Ciwon daji na Pancreatic: ganewar asali
Idan likita ya yi zargin cewa wani yana da ciwon daji na pancreatic, zai fara tambayar majiyyacin tarihin likita, tarihin lafiyar iyali, kuma ya duba alamun cutar. Ana iya amfani da waɗannan gwaje-gwaje masu zuwa don gano ciwon daji na pancreatic.
Gwaji na gabaɗaya
1. Gwajin jiki
Likitan zai duba fata da idanunku don ganin ko rawaya ne, wanda alama ce ta jaundice.
Rashin tara ruwa mara kyau a cikin ciki, wanda ake kira ascites, na iya zama wata alamar ciwon daji.
2. Gwajin jini
Likitoci za su iya ɗaukar samfuran jini don bincika ƙananan matakan bilirubin da sauran abubuwa.
CA19-9 alama ce ta ƙari. CA19-9 sau da yawa ya fi girma a cikin marasa lafiya da ciwon daji na pancreatic, amma CA 19-9 bai kamata a yi amfani da shi azaman mai nuna alama ga ciwon daji na pancreatic ba, saboda babban matakin CA 19-9 na iya zama alamar wasu cututtuka. Misalai sun haɗa da pancreatitis, cirrhosis na hanta da toshewar bile duct na kowa.
3. Duban hoto
Binciken hoto yana taimaka wa likitan gano inda ciwon daji yake da kuma ko ya yadu daga pancreas zuwa wasu sassan jiki.
Computer tomography (CT or CAT) scan.
Positron emission tomography (PET) scan or PET-CT scan.
Duban dan tayi
Endoscopic Duban dan tayi (EUS)
Endoscopic retrograde cholangiopancreatography (ERCP)
Hanyoyin ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwa (PTC)
Binciken biopsy da nama
Kyakkyawan buri na allura (FNA), ta yin amfani da allura masu kyau da aka saka a cikin pancreas don neman sel.
4. Gano kwayoyin cutar tumo
Likitanka na iya ba da shawarar gwaje-gwajen dakin gwaje-gwaje akan ƙari ko samfuran jini don nemo alamomin halittu daban-daban. Masu nazarin halittu sunadaran sunadarai ne da kwayoyin halitta musamman ga takamaiman cututtukan daji, kuma sakamakon waɗannan gwaje-gwajen na iya taimakawa wajen jagorantar yanke shawarar jiyya.
Ciwon daji na Pancreatic: cututtuka
Hanyar da ta fi dacewa don magance ciwon daji na pancreatic shine a raba shi zuwa kashi 4: bisa ga ko za a iya cire shi ta hanyar tiyata da kuma inda aka rarraba shi.
Ciwon daji na pancreatic
Ana iya cire wannan ciwon daji na pancreatic ta hanyar tiyata. Ciwon daji na iya kasancewa a cikin maƙarƙashiya kawai ko kuma ya shimfiɗa a waje da shi, amma bai girma zuwa wani muhimmin jijiya ko jijiya a wannan yanki ba. Babu wata shaida da ke nuna cewa ciwon ya yadu fiye da pancreas. Kusan kashi 10 zuwa 15% na marasa lafiya suna a wannan matakin lokacin da aka gano su.
Border resectable pancreatic cancer
Tumors that may be difficult or impossible to surgically remove at first diagnosis, but after chemotherapy and / or radiation therapy, the tumor can be reduced first, then the tumor can be surgically removed later, marginal cancer cells are negative, marginal negative means no visible Cancer cells are left behind.
Ciwon daji na pancreatic a cikin gida
Wannan nau'in ciwon har yanzu yana cikin yankin da ke kusa da pancreas, amma saboda ya girma ya zama wata jijiya ko jijiya ko gabar da ke kusa, ba za a iya cire shi ta hanyar tiyata ba. Duk da haka, babu wata alama da ke nuna cewa ta motsa zuwa kowane nisa a cikin jiki. Kimanin kashi 35% zuwa 40% na marasa lafiya suna a wannan matakin a lokacin ganewar asali.
Metastatic ciwon daji na pancreatic
Ciwon daji ya yadu fiye da pancreas, kamar hanta ko kuma nisa na ciki. Kimanin kashi 45 zuwa 55% na marasa lafiya suna a wannan matakin lokacin da aka gano su.
Farashin TNM
Likitoci sukan yi amfani da tsarin TNM don magance ciwon daji na pancreatic waɗanda za a iya yi musu aiki. Yawancin marasa lafiya da ciwon daji na pancreatic ba za su iya yin tiyata ba. Don haka, tsarin TNM baya amfani da duk cututtukan daji na pancreatic kamar sauran cututtukan daji.
Mataki na 0: yana nufin carcinoma a wurin, ciwon daji bai riga ya girma daga bututun ba (Tis, N0, M0).
Mataki na IA: Ciwon daji na pancreatic yana da 2 cm ko ƙarami kuma bai yada zuwa ƙwayoyin lymph ko wasu sassan jiki ba (T1, N0, M0).
Mataki na IB: Ciwon daji na pancreatic ya fi 2 cm girma kuma bai yada zuwa ƙwayoyin lymph ko wasu sassan jiki ba (T2, N0, M0).
Mataki na II: Ciwon daji ya wuce pancreas, amma ciwon bai yada zuwa arteries ko veins na kusa ba, kuma bai yadu zuwa kowane nau'in lymph ko wasu sassan jiki (T3, N0, M0).
Mataki na IIB: Ciwon daji na kowane girman da bai yada zuwa arteries ko veins na kusa ba, amma ya yada zuwa ƙwayoyin lymph kuma bai yada zuwa wasu sassan jiki ba (T1, T2 ko T3; N1; M0).
Mataki na III: Ciwon daji ya yadu zuwa ga jijiyoyin jini, veins, da / ko nodes na lymph, amma bai yada zuwa wasu sassan jiki ba (T4, N1, M0).
Mataki na IV: Duk wani ƙari da ya yaɗu zuwa wasu sassan jiki (kowane T, kowane N, M1).
Komawa: Ciwon daji wanda ya sake dawowa shine kansar da ya warke bayan magani. Idan ciwon daji ya dawo, za a sake yin wani zagaye na gwaji don fahimtar girman maimaitawar. Waɗannan gwaje-gwaje da sikanin yawanci suna kama da abin da aka yi yayin ganewar asali.
Ciwon daji na Pancreatic: zaɓuɓɓukan magani
Zaɓuɓɓukan magani na yau da kullun don ciwon daji na pancreatic an jera su a ƙasa. Zaɓuɓɓukan jiyya na yanzu don ciwon daji na pancreatic sune tiyata, radiation far, chemotherapy, da kuma niyya far. Zaɓuɓɓukan jiyya da shawarwari sun dogara da dalilai da yawa, gami da nau'in da matakin ciwon daji, yiwuwar illa, da fifikon haƙuri da lafiyar gaba ɗaya.
Tun da farko an gano ciwon daji na pancreatic, mafi girman yawan nasarar maganin. Duk da haka, magani mai aiki zai iya taimakawa wajen sarrafa cutar marasa lafiya da ciwon daji na pancreatic mai ci gaba don taimaka musu su rayu tsawon lokaci.
Aikin tiyata na Pancreatic
Surgeons remove all or part of the pancreas according to the location and size of the pancreatic tumor, and the area of healthy tissue surrounding the tumor is often removed. The purpose of the operation is to have a “clean edge”, which means to go to the edge of the operation, except for healthy tissue, there are no cancer cells.
Abin takaici, kusan kashi 20 cikin XNUMX na marasa lafiya da ke fama da ciwon daji na pancreatic ne kawai za su iya yin tiyata saboda yawancin ciwon daji na pancreatic sun riga sun daidaita a lokacin ganewar asali. Idan tiyata ba zaɓi na farko ba ne, ku da likitan ku za ku yi magana game da wasu zaɓuɓɓukan magani.
Pancreatic cancer surgery can be used in combination with radiation therapy and / or chemotherapy. Radiation therapy and chemotherapy are usually given after surgery and are called adjuvant therapy. Chemotherapy and radiotherapy given before surgery to shrink the tumor are called neoadjuvant therapy. If these treatments are given before surgery, the tumor usually needs to be restaged before surgery.
Likitoci na iya yin tiyata iri-iri dangane da manufar tiyatar:
Laparoscopy
Likitan na iya zaɓar farawa da laparoscope don ganin ko ciwon daji ya yadu zuwa wasu sassan ciki. Idan ya riga ya daidaita, ba a ba da shawarar cire ƙwayar ƙwayar cuta ta farko ba.
Tiyata kawar da ƙari na pancreatic
Hanyar tiyata ya dogara ne akan inda ciwon daji yake a cikin pancreas, kuma ana cire nodes na lymph na kusa a matsayin wani ɓangare na tiyata.
Idan ciwon daji ya kasance a cikin kan pancreas kawai, likitan tiyata na iya yin aikin Whipple, wanda shine babban aiki wanda likitan tiyata ya cire kai da ƙananan hanji, wani ɓangare na bile duct da ciki na pancreas, sannan ya sake haɗuwa. tsarin narkewar abinci da tsarin bile ducts.
Idan ciwon daji yana cikin wutsiya na pancreas, aikin gama gari shine pancreatectomy distal. A cikin wannan aiki, likitan fiɗa yana cire wutsiya na pancreas, jikin maƙarƙashiya, da kuma magudanar ruwa.
Idan ciwon daji ya yadu zuwa ga pancreas, ko kuma yana cikin yankuna da yawa na pancreas, ana iya buƙatar cikakken pancreatectomy. Pancreatectomy shine cirewar gabaɗayan pancreas, wani ɓangare na ƙananan hanji, wani ɓangare na ciki, ƙwayar bile na kowa, gallbladder da safiya.
Bayan tiyatar, majiyyaci na bukatar ya zauna a asibiti na tsawon kwanaki kuma yana iya bukatar ya huta a gida na kusan wata guda. Abubuwan da ke haifar da tiyata sun haɗa da gajiya da zafi a cikin 'yan kwanaki na farko bayan tiyata. Sauran illolin da cutar ta haifar
removal of the pancreas include indigestion and diabetes.
Maganin radiation a cikin ciwon daji na pancreatic
Radiation therapy uses high-energy x-rays or other particles to destroy cancer cells. The most common type of radiation therapy is called external radiation therapy, which is radiation given from a machine outside the body.
Maganin radiation na waje shine nau'in maganin radiation da aka fi amfani dashi don ciwon daji na pancreatic. Shirye-shiryen jiyya na radiation yawanci ana ba da su ta takamaiman adadin jiyya na tsawon lokaci.
Akwai hanyoyi daban-daban na maganin radiation:
Hakanan ana kiran maganin radiation na al'ada na al'ada ko daidaitaccen maganin radiation. Ana ba shi ƙarancin maganin radiation kowace rana har tsawon makonni 5 zuwa 6.
Stereotactic radiotherapy (SBRT) ko Cyber knife
Stereotactic radiotherapy (SBRT) ko Cyber knife za a iya ba da mafi girman kashi na magani kowace rana na ɗan gajeren lokaci, yawanci kusan kwanaki 5. Wannan sabon nau'in maganin radiation ne wanda zai iya samar da ƙarin jiyya na rauni kuma yana buƙatar ƙarancin jiyya. Sai kawai a cikin cibiyoyin rediyo na musamman tare da ƙwarewa da ƙwarewa za a iya amfani da wannan fasaha don magance ciwon daji na pancreatic.
Chemotherapy a cikin ciwon daji na pancreatic
Chemotherapy yawanci ana ba da shi a lokaci ɗaya da maganin radiation domin yana iya haɓaka tasirin maganin radiation, wanda ake kira radiation sensitization. Haɗin yin amfani da chemotherapy da radiotherapy na iya rage ƙwayar ƙwayar cuta kuma ya taimaka wa likita ya sake cire ƙari ta hanyar tiyata. Duk da haka, idan aka yi amfani da ita a lokaci guda tare da maganin radiation, adadin chemotherapy yawanci yana ƙasa da na chemotherapy kadai.
Magungunan radiation na iya taimakawa wajen rage yiwuwar sake dawowa ko ciwon daji na pancreatic, amma har yanzu akwai rashin tabbas da yawa game da ko zai iya tsawaita majiyyaci.
Illolin maganin radiation na iya haɗawa da gajiya, ƙarancin fata, tashin zuciya, ciwon ciki da gudawa. Bayan jiyya, yawancin illolin za su ɓace.
jiyyar cutar sankara
Chemotherapy yana amfani da kwayoyi don lalata ƙwayoyin kansa ta hanyar hana ikon girma da rarrabuwa.
Marasa lafiya na iya karɓar magani 1 ko haɗin magunguna daban-daban a lokaci guda. Waɗannan su ne magungunan da Hukumar Abinci da Magunguna ta Amurka (FDA) ta amince da ita don ciwon daji na pancreatic:
Capecitabine (Xeloda)
Erlotinib (Tarceva)
Fluorouracil (5-FU)
Gemcitabine (Gemzar)
Irinotecan (Camptosar)
Folic acid (Wellcovorin)
Paclitaxel (Abraxane)
Nanoliposome irinotecan (Onivyde)
Oxaliplatin (Eloxatin)
Lokacin da aka yi amfani da kwayoyi biyu ko fiye tare, yawanci ana samun ƙarin illa. Magungunan haɗin gwiwar ƙwayoyi yawanci mafi kyau ga marasa lafiya da yanayin jiki mai kyau kuma suna iya kula da kansu.
Wani nau'in maganin da za a yi amfani da shi ya dogara ne akan cibiyar ciwon daji, musamman ma masanin ilimin cututtuka game da maganin, da kuma illolin daban-daban da kuma lafiyar majiyyaci. Chemotherapy don ciwon daji na pancreatic an raba shi zuwa nau'ikan masu zuwa bisa ga lokaci:
Chemotherapy na farko
Wannan yawanci yana nufin magani na farko ga marasa lafiya masu ci gaba a cikin gida ko ciwon daji na pancreatic metastatic.
Chemotherapy na layi na biyu
Lokacin da jiyya ta farko ba ta aiki ko kuma juriya na ƙwayoyi ba zai iya sarrafa ci gaban kansa ba, ciwon daji ana kiransa kansar refractory. Magani na farko wani lokaci baya aiki kwata-kwata kuma ana kiransa juriya na ƙwayoyi. A wannan yanayin, idan yanayin lafiyar majiyyaci yana da kyau, mai haƙuri zai iya amfana daga jiyya tare da wasu magunguna. Babban binciken ciwon daji na pancreatic na yanzu ya fi mayar da hankali kan haɓaka wasu magungunan jiyya na layi na biyu, da magungunan jiyya na layi na uku da sauran magungunan jiyya, wasu daga cikinsu sun nuna kyakkyawan fata.
Maganin da ba daidai ba
Non-standard treatment means that the drug used is not an indication for FDA approved treatment, which means that the FDA has not approved the drug for pancreatic cancer treatment, which is different from the drug’s instructions for use. For example, if your doctor wants to use drugs approved only for breast cancer to treat pancreatic cancer. At present, doctors recommend it only when there is substantial evidence that the drug may be effective for another disease. This evidence may include previously published studies, promising results from ongoing studies, or tumor genetic testing results suggesting that the drug may work.
Chemotherapy sakamako masu illa
The side effects of chemotherapy depend on which drugs patients receive, and not all patients have the same side effects. Side effects may include loss of appetite, nausea, vomiting, diarrhea, gastrointestinal problems, aphthous ulcers, and hair loss. People who receive chemotherapy are also more likely to have white blood cells, red blood cells, and thrombocytopenia due to chemotherapy, and are prone to infection, blood stasis, and bleeding.
Wasu magungunan da ake amfani da su don ciwon daji na pancreatic kuma suna da alaƙa da takamaiman illa. Misali, capecitabine na iya haifar da ja da rashin jin daɗi a cikin tafin hannu da tafin ƙafafu. Ana kiran wannan yanayin ciwon ƙafar hannu. Oxaliplatin na iya haifar da raguwa da tingling a cikin yatsu da yatsun kafa, kuma ana kiran shi neuropathy na gefe. Peripheral neuropathy kuma sakamako ne na gefen paclitaxel. Waɗannan illolin yawanci suna ɓacewa tsakanin jiyya da kuma bayan ƙarshen jiyya, amma wasu alamun cutar na iya daɗe da muni yayin da ake ci gaba da jiyya.
Fahimtar ainihin ilimin chemotherapy kuma shirya don magani. Ana ci gaba da tantance magungunan da ake amfani da su don magance cutar kansa. Yin magana da likitan ku yawanci shine hanya mafi kyau don fahimtar maganin da aka rubuta muku, manufarsa da yiwuwar illarsa ko hulɗa tare da wasu magunguna. Ƙara koyo game da magungunan likitancin ku ta amfani da bayanan magunguna da ake nema.
Magungunan maganin miyagun ƙwayoyi
Maganin da aka yi niyya magani ne ga takamaiman ƙwayoyin cuta na kansa, sunadaran gina jiki ko mahallin nama waɗanda ke ba da gudummawa ga ci gaban kansa da rayuwa. Wannan maganin zai iya hana haɓakawa da yaduwar ƙwayoyin cutar kansa, yayin da rage lalacewa ga ƙwayoyin lafiya.
Recent studies have shown that not all tumors have the same target. To find the most effective treatment, your doctor may perform a tumor genetic test to determine the genes, proteins, and other factors in the tumor. This helps doctors better find the most effective treatment for each patient.
Erlotinib is approved by the FDA for use in combination with gemcitabine in the treatment of patients with advanced pancreatic cancer. Erlotinib can block the role of epidermal growth factor receptor (EGFR), an abnormal protein that helps the growth and spread of cancer. Side effects of erlotinib include acne rashes.
Metastatic ciwon daji na pancreatic
If the cancer spreads from its primary site to another part of the body, doctors call it metastatic cancer. If this happens, it is a good idea to talk to a doctor with experience in treatment. Different doctors can have different opinions on the best standard treatment plan. In addition, participation in clinical trials may be an option.
Tsarin jiyya na ciwon daji na pancreatic metastatic na iya haɗawa da haɗin magungunan da ke sama, kuma shirin jiyya ya dogara ne akan lafiyar majiyyaci da abubuwan da ake so.
Magani na farko ya haɗa da:
Haɗin ilimin chemotherapy tare da fluorouracil, leucovorin, irinotecan da oxaliplatin ana kiransa FOLFIRINOX.
Ana amfani da Gemcitabine tare da paclitaxel azaman jiyya na farko ko jiyya na layi na biyu ga marasa lafiya waɗanda suka karɓi FOLFIRINOX.
Jiyya na layi na biyu ya haɗa da zaɓuɓɓuka masu zuwa. Ana amfani da waɗannan da yawa a cikin marasa lafiya waɗanda ke da ci gaban cuta ko kuma suna da mummunan tasiri yayin jiyya na farko.
Ga marasa lafiya waɗanda suka riga sun karɓi gemcitabine da paclitaxel, haɗin fluorouracil da irinotecan ko oxaliplatin shine zaɓi mai yiwuwa. Ga marasa lafiya wanda yanayin jikinsu
ns ba zai iya karɓar magunguna da yawa ba, capecitabine shine zaɓi tare da ƙarancin sakamako masu illa.
Ga marasa lafiya da suka riga sun karbi FOLFIRINOX, tsarin da ke dauke da gemcitabine, irin su gemcitabine kadai ko a hade tare da paclitaxel, zaɓi ne mai dacewa.
Ciwon daji na Pancreatic: bincike
Likitoci suna aiki tuƙuru don ƙarin koyo game da maganin ciwon daji na pancreatic, yadda ake rigakafin kansar pancreatic, yadda ake bi da shi yadda ya kamata, da yadda ake ba da kyakkyawar kulawa ga majiyyata.
Genetics da binciken kwayoyin halitta
A cikin ciwon daji, ƙwayoyin cuta da suka lalace ko marasa kyau na iya haifar da haɓakar ƙwayoyin cuta marasa sarrafawa. Yawancin sabbin ci gaban bincike sun dogara ne akan gano kwayoyin halitta da sunadarai da suka lalace, gyara su ko canza su don magance cutar kansar pancreatic.
Daban-daban dabaru na kwayoyin (kamar jerin DNA da bincike na maye gurbi) yanzu ana iya amfani da su don nazarin samfuran ƙari na pancreatic don neman canje-canjen kwayoyin halitta. Ana iya yin waɗannan nazarin a yanzu akan samfuran jini saboda sabuwar fasaha ta ba da damar tattarawa da kuma nazarin DNA ƙari da ke cikin jini. Likitoci na iya nemo sabbin magunguna da aka yi niyya don magance cutar kansar pancreatic bisa bayanan gwajin kwayoyin halitta.
Immunotherapy a cikin ciwon daji na pancreatic
Immunotherapy aims to enhance the body’s natural defense capabilities against cancer. It uses materials made by the body or laboratory to improve or restore the function of the immune system and target the treatment of pancreatic cancer.
An example of immunotherapy is a cancer vaccine, which can be made from a variety of sources, including pancreatic cancer cells, bacterial or human specific tumor cells. Many clinical trials have been completed or are in progress, attempting to use vaccines to treat various types of cancer, including pancreatic cancer. According to the patient’s condition, vaccine therapy can be given after chemotherapy, during chemotherapy or during alternative chemotherapy.
Another type of immunotherapy is a drug called an immune checkpoint inhibitor, which includes PD-1 and CTLA-4 antibodies. Immune checkpoint inhibitors have been approved for other types of cancer, such as melanoma and lung cancer, but are currently not suitable for pancreatic cancer. In general, these drugs are not very effective for pancreatic cancer. However, they may be suitable for a few pancreatic cancer patients with certain genetic mutations. The ongoing pancreatic cancer research is testing the combined effect of immune checkpoint inhibitors and chemotherapy or other new immunotherapy.
Bugu da ƙari, masu bincike suna nazarin hanyoyin tattarawa da kuma gyara kwayoyin halitta T Kwayoyin, wanda ake kira adive immunotherapy.
Farfesa da aka tsara
Erlotinib a halin yanzu an yarda da shi don maganin ciwon daji na pancreatic kuma ana amfani dashi a hade tare da gemcitabine. Masana kimiyya suna nazarin wasu magungunan da za su iya toshe girma da yaduwar ciwace-ciwacen ciwace-ciwacen daji guda 6 7 6 7, a matsayin magani guda ɗaya kuma a matsayin wani ɓangare na hanyoyin haɗin gwiwa don ciwon daji na pancreatic. Duk da haka, wasu hanyoyin kwantar da hankali, ciki har da bevacizumab (Avastin) da cetuximab (Erbitux), ba a nuna su don tsawaita rayuwar masu ciwon daji na pancreatic ba. Kwayar halittar da ake kira Ras sau da yawa tana canzawa a cikin ciwon daji na pancreatic. Masu bincike suna da sha'awar Ras sosai, amma haɓakar ƙwayoyi don wannan takamaiman kwayar halitta yana da matukar wahala.
Maganin kwayoyin halitta a cikin ciwon daji na pancreatic
Maganin kwayoyin halitta shine isar da takamaiman kwayoyin halitta zuwa kwayoyin cutar kansa, yawanci ke ɗauke da ƙwayoyin cuta na musamman. Kwayoyin halitta na yau da kullun waɗanda ake kaiwa tsakiyar ƙwayoyin cutar kansa ana shigar da su a cikin ƙwayoyin aiki na ƙwayoyin cutar kansa yayin da ƙwayoyin kansa suka rabu, suna maye gurbin abubuwan da ke haifar da haɓakar ciwon daji. Kwayoyin halittar da ke sa ƙwayoyin kansa su mutu.
jiyyar cutar sankara
Har yanzu ana yin nazarin sabbin nau'ikan nau'ikan chemotherapy na yau da kullun. Misali ɗaya shine nanoliposome irinotecan, wanda yanzu an yarda dashi azaman magani na layi na biyu don ciwon daji na pancreatic.
Ciwon daji mai tushe
Kwayoyin ciwon daji na pancreatic sel waɗanda zasu iya jure wa kansa musamman. Binciken na yanzu yana mayar da hankali ne kan gano magungunan da za su iya kaiwa hari musamman ga ƙwayoyin cutar kansa.
