I-hepatocellular carcinoma yiyona mdlavuza wesibindi oyinhloko kakhulu. Kuthinta inani elikhulayo labantu emazweni asentshonalanga, ngokuvamile nge-cirrhosis noma esinye isifo sesibindi. Naphezu kokuqhubeka kokwelashwa, ngokuvamile kuyabulala.

Incazelo

I-Hepatocellular carcinoma (okukhulunywa ngayo ngesifinyezo i-CHC) umdlavuza ovela kumaseli esibindi. Ngakho-ke umdlavuza oyinhloko wesibindi, ngokuphambene nalokho okubizwa ngokuthi umdlavuza "wesibili" ohambisana nezinhlobo zomdlavuza we-metastatic ovela kwenye indawo emzimbeni.

Izimbangela

Ezimweni eziningi, i-hepatocellular carcinoma ibangelwa i-hepatic cirrhosis, umphumela wesifo esingalapheki sesibindi: i-hepatitis yegciwane, i-hepatitis enotshwala, i-autoimmune hepatitis, njll.

Le cirrhosis ibonakala ngokuvuvukala okungapheli kwesibindi okuhambisana nokubhujiswa kwamangqamuzana esibindi. Ukuvuselelwa okungalawuleki kwamangqamuzana acekeleke phansi kubangela ukuvela kwamaqhuqhuva angavamile kanye nezicubu ze-fibrous (fibrosis). Lezi zilonda zikhuthaza ukuguqulwa kwesimila kwamaseli wesibindi kanye ne-carcinogenesis (ukwakheka kwesimila esibi sesibindi).

kwesifo

Ukuhlolwa kwe-hepatic carcinoma ngokuvamile kusekelwe ekutholeni i-nodule ku-ultrasound ezigulini eziqashwe isifo sesibindi esingamahlalakhona. 

Uma kwenzeka kuba nesimila esithuthukile, ukuxilongwa kungabuye kubhekwe lapho kuvela izimpawu.

AMAPOSA

Ukuxilongwa kuqinisekiswa ngokuhlolwa okwengeziwe kwezithombe. Udokotela uzo-oda ukuskena kwesisu (i-helical scan), kwesinye isikhathi i-MRI kanye / noma i-ultrasound ehlukile. 

Ukuhlolwa kokunwetshwa kwesimila kungabiza i-MRI yesisu kanye ne-thoracic noma i-thoraco-abdominal CT scan. I-Doppler ultrasound ingasetshenziswa ukuhlola ukungahambi kahle kwegazi engosini njengomphumela womdlavuza. Kuyaqabukela, ukuskena kwe-PET kuzokwenziwa ukuze kubonakale kangcono isimila futhi kubhekwe ukuthi kungenzeka yini ukusakazeka ngaphandle kwesibindi.

Ukuhlolwa kwezinto eziphilayo

Cishe ingxenye ye-hepatocellular carcinomas, ukuhlolwa kwegazi kubonisa izinga eliphezulu ngokungavamile le-alfafoetoprotein (AFP), ekhishwa isimila.

i-biopsy

Ukuhlolwa kwamasampula ezicubu zesimila kusiza ukugwema amaphutha okuxilongwa kanye nokuveza isimila sesibindi ukuze siqondise ukwelashwa.

Abantu abathintekayo

I-Hepatocellular carcinoma iwumdlavuza wesibindi ovame kakhulu. Ingeyesihlanu emhlabeni jikelele edala umdlavuza futhi ingeyesithathu ezibulalayo.

ENingizimu-mpumalanga ye-Asia nase-Afrika, kungathinta abantu abasha abane-cirrhosis ye-hepatitis B.

Emazweni aseNtshonalanga, lapho ngezinye izikhathi ihlotshaniswa nesifo sokusha kwesibindi kohlobo C kodwa lapho sihlala siwumphumela wokusha kwesibindi kotshwala kaningi, kwanda kakhulu kusukela ngawo-1980. 

E-France, inani lamacala amasha atholakala unyaka ngamunye ngaleyo ndlela lenyuka lisuka ku-1800 ngo-1980 laya ku-7100 ngo-2008 futhi laya ku-8723 ngo-2012. Lokhu kwanda ngokungangabazeki futhi ngokwengxenye kubonisa ukuthuthukiswa kokuxilongwa nokuphathwa okungcono kwezinye izinkinga ze-cirrhosis. Ngokusho kweNational Institute for Public Health Surveillance (InVS), izinga lokuvela kwamacala amasha ngo-2012 laliyi-12,1 / 100 emadodeni kanye ne-000 / 2,4 kwabesifazane.

Naphezu kokulawulwa okungcono kwesifo sokusha kwesibindi kohlobo B kanye nokwehla okuphelele kokusetshenziswa kotshwala, i-hepatocellular carcinoma iseyinkinga enkulu yezempilo yomphakathi namuhla.

Izici zengozi

Iminyaka engaphezu kweminyaka engama-55, ubulili besilisa kanye ne-cirrhosis ethuthukisiwe yizici eziyinhloko zengozi ye-hepatocellular carcinoma. E-France, ukuphuza ngokweqile utshwala kuseyiyona nto eyingozi enkulu ye-cirrhosis, ngakho-ke umdlavuza wesibindi.

Ukukhuluphala ngokweqile kanye nokuphazamiseka okuhambisana nakho komzimba, okukhuthaza isifo sesibindi esinamafutha ("isibindi esinamafutha"), nakho kuxhunyaniswa nengozi eyengeziwe yomdlavuza wesibindi.

Ezinye izici zobungozi zingangenelela:

• ukubhema,
• ukuvezwa kwezidakamizwa ezithile (ama-aflatoxin, i-thorium dioxide, i-vinyl chloride, i-plutonium, njll.),
• ukutheleleka ngezinhlobo ezithile ze-fluke,
• isifo sikashukela,
• i-hemochromatosis (isifo sofuzo esidala ukugcwala kwensimbi esibindini)…

I-Hepatocellular carcinoma ingathuthuka buthule isikhathi eside. Izimpawu zibonakala sekwedlule isikhathi, esigabeni esithuthukile sesimila, futhi kaningi azicacisi nomdlavuza uqobo. Zibangelwa yi-cirrhosis noma ukuvinjelwa kwe-portal vein kanye / noma ama-bile ducts.

Ubuhlungu

Kuvame ukuba buhlungu obuthuntu esifundeni se-epigastric. Izinhlungu ezicijile azivamile.

jaundice

I-jaundice (i-jaundice), eyenza isikhumba namhlophe kwamehlo kubonakale phuzi, ibangelwa i-bilirubin (i-bile pigment) eningi egazini.  

Ukunwebeka kwesisu

I-Cirrhosis, kanye ne-hepatocellular carcinoma uqobo, yizimbangela zama-ascites, abonakala ngokuchithwa koketshezi esiswini.

Ezinye izimpawu:

• ukopha kwesisu ngokugqabuka kwesimila,
• ukuphazamiseka kwemisebenzi yokugaya ukudla (ukungathandi ukudla, igesi, isifo sohudo noma ukuqunjelwa, njll),
• ukutheleleka,
• ukuphelelwa umoya okubangelwa isimila esikhulu esicindezela i-diaphragm
• ukuwohloka okujwayelekile kwezempilo…

Ukuphathwa kokwelashwa kuyahlukahluka ngokuya ngezici zesimila, ikakhulukazi ukunwetshwa kwaso, isimo sesibindi nesimo jikelele sempilo yesiguli. Kuma-cancer asethuthukile, isibikezelo sihlala sifiphele naphezu kwentuthuko ekwelashweni.

Ukufakelwa kwesibindi

Inikeza ukwelashwa kokwelapha kokubili isimila kanye nembangela yaso - i-cirrhosis - futhi ngokuvamile ivumela ukuphulukiswa, inqobo nje uma isiguli sihlangabezana nemibandela yokwabiwa kwegraft:

• isimila sendawo: isisu esisodwa esifinyelela ku-1 cm ububanzi, noma amaqhuqhuva ama-6 angaphansi kuka-4 cm uma izinga le-alphafoetoprotein lingaphansi kuka-3 ng / ml,
• ukungabikho kwezifo zemithambo yesibindi (i-portal noma i-hepatic thrombosis),
• akukho ukuphikisana: ukuphuza utshwala obusebenzayo, isiguli esikhulile kakhulu noma esinempilo ebuthaka, ama-pathologies ahambisanayo, njll.

E-France, cishe i-10% yeziguli izofaneleka ukufakelwa. Esimeni sokushoda kwama-grafts, kwenziwa ku-3 kuya ku-4% wabo. Ezinye izindlela zingenzeka ngezinye izikhathi, isibonelo ukufakelwa kwe-hemifoie okuwumphumela womnikelo womndeni noma owanikela oshonile noma isibindi esiphethe i-amyloid neuropathy, esebenza ngendlela efanele kodwa engabangela iminyaka yebanga lesifo sezinzwa. 

Izinkinga yilezo zanoma yikuphi ukufakelwa.

I-Chemoembolization

Lokhu kwelashwa kungaba ukwelashwa okulindayo kokufakelwa kabusha, futhi kungaphindaphindwa njalo ezinyangeni ezimbili kuya kwezintathu. Ihlanganisa ukwelapha ngamakhemikhali okujovwe ngomzila we-arterial kanye ne-embolization, okungukuthi ukuvinjwa kwesikhashana komthambo we-hepatic ngokwawo noma kwamagatsha ahlinzeka isimila "ngama-embolization agents". Lapho kungekho ukunikezwa kwegazi, ukukhula kwesimila kuyancipha, futhi ubukhulu besimila bungancishiswa kakhulu.

Izindlela zokubhujiswa kwendawo nge-radiofrequency (izicubu ezingaphansi kuka-2 cm) noma ama-microwaves (izicubu ezi-2 kuye ku-4 cm) zidinga ukubonakala okuhle kwesimila. Lezi zindlela zokwelapha zenziwa ekamelweni lokuhlinza, ngaphansi kwe-anesthesia jikelele. Kukhona ukuphikisana, kufaka phakathi ama-ascites noma inani eliphansi kakhulu leplatelet yegazi.

ukuhlinzwa

Ukukhethwa kokuhlinzwa ukuze ususe isimila kuncike, phakathi kwezinye izinto, endaweni lapho kukhona khona i-carcinoma kanye nesimo jikelele sesiguli. Imvamisa, ukungenelela kugcinelwe izimila ezingaphezulu futhi hhayi ezinkulu kakhulu (isiguli kufanele sigcine izicubu zesibindi ezanele ezinempilo). Ukusebenza kahle kuhle impela.

I-radiotherapy yangaphandle ingenye indlela yokucekelwa phansi kwendawo kwe-hepatic carcinoma eveza iqhubu elilodwa elingaphansi kuka-3 cm, ikakhulukazi engxenyeni engenhla yesibindi. Kudinga izikhathi eziningana.

I-Classical intravenous chemotherapy ayisebenzi kahle, ikakhulukazi njengoba isifo sesibindi esingaphansi sidinga imithamo ephansi. Eminyakeni eyishumi edlule noma ngaphezulu, izindlela zokwelapha zomdlavuza ezihlosiwe zethulwe ekwelapheni i-hepatocellular carcinomas. Ama-antiangiogenic ahlinzekwa ngomlomo (i-Sorafenib noma amanye ama-molecule) asetshenziswa ikakhulukazi, avimbela ukuthuthukiswa kwemikhumbi emincane yokondla isimila. Lezi yizindlela zokwelapha ezidambisa ubuhlungu, okwenza kube nokwenzeka ukwelula ukuphila.

Ukuvimbela i-hepatocellular carcinoma kulele ikakhulukazi ekulweni nokuluthwa utshwala. Kungcono ukunciphisa ukuphuza utshwala kuziphuzo ezi-3 ngosuku kwabesilisa neziphuzo ezi-2 zabesifazane.

Ukuhlolwa nokuphathwa kwesifo sokusha kwesibindi esidala ukuqina kwesibindi nakho kunendima okufanele kuyibambe. Ukuvimbela ukungcoliswa kocansi kanye ne-intravenous kanye nokugomela i-hepatitis B kuyasebenza.

Ukulwa nokukhuluphala kunomthelela ekuvimbeleni.

Ekugcineni, ukwenza ngcono ukuxilongwa kusenesikhathi kuyinkinga ebalulekile ekunikeni amandla ukwelashwa okwelaphayo.