Cov ntaub ntawv kho mob qhia tias tus lej ntawm cov kab mob oncological tau nce zuj zus. Cov txiaj ntsig tuag tau raug kaw ntau dua txhua xyoo. Qhov tseeb no ua rau muaj kev txhawj xeeb ntau dua thiab yuam cov kws kho mob ua haujlwm tiv thaiv ntawm cov pej xeem kom tsawg kawg me ntsis txwv qhov kev loj hlob zuj zus ntxiv.
Carcinoid syndrome: nws yog dab tsi?
Carcinoids yog cov qog hlav ntau tshaj plaws los ntawm cov hlwb ntawm cov kab mob neuroendocrine. Cov hlwb no tuaj yeem pom nyob rau hauv txhua lub cev thiab cov ntaub so ntswg ntawm lub cev. Lawv lub luag haujlwm tseem ceeb yog tsim cov khoom muaj protein ntau. Kwv yees li yim caum feem pua ntawm tag nrho cov carcinoids nyob hauv plab hnyuv, ua raws li lub ntsws. Ntau zaus tsawg dua, tsuas yog tsib feem pua ntawm cov neeg mob, neoplasms pom nyob rau hauv lwm yam kabmob thiab cov ntaub so ntswg.
Carcinoid syndrome thiab qog nqaij hlav carcinoid yog sib cais ntawm ib leeg, vim tias tus mob no yog cov tsos mob tshwm sim tawm tsam keeb kwm ntawm kev loj hlob thiab kev ua haujlwm ntawm cov qog nqaij hlav malignant. Tom qab tag nrho, lub cev reacts rau kev noj cov tshuaj hormones secreted los ntawm cov qog mus rau hauv cov ntshav. Cov plab hnyuv carcinoids tuaj yeem ua "tsim", uas yog, lawv tsis tshwm sim lawv tus kheej hauv txhua txoj kev kom txog thaum metastases tshwm sim thiab tus kab mob kis mus rau theem kawg.
Yog vim li cas
Cov kws tshawb fawb tseem tsis tau muaj ntaub ntawv txaus los nkag siab tias vim li cas carcinoid syndrome thiab qog nqaij hlav carcinoid tsim. Cov kws tshawb fawb tuaj yeem xav txog qhov etiology ntawm tus kab mob, tab sis txhua tus pom zoo tias lub cev tsis muaj zog ntawm qee lub sijhawm tsis paub txog cov hlwb hloov pauv ntawm APUD system (ib qho lus luv luv los ntawm thawj cov ntawv ntawm cov lus "amines", "precursor", "assimilation", "decarboxylation").
Ib lub cell tsis txaus txaus los tsim cov neoplasm puv puv uas yuav tsim cov tshuaj hormones thiab hloov tag nrho cov txheej txheem biochemical hauv tib neeg lub cev kom haum rau nws tus kheej xav tau.
Pathogenesis
Cov kab mob carcinoid tshwm sim li cas? Nws yog dab tsi thiab yuav tiv thaiv nws li cas? Muab hais tias cov hlwb neuroendocrine nyob thoob plaws hauv lub cev, thiab cov qog ua haujlwm tsis ua rau pom kev kho mob, cov kws kho mob tsis tuaj yeem txwv cov txheej txheem no.
Ib ntus hauv lub xovtooj ntawm tes muaj "kev tawg" ntawm DNA, uas tsis raug rov qab los yog txuas ntxiv ua haujlwm nrog cov khoom puas. Qhov no ua rau kev ua haujlwm tsis zoo ntawm lub cell thiab nws qhov kev faib tsis tau. Yog tias lub cev muaj kev noj qab haus huv, ces lub cev tiv thaiv kab mob yuav teb rau qhov kev hloov pauv thiab tshem tawm ntawm qhov tsis txaus ntseeg. Yog tias qhov no tsis tshwm sim, lub xov tooj ntawm tes yuav sib npaug, tsim ntau lab luam ntawm nws tus kheej thiab pib faibCov tshuaj lom thiab cov tshuaj hormones thoob plaws hauv lub cev.
Ntau zaus, cov kws kho mob tsis tuaj yeem nrhiav cov qog txawm tias pom tseeb tias muaj mob carcinoid syndrome.
Carcinoma hauv ntsws
Tsuas yog hauv kaum feem pua ntawm cov neeg mob, cov qog tuaj yeem tsim nyob rau hauv txoj kev ua pa thiab, raws li, carcinoid syndrome. Cov cim qhia hauv lub ntsws yuav tsis yog qhov tshwj xeeb, thiab qee zaum lawv yuav tsis nyob txhua qhov. Qhov no yog vim qhov me me ntawm neoplasm thiab tsis muaj metastasis. Cov neeg mob nrhiav kev pab nrog tus kab mob uas twb muaj lawm thiab, raws li txoj cai, tsis yog rau tus kws kho mob oncologist, tab sis ua ntej rau tus kws kho mob. Nws tuaj yeem kho tus mob bronchiolitis ntev, mob hawb pob lossis ua pa tsis ua haujlwm kom txog thaum nws xav tias muaj cov txheej txheem oncological.
Cov tsos mob hauv qhov no yog atypical:
- nrawm, lub plawv dhia;
- dyspepsia;
- xav kub thiab maj ntshav mus rau ib nrab ntawm lub cev;
- hnoos, ua tsis taus pa;
- Nyob zoo ib tsoom phooj ywg sawv daws.
Nrog cov kab mob zoo li no, nws nyuaj rau xav tias muaj kab mob carcinoid. Tsis muaj kev qaug zog, poob ceeb thawj, txo kev tiv thaiv, qaug zog thiab lwm yam tsos mob ntawm cov txheej txheem oncological.
qog nqaij hlav ntawm txoj hnyuv
Nyob rau hauv txoj hnyuv me, cov qog nqaij hlav thiab cov kab mob carcinoid nrog tau raug kaw me ntsis ntau dua li hauv lub ntsws. Nws cov tsos mob tsis zoo heev. Feem ntau tsuas yog mob plab tsis muaj mob xwb. Qhov no yog vim qhov me me ntawm cov qog. Qee zaum nws tsis tuaj yeem kuaj pom txawm tias thaum lub sijhawm ua haujlwm. Feem ntau kev kawmpom muaj caij nyoog thaum x-ray.
Tsuas yog li ntawm kaum feem pua ntawm tag nrho cov qog ntawm cov hnyuv me ntawm cov etiology no yog qhov ua rau mob carcinoid. Rau tus kws kho mob, qhov no txhais tau hais tias cov txheej txheem tau dhau los ua malignant thiab kis mus rau daim siab. Cov qog no tuaj yeem ua rau muaj kev cuam tshuam ntawm txoj hnyuv lumen thiab, vim li ntawd, plab hnyuv txhaws. Tus neeg mob tuaj rau hauv tsev kho mob nrog mob cramping, xeev siab, ntuav thiab quav quav. Thiab yog vim li cas rau tus mob no yuav pom tsuas yog nyob rau ntawm lub rooj khiav hauj lwm.
Kev cuam tshuam tuaj yeem tshwm sim ncaj qha los ntawm qhov loj ntawm cov qog, thiab torsion ntawm txoj hnyuv vim qhov tshwm sim ntawm fibrosis thiab o ntawm nws cov mucous membrane. Qee zaum caws pliav cuam tshuam cov ntshav mus rau thaj tsam ntawm txoj hnyuv, ua rau necrosis thiab peritonitis. Ib yam ntawm cov xwm txheej no ua rau muaj kev phom sij rau lub neej thiab tuaj yeem ua rau tus neeg mob tuag.
Tumor of appendix
Cov kab mob ntawm daim ntawv ntxiv yog qhov tsawg hauv lawv tus kheej. Ntawm lawv, carcinoids nyob hauv thawj qhov chaw muaj koob npe, tab sis xyaum tsis ua rau carcinoid syndrome. Lawv cov cim tseem ceeb heev. Raws li txoj cai, cov no yog cov kev tshawb pom ntawm cov kws kho mob tom qab phais mob appendectomy. Cov qog tsis ncav cuag ib centimeter loj thiab coj tus cwj pwm "tshaj". Tej zaum cov qog yuav tshwm sim nyob rau hauv lwm qhov chaw tom qab tshem tawm ntawm cov appendix yog negligible.
Tab sis yog tias qhov kuaj pom neoplasm yog ob centimeters lossis ntau dua qhov loj, ces ib tus yuav tsum ceev faj ntawm cov kab mob metastasis rau cov qog nqaij hlav hauv zos thiab nthuav tawm cov qog hlwb mus rau lwm yam kabmob. Nyob rau hauv rooj plaub no, ib qho appendectomy zoo tib yam yuav tsis tiv nrog tag nrho cov kev tso tawm, thiab oncologists yuav tsum tau koom tes rau txoj kev kho mob.
Lub plab carcinoid qog
Lwm qhov chaw nyob hauv qhov chaw uas tus mob carcinoid tsis tau qhia. Tsis muaj cov cim qhia thiab qog pom tshwm sim thaum lub sijhawm kuaj mob xws li colonoscopy lossis sigmoidoscopy.
Qhov yuav tshwm sim ntawm malignancy (malignancy) thiab cov tsos mob ntawm cov metastases nyob deb yog nyob ntawm qhov loj ntawm cov qog. Yog hais tias nws txoj kab uas hla tshaj ob centimeters, ces qhov kev pheej hmoo ntawm cov teeb meem yog hais txog yim caum feem pua. Yog tias cov neoplasm tsis ncav cuag ib centimeter ntawm txoj kab uas hla, ces koj tuaj yeem ua tau cuaj caum-yim feem pua paub tseeb tias tsis muaj metastases.
Yog li ntawd, txoj hauv kev rau kev kho mob hauv ob kis no yuav txawv. Cov qog me me feem ntau raug tshem tawm los ntawm kev siv lub plab zom mov, thiab yog tias muaj cov tsos mob ntawm malignancy, ces tag nrho lub qhov quav yuav raug tshem tawm, nrog rau kev siv tshuaj khomob.
Gastral carcinoid
Muaj peb hom kab mob plab carcinoid uas ua rau carcinoid syndrome. Cov tsos mob ntawm hom 1 qog:
- me me (txog 1cm);
- kev kawm zoo.
Tej zaum nyuaj kis ntawm cov qog, thaum txheej txheem ntes tag nrho lub plab. Lawv cuam tshuam nrog percynos anemia lossis mob gastritis hauv tus neeg mob. Kev kho mob ntawm cov qog no yog noj somatostatins, inhibition ntawm gastrin ntau lawm, los yog resection.plab.
Cov qog ntawm hom thib ob loj hlob qeeb, tsis tshua muaj mob. Lawv yeej nyob rau hauv cov neeg mob uas muaj kab mob caj ces xws li ntau yam endocrine neoplasia. Tsis tsuas yog lub plab tuaj yeem cuam tshuam, tab sis kuj tseem cuam tshuam rau epiphysis, thyroid caj pas, pancreas.
Qhov thib peb ntawm qog yog ib qho loj neoplasm uas loj hlob hauv plab noj qab haus huv. Lawv yog cov malignant, nkag mus tob rau hauv cov phab ntsa ntawm lub cev thiab muab ntau yam metastases. Tej zaum yuav ua rau perforation thiab los ntshav.
Cov hnyuv loj yog qhov chaw uas mob carcinoid thiab qog nqaij hlav cancer feem ntau raug kuaj pom. Daim duab ntawm lub mucosa thaum lub sij hawm soj ntsuam ntawm ntu ntawm txoj hnyuv no qhia tau hais tias muaj cov qog loj (tsib centimeters los yog ntau dua). Lawv metastasize rau cov qog ntshav hauv cheeb tsam thiab yuav luag ib txwm ua tsis zoo.
Oncologists nyob rau hauv cov xwm txheej zoo li no qhia txog kev phais radical nrog kev kho mob ntxiv thiab neoadjuvant kom ua tiav cov txiaj ntsig zoo tshaj plaws. Tab sis qhov kev muaj sia nyob rau cov neeg mob no tseem tsis zoo.
Carcinoid syndrome: cov tsos mob, duab
Kev tshwm sim ntawm carcinoid syndrome nyob ntawm seb cov tshuaj uas cov qog tso tawm. Cov no tuaj yeem yog serotonin, bradykinin, histamine lossis chromogranin A. Cov tsos mob feem ntau yog:
- Liab ntawm lub ntsej muag thiab lub cev sab sauv. Nws tshwm sim hauv yuav luag txhua tus neeg mob. Nrog rau qhov kub nce hauv zos. Kev qaug dab peg tshwm sim spontaneouslytshwm sim los ntawm cawv, kev ntxhov siab lossis kev tawm dag zog. Nyob rau tib lub sijhawm, tachycardia tau pom, siab poob.
- quav quav. Tam sim no nyob rau hauv ¾ ntawm cov neeg mob. Raws li txoj cai, qhov no tshwm sim vim yog khaus ntawm daim tawv nqaij ntawm lub plab zom mov, plab hnyuv txhaws.
- Kev mob ntawm lub plawv muaj nyob hauv ib nrab ntawm cov neeg mob. Carcinoid syndrome pab tsim cov valvular stenosis thiab ua rau lub plawv tsis ua hauj lwm.
- hawb pob hauv ntsws yog qhov tshwm sim ntawm bronchospasm.
- Mob plab yog txuam nrog cov tsos mob ntawm metastases nyob rau hauv daim siab, plab hnyuv ob leeg los yog qog loj hlob nyob rau hauv lwm yam kabmob.
Kev kub ntxhov Carcinoid yog ib yam mob uas tshwm sim los ntawm cov ntshav siab sai sai thaum phais. Yog li ntawd, cov neeg mob tau muab tshuaj somatostatin ua ntej kev ua haujlwm zoo li no.
Diagnosis
Puas tau kuaj pom Carcinoid Syndrome? Cov paib, cov duab, kev kho cov tsos mob sib txawv tsis muab cov duab pom tseeb lossis pom pom. Feem ntau, qog nqaij hlav yog ib qho kev nrhiav pom los ntawm ib tus kws phais lossis tus kws kho mob radiologist. Txhawm rau kom paub meej tias muaj cov neoplasm, koj yuav tsum tau kuaj xyuas qhov chaw cuam tshuam thiab tshuaj xyuas cov ntaub so ntswg.
Koj tseem tuaj yeem siv cov kev ntsuas txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau nws cov tshuaj hormone Qhov tshwj xeeb tshaj plaws yog qhov kev sim rau tus nqi ntawm 5-hydroxyindoleacetic acid. Yog tias nws qib siab,ces qhov tshwm sim ntawm carcinoid yog yuav luag 90%.
Tshuaj khomob
Nws puas muaj txiaj ntsig los kho tus mob carcinoid nrog tshuaj kho mob? Cov paib, cov duab ntawm cov mucosa thaum lub sij hawm FGDS, ib qho kev kuaj mob ntawm cov qog nqaij hlav hauv cheeb tsam thiab cov kev hloov hauv cov qib hormonal tuaj yeem ua rau tus kws kho mob lub tswv yim ntawm cov teeb meem uas muaj cov qog ua rau hauv tus neeg mob lub cev. Yog tias qhov kev cia siab rau tus neeg mob tsis zoo txawm tias cov qog raug tshem tawm, cov kws tshaj lij qhia kom siv tshuaj khomob.
Feem ntau, cov kws kho mob siv cytostatics los txwv kev loj hlob thiab kev loj hlob ntawm neoplasms. Tab sis vim muaj ntau cov kev phiv tshwm sim, txoj kev no tau pom zoo kom siv tsuas yog thaum muaj xwm txheej ceev. Tsis tas li ntawd, nws cov txiaj ntsig tsuas yog 40%.
kho mob
Muaj qhov tsis xis nyob uas tau pom tawm tsam keeb kwm ntawm pathologies xws li carcinoid syndrome thiab carcinoid qog. Cov tsos mob feem ntau yog ze ze rau hom tshuaj hormones uas cov qog tso tawm. Yog hais tias nws yog serotonin, ces tus neeg mob tau muab tshuaj antidepressants. Yog tias lub ntsiab "tus neeg ua phem" yog histamine, ces histamine receptor blockers tuaj rau hauv kev kho.
Synthetic analogues ntawm somatostatin tau pom tias txo cov tsos mob yuav luag 90%. Lawv txwv kev tsim ntau cov tshuaj hormones ib zaug thiab yog li muaj qhov chaw ruaj khov rau lawv tus kheej hauv kev kho tus kab mob no.
kev kho mob phais
Ib theem tseem ceeb ntawm kev kho mob yog tshem tawm cov qog ntawm lub cev, tshawb nrhiav thiab tshem tawm cov metastases, ligation ntawm cov hlab ntsha.lub siab.
Qhov chaw thiab qhov loj ntawm neoplasm, qhov muaj lossis tsis muaj metastases cuam tshuam rau qhov ntim ntawm kev phais. Feem ntau, cov kws phais tshem tawm qhov cuam tshuam ntawm lub cev thiab pob khoom ntawm cov qog ntshav hauv cheeb tsam. Raws li txoj cai, qhov no txaus kom tshem tawm ib tus neeg ntawm carcinoid mus tas li. Nyob rau hauv cov neeg mob siab heev, thaum tsis muaj kev kho mob radical, tus neeg mob tau txais kev kho mob rau cov hlab ntsha hepatic embolization kom tshem tawm cov tsos mob ntawm tus kab mob.
Huab cua
Yuav ua li cas rau cov neeg mob kuaj mob carcinoid thiab qog nqaij hlav carcinoid? Kub flashes, plawv palpitations thiab ua tsis taus pa luv yuav nyob nrog lawv mus tas li ntawm lawv lub neej, tab sis yuav ua tsis tshua muaj suab nrov tom qab kho.
Tshuaj paub cov xwm txheej thaum cov neeg mob nyob tau ntau tshaj kaum xyoo tom qab kev phais thiab kho cov tsos mob. Tab sis qhov nruab nrab, lawv lub neej expectancy yog li 5-10 xyoo. Cov qog nqaij hlav nyob hauv lub ntsws muaj qhov tshwm sim phem tshaj plaws, thiab cov kab mob hauv cov hnyuv tau pom zoo tshaj plaws.
