Txheej txheem cej luam ntawm daim tawv nqaij (daim tawv nqaij) lymphoma
Lymphoma yog ib hom mob qog noj ntshav uas pib hauv cov qe ntshav dawb hu ua lymphocytes. Cov qe ntshav no feem ntau nyob hauv peb lub cev lymphatic, tab sis muaj peev xwm taug kev mus rau txhua qhov ntawm peb lub cev. Lawv yog cov hlwb tseem ceeb ntawm peb lub cev tiv thaiv kab mob, tiv thaiv kab mob thiab kab mob, thiab pab lwm lub cev tiv thaiv kab mob ua haujlwm zoo dua.
Hais txog Lymphocytes
Peb muaj ntau hom lymphocytes, nrog rau cov pab pawg tseem ceeb B-cell lymphocytes thiab T-cell lymphocytes. Ob leeg B thiab T-cell lymphocytes muaj lub luag haujlwm tshwj xeeb, muaj "immunological nco". Qhov no txhais tau hais tias thaum peb muaj kab mob, kab mob, lossis yog tias qee lub hlwb puas (lossis hloov pauv), peb cov lymphocytes tshuaj xyuas cov cell thiab tsim tshwj xeeb "nco B lossis T-cells".
Cov hlwb nco no khaws tag nrho cov ntaub ntawv hais txog yuav ua li cas tiv thaiv tus kab mob, lossis kho cov hlwb puas yog tias tib yam kab mob lossis kev puas tsuaj tshwm sim dua. Txoj kev no lawv tuaj yeem rhuav tshem lossis kho cov hlwb sai dua thiab ua tau zoo dua lwm zaus.
- B-cell lymphocytes kuj ua cov tshuaj tiv thaiv kab mob (immunoglobulins) los pab tiv thaiv kab mob.
- T-hlwb pab tswj peb lub cev tiv thaiv kab mob kom peb lub cev tiv thaiv kab mob ua haujlwm zoo los tiv thaiv kab mob, tab sis kuj tseem pab tiv thaiv kev tiv thaiv kab mob thaum kis kab mob.
Lymphocytes tuaj yeem ua cov qog nqaij hlav qog nqaij hlav cancer
Cutaneous lymphomas tshwm sim thaum twg B-hlwb lossis T-cells uas mus rau koj daim tawv nqaij ua qog noj ntshav. Cov qog nqaij hlav qog nqaij hlav cancer ces faib thiab loj hlob tsis tuaj yeem, lossis tsis tuag thaum lawv yuav tsum.
Ob tus neeg laus thiab menyuam yaus tuaj yeem tau txais cov qog nqaij hlav qog nqaij hlav thiab feem ntau cov neeg uas muaj qog nqaij hlav qog nqaij hlav yuav muaj cov qog nqaij hlav T-hlwb. Tsuas yog kwv yees li 5 ntawm txhua 20 tus neeg uas muaj cov qog nqaij hlav qog nqaij hlav yuav muaj B-cell lymphoma.
Cutaneous lymphomas kuj muab faib ua:
- Indolent - Indolent lymphomas loj hlob qeeb thiab feem ntau dhau mus rau theem uas lawv "pw tsaug zog" ua rau tsis muaj kev phom sij rau koj. Tej zaum koj yuav tsis xav tau kev kho mob yog tias koj muaj tus kab mob qog nqaij hlav hauv plab, txawm tias qee tus neeg yuav. Feem ntau indolent lymphomas tsis kis mus rau lwm qhov ntawm koj lub cev, tab sis qee qhov tuaj yeem npog ntau qhov chaw ntawm daim tawv nqaij. Nyob rau tib lub sijhawm, qee cov qog nqaij hlav hauv plab tuaj yeem ua rau theem siab, txhais tau tias lawv kis mus rau lwm qhov ntawm koj lub cev, tab sis qhov no tsis tshua muaj feem ntau cov qog ntshav qog ntshav.
- Hais lus phem - Aggressive lymphomas yog lymphomas loj hlob sai uas tuaj yeem loj hlob sai thiab kis mus rau lwm qhov ntawm koj lub cev. Yog tias koj muaj mob qog nqaij hlav qog nqaij hlav, koj yuav tsum pib kho sai sai tom qab koj tau kuaj pom tus kab mob.
Cov tsos mob ntawm Cutaneous Lymphoma
Indolent daim tawv nqaij lymphoma
Tej zaum koj yuav tsis muaj cov tsos mob tshwm sim yog tias koj muaj tus mob qog nqaij hlav hauv plab. Vim tias cov qog ntshav qog ntshav tsis loj hlob qeeb, lawv loj hlob ntau xyoo, yog li cov pob liab liab los yog qhov txhab ntawm koj daim tawv nqaij yuav tsis pom. Yog tias koj tau txais cov tsos mob lawv yuav suav nrog:
- ib pob khaus uas tsis ploj mus
- khaus lossis mob qhov chaw ntawm koj daim tawv nqaij
- flat, reddish, scaly thaj ua rau ntawm daim tawv nqaij
- cov mob uas tuaj yeem tawg thiab los ntshav thiab tsis kho raws li qhov xav tau
- generalized redness tshaj qhov chaw ntawm daim tawv nqaij
- ib zaug, los yog ntau pob ntawm koj daim tawv nqaij
- Yog tias koj muaj tawv nqaij tawv, koj tuaj yeem muaj cov tawv nqaij sib dua li lwm tus (tsis yog liab).
Patches, papules, plaques thiab qog - Dab tsi yog qhov txawv?
Cov kab mob uas koj muaj nrog cov qog nqaij hlav qog nqaij hlav tuaj yeem ua pob liab liab, lossis tuaj yeem raug hu ua thaj ua rau thaj, papules, plaques lossis qog.
Patches - feem ntau yog thaj chaw tiaj ntawm daim tawv nqaij uas txawv ntawm daim tawv nqaij ncig nws. Lawv tuaj yeem ua tau du lossis scaly thiab tuaj yeem zoo li cov pob liab liab.
Cov ntsiav tshuaj - yog qhov me me, tawv tawv tawv, thiab tej zaum yuav zoo li pob ntxau tawv.
Cov Qhua - yog thaj chaw tawv tawv ntawm cov tawv nqaij uas feem ntau tsa me ntsis, tuab ntawm cov tawv nqaij uas feem ntau scaly. Plaques feem ntau tuaj yeem yuam kev rau eczema lossis psoriasis.
Cov qog nqaij hlav - yog pob pob, pob los yog nodules uas tej zaum yuav ua mob uas tsis kho.
Aggressive thiab Advanced cutaneous lymphoma
Yog tias koj muaj mob hnyav lossis mob qog nqaij hlav qog nqaij hlav, koj tuaj yeem muaj cov tsos mob saum toj no, tab sis koj kuj yuav muaj lwm yam tsos mob. Cov no tuaj yeem suav nrog:
- Cov qog nqaij hlav o uas koj tuaj yeem pom lossis hnov zoo li pob hauv qab koj daim tawv nqaij - cov no feem ntau yuav nyob hauv koj lub caj dab, caj dab lossis puab tais.
- Kev qaug zog uas yog kev nkees heev tsis zoo tuaj nrog so lossis pw tsaug zog.
- Los ntshav los yog bruising.
- Cov kab mob uas rov qab los los tsis ploj mus.
- Ua tsis taus pa.
- B-cov tsos mob.
Yuav kuaj li cas cutaneous lymphoma?
Koj yuav xav tau ib qho biopsy lossis ob peb biopsies los kuaj xyuas cov qog nqaij hlav qog nqaij hlav. Hom biopsy koj muaj yuav nyob ntawm seb hom pob liab liab lossis qhov txhab uas koj muaj, qhov twg lawv nyob ntawm koj lub cev thiab lawv loj npaum li cas. Nws tseem yuav nyob ntawm seb nws tsuas yog koj cov tawv nqaij uas raug cuam tshuam, lossis yog tias cov qog ntshav qog tau kis mus rau lwm qhov ntawm koj lub cev xws li koj cov qog nqaij hlav, lub cev, cov ntshav lossis cov pob txha. Qee hom biopsies uas yuav raug pom zoo rau koj tau teev tseg hauv qab no.
Nqaij xyoob tawv nqaij
Daim tawv nqaij biopsy yog thaum cov qauv ntawm koj cov pob liab liab los yog qhov txhab raug tshem tawm thiab xa mus rau kev kuaj mob. Qee qhov xwm txheej, yog tias koj muaj qhov mob ib leeg, tag nrho cov kab mob yuav raug tshem tawm. Muaj ntau txoj hauv kev los ua daim tawv nqaij biopsy, thiab koj tus kws kho mob yuav tuaj yeem tham nrog koj txog qhov zoo ntawm daim tawv nqaij biopsy rau koj qhov xwm txheej.
Lymph node biopsy
Yog tias koj muaj cov qog nqaij hlav o uas tuaj yeem pom lossis hnov mob, lossis uas tau tshwm sim ntawm kev soj ntsuam, koj tuaj yeem kuaj xyuas seb tus lymphoma tau kis mus rau koj cov qog nqaij hlav. Muaj ob lub ntsiab ntawm lymph node biopsies siv los kuaj xyuas lymphoma.
Lawv muaj xws li:
Siv rab koob muab siv - qhov twg ib rab koob siv los tshem tawm cov qauv ntawm koj cov qog nqaij hlav. Koj yuav muaj tshuaj loog hauv zos kom loog qhov chaw kom koj tsis txhob hnov qab txog qhov mob no. Qee zaum, tus kws kho mob lossis tus kws kho mob radiologist tuaj yeem siv ultrasound coj tus koob mus rau qhov chaw zoo rau kev kuaj ntshav.
Kev kuaj ntshav biopsy - Nrog rau kev kuaj ntshav biopsy koj yuav muaj cov tshuaj loog dav dav kom koj tsaug zog los ntawm tus txheej txheem. Tag nrho cov qog ntshav los yog qhov txhab raug tshem tawm thaum lub sij hawm excisional biopsy yog li tag nrho cov node los yog qhov txhab tuaj yeem kuaj xyuas hauv pathology rau cov tsos mob ntawm lymphoma. Tej zaum koj yuav muaj ob peb stitches thiab hnav khaub ncaws thaum koj sawv. Koj tus kws saib xyuas neeg mob yuav tuaj yeem tham nrog koj txog kev tu lub qhov txhab, thiab thaum twg / yog tias koj xav tau tshem cov stitches.
Subtypes ntawm indolent cutaneous T-cell lymphomas
Mycosis Fungoides yog hom kab mob feem ntau ntawm cov tawv nqaij tawv nqaij T-cell lymphoma. Nws feem ntau cuam tshuam rau cov neeg laus, thiab cov txiv neej me ntsis ntau dua li cov poj niam, tab sis cov me nyuam kuj tuaj yeem tsim MF. Hauv cov menyuam yaus nws cuam tshuam rau cov tub thiab ntxhais sib npaug thiab feem ntau kuaj pom muaj hnub nyoog 10 xyoo.
MF feem ntau tsuas yog cuam tshuam rau koj cov tawv nqaij, tab sis li ntawm 1 ntawm 10 tus neeg yuav muaj ntau hom MF uas tuaj yeem kis rau koj cov qog nqaij hlav, ntshav thiab cov kab mob hauv nruab nrog cev. Yog tias koj muaj MF txhoj puab heev, koj yuav xav tau kev kho mob zoo ib yam li cov kev kho mob uas tau muab rau lwm cov qog nqaij hlav T-cell lymphoma aggressive.
Primary cutaneous ALCL yog ib qho mob qog nqaij hlav (loj hlob qeeb) uas pib hauv T-cells hauv cov khaubncaws sab nraud povtseg ntawm koj cov tawv nqaij.
Hom lymphoma no qee zaum hu ua subtype of cutaneous lymphoma thiab qee zaum hu ua subtype of Anaplastic Loj Cell Lymphoma (ALCL). Yog vim li cas rau cov kev faib tawm txawv yog vim cov qog ntshav qog ntshav muaj cov yam ntxwv zoo sib xws rau lwm hom ALCL xws li ua cov hlwb loj heev uas zoo li txawv ntawm koj cov T-cells ib txwm. Txawm li cas los xij, nws feem ntau tsuas yog cuam tshuam rau koj cov tawv nqaij thiab loj hlob qeeb heev.
Tsis zoo li aggressive subtypes ntawm cutaneous lymphoma thiab ALCL, tej zaum koj yuav tsis xav tau kev kho mob rau PcALCL. Tej zaum koj yuav nyob nrog PcALCL rau tag nrho koj lub neej, tab sis nws yog ib qho tseem ceeb kom paub, tias koj tuaj yeem ua neej nyob nrog nws, thiab nws yuav tsis muaj qhov tsis zoo rau koj txoj kev noj qab haus huv. Nws feem ntau tsuas cuam tshuam rau koj cov tawv nqaij thiab heev tsis tshua muaj kis koj cov tawv nqaij mus rau lwm qhov ntawm koj lub cev.
PcALCL feem ntau pib nrog pob pob los yog pob ntawm koj cov tawv nqaij uas yuav khaus lossis mob, tab sis kuj yuav tsis ua rau koj tsis xis nyob. Qee zaum, nws yuav zoo li mob uas tsis zoo li koj xav tau. Ib qho kev kho mob ntawm PcALCL yuav yog los txhim kho qhov khaus lossis mob, lossis txhim kho qhov zoo ntawm lymphoma es tsis yog kho cov lymphoma nws tus kheej. Txawm li cas los xij, yog tias PcALCL tsuas yog cuam tshuam rau thaj tsam me me ntawm daim tawv nqaij, nws yuav raug tshem tawm nrog kev phais lossis los ntawm kev siv xov tooj cua.
PcALCL feem ntau tshwm sim rau cov neeg muaj hnub nyoog 50-60 xyoo, tab sis tuaj yeem cuam tshuam rau txhua tus hnub nyoog, suav nrog menyuam yaus.
SPTCL tuaj yeem tshwm sim hauv cov menyuam yaus thiab cov neeg laus tab sis muaj ntau dua rau cov neeg laus, nrog rau qhov nruab nrab hnub nyoog ntawm kev kuaj mob yog 36 xyoo. Nws yog lub npe hu ua qhov no vim tias nws zoo li lwm yam mob hu ua panniculitis, uas tshwm sim thaum cov nqaij rog hauv qab ntawm daim tawv nqaij tau o, ua rau pob txha loj tuaj. Kwv yees li ntawm ib ntawm tsib tus neeg uas muaj SPTCL tseem yuav muaj tus kab mob auto-immune uas twb muaj lawm uas ua rau koj lub cev tiv thaiv kab mob tawm tsam koj lub cev.
SPTCL tshwm sim thaum cov qog nqaij hlav T-hlwb mus rau thiab nyob twj ywm hauv cov txheej txheem sib sib zog nqus ntawm koj cov tawv nqaij thiab cov nqaij rog, ua rau cov pob txha tuaj rau hauv koj daim tawv nqaij uas koj tuaj yeem pom lossis hnov. Koj tuaj yeem pom qee cov plaques ntawm koj daim tawv nqaij. Feem ntau cov kab mob yog nyob ib ncig ntawm 2 cm loj los yog tsawg dua.
Lwm yam kev mob tshwm sim uas koj tuaj yeem tau txais nrog SPTCL suav nrog:
- ntshav txhaws lossis los ntshav txawv txawv
- tshee
- haemophagocytic lymphohistiocytosis - ib qho mob uas koj muaj ntau lub cev tiv thaiv kab mob uas ua rau muaj kev puas tsuaj rau koj cov pob txha, cov qe ntshav thiab cov kabmob.
- Lub siab loj thiab/los yog tus po.
Lymphomatoid papulosis (LyP) tuaj yeem cuam tshuam rau menyuam yaus thiab cov neeg laus. Nws tsis yog mob qog noj ntshav yog li tsis yog hom lymphoma. Txawm li cas los xij, nws raug suav hais tias yog ib qho ua ntej rau cutaneous T-cell lymphoma xws li Mycosis Fungoides lossis Primary Cutaneous Anaplastic Loj Cell Lymphoma, thiab tsis tshua muaj ntau dua. Hodgkin Lymphoma. Yog tias koj tau kuaj pom tus mob no koj yuav tsis xav tau kev kho mob, tab sis yuav raug saib xyuas los ntawm koj tus kws kho mob kom ze rau txhua yam cim ntawm LyP tig mus rau mob qog noj ntshav.
Nws yog ib qho mob uas cuam tshuam rau koj cov tawv nqaij uas koj yuav muaj pob uas tuaj thiab mus rau ntawm koj daim tawv nqaij. Cov kab mob yuav pib me me thiab loj tuaj. Lawv tuaj yeem tawg thiab los ntshav ua ntej ziab thiab tawm mus yam tsis muaj kev kho mob. Nws tuaj yeem siv li 2 lub hlis kom qhov txhab ploj mus. Txawm li cas los xij, yog tias lawv ua rau mob lossis khaus lossis lwm yam tsos mob tsis xis nyob koj yuav tau kho kom zoo dua cov tsos mob no.
Yog tias koj nquag tau pob liab liab los yog qhov txhab zoo li no, mus ntsib koj tus kws kho mob kom kuaj pom tus kab mob.
Subtypes ntawm indolent B-cell cutaneous lymphomas
Primary Cutaneous Follicle Center Lymphoma (pcFCL) yog ib qho kev loj hlob qeeb (loj hlob qeeb) B-cell lymphoma. Nws tshwm sim nyob rau sab hnub poob ntiaj teb thiab cuam tshuam rau cov neeg laus, nrog rau qhov nruab nrab hnub nyoog ntawm kev kuaj mob yog 60 xyoo.
Qhov no yog qhov feem ntau subtype ntawm Cutaneous B-Cell Lymphoma. Nws yog feem ntau indolent (loj hlob qeeb) thiab loj hlob ntau lub hlis, lossis txawm xyoo. Nws feem ntau tshwm li pob liab liab los yog xim av los yog qog ntawm daim tawv nqaij ntawm koj lub taub hau, caj dab, hauv siab, lossis plab. Ntau tus neeg yuav tsis xav tau kev kho mob rau pcFCL tab sis yog tias koj muaj cov tsos mob tsis xis nyob, lossis muaj teeb meem los ntawm nws qhov tsos, koj tuaj yeem tau txais kev kho mob los txhim kho cov tsos mob lossis cov tsos mob ntawm lymphoma.
Primary Cutaneous Marginal Zone Lymphoma (pcMZL) yog qhov thib ob feem ntau subtype ntawm B-cell cutaneous lymphomas thiab cuam tshuam rau cov txiv neej ob zaug ntau npaum li cov poj niam, tab sis nws kuj tuaj yeem tshwm sim hauv cov menyuam yaus. Nws muaj ntau dua rau cov neeg laus hnub nyoog tshaj 55 xyoo, thiab cov neeg uas tau kis tus kab mob Lyme yav dhau los.
Kev hloov ntawm daim tawv nqaij tuaj yeem tsim nyob rau hauv ib qho chaw, lossis ntau qhov chaw nyob ib puag ncig koj lub cev. Feem ntau nws pib ntawm koj txhais caj npab, hauv siab los yog rov qab li paj yeeb, liab lossis liab doog los yog pob.
Cov kev hloov no tshwm sim nyob rau lub sij hawm ntev, yog li tej zaum yuav tsis pom ntau. Tej zaum koj yuav tsis xav tau kev kho mob ntawm pcMZL, tab sis muaj kev kho mob yog tias koj muaj cov tsos mob uas ua rau koj txhawj xeeb.
Qhov no yog ib hom kab mob tsawg heev ntawm CBCL pom nyob rau hauv cov neeg mob uas tsis muaj zog tiv thaiv kab mob thiab tau muaj tus kab mob Epstein-Barr - tus kab mob uas ua rau mob qog nqaij hlav.
Tej zaum koj yuav tsuas muaj ib qho mob ntawm koj daim tawv nqaij lossis hauv koj lub plab lossis lub qhov ncauj. Cov neeg feem coob tsis xav tau kev kho mob rau qhov subtype ntawm CBCL. Txawm li cas los xij, yog tias koj noj cov tshuaj tiv thaiv kab mob, koj tus kws kho mob yuav tshuaj xyuas cov tshuaj kom tso cai rau koj lub cev tiv thaiv kab mob kom rov zoo me ntsis.
Muaj tsawg zaus, koj yuav xav tau kev kho mob nrog monoclonal antibody lossis tshuaj tiv thaiv kab mob.
Subtypes ntawm Aggressive Lymphoma
Sezary Syndrome yog li ntawd lub npe vim hais tias cov qog nqaij hlav T-hlwb hu ua Sezary hlwb.
Nws yog qhov mob hnyav tshaj plaws ntawm T-cell lymphoma (CTCL) thiab tsis zoo li lwm hom CTCL, cov qog nqaij hlav qog nqaij hlav (Sezary) pom tsis tau tsuas yog nyob rau hauv cov khaubncaws sab nraud povtseg ntawm koj cov tawv nqaij, tab sis kuj nyob rau hauv koj cov ntshav thiab pob txha pob txha. Lawv kuj tuaj yeem kis mus rau koj cov qog nqaij hlav thiab lwm yam kabmob.
Sezary Syndrome tuaj yeem cuam tshuam rau leej twg tab sis feem ntau me ntsis hauv cov txiv neej hnub nyoog tshaj 60 xyoo.
Cov tsos mob koj tuaj yeem tau nrog Sezary Syndrome muaj xws li:
- B-cov tsos mob
- khaus hnyav
- o cov qog ntshav o
- mob siab thiab/lossis tus po
- thickening ntawm daim tawv nqaij ntawm xib teg ntawm koj txhais tes los yog ob txhais taw
- thickening ntawm koj cov ntiv tes thiab cov ntiv taw
- cov plaub hau tsis
- drooping ntawm koj lub qhov muag lub hau (qhov no yog hu ua ectropion).
Vim tias qhov loj hlob sai ntawm cov hlwb Sezary, koj tuaj yeem teb tau zoo rau kev kho mob uas ua haujlwm los ntawm kev rhuav tshem cov hlwb sai. Txawm li cas los xij, kev rov qab los yog tshwm sim nrog Sezary Syndrome, txhais tau tias txawm tias tom qab cov lus teb zoo, nws zoo li tus kab mob yuav rov qab los thiab xav tau kev kho mob ntxiv.
Qhov no yog ib qho tsis tshua muaj thiab txhoj puab heev T-cell lymphoma uas ua rau ntau qhov nqaij tawv nqaij loj hlob sai ntawm daim tawv nqaij thoob plaws lub cev. Cov kab mob tuaj yeem yog papules, nodules lossis qog nqaij hlav uas tuaj yeem ua rau mob thiab tshwm sim raws li qhov mob qhib. Qee tus yuav zoo li cov plaques lossis thaj ua rau thaj thiab qee qhov yuav los ntshav.
Lwm cov tsos mob tuaj yeem suav nrog:
- B-cov tsos mob
- Poob tsis qab los noj mov
- qaug zog
- raws plab
- ntuav
- o cov qog ntshav o
- daim siab loj los yog tus po.
Vim yog qhov ua phem, PCAETL tuaj yeem kis mus rau thaj chaw hauv koj lub cev nrog rau cov qog ntshav thiab lwm yam kabmob.
Koj yuav xav tau kev kho mob nrog kws khomob sai sai tom qab kuaj mob.
Primary Cutaneous (tawv nqaij) Diffuse Loj B-cell cov mob ntsws yog ib hom kab mob qog nqaij hlav tsawg tsawg uas cuam tshuam tsawg dua 1 ntawm 100 tus neeg nrog NHL.
Qhov no tsis tshua muaj ntau dua li lwm cov subtypes ntawm Cutaneous B-Cell Lymphomas. Nws muaj ntau dua rau cov poj niam ntau dua li cov txiv neej thiab nyiam ua nruj lossis loj hlob sai. Qhov no txhais tau hais tias zoo li cuam tshuam rau koj cov tawv nqaij, nws tuaj yeem kis mus rau lwm qhov ntawm koj lub cev, suav nrog koj cov qog nqaij hlav thiab lwm yam kabmob.
Nws tuaj yeem txhim kho ntau lub lis piam mus rau hli, thiab nws feem ntau cuam tshuam rau cov neeg laus nyob ib puag ncig ntawm 75 xyoo. Nws feem ntau pib ntawm koj ob txhais ceg (Leg-type) ua ib lossis ntau qhov mob / qog tab sis tuaj yeem loj hlob ntawm koj txhais tes thiab lub cev (hauv siab, nraub qaum thiab plab).
Nws yog hu ua Primary Cutaneous Diffuse Loj B-cell Lymphoma vim tias thaum nws pib hauv B-hlwb hauv cov khaubncaws sab nraud povtseg ntawm koj cov tawv nqaij, cov qog nqaij hlav qog nqaij hlav zoo ib yam li cov muaj nyob hauv lwm cov subtypes ntawm Diffuse Loj B-cell Lymphoma (DLBCL). Vim li no, qhov no subtype ntawm cutaneous B-cell Lymphoma feem ntau kho zoo ib yam li lwm yam subtypes ntawm DLBCL. Yog xav paub ntxiv txog DLBCL, nyem qhov no.
Staging ntawm Cutaneous Lymphoma
Thaum nws tau raug lees paub tias koj muaj tus kab mob qog nqaij hlav qog nqaij hlav, koj yuav tsum tau kuaj ntau ntxiv kom pom tias lymphoma tau kis mus rau lwm qhov ntawm koj lub cev.
Kev kuaj lub cev
Koj tus kws kho mob yuav kuaj xyuas lub cev thiab xyuas cov tawv nqaij thoob plaws koj lub cev kom pom tias koj cov tawv nqaij cuam tshuam los ntawm lymphoma ntau npaum li cas. Tej zaum lawv yuav thov kom koj qhov kev tso cai thaij duab kom lawv muaj cov ntaub ntawv uas nws zoo li ua ntej koj pib kho. Lawv mam li siv cov no los xyuas seb puas muaj kev txhim kho nrog kev kho mob. Kev tso cai yog koj xaiv, koj tsis tas yuav muaj cov duab yog tias koj tsis xis nyob nrog qhov no, tab sis yog tias koj pom zoo, koj yuav tsum tau kos npe rau daim ntawv tso cai.
Positron Emission Tomography (PET) Scan
PET scan yog ib qho scan ntawm koj lub cev tag nrho. Nws tau ua tiav hauv ntu tshwj xeeb ntawm lub tsev kho mob hu ua "nuclear tshuaj" thiab koj yuav tau txais kev txhaj tshuaj ntawm cov tshuaj radioactive uas cov qog ntshav qog ntshav tau nqus. Thaum lub scan raug coj mus, cov cheeb tsam uas muaj lymphoma ces teeb rau ntawm lub scan kom pom qhov chaw lymphoma thiab qhov loj thiab cov duab ntawm nws.
Xam Xaj Tomography (CT) scan
CT scan yog ib qho X-ray tshwj xeeb uas siv 3 qhov duab ntawm sab hauv koj lub cev. Feem ntau nws yuav siv sij hawm soj ntsuam ntawm thaj tsam ntawm koj lub cev xws li koj lub hauv siab, lub plab lossis lub plab mog. Cov duab no tuaj yeem qhia tau yog tias koj muaj cov qog nqaij hlav o tob hauv koj lub cev, lossis cov chaw uas zoo li mob qog noj ntshav hauv koj lub cev.
Bone Marrow Biopsy
Feem ntau cov neeg mob qog nqaij hlav qog nqaij hlav yuav tsis xav tau cov pob txha pob txha. Txawm li cas los xij, yog tias koj muaj qhov mob hnyav, koj yuav xav tau ib qho los xyuas seb cov lymphoma tau kis mus rau koj cov pob txha.
Ob hom biopsies raug coj mus kuaj thaum lub sijhawm kuaj pob txha:
- Pob txha pob txha aspirate (BMA): Qhov kev ntsuam xyuas no siv cov kua me me hauv cov pob txha pob txha
- Pob txha pob txha aspirate trephine (BMAT): Qhov kev sim no siv cov qauv me me ntawm cov pob txha pob txha
TNM / B staging system rau cutaneous lymphoma
Kev kho mob ntawm daim tawv nqaij lymphoma siv ib qho system hu ua TNM. Yog tias koj muaj MF lossis SS yuav muaj ib tsab ntawv ntxiv ntxiv - TNMB.
T = loj Tumour - lossis ntau npaum li cas ntawm koj lub cev raug cuam tshuam los ntawm lymphoma.
N = lymph Nodes koom nrog - xyuas seb cov lymphoma tau mus rau koj cov qog nqaij hlav, thiab muaj pes tsawg cov qog nqaij hlav lymphoma hauv lawv.
M = Metastasis - xyuas seb, thiab nyob deb npaum li cas cov lymphoma tau kis hauv koj lub cev.
B = Blood – (MF lossis SS nkaus xwb) kuaj seb lymphoma nyob rau hauv koj cov ntshav thiab cov pob txha ntau npaum li cas.
TNM/B Staging of Cutaneous Lymphoma |
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Cutaneous Lymphoma |
Mycosis fungoides (MF) lossis Sezary Syndrome (SS) nkaus xwb |
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TLub Pob Tawblos yog daim tawv nqaijcuam tshuam |
T1 - Koj tsuas muaj ib qho mob xwb.T2 - Koj muaj ntau dua ib daim tawv nqaij tab sis qhov txhab nyob rau hauv ib cheeb tsam, los yog ob qhov chaw nyob ze ua ke koj lub cev.T3 - Koj muaj qhov txhab nyob rau ntau qhov chaw ntawm koj lub cev. |
T1 - Tsawg dua 10% ntawm koj cov tawv nqaij raug cuam tshuam.T2 - Ntau tshaj 10% ntawm koj cov tawv nqaij raug cuam tshuam.T3 - koj muaj ib lossis ntau cov qog loj dua 1cm.T4 - koj muaj erythema (redness) npog ntau tshaj 80% ntawm koj lub cev. |
NLymphNodes |
N0 - koj cov qog nqaij hlav zoo li qub.N1 - ib pawg ntawm cov qog ntshav qab zib tau koom nrog.N2 - ob lossis ntau pawg ntawm cov qog ntshav qab zib cuam tshuam rau hauv koj lub caj dab, saum koj lub clavicle, underarms, pob txha los yog hauv caug.N3 - cov qog ntshav hauv, lossis ze koj lub hauv siab, lub ntsws thiab cov hlab ntsha, cov hlab ntsha loj (aortic) lossis lub duav. |
N0 - Koj cov qog ntshav qab zib zoo li qub.N1 - Koj muaj cov qog ntshav qog ntshav txawv txav nrog kev hloov pauv qib qis.N2 - Koj muaj cov qog nqaij hlav txawv txav nrog kev hloov pauv qib siab.Nx – Koj muaj cov qog ntshav qog txawv txawv, tab sis qib tsis paub. |
Mmetastasis(kis mus) |
M0 - Tsis muaj ib qho ntawm koj cov qog nqaij hlav raug cuam tshuam.M1 - lymphoma tau kis mus rau koj cov qog nqaij hlav sab nraud ntawm koj daim tawv nqaij. |
M0 - Tsis muaj ib qho ntawm koj lub cev hauv nruab nrog cev, xws li lub ntsws, lub siab, lub raum, lub hlwb.M1 - lymphoma tau kis mus rau ib lossis ntau dua ntawm koj lub cev. |
Bntshav |
N / A |
B0 - tsawg dua 5% (5 ntawm txhua 100) cov qog nqaij hlav qog noj ntshav hauv koj cov ntshav.Cov qog nqaij hlav cancer hauv koj cov ntshav no hu ua Sezary cells.B1 - Ntau tshaj 5% ntawm cov lymphocytes hauv koj cov ntshav yog Sezary hlwb.B2 - Ntau tshaj 1000 Sezary hlwb hauv ib qho me me (1 microliter) ntawm koj cov ntshav. |
Koj tus kws kho mob tuaj yeem siv lwm cov ntawv xws li "a" lossis "b" los piav qhia ntxiv txog koj cov qog ntshav qog ntshav. Cov no tuaj yeem xa mus rau qhov loj ntawm koj cov qog ntshav qog ntshav, txoj hauv kev uas cov hlwb zoo li, thiab seb lawv txhua tus tuaj ntawm ib lub xovtooj tsis zoo (clones) lossis ntau dua ib lub xovtooj tsis zoo.Nug koj tus kws kho mob kom piav qhia koj tus kheej theem thiab qib, thiab nws txhais li cas rau koj txoj kev kho mob. |
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Kev kho mob rau Indolent Cutaneous Lymphoma
Feem ntau cov lymphomas tsis tuaj yeem kho tsis tau txawm tias qhov no, ntau tus neeg uas muaj cov qog nqaij hlav hauv plab yuav tsis xav tau kev kho mob.
Indolent cutaneous lymphomas kuj feem ntau tsis muaj teeb meem rau koj txoj kev noj qab haus huv, yog li txhua yam kev kho mob uas koj muaj yuav yog tswj koj cov tsos mob ntau dua li kho koj tus kab mob.
Qee cov tsos mob uas yuav tau txais txiaj ntsig los ntawm kev kho mob muaj xws li:
- mob
- khaus
- qhov txhab los yog mob uas ua rau los ntshav
- kev txaj muag lossis kev ntxhov siab cuam tshuam txog txoj kev lymphoma zoo li.
Hom kev kho mob tuaj yeem suav nrog cov hauv qab no.
Kev kho mob hauv zos lossis tawv nqaij.
Kev kho mob pleev xim yog cov tshuaj pleev xim uas koj rub rau hauv thaj tsam ntawm lymphoma, thaum kho cov tawv nqaij tuaj yeem suav nrog kev kho hluav taws xob lossis kev kho mob phototherapy. Hauv qab no yog cov ntsiab lus ntawm qee cov kev kho mob uas koj tuaj yeem muab.
Corticosteroids - yog tshuaj lom rau lymphoma hlwb thiab pab ua kom puas. Lawv tuaj yeem txo qhov mob thiab pab txhim kho cov tsos mob xws li khaus khaus.
Retinoids - yog cov tshuaj zoo ib yam li vitamin A. Lawv tuaj yeem pab txo qhov mob, thiab tswj kev loj hlob ntawm cov hlwb ntawm daim tawv nqaij. Lawv tau siv tsawg dua, tab sis muaj txiaj ntsig zoo rau qee yam ntawm daim tawv nqaij lymphoma.
Phototherapy – yog hom kev kho mob uas siv lub teeb tshwj xeeb (feem ntau UV) ntawm thaj chaw ntawm koj cov tawv nqaij cuam tshuam los ntawm lymphoma. UV cuam tshuam nrog cov txheej txheem loj hlob ntawm lub hlwb, thiab los ntawm kev ua kom cov txheej txheem loj hlob, cov qog ntshav qog raug puas tsuaj.
Radiotherapy - siv X-rays los ua kev puas tsuaj rau lub cell DNA (cov khoom siv caj ces ntawm lub cell) uas ua rau nws tsis tuaj yeem ua rau lymphoma kho nws tus kheej. Qhov no ua rau lub cell tuag. Nws feem ntau yuav siv li ob peb hnub lossis txawm lub lis piam tom qab kev kho hluav taws xob pib rau lub hlwb kom tuag. Cov nyhuv no tuaj yeem kav ntev li ob peb lub hlis, txhais tau hais tias cov qog nqaij hlav qog nqaij hlav cancer hauv thaj chaw kho mob tuaj yeem raug rhuav tshem txawm tias lub hlis tom qab kev kho mob tiav lawm.
Qee zaum koj yuav raug phais, nyob rau hauv ib qho chaw hauv zos lossis cov tshuaj loog kom tshem tawm tag nrho thaj chaw ntawm daim tawv nqaij cuam tshuam los ntawm lymphoma. Qhov no yuav muaj ntau dua yog tias koj muaj ib qho mob lossis ntau qhov txhab me me. Nws yog feem ntau siv los ua ib feem ntawm cov txheej txheem los kuaj xyuas koj cov lymphoma, tsis yog kev kho mob.
Kev kho mob
Yog tias koj muaj ntau qhov chaw ntawm koj lub cev uas cuam tshuam los ntawm lymphoma, koj tuaj yeem tau txais txiaj ntsig los ntawm kev kho mob xws li tshuaj tua kab mob, tshuaj tiv thaiv kab mob lossis kev kho mob. Cov no tau piav qhia ntau ntxiv hauv nqe lus tom ntej - Kev kho mob rau cov qog nqaij hlav qog nqaij hlav aggressive.
Kev kho mob rau Aggressive lossis Advanced Cutaneous Lymphoma
Kev txhoj puab heev thiab / lossis cov qog ntshav qog ntshav siab tau kho zoo ib yam li lwm hom qog ntshav qog ntshav thiab tuaj yeem suav nrog:
Kev kho mob
Tshuaj kho mob yog ib hom kev kho mob uas ncaj qha tawm tsam cov cell loj hlob sai, yog li nws tuaj yeem ua tau zoo ntawm kev rhuav tshem cov lymphomas sai. Tab sis nws tsis tuaj yeem qhia qhov txawv ntawm kev noj qab haus huv thiab mob qog noj ntshav sai sai, yog li nws tuaj yeem ua rau qee qhov kev mob tshwm sim tsis zoo xws li plaub hau poob, xeev siab thiab ntuav, lossis raws plab lossis cem quav.
Immunotherapies tuaj yeem pab koj lub cev tiv thaiv kab mob kom pom thiab tawm tsam cov qog ntshav qab zib kom zoo dua. Lawv tuaj yeem ua qhov no hauv ntau txoj hauv kev. Qee qhov, xws li cov tshuaj tiv thaiv kab mob monoclonal txuas rau lymphoma los pab koj lub cev tiv thaiv kab mob "pom" cov lymphoma kom nws tuaj yeem paub thiab rhuav tshem nws. Lawv kuj tuaj yeem cuam tshuam cov qauv ntawm cov phab ntsa lymphoma, ua rau lawv tuag.
- Rituximab yog ib qho piv txwv ntawm cov tshuaj tiv thaiv kab mob monoclonal uas yuav raug siv los kho tuaj B-cell lymphomas suav nrog cutaneous B-cell lymphoma yog tias lawv muaj CD20 cim rau lawv.
- Mogamulizumab yog ib qho piv txwv ntawm monoclonal antibody pom zoo rau cov neeg muaj Mycosis Fungides lossis Sezary Syndrome.
- Brentuximab vedotin yog ib qho piv txwv ntawm "conjugated" monoclonal antibody uas tau pom zoo rau qee yam ntawm lwm yam T-xov tooj lymphoma uas muaj CD30 cim rau lawv. Nws muaj cov kab mob sib txuas (conjugated) rau cov tshuaj tiv thaiv kab mob, thiab cov tshuaj tiv thaiv kab mob xa cov tshuaj lom ncaj qha mus rau hauv lub lymphoma cell kom puas nws los ntawm sab hauv.
Lwm tus, xws li interleukins thiab interferons yog cov protein tshwj xeeb uas tshwm sim hauv peb lub cev, tab sis kuj tuaj yeem siv los ua tshuaj. Lawv ua haujlwm los ntawm kev txhawb nqa koj lub cev tiv thaiv kab mob, pab nws kom sawv lwm lub cev tiv thaiv kab mob, thiab los ntawm kev qhia koj lub cev kom ua kom lub cev tiv thaiv kab mob ntau dua los tua cov qog ntshav.
Koj tuaj yeem muaj kev tiv thaiv kab mob ntawm lawv tus kheej, lossis ua ke nrog lwm hom kev kho mob xws li kws khomob.
Targeted therapies yog cov tshuaj uas ua rau lub hom phiaj ib yam dab tsi tshwj xeeb rau lymphoma cell, yog li lawv feem ntau muaj kev phiv tsawg dua li lwm yam kev kho mob. Cov tshuaj no ua haujlwm los ntawm kev cuam tshuam cov cim qhia tias lymphoma hlwb xav tau kom muaj sia nyob. Thaum lawv tsis tau txais cov cim no, cov qog ntshav qog ntshav tsis loj hlob, lossis tshaib plab vim lawv tsis tau txais cov as-ham uas lawv xav tau kom muaj sia nyob.
Qia cell hloov
Stem cell transplants tsuas yog siv yog tias koj lymphoma tsis teb rau lwm yam kev kho mob (yog refractory), los yog rov qab los tom qab ib lub sij hawm ntawm remission (relapse). Nws yog ib qho kev kho mob ntau yam uas koj tus kheej, lossis tus neeg pub cov qia hlwb (cov qe ntshav tsis paub qab hau) raug tshem tawm los ntawm cov txheej txheem hu ua apheresis, thiab muab rau koj tom qab, tom qab koj tau siv tshuaj kho mob siab.
Nrog cutaneous lymphoma, nws muaj ntau dua rau koj tau txais cov qia hlwb los ntawm tus neeg pub dawb es tsis yog koj tus kheej. Hom kev hloov ntawm qia cell no hu ua Allogeneic Stem Cell hloov.
Extracorporeal photopheresis (ECP)
Extracorporeal photopheresis yog ib qho kev kho mob uas feem ntau siv rau MF thiab SS siab heev. Nws yog txheej txheem ntawm "ntxuav" koj cov ntshav thiab ua rau koj lub cev tiv thaiv kab mob ntau dua rau cov lymphoma ua rau cov qog ntshav qog ntshav raug tua. Yog tias koj xav tau kev kho mob no, koj tus kws kho mob yuav tuaj yeem muab cov ntaub ntawv ntxiv rau koj.
soj ntsuam hlw kom qis
Nws raug pom zoo tias txhua lub sijhawm koj xav tau pib kho koj nug koj tus kws kho mob txog kev sim tshuaj koj yuav tsim nyog tau txais. Kev sim tshuaj kho mob yog qhov tseem ceeb los nrhiav cov tshuaj tshiab, lossis kev sib xyaw ntawm cov tshuaj los txhim kho kev kho mob qog nqaij hlav qog nqaij hlav yav tom ntej.
Lawv kuj tseem tuaj yeem muab sijhawm rau koj sim tshuaj tshiab, ua ke ntawm cov tshuaj lossis lwm yam kev kho mob uas koj yuav tsis tuaj yeem tawm sab nraud ntawm kev sim. Yog tias koj xav koom nrog hauv kev sim tshuaj, nug koj tus kws kho mob seb qhov kev sim tshuaj twg koj tsim nyog tau txais.
Muaj ntau yam kev kho mob thiab kev kho mob tshiab ua ke uas tam sim no raug sim hauv kev sim tshuaj thoob ntiaj teb rau cov neeg mob uas tau kuaj pom tshiab thiab rov qab mob qog nqaij hlav.
Cov kev kho mob rau kev txhoj puab heev lossis lig-theem cutaneous lymphoma | |
B-cell cutaneous | T-cell daim tawv nqaij |
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Kuj nug koj tus kws kho mob hematologist lossis tus kws kho mob oncologist txog txhua qhov kev sim tshuaj uas koj tuaj yeem tsim nyog tau txais. | |
Yuav ua li cas thaum kho tsis ua hauj lwm, los yog lymphoma rov qab los
Qee zaum kev kho mob lymphoma tsis ua haujlwm thaum xub thawj. Thaum qhov no tshwm sim nws hu ua refractory lymphoma. Hauv lwm qhov xwm txheej, kev kho mob yuav ua haujlwm zoo, tab sis tom qab lub sijhawm tshem tawm cov qog ntshav qab zib tuaj yeem rov qab los - qhov no yog hu ua rov ua dua.
Txawm hais tias koj muaj tus kab mob lymphoma relapsed los yog refractory, koj tus kws kho mob yuav xav sim lwm txoj kev kho mob uas yuav ua haujlwm zoo dua rau koj. Cov kev kho mob tom ntej no yog hu ua kev kho mob thib ob, thiab tej zaum yuav zoo dua li kev kho thawj zaug.
Tham nrog koj tus kws kho mob txog qhov kev cia siab ntawm koj txoj kev kho mob yog dab tsi, thiab qhov kev npaj yuav ua li cas yog tias ib qho ntawm lawv tsis ua haujlwm.
Yuav xav li cas thaum kho tiav
Thaum koj ua tiav koj qhov kev kho mob koj tus kws kho mob tshwj xeeb yuav tseem xav pom koj tsis tu ncua. Koj yuav tau kuaj xyuas tsis tu ncua nrog rau kev kuaj ntshav thiab kuaj ntshav. Ntau npaum li cas koj muaj cov kev ntsuam xyuas no yuav nyob ntawm koj tus kheej qhov xwm txheej thiab koj tus kws kho mob hematologist yuav tuaj yeem qhia koj ntau npaum li cas lawv xav pom koj.
Nws tuaj yeem yog lub sijhawm zoo siab lossis lub sijhawm ntxhov siab thaum koj kho tiav - qee zaum ob leeg. Yog tsis muaj txoj cai los tsis yog txoj kev xav. Tab sis nws yog ib qho tseem ceeb los tham txog koj txoj kev xav thiab yam koj xav tau nrog koj cov neeg koj hlub.
Kev txhawb nqa muaj nyob yog tias koj muaj lub sijhawm nyuaj los daws qhov kawg ntawm kev kho mob. Tham nrog koj pab neeg kho mob - koj tus kws kho mob haematologist lossis tus kws saib xyuas mob qog noj ntshav tshwj xeeb raws li lawv tuaj yeem xa koj mus rau kev pab sab laj hauv tsev kho mob. Koj tus kws kho mob hauv zos (tus kws kho mob dav dav - GP) kuj tuaj yeem pab nrog qhov no.
Lymphoma Care Nurses
Koj tseem tuaj yeem muab ib qho ntawm peb Cov Kws Kho Mob Lymphoma Care hu lossis email. Tsuas yog nyem rau ntawm "Tshem Tawm Peb" khawm nyob hauv qab ntawm qhov screen kom paub meej txog kev sib cuag.
Ntsiab lus
- Cutaneous lymphoma yog ib qho subtype ntawm Non-Hodgkin Lymphoma uas tshwm sim los ntawm cov qog nqaij hlav qog nqaij hlav hu ua lymphocytes, taug kev mus thiab nyob hauv cov khaubncaws sab nraud povtseg ntawm koj cov tawv nqaij.
- Indolent Cutaneous Lymphomas yuav tsis xav tau kev kho mob vim lawv feem ntau tsis txaus ntshai rau koj txoj kev noj qab haus huv, tab sis koj tuaj yeem tau txais kev kho mob los tswj cov tsos mob yog tias lawv ua rau koj tsis xis nyob, lossis yog tias lymphoma kis mus rau koj cov qog nqaij hlav lossis lwm qhov hauv koj lub cev.
- Aggressive Cutaneous Lymphomas xav tau kev kho sai tom qab koj kuaj pom.
- Muaj ntau tus kws kho mob tshwj xeeb sib txawv uas tuaj yeem tswj hwm koj txoj kev saib xyuas, thiab qhov no yuav nyob ntawm koj tus kheej qhov xwm txheej.
- Yog tias koj tus lymphoma cuam tshuam rau koj lub hlwb lossis lub siab koj tuaj yeem nug koj tus kws kho mob kom xa mus rau tus kws kho mob hlwb kom pab koj daws.
- Ntau yam kev kho mob yog tsom los txhim kho koj cov tsos mob; Txawm li cas los xij, koj kuj yuav xav tau kev kho mob los tswj cov qog ntshav qog ntshav, thiab cov no tuaj yeem suav nrog kev kho mob, tshuaj tiv thaiv kab mob monoclonal, kev kho mob thiab cov qia cell hloov.
