Types/bone/bone-fact-sheet

Chirwere chepfupa chepuraimari

Chii chinonzi mapundu emabhonzo?

Mhando dzakasiyana dzemamota dzinogona kukura mumapfupa: mapundu ekutanga emapfupa, ayo anoumba kubva munyama yemapfupa uye anogona kunge ari akaipa (cancer) kana benign (kwete cancer), uye mamastastatic tumors (mamota anomuka kubva kune cancer maseru akaumba kumwe kunhu mumuviri uye ndokupararira kufupa). Malignant primary bone tumors (primary bone cancer) haina kujairika pane benign primary bone tumors. Ose maviri marudzi epamuviri mapundu anogona kukura uye kumanikidza ane hutano mapfupa tishu, asi ane huturu mamota kazhinji haaparadzi kana kuparadza mapfupa emapundu uye haawanzo kuve tyisidziro kuhupenyu.

Chekutanga mapfupa ekenza anowanikwa mune yakakura chikamu checancer inonzi sarcomas. (Soft-tissue sarcomas — sarcomas dzinotanga mumhasuru, mafuta, fibrous tishu, tsinga dzeropa, kana zvimwe zvinyama zvinotsigira zvemuviri, kusanganisira synovial sarcoma - hazvina kutaurwa mune ino gwaro rechokwadi.)

Kenza yepfupa yepuraimari haiwanzoitika. Iyo inoverengera zvakaderera zvishoma pane 1% yeese matsva cancer anowanikwa. Mu2018, inofungidzirwa 3,450 mitsva mitsva yekenza yekutanga yemapfupa ichaonekwa muUnited States (1).

Gomarara rinosanganisa (richipararira) kumabhonzo kubva kune mamwe mativi emuviri rinonzi gomarara repfupa (kana repiri) uye rinotumidzwa nenhengo kana munyama marakatanga-semuenzaniso, segomarara repazamu rakasangana nefupa. . Muvanhu vakuru, mamota ane cancer ane metastasized kune pfupa akajairika zvakanyanya kupfuura epamberi kenza yemapfupa. Semuenzaniso, pakupera kwa2008, inofungidzirwa vanhu vakuru mazana maviri nemakumi masere vane makore gumi nemasere kusvika makumi matanhatu nematanhatu muUnited States vaigara nekenza yemastastatic mumapfupa (2).

Kunyangwe mhando zhinji dzekenza dzichigona kupararira kusvika pfupa, metastasis yemapfupa inonyanya kuitika nemamwe makenza, anosanganisira cancer neprostate cancer. Metastatic tumors mufupa inogona kukonzera kutsemuka, kurwadziwa, uye zvisina kujairika mazinga ecalcium muropa, mamiriro anonzi hypercalcemia.

Ndeapi marudzi akasiyana ekenza yemapfupa ekutanga?

Mhando dzekenza yemapfupa yekutanga inotsanangurwa neayo maseru ari mupfupa anovamutsa.

Osteosarcoma

Osteosarcoma inomuka kubva kumaseru-anogadzira maseru anonzi maosteoblast mune easteoid tishu (isina kusimba bone tishu). Iri bundu rinowanzoitika paruoko padyo nepafudzi uye mugumbo padyo nemabvi muvana, vachiri kuyaruka, uye vechidiki vakuru (3) asi rinogona kuitika mune chero pfupa, kunyanya kune vakuru vakuru. Inowanzo kukura nekukurumidza uye inopararira kune dzimwe nhengo dzemuviri, kusanganisira mapapu. Njodzi yeosteosarcoma yakakwira kwazvo pakati pevana nevechiri kuyaruka vane makore gumi nemapfumbamwe. Vanhurume vanowanzoita kupfuura vakadzi kukudziridza osteosarcoma. Pakati pevana, osteosarcoma inowanzoitika kune vatema uye mamwe madzinza / madzinza kupfuura evachena, asi pakati pevakuru inowanzoonekwa nevachena kupfuura mamwe marudzi / madzinza.

Chondrosarcoma

Chondrosarcoma inotanga mu cartilaginous tishu. Cartilage irwo rudzi rwehutachiona hunobatanidza hunofukidza magumo emapfupa uye nekurongedza majoini. Chondrosarcoma kazhinji inogadzira mapapiro, gumbo repamusoro, uye bendekete uye kazhinji inokura zvishoma nezvishoma, kunyangwe dzimwe nguva inogona kukura nekukurumidza uye kupararira kune dzimwe nhengo dzemuviri. Chondrosarcoma inowanikwa kunyanya kune vanhu vakuru (vanopfuura makore makumi mana). Ngozi inowedzera nekukura. Mhando isingawanzo ye chondrosarcoma inonzi extraskeletal chondrosarcoma haina kuumba mune bone cartilage. Pane kudaro, inogadzira munyama dzakapfava dzechikamu chepamusoro chemaoko nemakumbo.

Ewing sarcoma

Kuchera sarcoma kunowanzo simuka mupfupa asi kunogona zvakare kusimuka mune yakapfava nyama (tsandanyama, mafuta, fibrous tishu, tsinga dzeropa, kana zvimwe zvinotsigira). Kuchera sarcomas zvinowanzo fomu mumapapiro, makumbo, kana mbabvu, asi zvinogona kuumba mune chero bhonzo (3). Bundu iri rinowanzo kukura nekukurumidza uye rinopararira kune dzimwe nhengo dzemuviri, kusanganisira mapapu. Ngozi yeEwing sarcoma ndeyepamusoro muvana nevechiri kuyaruka vari pasi pemakore gumi nemapfumbamwe. Vakomana vane mikana yekukura Ewing sarcoma kupfuura vasikana. Kutora sarcoma kunowanzoitika kune vachena kupfuura vatema kana maAsia.

Chordoma

Chordoma ibundu risingawanzo rinowanikwa mumapfupa emusana. Aya mamota anowanzoitika kune vakura vakuru uye anowanzo gadzira pazasi pemuzongoza (sacrum) uye pazasi pehenya. Vanenge varume vakapetwa kaviri sevakadzi vanoonekwa kuti vane chordoma. Kana zvikaitika muvanhu vadiki nevana, zvinowanzo kuwanikwa pazasi pehenya uye mumuromo wechibereko (mutsipa).

Mhando dzinoverengeka dzemabundu ane pfupa anogona, mune zvisingawanzoitika zviitiko, kuve akaipa uye kupararira kune dzimwe nhengo dzomuviri (4). Izvi zvinosanganisira hofori yesero bundu repfupa (inonziwo osteoclastoma) uye osteoblastoma. Giant sero bundu repfupa rinowanzoitika kumagumo emapfupa marefu emaoko nemakumbo, kazhinji padhuze nemubatanidzwa wemabvi (5). Aya mamota, ayo anowanzoitika kune vechidiki uye vepakati-vakuru vanhu vakuru, anogona kuve enzvimbo ane hukasha, achikonzera kuparadzwa kwepfupa. Muzviitiko zvisingawanzo vanogona kupararira (metastasize), kazhinji kumapapu. Osteoblastoma inotsiva yakajairwa yakaoma pfupa tishu ine isina kusimba fomu inonzi osteoid. Bundu iri rinonyanya kuitika mumuzongoza (6). Iyo inononoka-kukura uye inoitika mune vechidiki uye vepakati-vakuru vakuru. Zviitiko zvisingawanzo zvechirwere ichi kuva zvinokuvadza zvakataurwa.

Ndezvipi zvinokonzeresa zvegomarara repfupa?

Kunyangwe kenza yemapfupa yekutanga isina chikonzero chakanyatso tsanangurwa, vaongorori vakaona zvinhu zvinoverengeka zvinowedzera mukana wekuvandudza mamota aya.

• Yapfuura kenza kurapwa nemwaranzi, chemotherapy, kana stem cell kuisirwa. Osteosarcoma inowanzoitika kazhinji muvanhu vakambove nemushonga wepamusoro wekunze kwemwaranzi (kunyanya panzvimbo iri mumuviri wakapihwa radiation) kana kurapwa nemamwe madhiragi ekenza, kunyanya alkylating vamiririri; avo vanorapwa panguva yehudiki vane njodzi yakanyanya. Uye zvakare, osteosarcoma inokura mune diki muzana (ingangoita 5%) yevana vari kuita myeloablative hematopoietic stem cell kuisirwa.

• Mamwe mamiriro ezvinhu akagara nhaka.Chiverengero chidiki chegomarara remabhonzo chakakonzerwa nemamiriro ekugara nhaka (3). Semuenzaniso, vana vakave nenhaka retinoblastoma (gomarara risingazivikanwe reziso) vari panjodzi yakakura yekuve neosteosarcoma, kunyanya kana ikarapwa nemwaranzi. Nhengo dzemhuri dzine Li-Fraumeni syndrome vari panjodzi yekuwedzera kweosteosarcoma uye chondrosarcoma pamwe nemamwe marudzi ekenza. Pamusoro pezvo, vanhu vane nhaka yekuremara kwemapfupa vane mukana wekuwedzera wehupenyu hwekuvandudza chondrosarcoma. Childhood chordoma inosanganisirwa netuberous sclerosis yakaoma, chirwere chemagene umo mabundu ane hunyoro anoumba itsvo, huropi, maziso, moyo, mapapu uye ganda. Kunyangwe Ewing sarcoma isina kunyanyobatanidzwa nechero nhaka yekenza syndromes kana congenital hosha dzevacheche (7, 8),

• Dzimwe benign mapfupa mamiriro. Vanhu vane makore anopfuura makumi mana vane chirwere chePaget chepfupa (chimiro chisina kunaka chinoratidzwa nekukura kusingaenzanisike kwemasero matsva emapfupa) vari panjodzi yekuwedzera osteosarcoma

Ndezvipi zviratidzo zvegomarara repfupa?

Marwadzo ndicho chiratidzo chinowanzozivikanwa chegomarara repfupa, asi hadzisi kenza dzese dzemapfupa dzinokonzera kurwadziwa. Kuramba uchirwadziwa kana kujairika kurwadziwa kana kuzvimba mukati kana padyo nefupa kunogona kukonzerwa nekenza kana nemamwe mamiriro. Zvimwe zviratidzo zvegomarara repfupa zvinosanganisira bundu (iro rinogona kunzwa rakapfava uye rinodziya) mumaoko, makumbo, chifuva, kana chiuno; fivha isina kutsanangurwa; uye pfupa rinotyoka pasina chikonzero chinozivikanwa. Izvo zvakakosha kuti uone chiremba kuti uone chinokonzera chero zviratidzo zvepfupa.

Kenza yemapfupa inoonekwa sei?

Kubatsira kuongorora gomarara repfupa, chiremba anobvunza nezvenhoroondo yemurwere yemunhu uye yemhuri. Chiremba anoitawo bvunzo dzepanyama uye anogona kuraira murabhoritari uye kumwe kuongorora kwekuongorora. Iyi bvunzo inogona kusanganisira zvinotevera:

• X-ray, iyo inogona kuratidza nzvimbo, kukura, uye chimiro chebundu repfupa. Kana ma-x-ray achiratidza kuti nzvimbo isina kujairika inogona kunge iri cancer, chiremba anogona kukurudzira miedzo yakakosha yekufungidzira. Kunyangwe kana x-ray ichiratidza kuti nzvimbo isina kujairika iri benign, chiremba angangoda kuita mimwe miedzo, kunyanya kana murwere achirwadziwa zvisingaite kana kuramba uchirwadziwa.

• Bonzo scan, inova bvunzo iyo inoverengeka yezvinhu zvine radioactive zvinoiswa mukati meropa reropa uye inofamba nepakati neropa; iyo inobva yaunganidza mumapfupa uye inoonekwa ne scanner.

• A computed tomography (CT kana CAT) scan, inova nhevedzano yemifananidzo yakadzama yenzvimbo dziri mukati memuviri, dzakatorwa kubva kumakona akasiyana, ayo akagadzirwa nekombuta yakabatana neiyo x-ray muchina.

• Iyo magnetic resonance imaging (MRI) maitiro, ayo anoshandisa simba rine magineti rakabatana nekombuta kugadzira mifananidzo yakajeka yenzvimbo dziri mukati memuviri pasina kushandisa x-rays.

• A positron emission tomography (PET) scan, mune shoma radioactive glucose (shuga) inopinzwa mutsinga, uye scanner inoshandiswa kugadzira yakadzama, mifananidzo yemakomputa enzvimbo dziri mukati memuviri panoshandiswa glucose. Nekuti maseru ekenza anowanzo shandisa glucose yakawanda kupfuura akajairwa maseru, iyo mifananidzo inogona kushandiswa kutsvaga cancer maseru mumuviri.

• Angiogram, inova x-ray yemitsipa yeropa.

• Biopsy (kubviswa kwesuruvara sampu kubva mubundu repfupa) kuona kana gomarara riripo. Chiremba anovhiya anogona kuita tsono biopsy, an excisional biopsy, kana incisional biopsy. Munguva yetsono biopsy, chiremba anovhiya anoita gomba diki mufupa uye anobvisa sampuli yetishu kubva pabundu riine chimbo chakaita setsono. Nezvakanaka biopsy, chiremba anovhiya anobvisa bundu rese kana inofungira nzvimbo yekuongororwa. Mune incisional biopsy, chiremba anovhiya anocheka mune bundu uye anobvisa sampuro yeturu. Biopsies anonyanya kuitwa nachiremba wemapfupa oncologist (chiremba akawana mukurapa kenza yemapfupa) nekuti kuiswa kweiyo biopsy incision kunogona kukanganisa sarudzo dzinotevera dzekuvhiya. Nyanzvi yezvirwere (chiremba anozivisa chirwere nekuongorora maseru uye zvinyama pasi pe microscope) anoongorora nyama kuti aone kana iri cancer.

• Kuongororwa kweropa kuona huwandu hwemakemikari maviri anonzi alkaline phosphatase uye lactate dehydrogenase. Zvikuru zvemakemikari aya anogona kunge aripo muropa revanhu vane osteosarcoma kana Ewing sarcoma. Ropa rakakwira realkaline phosphatase inoitika kana masero anogadzira mapfupa emuviri ari kushanda-vana pavanenge vachikura, kana pfupa rakatyoka riri kugadzikana, kana apo chirwere kana bundu rinokonzeresa kugadzirwa kwemapfupa asina kujairika. Nekuti huwandu hwakawanda hwealkaline phosphatase hwakajairika mukukura kwevana nevechiri kuyaruka, bvunzo iyi haisi chiratidzo chechokwadi chegomarara repfupa.

Kanzuru yemapfupa inorapwa sei?

Kurapa sarudzo kunoenderana nerudzi, saizi, nzvimbo, uye nhanho yekenza, pamwe nezera remunhu uye hutano hwese. Kurapa sarudzo yekenza yemapfupa kunosanganisira kuvhiyiwa, chemotherapy, radiation radiation, cryosurgery, uye yakanangwa kurapwa.

• Kuvhiya ndiko kwakajairwa kurapwa kwekenza yemapfupa. Chiremba anovhiya anobvisa bundu rese nemakaro asina kunaka (ndokuti, hapana masero ekenza anowanikwa kumucheto kwetishu yakabviswa panguva yekuvhiyiwa). Chiremba anovhiya anogona zvakare kushandisa akakosha ekuvhiya nzira kudzikisira huwandu hwehutachiona hune hutano hwakabviswa pamwe chete nebundu.Kuvandudzika kunoshamisa muhunyanzvi hwekuvhiya uye preoperative bundu kurapwa kwakaita kuti zvikwanisike kune vazhinji varwere vane gomarara repfupa muruwoko kana gumbo kudzivirira nzira dzakakomba dzekuvhiya (ndiko kuti, kubviswa kwese nhengo). Nekudaro, vazhinji varwere vanovhiyiwa -makumbo-ekuvhiya vanoda kuvhiya kwekugadzirisa kuti vadzokerezve nhengo (3).

• Chemotherapy ndiko kushandiswa kwemishonga yeanticancer kuuraya maseru ekenza. Varwere vane Ewing sarcoma (ichangobva kuongororwa uye inowanzoitika) kana ichangobva kuongororwa osteosarcoma vanowanzo gamuchira musanganiswa wemishonga inorwisa kenza vasati vavhiyiwa. Chemotherapy haiwanzoshandiswa kurapa chondrosarcoma kana chordoma (3).

• Radiation therapy, inonziwo radiotherapy, inosanganisira kushandiswa kwesimba-simba x-rays kuuraya cancer maseru. Mushonga uyu unogona kushandiswa musanganiswa nekuvhiya. Inowanzo shandiswa kurapa Ewing sarcoma (3). Inogona zvakare kushandiswa nemamwe marapirwo eosteosarcoma, chondrosarcoma, uye chordoma, kunyanya kana kenza shoma yasara mushure mekuvhiyiwa. Iyo inogona zvakare kushandiswa kune varwere vasina kuvhiyiwa Chinhu chine mwaranzi chinounganidza mupfupa, chinonzi samarium, iri fomu yemukati yekurapa kwehutachiona iyo inogona kushandiswa yega kana ne stem cell yekuisa kurapa osteosarcoma iyo yadzoka mushure mekurapwa. mune rimwe pfupa.

• Cryosurgery iko kushandiswa kwemvura senitrogen kuomesa uye kuuraya cancer maseru. Unyanzvi uhu dzimwe nguva hunogona kushandiswa pachinzvimbo chekuvhiya kwakajairika kuti uparadze mamota mupfupa (10).

• Kurapa kwakanangwa ndiko kushandiswa kwechirwere chakagadzirirwa kusangana nechero mamorekuru ane chekuita mukukura nekupararira kwemasero ekenza. Iyo monoclonal antibody denosumab (Xgeva®) chirwere chakanangwa chinotenderwa kurapa vanhu vakuru uye vane mafupa ekukura vachiri kuyaruka vane hofori sero bundu repfupa risingakwanise kubviswa nekuvhiya. Iyo inodzivirira kuparadzwa kwepfupa kunokonzerwa nerudzi rwechitokisi maseru inonzi osteoclast.

Rumwe ruzivo nezve kurapwa kweakasarudzika mhando dzekenza yemapfupa inogona kuwanikwa mune inotevera ® kenza yekurapa pfupiso:

• Ewing Sarcoma Kurapa

• Osteosarcoma uye Malignant Fibrous Histiocytoma yeBone Kurapa

• Asingazivikanwe Kenza dzeVana Kurapa (chikamu cheChordoma)

Ndeipi mhedzisiro yekurapa kenza yemapfupa?

Vanhu avo vakarapwa kenza yemapfupa vane mukana wakawedzera wekukudziridza kunonoka mhedzisiro yekurapa sezvavanokwegura. Iyi mhedzisiro mhedzisiro inoenderana nerudzi rwekurapa uye zera remurwere pakurapwa uye zvinosanganisira matambudziko epanyama anosanganisira moyo, mapapu, kunzwa, kubereka, uye pfupa; matambudziko etsinga; uye chechipiri kanzura (acute myeloid leukemia, myelodysplastic syndrome, uye radiation-induced sarcoma). Kurapa kwemapfupa emapfupa necryosurgery kunogona kutungamira kukuparadzwa kwemapfupa emapfupa ari padyo uye kunoguma nekutyoka, asi izvi zvinogona kusaonekwa kwenguva yakati mushure mekurapwa kwekutanga.

Kenza yemapfupa dzimwe nguva inosanganisa, kunyanya kumapapu, kana inogona kudzoka (kudzoka), kungave panzvimbo imwechete kana mune mamwe mapfupa mumuviri. Vanhu vane kenza yemapfupa vanofanirwa kuona chiremba wavo nguva dzose uye vanofanirwa kuzivisa chero zviratidzo zvisina kujairika ipapo ipapo. Kutevera kunosiyana pamhando dzakasiyana uye nhanho dzegomarara repfupa. Kazhinji, varwere vanoongororwa kazhinji nachiremba wavo uye vanogara vachiongororwa ropa uye x-ray. Kugara uchitevedza kuchengetedza kunoona kuti shanduko mune hutano inokurukurwa uye kuti matambudziko anorapwa nekukurumidza sezvazvinogona.

Sarudzo Dzinongedzwa '

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7. Mirabello L, Curtis RE, Savage SA. Kenza Bone. Muna: Michael Thun M, Linet MS, Cerhan JR, Haiman CA, Schottenfeld D, vapepeti. Schottenfeld uye Fraumeni, Cancer Epidemiology uye Kudzivirira. Yechina edition. New York: Oxford University Press, 2018.
8. Roman E, Lightfoot T, Picton S Kinsey S. Cancers Yevacheche. Muna: Michael Thun M, Linet MS, Cerhan JR, Haiman CA, Schottenfeld D, vapepeti. Schottenfeld uye Fraumeni, Cancer Epidemiology uye Kudzivirira. Yechina edition. New York: Oxford University Press, 2018.
9. Machiela MJ, Grünewald TGP, Surdez D, et al. Genome-wide musangano kudzidza kunozivisa akawanda matsva loci ane hukama neEwing sarcoma mukana. Natural Kutaurirana 2018; 9 (1): 3184. [PubMed Abstract]
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