Kuti mumvetse FL, muyenera kudziwa pang'ono za ma lymphocyte a B-Cell.
B-cell lymphocytes:
- Ndi mtundu wa maselo oyera a magazi
- Menyani matenda ndi matenda kuti mukhale athanzi.
- Kumbukirani matenda omwe mudakhala nawo m'mbuyomu, kotero ngati mutatenganso matenda omwewo, chitetezo chamthupi chanu chingathe kulimbana nacho moyenera komanso mwachangu.
- Amapangidwa m'mafupa anu (gawo la spongy pakati pa mafupa anu), koma nthawi zambiri amakhala mu ndulu ndi ma lymph nodes anu. Ena amakhala mu thymus ndi magazi anunso.
- Mutha kuyenda kudzera m'mitsempha yanu kupita ku gawo lililonse la thupi lanu kukalimbana ndi matenda kapena matenda.
Follicular lymphoma (FL) imayamba pamene B-maselo anu amakhala ndi khansa
FL imayamba pamene ena a B-cell lymphocyte anu amaitana follicular pakati B-maselo kukhala khansa. Dokotala akamayang'ana magazi anu kapena ma biopsies, pansi pa maikulosikopu amawona kuti muli ndi maselo osakanikirana a centrocyte, omwe ndi ang'onoang'ono mpaka apakatikati a B-maselo, ndi ma centroblasts omwe ndi B-maselo akulu.
Lymphoma imachitika pamene maselowa amakula mosalamulirika, amakhala achilendo, ndipo samafa akayenera.
Mukakhala ndi FL ma B-maselo a khansa:
- Sizigwira ntchito moyenera polimbana ndi matenda ndi matenda.
- Zitha kuwoneka mosiyana ndi maselo anu athanzi a B-lymphocyte.
- Zingayambitse lymphoma kukula ndikukula mbali iliyonse ya thupi lanu.
FL ndi lymphoma yomwe ikukula pang'onopang'ono (indolent) lymphoma ndipo chifukwa cha ulesi wa lymphoma iyi imapezeka kawirikawiri ikafika patsogolo. Advanced stage FL sichiza, koma cholinga cha chithandizo ndi kuletsa matenda kwa zaka zambiri. Ngati FL wanu wapezeka koyambirira, mutha kuchiritsidwa ndi mitundu ina yamankhwala.
Nthawi zina, Follicular lymphoma (FL) imatha kuwonetsa ma cell osakanikirana omwe amaphatikizanso aggressive (akukula mwachangu) B-Cell Lymphoma. Kusintha kwa khalidweli kumatha kuchitika pakapita nthawi ndipo kumatchedwa 'kusintha'. Kusinthidwa kwa FL kumatanthauza kuti maselo anu amaoneka ndikuchita ngati Kufalitsa B cell lymphoma (DLBCL) kapena kawirikawiri, Burkitt's lymphoma (BL).
Ndani amapeza follicular lymphoma (FL)?
FL ndiye mtundu wofala kwambiri wa Lymphoma ya Non-Hodgkin (NHL) yomwe ikukula pang'onopang'ono (indolent). Pafupifupi 2 mwa anthu 10 aliwonse omwe ali ndi indolent lymphomas omwe ali ndi mtundu wa FL. Ndilofala kwambiri mwa anthu opitilira zaka 50, ndipo amayi amawapeza pafupipafupi pang'ono kuposa amuna.
Pediatric follicular lymphoma ndi yosowa koma imatha kuchitika mwa ana, achinyamata ndi achinyamata. Zimakhala zosiyana ndi zamagulu akuluakulu ndipo zimatha kuchiritsidwa.
Nchiyani chimayambitsa follicular lymphoma?
Sitikudziwa chomwe chimayambitsa FL, koma zifukwa zosiyanasiyana zowopsa zimaganiziridwa kuti zimawonjezera chiopsezo chanu chokhala nacho. Zina, zowopsa za FL zimaganiziridwa kuti ndi izi:
- Zomwe zimakhudza chitetezo chanu cha mthupi monga matenda a Celiac, Sjogren's syndrome, lupus, nyamakazi kapena kachilombo ka HIV (HIV)
- chithandizo cham'mbuyomu khansa, ndi chemotherapy kapena radiation therapy
- wachibale yemwe ali ndi lymphoma
*Ndikofunikira kudziwa kuti si anthu onse omwe ali ndi ziwopsezozi omwe angapangike FL, ndipo anthu ena omwe alibe chilichonse mwazowopsa amatha kukhala ndi FL.
Wodwala ali ndi follicular lymphoma (FL)
Zizindikiro za follicular lymphoma (FL)
Mwina mulibe zizindikiro zilizonse mukapezeka ndi FL. Anthu ambiri amawazindikira kokha akayezetsa magazi, sikani, kapena kuunika zina. Ichi ndi chifukwa cha ulesi - kukula pang'onopang'ono kapena kugona kwa FL.
Ngati mukukumana ndi zizindikiro, zizindikiro zoyamba ndi zizindikiro za FL zingakhale zotupa, kapena zotupa zingapo zomwe zikupitiriza kukula. Mutha kuzimva kapena kuziwona pakhosi, m'khwapa, kapena m'chiuno. Mitsempha iyi ndi yokulitsa ma lymph nodes (ma glands), kutupa chifukwa chokhala ndi ma B-cell ambiri a khansa omwe amamera mmenemo. Nthawi zambiri zimayambira mu gawo limodzi la thupi lanu, kenako zimafalikira m'mitsempha yanu yonse.
Ma lymph nodes amatha kukula pang'onopang'ono kwa nthawi yayitali, zomwe zimapangitsa kuti zikhale zovuta kuzindikira ngati pali kusintha.
Follicular Lymphoma (FL) imatha kufalikira ku gawo lililonse la thupi lanu
FL ikhoza kufalikira kwa inu
- nthata
- thymus
- mapapo
- chiwindi
- mafupa
- fupa la fupa
- kapena ziwalo zina.
Mphuno yanu ndi chiwalo chomwe chimasefa magazi anu ndikukhala athanzi. Ndi chiwalo cha ma lymphatic system komwe ma B-cell anu amakhala ndikupanga ma antibodies kuti amenyane ndi matenda. Ili kumanzere kwa mimba yanu yakumtunda pansi pa mapapo anu komanso pafupi ndi mimba yanu (mimba).
Mphuno yanu ikakula kwambiri, imatha kukupanikizani m'mimba ndikukupangitsani kumva kuti mwakhuta, ngakhale simunadye kwambiri.
Thymus yanu ndi gawo la lymphatic system yanu. Ndi chiwalo chooneka ngati gulugufe chomwe chimakhala kuseri kwa fupa la pachifuwa chanu kutsogolo kwa chifuwa chanu. Ma cell ena a B amakhalanso ndikudutsa mu thymus.
General zizindikiro za lymphoma
Zizindikiro zambiri za FL zingakhale zofanana ndi zizindikiro zomwe zimapezeka mwa anthu amtundu uliwonse wa lymphoma izi zingaphatikizepo:
- kutopa modabwitsa (topa)
- kumva kupuma
- khungu kuyabwa
- matenda omwe samachoka kapena kubwereranso
- kusintha kwa kuyezetsa magazi
- maselo ofiira otsika ndi mapulateleti
- ma lymphocyte ndi/kapena ma lymphocyte omwe sagwira ntchito bwino
- maselo oyera otsika (kuphatikiza ma neutrophils)
- high lactic acid dehydrogenase (LDH) - mtundu wa mapuloteni omwe amagwiritsidwa ntchito kupanga mphamvu. Ngati maselo anu awonongeka ndi lymphoma yanu, LDH ikhoza kutuluka m'maselo anu ndi magazi anu
- high beta-2 microglobulin - mtundu wa mapuloteni opangidwa ndi maselo a lymphoma. Zitha kupezeka m'magazi anu, mkodzo kapena cerebral spinal fluid
- B-zizindikiro
Zizindikiro zina za follicular lymphoma zingadalire kumene matenda anu ali m'thupi lanu
Dera lomwe lakhudzidwa | zizindikiro |
M'matumbo - kuphatikizapo m'mimba ndi matumbo anu | Mseru kapena kusanza kapena kusanza (kumva kudwala m'mimba mwako kapena kutaya mtima) Kutsekula m'mimba kapena kudzimbidwa (madzi kapena chimbudzi cholimba) Magazi mukapita kuchimbudzi Kukhuta ngakhale simunadye zambiri |
Chapakati mantha dongosolo (CNS) - kuphatikizapo ubongo wanu ndi msana | Kusokonezeka kapena kukumbukira kusintha Kusintha kwa umunthu Kugonjetsa Kufooka, dzanzi, kuyaka kapena mapini ndi singano m'manja ndi miyendo yanu |
Chifuwa | Kupuma pang'ono Kupweteka pachifuwa Chifuwa chouma |
M'mafupa | Kuchepa kwa magazi kuphatikiza ma cell ofiira, maselo oyera ndi mapulateleti kumabweretsa: o Kulephera kupuma o Matenda obwera mozama kapena ovuta kuwachotsa o Kutuluka magazi modabwitsa kapena mabala
|
Skin | Kuwoneka kofiira kapena kofiirira Ziphuphu ndi Ziphuphu pakhungu lanu zomwe zingakhale zofiira kapena zofiira kapena zofiirira Kuyabwa |
Nthawi yoti mukumane ndi dokotala
Pali zizindikiro zina zomwe zingasonyeze kuti FL yanu ikuyamba kukula kapena kukhala yaukali. Ngati mukukumana ndi zina mwazizindikirozi, funsani dokotala. Osadikirira nthawi zina. Ndikofunika kuti muwalole mwamsanga kuti athe kupanga mapulani a chithandizo ngati mukufunikira.
Lumikizanani ndi anu ngati:
- kukhala ndi ma lymph nodes otupa omwe sachoka, kapena ngati ali okulirapo kuposa momwe mungayembekezere matenda
- nthawi zambiri amalephera kupuma popanda chifukwa
- kumva kutopa kwambiri kuposa masiku onse ndipo sizikhala bwino ndi kupuma kapena kugona
- zindikirani kutuluka magazi kapena kuvulala kwachilendo (kuphatikiza ndi maliseche, mphuno kapena mkamwa)
- kukhala ndi zidzolo zachilendo (kutupa kwa mawanga ofiira kungatanthauze kuti mukutuluka magazi pansi pa khungu lanu)
- kuyabwa kwambiri kuposa masiku onse
- kukhala ndi chifuwa chowuma chatsopano
- kukhala ndi zizindikiro za B.
Ndikofunika kuzindikira kuti zizindikiro zambiri za FL zikhoza kukhala zokhudzana ndi zifukwa zina osati khansa. Mwachitsanzo, kutupa kwa ma lymph nodes kumatha kuchitika ngati muli ndi matenda. Nthawi zambiri, ngati muli ndi matenda, zizindikiro zimasintha, ndipo ma lymph nodes amabwereranso kukula kwake pakangopita milungu ingapo. Ndi lymphoma, zizindikirozi sizidzatha. Zitha kuipiraipira.
Kodi follicular lymphoma (FL) imadziwika bwanji?
Kuzindikira FL nthawi zina kumakhala kovuta ndipo kumatha kutenga milungu ingapo.
Ngati dokotala akuganiza kuti muli ndi lymphoma, ayenera kukonzekera mayesero angapo ofunikira. Mayeserowa amafunikira kuti atsimikizire kapena kuchotsa lymphoma monga chifukwa cha zizindikiro zanu. Kutsimikizira mtundu wa Non-Hodgkin's Lymphoma (NHL) n'kofunika kwambiri chifukwa kasamalidwe ndi chithandizo cha subtype yanu zingakhale zosiyana ndi zina za NHL.
Kuti muzindikire FL mudzafunika biopsy. Biopsy ndi njira yochotsera gawo, kapena zonse zomwe zakhudzidwa ndi lymph node ndi/kapena fupa. Biopsy imafufuzidwa ndi asayansi mu labotale kuti awone ngati pali zosintha zomwe zimathandiza dokotala kuzindikira FL.
Mukakhala ndi biopsy, mutha kukhala ndi mankhwala am'deralo kapena onse. Izi zidzatengera mtundu wa biopsy ndi gawo la thupi lanu lomwe latengedwa. Pali mitundu yosiyanasiyana ya ma biopsies, ndipo mungafunike kuposa imodzi kuti mupeze zitsanzo zabwino kwambiri.
Mayeso a magazi
Mudzayezetsa magazi ambiri pakapita nthawi. Mudzayamba kuyezetsa magazi ngakhale musanapezeke ndi FL. Mudzakhala nawonso musanayambe komanso panthawi ya chithandizo ngati mukufuna chithandizo. Amapatsa dokotala chithunzithunzi cha thanzi lanu lonse, kotero kuti akhoza kupanga zisankho zabwino kwambiri ndi inu zokhudzana ndi zosowa zanu zachipatala ndi chithandizo.
Sinono yabwino kapena core biopsy
A core biopsy amaphatikizapo dokotala kugwiritsa ntchito singano ndikuyiyika mu lymph node yanu yotupa kapena chotupa kuti athe kuchotsa chitsanzo cha minofu kuti ayese lymphoma. Izi nthawi zambiri zimachitika pansi pa mankhwala oletsa ululu wapafupi, mukakhala maso.
Ngati lymph node yomwe yakhudzidwa ili mkati mwa thupi lanu, biopsy ikhoza kuchitidwa mothandizidwa ndi ultrasound kapena chidziwitso chapadera cha x-ray (imaging).
Excisional node biopsy
Excisional biopsy imachitika ngati ma lymph node otupa ali ozama kwambiri kuti afikire ndi singano, kapena ngati dokotala akufuna kuchotsa ndikuyang'ana lymph node yonse.
Zidzachitidwa ngati njira ya tsiku kumalo opangira opaleshoni ndipo mudzakhala ndi mankhwala opha ululu kuti mugone kwa kanthawi pang'ono pamene ntchitoyi ikuchitika. Mukadzuka mudzakhala ndi bala laling'ono ndi zosoka. Dokotala wanu kapena namwino adzatha kukudziwitsani momwe mungasamalire bala, komanso nthawi yoti mutulutse zilonda zanu.
Dokotala adzakusankhani biopsy yabwino kwa inu.
Results
Dokotala wanu akapeza zotsatira za kuyezetsa magazi ndi ma biopsies adzatha kukuuzani ngati muli ndi FL ndipo akhoza kukuuzani kuti muli ndi mtundu wanji wa FL. Adzafuna kuchita mayeso ochulukirapo kuti akwaniritse ndikuyika FL yanu.
Kuwerengera ndi kuwerengera follicular lymphoma
Mukapezeka ndi FL, dokotala wanu adzakhala ndi mafunso ambiri okhudza lymphoma yanu. Izi ziphatikizapo:
- Kodi lymphoma yanu ndi gawo liti?
- Kodi lymphoma yanu ndi kalasi yanji?
- Kodi muli ndi mtundu wanji wa FL?
Dinani pamitu ili m'munsiyi kuti mudziwe zambiri za masanjidwe ndi masanjidwe.
Kuwerengera kumatanthawuza kuchuluka kwa thupi lanu lomwe limakhudzidwa ndi lymphoma yanu - kapena, momwe yafalikira kuchokera pomwe idayambira.
B-maselo amatha kupita ku gawo lililonse la thupi lanu. Izi zikutanthauza kuti ma cell a lymphoma (ma cell a khansa B), amathanso kupita ku gawo lililonse la thupi lanu. Mudzafunika kuyesanso kuti mupeze zambiri. Mayesowa amatchedwa staging test ndipo mukapeza zotsatira, mupeza ngati muli ndi siteji yoyamba (I), siteji yachiwiri (II), gawo lachitatu (III) kapena gawo lachinayi (IV) FL.
Gawo lanu la FL lidzadalira:
- Ndi madera angati a thupi lanu omwe ali ndi lymphoma
- Kumene lymphoma imaphatikizapo ngati ili pamwamba, pansi kapena mbali zonse za diaphragm (minofu yaikulu, yooneka ngati dome pansi pa nthiti yomwe imalekanitsa chifuwa ndi mimba yanu)
- Kaya lymphoma yafalikira ku mafupa anu kapena ziwalo zina monga chiwindi, mapapo, khungu kapena fupa.
Gawo XNUMX ndi lachiwiri limatchedwa 'gawo loyambirira kapena lochepa' (lokhala ndi gawo laling'ono la thupi lanu).
Gawo III ndi IV limatchedwa 'advanced stage' (lofalikira kwambiri).
Gawo 1 | Malo amodzi a lymph node amakhudzidwa, kaya pamwamba kapena pansi pa diaphragm*. |
Gawo 2 | Magawo awiri kapena angapo a ma lymph node amakhudzidwa mbali imodzi ya diaphragm *. |
Gawo 3 | Malo ochepera a lymph node kumtunda ndi gawo limodzi la m'munsi mwa diaphragm amakhudzidwa. |
Gawo 4 | Lymphoma ili m'ma lymph nodes angapo ndipo yafalikira kumadera ena a thupi (monga mafupa, mapapo, chiwindi). |
Zowonjezera masiteji
Dokotala wanu anganenenso za siteji yanu pogwiritsa ntchito kalata, monga A, B, E, X kapena S. Makalatawa amapereka zambiri zokhudza zizindikiro zomwe muli nazo kapena momwe thupi lanu likukhudzidwira ndi lymphoma. Zonsezi zimathandiza dokotala wanu kupeza ndondomeko yabwino yothandizira inu.
Letter | kutanthauza | Importance |
A kapena B |
|
|
E ndi X |
|
|
S |
|
(Nyendo yanu ndi chiwalo cha m'mitsempha yanu yomwe imasefa ndikuyeretsa magazi anu, ndipo ndi malo omwe B-maselo anu amapumula ndikupanga ma antibodies) |
Mayeso a masiteji
Kuti mudziwe kuti muli ndi gawo liti, mutha kufunsidwa kuti muyese ena mwa magawo awa:
Scut tomography (CT) Scan
Makani awa amatenga zithunzi za mkati mwa chifuwa, mimba kapena chiuno. Amapereka zithunzi zatsatanetsatane zomwe zimapereka zambiri kuposa X-ray wamba.
Positron emission tomography (PET) scan
Ichi ndi jambulani chomwe chimajambula zithunzi za mkati mwa thupi lanu lonse. Mudzapatsidwa ndi singano ndi mankhwala omwe maselo a khansa - monga maselo a lymphoma amayamwa. Mankhwala omwe amathandiza PET scan kudziwa komwe lymphoma ili ndi kukula kwake ndi mawonekedwe ake powunikira malo omwe ali ndi maselo a lymphoma. Maderawa nthawi zina amatchedwa "otentha".
Kupopera kwa Lumbar
Kuphulika kwa lumbar ndi njira yomwe imachitidwa kuti muwone ngati muli ndi lymphoma yanu dongosolo lalikulu la mitsempha (CNS), zomwe zimaphatikizapo ubongo wanu, msana ndi malo ozungulira maso anu. Muyenera kunena mwakachetechete kwambiri panthawi ya opaleshoniyo, kotero kuti makanda ndi ana akhoza kupatsidwa mankhwala opha ululu kuti awagone kwa kanthawi kochepa. Akuluakulu ambiri amangofunika mankhwala ochititsa dzanzi m'deralo.
Dokotala wanu amalowetsa singano kumbuyo kwanu, ndikutulutsa madzi pang'ono otchedwa "cerebral spinal fluid” (CSF) kuchokera kuzungulira msana wanu. CSF ndi madzimadzi omwe amagwira ntchito ngati chotsitsa ku CNS yanu. Imanyamulanso mapuloteni osiyanasiyana ndi matenda olimbana ndi ma cell a chitetezo chamthupi monga ma lymphocyte kuti ateteze ubongo wanu ndi msana. CSF ingathandizenso kukhetsa madzi owonjezera omwe mungakhale nawo muubongo wanu kapena kuzungulira msana wanu kuti mupewe kutupa m'malo amenewo.
Zitsanzo za CSF zidzatumizidwa ku matenda ndi kufufuzidwa ngati pali zizindikiro za lymphoma.
Mafupa a mafupa amatha
- Bone marrow aspirate (BMA): mayesowa amatenga madzi pang'ono omwe amapezeka mu fupa la mafupa.
- Bone marrow aspirate trephine (BMAT): mayesowa amatenga chitsanzo chaching'ono cha minofu ya mafupa.
Zitsanzozo zimatumizidwa ku pathology komwe amakawona ngati pali zizindikiro za lymphoma.
Njira yopangira ma biopsies a m'mafupa imatha kusiyana kutengera komwe mukumwa mankhwala, koma nthawi zambiri imaphatikizapo mankhwala ogonetsa am'deralo kuti athetse vutolo.
M'zipatala zina, mutha kupatsidwa mankhwala opepuka omwe amakuthandizani kuti mupumule ndipo angakulepheretseni kukumbukira njirayo. Komabe anthu ambiri safuna izi ndipo m'malo mwake akhoza kukhala ndi "mluzu wobiriwira" woti aziyamwa. Mluzu wobiriwirawu uli ndi mankhwala opha ululu mmenemo (otchedwa Penthrox kapena methoxyflurane), omwe mumagwiritsa ntchito pakufunika nthawi yonseyi.
Onetsetsani kuti mufunse dokotala zomwe zilipo kuti mukhale omasuka panthawi ya ndondomekoyi, ndipo kambiranani nawo zomwe mukuganiza kuti zingakhale zabwino kwambiri kwa inu.
Zambiri za biopsies ya m'mafupa zitha kupezeka patsamba lathu Pano.
Maselo anu a lymphoma ali ndi kakulidwe kosiyana ndipo amawoneka mosiyana ndi maselo abwinobwino. Kalasi ya Follicular lymphoma yanu ndi momwe maselo anu a lymphoma amawonekera pansi pa microscope. Magulu 1-2 (otsika kalasi) ali ndi ma centroblasts ochepa (akuluakulu B-maselo). Maphunziro a 3a ndi 3b (makalasi apamwamba) ali ndi chiwerengero chachikulu cha centroblasts (maselo akuluakulu a B), ndipo nthawi zambiri ma centrocytes (maselo aang'ono mpaka apakati B) amawonekanso. Maselo anu adzawoneka mosiyana ndi maselo abwinobwino ndikukula mosiyana. Ma cell a centroblast akamawonetsa kwambiri chotupa chanu chimakhala chaukali (chikukula mwachangu). Chidule cha magiredi chili pansipa.
Bungwe la World Health Organization (WHO) lolemba za follicular lymphoma (FL)
kalasi | Tanthauzo |
1 | Otsika: 0-5 centroblasts amawonedwa m'maselo a lymphoma. 3 mwa 4 maselo ndi indolent (kukula pang'onopang'ono) follicular B-maselo |
2 | Kalasi yotsika: 6-15 centroblasts amawoneka m'maselo a lymphoma. 3 mwa 4 maselo ndi indolent (kukula pang'onopang'ono) follicular B-maselo |
3A | Makalasi apamwamba: Kupitilira 15 centroblasts komanso ma centrocyte omwe amapezeka m'maselo a lymphoma. Pali kusakanikirana kwa ma cell a indolent (akukula pang'onopang'ono) a follicular lymphoma cell ndi aggressive (akukula mwachangu) ma cell a lymphoma otchedwa ma cell akuluakulu a B. |
3B | Makalasi apamwamba: Kupitilira 15 centroblasts ndi Ayi ma centrocyte omwe amapezeka m'maselo a lymphoma. Pali kusakanikirana kwa ma cell a indolent (akukula pang'onopang'ono) a follicular lymphoma cell ndi aggressive (akukula mwachangu) ma cell a lymphoma otchedwa ma cell akuluakulu a B. chifukwa cha Giredi 3b iyi imatengedwa ngati Diffuse Large B Cell Lymphoma subtype (DLBCL) ADD: Lumikizani ku DLBCL |
Kuyika ndi kusanja kwa FL yanu ndikofunikira kwambiri chifukwa kumawonetsa ngati mukufuna chithandizo komanso mtundu wanji wa chithandizo.
- Gawo IV FL singafunikire chithandizo nthawi yomweyo ndipo mutha kuyang'anitsitsa (yang'anani ndikudikirira) popeza muli ndi kalasi yotsika (kukula pang'onopang'ono) FL.
- kalasi FL- 3A ndi 3B imachitiridwa mobwerezabwereza mofanana ndi DLBCL yomwe ndi mtundu wovuta kwambiri wa NHL.
Ndikofunika kuti muyankhule ndi dokotala wanu za zomwe zimayambitsa chiopsezo chanu kuti mukhale ndi malingaliro omveka bwino pazomwe mungayembekezere kuchokera kumankhwala anu.
Mitundu ya Follicular lymphoma (FL)
Dokotala wanu akapeza zotsatira zanu zonse, adzatha kukudziwitsani siteji ndi kalasi ya FL yomwe muli nayo. Mutha kuuzidwanso kuti muli ndi mtundu wina wa FL, koma izi sizili choncho kwa aliyense.
Ngati mwauzidwa kuti muli ndi kagawo kakang'ono, dinani maulalo omwe ali pansipa kuti mudziwe zambiri za subtype imeneyo.
Duodenal-type follicular lymphoma imatchedwanso primary gastrointestinal follicular lymphoma (PGFL). Ndi FL yomwe ikukula pang'onopang'ono ndipo nthawi zambiri imapezeka itangoyamba kumene.
Imakula mu gawo loyamba la matumbo anu aang'ono (duodenum), itangodutsa m'mimba mwanu. PGFL nthawi zambiri imapezeka m'malo, zomwe zikutanthauza kuti imapezeka pamalo amodzi, ndipo nthawi zambiri sichifalikira kumadera ena a thupi lanu.
zizindikiro
Zizindikiro zina zomwe mungakhale nazo ndi PGFL zimaphatikizapo kupweteka kwa m'mimba ndi kutentha pamtima, kapena simungakhale ndi zizindikiro konse. Chithandizo chikhoza kukhala opaleshoni kapena kuyang'ana ndikudikirira (kuyang'anitsitsa). malingana ndi zizindikiro zanu.
Ngakhale opaleshoni ikafunika, zotsatira za anthu omwe ali ndi Duodenal-type FL ndi zabwino kwambiri.
Ma FL omwe amawonekera kwambiri ndi gulu la maselo amwazikana (ofalikira) omwe amapezeka gawo limodzi la thupi lanu. Zizindikiro zazikulu ndi kuchuluka kwakukulu (chotupa) chomwe chimawoneka ngati chotupa m'dera lanu la groin (inguinal).
Mtundu wa follicular lymphoma wa ana ndi wosowa kwambiri wa follicular lymphoma. Nthawi zambiri imakhudza ana koma imathanso kugwira akulu mpaka zaka 40 zakubadwa.
Kafukufuku akuwonetsa kuti P-TFL ndi yapadera komanso yosiyana ndi ma follicular lymphoma. Zimakhala ngati chotupa chosaopsa (chopanda khansa) ndipo nthawi zambiri chimapezeka mu gawo limodzi lokha la thupi lanu. Nthawi zambiri sichimafalikira kutali ndi malo omwe amayamba kukula.
PTFL imapezeka kwambiri m'ma lymph nodes pafupi ndi mutu ndi khosi lanu.
Kuchiza kwa mtundu wa follicular lymphoma wa ana kungaphatikizepo opaleshoni kuchotsa ma lymph node omwe akhudzidwa, kapena penyani & dikirani (kuyang'anira mwachangu). Pambuyo pa chithandizo chopambana, subtype iyi sibwereranso.
Kumvetsetsa lymphoma cytogenetics yanu
Komanso mayesero onse omwe ali pamwambawa, mukhoza kukhala ndi mayesero a cytogenetic. Apa ndipamene magazi anu ndi zotupa zanu zimafufuzidwa kuti muwone kusiyana kwa majini omwe angakhale nawo pa matenda anu. Kuti mumve zambiri pa izi chonde onani gawo lathu pakumvetsetsa chibadwa chanu cha lymphoma patsamba lino. Mayesero omwe amagwiritsidwa ntchito poyang'ana kusintha kwamtundu uliwonse amatchedwa cytogenetic tests. Mayesowa amayang'ana kuti awone ngati mwasintha ma chromosome ndi majini.
Nthawi zambiri timakhala ndi ma chromosomes 23, ndipo amawerengedwa molingana ndi kukula kwake. Ngati muli ndi FL, ma chromosome anu amatha kuwoneka mosiyana.
Kodi majini ndi ma chromosome ndi chiyani?
Selo lililonse lomwe limapanga thupi lathu limakhala ndi phata, ndipo mkati mwa phata muli ma chromosomes 23. Chromozomu iliyonse imapangidwa kuchokera ku DNA (deoxyribonucleic acid) yomwe ili ndi chibadwa chathu.
Majini athu amapereka malamulo ofunikira kuti apange maselo onse ndi mapuloteni m'thupi lathu ndikuwauza momwe angawonekere kapena kuchita.
Ngati pali kusintha (kusintha) m'ma chromosome kapena majini, mapuloteni ndi maselo anu sangagwire ntchito bwino.
Ma lymphocyte amatha kukhala maselo a lymphoma chifukwa cha kusintha kwa majini (kutchedwa masinthidwe kapena kusintha) mkati mwa maselo. Lymphoma biopsy yanu ikhoza kuyang'aniridwa ndi katswiri wazachipatala kuti awone ngati muli ndi masinthidwe amtundu uliwonse.
Kodi masinthidwe a FL amawoneka bwanji?
Kulankhula mopambanitsa
Kafukufuku wapeza kuti kusintha kwa majini kosiyanasiyana (kusintha) kungayambitse kufotokoza mopambanitsa (zochuluka) za mapuloteni ena pamwamba pa maselo a FL. Mapuloteniwa akamanenedwa mopambanitsa, amatero thandizani khansa yanu kukula.
Mapuloteni osiyanasiyana ndi gawo la gulu lomwe nthawi zambiri limauza maselo kuti akule, kapena kufa ndikusunga bwino. Amazindikiranso ngati selo liwonongeka, kapena liyamba kukhala la khansa, ndikuwuza maselowa kuti adzikonze okha, kapena kufa. Koma kuchulukirachulukira kwa mapuloteni ena omwe amauza maselo a lymphoma kuti akule, kumapangitsa kuti njirayi ikhale yosakwanira, ndikupangitsa kuti maselo a khansa apitirire kukula ndikuchulukana.
Mapuloteni ena omwe amatha kufotokozedwa kwambiri pama cell anu a FL ndi awa:
- CD5
- CD10
- CD20
- CD23
- CD43
- Mtengo wa BCL6
- Zamgululi
- MUM1
Kusamutsa
Majini amathanso kuyambitsa kusintha kwa ntchito ndi kukula chifukwa cha a kusuntha. Kusuntha kumachitika pamene majini a ma chromosome awiri osiyana asinthana malo. Kusamutsa kumakhala kofala kwambiri mwa anthu omwe ali ndi FL. Ngati mumasamutsa m'maselo anu a FL, ndiye kuti izi zitha kukhala pakati pa chromosome yanu ya 14 ndi 18. Mukakhala ndi kusintha kwa majini pa ma chromosome a 14 ndi 18 amalembedwa ngati t ( 14:18 ).
Chifukwa chiyani kuli kofunika kudziwa za kusintha kwa majini komwe ndili nako?
Kusintha kwa majini ndikofunika chifukwa kungathandize dokotala wanu kulosera momwe FL yanu idzachitira ndikukula. Zimawathandizanso kukonzekera zomwe tratment ingagwire ntchito bwino kwa inu.
Kukumbukira dzina la kusintha kwa majini sikofunikira. Koma, kudziwa kuti muli ndi ena mwa masinthidwe a majini kumafotokoza chifukwa chomwe mungafunikire chithandizo kapena mankhwala osiyanasiyana kwa ena omwe ali ndi FL.
Kupezeka kwa kusintha kwa majini mu lymphoma kwachititsa kuti afufuze ndi kupanga mankhwala atsopano omwe amakhudza mapuloteni kapena majini omwe akukhudzidwa. Kafukufukuyu akupitilira pomwe pali zosintha zambiri.
Njira zina zomwe kusintha kwa majini kungakhudzire chithandizo chanu ndi monga:
- Ngati CD20 ikuchulukirachulukira pama cell anu a FL ndipo mukufuna chithandizo, mutha kumwa mankhwala otchedwa rituximab (otchedwanso Mabthera kapena Rituxan). Kuchuluka kwa CD20 kumakhala kofala kwambiri mwa anthu omwe ali ndi follicular lymphoma.
- Ngati muli ndi IRF4 kapena MUM1 mochulukirachulukira, zingasonyeze kuti FL yanu ndi yaukali kuposa yaulesi, ndipo ingafunike chithandizo.
- Kusintha kwina kwa majini kungatanthauze kuti chithandizo chomwe mukuchifuna chidzakhala chothandiza kwambiri pochiza FL yanu.
Mafunso oti mufunse dokotala wanu
Zingakhale zovuta kudziwa mafunso oyenera kufunsa pamene mukuyamba kulandira chithandizo. Ngati simukudziwa, zomwe simudziwa, mungadziwe bwanji zomwe mungafunse?
Kukhala ndi chidziwitso choyenera kungakuthandizeni kudzidalira komanso kudziwa zomwe mungayembekezere. Zingakuthandizeninso kukonzekera pasadakhale zomwe mungafunike.
Talemba mndandanda wa mafunso omwe mungawapeze kukhala othandiza. Zoonadi, mkhalidwe wa aliyense ngwosiyana, chotero mafunso ameneŵa samakhudza chirichonse, koma amapereka chiyambi chabwino.
Dinani ulalo womwe uli pansipa kuti mutsitse PDF yosindikizidwa ya mafunso kwa dokotala wanu
Chithandizo cha Follicular Lymphoma (FL)
Zotsatira zonse za ma biopsies anu, kuyezetsa kwa cytogenetic ndi ma scans abwera, dokotala wanu azitha kukonza momwe mungasamalire FL yanu. Nthawi zambiri izi zitha kutanthauza kutenga njira ya "Penyani ndi Kudikirira". Izi zikutanthauza kuti lymphoma yanu sifunikira chithandizo chilichonse, koma adzafuna kuyang'anitsitsa kuti awone ngati lymphoma ikuyamba kukula kwambiri, kapena kukupangitsani kukhala ndi zizindikiro kapena kusakhala bwino. Mutha kutsitsa zolemba zathu pa Watch and Wait podina ulalo womwe uli pansipa.
Nthawi yoyambira chithandizo
Dokotala wanu adzawunikanso izi kuti akusankhireni chithandizo chabwino kwambiri. Kumalo ena a khansa, dokotala amakumananso ndi gulu la akatswiri kuti akambirane njira yabwino kwambiri yochizira. Izi zimatchedwa a Multidisciplinary team (MDT) msonkhano.
Dokotala wanu adzaganizira zambiri za FL yanu. Zosankha za nthawi kapena ngati muyenera kuyamba komanso chithandizo chomwe chili chabwino kwambiri chimachokera pa:
- Gawo lanu la lymphoma, kusintha kwa majini, ndi zizindikiro
- Zaka zanu, mbiri yakale yachipatala, ndi thanzi lanu
- Ubwino wanu wapano wakuthupi ndi wamaganizidwe komanso zokonda za odwala.
Mayesero ochulukirapo atha kulamulidwa musanayambe chithandizo kuti mutsimikizire kuti mtima wanu, mapapo ndi impso zimatha kuthana ndi mankhwalawa. Izi zingaphatikizepo ECG (electrocardiogram), kuyesa ntchito yamapapu kapena kusonkhanitsa mkodzo wa maola 24.
Dokotala wanu kapena namwino wa khansa akhoza kukufotokozerani za dongosolo lanu lamankhwala ndi zotsatirapo zake ndipo mulipo kuti muyankhe funso lililonse lomwe mungakhale nalo. Ndikofunika kuti mufunse dokotala wanu ndi/kapena namwino wa khansa mafunso pa chilichonse chomwe simukuchidziwa.
Cholinga chothandizira FL ndi:
- Kutalikitsa chikhululukiro
- Perekani chithandizo cha matenda
- Kukulitsa umoyo wa moyo
- Chepetsani zizindikiro kapena zotsatira zake ndi chithandizo chothandizira kapena chothandizira
Mukhozanso kuyimbira foni kapena kutumiza imelo ku Lymphoma Australia Namwino Helpline ndi mafunso anu ndipo titha kukuthandizani kuti mudziwe zolondola.
Penyani ndi Kudikira
Nthawi zina dokotala angasankhe kuti musamalandire chithandizo chamankhwala. Izi zili choncho chifukwa nthawi zambiri, Follicular Lymphoma imakhala yogona (kapena kugona) ndipo imakula pang'onopang'ono kotero kuti sikuyambitsa vuto lililonse m'thupi lanu. Kafukufuku wasonyeza kuti palibe phindu poyambitsa mankhwala panthawiyi, ndipo zimabwera ndi chiopsezo cha zotsatirapo za mankhwala.
Ngati lymphoma "idzuka" kapena ikayamba kukula mofulumira, ndiye kuti mudzapatsidwa chithandizo chokhazikika.
Namwino wa namwino wa Lymphoma:
Foni: 1800 953 081
Email: nurse@lymphoma.org.au
Kodi chithandizo cha Follicular Lymphoma (FL) chikufunika liti?
Monga tafotokozera pamwambapa, si onse omwe ali ndi FL omwe adzafunika kuyamba kulandira chithandizo nthawi yomweyo. Pofuna kuthandiza madokotala kudziwa nthawi yoti ayambe kulandira chithandizo, njira yotchedwa 'GELF criteria' inakhazikitsidwa. Ngati muli ndi chimodzi kapena zingapo mwa zizindikiro izi, ndizotheka kuti mungafunike chithandizo:
- Chotupa chachikulu kuposa 7cm kukula.
- Ma lymph nodes atatu otupa m'malo atatu mosiyanasiyana, onse ndi akulu kuposa 3cms kukula kwake.
- Zizindikiro za B zosalekeza.
- Kukula ndulu (splenomegaly)
- Kupsyinjika kwa ziwalo zanu zonse zamkati chifukwa cha kutupa kwa ma lymph nodes.
- Madzi okhala ndi ma cell a lymphoma m'mapapu anu kapena pamimba (Pleural effusions kapena ascites).
- Maselo a FL omwe amapezeka m'magazi anu kapena m'mafupa anu (kusintha kwa leukemic) kapena kuchepa kwa maselo ena a magazi (cytopenias). Izi zikutanthauza kuti FL yanu ikuletsa mafupa anu kuti asapange maselo okwanira a thanzi.
- LDH yokwezeka kapena Beta2-microglobulin (awa ndi mayeso a magazi).
Dinani pamitu yomwe ili pansipa kuti muwone mitundu yosiyanasiyana yamankhwala yomwe ingagwiritsidwe ntchito kuyang'anira FL yanu.
Thandizo lothandizira limaperekedwa kwa odwala ndi mabanja omwe akudwala kwambiri. Chisamaliro chothandizira chingathandize odwala kukhala ndi zizindikiro zochepa, ndipo amakhala bwino mofulumira posamalira mbali za chisamaliro chawo.
Kwa ena a inu omwe ali ndi FL, maselo anu a leukemic amatha kukula mosalekeza ndikudzaza mafupa anu, magazi, ma lymph nodes, chiwindi kapena ndulu. Chifukwa mafupa ali odzaza ndi maselo a FL omwe ali aang'ono kwambiri kuti asagwire ntchito bwino, maselo anu abwino a magazi adzakhudzidwa. Thandizo lothandizira lingaphatikizepo zinthu monga inu kuikidwa magazi kapena kuikidwa magazi m'chipinda chapansi pa ward kapena mu intravenous infusion suite m'chipatala. Mutha kukhala ndi maantibayotiki kuti mupewe kapena kuchiza matenda.
Zingaphatikizepo kukaonana ndi gulu la chisamaliro chapadera kapena chisamaliro chochepa. Zitha kukhalanso kukambirana za chisamaliro chamtsogolo, chomwe chimatchedwa Advanced Care Planning. Zinthu izi ndi gawo la kasamalidwe kosiyanasiyana ka lymphoma.
Chisamaliro chothandizira chingaphatikizepo chithandizo chamankhwala chomwe chimathandiza kusintha zizindikiro zanu ndi zotsatirapo zake, komanso kutha kwa chisamaliro ngati pakufunika kutero.
Ndikofunikira kudziwa kuti gulu la Palliative Care litha kuyitanidwa nthawi iliyonse munjira yanu yamankhwala osati kumapeto kwa moyo. Amatha kuwongolera ndikuwongolera zizindikiro (monga zovuta kuletsa kupweteka ndi nseru) zomwe mungakhale mukukumana nazo chifukwa cha matenda anu kapena chithandizo chake.
Ngati inu ndi dokotala mwasankha kugwiritsa ntchito chithandizo chothandizira kapena kusiya chithandizo chamankhwala cha lymphoma yanu, zinthu zambiri zingatheke kukuthandizani kuti mukhale athanzi komanso omasuka kwa nthawi ndithu.
Radiation therapy ndi chithandizo cha khansa chomwe chimagwiritsa ntchito kuchuluka kwa radiation kupha ma cell a lymphoma ndikuchepetsa zotupa. Musanayambe kukhala ndi ma radiation, mudzakhala ndi gawo lokonzekera. Gawoli ndilofunika kuti ochiritsa ma radiation akonzekere momwe angalondolere ma radiation ku lymphoma, ndikupewa kuwononga maselo athanzi. Chithandizo cha radiation nthawi zambiri chimakhala pakati pa milungu 2-4. Panthawi imeneyi, muyenera kupita kumalo opangira ma radiation tsiku lililonse (Lolemba-Lachisanu) kuti mukalandire chithandizo.
*Ngati mukukhala kutali ndi malo opangira ma radiation ndipo mukufuna thandizo la malo oti mukhale panthawi ya chithandizo, chonde lankhulani ndi dokotala kapena namwino wanu za chithandizo chomwe mungapeze. Mutha kulumikizananso ndi Cancer Council kapena Leukemia Foundation mdera lanu ndikuwona ngati angathandize kwinakwake kukhala.
Mutha kumwa mankhwalawa ngati piritsi kapena kuperekedwa ngati dontho (kulowetsedwa) mumtsempha wanu (m'magazi anu) ku chipatala cha khansa kapena chipatala. Mankhwala angapo a chemo amatha kuphatikizidwa ndi mankhwala a immunotherapy. Chemo imapha ma cell omwe amakula mwachangu kotero amatha kukhudzanso ena mwama cell anu abwino omwe amakula mwachangu kumabweretsa zotsatira zoyipa.
Mutha kukhala ndi kulowetsedwa kwa MAB ku chipatala cha khansa kapena chipatala. Ma MAB amamatira ku cell ya lymphoma ndikukopa matenda ena omwe amalimbana ndi maselo oyera amagazi ndi mapuloteni ku khansa kuti chitetezo chanu cha mthupi chitha kulimbana ndi FL.
MABS idzagwira ntchito ngati muli ndi mapuloteni enieni kapena zolembera pama cell anu a lymphoma. Chizindikiro chodziwika bwino mu FL ndi CD20. Ngati muli ndi cholemberachi mutha kupindula ndi chithandizo ndi MAB.
Chemotherapy pamodzi ndi MAB (mwachitsanzo, rituximab).
Mutha kuwatenga ngati piritsi kapena kulowetsedwa mumtsempha wanu. Thandizo la pakamwa litha kuperekedwa kunyumba, ngakhale kuti ena amafunikira kuchipatala kwakanthawi kochepa. Ngati muli ndi kulowetsedwa, mukhoza kumwa ku chipatala cha tsiku kapena kuchipatala. Njira zochiritsira zomwe zimagwiritsidwa ntchito zimagwirizanitsa ndi maselo a lymphoma ndikuletsa zizindikiro zomwe zimafunika kuti zikule ndikupanga maselo ambiri. Izi zimalepheretsa kukula kwa khansa ndikupangitsa kuti ma cell a lymphoma afe.
Kuyika kwa tsinde kapena fupa la mafupa kumachitidwa kuti m'malo mwa mafupa anu odwala ndi maselo atsopano omwe amatha kukula kukhala maselo athanzi amagazi. Kuika mafupa a m'mafupa nthawi zambiri kumangochitika kwa ana omwe ali ndi FL, pamene ma cell cell transplants amachitidwa kwa ana onse akuluakulu.
Poika mafupa a mafupa, maselo a tsinde amachotsedwa molunjika kuchokera m'mafupa, kumene monga momwe zimakhalira ndi maselo amtundu, maselo amachotsedwa m'magazi.
Ma cell stem amatha kuchotsedwa kwa wopereka kapena kusonkhanitsidwa kuchokera kwa inu mutalandira chemotherapy.
Ngati inu tsinde maselo amachokera kwa wopereka, amatchedwa allogeneic stem cell transplant.
Ngati ma tsinde anu asonkhanitsidwa, amatchedwa autologous stem cell transplant.
Maselo a tsinde amasonkhanitsidwa kudzera mu njira yotchedwa apheresis. Inu (kapena wopereka wanu) mudzalumikizidwa ndi makina a apheresis ndipo magazi anu adzachotsedwa, ma cell tsinde amalekanitsidwa ndikusonkhanitsidwa m'thumba, kenako magazi anu onse amabwerera kwa inu.
Musanayambe ndondomekoyi, mudzalandira mankhwala a chemotherapy kapena ma radiotherapy a thupi lonse kuti muphe maselo anu onse a lymphoma. Komabe chithandizo cha mlingo waukuluwu chidzaphanso maselo onse a m'mafupa anu. Chifukwa chake ma tsinde osonkhanitsidwa adzabwezeredwa kwa inu (kusinthidwa). Izi zimachitika mofanana ndi momwe kuthiridwa magazi kumaperekedwa, kupyolera mu kudonthezera mumtsempha wanu.
CAR T-cell therapy ndi chithandizo chatsopano chomwe chidzaperekedwa ngati mwalandira kale mankhwala ena osachepera awiri a FL yanu.
Nthawi zina, mutha kupeza chithandizo cha CAR T-cell polowa nawo mayeso azachipatala.
CAR T-cell therapy imaphatikizapo njira yoyamba yofanana ndi kuika maselo a stem, kumene ma T-cell lymphocyte amachotsedwa m'magazi anu panthawi ya apheresis. Monga inu B-cell lymphocytes, T-maselo ndi mbali ya chitetezo chanu cha mthupi ndipo amagwira ntchito ndi B-maselo anu kuti akutetezeni ku matenda ndi matenda.
Ma T-cell akachotsedwa, amatumizidwa ku labotale komwe amapangidwanso. Izi zimachitika polumikizana ndi T-cell ku antigen yomwe imathandiza kuzindikira lymphoma momveka bwino ndikumenyana nayo bwino.
Chimeric amatanthauza kukhala ndi magawo omwe ali ndi chiyambi chosiyana kotero kuti kulumikiza kwa antigen ku T-cell kumapangitsa kukhala chimeric.
Ma T-cell akapangidwanso adzabwezedwa kwa inu kuti muyambe kulimbana ndi lymphoma.
Thandizo loyamba - kuyambira chithandizo
Kuyambira Therapy
Mukayamba kumwa mankhwala, amatchedwa chithandizo choyamba. Mukamaliza kulandira chithandizo choyamba, simungafunenso chithandizo kwa zaka zambiri. Anthu ena amafunikira chithandizo chochulukirapo nthawi yomweyo, ndipo ena amatha miyezi kapena zaka asanafunikire chithandizo chochulukirapo.
Mukayamba kulandira chithandizo, mutha kukhala ndi mankhwala opitilira umodzi. Izi zingaphatikizepo chemotherapy, anti-monoclonal antibody kapena mankhwala omwe akuwongolera. Nthawi zina, mutha kulandira chithandizo cha radiation kapena opaleshoni, kapena m'malo mwa mankhwala.
Chithandizo mkombero
Mukakhala ndi mankhwalawa, mudzakhala nawo mozungulira. Izi zikutanthauza kuti mudzakhala ndi chithandizo, ndiye kupuma, ndiye kuzungulira kwina (kuzungulira) kwa mankhwala. Kwa anthu ambiri omwe ali ndi FL, chemoimmunotherapy ndi othandiza kuti athetse chikhululukiro (palibe zizindikiro za khansa).
Ndondomeko yanu yonse yamankhwala ikaphatikizidwa, imatchedwa protocol yanu yamankhwala. Malo ena angatchule kuti njira ya chithandizo.
Dokotala wanu adzakusankhirani njira yabwino yothandizira mankhwala malinga ndi zomwe zili pansipa
- Gawo ndi kalasi ya FL yanu.
- Kusintha kulikonse komwe muli nako.
- Zaka zanu komanso thanzi lanu lonse.
- Matenda ena kapena mankhwala omwe mungakhale mukumwa.
- Zokonda zanu mutakambirana zomwe mungachite ndi dokotala wanu.
Zitsanzo za ma protocol a chemoimmunotherapy omwe mungapeze kuchitira FL
- BR kuphatikiza kwa Bendamustine ndi Rituximab (a MAB).
- BO kapena GB- kuphatikiza kwa Bendamustine ndi Obinutuzumab (a MAB).
- RCHOP kuphatikiza kwa rituximab (MAB) yokhala ndi mankhwala a chemotherapy cyclophosphamide, doxorubicin, vincristine ndi prednisolone. Ndondomekoyi imagwiritsidwa ntchito pochiza FL ikakhala giredi yapamwamba, nthawi zambiri giredi 3a ndi kupitilira apo.
- O- CHOP kuphatikiza kwa Obinutuzumab, cyclophosphamide, vincristine, doxorubicin ndi prednisolone. Ndondomekoyi imagwiritsidwa ntchito pochiza FL ikakhala giredi yapamwamba, nthawi zambiri giredi 3a ndi kupitilira apo.
Zovuta zachipatala
Pali mayesero ambiri azachipatala ku Australia komanso padziko lonse lapansi, kufunafuna njira zowongolera chithandizo cha anthu omwe ali ndi lymphoma. Ngati mukufuna kudziwa zambiri za mayeso azachipatala, dinani batani pansipa. Mukhozanso kulankhula ndi dokotala wanu katswiri - hematologist wanu kapena oncologist za mayesero omwe mungakhale nawo.
Chithandizo chamankhwala
Thandizo lothandizira limaperekedwa ndi cholinga choti musakhululukire kwa nthawi yayitali, mutatha kulandira chithandizo choyamba.
Kukhululukidwa kwathunthu
Anthu ambiri amayankhidwa bwino kwambiri pa chithandizo choyamba ndipo amapeza chikhululukiro chonse. Izi zikutanthauza kuti mukamaliza mankhwala anu, palibe FL yotsalira m'thupi lanu. Izi zitha kutsimikiziridwa pambuyo pa PET scan. Komabe ndikofunikira kumvetsetsa kuti kukhululukidwa kwathunthu sikufanana ndi kuchiritsa. Ndi mankhwala, lymphoma yapita ndipo sizingatheke kubwerera.
Koma tikudziwa ndi ma indolent lymphomas monga FL, nthawi zambiri amabwera pakapita nthawi. Izi zitha kukhala miyezi kapena zaka mutalandira chithandizo, komabe ndizotheka kubwereranso. Izi zimatchedwa kuyambiranso. Zikachitika, mungafunike chithandizo chochulukirapo, kapena mutha kupita ku "yang'anani ndikudikirira" ngati ikhala chete popanda zizindikiro.
Kukhululuka pang'ono
Kwa anthu ena, kulandira chithandizo choyamba sikubweretsa chikhululukiro chonse, koma kukhululukidwa pang'ono. Izi zikutanthauza kuti matenda ambiri apita, koma pali zizindikiro zina zomwe zatsala m'thupi lanu. Akadali yankho labwino, chifukwa kumbukirani FL ndi indolent lymphoma yomwe siingachiritsidwe. Koma ngati muli ndi yankho laling'ono, likhoza kubwereranso kukagona, ndipo simungafunenso chithandizo chamankhwala koma pitirizani kuyang'ana ndikudikirira.
Kaya mwakhululukidwa kwathunthu kapena pang'ono zitha kuwoneka pakutsata kwanu kwa PET scan.
Pofuna kuti musakhululukidwe kwa nthawi yayitali, dokotala wanu angakulozeni kuti mupite ku chithandizo chamankhwala kwa zaka ziwiri mutalandira chithandizo choyamba.
Kodi chithandizo chamankhwala chimaphatikizapo chiyani?
Thandizo lothandizira limaperekedwa kamodzi pa miyezi 2-3 iliyonse ndipo ndi antibody monoclonal. Ma antibodies a monoclonal omwe amagwiritsidwa ntchito pokonza ndi rituximab kapena obinutuzumab. Mankhwala onsewa ndi othandiza mukakhala ndi mapuloteni a CD20 pama cell anu a lymphoma, omwe amapezeka ndi FL.
Chithandizo chachiwiri
Ngati FL yanu iyambiranso kapena ikukana kulandira chithandizo choyamba, mungafunike chithandizo chachiwiri. Refractory FL ndi pamene mulibe kukhululukidwa kwathunthu kapena pang'ono pamankhwala anu oyamba.
Ngati muli ndi zaka zosakwana 70, mutha kupatsidwa mankhwala osiyanasiyana, kenako ndikumuika mu cell cell. Komabe, kusintha kwa stem cell sikoyenera kwa aliyense. Dokotala wanu azitha kulankhula nanu zambiri za kuyenerera kwanu pamtundu wa chithandizochi.
Ngati mulibe stem cell transplant, pali njira zina zothandizira zomwe mungapatsidwe.
Mankhwalawa amagwiritsidwa ntchito kuti mubwerere ku chikhululukiro ndikuwongolera lymphoma yanu nthawi yayitali.
Njira zochizira ngati muli ndi stem cell transplant
Pangani
RICE ndi mankhwala amphamvu kwambiri a ma fractionated (wosweka) kapena infusional (kudzera kudontholera) mlingo wa ifosfamide, carboplatin ndi etoposide. Mutha kukhala ndi izi ngati mwayambiranso kapena musanayambe kupatsirana ma cell a autologous. Mudzafunika kulandira chithandizochi kuchipatala
R-GDP
R-GDP ndi kuphatikiza kwa gemcitabine, dexamethasone ndi cisplatin. Mutha kukhala ndi izi ngati mwayambiranso kapena musanayambe kupatsirana ma cell a autologous.
Njira zochizira ngati mulibe chotengera stem cell
R-CHOP / O-CHOP
R-CHOP kapena O-CHOP ndi kuphatikiza kwa rituximab kapena obinutuzumab (a MAB) yokhala ndi chemo mankhwala cyclophosphamide, doxorubicin, vincristine ndi prednisolone ulalo wa eviQ.
R-CVP
R-CVP ndi kuphatikiza kwa rituximab, cyclophosphamide, vincristine ndi prednisolone. Mutha kukhala ndi izi ngati ndinu wamkulu ndi zovuta zina zaumoyo.
O-CVP
O-CVP ndi obinutuzimab, cyclophosphamide, vincristine ndi prednisolone. Mutha kukhala ndi izi ngati ndinu wamkulu ndi zovuta zina zaumoyo.
Mafunde
Chithandizo cha radiation chingagwiritsidwe ntchito ngati FL yanu iyambiranso. Nthawi zambiri zimachitika ngati zibwereranso m'dera limodzi ndikuthandizira kuwongolera FL yanu ndikuchepetsa zizindikiro zomwe mungakhale mukuzipeza.
Chithandizo chachitatu
Nthawi zina, mungafunike chithandizo chochulukirapo mukayambiranso kachiwiri kapena katatu. Mankhwala a mzere wachitatu nthawi zambiri amakhala ofanana ndi omwe ali pamwambapa.
Nthawi zina, ngati FL yanu "ikusintha" ndikuyamba kuchita zinthu ngati gulu lamphamvu la lymphoma lotchedwa Diffuse big B-cell lymphoma, mukhoza kulandira chithandizo cha CAR T-cell ngati chithandizo chachitatu kapena chachinayi. Dokotala wanu adzakuuzani ngati FL yanu ikuyamba kusintha.
Kusintha Lymphoma
Lymphoma yosinthidwa ndi lymphoma yomwe poyamba inkapezeka kuti ndi yosasamala (kukula pang'onopang'ono) koma yasandulika (kusinthidwa kukhala) lymphoma yaukali (ikukula mofulumira).
Kusintha kwa FL yanu kungatheke ngati muli ndi kusintha kwa majini ku maselo anu a lymphoma pakapita nthawi, zomwe zimayambitsa kuwonongeka kwina. Izi zikhoza kuchitika mwachibadwa, kapena chifukwa cha mankhwala ena. Izi zowonjezera kuwonongeka kwa majini kumapangitsa kuti maselo akule mofulumira.
Chiwopsezo cha kusintha ndi chochepa. Kafukufuku akuwonetsa kuti pazaka 10 mpaka 15 atapezeka kuti ali ndi matenda, pafupifupi anthu 2-3 mwa 100 omwe ali ndi FL chaka chilichonse, amatha kusintha kukhala mtundu wankhanza kwambiri.
Nthawi yapakati kuchokera ku matenda mpaka kusintha ndi zaka 3-6.
Ngati mutasintha kuchokera ku FL, ndizotheka kuti idzasintha kukhala kagawo kakang'ono ka lymphoma yotchedwa Diffuse big B-cell lymphoma (DLBCL) kapena, kawirikawiri Burkitt lymphoma. Mudzafunika chithandizo cha chemoimmunotherapy nthawi yomweyo.
Chifukwa cha kupita patsogolo kwamankhwala, zotsatira za kusintha kwa follicular lymphoma zakhala zikuyenda bwino m'zaka zaposachedwa.
Zotsatira zoyipa za mankhwala
Pali zovuta zambiri zomwe mungapeze kuchokera kumankhwala anu a FL. Musanayambe kulandira chithandizo, dokotala wanu kapena namwino ayenera kukufotokozerani zovuta zonse zomwe mungakumane nazo. Simungawapeze onse, koma ndikofunikira kudziwa zomwe muyenera kuyang'ana komanso nthawi yoti mukumane ndi dokotala. Onetsetsani kuti muli ndi tsatanetsatane wa omwe muyenera kulumikizana nawo mukakhala bwino pakati pausiku kapena kumapeto kwa sabata pomwe dokotala sangakhalepo.
Chimodzi mwazotsatira zoyipa zamankhwala ndikusintha kwamagazi anu. Pansipa pali tebulo lomwe limafotokoza maselo a magazi omwe angakhudzidwe komanso momwe angakukhudzireni.
Maselo a magazi omwe amakhudzidwa ndi chithandizo cha FL
Maselo oyera | Maselo ofiira ofiira | Mapulateleti (komanso maselo a magazi) | |
Dzina Lachipatala | Ma Neutrophils & Lymphocytes | Mabakiteriya | Mapulatifomu |
Amachita chiyani? | Menyani Matenda | Kunyamula mpweya | Lekani magazi |
Kodi kuchepa kumatchedwa chiyani? | Neutropenia & lymphopenia | Anemia | Supombocytopenia |
Kodi izi zikhudza bwanji thupi langa? | Mutenga matenda ochulukirapo ndipo mutha kukhala ndi vuto lowachotsa ngakhale mutamwa maantibayotiki | Mutha kukhala ndi khungu lotuwa, kumva kutopa, kupuma, kuzizira komanso chizungulire | Mukhoza kuvulazidwa mosavuta, kapena kutuluka magazi omwe sasiya mwamsanga pamene mwacheka |
Kodi gulu langa lachipatala lichita chiyani kuti likonze izi? | ● Kuchedwetsa chithandizo cha lymphoma ● Akupatseni mankhwala akumwa kapena m’mitsempha ngati muli ndi matenda | ● Kuchedwetsa chithandizo cha lymphoma ● Kukupatsani magazi ofiira ngati maselo anu ndi otsika kwambiri | ● Kuchedwetsa chithandizo cha lymphoma ● Apatseni magazi a m’magazi ngati maselo anu ndi otsika kwambiri |
Zotsatira zina zodziwika za chithandizo cha FL
M'munsimu muli mndandanda wa zotsatira zina zodziwika za mankhwala a FL. Ndikofunika kuzindikira kuti tsopano mankhwala onse angayambitse zizindikirozi, ndipo muyenera kulankhula ndi dokotala wanu kapena namwino za zotsatira zake zomwe zingayambitsidwe ndi chithandizo chamankhwala chanu.
- Kumva kudwala m'mimba (nseru) ndi kusanza.
- Kupweteka mkamwa (mucositis) ndi kusintha kwa kukoma kwa zinthu.
- Matenda a m'matumbo monga kudzimbidwa kapena kutsekula m'mimba (cholimba kapena chamadzimadzi).
- Kutopa, kapena kusowa mphamvu zomwe sizikhala bwino mukapuma kapena kugona (kutopa).
- Minofu (myalgia) ndi mafupa (arthralgia) ululu ndi ululu.
- Tsitsi ndi kuwonda (alopecia) - pokhapokha ndi mankhwala ena.
- Mind fogginess ndi kuvutika kukumbukira zinthu (chemo brain).
- Kusintha kwa kumva m'manja ndi kumapazi monga kumva kulasalasa, mapini ndi singano kapena kupweteka (neuropathy).
- Kuchepa kwa chonde kapena kusamba koyambirira (kusintha kwa moyo).
Chisamaliro chotsatira - chimachitika ndi chiyani mankhwala akatha?
Mukamaliza mankhwala, mungafune kuponyera nsapato zanu zovina, ikani mikono yanu mumlengalenga ndi phwando monga mnyamata uyu (ngati muli ndi mphamvu), kapena mukhoza kudzazidwa ndi nkhawa ndi nkhawa pa zomwe zikubwera.
Maganizo onsewa ndi ofala komanso abwinobwino. Si zachilendonso kumva mwanjira ina, mphindi imodzi, ndi zinanso mphindi ina.
Simuli nokha mankhwala akatha. Mudzalumikizanabe ndi gulu lanu la akatswiri, ndipo mutha kuwayimbira ngati muli ndi nkhawa.
Mudzayang'aniridwa ndi kuyezetsa magazi ndi kuyezetsa thupi kuti muwone ngati muli ndi zizindikiro zilizonse kapena kubwereranso kapena zotsatira zokhalitsa za mankhwala anu. Nthawi zina, mutha kupanga sikani monga PET kapena CT, koma izi sizikhala zofunikira ngati mayeso ena onse ali abwinobwino ndipo simukupeza zizindikiro.
Kuthamangitsani
Kuneneratu ndi mawu omwe amagwiritsidwa ntchito pofotokoza njira yomwe ingatheke matenda anu, momwe angayankhire chithandizo ndi momwe mungachitire panthawi ya chithandizo ndi pambuyo pake.
Pali zinthu zambiri zomwe zimapangitsa kuti mukhale ndi matenda anu ndipo sizingatheke kufotokoza zonse zokhudzana ndi matenda. Komabe, FL nthawi zambiri imayankha bwino kwambiri pa chithandizo ndipo odwala ambiri omwe ali ndi khansara amatha kuchotsedwa nthawi yayitali - kutanthauza kuti mutalandira chithandizo, palibe chizindikiro cha FL m'thupi lanu.
Zinthu zomwe zingakhudze prognosis
Zina mwazinthu zomwe zingakhudze kuneneratu kwanu ndi izi:
- Mumakalamba komanso thanzi lanu lonse panthawi ya matenda.
- Momwe mumayankhira chithandizo.
- Bwanji ngati ma genetic masinthidwe muli nawo.
- Mtundu wocheperako wa FL womwe muli nawo.
Ngati mukufuna kudziwa zambiri za matenda anu, chonde lankhulani ndi katswiri wa hematologist kapena oncologist. Adzatha kukufotokozerani zomwe zingakuwopsezeni komanso zomwe zikukuchitikirani.
Kupulumuka - kukhala ndi follicular lymphoma
Kukhala ndi moyo wathanzi, kapena kusintha kwa moyo wabwino mukalandira chithandizo kungathandize kwambiri kuti muchiritsidwe. Pali zambiri zomwe mungachite kuti mukhale ndi moyo wabwino Mtengo wa DLBCL.
Anthu ambiri amapeza kuti atapezeka ndi khansa, kapena kulandira chithandizo, zolinga zawo ndi zomwe amaika patsogolo pamoyo wawo zimasintha. Kudziwa ‘zachilendo’ zanu kungatenge nthawi komanso kukukhumudwitsani. Zoyembekeza za banja lanu ndi anzanu zingakhale zosiyana ndi zanu. Mutha kudzimva kukhala osungulumwa, kutopa kapena kuchuluka kwa malingaliro osiyanasiyana omwe angasinthe tsiku lililonse.
Zolinga zazikulu pambuyo pa chithandizo chanu Zamgululi ndi kukhalanso ndi moyo ndipo:
- Khalani otanganidwa momwe mungathere pantchito yanu, banja, ndi maudindo ena amoyo.
- Chepetsani zotsatirapo ndi zizindikiro za khansa ndi chithandizo chake.
- Dziwani ndikuwongolera zovuta zilizonse mochedwa.
- Thandizani kuti mukhale odziyimira pawokha momwe mungathere.
- Sinthani moyo wanu ndikukhala ndi thanzi labwino.
Mitundu yosiyanasiyana ya kukonzanso khansa ikhoza kulangizidwa kwa inu. Izi zitha kutanthauza chilichonse chamitundumitundu za mautumiki monga:
- Physical therapy, kusamalira ululu.
- Kukonzekera kwa zakudya ndi masewera olimbitsa thupi.
- Uphungu wamalingaliro, ntchito ndi zachuma.
