Casharkab 65aad

 Habdhiska dheefshiidka (digestive system).

Casharkab 65aad

Pancreatic cancer

Kansarka ganaca waxa uu ka yimaadaa unugyada ganaca isbadintooda xad dhaaf noqota, badanaa waxa ka masuul ah qanirka marinle ah(exocrine gland) kaasoo soo saaraya dheecaannada dheefshiidka. Nooca ugu badan ku dhaca waa adenocarcinoma. Kansarka ganaca waxa uu dhacaa marka unugyada ganaca DNA isbeddel ku yimaado. Sida caadiga unugyada ganaca qeybsankooda waxa uu u dhacaa si xaddidan oo nidaamsan. Unugyada kansarkan waxay noqdaan kuwa xakameynta iyo awaamirta unugga caadiga qeybsankiisa ayay ka leexdaan, waxay noqdaan kuwa xawli ku kordha. Unugyada kansarka waxay sameysanayaan kuus ama buro. Buradaasi waa ay koreysaa, kaddib waxay saameyneysaa nuddaha kale ee jirka caafimaadka qaba. Waqti kaddib haddii aan la ogaan kansarka waxa uu noqdaan mid ku faafa jirka intiisa kale saameyn xooggan ku yeesha. Ama wadda gaara qeybaha jirka kale. Kansarka ganaca waxa uu ka soo bilowdaa unugyada ku wareegsan mirrinnada ganaca. Kansarka waxa uu isbeddel xooggan ku keenayaa hidda sidaha( KRAS, p53,SMAD4, IYO CDKN2A) isbeddelkaasi hidda sidaha waxa uu horseed u noqonayaan in unugyada ay xakameysmi waayaan. Kansarkaan waxa uu saameyn karaa meelaha u dhow sida, laba iyo tabon(duodenum), laha, beerka, mararka qaarna sambabada. 

Maxaa keenna?

1:Chronic Inflammation: ololka muddada soo jiitama ee ku dhaca ganaca waxa uu keenaa in unugyada ganaca dhaawaca uu ku soo labo noqdo dhowr mar, taasina waxay keeneysaa inuu adkaado, waxa soo gaaraya dhaawac xooggan. Tanina waxay sarre u qaadeysaa isbeddelka hidda sidadaha unugyada ganaca. Ololka joogtada waxa keenaya inuu abuuro deegaan qalqalsan, iyado la soo deynayo qalqalin dheecaan. Tanina waxay siyaadineysaa isbeddelka hidda sidaha ganaca.

2:Diabetes mellitus (macaanka:).Sokorta oo waqti dheer kacsanaanta, iyo iska caabinta maadada insulinta, taasina waxay keeneysa ololka raagga ee ganaca. Ololkaasi waxa uu beddelayaa DNA, haddii uu dhaawac soo gaaro DNA waxa siyaadada qatarka isbeddelka hidda sidaha taasoo keeneysa kansar. 

3:. Hyperinsulinemia: kacsanaanta maadada sokorta xakameysa waxay carineysaa koritaanka unugyada, iyagoo laga dhigayo faldajiyaha(insulin like growth factor) waxa uu sare u qaadayaa in ay ungyada bataan waxa la xidhayaa hannaanka unugyada lagu dilo. Waxay tanina abuureysaa sameysanka kansarka. 

4:Sigaarka(Smoking): waxa uu keenaa kansar isagoo u keenna habab kala duwan, waa kiimiko qatar ah laga helo tubaakada, kiimikooyinkaas ku jira waxa ka mid ah polycyclic aromatic hydrocarbons (PAHs), nitrosamines, iyo benzene, waa kansar dhaliyayaal kuwaasoo dhaawaca DNA. Kansar dhalliyaha ku jirra sigaarka waxa uu keenayaa inuu isbeddel ku keenno hidda sidaha, gaar ahaan kuwa nidaamsha koritaanka iyo dayactirka(tumor suppressor genes, oncogenes). Kiimikooyinka kansarka keenna waxay soo galayaan qulqulka dhiigga waxa aynna soo gaarayaan ganaca. Kiimikooyinkan waxay toos u dhaawacayaan unugyada ganaca, iyagoo isbeddel ku keenaya hidda sidaha. Waxa xumaanaya hannaanka loo xakameeyo unugyada qeybsankooda. Markay dhaawacmaan unugyada ganaca ma awooddaayaan sidii caadiga ahayd in a u nidaamshaan koritaanka unugga, waxay keeneysaa in la xakameyn waayo unugyada oo ay xadkooda dhaafaan, unugyada waxay noqdaan buradada faafta( malignant) 

5:Cayilka waa qatar keeni karta kansarka ganaca, waxa uu la xidhiidhaa ololka muddada dheer soo jiimta iyo iskacaabinta maadada sokorta xakameysa(insulin), iyo isbeddelada hormoonnada. Nud xeydheedka waxa uu soo deynaya qofka cayilan maadooyinka ololka(cytokines) waxay sarre u qaadayaan ololka. Ololkaasi waxa uu keenayaa inuu dhaawacmo unugyada ganaca, qofka cayilan waxa uu keenayaa iska caabinta maadada sokorta xakameysa, taasi waxay keeneysaa unugyada ganaca in la cariyo sidaasna ay Ku bataan. Hormoonnadaas isbeddelay waxay ka qeyb qaadanayaan inuu kansarka sameysmo, waxay sarre u qaadayaan badashada unugyada xad ka baxa ah.

6:Waxaa kaloo keeni in qoyska ay lahaayeen kansarka ganaca taasi waxay qofka kale u nugleysiineysaa qatarta inuu qofka kale ku dhaco kansarka ganaca.

7:Waxaa kaloo keenna da'a gaar ahaan 60 sanno wixii ka wayn.

Calaamadaha. 

1:Jaundice: Indhaha iyo maqaarka oo jaalla noqdo.

2:Abdominal pain :calool xanuun, kaasoo ku faafaya dhabarka dambe

3:miisaanka oo hoos u dhaca.

4: Kaadida oo madow noqota.

5: matag iyo lallabo. 

6: Daal.

Baadhitaanka. 

1. Imaging studies: hubbintan hummaaga gaar ahaan iskaanka waana midka ugu muhuumsan lagu ogaanayo heerarka kansarka ganaca. Sidoo kale waxa la saarayaa hubbinta kale MRI.

2::Endoscopic Ultrasound (EUS) waa kaamiro lagu xidhoyo cirbad si markaasi cad looga soo qaado iyadana waxay sahleysaa in go'aan laga gaaro kansarka.

3:Blood tests. Hubbinta dhiigga waxa laga baadhayaa haddii ay kacsanyihin waxyaabaha calaamadiya kansarka. (CA19-9).

4:Liver function tests: waxa la hubbinayaa dheennacada ganaca.

5. Histopathology : waxa laga qaadayaa cad si markaasi go'aan sax looga gaaro kansarka.

Daaweynta.

1:Surgical resection: waxaa loo sameynayaa qaliinka, qaalinka waxaa loo eegayaa heerka uu gaaray kansarka, haddii uu dhammaan saameeyay waxaa loo sameynayaa in laga saaro ganaca(pancreatectomy iyo whipple procedure).

2:Waxaa kaloo la siinayaa Chemotherapy sida gemcitabine, FOLFIRINOX

3:Targeted therapy: waxa la siinayaa dawooyin si markaasi loo xakameeyo koritaanka unugyada. Kuwa ugu badan la isticmaalo waxa ka mid ah: Erlotinib.Olaparib.Larotrectinib.Entrectinib.

4:Waxaa kaloo loo sameynayaa daweynta shucaaca(radiotherapy).

5: Waxaa kaloo la siinayaa xanuun 

References:

Books:

1. Harrison’s Principles of Internal Medicine (Current Edition)

2. Schwartz’s Principles of Surgery (Current Edition)

3. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice

4. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease (Current Edition)

5. DeVita, Hellman, and Rosenberg's Cancer: Principles & Practice of Oncology

6. The MD Anderson Manual of Medical Oncology (Current Edition)

7. Abeloff's Clinical Oncology (Current Edition)

8. Bailey & Love’s Short Practice of Surgery (Current Edition)

9. American Society of Clinical Oncology (ASCO) Guidelines and Updates

10. NCCN Guidelines (National Comprehensive Cancer Network)

Websites:

1. Mayo Clinic – Pancreatic Cancer Overview

2. National Cancer Institute (NCI)

3. American Cancer Society

4. National Comprehensive Cancer Network (NCCN)

5. Cancer Research UK

6. Amboss – Pancreatic Cancer Module

7. Medscape – Pancreatic Cancer Diagnosis and Treatment

8. UpToDate – Pancreatic Cancer: Clinical Features and Diagnosis

9. Cleveland Clinic – Pancreatic Cancer Management

10. Johns Hopkins Medicine – Pancreatic Cancer Research and Treatments

W/Q: Indha_caad