Mitundu / chiwindi / wodwala / bile-duct-treatment-pdq

Khansa ya Bile Duct (Cholangiocarcinoma) Chithandizo

Zambiri Zokhudza Khansa ya Mitsempha Yambiri

MFUNDO ZOFUNIKA

• Khansara yamagazi ndimatenda osowa pomwe m'maselo owopsa (khansa) amapangika m'matope a bile.

• Kukhala ndi colitis kapena matenda ena a chiwindi kumatha kuonjezera ngozi ya khansa ya bile.

• Zizindikiro za khansa ya bile imaphatikizanso jaundice komanso kupweteka m'mimba.

• Kuyesa komwe kumayesa ma ducts a ziwalo ndi ziwalo zoyandikira kumagwiritsidwa ntchito kuti mupeze (kupeza), kuzindikira, ndikuwonetsa khansa ya bile.

• Njira zosiyanasiyana zitha kugwiritsidwa ntchito kupeza mtundu wa minofu ndikuzindikira khansa ya bile.

• Zinthu zina zimakhudzanso madandaulo (mwayi wochira) ndi njira zamankhwala.

Khansara yamagazi ndimatenda osowa pomwe m'maselo owopsa (khansa) amapangika m'matope a bile.

Ma netiwebu, omwe amatchedwa ducts, amalumikiza chiwindi, ndulu, ndi matumbo ang'onoang'ono. Netiwekiyi imayamba m'chiwindi pomwe timadontho tating'onoting'ono tambiri timasonkhanitsa bile (kamadzimadzi kamene kamapangidwa ndi chiwindi kuti kaphwanye mafuta pakudya). Timadontho tating'onoting'ono timasonkhana kuti apange timadontho todzidzimutsa tomwe timatuluka pachiwindi. Mimbayi iwiri imalumikizana kunja kwa chiwindi ndikupanga njira yodziwika bwino yachiwindi. Msewu wamanjenje umalumikiza ndulu ndi njira wamba yodziwika bwino. Kuwira kochokera pachiwindi kumadutsa timadontho tosokonekera, njira yodziwika yodziwika bwino, ndi chotupa cha cystic ndipo chimasungidwa mu ndulu.

Chakudya chikamakumbidwa, ndulu yomwe imasungidwa mu ndulu imatulutsidwa ndipo imadutsa mumtsinje wa cystic kupita kumtunda wamba wa bile komanso m'matumbo ang'onoang'ono.

Khansa yamafuta amadzimadzi amatchedwanso cholangiocarcinoma.

Pali mitundu iwiri ya khansa ya bile:

• Khansa ya m'mimba ya intrahepatic bile: Khansa yamtunduwu imapangidwa m'matope amkati mwa chiwindi. Khansa yochepa chabe ya khansa ya m'mimba ndiyo intrahepatic. Khansa ya m'mimba ya intrahepatic bile imatchedwanso intrahepatic cholangiocarcinomas.

Anatomy ya intrahepatic bile ducts. Intrahepatic bile ducts ndi netiweki yamachubu zazing'ono zomwe zimanyamula bile mkati mwa chiwindi. Timadontho tating'onoting'ono kwambiri, tomwe timatchedwa ductules, timasonkhana pamodzi kuti apange ndulu yolondola ya hepatic bile ndi mbali yakumanzere ya hepatic bile, yomwe imatulutsa bile pachiwindi. Bile amasungidwa mu ndulu ndipo amatulutsidwa pomwe chakudya chikugayidwa.

• Khansa ya ndere ya Extrahepatic bile: Njira ya extrahepatic bile imapangidwa ndi dera la hilum ndi dera lakutali. Khansa imatha kupezeka mdera lililonse:

• Khansa ya perihilar bile khansa: Khansa yamtunduwu imapezeka mdera la hilum, komwe madontho a ndulu yakumanja ndi kumanzere amatuluka m'chiwindi ndikuphatikizana kuti apange njira yodziwika bwino yachiwindi. Khansa ya khansa ya bile yotchedwa Perihilar bile imatchedwanso chotupa cha Klatskin kapena perihilar cholangiocarcinoma.

• Khansa yapadera ya khansa ya bile: Mtundu wa khansa umapezeka mdera lakutali. Dera lakutali limapangidwa ndi njira yodziwika bwino ya bile yomwe imadutsa m'mapapo ndipo imathera m'matumbo ang'onoang'ono. Khansa yapadera ya extrahepatic bile duct imatchedwanso extrahepatic cholangiocarcinoma.

Kutulutsa kwa ma ducts a extrahepatic bile. Ma Extrahepatic bile ducts ndimachubu tating'ono tomwe timanyamula bile kunja kwa chiwindi. Amapangidwa ndi njira yodziwika bwino ya chiwindi (dera la hilum) ndi njira yodziwika ya bile (distal region). Mayiwo amapangidwa m'chiwindi ndipo amayenda kudzera panjira yodziwika bwino yapa hepatic ndi chotengera cha cystic kupita ku ndulu, komwe amasungidwa. Bile amatulutsidwa mu ndulu pamene chakudya chikugayidwa.

Kukhala ndi colitis kapena matenda ena a chiwindi kumatha kuonjezera ngozi ya khansa ya bile.

Chilichonse chomwe chimakulitsa chiopsezo chotenga matenda chimatchedwa chiopsezo. Kukhala ndi chiwopsezo sikutanthauza kuti udzakhala ndi khansa; kusakhala ndi zoopsa sikutanthauza kuti simudzakhala ndi khansa. Anthu omwe amaganiza kuti atha kukhala pachiwopsezo ayenera kukambirana izi ndi adotolo.

Zowopsa za khansa ya bile imakhala ndi izi:

• Pulayimale sclerosing cholangitis (matenda omwe amapita patsogolo pomwe ma ducts amadzitsekera chifukwa chotupa komanso m'mabala).

• Ulcerative colitis wamatenda.

• Mphutsi m'matope a bile (zotupa zimaletsa kutuluka kwa ndulu ndipo zimatha kuyambitsa kutupa kwa ndulu, kutupa, ndi matenda).

• Kutenga matenda opatsirana a chiwindi ku China.

Zizindikiro za khansa ya bile imaphatikizanso jaundice komanso kupweteka m'mimba.

Izi ndi zizindikilo zina zimatha kubwera chifukwa cha khansa ya bile kapena njira zina. Funsani dokotala ngati muli ndi izi:

• Jaundice (chikasu chachikopa kapena azungu amaso).

• Mkodzo wakuda.

• Mpando wachikopa.

• Ululu m'mimba.

• Malungo.

• Khungu loyabwa.

• Nseru ndi kusanza.

• Kuchepetsa thupi pazifukwa zosadziwika.

Kuyesa komwe kumayesa ma ducts a ziwalo ndi ziwalo zoyandikira kumagwiritsidwa ntchito kuti mupeze (kupeza), kuzindikira, ndikuwonetsa khansa ya bile.

Ndondomeko zomwe zimapanga zithunzi zamadontho a bile ndi malo oyandikira zimathandizira kuzindikira khansa ya ndulu ndikuwonetsa momwe khansara yafalikira. Njira yomwe amagwiritsidwa ntchito pofufuza ngati maselo a khansa afalikira mkati ndi mozungulira madontho a bile kapena mbali zakutali za thupi amatchedwa staging.

Pofuna kukonzekera chithandizo chamankhwala, ndikofunikira kudziwa ngati khansara ya bile ingachotsedwe ndi opaleshoni. Kuyezetsa ndi njira zodziwira, kuzindikira, ndi khansa ya khosi ya bile nthawi zambiri imachitika nthawi yomweyo.

Mayeso ndi njira zotsatirazi zitha kugwiritsidwa ntchito:

• Kuwunika kwakuthupi ndi mbiri: Kuyesedwa kwa thupi kuti muwone zizindikiritso zaumoyo, kuphatikiza kuyang'ana ngati pali matenda, monga zotupa kapena china chilichonse chomwe chikuwoneka chachilendo. Mbiri yokhudzana ndi thanzi la wodwalayo komanso matenda am'mbuyomu komanso chithandizo chamankhwala adzachitidwanso.

• Kuyesa kwa chiwindi: Njira yoyeserera magazi kuti ayese kuchuluka kwa bilirubin ndi alkaline phosphatase yomwe imatulutsidwa m'magazi ndi chiwindi. Zambiri kuposa izi zitha kukhala chizindikiro cha matenda a chiwindi omwe angayambitsidwe ndi khansa ya bile.

• Kuyesa kwantchito: Njira zamankhwala zomwe zimayesa mitundu ya minofu, magazi, mkodzo, kapena zinthu zina m'thupi. Mayesowa amathandizira kuzindikira matenda, kukonzekera ndikuwunika chithandizo, kapena kuwunika matendawa kwakanthawi.

• Carcinoembryonic antigen (CEA) ndi CA 19-9 test marker test: Njira yoyeserera magazi, mkodzo, kapena minofu kuti izindikire kuchuluka kwa zinthu zina zopangidwa ndi ziwalo, zotupa, kapena zotupa m'thupi. Zinthu zina zimalumikizidwa ndi mitundu ina ya khansa ikapezeka m'magulu owonjezeka mthupi. Izi zimatchedwa zolembera zotupa. Kuposa kuchuluka kwa carcinoembryonic antigen (CEA) ndi CA 19-9 kungatanthauze kuti pali khansa ya bile.

• Kuyesa kwa Ultrasound: Njira yomwe mafunde amawu amphamvu (ultrasound) amachotsedwa pamatumba kapena ziwalo zamkati, monga pamimba, ndikupanga mawonekedwe. Zolembawo amapanga chithunzi cha matupi amthupi otchedwa sonogram. Chithunzicho chimatha kusindikizidwa kuti chiwonedwe pambuyo pake.

• CT scan (CAT scan): Njira yomwe imapanga zithunzi zingapo zamkati mwa thupi, monga pamimba, zojambulidwa mosiyanasiyana. Zithunzizo zimapangidwa ndi kompyuta yolumikizidwa ndi makina a x-ray. Utoto ukhoza kulowetsedwa mumtsempha kapena kumeza kuti ziwalo kapena ziwalo ziwoneke bwino. Njirayi imatchedwanso computed tomography, kompyuta tomography, kapena kompyuta axial tomography.

• MRI (magnetic resonance imaging): Njira yomwe imagwiritsa ntchito maginito, mafunde a wailesi, ndi kompyuta kuti ipange zithunzi zingapo za malo amkati mwa thupi. Njirayi imatchedwanso nuclear magnetic resonance imaging (NMRI).

• MRCP (magnetic resonance cholangiopancreatography): Njira yomwe imagwiritsa ntchito maginito, mafunde a wailesi, ndi kompyuta kuti ipange zithunzi zingapo za magawo amkati mwa thupi monga chiwindi, mapiko a ndulu, ndulu, kapamba, ndi kapamba.

Njira zosiyanasiyana zitha kugwiritsidwa ntchito kupeza mtundu wa minofu ndikuzindikira khansa ya bile.

Maselo ndi ziphuphu zimachotsedwa panthawi yomwe zimachitika kuti ziwoneke ndi microscope ndi wodwala kuti aone ngati ali ndi khansa. Njira zosiyanasiyana zitha kugwiritsidwa ntchito kupeza mtundu wa maselo ndi minofu. Mtundu wa njira zomwe amagwiritsidwa ntchito zimatengera ngati wodwalayo ali bwino kuti achite opaleshoni.

Mitundu yamachitidwe a biopsy ndi awa:

• Laparoscopy: Njira yochitira opareshoni yoyang'ana ziwalo zamkati mwamimba, monga timitsempha ta ndulu ndi chiwindi, kuti muwone ngati ali ndi khansa. Tizinthu tating'onoting'ono (todulira) timapangidwa pakhoma pamimba ndipo laparoscope (chubu chowonda, chowunikira) imayikidwa mchimodzi mwazomwe zimapangidwazo. Zida zina zitha kulowetsedwa mwanjira yomweyo kapena zina kuti achite njira monga kutenga zitsanzo za minofu kuti aone ngati ali ndi khansa.

• Percutaneous transhepatic cholangiography (PTC): Njira yogwiritsira ntchito X-ray chiwindi ndi ducts. Singano yopyapyala imalowetsedwa kudzera pakhungu pansi pa nthiti ndikufika pachiwindi. Utoto umalowetsedwa m'chiwindi kapena m'mabande am'mimba ndipo x-ray imatengedwa. Chitsanzo cha minofu chimachotsedwa ndikuwunika ngati ali ndi khansa. Ngati phula la ndulu litatsekedwa, chubu chofiyira chosasunthika chomwe chimatchedwa stent chimatha kutsalira m'chiwindi kuti chikhetse ndulu m'matumbo ang'onoang'ono kapena thumba lakutolera kunja kwa thupi. Njirayi itha kugwiritsidwa ntchito ngati wodwala sangathe kuchitidwa opaleshoni.

• Endoscopic retrograde cholangiopancreatography (ERCP): Njira yogwiritsira ntchito X-ray ducts (machubu) omwe amanyamula bile kuchokera pachiwindi kupita ku ndulu komanso kuchokera ku ndulu kupita kumatumbo ang'onoang'ono. Nthawi zina khansa ya bile imapangitsa kuti mitengoyi ichepetse komanso kutseka kapena kuchepetsa kutuluka kwa bile, kuyambitsa matenda a jaundice. Endoscope imadutsa pakamwa ndi m'mimba ndikulowa m'matumbo ang'onoang'ono. Utoto umalowetsedwa kudzera mu endoscope (chida chochepa, chokhala ngati chubu chokhala ndi kuwala ndi mandala owonera) m'mabowo am'mimba ndipo x-ray imatengedwa. Chitsanzo cha minofu chimachotsedwa ndikuwunika ngati ali ndi khansa. Ngati phula la ndulu litatsekedwa, chubu chochepa kwambiri chitha kulowetsedwa mumsewu kuti chimatseke. Chubu ichi (kapena stent) chitha kusiya m'malo kuti pakhale njira yotseguka. Njirayi itha kugwiritsidwa ntchito ngati wodwala sangathe kuchitidwa opaleshoni.

• Endoscopic ultrasound (EUS): Njira yomwe endoscope imayikidwa mthupi, nthawi zambiri kudzera pakamwa kapena m'matumbo. Endoscope ndi chida chopyapyala, chokhala ngati chubu chokhala ndi kuwala ndi mandala owonera. Kafukufuku kumapeto kwa endoscope amagwiritsidwa ntchito kuphulitsa mafunde amphamvu kwambiri (ultrasound) pamatumba amkati kapena ziwalo ndikupanga mawonekedwe. Zolembawo amapanga chithunzi cha matupi amthupi otchedwa sonogram. Chitsanzo cha minofu chimachotsedwa ndikuwunika ngati ali ndi khansa. Njirayi imatchedwanso endosonography.

Zinthu zina zimakhudzanso madandaulo (mwayi wochira) ndi njira zamankhwala.

Kulosera (mwayi wochira) ndi njira zamankhwala zimadalira izi:

• Kaya khansara ili kumtunda kapena kumunsi kwa dongosolo la bile.

• Gawo la khansa (ngakhale limakhudza timabowo tokha kapena lafalikira ku chiwindi, ma lymph node, kapena malo ena m'thupi).

• Kaya khansara yafalikira m'mitsempha yapafupi kapena mitsempha.

• Kaya khansayo itha kuchotsedwa kwathunthu ndi opareshoni.

• Kaya wodwalayo ali ndi zovuta zina, monga primary sclerosing cholangitis.

• Kaya mulingo wa CA 19-9 ndiwokwera kuposa wamba.

• Kaya khansa yapezeka kumene kapena yabwereranso (bwererani).

Njira zochiritsira zimadaliranso zomwe zimayambitsa khansa. Khansara yamagazi imapezeka pambuyo poti yafalikira ndipo silingathe kuchotsedwa kwathunthu ndi opaleshoni. Chithandizo chothandizira chingathetsere zizindikiro ndikuthandizira moyo wa wodwalayo.

Magawo a Khansa Yothira Mitsempha

MFUNDO ZOFUNIKA

• Zotsatira zakuyesa ndikuwonetsa magawo amagwiritsidwa ntchito kuti apeze ngati maselo a khansa afalikira.

• Pali njira zitatu zomwe khansa imafalikira mthupi.

• Khansa imatha kufalikira pomwe idayamba kupita mbali zina za thupi.

• Magawo amagwiritsidwa ntchito pofotokozera mitundu yosiyanasiyana ya khansa ya bile.

• Khansa ya m'mimba ya intrahepatic bile

• Khansa ya perihilar bile khansa

• Khansa yapadera ya khansa ya bile

• Magulu otsatirawa amagwiritsidwa ntchito pokonzekera chithandizo:

• Khansa yotulutsa ndulu yotseguka (yakomweko)

• Khansa ya khansa ya ndulu yosasunthika, metastatic, kapena recurrent

Zotsatira zakuyesa ndikuwonetsa magawo amagwiritsidwa ntchito kuti apeze ngati maselo a khansa afalikira.

Njira yomwe imagwiritsidwa ntchito pofufuza ngati khansa yafalikira mbali zina za thupi imatchedwa staging. Kwa khansa ya bile, zomwe zimapezeka pamayeso ndi njira zake zimagwiritsidwa ntchito pokonzekera chithandizo, kuphatikiza ngati chotupacho chingachotsedwe ndi opaleshoni.

Pali njira zitatu zomwe khansa imafalikira mthupi.

Khansa imatha kufalikira kudzera mu minofu, ma lymph system, ndi magazi:

• Minofu. Khansara imafalikira kuchokera pomwe idayamba ndikukula kupita kumadera oyandikana nawo.

• Lymph dongosolo. Khansara imafalikira kuchokera pomwe idayamba polowa m'mitsempha. Khansara imadutsa m'mitsempha yamafuta kupita mbali zina za thupi.

• Magazi. Khansara imafalikira kuchokera pomwe idayamba ndikulowa m'magazi. Khansara imadutsa m'mitsempha yamagazi kupita mbali zina za thupi.

Khansa imatha kufalikira pomwe idayamba kupita mbali zina za thupi.

Khansa ikafalikira mbali ina ya thupi, imatchedwa metastasis. Maselo a khansa amachoka pomwe adayamba (chotupa choyambirira) ndikuyenda mumitsempha kapena magazi.

• Lymph dongosolo. Khansara imalowa mumitsempha, imadutsa m'mitsempha yamafuta, ndikupanga chotupa (chotupa cha metastatic) gawo lina la thupi.

• Magazi. Khansara imalowa m'magazi, imadutsa m'mitsempha yamagazi, ndikupanga chotupa (chotupa cha metastatic) gawo lina la thupi.

Chotupa cha metastatic ndi khansa yofanana ndi chotupa chachikulu. Mwachitsanzo, ngati khansa ya bile imafalikira pachiwindi, maselo a khansa m'chiwindi alidi ma cell a khansa ya bile. Matendawa ndi khansa ya m'matumbo ya ndulu, osati khansa ya chiwindi.

Magawo amagwiritsidwa ntchito pofotokozera mitundu yosiyanasiyana ya khansa ya bile.

Khansa ya m'mimba ya intrahepatic bile

• Gawo 0: Pa khansa 0 intrahepatic bile duct khansa, maselo achilendo amapezeka mkatikati mwa minofu yomwe ili mkati mwa intrahepatic bile duct. Maselo achilendowa amatha kukhala khansa ndikufalikira m'minyewa yabwinobwino. Gawo 0 limatchedwanso carcinoma in situ.

• Gawo I: Khansa ya intrahepatic bile khansa imagawidwa m'magawo IA ndi IB.

Kukula kwa zotupa nthawi zambiri kumayeza masentimita (cm) kapena mainchesi. Zakudya zodziwika bwino zomwe zitha kugwiritsidwa ntchito posonyeza kukula kwa chotupa mu cm zimaphatikizapo: nsawawa (1 cm), chiponde (2 cm), mphesa (3 cm), mtedza (4 cm), laimu (5 cm kapena 2) mainchesi), dzira (6 cm), pichesi (7 cm), ndi manyumwa (masentimita 10 kapena mainchesi 4).

• Pa siteji IA, khansa yapangidwa mu intrahepatic bile duct ndipo chotupacho ndi masentimita 5 kapena ocheperako.

• Mu gawo IB, khansa yapangidwa mu intrahepatic bile duct ndipo chotupacho chimakhala chachikulu kuposa masentimita asanu.

• Gawo II: Mu khansa yachiwiri ya khansa ya m'mimba ya intrahepatic bile, izi ndi izi:

• chotupacho chafalikira kukhoma kwa njira yolumikizira intrahepatic bile mumtsuko wamagazi; kapena

• chotupa choposa chimodzi chapangidwa mu ndulu ya intrahepatic bile ndipo chitha kufalikira mumtsuko wamagazi.

• Gawo lachitatu: Khansa yachitatu ya intrahepatic bile khansa imagawidwa m'magawo IIIA ndi IIIB.

• Mu gawo IIIA, chotupacho chafalikira kudzera mu kapisozi (chakunja chakunja) cha chiwindi.

• Pa gawo IIIB, khansa yafalikira ku ziwalo kapena zotupa pafupi ndi chiwindi, monga duodenum, koloni, m'mimba, njira yolumikizira ya ndulu, khoma la m'mimba, diaphragm, kapena gawo la vena cava kuseli kwa chiwindi, kapena khansa yafalikira ma lymph nodes apafupi.

• Gawo IV: Khansa yapakati ya intrahepatic bile khansa, khansa yafalikira mbali zina za thupi, monga mafupa, mapapo, ma lymph node akutali, kapena minofu yolumikizira khoma la pamimba komanso ziwalo zambiri pamimba.

Khansa ya perihilar bile khansa

• Gawo 0: Pa khansa ya 0 perihilar bile khansa, maselo osadziwika amapezeka mkatikati mwa minofu yomwe ili perihilar bile duct. Maselo achilendowa amatha kukhala khansa ndikufalikira m'minyewa yabwinobwino. Gawo 0 limatchedwanso carcinoma in situ kapena high-grade dysplasia.

• Gawo I: Pa khansa yoyamba ya khansa ya ndulu, khansa yapangidwa mkatikati mwa minofu yomwe imalumikizana ndi perihilar bile rope ndipo yafalikira mumisempha kapena ulusi wopindika wa khoma la perihilar bile.

• Gawo lachiwiri: Gawo lachiwiri la khansa ya perihilar bile khansa, khansa yafalikira kukhoma la perihilar bile duct kupita kuma minofu apafupi kapena minofu ya chiwindi.

• Gawo lachitatu: Khansa yapa bile ya perihilar bile khansa imagawidwa m'magawo IIIA, IIIB, ndi IIIC.

• Gawo IIIA: khansa yafalikira ku nthambi mbali imodzi ya mtsempha wamagazi kapena ya mtsempha wama portal.

• Gawo IIIB: khansa yafalikira ku chimodzi kapena zingapo zotsatirazi:

• gawo lalikulu la mtsempha wamafuta kapena nthambi zake mbali zonse ziwiri;

• mtsempha wamagazi wamba;

• njira yolondola ya chiwindi ndi nthambi yakumanzere yamitsempha ya chiwindi kapena yamitsempha yapa portal;

• chingwe chakumanzere chakumanzere ndi nthambi yolondola yamitsempha yapa chiwindi kapena yamitsempha yapa portal.

• Gawo IIIC: khansa yafalikira ku 1 mpaka 3 ma lymph node apafupi.

• Gawo lachinayi: Khansa ya khansa ya bile yomwe imachitika m'magulu anayi imagawika magawo a IVA ndi IVB.

• Gawo IVA: Khansa yafalikira mpaka 4 kapena kuposa ma lymph node apafupi.

• Gawo IVB: Khansa yafalikira mbali zina za thupi, monga chiwindi, mapapo, fupa, ubongo, khungu, ma lymph node akutali, kapena minofu yolumikizira khoma la pamimba ndi ziwalo zambiri zam'mimba.

Khansa yapadera ya khansa ya bile

• Gawo 0: Pa siteji 0 distal extrahepatic bile duct khansa, maselo achilendo amapezeka mkatikati mwa minofu yomwe imayika mbali ya distep extrahepatic bile duct. Maselo achilendowa amatha kukhala khansa ndikufalikira m'minyewa yabwinobwino. Gawo 0 limatchedwanso carcinoma in situ kapena high-grade dysplasia.

Mamilimita (mm). Pensulo yakuthwa ili pafupifupi 1 mm, krayoni yatsopano ndi pafupifupi 2 mm, ndipo chofufutira pensulo chatsopano ndi pafupifupi 5 mm.

• Gawo I: Pakadali pano ndimasiya khansa ya ndere ya extrahepatic bile, khansa yapanga ndikufalikira ochepera mamilimita 5 kukhoma la distal extrahepatic bile duct.

• Gawo lachiwiri: Khansa yachiwiri ya extrahepatic bile khansa imagawidwa m'magawo IIA ndi IIB.

• Gawo IIA: Khansa yafalikira:

• ochepera mamilimita 5 kukhoma kwa distal extrahepatic bile duct ndipo yafalikira ku 1 mpaka 3 ma lymph node apafupi; kapena

• 5 mpaka 12 millimeters kukhoma kwa distal extrahepatic bile ritsa.

• Gawo IIB: Khansa yafalikira mamilimita 5 kapena kupitilira kukhoma la distal extrahepatic bile duct. Khansa ikhoza kufalikira mpaka 1 mpaka 3 ma lymph node apafupi.

• Gawo lachitatu: Khansa yachitatu ya extrahepatic bile khansa imagawidwa m'magawo IIIA ndi IIIB.

• Gawo IIIA: Khansa yafalikira kukhoma la distal extrahepatic bile duct mpaka 4 kapena ma lymph node apafupi.

• Gawo IIIB: Khansa yafalikira kuzombo zazikulu zomwe zimanyamula magazi kumimba m'mimba. Khansa ikhoza kufalikira ku 1 kapena ma lymph node apafupi.

• Gawo lachinayi: Gawo lachitatu la khansa yapadera ya khansa ya khosi, khansa yafalikira mbali zina za thupi, monga chiwindi, mapapo, kapena minofu yolumikizira khoma la pamimba komanso ziwalo zambiri zam'mimba.

Magulu otsatirawa amagwiritsidwa ntchito pokonzekera chithandizo:

Khansa yotulutsa ndulu yotseguka (yakomweko)

Khansara ili m'deralo, monga gawo lakumunsi kwa bile kapena dera la perihilar, komwe imatha kuchotsedwa kwathunthu ndi opareshoni.

Khansa ya khansa ya ndulu yosasunthika, metastatic, kapena recurrent

Khansa yosagwiritsika ntchito singathe kuchotsedwa kotheratu ndi opaleshoni. Odwala ambiri omwe ali ndi khansa ya bile sangatulutsidwe khansa chifukwa cha opaleshoni.

Metastasis ndikufalikira kwa khansa kuchokera kumalo oyambira (komwe idayambira) kupita kumalo ena mthupi. Khansara yamafuta am'mimba imatha kufalikira pachiwindi, mbali zina zam'mimba, kapena kumadera akutali a thupi.

Khansa yapakhungu ya bile yotulutsa khansa ndi khansa yomwe yabwereranso (kubwerera) itachiritsidwa. Khansara imatha kubwereranso m'matumbo a bile, chiwindi, kapena ndulu. Nthawi zambiri, imatha kubwerera kumadera akutali a thupi.

Chithandizo Chosankha Mwachidule

MFUNDO ZOFUNIKA

• Pali mitundu yosiyanasiyana ya chithandizo cha odwala khansa ya bile.

• Mitundu itatu yamankhwala ogwiritsidwa ntchito imagwiritsidwa ntchito:

• Opaleshoni

• Thandizo la radiation

• Chemotherapy

• Mitundu yatsopano yamankhwala ikuyesedwa m'mayesero azachipatala.

• Kuika chiwindi

• Chithandizo cha khansa ya bile ingayambitse zovuta.

• Odwala angaganize zopita nawo kukayezetsa.

• Odwala amatha kulowa m'mayesero azachipatala asanayambe, asanayambe, kapena atayamba kulandira chithandizo cha khansa.

• Mayeso otsatirawa angafunike.

Pali mitundu yosiyanasiyana ya chithandizo cha odwala khansa ya bile.

Pali mitundu ingapo yamankhwala othandizira odwala omwe ali ndi khansa ya bile. Mankhwala ena ndi ofanana (mankhwala omwe akugwiritsidwa ntchito pano), ndipo ena akuyesedwa m'mayesero azachipatala. Kuyesedwa kwachipatala ndi kafukufuku wofufuza wothandizira kusintha chithandizo chamakono kapena kupeza zidziwitso zamankhwala atsopano kwa odwala khansa. Pamene mayesero azachipatala awonetsa kuti chithandizo chatsopano ndichabwino kuposa chithandizo chamankhwala, chithandizocho chitha kukhala chamankhwala wamba. Odwala angaganize zopita nawo kukayezetsa. Mayesero ena azachipatala ndi otseguka kwa odwala omwe sanayambe kulandira chithandizo.

Mitundu itatu yamankhwala ogwiritsidwa ntchito imagwiritsidwa ntchito:

Opaleshoni

Mitundu yotsatirayi imagwiritsidwa ntchito pochiza khansa ya bile:

• Kuchotsa njira yotulutsa ndulu: Njira yochitira opaleshoni yochotsa gawo limodzi la ndulu ngati chotupacho ndi chaching'ono komanso mumalo okhaokha. Matenda am'mimba amachotsedwa ndipo matupi am'mimba amawonedwa pansi pa microscope kuti awone ngati pali khansa.

• Hepatectomy yapadera: Njira yochitira opaleshoni yomwe gawo la chiwindi pomwe khansa imapezeka limachotsedwa. Gawo lomwe lachotsedwa lingakhale khungu, lobe lonse, kapena gawo lalikulu la chiwindi, komanso minofu yabwinobwino yozungulira.

• Njira ya Whipple: Njira yochitira opaleshoni yomwe mutu wa kapamba, ndulu, gawo la m'mimba, gawo la m'matumbo ang'onoang'ono, ndi chotupa cha ndulu zimachotsedwa. Mpheta zimasowa kuti zizipanga timadziti ndi insulin.

Dokotala atachotsa khansa yonse yomwe imawonekera panthawi yochitidwa opaleshoniyi, odwala ena atha kupatsidwa chemotherapy kapena radiation pochita opaleshoni kuti aphe maselo aliwonse a khansa omwe atsala. Chithandizo chomwe chimaperekedwa pambuyo pa opareshoni, kuti muchepetse chiopsezo kuti khansa ibwererenso, amatchedwa adjuvant therapy. Sizikudziwika ngati chemotherapy kapena radiation radiation yoperekedwa atachitidwa opaleshoni imathandiza kuti khansa isabwererenso.

Mitundu yotsatirayi ya opaleshoni yotsitsimula ikhoza kuchitidwa kuti muchepetse zisonyezo zomwe zimayambitsidwa ndi chotchinga cha ndulu ndikuthandizira kukhala ndi moyo wabwino:

• Kudutsa kwa biliary: Ngati khansara ikuletsa njira ya bile ndipo bile ikukula mu ndulu, kulambalala kwa biliary kutha kuchitidwa. Pochita opaleshoniyi, adotolo adula ndulu kapena chidebe m'derali asanafike kutseka ndikuisokerera m'mbali mwa ndulu ya ndulu yomwe idadutsa kutsekeka kapena m'matumbo ang'onoang'ono kuti ipange njira yatsopano kuzungulira malo otsekedwa.

• Kukhazikitsidwa kwa endoscopic stent: Ngati chotupacho chikuletsa njira ya bile, opareshoni itha kuchitidwa kuti ipange stent (chubu chochepa) kuti itulutse bile yomwe yamanga m'deralo. Dotolo amatha kuyika stent kudzera pacatheter yomwe imakoka nduluyo mu thumba kunja kwa thupi kapena stent imatha kuzungulira malo otsekedwa ndikutulutsa nduluyo m'matumbo ang'onoang'ono.

• Percutaneous transhepatic biliary drainage: Njira yogwiritsira ntchito X-ray chiwindi ndi ma ducts. Singano yopyapyala imalowetsedwa kudzera pakhungu pansi pa nthiti ndikufika pachiwindi. Utoto umalowetsedwa m'chiwindi kapena m'mabande am'mimba ndipo x-ray imatengedwa. Ngati phula la ndulu litatsekedwa, chubu chofiyira chosasunthika chomwe chimatchedwa stent chimatha kutsalira m'chiwindi kuti chikhetse ndulu m'matumbo ang'onoang'ono kapena thumba lakutolera kunja kwa thupi.

Thandizo la radiation

Thandizo la radiation ndi chithandizo cha khansa chomwe chimagwiritsa ntchito ma x-ray amphamvu kapena mitundu ina ya radiation kuti iphe ma cell a khansa kapena kuti asakule. Pali mitundu iwiri ya mankhwala a radiation:

• Mankhwala ochiritsira akunja amagwiritsa ntchito makina kunja kwa thupi kuti atumize cheza chaku khansa.

• Njira yothandizira poizoniyu yamkati imagwiritsa ntchito mankhwala a radioactive otsekedwa ndi singano, njere, mawaya, kapena ma catheters omwe amayikidwa mwachindunji kapena pafupi ndi khansa.

Mankhwala akunja amkati ndi amkati amagwiritsidwa ntchito pochiza khansa ya bile.

Sizikudziwika ngati chithandizo chamagetsi chakunja chimathandizira kuchiza khansa ya bile yotulutsa bulu. Mu khansa yosasunthika, ya metastatic, kapena yobwerezabwereza ya khansa ya ndulu, njira zatsopano zothetsera mphamvu yakuchipatala kwa maselo a khansa zikuwerengedwa:

• Thandizo la Hyperthermia: Chithandizo chomwe minofu yamthupi imakumana ndi kutentha kwambiri kuti ma cell a khansa azindikire zotsatira za mankhwala a radiation ndi mankhwala ena opha khansa.

• Ma Radiosensitizers: Mankhwala omwe amapangitsa kuti ma cell a khansa azimva kulira kwa radiation. Kuphatikiza mankhwala a radiation ndi ma radiosensitizers atha kupha ma cell ambiri a khansa.

Chemotherapy

Chemotherapy ndi mankhwala a khansa omwe amagwiritsa ntchito mankhwala oletsa kukula kwa maselo a khansa, mwina popha ma cell kapena kuwaletsa kuti asagawane. Chemotherapy ikamamwa pakamwa kapena kulowetsedwa mumtsempha kapena minofu, mankhwalawa amalowa m'magazi ndipo amatha kufikira ma cell a khansa mthupi lonse (systemic chemotherapy). Chemotherapy ikaikidwa molunjika m'matumbo a cerebrospinal, chiwalo, kapena thupi ngati pamimba, mankhwalawa amakhudza kwambiri ma cell a khansa m'malo amenewo (chemotherapy am'madera).

Chemic system imagwiritsidwa ntchito pochiza khansa yosasunthika, metastatic, kapena recurrent khansa ya bile. Sizikudziwika ngati systemic chemotherapy imathandizira kuchiza khansa ya bile yotulutsa bulu.

Mu khansa yosasunthika, ya metastatic, kapena yokhazikika ya khansa ya m'mimba, kupendekera kwapakati pamitsempha kumaphunziridwa. Ndi njira yomwe magazi amatulutsira chotupa pambuyo poti mankhwala a anticancer aperekedwa m'mitsempha yamagazi pafupi ndi chotupacho. Nthawi zina, mankhwala a anticancer amalumikizidwa ndi mikanda yaying'ono yomwe imayikidwa mumtsempha womwe umadyetsa chotupacho. Mikanda imatseka magazi kutuluka potulutsa mankhwalawo. Izi zimapangitsa kuti mankhwala ochulukirapo afike pachotupa kwa nthawi yayitali, yomwe imatha kupha ma cell ambiri a khansa.

Mitundu yatsopano yamankhwala ikuyesedwa m'mayesero azachipatala.

Gawo lachiduleli likufotokoza zamankhwala omwe akuwerengedwa m'mayesero azachipatala. Sizingatchule chithandizo chilichonse chatsopano chomwe akuphunzira. Zambiri zamayeso azachipatala zimapezeka patsamba la NCI.

Kuika chiwindi

Pakumuika chiwindi, chiwindi chonse chimachotsedwa ndikusinthidwa ndi chiwindi chopatsa thanzi. Kuika chiwindi kumachitika mwa odwala omwe ali ndi khansa ya perihilar bile duct. Ngati wodwalayo ayenera kudikirira chiwindi chomwe wapereka, amalandiranso chithandizo pakafunika kutero.

Chithandizo cha khansa ya bile ingayambitse zovuta. Kuti mumve zambiri zamankhwala obwera chifukwa cha khansa, onani tsamba lathu la Zotsatira Zotsatira.

Odwala angaganize zopita nawo kukayezetsa.

Kwa odwala ena, kutenga nawo mbali pakuyesa chithandizo chachipatala kungakhale njira yabwino kwambiri yothandizira. Mayesero azachipatala ndi gawo limodzi la kafukufuku wa khansa. Mayesero azachipatala amachitika kuti apeze ngati mankhwala atsopano a khansa ndi otetezeka komanso ogwira ntchito kapena abwinoko kuposa mankhwala wamba.

Njira zambiri zamankhwala zochiritsira khansa zimachokera kumayeso am'mbuyomu azachipatala. Odwala omwe amatenga nawo mbali pachipatala atha kulandira chithandizo chofananira kapena kukhala oyamba kulandira chithandizo chatsopano.

Odwala omwe amatenga nawo mbali pazoyeserera zamankhwala amathandizanso kukonza momwe khansa idzathandizire mtsogolo. Ngakhale mayesero azachipatala satsogolera kuchipatala chatsopano, nthawi zambiri amayankha mafunso ofunikira ndikuthandizira kupititsa patsogolo kafukufuku.

Odwala amatha kulowa m'mayesero azachipatala asanayambe, asanayambe, kapena atayamba kulandira chithandizo cha khansa.

Mayesero ena azachipatala amangophatikizapo odwala omwe sanalandire chithandizo. Mayesero ena amayesa chithandizo kwa odwala omwe khansa yawo sinakhale bwino. Palinso mayesero azachipatala omwe amayesa njira zatsopano zothetsera khansa kuti isabwererenso (kubwerera) kapena kuchepetsa zovuta zoyambitsidwa ndi khansa.

Mayesero azachipatala akuchitika m'malo ambiri mdziko muno. Zambiri zamayeso azachipatala othandizidwa ndi NCI zitha kupezeka patsamba lofufuza zamankhwala la NCI. Mayesero azachipatala othandizidwa ndi mabungwe ena amapezeka patsamba la ClinicalTrials.gov.

Mayeso otsatirawa angafunike.

Ena mwa mayesero omwe adachitika kuti apeze khansa kapena kuti adziwe momwe khansa iliri angabwerezedwenso. Mayesero ena adzabwerezedwa kuti awone momwe mankhwalawa akugwirira ntchito. Zisankho zakuti mupitilize, kusintha, kapena kusiya kulandira chithandizo zitha kutengera zotsatira za mayeso awa.

Kuyesaku kumangopitilira kuchitika nthawi ndi nthawi mankhwala atatha. Zotsatira zamayesowa zitha kuwonetsa ngati vuto lanu lasintha kapena ngati khansa yabwereranso (bwererani). Mayesowa nthawi zina amatchedwa kuyesa kutsata kapena kukayezetsa.

Njira Zothandizira Kuchiza Khansa Yambiri

M'chigawo chino

• Khansa Yamkati Ya Intrahepatic Bile

• Khansa Yoyipa Ya Intrahepatic Bile Duct

• Khansa Yosasunthika, Yobwereza, kapena Metastatic Intrahepatic Bile Duct

• Khansa ya Perihilar Bile Duct

• Khansa Yotulutsa Perihilar Bile Duct

• Khansa Yosasunthika, Yobwereza, kapena Metastatic Perihilar Bile Duct

• Khansa Yakutali Yowonjezera Yopanda Khansa

• Khansa Yoyipa Yakutali Yowonjezera Yopanda Khansa

• Khansa Yosasunthika, Yobwereza, kapena Metastatic Distal Extrahepatic Bile Duct

Kuti mumve zambiri zamankhwala omwe atchulidwa pansipa, onani gawo la Chisankho Chachidule.

Chiyanjano cha mndandanda wa mayesero omwe alipo tsopano akuphatikizidwa pa gawo lililonse la mankhwala. Kwa mitundu kapena magawo ena a khansa, mwina sipangakhale mayeso omwe atchulidwa. Funsani dokotala wanu za mayeso azachipatala omwe sanalembedwe pano koma omwe angakhale oyenera kwa inu.

Khansa Yamkati Ya Intrahepatic Bile

Khansa Yoyipa Ya Intrahepatic Bile Duct

Chithandizo cha khansa yotulutsa intrahepatic bile khansa imatha kuphatikiza:

• Kuchita opaleshoni kuti muchotse khansa, yomwe imatha kuphatikizanso ndi hepatectomy. Kukulitsa kumatha kuchitika musanachite opaleshoni.

• Opaleshoni yotsatiridwa ndi chemotherapy ndi / kapena radiation radiation.

Gwiritsani ntchito kusaka kwathu kwamankhwala kuti mupeze mayesero azachipatala omwe amathandizidwa ndi NCI omwe akulandira odwala. Mutha kusaka mayesero kutengera mtundu wa khansa, zaka za wodwalayo, komanso komwe mayeserowo akuchitika. Zambiri pazokhudza mayesero azachipatala zimapezekanso.

Khansa Yosasunthika, Yobwereza, kapena Metastatic Intrahepatic Bile Duct

Chithandizo cha khansa yosasunthika, yobwereza, kapena metastatic intrahepatic bile khansa imatha kuphatikizira izi:

• Kukhazikika mwamphamvu ngati mankhwala ochepetsa nkhawa kuti athetse vuto ndikukhala ndi moyo wabwino.

• Thandizo lakunja kapena lamkati lamankhwala ngati mankhwala ochepetsa nkhawa kuti muchepetse zizolowezi ndikukhalitsa moyo wabwino.

• Chemotherapy.

• Kuyesedwa kwachipatala kwa mankhwala amtundu wakunja kuphatikiza ndi hyperthermia therapy, mankhwala a radiosensitizer, kapena chemotherapy.

Gwiritsani ntchito kusaka kwathu kwamankhwala kuti mupeze mayesero azachipatala omwe amathandizidwa ndi NCI omwe akulandira odwala. Mutha kusaka mayesero kutengera mtundu wa khansa, zaka za wodwalayo, komanso komwe mayeserowo akuchitika. Zambiri pazokhudza mayesero azachipatala zimapezekanso.

Khansa ya Perihilar Bile Duct

Khansa Yotulutsa Perihilar Bile Duct

Chithandizo cha khansa yotulutsa perihilar bile khansa ingaphatikizepo izi:

• Kuchita opaleshoni kuti muchotse khansa, yomwe imatha kuphatikizanso ndi hepatectomy.

• Kukhazikika mwamphamvu kapena njira yodutsira yodutsa ngati njira yothandizira, kuti muchepetse jaundice ndi zizindikilo zina ndikukhalitsa moyo wabwino.

• Opaleshoni yotsatiridwa ndi radiation radiation ndi / kapena chemotherapy.

Gwiritsani ntchito kusaka kwathu kwamankhwala kuti mupeze mayesero azachipatala omwe amathandizidwa ndi NCI omwe akulandira odwala. Mutha kusaka mayesero kutengera mtundu wa khansa, zaka za wodwalayo, komanso komwe mayeserowo akuchitika. Zambiri pazokhudza mayesero azachipatala zimapezekanso.

Khansa Yosasunthika, Yobwereza, kapena Metastatic Perihilar Bile Duct

Kuchiza kwa khansa yosasunthika, yabwinobwino, kapena metastatic perihilar bile khansa ingaphatikizepo izi:

• Kukhazikika kwamphamvu kapena kudumphadumpha ngati njira yothandizira kuti muchepetse zizindikiritso ndikukhalitsa moyo wabwino.

• Thandizo lakunja kapena lamkati lamankhwala ngati mankhwala ochepetsa nkhawa kuti muchepetse zizolowezi ndikukhalitsa moyo wabwino.

• Chemotherapy.

• Kuyesedwa kwachipatala kwa mankhwala amtundu wakunja kuphatikiza ndi hyperthermia therapy, mankhwala a radiosensitizer, kapena chemotherapy.

• Kuyesedwa kwachipatala kwa chemotherapy ndi radiation radiation kutsatiridwa ndi kumuika chiwindi.

Gwiritsani ntchito kusaka kwathu kwamankhwala kuti mupeze mayesero azachipatala omwe amathandizidwa ndi NCI omwe akulandira odwala. Mutha kusaka mayesero kutengera mtundu wa khansa, zaka za wodwalayo, komanso komwe mayeserowo akuchitika. Zambiri pazokhudza mayesero azachipatala zimapezekanso.

Khansa Yakutali Yowonjezera Yopanda Khansa

Khansa Yoyipa Yakutali Yowonjezera Yopanda Khansa

Chithandizo cha khansa yotulutsa magazi ya khansa ya ndulu ingaphatikizepo izi:

• Kuchita opaleshoni kuti muchotse khansa, yomwe ingaphatikizepo njira ya Whipple.

• Kukhazikika mwamphamvu kapena njira yodutsira yodutsa ngati njira yothandizira, kuti muchepetse jaundice ndi zizindikilo zina ndikukhalitsa moyo wabwino.

• Opaleshoni yotsatiridwa ndi radiation radiation ndi / kapena chemotherapy.

Gwiritsani ntchito kusaka kwathu kwamankhwala kuti mupeze mayesero azachipatala omwe amathandizidwa ndi NCI omwe akulandira odwala. Mutha kusaka mayesero kutengera mtundu wa khansa, zaka za wodwalayo, komanso komwe mayeserowo akuchitika. Zambiri pazokhudza mayesero azachipatala zimapezekanso.

Khansa Yosasunthika, Yobwereza, kapena Metastatic Distal Extrahepatic Bile Duct

Kuchiza kwa khansa yosasunthika, yobwereza, kapena metastatic distal extrahepatic bile khansa ingaphatikizepo izi:

• Kukhazikika kwamphamvu kapena kudumphadumpha ngati njira yothandizira kuti muchepetse zizindikiritso ndikukhalitsa moyo wabwino.

• Thandizo lakunja kapena lamkati lamankhwala ngati mankhwala ochepetsa nkhawa kuti muchepetse zizolowezi ndikukhalitsa moyo wabwino.

• Chemotherapy.

• Kuyesedwa kwachipatala kwa mankhwala amtundu wakunja kuphatikiza ndi hyperthermia therapy, mankhwala a radiosensitizer, kapena chemotherapy.

Gwiritsani ntchito kusaka kwathu kwamankhwala kuti mupeze mayesero azachipatala omwe amathandizidwa ndi NCI omwe akulandira odwala. Mutha kusaka mayesero kutengera mtundu wa khansa, zaka za wodwalayo, komanso komwe mayeserowo akuchitika. Zambiri pazokhudza mayesero azachipatala zimapezekanso.

Kuti mudziwe zambiri za khansa yamagazi

Kuti mumve zambiri kuchokera ku National Cancer Institute yokhudza khansa ya bile, onani izi:

• Khansa Yam'mimba Yamatenda a Chiwindi ndi Mitsempha

Kuti mumve zambiri za khansa ndi zinthu zina zochokera ku National Cancer Institute, onani izi:

• Za Khansa

• Kusinthana

• Chemotherapy and You: Kuthandiza Anthu Omwe Ali Ndi Khansa

• Thandizo la Radiation ndi Inu: Thandizo kwa Anthu Omwe Ali ndi Khansa

• Kulimbana ndi khansa

• Mafunso oti mufunse dokotala wanu za khansa

• Kwa Opulumuka ndi Owasamalira