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Tuesday, June 19

အူမၾကီး ကင္ဆာ အေၾကာင္းသိေကာင္းစရာ


ကြ်န္ေတာ္႔ကို  သူငယ္ခ်င္းတစ္ေယာက္ေမးလာလုိ႔   ေဒါက္တာတင္႔ေဆြဆီေမးလ္ပုိ႔ျပီး ေမးထားတာပါ။  ကြ်န္ေတာ္က်န္းမာေရးနဲ႔ပက္သက္တဲ႔အေၾကာင္းအရာမ်ားကုိ ေတာ္ေတာ္မ်ားမ်ားေမးဖူးတယ္။ ေဒါက္တာက အျမဲတမ္းေမးလ္ျပန္ပို႔ေပးတယ္။ ကြ်န္ေတာ္သိခ်င္တာမွန္သမွ်ကို မအားလပ္တဲ႔ၾကား ကေနေမးလ္ ပုိ႔ေပးတဲ႔အတြက္ ေဒါက္တာကို ဒီကေနပဲ အရမ္းေက်းဇူးတင္ေၾကာင္း ေျပာလုိက္ပါရေစ.........။ သူငယ္ခ်င္းတုိ႔လည္း က်န္းမာေရးန႔ပက္သက္ျပီးသိလုိသမွ် ေမးခ်င္တယ္ဆုိရင္ ေဒါက္တာရဲ႕ Email ပါ ေရးေပးလုိက္ပါတယ္။  drswe01@gmail.com


Tue, Jun 19, 2012 at 12:55 AM
ေဒါက္တာခင္ဗ်ာ ကြ်န္ေတာ္ အူကင္ဆာနဲ႔ပက္သက္တဲ့အေၾကာင္းေလး သိခ်င္ပါတယ္ခင္ဗ်ာ။


Bowel cancer အူကင္ဆာလို႔ ေခၚတာဟာ Colorectal cancers ျဖစ္တယ္။ Colon cancer အူမၾကီး-ကင္ဆာ နဲ႔ Rectal cancer အစာေဟာင္းအိမ္-ကင္ဆာကို ေပါင္းေခၚထားတာ ျဖစ္တယ္။ အမ်ိဳးသားေတြမွာ တတိယေျမာက္ နဲ႔ အမ်ိဳးသမီးေတြမွာ စတုတၳေျမာက္ အျဖစ္အမ်ားဆံုး ကင္ဆာျဖစ္တယ္။ ဖြံ႔ျဖိဳးတိုးတက္ႏိုင္ငံေတြမွာ ပိုျဖစ္တယ္။ ၆ဝ% ရွိတယ္။ ၂ဝဝဂ ေလ့လာမႈအရ တကမာၻလံုးမွာ လူနာသစ္ေပါင္း ၁႕၂၃ သန္းရွိျပီး၊ ၆ သိန္းေက်ာ္ ေသဆံုးရတယ္။ Colon cancer အူမၾကီး-ကင္ဆာ အမ်ားစုက ကင္ဆာမဟုတ္တဲ့ Polyps အသားပိုကေနစတယ္။

ျဖစ္ကာစမွာ အူမၾကီးရဲ႕ အတြင္းဆံုးလႊာကေနျဖစ္ျပီး ေစာေစာမသိလို႔ ေဆးမကုရင္ အူမၾကီးရဲ႕ ၾကြက္သားလႊာအထိ ေရာက္လာမယ္။ အူနံရံမွာသာ ျဖစ္ေနေသးရင္ ကုရတာလြယ္တယ္။ ခြဲစိတ္မယ္။ ေနာက္က်မွသိရင္ေတာ့ အသက္ ရွည္ႏိုင္သမွ် ရွည္ေအာင္ Chemotherapy ေဆးေပးကုသမယ္။

 

Cause ဘာလို႔ျဖစ္သလဲ

• အသက္ၾကီးမွ ျဖစ္တာမ်ားတယ္။
• ေယာက္်ားေတြမွာ ပိုျဖစ္တယ္။
• အမ်ိဳးထဲမွာ တေယာက္မက ျဖစ္တတ္တယ္။ ဒါေပမဲ့ ၇၅-၉၅% ဟာ မ်ိဳးဗီဇနဲ႔ မပတ္သက္တာ ေတြ႔ရတယ္။
• လူေနမႈပံုစံ (အစားအေသာက္၊ အရက္ေသာက္၊ ေဆးလိပ္ေသာက္) ေၾကာင့္လဲ ျဖစ္ႏိုင္တယ္။
• Inflammatory bowel disease (Ulcerative colitis and Crohn's disease) ရွိေနသူေတြမွာ ပိုျဖစ္တယ္။
o Crohn's disease ရွိသူထဲက ၁ဝ ႏွစ္အတြင္း ၂%၊ ၂ဝ ႏွစ္အတြင္း ၈% နဲ႔ ၃ဝ ႏွစ္အတြင္း ၁၈% အူမၾကီး-ကင္ဆာ လာျဖစ္တယ္။
o Ulcerative colitis ရွိေနသူထဲက ၂ဝ% ဟာ ၁ဝ ႏွစ္ေနရင္ အူမၾကီး-ကင္ဆာျဖစ္လာတယ္။

Diagnosis ေရာဂါေသျခာေအာင္ Sigmoidoscopy or Colonoscopy စမ္းရင္းနဲ႔ Tumor biopsy အသားစ ျဖတ္ယူ စစ္ေဆးတာ လုပ္ရတယ္။ Barium enema စအိုကေန ေဆးသြင္းျပီး ဓါတ္မွန္ရိုက္တာလဲ လုပ္တယ္။ ေရာဂါ ဘယ္အထိ ျပန္႔ေနသလဲ သိေအာင္ CT scan လုပ္ရတယ္။ ေရာဂါေဗဒအရေျပာရရင္ ၉၅% က Adenocarcinoma အမ်ိဳးအစားျဖစ္ျပီး က်န္တာက Lymphoma နဲ႔ Squamous cell carcinoma အမ်ိဳးအစားျဖစ္တယ္။

အူမၾကီးဆိုတာ ညာဘက္အထက္တန္းေနတာ၊ ကန္႔လန္႔တန္းေနတာ နဲ႔ ဘယ္ဘက္ေအာက္တန္းေနတာဆိုျပီး ရွိတယ္။ ညာဘက္ျဖစ္တာမ်ိဳးက အူလမ္းပိတ္တာ ျဖစ္ခဲတယ္။ ေသြးယိုရာကေန ေသြးအားနည္းေနတာ မ်ားတယ္။ ဘယ္ဘက္က ျဖစ္တာ ဆိုရင္ အူလမ္းပိတ္တတ္တယ္။

• အထဲမွာ ေရာဂါစေနေပမဲ့ ဘာမွမခံစားရဘူး။ ဒါေၾကာင့္ သိရင္ ေနာက္က်ေနတတ္တယ္။
• သိသာတဲ့ ေရာဂါ လကၡဏာေတြက
o စအိုကေန ေသြးယိုမယ္၊ ဝမ္းသြားရင္း ေသြးပါမယ္။
o ၾကာေတာ့ ေသြးအားနည္းလာမယ္။
o လူက ပိန္လာမယ္။ အားယုတ္မယ္။
o ဝမ္းသြားရတာ အရင္လိုမဟုတ္တာျဖစ္မယ္။ ဝမ္းခ်ဳပ္တာ၊ ဝမ္းေလွ်ာတာေတြ ျဖစ္မယ္။ ဝမ္းခ်ဳပ္တာ မ်ားတယ္။ ဝမ္းသြားျပီးေပမဲ့ မကုန္ေသးသလိုခံစားရႏိုင္တယ္။
o အစားအေသာက္ ပ်က္မယ္။
o ကိုယ္ပူမယ္။
o ပ်ိဳ႕-အန္ခ်င္တာ ျဖစ္မယ္။ ဗိုက္ေအာင့္၊ ေလထိုး အေနရခက္မယ္။

Risk factors ဘယ္လိုလူမ်ိဳးေတြမ်ာ သတိထားရမလဲ

• Older age ကင္ဆာ ၉ဝ% ဟာ အသက္ ၅ဝ ေက်ာ္ေတြျဖစ္တယ္။
• African-American race အာဖရိကႏြယ္ဖြါးေတြမွာ ပိုျဖစ္တယ္။
• colorectal polyps ကင္ဆာမဟုတ္တဲ့ အသားပိုရွိေနသူ။
• Ulcerative colitis and Crohn's disease ေရာဂါရွိေနသး၊
• Inherited syndromes မ်ိဳးရိုးရွိသူ။
• Low-fiber, high-fat diet အဆီမ်ားမ်ားစားျပီး အသီအႏွံစားနည္းသူ။
• A sedentary lifestyle ကိုယ္လက္လႈတ္ရွားမႈ နည္းသူေတြ
• Diabetes ဆီးခ်ိဳရွိသူ။
• Obesity ကိုယ္ခႏၶာဝသူ။
• Smoking ေဆးလိပ္ေသာက္သူ။
• Alcohol အရက္ေသာက္သူ။
• Radiation therapy for cancer ကင္ဆာတခုခုအတြက္ ဓါတ္ကင္ရသူ။

Stages of colon cancer အဆင့္ခြဲျခားျခင္း

1. အဆင့္ (၁) အူမၾကီးနံရံ အတြင္းဆံုးလႊာမွာသာရွိေသးသူ။
2. အဆင့္ (၂) အူမၾကီးနံရံတခုလံုးမွာျဖစ္ေနသူ။
3. အဆင့္ (၃) အူမၾကီးနံရံအျပင္ အနီးအနားက တက္ေစ့ေတြအထိေရာက္ေနသူ။
4. အဆင့္ (၄) အူမၾကီးနံရံ၊ အနီးအနားက တက္ေစ့ေတြအျပင္ အသဲ၊ အဆုပ္စတာေတြအထိ ေရာက္ေနသူ။

Treatments and drugs ဘယ္လိုကုသမလဲ

• Surgery for early-stage colon cancer ေစာေသးတာအတြက္ ခြဲစိတ္ကုသနည္း။ အသားပိုအဆင့္သာ ရွိေသးမယ္၊ ကင္ဆာကေသးမယ္၊ ေနရာတခုေလးမွာသာကြက္ျဖစ္မယ္ဆိုရင္ ခြဲစိတ္ထုတ္ျပစ္မယ္။ Colonoscopy ကရိယာနဲ႔စစ္ေဆးရင္း လုပ္မယ္။
• အရြယ္အစားပိုၾကီးတာဆိုရင္ Laparoscopic surgery ကရိယာသံုးျပီး ခြဲထုတ္မယ္။
• Surgery for invasive colon cancer ေနာက္က်လာျပီျဖစ္တဲ့ ကင္ဆာကို ခြဲစိတ္နည္း။ Partial colectomy ျဖစ္ေနတဲ့ေနရာက္ို ျဖတ္ထုတ္မယ္။ ေဘးက ေကာင္းေနေသးတဲ့ ေနရာကိုပါ ထုတ္မယ္။ တက္ေစ့လဲ ထုတ္မယ္။ ထိပ္စႏွစ္ဘက္ကို ဆက္ေပးလို႔ရရင္ ဆက္ေပးမယ္။
• ဒါမွမဟုတ္ ဝမ္းသြားလမ္းကို ဗိုက္ကေနအသစ္လုပ္ေပးမယ္။ တခါတေလ Temporary colostomy ယာယီ အဲလိုလုပ္ရျပီး။ တခါတေလ Permanent colostomy ရာသက္ပန္ လုပ္ေပးရတယ္။
• ေနာက္က်ေနတဲ့ အူလမ္းပိတ္ေနတဲ့ ကင္ဆာဆိုရင္ အူလမ္းပြင့္ေအာင္ ခြဲစိတ္တာလုပ္မယ္။ ေရာဂါကို တိုက္ရိုက္ ကုတဲ့သေဘာေတာ့ မဟုတ္ဘူး။
• တကယ္လို႔ အသဲအထိ ေရာက္ေနတာ ေတြ႔ရေပမဲ့ လူက ခံႏိုင္ရည္ေကာင္းေနရင္ ကူးစက္ေနတဲ့ေနရာက ကင္ဆာ အက်ိတ္ကို ထုတ္ေပးမယ္။
• Chemotherapy ေဆးေပးကုသနည္းကို ခြဲစိတ္တာ မလုပ္ခင္ျဖစ္ျဖစ္ လုပ္ျပီးမွျဖစ္ျဖစ္ တြဲလုပ္တာလဲရွိတယ္။ Chemotherapy ဆိုတာ ကင္ဆာ (ဆဲလ္) ေတြကို ေသေစဘို႔ျဖစ္တယ္။ Radiation therapy ဓါတ္ကင္တာနဲ႔ တြဲေပးရတာလဲ ရွိတယ္။ 5-flourauracil (5-FU) ေဆးကိုသံုးတာမ်ားတယ္။
• Radiation therapy ဓါတ္ကင္တယ္ဆိုတာ X-rays ဓါတ္မွန္ေရာင္ျခည္နဲ႔ ကင္ဆာ (ဆဲလ္) ေတြကို ေသေစတာျဖစ္တယ္။ ခြဲစိတ္ထုတ္ေပမဲ့ က်န္ေနႏိုင္တာကို ေသေစမယ္။ အရြယ္အစားကိုလဲ ေသးေစလို႔ ပိတ္ေနတာ၊ ဖိေနတာရွိရင္ သက္သာေစမယ္။ ေရာဂါ ေစာေစာပိုင္းအဆင့္အတြက္ မသံုးဘူး။ ခြဲစိတ္တာ၊ ေဆးေပးတာ နဲ႔ ဓါတ္ကင္တာ တြဲလုပ္ရတာေတြလဲရွိတယ္။
• Targeted drug therapy ေဆးေပးနည္းတမ်ိဳးလဲရွိတယ္။ ေရာဂါ ေနာက္ပိုင္းေရာက္ေနသူေတြအတြက္ Bevacizumab (Avastin), Cetuximab (Erbitux) and Panitumumab (Vectibix) ေဆးေတြကိုသံုးတယ္။

ဘယ္ေလာက္ၾကာၾကာ ေနႏိုင္မလဲ 

• ေရာဂါ ဘယ္ေလာက္ေစေစာသိသလဲ။ ဘယ္အတိုင္းအတာအထိ ကုသမႈခံယူသလဲအေပၚမူတည္တယ္။
• အူမၾကီးနံရံမွာသာျဖစ္ေနသူက ခြဲစိတ္ကုသမႈခံယူလိုက္ရင္ အသက္ၾကာၾကာရွင္ဘို႔ ၈ဝ% ရွိမယ္။
• ေနာက္က်မွသိရ-ကုရသူဆိုရင္ ၅ ႏွစ္သက္တမ္းေနႏိုင္မႈ ၁ဝ% ရွိမယ္။
• ကင္ဆာက တက္ေစ့ေတြအထိ ေရာက္ေနသူေတြမွာ ၅ ႏွစ္သက္တမ္းႏွဳန္း ၆၅% ရွိတယ္။
• တျခားအဂၤါေတြအထိ ေရာက္ေနသူေတြမွာ ၈% ရွိတယ္။

အူမၾကီးကင္ဆာ ဘယ္လိုကာကြယ္မလဲ

• ေစာေစာသိေအာင္လုပ္ပါ။
• Digital rectal examination စအိုလမ္းကို စမ္းသပ္ျခင္း နဲ႔ Stool occult blood testing ဝမ္းထဲမွာ မ်က္စိနဲ႔ မျမင္ရတဲ့ေသြး ပါေန-မေန စစ္ေဆးတာ လုပ္ရမယ္။ ဝမ္းထဲမွာ အဲလိုစစ္မွ ေသြးေတြ႔သူေတြထဲက ၃ဝ-၄၅% ဟာ Colon polyp အသားပိုအဆင့္ နဲ႔ ၃-၅% ဟာ Colon cancer ကင္ဆာ ရွိေနတာ ေတြ႔ရတယ္။
• Stool occult blood အေပါင္းျပသူေတြကို Barium enema x-rays, colonoscopies ေတြဆက္လုပ္ရမယ္။
• ဝမ္းထဲေသြး ပါ-မပါစစ္လို႔ အႏုတ္ျပတိုင္းလဲ ကင္ဆာ မရွိဘူးလို႔ အေသအျခာ မေျပာႏိုင္ေသးဘူး။ ၂ဝ% ေလာက္မွာ အဲလိုျဖစ္တယ္။
• ဝမ္းေသြးစစ္တာ ေအာင္ေပမဲ့ ျဖစ္ႏိုင္ေျခစာရင္းထဲပါေနသူေတြကို Flexible sigmoidoscopies or Colonoscopies ေတြပါ လုပ္သင့္တယ္။
• အသက္ ၅ဝ ေက်ာ္ရင္ ၃-၅ ႏွစ္တခါလုပ္ဘို႔ လမ္းညႊန္တယ္။
• Genetic counseling and testing မ်ိဳးဗီဇစစ္ေဆးနည္းေတြ အသစ္ေပၚလာျပီ။ ေသြးစစ္တာပါ။ FAP, AFAP, MYH, and HNPCC ေတြရွိသူေတြကို Hereditary colon cancer syndromes လို႔ေခၚတယ္။
• Diet and colon cancer အူမၾကီးကင္ဆာနဲ႔ အစားအစာ
o အဆီေလွ်ာ့ပါ။ အသား၊ ဥ၊ ႏို႔ထြက္အစားအစာေတြ၊ သားသံုးဆီေတြကေန ရတာေတြကို ေလွ်ာ့ပါ။
o Fiber (ဖိုက္ဘာ) ဆိုတာ ဟင္းသီးဟင္းရြက္၊ အသီးအႏွံေတြ၊ အျဖဴဆြတ္ေနေအာင္လုပ္မထားတဲ့ ဆန္-ဂ်ံဳမံႈ႔ေတြနဲ႔ လုပ္တဲ့ အစာေတြက ရတယ္။ (ဖိုက္ဘာ) က ေက်ခ်က္-ေပ်ာ္ဝင္မသြားႏိုင္ဘူး။ ဝမ္းထဲမွာ အတိုင္းသားလို ပါေနမယ္။ အစာထဲက potential carcinogens ကင္ဆာျဖစ္ေစႏိုင္တာေတြကို ဖယ္ထုတ္ေပးမယ္။ ဝမ္းသြားလြယ္ေစလို႔ အဲလိုဓါတ္ေတြ အထဲမွာ ၾကာၾကာမေနေစႏိုင္ဘူး။

Dr. တင့္ေဆြ
၁၉-၆-၂ဝ၁၂

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