{"id":3878,"date":"2020-04-14T17:30:30","date_gmt":"2020-04-14T14:30:30","guid":{"rendered":"https:\/\/rugute.lt\/?page_id=3878"},"modified":"2022-01-12T09:55:30","modified_gmt":"2022-01-12T07:55:30","slug":"neuroblastoma","status":"publish","type":"page","link":"https:\/\/rugute.lt\/en\/informacija\/piktybiniai-navikai\/neuroblastoma\/","title":{"rendered":"Neuroblastoma"},"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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Neuroblastoma<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Neuroblastoma \u2013 tai piktybinis simpatin\u0117s nerv\u0173 sistemos navikas. \u0160i sistema reguliuoja organizmo funkcijas, i\u0161skirdama chemi\u0161kai aktyvias med\u017eiagas, pavyzd\u017eiui, adrenalin\u0105. Daugiau nei pus\u0117 \u0161i\u0173 navik\u0173 i\u0161sivysto antinks\u010diuose.<\/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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Neuroblastoma sudaro 8-10 % vis\u0173 piktybini\u0173 vaik\u0173 navik\u0173 ir yra da\u017eniausias navikas pirmaisiais gyvenimo metais. Did\u017eiajai daliai vaik\u0173 neuroblastoma diagnozuojama iki 5 m. am\u017eiaus. Berniukai serga da\u017eniau nei mergait\u0117s.<\/p>\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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Da\u017eniausiai neuroblastoma i\u0161sivysto be jokios ai\u0161kios prie\u017easties. Pasteb\u0117tas ry\u0161is su kitomis ligomis, pvz., Hirschprungo liga (storosios \u017earnos vystymosi anomalija) ar von Recklinghauseno neurofibromatoze. Ma\u017edaug 1-2 % atvej\u0173 nustatoma \u0161eimin\u0117 ligos anamnez\u0117, tokiais atvejais paprastai randami dauginiai tumorai. Manoma, jog paveldimos neuroblastomos atveju \u012fvyksta geno, esan\u010dio 16 chromosomoje, mutacija.<\/p>\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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Liga gali pasireik\u0161ti \u012fvairiais simptomais. Jie priklauso nuo naviko lokalizacijos ir i\u0161plitimo. Neuroblastomai esant pilve, t\u0117vai prausdami ar rengdami vaik\u0105 paprastai ap\u010diuopia darin\u012f ar guz\u0105. Pilvas gali atrodyti padid\u0117j\u0119s. Jei tumoras susidaro kr\u016btin\u0117s l\u0105stoje ar kakle, gali atsirasti l\u0117tinis kosulys, dusulys, i\u0161ry\u0161k\u0117ti Hornerio sindromas (voko nusileidimas, susiaur\u0117j\u0119s vyzdys, suma\u017e\u0117j\u0119s pakenktos pus\u0117s veido prakaitavimas). Vaikas ima blogai valgyti, netenka svorio, da\u017enai viduriuoja ar vemia. Gali pakilti temperat\u016bra, atsirasti ne\u012fprastas nuovargis, irzlumas.<\/div>
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Retas, bet gana b\u016bdingas, opsomioklonijos sindromas, pasirei\u0161kiantis sutrikusia koordinacija ir staigiais nevalingais aki\u0173 judesiais (\u201e\u0161okan\u010di\u0173 aki\u0173 ir p\u0117d\u0173\u201c sindromas).<\/div>
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Net 75 % atvej\u0173 diagnoz\u0117s nustatymo metu, navikas jau b\u016bna i\u0161plit\u0119s \u012f aplinkinius audinius arba metastazav\u0119s. Tumorui i\u0161plitus \u012f kaulus, vaikas pradeda \u0161lubuoti, vengia stotis, vyresni skund\u017eiasi kaul\u0173 skausmais. Atsiradus metastaz\u0117ms akiduob\u0117se, aplink akis pastebimi juodi ratilai. Jei navikas pa\u017eeid\u017eia nugaros smegenis, atsiranda nugaros skausmai, sutrinka \u0161lapinimasis ar tu\u0161tinimasis. Gali atsirasti gal\u016bni\u0173 silpnumas. Pa\u017eeidus kaul\u0173 \u010diulpus, d\u0117l ma\u017eakraujyst\u0117s i\u0161blyk\u0161ta oda, o suma\u017e\u0117jus trombocit\u0173 skai\u010diui, joje atsiranda smulkios kraujosruvos.<\/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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Diagnozuojant lig\u0105, atliekami \u012fvair\u016bs tyrimai:<\/div>
– klinikinis kraujo tyrimas;<\/div>
– radioizotopinis kaul\u0173 skenavimas;<\/div>
– pilvo kompiuterin\u0117 (KT) ir\/ar magnetinio rezonanso tomografija (MRT), atkreipiant d\u0117mes\u012f \u012f limfmazgius ir kepenis;<\/div>
– kr\u016btin\u0117s l\u0105stos rentgenografija, esant reikalui \u2013 KT, MRT;<\/div>
– hormoniniai tyrimai: katecholamin\u0173 ir j\u0173 skilimo produkt\u0173 (vanililmigdol\u0173, homovanilin\u0117s r\u016bg\u0161ties) koncentracijos nustatymas \u0161lapime;<\/div>
– padid\u0117jusi\u0173 limfmazgi\u0173 bei paties tumoro biopsija (audinio pa\u0117mimas tolimesniam i\u0161tyrimui mikroskopu ir genetiniams tyrimams \u2013 N-myc, kitaip MYCN, geno kiekio nustatymui);<\/div>
– kaul\u0173 \u010diulp\u0173 aspiracija ir biopsija.<\/div>
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Priklausomai nuo vaiko am\u017eiaus, naviko dyd\u017eio, i\u0161plitimo \u012f limfmazgius, gretimus ir atokius organus, nustatoma ligos stadija.<\/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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Priklausomai nuo ligos stadijos ir jos atsinaujinimo (recidyvo) rizikos, gali b\u016bti taikomas chirurginis, spindulinis gydymas, chemoterapija ir, kai kada, kaul\u0173 \u010diulp\u0173 ar periferini\u0173 kamienini\u0173 l\u0105steli\u0173 transplantacija. Gydymo tikslas \u2013 kuo grei\u010diau sunaikinti visas navikines l\u0105steles, taip pasiekiant visi\u0161k\u0105 remisij\u0105. Laikoma, kad remisija pasiekta, kuomet i\u0161nyksta visi ligos simptomai ir po\u017eymiai, o navikini\u0173 l\u0105steli\u0173 nerandama jokiais \u012fprastiniais tyrimo metodais.<\/div>
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Chirurginis gydymas<\/i><\/div>
Jei navikas nei\u0161plit\u0119s ir j\u012f \u012fmanoma pa\u0161alinti, operacija atliekama kaip galima grei\u010diau. Deja, da\u017eniausiai prie\u0161 operacij\u0105 tenka taikyti chemoterapij\u0105, kad navikas suma\u017e\u0117t\u0173. Toli pa\u017eengusios ligos atvejais, net po chemoterapijos, chirurginis tumoro pa\u0161alinimas b\u016bna nepilnas, tod\u0117l papildomai taikomas spindulinis gydymas.<\/div>
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Operuojant, be pirminio naviko, \u0161alinami ir greta esantys limfmazgiai, siekiant \u012fvertinti ar tumoras nei\u0161plit\u0119s. Pagrindin\u0117s komplikacijos: kraujavimas, s\u0105aug\u0173 susidarymas, inkst\u0173 kraujagysli\u0173 pa\u017eeidimas, pooperacinis Hornerio sindromas. Komplikacijos retesn\u0117s, jei prie\u0161 operacij\u0105 taikyta chemoterapija.<\/div>
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Chemoterapija<\/i><\/div>
Chemoterapija taikoma beveik visiems gydomiems vaikams. Da\u017eniausiai naudojamas sud\u0117tinis gydymas karboplatina, ciklofosamidu, doksorubicinu, etopozidu. Kiti vartojami vaistai: ifosfamidas, cisplatina, topotekanas, irinotekanas, melfalanas. Gydymas skiriamas naudojantis protokolu, kuriame nurodomi gydymui vartojami vaistai, j\u0173 doz\u0117s, skyrimo b\u016bdas ir re\u017eimas.<\/div>
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Spindulinis gydymas<\/i><\/div>
Pagrindinis spindulinio gydymo tikslas – sunaikinti naviko liku\u010dius, kuri\u0173 nepavyko pa\u0161alinti chirurgi\u0161kai net po keli\u0173 chemoterapijos kurs\u0173. Viso k\u016bno ap\u0161vitinimas gali b\u016bti taikomas prie\u0161 kaul\u0173 \u010diulp\u0173 transplantacij\u0105. Kartais spindulinis gydymas naudojamas kaip skausmo mal\u0161inimo metodas, esant kaul\u0173 pa\u017eeidimams.<\/div>
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Kaul\u0173 \u010diulp\u0173 ir kamienini\u0173 l\u0105steli\u0173 transplantacija<\/i><\/div>
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<\/i>Per paskutinius 15 m. didel\u0117s rizikos ar recidyvavusios neuroblastomos gydymui vis da\u017eniau taikoma kamienini\u0173 l\u0105steli\u0173 transplantacija. Prie\u0161 \u0161i\u0105 proced\u016br\u0105 skiriamas parengiamasis chemoterapinis ar spindulinis gydymas.<\/div>
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Biologiniai moduliatoriai ir kitos priemon\u0117s<\/i><\/div>
Tiriama eil\u0117 kit\u0173 priemoni\u0173: 13-cis-retinoin\u0117 r\u016bg\u0161tis, citokin\u0173 (IL-2) genetin\u0117 terapija ir kitos imunoterapijos priemon\u0117s (pvz., monokloniniai antik\u016bnai prie\u0161 GD2 gangliozidus, esan\u010dius neuroblastomos l\u0105stel\u0117se), antiangiogeneziniai (kraujagysli\u0173 susidarym\u0105 stabdantys) vaistai.<\/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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Per pastaruosius du de\u0161imtme\u010dius neuroblastom\u0173 gydymas \u017eymiai pager\u0117jo. Esant nedideliam, nors ir metastazavusiam navikui, did\u017eioji dalis vaik\u0173 pagydomi. Susirgus k\u016bdikyst\u0117je, net ir esant i\u0161plitusiam navikui (vadinamoji 4S stadija), gana didel\u0117 tumoro savaiminio i\u0161nykimo tikimyb\u0117.<\/div>\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 Neuroblastoma Neuroblastoma \u2013 tai piktybinis simpatin\u0117s nerv\u0173 sistemos navikas. \u0160i sistema reguliuoja organizmo funkcijas, i\u0161skirdama chemi\u0161kai aktyvias med\u017eiagas, pavyzd\u017eiui, adrenalin\u0105. Daugiau nei pus\u0117 \u0161i\u0173 navik\u0173 i\u0161sivysto antinks\u010diuose. Sergamumas Neuroblastoma sudaro 8-10 % vis\u0173 piktybini\u0173 vaik\u0173 navik\u0173 ir yra da\u017eniausias navikas pirmaisiais gyvenimo metais. Did\u017eiajai daliai vaik\u0173 neuroblastoma diagnozuojama iki 5 m. am\u017eiaus. Berniukai […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":3842,"menu_order":4,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"footnotes":""},"class_list":["post-3878","page","type-page","status-publish","hentry"],"yoast_head":"\nNeuroblastoma - Labdaros ir paramos fondas \u201eRugut\u0117\u201c<\/title>\n<meta name=\"description\" content=\"Neuroblastoma \u2013 tai piktybinis simpatin\u0117s nerv\u0173 sistemos navikas. \u0160i sistema reguliuoja organizmo funkcijas, i\u0161skirdama chemi\u0161kai aktyvias...\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/rugute.lt\/en\/informacija\/piktybiniai-navikai\/neuroblastoma\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Neuroblastoma - Labdaros ir paramos fondas \u201eRugut\u0117\u201c\" \/>\n<meta property=\"og:description\" content=\"Neuroblastoma \u2013 tai piktybinis simpatin\u0117s nerv\u0173 sistemos navikas. \u0160i sistema reguliuoja organizmo funkcijas, i\u0161skirdama chemi\u0161kai aktyvias...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/rugute.lt\/en\/informacija\/piktybiniai-navikai\/neuroblastoma\/\" \/>\n<meta property=\"og:site_name\" content=\"Labdaros ir paramos fondas \u201eRugut\u0117\u201c\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/rugute\/\" \/>\n<meta property=\"article:modified_time\" content=\"2022-01-12T07:55:30+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/rugute.lt\/wp-content\/uploads\/2019\/01\/rugute_logo_uzrasas.png\" \/>\n\t<meta property=\"og:image:width\" content=\"2000\" \/>\n\t<meta property=\"og:image:height\" content=\"646\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/png\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:site\" content=\"@rugute\" \/>\n<meta name=\"twitter:label1\" content=\"Estimated reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"4 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":[\"WebPage\",\"MedicalWebPage\"],\"@id\":\"https:\\\/\\\/rugute.lt\\\/informacija\\\/piktybiniai-navikai\\\/neuroblastoma\\\/\",\"url\":\"https:\\\/\\\/rugute.lt\\\/informacija\\\/piktybiniai-navikai\\\/neuroblastoma\\\/\",\"name\":\"Neuroblastoma - 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