Gomarara redundira

Gomarara redundira igomarara rinotangira mudundira. Iyo dundira inhengo yemuviri inobata nekuburitsa weti. Icho chiri pakati pezasi kwedumbu.

Gomarara redundiro rinowanzotanga kubva kumasero anonamira dundira. Aya maseru anonzi maseru echinjana.

Aya mamota akasarudzika nenzira yaanokura nayo:

• Mapundu emapapillary anoita kunge mapundu uye akasungirirwa padzinde.
• Carcinoma in situ tumors yakati sandara. Izvo zvakanyanya kushomeka. Asi ivo vanopinda zvakanyanya uye vane mhedzisiro yakaipa.

Chikonzero chaicho chegomarara redundiro hachizivikanwe. Asi zvinhu zvinoverengeka zvinogona kukuita iwe mukana wekukudziridza zvinosanganisira:

• Kusvuta fodya - Kusvuta kunowedzera mukana wekuva nekenza yedundira. Kusvikira pahafu yekenza dzedundira dzinogona kukonzerwa noutsi hwefodya.
• Yega kana yemhuri nhoroondo yekenza yedundira - Kuva nemumwe munhu mumhuri ane gomarara redundiro kunowedzera mukana wako wekukudziridza.
• Kemikari kuratidzwa pabasa - Gomarara redundira rinogona kukonzerwa nekusangana nemakemikari anokonzera gomarara kubasa. Aya makemikari anonzi carcinogens. Vashandi vedhayi, vanoshanda nerabha, vashandi veganda, vatyairi vemarori, uye vanoshandisa mishonga yezvipembenene vari panjodzi huru.
• Chemotherapy - Iyo chemotherapy mushonga cyclophosphamide inogona kuwedzera njodzi yekenza yedundira.
• Radiation kurapwa - Radiation kurapa kunzvimbo yepelvis yekurapa kenza yeprostate, testes, cervix, kana chibereko kunowedzera njodzi yekuva nekenza yedundira.
• Utachiona hweBladder - Iyo yakareba-refu (isingagumi) hutachiona hwechiropa kana kutsamwa kunogona kutungamira kune imwe mhando yekenza yedundira.

Kutsvagurudza hakuna kuratidza humbowo hwakajeka hwekuti kushandisa zvinotapira zvekugadzira zvinotungamira kukenza yedundira.

Zviratidzo zvegomarara redundira zvinogona kusanganisira:

• Marwadzo emudumbu
• Ropa mune weti
• Kurwadziwa kwepfupa kana hunyoro kana kenza ikapararira kufupa
• Kuneta
• Kunorwadza weti
• Urinary frequency uye kukurumidza
• Urine leakage (kusagadzikana)
• Kuonda

Zvimwe zvirwere nemamiriro ezvinhu zvinogona kukonzera zviratidzo zvakafanana. Izvo zvakakosha kuti uone wako wekuchengeta hutano kuti atonge kunze zvimwe zvese zvinokonzeresa zvikonzero.

Iye mupi achaita ongororo yemuviri, kusanganisira rectal uye pelvic bvunzo.

Miedzo inogona kuitwa inosanganisira:

• Abdominal uye pelvic CT scan
• Abdominal MRI scan
• Cystoscopy (kuongorora mukati mechidzitiro nekamera), ine biopsy
• Inopinza pyelogram - IVP
• Kuongorora urinal
• Weti cytology

Kana bvunzo dzikaratidza kuti une gomarara redundira, mimwe miedzo ichaitwa kuti uone kana gomarara rapararira. Uku kunodaidzwa kunzi staging. Kugadzira nhanho kunobatsira kutungamira kurapa mune ramangwana nekutevera uye kunokupa imwe pfungwa yezvaunotarisira mune ramangwana.

Iyo TNM (bundu, node, metastasis) sisitimu sisitimu inoshandiswa kukonzeresa kenza yedundira:

• Ta - Gomarara iri mumucheto wedundira chete uye harina kupararira.
• T1 - Kenza inopfuura nepaburi redundira, asi haisvike mhasuru yedundira.
• T2 - Kenza inopararira kune mhasuru yedundira.
• T3 - Kenza inopararira ichipfuura dundira ichipinda mumatumbu ane mafuta akaikomberedza.
• T4 - Gomarara rapararira kune zvivakwa zviri padyo senge prostate gland, chibereko, nyini, rectum, mudumbu madziro, kana rusvingo rwechiuno.

Mamota akaiswawo mumapoka zvichienderana nekuti anoonekwa sei pasi pe microscope. Izvi zvinonzi kuisa bundu. Bundu repamusoro rinokurumidza kukura uye riine mukana wekupararira. Gomarara redundira rinogona kupararira munzvimbo dziri padyo, kusanganisira iyo:

• Makemikari mapfundo muchiuno
• Mapfupa
• Chiropa
• Mapapu

Kurapa kunoenderana nedanho rekenza, kuomarara kwezviratidzo zvako, uye hutano hwako hwese.

Stage 0 uye ini kurapwa:

• Kuvhiya kubvisa bundu pasina kubvisa iro rasara redundira
• Chemotherapy kana immunotherapy yakaiswa yakananga mudundira
• Immunotherapy inopiwa intravenously ne pembrolizumab (Keytruda) kana gomarara richienderera richidzoka mushure mezviyero zvataurwa pamusoro

Stage II uye III kurapa:

• Kuvhiya kubvisa iro rose dundira (radical cystectomy) uye lymph node dziri pedyo
• Kuvhiya kubvisa chete chikamu chedundira, kuchiteverwa nemwaranzi uye chemotherapy
• Chemotherapy yekudzikisa bundu usati wavhiyiwa
• Iko kusanganiswa kwechemotherapy uye radiation (mune vanhu vanosarudza kusavhiyiwa kana vasingakwanise kuvhiyiwa)

Vazhinji vanhu vane mamota echikamu IV havagone kurapwa uye kuvhiyiwa hakuna kukodzera. Mune vanhu ava, chemotherapy inowanzo fungidzirwa.

CHEMOTHERAPY

Chemotherapy inogona kupihwa kune vanhu vane chirwere cheChipiri II uye III kumberi kana mushure mekuvhiyiwa kubatsira kudzivirira bundu kubva kudzoka.

Kwechirwere chekutanga (nhanho 0 uye ini), chemotherapy inowanzo kupihwa yakananga mudundira.

IMMUNOTHERAPY

Gomarara redundira rinowanzo kurapwa ne immunotherapy. Mukurapa uku, mushonga unokonzeresa immune system yako kurwisa nekuuraya masero ekenza. Immunotherapy yekenza yekutanga dundira kenza inowanzoitwa pachishandiswa mushonga weBacilleCalmette-Guerin (unowanzozivikanwa se BCG). Kana gomarara rikadzoka mushure mekushandisa BCG, vamiririri vatsva vanogona kushandiswa.

Sezvo nezvose kurapa, mhedzisiro inogoneka. Kumbira mupiki wako mhedzisiro yaungatarisira, uye zvekuita kana zvikaitika.

Kuvhiya

Kuvhiya kenza yedundira inosanganisira:

• Transurethral resection yedundira (TURB) - Cancerous bladder tishu inobviswa kuburikidza nerethra.
• Kusarura kwakaperera kana kwakakwana kwedundira - Vanhu vazhinji vane gomarara redundiro II kana III vangangoda kuti dundira ravo ribviswe (radical cystectomy). Dzimwe nguva, chikamu chedundira chete chinobviswa. Chemotherapy inogona kupihwa pamberi kana mushure mekuvhiyiwa uku.

Kuvhiya kunogona kuitwawo kuti ubatsire muviri wako kubuda weti mushure mekunge dundira rabviswa. Izvi zvinogona kusanganisira:

• Ileal rukoronga - Iyo diki yeti weti inovhiya inogadzirwa kubva muchidimbu chidiki chemuviri wako mudumbu. Iwo ureters anodurura weti kubva kuitsvo akasungirirwa kune mumwe mugumo wechikamu ichi. Iwo mumwe mugumo unounzwa kuburikidza nekuvhura muganda (a stoma). Iyo stoma inobvumidza munhu kuburitsa iyo yakaunganidzwa weti kubva mudura.
• Continent urinary dura - Homwe yekuunganidza weti inogadzirwa mukati memuviri wako uchishandisa chidimbu chemuura wako. Iwe unozofanirwa kuisa chubhu mumuromo weganda rako (stoma) muhomwe iyi kudhonza weti.
• Orthotopic neobladder - Kuvhiya uku kuri kuwedzera kuitika muvanhu vakabviswa dundira. Chikamu chemuwuru chako chakapetwa kuita homwe inounganidza weti. Inosungirirwa panzvimbo iri mumuviri umo weti inowanzo durura kubva mudundira. Maitiro aya anotendera iwe kuti uchengetedze imwe yakajairika kudzora weti.

Unogona kudzikisira kushushikana kwehurwere nekujoinha boka rekutsigira gomarara. Kugovana nevamwe vane zvakajairika zviitiko uye matambudziko zvinogona kukubatsira kuti usazonzwa kusurukirwa.

Mushure mekurapwa kwegomarara redundira, iwe unozotariswa nachiremba. Izvi zvinogona kusanganisira:

• CT inoongorora kuongorora kupararira kana kudzoka kwekenza
• Kuongorora zviratidzo zvinogona kuratidza kuti chirwere ichi chiri kuramba chichiwedzera, senge kuneta, kuonda, kuwedzera marwadzo, kuderera kwematumbo uye dundira basa, uye kushaya simba
• Pedzisa kuwanda kweropa (CBC) kuongorora kweanemia
• Kuongorora kwedundira kwemwedzi mitatu kusvika kumitanhatu mushure mekurapwa
• Urinalysis kana iwe usina kubviswa dundira rako

Kunyatsoita sei munhu ane gomarara redundira kunoenderana nedanho rekutanga uye mhinduro pakurapwa kwekenza yedundira.

Maonero eiyo nhanho 0 kana ini kenza yakanyatsonaka. Kunyangwe njodzi yekudzoka nekenza iri yakakwira, kanzuru zhinji dzedundira dzinodzoka dzinogona kuvhiyiwa uye kurapwa.

Mari yekurapa kwevanhu vane danho rechitatu III iri pasi pe50%. Vanhu vane gomarara IV redundira kenza havawanzo kurapwa.

Gomarara redundiro rinogona kupararira kupinda munhengo dziri pedyo. Vanogona zvakare kufamba nepakati pemimba yepamuviri uye vanopararira kuchiropa, mapapu nemapfupa. Zvimwe zvinetso zvegomarara redundira zvinosanganisira:

• Anemia
• Kuzvimba kweiyo ureters (hydronephrosis)
• Urethral kuomesa
• Urinary kusagadzikana
• Erectile kusagadzikana muvarume
• Kusagadzikana pabonde kuvakadzi
  

Fonera mupiki wako kana uine ropa mumurini rako kana zvimwe zviratidzo zvekenza yedundira, kusanganisira:

• Kakawanda weti
• Kunorwadza weti
• Inokurumidza inoda kuita weti

Kana uchisvuta, rega. Kusvuta kunogona kuwedzera njodzi yako yekenza yedundira. Dzivisa kusangana nemakemikari akabatanidzwa nekenza yedundira.

Shanduko yesero carcinoma yedundira; Kenza yeurothelial

• Cystoscopy
• Yechikadzi weti turakiti
• Varume urinary turakiti

Cumberbatch MGK, Jubber I, Nhema PC, et al. Epidemiology yekenza yedundira: kuongororwa kwakarongeka uye kugadziridzwa kwazvino kwenjodzi zvinhu mu2018. Eur Urol. 2018; 74 (6): 784-795. PMID: 30268659 pubmed.ncbi.nlm.nih.gov/30268659/.

National Cancer Institute webhusaiti. Kenza yemukaka yekurapa (PDQ) - hutano nyanzvi vhezheni. www.cancer.gov/types/bladder/hp/bladder-treatment-pdq. Yakagadziridzwa Ndira 22, 2020. Yakasvika muna Kukadzi 26, 2020.

National Yakakwana Cancer Network webhusaiti. NCCN kiriniki yekudzidzira nhungamiro mune oncology (NCCN nhungamiro): Gomarara redundira. Shanduro 3.2020. www.nccn.org/professionals/physician_gls/pdf/bladder.pdf. Yakagadziridzwa Ndira 17, 2020. Yakasvika muna Kukadzi 26, 2020.

Smith AB, Balar AV, Milowsky MI, Chen RC. Carcinoma yedundira. Mune: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff's Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020: chap 80.