Kukho iziqendu ezininzi zolwazi ogqirha bajonge ukuze bafumane umhlaza wesibeleko . Imvavanyo yokucinga ingabandakanya uhlobo olukhethekileyo lwe-CT scan, esiswini lwe-endoscopic, i-MRI, okanye i-ERCP. Iimvavanyo zegazi zingabangela izimbande ze-jaundice kunye nabamakishi be-tumor. Kwaye nembali yonyango ejolise kumngcipheko, kunye nokuhlolwa komzimba, kubalulekile.
I-biopsy isenokuthi okanye ayimfuneko, kuxhomekeke kwezinye iziphumo. Emva kokuxilongwa, isiteji senziwa ukuze kuchongwe unyango olufanelekileyo kakhulu kwisifo.
Wonke umntu kufuneka aqaphele iimpawu zokulumkisa kunye neempawu zesifo somhlaza we-pancreatic , ngoko banokufuna uvavanyo lwezonyango ngokukhawuleza.
IiLabs kunye novavanyo
Ukuvavanywa komdlavuza onomdlavuza oqhelekileyo uqala ngokuqaphela imbali kunye nokuhlolwa komzimba. Ugqirha uya kukubuza imibuzo malunga nayiphi na ingozi enokuba nayo, kubandakanywa nembali yentsapho yesifo, kwaye uya kubuza malunga neempawu zakho. Emva koko uza kwenza uvavanyo olubonakalayo ekhangela ulusu kunye namehlo ngenxa yobungqina bentambo ; ukuhlola isisu sakho ukuba ubunzima okanye ukukhuliswa kwesibindi sakho, okanye naluphina ubungqina be- ascites (ukwakheka kwe-fluid esiswini), kwaye ukhangele iirekhodi zakho ukubona ukuba ulahlekelwe isisindo.
Ukuhlolwa kwegazi okungafaniyo nomdlavuza we-pancreatic ayifanelekanga kodwa ngamanye amaxesha uncedo ekufumaneni ukuxilongwa xa kudibaniswa neemvavanyo zengqondo.
Uvavanyo lunokuquka:
- Izilingo zomsebenzi wentsholongwane, ngamanye amaxesha zonyuka
- Inani elipheleleyo legazi (iCBC), lifuna inani eliphezulu leplatelet (thrombocytosis) ngokukodwa
- Uvavanyo lwe-bilirubin: Kukho iintlobo ezahlukeneyo ze-bilirubin, kwaye kusekelwe eluhlobo oluthile oluvivinywayo, oogqirha banokufumana izikhombo malunga nomthombo wentsholongwane. Nge-jaundice ephazamisayo (ngenxa yesifo se-pancreatic esichukumisa kwi-buct ye-bison), kukho ukuphakama kokubili kunye ne-bilirubin yonke.
Igazi leswekile lidla ngokuphakanyiswa, malunga neepesenti ezingama-80 zabantu abanomdlavuza we-pancreatic baya kuba ne-insulin yokuxhatshazwa okanye isifo sikashukela. Phantse isiqingatha sabantu banokuphakama kwi-serum amylase kunye ne-serum lipase kwizigaba zokuqala zesi sifo, kodwa ngaphantsi kwezifo eziphambili.
Amakhwala aMandla
Iimpawu zamathambo zi-protein ezifihliwe ngamaseli omhlaza kwaye ziyafumaneka ngokuhlolwa kwegazi. Omnye wala manqaku, i- carcinoembryonic antigen (i-CEA), iphakanyisiwe malunga nesiqingatha sabantu abafumene isifo kodwa iphinda iphakanyiswe kwezinye iindidi zeemeko. Iinqanaba ze-CA 19-9 zi novavanyo, kodwa ekubeni zihlala ziphakanyisiwe kwaye ziphakanyiswe amanqanaba zingabonakalisa nezinye iimeko zonyango, oku akuncedi ngakumbi ekufumaneni i-diagnosis ye-cancer ye-pancreatic. Esi siphumo, kunoko, sinceda ekunqumeni ukuba isifo se-pancreatic sisuswe ngokugqithiseleyo, kunye nokulandela inkqubo yokonyango.
Iimvavanyo zegazi ze-Neuroendocrine
Iimvavanyo ezithile zegazi nazo zinokukunceda ekufumaneni uhlobo olunqabileyo lwee-cancer ze-pancreatic ezibhekiselwe kwiimvumi ze-neuroendocrine. Ngokungafani neentlungu ezininzi ze-pancreatic, eziqulethwe ngamaseli enza i-enzyme yokugaya, ezi zicubu ziquka iiseli ze-endocrine ezenza ama-hormone afana ne-insulin, i-glucagon kunye ne-somatostatin.
Amanqanaba okulinganisa la ma hormone, kwakunye nokuqhuba ezinye iimvavanyo zegazi, zinokuba luncedo ekuhloleni ezi zicubu.
Ukucinga
Uvavanyo lokucinga ngokuqhelekileyo luyindlela eyona nto yokuqinisekisa okanye ukuphikisa ubungqina bunzima kwi-pancreas. Izinketho ziquka:
CT Scan
I-computerized tomography (CT) isebenzisa ii-X-ray ukudala isahluko esiphambeneyo sommandla kwaye ngokuqhelekileyo iyona nto ingundoqo yokuxilongwa. Ukuba ugqirha ugxeka umdlavuza we-pancreatic ngokukhethekileyo, uhlobo olukhethiweyo lwe-CT olubizwa ngokuba yi-multiplephase CT okanye i-pancreatic protocol CT isicetyiswa rhoqo.
I-CT scan ingaba luncedo kokubaluleka kwesisu (ukuqikelela ubungakanani bayo kunye nendawo kwi-pancreas) kunye nokukhangela nawuphi na ubungqina bokusabalala kwii-lymph nodes okanye kwezinye iindawo.
I-CT ingaba isebenze ngakumbi kunokuba i-endoscopic ultrasound ekunqumeni ukuba umhlaza usasazeke kwi-artery methesteric ephezulu (kubalulekile ekukhetheni unyango).
I-Endoscopic Ultrasound (EUS)
I-ultrasound isebenzisa amagagasi omsindo ukudala umfanekiso wangaphakathi lomzimba. I-conventional (transcutaneous) i-ultrasound ayedla ukuba yenziwe xa ugqirha egxeka umdlavuza we-pancreatic, njengokuba igesi yamathumbu ingenza ukubonakalisa i-pancreas nzima. Kodwa kunokuba luncedo xa ufuna ezinye iingxaki zesisu.
I-endoscopic ultrasound ingaba yinkqubo ebalulekileyo ekwenzeni ukuxilongwa. Yenziwe nge-endoscopy, ityhubhu eguquguqukayo eneprojekthi ye-ultrasound ekupheleni kwayo ifakwe emlonyeni ize ifakwe phantsi kwisisu okanye emathunjini amancinci, ukwenzela ukuba i-scan iyenziwe ngaphakathi. Ekubeni le mimandla isondele kakhulu kwi-pancreas, uvavanyo luvumela oogqirha ukuba bajonge kakhulu kulungu.
Ngokusetyenziswa kwamachiza (i-sedation sedation), abantu baqhele ukunyamezela inkqubo kakuhle. Uvavanyo luya kuchaneka ngakumbi kune-CT ukuhlola ubungakanani kunye nobukhulu be-tumor kodwa alukho kakuhle ekufumaneni nayiphi na isasazeka esikwi-tumor (i-metastases) okanye ukugqiba ukuba i-tumor iquka imithana yegazi.
I-Endoscopic Retrograde i-Cholangiopancreatographyography (ERCP)
I-Endoscopic retrograde ye-cholangiopancreatographyography (ERCP) ngumvavanyo oquka i-endoscopy kunye ne-X-ray ukuze kukhangelelwe i-bile ducts. I-ERCP ingaba vavanyo oluvakalayo lokufumana umdlavuza we-pancreatic kodwa ayikho into echanekileyo yokuhlukanisa isifo kwezinye iingxaki, ezifana ne-pancreatitis. Kwakhona inkqubo enomngcipheko enxulumene neemvavanyo ezingentla.
MRI
I-imagery resonance imagination (i-MRI) isebenzisa amatshini kunokuba i-X-ray idale umfanekiso wesakhiwo sangaphakathi. I-MRI isetyenzisiweyo ngaphantsi kwe-CT kunye nomhlaza womdlavuza kodwa ingasetyenziswa kwiimeko ezithile. Njengoko i-CT, kukho iintlobo ezikhethekileyo ze-MRI, kuquka noMnu cholangiopancreatography (MRCP). Ekubeni ingazange ifundwe kangangoko iimvavanyo ezingasentla, zisetyenziselwa ngokubanzi abantu abaxilongwa ngokungaxhomekiyo ngokusekelwe kwezinye iingcaphephe, okanye ukuba umntu unobungozi obuthathaka owenziwe ngetekisi.
I-Octreoscan
Uvavanyo oluthiwa yi-octreoscan okanye i-somatostatin receptor scintigraphy (SRC) enokwenziwa xa i-tumor neuroendocrine ye-pancreas ilungelwa. Kwi-octreoscan, iprotheni e-radioactive (ebizwa ngokuba yi-tracer) ifakwe kwi-vein. Ukuba isifo se-neuroendocrine sikhona, umculi uya kubopha kwiiseli kwisisu. Kwiiyure ezimbalwa kamva, i-scan (scintigraphy) eyenziwe eyenza i-radiation ekhutshwayo (i-neuroendocrine tumors will shine, if present).
PET scan
I-PET ihlola, ihlala ihlanganiswe ne-CT (i-PET / CT), inokwenziwa ngamanye amaxesha, kodwa isetyenziselwa kakhulu umdlavuza we-pancreatic kunezinye ezinye i-cancer. Kule vavanyo, ixabiso elincinci lomshukela omshubileyo lijongelwa kwisisu kwaye iskripthi yenziwa emva kokuba ushukela unalo ixesha lokungena kwiiseli. Iiseli ezikhulayo ngokukhawuleza, ezinjengeeseli zomhlaza, "ziya kukhanya," ngokungafani nendawo yeeseli eziqhelekileyo okanye iisundu ezinqabileyo.
Biopsy
Ngamanye amaxesha isampuli yamathambo (i-biopsy) ifunekayo ukuqinisekisa ukuxilongwa, kunye nokujonga kwiimpawu zee-molecular ze-tumor.
Inaliti ye-biopsy (inqubo apho inaliti encinci ibhekiswa ngesikhumba esiswini nasepancreas ukuze ikhuphe isampuli yenyama) isoloko isenziwa ngokusebenzisa isikhokelo nge-ultrasound okanye i-CT. Kukho nkxalabo yokuba olu hlobo lwe-biopsy lungenza "imbewu" i-tumor, okanye ibangele ukusasazeka komhlaza kumgca apho inaliti ifakwa khona. Ayaziwa ukuba kwenzeka kangaphi ukuhluma imbewu, kodwa ngokucwangcisa ngo-2017, inani leemeko zengxelo ye-seeding ngenxa ye-endoscopic ekhokelwayo inaliti efunyenwe yintsholongwane eqhutywe ngokukhawuleza.
Ekubeni i-biopsies yenzelwe ngokuyinhloko ukujonga ukuba unyango luya kwenziwa (unyango kuphela oluphucula ukuhlala ixesha elide), oku kukuxhalabisa ukuthetha ngogqirha wakho.
Njengendlela enye, i- laparoscopy ingasetyenziselwa, ingakumbi ukuba i-tumor iyakwazi ukususwa (i-resectable). Kwi-laparoscopy, izinto ezincinci ezinokubonwa ezincinci zenziwa kwisisu kunye nesicatshulwa esincinci singeniswa ukuba senze i-biopsy. Ekubeni, malunga nama-20 ekhulwini kweso sithuba, abantu bafumanekile ukuba banesifo esingenakukhubazeka emva kokuba unyango sele seluqalwe ngumdlavuza we-pancreatic, amanye amagqirha ancomela ukwenza lo vavanyo kunoma ubani oya kutyunjwa (ukukhusela ukuhlinzwa okungeyomfuneko).
Ukuxilongwa okuhlukeneyo
Kukho imimiselo yeemeko ezinokuthi zifanise iimpawu zesifo somhlaza we-pancreatic okanye zenze iziphumo ezifanayo kwiimvavanyo zegazi kunye nokucinga. Oogqirha baya kusebenza ukulawula oku kulandelayo ngaphambi kokuba bafumane ukuxilongwa:
- Ukugqithiswa kwemibhobho yebhayisi: Ukugqithiswa kwe-bile ukuhamba kungonakaliswa ngokungaqhelekanga kwe-bile duct. Kungenzeka kubangelwa i-gallstones okanye utyando ukuba uwasuse, kodwa kunokubangelwa ngumdlavuza we-pancreatic.
- I-pancreatitis enobuchule okanye engapheliyo: I- Pancreatitis , ukuvuvukala kwe-pancreas, inokubangela iimpawu ezifanayo, kodwa ayiyi kubangela ubunzima. Ku-1 abantu base-20, i-pancreatitis ekhoyo ikhona ngexesha lokuxilongwa komhlaza we-pancreatic.
- Amathambo emibhobho yamathambo: Amatye kwi-buct buct angabangela iimpawu ze-jaundice ezithintekayo kwaye kaninzi kunokubonakala kwi-ultrasound. Nangona kunjalo, i-bile duct strictures, nangona kunjalo, inokuthi ikhona kunye nomdlavuza we-pancreatic.
- Ampullary carcinoma
- Umdlavuza we-Gallbladder : I-Gallbladder khancer ingabonakala ifana kakhulu neengcambu ze-pancreatic, kodwa ingahlukana ne-CT okanye iMRI.
- Gallstones (i-cholelithiasis)
- Izilonda okanye izilonda zomzimba
- Aneorysm yesisu
- Pancreatic lymphoma
- I-gastric lymphoma
- Umhlaza wesifo
- Umhlaza wesifo somhlaza
Ukucwangcisa
Ukumisela isigaba somdlavuza womdlavuza kubaluleke gqitha xa kuziwa ekunqumeni ukuba umhlaza ungasuswa okanye ungathanga. Ukuba isiteji singenakulungile, kunokukhokelela ekusebenzeni okungadingekile. Isitetimenti sinokukunceda ekuqikeleleni ukuhlaselwa kwesifo.
TNM
Oogqirha basebenzisa inkqubo ebizwa ngokuba yi-TNM stage yokufumana isigaba se-tumor. Oku kunokudideka kakhulu ekuqaleni kodwa kulula kakhulu ukuyiqonda ukuba uyazi ukuba zeziphi iileta zithetha.
T imela i-tumor. I-tumor inikwe inombolo ukusuka kwi-T1 ukuya kwi-T4 ngokusekelwe kubukhulu be-tumor, kunye nezinye izakhiwo eziye zahlasela.
| T1 | Ukuxhamla kuvaliwe kuma-pancreas kwaye ngaphantsi kwe-2 cm |
| T2 | Ukuxhamla kuvaliwe kuma-pancreas kunye no-2 cm |
| T3 | Ukuxhamla kudlulela ngaphaya kweepancreas (ukuya kwi-duodenum, i-bile duct, i-portal okanye i-veenteric veineric), kodwa ayibandakanyi i-axis i-celiac okanye i-artery mesenteric ephezulu |
| T4 | Ukuxhamla kubandakanya umthambo we-celiac okanye umthambo ophezulu we-mesenteric |
I-N imele i-lymph nodes. I-N0 yayiza kuthetha ukuba i-tumor ayizange isasaze nakweyiphi i-lymph nodes. I-N1 ithetha ukuba i-tumor isasaze kwii-lymph nodes eziseduze.
| N0 | Akukho ukubandakanyeka kwee-lymph nodes zengingqi |
| N1 | I-lymph nodes zengingqi zenza umhlaza |
M imelela i-metastases. Ukuba i-tumor ayifakwanga, iya kuchazwa njenge-M0. Ukuba isasazeke kwiindawo ezikude (ngaphaya kweepancreas) kuya kubhekiselwa kuM1.
| M0 | Akukho mastasis ede |
| M1 | Metastasis ephakathi |
Ngokusekelwe kwi-TNM, izibilini zinikezelwa kwisigaba esiphakathi kwe-0 no-4.
Isigaba sesi-0: Isigaba se-0 siphinde sibhekiswe njenge- carcinoma esicacileyo kwaye ibhekisela kumhlaza ongazange usasaze into ebizwa ngokuba yi-membrane. Ezi zicubu aziyiyo ingenelo (nangona izigaba ezilandelayo zikhona) kwaye kufuneka ukuba ziphilise ngokupheleleyo.
Isigaba 1: Isigaba se-1 (i-T1 okanye i-T2, i-N0, i-M0) i-pancreatic cancers igcinwe kwi-pancreas kwaye ingaphantsi kwama-4 cm (malunga no-2 intshi) ububanzi.
Isigaba sesi-2: Iimpawu ze-Stage 2 (i-T3, i-N0, i-M0 okanye i-T1-3, i-N1, i-M0) iyakwandisa ngaphaya kwama-pancreas (ngaphandle kokubandakanya i-axis i-celiac okanye i-artery mesenteric ephezulu) kwaye ayizange isasaze kwi-lymph nodes, okanye ivalwe i-pancreas kodwa isasazeka kwii-lymph nodes.
Isigaba sesi-3: Iimpawu ze-Stage 3 (T4, nayiphi na i-N, M0) iyakwandisa ngaphaya kwee-pancreas kwaye ifaka i-artery celiac okanye umthambo we-mesenteric ophezulu. Basenokungenako okanye basasaze kwi-lymph nodes, kodwa abazange basasaze kwiindawo ezikude zomzimba.
Isigaba sesi-4: Iimpawu ze-Stage 4 (nayiphi na i-T, nayiphi na i-N, M1) ingaba nayiphi na ubukhulu. Ngethuba xa banokuthi basasazeka okanye bangenakwandisa kwii-lymph nodes, baye basasaza kwiindawo ezikude ezifana nesibindi, i-peritoneum (iimbumba ezihamba nomgca wesisu), amathambo, okanye imiphunga.
> Imithombo:
> I-American Society of Clinic Oncology. Cancer.Net. Updated 12/2016. https://www.cancer.net/cancer-types/pancreatic-cancer/diagnosis
> IiNtsholongwane ezikhoyo kunye neZiphuthumayo kwiCancreatic Cancer, i-Springer Verlag, ngo-2017.
> De la Cruz, M., Young, A., noMnu Ruffin. Ukuxilongwa noLawulo lweCancretic Cancer. WaseMerika ugqirha . 2014. 89 (8): 626-632.
> Kikuyama, M., Kamisawa, T., Kuruma, S. et al. Ukuxilongwa kwangaphambili kuPhuculo lweNtsholongwane embi yeCancreatic Cancer. Cancers . 2018. 10 (2) :. pii: E48.
> Minaga, K., Takenaka, M., Katanuma, A. et al. Ukutyalwa kweeNtsana zeeNtsana: Ukugqithiswa kwexesha eliqhelekileyo Inkxalabo ye-Endoscopic Ultrasound-Ekhokelwa kakuhle-Inaliti yokuphefumula. Oncology . 2017. 93 Isibonelelo 1: 107-112.