Cov Mob Khees Xaws Tsev Menyuam Muaj Dab Tsi Zoo Li Cas thiab Koj Yuav Tsum Pom Lawv Li Cas?

Zoo Siab

• Mob cancer ntawm zes qe menyuam yog dab tsi?
• Cov tsos mob ntxov ntxov ntawm zes qe menyuam yog dab tsi?
• Hom mob qog qe menyuam
• Cov hlwv ntawm zes qe menyuam
• Qhov muaj feem yuav ua mob kheesxaws ntawm zes qe menyuam
• Yuav kuaj li cas thiaj paub hais tias kheesxaws ntawm zes qe menyuam?
• Dab tsi yog ntau theem ntawm qog nqaij hlav zes qe menyuam?
• Theem 1
• Theem 2
• Theem 3
• Theem 4
• Yuav kho tus mob kheesxaws ntawm zes qe menyuam li cas
• Kev phais mob
• Cov hom phiaj kho
• Fertility preservation
• Kev tshawb nrhiav thiab mob kheesxaws ntawm zes qe menyuam
• Puas tuaj yeem tiv thaiv tus mob qog qe menyuam tau?
• Qhov tshwm sim yog dab tsi?
• Ciaj sia taus tus nqi
• 5-xyoos tus nqi txheeb ze nyob rau mob qog qe menyuam

Zes qe menyuam yog ob lub cev ua poj niam cov qog uas tsim cov qe, lossis qe. Lawv kuj tsim cov poj niam cov tshuaj hormones estrogen thiab progesterone.

Kwv yees li 21,750 tus poj niam hauv Tebchaws Meskas yuav tau kuaj mob qog qe ntshav hauv xyoo 2020, thiab kwv yees li 14,000 tus pojniam yuav tuag vim tus mob.

Hauv tsab xov xwm no koj yuav pom cov lus qhia txog mob qog qe menyuam nrog rau:

• cov tsos mob
• hom
• txaus ntshai
• kev kuaj mob
• theem
• kev kho mob
• kev tshawb nrhiav
• tus nqi nyob

Mob cancer ntawm zes qe menyuam yog dab tsi?

Kheesxaws ntawm zes qe menyuam yog thaum cov hlwb tsis zoo nyob hauv lub zes qe menyuam pib hlav tawm tsis tuaj yeem tswj tau thiab tsim cov qog ntshav. Yog tias tsis kho, lub qog yuav kis mus rau lwm qhov ntawm lub cev. Qhov no yog hu ua metastatic ovarian mob cancer.

Kheesxaws ntawm zes qe menyuam feem ntau muaj cov cim ceebtoom, tabsis qhov tshwm sim ntxov tshaj plaws yog vague thiab yoojyim tshem tawm. Nees nkaum feem pua ​​ntawm cov mob qog ntawm zes qe menyuam raug kuaj pom thaum ntxov.

Cov tsos mob ntxov ntxov ntawm zes qe menyuam yog dab tsi?

Nws yog ib qho yooj yim uas yuav zam dhau cov tsos mob ntxov ntxov ntawm zes qe menyuam vim tias lawv zoo ib yam li lwm yam mob lossis lawv nyiam tuaj thiab mus. Cov tsos mob thaum ntxov suav nrog:

• tsam plab, hauv plab thiab qhov mob
• txawv txav puv plab tom qab noj mov
• nyuaj noj
• nce ntxiv tso zis
• kev tso zis kom tso zis ntau ntxiv

Kheesxaws ntawm zes qe menyuam kuj tuaj yeem ua rau lwm cov tsos mob, xws li:

• nkees
• kem plab
• Kev mob siab
• cem quav
• rov qab mob
• coj khaub ncaws tsis xwm yeem
• kev sib deev zoo heev
• dermatomyositis (ib yam mob tsis tshua muaj kab mob tuaj yeem ua rau tawv nqaij, ua rau lub cev tsis muaj zog, thiab cov leeg mob)

Cov tsos mob no yuav tshwm sim rau qee qhov laj thawj. Lawv yuav tsis tas vim yog mob qog mis. Coob tus pojniam muaj qee cov teeb meem no ib zaug lossis ib zaug.

Cov tsos mob no feem ntau ib ntus thiab teb rau kev kho mob yooj yim feem ntau.

Cov tsos mob yuav mob ntev yog tias lawv yog vim muaj kabmob ua qog thiab ov. Cov tsos mob tshwm sim feem ntau yuav hnyav dua li cov kabmob loj tuaj. Los ntawm lub sijhawm no, tus kabmob kheesxaws feem ntau kis tawm sab nraud ntawm zes qe menyuam, ua rau nws hnyav dua los kho kho kom zoo.

Ib zaug ntxiv, mob qog noj ntshav tau zoo tshaj thaum kuaj tau ntxov. Thov nrog koj tus kws kho mob yog tias koj muaj cov tsos mob tshiab thiab txawv txawv.

Hom mob qog qe menyuam

Zes qe menyuam ua los ntawm peb hom hlwb. Txhua lub cell tuaj yeem tsim mus rau ntau hom qog:

• Epithelial hlav ua rau hauv txheej txheej ntawm daim ntaub ntawm sab nraud ntawm lub zes qe menyuam. Kwv yees 90 feem pua ​​ntawm cov qog nqaij hlav zes qe menyuam yog cov qog mob epithelial.
• Stromal hlav loj hlob hauv cov keeb-tsim cov qe ntshav. Xya feem pua ​​ntawm zes qe menyuam mob qog nqaij hlav yog stromal hlav.
• Cov qog cell txhim kho hauv cov qe ua cov qe. Cov qog cell ua pob yog qhov tsawg.

Cov hlwv ntawm zes qe menyuam

Cov hlwv ntawm zes qe menyuam feem ntau yuav tsis mob qog. Cov no yog hu ua benign cysts. Txawm li cas los xij, tsawg tsawg tus tuaj yeem mob qog noj ntshav.

Zus qog ntawm zes qe menyuam yog cov kua nyeem lossis cua uas tsim tawm hauv lossis ib ncig ntawm lub zes qe menyuam. Feem ntau cov hlwv ntawm zes qe menyuam tsim ua qhov haujlwm ntawm ovulation, uas yog thaum lub zes qe menyuam tawm lub qe. Feem ntau lawv tsuas ua mob me me, zoo li tsam plab, thiab ploj mus yam tsis tau kho.

Cov hlwv ntau tshaj li qhov kev txhawj xeeb yog tias koj tsis ovulating. Cov poj niam nres ovulating tom qab lawm. Yog tias zes qe menyuam tawm tom qab lub cev ntas, koj tus kws kho mob yuav xav ua ntau qhov kev ntsuam xyuas kom paub qhov ua rau cyst, tshwj xeeb tshaj yog tias nws loj lossis tsis ploj mus li ntawm ob peb hlis.

Yog tias lub cyst ploj mus, koj tus kws kho mob yuav pom zoo kom phais tshem nws hauv qhov xwm txheej. Koj tus kws kho mob tsis tuaj yeem txiav txim siab tau tias nws yog mob qog nqaij hlav loj txog thaum lawv tshem tawm phais.

Qhov muaj feem yuav ua mob kheesxaws ntawm zes qe menyuam

Qhov tseeb ua kom mob kheesxaws ntawm zes qe menyuam tsis tau paub meej. Txawm li cas los xij, cov xwm txheej no tuaj yeem ua rau koj txoj kev pheej hmoo:

• tsev neeg muaj keeb kwm mob cancer ntawm zes qe menyuam
• kev hloov caj ces ntawm cov noob muaj feem nrog kev mob kheesxaws ntawm zes qe menyuam, xws li BRCA1 lossis BRCA2
• keeb kwm tus kheej ntawm mis, uterine, lossis mob qog noj ntshav
• rog dhau
• kev siv qee yam tshuaj muaj peev xwm lossis kev kho tus kabmob hormone
• tsis muaj keeb kwm kev xeeb tub
• endometriosis

Lub hnub nyoog laus dua yog lwm yam kev pheej hmoo. Feem ntau ntawm cov mob kheesxaws ntawm zes qe menyuam pib tom qab lawm.

Nws muaj peev xwm yuav mob kheesxaws ntawm zes qe menyuam tsis muaj yam xwm txheej no. Zoo li no, muaj ib qho ntawm cov kev pheej hmoo tsis tas tsis txhais tau tias koj yuav muaj mob qog mis hlav qe.

Yuav kuaj li cas thiaj paub hais tias kheesxaws ntawm zes qe menyuam?

Nws yooj yim dua los kho mob zes qe menyuam thaum koj tus kws kho mob kuaj nws thaum ntxov. Txawm li cas los xij, nws tsis yooj yim los tshawb txog.

Koj lub zes qe menyuam yog nyob tob hauv lub plab zom plab, yog li koj tsis zoo li yuav mob qog. Kuj tsis tau muaj kev tshuaj ntsuam kab mob ib txwm muaj rau tus mob zes qe menyuam. Yog vim li ntawd nws thiaj tseem ceeb rau koj qhia qhov txawv txav lossis cov tsos mob mus rau koj tus kws kho mob.

Yog tias koj tus kws kho mob txhawj xeeb tias koj muaj kabmob kheesxaws ntawm zes qe menyuam, lawv yuav pom zoo kom kuaj plab mos. Kev ntsuam xyuas lub plab mog tuaj yeem pab koj tus kws kho mob tshawb pom qhov tsis meej, tab sis cov qog ntawm zes qe menyuam yog qhov nyuaj rau lub siab.

Raws li cov qog loj tuaj, nws nias tawm ntawm lub zais zis thiab qhov quav. Koj tus kws kho mob tuaj yeem tshawb pom qhov kev tsis sib haum xeeb thaum lub sijhawm xoo pob qij txha tawm ntawm qhov chaw mos.

Koj tus kws khomob yuav ua cov kev sim nram no:

• Transvaginal ultrasound (TVUS). TVUS yog ib hom kev ntsuam xyuas uas siv lub suab tsis meej los kuaj qog hauv qog, nrog rau zes qe menyuam. Txawm li cas los xij, TVUS tsis tuaj yeem pab koj tus kws kho mob txiav txim siab tias qog hlav qog noj ntshav.
• Mob plab thiab pelvic CT scan. Yog tias koj ua xua rau zas xim, lawv tuaj yeem yuam kom kuaj pob qij txha MRI.
• Kuaj ntshav los ntsuas kab mob qog ntshav ntshav antigen 125 (CA-125) qib. Qhov ntsuas CA-125 yog biomarker uas tau siv los ntsuas kev teb rau kev mob kheesxaws ntawm zes qe menyuam thiab lwm cov qog nqaij hlav hauv tsev menyuam. Txawm li cas los xij, ua kev coj khaub ncaws, poj niam uterine fibroids, thiab mob cancer ntawm uterine kuj tseem tuaj yeem cuam tshuam txog CA-125 qib hauv cov ntshav.
• Raug me. Yuav siv ib qhov nqaij me me coj mus kuaj qhov nqaij mos tawm ntawm lub zes qe menyuam thiab mus tsom rau qhov hnoos qeev tawm hauv lub tshuab tsom.

Nws yog ib qho tseem ceeb kom nco ntsoov tias, txawm hais tias txhua yam kev sim no tuaj yeem pab qhia koj tus kws kho mob rau kev kuaj mob, kev kuaj mob li ib feem ntawm koj tus kws kho mob tuaj yeem lees paub seb koj puas muaj mob qog mis.

Dab tsi yog ntau theem ntawm qog nqaij hlav zes qe menyuam?

Koj tus kws kho mob txiav txim siab qhov theem nyob ntawm seb mob cancer kis tau deb npaum li cas. Muaj plaub ntu, thiab txhua theem muaj kab mob qaum:

Theem 1

Theem 1 mob kheesxaws ntawm zes qe menyuam muaj peb ntu:

• Theem 1A.Cov qog noj ntshav qis, lossis ib cheeb tsam hauv tsev, rau ib lub qe.
• Theem 1B. Tus kabmob yog nyob rau ob leeg zes qe menyuam.
• Theem 1C. Kuj tseem muaj cov kabmob kheesxaws tawm sab nraud ntawm lub zes qe menyuam thiab.

Theem 2

Hauv theem 2, lub qog tau kis mus rau lwm qhov chaw hu ua pelvic. Nws muaj ob lub qhov hauv qab:

• Theem 2A. Tus kabmob tau kis mus rau lub tsev menyuam lossis txoj hlab qe ntshav.
• Theem 2B. Tus kabmob tau kis mus rau lub zais zis lossis lub qhov quav.

Theem 3

Theem 3 mob zes qe menyuam muaj peb ntu:

• Theem 3A. Tus kabmob tau kis tus kabmob me me dhau ntawm lub plab mog mus rau sab hauv lub plab thiab cov qog ntshav hauv lub plab.
• Theem 3B. Cov qog nqaij hlav cancer tau kis ntau dhau ntawm lub plab mog mus rau sab hauv lub plab thiab pom tau qhov muag tsis pom tab sis ntsuas tsawg dua 2 cm.
• Theem 3C. Kev tso cov qog nqaij hlav yam tsawg kawg yog 3/4 ntawm nti yog pom ntawm lub plab los yog sab nraum tus po lossis daim siab. Txawm li cas los xij, tus kabmob kheesxaws tsis nyob hauv tus po lossis daim siab.

Theem 4

Hauv theem 4, lub qog tau metastasized, lossis kis, dhau ntawm lub plab mog, plab, thiab qog rau daim siab lossis lub ntsws. Muaj ob txoj hauv kev hauv theem 4:

• Hauv theem 4A, cov qog ua ntshav nyob hauv cov kua dej ncig ntawm lub ntsws.
• Hauv theem 4B, kev ua haujlwm siab tshaj plaws, cov hlwb tau mus txog sab hauv ntawm tus po lossis daim siab lossis lwm yam kabmob nyob deb li daim tawv lossis lub hlwb.

Yuav kho tus mob kheesxaws ntawm zes qe menyuam li cas

Cov kev kho mas nyob ntawm saib yuav kis tus kab mob cancer mus deb npaum li cas. Ib pab kws kho mob yuav txiav txim txog phiaj xwm kho mob raws li koj qhov xwm txheej. Nws feem ntau yuav suav nrog ob lossis ntau dua ntawm cov hauv qab no:

• kev kho tshuaj
• phais mus rau theem mob cancer thiab tshem tawm cov qog
• hom phiaj kho
• kev kho tshuaj hormones

Kev phais mob

Kev phais mob yog qhov kev kho mob tseem ceeb tshaj plaws ntawm zes qe menyuam.

Lub hom phiaj ntawm kev phais mob txhawm rau tshem tawm cov qog, tab sis kab mob hysterectomy, lossis tag nrho kev tshem tawm ntawm lub tsev menyuam, feem ntau tsim nyog.

Koj tus kws kho mob tseem yuav hais kom koj tshem ob txoj hlab zes qe menyuam thiab txoj hlab qe menyuam, cov qog ntshav nyob ze, thiab lwm qhov chaw mos.

Txheeb xyuas txhua qhov chaw qog ua haujlwm nyuaj.

Hauv ib txoj kev tshawb nrhiav, cov neeg tshawb nrhiav tau tshawb txoj hauv kev los txhim kho kev phais mob kom yooj yim dua los tshem tawm tag nrho cov qog nqaij hlav cancer.

Cov hom phiaj kho

Cov hom phiaj kho, xws li kev siv tshuaj kho mob, tua cov qog nqaij hlav cancer thaum ua me ntsis kev puas tsuaj rau cov kab mob hauv lub cev.

Cov hom phiaj tshiab tshaj los kho cov mob qog nqaij hlav rau mob qog nqaij hlav siab phem muaj xws li PARP inhibitors, uas yog cov tshuaj uas thaiv cov enzyme uas siv los ntawm cov hlwb los kho kev puas tsuaj rau lawv cov DNA.

Thawj PARP inhibitor tau txais kev pom zoo hauv 2014 siv rau hauv kev mob qog ntawm zes qe menyuam uas tau raug kho yav tas los nrog peb kab ntawm cov kws khomob (txhais tau hais tias tsawg kawg yog ob leeg rov muaj dua).

Peb tus PARP inhibitors muaj tam sim no suav nrog:

• olaparib (Lynparza)
• niraparib (Zejula)
• rucaparib (Rubraca)

Qhov sib ntxiv ntawm lwm cov tshuaj, bevacizumab (Avastin), kuj tau siv nrog kev kho mob tshuaj tom qab kev phais.

Fertility preservation

Cov kev kho mob qog noj ntshav, suav nrog kev siv tshuaj, hluav taws xob, thiab phais mob tuaj yeem ua rau koj cov plab hnyuv siab raum ua rau lub cev xeeb tub nyuaj.

Yog tias koj xav cev xeeb tub yav tom ntej, nrog koj tus kws kho mob tham ua ntej pib kev kho mob. Lawv tuaj yeem sib tham txog koj cov kev xaiv rau qee qhov tsim nyog khaws cia koj qhov kev xeeb tub.

Cov kev xaiv tau kev nyab xeeb muaj peev xwm suav nrog:

• Embryo khov. Qhov no yuav tsum khov lub qe ua paug.
• Oocyte khov. Cov txheej txheem no yuav tsum cia kom khov rau cov qe tsis ua tiav.
• Kev phais kom muaj peev xwm xeeb tub. Muaj qee kis, kev phais mob uas tsuas tshem tawm ib lub zes qe menyuam thiab ua rau lub zes qe menyuam noj qab nyob zoo tuaj yeem ua. Qhov no feem ntau tsuas ua tau nyob rau theem ntxov ntawm zes qe menyuam mob cancer.
• Kev khaws cov nqaij cia ntawm zes qe menyuam. Qhov no suav nrog kev tshem tawm thiab khov ntawm zes qe menyuam cov ntaub so ntswg rau kev siv yav tom ntej.
• Kev zes qe menyuam. Qhov no koom nrog kev noj cov tshuaj hormones rau tshuaj tiv thaiv ntawm zes qe menyuam ib ntus.

Kev tshawb nrhiav thiab mob kheesxaws ntawm zes qe menyuam

Cov kev kho mob tshiab rau kev mob qog ntawm zes qe menyuam yog kawm txhua xyoo.

Cov kws tshawb nrhiav tseem tshawb nrhiav txoj hauv kev tshiab los kho platinum-resistant tus kabmob kheesxaws. Thaum platinum tsis kam tshwm sim, cov qauv tshuaj thawj cov kab mob xws li carboplatin thiab cisplatin tsis ua hauj lwm zoo.

Yav tom ntej ntawm PARP inhibitors yuav txheeb xyuas seb lwm cov tshuaj tuaj yeem siv ua ke nrog lawv los kho cov qog uas qhia tau cov yam ntxwv zoo li cas.

Tsis ntev los no, qee qhov kev cog lus zoo tau pib soj ntsuam kev kho mob xws li cov tshuaj tiv thaiv muaj peev xwm tiv thaiv kev mob kheesxaws ntawm zes qe menyuam uas qhia cov protein muaj sia nyob.

Thaum lub Tsib Hlis 2020, tau muab luam tawm rau lub peev xwm tshiab tiv thaiv tshuaj-tshuaj sib txuas (ADC) los kho platinum-resistant ntawm zes qe menyuam mob.

Cov hom phiaj tshiab tau muab kho, suav nrog cov tshuaj tiv thaiv navicixizumab, ATR inhibitor AZD6738, thiab Wee1 inhibitor adavosertib. Txhua tus tau pom cov cim los tiv thaiv qog.

taw tus tib neeg cov noob caj dab kom kho lossis kho kab mob. Hauv 2020, ib theem III kev sim rau kev kho tus kheej VB-111 (ofranergene obadenovec) txuas ntxiv nrog rau cov txiaj ntsig tau zoo.

Xyoo 2018, FDA ceev nrooj los kho cov protein kho hu ua AVB-S6-500 rau platinum-resistant kev mob kheesxaws zes qe menyuam. Qhov no lub hom phiaj txhawm rau tiv thaiv qog hlav hlav thiab qog noj ntshav kis los ntawm kev thaiv ib qho tseem ceeb ntawm txoj kev hloov molecular.

Qhov kev sim kho mob txuas ntxiv txuas ntxiv ntawm kev kho tshuaj tiv thaiv (uas pab kho tib neeg lub cev tiv thaiv kab mob cancer) nrog cov kev kho mob uas twb tau pom zoo lawm tau cog lus tseg.

Kev kuaj mob lub hom phiaj tau kho rau cov neeg uas muaj ntau ntau theem ntawm tus kabmob no.

Kev kho kheesxaws ntawm zes qe menyuam feem ntau tsom rau kev phais kom tshem tawm lub zes qe menyuam thiab tsev menyuam thiab siv tshuaj kho. Raws li qhov tshwm sim, qee tus poj niam yuav hnov ​​cov tsos mob lawm.

Ib tsab xov xwm 2015 tau saib ntawm kev siv tshuaj khomob intraperitoneal (IP). Qhov kev tshawb nrhiav no pom tau tias cov uas tau txais kev kho IP muaj qhov nruab nrab kev muaj sia nyob ntev li ntawm 61.8 lub hlis. Qhov no yog kev txhim kho piv rau 51.4 lub hlis rau cov neeg uas tau txais kev kho mob txheem.

Puas tuaj yeem tiv thaiv tus mob qog qe menyuam tau?

Nws tsis muaj ib txoj kev pov thawj los mus tshem tawm qhov koj yuav muaj mob kheesxaws ntawm zes qe menyuam. Txawm li cas los xij, muaj cov txheej txheem koj tuaj yeem ua los txo koj txoj kev pheej hmoo.

Cov ntsiab lus tau pom tias yuav txo qis koj qhov kev pheej hmoo ntawm kev tsim mob qog nqaij hlav zes qe menyuam muaj xws li:

• noj tshuaj txwv kom tsis txhob muaj menyuam
• pub niam mis
• cev xeeb tub
• phais cov txheej txheem rau koj cov plab hnyuv siab raum (zoo li txoj hlab ntshav lossis txoj hlab hlav)

Qhov tshwm sim yog dab tsi?

Koj txoj kev xam pom yog nyob ntawm ntau yam, suav nrog:

• theem ntawm mob cancer ntawm kev kuaj mob
• koj kev noj qab haus huv tag nrho
• zoo li cas koj teb rau kev kho mob

Txhua tus mob qog muaj qhov tsis txawv, tab sis theem ntawm cancer yog qhov cim tseem ceeb tshaj plaws ntawm kev saib pom.

Ciaj sia taus tus nqi

Tus nqi ntawm kev muaj sia nyob yog feem pua ​​ntawm cov poj niam uas muaj sia nyob qee xyoo ntawm cov theem ntawm kev kuaj mob.

Piv txwv li, 5 xyoo ntawm kev muaj sia nyob yog qhov feem pua ​​ntawm cov neeg mob uas tau txais kev kuaj mob nyob rau qee theem thiab nyob tsawg kawg 5 xyoos tom qab lawv tus kws kho mob tau kuaj pom lawv.

Tus txheeb ze tus nqi tseem yuav siv mus rau hauv tus account qhov xav tias yuav tuag rau cov neeg uas tsis muaj mob qog noj ntshav.

Kev mob kheesxaws Epithelial yog hom mob kheesxaws ntau tshaj ntawm zes qe menyuam. Ciaj sia nyob tus nqi yuav txawv raws hom mob cancer ntawm zes qe menyuam, kev muaj mob cancer, thiab txuas ntxiv mus kho kho mob.

Cov American Cancer Society siv cov ntaub ntawv los ntawm SEER cov ntaub ntawv khaws tseg uas National National Cancer Institute (NCI) tswj hwm kwv yees tus nqi txheeb ze rau hom mob qog qe menyuam.

Nov yog li cas SEER tam sim no categorizes ntau theem:

• Laus. Tsis muaj daim phiajcim qhia tias tus kabmob tau ri mus deb sab nraud lub zes qe menyuam.
• Cheeb Tsam. Cov kab mob khees xaws tau nthuav tawm sab nraum lub zes qe menyuam mus rau cov tsev nyob ze lossis cov qog ntshav.
• Deb. Kab mob kheesxaws tau kis mus rau thaj chaw ntawm lub cev, xws li lub siab lossis lub ntsws.

5-xyoos tus nqi txheeb ze nyob rau mob qog qe menyuam

Caw neeg mob kheesxaws ntau tsis muaj mob

Cov hlwv ntawm zes qe menyuam qog

Cov qog cell ua haujlwm ntawm lub zes qe menyuam

Nco ntsoov tias cov ntaub ntawv no los ntawm cov kev tshawb fawb uas yuav yog tsawg kawg 5 xyoos lossis laus dua.

Cov kws tshawb fawb tseem tab tom tshawb nrhiav ntau txoj hauv kev txhim kho thiab txhim khu kev qha txhawm rau txhawm rau kuaj mob qog qe menyuam ntxov. Cov kev pom zoo hauv kev kho mob ua kom zoo dua qub, thiab nrog nws, qhov pom ntawm tus kabmob kheesxaws ntawm zes qe menyuam.