Nzira yekudzivirira sei kudzoka kwegomarara re colorectal? Nzira yekurapa kudzokorora kwegomarara remukati mushure mekuvhiyiwa?
Colorectal kenza inowanzo kuve yakaipa bundu, kusanganisira colon uye rectal cancer. Chiitiko checolorectal cancer kubva kumusoro kusvika pasi ndiyo rectum, sigmoid colon, kukwira colon, kuburuka colon, uye transverse colon. Mumakore achangopfuura, pave paine chiitiko chakanangana neiyo proximal (kurudyi colon)
Kana kenza yakajeka ikaonekwa nekukurumidza, inogona kupora.
Makore mashanu ekupona mwero wekenza yakajeka
Sekureva kweUS ASCO yepamutemo webhusaiti dhata, makore mashanu ekupona mwero wecolorectal cancer varwere i5%. Nekudaro, iro rekupona kwecolorectal cancer inogona kusiyana zvichienderana zvinoverengeka zvezvinhu, kunyanya danho.
Kune cancer cancer, huwandu hwese hwemakore mashanu hwekupona ndeye 5%. 64-makore ekupona kwekenza yekoloni yemunharaunda ndeye 5%; 90-makore ekupona mwero i5% ye metastasis kune yakatenderedza tishu kana nhengo uye / kana yedunhu lymph nodes; 71-makore ekupona mwero i5% yecolon cancer yakaitika kure.
Kune kenza rectal, iyo yese yemakore mashanu ekupona mwero ndeye 5%. Iyo makore mashanu-ekupona mwero weinowanikwa munzvimbo rectal cancer ndeye 67%; makore mashanu ekupona mwero ndeye 5% yemastastase kune akakomberedza matishu kana nhengo uye / kana enharaunda node node. Kana metastases iri kure ikaitika mukenza yerexal, makore mashanu ekupona mwero iri gumi muzana.
Kurapa kwazvino kwegomarara re colorectal kunosanganisira kuvhiyiwa, chemotherapy, radiotherapy, kurapa kwakanangwa, uye immunotherapy. Kuvhiya ndiyo nzira yakasarudzika yekurapa colorectal cancer. Asi Vicki, mupepeti wepamba asina cancer, akadzidza kuti vangangoita 60% kusvika 80% yevarwere vane rectal cancer vanozotangazve mukati memakore maviri mushure mekuvhiyiwa.
Nzira yekudzivirira sei kunyatsoita kenza yakajeka?
Natsiridza mararamiro
Rega doro, rega doro, rega doro, zvinhu zvakakosha zvinotaurwa katatu, unofanira kusiya doro. Uyewo, usasvuta, usanyanyoshanda, uye gara uchifara.
Kudzidzira kwakakodzera, mwedzi 2-3 mushure mekuvhiyiwa, unogona kuita zvinyoro zvishoma, zvakadai sokufamba, uye zvishoma nezvishoma kuwedzera kubva pamaminitsi gumi nemashanu kusvika kumaminitsi makumi mana; iwe unogona zvakare kurovedza muviri qigong, Tai Chi, maekisesaizi eredhiyo uye mamwe maekisesaizi akapfava.
Kunyanya kutariswa kunofanirwa kubhadharwa kuchikafu, usadye chikafu chakaumbwa, bhengi, bhekoni, tofu uye zvimwe zvekudya zvine nitrite, uye usadye mishonga yechinyakare yechiChinese uye zvigadzirwa zvehutano.
Kudya kwemashure mekuvhiya kunonyanya kuve kwakareruka, uye kudyiwa kweprotein yemhando yepamusoro senge jena jena uye nyama isina mafuta inowedzerwa zvakakodzera. Kudya kwemashure mekuvhiya kunowanzo shanduka kubva mumvura, porridge, mukaka, mazai ane steamed, hove, nyama yakasendamira kune chikafu chakajairwa.
Edza kudya chikafu chiri nyore kugaya, nzvenga zvine mafuta, zvinonhuwirira, zvinogumbura, zvakaoma, zvinonamira uye zvimwe zvekudya, idya chikafu chakaringana, idya zvishoma, uye haifanire kuzara.
Kugara kudyiwa nzungu senge cashews, hazelnuts, walnuts, maarmonds, uye walnuts kunogona kuderedza kudzoka kwekenza yemuura.
Postoperative kuchengetedza mazano ekenza yakajeka
Iyo suture inopera mazuva 7-10 mushure mekenza yekoloni. Vakwegura varwere kana varwere vane mamwe matambudziko vanogona nenzira yakafanira kuwedzera nguva yekubvisa. Mushure mekubvisa musono, vanofanirwa kutarisisa hutsanana hweronda kudzivirira hutachiona.
Mushure mekunge suture yabviswa, iwo ekupfekedza uye emudumbu mabhendi anofanirwa kuramba achisimbiswa mukati mekupora kwemaronda kusvikira iyo yekuvhiya incision yapora zvachose, izvo zvinotora ingangoita hafu yemwedzi.
Anodhonza ganda anofanira kubviswa mazuva gumi mushure mekuvhiya. Ronda rinofanirwa kuchengetwa rakachena uye rakaomesa sezvinobvira kudzikisa kudikitira. Unogona kugeza, asi haugone kukwiza ronda.
Zvakajairika kuva nechiveve chakakomberedza ronda mushure mekuvhiyiwa, rinozopera mushure mechinguva.
Zvakajairika kuti maronda abude. Chishoma chinogona kushandiswa kune disinfection yemuno. Tsiva kupfeka pamusoro. Nekudaro, kana huwandu hwe exudate hwakakura uye hwakatsvuka kutsvuka, kuzvimba uye kurwadziwa kunoitika, unofanirwa kubata chiremba wako nenguva yekurapa ronda.
Kana iyo incision yekuvhiya yave kuda kukura, inozonzwa ichinzwika, inowanzozivikanwa se "nyama refu". Panguva ino, dzivisa kukwenya, usawane mvura, uye dzivirira hutachiona.
Ronda racho rinopfuura nguva yekuporeswa, asi zvakadaro harikure zvakanaka. Unofanirwa kutsvaga chiremba anovhiya kuti aubate, chinja mushonga nenguva, suka ronda, uye ubatise hutachiona. Panguva imwecheteyo, teerera kudzora shuga yeropa uye kusimbisa chikafu.
Maronda ekurumwa anowanzo kutora mwedzi kupora. Mushure mekupora, unogona zvishoma nezvishoma kudzidzira squatting, 3-5 maminetsi nguva imwe neimwe, kamwe chete mangwanani uye masikati.
Kana ronda racho richipora zvakanaka, unogona kutora shawa mazuva 7-14 mushure mekubvisa suture. Unogona kushandisa kugeza muviri kana sipo, asi nzvenga ronda.
Kuongorora kwenguva nenguva
Zvinoenderana nehuwandu, kudzokororazve uye metastasis mwero weanoshanda mushure mekenza kenza muChina yakakwira se50%, uye inopfuura 90% yekudzokorora uye metastasis inoitika mumakore 2-3 mushure mekushanda, uye mwero wekudzokorora wakaderera mushure memakore mashanu. . Naizvozvo, kuvhiyiwa hakusi kushanda kwenguva imwe chete, uye unofanirwa kuomerera pakuongororwazve mushure mekuvhiyiwa.
Varwere vane gomarara remudumbu ndivo vangangodzokazve mukati memakore matatu mushure mekuvhiyiwa. Munguva iyi, huwandu hwekuongororwazve hunofanirwa kuve hwakawandisa; mushure memakore matatu, iyo yekuongorora-zvakare nguva inogona kuwedzerwa nenzira kwayo.
Kazhinji, inoongororwa yega yega 3 mwedzi mukati megore rimwe mushure mekuvhiyiwa; inoongororwa semi-pagore mumakore ekutanga 1-2 makore; uye makore ese 3-4. Yakananga nguva yekudzokorora inodawo kutsvaga kwavo chiremba kuti vaone.
Munguva yekuongorora, zvinhu zvinofanirwa kuongororwa zvinosanganisira:
Kuongororwa kweropa: maitiro eropa, chiropa uye itsvo basa, mamaki mamaki (CEA, nezvimwewo);
Kufungidzira kuongorora: B-ultrasound, chest radiograph
Colonoscopy: yakaitwa mwedzi mitatu mushure mekuvhiyiwa kuti uone kupora kweanastomosis yekuvhiya uye kucherechedza polyps mune zvimwe zvikamu.
Nzira yekurapa kenza yekoloni kudzokazve mushure mekuvhiyiwa?
Kuvhiya kwechipiri
Nzira yakanyanya kunaka yekudzokororazve kwevarwere vegomarara mushure mekuvhiyiwa kubvisa maronda anowanzoitika kuzadzisa chinangwa chekurapa kwakanyanya. Chinhu chekutanga chekuita kuona kana yechipiri yekuvhiya resection inogona kuitwa. Kana nzira dzekuvhiya dzikasangana, bundu rinogona kuvhiyiwa.
Kana paine maronda mazhinji, nzvimbo yekupinda iri yakakura, kana metastases iri kure, kana kumisikidza kuri kuita njodzi, uye kana mukana wekuvhiya usina kuvimbiswa, dzimwe nzira dzekurapa dzinogona kusarudzwa.
Mishonga inoshandiswa mukurapa kenza yekoloni
Kenza yekoloni chemotherapy mishonga
Kazhinji chemotherapeutics ndeye 5-fluorouracil, irinotecan, oxaliplatin, calcium folinate, capecitabine, tigio (S-1), uye TAS-102 (trifluridine / tipiracil).
Nekudaro, chemotherapy yekenza yekoloni inowanzo kuve musanganiswa weanoverengeka chemotherapeutics, uye zvakajairika nzira dzekubatanidza ndedze:
1.FOLFOX (fluorouracil, calcium folinate, oxaliplatin)
2.FOLFIRI (fluorouracil, calcium folinate, irinotecan)
3.CAPEOX (Capecitabine, Oxaliplatin)
4.FOFOXIRI (fluorouracil, calcium folinate, irinotecan, oxaliplatin)
Gomarara rekoloni rinotarisa zvinodhaka nemishonga yekudzivirira
1. KRAS / NRAS / BRAF mishonga yemusango yakanangwa: cetuximab kana panitumumab (inowanzo shandiswa mugomarara rekuruboshwe)
2. Anti-angiogenesis inhibitors: bevacizumab kana ramonizumab kana ziv aflibercept
3. BRAF V600E yakanangwa zvinodhaka: dalafenib + trimetinib; connetinib + bimetinib
4. NTRK fusion yakanangana nemishonga: Larotinib; Emtricinib
5.MSI-H (dMMR) PD-1: Paimumab; Navumab ± Ipilimumab
6.HER2-yakanaka yakanangwa nemushonga: Trastuzumab + (Pertuzumab kana Lapatinib)
Pamusoro pekuvhiyiwa uye radiotherapy yekenza yepamusoro yekoloni, systemic mishonga inzvimbo yakakosha yekurapa. Mhemberero
st-line kurapwa kunoreva danho rekutanga kurapwa nemishonga yeanticancer, inonziwo yekutanga kurapwa. Pane zvakawanda sarudzo yemutsara wekutanga kurapwa kwekenza yepamusoro yekoloni, kazhinji yakavakirwa pane chemotherapy.
Nekudaro, mamiriro emurwere uye mamiriro epanyama anofanirwa kusiyaniswa. Mushure mekuteedzana kwebvunzo, varwere vanogona kukamurwa muzvikamu zviviri: varwere vanokodzera kurapwa kwakanyanya uye avo vasina.
Kusarudzwa kwezvinodhaka kune yakanyanya-yakasimba kurapwa kwevanorwara nekenza varwere
Yakakamurwa muzvikamu zvitatu:
Chekutanga-mutsara mhinduro ne oxaliplatin
Chekutanga-mutsara mhinduro ne irinotecan
(1) Yekutanga-mutsara chirongwa chine oxaliplatin
FOLFOX ± bevacizumab
CAPEOX ± Bevacizumab
FOLFOX + (cetuximab kana panitumumab) (chete yeKRAS / NRAS / BRAF yemusango-mhando yakasara cancer cancer)
(B) yekutanga-mutsara chirongwa chine irinotecan
FOLFIRI ± bevacizumab kana
FOLFIRI + (cetuximab kana panitumumab) (chete yeKRAS / NRAS / BRAF yemusango-mhando yakasara cancer cancer)
(III) Yekutanga-mutsara chirongwa chine oxaliplatin + irinotecan
FOLFOXIRI ± Bevacizumab
Kusarudzwa kwezvinodhaka hakuna kukodzera kurapwa kwakanyanya mukenza yakajeka
Yekutanga-mutsara marapirwo sarudzo
1. Kuiswa mukati kwe5-fluorouracil + calcium folinate ± bevacizumab kana
2.Capecitabine ± Bevacizumab
3. Cetuximab kana panitumumab) (Kirasi 2B humbowo, chete hweKRAS / NRAS / BRAF yemusango-mhando yakasara cancer cancer)
4. Navumab kana Paimumab (chete ye dMMR / MSI-H)
5. Nivolumab + Ipilimumab (mhando 2B humbowo, inoshanda chete kune dMMR / MSI-H)
6. Trastuzumab + (Pertuzumab kana Lapatinib) (yemamota ane HER2 inosimudzira uye RAS mhando yemusango)
1) Mushure mekurapa kuri pamusoro, chinzvimbo chinoshanda hachigadzirike, uye kurapwa kwakanyanya kutsigira (palliative care) kunosarudzwa;
2) Mushure mekurapa kwepamusoro, iyo inoshanda mamiriro inovandudzika, uye yakasimba-simba yekutanga chirongwa chinogona kutariswa.
Yekupedzisira mishonga sarudzo mukenza yakajeka
Rigfini
Trifluorothymidine + tipiracil
Kuchengetedza kwakanyanya kutsigira (palliative care)
References:
https://www.cancer.net/cancer-types/colorectal-cancer/statistics
https://zhuanlan.zhihu.com/p/42575420
https://www.nccn.org/professionals/physician_gls/default.aspx
