Kokoram

**Kokoram**() yɛ nyarewa kuw bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afa afoforo so anaasɛ ɛbɛtrɛw mu. Eyinom ne akisikuru a ɛnyɛ hu a ɛntrɛw no bɔ abira. Nsɛnkyerɛnne ne sɛnkyerɛnne ahorow a ebetumi aba no bi ne akisikuru, mogya a ɛnteɛ, ɔfe a ɛtra hɔ kyɛ, ne mu duru a ɛso tew a wontumi nkyerɛkyerɛ mu, ne nsakrae a ɛba wɔ ne dwensɔtwaa mu. Bere a saa sɛnkyerɛnne ahorow yi betumi akyerɛ sɛ kokoram de, nanso ebetumi de nneɛma afoforo nso aba. Kokoram ahorow bɛboro 100 na ɛka nnipa.

Tawa a wɔde di dwuma no na ɛde kokoram wuwu bɛyɛ 22% ba. 10% foforo nso fi kɛseyɛ mmoroso, aduan pa a wonni, apɔw-mu-teɛteɛ a wonnya anaasɛ nsa a wɔnom boro so. Nneɛma afoforo a ɛde ba ne ɔyare mmoawa bi, mframa a ɛma ɛyɛ ion a wɔde wɔn ho hyɛ mu, ne nneɛma a atwa yɛn ho ahyia a ɛde efi ba. Wɔ aman a afei na wɔrenya nkɔso mu no, kokoram 15% fi nyarewa te sɛ Helicobacter pylori, mmerɛbo mu yare B, mmerɛbo mu yare C, nnipa papillomavirus yare mmoawa, Epstein–Barr mmoawa ne nnipa nipadua mu tumi a ɛko tia nyarewa (HIV). Anyɛ yiye koraa no, saa nneɛma yi yɛ adwuma, ne fa bi, denam nkwammoaa bi awosu mu nkwaadɔm a wɔsakra no so. Mpɛn pii no, ɛho hia sɛ wɔyɛ nsakrae pii wɔ awosu mu ansa na kokoram aba.Bɛyɛ kokoram 5–10% fi awosu mu sintɔ ahorow a wonya fi awo mu. Wobetumi de nsɛnkyerɛnne ne sɛnkyerɛnne ahorow bi anaa nhwehwɛmu a wɔde hwehwɛ kokoram mu ahu kokoram.Afei wɔtaa de nnuruyɛ mu mfoniniyɛ hwehwɛ mu bio na wɔde nipadua mu nhwehwɛmu si so dua.

Wobetumi atew asiane a ɛwɔ hɔ sɛ obi benya kokoram ahorow bi so denam sigaretnom a wɔrennom, ne mu duru a ɛfata a wɔbɛkɔ so atra mu, nsa a wɔnom ano hye, nhabannuru, nnuaba, ne aburow a wɔayam no yiye a wobedi, nyarewa bi a wɔde yare mmoawa ba a wɔbɛbɔ wɔn ho ban, nam a wɔayɛ ho adwuma ne nam kɔkɔɔ a wɔbɛtow ano hye, ne nea wɔbɛto ano hye so owia hann a ɛba tẽẽ.Sɛ wohu ntɛm denam nhwehwɛmu so a, ɛho wɔ mfaso ma awotwaa ne akyi berɛmo mu kokoram. Mfaso a ɛwɔ nufu mu kokoram a wɔhwehwɛ mu no yɛ nea akyinnyegye wom.Wɔtaa de mframa bɔne a wɔde sa yare, oprehyɛn, nnuru a wɔde sa yare ne ayaresa a wɔde wɔn ani asi so a wɔaka abom bi sa kokoram. Ɛyaw ne sɛnkyerɛnne ahorow a wɔde di dwuma no yɛ ɔhwɛ no fa titiriw. Ayaresa a ɛma obi ho dwo no ho hia titiriw wɔ nnipa a wɔwɔ yare a emu yɛ den no mu. Hokwan a ɛwɔ hɔ sɛ obi benya nkwa no gyina kokoram ko a ɛwɔ ne baabi a yare no kodu bere a wɔrefi ayaresa ase no so.[10] Wɔ mmofra a wonnii mfe 15 mu bere a wohu yare no, sɛ wɔkyekyem pɛpɛɛpɛ a, mfe anum a wɔde tra ase wɔ aman a wɔanya nkɔso no mu no yɛ 80%Wɔ kokoram ho wɔ United States no, sɛ wɔkyekyem pɛpɛɛpɛ a, mfe anum a wɔde tra ase no yɛ 66%.

Wɔ afe 2015 mu no, nnipa bɛyɛ ɔpepem 90.5 wɔ wiase nyinaa nyaa kokoram.[18] Wɔ afe 2019 mu no, kokoram a ɛba afe biara no nyaa nkɔanim nnipa ɔpepem 23.6 na nnipa ɔpepem 10 na wowuwui wɔ wiase nyinaa, a ɛkyerɛ wɔ mfe du a atwam no mu no, nkɔanim 26% ne 21%, sɛnea ɛte biara.

Kokoram ahorow a ɛtaa ba mmarima so ne ahurututu mu kokoram, prostate kokoram, akyi berɛmo mu kokoram, ne yafunu mu kokoram.Wɔ mmea mu no, nea ɛtaa ba ne nufu mu kokoram, kokoram a ɛwɔ akyi berɛmo mu, ahurututu mu kokoram, ne awotwaa mu kokoram. Sɛ wɔde honam ani kokoram a ɛnyɛ melanoma ka kokoram foforo a ɛba nyinaa ho afe biara a, anka ɛbɛyɛ nea ɛba no mu bɛyɛ 40%.Wɔ mmofra mu no, lymphoblastic leukemia a emu yɛ den ne amemene mu akisikuru na abu so kɛse, gye Afrika, baabi a lymphoma a ɛnyɛ Hodgkin taa ba no.Wɔ afe 2012 mu no, mmofra bɛyɛ 165,000 a wonnii mfe 15 na wohui sɛ wɔwɔ kokoram. Kokoram ho asiane no kɔ soro kɛse bere a obi nyin no, na kokoram pii taa ba aman a wɔanya nkɔso ne mu . Nneɛma dodow rekɔ soro bere a nnipa pii tra ase kosi wɔn nkwakoraa ne mmerewa ne asetra mu nsakrae ba wɔ aman a afei na wɔrenya nkɔso no mu no.Wɔbuu akontaa sɛ wiase nyinaa sikasɛm mu ka a wɔbɔ wɔ kokoram ho nyinaa yɛ U.S. dɔla ɔpepepem 1.16 afe biara de besi afe 2010.

## Etymology ne nkyerɛase ahorow
Asɛmfua no fi tete Hela asɛmfua καρκίνος, a ɛkyerɛ krak ne akisikuru mu. Helafo nnuruyɛfo Hippocrates ne Galen, ne afoforo, hui sɛ krak ne akisikuru bi a ntini a ahonhon no di nsɛ. Wɔde asɛmfua no baa Borɔfo kasa mu wɔ nnɛyi aduruyɛ mu ntease mu bɛyɛ afe 1600 mu.

Kokoram yɛ nyarewa abusua kɛse bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afa afoforo so anaasɛ ɛbɛtrɛw mu. Wɔyɛ neoplasm ahorow no fa ketewaa bi. Neoplasm anaa tumor yɛ nkwammoaa kuw bi a wɔanyinyin a wɔanhyɛ da na ɛbɛtaa ayɛ mass anaa akisikuru, nanso ebetumi akyekyɛ wɔ ɔkwan a ɛtrɛw so.

Nkwammoaa a ɛwɔ akisikuru no nyinaa da kokoram agyiraehyɛde ahorow asia adi. Saa su ahorow yi ho hia na ama wɔanya akisikuru a ɛyɛ hu. Nea ɛka ho ne:.

Nkwammoaa nyin ne mpaapaemu nni nsɛnkyerɛnne a ɛfata

Nkɔso a ɛkɔ so ne mpaapaemu a wɔde nsɛnkyerɛnne a ɛne no bɔ abira mpo ama

Nkwammoaa a wɔayɛ ho nhyehyɛe a wobewuwu a wɔbɛkwati

Nkwammoaa mu mpaapaemu dodow a anohyeto nni mu

Mogya ntini a wɔyɛ no ho nkuranhyɛ

Ntini mu ntua ne metastases a ɛba .

Nkɔso a efi nkwammoaa a ɛteɛ mu kɔ nkwammoaa a ebetumi ayɛ kɛse a wotumi hu mu kɔ kokoram koraa mu no fa anammɔn pii a wɔfrɛ no nkɔso a ɛyɛ hu ho.

## Nsɛnkyerɛnne ne sɛnkyerɛnne ahorow
Sɛ kokoram fi ase a, ɛmma yare no ho sɛnkyerɛnne biara mma. Nsɛnkyerɛnne ne sɛnkyerɛnne ahorow da adi bere a aduru no nyin anaasɛ ɛyɛ kurukuruwa no. Nea ebefi mu aba no gyina kokoram no su ne faako a ɛwɔ so. Nsɛnkyerɛnne kakraa bi na ɛwɔ hɔ pɔtee. Pii taa ba ankorankoro a wɔwɔ tebea afoforo mu. Kokoram betumi ayɛ den sɛ wobehu na wobetumi abu no sɛ "ɔsuasua kɛse.

Nkurɔfo betumi ayɛ basaa anaa adwenemhaw bere a wɔahu yare no akyi. Asiane a ɛwɔ hɔ sɛ nnipa a wɔwɔ kokoram bekum wɔn ho no bɛyɛ mmɔho abien.

**Nsɛnkyerɛnne a ɛwɔ mpɔtam hɔ**

Mpɔtam hɔ sɛnkyerɛnne ahorow betumi aba esiane akisikuru no kɛse anaasɛ ne kuru nti. Sɛ nhwɛso no, nneɛma pii a efi ahurututu mu kokoram mu ba no betumi asiw ahurututu no ano na ɛde ɔfe anaa ahurututu mu yare aba; esophageal cancer betumi ama esophagus no ayɛ teateaa, na ama ayɛ den anaasɛ ɛyɛ yaw sɛ wɔbɛmene; na kokoram a ɛba akyi berɛmo mu no betumi ama dwensɔtwaa no ayɛ ketewaa anaasɛ asiw, na aka dwensɔtwaa no su ahorow. Nneɛma a ɛdɔɔso wɔ nufu anaa awotwaa mu no betumi ama akuru a wotumi hu aba. Akuru betumi ama mogya atu a ebetumi ama woanya sɛnkyerɛnne ahorow te sɛ mogya a ɛbɛfe (ahurututu mu kokoram), mogya a ɛtɔ obi nipadua mu anaasɛ mogya a ɛtɔ obi akyi berɛmo mu (kokoram a ɛba obi akyi berɛmo mu), mogya a ɛba nsuo mu (akisikuru mu kokoram), anaa mogya a ɛtɔ obi awotwaa mu a ɛnteɛ (endometrial anaa awotwaa mu kokoram). Ɛwom sɛ ɛyaw a ɛwɔ baabiara betumi aba wɔ kokoram a ɛkɔ anim mu de, nanso mpɛn pii no akisikuru a edi kan no nyɛ yaw. Kokoram ahorow bi betumi ama nsu aboaboa ano wɔ koko anaa yafunu mu.

**Nsɛnkyerɛnne a ɛwɔ nhyehyɛe mu**

Nneɛma a ɛwɔ nipadua no mu no betumi aba esiane sɛnea nipadua no yɛ n’ade wɔ kokoram no ho nti. Ebia nea ɛka eyi ho ne ɔbrɛ, mu duru a wɔanhyɛ da a ɛso tew, anaasɛ honam ani a ɛbɛsakra.Kokoram ahorow bi betumi ama nipadua no mu ɔhyew tebea bi a ɛma ntini ahorow no kɔ so hwere na ɛyɛ mmerɛw, a wɔfrɛ no cachexia.

Kokoram ahorow bi te sɛ Hodgkin yare, mogya mu kokoram, ne mmerɛbo anaa asaabo mu kokoram betumi ama obi anya atiridii a ɛkɔ so daa.

Kokoram ho sɛnkyerɛnne ahorow bi a ɛba nipadua no mu no fi hormone anaa molecule afoforo a akisikuru no de ba, a wɔfrɛ no paraneoplastic syndromes no. Paraneoplastic syndromes a ɛtaa ba no bi ne hypercalcemia, a ebetumi ama adwene mu tebea asakra, akisikuru ne nsu a ɛho ayɛ fi, anaasɛ hyponatremia, a ɛno nso betumi ama adwene mu tebea asakra, ɔfe, tiyɛ, anaa akisikuru.

Nneɛma a ɛtrɛw kɔ mmeae afoforo

**Asɛm titiriw: Metastasis**

Metastasis yɛ kokoram a ɛtrɛw kɔ mmeae afoforo wɔ nipadua no mu. Wɔfrɛ akisikuru a apete no metastatic tumors, bere a wɔfrɛ nea edi kan no akisikuru titiriw. Ɛkame ayɛ sɛ kokoram nyinaa tumi kɔ mmeae afoforo. Kokoram a wowuwu dodow no ara fi kokoram a akɔ mmeae afoforo.

Metastasis taa ba wɔ kokoram no fa a etwa to no mu na ebetumi afa mogya anaa ntini a ɛma mogya tu no anaa n’abien nyinaa so aba. Anamɔn a ɛtaa ba wɔ metastasis mu ne mpɔtam hɔ ntua, ntini a ɛkɔ mogya anaa ntini mu, mogya a ɛkɔ nipadua no mu, ntini a ɛkɔ ntini foforo no mu, ntini a ɛdɔɔso ne ntini a ɛma mogya tu. Kokoram ahorow taa kɔ akwaa pɔtee bi mu, nanso ne nyinaa mu no, mmeae a ɛtaa kɔ mmeae afoforo ne ahurututu, mmerɛbo, amemene ne nnompe.

## Nneɛma a ɛde ba
Kokoram dodow no ara, bɛyɛ 90–95% wɔ nsɛm no mu, fi awosu mu nsakrae a efi nneɛma a atwa yɛn ho ahyia ne asetra kwan mu nneɛma mu ba. 5–10% a aka no fi awosu mu nneɛma. Nneɛma a atwa yɛn ho ahyia kyerɛ biribiara a ɛde ba a ɛnyɛ agyapade, te sɛ asetra kwan, sikasɛm, ne suban mu nneɛma na ɛnyɛ efi ara kwa. Nneɛma a atwa yɛn ho ahyia a ɛtaa ma kokoram wuwu no bi ne tawa a wɔnom (25–30%), aduan ne kɛseyɛ mmoroso (30–35%), ɔyare mmoawa (15–20%), mframa bɔne (a ɛma ɛyɛ ion ne nea ɛnyɛ ion nyinaa, ɛkɔ 10%) . , nipadua mu dwumadi a wonnya, ne efi. Ɛte sɛ nea adwene mu nhyɛso nyɛ asiane a ɛma kokoram fi ase,ɛwom sɛ ebetumi ama nea efi mu ba no asɛe wɔ wɔn a wɔwɔ kokoram dedaw no mu de.

Mpɛn pii no, wontumi nkyerɛ nea ɛde kokoram pɔtee bi bae efisɛ nneɛma ahorow a ɛde ba no nni nsateaa pɔtee bi. Sɛ nhwɛso no, sɛ obi a ɔnom tawa pii nya ahurututu mu kokoram a, ɛnde ɛbɛyɛ sɛ tawa nom no na ɛde bae, nanso esiane sɛ obiara wɔ hokwan ketewaa bi sɛ obenya ahurututu mu kokoram esiane mframa a wɔsɛe no anaa mframa a wɔde ma nti, ebia kokoram no nyaa nkɔso maa saa nneɛma no mu biako. Sɛ yɛyi ɔyare mmoawa a ɛntaa nsi a ɛba wɔ nyinsɛn ne akwaa a wɔde ma bere ne bere mu no nkutoo ho a, mpɛn pii no kokoram nyɛ yare a wɔde kɔ nnipa mu,nanso nneɛma a ebia ɛmaa kokoram bae no betumi ayɛ nea wɔde kɔ nnipa mu; te sɛ oncovirus te sɛ hepatitis B, Epstein-Barr mmoawa ne HIV.

**Nnuru a wɔde yɛ nnuru**

Nsɛm foforo: Nsa ne kokoram ne Sigaretnom ne kokoram

Ahurututu mu kokoram a ɛba no ne sigaretnom wɔ abusuabɔ kɛse.

Wɔde nneɛma pɔtee bi a wɔde di dwuma no bata kokoram ahorow pɔtee bi ho. Wɔfrɛ saa nneɛma yi nnuru a ɛma obi nya kokoram.

Sɛ nhwɛso no, tawa wusiw na ɛde ahurututu mu kokoram 90% ba. Ɛsan nso de kokoram ba anom, ti, kɔn, yafunu, akisikuru, asaabo, ɛwo ne dwensɔtwaa mu.Tawa wusiw wɔ nneɛma bɛboro aduonum a wonim sɛ ɛde kokoram ba, a nitrosamines ne polycyclic aromatic hydrocarbons ka ho.

Tawa na ɛde kokoram wuwu bɛyɛ nnipa baanum biara mu biako wɔ wiase nyinaane bɛyɛ baasa biara mu biako wɔ aman a wɔanya nkɔso no mu.Nnipa dodow a wowuwu wɔ ahurututu mu kokoram mu wɔ United States no ada sigaretnom kwan no adi, na sigaretnom dodow a ɛkɔ soro na ɛno akyi no, nnipa dodow a wowuwu wɔ ahurututu mu kokoram mu no kɔ soro kɛse, na nnansa yi ara, nnipa dodow a wowuwu wɔ ahurututu mu kokoram mu no so atew fi 1950 mfe no mu na ɛno akyi no, nnipa dodow a wowuwu wɔ ahurututu mu kokoram mu wɔ mmarima mu no so atew fi 1990 . Ɔde ne nsa kyerɛɛ ne so.

Wɔ Europa Atɔe Fam no, kokoram a ɛba mmarima mu 10% ne mmea mu kokoram 3% fi nsa a wɔnom, titiriw mmerɛbo ne aduan mu kokoram. Kokoram a efi nnuru a wɔde di dwuma wɔ adwuma mu mu ba no betumi ama wɔanya nsɛm no mu 2 kosi 20%, anyɛ yiye koraa no, ebetumi ama nnipa 200,000 awuwu. Kokoram te sɛ ahurututu mu kokoram ne mesothelioma betumi afi tawa wusiw anaa asbestos nhama a wɔhome mu, anaasɛ mogya mu kokoram a efi benzene a wɔde wɔn ho hyɛ mu no mu aba.

Wonim sɛ sɛ obi nya perfluorooctanoic acid (PFOA) a wɔde di dwuma titiriw wɔ Teflon a wɔyɛ mu a, ɛde kokoram ahorow abien ba.

**Adidi ne apɔw-mu-teɛteɛ**

Asɛm titiriw: Aduandi ne kokoram

Adidi, nipadua mu dwumadi ne kɛseyɛ mmoroso ne kokoram a wowuwu no mu bɛyɛ 30–35% wɔ abusuabɔ.[3][54] Wɔ United States no, nipadua mu duru a ɛboro so no ne kokoram ahorow pii a ɛba no wɔ abusuabɔ na ɛyɛ ade a ɛma kokoram wuwu 14–20% ba.[54] UK nhwehwɛmu bi a nnipa bɛboro ɔpepem 5 ho nsɛm ka ho kyerɛe sɛ anyɛ yiye koraa no nipadua mu duru a ɛkɔ soro no ne kokoram ahorow 10 wɔ abusuabɔ na ɛde nsɛm bɛyɛ 12,000 ba afe biara wɔ saa ɔman no mu. Wogye di sɛ apɔw-mu-teɛteɛ a wɔnyɛ no boa ma kokoram ho asiane ba, ɛnyɛ nkɛntɛnso a enya wɔ nipadua mu duru so nko so na mmom nkɛntɛnso bɔne a enya wɔ nipadua no mu tumi a ɛko tia nyarewa ne nipadua no mu ntini a ɛma nipadua no mu yɛ den so nso.[54] Nkɛntɛnso a efi aduan mu ba no bɛboro fa fi aduan pa a wodi boro so (adidi pii), sen sɛ ebefi nhabannuru kakraa bi anaa nnuan afoforo a ahoɔden wom a wodi mu.

Nnuan pɔtee bi ne kokoram pɔtee bi wɔ abusuabɔ. Aduan a nkyene pii wom no ne yafunu mu kokoram wɔ abusuabɔ.[56] Aflatoxin B1, a ɛtaa de efi gu aduan mu no de mmerɛbo mu kokoram ba.[56] Betel nut a wɔwe no betumi ama obi anya kokoram wɔ anom.[56] Ebia nsonsonoe a ɛwɔ ɔman no aduan mu nneyɛe mu no bɛkyerɛkyerɛ nsonsonoe a ɛwɔ kokoram a ɛba mu no mu fa bi. Sɛ nhwɛso no, yafunu mu kokoram abu so kɛse wɔ Japan esiane nkyene pii a wodi nti[57] bere a akyi berɛmo mu kokoram abu so kɛse wɔ United States. Atubrafo kokoram ho nsɛm no te sɛ wɔn man foforo no de, mpɛn pii no wɔ awo ntoatoaso biako mu.[58]

**Nsaneɛ**

Asɛm titiriw: Nneɛma a ɛde kokoram ba a ɛde ɔyare mmoawa ba

Wɔ wiase nyinaa no, nnipa a kokoram kunkum wɔn no mu bɛyɛ 18% fa nyarewa a wɔde yare mmoawa ba ho. Saa dodow yi fi 25% a ɛkorɔn wɔ Afrika kosi nea ennu 10% wɔ aman a wɔanya nkɔso no mu. Virus ne nneɛma a wɔtaa de nyarewa ba a ɛde kokoram ba nanso kokoram mmoawa ne mmoawa a wɔsɛe nnɔbae nso betumi adi dwuma.

Oncovirus (mmoawa a ebetumi de kokoram aba) no bi ne nnipa papillomavirus (awotwaa mu kokoram), Epstein–Barr mmoawa (B-cell lymphoproliferative disease ne nasopharyngeal carcinoma), Kaposi sarcoma herpesvirus (Kaposi sarcoma ne primary effusion lymphomas), hepatitis B ne hepatitis C mmoawa ( hepatocellular carcinoma) ne nnipa T-nkwaboaa mu kokoram mmoawa-1 (T-nkwaboaa mu kokoram). Mmoawa a wɔde nyarewa ba no nso betumi ama kokoram ho asiane no ayɛ kɛse, sɛnea wohu wɔ yafunu mu kokoram a Helicobacter pylori de ba no mu no.[59][60] Nkwammoaa a wɔde nyarewa ba a ɛne kokoram wɔ abusuabɔ no bi ne Schistosoma haematobium (squamous cell carcinoma a ɛwɔ akisikuru mu) ne mmerɛbo mu flukes, Opisthorchis viverrini ne Clonorchis sinensis (cholangiocarcinoma).

**Mframa a wɔde yɛ adwuma**

Asɛm titiriw: Kokoram a mframa bɔne de ba

Mframa a wɔde di dwuma te sɛ ultraviolet mframa ne nneɛma a ɛma mframa bɔ kɛse no yɛ asiane a ɛde kokoram ba. Honam ani kokoram pii a ɛnyɛ melanoma no fi mframa a ano yɛ den a ɛbɔ, a ne fa kɛse no ara fi owia hann mu.Nneɛma a ɛma mframa bɔne a ɛma ɛyɛ hyew ba no bi ne aduruyɛ mu mfoninitwa ne radon mframa.

Ionizing radiation nyɛ mutagen a ɛyɛ den titiriw.Sɛ nhwɛso no, radon gas a wɔde di dwuma wɔ atrae no wɔ kokoram ho asiane te sɛ sigaretnom a wɔnyɛ hwee.[65] Mframa a wɔde ma no yɛ kokoram fibea a ano yɛ den kɛse bere a wɔde ka nneɛma afoforo a ɛde kokoram ba te sɛ radon ne tawa wusiw ho ka ho no.Mframa a ɛbɔ no betumi de kokoram aba nipadua no afa dodow no ara, mmoa nyinaa mu ne mfe biara mu. Mmofra taa nya mogya mu kokoram a mframa bɔne de ba no mmɔho abien sen mpanyimfo; mframa a wɔde ma ansa na wɔawo no nya nkɛntɛnso no mmɔho du.[65]

Mframa a ɛma ɛyɛ hyew a wɔde di dwuma wɔ aduruyɛ mu no yɛ kokoram a mframa bɔne de ba no fibea ketewaa bi nanso ɛrenya nkɔanim. Wobetumi de mframa a ɛma ɛyɛ ion adi dwuma de asa kokoram afoforo, nanso eyi betumi, wɔ tebea horow bi mu no, ama kokoram a ɛto so abien aba.[65] Wɔde di dwuma nso wɔ aduruyɛ mu mfonini ahorow bi mu.

Sɛ obi nya ultraviolet mframa a efi owia mu bere tenten a, ebetumi ama wanya melanoma ne honam ani yare afoforo. Adanse a emu da hɔ kyerɛ sɛ mframa a ɛbɔ denneennen, titiriw UVB a ɛnyɛ ionizing medium wave no, na ɛde honam ani kokoram dodow no ara a ɛnyɛ melanoma ba, a ɛyɛ kokoram ahorow a abu so sen biara wɔ wiase no.

Wiase Akwahosan Ahyehyɛde no Amanaman Ntam Dwumadibea a Ɛhwɛ Kokoram Ho Nhwehwɛmu So no aka radio frequency radiation a ɛnyɛ ionizing a efi telefon a wokura kyin mu, anyinam ahoɔden a wɔde fa nneɛma ne nneɛma afoforo a ɛtete saa mu no ho asɛm sɛ ebetumi ayɛ kokoram. Nanso, adanse ntumi nkyerɛɛ biribi a ɛhaw adwene.Nea ɛka eyi ho ne sɛ nhwehwɛmu ahorow nhuu abusuabɔ a ɛkɔ so daa wɔ telefon a wokura kyin mframa ne kokoram ho asiane ntam.

**Agyapade**

Asɛm titiriw: Kokoram yare

Kokoram dodow no ara nyɛ nea wonya fi awo mu (ɛba bere ne bere mu). Kokoram a wonya fi awo mu no fi awosu mu sintɔ bi a wonya fi awo mu titiriw. Nnipa dodow a ennu 0.3% na wɔde awosu mu nsakrae a ɛwɔ nkɛntɛnso kɛse wɔ kokoram ho asiane so na eyinom de kokoram a ennu 3–10% ba. Saa nsɛnkyerɛnne yi bi ne: nkwaadɔm mu nsakrae ahorow bi a wonya fi awo mu wɔ awosu mu nkwaadɔm BRCA1 ne BRCA2 mu a asiane bɛboro 75% wɔ nufu mu kokoram ne awotwaa mu kokoram ho, ne awosu mu kokoram a ɛnyɛ polyposis colorectal cancer (HNPCC anaa Lynch syndrome), a ɛwɔ bɛyɛ 3 mu % nnipa a wɔwɔ kokoram a ɛwɔ akyi berɛmo mu,ne afoforo.

Akontaabu mu wɔ kokoram ahorow a ɛma nnipa dodow no ara wuwu no ho no, asiane a ɛwɔ hɔ sɛ wobenya kokoram a ɛwɔ akyi berɛmo mu bere a wɔahu sɛ obusuani bi a odi kan (ɔwofo, onua anaa abofra) wɔ bi no bɛyɛ 2.Asiane a ɛne no hyia no yɛ 1.5 ma ahurututu mu kokoram,ne 1.9 ma prostate kokoram. Wɔ nufu mu kokoram ho no, asiane a ɛwɔ hɔ no yɛ 1.8 a obusuani a odi kan anya bi bere a wadi mfe 50 anaa nea ɛboro saa, ne 3.3 bere a obusuani no nyaa bi bere a na onnii mfe 50 no.

Nnipa a wɔware no wɔ asiane kɛse sɛ wobenya kokoram efisɛ wɔwɔ nkwammoaa pii sen nnipa a wɔyɛ tiaa. Esiane sɛ awosu mu nneɛma na ɛkyerɛ ɔsorokɔ kɛse nti, nnipa a wɔware no wɔ kokoram ho asiane a ɛkɔ soro fi awo mu.

**Honam fam nneɛma a wɔde yɛ nneɛma**

Nneɛma bi de kokoram ba titiriw denam ne honam fam nkɛntɛnso so, sen sɛ ɛbɛyɛ nnuru. Eyi ho nhwɛso titiriw ne asbestos a wɔde wɔn ho hyɛ mu bere tenten, mineral fibers a ɛwɔ abɔde mu a ɛyɛ ade titiriw a ɛde mesothelioma (kokoram a ɛwɔ serous membrane mu) ba mpɛn pii no serous membrane a atwa ahurututu no ho ahyia no. Wogye di sɛ nneɛma afoforo a ɛwɔ saa kuw yi mu, a nhama a ɛte sɛ asbestos a ɛwɔ abɔde mu ne nea wɔayɛ no nyinaa ka ho, te sɛ wollastonite, attapulgite, ahwehwɛ nwi ne abotan nwi no wɔ nkɛntɛnso a ɛte saa ara.[ Nneɛma nketenkete a ɛnyɛ fibrous a ɛde kokoram ba no bi ne powder metallic cobalt ne nickel ne crystalline silica (quartz, cristobalite ne tridymite). Mpɛn pii no, ɛsɛ sɛ honam fam nneɛma a ɛde kokoram ba no kɔ nipadua no mu (te sɛ nea ɛnam ɔhome so) na ɛhwehwɛ sɛ wɔde di dwuma mfe pii na ama kokoram aba.

Nipadua mu apirakuru a ɛde kokoram ba no ntaa mma.Sɛ nhwɛso no, wonnya nkyerɛɛ nsɛm a wɔka sɛ nnompe a ebubui no maa nnompe mu kokoram bae.Saa ara nso na wonnye nipadua mu apirakuru ntom sɛ ɛde awotwaa mu kokoram, nufu mu kokoram anaa amemene mu kokoram ba.Fibea biako a wogye tom ne nneɛma a ɛyɛ hyew a wɔtaa de gu nipadua no so bere tenten. Ebetumi aba sɛ nipadua no fa koro no ara a ɛhyew mpɛn pii, te sɛ nea kanger ne kairo a wɔde yɛ ɔhyew (fango nsa a wɔde yɛ hyew) de ba no betumi ama obi anya honam ani kokoram, titiriw sɛ nnuru a ɛde kokoram ba nso wɔ hɔ a Sɛ wɔtaa nom tii a ɛyɛ hyew a ɛyɛ hyew a, ebetumi ama woanya kokoram wɔ aduan mu.Mpɛn pii no, wogye di sɛ kokoram sɔre, anaasɛ wɔhyɛ kokoram a na ɛwɔ hɔ dedaw ho nkuran, wɔ ayaresa no mu, sen sɛ ɛbɛba tẽẽ denam ahodwiriw no so.[79] Nanso, sɛ obi pira ntini koro no ara mpɛn pii a, ebetumi ama nkwammoaa no adɔɔso dodo, na afei ebetumi ama asiane a ɛwɔ hɔ sɛ obi bɛsakra kokoram no ayɛ kɛse.

Wɔasusuw sɛ ɔfe a enni sabea no de nkwaadɔm mu nsakrae ba tẽẽ. Ɔfe betumi aboa ma kokoram nkwammoaa no adɔɔso, atra ase, angiogenesis ne atutra denam nkɛntɛnso a enya wɔ tumor microenvironment no so.Oncogenes no kyekye pro-tumorigenic microenvironment a ɛma ɔhyew.

**Nkwammoaa a ɛwɔ nipadua mu**

Nkwammoaa bi di dwuma wɔ kokoram a ɛba no mu denam nkwammoaa a ɛdɔɔso no so.[84] Nneɛma a ɛte sɛ insulin a ɛma onyin ne protein ahorow a ɛkyekyere wɔn no di dwuma titiriw wɔ kokoram nkwammoaa a ɛdɔɔso, nsonsonoe ne apoptosis mu, na ɛkyerɛ sɛ ebetumi aba sɛ wɔde wɔn ho ahyɛ kokoram a ɛba mu.

Hormone yɛ nneɛma a ɛho hia wɔ kokoram a ɛfa nna ho mu, te sɛ nufu, endometrium, prostate, ovary ne testis kokoram ne thyroid kokoram ne nnompe mu kokoram nso. Sɛ nhwɛso no, mmea a wɔwɔ nufu mu kokoram mmabea wɔ estrogen ne progesterone dodow a ɛkɔ soro kɛse sen mmea a wonni nufu mu kokoram mmabea. Saa hormone dodow a ɛkɔ soro yi betumi akyerɛkyerɛ asiane kɛse a ɛwɔ hɔ sɛ wobenya nufu mu kokoram no mu, bere mpo a nufu mu kokoram awosu mu abɔde biara nni hɔ no. Saa ara nso na mmarima a wofi Afrika nananom no wɔ testosterone dodow a ɛkɔ soro kɛse sen mmarima a wofi Europa nananom na wɔwɔ prostate kokoram dodow a ɛne no hyia. Mmarima a wofi Asia, a androstanediol glucuronide a ɛma testosterone yɛ adwuma no sua koraa no, na wɔwɔ prostate kokoram a ɛba fam koraa.[84]

Nneɛma afoforo nso fa ho: nnipa a wɔayɛ kɛse mmoroso no wɔ hormone ahorow bi a ɛne kokoram wɔ abusuabɔ no dɔɔso na saa kokoram ahorow no dodow kɔ soro.[84] Mmea a wɔnom nnuru a wɔde si hormone ananmu no wɔ asiane kɛse sɛ wobenya kokoram a ɛne saa hormone ahorow no wɔ abusuabɔ.[84] Ɔkwan foforo so no, nnipa a wɔteɛteɛ wɔn apɔw mu sen sɛ wɔkyekyem pɛpɛɛpɛ no, saa hormone ahorow yi sua na asiane a ɛwɔ hɔ sɛ wobenya kokoram no sua.[84] Ebia nkwaadɔm a ɛma obi nyin no na ɛma osteosarcoma nya nkɔso.[84] Ayaresa ne akwan horow bi a wɔfa so siw ano no de nea ɛde ba yi di dwuma denam hormone dodow a wɔtew so wɔ ɔkwan a wɔde nsa ayɛ so na ɛnam so ma kokoram ahorow a ɛyɛ hormone no yɛ mmerɛw no abam bu so.[84]

**Nyarewa a nipadua no tumi ko tia nyarewa**

Abusuabɔ bi wɔ celiac yare ne kokoram nyinaa ho asiane a ɛkɔ soro no ntam. Nnipa a wɔwɔ celiac yare a wɔansa wɔn yare no wɔ asiane kɛse, nanso asiane yi so tew bere a bere kɔ so bere a wɔahu sɛ wɔwɔ coeliac yare no akyi no, ebia esiane aduan a gluten nnim a wogye tom nti, a ɛte sɛ nea ɛwɔ dwuma a ɛbɔ ho ban fi ɔyare bɔne a ɛbɛba nnipa a wɔwɔ celiac yare no mu no ho . Nanso, ɛte sɛ nea bere a wɔkyɛ wɔ yare a wohu ne aduan a gluten nnim a wofi ase di no ma asiane a ɛwɔ hɔ sɛ wobenya nyarewa bɔne no yɛ kɛse.[86] Nnipa a wɔwɔ Crohn yare ne akisikuru a ɛma obi nya yafunu mu kokoram dodow kɔ soro, esiane ɔfe a enni sabea nti. Afei nso, nnuru a ɛma nipadua no tumi ko tia nyarewa ne nnuru a wɔde sa nyarewa yi betumi ama wɔanya nyarewa bɔne a ɛwɔ dwensɔtwaa no akyi.[87]

## Pathophysiology ho adesua
**Awosu mu nneɛma**

Asɛm titiriw: *Oncogenomics*

Kokoram yɛ yare titiriw a ɛma ntini ahorow nyin. Sɛnea ɛbɛyɛ a nkwammoaa a ɛteɛ bɛdan kokoram nkwammoaa no, ɛsɛ sɛ wɔsesa awosu mu nkwaadɔm a ɛhwɛ nkwammoaa nyin ne nsonsonoe so no.[88]

Wɔakyekyɛ awosu mu nkwaadɔm a ɛka wɔn no mu akuw abien a ɛtrɛw. Oncogenes yɛ awosu mu nkwaadɔm a ɛma nkwammoaa nyin na wɔwo. Tumor suppressor genes yɛ awosu mu nkwaadɔm a esiw nkwammoaa mu mpaapaemu ne nkwa ano. Nsakrae a ɛyɛ hu betumi aba denam oncogenes foforo a ɛba, oncogenes a ɛfata a wɔda no adi boro so a ɛmfata, anaasɛ awosu mu nkwaadɔm a esiw akisikuru ano a wɔda no adi yiye anaasɛ ɛma ɛyɛ adwuma no so. Mpɛn pii no, ɛho hia sɛ wɔyɛ nsakrae wɔ awosu mu nkwaadɔm pii mu na ama wɔadan nkwammoaa a ɛteɛ no ayɛ no kokoram nkwammoaa.[89]

Awosu mu nsakrae betumi aba wɔ gyinabea ahorow ne akwan horow so. Nkwammoaa a wonya anaasɛ ɛyera wɔ chromosome mũ no nyinaa mu no betumi aba denam mfomso ahorow a ɛba wɔ mitosis mu no so. Nea ɛtaa ba ne nkwaadɔm mu nsakrae, a ɛyɛ nsakrae a ɛba wɔ genomic DNA no nucleotide ahorow a ɛtoatoa so no mu.

Nkwammoaa mu nsakrae akɛse no fa chromosome bi fa bi a wɔpopa anaasɛ wonya ho. Genomic amplification ba bere a nkwammoaa bi nya chromosomal locus ketewaa bi mfonini ahorow (mpɛn pii no 20 anaa nea ɛboro saa), a mpɛn pii no oncogenes biako anaa nea ɛboro saa ne awosu mu nneɛma a ɛbɛn ho wom no. Translocation ba bere a chromosomal mmeae abien a ɛsono emu biara no bom wɔ ɔkwan a ɛnteɛ so, mpɛn pii no wɔ beae a ɛda nsow no. Eyi ho nhwɛso a wonim no yiye ne Philadelphia chromosome, anaasɛ chromosome 9 ne 22 a ɛkɔ baabi foforo, a ɛba wɔ myelogenous leukemia a enni sabea mu na ɛma wɔyɛ BCR-abl fusion protein, oncogenic tyrosine kinase.

Nkwammoaa mu nsakrae nketenkete bi ne point mutations, deletions, ne insertions, a ebetumi aba wɔ awosu mu nkwaadɔm bi promoter region na aka ne nkyerɛkyerɛmu, anaasɛ ebetumi aba wɔ gene no coding sequence mu na asakra ne protein product no dwumadi anaasɛ egyina pintinn. Awosu mu nkwaadɔm biako a wɔbɛsɛe no nso betumi afi genomic nneɛma a efi DNA mmoawa anaa retrovirus mu a wɔaka abom no mu aba, na ama wɔada ɔyare mmoawa no oncogenes adi wɔ nkwammoaa a ɔyare no ne n’asefo mu.

Nsɛm a ɛwɔ nkwammoaa a nkwa wom DNA mu no a wɔbɛsan ayɛ no foforo no bɛma mfomso ahorow bi aba (nsakrae a ɛsakra). Wɔde mfomso a wɔteɛteɛ ne nea wosiw ano a ɛyɛ den ahyɛ adeyɛ no mu na ɛbɔ nkwammoaa no ho ban fi kokoram ho. Sɛ mfomso kɛse bi ba a, nkwammoaa a asɛe no betumi asɛe ne ho denam nkwammoaa a wɔayɛ ho nhyehyɛe a wowuwu, a wɔfrɛ no apoptosis no so. Sɛ mfomso a wɔhwɛ so no di nkogu a, ɛnde nkwaadɔm mu nsakrae no bɛkɔ so atra ase na wɔde akɔ nkwammoaa a wɔyɛ mmabea no mu.

Nneɛma bi a atwa yɛn ho ahyia no ma mfomso ahorow taa ba na ɛtrɛw. Nneɛma a atwa yɛn ho ahyia a ɛte saa no betumi ayɛ nneɛma a ɛhaw adwene a wɔfrɛ no carcinogens a ɛwɔ hɔ, nipadua mu opira a ɛba mpɛn pii, ɔhyew, ionizing radiation anaasɛ hypoxia.[90]

Mfomso ahorow a ɛde kokoram ba no yɛ nea ɛma ne ho yɛ kɛse na ɛma ɛyɛ kɛse, sɛ nhwɛso no:

Nkwammoaa bi mfiri a wɔde siesie mfomso ahorow no mu nsakrae betumi ama saa nkwammoaa no ne ne mma aboaboa mfomso ano ntɛmntɛm.

Nsakrae foforo a ɛbɛba oncogene mu no betumi ama nkwammoaa no awo ntɛmntɛm na ayɛ mpɛn pii asen ne mfɛfo a ɛteɛ no.

Nkwammoaa mu nsakrae foforo betumi ama awosu mu abɔde bi a esiw akisikuru ano no ayera, na asɛe apoptosis sɛnkyerɛnne kwan no na ama nkwammoaa no anwu.

Ebia nsakrae foforo a ɛbɛba nkwammoaa no mfiri a ɛma nsɛnkyerɛnne no mu no de nsɛnkyerɛnne a ɛde mfomso ba no bɛkɔ nkwammoaa a ɛbɛn hɔ no mu.

Nkwammoaa a ɛteɛ a ɛdan kokoram no te sɛ nkɔnsɔnkɔnsɔn a mfomso ahorow a edi kan no de ba, a ɛyɛ kɛse ma ɛyɛ mfomso a emu yɛ den kɛse, na emu biara ma nkwammoaa no guan nkakrankakra wɔ nneɛma pii a wɔde di dwuma a ɛma ntini ahorow a ɛfata nyin no ano hye. Saa tebea a ɛte sɛ atuatew yi yɛ wɔn a wɔyɛ den sen biara no nkwa a wɔmpɛ, baabi a tumi horow a ɛkanyan adannandi no yɛ adwuma tia nipadua no nhyehyɛe ne nhyehyɛe a ɛma ɛyɛ adwuma no. Sɛ kokoram fi ase reba a, saa adeyɛ a ɛkɔ so yi a wɔfrɛ no clonal evolution no ma nkɔso kɔ mmeae a ɛyɛ hu kɛse.[91] Clonal adannandi de intra-tumour heterogeneity (kokoram nkwammoaa a ɛwɔ heterogeneous mutations) a ɛma ɛyɛ den sɛ wɔbɛyɛ ayaresa akwan a etu mpɔn na ɛhwehwɛ sɛ wɔfa ɔkwan a ɛyɛ adannandi so de yɛ ayaresa ho nhyehyɛe.

Wɔakyekyɛ su tumi ahorow a kokoram ahorow nya no mu akuw ahorow, titiriw no, apoptosis a wɔkwati, onyin ho sɛnkyerɛnne a obi tumi yɛ ne ho, sɛnkyerɛnne a ɛko tia onyin ho nkate, ntini a ɛkɔ so tra hɔ, tumi a ɛsan yɛ bio a anohyeto nni mu, metastasis, ahoɔden a ɛsakra ho nhyehyɛe a wɔsan yɛ ne nipadua no mu tumi a ɛko tia nyarewa a wɔkwati ][29] na ɛwɔ hɔ.

**Epigenetics ho nimdeɛ**

Adwene a wɔtaa kura wɔ kokoram ho no yɛ nyarewa ahorow bi a awosu mu nkwaadɔm a ɛnteɛ a ɛkɔ so nkakrankakra a nea ɛka ho ne nsakrae a ɛba wɔ awosu mu nkwaadɔm a esiw akisikuru ano ne oncogenes ne nkwaboaa mu nneɛma a ɛnteɛ so na ɛba. Akyiri yi epigenetic nsakrae ahorow no di dwuma.[92]

Epigenetic nsakrae yɛ nsakrae a ɛfa dwumadi ho wɔ genome no mu a ɛnsakra nucleotide ntoatoaso no. Nsakraeɛ a ɛte saa ho nhwɛsoɔ ne nsakraeɛ a ɛba DNA methylation (hypermethylation ne hypomethylation), histone nsakraeɛ[93] ne nsakraeɛ a ɛba wɔ chromosomal architecture mu (a ɛnam protein te sɛ HMGA2 anaa HMGA1 a wɔda no adi a ɛmfata so na ɛba).[94] Saa nsakrae yi mu biara hwɛ awosu mu nkwaadɔm a wɔda no adi no so a ɛnsakra DNA a ɛwɔ ase no. Ebia nsakrae yi bɛkɔ so atra hɔ denam nkwammoaa mu mpaapaemu so, ɛbɛtra hɔ awo ntoatoaso pii na wobetumi abu no sɛ ɛyɛ epimutations (a ɛne nkwaadɔm mu nsakrae yɛ pɛ).

Epigenetic nsakrae taa ba wɔ kokoram ahorow mu. Sɛ nhwɛso no, nhwehwɛmu bi kaa awosu mu nkwaadɔm a ɛkyerɛw protein a wɔtaa sesa wɔ wɔn methylation mu a ɛne kokoram wɔ akyi berɛmo mu no din. Nea ɛka eyinom ho ne awosu mu nkwaadɔm 147 a wɔde hypermethylated ayɛ ne 27 a wɔayɛ no hypomethylated. Wɔ hypermethylated genes no mu no, 10 yɛɛ hypermethylated wɔ 100% a ɛwɔ akyi berɛmo mu kokoram mu na afoforo pii nso yɛɛ hypermethylated wɔ bɛboro 50% mu wɔ akyi berɛmo mu kokoram mu.[95]

Bere a wohu epigenetic nsakrae wɔ kokoram ahorow mu no, ebia epigenetic nsakrae a ɛba DNA asiesie awosu mu nkwaadɔm mu, a ɛma DNA asiesie protein ahorow a wɔda no adi so tew no ho hia titiriw. Wosusuw sɛ nsakrae a ɛte saa no ba ntɛm wɔ kokoram mu nkɔso mu na ɛbɛyɛ sɛ ɛno na ɛde awosu mu nkwaadɔm a entumi nnyina pintinn a ɛyɛ kokoram no su ba.[96][97][98]

DNA a wosiesie no awosu mu nkwaadɔm a wɔda no adi so tew no sɛe DNA a wosiesie no. Eyi na wɔakyerɛ wɔ mfonini no mu wɔ 4th level no so fi soro. (Wɔ mfonini no mu no, nsɛmfua kɔkɔɔ kyerɛ dwuma titiriw a DNA a wɔsɛe no ne sintɔ ahorow a ɛwɔ DNA a wosiesie mu no di wɔ kokoram mu nkɔso mu.) Sɛ DNA a wosiesie no yɛ nea enni mu a DNA a wɔsɛe no kɔ so tra nkwammoaa mu wɔ dodow a ɛkorɔn sen sɛnea ɛtaa ba (ɔfa a ɛto so 5) na ɛma mpɛn dodow a ɛkɔ soro mutation ne/anaasɛ epimutation (6th level). Nkwammoaa mu nsakrae dodow kɔ soro kɛse wɔ nkwammoaa a asɛe wɔ DNA a ɛne ne ho nhyia asiesie mu[99][100] anaasɛ homologous recombinational repair (HRR) mu.[101] Nkwammoaa a wɔsan hyehyɛ wɔn ho ne aneuploidy nso kɔ soro wɔ nkwammoaa a HRR asɛe no mu.[102]

DNA a wɔsɛe no kɛse no ma nkwaadɔm mu nsakrae kɔ soro (mfonini no fa nifa so) na ɛma nipadua no mu nkwaadɔm mu nsakrae kɔ soro. Bere a wɔresiesie DNA nhama abien a abubu, anaasɛ wɔresiesie DNA afoforo a asɛe no, mmeae a wosiesie no a wɔansiesie no yiye no betumi ama epigenetic gene silencing.[103][104]

DNA a esiesie protein ahorow a wɔankyerɛ no yiye esiane nkwaadɔm mu nsakrae a wonya fi awo mu nti no betumi ama kokoram ho asiane ahorow no ayɛ kɛse. Ankorankoro a wɔwɔ DNA a wosiesie awosu mu nkwaadɔm 34 no mu biara mu ɔhaw a wonya fi awo mu (hwɛ asɛm DNA a wosiesie-a enni hɔ) no anya kokoram ho asiane a ɛkɔ soro, a sintɔ ahorow bi hwɛ hu sɛ wobenya kokoram hokwan 100% wɔ wɔn nkwa nna nyinaa mu (e.g. p53 mutations).[105] Wɔahyɛ DNA a esiesie nipadua no mu nsakrae a ɛba wɔ nipadua no mu no nsow wɔ mfonini no benkum so. Nanso, mmoawa mu nkwaadɔm mu nsakrae a ɛte saa (a ɛde kokoram a ɛkɔ nipadua no mu kɛse ba) na ɛde kokoram bɛyɛ ɔha biara mu nkyem 1 pɛ ba.[106]

Wɔ kokoram ahorow a ɛba bere ne bere mu mu no, ɛtɔ mmere bi a DNA a wosiesie no mu sintɔ ahorow no fi DNA a wosiesie awosu mu abɔde mu nkwaadɔm mu nsakrae a ɛba nanso ɛtaa fi epigenetic nsakrae a ɛtew DNA a wosiesie awosu mu nkwaadɔm a wɔda no adi no so anaasɛ ɛma ɛyɛ komm no so. Eyi na wɔakyerɛ wɔ mfonini a ɛwɔ 3rd level no mu. Nhwehwɛmu pii a wɔyɛe wɔ kokoram a dade a emu yɛ duru de ba ho no kyerɛ sɛ dade a emu yɛ duru a ɛte saa no ma DNA a esiesie enzyme ahorow a wɔda no adi no so tew, na ebinom nam epigenetic akwan horow so. Wɔkyerɛ sɛ DNA a wosiesie no a wosiw ano no ne ɔkwan titiriw a wɔfa so de kokoram ba a dade a emu yɛ duru de ba no mu. Nea ɛka ho no, nsakrae a ɛtaa ba wɔ DNA ntoatoaso no mu wɔ epigenetic mu no kyerɛ RNA nketewa a wɔfrɛ no microRNAs (anaa miRNAs). miRNA ahorow no nkyerɛw protein ahorow, na mmom ebetumi "de wɔn ani asi" protein-coding genes so na ɛtew wɔn nkyerɛkyerɛmu so.

Kokoram taa fi nkwaadɔm mu nsakrae ne epimutations a wɔaboaboa ano a ɛma wonya mfaso a wɔpaw a ɛde clonal ntrɛwmu ba (hwɛ Field defects in progression to cancer). Nanso, ebia nkwaadɔm mu nsakrae ntaa mma wɔ kokoram ahorow mu te sɛ epigenetic nsakrae no. Sɛ wɔkyekyem pɛpɛɛpɛ a, nufu anaa akyi berɛmo mu kokoram betumi anya nkwaadɔm mu nsakrae bɛyɛ 60 kosi 70 a ɛsakra protein, a emu bɛyɛ abiɛsa anaa anan betumi ayɛ "draiver" mu nsakrae na nea aka no betumi ayɛ "akwantufo" mu nsakrae.[107]

**Nneɛma a ɛtrɛw kɔ mmeae afoforo**

Asɛm titiriw: *Metastasis*

Metastasis yɛ kokoram a ɛtrɛw kɔ mmeae afoforo wɔ nipadua no mu. Wɔfrɛ akisikuru a apete no metastatic tumors, bere a wɔfrɛ nea edi kan no akisikuru titiriw. Ɛkame ayɛ sɛ kokoram nyinaa tumi kɔ mmeae afoforo.[35] Kokoram a wowuwu dodow no ara fi kokoram a akɔ mmeae afoforo.[36]

Metastasis taa ba wɔ kokoram no fa a etwa to no mu na ebetumi afa mogya anaa ntini a ɛma mogya tu no anaa n’abien nyinaa so aba. Anamɔn a ɛtaa ba wɔ metastasis mu ne mpɔtam hɔ ntua, ntini a ɛkɔ mogya anaa ntini mu, mogya a ɛkɔ nipadua no mu, ntini a ɛkɔ ntini foforo no mu, ntini a ɛdɔɔso ne ntini a ɛma mogya tu. Kokoram ahorow taa kɔ akwaa pɔtee bi mu, nanso ne nyinaa mu no, mmeae a ɛtaa kɔ mmeae afoforo ne ahurututu, mmerɛbo, amemene ne nnompe.[35]

**Nneɛma a ɛma nipadua no yɛ adwuma**

Asɛm titiriw: *Tumor metabolome*

Nkwammoaa a ɛyɛ daa no taa nya ahoɔden bɛyɛ 30% pɛ fi glycolysis mu,[108] bere a kokoram dodow no ara de ne ho to glycolysis so ma ahoɔden yɛ (Warburg nkɛntɛnso).[109][110][111] Nanso kokoram ahorow kakraa bi de wɔn ho to oxidative phosphorylation so sɛ ahoɔden fibea titiriw, a lymphoma, mogya mu kokoram, ne endometrial kokoram ka ho.[112] Nanso, wɔ saa nsɛm yi mu mpo no, glycolysis a wɔde di dwuma sɛ ahoɔden fibea no ntaa ntra 60%.[108] Kokoram kakraa bi de glutamine di dwuma sɛ ahoɔden fibea titiriw, ne fa bi ne sɛ ɛma nitrogen a ɛho hia ma nucleotide (DNA,RNA) a wɔyɛ no.[113][108] Kokoram ntini mu nkwammoaa taa de oxidative phosphorylation anaa glutamine di dwuma sɛ ahoɔden fibea titiriw.[114]

Nhwehwɛmu pii akyerɛ sɛ wɔpaw enzyme sirtuin 6 no adwuma wɔ oncogenesis mu wɔ akisikuru ahorow ahorow mu denam glycolysis a ɛma ɛba no so.[111] Sirtuin foforo, sirtuin 3 siw kokoram a egyina glycolysis so ano, nanso ɛhyɛ kokoram a egyina oxidative phosphorylation so no ho nkuran.[115]

Ɛtɔ mmere bi a wɔkamfo aduan a carbohydrate kakraa bi na ɛwom (ketogenic diet) kyerɛ sɛ aduru a ɛboa ma kokoram sa.[116][117]

## Nhwehwɛmu a wɔyɛe
Wohu kokoram dodow no ara mfiase no esiane sɛnkyerɛnne anaa sɛnkyerɛnne ahorow a ɛda adi anaasɛ ɛnam nhwehwɛmu so nti.[118] Eyinom mu biara mma wonhu yare no yiye, a ɛhwehwɛ sɛ ɔyare ho ɔbenfo hwehwɛ ntini bi mu nhwehwɛmu mu. Wɔde nnuruyɛ mu nhwehwɛmu hwehwɛ nnipa a wosusuw sɛ wɔwɔ kokoram no mu. Eyinom taa bi ne mogya mu nhwehwɛmu, X-ray, (contrast) CT scan ne endoscopy.

Ntini a wohu fi biopsy no mu no kyerɛ nkwammoaa ko a ɛredɔɔso, ne nipadua mu nkwaadɔm mu gyinabea, awosu mu nneɛma a ɛnteɛ ne nneɛma afoforo. Sɛ wɔka nsɛm yi bom a, mfaso wɔ so sɛ wɔde bɛhwehwɛ nea ɛbɛba daakye no mu na wɔapaw ayaresa a eye sen biara.

Cytogenetics ne immunohistochemistry yɛ ntini mu nhwehwɛmu ahorow afoforo. Saa nhwehwɛmu ahorow yi ma wonya nsɛm a ɛfa molecule nsakrae (te sɛ nkwaadɔm mu nsakrae, fusion genes ne akontaahyɛde mu nsakrae a ɛba wɔ chromosome mu) ho na ɛnam so betumi akyerɛ nkɔmhyɛ ne ayaresa a eye sen biara nso.

Kokoram a wohu no betumi de adwene mu haw aba na adwene mu nneyɛe te sɛ kasa mu ayaresa betumi aboa nkurɔfo wɔ eyi mu.[119]

## Nkyekyɛmu

Nsɛm foforo: Kokoram ahorow a wɔahyehyɛ ne Nsɛmfua a ɛfa oncology ho a wɔahyehyɛ

Wɔkyekyɛ kokoram ahorow mu sɛnea nkwammoaa a akisikuru no te sɛ wɔn no te ma enti wosusuw sɛ ɛno na ɛde akisikuru no bae. Saa ahorow yi bi ne:

Carcinoma: Kokoram a wonya fi nkwammoaa a ɛwɔ nipadua no mu no mu. Kokoram a ɛtaa ba no pii ka saa kuw yi ho na ɛkame ayɛ sɛ nea ɛwɔ nufu, prostate, ahurututu, dwensɔtwaa ne akyi berɛmo mu nyinaa ka ho.

Sarcoma: Kokoram a efi ntini a ɛka bom (i.e. nnompe, ntini, srade, ntini), a emu biara fi nkwammoaa a efi mesenchymal nkwammoaa a ɛwɔ nnompe mu ntini no akyi mu ba.

Lymphoma ne leukemia: Saa akuw abien yi fi nkwammoaa a ɛma mogya yɛ adwuma (a ɛyɛ mogya) a efi ntini no mu na ɛtaa nyin wɔ ntini a ɛma mogya tu ne mogya mu, sɛnea ɛte biara.[120]

Nkwammoaa mu akisikuru: Kokoram a efi nkwammoaa a ɛwɔ tumi pii mu ba, na ɛtaa ba awotwaa anaa awotwaa no mu (seminoma ne dysgerminoma, sɛnea ɛte biara).

Blastoma: Kokoram a efi "precursor" nkwammoaa a ennyinii anaasɛ awotwaa mu ntini mu ba.

Wɔtaa de -carcinoma, -sarcoma anaa -blastoma di dwuma de to kokoram din sɛ akyi, a Latin anaa Hela asɛmfua a ɛkyerɛ akwaa anaa ntini a efi mu no yɛ ntini. Sɛ nhwɛso no, wɔfrɛ mmerɛbo mu ntini mu kokoram a efi nkwammoaa a ɛwɔ nipadua no mu a ɛyɛ hu mu ba no hepatocarcinoma, bere a wɔfrɛ ɔyare bɔne a efi mmerɛbo mu nkwammoaa a edi kan a edi kan mu ba no hepatoblastoma na wɔfrɛ kokoram a efi srade nkwammoaa mu ba no liposarcoma. Wɔ kokoram ahorow bi a abu so ho no, wɔde Engiresi akwaa din no na edi dwuma. Sɛ nhwɛso no, wɔfrɛ nufu mu kokoram a ɛtaa ba no. Ɛha no, asɛmfua a wɔde gyina hɔ ma ductal no kyerɛ sɛnea kokoram no da adi wɔ afiri a wɔde hwɛ nneɛma nketenkete mu, a ɛkyerɛ sɛ efi ase wɔ nufusu ntini ahorow no mu.

Wɔde -oma di dwuma sɛ akyigyina a akwaa no din yɛ ntini no na ɛto akisikuru a ɛnyɛ hu (a ɛnyɛ kokoram) din. Sɛ nhwɛso no, wɔfrɛ ntini mu nkwammoaa a ɛyɛ mmerɛw akisikuru a ɛnyɛ hu no leiomyoma (din a wɔtaa de frɛ saa akisikuru a ɛnyɛ hu a ɛtaa ba wɔ awotwaa no mu yi ne fibroid). Nea ɛyɛ ahodwiriw no, kokoram ahorow bi de -noma akyigyinafo di dwuma, nhwɛso ahorow a melanoma ne seminoma ka ho.

Wɔto kokoram ahorow bi din esiane sɛnea nkwammoaa no kɛse ne sɛnea ɛte wɔ afiri a wɔde hwɛ nneɛma nketenkete mu nti, te sɛ nkwammoaa akɛse mu kokoram, spindle cell carcinoma ne nkwammoaa nketewa kokoram.

## Siw a wosiw ano
Wɔkyerɛkyerɛ kokoram ano aduru mu sɛ nneɛma a ɛyɛ nnam a wɔde bɛtew kokoram ho asiane so.[121] Kokoram dodow no ara fi nneɛma a atwa yɛn ho ahyia a asiane wom. Nneɛma a atwa yɛn ho ahyia yi mu pii yɛ asetra kwan a wotumi di so. Enti, mpɛn pii no, wotumi siw kokoram ano.[122] Kokoram a ɛtaa ba no mu 70% kosi 90% fi nneɛma a atwa yɛn ho ahyia mu ma enti wobetumi asiw ano.[123]

Wobetumi asiw kokoram a wowuwu no mu bɛboro 30% ano denam asiane ahorow a wɔbɛkwati a nea ɛka ho ne: tawa, mu duru a ɛboro so/kɛseyɛ mmoroso, aduan pa a wonni, apɔw-mu-teɛteɛ a wɔnyɛ, nsa, nyarewa a wonya fi nna mu ne mframa a wɔsɛe no no so. Bio nso, wobetumi abu ohia sɛ asiane a ɛnteɛ a ɛde nnipa kokoram ba.[125] Ɛnyɛ nneɛma a atwa yɛn ho ahyia a ɛde ba nyinaa na wotumi di so, te sɛ mframa a efi abɔde mu a ɛba akyi ne kokoram a ɛnam awosu mu nyarewa so de ba na enti wontumi mfa ankorankoro nneyɛe nsiw ano.

**Aduan a wodi**

Asɛm titiriw: Aduandi ne kokoram

Bere a wɔahyɛ nyansahyɛ ahorow pii a ɛfa aduan ho ho nyansa sɛ ɛbɛtew kokoram ho asiane so no, adanse a ɛfoa so no nyɛ nea edi mũ.[13][126] Nneɛma atitiriw a ɛma asiane no yɛ kɛse ne kɛseyɛ mmoroso ne nsa a wɔnom. Wɔde nnuan a nnuaba ne nhabannuru kakraa bi na ɛwom ne nam kɔkɔɔ pii wom no aka ho nanso nhwehwɛmu ne meta-nhwehwɛmu ahorow no nnya nsɛm a ɛkɔ so daa.[127][128] Afe 2014 meta-analysis anhu abusuabɔ biara a ɛda nnuaba ne nhabannuru ne kokoram ntam.[129] Kafe ne mmerɛbo mu kokoram ho asiane a ɛso tew no wɔ abusuabɔ.[130] Nhwehwɛmu ahorow akyerɛ sɛ nam kɔkɔɔ anaa wɔayɛ no foforo a wodi boro so no ne asiane a ɛkɔ soro a ɛne sɛ wobenya nufu mu kokoram, akyi berɛmo mu kokoram ne dwensɔtwaa mu kokoram, adeyɛ a ebetumi afi nneɛma a ɛde kokoram ba a ɛwɔ nam a wɔanoa wɔ ɔhyew a ɛkɔ soro mu no mu. Wɔ afe 2015 mu no IARC bɔɔ amanneɛ sɛ nam a wɔayɛ no foforo a wodi (e.g., bacon, ham, hot dogs, soseji) ne, wɔ ɔkwan ketewaa bi so no, nam kɔkɔɔ a wodi no ne kokoram ahorow bi wɔ abusuabɔ.[133][134]

Mpɛn pii no, aduan ho nyansahyɛ ahorow a wɔde siw kokoram ano no bi ne sɛ wobesi nhabannuru, nnuaba, aburow a wɔayam ne mpataa so dua na wɔakwati nam a wɔayɛ ho adwuma ne nam kɔkɔɔ (nantwinam, mprako nam, oguammaa nam), mmoa srade, nnuan a wɔayam ne carbohydrates a wɔayɛ no yiye.

**Nnuru a wɔde di dwuma**

Wobetumi de nnuru adi dwuma de asiw kokoram ano wɔ tebea horow kakraa bi mu.[135] Wɔ nnipa dodow no ara mu no, NSAID ahorow no ma asiane a ɛwɔ hɔ sɛ wobenya kokoram a ɛwɔ akyi berɛmo mu no so tew; nanso esiane koma ne ntini ne yafunu mu nsunsuanso nti, sɛ wɔde di dwuma de siw ano a, ɛde ɔhaw nyinaa ba.[136] Wɔahu sɛ aspirin tew asiane a ɛwɔ hɔ sɛ kokoram betumi awu no so bɛyɛ 7%.[137] Ebia nnuru a esiw COX-2 ano no bɛtew sɛnea polyp a ɛba nnipa a wɔwɔ abusua mu adenomatous polyposis mu no so; nanso, ɛne nsunsuanso bɔne koro no ara a NSAIDs de ba no wɔ abusuabɔ.[138] Tamoxifen anaa raloxifene a wɔde di dwuma da biara da no ma asiane a ɛwɔ hɔ sɛ mmea a asiane kɛse wom benya nufu mu kokoram no so tew.[139] Mfaso a ɛwɔ so ne ɔhaw a ɛwɔ 5-alpha-reductase inhibitor te sɛ finasteride so no mu nna hɔ.[140]

Ɛte sɛ nea vitamin a wɔde ma no ntumi nsiw kokoram ano.[141] Bere a vitamin D a ɛba fam wɔ mogya mu no ne kokoram ho asiane a ɛkɔ soro no wɔ abusuabɔ no,[142][143][144] sɛ ebia saa abusuabɔ yi de ba na vitamin D a wɔde ma no yɛ ahobammɔ no, wonhu. Nhwehwɛmu bi a wɔyɛe wɔ afe 2014 mu no kyerɛe sɛ nnuru a wɔde ka aduan ho no nni nkɛntɛnso kɛse biara wɔ kokoram ho asiane so.[146] Nhwehwɛmu foforo a wɔyɛe wɔ afe 2014 mu no de baa awiei sɛ ebia vitamin D3 bɛtew asiane a ɛwɔ hɔ sɛ kokoram bewuwu no so (owu kakraa bi wɔ nnipa 150 a wɔsa wɔn yare wɔ mfe 5 mu), nanso wɔhyɛɛ dadwen wɔ nsɛm a wɔde ama no yiye ho no nsow.[147]

Beta-Carotene a wɔde ma no ma ahurututu mu kokoram dodow kɔ soro wɔ wɔn a asiane kɛse wom no mu.[148] Folic acid a wɔde ma no ntumi nsiw kokoram a ɛwɔ akyi berɛmo mu no ano na ebetumi ama akyi berɛmo mu polyps akɔ soro.[149] Wɔnkyerɛe sɛ selenium a wɔde ka ho no brɛ asiane a ɛwɔ hɔ sɛ obi benya kokoram no ase.[150]

**Abota**

Wɔayɛ nnuru a wɔde bɔ nkurɔfo ho ban a ɛmma mmoawa bi a wɔde kokoram ba no ntumi nnya ɔyare mmoawa.[151] Nnipa papillomavirus vaccine (Gardasil ne Cervarix) ma asiane a ɛwɔ hɔ sɛ wobenya awotwaa mu kokoram no so tew.[151] Hepatitis B vaccine no siw hepatitis B mmoawa a wobenya no ano na ɛnam so ma asiane a ɛwɔ hɔ sɛ wobenya mmerɛbo mu kokoram no so tew.[151] Wɔkamfo nnipa papillomavirus ne hepatitis B nnuru a wɔde bɔ nkurɔfo ho ban no kyerɛ wɔ baabi a nneɛma ma kwan.[152]

## Nhwehwɛmu a wɔyɛ
Nea ɛnte sɛ mmɔden a wɔbɔ sɛ wobehu kokoram a sɛnkyerɛnne ne nnuruyɛ mu sɛnkyerɛnne ahorow kanyan no, kokoram nhwehwɛmu hwehwɛ sɛ wɔbɔ mmɔden sɛ wobehu kokoram bere a ayɛ basaa akyi, nanso ansa na sɛnkyerɛnne biara a wobehu no ada adi.[153] Eyi betumi ayɛ nipadua mu nhwehwɛmu, mogya anaa nsu mu nhwehwɛmu anaa aduruyɛ mu mfoninitwa.[153]

Wɔntumi nyɛ kokoram nhwehwɛmu wɔ kokoram ahorow pii ho. Sɛ wotumi yɛ nhwehwɛmu mpo a, ebia wɔrenkamfo nkyerɛ obiara. Amansan nyinaa nhwehwɛmu anaa nhwehwɛmu a wɔyɛ wɔ nnipa pii mu no fa obiara ho nhwehwɛmu ho.[154] Nhwehwɛmu a wɔpaw no kyerɛ nnipa a wɔwɔ asiane kɛse mu, te sɛ nnipa a wɔwɔ abusua abakɔsɛm.[154] Wosusuw nneɛma pii ho de kyerɛ sɛ ebia mfaso a ɛwɔ nhwehwɛmu so no dɔɔso sen asiane ne ɛka a wɔbɔ wɔ nhwehwɛmu no ho anaa.[153] Nneɛma yi bi ne:

Nneɛma a ebetumi apira obi wɔ sɔhwɛ a wɔde hwehwɛ nneɛma mu no mu: sɛ nhwɛso no, X-ray mfonini ahorow no fa mframa a ɛyɛ ionizing a ebetumi apira obi ho

Sɛnea ɛbɛyɛ yiye sɛ sɔhwɛ no bɛkyerɛ kokoram no yiye

Sɛnea ɛbɛyɛ yiye sɛ kokoram wɔ hɔ: Mpɛn pii no, nhwehwɛmu nyɛ mfaso wɔ kokoram a ɛntaa nsi ho.

Ɔhaw a ebetumi afi akwan horow a wɔfa so di akyi no mu aba

Sɛ ebia ayaresa a ɛfata wɔ hɔ anaa

Sɛ ebia sɛ wohu no ntɛm a, ɛma nea efi ayaresa mu ba no tu mpɔn anaa

Sɛ ebia kokoram no behia ayaresa da bi anaa

Sɛ ebia sɔhwɛ no yɛ nea nkurɔfo no gye tom anaa: Sɛ nhwehwɛmu a wɔde hwehwɛ nneɛma mu no yɛ adesoa dodo (sɛ nhwɛso no, ɛyɛ yaw kɛse) a, ɛnde nkurɔfo bɛpow sɛ wɔde wɔn ho bɛhyɛ mu.[154]

Ɛka

**Nyansahyɛ ahorow**

U.S. Nnwumakuw a Wɔde Siw Ano Dwumadibea

U.S. Preventive Services Task Force (USPSTF) de nyansahyɛ ahorow ma wɔ kokoram ahorow ho:

Kamfo kyerɛ denneennen sɛ wɔnyɛ awotwaa mu kokoram nhwehwɛmu wɔ mmea a wɔde wɔn ho hyɛ nna mu na anyɛ yiye koraa no wɔwɔ awotwaa mu kosi sɛ wobedi mfe 65.[155]

Kamfo kyerɛ sɛ wɔnhwɛ Amerikafo mu sɛ ebia wɔwɔ kokoram wɔ akyi berɛmo mu denam mogya a wɔde yɛ asumansɛm mu nhwehwɛmu a wɔyɛ wɔ nsu mu, sigmoidoscopy, anaa colonoscopy so mfi ase fi mfe 50 kosi mfe 75 so.[156]

Adanse nnɔɔso a ɛbɛkamfo akyerɛ sɛ ɛsɛ sɛ wɔyɛ honam ani kokoram,[157] anom kokoram,[158] ahurututu mu kokoram,[159] anaasɛ prostate kokoram wɔ mmarima a wonnii mfe 75 mu anaasɛ wɔkasa tia.[160]

Wɔnkamfo nhwehwɛmu a wɔyɛ no daa nkyerɛ wɔ akisikuru mu kokoram,[161] awotwaa mu kokoram,[162] awotwaa mu kokoram,[163] dwensɔtwaa mu kokoram,[164] anaa prostate kokoram ho.[165]

Kamfo kyerɛ sɛ wɔnyɛ nufu mu kokoram nhwehwɛmu mfe abien biara fi mfe 50–74, nanso ɛnkamfo kyerɛ sɛ wɔnyɛ nufu mu nhwehwɛmu anaasɛ wɔnyɛ nufu mu nhwehwɛmu wɔ ayaresabea.[166] Cochrane nhwehwɛmu bi a wɔyɛe wɔ afe 2013 mu no de baa awiei sɛ nufu mu kokoram nhwehwɛmu a wɔde mammography yɛe no nni nkɛntɛnso biara wɔ owu a wɔtew so esiane sɛ wohu yare no boro so ne ayaresa a ɛboro so nti.[167]

Japan

Screens a wɔde hwehwɛ yafunu mu kokoram a wɔde photofluorography di dwuma esiane sɛ ɛdɔɔso wɔ hɔ nti.[23]

**Awosu mu nhwehwɛmu**

Awosu mu nhwehwɛmu a wɔbɛyɛ ama ankorankoro a wɔwɔ asiane kɛse mu sɛ wobenya kokoram ahorow bi no, akuw a ɛnyɛ aban de kamfo kyerɛ.[152][168] Afei wɔn a wokura saa nkwaadɔm mu nsakrae yi betumi ayɛ nhwehwɛmu kɛse, nnuru a wɔde siw ano, anaa oprehyɛn a wɔde besiw ano na ama asiane a ɛbɛba akyiri yi no so atew.[168]

## Ntotoeɛ
Ayaresa ahorow pii wɔ hɔ a wɔde sa kokoram. Nea ɛho hia titiriw ne oprehyɛn, nnuru a wɔde sa yare, mframa a wɔde sa yare, hormone a wɔde sa yare, ayaresa a wɔde wɔn ani asi so ne ayaresa a wɔde ma obi ho brɛ ase. Ayaresa ahorow a wɔde di dwuma no gyina kokoram no ko, beae ne ne gyinabea ne ɔyarefo no akwahosan ne nea ɔpɛ so. Ebia ayaresa atirimpɔw no bɛyɛ nea ɛbɛsa yare anaasɛ ɛrenyɛ saa.

**Nnuru a wɔde sa yare**

Nnuru a wɔde sa yare no yɛ kokoram a wɔde nnuru biako anaa nea ɛboro saa a ekum ɔyare mmoawa (nnuru a wɔde sa yare) a wɔde sa kokoram sɛ nhyehyɛe a wɔahyɛ da ayɛ no fa. Asɛmfua no fa nnuru ahorow ho, a wɔakyekyɛ mu ayɛ no akuw a ɛtrɛw te sɛ alkylating agents ne antimetabolites.[169] Nnuru a wɔde sa yare a wɔde di dwuma wɔ amanne kwan so no yɛ adwuma denam nkwammoaa a ɛpaapae ntɛmntɛm a ekunkum wɔn no so, na ɛyɛ kokoram nkwammoaa dodow no ara su titiriw.

Wohui sɛ nnuru a wɔde kum nkwaboaa a wɔaka abom a wɔde bɛma no ye sen aduru biako, adeyɛ a wɔfrɛ no ayaresa a wɔaka abom, a ɛwɔ mfaso wɔ akontaabu a ɛfa nkwa a wonya ne sɛnea wɔyɛ wɔn ade wɔ akisikuru no ho ne sɛnea yare no kɔ so no mu. Cochrane nhwehwɛmu bi de baa awiei sɛ ayaresa a wɔaka abom no tu mpɔn kɛse de sa nufu mu kokoram a ɛkɔ mmeae afoforo no. Nanso, mpɛn pii no ɛnyɛ nea ɛyɛ nokware sɛ ebia nnuru a wɔde ka bom no ma akwahosan pa ba, bere a wosusuw nkwa ne awuduru nyinaa ho no.[171]

Ayaresa a wɔde wɔn ani asi so yɛ nnuru a wɔde sa yare a wɔde wɔn ani si molecule mu nsonsonoe pɔtee a ɛwɔ kokoram ne nkwammoaa a ɛteɛ ntam so. Ayaresa ahorow a edi kan a wɔde wɔn ani sii so no siw estrogen receptor molecule no kwan, na esiw nufu mu kokoram no nyin ano. Nhwɛso foforo a wɔtaa yɛ ne Bcr-Abl inhibitors kuw no, a wɔde sa myelogenous leukemia a enni sabea (CML).[4] Mprempren, ayaresa ahorow a wɔde wɔn ani asi so wɔ hɔ ma kokoram ahorow a ɛtaa ba no pii, a nea ɛka ho ne akisikuru, nufu mu kokoram, kokoram a ɛwɔ akyi berɛmo mu, asaabo mu kokoram, mogya mu kokoram, mmerɛbo mu kokoram, ahurututu mu kokoram, lymphoma, dwensɔtwaa mu kokoram, prostate kokoram, honam ani kokoram, ne thyroid kokoram sɛ ne kokoram ahorow afoforo nso.[172]

Sɛnea nnuru a wɔde sa yare no tumi yɛ adwuma no gyina kokoram ko a ɛba ne ne fa a ɛkɔ so no so. Sɛ wɔde oprehyɛn ka ho a, nnuru a wɔde sa yare no ada adi sɛ mfaso wɔ so wɔ kokoram ahorow a nufu mu kokoram, akyi berɛmo mu kokoram, dwensɔtwaa mu kokoram, nnompe mu sarcoma, awotwaa mu kokoram, mmadwoa mu kokoram ne ahurututu mu kokoram ahorow bi ka ho mu. Nnuru a wɔde sa yare no sa kokoram ahorow bi, te sɛ mogya mu kokoram binom,[174][175] entumi nyɛ adwuma wɔ amemene mu akisikuru binom mu,[176] na ɛho nhia wɔ afoforo mu, te sɛ honam ani kokoram dodow no ara a ɛnyɛ melanoma.[177] Mpɛn pii no, awuduru a ɛwɔ nipadua no mu ntini afoforo mu no na ɛma nnuru a wɔde sa yare no tu mpɔn no. Bere a nnuru a wɔde sa yare no mma wonnya ayaresa a ɛtra hɔ daa mpo no, ebetumi ayɛ nea mfaso wɔ so sɛ wɔbɛtew sɛnkyerɛnne ahorow te sɛ ɛyaw so anaasɛ wɔbɛtew akisikuru a wontumi nyɛ oprehyɛn no kɛse so a wɔwɔ anidaso sɛ wɔbɛyɛ oprehyɛn daakye.

**Mframa a wɔde yɛ adwuma**

Mframa a wɔde sa yare no fa mframa a ɛma ɛyɛ hyew a wɔde di dwuma de bɔ mmɔden sɛ wɔbɛsa yare no ho sɛnkyerɛnne ahorow no yare anaasɛ wɔbɛma atu mpɔn ho. Ɛyɛ adwuma denam DNA a ɛwɔ kokoram ntini mu a ɛsɛe no so, na ekum no. Nea ɛbɛyɛ na wɔakwati ntini a ɛteɛ (te sɛ honam ani anaa akwaa ahorow, a ɛsɛ sɛ mframa fa mu na ɛsa akisikuru no) no, wɔde mframa a wɔayɛ no sɛnea ɛte no fi mmeae pii a wɔde wɔn ho hyɛ mu no si hɔ ma ɛne akisikuru no hyia, na ɛma wonya dodow kɛse wɔ hɔ sen ntini a atwa ho ahyia a ɛwɔ apɔwmuden no mu . Sɛnea ɛte wɔ nnuru a wɔde sa yare ho no, ɛsono sɛnea kokoram yɛ wɔn ade wɔ mframa a wɔde sa yare no ho.[178][179][180]

Wɔde mframa bɔne a wɔde sa yare di dwuma wɔ nsɛm no mu bɛyɛ fa mu. Mframa a ɛbɔ no betumi afi nneɛma a ɛwɔ mu (brachytherapy) anaasɛ afi mu. Mframa a wɔde ma no taa yɛ X-ray a ahoɔden nnim a wɔde sa honam ani kokoram, bere a wɔde X-ray a ahoɔden wom kɛse di dwuma ma kokoram a ɛwɔ nipadua no mu.[181] Wɔtaa de mframa bɔne di dwuma de ka oprehyɛn ne anaasɛ nnuru a wɔde sa yare ho. Wɔ kokoram ahorow bi te sɛ ti ne kɔn mu kokoram a ɛba ntɛm ho no, wobetumi de adi dwuma nkutoo.[182] Wɔ nnompe a ɛtrɛw a ɛyɛ yaw ho no, wɔahu sɛ ɛyɛ adwuma yiye wɔ ayarefo bɛyɛ 70% mu.[182]

**Sɛɛgyiri**

Oprehyɛn ne ɔkwan titiriw a wɔfa so sa kokoram dodow no ara a atew ne ho a ɛyɛ den no yare na ebetumi adi dwuma wɔ nkwa a wɔma ɛyɛ mmerɛw na ɛma ɛyɛ tenten no mu. Mpɛn pii no, ɛyɛ ade titiriw a ɛma wotumi hu akisikuru no yiye na wɔde si baabi a ɛsɛ sɛ wɔyɛ no, efisɛ mpɛn pii no ɛho hia sɛ wɔyɛ nipadua no mu nhwehwɛmu. Wɔ kokoram a ɛwɔ baabi a ɛwɔ no mu no, oprehyɛn taa bɔ mmɔden sɛ wobeyi aduru no nyinaa aka ho, wɔ tebea horow bi mu no, ntini a ɛwɔ mpɔtam hɔ no. Wɔ kokoram ahorow bi ho no eyi dɔɔso sɛ ebeyi kokoram no afi hɔ.[173]

**Ayaresa a ɛma obi ho dwo no**

Palliative care yɛ ayaresa a ɛbɔ mmɔden sɛ ɛbɛboa ɔyarefo no ma ne ho atɔ no na ebia wɔde bɛka mmɔden a wɔbɔ sɛ wɔbɛsa kokoram no ho. Nea ɛka ayaresa a ɛma obi ho dwo no ho ne adeyɛ a ɛbɛtew honam fam, nkate fam, honhom fam ne adwene ne asetram haw so. Nea ɛnte sɛ ayaresa a ne botae ne sɛ ebekum kokoram nkwammoaa tẽẽ no, botae titiriw a ɛwɔ ayaresa a ɛma obi ho dwo no mu ne sɛ ɛbɛma asetra atu mpɔn.

Mpɛn pii no, nnipa a wɔwɔ kokoram ayaresa no fa ahorow nyinaa nya ayaresa bi a ɛma obi ho brɛ ase. Wɔ tebea horow bi mu no, nnuruyɛ ho adwumayɛfo ahyehyɛde ahorow kamfo kyerɛ sɛ ayarefo ne nnuruyɛfo de ayaresa a ɛma obi ho dwo nkutoo na ɛyɛ wɔn ade wɔ kokoram ho.[183] Eyi fa ayarefo a:[184] .

da adwumayɛ tebea a ɛba fam adi, a ɛkyerɛ sɛ wontumi nhwɛ wɔn ho yiye[183] ​​.

annya mfaso biara amfi ayaresa ahorow a egyina adanse so a wɔadi kan de ama no mu[183] ​​.

mfata sɛ wɔde wɔn ho hyɛ ayaresabea sɔhwɛ biara a ɛfata mu[183].

adanse a emu yɛ den biara nni hɔ a ɛkyerɛ sɛ ayaresa bɛyɛ nea etu mpɔn[183] ​​.

Ebia wɔde ayaresa a ɛma obi ho dwo no frafra ayaresabea a wɔhwɛ wɔn a wɔyare no mu ma enti bere a nkurɔfo bɛn nkwa awiei nkutoo na wɔbɛkyerɛ. Te sɛ ayaresabea a wɔhwɛ wɔn a wɔyare no, ayaresa a ɛma obi ho dwo no bɔ mmɔden sɛ ɛbɛboa ɔyarefo no ma wadi n’ahiade ahorow a ehia ntɛm ara no ho dwuma na ama awerɛkyekye ayɛ kɛse. Nea ɛnte sɛ ayaresabea a wɔhwɛ wɔn a wɔyare no, ayaresa a ɛma obi ho dwo no nhwehwɛ sɛ nkurɔfo gyae ayaresa a wɔde wɔn ani asi kokoram no so no.

Ɔman no aduruyɛ ho akwankyerɛ pii kamfo kyerɛ sɛ wɔmfa ayaresa a ɛma obi ho dwo no ntɛm mma ayarefo a wɔn kokoram no ama wɔanya sɛnkyerɛnne ahorow a ɛhaw adwene anaasɛ wohia mmoa a wɔde begyina wɔn yare no ano. Wɔ ayarefo a wodii kan hui sɛ wɔwɔ yare a ɛtrɛw kɔ mmeae afoforo no mu no, wobetumi akyerɛ sɛ wɔmfa ayaresa a ɛma obi ho brɛ ase ntɛm ara. Wɔkyerɛ sɛ wɔhwɛ ayarefo a wɔn nkwa nna nnu asram 12 a wɔde ayaresa a ano yɛ den mpo ama wɔn no yare a ɛma obi ho brɛ ase.[185][186][187]

**Nneɛma a ɛko tia nyarewa**

Asɛm titiriw: Kokoram a wɔko tia nyarewa

Ayaresa ahorow a wɔde nipadua no mu tumi a ɛko tia nyarewa di dwuma, a ɛkanyan anaa ɛboa nipadua no mu tumi a ɛko tia nyarewa ma ɛko tia kokoram no, wɔde adi dwuma fi 1997. Akwan a wɔfa so yɛ no bi ne nipadua mu nkwammoaa a wɔko tia nyarewa, ayaresa a wɔde hwɛ nneɛma mu, ne nkwammoaa a wɔde wɔn kɔ baabi foforo.[188]

**Laser ayaresa**

Asɛm titiriw: Laser a wɔde sa kokoram

Laser ayaresa de hann a ano yɛ den kɛse di dwuma de sa kokoram denam akisikuru anaa nea enyin ansa na kokoram reba no a ɛtew so anaasɛ ɛsɛe no so. Wɔtaa de laser sa kokoram a ɛwɔ nipadua no ani anaa akwaa a ɛwɔ nipadua no mu no so kɛse. Wɔde sa basal cell honam ani kokoram ne afoforo te sɛ awotwaa, ɔbarima akyi berɛmo, ɔbea awotwaa mu, awotwaa mu kokoram a ɛnyɛ nkwammoaa nketewa no mfiase pɛɛ. Wɔtaa de ka ayaresa afoforo te sɛ oprehyɛn, nnuru a wɔde sa yare, anaa mframa a wɔde sa yare ho. Laser-induced interstitial thermotherapy (LITT), anaasɛ interstitial laser photocoagulation, de laser di dwuma de sa kokoram ahorow bi denam hyperthermia a ɛde ɔhyew di dwuma de tew akisikuru so denam kokoram nkwammoaa a ɛsɛe anaasɛ ekum so no so. Laser yɛ pɛpɛɛpɛ sen oprehyɛn na ɛmma nneɛma nsɛe pii, ɛnyɛ ɛyaw, mogya tu, ɛho ahon, na ɛnyɛ akuru pii. Ade a enye wɔ ho ne sɛ ɛsɛ sɛ nnuruyɛfo a wɔyɛ oprehyɛn nya ntetee titiriw. Ebia ne bo yɛ den sen ayaresa afoforo.[189]

**Nnuru a wɔde si ananmu**

Kokoram ayaresa a wɔde ka ho ne nea wɔde si ananmu yɛ ayaresa ahorow, nneyɛe ne nneɛma ahorow a ɛnyɛ nnuru a wɔde di dwuma daa no fa.[190] "Aduru a wɔde ka ho" kyerɛ akwan ne nneɛma a wɔde di dwuma ka nnuru a wɔde di dwuma ho, bere a "aduru foforo" kyerɛ nnuru a wɔde di dwuma sen sɛ wɔde nnuru a wɔde di dwuma daa bedi dwuma.[191] Wɔnyɛɛ nnuru a wɔde ka kokoram ho ne nea wɔde si ananmu dodow no ara ho nhwehwɛmu anaasɛ wɔmfa akwan horow a wɔtaa fa so te sɛ nnuruyɛ mu sɔhwɛ ahorow nsɔ nhwɛ. Wɔayɛ ayaresa foforo bi ho nhwehwɛmu na wɔada no adi sɛ entu mpɔn nanso wɔda so ara da so ara di gua na wɔhyɛ ho nkuran. Kokoram ho nhwehwɛmufo Andrew J. Vickers kae sɛ, "Ahyɛnsode a ɛne sɛ 'wɔnkyerɛ sɛ ɛyɛ nokware' no mfata mma ayaresa a ɛtete saa; ɛyɛ bere a ɛsɛ sɛ yɛka sɛ kokoram ayaresa foforo pii 'wɔakyerɛ sɛ ɛnyɛ nokware'."[192]

## Nsɛm a Wɔka Kyerɛ
Nnipa dodow a wonya nkwa no gu ahorow sɛnea kokoram kokoram no te ne baabi a wohu no, efi nnipa dodow no ara a wonya nkwa so kosi wɔn a wowuwu koraa wɔ mfe anum akyi bere a wɔahu sɛ wɔanya bi no so. Sɛ kokoram bi kɔ mmeae afoforo wie a, mpɛn pii no, nkɔmhyɛ no mu yɛ den kɛse. Ayarefo a wɔrenya kokoram a ɛba nipadua no mu ayaresa (a carcinoma in situ ne honam ani kokoram a ɛnyɛ melanoma nka ho) no mu bɛyɛ fa wuwu wɔ saa kokoram no anaa n’ayaresa no mu.[23] Kokoram a wowuwu no mu dodow no ara fi akisikuru titiriw no a ɛkɔ mmeae afoforo.[194]

Nkwa a wonya no nye koraa wɔ aman a afei na wɔrenya nkɔso no mu,[23] ne fa bi ne sɛ kokoram ahorow a abu so wɔ hɔ no yɛ den sɛ wɔbɛsa sen nea ɛne aman a wɔanya nkɔso wɔ abusuabɔ no.[195]

Wɔn a wonya nkwa wɔ kokoram mu no nya kokoram titiriw a ɛto so abien a ɛyɛ bɛyɛ wɔn a wonhu da no mmɔho abien.[196] Wogye di sɛ asiane a ɛkɔ soro no fi hokwan a ɛwɔ hɔ sɛ obi benya kokoram biara kwa, sɛnea ebetumi aba sɛ obenya nkwa wɔ kokoram a edi kan no mu, asiane koro no ara a ɛde kokoram a edi kan no bae, nneɛma bɔne a wɔmpɛ a efi kokoram a edi kan a wɔsa mu (titiriw mframa a wɔde sa yare), ne sɛ wobedi nhwehwɛmu a wɔyɛ no so yiye.[196]

Nkwa a wobenya bere tiaa anaa bere tenten a wɔbɛka ho asɛm no gyina nneɛma pii so. Nea ɛho hia sen biara ne kokoram no su ne ɔyarefo no mfe ne n’akwahosan nyinaa. Wɔn a wɔayɛ mmerɛw wɔ akwahosan ho haw afoforo ho no nya nkwa dodow a ɛba fam sen nnipa a anka wɔwɔ apɔwmuden no. Ɛnyɛ den koraa sɛ wɔn a wɔadi mfe ɔha no bɛtra ase mfe anum sɛ ayaresa no kɔ yiye mpo a. Nnipa a wɔbɔ amanneɛ sɛ wɔn asetra yɛ papa no taa tra ase kyɛ.[197] Nnipa a wɔn asetra nyɛ papa no betumi anya adwenemhaw ne nsɛnnennen afoforo ne/anaasɛ yare no nkɔso a ɛsɛe asetra pa ne dodow no nyinaa. Bio nso, ayarefo a wɔn nkɔmhyɛ a enye koraa no betumi anya adwenemhaw anaasɛ wɔbɛbɔ amanneɛ sɛ wɔn asetra nyɛ papa efisɛ wohu sɛ ɛda adi sɛ wɔn tebea no betumi akum wɔn.

Nnipa a wɔwɔ kokoram no wɔ asiane kɛse sɛ mogya bɛtɔ wɔn ntini mu a ebetumi de wɔn nkwa ato asiane mu.[198] Nnuru a ɛma mogya tew te sɛ heparin a wɔde di dwuma no ma asiane a ɛwɔ hɔ sɛ mogya bɛtɔ no so tew nanso wɔankyerɛ sɛ ɛma nnipa a wɔwɔ kokoram no nkwa nna yɛ kɛse.[198] Nnipa a wɔnom nnuru a ɛma mogya tu no nso wɔ asiane kɛse sɛ mogya bɛtɔ wɔn.[198]

Ɛwom sɛ kokoram ahorow bi ntaa mma koraa de, nanso efi bere a ɛkɔ anim mpo no betumi asa ara kwa. Saa adeyɛ yi na wɔfrɛ no fafiri a ɛba ara kwa.[199]

## Nyarewa a Ɛtrɛw Ho Adesua
Akontabuo kyerɛ sɛ wɔ afe 2018 mu no, nnipa foforɔ ɔpepem 18.1 na wɔanya kokoram na nnipa ɔpepem 9.6 wuwu wɔ wiase nyinaa.[201] Mmarima bɛyɛ 20% ne mmea 17% benya kokoram wɔ bere bi mu bere a mmarima 13% ne mmea 9% bewuwu wɔ ho.[201]

Wɔ afe 2008 mu no, wɔhunuu kokoram bɛyɛ ɔpepem 12.7 (a honam ani kokoram a ɛnyɛ melanoma ne kokoram afoforo a ɛnyɛ nea ɛkɔ nipadua mu nka ho)[23] na wɔ afe 2010 mu no, ɛkame ayɛ sɛ nnipa ɔpepem 7.98 wuwui.[202] Kokoram na ɛma nnipa wuwu no mu bɛyɛ 16%. Nea ɛtaa ba wɔ afe 2018 mu ne ahurututu mu kokoram (awuwu ɔpepem 1.76), akyi berɛmo mu kokoram (860,000) yafunu mu kokoram (780,000), mmerɛbo mu kokoram (780,000), ne nufu mu kokoram (620,000).[2] Eyi ma kokoram a ɛba no yɛ nea ɛde owu ba kɛse wɔ aman a wɔanya nkɔso no mu na ɛto so abien wɔ aman a afei na wɔrenya nkɔso no mu.[23] Nsɛm no mu bɛboro fa na ɛba wɔ aman a afei na wɔrenya nkɔso no mu.[23]

Nnipa a kokoram kunkum wɔn no dodow yɛ ɔpepem 5.8 wɔ 1990 mu.[202] Owu akɔ soro titiriw esiane nkwa tenten ne asetra mu nsakrae a aba wɔ aman a afei na wɔrenya nkɔso no mu nti.[23] Asiane a ɛho hia sen biara a ɛma obi nya kokoram ne mfe a obi adi.[203] Ɛwom sɛ ebetumi aba sɛ kokoram bɛba wɔ mfe biara mu de, nanso ayarefo dodow no ara a wɔwɔ kokoram a ɛba nipadua no mu no adi boro mfe 65.[203] Sɛnea kokoram ho nhwehwɛmufo Robert A. Weinberg kyerɛ no, "Sɛ yɛtra ase kyɛ a, anka yɛn nyinaa benya kokoram."[204] Wɔkyerɛ sɛ abusuabɔ a ɛda onyin ne kokoram ntam no bi fi immunosenescence,[205] mfomso ahorow a ɛboaboa ano wɔ DNA mu boro so nkwa nna nyinaa[206] ne nsakrae a ɛfa mfe a obi adi ho wɔ endocrine nhyehyɛe no mu.[207] Nkɛntɛnso a onyin nya wɔ kokoram so no yɛ den esiane nneɛma te sɛ DNA a ɛsɛe ne ɔfe a ɛhyɛ ho nkuran ne nneɛma te sɛ ntini mu onyin ne endocrine nsakrae a esiw ano nti.[208]

Kokoram ahorow bi a enyin nkakrankakra no abu so titiriw, nanso mpɛn pii no enkum nnipa. Nhwehwɛmu a wɔyɛe wɔ amu ho nhwehwɛmu a wɔyɛe wɔ Europa ne Asia kyerɛe sɛ nnipa bɛyɛ 36% wɔ thyroid kokoram a wonnya nhui na ɛda adi sɛ ɛnyɛ asiane biara bere a wowuwui no na mmarima 80% nya prostate kokoram bere a wɔadi mfe 80.[209][210] Esiane sɛ saa kokoram ahorow yi mma ɔyarefo no nwu nti, anka sɛ wohu no a, ɛbɛgyina hɔ ama ɔyarefo a wɔahu no boro so sen sɛ wobenya ayaresa a mfaso wɔ so.

Mmofra mu kokoram abiɛsa a ɛtaa ba ne mogya mu kokoram (34%), amemene mu akisikuru (23%) ne lymphomas (12%).[211] Wɔ United States no, kokoram ka mmofra 285 biara mu bɛyɛ 1.[212] Mmofra mu kokoram dodow kɔɔ soro 0.6% afe biara wɔ 1975 ne 2002 ntam wɔ United States[213] ne 1.1% afe biara wɔ 1978 ne 1997 ntam wɔ Europa.[211] Mmofra mu kokoram a wowuwui no so tew fa wɔ afe 1975 ne 2010 ntam wɔ United States.[212]

## Abakɔsɛm
Kokoram atra hɔ wɔ nnipa abakɔsɛm nyinaa mu.[214] Kyerɛwtohɔ a edi kan a wɔakyerɛw afa kokoram ho no fi bɛyɛ afe 1600 A.Y.B. Hippocrates (bɛyɛ 460 A.Y.B. – bɛyɛ 370 A.Y.B.) kaa kokoram ahorow pii ho asɛm, na ɔde Hela asɛmfua καρκίνος karkinos (krak anaa krak) frɛɛ wɔn.[214] Saa din yi fi sɛnea akisikuru bɔne a ɛyɛ den a wɔatwa no anim no te, a "ntini no trɛw wɔ afa nyinaa sɛnea aboa a krak no wɔ ne nan, baabi a onyaa ne din no".[215] Galen kae sɛ "wɔfrɛ nufu no mu kokoram saa esiane sɛ wɔsusuw sɛ ɛte sɛ krak a ɛnam akisikuru no akyi tenten ne ntini a ɛtrɛw a ɛbɛn hɔ no so de ma nti".[216]: 738 Celsus (c. 25 BC – 50 AD) a wɔkyerɛɛ ase karkinos kɔ Latin kokoram mu, a ɛsan kyerɛ krak na wɔkamfo oprehyɛn kyerɛ sɛ ayaresa.[214] Galen (afeha a ɛtɔ so mmienu Y.B.) ne oprehyɛn a wɔde bedi dwuma no annye antom na ɔkamfoo nnuru a wɔde tew nneɛma ho mmom kyerɛe.[214] Saa nyansahyɛ ahorow yi gyinaa hɔ kɛse mfe 1000.[214]

Wɔ afeha a ɛto so 15, 16 ne 17 mu no, ɛbɛyɛɛ nea wogye tom sɛ nnuruyɛfo bɛtetew nipadua mu de ahu nea ɛde owu ba.[217] Germanni ɔbenfo Wilhelm Fabry gye di sɛ nufu mu kokoram fi nufusu mu ntini bi mu. Na Dutchni ɔbenfo Francois de la Boe Sylvius a odi Descartes akyi no gye di sɛ yare nyinaa fi nnuru a wɔde di dwuma mu ba na nsu a ɛwɔ ntini mu a ɛyɛ acid no na ɛde kokoram ba. Ne bere sofo Nicolaes Tulp gye dii sɛ kokoram yɛ awuduru a ɛtrɛw nkakrankakra na ɔde baa awiei sɛ ɛyɛ ɔyare mmoawa.[218]

Oduruyɛfo John Hill kaa tawa ho asɛm sɛ ɛno na ɛde hwene mu kokoram ba wɔ afe 1761 mu.[217] Eyi akyi no, amanneɛbɔ a Britania oduruyɛfo Percivall Pott de mae wɔ 1775 mu sɛ chimney sweeps’ carcinoma, a ɛyɛ kokoram a ɛwɔ akyi berɛmo mu no yɛ yare a abu so wɔ chimney sweeps mu bae.[219] Esiane sɛ wɔde afiri a wɔde hwɛ nneɛma nketenkete no dii dwuma kɛse wɔ afeha a ɛto so 18 mu nti, wohui sɛ ‘kokoram awuduru’ no trɛw fi akisikuru titiriw no mu fa ntini a ɛma mogya tu no mu kɔ mmeae afoforo ("metastasis"). Engiresini oduruyɛfo Campbell De Morgan na odii kan hyehyɛɛ yare no ho adwene yi wɔ 1871 ne 1874 ntam.[220]

## Ɔmanfo ne amammerɛ
Ewom sɛ ebia nyarewa pii (te sɛ koma a entumi nyɛ adwuma yiye) bɛkɔ so ayɛ bɔne sen kokoram dodow no ara de, nanso kokoram yɛ nea ehu ne ahyɛde ahorow a abu so. Wɔda so ara de "yare tenten" a wɔde kyerɛkyerɛ kokoram ahorow a ɛde owu ba no mu nsɛm a ɛyɛ dɛ no di dwuma wɔ owu ho nsɛm mu, sen sɛ wɔbɛbɔ yare no din pefee, a ɛda animtiaabu bi a ɛda adi sɛ ɛyɛ animtiaabu adi.[221] Wɔsan nso ka kokoram ho asɛm sɛ "C-asɛmfua";[222][223][224] Macmillan Kokoram Mmoa de asɛmfua no di dwuma de bɔ mmɔden sɛ ɛbɛtew ehu a ɛwɔ yare no ho no so.[225] Wɔ Nigeria no, ɛhɔnom din biako a wɔde frɛ kokoram no kyerɛ ase kɔ Borɔfo kasa mu sɛ "yare a wontumi nsa".[226] Saa gyidi a emu dɔ yi a ɛne sɛ ɛho hia sɛ kokoram yɛ yare a emu yɛ den na ɛtaa kum nnipa no da adi wɔ nhyehyɛe ahorow a ɔmanfo paw de boaboa kokoram ho akontaabu ano no mu: kokoram a abu so sen biara—honam ani kokoram a ɛnyɛ melanoma, a ɛyɛ kokoram a ɛba wiase nyinaa no mu bɛyɛ nkyem abiɛsa mu biako, . nanso owu kakraa bi pɛ[227][228]—wɔayi afi kokoram akontaabu mu titiriw efisɛ ɛnyɛ den sɛ wɔbɛsa na ɛkame ayɛ sɛ bere nyinaa wɔsa, mpɛn pii no wɔ ayaresa biako, tiawa, a wɔde kɔ ayaresabea.[229]

Atɔe fam adwene ahorow a ɛfa hokwan ahorow a ayarefo wɔ ma nnipa a wɔwɔ kokoram ho no bi ne asɛyɛde a ɛne sɛ wɔbɛda ayaresa tebea no adi akyerɛ onipa no koraa, ne hokwan a wɔwɔ sɛ wɔde wɔn ho hyɛ gyinaesi ahorow a wɔkyɛ mu wɔ ɔkwan a ɛkyerɛ obu ma onipa no ankasa gyinapɛn ahorow so. Wɔ amammerɛ afoforo mu no, wɔpɛ hokwan ne gyinapɛn afoforo. Sɛ nhwɛso no, Afrikafo amammerɛ dodow no ara bu mmusua mũ nyinaa sɛ ɛsom bo sen sɛ wobebu ankorankoro ho adwene. Wɔ Afrika mmeae bi no, wɔtaa hu yare no akyiri yi araa ma wontumi nsa, na sɛ wonya ayaresa koraa a, ɛbɛma abusua no asɛe ntɛm. Esiane saa nneɛma yi nti, Afrika akwahosan ho adwumayɛfo taa ma abusua mufo si gyinae sɛ ebia, bere ne ɔkwan a wɔbɛfa so ada ɔyare no adi, na wɔtaa yɛ saa nkakrankakra na wɔkyinkyin, bere a onipa no kyerɛ anigye ne tumi a ɔde gyina nsɛm a ɛyɛ awerɛhow no ano no .[226] . Nnipa a wofi Asia ne Amerika Kesee Fam aman mu nso taa pɛ ɔkwan a wɔfa so da no adi brɛoo na ɛnyɛ pefee sen sɛnea wɔpɛ wɔ United States ne Europa Atɔe Fam no, na wogye di sɛ ɛtɔ mmere bi a ɛbɛyɛ papa sɛ wɔrenka kokoram a wɔahu ho asɛm nkyerɛ wɔn ] . Mpɛn pii no, yare no a wɔda no adi no abu so sen sɛnea na ɛte wɔ afeha a ɛto so 20 no mu no, nanso wɔmfa nkɔmhyɛ no ho asɛm a edi mũ mma ayarefo pii wɔ wiase nyinaa.[226]

Wɔ United States ne amammerɛ afoforo bi mu no, wobu kokoram sɛ yare a ɛsɛ sɛ "wɔko" na ama "ɔmanfo atuatew" no aba awiei; wɔde Ɔko a Wɔde Ko Tia Kokoram too gua wɔ U.S. Asraafo kasakoa abu so titiriw wɔ nkɛntɛnso a kokoram nya wɔ nnipa so ho nkyerɛkyerɛmu mu, na esi ɔyarefo no akwahosan tebea ne hia a ehia sɛ n’ankasa yɛ nneɛma a ɛyɛ gyinaesi ntɛm ara sen sɛ ɔbɛtwentwɛn ne nan ase, abu n’ani agu so anaasɛ ɔde ne ho ato afoforo so koraa no nyinaa so dua. Asraafo kasakoa ahorow no nso boa ma ntease ba ayaresa a emu yɛ den, a ɛsɛe ade.[230][231]

Wɔ 1970 mfe no mu no, na kokoram ayaresa foforo a agye din kɛse wɔ U.S. no yɛ ɔkasa ayaresa titiriw bi, a egyina adwene a ɛne sɛ kokoram fi adwene bɔne so.[232] Na wogye di sɛ nnipa a wɔwɔ "kokoram nipasu"—wɔn adwenemhaw, wɔahyɛ wɔn so, wɔtan wɔn ho na wosuro sɛ wɔbɛda wɔn nkate adi—nam akɔnnɔ a wɔwɔ wɔ wɔn adwene mu so daa kokoram adi. Adwene ne nneyɛe ho animdefo binom kae sɛ ayaresa a wɔde bɛsakra ɔyarefo no adwene wɔ asetra ho no bɛsa kokoram no.[232] Nea ɛka nneɛma afoforo ho ne sɛ, saa gyidi yi maa ɔmanfo kwan ma wɔde asodi no too nea wɔayɛ no bɔne no so sɛ ɔno na ɔde kokoram no bae (denam "ɔpɛ" no so) anaasɛ osiw n'ayaresa ano (denam sɛ wannyɛ obi a ɔwɔ anigye, onsuro ne ɔdɔ sɛnea ɛsɛ so).[233] Ɛsan nso maa ayarefo dadwen yɛɛ kɛse, efisɛ wogye dii wɔ ɔkwan a ɛnteɛ so sɛ abɔde mu nkate a ɛne awerɛhow, abufuw anaa ehu ma wɔn nkwa nna yɛ tiaa.[233] Susan Sontag dii adwene no ho fɛw, a otintim Illness sɛ Metaphor bere a na ɔrenya ahoɔden afi nufu mu kokoram ayaresa mu wɔ 1978 mu no.[232] Ɛwom sɛ mprempren wɔtaa bu mfitiase adwene no sɛ nkwaseasɛm de, nanso adwene no fa bi kɔ so tra hɔ wɔ ɔkwan a wɔatew so so a gyidi a ɛtrɛw, nanso ɛnteɛ, a ɛne sɛ sɛ wɔhyɛ da nya adwene pa ho su a, ɛbɛma nkwa a wobenya no ayɛ kɛse. Saa adwene yi mu yɛ den titiriw wɔ nufu mu kokoram amammerɛ mu.[233]

Adwene biako a ɛfa nea enti a wɔde asodi to nnipa a wɔwɔ kokoram so anaasɛ wɔbɔ wɔn animtiaa, a wɔfrɛ no wiase atɛntrenee ho adwene a ɛne sɛ kokoram ho asodi a wɔde to ɔyarefo no nneyɛe anaa ne suban so no ma wɔn a wɔde asodi no to wɔn so no tumi san nya tumidi ho adwene. Eyi gyina asodifo no gyidi so sɛ wiase no yɛ nea ɛteɛ titiriw na enti ɛsɛ sɛ yare biara a ɛyɛ hu, te sɛ kokoram, yɛ asotwe bi a wɔde ma wɔ nneɛma bɔne a wɔpaw ho, efisɛ wɔ wiase a ɛteɛ mu no, nneɛma bɔne rensi nnipa pa ] .

**Sikasɛm mu nkɛntɛnso**

Wɔbuu akontaa sɛ sika a wɔsɛee no nyinaa wɔ akwahosan ho wɔ kokoram ho wɔ U.S. no yɛ dɔla ɔpepepem 80.2 wɔ afe 2015 mu.[235] Ɛwom mpo sɛ akwahosan ho sika a wɔsɛe wɔ kokoram ho no akɔ soro koraa wɔ mfe du du a atwam no mu de, nanso akwahosan ho sika a wɔsɛe no wɔ kokoram ayaresa ho no mu kyɛfa no akɔ so abɛn 5% wɔ 1960 ne 2004 ntam.[236][237] Wɔahu nhyehyɛe a ɛte saa ara wɔ Europa baabi a wɔsɛe akwahosan ho sika nyinaa mu bɛyɛ 6% wɔ kokoram ayaresa ho.[238][239] Wɔ akwahosan ho ka ne sikasɛm mu awuduru akyi no, kokoram de ɛka a ɛnteɛ ba wɔ adwumayɛ mu a wɔhwere esiane nna a wɔyare, tumi a wontumi nyɛ daa ne dɛmdi ne owu a ɛba ntɛm wɔ mfe a wɔde yɛ adwuma mu nti. Kokoram de ka nso ba wɔ ɔhwɛ a wɔmfa nhyehyɛe mu ho. Wɔtaa bu akontaa sɛ ɛka a wɔbɔ wɔ ɔkwan a ɛnteɛ so ne ɔhwɛ a ɛnyɛ ɔkwan pa so ho ka no boro anaasɛ ɛne kokoram ho ka a wɔbɔ wɔ akwahosan ho no yɛ pɛ.[240][239]

**Adwumayɛbea**

Wɔ United States no, wɔde kokoram ka ho sɛ tebea a wɔabɔ ho ban denam Equal Employment Opportunity Commission (EEOC) so, titiriw esiane sɛ kokoram betumi anya nkɛntɛnso a ɛyɛ nyiyim wɔ adwumayɛfo so nti.[241] Nyiyim wɔ adwumam betumi aba sɛ adwumawura bi kura atoro gyidi sɛ obi a ɔwɔ kokoram ntumi nyɛ adwuma bi yiye, na ebetumi abisa akwamma a wɔde yare pii sen adwumayɛfo afoforo a. Adwumawuranom nso betumi agyina adwene a ɛnteɛ a wɔwɔ wɔ kokoram mu dɛmdi ho so asi gyinae sɛ wɔbɛfa wɔn adwuma mu anaasɛ wobeyi wɔn afi adwumam, sɛ ɛwɔ hɔ a. EEOC de nsɛmbisa akwankyerɛ ma adwumawuranom, ne ano aduru a ɛbɛtumi aba a wɔde bɛsɔ adwumayɛfoɔ a wɔwɔ kokoram ahwɛ na wɔagye wɔn atom.[241]

## Hwehwɛ mu
Esiane sɛ kokoram yɛ nyarewa kuw bi nti,[242][243] ɛnyɛ nea ɛbɛyɛ yiye sɛ "kokoram aduru" biako bɛba da bi sɛnea ayaresa biako bɛba ama nyarewa a wɔde yare mmoawa ba nyinaa.[244] Bere bi na wosusuw sɛ angiogenesis inhibitors wɔ ɔkwan a ɛnteɛ so sɛ ebetumi ayɛ "dwetɛ tuo" ayaresa a wɔde di dwuma wɔ kokoram ahorow pii ho.[245] Wɔde nnuru a esiw angiogenesis ano ne nnuru afoforo a wɔde sa kokoram bom di dwuma de tew kokoram yare ne owu so.[246]

Wɔyɛ kokoram ayaresa a wɔsɔ hwɛ ho nhwehwɛmu wɔ ayaresabea sɔhwɛ ahorow mu de toto ayaresa a wɔahyɛ ho nyansa no ho ne ayaresa a eye sen biara a ɛwɔ hɔ dedaw no. Wobetumi asɔ ayaresa ahorow a edii nkonim wɔ kokoram ahorow biako mu no ahwɛ wɔ ahorow afoforo ho.[247] Wɔreyɛ nhwehwɛmu a wɔde hu yare no sɛnea ɛbɛyɛ a wɔde ayaresa a ɛfata bɛma ayarefo a wɔfata no yiye, a egyina wɔn ankorankoro abɔde a nkwa wom so.[248]

Kokoram ho nhwehwɛmu twe adwene si nsɛm a edidi so yi so:

Nneɛma (sɛ nhwɛso no, mmoawa) ne nsɛm a esisi (sɛ nhwɛso no, nkwaadɔm mu nsakrae) a ɛde awosu mu nsakrae ba anaasɛ ɛma ɛyɛ mmerɛw wɔ nkwammoaa a wɔahyɛ sɛ wɔbɛyɛ kokoram no mu.

Sɛnea awosu mu nneɛma a ɛsɛe ade no te pɔtee ne awosu mu nkwaadɔm a ɛka no.

Nea efi saa awosu mu nsakrae ahorow no mu ba wɔ nkwammoaa no abɔde a nkwa wom so, wɔ kokoram nkwammoaa bi su ahorow a ɛkyerɛkyerɛ mu a ɛma ɛba ne awosu mu nsɛm afoforo a ɛma kokoram no kɔ so kɔ so no yɛ mmerɛw no mu.

Ntease a ɛkɔ anim wɔ molecule biology ne cellular biology ho esiane kokoram ho nhwehwɛmu nti no ama wɔanya kokoram ho ayaresa foforo fi bere a U.S. Ɔmampanyin Richard Nixon de "Kokoram Ko" too gua wɔ 1971. Efi saa bere no, ɔman no asɛe bɛboro dɔla ɔpepepem 200 wɔ kokoram ho nhwehwɛmu ho, a nea ɛka ho ne nneɛma a efi ɔman ne ankorankoro nnwuma mu.[249] Nnipa dodow a wowuwu wɔ kokoram mu (sɛ wɔyɛ nsakrae wɔ nnipa dodow ne mfe a wɔadi ho a) so tew ɔha biara mu nkyem anum wɔ 1950 ne 2005 ntam hɔ.[250]

Ɛte sɛ nea sikasɛm mu ahonyade ho akansi no asiw adebɔ, biakoyɛ, asiane a wɔde wɔn ho to so ne mfitiase nsusuwii a ɛho hia na wɔahu nneɛma atitiriw no ano, na ɛmaa nhwehwɛmu a asiane kakraa bi na ɛwɔ mu a ɛfa nkɔso nketenkete a ɛkɔ soro ho no ani gye ho sɛnea ɛnsɛ sen nhwehwɛmu a asiane wom, a ɛyɛ foforo kɛse. Ɛte sɛ nea nea efi akansi mu ba afoforo ne nhwehwɛmu pii a wɔka nsɛm a ɛyɛ nwonwa a wontumi nsan nyɛ nea efi mu ba no ne nkannyan a ɛnteɛ a ɛhyɛ ahyehyɛde ahorow a wɔde mmoa ma no nkuran ma wonnyin a wɔmfa sika a ɛdɔɔso nsi wɔn ankasa adesuabea ne adwumayɛbea ahorow mu.

*Wɔreyɛ* virotherapy a wɔde convert virus di dwuma no ho nhwehwɛmu.

Wɔ COVID-19 ɔyaredɔm no akyi no, adwennwene aba sɛ kokoram ho nhwehwɛmu ne ayaresa no rebrɛ ase.[255][256]

## Nyinsɛn
Kokoram ka mmea a wɔyem 1,000 biara mu bɛyɛ 1. Kokoram a ɛtaa hu wɔ nyinsɛn mu no ne kokoram a ɛtaa hu wɔ mmea a wɔnnyinsɛn mu wɔ awo mfe mu no yɛ pɛ: nufu mu kokoram, awotwaa mu kokoram, kokoram, mogya mu kokoram, lymphoma, melanoma, ovarian kokoram ne kokoram a ɛwɔ akyi berɛmo mu.

Ɛyɛ den sɛ wobehu kokoram foforo wɔ ɔbea a onyinsɛn mu, a ne fa bi ne sɛ wɔtaa fa no sɛ yare no ho sɛnkyerɛnne biara yɛ ɔhaw a ɛfata a ɛbata nyinsɛn ho. Ne saa nti, wɔtaa hu kokoram no akyiri kakra sen sɛ wɔkyekyem pɛpɛɛpɛ a. Wobu mfoninitwa akwan bi te sɛ MRI (magnetic resonance imaging), CT scans, ultrasounds ne mammograms a wɔde awotwaa no bɔ ho ban no sɛ asiane biara nni ho bere a wɔyem no; afoforo binom te sɛ PET scans no nyɛ saa.[257]

Mpɛn pii no, ayaresa no yɛ nea wɔde ma mmea a wonnyinsɛn no ara pɛ. Nanso, mpɛn pii no, wɔkwati mframa bɔne ne nnuru a ɛma anyinam ahoɔden bere a wɔyem no, titiriw sɛ ebia akokoaa no dodow boro 100 cGy a. Wɔ tebea horow bi mu no, sɛ wohu kokoram no akyiri yi wɔ nyinsɛn no mu a, wɔtwentwɛn ayaresa ahorow bi anaa ne nyinaa ase kosi sɛ wɔbɛwo no akyi. Wɔtaa de awo ntɛm di dwuma de ma ayaresa no mfiase nya nkɔso. Mpɛn pii no, asiane nnim oprehyɛn, nanso oprehyɛn a wɔyɛ wɔ akyi berɛmo mu wɔ ɔsram abiɛsa a edi kan no mu no betumi ama nyinsɛn atu. Ayaresa ahorow bi, titiriw nnuru bi a wɔde sa yare a wɔde ma wɔ ɔsram abiɛsa a edi kan no mu no ma asiane a ɛwɔ hɔ sɛ wobenya awo mu dɛmdi ne nyinsɛn a wɔbɛhwere (nyinsɛn a woyi gu a ɛba ara kwa ne awo a wowuwu) no yɛ kɛse.[257]

Ɛho nhia sɛ woyi nyinsɛn gu a wɔpaw no, na wɔ kokoram ahorow ne ne fa ahorow a ɛtaa ba no fam no, ɛmma ɛna no nkwa nna nkɔ anim. Wɔ nsɛm kakraa bi mu, te sɛ awotwaa mu kokoram a ɛkɔ anim no, wontumi ntoa nyinsɛn no so na wɔ afoforo mu no, ɔyarefo no betumi ama nyinsɛn no aba awiei sɛnea ɛbɛyɛ a obetumi afi ase ayɛ nnuru a ano yɛ den.[257]

Ayaresa ahorow bi betumi asiw ɛna no kwan sɛ ɔbɛwo wɔ ɔbea no awotwaa mu anaasɛ ɔbɛma nufu.[257] Ebia awotwaa mu kokoram bɛhwehwɛ sɛ wɔwo no *denam* oprehyɛn a wɔde yɛ oprehyɛn so. Mframa a wɔde kɔ nufu no mu no ma tumi a saa nufu no tumi yɛ nufusu no so tew na ɛma asiane a ɛwɔ hɔ sɛ obenya nufu mu yare no yɛ kɛse. Afei nso, sɛ wɔde nnuru a wɔde sa yare ma wɔ awo akyi a, nnuru no pii pue wɔ nufusu mu, na ebetumi apira akokoaa no.[257]

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