Ukwelashwa komdlavuza we-pancreatic kungabandakanya ukuhlinzwa, i-chemotherapy, ukwelashwa okuhlosiwe, nokuhlolwa kwamakliniki kugxile ezithombeni ezintsha, njenge-immunotherapy. Ngenxa yokukhetha okulinganiselwe okwandisa impilo ngezinga elibalulekile lapho ukuhlinzeka kungenakwenzeka, i-National Cancer Institute incoma ukucubungula ukuhlolwa komtholampilo.
Izinketho zokwelapha okwamanje ziyatholakala zingenziwa ngezigaba:
- Ukwelapha: Lezi zokwelapha zenziwa nethemba lokuthola isikhathi eside sokuphila nesifo.
- I-Palliative: Lezi zokwelapha ezingase zingenwe ukusinda, kodwa ngcono izinga lokuphila kulabo abaphila nalesi sifo.
Ukwelashwa okubhekene nomdlavuza ngokwayo kungenziwa ngezigaba ezilandelayo:
- Izindlela zokwelashwa zendawo: Lezi zindlela zokwelapha umdlavuza lapho zivela khona, futhi zibandakanya ukwelashwa kanye nemithi yokwelapha.
- Imithi yokwelashwa: Lezi zokwelapha zenzelwe ukubhekana namangqamuzana omdlavuza noma yikuphi emzimbeni (kufaka phakathi izidakamizwa) futhi zibandakanya i-chemotherapy kanye neminye imithi emisha etholakala ekuvivinyweni kwemitholampilo.
Lapha, ukubuka konke okukhethwa kukho okwamanje okwenziwe ukwelashwa kokubili kancreatic kancreatic zakuqala futhi eziphambili.
Ukuhlinzwa
Ukwelashwa yiyona ndlela yokwelashwa yodwa ehlinzeka ithuba lokuba "ukwelapha" umdlavuza, noma okungenani ukwandise amathuba okuphila isikhathi eside. Lokho kusho ukuthi cishe amaphesenti angu-15 kuphela kuya kuma-20 amaphesenti abantu abanomdlavuza we-pancreatic abavunyelwa ukuhlinzwa.
Ngeshwa, kungaba nzima, ngisho nokuhlolwa kwe-imaging esitholakalayo, ukwazi ukuthi umdlavuza usakaze yini lapho ukuhlinzwa kungenakwenzeka ngaphambi kokuba ukuhlinzwa ngokwayo kwenziwe. (Ukwelapha i-pancreatic cancers eyasakazekile, kufaka phakathi isigaba sesithathu kanye nesigaba se-4, asikhulisi ukusinda kodwa kwenza kancane kancane ikhwalithi yokuphila.) Phakathi nokuhlinzwa, odokotela bathola ukuthi umdlavuza usakaze kakhulu ukuze inqubo ibhekwe njengendlela enhle cishe amaphesenti angu-20 yesikhathi.
Abanye odokotela batusa ukwenza i-laoposcopic biopsy (uhlolo lapho kutholakala khona ukucubungula okuncane okusesiswini esiswini kanye nesiphrokhthi kufakwa ukuze kususwe ucezu oluncane lwe-pancre futhi uhlole indawo ezungezile) ngaphambi kokuhlinzwa ukubhekwa. Ukwenza kanjalo kunganciphisa ithuba lokuhlinzwa okungadingekile kanye nobuhlungu obulandelayo nezinkinga zalo.
Izinselele Nokucabangela
I-pancreas ivele ngemuva kwesisu futhi ihambisana nezinhlaka ezimbalwa ezibalulekile. Ngokuqondile ngemuva kwama-pancreas iqoqo lemithambo emikhulu yegazi. Uma i-tumor ichazwa ngokuthi "iqhubekile endaweni," kusho ukuthi lesi sifo singase sigqugquzele lezi zimfutho ezinkulu zegazi, zenze ukususwa kwazo zonke izidumbu ngaphandle kokulimaza izitsha ukuthi zingenakwenzeka. Uma lokhu kwenzeka, umuntu angase abe ngumuntu ozohlinzwa noma angabe engaba ngumsebenzi. Ezinye izikhungo eziphezulu eziphezulu ziyakwazi ukususa nokuvuselela imithwalo yegazi ngezinga elihlukile, noma kunjalo, ngakho-ke amanye amantombazane ayekade ecatshangwa ukuthi angasebenzi kahle manje angakwazi ukusebenza.
Ukuqonda i-anatomy nakho kuyasiza kulabo abafunda ukuthi banesifo esingenamkhawulo . Lokhu kubandakanya abantu abanomdlavuza ovulela amaphesenti angu-50 noma ngaphansi kwesitsha segazi.
Ayikho ukwelashwa okujwayelekile kwalesi simo, kodwa abanye odokotela bakholelwa ukuthi ukuhlinzeka ngamakhemikhali (noma ngaphandle kwe-radiation therapy) ukuze unciphise isisu kungenza okwanele ukuthi kungasuswa ngokuhlinzwa.
Izinqubo
Uma ubhekwa njengomuntu okhethwe ukuhlinzwa, okukhethwa kukho okulandelayo kungenziwa:
- Inqubo ye-Whipple (Pancreaticoduodenectomy): Inqubo ye-Whipple yindlela ejwayelekile kunazo zonke eyenziwe ngomdlavuza we-pancreatic futhi kuyindlela yokukhetha abantu abanomdlavuza wekhanda le-pancreas kanye necala lokuqala. Kulo msebenzi wokuhlinzwa, i-gallbladder, i-bile-duct evamile, ingxenye enkulu yamaphakethe (kufaka phakathi ikhanda), ingxenye ye-duodenum, ingxenye yesisu, i-spleen, ne-lymph nodes eziseduze zisusiwe. Ingxenye yomzimba nomsila we-pancreas ashiywe ngemuva ukuze alondoloze umsebenzi wayo (ukukhiqizwa kwama-enzyme nokugoma ama-hormone).
- Ukuguquguquka kwenqubo ye-Whipple : Kunezinhlobo ezihlukahlukene ezinkambisweni ze-whipple zakudala ezigcina ubuningi besisu nesengxenye yokuqala yomathumbu amancane, ngokuvamile eyaziwa njenge-pylorus-ekulondolozeni i-pancreaticoduodenectomy. Lezi zinqubo zenziwa ukusiza ukunciphisa izinkinga ezithile emva kokusebenza.
- I-Pancreatectomy ye-Distal: I- Cancers emzimbeni noma emsila we-pancreas ayisebenzi kaningi, kepha lapho ikhona, umsila we-pancreas ungasuswa noma ungenayo iphleen.
- Ingqikithi ye-Pancreatectomy: Ingqikithi ye-pancreatectomy ifana nenqubo ye-Whipple, kodwa ihluke ngokuthi wonke ama-pancreas asusiwe. Lokhu kwenziwa uma kudingekile ukususa sonke isisu esibonakalayo.
Imiphumela emibi nezinkinga
Zonke izinketho zokuhlinzwa zomdlavuza we-pancreatic zihlinzwa kakhulu, futhi izinkinga noma ukufa akuvamile. Izingozi ezivamile zibandakanya izingozi ezihlobene ne-anesthesia ejwayelekile, ukuphuma kwegazi, ukutheleleka, nokuthuthukiswa kwezindwangu zegazi ngemva kokuhlinzwa. Ingozi yezindwangu zegazi iphezulu kakhulu kubantu abanomdlavuza we-pancreatic, futhi ukuhlinzekwa kwengeza kule ngozi. Ukusebenzisa amadivaysi okucindezela emilenzeni ngesikhathi nangemva kokuhlinzwa, kanye nabasebenzi begazi banganciphisa lokhu ngezinga elithile.
Inkinga ejwayelekile kakhulu yesikhathi eside yokuhlinza ukuphindaphindiwe komdlavuza, futhi lokhu, ngeshwa, kuvame kakhulu. Ithuba lokuthi umdlavuza we-pancreatic uzophinde uphinde uhlinzekwe kuxhomeke ezicini eziningi, futhi udokotela wakho ohlinzayo kuphela uzokwazi ukulinganisa ukuthi lokhu kungasho ukuthini kuwe.
Inqubo ngayinye ingabangela nezinye izinkinga. Isibonelo, ku-pancreaticoduodenectomy, ukukhishwa kwengxenye yesisu kanye nengxenye yokuqala yamathumbu amancane kungabangela ukulahla isifo , isimo esingabangela ukuhuda okuphawulekayo ngemuva kokudla. Kungabuye kwandise amathuba okuba ne-reflux ye-bile, isimo lapho i-bile ihamba ngendlela engafanele futhi ingena esiswini okubangelwa ukuvuvukala nokungahambi kahle.
Uma i-pancreatectomy ephelele isenziwa, wonke umsebenzi we-pancreatic yiqiniso, olahlekile ngokuphelele. Akukho ukukhiqizwa kwe-insulini, i-glucagon, noma ama-enzyme wokugaya. Isifo sikashukela singenakugwema futhi ukwelapha kwe-insulin kanye nokushintshwa kwe-enzyme kuyadingeka ngemuva kokuhlinzwa.
Kungakhathaliseki ukuthi uzodinga ama-enzymes noma ama-hormone engeziwe ngemuva kokuba ingxenye ye-pancreas isuswe kuxhomeke ezinkathini eziningana, kufaka phakathi inani lomonakalo kuma-pancreas kusukela ku-tumor ngaphambi kokuhlinzwa. Ngenhlanhla, abantu abadingi ama-pancreas abo bonke ukwenza inani elanele le-insulini, futhi baphila impilo evamile kungenzeka emva kokuhlinzwa.
Ukuhlinza nge-Palliative
Ukwelashwa kungenziwa futhi kubantu abanomdlavuza we-pancreatic ukunciphisa izimpawu kodwa hhayi ukuphilisa lesi sifo. Kuyinto evamile kakhulu ukuthi ibhande elivamile le-bile livalwe yizicubu. Uma lokhu kwenzeka, i-stent ingafakwa (nge-endoscopy) noma ukuhlinzekwa okudlula ukuhamba kungenziwa.
Ukukhetha Isibhedlela
Uma ungumuntu obhekene nokuhlinzwa, kubaluleke kakhulu ukuthi ufune ukunakekelwa esibhedlela esenza ivolumu enkulu yalezi zindlela zokuhlinzwa. Lokhu kusho ukukhetha indawo eyenza ukuhlinza umdlavuza we-pancreatic engaphezu kuka-15 ngonyaka futhi ingabika ingozi ephansi yokufa nokuhlala esibhedlela esifushane.
I-Chemotherapy
I-Chemotherapy ingasetshenziswa ngezindlela ezimbalwa zabantu abanomdlavuza we-pancreatic.
I-neoadjuvant chemotherapy: i- Neoadjuvant chemotherapy ibhekisela ekusetshenzisweni kwe-chemotherapy ngaphambi kokuhlinzwa ukwenzela ukunciphisa isisu kangangokuthi ukuhlinzwa kungenzeka (njengoba kuxoxwe ngenhla).
I-Adjuvant chemotherapy: I- Adjuvant chemotherapy ibhekisela kumakhemikhali asetshenziswayo ngaphezu kokuhlinzwa. Amakhansela asePancreatic avame ukubuya ngemva kokuhlinzwa, okusho ukuthi amangqamuzana omdlavuza avame ukushiywa ngemuva (kodwa angase abe mncane kakhulu ukuba angabonwa ekuhloleni izithombe). Uma i-chemotherapy isetshenziswa ngemva kokuhlinzwa, kucatshangwa ukuthi kuthuthukiswe izinyanga ezintathu kuya kwezine.
I-chemotherapy enama-palliative: Isikhathi esiningi lapho i-chemotherapy ibhekwa njengomdlavuza we-pancreatic, unikezwa ngamathemba ukuthi iyoyandisa impilo, kodwa ingelapheki umdlavuza. Ngokuvamile, i-chemotherapy iholela ekuthuthukiseni okuncane, kodwa okuphawulekayo ngobude bokusinda.
Izidakamizwa ezisetshenziswa kakhulu zihlanganisa:
- Abraxane (i-albin-bound paclitaxel)
- I-Gemzar (gemcitabine)
- I-5-FU (i-fluorouracil)
- I-Onivyac (umjovo we-irinotecan liposome)
Lezi zidakamizwa zinikezwa ngokuhlanganiswa futhi zinganikezwa kanye nokwelashwa okuhlosiwe, i-immunotherapy, noma ngezinye izikhathi, ukwelapha imishanguzo. Lezi zidakamizwa zinikezwa ngezikhathi ezithile ngezikhathi ezithile (njengokungathi ngeviki amasonto amathathu, kulandelwa isonto elilodwa ukuvala) imijikelezo eminingi.
Inhlanganisela emithathu yezidakamizwa, i-Folfirinex (i-5-FU / leucovorin, i-irinotecan ne-oxaliplatin) ibonakala isebenza kahle, kodwa inesifo esinobuthi kunamanye okukhethwa kukho futhi isetshenziselwa abantu abanempilo enhle (labo abanesimo esihle sokusebenza ). Ukubuyekezwa kwezifundo ezingu-2018 ebheka inhlanganisela ehlukahlukene yezidakamizwa ezitholakala ukuthi uFolfirinex waba nethonya elikhulu ekukhuliseni ukusinda.
Imiphumela emibi ye-Chemotherapy
Imiphumela emibi ye-chemotherapy ingaba yinto ephawulekayo futhi ihlanganisa ukulahleka kwezinwele; ukunxanxathela nokuhlanza (nakuba ukwelashwa ukunciphisa lezi zimpawu kuye kwathuthuka kakhulu eminyakeni yamuva); ukukhishwa kwamathambo emathambo okuholela ekunciphiseni kwegazi elimhlophe, amangqamuzana egazi abomvu (i-anemia), namaplatelet, nokuningi.
Ukwelashwa okubhekiswe
Imithi ehlosiwe yizidakamizwa ezikhomba izindlela ezithile ekukhuleni kwamangqamuzana omdlavuza. Njengoba lezi zikwelapha zihloselwe ikakhulukazi emangqamuzaneni omdlavuza ngokuvamile (kodwa hhayi ngaso sonke isikhathi) abe nemiphumela emibi kakhulu kune-chemotherapy.
Isidakamizwa somlomo esivame ukusetshenziswa kubantu abanomdlavuza we-pancreatic, i-Tarceva (erlotinib) isebenza ngokuvimbela indlela ekukhuleni kwamangqamuzana omdlavuza. Esikhundleni sokubulala amangqamuzana omdlavuza, kubangelwa ukuthi balambile bese beyeka ukuphindaphinda kwabo. I-Tarceva ivame ukusetshenziswa kanye noGemzar. Imiphumela emibi kakhulu yeTarceva ihlanganisa ukugquma okunjenge-acne kanye nesifo sohudo.
Izivivinyo zemitholampilo
Kunezinhlobo eziningi zokwelashwa kwemitholampilo eziqhubekayo zokuhlolwa komdlavuza we-pancreatic inhlanganisela ehlukahlukene yezokwelapha ezingenhla, kanye nezinqubo ezintsha ezifana ne- immunotherapy . Nakuba ezinye zezokwelapha ziqala ukufundiswa nomdlavuza we-pancreatic, ngezinye izikhathi ziye zaholela ekulawuleni okuphawulekayo kwamanqamu aphakeme, njengomdlavuza wamaphaphu, futhi ulethe ithemba lokuthi imithi engcono yomdlavuza we-pancreatic izotholakala esikhathini esizayo.
Imithi Ephelele (CAM)
Ngesikhathi samanje, azikho ezinye izindlela zokwelashwa ezibonisa noma yikuphi ukuphumelela ekwelapheni umdlavuza we-pancreatic. Kodwa ezinye izindlela zokwelashwa zingasiza abantu ukuba babhekane nezinkinga ezibangelwa umdlavuza nomdlavuza wesikhumba, futhi eziningi zezikhungo zomdlavuza ezinkulu manje zinikeza izinketho zokuhlanganisa. Izibonelo zihlanganisa ukukhwabanisa, ukuzindla, ukwelapha ukusikhipha, kanye ne-yoga.
Izithako
Abantu abaningi bafuna izithako zokudla kanye nezomuthi uma befunda ngokuchazwa komdlavuza we-pancreatic. Kubalulekile ukuqaphela ukuthi amanye amavithamini kanye nezondlo zokudla anganciphisa ukusebenza kwemithi yomdlavuza .
Ucwaningo ebhodini lubukeze amakhemikhali ambalwa asetshenziswe ku-Ayurveda, afana ne-triphala, no-nigella sativa (omnyama ohamba phambili). Ngenkathi kube khona ukutholakala okuthembisayo okubonisa ukuvimbela ukukhula kwamangqamuzana e-pancreatic abantu asetshenziselwa ithubhu yokuhlola, asazi ukuthi lezi zinhlanganisela ziyoba nomthelela kubantu. Ngaphezu kwalokho, lezi zithako ezingenakulawulwa e-United States futhi zingase ziphazamise ezinye izifo. Lokhu yisikhumbuzo esihle, noma kunjalo, ukukhuluma ne-oncologist yakho mayelana nanoma yimaphi amavithamini, amaminerali, noma izithako zokudla ozikholelwayo / ucabanga ngokuthatha.
Kuyathakazelisa ukuthi ucwaningo olubheke umdlavuza wesifo somdlavuza (isifo sokulahlekelwa kwesisindo, ukulahlekelwa ukudla, nokulahleka kwesisindo esithinta iningi labantu abanekhanda lomdlavuza) lithole ukuthi i-omega-3 fatty acids ingasiza kakhulu, njengoba kukhona okuncane kakhulu okwenza ngempela umehluko kule syndrome. Njengoba kucatshangwa ukuthi i-cachexia iyimbangela eqondile yokufa ngamaphesenti angu-20 abantu abanomdlavuza, lokhu kubalulekile ukukhuluma ne-oncologist yakho. Kunemithombo eminingi ye-omega-3s yokudla, futhi iningi lezinhlelo ze-oncologists zincoma ukuthola izakhi ngokusebenzisa ukudla kunokuba izithako.
Ukunakekelwa kwe-Palliative
Ukunakekelwa kwe-palliative akufani ne-hospice, futhi kungasetshenziswa ngisho nakubantu abanezinambuzane eziphilisa kakhulu. Sigxile empilweni kanye nokuphila komuntu ophila nomdlavuza, kunokuba ukwelashwa komdlavuza uqobo. Ukunakekelwa kwe-palliative empeleni kuyinhloko yokwelapha kubantu abaningi abatholakala benomdlavuza we-pancreatic. Lokhu kungabandakanya ukuhlinzwa noma i-chemotherapy, njengoba kuphawuliwe ngenhla, kodwa futhi nezinye izinketho.
Izibonelo zihlanganisa ukuphathwa kahle kobuhlungu; ukulawula ezinye izimpawu zomzimba, ezifana nezinkinga zokugaya ukudla; ukusekelwa okunomsoco; nokusekelwa ngokomzwelo kokucindezeleka, ukukhathazeka nokucindezeleka. Ukunakekelwa kwe-palliative kungasiza futhi ekubhekaneni nokukhathazeka okungokomoya, ukunakekelwa komnakekeli kanye nokukhulumisana, nezinkinga ezingokoqobo ezivela kumshuwalense kuya ekusizeni kwezezimali nezomthetho.
Izikhungo eziningi zomdlavuza manje zinikeza inhlangano eqenjini lokunakekelwa kwezinwele ukuze kuqinisekiswe ukuthi izimpawu zibhekiswe nakanjani.
Amakhambi asekhaya kanye nendlela yokuphila
Njengoba ikhwalithi yokuphila nomdlavuza we-pancreatic ibaluleke kakhulu, izinyathelo ezithuthukisa ziyinhloko. Ukudla ukudla okunempilo kungenze umehluko ngomdlavuza wakho, kodwa abantu abaningi bazizwa beba ngcono uma bedla ukudla okucebile izithelo nemifino. Ukuzivocavoca kuyawusizo futhi, mhlawumbe ngokungafani, kungasiza ukunciphisa umlenze wesifo somdlavuza.
Abanye abantu bayazibuza ukuthi kuwufanele yini ukuyeka ukubhema ngemva kokutholakala, ikakhulukazi ngomdlavuza we-pancreatic. Impendulo inguyebo. Kunezizathu ezimbalwa eziqinile zokuthi kungani ukuyeka ukutholakala kokuthola umdlavuza kungasiza kakhulu.
> Imithombo:
> Ukwelashwa Kwamanje Nekukhulayo Emdlalweni We-Pancreatic Cancer, Springer Verlag, 2017.
> De la Cruz, M., Young, A., noMnu Ruffin. Ukuxilongwa Nokuphathwa Kwe-Cancer Pancreatic. I-American Family Physician . 2014. 89 (8): 626-632.
> National Cancer Institute. Ukwelapha I-Cancer Pancreatic (PDQ) -Health Professional Version. Kubuyekezwe 01/26/18. https://www.cancer.gov/types/pancreatic/hp/pancreatic-treatment-pdq
> Zhang, S., Liu, G., Li, X., Liu, L., no S. Yu. Ukusebenza kweMithi ehlukene yamaKhemotherapy ekuPhilweni kweKhansela yePancreatic Advanced noma ye-Metastatic: A Network Meta-Analysis. Journal of Physiology Cellular . 2018. 233 (4): 3352-3374.