Types/skin/patient/merkel-cell-treatment-pdq

Kuchiza kwa Merkel Cell Carcinoma

Zambiri Zokhudza Merkel Cell Carcinoma

MFUNDO ZOFUNIKA

• Merkel cell carcinoma ndi matenda osowa kwambiri omwe maselo oyipa (khansa) amapangidwa pakhungu.

• Kutuluka kwa dzuwa komanso kukhala ndi chitetezo chamthupi chofooka kumatha kukhudza chiopsezo cha Merkel cell carcinoma.

• Merkel cell carcinoma nthawi zambiri imawoneka ngati chotupa chopanda ululu pakhungu lowonekera padzuwa.

• Kuyesa ndi njira zomwe zimayang'ana khungu zimagwiritsidwa ntchito kuti zidziwike (kupeza) ndikuzindikira Merkel cell carcinoma.

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

Merkel cell carcinoma ndi matenda osowa kwambiri omwe maselo oyipa (khansa) amapangidwa pakhungu.

Maselo a Merkel amapezeka pamwamba pakhungu. Maselowa ali pafupi kwambiri ndi mathero omwe amamva kukhudza. Merkel cell carcinoma, yotchedwanso neuroendocrine carcinoma ya khungu kapena khansa ya trabecular, ndi mtundu wosowa kwambiri wa khansa yapakhungu yomwe imayamba maselo a Merkel atakula. Merkel cell carcinoma imayamba nthawi zambiri m'malo akhungu lowala ndi dzuwa, makamaka mutu ndi khosi, komanso mikono, miyendo, ndi thunthu.

Anatomy ya khungu lowonetsa khungu, khungu, ndi minofu yocheperako. Maselo a Merkel ali m'maselo oyambira m'munsi mwa epidermis ndipo amalumikizidwa ndi mitsempha.

Merkel cell carcinoma imakula msanga ndikusintha (kufalikira) koyambirira. Nthawi zambiri imafalikira ku ma lymph node oyandikira kenako imafalikira kumatenda kapena khungu kumadera akutali a thupi, mapapo, ubongo, mafupa, kapena ziwalo zina.

Merkel cell carcinoma ndiye chinthu chachiwiri chomwe chimayambitsa khansa yapakhungu pambuyo pa khansa yapakhungu.

Kutuluka kwa dzuwa komanso kukhala ndi chitetezo chamthupi chofooka kumatha kukhudza chiopsezo cha Merkel cell carcinoma.

Chilichonse chomwe chimakulitsa chiopsezo chotenga matenda chimatchedwa chiopsezo. Kukhala ndi chiwopsezo sikutanthauza kuti udzakhala ndi khansa; kusakhala ndi zoopsa sikutanthauza kuti simudzakhala ndi khansa. Lankhulani ndi dokotala ngati mukuganiza kuti mutha kukhala pachiwopsezo. Zowopsa za Merkel cell carcinoma ndi izi:

• Kuwululidwa ku dzuwa lachilengedwe lambiri.

• Kuwonetsedwa ndi kuwala kwa dzuwa, monga kuchokera kumabedi ofufuta kapena psoralen ndi mankhwala a ultraviolet A (PUVA) a psoriasis.

• Kukhala ndi chitetezo cha mthupi chofooketsedwa ndi matenda, monga matenda a khansa ya m'magazi kapena kachilombo ka HIV.

• Kutenga mankhwala omwe amachititsa kuti chitetezo cha mthupi chisamagwire ntchito, monga pambuyo poti thupi limaikidwa.

• Kukhala ndi mbiri ya mitundu ina ya khansa.

• Kukhala wamkulu kuposa zaka 50, wamwamuna, kapena woyera.

Merkel cell carcinoma nthawi zambiri imawoneka ngati chotupa chopanda ululu pakhungu lowonekera padzuwa.

Izi ndi zina zosintha pakhungu zimatha kuyambitsidwa ndi Merkel cell carcinoma kapena zina. Funsani dokotala wanu mukawona kusintha pakhungu lanu.

Merkel cell carcinoma nthawi zambiri imawoneka pakhungu lowonekera padzuwa ngati chotumphuka chimodzi chomwe ndi:

• Kukula msanga.

• Zopanda pake.

• Okhazikika komanso owoneka ngati mzikiti kapena anakulira.

• Ofiira kapena mtundu wa violet.

Kuyesa ndi njira zomwe zimayang'ana khungu zimagwiritsidwa ntchito kuti zidziwike (kupeza) ndikuzindikira Merkel cell carcinoma.

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.

• Kuyezetsa khungu lathunthu: Dotolo kapena namwino amayang'ana khungu kuti apeze zotupa kapena mawanga omwe amawoneka achilendo pamtundu, kukula, mawonekedwe, kapangidwe. Kukula, mawonekedwe, ndi kapangidwe ka ma lymph node nawonso ayang'aniridwa.

• Khungu lakhungu: Kuchotsa khungu kapena khungu lamatenda kuti athe kuwonedwa ndi microscope ndi wodwala kuti aone ngati ali ndi khansa.

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

Kulosera (mwayi wochira) ndi njira zamankhwala zimadalira izi:

• Gawo la khansa (kukula kwa chotupacho komanso ngati chafalikira kumatenda kapena mbali zina za thupi).

• Kumene khansara ili mthupi.

• Kaya khansa yapezeka kumene kapena yabwereranso (bwererani).

• Msinkhu wa wodwalayo komanso thanzi lake lonse.

Kulosera kumadalira momwe chotupacho chakulira kwambiri pakhungu.

Magawo a Merkel Cell Carcinoma

MFUNDO ZOFUNIKA

• Merkel cell carcinoma atapezeka, amayesedwa kuti apeze ngati maselo a khansa afalikira mbali zina za thupi.

• Pali njira zitatu zomwe khansa imafalikira mthupi.

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

• Magawo otsatirawa amagwiritsidwa ntchito pa Merkel cell carcinoma:

• Gawo 0 (carcinoma in situ)

• Gawo I

• Gawo II

• Gawo III

• Gawo IV

Merkel cell carcinoma atapezeka, amayesedwa kuti apeze ngati maselo a khansa afalikira mbali zina za thupi.

Njira yomwe imagwiritsidwa ntchito pofufuza ngati khansa yafalikira mbali zina za thupi imatchedwa staging. Zomwe amapeza kuchokera pakukonzekera zimatsimikizira gawo la matendawa. Ndikofunikira kudziwa siteji kuti mukonzekere chithandizo.

Mayeso ndi njira zotsatirazi zitha kugwiritsidwa ntchito pokonza:

• 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. Kujambula kwa CT pachifuwa ndi pamimba kungagwiritsidwe ntchito poyang'ana khansa yaying'ono yamapapo yam'mapapo, kapena kupeza Merkel cell carcinoma yomwe yafalikira. Kujambula kwa CT kwa mutu ndi khosi kungagwiritsidwenso ntchito kupeza Merkel cell carcinoma yomwe yafalikira ku ma lymph node. Njirayi imatchedwanso computed tomography, kompyuta tomography, kapena kompyuta axial tomography.

• PET scan (positron emission tomography scan): Njira yopezera maselo oyipa mthupi. Gulu laling'ono la shuga (radio) limabayidwa mumtsempha. Chojambulira cha PET chimazungulira thupi ndikupanga chithunzi cha komwe glucose imagwiritsidwa ntchito mthupi. Maselo otupa owopsa amawonekera pachithunzichi chifukwa amakhala otanganidwa ndipo amatenga shuga wambiri kuposa momwe maselo amachitira.

• Lymph node biopsy: Pali mitundu ingapo yamankhwala am'magazi omwe amagwiritsidwa ntchito popanga Merkel cell carcinoma.

• Sentinel lymph node biopsy: Kuchotsa kwa sentinel lymph node panthawi yochita opareshoni. Sentinel lymph node ndiye njira yoyamba yam'magulu am'magazi kuti alandire madzi m'mimba kuchokera pachotupa choyambirira. Ndi lymph node yoyamba yomwe khansa imafalikira kuchokera ku chotupa choyambirira. Mankhwala a radioactive ndi / kapena utoto wabuluu amabayidwa pafupi ndi chotupacho. Katunduyu kapena utoto umadutsa m'mitsempha yam'mimba kupita kumalo am'mimba. Nthenda yoyamba yolandila mankhwala kapena utoto imachotsedwa. Wodwala amayang'ana minofu pansi pa microscope kuti ayang'ane maselo a khansa. Ngati maselo a khansa sapezeka, mwina sikofunikira kuchotsa ma lymph node ambiri. Nthawi zina, sentinel lymph node imapezeka m'magulu angapo am'magulu.

Sentinel lymph node biopsy ya khungu. Mankhwala opangira ma radio ndi / kapena utoto wabuluu amabayidwa pafupi ndi chotupacho (gulu loyamba). Zinthu zolembedwazo zimapezeka mowonekera komanso / kapena ndi kafukufuku yemwe amapeza ma radioactivity (gulu lapakati). Ma sentinel node (ma lymph node oyamba kutenga zinthuzo) amachotsedwa ndikuwunika ngati ali ndi khansa (gawo lomaliza).

• Lymph node dissection: Njira yochitira opaleshoni yomwe ma lymph node amachotsedwa ndipo mtundu wa minofu umayang'aniridwa ndi microscope ngati pali zizindikiro za khansa. Pochotsa minyewa yam'magawo am'magawo ena am'mimba, amachotsa ena mwa ma lymph node. Pochotsa minyewa yayikulu kwambiri yam'mimba, ma lymph node ambiri kapena aliwonse pachotupa amachotsedwa. Njirayi imatchedwanso lymphadenectomy.

• Core singano biopsy: Njira yochotsera nyemba pogwiritsa ntchito singano yayikulu. Wodwala amayang'ana minofu pansi pa microscope kuti ayang'ane maselo a khansa.

• Chida chabwino cha singano: Njira yochotsera minofu pogwiritsa ntchito singano yopyapyala. Wodwala amayang'ana minofu pansi pa microscope kuti ayang'ane maselo a khansa.

• 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 pothandiza kuzindikira khansa ndikuthandizira kudziwa khansa yamtundu wina wa khansa.

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 Merkel cell carcinoma imafalikira pachiwindi, maselo a khansa pachiwindi ndi maselo a Merkel omwe ali ndi khansa. Matendawa ndi metastatic Merkel cell carcinoma, osati khansa ya chiwindi.

Magawo otsatirawa amagwiritsidwa ntchito pa Merkel cell carcinoma:

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).

Gawo 0 (carcinoma in situ)

Pachigawo 0, maselo osadziwika a Merkel amapezeka pamwamba pa khungu. Maselo achilendowa amatha kukhala khansa ndikufalikira m'minyewa yabwinobwino.

Gawo I

Pachigawo choyamba ine, chotupacho chili ndi masentimita awiri kapena ocheperako.

Gawo II

Gawo lachiwiri Merkel cell carcinoma lagawidwa magawo IIA ndi IIB.

• Mu gawo IIA, chotupacho chimakhala chachikulu kuposa 2 sentimita.

• Pa gawo IIB, chotupacho chafalikira kumatikita oyandikana nawo, minofu, mafupa, kapena fupa.

Gawo III

Gawo lachitatu Merkel cell carcinoma lagawika magawo IIIA ndi IIIB.

Mu gawo IIIA, chimodzi mwazinthu izi chikupezeka:

• chotupacho chimatha kukula ndipo mwina chafalikira kumatikita oyandikana nawo, minofu, mafupa, kapena mafupa. Nthenda yam'mimba siyimveke poyesedwa koma khansa imapezeka mu lymph node ndi sentinel lymph node biopsy kapena pambuyo poti lymph node ichotsedwa ndikuyang'aniridwa ndi microscope ngati ali ndi khansa; kapena

• Nthenda yotupa imamvekera mukamayesa thupi komanso / kapena kuwonedwa poyesa kujambula. Lymph node ikachotsedwa ndikuyang'aniridwa ndi microscope ngati ili ndi khansa, khansa imapezeka mu lymph node. Malo omwe khansayo idayambira sakudziwika.

Mu gawo IIIB, chotupacho chimatha kukula kulikonse ndipo:

• atha kufalikira kumalumikizidwe oyandikana nawo, minofu, mafupa, kapena mafupa. Nthenda yotupa imamvekera pakuyesa kwakuthupi ndi / kapena kuwonedwa pamayeso ojambula. Lymphode ikachotsedwa ndikuyang'aniridwa ndi microscope ngati ili ndi khansa, khansa imapezeka mu lymph node; kapena

• khansa ili mumtsuko wam'mimba pakati pa chotupa choyambirira ndi ma lymph node omwe ali pafupi kapena kutali. Khansa ikhoza kufalikira ku ma lymph node.

Gawo IV

Pa gawo IV, chotupacho chafalikira pakhungu lomwe silili pafupi ndi chotupa choyambirira kapena mbali zina za thupi, monga chiwindi, mapapo, fupa, kapena ubongo.

Merkel Cell Carcinoma Yambiri

Recurrent Merkel cell carcinoma ndi khansa yomwe yabwereranso (kubwerera) itachiritsidwa. Khansara imatha kubwerera pakhungu, ma lymph node, kapena mbali zina za thupi. Sizachilendo kuti Merkel cell carcinoma ibwererenso.

Chithandizo Chosankha Mwachidule

MFUNDO ZOFUNIKA

• Pali mitundu yosiyanasiyana ya chithandizo cha odwala omwe ali ndi Merkel cell carcinoma.

• Mitundu inayi yamankhwala omwe amagwiritsidwa ntchito amagwiritsidwa ntchito:

• Opaleshoni

• Thandizo la radiation

• Chemotherapy

• Chitetezo chamatenda

• Mitundu yatsopano yamankhwala ikuyesedwa m'mayesero azachipatala.

• Chithandizo cha Merkel cell carcinoma chingayambitse mavuto.

• 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 Merkel cell carcinoma.

Pali mitundu yosiyanasiyana ya mankhwala kwa odwala omwe ali ndi Merkel cell carcinoma. 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 inayi yamankhwala omwe amagwiritsidwa ntchito amagwiritsidwa ntchito:

Opaleshoni

Njira imodzi kapena zingapo zotsatirazi zitha kugwiritsidwa ntchito pochiza Merkel cell carcinoma:

• Kudandaula kwina kulikonse: Khansara imadulidwa pakhungu limodzi ndi minofu ina yozungulira. Sentinel lymph node biopsy imatha kuchitika panthawi yocheka kwambiri. Ngati pali khansa m'matenda am'mimba, mungathenso kusungunula ma lymph node.

• Lymph node dissection: Njira yochitira opaleshoni yomwe ma lymph node amachotsedwa ndipo mtundu wa minofu umayang'aniridwa ndi microscope ngati pali zizindikiro za khansa. Pazotupa zam'magawo am'magawo am'mimba, zotupa zina zam'mimba zimachotsedwa; chifukwa cha kusalongosoka kwakukulu kwa ma lymph node, ambiri kapena ma lymph node onse am'matumbo amachotsedwa. Njirayi imatchedwanso lymphadenectomy.

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.

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.

Momwe mankhwala a radiation amaperekedwera zimadalira mtundu ndi gawo la khansa yomwe ikuthandizidwa. Thandizo la radiation lakunja limagwiritsidwa ntchito pochiza Merkel cell carcinoma, ndipo itha kugwiritsidwanso ntchito ngati mankhwala ochepetsa nkhawa kuti muchepetse zizindikiritso ndikukhalitsa moyo wabwino.

Chemotherapy

Chemotherapy ndi chithandizo cha khansa chomwe chimagwiritsa ntchito mankhwala kuletsa kukula kwa maselo a khansa, mwina popha ma cell kapena poyimitsa ma cell 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). Momwe chemotherapy imaperekedwa imadalira mtundu ndi gawo la khansa yomwe ikuchitidwa.

Chitetezo chamatenda

Immunotherapy ndi chithandizo chomwe chimagwiritsa ntchito chitetezo cha mthupi cha wodwalayo kuthana ndi khansa. Zinthu zomwe thupi limapanga kapena zopangidwa mu labotale zimagwiritsidwa ntchito kukulitsa, kuwongolera, kapena kubwezeretsa chitetezo chamthupi cha khansa. Chithandizo cha khansa choterechi chimatchedwanso biotherapy kapena biologic therapy.

Mitundu ina ya ma cell a chitetezo, monga T cell, ndi ma cell ena a khansa ali ndi ma protein ena, otchedwa checkpoint protein, kumtunda kwawo omwe amasunga mayankho amthupi. Maselo a khansa ali ndi mapuloteni ambiri, samenyedwa ndikuphedwa ndi ma T. Chitetezo cha chitetezo cha mthupi chimatseka mapuloteniwa ndipo kuthekera kwa maselo a T kupha ma cell a khansa kumakulitsidwa.

Pali mitundu iwiri ya chitetezo cha chitetezo cha mthupi:

• PD-1 inhibitor: PD-1 ndi mapuloteni pamwamba pa ma T omwe amathandiza kuti chitetezo cha mthupi chitetezedwe. PD-1 ikamangirira puloteni ina yotchedwa PDL-1 pakhungu la khansa, imayimitsa T cell kuti isaphe khungu la khansa. PD-1 inhibitors amadziphatika ku PDL-1 ndikulola ma T maselo kupha ma cell a khansa. Avelumab ndi pembrolizumab amagwiritsidwa ntchito pochizira Merkel cell carcinoma. Nivolumab ikuwerengedwa kuti ithetse Merkel cell carcinoma.

Chitetezo cha chitetezo cha mthupi. Mapuloteni owunika, monga PD-L1 pama cell a chotupa ndi PD-1 pama cell a T, amathandizira kuyang'anira mayankho amthupi. Kumanga kwa PD-L1 mpaka PD-1 kumapangitsa kuti ma T asaphe ma cell am'mimba (gulu lakumanzere). Kuletsa kumangiriza kwa PD-L1 mpaka PD-1 yokhala ndi chitetezo chodzitetezera (anti-PD-L1 kapena anti-PD-1) kumalola ma T maselo kupha ma cell a chotupa (gulu lamanja).

• CTLA-4 inhibitor: CTLA-4 ndi mapuloteni pamwamba pa ma T omwe amathandiza kuti chitetezo cha mthupi chitetezedwe. CTLA-4 ikamangirira puloteni ina yotchedwa B7 pa khungu la khansa, imayimitsa T cell kuti isaphe khungu la khansa. CTLA-4 inhibitors amadziphatika ku CTLA-4 ndikulola ma T maselo kupha ma cell a khansa. Ipilimumab ndi mtundu wa CTLA-4 inhibitor yomwe ikuwerengedwa kuti ithetse Merkel cell carcinoma.

Chitetezo cha chitetezo cha mthupi. Mapuloteni a checkpoint, monga B7-1 / B7-2 pama cell antigen-presenting cell (APC) ndi CTLA-4 pama cell a T, amathandizira kuteteza mayankho a chitetezo cha mthupi. T-cell receptor (TCR) ikamangirira ku antigen komanso mapuloteni akuluakulu a histocompatibility complex (MHC) pa APC ndi CD28 amamangiriza ku B7-1 / B7-2 pa APC, T cell imatha kuyatsidwa. Komabe, kumangiriza kwa B7-1 / B7-2 mpaka CTLA-4 kumapangitsa kuti ma T maselo akhale osagwira ntchito kotero kuti sangathe kupha ma cell am'mimba mthupi (kumanzere). Kuletsa kumangiriza kwa B7-1 / B7-2 mpaka CTLA-4 yokhala ndi chitetezo cha chitetezo cha mthupi (anti-CTLA-4 antibody) kumalola ma T kuti azitha kugwira ntchito ndikupha ma cell a chotupa (gulu lamanja).

Onani Mankhwala Ovomerezeka a Khansa Yapakhungu kuti mumve zambiri.

Mitundu yatsopano yamankhwala ikuyesedwa m'mayesero azachipatala.

Zambiri zamayeso azachipatala zimapezeka patsamba la NCI.

Chithandizo cha Merkel cell carcinoma chingayambitse mavuto.

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 ndi Gawo

M'chigawo chino

• Gawo I ndi Gawo II Merkel Cell Carcinoma

• Gawo lachitatu Merkel Cell Carcinoma

• Gawo IV Merkel Cell Carcinoma

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

Gawo I ndi Gawo II Merkel Cell Carcinoma

Chithandizo cha gawo I ndi gawo lachiwiri Merkel cell carcinoma chingaphatikizepo izi:

• Kuchita opaleshoni kuti muchotse chotupacho, monga kuthamangitsidwa kwina kulikonse komwe kulibe kapena kupatsirana kwa lymph node.

• Thandizo la radiation mutatha opaleshoni.

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.

Gawo lachitatu Merkel Cell Carcinoma

Chithandizo cha gawo lachitatu Merkel cell carcinoma chingaphatikizepo izi:

• Kudumphadumpha konse komwe kuli ndi kapena kupatsirana kwa lymph node.

• Thandizo la radiation.

• Immunotherapy (immune checkpoint inhibitor therapy pogwiritsa ntchito pembrolizumab), yamatenda omwe sangachotsedwe ndi opaleshoni.

• Kuyesedwa kwachipatala kwa chemotherapy.

• Kuyesedwa kwachipatala kwa immunotherapy (nivolumab).

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.

Gawo IV Merkel Cell Carcinoma Chithandizo cha gawo IV Merkel cell carcinoma chingaphatikizepo izi:

Immunotherapy (immune checkpoint inhibitor therapy pogwiritsa ntchito avelumab kapena pembrolizumab). Chemotherapy, opareshoni kapena mankhwala othandizira poizoniyu ngati mankhwala ochepetsa nkhawa kuti athe kuchepetsa zizolowezi ndikukhala ndi moyo wabwino. Kuyesedwa kwachipatala kwa immunotherapy (nivolumab ndi ipilimumab). 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.

Njira Zothandizira Kuchiza Merkel Cell Carcinoma

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

Chithandizo cha Merkel cell carcinoma chingaphatikizepo izi:

• Kudulidwa kwapafupipafupi kuchotsa malo okulirapo a minofu kuposa momwe adachotsedwera pakuchita opaleshoni koyambirira. Kutsekemera kwa lymph node kungathenso kuchitidwa.

• Thandizo la radiation mutatha opaleshoni.

• Chemotherapy.

• Thandizo la radiation ndi / kapena opareshoni ngati mankhwala ochepetsa nkhawa kuti athetse zofooka ndikukhalitsa moyo wabwino.

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 Merkel Cell Carcinoma

Kuti mumve zambiri kuchokera ku National Cancer Institute yokhudza Merkel cell carcinoma, onani izi:

• Khansa Yapakhungu (Kuphatikiza Melanoma) Tsamba Loyambira

• Kupewa Khansa Yapakhungu

• Kuwunika Khansa Yapakhungu

• Sentinel Lymph Node Zolemba

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