Ungakuvimbela kanjani ukubuyela emuva komdlavuza onemibala, ukuthi ukwelapha kanjani ukubuyela emuva komdlavuza obala ngemuva kokuhlinzwa?
Colorectal cancer is a common malignant tumor, including colon cancer and rectal cancer. The incidence of colorectal cancer from high to low is rectum, sigmoid colon, ascending colon, descending colon and transverse colon. In recent years, there is a trend toward the proximal end (right colon). If umdlavuza colorectal is detected early, it can usually be cured.
Izinga lokusinda leminyaka engu-5 lomdlavuza obala ngokwebala
Ngokuya ngemininingwane esemthethweni ye-US ASCO, isilinganiso seminyaka emi-5 sokusinda kweziguli ezinomdlavuza obomvu ngama-65%. Kodwa-ke, izinga lokusinda komdlavuza onobala lingahluka ngokuya ngezici eziningi, ikakhulukazi isigaba.
Ukuze umdlavuza colon, the overall 5-year survival rate is 64%. The 5-year survival rate for limited-stage colon cancer is 90%; the 5-year survival rate is 71% for metastasis to surrounding tissues or organs and / or regional lymph nodes; the 5-year survival rate is 14% if colon cancer has metastasized distant .
Ngomdlavuza we-rectal, inani lokusinda leminyaka emihlanu liyi-5%. Izinga lokusinda leminyaka eyisi-67 lomdlavuza wesikali onqunyelwe lingama-5%; isilinganiso seminyaka emihlanu sokusinda kwe-metastasis kwizicubu noma izitho ezizungezile kanye / noma ama-lymph node wesifunda angama-89%. Uma kune-metastasis ekude yomdlavuza we-rectal, izinga lokusinda leminyaka emihlanu liyi-5%.
Currently, treatments for colorectal cancer include surgery, chemotherapy, radiotherapy, targeted therapy, and immunotherapy. Ukuhlinzwa kuyindlela ekhethwayo yokuqeda umdlavuza obala ngokombala. Kepha uVicki, umhleli wekhaya elingenawo umdlavuza, ufunde ukuthi cishe iziguli ezingama-60% kuya kwezingu-80% ezinomdlavuza we-rectal zizobuyela emuva eminyakeni emibili ngemuva kokuhlinzwa.
Ungakuvimbela kanjani ngempumelelo ukuphindeka komdlavuza onobala?
Thuthukisa indlela yokuphila
Ukuyeka ukuphuza, ukuyeka ukuphuza, ukuyeka ukuphuza, ukusho izinto ezibalulekile kathathu, kufanele uyeke ukuphuza. Ngaphezu kwalokho, ungabhemi, ungasebenzi ngokweqile, futhi ugcine isimo senjabulo.
Ukuzivocavoca okufanele, izinyanga ezingu-2-3 emva kokuhlinzwa, ungenza izivivinyo ezithambile, njengokuhamba, kancane kancane ukwandisa kusuka kumaminithi angu-15 kuya kumaminithi angu-40; ungakwazi futhi ukuzijwayeza i-qigong, i-Tai Chi, i-radio gymnastics nokunye ukuvivinya umzimba okumnene.
Nakekela ngokukhethekile ekudleni, ungadli ukudla okunesikhunta, i-barbecue, i-bacon, i-tofu, i-nitrite equkethe ukudla, futhi ungadli umuthi waseChina nemikhiqizo yezempilo.
Ukudla okwenziwa ngemuva kokuhlinzwa kulula kakhulu, futhi ukutholakala kwamaprotheni asezingeni eliphakeme, njengenyama emhlophe yeqanda nenyama, kukhushulwa ngokufanele. Ukudla okwenziwa ngemuva kokuhlinzwa kuvame ukusuka emanzini, iphalishi, ubisi, amaqanda ashubile, inhlanzi, inyama engenamzimba ekudleni okujwayelekile.
Yidla ukudla okugayekayo ngangokunokwenzeka, gwema okunamafutha, okubabayo, okucasulayo, okunzima kakhulu, okunamathelayo nokunye ukudla, yidla ukudla okunomsoco, udle ukudla okumbalwa futhi ungadli kakhulu esidlweni ngasinye.
Ukusetshenziswa njalo kwamantongomane anjengama-cashew, ama-hazelnuts, ama-walnuts, ama-alimondi, nama-walnuts kunganciphisa izinga lokuphindaphinda komdlavuza wamathumbu.
Iseluleko sobuhlengikazi sangemva kokuhlinzwa somdlavuza onobala
Ukususwa komthungo kwaqedwa ezinsukwini eziyi-7-10 ngemuva kokuhlinzwa komdlavuza wamathumbu. Iziguli ezindala noma iziguli ezinezinkinga ezithile zingasandisa kahle isikhathi sokususa intambo. Ngemuva kokukhipha intambo, naka inhlanzeko yenxeba ukugwema ukutheleleka.
Ngemuva kokuthi imithungo isusiwe, kuyadingeka ukuqhubeka nokumboza ukugqoka nokuqinisa ibhande lesisu ngesikhathi sokuphulukiswa kwesilonda kuze kube yilapho imbobo yokuhlinzwa isilulame ngokuphelele, ethatha cishe isigamu senyanga.
Okungenani izinsuku eziyi-10 ngemuva kokuhlinzwa, ophakamisa isikhumba angasuswa, futhi isilonda kufanele sigcinwe sihlanzekile futhi somile ngangokunokwenzeka ukunciphisa ukujuluka. Ungageza, kepha ungasigcobi isilonda.
Kuyinto evamile ukuzwa ukuba ndikindiki eduze kwesilonda ngemuva kokuhlinzwa, futhi kuzonyamalala ngemuva kwesikhashana.
Kujwayelekile ukuthi inxeba licwebezele, futhi inani elincane lingakhishwa ngegciwane ngokwengxenye, futhi ukugqoka ebusweni kungashintshwa. Kodwa-ke, uma inani le-exudate likhulu futhi kubomvu kakhulu futhi ukuvuvukala kwenzeka, kufanele kuthintwe udokotela ngesikhathi sokwelashwa kwesilonda.
Lapho ukusikeka kokuhlinzwa sekuzokhula, kuzozizwa kuluma, okwaziwa kakhulu ngokuthi "inyama ende". Ngalesi sikhathi, gwema ukuklwebheka, amanzi nokutheleleka.
Isilonda asikapholi ngaphezu kwesikhathi sokuphulukiswa. Udinga ukuthola udokotela ohlinzayo ozobhekana nayo, ushintshe ukugqoka ngesikhathi, uhlanze isilonda, welaphe nokutheleleka, unake nokulawula ushukela wegazi nokuqinisa ukondleka komzimba.
Amanxeba endunu ngokuvamile athatha inyanga eyodwa ukuphola. Ngemuva kokuphulukiswa, ungajwayeza kancane ukunyakaza kwe-squat, imizuzu engu-3-5 isikhathi ngasinye, kanye ekuseni nantambama.
Uma isilonda siphola kahle, ungageza ezinsukwini eziyi-7-14 ngemuva kokususwa komthungo. Ungasebenzisa ijeli yokugeza noma insipho, kepha gwema isilonda.
Ukubuyekezwa njalo
Ngokwezibalo, izinga lokuphindaphinda kanye ne-metastasis yomdlavuza obala e-China lifike kuma-50%, futhi ngaphezulu kwe-90% yokuphindaphinda kanye ne-metastasis kwenzeka eminyakeni engu-2-3 ngemuva kokuhlinzwa, futhi izinga lokuphindeka liphansi ngemuva kweminyaka emihlanu. Ngakho-ke, ukusebenza akukona kanye futhi, futhi kufanele siphikelele ekubuyekezweni okujwayelekile ngemuva kokuhlinzwa.
Iziguli ezinomdlavuza wamathumbu kungenzeka ziphinde zibuyele emuva eminyakeni emithathu ngemuva kokuhlinzwa. Ngalesi sikhathi, inani lokuhlolwa kabusha kweziguli kufanele liphindaphindwe; ngemuva kweminyaka emi-3, isikhathi sokuhlola kabusha singanwetshwa ngokufanele.
Ngokuvamile, phinda uhlole njalo ezinyangeni ezi-3 kungakapheli unyaka owodwa ngemuva kokusebenza; phinda uhlole njalo uhhafu wonyaka eminyakeni emibili kuya kwezi-1-2; yihlole kanye ngonyaka eminyakeni engama-3-4. Isikhathi esithile sokubuyekeza sidinga nokuthola udokotela wakho ozosinquma Ngesikhathi sokubuyekezwa, izinto ezizobhekwa zifaka phakathi,
Ukuhlolwa kwegazi: blood routine, liver and kidney function, isisu markers (CEA, etc.);
Ukuhlola ukuhlolwa: isisu se-pelvic ultrasound, i-radiograph yesifuba
I-Colonoscopy: Izinyanga ezi-3 ngemuva kokuhlinzwa ukunquma ukuphulukiswa kwe-anastomosis kanye nokugcina ama-polyps kwezinye izingxenye
Ungakwelapha kanjani ukuphindaphinda komdlavuza wamathumbu ngemuva kokuhlinzwa?
Ukuhlinzwa kwesibili
Indlela ekahle kunazo zonke ezigulini ezinomdlavuza obala ngokwebala ukuthi zibuyele emuva ukususa izilonda eziphindaphindayo ukufeza inhloso yokwelashwa okunamandla. Okokuqala, kuya ngokuthi ngabe kungenziwa yini ukuhlinzwa kokuhlinzwa okwesibili. Uma ihlangabezana nenqubo yokuhlinzwa, isimila singasuswa ngokuhlinzwa.
Uma kunezilonda eziningi, indawo yokuhlasela inkulu kakhulu, noma i-metastasis ikude, uma ukusebenzelana kabusha kuthanda ukuba sengozini, ezinye izindlela zokwelashwa zingakhethwa lapho inzuzo yokuhlinzwa ingaqinisekisiwe.
Imithi
I-Colon cancer chemotherapy
Imithi ejwayelekile ye-chemotherapeutic i-5-fluorouracil, irinotecan, oxaliplatin, calcium folinate, capecitabine, tigeol (S-1), TAS-102 (trifluridine / tipiracil).
Kodwa-ke, i-colon cancer chemotherapy imvamisa iyinhlanganisela yemithi eminingana yokwelapha ngamakhemikhali. Izinhlanganisela ezivamile yilezi:
1.FOLFOX (i-fluorouracil, i-calcium folinate, i-oxaliplatin)
2.I-FOLFIRI (i-fluorouracil, i-calcium folinate, i-irinotecan)
I-3.CAPEOX (ICapecitabine, i-Oxaliplatin)
I-FOLFOXIRI (i-fluorouracil, i-calcium folinate, i-irinotecan, i-oxaliplatin)
Izidakamizwa ezibhekiswe kumdlavuza wekoloni kanye nezidakamizwa zokuzivikela komzimba
1. Izidakamizwa ezihlosiwe zasendle ze-KRAS / NRAS / BRAF: i-cetuximab noma i-panitumumab (evamise ukusetshenziselwa umdlavuza wamakholoni wesobunxele)
2. Ama-anti-angiogenesis inhibitors: i-bevacizumab noma i-ramucirumab noma i-ziv abercept
3. Izidakamizwa ezibhekiswe ku-BRAF V600E: dabrafenib + trametinib; connetinib + bimetinib
4. Isidakamizwa esihlosiwe sokuhlanganiswa kwe-NTRK: I-Larotinib; I-Entratinib
5.MSI-H (dMMR) PD-1: pembrolizumab; nivolumab ± ipilimumab
6. Isidakamizwa esibhekiswe ku-HER2: i-trastuzumab + (pertuzumab noma i-lapatinib)
Ngaphezu kokuhlinzwa nokwelashwa ngemisebe, umdlavuza wamakholoni osezingeni eliphakeme uyisigaba esibalulekile sokwelapha. Ukwelashwa kolayini wokuqala kubhekisa esigabeni sokuqala sokwelashwa nge-antic
izidakamizwa zomdlavuza, ezibizwa nangokuthi ukwelashwa kokuqala. Kunezinketho eziningi zokwelapha umugqa wokuqala womdlavuza wekoloni osethuthukile, ngokuvamile okusekelwe ku-chemotherapy.
Kodwa-ke, kubalulekile ukuhlukanisa isimo sesiguli nesimo somzimba. Ngemuva kochungechunge lwezivivinyo, iziguli zingahlukaniswa zibe izinhlobo ezimbili zeziguli ezilungele ukwelashwa okunamandla futhi ezingakulungele ukwelashwa okunamandla.
Ukukhethwa kwemithi efanelekile ezigulini ezinokwelapha okuphezulu
Ihlukaniswe ngezigaba ezintathu:
Isixazululo somugqa wokuqala nge-oxaliplatin
Isixazululo somugqa wokuqala nge-irinotecan
(1) Isixazululo somugqa wokuqala esiqukethe i-oxaliplatin
FOLFOX ± bevacizumab
ICAPEOX ± bevacizumab
I-FOLFOX + (i-cetuximab noma i-panitumumab) (kuphela i-KRAS / NRAS / BRAF yohlobo lwasendle lomdlavuza wamakholoni)
(2) Uhlelo lomugqa wokuqala nge-irinotecan
FOLFIRI ± bevacizumab noma
I-FOLFIRI + (i-cetuximab noma i-panitumumab) (kuphela i-KRAS / NRAS / BRAF yohlobo lwasendle lomdlavuza wamakholoni)
(3) Isixazululo somugqa wokuqala esiqukethe i-oxaliplatin + irinotecan
I-FOLFOXIRI ± bevacizumab
Ukukhethwa kwemithi akulungele ukwelashwa okunamandla kakhulu
Izinketho zemithi yomugqa wokuqala
1. Ukufakwa kwe-5-fluorouracil + calcium folinate ± bevacizumab noma
2. ICapecitabine + Bevacizumab
3. I-Cetuximab noma i-panitumumab (Ubufakazi be-Class 2B, busebenza kuphela ku-KRAS / NRAS / BRAF uhlobo lwasendle lomdlavuza wamakholoni wesobunxele)
I-Nivolumab noma i-pembrolizumab (ye-dMMR / MSI-H kuphela)
5. INivolumab + Ipilimumab (Ubufakazi beClass 2B, busebenza kuphela ku-dMMR / MSI-H)
6. I-Trastuzumab + (i-Pertuzumab noma i-Lapatinib) (Kusebenza kuma-HER2 akhulisiwe nezicubu zohlobo lwe-RAS zasendle)
1) Ngemuva kokwelashwa okungenhla, akukho ukuthuthuka esimweni sokusebenza, khetha ukwelashwa okusekelayo okungcono kakhulu (ukunakekelwa kokuthokomala);
2) Ngemuva kokwelashwa okungenhla, isimo sokusebenza siyathuthuka, futhi kungacatshangelwa uhlelo lokuqala ngamandla amakhulu.
Ukukhethwa kwemithi yokugcina
I-Regefini
I-Trifluorothymidine + tipiracil
Ukwelashwa okuhle kakhulu (ukunakekelwa okunciphisayo)
