Rhabdomyosarcoma yog hais txog ib qho ntawm ntau yam ntawm sarcoma - mob qog noj ntshav ntawm cov nqaij mos, pob txha lossis cov ntaub so ntswg. Cov qog feem ntau tshwm nyob rau hauv cov nqaij ntshiv ntawm cov pob txha. Rhabdomyosarcomas yog malignant neoplasms uas tshwm sim hauv cov leeg pob txha. Lawv pib hauv ib feem ntawm lub cev lossis hauv ntau qhov chaw ib zaug.
Microscopically, rhabdomyosarcoma nyob rau hauv cov neeg laus zoo li oblong los yog round cells nrog ib tug txawv txawv. Cov qog no yog tus yam ntxwv ntawm menyuam yaus.
Types of rhabdomyosarcomas
Rhabdomyosarcomas raws li lawv cov qauv sab hauv tau muab faib ua hom:
1. Embryonic rhabdomyosarcoma muaj cov kab mob puag ncig thiab spindle-zoo li lub hlwb, txoj kev kawm ntawm cytoplasm uas qhia tau hais tias transverse los yog longitudinal striation. Hom rhabdomyosarcoma no feem ntau tshwm sim. Embryonic rhabdomyosarcoma tshwm nyob rau hauv cov menyuam yaus thiab cov hluas. Nws nyob hauv lub caj dab lossis lub taub hau, ntawm qhov chaw mos, hauvnasopharynx. Cov qog yog rhiab heev rau kev kho hluav taws xob, tab sis nws tuaj yeem rov tshwm sim sai.
2. Alveolar rhabdomyosarcoma muaj nyob rau hauv nws cov muaj pes tsawg leeg ntawm cov hlwb ntawm ib puag ncig thiab oval zoo, uas yog surrounded los ntawm partitions ntawm connective cov ntaub so ntswg. Hom qog no yog tus cwj pwm los ntawm qhov tshwm sim ntawm ob txhais ceg lossis caj npab, plab, hauv siab, qhov quav lossis qhov chaw mos. Feem ntau nws tuaj yeem pom hauv cov tub ntxhais hluas thiab cov neeg laus ntawm cov ceg. Qhov kev cia siab tsis zoo.
3. Cov muaj pes tsawg leeg ntawm pleomorphic rhabdomyosarcoma yog polymorphic spindle-zoo li tus, ribbon-puab, stellate hlwb, qog los ntawm uas tuaj yeem tshwm sim ntawm ob txhais ceg lossis caj npab ntawm tib neeg. Raws li txoj cai, kev loj hlob ntawm rhabdomyosarcomas tshwm sim sai thiab tsis ua rau mob thiab ua haujlwm tsis zoo. Tsuas muaj kev nthuav dav ntawm cov leeg. Lawv feem ntau loj hlob ntawm daim tawv nqaij thiab ua ulcerated, tsim exophytic, los ntshav qog.
Risk Factor
Ntawm ib puag ncig ib puag ncig, tsis muaj cov xwm txheej zoo li no tau pom tias ua rau muaj qhov tshwm sim ntawm cov qog no. Qhov no txawv rhabdomyosarcoma los ntawm cov qog nqaij hlav feem ntau.
Vim qhov tseeb tias qhov tseeb ua rau kev loj hlob ntawm qog nqaij hlav tsis paub, tsis muaj lus qhia tuaj yeem muab los zam nws qhov tsim. Txawm li cas los xij, nws yuav tsum tau nco ntsoov tias nrog kev kho mob txaus ntawm rhabdomyosarcoma, cov neeg mob tuaj yeem kho tau tag nrho.
Cov xwm txheej pheej hmoo rau fetal rhabdomyosarcoma yog cov kab mob txiav txim siab caj ces:
1. Li-Fraumeni syndrome, uas yog ib yam kab mob uas tsis tshua muajib qho kev zoo yog tau txais txiaj ntsig thaum muaj kev puas tsuaj txaus rau cov noob hauv ib tus niam txiv kom cov qog ntawm ntau hom tshwm sim nrog ntau zaus. Hauv cov kab mob no, cov kev cuam tshuam tshwj xeeb ntawm cov ntaub so ntswg rau cov qog tau txais, thaum qhov tshwm sim ntawm kev tsim cov qog nqaij hlav thaum muaj hnub nyoog hluas (txog 30 xyoo) nce siab heev.
2. Neurofibromatosis hom 1 yog hom kab mob uas tshwm sim ntau tshaj plaws uas ua rau mob qog noj ntshav.
3. Beckwith-Wiedemann Syndrome yog ib yam kab mob uas tshwm sim los ntawm macrosomia, macroglossia thiab omphalocele. Nws kuj tshwm sim nws tus kheej hauv cov menyuam yaus uas muaj qhov tsis xws luag ntawm phab ntsa hauv plab, hernia, neonatal hypoglycemia, thiab kev sib txawv ntawm cov leeg nqaij.
4. Costello's Syndrome yog ib yam kab mob uas tsis tshua muaj tshwm sim los ntawm kev tsis sib haum xeeb: kev loj hlob retardation, lub ntsej muag ntxhib, tawv nqaij hloov.
5. Noonan Syndrome yog ib hom kab mob caj ces uas tshwm sim los ntawm luv luv stature thiab deviations nyob rau hauv somatic txoj kev loj hlob. Muaj peev xwm loj hlob nyob rau hauv tag nrho tsev neeg los yog ib tug neeg.
Cov menyuam mos uas hnyav dhau thiab siab thaum yug los muaj kev pheej hmoo ntau dua ntawm kev tsim fetal rhabdomyosarcoma dua lwm tus. Raws li txoj cai, qhov ua rau embryonic rhabdomyosarcoma tsis paub. Cov tsos mob ntawm tus kab mob yog qhov tshwm sim ntawm cov qog ua kom loj thiab loj dua.
Symptoms
Cov tsos mob ntawm tus kab mob yog txiav txim los ntawm daim ntawv ntawm mob qog noj ntshav. Yuav tsum muaj lus qhia kho mob ceev yog tias menyuam yaus muaj ib yam hauv qab noCov cim qhia ntawm mob qog noj ntshav:
- o lossis o uas nce qhov loj lossis tsis ploj mus, qee zaum mob;
- qhov muag pom;
- mob taub hau;
- nyuaj nrog quav thiab tso zis;
- ntshav tso zis;
- ntshav hauv qhov quav, caj pas, qhov ntswg.
Diagnosis
Tam sim no, tsis muaj txoj hauv kev tau tsim los kuaj rhabdomyosarcoma ua ntej nws thawj cov tsos mob tshwm sim.
Cov cim qhia ntxov tshaj plaws ntawm oncology yog qhov o hauv zos lossis induration uas tsis ua teeb meem lossis mob thaum xub thawj. Cov tsos mob no yog yam ntxwv ntawm rhabdomyosarcomas ntawm caj npab, ceg, thiab pob tw.
Yog cov qog nyob hauv thaj chaw peritoneum lossis pelvic cheeb tsam, tej zaum yuav muaj mob hauv plab, ntuav lossis cem quav. Qhov no yog ib qho embryonic rhabdomyosarcoma ntawm retroperitoneum. Tsis tshua muaj, tsim nyob rau hauv lub biliary ib ntsuj av, rhabdomyosarcoma ua rau jaundice.
Yog xav tias qhov neoplasm no, yuav tsum tau kuaj xyuas seb hom rhabdomyosarcoma tau tshwm sim.
Feem ntau, rhabdomyosarcoma tshwm sim hauv thaj chaw uas nws pom tau yooj yim, xws li hauv qhov ntswg kab noj hniav lossis sab nraum lub qhov muag. Yog hais tias lub qhov muag protrudes, los yog qhov ntswg tawm, koj yuav tsum tam sim ntawd sab laj nrog kws kho mob nrog ib tug xav tias ntawm ib tug qog nyob rau hauv thiaj li yuav kuaj tau nws nyob rau hauv thaum ntxov theem ntawm nws txoj kev loj hlob. Nyob rau hauv cov ntaub ntawv thaum rhabdomyosarcoma tshwm nyob rau saum npoo ntawm lub cev, nws yog yooj yim nrhiav tau yam tsis muaj kev ntsuam xyuas tob. Qhov no muaj tseebhu ua soft tissue fetal rhabdomyosarcoma.
Hauv 30% ntawm cov neeg mob, embryonic rhabdomyosarcoma pom nyob rau theem pib, thaum nws tuaj yeem tshem tawm tag nrho. Tab sis nyob rau hauv feem coob ntawm cov neeg mob, kev soj ntsuam kom ntxaws qhia me me metastases, kev kho mob uas yuav tsum tau chemotherapy.
Embryonic rhabdomyosarcomas, nyob rau hauv thaj tsam testicular, feem ntau tsim nyob rau hauv cov menyuam yaus thiab raug kuaj pom los ntawm tus menyuam niam txiv thaum ntxuav. Yog cov qog tshwm sim hauv cov zis, lawv ua rau tso zis tsis yooj yim lossis pom, cov tsos mob uas yuav tsum tsis txhob quav ntsej.
Tumor stages
1. Thawj theem. Cov qog tuaj yeem ua tau ntawm txhua qhov loj, tab sis nws tseem tsis tau kis mus rau cov kab mob ntawm cov kab mob lymphatic thiab nyob rau hauv ib qho ntawm thaj chaw zoo ntawm lub cev:
- qhov muag lossis qhov muag;
- caj dab thiab lub taub hau (tsis suav nrog cov ntaub so ntswg hauv thaj tsam ntawm lub hlwb thiab qaum qaum);
- kab mob biliary thiab gallbladder;
- hauv tsev menyuam lossis qe qe.
Qhov chaw tsis tau teev tseg yog suav tias yog thaj chaw tsis zoo.
2. Qhov thib ob theem. Cov qog yog nyob rau hauv ib qho ntawm cov cheeb tsam tsis zoo (cov cheeb tsam uas tsis nyob rau hauv cov npe ntawm cov neeg nyiam). Qhov loj ntawm cov qog tsis pub tshaj 5 cm, thiab tsis kis mus rau cov qog nqaij hlav.
3. Peb theem. Cov qog nyob hauv thaj chaw tsis zoo, thiab ib qho ntawm cov xwm txheej hauv qab no tau ntsib:
- qhov loj ntawm cov qog tsawg dua 5 cm, thiab nws tau kis mus rau cov qog nqaij hlav ze tshaj plaws;
- qhov loj ntawm cov qog tshaj 5 cm, thiab muajkev pheej hmoo uas nws yuav kis mus rau cov qog nqaij hlav nyob ze.
4. Plaub theem. Qhov loj ntawm cov qog tuaj yeem yog ib qho, thiab nws tau kis mus rau cov qog nqaij hlav ze tshaj plaws. Mob qog noj ntshav tau kis mus rau thaj chaw deb ntawm lub cev.
Risk pawg
Cov pab pawg pheej hmoo raug muab rau tus neeg mob txiav txim siab qhov yuav tshwm sim ntawm rhabdomyosarcoma. Txhua tus me nyuam tau txais kev kho mob rau fetal rhabdomyosarcoma yuav tsum tau txais kev kho mob ntxiv kom txo tau cov qog nqaij hlav. Hom tshuaj tiv thaiv kab mob qog noj ntshav, ntau npaum li cas, thiab tus naj npawb ntawm cov kev sib ntsib yog txhua tus txiav txim siab seb tus menyuam puas nyob qis, nruab nrab, lossis muaj kev pheej hmoo siab.
xaiv kev kho mob
Cov neeg mob uas muaj tus mob rhabdomyosarcoma tuaj yeem kho tau ntau txoj hauv kev. Kev kho mob qog nqaij hlav muaj cov txheej txheem cais uas suav tias yog ib txwm muaj. Lwm txoj hauv kev yog nyob rau theem ntawm kev sim tshuaj. Kev sim tshuaj kho mob yog siv los txhim kho cov kev kho mob uas twb muaj lawm lossis kom nce cov ntaub ntawv ntawm cov kev kho mob tshiab rau cov neeg mob rhabdomyosarcoma. Yog hais tias, raws li qhov tshwm sim ntawm kev sim tshuaj, nws hloov tawm hais tias txoj kev tshiab ntawm kev kho mob yog superior rau ib txwm sawv daws yuav, ces tus tshiab txoj kev kho yuav ua ib txwm.
Vim tias mob qog noj ntshav tshwm sim hauv ntau qhov chaw ntawm lub cev, muaj ntau yam kev kho mob. Kev kho mobrhabdomyosarcoma hauv cov menyuam yaus yog saib xyuas los ntawm kws kho mob oncologist.
Ntawm cov kev kho mob, muaj cov uas tuaj yeem ua rau muaj kev phiv, txawm tias tom qab lub sijhawm ntev dhau los txij li kev kho mob.
Surgery
Txoj kev phais, lossis tshem tawm cov qog, yog siv dav hauv kev kho mob rhabdomyosarcoma. Txoj haujlwm no hu ua "wide local excision". Qhov kev cuam tshuam no muaj nyob rau hauv kev tshem tawm cov qog thiab ib feem ntawm cov ntaub so ntswg nyob sib ze nrog rau cov qog nqaij hlav, uas tseem cuam tshuam los ntawm rhabdomyosarcoma. Kev kho mob qee zaum muaj ntau yam kev phais. Cov hauv qab no cuam tshuam rau kev txiav txim siab ntawm lub hom phiaj ntawm kev ua haujlwm thiab nws hom:
- qhov chaw pib qhov chaw ntawm lub qog;
- uas lub luag haujlwm ntawm tus menyuam lub cev cuam tshuam los ntawm qog;
- qog teb rau kev kho hluav taws xob lossis kws khomob, uas tuaj yeem siv tau raws li qhov tseem ceeb.
Kev tshem tawm tag nrho cov qog tsis tuaj yeem ua tau rau cov menyuam feem coob.
Embryonic mos cov ntaub so ntswg rhabdomyosarcoma nyhav tsim nyob rau hauv ntau qhov chaw ntawm lub cev, txhua yam yuav tsum tau nws tus kheej ua hauj lwm. Kev cuam tshuam ntawm kev phais yog qhia nyob rau hauv rooj plaub ntawm rhabdomyosarcoma ntawm qhov chaw mos lossis ob lub qhov muag, yog tias qhov kev txiav txim siab tau lees paub qhov kev kuaj mob. Kev kho tshuaj khomob lossis kev kho hluav taws xob tuaj yeem muab ua ntej kev phais kom txo qis cov qog loj uas tsis tuaj yeem ua haujlwm kom yooj yim tshem cov qog nqaij hlav.
Txawm tias tus kws kho mob tswj kom tshem tawm tag nrho cov qog, cov neeg mob tom qab kev ua haujlwm yuav tsum raug siv tshuaj khomob txhawm rau txhawm rau txo cov qog nqaij hlav cancer,cov muaj sia nyob. Kev kho hluav taws xob yog siv nrog rau kev siv tshuaj khomob. Kev kho kom txo tau qhov kev pheej hmoo ntawm rov tshwm sim yog hu ua adjuvant therapy.
Kev kho hluav taws xob
hom kev kho no siv x-ray lossis lwm hom hluav taws xob. Kev kho hluav taws xob yog qhia txog kev tua cov qog hlwb lossis nres nws txoj kev loj hlob. Ob txoj kev kho hluav taws xob tau pom lawv daim ntawv thov hauv tshuaj - sab nraud thiab sab hauv.
Sab nraud siv hluav taws xob sab nraud ntawm tib neeg lub cev los ua kom cov qog nqaij hlav. Internal radiation therapy, los yog brachytherapy, tsim irradiation ntawm ib tug qog nrog qhov chaw ntawm radioactive tshuaj nyob ze rau nws nyob rau hauv tib neeg lub cev. Nws yog siv los kho cov qog nqaij hlav ntawm lub zais zis, lub taub hau, caj dab, prostate, vulva.
Hom kev kho hluav taws xob thiab cov koob tshuaj yog txiav txim siab los ntawm lub hnub nyoog ntawm tus menyuam thiab hom qog, nws qhov chaw pib hauv cheeb tsam, nrog rau muaj cov qog seem thiab qib ntawm cov qog nqaij hlav ntawm cov qog nqaij hlav ze tshaj tom qab. phais.
Tshuaj khomob
Nov yog hom kev kho mob qog noj ntshav uas siv tshuaj los txwv kev loj hlob ntawm cov qog nqaij hlav cancer. Cov tshuaj kws khomob pab tua cov hlwb no lossis tiv thaiv kom tsis txhob sib faib. Thaum ua cov txheej txheem ntawm kev siv tshuaj khomob, cov tshuaj tau noj hauv qhov ncauj lossis muab tso rau hauv cov hlab ntsha lossis intramuscularly. Ib zaug hauv cov hlab ntsha, cov tshuaj cuam tshuam rau cov qog hlwb thoob plaws hauv lub cev. Nrog rau kev kho mob hauv cheeb tsam, cov tshuaj tau txhaj ncaj qha mus rau hauv lub cev thiab kab noj hniav ntawm lub cev, nrog rau cov kua cerebrospinal. Combination chemotherapy, uas yog ib qho kev kho mob uas siv ntau tshaj ib qho tshuaj tiv thaiv kab mob, feem ntau siv. Cov txheej txheem ntawm chemotherapy yog xaiv nyob ntawm seb hom thiab theem ntawm kev loj hlob ntawm neoplasm.
Tshuaj khomob yog qhia rau txhua tus menyuam uas raug kho rau rhabdomyosarcoma. Nws tso cai rau koj kom txo qis qhov yuav tshwm sim ntawm tus kab mob. Kev xaiv ntawm cov tshuaj, nws cov koob tshuaj thiab tus naj npawb ntawm cov txheej txheem yog txiav txim siab los ntawm pab pawg muaj kev pheej hmoo rau rhabdomyosarcoma.
kev kho tshiab
Kev kho tshiab rau rhabdomyosarcoma hauv kev sim:
- Kev siv tshuaj kho mob siab ua ke nrog kev hloov pauv ntawm cov qia. Cov txheej txheem tso cai rau kev txhim kho kev hloov pauv ntawm cov hlwb hematopoietic uas raug rhuav tshem thaum kho mob qog noj ntshav. Ua ntej kev kho mob, cov qe ntshav tsis paub tab raug tshem tawm ntawm tus neeg mob cov pob txha lossis cov ntshav thiab khaws cia. Thaum kawg ntawm kev siv tshuaj khomob, cov qia hlwb tau muab khaws cia thiab rov qab mus rau tus neeg mob los ntawm kev txhaj tshuaj. Ua li no, cov ntshav rov qab los.
- Immunotherapy. Hom kev kho no siv tus neeg mob lub cev tiv thaiv kab mob los tiv thaiv qog noj ntshav. Cov tshuaj siv los ua kom nce lossis kho lub cev tiv thaiv kab mob qog noj ntshav. Hom kev kho qog no hu ua biotherapy.
- Txoj kev kho mob. Hom kev kho no yog qhia tawm tsam metastases. Lub hom phiaj kho yog raws li kev siv cov tshuaj tiv thaiv tshwj xeeb uas khi rau cov qog nqaij hlav cancer. Cov tshuaj tiv thaiv no zoo ib yam li cov tshuaj tiv thaiv kab mob ntawm tib neeg lub cev. Tib lub sijhawm, lawv sawv cevcov tshuaj siv high-tech. Ua tsaug rau cov phiaj xwm kev kho mob hauv kev kho mob "chemo", nws tuaj yeem pom thiab tawm tsam tsuas yog cov qog nqaij hlav cancer tsis ua mob rau cov hlwb noj qab haus huv. Hauv rhabdomyosarcoma, angiogenesis inhibitors yog siv raws li kev kho mob. Cov tshuaj no cuam tshuam nrog kev tsim cov hlab ntsha hauv neoplasms. Qhov no ua rau cov qog tshaib plab thiab tsis loj hlob. Angiogenesis inhibitors thiab monoclonal antibodies yog hom tshuaj tua kab mob hauv kev sim tshuaj tiv thaiv fetal rhabdomyosarcoma.
