Mukenza wepancreatic: kuongororwa
Kana chiremba achifungidzira kuti mumwe munhu ane kenza yepancreatic, anotanga abvunza nhoroondo yekurapa kwemurwere, nhoroondo yezvehutano hwemhuri, uye kutarisa zviratidzo zvechirwere. Iyi inotevera miedzo inogona kushandiswa kuongorora pancreatic cancer.
General bvunzo
1. Kuongorora kwepanyama
Chiremba anoongorora ganda rako nemaziso kuti aone kana iri yero, chinova chiratidzo chejaundice.
Kusanzwisisika kwemvura kuwanda mudumbu, kunonzi ascites, kunogona kunge kuri chimwe chiratidzo checancer.
2. Kuongorora ropa
Vanachiremba vanogona kutora masampuli eropa kuti vatarise masheya asina kujairika ebilirubin nezvimwe zvinhu.
CA19-9 ibundu mucherechedzo. CA19-9 inowanzo kuve yakakwira muvarwere vane cancer yepancreatic, asi CA 19-9 haifanire kushandiswa sechiratidzo chekuongororwa kwechirwere chepancreatic cancer, nekuti iro rakakwira danho reCA 19-9 rinogona zvakare kuve chiratidzo cheimwe hosha. Mienzaniso inosanganisira kurwara nepancreatitis, chiropa cirrhosis uye kutadzisa iyo yakajairika bile duct.
3. Kuongorora mifananidzo
Kuongorora kwekufungidzira kunobatsira chiremba kuti azive kuti gomarara riripi uye kuti rapararira kubva mupancreas kuenda kune zvimwe zvikamu zvemuviri.
Computer tomography (CT or CAT) scan.
Positron emission tomography (PET) scan or PET-CT scan.
Ultrassom
Endoscopic Ultrasound (EUS)
Endoscopic retrograde cholangiopancreatography (ERCP)
Percutaneous transhepatic cholangiography (PTC)
Biopsy uye kuongorora kwemashuga
Fine sindano aspiration (FNA), uchishandisa tsono dzakanaka dzakaiswa mupancreas kuti dzive maseru maseru.
4. Kuonekwa kweMolecular yebundu
Chiremba wako anogona kukurudzira bvunzo dzevarabhoritari pane bundu kana masampuli eropa kuti uwane akasiyana biomarkers. Biomarkers mapuroteni uye magene anoenderana nekenza chaiyo, uye mhedzisiro yeiyi bvunzo inogona kubatsira kutungamira sarudzo dzekurapa.
Mukenza wepancreatic: staging
Iyo yakajairika nzira yekuratidzira gomarara repancreatic kuripatsanura muzvikamu zvina: zvinoenderana nekuti inogona kuvhiyiwa here uye kwainogoverwa
Inogadziriswa kenza yepancreatic
Ichi kenza yepancreatic inogona kuvhiyiwa ichibviswa. Bundu rinogona kungowanikwa mupancreas kana kuwedzera kunze kwaro, asi harina kukura kuita arteri yakakosha kana tsinga munzvimbo ino. Iko hakuna humbowo hwekuti bundu rakapararira kupfuura rwatata. Vanenge gumi muzana kusvika gumi muzana muzana yevarwere vari panguva ino pavanowanikwa.
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.
Mukenza yepamberi yepancreatic cancer
Rudzi urwu rwechironda rwuchiri munzvimbo yakatenderedza rwatata, asi nekuti rwakura kuita tsinga iri pedyo kana tsinga kana nhengo iri pedyo, haigone kuvhiyiwa. Zvisinei, hapana chinoratidza kuti chakatamira kune chero chinhambwe mumuviri. Vanosvika makumi matatu nezvishanu kubva muzana kusvika makumi mana muzana yevarwere vari panguva ino panguva yekuongororwa.
Metastatic pancreatic kenza
Bundu rakapararira kupfuura rwatata, senge chiropa kana chikamu chiri padumbu chedumbu. Vanosvika makumi mashanu nezvishanu kubva muzana kusvika makumi mashanu kubva muzana muzana yevarwere vari padanho rino pavanoonekwa.
TNM kurongedza
Vanachiremba vanowanzo shandisa iyo TNM system kuomesa pancreatic kenza varwere vanogona kuvhiyiwa. Varwere vazhinji vane gomarara repancreatic havagone kuvhiyiwa. Naizvozvo, iyo TNM system haishande kune ese epancreatic kenza sedzimwe kenza.
Stage 0: zvinoreva carcinoma in situ, kenza haisati yakura kubva mupombi (Tis, N0, M0).
Stage IA: Iyo pancreatic bundu iri 2 cm kana diki uye haina kupararira kune lymph node kana zvimwe zvikamu zvemuviri (T1, N0, M0).
Nhanho IB: Iyo pancreatic bundu rakakura kupfuura 2 cm uye haina kupararira kune lymph node kana zvimwe zvikamu zvemuviri (T2, N0, M0).
Stage IIA: Bundu riri pamusoro pepascreas, asi bundu harina kupararira kune tsinga dziri pedyo kana tsinga, uye harina kupararira kune chero lymph node kana zvimwe zvikamu zvemuviri (T3, N0, M0).
Stage IIB: Bundu rehukuru hwese husina kupararira kune tsinga dziri pedyo kana tsinga, asi rapararira kune lymph node uye harina kupararira kune dzimwe nhengo dzemuviri (T1, T2 kana T3; N1; M0)
Chikamu chechitatu: Bundu rakapararira kune arteri aripo, mitsipa, uye / kana lymph node, asi harina kupararira kune zvimwe zvikamu zvemuviri (T4, N1, M0).
Stage IV: Chero bundu rakapararira kune zvimwe zvikamu zvemuviri (chero T, chero N, M1).
Kudzokazve: Gomarara rakadzokororwa igomarara rakapora mushure mekurapwa. Kana gomarara rikadzoka, pachave neimwe denderedzwa rekuyedza kuti unzwisise kukura kwekudzokazve. Iyi bvunzo uye zviyero zvinowanzo fanika nezvakaitwa panguva yekutanga kuongororwa.
Kenza yepancreatic: sarudzo dzekurapa
Sarudzo dzinowanzozivikanwa dzekurapa kenza yepancreatic dzakanyorwa pazasi. Sarudzo dzazvino dzekurapa kenza yepancreatic kuvhiyiwa, kurapwa nemwaranzi, chemotherapy, uye kurapwa kwakanangwa Masarudzo ekurapa uye kurudziro zvinoenderana nezvinhu zvinoverengeka, zvinosanganisira mhando uye danho rekenza, zvinokanganisa mhedzisiro, uye zvinodiwa nevarwere uye hutano hwakazara.
Pakutanga kenza yepancreatic yakaonekwa, iyo inowedzera yakabudirira mushonga wekuporesa. Nekudaro, kurapa kwakasimba kunogona kubatsira kudzora chirwere chevarwere vane yakakwira pancreatic cancer kuvabatsira kurarama kwenguva yakareba.
Pancreatic kenza yekuvhiya
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.
Nehurombo, chete vangangoita makumi maviri muzana yevarwere vane gomarara repancreatic vanogona kuvhiyiwa nekuti vazhinji kenza yepancreatic yatove nemastasized panguva yekuongororwa. Kana kuvhiya isiri yekutanga sarudzo, iwe nachiremba wako munotaura nezve dzimwe nzira dzekurapa.
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.
Vanachiremba vanovhiya vanogona kuita mhando dzakasiyana dzekuvhiya zvichienderana nechinangwa chekuvhiya.
Laparoscopy
Chiremba anogona kusarudza kutanga neparacoscope kuti aone kana gomarara rapararira kune dzimwe nzvimbo dzemudumbu. Kana yatove metastasized, kuvhiya kubviswa kweiyo yekutanga bundu hakuwanzo kukurudzirwa.
Kuvhiya kubviswa kwepancreatic bundu
Nzira yekuvhiya inoenderana nekuti bundu riripi mupancreas, uye lymph node dziri padyo dzinobviswa sechikamu chekuvhiya.
Kana gomarara riri mumusoro mepancreas chete, chiremba anovhiya anogona kuita oparesheni yeWhipple, rinova basa rakawandisa iro chiremba anovhiya anobvisa musoro uye ura hudiki, chikamu chedumbu uye dumbu remanyatata, obva abatanazve iyo yekugaya turakiti uye bile duct system.
Kana iyo kenza iri mumuswe wepancreas, iyo yakajairika kuvhiya ndeye distal pancreatectomy. Mukuvhiya uku, chiremba anovhiya anobvisa muswe wepancreas, muviri wepancreas, uye spleen.
Kana gomarara rikapararira mupancreas, kana riri munzvimbo zhinji dzepancreas, pancreatectomy yakazara ingangodikanwa. Pancreatectomy ndiko kubviswa kwepancreas yese, chikamu chemuviri mudumbu, chikamu chedumbu, yakajairika bile duct, nduru uye spleen.
Mushure mekuvhiyiwa, murwere anoda kugara muchipatara kwemazuva akati wandei uye angangoda kuzorora kumba kweinenge mwedzi. Zvimwe zvinokanganisa zvekuvhiya zvinosanganisira kuneta uye kurwadziwa mumazuva ekutanga mushure mekuvhiyiwa. Mimwe mhedzisiro inokonzerwa ne
removal of the pancreas include indigestion and diabetes.
Radiation kurapwa mukenza yepancreatic
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.
External radiation therapy ndiyo inonyanyo shandiswa mhando ye radiation kurapwa kwecancreatic cancer. Zvirongwa zvekurapa radiation (zvirongwa) zvinowanzo kupihwa nenhamba yakati yekurapa kwenguva yakati rebei.
Kune nzira dzakasiyana dzekurapwa nemwaranzi:
Chinyakare radiation radiation inonzi zvakare yakasarudzika kana yakajairwa radiation kurapwa. Inopihwa yakaderera dosi ye radiation kurapwa zuva rega rega kwemavhiki mashanu kusvika matanhatu.
Stereotactic radiotherapy (SBRT) kana Cyber banga
Stereotactic radiotherapy (SBRT) kana Cyber banga rinogona kupihwa yakakwira dosi yekurapa mazuva ese kwenguva pfupi, kazhinji angangoita mazuva mashanu. Iyi ndiyo mhando nyowani yeradio kurapwa iyo inogona kupa yakawanda yemuno kurapwa maronda uye inoda mashoma marapirwo. Chete munzvimbo dzakasarudzika radiotherapy nzvimbo ine ruzivo uye hunyanzvi ndiyo nzira iyi inogona kushandiswa kurapa cancer pancreatic.
Chemotherapy mukenza yepancreatic
Chemotherapy inowanzo kupihwa panguva imwe chete neye radiation radiation nekuti inogona kusimudzira mhedzisiro ye radiation radiation, iyo inonzi radiation sensitization. Iko kushandiswa kwakabatana kwechemotherapy uye radiotherapy kunogona kudzikisira bundu uye kubatsira chiremba kubvisa bundu zvakare kuburikidza nekuvhiya. Nekudaro, kana ikashandiswa panguva imwe chete neye radiation radiation, iyo chemotherapy inowanzo kuve yakaderera pane iyo yekemotherapy chete.
Radiation kurapa kunogona kubatsira kudzikisira mukana wepancreatic cancer kudzokerazve kana kukudzirazve kukura, asi kuchine zvakawanda kusava nechokwadi pamusoro pekuti zvinogona kuwedzera murwere here.
Mhedzisiro mhedzisiro ye radiation radiation inogona kusanganisira kuneta, kupfava kweganda kugadzirisa, kuda kurutsa, mudumbu kugumbuka uye manyoka. Mushure mekurapwa, yakawanda yemhedzisiro inonyangarika.
Kurapwa
Chemotherapy inoshandisa mishonga yekuparadza cancer maseru nekudzivirira kugona kwavo kukura uye kupatsanuka.
Varwere vanogona kugamuchira 1 mushonga kana musanganiswa wemishonga yakasiyana panguva imwe chete. Izvi zvinotevera mishonga inogamuchirwa neU.S.Food and Drug Administration (FDA) yekenza yepancreatic:
Capecitabine (Xeloda)
Erlotinib (Tarceva)
Fluorouracil (5-FU)
Gemcitabine (Gemzar)
Irinotecan (Camposar)
Folic acid (Wellcovorin)
Paclitaxel (Abraxane)
Nanoliposome irinotecan (Onivyde)
Oxaliplatin (Eloxatin)
Kana madhiragi maviri kana anopfuura achishandiswa pamwechete, panowanzo kuve nemhedzisiro. Mushonga wekusanganisa mushonga unowanzo kuve wakanakira varwere vane hutano hwakanaka uye vanogona kuzvitarisira.
Iko kusanganiswa kwemushonga kwekushandisa kunoenderana nekenza kenza, kunyanya chiitiko che oncologist nemushonga, pamwe nemhedzisiro dzakasiyana uye hutano hwese hwemurwere. Iyo chemotherapy yekenza yepancreatic yakakamurwa kuita aya anotevera maererano nenguva:
Chekutanga-mutsara chemotherapy
Izvi zvinowanzoreva kurapwa kwekutanga kwevarwere vane kenza yepanzvimbo yepamusoro kana metastatic kenza.
Chechipiri-mutsara chemotherapy
Kana yekutanga-kurapwa kurapwa kusingashande kana kupokana nemushonga isingakwanise kudzora gomarara kukura, kenza inonzi refractory cancer. Mutsetse wekutanga kurapwa dzimwe nguva haushande zvachose uye unonzi kusagadzikana kwemishonga. Mune ino kesi, kana hutano hwese hwemurwere hwakanaka, murwere anogona kubatsirwa nekurapwa nemimwe mishonga. Tsvagiridzo huru yazvino yepancreatic yegomarara yakanyanya kutarisana nekuvandudzwa kwemamwe marapirwo emutsara wechipiri, pamwe neyechitatu-mishonga yekurapa mishonga uye mimwe mishonga yekurapa, mimwe yacho yakaratidza tariro yakakura.
Asiri-akajairwa kurapwa
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 mhedzisiro
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.
Mimwe mishonga inoshandiswa yekenza yepancreatic inosanganisirwa pamwe nemamwe mhedzisiro. Semuenzaniso, capecitabine inogona kukonzera kutsvuka uye kusagadzikana muzvanza nemakumbo etsoka. Aya mamiriro anonzi ruoko-tsoka tsoka. Oxaliplatin inogona kukonzeresa uye kugwinha muminwe nezvigunwe, uye inonzi peripheral neuropathy. Peripheral neuropathy zvakare iri mhedzisiro mhedzisiro yepaclitaxel. Iyi mhedzisiro inowanzo nyangarika pakati pekurapwa uye mushure mekurapwa kupera, asi zvimwe zviratidzo zvinogona kugara kwenguva yakareba uye zvichitowedzera sezvo kurapwa kunoenderera.
Nzwisisa ruzivo rwekutanga rwemakemikari uye gadzirira kurapwa. Zvinodhaka zvinoshandiswa kurapa gomarara zvinogara zvichiongororwa. Kutaura nachiremba wako inowanzo iri nzira yakanakisa yekunzwisisa mushonga wawakatemerwa iwe, chinangwa chayo pamwe nezvinogona kuitika kana kusangana nemimwe mishonga. Dzidza zvakawanda nezvemishonga yako yekunyorera uchishandisa dhatabhesi rezvinodhaka
Targeted drug therapy
Targeted Therapis kurapwa kwecancer-yakanangana nemajini, mapuroteni kana nharaunda nharaunda dzinobatsira mukukura kwegomarara nekupona. Uku kurapa kunogona kudzivirira kukura uye kupararira kwekenza maseru, uku uchidzikisa kukuvara kwemasero ane hutano.
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 pancreatic cancer kurapwa
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.
Iyo yekurapa chirongwa che metastatic pancreatic cancer inogona kusanganisira musanganiswa weanorapwa pamusoro, uye chirongwa chekurapa chinoenderana zvakanyanya nehutano hwese hwomurwere nezvaanofarira.
Kutanga-mutsara kurapwa kunosanganisira:
Iko kusanganiswa kwekemotherapy ne fluorouracil, leucovorin, irinotecan uye oxaliplatin inonzi FOLFIRINOX.
Gemcitabine plus paclitaxel inoshandiswa sekutanga-kurapwa kurapwa kana wechipiri-mutsara kurapwa kwevarwere vakagamuchira FOLFIRINOX.
Yechipiri-mutsara kurapwa kunosanganisira zvinotevera sarudzo. Izvi zvinowanzo shandiswa kune varwere vane chirwere chekufambira mberi kana vane zvakakomba mhedzisiro panguva yekutanga-mutsara kurapwa.
Kune varwere vakatowana gemcitabine uye paclitaxel, mubatanidzwa we fluorouracil uye irinotecan kana oxaliplatin ingangoita sarudzo. Kune varwere vane muviri wepanyama
ns haigone kugamuchira akawanda madhiragi, capecitabine ndiyo sarudzo ine mashoma mhedzisiro.
Kune varwere vakatogamuchira FOLFIRINOX, regimen ine gemcitabine, senge gemcitabine yoga kana pamwe chete ne paclitaxel, ndiyo sarudzo yakakodzera.
Kenza yepancreatic: tsvagiridzo
Vanachiremba vari kushanda nesimba kuti vadzidze zvakawanda nezvekurapa kwechirwere chepancreatic cancer, maitiro ekudzivirira gomarara repancreatic, maitiro ekurapa nemazvo, uye nzira yekupa yakanyanya kuchengetwa kwevarwere.
Genetics uye mamorekuru kutsvagisa
Mukenza, zvakakanganisika kana zvisina kujairika magene anogona kukonzera kusadzora kukura kwesero. Kufambira mberi kwakawanda kutsva kwakavakirwa pakuona majini nemapuroteni akakuvara, kuzvigadzirisa kana kuzvichinja kurapa gomarara repancreatic.
Maitiro akasiyana ema molecular (akadai seDNA kuteedzerana uye kuongorora mutest) izvozvi anogona kushandiswa kuongorora pancreatic bundu sampuli kutsvaga shanduko. Kuongorora uku iko zvino kwave kutoitwa pasampuli dzeropa nekuti tekinoroji nyowani inobvumidza kuunganidzwa uye kuongororwa kwethumba reDNA riripo muropa. Vanachiremba vanogona kuwana yakanangwa mishonga mitsva yekurapa gomarara repancreatic zvichibva pane ruzivo rwekuongorora.
Immunotherapy mukenza yepancreatic
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.
Uye zvakare, vaongorori vari kudzidza nzira dzekuunganidza nekugadzirisa maseru eT, ayo anonzi ekugashira immunotherapy.
Targeted therapy
Erlotinib parizvino yakatenderwa kurapwa kwakanangana nekenza yepancreatic uye inoshandiswa musanganiswa ne gemcitabine. Masayendisiti ari kudzidza mimwe mishonga inogona kutadzisa kukura nekupararira kwemamota 6 7 6 7, semushonga mumwechete uye sechikamu chemubatanidzwa wekurapa kenza yepancreatic. Nekudaro, mamwe marapirwo akanangwa, anosanganisira bevacizumab (Avastin) uye cetuximab (Erbitux), haana kuratidzirwa kuwedzera hupenyu hwevarwere vepancreatic cancer. Iyo geni inonzi Ras inowanzo shandurwa mukenza yepancreatic. Vatsvakurudzi vanofarira Ras, asi kugadzirwa kwemishonga yeiyi geni kwakaoma.
Gene kurapa mukenza yepancreatic
Gene kurapa ndiko kuendesa kwemajeni chaiwo kumasero ekenza, anowanzo kutakurwa nemavhairasi akagadzirwa. Magen'a akajairwa anounzwa pakati pemasero ekenza anoiswa mumajini anoshanda emakenza masero ekenza paanogovana, achitsiva zvakashata zvinopa kukura kwekenza. Majini anokonzera cancer maseru kufa.
Kurapwa
Hutsva uye hwakasimba mhando dzeyakajairwa chemotherapy achiri kuongororwa. Mumwe muenzaniso ndeye nanoliposome irinotecan, iyo yave kubvumidzwa senzira yechipiri-kurapwa kweiyo yakakwira pancreatic cancer.
Cancer masero masero
Pancreatic cancer maseru maseru maseru anogona kunge achinyanya kupokana nekenza. Tsvagurudzo yazvino yakanangana nekutsvaga mishonga inogona kutarisisa cancer maseru maseru.
