Akwai matsaloli masu yawa ga cimma kyakkyawan kulawa ga ciwon daji na prostate . Da farko, kamar yadda za mu gani a ƙarshen wannan labarin, ciwon gurguwar ƙwayar cuta abu ne mai mahimmanci, wanda ke nufin ƙaddara mafi dacewa farfesa zai iya zama mai rikitarwa. Na biyu, yawan abin da ba a iya tsarawa da kuma bayanan da ke cikin yanar-gizon yana da matukar damuwa da kuma wanda ba a iya sarrafa shi ba. Doctors , bari marasa lafiya, su zama mamaye.
Na uku, lokaci-lokaci tsakanin marasa lafiya da likitoci na ci gaba da raguwa saboda fadada manyan kasuwancin da gwamnati a cikin kulawa. A kan waɗannan matsalolin, la'akari da yadda kusan likitoci ba kwarewa a zaɓin magani . Suna kawai kwarewa a ko dai tiyata ko radiation, saboda haka yanke shawara tsari ya bar wa haƙuri.
Ya Kamata Majibinci Su Yi Umurnin Zaɓin Shirin Guda?
Ma'aikatan da ke kula da marasa lafiya na prostate suna kula da iyakokin da aka lissafa a sama. Kuma sun gane akwai wasu matsaloli. Na farko shi ne cewa likitoci suna da babbar rikici na sha'awa. An biya su ne kawai don gudanar da wani nau'i guda ɗaya kawai, aikin tiyata ko radiation . A sakamakon haka, suna da karfin bayar da shawarwari masu karfi. Sau nawa ne marasa lafiya sun ji daga likitansu, "Kana buƙatar zama wanda ya yanke shawara"?
Abu na biyu, zancen muhimmancin ciwon daji ya kamu da cutar ta hanyar ciwon ciwon gurguntaccen mahaifa.
Ya ɗauki shekaru goma don tasiri na shawarar yanke shawara don a gane. Sanarwar ta kara tsanantawa da tsofaffi tsofaffi na marasa lafiya na prostate. Rashin mutuwa daga tsofaffi yana da haɗari mafi girma fiye da ciwon daji kanta. A ƙarshe, a cikin yanayin wannan ciwon daji, mai ciwo mai saurin girma, tasirin magani a kan kyawawan abubuwan rayuwa kamar ƙazanta ko rashin tabbas-na iya zama mafi girma fiye da tasiri akan rayuwa.
Wanne ne mafi kyau matsayi don daidaita ma'auni mai kyau na rayuwa tare da rayuwa fiye da mai haƙuri?
Sanin Matakanku
Kasancewa a cikin tsari na zaɓin magani shine sabili da haka marasa lafiya marasa lafiya na prostate. Zaɓin magani yana shawo kan yanayin ciwon daji, shekarun mai haƙuri, da kuma manufofin sa-rai. A sakamakon haka, sanin ciwon ciwon daji yana da mahimmanci:
- Ya rage adadin maganin warkewa kuma ya kawar da bukatar buƙata ta hanyar yawancin bayanai maras muhimmanci.
- Yana inganta likitancin likita. Doctors za su iya tsallake bayanan da suka dace game da mataki kuma su tsallake zuwa dama don tattaunawar da aka kwatanta game da maganin da aka fi amfani dasu a kan ƙaddamarwa na musamman.
- Hanyar da ta fi dacewa don samun cikakken hangen nesa game da hadarin ciwon daji da kuma gaggawa (ko rashin shi) don ƙarin magani mai tsanani (duba ƙasa).
Hanya guda biyar na Blue
Akwai matakai guda biyar na ciwon daji na ƙwayar cuta - Sky, Teal, Azure, Indigo, Royal -achine da ke dauke da ƙananan subtypes guda uku da ake kira Low, Basic and High , domin cikakkun matakan 15. Matakan farko na farko, Sky, Teal, da Azure , sun kasance daidai da nau'in haɗari na ƙasƙancin Low, Intermediate, da kuma cututtuka masu girma wanda Anthony D'Amico na Harvard Medical School ya bunkasa.
Indigo da Royal suna wakiltar ci gaba da ci gaba da ciwon ciwon gurbi , haka nan. Akwai wasu lokuta masu yawa, amma duk suna da raunana. Sai kawai Sakamakon Blue yana wakiltar cikewar ciwon ƙwayar cutar ciwon gurgu.
Rashin Hadarin Mutuwa daga Ciwon Cutar Canjin
Ɗaya daga cikin mafi yawan amfanin da ake da shi shi ne cewa yana ba da hankali game da mummunar cutar, wanda shine daya daga cikin muhimman abubuwan da zasu yanke shawara mafi kyau. Muhimmancin jiyya ya kamata a fara tare da mummunar cutar. Magunguna marasa lafiya sun cancanci magani mai kyau. Magungunan cututtuka suna buƙatar ci gaba mai tsanani.
Rashin jurewar maganin sakamako na rashin lafiya ba zai iya yarda ba idan ciwon daji ke da sauƙi, yayin da za a iya karɓan sakamako mai yawa idan cutar ta barazana ta rayuwa. Table na 1 ya nuna yadda yawancin mace ke mutuwa tsakanin matakai.
Table na 1: Hadarin Mutuwa Da Matakan
Sashe na Blue | Degree of Treatment Intensiveity Recommended | Hadarin na Mutuwa | % of Newly-Diagnosed per Stage |
Sky | Babu | <1% | 50% |
Teal | Matsakaici | 2% | 30% |
Azure | M | 5% | 10% |
Indigo | Mod. Don Max. | <50% | 0% |
Royal | M | > 50% | 10% |
Muhimmiyar mahimmanci: Tebur a sama ya nuna cewa matsayi na ƙarfin jiyya ya bada shawarar don kashi 80 cikin dari na maza da suka kamu da cutar ( Sky da Teal ) ko dai a matsakaici ko babu.
Lokaci na Mutuwa Daga Ciwon Ciwon Ƙari
Ciwon daji na ƙwayar cuta yana nuna bambanci daga wasu cututtuka, musamman a yadda sannu a hankali yake girma. Alal misali, ƙwayar cuta daga ciwon huhu na huhu ko ciwon cizon sauro zai iya faruwa a cikin shekarar farko na ganewar asali. Sanarwarmu da irin wannan ciwon daji ya nuna dalilin da ya sa kalmar nan "ciwon daji" ta haifar da damuwa sosai. Ciwon daji, muna tsammanin, yayi daidai da mutuwa. Amma duba yadda lissafin da ke Table 2 ya nuna yadda bambancin ciwon daji ke nunawa.
Table 2: Taruwar Survival na Newly-Diagnosed Ciwon Ƙari Ciwo
Taruwar Survival | Kwanan asali na ganewar asali | |
5 Shekara | 99% | 2012 |
10 Shekara | 98% | 2007 |
15 Shekara | 94% | 2002 |
Fiye da shekaru 15 | 86% | Ƙarshen shekarun 1990s |
Ka yi la'akari da cewa za a iya ƙayyadad da yawan zafin rayuwa ta hanyar sassaucin lokaci; Ana iya lissafin mace mai shekaru 10 kawai a cikin mutanen da aka gano a baya a 2007, kuma ta hanyar yau, farfadowa baya bayanan. Saboda haka, kididdigar rayuwa da ke dogara da fasahar tsofaffi ba zata wakilci yiwuwar mai haƙuri da ke shan magani a yau. Za'a ci gaba da samun sauƙi tare da lokaci, kuma, idan akwai wani abu, maza masu fama da ciwon gurguwar karuwanci na da lokaci.
Sauran Tsarin Gudanarwar Ba Su Kammala
Lokacin da mutane suka tambayi likitocin su, "Wane mataki ne ni?" Sun saba da cewa akwai hanyoyi masu yawa daban daban. Bari mu yi nazarin taƙaitaccen tsarin sauran tsarin:
- Ƙwararren ƙwayar cuta (A, B, C, da D) ya danganta da yadda ake jin ƙuƙwalwar ƙwayar cutar a kan jarrabawar kwayoyi (DRE). An tsara wannan tsarin kafin a ƙirƙiri PSA kuma likitoci sunyi amfani dashi don sanin idan an yarda da aikin mai karuwanci (Dubi Table 3).
- Tsarin maganin matsalolin ya shafi dangantaka da ciwon daji da aka ƙayyade ta hanyar tiyata ko ta biopsy.
- TNM Staging ya ƙunshi bayanin daga duka 1 da 2 tare da bayanan da aka samo daga ƙuƙwalwar ƙwayar ko CT ta duba.
- Yanayin jadawalin yanayin, wanda ke raba sababbin mutanen da aka bincikar da su zuwa ƙananan, matsakaici, da ƙananan haɗari, yana amfani da bayanan daga 1 da 2 tare da matakin PSA.
Tableau 3: Sashen Kasuwanci (DRE Stage)
Stage | Bayani |
T1 : | Tumo da DRE ba za a iya ji ba |
T2 : | Tumo da aka tsare a cikin prostate T2a: Tumo a <50% na lobe daya T2b: Tumor a cikin> 50% na daya lobe amma ba duka lobes T2c: Tumo ji a cikin duka lobes |
T3 : | Tumo wanda ya karu ta hanyar gurguwar prostate T3a: Extracapsular extension T3b: Tumatir da ke shiga cikin jigilar kwayoyin halitta (s) |
T4 : | Tumo wanda ya shiga cikin dubun magunguna ko mafitsara |
Mawallafi na Tsarin Blue
Tsarin Blue tsarin yana amfani da dukkanin tsarin tsarin (1, 2, 3 da 4 da aka lissafa a sama), kuma ya ƙunshi bayanin game da ko tiyata ko aikin rigakafi na baya.
- Binciken gyare-gyare na tauraron sharuddan: Kullum tare da nodule vs. mass
- Gleason score : 6 vs. 7 vs. 8-10
- PSA: <10 vs. 10-20 vs. fiye da 20
- Tashin kwayoyin halitta: Ƙananan vs. wani matsakaici mai yawa vs. mutane da yawa
- Na farko farfado: A'a vs. a'a
- Hoto: Tsarin cuta, ko a cikin ƙwayar lymph ko kasusuwa
Zaka iya ƙayyade mataki a kan layi a shafin yanar gizon PCRI ta hanyar amsa tambayoyin ɗan gajeren lokaci a stagingprostatecancer.org.
Mene ne Ba daidai ba Tare da Tsarin Kasuwancin Yanayi?
Tsarin tsarin ladabi na haɗari, wadda aka gina ta uku da aka tsara a cikin jerin samfurin da aka sama a sama, ba ya haɗa da abubuwa da yawa masu muhimmanci wadanda suka inganta ingantaccen daidaitawa:
- Binciken Multiparametric-MRI
- Yawan yawan kwayoyin halittun dake dauke da ciwon daji
- PET duba bayanai
A saman wannan, tsarin tsarin hadarin ba ya haɗa da maza da suka sake komawa cutar, maza da juriya na hormone, ko maza da matakan da ke cikin kasusuwa.
Da zarar ka san matakinka, wane magani ne mafi kyau?
Babban darajar sanin matakin mutum shi ne cewa yana ba marasa lafiya da likitoci damar zama a cikin mafi kyawun zabin maganin. A cikin ragowar wannan labarin, ana gabatar da wasu samfurori na musamman don magance kowane mataki.
Sky
Tun da Sky (Low-Risk) wani abu ne mai banƙyama, kuma tun da yanzu mun sani cewa Gleason 6 bai taba yin amfani da shi ba, suna lakabi shi "ciwon daji" shi ne cikakkiyar kuskure. Da kyau, Sky za a kira shi a matsayin ciwon daji maimakon ƙwayar ciwon daji. Saboda haka, dukkanin bambancin uku na Sky , ( Low, Basic and High) ana gudanar tare da kulawar aiki. Babban haɗari ga maza a cikin Sky shine rashin gazawar gano mummunan cututtuka na wulakanci. Sabili da haka yin nazari tare da MRI multiparametric a cibiyar da ke fama da cututtuka yana da hankali.
Teal
Tsarin (Matsakaici-Matsakaici) wani yanayi ne mai ƙananan yanayi tare da kyakkyawar tsayayyen rayuwa. Duk da haka, yawanci mutane suna buƙatar magani. Banda shine Low-Teal , wanda ake sa ido mai kulawa. Don samun cancanta a matsayin Low-Teal da Gleason dole ne 3 + 4 = 7, ba 4 + 3 = 7, yawan maki 4 a cikin biopsy dole ne kasa da kashi 20, kawai 3 ko kadan kwayoyin biopsy zasu iya ƙunsar ciwon daji, babu mabukaci zai iya zama fiye da kashi 50 cikin maye gurbin da ciwon daji, kuma sauran abubuwan da aka gano zasu kasance kamar Sky .
Basic-Teal yana da ƙari fiye da 50 a yanzu. Maza tare da Basic-Teal su ne 'yan takara masu dacewa don farfadowa tare da kusan dukkanin magunguna na yau da kullum, ciki har da saitunan iri, IMRT, Protonrapy, SBRT, maganin hormone, da kuma tiyata.
High-Teal ya ƙunshi kowane nau'i na ma'auni don mai haƙuri wanda ba zai dace ba a cikin Ƙananan ko Ƙari . High-Teal ne mafi muni kuma ya kamata a bi da ita tare da haɗin haɗuwa wanda ya hada da IMRT, tsaba, da kuma jigilar ka'idar hormone hudu zuwa shida.
Azure
Azure (Babban Haɗari) yana ƙunshe da subtypes guda uku. Low-Azure ne Gleason 4 + 4 = 8 tare da ƙwayoyin biopsy mai kyau biyu ko kadan, babu kwayar halittu fiye da 50% da ciwon daji, da sauran abubuwan kamar Sky . Maza tare da Low-Azure suna bi da hanyar kamar High-Teal.
Basic-Azure shine mafi yawan irin Azure kuma ya wakiltar wani abu a cikin Azure category wanda ya kasa cika ka'idodin Low ko High . Basic-Azure ana bi da shi tare da radiation, tsaba, da kuma maganin hormone na watanni 18.
Babban Azure an bayyana a matsayin daya ko fiye daga cikin wadannan: PSA fiye da 40, Gleason 9 ko 10, fiye da kashi 50 na kwayoyin biopsy, ko ciwon daji a cikin ƙwayar salula ko ƙwayoyin pelvic. High-Azure ana bi da shi a matsayin Basic-Azure, ko da yake yiwu tare da Bugu da ƙari na Zytiga, Xtandi, ko Taxotere.
Indigo
An bayyana Indigo a matsayin sake dawowa da ciwon daji bayan ta tiyata ko radiation. Ko Indigo ne Low, Basic ko High an ƙaddara ta hanyar yiwuwar ciwon daji ya yadu cikin kwakwalwan pelvic. Low-Indigo yana nufin haɗarin yana da ƙasa. Don samun cancantar Low-Indigo, PSA ya zama <0.5 bayan aikin tiyata ko kuma <5.0 bayan radiation ta baya. Har ila yau, dole ne lokacin jinkirin PSA ya zama watanni 8. Bugu da kari, Stage na Blue kafin aikin tiyata ko radiation ya kasance Sky ko Teal . Jiyya ga Low-Indigo na iya kunshi radiation (bayan an tilastawa tiyata) ko adana cryotherapy (bayan radiation ta baya).
Basic-Indigo na nufin cewa binciken da kuma binciken bincike bai nuna ba kwayoyin halitta ba (wanda aka sani da kayan aiki), amma sharuɗɗa masu kyau waɗanda aka ambata a sama don Low-Indigo basu da kyau. A wasu kalmomi, daya ko fiye daga wasu dalilai da dama sun nuna cewa zanen microvopic pelvic zai iya kasancewa. Don Basic-Indigo , m hade tare da radiation zuwa ga pelvic nodes da magani hormonal ya kamata a yi amfani.
High-Indigo yana nufin sauti suna tabbatar da wanzu a cikin ƙananan ƙwayoyin lymph. Kula da High-Indigo daidai yake da Asali - Indigo sai dai ƙarin farfado da Zytiga, Xtandi, ko Taxotere za a iya la'akari.
Royal
Mutum a cikin Royal suna da jigilar hanzari (wani PSA mai tashi tare da low testosterone) ko metastases a bayan ko a waje da ƙananan ƙuƙwalwa (ko duka biyu). Low-Royal yana da tsayayyen hormone "ba tare da wani matakan da aka gano ba. Wadannan mutane kusan lokuta suna da ƙananan cututtukan cututtuka amma bazai yiwu ba su gane da kashi mai kyau ko CT. Sabo, za a iya buƙatar PET mai karfin iko irin su Axumin, PSMA, ko Carbon 11 don neman metastases. Da zarar an samo ganyayyaki, magani zai kasance daidai da Basic-Royal .
Basic-Royal shi ne rashin daidaituwa na rashin lafiya (a waje da ƙashin ƙugu) amma yawan adadin metastases biyar ne ko ƙasa. Jiyya don Basic-Royal ne hade da SBRT ko IMRT zuwa duk shafukan da aka sani da cutar, Provenge immunotherapy, da Zytiga ko Xtandi.
High-Royal yana nufin cewa an gano fiye da biyar metastases . SBRT ko IMRT tare da yawancin ƙwayoyin sadarwar da ba su da amfani. Lokacin da cutar ba ta ci gaba da sauri ko mai raɗaɗi, magani ya kunshi Provenge da Zytiga ko Xtandi suka biyo baya. Ya kamata a kula da mummunar cuta ko kuma ci gaba da sauri tare da Taxotere.
> Sources:
> Aminiya, Anthony V., et al. "Tsarin binciken da aka samo asali na adenocarcinoma na asibiti na prostate." Jaridar urology 158.4 (1997): 1422-1426.
> Frank, Steven J., et al. "Tsarin lokaci na biyu gwajin gwaji na dindindin da ake ginawa prostate brachytherapy ga matsanancin haɗari na ciwon ciwon gurguwar karuwanci: inganci, guba, da kuma kyakkyawan sakamakon rayuwa." Littafin Labaran Lafiya na Labaran Duniya * Biology * Physics (2017).
> Labaran Labaran Ciwon Kankara 2017. https://www.cancer.net/cancer-types/prostate-cancer/statistics
> Sylvester, John E., et al. "Rubuce-gyaren halittu mai shekaru 15 da haihuwa na rayuwa ba tare da tsiraici ba a ciwon kwakwalwa na T1-T3 na ciwon gurguwar ƙwayar cutar ta hanyar haɗakarwa ta hanyar rediyo da farfadowa; Littafin Labaran Lafiya na Duniya * Biology * Kwararru 67.1 (2007): 57-64.