Kankarar cutar sankarar bargo, wani ciwon daji na jikin jini, ana zaton shi a matsayin yanayin da ke shafar yara da matasa-a gaskiya, shi ne ciwon daji na yau da kullum na yara. Duk da haka, cutar sankarar ta shafi wasu tsofaffi tsofaffi da kuma mutane a cikin shekaru 60, musamman.
Yayinda kulawa ga tsofaffi na iya zama ƙalubale, a yau akwai ƙarin yawan zaɓuɓɓuka-ko da idan kun isa isa ku tuna da Eisenhower da JFK.
Sabbin nau'o'in maganin magungunan sunadaran da zasu iya taimakawa wajen yaki da cutar, ko da lokacin da jikinka ba zai iya ɗaukar mummunan lalacewa na kariya ba. Wannan ya ce, ko da a zamanin yau, cutar sankarar bargowa ce mai wuya ga mutane da yawa.
Ciwon sankarar bargowa A cikin tsofaffi
Likimamin jini na lymphocytic na zamani shine (CLL) mafi yawan cutar sankarar bargo a cikin manya, tare da matsakaicin shekarun da aka gano a kimanin shekaru 71. Murar cutar sankarar myeloid mai muni (AML) tana da matsayi na biyu a cikin tsofaffi, tare da shekarun shekaru a ganewar asali na shekaru 67; kuma fiye da kashi 60 cikin sababbin marasa lafiya da suka kamu da cutar tare da AML sun kai 60. Kamar haka, ana tattaunawa CLL da AML da yawa a nan, duk da haka, tsofaffi na iya bunkasa wasu nau'i biyu na cutar sankarar bargo. Shekaru fiye da shekaru 70 yana da matsalar haɗari ga ƙwayar cutar ciwon sankarar lymphoblastic mai tsanani (ALL), wanda ake kira ƙananan cutar sankarar lymphocytic. Kuma game da cutar sankarar mahaifa na kullum (CML), kimanin kashi 50 na marasa lafiya tare da CML sun kai shekaru 66 da haihuwa.
Maganin Dattawan da aka gano da cutar sankarar bargo
CLL da AML sune cutar sankarar sanadiya da yafi yawa don fitowa daga baya a rayuwa. Daga cikin guda biyu, AML shine yawan ci gaba da sauri. Rahotanni na malignancies biyu (dukkanin kungiyoyin shekaru) a 2016 kamar haka:
- 18,960 sababbin lokuta da kuma 4,660 mutuwar daga CLL
- 19,950 sababbin lokuta da mutuwar 10,430 daga AML.
CLL da AML suna da cututtuka daban-daban, suna nuna muhimmancin bambance-bambance tsakanin leukemias mai tsanani da na kullum, a gaba ɗaya. Dukkanin leukemias farawa lokacin da sassan jikin kasusuwa - ma'aikacin jikinka don yin sabon jini - fara fara samar da jini maras kyau. Kwayoyin nama a cikin kututtukan kasusuwa kullum suna haifar da dukkanin jinin jinin ci gaba, yin sabon sel don maye gurbin tsohon. Lurar cutar sankarar ƙanƙara ta ƙunshi ƙwayoyin jini marasa ƙarfi kuma suna kokarin ci gaba sosai. Cutar cutar sankarar bargo yana dauke da kwayoyin jini wadanda ke da ɗan adam, amma har yanzu suna da hauka, kuma yawancin leukemias na cigaban sannu a hankali, a kan tsawon watanni da shekaru.
CLL
CLL ne ciwon daji na fararen jini a cikin gidan B-lymphocyte. B-lymphocytes, ko B-sassan, su ne lymphocytes waɗanda za su iya zama kunnawa kuma su kai ga samar da kwayar cutar. Sauran irin lymphocytes su ne kwayoyin T, waɗanda suka fi kama da 'santiri', ko sakin soja.
CLL ba yakan haifar da bayyanar cututtuka ba tun da wuri, kuma mutum ba dole ba ne ya san cewa yana da CLL a farkon. A gaskiya, sau da yawa, mutane suna bincikar su bayan sunyi gwajin jini. Lokacin da CLL ke haifar da bayyanar cututtuka, wasu daga cikin mafi yawan sune: jin damu da rauni; ko kuma samun ƙwayar lymph a cikin wuyansa, a ƙarƙashin hannu ko a cikin kullun; ko fadowa rashin lafiya ga cututtuka da sauƙi fiye da al'ada; ko da ciwon fuka, ko manyan sweats a lokacin dare; ko rasa nauyi ba tare da ƙoƙari ba.
A cikin CLL, kwayoyin cutar kanjamau sun kasance mafi yawa a cikin jini, ƙashin kashi, da kuma ƙwayar lymph. Wani yanayin da ake danganta, wanda ake kira ƙananan cutar sankarar lymphocytic, ko SLL, wani ciwon daji ne wanda ke farawa a cikin sel na B-cell, kamar CLL, duk da haka, mutumin da ke tare da SLL ba shi da babban lambobin jini a jini.
Sakamakon ganewa na CLL na buƙatar gwaje-gwaje na jini, kuma yawancin ƙwayoyin B dake cikin jininku dole ne a ƙayyade. CLL an gano shi ta wurin kasancewar akalla 5-nau'in B-kwayar cuta ta ml da jini, kuma sassan B dole ne su kasance "kofe" ko clones na wannan mummunar mahaifa. Wannan ake kira monoclonality.
Kwayoyin CLL sun buƙaci a jarraba su don ganin abin da yake a kan su. Suna iya samun nau'in alamun sunadarai ko alamar alama. Laboratories koma zuwa wadannan alamomin mai amfani ta yin amfani da harufan haruffan CD kuma biyan bayanan murya. A cikin CLL, kwayoyin suna iya samun alamar alama mai suna CD5, CD19, da kuma CD23 a saman su; Wasu suna da CD20, amma babu wanda ke CD10. A wasu lokuta, kana buƙatar samun wasu gwaje-gwajen da aka yi a banda gwajin jini, irin su biopsy yaduwar kwayar cutar ko kwayar halitta mai cin gashin jini-duk da haka, wannan ba labari ne na al'ada ba na ganowa na CLL.
CLL vs. MBL
Nazarin ya nuna cewa mutane 3 zuwa 5 cikin dari 40, lokacin da aka jarraba su tare da gwaje-gwaje masu gwaji, sun nuna yawan mutane na lymphocytes, kamar CLL. Wannan binciken ya haifar da samfurin ganewa na MBL, wanda aka dauke shi zuwa CLL.
Idan kana da ƙasa fiye da 5-nau'in B-daya, babu ƙumbadadden ƙumbaduwa kuma babu sauran alamun CLL, za a iya gano ku tare da ƙwayar B-lymphocytosis monoclonal (MBL). Wannan na kowa ne a cikin tsofaffi, kuma ba a ciwon daji ba tukuna. Ƙananan mutane da BML suna ci gaba da samar da CLL; duk da haka akwai yiwuwar, sabili da haka ana jiran shawarar jirage.
Ko da kuna da ganewar asali na CLL, hukuncin da za a bi da shi bazai kasance ƙarshe ƙaddamarwa ba. A baya, likitoci sun gaya wa masu lafiya tare da CLL cewa lokacin "jiran jiragen" ya kamata ya bi ganewar asali har sai cutar ta ci gaba, a lokacin da za'a fara farfadowa. Duk da yake wannan har yanzu yana iya kasancewa a lokuta da dama, akwai fahimtar fahimtar cewa lokuta daban-daban na CLL iya nuna hali daban, kuma wasu lokuta na CLL na iya kira don farfadowa da sauri.
Wani ɓangare na shirin da ku da likitanku zasu yi shine don sanin lokacin da magani don CLL ya fara. An yanke shawarar ne bisa ga alamun bayyanar CLL, sakamakon binciken gwaje-gwajen da kuma kima na daidaitawa. Don CLL, tsarin tsararwar Rai yana amfani da shi, daga Stage I zuwa Stage IV. Haka kuma akwai tsarin tsarin binet na CLL wanda ke ƙaddamar da matakan A, B, da C, amma ba amfani dashi don yanke shawarar lokacin da za a fara jiyya ba.
Doctors raba raƙuman Rai a cikin ƙananan, matsakaici, da kuma ƙananan haɗari lokacin da aka yanke shawarar zaɓuɓɓukan magani.
- Sashe na 0 ana daukar ƙananan hadarin.
- Sakamakon I da II ana daukar matsanancin hadarin.
- Matakan III da na IV suna dauke da haɗari.
Ga mutanen dake tare da CLL na RAI matakai na 0, I da II, yana yiwuwa yiwuwar magani ba za'a buƙata ba. Duk da haka, ga mutumin da ke fama da cutar ta farko da CLL mai aiki - alal misali tare da bayyanar cututtuka na CLL irin su gajiya mai tsanani ko zazzaɓi, daɗawar dare ko rashin asarar rashin nauyi - an shawarci magani.
Sauran dalilai tare da mataki suna la'akari da wasu lokuta lokacin kallon zaɓuɓɓukan magani. Abubuwan da ke hade da raƙuman lokacin sauƙi suna kiransa ƙananan dalilai masu ganewa, yayin da abubuwan da suka danganci tsawon rayuwarsu su ne abubuwan ƙwarewa masu kyau.
Wasu abubuwan da suka danganci kwayoyin cutar sankarar jini sune amfani da su: ZAP-70, CD38, da kuma ragowar mutun na IGHV don raba ka'idodin CLL zuwa ƙungiyoyi 2, da jinkirin girma da sauri. Mutanen da suke da hankali irin wannan CLL suna da rai kuma suna iya jinkirta jinkirin yin magani har ma.
Sauran maganin kulawa na CLL kullum sun fada cikin fannonin farfadowa irin su chemotherapy, maganin farfadowa, immunotherapy, immunomodulators, da steroids. Ba duk maganin da ya dace ba ga kowa da CLL. Da zarar likitoci suka koyi game da CLL daban-daban, ƙwarewar ƙwarewar musamman na iya zama daidai ga wasu lokuta CLL amma ba wasu.
Wasu hanyoyin kwantar da hankali suna bincike ne kuma zai iya zama mai sauki idan ka shiga gwaji. Bisa ga gwaji na asibiti, da zarar an tabbatar da farfadowa don lafiya da tasiri ga CLL, FDA ya amince da miyagun ƙwayoyi kuma ya zama mafi yawan samuwa.
Shekaru da kuma kiwon lafiya na gari sun zama mahimmanci a yayin da suke yanke shawara kan magani. Alal misali, wasu jiyya na farko na CLL za a iya sanya su a matsayin mafi dacewa ga ƙananan yara masu lafiya da CLL; wasu lokuta na farko da za a iya jiyya ko tsari zai iya zama mafi alhẽri ga wadanda suka tsufa ko kuma marasa lafiya.
Taimakon tallafi shine magani wanda ba zai warke ciwon daji ba amma yana so ya sa rayuwa tare da CLL mafi kyau a gare ku. Taimakon tallafi ya haɗa da abubuwa kamar maganin alurar rigakafi, fassarar jini, magungunan magunguna, har ma taimakawa tare da kulawa idan akwai likitoci daban daban.
Tsofaffi da AML
A cewar Cibiyar Cancer na Amurka, cutar cutar sankarar myeloid mai tsanani ita ce cutar ta tsofaffi kuma ba a sani ba kafin shekarun 45. Matsakaicin shekarun mai haƙuri tare da AML shine kusan shekara 67.
Alamun bayyanar AML suna da alaka da ƙananan jinin mutum. Lokacin da kwayoyin cutar sankarar bargo ke ɗauke da kasusuwa, sai suka tarwatsa kwayoyin jini, wanda ya haifar da karancin jini. Rashin jinin jini yana haifar da anemia da kuma alamun bayyanar kamar rauni da zama gaji sosai. Rashin farin jini yana haifar da neutropenia, mai yiwuwa tare da bayyanar cututtuka irin su zazzabi da kamuwa da cuta. Rashin gajerun plalets yana haifar da thrombocytopenia da bayyanar cututtuka irin su zubar da jini ko ƙyama . Kuma haɗuwa da waɗannan bayyanar cututtuka suna na kowa.
A cikin ganewar asali na AML, akwai irregularities a gwajin jini; Duk da haka, ba kamar bayyanar da aka gano na CLL ba, fatawar fata / biopsy yawanci ana buƙata don ganewa da kuma kimanta AML. Yawancin nau'o'in AML da yawa sun sani yanzu.
Bayan bayanan AML, tare da bangaren kula da lafiyar ku, ku ci gaba da fahimtar manufar farfadowa, da magunguna na jiyya. Kimanin rabin tsofaffin tsofaffin marasa lafiya na AML sun shiga cikin gyare-gyare bayan jiyya na farko, a cewar Cibiyar Cancer na Amurka. Mutanen da suka cimma cikakkiyar gyarawa sun inganta rayuwa mafi kyau idan aka kwatanta da marasa lafiya da suka karbi maganin farfadowa, watakila saboda rashin asibiti, karuwa, da maganin rigakafi. Masu sauraron AML na dogon lokaci suna wakilci a cikin dukkanin kungiyoyi; duk da haka, sake komawa baya bayan farfadowa na farko yana da yawa. Sau da yawa, marasa lafiya da AML suna ƙarfafa su shiga cikin gwaje-gwaje na asibiti domin su sami damar samun sababbin hanyoyin kwantar da hankulansu da kuma haɗaka tare da fatan inganta yanayin su.
Ga masu tsofaffin marasa lafiya wadanda suka kasance marasa lafiya ko kuma in ba haka ba ba su da lafiya, ko kuma suna da talauci na jiki, wani lokacin taimako da / ko žananan likitan ƙwayar cuta ne aka zaɓa. Taimakon tallafi ya hada da fassarar jini, maganin rigakafi, da sauran magunguna da ke taimakawa lafiyar mutum amma ba su kawar da ciwon daji ba.
> Sources:
> Ƙungiyar Amirka ta Harkokin Halitta. Jiyya na marasa lafiya marasa lafiya da myeloid cutar sankarar bargo.
> Chiorazzi N, Rai K, Ferrarini M. Chronic Lymhocytic cutar sankarar bargo. N Engl J Med. 2005; 352: 804-15.
> Sharuɗɗan NCCN. Kwawon cutar sankarar Lymphocytic na yau da kullum. Shafin 1. 2016.