{"id":3861,"date":"2020-04-14T17:01:45","date_gmt":"2020-04-14T14:01:45","guid":{"rendered":"https:\/\/rugute.lt\/?page_id=3861"},"modified":"2022-01-12T09:49:21","modified_gmt":"2022-01-12T07:49:21","slug":"kaulu-sarkomos","status":"publish","type":"page","link":"https:\/\/rugute.lt\/en\/informacija\/piktybiniai-navikai\/kaulu-sarkomos\/","title":{"rendered":"Kaul\u0173 sarkomos"},"content":{"rendered":"
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Piktybiniai navikai<\/h6>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Kaul\u0173 sarkomos<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Kaul\u0173 sarkomos \u2013 tai grup\u0117 piktybini\u0173 kaul\u0173 navik\u0173. Da\u017eniausios i\u0161 j\u0173 tiek vaikams, tiek suaugusiems \u2013 osteosarkoma ir Ewingo (Juingo) sarkoma.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t

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Osteosarkoma \u2013 viena pagrindini\u0173 kaul\u0173 piktybini\u0173 navik\u0173 r\u016b\u0161i\u0173, sudaro \u0161e\u0161tadal\u012f vis\u0173 vaik\u0173 piktybini\u0173 navik\u0173. Vaikams tumoras da\u017eniausiai lokalizuojasi kaul\u0173 galuose, kur augimas intensyviausias, ypa\u010d \u0161launikaulyje ar blauzdos kauluose apie kel\u012f, re\u010diau \u2013 dubenkaulyje, \u017eandikauliuose ar \u0161onkauliuose. 20 % atvej\u0173, diagnozavus lig\u0105, i\u0161 karto nustatomos metastaz\u0117s (da\u017eniausiai plau\u010diuose).<\/div>
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Sergamumas<\/b><\/div>
Serga vyresni nei 10 m. vaikai, did\u017eioji dalis \u2013 paauglyst\u0117je, kuomet, suintensyv\u0117jus skeleto augimui, nevaldomai ir be tvarkos ima daugintis kaulinio audinio l\u0105stel\u0117s. Berniukai serga du kartus da\u017eniau.<\/div>
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Prie\u017eastys<\/b><\/div>
Prie\u017eastys, kod\u0117l i\u0161sivysto osteosarkoma, iki galo nei\u0161ai\u0161kintos. Nustatyta paveldimumo \u012ftaka, taip pat ry\u0161ys su kitais navikais (pvz., paveldima retinoblastomos forma, Li-Fraumeni sindromu). Pasteb\u0117ta, jog radiacija, tame tarpe spindulinis gydymas, ar chemoterapija didel\u0117mis alkilinan\u010di\u0173 vaist\u0173 (pvz., ciklofosfamido, ifosfamido), antraciklin\u0173 (pvz., doksorubicino, idarubicino) doz\u0117mis, padidina ligos rizik\u0105.<\/div>
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Pagrindiniai po\u017eymiai:<\/i><\/div>
– kaul\u0173 skausmas, da\u017eniausiai gal\u016bn\u0117se, galintis suintensyv\u0117ti fizinio kr\u016bvio metu, arba atvirk\u0161\u010diai – nakt\u012f;<\/div>
– skaudamos vietos paraudimas, patinimas;<\/div>
– judesi\u0173 ribotumas, \u0161lubavimas;<\/div>
– kaul\u0173 l\u016b\u017eiai menkiausio fizinio kr\u016bvio metu.<\/div>
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Esant metastaz\u0117ms plau\u010diuose, da\u017eniausiai neb\u016bna joki\u0173 po\u017eymi\u0173, tik kartais pasirei\u0161kia kosulys, dusulys, kr\u016btin\u0117s skausmas. Pa\u017eengusios ligos atveju atsiranda kar\u0161\u010diavimas, svorio kritimas.<\/div>
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Diagnostika<\/b><\/div>
\u012etarus osteosarkom\u0105, atliekama pa\u017eeistos vietos rentgenograma, kai kada \u2013 magnetinio rezonanso tomografija, radioizotopinis kaul\u0173 skenavimas. Paimamas kraujas klinikiniam ir biocheminiam tyrimui. Ligai b\u016bdingas ferment\u0173 (\u0161armin\u0117s fosfataz\u0117s ir laktatdehidrogenaz\u0117s, kitaip LDH) aktyvumo padid\u0117jimas. Diagnoz\u0117s patvirtinimui atliekama biopsija (audinio gabal\u0117lio pa\u0117mimas tolimesniam i\u0161tyrimui mikroskopu). Metastaz\u0117ms plau\u010diuose aptikti taikoma kr\u016btin\u0117s l\u0105stos rentgenografija ar kompiuterin\u0117 tomografija.<\/div>
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Remiantis mikroskopine i\u0161vaizda, tumoro dyd\u017eiu ir i\u0161plitimu, nustatoma ligos stadija.<\/div>
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Gydymas<\/b><\/div>
Daugumai pacient\u0173 taikomas chemoterapinis gydymas, po kurio atliekama naviko pa\u0161alinimo operacija. V\u0117liau skiriamas papildomas chemoterapijos kursas. Spindulinis gydymas n\u0117ra itin efektyvus.<\/div>
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Chirurginis gydymas<\/i><\/div>
Operacinis naviko pa\u0161alinimas \u2013 svarbiausias osteosarkomos gydymo b\u016bdas. Stengiamasi pa\u0161alinti kiek galima daugiau navikinio audinio kartu su j\u012f supan\u010diais sveikais audiniais (t.y. „sveik\u0173 audini\u0173 ribose”) bei gretimais limfmazgiais. Kartais \u0161alinamos ir metastaz\u0117s plau\u010diuose. Esant navikui ilguosiuose kauluose, atliekama gal\u016bn\u0119 i\u0161sauganti operacija arba amputacija. Operacijos metodas pasirenkamas priklausomai nuo daugelio veiksni\u0173. Kadangi pagrindinis gydymo tikslas \u2013 visi\u0161kai pa\u0161alinti navik\u0105, amputacija atliekama, jei:<\/div>
– navikas didelis;<\/div>
– apima greta esan\u010dius svarbius nervus ar kraujagysles;<\/div>
– n\u0117ra atsako \u012f chemoterapij\u0105;<\/div>
– \u012fvyk\u0119s kaulo l\u016b\u017eis (d\u0117l kartu taikomos chemoterapijos kaulas blogai gyja);<\/div>
– kojos navikas i\u0161sivyst\u0117 labai ma\u017eam vaikui.<\/div>
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Kadangi \u0161is gydymo metodas gana traumuojantis, reikalinga ilgalaik\u0117 reabilitacija ir psichologin\u0117 pagalba. Tinkamas protezo parinkimas gali gr\u0105\u017einti vaik\u0105 \u012f aktyv\u0173 gyvenim\u0105.<\/div>
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Siekiant geresnio funkcinio ir psichologinio rezultato, jei tik \u012fmanoma, atliekama gal\u016bn\u0119 i\u0161sauganti operacija. Norint atstatyti kaulo vientisum\u0105, defekto vietoje implantuojamos kaulo dalel\u0117s i\u0161 kitos k\u016bno vietos (da\u017eniausiai dubens) arba panaudojamos dirbtin\u0117s med\u017eiagos (plieniniai ar titaniniai endoprotezai). Vaikui augant, protezus tenka keisti.<\/div>
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Iki operacijos svarbu riboti pakenktos gal\u016bn\u0117s kr\u016bv\u012f, kad ne\u012fvykt\u0173 l\u016b\u017eis ar naviko l\u0105stel\u0117s nei\u0161sis\u0117t\u0173 susitraukin\u0117jant raumenims.<\/div>
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Chemoterapija <\/i><\/div>
Chemoterapija paskiriama dar iki operacijos, tikintis, kad naviko apimtis suma\u017e\u0117s ir j\u012f bus galima pa\u0161alinti chirurgi\u0161kai. Chemoterapij\u0105 papildomai taikant po chirurginio gydymo, sunaikinamos nepa\u0161alintos l\u0105stel\u0117s. Da\u017eniausiai naudojamas metotreksatas (didel\u0117mis doz\u0117mis), doksorubicinas, ciklofosamidas, ifosfamidas, cisplatina, karboplatina ir etopozidas.<\/div>
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Spindulinis gydymas<\/i><\/div>
Kadangi aplinkiniai sveikieji audiniai yra jautresni spinduliuotei nei pats navikas, pirminio tumoro gydymui \u0161is metodas taikomas retai. Kartais jis naudojamas metastazini\u0173 \u017eidini\u0173 sukeltam skausmui mal\u0161inti.<\/div>
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Kitos priemon\u0117s <\/i><\/div>
<\/i>Tiriamos monoklonini\u0173 antik\u016bn\u0173 panaudojimo kartu su chemoterapija galimyb\u0117s.<\/div>
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Prognoz\u0117<\/b><\/div>
Tikimyb\u0117 pasveikti priklauso nuo:<\/div>
– naviko mikroskopinio vaizdo, vietos, dyd\u017eio ir i\u0161plitimo;<\/div>
– ligos trukm\u0117s;<\/div>
– laboratorini\u0173 tyrim\u0173 rezultat\u0173;<\/div>
– operacijos radikalumo (kiek daug navikini\u0173 masi\u0173 pavyko pa\u0161alinti) ar atsako \u012f chemoterapij\u0105;<\/div>
– paties paciento individuali\u0173 savybi\u0173 (am\u017eiaus, gretutini\u0173 lig\u0173).<\/div>
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Esant nei\u0161plitusiam navikui, i\u0161gyvenamumas siekia 70-90 %.<\/div>\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t
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Ewingo sarkoma savo mikroskopiniu vaizdu ir jautrumu spinduliniam gydymui visi\u0161kai nepana\u0161i osteosarkom\u0105. Ji, kartu su ekstraskeletine (ne kauline) Ewingo sarkoma ir primityviu periferiniu neuroektoderminiu tumoru (PNET, kitaip – periferine neuroepitelioma), sudaro taip vadinam\u0105 Ewingo navik\u0173 grup\u0119. \u0160i navik\u0173 grup\u0117 priklauso \u201ema\u017e\u0173 apvali\u0173 m\u0117lyn\u0173 l\u0105steli\u0173 navikams\u201c (angl. small round blue cell tumors), pasi\u017eymintiems identi\u0161ka kilme i\u0161 primityvi\u0173 nervini\u0173 l\u0105steli\u0173.<\/div>
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Sergamumas<\/b><\/div>
\u0160ie tumorai palyginti reti. Ewingo sarkoma sudaro apie 90 % \u0161ios grup\u0117s navik\u0173 ir apie tre\u010ddal\u012f piktybini\u0173 kaul\u0173 navik\u0173 . Da\u017eniausiai susergama paauglyst\u0117je. D\u0117l intensyvesnio augimo da\u017eniau serga vaikinai. B\u016bdingiausia Ewingo sarkomos lokalizacija – \u0161launikaulis, dubens kaulai, re\u010diau – \u017eastikaulis, \u0161onkauliai.<\/div>
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Navikin\u0117s l\u0105stel\u0117s da\u017eniausiai metastazuoja \u012f plau\u010dius, kaulus, kaul\u0173 \u010diulpus, re\u010diau \u2013 \u012f limfmazgius, centrin\u0119 nerv\u0173 sistem\u0105 (galvos ir nugaros smegenis).<\/div>
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Prie\u017eastys<\/b><\/div>
Nors ry\u0161io su kitomis paveldimomis ligomis nenustatyta, net 90 % atvej\u0173 naviko l\u0105stel\u0117se randama specifin\u0117 mutacija, vadinama t(11;22) translokacija (genetin\u0117s med\u017eiagos pasikeitimas tarp 11 ir 22 chromosom\u0173).<\/div>
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Po\u017eymiai<\/b><\/div>
Pagrindiniai po\u017eymiai:<\/div>
– skausmas tumoro srityje;<\/div>
– skausmingos vietos patinimas ir paraudimas;<\/div>
– kar\u0161\u010diavimas, greitas nuovargis, suma\u017e\u0117j\u0119s apetitas, k\u016bno svorio kritimas;<\/div>
– kaul\u0173 l\u016b\u017eiai menkiausio fizinio kr\u016bvio metu;<\/div>
– esant nugaros smegen\u0173 pa\u017eeidimui – paraly\u017eiai, dubens organ\u0173 funkcijos sutrikimas.<\/div>
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Kadangi po\u017eymiai primena infekcin\u012f susirgim\u0105, ligos diagnozavimas neretai u\u017etrunka (da\u017eniausiai \u012ftariamas osteomielitas).<\/div>
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Diagnostika<\/b><\/div>
Ligai diagnozuoti atliekama pa\u017eeistos vietos rentgenograma, kai kada \u2013 kompiuterin\u0117 ar magnetinio rezonanso tomografija, radioizotopinis kaul\u0173 skenavimas. Paimamas kraujas klinikiniam ir biocheminiam tyrimui (randama padid\u0117jusi LDH koncentracija). Diagnoz\u0117s patvirtinimui atliekama biopsija (audinio gabal\u0117lio pa\u0117mimas tolimesniam i\u0161tyrimui mikroskopu bei molekulin\u0117s diagnostikos metodais). Metastaz\u0117ms aptikti taikoma kr\u016btin\u0117s l\u0105stos rentgenografija, \u012fvairi\u0173 viet\u0173 kompiuterin\u0117 tomografija, kaul\u0173 \u010diulp\u0173 aspiracija ir biopsija.<\/div>
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Priklausomai nuo naviko i\u0161plitimo \u012f aplinkinius ir atokius organus, nustatoma ligos stadija.<\/div>
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Gydymas<\/b><\/div>
Gydymo tikslas \u2013 i\u0161gydyti ligon\u012f, i\u0161saugant kuo didesn\u012f pakenktos vietos funkcionalum\u0105. Da\u017eniausiai taikomas chirurginis gydymas ir\/arba spindulinis gydymas, juos kombinuojant su chemoterapija.<\/div>
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Chirurginis gydymas<\/i><\/div>
Operacijos metu stengiamasi pa\u0161alinti, kiek \u012fmanoma, daugiau naviko, geriausia \u2013 sveik\u0173 audini\u0173 ribose. Jei tumoras lokalizuojasi plok\u0161\u010diuosiuose kauluose, jis tiesiog pa\u0161alinamas. Rezekavus vis\u0105 \u0161onkaul\u012f, kr\u016btin\u0117s l\u0105sta sutvirtinama sintetiniais pakaitalais. \u0160alinant ilg\u0173j\u0173 kaul\u0173 navik\u0105, gal\u016bn\u0119 stengiamasi i\u0161saugoti, jei to padaryti ne\u012fmanoma, atliekama amputacija (pla\u010diau \u017er. \u201eOsteosarkoma\u201c). Chirurgi\u0161kai gali b\u016bti \u0161alinamos ir metastaz\u0117s.<\/div>
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Spindulinis gydymas<\/i><\/div>
Spindulinis gydymas taikomas, kai naviko nepavyksta visi\u0161kai pa\u0161alinti. Da\u017eniausiai naudojamas vietinis i\u0161orinis spindulinis gydymas naviko srityje.<\/div>
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Chemoterapija <\/i><\/div>
Chemoterapija da\u017eniausiai naudojama sunaikinti po operacijos ar radioterapijos likusias navikines l\u0105steles. Ji taip pat taikoma prie\u0161 operacij\u0105, norint,kad navikas suma\u017e\u0117t\u0173. Da\u017eniausiai naudojamas vinkristinas, doksorubicinas, ciklofosamidas, ifosfamidas ir etopozidas.<\/div>
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Kaul\u0173 \u010diulp\u0173 ir periferini\u0173 kamienini\u0173 l\u0105steli\u0173 transplantacija<\/i><\/div>
Vienas perspektyviausi\u0173 i\u0161plitusios Ewingo sarkomos gydymo metodas \u2013 kaul\u0173 \u010diulp\u0173 transplantacija. Prad\u017eioje skiriamos didel\u0117s chemoterapini\u0173 preparat\u0173 doz\u0117s, visi\u0161kai sunaikinan\u010dios tiek navikines, tiek kamienines kraujodaros l\u0105steles, esan\u010dias kaul\u0173 \u010diulpuose. Po to \u012f kraujotak\u0105 suleid\u017eiamos i\u0161 anksto surinktos kamienin\u0117s l\u0105stel\u0117s, kurios prigyja kaul\u0173 \u010diulpuose ir atnaujina kraujo l\u0105steli\u0173 gamyb\u0105.<\/div>
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Kitos priemon\u0117s <\/i><\/div>
Tiriama monoklonini\u0173 antik\u016bn\u0173 panaudojimo kartu su chemoterapija galimyb\u0117.<\/div>
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Prognoz\u0117 <\/i><\/b><\/div>
Prognoz\u0117 priklauso nuo naviko i\u0161plitimo, taikyto gydymo, paciento individuali\u0173 savybi\u0173. 5 m. i\u0161gyvenamumas, esant nei\u0161plitusiam navikui, siekia 60 %. I\u0161gyvenamumas padid\u0117ja iki 80 %, jei nei\u0161plit\u0119s navikas lokalizuotas \u017eemiau alk\u016bni\u0173 ar keli\u0173. Esant i\u0161plitusiam navikui, 5 m. i\u0161gyvenamumas siekia apie 25 %.<\/div>\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t
\n\t\t\t\t\t\t\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t<\/i>\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t<\/i>\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tKiti piktybiniai kaul\u0173 navikai\t\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t
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Piktybin\u0117 fibrozuojanti kaul\u0173 histiocitoma retesn\u0117. Jos atsiradimas da\u017enai siejamas su taikytu spinduliniu gydymu ar kita radioaktyvia spinduliuote. \u0160io naviko gydymo metodai ir atsakas \u012f terapij\u0105 labai pana\u0161\u016bs \u012f osteosarkomos.<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"

Piktybiniai navikai Kaul\u0173 sarkomos Kaul\u0173 sarkomos \u2013 tai grup\u0117 piktybini\u0173 kaul\u0173 navik\u0173. Da\u017eniausios i\u0161 j\u0173 tiek vaikams, tiek suaugusiems \u2013 osteosarkoma ir Ewingo (Juingo) sarkoma. Osteosarkoma Osteosarkoma \u2013 viena pagrindini\u0173 kaul\u0173 piktybini\u0173 navik\u0173 r\u016b\u0161i\u0173, sudaro \u0161e\u0161tadal\u012f vis\u0173 vaik\u0173 piktybini\u0173 navik\u0173. Vaikams tumoras da\u017eniausiai lokalizuojasi kaul\u0173 galuose, kur augimas intensyviausias, ypa\u010d \u0161launikaulyje ar blauzdos kauluose apie […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":3842,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"footnotes":""},"class_list":["post-3861","page","type-page","status-publish","hentry"],"yoast_head":"\nKaul\u0173 sarkomos - Labdaros ir paramos fondas \u201eRugut\u0117\u201c<\/title>\n<meta name=\"description\" content=\"Kaul\u0173 sarkomos \u2013 tai grup\u0117 piktybini\u0173 kaul\u0173 navik\u0173. 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