Magawo Khansa Yapakhungu: Kodi Amatanthauza Chiyani?

Zamkati

• Zomwe muyenera kudziwa pamagulu a khansa
• Magawo oyambira khansa yapakhungu yoyambira
• Njira zothandizira
• Magawo a khansa ya pakhungu
• Chithandizo cha khansa ya khansa
• Mfundo yofunika

Magawo a khansa amafotokoza kukula kwa chotupa choyambirira komanso momwe khansa yafalikira kuchokera pomwe idayambira. Pali malangizo osiyanasiyana okhudza mitundu yosiyanasiyana ya khansa.

Staging imapereka chithunzithunzi cha zomwe muyenera kuyembekezera. Dokotala wanu adzagwiritsa ntchito mfundoyi kuti akupatseni njira yabwino kwambiri yothandizira.

Munkhaniyi, tiwona mozama momwe m'mene khansa yapakhosi ya cell, squamous cell, ndi khansa ya khansa ya khansa ya khansa ya khansa ya khansa ya khansa ya khansa ya khansa ya khansa ya khansa ya khansa ya khansa ya khansa ya khansa ya khansa ya khansa ya khansa ya khansa ya khansa ya khansa ya khansa ya khansa ya khansa ya khansa ya khansa ya khansa ya khansa ya khansa ya melanoma

Zomwe muyenera kudziwa pamagulu a khansa

Khansa ndi matenda omwe amayamba m'dera limodzi laling'ono la thupi, monga khungu. Ngati sanalandire msanga, amatha kufalikira mbali zina za thupi.

Madokotala amagwiritsa ntchito zidziwitso kuti amvetse:

• kuchuluka kwa khansa m'thupi la munthu
• komwe kuli khansara
• kaya khansara yafalikira kupitirira pomwe idayambira
• momwe angachiritse khansa
• chomwe malingaliro kapena malingaliro ake ali

Ngakhale khansa imakhala yosiyana ndi aliyense, khansa yomwe ili ndi gawo lomwelo imathandizidwa chimodzimodzi ndipo nthawi zambiri imakhala ndi malingaliro ofanana.

Madokotala amagwiritsa ntchito chida chodziwika kuti dongosolo la TNM kukhazikitsa mitundu yosiyanasiyana ya khansa. Dongosolo lokhazikitsa khansa limaphatikizapo mfundo zitatu izi:

• T:tkukula kwa umor ndi momwe chakulira pakhungu
• N: zamitsempha nkutenga nawo mbali
• M:metastasis kapena ngati khansara yafalikira

Khansa yapakhungu idakhazikitsidwa kuyambira 0 mpaka 4. Monga mwalamulo, kutsitsa kuchuluka kwa ziwonetsero, khansa imafalikira pang'ono.

Mwachitsanzo, gawo 0, kapena carcinoma in situ, amatanthauza maselo achilendo, omwe amatha kukhala ndi khansa, alipo. Koma maselowa amakhalabe m'maselo omwe adayamba kupanga. Sanakule kukhala minofu yapafupi kapena kufalikira kumadera ena.

Gawo 4, komano, ndipamwamba kwambiri. Pakadali pano, khansara yafalikira ku ziwalo zina kapena ziwalo zina za thupi.

Magawo oyambira khansa yapakhungu yoyambira

Kuyika masitepe nthawi zambiri sikofunikira pa khansa yapakhungu yapansi yama cell. Ndi chifukwa chakuti khansa imeneyi imachiritsidwa nthawi zambiri isanafalikire kumadera ena.

Khansa ya khungu la squamous imakhala ndi mwayi waukulu wofalikira, ngakhale chiwopsezo chake chidakali chochepa.

Ndi mitundu iyi ya khansa yapakhungu, zina zimatha kupangitsa kuti maselo a khansa azitha kufalikira kapena kubwerera ngati achotsedwa. Izi ndizoopsa kwambiri monga:

• carcinoma (maselo a khansa) opitilira 2 mm (millimeters)
• kulowerera m'mitsempha pakhungu
• kulowa m'magawo apansi akhungu
• malo pamlomo kapena khutu

Khansa ya khungu la squamous cell ndi basal cell imakhala motere:

• Gawo 0: Maselo a khansa amapezeka kokha kumtunda kwa khungu (epidermis) ndipo sanafalikire pakhungu.
• Gawo 1: Chotupacho chili 2 cm (centimeters) kapena kuchepera, sichinafalikire ku ma lymph node apafupi, ndipo chimakhala ndi chiopsezo chimodzi kapena zochepa.
• Gawo 2: Chotupacho ndi 2 mpaka 4 cm, sichinafalikire ku ma lymph node apafupi, kapena chotupacho ndi kukula kulikonse ndipo chimakhala ndi ziwopsezo ziwiri kapena zingapo zowopsa.
• Gawo 3: Chotupacho chimaposa masentimita 4, kapena chafalikira ku chimodzi mwa izi:
  • Minofu yothina, yomwe ndi yakuya kwambiri, mkatikati mwa khungu lomwe limakhala ndi mitsempha yamagazi, mathero amitsempha, ndi ma follicles atsitsi
  • fupa, komwe lawonongeka pang'ono
  • mwanabele
• Gawo 4: Chotupacho chimatha kukula kulikonse ndipo chafalikira ku:
  • mwana wamphongo m'modzi kapena angapo, omwe ndi akulu kuposa 3 cm
  • fupa kapena mafupa
  • ziwalo zina m'thupi

Njira zothandizira

Ngati khansa ya khungu la squamous kapena basal cell imagwidwa msanga, imachiritsidwa kwambiri. Njira zosiyanasiyana zopangira maopareshoni nthawi zambiri zimagwiritsidwa ntchito kuchotsa ma cell a khansa.

Njira zochitira opaleshonizi nthawi zambiri zimachitikira ku ofesi ya dokotala kapena kuchipatala cha odwala omwe ali pansi pa anesthesia yakomweko. Izi zikutanthauza kuti mudzakhala ogalamuka, ndipo malo okha ozungulira khansa yapakhungu ndi omwe adzachita dzanzi. Mtundu wa opaleshoni yomwe yachitika umadalira:

• mtundu wa khansa yapakhungu
• kukula kwa khansara
• komwe kuli khansara

Ngati khansara yafalikira pakhungu kapena ili ndi chiopsezo chachikulu chofalikira, mankhwala ena angafunike pambuyo pochitidwa opaleshoni, monga radiation kapena chemotherapy.

Zina mwa njira zodziwika bwino zochiritsira khansa yam'munsi kapena squamous cell khansa ndi izi:

• Chisangalalo: Mwachidwi, dokotala wanu amagwiritsa ntchito lumo lakuthwa kapena scalpel kuchotsa minofu ya khansa ndi minofu ina yathanzi. Minofu yomwe yachotsedwa imatumizidwa ku labotale kuti ikawunikidwe.
• Kukonzekera kwa magetsi: Amadziwikanso kuti curettage and electrodeiccation, njirayi ndiyabwino kwambiri khansa yapakhungu yomwe ili pamwamba pakhungu. Dokotala wanu adzagwiritsa ntchito chida chapadera chotchedwa curette kuti athetse khansa. Kenako khungu limatenthedwa ndi maelekitirodi kuti awononge khansa iliyonse yomwe yatsala. Njirayi imabwerezedwa kangapo paulendo womwewo ku ofesi kuti awonetsetse kuti khansa yonse yachotsedwa.
• Mohs opaleshoni: Ndi njirayi, dokotala wanu amagwiritsa ntchito scalpel kuti achotse khungu losazolowereka mosadukiza pamodzi ndi minofu ina yoyandikana nayo. Khungu limayesedwa pogwiritsa ntchito makina oonera zinthu zing'onozing'ono akangotulutsidwa. Ngati maselo a khansa apezeka, khungu lina limachotsedwa nthawi yomweyo mpaka pomwe sipadzakhalanso khungu la khansa.
• Kuchiza opaleshoni: Ndi cryosurgery, madzi asafe amagwiritsidwa ntchito kuzizira ndikuwononga minofu ya khansa. Mankhwalawa amabwerezedwa kangapo paulendo womwewo kuofesi kuti awonetsetse kuti minofu yonse ya khansa yawonongeka.

Magawo a khansa ya pakhungu

Ngakhale khansa ya khansa siidziwika kwenikweni ngati khansa yapakhungu yapakhungu kapena khansa ya squamous cell, ndiyolimba mtima kwambiri. Izi zikutanthauza kuti ndizotheka kufalikira kumatenda apafupi, ma lymph node, ndi ziwalo zina za thupi, poyerekeza ndi khansa ya khungu la nonmelanoma.

Matenda a khansa amakhala motere:

• Gawo 0: Maselo a khansa amapezeka kokha kunja kwa khungu ndipo sanalowerere minofu yapafupi. Pakadali pano, khansara imatha kuchotsedwa ndi opaleshoni yokha.
• Gawo 1A: Chotupacho sichiposa 1 mm wandiweyani. Itha kapena isakhale ndi zilonda zam'mimba (kuphulika pakhungu komwe kumalola minofu yomwe ili pansipa kuti iwonetsere).
• Gawo 1B: Kutupa kwa chotupa ndi 1 mpaka 2 mm, ndipo palibe zilonda.
• Gawo 2A: Chotupa ndi 1 mpaka 2 mm wakuda ndi zilonda zam'mimba, kapena ndi 2 mpaka 4 mm ndipo sizilonda zam'mimba.
• Gawo 2B: Chotupa ndi 2 mpaka 4 mm wakuda ndi zilonda zam'mimba, kapena ndizoposa 4 mm ndipo sizilonda zam'mimba.
• Gawo 2C: Chotupa chimakhala choposa 4 mm wakuda komanso zilonda zam'mimba.
• Gawo 3A: Kutupa kwa chotupa sikuposa 1 mm ndipo pali zilonda zam'mimba, kapena ndi 1 mpaka 2 mm osati zilonda zam'mimba. Khansa imapezeka mu 1 mpaka 3 sentinel lymph node.
• Gawo 3B: Chotupacho chimakhala chachikulu mpaka 2 mm ndi zilonda zam'mimba, kapena 2 mpaka 4mm popanda zilonda, kuphatikiza khansa ilipo mu imodzi mwazi:
  • mwanabele mmodzi kapena atatu
  • m'magulu ang'onoang'ono a zotupa, zotchedwa microsatellite tumors, pafupi ndi chotupa choyambirira
  • m'magulu ang'onoang'ono a chotupa mkati mwa 2 cm ya chotupacho, chotchedwa satellite zotupa
  • m'maselo omwe afalikira ku zotengera zam'mimba zapafupi, zomwe zimadziwika kuti metastases
• Gawo 3C: Chotupacho chimakhala chachikulu mpaka 4 mm ndi zilonda zam'mimba, kapena 4 mm kapena zokulirapo popanda zilonda, kuphatikiza khansa ilipo mu umodzi mwazi:
  • Ma lymph nodes awiri kapena atatu
  • chimodzi kapena zingapo, kuphatikiza pali zotupa za microsatellite, zotupa za satellite, kapena metastases oyenda
  • mfundo zinayi kapena zingapo kapena nambala iliyonse yazinthu zosakanikirana
• Gawo 3D: Kutupa kwa chotupa kwadutsa 4 mm ndipo ndi zotupa. Maselo a khansa amapezeka m'malo awa:
  • ma lymph node anayi kapena kupitilira apo kapena manambala aliwonse osakanikirana
  • mfundo ziwiri kapena zingapo kapena zingapo zilizonse zosakanikirana, kuphatikiza pali zotupa za microsatellite, zotupa za satelayiti, kapena ma metastases oyenda
• Gawo 4: Khansa yafalikira kumadera akutali a thupi. Izi zitha kuphatikizira ma lymph node kapena ziwalo monga chiwindi, mapapo, fupa, ubongo, kapena njira yogaya chakudya.

Chithandizo cha khansa ya khansa

Kwa khansa ya khansa, chithandizo chimadalira kwambiri gawo komanso malo omwe khansa imakula. Komabe, palinso zifukwa zina zomwe zingapangitse mtundu wa mankhwala omwe amagwiritsidwa ntchito.

• Gawo 0 ndi 1: Ngati khansa ya khansa yapezeka msanga, kuchotsedwa kwa chotupacho ndi minofu yoyandikana nayo nthawi zambiri ndizofunikira. Kuwunika khungu pafupipafupi ndikulimbikitsidwa kuti zitsimikizire kuti palibe khansa yatsopano yomwe imayamba.
• Gawo 2: Khanda la khansa ndi minofu yozungulira idzachotsedwa opaleshoni.Dokotala wanu angalimbikitsenso sentinel lymph node biopsy kuti atsimikizire kuti khansara siinafalikire ku ma lymph node apafupi. Ngati lymph node biopsy ipeza ma cell a khansa, adotolo angavomereze kuti achotse ma lymph node m'derali. Izi zimadziwika kuti lymph node dissection.
• Gawo 3: Khansa ya khansa imachotsedwa opaleshoni limodzi ndi minofu yambiri. Chifukwa chakuti khansara yafalikira ku ma lymph node panthawiyi, chithandizo chingaphatikizepo kusalaza kwa lymph node. Pambuyo pa opaleshoni, mankhwala ena adzavomerezedwa. Zitha kuphatikiza:
  • mankhwala a immunotherapy omwe amathandiza kulimbikitsa chitetezo cha mthupi lanu polimbana ndi khansa
  • mankhwala othandiza omwe amaletsa mapuloteni, michere, ndi zinthu zina zomwe zimathandiza khansa kukula
  • mankhwala a radiation omwe amayang'ana kwambiri malo omwe ma lymph node adachotsedwa
  • chemotherapy yokhayokha, yomwe imaphatikizapo kumangodutsa kumene kunali khansa
• Gawo 4: Kuchotsa opaleshoni ya chotupa ndi ma lymph node nthawi zambiri amalimbikitsidwa. Chifukwa khansara yafalikira ku ziwalo zakutali, chithandizo chowonjezera chingaphatikizepo chimodzi kapena zingapo zotsatirazi:
  • mankhwala a immunotherapy omwe amadziwika kuti checkpoint inhibitors
  • mankhwala osokoneza bongo
  • chemotherapy

Mfundo yofunika

Magawo a khansa yapakhungu angakuuzeni zambiri za momwe matendawa afikira. Dokotala wanu adzawona mtundu wa khansa yapakhungu komanso gawo kuti adziwe mankhwala oyenera kwa inu.

Kuzindikira koyambirira ndi chithandizo chake kumapereka chiyembekezo chabwino. Ngati muli pachiwopsezo chachikulu cha khansa yapakhungu kapena mukawona china chake chachilendo pakhungu lanu, pangani nthawi yowunika khansa yapakhungu posachedwa.