Yiziphi lezi zimila ezakha emzimbeni wakho, emigudwini yakho yenyongo? Ake sixoxe ngama-Klatskin Tumors!

Wake wazizwa sengathi amehlo akho aphenduka aphuzi ngenxa yobuhlungu besisu? Noma mhlawumbe uzizwa sengathi wehlisa isisindo? Lezi yizinto ngezinye izikhathi esingazinaki kakhulu, kodwa zingaba izimpawu zezifo ezithile ezingavamile. Namuhla sizokhuluma ngesifo esingathi sína, kodwa kubaluleke kakhulu ukusazi. Leso yisimo esibizwa ngokuthi i-Klatskin Tumor .

Iyini i-Klatskin Tumor?

Kalula nje, la mathumba e-Klatskin awuhlobo lwesimila esinomdlavuza esikhula emigudwini ye-bile ngaphandle kwesibindi sethu. Cabanga ngakho, isibindi sethu sikhiqiza uketshezi olubizwa ngokuthi i-bile, olusiza ekugayweni kokudla. Le nyongo igeleza ngemigudu emincane futhi ihlangane ukuze yakhe umsele oyinhloko we-bile. Ikakhulukazi, la mathumba avame ukwakheka endaweni ebizwa ngokuthi 'i-hilum', lapho imigudwini ye-bile yesokudla nesobunxele evela esibindini ihlangana khona ukuze yakhe umsele oyinhloko we-bile. Odokotela babiza lokhu ngokuthi 'i-Hilar Cholangiocarcinoma' . Uma la mathumba etholakala futhi elashwa kusenesikhathi, kunamathuba okuthi angelapheka. Izinto ezifana nokuhlinzwa nokufakelwa kwesibindi yizona zindlela zokwelapha eziyinhloko. Kukhona futhi nezindlela zokwelapha zokunciphisa izimpawu. Ucwaningo luyenziwa futhi ekwelashweni okusha.

Kungavamile kangakanani lokhu?

Lesi yisimo esingavamile kakhulu . Kulinganiselwa ukuthi cishe umuntu oyedwa kwabayizinkulungwane eziyikhulu uba nalesi sifo. Lokho kusho ukuthi akusona isifo esithinta abantu abaningi.

Ziyini izimpawu ze-Klatskin Tumor?

Ngakho-ke, lapho kwakheka lezi zimila ze-bile duct, zivimba ukugeleza kwe-bile kusuka enyongweni. Yilapho kuvela khona izimpawu ezahlukahlukene. Lezi zivela kancane kancane, ngakho ngezinye izikhathi singase singaziboni.

• Ubuhlungu besisu: Ubuhlungu besisu obuqhubekayo, ngezinye izikhathi obuba bubi kakhulu, ikakhulukazi ohlangothini oluphezulu kwesokudla lwesisu.
• Ukukhathala: Umuzwa wokukhathala okukhulu ongapheli ngisho nangemva kokulala kahle ebusuku.
• Isicanucanu: Umuzwa wokugula, mhlawumbe nokuhlanza.
• Ukwehlisa isisindo: Ukwehlisa isisindo ngaphandle kwesizathu esibonakalayo futhi ngaphandle kokunciphisa ukudla.
• I-jaundice: Ukuphuzi kwamhlophe emehlweni nasesikhumbeni. Lokhu kwenzeka lapho inyongo ingaphumi kahle, okubangela ukuthi into ephuzi ebizwa ngokuthi i-bilirubin iqoqeke egazini. Umchamo ungaba phuzi omnyama kanti indle ingaba mhlophe ngokuphaphathekile.
• Isikhumba esilumayo: Abanye abantu bangase babe nokulunywa emzimbeni wonke, okubuye kube yinkinga ehlobene nenyongo.

Lezi zimpawu kungaba nzima ukuziphila nazo, ngakho-ke ungangabazi ukufuna iseluleko sezokwelapha. Into ebaluleke kakhulu ukuthola imbangela ngokushesha.

Yiziphi izimbangela ze-Klatskin Tumor?

Abacwaningi abakayitholi imbangela eqondile yalezi zimila zesikhumba.Kodwa nakhu okwenzekayo: Lawa mathumba akheka lapho kwenzeka ushintsho lwezakhi zofuzo (ukuguqulwa kwezakhi zofuzo) emaseli ajwayelekile emizimbeni yethu, okubangela ukuthi lawo maseli ahlukane ngendlela engavamile futhi aphindaphindeke ngendlela engalawuleki.

Kodwa-ke, kutholakale izinto ezithile ezandisa ingozi yalesi simo. Okusho ukuthi, izinto ezifana nezifo ezithile kanye nezinguquko zofuzo ezenzeka ngemva kokuzalwa kwethu.

Ezinye izimo ezandisa le ngozi yilezi:

• Inkinga yokusebenzisa utshwala: Wonke umuntu uyazi ukuthi utshwala abulungele isibindi. Ukusebenzisa utshwala obuningi isikhathi eside kulimaza isibindi futhi kwandisa ingozi yalolu hlobo lomdlavuza.
• Amatshe enyongo (i-Choldocholithiasis): Amatshe avimba imisele yenyongo angabangela ukuvuvukala kwesikhathi eside kanye noshintsho lwamaseli.
• I-pancreatitis engapheli: Ukuvuvukala kwe-pancreas isikhathi eside.
• I-Clonorchiasis: Lokhu ukutheleleka okubangelwa yi-parasite yesibindi saseShayina. Le parasite ihlala emigudwini ye-bile futhi ibangela umonakalo wesikhathi eside.
• I-Primary sclerosing cholangitis (PSC): Lesi yisimo lapho imibhobho yenyongo ivuvukala, ibe nezibazi, futhi inciphe. Lesi futhi yisimo esikhuphula kakhulu ingozi yezimila zeKlatskin.
• Amanye amagciwane: Ukulimala kwesibindi okubangelwa amagciwane, ikakhulukazi i-hepatitis B kanye ne-hepatitis C, nakho kungase kuhileleke.
• Ubudala: Abantu abangaphezu kweminyaka engu-50 ubudala basengozini enkulu.
• Ukukhuluphala ngokweqile kanye nesifo sikashukela nakho kucatshangwa ukuthi kwandisa ingozi ngezinga elithile.

Yiziphi izinkinga ezingabangelwa yilokhu?

Lesi simo singadala izinkinga ezinkulu .

• Amahlule egazi: Umdlavuza ungasakazekela emithanjeni yegazi emikhulu bese wenza amahlule egazi.
• I-cholestasis engaphandle kwesibindi: Lokhu kwenzeka lapho umgudu omkhulu we-bile ngaphandle kwesibindi uvalwa yi-tumor. Lokhu kungenza i-jaundice ibe yimbi kakhulu.
• Umdlavuza we-Metastatic: Lawa mathumba e-Klatskin angasakazeka esuka emigudwini ye-bile ngaphandle kwesibindi aye esibindini uqobo, emaphashini, emathanjeni, kuma-lymph node, nakwezinye izingxenye zesisu.

Itholakala kanjani i-Klatskin Tumor?

Uma unalezi zimpawu, into yokuqala udokotela wakho azokwenza ukukuhlola kahle. Ikakhulukazi isisu sakho. Bazohlola ukuthi isisu sakho sivuvukile, sinamaqhubu, noma sibuhlungu uma usithinta. Bazohlola nokuthi isikhumba sakho namehlo akho aphuzi yini.

Bese benza ukuhlolwa kwegazi, ukuhlolwa kwezithombe, nezinye izinto ukuze babone ukuthi kwenzekani ngempela emigudwini yenyongo. Bangase futhi benze ukuhlolwa kwezakhi zofuzo ukuze babheke izinguquko zezakhi zofuzo.

Ukuhlolwa kwegazi

• Izimpawu zomdlavuza:Lezi zibheka izinto ezithile egazini ezingaba uphawu lwesimila se-Klatskin. Isibonelo, zibheka izinga lento ebizwa ngokuthi i-carbohydrate antigen (CA) 19-9 . Uma izinga lalokhu liphezulu kakhulu, kungaba uphawu lwalesi sifo. Kodwa-ke, akuwona wonke umuntu onaleli zinga onomdlavuza, futhi ungaba phezulu nangezinye izizathu.
• Ukuhlolwa kokusebenza kwesibindi: Lokhu kufaka phakathi ukuhlolwa kwe-bilirubin kanye nokuhlolwa kokuhlola ama-enzyme esibindi aphezulu. Lokhu kunganikeza umbono wokuthi isibindi sonakele noma ukuthi ukugeleza kwe-bile kuvinjiwe.

Ukuhlolwa kwezithombe

Lezi zivivinyo zithatha izithombe zengaphakathi lomzimba. Ezinye izivivinyo zezithombe zingathatha nesampula yezicubu (i-biopsy) bese ziyihlola ngudokotela wezifo. Yilokhu okuzonquma ukuthi umdlavuza noma cha.

• Ukuskena nge-ultrasound: Lokhu ukuhlolwa okulula okwenziwa kuqala.
• I-CT (CT - Computed Tomography) Scan: Lokhu kungathatha izithombe ezicacile.
• I-MRI (Umfanekiso Wokuqabulana Kwamagnetic): Lokhu kungathatha nezithombe ezicacile nezinemininingwane.
• I-ERCP (i-Endoscopic Retrograde Cholangiopancreatography): Kule nqubo, kufakwa i-endoscope (ithubhu elincane elinekhamera) ngomlomo, esiswini, kanye nasemiseleni ye-bile. Amasampula angathathwa lapho, bese kufakwa i-stent endaweni evinjiwe ukusiza ukugeleza kwe-bile.
• I-MRCP (i-Magnetic Resonance Cholangiopancreatography): Lokhu kufana ne-MRI, kodwa kwenziwa ngqo ukubheka imigudu ye-bile kanye nemigudu ye-pancreatic. Akukho okufakwa emzimbeni ngalokhu.

Izigaba zomdlavuza

Uma utholakale unalesi sifo, udokotela wakho uzolandela ukunquma isigaba somdlavuza (ukukhula komdlavuza) . Lokhu kubalulekile ekuhleleni ukwelashwa kanye nokunquma isibikezelo ngemva kokwelashwa.

Izigaba zomdlavuza zihlukaniswa ngokususelwa kubukhulu besimila (T), ukuthi umdlavuza usakazeke yini kuma-lymph node (N), nokuthi ngabe usakazeke yini ezithweni ezikude (M - metastasized). Ngezinye izikhathi, ukubonakala kwamangqamuzana omdlavuza ngaphansi kwe-microscope (ibanga lomdlavuza) nakho kuyacatshangelwa.

Izigaba zezimila zeKlatskin zimi kanje:

• Isigaba 0: Isimila sisezingqimbeni zangaphakathi zomsele we-bile kuphela. Asikasabalali siye ezingqimbeni ezijulile, kuma-lymph node, noma kwezinye izingxenye zomzimba.
• Isigaba I: Umdlavuza useludongeni lomsele wenyongo, kodwa awukasabalali ngaphandle komsele wenyongo.
• Isigaba II: Isimila sesisabalale ezicutshini ezinamafutha eziseduze noma ezicutshini zesibindi eziseduze.
• Isigaba IIIA: Umdlavuza ususakazekele emagatsheni omunye wemithambo yegazi eyinhloko esibindini (kwesokudla noma kwesobunxele).
• Isigaba IIIB: Isimila sesisabalale kuzo zombili izinhlangothi zemithambo yegazi eyinhloko esibindini, noma kwezinye imisele yenyongo kolunye uhlangothi lwesibindi kanye nakumthambo wegazi oyinhloko kolunye uhlangothi.
• Isigaba IIIC: Umdlavuza ususakazekele ku-lymph node eyodwa kuya kwezintathu eziseduze.
• Isigaba IVA: Isimila sesisabalale saya kuma-lymph node amane noma ngaphezulu.
• Isigaba se-IVB: Umdlavuza manje ususakazekele ezingxenyeni ezikude zamaphaphu, amathambo, noma isibindi.

Yiziphi izindlela zokwelapha i-Klatskin Tumor?

Izinketho zokwelapha zincike ezintweni eziningi, okuhlanganisa isimo sakho, isigaba somdlavuza, kanye nempilo yakho iyonke. Kodwa-ke, ukuhlinzwa kuvame ukuba yindlela yokuqala nevame kakhulu yokwelapha lesi sifo.

Kunezinhlobo ezahlukene zokuhlinzwa:

• Ukugeleza kwenyongo: Lokhu kwenzelwa ukususa inyongo eningi eqongeleleke esibindini. Lokhu kunganciphisa izimpawu ezifana ne-jaundice. Lokhu kungenziwa nge-ERCP ene-stent noma ngepayipi langaphandle.
• Ukususwa kwesibindi okwandisiwe: Kubantu abanezimila ezisesigabeni sokuqala, ukususwa kwesibindi kungasusa ingxenye yesibindi, imibhobho ye-bile, i-gallbladder, kanye nama-lymph node aseduze.
• Ukufakelwa kwesibindi: Okuwukuphela kwendlela yokwelapha lesi sifo ngokuphelele ukususa isimila somdlavuza. Lokhu kungadinga ukususa sonke isibindi nokwenza ukufakelwa kwesibindi. Lokhu akunakwenzeka kuwo wonke umuntu, futhi kudinga ukufaneleka.

Kanye nokuhlinzwa, noma ezimweni lapho ukuhlinzwa kungenzeki khona, odokotela basebenzisa ukwelashwa okubizwa ngokuthi i-chemoradiation . Lokhu kuyinhlanganisela ye -chemotherapy kanye ne-radiation therapy . Lokhu kwelashwa kubulala amangqamuzana omdlavuza noma kulawula ukukhula kwawo.

Manje kunezindlela ezimbili ezintsha zokwelapha izimila ze-squamous cell ezisakazeka kalula:

• Ukwelashwa nge-immunotherapy: Isibonelo, imithi ebizwa ngokuthi 'i-immune checkpoint inhibitors' . Lokhu kusebenza ngokusiza amasosha omzimba wakho ukulwa nomdlavuza.
• Ukwelashwa okuqondiwe: Imithi efana ne -fibroblast growth factor receptor (FGFR) inhibitors noma i-IDH inhibitors . I-FGFR inhibitors ivimba amangqamuzana omdlavuza ekukhuleni futhi iwabulale. I-IDH inhibitors ivimba iphrotheni engajwayelekile ethinta ukukhula okuvamile kwamangqamuzana. Lokhu akusebenzi kuwo wonke umuntu, futhi kunikezwa kuphela abantu abanezinguquko ezithile zofuzo emaseli abo omdlavuza.

Izinkinga nemiphumela emibi yokwelashwa

Ukufakelwa kwesibindi kanye nokufakelwa kwesibindi kuyimisebenzi emikhulu yokuhlinzwa, futhi ngenxa yalokho, kungaba nezinkinga ezinkulu.

• Ama-Ascites: Ukuqongelela koketshezi esiswini.
• Ukuvuza kwenyongo: Ngesikhathi sokuhlinzwa kwesibindi, imisele yenyongo yesibindi ingonakala, okubangela ukuthi inyongo eningi ivuza esibindini.
• I-Deep Vein Thrombosis (DVT): Ukwakheka kwehlule legazi emithanjeni ejulile yomzimba ngemva kokuhlinzwa.
• Ukutheleleka: Ukutheleleka kungenzeka endaweni yokuhlinzwa, emgudwini womchamo, noma emaphashini.
• Ukwehluleka kwezinso: Ngezinye izikhathi ukuhlinzwa kwesibindi kungathinta izinso futhi kubangele ukuthi ziyeke ukusebenza.
• Ukwehluleka kwesibindi: Lokhu kungenzeka uma ingxenye yesibindi isuswa (i-hepatectomy).
• Ukwenqatshwa kwezitho zomzimba: Umzimba ungase wenqabe isibindi esifakwe kwenye indawo.

Imiphumela emibi evamile yokwelashwa ngemisebe kanye ne-chemotherapy yile:

• Ngikhathele.
• Ukulahlekelwa izinwele.
• Isicanucanu nokuhlanza.
• Izilonda zomlomo.
• Uhudo.
• I-anemia.

Odokotela banikeza nezeluleko kanye nemithi yokulawula le miphumela emibi.

Lingakanani izinga lokusinda kwe-Klatskin Tumor?

Uma uzwa ngesifo esinjengalesi, omunye wemibuzo yokuqala efika engqondweni ukuthi 'izinga lokusinda' liyini. Lokhu kubhekisela kumaphesenti abantu abanohlobo oluthile lomdlavuza abasaphila eminyakeni emihlanu ngemva kokutholakala benalesi sifo.

I-National Cancer Institute (NCI) e-United States iqoqa idatha enjalo. Nakuba kungekho datha ethile yezimila ze-Klatskin, kunedatha yazo zonke izinhlobo zomdlavuza we-bile duct ezikhula ngaphandle kwesibindi. Ngakho-ke, jikelele, abantu abangu-9% abanomdlavuza we-bile duct ongaphandle kwesibindi bayaphila eminyakeni emihlanu ngemva kokuxilongwa.

Kodwa uma ucabanga ngalezi zibalo, kufanele kukhunjulwe izinto ezimbili:

• Lokhu kumane nje kuyizilinganiselo: kusekelwe kokuhlangenwe nakho kwabanye. Isimo sakho singase sihluke kakhulu. Isibonelo, impilo yakho iyonke, ubudala, isigaba somdlavuza, kanye nokusabela kwakho ekwelashweni kungathinta la mazinga.
• Lezi zinombolo zingokomlando: Zibonisa isikhathi esidlule samuva nje, hhayi isikhathi samanje. Lezi zilinganiso zilinganiswa njalo eminyakeni emihlanu. Ngakho-ke umthelela wokwelashwa okusha awubonakali kulokhu.

Into ebalulekile ukuthi lezi zibalo azisho yonke indaba. Wonke umuntu uhlukile, futhi ukwelashwa kuyathuthuka ngaso sonke isikhathi. Kungumqondo omuhle ukukhuluma nodokotela wakho ngalokhu bese ubabuza ukuthi lolu lwazi lusho ukuthini kuwe. Kubalulekile ukuhlala unethemba futhi unethemba.

Ngingazinakekela kanjani?

Ukugcina impilo yakho isezingeni eliphezulu ngemva kwalokhu kutholakala, ukwelashwa, kanye nokululama kuyinto engcono kakhulu ongayenza wena. Nazi ezinye iziphakamiso:

• Yidla kahle:Yidla ukudla okunempilo nokulinganiselayo. Yidla amaprotheni amaningi angenawo amafutha amaningi, imifino, izithelo, kanye nokusanhlamvu okuphelele. Xhumana nodokotela wakho noma uchwepheshe wezokudla ukuze uthole iseluleko.
• Gwema ulwazi olungelona iqiniso: Njengoba lesi yisifo esingavamile, ungase ungazi okuningi ngaso. Ukufuna ulwazi ku-inthanethi kungaba yinto edidayo futhi eyesabekayo. Kodwa ulwazi lungamandla . Thola ulwazi emithonjeni ethembekile kuphela. Yenza konke okusemandleni akho ukucwaninga amaqiniso, bese ubuza ithimba lakho lezokwelapha noma yimiphi imibuzo noma ukukhathazeka ongase ube nakho.
• Sekela impilo yakho yengqondo: Ngomdlavuza ongavamile njengalona, ​​ungalimaza impilo yakho yengqondo, njengoba uvame ukudinga ukuhlinzwa nokwelashwa kwesikhathi eside. Kuvamile ukuzizwa udabuke, wesaba, futhi ukhathazekile. Buza ithimba lakho lezokwelapha ngezinhlelo kanye nokwelulekwa okungasiza ngalokhu. Khuluma nomndeni nabangane.
• Cabanga ngezinhlelo zokusinda emdlavuza: Lezi zigxile empilweni, enhlalakahleni, kanye nekhwalithi yokuphila ngenkathi uphila nomdlavuza.
• Buza ngokunakekelwa kokunciphisa ubuhlungu: Ukunakekelwa kokunciphisa ubuhlungu kuyindlela yokwelapha engeke yelaphe lesi sifo, kodwa ingasiza ekulawuleni izimpawu futhi ithuthukise ikhwalithi yokuphila. Ukunakekelwa kokunciphisa ubuhlungu komdlavuza we-bile duct kungasiza ngesicanucanu, ukuqeda ubuhlungu, kanye nokugcina ukugeleza kwe-bile ezindaweni lapho isimila siyivimba khona.

Kufanele ngimbone nini udokotela?

Uma kutholakale ukuthi unesimila seKlatskin, xhumana nodokotela wakho njalo.

• Buza udokotela wakho ukuthi yiziphi izinguquko (ukwanda kwezimpawu, izimpawu ezintsha) ongazilindela.
• Uma izimpawu ezifana nobuhlungu, isicanucanu nokuhlanza ziba zimbi kakhulu, noma uma kuvela izimpawu ezintsha , yazisa udokotela wakho ngokushesha .
• Uma imiphumela emibi yokwelashwa inzima kakhulu, mtshele ngakho.
• Udokotela wakho unezindlela zokwelapha ezingasiza ekunciphiseni izimpawu ezithinta impilo yakho yansuku zonke kanye nekhwalithi yempilo.

Yimiphi imibuzo okufanele ngiyibuze udokotela?

Cishe usufunde okuningi ngamathumba e-Klatskin futhi unemibuzo ngesimo sakho. Bhala le mibuzo uma uya kudokotela wakho.

• Wazi kanjani ukuthi nginalolu hlobo lomdlavuza?
• Iyini isigaba somdlavuza? Kusho ukuthini?
• Yiziphi izindlela zokwelapha enginazo? Yiziphi izinzuzo kanye nokungalungi kwalokhu ngakunye?
• Ingabe ikhona ikhambi eliphelele lalokhu?
• Impilo yami izobe injani ngemva kokwelashwa?
• Ingabe kukhona ukuhlolwa kwemitholampilo okufanele ngikucabangele?
• Ingabe ngidinga ukushintsha indlela engidla ngayo nendlela yami yokuphila?
• Mina nomndeni wami singalutholaphi usizo lokubhekana nalesi simo?

Ekugcineni, khumbula...

I-Klatskin tumor (i-hilar cholangiocarcinoma) iyisifo esiyinselele ngempela nesingathi sína.Akungabazeki ukuthi kuyisifo. Kuvamile ukuzizwa wesaba uma usizwa. Kodwa-ke, idatha efana namazinga okusinda ayisho yonke indaba yalesi sifo. Kuyisifo esingelapheka kakhulu, futhi abacwaningi benza izivivinyo zemitholampilo zokwelapha okusha.

Uma unalesi simo, ithimba lakho lezokwelapha lingakusiza ukuthi uphathe izimpawu zakho kanye nemiphumela emibi yokwelashwa. Bazokujabulela futhi ukusikisela izivivinyo zezokwelapha ongase ufune ukuzicabangela. Ungalokothi ulahle ithemba. Into ebaluleke kakhulu ukwaziswa nokulandela iseluleko sikadokotela wakho.

Isimila seKlatskin , iHilar Cholangiocarcinoma, umdlavuza we-bile duct, umdlavuza wesibindi, umkhuhlane ophuzi, i-jaundice, izimpawu zomdlavuza, ukwelashwa komdlavuza