Ke nānā nei ka pae o ka lymphoma i ka nui o kou kino e pili ana i ka lymphoma, a hāʻawi i ka ʻike e pili ana i ke ʻano o nā ʻano lapaʻau maikaʻi loa no ʻoe.
He aha ke ʻano o ka hoʻokūkū?
ʻO ka hoʻokūkū e pili ana i ka nui o kou kino i hoʻopilikia ʻia e kāu lymphoma - a i ʻole ka lōʻihi o ka laha ʻana mai kahi i hoʻomaka mua ai.
Hiki i nā Lymphocytes ke hele i kekahi wahi o kou kino. 'O ia ho'i, hiki ke hele i kekahi wahi o kou kino. Pono ʻoe e hoʻāʻo hou aʻe e ʻike i kēia ʻike. Kapa ʻia kēia mau hoʻokolohua he staging tests a ke loaʻa iā ʻoe nā hopena, e ʻike ʻoe inā loaʻa iā ʻoe ka pae mua (I), pae ʻelua (II), pae ʻekolu (III) a i ʻole lymphoma pae ʻehā (IV).
ʻO Lymphoma Staging - ʻO Ann Arbor a i ʻole Lugano Staging System
E pili ana kāu pae o ka lymphoma i:
- ʻEhia mau wahi o kou kino i loaʻa i ka lymphoma
- Ma kahi e komo ai ka lymphoma inā aia ma luna, ma lalo a ma nā ʻaoʻao ʻelua o kāu diaphragm (he ʻiʻo nui, ʻano dome ma lalo o kou iwi iwi ʻaoʻao e hoʻokaʻawale i kou umauma mai kou ʻōpū)
- Inā ua laha ka lymphoma i kou iwi iwi a i ʻole nā mea ʻē aʻe e like me kou ake, akemāmā, ʻili a iwi paha.
Kapa ʻia nā pae I a me II 'o ka pae mua a i ʻole ka palena palena' (e pili ana i kahi ʻāpana o kou kino).
Ua kapa ʻia nā pae III a me IV he 'pae holomua' (ʻoi aku ka laulā). He mea nui e ʻike ʻaʻole e like me nā maʻi maʻi maʻi ʻē aʻe, hiki ke ho'ōla ʻia ka nui o nā lymphoma aggressive stage. E kamaʻilio me kāu kauka e pili ana i kou manawa e ola ai a i ʻole ke kala lōʻihi.
Hana 1 | Hoʻopili ʻia hoʻokahi wahi puʻupuʻu lymph, ma luna a ma lalo paha o ka diaphragm*. |
Hana 2 | Hoʻopili ʻia ʻelua a ʻoi aʻe paha nā ʻāpana lymph node ma ka ʻaoʻao hoʻokahi o ka diaphragm*. |
Hana 3 | Hoʻokahi liʻiliʻi liʻiliʻi o ka lymph node ma luna a ma ka liʻiliʻi hoʻokahi wahi lymph node ma lalo o ka diaphragm* e pili ana. |
Hana 4 | Aia ka Lymphoma i loko o nā pūnana lymph he nui a ua laha i nā wahi ʻē aʻe o ke kino (e laʻa i nā iwi, nā māmā, nā ate). |
ʻO ka ʻike hoʻokūkū keu
Hiki i kāu kauka ke kamaʻilio e pili ana i kāu pae ma ka hoʻohana ʻana i kahi leka, e like me A,B, E, X a i ʻole S. Hāʻawi kēia mau leka i ka ʻike hou aku e pili ana i nā hōʻailona āu i loaʻa ai a i ʻole ka hopena o kou kino e ka lymphoma. Kōkua kēia ʻike a pau i kāu kauka e ʻimi i ka hoʻolālā lapaʻau maikaʻi loa no ʻoe.
palapala | Meaning | nui |
A i ʻole B |
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E & X |
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S |
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(ʻO kā mākou spleen he ʻōkana i loko o kā mākou ʻōnaehana lymphatic ʻo ia ka kānana a hoʻomaʻemaʻe i ko mākou koko, a he wahi ia e hoʻomaha ai kā mākou B-cell a hana i nā antibodies) |
Nā hoʻāʻo no ke kahua
No ka ʻike ʻana i ka pae āu e loaʻa ai, e noi ʻia paha ʻoe e loaʻa i kekahi o kēia mau hoʻokolohua staging:
Ka pākuʻina o ka tomography (CT)
Lawe kēia mau kiʻi i nā kiʻi o loko o kou umauma, ka ʻōpū a i ʻole ke pelvis. Hāʻawi lākou i nā kiʻi kikoʻī e hāʻawi i ka ʻike hou aku ma mua o kahi X-ray maʻamau.
ʻO ka ʻōmole helu Positron emoate (PET)
He scan kēia e kiʻi i nā kiʻi o loko o kou kino holoʻokoʻa. E hāʻawi ʻia ʻoe i kahi lāʻau lapaʻau e hoʻopaʻa ʻia ai nā cell cancerous - e like me nā cell lymphoma. ʻO ka lāʻau lapaʻau e kōkua ana i ka PET scan e ʻike i kahi o ka lymphoma a me ka nui a me ke ʻano ma ke kuhikuhi ʻana i nā wahi me nā cell lymphoma. Ua kapa ʻia kēia mau wahi he "wela".
Pahu lumbar
ʻO ka ʻoki ʻana i ka lumbar kahi hana e nānā ai inā loaʻa iā ʻoe kahi lymphoma i loko o kou ʻōnaehana ʻōnaehana waena (CNS), e pili ana i kou lolo, spinal cord a me kahi wahi a puni kou mau maka. Pono ʻoe e noho mālie i ka wā o ke kaʻina hana, no laila e loaʻa i nā pēpē a me nā keiki ka maʻi maʻi maʻamau e hoʻomoe iā lākou no kekahi manawa liʻiliʻi ke pau ke kaʻina hana. Pono ka hapa nui o ka poʻe mākua i kahi anesthetic kūloko no ke kaʻina hana e hoʻopau ai i ka wahi.
Na kāu kauka e hoʻokomo i ka nila ma kou kua, a e lawe i kahi wai liʻiliʻi i kapa ʻia ʻo "ka wai o ke kuamoʻo o ka lolo” (CSF) mai a puni kou iwi kuamoʻo. ʻO ka CSF kahi wai e hana like me ka mea hoʻopuʻi i kou CNS. Lawe pū ia i nā protein like ʻole a me nā maʻi e hakakā ana i nā cell immune e like me nā lymphocytes e pale i kou lolo a me ke kuamoʻo. Hiki nō hoʻi iā CSF ke kōkua i ka hoʻokahe ʻana i kekahi wai ʻē aʻe i loaʻa iā ʻoe i loko o kou lolo a i ʻole a puni kou iwi kuamoʻo e pale ai i ka pehu ʻana ma ia mau wahi.
A laila e hoʻouna ʻia ka laʻana CSF i ka pathology a nānā ʻia no nā hōʻailona o ka lymphoma.
Biopsy iwi ʻōiwi
- ʻO ka aspirate iwi iwi (BMA): lawe ʻia kēia hoʻāʻo ʻana i kahi wahi liʻiliʻi o ka wai i loaʻa ma ka hakahaka o ka iwi.
- ʻO ka iwi aspirate trepine (BMAT): lawe kēia ho'āʻo i kahi laʻana liʻiliʻi o ka ʻiʻo iwi iwi.
Hoʻouna ʻia nā laʻana i ka pathology kahi e nānā ʻia ai nā hōʻailona o ka lymphoma.
Hiki ke ʻokoʻa ke kaʻina hana no nā biopsies iwi iwi ma muli o kahi āu e mālama ai, akā e hoʻokomo pinepine ʻia kahi anesthetic kūloko e hoʻopau i ka wahi.
Ma kekahi mau haukapila, hiki ke hāʻawi ʻia iā ʻoe i ka hoʻomaha māmā e kōkua iā ʻoe e hoʻomaha a hiki ke kāpae iā ʻoe mai ka hoʻomanaʻo ʻana i ke kaʻina hana. ʻAʻole pono ka nui o ka poʻe i kēia a loaʻa paha i kahi "whistle green" e omo ai. He lāʻau hōʻeha ʻeha ko loko o kēia puʻupuʻu ʻōmaʻomaʻo (i kapa ʻia ʻo Penthrox a i ʻole methoxyflurane), āu e hoʻohana ai e like me ka mea e pono ai i ke kaʻina hana.
E hōʻoia ʻoe e nīnau i kāu kauka i nā mea i loaʻa e hōʻoluʻolu iā ʻoe i ka wā o ke kaʻina hana, a e kamaʻilio pū me lākou e pili ana i kou manaʻo he koho maikaʻi loa ia no ʻoe.
Hiki ke loaʻa ka ʻike hou aku e pili ana i nā biopsies iwi ma kā mākou ʻaoʻao pūnaewele ma aneʻi.
Ka hoʻonohonoho ʻana o CLL - ʻO ka ʻōnaehana hoʻonohonoho RAI
He ʻokoʻa iki ka hoʻonohonoho ʻana no CLL ma mua o nā ʻano subtypes ʻē aʻe o lymphoma, no ka mea, hoʻomaka ka CLL i loko o ke koko a me ka iwi iwi.
E nānā ka RAI staging system i kāu CLL e ʻike inā loaʻa iā ʻoe, a i ʻole ʻaʻohe o kēia mau mea:
- kiʻekiʻe o nā lymphocytes i loko o kou koko a iwi iwi paha - kapa ʻia kēia he lymphocytosis (lim-foe-cy-toe-sis)
- pehu nā ʻōpū lymph - lymphadenopathy (limf-a-den-op-ah-thee)
- he spleen i hoʻonui ʻia - splenomegaly (splen-oh-meg-ah-lee)
- haʻahaʻa haʻahaʻa o ke koko ʻulaʻula i loko o kou koko - anemia (a-nee-mee-yah)
- nā pae haʻahaʻa o nā platelets i kou koko - thrombocytopenia (throm-bow-cy-toe-pee-nee-yah)
- ake nui - hepatomegaly (hep-at-o-meg-a-lee)
He aha ke ʻano o kēlā me kēia pae RAI
| RAI pae 0 | ʻO Lymphocytosis a ʻaʻohe hoʻonui ʻia o nā puʻupuʻu lymph, spleen, a i ʻole ate, a me nā helu koko ʻulaʻula maʻamau a me nā helu platelet. |
| RAI pae 1 | ʻO Lymphocytosis a me ka hoʻonui ʻia o nā lymph nodes. ʻAʻole i hoʻonui ʻia ka spleen a me ka ate a ʻo ka helu ʻulaʻula a me ka helu platelet he mea maʻamau a haʻahaʻa iki paha. |
| RAI pae 2 | ʻO Lymphocytosis a me ka spleen i hoʻonui ʻia (a me ke akepaʻa i hoʻonui ʻia paha), me ka hoʻonui ʻia ʻana o nā pūnaʻi lymph. He mea maʻamau a haʻahaʻa iki paha ka helu ʻulaʻula a me ka platelet |
| RAI pae 3 | ʻO Lymphocytosis a me ka anemia (kakaikahi loa nā pūnaʻi koko ʻulaʻula), me ka hoʻonui ʻia ʻana o nā pūnana lymph, spleen, a i ʻole ate. Kokoke ka helu maʻamau. |
| RAI pae 4 | ʻO Lymphocytosis me ka thrombocytopenia (kakaikahi loa nā platelets), me ka anemia a i ʻole, hoʻonui ʻia nā ʻōpū lymph, spleen, a i ʻole ate. |
* ʻO ka Lymphocytosis ka nui o nā lymphocytes i loko o kou koko a i ʻole ka iwi iwi
Ka Papa Hoʻonaʻauao o Lymphoma
He ʻokoʻa ka ulu ʻana o kāu mau sela lymphoma, a ʻokoʻa ka nānā ʻana i nā cell maʻamau. ʻO ka pae o kāu lymphoma ka wikiwiki o ka ulu ʻana o kāu mau sela lymphoma, e pili ana i ka nānā ʻana ma lalo o kahi microscope. ʻO nā papa he 1-4 (haʻahaʻa, waena, kiʻekiʻe). Inā loaʻa iā ʻoe kahi lymphoma papa kiʻekiʻe, ʻokoʻa loa ke ʻano o kāu mau pūnaewele lymphoma mai nā pūnaewele maʻamau, no ka mea ke ulu wikiwiki nei lākou e ulu pono. Aia ma lalo kahi ʻike o nā māka.
- G1 - papa haʻahaʻa - ke nānā aku nei kāu mau cell i kahi maʻamau, a ulu lākou a pālahalaha mālie.
- G2 – papa waena – ke hoʻomaka nei kāu mau cell e nānā ʻokoʻa akā aia kekahi mau cell maʻamau, a ulu a laha lākou ma kahi wikiwiki.
- G3 – papa kiʻekiʻe – ʻokoʻa ke ʻano o kāu mau cell me kekahi mau cell maʻamau, a ulu lākou a pālahalaha wikiwiki.
- G4 - papa kiʻekiʻe - ʻokoʻa loa kāu mau cell i ka mea maʻamau, a ulu a palahalaha loa lākou.
Hoʻohui kēia ʻike āpau i ke kiʻi holoʻokoʻa a kāu kauka i kūkulu ai e kōkua i ka hoʻoholo ʻana i ke ʻano o ka lāʻau lapaʻau maikaʻi loa no ʻoe.
He mea nui e kamaʻilio me kāu kauka e pili ana i kāu mau mea pilikia ponoʻī i hiki iā ʻoe ke ʻike maopopo i ka mea e manaʻo ai mai kāu mau lapaʻau.
