peritoneal.
• Laparoscopy: No ka hōʻoia ʻana i ka maʻi, hiki i ke kauka ke hana i kahi laparoscopy. Pili kēia i ka hana ʻana i kekahi mau ʻoki liʻiliʻi ma ka ʻōpū a me ka hoʻokomo ʻana i kahi mea hana i lako me ke kāmela. I loko o kēia kaʻina hana, lawe ʻia kahi laʻana liʻiliʻi o nā ʻiʻo ʻē (i kapa ʻia he biopsy) , a laila nānā ʻia ma lalo o kahi microscope e kahi pathologist (he kauka loea i ka nānā ʻana i nā ʻiʻo) e hoʻoholo ai inā loaʻa ka maʻi ʻaʻai.
• Paracentesis: Inā piha kou ʻōpū i ka wai (i kapa ʻia ʻo ascites), hiki i kāu kauka ke lawe i kahi laʻana o ka wai a hoʻāʻo iā ia. Hana pinepine ʻia kēia i ka wā o ka laparoscopy.
• Hoʻokolokolo Pelvic:E nānā ʻia kou ʻōpū, cervix, uterus, fallopian tubes, ovaries, a me ka rectum no kekahi mau puʻupuʻu a i ʻole nā ​​​​wahi ʻē.

E aʻo pū kākou e pili ana i nā hoʻokolohua kūikawā

Inā loaʻa iā ʻoe kekahi o kēia mau kūlana, hiki i kāu kauka ke kuhikuhi iā ʻoe i kahi kākā'ōlelo genetic e kamaʻilio e pili ana i kekahi o nā kūlana genetic e pili ana me ka hoʻonui ʻia o ka pilikia o ka hoʻomohala ʻana i ka maʻi ʻaʻai peritoneal:

• Inā ua loaʻa i kahi lālā pili o ka ʻohana (makuahine, kaikuahine, kaikamahine) ka maʻi ʻaʻai peritoneal, ka maʻi ʻaʻai fallopian tube, a i ʻole ka maʻi ʻaʻai ovarian.
• Inā he loli ka gene 'BRCA1' a 'BRCA2' paha kekahi o ka ʻohana.
• Inā loaʻa kekahi o ka ʻohana i ka Lynch Syndrome.

He aha ke kahua o kēia maʻi kanesa?

Ma muli o ka ʻike pinepine ʻole ʻia o nā hōʻailona i nā pae mua o ke kanesa peritoneal mua, aia ka maʻi kanesa i ke kahua 3 a i ʻole 4 i ka wā e ʻike ʻia ai.

• Pae 3: Ua pālahalaha ke kanesa ma waho o ka lua pelvic a i ʻole i nā lymph nodes ma ke kua o ka ʻōpū.
• Pae 4: Ua pālahalaha ke kanesa i nā ʻōpū ma waho o ka ʻōpū (e.g., nā māmā, ke akepaʻa, ka spleen) a i ʻole i ka membrane e uhi ana i nā māmā a me ka umauma.

Pehea e mālama ʻia ai kēia a pehea e hoʻokele ʻia ai?

ʻO ka mālama ʻana i ke kanesa peritoneal mua e pili ana i kekahi mau kumu:

• Ka nui a me ka wahi o ka puʻupuʻu kanesa.
• Ke kahua o ka maʻi ʻaʻai.
• Kou makahiki a me kou olakino holoʻokoʻa.

ʻO ka hapa pinepine, e hana nā kauka i ke ʻoki kino ma ke ʻano he lāʻau lapaʻau mua. Loaʻa paha iā ʻoe kahi kaʻina hana i kapa ʻia ʻo ke ʻoki kino cytoreductive . ʻO ka pahuhopu o kēia, ʻo ia ka wehe ʻana i ka nui o nā hunaola kanesa e like me ka hiki. Ua hōʻike ʻia e ka noiʻi ʻana ʻoi aku ka maikaʻi o nā hopena ke hana ʻia kēia ʻoki kino e kahi gynecologic oncologist (he kauka loea i ka mālama ʻana i nā maʻi a me nā kanesa o ka ʻōnaehana hānau wahine).

Hiki i ke kauka lapaʻau ke wehe i:

• ʻO nā ʻōpū Fallopian a me nā ovaries (ua kapa ʻia kēia he 'oophorectomy ').
• ʻO ka ʻōpū (ua kapa ʻia kēia he 'hysterectomy ').
• ʻO ka ʻiʻo momona a puni kou ʻōpū, i kapa ʻia ʻo ka omentum (ua kapa ʻia kēia he 'omentectomy ').
• Nā ʻiʻo ʻē aʻe.

I mea e pale ai i nā hunaola kanesa mai ka laha ʻana i nā wahi ʻē aʻe o ke kino, hiki i kāu hoʻolālā lapaʻau ke komo pū me:

• Kemoterapi: Hāʻawi ʻia ka kemoterapi kuʻuna no ka maʻi ʻaʻai peritoneal ma ke ʻano intravenous a i ʻole pololei i loko o ka lua ʻōpū (intraperitoneal). I kekahi mau hihia, hoʻohana nā kauka i nā lāʻau kemoterapi wela (ua kapa ʻia kēia he kemoterapi hyperthermic intraperitoneal (HIPEC)).) hoʻohana ʻia. Hāʻawi koke ʻia kēia lāʻau lapaʻau `HIPEC` ma hope o ke ʻoki cytoreductive, ʻoiai ʻoe e noho ana ma lalo o ka anesthesia i loko o ka lumi hana, a ua hoʻokomo ʻia i loko o ka lua ʻōpū. Hiki i kēia ʻano hana `HIPEC` ke ʻoi aku ka maikaʻi no ka hāʻawi ʻana i ka chemotherapy no kekahi mau maʻi kanesa.
• Lapaʻau i hoʻolālā ʻia: Hiki i ke kauka ke hoʻohana i nā lāʻau lapaʻau kikoʻī e hoʻolālā wale ana i nā hunaola kanesa, me ka ʻole o ka hōʻino ʻana i nā hunaola maʻamau.
• ʻO ka lāʻau lapaʻau hormonal: I nā hihia holomua, hoʻohui pinepine nā kauka i ka lāʻau lapaʻau hormonal me ka chemotherapy. Hana kēia lāʻau lapaʻau ma ke kāohi ʻana i nā hormones kūlohelohe o kou kino mai ka hiki ʻana aku i nā hunaola kanesa, e pale ana iā lākou mai ka ulu ʻana.
• Lapaʻau radiation: ʻAʻole hoʻohana pinepine ʻia ka lāʻau radiation ma ke ʻano he lāʻau mua no ka maʻi ʻaʻai peritoneal. Inā ua hoʻi mai ke kanesa ma hope o ka lāʻau mua a ua kaupalena ʻia i kahi wahi liʻiliʻi, hiki ke hāʻawi ʻia ka lāʻau radiation.

Pehea e hiki ai iaʻu ke hōʻemi i koʻu pilikia o ka loaʻa ʻana o kēia?

Inā ua hana ʻoe i kēia mau mea, hiki ke hoʻemi iki ʻia kou pilikia o ka loaʻa ʻana o ka maʻi ʻaʻai peritoneal mua:

• Inā ua hānai ʻia nā keiki i ka waiū umauma.
• Inā ua hānau ʻoe i nā keiki.
• Inā ua lawe ʻoe i nā lāʻau hoʻomalu hānau.
• Inā ua wehe ʻia kāu mau ʻōpū fallopian a me/a i ʻole nā ​​ovaries ma ke ʻoki ʻana.
• Inā ua nakinaki ʻia nā ʻōpū fallopian (tubal ligation).

ʻO kekahi poʻe me ka mōʻaukala ʻohana o ka maʻi ʻaʻai ovarian a i ʻole ka poʻe me ka hoʻololi ʻana o ka gene BRCA i loaʻa i ka nui o ka pilikia o ka loaʻa ʻana o ka maʻi ʻaʻai peritoneal koho e wehe ʻia kā lākou ovaries a me nā fallopian tubes. He mea nui e hoʻomanaʻo ʻoiai ʻo kēia ʻoki kino e hōʻemi ana i ka pilikia o ka loaʻa ʻana o ka maʻi ʻaʻai peritoneal, ʻaʻole ia e hoʻopau loa iā ia .

He aha ka wā e hiki mai ana no kekahi me kēia maʻi? (Wānana)

Ma muli o ka ʻike pinepine ʻia ʻana o ke kanesa peritoneal i kahi pae hope o ka maʻi, maikaʻi ʻole ka prognosis. Hiki i ke kanesa ke hoʻi hou ma hope o ka mālama ʻana. Eia nō naʻe, hiki i ka ʻike mua ʻana ke kōkua i ka hoʻomaikaʻi ʻana i nā hopena.

Ma kahi o ka hapalua o ka poʻe me ka maʻi ʻaʻai peritoneal, fallopian tube, a i ʻole ovarian e ola ana i ʻelima mau makahiki a ʻoi aku paha ma hope o ka hōʻoia ʻana. ʻOiai ʻoi aku ka lōʻihi o ke ola o ka poʻe ʻōpio, ʻoi aku ka maikaʻi ʻole o ka wānana no ka poʻe ʻelemakule.

Hiki ke piʻi aʻe ka nui o ke ola ma nā hihia e like me kēia:

• Inā ʻaʻole i pālahalaha ke kanesa i kou mau lymph nodes.
• Inā ua loaʻa iā ʻoe ka lāʻau lapaʻau 'HIPEC'.
• Inā ua wehe ke kauka ʻoki i ka nui o ke kanesa e like me ka hiki.

Ke hana ʻia nei kekahi mau hoʻokolohua lapaʻau e ʻimi i nā ala hou e mālama ai i ka maʻi ʻaʻai peritoneal. ʻO kēia mau lāʻau lapaʻau hou e komo pū me nā therapies i hoʻolālā ʻia a me ka immunotherapy.ʻO ka Immunotherapy e pili ana i ka hoʻoulu ʻana i kāu ʻōnaehana palekana e ʻike a hoʻouka i nā hunaola kanesa i loko o kou kino.

Pehea lā wau e mālama ai iaʻu iho?

I mea e kōkua ai i ka hoʻokele ʻana i nā hōʻailona o ke kanesa peritoneal holomua, hiki i kāu kauka ke kuhikuhi iā ʻoe e ʻike i kahi mea lawelawe lāʻau palliative (kahi kahua lāʻau lapaʻau e kālele ana i ka hōʻoluʻolu a me ka hoʻoponopono ʻana i nā hōʻailona o kahi maʻi koʻikoʻi). Hiki i kāu mālama ke komo pū me:

• Hoʻemi i ka nausea a me ka luaʻi ʻana.
• He kūkākūkā meaʻai e loaʻa ai nā ʻōlelo aʻoaʻo e pili ana i ka makemake e ʻai a me ka papaʻai.
• Ka mālama ʻana i ka ʻeha.
• ʻO ka paracentesis e wehe i ka wai mai kou ʻōpū (ascites).

Pehea lā e hiki ai iaʻu ke hoʻoponopono maikaʻi i kahi kūlana e like me kēia?

ʻO ke komo ʻana i kahi hui kākoʻo me nā poʻe ʻē aʻe e hele ana i ka mālama like me ʻoe hiki ke kōkua iā ʻoe e noho mehameha. Hiki i nā hui kākoʻo ke kōkua i kou ʻohana e hoʻomaopopo i ka mea āu e hele nei.

ʻO ka leka koʻikoʻi loa e lawe i ka home

ʻO ke kanesa peritoneal mua kahi ʻano kanesa kakaikahi e ulu ana i loko o ka ʻōpū. ʻIke pinepine ʻia nā hōʻailona ma hope o ka ulu ʻana o ke kanesa, no laila ua ʻike pinepine ʻia i kahi pae ma hope. Eia nō naʻe, hiki i nā lāʻau lapaʻau holomua e like me HIPEC, ka lāʻau lapaʻau i kuhikuhi ʻia, a me ke ʻoki kino ke hoʻomaikaʻi i nā hopena. Ke hana ʻia nei nā hoʻokolohua lapaʻau e ʻimi i nā koho lapaʻau ʻē aʻe e hiki ke hoʻonui i nā helu ola.

ʻO ka mea nui loa, inā hoʻomau ʻoe i nā hōʻailona i ʻōlelo ʻia ma luna (ʻoi aku ka loli maʻamau ʻole i loko o ka ʻōpū, ka ʻeha, ke kaumaha), pono ʻoe e ʻimi i ke kōkua lapaʻau. ʻO ka wā mua e ʻike ʻia ai, ʻo ka nui o ka kūleʻa o ka lāʻau.

ʻO ke kanesa Peritoneal, Ke kanesa peritoneal mua, Ke kanesa Peritoneal, Ke kanesa ʻōpū, Ke kanesa wahine, Nā hōʻailona kanesa, Lapaʻau kanesa