Kukhona izingcezu eziningi zokwaziswa odokotela abhekayo ukuze bathole umdlavuza we-pancreatic . Ukuhlola ukuhlola kungase kuhlanganise uhlobo olukhethekile lwe-CT scan, esiswini se-endoscopic, i-MRI, noma i-ERCP. Ukuhlolwa kwegazi kungabheka izimbangela ze-jaundice kanye nama-marker tumor. Futhi umlando wezokwelapha obhekene nezici zobungozi, kanye nokuhlolwa ngokomzimba, kubalulekile.
I-biopsy ingase ingadingeki noma ingadingeki, kuye kwezinye iziphumo. Ngemuva kokuxilongwa, isiteji senziwa ukuze kunqume ukwelashwa okufanele kakhulu kwalesi sifo.
Wonke umuntu kufanele aqaphele izimpawu zokuxwayisa ezingase zibe khona kanye nezimpawu zomdlavuza we-pancreatic , ngakho-ke bangafuna ukuhlolwa kwezokwelapha ngokushesha ngangokunokwenzeka.
Ama-Labs nezivivinyo
Ukuhlolwa komdlavuza we-pancreatic ngokuvamile uqala ngomlando oqaphele nokuhlolwa ngokomzimba. Udokotela wakho uzokubuza imibuzo mayelana nanoma yiziphi izinto eziyingozi ongase ube nazo, kufaka phakathi umlando womndeni wesifo, futhi uzobuza mayelana nezimpawu zakho. Khona-ke uzokwenza ukuhlolwa kwangokwenyama ebuka isikhumba sakho namehlo ukuze uthole ubufakazi be- jaundice ; ukuhlola isisu sakho ngenqwaba noma ukukhulisa kwesibindi sakho, nanoma yibuphi ubufakazi be- ascites (ukwakheka kwe-fluid esiswini), nokuhlola amarekhodi akho ukuze ubone ukuthi ulahlekelwe isisindo.
Ukuhlolwa kwegazi okungavamile nomdlavuza we-pancreatic akuyona into ecacile kodwa ngezinye izikhathi kuyasiza ekutholeni ukuxilongwa uma kuhlangene nokuhlolwa kwe-imaging.
Uvivinyo lungabandakanya:
- Ukuvivinya kokusebenza kwesibindi, okwakhiwa ngezinye izikhathi
- Inani eliphelele legazi (CBC), libheke inani eliphakeme leplatelet (thrombocytosis) ikakhulukazi
- Isivivinyo se-bilirubin: Kunezinhlobo ezahlukene ze-bilirubin, futhi ngokusekelwe ohlotsheni oluthile oluvivinywe, odokotela bangathola izinkomba mayelana nomthombo wanoma iyiphi i-jaundice onayo. Nge-jaundice engavinjelwanga (ngenxa yesifo se-pancreatic esicindezelayo emgodini we-bile ovamile), kuneziphakamiso kokubili ezihlanganisiwe ne-bilirubin esiphelele.
I-sugar sugar ngokuvamile iphakanyisiwe, njengoba cishe amaphesenti angama-80 abantu abanomdlavuza we-pancreatic bazokhipha ukukhishwa kwe-insulin noma isifo sikashukela. Cishe isigamu sabantu sine-serum amylase ne-serum lipase ezinyangeni zokuqala zalesi sifo, kodwa ngaphansi kwesifo esiphezulu.
Amakhamera we-Tumor
Ama-tumor markers angama-protein asekelwe ngamangqamuzana omdlavuza futhi angatholakala ngokuhlolwa kwegazi. Omunye walezi zimpawu, i- carcinoembryonic antigen (CEA), uphakanyisiwe cishe engxenyeni yabantu ababhekene nesifo kepha futhi uphakanyisiwe kwezinye izinhlobo eziningi zezimiso. Amazinga ka-CA 19-9 angahlolwa, kodwa njengoba angahlali ephakeme futhi ekhuphuka amazinga angabonisa nezinye izimo zezokwelapha, lokhu akusizi ngokukhethekile ekutholeni ukuxilongwa komdlavuza we-pancreatic. Kodwa-ke, umphumela uyasiza ekunqumeni ukuthi isifo sofuba singasuswa ngokuhlinzwa, futhi ngokulandela inkambo yokwelapha.
Izivivinyo zegazi ze-Neuroendocrine
Ukuhlolwa kwegazi okunye kungase kube usizo ekutholeni uhlobo olungajwayelekile lwegazi lomdlavuza olubizwa ngokuthi i-neuroendocrine tumors. Ngokungafani nezicubu eziningi ze-pancreatic, ezakhiwa ngamangqamuzana enza ama-enzyme okugaya, lezi zicubu zihlanganisa amangqamuzana e-endocrine enza ama-hormone afana ne-insulin, i-glucagon, ne-somatostatin.
Ukulinganisa amazinga ama-hormone, kanye nokuqhuba ezinye izivivinyo zegazi, kungasiza ekuhloleni lezi zicubu.
Ukucabanga
Ukuhlola ukuhlola ngokuvamile kuyindlela eyinhloko yokuqinisekisa noma yokuphikisa ubukhona besisindo kuma-pancreas. Izinketho zingafaka:
I-CT Scan
I-tomography ye-computer (CT) isebenzisa i-X-ray ukudala ingxenye yesigcawu somzimba futhi ngokuvamile iyisisekelo sokuxilongwa. Uma udokotela esho umdlavuza we-pancreatic ngokuqondile, uhlobo olukhethekile lwe-CT scan olubizwa ngokuthi i-multiphase CT ye-helical CT noma ngokuvamile i-pancreatic protocol CT scan.
I-scan ye-CT ingaba usizo kokubili ukuhlukanisa isisu (ukucacisa ubukhulu bayo kanye nendawo emaqenjini) futhi ubheke noma yibuphi ubufakazi obusakaze kuma-lymph nodes noma kwezinye izifunda.
I-CT ingase iphumelele kakhulu kune-endoscopic ultrasound ekunqumeni ukuthi umdlavuza usakaze yini kumthambo omkhulu we-mesenteric (obalulekile ekukhetheni ukwelashwa).
I-Endoscopic Ultrasound (EUS)
I-Ultrasound isebenzisa amagagasi omsindo ukudala isithombe sangaphakathi komzimba. Ukuvamile (i-transcutaneous) i-ultrasound akuvamile ukwenza uma udokotela esho umdlavuza we-pancreatic, njengoba igesi lomathumbu lingenza ukuboniswa kwe-pancreas kunzima. Kodwa kungase kube usizo uma ufuna ezinye izinkinga zesisu.
I-ultrasound endoscopic ingaba inqubo ebalulekile ekwenzeni ukuxilongwa. Ukwenziwa nge-endoscopy, ithubhu eguquguqukayo ene-ultrasound probe ekupheleni kwayo ifakwe emlonyeni futhi ifakwe phansi esiswini noma emathunjini amancane, ukuze iskena singenziwa ngaphakathi. Njengoba lezi zindawo ziseduze kakhulu ne-pancreas, ukuhlolwa kuvumela odokotela ukuba babheke kahle isitho.
Ngokusebenzisa imithi (conscious sedation), abantu ngokuvamile babekezelela inqubo kahle. Ukuhlolwa kungase kunembile kakhulu kune-CT ukuhlola ubukhulu nobukhulu besisu kepha akusizi kahle ukuthola ukusabalala okude kwesikhumba (imetastase) noma ukuthola ukuthi i-tumor ihilela imithwalo yegazi.
I-Endoscopic Retrograde ye-Cholangiopancreatography (ERCP)
I-endoscopic retrograde ye-cholangiopancreatography (ERCP) iyisivivinyo esihilela i-endoscopy kanye ne-X-ray ukuze sibone ngeso lengqondo amadoksi we-bile. I-ERCP ingaba isilingo esibucayi sokuthola umdlavuza we-pancreatic kodwa ayikho enembile ekuhlukaniseni lesi sifo kwezinye izinkinga, njenge-pancreatitis. Kuyinto inqubo engavamile kakhulu ngokuphathelene nezivivinyo ezingenhla.
I-MRI
I-imagery ye-resonance magnetic (MRI) isebenzisa amamitha kune-X-ray ukudala isithombe sesakhiwo sangaphakathi. I-MRI isetshenziswa kaningi kune-CT nge-cancer ye-pancreatic kodwa ingasetshenziswa ezimweni ezithile. Njengo-CT, kunezinhlobo ezikhethekile ze-MRI, kufaka phakathi uM MR cholangiopancreatography (MRCP). Njengoba ingakafundiwe ngokulingana nezivivinyo ezingenhla, isetshenziselwa ngokuyinhloko abantu abangabonwa ngokucacile ngokusekelwe kwezinye izifundo, noma uma umuntu enesifo sofuzo kumdayisi ohlukile owenzelwe i-CT.
I-Octreoscan
Uhlolo olubizwa ngokuthi i-octreoscan noma i-somatostatin receptor scintigraphy (SRC) lingahle lenziwe uma isifo se-neuroendocrine se-pancreas sikholelwa. Ku-octreoscan, iprotheyini enomsakazo (ebizwa ngokuthi i-tracer) ifakwe ku-vein. Uma i-neuroendocrine isisu, i-tracer izobopha amangqamuzana e-tumor. Amahora ambalwa kamuva, ukukhishwa kwesikrini (ukukhwabanisa) kwenziwa okwenza noma yimiphi imisebe ekhishwayo (izicubu ze-neuroendocrine zizokhanya, uma zikhona).
I-PET Scan
Ukuhlola kwe-PET, okuvame ukuhlanganiswa ne-CT (PET / CT), kungenziwa ngezikhathi ezithile, kepha kusetshenziswa kakhulu kaningi ngomdlavuza we-pancreatic kunezinye ezinye umdlavuza. Kulesi sivivinyo, inani elincane lokushukela omsakazo lujojelwa ngaphakathi kwe-vein bese kuthathwa iskena ngemuva kokuba ushukela lunezikhathi zokubanjwa ngamaseli. Amaseli akhulayo, njengamaseli omdlavuza, azo "avuke," ngokungafani nezindawo zamaseli avamile noma izicubu ezincane.
I-Biopsy
Ngesinye isikhathi kudingeka isampula yamathishu (i-biopsy) ukuqinisekisa ukuxilongwa, kanye nokubukeka kwezici ze-molecular of the tumor.
Inaliti ehle kakhulu ye-needle (inqubo lapho inaliti encane iqondiswa khona esikhumbeni esiswini nasezimpandeni ukuze kukhishwe isampula yamathishu) kuvamise ukwenziwa ngokusebenzisa isiqondiso nge-ultrasound noma i-CT. Kukhona ukukhathazeka ukuthi lolu hlobo lwe-biopsy lungahle lube "luhlwanyela" lesi sifo, noma lube nomphumela wokusakazwa komdlavuza eceleni komugqa lapho inaliti isungulwa khona. Ayaziwa ukuthi kwenzeka kanjani ukuhlwanyela isikhathi eside, kodwa ngokusho kokucwaninga ngo-2017, inani lemibiko ye-seeding ngenxa ye-endoscopic-eqondiswa kahle ye-sindles aspiration iye yanda ngokushesha.
Njengoba i-biopsies yenzeka ngokuyinhloko ukubona ukuthi ukuhlinzwa kungenziwa (ukwelashwa kuphela okuthuthukisa ukuhlala isikhathi eside), lokhu kukukhathazeka okufanele ukukhuluma ngakho nodokotela wakho.
Njengendlela ehlukile, i- laparoscopy ingahle isetshenziswe, ikakhulukazi uma isisu singasuswa (sisetshenziswe). Ku-laparoscopy, ukucubungula okuncane okuncane kwenziwa kwisisu futhi insimbi encane ifakwe ukwenza i-biopsy. Njengoba, cishe amaphesenti angu-20 yaleso sikhathi, abantu batholakala ukuthi banezifo ezingenakusebenza ngemva kokuba ukuhlinzwa sekuqalile kakade ngomdlavuza we-pancreatic, abanye odokotela batusa ukuba benze lokhu kuhlolwa kunoma ubani ozohlinzwa (ukugwema ukuhlinzeka okungadingekile okukhulu).
Ukuhlonza okuhlukile
Kunezimo eziningi ezingase zilingise izimpawu zomdlavuza we-pancreatic noma zenze iziphumo ezifanayo ekuhlolweni kwegazi nokucabanga. Odokotela bazosebenza ukulawula okulandelayo ngaphambi kokuthola ukuxilongwa:
- Ukuqiniswa komgwaqo wamanzi: Ukuqina kwe-bile ukuhamba kancane okungavamile kwe-bile duct. Kungase kubangelwe ama-gallstones noma ukuhlinzwa ukuze abasuse, kodwa futhi kungabangelwa umdlavuza we-pancreatic.
- I-pancreatitis enobuhlungu noma engapheliyo: I- Pancreatitis , ukuvuvukala kwe-pancreas, ingabangela izimpawu ezifanayo, kodwa akubanga ukuthi isisindo. Ephakathi kwabantu abangu-20 kuya kwezingu-20, i-pancreatitis enamandla ikhona ngesikhathi sokuxilongwa komdlavuza we-pancreatic.
- Amatshe okudoba amabhilidi: Amatshe agcwele i-bile duct angabangela izimpawu ze-obstructive jaundice futhi angabonakala ku-ultrasound. Njengama-bile duct strictures, noma kunjalo, kungenzeka ukuthi abekhona nomdlavuza we-pancreatic.
- Ampullary carcinoma
- Umdlavuza we-Gallbladder : I-Gallbladder Cancer ingabonakala ifana kakhulu ne-kancreatic kancreatic, kodwa ingahlukaniswa ne-CT noma i-MRI.
- Ama-gallstones (i-cholelithiasis)
- Izilonda zesisu noma i-duodenal
- I-aortic aneurysm yesisu
- I-pancreatic lymphoma
- I-gastric lymphoma
- Umdlavuza wesibindi
- Umdlavuza we-buct webheyili
Isiteji
Ukunquma isiteleka somdlavuza we-pancreatic kubaluleke kakhulu uma kuziwa ekunqumeni ukuthi umdlavuza ungaqedwa yini noma cha. Uma isiteji singalungile, kungaholela ekuhlinzekeni okungadingekile. Ukuncintisana kungasiza ekuhloleni ukuchazwa kwesifo.
I-TNM Isiteji
Odokotela basebenzisa uhlelo olubizwa ngokuthi i-TNM esiteji sokuthola isiteji sesisu. Lokhu kungase kudideke kakhulu ekuqaleni kodwa kulula ukuyiqonda uma wazi ukuthi lezi zincwadi zisho ukuthini.
T imelela isisu. I-tumor inikezwa inombolo kusuka ku-T1 kuya ku-T4 isekelwe ngobukhulu be-tumor, kanye nezinye izakhiwo kungenzeka ukuthi lesi sifo singene.
| T1 | I-tumor ivaliwe kuma-pancreas futhi angaphansi kwe-2 cm |
| T2 | I-tumor ivinjiwe kuma-pancre futhi ngaphezu kuka-2 cm |
| T3 | I-tumor idlulisa ngaphezu kwamaphancasi (kuya kwe-duodenum, i-bile duct, i-portal noma i-veenteric vein), kodwa ayifaki i-axis e-celiac noma umthambo omkhulu we-mesenteric |
| T4 | I-tumor ihilela umthambo we-celiac noma umthambo omkhulu we-mesenteric |
I-N imele ama-lymph nodes. I-N0 ingasho ukuthi isisu asizange sisakaze kunoma yiziphi izilonda zamagciwane. I-N1 isho ukuthi i-tumor isakaze emaphethini omzimba oseduze.
| N0 | Akukho ukubandakanyeka kwamakhansela wesifunda |
| N1 | Ama-lymph node zesifunda anomdlavuza |
M imelela ama-metastases. Uma isisu singasakazeka, sizochazwa njengo M0. Uma isakazeke ezindaweni ezikude (ngaphesheya kwamaphakheji) izobizwa ngokuthi yi-M1.
| M0 | Ayikho i-metastasis eseduze |
| I-M1 | I-metastasis eseduze |
Ngokusekelwe ku-TNM, izicubu zinikezwa isiteji esiphakathi kwe-0 no-4. Kukhona futhi izindawo.
Isigaba sesi-0: Isigaba esingu-0 siphinde sabizwa ngokuthi i- carcinoma in situ futhi sibhekisela kumdlavuza ongakaze usakaze into ebizwa ngokuthi i-membrane engaphansi. Lezi zicubu aziyona inselele (nakuba izigaba ezilandelayo zikhona) futhi kufanele zithathwe ngokuphelele.
Isigaba 1: Amagciwane we-pancreatic (Stage 1 (Stage 1 (T1 noma T2, N0, M0) agcinwe kuma-pancreas futhi angaphansi kuka-4 cm (cishe ngamasentimitha amabili) ububanzi.
Isigaba sesi-2: Izicubu zesigaba sesi-2 (noma i-T3, N0, M0 noma i-T1-3, i-N1, i-M0) ingaba ngaphezu kwe-pancreas (ngaphandle kokubandakanya i-axis e-celiac noma umthambo omkhulu we-mesenteric) futhi ingafaki ku-lymph nodes, noma ivalwe ama-pancreas kodwa asakaze kuma-lymph nodes.
Isigaba sesi-3: Izicubu ze-Stage 3 (T4, nanoma yiliphi i-N, M0) lidlula ngapha kwamaphanta futhi zibandakanya umthambo we-celiac noma umthambo we-mesenteric ophakeme. Kungenzeka ukuthi kungenzeka noma kungakaze kusakaze kuma-lymph nodes, kodwa ayizange isakaze ezindaweni ezikude zomzimba.
Isiteji sesi-4: Izicubu zesigaba se-4 (noma yikuphi u-T, nanoma iyiphi i-N, M1) ingaba yisayizi. Ngenkathi kungenzeka noma zingakaze zisakaze kuma-lymph nodes, zisakaze ezindaweni ezikude ezifana nesibindi, i-peritoneum (i-membranes eqondisa isisu somzimba), amathambo noma amaphaphu.
> Imithombo:
> Society of American of Clinical Oncology. I-Cancer.Net. Kubuyekezwe i-12/2016. https://www.cancer.net/cancer-types/pancreatic-cancer/diagnosis
> 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.
> Kikuyama, M., Kamisawa, T., Kuruma, S. et al. Ukutholwa Kwesandulela Ngaphambi Kokuthuthukisa Ukukhubazeka Okubi Kwe-Cancer Pancreatic. Amanqamu . 2018. 10 (2) :. pii: E48.
> Minaga, K., Takenaka, M., Katanuma, A. et al. Ukulingana kwe-Needle Tract: Ukungaqapheli Okujwayelekile Ukuxilongwa Kwe-Endoscopic Ultrasound-Ukuqondiswa Okuhle-Isinxephezelo Ukuphefumula. I-oncology . 2017. 93 Ukusekela 1: 107-112.