Kansarka mindhicirka weyn (colon cancer) waa koritaan aan caadi ahayn oo ka bilaabma qayb ka mid ah mindhicirka weyn oo la yiraahdo colon. Colon-ku waa qaybta ugu horreysa uguna dheer ee mindhicirka weyn, halka mindhicirka weynna uu yahay qaybta ugu dambeysa ee hab-dhiska dheef-shiidka. Hab-dhiska dheef-shiidku wuxuu burburiyaa cuntada si jirku uga faa’iidaysto.
Kansarka colon-ka badanaa wuxuu ku dhacaa dadka waaweyn, inkastoo uu ku dhici karo da’ kasta. Inta badan wuxuu ka bilaabmaa burooyin yaryar oo unugyo ah oo la yiraahdo polyps, kuwaas oo ka samaysma gudaha colon-ka. Polyps-ku caadi ahaan ma aha kansar, laakiin qaar ka mid ah ayaa waqti ka dib isu beddeli kara kansar.
Polyps-ku badanaa calaamado ma keenaan. Sidaas darteed, dhakhaatiirtu waxay ku talinayaan in si joogto ah loo sameeyo baaritaanno lagu ogaanayo polyps-ka colon-ka. Helitaanka iyo ka saarista polyps-ku waxay ka hortagi kartaa kansarka colon-ka.
Haddii kansarka colon-ku soo baxo, waxaa jira daaweyno badan oo lagu xakameyn karo, sida qalliin, shucaac (radiation therapy), iyo daawooyin ay ka mid yihiin kiimiko (chemotherapy), daaweynta la beegsado (targeted therapy), iyo immunotherapy.
Mararka qaarkood kansarka colon-ka waxaa loo yaqaan kansarka mindhicirka iyo malawadka (colorectal cancer), maadaama uu isku darayo kansarka colon-ka iyo kan malawadka (rectum), oo ka bilaabma malawadka.
Calaamadaha
Dad badan oo qaba kansarka colon-ka bilowgiisa ma laha calaamado. Marka calaamado soo baxaan, waxay ku xirnaan karaan cabbirka kansarka iyo meesha uu kaga yaal mindhicirka weyn.
Calaamadaha waxaa ka mid noqon kara:
• Isbeddel ku yimaada saxarada, sida shuban ama calool-fadhiyo soo noqnoqda.
• Dhiig ka yimaada malawadka ama dhiig ku jira saxarada.
• Xanuun ama raaxo-darro joogto ah oo caloosha ah, sida murgacasho, gaas ama xanuun.
• Dareen ah in mindhicirku uusan si buuxda u faaruqin markaad saxarooto.
• Daal ama tabar-darro.
• Miisaan lumis aan ula kac ahayn.
Goorta la arko dhakhtar
Haddii aad aragto calaamado sii jira oo ku welwel gelinaya, samee ballan aad kula kulanto xirfadle caafimaad.
Sababaha keena
Dhakhaatiirtu si dhab ah uma oga waxa sababa inta badan kansarrada colon-ka.
Kansarka colon-ku wuxuu dhacaa marka unugyada colon-ka ay yeeshaan isbeddel ku yimaada DNA-ga. DNA-gu wuxuu xambaarsan yahay tilmaamaha u sheegaya unugga waxa uu sameynayo. Isbeddelladani waxay keenaan in unugyadu si degdeg ah u tarmaan, isla markaana ay sii noolaadaan xitaa marka unugyada caafimaadka qaba ay si dabiici ah u dhintaan.
Tani waxay keentaa in unugyo aad u badan ay ururaan oo sameeyaan buro (tumor). Unugyadani waxay weerari karaan oo burburin karaan unugyada caafimaadka qaba. Waqti ka dib, unugyada kansarka ayaa ka go’i kara meesha asalka ah oo ku faafi kara qaybaha kale ee jirka. Marka kansarku fido, waxaa loo yaqaan kansar fiday (metastatic cancer).
Qodobada kordhiya khatarta
Waxyaabaha kordhin kara halista kansarka colon-ka waxaa ka mid ah:
• Da’ weyn — inkastoo uu ku dhici karo da’ kasta, badanaa wuxuu ku badan yahay dadka ka weyn 50 sano. Si kastaba, tirada dadka ka yar 50 sano ee uu ku dhacayo ayaa sii kordheysa.
• Dadka madow ee ku nool Maraykanka ayaa leh khatar ka sarreysa dadka jinsiyadaha kale.
• Taariikh hore oo kansarka mindhicirka ama polyps ah.
• Cudurrada bararka mindhicirka (inflammatory bowel diseases) sida ulcerative colitis iyo Crohn’s disease.
• Cudurrada hidde-sidaha ee qoysaska ku soo noqnoqda, sida familial adenomatous polyposis iyo Lynch syndrome.
• Qof qoyskaaga ka mid ah oo qaba kansarka colon-ka ama malawadka.
• Cunto fiber-yar oo dufan iyo kalooriyo badan leh, gaar ahaan cunista hilibka cas iyo kan la warshadeeyay.
• Jimicsi la’aan.
• Sonkorow ama caabbinta insulin-ka.
• Cayil.
• Sigaar cabid.
• Cabitaanka khamriga oo badan.
• Shucaac hore loogu sameeyay caloosha si loo daaweeyo kansar kale.
Ka hortagga
Baaritaanka hore (screening)
Dhakhaatiirtu waxay ku talinayaan in dadka halistoodu dhexdhexaadka tahay ay bilaabaan baaritaanka kansarka colon-ka qiyaastii da’da 45 sano. Dadka halistoodu sarreyso — sida kuwa leh taariikh qoys — waa inay bilaabaan baaritaanka ka hor.
Waxaa jira baaritaanno kala duwan oo loo adeegsado ogaanista hore. Kala hadal kooxdaada caafimaad si aad u doorato kan kugu habboon.
Isbeddellada nololeed ee yareeya halista
Si loo yareeyo khatarta kansarka colon-ka:
• Cun miro, khudaar iyo qamadi dhan (whole grains) kala duwan.
• Haddii aad cabto khamri, ku koob hal cabitaan maalintii dumarka iyo laba ragga.
• Jooji sigaarka.
• Samee jimicsi ugu yaraan 30 daqiiqo inta badan maalmaha usbuuca.
• Ilaali miisaan caafimaad leh; haddii aad u baahan tahay dhimista miisaanka, samee si tartiib ah adigoo yareynaya kalooriyada kordhinayana dhaqdhaqaaqa.
Ka hortag gaar ah oo loogu talagalay dadka halistoodu sarreyso
Daawooyin qaarkood, sida aspirin, ayaa laga yaabaa inay yareeyaan halista polyps ama kansarka colon-ka. Si kastaba, isticmaalka maalinlaha ah ee aspirin-ku wuxuu leeyahay khataro, sida boog iyo dhiig-bax ku dhaca hab-dhiska dheef-shiidka.
Sidaa darteed, daawooyinkan badanaa waxaa loo qoondeeyaa dadka halistoodu sarreyso. Haddii aad halis sare leedahay, kala hadal dhakhtarkaaga si loo qiimeeyo waxa adiga kugu habboon.
Saynisyahanadu maxa ka og yihiin ilaa hadda xanuunkan
Kansarka mindhicirka weyn (colorectal cancer) ayaa muddo dheer jahawareer ku hayay saynisyahannada, sababtoo ah si ka duwan burooyinka (tumors) kale intooda badan, bukaannadu mararka qaarkood way ka fiicnaadaan marka kansarkoodu uu ka buuxo unugyo difaac oo xakameeya hab-dhiska difaaca jirka, kuwaas oo loo yaqaan regulatory T cells (Treg). Cilmi-baaris cusub ayaa ugu dambayn sharraxday sababta arrintani u dhacdo.
Saynisyahannadu waxay ogaadeen in unugyada Treg aysan isku mid ahayn: nooc-hoosaad ka mid ahi wuxuu ka caawiyaa xakamaynta koritaanka burooyinka, halka mid kale uu ka ilaaliyo kansarka weerarka hab-dhiska difaaca. Isku dheelitirka u dhexeeya unugyadan “wanaagsan” iyo kuwa “xun” ayaa go’aamin kara in buradu korto ama yaraato.
Burooyinka adag intooda badan, tiro badan oo Treg ah waxay la xiriiraan natiijooyin liita, maadaama unugyadani ay si dabiici ah u yareeyaan ama u xakameeyaan awoodda difaaca jirka, taas oo daciifin karta awoodda jirku u leeyahay inuu la dagaallamo kansarka.
Si kastaba ha ahaatee, kansarka mindhicirka weyn waa ka-reeban dhif ah oo jahawareer leh. Cudurkan, burooyinka leh Treg badan ayaa badanaa lala xiriiriyaa cimri-dherer iyo badbaado dheer. Muddo sanado ah, cilmi-baarayaashu ma fahmin sababta ay tani uga duwan tahay kansarrada kale.
Daraasad cusub oo ka timid cilmi-baarayaal ka tirsan Sloan Kettering Institute ee Memorial Sloan Kettering Cancer Center (MSK) ayaa hadda bixisay sharraxaad cad. Natiijooyinkani waxay gacan ka geysan karaan horumarinta daaweynta immunotherapy ee dadka intooda badan qaba kansarka mindhicirka weyn, waxayna suurtagal tahay inay khuseeyaan kansarro kale oo ka samaysma maqaarka iyo xuubabka daboola caloosha, afka, iyo hunguriga.
Ogaanshaha ugu muhiimsan ayaa ah in unugyada Treg aysan isku mid ahayn. Sida lagu daabacay joornaalka sayniska ee Immunity, waxa ugu muhiimsan ma aha oo keliya tirada Treg ee jirta, balse waa nooca ay yihiin.
Daraasaddan waxaa hoggaaminayay Dr. Xiao Huang, Dr. Dan Feng (oo hadda jooga Icahn School of Medicine at Mount Sinai), iyo Dr. Sneha Mitra. Waxay ku dhisnayd in ka badan 20 sano oo cilmi-baaris ah oo uu sameeyay Dr. Alexander Rudensky, oo ah khabiir caalami ah oo ku takhasusay unugyada Treg. Cilmi-baaristiisu waxay muujisay in Treg ay ilaaliyaan “dulqaadka difaaca” (immune tolerance), taas oo ka hortagta in hab-dhiska difaacu si khaldan u weeraro unugyada jirka, bakteeriyada faa’iidada leh, ama cuntooyinka maalinlaha ah.
Kansarka mindhicirka weyn waa sababta labaad ee ugu badan ee dhimashada la xiriirta kansarka marka ragga iyo dumarka la isku daro, sida ay sheegtay American Cancer Society.
Daraasaddan, cilmi-baarayaashu waxay diiradda saareen nooca ugu badan ee kansarkan, oo ah burooyinka loo yaqaan microsatellite stable (MSS) leh mismatch repair oo shaqaynaya (MMRp). Noocan badanaa si fiican ugama jawaabo daaweynta checkpoint inhibitor immunotherapy. Hase yeeshee, nooca ka soo horjeeda — kansarrada leh microsatellite instability sare (MSI-H) iyo mismatch repair deficiency (MMRd) — ayaa inta badan si wanaagsan uga jawaaba immunotherapy, mararka qaarna bukaanku uma baahdaan qalliin, kiimiko, ama shucaac.
Markii ay baareen unugyada Treg ee ku jira burooyinka, cilmi-baarayaashu waxay ogaadeen laba kooxood oo waaweyn:
- Koox soo saarta walax calaamadeeye ah oo la yiraahdo interleukin-10 (IL-10).
- Koox aan soo saarin IL-10.
Unugyada Treg ee IL-10-positive ah waxay gaabiyaan koritaanka burooyinka, iyagoo yareeya dhaqdhaqaaqa unugyada Th17 ee soo saara interleukin-17 (IL-17), taas oo dhiirrigelisa koritaanka kansarka. Marka unugyadan “wanaagsan” la tirtiro, burooyinku si dhaqso ah ayey u koraan.
Dhanka kale, unugyada Treg ee IL-10-negative ah waxay xakameeyaan unugyada difaaca ee xooggan, gaar ahaan CD8+ T cells oo si gaar ah ula dagaallama kansarka. Marka noocan “waxyeellada leh” la tirtiro, burooyinku way yaraadaan.
Markii xog laga helay bukaanno qaba kansarka mindhicirka weyn la falanqeeyay, natiijooyinku waxay xaqiijiyeen isla qaabkaas: bukaannada leh tiro badan oo IL-10-positive Treg ah waxay noolaayeen waqti dheer, halka kuwa leh IL-10-negative Treg badan ay heleen natiijooyin liita.
Cilmi-baarayaashu waxay sidoo kale ogaadeen in unugyada IL-10-negative ay muujiyaan heerar sare oo borotiin la yiraahdo CCR8. Shaqo hore oo ay sameeyeen cilmi-baarayaal ka tirsan MSK ayaa muujisay in CCR8 sidoo kale ku badan yahay kansarro kale sida kansarka naasaha. Tani waxay keentay fikrad ah in la isticmaalo unugyo difaac (antibodies) si gaar ah u beegsada CCR8 si loo tirtiro unugyada Treg ee waxyeellada leh, iyadoo la ilaalinayo kuwa faa’iidada leh.
Tijaabooyin caafimaad (clinical trials) oo dhowr ah ayaa hadda ka socda MSK iyo xarumo kale si loo tijaabiyo habkan, kaligiis ama lala daro daaweynta immunotherapy ee horey u jirtay. Daraasaddan cusub waxay sii xoojinaysaa rajada in istaraatiijiyaddan lagu daaweyn karo kansarka mindhicirka weyn iyo kansarro kale oo la mid ah.
Markii la baaray kansarka ku faafay beerka (metastatic colorectal cancer), cilmi-baarayaashu waxay arkeen qaab difaac oo ka duwan. Xaaladdan, unugyada IL-10-negative ayaa aad uga batay kuwa IL-10-positive. Marka dhammaan unugyada Treg la tirtiro, burooyinka ku fiday beerka way yaraadeen — taasoo muujinaysa in daaweyntu u baahan tahay in lagu saleeyo nooca unugga iyo heerka cudurka.
Daraasaddan waxay iftiimisay sida ay muhiim u tahay in si gaar ah loo beegsado noocyada kala duwan ee unugyada difaaca, halkii si guud loo tirtiri lahaa dhammaantood, si loo helo daaweyn kansar oo wax ku ool ah.