Irin Irin Ciwon Cutar Blood Yafi Karuwa A Cikin Tsofaffi
Murawon cutar sankarar myeloid mai tsanani (AML) shine irin ciwon daji da ke farawa a cikin kasusuwa na kasusuwa inda aka samar da jini sannan kuma motsawa zuwa cikin jikin jini. Daga can, ciwon daji zai iya yadawa zuwa wasu sassan jiki ciki har da hanta, sutura, fata, kwakwalwa, da kuma kashin baya.
AML tana shafar kusan mutane miliyan daya a kowace shekara kuma yana kaiwa ga mutuwar mutane 150,000.
A {asar Amirka kadai, a tsakanin shekaru 10,000 zuwa 18,000 ana bincikar su kowace shekara.
Ba kamar sauran cututtuka na cutar sankarar bargo ba , wanda ke da tayar da yara, AML yana shafar shekaru 65. Yawancin shekarun wannan shekara, tsawon shekaru biyar yana da matukar talauci, kuma yana kusa da kashi biyar kawai. Cutar da yawa a cikin matasa ya fi dacewa da ko'ina daga kashi 25 zuwa kashi 70 cikin dari don samun cikakkiyar gyarawa bayan yaduwar cutar.
Abubuwa da ke fama da cutar
Lukurmin sankara ne wata ƙungiya daban-daban na cututtuka da ke shafar kyallen jini da jini da kansu. Yayinda cutar ta fi rinjaye yawan jini , wasu nau'i na cutar sun kai hari kan wasu nau'in tantanin halitta.
A cikin yanayin AML, ana amfani da kalmar "m" saboda ciwon daji ke ci gaba da sauri, yayin da "myeloid" yana nufin ɓangaren kasusuwa da ƙananan jini wanda kwayar nama ta haifar.
AML tasowa a cikin wani jini marar jini wanda aka sani da myeloblast.
Waɗannan su ne kwayoyin da, a cikin yanayi na al'ada, zasu yi girma cikin cikakkun jini kamar jini ko grancy . Duk da haka, tare da AML, ƙwayoyin ƙwaƙwalwar ƙwaƙwalwa za su zama "daskararre" a cikin mummunan yanayin amma suna ci gaba da ninkawa marar kyau.
Ba kamar sauran kwayoyin da ke da kayyadadden ƙwayar rai ba, kwayoyin ciwon daji sune "m" kuma za su ci gaba da yin jayayya ba tare da iyaka ba.
Tare da AML, kwayoyin jini masu yaduwa za su iya fitowa daga al'ada kuma har ma suna tsangwama tare da ci gaba da sabon jini jini, jini na jini (erythrocytes), da plalets ( thrombocytes ).
AML ba kamar ɗan uwansa ba ne cutar tawon jini sankarar lymphocytic (ALL) wanda ke shafar wani nau'in jini na jini wanda aka sani da lymphocyte . Yayinda AML ke shafar tsofaffi, tsofaffin yara sukan kai yara tsakanin shekaru biyu da biyar.
Alamomin farko da cututtukan cututtuka
Alamar bayyanar AML tana da alaka da kawar da kwayoyin jini na al'ada ta hanyar ƙwayoyin cuta. Rashin jinin jini na yau da kullum zai iya barin mutumin da zai iya kamuwa da kamuwa da cuta da sauran cututtuka da jikin zai iya hana.
Ta hanyar zane, jinsin jinin fararen tsakiya na tsakiya ne ga tsarin rigakafi. Kwayoyin jini, da bambanci, suna da alhakin ɗauke da oxygen zuwa kuma cire carbon dioxide daga kyallen takalma, yayin da platelets suna da mahimmanci ga jini jini.
Rushewar wani daga cikin wadannan kwayoyin halitta zai iya haifar da kwatsam na bayyanar cututtuka, sau da yawa wadanda basu da ƙwarewa da wuya a gane asali. Misalan sun haɗa da:
- Rashin jinin jini yana iya ƙara haɗarin cututtukan da ba zai tafi ba. Wadannan sun hada da bayyanar cututtuka da suka shafi rashin leukocytes (leukopenia) ko neutrophils ( neutropenia ).
- Rashin jinin jinin zai iya haifar da anemia wanda zai iya nuna tare da alamu na gajiya, kwarewa, rashin ƙarfin numfashi, ciwon kai, damuwa, da rauni.
- Rashin gajerun plalets zai iya haifar da thrombocytopenia da ci gaba da zubar da zubar da jini, ƙetare ko zubar da jini, ko ƙananan hanci.
Daga baya Stage Symptoms
Yayin da cutar ta ci gaba, wasu, karin bayyanar cututtuka na iya fara farawa. Saboda cututtukan sankarar bargo sun fi girma fiye da kodoyin jini na yau da kullum, sun fi dacewa su kasance a cikin ƙananan ƙwayoyin tsarin sigina ko kuma su tattara wasu gabobin jiki.
Dangane da inda wuri ya faru, mutum zai iya fuskanta:
- Chloromas , mai tarin kwayoyin halitta wanda zai iya zama cikin, a madadin, wani nau'i mai kama da ƙwayar waje a cikin kututtukan kasusuwa, raguwa mai kamala, ko kuma zubar da jin zafi da ƙumburi na gumisai
- Leukostasis , wani gaggawa na gaggawa wanda rikici zai iya haifar da bayyanar cututtuka kama da bugun jini
- Dama na ciwo , mai raɗaɗi mai laushi mai raɗaɗi yana fitowa a kan makamai, kai, kafafu, da akwati
- Sikakken ɓacin hankali (DVT) wanda za'a iya katange jikin, mafi sau da yawa a cikin kafa
- Abolism na Pulmonary (PE) , da rikici da wani maganin cikin huhu
- Tsomawa na ciki saboda tarawar kwayoyin halitta a cikin mahaifa da hanta
- Maganin cutar sankarar barji wanda ke nuna rashin lafiya mai tsanani irin su ciwon kai, zubar da jini, hangen nesa, kullun, matsala da daidaitawa,
Mafi mahimmanci, AML zai iya rinjayar kodan, ƙwayoyin lymph, idanu, ko kuma kwayoyin.
Dalili da Dalili Dama
Akwai lambobin haɗari masu dangantaka da AML. Duk da haka, samun daya ko ma da dama daga cikin waɗannan dalilai ba yana nufin cewa za ku sami cutar sankarar bargo ba. Har zuwa yau, har yanzu ba mu fahimci cikakken dalilin da yasa wasu kwayoyin za su juya rikici ba yayin da wasu ba suyi ba.
Abin da muka sani shi ne cewa cutar cututtuka ta haifar da kuskure ne na coding wanda zai iya faruwa a wani lokaci yayin da tantanin halitta ya rabu. Muna koma zuwa wannan a matsayin maye gurbin. Duk da yake mafi yawan maye gurbin bazai kai ga ciwon daji ba, akwai lokutan da kuskure zai "kashe" wani abu da ake kira ɓacin murfin tumo wanda ya nuna tsawon lokacin da kwayar halitta ke rayuwa. Idan wannan ya faru, ɓangaren mahaukaci zai iya zamewa daga cikin iko ba zato ba tsammani.
Akwai lambobin haɗari masu dangantaka da wannan:
- Shan taba
- Hanyoyin sana'a masu amfani da sunadaran, musamman ga benzene
- Wasu cututtukan shan magani na ciwon daji da suka hada da cyclophosphamide , mechlorethamine, procarbazine, chlorambucil, melphalan, busulfan, carmustine, cisplatin, da carboplatin
- High radiation watsawa, irin su tare da ciwon daji radiotherapy
- Samun wasu cututtukan jini na yau da kullum irin su cutar myeloproliferative (MPS) ko kuma myelodysplastic syndromes (MDS)
- Samun wasu cututtuka irin su Down syndrome , Fanconi anemia , da kuma neurofibromatosis type 1
Don dalilan da ba a sani ba, maza suna da kashi 67 cikin 100 na iya samun AML fiye da mata.
Sanin asali
Idan ana zargin AML, zanewar asali zai fara ne tare da jarrabawar jiki da kuma nazarin likita da tarihin iyali. A lokacin jarraba, likita zai kula da alamun da ake yi kamar yalwatawa, zub da jini, kamuwa da cuta, ko kuma duk wani abu marar kyau na idanu, baki, hanta, yaduwa, ko ƙwayar lymph. Za a yi cikakken ƙididdigar jini (CBC) don gano duk wani mummunan abu a cikin jini.
Bisa ga waɗannan binciken, likita na iya yin umarni da yawa gwaje-gwaje don tabbatar da ganewar asali. Wadannan sun haɗa da:
- Maƙarar da aka yi wa fata wanda ake saɓo ɓawon ɓawon nama ta hanyar sa wani dogon dogon a cikin kashi, yawanci a kusa da hip
- Kwayar da aka yi wa maniyyi wanda aka sanya babban allura mai zurfi a cikin kashi don cire kwayoyin
- Lumbar puncture ( tabarka ta tsakiya) wanda an saka kananan ƙwayar tsakanin kasusuwa na kashin kashin baya don cire ruwan sanyi (CSF )
- Gwaje-gwaje-gwaje irin su X-ray, duban dan tayi, ko lissafin rubutu (CT )
- Ruwan jini na jini wanda aka bincika jini a ƙarƙashin microscope, yawanci da ƙyamar cewa ba wai kawai sa ido akan kwayoyin cutar sankarar bargo ba amma taimakawa tsakanin bambancin AML da ALL
- Gudun hanyoyi masu gujewa wanda ake amfani da sunadarai masu karewa, wanda ake kira AMD antibodies, a cikin jini ko samfurin CSF don tabbatar da kasancewa a cikin sel
- Cytogenetics inda kwayoyin cutar cutar sankarar suna "girma" a cikin lab kuma an yi nazarin su a karkashin na'urar ƙwararrakin lantarki don gane ƙayyadaddun tsari ta hanyar alamarsu ta chromosomal
Tsarin
Ana yin gyaran maganin canji domin sanin ƙimar da ciwon daji ya yada. Wannan, bi da bi, yana taimaka wa likita ya ƙayyade hanya mai dacewa don kulawa don kada mutumin ya damu ko kuma ya dame shi. Hanya na taimakawa wajen hango ko yaya tsawon rai zai iya tsira bayan magani.
Domin AML ba ya haɗa da samuwar mummunar ciwon da aka gani a wasu nau'o'in ciwon daji, baza a iya daidaita shi da tsari na TNM (ƙwayoyin tumo / lymph node / malignancy ) ba.
Akwai hanyoyi daban-daban guda biyu a yanzu suna amfani da su na AML: Faransanci na Faransanci da Birtaniya (FAB) na AML da Kungiyar Lafiya ta Duniya (WHO) ta AML.
Fax Classification
An kirkiro jinsin Faransanci-Amurka-Birtaniya (FAB) a cikin shekarun 1970s kuma ya haifar da cutar dangane da irin nauyin kwayar halitta.
Dalilin da ake yi don daidaitawa abu ne mai sauƙi: AML zai bi misali wanda ƙananan mahaifa su ne farkon kwayoyin da za a shafa. Yayin da cutar ta ci gaba, zai fara rinjayar mahaifa a cikin matakai na baya na maturation sannan kuma ci gaba zuwa girma kwayoyin jini (kamar monocytes da eosinophils) kafin motsi zuwa kwayoyin jini (erythrocytes) da kuma karshe megakaryoblasts
Wannan cigaba zai samar da bayanin da ake bukata don sanin yadda ciwon daji ke ci gaba.
FAB ta fara sauti daga M0 (don AML farko) zuwa M7 (don AML mafi girma) kamar haka:
- M0: ƙananan cutar sankarar sankarar myeloblastic
- M1: m cutar da cutar sankarar myeloblastic mai tsanani
- M2: myeloblastic cutar sankarar bargo tare da maturation
- M3: m mai yaduwar cutar sankarar jini
- M4: m cutar da cutar sankarar myelomonocytic
- M4 eos: cututtukan cutar sankarar bargo tare da eosinophilia
- M5: karar cutar sankarar monocytic
- M6: cutar mai sankarar erythrocytic mai tsanani
- M7: m miyagaryoblastic cutar sankarar bargo
Kungiyar WHO
Ƙungiyar Lafiya ta Duniya ta ƙaddamar da sabuwar hanyar tsara AML a shekarar 2008. Ba kamar tsarin FAB ba, ƙungiyar WHO ta ɗauka la'akari da wasu maye gurbin da aka samu a lokacin bincike na cytogenetic. Har ila yau yana da nasaba cikin yanayin kiwon lafiya wanda zai iya inganta ko kuma kara tsananta yanayin da mutum ya shafa.
Cibiyar WHO tana da karfin gaske a cikin bincikenta na cutar kuma za'a iya karya shi kamar haka:
- AML tare da magungunan kwayoyin maimaitawa (ma'anar ma'anarta, halayyar dabi'a)
- AML tare da canje-canje na myelodysplasia (ma'ana ma'anar MDS, MDP, ko wasu ƙananan cuta)
- Far-related myeloid neoplasms (ma'ana alaka da kafin chemotherapy ko radiation far)
- Sarcoma myeloid (ma'anar AML tare da chloroma)
- Maganin ƙwayoyin cuta da aka danganta da Down syndrome
- Blastic plasmacytoid dendritic cell neoplasm (wani m irin ciwon daji halin fata raunuka)
- AML ba tareda rarraba (ainihin tsarin FAB guda bakwai tare da ƙarin ƙwayoyin cuta biyu)
Jiyya
Idan aka bincikar da AML, nauyin da tsawon lokacin jiyya za a ƙaddara ta hanyar mataki na ciwon daji da lafiyar lafiyar mutum.
Yawancin magana, magani zai fara da chemotherapy. Wannan na iya haɗa da kwayoyin tsara tsofaffin kwayoyi wanda zasu iya rinjayar duka kwayoyin cuta da kwayoyin cutar da ba wanda ba zai yiwu ba kuma sababbin sababbin kwayoyin da aka yi niyyar amfani da kwayoyi wanda ba sa a cikin kwayoyin cutar kankara kawai.
Anyi amfani da tsarin tsabtace chemotherapy a matsayin "7 + 3" saboda an ba da magani mai cututtukan da ake kira cytarabine a matsayin jigilar jini (IV) mai ci gaba a cikin kwana bakwai da biye bayan kwana uku na wani magani da aka sani da anthracycline . Har zuwa kashi 70 cikin dari na mutanen da ke tare da AML zasu sami gafara bayan "7 + 3" farfadowa.
Da wannan aka ce, ƙananan ƙwayoyin cutar sankarar bargo za su iya kasancewa bin chemotherapy, wanda zai haifar da komawa cikin mafi yawan lokuta. Don guje wa wannan, likitoci zasu rubuta labaran da ke gudana bisa ga sakamakon bayanan likita da yanayin kiwon lafiya.
A cikin mutanen da ke da alamun bincike masu kyau, magani zai iya haɗawa da uku zuwa biyar nau'o'in ƙwayar cuta mai kisa, wanda aka kira shi chemotherapy.
Ga wadanda ke da haɗari na haɗuwa, wasu, ana iya buƙatar magunguna mafi tsanani ciki har da suturar suturar sutura idan an samu mai bayarwa. Kadan ƙari, tiyata ko radiation far kuma iya bada shawarar.
Saboda AML chemotherapy yana da tsayin dakawa wajen kawar da mummunan cututtuka, marasa lafiya marasa lafiya bazai iya jurewa magani ba kuma ana iya ba su ƙanƙancin chemo ko kulawa mai mahimmanci .
Survival
Halin da ake ciki ga mutumin da ya kamu da magani na AML zai iya bambanta da yawa bisa ga tsarin ciwon daji a lokacin ganewar asali. Amma, akwai wasu dalilai da zasu iya hango tunanin yiwuwar sakamako. Tsakanin su:
- Mutanen da aka bincikar da MDS da MPD suna da lokacin rayuwa daga jere tara zuwa 11,8 shekaru dangane da mummunar matsalar.
- Wasu maye gurbin chromosomal da aka gano ta hanyar cytogenetics zai iya haifar da adadin shekaru biyar na rayuwa kamar yadda kaso 15 cikin dari zuwa kashi 70 cikin dari.
- Mutane fiye da 60 wadanda suka kamu da launi na dehydrogenase (nuna yawan lalacewar nama) kullum suna da mummunan sakamako.
Yawanci, yawan magani na AML shine tsakanin kashi 20 da kashi 45 cikin dari. Yawancin tsaran kudi na tallafawa sun kasance mafi girma a cikin ƙananan yara waɗanda suka fi iya magance magani.
Kalma Daga
Idan an gano ku tare da AML, za ku fuskanci kalubale na tunani da na jiki wanda zai iya wahala don shawo kan ku. Kada ku tafi shi kadai. Za ku ci gaba da samun nasara idan kun gina cibiyar sadarwa ta tallafawa ƙaunatattunku, likitoci na kiwon lafiya, da sauransu waɗanda suka wuce ko kuma suna shan magani.
Ko da bayan da aka samu magani, jin tsoro game da sake dawowa zai iya jurewa har tsawon watanni ko ma shekaru. Tare da goyon baya, za ka iya magance wadannan damuwa kuma ka koyi don kula da lafiyarka tare da ziyarar likita ta yau da kullum. Kullum magana, idan sake dawowa bai faru a cikin 'yan shekarun nan ba, watakila AML ba zata dawo ba.
Duk da yake babu wani abin da za ku iya dauka don hana sake dawowa, salon sa mai kyau yana iya inganta ƙimarku. Wannan ya hada da bada kyakkyawan halaye na cin abinci, yin motsawa akai-akai, dakatar da shan taba, da kuma samun hutawa sosai don kauce wa wahala da gajiya.
A ƙarshe, yana da muhimmanci a dauki abubuwa a rana ɗaya kuma a sami wani wanda zaka iya juyawa idan kana bukatar goyan baya.
> Sources:
> Cibiyar Ciwon Ƙwayar Yammacin Amirka. "Tasirin Tattalin Arziki ga Myelodysplastic Syndromes." Washington, DC; sabunta Janairu 22, 2018.
> De Kouchenovsky, da ni da Abdul Hay, M. "Murar cutar sankarar mireloid mai tsanani: cikakken nazari da 2016 sabuntawa." Blood Can J. 2016; 6; e441.
> Döhner, H .; Weisdorf, D .; da kuma Bloomfield, C. "Murar cutar sankarar myeloid m." New Engl J Med . 2015; 373 (12): 1136-52. DOI: 10.1056 / NEJMra1406184.