Unyango lomhlaza wesifo somdlavuza ungabandakanya ukuhlinzwa, i-chemotherapy, unyango olujoliswe kuyo, kunye novavanyo lweekliniki ezigxilwe kunyango olutsha, njenge-immunotherapy. Ngenxa yokukhetha okuncinciweyo okwandisa ubomi kwizinga elithile xa utyando lungenakwenzeka, iNational Cancer Institute incoma ukuba kuhlolwe isilingo seklinikhi.
Izinyango zokwelapha okwangoku zikhoyo zingabalwa njenge:
- Inkcazo: Ezi zonyango zenziwa ngethemba lokufumana ixesha elide lokuphila nesifo.
- I-Palliative: Ezi zonyango ezingenakwandisa ubomi, kodwa ukuphucula umgangatho wobomi kulabo abaphila nesifo.
Unyango olujongene nomhlaza ngokwawo luyahlulwa ngokubanzi njengoko:
- Ionyango zengingqi: Ezi zonyango eziphatha umdlavuza apho zivela khona, kwaye zibandakanya unyango kunye nokunyanga kwamayeza.
- Iinkqubo zokonyango: Ezi zonyango zenzelwe ukujongana neeseli zomhlaza naphi na emzimbeni (kuquka i-metastases) kwaye zibandakanya i-chemotherapy kunye namanye amachiza amasha atholakalayo kwizilingo zonyango.
Apha, ukujonga ngokubanzi iinketho ezikhoyo okwangoku unyango lwama-khancers of early and advanced avancers.
Ukuhlinzwa
Inyango yonyango kuphela yonyango olunikeza ithuba lokuba "unyango" lomhlaza, okanye ubuncinane ukwandisa ithuba lokuphila ixesha elide. Oko kwathiwa, kuphela i-15% ukuya kuma-20 ekhulwini kubantu abanomdlavuza we-pancreatic abaviwa ukuba baqeshwe.
Ngelishwa, kunokuba nzima, nangona iimvavanyo zengqondo ezikhoyo, ukuba ngaba umhlaza usasazeke kwindawo apho ukuhlinzwa kungenakwenzeka ngaphambi kokuba utyando lwenziwa. (Ukwelapha i-pancreatic cancers ezithe zazeka, kubandakanywa isigaba 3 kunye nesigaba se-4 izikhumba, asinyuli ukwanda komzimba kodwa iyanciphisa kakhulu umgangatho wobomi.) Ngethuba lokuhlinzwa, oogqirha bafumene ukuba umdlavuza usasazeke kakhulu ukuba inkqubo ibhekwe njengento efanelekileyo malunga neepesenti ezingama-20 zexesha.
Amanye amagqirha ancomela ukuba enze i-laparoscopic biopsy (uvavanyo apho kukho izimbalwa ezincinci ezifakwe kwiiswini kunye neprobethi ifakwe ukuze kususwe iqela elincinci lepascreas kwaye uhlolisise indawo ejikelezileyo) phambi kokuba utyando luqwalaselwe. Ukwenza oko kunganciphisa ithuba lokuhlinzwa okungadingekile kunye nentlungu elandelayo kunye neengxaki zayo.
Iingxaki kunye nokuqwalasela
I-pancreas iphela emva kwesisu kwaye ilandelelaniswe nezixhobo ezibalulekileyo. Ngokukhawuleza emva kwe-pancreas kukuqokelela kwemithambo emikhulu yegazi. Ukuba i-tumor ichazwa ngokuthi "iqhutywe phambili kwendawo," kuthetha ukuba i-tumor ingaba ikhupha le mijelo yegazi enkulu, yenza ukuba kususwe yonke i-tumor ngaphandle kokulimaza iinqanawa ezikufutshane-ezingenakwenzeka. Xa oku kwenzeka, umntu unako okanye angaba ngumviwa wokuhlinzwa. Amanye amaziko aphezulu aphezulu anokukwazi ukususa nokuvuselela imithambo yegazi kwiimitha ezihlukeneyo, nangona kunjalo, ngoko ezinye i-cancer ezicatshulwa ngaphambili zingenakwenzeka.
Ukuqonda i-anatomy kuya kunceda abo bafunda banesi sifo esingasemgangathweni . Oku kubandakanya abantu abanomdlavuza ovula iipesenti ezingama-50 okanye ngaphantsi kwesitya segazi.
Akukho nonyango oluqhelekileyo kule meko, kodwa abanye oogqirha bakholelwa ukuba ukunika i-chemotherapy (okanye ngaphandle kwonyango lwe-radiation) ukunciphisa i-tumor ingenza ngokwaneleyo ukuze isuswe.
Iinkqubo
Ukuba uthathwa njengomgqatswa wokuhlinzwa, oku kukhethwa oku kulandelayo:
- Inkqubo ye-Whipple (i-Pancreaticoduodenectomy): Inkqubo ye-Whipple yinkqubo eqhelekileyo yenziwa ngumhlaza wesifo somdlavuza kunye nolu khetho kubantu abanomdlavuza entloko yepakreta kunye necala lokuqala. Kule ndlela yokuhlinzwa, i-gallbladder, i-buct buct ejwayelekile, inxalenye enkulu yepascreas (kubandakanywa intloko), inxalenye ye-duodenum, inxalenye yesisu, i-spleen kunye ne-lymph node eseduze. Ingxenye yomzimba kunye nomsila we-pancreas ishiywa ngasemva ukuze ugcine umsebenzi wayo (ukuveliswa kwe-enzyme yokutya kunye nama-hormone).
- I-Whipple Procedure Variations: Kukho iintlobo ezahlukahlukeneyo kwinkqubo ye-Whipple eklasini egcina ngaphezulu kwesisu kunye nengxenye yokuqala yesisu esincinci, esivame ukubizwa ngokuba yi-pylorus-igcina i-pancreaticoduodenectomy. Ezi nkqubo zenziwa ukuze kuncitshiswe ukunciphisa iingxaki ezithile emva kokusebenza.
- I-Pancreatectomy ye-Distal: I- Cancers yomzimba okanye umsila we-pancreas ayisoloko isebenza, kodwa xa ikhona, umsila wee-pancreas unokususwa kunye okanye ngaphandle kwepen.
- I-Pancreatectomy iyonke: I-pancreatectomy iyonke ifana nenkqubo ye-Whipple, kodwa ihluke ukuba zonke i-pancreas isuswe. Oku kwenziwa xa kuyimfuneko ukususa yonke i-tumor ebonakalayo.
Iziphumo eziPhakathi kunye neengxaki
Zonke iindlela zokugonywa ngumdlavuza we-pancreatic ziyi-major surgery, kwaye iingxaki okanye ukufa akuqhelekanga. Izingozi eziqhelekileyo zibandakanya iingozi ezinxulumene ne-anesthesia jikelele, ukuphuma kwegazi, izifo, kunye nokuphuhliswa kwegazi emva kokuhlinzwa. Umngcipheko weengcezu zegazi uphakamileyo kakhulu kubantu abanomdlavuza we-pancreatic, kwaye uphando longeza kule mngcipheko. Ukusebenzisa izixhobo zokuncintisa emilenzeni ngexesha kunye nangemva kokuhlinzwa, kunye nabagcini begazi banokunciphisa oku ngezinga elithile.
Ingxaki eqhelekileyo yexesha elide yokuhlinzwa yinto ephindaphindiweyo yomhlaza, kwaye oku, ngelishwa, ininzi kakhulu. Ithuba lokuba umhlaza we-pancreatic uza kubuya emva kokuhlinzwa kuxhomekeka kwizinto ezininzi, kwaye kuphela ugqirha wakho oza kukwazi ukuqikelela oko oku kuthetha ntoni kuwe.
Inkqubo nganye inokubangela neminye imiba. Ngokomzekelo, kwi-pylorus-ukugcina i-pancreaticoduodenectomy, ukususwa kweengxenye zesisu kunye nenxalenye yokuqala yesisu esincinci kunokubangela ukulahla i-syndrome , imeko engabangela ukurhoxisa okufutshane emva kokutya. Iyakwandisa nokuba nethuba le-reflux ye-bile, imeko apho i-bile ihamba ngendlela engafanelekanga kwaye ingene kwisisu esiphumela ngenxa yokuvuvukala kunye nokuphazamiseka.
Xa i-pancreatectomy epheleleyo iyenziwa, yonke imisebenzi ye-pancreatic yiyo, ilahlekile ngokupheleleyo. Akukho mveliso ye-insulini, i-glucagon, okanye i-enzyme yokugaya. Isifo sikashukela singenakupheka kwaye unyango lwe-insulin kunye nokutshintshwa kwe-enzyme kuyimfuneko emva kokuhlinzwa.
Kungakhathaliseki ukuba uya kufuna i-enzymes okanye i-hormones eyongezelelweyo emva kokuba inxalenye yepakreas isuswe kuxhomekeke kwimibandela emininzi, kubandakanywa nomonakalo kwi-pancreas ukusuka kwidumbu ngaphambi kokuhlinzwa. Ngethamsanqa, abantu abayidingi i-pancreas yabo yonke ukwenza inani elaneleyo le-insulin, kwaye bahlala ubomi obuqhelekileyo emva kokuhlinzwa.
Ugqirha lwePalliative
Unokuphelelwa ngonyango kubantu abanomdlavuza we-pancreatic ukunciphisa iimpawu kodwa bengaphilisi isifo. Kuqhelekile ukuba i-buct ye-bison eqhelekileyo ikhutshwe yizo zicubu. Xa oko kwenzeka, i-stent ingafakwa (nge-endoscopy) okanye utyando olunqumla i-conduit lungenziwa.
Ukukhetha iSibhedlele
Ukuba ungumgqatswa wokuhlinzwa, kubaluleke kakhulu ukuba ufuna ukunyamekela esibhedlele esenza umthamo omkhulu wezo zonyango. Oko kuthetha ukukhetha isibonelelo esenza utyando lwe-pancreatic cancer engaphezu kwe-15 ngonyaka kwaye unokubika ingxelo engciphekweni yokufa kunye nesibhedlele esifutshane.
Chemotherapy
I-Chemotherapy ingasetyenziswa ngeendlela ezimbalwa zabantu abanomdlavuza we-pancreatic.
I-neoadjuvant chemotherapy: i- Neoadjuvant chemotherapy ibhekisela ekusebenziseni i-chemotherapy phambi kokuhlinzwa ukuze ihlaziye isifo ukuze utyando lunokwenzeka (njengoko kuchaziwe ngentla).
I-chemotherapy ye-Adjuvant: I- adjuvant chemotherapy ibhekisela kwi-chemotherapy esetyenziswe ngaphezu kokuhlinzwa. Amagciwane angama-Pancreatic aphinde aphinde abuye emva kokuhlinzwa, oko kuthetha ukuba iiseli zomhlaza zihlala zishiywa ngasemva (kodwa zinokuba zincinane kakhulu ukuba zingabonwa kwiimvavanyo zokucinga). Xa i-chemotherapy isetyenziswe emva kokuhlinzwa, kucingelwa ukuba kuphuculwe ukusinda ngeenyanga ezintathu ukuya kwezine.
I-chemotherapy ehambayo: Ixesha elininzi xa i-chemotherapy ithathwa njengomdlavuza we-pancreatic, unikezwa ngethemba lokuba iya kwandisa ubomi, kodwa ingaphilisi umdlavuza. Ngokubanzi, i-chemotherapy iphumela kwiziphumo ezincinci, kodwa eziphuculweyo ezibonakalayo ngobude bokusinda.
Izidakamizwa ezisetyenziswa kakhulu ziquka:
- Abraxane (i-albumin-bound paclitaxel)
- Gemzar (gemcitabine)
- 5-FU (fluorouracil)
- I-Onivyac (irinotecan liposome injection)
Ezi ziyobisi zivame ukunikezelwa kunye kwaye ziyakunikwa kunye neyeza elithe ngqo, i-immunotherapy, okanye ngamanye amaxesha, unyango lwamayeza. Amachiza anikezwa ngaphakathi ngexesha elithile (njengangoko kanye ngeveki kwiiveki ezintathu, zilandelwa enye iveki ekhutshwayo) ngenani lemijikelezo.
Inhlanganisela yesithathu yeziyobisi, iFolfirinex (i-5-FU / leucovorin, i-irinotecan kunye ne-oxaliplatin) ibonakala isebenza kakuhle, kodwa inetyhefu ngaphezu kwezinye iindlela kwaye isetyenziselwa kakhulu abantu abanezempilo jikelele (abo banesimo esihle sokusebenza ). Uhlolo lwe-2018 lweengxelo ezijongene nokudibanisa ezahlukeneyo kweziyobisi zifumene ukuba iFolfirinex inefuthe elikhulu ekuphuculeni ukusinda.
Imiphumo emibi yeKhemotherapy
Imiphumo emibi ye-chemotherapy ingaba yinto ebalulekileyo kwaye ibandakanya ukulahleka kweenwele; isicupunu kunye nokuhlanza (nangona unyango lokunciphisa le mpawu luye lwaphucula kakhulu kwiminyaka yamuva); ukunciphisa umongo weethambo okubangelwa ukunciphisa inani legazi elimhlophe, amangqamuzana egazi obomvu (i-anemia), kunye neeplatelets, kunye nokunye.
Unyango olujoliswe
Iipilisi ezijoliswe kuzo ziyizilwanyana ezijolise kumzila othile ekukhuleni kwamaseli omhlaza. Ekubeni ezo zonyango zijoliswe ngokukodwa kumaseli omhlaza abahlala behlala nawo (kodwa kungekho njalo) aneziphumo ezimbi ezimbalwa kune-chemotherapy.
Isidakamizwa somlomo esisetyenziswa ngamanye amaxesha kubantu abanomdlavuza we-pancreatic, iTarceva (erlotinib) isebenza ngokuthintela indlela ekukhuleni kwamaseli omhlaza. Esikhundleni sokubulala amangqamuzana omhlaza, kubangelwa ukuba balambile kwaye bayeke ukuphindaphinda kwabo. I-Tarceva idla ngokusetyenziswa kunye noGemzar. Iziphumo eziqhelekileyo eziqhelekileyo zeTarceva ziquka ukugqithiswa kwe-acne kunye nehudo.
Uvavanyo lweZliniki
Kukho inani leemvavanyo zonyango ekwenzeni ukuhlolwa koomdlavuza we-pancreatic ezahlukeneyo zonyango olulapha ngasentla, kunye neyeza zonyango ezinjenge- immunotherapy . Nangona ezinye zonyango ziqala ukufundiswa ngomdlavuza we-pancreatic, ngamanye amaxesha kukhokelela ekulawuleni ngokukodwa kweengqungquthela eziphambili, ezifana nomhlaza wamaphaphu, kwaye zizise ithemba lokuba unyango olungcono lwe-cancer yomdlavuza luya kufumaneka kwikamva.
I-Medicine Complementary (CAM)
Ngexesha langoku, akukho zonyango ezizezinye ezibonisa naluphi uphumelelo ekuphatheni umdlavuza we-pancreatic. Kodwa ezinye iindlela zonyango , zinokunceda abantu bajamelane neempawu ezibangelwa ngumhlaza kunye nokunyangwa komhlaza, kwaye amaninzi eziko elikhulu lomhlaza manje anika ithuba lokudibanisa. Imizekelo ibandakanya ukuguqulwa, ukucamngca, ukucoca umzimba, kunye ne yoga.
Izibonelelo
Abantu abaninzi bafuna ukuncedisa ukutya kunye nemifuno xa befunda malunga nokugqitywa komdlavuza we-pancreatic. Kubalulekile ukuqaphela ukuba ezinye izithako ze-vithamine kunye nezondlo zinganciphisa ukuphumelela kokonyango lwemhlaza .
Uphando kwilebhu ibhekisele kwizixhobo ezimbalwa ezisetyenzisiweyo kwi-Ayurveda, njenge triphala, kunye no-nigella sativa (umnyama omnyama). Nangona kukho iziphumo ezithembisayo ezibonisa ukukhuselwa kokukhula kwamaseli e-pancreatic asetshenziswe kwiphubhu yokuvavanya, asiyazi ukuba ezi zinto ziza kuba nefuthe kubantu. Ukongezelela, ezi zongezelelo zilawulwa ngokungekho mthethweni eUnited States kwaye ziyakwazi ukuphazamisa ezinye izibonelelo. Esi sikhumbuzo esihle, nangona kunjalo, ukuthetha ne-oncologist yakho malunga nayiphi na iivithamini, amaminerali, okanye izongezelelo zokutya okhoyo / ucinga ngokuthatha.
Kuyathakazelisa ukuba uphando olujongene nomdlavuza wesifo somhlaza (isifo sokulahlekelwa kwesisindo, ukulahleka kwesidlo, kunye nokulahlekelwa kwesisundu somzimba esichaphazela uninzi lwabantu abanomdlavuza we-pancreatic) sitholile ukuba i-omega-3 fatty acids ingabalulekile kuba luncedo, njengoko kukho encinci kakhulu eyenza ngokwenene imenehluko kule syndrome. Ekubeni i-cachexia icingelwa ukuba iyona nto ibangela ukufa kwabantu ngama-20 ekhulwini abantu abanomdlavuza, oku kulungile ukuthetha ne-oncologist yakho. Kukho imithombo emininzi ye-omega-3s yokutya, kwaye ixesha elininzi le-oncologists lincoma ukuba ufumane izondlo ngokutya kunokutya.
Unonophelo loLuntu
Ukunyamekela okuqhelekileyo akufani ne-hospice, kwaye ingasetyenziselwa abantu abantu abanezifo ezinconywa kakhulu. Ijolise kwimpilo kunye nokuphila komntu ophila nomhlaza, kunokuba unyangwe ngumhlaza ngokwawo. Ukunyamekela ngokunyanisekileyo ngokwenene kuyona nto ingundoqo yonyango kubantu abaninzi abanokufumana ukuba banomdlavuza we-pancreatic. Oku kungabandakanya ukuhlinzwa okanye i-chemotherapy, njengoko kuchaziwe ngasentla, kodwa kunye nezinye iindlela.
Imizekelo ibandakanya ukuphathwa kobuhlungu obukhulu; ukulawula ezinye iimpawu zomzimba, ezifana nemiba yokutya; inkxaso yokondla; kunye nenkxaso yemoya yokuxinezeleka, ukuxhalabisa nokuxinezeleka. Ukunyamekela okunyamekayo kunokuba luncedo ekujonganeni nokukhathazeka ngokomoya, iimfuno zononophelo kunye noqhagamshelwano kunye nemiba eqhelekileyo evela kwi-inshurensi ukuya kwenkxaso yemali kunye nezomthetho.
Amanqanaba omhlaza amaninzi ngoku anikezela iqela elijongene nokunyamekela ukuba kuqinisekiswe ukuba impawu zibhekiswe kunye nokusemandleni.
IziPhulo zaseKhaya kunye nokuPhila
Ekubeni umgangatho wobomi kunye nomdlavuza we-pancreatic ubaluleke kakhulu, amanyathelo aphuculayo aphezulu. Ukutya ukutya okunempilo kunokuthi kungenzi umehluko ngomhlaza wakho, kodwa abaninzi abantu baziva bephucula xa badla ukutya okunotye kwizityalo nemifuno. Ukuzivocavoca kunceda kwaye, mhlawumbi ngokungabonakaliyo, kunokuncedisa ukunciphisa i-cachexia yomhlaza.
Abanye abantu bayazibuza ukuba kukufanelekile ukuyeka ukutshaya emva kokuvavanywa, ngokukodwa ngomdlavuza omkhulu we-pancreatic. Impendulo nguyebo. Kukho izizathu ezinobungqina obangela ukuba ukuyeka emva kokuxilongwa komhlaza kunokunceda kakhulu.
> Imithombo:
> 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.
> INational Cancer Institute. Ukwelashwa kweCancreatic Cancer (PDQ) -I-Professional Professional Version. Ukuhlaziywa 01/26/18. https://www.cancer.gov/types/pancreatic/hp/pancreatic-treatment-pdq
> Zhang, S., Liu, G., Li, X., Liu, L., no-Yu. Ukusebenza kweempawu ezihlukeneyo ze-Chemotherapy kwi-Treatment ye-Cancer ephezulu okanye ye-Metastatic Cancer Pancreatic: I-Network Meta-Analysis. Umbhalo we-Cellular Physiology . 2018. 233 (4): 3352-3374.