Abubuwan Gaggawa na Oncologic: Babban Ciwon Vena Cava, Ciwon Kashin baya, da Tumor Lysis¶

Marasa lafiya da ke zaune tare da ciwon daji ko yin aikin chemotherapy, immunotherapy, ko radiation farfesa suna fuskantar gaggawa na tsari guda uku da na rayuwa waɗanda zasu iya haifar da inna na dindindin, toshewar hanyar iska, ko kamawar zuciya a cikin sa'o'i idan an yi kuskure a matsayin sakamako masu illa na yau da kullun: ** Superior Vena Cava (SVC) Syndrome *, ** Malignant Spinal Cord Compression, MS Syndrome da Lysis Syndrome. (TLS). Gane kumburin fuska da wuyan wuyansa wanda ke tsananta lokacin lanƙwasa gaba, sabon ciwon baya tare da raunin ƙafafu ko riƙewar fitsari, ko ciwon ƙwayar cuta bayan chemotherapy da ƙwayar cuta mai duhu ko rashin fitsari yana ba iyalai da masu amsawa na farko su haifar da ka'idojin asibiti nan da nan kafin lalacewar nama maras iya canzawa. Idan mutumin da aka sani ko wanda ake zargi da cutar kansa ya sami ɗayan waɗannan jajayen tutoci, kira lambar gaggawa ta gida ta mu lambobin gaggawa directory da faɗakar da ƙungiyar oncology, saboda waɗannan rikice-rikice akai-akai suna haɗuwa da neutropenic zazzabi da kuma chemotherapy kamuwa da cuta, cauda equina syndrome, kuma huhu embolism.

Yi wannan yanzu¶

1. **Kira lambar gaggawa ta gida nan da nan idan alamun jajayen hanyoyin iska, jijiya, ko na zuciya sun bayyana ***: Kiran kira 911 a cikin Amurka da Kanada, 112 a cikin Tarayyar Turai, 999 a cikin United Kingdom, 000 a Ostiraliya, ko duba ƙasashen waje namu. lambobin gaggawa directory. Faɗa wa mai aikawa da takamaiman cutar sankara na majiyyaci kuma ya bayyana "Gaggawar Oncologic: Ƙunƙarar Maɗaukakin Vena Cava da ake tuhuma, Ƙunƙarar Ciwon Laya, ko Ciwon Tumor Lysis."
2. Don kumburin fuska/wuyan wuya da rashin numfashi (wanda ake zargin SVC Syndrome), kiyaye mara lafiya a tsaye a tsaye (Matsayin Fowler): Kada ku taɓa kwanciya da majiyyaci da cikar fuska, ɗigon wuyan wuyan wuyansa, tsawa, ko stridor lebur a bayansu. Kwance kwance yana ƙaruwa da hawan jini na hydrostatic a cikin kai, makogwaro, da ƙwaƙwalwa, wanda zai iya haɓaka cikakkiyar toshewar hanyar iska da sauri. Sake ƙwanƙolin riga, ɗaure, da sarƙaƙƙiya nan da nan.
3. ** Kare babban jiki mai kumbura daga allura ko hawan jini a cikin SVC Syndrome ***: Faɗa wa ma'aikatan jinya da ma'aikatan jinya na gaggawa ** kada su sanya layin jini, zana jini, ko kumbura cutar hawan jini a kan kumbura hannuwa *** (musamman a gefen tashar tashar jirgin ruwa ta tsakiya mai ciki ko layin PICC mai saurin jinkirin ƙwayar cuta), yayin da isar da haɗarin bugun zuciya mai ƙarfi. thrombosis ko extravasation.
4. **Don sabon ciwon baya tare da rauni na ƙafafu, ƙumburi, ko matsalar mafitsara (wanda ake zargin Spinal Cord Compression), kwanta majiyyaci a kwance kuma ya hana kashin baya : Saboda ƙwayar ƙwayar cuta ta epidural metastasis ko rugujewar vertebral na ƙwayar cuta yana sa ginshiƙin kashin baya ya zama mara ƙarfi, kiyaye mara lafiya kwance a kwance a cikin tsaka mai wuya. Kada ka bari su yi ƙoƙarin tafiya zuwa mota, karkatar da jikinsu, ko zama ba tare da tallafi ba. Bukatar ** gaggawar MRI gabaɗayan kashin baya da kuma babban adadin dexamethasone na cikin jini nan take bayan isar asibiti.
5. Domin ciwon ciki, rudani, tashin zuciya, ko rashin fitsari a cikin kwanaki 1 zuwa 7 na maganin ciwon daji (Tumor Lysis Syndrome), dakatar da duk abincin potassium da phosphorus: Nan da nan hana abubuwan da ke cikin potassium na baka, abinci mai wadatar potassium (ayaba, ruwan lemu, ruwan kwakwa, maye gurbin gishiri), da NSAID masu rage jin zafi (ibupron, naproxen koda). Nemi ** kai tsaye ECG mai guba 12** daga ma'aikatan lafiya don tantance cututtukan zuciya na hyperkalemic mai kisa.
6. **Kawo katin jiyya na oncology na majiyyaci, kalanda chemotherapy, da bayanan layi na tsakiya ***: Ma'aikatan jinya na hannu ainihin sunaye da kwanakin chemotherapy na baya-bayan nan, maganin da aka yi niyya (kamar venetoclax, rituximab, ko CAR-T cell therapy), jiyya na radiation, kuma ko mai haƙuri yana da tashar tashar kirji (Port-a-Cath.) ko PICC.

Bishiyar yanke shawara: Bambance-bambancen manyan abubuwan gaggawa na oncologic guda uku¶

flowchart TD
    Start["Marasa lafiya tare da Ciwon daji mai Aiki, Kwanan nan, ko Ba'a Gane shi Yana Haɓaka Mummunan Alamu"] --> SymptomBranch{"Gano Tarin Alamun Farko"}

    SymptomBranch -->|"Kumbura fuska, wuya, ko hannaye + jijiyar wuyan wuyan, mafi muni lokacin lanƙwasawa gaba ko kwance, tare da tari, muryoyin murya, stridor, ko ciwon kai."| SVCBranch["SYNDROME DA ake zargi SUPERIOR VENA CAVA (SVC) SYNDROME: 1. Zauna da haƙuri sosai (digiri 45 zuwa 90); KADA KA kwanta lebur 2. Bincika alamar Pemberton (ka guji tsokana idan stridor ya kasance) 3. Kira 911 / 112 / 999 STAT idan stridor, rudani, ko dyspnea mai tsanani 4. Guji layukan IV ko BP cuffs a cikin kumbura na sama masu kumbura 5. Asibiti Contrast Chest CT / Anticods"]

    SymptomBranch -->|"Sabo ko ciwon baya ko wuyansa (mafi muni kwance ko tari) + raunin ƙafafu, raɗaɗi, rashin tsayawa tsayin daka, KO riƙe mafitsara."| MSCCBranch["CUTAR DA CUTAR DA CUTAR CIKI (MSCC): 1. Sanya FLAT mara lafiya a cikin tsaka tsaki na kashin baya; KADA kuyi tafiya 2. Kira 911 / 112 / 999 don jigilar jigilar kaya zuwa asibiti mai iya MRI 3. Gudanar da STAT IV Dexamethasone (10 mg zuwa 16 mg bolus) kafin ko lokacin dubawa"]

    SymptomBranch -->|"A cikin sa'o'i 12 zuwa kwanaki 7 da fara Chemotherapy, Steroids, Venetoclax, Monoclonal Antibodies, ko CAR-T: tashin zuciya, maƙarƙashiya, bugun zuciya, duhu ko fitsari mara kyau, ko kamawa."| TLSBranch["TUMOUR LYSIS SYNDROME (TLS): 1. Kira 911 / 112/999 da buƙatar ECG mai guba 12 nan take (duba T-waves) Creatinine, LDH 4. M IV Isotonic Crystalloid Hydration (2 zuwa 3 L / m2 / rana) 5. IV Rasburicase (uric acid washout) + Hyperkalemia Ceto (IV Calcium Gluconate + Insulin / Glucose)"]

1. Maganganun Vena Cava (SVC) Ciwon Ciwon Jiki: Ciwon Jiki da Jiki na Sama¶

Pathophysiology: Dalilin da yasa Babban Vena Cava ke matsawa da sauƙi¶

The superior vena cava (SVC) ita ce babbar sirara mai bango, jijiyar da ba ta da ƙarfi wacce ke magudanar da kusan kashi ɗaya bisa uku na duk jinin jijiya da ke dawowa zuwa madaidaicin atrium na zuciya ***, yana ɗauke da jinin da ba shi da iskar oxygen daga kwakwalwa, kai, wuyansa, hannuwa biyu, da bangon kirji na sama. Saboda SVC yana zaune tam wedged a cikin m, wanda ba za a iya fadada dama na gaba-superior mediastinum (kewaye da sternum a gaba, da trachea da dama mainstem bronchus a baya, da aorta zuwa hagunsa, da sarƙoƙi na paratracheal da mediastinal lymph nodes), yana da matukar damuwa ga matsawa na waje ko ciki.

1. Mummunan matsawa na waje ko mamayewa kai tsaye (kashi 60 zuwa 85 na lokuta):
2. ** Ciwon daji na Huhu *** shine sanadi na lamba-daya, yana lissafin kusan kashi 70 zuwa 75 na m SVC ciwo. Canjin huhu na huhu (SCLC) yana girma cikin sauri a cikin nodes na tsakiya na tsakiya kuma yana haifar da toshewar SVC mai tsanani, wanda ke biye da shi ta gefen dama ** ciwon huhu mara ƙananan ƙwayoyin cuta (NSCLC, musamman squamous cell carcinoma da adenocarcinoma)**.
3. ** Non-Hodgkin Lymphoma (NHL)** (irin su yaduwa manyan B-cell lymphoma ko na farko mediastinal babban B-cell lymphoma) lissafin ** 10 zuwa 15 bisa dari ** na m lokuta, tare da na gaba mediastinal ** thymomas, germ cell ciwace-ciwacen daji, da kuma metastatic nono ko testicular cancers ***.
4. (Lura: Lymphoma na Hodgkin yawanci yana haɓaka mediastinum amma yawanci yakan haifar da cikakken ciwo na SVC idan aka kwatanta da lymphoma Non-Hodgkin.)
5. ** Thrombosis mai alaƙa da catheter (kashi 15 zuwa 40 na lokuta na zamani)**:
6. Marasa lafiya na ciwon daji akai-akai suna da wurin zama ** na tsakiya venous catheters, dasa tashar jiragen ruwa (Port-a-Cath), layukan PICC, ko bugun bugun zuciya** wanda aka zare kai tsaye ta cikin jijiyar subclavian da mafi girman vena cava. Haɗe tare da yanayin rashin ƙarfi na hypercoagulable, ƙwayar fibrin ko ɗigon jini zai iya samuwa a kusa da tip catheter kuma ya rufe lumen SVC sosai.

Lokacin da aka katange SVC ** sama ko musamman a ƙasa da mahaɗin azygos vein ** (wanda ke aiki a matsayin babban abin dogaro na baya zuwa ga ƙananan vena cava), matsa lamba a cikin kai, wuyansa, da hannaye suna tashi daga al'ada ** 2 zuwa 8 mmHg zuwa 20 zuwa 40 mmHg ko mafi girma : - Idan ciwon daji ya girma a hankali a cikin watanni, jiki yana ɗaukar ƙananan jijiyoyi a kan bangon kirji, veins na ciki, da tsarin azygos, yana ba da izinin zubar da ruwa. - Idan ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar cuta ce ta hana SVC. Ruwa yana zubowa da sauri daga cikin capillaries masu laushi zuwa cikin laushin kyallen fuska, igiyoyin murya (laryngeal edema), mucosa bronchial ( kunkuntar bronchial *), da kwakwalwa ( cunkosowar jini na kwakwalwa da kuma tada hankalin intracranial **).

Gane Ciwon SVC: Alamomin Gargaɗi na Farko vs. Rikicin Jirgin Sama/Cerebral¶

Alamun SVC ciwo ne na al'ada ** abu mafi muni na farko da safe ** bayan mara lafiya yana kwance a gado duk dare, kuma ** ya fi muni sosai a duk lokacin da mai haƙuri ya lanƙwasa gaba don ɗaure takalmansa, ya sunkuya, ko ya kwanta **:

• Fuskar fuska, wuya, da kuma periorbital edema ("Shirt Collar Sign" / Stokes Collar): Mutum ya ga gashin ido yana kumbura yayin farkawa, fuskarsa ta yi kama da kumbura da jajaye ko ja-ja-ja-ja (facial plethora), kuma ba za su iya sake danna kwalawar rigar rigar da suka saba ba saboda kewaye wuyansu ya fadada.
• Kumburi na sama na gefe biyu ko na bai-daya: Zobba suna jin matsi akan yatsu, kuma hannu ɗaya ko biyu suna kama da kumbura da nauyi.
• Rashin bugun jini na Jugular Venous Distention (JVD) da jijiyar bangon ƙirji mai faɗi: Jijiyoyin jugular na waje da ke gefen wuyan wuyansu suna tsayawa kamar igiyoyi masu kauri ko da lokacin da majiyyaci ke zaune a tsaye, sai gaɓoɓin gizo-gizo na jijiyoyi masu ƙarfi-blue tortuous suna bayyana a saman kirjin sama da kafadu.
• ** Alamar Pemberton ***: Idan majiyyaci ya ɗaga hannayensu biyu a tsaye kusa da kunnuwansu na tsawon daƙiƙa 30 zuwa 60, mashigar thoracic ta ƙara raguwa (tasirin "kwalabe-cikin-kwalba"), yana haifar da fashewar fuska, cyanosis, inspiratory stridor, da veins na wuyansa. ( Gargadi na farko: KADA KA yi aikin Pemberton da gangan akan majiyyaci wanda ya riga ya sha iska ko kuma yana da ƙarfi, saboda yana iya haifar da syncope ko toshewar iska.)
• ** Darasi na 3 da Sashi na 4 Jajayen Tutoci masu Barazana Rayuwa (Yale / Yu SVC Tsananin Girmamawa)**:
• Edema na Laryngeal da Faryngeal: Muryar da ba ta da ƙarfi ko murzawa, da wahalar haɗiye miyagu (dysphagia), jin kullun da ke rufe makogwaro, da ** stridor mai ban sha'awa ** (ƙarashin ƙarar ƙara lokacin numfashi).
• Cerebral Edema: Rage ciwon kai wanda ke fashewa da tsanani lokacin tari ko lankwasawa, duhun gani, dizziness, syncope (rauni), gajiya, rudani, ko suma.

Agajin Gaggawa da Ceto Asibiti don Ciwon SVC¶

1. **Madaidaicin Matsayi ***: Ajiye mara lafiya a zaune a ** 45 zuwa 90 digiri ** a kowane lokaci, gami da shimfidar motar asibiti da kuma cikin gadon sashen gaggawa.
2. ** Ƙarin Oxygen ***: Ba da iskar oxygen don kula da SpO2 sama da 94% (ko 88 zuwa 92% idan COPD hypercapnic na yau da kullun).
3. **Kada Ka Taɓa Ƙaddamar da Flat ɗin Mara lafiya don Hoto ***: Idan majiyyaci ba zai iya kwanciya kwance ba na tsawon mintuna 3 ba tare da haƙi ba ko stridor, ma'aikatan rediyo dole ne su daidaita hanyar iska ko ɗaga jiki na sama kafin yunƙurin haɓaka CT venogram na ƙirji.
4. Masu Shirye-Shiryen Asibiti:
5. ** Endovascular SVC Stenting ***: Masu aikin rediyo na tsaka-tsaki na iya zana siginar ƙarfe mai haɓaka kai tsaye a cikin SVC mai kunkuntar ta hanyar jijiya ta mata, maido da magudanar jini da kuma kawar da kumburin fuska, ciwon kai, da kumburin iska a cikin sama da kashi 90 cikin 100 na marasa lafiya (kuma ba tare da tsoma baki tare da ƙari ba).
6. Corticosteroids (Dexamethasone 4 MG zuwa 8 mg IV kowane awa 6): Yana saurin raguwar ciwace-ciwacen ƙwayoyin cuta na steroid (irin su lymphoma ko thymoma) kuma yana rage kumburin laryngeal/cerebral kumburi. (Lura: Idan har yanzu majiyyaci bai tabbatar da ganewar ciwon daji ba kuma yana da iska mai ƙarfi, likitocin ciwon daji suna ƙoƙari su sami biopsy na gaggawa kafin su fara babban adadin steroids, kamar yadda steroids na iya haifar da lysis da sauri kuma ya ɓoye ilimin ilimin cututtuka na lymphoma.)
7. ** Catheter Thrombolysis ko Anticoagulation ***: Idan an haifar da shi ta hanyar ɗigon jini na Port-a-Cath ko PICC, an ƙaddamar da maganin maganin ƙwanƙwasa (heparin-ƙananan-nauyi mai nauyi ko anticoagulants na baka kai tsaye), kuma ana cire catheter kawai idan ya lalace, kamuwa da cuta, ko kuma ba a buƙata bayan an kafa maganin rigakafi.

2. Malignant Spinal Cord Compression (MSCC): Kiyaye Iyawar Tafiya¶

Pathophysiology: Yadda Ciwon daji na Metastatic ke Rushe Igiyar Spinal¶

Malignant Spinal Cord Compression (MSCC) yana faruwa a cikin ** 3 zuwa 5 bisa dari na duk masu fama da ciwon daji ** (mafi yawanci a cikin ** ciwon nono, ciwon prostate, kansar huhu, carcinoma na renal cell, myeloma mai yawa, da lymphoma **). A cikin kashi 85 zuwa 90 na lokuta, ƙwayoyin tumo suna yadawa ta hanyar jini (hematogenous metastasis) ko Batson's venous plexus a cikin spongy kashi na ** vertebral jiki ** a cikin kashin baya: - ** Kashin baya na thoracic (T1 zuwa T12) ***: Lissafi na ** 60 zuwa 70 bisa dari ** na duk lokuta na MSCC (inda canal na kashin baya ya fi kunkuntar). - ** Lumbosacral spine (L1 zuwa S1): Lissafi na ** 20 zuwa 30 bisa dari ** na lokuta (matsawa ** conus medullaris ** ko tushen jijiya cauda equina kasa L1/L2). - ** Kashin mahaifa (C1 zuwa C7) ***: Lissafi na ** 10 bisa dari ** na lokuta (dauke da mafi girman haɗarin quadriplegia da jijiyar jijiyar phrenic diaphragm). - **Matsakai da yawa na lokaci ɗaya ***: Har zuwa ** 20 zuwa 30 bisa dari na marasa lafiya suna da ƙwayar ƙwayar cuta ta epidural a matakan kashin baya biyu ko fiye daban-daban a lokaci guda ***, wanda shine dalilin da yasa hoton gaggawa dole ne ya rufe ** gaba ɗaya spine **.

Yayin da ƙari ke tsiro daga jikin kashin baya zuwa cikin ** epidural space** (ko kuma yana haifar da karaya mai saurin tura kasusuwa baya zuwa canal na kashin baya), yana haifar da lalacewa ta matakai biyu: 1. Matsayi na Farko (Venous Plexus Congestion & Vasogenic Edema)*: Matsalolin na farko sun fara matsawa ƙananan jijiyar venous plexus, yana haifar da ruwa ya zubo a cikin kashin baya (vasogenic edema). A wannan mataki, Dexamethasone na cikin jini yana rage kumburi da sauri kuma yana dawo da watsa jijiya. 2. Late Ireversible Phase (Arterial Ischemia & Spinal Cord Infarction): Idan matsawa ya ci gaba da kasancewa ba a kula da shi ba har tsawon sa'o'i, matsa lamba ya wuce karfin bugun jini, tsinkewar arteries na kashin baya kuma yana haifar da ** ci gaba na ischemic spinal cord infarction (bugun jini na kashin baya). Da zarar igiyar ta yi rauni, babu tiyata ko radiation da zai iya dawo da motsin ƙafafu.

Tsarin Lokaci na Asibiti: Me yasa Ciwon Baya Ya Gabatar Shanyayye ta Makonni¶

A cikin ** 90 zuwa 95 bisa dari na marasa lafiya ***, MSCC yana biye da ci gaba mai zurfi na matakai hudu, kuma ** ciwon baya shine kusan alamar gargadi na farko **, yana bayyana makonni kafin kowane rauni na ƙafa:

1. Mataki na 1: Ciwon Baya Mai Mugun Radi da Radicular (Tagar Gargaɗi na Farko):
2. Ba kamar na yau da kullun na tsokar baya ba (wanda ke jin daɗi lokacin kwantawa akan gado da daddare kuma yana jin zafi lokacin motsi da rana), m ciwon kashin baya yana da muni sosai lokacin kwanciya barci da daddare (ciwon dare na dare) saboda kwanciya bacci yana ƙara tsayin kashin baya kuma yana karkatar da jijiyar epidural a kusa da ƙari.
3. Ciwo yana ƙaruwa sosai tare da tari, atishawa, dariya, ko damuwa a bayan gida (Valsalva maneuver).
4. Radicular band-kamar zafi: Tushen tushen jijiya na thoracic yakan aika da matsattse, konawa, ko harbin harbin zafi wanda ke nannade bangarorin biyu na haƙarƙari ko cikin ciki kamar bel ko corset (sau da yawa ana kuskure a matsayin cutar gallbladder, pleurisy, ko shingles).
5. Mataki na 2: Rashin Rauni na Motoci da Rashin Aikin Lantarki na Corticospinal (Sa'o'i zuwa Kwanaki Kafin Shanyayyen):
6. Mara lafiya yana lura da kafafun su suna jin ** "nauyi," taurin kai, ko m**. Suna kokawa don tashi daga ƙaramin kujera ko kujerar bayan gida ba tare da turawa da hannu ba, kama yatsunsu a kan darduma, ko yin tuntuɓe lokacin hawan matakala.
7. Mataki na 3: Asarar Hankali da Ataxia na Ji:
8. Numbness, fil-da-allura (paresthesias), ko wani keɓaɓɓen a kwance "matakin ji" a cikin ƙirji ko ciki da ke ƙasa wanda ƙwanƙwasa ko yanayin zafin jiki ke jin dushewa. Asarar ginshiƙin ƙwanƙwasa (hankalin haɗin gwiwa) yana sa majiyyaci ji kamar suna "tafiya akan ulun auduga" kuma yana haifar da rashin kwanciyar hankali yayin rufe idanunsu.
9. **Mataki na 4: Rashin Gaggawar Sphincter (Late, Alamar Gaggawa)*:
10. ** Riƙewar fitsari mara radadi tare da wuce gona da iri** (rashin fitar da mafitsara gabaɗaya, sannan kuma ɗifar ruwa), asarar sautin sphincter na dubura, maƙarƙashiya, ko ** saddle anesthesia** (launi lokacin shafan perineum, al'aura, ko gindin ciki).

Taimakon Gaggawa da Ka'idar Asibiti don MSCC da ake zargi¶

• ** Flat Spinal Immobilization : Idan mai haƙuri yana da sabon ciwo na kashin baya tare da raunin neurological ko kuma wanda ake zargin cututtuka na vertebral fracture, ajiye su a kwance a kan wani wuri mai tsayi har sai hoton ya tabbatar da ko ginshiƙan kashin baya ya tabbata (an tantance shi a asibiti ta amfani da ** Spinal Instability Neoplastic Score [SINS]).
• Dexamethasone na Ciki nan da nan (Ba da Kafin Jiran MRI): Jagororin ƙasa (NICE NG234 a cikin Burtaniya, ASCO a Amurka) sun ba da umarni cewa lokacin da ake zargin MSCC da rashin lafiya (duk wani mai ciwon daji tare da sabon motar motsa jiki / ji / alamun mafitsara), likitoci yakamata su ba da ** nan da nan ta hanyar ɗaukar nauyi na intravenousxamethone 6 mg na bolus 6 mg. IV, biye da 4 MG IV / PO a kowace sa'o'i 6, an haɗa su tare da mai hana proton-pump don kariya daga ciki) nan da nan da isowa ***, ba tare da jiran sa'o'i na MRI scan don ƙare ba.
• ** Gadolinium na Gadolinium MRI na gaggawa a cikin sa'o'i 24: Domin har zuwa kashi ɗaya bisa uku na marasa lafiya suna da matakan tsalle-tsalle masu yawa, MRI dole ne ya duba ** duka mahaifa, thoracic, da lumbosacral spine **.
• ** Tabbataccen Decompression a cikin sa'o'i 24 (Patchell Trial Standard) : Gwajin da bazuwar alama (Patchell et al., * Lancet) ya tabbatar da cewa ga marasa lafiya tare da matsawa matakin guda ɗaya, yanayin aiki mai kyau, da rashin kwanciyar hankali na kashin baya ko ciwace-ciwacen rediyo (kamar kwayar cutar koda, melanoma, ko sarcompressalization na kashin baya), radiotherapy yana haifar da haɓakar ƙimar da aka adana ambulation (84% vs 57%) fiye da radiotherapy kaɗai. Don ciwace-ciwacen radiyo (lymphoma, myeloma, ciwon huhu na ƙananan ƙwayoyin cuta) ba tare da rashin kwanciyar hankali ba, gaggawa ** na waje na rediyon rediyo ko stereotactic body radiotherapy (SBRT)** yana farawa nan da nan.

3. Tumor Lysis Syndrome (TLS): Tsunami Metabolic Bayan Jiyya¶

Pathophysiology: Dalilin Mutuwar Kwayoyin Ciwon daji Guba a cikin jini¶

Abin ban sha'awa, ** Tumor Lysis Syndrome (TLS)** yana faruwa ne lokacin da ciwon daji ke aiki * da sauri* (ko lokacin da babban ƙwayar ƙwayar cuta ta haɓaka samar da jini da lyses kwatsam). Yana faruwa akai-akai a cikin sa'o'i 12 zuwa 72 (har zuwa kwanaki 7) bayan farawa chemotherapy cytotoxic, babban adadin corticosteroids, abubuwan da aka yi niyya na baka (kamar BCL-2 inhibitor veetoclax), ƙwayoyin rigakafi na monoclonal (rituximab, obinutuzumab), ko CAR-T marasa lafiya tare da ciwon daji da sauri. - Mafi Haɗarin Ciwon Ciwon daji: Burkitt lymphoma,*Cutar cutar sankarar bargo ta Lymphoblastic (ALL)**, *Cutar cutar sankarar bargo mai saurin gaske (AML) - Tsarin Ciwon Ciwon Ciki (Rare amma Yana ƙaruwa): Ciwon daji na huhu, ƙananan ƙwayoyin cuta, ciwon hanta, da neuroblastoma.

Lokacin da biliyoyin mugayen ƙwayoyin cuta suka fashe a lokaci guda, sai su zubar da manya-manyan rumbunan ajiyar su na cikin ciki na potassium,phosphorus, da nucleic acid (purines) kai tsaye cikin jini cikin sauri fiye da yadda koda ke fitar da su, yana haifar da rikice-rikice na rayuwa guda huɗu na rayuwa a lokaci guda (Cairo-Bishop: Criteria)***

1. Hyperkalemia (Potassium 6.0 mmol/L ko sama, ko 25% ya tashi daga asali) - Mafi Kisan Kai tsaye*:
2. Potassium shine babban sinadari na cikin salula. Yayin da sel suka fashe, sinadarin potassium yana karuwa a cikin awanni 6 zuwa 24**, yana lalata membranes na sel na zuciya da haifar da rauni na tsoka, gurguntsuwa sama, ** kololuwar T-waves, faffadan rukunin QRS, tsarin ECG na sine-wave, da fibrillation na ventricular kwatsam ko kamawar zuciya na asystolic**.
3. Hyperphosphatemia (Phosphorus 1.45 mmol/L [4.5 mg/dL] ko mafi girma a cikin manya, ko 2.1 mmol/L [6.5 mg/dL] a yara) & Hypocalcemia na biyu (Calcium 1.75 mmol/L [7.0 mg/dL] ko ƙasa)
4. Kwayoyin cutarwa sun ƙunshi har zuwa ** sau huɗu fiye da phosphorus na cikin salula ** fiye da sel na al'ada. Lokacin da ambaliya ta shiga cikin jini, wuce haddi phosphate yana ɗaure tam zuwa ionized ionized calcium (Ca2+), yana samar da lu'ulu'u marasa narkewa calcium-phosphate crystals waɗanda ke tsiro a cikin tubules na koda da myocardium.
5. Yayin da ake fitar da calcium kyauta daga cikin jini ta hanyar phosphate, mai haƙuri yana tasowa mai tsanani ** hypocalcemia , yana haifar da ciwon tsoka mai raɗaɗi, ** carpopedal spasm (alamar Trousseau) , murƙushe fuska ( Alamar Chvostek), tetany, laryngospasm, ** valented interhypod da kuma gama-gari ** seizures ***.
6. ** Hyperuricemia (Uric Acid 476 micromol/L [8.0 mg/dL] ko sama) & Rawanin Kodan Oliguric**:
7. DNA da aka saki da purines RNA (adenine da guanine) suna metabolized ta hanta enzyme xanthine oxidase cikin rashin narkewar rashin ƙarfi ** uric acid**. A cikin tubules distal acidic da tattara ducts na kodan, lu'ulu'u na uric acid da lu'ulu'u na calcium-phosphate suna haɓaka kamar sludge, toshe nephrons kuma suna haifar da gazawar oliguric renal (anuria)**. Da zarar fitar fitsari ya tsaya, matakan potassium da phosphorus suna karkata zuwa sama ba tare da kulawa ba.

Teburin kwatance: Bambance-bambancen manyan gaggawa na oncologic guda uku¶

Lambobin gaggawa na yanki da ka'idojin hukumar¶

• Amurka da Kanada: Kira 911 nan take kuma sanar da majinyacin na sa'o'i 24 akan aikin oncology. Kulawar asibiti yana biye da National Comprehensive Cancer Network (NCCN), ** American Society of Clinical Oncology (ASCO)**, da Infectious Diseases Society of America (IDSA) jagororin aikin likita don MSCC, ciwon SVC, da Cairo-Bishop TLS grading.
• ** United Kingdom : Kira 999 don motar asibiti ta gaggawa KUMA a lokaci guda kira 24-hour Acute Oncology Service (AOS) / Chemotherapy Hotline da aka jera akan jan majiyyaci ** Katin Jijjiga Ciwon daji na NHS. Duk asibitocin NHS suna aiki da sadaukarwar hanyar MSCC Coordinator path a ƙarƙashin ** Jagoran NICE NG234 ( Matsalolin kashin baya da matsawa na kashin baya*)**, wanda ke ba da umarni MRI da ingantaccen tsarin kulawa a cikin sa'o'i 24 da ake zargi da matsawa igiya.
• Tarayyar Tarayyar Turai: Dial 112 a duk ƙasashe membobin EU. Ƙungiyoyin asibitoci suna bin ** Ƙungiyar Turai don Magungunan Oncology (ESMO) ** ka'idodin aikin asibiti don abubuwan gaggawa na oncologic, ta yin amfani da hanzarin endovascular stenting, MRI na kashin baya, da kuma prophylaxis na rasburicase.
• ** Ostiraliya da New Zealand *: Kira 000 a Ostiraliya ko 111 a New Zealand. Sassan gaggawa suna bin ** eviQ (Cibiyar Ciwon daji NSW) Ka'idojin asibiti na gaggawa na Oncological don MSCC (dexamethasone na gaggawa + MRI gabaɗayan kashin baya), toshewar SVC, da haɓakar haɗarin Tumor Lysis Syndrome.
• Indiya da Asiya-Pacific: Kiran kira 112 a Indiya, 995 a Singapore,119* a Japan da Koriya ta Kudu, ko 999 a Hong Kong da Malaysia. Nemi jigilar kaya zuwa babban asibiti tare da MRI na sa'o'i 24, aikin rediyo na tsaka-tsaki, tiyatar neurosurgery/kashin baya, da iyawar hemodialysis.

Tambayoyin da ake yawan yi¶

Me yasa kumburin fuska da ciwon kai a cikin Babban Vena Cava (SVC) Syndrome ke fara muni da safe ko lokacin lanƙwasa?¶

Lokacin da ƙari ko gudan jini ya toshe babban vena cava, venous jini daga kai da wuyansa ba zai iya matsewa cikin sauƙi a cikin zuciya. Yayin da kuke zaune ko a tsaye, nauyi yana taimakawa wajen ja da jini mai jijiya zuwa ƙasa ta ƴan ƙananan jijiyoyi a bangon ƙirji. Lokacin da kuke kwance a kan gado na dare ko kuma kun lanƙwasa gaba don ɗaure takalmanku, nauyi yana ɓacewa kuma matsa lamba mai ƙarfi a cikin kai, fuska, fatar ido, da makogwaro yana tashi sama, yana haifar da kumburin fuska na safiya, ciwon kai, da ƙarancin numfashi wanda ya ɗan inganta bayan zama tsaye na awa ɗaya.

Ta yaya zan iya bambanta tsakanin talakawa ciwon baya na tsoka da farkon Malignant Spinal Cord Compression (MSCC) a cikin wani mai ciwon daji?¶

Nau'in tsoka na yau da kullun yana jin zafi yayin aikin motsa jiki kuma yana jin daɗi sosai lokacin da kuka kwanta kwance akan gado don hutawa. Mummunan ciwon kashin baya daga vertebral metastasis yana nuna halin da ake ciki daidai da daddare lokacin da yake kwance a gado (ciwowar dare), yana tada majiyyaci daga barci, yana daɗaɗawa sosai lokacin tari, atishawa, ko tari, sau da yawa yana haskakawa kamar bel ɗin da ke kusa da ƙirji ko ciki, ƙwanƙwasa ƙafafu da wahala, rashin jin daɗi. mafitsara.

Me yasa yake da haɗari ga majiyyaci da ake zargin Malignant Spinal Cord Compression don jira har zuwa Litinin don MRI na waje?¶

Da zarar kumburin kashin baya ya fara matsawa kashin baya, kumburin jijiyoyi na iya ci gaba zuwa rugujewar jijiyoyin kashin baya da ba za a iya jurewa ba a cikin sa'o'i kadan. Gwajin gwaje-gwaje na asibiti akai-akai ya nuna cewa kashi 80 zuwa 90 cikin 100 na marasa lafiya waɗanda har yanzu suna iya tafiya lokacin da dexamethasone na gaggawa da naƙasa suka fara za su ci gaba da yin tafiya, yayin da ƙasa da kashi 10 zuwa 20 na marasa lafiya waɗanda suka zama gurɓata gaba ɗaya kafin magani ya sake dawowa. Sabuwar raunin ƙafa ko riƙe mafitsara a cikin majinyacin kansa shine gaggawar asibiti na sa'a ɗaya, ba matsalan asibitin waje ba.

Me yasa Tumor Lysis Syndrome zai iya faruwa bayan fara maganin da aka yi niyya kamar venetoclax ko ma kawai allunan steroid, ba tare da maganin chemotherapy na gargajiya ba?¶

Wasu cututtuka na jini (musamman Burkitt lymphoma, m lymphoblastic leukemia [ALL], da kuma cutar sankarar lymphocytic na yau da kullum [CLL]) suna da matukar damuwa ga maganin maganin da aka yi niyya kamar venetoclax (wanda ke toshe furotin tsira BCL-2) ko ma kashi ɗaya na prednisone ko dexamethasone. Saboda waɗannan magungunan suna haifar da mutuwar ƙwayoyin cuta masu yawa (apoptosis) a cikin sa'o'i, biliyoyin cutar sankarar bargo ko ƙwayoyin lymphoma sun fashe a lokaci guda, suna ambaliya jini tare da matakan kisa na potassium, phosphorus, da uric acid kamar yadda yake da sauri kamar chemotherapy mai tsanani.

Menene bambanci tsakanin allopurinol da rasburicase a cikin maganin Tumor Lysis Syndrome?¶

Allopurinol yana toshe enzyme xanthine oxidase ta yadda jiki ya daina yin *sabon* uric acid, amma ba zai iya cire katafaren tafkin uric acid da ke yawo a cikin jini yana toshe koda. Rasburicase shine recombinant enzyme (urate oxidase) wanda aka ba ta cikin jini a cikin babban haɗari ko ciwo na Tumor Lysis Syndrome wanda ke rushe uric acid a cikin allantoin (wani abu wanda yake sau 5 zuwa 10 mafi narkewa a cikin fitsari fiye da uric acid), yana rage matakan uric acid na jini zuwa sifili a cikin sa'o'i 4 kuma yana ceton koda gazawar.

*Wannan jagorar tana ba da bayanan ilimi na gaggawa kuma baya maye gurbin ƙwararrun ƙima na likitanci ko ƙwararrun kula da cututtukan daji. Saboda matsalolin gaggawa na oncologic na iya haifar da toshewar iska, gurgujewa, ko kamawar zuciya na hyperkalemic, muna ba da shawarar ɗaukar ƙwararrun ƙwararrun taimako na farko da kwas na CPR daga Red Cross, St John Ambulance, ko kuma mai ba da horo na gaggawa na gida.

Jagora masu alaƙa¶

• Zazzaɓin Neutropenic, kamuwa da cutar chemotherapy, da gaggawar likita na oncologic
• Cauda equina ciwo da m kashin baya matsawa ja tutoci
• Cutar kumburin huhu da thrombosis mai zurfi (DVT)
• Mummunan rauni na koda, rhabdomyolysis, da duhun fitsari
• Samun dialysis (AV fistula) yana zubar da jini da rashin samun hyperkalemia na dialysis

Tushen da jagorar hukuma¶

• ** Cibiyar Harkokin Kiwon Lafiya da Kulawa ta Kasa (NICE, United Kingdom): *** * Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun NG234 (2023)
• ** National Comprehensive Cancer Network (NCCN) da American Society of Clinical Oncology (ASCO, United States): ** * Ka'idodin Ayyukan Kula da Lafiya a cikin Oncology: Gudanar da Ciwon Ciwon Vena Cava mai Girma, Mummunan Ciwon Kashin Kashin Kaya, da Ciwon Tumor Lysis Syndrome *.
• ** Ƙungiyar Turai don Magungunan Oncology (ESMO):** * Sharuɗɗan Ayyuka na Clinical na ESMO don Ganewa, Jiyya, da Bibiya na Gaggawa na Oncological *.
• ** Ƙungiyar Biritaniya don Ciwon Jini (BSH, United Kingdom) da Ƙungiyar Ƙwararrun Ƙwararru ta Duniya (Cairo-Bishop / Coiffier et al.):** Sharuɗɗa don Gudanar da Ciwon Tumor Lysis a Manya da Yara masu Ciwon Jiki.
• Cibiyar Ciwon daji NSW (eviQ, Ostiraliya): Ka'idojin Albarkatun Kiwon Lafiya don Gaggawa na Oncological: Mafi Girma Vena Cava toshewa, Mummunan Ciwon Laya, da Ciwon Tumor Lysis.