Dhibaatooyinkee noocee ayaa dhakhtarkaagu raadin doonaa?
Sida daweyn kasta, waxaa jira dabeecad iyo hoos u dhac. Dhanka dabeecada waa habka difaaca jirka loo isticmaalo si loo wanaajiyo saadaasha noocyada kansarka qaarkood sida kansarka sambabada unugyada yaryar, melanoma, kansarka unugyada kansarka, kansarka mindhicirka, iyo Hodgkin's lymphoma. Si kale haddii loo dhigo, dadka waxaa la siiyaa fursad labaad oo ah nolol dheer oo nolol raaxo leh - dhacdo taas oo macnaheedu yahay isbedelka wejiga daaweynta kansarka.
Dabcan, faahfaahinta tallaalka immunotherapy waa uun bilawga, tani waa degaan soo noqnoqonaya oo aad u xiiso badan oo ah cilmi baaris iyo daryeel caafimaad hadda.
Iyadoo taasi, iyada oo dad badani lagu daaweynayo immunotherapy, gaar ahaan kontoroolka baaritaanka (ipilimumab, nivolumab, iyo pembrolizumab), dhakhaatiirtu waxay xusayaan dhibaatooyinka khaaska ah ee laga yaabo in ay ka soo baxaan daawadan cusub.
Guudmarka Calaamadaha Baaritaanka
Si aad u fahamto saameynta xun ama sunta xakamaynta kontoroolka , waxaa muhiim ah in la fahmo sida nooca immunotherapy u shaqeyso.
Muddada kooban, baroodhka difaaca ayaa caadi ahaan ku dhajiya dusha sare ee unugyada difaaca jirka (oo loo yaqaanno T cells). Mammogaradahaan koontaroolayaasha waxay ka shaqeeyaan marin-wadareedka calaamadaha isku-dhafan si loo joojiyo unugyada T-da ee ka soo horjeeda unugyada caafimaadka qaba-unugyada xun, kuwa shisheeyaha ah (tusaale ahaan, unugyada fayraska qaba cudurka).
Nasiib darro, unugyada kansarku waxay khiyaanaynayaan in ay sameeyaan oo ay muujiyaan kantaroolkooda kantaroolka, taasina waa sababta aadan jidhkaaga u weerarin buro qalooc leh, sida aad u malayn lahayd inay tahay.
Cilmi-baarayaashu, inkastoo, waxay dib u soo jeesteen iyagoo abuuraya daweyno ka horjoogsanaya koontarooyinkan ku yaala unugyada kansarka ee rajada ah in imminka nidaamka difaaca jirku aqoonsan doono kansarku sida ajnabiga ah, weeraraan, iyo nadiifi.
Saameynta Sunta Baaritaanka
Dabcan, dhibaatooyin ayaa laga yaabaa inay soo baxaan haddii nidaamka difaaca jirka uu xoogaa jahwareer ku dhaco oo uu bilaabo inuu weeraro caadiga ah, unugyo caafimaad qaba marka lagu daro unugyada kansarka xun.
Si kale haddii loo dhigo, bararka daran, dhaawaca xubnaha, iyo cudurada isbitaallada ayaa dhici kara iyadoo la isticmaalayo kontoroolayaasha baaritaanka.
Dhab ahaantii, cilmi-baadhis ayaa muujisay in suntaas lagu magacaabo, oo lagu magacaabo dhacdooyinka xasaasiga ah ee la xidhiidha difaaca jidhka, waxay ku dhacaan ilaa 85 boqolkiiba dadka ka dib markii la daaweynayo baaritaanka kontoroolka ipilimumab. Waxay ku dhacaan illaa 70 boqolkiiba dadka ka dib marka la daaweeyo kaadida baaritaanka nivolumab ama pembrolizumab.
Dhinaca kale, ipilimumab ayaa horjoogsanaya koontaroolka difaaca jirka ee CTLA-4 (cytotoxic T-lymphocyte-associated protein 4) waxaana loo isticmaalay daaweynta melanoma .
Nivolumab iyo pembrolizumab PD-1 (Barnaamijka dhimashada dhimashada ee barnaamijka loo yaqaan 'receptor-1') ayaa loo isticmaalay in lagu daweeyo kansarrada sida melanoma, kansarka unugyada kalyaha, kansarka sanbabada unugyada yaryar, iyo Hodgkin's lymphoma.
Hase yeeshee, dib u soo noqoshada suntan, si kastaba ha ahaatee, nidaamyada bartilmaameedka ugu muhiimsan ee kantaroolayaasha kantaroolayaasha "si khalad ah" u weeraraan jirka waa maqaarka, mareenka caloosha, beerka, iyo hababka qanjirada.
Dhibaatooyinka Maqaarka
Dhibaatooyinka maqaarku waa kuwa ugu caansan ee la xidhiidha difaaca jirka ee la xidhiidha qaadista koontaroolka koontaroolka, waxayna sidoo kale u muuqdaan inay ugu horreyn ku dhacaan daaweynta.
Tusaalooyinka dhibaatooyinka maqaarka waxaa ka mid ah finan, cuncun, alopecia (timo lumis), iyo vitiligo .
Dhibaatooyinka afka waxaa ka mid ah afka qalalan iyo afka cunaha (marka boogaha ay sameeyaan afka) waxay sidoo kale dhici karaan.
Daaweynta finan-yarida badanaa waxay ku xirantahay isticmaalka kareemka corticosteroid topical. Inkastoo haddii finanku ay daran yihiin, corticosteroid-afka ayaa mararka qaarkood loo baahan yahay. Qaadashada antihistamine afka ah sida Benadryl (diphenhydramine) ayaa caawin karta cuncunka.
Marar dhif ah, haddii finanku ay daran yihiin, taasoo macnaheedu yahay in uu daboolo in ka badan 30 boqolkiiba jirka, qofku wuxuu ubaahnaan doonaa inuu kudhaco steroids oo laga soo qaado xididka (xididada) oo ay raacdo qandhada afka steroids.
Waxa kale oo muhiim ah in la ogaado in finanka aadka u daran sida Stevens-Johnson syndrome-ka in badanaa laga soo sheego dadka isticmaalaya koontarool baaritaan.
Tani waa sababta adiga ama dhakhtarkaaga kansarku uu si taxadar leh kuu ilaalin doono intaad qaadanayso immunotherapy isla markiiba waxaad arkaysaa dhakhtarka maqaarka haddii finanku ay u muuqdaan kuwo walwalsan (sida haddii ay abuurayso finan yaryar) ama haddii aadan gargaar ka helin tallaabooyin sahlan sida cream cream
Miyir beelka xayawaanka
Shubanka iyo colitis, taas oo keenta xanuunka caloosha iyo mararka qaarkood dhiigga saxarada, waa laba dhibaato oo mindhicirka ah oo laga yaabo in ay dhacaan sababtoo ah qaadashada koontarool baaritaan. Haddii dhibaatooyinkani ay dhacaan, waxay guud ahaan muujiyaan lix wiig ama ka dib markaan bilaabin difaaca jirka.
Taasi waxay sheegtey, dhibaatooyinkani waxa ay u muuqdaan inay ka badan yihiin dadka qaata CTLA-4 xakameynta unugyada (tusaale ahaan, silica silica ee melanoma), marka la barbardhigo kuwa qaata PD-1 inhibitors (tusaale ahaan, nivolumab ee unug kor u kaca kansarka sanbabada sambabada).
Daaweynta shuban sahlan iyo mid hore ah waxaa ka mid ah helitaanka dheecaan badan, cunto cuno shuban , iyo suurogal ahaan daawo shuban ah sida Imodium (loperamide). Laakiin haddii shubanku sii socdo in ka badan laba ama saddex maalmood, inkastoo ay jiraan daaweyn fudud, ama haddii shubanku uu ka culus yahay (afar ama kabadan saxarado maalin kasta ah oo caadi ah), qiimeyn buuxda ayaa la sameyn doonaa si loo qiimeeyo shubanka sida infekshanku waa dembiile, maahan daroogada.
Haddii infekshanku meesha ka baxo, sababtuna waxay tahay daaweynta la xidhiidha, corticosteroids ayaa loo baahan yahay marmarka qaarkoodna xitaa xoogaa daaweyn ah oo xoojiya nidaamka difaaca sida Remicade (infliximab) ayaa loo baahan yahay.
Mid ka mid ah halista ugu weyn ee nolosha, xitaa aan caadi ahayn, dhibaatooyinka colitis ee takhaatiirta u fiirsada waa xayawaanka mindhicirka (meesha godka ka yimaada derbiga xiidmaha oo ka yimaada infakshan daran).
Sunta Beerka
Calaamadeynta baaritaanka waxay keeni kartaa kor u kaca heerarka enzymes ee beerka, kaas oo barar ku dhaca bararka signalka. Qiyaasahaas ayaa guud ahaan la arkaa ilaa laba illaa saddex bilood kaddib marka la bilaabayo daaweynta.
Caadi ahaan, dhakhtarku wuxuu kormeeri doonaa baaritaanka dhiigaaga ee dhiigaaga , gaar ahaan ka hor qiyaas kasta oo ka mid ah tallaalka immunotherapy, iyo haddii enzymes la kordhiyo, shaqo ayaa la sameyn doonaa si loo ogaado in sababta ay u la xiriirto difaaca jirka ama wax kale (tusaale, daawo kale ama caabuq fayras).
Sida dhibaatooyinka kale ee is-difaaca jirka ee la xiriira, haddii sababta loo go'aamiyay in lala xiriiriyo difaaca jirka, waxaa loo qorayaa corticosteroids. Haddii sunta sunta ay tahay mid daran, daaweynta immunotherapy waxaa laga yaabaa in loo baahdo in la joojiyo.
Sumowga Nidaamka Endocrine
Dhacdooyinka isdaba-yaryar ee la xiriira tallaalka ayaa laga yaabaa inay ku dhacaan nidaamka xididdada jirka, kuwaas oo ay ku jiraan qanjirka 'pituitary', qanjirka 'thyroid', iyo qanjirka 'adrenal'. Celcelis ahaan, calaamaduhu waxay muuqdaan illaa sagaal usbuuc kaddib marka la bilaabayo daaweynta waxayna ku jiri karaan
- Daal
- Tabaruce
- Lalabbo
- Jahwareer
- Madax xanuun
- Cunto xumo
- Dhibaatooyinka aragtida
- Qandho
Mid ka mid ah dhibaatooyinka ugu caansan ee cillad maskaxda ku dhaca ayaa ah hypothyroidism , oo ah marka qofku yeesho qanjirro aan firfircooneyn.
Xanuunka qanjirka thieroid, oo loo yaqaan hyperthyroidism, ayaa sidoo kale la soo sheegay. Xaaladaha labadaba waxaa maamula takhasusle (endocrinologist) oo lagu ogaado baaritaanka dhiigga, ugu badnaan imtixaanka dhiigga ee hormoonaya (TSH). Hypothyroidism waxay u baahan tahay daaweynta hormoonka thyroid, oo loo yaqaan 'Synthroid (levothyroxine).
Marka laga soo tago hypothyroidism, dhibaatada kale ee loo yaqaan 'endocrinoid' oo laga yaabo inay keento kantaroolka difaaca jirka ee immunotherapy waa hypophysitis, taas oo ah caabuqa qanjirka 'pituitary gland' taas oo loo yaqaanno qanjirka 'master' sababta oo ah waxay sii daayaan hormoono badan oo jidhka ah.
Hypophysitis waxay keeni kartaa daal iyo madax xanuun iyo baaritaano dhiig ayaa muujinaya heerar dhowr ah oo hooseeya. Imtixaannada sawirka ayaa sidoo kale muujin kara barar qanjirka pituitary. Haddii la ogaado ugu dhakhsaha badan, corticosteroids qadar badan ayaa dejin kara infakshanka hoosta ku filan si looga hortago baahida loo qabo daaweynta hormoonka muddada dheer.
Haddii qanjidhada adrenal-ka ay saameeyaan, qofku wuxuu yeelan karaa dhiig-yaraanta, fuuqbaxa, iyo dhibaatooyinka elektaroolka sida heerarka potassium-ka sarreeya iyo heerarka sodium ee hooseeya ee dhiigga. Tani waa xaalad caafimaad oo degdeg ah waxayna u baahan tahay in qof isbitaal la dhigo oo la siiyo corticosteroids.
Ugu dambeyntii, nooca cusub ee sonkorowga nooca I ayaa dhif ah in lala xiriiriyo qaadashada PD-1 inhibitor. Tani waa sababta ay dhakhaatiirtu inta badan u eegi doonaan gulukooska (sonkorta dhiigaaga) markaad bilaabayso daaweynta.
Dhibaatooyinka Daruuriga ah
Tallaal-difaaceed ayaa sidoo kale kicin kara caabuqa sambabada, tanina waxaa loo yaqaannaa pneumonitis, inkastoo ay dhif tahay, marka la barbardhigo sunta kor ku xusan. Saameyntan saameyntani waxay si gaar ah uga welweleysaa dadka qaba kansarka sambabada sare ee loo yaqaan immunotherapy, sababtoo ah hawlgalkooda sambabada ayaa horay u jirey kansar. Waxay keeni kartaa astaamo sida qufac ama dhibaatooyin neefsasho.
Inkastoo sida caadiga ah saameyn aan caadi aheyn, pneumonitis waxay noqon kartaa nolol khatar ah. Haddii lagaa shakiyo, dhakhtarkaaga ayaa ka talaabaya sababaha kale ee sambabada sanbabada sida infakshanka sambabada (oo loo yaqaanno pneumonia) ama horumarka kansarka. Dhakhtarku wuxuu caadi ahaan dalbanayaa baaritaanka CT-ga ee laabta si uu u caawiyo baaritaanka.
Daaweyntu badanaa waxaa ka mid ah joojinta difaaca jir-dilida muddo cayiman muddada qofka la socdo kormeerka dhow ee sambabada. Corticosteroids ayaa sidoo kale la bixiyaa inta badan, iyo xaaladaha daran, talaal-difaaceed sida Remicade (infliximab) ayaa loo baahan karaa haddii qofku aanu ku fiicnayn steroids.
Ugu dambeyntii, waxyeellooyinka kale ee aan la taaban karin ee difaaca jirka ayaa la soo sheegay sida dareemayaasha ama dhibaatooyinka indhaha. Tusaale ahaan, dhakhtarkaagu wuxuu kuu gudbin doonaa takhasus, dhakhtar neerfisle ah ama dhakhtarka indhaha , si loogu helo ogeysiis habboon iyo qorshe daaweyn.
Ereyga
Haddii adiga ama qofka aad jeceshahay ay qaataan kantarool baaritir, waxaa wanaagsan in aad aqoon u leedahay sunta kala duwan ee la xidhiidha, sababtoo ah waxay ka duwan yihiin kuwa la xidhiidha kiimikada dhaqameed.
Si kale haddii loo dhigo, calaamadaha la taaban karo iyo astaamaha saameynahan dambe ayaa ah mid cusub oo ah dhakhtarrada kansarka. Hase yeeshee, ha ka baqin iyaga. Taa baddalkeeda, wax baro iyo feejignaan, inta badan ayaa xallin doona haddii si deg deg ah loo aqoonsado.
> Ilo:
> Kroschinsky F et al. Daawooyinka cusub, sunta cusub: waxyeelooyinka daran ee hargabka casriga ah iyo difaaca kansarka iyo maamulkooda. Daryeelka Xatooyada 2017; 21: 89.
> Linardou H, Gogas H. Maaraynta sunta difaaca jirka ee loogu talagalay bukaanka qaba melaniga metastatic. Ann Translation Med . 2016 Jul; 4 (14): 272.
> Michot JM et al. Dhacdooyinka is-miidaaminta ee la xidhiidha xakamaynta difaaca jirka: dib-u-eegis dhamaystiran. Eur J Cancer . 2016 Feb; 54: 139-48.
> Dugsi M, Wolchok J. Sunnada sunta leh ee la xiriirta difaaca jirka ee difaaca jirka. In: UpToDate, Atkins MB (Ed), UpToDate, Waltham, MA.
> Villadolid J, Amin A. Kaadi-barayaasha koontaroolka ee daaweynta bukaan-socodka: cusbooneysiin maareynta maaddooyinka sunta ah ee la xiriira. Tarjunka Cudurka Lung Cancer 2015 Oct; 4 (5): 560-75.