Umdlavuza we-Bile duct (cholangiocarcinoma)

Uyini umdlavuza we-bile duct (cholangiocarcinoma)?

I-Cholangiocarcinoma umdlavuza oqala emiseleni yenyongo, ethutha i-bile fluid egayekayo. Ama-bile ducts amashubhu asuka esibindini sakho aye enyongweni kanye namathumbu amancane.

I-Cholangiocarcinoma, evame ukubizwa ngokuthi umdlavuza we-bile duct, ivame kakhulu kubantu abaneminyaka engaphezu kwengu-50, kodwa ingagadla noma ngubani kunoma ibuphi ubudala.

I-Cholangiocarcinoma ihlukaniswe ngezigaba ezine ngokuya ngokuthi umdlavuza uvela kuphi emibhobho yenyongo:

• I-intrahepatic cholangiocarcinoma occurs in the parts of the bile ducts within the liver and is sometimes classified as a type of umdlavuza wesibindi.
• I-Hilar cholangiocarcinoma kwenzeka emithanjeni yenyongo ngaphandle kwesibindi. Lolu hlobo lubizwa nangokuthi i-perihilar cholangiocarcinoma.
• I-cholangiocarcinoma ekude kwenzeka engxenyeni yomgudu wenyongo oseduze kwamathumbu amancane. Lolu hlobo lubizwa nangokuthi i-extrahepatic cholangiocarcinoma.

I-Cholangiocarcinoma ivame ukutholakala ngemuva kokuthuthuka, okwenza ukwelashwa okuphumelelayo kube yinselele.

Izimpawu ze-cholangiocarcinoma

Izimpawu nezimpawu ze-cholangiocarcinoma zifaka:

• Ukuphuzi kwesikhumba sakho nokumhlophe kwamehlo akho (i-jaundice)
• Isikhumba esilumayo kakhulu
• Izitulo ezinemibala emhlophe
• Ukukhathala
• Ubuhlungu besisu ohlangothini lwesokunene, ngezansi nje kwezimbambo
• Ukwehlisa isisindo ngaphandle kokuzama
• Fever
• Izithukuthuku ebusuku
• Umchamo omnyama

Izimbangela ze-cholangiocarcinoma

Cholangiocarcinoma develops when the DNA of cells in the bile ducts changes. The DNA of a cell includes the instructions that tell it what to do. The modifications cause the cells to grow uncontrollably, resulting in a mass of cells (isisu) that can infiltrate and kill healthy body tissue. What causes the alterations that lead to cholangiocarcinoma is unknown.

Izici ezingakhuphula ubungozi be-cholangiocarcinoma zifaka:

• I-primary sclerosing cholangitis. Lesi sifo sibangela ukuqina nokusikeka kwemibhobho yenyongo.
• Isifo esingalapheki sesibindi. Ukuqubuka kwesibindi okubangelwa umlando wezifo ezingapheli zesibindi kwandisa ingozi ye-cholangiocarcinoma.
• Izinkinga zamanzi emifula zikhona lapho kuzalwa. Abantu abazalwa bephethe i-cyledochal cyst, edala imiphongolo ye-bile evulekile futhi engajwayelekile, banengozi eyengeziwe ye-cholangiocarcinoma.
• Igciwane lesibindi. Ezindaweni eziseNingizimu-mpumalanga ye-Asia, i-cholangiocarcinoma ihlotshaniswa nokutheleleka kwesibindi, okungenzeka ngokudla inhlanzi eluhlaza noma engaphekiwe.
• Ukuguga. I-Cholangiocarcinoma ivela kaningi kubantu abadala abaneminyaka engaphezu kwengama-50.
• Ukubhema. Ukubhema kuhlotshaniswa nengozi eyengeziwe ye-cholangiocarcinoma.
• Isifo sikashukela. Abantu abanesifo sikashukela sohlobo 1 noma 2 bangaba nengozi eyengeziwe ye-cholangiocarcinoma.
• Izimo ezithile ezizuzwe njengefa. Ezinye izinguquko ze-DNA ezidluliselwe zisuka kubazali ziye ezinganeni zidala izimo ezandisa ubungozi be-cholangiocarcinoma. Izibonelo zalezi zimo zifaka phakathi i-cystic fibrosis ne-Lynch syndrome.

Ungayivimbela kanjani i-cholangiocarcinoma?

Yeka ukubhema: Ingozi ephezulu ye-cholangiocarcinoma ihlotshaniswa nokubhema. Yeka ukubhema uma ubhema. Uma uke wazama ukuyeka phambilini kepha wangaphumelela, khuluma nodokotela wakho ngokuyeka amaqhinga.

Nciphisa ubungozi bokuhlaselwa yisifo sesibindi: Isigameko esiphakeme se-cholangiocarcinoma sixhunyaniswa nokugula okungapheli kwesibindi. Ezinye izimbangela zezifo zesibindi azinakugwenywa, kepha ezinye zingagwenywa. Yenza konke ongakwenza ukuvikela isibindi sakho.

Uma ukhetha ukuphuza, isibonelo, phuza ngokulinganisela ukunciphisa ingozi yokuvuvukala kwesibindi (i-cirrhosis). Lokho kungafika esiphuzweni esisodwa ngosuku kwabesifazane kuze kufike eziphuzweni ezimbili ngosuku kwabesilisa kubantu abaphilile. Gcina inkomba yomzimba ephilile (BMI). Landela izincomo zokuphepha ngenkathi usebenza ngamakhemikhali.

Ukuxilongwa kwe-cholangiocarcinoma

Isivivinyo somsebenzi wesibindi: Ukuhlolwa kwegazi ukuhlola ukusebenza kwesibindi kunganikeza izinkomba kudokotela wakho ngokuthi yini ebangela izimpawu zakho.

Isivivinyo somaka wesimila:

Izinga le-carbohydrate antigen (CA) 19-9 egazini lakho linganikeza imininingwane eyengeziwe kudokotela wakho maqondana nokuxilongwa kwakho. I-CA 19-9 yiprotheni elenza ukuthi amangqamuzana omdlavuza we-bile akhiqize ngokweqile.

However, a high amount of CA 19-9 in your blood does not necessarily indicate that you have umgudu wenyongo cancer. Other bile duct illnesses, such as bile duct inflammation and occlusion, can produce this effect.

I-ERCP: Ishubhu encane, eguquguqukayo enekhamera encane ithunyelwa entanyeni yakho nasemgudwini wakho wokugaya ukudla emathunjini akho amancane ngesikhathi se-endoscopic retrograde cholangiopancreatography (ERCP). Ikhamera isetshenziselwa ukubheka ukuxhumana phakathi kwamapayipi akho enyongo namathumbu akho amancane. Lokhu kwelashwa kungasetshenziselwa ukufaka udayi emiphongolweni ye-bile ukuze ibonakale ngokusobala kakhulu ezifundweni ze-imaging.

Ukuhlola ukuhlolwa: Your doctor can use imaging tests to look at your internal organs and seek for signs of cholangiocarcinoma. Ultrasound, computerized tomography (CT) scans, and imaging resonance magnetic (MRI) combined with magnetic resonance cholangiopancreatography are all used to identify bile duct cancer (MRCP). MRCP is becoming a more popular noninvasive option to ERCP. It provides 3D images without requiring the use of a dye to enhance the visuals.

Isidumbu: 

I-biopsy inqubo lapho kususwa khona futhi kuhlolwe isampula elincane lezicubu ngaphansi kwesibonakhulu.

Uma indawo esolisayo isondele lapho umgudu we-bile uhlangana khona namathumbu amancane, udokotela wakho angenza i-ERCP ukuqoqa isampula ye-biopsy. Uma indawo esolisayo itholakala ngaphakathi noma eduze kwesibindi, udokotela wakho angathatha isampula lezicubu ngokudlulisa inaliti ende esikhunjeni sakho endaweni ethintekile (inaliti enhle). Ukuqondisa inaliti iye endaweni eqondile, angahle asebenzise isivivinyo sokuthatha izithombe, njenge-endoscopic ultrasound noma i-CT scan.

Indlela udokotela wakho athola ngayo isampula ye-biopsy ingaba nomthelela kuzinketho zokwelashwa ongazithola kamuva. Ngeke uvumeleke ukufakelwa isibindi uma i-bile duct carcinoma yakho ichazwa ngenhloso yenaliti enhle. Ungesabi ukubuza ngokuhlangenwe nakho kukadokotela wakho ngokuxilongwa kwe-cholangiocarcinoma. Thola umbono wesibili uma ungabaza.

Ukwelashwa kwe-cholangiocarcinoma

Ukwelashwa kwe-cholangiocarcinoma (umdlavuza we-bile duct) kungafaka:

Ukuhlinzwa: Uma kungenzeka, odokotela bazama ukususa umdlavuza omningi ngangokunokwenzeka. Lokhu kufaka ukusika ingxenye yomgudu wenyongo nokuxhuma kabusha ukusika okuphela kwezicubu zomgudu omncane kakhulu we-bile. Izicubu zesibindi eziseduze, izicubu ze-pancreatic, noma ama-lymph node angasuswa kanye nezicubu zomzimba ezithuthuke kakhulu.

Ukufakelwa kwesibindi: Kulabo abane-hilar cholangiocarcinoma, ukuhlinzwa ukuze ususe isibindi sakho bese usifaka esikhundleni salowo ovela kumnikeli (ukufakelwa kwesibindi) kungaba yindlela kwezinye izimo. Ukufakelwa kwesibindi kungaba ikhambi kubantu abaningi abane-hilar cholangiocarcinoma, kepha kunethuba lokuthi umdlavuza uzobuya ngemuva kokufakelwa. 

I-Chemotherapy: I-Chemotherapy yindlela yokwelapha esebenzisa amakhemikhali ukubulala amangqamuzana omdlavuza. Ngaphambi kokufakelwa kwesibindi, i-chemotherapy ingasetshenziswa. Kungaba futhi inketho kulabo abane-cholangiocarcinoma esezingeni eliphakeme abafuna ukunciphisa lesi sifo nokunciphisa izimpawu. Imithi yokwelashwa ngamakhemikhali ingafakwa emthanjeni futhi isabalale emzimbeni wonke. Ngenye indlela, imishanguzo ingahlinzekwa ngendlela yokuthi ifinyelele kumaseli womdlavuza ngqo.

Ukwelashwa ngemisebe: Ukubulala amangqamuzana omdlavuza, ukwelashwa ngemisebe kusebenzisa imishayo yamandla ephezulu evela emithonjeni enjenge-X-ray nama-proton. Isisetshenziswa esithumela imishayo yemisebe emzimbeni wakho singasetshenziswa ekwelashweni ngemisebe (imisebe yangaphandle yomsebe). Kungabandakanya nokujova izinto ezinemisebe emzimbeni wakho eduze kwendawo enomdlavuza (brachytherapy).

Ukwelashwa okuhlosiwe: Imithi yokwelashwa ehlosiwe yenzelwe ukukhomba ukungajwayelekile okuthile okutholakala kumaseli womdlavuza. Ukwelashwa kwemithi okuhlosiwe kungabulala amangqamuzana omdlavuza ngokuvimbela lokhu kuphazamiseka. Udokotela wakho angahlola amangqamuzana akho omdlavuza ukubona ukuthi ukwelashwa okuhlosiwe kwe-cholangiocarcinoma kunenzuzo yini.

I-Immunotherapy: I-Immunotherapy uhlobo lokwelashwa komdlavuza olusebenzisa amasosha akho omzimba. Ngoba amangqamuzana omdlavuza enza amaprotheni awasizayo acashe kumaseli omzimba omzimba, amasosha omzimba wakho alwa nezifo angahle angahlaseli umdlavuza wakho. I-Immunotherapy isebenza ngokuphazamisa izinqubo zemvelo zesistimu yomzimba. I-Immunotherapy ingaba yindlela yokukhetha iziguli eziphambili ze-cholangiocarcinoma ezehlulekile ukuphendula ekwelashweni okuvamile.

Ukushisa amaseli omdlavuza: Amandla kagesi asetshenziselwa ukushisa nokubhubhisa amangqamuzana omdlavuza ekususeni kwe-radiofrequency. Udokotela ufaka inaliti eyodwa noma ezingaphezulu ezincanyana esiswini sakho usebenzisa ukuhlolwa kwe-imaging, njenge-ultrasound, njengomhlahlandlela. Lapho izinaliti zifika kulesimila, amandla kagesi ayazishisa, abulale amangqamuzana omdlavuza.

Ukwelashwa kwe-Photodynamic: Ikhemikhali elizwela ukukhanya lifakwa emthanjeni futhi liqoqeka kumaseli omdlavuza akhula ngokushesha ekwelashweni kwe-photodynamic. Amaseli womdlavuza afa ngenxa yokusabela kwamakhemikhali okubangelwa ukukhanya kwelaser okuqondiswe kuwo. Kudingeka ukwelashwa okuningi. Ukwelashwa kwe-Photodynamic kungakwenza uzizwe ungcono futhi kungahle kumise nokuqhubeka komdlavuza wakho. Ngemuva kokwelashwa kwakho, uzodinga ukuphuma elangeni.

Amapayipi we-biliary: I-Biliary drainage yindlela yokubuyisela ukugeleza kwe-bile. Kungabandakanya ukufaka ishubhu elincane emgodini we-bile ukukhipha i-bile. Ezinye izinketho zibandakanya ukuhlinzeka ngokudlula eceleni ukuze kuguqulwe i-bile ezungeze ukulimala kanye nama-stents ukugcina umgudu we-bile othintekayo womdlavuza uvulekile. Izinsiza zokuhambisa amanzi nge-biliary ekusizeni izimpawu nezimpawu ze-cholangiocarcinoma.