Rigakafin cutar kansa
Hana sake kamuwa da cutar hanta, hana sake kamuwa da cutar hanta bayan tiyata, yadda za a hana sake kamuwa da cutar hanta, yadda za a kiyaye sake kamuwa da cutar kansar hanta
Liver cancer is the second leading cause of cancer death in the world, of which hepatocellular carcinoma (HCC) is the most common type of liver cancer. Globally, nearly half of new cases of liver cancer occur in China. The treatment options for patients with advanced hepatocellular carcinoma are very limited. The currently approved treatment options have a tumo progression-free survival of about 3-7 months and a total survival of about 9-13 months
Adadin rayuwa na shekaru biyar na ciwon daji na hanta
The five-year survival rate of patients with ciwon daji is low, according to data from the US ASCO official website:
44% na marasa lafiya an bincikar su da cutar sankarar hanta kuma matakin rayuwarsu na shekaru 5 ya kasance 31%.
Idan kansar hanta ta bazu zuwa sassan jiki ko gabobin jikinsu da / ko yanki na lymph, ƙimar rayuwa na shekaru 5 11% ne.
Idan ciwon daji ya bazu nesa da jiki, ƙimar rayuwa na shekaru 5 2% ne.
Koyaya, koda an sami cutar kansa a wani mataki na ci gaba, ana iya amfani da magunguna daban-daban don taimakawa marasa lafiya da ciwon hanta hanta tsawanta rayuwarsu. Yin aikin tiyata shine mafi kyawun zaɓi don marasa lafiya da ciwon hanta. Yawancin marasa lafiya suna tunanin yin aikin tiyata a farko, amma har yanzu suna fuskantar haɗarin sake dawowa bayan tiyata.
Ta yaya za a iya hana sake dawowa kansar hanta?
Binciken lokaci-lokaci
Compared with malignant tumors such as breast cancer and huhu cancer, the recurrence rate of liver cancer is relatively high: Generally, the recurrence rate after three years is about 40% -50%, and the recurrence rate after five years is 60% -70% .
Sabili da haka, ya zama dole a bita akai-akai kuma a bi umarnin likitan, koda kuwa an sami alamun farkon cutar metastasis, har yanzu akwai damar da za a iya sakewa ta hanyar tiyata. Idan aka gano dukkanin metastases na jiki saboda rashin kulawa da bita, magani zai zama da wahala sosai.
Abubuwan da ake buƙatar bincika don nazarin kansar hanta na yau da kullun sun haɗa da:
Gwajin aikin hanta
Gwajin aikin hanta gabaɗaya shine mafi ƙarfin gano yanayin hanta a halin yanzu don cututtuka da kumburi, amma sau da yawa sun kasa gano kasancewar cirrhosis da kansar hanta, kuma ba za su iya gano ko suna kamuwa da ƙwayoyin cutar hanta iri-iri ba.
Alpha furotin
Idan ingantaccen alpha-fetoprotein tabbatacce ya ragu zuwa na al'ada bayan cirewar ciwon kansar hanta, sannan kuma ya sake ƙaruwa, babu wani bayani game da cutar hanta mai ci gaba, wanda ke nuna cewa kansar hanta ta sake dawowa.
Ga marasa lafiya da ke da mummunan alpha-fetoprotein kafin a shawo kan cutar hanta, alpha-fetoprotein na iya zama mai kyau yayin sake dawowa, kuma ya kamata a ci gaba da bin alpha-fetoprotein bayan tiyata.
M duban dan tayi
B-duban dan tayi yana da fa'idodi na ƙwarewa, dacewa, da tsada. Hanya ce mai mahimmanci don sa ido kan sake dawo da ciwon hanta. Ciki duban dan tayi gwaji ne mai mahimmanci
Rage rediyo
Wasu raunuka masu maimaitawa sun fara faruwa a cikin huhu, haka kirji Harkokin X ana buƙatar saka idanu akan ƙirji don maimaitawa.
CT, PET-CT
Lokacin da likita bai tabbatar da ko canja wurin bayan B-ultrasound, CT scan ya kamata a yi a cikin lokaci. Idan akwai wani metastasis a wani sashe, to ana yin gwajin PET-CT gaba ɗaya. Masu fama da ciwon hanta masu sanyi suna iya yin gwajin PET-CT sau ɗaya a shekara don gano ciwace-ciwacen da suka fi girma fiye da 2mm a cikin jiki gaba ɗaya a lokaci ɗaya, yana rage rikitarwa da rashin tabbas na gwaje-gwaje da yawa.
Canja salon rayuwa
Bar barasa, bar barasa, bar barasa, an faɗi abubuwa masu mahimmanci sau uku, dole ne ku daina barasa. Har ila yau, kada ku sha taba, kada ku wuce gona da iri, kuma ku kasance cikin farin ciki.
motsa jiki da ya dace, watanni 2-3 bayan tiyata, za ku iya yin motsa jiki mai laushi, kamar tafiya, kuma a hankali ƙara daga minti 15 zuwa minti 40; Hakanan zaka iya motsa jiki na qigong, Tai Chi, motsa jiki na rediyo da sauran motsa jiki masu laushi.
Ya kamata a ba da kulawa ta musamman ga abincin, kada ku ci abinci mai laushi, barbecue, naman alade, tofu da sauran abinci masu dauke da sinadarin nitrite, kuma kada ku ci magungunan gargajiya na kasar Sin da kayayyakin kiwon lafiya.
Abincin bayan bayan shine yafi haske, kuma yawan cin protein mai inganci irin su kwai fari da nama mai kiba ya karu yadda ya kamata. Abincin bayan bayan gida gaba daya yana canzawa daga ruwa, alawar, madara, ƙwai mai daɗi, kifi, naman nama zuwa abincin yau da kullun.
Yi ƙoƙari ku ci abinci mai narkewa cikin sauƙi, ku guji maƙarƙashiya, yaji, mai tayar da hankali, mai wuya, mai liƙufa da sauran abinci, ku ci daidaitaccen abinci, ku rage cin abinci kaɗan, kuma kada ku ƙoshi.
Yaya za a hana sake dawowa kansar hanta bayan tiyata?
At present, the main treatment options for liver cancer include liver transplantation (liver replacement), liver cancer resection, transcatheter arterial chemoembolization, radiofrequency ablation / microwave ablation, high-intensity focused ultrasound (HIFU), absolute alcohol injection, molecular targets To drugs, etc., while radiotherapy, chemotherapy, and immunotherapy magani ne na adjuvant, galibi ba a matsayin babban shirin jiyya ba.
Tiyata mai tsabta
Hanyar da ta fi dacewa don maganin ciwon daji na hanta ita ce kawar da ciwon daji don cimma burin magani na tsattsauran ra'ayi. Idan an cika ka'idojin tiyata, ana iya cire duk ciwace-ciwacen ta hanyar tiyata.
Idan akwai raunuka da yawa, yankin mamayewa yana da girma babba, ko kuma metastases mai nisa, ana iya zaɓar raunin tumo bisa ga yanayin. Idan ba a tabbatar da fa'idar tiyata ba, za a iya zaɓar wasu hanyoyin magani.
Maganin cin zali mara nauyi
Magungunan cin zali na ƙasa hanya ce ta musamman don maganin kansar hanta, gami da waɗannan ukun:
1. Transcatheter jijiya chemoembolization
Saka wani bututu daga jijiyar fem na kasan wata gabar ko kuma radial artery na sama zuwa hanta, sannan ka toshe jijiyoyin dake ciyar da kumburin, kuma ciwon zai shiga necrosc necrosis. A lokaci guda, ana sanya magungunan ƙwayoyi a cikin ƙari tare da lipiodol. Game da shafar ƙwayar hanta ta yau da kullun, ana iya ci gaba da kashe ƙwayoyin ƙari.
2.Che Chemical
Yawancin lokaci a ƙarƙashin jagorancin B duban dan tayi ko CT, allurar cikakken barasa a cikin shafin yanar gizon yana sa ƙwayoyin ƙwayar cikin sauri bushewa kuma sunadarai suna ƙyamarwa kuma suna haɗuwa, ta haka yana kashe ƙwayoyin tumo, amma wannan hanyar ba a amfani da ita a halin yanzu.
3. Rage jiki
Ciki har da cirewar yanayin rediyo da goge microwave, kuma a ƙarƙashin jagorar B duban dan tayi ko CT, ana kashe ƙwayoyin ƙwayoyin cutar sakamakon tasirin zafi na allurar huda.
Radiotherapy a cikin ciwon hanta
Radiotherapy yawanci ana amfani dashi azaman ƙarin magani. Don ciwon hanta a wurare na musamman (kamar su jijiyoyin jini, sashin jiki, ko manyan jijiyoyin da ke kusa da su), ba za a iya samun magani mai cutarwa kaɗan ba, ko kuma ba za a iya yin magani mai tsafta ba cikin tsafta. Za'a iya zaɓar radiyo
Maganin Proton a cikin maganin cutar kansar hanta
Radiotherapy magani ne mai adjuvant ga yawancin marasa lafiya da ke fama da ciwon hanta bayan tiyata. Koyaya, a cikin aikin rediyo na gargajiya, hasken X ko haskoki na photon babu makawa ana watsa su zuwa wurin ƙari da kyallen kyallen da ke kewaye. Wannan zai iya lalata nama mai lafiya kusa da kusa kuma yana iya haifar da illa mai tsanani. Proton far zai iya guje wa waɗannan tasirin.
Sabanin haka, maganin proton yana amfani da iska mai yaduwa kuma zai iya tsayawa a shafin ƙari ba tare da barin ƙwayar radiation a bayan tumo ba, don haka yana da
mai yuwuwa ya lalata nama mai lafiya a kusa. Wasu masana sun yi imanin cewa maganin proton ya fi aminci fiye da maganin radiation na gargajiya. Marasa lafiya na ciwon daji suna da ƙarancin rigakafi, babban tasirin radiation mai ƙarfi na iya haifar da lahani ga gabobin al'ada cikin sauƙi, haifar da mummunan halayen halayen, kuma ya kawo nauyi mai nauyi ga jikin da ya riga ya rauni. Musamman ga ciwon daji na hanta, ciwon daji yana kusa da wasu muhimman gabobin jiki, kamar huhu, zuciya, esophagus, da dai sauransu. Haka kuma akwai ciwon kwakwalwa na yau da kullum. Zaɓin maganin proton na iya yadda ya kamata ya guje wa lalacewa ga kyallen jikin lafiya da ke kewaye da kuma cimma kisa-kashe kamar tasirin rediyo na gargajiya.
Maganin cutar kansar hanta
1. Chemotherapy
Chemotherapy ya haɗa da ƙwayar cuta ta jiki da ƙwararrakin gida. Magungunan ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwa ce da aka ambata a sama. Amfani da magungunan ƙwayar cuta bai kai 10% ba, kuma illolin suna da tsanani. Yawancin marasa lafiya ba za su zaɓi ba.
2.Tagaggen magani
Magungunan da aka yi niyya an amince da su don ciwon hanta a gida da waje
| date | FDA ta amince da maganin ƙwayar cutar hanta | Bayyanawa | Yarda da gida |
| Nuwamba 2007 | Sorafenib (Sorafenib, Nexavar) | Don maganin cututtukan hanta da hanta | Lissafi da shiga cikin inshorar lafiya |
| Agusta 2018 | Lenvatinib (Levatinib, Lenvima) | Don maganin layin farko na cututtukan hanta da ba shi da magani | Ku tafi jama'a |
| Afrilu 2017 | Regorafenib (Sigvarga) | Jiyya ta biyu don cutar kansar hanta mai kama da sorafenib | Lissafi da shiga cikin inshorar lafiya |
| Satumba 2017 | Nivolumab (navumab, Opdivo) | Jiyya ta biyu don cutar kansar hanta mai kama da sorafenib | Ku tafi jama'a |
| Nuwamba 2018 | 'Yancin (Keytruda) | Jiyya ta biyu don cutar kansar hanta mai kama da sorafenib | Ku tafi jama'a |
| Janairu 2019 | Cabozantinib (Cabometyx) | Jiyya ta biyu don cutar kansar hanta mai kama da sorafenib | Ku tafi jama'a |
| Iya 2019 | Distance Ga-Rankuwa-Ramucirumab (Rimolimumab, Cyramza) | Monotherapy ga marasa lafiya na cututtukan hanta tare da alpha-fetoprotein (AFP) ≥400ng / ml kuma a baya anyi maganin surafenib | Ba a jera ba |
Zaɓin maganin layin farko don cutar hanta
(1) Sorafenib
Yawancin bincike na asibiti sun nuna cewa Sorafenib yana da wasu fa'idodin rayuwa ga marasa lafiya da ciwon hanta mai ci gaba a cikin ƙasashe daban-daban da kuma baya tare da cututtukan hanta daban-daban (matakin shaida 1).
Abunda aka saba amfani dashi shine MG 400 a baki, sau biyu a rana. Ana iya amfani dashi don Yara-Pugh Class A ko B tare da aikin hanta. Idan aka kwatanta da aikin hanta na Yara-Pugh B, Child-Pugh A amfanin rayuwar marasa lafiya ya fi bayyana.
Kuna buƙatar kulawa da tasiri akan HBV da aikin hanta, da inganta haɓaka cutar hanta ta asali a cikin aikin. Mafi munin halayen rashin lafiya shine gudawa, raunin nauyi, ciwon hannu da ƙafa, kurji, myocardial ischemia, da hauhawar jini, wanda yawanci ke faruwa tsakanin makonni 2 zuwa 6 bayan fara magani.
(2) Lemvatinib
Lenvatinib ya dace da marasa lafiyan da basu da matsala da mataki na IIb, IIIa, IIIb, aikin hanta Child-Pugh A ciwon hanta na hanta, kuma maganin sa na farko baya ƙasa da sorafenib. Ciwon hanta mai alaƙa da HBV yana da mafi alfanun Tsira [185] (matakin shaidar 1).
An amince da Lenvatinib don amfani dashi a cikin Yara-Pugh A masu fama da cutar kansar hanta tare da ci gaba da ciwon hanta. Amfani: 12mg, na baka, sau ɗaya kowace rana don nauyin jiki ≥60kg; 8mg, na baka, sau daya a rana domin nauyin jiki <60kg. Matsalolin illa na yau da kullun sune hauhawar jini, gudawa, rage ci, gajiya, ciwon ƙafa, ƙashin furotin, tashin zuciya, da hypothyroidism.
(3) Ciwon sankarar magani
The FOLFOX4 (fluorouracil, calcium folinate, oxaliplatin) protocol is approved in China for the treatment of locally advanced and metastatic liver cancer that is not suitable for surgical resection or local treatment (level of evidence 1).
Yawancin karatun lokaci na II sunyi rahoton cewa ilimin kimiya tare da oxaliplatin haɗe tare da sorafenib na iya haɓaka ƙimar amsawa na haƙiƙa, faɗaɗa rayuwa mara ci gaba da rayuwa gabaɗaya, da samar da aminci mai kyau (matakin shaida 3).
Ga marasa lafiya da ke da aiki mai kyau na hanta da yanayin jiki, ana iya yin la'akari da wannan haɗin haɗin gwiwa, amma har yanzu ana buƙatar nazarin binciken bazuwar asibiti don samar da babbar shaidar shaidar likita. Kari akan haka, arsenic trioxide yana da wani sakamako na magance cutar kansar hanta mai ci gaba (matakin shaidar 3). A aikace-aikacen asibiti, ya kamata a kula don saka idanu da kuma hana cutar hanta da koda.
Layi na biyu na maganin cutar hanta
(1) Regorafenib
An yarda Regorafenib don amfani a cikin marasa lafiya tare da mataki na IIb, IIIa, da IIIb ciwon daji na hanta na CNLC waɗanda aka taɓa bi da su tare da sorafenib (matakin shaida na 1). Amfani shine 160mg sau ɗaya kowace rana don sati 3 kuma an dakatar dashi na sati 1.
A China, matakin farko zai iya zama 80mg ko 120mg sau ɗaya, sau ɗaya a rana, kuma a hankali ya karu bisa ga haƙuri da haƙuri. Abubuwa masu illa na yau da kullun sune hauhawar jini, halayen fata na ƙafa-ƙafa, gajiya, da gudawa.
(2) Navumab da Paimumab
FDA ta Amurka ta amince da amfani da Navulinu monoclonal antibodies (Nivolumab) da Pabrolizumab monoclonal antibodies (Pembrolizumab) a cikin marasa lafiya da ciwon hanta da suka ci gaba ko ba za su iya jure wa sorafenib ba bayan maganin sorafenib na baya (matakin shaida 2).
A yanzu haka, kamfanonin kasar Sin sun kirkiro masu hana bincikar masu kariya ta rigakafi, kamar su kwayoyin antillidizum monoclonal, Treplepril monoclonal antibodies, da Xindili monoclonal antibodies, ana gudanar da bincike na asibiti. Haɗin magungunan rigakafi da magungunan da aka yi niyya, magungunan ƙwayoyi, da magunguna na yau da kullun ana bincika su koyaushe.
Sauran immunomodulators (kamar interferon α, thymosin α1, da sauransu), immunotherapy na salula (kamar su. chimeric antigen receptor T cell far, CAR-T, and cytokine-induced killer cell therapy, CIK) all have certain antitumor effects. However, it is yet to be verified by large-scale clinical studies.
(3) Zaɓuɓɓukan maganin layi na biyu da ake dasu a Amurka
Bugu da ƙari, FDA ta Amurka ta amince da cabozantinib ga marasa lafiya da ke fama da ciwon hanta wanda ya ci gaba bayan aikin layin farko (matakin shaida na 1), kuma ya amince da yin amfani da Lemorex monoclonal antibody don yin layi na biyu na marasa lafiya da hanta matakan AFP ≥400ng / ml (matakin shaida na 1)). Koyaya, waɗannan magungunan biyu ba a kasuwa a China ba. Bincike na asibiti na karamin kwayar cutar anti-angiogenesis da ke niyya kan apatinib don maganin layi na biyu na masu cutar hanta na hanta yana gudana.
