Gawo 4 Renal Cell Carcinoma: Chithandizo ndi Matenda

Zamkati

• Njira zochiritsira RCC
• Opaleshoni
• Chitetezo chamatenda
• Zoletsa zoletsa
• Kuphatikiza-2
• Zolemba za alpha
• Chithandizo chofuna
• mTOR zoletsa
• Thandizo la radiation
• Chemotherapy
• Mayesero azachipatala
• Renal cell carcinoma ikuwonetsa
• Chiwonetsero

Renal cell carcinoma (RCC) ndi mtundu wa khansa yomwe imakhudza maselo a impso. RCC ndiye khansa yodziwika kwambiri ya impso. Pali zifukwa zingapo zowopsa pakupanga RCC, kuphatikiza:

• banja mbiri ya matenda
• kusuta
• kunenepa kwambiri
• kuthamanga kwa magazi
• matenda a impso a polycystic

Zikawonekera koyambirira, zimakulitsa mwayi wanu wamankhwala othandiza.

Njira zochiritsira RCC

Ngakhale gawo 4 RCC amadziwika kuti ndi gawo lapamwamba la khansa, pali njira zina zamankhwala zomwe zingapezeke.

Opaleshoni

Nthawi zina, chotupa chachikulu chikachotsedwa ndipo khansa isafalikire kwambiri, nephrectomy yayikulu imatha kuchitidwa. Izi zimaphatikizapo kuchotsa opaleshoni impso zambiri kapena zonse zomwe zakhudzidwa.

Kuchotsa opaleshoni zotupa zina kungafune kwa anthu omwe ali ndi khansa ya m'mimba. Gulu la akatswiri lisankha ngati zotupa zama metastasised zitha kuchotsedwa popanda chiopsezo chachikulu.

Ngati opaleshoni siyingatheke, kuphatikiza kwa chotupa kumatha kugwiritsidwa ntchito. Njirayi imadula magazi pamotopo, zomwe zimathandiza kuchepetsa zizindikilo.

Akachitidwa opaleshoni kuti achotse zotupa zakomweko, anthu ambiri angafunike chithandizo chamagetsi. Mankhwalawa amathandiza khansa mthupi lonse. Itha kuthandizira kuchepetsa kuyambiranso kwa khansa.

Mankhwala othandizira pa gawo la 4 RCC amaphatikiza ma immunotherapy, chithandizo chofunikira, radiation, ndi chemotherapy.

Chitetezo chamatenda

Immunotherapy ndi njira yothandizira yomwe cholinga chake ndikulimbikitsa chitetezo cha mthupi kuti chiwononge maselo a khansa. Sikuti aliyense amene ali ndi RCC amayankha bwino kuchipatala, ndipo zotsatirapo zake zimakhala zoyipa.

Immunotherapy, kapena biologic therapy, ndi chithandizo chomwe chimathandiza chitetezo cha mthupi lanu kulimbana ndi khansa. Nthawi zambiri zimayambitsidwa pomwe RCC siyingachotsedwe ndi opaleshoni.

Immunotherapy imagwiritsa ntchito mitundu ingapo ya mankhwala:

Zoletsa zoletsa

Chitetezo chanu chamthupi chimagwiritsa ntchito njira ya "malo ochezera" kusiyanitsa pakati pa maselo athanzi ndi khansa. Checkpoint inhibitors cholinga chake ndi kuthandiza chitetezo cha mthupi lanu kupeza maselo a khansa omwe amabisala m'thupi lanu.

Nivolumab (Opdivo) ndi malo ochezera omwe amayendetsedwa kudzera mu IV yomwe yakhala ikuthandizira RCC mzaka zaposachedwa.

Zotsatira zoyipa zimaphatikizapo:

• zidzolo
• kutopa
• kutsegula m'mimba
• nseru
• mutu
• zotupa pakhungu
• kupweteka pamodzi
• kupweteka m'mimba
• kuvuta kupuma

Kuphatikiza-2

Interleukin-2 (IL-2, Proleukin) ndimapuloteni opanga omwe amatchedwa cytokines omwe cholinga chake ndi kuyambitsa chitetezo cha mthupi lanu kuti chiwononge zotupa.

Ikuwonetsedwa kuti ili ndi kuthekera. Itha kukhala ndi zovuta zoyipa kotero imagwiritsidwa ntchito mwa anthu athanzi omwe amatha kupirira zotsatirapo zake.

Chimodzi mwazothandiza pa amuna azungu ambiri omwe ali ndi mtundu wankhanza wa RCC adawona kupulumuka kwakukulu pogwiritsa ntchito interleukin-2 yolemera kwambiri.

Zotsatira zoyipa zimaphatikizapo:

• kutopa
• magazi
• kuzizira
• malungo
• kuthamanga kwa magazi
• madzimadzi m'mapapu
• kuwonongeka kwa impso

Zolemba za alpha

Ma interferon ali ndi ma virus, antiproliferative (omwe amaletsa kukula kwa khansa), komanso ma immunomodulatory (amakhudza chitetezo chamthupi). Alpha ya Interferon ikufuna kuletsa maselo otupa kuti asagawane ndikukula.

Nthawi zina Interferon amaperekedwa ndi mankhwala ena, monga bevacizumab (Avastin).

Zotsatira zoyipa za interferon ndizo:

• nseru
• zizindikiro ngati chimfine
• kutopa

Ma Interferon asinthidwa m'malo ndi mankhwala omwe athandizidwa ndi m'modzi. Mankhwala a interferon osagwiritsidwa ntchito nthawi zambiri sagwiritsidwanso ntchito.

Chithandizo chofuna

Chithandizo choyenera cha RCC chimatanthauza kugwiritsa ntchito mankhwala omwe amayang'ana makamaka ma cell a khansa. Mankhwala oyenera ndiofunika chifukwa samapweteketsa kapena kupha maselo athanzi mthupi.

Pali mankhwala angapo olimbana ndi gawo la 4 RCC omwe amaletsa kukula kwama cell. Amayang'ana puloteni yotchedwa vascular endothelial growth factor (VEGF) yomwe imalimbikitsa kukula kwa maselo a khansa.

Kupanga kwa mankhwalawa kwathandizira kuwonjezera miyoyo ya odwala ena a 4. Chithandizochi chatsimikizira kuti chikulonjeza mokwanira kuti ofufuza apitiliza kupanga mankhwala osokoneza bongo.

Mankhwala a bevacizumab (Avastin) amatseka VEGF ndipo amaperekedwa kudzera mumtsempha.

Zotsatira zoyipa zimaphatikizapo:

• kutsegula m'mimba
• kuonda
• kukomoka
• njala
• kutentha pa chifuwa
• zilonda mkamwa

Tyrosine kinase inhibitor (TKI) imayimitsa kukula kwa chotengera chamagazi m'matumbo ndipo imabwera ngati mapiritsi. Zitsanzo za mtundu uwu wa mankhwala ndi awa:

• Chinyama (Nexavar)
• cabozantinib (Cabometyx)
• pazopanib (Wotchuka)
• sunitinib (Sutent)

Zotsatira zoyipa za ma TKI ndi awa:

• kuthamanga kwa magazi
• nseru
• kutsegula m'mimba
• kupweteka m'manja ndi m'miyendo

mTOR zoletsa

Makina opanga rapamycin (mTOR) inhibitors amalimbana ndi protein ya mTOR, yomwe imalimbikitsa kukula kwa khansa ya m'mitsempha ya m'mitsempha.

Izi zikuphatikiza:

• temsirolimus (Torisel), yoyendetsedwa kudzera mu IV
• everolimus (Afinitor), wotengedwa pakamwa pamapiritsi

Zotsatira zoyipa zimaphatikizapo:

• zidzolo
• kufooka
• njala
• zilonda mkamwa
• madzimadzi kumaso kapena miyendo
• shuga wambiri wamagazi ndi cholesterol

Thandizo la radiation

Poizoniyu amagwiritsa ntchito ma X-ray amphamvu kwambiri kupha ma cell a khansa. Poizoniyu atha kugwiritsidwanso ntchito atachitidwa opaleshoni kuti aphe maselo aliwonse a khansa omwe adatsalira atalandira chithandizo.

Mu RCC yapamwamba, imagwiritsidwa ntchito nthawi zambiri kuthana ndi zowawa kapena zotupa. Chithandizo chamtunduwu chimatchedwa chisamaliro chothandizira.

Zotsatira zoyipa za radiation ndi monga:

• kukhumudwa m'mimba
• khungu lofiira
• kutopa
• kutsegula m'mimba

Chemotherapy

Chemotherapy ndi njira yothandizira mitundu ingapo ya khansa. Zimaphatikizapo kugwiritsa ntchito mankhwala osokoneza bongo kapena kuphatikiza mankhwala kuti muphe maselo a khansa.

Mankhwala a chemotherapy samalimbikitsidwa, komabe, amapheranso maselo abwinobwino ndikupanga zovuta zambiri.

Chemotherapy nthawi zambiri imagwira ntchito bwino kwa anthu omwe ali ndi RCC. Komabe, dokotala wanu angakulimbikitseni ngati mankhwala a immunotherapy ndi mankhwala omwe akugwiritsidwa ntchito sanagwire ntchito.

Mankhwalawa amatengedwa kudzera m'mitsempha kapena mapiritsi. Amaperekedwa m'zinthu zopumula. Muyenera kulandira chemotherapy mwezi uliwonse kapena miyezi ingapo.

Zotsatira zoyipa zimaphatikizapo:

• kutopa
• zilonda mkamwa
• nseru ndi kusanza
• kutsegula m'mimba kapena kudzimbidwa
• kutayika tsitsi
• njala
• chiopsezo chowonjezeka cha matenda opatsirana

Mayesero azachipatala

Njira ina kwa anthu omwe ali ndi gawo la 4 RCC ndikutenga nawo gawo pazoyeserera zamankhwala. Mayesero azachipatala ndi mayeso ofufuza poyesa mankhwala ndi mankhwala atsopano.

Mutha kukambirana za mayesero amakono azachipatala - komanso zomwe zingabweretse mavuto - ndi dokotala wanu kapena wothandizira zaumoyo.

Renal cell carcinoma ikuwonetsa

Madokotala omwe amapeza ndikuchiza RCC ndi mitundu ina ya khansa amagwiritsa ntchito njira zowonetsera. Munthu aliyense yemwe ali ndi RCC amapatsidwa nambala kuyambira 1 mpaka 4. Gawo 1 ndiye gawo loyambirira la matendawa ndipo gawo 4 ndiye lomaliza komanso lotsogola kwambiri.

Kuyika ma RCC kutengera:

• kukula kwa chotupa chachikulu mu impso
• kufalikira kwa maselo a khansa kuchokera pachotupa choyambirira kupita kumatenda oyandikira
• kuchuluka kwa metastasis
• kufalikira kwa khansa kumaziwalo ena mthupi

Gawo 4 RCC itha kuphatikizira njira zingapo zophatikizira:

• Pamene chotupa chachikulu chimakhala chachikulu ndipo chafalikira mu impso zonse ndi minyewa yapafupi. Pakadali pano, maselo a khansa atha kapena sangafalikire m'ziwalo zina m'thupi.
• Khansara ikafalikira ndipo imapezeka m'malo akutali. Poterepa, chotupacho chimatha kukula, ndipo mwina pangakhale khansara m'matumba oyandikira impso nthawi yomweyo.

Chiwonetsero

Kuchuluka kwa zaka 5 zapakati pa anthu omwe ali ndi gawo 4 RCC ndi 12%. Komabe, zochitika zosiyanasiyana zitha kupangitsa kuchuluka kwapulumuka.

Anthu omwe amatha kuchitidwa opaleshoni kuti achotse zotupa zam'mimba amakhala ndi ziwerengero zabwino zopulumuka, ndipo ambiri omwe amathandizidwa ndi mankhwala omwe akulimbana nawo amakhala ndi moyo nthawi yayitali kuposa omwe satero.