Sidee looga hortagaa soo noqoshada kansarka beerka?

Ka hortagga kansarka beerka

Ka hortagga soo noqoshada kansarka beerka, ka hortagga soo noqoshada kansarka beerka qalliinka ka dib, sida looga hortago soo noqoshada kansarka beerka, sida looga hortago soo noqoshada kansarka beerka

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 buro progression-free survival of about 3-7 months and a total survival of about 9-13 months

Heerka badbaadada shanta sano ee kansarka beerka

The five-year survival rate of patients with kansarka beerka is low, according to data from the US ASCO official website:

44% bukaanada ayaa laga helay kansarka beerka ee marxaladda hore halka heerka badbaadadooda 5-sano ay ahayd 31%.

Haddii kansarka beerka uu ku faafo unugyada ku xeeran ama xubnaha iyo/ama qanjidhada gobolka, heerka badbaadada 5-sano waa 11%.

Haddii uu kansarku ku faafo meel ka fog jidhka, heerka badbaadada 5-sano waa 2%.

Si kastaba ha ahaatee, xitaa haddii kansarka la ogaado inuu ku jiro marxalad hore, daaweyno kala duwan ayaa loo isticmaali karaa si loo caawiyo bukaanada qaba kansarka beerka inay sii dheereeyaan badbaadadooda. Qalliinku waa daawaynta ugu fiican ee bukaanada qaba kansarka beerka. Bukaanjiifka badankoodu waxay ka fikiraan dib-u-soo-celinta qalliinka marka hore, laakiin wali waxay la kulmaan khatarta soo noqoshada ka dib qalliinka qalliinka.

Sidee si wax ku ool ah looga hortagi karaa soo noqoshada kansarka beerka? 

Dib u eegis xilliyeed

Compared with malignant tumors such as breast cancer and sambabada 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% .

Sidaa darteed, waxaa lagama maarmaan ah in si joogto ah dib loogu eego oo loo raaco amarka dhakhtarka, xitaa haddii calaamadaha hore ee metastasis la helo, weli waxaa jira fursad ah in qaliin lagu sameeyo. Haddii jirka oo dhan la ogaado in la dayacay dib u eegis, daaweyntu aad ayay u adag tahay.

Waxyaabaha u baahan in la hubiyo dib u eegista kansarka beerka ee joogtada ah waxaa ka mid ah:

Tijaabada shaqada beerka

Tijaabada shaqada beerka guud ahaan waa kuwa ugu awooda badan in lagu ogaado xaalada beerka ee hadda jira ee cudurada iyo caabuqyada, laakiin inta badan waxay ku guuldareystaan ​​inay ogaadaan jiritaanka cirrhosis iyo kansarka beerka, mana ogaan karaan inay qabaan fayrasyo ​​cagaarshow kala duwan.

Alpha fetoprotein

Haddii alfa-fetoprotein togan uu hoos u dhaco si caadi ah ka dib qaliinka laga saaray kansarka beerka, ka dibna mar kale kordho, ma jirto wax sharraxaad ah oo ku saabsan cudurka beerka firfircoon ee joogtada ah, taas oo muujinaysa in kansarka beerka uu soo noqnoqday.

Bukaanada qaba alfa-fetoprotein taban ka hor inta aan la soo saarin kansarka beerka, alfa-fetoprotein waxay noqon kartaa mid wanaagsan inta lagu jiro soo noqoshada, alfa-fetoprotein waa in weli la sii wado qalliinka ka dib.

Ultrasound caloosha

B-ultrasound waxay leedahay faa'iidooyinka dareenka, ku habboonaanta, iyo qiimaha jaban. Waa hab muhiim ah oo lagula socdo soo noqoshada kansarka beerka. Ultrasound-ka caloosha waa baaritaan lama huraan ah

Raadiyaha laabta

Qaar ka mid ah nabarrada soo noqnoqda ayaa marka hore ku dhaca sambabada, sidaas darteed xabadka Raajooyin ayaa loo baahan yahay si loola socdo laabta soo noqoshada.

CT, PET-CT

Marka dhakhtarku aanu wali hubin in la wareejinayo B-ultrasound ka dib, CT scan waa in lagu sameeyaa wakhtiga. Haddii ay jiraan wax kale oo metastasis ah oo qayb kale ah, markaa waxaa la sameeyaa baaritaanka PET-CT ee jirka oo dhan. Bukaannada qaba kansarka beerka ee xaaladdoodu ay wanaagsan tahay waxay samayn karaan baaritaan PET-CT sannadkiiba hal mar si loo ogaado burooyinka ka weyn 2mm ee jirka oo dhan hal mar, taas oo yareyneysa kakanaanta iyo hubin la'aanta baaritaanno badan.

Beddel qaab nololeedka

Jooji khamriga, joojiso khamriga, joojiso khamriga, waxyaabaha muhiimka ah ayaa la sheegay saddex jeer, waa inaad joojisaa khamriga. Sidoo kale, ha cabbin sigaar, ha ka badin, oo faraxsanow.

Jimicsi ku habboon, 2-3 bilood qalliinka ka dib, waxaad samayn kartaa jimicsi dabacsan, sida socodka, oo si tartiib tartiib ah u kordhi 15 daqiiqo ilaa 40 daqiiqo; Waxa kale oo aad jimicsan kartaa qigong, Tai Chi, jimicsi raadiyaha iyo jimicsiyo kale oo dabacsan.

Feejignaan gaar ah waa in la siiyaa cuntada, ha cunin cunno caaryo ah, hilib dubis, hilib doofaar, tofu iyo cuntooyinka kale ee ay ku jirto nitrite, hana cunin dawooyinka dhaqameed ee Shiinaha.

Cuntada qalliinka ka dib badanaa waa iftiin, iyo qaadashada borotiin tayo sare leh sida ukunta cad iyo hilibka caatada ah ayaa si habboon loo kordhiyay. Cuntada qalliinka ka dib guud ahaan waxay u gudubtaa biyaha, boorashka, caanaha, ukunta uumiga ah, kalluunka, hilibka caatada ah ee cuntada caadiga ah.

Isku day inaad cuntid cunnooyinka si fudud loo shiidi karo, ka fogow dufanka, basbaaska, cuncunka, adag, dhegta leh iyo cuntooyinka kale, cun cunno isku dheellitiran, cun cunno yar, mana aha inay dhergaan.

Sidee looga hortagi karaa soo noqoshada kansarka beerka qaliinka ka dib?

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 waa daawaynta adjuvant, guud ahaan maaha sida qorshaha daawaynta ugu weyn.

Qalliin nadiif ah

Habka ugu habboon ee daaweynta kansarka beerka waa in meesha laga saaro boogaha burooyinka si loo gaaro yoolka daaweynta xagjirka ah. Haddii shuruudaha qalliinka la buuxiyo, dhammaan burooyinka waa laga saari karaa qaliin.

Haddii ay jiraan nabaro kala duwan, aagga duulaanka ayaa ah mid aad u ballaaran, ama metastases fog, dib-u-soo-baxa burooyinka ayaa loo dooran karaa iyadoo loo eegayo xaaladda. Xaaladda ah in faa'iidada qalliinka aan la damaanad qaadi karin, hababka kale ee daaweynta ayaa la dooran karaa.

Daawaynta ugu yar

Daawaynta ugu yar waa hab gaar ah oo loogu talagalay daaweynta kansarka beerka, oo ay ku jiraan saddexdan:

1. Chemoembolization arterial transcatheter

Geli tuubo ka soo baxda halbowlaha femoral ee qaybta hoose ama xididdada radial ee addinka sare ilaa beerka, oo xidhi xididada quudiya burada, buradana waxay mari doontaa ischemic necrosis. Isla mar ahaantaana, daawooyinka kiimikaad ayaa lagu shubaa buro leh lipiodol. Haddii ay dhacdo in ay saamayso unugyada caadiga ah ee beerka, unugyada burooyinka waa la sii dili karaa.

2. Kiimikada oo laga takhaluso

Sida caadiga ah iyada oo la raacayo hagida B ultrasound ama CT, cirbadeynta khamriga saxda ah ee goobta burada ayaa ka dhigaysa unugyada burooyinka si dhakhso ah u fuuqbaxa oo borotiinada ayaa denature oo xinjirowga, taas oo dila unugyada burooyinka, laakiin habkan hadda waa mid aan la isticmaalin.

3. Jir-dilid

Marka lagu daro soo-baxa soo noqnoqda shucaaca iyo mikrowave, sidoo kale iyada oo la raacayo hagida B ultrasound ama CT, unugyada burooyinka waxaa lagu dilay saamaynta thermogenic ee irbadda dalool.

Daaweynta shucaaca ee kansarka beerka

Dawaynta shucaaca waxaa badanaa loo isticmaalaa daawayn kaabayaal ah. Kansarka beerka ee meelo gaar ah (sida xididdada xididdada dhiigga, biliary mareenka, ama xididdada waaweyn ee ku dheggan), daawaynta ugu yar lama heli karo, ama daawaynta ugu yar lama samayn karo si nadiif ah. Daaweynta shucaaca waa la dooran karaa.

Daaweynta Proton ee daaweynta kansarka beerka

Dawaynta shucaaca waa daawaynta adjuvant ee bukaanno badan oo qaba kansarka beerka qalitaanka ka dib. Si kastaba ha ahaatee, shucaaca dhaqameed, raajada ama shucaaca photon ayaa si lama filaan ah loogu kala qaadaa goobta burada iyo unugyada caafimaadka qaba ee ku hareeraysan. Tani waxay dhaawici kartaa unug caafimaad qaba oo dhow waxayna sababi kartaa waxyeelooyin halis ah. Daaweynta Proton waxay si fiican uga fogaan kartaa dhibaatooyinkaas soo raaca.

Taas bedelkeeda, daawaynta proton waxay isticmaashaa shucaaca proton beam irradiation waxayna joogsan kartaa goobta burada iyada oo aan laga tagin qiyaasta shucaaca gadaasha burada, markaa waa u
waxay u badan tahay inay waxyeeleeyaan unug caafimaad qaba oo dhow. Khubarada qaar ayaa aaminsan in daawaynta proton ay ka badbaado badan tahay daawaynta shucaaca ee caadiga ah. Bukaanjiifka kansarku waxay leeyihiin difaac hooseeya, soo-gaadhista shucaaca xooggan waxay si fudud u dhaawaci kartaa xubnaha caadiga ah, waxay sababi kartaa falcelin xun oo xun, waxayna culeys halis ah u keentaa jirkii horeba daciifka ahaa. Gaar ahaan kansarka beerka, burooyinka nabarrada waxay ku xigaan xubno badan oo muhiim ah, sida sambabada, wadnaha, hunguriga, iwm. Waxa kale oo jira qaybo badan oo maskaxda ah. Doorashada daawaynta proton waxay si wax ku ool ah uga fogaan kartaa dhaawaca unugyada caafimaadka qaba ee ku hareeraysan waxayna gaari kartaa dilaaga burooyinka sida saameynta shucaaca dhaqameed.

Daaweynta kansarka beerka

1. Chemotherapy

Chemotherapy waxaa ka mid ah daaweynta kiimikaad ee habaysan iyo kiimoteraabiga maxalliga ah. Kiimoterabiga maxalliga ahi waa kiimiko-qaadista halbowlaha transcatheter ee kor lagu sheegay. Waxtarka daaweynta kemotherabi waa in ka yar 10%, waxyeellooyinkuna waa halis. Bukaannada badankoodu ma dooran doonaan.

2.Daawaynta la beegsaday

Daawooyinka la beegsaday ee loo oggolaaday kansarka beerka gudaha iyo dibaddaba

Xulashada daaweynta safka hore ee kansarka beerka

(1) Sorafenib

Tiro cilmi-baaris caafimaad ah ayaa muujisay in Sorafenib ay leedahay faa'iidooyin badbaado oo gaar ah oo loogu talagalay bukaannada qaba kansarka beerka sare ee dalal kala duwan iyo asal ahaan cudurrada beerka ee kala duwan (heerka caddaynta 1).

Isticmaalka caadiga ah ee lagu taliyay waa 400 mg afka, laba jeer maalintii. Waxaa loo isticmaali karaa bukaanjiifka Class-Pugh Class A ama B ee leh shaqada beerka. Marka loo barbardhigo shaqada beerka ee Child-Pugh B, Child-Pugh A Faa'iidada badbaadada bukaanka ayaa aad u muuqata.

Waxaad ubaahantahay inaad fiiro gaar ah u yeelato saameynta HBV iyo shaqada beerka, iyo kor u qaadida maaraynta cudurka aasaasiga ah ee beerka inta lagu gudajiro howsha. Dareen-celinta xun ee ugu caansan waa shuban, miisaanka oo yaraada, cilladda gacanta iyo cagaha, firiiric, myocardial ischemia, iyo dhiig-kar, oo badanaa ku dhaca 2 ilaa 6 toddobaad ka dib bilowga daaweynta.

(2) Lemvatinib

Lenvatinib wuxuu ku habboon yahay bukaanjiifka aan lakala furi karin ee leh heerka IIb, IIIa, IIIb, shaqada beerka ee Child-Pugh A kansarka beerka, iyo daaweyntiisa safka koowaad ma liito sorafenib. Kansarka beerka ee la xiriira HBV wuxuu leeyahay faa iidooyin Badbaadada [185] (heerka caddaynta 1).

Lenvatinib ayaa loo oggolaaday in loo isticmaalo bukaan-socodka kansarka beerka ee loo yaqaan 'Child-Pugh A' oo qaba kansarka beerka ee horumarsan. Isticmaalka: 12mg, afka, hal mar maalintii culeyska jirka ≥60kg; 8mg, afka, hal mar maalintii culeyska jirka <60kg. Dareen-celinta xun ee caadiga ah waa dhiig-kar, shuban, rabitaanka cuntada oo yaraada, daal, cilladda gacanta, cilladda borotiinka, lallabbada, iyo hypothyroidism.

(3) Dawaynta kimikalka

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).

Daraasado badan oo wajiga II ah ayaa soo sheegay in daaweynta kemotherabi ee nidaamsan ee leh oxaliplatin oo ay weheliso sorafenib ay hagaajin karto heerarka jawaabta ujeeddada, kordhinta badbaadada horumarka lahayn iyo guud ahaan badbaadada, iyo inay bixiso nabadgelyo wanaagsan (heerka caddaynta 3).

Bukaannada qaba shaqo wanaagsan oo beerka ah iyo xaalad jireed, daaweyntan isku dhafan ayaa la tixgelin karaa, laakiin daraasadaha la kala soocay ee kiliinikada ayaa wali loo baahan yahay si loo bixiyo caddayn caafimaad oo caddayn heer sare ah. Intaa waxaa sii dheer, arsenic trioxide waxay leedahay saameyn daaweyn gaar ah oo ku saabsan kansarka beerka ee horumarsan (heerka caddaynta 3). Codsiga bukaan socodka, taxaddar waa in la sameeyaa si loola socdo oo looga hortago sumowga beerka iyo kelyaha.

Daaweynta-labaad ee kansarka beerka

(1) Regorafenib

Regorafenib waxaa loo oggol yahay in loo isticmaalo bukaanada qaba heerka IIb, IIIa, iyo IIIb kansarka beerka CNLC ee horay loogu daaweeyay sorafenib (heerka caddaynta 1). Isticmaalku waa 160mg hal mar maalintii muddo 3 toddobaad ah waana la joojiyey 1 toddobaad.

Shiinaha, qiyaasta ugu horreysa waxay noqon kartaa 80mg ama 120mg hal mar, hal mar maalintii, waxayna tartiib tartiib u kordheysaa iyadoo loo eegayo dulqaadka bukaanka. Dhacdooyinka xun ee caadiga ah waa dhiig-kar, falcelinta maqaarka lugta lugta, daal, iyo shuban.

(2) Navumab iyo Paimumab

FDA waxay ogolaatay isticmaalka Navulinu monoclonal antibodies (Nivolumab) iyo Pabrolizumab monoclonal antibodies (Pembrolizumab) ee bukaanada qaba kansarka beerka kuwaas oo horumaray ama aan u dulqaadan karin sorafenib ka dib daaweyn hore oo sorafenib ah (heerka caddaynta 2).

Waqtigan xaadirka ah, horjoogayaasha isbaarada difaaca ee ay si madax banaan u soo saareen shirkadaha Shiinaha, sida Carellidizum monoclonal antibodies, difaaca jirka ee Treplepril monoclonal, iyo Xindili monoclonal antibodies, ayaa ku socda cilmi baaris caafimaad. Isku darka tallaalka difaaca jirka iyo dawooyinka la beegsaday, daawooyinka kiimikaad, iyo daawaynta jirka ayaa si joogto ah loo sahamiyaa.

Immunomodulators kale (sida interferon α, thymosin α1, iwm.), immunotherapy unugyada (sida. Chimeric antigen receptor T cell therapy, 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) Ikhtiyaarada daawaynta safka labaad ee laga heli karo Maraykanka

Intaa waxaa dheer, US FDA waxay ansixisay cabozantinib bukaanada qaba kansarka beerka kaas oo horumaray ka dib daaweynta nidaamka ugu horreeya (heerka caddaynta 1), waxayna oggolaatay isticmaalka Lemorex monoclonal antibody ee daaweynta safka labaad ee bukaanka qaba beerka heerarka AFP ≥400ng / mL (heerka caddaynta 1)). Si kastaba ha ahaatee, labadan daawo ayaan suuqyo laga dhigin Shiinaha. Cilmi-baarista bukaan-socodka ee unugyada-yar-yar-yar-yar-yar-yar-yar-yar-yar-yar oo lagu beegsanayo daroogada apatinib ee daaweynta safka labaad ee bukaannada kansarka beerka ayaa socda.