Kanesa maʻi ʻaʻai

ʻO ka maʻi ʻaʻai ʻāwīwī kahi maʻi ʻaʻai e hoʻomaka i loko o ka puhā. ʻO ka pūpū ka ʻāpana o ke kino e paʻa a hoʻokuʻu i ka mimi. Aia ia ma waenakonu o ka ʻōpū o lalo.

Hoʻomaka pinepine ka maʻi ʻaʻai ʻāwīwī mai nā hunaola e uhi ana i ka puhā. Kapa ʻia kēia mau hunaola nā ʻāpana hoʻololi.

Hoʻokaʻawale ʻia kēia mau tumors e ke ala e ulu ai:

• ʻO nā kūpeʻe papillary e like me nā warts a hoʻopili ʻia i kahi ʻau.
• Pālahalaha nā maʻi ʻōiwi. ʻOi aku ka liʻiliʻi o ka maʻamau. Akā ʻoi aku ka nui o ka invasive a me ka hopena maikaʻi ʻole.

ʻAʻole ʻike ʻia ke kumu kūpono o ka maʻi ʻaʻai. Akā i kekahi mau mea e hoʻonui iā ʻoe e hoʻomohala iā ia e komo pū me:

• ʻO ka puhipaka Cigarette - hoʻonui nui ka puhihihi i ka makaʻu o ka maʻi ʻana i ka maʻi ʻaʻai. Hiki i ka hapalua o nā maʻi ʻaʻai āpau ke kumu ʻia e ka uahi paka.
• ʻO ka mōʻaukala pilikino a ʻohana paha o ka maʻi ʻaʻai - ʻo ka loaʻa ʻana o kekahi i ka ʻohana me ka maʻi ʻaʻai pākī e hoʻonui ai i kou makaʻu i ka hoʻomohala ʻana iā ia.
• Hōʻike kemikala i ka hana - Hiki ke kumu ʻia ka maʻi ʻaʻai Bladder e ke hui pū ʻana me nā kemika i loaʻa i ka maʻi ʻaʻai i ka hana. Kapa ʻia kēia mau kemika he carcinogens. ʻO ka poʻe hana kala, nā limahana hana kāpili, nā limahana aluminika, nā limahana ʻili, nā kalaiwa kalaka, a me nā mea hoʻohana pesticide ka mea nui o ka makaʻu.
• Chemotherapy - Hiki i ka chemotherapy lāʻau cyclophosphamide ke hoʻonui i ka makaʻu no ka maʻi ʻaʻa maʻi.
• Lapaʻau hoʻomālama - Hoʻomaʻamaʻa hou ka radiation radiation i ka pelvis region no ka mālama ʻana i nā maʻi ʻaʻai o ka prostate, testes, cervix, a i ʻole uterus hoʻonui i ka makaʻu o ka ulu ʻana i ka maʻi ʻaʻa maʻi.
• Ka maʻi ʻaʻai - He maʻi wā lōʻihi (mau) a me ka huhū paha e alakaʻi aku ai i kekahi ʻano maʻi maʻi ʻaʻai.

ʻAʻole i hōʻike ʻia kahi noiʻi i ka hōʻike maopopo e pili ana i ka hoʻohana ʻana i nā mea hoʻonaninani i alakaʻi ʻia i ka maʻi ʻaʻai.

Hiki i nā ʻōuli o ka maʻi ʻaʻai ke komo pū me:

• Abdominal eha
• Koko i ka mimi
• ʻO ka ʻeha o ka iwi a palupalu paha inā hohola ka maʻi ʻaʻai i ka iwi
• Ka luhi
• Urination ʻeha
• ʻO ke alapine urinary a me ka wikiwiki
• Urine leakage (incontinence)
• Kaumaha emi

Hiki i nā maʻi a me nā kūlana ʻē aʻe ke kumu i nā ʻōuli like. He mea nui ia e ʻike i kāu mea mālama ola e kāpae i nā kumu ʻē aʻe āpau.

E hana ana ka mea hāʻawi i kahi hoʻokolohua kino, e like me ka hoʻokolokolo kūpono a me ka pelvic.

ʻO nā hoʻāʻo e hana ʻia ana paha:

• ʻO ka scanʻana o ka ʻōpū a me ka pelvic CT
• Scanner MRI ʻōpū
• Cystoscopy (ke nānā nei i ka loko o ka puhā me kahi kāmela), me ka biopsy
• Pyelogram Intravenous - IVP
• Urinalysis
• ʻĀmiu cytology

Inā hōʻoia nā hōʻoia ua loaʻa ʻoe i ka maʻi ʻaʻa ʻai, hana ʻia nā hoʻokolohua hou aku e ʻike inā ua pālahalaha ka maʻi ʻaʻai. Kāhea ʻia kēia. Kōkua ke kau ʻana i ke alakaʻi ʻana i ka mālama e hiki mai ana a me ka ukali ʻana a hāʻawi iā ʻoe i kekahi manaʻo o ka mea e kali ai i ka wā e hiki mai ana.

Hoʻohana ʻia ka ʻōnaehana hoʻonohonoho TNM (tumo, node, metastasis) e hoʻokumu ai i ka maʻi ʻaʻa maʻi.

• Ta - Aia ka maʻi ʻaʻai i ka pale o ka maʻi ʻaʻai wale a ʻaʻole pālahalaha.
• T1 - Hele ka maʻi ʻaʻai i loko o ka uhi o ka maʻi ʻaʻū, akā ʻaʻole i hiki i ka mākala pūpū.
• T2 - Hoʻolahalaha ke kanesa i ka mākeke o ka maʻi ʻaʻai.
• T3 - Hoʻolahalaha ka maʻi ʻaʻai ma mua o ka maʻi bladder i loko o ka momona momona e puni ana iā ia.
• T4 - Ua pālahalaha ʻia ka maʻi ʻaʻai i nā hale kokoke e like me ka gland prostate, uterus, pūnana, puhaka, paia ʻōpū, a me nā paia pelvic.

Hoʻohui pū ʻia nā tumora e pili ana i ka ʻike ʻia ma lalo o kahi microscope. Kapa ʻia kēia grading ka tumo. Ke ulu wikiwiki nei kahi tumo kiʻekiʻe a ʻoi aku paha ka pālahalaha ʻana. Hiki ke pālahalaha ka maʻi ʻaʻai Bladder i nā wahi kokoke, me nā:

• Lymph nodes i ka pelvis
• Iwi
• Akepaʻa
• Lungs

Pili ka mālama ʻana i ke kahua o ka maʻi ʻaʻai, ke koʻikoʻi o kāu mau ʻōuli, a me kou olakino holoʻokoʻa.

Maʻi i ka pae 0 a me I:

• Hoʻopau ke ʻoki e wehe i ka tumo me ka ʻole o ka hemo ʻana o ke koena o ka bladder
• Hoʻokomo pololei ʻia ʻo Chemotherapy a i ʻole immunotherapy i loko o ka bladder
• Hāʻawi ʻia ʻo Immunotherapy me ka intravenous me pembrolizumab (Keytruda) inā hoʻomau ka hoʻi o ka maʻi ʻaʻai ma hope o nā hana i luna.

Maʻi i ka pae II a me III:

• Hoʻopau ke ʻoki e wehe i ka bladder holoʻokoʻa (cystectomy radical) a me nā lymph node kokoke
• ʻO ke ʻoki kino e hemo ai i kahi ʻāpana wale o ka bladder, ukali ʻia e radiation a me chemotherapy
• Chemotherapy e hoʻoliʻiliʻi i ka tumer ma mua o ke kahakaha ʻana
• ʻO kahi hui pū ʻana o chemotherapy a me radiation (i ka poʻe i koho ʻaʻole e loaʻa i kahi ʻoki a i ʻole hiki ʻole ke ʻoki ʻia)

ʻAʻole hiki ke hoʻōla ʻia ka hapanui o ka poʻe me nā tumors IV a kūpono ʻole ke ʻoki. I kēia mau poʻe, noʻonoʻo pinepine ʻia ka chemotherapy.

CHEMOTHERAPY

Hāʻawi ʻia ʻo Chemotherapy i ka poʻe me ka maʻi II a me ka maʻi III ma mua a ma hope paha o ke kaha ʻana e pale ai i ka hoʻi ʻana o ka tumo.

No nā maʻi mua (nā pae 0 a me I), hāʻawi pinepine ʻia ka chemotherapy i loko o ka pūpū.

IMMUNOTHERAPY

Mālama pinepine ʻia nā maʻi ʻaʻai me ka immunotherapy. I kēia lapaʻau ʻana, hoʻowalewale kahi lāʻau i kou ʻōnaehana pale pale e hoʻouka aku a pepehi i nā hunaola maʻi ʻaʻai. Hana pinepine ʻia ʻo Immunotherapy no ka maʻi ʻaʻai mua o ka maʻi ʻaʻai i ka hoʻohana ʻana i ka lāʻau BacilleCalmette-Guerin vaccine (ʻike ʻia ʻo BCG). Inā hoʻi ka maʻi ʻaʻai ma hope o ka hoʻohana ʻana o BCG, hiki ke hoʻohana i nā ʻākena hou.

E like me nā mālama ʻana a pau, hiki nō nā hopena. E nīnau i kāu mea hāʻawi i nā hopena ʻaoʻao āu e manaʻo ai, a he aha e hana ai inā kū lākou.

NA MEA HANA

ʻO ke kaʻahana no ka maʻi ʻaʻai maʻi:

• Transurethral resection of the bladder (TURB) - Wehe ʻia ka maʻi ʻaʻai maʻi maʻi ma o ka urethra.
• ʻO ka hapa a hemo loa paha o ka maʻi huki - Pono paha ka poʻe he nui me ka maʻi maʻi maʻi pae II a III paha e kāpae i kā lākou pākeke (cystectomy radical). I kekahi manawa, hemo wale ka hapa o ka ʻai. Hāʻawi ʻia ʻo Chemotherapy ma mua a ma hope paha o kēia ʻoki.

Hiki ke hana ʻoki ʻia e kōkua ai i kou kino e hoʻokahe i ka mimi ma hope o ka hemo ʻana o ka ʻōpū. Hoʻopili paha kēia:

• Alawai Ileal - Hoʻokumu ʻia kahi waihona mimi liʻiliʻi mai kahi ʻāpana pōkole o kou ʻōpū liʻiliʻi. Hoʻopili nā ureter e hoʻokahe i ka mimi mai nā puʻupaʻa i hoʻokahi wēlau o kēia ʻāpana. Hoʻopuka ʻia ka hopena ʻē aʻe ma o ka wehe ʻana i ka ʻili (kahi stoma). ʻAe ka stoma i ke kanaka e hoʻokahe i ka mimi i hōʻiliʻili ʻia mai loko mai o ka waihona.
• Continental urinary reservoir - Hana ʻia kahi ʻeke e hōʻiliʻili i ka mimi i loko o kou kino e hoʻohana ana i kahi ʻāpana o kou ʻōpū. Pono ʻoe e hoʻokomo i kahi paipu i loko o kahi wehe i kou ʻili (stoma) i loko o kēia ʻeke e ninini i ka mimi.
• ʻO neobladder Orthotopic - Ke lilo nei kēia ʻoki i mea maʻamau i ka poʻe i wehe ʻia kā lākou ʻaʻa. Hoʻopili ʻia kahi ʻāpana o kou ʻōpū e hana i ʻeke e ʻohiʻohi i ka mimi. Hoʻopili ʻia ia i kahi i loko o ke kino kahi e hemo mau ai ka mimi mai loko mai o ka ʻai. Hāʻawi kēia kaʻina iā ʻoe e mālama i kahi kaohi mimi maʻamau.

Hiki iā ʻoe ke hoʻomāmā i ke koʻikoʻi o ka maʻi ma ke komo ʻana i kahi hui kākoʻo maʻi ʻaʻai. ʻO ke kaʻana ʻana me nā poʻe ʻē aʻe i loaʻa nā ʻike a me nā pilikia maʻamau e hiki ke kōkua iā ʻoe e noʻonoʻo ʻole.

Ma hope o ka mālama ʻana no ka maʻi ʻaʻai ʻōpū, e kiaʻi pono ʻia ʻoe e ke kauka. Hoʻopili paha kēia:

• Nānā ʻo CT e nānā no ka laha a hoʻi ʻana o ka maʻi ʻaʻai
• ʻO ka nānā ʻana i nā ʻōuli e kuhi paha ka maʻi ʻoi aku ka maikaʻi, e like me ka luhi, ka pohō o ke kaumaha, hoʻonui i ka ʻeha, hoʻoliʻiliʻi ka ʻōpū a me ka hana o ka maʻi ʻaʻa.
• Helu piha ke koko (CBC) e nānā no ka anemia
• ʻO nā hoʻāʻo Bladder i kēlā me kēia 3 a 6 mau mahina ma hope o ka mālama ʻana
• ʻO Urinalysis inā ʻaʻole ʻoe i lawe aku i kāu ʻaʻa

Pehea ka maikaʻi o ke kanaka me ka maʻi ʻaʻai bladder ma muli o ka pae mua a me ka pane ʻana i ka mālama ʻana i ka maʻi ʻaʻai.

ʻOi aku ka maikaʻi o ka nānā no ke kahua 0 a i ʻole i nā maʻi ʻaʻai. ʻOiai kiʻekiʻe ka makaʻu no ka hoʻi ʻana o ka maʻi ʻaʻai, ʻo ka hapa nui o nā maʻi ʻaʻai e hoʻi hiki ke lawe ʻia i kahi ʻoki kino a hoʻōla ʻia.

ʻO nā helu hōʻola no ka poʻe me nā tumors pae III ma lalo o 50%. ʻO nā poʻe me ka maʻi maʻi maʻi maʻi maʻi IV i ka maʻi laha e hoʻōla ʻia.

Pāhola paha nā maʻi ʻaʻai i loko o nā lālā kokoke. Hele pū paha lākou ma o nā pelvic lymph nodes a pāhola aʻe i ke ake, nā akemāmā, a me nā iwi. ʻO nā pilikia hou aʻe o ka maʻi ʻaʻai maʻi:

• Anemia
• ʻO ka pehu ʻana o nā ureter (hydronephrosis)
• Hoʻopaʻa urethral
• Miki ʻole
• ʻO ka hana kīnā ʻole o Erectile i nā kāne
• ʻO ka moe kolohe i nā wahine
  

Kāhea i kāu mea hāʻawi inā loaʻa kou koko i kāu mimi a i ʻole nā ​​hōʻailona ʻē aʻe o ka maʻi ʻaʻa maʻi, me:

• Urination pinepine
• Urination ʻeha
• Pono urinary

Inā puhi ʻoe, haʻalele. Hiki i ka puhihihi ke hoʻonui i kou makaʻu no ka maʻi ʻaʻai. Hōʻalo i ka hoʻopili ʻana i nā kemika i hoʻopili ʻia i ka maʻi ʻaʻa maʻi.

Ka maʻi kanesa transitional o ka maʻi ʻaʻai; Maʻi ʻaʻai Urothelial

• Cystoscopy
• ʻĀpana mimi wahine
• ʻĀpana mimi kāne

Cumberbatch MGK, Jubber I, Black PC, a me al. Epidemiology o ka maʻi ʻaʻai bladder: kahi ʻōnaehana loiloi a me ka hōʻano hou o nā mea pilikia i ka 2018. ʻO Eur Urol. 2018; 74 (6): 784-795. PMID: 30268659 pubmed.ncbi.nlm.nih.gov/30268659/.

Pūnaewele ʻo National Cancer Institute. ʻO ka mālama ʻana i ka maʻi ʻaʻai ʻōpū (PDQ) - mana ʻoihana olakino. www.cancer.gov/types/bladder/hp/bladder-treatment-pdq. Hoʻohou i Ianuali 22, 2020. Loaʻa iā Pepeluali 26, 2020.

Pūnaewele Pūnaewele Manuahi Manuahi. Nā kulekele hana lapaʻau NCCN i ka oncology (nā alakaʻi NCCN): Ka maʻi ʻaʻa maʻi. Mana 3.2020. www.nccn.org/professionals/physician_gls/pdf/bladder.pdf. Hoʻohou i Ianuali 17, 2020. Loaʻa iā Pepeluali 26, 2020.

Smith AB, Balar AV, Milowsky MI, Chen RC. Ka maʻi kanesa o ka ʻai. I: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. ʻO Oncology Clinical ʻo Abboff. ʻElua huaʻōlelo Piladelapia, PA: Elsevier; 2020: chap 80.