Umdlavuza wesibindi

Uyini umdlavuza wesibindi?

Umdlavuza wesibindi ukukhula nokwanda kwamaseli angenampilo esibindi. Umdlavuza oqala esibindini ubizwa ngokuthi umdlavuza oyinhloko wesibindi. Umdlavuza osakazekela esibindini uvela kwesinye isitho ubizwa ngokuthi yi-metastatic cancer cancer. I-Hepatocellular carcinoma (HCC) uhlobo oluvame kakhulu lomdlavuza oyinhloko wesibindi.

Isibindi

Isibindi sakhiwe ngamaseli abizwa ngokuthi ama-hepatocyte. Iphinde ibe nezinye izinhlobo zamangqamuzana, kuhlanganise namangqamuzana azungeza imithambo yegazi namangqamuzana azungeza amashubhu amancane esibindini abizwa ngokuthi ama-bile ducts. I-bile ducts ithwala i-bile isuka esibindini iye ku-gallbladder noma ngqo emathunjini.

Isibindi isitho esiyindlala esikhulu kunazo zonke emzimbeni futhi senza imisebenzi ehlukahlukene ebucayi ukugcina umzimba ungenabo ubuthi nezinto eziyingozi. Itholakala engxenyeni engakwesokudla ephezulu yesisu, ngaphansi kwezimbambo. Isibindi sinesibopho sokukhiqiza i-bile, okuyinto ekusiza ukugaya amafutha, amavithamini, nezinye izakhi zomzimba. Lesi sitho esibalulekile futhi sigcina izakhamzimba ezinjenge-glucose, ukuze uhlale wondlekile ngezikhathi lapho ungadli khona. Iphinde iphule imithi kanye nobuthi. Lapho umdlavuza uvela esibindini, ubhubhisa amangqamuzana wesibindi futhi uphazamise amandla esibindi okusebenza kahle.

Umdlavuza wesibindi ngokuvamile uhlukaniswa njengowokuqala noma wesibili. Umdlavuza wesibindi oyinhloko uqala kumaseli wesibindi. Umdlavuza wesibindi wesibili ukhula lapho amangqamuzana omdlavuza avela kwesinye isitho esakazeka esibindi. Ngokungafani namanye amaseli emzimbeni, amangqamuzana omdlavuza angaqhamuka esizeni sokuqala, noma lapho umdlavuza waqala khona. Amaseli ahambela ezinye izindawo zomzimba ngegazi noma ngohlelo lwe-lymphatic. Amaseli womdlavuza ekugcineni aqoqa kwesinye isitho somzimba bese eqala ukukhula lapho.

Awukwazi ukuhlala ngaphandle kwesibindi sakho. Inemisebenzi eminingi ebalulekile:

• Iyaphuka futhi igcine izakhi zomzimba eziningi ezimuncwa emathunjini okudingeka umzimba wakho usebenze. Ezinye izakhi zomzimba kufanele zishintshwe (zihlanganiswe namakhemikhali) esibindi ngaphambi kokuba zisetshenziselwe amandla noma ukwakha nokulungisa izicubu zomzimba.
• Kwenza izinto eziningi ezijiyisayo ezikugcina ungophi kakhulu uma usikiwe noma ulimele.
• Inikela nge-bile emathunjini ukusiza ukumunca izakhamzimba (ikakhulukazi amafutha).
• Kwephula utshwala, izidakamizwa, nokungcola okunobuthi egazini, okudlula kusuka emzimbeni ngomchamo nasesitulweni

Izinhlobo ezahlukahlukene zamaseli esesibindi zingakha izinhlobo eziningana zamathumba amabi (anomdlavuza) kanye ne-benign (angenawo umdlavuza). Lezi zicubu zinezimbangela ezihlukile, ziphathwa ngendlela ehlukile, futhi zinezimpawu ezihlukile (umbono).

Yiziphi izinto ezinobungozi nezimbangela zomdlavuza wesibindi?

• Ukutheleleka isikhathi eside kwesifo sokusha kwesibindi kohlobo B kanye nesifo sokusha kwesibindi kohlobo C kuxhunyaniswa nomdlavuza wesibindi ngoba kuvame ukuholela ekuthini isifo sokuqina kwesibindi. I-Hepatitis B ingaholela kumdlavuza wesibindi ngaphandle kwe-cirrhosis.
• Ukuphuza ngokweqile.
• Ukukhuluphala nesifo sikashukela kuhlotshaniswa kakhulu nohlobo lwesifo esingajwayelekile esibizwa ngokuthi isifo se-nonalcoholic fatty liver (NAFLD) esingakhuphula ubungozi besifo somdlavuza wesibindi, ikakhulukazi kulabo abaphuza kakhulu noma abane-hepatitis yegciwane.
• Izifo ezithile ze-metabolic.
• Ukuvezwa kwemvelo kuma-aflatoxin.
• Ezinye izifo eziningi zesibindi, kufaka phakathi izifo ezizimele njenge-PBC, nezinye izifo ezingavamile ezifana ne-Tyrosinemia, i-Alpha1-antitrypsin ukuntuleka, i-Porphyria cutanea tarda, isifo sokugcina i-Glycogen, kanye nesifo se-Wilson kungaholela ku-cirrhosis, okwandisa ingozi yomdlavuza wesibindi.

Odokotela abaqiniseki ukuthi kungani abanye abantu benomdlavuza wesibindi kanti abanye abawutholi. Kodwa-ke, kunezici ezithile ezaziwa ukwanda kwengozi yokuba nomdlavuza wesibindi:

• Umdlavuza wesibindi uvame kakhulu kubantu abangaphezu kweminyaka engama-50.
• Ukutheleleka isikhathi eside kwesifo sokusha kwesibindi kohlobo B noma C kungasilimaza kakhulu isibindi sakho. I-hepatitis isakazeka isuka kumuntu iye komunye umuntu ngokuthinta ngqo uketshezi lomzimba lomuntu onegciwane, njengegazi labo noma isidoda. Kungaphinde kudluliselwe kusuka kumama kuye enganeni ngesikhathi sokubeletha. Unganciphisa ubungozi be-hepatitis B no-C ngokusebenzisa ukuvikelwa ngesikhathi sokuya ocansini. Kukhona nomuthi wokugoma ongakuvikela ku-hepatitis B.
• Ukuba neziphuzo ezidakayo ezimbili noma ngaphezulu nsuku zonke eminyakeni eminingi kwandisa ingozi yokuba nomdlavuza wesibindi.
• I-Cirrhosis iyindlela yokulimala kwesibindi lapho izicubu ezinempilo zithathelwa indawo izicubu ezinesibazi. Isibindi esinesibazi asikwazi ukusebenza kahle futhi ekugcineni singaholela ezinkingeni eziningi, kufaka phakathi umdlavuza wesibindi. Ukuphuza ngokweqile isikhathi eside kanye ne-hepatitis C yizimbangela ezivame kakhulu zesifo sokuqina kwesibindi e-United States. Iningi labantu baseMelika abanomdlavuza wesibindi bane-cirrhosis ngaphambi kokuba babe nomdlavuza wesibindi.
• Ukuvezwa kwe-aflatoxin kuyingozi. I-Aflatoxin iyinto enobuthi ekhiqizwa uhlobo lwesikhunta olungakhula kumakinati, okusanhlamvu nasemmbileni. E-United States, imithetho yokuphathwa kokudla inciphisa ukutholakala okubanzi kwe-aflatoxin. Ngaphandle kwezwe, ukuvezwa kwe-aflatoxin kungaba phezulu.
• Isifo sikashukela nokukhuluphala nakho kuyizinto eziyingozi. Abantu abanesifo sikashukela bavame ukukhuluphala ngokweqile noma ukukhuluphala, okungadala izinkinga zesibindi futhi kwandise ingozi yomdlavuza wesibindi.

Inkomba: Ezempilo

Ungayinciphisa kanjani ingozi yomdlavuza wesibindi?

Izinyathelo zokunciphisa ingozi yomdlavuza wesibindi zifaka:

• Njalo bheka udokotela ogxile kwizifo zesibindi
• Khuluma nodokotela wakho ngokuvimbela i-virus ye-hepatitis, kufaka phakathi imigomo ye-hepatitis A ne-hepatitis B
• Thatha izinyathelo ukuvimbela ukuvezwa kwesifo sokusha kwesibindi kohlobo B kanye nesifo sokusha kwesibindi kohlobo C. Ungathola kabanzi mayelana nokuthi ungasivimbela kanjani i-hepatitis B lapha, nokuthi ungasivimbela kanjani i-hepatitis C lapha.
• Uma une-cirrhosis noma isifo esingalapheki sesibindi, landela izincomo zikadokotela wakho zokwelashwa bese uhlolwe njalo ngomdlavuza wesibindi
• Uma ukhuluphele ngokweqile noma ukhuluphele ngokweqile, unesifo sikashukela, noma uphuza kakhulu, khuluma nodokotela wakho

Utholakala kanjani umdlavuza wesibindi?

Ukuxilongwa komdlavuza wesibindi kuqala ngomlando wezokwelapha kanye nokuhlolwa komzimba. Qiniseka ukuthi utshela udokotela wakho uma unomlando wokusebenzisa kabi utshwala isikhathi eside noma ukutheleleka okungapheli kwe-hepatitis B noma C.

Ukuhlolwa kokuxilongwa kanye nezinqubo zomdlavuza wesibindi kufaka lokhu okulandelayo:

• Ukuhlolwa kokusebenza kwesibindi kusiza udokotela wakho ukuthi anqume impilo yesibindi sakho ngokulinganisa amazinga wamaprotheni, ama-enzyme wesibindi, kanye ne-bilirubin egazini lakho.
• Ukuba khona kwe-alpha-fetoprotein (AFP) egazini kungaba uphawu lomdlavuza wesibindi. Le phrotheni ivame ukukhiqizwa kuphela esibindini nasesikhumbeni sezingane ngaphambi kokuba zizalwe. Ukukhiqizwa kwe-AFP kuvamisile ukuma ngemuva kokuzalwa.
• Iskena se-CT noma iMRI esiswini sikhiqiza izithombe ezinemininingwane yesibindi nezinye izitho esiswini. Bangavumela udokotela wakho ukuthi akhombe lapho kutholakala khona isimila, anqume ubukhulu baso, futhi ahlole ukuthi asinabele yini kwezinye izitho.

Ukuphika kwesibindi

Olunye uvivinyo lokuxilonga olutholakalayo yi-biopsy yesibindi. I-biopsy yesibindi ihilela ukususa isiqeshana esincane sezicubu zesibindi. Kwenziwa njalo kusetshenziswa i-anesthesia ukukuvimbela ekuzweni noma yibuphi ubuhlungu ngesikhathi senqubo.

Ezimweni eziningi, kwenziwa i-biopsy yenaliti. Phakathi nale nqubo, udokotela wakho uzofaka inaliti encane esiswini sakho nasesibindi sakho ukuthola isampula lezicubu. Isampula bese ihlolwa ngaphansi kwesibonakhulu ukuthola izimpawu zomdlavuza.

I-biopsy yesibindi nayo ingenziwa kusetshenziswa i-laparoscope, eyishubhu ezacile, eguquguqukayo enekhamera enamathiselwe. Ikhamera ivumela udokotela wakho ukuthi abone ukuthi isibindi sibukeka kanjani nokuthi enze i-biopsy enembile. I-laparoscope ifakwa ngokusika okuncane esiswini. Uma kudingeka amasampula wezicubu ezivela kwezinye izitho, udokotela wakho uzokwenza imbobo enkulu. Lokhu kubizwa ngokuthi yi-laparotomy.

Uma umdlavuza wesibindi utholakala, udokotela wakho uzonquma isigaba somdlavuza. Isiteji sichaza ubunzima noma ubukhulu bomdlavuza. Kungasiza udokotela wakho ukunquma izinketho zakho zokwelashwa nombono wakho. Isigaba 4 yisigaba esithuthuke kakhulu somdlavuza wesibindi.

Izinhlobo zomdlavuza wesibindi

Umdlavuza wesibindi oyinhloko

Umdlavuza oqala esibindini ubizwa ngokuthi umdlavuza oyinhloko wesibindi. Kunezinhlobo ezingaphezu kweyodwa zomdlavuza oyinhloko wesibindi.

I-hepatocellular carcinoma (HCC)

Le yindlela ejwayelekile yomdlavuza wesibindi kubantu abadala.

Umdlavuza we-hepatocellular ungaba namaphethini wokukhula ahlukile:

• Ezinye ziqala njengesimila esisodwa esikhula sibe sikhulu. Kuphela ngemuva kwesifo lapho sisakazeka kwezinye izingxenye zesibindi.
• Uhlobo lwesibili lubonakala luqala amaqhuqhuva amaningi omdlavuza wesibindi sonke isibindi, hhayi isimila esisodwa. Lokhu kubonakala kaningi kubantu abane-cirrhosis (ukulimala okungapheli kwesibindi) futhi kuyindlela evame kakhulu ukubonwa e-United States.

Odokotela bangahlukanisa ama-subtypes amaningana we-HCC. Ngokuvamile lawa ma-subtypes awathinti ukwelashwa noma ukubikezela (umbono). Kepha enye yalezi zinhlayiya, i-fibrolamellar, kubalulekile ukuqaphela. Akuvamile, okwenza ngaphansi kwe-1% lama-HCC futhi kuvame ukubonakala kwabesifazane abangaphansi kweminyaka yobudala engama-35. Imvamisa sonke isibindi asinasifo. Le subtype ithambekele ekubeni nombono ongcono kunezinye izinhlobo ze-HCC.

I-Intrahepatic cholangiocarcinoma (umdlavuza we-bile duct)

Cishe u-10% kuya ku-20% womdlavuza oqala esibindini yi-intrahepatic cholangiocarcinomas. Lawa mdlavuza aqala kumaseli agudla amapayipi amancane enyongo (amashubhu ahambisa inyongo eya enyongweni) ngaphakathi kwesibindi. Iningi le-cholangiocarcinomas, noma kunjalo, empeleni liqala emapayipini enyongo ngaphandle kwesibindi.

Nakuba lonke lolu lwazi luphathelene nomdlavuza we-hepatocellular, i-cholangiocarcinoma ivame ukuphathwa ngendlela efanayo. Ukuze uthole imininingwane eyengeziwe ngalolu hlobo lomdlavuza, bheka i-Bile Duct Cancer.

I-Angiosarcoma ne-hemangiosarcoma

Lawa angama-cancer angavamile aqala kumaseli afaka imithambo yegazi yesibindi. Abantu abadalulwe i-vinyl chloride noma i-thorium dioxide (Thorotrast) maningi amathuba okuthi bahlakulele le mdlavuza. Amanye amacala kucatshangwa ukuthi abangelwa ukuvezwa i-arsenic noma i-radium, noma isimo esizuzwe njengefa esaziwa njenge-hemochromatosis yefa. Cishe uhhafu wawo wonke amacala, asikho isizathu esingabonakala.

Lezi zicubu zikhula ngokushesha futhi ngokuvamile zisabalele kakhulu ukuthi zingasuswa ngokuhlinzwa lapho zitholakala. Ukwelashwa ngamakhemikhali nokwelashwa ngemisebe kungasiza ekunciphiseni isifo, kepha lawa mdlavuza ngokuvamile kunzima kakhulu ukuselapha. Lawa mdlavuza uphathwa njengamanye ama-sarcomas. Ngeminye imininingwane, bheka iSoft Tissue Sarcoma.

I-hepatoblastoma

Lolu uhlobo lomdlavuza oluyivelakancane olukhula ezinganeni, ngokuvamile kulezo ezingaphansi kweminyaka emi-4 ubudala. Amaseli we-hepatoblastoma afana namaseli esibindi se-fetus. Cishe izingane ezimbili kwezingu-2 ezinalezi zimila zelashwa ngokuphumelelayo ngokuhlinzwa nangokwelashwa ngamakhemikhali, nakuba lezi zimila kunzima ukwelapheka uma zisakazekele ngaphandle kwesibindi.

Umdlavuza wesibindi wesibili (umdlavuza wesibindi we-metastatic)

Isikhathi esiningi lapho umdlavuza utholakala esibindini awuzange uqale lapho kepha usabalale (wagcotshwa) kusuka kwenye indawo emzimbeni, njengamanyikwe, ikholoni, isisu, isifuba noma iphaphu. Ngenxa yokuthi lo mdlavuza ususabalale endaweni yawo yokuqala (yokuqala), ubizwa ngokuthi ngumdlavuza wesibindi wesibili. Lezi zicubu zibizwa ngamagama futhi zelashwe ngokususelwa endaweni yazo eyinhloko (lapho ziqale khona). Isibonelo, umdlavuza oqale emaphashini futhi usabalale uye esibindini ubizwa ngokuthi umdlavuza wamaphaphu ngokusakazeka kwesibindi, hhayi umdlavuza wesibindi. Iphinde iphathwe njengomdlavuza wamaphaphu.

E-United States naseYurophu, izicubu zesibindi zesibili (metastatic) zivame kakhulu kunomdlavuza wesibindi oyinhloko. Okuphambene kunjalo ezindaweni eziningi zase-Asia nase-Afrika.

Ngeminye imininingwane ngamastastases wesibindi avela ezinhlotsheni ezahlukahlukene zomdlavuza, bheka izinhlobo ezithile zomdlavuza, kanye ne-Advanced Cancer.

Izilonda zesibindi seBenign

Izicubu zeBenign kwesinye isikhathi zikhula ngokwanele ukudala izinkinga, kepha azikhuli zibe izicubu eziseduze noma zisabalale ziye ezingxenyeni ezikude zomzimba. Uma zidinga ukwelashwa, isiguli singalapheka ngokuhlinzwa.

IHemangioma

Uhlobo oluvame kakhulu lwesimila sesibindi esibi, ama-hemangiomas, luqala emithanjeni yegazi. Ama-hemangiomas amaningi esibindi abanga zimpawu futhi awadingi ukwelashwa. Kodwa abanye bangopha futhi badinga ukususwa ngokuhlinzwa.

I-adenoma ye-hepatic

I-hepatic adenoma yisimila esibi esiqala kusuka kuma-hepatocyte (uhlobo oluyinhloko lweseli lesibindi). Iningi alibangeli zimpawu futhi alidingi ukwelashwa. Kodwa ezinye zigcina zibangele izimpawu, njengobuhlungu noma isigaxa esiswini (esiswini) noma ukulahleka kwegazi. Ngoba kunengozi yokuthi isimila singadabhuka (okuholele ekulahlekelweni kakhulu kwegazi) kanye nengozi encane yokuthi singagcina sikhule saba ngumdlavuza wesibindi, ochwepheshe abaningi bavame ukweluleka ukuhlinzwa ukuze kususwe isimila uma kungenzeka.

Ukusebenzisa imishanguzo ethile kungandisa ingozi yokuthola lezi zicubu. Abesifazane banethuba eliphakeme lokuba nesinye salezi zicubu uma bephuza amaphilisi okuvimbela inzalo, yize lokhu kungavamile. Amadoda asebenzisa i-anabolic steroids nawo angahlakulela lezi zicubu. I-Adenomas ingancipha lapho imiswa le mithi.

I-hyperplasia ye-nodular ejwayelekile

I-Focal nodular hyperplasia (FNH) ukukhula okufana nesimila okwenziwe ngezinhlobo zamaseli eziningana (ama-hepatocyte, amaseli we-bile duct, kanye namaseli wezicubu ezihlanganayo). Yize izicubu ze-FNH zilungile, zingadala izimpawu. Kungaba nzima ukuwazisa ngaphandle komdlavuza weqiniso wesibindi kanti odokotela kwesinye isikhathi bayawususa lapho ukuxilongwa kungacaci.

Kokubili i-adenomas ye-hepatic kanye nezicubu ze-FNH zivame kakhulu kwabesifazane kunamadoda.

Uphathwa kanjani umdlavuza wesibindi?

Ukwelashwa komdlavuza wesibindi kuyahlukahluka. Kuya nge:

• inani, usayizi, nendawo yamathumba esibindi
• ukuthi isibindi sisebenza kahle kanjani
• noma ngabe i-cirrhosis ikhona
• ngabe isimila sesisabalalele yini kwezinye izitho

Uhlelo lwakho lokwelashwa oluthile luzosuselwa kulezi zinto. Ukwelashwa komdlavuza wesibindi kungafaka okulandelayo:

Ukwelashwa kwe-Proton

Ukwelashwa kweProton kukhombise ukuthi kuyindlela enhle kakhulu yokwelashwa komdlavuza wesibindi ongasetshenziswanga. Ezimweni eziningi kubonakala ukuthi isimila siphela ngokuphelele ngemuva kokwelapha i-proton.

I-hepatectomy

I-hepatectomy yenziwa ukususa ingxenye yesibindi noma sonke isibindi. Lokhu kuhlinzwa kuvame ukwenziwa lapho umdlavuza ugcinwe esibindini. Ngokuhamba kwesikhathi, izicubu ezinempilo ezisele zizokhula kabusha bese zithatha ingxenye elahlekile.

Ukufakelwa kwesibindi

Ukufakelwa kwesibindi kuhilela ukufaka sonke isibindi esinezifo ngesibindi esinempilo esivela kumnikeli ofanele. Ukufakelwa kungenziwa kuphela uma umdlavuza ungakasakazeki kwezinye izitho. Imithi yokuvikela ukwenqatshwa inikezwa ngemuva kokufakelwa kabusha.

Ukususwa kwemali

I-Ablation ifaka ukusetshenziswa komjovo wokushisa noma we-ethanol ukubhubhisa amangqamuzana omdlavuza. Kwenziwa kusetshenziswa i-anesthesia yendawo. Lokhu kufiphaza indawo ukukuvimbela ekubeni uzwe ubuhlungu. I-Ablation ingasiza abantu abangakhethelwa ukuhlinzwa noma ukufakelwa.

Ukwelashwa ngamakhemikhali

I-Chemotherapy iyindlela enolaka yokwelashwa kwezidakamizwa ebulala amangqamuzana omdlavuza. Imithi ijojowe ngemithambo, noma ngomthambo. Ezimweni eziningi, i-chemotherapy inganikezwa njengokwelashwa kweziguli. I-Chemotherapy ingasebenza ekwelapheni umdlavuza wesibindi, kepha abantu abaningi baba nemiphumela engemihle ngesikhathi sokwelashwa, kufaka phakathi ukuhlanza, ukuncipha kwesifiso sokudla, nokubanda. I-Chemotherapy ingakhuphula nobungozi bokutheleleka.

I-Radiation Therapy

Ukwelashwa ngemisebe kuhilela ukusetshenziswa kwemishayo yamandla emisebe ephezulu ukubulala amangqamuzana omdlavuza. Ingalethwa ngemisebe yangaphandle yesigxobo noma ngemisebe yangaphakathi. Kumisebe yegongolo yangaphandle, imisebe ibhekiswe esiswini nasesifubeni. Imisebe yangaphakathi ifaka phakathi ukusebenzisa ipayipi lokufaka umjovo ukuze kufakelwe imisebe emincane emisebeni ye-hepatic. Imisebe bese ibulala umthambo we-hepatic, umthambo wegazi onikeza igazi esibindini. Lokhu kunciphisa inani legazi eligeleza ku-tumor. Lapho umthambo we-hepatic uvaliwe, umthambo we-portal uyaqhubeka nokondla isibindi.

Ukwelashwa okubhekiswe

Ukwelashwa okuhlosiwe kubandakanya ukusetshenziswa kwemithi eyenzelwe ukushaya amangqamuzana omdlavuza lapho esengozini khona. Zinciphisa ukukhula kwesimila futhi zisize ukuvala ukunikezwa kwegazi kulesimila. I-Sorafenib (Nexavar) ivunyelwe njengokwelashwa okubhekiswe kubantu abanomdlavuza wesibindi. Ukwelashwa okuhlosiwe kungasiza kubantu abangabhaliselwa ukufakelwa i-hepatectomy noma ukufakelwa kwesibindi. Kodwa-ke, ukwelashwa okuqondisiwe kungaba nemiphumela emibi kakhulu.

Ukuhlanganiswa kanye ne-Chemoembolization

Ukuhlanganiswa kanye ne-chemoembolization kuyizinqubo zokuhlinzwa. Sekwenziwe ukuvimba umthambo we-hepatic. Udokotela wakho uzosebenzisa izipanji ezincane noma ezinye izinhlayiya ukwenza lokhu. Lokhu kunciphisa inani legazi eligelezela esihlahleni. E-chemoembolization, udokotela wakho ujova izidakamizwa ze-chemotherapy emthanjeni we-hepatic ngaphambi kokuba izinhlayiya zijojowe. Ukuvinjelwa okwenziwe kugcina imishanguzo ye-chemotherapy esibindi isikhathi eside.