Kodi ndi zotupa ziti zomwe zimapangika mkati mwa thupi lanu, m'mitsempha yanu ya ndulu? Tiyeni tikambirane za Klatskin Tumors!

Kodi munayamba mwamvapo ngati maso anu akusintha kukhala achikasu chifukwa cha kupweteka m'mimba? Kapena mwina mumangomva ngati mukuchepetsa thupi? Izi ndi zinthu zomwe nthawi zina sitimaziganizira kwambiri, koma zitha kukhala zizindikiro za matenda ena osowa. Lero tikambirana za matenda omwe ndi oopsa pang'ono, koma ndikofunikira kwambiri kuwadziwa. Umenewo ndi vuto lotchedwa Klatskin Tumor .

Kodi Chotupa cha Klatskin n'chiyani?

Mwachidule, zotupa za Klatskin izi ndi mtundu wa chotupa cha khansa chomwe chimayamba m'mitsempha ya ndulu kunja kwa chiwindi chathu. Taganizirani izi, chiwindi chathu chimapanga madzi otchedwa ndulu, omwe amathandiza kugaya chakudya. Ndulu iyi imayenda kudzera m'njira zazing'ono ndipo imalumikizana kuti ipange ndulu yayikulu. Makamaka, zotupa izi nthawi zambiri zimapangidwa m'dera lotchedwa 'hilum', komwe ndulu yakumanja ndi yakumanzere yochokera ku chiwindi imalumikizana kuti ipange ndulu yayikulu. Madokotala amatchanso izi 'Hilar Cholangiocarcinoma' . Ngati zotupa izi zapezeka ndikuchiritsidwa msanga, pali mwayi woti zitha kuchiritsidwa. Zinthu monga opaleshoni ndi kusamutsa chiwindi ndiye njira zazikulu zochiritsira. Palinso njira zochepetsera zizindikiro. Kafukufuku akuchitikanso pamankhwala atsopano.

Kodi izi ndi zachilendo bwanji?

Imeneyi ndi matenda osowa kwambiri . Akuti pafupifupi munthu m'modzi pa anthu 100,000 amadwala matendawa. Izi zikutanthauza kuti si matenda omwe amakhudza anthu ambiri.

Kodi zizindikiro za Klatskin Tumor ndi ziti?

Choncho, pamene zotupa za ndulu izi zimayamba, zimatseka kutuluka kwa ndulu kuchokera mu ndulu. Pamenepo ndi pomwe zizindikiro zosiyanasiyana zimawonekera. Izi zimawonekera pang'onopang'ono, kotero nthawi zina sitingazizindikire.

• Kupweteka m'mimba: Kupweteka kwa m'mimba kosalekeza, komwe nthawi zina kumakulirakulira, makamaka kumtunda kwa mimba.
• Kutopa: Kumva kutopa kwambiri komwe sikutha ngakhale mutagona tulo tabwino usiku.
• Kusanza: Kumva ngati ukudwala, mwina kusanza.
• Kuchepetsa thupi: Kuchepetsa thupi popanda chifukwa chomveka komanso popanda kuchepetsa thupi.
• Jaundice: Kuyera kwa maso ndi khungu. Izi zimachitika pamene ndulu siikutuluka bwino, zomwe zimapangitsa kuti chinthu chachikasu chotchedwa bilirubin chizisonkhana m'magazi. Mkodzo ukhoza kukhala wachikasu wakuda ndipo ndowe zimatha kukhala zoyera.
• Khungu loyabwa: Anthu ena amatha kuyabwa thupi lonse, zomwe zimadzanso ndi vuto la ndulu.

Zizindikiro zimenezi zingakhale zovuta kuzipirira, choncho musazengereze kufunafuna upangiri wa dokotala. Chofunika kwambiri ndikupeza chomwe chikuyambitsa vutoli mwachangu.

Kodi zimayambitsa matenda a Klatskin Tumor ndi ziti?

Ofufuza sanapezebe chomwe chimayambitsa matenda a khungu amenewa.Koma izi ndi zomwe zimachitika: Zotupazi zimachitika pamene kusintha kwa majini (kusintha kwa majini) kumachitika m'maselo abwinobwino a thupi lathu, zomwe zimapangitsa kuti maselowo agawikane modabwitsa ndikuchulukana mosalamulirika.

Komabe, zinthu zina zapezeka zomwe zimawonjezera chiopsezo cha vutoli. Izi zikutanthauza zinthu monga matenda ena ndi kusintha kwa majini komwe kumachitika tikabadwa.

Zina mwa zinthu zomwe zimawonjezera chiopsezochi ndi izi:

• Kumwa mowa mopitirira muyeso: Aliyense amadziwa kuti mowa si wabwino ku chiwindi. Kumwa mowa mopitirira muyeso kwa nthawi yayitali kumawononga chiwindi ndikuwonjezera chiopsezo cha khansa yamtunduwu.
• Miyala ya m'mimba (Choldocholithiasis): Miyala yotseka ndulu ingayambitse kutupa kwa nthawi yayitali komanso kusintha kwa maselo.
• Pancreatitis yosatha: Kutupa kwa kapamba kwa nthawi yayitali.
• Clonorchiasis: Iyi ndi matenda omwe amayamba chifukwa cha kachilombo ka chiwindi ka ku China. Kachiromboka kamakhala m'mitsempha ya ndulu ndipo kamayambitsa kuwonongeka kwa nthawi yayitali.
• Primary sclerosing cholangitis (PSC): Iyi ndi matenda omwe ma ducts a bile amatupa, amatupa, komanso amachepa. Izi ndi matenda omwe amawonjezera kwambiri chiopsezo cha matenda a Klatskin.
• Mavairasi ena: Kuwonongeka kwa chiwindi komwe kumachitika chifukwa cha mavairasi, makamaka chiwindi cha mtundu wa B ndi chiwindi cha mtundu wa C, kungachitikenso.
• Zaka: Anthu azaka zopitilira 50 ali pachiwopsezo chachikulu.
• Kunenepa kwambiri ndi matenda a shuga zimaganiziridwanso kuti zimawonjezera chiopsezo cha matendawa pamlingo winawake.

Kodi izi zingayambitse mavuto otani?

Vutoli lingayambitse mavuto aakulu .

• Magazi amaundana: Khansa imatha kufalikira ku mitsempha ikuluikulu yamagazi ndikupanga magazi amaundana.
• Cholestasis ya m'chiwindi: Izi zimachitika pamene njira yaikulu ya ndulu kunja kwa chiwindi yatsekedwa ndi chotupa. Izi zitha kukulitsa jaundice.
• Khansa ya metastatic: Zotupa za Klatskin izi zimatha kufalikira kuchokera m'mitsempha ya ndulu kunja kwa chiwindi kupita ku chiwindi, mapapo, mafupa, ma lymph nodes, ndi mbali zina za mimba.

Kodi Klatskin Tumor imapezeka bwanji?

Ngati muli ndi zizindikiro izi, chinthu choyamba chomwe dokotala wanu angachite ndikukuyang'anirani bwino. Makamaka mimba yanu. Adzayang'ana ngati mimba yanu yatupa, ili ndi zotupa, kapena ikupweteka mukakhudza. Adzayang'ananso ngati khungu ndi maso anu ndi achikasu.

Kenako, amachita mayeso a magazi, kujambula zithunzi, ndi zina kuti aone zomwe zikuchitika ku ndulu. Angayesenso kuchita mayeso a majini kuti aone kusintha kwa majini.

Kuyezetsa magazi

• Zizindikiro za chotupa:Izi zimayang'ana zinthu zina m'magazi zomwe zingakhale chizindikiro cha chotupa cha Klatskin. Mwachitsanzo, zimayang'ana kuchuluka kwa chinthu chotchedwa carbohydrate antigen (CA) 19-9 . Ngati kuchuluka kwa izi kuli kwakukulu kwambiri, kungakhale chizindikiro cha matendawa. Komabe, si aliyense amene ali ndi kuchuluka kumeneku ali ndi khansa, ndipo ikhozanso kukhala yokwera pazifukwa zina.
• Mayeso a ntchito ya chiwindi: Izi zikuphatikizapo mayeso a bilirubin ndi mayeso owunikira kuchuluka kwa ma enzymes a chiwindi. Izi zingapereke lingaliro la ngati chiwindi chawonongeka kapena ngati kutuluka kwa ndulu kwatsekedwa.

Mayeso ojambula zithunzi

Mayeso amenewa amajambula zithunzi za mkati mwa thupi. Mayeso ena ojambulira zithunzi amathanso kutenga chitsanzo cha minofu (biopsy) ndikuyiyesa ndi dokotala wa matenda. Ichi ndi chomwe chidzatsimikizire ngati ndi khansa kapena ayi.

• Kujambula kwa Ultrasound: Iyi ndi njira yosavuta yoyezera yomwe imachitika kaye.
• Kujambula kwa CT (CT - Computed Tomography): Izi zitha kujambula zithunzi zomveka bwino.
• MRI (Magnetic Resonance Imaging): Izi zithanso kujambula zithunzi zomveka bwino komanso zatsatanetsatane.
• ERCP (Endoscopic Retrograde Cholangiopancreatography): Mu njirayi, endoscope (chubu chopyapyala chokhala ndi kamera) imayikidwa kudzera pakamwa, m'mimba, ndi m'mitsempha ya ndulu. Zitsanzo zimatha kutengedwa kuchokera pamenepo, ndipo stent ikhoza kuyikidwa pamalo otsekedwa kuti ndulu iyende bwino.
• MRCP (Magnetic Resonance Cholangiopancreatography): Izi zikufanana ndi MRI, koma zimachitika makamaka kuti ziwone ma ducts a bile ndi ma ducts a pancreatic. Palibe chomwe chimayikidwa m'thupi pa izi.

Magawo a khansa

Ngati mwapezeka ndi matendawa, dokotala wanu adzafufuza gawo la khansa (kuchuluka kwa khansa) . Izi ndizofunikira pokonzekera chithandizo ndi kudziwa nthawi yomwe khansa idzachitike mutalandira chithandizo.

Magawo a khansa amagawidwa kutengera kukula kwa chotupa (T), ngati khansa yafalikira ku ma lymph nodes (N), komanso ngati yafalikira ku ziwalo zakutali (M - metastasized). Nthawi zina, mawonekedwe a maselo a khansa pansi pa maikulosikopu (kalasi ya khansa) amaganiziridwanso.

Magawo a zotupa za Klatskin ndi awa:

• Gawo 0: Chotupacho chili mkati mwa ndulu yokha. Sichinafalikire ku zigawo zakuya, ma lymph node, kapena ziwalo zina za thupi.
• Gawo Loyamba: Khansa ili pakhoma la ndulu, koma sinafalikire kunja kwa ndulu.
• Gawo Lachiwiri: Chotupacho chafalikira ku minofu yamafuta yapafupi kapena minofu ya chiwindi yapafupi.
• Gawo IIIA: Khansa yafalikira ku nthambi za imodzi mwa mitsempha yayikulu yamagazi m'chiwindi (kumanja kapena kumanzere).
• Gawo IIIB: Chotupacho chafalikira mbali zonse ziwiri za mitsempha yayikulu yamagazi m'chiwindi, kapena ku misempha ina ya ndulu mbali imodzi ya chiwindi ndi ku mitsempha yayikulu yamagazi mbali inayo.
• Gawo lachitatu: Khansa yafalikira ku malo amodzi kapena atatu apafupi a lymph nodes.
• Gawo la IVA: Chotupacho chafalikira mpaka ku ma lymph nodes anayi kapena kuposerapo.
• Gawo la IVB: Khansa tsopano yafalikira kumadera akutali a mapapo, mafupa, kapena chiwindi.

Kodi mankhwala a Klatskin Tumor ndi ati?

Njira zochiritsira zimadalira zinthu zambiri, kuphatikizapo vuto lanu, gawo la khansa, komanso thanzi lanu lonse. Komabe, opaleshoni nthawi zambiri ndiyo njira yoyamba komanso yodziwika bwino yochiritsira matendawa.

Pali mitundu yosiyanasiyana ya opaleshoni:

• Kutulutsa madzi m'chiwindi: Izi zimachitika kuti achotse ndulu yochulukirapo yomwe yasonkhana m'chiwindi. Izi zitha kuchepetsa zizindikiro monga jaundice. Izi zitha kuchitika kudzera mu ERCP yokhala ndi stent kapena ndi chubu chakunja.
• Kuchotsa chiwindi kwa nthawi yayitali: Kwa anthu omwe ali ndi zotupa zoyambirira, kuchotsa chiwindi kumatha kuchotsa gawo la chiwindi, ndulu, ndulu, ndi ma lymph nodes apafupi.
• Kuika chiwindi: Njira yokhayo yochiritsira matendawa kwathunthu ndikuchotsa chotupa cha khansa. Izi zingafunike kuchotsa chiwindi chonse ndikuyika chiwindi. Izi sizingatheke kwa aliyense, ndipo zimafuna kuyenerera.

Pamodzi ndi opaleshoni, kapena ngati opaleshoni siingatheke, madokotala amagwiritsa ntchito chithandizo chotchedwa chemoradiation . Ichi ndi kuphatikiza kwa chemotherapy ndi radiation therapy . Mankhwalawa amapha maselo a khansa kapena kuwongolera kukula kwawo.

Pali njira ziwiri zatsopano zochizira matenda a squamous cell tumors omwe afalikira m'thupi:

• Chithandizo cha Immunotherapy: Mwachitsanzo, mankhwala otchedwa 'immunocheckpoint inhibitors' . Mankhwalawa amagwira ntchito pothandiza chitetezo chanu cha mthupi kumenyana ndi khansa.
• Chithandizo cholunjika: Mankhwala monga zoletsa kukula kwa fibroblast factor receptor (FGFR) kapena zoletsa IDH . Zoletsa FGFR zimaletsa maselo a khansa kukula ndikuwapha. Zoletsa IDH zimaletsa puloteni yosazolowereka yomwe imakhudza kukula kwa maselo. Izi sizigwira ntchito kwa aliyense, ndipo zimaperekedwa kwa anthu okhawo omwe ali ndi kusintha kwa majini m'maselo awo a khansa.

Mavuto ndi zotsatirapo zake pa chithandizo

Kuchotsa chiwindi ndi kuyika chiwindi ndi opaleshoni yaikulu, ndipo motero, ikhoza kukhala ndi mavuto aakulu.

• Ascites: Kusonkhanitsa madzi m'mimba.
• Kutuluka kwa ndulu: Pa opaleshoni ya chiwindi, njira zotulutsira ndulu m'chiwindi zimatha kuwonongeka, zomwe zimapangitsa kuti ndulu yochulukirapo ituluke m'chiwindi.
• Kutsekeka kwa mitsempha yakuya (DVT): Kupangika kwa magazi kuundana m'mitsempha yakuya ya thupi pambuyo pa opaleshoni.
• Matenda: Matendawa amatha kuchitika pamalo ochitira opaleshoni, m'njira ya mkodzo, kapena m'mapapo.
• Kulephera kwa impso: Nthawi zina opaleshoni ya chiwindi ingakhudze impso ndikuzipangitsa kuti zisiye kugwira ntchito.
• Kulephera kwa chiwindi: Izi zitha kuchitika ngati gawo lina la chiwindi lachotsedwa (hepatectomy).
• Kukana chiwalo: Thupi likhoza kukana chiwindi choikidwa m'malo ena.

Zotsatira zoyipa zomwe zimachitika chifukwa cha radiation therapy ndi chemotherapy ndi izi:

• Wotopa.
• Kutaya tsitsi.
• Kusanza ndi kusanza.
• Zilonda pakamwa.
• Kutsegula m'mimba.
• Kuchepa kwa magazi m'thupi.

Madokotala amaperekanso upangiri ndi mankhwala kuti athetse mavutowa.

Kodi chiŵerengero cha kupulumuka kwa Klatskin Tumor ndi chotani?

Mukamva za matenda ngati awa, funso loyamba lomwe limabwera m'maganizo mwanu ndi lakuti 'chiŵerengero cha anthu opulumuka' ndi chiyani. Izi zikutanthauza kuchuluka kwa anthu omwe ali ndi khansa yamtundu winawake omwe akadali ndi moyo zaka zisanu kuchokera pamene adapezeka ndi matendawa.

Bungwe la National Cancer Institute (NCI) ku United States limasonkhanitsa deta yotereyi. Ngakhale kuti palibe deta yeniyeni ya zotupa za Klatskin, pali deta ya mitundu yonse ya khansa ya ndulu yomwe imapezeka kunja kwa chiwindi. Chifukwa chake, anthu 9% omwe ali ndi khansa ya ndulu yakunja kwa chiwindi amakhala ndi moyo zaka zisanu atapezeka ndi matendawa.

Koma poganizira za ziwerengerozi, zinthu ziwiri ziyenera kukumbukiridwa:

• Izi ndi ziwerengero chabe: zimachokera ku zomwe ena akumana nazo. Mkhalidwe wanu ungasiyane kwambiri. Mwachitsanzo, thanzi lanu lonse, zaka zanu, gawo lanu la khansa, komanso momwe mumayankhira chithandizo zingakhudze kuchuluka kwa matendawa.
• Ziwerengerozi ndi zakale: Zimasonyeza zakale zaposachedwa, osati zamakono. Ziwerengerozi zimayesedwa zaka zisanu zilizonse. Choncho zotsatira za mankhwala atsopano sizikuonekera mu izi.

Chofunika kwambiri ndichakuti ziwerengerozi sizikufotokoza nkhani yonse. Aliyense ndi wosiyana, ndipo chithandizo chikusintha nthawi zonse. Ndibwino kulankhula ndi dokotala wanu za izi ndikuwafunsa zomwe izi zikutanthauza kwa inu. Ndikofunikira kukhala ndi chiyembekezo komanso chiyembekezo.

Kodi ndingadzisamalire bwanji?

Kusunga moyo wanu wabwino mutatha kupeza chithandizo, kulandira chithandizo, ndi kuchira ndiye chinthu chabwino kwambiri chomwe mungachite nokha. Nazi malingaliro ena:

• Idyani bwino:Idyani zakudya zopatsa thanzi komanso zopatsa thanzi. Idyani mapuloteni ambiri opanda mafuta ambiri, ndiwo zamasamba, zipatso, ndi tirigu wonse. Funsani dokotala wanu kapena katswiri wa zakudya kuti akupatseni upangiri.
• Pewani mfundo zabodza: ​​Popeza iyi ndi matenda osowa, simungadziwe zambiri za matendawa. Kufufuza zambiri pa intaneti kungakhale kosokoneza komanso koopsa. Koma chidziwitso ndi champhamvu . Pezani mfundo kuchokera ku magwero odalirika okha. Yesetsani kufufuza zoona zake, ndipo funsani gulu lanu lachipatala mafunso kapena nkhawa zilizonse zomwe mungakhale nazo.
• Thandizani thanzi lanu la maganizo: Ndi khansa yosowa ngati iyi, ingawononge thanzi lanu la maganizo, chifukwa nthawi zambiri imafuna opaleshoni ndi chithandizo cha nthawi yayitali. Ndizachibadwa kumva chisoni, mantha, komanso nkhawa. Funsani gulu lanu lachipatala za mapulogalamu ndi upangiri womwe ungathandize pa izi. Lankhulani ndi abale ndi abwenzi.
• Ganizirani mapulogalamu opulumutsa anthu ku khansa: Izi zimayang'ana kwambiri thanzi, thanzi, komanso moyo wabwino pamene muli ndi khansa.
• Funsani za chisamaliro chochepetsa ululu: Chisamaliro chochepetsa ululu ndi chithandizo chomwe sichingachiritse matendawa, koma chingathandize kuwongolera zizindikiro ndikukweza moyo. Chisamaliro chochepetsa ululu cha khansa ya ndulu chingathandize kuchepetsa nseru, kuchepetsa ululu, komanso kusunga ndulu m'malo omwe chotupa chikuletsa.

Ndiyenera kupita kwa dokotala liti?

Ngati mwapezeka ndi chotupa cha Klatskin, pitirizani kukaonana ndi dokotala nthawi zonse.

• Funsani dokotala wanu kusintha komwe mungayembekezere (kuwonjezeka kwa zizindikiro, zizindikiro zatsopano).
• Ngati zizindikiro monga kupweteka, nseru, ndi kusanza zikukulirakulira, kapena ngati zizindikiro zatsopano zikuwonekera , dziwitsani dokotala nthawi yomweyo .
• Ngati zotsatirapo zoyipa za chithandizo zili zoopsa, auzeni za izo.
• Dokotala wanu ali ndi mankhwala othandiza kuchepetsa zizindikiro zomwe zimakhudza moyo wanu watsiku ndi tsiku komanso moyo wabwino.

Ndi mafunso ati omwe ndiyenera kufunsa dokotala?

Mwina mwawerenga zambiri zokhudza zotupa za Klatskin ndipo muli ndi mafunso okhudza vuto lanu. Lembani mafunso awa mukapita kukaonana ndi dokotala wanu.

• Kodi mukudziwa bwanji kuti ndili ndi khansa yamtunduwu?
• Kodi khansa imayamba bwanji? Kodi imatanthauza chiyani?
• Kodi ndi njira ziti zochiritsira zomwe ndili nazo? Kodi ubwino ndi kuipa kwa njira iliyonse ndi kotani?
• Kodi pali mankhwala athunthu a izi?
• Kodi moyo wanga udzakhala bwanji nditalandira chithandizo?
• Kodi pali mayesero aliwonse azachipatala omwe ndiyenera kuganizira?
• Kodi ndiyenera kusintha zakudya ndi moyo wanga?
• Kodi ine ndi banja langa tingapeze kuti thandizo lothana ndi vutoli?

Pomaliza, kumbukirani...

Chotupa cha Klatskin (hilar cholangiocarcinoma) ndi matenda ovuta komanso oopsa.Palibe kukayika kuti ndi matenda. N'zachibadwa kuchita mantha mukamva izi. Komabe, deta monga kuchuluka kwa anthu omwe akupulumuka sizifotokoza nkhani yonse ya matendawa. Ndi matenda omwe amatha kuchiritsidwa kwambiri, ndipo ofufuza akuchita mayeso azachipatala a mankhwala atsopano.

Ngati muli ndi vutoli, gulu lanu lachipatala lingakuthandizeni kuthana ndi zizindikiro zanu komanso zotsatirapo zake pa chithandizo. Adzasangalalanso kukupatsani malingaliro a mayeso azachipatala omwe mungafune kuganizira. Musataye mtima. Chofunika kwambiri ndikudziwa ndikutsatira malangizo a dokotala wanu.

Chotupa cha Klatskin , Hilar Cholangiocarcinoma, Khansa ya Mtsempha wa Bile, Khansa ya Chiwindi, Malungo Achikasu, Jaundice, Zizindikiro za Khansa, Chithandizo cha Khansa