Cholangiocarcinoma ndi khansa ya m'matumbo a bile. Zimakhudza epithelium ya mtengo wa intra kapena wowonjezera wa hepatic biliary, kutanthauza kuti minofu yopangidwa ndi maselo oyandikana kwambiri omwe amapanga njira zosonkhanitsira bile. Bile ndi madzi achikasu a viscous opangidwa ndi chiwindi, motero kuthekera kwa chitukuko cha intra kapena owonjezera chiwindi matenda.

Ngakhale kuti matendawa sakudziwikabe pang'ono, cholangiocarcinoma imapanga pafupifupi 3% ya khansa ya m'mimba komanso pafupifupi 10 mpaka 15% ya matenda a hepato-biliary. Pali kuchulukitsidwa kwachimuna pang'ono pakukula kwa matendawa. Kuphatikiza apo, matendawa amayamba pafupifupi zaka 50 mpaka 70.

Magwero a chitukuko cha chotupa ichi akadali bwino. Komabe, zitha kuwoneka kuti zimachitika mwapang'onopang'ono, kutanthauza kuti zimakhudza anthu ena mwa anthu popanda kukhala ndi "matenda opatsirana". (1)

Khansara iyi imatha kuchitika pa:

- intrahepatic bile ducts. Njirazi zimapangidwa ndi tinjira tating'onoting'ono (canaliculi), ma Herring ducts ndi ma bile ducts. Gulu la matchaneloli limabwera palimodzi kuti lipange tchanelo wamba kumanzere ndi kumanja. Izi zimasiya chiwindi kuti zipange njira yofanana ndi ya extrahepatic. Mtundu wina wa chotupa chokhudza mphambano pakati pa kumanja ndi kumanzere kwa chiwindi ducts amatchedwa: chotupa cha Klatskin;

- extrahepatic bile ducts, wopangidwa ndi ndulu yayikulu ya ndulu ndi chowonjezera cha bile.

Zizindikiro zomwe zimagwirizanitsidwa ndi mtundu uwu wa khansa ndizosiyana malinga ndi kuwonongeka kwa intra kapena kuwonjezereka kwa chiwindi. Komanso, matenda mawonetseredwe zambiri kuoneka pamene matenda pa siteji patsogolo pa chitukuko chake.

Ndi matenda osowa omwe amapezeka 1 pa 100 anthu. (000)

Zizindikiro za matendawa zimawonekera pamlingo wapamwamba ndipo zimasiyana malinga ndi malo a chotupacho.

Zowonadi, ngati chotupacho ndi chachilendo, zizindikiro zofananira ndi izi: (1)

- mawonekedwe a cholestatic: chimbudzi chowoneka bwino, jaundice, mkodzo wakuda, pruritus, etc.;

- kusapeza bwino;

- kuchepa thupi;

- kumva kutopa ndi kufooka.

Pankhani ya kukhudzidwa kwa intrahepatic, matendawa amatanthauzidwa kwambiri chifukwa cha kusapeza bwino komanso zizindikiro zina za m'mimba monga:

- kuchepa thupi;

- anorexia;

- kupweteka kwa m'mimba.

Zizindikiro zina zimathanso kugwirizana ndi matendawa: (2)

- malungo ;

- kuyabwa;

- kupweteka kumtunda kumanja kwa mimba.

Matendawa amafotokozedwa m’magawo angapo: (3)

- Gawo 1a: khansayo imapezeka m'matumbo a bile;

- Gawo 1b: khansa imayamba kufalikira ndikufalikira kudzera m'mitsempha yamagazi;

- Gawo 2: khansa imayamba kufalikira kudzera m'matumbo (makamaka pachiwindi) ndi mitsempha yamagazi;

- Gawo 3: khansa imapezeka m'mitsempha yambiri yamagazi ndi mitsempha yamagazi;

- Gawo 4: khansa imafalikira ku ziwalo zonse.

Zomwe zimayambitsa khansa ya m'matumbo mpaka pano sizikudziwikabe. Komabe, zifukwa zomwe zimayambitsa chitukuko cha cholangiocarcinoma zimamveka bwino.

Khansara imachokera ku masinthidwe mkati mwa chotengera chidziwitso cha ma cell: DNA.

Kusintha kwa ma genetic mkati mwa maselo kumapangitsa kuti chitukuko chiwonjezeke komanso kukula kosalamulirika kwa maselo zomwe zimapangitsa kuti pakhale chotupa cha cell chotchedwa chotupa.

Ngati khansayo sinapezeke munthawi yake komanso / kapena osalandira chithandizo mwachangu, ndiye kuti chotupacho chimakula ndikufalikira ku ziwalo zina zathupi kapena by kutuluka kwa magazi. (3)

Cholangiocarcinoma imadziwika ndi chotupa chomwe chimakhudza ma ducts a bile. Izi nthawi zambiri zimayamba pang'onopang'ono ndipo kusinthika kwake kukhala metastatic state kumakhalanso kochedwa.

Komanso, kuyezetsa matenda nthawi zambiri zimachitika pa siteji zapamwamba cha chotupa.

Chotupacho chimatha kukula pamlingo uliwonse panjira ya bile ndikuletsa kutuluka kwa bile.

Ngakhale kuti chiyambi chenicheni cha matendawa ndi, mpaka lero, sichidziwikabe, zifukwa zambiri zowopsa zomwe zimagwirizanitsidwa ndi matendawa ndi zomveka. Izi ndizochitika makamaka ndi: (2)

• kukhalapo kwa cysts mu bile ducts;
• matenda kutupa kwa bile ducts kapena chiwindi;
• pulayimale ndi sekondale sclerosing cholangitis (necrotizing kutupa kwa bile ducts kuwachititsa kupapatiza ndi kusokoneza yachibadwa kutuluka kwa bile);
• ulcerative colitis (matenda otupa a matumbo akulu);
• matenda a typhoid (kukula kwa malungo a typhoid omwe chiyambi chake chimachokera ku mankhwala opatsirana ndipo amatha kupatsirana kuchokera kwa munthu wina kupita kwa wina);
• matenda a parasitic ndi Opisthochis viverrini awiri Clonorchis sinensis;
• kukhudzana ndi thorotrast (chosiyanitsa chomwe chimagwiritsidwa ntchito mu x-ray radiographs).

 Zinthu zinanso zaumwini zimagwiranso ntchito pakukula kwa chotupa chotere: (3)

• zaka; anthu opitirira zaka 65 ali ndi chiopsezo chachikulu chokhala ndi matendawa;
• kukhudzana ndi mankhwala. Kuwonekera kwa thorotrast ndiye chitsanzo chowonetsera kwambiri. Zowonadi, zatsimikiziridwa kuti kukhudzana ndi mankhwalawa omwe amagwiritsidwa ntchito kwambiri mu radiography, asanaletsedwe mu 1960s, kumawonjezera chiopsezo chokhala ndi cholangiocarcinoma. Mankhwala ena amathandizanso kukulitsa chiopsezo chotenga matendawa, monga asbestos kapena PCBs (polychlorinated biphenyls). Yoyamba idagwiritsidwa ntchito kwa nthawi yayitali ngati chinthu choyaka moto m'magawo omanga, omanga ndi mafakitale. Ma PCB akhala akugwiritsidwa ntchito nthawi zambiri m'makampani ndi zomangamanga. Mankhwalawa tsopano akutsatiridwa ndi malamulo okhwima;
• kukhalapo kwa chiwindi B kapena C;
• kukhalapo kwa cirrhosis;
• HIV (Human Immunodeficiency Virus);
• mtundu I ndi mtundu II shuga;
• kunenepa kwambiri;
• fodya.

Kuyeza kosiyana siyana kwa khansa ya m'matumbo a bile kuyenera kuchitidwa kuti adziwe matenda. (3)

• kuyezetsa magazi kumagwiritsidwa ntchito pozindikira cholangiocarcinoma. M'malo mwake, pomwe chotupa chimayamba m'matumbo a bile, maselo a khansa amatulutsa mankhwala omwe amatha kuzindikirika poyezetsa magazi. Komabe, zolemberazi zitha kutulutsidwanso pamikhalidwe ina. Kukhalapo kwa zinthu izi sikugwirizana mwadongosolo ndi chitukuko cha khansa ya ndulu ducts;
• scanner ya ma ducts a bile imapangitsa kuti azitha kupeza chithunzi chamkati mwa gawo ili la thupi kuti azindikire zolakwika zilizonse;
• tomography, kupyolera mu mndandanda wa X-rays a chiwindi, imalola kusanthula mwatsatanetsatane za chiwalo ichi kudzera muzithunzi za 3-dimensional;
• MRI (Maginito Resonance Imaging), pogwiritsa ntchito dongosolo la maginito ndi mafunde a wailesi kuti apeze chithunzi cha mkati mwa chiwindi;
• retrograde cholangiopancreatography endoscopy ndi njira yowunikira mwatsatanetsatane zovuta za ndulu;
• percutaneous transhepatic cholangiography amagwiritsidwanso ntchito kuti apeze tsatanetsatane wa ndulu;
• biopsy imalola kutsimikizira kwa matendawa.

Matenda ambiri a khansa ya m'matumbo osachiritsika sangathe kuchira. Komabe, chithandizo cha matendawa nthawi zambiri chimakhala ndi zizindikiro zake.

Kutsata kwa odwala kumachitika chifukwa cha gulu lamitundu yosiyanasiyana lomwe limapangidwa ndi akatswiri (madokotala, oncologist, radiologist, anamwino, gastroenterologist, etc.). (3)

Mankhwala operekedwa amadalira zizindikiro komanso momwe khansara ikukulira.

Mu magawo 1 ndi 2, opaleshoni ndizotheka kukonzanso gawo la ndulu, ndulu kapena chiwindi.

Mu gawo 3, mwayi wopambana wa chithandizo umadalira kuchuluka kwa kuwonongeka kwa mitsempha ya mitsempha.

Pomaliza, mu gawo 4, chiwongola dzanja chamankhwala chimakhala chochepa.

Kuchiza kwa matendawa kungayambitse njira zopangira opaleshoni zomwe zimalola kukonzanso minofu ya khansa: mbali ya ndulu ya bile yomwe ili ndi maselo a khansa, ndulu ya ndulu, ziwiya zina zam'mimba zomwe zakhudzidwa kapena gawo la chiwindi.

Kawirikawiri, pakati pa 20% ndi 40% ya anthu omwe akuchitidwa opaleshoni amapulumuka zaka 5 kapena kuposerapo pambuyo pa opaleshoniyo.

Potsutsana ndi kupweteka kwa m'mimba, jaundice, ndi zina zotero, kutsegula kwa ma ducts a bile nthawi zina kumafunika. Kutulutsidwa kumeneku kumachitika pogwiritsa ntchito chubu chochepa kwambiri chomwe chimadutsa munjira za bile.

Thandizo la radiation si njira yochiritsira ya cholangiocarcinoma, komabe ikhoza kukhala yothandiza kuchepetsa zizindikiro komanso kuchepetsa kufalikira kwa metastases. Pali mitundu iwiri ya ma radiation therapy: kunja kwa beam radiation therapy komanso mkati mwa radiation therapy.

Kuphatikiza apo, radiotherapy imatha kuyambitsa zovuta zina monga nseru, kusanza kapena kutopa kwambiri.

Chemotherapy imagwiritsidwanso ntchito pazolinga zofanana ndi chithandizo cha radiation. Kapena kuchepetsa zizindikiro, kuti achepetse kufalikira kwa chotupacho ndikuwonjezera nthawi ya moyo wa munthu wokhudzidwayo. Chemotherapy nthawi zambiri imaphatikizidwa ndi radiotherapy. Zotsatira zoyipa zomwe zimagwirizanitsidwa ndi chemotherapy ndizomwe zimagwirizanitsidwa ndi radiotherapy kuphatikiza tsitsi.

Kafukufuku wina wasonyeza ubwino wokhudzana ndi kuphatikiza mankhwala awiri omwe amagwiritsidwa ntchito mu chemotherapy (Cisplatin ndi Gemcitabine).

Pakali pano, mankhwala okhudzana ndi khansa ya m'matumbo a bile sagwira ntchito mofanana ndi omwe amagwirizana ndi mitundu ina ya khansa. Choncho, maphunziro ambiri amaganizira za khansa yamtunduwu kuti apeze njira zabwino zothandizira matendawa.

Kuonjezera apo, kafukufuku wokhudzana ndi chitukuko cha mankhwala ochizira omwe akugwiritsidwa ntchito ndi amakono. Awa ndi mankhwala omwe amayang'ana gawo linalake la chitukuko cha khansa.