Ungakuvimbela kanjani ukuphindaphinda komdlavuza we-colorectal? Indlela yokwelapha ukuphindaphinda komdlavuza we-colorectal ngemva kokuhlinzwa?
Umdlavuza we-Colorectal uyisigaxa esivamile esibi, kufaka phakathi umdlavuza we-colon kanye ne-rectal. Isigameko somdlavuza obala kusuka phezulu kuye phansi yi-rectum, sigmoid colon, ikhuphuka ikholoni, ikholoni eyehlayo, nekholoni eguqukayo. Eminyakeni yamuva nje, kube nokuthambekela ekubhekaneni ne-proximal (kwesokudla ikholoni).
Uma umdlavuza omnyama utholakala kusenesikhathi, ungalapheka.
Isilinganiso seminyaka engu-5 sokusinda komdlavuza onobala
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.
Ngomdlavuza wekoloni, isilinganiso seminyaka emihlanu sokusinda singama-5%. Isilinganiso seminyaka emi-64 sokusinda komdlavuza wekoloni wasendaweni singama-5%; Isilinganiso seminyaka engu-90 sokusinda singama-5% se-metastasis ezicutshini ezizungezile noma izitho kanye / noma ama-lymph nodes esifunda; Izinga lokusinda leminyaka engu-71 liyi-5% lomdlavuza wekoloni owenzeke kude.
Ngomdlavuza we-rectal, isilinganiso seminyaka emihlanu sokusinda singama-5%. Izinga lokusinda leminyaka emihlanu lomdlavuza we-rectal wendawo yi-67%; isilinganiso sokusinda seminyaka emi-5 singama-89% we-metastases kwizicubu noma izitho ezizungezile kanye / noma ama-lymph node wesifunda. Uma ama-metastases akude avela kumdlavuza we-rectal, izinga lokusinda leminyaka emihlanu liyi-5%.
Ukwelashwa kwamanje komdlavuza we-colorectal kufaka phakathi ukuhlinzwa, i-chemotherapy, i-radiotherapy, ukwelashwa okuhlosiwe, kanye ne-immunotherapy. Ukuhlinzwa kuyindlela ekhethwayo yokwelapha umdlavuza we-colorectal. Kodwa u-Vicki, umhleli wasekhaya ongenawo umdlavuza, wafunda ukuthi cishe amaphesenti angu-60 kuya kwangu-80 eziguli ezinomdlavuza wamabele azophinde aqale phakathi neminyaka emi-2 ngemva kokuhlinzwa.
Ungakuvimbela kanjani ngempumelelo ukuphindeka komdlavuza onobala?
Thuthukisa indlela yokuphila
Yeka utshwala, yeka utshwala, yeka utshwala, izinto ezibalulekile zishiwo kathathu, kufanele uyeke utshwala. Futhi, ungabhemi, ungasebenzisi ngokweqile, futhi uhlale ujabule.
Ukuzivocavoca okufanele, izinyanga ezingu-2-3 ngemva kokuhlinzwa, ungenza izivivinyo ezithambile, njengokuhamba, futhi kancane kancane ukwandisa kusuka kumaminithi angu-15 kuya kumaminithi angu-40; ungakwazi futhi ukuzivocavoca i-qigong, i-Tai Chi, izivivinyo zomsakazo nezinye izivivinyo ezithambile.
Ukunakekelwa okukhethekile kufanele kukhokhelwe ekudleni, ungadli ukudla okubunjiwe, i-barbecue, i-bacon, i-tofu nokunye ukudla okuqukethe i-nitrite, futhi ungadli umuthi wendabuko nemikhiqizo yezempilo yase-China.
Ukudla kwangemva kokuhlinzwa kulula kakhulu, futhi ukutholakala kwamaprotheni asezingeni eliphakeme njengeqanda elimhlophe nenyama enciphile kuyanda ngokufanele. Ukudla okwenziwa ngemuva kokuhlinzwa kuvame ukusuka emanzini, iphalishi, ubisi, amaqanda ashubile, inhlanzi, inyama engenamafutha kuya ekudleni okujwayelekile.
Zama ukudla ukudla okugaya kalula, gwema okunamafutha, okubabayo, okucasulayo, okunzima, okunamathelayo nokunye ukudla, yidla ukudla okunomsoco, udle ukudla okumbalwa, futhi akufanele kugcwale.
Ukusetshenziswa njalo kwamantongomane afana nama-cashews, ama-hazelnuts, ama-alimondi, nama-walnuts kunganciphisa izinga lokuphindaphinda komdlavuza wamathumbu.
Izincomo zokunakekelwa kwangemva kokuhlinzwa zomdlavuza onobala
I-suture iqediwe ezinsukwini ezingu-7-10 ngemuva komdlavuza wekoloni. Iziguli ezindala noma iziguli ezinezinkinga ezithile zingasandisa ngokufanele isikhathi sokususwa komthungo. Ngemuva kokususwa komthungo, kufanele banake inhlanzeko yenxeba ukugwema ukutheleleka.
Ngemuva kokuthi umthungo ususiwe, amabhande wokugqoka nawesisu kufanele aqhubeke nokuqiniswa ngesikhathi sokuphulukiswa kwesilonda kuze kube yilapho imbobo yokuhlinzwa isilulame ngokuphelele, ethatha cishe isigamu senyanga.
Lowo odonsa isikhumba kufanele asuswe okungenani ezinsukwini eziyi-10 ngemuva kokuhlinzwa. Isilonda kufanele sigcinwe sihlanzekile futhi somile ngangokunokwenzeka ukunciphisa ukujuluka. Ungageza, kepha awukwazi ukugcoba isilonda.
Kujwayelekile ukuthi ube ndikindiki ezungeze isilonda ngemuva kokuhlinzwa, okuzonyamalala ngemuva kwesikhashana.
Kujwayelekile ukuthi amanxeba aphume. Inani elincane lingasetshenziselwa ukubulala amagciwane endawo. Shintsha ukugqoka ngaphezulu. Kodwa-ke, uma inani le-exudate likhulu futhi libomvu ngokubomvu, kwenzeka ukuvuvukala nobuhlungu, kufanele uxhumane nodokotela wakho ngesikhathi ukuze welaphe isilonda.
Lapho ukusikeka kokuhlinzwa sekuzokhula, kuzozizwa kuluma, okwaziwa kakhulu ngokuthi "inyama ende". Ngalesi sikhathi, gwema ukuklwebheka, ungawatholi amanzi, futhi ugweme ukutheleleka.
Isilonda singaphezu kwesikhathi sokuphola, kepha asikhuli kahle. Udinga ukuthola udokotela ohlinzayo ozobamba, ushintshe umuthi ngesikhathi, uhlanze isilonda, welaphe nokutheleleka. Ngasikhathi sinye, naka ukulawula ushukela wegazi nokuqinisa umsoco.
Amanxeba endunu ngokuvamile athatha inyanga ukuphola. Ngemuva kokuphulukiswa, ungajwayela ukuhamba kancane, imizuzu engu-3-5 isikhathi ngasinye, kanye ekuseni nantambama.
Uma isilonda siphola kahle, ungageza ezinsukwini eziyi-7-14 ngemuva kokukhipha umthungo. Ungasebenzisa ukugeza umzimba noma insipho, kepha gwema isilonda.
Ukubuyekeza ngezikhathi ezithile
Ngokwezibalo, ukuphindaphinda kanye nesilinganiso semastastasis somdlavuza we-colon ngemuva kokuhlinzwa e-China siphezulu ngama-50%, futhi ngaphezu kwe-90% yokuphindaphinda kanye ne-metastasis kwenzeka eminyakeni engu-2-3 ngemuva kokuhlinzwa, futhi inani lokuphindeka liphansi ngemuva kweminyaka emihlanu . Ngakho-ke, ukuhlinzwa akuyona into yesikhathi esisodwa, futhi kufanele uphikelele ekubuyekezweni okujwayelekile ngemuva kokuhlinzwa.
Iziguli ezinomdlavuza wamathumbu zinamathuba amaningi okuthi zibuyele emuva kungakapheli iminyaka emithathu zihlinziwe. Ngalesi sikhathi, inani lokuhlolwa kabusha kufanele liphindaphindwe; ngemuva kweminyaka emi-3, isikhathi sokuhlola kabusha singezwa ngokufanele.
Ngokuvamile, kubuyekezwa njalo ezinyangeni ezi-3 kungakapheli unyaka owodwa ngemuva kokuhlinzwa; ibuyekezwa njalo ngonyaka ngonyaka wokuqala we-1-2; futhi njalo eminyakeni engu-3-4. Isikhathi esithile sokubuyekeza sidinga nokuthola udokotela wabo ozonquma.
Ngesikhathi sokubuyekezwa, izinto ezizobhekwa zifaka:
Ukuhlolwa kwegazi: ukusebenza kwegazi, ukusebenza kwesibindi nezinso, omaka besimila (i-CEA, njll.);
Ukuhlola ukuhlolwa: i-B-ultrasound, i-radiograph yesifuba
IColonoscopy: yenziwa ezinyangeni ezintathu ngemuva kokuhlinzwa ukunquma ukuphulukiswa kwe-anastomosis yokuhlinzwa nokubuka ama-polyps kwezinye izingxenye.
Ungakwelapha kanjani ukuphindaphinda komdlavuza wamathumbu ngemuva kokuhlinzwa?
Ukuhlinzwa kwesibili
Indlela ekahle kunazo zonke yokuphindeka kweziguli ezinomdlavuza ngemuva kokuhlinzwa ukususa izilonda eziphindaphindayo ukufeza inhloso yokwelashwa okunamandla. Into yokuqala okufanele uyenze ukubona ukuthi kungenziwa yini ukuhlinzwa okwesibili kokuhlinzwa. Uma izindlela zokuhlinza zihlangatshezwa, isimila singasuswa ngokuhlinzwa.
Uma kunezilonda eziningi, indawo yokuhlasela inkulu kakhulu, noma ama-metastases akude, uma ukusebenzelana kabusha kuthanda ukuba sengozini, futhi esimweni lapho inzuzo yokuhlinzwa ingaqinisekisiwe, ezinye izindlela zokwelashwa zingakhethwa.
Imithi esetshenziswa ekwelashweni komdlavuza wekoloni
Izidakamizwa ze-Colon cancer chemotherapy
I-chemotherapeutics evamile i-5-fluorouracil, irinotecan, oxaliplatin, calcium folinate, capecitabine, tigio (S-1), kanye ne-TAS-102 (trifluridine / tipiracil).
Kodwa-ke, i-chemotherapy yomdlavuza wekoloni imvamisa inhlanganisela yamakhemikhali amaningi, futhi izindlela ezijwayelekile zokuhlanganisa yilezi:
1.FOLFOX (i-fluorouracil, i-calcium folinate, i-oxaliplatin)
2.FOLFIRI (i-fluorouracil, i-calcium folinate, i-irinotecan)
I-3.CAPEOX (ICapecitabine, i-Oxaliplatin)
I-4.FOLFOXIRI (i-fluorouracil, i-calcium folinate, i-irinotecan, i-oxaliplatin)
Umdlavuza we-Colon oqonde izidakamizwa kanye nezidakamizwa zokuzivikela
1. I-KRAS / NRAS / BRAF izidakamizwa ezihlosiwe zohlobo lwasendle: i-cetuximab noma i-panitumumab (evame ukusetshenziswa kumdlavuza wekholoni kwesokunxele)
2. Ama-anti-angiogenesis inhibitors: i-bevacizumab noma i-ramonizumab noma i-ziv aflibercept
3. Izidakamizwa eziqondiwe ze-BRAF V600E: i-dalafenib + trimetinib; connetinib + bimetinib
4. I-NTRK fusion eqondise izidakamizwa: I-Larotinib; Emtricinib
5.MSI-H (dMMR) PD-1: Paimumab; Navumab ± Ipilimumab
Isidakamizwa esibhekiswe ku-6.HER2: iTrastuzumab + (iPertuzumab noma iLapatinib)
Ngaphezu kokuhlinzwa nokwelashwa ngemisebe ngomdlavuza othuthukile wamakholoni, imishanguzo yesistimu iyisigaba sokwelapha esibalulekile Umsinga
Ukwelashwa kwe-st-line kubhekisa esigabeni sokwelashwa kokuqala ngemithi elwa nomdlavuza, ebizwa nangokuthi ukwelashwa kokuqala. Kunezinketho eziningi zokwelashwa komugqa wokuqala komdlavuza othuthukile wamakholoni, imvamisa osuselwa ekhemotherapy.
Kodwa-ke, kufanele kuhlukaniswe isimo sesiguli nesimo somzimba. Ngemuva kochungechunge lwezivivinyo, iziguli zingahlukaniswa ngezigaba ezimbili: iziguli ezilungele ukwelashwa okunamandla kakhulu nalabo abangafanelekile.
Ukukhethwa kwezidakamizwa zokwelashwa okuphezulu kweziguli ezinomdlavuza
Ihlukaniswe ngezigaba ezintathu:
Izixazululo zomugqa wokuqala nge-oxaliplatin
Izixazululo zomugqa wokuqala ezine-irinotecan
(1) Uhlelo lomugqa wokuqala oluqukethe i-oxaliplatin
I-FOLFOX ± bevacizumab
ICAPEOX ± Bevacizumab
I-FOLFOX + (i-cetuximab noma i-panitumumab) (kuphela i-KRAS / NRAS / BRAF yohlobo lwasendle lomdlavuza wamakholoni)
(B) uhlelo lomugqa wokuqala oluqukethe i-irinotecan
FOLFIRI ± bevacizumab noma
I-FOLFIRI + (i-cetuximab noma i-panitumumab) (kuphela i-KRAS / NRAS / BRAF yohlobo lwasendle lomdlavuza wamakholoni)
(III) Uhlelo lomugqa wokuqala oluqukethe i-oxaliplatin + irinotecan
I-FOLFOXIRI ± Bevacizumab
Ukukhethwa kwezidakamizwa akulungele ukwelashwa okunamandla kakhulu kumdlavuza we-colorectal
Izinketho zemithi yomugqa wokuqala
1. Ukufakwa kwe-5-fluorouracil + calcium folinate ± bevacizumab noma
2.I-Capecitabine ± Bevacizumab
3. I-Cetuximab noma i-panitumumab) (Ubufakazi be-Class 2B, obenzelwe i-KRAS / NRAS / BRAF kuphela yomdlavuza wasekholoni wesobunxele)
I-Navumab noma i-Paimumab (ye-dMMR / MSI-H kuphela)
5. INivolumab + Ipilimumab (thayipha ubufakazi 2B, busebenza kuphela ku-dMMR / MSI-H)
6. I-Trastuzumab + (i-Pertuzumab noma i-Lapatinib) (yamathumba ane-HER2 yokukhulisa nohlobo lwasendle lwe-RAS)
1) Ngemuva kokwelashwa okungenhla, isimo sokusebenza asithuthuki, futhi kukhethwa ukwelashwa okungcono kakhulu (i-palliative care);
2) Ngemuva kokwelashwa okungenhla, isimo sokusebenza siyathuthuka, futhi kungacatshangelwa isu lokuqala elinamandla amakhulu.
Ukukhethwa kwemithi kokugcina kumdlavuza obala ngokwezibalo
URigfini
I-Trifluorothymidine + tipiracil
Ukunakekelwa okuhle kakhulu (ukunakekelwa okunciphisayo)
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
