Primary mob cancer yog tsawg. Feem ntau, mob qog noj ntshav ntawm lub cev yog qhov thib ob, uas yog, metastatic. Cov qog nqaij hlav hauv siab muaj xws li cholangio- thiab hepatocellular carcinoma. Cov hom mob qog noj ntshav zoo ib yam tuaj yeem tshwm sim hauv cov txiv neej thiab poj niam (tsawg dua). Thaum yau, cov qog no yuav luag tsis pom. Cov neeg mob hluas tuaj yeem tsim mob qog noj ntshav uas tshwm sim los ntawm cov ntaub so ntswg, hu ua hepatoblastoma. Qhov no pathology yog tsawg. Yuav luag tag nrho cov kab mob hauv lub siab yog suav tias yog txhoj puab heev. Lawv coj qhov chaw thib 5 ntawm kev tuag hauv cov qauv ntawm oncological pathologies. Tam sim no, kev tshawb nrhiav tab tom nrhiav rau txoj kev tshiab ntawm kev tawm tsam mob qog noj ntshav. Kev vam meej tau ua tiav los ntawm kev tshawb pom ntawm cov phiaj xwm thiab kev tiv thaiv kab mob.
Kev piav qhia ntawm hepatocellular carcinoma
Hepatocellular carcinoma yog cov qog hlav los ntawm daim siab hlwb uas tau dhau los ntawm atypia. Piv nrog rau lwm cov thawj oncological pathologies ntawm lub cev, nws yog feem ntau. Cov qog no tseem hu ua hepatocellular carcinoma. Raws li qhov zaus ntawm qhov tshwm sim, hepatocellular carcinoma ntawm cov txiv neej nyob qib 5 hauv ntiaj teb. Cov qog no tshwm sim ntau zaus hauv cov tebchaws tsim. Nws yog ib yam kab mob oncological hnyav thiab sai heev thiab feem ntau ua rau tuag. Lub ntsiab lus yog tsis tsuas yog nyob rau hauv lub lig kev kuaj mob ntawm pathology, tab sis kuj nyob rau hauv nws aggressiveness thiab muaj peev xwm mus metastasize rau lwm yam kabmob. Qhov no yog vim qhov peculiarities ntawm cov ntshav muab rau lub siab.
Txhua hom mob qog noj ntshav tau teev nyob rau hauv International Classification of Diseases (ICD). Zoo li lwm yam kab mob oncological, hepatocellular carcinoma kuj muaj nws tus kheej cov cai tshwj xeeb. ICD-10 yog siv nyob rau hauv tag nrho cov teb chaws ntawm lub ntiaj teb no. Hauv kev faib tawm, tus kab mob muaj tus lej C22.0, uas txhais tau tias "hepatocellular cancer." Feem ntau, cov kab mob no tshwm sim tawm tsam keeb kwm yav dhau los ntawm cov kab mob ntev, nyob rau hauv qhov cuam tshuam ntawm qhov tsis zoo.
Ua rau daim siab mob cancer
Raws li koj paub, etiology ntawm malignant neoplasms tseem tsis tau kawm. Txawm li cas los xij, cov kws tshawb fawb tau ntev los paub tseeb tias yam twg ua rau muaj kev loj hlob ntawm ib qho qog. Hepatocellular carcinoma yog tsis muaj kev zam. Cov kev cuam tshuam hauv qab no ua rau nws:
- Kev thauj mus los ntev ntawm qee tus kab mob. Nws ntseeg tau tias cov kab mob xws li kab mob siab B thiab C ua rau muaj kev pheej hmoo ntawm kev tsim kab mob siab rau ntau dua 100 zaug. Tsis tas li ntawd, cov kab mob no feem ntau asymptomatic. Yog li ntawd, txhawm rau txo qhov kev pheej hmoo ntawm kev mob qog noj ntshav, koj yuav tsum pub ntshav rau cov kab mob ib ntus.kab mob siab.
- Cirrhosis ntawm daim siab ntawm txhua yam etiology. Kev hloov ntawm hepatocytes nrog cov ntaub so ntswg feem ntau tshwm sim los ntawm kev kis tus kab mob mus ntev, haus cawv thiab siv yeeb tshuaj.
- noj zaub mov nplua nuj nyob hauv aflatoxins.
- Ntxhais muaj kab mob.
- Siv tshuaj hepatotoxic.
Yog tias koj tsis suav nrog cov npe ua rau muaj kev cuam tshuam, kev pheej hmoo ntawm kev tsim kab mob hepatocellular carcinoma tsawg heev. Txawm li cas los xij, tsis muaj leej twg tiv thaiv kab mob no. Zoo li lwm yam mob qog noj ntshav, nws tuaj yeem tshwm sim los ntawm kev raug hluav taws xob ionizing, haus luam yeeb, noj tsis txaus, kev ntxhov siab, thiab lwm yam.
Pathogenesis ntawm hepatocellular carcinoma
Raws li qhov tshwm sim ntawm cov txheej txheem mob ntev, cov kab mob siab ib txwm pib hloov mus ua cov qog. Dab tsi ua rau qhov no tsis paub meej. Vim qhov kev ua ntawm tus kab mob no, lub siab cov ntaub so ntswg ua o, lub cev ua o thiab mob. Lub permeability ntawm cov hlab ntsha nce, lawv dhau los ua ntshav. Yog li ntawd, lub siab ua haujlwm tsis zoo. Ntxiv nrog rau qhov tseeb tias lub cev raug rhuav tshem los ntawm cov kab mob kis, nws tseem cuam tshuam los ntawm lwm yam khoom tsis zoo los ntawm cov khoom noj. Tag nrho cov no coj mus rau cellular transformation. Lub nucleus loj tuaj, lub cytoplasm thiab lwm yam organelles tau tsiv mus rau qhov chaw. Tom qab ntawd, lub cell pib faib unmotivated. Ntau cov nuclei tshwm sim, cov txheej txheem metabolic hauv hepatocyte cuam tshuam. pib synthesized nyob rau hauv lub cellqog nqaij hlav proteins uas kis tau sai heev los ntawm cov hlab ntsha. Yog li kab mob siab C thiab kab mob siab hepatocellular carcinoma sib cuam tshuam.
Nws yuav tsum nco ntsoov tias tus kab mob kis no yuav luag ib txwm ua rau kev loj hlob ntawm daim siab cirrhosis lossis mob qog noj ntshav. Feem ntau, nws tau kuaj pom thaum muaj teeb meem tshwm sim. Lwm lub npe rau tus kab mob siab C yog "tus neeg tua neeg zoo". Qhov no yog vim qhov tsis ua tiav ntawm kev kho mob tshwm sim ntawm cov kab mob pathology tau ntau xyoo thiab kev tuag yam tsis muaj kev tuag vim yog kev ua haujlwm ntawm lub siab ua haujlwm.
Kev faib tawm ntawm cov kab mob hepatocellular carcinomas
Hepatocellular carcinoma ntawm daim siab tau muab faib ua ntau hom morphological thiab kho mob. Tsis tas li ntawd, cov qog yog cais raws li theem ntawm kev loj hlob thiab qhov hnyav. Nyob ntawm daim duab macroscopic, nodular, loj heev thiab diffuse cov ntaub ntawv ntawm daim siab mob cancer yog txawv. Fibrolamellar hepatocellular carcinoma yog suav tias yog ib hom kev sib cais. Raws li daim duab kho mob, 6 hom kab mob hepatocellular carcinoma yog qhov txawv. Ntawm lawv:
- Hepatomegalic variant.
- Icteric form.
- - Kubkub variant ntawm daim siab mob cancer.
- Ascitic form.
- mob plab variant.
- Metastatic daim siab mob cancer.
Feem ntau muaj kev sib xyaw ua ke ntawm ntau qhov kev xaiv kho mob. Cov theem ntawm hepatocellular carcinoma nyob ntawm qhov loj ntawm cov qog thiab nws kis mus rau cov qog nqaij hlav nyob ze thiab lwm yam kabmob.
Hepatocellular carcinoma: Cov tsos mob
Cov tsos mob ntawm tus kab mob yog nyob ntawm daim ntawv kho mob ntawm carcinoma. Feem ntau, mob qog noj ntshav thaum ntxov tsis muaj tsos mob. Tsis tas li ntawd, kev kuaj mob yog qhov nyuaj vim qhov tseeb tias cov tsos mob ntawm cov qog zoo ib yam li cov duab kho mob ntawm lwm cov kab mob siab (mob siab, mob cirrhosis). Kev tshwm sim lig ntawm kev mob qog noj ntshav muaj xws li qhov kub thiab txias subfebrile, tsis qab los noj mov, tsis muaj zog, o cov qog nqaij hlav, thiab poob phaus. Nrog rau daim ntawv hepatomegalic ntawm carcinoma, muaj ib tug pronounced o ntawm daim siab, mob nyob rau hauv txoj cai hypochondrium. Hauv ib feem peb ntawm cov neeg mob, ib qho icteric variant ntawm pathology tau pom. Nws muaj qhov tsis zoo. Jaundice tshwm sim thawj zaug lossis thib ob ntawm cov txheej txheem qog.
Ntxiv rau, cov neeg mob yws ntawm qhov mob thiab khaus. Nrog rau daim ntawv ua npaws, muaj qhov nce ntxiv hauv lub cev kub, tsis kaj siab, mob siab rau hauv plab plab. Ascites tshwm sim nyob rau theem kawg ntawm kev mob qog noj ntshav, nrog rau cov tsos mob ntawm cov qog intoxication. Daim ntawv mob plab yog tsawg dua. Nws yog tus cwj pwm los ntawm qhov mob hnyav, nruj ntawm cov leeg nqaij. Nyob rau hauv metastatic variant ntawm hepatocellular cancer, cov tsos mob ntawm kev puas tsuaj rau lwm yam kabmob predominate. Ntawm lawv yog pob txha, ntsws, hnyuv.
Morphological daim ntawv ntawm daim siab carcinoma
Cov kab mob qog hauv qab no yog qhov txawv ntawm morphology:
- Massive hepatocellular carcinoma. Nws occupies tag nrho ntu los yog ib lub lobe ntawm lub siab. Thaum txiav, nws muaj tseebciam teb. Tsis tas li ntawd, cov foci me me (satellites) tuaj yeem muaj nyob hauv cov qog nqaij hlav. Ib qho ntawm ntau hom mob qog noj ntshav siab loj yog kab noj hniav. Nyob rau hauv incision, ib tug qog node yog pom, nyob rau hauv uas muaj ib tug xim av kua. Cov phab ntsa ntawm cov kab noj hniav yog tuab thiab du.
- Nodular carcinoma ntawm daim siab. Nws yog tus cwj pwm los ntawm ntau cov qog foci nyob rau tag nrho saum npoo ntawm parenchyma ntawm lub cev.
- Diffuse daim siab mob cancer. Feem ntau feem ntau tshwm sim ntawm keeb kwm ntawm cirrhosis. Tag nrho parenchyma muaj cov ntsiab lus ntawm cov ntaub so ntswg sib txuas thiab cov hlwb atypical.
Fibrolamellar carcinoma muaj ib lossis ntau lub nodules loj. Feem ntau nws yog localized nyob rau sab laug lobe ntawm lub siab. Cov xim ntawm cov qog yog daj lossis ntsuab. Lwm daim ntawv cais yog encapsulated (me) hepatocellular carcinoma. Nws yog tus cwj pwm los ntawm kev pom zoo thiab kev loj hlob qeeb, qhov loj ntawm cov qog tsis pub tshaj 5 cm inch.
Kev kuaj mob hepatocellular carcinoma ntawm daim siab
Ntau qhov kev kuaj xyuas yuav tsum tau ua ua ntej kuaj pom tus kab mob xws li hepatocellular carcinoma. Kev kuaj mob ntawm pathology muaj ntau theem. Ua ntej, tus kws kho mob mloog txhua tus neeg mob cov lus tsis txaus siab thiab ua qhov kev ntsuam xyuas. Kev saib xyuas tshwj xeeb yog them rau ntawm daim tawv nqaij (xim, muaj qhov khawb, hemorrhages), lymph nodes, palpation ntawm daim siab. Hauv kev mob cancer, cov khoom noj khoom hauv nruab nrog cev, ib qho kev ntxhib los mos, thiab mob plab yog sau tseg. Qhov no yog ua raws li cov kev xeem. Ntawm lawv:
- UAC, biochemical analysisntshav.
- Kev txiav txim siab ntawm qib ntawm tus cim tshwj xeeb - alpha-fetoprotein.
- Ultrasound ntawm lub plab hnyuv plab.
- Computed tomography.
- Tshawb nrhiav cov hlab ntsha ntawm lub siab. Cov no suav nrog angio- thiab portohepatography.
Kev kuaj mob yog nyob ntawm kev tshawb pom cytological thiab histological. Txhawm rau ua cov kev tshawb fawb no, kev kuaj ntshav ntawm lub cev yog ua.
Hepatocellular carcinoma ntawm daim siab: kho tus kab mob
Kev xaiv kev kho mob yog nyob ntawm daim ntawv morphological thiab qhov loj ntawm cov qog, nrog rau theem ntawm cov txheej txheem oncological. Nyob rau theem pib ntawm kev mob qog noj ntshav, kev phais, kev ua kom lub cev ntawm cov nodular formations, thiab tshuaj kho mob tau ua. Rau cov qog diffuse, hepatic artery embolization yog ua. Qhov no yuav pab kom qeeb qhov kev loj hlob ntawm neoplasm thiab txo cov txheej txheem. Hepatocellular carcinoma ntawm daim siab yog insensitive rau kev kho hluav taws xob. Tsis tas li ntawd, nws tsis tshua teb rau chemotherapy, tsuas yog 15-20% ntawm cov neeg mob tau txais txiaj ntsig zoo ib ntus. Ib txoj hauv kev yog hloov daim siab. Txoj kev no tau siv dav hauv cov tebchaws tsim. Kev hloov pauv hauv nruab nrog cev pub dawb tsuas yog ua thaum pib mob qog noj ntshav xwb. Nyob rau hauv lub xub ntiag ntawm nyob deb metastases, cov tsos mob kho yog suav hais tias tsuas yog kev kho mob. Nws suav nrog kev kho mob palliative (kev saib xyuas neeg mob, kev kho mob hlwb) thiab kev tswj qhov mob.
Kev kho mob ntawm daim siab mob cancer
Kev cuam tshuam kev phais yog ua nyob rau hauv yuav luag txhua tus neeg mob uas tau kuaj pom"hepatocellular carcinoma". Kev kho mob muaj xws li daim siab resection nyob rau hauv lub anatomical cheeb tsam (ntu, lobe, ib nrab ntawm lub cev). Yog hais tias lub node me me, nws yog enucleated nrog ib tug tshwj xeeb aspirator. Lwm txoj kev kho mob phais yog percutaneous embolization ntawm daim siab hlab ntsha.
Txoj hauv kev zoo tshaj plaws yog kev hloov pauv ntawm lub cev lossis ib feem ntawm nws. Lub siab cov ntaub so ntswg muaj peev xwm rov tsim dua tshiab. Raws li qhov tshwm sim, tus neeg mob kho tau tiav.
Tshuaj kho rau kab mob siab hepatocellular
Ntxiv rau cov tshuaj chemotherapeutic, ib pawg tshuaj tshiab ntawm cov tshuaj siv nquag siv - protein kinase inhibitors. Lawv qhov kev txiav txim yog los txo qhov kev loj hlob ntawm cov qog hlwb. Txawm tias muaj ntau yam kev phiv, cov tshuaj no zoo heev. Ib qho piv txwv ntawm cov tshuaj los ntawm pab pawg no yog Nexavar.
Kev kuaj mob rau kab mob hepatocellular
Ib qho ntawm cov mob hnyav heev neoplasms ntawm lub plab zom mov yog hepatocellular carcinoma ntawm daim siab. Qhov kev cia siab rau cov qog no tsis zoo nyob rau hauv feem ntau. Qhov siab 5-xyoos ciaj sia taus tsuas yog pom nrog me me ntawm kev tsim tom qab kev kho mob phais lossis hloov daim siab. Feem ntau muaj qhov rov tshwm sim ntawm cov qog thiab sai metastasis. Kev ua haujlwm ntawm lub cev ua rau tuag.
Tiv thaiv kab mob siab hepatocellular
Kev tiv thaiv suav nrog kev tshuaj xyuas txhua xyoo rau tus kab mob siab kab mob siab, zam tshuaj thiab cawv. Nws yog ib qho tsim nyog yuav tsum nco ntsoov tias qhov mob ntawm daim siab tuaj yeem tau txais los ntawm kev ua haujlwm xws li kev kho hniav thiab cov txheej txheem kom hniav zoo nkauj, tso ntshav.
