ʻO ka mucositis kahi huaʻōlelo lapaʻau no nā ʻeha, ʻeha a me ka ʻāʻī ma kāu ʻāpana ʻōpū (GI). Loaʻa i kā mākou ʻāpana GI ko mākou waha, esophagus (paipu meaʻai ma waena o ko mākou waha a me ka ʻōpū), ka ʻōpū a me ka ʻōpū. Hiki i nā lāʻau lapaʻau he nui no ka lymphoma ke hoʻoulu i ka mucositis hiki ke ʻeha, hoʻonui i kou pilikia o ka maʻi a me ke koko, a paʻakikī ke kamaʻilio, ʻai a inu paha.
E kūkākūkā kēia ʻaoʻao i ka mucositis o ka waha a me ka puʻu. No ka ʻike hou aku e pili ana i ka mucositis e pili ana i kou ʻōpū, hiki ke hoʻoulu i ka maʻi maʻi a me ka constipation, e ʻoluʻolu Bus maʻaneʻi.
He aha ka mucositis?
Hiki i ka mucositis ke hopena i ka ʻeha, nā wahi haʻihaʻi o ka mucous membranes (lining) o kou waha a me ka puʻu. Hiki ke koko kēia mau wahi haʻihaʻi, ʻoiai inā ʻoe thrombocytopenic, a i ʻole e maʻi ʻia. ʻOi aku ka nui o ka loaʻa ʻana o ka maʻi mucositis inā ʻoe neutropenic, akā na'e hiki ke loa'a ka ma'i i ka hana pono 'ana o kou kino.
Hiki i ka mucositis ke pehu, ʻeleʻele, ʻulaʻula a keʻokeʻo paha i loko o kou waha a me kou ʻāʻī, ʻoiai inā paʻa ka mucous membrane.
Nā wehewehe
ʻO ka Thrombocytopenic ka huaʻōlelo lapaʻau no ka wā he haʻahaʻa kou pae platelet. Kōkua nā platelets i ko mākou koko e hoʻopaʻa ʻia e pale i ke koko a me ka ʻeha.
ʻO Neutropenic ka huaʻōlelo lapaʻau no ka wā e loaʻa ai nā neutrophils haʻahaʻa. ʻO Neutrophils kekahi ʻano o ke koko keʻokeʻo keʻokeʻo a ʻo ia nā cell mua o ko mākou kino e hakakā ai i ka maʻi.
Nā kumu o ka mucositis
ʻO ka mea pōʻino, ʻaʻole hoʻopau wale kekahi mau lapaʻau no ka lymphoma i nā pūnaewele lymphoma, akā hiki ke hoʻouka i kekahi o kāu mau sela maikaʻi. ʻO nā lāʻau lapaʻau nui e hiki ke hoʻoulu i ka mucositis o kou waha a me kou puʻu i helu ʻia ma lalo nei. Kaomi ma nā poʻomanaʻo e aʻo hou aku.
He lāʻau lapaʻau ʻo Chemotherapy e hana ana ma ka luku ʻana i nā cell e ulu a hoʻonui wikiwiki paha. Systemic 'o ia ho'i ka hele 'ana ma kou kahawai koko, a no laila hiki ke ho'opilikia i kekahi wahi o kou kino. He mea maikaʻi kēia i ka mālama ʻana i nā ʻano lymphoma he nui. Eia nō naʻe, ulu a hoʻonui koke ka nui o kā mākou mau sela olakino. ʻO nā pūnaewele i loko o kā mākou ʻāpana GI kekahi o kēlā mau cell e ulu wikiwiki nei.
ʻAʻole hiki i ka Chemotherapy ke ʻike i ka ʻokoʻa ma waena o nā pūnaewele lymphoma maʻi maʻi a me kāu mau sela olakino. No laila, hiki i ka chemotherapy ke hoʻouka i nā pūnaewele i kāu ʻāpana GI e hopena ai i ka mucositis.
Hoʻomaka ka mucositis i kekahi mau lā ma hope o ka mālama ʻana a nalowale i loko o 2-3 mau pule ma hope o kou hoʻopau ʻana i ka mālama ʻana. Hiki i kāu ʻōnaehana pale i hoʻohaʻahaʻa ʻia (neutropenia) a me ka thrombocytopenia ma muli o kāu chemotherapy hiki ke hōʻeha i ka mucositis, me ka pilikia o ke koko a me nā maʻi.
ʻOi aku ka manaʻo o ka radiotherapy ma mua o ka chemotherapy, no laila pili wale i ka wahi liʻiliʻi o kou kino i loaʻa i ka lāʻau lapaʻau. Eia nō naʻe, ʻaʻole hiki i ka radiotherapy ke ʻike i ka ʻokoʻa ma waena o nā pūnaewele lymphoma maʻi maʻi a me kāu mau sela olakino.
Ke huli nei ka radiotherapy i ka lymphoma kokoke i kou waha a i ʻole ka ʻāʻī, e like me nā ʻōpū lymph ma kou poʻo a me kou ʻāʻī, hiki iā ʻoe ke loaʻa i ka mucositis.
ʻO nā mea hoʻopaʻa hoʻopaʻa palekana (ICI) e like me nivolumab a i ʻole pembrolizumab he ʻano o ka antibody monoclonal. He ʻokoʻa iki kā lākou hana ʻana i nā lāʻau lapaʻau ʻē aʻe no ka lymphoma.
Loaʻa i kā mākou mau cell maʻamau nā wahi hoʻopaʻa palekana ma luna o lākou. ʻO kekahi o kēia mau mea i kapa ʻia ʻo PD-L1 a i ʻole PD-L2. Ke kōkua nei kēia mau wahi hoʻopaʻa i ko mākou ʻōnaehana pale e ʻike i kā mākou mau sela ponoʻī. Ua waiho wale ʻia nā kelepona me nā wahi hōʻoia e kā mākou ʻōnaehana pale, akā ʻike ʻia nā cell me ka ʻole o nā wahi hōʻoia he pōʻino, no laila hoʻopau kā mākou ʻōnaehana pale i nā cell i loaʻa ʻole nā māka.
Eia nō naʻe, hoʻololi kekahi mau maʻi maʻi a me nā lymphomas e ulu i kēia mau wahi hoʻopaʻa pale. Ma ka loaʻa ʻana o kēia mau wahi hoʻopaʻa kino, ʻo ka Hiki i ka lymphoma ke hūnā mai kou ʻōnaehana pale.
Ke hana nei nā mea hoʻopaʻa hoʻopaʻa kino ma ka hoʻopili ʻana i nā wahi hoʻopaʻa PD-L1 a i ʻole PD-L2 ma nā pūnaewele lymphoma, a ma ka hana ʻana i kēia, hūnā ka mea hoʻopaʻa hoʻopaʻa i ka pale mai kāu ʻōnaehana pale. Ma muli o ka hiki ʻole i kāu ʻōnaehana pale ke ʻike hou i ka wahi hoʻopaʻa, hiki iā ia ke hoʻomaopopo i ka pilikia o nā sela lymphoma a no laila e luku iā lākou.
No ka mea, aia nō kēia mau wahi hoʻopaʻa i kāu mau keena olakino, i kekahi manawa hiki i ka mālama ʻana me nā mea hoʻopaʻa hoʻopaʻa pale pale ke hoʻouka i kāu ʻōnaehana pale i kāu mau sela maikaʻi. Ke ʻike ʻole kāu ʻōnaehana pale i nā cell i loko o kāu ʻāpana GI e like me ka mea maʻamau, hiki iā lākou ke hopena i kahi hoʻouka auto-immune kahi e hakakā ai kāu ʻōnaehana pale i kāu mau sela olakino, e hoʻoulu ai i ka mucositis. He manawa pōkole kēia a hoʻomaikaʻi i ka wā e pau ai ka mālama ʻana. I nā hihia kakaʻikahi, hiki i nā mea hoʻopaneʻe hoʻopaʻa kino ke hoʻoulu i nā kūlana auto-immune lōʻihi.
Ka hoʻololi ʻana o nā pūnaʻi kumu hoʻohana ʻia ma ke ʻano he lāʻau hoʻopakele e hoʻopakele i kou iwi iwi ma hope o ka loaʻa ʻana o ka nui o ka chemotherapy.
He hopena maʻamau ka mucositis ke loaʻa iā ʻoe kahi hoʻololi ʻana o ke kelepona ma muli o ka nui o ka chemotherapy. ʻO ka omo ʻana i ka hau ma kahi o 20 mau minuke ma mua a ma hope o kekahi mau chemotherapies i hāʻawi ʻia no ka transplant cell stem hiki ke kōkua i ka hōʻemi ʻana i ka paʻakikī o ka mucositis. E nīnau i kāu kahu hānai e pili ana i kēia inā loaʻa iā ʻoe ka hoʻololi ʻana i ka stem cell
Ka pale ʻana i ka mucositis
E like me ka nui o nā mea, ʻoi aku ka maikaʻi o ka pale ʻana ma mua o ka mālama ʻana. ʻO ka mea pōʻino, ma muli o ke ʻano o ka hana ʻana o kekahi mau lapaʻau, ʻaʻole hiki iā ʻoe ke pale i ka mucositis i nā manawa a pau. Akā aia kekahi mau ala e pale aku ai i ka paʻakikī a mālama i nā pilikia o ke koko a me ka maʻi.
Dentist
Ma mua o kou hoʻomaka ʻana i ka mālama ʻana he manaʻo maikaʻi paha e ʻike i kahi niho niho inā loaʻa iā ʻoe kekahi hopohopo e pili ana i kou mau niho. ʻAʻole hiki kēia i nā manawa a pau, ma muli o kāu ʻano subtype a me ka pae o ka lymphoma, eia naʻe pono e nīnau i kāu haematologist a i ʻole oncologist e pili ana.
ʻO nā pilikia āu i loaʻa ai i kou mau niho a i ʻole nā ʻāʻī e hiki ke ʻoi aku ka ʻino i ka wā o ka mālama ʻana a hoʻokau iā ʻoe i kahi maʻi kiʻekiʻe aʻe o ka maʻi, ʻoi aku ka ʻeha a paʻakikī o kāu mucositis. ʻO ke ʻano o nā maʻi maʻi, pono ʻoe e lohi i ka mālama ʻana.
ʻO kekahi mau kauka niho kūikawā i ka mālama ʻana i ka poʻe me ka maʻi kanesa. E noi i ka ʻōlelo aʻoaʻo a i ʻole ka hāʻawi ʻana mai kāu haematologist a i ʻole oncologist.
Malama waha
Nui nā halemai e ʻōlelo aku i kahi ʻano hoʻoponopono waha no ʻoe e hoʻohana ai. I kekahi mau hihia, he wai paʻakai kēia me ka soda bicarbonate i loko.
Inā he niho niho kou, e wehe i kēia mau mea ma mua o ka holoi ʻana i kou waha.
E hoʻomaʻemaʻe i nā niho niho ma mua o ka hoʻihoʻi ʻana i loko o kou waha.
E hana i kāu holoi waha ponoʻī
Hiki iā ʻoe ke hana i kou waha ponoʻī inā makemake ʻoe.
E hoʻolapalapa i kahi wai a laila e maʻalili.
nā mea hoʻohui
- Hoʻokahi kīʻaha (250mls) o ka wai i hoʻolapalapa ʻia
- 1/4 o kahi teaspoon (tsp) o ka paʻakai
- 1/4 teaspoon (tsp) o ka soda bicarbonate.
E hoʻohana i kahi puna ana e ana i ka nui o ka paʻakai a me ka bicarbonate o ka soda. Inā ʻoe e hoʻomāhuahua i ka ikaika, e ʻeha paha kou waha a ʻoi aku ka ʻino o kou mucositis.
hana
- E hoʻokomo i ka paʻakai a me ka bicarbonate o ka soda i loko o ka wai maloʻo a hoʻoulu.
- E lawe i ka waha - MAI ANU.
- Holoi i ka wai a puni kou waha a hoʻomaloʻo no 30 mau kekona.
- E kuha i ka wai.
- E hana hou i 3 a 4 mau manawa.
E hana i kēia ma hope o kēlā me kēia ʻai a ma mua o ka moe - ma kahi o 4 mau manawa i ka lā.
E pale i ka holoi waha me ka waiʻona
Mai hoʻohana i ka waha me ka waiʻona i loko o ia mau mea. E nānā i ka papa inoa o nā mea hoʻohana no ka nui o nā holoi waha he waiʻona. He ʻoʻoleʻa loa kēia mau holoi waha no kou waha i ka wā o ka mālama ʻana a hiki ke hōʻeha i ka mucositis, e hōʻeha ai i ka ʻeha.
E hoʻohana i ka lip balm
Brushing
E hoʻohana i kahi pulupulu niho palupalu. Mai hoʻohana i ka pulupulu niho maʻamau a paʻakikī paha e palaki i kou mau niho. Inā ʻeha loa kou waha a paʻakikī ke wehe ʻana, ʻoi aku ka maʻalahi o ka hoʻohana ʻana i ka pulupulu keiki me kahi poʻo liʻiliʻi. Palaki ma ka liʻiliʻi ʻelua i ka lā - hoʻokahi i ke kakahiaka a hoʻokahi i ka pō ma hope o ka ʻai ʻana.
E hoʻomaʻemaʻe i kou alelo. ʻO ke kua o ka hapa nui o nā pulumu niho he mau kuali liʻiliʻi e kōkua i ka wehe ʻana i nā hua bacteria i kūkulu ʻia a me ka uhi keʻokeʻo mai kou alelo. Hiki nō hoʻi iā ʻoe ke hoʻohana i ka bristle palupalu o kāu pulupulu niho a i ʻole ke kūʻai ʻana i kahi ʻōpala alelo mai ka hapa nui o nā lāʻau lapaʻau. E akahai i kou hoʻomaʻemaʻe ʻana i kou alelo, a hoʻomaka mai ke kua a e hana i kou ala i mua.
Manaʻo ka Australia Dental Association ʻaʻole e holoi i kou waha me ka wai ma hope o kou palaki ʻana i kou mau niho. ʻAe kēia i ka paʻi fluoride e noho lōʻihi ma kou mau niho e hāʻawi iā ʻoe i ka pale hou aku.
ʻO ka floss wale nō inā he ʻāpana ia o kāu hana maʻamau i kēlā me kēia lā.
Inā ua ho'ohana mau 'oe i ka flossing ma mua o kou ho'omaka 'ana i ka lapa'au, hiki iā 'oe ke ho'omau i ka floss.
Inā ʻaʻole ʻoe i floss ma mua, a i ʻole ʻoe i flossed mau, ʻaʻole hoʻomaka i ka wā mālama. Loaʻa paha iā ʻoe ka mumū i loko o kou ʻāʻī inā ʻaʻole ʻoe i holo mua.
Hiki ke ʻoki i ke koko a hoʻonui i kou pilikia o ka maʻi ʻana i ka flossing inā loaʻa ʻoe i ka ʻāʻī.
Inā holo ʻoe a kahe ke koko, e kāpae koke i ka flossing.
Holoi i kou waha me ka waha i ʻōlelo ʻia iā ʻoe a inā ʻaʻole pau ke koko ma hope o kekahi mau minuke, a i ʻole he mau hōʻailona o ka maʻi, e kelepona i kāu kauka.
ʻO nā meaʻai e ʻai a pale ʻia ke loaʻa ʻoe i ka mucositis
Hiki i kekahi mau mea'ai ke ho'onui i ka mucositis a i 'ole e 'eha ke 'ai ke loa'a 'oe i ka mucositis. Eia nō naʻe, he mea nui ka ʻai maikaʻi. Pono e loaʻa i kou kino nā meaʻai kūpono e kōkua iā ʻoe e ola hou. Aia ka papa ma lalo nei i nā meaʻai āu e ʻai ai a ʻaʻole pono e ʻai inā loaʻa iā ʻoe ka mucositis.
Hiki iā ʻoe ke maʻalahi ke inu me kahi mauʻu i hiki iā ʻoe ke hoʻonohonoho i ka mauʻu ma mua o nā wahi ʻeha o ka mucositis. E hōʻoia i ka maʻalili a me ka mahana paha kāu meaʻai a me nā mea inu. E pale i nā meaʻai wela a me nā mea inu.
E ʻai i kēia: | Mai ʻai i kēia: |
hua Hiki i ka tuna a i ʻole ka salmon Nā ʻiʻo kuke lohi Nā noodles palupalu a i ʻole pasta Laiki keʻokeʻo i kuke ʻia ʻO nā mea kanu mashed - ʻo ia ka ʻuala, kāloti pī, ʻuala ʻO ka spinach a i ʻole ke kulina Nā pīni i hoʻomoʻa ʻia Tofu Yoghurt, cottage cheese, milk (inā ʻoe neutropenic, e pale i ka paʻakai palupalu a e hoʻopaʻa i ka waiū a me ka yoghurt i pasteurized) palaoa palupalu ʻĀlana maia ʻO ka meloni a i ʻole nā melon ʻē aʻe ʻO nā poloka hau (ʻalo i nā ʻaoʻao ʻoi o ka ʻeke), jelly a ice-cream kīʻa ʻole ka caffeine ʻO nā protein lulu a i ʻole nā mea smoothies. | ʻOkiʻoki paʻakikī o kaʻiʻo ʻO nā ʻāpana kulina a i ʻole nā ʻāpana crunchy ʻē aʻe ʻO nā meaʻai paʻakikī, ʻuʻuku a maʻa paha e like me nā loli, nā kuki, nā berena ʻōpala, nā pahū a me ka palaoa maloʻo. Pākē ʻO nā hua citrus e like me nā ʻalani, nā lemona, nā limes a me nā mandarins Nā meaʻai paʻakai Nati a hua ʻAla a mango Nā meaʻai wela - wela wela a wela wela ʻO ka caffeine e like me ke kofe a i ʻole nā mea inu ikaika ʻO ka waiʻona e like me ka pia, ka waina, ka waiʻona a me ka waiʻona. |
Ka mālama ʻana i ka waha maloʻo
ʻO ka maloʻo ʻana, nā lāʻau lapaʻau no ka lymphoma, a me nā lāʻau lapaʻau ʻē aʻe e like me ka ʻeha ʻeha hiki ke hoʻomaloʻo i ka waha. He mea paʻakikī ka waha maloʻo ke ʻai, inu a ʻōlelo. Hiki iā ia ke hoʻoulu i kahi uhi keʻokeʻo o ka bacteria e ulu ma kou alelo e hiki ke alakaʻi i ka ʻono ʻino i kou waha, ka hanu ʻino a me ka hilahila.
Hiki i kēia kūkulu ʻana o ka bacteria ke hoʻoulu i nā maʻi i hiki ke lilo i mea koʻikoʻi ʻoiai e nāwaliwali kou ʻōnaehana pale mai ka mālama ʻana.
ʻO ka loaʻa ʻana o ka waha maloʻo no ka manawa lōʻihi hiki ke hoʻonui i kou pilikia o ka pala niho (nā lua o kou mau niho).
E inu i ka liʻiliʻi o 2-3 lita o ka wai i kēlā me kēia lā. E hōʻalo i ka caffeine a me ka waiʻona no ka mea hiki i kēia mau mea ke hōʻino i ka waha maloʻo. ʻO ka hoʻohana ʻana i ka holoi waha e like me ka mea i hōʻike ʻia ma luna nei e kōkua pū i ka waha maloʻo.
Inā lawa ʻole kēia mau holoi waha, hiki iā ʻoe ke kūʻai pani kohu mai kāu lāʻau lapaʻau kūloko. ʻO kēia nā haʻina e kōkua i ka hoʻihoʻi ʻana a me ka pale ʻana i ka makū o kou waha.
xerostomia
ʻO ka huaʻōlelo lapaʻau no ka waha maloʻo ʻo Xerostomia.
He aha ke ʻano o ka mucositis?
- ʻO nā ʻeha i loko o kou waha he ʻulaʻula, keʻokeʻo, e like me ka maʻi ʻeha a i ʻole nā ʻōpala
- ʻO ka pehu ma kou ʻāʻī, waha, a ʻāʻī paha
- ʻEha a ʻoluʻolu paha i ka nau ʻana a me ka ʻai ʻana
- ʻAi keʻokeʻo a melemele paha ma kou waha a ma kou alelo
- Hoʻonui ʻia ka mucus ma ka waha - mānoanoa saliva
- Puʻuwai a i ʻole indigestion.
lapaʻau
ʻAʻole hiki ke pale ʻia ka mucositis i nā manawa a pau, akā aia nā lāʻau lapaʻau e kōkua iā ʻoe e ʻoluʻolu i ka wā e hoʻōla ai.
Kāohi a mālama paha i nā maʻi maʻi
Hiki i kāu kauka ke kauoha i nā lāʻau lapaʻau e pale aku ai iā ʻoe i ka loaʻa ʻana o nā maʻi e like me ka thrush ma kou waha a i ʻole nā ʻeha anu (herpes).
- Anti-viral ʻO ka lāʻau lapaʻau e like me ka valacyclovir hiki ke kōkua i ka pale ʻana a i ʻole ka hōʻemi ʻana i nā ʻeha o ke anuanu i hoʻokumu ʻia e ka maʻi herpes simplex.
- Pākuʻi kūleʻa Hiki ke ho'ohana 'ia ka lā'au lapa'au e like me ka nystatin no ka mālama 'ana i ka ma'i ma'i waha e hiki ke ho'onui i ka mucositis.
- Antibiotics - Inā he wahi haʻihaʻi ʻoe ma kou lehelehe, a i ʻole ma kou waha a i ʻole esophagus hiki iā ʻoe ke loaʻa i ka maʻi bacteria e hōʻeha ai i kou mucositis. Hāʻawi ʻia paha ʻoe i nā lāʻau antibiotic e kōkua i ke kaua ʻana i ka maʻi.
Pahū maikaʻi
- ʻO ka ʻaila ʻo Kenalog a i ʻole bongela (ma luna o ka pā)
- Xylocaine jelly (kaukau wale no).
ʻO nā lāʻau lapaʻau ʻē aʻe
- Panadol hiki ke hoʻoheheʻe - hoʻoheheʻe i ka panadol i loko o ka wai, ʻūlū a puni kou waha a kāmu me ia ma mua o ka ʻai ʻana. Hiki iā ʻoe ke kūʻai i kēia ma ke kūʻai aku ma ka hale kūʻai a i ʻole ka lāʻau lapaʻau.
- Endone - He papa kuhikuhi wale nō kēia. Inā maikaʻi ʻole nā koho i luna, e noi i kāu kauka no ka ʻōlelo kuhikuhi.
Tube Nasogastric
I nā hihia koʻikoʻi loa o ka mucositis, hiki i kāu kauka ke ʻōlelo aku e loaʻa iā ʻoe kahi paipu nasogastric (NGT) e hānai ʻia. ʻO ka NGT he paipu palupalu a maʻalahi i hoʻokomo ʻia i loko o kekahi o kou puka ihu a iho i kou esophagus i loko o kou ʻōpū. ʻO ka meaʻai wai piha i nā meaʻai, a hiki ke waiho ʻia ka wai i lalo o ka paipu. ʻAe kēia iā ʻoe e kiʻi i nā meaʻai a me nā wai āu e pono ai i ka wā e hoʻōla ai kāu mucositis.
hōʻuluʻulu manaʻo
- ʻO ka mucositis kahi hopena maʻamau o ka mālama lymphoma.
- ʻOi aku ka maikaʻi o ka pale ʻana ma mua o ka mālama ʻana, akā ʻaʻole hiki i nā manawa a pau.
- Inā pono, e ʻike i ke kauka niho ma mua o kou hoʻomaka ʻana i ka mālama ʻana - e nīnau i kāu kauka haematologist a i ʻole ʻoncologist inā ʻike ʻoe i kekahi, a ʻo wai kā lākou e ʻōlelo aku ai.
- E hoʻohana i ka pulupulu niho palupalu, e palaki i kou mau niho ma hope o ka ʻai ʻana i ke kakahiaka a me ka pō, a holoi me ka wai holoi waha ʻole ma ka liʻiliʻi 4 manawa i ka lā – Mai poina e hoʻomaʻemaʻe i kou alelo.
- Pono paha ʻoe i ka lāʻau no ka pale a mālama ʻana i nā maʻi.
- E hōʻalo i nā meaʻai e hōʻeha ai ka mucositis a i ʻole ka ʻeha, akā e mālama pono ʻoe e ʻai a inu maikaʻi.
- Hiki ke kōkua i ka ʻaila poni - inā ʻaʻole, e noi i kāu kauka no ke kau ʻana.
- Hiki ke kōkua pū ka panadol soluble a i ʻole nā papa endone inā ʻaʻole lawa ka ʻaila.
- E kamaʻilio me kāu kauka lapaʻau a kauka paha no ka ʻōlelo aʻo hou aku inā ʻaʻole maikaʻi kāu mucositis me nā ʻōlelo aʻoaʻo ma luna.
- Kāhea i kā mākou mau kahu hānai Lymphoma no ka ʻike hou aku a i ʻole ka ʻōlelo aʻoaʻo. Kaomi ma ke pihi hoʻokaʻaʻike mai iā mākou ma lalo o ka pale no nā kikoʻī pili.
