Neuroblastoma yog ib qho ntawm cov qog nqaij hlav ntau tshaj plaws hauv cov menyuam yaus. Peb hais txog cov qog nqaij hlav hlwb ntxiv vim nws pib hauv lub paj hlwb tab sis tsis nyob hauv lub hlwb. Ob peb txoj kev kho mob tuaj yeem txiav txim siab nyob ntawm qhov xwm txheej.

Kev txhais ntawm neuroblastoma

Neuroblastoma yog ib hom mob qog noj ntshav. Cov qog malignant no muaj qhov tshwj xeeb ntawm kev txhim kho ntawm theem ntawm neuroblasts, uas yog cov paj hlwb tsis paub qab hau ntawm lub paj hlwb sympathetic. Cov tom kawg yog ib qho ntawm peb lub hauv paus ntawm lub paj hlwb uas tswj hwm lub cev tsis muaj zog xws li kev ua pa thiab kev zom zaub mov.

Ib tug neuroblastoma tuaj yeem tsim nyob rau hauv ntau qhov sib txawv ntawm lub cev. Txawm li cas los xij, hom mob qog noj ntshav no feem ntau tshwm sim nyob rau hauv lub plab ntawm theem ntawm cov qog adrenal (nyob saum lub raum), nrog rau raws tus txha nraub qaum. Tsis tshua muaj, nws tuaj yeem tshwm sim hauv caj dab, thorax lossis pelvis (lub plab me me).

Thaum nws loj tuaj, neuroblastoma tuaj yeem ua rau metastasis. Cov no yog cov qog nqaij hlav thib ob: cov hlwb ntawm cov qog thawj zaug khiav tawm thiab colonize lwm cov ntaub so ntswg thiab / lossis cov kabmob.

Classification ntawm neuroblastomes

Cov qog nqaij hlav tuaj yeem raug cais raws li ntau qhov kev txwv. Piv txwv li, staging pab ntsuam xyuas qhov mob qog noj ntshav. Nyob rau hauv cov ntaub ntawv ntawm neuroblastoma, ob hom staging yog siv.

Thawj theem yog feem ntau siv. Nws faib cov neuroblastomas los ntawm theem 1 txog 4 thiab tseem suav nrog theem 4s. Qhov no yog kev faib tawm los ntawm qhov hnyav, los ntawm qhov hnyav tshaj plaws mus rau qhov hnyav tshaj plaws:

• theem 1 txog 3 sib raug rau cov ntawv hauv zos;
• theem 4 xaiv cov ntaub ntawv metastatic (kev tsiv teb tsaws ntawm cov qog nqaij hlav cancer thiab colonization ntawm lwm cov qauv hauv lub cev);
• theem 4s yog ib daim ntawv tshwj xeeb uas tshwm sim los ntawm metastases hauv daim siab, tawv nqaij thiab pob txha pob txha.

Qhov thib ob theem kuj muaj 4 theem: L1, L2, M, MS. Nws tsis tsuas yog ua rau nws muaj peev xwm sib txawv hauv zos (L) los ntawm cov ntaub ntawv metastatic (M), tab sis kuj yuav tsum coj mus rau hauv tus account qee yam kev pheej hmoo ntawm kev phais.

Ua rau du neuroblastome

Zoo li ntau lwm hom mob qog noj ntshav, neuroblastomas muaj keeb kwm uas tseem tsis tau tsim kom tiav.

Txog niaj hnub no, nws tau pom tias kev loj hlob ntawm neuroblastoma tuaj yeem yog vim los yog nyiam los ntawm ntau yam kab mob tsawg:

• hom 1 neurofibromatosis, lossis Recklinghausen's tus kab mob, uas yog ib qho kev txawv txav ntawm kev loj hlob ntawm cov ntaub so ntswg neural;
• Hirschsprung tus kab mob uas yog qhov tshwm sim ntawm qhov tsis muaj paj hlwb hauv cov phab ntsa ntawm txoj hnyuv;
• Ondine syndrome, los yog congenital central alveolar hypoventilation syndrome, uas yog yus muaj los ntawm ib tug congenital tsis muaj kev tswj ntawm lub hauv paus ntawm kev ua pa thiab diffuse kev puas tsuaj rau lub autonomic paj hlwb.

Hauv qee kis, neuroblastoma kuj tau pom hauv cov neeg muaj:

• Beckwith-Wiedemann syndrome uas yog tus cwj pwm los ntawm kev loj hlob ntau dhau thiab kev yug me nyuam;
• Di-George Syndrome, kev yug me nyuam hauv cov chromosomes uas feem ntau ua rau lub plawv tsis xws luag, lub ntsej muag dysmorphism, kev loj hlob qeeb thiab kev tiv thaiv kab mob.

Diagnostic du neuroblastome

Hom mob qog noj ntshav no tuaj yeem raug xav tias yog vim qee yam kev kuaj mob. Kev kuaj mob ntawm neuroblastoma tuaj yeem paub tseeb thiab tob zuj zus los ntawm:

• kev kuaj zis uas ntsuas cov qib ntawm qee cov metabolites uas nws cov excretion nce thaum lub sij hawm neuroblastoma (xws li homovanilic acid (HVA), vanillylmandelic acid (VMA), dopamine);
• imaging ntawm thawj qog los ntawm ultrasound, CT scan lossis MRI (magnetic resonance imaging);
• MIBG (metaiodobenzylguanidine) scintigraphy, uas sib haum rau kev kuaj pom hauv cov tshuaj nuclear;
• ib qho biopsy uas muaj kev noj cov ntaub so ntswg rau kev tsom xam, tshwj xeeb tshaj yog tias xav tias mob qog noj ntshav.

Cov kev ntsuam xyuas no tuaj yeem siv los txheeb xyuas qhov kev kuaj mob ntawm neuroblastoma, ntsuas nws qhov twg thiab kuaj xyuas seb puas muaj lossis tsis muaj metastases.

Neuroblastomas feem ntau tshwm sim hauv cov menyuam mos thiab menyuam yaus. Lawv sawv cev rau 10% ntawm cov menyuam yaus mob qog noj ntshav thiab 15% ntawm cov qog nqaij hlav malignant hauv cov menyuam yaus hnub nyoog qis dua 5 xyoos. Txhua xyoo, nyob ib ncig ntawm 180 tus neeg mob tshiab tau txheeb pom hauv Fabkis.

• Asymptomatic: Ib tus neuroblastoma tuaj yeem tsis pom, tshwj xeeb tshaj yog thaum nws pib. Thawj cov tsos mob ntawm neuroblastoma feem ntau pom thaum lub qog kis.
• Kev mob hauv cheeb tsam: Kev loj hlob ntawm neuroblastoma feem ntau nrog qhov mob hauv thaj tsam cuam tshuam.
• Kev o hauv zos: Ib pob, pob, lossis o tuaj yeem tshwm sim hauv qhov chaw cuam tshuam.
• Kev hloov pauv ntawm cov xwm txheej dav dav: Ib qho neuroblastoma cuam tshuam kev ua haujlwm ntawm lub paj hlwb, uas tuaj yeem ua rau tsis qab los noj mov, poob phaus, kev loj hlob qeeb.

Txog niaj hnub no, peb txoj kev kho mob tseem ceeb tuaj yeem siv tau:

• phais kom tshem tawm cov qog;
• kev kho hluav taws xob, uas siv hluav taws xob los rhuav tshem cov qog nqaij hlav cancer;
• chemotherapy, uas siv cov tshuaj los txwv kev loj hlob ntawm cov qog nqaij hlav cancer.

Tom qab cov kev kho mob tau hais los saum toj no, kev hloov pauv ntawm cov qia tuaj yeem muab tso rau hauv qhov chaw kom rov ua haujlwm zoo ntawm lub cev.

Immunotherapy yog ib txoj hauv kev tshiab rau kev kho mob qog noj ntshav. Nws tuaj yeem yog ib qho ntxiv lossis lwm txoj hauv kev kho mob uas tau hais los saum toj no. Kev tshawb fawb ntau tab tom pib. Lub hom phiaj ntawm kev tiv thaiv kab mob yog los txhawb lub cev tiv thaiv kab mob los tiv thaiv kev loj hlob ntawm cov qog nqaij hlav cancer.

Lub hauv paus chiv keeb ntawm neuroblastomas tseem tsis to taub txog niaj hnub no. Tsis muaj kev tiv thaiv yuav raug txheeb xyuas.

Kev tiv thaiv cov teeb meem yog nyob ntawm kev kuaj mob ntxov. Qee zaum nws muaj peev xwm txheeb xyuas tus mob neuroblastoma thaum lub sij hawm antenatal ultrasound. Tsis tas li ntawd, kev ceev faj yog qhov tseem ceeb tom qab yug me nyuam. Kev saib xyuas tus menyuam tsis tu ncua yog qhov tseem ceeb.