Osteosarcoma

**Osteosarcoma** ( **OS** ) ko **osteogenic sarcoma** ( **OGS** ) (ko kuma kawai ciwon daji na cikin ƙashi ) ciwon daji na cikin kashi . Musamman, shi ne neoplasm wanda ya taso daga tsohuwar sel da aka canza daga asalin mesenchymal (kuma haka sarcoma ) kuma yana nuna bambancin osteoblastic kuma yana haifar da mummunan osteoid .

Osteosarcoma shine mafi yawan nau'in tarihin tarihi na sarcoma na kashi na farko. Ya fi yaduwa a cikin matasa da matasa.

## Alamomi
Yawancin marasa lafiya na farko suna kokawa game da ciwo wanda zai iya zama mafi muni da dare, yana iya zama tsaka-tsaki kuma yana da bambanci kuma yana iya faruwa na dogon lokaci. Matasan da ke aiki a wasanni sukan koka game da ciwo a cikin ƙananan femur, ko kuma nan da nan a ƙarƙashin gwiwa. Idan ƙari yana da girma, zai iya bayyana a matsayin kumburi a fili. Wani lokaci karaya kwatsam shine alamar farko saboda kashin da ya shafa ba shi da ƙarfi kamar kashi na al'ada kuma yana iya karyewa ta hanyar da ba ta dace ba tare da ƙananan rauni . A lokuta da ƙarin ciwace-ciwacen daji masu zurfi waɗanda ba su da kusanci da fata, kamar waɗanda suka samo asali daga ƙashin ƙugu, kumburin da ba a iya gani ba na iya bayyana.

## Dalilai
Ƙungiyoyin bincike da yawa suna bincikar ƙwayoyin cutar kansa da yuwuwar su na haifar da ciwace-ciwace tare da kwayoyin halitta da sunadarai masu haifar da abubuwa daban-daban. Maganin rediyo don yanayin da ba shi da alaƙa yana iya zama sanadi mai wuyar gaske. 

* Karamin chromosome na babban adadi ko chromosome yana nan a cikin ƙwayoyin tumor ƙananan ƙwararrun OS ciki har da ƙananan OS Central OS da paraosteal OS (duba sashe Variants), yana ɗaukar nau'ikan kwayoyin halitta masu yuwuwar cutar daji, kuma ana tunanin su taimakawa wajen ci gaban wadannan OS. (Dubi Ƙananan chromosomes masu alamar adadi da katuwar chromosomes na sanda a cikin osteosarcomas )
* Lamurra na iyali inda shafewar chromosome 13q14 ya hana ƙwayar retinoblastoma yana da alaƙa da babban haɗarin ci gaban osteosarcoma.
* Dysplasias na kasusuwa, ciki har da cutar Paget na kashi, dysplasia fibrous, enchondromatosis, da kuma exostoses masu yawa na gado, ƙara haɗarin osteosarcoma.
* Li-Fraumeni ciwo (germline TP53 maye gurbi) abu ne mai kaifi don ci gaban osteosarcoma.
* Rothmund-Thomson ciwo (watau autosomal recessive Association of congenital kashi lahani, gashi da fata dysplasias, hypogonadism, da kuma cataracts) yana da alaƙa da ƙara haɗarin wannan cuta.
* Manyan allurai na Sr-90, wanda ake wa lakabi da mai neman kashi, yana kara haɗarin kamuwa da cutar kansar kasusuwa da cutar sankarar bargo a cikin dabbobi kuma ana tsammanin yin hakan a cikin mutane.

Babu wata ƙayyadaddun alaƙa tsakanin fluorid na ruwa da ciwon daji ko mutuwa saboda ciwon daji, duka ga kansar gabaɗaya kuma musamman ga kansar ƙashi da osteosarcoma. Jerin bincike ya kammala cewa tattarawar fluoride a cikin ruwa baya haɗuwa da osteosarcoma. Imani game da alaƙar bayyanar da fluoride da osteosarcoma sun samo asali ne daga nazarin shirin Amurka na Toxicology a cikin 1990, wanda ya nuna shaida mara tabbas na haɗin fluoride da osteosarcoma a jikin beraye maza. Amma har yanzu babu wata kwakkwarar shaida na halin da ke haifar da ciwon daji na fluoride a jikin beraye.  An yi amfani da fluoridation na ruwa a duk duniya don inganta lafiyar hakori na 'yan ƙasa. Hakanan ana ɗaukarsa a matsayin babban nasarar lafiya.  Ana daidaita matakan tattara fluoride a cikin samar da ruwa, kamar Hukumar Kare Muhalli ta Amurka ta tsara matakan fluoride don kada su wuce milligrams 4 a kowace lita.  A haƙiƙa, kayan ruwa sun riga sun sami fluoride da ke faruwa na halitta, amma yawancin al'ummomi sun zaɓi ƙara ƙarin fluoride har ya iya rage ruɓar haƙori.  Fluoride kuma sananne ne don ikon sa na haifar da sabon samuwar kashi.  Duk da haka, ƙarin bincike ya nuna babu haɗarin osteosarcoma daga ruwa mai fluoridated a cikin mutane.  Yawancin bincike sun haɗa da ƙidayar adadin marasa lafiyar osteosarcoma a wasu yankuna na musamman waɗanda ke da bambancin adadin fluoride a cikin ruwan sha. Binciken kididdiga na bayanan bai nuna wani gagarumin bambanci a cikin abubuwan da suka faru na osteosarcoma a cikin yankuna daban-daban na fluoridated.  Wani muhimmin bincike ya haɗa da tattara samfuran kashi daga marasa lafiya osteosarcoma don auna ƙwayar fluoride da kwatanta su da samfuran kashi na sababbin ciwace-ciwacen ƙasusuwa. Sakamakon shi ne cewa matsakaicin matsakaicin fluoride na tsakiya a cikin samfurori na kashi na marasa lafiya osteosarcoma da ciwon tumo ba su da bambanci sosai.  Ba wai kawai tattarawar fluoride a cikin ƙasusuwa ba, bayyanar Fluoride na marasa lafiya osteosarcoma kuma an tabbatar da cewa bai bambanta da mutane masu lafiya ba. 

## Makanikai

Osteosarcomas yakan faru ne a wuraren haɓakar ƙashi, mai yiwuwa saboda yaduwa yana sa ƙwayoyin osteoblastic a cikin wannan yanki suna da wuyar samun maye gurbin da zai iya haifar da canji na sel (jin RB da p53 suna da hannu sosai). Ana iya gano ƙwayar cuta a ƙarshen kashi (mafi yawanci a cikin metaphysis). Mafi sau da yawa yana rinjayar kusancin ƙarshen tibia ko humerus, ko kuma ƙarshen femur . Osteosarcoma yana kula da yankunan da ke kusa da gwiwa a cikin 60% na lokuta, 15% a kusa da hip, 10% a kafada, da 8% a cikin jaw . Ciwon daji yana da ƙarfi, mai wuya, mara daidaituwa ("bishiyar fir," "cin asu", ko bayyanar "rana ta fashe" akan gwajin X-ray) saboda ƙwayar ƙwayar cuta ta ƙashin ƙashin ƙugu yana haskakawa a kusurwoyi masu kyau. Wadannan kusurwoyi madaidaici suna samar da abin da aka sani da triangle Codman, wanda shine halayyar amma ba bincike na osteosarcoma ba. Ana shigar da kyallen da ke kewaye.

A microscopically: Siffa ta osteosarcoma ita ce kasancewar osteoid (samuwar kashi) a cikin ƙwayar cuta. Kwayoyin Tumor suna da yawa pleomorphic ( anaplastic ), wasu suna da girma, masu yawa atypical mitoses . Wadannan sel suna samar da osteoid wanda ke kwatanta trabeculae marasa daidaituwa (amorphous, eosinophilic / ruwan hoda) tare da ko ba tare da ƙididdigar tsakiya ba ( hematoxylinophilic / blue, granular) - kashi. An haɗa ƙwayoyin tumor a cikin matrix osteoid . Dangane da sifofin sel masu ƙari (ko sun yi kama da sel na kashi, ƙwayoyin guringuntsi, ko ƙwayoyin fibroblast), za a iya rarraba ƙari. Osteosarcomas na iya nuna manyan ƙwayoyin osteoclast masu yawa.

## Bincike

Likitocin iyali da likitocin kasusuwa ba kasafai suke ganin mugun ciwan kashi (mafi yawan ciwan kashi ba su da kyau ). Hanyar ganewar osteosarcoma yawanci yana farawa da X-ray, yana ci gaba da haɗuwa da sikanin ( CT scan, PET scan, duban kashi, MRI ) kuma ya ƙare tare da biopsy na tiyata . Halin da ake gani sau da yawa a cikin X-ray shine triangle na Codman, wanda shine ainihin rauni na subperiosteal da aka samu lokacin da periosteum ya tashi saboda ƙari. Fina-finai suna da ban sha'awa, amma biopsy na kashi shine kawai tabbataccen hanya don sanin ko ciwace- ciwacen daji ba shi da kyau ko mara kyau .

Yawancin lokuta, alamun farko na osteosarcoma ana kama su akan hasken X-ray da aka ɗauka yayin duban hakori na yau da kullun. Osteosarcoma yana tasowa akai-akai a cikin mandible (ƙananan muƙamuƙi); don haka, an horar da likitocin hakora don neman alamun da za su iya nuna osteosarcoma. Ko da yake binciken rediyo na wannan ciwon daji ya bambanta sosai, yawanci mutum yana ganin faɗaɗa daidaitaccen sararin ligament na periodontal. Likitan hakori wanda ke da dalilin zargin osteosarcoma ko wata cuta mai rikicewa zai tura mara lafiya zuwa likitan Oral & Maxillofacial don biopsy. Wani ƙwararren likitan likitancin kasusuwa ya kamata ya yi nazarin halittun da ake zargin osteosarcoma a waje da yankin fuska. Ƙungiyar Ciwon daji ta Amirka ta ce: "Wataƙila a cikin wani ciwon daji da ke da muhimmanci a yi wannan hanya yadda ya kamata. Kwayar cutar kwayar halitta da ba ta dace ba na iya yin wahala a ceci abin da ya shafa daga yanke." Hakanan yana iya daidaitawa ga huhu, galibi yana bayyana akan X-ray na ƙirji a matsayin kaɗaici ko zagaye nodules da yawa galibi a ƙananan yankuna.

### Bambance-bambance

* Na al'ada: osteoblastic, chondroblastic, fibroblastic OS
* Telangiectatic OS
* Small cell OS
* Ƙananan OS na tsakiya
* Periosteal OS
* Paraosteal OS
* Na biyu OS
* High-sa surface OS
* Extraskeletal OS

## Magani
Cikakken, tiyata, *en block* resection na ciwon daji, shine maganin zabi a cikin osteosarcoma. Ko da yake kusan kashi 90 cikin 100 na marasa lafiya suna iya yin tiyatar ceton gaɓoɓi, matsaloli, musamman kamuwa da cuta, sassautawar prosthetic da rashin haɗin gwiwa, ko sake dawowar ƙari na gida na iya haifar da buƙatar ƙarin tiyata ko yankewa.

Ana amfani da Mifamurtide bayan an yi wa maijiyya tiyata don cire ƙwayar cuta tare da chemotherapy don kashe sauran ƙwayoyin cutar kansa don rage haɗarin sake dawowa. Har ila yau, akwai zaɓi don yin rotationplasty bayan an fitar da ƙari..

Marasa lafiya tare da osteosarcoma ya kasan ce kuma an fi kulawa da su ta hanyar likitanci da kuma likitan da ya ƙware wajen sarrafa sarcomas. Daidaitaccen magani na yanzu shine a yi amfani da chemotherapy neoadjuvant (chemotherapy da aka bayar kafin a yi tiyata) sannan a sake yin aikin tiyata. Yawan adadin necrosis cell tumor cell (mutuwar kwayar halitta) da aka gani a cikin ciwon daji bayan tiyata yana ba da ra'ayi game da tsinkaya kuma ya ba da damar likitan ilimin likitancin likita idan ya kamata a canza tsarin ilimin chemotherapy bayan tiyata.

Daidaitaccen magani shine haɗuwa da ƙwayar kuma ko kuma a cikin wani nau'i na methotrexate mai girma tare da leucovorin ceto, intra-arterial cisplatin, adriamycin, ifosfamide tare da mesna, BCD ( bleomycin, cyclophosphanomycin, da damcin). ), Etoposide, da muramyl tripeptide.  Ana iya amfani da rotationplasty . Ifosfamide za a iya amfani da shi azaman maganin adjuvant idan ƙimar necrosis yayi ƙasa.

Duk da nasarar chemotherapy don osteosarcoma, yana da ɗaya daga cikin mafi ƙanƙanta adadin rayuwa don ciwon daji na yara. Mafi kyawun rahoton shekaru 10 na rayuwa shine 92%; Yarjejeniyar da aka yi amfani da ita wani tsari ne mai tsanani na intra-arterial wanda ke keɓance jiyya bisa ga amsawar arteriographic. Rayuwa ba tare da aukuwa na shekaru uku daga 50% zuwa 75% ba, kuma rayuwa ta shekaru biyar tana daga 60% zuwa 85+% a wasu binciken. Gabaɗaya, 65-70% marasa lafiya da aka bi da su shekaru biyar da suka gabata za su rayu a yau. Waɗannan ƙimar rayuwa gabaɗaya matsakaita ne kuma sun bambanta sosai dangane da ƙimar necrosis ɗaya.

Filgrastim ko pegfilgrastim suna taimakawa tare da kirga fararen ƙwayoyin jini da ƙididdigar neutrophil . Jinin da epoetin alfa suna taimakawa tare da anemia . Ƙididdiga a kan rukunin layin salula na osteosarcoma ya gano sababbin abubuwan da aka raba da kuma takamaiman maƙasudin warkewa (proteomic da genetic) a cikin osteosarcoma, yayin da phenotypes ya nuna ƙarar rawar ƙwayoyin ƙwayoyin cuta.

## Manazarta