He aha te Hilar Cholangiocarcinoma? Tohutohu, Take, me te Maimoatanga

Ko te hilar cholangiocarcinoma tētahi momo mate pukupuku i roto i te ngutu o te wai kawa e tupu ana i te wāhi e tutaki ai ngā ngutu wai kawa maui me te matau, tata atu ki tō ate. Ko tēnei wāhi e kiia nei ko te hilum, koia te take i kiia ai e ngā tākuta ko te "mate pukupuku Klatskin" i muri i te tākuta i whakaatu tuatahi i te āhuatanga.

Whakaarohia ō ngutu wai kawa hei ngā pūtu iti e kawe ana i te wai kawa mai i tō ate hei awhina i te whakahaere kai. Ka puta te mate pukupuku ki tēnei hononga nui, ka taea te aukati i te rere o te wai kawa, ā, ka puta mai ngā raruraru nui. Ahakoa he momo mate pukupuku onge tēnei, ko te mārama ki a ia ka āhei te awhina i a koe ki te mohio wawe ki ngā tohu, ā, ki te rapu i te tiaki tika.

He aha ngā tohu o te hilar cholangiocarcinoma?

Ka tupu haere mā te ngāwari ngā tohu o te hilar cholangiocarcinoma, ā, ka taea te whakaaro he āhuatanga ke. Ko te jaundice, te kōwhai o tō kiri me ō kanohi, ko te tohu tuatahi, te tino kitea hoki e pā ana ki a koe.

Ko ēnei ngā tohu matua hei tiaki, mā te tīmata ki ngā mea tino noa:

• Te kōwhai o te kiri me ngā ma o ngā kanohi (jaundice)
• Te mimi pouri e rite ana ki te tii, te kola rānei
• Ngā paru mā, pērā i te paru
• Te ngau nui puta noa i tō tinana
• Te mamae o te kopu, inā te taha matau o runga
• Te ngaro o te taumaha kaore i whakamāramahia i roto i ngā wiki
• Te ngaro o te hiahia kai
• Te ngenge kaore e pai ake me te okioki

Kaore i te noa, ka pā pea te kirika, te ruaki rānei. Ka kite etahi i te pupuhi o to ratou kopu, te ngawari rānei ki te pa. Ka puta ēnei tohu nā te aukatinga o te rere o te wai kawa e te mate pukupuku, ka puta te wai kawa ki roto i tō toto me ō kiko.

He aha ngā take o te hilar cholangiocarcinoma?

Kāore i tino mārama te take tika o te hilar cholangiocarcinoma, engari ka tupu ina puta ngā huringa ki ngā pūtau i roto i ō ngutu wai kawa, ka tupu haere koretake. Ka taea te puta ēnei huringa pūtau nā te mumura roa, te pakaru rānei o ngā ngutu wai kawa i roto i ngā tau maha.

He maha ngā take ka piki ake ai tō tūponotanga ki te whanake i tēnei āhuatanga:

• Te cholangitis sclerosing matua (he mate ate roa e puta ai te toka)
• Ngā kōhatu ngutu wai kawa, ngā mate rānei
• Ngā mate huhu ate (he noa ake i ētahi wāhi o Āhia)
• Te mate pūkahukahu mumura, inā te mate ulcerative colitis
• Ētahi āhuatanga ira tuku iho pērā i te mate Lynch
• Te whakamahinga i ētahi matū motuhake pērā i te thorium dioxide
• Te pakeke neke atu i te 65 tau

Heoi, i roto i te nuinga o ngā take, ka tupu te hilar cholangiocarcinoma ki ngā tāngata kaore he take morearea e mohiotia ana. Ka raru pea tēnei, engari he mea nui kia mahara kei te whakaatu ngā take morearea ka tupu pea te āhuatanga, ā, kāore te kore o rātou e whakamana kaore koe e whiwhi.

Nōhea koe me haere ki te tākuta mō te hilar cholangiocarcinoma?

Me whakapiri wawe koe ki tō kaiwhakarato hauora mēnā ka kite koe i te kōwhai o tō kiri, o ō kanohi rānei, inā te wāhi atu ki ētahi atu tohu. Ko te jaundice he mea nui tonu te tiaki hauora, nā te mea ka whakaatu he mea kei te pā ki tō ate, ki ō ngutu wai kawa rānei.

Kaua e tatari mēnā ka pā te mamae o te kopu i te taha matau o runga, inā te wāhi atu ki te ngaro o te taumaha kaore i whakamāramahia, ngā huringa rānei i te tae o tō mimi, o ō paru rānei. Ka taea e ēnei tohu te tohu i te āhuatanga nui e hiahia ana ki te arotake wawe.

I tua atu, rapuhia te tiaki hauora mēnā ka puta te ngau nui, kaore i whakamāramahia puta noa i tō tinana, te ngaro rānei o tō hiahia kai me te ngenge nui. Ahakoa he maha ngā take o ēnei tohu, ko te kite wawe me te maimoatanga o tetahi āhuatanga e tū ana ka āhei te arahi ki ngā hua pai ake.

He aha ngā take morearea mō te hilar cholangiocarcinoma?

Ko te mārama ki ō take morearea ka āhei te awhina i a koe me tō tākuta ki te whakatau i ngā whakatau whakamārama mō te whakamātautau me te aukati. Ko te pakeke tētahi o ngā take tino nui, nā te mea ko te nuinga o ngā tāngata e whakatauhia ana he hilar cholangiocarcinoma kei runga ake i te 65 tau.

Ko ngā āhuatanga hauora e puta ai te mumura roa i roto i ō ngutu wai kawa te tino morearea:

• Ka piki ake te morearea o te cholangitis sclerosing matua e te 10-15%
• Ngā mate ngutu wai kawa roa, ngā kōhatu rānei
• Te mate pūkahukahu mumura, inā te mate ulcerative colitis
• Te mate Caroli (he āhuatanga onge e puta ai te whānui o te ngutu wai kawa)
• Ngā cysts choledochal (ngā whānui koretake o te ngutu wai kawa)

He wāhi hoki ngā mate me ngā take taiao. Ko ngā mate huhu ate, he noa i ētahi wāhi o Tonga-āhia, ka piki ake te morearea. Kua honoa ano te whakamahinga o te thorium dioxide, he kai whakakā te whakamahi i roto i te whakaahua hauora i ngā tekau tau ki muri, ki ngā mate pukupuku ngutu wai kawa.

Ko te whai i ēnei take morearea kāore e tikanga ka whanake koe i te hilar cholangiocarcinoma, engari ko te tikanga kia tupato koe me tō tākuta mō ngā tohu, kia whakaaro hoki ki ngā ine whakamātautau tika.

He aha ngā raruraru pea o te hilar cholangiocarcinoma?

Ka taea e te hilar cholangiocarcinoma te arahi ki ngā raruraru nui, te nuinga na tōna wāhi i te hononga nui o ō ngutu wai kawa. Ko te take tino nui ko te aukatinga katoa o te ngutu wai kawa, ka taea te puta i te jaundice nui me te kore mahi o te ate.

Ko ēnei ngā raruraru noa:

• Te kore mahi o te ate nui mai i te aukatinga o te rere o te wai kawa
• Te cholangitis (he mate ngutu wai kawa kino)
• Te kore mahi o te ate i roto i ngā take whanake
• Ngā raruraru toto toto nā te kore mahi o te ate
• Ngā raruraru whatukuhu e pā ana ki te jaundice nui
• Te kore kai pai nā te kore whakahaere pai o te ngako

Ka taea e ngā raruraru iti, engari he kino te pānga ki te hypertension portal, te piki o te toto i roto i ngā oko tata ki tō ate, me te ascites, te pupuhi o te wai i roto i tō kopu. Ka taea hoki e ētahi te whanake i ngā mate tuarua nā te ngoikore o to ratou pūnaha mate.

Ko te rongo pai ko te nuinga o ēnei raruraru ka taea te whakahaere, te aukati rānei me te tiaki hauora wawe me te maimoatanga tika. Ka tirotiro tata atu tō rōpū hauora ki a koe, ka tango hoki i ngā mahi hei whakautu i ngā raruraru i te wā e puta mai ana.

Me pēhea te whakatau i te hilar cholangiocarcinoma?

Ko te whakatau i te hilar cholangiocarcinoma ka tīmata mā te arotake a tō tākuta i ō tohu me te mahi i te whakamātautau tinana. Ka titiro rātou ki ngā tohu o te jaundice, ka pa ki tō kopu hei tirotiro i ngā kiko nui, ngā mate rānei.

Ka tono pea tō tākuta i ngā whakamātautau maha hei whiwhi i te whakaahua katoa:

1. Ngā whakamātautau toto hei tirotiro i te mahi o te ate me te rapu i ngā tohu mate pukupuku
2. Te CT scan, te MRI rānei hei kite i ngā ngutu wai kawa me ngā hanganga tata
3. Te MRCP (magnetic resonance cholangiopancreatography) mō te whakaahua taipitopito o te ngutu wai kawa
4. Te ERCP (he mahi whakamātautau) hei kite tika me te tango i ngā tauira kiko o ngā ngutu wai kawa
5. Te PET scan hei whakatau mēnā kua horapa te mate pukupuku

He mea nui te mahi ERCP, nā te mea ka taea e ia tō tākuta te kite i roto i ō ngutu wai kawa, te tango hoki i ngā tauira kiko mō te whakatau tika. I te wā o tēnei mahi, ka taea e rātou te whakanoho i te stent hei awhina i te whakaheke i te wai kawa kua aukati, hei whakaora hoki i ō tohu.

Ka roa pea te whiwhi i te whakatau tika, me ngā whakamātautau maha, ka raru pea. Kia mahara ko ia whakamātautau ka homai ngā korero nui e āhei te awhina i tō rōpū hauora ki te hanga i te mahere maimoatanga pai mō tō āhuatanga motuhake.

He aha te maimoatanga mō te hilar cholangiocarcinoma?

Ko te maimoatanga mō te hilar cholangiocarcinoma e whakawhirinaki ana ki ngā take maha, tae atu ki te rahi o te mate pukupuku, te wāhi, me te horapa atu rānei ki ētahi atu wāhi o tō tinana. Ko te whāinga tonu ko te whakarato i te maimoatanga tino whai hua i te wā e pupuri ana i tō kounga ora.

Ko te pokanga te huarahi pai mō te ora roa ina taea te tango katoa i te mate pukupuku. Ka uru pea tēnei ki te tango i tētahi wāhanga o tō ate me ngā ngutu wai kawa kua pā. Ka whakatau tō taote mēnā he pai koe hei kaitono i runga i tō hauora whānui me ngā āhuatanga o te mate pukupuku.

Ina kore e taea te pokanga, ko ētahi atu whiringa maimoatanga ko:

• Te chemotherapy hei whakaiti i te mate pukupuku, hei whakaheke rānei i tōna tipu
• Te rongoā radiation hei whakaeke i ngā pūtau mate pukupuku
• Te stenting ngutu wai kawa hei whakaora i ngā aukatinga me te whakapai ake i ngā tohu
• Te rongoā photodynamic (he maimoatanga rama motuhake)
• Ngā whakamātautau hauora mō ngā maimoatanga whakamātautau hou

Ka whiwhi te nuinga o ngā tāngata i te huinga o ngā maimoatanga e rite ana ki tō rātou āhuatanga motuhake. Ka mahi ngātahi tō rōpū mate pukupuku ki a koe hei whakamārama i ia whiringa, hei awhina hoki i a koe ki te whakatau i ngā whakatau whakamārama mō tō tiaki.

Me pēhea te whakahaere i ngā tohu i te kāinga?

Ahakoa he mea nui te maimoatanga hauora, he maha ngā mea ka taea e koe te mahi i te kāinga hei awhina i te whakahaere i ngā tohu me te whakapai ake i tō mārohirohi. Aro atu ki te kai i ngā kai iti, ngā kai noa e ngāwari ana ki te whakahaere i tō tinana, inā te pānga o te ruaki, te ngaro rānei o te hiahia kai.

Mō te ngau e pā ana ki te jaundice, ngana ki te kaukau makariri, ki te horoi rānei, me te whakamahi i ngā whakauru ngawari, kaore he kakara. Kaua e whakamahi i te wai wera me ngā haukāinga koi, ka taea te whakaiti i te ngau. Ka kite etahi ko te kakahu huruhuru, ngawari te awhina i te whakaiti i te mamae o te kiri.

Kia makona te inu wai i te rā katoa, kia whakaaro ki te pupuri i te puka tohu hei whai i ngā mea e awhina ana i a koe ki te pai ake. Ka taea te whai hua ēnei korero mō tō rōpū hauora. Kaua e whakaroa ki te whakapiri atu ki tō rōpū hauora mēnā ka kino ake ngā tohu, te puta mai rānei o ngā āwangawanga hou.

Me pēhea te whakarite mō tō hui tākuta?

Ko te whakarite mō tō hui ka āhei te awhina i te whakarite ka whiwhi koe i te hua pai rawa atu i tō wā me tō kaiwhakarato hauora. Tuhia ō tohu katoa, tae atu ki te wā i tīmata ai rātou me ngā mea e pai ake ai, e kino ake ai rānei.

Kawe mai i te rārangi katoa o ngā rongoā, ngā taapiri, me ngā huaora katoa e inu ana koe, me ngā hua whakamātautau hou, ngā rēkōta hauora rānei. Whakaarohia te kawe mai i tētahi mema whānau, hoa rānei hei awhina i a koe ki te mahara ki ngā korero nui i te wā o te haerenga.

Whakaritea he rārangi o ngā pātai e hiahia ana koe ki te ui ki tō tākuta. Ka uru pea ēnei ki ngā pātai mō tō whakatau, ngā whiringa maimoatanga, ngā pānga pea, me ngā mea e tumanakohia ana i mua. Kaua e manukanuka ki te ui i ngā pātai maha – e hiahia ana tō rōpū hauora ki te whakarite ka mārama koe ki tō āhuatanga me tō mahere maimoatanga.

He aha te mea nui mō te hilar cholangiocarcinoma?

Ko te hilar cholangiocarcinoma he āhuatanga nui, engari ka taea te whakaora, inā te kite wawe. Ko te mea nui kia mahara ko te tiaki hauora wawe mō ngā tohu pērā i te jaundice ka taea te whakarereke nui i tō hua.

Ahakoa ka raru pea tēnei whakatau, kia mahara kei te pai haere tonu ngā maimoatanga, ā, he maha ngā tāngata e ora ana i te hilar cholangiocarcinoma ki te ora whai hua. Kei reira tō rōpū hauora hei tautoko i a koe i ia kaupae o te ara, ā, kei reira ngā rauemi hei awhina i a koe me tō whānau ki te haere i tēnei haerenga.

Kia hono tonu ki tō rōpū hauora, kaua e whakaroa ki te ui i ngā pātai, kia mahara ko te tiaki i tō oranga hinengaro he mea nui ano te whakautu i ngā āhuatanga tinana o tō āhuatanga. Kāore koe i te kotahi i roto i tēnei wheako.

Ngā pātai noa e uihia ana mō te hilar cholangiocarcinoma

He mate ira tuku iho te hilar cholangiocarcinoma?

Ko te nuinga o ngā take o te hilar cholangiocarcinoma kāore i te mate ira tuku iho, ko te tikanga kāore i te rere i roto i ngā whānau. Heoi, ka taea e ētahi āhuatanga ira tuku iho pērā i te mate Lynch te piki ake o tō morearea. Mēnā he hītori whānau koe o ngā mate pukupuku ngutu wai kawa, ngā āhuatanga e pā ana rānei, kōrerohia tēnei ki tō tākuta hei whakatau mēnā he pai te whakaaro ira tuku iho.

E hohoro ana te tipu o te hilar cholangiocarcinoma?

Ko te hilar cholangiocarcinoma te nuinga o te tipu haere mā te ngāwari i te whakataurite ki ētahi atu mate pukupuku, te tupu haere i roto i ngā marama, ngā tau rānei. He mea whakatenatena tēnei āhuatanga tipu mā te ngāwari, nā te mea he wā pea ki te whakarite i te maimoatanga me te tirotiro i ngā whiringa rerekē. Heoi, ka rerekē te tere o te tipu mai i te tangata ki te tangata i runga i ngā take maha.

Ka taea te aukati i te hilar cholangiocarcinoma?

Ahakoa kāore e taea te aukati katoa i te hilar cholangiocarcinoma, ka taea e koe te whakaiti i tō morearea mā te whakahaere i ngā āhuatanga e tū ana pērā i te mate pūkahukahu mumura me te karo i ngā take morearea e mohiotia ana ina taea. Ko te tiaki hauora noa me te maimoatanga wawe o ngā raruraru ngutu wai kawa ka āhei te awhina. Mēnā he cholangitis sclerosing matua koe, ka tono pea tō tākuta i te tirotiro noa.

He aha te reiti ora mō te hilar cholangiocarcinoma?

Ka rerekē ngā reiti ora i runga i ngā take pērā i te wā o te whakatau, tō hauora whānui, me te pai o tō whakautu ki te maimoatanga. Ko ngā mate pukupuku o te wā tuatahi ka taea te tango mā te pokanga te nuinga o ngā hua pai. Ka taea e tō tākuta te whakarato i ngā korero motuhake atu i runga i tō āhuatanga motuhake, nā te mea he motuhake ia take.

Me pokanga ahau mō te hilar cholangiocarcinoma?

Ko te pokanga te maimoatanga e pai ana ina taea te tango katoa i te mate pukupuku, ā, he hauora koe mō te mahi. Heoi, kāore te katoa e kaitono pokanga, ā, kei reira ngā maimoatanga kore-pokanga whai hua. Ka arotake tō rōpū hauora i tō āhuatanga motuhake, ka kōrero hoki ki a koe mō ngā whiringa maimoatanga tika katoa.