Khansara ya m'mphuno imayambira kuseri kwa mphuno, kuchokera pamwamba pa mkamwa wofewa mpaka kumtunda kwa mmero. Anthu omwe ali ndi vutoli nthawi zambiri amakhala ndi tinthu tating'onoting'ono m'khosi, amatha kumva kukhuta kapena kupweteka m'makutu, komanso kumva kusamva. Pambuyo pake zizindikiro zake ndi monga mphuno yothamanga, kutsekeka kwa mphuno, kutupa kumaso ndi dzanzi. Biopsy ndiyofunikira kuti muzindikire ndi kuyesa kuyesa (CT, MRI, kapena PET) kuti awone kukula kwa khansayo. Chithandizo chimachokera ku radiotherapy ndi chemotherapy komanso, mwapadera, pa opaleshoni.

Khansara ya nasopharyngeal, yomwe imatchedwanso nasopharynx, cavum kapena epipharynx, ndi khansa ya epithelial, yomwe imayambira m'maselo a kumtunda kwa pharynx, kuseri kwa ndime za m'mphuno, kuchokera kumtunda wofewa kupita kumtunda wa mphuno. khosi. Makhansa ambiri a nasopharynx ndi squamous cell carcinomas, zomwe zikutanthauza kuti amamera m'maselo a squamous omwe amakhala mu nasopharynx.

Ngakhale kuti khansa ya nasopharyngeal imatha kukula pa msinkhu uliwonse, imakhudza makamaka achinyamata ndi odwala omwe ali ndi zaka zoposa 50. Ngakhale kuti ndizosowa ku United States ndi Western Europe, ndizofala ku Asia ndipo ndi imodzi mwa khansa yomwe imapezeka kwambiri pakati pa anthu a ku China osamukira ku United States. Mayiko, makamaka omwe aku South China komanso akumwera. - Asiya. Khansara ya Nasopharyngeal ndiyosowa ku France yokhala ndi vuto limodzi pa anthu 100 aliwonse. Amuna amakhudzidwa pafupipafupi kuposa akazi.

Zotupa za nasopharyngeal epithelial zagawidwa ndi World Health Organisation potengera kusiyanitsa kwa maselo oyipa:

• Mtundu Woyamba: wosiyanitsa keratinizing squamous cell carcinoma. Zosowa, zimawonedwa makamaka m'madera a dziko omwe ali ndi zochitika zochepa kwambiri;
• Mtundu Wachiwiri: kusiyanitsa squamous cell carcinoma (35 mpaka 40% ya milandu);
• Mtundu Wachitatu: Carcinoma Wosadziwika wa Nasopharyngeal Type (UCNT: Undifferenciated Carcinoma ya Nasopharyngeal Type). Zimayimira 50% ya milandu ku France, ndi pakati pa 65% (North America) ndi 95% (China) ya milandu;
• Lymphomas yomwe imayimira pafupifupi 10 mpaka 15% ya milandu.

Ma khansa ena a nasopharyngeal ndi awa:

• adenoid cystic carcinomas (cylindromes);
• zotupa zosakanikirana;
• adenocarcinoma;
• fibrosarcoma;
• osteosarcoma;
• chondrosarcoma;
• melanoma.
  

Zinthu zingapo zachilengedwe komanso zamakhalidwe zawonetsedwa kuti ndizowopsa kwa anthu zokhudzana ndi khansa ya nasopharyngeal:

• Kachilombo ka Epstein-Barr: kachilombo kameneka ka m'banja la herpes kamayambitsa ma lymphocyte a chitetezo cha mthupi ndi maselo ena a m'kamwa ndi pharynx. Infection zambiri zimachitika ali mwana ndipo angasonyeze ngati kupuma thirakiti matenda kapena matenda mononucleosis, wofatsa matenda a ubwana ndi unyamata. Anthu opitilira 90 pa XNUMX aliwonse padziko lonse lapansi ali ndi kachilomboka, koma nthawi zambiri alibe vuto. Izi zili choncho chifukwa si anthu onse omwe ali ndi kachilombo ka Epstein-Barr omwe amakhala ndi khansa ya nasopharyngeal;
• kudya nsomba zambiri zosungidwa kapena zokonzedwa mumchere, kapena chakudya chosungidwa ndi nitrites: njira iyi yosungira kapena kukonzekera ikuchitika m'madera angapo a dziko lapansi, makamaka ku South-East Asia. Komabe, njira yolumikizira chakudya chamtundu uwu ndi mapangidwe a khansa ya nasopharyngeal sichinatsimikizidwe bwino. Malingaliro awiri amayikidwa patsogolo: kupangidwa kwa nitrosamines ndi kubwezeretsanso kachilombo ka Epstein-Barr;
• kusuta: chiwopsezo chimawonjezeka ndi kuchuluka komanso nthawi yomwe amamwa fodya;
• formaldehyde: yomwe idayikidwa mu 2004 pakati pa zinthu zomwe zatsimikiziridwa mwa anthu za khansa ya nasopharynx. Kuwonekera kwa formaldehyde kumachitika m'malo opitilira zana komanso magawo osiyanasiyana azinthu: zowona zanyama, zodzola, zamankhwala, mafakitale, ulimi, etc.
• fumbi la nkhuni: limatulutsa pa ntchito yokonza matabwa (kugwetsa, kudula, kupeta), kukonza matabwa a nkhuni kapena mapanelo amatabwa, kunyamula tchipisi ndi utuchi chifukwa cha kusintha kumeneku, kumaliza mipando (ginning). Fumbi la nkhunili limatha kukomoka, makamaka ndi anthu omwe amawonekera panthawi yantchito yawo.

Zina zomwe zingayambitse khansa ya nasopharyngeal zimaganiziridwa pazomwe zilipo panopa:

• kusuta fodya;
• Kumwa mowa;
• kudya nyama yofiira kapena yokonzedwa;
• matenda a papillomavirus (HPV 16).

Chiwopsezo cha chibadwa chimadziwikanso ndi maphunziro ena.

Nthawi zambiri, khansa ya nasopharyngeal imayamba kufalikira ku ma lymph nodes, zomwe zimapangitsa kuti tinthu tating'onoting'ono tituluke m'khosi, zisanachitike zizindikiro zina. Nthawi zina kutsekeka kosalekeza kwa mphuno kapena machubu a eustachian kungayambitse kumva kukhuta kapena kupweteka m'makutu, komanso kumva kumva, kumbali imodzi. Ngati chubu cha eustachian chatsekedwa, kutuluka kwamadzimadzi kumachulukana pakati pa khutu.

Anthu omwe ali ndi matendawa amathanso kukhala ndi:

• nkhope yotupa;
• mphuno yothamanga ya mafinya ndi magazi;
• epistaxis, ndiko kuti, mphuno;
• magazi m'malovu;
• mbali yopuwala ya nkhope kapena diso;
• khomo lachiberekero lymphadenopathy.

Kuti adziwe khansa ya m'mphuno, dokotala amafufuza kaye mphuno yake ndi galasi lapadera kapena chubu chochepa, chosinthika, chotchedwa endoscope. Ngati chotupa chapezeka, dokotala ndiye kuti ali ndi nasopharyngeal biopsy, momwe minofu imatengedwa ndikuwunikiridwa pa microscope.

Kujambula kwa computed tomography (CT) kwa skull base ndi magnetic resonance imaging (MRI) ya mutu, nasopharynx, ndi tsinde la chigaza kumachitika kuti awone kukula kwa khansa. Kujambula kwa positron emission tomography (PET) kumachitikanso kawirikawiri kuti awone kukula kwa khansa ndi ma lymph nodes pakhosi.

Kuchiza koyambirira kumathandizira kwambiri kuzindikirika kwa khansa ya nasopharyngeal. Pafupifupi 60-75% ya anthu omwe ali ndi khansa yoyambirira amakhala ndi zotsatira zabwino ndipo amakhala ndi moyo kwa zaka zosachepera 5 atazindikira.

Monga momwe zimakhalira ndi khansa zonse za ENT, njira zina zosiyana ndi njira zochiritsira zimakambidwa mu CPR kuti apatse wodwalayo pulogalamu yamankhwala payekha. Msonkhanowu ukuchitika pamaso pa asing'anga osiyanasiyana omwe akukhudzidwa ndi chisamaliro cha wodwalayo:

• dokotala wa opaleshoni;
• radiothérapeute;
• oncologist;
• radiologist;
• katswiri wa zamaganizo;
• anatomopathologist;
• dotolo wamano.

Chifukwa cha mawonekedwe awo komanso kufalikira kwawoko, khansa ya nasopharyngeal sichipezeka ku chithandizo cha opaleshoni. Nthawi zambiri amathandizidwa ndi chemotherapy ndi radiotherapy, yomwe nthawi zambiri imatsatiridwa ndi adjuvant chemotherapy:

• chemotherapy: amagwiritsidwa ntchito kwambiri, chifukwa khansa ya nasopharyngeal ndi zotupa za chemosensitive. Mankhwala omwe amagwiritsidwa ntchito kwambiri ndi bleomycin, epirubicin ndi cisplatin. Chemotherapy imagwiritsidwa ntchito yokha kapena kuphatikiza ndi radiotherapy (concomitant radiochemotherapy);
• kunja mtengo radiation mankhwala: amachitira chotupa ndi mwanabele madera;
• conformational radiotherapy with intensity modulation (RCMI): imalola kusintha kwa chotupa dosimetric kuphimba ndikusunga bwino kwazinthu zathanzi komanso madera omwe ali pachiwopsezo. Kupindula kwa kawopsedwe ka malovu ndikofunika kwambiri poyerekeza ndi kuyatsa wamba komanso moyo wabwino pakapita nthawi;
• brachytherapy kapena kuyika kwa implantation ya radioactive: ingagwiritsidwe ntchito ngati chowonjezera pambuyo pa kuyatsa kwakunja pamlingo wokwanira kapena ngati chophatikizira pakangochitika pang'ono pang'ono.

Chotupacho chikawonekeranso, chithandizo cha radiation chimabwerezedwa kapena, muzochitika zenizeni, opaleshoni ikhoza kuyesedwa. Izi zimakhala zovuta chifukwa nthawi zambiri zimachotsa mbali ya chigaza. Nthawi zina zimachitika kudzera m'mphuno pogwiritsa ntchito endoscope.