Cov txiav txiav muaj lub luag haujlwm tseem ceeb hauv kev zom zaub mov, thiab nws tso tawm ntau cov tshuaj hormones, suav nrog ib qho rau cov metabolism hauv qab zib, suav nrog insulin thiab glucagon. Kev mob qog noj ntshav tau ua rau muaj kev nyuaj rau cov kws kho mob kom nrhiav thiab kuaj mob nyob rau theem pib. Nws tsis ua rau muaj tsos mob thaum ntxov, yog li thaum lub sijhawm mob tom qab ua rau muaj kev cuam tshuam cov tsos mob thiab kuaj mob qog noj ntshav, nws feem ntau lig dhau rau kev kho mob. Tsis muaj ib kauj ruam lossis teeb tsa kev sim yooj yim rau kev kuaj pom nws thaum ntxov. Cov xov xwm zoo, txawm li cas los xij, yog cov neeg "muaj kev pheej hmoo siab" (vim lawv caj ces/tsev neeg keeb kwm ntawm kev mob qog noj ntshav pancreatic, piav qhia hauv qab no) tuaj yeem tau txais qhov nyuaj, rov tshuaj ntsuam xyuas ntau xyoo nyob rau xyoo uas mob qog noj ntshav feem ntau yuav tshwm sim. Ntev npaum li cas tus neeg mob qog noj ntshav yuav nyob thiab seb nws puas yuav (lossis yuav tsis) tuag los ntawm tus kab mob, tseem paub tias yog kev kwv yees, nyob ntawm ntau yam, suav nrog theem mob qog noj ntshav, tib neeg kev noj qab haus huv, kev kho mob siv, thiab seb lub cev teb rau kev kho mob.
Cov kauj ruam
Txoj Kev 1 ntawm 2: Ntsuam Xyuas Tib Neeg Muaj Kev Ruaj Ntseg
Kauj Ruam 1. Txiav txim siab seb koj puas muaj kev pheej hmoo siab
Yog tias koj tau muaj ob lossis ntau tus thawj qib txheeb ze nrog mob qog noj ntshav pancreatic, koj pom tias muaj kev pheej hmoo siab. Xwb, yog tias koj tau muaj thawj qib txheeb ze nrog mob qog noj ntshav pancreatic kuaj pom muaj hnub nyoog qis dua 50 xyoos, koj kuj tseem raug cais raws li kev pheej hmoo siab. Ua "kev pheej hmoo siab" ua rau koj tsim nyog rau kev kuaj mob qog noj ntshav pancreatic uas tam sim no tsis muaj rau cov pej xeem.
Koj kuj tseem tuaj yeem raug cais raws li kev pheej hmoo siab, yog tias koj kuaj pom tus kab mob zoo lossis yog tias koj yog tus nqa khoom ntawm kev hloov pauv caj ces uas tau txuas rau qhov kev pheej hmoo ntawm mob qog noj ntshav ntau ntxiv
Kauj Ruam 2. Phau ntawv teem sijhawm nrog kws sab laj txog caj ces, tus kws kho mob, lossis lwm tus kws saib xyuas kev noj qab haus huv uas tau kawm tiav hauv kev tshuaj xyuas kev tshuaj ntsuam caj ces
Tus neeg no tuaj yeem pab koj tus kheej thiab koj tsev neeg nkag siab lawv cov kev xeem thiab cov txiaj ntsig. Koj tus kws kho mob yuav xav tau nkag mus rau ib lub chaw kuaj ntshav uas ua kev kuaj caj ces, yog koj xav tias qhov no yuav siv rau koj.
Kwv yees li 10% ntawm cov qog nqaij hlav pancreatic tau txuas rau cov caj ces, thiab cov tib neeg uas poob rau hauv qeb kev pheej hmoo siab vim yog cov laj thawj no tsim nyog tau txais kev tshuaj xyuas
Kauj Ruam 3. Xav txog CT (raws li xoo hluav taws xob, muaj kev txhawj xeeb txog kev nyab xeeb) piv rau MRI scan (duab sib nqus sib nqus, teeb meem rau stents tsis ntev los no teeb tsa, lwm yam khoom siv hlau, phaj, ntsia hlau, pins, thiab lwm yam)
). CT lossis MRI txoj kev tshuaj xyuas muaj rau cov tib neeg muaj kev pheej hmoo siab. Qhov kev sib tw nrog CT lossis MRI scan yog qhov nws tuaj yeem nyuaj rau kuaj pom ntxov thiab/lossis muaj qhov txhab me me ntawm cov txiav txiav lossis nthuav mus rau duodenum, zais zis, lub siab thiab nrog rau cov txuj ci siv ib leeg. Txawm li cas los xij, nws zoo dua li tsis muaj dab tsi, thiab lawv yog cov kev xaiv siv duab zoo tshaj plaws tam sim no muaj. Nws tseem yog qhov ntsuas nrawm thiab tsis cuam tshuam.
Kauj Ruam 4. Xaiv qhov txheej txheem tshuaj ntsuam xyuas
Hloov chaw ntawm CT lossis MRI, koj tuaj yeem xaiv ERCP (endoscopic retrograde cholangiopancreatography) lossis EUS (endoscopic ultrasound). Ob qho no cia siab rau tubing raug tso rau hauv koj lub plab zom mov los ntawm koj lub qhov ncauj thaum koj tsaug zog nyob rau hauv tshuaj loog txhawm rau txheeb xyuas cov txiav txiav thiab thaj tsam ib puag ncig ua ntej yam tsis muaj qhov sib txawv thiab feeb tom qab nrog nws (iodine "zas"). Lawv yog cov kev sim sab hauv uas cuam tshuam nrog qee qhov kev pheej hmoo ntawm ntshav los yog kis kab mob-thiab nyuaj dua los ua-tab sis tuaj yeem muab sijhawm rau koj tus kws kho mob kom pom thawj zaug seb koj cov txiav txiav zoo li cas, thiab seb puas muaj qhov tsis txaus ntseeg lossis hais txog qhov txhab lossis qog nqaij hlav tam sim no nyob ntawd lossis ze (uas tuaj yeem qhia tias muaj mob qog noj ntshav).
Hmoov tsis zoo, tam sim no tsis muaj cov cuab yeej nrhiav pom los kuaj tus kab mob thaum ntxov txaus rau kev kho mob tau zoo
Kauj Ruam 5. Paub tias tam sim no tsis tau teeb tsa cov lus qhia ib puag ncig
Txawm hais tias muaj kev pom zoo tias kev tshuaj ntsuam yuav tsum muaj rau cov tib neeg muaj kev pheej hmoo siab, qhov zaus thiab hom kev tshuaj ntsuam xyuas yog txiav txim siab raws qhov xwm txheej. Yav tom ntej, yuav muaj cov lus qhia kho mob thiab cov lus pom zoo/txheej txheem; txawm li cas los xij, txij li kev tshuaj xyuas yog qhov tshiab, tam sim no yuav yog kev txiav txim siab ntawm koj thiab koj tus kws kho mob/pab neeg saib xyuas.
Txoj Kev 2 ntawm 2: Txheeb Xyuas Cov Pej Xeem Loj
Kauj Ruam 1. Nkag siab tias kev rog, ntxiv rau kev haus luam yeeb thiab kev haus cawv muaj feem cuam tshuam nrog kev pheej hmoo ntawm kev tsim ntau hom mob qog noj ntshav nrog rau mob qog noj ntshav
Tam sim no tsis muaj kev tshuaj ntsuam xyuas rau cov pej xeem. Los ntawm lub sijhawm kuaj mob raws li mob, mob qog noj ntshav feem ntau kis mus rau lwm qhov hauv lub cev, txhais tau tias tus neeg mob muaj qhov kwv yees kwv yees li ntawm 6 lub hlis txog 2 xyoos kom nyob tom qab lub sijhawm kuaj mob. Hauv Asmeskas "tsib xyoos kev muaj sia nyob" (tej zaum yuav raug tshem tawm, lossis tsis yog) rau qee cov qog nqaij hlav, xws li mis, prostate, thiab qog noj ntshav qog noj ntshav, tam sim no tshaj 90 feem pua. Kev tsis muaj peev xwm kuaj pom tus mob qog noj ntshav ua ntej nrog kev kuaj mob yooj yim yog teeb meem loj; zoo li no, nws tau dhau los ua qhov tseem ceeb ntawm kev tshawb fawb kho mob niaj hnub no.
- Yog vim li cas muaj tsis muaj muaj txiaj ntsig mob qog noj ntshav "kuaj ntshav" muaj rau cov pej xeem (cov uas tsis muaj kev pheej hmoo siab) yog vim qhov kev ntsuas ntshav tam sim no tau txiav txim los ntawm cov kws kho mob tsis ntseeg tau lossis raug, thiab lawv tsis muaj kev txhim kho tseem ceeb ntawm kev kuaj mob qog noj ntshav thaum ntxov.
- Lwm qhov kev xaiv tshuaj ntsuam (cov uas pom kev ncaj qha rau tus txiav thiab tau muab rau cov neeg muaj kev pheej hmoo siab) yog qhov tseeb tab sis raug nqi ntau rau cov neeg mob thiab kev kho mob rau kev siv dav.
- Lwm yam kev pheej hmoo rau mob qog noj ntshav muaj xws li mob pancreatitis ntev thiab mob ntshav qab zib.
Kauj Ruam 2. Feem ntau cov qog nqaij hlav cancer hauv lub cev "exocrine" thiab tsis ua rau muaj cov tsos mob tshwm sim
Cov kab mob Exocrine ua haujlwm hauv cov txiav txiav los ntawm kev tsim cov enzymes ntau dua li cov tshuaj hormones uas yuav ua rau pom cov tsos mob thaum ntxov. Qhov no ua rau nws tsis yooj yim rau tus neeg mob paub tias lawv muaj mob, thiab tseem nyuaj dua rau kev txheeb xyuas cov qog nqaij hlav pancreatic raws sijhawm. Kuj rau feem ntau cov neeg mob nrog qhov no (sneaky) exocrine pancreatic cancer, kev kho tam sim no ua tsis kho mob qog noj ntshav.
Kev cia siab kho rau qhov tsis tshua muaj tshwm sim, mob qog noj ntshav ua rau mob qog noj ntshav, tshwm sim los ntawm cov islet cells, "neuroendocrine (PNET)," muaj kev kwv yees zoo dua li mob qog noj ntshav pancreatic exocrine nrog cov tshuaj pom zoo rau lawv
Kauj Ruam 3. Paub txog cov tsos mob ntawm tus mob qog noj ntshav
Txij li cov pej xeem dav dav yog tsis tam sim no muaj kev kuaj mob qog noj ntshav pancreatic, yog tias koj pib pom cov tsos mob tsis txaus ntseeg nws yog ib qho tseem ceeb kom tau teem sijhawm nrog koj tus kws kho mob kom sai li sai tau. Nws lossis nws tuaj yeem xaj xaj tshuaj ntsuam xyuas txhawm rau txiav txim siab seb nws puas yog mob qog noj ntshav. Cov tsos mob tshwm sim ntawm mob qog noj ntshav pancreatic suav nrog:
- Daj daj ntawm koj cov tawv nqaij thiab ntawm qhov muag ntawm koj lub qhov muag (hu ua "jaundice") tshwm sim los ntawm lub siab enzymes xws li bilirubin (liab-bile)
- Mob hauv koj lub plab sab sauv uas tuaj yeem tawg mus rau koj lub nraub qaum thiab sab nraub qaum ntawm tus tav
- Cov ntshav txhaws, kuaj ntshav qab zib, thiab qaug zog.
- Kev poob phaus tsis tau piav qhia, vim yog cov teeb meem qab zib metabolism tshwm sim los ntawm cov kab mob uas muaj kab mob
- Ua tsis qab los noj mov, vim zaub mov saj txawv yog tias koj muaj daj daj.
Kauj Ruam 4. Paub tias yuav kuaj ntshav rau yav tom ntej
Hom kev ntsuas ntsuas zoo tshaj yuav yog kuaj ntshav, vim tias nws pheej yig, yooj yim, thiab tuaj yeem npaj tau rau cov neeg coob. Lub hom phiaj ntawm kev kuaj ntshav yuav yog txhawm rau ntsuas qee yam cim (s) uas tau pom tias muaj kev cuam tshuam nrog kev pheej hmoo siab ntawm kev mob qog noj ntshav pancreatic.
Cov uas tau pom tias muaj kev pheej hmoo siab los ntawm kev kuaj ntshav kuaj ntshav tom qab ntawv yuav tau txais kev tshuaj xyuas ntxaws ntxiv los ntawm lawv tus kws kho mob, txhawm rau txiav txim siab seb puas muaj tseeb lossis tsis muaj mob qog noj ntshav tam sim no
Kauj Ruam 5. Ua raws li kev tshawb fawb kho mob
Muaj ntau qhov kev tshawb fawb txaus siab mus rau tam sim no hauv thaj chaw ntawm cov noob caj noob ces, proteomics (kev tshuaj xyuas cov protein tshwj xeeb uas tuaj yeem cuam tshuam nrog mob qog noj ntshav pancreatic), thiab lwm yam biomarkers (cov tshuaj uas tuaj yeem ntsuas hauv lub cev uas tuaj yeem cuam tshuam nrog kev kuaj pom ntxov ntawm mob qog noj ntshav pancreatic). Vam tias yav tom ntej yuav muaj cov ntaub ntawv txaus los sib sau rau hauv zej zog kev kho mob kom tuaj nrog cov kev sim uas muaj txiaj ntsig uas tuaj yeem nthuav tawm rau cov pej xeem mus kuaj mob qog noj ntshav pancreatic.
Lub tswv yim
- Kev kis mob qog noj ntshav: Tus neeg uas tau txais lub cev lossis nqaij los ntawm tus pub dawb uas muaj mob qog noj ntshav yav dhau los tuaj yeem muaj kev pheej hmoo pheej hmoo txhim kho mob qog noj ntshav hloov pauv mus rau yav tom ntej. Txawm li cas los xij, qhov kev pheej hmoo yog qhov tsawg heev-txog ob kis mob qog noj ntshav ntawm 10,000 tus neeg hloov pauv lub cev. Cov kws kho mob zam kev siv lub cev lossis cov ntaub so ntswg los ntawm cov neeg pub dawb uas muaj keeb kwm mob qog noj ntshav.
- Kev kis tus mob qog noj ntshav: Kev phais lossis qog nqaij hlav qog nqaij hlav hauv tsev yuav ua rau mob qog noj ntshav kis mus rau lwm qhov hauv lub cev yog qhov tsawg heev. Tsuas yog ua raws cov txheej txheem txheej txheem, kws phais neeg siv cov txheej txheem tshwj xeeb thiab ua ntau qib los tiv thaiv cov qog nqaij hlav cancer los ntawm kev kis mob thaum lub sijhawm kuaj mob lossis phais kom tshem tawm cov qog. Piv txwv, yog tias lawv yuav tsum tshem cov ntaub so ntswg los ntawm ntau qhov chaw ntawm lub cev, lawv siv cov cuab yeej phais mob sib txawv (tsis muaj menyuam) rau txhua thaj chaw.
- Ib hom mob qog noj ntshav pancreatic yog tus tua neeg loj, "adenocarcinoma", uas suav txog feem ntau ntawm cov mob qog noj ntshav pancreatic. Lawv yog cov qog uas tshwm sim los ntawm qhov ib txwm muaj, tsis muaj kev phom sij rau cov kab mob uas ua rau kab mob pancreatic ducts, thiab tseem kab lossis npog lub cev, kab noj hniav hauv lub cev thiab cov hlab ntsha thoob plaws lub cev.
- 90 txog 95 feem pua ntawm cov qog nqaij hlav yog "tsis yog xeeb leej xeeb ntxwv"-tab sis yog "tshwm sim"-tshwm sim los ntawm kev hloov pauv uas tshwm sim thaum tib neeg lub neej vim kev hloov pauv ntawm tes vim kev laus thiab kis rau ib puag ncig ib puag ncig, xws li haus luam yeeb thiab hluav taws xob.
Lus ceeb toom
- Cov qog nqaij hlav tuaj yeem tshwm sim los ntawm qee cov kab mob (qee hom tib neeg papillomavirus, lossis HPV, piv txwv) thiab kab mob (xws li Helicobacter pylori) hauv qee tus neeg, xov xwm tsis zoo. Tab sis, thaum tus kab mob lossis kab mob tuaj yeem kis ntawm ib tus neeg mus rau lwm tus, cov qog nqaij hlav qee zaum lawv tuaj yeem ua rau tsis kis ntawm ib tus neeg mus rau lwm tus (xov xwm zoo).
- Hom zaub mov twg koj noj (kho nrog nitrates, haus cov zaub mov muaj haus ntau), koj noj ntau npaum li cas (rog rog), thiab seb koj qoj ib ce (nyob haum), kuj tseem tuaj yeem cuam tshuam koj txoj kev pheej hmoo mob qog noj ntshav.
