Hodgkin lymphoma (HL) imhando yegomarara reropa rinokura nekukurumidza (ane hasha) rinobata vese vakuru nevana. Inobata rudzi rwesero jena reropa rinonzi B-cell lymphocytes, izvo zviri chikamu chemuviri wako wekuzvidzivirira.
Kuongorora kweHodgkin Lymphoma (HL)
Hodgkin lymphoma igomarara reropa rinorapika iro rakatanga kuwanikwa mumurwere kuma1830s, nachiremba wechiRungu anonzi Thomas Hodgkin. Kuongororwa uku kwakaitwa mushure mekunge masayendisiti maviri anonzi Reed naSternberg, aongorora matishu evanhu vane Hodgkin lymphoma. Vakaona kuti vanhu vese vane HL vaive nerumwe rudzi rwesero isina kujairika. Nekuti Reed naSternberg ndivo vakatanga kuwana chitokisi ichi, vakachidaidza kuti Reed-Sternberg cell.
Nezve Reed Sternberg masero uye Hodgkin Lymphoma
- Masero eReed-Sternberg akakura zvisingaite, ane hutsinye (kenza), akakura B-cell lymphocytes.
- Kuvapo kwemasero eReed-Sternberg kunobatsira vanachiremba kuongorora Hodgkin lymphoma (HL) panzvimbo yenon-Hodgkin lymphoma (NHL).
- Ese lymphomas akawanikwa mushure meHodgkin lymphoma (isina Reed-Sternberg cell) inonzi non-Hodgkin lymphoma.
Zvikonzero Zvengozi pakuvandudza Hodgkin Lymphoma (HL)
Hatizivi kuti chii chinokonzera Hodgkin lymphoma, asi zvakasiyana-siyana zvinokonzera njodzi zvinofungidzirwa kuti zvinobatanidzwa. Zvimwe zvezvinhu izvi zvine njodzi zvinosanganisira kana uine:
- Akambove nehutachiona hweEpstein Barr (EBV). EBV inokonzera mononucleosis (inozivikanwawo se "mono" kana glandular fever).
- Human immunodeficiency virus (HIV).
- Zvimwe zvirwere zve immune system yako, senge autoimmune lymphoproliferative syndrome.
- Simba rekudzivirira rakadzikama mushure menhengo/stem cell kutapura. Kana, kubva kune mimwe mishonga yaungave uchitora.
- Mubereki, mukoma, kana hanzvadzi ine nhoroondo yega yeHodgkin lymphoma.
Zvakakosha kucherechedza kunyange zvakadaro, kuti havasi vanhu vose vane ngozi idzi vachaita HL, uye vamwe vanhu vasina ruzivo rwengozi dzinozivikanwa vanogona kuramba vachigadzira HL.
Kuti unzwisise HL, unofanirwa kuziva zvishoma nezveB-Cell lymphocytes yako (kana B-masero)
B-Masero:
- Imhando yemasero machena eropa.
- Rwisa utachiona nezvirwere kuti uchengetedze hutano.
- Rangarira utachiona hwawaiva nahwo munguva yakapfuura, saka kana ukawana utachiona humwe chetehwo zvakare, immune system yemuviri wako inogona kurwisa zvakanyanya uye nekukurumidza.
- Inogadzirwa mumwongo wako (iyo spongy chikamu chiri pakati pemapfupa ako), asi kazhinji inogara mune yako lymphatic system, kusanganisira mune yako spleen, thymus uye lymph nodes.
- Inogona kufamba kuburikidza ne lymphatic system yako, uye kunze kune chero chikamu chemuviri wako kurwisa hutachiona kana chirwere.
Hodgkin Lymphoma inokura apo mamwe maB-masero ako anova kenza
HL inokura apo mamwe maB-cell ako anoita kenza. Dzinokura zvisingadzoreki, hadzina kujairika uye hadzife padzinofanira.
Paunenge uine HL ane cancer B-masero:
- Hazvishande zvinobudirira kurwisa hutachiona uye zvirwere.
- Iva akakura kupfuura zvavanofanira uye tarisa zvakasiyana kune ako ane hutano B-masero.
- Inogona kukonzera lymphoma kukura uye kukura mune chero chikamu chemuviri wako.
Zvikamu zveHodgkin Lymphoma (HL)
Hodgkin Lymphoma yakambopatsanurwa kuita 4 subtypes yeClassical Hodgkin Lymphoma, uye yakaparadzana subtype inonzi Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL). Zvakadaro, kumwe kutsvagurudza kwakawana kuti NLPHL haina hunhu hweHodgkin Lymphoma uye saka yave kupihwa zita rekuti Nodular Lymphocyte Predominant B-cell Lymphoma (NLPBCL). Kuti udzidze zvakawanda nezve NLPBCL ndapota tinya pano.
Kuti udzidze zvakawanda nezve subtypes yekirasi Hodgkin Lymphoma enderera pane ino peji.
Classical Hodgkin Lymphoma (cHL)
Classical Hodgkin Lymphoma (cHL) iri kukurumidza kukura (aggressive) B-cell lymphoma. Nekudaro, cHL inowanzo pindura zvakanyanya kune yakajairwa kurapwa nechemotherapy. Vanoda kusvika vapfumbamwe mugumi vanhu vanoenda mukurerukirwa mushure mekurapwa kwekutanga. Izvi zvinoreva kuti hapana chiratidzo che lymphoma chakasara mumuviri wako. Vechidiki kunyanya, vanonyatsofarira kurapwa.
Kune mamwe madiki mana echHL kugadzira cHL iyo inonyanya kuzivikanwa subtype yeHodgkin lymphoma. Yako biopsy samples ichapa pathologist ruzivo rwunodiwa kuti chiremba wako aone kuti ndeipi subtype yaunayo. The pathologist anotarisa zvinotevera:
- Nhamba uye chimiro cheReed-Sternberg masero.
- Saizi uye musanganiswa weakajairika uye abnormal lymphocytes.
Zvisinei nekuti ndeipi subtype yeCHL yaunayo, iwe unogona kunge uine mhando imwechete yekurapa. Kana iwe uchiziva yako subtype, tinya pane iri pazasi musoro kuti uone snapshot.
Nodular sclerosis classical Hodgkin lymphoma (NScHL) ndiyo inonyanya kuzivikanwa subtype. Vanenge 6-8 kubva muvanhu gumi vese vane CHL vachange vaine subtype iyi.
NScHL inotumidzwa nekuda kwekuti masero anotarisa sei pasi pe microscope. Inowanzokura mukati mepakati pechipfuva chako (mediastinum), asi inogonawo kukura muspleen yako, mapapu, bone kana bone marrow. Kashoma inogona kukura muchiropa chako.
Mixed cellularity classical Hodgkin lymphoma (MC-cHL) ndiyo yechipiri inonyanya kuzivikanwa subtype yeCHL. Inowanzoitika muvarume kupfuura vakadzi, uye kazhinji inobata vanhu vakuru.
MC-cHL inowanzokura mumalymph nodes pasi peganda rako mukati memafuta ane mafuta, asi inogonawo kukura muspleen yako, bone marrow, chiropa nedzimwe nhengo.
Lymphocyte rich classical Hodgkin lymphoma (LR-cHL) ishoma subtype yeCHL. Inowanzoonekwa pazera rekutanga pane mamwe masubtypes echHL, uye muvanhu vakuru.
Kana uchinge warapwa, vanhu vazhinji vanopora – zvichireva kuti hazviite kuti lymphoma idzoke mune ramangwana. Kazhinji inokura mumalymph nodes emutsipa wako pasi peganda rako, mukati memafuta ako.
Lymphocyte yakapera classical Hodgkin lymphoma (cHL) ndiyo isingawanzo diki yechHL ine isingasviki 5 muvanhu zana vane iyi subtype. LD-cHL inowanzoitika kune varwere vane hutachiona hweHuman Immunodeficiency Virus (HIV) kana Epstein Barr virus (EBV).
LD-cHL inogona kuitika mune yako:
- bone marrow
- lymph nodes yakadzika mudumbu mako (mudumbu)
- nhengo dzakaita sechiropa chako, pancreas, dumbu uye ura.
Chiitiko chemurwere neHodgkin Lymphoma
Dzimwe nguva zvinogona kubatsira kunzwa kuumba mumwe munhu akambosangana nezvauri kusangana nazvo. Mumavhidhiyo mapfupi aya, Briony anogovera nyaya yake nezvekugara naye, uye kurova nhanho 4 Hodgkin Lymphoma.
Dzvanya pamalink ari pazasi kuti unzwe nyaya yake.
Zviratidzo zveHodgkin Lymphoma
Chiratidzo chekutanga kana chiratidzo cheHL chinogona kunge chiri bundu, kana mapundu akawanda anoramba achikura. Mamwe mapundu anogona kunzwika nekuti ari padyo neganda rako, asi mamwe anogona kungowanikwa kana uine scan.
Mapundu aya malymph nodes akazvimba, akazara nemaB-cell ane gomarara. Dzinowanzotanga muchikamu chimwe chemuviri wako, kazhinji musoro, mutsipa kana chipfuva uye dumbu, zvobva zvapararira mukati me lymphatic system yako. Inogona kupararira kune spleen yako, mapapu, chiropa, mapfupa, mwongo kana dzimwe nhengo.
spleen yako
Spleen yako inhengo inosefa ropa rako nekurichengeta riine hutano, uye ndeimwe yenhengo dzako huru dze lymphatic. Iri kuruboshwe rwedumbu rako repamusoro pasi pemapapu ako uye pedyo nedumbu rako (tummy). Kana HL yako ikapararira kune spleen yako inogona kukura zvakanyanya uye kuisa simba padumbu rako, zvichiita kuti unzwe wakaguta kunyange usina kudya zvakanyanya.
Zvimwe zviratidzo
Iwe unogona kunge uine zviratidzo zvakadai sekusvotwa, manyoka kana kuvimbiswa, zvichienderana nekuti lymphoma yako iri kukura kupi.
Zvimwe zviratidzo, zvaunogona kuwana zvinosanganisira:
- Kunzwa kuneta zvisina kujairika (kuneta, hakuiti nani mushure mekunge wazorora kana kurara).
- Kunzwa kupera simba (kana uine lymph nodes yakazvimba muchipfuva chako).
- Chikosoro (kazhinji chikosoro chakaoma, kana uine lymph nodes yakazvimba muchipfuva chako).
- Kupwanya kana kubuda ropa zviri nyore kupfuura nguva dzose (nekuda kwekuderera kwe platelet count).
- Itchy ganda.
- Ropa mupoo yako (izvi zvinogona kuitika kana uine HL mudumbu mako kana mumatumbo).
- Zvirwere zvisingapere, kana kuti zvinoramba zvichidzoka (zvekare).
- B-zviratidzo.
B Zviratidzo
Chinyorwa chakakosha - Nguva yekusangana nachiremba wako
Zvakakosha kuziva kuti zvizhinji zvezviratidzo nezviratidzo zveHL zvinogona kuwirirana nezvimwe zvinokonzera kunze kwekenza. Semuenzaniso, kuzvimba lymph nodes kunogonawo kuitika kana uine hutachiona. Kazhinji zvakadaro, kana uine hutachiona, zviratidzo zvinova nani uye lymph nodes inodzokera kuhukuru hwemazuva ese mumavhiki mashoma.
Ne lymphoma, zviratidzo izvi hazvizoperi. Vanogona kutowedzera. Iwe unofanirwa kubata chiremba wako kana ukawana:
- Kuzvimba malymph nodes asingaendi, kana kuti akakura kupfuura zvaungatarisira kune utachiona.
- Kufema pasina chikonzero.
- Kunyanya kuneta kupfuura nguva dzose uye hazviiti nani nekuzorora kana kurara.
- Kubuda ropa zvisina kujairika kana mavanga (kusanganisira mupoo yako, kubva mumhino dzako kana mazamu).
- Inovava kupfuura zvamazuva ese.
- Chikosoro chitsva chakaoma.
- B-zviratidzo.
Hodgkin Lymphoma inowanikwa sei
Chiremba wako anogona kufungidzira kuti une lymphoma pavanowana mhinduro dzeropa rako, X-ray, kana mamwe ma scan mhinduro. Vanogonawo kuona bundu kana vakaongorora muviri. Asi kuti uongorore HL, iwe uchada biopsy. A biopsy inzira yekubvisa chikamu, kana yese ye yakakanganiswa lymph node kana mwongo. Iyo biopsy inobva yaongororwa nevanoongorora zvirwere murabhoritari, kuti vaone kana pane kuchinja kunobatsira chiremba kuongorora HL.
Zvinogona kuve nehunyengeri kuongorora iyo chaiyo subtype yeHL yaunayo, saka ungangoda kuve neinodarika imwe biopsy. Chiremba wako anokwanisa kuongorora kuti ndeupi subtype yaunayo nekutarisa ropa rako uye zvese biopsies pasi pe microscope, kana kubva kumushumo wavanowana kubva kuzvirwere. Kana iwe usati watoziva, bvunza chiremba wako kuti ndeupi subtype yaunayo.
Iwe unogona kunge uine mushonga wekutindivadza wepanzvimbo kana wakajairwa kana uine biopsy. Izvi zvinoenderana nekuti ndeipi chikamu chemuviri wako iyo biopsy inotorwa kubva.
Biopsy
Kuti uongorore HL iwe uchada mabiopsies emalymph nodes ako akazvimba, uye mwongo wako. A biopsy inguva apo chidimbu chiduku chetishu chinobviswa uye chinoongororwa murabhoritari pasi pemaikorosikopu. The pathologist anozotarisa nzira, uye nekukurumidza sei masero ako ari kukura.
Pane nzira dzakasiyana dzekuwana yakanakisa biopsy. Chiremba wako achakwanisa kukurukura mhando yakanakisisa yemamiriro ako ezvinhu. Zvimwe zvezvinowanzozivikanwa biopsies zvinosanganisira:
Excisional node biopsy
Mhando iyi yebiopsy inobvisa lymph node yose. Kana lymph node yako iri pedyo neganda rako uye inonzwa zviri nyore, iwe unogona kunge uine anesthetic yemunharaunda kuti uite chiveve nzvimbo yacho. Zvadaro, chiremba wako achacheka (inonziwo incision) muganda rako pedyo, kana pamusoro pe lymph node. Yako lymph node ichabviswa kuburikidza nekucheka. Iwe unogona kunge uine stitches mushure mekuita uku uye zvishoma kupfeka pamusoro.
Kana lymph node yakadzika zvakanyanya kuti chiremba anzwe, ungangoda kuti excisional biopsy iitwe muchipatara ichivhiya theatre. Unogona kupihwa mushonga wekutindivadza – unova mushonga wekukurarisa paunenge uchibviswa lymph node. Mushure me biopsy, iwe unenge uine ronda diki, uye unogona kunge uine matinji ane zvishoma kupfeka pamusoro.
Chiremba wako kana mukoti achakuudza kuti ungachengeta sei ronda racho, uye pavanenge vachida kukuona zvakare kuti ubvise zviso.
Core kana yakanaka tsono biopsy
Mhando iyi yebiopsy inongotora sampuli kubva kune yakakanganiswa lymph node - haibvise lymph node yose. Chiremba wako achashandisa tsono kana imwe mudziyo unokosha kutora sampuli. Kazhinji unozopihwa mushonga wekutindivadza. Kana lymph node yakadzika zvakanyanya kuti chiremba wako aone uye anzwe, unogona kunge uine biopsy inoitwa mudhipatimendi reradiology. Izvi zvinobatsira kune zvakadzama biopsies nekuti radiologist inogona kushandisa Ultrasound kana X-ray kuona lymph node uye kuve nechokwadi kuti vanowana tsono panzvimbo chaiyo.
A core tsono biopsy inopa yakakura biopsy sample pane yakanaka tsono biopsy.
Kuronga uye Kugashira kweHodgkin Lymphoma
Kuronga uye kugadzika inzira iyo chiremba wako anogona kutsanangura kuti yakawanda sei yemuviri wako inobatwa ne lymphoma, uye kuti masero e lymphoma ari kukura sei.
Nekuti lymphoma masero anogona kuenda kune chero chikamu chemuviri wako saka kana uine HL, chiremba wako acharonga mimwe miedzo kuti aone kana iri kumwe kumwe. Iyi bvunzo inonzi "staging" uye inogona kusanganisira:
Kuyera ropa
Kuongororwa ropa kunogona kuitwa kutarisa zvinhu zvakasiyana-siyana zvinosanganisira huwandu hweropa rako, kushanda kwechiropa neitsvo uye kugona kwemuviri wako kuvhara ropa rako.
Positron emission tomography (PET) scan
A PET scan is a whole body scan kuti uone pari kukura lymphoma. Iwe uchange uine jekiseni usati waongororwa nemhinduro inotorwa nemasero e-lymphoma. Izvi zvinoita kuti masero e-lymphoma avheneke paPET scan.
Computed tomography (CT) scan
CT inoongorora ipa mufananidzo wakadzama pane wenguva dzose X-ray uye unotarisa panzvimbo yenzvimbo sechipfuva chako kana dumbu
Lumbar kubaya
lumbar punctures anoshandiswa kutarisa kana uine lymphoma muuropi yako kana musana. Chiremba wako achashandisa tsono kutora sampuli yemvura kubva pedyo nemuzongoza wako.
Cytogenetic miedzo
Cytogenetic miedzo Iyi icheki yekuchinja kwemajini (kunonziwo kuchinja kana kusiyana) kunogona kuve nechekuita nechirwere chako.
Bone marora bhiopsy
A pfupa remongo bops inoitirwa kutarisa kana uine lymphoma masero mubome marrow uko masero ako eropa anogadzirwa. Chiremba wako achashandisa tsono kutora sampuli yemwongo kubva pakati pepfupa rako - kazhinji chiuno chako, asi dzimwe nguva muenzaniso unogona kutorwa kubva kune rimwe pfupa. Izvi zvichaitwa neanesthetic yemunharaunda.
Rumwe ruzivo nezve bvunzo, kuongororwa uye staging inogona kuwanikwa nekudzvanya bhatani riri pazasi.
Kurapa kweHodgkin Lymphoma
Chii chinonzi staging?
Mushure mekunge waonekwa, chiremba wako anotarisa pamhedzisiro yako yese yekuongorora kuti aone kuti Hodgkin Lymphoma yako iri padanho ripi. Staging inoudza chiremba kuti lymphoma yakawanda sei mumuviri wako, ingani nzvimbo dzemuviri wako dzine kenza B-masero, uye kuti muviri wako uri kurarama sei nechirwere.
Danho rinobva pa:
- Nhamba uye nzvimbo ye lymph nodes zvakakanganiswa.
- Nzvimbo yemalymph nodes akabatwa - ari pamusoro, pasi kana kumativi ose e diaphragm.
- Ingave chirwere ichi chapararira kumwongo wako kana kune dzimwe nhengo dzakaita sechiropa chako, mapapu, bhonzo kana ganda.
Zvikamu zvina zveHodgkin Lymphoma (HL)
Matanho mana eHL anosanganisira:
- Danho 1 uye nhanho yechipiri inonzi 'yekutanga/yakaganhurwa nhanho' (inosanganisira nzvimbo ine diki yemuviri).
- Danho rechitatu nechina rinonzi 'advanced stage' (yakawanda).
- Kusiyana nemamwe marudzi egomarara, iwe unogona kuenda mukuregererwa kana kurapwa kubva padanho repamusoro (3 kana 4) HL.
danho 1 | imwe lymph node nzvimbo inobatwa, kungave pamusoro kana pasi pe diaphragm yako. |
danho 2 | maviri kana anopfuura ma lymph node nzvimbo anokanganisa kune rimwe divi re diaphragm yako. |
danho 3 | Inenge imwe lymph node nzvimbo kumusoro uye imwe lymph node nzvimbo pazasi diaphragm yako inobatwa. |
danho 4 | lymphoma iri mumalymph nodes akawanda, uye yakapararira kune dzimwe nhengo dzemuviri wako (semumapfupa, mapapu, chiropa). |
Mamwe maitiro ekugadzirisa
Mukuwedzera kune nhamba inoshandiswa kutsanangura nhanho yako, pane zvimwe zvinhu izvo chiremba wako achafunga nezvazvo pakusarudza nzira dzakanakisisa dzokukurapa. Vachatarisa kuti lymphoma iri kukanganisa sei muviri wako, uye zviratidzo zvipi zvauri kuita. Nekuda kwezviwanikwa izvi, kuwedzera kune nhamba yaunayo yedanho rako, unogona zvakare kuve netsamba. Ndapota ona tafura iri pasi apa kuti uone kuti mavara anorevei.
tsamba | zvichireva | kukosha |
A kana B |
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E & X |
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S |
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Inzwa zvakananga kubva kuna Nyanzvi yeLymphoma nezve Staging Lymphoma
Giredhi reHodgkin lymphoma yako nderekuti masero ako anotarisa sei pasi pemaikorosikopu, uye kuti anokura nekukurumidza sei nekugadzira masero matsva egomarara. Iwo mamakisi ari Magiredhi 1-4 (akaderera, epakati, akakwirira).
- G1 - yakaderera giredhi - maseru ako anotaridzika padyo neakajairika uye anokura uye anopararira zvishoma nezvishoma.
- G2 - giredhi repakati - maseru ako ari kutanga kutaridzika zvakasiyana asi mamwe maseru akajairwa aripo uye anokura nekupararira pamwero wepakati.
- G3 - giredhi repamusoro - maseru ako anotaridzika zvakasiyana nemaseru mashoma akajairwa uye anokura nekupararira nekukurumidza.
- G4 - giredhi repamusoro - maseru ako anotaridzika zvakasiyana kune akajairwa uye anokura nekupararira nekukurumidza.
Zvimwe Zviitiko zveGrading
HL inogona kuonekwa zvakare se'inofarirwa' kana 'isingafadzi' zvichienderana nezvakaderera, zvepakati kana kuti zvine njodzi zvakanyanya zvaungave nazvo kana kuti usina. Izvi zvinogona kukanganisa rudzi rwekurapa kwaunopihwa, uye kuti unopindura sei pakurapwa. Izvi zvinonzi 'Risk Adapted' therapy.
Ruzivo rwese urwu runopa chiremba wako mufananidzo wakanaka kuti ubatsire kusarudza yakanakira mhando yekurapa iwe.
Kungotaura - staging inotarisa apo Hodgkin Lymphoma yako iri kukura, uye giredhi rinotarisa sei Hodgkin Lymphoma yako iri kukura.
Kunzwisisa yako lymphoma genetics
Cytogenetic tests inotarisa kuchinja mumakromosomes ako kana majini. Kazhinji tine 23 mapeya emachromosome, uye anoverengwa zvichienderana nekukura kwawo. Kana uine HL, machromosome ako anogona kutaridzika akati siyanei.
Chii chinonzi majini uye chromosomes
Sero rimwe nerimwe rinoumba muviri wedu rine nucleus, uye mukati memukati mune mapeya 23 emakromosomes.
Chromosome imwe neimwe inogadzirwa netambo refu dzeDNA (deoxyribonucleic acid) ine majini edu.
Majini edu anopa kodhi inodiwa kugadzira maseru nemapuroteni ese ari mumuviri wedu, uye anovaudza maitiro ekutarisa kana kuita.
Kana paine shanduko mumakromosomes aya kana majini, mapuroteni ako nemasero haashande nemazvo.
Lymphocytes inogona kuva masero e-lymphoma nekuda kwekuchinja kwemajini (kunonzi kushanduka kana kusiyana) mukati memasero. Yako lymphoma biopsy inogona kutariswa nenyanzvi yepathologist kuona kana uine chero gene mutations.
Ko HL mutations inoita sei?
Tsvagiridzo yakawana akasiyana gene abnormalities ayo anogona kukonzera mamwe mapuroteni kukura pamusoro peHL masero. Aya mapuroteni anogona kubatsira lymphoma kuvanza kubva kune immune system yako kana, kuita kuti gomarara rikure zvisingaite.
- mamwe masero eHodgkin lymphoma anogona kutaridzika zvishoma nekuva nezvakawandisa (kuwedzeredza) kweprotein inonzi CD30 kunze kwesero.
- kana uine Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL), unogona kuwedzeredza protein inonzi CD20 yekunze kwemasero ako.
- mamwe masero eHodgkin Lymphoma anogona kunge aine "immune checkpoint" inonzi PD-L1 kana PD-L2 pachitokisi. Iyi immune yekutarisa inobatsira iyo lymphoma kuvanda kubva kune immune system yako saka haigone kuwana nekuuraya iyo lymphoma sezvayaizoita.
Shanduko idzi dzakakosha nekuti dzinogona kukanganisa rudzi rwemushonga waunowana.
Machinjiro ako anogona kukanganisa kurapwa kwaunowana
Mamwe maHodgkin lymphoma anogona kurapwa nemonoclonal antibody (MAB), asi chete kana masero ako eHL achiwedzera mamwe maprotein marker. Kana yako Hodgkin lymphoma masero akawandisa:
- CD30 unogona kupihwa MAB inonzi brentuximab vedotin, inonangana neCD30.
- CD20 unogona kupihwa MAB inonzi rituximab, inonangana neCD20. CD20 haiwanikwe pamasero egomarara emhando yeHodgkin Lymphoma, asi inogona kuwanikwa pamaseru ari muNodular Lymphocyte-yakanyanya kuHodgkin Lymphoma (uye isiri Hodgkin lymphomas).
- Iyo immune yekutarisa PD-L1 kana PD-L2 iwe unogona kupihwa MAB inonzi pembrolizumab, iyo yakanangana neiyo immune system, ichiita kuti lymphoma iwedzere kuoneka kune immune system yako.
Kurapa kweHodgkin Lymphoma
Kune akawanda akasiyana marapirwo anowanikwa eHodgkin Lymphoma. Kurapa kwakanakisisa kwauri kuchaenderana nezvinhu zvakawanda zvinosanganisira zera rako, hutano hwako hwose, uye danho uye giredhi re lymphoma yako. Chiremba wako achafungawo nezvehumwe hurwere hwaungave uine uye marapiro auri kuita kune izvozvo.
Usati watanga kurapwa, unenge wava neongororo dzakawanda dzinodanwa "Baseline Tests". Miedzo iyi inoitwa kuti uve nechokwadi chekuti wakagwinya zvekushingirira kurapwa, uye kuti chiremba wako ataure nezve kurapwa kwako kwese kuti ave nechokwadi chekuti kurapwa hakusi kukuvadza zvakanyanya kunhengo dzako. Ongororo dzauinadzo, zvinoenderana nekuti unenge uchirapwa rudzii.
Kana iwe wakave nekurapa kwe lymphoma yako munguva yakapfuura, chiremba wako achafunga kuti yakashanda sei kwauri, uye kuti yakaipa sei chero mhedzisiro yaive kwauri. Chiremba wako anozokwanisa kukupa nzira dzakanakisa dzekurapa iwe zvichienderana nemamiriro ako wega. Kana usina chokwadi kuti sei chiremba akaita sarudzo dzavanenge vaita, tapota iva nechokwadi chekuvabvunza kuti vakutsanangurire - varipo kuti vakubatsire.
Unogona kupihwa imwe kana akawanda emhando dzekurapa dziri pasi apa.
Rutsigiro runopiwa kuvarwere nemhuri dzinotarisana nechirwere chakakomba. Tsigiro yekuchengeta inogona kubatsira varwere kuve nezviratidzo zvishoma, uye kuita zvirinani nekukurumidza nekuteerera kune izvo zvikamu zvekuchengeta kwavo.
Kurapa kweHL kunogona kukanganisa masero ako akanaka eropa izvo zvinogona kuita kuti iwe ushaye masero eropa ane hutano akakwana kuti ugare wapora. Nekuda kweizvozvo, unogona kuisirwa ropa nesero dzvuku rakazara kana maplatelet kuti uvandudze mazinga ako emasero eropa aya. Kana masero machena eropa akadzikira - kana achitarisirwa kudzikira, unogona kubaiwa jekiseni rinopinda mudumbu mako rinobatsira kuti mwongo webhonzo uburitse mamwe masero aya. Iwe unogona zvakare kuda mishonga inorwisa mabhakitiriya kana iwe ukawana hutachiona asi masero machena ako akadzikira, kuti akubatsire kurwisa chero hutachiona.
Rutsigiro rwerutsigiro runogonawo kusanganisira kuona nyanzvi dzakasiyana dzine hunyanzvi mune dzimwe nzvimbo dzehutano hwako kana kuronga kutarisirwa kweramangwana sekukubatsira iwe kugadzira Urongwa Hwepamusoro Hwekuchengetedza kutsanangura zvishuwo zvako zvehutano hwako mune ramangwana. Kana uine zviratidzo kana mhedzisiro isiri kuita zvakanaka, unogona kupihwa kubvunzana neve palliative care timu inyanzvi mukugadzirisa zvinonetsa kurapa zviratidzo zvakaita sekurwadziwa uye kusvotwa zvisina kuvandudzwa nekurapa kwakajairwa. Izvi zvinhu chikamu che multidisciplinary manejimendi ye lymphoma.
Radiation therapy kurapwa kwegomarara kunoshandisa huwandu hwakanyanya hwemwaranzi kuuraya lymphoma masero uye kuderedza mamota. Usati wava neradiation, unenge uine nguva yekuronga. Ichi chikamu chakakosha kuti varapi veradiation varonge nzira yekunangana nemwaranzi kune lymphoma, uye kudzivirira kukuvadza masero ane hutano. Radiation therapy inowanzotora pakati pemavhiki e2-4. Munguva iyi, iwe uchafanirwa kuenda kunzvimbo yeradiation mazuva ese (Muvhuro-Chishanu) kunorapwa.
*Kana uchigara kure neradiation centre uye uchida rubatsiro nenzvimbo yekugara panguva yekurapwa, ndapota taura nachiremba wako kana mukoti nezverubatsiro rwaunowana. Iwe unogona zvakare kubata Cancer Council kana Leukemia Foundation iri mudunhu rako uye uone kana vachigona kubatsira nenzvimbo yekugara.
Unogona kunwa mishonga iyi sehwendefa uye/kana kupihwa sedhipu (kupinza) mutsinga yako (muropa rako) kukiriniki yegomarara kana kuchipatara. Mishonga yakawanda yakasiyana yekemo inogona kusanganiswa nemushonga we immunotherapy. Chemo inouraya masero ari kukurumidza kukura saka anogona zvakare kukanganisa mamwe masero ako akanaka anokura nekukurumidza achikonzera mhedzisiro.
Unogona kunge uine MAB infusion kukiriniki yegomarara kana kuchipatara. MABs inonamatira kune lymphoma cell uye inokwezva zvimwe zvirwere zvinorwisa masero machena eropa uye mapuroteni kune kenza kuitira kuti immune system yako irwise HL.
MABS inongoshanda chete kana uine mapuroteni chaiwo kana mamaki pamasero ako elymphoma.
Immune checkpoint inhibitors (ICIs) rudzi rutsva rwemonoclonal antibody (MAB) uye inoshanda zvishoma zvakasiyana kune mamwe MABS.
ICIs inoshanda kana masero ako ebundu agadzira "immune checkpoints" paari ayo anowanzo kuwanikwa pamaseru ako ane hutano. Iyo immuen yekutarisa inoudza immune system yako kuti sero rine hutano uye rakajairwa, saka immune system yako inoisiya yega.
ICIs inoshanda nekuvharira immune checkpoint kuitira kuti masero ako e-lymphoma arege kuita kunge ane hutano, masero akajairwa. Izvi zvinobvumira immune system yako kuti uvazive segomarara, uye wotanga kuvarwisa.
Chemotherapy yakasanganiswa neMAB (semuenzaniso, rituximab).
Unogona kutora izvi sepiritsi kana infusion mutsinga yako. Kurapa nemuromo kunogona kutorwa kumba, asi kumwe kunoda kugara muchipatara kwenguva pfupi. Kana uine infusion, unogona kuva nayo kukiriniki yezuva kana muchipatara. Targeted therapies inonamira kune lymphoma cell uye inovhara masaini iyo inoda kukura uye kugadzira mamwe masero. Izvi zvinomisa gomarara kukura uye zvinoita kuti masero e-lymphoma afe.
A stem cell kana bone marrow transplant inoitwa kutsiva bhonzo rako rine chirwere nemasero matsva anogona kukura kuita masero matsva eropa ane hutano. Bone marrow transplants inowanzoitwa chete kuvana vane HL, nepo stem cell transplants inoitwa kune vese vana vakuru.
Mune pfupa rekuisa pfupa, stem masero anobviswa zvakananga kubva mumwongo, uko sekunge ne stem cell transplant, stem masero anobviswa kubva muropa.
Masero e stem anogona kubviswa kubva kune anopa kana kutorwa kubva kwauri mushure mekunge waita chemotherapy.
Kana iwe stem masero achibva kune anopa, anonzi an allogeneic stem cell transplant.
Kana masero ako ega akaunganidzwa, anonzi an autologous stem cell transplant.
Masero emazita anounganidzwa kuburikidza nenzira inonzi apheresis. Iwe (kana mupi wako) uchabatanidzwa kusvika kumuchina weapheresis uye ropa rako richabviswa, masero e stem akaparadzaniswa uye anounganidzwa mubhegi, uye ropa rako rose rinodzoserwa kwauri.
Usati waitwa, iwe uchawana yakakwira-dose chemotherapy kana yakazara-muviri radiotherapy kuuraya ese ako lymphoma masero. Zvakadaro kurapwa kwedosi yakakwirira kunourayawo maseru ese ari mumwongo wako. Saka masero akaunganidzwa anozodzoserwa kwauri (akasimwa). Izvi zvinoitika mune zvakangofanana nekuwedzerwa ropa kunoitwa, kuburikidza nekudonha mutsinga yako.
Kutanga kurapwa
Zvinogona kunetsa kuziva kuti ndeipi mibvunzo yekubvunza paunenge uchitanga kurapwa. Kana iwe usingazive, zvausingazive, ungaziva sei zvekubvunza?
Kuva neruzivo rwakakodzera kunogona kukubatsira kuti unzwe uine chivimbo uye kuziva zvekutarisira. Inogonawo kukubatsira kuronga pachine nguva pane zvaungade.
Tinoisa pamwe chete rondedzero yemibvunzo yaungawana inobatsira. Zvechokwadi, mamiriro ezvinhu emunhu wose akasiyana, saka mibvunzo iyi haitauri zvose, asi inopa mavambo akanaka.
Dzvanya pane iyi link iripazasi kuti utore inodhinda PDF yemibvunzo yachiremba wako.
Dzvanya apa kuti Dhawunirodha Mibvunzo yekubvunza Chiremba wako
Kekutanga kurapwa kunonzi kurapwa kwekutanga. Kana uchinge wapedza kurapwa kwako kwekutanga, ungasazoda kurapwa zvakare, asi vamwe vanhu vangangoda kurapwa kwakawanda pakarepo, uye vamwe vanogona kutora mwedzi yakawanda kana makore vasina kurapwa, vasati vada kumwe kurapwa.
Chekutanga-mutsara kurapwa kweClassic Hodgkin lymphoma
Rudzi rwekurapa rwauinarwo rwunoenderana ne:
- rudzi rweHodgkin lymphoma yaunayo
- danho uye giredhi ye lymphoma yako
- zera rako uye hutano hwese
- chero zvimwe zvirwere zvaunazvo kana mishonga yauri kunwa
- zvaunofarira mushure mekutaura nachiremba wako nezvesarudzo dzako.
Mamwe marapirwo akajairika aungade paunotanga kurapwa anotsanangurwa pazasi.
Kurapa kwemagetsi
Radiation inogona kupihwa nechemotherapy, kana yega.
Kurapwa
Kana uchida kutanga kurapwa, unogona kuva nemishonga inopfuura mumwechete, uye inogona kusanganisira marudzi akasiyana-siyana echemotherapy monoclonal antibody kana immune checkpoint inhibitor. Paunenge uchinge uine marapirwo aya, unoave nawo mumacycles. Izvi zvinoreva kuti iwe uchave nekurapwa, wozozorora, uyezve imwe kutenderera (kutenderera) kwekurapa.
ABVD
ABVD inzira yakajairika yekurapa inoshandiswa kune vanhu vane HL. Iko kusanganiswa kwemishonga yechemotherapy inonzi doxorubicin, bleomycin, vinblastine uye dacarbazine.
Yakawedzera BEACOPP
Escalated BEACOPP imwe protocol inoshandiswa kune vamwe vanhu vane HL. Iko kusanganiswa kwemishonga yechemotherapy inonzi bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine uye procarbazine. Iwe zvakare uchapihwa steroid mushonga unonzi prednisolone. Iwe haungapihwe mishonga iyi yese pazuva rimwe, asi iwe uchave nayo ese pamusoro pemazuva masere. Iwe uchave uine steroid kwemavhiki e8, wozozorora, uye wozotanga kutenderera kwako kunotevera.
BrCADD
BrECAD inogona kushandiswa kana iwe uine danho repamusoro Hodgkin Lymphoma. Yakaratidza migumisiro yakanaka kwazvo, nevanhu vakawanda vachiporeswa kana kupinda mukuregererwa kwenguva refu. Iyo protocol inosanganisira chemotherapy uye a conjugated monoclonal antibody inonzi Brentuximab vedotin. Iyo vedotin ikemikari yakasungirirwa kune brentuximab antibody uye ine chepfu kune lymphoma masero.
Mishonga yechemotherapy iri muprotocol iyi inosanganisira etoposide, cyclophosphamide, doxorubicin uye dacarbazine. Iwe zvakare uchange uine steroid inonzi dexamethasone.
chenjedzo
Kana uchirapwa ne bleomycin, zvinogona kukurudzirwa kuti iwe usava nepamusoro-kuyerera kweokisijeni mune ramangwana. Okisijeni yakakwira yakonzera vanga mumapapu evamwe vanhu vanga vaine bleomycin.
Kana iwe uchida rubatsiro rwekufema mune ramangwana, unogona kuramba uchirapwa nemhepo yekurapa kana dzimwe nzira. Mune zvimwe zviitiko, chiremba wako anogona kuramba achikupa kukupa yakakwira-kuyerera okisijeni kana mabhenefiti achipfuura njodzi. Zvisinei, tinokurudzira izvozvo kana wakamborapwa bleomycin, ita kuti vanachiremba vako vese nemanesi vazive.
Zvimwe zvipatara zvinogona kukupa zita dzvuku bhendi uye kuisa oxygen pasi sechirwere. Zvakakosha kuziva kuti ichi hachisi chirwere, asi chiyeuchidzo chekusakupa oxygen kuburikidza nemasikisi kana nasal prongs.
Clinical trials
Kune nguva dzose miedzo yakawanda yekiriniki iri kuitika uye kana ukasangana nezvinodiwa unogona kukwanisa kujoina kiriniki kuyedzwa. Bvunza chiremba wako nezveizvi. Kana iwe uchida rumwe ruzivo nezve kliniki miedzo, ndapota ona yedu Kunzwisisa kliniki miedzo yewebhu peji pano
Yechipiri-mutsara kurapwa
Vanhu vazhinji vanorapwa nemishonga yavo yekutanga asi kune vamwe, kurapwa kwekutanga kunogona kusashanda sezvavanoshuvira. Ichi chinonzi 'refractory' chirwere. Vamwe vanogona kuve nemhedzisiro yakanaka kubva mukurapwa kwekutanga, asi mushure memwedzi kana makore, iyo HL inogona kudzoka. Izvi zvinonzi 'kudzokazve'. Kana uine refractory kana kudzoka zvakare HL ungangoda kurapwa zvakare. Izvi zvinonzi kurapa kwechipiri. Kana iwe uchida kurapwa kwemutsara wechipiri, ungangoda kuongororwa ongororo zvakare, sezvawakaita usati watanga kurapwa kekutanga.
Mhando dzekurapa kwechipiri
Chechipiri-mutsara kurapwa kunogona kusanganisira:
- High-dose chemotherapy uyezve stem cell transplant
- Mhando dzakasiyana dzechemotherapy (Senge IGEV - prednisolone, vinorelbine, gemcitabine, ifosfamide, ine mesna uye pegfilgrastim)
- A monoclonal antibody kana immune checkpoint inhibitor (yakadai sebrentuximab vedotin kana pembrolizumab)
- Radiotherapy
- Kana kuti unogona kunge uchikodzera kuyedza kiriniki - Bvunza chiremba wako nezve izvi.
Mune zvimwe zviitiko zvisingawanzoitiki, apo Hodgkin Lymphoma inodzoka, inogona kunge yakashandura maitiro ayo. Dzimwe Hodgkin Lymphoma's, padzinotangazve, dzinogona kukura neprotein CD20 pachitokisi, kunyangwe usina kuwedzeredza CD20 pawakatanga kuongororwa. Muchiitiko ichi kurapwa kunogona kuchinja zvishoma sezvo Hodgkin Lymphoma inotanga kutaridzika zvishoma kunge isiri Hodgkin lymphoma. Asi zvakare, izvi hazviwanzoitiki, uye kana zvikaitika kwauri, chiremba wako achakwanisa kutaura newe nezve nzira yakanakisisa yekuzvirapa.
Mutsara wechitatu kurapwa
Kune vamwe vanhu, mutsara wechitatu uye kunyange wechina wekurapa unogona kudiwa. Izvi zvinogona kusanganisira musanganiswa wemishonga iri pamusoro. Chiremba wako achakwanisa kutaura newe nezve sarudzo dzakanakisa dzemamiriro ako wega.
Rumwe ruzivo rwemaprotocol akasiyana ekurapa anogona kutariswa kuburikidza eviQ here.
KLINICAL MIEDZO
Miedzo yemakiriniki inzira yakakosha yekutsvaga mishonga mitsva, kana misanganiswa yemishonga yekuvandudza kurapwa kwevanhu vane Hodgkin Lymphoma mune ramangwana. Vanogona zvakare kukupa mukana wekuyedza mushonga mutsva, musanganiswa wemishonga kana kumwe marapirwo ausingakwanise kuwana kunze kwekuedzwa. Mimwe miedzo yekiriniki yeHodgkin Lymphoma iri kutarisa CAR-T cell therapy, kuona kana izvi zvingashanda kuvanhu vane HL.
Kurapa kweHL kunogona kusiya mhedzisiro yekusingaperi kana mamiriro ehutano asingaperi mwedzi kusvika kumakore mushure mekurapwa. Zvimwe zvinangwa zvezvimwe zviedzo zvekiriniki ndezvekutarisa kuti tingadzikise sei mhedzisiro inononoka uye zvimwe zvinoramba zvichiitika kubva mukurapwa.
Kana iwe uchida kutora chikamu muchirongwa chekiriniki, bvunza chiremba wako kuti ndeapi miedzo yekiriniki yaunokodzera. Iwe unogona zvakare kuverenga yedu 'Kunzwisisa Clinical Miedzo' pepa rechokwadi, iro rinonyorawo mawebhusaiti aunogona kushanyira kuti uwane kukiriniki kuyedzwa. Dzvanya pano kubatanidza kune pepa redu rechokwadi.
Zvakajairwa nemishonga
Pane zvakawanda zvakasiyana mhedzisiro yaunogona kuwana kubva mukurapwa kwako kweHL. Usati watanga kurapwa kwako, chiremba wako kana mukoti anofanira kutsanangura zvese zvinotarisirwa zvinokonzeresa zvaungasangana nazvo. Iwe unogona kusazviwana zvese, asi zvakakosha kuziva zvekutarisa uye nguva yekusangana nachiremba wako. Ita shuwa kuti une ruzivo rwekuti ndiani waunofanirwa kubata kana ukapora pakati pehusiku kana pakupera kwevhiki apo chiremba wako angave asipo.
Chimwe chezvakanyanya kukonzeresa kurapwa ndechekuchinja kwehuwandu hweropa rako. Pazasi pane tafura inotsanangura kuti ndeapi masero eropa anogona kukanganiswa uye kuti izvo zvingakubata sei iwe.
Masero eropa akabatwa neHL kurapwa
Maso matsvuku eropa | Masero matsvuku eropa | Platelets (uyewo masero eropa) | |
Zita Rezvokurapa | Neutrophils uye Lymphocytes | Erythrocytes | Platelets |
Vanoitei? | Kurwisa Utachiona | Takura oxygen | Regedza kubuda ropa |
Kushomeka kunonzi chii? | Neutropenia uye lymphopenia | Anemia | Thrombocytopenia |
Izvi zvichakanganisa sei muviri wangu? | Iwe uchawana humwe hutachiona uye unogona kunetseka kuzvibvisa kunyangwe nekutora mishonga inorwisa mabhakitiriya. | Unogona kuva neganda rakachenuruka, kunzwa kuneta, kufema, kutonhora uye dzungu. | Unogona kukuvara nyore, kana kubuda ropa risingamire nekukurumidza kana wachekwa. |
Chii chichaitwa neboka rangu rekurapa kugadzirisa izvi? | Kunonoka kurapwa kwako lymphoma. Inogona kukupa jekiseni mudumbu rako nemushonga unokurudzira mwongo wako kugadzira masero machena eropa. Kukupa mishonga yemuromo kana intravenous kana uine utachiona. | Kunonoka kurapwa kwako lymphoma. Kukupa ropa dzvuku kana nhamba yako yemasero yakaderera. | Kunonoka kurapwa kwako lymphoma. Kukupa kuwedzerwa kweplatelet kana nhamba yako yesero yakaderera. |
Zvimwe zvinowanzoitika pakurapa HL
Pazasi pane rondedzero yezvimwe zvakajairika mhedzisiro yekurapwa kweHL. Zvakakosha kuziva kuti zvino marapirwo ese achakonzera zviratidzo izvi, uye unofanira kutaura nachiremba wako kana mukoti kuti ndeapi maside-effects angakonzereswa kurapwa kwako wega.
- Kunzwa kurwara mudumbu (nausea) uye kurutsa.
- Muromo unorwadza (mucositis) uye kuchinja kune kuravira kwezvinhu.
- Matambudziko emudumbu akadai sekuvhara kana manyoka (poo yakaoma kana ine mvura).
- Kuneta, kana kushaya simba risingaite zvakanaka mushure mekuzorora kana kurara (kuneta).
- Tsandanyama (myalgia) uye majoini (arthralgia) aches uye marwadzo.
- Kupera kwebvudzi uye kuonda (alopecia) - chete nemamwe marapirwo.
- Mind fogginess uye kuoma mukurangarira zvinhu (chemo brain).
- Shanduko yekunzwa mumaoko ako netsoka senge kurira, mapini netsono kana kurwadziwa (neuropathy).
- Kuderedza kubereka kana kutanga kuenda kumwedzi (kuchinja kwehupenyu).
Prognosis yeHodgkin Lymphoma - uye chii chinoitika kana kurapwa kwapera
Prognosis ishoko rinoshandiswa kutsanangura nzira ingangove yechirwere chako, kuti chichapindura sei kurapwa uye kuti uchaita sei panguva uye mushure mekurapwa.
Pane zvakawanda zvinokonzeresa kufungidzira kwako uye hazvigoneke kupa chirevo chakazara nezve prognosis. Zvakadaro, Hodgkin lymphoma inowanzopindura zvakanaka pakurapwa uye varwere vazhinji vane gomarara iri vanogona kurapwa - zvichireva kuti mushure mekurapwa, hapana chiratidzo cheHodgkin Lymphoma mumuviri wako.
Zvinhu zvinogona kukanganisa prognosis
Zvimwe zvinhu zvinogona kukanganisa prognosis yako zvinosanganisira:
- Iwe zera uye hutano hwese panguva yekuongororwa.
- Mapinduriro aunoita pakurapwa.
- Ko kana paine genetic mutations iwe unayo.
- Iyo subtype yeHodgkin Lymphoma yaunayo.
Kana iwe uchida kuziva zvakawanda nezve fungidziro yako, ndapota taura nenyanzvi yako yehematologist kana oncologist. Vachakwanisa kutsanangura njodzi yako uye fungidziro kwauri.
