Mitundu / chiwindi / wodwala / chithandizo cha chiwindi cha mwana-pdq

Kuchiza Khansa Ya Chiwindi Chaubwana

Zambiri Za Khansa Ya Chiwindi Yaubwana

MFUNDO ZOFUNIKA

• Khansa ya chiwindi yaubwana ndi matenda omwe ma cell owopsa (khansa) amapangidwa m'matumba a chiwindi.

• Pali mitundu yosiyanasiyana ya khansa ya chiwindi yaubwana.

• Matenda ena ndi mikhalidwe imatha kuwonjezera chiopsezo cha khansa ya chiwindi yaubwana.

• Zizindikiro za khansa ya chiwindi yaubwana zimaphatikizapo chotupa kapena kupweteka pamimba.

• Kuyesa komwe kumayesa chiwindi ndi magazi amagwiritsidwa ntchito kuti apeze (kupeza) ndikuzindikira khansa ya chiwindi yaubwana ndikupeza ngati khansara yafalikira.

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

Khansa ya chiwindi yaubwana ndi matenda omwe ma cell owopsa (khansa) amapangidwa m'matumba a chiwindi.

Chiwindi ndi chimodzi mwa ziwalo zazikulu kwambiri mthupi. Ili ndi ma lobes awiri ndipo imadzaza kumanja chakumanja kwa mimba mkati mwa nthiti. Ntchito zitatu zofunika kwambiri m'chiwindi ndi izi:

• Sefa zovulaza zamagazi kuti zitha kupitsidwira m'thupi ndi mkodzo.

• Kupanga bile kuti izithandiza kugaya mafuta pachakudya.

• Kusunga glycogen (shuga), yomwe thupi limagwiritsa ntchito mphamvu.

Thupi la chiwindi. Chiwindi chili pamimba chapafupi pafupi ndi m'mimba, matumbo, ndulu, ndi kapamba. Chiwindi chili ndi lobe lamanja ndi lobe lamanzere. Lobe iliyonse imagawika m'magawo awiri (osawonetsedwa).

Khansa ya chiwindi ndiyosowa kwa ana ndi achinyamata.

Pali mitundu yosiyanasiyana ya khansa ya chiwindi yaubwana.

Pali mitundu iwiri ikuluikulu ya khansa ya chiwindi yaubwana:

• Hepatoblastoma: Hepatoblastoma ndi mtundu wodziwika bwino wa khansa ya chiwindi yaubwana. Nthawi zambiri zimakhudza ana ochepera zaka zitatu.

Mu hepatoblastoma, histology (momwe ma cell a khansa amawonekera pansi pa microscope) imakhudza momwe khansa imathandizira. Histology ya hepatoblastoma itha kukhala imodzi mwa izi:

• Mbiri yosakanikirana bwino ya fetal (fetal pure).

• Selo yaying'ono yosasiyanitsa histology.

• Mbiri yosasiyanitsa bwino ya fetal, cell yaying'ono yosasiyanitsa.

• Hepatocellular carcinoma: Hepatocellular carcinoma nthawi zambiri imakhudza ana okalamba komanso achinyamata. Ndizofala kwambiri kumadera a Asia omwe ali ndi chiwopsezo chachikulu cha matenda a hepatitis B kuposa ku US

Mitundu ina yocheperako ya khansa ya chiwindi yaubwana ndi iyi:

• Matenda osakanikirana am'mimba a chiwindi: Mtundu uwu wa khansa ya chiwindi nthawi zambiri imachitika mwa ana azaka zapakati pa 5 ndi 10. Nthawi zambiri imafalikira mchiwindi komanso / kapena m'mapapu.

• Infantile choriocarcinoma ya chiwindi: Ichi ndi chotupa chosowa kwambiri chomwe chimayambira mu placenta ndikufalikira kwa mwana wosabadwayo. Chotupacho chimapezeka miyezi ingapo yoyambirira ya moyo. Komanso, mayi wamwanayo amatha kupezeka ndi choriocarcinoma. Choriocarcinoma ndi mtundu wa matenda opatsirana pogonana. Onani chidule cha pa Gestational Trophoblastic Disease Treatment kuti mumve zambiri zamankhwala choriocarcinoma kwa mayi wa mwanayo.

• Zotupa za chiwindi cham'mimba: Zotupazi zimapangidwa m'chiwindi kuchokera m'maselo omwe amapanga mitsempha yamagazi kapena zamitsempha. Zotupa za chiwindi zam'mimba zimatha kukhala zoyipa (osati khansa) kapena zoyipa (khansa). Onani chidule cha pa Chithandizo cha Ana Vascular Tumors Chithandizo kuti mumve zambiri zamatenda a chiwindi.

Chidulechi ndi cha chithandizo cha khansa yoyamba ya chiwindi (khansa yomwe imayamba m'chiwindi). Chithandizo cha khansa ya chiwindi ya metastatic, yomwe ndi khansa yomwe imayambira mbali zina za thupi ndikufalikira ku chiwindi, sichinafotokozedwe mwachidule.

Khansa yoyamba ya chiwindi imatha kupezeka mwa akulu ndi ana. Komabe, chithandizo cha ana ndichosiyana ndi chithandizo cha akulu. Onani chidule cha pa Chithandizo cha Khansa Yaikulu ya Chiwindi cha Akulu kuti mumve zambiri zamankhwala akulu.

Matenda ena ndi mikhalidwe imatha kuwonjezera chiopsezo cha khansa ya chiwindi yaubwana.

Chilichonse chomwe chimakulitsa mwayi wanu wodwala chimatchedwa chiopsezo. Kukhala ndi chiwopsezo sikutanthauza kuti udzakhala ndi khansa; kusakhala ndi zoopsa sikutanthauza kuti simudzakhala ndi khansa. Lankhulani ndi dokotala wa mwana wanu ngati mukuganiza kuti mwana wanu akhoza kukhala pachiwopsezo.

Zowopsa za hepatoblastoma zimaphatikizapo ma syndromes kapena zinthu zotsatirazi:

• Matenda a Aicardi.

• Matenda a Beckwith-Wiedemann.

• Hemihyperplasia.

• Wodziwika bwino wa adenomatous polyposis (FAP).

• Matenda osungira Glycogen.

• Kulemera kwambiri pobadwa.

• Matenda a Simpson-Golabi-Behmel.

• Zosintha zina zamtundu, monga Trisomy 18.

Ana omwe ali pachiwopsezo cha hepatoblastoma atha kuyesedwa kuti awone ngati ali ndi khansa asanawonekere. Miyezi itatu iliyonse mpaka mwana atakwanitsa zaka 4, amayesedwa m'mimba mwa ultrasound ndipo mulingo wa alpha-fetoprotein wamagazi umayang'aniridwa.

Zowopsa za hepatocellular carcinoma ndi izi:

• Matenda a Alagille.

• Matenda osungira Glycogen.

• Matenda a Hepatitis B omwe amapatsira kuchokera kwa mayi kupita kwa mwana atabadwa.

• Kupitilira kwamabanja intrahepatic matenda.

• Matenda a Tyrosinemia.

Odwala ena omwe ali ndi tyrosinemia adzadulidwa chiwindi kuti athe kuchiza matendawa pasanakhale zizindikilo za khansa.

Zizindikiro za khansa ya chiwindi yaubwana zimaphatikizapo chotupa kapena kupweteka pamimba.

Zizindikiro zimakhala zofala kwambiri chotupacho chikakula. Zinthu zina zimatha kuyambitsa zizindikilo zomwezo. Funsani dokotala wa mwana wanu ngati mwana wanu ali ndi zotsatirazi:

• Bulu m'mimba lomwe lingakhale lopweteka.

• Kutupa m'mimba.

• Kuchepetsa thupi popanda chifukwa chodziwika.

• Kutaya njala.

• Nseru ndi kusanza.

Kuyesa komwe kumayesa chiwindi ndi magazi amagwiritsidwa ntchito kuti apeze (kupeza) ndikuzindikira khansa ya chiwindi yaubwana ndikupeza ngati khansara yafalikira.

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.

• Chiyeso cha serum tumor marker: Njira yoyeserera magazi kuti ayese kuchuluka kwa zinthu zina zomwe zimatulutsidwa m'magazi ndi ziwalo, ziwalo, kapena zotupa m'mthupi. Zinthu zina zimalumikizidwa ndi mitundu ina ya khansa ikapezeka m'magazi ochulukirapo. Izi zimatchedwa zolembera zotupa. Magazi a ana omwe ali ndi khansa ya chiwindi atha kukhala ndi mahomoni ochulukirapo otchedwa beta-human chorionic gonadotropin (beta-hCG) kapena puloteni yotchedwa alpha-fetoprotein (AFP). Khansa ina, zotupa zowopsa za chiwindi, ndi zina zomwe sizimayambitsa khansa, kuphatikiza matenda a chiwindi ndi hepatitis, zitha kuwonjezera kuchuluka kwa AFP.

• Kuwerengera kwathunthu kwa magazi (CBC): Njira yomwe magazi amatengedwa ndikuwunika zotsatirazi:

• Chiwerengero cha maselo ofiira, maselo oyera amwazi, ndi ma platelet.

• Kuchuluka kwa hemoglobin (puloteni yomwe imanyamula mpweya) m'maselo ofiira amwazi.

• Gawo la magazi lomwe limapangidwa ndi maselo ofiira.

• Kuyesa kwa chiwindi: Njira yoyeserera magazi kuti ayese kuchuluka kwa zinthu zina zomwe zimatulutsidwa m'magazi ndi chiwindi. Kuchulukirapo kuposa chinthu chachilendo kungakhale chizindikiro cha kuwonongeka kwa chiwindi kapena khansa.

• Kafukufuku wama chemistry a magazi: Njira yoyeserera magazi kuti ayese kuchuluka kwa zinthu zina, monga bilirubin kapena lactate dehydrogenase (LDH), yotulutsidwa m'magazi ndi ziwalo ndi minyewa mthupi. Kuchuluka kwazinthu zosazolowereka (zakumwamba kapena zochepa) kungakhale chizindikiro cha matenda.

• Kuyezetsa kachilombo ka Epstein-Barr (EBV): Kuyezetsa magazi kuti muwone ngati ma antibodies ku EBV ndi ma DNA a EBV. Izi zimapezeka m'magazi a odwala omwe ali ndi kachilombo ka EBV.

Kuyesa kwa matenda a chiwindi: Njira yomwe magazi amayang'aniridwa ngati ali ndi kachilombo ka hepatitis.

• MRI (magnetic resonance imaging) yokhala ndi gadolinium: Njira yomwe imagwiritsa ntchito maginito, mafunde a wailesi, ndi kompyuta kuti ipange zithunzi zingapo za zigawo mkati mwa chiwindi. Chinthu chotchedwa gadolinium chimalowetsedwa mumtsempha. Gadolinium imasonkhanitsa mozungulira maselo a khansa kuti athe kuwonekera pachithunzichi. Njirayi imatchedwanso nuclear magnetic resonance imaging (NMRI).

Kujambula kwamaginito (MRI) pamimba. Mwanayo wagona patebulo lomwe limalowa mu sikani ya MRI, yomwe imatenga zithunzi zamkati mwa thupi. Pedi pamimba pamwana limathandizira kuti zithunzizo zizimveka bwino.

• CT scan (CAT scan): Njira yomwe imapanga zithunzi zingapo zamatupi amthupi, 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. Mu khansa ya chiwindi yaubwana, CT scan pachifuwa ndi pamimba nthawi zambiri imachitika.

Kusanthula kwam'mimba kwa kompyuta. Mwanayo wagona patebulo lomwe limadutsa pa scanner ya CT, yomwe imatenga zithunzi za x-ray zamkati mwamimba.

• Kuyesa kwa Ultrasound: Njira yomwe mafunde amawu amphamvu (ultrasound) amachotsedwa pamatumba kapena ziwalo zamkati ndikupanga mawonekedwe. Zolembawo amapanga chithunzi cha matupi amthupi otchedwa sonogram. Chithunzicho chimatha kusindikizidwa kuti chiwonedwe pambuyo pake. Mu khansa ya chiwindi yaubwana, kuyezetsa magazi pamimba kuti muwone mitsempha yayikulu yamagazi kumachitika.

M'mimba ultrasound. Transducer ya ultrasound yolumikizidwa ndi kompyuta imakanikizidwa pakhungu la pamimba. Transducer imaponya mafunde am'mimba ndi ziwalo zamkati kuti apange ma echo omwe amapanga sonogram (chithunzi cha pakompyuta).

• X-ray ya m'mimba: X-ray ya ziwalo m'mimba. X-ray ndi mtundu wa mphamvu yamphamvu yomwe imatha kupyola thupi kupita mufilimu, ndikupanga chithunzi cha madera amkati mwa thupi.

• Biopsy: Kuchotsa zitsanzo zamaselo kapena zotupa kotero kuti zitha kuwonedwa ndi microscope kuti muwone ngati pali khansa. Chitsanzocho chingatengedwe pa opaleshoni kuti muchotse kapena muwone chotupacho. Katswiri wazachipatala amayang'ana nyemba pansi pa microscope kuti adziwe mtundu wa khansa ya chiwindi.

Mayeso otsatirawa atha kuchitidwa pamtundu wa minofu yomwe yachotsedwa:

• Immunohistochemistry: Kuyesa kwa labotale komwe kumagwiritsa ntchito ma antibodies kuti aone ngati ali ndi ma antigen (zolembera) muzitsanzo za minofu ya wodwala. Ma antibodies nthawi zambiri amalumikizidwa ndi enzyme kapena utoto wa fulorosenti. Ma antibodies atagwirizana ndi antigen inayake munthawi ya minofu, enzyme kapena utoto umayambitsidwa, ndipo antigen imatha kuwonedwa ndi microscope. Mayeso amtunduwu amagwiritsidwa ntchito poyang'ana kusintha kwa majini, kuthandiza kuzindikira khansa, ndikuthandizira kudziwa khansa yamtundu wina wa khansa.

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

Kulosera (mwayi wochira) ndi chithandizo cha hepatoblastoma chimadalira izi:

• Gulu la PRETEXT.

• Kukula kwa chotupacho.

• Kaya mtundu wa hepatoblastoma umasiyanitsa bwino fetal (pure fetal) kapena ka cell kakang'ono kosasiyanitsa histology.

• Kaya khansara yafalikira m'malo ena mthupi, monga diaphragm, mapapo, kapena mitsempha yayikulu yamagazi.

• Kaya pali chotupa choposa chimodzi m'chiwindi.

• Kaya chophimba chakunja chotupa chatseguka.

• Momwe khansa imayankhira chemotherapy.

• Kaya khansayo ikhoza kuchotsedwa kwathunthu ndi opaleshoni.

• Kaya wodwalayo atha kupatsidwa chiwindi.

• Kaya magulu a magazi a AFP atsikira mutalandira chithandizo.

• Zaka za mwanayo.

• Kaya khansa yapezeka kumene kapena yabwereranso.

Kulosera (mwayi wochira) ndi njira zamankhwala za hepatocellular carcinoma zimadalira izi:

• Gulu la PRETEXT.

• Kaya khansara yafalikira m'malo ena mthupi, monga mapapo.

• Kaya khansayo ikhoza kuchotsedwa kwathunthu ndi opaleshoni.

• Momwe khansa imayankhira chemotherapy.

• Kaya mwanayo ali ndi matenda a hepatitis B.

• Kaya khansa yapezeka kumene kapena yabwereranso.

Kwa khansa ya chiwindi yaubwana yomwe imabwereranso (imabwereranso) italandira chithandizo choyambirira, madandaulo ndi njira zamankhwala zimadalira:

• Komwe m'thupi chotupacho chidabweranso.

• Mtundu wa mankhwala omwe amathandizira khansa yoyamba.

Khansa ya chiwindi yaubwana ikhoza kuchiritsidwa ngati chotupacho ndi chaching'ono ndipo chitha kuchotsedwa kotheratu ndi opaleshoni. Kuchotsa kwathunthu kumatheka nthawi zambiri kwa hepatoblastoma kuposa hepatocellular carcinoma.

Magawo a Khansa ya Chiwindi Yaubwana

MFUNDO ZOFUNIKA

• Pambuyo podziwika kuti khansa ya chiwindi yaubwana, amayesedwa kuti apeze ngati maselo a khansa afalikira mkati mwa chiwindi kapena mbali zina za thupi.

• Pali magulu awiri opangira khansa ya chiwindi yaubwana.

• Pali magulu anayi a PRETEXT ndi POSTTEXT:

• PRETEXT ndi POSTTEXT Gulu I

• PRETEXT ndi POSTTEXT Gulu II

• PRETEXT ndi POSTTEXT Gulu Lachitatu

• PRETEXT ndi POSTTEXT Gulu IV

• Pali njira zitatu zomwe khansa imafalikira mthupi.

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

Pambuyo podziwika kuti khansa ya chiwindi yaubwana, amayesedwa kuti apeze ngati maselo a khansa afalikira mkati mwa chiwindi kapena mbali zina za thupi.

Njira yomwe amagwiritsidwa ntchito pofufuza ngati khansara yafalikira mkati mwa chiwindi, kumatumba oyandikira kapena ziwalo, kapena mbali zina za thupi amatchedwa staging. Mu khansa ya chiwindi yaubwana, magulu a PRETEXT ndi POSTTEXT amagwiritsidwa ntchito m'malo mwa siteji kukonzekera chithandizo. Zotsatira za mayeso ndi njira zomwe zachitika kuti azindikire, kuzindikira, ndikupeza ngati khansara yafalikira amagwiritsidwa ntchito kudziwa magulu a PRETEXT ndi POSTTEXT.

Pali magulu awiri opangira khansa ya chiwindi yaubwana.

Magulu awiri amagwiritsidwa ntchito pa khansa ya chiwindi yaubwana kusankha ngati chotupacho chitha kuchotsedwa ndi opaleshoni:

• Gulu la PRETEXT limafotokoza chotupacho wodwalayo asanalandire chithandizo chilichonse.

• Gulu la POSTTEXT limafotokoza chotupacho wodwalayo atalandira chithandizo chamankhwala monga neoadjuvant chemotherapy.

Pali magulu anayi a PRETEXT ndi POSTTEXT:

Chiwindi chagawika m'magulu anayi. Magulu a PRETEXT ndi POSTTEXT amadalira magawo ati a chiwindi omwe ali ndi khansa.

PRETEXT ndi POSTTEXT Gulu I

Chiwindi PRETEXT I. Khansa imapezeka m'chigawo chimodzi cha chiwindi. Zigawo zitatu za chiwindi zomwe zili moyandikana zilibe khansa.

Mu gulu I, khansara imapezeka m'chigawo chimodzi cha chiwindi. Zigawo zitatu za chiwindi zomwe zili moyandikana zilibe khansa.

PRETEXT ndi POSTTEXT Gulu II

Chiwindi PRETEXT II. Khansa imapezeka mgawo limodzi kapena awiri a chiwindi. Magawo awiri a chiwindi omwe ali pafupi wina ndi mnzake alibe khansa.

Mu gulu lachiwiri, khansa imapezeka mgawo limodzi kapena awiri a chiwindi. Magawo awiri a chiwindi omwe ali pafupi wina ndi mnzake alibe khansa.

PRETEXT ndi POSTTEXT Gulu Lachitatu

Chiwindi PRETEXT III. Khansara imapezeka m'magawo atatu a chiwindi ndipo gawo limodzi lilibe khansa, kapena khansa imapezeka m'magawo awiri a chiwindi ndipo magawo awiri omwe sali oyandikana alibe khansa.

Mu gulu lachitatu, chimodzi mwa izi ndi chowonadi:

• Khansa imapezeka m'magawo atatu a chiwindi ndipo gawo limodzi lilibe khansa.

• Khansa imapezeka m'magawo awiri a chiwindi komanso magawo awiri omwe sali pafupi wina ndi mnzake alibe khansa.

PRETEXT ndi POSTTEXT Gulu IV

Chiwindi PRETEXT IV. Khansa imapezeka m'magulu onse anayi a chiwindi.

Mu gulu IV, khansa imapezeka m'magulu onse anayi a chiwindi.

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 chiwindi yaubwana imafalikira m'mapapu, maselo a khansa m'mapapo alidi maseli a khansa ya chiwindi. Matendawa ndi khansa ya chiwindi, osati khansa yamapapu.

Khansa Ya chiwindi Yobwerezabwereza

Khansa ya chiwindi yobwerezabwereza ndi khansa yomwe yabwereranso (kubwerera) itachiritsidwa. Khansara imatha kubwerera m'chiwindi kapena mbali zina za thupi. Khansa yomwe ikukula kapena kukulira pakuthandizidwa ndi matenda opita patsogolo.

Chithandizo Chosankha Mwachidule

MFUNDO ZOFUNIKA

• Pali mitundu yosiyanasiyana ya chithandizo cha odwala omwe ali ndi khansa ya chiwindi yaubwana.

• Ana omwe ali ndi khansa ya chiwindi ayenera kukonzekera chithandizo chawo ndi gulu la othandizira azaumoyo omwe ndi akatswiri othandiza khansa yosowa iyi yaubwana.

• Chithandizo cha khansa ya chiwindi yaubwana chingayambitse zovuta.

• Mitundu isanu ndi umodzi yamankhwalawa amagwiritsidwa ntchito:

• Opaleshoni

• Kudikira kudikira

• Chemotherapy

• Thandizo la radiation

• Thandizo la Ablation

• Chithandizo cha ma virus

• Mitundu yatsopano yamankhwala ikuyesedwa m'mayesero azachipatala.

• Chithandizo chofuna

• 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 omwe ali ndi khansa ya chiwindi yaubwana.

Pali mitundu yosiyanasiyana ya chithandizo kwa ana omwe ali ndi khansa ya chiwindi. 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.

Kuchita nawo mayeso azachipatala kuyenera kuganiziridwa kwa ana onse omwe ali ndi khansa ya chiwindi. Mayesero ena azachipatala ndi otseguka kwa odwala omwe sanayambe kulandira chithandizo.

Ana omwe ali ndi khansa ya chiwindi ayenera kukonzekera chithandizo chawo ndi gulu la othandizira azaumoyo omwe ndi akatswiri othandiza khansa yosowa iyi yaubwana.

Chithandizo chidzayang'aniridwa ndi oncologist wa ana, dokotala yemwe amadziwika bwino pochiza ana omwe ali ndi khansa. Ocologist wa ana amagwira ntchito ndi ena othandizira zaumoyo omwe ndi akatswiri pochiza ana omwe ali ndi khansa ya chiwindi komanso omwe amakhazikika m'malo ena azamankhwala. Ndikofunikira kwambiri kukhala ndi dokotala wa ana yemwe akudziwa bwino za opareshoni ya chiwindi yemwe amatha kutumiza odwala ku pulogalamu yokawonjezera chiwindi ngati pakufunika kutero. Akatswiri ena atha kukhala ndi izi:

• Dokotala wa ana.

• Wofufuza oncologist.

• Katswiri wa namwino wa ana.

• Katswiri wokonzanso.

• Katswiri wa zamaganizo.

• Wogwira ntchito.

Chithandizo cha khansa ya chiwindi yaubwana chingayambitse zovuta.

Kuti mumve zambiri zamankhwala oyambilira omwe amayamba mukalandira chithandizo cha khansa, onani tsamba lathu la Zotsatira Zotsatira.

Zotsatira zoyipa za mankhwala a khansa omwe amayamba atalandira chithandizo ndikupitilira kwa miyezi kapena zaka amatchedwa zotsatira zakuchedwa. Zotsatira zakumapeto kwa chithandizo cha khansa zitha kuphatikiza:

• Mavuto athupi.

• Kusintha kwa malingaliro, malingaliro, kuganiza, kuphunzira, kapena kukumbukira.

• Khansa yachiwiri (mitundu yatsopano ya khansa).

Zotsatira zina mochedwa zimatha kuthandizidwa kapena kuwongoleredwa. Ndikofunika kulankhula ndi madotolo a mwana wanu zamankhwala omwe khansa imatha kukhala nawo pamwana wanu. (Onani chidule cha pa Zotsatira Zotsiriza za Chithandizo cha Khansa ya Ana kuti mumve zambiri).

Mitundu isanu ndi umodzi yamankhwalawa amagwiritsidwa ntchito:

Opaleshoni

Ngati n'kotheka, khansayo imachotsedwa ndi opaleshoni.

• Matenda a hepatectomy: Kuchotsa gawo la chiwindi pomwe khansa imapezeka. Gawo lomwe lachotsedwa lingakhale mphete, lobe lonse, kapena gawo lokulirapo la chiwindi, pamodzi ndi minofu yaying'ono yozungulira.

• Kuika chiwindi chonse ndi kuchotsa chiwindi: Kuchotsa chiwindi chonse ndikutsatira chiwindi chathanzi kuchokera kwa woperekayo. Kuika chiwindi kumatha kutheka ngati khansa isafalikire kupitirira chiwindi ndipo chiwindi choperekedwa chingapezeke. Ngati wodwalayo ayenera kudikirira chiwindi chomwe wapereka, amalandiranso chithandizo pakafunika kutero.

• Kukhazikitsanso kwa metastases: Opaleshoni yochotsa khansa yomwe yafalikira kunja kwa chiwindi, monga minofu yapafupi, mapapo, kapena ubongo.

Mtundu wa opaleshoni womwe ungachitike umadalira izi:

• Gulu la PRETEXT ndi gulu la POSTTEXT.

• Kukula kwa chotupa chachikulu.

• Kaya pali chotupa choposa chimodzi m'chiwindi.

• Kaya khansara yafalikira kumitsempha yamagazi yayikulu yapafupi.

• Mulingo wa alpha-fetoprotein (AFP) m'magazi.

• Kaya chotupacho chitha kuchepa ndi chemotherapy kuti chichotsedwe ndi opaleshoni.

• Kaya kuika chiwindi kukufunika.

Chemotherapy nthawi zina amaperekedwa asanachite opareshoni kuti achepetse chotupacho ndikupangitsa kuti kusavutike kuchotsa. Izi zimatchedwa neoadjuvant therapy.

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.

Kudikira kudikira

Kuyembekezera mwachidwi kumayang'anitsitsa matenda a wodwalayo osamupatsa chithandizo chilichonse mpaka zizindikilo kapena zizindikiritso zikuwoneka kapena kusintha. Mu hepatoblastoma, mankhwalawa amangogwiritsidwa ntchito pazotupa zazing'ono zomwe zachotsedweratu ndi opaleshoni.

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). Chithandizo chogwiritsa ntchito mankhwala opatsirana opitilira khansa chimodzi chimatchedwa kuphatikiza chemotherapy.

Chemoembolization ya mtsempha wamagazi (mtsempha waukulu womwe umapereka magazi ku chiwindi) ndi mtundu wa chemotherapy m'chigawo chomwe chimagwiritsidwa ntchito pochiza khansa ya chiwindi yaubwana yomwe singachotsedwe ndi opaleshoni. Mankhwala oletsa khansa amabayidwa mumitsempha ya hepatic kudzera mu catheter (chubu chochepa). Mankhwalawa amasakanikirana ndi chinthu chomwe chimatseka mtsempha wamagazi, kudula magazi mpaka chotupacho. Mankhwala ambiri a anticancer atsekedwa pafupi ndi chotupacho ndipo pang'ono pokha mankhwalawo amafika mbali zina za thupi. Kutsekeka kumatha kukhala kwakanthawi kapena kosatha, kutengera chinthu chomwe chimagwiritsa ntchito kutseka mtsempha. Chotupacho chimalephera kupeza mpweya ndi michere yomwe imafunikira kukula. Chiwindi chimapitilizabe kulandira magazi kuchokera pamitsempha yotupa, yomwe imanyamula magazi kuchokera m'mimba ndi m'matumbo kupita ku chiwindi.

Momwe chemotherapy imaperekedwa imadalira mtundu wa khansa yomwe ikuchitidwa komanso gulu la PRETEXT kapena POSTTEXT.

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.

Radioembolization ya mtsempha wamagazi (mtsempha waukulu womwe umapereka magazi ku chiwindi) ndi mtundu wa mankhwala amkati amkati omwe amagwiritsidwa ntchito pochiza hepatocellular carcinoma. Kamtengo kakang'ono kwambiri ka radioactive kamamangiriridwa ku mikanda ing'onoing'ono yomwe imayikidwa mumtsempha wa hepatic kudzera mu catheter (chubu chochepa). Mikanda imasakanizidwa ndi chinthu chomwe chimatseka mtsempha wamagazi, kudula magazi kutuluka chotupa. Ma radiation ambiri agwidwa pafupi ndi chotupacho kuti aphe ma cell a khansa. Izi zachitika kuti muchepetse zizindikilo ndikusintha moyo wa ana omwe ali ndi hepatocellular carcinoma.

Momwe mankhwala a radiation amaperekedwera zimadalira mtundu wa khansa yomwe ikuchitidwa komanso gulu la PRETEXT kapena POSTTEXT. Thandizo la radiation lakunja limagwiritsidwa ntchito pochizira hepatoblastoma yomwe singachotsedwe ndi opaleshoni kapena kufalikira mbali zina za thupi.

Thandizo la Ablation

Thandizo la Ablation limachotsa kapena kuwononga minofu. Mitundu yosiyanasiyana yamankhwala amachiritso amagwiritsidwa ntchito pa khansa ya chiwindi:

• Kuchotsa ma radiofrequency: Kugwiritsa ntchito singano zapadera zomwe zimayikidwa kudzera pakhungu kapena kudzera pachimake pamimba kuti chifike pachotupacho. Mafunde a wailesi yamphamvu kwambiri amatenthetsa singano ndi chotupa chomwe chimapha ma cell a khansa. Kuchotsa ma radiation kumagwiritsidwa ntchito pochizira hepatoblastoma.

• Jakisoni wa ethanol wothandizila: Singano yaying'ono imagwiritsidwa ntchito kubaya ethanol (mowa weniweni) mwachindunji mu chotupa chopha ma cell a khansa. Chithandizo chingafune jakisoni angapo. Jakisoni wa ethanol amagwiritsidwa ntchito pochizira hepatoblastoma.

Chithandizo cha ma virus

Hepatocellular carcinoma yomwe imalumikizidwa ndi kachilombo ka hepatitis B itha kuchiritsidwa ndi mankhwala oletsa tizilombo toyambitsa matenda.

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.

Chithandizo chofuna

Chithandizo choyenera ndi mtundu wa chithandizo chomwe chimagwiritsa ntchito mankhwala osokoneza bongo kapena zinthu zina kuti ziwononge maselo ena a khansa. Thandizo la Tyrosine kinase inhibitor (TKI) ndi mtundu wa mankhwala omwe amalimbana nawo. Zizindikiro zama TKIs zofunika kuti zotupa zikule. Sorafenib ndi pazopanib ndi ma TKI omwe amaphunziridwa kuti azitha kuchiza matenda a hepatocellular carcinoma omwe abweranso ndipo atangopezekanso kumene kwa embryonal sarcoma ya chiwindi.

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 apeze gulu la omwe angathandizidwe akhoza kubwerezedwa. Mayesero ena adzabwerezedwa kuti awone momwe chithandizo chikuyendera. 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 Ya Chiwindi Chaubwana

M'chigawo chino

• Hepatoblastoma

• Matenda a hepatocellular Carcinoma

• Embryonal Sarcoma Ya Chiwindi

• Infantile Choriocarcinoma ya Chiwindi

• Zotupa Za Chiwindi Cha Mitsempha

• Khansa Ya chiwindi Yobwerezabwereza

• Zosankha Zamankhwala M'mayesero Achipatala

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

Hepatoblastoma

Njira zochiritsira hepatoblastoma zomwe zingachotsedwe ndi opaleshoni panthawi yodziwitsa zitha kukhala izi:

• Opaleshoni yochotsa chotupacho, kenako ndi chemotherapy yosakanikirana ya hepatoblastoma yomwe siyosiyana kwenikweni ndi fetal histology. Kwa hepatoblastoma yokhala ndi khungu laling'ono losadziwika bwino, chemotherapy yamphamvu imaperekedwa.

• Kuchita opaleshoni kuti achotse chotupacho, ndikudikirira mwachidwi kapena chemotherapy, kwa hepatoblastoma yokhala ndi mbiri yakale ya fetal histology.

Njira zochiritsira hepatoblastoma zomwe sizingachotsedwe ndi opaleshoni kapena sizichotsedwa nthawi yodziwika zitha kukhala izi:

• Kuphatikiza kwa chemotherapy kuti muchepetse chotupacho, kenako ndikuchitidwa opaleshoni kuti achotse chotupacho.

• Kuphatikiza kwa chemotherapy, kutsatiridwa ndi kumuika chiwindi.

• Chemoembolization ya mtsempha wamagazi kuti muchepetse chotupacho, kenako ndikuchitidwa opaleshoni kuchotsa chotupacho.

• Ngati chotupa m'chiwindi sichingachotsedwe ndi opareshoni koma palibe zizindikilo za khansa m'malo ena amthupi, chithandizocho chitha kukhala kumuika chiwindi.

Kwa hepatoblastoma yomwe yafalikira mbali zina za thupi panthawi yodziwitsa, chemotherapy yophatikizira imaperekedwa kuti muchepetse zotupa m'chiwindi ndi khansa yomwe yafalikira mbali zina za thupi. Pambuyo pa chemotherapy, kuyesa kuyerekezera kumachitika kuti muwone ngati zotupazo zingachotsedwe ndi opaleshoni.

Njira zochiritsira zingaphatikizepo izi:

• Ngati chotupacho m'chiwindi ndi ziwalo zina za thupi (zomwe nthawi zambiri zimakhala zotupa m'mapapo) zingathe kuchotsedwa, opareshoni ichitidwa kuti ichotse zotupazo kenako ndi chemotherapy kuti iphe maselo aliwonse a khansa omwe atsalira.

• Ngati chotupa m'mbali zina za thupi sichingachotsedwe kapena kuikidwa chiwindi sikutheka, chemotherapy, chemoembolization ya mitsempha yotupa, kapena mankhwala a radiation angaperekedwe.

• Ngati chotupa cha mbali zina za thupi sichingachotsedwe kapena wodwalayo safuna kuchitidwa opareshoni, kuperekedwaku kungaperekedwe.

Njira zochiritsira m'mayesero azachipatala a hepatoblastoma omwe atangopezekapo ndi awa:

• Kuyesedwa kwachipatala kwa chemotherapy ndi opaleshoni.

Matenda a hepatocellular Carcinoma

Njira zochiritsira hepatocellular carcinoma yomwe imatha kuchotsedwa ndikuchitidwa opaleshoni nthawi yodziwitsa izi ingaphatikizepo izi:

• Kuchita maopareshoni okha kuchotsa chotupacho.

• Opaleshoni yochotsa chotupacho, kenako chemotherapy.

• Mgwirizano wa chemotherapy, kenako opaleshoni yochotsa chotupacho.

Njira zochiritsira hepatocellular carcinoma zomwe sizingachotsedwe ndi opaleshoni ndipo sizinafalikire mbali zina za thupi panthawi yodziwitsa izi zingaphatikizepo izi:

• Chemotherapy kuti achepetse chotupacho, kenako opaleshoni kuti achotse chotupacho.

• Chemotherapy kuti muchepetse chotupacho. Ngati opaleshoni yochotsa chotupacho sichingatheke, chithandizo china chimatha kukhala ndi izi:

• Kuika chiwindi.

• Chemoembolization ya mtsempha wamagazi kuti muchepetse chotupacho, kenako ndikuchitidwa opaleshoni kuchotsa chotupacho kapena kumuika chiwindi.

• Chemoembolization ya mitsempha ya hepatic yokha.

• Chemoembolization ikutsatiridwa ndi kumuika chiwindi.

• Radioembolization ya mtsempha wamagazi wothandizila ngati mankhwala ochepetsa nkhawa kuti athetse zofooka ndikukhalitsa moyo wabwino.

Chithandizo cha hepatocellular carcinoma chomwe chafalikira mbali zina za thupi nthawi yakuzindikira chingaphatikizepo:

• Kuphatikiza kwa chemotherapy kuti muchepetse chotupacho, kenako opaleshoni kuti achotse chotupacho mchiwindi komanso malo ena omwe khansa yafalikira. Kafukufuku sanawonetse kuti mankhwalawa amagwira ntchito bwino koma odwala ena atha kukhala ndi phindu lina.

Chithandizo cha hepatocellular carcinoma yokhudzana ndi matenda a hepatitis B virus (HBV) ndi awa:

• Opaleshoni kuchotsa chotupacho.

• Mankhwala ochepetsa mphamvu ya kachilombo ka HIV omwe amachiza matenda omwe amayamba chifukwa cha kachilombo ka hepatitis B.

Njira zochiritsira m'mayesero azachipatala a hepatocellular carcinoma omwe amapezeka kuti ndi awa ndi awa:

• Kuyesedwa kwachipatala kwa chemotherapy ndi opaleshoni.

Embryonal Sarcoma Ya Chiwindi

Njira zochiritsira zosakanikirana ndi embryonal sarcoma ya chiwindi zingaphatikizepo izi:

• Kuphatikiza kwa chemotherapy kuti muchepetse chotupacho, kenako ndikuchitidwa opaleshoni kuti achotse chotupacho momwe zingathere. Chemotherapy itha kuperekedwanso pambuyo pochitidwa opaleshoni kuti ichotse chotupacho.

• Opaleshoni yochotsa chotupacho, kenako chemotherapy. Kuchita opaleshoni yachiwiri kungachitike kuti muchotse chotupa chomwe chatsala, ndikutsatira chemotherapy yambiri.

• Kuika chiwindi ngati opaleshoni yochotsa chotupacho sichingatheke.

• Kuyesedwa kwamankhwala kwamankhwala atsopano omwe atha kuphatikizira othandizira (pazopanib), chemotherapy ndi / kapena radiation radiation asanachite opaleshoni.

Infantile Choriocarcinoma ya Chiwindi

Chithandizo cha choriocarcinoma ya chiwindi mwa makanda chitha kukhala izi:

• Kuphatikiza kwa chemotherapy kuti muchepetse chotupacho, kenako ndikuchitidwa opaleshoni kuti achotse chotupacho.

• Opaleshoni kuchotsa chotupacho.

Zotupa Za Chiwindi Cha Mitsempha

Onani chidule cha pa Chithandizo cha Ana Vascular Tumors Chithandizo kuti mumve zambiri za chithandizo chazotupa zamatenda a chiwindi.

Khansa Ya chiwindi Yobwerezabwereza

Chithandizo cha hepatoblastoma chopita patsogolo kapena chokhazikika chingaphatikizepo izi:

• Opaleshoni kuti achotse zotupa zapadera (zosakwatira ndi zopatukana) zamatenda omwe alibe kapena chemotherapy.

• Kuchotsa ma Radiofrequency.

• Kuphatikiza chemotherapy.

• Kuika chiwindi.

• Ablation therapy (radiofrequency ablation kapena jekeseni wa ethanol percutaneous) ngati mankhwala ochepetsa nkhawa kuti athetse zizindikiritso ndikukhalitsa moyo wabwino.

• Kuyesedwa kwachipatala komwe kumayang'ana chotupa cha wodwalayo ngati majini ena asintha. Mtundu wa mankhwala omwe akulimbikitsidwa omwe adzapatsidwe kwa wodwala umadalira mtundu wa kusintha kwa majini.

Chithandizo cha hepatocellular carcinoma chopita patsogolo kapena chokhazikika chingaphatikizepo izi:

• Chemoembolization ya mtsempha wamagazi wothandizira kuti muchepetse chotupacho musanaike chiwindi.

• Kuika chiwindi.

• Kuyesedwa kwachipatala kwa mankhwala omwe akulimbana nawo (sorafenib).

• Kuyesedwa kwachipatala komwe kumayang'ana chotupa cha wodwalayo ngati majini ena asintha. Mtundu wa mankhwala omwe akulimbikitsidwa omwe adzapatsidwe kwa wodwala umadalira mtundu wa kusintha kwa majini.

Chithandizo cha embryonal sarcoma ya chiwindi chingaphatikizepo izi:

• Kuyesedwa kwachipatala komwe kumayang'ana chotupa cha wodwalayo ngati majini ena asintha. Mtundu wa mankhwala omwe akulimbikitsidwa omwe adzapatsidwe kwa wodwala umadalira mtundu wa kusintha kwa majini.

Chithandizo cha choriocarcinoma chokhazikika cha chiwindi mwa makanda chitha kukhala izi:

• Kuyesedwa kwachipatala komwe kumayang'ana chotupa cha wodwalayo ngati majini ena asintha. Mtundu wa mankhwala omwe akulimbikitsidwa omwe adzapatsidwe kwa wodwala umadalira mtundu wa kusintha kwa majini.

Zosankha Zamankhwala M'mayesero Achipatala

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 ya chiwindi yaubwana

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

• Khansa Yam'mimba Yamatenda a Chiwindi ndi Mitsempha

• Computed Tomography (CT) Zithunzi ndi Khansa

• MyPART - Chotupa Changa Chotengera Ana ndi Achikulire

Kuti mumve zambiri za khansa yaubwana ndi zina zothandiza za khansa, onani izi:

• Za Khansa

• Khansa Za Ana

• Cure Search for Cancer ya Ana Tulukani Chodzikanira

• Zotsatira Zochedwetsa Khansa Yaana

• Achinyamata ndi Achinyamata Achikulire ndi Khansa

• Ana omwe ali ndi khansa: Upangiri wa Makolo

• Khansa mwa Ana ndi Achinyamata

• Kusinthana

• Kulimbana ndi khansa

• Mafunso oti mufunse dokotala wanu za khansa

• Kwa Opulumuka ndi Owasamalira