Ibihe byihutirwa bya Oncologic: Indwara ya Vena Cava isumba izindi, kwikuramo umugongo, na Tumor Lysis¶

Abarwayi babana na kanseri cyangwa barimo gukorerwa chimiotherapie, immunotherapie, cyangwa imiti ivura imirasire bahura n’ibintu bitatu byihutirwa byubatswe na metabolike bishobora gutera ubumuga buhoraho, guhagarika umwuka, cyangwa gufatwa n’umutima byica mu masaha make iyo bisuzumwe nabi nkingaruka zisanzwe zo kuvura: ** Indwara ya Vena Cava (SVC) Syndrome **, ** Malignant Spinal Cord Compression (MSCC) **, na ** Tumor Lys. Kumenya kubyimba mumaso no mumajosi bikomera mugihe wunamye imbere, ububabare bushya bwumugongo buherekejwe nintege nke zamaguru cyangwa kugumana inkari, cyangwa imitsi nyuma ya chimiotherapie imitsi hamwe ninkari zijimye cyangwa zidahari bituma imiryango nabasubiza mbere bahita batera protocole yibitaro mbere yuko ibyangirika bidasubirwaho. Niba umuntu urwaye kanseri azwi cyangwa akekwaho kurwara kimwe muri ibyo bendera ritukura, hamagara nimero yawe yihutirwa ukoresheje iwacu nimero yihutirwa ububiko no kumenyesha itsinda rya oncology, nkuko izi crise zikunze guhura umuriro wa neutropenic na infection ya chimiotherapie, Indwara ya cauda, na embolism.

Kora ubu¶

1. ** Hamagara nimero yawe yihutirwa ako kanya niba amabendera atukura yumuyaga, neurologiya, cyangwa umutima yumutima bigaragara **: Hamagara ** 911 ** muri Amerika na Kanada, ** 112 ** hirya no hino mubumwe bw’ibihugu by’Uburayi, ** 999 ** mu Bwongereza, ** 000 ** muri Ositaraliya, cyangwa urebe mpuzamahanga nimero yihutirwa ububiko. Bwira abohereje indwara yihariye ya kanseri umurwayi hanyuma utangaze ** "Ibihe byihutirwa bya Oncologic: Ukekwaho kuba hejuru ya Vena Cava Kubuza, Gukomeretsa Umugongo, cyangwa Indwara ya Tumor Lysis." **
2. ** Kubyimba mu maso / mu ijosi no guhumeka (Syndrome ya SVC ikekwa), komeza umurwayi yicare neza (umwanya wa Fowler) **: Ntukigere ushyira umurwayi ufite isura yuzuye mumaso, imitsi y'ijosi yagutse, gutontoma, cyangwa umuhanda urambitse inyuma. Kubeshya supine byongera umuvuduko wamaraso wa hydrostatike mumutwe, mu kanwa, no mubwonko, bishobora guhita bigabanya umuvuduko wuzuye wumuyaga uhumeka cyangwa ubwonko bwubwonko. Irekure amakariso akomeye, amakariso, nizosi.
3. ** Kurinda umubiri wo hejuru wabyimbye inshinge cyangwa umuvuduko wamaraso muri Syndrome ya SVC **: Bwira inkeragutabara nabaforomo wihutirwa ** kudashyira imirongo yimitsi, gushushanya amaraso, cyangwa gushyiramo umuvuduko wamaraso kumaboko yabyimbye ** (cyane cyane kuruhande rwicyambu cyo hagati cyimbere cyangwa umurongo wa PICC), kuko umuvuduko ukabije wumuvuduko wamaraso utanga umuvuduko wamaraso.
4. ** Kubabara umugongo mushya ufite intege nke zamaguru, kunanirwa, cyangwa ibibazo byuruhago (Gukekwaho gukomeretsa uruti rwumugongo), shyira umurwayi hasi hanyuma uhagarike umugongo **: Kuberako ibibyimba byibyorezo metastasis cyangwa gusenyuka kwa patologique bituma inkingi yumugongo idahungabana, komeza umurwayi aryamye muburyo butabogamye. Ntukemere ko bagerageza kugenda mumodoka, kugoreka umubiri wabo, cyangwa kwicara badashyigikiwe. Saba ** ibyihutirwa byose byumugongo MRI hamwe nu mitsi wihuse ya-dexamethasone ** ukigera mubitaro.
5. ** Kubyibushye, urujijo, isesemi, cyangwa inkari nke mugihe cyiminsi 1 kugeza 7 yo kuvura kanseri (Suspect Tumor Lysis Syndrome), hagarika gufata potasiyumu zose hamwe na fosifore **: Hita uhagarika inyongera ya potasiyumu yo mu kanwa, ibiryo bikungahaye kuri potasiyumu (ibitoki, umutobe wa orange, insimburangingo ya NSA, hamwe na NSA; gukomeretsa impyiko). Saba ** ako kanya 12-bayobora ECG ** kuva mubatabazi kugeza kuri ecran ya hyperkalemic yica umutima.
6. ** Zana ikarita yo kuvura umurwayi wa oncologiya, ikirangaminsi ya chimiotherapie, hamwe namakuru yo kumurongo wo hagati **: Inkeragutabara zintoki amazina nitariki ya chimiotherapie iheruka, kuvura intego (nka venetoclax, rituximab, cyangwa CAR-T ivura selile), kuvura imirasire, kandi niba umurwayi afite icyambu cyatewe (Port-a-Cath) cyangwa umurongo wa PICC.

Igiti cyemezo: Gutwara ibintu bitatu byingenzi byihutirwa bya oncologique¶

flowchart TD
    Start["Umurwayi ufite Kanseri ifatika, iheruka, cyangwa idasuzumwe ikuramo ibimenyetso bikaze"] --> SymptomBranch{"Menya Ikimenyetso Cyibanze"}

    SymptomBranch -->|"Isura, ijosi, cyangwa amaboko yabyimbye + imitsi yagutse y'ijosi, bibi iyo yunamye imbere cyangwa aryamye neza, hamwe n'inkorora, ijwi ritontoma, umuhanda, cyangwa kubabara umutwe"| SVCBranch["UMUKUNZI WEMEJWE VENA CAVA (SVC) SYNDROME: 1. Wicare umurwayi CYANE (dogere 45 kugeza 90); NTUKIGERE urambika 2. Reba ibimenyetso bya Pemberton (irinde gutera uburakari niba umuhanda uhari) 3. Hamagara 911/112/999 STAT niba umuhanda, urujijo, cyangwa dyspnea ikabije 4. Irinde imirongo ya IV cyangwa udupapuro twa BP mu gice cyo hejuru cyabyimbye 5. Ibitandukanya ibitaro CT + Endovascular SVC Stent / Steroids / Anticoagulation."]

    SymptomBranch -->|"Ububabare bushya cyangwa bubabaza umugongo cyangwa ijosi (bibi cyane kuryama neza cyangwa gukorora) + intege nke zamaguru, kunanirwa, kugenda udahagaze, CYANGWA kugumana uruhago"| MSCCBranch["BITEKEREZO BY'INGENZI ZIKURIKIRA (MSCC): 1. Shyira umurwayi FLAT mu guhuza urutirigongo; ntugende 2. Hamagara 911/112/999 kugirango utwarwe kurambura ibitaro bishoboye MRI 3. Umuyobozi wa STAT IV Dexamethasone (10 mg kugeza 16 mg bolus) mbere cyangwa mugihe cya scan 4. Kora Emergency Whole-Spine MRI mumasaha 5."]

    SymptomBranch -->|"Mu masaha 12 kugeza ku minsi 7 yo gutangira Chimiotherapie, Steroide, Venetoclax, Antibodies za Monoclonal, cyangwa CAR-T: isesemi, kubabara, palpitations, inkari zijimye cyangwa nkeya, cyangwa gufatwa"| TLSBranch["SYNDROME YAKOMEYE TUMOR LYSIS (TLS): 1. Hamagara 911/112/999 hanyuma usabe ECG iyobowe na 12 (reba T-waves) Hydrasiyo ya Crystalloid (2 kugeza 3 L / m2 / kumunsi) 5. IV Rasburicase (gusohora aside uric) + Gutabara Hyperkalemia (IV Kalisiyumu Gluconate + Insuline / Glucose)"]

1.¶

Pathophysiology: Impamvu Vena Cava isumba byose igabanya byoroshye¶

** isumba vena cava isumba izindi (SVC) ** numuyoboro munini uruzitiro rukomeye, rufite umuvuduko muke utwara hafi ** kimwe cya gatatu cyamaraso yimitsi yose asubira muri atrium iburyo yumutima **, yitwaje amaraso ya dexygene yavuye mubwonko, mumutwe, ijosi, amaboko yombi, no kurukuta rwo hejuru. Kuberako SVC yicaye cyane imbere imbere, idashobora kwaguka iburyo imbere-isumba mediastinum (izengurutswe na sternum imbere, trachea hamwe na bronchus iburyo inyuma, aorta ibumoso bwayo, n'iminyururu ya lymph node ya paratracheal na mediastinal), irashobora kwibasirwa cyane no kwikuramo hanze cyangwa kwambara imbere:

1. ** Kwikuramo nabi cyangwa gutera nabi (60 kugeza 85% byimanza) **:
2. ** Kanseri y'ibihaha ** niyo mpamvu ya mbere itera, bingana na ** 70 kugeza 75 ku ijana by'indwara ya syndrome ya SVC mbi **. ** Kanseri y'ibihaha ntoya (SCLC) ** ikura vuba mumyanya yo hagati ya lymph node kandi igatera inzitizi zikomeye za SVC, igakurikirwa cyane na kanseri y'ibihaha ** itari kanseri y'ibihaha (NSCLC, cyane cyane kanseri y'udukoko twa kanseri na adenocarcinoma) **.
3. ** Lymphoma itari Hodgkin (NHL) ** (nka diffuse nini ya B-selile lymphoma cyangwa primaire nini ya B-selile lymphoma) ihwanye na ** 10 kugeza kuri 15 ku ijana ** byindwara mbi, hamwe na thimoma yimbere yimbere, ibibyimba bya mikorobe, na kanseri yibere **.
4. *.
5. ** Thrombose ifitanye isano na Catheter (15 kugeza 40% byimanza zigezweho) **:
6. Abarwayi ba kanseri bakunze gutura ** hagati ya catheters yo hagati, ibyambu byatewe mu gituza (Port-a-Cath), imirongo ya PICC, cyangwa pacemaker bayobora ** bifatanye neza binyuze mumitsi ya subclavian na vena cava isumba izindi. Ufatanije na hypercoagulable imiterere ya malignance, icyatsi cya fibrin cyangwa amaraso arashobora gukora hafi yumutwe wa catheter hanyuma bikabuza cyane SVC lumen.

Iyo SVC ihagaritswe ** hejuru cyangwa cyane cyane munsi yisangano ryumuvuduko wa azygos ** (ikora nkingwate yambere isubira inyuma ya vena cava yo hasi), umuvuduko wamaraso mumutwe, ijosi, namaboko hejuru cyane kuva ** 2 kugeza 8 mmHg kugeza kuri 20 kugeza kuri 40 mmHg cyangwa hejuru ya : - Niba ikibyimba gikura buhoro buhoro mumezi, umubiri winjiza imitsi yagutse hejuru yurukuta rwigituza, imitsi yinyamabere yimbere, hamwe na sisitemu ya azygos, bigatuma amazi atemba. - Niba ikibyimba gikura vuba-selile yibihaha, lymphoma, cyangwa acute catheter trombus ihagarika SVC muminsi, imitsi yingwate ntigira umwanya wo kwaguka. Amazi ava vuba vuba muri capillaries yinjijwe mumyanya yoroheje yo mumaso, imigozi yijwi ( laryngeal edema ), mucosa bronchial ( bronchial تارing ), n'ubwonko ( ubwonko bwubwonko bwubwonko kandi butera umuvuduko wimitsi **).

Kumenya Indwara ya SVC: Ibimenyetso Byiburira hakiri kare na Airway / Cerebral Crisis¶

Ibimenyetso bya syndrome ya SVC mubisanzwe ** ikintu cya mbere kibi cyane mugitondo ** nyuma yuko umurwayi aryamye hasi muburiri ijoro ryose, kandi ** bikarushaho kuba bibi cyane igihe cyose umurwayi yunamye ngo aboshye inkweto, arunama, cyangwa aryamye **:

• ** Indwara yo mu maso, ijosi, na periorbital ("Ikimenyetso cy'ishati" / Ikariso ya Stoke) : Umuntu abona ko amaso yabo yuzuye ibibyimba amaze kubyuka, mu maso habo hasa no kubyimba no gutukura cyangwa ubururu butukura-ubururu ( plethora yo mu maso **), kandi ntibashobora kongera gukanda amakariso yabo asanzwe kuko umuzenguruko wabo wagutse.
• ** Impande zombi cyangwa uruhande rumwe hejuru kubyimba **: Impeta zumva zifatiye ku ntoki, kandi amaboko imwe cyangwa yombi asa nkabyimbye kandi aremereye.
• ** Non-pulsatile Jugular Venous Distention (JVD) hamwe nigitereko cyagutse cyigituza cyigituza **: Imitsi yo hanze yigitereko kuruhande rw ijosi iragaragara nkumugozi wijimye nubwo umurwayi yicaye hejuru, kandi igitagangurirwa kigaragara cyumutuku wijimye wijimye wijimye ugaragara hejuru yigituza no mubitugu.
• ** Ikimenyetso cya Pemberton **: Niba umurwayi yazamuye amaboko yombi agororotse iruhande rwamatwi yamasegonda 30 kugeza kuri 60, injyana ya thoracic iragabanuka cyane ("cork-in-icupa"), itera gukubita mumaso itukura mumaso, cyanose, umuhanda utera imbaraga, hamwe nu mitsi yijosi. *.
• ** Icyiciro cya 3 nicyiciro cya 4 Ibyangiza ubuzima Ibendera ritukura (Yale / Yu SVC Grade Severity) **:
• ** Indwara ya Laryngeal na Pharyngeal Edema **: Ijwi ritontoma cyangwa rivurunganye, ingorane zo kumira amacandwe (dysphagia), kumva ikibyimba gifunga umuhogo, na ** umuhanda utera imbaraga ** (ijwi ryijwi rirenga cyane iyo uhumeka).
• ** Ubwonko bwubwonko **: Kubabaza umutwe uhagaze uturika cyane mugihe ukorora cyangwa wunamye, kutabona neza, kuzunguruka, syncope (gucika intege), ubunebwe, urujijo, cyangwa koma.

Ako kanya Imfashanyo Yambere nubutabazi bwibitaro bya Syndrome ya SVC¶

1. ** Umwanya uhamye Upright **: Komeza umurwayi yicaye kuri dogere 45 kugeza kuri 90 dogere ** igihe cyose, harimo no kumurambararo wa ambulance no muburiri bwishami ryihutirwa.
2. ** Oxygene yinyongera **: Koresha ogisijene kugirango ugumane SpO2 hejuru ya 94% (cyangwa 88 kugeza 92% niba COPD idakira hypercapnic).
3. ** Ntuzigere uhatira Flat Patient Kwishushanya **: Niba umurwayi adashobora kuryama neza muminota 3 adahumeka cyangwa umuhanda, abakozi ba radiologiya bagomba guhagarika inzira yumuyaga cyangwa kuzamura umubiri wo hejuru mbere yo kugerageza itandukaniro rya CT venogramu yigituza.
4. ** Intego zigenewe ibitaro **:
5. ** Endovascular SVC Stenting **: Inzobere mu bumenyi bwa radiologue zirashobora gutondekanya icyuma cyaguka cyikwirakwiza hejuru ya SVC yagabanutse binyuze mu mitsi y’umugore, kugarura imiyoboro y’amaraso no kugabanya kubyimba mu maso, kubabara umutwe, no guhumeka neza mu masaha ya ** 24 kugeza kuri 72 ** mu barwayi barenga 90 ku ijana (kandi bitabangamiye ibibyimba bikurikiraho).
6. ** Corticosteroide (Dexamethasone 4 mg kugeza 8 mg IV buri masaha 6) **: Igabanya vuba ibibyimba biterwa na steroid (nka ** lymphoma cyangwa thymoma **) kandi bigabanya uburibwe bwo mu nda / ubwonko. *.
7. ** Catheter Thrombolysis cyangwa Anticoagulation **: Niba iterwa na Port-a-Cath cyangwa PICC umurongo wamaraso, haterwa imiti igabanya ubukana (heparin ifite uburemere buke bwa heparin cyangwa anticagulants yo mu kanwa), kandi catheter ikurwaho gusa iyo yangiritse, yanduye, cyangwa ntigikenewe nyuma yo kurwanya anticoagulation.

2. Kwangirika kw'umugongo mubi (MSCC): Kubungabunga ubushobozi bwo kugenda¶

Pathophysiology: Uburyo Kanseri Metastatike Ijanjagura Uruti rw'umugongo¶

** Indwara ya Spinal Cord Compression (MSCC) ** iboneka muri ** 3 kugeza 5% byabarwayi ba kanseri ** (cyane cyane muri ** kanseri yamabere, kanseri ya prostate, kanseri yibihaha, kanseri yimpyiko, myeloma nyinshi, na lymphoma **). Muri 85 kugeza kuri 90 ku ijana by'indwara, ingirabuzimafatizo zikwirakwira binyuze mu maraso (hematogenous metastasis) cyangwa imitsi y'amaraso ya Batson mu magufwa ya spongy y'umubiri wa ** vertebral ** mu ruti rw'umugongo: - ** Uruti rw'umugongo (T1 kugeza T12) **: Konti ya ** 60 kugeza 70 ku ijana ** mu manza zose za MSCC (aho umuyoboro wumugongo uba muto). - ** Umugongo wa Lumbosacral (L1 kugeza S1) **: Konti ya ** 20 kugeza 30 ku ijana ** yimanza (guhagarika ** conus medullaris ** cyangwa cauda equina imizi munsi ya L1 / L2). - ** Uruti rw'umugongo (C1 kugeza C7) **: Ibarirwa kuri ** 10 ku ijana ** by'imanza (zitwara ibyago byinshi byo kwandura kwadriplegia na frenic nervice diaphragm paralise). - ** Inzego nyinshi icyarimwe **: Abagera kuri ** 20 kugeza 30 ku ijana byabarwayi bafite ibibyimba byibyorezo byindwara yibice bibiri cyangwa byinshi bitandukanye mugihe kimwe **, niyo mpamvu amashusho yihutirwa agomba guhora apfukirana ** umugongo wose **.

Mugihe ikibyimba kimaze gukura kiva mumubiri winyuma cyumwanya wa ** icyorezo cya epidural ** (cyangwa gitera kuvunika indwara ya pathologiya isunika ibice byamagufwa inyuma mumugongo wumugongo), byangiza ibyiciro bibiri: 1. ** Icyiciro cya mbere gisubira inyuma (Venous Plexus Congestion & Vasogenic Edema) **: Misa yabanje guhonyora umuvuduko ukabije w'icyorezo cya epidural venus plexus, bigatuma amazi ava mumugongo wera (vasogenic edema). Kuri iki cyiciro, ** imitsi ya dexamethasone igabanya vuba kubyimba kandi igarura kwanduza imitsi **. 2. ** Icyiciro cyatinze kidasubirwaho (Arterial Ischemia & Spinal Cord Infarction) **: Niba kwikomeretsa bikomeje kutavurwa amasaha menshi, umuvuduko urenze umuvuduko wa arterial perfusion, ugahagarika imitsi yumugongo kandi ugatera ** infashanyo yumugongo uhoraho (stroke yumugongo) **. Umugozi umaze kwandura, nta kubaga cyangwa imirasire bishobora kugarura ukuguru.

Igihe cyamavuriro: Impamvu ububabare bwinyuma bubanziriza ubumuga nibyumweru¶

Muri ** 90 kugeza 95% byabarwayi **, MSCC ikurikira ibyiciro bine byateganijwe gutera imbere, kandi ** ububabare bwumugongo burigihe nikimenyetso cyambere cyo kuburira **, kigaragara ibyumweru mbere yuko intege nke zamaguru zigenda:

1. ** Icyiciro cya 1: Ububabare Bwinyuma na Radicular Ububabare Bwinyuma (Idirishya Ryiburira) **:
2. Bitandukanye n'imitsi isanzwe yinyuma (yunvikana neza iyo aryamye muburiri nijoro kandi ikababara iyo ugenda kumanywa), ** ububabare bwumugongo bubi burigihe iyo uryamye muburiri nijoro (ububabare bwijoro nijoro) ** kuko kubeshya supine byongerera umugongo kandi bikagabanya icyorezo cyimyanya ndangagitsina ikikije ikibyimba.
3. Ububabare bwiyongera cyane hamwe na ** gukorora, kuniha, guseka, cyangwa kunaniza umusarani (maneuver ya Valsalva) **.
4. ** Ububabare bumeze nkububabare **: Kwiyunvira kwumuzi wa Thoracic akenshi byohereza umurongo ufatanye, utwika, cyangwa urasa ububabare buzengurutse impande zombi zurubavu cyangwa inda nkumukandara ukomeye cyangwa corset (akenshi bisuzumwa nabi nkindwara zifata umwijima, pleurisy, cyangwa shitingi).
5. ** Icyiciro cya 2: Intege nke za moteri na Corticospinal Tract Imikorere (Amasaha Yiminsi Mbere Yubumuga) **:
6. Umurwayi abona amaguru yabo yumva ** "aremereye," akomeye, cyangwa atuje **. Barwanira kuzamuka bava ku ntebe yo hasi cyangwa ku musarani badasunika amaboko, gufata amano ku matapi, cyangwa gutsitara iyo bazamutse ingazi.
7. ** Icyiciro cya 3: Gutakaza Sensory na Sensory Ataxia **:
8. Kunanirwa, pin-na-inshinge (paresthesiya), cyangwa itandukanyirizo ritandukanye rya ** "urwego rwo kumva" ** hejuru yigituza cyangwa inda munsi aho pinprick cyangwa ubushyuhe bwumva bidakabije. Gutakaza inkingi ya dorsal proprioception (imyanya ihuriweho hamwe) ituma umurwayi yumva ari "agenda hejuru yubwoya bw'ipamba" kandi bigatera ihungabana rikomeye iyo bafunze amaso.
9. ** Icyiciro cya 4: Kunanirwa kwa Sphincter Autonomic (Gutinda, Ikimenyetso cyihutirwa) **:
10. ** Kugumana inkari zitagira ububabare hamwe no kutuzura kwinshi ** (kutabasha gukuramo uruhago rwose, bigakurikirwa na dribbling), gutakaza ijwi rya sphincter tone, kuribwa mu nda, cyangwa anesthesia ya ** ya ** (kunanirwa iyo uhanagura perineum, imyanya ndangagitsina, cyangwa ikibuno cy'imbere).

Ako kanya Imfashanyo Yambere na Porotokole Ibitaro kubakekwaho MSCC¶

• ** Flat Spinal Immobilisation **: Niba umurwayi afite ububabare bushya bwumugongo hamwe na deficite neurologique cyangwa gukekwaho kuvunika indwara ya vertebral vertebral, komeza uryame hejuru yubutaka kugeza amashusho yerekana niba inkingi yumugongo ihagaze neza (isuzumwa mubitaro ukoresheje amanota ya ** Spinal Instability Neoplastic Score [SINS] **).
• ** Ako kanya Dexamethasone Yinjira (Tanga Mbere yo Gutegereza MRI) **: Amabwiriza yigihugu (NICE NG234 mu Bwongereza, ASCO muri Amerika) ategeka ko mugihe amakenga y’amavuriro kuri MSCC ari menshi (umurwayi wa kanseri wese ufite ibimenyetso bishya bya moteri / ibyiyumvo / uruhago), abaganga bagomba gutanga ** ako kanya imizigo ya mg / IV ikurikirwa na mg / IV. inhibitori ya proton-pomp kugirango irinde igifu) ako kanya ukigera **, udategereje amasaha kugirango scan ya MRI irangire.
• ** Emergency Whole-Spine Gadolinium MRI mu masaha 24 **: Kuberako abagera kuri kimwe cya gatatu cyabarwayi bafite metastase yo murwego rwo hejuru, MRI igomba gusikana ** umugongo wose winkondo y'umura, thoracic, na lumbosacral **.
• ** Defompitive Decompression mu masaha 24 (Patchell Trial Standard) **: Ikigeragezo cyihariye cyateganijwe (Patchell et al., * Lancet *) cyerekanye ko kubarwayi bafite kwikanyiza kurwego rumwe, imikorere myiza, hamwe no guhungabana kwumugongo cyangwa ibibyimba bya radioresistant (nka selile yimpyiko, melanoma, cyangwa sarcoma), ** byatewe no kugabanuka kwa radiyo iterwa no kugabanuka kwa radiyo. (84% vs 57%) kuruta radiotherapi yonyine. Kubibyimba bya radiosensitifike cyane (lymphoma, myeloma, kanseri y'ibihaha ntoya) idafite ihungabana ry'amagufwa, byihutirwa ** hanze ya radiotherapi yo hanze cyangwa radioterapi yumubiri wa stereotactique (SBRT) ** itangira ako kanya.

3. Indwara ya Tumor Lysis (TLS): Tsunami ya nyuma yo kuvurwa¶

Pathophysiology: Impamvu Gupfa Kanseri Yica Uburozi Amaraso¶

Iparadizo, ** Syndrome ya Tumor Lysis (TLS) ** iterwa mugihe kuvura kanseri ikora * byihuse * (cyangwa mugihe ikibyimba kinini kirenze amaraso yacyo na lyses ubwayo). Bibaho cyane mumasaha ** 12 kugeza 72 (kugeza kuminsi 7) nyuma yo gutangiza chimiotherapie cytotoxic, corticosteroide ikabije, imiti igabanya umunwa (nka BCL-2 inhibitor venetoclax), antibodiyite za monoclonal (rituximab, obinutuzumab), cyangwa kanseri yubuvuzi bwa CAR-T ** kubarwayi bafite kanseri yiyongera cyane: - ** Kanseri Yibyago Byinshi **: ** Burkitt lymphoma **, ** Acute Lymphoblastic Leukemia (BYOSE) **, ** Acute Myeloid Leukemia (AML) ** hamwe na selile yamaraso yera yera, ** Diffuse Kinini B-Cell Lymphoma (DLBCL) **, na ** Lymphocytic Leukemia (CLL) ** itangira venetoclax. - ** Ibibyimba bikomeye (Ntibisanzwe ariko Kwiyongera) **: Kanseri y'ibihaha ntoya, kanseri y'ibibyimba ya mikorobe, hepatoblastoma, na neuroblastoma.

Iyo amamiliyaridi yingirabuzimafatizo mbi yamenetse icyarimwe, bajugunya ububiko bwabo bunini bwingirangingo bwa ** potasiyumu, fosifore, na acide nucleic acide (purine) ** mu maraso byihuse kuruta impyiko zishobora kubisohora, bigatera ** bine icyarimwe icyarimwe cyangiza ubuzima bwa metabolike (Cairo-Bishop Criteria) **:

1. ** Hyperkalemia (Potasiyumu 6.0 mmol / L cyangwa irenga, cyangwa 25% izamuka kuva kuri baseline) - Umwicanyi Ako kanya **:
2. Potasiyumu ni ingirabuzimafatizo nyamukuru. Mugihe ingirabuzimafatizo ziturika, potasiyumu ya serumu yiyongera mumasaha ** 6 kugeza 24,
3. ** Hyperphosphatemia (Fosifore 1,45 mmol / L [4.5 mg / dL] cyangwa irenga ku bantu bakuru, cyangwa 2,1 mmol / L [6.5 mg / dL] mu bana) & Hypocalcemia yisumbuye (Kalisiyumu 1,75 mmol / L [7.0 mg / dL] cyangwa munsi) **:
4. Utugingo ngengabuzima turimo ibintu bigera kuri ** inshuro enye fosifore yo mu nda idasanzwe kuruta selile zisanzwe. Iyo yuzuye mumaraso, fosifate irenze ihuza cyane na calcium ya ionisiyumu ** (Ca2 +) **, ikora kristaliyumu ** calcium-fosifate kristaliste ** igwa imbere mumyanya yimpyiko na myocardium.
5. Nkuko calcium yubusa ionisiyumu ikurwa mumaraso na fosifate, umurwayi agira uburibwe bukabije bwa hypocalcemia **, bigatera imitsi ibabaza, ** spasimasi ya carpopedal (ikimenyetso cya Trousseau) **, kunyeganyeza mumaso (ikimenyetso cya Chvostek **), tetany, laryngospasm, ** igihe kirekire QT intera (Torsades de Pointes arrhyths).
6. ** Hyperuricemia (Acide Uric 476 micromol / L [8.0 mg / dL] cyangwa irenga) & Gukomeretsa kw'impyiko zikomeye Oliguric **:
7. ADN yarekuwe hamwe na RNA purine (adenine na guanine) ihindurwa na enzyme yumwijima ** xanthine oxydease ** ikabura nabi ** acide ya uric **. Imbere ya acide ya acide ya kure no gukusanya imiyoboro y'impyiko, kristu ya acide ya uric na kristu ya calcium-fosifate igwa nk'isuka, gucomeka kuri nephron no gutera ** kunanirwa kw'impyiko zikomeye (anuria) **. Iyo inkari zimaze guhagarara, potasiyumu na fosifore bizunguruka hejuru bitagenzuwe.

Imbonerahamwe yo kugereranya: Gutandukanya ibintu bitatu byingenzi byihutirwa bya oncologique¶

Inomero zihutirwa zo mukarere hamwe na protocole yikigo¶

• ** Amerika na Kanada **: Hamagara ** 911 ** ako kanya hanyuma umenyeshe serivisi yumurwayi amasaha 24 kuri serivisi ya oncology. Kwita ku bitaro bikurikira ** Urwego rw’igihugu rushinzwe kanseri (NCCN) **, ** Umuryango w’Abanyamerika w’ubuvuzi bwa Oncologiya (ASCO) **, na ** Umuryango w’indwara zandura muri Amerika (IDSA) ** amabwiriza y’ubuvuzi bwa MSCC, syndrome ya SVC, na Cairo-Bishop TLS amanota.
• ** Ubwongereza **: Hamagara ** 999 ** kuri ambulance yihutirwa KANDI icyarimwe uhamagare ** Serivisi ishinzwe amasaha 24 ya Acute Oncology Service (AOS) / Umuyoboro wa Chimiotherapie ** urutonde rwumutuku ** NHS Ikarita yo Kumenyesha Kanseri *. Ibitaro byose bya NHS bikora inzira yihariye ya ** MSCC Umuhuzabikorwa ** munsi ya ** NICE Guideline NG234 ( Metinal metastase na metastatic spinal cord compression *) **, itegeka MRI no gutegura gahunda yo kuvura byimazeyo mumasaha 24 ukekwaho gukomeretsa umugozi.
• ** Umuryango w’ubumwe bw’ibihugu by’i Burayi **: Hamagara ** 112 ** mu bihugu byose bigize Umuryango w’ubumwe bw’ibihugu by’Uburayi. Amakipe y'ibitaro akurikiza ** Umuryango w’ibihugu by’i Burayi ushinzwe ubuvuzi Oncology (ESMO) ** amabwiriza y’ubuvuzi y’ubuvuzi bwihutirwa kuri oncologique, ukoresheje stent endovasculaire yihuta, MRI-umugongo wose, hamwe na prophylaxis ya rasburicase.
• ** Australiya na Nouvelle-Zélande **: Hamagara ** 000 ** muri Ositaraliya cyangwa ** 111 ** muri Nouvelle-Zélande. Inzego zishinzwe ubutabazi zikurikiza ** eviQ (Ikigo cya Kanseri NSW) ** Porotokole ya Oncologiya Emergency Emergency Clinical ya MSCC (ako kanya dexamethasone + umugongo wose wa MRI), inzitizi ya SVC, hamwe na Syndrome ya Tumor Lysis.
• ** Ubuhinde na Aziya-Pasifika **: Hamagara ** 112 ** mu Buhinde, ** 995 ** muri Singapuru, ** 119 ** mu Buyapani na Koreya y'Epfo, cyangwa ** 999 ** muri Hong Kong na Maleziya. Saba ubwikorezi mubitaro bya kaminuza bifite amasaha 24 MRI, radiologiya interventionaliste, neurosurgie / kubaga umugongo, hamwe nubushobozi bwa hemodialyse.

Ibibazo bikunze kubazwa¶

Kuki kubyimba mumaso no kubabara umutwe muri Syndrome ya Superior Vena Cava (SVC) birushaho kuba bibi ikintu cya mbere mugitondo cyangwa mugihe cyunamye?¶

Iyo ikibyimba cyangwa amaraso yabujije vena cava isumba izindi, amaraso yimitsi ava mumutwe no mumajosi ntashobora gutemba byoroshye mumutima. Mugihe wicaye cyangwa uhagaze neza, uburemere bufasha gukurura amaraso yimitsi hepfo binyuze mumitsi mito ingwate murukuta rwigituza. Iyo uryamye mu buriri ijoro ryose cyangwa wunamye kugira ngo uhambire inkweto zawe, imbaraga ziratakara kandi umuvuduko w'amaraso wa hydrostatike mu mutwe, mu maso, mu jisho, no mu muhogo urazamuka hejuru, bigatera guhindagurika mu maso mu gitondo, kubabara umutwe, no guhumeka neza bikagenda neza nyuma yo kwicara neza isaha imwe.

Nabwirwa n'iki itandukaniro riri hagati y'ububabare busanzwe bw'imitsi n'imitsi ya Malignant Spinal Cord Compression (MSCC) ku muntu urwaye kanseri?¶

Imitsi isanzwe yinyuma hafi ya yose irababaza mugihe cyimyitozo ngororamubiri kandi ukumva umeze neza iyo uryamye hasi muburiri kugirango uruhuke. Ububabare bwumugongo buterwa na metastasis ya vertebral yitwara muburyo bunyuranye: buranga umuriro nijoro iyo uryamye neza muburiri (ububabare bwijoro nijoro), ukangura umurwayi ibitotsi, ukomera cyane mugihe ukorora, kuniha, cyangwa kunanirwa, akenshi urabagirana nkumukandara ufunze uzengurutse igituza cyangwa inda, hanyuma ugakurikirwa no kunanirwa kwamaguru.

Ni ukubera iki biteje akaga umurwayi ukekwaho kuba Malignant Spinal Cord Compression gutegereza kugeza kuwa mbere kwa MRI yo hanze?¶

Ikibyimba cy'umugongo kimaze gutangira kwikuramo uruti rw'umugongo, kubyimba kw'imitsi birashobora gutera imbere kugeza igihe bidasubirwaho imiyoboro y'uruti rw'umugongo (uruti rw'umugongo) mu masaha make. Igeragezwa ry’amavuriro ryerekana ko 80 kugeza 90 ku ijana by’abarwayi bagishoboye kugenda igihe dexamethasone yihutirwa na decompression itangiye bizakomeza ubushobozi bwabo bwo kugenda, mu gihe abarwayi batageze ku 10 kugeza kuri 20 ku ijana by’abafite ubumuga burundu mbere yo kwivuza bagarura ibyifuzo. Intege nke zamaguru cyangwa kugumana uruhago kumurwayi wa kanseri nikibazo cyisaha imwe yibitaro, ntabwo ari ikibazo cyamavuriro.

Kuki Syndrome ya Tumor Lysis ishobora kubaho nyuma yo gutangira ibinini bigenewe nka venetoclax cyangwa se ibinini bya steroid gusa, nta chimiotherapie gakondo ya IV?¶

Kanseri zimwe na zimwe z'amaraso (cyane cyane lymphoma ya Burkitt, lymphoblastique leukemia ikaze [BYOSE], hamwe na lymphocytike leukemia idakira [CLL]) zumva bidasanzwe uburyo bwo kuvura indwara zo mu kanwa nka venetoclax (ibuza poroteyine ya BCL-2 kubaho) cyangwa se ikinini kimwe cya prednisone cyangwa dexamethasone. Kubera ko iyi miti itera urupfu runini rwa selile (apoptose) mu masaha make, miliyari za leukemia cyangwa selile lymphoma zarafunguwe icyarimwe, zuzura amaraso hamwe na potasiyumu, fosifore, na aside irike byihuse nka chimiotherapie ikabije.

Ni irihe tandukaniro riri hagati ya allopurinol na rasburicase mu kuvura indwara ya Tumor Lysis?¶

Allopurinol ihagarika enzyme xanthine oxyde kugirango umubiri uhagarike gukora * aside * ya uric, ariko ntishobora gukuraho ikidendezi kinini cya acide uric kimaze kuzenguruka mumaraso no gufunga impyiko. Rasburicase ni enzyme ya recombinant (urate oxydease) itangwa mu mitsi muri Syndrome ya Tumor Lysis ifite ibyago byinshi cyangwa ikora cyane igabanya aside irike iriho muri allantoin (ibintu bikubye inshuro 5 kugeza ku 10 gushonga mu nkari kuruta aside irike), bikagabanya urugero rwa aside irike mu maraso mu gihe cy'amasaha 4 kandi bigakiza impyiko zikomeye.

• Aka gatabo gatanga amakuru yuburezi bwihutirwa kandi ntasimbuza isuzuma ryubuvuzi bwumwuga cyangwa ubuvuzi bwihariye bwa oncology. Kubera ko ibyihutirwa bya oncologique bishobora gutera byihuse guhagarika inzira zo guhumeka, kumugara, cyangwa gufatwa n'indwara z'umutima hyperkalemique, turasaba cyane ko twafata ibyemezo byihutirwa byihutirwa hamwe na CPR muri Croix-Rouge, Ambulance ya St John, cyangwa abatanga amahugurwa yihutirwa yemewe. *

Kuyobora¶

• Indwara ya Neutropenique, kwandura chimiotherapie, hamwe nubuvuzi bwihutirwa bwa oncologic
• Indwara ya Cauda equina hamwe na acute umugongo kwikuramo amabendera atukura
• Embolism yo mu bihaha hamwe na trombose ndende (DVT)
• Gukomeretsa impyiko, rhabdomyolysis, hamwe ninkari zijimye
• Dialysis kwinjira (AV fistula) kuva amaraso no kubura dialyse hyperkalemia

Inkomoko nubuyobozi¶

• ** Ikigo cyigihugu gishinzwe ubuzima n’ubuvuzi bwiza (NICE, Ubwongereza): ** * Metastase Spinal Metastase na Metastatic Spinal Cord Compression: NICE Guideline NG234 (2023) *: Ibimenyetso by ibendera ritukura, ubudahangarwa bwumugongo, kunywa dexamethasone byihuse, inzira yamasaha 24 yose ya MRI, ninzira zo kubaga / radiotherapi.
• ** Ihuriro ry’igihugu ryita kuri kanseri (NCCN) hamwe n’umuryango w’abanyamerika w’ubuvuzi bwa Oncologiya (ASCO, Amerika): ** * Amabwiriza y’ubuvuzi bwa Oncologiya: Ubuyobozi bw’indwara ya Vena Cava Syndrome, Indwara ya Spinal Cord Compression, na Syndrome ya Tumor Lysis *.
• ** Umuryango w’ubumwe bw’ibihugu by’i Burayi (ESMO): ** * Amabwiriza y’ubuvuzi bwa ESMO yo gusuzuma, kuvura, no gukurikirana ibintu byihutirwa bya Oncologiya *.
• ** Sosiyete y'Abongereza ishinzwe kuvura indwara (BSH, Ubwongereza) hamwe n'itsinda mpuzamahanga ry'impuguke (Cairo-Bishop / Coiffier n'abandi.): ** * Amabwiriza yo gucunga indwara ya Tumor Lysis mu bantu bakuru ndetse n'abana bafite indwara mbi ya Haematologiya *.
• ** Ikigo cya Kanseri NSW (eviQ, Ositaraliya): ** * Porotokole ya Clinical Resource Protocole yihutirwa rya Oncologiya: Kurwanya Vena Cava Kurwanya, Indwara Yumugongo Yangiza, na Syndrome ya Tumor Lysis *.