Khansara ya chikhodzodzo

Khansara ya chikhodzodzo ndi khansa yomwe imayamba mu chikhodzodzo. Chikhodzodzo ndi gawo la thupi lomwe limagwira ndikutulutsa mkodzo. Ili pakatikati pamimba.

Khansara ya chikhodzodzo nthawi zambiri imayamba kuchokera m'maselo okutira chikhodzodzo. Maselowa amatchedwa maselo osintha.

Zotupa izi zimawerengedwa ndi momwe amakulira:

• Zotupa za papillary zimawoneka ngati zopindika ndipo zimamangiriridwa ku phesi.
• Matenda a Carcinoma mu situ amakhala osalala. Sakhala ofala kwenikweni. Koma ndizowopsa ndipo zimakhala ndi zoyipa zoyipa.

Zomwe zimayambitsa khansa ya chikhodzodzo sizidziwika. Koma zinthu zingapo zomwe zingakupangitseni kukhala ndi mwayi wopanga izi ndi izi:

• Kusuta ndudu - Kusuta kumawonjezera chiopsezo chokhala ndi khansa ya chikhodzodzo. Mpaka theka la khansa yonse ya m'chikhodzodzo ingayambidwe ndi utsi wa ndudu.
• Mbiri yaumwini kapena yabanja ya khansara ya chikhodzodzo - Kukhala ndi wina m'banja yemwe ali ndi khansara ya chikhodzodzo kumawonjezera chiopsezo chotenga matendawa.
• Kuwonetsedwa ndi mankhwala kuntchito - Khansara ya chikhodzodzo imatha kubwera chifukwa chokhudzana ndi mankhwala omwe amayambitsa khansa kuntchito. Mankhwalawa amatchedwa khansa. Ogwiritsa ntchito utoto, opangira mphira, ogwira ntchito zotayidwa, ogwira ntchito zachikopa, oyendetsa magalimoto, komanso ogwiritsa ntchito mankhwala ophera tizilombo ali pachiwopsezo chachikulu.
• Chemotherapy - Chemotherapy mankhwala a cyclophosphamide atha kuwonjezera chiopsezo cha khansa ya chikhodzodzo.
• Chithandizo cha ma radiation - Chithandizo cha ma radiation kumalo amchiuno pochiza khansa ya prostate, testes, khomo pachibelekeropo, kapena chiberekero zimawonjezera chiopsezo chokhala ndi khansa ya chikhodzodzo.
• Matenda a chikhodzodzo - Matenda a chikhodzodzo otenga nthawi yayitali kapena kukwiya kumatha kubweretsa mtundu wina wa khansa ya chikhodzodzo.

Kafukufuku sanawonetse umboni wowonekeratu kuti kugwiritsa ntchito zotsekemera zopangira kumabweretsa khansa ya chikhodzodzo.

Zizindikiro za khansara ya chikhodzodzo zitha kuphatikiza:

• Kupweteka m'mimba
• Magazi mkodzo
• Kupweteka kwa mafupa kapena kufatsa ngati khansara imafalikira mpaka fupa
• Kutopa
• Kupweteka pokodza
• Kuthamanga kwa mkodzo komanso kufulumira
• Kutuluka kwa mkodzo (kusadziletsa)
• Kuchepetsa thupi

Matenda ena ndi mikhalidwe imatha kuyambitsa zofananira. Ndikofunika kuwona wothandizira zaumoyo wanu kuti athetse zina zonse zomwe zingayambitse.

Wothandizirayo ayesa kuyeza kwakuthupi, kuphatikiza kuyeza kwamitsempha ndi m'chiuno.

Mayeso omwe angachitike ndi awa:

• Mimba ndi m'mimba mwa CT scan
• Mimba ya m'mimba ya MRI
• Cystoscopy (kuyang'ana mkati mwa chikhodzodzo ndi kamera), ndi biopsy
• Mitsempha yotchedwa pyelogram - IVP
• Kupenda kwamadzi
• Mkodzo cytology

Ngati mayeso akutsimikizira kuti muli ndi khansara ya chikhodzodzo, mayeso ena adzachitika kuti awone ngati khansayo yafalikira. Izi zimatchedwa staging. Kuyika masitepe kumathandizira kuwongolera zamtsogolo ndikutsata ndikukupatsani lingaliro la zomwe muyenera kuyembekezera mtsogolo.

TNM (chotupa, mfundo, metastasis) njira yogwiritsira ntchito imagwiritsa ntchito khansa ya chikhodzodzo:

• Ta - Khansara ili m'mbali mwa chikhodzodzo chokha ndipo sichinafalikire.
• T1 - Khansara imadutsa mu chikhodzodzo, koma siyifika paminyempha ya chikhodzodzo.
• T2 - Khansara imafalikira mpaka minyewa ya chikhodzodzo.
• T3 - Khansara imafalikira chikhodzodzo kulowa m'matenda amafuta ozungulira.
• T4 - Khansara yafalikira kumadera oyandikira monga prostate gland, chiberekero, nyini, rectum, khoma lam'mimba, kapena khoma la m'chiuno.

Zotupa zimaphatikizidwanso kutengera momwe zimawonekera pa microscope. Izi zimatchedwa kukulitsa chotupacho. Chotupa chapamwamba chimakula mofulumira ndipo chimatha kufalikira. Khansara ya chikhodzodzo imafalikira kumadera oyandikira, kuphatikizapo:

• Matenda am'mimba m'chiuno
• Mafupa
• Chiwindi
• Mapapo

Chithandizo chimadalira gawo la khansa, kuopsa kwa zizindikilo zanu, komanso thanzi lanu lonse.

Gawo 0 ndi chithandizo changa:

• Opaleshoni yochotsa chotupacho osachotsa chikhodzodzo chonse
• Chemotherapy kapena immunotherapy imayikidwa mwachindunji mu chikhodzodzo
• Immunotherapy imaperekedwa mothandizidwa ndi pembrolizumab (Keytruda) ngati khansayo ipitilizabe kubwerera pambuyo pa izi

Chithandizo chachigawo chachiwiri ndi chachitatu:

• Opaleshoni yochotsa chikhodzodzo chonse (radical cystectomy) ndi ma lymph node apafupi
• Opaleshoni yochotsa mbali imodzi yokha ya chikhodzodzo, kenako ma radiation ndi chemotherapy
• Chemotherapy kuti achepetse chotupacho asanachite opareshoni
• Kuphatikiza kwa chemotherapy ndi radiation (mwa anthu omwe amasankha kuti asachite opareshoni kapena omwe sangachite opareshoni)

Anthu ambiri omwe ali ndi zotupa za gawo IV sangachiritsidwe ndipo opaleshoni siyoyenera. Mwa anthuwa, chemotherapy imaganiziridwa nthawi zambiri.

CHIWANDA

Chemotherapy imatha kuperekedwa kwa anthu omwe ali ndi matenda a gawo lachiwiri ndi lachitatu mwina asanachitike kapena atachitidwa opaleshoni kuti athetse chotupacho kuti chisabwerere.

Kwa matenda oyamba (magawo 0 ndi 1), chemotherapy nthawi zambiri imaperekedwa mwachindunji mu chikhodzodzo.

KUYAMBIRA MUNTHU

Khansa ya chikhodzodzo nthawi zambiri imachiritsidwa ndi immunotherapy. Pachithandizochi, mankhwala amachititsa kuti chitetezo cha mthupi chanu chiwonongeke ndikupha maselo a khansa. Immunotherapy ya khansa yoyambirira ya chikhodzodzo imagwiritsidwa ntchito pogwiritsa ntchito katemera wa BacilleCalmette-Guerin (wodziwika kuti BCG). Khansara ikadzabweranso BCG itagwiritsidwa ntchito, othandizira atsopano atha kugwiritsidwa ntchito.

Monga mankhwala onse, zotsatirapo ndizotheka. Funsani omwe akukuthandizani zotsatira zoyipa zomwe mungayembekezere, ndi zoyenera kuchita zikachitika.

KUGWIDWA

Kuchita opaleshoni ya khansara ya chikhodzodzo kumaphatikizapo:

• Transurethral resection ya chikhodzodzo (TURB) - Matenda a chikhodzodzo a khansa amachotsedwa kudzera mu urethra.
• Kutulutsa pang'ono kapena kwathunthu kwa chikhodzodzo - Anthu ambiri omwe ali ndi khansa yachiwiri ya khansa yachiwiri kapena yachitatu angafunikire kuchotsedwa chikhodzodzo (cystectomy). Nthawi zina, mbali imodzi yokha ya chikhodzodzo imachotsedwa. Chemotherapy itha kuperekedwa asanafike kapena pambuyo pa opaleshoniyi.

Opaleshoni imathandizidwanso kuti muthandize thupi lanu kukhetsa mkodzo chikhodzodzo chitachotsedwa. Izi zingaphatikizepo:

• Mtsinje wa Ileal - Malo osungira mkodzo ang'onoang'ono amapangidwa opaleshoni kuchokera pachidutswa chaching'ono cha m'mimba mwanu. Ma ureters omwe amatulutsa mkodzo kuchokera mu impso amamangiriridwa kumapeto amodzi a chidutswachi. Mapeto ena amatulutsidwa kudzera pakabowo pakhungu (stoma). Stoma imalola munthuyo kukhetsa mkodzo womwe watolerawo kuchokera mosungira.
• Malo osungira mkodzo wadziko lonse - Thumba loti mutenge mkodzo limapangidwa mkati mwa thupi lanu pogwiritsa ntchito matumbo anu. Muyenera kuyika chubu pakabowo pakhungu lanu (stoma) mchikwama ichi kuti mukhe mkodzo.
• Orthotopic neobladder - Opaleshoni iyi ikufala kwambiri mwa anthu omwe achotsedwa chikhodzodzo. Gawo lina la matumbo anu limapinda kuti mupange thumba lomwe limasonkhanitsa mkodzo. Amamangiriridwa pamalo pathupi pomwe mkodzo umatulukira m'chikhodzodzo. Njirayi imakuthandizani kuti muzitha kuyendetsa bwino mkodzo.

Mutha kuchepetsa nkhawa zamankhwala ndikulowa nawo gulu lothandizira khansa. Kugawana ndi ena omwe akumana ndi mavuto omwe akukumana nawo kungakuthandizeni kuti musamve nokha.

Mukalandira chithandizo cha khansa ya chikhodzodzo, dokotala adzakuyang'anirani. Izi zingaphatikizepo:

• Makina a CT amafufuza kufalikira kapena kubwerera kwa khansa
• Kuwunika zizindikiro zomwe zingawonetse kuti matendawa akuipiraipira, monga kutopa, kuchepa thupi, kupweteka kwambiri, kuchepa kwa matumbo ndi chikhodzodzo, komanso kufooka
• Kuwerengera magazi kwathunthu (CBC) kuti muwone kuchepa kwa magazi
• Mayeso a chikhodzodzo miyezi iliyonse itatu kapena isanu ndi umodzi mutalandira chithandizo
• Kuyeza urinal ngati simunachotse chikhodzodzo chanu

Momwe munthu amakhalira ndi khansa ya chikhodzodzo amatengera gawo loyambirira komanso mayankho ake kuchipatala cha khansa ya chikhodzodzo.

Maganizo a gawo 0 kapena khansa ndimabwino. Ngakhale kuti chiopsezo chobwerera khansa ndi chachikulu, khansa yambiri ya chikhodzodzo yomwe imabwerera imatha kuchotsedwa ndikuchiritsidwa.

Mankhwala ochiritsira anthu omwe ali ndi zotupa za gawo lachitatu ndi ochepera 50%. Anthu omwe ali ndi khansa ya chikhodzodzo cha IV sanachiritsidwe kawirikawiri.

Khansa ya chikhodzodzo imafalikira m'ziwalo zapafupi. Amathanso kuyenda pamatenda am'mimba ndikufalikira ku chiwindi, mapapo, ndi mafupa. Zowonjezera zovuta za khansara ya chikhodzodzo ndizo:

• Kuchepa kwa magazi m'thupi
• Kutupa kwa ureters (hydronephrosis)
• Kukhazikika kwa urethral
• Kusadziletsa kwamikodzo
• Kulephera kwa Erectile mwa amuna
• Kulephera kugonana kwa amayi
  

Itanani omwe akukuthandizani ngati muli ndi magazi mumkodzo kapena zizindikiro zina za khansa ya chikhodzodzo, kuphatikizapo:

• Kukodza pafupipafupi
• Kupweteka pokodza
• Chofunika kwambiri kukodza

Mukasuta, siyani. Kusuta kumatha kuwonjezera chiopsezo cha khansa ya chikhodzodzo. Pewani kukhudzana ndi mankhwala olumikizidwa ndi khansa ya chikhodzodzo.

Transitional cell carcinoma ya chikhodzodzo; Khansa ya muubongo

• Zojambulajambula
• Thirakiti lachikazi
• Njira yamkodzo wamwamuna

Cumberbatch MGK, Jubber I, PC Yakuda, et al. Epidemiology ya khansa ya chikhodzodzo: kuwunika mwatsatanetsatane ndikusintha kwazomwe zikuwopsa mu 2018. Eur Urol. 2018; 74 (6): 784-795. (Adasankhidwa) PMID: 30268659 pubed.ncbi.nlm.nih.gov/30268659/.

Tsamba la National Cancer Institute. Chithandizo cha khansa ya chikhodzodzo (PDQ) - mtundu wa akatswiri azaumoyo. www.cancer.gov/types/bladder/hp/bladder-kuchiza-pdq. Idasinthidwa pa Januware 22, 2020. Idapezeka pa February 26, 2020.

Tsamba la National Comprehensive Cancer Network. Malangizo azachipatala a NCCN mu oncology (malangizo a NCCN): Khansa ya chikhodzodzo. Mtundu 3.2020. www.nccn.org/professionals/physician_gls/pdf/bladder.pdf. Idasinthidwa pa Januware 17, 2020. Idapezeka pa February 26, 2020.

Smith AB, Balar AV, Milowsky MI, Chen RC. Carcinoma cha chikhodzodzo. Mu: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, olemba. Chipatala cha Abeloff's Oncology. Lachisanu ndi chimodzi. Philadelphia, PA: Elsevier; 2020: chap 80.