Ukraine

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      <text bytes="519" xml:space="preserve">{{Dialect|Asante}}
{{Ɔman
|name               = Ukraine
|flag               = Flag of Ukraine.svg
|coa                = Lesser Coat of Arms of Ukraine.svg
|map                = Ukraine_-_disputed_(orthographic_projection).svg
|capital            = [[Kyiv]]
|area               = 603,628
|population         = 41,167,336
|year               = 2022
}}
'''Ukraine''' ({{Audio|tw-Ukraine.ogg|pronounciation of &quot;Ukraine&quot;}})  (''Україна'') yε ɔman. Kro titiriw wɔ [[Kiev]].

[[Category:Ɔman]]
[[Category:Ukraine]]</text>
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  <page>
    <title>Mfinfini Mantan</title>
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  <page>
    <title>Asante Mantam</title>
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      <text bytes="12003" xml:space="preserve">{{Dialect|Akuapem}}

[[File:Ghana - Ashanti.svg|190px|right]]
'''Asante Mantam''' wɔ Ghana atɔe fam, na eno ne Mantam etɔ so miensa a eso paa wɔ mantam 16 no mu. Ne tɛtrɛtɛ yɛ 24,389&amp;nbsp;km (9,417 sq mi) wɔ Ghana nsase mu. Sɛ ɛba nnipa dodoɔ a ɛwɔ mantam ahorɔw no mu a, Asante Mantam na edikan. Nmipa akekan a ɛkɔɔ so wɔ afe 2010 no mu kyerɛ sɛ nnipa dodoɔ 4,780,380 a egyina hɔ ma ɔha mu nkyenkyem 19.4 na ɛwɔ Asante mantam no mu. Wonim Asante Mantam no sɛ ɛyɛ beae a sika kɔkɔɔ ne kookoo wɔ paa. Asante mantam ahenkurow ne [[:en:Kumasi|Kumasi]].

Asante Mantam wɔ Abibiman so wɔ Asaase so.

Asante ne din ahodo bi ne: Esuante. Afe [[1695]] beremu na Asantehene Nana Ɔsɛe Tutu tintimm no. Bere wɔ ha yɛ 0 nnɔnhwere firi Greenwich bere ho. Ɔda tentenedo 0.15Anee kɔpem 2.25Anee na tɛtɛredo 5.50Etifi kɔpem 7.46Etifi.

Atitirifo Otumfoo Ɔsɛe Tutu, ne John Kofi Agyekum Kufuor firi saa bea yi. Adaekɛse na Odwira ka [[afahyɛ]] na dwumadi ɛkɔ so wɔ Asanteman mu. [[Akan]]fo, Nkramofo na Akristofo ka nkorɔfo a wɔfi borɔn yi do.
== Asase ==

=== Beae ne ne kese ===
Asante Mantam si Ghana mfinfin pɛɛ . Mantam no ne mantam nsia na ɛbɔ hyeɛ a ɛne Bono, Bono Atoe, Ahafo Mantam, Apuei mantam  Mfinfin mantam ne Atɔe mantam . Asante mantam no wɔ mpesua 27 na emu bira wɔ Aban mu ananmusifo wɔ hɔ.

== Nsrahwɛbea ==

* Bobiri Afofanto kwaeɛbirentuo
* Bomfobiri mmoa kwaeɛbirentuo
* Digya Agodibea
* Kogyae abodeɛ akoraɛ
* Nnomaa ne kwaeɛbirentuo a ɛwɔ Owab

=== Agodibea ===

* Beae a wɔhwɛ ammamerɛ akorae
**
* Rattray Agodibea

=== Abakɔsem mmeaɛ ===

* Komfo Anokye sikan asoeɛ
* Manhyia Ahenfie akoraeɛ
* Kumasi Abankɛse ne Banbofo akoraeɛ
* Banbofo akoraeɛ
* Prempeh II mfedie  akoraeɛ
* Asante Amammerɛ  akoraeɛ
* [[Yaa Asantewaa]] akoraeɛ

=== Afahyakoraeɛ ===
[[File:Young_Drummers_at_Bomeng,_Ashanti.jpg|thumb|mmabun a wɔbɔ twene.]]
Afahyɛ ahorɔw pii na wodi wɔ  Asante Mantam mu, emu atitiriw ne Akwasidae ne Adae Kɛse. Eyinom yɛ afahyɛ a wodi no wɔ  akan man mu. Wodi saa afahyɛ ahorɔw yi de kae tete kandifo ne  adɔmmarima. ɛmfa ho sɛ saa foɔ  yi awuwu no, wogyidi sɛ wɔn akra da so te wɔn mu , na wɔn ani di ateasefo nneɛma a wɔyɛ no akyi ma nti, wɔ kɔ  wɔn nkyɛn abisa wɔ  Adae afahyɛ bre.

* Papa Afahyɛ
* Kente Afahyɛ
* Yaa Asantewaa Afahyɛ
* Mmoa Nni Nko Afahyɛ
* Nkyidwo Afahyɛ

=== Nsrahwɛbea afoforow ===
[[File:2010_FarmersDay_AshantiRegion_Ghana_5262946799.jpg|thumb|Kuayɛ ho Afahyɛ mfoni]]

* Kejetia Dwadibea
* Patakro abosomfie
* Adinkra ntoma tintimbea wɔ  Ntonso
* Adanwomase Kente Akura
* Bonwire Kente Akura
* Ahwiaa Nnuanwene akura

== Demographics ==
&lt;br /&gt;
[[File:Ass_Hall.jpg|thumb|Anglican Ntoaso sukuu, Kumasi]]

=== Ntoaso sukuu ahorɔw ===
{{colbegin|colwidth=30em}}
* Dadease Senior High School, Dadease
* Dompoase Senior High School, Dompoasi
* Afia Kobi Ampem Girls (Royal AKAGSHS)
* Adanwomase SENIOR High School (ADASS)
* Agogo State College, Agogo Asante-Akyem
* Agona SDA Senior High School, Agona
* [[Anglican Senior High School, Kumasi]]
* Asanteman School (Real Assas)
* Osei Tutu Senior High School (OT)
* Bekwai SDA Senior High  School
* [[Ghana Armed Forces Secondary Technical School, Kumasi]]
* Beposo Senior High School, Beposo
* Collins Secondary Commercial School, Agog o Asante-Akyem
* Effiduase Senior High School, Effiduase
* Ejisuman Senior High School, Ejisu
* Ejuraman Senior High School, Ejura
* Fomena T.I. Ahmadiyya Senior High School, Adansi Fomena
* Jachie-Pramso Senior High School (Formerly  MIGHTY JAPASS)
* Komfo Anokye Senior High School, Wiamoase
* [[Kumasi Academy]], Asokore-Mampong, Kumasi
* [[Kumasi Girls Senior High School|Kumasi Girls' Senior High School]]
* Kumasi Wesley Girls High School
* Kumasi High School 
* Obuasi Secondary Technical School (O.S.T.S)
* Wesley Senior High School (WEHIS), Bekwai
* Adventist Senior High School (ADASS),Bantama
* Ofoase Kokoben Senior High School (OFKOSS)
* Adventist Girls Senior High School (ADGISS),Ntonso
* [[Opoku Ware School]], Kumasi.
* [[St. Louis Senior High School]], Oduom
* Nkawie Secondary Technical School.
* Oppong Memorial Senior High School.
* Osei Kyeretwie Senior High School, Kumasi.
* [[Prempeh College]], Kumasi.
* Simms Senior High School, Fawoade
* Bonwire Senior High Tech. School.
* St Joseph Senior High School (Ehuren)
* St. Monica's Senior High School, Mampong
* Amaniampong Senior High School, Mampong
* T.I. Ahmadiyya Senior High School, Kumasi
* T.I. Ahmadiyya Girls' Senior High School, Asokore
* Jacobu Senior High School, Jacobu
* Juaben Senior High School, Juaben
* Yaa Asantewaa Girls' Senior High School, Tanoso
* [[Kumasi Senior High Technical School]] (K.S.T.S),
* [[Tepa Senior High School, Tepa]]. (GREAT TESS).
* Mabang Senior High School, Mabang.
{{colend}}

* Dadease Ntoaso sukuu, Dadease
* Dompoase Ntoaso sukuul, Dompoasi
* Afia Kobi Ampem mmaa (Royal AKAGSHS)
* Adanwomase SNtoaso sukuu (ADASS)
* Agogo State College, Agogo Asante-Akyem
* Agona SDA Ntoaso sukuul, Agona
* Anglican Ntoaso sukuu, Kumasi
* Asanteman Sukuu (Real Assas)
* Osei Tutu Ntoaso sukuu (OT)
* Bekwai SDA Ntoaso sukuu
* Ghana Armed Forces Secondary Technical School, Kumasi
* Beposo Ntoaso sukuu, Beposo
* Collins Secondary Commercial School, Agog o Asante-Akyem
* Effiduase Ntoaso sukuu, Effiduase
* Ejisuman Ntoaso sukuu, Ejisu
* Ejuraman Ntoaso sukuu, Ejura
* Fomena T.I. Ahmadiyya Ntoaso sukuu, Adansi Fomena
* Jachie-Pramso Ntoaso sukuu(tete no MIGHTY JAPASS)
* Komfo Anokye Ntoaso sukuu, Wiamoase
* Kumasi Academy, Ntoaso sukuu, Kumasi
* Kumasi mmaa' Ntoaso sukuu
* Kumasi Wesley mmaa Ntoaso sukuu
* Kumasi Ntoaso sukuu
* Obuasi Secondary Technical School (O.S.T.S)
* Wesley Ntoaso sukuu (WEHIS), Bekwai
* Adventist Ntoaso sukuu (ADASS),Bantama
* Ofoase Kokoben Ntoaso sukuu (OFKOSS)
* Adventist mmaa Senior High School (ADGISS),Ntonso
* Opoku Ntoaso sukuu, Kumasi.
* St. Louis Ntoaso sukuu, Oduom
* Nkawie Secondary Technical School.
* Oppong Nkae Ntoaso sukuu.
* Osei Kyeretwie Ntoaso sukuu, Kumasi.
* Prempeh College, Kumasi.
* Simms Ntoaso sukuul, Fawoade
* Bonwire Ntoaso sukuu
* St JosephNtoaso sukuu (Ehuren)
* St. Monica's Ntoaso sukuu, Mampong
* Amaniampong Ntoaso sukuu, Mampong
* T.I. Ahmadiyya Ntoaso sukuu, Kumasi
* T.I. Ahmadiyya mmaa Ntoaso sukuu, Asokore
* Jacobu Ntoaso sukuu, Jacobu
* Juaben Ntoaso sukuu, Juaben
* Yaa Asantewaa mmaa Ntoaso sukuu, Tanoso
* Kumasi Senior High Technical School (K.S.T.S),
* Tepa Ntoaso sukuu, Tepa. (GREAT TESS).
* Mabang Ntoaso sukuul, Mabang.

=== Sukuu Pɔn ===
Asante mantam wo oman sukuu pon baako ane din [[:en:Kwame Nkrumah University of Science and Technology|Kwame Nkrumah University of Science and Technology]] ne Polytechnic baako a ne nyinaa wo Kumasi. Ankoreankore suapon ahorow pii nso wo mantam no mu.
[[File:Kwame Nkrumah University of Science and Technology (KNUST) – Side view of the College of Architecture and Planning.JPG|thumb|Kwame Nkrumah Sukuu pɔn]]

==== Sukuu Pɔn ====
{{colbegin|colwidth=30em}}
* Kwame Nkrumah University of Science and Technology, Kumasi
* Ghana Baptist University College, Kumasi
* Spiritan University College, Ejisu
* [[Garden City University College]], Kenyasi, Kumasi
* University of Education, Kumasi Campus, Kumasi
* National Institute Of Information Technology, Kumasi Campus NIIT.
* [[Kumasi Technical University]], K-Poly
* IPMC, Kumasi Campus
* Akrokerri College of Education
* St. Monica's College of Education, Mampong
* Christian Service University College, Odeneho Kwadaso
* Wesley College of Education
* St. Louis College of Education
{{colend}}

* Kwame Nkrumah University of Science and Technology, Kumasi
* Ghana Baptist University College, Kumasi
* Spiritan University College, Ejisu
* Garden City University College, Kenyasi, Kumasi
* University of Education, Kumasi Campus, Kumasi
* National Institute Of Information Technology, Kumasi Campus NIIT.
* Kumasi Technical University, K-Poly
* IPMC, Kumasi Campus
* Akrokerri College of Education
* St. Monica's College of Education, Mampong
* Christian Service University College, Odeneho Kwadaso
* Wesley College of Education
* St. Louis College of Education
* University of Education, Mampog Campus
* Mampong Technical College of Education (MAMTECH)
* S.D.A. College of Education, Agona

== Ayaresa ==
[[File:Komfo_Anokye_Teaching_Hospital,_Kumasi,_Ghana.jpg|left|thumb|Komfo Anokye Ayaresabea]]
Kwadaso SDA HAyaresabeal

Komfo Anokye TAyaresabea

First care Ayaresabea

Tafo Aban Ayaresabea

Suntreso Government Hospital

== Agorɔ ==
[[File:Kumasi924.JPG|thumb|Baba Yara Agoprammaso]]
{{div col|colwidth=30em}}
*[[Asante Kotoko F.C.|Kumasi Asante Kotoko]]
*[[Ashanti Gold SC]]
*[[King Faisal Babes|King Faisal Babies F.C.]]
*[[New Edubiase United]]
*Main stadium is [[Kumasi Sports Stadium]]
{{div col end}}

* Kumasi Asante Kotoko
* Ashanti Gold SC
* King Faisal Babies F.C.
* New Edubiase United
* Main stadium is Kumasi Sports Stadium

== Mpesua ==
The political administration of the region is through the local government system. Under this administration system, the region is divided into 30 districts made up of 1 Metropolitan, 7 Municipal and 22 Ordinary districts. Each District, Municipal or Metropolitan Area, is administered by a Chief Executive, representing the central government but deriving authority from an Assembly headed by a presiding member elected from among the members themselves.
[[File:Districts_of_the_Ashanti_Region_(2012).svg|right|thumb|600x600px|DistrictsAsAsante mantam]]
{| class=&quot;wikitable&quot;
! colspan=&quot;3&quot; |Asante Mantam mu mpesua
|-
!Mpesua
!Ahenkurow
!Nnipa dodoɔ
|-
|Adansi Atifi
|Fomena
|235,680 (2000 census)
|-
|Adansi Atɔe
|New Edubiase
|129,325 (2000 census)
|-
|Afigya-Kwabre
|Kodie
|
|-
|Ahafo Ano Atifi
|Tepa
|71,856 (2000 census)
|-
|Ahafo Ano Atɔe
|Mankranso
|133,874 (2000 census)
|-
|Amansin Mfinfin
|Jacobu
|219, 508 (2000 census)
|-
|Amansie 
|Manso Nkwanta
|108, 768 (2000 census)
|-
|Asante Akim Nfinfin
|Konongo
|71,508 (2010 census)
|-
|Asante Akim Atifi
|Agogo, Ghana
|126, 465 (2000 census)
|-
|Asante Akim Atɔe
|Juaso
|96, 885 (2000 census)
|-
|Asokore Mampong Mpesua
|Asokore Mampong
|304,815 (2010 census)
|-
|Atwima Kwanwoma
|Foase Kokoben
|234, 759 (2000 census)
|-
|Atwima Mponua
|Nyinahin
|
|-
|Atwima Nwabiagya
|Nkawie
|
|-
|Bekwai mpesua
|Bekwai
|
|-
|Bosome Freho
|Asiwa
|
|-
|Bosomtwe
|Kuntenase
|145,524 (2000 census)
|-
|Ejisu-Juaben Mpesua
|Ejisu
|124,179 (2000 census)
|-
|Ejura/Sekyeredumase
|Ejura
|81, 119 (2000 census)
|-
|Kumasi Mpesua
|[[Kumase|Kumasi]]
|1,171,311 (2000 census)
|-
|Kwabre
|Mamponteng
|164,668 (2000 census)
|-
|Mampong Mpesua
|Mampong
|
|-
|Obuasi Mpesua
|Obuasi
|
|-
|Ofinso mpesua
|Offinso
|138, 190 (2000 census)
|-
|Offinso Atifi
|Akomadan
|
|-
|Sekyere Afram Plains
|Drobonso
|28,535 (2010 census)
|-
|Sekyere Mfinfin
|Nsuta
|
|-
|Sekyere Apuei
|Effiduase
|157, 378
|-
|Sekyerre Kumawu
|Kumawu
|65,402 (2010 census)
|-
|Sekyere Atɔe
|Agona Ashanti
|143, 213
|}

== Atitiriw a wofi Mantam no mu ==
{| class=&quot;wikitable&quot;
! colspan=&quot;2&quot; |Atitiriw a wofi Asante Mantam 
|-
!ɔmanni
!Settlement
|-
|Mamme Efya Nyarko
|Asante, Ghana
|-
|Richmond Boakye
|Agogo
|-
|Deborah Owusu-Bonsu
|Pakyi no2
|-
|Sulley Mantari
|Konongo
|-
|Sonia Ibrahim
|[[Kumase|Kumasi]]
|-
|Emmanuel Frimpong
|[[Kumase|Kumasi]]
|-
|Kofi Annan
|[[Kumase|Kumasi]]
|-
|John Kufuor
|[[Kumase|Kumasi]]
|-
|Isaac Vorsah
|[[Kumase|Kumasi]]
|-
|Juliet Ibrahim
|[[Kumase|Kumasi]]
|-
|Sam Jonah
|Obuasi
|-
|Rhian Benson
|[[Kumase|Kumasi]]
|-
|Samuel Kuffour
|[[Kumase|Kumasi]]
|-
|Tony Yeboah 
|[[Kumase|Kumasi]]
|-
|Kwadwo Asamoh
|[[Kumase|Kumasi]]
|-
|Maxwell Konadu
|[[Kumase|Kumasi]]
|-
|Harrison Afful
|[[Kumase|Kumasi]]
|-
|Quincy Owusu-Abeyie
|[[Kumase|Kumasi]]
|-
|Kevin-Prince Boateng
|[[Kumase|Kumasi]]
|-
|Kofi Kingston
|[[Kumase|Kumasi]]
|-
|-
|}

{{Mantamu a ɛwɔ Ghana}}

[[Nkyekyem:Mantamu a ɛwɔ Ghana]]
[[Nkyekyem:Gaana Mmantaw]]
[[Nkyekyem:Afanaa]]
[[Nkyekyεmu:Mantamu a ɛwɔ Ghana]]</text>
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[[File:Ghana - Ashanti.svg|190px|right]]
'''Asante Mantam''' wɔ Ghana atɔe fam, na eno ne Mantam etɔ so miensa a eso paa wɔ mantam 16 no mu. Ne tɛtrɛtɛ yɛ 24,389&amp;nbsp;km (9,417 sq mi) wɔ Ghana nsase mu. Sɛ ɛba nnipa dodoɔ a ɛwɔ mantam ahorɔw no mu a, Asante Mantam na edikan. Nmipa akekan a ɛkɔɔ so wɔ afe 2010 no mu kyerɛ sɛ nnipa dodoɔ 4,780,380 a egyina hɔ ma ɔha mu nkyenkyem 19.4 na ɛwɔ Asante mantam no mu. Wonim Asante Mantam no sɛ ɛyɛ beae a sika kɔkɔɔ ne kookoo wɔ paa. Asante mantam ahenkurow ne [[:en:Kumasi|Kumasi]].

Asante Mantam wɔ Abibiman so wɔ Asaase so.

Asante ne din ahodo bi ne: Esuante. Afe [[1695]] beremu na Asantehene Nana Ɔsɛe Tutu tintimm no. Bere wɔ ha yɛ 0 nnɔnhwere firi Greenwich bere ho. Ɔda tentenedo 0.15Anee kɔpem 2.25Anee na tɛtɛredo 5.50Etifi kɔpem 7.46Etifi.

Atitirifo Otumfoo Ɔsɛe Tutu, ne John Kofi Agyekum Kufuor firi saa bea yi. Adaekɛse na Odwira ka [[afahyɛ]] na dwumadi ɛkɔ so wɔ Asanteman mu. [[Akan]]fo, Nkramofo na Akristofo ka nkorɔfo a wɔfi borɔn yi do.
== Asase ==

=== Beae ne ne kese ===
Asante Mantam si Ghana mfinfin pɛɛ . Mantam no ne mantam nsia na ɛbɔ hyeɛ a ɛne Bono, Bono Atoe, Ahafo Mantam, Apuei mantam  Mfinfin mantam ne Atɔe mantam . Asante mantam no wɔ mpesua 27 na emu bira wɔ Aban mu ananmusifo wɔ hɔ.

== Nsrahwɛbea ==

* Bobiri Afofanto kwaeɛbirentuo
* Bomfobiri mmoa kwaeɛbirentuo
* Digya Agodibea
* Kogyae abodeɛ akoraɛ
* Nnomaa ne kwaeɛbirentuo a ɛwɔ Owab

=== Agodibea ===

* Beae a wɔhwɛ ammamerɛ akorae
**
* Rattray Agodibea

=== Abakɔsem mmeaɛ ===

* Komfo Anokye sikan asoeɛ
* Manhyia Ahenfie akoraeɛ
* Kumasi Abankɛse ne Banbofo akoraeɛ
* Banbofo akoraeɛ
* Prempeh II mfedie  akoraeɛ
* Asante Amammerɛ  akoraeɛ
* [[Yaa Asantewaa]] akoraeɛ

=== Afahyakoraeɛ ===
[[File:Young_Drummers_at_Bomeng,_Ashanti.jpg|thumb|mmabun a wɔbɔ twene.]]
Afahyɛ ahorɔw pii na wodi wɔ  Asante Mantam mu, emu atitiriw ne Akwasidae ne Adae Kɛse. Eyinom yɛ afahyɛ a wodi no wɔ  akan man mu. Wodi saa afahyɛ ahorɔw yi de kae tete kandifo ne  adɔmmarima. ɛmfa ho sɛ saa foɔ  yi awuwu no, wogyidi sɛ wɔn akra da so te wɔn mu , na wɔn ani di ateasefo nneɛma a wɔyɛ no akyi ma nti, wɔ kɔ  wɔn nkyɛn abisa wɔ  Adae afahyɛ bre.

* Papa Afahyɛ
* Kente Afahyɛ
* Yaa Asantewaa Afahyɛ
* Mmoa Nni Nko Afahyɛ
* Nkyidwo Afahyɛ

=== Nsrahwɛbea afoforow ===
[[File:2010_FarmersDay_AshantiRegion_Ghana_5262946799.jpg|thumb|Kuayɛ ho Afahyɛ mfoni]]

* Kejetia Dwadibea
* Patakro abosomfie
* Adinkra ntoma tintimbea wɔ  Ntonso
* Adanwomase Kente Akura
* Bonwire Kente Akura
* Ahwiaa Nnuanwene akura

== Demographics ==
&lt;br /&gt;
[[File:Ass_Hall.jpg|thumb|Anglican Ntoaso sukuu, Kumasi]]

=== Ntoaso sukuu ahorɔw ===
{{colbegin|colwidth=30em}}
* Dadease Senior High School, Dadease
* Dompoase Senior High School, Dompoasi
* Afia Kobi Ampem Girls (Royal AKAGSHS)
* Adanwomase SENIOR High School (ADASS)
* Agogo State College, Agogo Asante-Akyem
* Agona SDA Senior High School, Agona
* [[Anglican Senior High School, Kumasi]]
* Asanteman School (Real Assas)
* Osei Tutu Senior High School (OT)
* Bekwai SDA Senior High  School
* [[Ghana Armed Forces Secondary Technical School, Kumasi]]
* Beposo Senior High School, Beposo
* Collins Secondary Commercial School, Agog o Asante-Akyem
* Effiduase Senior High School, Effiduase
* Ejisuman Senior High School, Ejisu
* Ejuraman Senior High School, Ejura
* Fomena T.I. Ahmadiyya Senior High School, Adansi Fomena
* Jachie-Pramso Senior High School (Formerly  MIGHTY JAPASS)
* Komfo Anokye Senior High School, Wiamoase
* [[Kumasi Academy]], Asokore-Mampong, Kumasi
* [[Kumasi Girls Senior High School|Kumasi Girls' Senior High School]]
* Kumasi Wesley Girls High School
* Kumasi High School 
* Obuasi Secondary Technical School (O.S.T.S)
* Wesley Senior High School (WEHIS), Bekwai
* Adventist Senior High School (ADASS),Bantama
* Ofoase Kokoben Senior High School (OFKOSS)
* Adventist Girls Senior High School (ADGISS),Ntonso
* [[Opoku Ware School]], Kumasi.
* [[St. Louis Senior High School]], Oduom
* Nkawie Secondary Technical School.
* Oppong Memorial Senior High School.
* Osei Kyeretwie Senior High School, Kumasi.
* [[Prempeh College]], Kumasi.
* Simms Senior High School, Fawoade
* Bonwire Senior High Tech. School.
* St Joseph Senior High School (Ehuren)
* St. Monica's Senior High School, Mampong
* Amaniampong Senior High School, Mampong
* T.I. Ahmadiyya Senior High School, Kumasi
* T.I. Ahmadiyya Girls' Senior High School, Asokore
* Jacobu Senior High School, Jacobu
* Juaben Senior High School, Juaben
* Yaa Asantewaa Girls' Senior High School, Tanoso
* [[Kumasi Senior High Technical School]] (K.S.T.S),
* [[Tepa Senior High School, Tepa]]. (GREAT TESS).
* Mabang Senior High School, Mabang.
{{colend}}

* Dadease Ntoaso sukuu, Dadease
* Dompoase Ntoaso sukuul, Dompoasi
* Afia Kobi Ampem mmaa (Royal AKAGSHS)
* Adanwomase SNtoaso sukuu (ADASS)
* Agogo State College, Agogo Asante-Akyem
* Agona SDA Ntoaso sukuul, Agona
* Anglican Ntoaso sukuu, Kumasi
* Asanteman Sukuu (Real Assas)
* Osei Tutu Ntoaso sukuu (OT)
* Bekwai SDA Ntoaso sukuu
* Ghana Armed Forces Secondary Technical School, Kumasi
* Beposo Ntoaso sukuu, Beposo
* Collins Secondary Commercial School, Agog o Asante-Akyem
* Effiduase Ntoaso sukuu, Effiduase
* Ejisuman Ntoaso sukuu, Ejisu
* Ejuraman Ntoaso sukuu, Ejura
* Fomena T.I. Ahmadiyya Ntoaso sukuu, Adansi Fomena
* Jachie-Pramso Ntoaso sukuu(tete no MIGHTY JAPASS)
* Komfo Anokye Ntoaso sukuu, Wiamoase
* Kumasi Academy, Ntoaso sukuu, Kumasi
* Kumasi mmaa' Ntoaso sukuu
* Kumasi Wesley mmaa Ntoaso sukuu
* Kumasi Ntoaso sukuu
* Obuasi Secondary Technical School (O.S.T.S)
* Wesley Ntoaso sukuu (WEHIS), Bekwai
* Adventist Ntoaso sukuu (ADASS),Bantama
* Ofoase Kokoben Ntoaso sukuu (OFKOSS)
* Adventist mmaa Senior High School (ADGISS),Ntonso
* Opoku Ntoaso sukuu, Kumasi.
* St. Louis Ntoaso sukuu, Oduom
* Nkawie Secondary Technical School.
* Oppong Nkae Ntoaso sukuu.
* Osei Kyeretwie Ntoaso sukuu, Kumasi.
* Prempeh College, Kumasi.
* Simms Ntoaso sukuul, Fawoade
* Bonwire Ntoaso sukuu
* St JosephNtoaso sukuu (Ehuren)
* St. Monica's Ntoaso sukuu, Mampong
* Amaniampong Ntoaso sukuu, Mampong
* T.I. Ahmadiyya Ntoaso sukuu, Kumasi
* T.I. Ahmadiyya mmaa Ntoaso sukuu, Asokore
* Jacobu Ntoaso sukuu, Jacobu
* Juaben Ntoaso sukuu, Juaben
* Yaa Asantewaa mmaa Ntoaso sukuu, Tanoso
* Kumasi Senior High Technical School (K.S.T.S),
* Tepa Ntoaso sukuu, Tepa. (GREAT TESS).
* Mabang Ntoaso sukuul, Mabang.

=== Sukuu Pɔn ===
Asante mantam wo oman sukuu pon baako ane din [[:en:Kwame Nkrumah University of Science and Technology|Kwame Nkrumah University of Science and Technology]] ne Polytechnic baako a ne nyinaa wo Kumasi. Ankoreankore suapon ahorow pii nso wo mantam no mu.
[[File:Kwame Nkrumah University of Science and Technology (KNUST) – Side view of the College of Architecture and Planning.JPG|thumb|Kwame Nkrumah Sukuu pɔn]]

==== Sukuu Pɔn ====
{{colbegin|colwidth=30em}}
* Kwame Nkrumah University of Science and Technology, Kumasi
* Ghana Baptist University College, Kumasi
* Spiritan University College, Ejisu
* [[Garden City University College]], Kenyasi, Kumasi
* University of Education, Kumasi Campus, Kumasi
* National Institute Of Information Technology, Kumasi Campus NIIT.
* [[Kumasi Technical University]], K-Poly
* IPMC, Kumasi Campus
* Akrokerri College of Education
* St. Monica's College of Education, Mampong
* Christian Service University College, Odeneho Kwadaso
* Wesley College of Education
* St. Louis College of Education
{{colend}}

* Kwame Nkrumah University of Science and Technology, Kumasi
* Ghana Baptist University College, Kumasi
* Spiritan University College, Ejisu
* Garden City University College, Kenyasi, Kumasi
* University of Education, Kumasi Campus, Kumasi
* National Institute Of Information Technology, Kumasi Campus NIIT.
* Kumasi Technical University, K-Poly
* IPMC, Kumasi Campus
* Akrokerri College of Education
* St. Monica's College of Education, Mampong
* Christian Service University College, Odeneho Kwadaso
* Wesley College of Education
* St. Louis College of Education
* University of Education, Mampog Campus
* Mampong Technical College of Education (MAMTECH)
* S.D.A. College of Education, Agona

== Ayaresa ==
[[File:Komfo_Anokye_Teaching_Hospital,_Kumasi,_Ghana.jpg|left|thumb|Komfo Anokye Ayaresabea]]
Kwadaso SDA HAyaresabeal

Komfo Anokye TAyaresabea

First care Ayaresabea

Tafo Aban Ayaresabea

Suntreso Government Hospital

== Agorɔ ==
[[File:Kumasi924.JPG|thumb|Baba Yara Agoprammaso]]
{{div col|colwidth=30em}}
*[[Asante Kotoko F.C.|Kumasi Asante Kotoko]]
*[[Ashanti Gold SC]]
*[[King Faisal Babes|King Faisal Babies F.C.]]
*[[New Edubiase United]]
*Main stadium is [[Kumasi Sports Stadium]]
{{div col end}}

* Kumasi Asante Kotoko
* Ashanti Gold SC
* King Faisal Babies F.C.
* New Edubiase United
* Main stadium is Kumasi Sports Stadium

== Mpesua ==
The political administration of the region is through the local government system. Under this administration system, the region is divided into 30 districts made up of 1 Metropolitan, 7 Municipal and 22 Ordinary districts. Each District, Municipal or Metropolitan Area, is administered by a Chief Executive, representing the central government but deriving authority from an Assembly headed by a presiding member elected from among the members themselves.
[[File:Districts_of_the_Ashanti_Region_(2012).svg|right|thumb|600x600px|DistrictsAsAsante mantam]]
{| class=&quot;wikitable&quot;
! colspan=&quot;3&quot; |Asante Mantam mu mpesua
|-
!Mpesua
!Ahenkurow
!Nnipa dodoɔ
|-
|Adansi Atifi
|Fomena
|235,680 (2000 census)
|-
|Adansi Atɔe
|New Edubiase
|129,325 (2000 census)
|-
|Afigya-Kwabre
|Kodie
|
|-
|Ahafo Ano Atifi
|Tepa
|71,856 (2000 census)
|-
|Ahafo Ano Atɔe
|Mankranso
|133,874 (2000 census)
|-
|Amansin Mfinfin
|Jacobu
|219, 508 (2000 census)
|-
|Amansie 
|Manso Nkwanta
|108, 768 (2000 census)
|-
|Asante Akim Nfinfin
|Konongo
|71,508 (2010 census)
|-
|Asante Akim Atifi
|Agogo, Ghana
|126, 465 (2000 census)
|-
|Asante Akim Atɔe
|Juaso
|96, 885 (2000 census)
|-
|Asokore Mampong Mpesua
|Asokore Mampong
|304,815 (2010 census)
|-
|Atwima Kwanwoma
|Foase Kokoben
|234, 759 (2000 census)
|-
|Atwima Mponua
|Nyinahin
|
|-
|Atwima Nwabiagya
|Nkawie
|
|-
|Bekwai mpesua
|Bekwai
|
|-
|Bosome Freho
|Asiwa
|
|-
|Bosomtwe
|Kuntenase
|145,524 (2000 census)
|-
|Ejisu-Juaben Mpesua
|Ejisu
|124,179 (2000 census)
|-
|Ejura/Sekyeredumase
|Ejura
|81, 119 (2000 census)
|-
|Kumasi Mpesua
|[[Kumase|Kumasi]]
|1,171,311 (2000 census)
|-
|Kwabre
|Mamponteng
|164,668 (2000 census)
|-
|Mampong Mpesua
|Mampong
|
|-
|Obuasi Mpesua
|Obuasi
|
|-
|Ofinso mpesua
|Offinso
|138, 190 (2000 census)
|-
|Offinso Atifi
|Akomadan
|
|-
|Sekyere Afram Plains
|Drobonso
|28,535 (2010 census)
|-
|Sekyere Mfinfin
|Nsuta
|
|-
|Sekyere Apuei
|Effiduase
|157, 378
|-
|Sekyerre Kumawu
|Kumawu
|65,402 (2010 census)
|-
|Sekyere Atɔe
|Agona Ashanti
|143, 213
|}

== Atitiriw a wofi Mantam no mu ==
{| class=&quot;wikitable&quot;
! colspan=&quot;2&quot; |Atitiriw a wofi Asante Mantam 
|-
!ɔmanni
!Settlement
|-
|Mamme Efya Nyarko
|Asante, Ghana
|-
|Richmond Boakye
|Agogo
|-
|Deborah Owusu-Bonsu
|Pakyi no2
|-
|Sulley Mantari
|Konongo
|-
|Sonia Ibrahim
|[[Kumase|Kumasi]]
|-
|Emmanuel Frimpong
|[[Kumase|Kumasi]]
|-
|Kofi Annan
|[[Kumase|Kumasi]]
|-
|John Kufuor
|[[Kumase|Kumasi]]
|-
|Isaac Vorsah
|[[Kumase|Kumasi]]
|-
|Juliet Ibrahim
|[[Kumase|Kumasi]]
|-
|Sam Jonah
|Obuasi
|-
|Rhian Benson
|[[Kumase|Kumasi]]
|-
|Samuel Kuffour
|[[Kumase|Kumasi]]
|-
|Tony Yeboah 
|[[Kumase|Kumasi]]
|-
|Kwadwo Asamoh
|[[Kumase|Kumasi]]
|-
|Maxwell Konadu
|[[Kumase|Kumasi]]
|-
|Harrison Afful
|[[Kumase|Kumasi]]
|-
|Quincy Owusu-Abeyie
|[[Kumase|Kumasi]]
|-
|Kevin-Prince Boateng
|[[Kumase|Kumasi]]
|-
|Kofi Kingston
|[[Kumase|Kumasi]]
|-
|-
|}

{{Mantamu a ɛwɔ Ghana}}


[[Nkyekyεmu:Mantamu a ɛwɔ Ghana]]</text>
      <sha1>rkcu4t27uzqr66mbe0tznaf6daket33</sha1>
    </revision>
    <revision>
      <id>133048</id>
      <parentid>133045</parentid>
      <timestamp>2022-08-01T09:48:27Z</timestamp>
      <contributor>
        <username>Robertjamal12</username>
        <id>8680</id>
      </contributor>
      <model>wikitext</model>
      <format>text/x-wiki</format>
      <text bytes="11919" xml:space="preserve">{{Dialect|Akuapem}}

[[File:Ghana - Ashanti.svg|190px|right]]
'''Asante Mantam''' wɔ Ghana atɔe fam, na eno ne Mantam etɔ so miensa a eso paa wɔ mantam 16 no mu. Ne tɛtrɛtɛ yɛ 24,389&amp;nbsp;km (9,417 sq mi) wɔ Ghana nsase mu. Sɛ ɛba nnipa dodoɔ a ɛwɔ mantam ahorɔw no mu a, Asante Mantam na edikan. Nmipa akekan a ɛkɔɔ so wɔ afe 2010 no mu kyerɛ sɛ nnipa dodoɔ 4,780,380 a egyina hɔ ma ɔha mu nkyenkyem 19.4 na ɛwɔ Asante mantam no mu. Wonim Asante Mantam no sɛ ɛyɛ beae a sika kɔkɔɔ ne kookoo wɔ paa. Asante mantam ahenkurow ne [[:en:Kumasi|Kumasi]].

Asante Mantam wɔ Abibiman so wɔ Asaase so.

Asante ne din ahodo bi ne: Esuante. Afe [[1695]] beremu na Asantehene Nana Ɔsɛe Tutu tintimm no. Bere wɔ ha yɛ 0 nnɔnhwere firi Greenwich bere ho. Ɔda tentenedo 0.15Anee kɔpem 2.25Anee na tɛtɛredo 5.50Etifi kɔpem 7.46Etifi.

Atitirifo Otumfoo Ɔsɛe Tutu, ne John Kofi Agyekum Kufuor firi saa bea yi. Adaekɛse na Odwira ka [[afahyɛ]] na dwumadi ɛkɔ so wɔ Asanteman mu. [[Akan]]fo, Nkramofo na Akristofo ka nkorɔfo a wɔfi borɔn yi do.
== Asase ==

=== Beae ne ne kese ===
Asante Mantam si Ghana mfinfin pɛɛ . Mantam no ne mantam nsia na ɛbɔ hyeɛ a ɛne Bono, Bono Atoe, Ahafo Mantam, Apuei mantam  Mfinfin mantam ne Atɔe mantam . Asante mantam no wɔ mpesua 27 na emu bira wɔ Aban mu ananmusifo wɔ hɔ.

== Nsrahwɛbea ==

* Bobiri Afofanto kwaeɛbirentuo
* Bomfobiri mmoa kwaeɛbirentuo
* Digya Agodibea
* Kogyae abodeɛ akoraɛ
* Nnomaa ne kwaeɛbirentuo a ɛwɔ Owab

=== Agodibea ===

* Beae a wɔhwɛ ammamerɛ akorae
**
* Rattray Agodibea

=== Abakɔsem mmeaɛ ===

* Komfo Anokye sikan asoeɛ
* Manhyia Ahenfie akoraeɛ
* Kumasi Abankɛse ne Banbofo akoraeɛ
* Banbofo akoraeɛ
* Prempeh II mfedie  akoraeɛ
* Asante Amammerɛ  akoraeɛ
* [[Yaa Asantewaa]] akoraeɛ

=== Afahyakoraeɛ ===
[[File:Young_Drummers_at_Bomeng,_Ashanti.jpg|thumb|mmabun a wɔbɔ twene.]]
Afahyɛ ahorɔw pii na wodi wɔ  Asante Mantam mu, emu atitiriw ne Akwasidae ne Adae Kɛse. Eyinom yɛ afahyɛ a wodi no wɔ  akan man mu. Wodi saa afahyɛ ahorɔw yi de kae tete kandifo ne  adɔmmarima. ɛmfa ho sɛ saa foɔ  yi awuwu no, wogyidi sɛ wɔn akra da so te wɔn mu , na wɔn ani di ateasefo nneɛma a wɔyɛ no akyi ma nti, wɔ kɔ  wɔn nkyɛn abisa wɔ  Adae afahyɛ bre.

* Papa Afahyɛ
* Kente Afahyɛ
* Yaa Asantewaa Afahyɛ
* Mmoa Nni Nko Afahyɛ
* Nkyidwo Afahyɛ

=== Nsrahwɛbea afoforow ===
[[File:2010_FarmersDay_AshantiRegion_Ghana_5262946799.jpg|thumb|Kuayɛ ho Afahyɛ mfoni]]

* Kejetia Dwadibea
* Patakro abosomfie
* Adinkra ntoma tintimbea wɔ  Ntonso
* Adanwomase Kente Akura
* Bonwire Kente Akura
* Ahwiaa Nnuanwene akura

== Demographics ==
&lt;br /&gt;
[[File:Ass_Hall.jpg|thumb|Anglican Ntoaso sukuu, Kumasi]]

=== Ntoaso sukuu ahorɔw ===
{{colbegin|colwidth=30em}}
* Dadease Senior High School, Dadease
* Dompoase Senior High School, Dompoasi
* Afia Kobi Ampem Girls (Royal AKAGSHS)
* Adanwomase SENIOR High School (ADASS)
* Agogo State College, Agogo Asante-Akyem
* Agona SDA Senior High School, Agona
* [[Anglican Senior High School, Kumasi]]
* Asanteman School (Real Assas)
* Osei Tutu Senior High School (OT)
* Bekwai SDA Senior High  School
* [[Ghana Armed Forces Secondary Technical School, Kumasi]]
* Beposo Senior High School, Beposo
* Collins Secondary Commercial School, Agog o Asante-Akyem
* Effiduase Senior High School, Effiduase
* Ejisuman Senior High School, Ejisu
* Ejuraman Senior High School, Ejura
* Fomena T.I. Ahmadiyya Senior High School, Adansi Fomena
* Jachie-Pramso Senior High School (Formerly  MIGHTY JAPASS)
* Komfo Anokye Senior High School, Wiamoase
* [[Kumasi Academy]], Asokore-Mampong, Kumasi
* [[Kumasi Girls Senior High School|Kumasi Girls' Senior High School]]
* Kumasi Wesley Girls High School
* Kumasi High School 
* Obuasi Secondary Technical School (O.S.T.S)
* Wesley Senior High School (WEHIS), Bekwai
* Adventist Senior High School (ADASS),Bantama
* Ofoase Kokoben Senior High School (OFKOSS)
* Adventist Girls Senior High School (ADGISS),Ntonso
* [[Opoku Ware School]], Kumasi.
* [[St. Louis Senior High School]], Oduom
* Nkawie Secondary Technical School.
* Oppong Memorial Senior High School.
* Osei Kyeretwie Senior High School, Kumasi.
* [[Prempeh College]], Kumasi.
* Simms Senior High School, Fawoade
* Bonwire Senior High Tech. School.
* St Joseph Senior High School (Ehuren)
* St. Monica's Senior High School, Mampong
* Amaniampong Senior High School, Mampong
* T.I. Ahmadiyya Senior High School, Kumasi
* T.I. Ahmadiyya Girls' Senior High School, Asokore
* Jacobu Senior High School, Jacobu
* Juaben Senior High School, Juaben
* Yaa Asantewaa Girls' Senior High School, Tanoso
* [[Kumasi Senior High Technical School]] (K.S.T.S),
* [[Tepa Senior High School, Tepa]]. (GREAT TESS).
* Mabang Senior High School, Mabang.
{{colend}}

* Dadease Ntoaso sukuu, Dadease
* Dompoase Ntoaso sukuul, Dompoasi
* Afia Kobi Ampem mmaa (Royal AKAGSHS)
* Adanwomase SNtoaso sukuu (ADASS)
* Agogo State College, Agogo Asante-Akyem
* Agona SDA Ntoaso sukuul, Agona
* Anglican Ntoaso sukuu, Kumasi
* Asanteman Sukuu (Real Assas)
* Osei Tutu Ntoaso sukuu (OT)
* Bekwai SDA Ntoaso sukuu
* Ghana Armed Forces Secondary Technical School, Kumasi
* Beposo Ntoaso sukuu, Beposo
* Collins Secondary Commercial School, Agog o Asante-Akyem
* Effiduase Ntoaso sukuu, Effiduase
* Ejisuman Ntoaso sukuu, Ejisu
* Ejuraman Ntoaso sukuu, Ejura
* Fomena T.I. Ahmadiyya Ntoaso sukuu, Adansi Fomena
* Jachie-Pramso Ntoaso sukuu(tete no MIGHTY JAPASS)
* Komfo Anokye Ntoaso sukuu, Wiamoase
* Kumasi Academy, Ntoaso sukuu, Kumasi
* Kumasi mmaa' Ntoaso sukuu
* Kumasi Wesley mmaa Ntoaso sukuu
* Kumasi Ntoaso sukuu
* Obuasi Secondary Technical School (O.S.T.S)
* Wesley Ntoaso sukuu (WEHIS), Bekwai
* Adventist Ntoaso sukuu (ADASS),Bantama
* Ofoase Kokoben Ntoaso sukuu (OFKOSS)
* Adventist mmaa Senior High School (ADGISS),Ntonso
* Opoku Ntoaso sukuu, Kumasi.
* St. Louis Ntoaso sukuu, Oduom
* Nkawie Secondary Technical School.
* Oppong Nkae Ntoaso sukuu.
* Osei Kyeretwie Ntoaso sukuu, Kumasi.
* Prempeh College, Kumasi.
* Simms Ntoaso sukuul, Fawoade
* Bonwire Ntoaso sukuu
* St JosephNtoaso sukuu (Ehuren)
* St. Monica's Ntoaso sukuu, Mampong
* Amaniampong Ntoaso sukuu, Mampong
* T.I. Ahmadiyya Ntoaso sukuu, Kumasi
* T.I. Ahmadiyya mmaa Ntoaso sukuu, Asokore
* Jacobu Ntoaso sukuu, Jacobu
* Juaben Ntoaso sukuu, Juaben
* Yaa Asantewaa mmaa Ntoaso sukuu, Tanoso
* Kumasi Senior High Technical School (K.S.T.S),
* Tepa Ntoaso sukuu, Tepa. (GREAT TESS).
* Mabang Ntoaso sukuul, Mabang.

=== Sukuu Pɔn ===
Asante mantam wo oman sukuu pon baako ane din [[:en:Kwame Nkrumah University of Science and Technology|Kwame Nkrumah University of Science and Technology]] ne Polytechnic baako a ne nyinaa wo Kumasi. Ankoreankore suapon ahorow pii nso wo mantam no mu.
[[File:Kwame Nkrumah University of Science and Technology (KNUST) – Side view of the College of Architecture and Planning.JPG|thumb|Kwame Nkrumah Sukuu pɔn]]

==== Sukuu Pɔn ====
{{colbegin|colwidth=30em}}
* Kwame Nkrumah University of Science and Technology, Kumasi
* Ghana Baptist University College, Kumasi
* Spiritan University College, Ejisu
* [[Garden City University College]], Kenyasi, Kumasi
* University of Education, Kumasi Campus, Kumasi
* National Institute Of Information Technology, Kumasi Campus NIIT.
* [[Kumasi Technical University]], K-Poly
* IPMC, Kumasi Campus
* Akrokerri College of Education
* St. Monica's College of Education, Mampong
* Christian Service University College, Odeneho Kwadaso
* Wesley College of Education
* St. Louis College of Education
{{colend}}

* Kwame Nkrumah University of Science and Technology, Kumasi
* Ghana Baptist University College, Kumasi
* Spiritan University College, Ejisu
* Garden City University College, Kenyasi, Kumasi
* University of Education, Kumasi Campus, Kumasi
* National Institute Of Information Technology, Kumasi Campus NIIT.
* Kumasi Technical University, K-Poly
* IPMC, Kumasi Campus
* Akrokerri College of Education
* St. Monica's College of Education, Mampong
* Christian Service University College, Odeneho Kwadaso
* Wesley College of Education
* St. Louis College of Education
* University of Education, Mampog Campus
* Mampong Technical College of Education (MAMTECH)
* S.D.A. College of Education, Agona

== Ayaresa ==
[[File:Komfo_Anokye_Teaching_Hospital,_Kumasi,_Ghana.jpg|left|thumb|Komfo Anokye Ayaresabea]]
Kwadaso SDA HAyaresabeal

Komfo Anokye TAyaresabea

First care Ayaresabea

Tafo Aban Ayaresabea

Suntreso Government Hospital

== Agorɔ ==
[[File:Kumasi924.JPG|thumb|Baba Yara Agoprammaso]]
{{div col|colwidth=30em}}
*[[Asante Kotoko F.C.|Kumasi Asante Kotoko]]
*[[Ashanti Gold SC]]
*[[King Faisal Babes|King Faisal Babies F.C.]]
*[[New Edubiase United]]
*Main stadium is [[Kumasi Sports Stadium]]
{{div col end}}

* Kumasi Asante Kotoko
* Ashanti Gold SC
* King Faisal Babies F.C.
* New Edubiase United
* Main stadium is Kumasi Sports Stadium

== Mpesua ==
The political administration of the region is through the local government system. Under this administration system, the region is divided into 30 districts made up of 1 Metropolitan, 7 Municipal and 22 Ordinary districts. Each District, Municipal or Metropolitan Area, is administered by a Chief Executive, representing the central government but deriving authority from an Assembly headed by a presiding member elected from among the members themselves.
[[File:Districts_of_the_Ashanti_Region_(2012).svg|right|thumb|600x600px|DistrictsAsAsante mantam]]
{| class=&quot;wikitable&quot;
! colspan=&quot;3&quot; |Asante Mantam mu mpesua
|-
!Mpesua
!Ahenkurow
!Nnipa dodoɔ
|-
|Adansi Atifi
|Fomena
|235,680 (2000 census)
|-
|Adansi Atɔe
|New Edubiase
|129,325 (2000 census)
|-
|Afigya-Kwabre
|Kodie
|
|-
|Ahafo Ano Atifi
|Tepa
|71,856 (2000 census)
|-
|Ahafo Ano Atɔe
|Mankranso
|133,874 (2000 census)
|-
|Amansin Mfinfin
|Jacobu
|219, 508 (2000 census)
|-
|Amansie 
|Manso Nkwanta
|108, 768 (2000 census)
|-
|Asante Akim Nfinfin
|Konongo
|71,508 (2010 census)
|-
|Asante Akim Atifi
|Agogo, Ghana
|126, 465 (2000 census)
|-
|Asante Akim Atɔe
|Juaso
|96, 885 (2000 census)
|-
|Asokore Mampong Mpesua
|Asokore Mampong
|304,815 (2010 census)
|-
|Atwima Kwanwoma
|Foase Kokoben
|234, 759 (2000 census)
|-
|Atwima Mponua
|Nyinahin
|
|-
|Atwima Nwabiagya
|Nkawie
|
|-
|Bekwai mpesua
|Bekwai
|
|-
|Bosome Freho
|Asiwa
|
|-
|Bosomtwe
|Kuntenase
|145,524 (2000 census)
|-
|Ejisu-Juaben Mpesua
|Ejisu
|124,179 (2000 census)
|-
|Ejura/Sekyeredumase
|Ejura
|81, 119 (2000 census)
|-
|Kumasi Mpesua
|[[Kumase|Kumasi]]
|1,171,311 (2000 census)
|-
|Kwabre
|Mamponteng
|164,668 (2000 census)
|-
|Mampong Mpesua
|Mampong
|
|-
|Obuasi Mpesua
|Obuasi
|
|-
|Ofinso mpesua
|Offinso
|138, 190 (2000 census)
|-
|Offinso Atifi
|Akomadan
|
|-
|Sekyere Afram Plains
|Drobonso
|28,535 (2010 census)
|-
|Sekyere Mfinfin
|Nsuta
|
|-
|Sekyere Apuei
|Effiduase
|157, 378
|-
|Sekyerre Kumawu
|Kumawu
|65,402 (2010 census)
|-
|Sekyere Atɔe
|Agona Ashanti
|143, 213
|}

== Atitiriw a wofi Mantam no mu ==
{| class=&quot;wikitable&quot;
! colspan=&quot;2&quot; |Atitiriw a wofi Asante Mantam 
|-
!ɔmanni
!Settlement
|-
|Mamme Efya Nyarko
|Asante, Ghana
|-
|Richmond Boakye
|Agogo
|-
|Deborah Owusu-Bonsu
|Pakyi no2
|-
|Sulley Mantari
|Konongo
|-
|Sonia Ibrahim
|[[Kumase|Kumasi]]
|-
|Emmanuel Frimpong
|[[Kumase|Kumasi]]
|-
|Kofi Annan
|[[Kumase|Kumasi]]
|-
|John Kufuor
|[[Kumase|Kumasi]]
|-
|Isaac Vorsah
|[[Kumase|Kumasi]]
|-
|Juliet Ibrahim
|[[Kumase|Kumasi]]
|-
|Sam Jonah
|Obuasi
|-
|Rhian Benson
|[[Kumase|Kumasi]]
|-
|Samuel Kuffour
|[[Kumase|Kumasi]]
|-
|Tony Yeboah 
|[[Kumase|Kumasi]]
|-
|Kwadwo Asamoh
|[[Kumase|Kumasi]]
|-
|Maxwell Konadu
|[[Kumase|Kumasi]]
|-
|Harrison Afful
|[[Kumase|Kumasi]]
|-
|Quincy Owusu-Abeyie
|[[Kumase|Kumasi]]
|-
|Kevin-Prince Boateng
|[[Kumase|Kumasi]]
|-
|Kofi Kingston
|[[Kumase|Kumasi]]
|-
|-
|}

{{Mantamu a ɛwɔ Ghana}}
[[Nkyekyεmu:Mantam a ɛwɔ Ghana]]</text>
      <sha1>hljt9isotjebnbrdznxfo6bdsot3cfs</sha1>
    </revision>
  </page>
  <page>
    <title>Atɔɛ Mantam</title>
    <ns>0</ns>
    <id>4821</id>
    <revision>
      <id>133060</id>
      <parentid>108896</parentid>
      <timestamp>2022-08-01T10:04:16Z</timestamp>
      <contributor>
        <username>Robertjamal12</username>
        <id>8680</id>
      </contributor>
      <comment>/* Baabi a menyaa mmoa firiiɛ */</comment>
      <model>wikitext</model>
      <format>text/x-wiki</format>
      <text bytes="8478" xml:space="preserve">{{Dialect|Akuapem}}
{{Infobox officeholder
|honorific-prefix = 
|name        = Western Region
|type        = Regions of Ghana|Region
|image       = Plage du Ghana.jpg
|mapsize     = 150px
|image_caption   = Beach near Sekondi-Takoradi
|map_caption   =  Location of Western Region in Ghana
|image_map1   =  Western in Ghana 2018.svg
|subdivision_type1   =  Country
|subdivision_name1  =  [[Ghana]]
|term_end    =  &lt;!--Can be repeated up to eight times by adding a number--&gt;
| leader_title =  List of Ghanaian regional ministers|Regional Minister
|successor   =  &lt;!--Can be repeated up to eight times by adding a number--&gt;
|leader_name    = Hon. [[Kwabena Okyere Darko Mensah]]&lt;ref&gt;{{Cite web|url=http://ghana.gov.gh/index.php/governance/regional-ministers|title=Regional Ministers - Government of Ghana|website=ghana.gov.gh|access-date=2022-02-04|archive-date=2017-07-04|archive-url=https://web.archive.org/web/20170704052607/http://ghana.gov.gh/index.php/governance/regional-ministers|dead-url=yes}}&lt;/ref&gt;
| order2                 = &lt;!--Can be repeated up to eight times by changing the number--&gt;
| seat_type              =  Capital
| seat            = [[Sekondi-Takoradi]]
| term_end2              = 
| president2              = 
| predecessor2            = 
| successor2              =
| order3                  = 
| office3                 =  
| term_start3             = 
| term_end3               = 
| president3              = 
| predecessor3            = 
| successor3            = 
| order4                  = 
| office4                =  
| term_start4             = 
| term_end4               = 
| president4              = 
| predecessor4            = 
| successor4            = 
| birth_date              = 
| birth_place             = 
| death_date              =
| death_place             =
| restingplace            =
| restingplacecoordinates =
| birthname               =
| nationality             = {{flagicon|GHA}}[[Ghana]]
| party                   = 
| otherparty              = &lt;!--For additional political affiliations--&gt;
| spouse                  =
| partner                 = &lt;!--For those with a domestic partner and not married--&gt;
| relations               =
| children                =
| residence               =
| alma_mater              =
| occupation              =
| area_code                = Telephone numbers in Ghana|031
| committees              =
| portfolio               =
| signature               =
| signature_alt           =
| website                 =
| footnotes               =
}}
[[Image:Districts of the Western Region (2019).png|thumb|upright=1.5|Districts of the Western Region]]
Atɔe [[Mantamu a ɛwɔ Ghana|Mantam]]{{Audio|tw-Atɔe Mantam.ogg|sɛnea yɛbɔ &quot;Atɔe Mantam&quot;}} yɛ mantam a ɛwɔ anafo fam wɔ ɔman [[Ghana]] mu.&lt;ref&gt;&quot;Betway extends support to Volleyball Teams in the Western and Western North Regions&quot;. ''Citi Sports Online''. 2021-05-21. Retrieved 2021-05-21.&lt;/ref&gt; Ivory Coast hyeso wɔ saa mantam yi atɔe fam na ɛtrew kosi Mfimfini mantam a ɛda mantam yi apuei fam. mantam yi ahenkoro yɛ nkurow abien [[Sekondi ( Ghana parliament constituency )|Sekondi]] ne [[Takoradi (Ghana parliament constituency)|Takoradi]]. Atɔe Mantam da Ghana mpoano na nhenkurow Sekondi ne Takoradi ne kurow [[Akim Oda (Ghana parliament constituency)|Axim]] nyinaa da mpoano wɔ mantam yi mu. Cape Three Points, kurow a [[Ayɛwohummumɔ|Ayɛwohomummɔ]] bosome no wɔ afe mpem mmienu ne nson (2007) mu wohuu fango wɔ dodow a wotumi di mu gua nso wɔ saa mantam yi mu na ɛda mantam yi anafo fam tɔnn.

Wɔ Atɔe Mantam no, esiane sɛ nsu tɔ wɔ hɔ sen beae biara wɔ Ghana, ɛhɔ nsase sow aba paa na afei ɛhɔ nkoko yɛ frɔmfrɔm. Mmeae a  wotu sika kɔkɔɔ pii wɔ hɔ.

== Mansini ahodoɔ ==
Ansana ɔman Ghana rebɛkyekyɛ mantam ahodoɔ no mu wɔ [[ɔpɛnimaa]] bosome no mu wɔ afe mpem mmienu ne du nwɔtwe mu no&lt;ref&gt;Kaledzi, Isaac (26 June 2019). &quot;Ghana: Six new regions created after a referendum&quot;. ''Africa Needs''. Retrieved 18 December 2019.&lt;/ref&gt;&lt;ref&gt;&quot;Western&quot;. GhanaDistricts.com. Archived from the original on 18 January 2013. Retrieved 15 January 2013.&lt;/ref&gt;, na Atɔeɛ mantam no wɔ MMDA's ahodoɔ aduonu mmiensa (23).  (na ɛyɛ Metropolitan baako (1), Municipal du baako (11) ɛne Ordinary Assemblies du baako (11)). 
{| class=&quot;wikitable sortable&quot;
|+  Mansini ahodoɔ a ɛwɔ Atɔeɛ Mantam&lt;ref&gt;[http://www.geohive.com/cntry/ghana.aspx Western Region – Districts]&lt;/ref&gt;
|-
! #
! MMDA Name
! Capital
! MMDA Type
! Population&lt;br&gt;Census 2010&lt;ref name=&quot;:0&quot;&gt;Ghana Statistical Service&lt;/ref&gt;
! Population&lt;br&gt;Projection 2019&lt;ref name=&quot;:0&quot; /&gt;
|-
! 1
| [[Ahanta West Municipal District|Ahanta West]]
| [[Agona Nkwanta]]
| Municipal
| align=&quot;right&quot;|106,215
| align=&quot;right&quot;|139,188
|-
! -
| '''[[Aowin Municipal District|Aowin]]'''*
| [[Enchi]]
| Municipal
| align=&quot;right&quot;|117,886
| align=&quot;right&quot;|154,661
|-
! -
| '''[[Bia East District|Bia East]]'''*
| [[Adabokrom]]
| Ordinary
| align=&quot;right&quot;|27,393
| align=&quot;right&quot;|37,108
|-
! -
| '''[[Bia West District|Bia West]]'''*
| [[Essam, Ghana|Essam]]
| Ordinary
| align=&quot;right&quot;|88,939
| align=&quot;right&quot;|111,355
|-
! -
| '''[[Bodi District|Bodi]]'''*
| [[Bodi, Ghana|Bodi]]
| Ordinary
| align=&quot;right&quot;|53,314
| align=&quot;right&quot;|68,055
|-
! 2
| [[Ellembele District|Ellembelle]]
| [[Nkroful]]
| Ordinary
| align=&quot;right&quot;|87,501
| align=&quot;right&quot;|114,441
|-
! 3
| [[Jomoro Municipal District|Jomoro]]
| [[Half Assini]]
| Municipal
| align=&quot;right&quot;|150,107
| align=&quot;right&quot;|194,808
|-
! -
| '''[[Juabeso District|Juabeso]]'''*
| [[Juaboso]]
| Ordinary
| align=&quot;right&quot;|58,435
| align=&quot;right&quot;|77,678
|-
! 4
| [[Mpohor District|Mpohor]]
| [[Mpohor, Ghana|Mpohor]]
| Ordinary
| align=&quot;right&quot;|42,923
| align=&quot;right&quot;|55,678
|-
! 5
| [[Nzema East Municipal District|Nzema East]]
| [[Axim]]
| Municipal
| align=&quot;right&quot;|60,828
| align=&quot;right&quot;|80,480
|-
! 6
| [[Prestea-Huni Valley Municipal District|Prestea-Huni Valley]]
| [[Bogoso]]
| Municipal
| align=&quot;right&quot;|159,304
| align=&quot;right&quot;|207,237
|-
! -
| '''[[Sefwi Akontombra District|Sefwi-Akontombra]]'''*
| [[Sefwi Akontombra]]
| Ordinary
| align=&quot;right&quot;|82,467
| align=&quot;right&quot;|108,266
|-
! -
| '''[[Bibiani/Anhwiaso/Bekwai Municipal District|Bibiani/Anhwiaso/Bekwai]]'''*
| [[Bibiani]]
| Municipal
| align=&quot;right&quot;|123,272
| align=&quot;right&quot;|160,844
|-
! -
| '''[[Sefwi-Wiawso Municipal District|Sefwi-Wiawso]]'''*
| [[Wiawso]]
| Municipal
| align=&quot;right&quot;|139,200
| align=&quot;right&quot;|182,510
|-
! 7
| [[Sekondi Takoradi Metropolitan Assembly|Sekondi-Takoradi]]
| '''[[Sekondi]]'''
| Metropolitan
| align=&quot;right&quot;|559,548
| align=&quot;right&quot;|726,905
|-
! 8
| [[Effia Kwesimintsim Municipal District|Effia-Kwesimintsim]]
| [[Kwesimintsim]]
| Ordinary
| align=&quot;right&quot;|N/A
| align=&quot;right&quot;|N/A
|-
! 9
| [[Shama District|Shama]]
| [[Shama, Ghana|Shama]]
| Ordinary
| align=&quot;right&quot;|81,966
| align=&quot;right&quot;|105,173
|-
! -
| '''[[Suaman District|Suaman]]'''*
| [[Dadieso]]
| Ordinary
| align=&quot;right&quot;|20,529
| align=&quot;right&quot;|27,832
|-
! 10
| [[Tarkwa-Nsuaem Municipal District|Tarkwa-Nsuaem]]
| [[Tarkwa]]
| Municipal
| align=&quot;right&quot;|90,477
| align=&quot;right&quot;|117,550
|-
! 11
| [[Wassa Amenfi Central District|Wassa Amenfi Central]]
| [[Manso Amenfi]]
| Ordinary
| align=&quot;right&quot;|69,014
| align=&quot;right&quot;|89,703
|-
! 12
| [[Wassa Amenfi East Municipal District|Wassa Amenfi East]]
| [[Wassa-Akropong]]
| Municipal
| align=&quot;right&quot;|83,478
| align=&quot;right&quot;|108,272
|-
! 13
| [[Wassa Amenfi West Municipal District|Wassa Amenfi West]]
| [[Asankragua]]
| Municipal
| align=&quot;right&quot;|92,152
| align=&quot;right&quot;|120,643
|-
! 14
| [[Wassa East District|Wassa East]]
| [[Daboase]]
| Ordinary
| align=&quot;right&quot;|81,073
| align=&quot;right&quot;|105,163

|-
! colspan=&quot;3&quot;|Total 
!
| align=&quot;right&quot;|2,376,021
| align=&quot;right&quot;|3,093,201
|}

== Nnipa titriw a wɔwɔ Atɔeɛ Mantam no mu bi==
{| class=&quot;wikitable&quot;
|-
! colspan=3 | Nnipa titriw a wɔwɔ Atɔeɛ Mantam no mu bi.
|-
! #
! Citizen
! Settlement
|-
! 1
| [[Samuel Inkoom]]
| [[Sekondi-Takoradi]]
|-
! 2
| [[Nadia Buari]]
| [[Sekondi-Takoradi]]
|-
! 3
| [[Boris Kodjoe]]
| [[Sekondi-Takoradi]]
|-
! 4
| [[John Atta Mills]]
| [[Tarkwa]]
|-
! 5
| [[Kwame Nkrumah]]
| [[Nkroful]]
|-
! 6
| [[Anton Wilhelm Amo]]
| [[Axim]]
|-
! 7
| [[Joseph Boahen Aidoo]]
| [[Wassa Afransie]]
|-
! 8 
| [[Kofi Kinaata]]
| [[Takoradi]]
|-
! 9
| [[Gyedu-Blay Ambolley]]
| [[Sekondi-Takoradi]]
|-
! 10
| [[Godfried Gambrah]]
| [[Sekondi-Takoradi]]
|}

== Baabi a menyaa mmoa firiiɛ ==
&lt;references /&gt;{{Mantamu a ɛwɔ Ghana}}
[[Nkyekyεmu:Mantam a ɛwɔ Ghana]]</text>
      <sha1>g9o7oyrq393ohr8ebod62555fq4ed3d</sha1>
    </revision>
  </page>
  <page>
    <title>Tayanna</title>
    <ns>0</ns>
    <id>5393</id>
    <revision>
      <id>132982</id>
      <parentid>62326</parentid>
      <timestamp>2022-07-31T21:16:21Z</timestamp>
      <contributor>
        <username>Visem</username>
        <id>8735</id>
      </contributor>
      <model>wikitext</model>
      <format>text/x-wiki</format>
      <text bytes="9317" xml:space="preserve">{{Dialect|Akuapem}}
'''Tetyana Mykhaylivna Reshetnyak''' ({{Audio|tw-Tayanna.ogg|pronounciation of &quot;Tayanna&quot;}}) (Ukrainian: Тетяна Михайлівна Решетняк; wɔwoo no [[ɛbɔ]] bosome da a ɛtɔ so aduonu nkron wɔ afe apem ahankron ne aduowɔtwe nan nom) Tayanna, yɛ Ukraine nwomtonii,sinitwani ne obi a ɔtwerɛ nnwom.&lt;ref&gt;&quot;Тетяна Решетняк&quot;. ''kino-teatr.ua'' (in Ukrainian). Retrieved 23 February 2019.&lt;/ref&gt;&lt;ref&gt;https://kino-teatr.ua/uk/person/reshetnyak-tatyana-12460.phtml&lt;/ref&gt;

== NE HO ASƐM ==
'''N'abrabɔ ahyeaɛseɛ'''

Wɔwoo Reshetnyak wɔ kuro a ɛwɔ Chernivtsi Wɔdii mfɛ nnwɔtwe na n'awofoɔ ma no kɔɔ anwomtofoɔ sukuu, nanso ɔgyae sukuu mfeɛ mmienu akyire mu.&lt;ref&gt;&quot;TAYANNA: 10 Interesting facts about her and the final return to the Eurovision 2018&quot; (in Ukrainian). Archived from the original on 21 February 2018. Retrieved 23 February 2019.&lt;/ref&gt;&lt;ref&gt;https://web.archive.org/web/20180221044751/https://showmania.novy.tv/ua/news/2018/02/20/tayanna-10-tsikavih-faktiv-pro-finalistku-natsvidboru-na-yevrobachennya-2018/&lt;/ref&gt; Ɔdii mfeɛ aduasa no Tatiana hyɛaseɛ sua sɛdeɛ yɛde nne di dwuma wɔ nwomtoɔ mu, ɔdiikan de ne ho bɔɔ kuo bi ɛno akyire na ɔtee ne ho.Berɛ a Tayanna ɔrekɔ Lviv wɔ mfeɛ mpem mmienu ne baako nom no, ɔnyaa akwanya too dwom wɔ ne kuo nom wɔ berɛ na Pope John Paul II wɔ hɔ.Dwuamadie a ɛdikan a ɔkɔ yɛeɛ yɛ akwantuo a ɔtu kɔɔ Skadovsk berɛ a wɔrebɛdi afahyɛ agorɔ, ɛhɔ na ɔtɔɔ so mmiɛnsa. Tayanna nua mmarima yɛ mmiɛnsa,&lt;ref&gt;https://web.archive.org/web/20180221045542/https://ukr.segodnya.ua/lifestyle/showbiz/tayanna-rasskazala-ob-uhode-iz-gruppy-goryachiy-shokolad-1050739.html&lt;/ref&gt; &lt;ref&gt;&quot;TAYANNA: talking about her withdrawal from the group &quot;Hot Chocolate&quot;&quot; (in Ukrainian). Archived from the original on 21 February 2018. Retrieved 23 February 2019.&lt;/ref&gt;ntaafoɔ mmienu a wɔn yɛ dɔkɔdɔkɔ nnoɔma,ɛna baako nso to dwom ɛne Misua Marvin a ɔto dwom a nkurɔfoɔ nim no paa wɔ [[Ukraine]]. N'awofoɔ din de Natalia ne Aberɛ a Tatyana di mfeɛ du nnwɔtwe no, ɔwaree ɔbi a ɔde sini ba abɔnten a wagye din paa a yɛfrɛ no Dmitry Klimashenko.

'''Mfeɛ mpem mmienu ne nnwɔtwe (2008) de kɔsi mfeɛ mpem mmienu ne du baako (2011):Hot chocolate'''

Wɔ mfeɛ mpem mmienu ne nnwɔtwe nom no, Tatyana kɔkaa Hot chocolate &lt;small&gt;(''Горячий Шоколад'') mma&lt;/small&gt; kuo no ho. Mfeɛ mmiɛnsa a ɔwareeɛ akyire no ɔyɛɛ n'adwene sɛ ɔbɛgyae Dmitry Klimashenko awareɛ. Dmitry annye ne nsusuiɛ no anntom nti ɔyii Tatyana firii mmaa kuo nom hyɛɛ no sɛ ɔntua [[Amerika|America]] sika mpem aduonum (50,00$).&lt;ref&gt;https://ktelegram.com/tayanna-told-about-the-relationship-with-a-married-producer-and-called-the-name-of-the-father-of-your-child-24-channel/39477/&lt;/ref&gt;&lt;ref&gt;&quot;Tayanna told about her relationship with a married producer&quot;. ''ktelegram.com''.&lt;/ref&gt;&lt;ref&gt;https://web.archive.org/web/20180221045542/https://ukr.segodnya.ua/lifestyle/showbiz/tayanna-rasskazala-ob-uhode-iz-gruppy-goryachiy-shokolad-1050739.html&lt;/ref&gt;

'''Mfeɛ mpem mmienu ne du nan(2014) de kɔsi mfeɛ mpem mmienu ne du nsia(2016): The voice of Ukraine.'''

Wɔ mfeɛ mpem mmienu ne du nan mu no, Reshetnyak de ne ho hyɛɛ &quot;The voice of [[Ukraine]]&quot; a ɛtɔ so nan no mu  (''Голос країни'') nanso nea ɛkɔyɛeɛ ne sɛ wɔn a wɔkyerɛkyerɛ wɔ no annnane wɔn nkonwa no. Wɔ afe korɔ noa ara mu no, ɔde ne nwom &quot;Znayu i veryu &lt;small&gt;(Знаю и верю)&lt;/small&gt;&quot; ahwɛgorɔ baa abɔten. Wɔ mfeɛ mpem mmienu ne du num(2015) mu no, ɔsane kɔɔ &quot;The voice of [[Ukraine]]&quot;, ɛhɔ na ɔmaa akyerɛkyerɛfoɔ no nyinaa danee wɔn nkonwa wɔ berɛ a ɔreto Ukraine nwom&quot;Kray miy ridnyy kray &lt;small&gt;(Край мій рідний край)&lt;/small&gt;&quot;.Tatiana yii Potap sɛ obi a ɔbɛkyerɛkerɛ no wɔ ne nwomtoɔ mu ɛna ɛmaa no duru akansie no a ɛtɔ so num no mpɔmpɔnsoɔ, ɛhɔ na Anyin Kopitin a ɔwɔ akansie no a ɛtwatoɔ nom no dii ntwo.&lt;ref&gt;&quot;Final Show &quot;The Voice of Ukraine – Season 5&quot; Emotions and unique Tina Karol (19 photos)&quot; (in Ukrainian). Retrieved 23 February 2019&lt;/ref&gt;

'''Ɛfiri mfeɛ mpem mmienu ne du nson(2017) de bɛpem nnɛ.'''

Wɔ mfeɛ mpem mmienu ne du nson (2017) mu no, Tayanna wiee [[Ukraine]] Vidbir 2017 wiase mu nnipa a wɔyii wɔn kɔɔ Eurovisionsong contest 2017 a ɔtoo nnwom &quot;I Love You&quot;. Ɛwom sɛ nea ɛdikan no ɔne O.Torvald nyaa mma pɛ deɛ, nnipa anto aba amma nowɔ kasa mfoni no nti wanntumi annyina [[Ukraine]] anan mu annkɔ Eurovison 2017 no bi. &lt;ref&gt;&quot;Trymay mene: New album by Tayanna&quot;&lt;/ref&gt;Wɔ [[obubuo]] bosome a ɛtɔ so du nson wɔ mfeɛ mpem mmienu ne du nson (17 Nov,2017), ɔde ne nnwom &quot;Trymay mene  &lt;small&gt;(''Тримай мене'')&lt;/small&gt;&quot;,  a ɔne Alan Badoev ka bomm yɛeɛ no baa abɔten. Na ne album no kurw nnwom nson wɔ [[Ukraine]]. Wɔ [[ɔpɛnimaa]] bosome wɔ mfeɛ mpem mmienu ne du nson mu no, Tayanna kɔdaa ne nnwom &quot;skoda (Шкода) wɔ [[Ukraine]] music show M1Music Awards 2017 afe mu ɛna ɔdii nkunim wɔ&quot;Proryv &lt;small&gt;(Прорив року)&lt;/small&gt;&quot;  wɔ afe no mu nyinaa. Wɔ [[ɔbɛnem]] bosome wɔ mfeɛ mpem mmienu ne du nnwɔtwe mu no, de ne ho kɔkaa Vidbir 2018 a ɔtoo &quot;Lelya&lt;small&gt;(''Леля'')&lt;/small&gt;&quot; mu a ɛtɔso mmienu a ɔpere sɛ ɔbɛgyina hɔ ama [[Ukraine]] wɔ Eurovision ne mpaninfie so. Ɛwɔm sɛ na nnipa pii noa pɛsɛ ɔdi nkunim deɛ, nanso ɔdii ntwo wɔ aberɛ a Melovin de aba baako dii ne so nkunim.&lt;ref&gt;Macgillivray, Lynn. &quot;Mélovin chosen to represent Ukraine at Eurovision 2018&quot;. ''celebmix.com''.&lt;/ref&gt;

Wɔ mfeɛ mpem mmienu ne du nnwɔtwe mu no, ɔkɔɔ [[Ukraine]] nsrahwɛ. Wɔ [[Kɔtɔnimaa|kɔtonimaa]] bosome da a ɛtɔ so du nkron mu no, yɛtoo nsa frɛɛ no maa no kɔɔ dwumadie bi a na wɔredi no wɔ Golden Firebird Awards, ɔhɔ na ɔnyaa 'clip of the year&quot; ne nwomtonii a ɔyɛɛ adeɛ wɔ afe no mu nyinaa. Wɔ [[ɔpɛnimaa]] bosome da a ɛtɔ so du no, na ɔyɛ ɔhɔhoɔ a ɔda mu soronko wɔ woman of the third millennium abasobɔdeɛ, ɛhɔ na ɔtoo ne nwom foforɔ &quot;Fantastychna zhinka &lt;small&gt;(Фантастична жінка)&lt;/small&gt;&quot;  ɛna ɔnyaa abasobɔdeɛ wɔ yi a wɔyii no no.

Wɔ [[Obubuo]] bosome nom wɔ mfeɛ mpem mmienu ne du nnwɔtwe mu no Tayanna kaa sɛ ɔbɛbɔ mmɔden biara sɛ ɔbɛtumi agyina mu ama [[Ukraine]] wɔ Eurovision nwom akansie nom. Wɔ [[ɔpɛpɔn]] bosome da a ɛtɔ so du wɔ mfeɛ mpem mmienu ne du nkron mu no, ɔde nwom 'Ochi(eyes) dii nkunim kɔɔ Vidbir afe mpem mmienu ne du nkron (2019) semi-finals .  Wɔ [[ɔpɛpɔn]] bosome da a ɛtɔ so aduonu mmienu no, Tayanna bɔɔ dawuro faa ne abɛɛfo ntentan a ɔwɔ nyinaa so sɛ ɔntumi ntoa so wɔ nnipa a [[Ukraine]]&lt;nowiki/&gt;foɔ reyi wɔn ama wɔn akɔdi dwuma no. Wɔ [[Ɔgyefuo|ɔgyefoɔ]] bosome da a ɛtɔ so nwɔtwe no, ɔde ne nwom foforɔ a anka ɔbɛda no adi wɔ Eurovision song contest 2019 akansie wɔ Tel Aviv,Israel a anka ɔbɛgyina mu ama [[Ukraine]] no ase no baa abɔnten. &lt;ref&gt;Petersen, Christian. &quot;Ukraine: Tayanna withdraws from Vidbir 2019&quot;. ''eurovisionworld.com''. Retrieved 23 February 2019&lt;/ref&gt;Wɔ [[Kɔtɔnimaa]] bosome nom wɔ mfeɛ mpem mmienu ne aduonu baako nom no, wɔfaa no adi sɛ ɔno na ɔyɛ [[Ukraine]] kasamafoɔ ma mfeɛ mpem mmienu ne du baako Eurovision song contest no, ɔkekanfoɔ ma wɔn a wɔde mma no ba abɔten wɔ ɔman nom wɔ akansie no awieɛ.

== Nnwom a apue abɔnten. ==
'''Studio albums'''

* 9 песен из жизни &lt;small&gt;(&quot;''9 songs of life''&quot;)&lt;/small&gt; (2016)
* Тримай мене &lt;small&gt;(&quot;''Hold me''&quot;)&lt;/small&gt; (2017)


EPS

.TAYANNA. Портреты &lt;small&gt;(&quot;''Portraits''&quot;)&lt;/small&gt; (2016)

'''Singles'''

* &quot;Я или она&quot; &lt;small&gt;(&quot;''Me or she''&quot;) with Lavika&lt;/small&gt; (2014)
* &quot;Только Ты&quot; &lt;small&gt;(&quot;''Only You''&quot;)&lt;/small&gt; (2014)
* &quot;Самолёты&quot; &lt;small&gt;(&quot;''Airplanes''&quot;)&lt;/small&gt; (2014)
* &quot;Обними&quot; &lt;small&gt;(&quot;''Hug''&quot;)&lt;/small&gt; (2014)
* &quot;Любви больше нет&quot; &lt;small&gt;(&quot;''There is no more love''&quot;)&lt;/small&gt; (2014)
* &quot;Знаю и верю&quot; &lt;small&gt;(&quot;''I know and believe''&quot;)&lt;/small&gt; (2014)
* &quot;Забудь&quot; &lt;small&gt;(&quot;''Forget''&quot;)&lt;/small&gt; (2014)
* &quot;Если ты ждёшь&quot; &lt;small&gt;(&quot;''If you're waiting''&quot;)&lt;/small&gt; (2014)
* &quot;Дышим&quot; &lt;small&gt;(&quot;''Breathe''&quot;)&lt;/small&gt; (2014)
* &quot;Pretty Lie&quot; &lt;small&gt;with Lavika&lt;/small&gt; (2014)
* &quot;I Am the One&quot; (2014)
* &quot;Да!&quot; &lt;small&gt;(&quot;''Yes''&quot;)&lt;/small&gt; (2015)
* &quot;9 жизней&quot; &lt;small&gt;(&quot;''9 lives''&quot;)&lt;/small&gt; (2015)
* &quot;Осень&quot; &lt;small&gt;(&quot;''Autumn''&quot;)&lt;/small&gt; (2016)
* &quot;I Love You&quot; (2017)
* &quot;Шкода&quot; &lt;small&gt;(&quot;''It's a shame''&quot;)&lt;/small&gt; (2017)
* &quot;Квітка&quot; &lt;small&gt;(&quot;''Flower''&quot;)&lt;/small&gt; (2017)
* &quot;Леля&quot; &lt;small&gt;(&quot;''Lelya''&quot;)&lt;/small&gt; (2018)
* &quot;Фантастична жiнка&quot; &lt;small&gt;(&quot;''Fantastic woman''&quot;)&lt;/small&gt; (2018)
* &quot;Очі&quot; &lt;small&gt;(&quot;''Eyes''&quot;)&lt;/small&gt; (2019)
* &quot;Як плакала вона&quot; &lt;small&gt;(&quot;''How she cried''&quot;)&lt;/small&gt; (2019)
* &quot;Мурашки&quot; &lt;small&gt;(&quot;''Creepy''&quot;)&lt;/small&gt; (2019)
* &quot;Ейфорія&quot; &lt;small&gt;(&quot;''Euphoria''&quot;)&lt;/small&gt; (2020)
* &quot;Жіноча cила&quot; &lt;small&gt;(&quot;''Female strength''&quot;)&lt;/small&gt; (2020)
* &quot;Плачу і сміюся&quot; &lt;small&gt;(&quot;''I cry and laugh''&quot;)&lt;/small&gt; (2020)
* &quot;Вийди на свiтло&quot; &lt;small&gt;(&quot;''Come to light''&quot;)&lt;/small&gt; (2020)
* &quot;100 днiв&quot; &lt;small&gt;(&quot;''100 days''&quot;)&lt;/small&gt; (2020)

== Beaɛ a menyaa mmoa firiiɛ ==
[[Category:Ukraine]]</text>
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  <page>
    <title>Apuei Mantam (Ghana)</title>
    <ns>0</ns>
    <id>6728</id>
    <revision>
      <id>133051</id>
      <parentid>87812</parentid>
      <timestamp>2022-08-01T09:54:54Z</timestamp>
      <contributor>
        <username>Robertjamal12</username>
        <id>8680</id>
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      <model>wikitext</model>
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      <text bytes="6207" xml:space="preserve">{{Dialect|Akuapem}}

[[File:Umbrella Rock at Boti Falls.jpg|thumb]]

'''Apeui Mantam''' wɔ [[:en:Ghana|Ghana]] anafoɔ fam na ɛka Mantam dunsia (Tete na ɛyɛ du) a ɛwɔ Ghana no ho. Apuei Mantan ne [[:en:Lake_Volta|Lake Volta]] bɔ hyeɛ wɔ apeui fam, [[:en:Bono_East_Region|Bono East Region]] ne Asante mantam wɔ atifi fam,Asante Mantam wɔ atɔe fam. ɛne Mfinfin mantam ne Nkran Mantam bɔ hyeɛ wɔ atɔe fam. Akanfoɔ ne nnipa dodoɔ a wɔ wɔ Apuei Mantam no mu  na kasa ahorɔw a wɔka wɔ mantam no mu ne [[:en:Akan_language|Akan]], [[:en:Ewe_language|Ewe]], krobo ne Brɔfo kasa. Apuei Mantam Ahenkurow ne [[:en:Koforidua|Koforidua]] .Apeui Mantam yɛ beaɛ a [[:en:Akosombo_Dam|Akosombo dam]]  no wɔ na ɛhɔ na anyinam Ahoɔden a yenya no fa kese no fi. Apuei Mantam asase no kɛse yɛ kilomita no 19,323 a egyina hɔ ma ɔha mu nkyekyem 8.1 wɔ Ghana nsase mu.

== Anyinam ahoɔden ==
Mfirinwuma a ɛma Anyinam ahoɔden wo akosombo no mu gu ahorɔw miensah; [[:en:Black_Volta|Black Volta]], [[:en:White_Volta|White Volta]] ne [[:en:Red_Volta|Red Volta]]. Akosombo mfirinwuma no nam [[:en:Gulf_of_Guinea|Gulf of Guinea]]  de ko gu [[:en:Atlantic_Ocean|Atlantic Ocean]]{{wide image|Akosombo Dam, Akosombo Panorama.jpg|600px|[[Wide dynamic range]] of [[Akosombo Hydroelectric Project]]: [[hydroelectric dam]] on Lake Volta in [[Akosombo]], Eastern region, Akosombo [[canyon]]. The [[construction]] of the [[dam]] in the [[Volta Basin]] resulted in the subsequent creation of Lake Volta.&lt;ref name=Fobil/&gt; [[Lake Volta]] is the [[Earth]]'s largest man-made lake and [[artificial lake]], covering {{convert|8502|km2}}, which is 3.6% of [[Ghana]]'s [[landform]].&lt;ref name=Fobil&gt;{{Harvnb|Fobil|2003}}&lt;/ref&gt;|70%|none}}

== Adesua ==

=== Ntoaso sukuu ===

** Akim Achiase ntoaso sukuu
** Krobo     mmaa' Presbyterian Ntoaso sukuu
** St.     Peter's Boys Ntoaso sukuu
** Aburi     mmaa 'Ntoaso sukuu
** St Roses    Ntoaso sukuu (Akwatia)
** Pope John Senior High School and Minor Seminary
** Ofori     Panin Ntoaso sukuu
** Suhum Presbyterian Ntoaso sukuu
** Nifa Ntoaso sukuu
** Presbyterian Ntoaso sukuu Mampong
** Methodist Senior High Technical School (Akuse)
** Koforidua     Secondary Technical School
** Akosombo     International School
** New Juaben Senior High Commercial School
** Akwamuman Ntoaso sukuu
** Okuapeman     Ntoaso sukuu
** St Matins Ntoaso sukuu
** Benkum Ntoaso sukuu
** Ghana Ntoaso sukuu, Koforidua
** Asamankese Ntoaso sukuu
** Akim Oda Ntoaso sukuu
** Akim Swedru Ntoaso sukuu
** Saint Francis Ntoaso sukuu
** Mpraeso Ntoaso sukuu
** Oti Boateng Ntoaso sukuul
** Oyoko     Methodist Ntoaso sukuu
** Nkawkaw Ntoaso sukuul
** Sekyere Ntoaso sukuu
** Nkwatia PresbyNtoaso sukuu
** Suhum     Senior High and technical School
** Mangoase Ntoaso sukuu
** St Thomas Senior High Technical School, Asamankese
** Akroso Ntoaso sukuu
** Adeisu Presbyterian Senior High School
** Nsawam Ntoaso sukuu
** Saviour Ntoaso sukuu
** Asesewa Ntoaso sukuu
** Klo Agogo Ntoaso sukuu
** Manya Krobo Ntoaso sukuul
** Yilo Krobo Ntoaso sukuu
** Anum Presby Ntoaso sukuu
** Boso Senior High Tech School
** Akro Sectech, Odumase Krobo
** Kwabeng Anglican Senior High and Technical School
** Donkorkrom Agric Ntoaso sukuul
** St Fidelis Ntoaso sukuu
** Methodist    mmaa  Ntoaso sukuu, Mamfe
** Asuom Ntoaso sukuu
** Adukrom Presbyterian Ntoaso sukuu  &lt;br /&gt;

=== Suapɔn Ahorɔw ===

* [[Ahyɛasiɛ Sukuupɔn|Ashesi Suapɔn]]
* All Nations University
* University College of Agriculture and Environmental Studies
* Koforidua Technical University
* Presbytarian Suapɔn (Abetifi Kwahu)

=== Mansin nsakrae ===
Wɔtee Achiase mansin no fii Birim Atifi mansin nhowɔ ɔgyefo da a ɛtɔ so 22, afe 2019 mu. Afram Plains mansin no mu akyɛ mienu a wɔn de foforo ne Kwaku Afram Plains Atifi mansin a ne kuropɔn ne Donkorkrom. Kwahu Afram Plains Atifi mansin no kuropɔn ne Tease. Akuapim anafo mansin , Akim Apueɛ mansin, Kwahu atɔe mansin ne Brim mfinfin mansin a ɛyɛ foforɔ kora yɛ ade a wapegya  wɔn mu ayɛ wɔn amansin akɛse. Amansin afoforo ne Akyemansa mansin ne Kwahu apuei mansin. Manya Krobo mansin yɛ ade a w'akyɛm mienu ayɛ no Lower manya Krobo mansin ne Upper Manya krobo mansin

=== Amansin ===
Amansin dodoɔ a ɛwɔ Apuei mantam yɛ ade a wɔn dodoɔ mu akɔ soro fri 21 akɔ du 26.
[[File:Districts_of_the_Eastern_Region_(2012).svg|right|thumb|600x600px|DistrictsApApuei Mantam]]
{| class=&quot;wikitable sortable&quot;
! colspan=&quot;4&quot; |Amansin a ɛwɔ Apuei Mantam
|-
!#
!Amansin
!Ahenkuro
!Nnipa dodoɔ
|-
!1
|Akuapim Atifi mansin
|Akropong
|136,483
|-
!2
|Akuapim Anafoɔ mansi&lt;br /&gt;
|Aburi
|37,501
|-
!3
|Akyemansa
|Ofoase
|97,374
|-
!4
|Asuogyaman
|Atimpoku
|98,046
|-
!5
|Atiwa
|Kwaben
|110,622
|-
!6
|Ayensu
|Coaltar
|77,193
|-
!7
|Brim mfinfin mansin
|[[Akim Oda]]
|144,869
|-
!8
|Brim atifi
|New Abrim
|78,907
|-
!9
|Brim anafoɔ 
|Akim sweduru
|119,767
|-
!10
|Denkyembour
|Akwatia
|78,841
|-
!11
|Brim apuei mansin
|Kibi
|167,896
|-
!12
|Fanteakwa
|Begoro
|108,614
|-
!13
|Kwaebiberem
|Kade
|113,721
|-
!14
|Kwahu Afram Plains Atifi
|Donkorkrom
|102,423
|-
!15
|Kwahu Afram Plains Anafoɔ
|Tease
|115,812
|-
!16
|Kwahu Apuei
|Abetifi
|77,125
|-
!17
|Kwahu Anafoɔ
|Mpraeso
|69,757
|-
!18
|Kwahu atɔe mansin
|Nkawkaw
|93,584
|-
!19
|Lower Manya krobo
|Odumasi Krobo
|89,246
|-
!20
|New-Juaben Mansin
|[[Koforidua]]
|183,727
|-
!21
|Nsawam Adoagyire Mansin
|Nsawam
|86,000
|-
!22
|Suhum mansin
|Suhum
|90,358
|-
!23
|Upper Manya Krobo
|Asesewa
|72,092
|-
!24
|Upper West Akim
|Adeiso
|87,051
|-
!25
|Akim Atɔe mansim
|Asamankese
|108,298
|-
!26
|Yilo Krobo
|Somanya
|87,847
|-
! colspan=&quot;3&quot; |Total
!2,633,154
|}

== Nnipa Titiriw ==
{| class=&quot;wikitable&quot;
! colspan=&quot;3&quot; |Nnipa Titiriw a wofi Apuei Mantam
|-
!#
!Ɔmani
!Kurow
|-
!1
|Nana Akuffo-Addo
|Kibi
|-
!2
|Yaw Boakye Yiadom
|Akyem Apuei Mansin (Akyem-Maase,Bunso)
|-
!3
|George Boateng 
|Nkawkaw
|-
!4
|[[J.B. Danquah|Dr. J. B. Danquah]]
|Kibi
|-
!5
|[[:en:Samuel_Wilberforce_Awuku-Darko|Samuel Wilberforce Awuku-Darko]]
|Suhum
|-
!6
|[[:en:Fred_Akuffo|Frederick W. K. Akuffo]]
|Akropong
|-
!7
|[[:en:Thomas_Partey|Thomas Teye Partey]]
|Krobo Odumase
|}

{{Mantamu a ɛwɔ Ghana}}
[[Nkyekyεmu:Mantam a ɛwɔ Ghana]]</text>
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  </page>
  <page>
    <title>Atifi Mantam (Ghana)</title>
    <ns>0</ns>
    <id>6739</id>
    <revision>
      <id>133052</id>
      <parentid>123188</parentid>
      <timestamp>2022-08-01T09:56:55Z</timestamp>
      <contributor>
        <username>Robertjamal12</username>
        <id>8680</id>
      </contributor>
      <model>wikitext</model>
      <format>text/x-wiki</format>
      <text bytes="3817" xml:space="preserve">{{Dialect|Akuapem}}

'''Atifi Mantam''' no yɛ Mantam 16 a ɛwɔ Ghana no mu baako. Atifi Mantam no da  Atifi fam wɔ Ghana na  na Mantam no ne Mantam a ɛso paa wɔ amantam 16 no mu, na ne kɛse yɛ 70,384 kilomita anaa ɔha mu nkyekyɛmu 31 wɔ Ghana nsase mu. Wɔ Bomsome a ɛtwa toɔ no da ɛtɔ so 2018 mu, wɔtee [[:en:Savannah Region|Savannah Region]] ne Atifi Apuei Mantam fii Atifi Mantam no ho.Mantam no kura amansin 14 na n'ahenkuro ne Tamale

== Asase ne ewiem nsakrae ==

=== Asase no sibea ne ne kɛse ===
Atifi Mantam no ne [[:en:North East Region, Ghana|North East region]] bɔ hyeɛ wɔ atifi fam, wɔ apeui fam nso, ɛnɛ Ghana-Togo hyeɛ so na ebɔ hyeɛ. wɔ anafoo fam no nso, ɛne Oti Mantam na ɛbɔ hyeɛ. Atifi mantam ne [[:en:Savannah Region|Savannah Region]] bɔ hyeɛ wɔ atɔe fam. Atifi fam kura amansin 14.

=== Ewiem nsakrae ===
[[File:Baobob_tree.jpg|left|thumb|194x194px|Baobab dua]]
Atifi Mantam no yɛ Mantam a ɛyɛ wosee sen Ghana anafo fam esiane bɛn a ɛbɛn [[:en:Sahel|Sahel]] ne [[:en:Sahara|Sahara]]. Atifi mantam nsase no dodoɔ no ara yɛ ɛsrɛ so ne titiriw savanna, na nnua a etumi gyina ɔpɛ ano te sɛ [[:en:Adansonia digitata|baobabs]] anaa [[:en:Acacia|acacias]] wɔso pii. ɔpɛ bre no hyɛ ase fi ɔgyefo kosi ɔbenima. Osutɔ bre no hyɛ ase fi Kitawonsa bosome kosi ɔpenimma bosome no mu. Ewiem yɛ hye paa wɔ ɔpɛ bre awie na ewiem dwo fɔm wɔ osutɔbre. Mframa a ano yɛ hye bɔ fi sahara fam wɔ '''Ɔpɛnimma''' awie ne ɔgyefo ahyease.{{clear left}}

== Sikasɛm ==
 
Ɔha mu nkyekyɛmu 75 a wɔ Mantam no mu yɛ  Akuafo. Nea enti a nnipa nnɔso wɔ mantam no mu ne sɛ, nnipa pii di atukɔtena esiane ewiem tebea a ɛwɔ hɔ no nti.

== Mantam no ==
Atifi Mantam yɛ mantam a esua wɔka Brɔfo kasa ne kasa ahorɔw. ɔha mu nkyekyemu 52 ka kasa a efiri [[:en:Oti–Volta languages|Oti–Volta]] mmusua kuo a efiri [[:en:Niger–Congo languages|Niger–Congo language family]]. Kasa no bi ne [[:en:Dagbani language|Dagbani]], [[:en:Mamprusi language|Mamprusi]] anaa [[:en:Konkomba language|Konkomba]]. Dagbon Ahenie a ɛyɛ Dagonbafoo  no wɔ mantam no mu.

== Nsrahwɛbea ahorɔw ==

* Naa Gbewaa Ahenfie, Yendi
* Saakpoli nkoa Abura
* Diarre Napagaduungbanani
* Naa Binbegu Boabab Dua, Yendi
* Buntaga  nsuban
* Sabali (Asubɔnten Oti)
* Nawuni Asubɔnten (Volta Fitaa)

=== ɔsom ===
Nnipa miensa biara wɔ nnipa nnum mu yɛ wɔn a wɔ dɔm nkramo som (60.0%).

== Amansin ==
[[File:Districts_of_the_Northern_Region_(2018).png|right|thumb|610x610px|DistrictAaAtifi Mantam]]
Atifi Mantam a ɛwɔ Ghana no kura amansin 16. Emu 11 yɛ amansin nketewaa na 5 a aka no yɛ amansin akɛse
{| class=&quot;wikitable&quot;
! colspan=&quot;4&quot; |Districts in Northern region
|-
!#
!Amansin
!Ahenkuro
!Nnipa dodoo
|-
!1
|Gushegu
|Gushegu
|
|-
!2
|Karaga
|Karaga
|
|-
!3
|Kpandai
|[[Kpandae|Kpandai]]
|108,816
|-
!4
|Kumbungu
|Kumbugu
|
|-
!5
|Mion
|Sang
|
|-
!6
|Nanton
|Nanton
|
|-
!7 
|Nanumba Atifi fam
|Bimbila
|
|-
!8
|Nanumba Anafo fam
|Wulensi
|
|-
!9
|Saboba
|Saboba
|
|-
!10
|Sagnarigu
|Sagnarigu
|
|-
!11
|Savelugu
|Savelugu
|
|-
!12
|Tamale Mansin
|Tamale
|
|-
!13
|Tatale Sangule 
|Tatale
|
|-
!14
|Talon
|Tolon
|
|-
!15
|Yendi Mansin
|Yendi
|
|-
!16
|Zabzugu
|Zabzugu
|
|-
|}

== Nnipa Titiriw ==
{| class=&quot;wikitable&quot;
|+Nnipa Titiriw a wofi Atifi Mantam mu , Dagbon
!#
!Omanii
!Kuro
|-
! scope=&quot;row&quot; |1
|[[:en:Aliu Mahama|Aliu Mahama]]
|[[:en:Yendi|Yendi]]
|-
! scope=&quot;row&quot; |2
|[[:en:Wakaso|Wakaso]]
|[[:en:Tamale, Ghana|Tamale]]
|-
! scope=&quot;row&quot; |3
|[[:en:Abdul Majeed Waris|Majeed Waris]]
|[[:en:Tamale, Ghana|Tamale]]
|-
! scope=&quot;row&quot; |4
| [[:en:Haruna Iddrisu|Haruna Iddrisu]]
| [[:en:Tamale, Ghana|Tamale]]
|-
! scope=&quot;row&quot; |5
| [[:en:Lawyer Abdulai Mumuni|Lawyer Abdulai Mumuni]]
|Kumbungu
|}

{{Mantamu a ɛwɔ Ghana}}
[[Nkyekyεmu:Mantam a ɛwɔ Ghana]]</text>
      <sha1>409hesrcvztwkakhcjr52ffi8eiv0gd</sha1>
    </revision>
  </page>
  <page>
    <title>Etuo</title>
    <ns>0</ns>
    <id>6831</id>
    <revision>
      <id>132961</id>
      <parentid>59182</parentid>
      <timestamp>2022-07-31T13:44:17Z</timestamp>
      <contributor>
        <username>Nana Sintim</username>
        <id>11223</id>
      </contributor>
      <comment>I created the link</comment>
      <model>wikitext</model>
      <format>text/x-wiki</format>
      <text bytes="1045" xml:space="preserve">Wɔatwerɛ nsɛm yi Asante kasa mu[[File:SIG_Pro_by_Augustas_Didzgalvis.jpg|thumb|Etuo ho mfoni]]Etuo yɛ akodeɛ bi a yayɛ no sɛneɛ ɛbɛyɛ a A '''gun''' is a [[ranged weapon]] designed to use a shooting tube ([[gun barrel]]) to launch [[Projectile|projectiles]]. The projectiles are typically solid, but can also be pressurized [[liquid]] (e.g. in [[Water gun|water guns]]/[[Water cannon|cannons]], [[Spray nozzle|spray guns]] for [[Spray painting|painting]] or [[pressure washing]], [[projected water disruptors]], and technically also [[Flamethrower|flamethrowers]]), [[gas]] (e.g. [[light-gas gun]]) or even [[Charged particle|charged particles]] (e.g. [[Plasma torch|plasma gun]]). Solid projectiles may be free-flying (as with [[bullets]] and [[Artillery shell|artillery shells]]) or tethered (as with [[Taser gun|Taser guns]], [[Speargun|spearguns]]&lt;nowiki/&gt;and [[Harpoon gun|harpoon guns]]). A large-[[caliber]] gun is also called a [[cannon]].

== Abakɔsɛm ==
[[File:Yuan chinese gun.jpg|thumb|[[China]] etuo (1271-1368)]]
&lt;br /&gt;</text>
      <sha1>e973su2yef8v47y6g35ifo6u3qpvxqc</sha1>
    </revision>
    <revision>
      <id>132983</id>
      <parentid>132961</parentid>
      <timestamp>2022-07-31T21:33:07Z</timestamp>
      <contributor>
        <username>Nana Sintim</username>
        <id>11223</id>
      </contributor>
      <minor />
      <model>wikitext</model>
      <format>text/x-wiki</format>
      <text bytes="992" xml:space="preserve">Wɔatwerɛ nsɛm yi Asante kasa mu[[File:SIG_Pro_by_Augustas_Didzgalvis.jpg|thumb|Etuo ho mfoni]]Etuo yɛ akodeɛ bi a yayɛ no sɛneɛ ɛbɛyɛ a ɛbɛwɔ etuo adeɛ a ɛma  no to berɛ a aboba hyɛ mu. Etuo akorabaThe projectiles are typically solid, but can also be pressurized [[liquid]] (e.g. in [[Water gun|water guns]]/[[Water cannon|cannons]], [[Spray nozzle|spray guns]] for [[Spray painting|painting]] or [[pressure washing]], [[projected water disruptors]], and technically also [[Flamethrower|flamethrowers]]), [[gas]] (e.g. [[light-gas gun]]) or even [[Charged particle|charged particles]] (e.g. [[Plasma torch|plasma gun]]). Solid projectiles may be free-flying (as with [[bullets]] and [[Artillery shell|artillery shells]]) or tethered (as with [[Taser gun|Taser guns]], [[Speargun|spearguns]]&lt;nowiki/&gt;and [[Harpoon gun|harpoon guns]]). A large-[[caliber]] gun is also called a [[cannon]].

== Abakɔsɛm ==
[[File:Yuan chinese gun.jpg|thumb|[[China]] etuo (1271-1368)]]
&lt;br /&gt;</text>
      <sha1>3wj1ql7r3d7mp5ru2xr9azyjs9hc4ce</sha1>
    </revision>
    <revision>
      <id>132992</id>
      <parentid>132983</parentid>
      <timestamp>2022-08-01T02:00:31Z</timestamp>
      <contributor>
        <username>Nana Sintim</username>
        <id>11223</id>
      </contributor>
      <comment>Mede atwerɛ no bi aka ho</comment>
      <model>wikitext</model>
      <format>text/x-wiki</format>
      <text bytes="513" xml:space="preserve">Wɔatwerɛ nsɛm yi Asante kasa mu[[File:SIG_Pro_by_Augustas_Didzgalvis.jpg|thumb|Etuo ho mfoni]]Etuo yɛ akodeɛ bi a yayɛ no sɛneɛ ɛbɛyɛ a ɛbɛwɔ etuo adeɛ a ɛma  no to berɛ a aboba hyɛ mu. Etuo akoraba anaa etuo aboba mpɛn pii no Ɛyɛ adeɛ ɛyɛ den nso yɛbɛtumi ayɛ bi nsuo bi te etuo a yɛde nsuo na egu mu. Etuo aboba a Ɛyɛ den no ebetumi ayɛ soronko sɛ entu mga wiem. Yɛfrɛ etuo kɛseɛ Kannon.

== Abakɔsɛm ==
[[File:Yuan chinese gun.jpg|thumb|[[China]] etuo (1271-1368)]]
&lt;br /&gt;</text>
      <sha1>ma8hu0a5kxeio2jeqyv96y8mgsqznjh</sha1>
    </revision>
    <revision>
      <id>133016</id>
      <parentid>132992</parentid>
      <timestamp>2022-08-01T02:49:17Z</timestamp>
      <contributor>
        <username>Nana Sintim</username>
        <id>11223</id>
      </contributor>
      <comment>Mede atwerɛ no bi aka ho</comment>
      <model>wikitext</model>
      <format>text/x-wiki</format>
      <text bytes="1236" xml:space="preserve">Wɔatwerɛ nsɛm yi Asante kasa mu[[File:SIG_Pro_by_Augustas_Didzgalvis.jpg|thumb|Etuo ho mfoni]]Etuo yɛ akodeɛ bi a yayɛ no sɛneɛ ɛbɛyɛ a ɛbɛwɔ etuo adeɛ a ɛma  no to berɛ a aboba hyɛ mu. Etuo akoraba anaa etuo aboba mpɛn pii no Ɛyɛ adeɛ ɛyɛ den nso yɛbɛtumi ayɛ bi nsuo bi te etuo a yɛde nsuo na egu mu. Etuo aboba a Ɛyɛ den no ebetumi ayɛ soronko sɛ entu mga wiem. Yɛfrɛ etuo kɛseɛ Kannon.

== Abakɔsɛm ==
[[File:Yuan chinese gun.jpg|thumb|[[China]] etuo (1271-1368)]]

=== Proto-gun ===
Yɛnyaa atuduro frii China firi afe 9th century.

Etuo a edi kan ne etuo aburugya a ɛfiri China wɔ afe 10–12th centuries. Na ehoo awenaakye maa yɛhunu dɛ ɛwɔ hɔ bɛyɛ afe 10th mfimfini ,edane adi sɛ ampue kɔpem afe 1132. Yɛhunu sɛ wɔde pamporo na ɛyɛɛ atuduro no na wɔde bɔɔ etuo foforɔ mu. Afe1100s awieeɛ no na etuo ho akadeɛ pii aba a ɛbɛboa ma atuduro no atumi ato apete yie. Na ɛto bɛyɛ 3 meta firi afe 13th century ahyaseɛ. Saa etuo yi abakwasɛm kyerɛ sɛ ɛyɛ  &quot;proto-etuo&quot; ɛfiri sɛ nentoeɛ no mfa ne barima a yɛmea so ma no to. Afei, etuo foforɔ baa bio a yɛfrɛ no eruptor, Wɔ owura Joseph Needham ɔsee, etuo a nni adeɛ a yɛmea so to nanso no etumi to.&lt;br /&gt;</text>
      <sha1>sute7jfxaa5qcf9z93usvfo3c88i0e5</sha1>
    </revision>
    <revision>
      <id>133019</id>
      <parentid>133016</parentid>
      <timestamp>2022-08-01T02:57:47Z</timestamp>
      <contributor>
        <username>Nana Sintim</username>
        <id>11223</id>
      </contributor>
      <comment>Matwerɛ bi aka ho</comment>
      <model>wikitext</model>
      <format>text/x-wiki</format>
      <text bytes="3291" xml:space="preserve">Wɔatwerɛ nsɛm yi Asante kasa mu[[File:SIG_Pro_by_Augustas_Didzgalvis.jpg|thumb|Etuo ho mfoni]]Etuo yɛ akodeɛ bi a yayɛ no sɛneɛ ɛbɛyɛ a ɛbɛwɔ etuo adeɛ a ɛma  no to berɛ a aboba hyɛ mu. Etuo akoraba anaa etuo aboba mpɛn pii no Ɛyɛ adeɛ ɛyɛ den nso yɛbɛtumi ayɛ bi nsuo bi te etuo a yɛde nsuo na egu mu. Etuo aboba a Ɛyɛ den no ebetumi ayɛ soronko sɛ entu mga wiem. Yɛfrɛ etuo kɛseɛ Kannon.

== Abakɔsɛm ==
[[File:Yuan chinese gun.jpg|thumb|[[China]] etuo (1271-1368)]]

=== Proto-gun ===
Yɛnyaa atuduro frii China firi afe 9th century.

Etuo a edi kan ne etuo aburugya a ɛfiri China wɔ afe 10–12th centuries. Na ehoo awenaakye maa yɛhunu dɛ ɛwɔ hɔ bɛyɛ afe 10th mfimfini ,edane adi sɛ ampue kɔpem afe 1132. Yɛhunu sɛ wɔde pamporo na ɛyɛɛ atuduro no na wɔde bɔɔ etuo foforɔ mu. Afe1100s awieeɛ no na etuo ho akadeɛ pii aba a ɛbɛboa ma atuduro no atumi ato apete yie. Na ɛto bɛyɛ 3 meta firi afe 13th century ahyaseɛ. Saa etuo yi abakwasɛm kyerɛ sɛ ɛyɛ  &quot;proto-etuo&quot; ɛfiri sɛ nentoeɛ no mfa ne barima a yɛmea so ma no to. Afei, etuo foforɔ baa bio a yɛfrɛ no eruptor, Wɔ owura Joseph Needham ɔsee, etuo a nni adeɛ a yɛmea so to nanso no etumi to.

== Etuo Ahodoɔ ==

=== Asogyafoɔ etuo ===

* [[Long gun]]
** [[Arquebus]]
** [[Blunderbuss]]
** [[Musket]]
*** [[Musketoon]]
*** [[Wall gun]]
*** [[Grenade launcher]]
** [[Submachine gun]]
*** [[Personal defense weapon]]
** [[Rifle]]
*** [[Lever-action rifle]]
*** [[Bolt-action rifle]]
*** [[Assault rifle]]
*** [[Battle rifle]]
*** [[Carbine]]
*** [[Designated marksman rifle]]
*** [[Service rifle]]
*** [[Sniper rifle]]
** [[Shotgun]]
*** [[Combat shotgun]]
*** [[Semi-automatic shotgun]]
*** [[Automatic shotgun]]

=== Etuo a yɛde kura yɛn nsam ===

* [[Handgun]]
** [[Derringer]]
** [[Pistol]]
*** [[Machine pistol]]
*** [[Service pistol]]
** [[Revolver]] [[IOF .32 Revolver]] chambered in .32 S&amp;W Long  Smith &amp; Wesson &quot;Military and Police&quot; [[revolver]]
*** [[Service revolver]]

=== Etuo a yɛde yɛ ɛha ===

* [[Air gun]]
** [[BB gun]]
* [[Elephant gun]]
* [[Express rifle]]
* [[Rimfire rifle]]
* [[Speargun]]
* [[Varmint rifle]]

=== Mfidi tuo ===

* [[Gatling gun]]
** [[Minigun]]

The [[Heckler &amp; Koch]] [[Heckler &amp; Koch MP5|MP5]]&lt;nowiki/&gt;submachine gun is widely used by law enforcement tactical teams and military forces.

* [[Nordenfelt gun]]
* [[Metal Storm Limited|Metal Storm]]
* [[Mitrailleuse]]
* [[Submachine gun]]
** [[Machine pistol]]
* [[Machine gun]]
** [[General-purpose machine gun]]
** [[Light machine gun]]
*** [[Squad Automatic Weapon]]
*** [[Infantry Automatic Rifle]]
** [[Medium machine gun]]
** [[Heavy machine gun]]

=== Autocannon ===

* [[Autocannon]]
* [[Chain gun]]
* [[Revolver cannon]]

=== Artillery ===

* [[Artillery|Artillery gun]]
** [[Cannon]]
** [[Carronade]]
** [[Falconet (cannon)|Falconet]]
** [[Field gun]]
** [[Howitzer]]

=== Tank ===

* [[Tank gun]]

=== Rescue equipment ===

* [[Flare gun]]
* [[Lyle gun]]

=== Training and entertainment ===

* [[Airsoft gun]]
* [[Cap gun]]
* [[Drill Purpose Rifle]]
* [[Nerf Blasters|Nerf gun]]
* [[Paintball marker|Paintball gun]]
* [[Potato cannon]]
* [[Prop gun]]
* [[Spud gun (toy)|Spud gun]]
* [[Water gun]]

=== Ahoɔden tuo ===

* [[Directed-energy weapon]]</text>
      <sha1>1okrfkmhnxgol0shbd4fifstgtixyzr</sha1>
    </revision>
    <revision>
      <id>133023</id>
      <parentid>133019</parentid>
      <timestamp>2022-08-01T03:01:53Z</timestamp>
      <contributor>
        <username>Nana Sintim</username>
        <id>11223</id>
      </contributor>
      <model>wikitext</model>
      <format>text/x-wiki</format>
      <text bytes="3443" xml:space="preserve">Wɔatwerɛ nsɛm yi Asante kasa mu[[File:SIG_Pro_by_Augustas_Didzgalvis.jpg|thumb|Etuo ho mfoni]]Etuo yɛ akodeɛ bi a yayɛ no sɛneɛ ɛbɛyɛ a ɛbɛwɔ etuo adeɛ a ɛma  no to berɛ a aboba hyɛ mu. Etuo akoraba anaa etuo aboba mpɛn pii no Ɛyɛ adeɛ ɛyɛ den nso yɛbɛtumi ayɛ bi nsuo bi te etuo a yɛde nsuo na egu mu. Etuo aboba a Ɛyɛ den no ebetumi ayɛ soronko sɛ entu mga wiem. Yɛfrɛ etuo kɛseɛ Kannon.

== Abakɔsɛm ==
[[File:Yuan chinese gun.jpg|thumb|[[China]] etuo (1271-1368)]]

=== Proto-gun ===
Yɛnyaa atuduro frii China firi afe 9th century.

Etuo a edi kan ne etuo aburugya a ɛfiri China wɔ afe 10–12th centuries. Na ehoo awenaakye maa yɛhunu dɛ ɛwɔ hɔ bɛyɛ afe 10th mfimfini ,edane adi sɛ ampue kɔpem afe 1132. Yɛhunu sɛ wɔde pamporo na ɛyɛɛ atuduro no na wɔde bɔɔ etuo foforɔ mu. Afe1100s awieeɛ no na etuo ho akadeɛ pii aba a ɛbɛboa ma atuduro no atumi ato apete yie. Na ɛto bɛyɛ 3 meta firi afe 13th century ahyaseɛ. Saa etuo yi abakwasɛm kyerɛ sɛ ɛyɛ  &quot;proto-etuo&quot; ɛfiri sɛ nentoeɛ no mfa ne barima a yɛmea so ma no to. Afei, etuo foforɔ baa bio a yɛfrɛ no eruptor, Wɔ owura Joseph Needham ɔsee, etuo a nni adeɛ a yɛmea so to nanso no etumi to.

== Etuo Ahodoɔ ==

=== Asogyafoɔ etuo ===

* [[Long gun]]
** [[Arquebus]]
** [[Blunderbuss]]
** [[Musket]]
*** [[Musketoon]]
*** [[Wall gun]]
*** [[Grenade launcher]]
** [[Submachine gun]]
*** [[Personal defense weapon]]
** [[Rifle]]
*** [[Lever-action rifle]]
*** [[Bolt-action rifle]]
*** [[Assault rifle]]
*** [[Battle rifle]]
*** [[Carbine]]
*** [[Designated marksman rifle]]
*** [[Service rifle]]
*** [[Sniper rifle]]
** [[Shotgun]]
*** [[Combat shotgun]]
*** [[Semi-automatic shotgun]]
*** [[Automatic shotgun]]

=== Etuo a yɛde kura yɛn nsam ===

* [[Handgun]]
** [[Derringer]]
** [[Pistol]]
*** [[Machine pistol]]
*** [[Service pistol]]
** [[Revolver]] [[IOF .32 Revolver]] chambered in .32 S&amp;W Long  Smith &amp; Wesson &quot;Military and Police&quot; [[revolver]]
*** [[Service revolver]]

=== Etuo a yɛde yɛ ɛha ===

* [[Air gun]]
** [[BB gun]]
* [[Elephant gun]]
* [[Express rifle]]
* [[Rimfire rifle]]
* [[Speargun]]
* [[Varmint rifle]]

=== Mfidi tuo ===

* [[Gatling gun]]
** [[Minigun]]

The [[Heckler &amp; Koch]] [[Heckler &amp; Koch MP5|MP5]]&lt;nowiki/&gt;submachine gun is widely used by law enforcement tactical teams and military forces.

* [[Nordenfelt gun]]
* [[Metal Storm Limited|Metal Storm]]
* [[Mitrailleuse]]
* [[Submachine gun]]
** [[Machine pistol]]
* [[Machine gun]]
** [[General-purpose machine gun]]
** [[Light machine gun]]
*** [[Squad Automatic Weapon]]
*** [[Infantry Automatic Rifle]]
** [[Medium machine gun]]
** [[Heavy machine gun]]

=== Autocannon ===

* [[Autocannon]]
* [[Chain gun]]
* [[Revolver cannon]]

=== Artillery ===

* [[Artillery|Artillery gun]]
** [[Cannon]]
** [[Carronade]]
** [[Falconet (cannon)|Falconet]]
** [[Field gun]]
** [[Howitzer]]

=== Tank ===

* [[Tank gun]]

=== Rescue equipment ===

* [[Flare gun]]
* [[Lyle gun]]

=== Training and entertainment ===

* [[Airsoft gun]]
* [[Cap gun]]
* [[Drill Purpose Rifle]]
* [[Nerf Blasters|Nerf gun]]
* [[Paintball marker|Paintball gun]]
* [[Potato cannon]]
* [[Prop gun]]
* [[Spud gun (toy)|Spud gun]]
* [[Water gun]]

=== Ahoɔden tuo ===

* [[Directed-energy weapon]]


== Beaeɛ a menyaa mmoa firiiɛ ==
Look up '''[[gun]]''' in Wiktionary, the free dictionary.

*
*
*
* .
*
*
*
*
* .
*
* .
*
*
* .
*
* .
* .
* .
*
*
*</text>
      <sha1>jk2q66ekihsyb2lpo8knxclpv19t3wl</sha1>
    </revision>
    <revision>
      <id>133024</id>
      <parentid>133023</parentid>
      <timestamp>2022-08-01T03:03:39Z</timestamp>
      <contributor>
        <username>Nana Sintim</username>
        <id>11223</id>
      </contributor>
      <comment>I creat reference</comment>
      <model>wikitext</model>
      <format>text/x-wiki</format>
      <text bytes="3500" xml:space="preserve">Wɔatwerɛ nsɛm yi Asante kasa mu[[File:SIG_Pro_by_Augustas_Didzgalvis.jpg|thumb|Etuo ho mfoni]]Etuo yɛ akodeɛ bi a yayɛ no sɛneɛ ɛbɛyɛ a ɛbɛwɔ etuo adeɛ a ɛma  no to berɛ a aboba hyɛ mu.&lt;ref&gt;https://en.m.wikipedia.org/wiki/Gun#cite_note-1&lt;/ref&gt;Etuo akoraba anaa etuo aboba mpɛn pii no Ɛyɛ adeɛ ɛyɛ den nso yɛbɛtumi ayɛ bi nsuo bi te etuo a yɛde nsuo na egu mu. Etuo aboba a Ɛyɛ den no ebetumi ayɛ soronko sɛ entu mga wiem. Yɛfrɛ etuo kɛseɛ Kannon.

== Abakɔsɛm ==
[[File:Yuan chinese gun.jpg|thumb|[[China]] etuo (1271-1368)]]

=== Proto-gun ===
Yɛnyaa atuduro frii China firi afe 9th century.

Etuo a edi kan ne etuo aburugya a ɛfiri China wɔ afe 10–12th centuries. Na ehoo awenaakye maa yɛhunu dɛ ɛwɔ hɔ bɛyɛ afe 10th mfimfini ,edane adi sɛ ampue kɔpem afe 1132. Yɛhunu sɛ wɔde pamporo na ɛyɛɛ atuduro no na wɔde bɔɔ etuo foforɔ mu. Afe1100s awieeɛ no na etuo ho akadeɛ pii aba a ɛbɛboa ma atuduro no atumi ato apete yie. Na ɛto bɛyɛ 3 meta firi afe 13th century ahyaseɛ. Saa etuo yi abakwasɛm kyerɛ sɛ ɛyɛ  &quot;proto-etuo&quot; ɛfiri sɛ nentoeɛ no mfa ne barima a yɛmea so ma no to. Afei, etuo foforɔ baa bio a yɛfrɛ no eruptor, Wɔ owura Joseph Needham ɔsee, etuo a nni adeɛ a yɛmea so to nanso no etumi to.

== Etuo Ahodoɔ ==

=== Asogyafoɔ etuo ===

* [[Long gun]]
** [[Arquebus]]
** [[Blunderbuss]]
** [[Musket]]
*** [[Musketoon]]
*** [[Wall gun]]
*** [[Grenade launcher]]
** [[Submachine gun]]
*** [[Personal defense weapon]]
** [[Rifle]]
*** [[Lever-action rifle]]
*** [[Bolt-action rifle]]
*** [[Assault rifle]]
*** [[Battle rifle]]
*** [[Carbine]]
*** [[Designated marksman rifle]]
*** [[Service rifle]]
*** [[Sniper rifle]]
** [[Shotgun]]
*** [[Combat shotgun]]
*** [[Semi-automatic shotgun]]
*** [[Automatic shotgun]]

=== Etuo a yɛde kura yɛn nsam ===

* [[Handgun]]
** [[Derringer]]
** [[Pistol]]
*** [[Machine pistol]]
*** [[Service pistol]]
** [[Revolver]] [[IOF .32 Revolver]] chambered in .32 S&amp;W Long  Smith &amp; Wesson &quot;Military and Police&quot; [[revolver]]
*** [[Service revolver]]

=== Etuo a yɛde yɛ ɛha ===

* [[Air gun]]
** [[BB gun]]
* [[Elephant gun]]
* [[Express rifle]]
* [[Rimfire rifle]]
* [[Speargun]]
* [[Varmint rifle]]

=== Mfidi tuo ===

* [[Gatling gun]]
** [[Minigun]]

The [[Heckler &amp; Koch]] [[Heckler &amp; Koch MP5|MP5]]&lt;nowiki/&gt;submachine gun is widely used by law enforcement tactical teams and military forces.

* [[Nordenfelt gun]]
* [[Metal Storm Limited|Metal Storm]]
* [[Mitrailleuse]]
* [[Submachine gun]]
** [[Machine pistol]]
* [[Machine gun]]
** [[General-purpose machine gun]]
** [[Light machine gun]]
*** [[Squad Automatic Weapon]]
*** [[Infantry Automatic Rifle]]
** [[Medium machine gun]]
** [[Heavy machine gun]]

=== Autocannon ===

* [[Autocannon]]
* [[Chain gun]]
* [[Revolver cannon]]

=== Artillery ===

* [[Artillery|Artillery gun]]
** [[Cannon]]
** [[Carronade]]
** [[Falconet (cannon)|Falconet]]
** [[Field gun]]
** [[Howitzer]]

=== Tank ===

* [[Tank gun]]

=== Rescue equipment ===

* [[Flare gun]]
* [[Lyle gun]]

=== Training and entertainment ===

* [[Airsoft gun]]
* [[Cap gun]]
* [[Drill Purpose Rifle]]
* [[Nerf Blasters|Nerf gun]]
* [[Paintball marker|Paintball gun]]
* [[Potato cannon]]
* [[Prop gun]]
* [[Spud gun (toy)|Spud gun]]
* [[Water gun]]

=== Ahoɔden tuo ===

* [[Directed-energy weapon]]


== Beaeɛ a menyaa mmoa firiiɛ ==
Look up '''[[gun]]''' in Wiktionary, the free dictionary.

*
*
*
* .
*
*
*
*
* .
*
* .
*
*
* .
*
* .
* .
* .
*
*
*</text>
      <sha1>npuqu287lzgo2umuel9unehj1lpg9yk</sha1>
    </revision>
    <revision>
      <id>133025</id>
      <parentid>133024</parentid>
      <timestamp>2022-08-01T03:04:45Z</timestamp>
      <contributor>
        <username>Nana Sintim</username>
        <id>11223</id>
      </contributor>
      <model>wikitext</model>
      <format>text/x-wiki</format>
      <text bytes="3387" xml:space="preserve">Wɔatwerɛ nsɛm yi Asante kasa mu[[File:SIG_Pro_by_Augustas_Didzgalvis.jpg|thumb|Etuo ho mfoni]]Etuo yɛ akodeɛ bi a yayɛ no sɛneɛ ɛbɛyɛ a ɛbɛwɔ etuo adeɛ a ɛma  no to berɛ a aboba hyɛ mu.&lt;ref&gt;https://en.m.wikipedia.org/wiki/Gun#cite_note-1&lt;/ref&gt;Etuo akoraba anaa etuo aboba mpɛn pii no Ɛyɛ adeɛ ɛyɛ den nso yɛbɛtumi ayɛ bi nsuo bi te etuo a yɛde nsuo na egu mu. Etuo aboba a Ɛyɛ den no ebetumi ayɛ soronko sɛ entu mga wiem. Yɛfrɛ etuo kɛseɛ Kannon.

== Abakɔsɛm ==
[[File:Yuan chinese gun.jpg|thumb|[[China]] etuo (1271-1368)]]

=== Proto-gun ===
Yɛnyaa atuduro frii China firi afe 9th century.

Etuo a edi kan ne etuo aburugya a ɛfiri China wɔ afe 10–12th centuries. Na ehoo awenaakye maa yɛhunu dɛ ɛwɔ hɔ bɛyɛ afe 10th mfimfini ,edane adi sɛ ampue kɔpem afe 1132. Yɛhunu sɛ wɔde pamporo na ɛyɛɛ atuduro no na wɔde bɔɔ etuo foforɔ mu. Afe1100s awieeɛ no na etuo ho akadeɛ pii aba a ɛbɛboa ma atuduro no atumi ato apete yie. Na ɛto bɛyɛ 3 meta firi afe 13th century ahyaseɛ. Saa etuo yi abakwasɛm kyerɛ sɛ ɛyɛ  &quot;proto-etuo&quot; ɛfiri sɛ nentoeɛ no mfa ne barima a yɛmea so ma no to. Afei, etuo foforɔ baa bio a yɛfrɛ no eruptor, Wɔ owura Joseph Needham ɔsee, etuo a nni adeɛ a yɛmea so to nanso no etumi to.

== Etuo Ahodoɔ ==

=== Asogyafoɔ etuo ===

* [[Long gun]]
** [[Arquebus]]
** [[Blunderbuss]]
** [[Musket]]
*** [[Musketoon]]
*** [[Wall gun]]
*** [[Grenade launcher]]
** [[Submachine gun]]
*** [[Personal defense weapon]]
** [[Rifle]]
*** [[Lever-action rifle]]
*** [[Bolt-action rifle]]
*** [[Assault rifle]]
*** [[Battle rifle]]
*** [[Carbine]]
*** [[Designated marksman rifle]]
*** [[Service rifle]]
*** [[Sniper rifle]]
** [[Shotgun]]
*** [[Combat shotgun]]
*** [[Semi-automatic shotgun]]
*** [[Automatic shotgun]]

=== Etuo a yɛde kura yɛn nsam ===

* [[Handgun]]
** [[Derringer]]
** [[Pistol]]
*** [[Machine pistol]]
*** [[Service pistol]]
** [[Revolver]] [[IOF .32 Revolver]] chambered in .32 S&amp;W Long  Smith &amp; Wesson &quot;Military and Police&quot; [[revolver]]
*** [[Service revolver]]

=== Etuo a yɛde yɛ ɛha ===

* [[Air gun]]
** [[BB gun]]
* [[Elephant gun]]
* [[Express rifle]]
* [[Rimfire rifle]]
* [[Speargun]]
* [[Varmint rifle]]

=== Mfidi tuo ===

* [[Gatling gun]]
** [[Minigun]]

The [[Heckler &amp; Koch]] [[Heckler &amp; Koch MP5|MP5]]&lt;nowiki/&gt;submachine gun is widely used by law enforcement tactical teams and military forces.

* [[Nordenfelt gun]]
* [[Metal Storm Limited|Metal Storm]]
* [[Mitrailleuse]]
* [[Submachine gun]]
** [[Machine pistol]]
* [[Machine gun]]
** [[General-purpose machine gun]]
** [[Light machine gun]]
*** [[Squad Automatic Weapon]]
*** [[Infantry Automatic Rifle]]
** [[Medium machine gun]]
** [[Heavy machine gun]]

=== Autocannon ===

* [[Autocannon]]
* [[Chain gun]]
* [[Revolver cannon]]

=== Artillery ===

* [[Artillery|Artillery gun]]
** [[Cannon]]
** [[Carronade]]
** [[Falconet (cannon)|Falconet]]
** [[Field gun]]
** [[Howitzer]]

=== Tank ===

* [[Tank gun]]

=== Rescue equipment ===

* [[Flare gun]]
* [[Lyle gun]]

=== Training and entertainment ===

* [[Airsoft gun]]
* [[Cap gun]]
* [[Drill Purpose Rifle]]
* [[Nerf Blasters|Nerf gun]]
* [[Paintball marker|Paintball gun]]
* [[Potato cannon]]
* [[Prop gun]]
* [[Spud gun (toy)|Spud gun]]
* [[Water gun]]

=== Ahoɔden tuo ===

* [[Directed-energy weapon]]


== Beaeɛ a menyaa mmoa firiiɛ ==
L</text>
      <sha1>9z5apx7ivfaqkflt3zrkmvzmstjl8cy</sha1>
    </revision>
    <revision>
      <id>133026</id>
      <parentid>133025</parentid>
      <timestamp>2022-08-01T03:06:17Z</timestamp>
      <contributor>
        <username>Nana Sintim</username>
        <id>11223</id>
      </contributor>
      <comment>I add  refrences</comment>
      <model>wikitext</model>
      <format>text/x-wiki</format>
      <text bytes="3467" xml:space="preserve">Wɔatwerɛ nsɛm yi Asante kasa mu[[File:SIG_Pro_by_Augustas_Didzgalvis.jpg|thumb|Etuo ho mfoni]]Etuo yɛ akodeɛ bi a yayɛ no sɛneɛ ɛbɛyɛ a ɛbɛwɔ etuo adeɛ a ɛma  no to berɛ a aboba hyɛ mu.&lt;ref&gt;https://en.m.wikipedia.org/wiki/Gun#cite_note-1&lt;/ref&gt;Etuo akoraba anaa etuo aboba mpɛn pii no Ɛyɛ adeɛ ɛyɛ den nso yɛbɛtumi ayɛ bi nsuo bi te etuo a yɛde nsuo na egu mu. Etuo aboba a Ɛyɛ den no ebetumi ayɛ soronko sɛ entu mga wiem. Yɛfrɛ etuo kɛseɛ Kannon.&lt;ref&gt;https://en.m.wikipedia.org/wiki/Gun#cite_note-FOOTNOTEAndrade201651-2&lt;/ref&gt;

== Abakɔsɛm ==
[[File:Yuan chinese gun.jpg|thumb|[[China]] etuo (1271-1368)]]

=== Proto-gun ===
Yɛnyaa atuduro frii China firi afe 9th century.

Etuo a edi kan ne etuo aburugya a ɛfiri China wɔ afe 10–12th centuries. Na ehoo awenaakye maa yɛhunu dɛ ɛwɔ hɔ bɛyɛ afe 10th mfimfini ,edane adi sɛ ampue kɔpem afe 1132. Yɛhunu sɛ wɔde pamporo na ɛyɛɛ atuduro no na wɔde bɔɔ etuo foforɔ mu. Afe1100s awieeɛ no na etuo ho akadeɛ pii aba a ɛbɛboa ma atuduro no atumi ato apete yie. Na ɛto bɛyɛ 3 meta firi afe 13th century ahyaseɛ. Saa etuo yi abakwasɛm kyerɛ sɛ ɛyɛ  &quot;proto-etuo&quot; ɛfiri sɛ nentoeɛ no mfa ne barima a yɛmea so ma no to. Afei, etuo foforɔ baa bio a yɛfrɛ no eruptor, Wɔ owura Joseph Needham ɔsee, etuo a nni adeɛ a yɛmea so to nanso no etumi to.

== Etuo Ahodoɔ ==

=== Asogyafoɔ etuo ===

* [[Long gun]]
** [[Arquebus]]
** [[Blunderbuss]]
** [[Musket]]
*** [[Musketoon]]
*** [[Wall gun]]
*** [[Grenade launcher]]
** [[Submachine gun]]
*** [[Personal defense weapon]]
** [[Rifle]]
*** [[Lever-action rifle]]
*** [[Bolt-action rifle]]
*** [[Assault rifle]]
*** [[Battle rifle]]
*** [[Carbine]]
*** [[Designated marksman rifle]]
*** [[Service rifle]]
*** [[Sniper rifle]]
** [[Shotgun]]
*** [[Combat shotgun]]
*** [[Semi-automatic shotgun]]
*** [[Automatic shotgun]]

=== Etuo a yɛde kura yɛn nsam ===

* [[Handgun]]
** [[Derringer]]
** [[Pistol]]
*** [[Machine pistol]]
*** [[Service pistol]]
** [[Revolver]] [[IOF .32 Revolver]] chambered in .32 S&amp;W Long  Smith &amp; Wesson &quot;Military and Police&quot; [[revolver]]
*** [[Service revolver]]

=== Etuo a yɛde yɛ ɛha ===

* [[Air gun]]
** [[BB gun]]
* [[Elephant gun]]
* [[Express rifle]]
* [[Rimfire rifle]]
* [[Speargun]]
* [[Varmint rifle]]

=== Mfidi tuo ===

* [[Gatling gun]]
** [[Minigun]]

The [[Heckler &amp; Koch]] [[Heckler &amp; Koch MP5|MP5]]&lt;nowiki/&gt;submachine gun is widely used by law enforcement tactical teams and military forces.

* [[Nordenfelt gun]]
* [[Metal Storm Limited|Metal Storm]]
* [[Mitrailleuse]]
* [[Submachine gun]]
** [[Machine pistol]]
* [[Machine gun]]
** [[General-purpose machine gun]]
** [[Light machine gun]]
*** [[Squad Automatic Weapon]]
*** [[Infantry Automatic Rifle]]
** [[Medium machine gun]]
** [[Heavy machine gun]]

=== Autocannon ===

* [[Autocannon]]
* [[Chain gun]]
* [[Revolver cannon]]

=== Artillery ===

* [[Artillery|Artillery gun]]
** [[Cannon]]
** [[Carronade]]
** [[Falconet (cannon)|Falconet]]
** [[Field gun]]
** [[Howitzer]]

=== Tank ===

* [[Tank gun]]

=== Rescue equipment ===

* [[Flare gun]]
* [[Lyle gun]]

=== Training and entertainment ===

* [[Airsoft gun]]
* [[Cap gun]]
* [[Drill Purpose Rifle]]
* [[Nerf Blasters|Nerf gun]]
* [[Paintball marker|Paintball gun]]
* [[Potato cannon]]
* [[Prop gun]]
* [[Spud gun (toy)|Spud gun]]
* [[Water gun]]

=== Ahoɔden tuo ===

* [[Directed-energy weapon]]


== Beaeɛ a menyaa mmoa firiiɛ ==
L</text>
      <sha1>n60hku217227f0vkklw62aoiby7mhe0</sha1>
    </revision>
    <revision>
      <id>133027</id>
      <parentid>133026</parentid>
      <timestamp>2022-08-01T03:07:41Z</timestamp>
      <contributor>
        <username>Nana Sintim</username>
        <id>11223</id>
      </contributor>
      <comment>I add  refrences</comment>
      <model>wikitext</model>
      <format>text/x-wiki</format>
      <text bytes="3526" xml:space="preserve">Wɔatwerɛ nsɛm yi Asante kasa mu[[File:SIG_Pro_by_Augustas_Didzgalvis.jpg|thumb|Etuo ho mfoni]]Etuo yɛ akodeɛ bi a yayɛ no sɛneɛ ɛbɛyɛ a ɛbɛwɔ etuo adeɛ a ɛma  no to berɛ a aboba hyɛ mu.&lt;ref&gt;https://en.m.wikipedia.org/wiki/Gun#cite_note-1&lt;/ref&gt;Etuo akoraba anaa etuo aboba mpɛn pii no Ɛyɛ adeɛ ɛyɛ den nso yɛbɛtumi ayɛ bi nsuo bi te etuo a yɛde nsuo na egu mu. Etuo aboba a Ɛyɛ den no ebetumi ayɛ soronko sɛ entu mga wiem. Yɛfrɛ etuo kɛseɛ Kannon.&lt;ref&gt;https://en.m.wikipedia.org/wiki/Gun#cite_note-FOOTNOTEAndrade201651-2&lt;/ref&gt;

== Abakɔsɛm ==
[[File:Yuan chinese gun.jpg|thumb|[[China]] etuo (1271-1368)]]

=== Proto-gun ===
Yɛnyaa atuduro frii China firi afe 9th century.&lt;ref&gt;https://en.m.wikipedia.org/wiki/Gun#cite_note-21&lt;/ref&gt;

Etuo a edi kan ne etuo aburugya a ɛfiri China wɔ afe 10–12th centuries. Na ehoo awenaakye maa yɛhunu dɛ ɛwɔ hɔ bɛyɛ afe 10th mfimfini ,edane adi sɛ ampue kɔpem afe 1132. Yɛhunu sɛ wɔde pamporo na ɛyɛɛ atuduro no na wɔde bɔɔ etuo foforɔ mu. Afe1100s awieeɛ no na etuo ho akadeɛ pii aba a ɛbɛboa ma atuduro no atumi ato apete yie. Na ɛto bɛyɛ 3 meta firi afe 13th century ahyaseɛ. Saa etuo yi abakwasɛm kyerɛ sɛ ɛyɛ  &quot;proto-etuo&quot; ɛfiri sɛ nentoeɛ no mfa ne barima a yɛmea so ma no to. Afei, etuo foforɔ baa bio a yɛfrɛ no eruptor, Wɔ owura Joseph Needham ɔsee, etuo a nni adeɛ a yɛmea so to nanso no etumi to.

== Etuo Ahodoɔ ==

=== Asogyafoɔ etuo ===

* [[Long gun]]
** [[Arquebus]]
** [[Blunderbuss]]
** [[Musket]]
*** [[Musketoon]]
*** [[Wall gun]]
*** [[Grenade launcher]]
** [[Submachine gun]]
*** [[Personal defense weapon]]
** [[Rifle]]
*** [[Lever-action rifle]]
*** [[Bolt-action rifle]]
*** [[Assault rifle]]
*** [[Battle rifle]]
*** [[Carbine]]
*** [[Designated marksman rifle]]
*** [[Service rifle]]
*** [[Sniper rifle]]
** [[Shotgun]]
*** [[Combat shotgun]]
*** [[Semi-automatic shotgun]]
*** [[Automatic shotgun]]

=== Etuo a yɛde kura yɛn nsam ===

* [[Handgun]]
** [[Derringer]]
** [[Pistol]]
*** [[Machine pistol]]
*** [[Service pistol]]
** [[Revolver]] [[IOF .32 Revolver]] chambered in .32 S&amp;W Long  Smith &amp; Wesson &quot;Military and Police&quot; [[revolver]]
*** [[Service revolver]]

=== Etuo a yɛde yɛ ɛha ===

* [[Air gun]]
** [[BB gun]]
* [[Elephant gun]]
* [[Express rifle]]
* [[Rimfire rifle]]
* [[Speargun]]
* [[Varmint rifle]]

=== Mfidi tuo ===

* [[Gatling gun]]
** [[Minigun]]

The [[Heckler &amp; Koch]] [[Heckler &amp; Koch MP5|MP5]]&lt;nowiki/&gt;submachine gun is widely used by law enforcement tactical teams and military forces.

* [[Nordenfelt gun]]
* [[Metal Storm Limited|Metal Storm]]
* [[Mitrailleuse]]
* [[Submachine gun]]
** [[Machine pistol]]
* [[Machine gun]]
** [[General-purpose machine gun]]
** [[Light machine gun]]
*** [[Squad Automatic Weapon]]
*** [[Infantry Automatic Rifle]]
** [[Medium machine gun]]
** [[Heavy machine gun]]

=== Autocannon ===

* [[Autocannon]]
* [[Chain gun]]
* [[Revolver cannon]]

=== Artillery ===

* [[Artillery|Artillery gun]]
** [[Cannon]]
** [[Carronade]]
** [[Falconet (cannon)|Falconet]]
** [[Field gun]]
** [[Howitzer]]

=== Tank ===

* [[Tank gun]]

=== Rescue equipment ===

* [[Flare gun]]
* [[Lyle gun]]

=== Training and entertainment ===

* [[Airsoft gun]]
* [[Cap gun]]
* [[Drill Purpose Rifle]]
* [[Nerf Blasters|Nerf gun]]
* [[Paintball marker|Paintball gun]]
* [[Potato cannon]]
* [[Prop gun]]
* [[Spud gun (toy)|Spud gun]]
* [[Water gun]]

=== Ahoɔden tuo ===

* [[Directed-energy weapon]]


== Beaeɛ a menyaa mmoa firiiɛ ==
L</text>
      <sha1>diwt85p5z7q0h4439wibcr4ku4jkoz6</sha1>
    </revision>
    <revision>
      <id>133028</id>
      <parentid>133027</parentid>
      <timestamp>2022-08-01T03:09:05Z</timestamp>
      <contributor>
        <username>Nana Sintim</username>
        <id>11223</id>
      </contributor>
      <model>wikitext</model>
      <format>text/x-wiki</format>
      <text bytes="3607" xml:space="preserve">Wɔatwerɛ nsɛm yi Asante kasa mu[[File:SIG_Pro_by_Augustas_Didzgalvis.jpg|thumb|Etuo ho mfoni]]Etuo yɛ akodeɛ bi a yayɛ no sɛneɛ ɛbɛyɛ a ɛbɛwɔ etuo adeɛ a ɛma  no to berɛ a aboba hyɛ mu.&lt;ref&gt;https://en.m.wikipedia.org/wiki/Gun#cite_note-1&lt;/ref&gt;Etuo akoraba anaa etuo aboba mpɛn pii no Ɛyɛ adeɛ ɛyɛ den nso yɛbɛtumi ayɛ bi nsuo bi te etuo a yɛde nsuo na egu mu. Etuo aboba a Ɛyɛ den no ebetumi ayɛ soronko sɛ entu mga wiem. Yɛfrɛ etuo kɛseɛ Kannon.&lt;ref&gt;https://en.m.wikipedia.org/wiki/Gun#cite_note-FOOTNOTEAndrade201651-2&lt;/ref&gt;

== Abakɔsɛm ==
[[File:Yuan chinese gun.jpg|thumb|[[China]] etuo (1271-1368)]]

=== Proto-gun ===
Yɛnyaa atuduro frii China firi afe 9th century.&lt;ref&gt;https://en.m.wikipedia.org/wiki/Gun#cite_note-21&lt;/ref&gt;

Etuo a edi kan ne etuo aburugya a ɛfiri China wɔ afe 10–12th centuries.&lt;ref&gt;https://en.m.wikipedia.org/wiki/Gun#cite_note-FOOTNOTENeedham1986222-23&lt;/ref&gt;Na ehoo awenaakye maa yɛhunu dɛ ɛwɔ hɔ bɛyɛ afe 10th mfimfini ,edane adi sɛ ampue kɔpem afe 1132. Yɛhunu sɛ wɔde pamporo na ɛyɛɛ atuduro no na wɔde bɔɔ etuo foforɔ mu. Afe1100s awieeɛ no na etuo ho akadeɛ pii aba a ɛbɛboa ma atuduro no atumi ato apete yie. Na ɛto bɛyɛ 3 meta firi afe 13th century ahyaseɛ. Saa etuo yi abakwasɛm kyerɛ sɛ ɛyɛ  &quot;proto-etuo&quot; ɛfiri sɛ nentoeɛ no mfa ne barima a yɛmea so ma no to. Afei, etuo foforɔ baa bio a yɛfrɛ no eruptor, Wɔ owura Joseph Needham ɔsee, etuo a nni adeɛ a yɛmea so to nanso no etumi to.

== Etuo Ahodoɔ ==

=== Asogyafoɔ etuo ===

* [[Long gun]]
** [[Arquebus]]
** [[Blunderbuss]]
** [[Musket]]
*** [[Musketoon]]
*** [[Wall gun]]
*** [[Grenade launcher]]
** [[Submachine gun]]
*** [[Personal defense weapon]]
** [[Rifle]]
*** [[Lever-action rifle]]
*** [[Bolt-action rifle]]
*** [[Assault rifle]]
*** [[Battle rifle]]
*** [[Carbine]]
*** [[Designated marksman rifle]]
*** [[Service rifle]]
*** [[Sniper rifle]]
** [[Shotgun]]
*** [[Combat shotgun]]
*** [[Semi-automatic shotgun]]
*** [[Automatic shotgun]]

=== Etuo a yɛde kura yɛn nsam ===

* [[Handgun]]
** [[Derringer]]
** [[Pistol]]
*** [[Machine pistol]]
*** [[Service pistol]]
** [[Revolver]] [[IOF .32 Revolver]] chambered in .32 S&amp;W Long  Smith &amp; Wesson &quot;Military and Police&quot; [[revolver]]
*** [[Service revolver]]

=== Etuo a yɛde yɛ ɛha ===

* [[Air gun]]
** [[BB gun]]
* [[Elephant gun]]
* [[Express rifle]]
* [[Rimfire rifle]]
* [[Speargun]]
* [[Varmint rifle]]

=== Mfidi tuo ===

* [[Gatling gun]]
** [[Minigun]]

The [[Heckler &amp; Koch]] [[Heckler &amp; Koch MP5|MP5]]&lt;nowiki/&gt;submachine gun is widely used by law enforcement tactical teams and military forces.

* [[Nordenfelt gun]]
* [[Metal Storm Limited|Metal Storm]]
* [[Mitrailleuse]]
* [[Submachine gun]]
** [[Machine pistol]]
* [[Machine gun]]
** [[General-purpose machine gun]]
** [[Light machine gun]]
*** [[Squad Automatic Weapon]]
*** [[Infantry Automatic Rifle]]
** [[Medium machine gun]]
** [[Heavy machine gun]]

=== Autocannon ===

* [[Autocannon]]
* [[Chain gun]]
* [[Revolver cannon]]

=== Artillery ===

* [[Artillery|Artillery gun]]
** [[Cannon]]
** [[Carronade]]
** [[Falconet (cannon)|Falconet]]
** [[Field gun]]
** [[Howitzer]]

=== Tank ===

* [[Tank gun]]

=== Rescue equipment ===

* [[Flare gun]]
* [[Lyle gun]]

=== Training and entertainment ===

* [[Airsoft gun]]
* [[Cap gun]]
* [[Drill Purpose Rifle]]
* [[Nerf Blasters|Nerf gun]]
* [[Paintball marker|Paintball gun]]
* [[Potato cannon]]
* [[Prop gun]]
* [[Spud gun (toy)|Spud gun]]
* [[Water gun]]

=== Ahoɔden tuo ===

* [[Directed-energy weapon]]


== Beaeɛ a menyaa mmoa firiiɛ ==
L</text>
      <sha1>2ka5v3pxwt79p8dkd03v5fv9gbuype5</sha1>
    </revision>
    <revision>
      <id>133029</id>
      <parentid>133028</parentid>
      <timestamp>2022-08-01T03:11:56Z</timestamp>
      <contributor>
        <username>Nana Sintim</username>
        <id>11223</id>
      </contributor>
      <comment>I add  refrences</comment>
      <model>wikitext</model>
      <format>text/x-wiki</format>
      <text bytes="3687" xml:space="preserve">Wɔatwerɛ nsɛm yi Asante kasa mu[[File:SIG_Pro_by_Augustas_Didzgalvis.jpg|thumb|Etuo ho mfoni]]Etuo yɛ akodeɛ bi a yayɛ no sɛneɛ ɛbɛyɛ a ɛbɛwɔ etuo adeɛ a ɛma  no to berɛ a aboba hyɛ mu.&lt;ref&gt;https://en.m.wikipedia.org/wiki/Gun#cite_note-1&lt;/ref&gt;Etuo akoraba anaa etuo aboba mpɛn pii no Ɛyɛ adeɛ ɛyɛ den nso yɛbɛtumi ayɛ bi nsuo bi te etuo a yɛde nsuo na egu mu. Etuo aboba a Ɛyɛ den no ebetumi ayɛ soronko sɛ entu mga wiem. Yɛfrɛ etuo kɛseɛ Kannon.&lt;ref&gt;https://en.m.wikipedia.org/wiki/Gun#cite_note-FOOTNOTEAndrade201651-2&lt;/ref&gt;

== Abakɔsɛm ==
[[File:Yuan chinese gun.jpg|thumb|[[China]] etuo (1271-1368)]]

=== Proto-gun ===
Yɛnyaa atuduro frii China firi afe 9th century.&lt;ref&gt;https://en.m.wikipedia.org/wiki/Gun#cite_note-21&lt;/ref&gt;

Etuo a edi kan ne etuo aburugya a ɛfiri China wɔ afe 10–12th centuries.&lt;ref&gt;https://en.m.wikipedia.org/wiki/Gun#cite_note-FOOTNOTENeedham1986222-23&lt;/ref&gt;Na ehoo awenaakye maa yɛhunu dɛ ɛwɔ hɔ bɛyɛ afe 10th mfimfini ,edane adi sɛ ampue kɔpem afe 1132. Yɛhunu sɛ wɔde pamporo na ɛyɛɛ atuduro no na wɔde bɔɔ etuo foforɔ mu. Afe1100s awieeɛ no na etuo ho akadeɛ pii aba a ɛbɛboa ma atuduro no atumi ato apete yie.&lt;ref&gt;https://en.m.wikipedia.org/wiki/Gun#cite_note-FOOTNOTEAndrade201652-26&lt;/ref&gt;Na ɛto bɛyɛ 3 meta firi afe 13th century ahyaseɛ. Saa etuo yi abakwasɛm kyerɛ sɛ ɛyɛ  &quot;proto-etuo&quot; ɛfiri sɛ nentoeɛ no mfa ne barima a yɛmea so ma no to. Afei, etuo foforɔ baa bio a yɛfrɛ no eruptor, Wɔ owura Joseph Needham ɔsee, etuo a nni adeɛ a yɛmea so to nanso no etumi to.

== Etuo Ahodoɔ ==

=== Asogyafoɔ etuo ===

* [[Long gun]]
** [[Arquebus]]
** [[Blunderbuss]]
** [[Musket]]
*** [[Musketoon]]
*** [[Wall gun]]
*** [[Grenade launcher]]
** [[Submachine gun]]
*** [[Personal defense weapon]]
** [[Rifle]]
*** [[Lever-action rifle]]
*** [[Bolt-action rifle]]
*** [[Assault rifle]]
*** [[Battle rifle]]
*** [[Carbine]]
*** [[Designated marksman rifle]]
*** [[Service rifle]]
*** [[Sniper rifle]]
** [[Shotgun]]
*** [[Combat shotgun]]
*** [[Semi-automatic shotgun]]
*** [[Automatic shotgun]]

=== Etuo a yɛde kura yɛn nsam ===

* [[Handgun]]
** [[Derringer]]
** [[Pistol]]
*** [[Machine pistol]]
*** [[Service pistol]]
** [[Revolver]] [[IOF .32 Revolver]] chambered in .32 S&amp;W Long  Smith &amp; Wesson &quot;Military and Police&quot; [[revolver]]
*** [[Service revolver]]

=== Etuo a yɛde yɛ ɛha ===

* [[Air gun]]
** [[BB gun]]
* [[Elephant gun]]
* [[Express rifle]]
* [[Rimfire rifle]]
* [[Speargun]]
* [[Varmint rifle]]

=== Mfidi tuo ===

* [[Gatling gun]]
** [[Minigun]]

The [[Heckler &amp; Koch]] [[Heckler &amp; Koch MP5|MP5]]&lt;nowiki/&gt;submachine gun is widely used by law enforcement tactical teams and military forces.

* [[Nordenfelt gun]]
* [[Metal Storm Limited|Metal Storm]]
* [[Mitrailleuse]]
* [[Submachine gun]]
** [[Machine pistol]]
* [[Machine gun]]
** [[General-purpose machine gun]]
** [[Light machine gun]]
*** [[Squad Automatic Weapon]]
*** [[Infantry Automatic Rifle]]
** [[Medium machine gun]]
** [[Heavy machine gun]]

=== Autocannon ===

* [[Autocannon]]
* [[Chain gun]]
* [[Revolver cannon]]

=== Artillery ===

* [[Artillery|Artillery gun]]
** [[Cannon]]
** [[Carronade]]
** [[Falconet (cannon)|Falconet]]
** [[Field gun]]
** [[Howitzer]]

=== Tank ===

* [[Tank gun]]

=== Rescue equipment ===

* [[Flare gun]]
* [[Lyle gun]]

=== Training and entertainment ===

* [[Airsoft gun]]
* [[Cap gun]]
* [[Drill Purpose Rifle]]
* [[Nerf Blasters|Nerf gun]]
* [[Paintball marker|Paintball gun]]
* [[Potato cannon]]
* [[Prop gun]]
* [[Spud gun (toy)|Spud gun]]
* [[Water gun]]

=== Ahoɔden tuo ===

* [[Directed-energy weapon]]


== Beaeɛ a menyaa mmoa firiiɛ ==
L</text>
      <sha1>4qt4bdkeqnatzjiaz23aidjzua278be</sha1>
    </revision>
    <revision>
      <id>133030</id>
      <parentid>133029</parentid>
      <timestamp>2022-08-01T03:14:22Z</timestamp>
      <contributor>
        <username>Nana Sintim</username>
        <id>11223</id>
      </contributor>
      <model>wikitext</model>
      <format>text/x-wiki</format>
      <text bytes="3768" xml:space="preserve">Wɔatwerɛ nsɛm yi Asante kasa mu[[File:SIG_Pro_by_Augustas_Didzgalvis.jpg|thumb|Etuo ho mfoni]]Etuo yɛ akodeɛ bi a yayɛ no sɛneɛ ɛbɛyɛ a ɛbɛwɔ etuo adeɛ a ɛma  no to berɛ a aboba hyɛ mu.&lt;ref&gt;https://en.m.wikipedia.org/wiki/Gun#cite_note-1&lt;/ref&gt;Etuo akoraba anaa etuo aboba mpɛn pii no Ɛyɛ adeɛ ɛyɛ den nso yɛbɛtumi ayɛ bi nsuo bi te etuo a yɛde nsuo na egu mu. Etuo aboba a Ɛyɛ den no ebetumi ayɛ soronko sɛ entu mga wiem. Yɛfrɛ etuo kɛseɛ Kannon.&lt;ref&gt;https://en.m.wikipedia.org/wiki/Gun#cite_note-FOOTNOTEAndrade201651-2&lt;/ref&gt;

== Abakɔsɛm ==
[[File:Yuan chinese gun.jpg|thumb|[[China]] etuo (1271-1368)]]

=== Proto-gun ===
Yɛnyaa atuduro frii China firi afe 9th century.&lt;ref&gt;https://en.m.wikipedia.org/wiki/Gun#cite_note-21&lt;/ref&gt;

Etuo a edi kan ne etuo aburugya a ɛfiri China wɔ afe 10–12th centuries.&lt;ref&gt;https://en.m.wikipedia.org/wiki/Gun#cite_note-FOOTNOTENeedham1986222-23&lt;/ref&gt;Na ehoo awenaakye maa yɛhunu dɛ ɛwɔ hɔ bɛyɛ afe 10th mfimfini ,edane adi sɛ ampue kɔpem afe 1132. Yɛhunu sɛ wɔde pamporo na ɛyɛɛ atuduro no na wɔde bɔɔ etuo foforɔ mu. Afe1100s awieeɛ no na etuo ho akadeɛ pii aba a ɛbɛboa ma atuduro no atumi ato apete yie.&lt;ref&gt;https://en.m.wikipedia.org/wiki/Gun#cite_note-FOOTNOTEAndrade201652-26&lt;/ref&gt;Na ɛto bɛyɛ 3 meta firi afe 13th century ahyaseɛ. Saa etuo yi abakwasɛm kyerɛ sɛ ɛyɛ  &quot;proto-etuo&quot; ɛfiri sɛ nentoeɛ no mfa ne barima a yɛmea so ma no to.&lt;ref&gt;https://en.m.wikipedia.org/wiki/Gun#cite_note-FOOTNOTEAndrade201646-27&lt;/ref&gt; Afei, etuo foforɔ baa bio a yɛfrɛ no eruptor, Wɔ owura Joseph Needham ɔsee, etuo a nni adeɛ a yɛmea so to nanso no etumi to.

== Etuo Ahodoɔ ==

=== Asogyafoɔ etuo ===

* [[Long gun]]
** [[Arquebus]]
** [[Blunderbuss]]
** [[Musket]]
*** [[Musketoon]]
*** [[Wall gun]]
*** [[Grenade launcher]]
** [[Submachine gun]]
*** [[Personal defense weapon]]
** [[Rifle]]
*** [[Lever-action rifle]]
*** [[Bolt-action rifle]]
*** [[Assault rifle]]
*** [[Battle rifle]]
*** [[Carbine]]
*** [[Designated marksman rifle]]
*** [[Service rifle]]
*** [[Sniper rifle]]
** [[Shotgun]]
*** [[Combat shotgun]]
*** [[Semi-automatic shotgun]]
*** [[Automatic shotgun]]

=== Etuo a yɛde kura yɛn nsam ===

* [[Handgun]]
** [[Derringer]]
** [[Pistol]]
*** [[Machine pistol]]
*** [[Service pistol]]
** [[Revolver]] [[IOF .32 Revolver]] chambered in .32 S&amp;W Long  Smith &amp; Wesson &quot;Military and Police&quot; [[revolver]]
*** [[Service revolver]]

=== Etuo a yɛde yɛ ɛha ===

* [[Air gun]]
** [[BB gun]]
* [[Elephant gun]]
* [[Express rifle]]
* [[Rimfire rifle]]
* [[Speargun]]
* [[Varmint rifle]]

=== Mfidi tuo ===

* [[Gatling gun]]
** [[Minigun]]

The [[Heckler &amp; Koch]] [[Heckler &amp; Koch MP5|MP5]]&lt;nowiki/&gt;submachine gun is widely used by law enforcement tactical teams and military forces.

* [[Nordenfelt gun]]
* [[Metal Storm Limited|Metal Storm]]
* [[Mitrailleuse]]
* [[Submachine gun]]
** [[Machine pistol]]
* [[Machine gun]]
** [[General-purpose machine gun]]
** [[Light machine gun]]
*** [[Squad Automatic Weapon]]
*** [[Infantry Automatic Rifle]]
** [[Medium machine gun]]
** [[Heavy machine gun]]

=== Autocannon ===

* [[Autocannon]]
* [[Chain gun]]
* [[Revolver cannon]]

=== Artillery ===

* [[Artillery|Artillery gun]]
** [[Cannon]]
** [[Carronade]]
** [[Falconet (cannon)|Falconet]]
** [[Field gun]]
** [[Howitzer]]

=== Tank ===

* [[Tank gun]]

=== Rescue equipment ===

* [[Flare gun]]
* [[Lyle gun]]

=== Training and entertainment ===

* [[Airsoft gun]]
* [[Cap gun]]
* [[Drill Purpose Rifle]]
* [[Nerf Blasters|Nerf gun]]
* [[Paintball marker|Paintball gun]]
* [[Potato cannon]]
* [[Prop gun]]
* [[Spud gun (toy)|Spud gun]]
* [[Water gun]]

=== Ahoɔden tuo ===

* [[Directed-energy weapon]]


== Beaeɛ a menyaa mmoa firiiɛ ==
L</text>
      <sha1>sbsfv84p3nnsomyhl3mzcvgnej0n7mv</sha1>
    </revision>
    <revision>
      <id>133031</id>
      <parentid>133030</parentid>
      <timestamp>2022-08-01T03:16:56Z</timestamp>
      <contributor>
        <username>Nana Sintim</username>
        <id>11223</id>
      </contributor>
      <comment>I crearte hyperlinks</comment>
      <model>wikitext</model>
      <format>text/x-wiki</format>
      <text bytes="3779" xml:space="preserve">Wɔatwerɛ nsɛm yi Asante kasa mu[[File:SIG_Pro_by_Augustas_Didzgalvis.jpg|thumb|Etuo ho mfoni]]Etuo yɛ akodeɛ bi a yayɛ no sɛneɛ ɛbɛyɛ a ɛbɛwɔ etuo adeɛ a ɛma  no to berɛ a aboba hyɛ mu.&lt;ref&gt;https://en.m.wikipedia.org/wiki/Gun#cite_note-1&lt;/ref&gt;Etuo akoraboɔ anaa etuo aboba mpɛn pii no Ɛyɛ adeɛ ɛyɛ den nso yɛbɛtumi ayɛ bi nsuo bi te etuo a yɛde nsuo na egu mu. Etuo aboba a Ɛyɛ den no ebetumi ayɛ soronko sɛ entu mga [[Wien|wiem]]. Yɛfrɛ etuo kɛseɛ Kannon.&lt;ref&gt;https://en.m.wikipedia.org/wiki/Gun#cite_note-FOOTNOTEAndrade201651-2&lt;/ref&gt;

== Abakɔsɛm ==
[[File:Yuan chinese gun.jpg|thumb|[[China]] etuo (1271-1368)]]

=== Proto-gun ===
Yɛnyaa atuduro frii China firi afe 9th century.&lt;ref&gt;https://en.m.wikipedia.org/wiki/Gun#cite_note-21&lt;/ref&gt;

Etuo a edi kan ne etuo aburugya a ɛfiri China wɔ afe 10–12th centuries.&lt;ref&gt;https://en.m.wikipedia.org/wiki/Gun#cite_note-FOOTNOTENeedham1986222-23&lt;/ref&gt;Na ehoo awenaakye maa yɛhunu dɛ ɛwɔ hɔ bɛyɛ afe 10th mfimfini ,edane adi sɛ ampue kɔpem afe 1132. Yɛhunu sɛ wɔde pamporo na ɛyɛɛ atuduro no na wɔde bɔɔ etuo foforɔ mu. Afe1100s awieeɛ no na etuo ho akadeɛ pii aba a ɛbɛboa ma atuduro no atumi ato apete yie.&lt;ref&gt;https://en.m.wikipedia.org/wiki/Gun#cite_note-FOOTNOTEAndrade201652-26&lt;/ref&gt;Na ɛto bɛyɛ 3 meta firi afe 13th century ahyaseɛ. Saa etuo yi abakwasɛm kyerɛ sɛ ɛyɛ  &quot;proto-etuo&quot; ɛfiri sɛ nentoeɛ no mfa ne barima a yɛmea so ma no to.&lt;ref&gt;https://en.m.wikipedia.org/wiki/Gun#cite_note-FOOTNOTEAndrade201646-27&lt;/ref&gt; Afei, etuo foforɔ baa bio a yɛfrɛ no eruptor, Wɔ owura Joseph Needham ɔsee, etuo a nni adeɛ a yɛmea so to nanso no etumi to.

== Etuo Ahodoɔ ==

=== Asogyafoɔ etuo ===

* [[Long gun]]
** [[Arquebus]]
** [[Blunderbuss]]
** [[Musket]]
*** [[Musketoon]]
*** [[Wall gun]]
*** [[Grenade launcher]]
** [[Submachine gun]]
*** [[Personal defense weapon]]
** [[Rifle]]
*** [[Lever-action rifle]]
*** [[Bolt-action rifle]]
*** [[Assault rifle]]
*** [[Battle rifle]]
*** [[Carbine]]
*** [[Designated marksman rifle]]
*** [[Service rifle]]
*** [[Sniper rifle]]
** [[Shotgun]]
*** [[Combat shotgun]]
*** [[Semi-automatic shotgun]]
*** [[Automatic shotgun]]

=== Etuo a yɛde kura yɛn nsam ===

* [[Handgun]]
** [[Derringer]]
** [[Pistol]]
*** [[Machine pistol]]
*** [[Service pistol]]
** [[Revolver]] [[IOF .32 Revolver]] chambered in .32 S&amp;W Long  Smith &amp; Wesson &quot;Military and Police&quot; [[revolver]]
*** [[Service revolver]]

=== Etuo a yɛde yɛ ɛha ===

* [[Air gun]]
** [[BB gun]]
* [[Elephant gun]]
* [[Express rifle]]
* [[Rimfire rifle]]
* [[Speargun]]
* [[Varmint rifle]]

=== Mfidi tuo ===

* [[Gatling gun]]
** [[Minigun]]

The [[Heckler &amp; Koch]] [[Heckler &amp; Koch MP5|MP5]]&lt;nowiki/&gt;submachine gun is widely used by law enforcement tactical teams and military forces.

* [[Nordenfelt gun]]
* [[Metal Storm Limited|Metal Storm]]
* [[Mitrailleuse]]
* [[Submachine gun]]
** [[Machine pistol]]
* [[Machine gun]]
** [[General-purpose machine gun]]
** [[Light machine gun]]
*** [[Squad Automatic Weapon]]
*** [[Infantry Automatic Rifle]]
** [[Medium machine gun]]
** [[Heavy machine gun]]

=== Autocannon ===

* [[Autocannon]]
* [[Chain gun]]
* [[Revolver cannon]]

=== Artillery ===

* [[Artillery|Artillery gun]]
** [[Cannon]]
** [[Carronade]]
** [[Falconet (cannon)|Falconet]]
** [[Field gun]]
** [[Howitzer]]

=== Tank ===

* [[Tank gun]]

=== Rescue equipment ===

* [[Flare gun]]
* [[Lyle gun]]

=== Training and entertainment ===

* [[Airsoft gun]]
* [[Cap gun]]
* [[Drill Purpose Rifle]]
* [[Nerf Blasters|Nerf gun]]
* [[Paintball marker|Paintball gun]]
* [[Potato cannon]]
* [[Prop gun]]
* [[Spud gun (toy)|Spud gun]]
* [[Water gun]]

=== Ahoɔden tuo ===

* [[Directed-energy weapon]]


== Beaeɛ a menyaa mmoa firiiɛ ==
L</text>
      <sha1>ej6mg8ih1zq3s810rheukj37gikcqn2</sha1>
    </revision>
    <revision>
      <id>133032</id>
      <parentid>133031</parentid>
      <timestamp>2022-08-01T03:19:29Z</timestamp>
      <contributor>
        <username>Nana Sintim</username>
        <id>11223</id>
      </contributor>
      <comment>I add hyperlink and refrences</comment>
      <model>wikitext</model>
      <format>text/x-wiki</format>
      <text bytes="3787" xml:space="preserve">Wɔatwerɛ nsɛm yi Asante kasa mu[[File:SIG_Pro_by_Augustas_Didzgalvis.jpg|thumb|Etuo ho mfoni]]Etuo yɛ akodeɛ bi a yayɛ no sɛneɛ ɛbɛyɛ a ɛbɛwɔ etuo adeɛ a ɛma  no to berɛ a aboba hyɛ mu.&lt;ref&gt;https://en.m.wikipedia.org/wiki/Gun#cite_note-1&lt;/ref&gt;Etuo akoraboɔ anaa etuo aboba mpɛn pii no Ɛyɛ adeɛ ɛyɛ den nso yɛbɛtumi ayɛ bi nsuo bi te etuo a yɛde nsuo na egu mu. Etuo aboba a Ɛyɛ den no ebetumi ayɛ soronko sɛ entu mga [[Wien|wiem]]. Yɛfrɛ etuo kɛseɛ Kannon.&lt;ref&gt;https://en.m.wikipedia.org/wiki/Gun#cite_note-FOOTNOTEAndrade201651-2&lt;/ref&gt;

== Abakɔsɛm ==
[[File:Yuan chinese gun.jpg|thumb|[[China]] etuo (1271-1368)]]

=== Proto-gun ===
Yɛnyaa atuduro frii China firi afe 9th century.&lt;ref&gt;https://en.m.wikipedia.org/wiki/Gun#cite_note-21&lt;/ref&gt;

[[Etuo]] a edi kan ne etuo aburugya a ɛfiri [[China]] wɔ afe 10–12th centuries.&lt;ref&gt;https://en.m.wikipedia.org/wiki/Gun#cite_note-FOOTNOTENeedham1986222-23&lt;/ref&gt;Na ehoo awenaakye maa yɛhunu dɛ ɛwɔ hɔ bɛyɛ afe 10th mfimfini ,edane adi sɛ ampue kɔpem afe 1132. Yɛhunu sɛ wɔde pamporo na ɛyɛɛ atuduro no na wɔde bɔɔ etuo foforɔ mu. Afe1100s awieeɛ no na etuo ho akadeɛ pii aba a ɛbɛboa ma atuduro no atumi ato apete yie.&lt;ref&gt;https://en.m.wikipedia.org/wiki/Gun#cite_note-FOOTNOTEAndrade201652-26&lt;/ref&gt;Na ɛto bɛyɛ 3 meta firi afe 13th century ahyaseɛ. Saa etuo yi abakwasɛm kyerɛ sɛ ɛyɛ  &quot;proto-etuo&quot; ɛfiri sɛ nentoeɛ no mfa ne barima a yɛmea so ma no to.&lt;ref&gt;https://en.m.wikipedia.org/wiki/Gun#cite_note-FOOTNOTEAndrade201646-27&lt;/ref&gt; Afei, etuo foforɔ baa bio a yɛfrɛ no eruptor, Wɔ owura Joseph Needham ɔsee, etuo a nni adeɛ a yɛmea so to nanso no etumi to.

== Etuo Ahodoɔ ==

=== Asogyafoɔ etuo ===

* [[Long gun]]
** [[Arquebus]]
** [[Blunderbuss]]
** [[Musket]]
*** [[Musketoon]]
*** [[Wall gun]]
*** [[Grenade launcher]]
** [[Submachine gun]]
*** [[Personal defense weapon]]
** [[Rifle]]
*** [[Lever-action rifle]]
*** [[Bolt-action rifle]]
*** [[Assault rifle]]
*** [[Battle rifle]]
*** [[Carbine]]
*** [[Designated marksman rifle]]
*** [[Service rifle]]
*** [[Sniper rifle]]
** [[Shotgun]]
*** [[Combat shotgun]]
*** [[Semi-automatic shotgun]]
*** [[Automatic shotgun]]

=== Etuo a yɛde kura yɛn nsam ===

* [[Handgun]]
** [[Derringer]]
** [[Pistol]]
*** [[Machine pistol]]
*** [[Service pistol]]
** [[Revolver]] [[IOF .32 Revolver]] chambered in .32 S&amp;W Long  Smith &amp; Wesson &quot;Military and Police&quot; [[revolver]]
*** [[Service revolver]]

=== Etuo a yɛde yɛ ɛha ===

* [[Air gun]]
** [[BB gun]]
* [[Elephant gun]]
* [[Express rifle]]
* [[Rimfire rifle]]
* [[Speargun]]
* [[Varmint rifle]]

=== Mfidi tuo ===

* [[Gatling gun]]
** [[Minigun]]

The [[Heckler &amp; Koch]] [[Heckler &amp; Koch MP5|MP5]]&lt;nowiki/&gt;submachine gun is widely used by law enforcement tactical teams and military forces.

* [[Nordenfelt gun]]
* [[Metal Storm Limited|Metal Storm]]
* [[Mitrailleuse]]
* [[Submachine gun]]
** [[Machine pistol]]
* [[Machine gun]]
** [[General-purpose machine gun]]
** [[Light machine gun]]
*** [[Squad Automatic Weapon]]
*** [[Infantry Automatic Rifle]]
** [[Medium machine gun]]
** [[Heavy machine gun]]

=== Autocannon ===

* [[Autocannon]]
* [[Chain gun]]
* [[Revolver cannon]]

=== Artillery ===

* [[Artillery|Artillery gun]]
** [[Cannon]]
** [[Carronade]]
** [[Falconet (cannon)|Falconet]]
** [[Field gun]]
** [[Howitzer]]

=== Tank ===

* [[Tank gun]]

=== Rescue equipment ===

* [[Flare gun]]
* [[Lyle gun]]

=== Training and entertainment ===

* [[Airsoft gun]]
* [[Cap gun]]
* [[Drill Purpose Rifle]]
* [[Nerf Blasters|Nerf gun]]
* [[Paintball marker|Paintball gun]]
* [[Potato cannon]]
* [[Prop gun]]
* [[Spud gun (toy)|Spud gun]]
* [[Water gun]]

=== Ahoɔden tuo ===

* [[Directed-energy weapon]]


== Beaeɛ a menyaa mmoa firiiɛ ==
L</text>
      <sha1>dqdduadtvrkaeibibyvqsdniocnwvgm</sha1>
    </revision>
  </page>
  <page>
    <title>Nhwɛsoɔ:Global Open Initiative/Twi Terminologies/entries</title>
    <ns>10</ns>
    <id>12259</id>
    <revision>
      <id>132936</id>
      <parentid>132917</parentid>
      <timestamp>2022-07-31T12:19:13Z</timestamp>
      <contributor>
        <username>Afriyie34</username>
        <id>10662</id>
      </contributor>
      <comment>/* Abusuabɔ ho nsɛmfua (Family related terminologies) */</comment>
      <model>wikitext</model>
      <format>text/x-wiki</format>
      <text bytes="37893" xml:space="preserve">=='''Entries'''==
*''Type  '''&lt;nowiki&gt;~~~~&lt;/nowiki&gt;''' next to the article(s) '''you have worked on''' and click '''publish changes'''.''
*A facilitator will review '''Twi Wikipedia, Wikicommons and Wikidata items''' and add {{Wei}} If the entry worked on meets the rules.

=='''Mmarahyɛbadwam ho nsɛm (Parliamentary related terminologies)'''==
# [[:en:Elections]] - [[Abatoɔ]]
# [[:en:Parliament]] - [[Mmarahyɛbadwafie]] [[Dwumadini:Opoku Akaadom Sympathy|Opoku Akaadom Sympathy]] ([[Dwumadini nkitahode:Opoku Akaadom Sympathy|Nkitahode beaɛ]]) 17:11, 4 Kitawonsa 2022 (UTC) [[Dwumadini:Opoku Akaadom Sympathy|Opoku Akaadom Sympathy]] gets '''3marks''' {{not done}}
# [[:en:Member of Parliament]] - [[Mmarahyɛbadwani]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 12:59, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Nana Sintim|Nana Sintim]] gets '''3.6marks''' {{done}}
# [[:en:Law]] - [[Mmara]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 21:37, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Nana Sintim|Nana Sintim]] gets '''3marks''' {{not done}}
# [[:en:Constitution]] - [[Amanmmara]] [[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 19:10, 16 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''3marks''' {{not done}}
# [[:en:Speaker of Parliament]] - [[Mmarahyɛbadwafie Kasamafoɔ]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 06:29, 5 Kitawonsa 2022 (UTC)[[Dwumadini:Nana Sintim|Nana Sintim]] gets '''4marks''' {{done}}
# [[:en:Justice]] - [[Atɛntenee]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:00, 24 Kitawonsa 2022 (UTC)
# [[:en:Corruption]] - [[Porɔɛe]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 23:49, 29 Kitawonsa 2022 (UTC)
# [[:en: Bribery]] - [[Kɛtɛasehyɛ]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 23:49, 29 Kitawonsa 2022 (UTC)
# [[:en: Constituency]] - [[Mpasua]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:40, 4 Kitawonsa 2022 (UTC) [[Dwumadini:AC Krah|AC Krah]] gets '''2.4marks''' {{not done}}
# [[:en: Amendment]] - [[Nsakraeɛ]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 06:58, 8 Kitawonsa 2022 (UTC) [[Dwumadini:Afia360|Afia360]] gets '''3.6marks''' {{done}}
# [[:en: President]] - [[Ɔmanpanin]]
# [[:en: Appoint]] - [[Y'apaw Obi]] [[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 18:09, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] '''2.6marks''' {{not done}}
# [[:en: Bylaws]] - [[Mmaranketewa]]
# [[:en: Minister]] - [[Mansoafoɔ]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 08:49, 30 Kitawonsa 2022 (UTC)
# [[:en:Minority]] - [[Ɛdɔm kumaa]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 07:19, 5 Kitawonsa 2022 (UTC)[[Dwumadini:Afia360|Afia360]]'''3.5marks''' {{done}}
# [[:en:Majority]] - [[Ɛdɔm kɛseɛ]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 23:21, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Nana Sintim|Nana Sintim]] gets '''3.6marks''' {{done}}
# [[:en:Court]] - [[Asɛmdibia]]
# [[:en:Minority Leader]] - [[Ɛdɔm Kumaa Panin]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 07:19, 5 Kitawonsa 2022 (UTC)[[Dwumadini:Afia360|Afia360]] gets '''2.8marks''' [[Dwumadini:Nana Sintim|Nana Sintim]] gets '''0.6marks'''{{not done}}
# [[:en:Majority Leader]] - [[Ɛdɔm kɛseɛ Panin]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 07:19, 5 Kitawonsa 2022 (UTC)[[Dwumadini:Afia360|Afia360]] gets '''2marks''' {{done}}
# [[:en:Democracy]] - [[Kabi-Ma-Menkabi]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 18:35, 27 Kitawonsa 2022 (UTC)
# [[:en:Prime Minister]] - [[Man soafo panyin]]
# [[:en:Municipality ]] - [[Munisipal]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 17:01, 9 Kitawonsa 2022 (UTC)
# [[:en:District]] - [[Mansini]] [[Dwumadini:Afriyie34|Afriyie34]] gets '''3marks''' {{done}}
# [[:en:Deputy Minister]] - [[Soafo Abadiakyiri]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:14, 9 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3marks''' {{done}}
# [[:en:Politician]] - [[Amammuifo]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 08:57, 11 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3.2marks''' {{done}}
# [[:en:Political Party]] - [[Amanyɔ kuo]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 19:13, 13 Kitawonsa 2022 (UTC)[[Dwumadini:Afia360|Afia360]] gets '''2marks''' {{not done}}
# [[:en:New Patriotic Party]] - [[New Patriotic Party (NPP)]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 22:20, 5 Kitawonsa 2022 (UTC)[[Dwumadini:Nana Sintim|Nana Sintim]] gets '''4marks {{done}}
# [[:en:Republic]] - [[Adehyeman]]
# [[:en:National Democratic Congress]] - [[National Democratic Congress (NDC)]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 14:19, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Afia360|Afia360]] gets '''4marks'''{{done}}
# [[:en:Convention People's Party]] - [[Convention People's Party (CPP)]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 11:05, 23 Kitawonsa 2022 (UTC)
# [[:en:People's National Convention]] - [[People's National Convention (PNC)]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 22:47, 3 Kitawonsa 2022 (UTC)[[Dwumadini:Afia360|Afia360]] gets '''2marks''' {{not done}}
# [[:en:All People's Congress]] - [[All People's Congress (APC)]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 10:01, 30 Kitawonsa 2022 (UTC)
# [[:en:Democratic Freedom Party]] - [[Democratic Freedom Party (DFP)]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 23:39, 3 Kitawonsa 2022 (UTC)[[Dwumadini:Afia360|Afia360]] gets '''4marks''' {{done}}
# [[:en:Democratic People's Party]] - [[Democratic People's Party (DPP)]] [[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''4marks''' {{done}}
# [[:en:Every Ghanaian Living Everywhere Party]] - [[Every Ghanaian Living Everywhere Party(EGLEP)]]
# [[:en:Great Consolidated Popular Party]] - [[Great Consolidated Popular Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 23:50, 3 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''3marks''' [[Dwumadini:Opoku Akaadom Sympathy|Opoku Akaadom Sympathy]] gets '''0.6marks''' {{done}}
# [[:en:Ghana Democratic Republican Party]] - [[Ghana Democratic Republican Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 00:27, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''3marks''' {{done}}
# [[:en:Ghana Freedom Party]] - [[Ghana Freedom Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 21:18, 3 Kitawonsa 2022 (UTC) [[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''4marks''' {{done}}
# [[:en:Ghana National Party]] - [[Ghana National Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 00:29, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''3marks''' {{done}}
# [[:en:Ghana Union Movement]] - [[Ghana Union Movement]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 00:57, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''3.8marks''' {{done}}
# [[:en:Liberal Party of Ghana]] - [[Liberal Party of Ghana]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 01:52, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''3.2marks''' {{done}}
# [[:en:National Democratic Party ]] - [[National Democratic Party ]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 03:42, 6 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''3.8marks''' {{done}}
# [[:en:National Reform Party]] - [[National Reform Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 02:23, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''3.2marks''' {{done}}
# [[:en:New Vision Party ]] - [[New Vision Party ]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 02:52, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''2.2marks''' {{done}}
# [[:en:People's Action Party ]] - [[People's Action Party ]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 10:36, 30 Kitawonsa 2022 (UTC)
# [[:en:People's Destiny Party]] - [[People's Destiny Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 01:33, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''2marks''' {{done}}
# [[:en:Power Unity Party]] - [[Power Unity Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 20:06, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''2.2marks''' {{done}}
# [[:en:Progressive People's Party]] - [[Progressive People's Party]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 18:35, 27 Kitawonsa 2022 (UTC)
# [[:en:Reformed Patriotic Democrats]] - [[Reformed Patriotic Democrats]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 04:02, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''2.4marks''' {{done}}
# [[:en:United Democratic Party]] - [[United Democratic Party]]
# [[:en:United Development System Party]] - [[United Development System Party]] [[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 22:50, 3 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''2marks''' {{done}}
# [[:en:United Front Party]] - [[United Front Party]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 14:55, 30 Kitawonsa 2022 (UTC)
# [[:en:United Ghana Movement]] - [[United Ghana Movement]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:23, 7 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3.2marks''' {{done}}
# [[:en:United Progressive Party]] - [[United Progressive Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 08:02, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''3.4marks''' {{done}}
# [[:en:United Renaissance Party]] - [[United Renaissance Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 03:17, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''2marks''' {{done}}
# [[:en:Yes People's Party]] - [[Yes People's Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 19:57, 3 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''2marks''' {{done}}
# [[:en:Ghana Redevelopment Party]] - [[Ghana Redevelopment Party]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:40, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''2marks''' {{done}}
# [[:en:Independent People's Party]] - [[Independent People's Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 23:37, 3 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''2.6marks''' {{done}}
# [[:en:National Convention Party]] - [[National Convention Party]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 06:31, 5 Kitawonsa 2022 (UTC)
# [[:en:National Independence Party ]] - [[National Independence Party ]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 00:59, 9 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''4marks''' {{done}}
# [[:en:People's Convention Party ]] - [[People's Convention Party ]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 06:35, 5 Kitawonsa 2022 (UTC)[[Dwumadini:Nana Sintim|Nana Sintim]] gets '''1.4marks''' {{done}}
# [[:en:People's Heritage Party ]] - [[People's Heritage Party ]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:40, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''2.2marks''' {{done}}
# [[:en:United Love Party ]] - [[United Love Party ]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:45, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3.2marks''' {{done}}
# [[:en:Action Congress Party]] - [[Action Congress Party]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:40, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''2.3marks {{done}}
# [[:en:All People's Party]] - [[All People's Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 14:04, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''3.2marks''' {{done}}
# [[:en:People's National Party]] - [[People's National Party]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 22:36, 30 Kitawonsa 2022 (UTC)
# [[:en:Popular Front Party]] - [[Popular Front Party]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:40, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''2.6marks''' {{done}}
# [[:en:Social Democratic Front ]] - [[Social Democratic Front ]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 00:41, 9 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''1mark''' {{done}}
# [[:en:Third Force Party]] - [[Third Force Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 19:59, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''1mark''' {{done}}
# [[:en:United National Convention ]] - [[United National Convention ]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 23:18, 5 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''1.8marks''' {{done}}
# [[:en:All People's Republican Party ]] - [[All People's Republican Party ]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 00:47, 9 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''1mark''' {{done}}
# [[:en:Justice Party ]] - [[Justice Party ]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 15:04, 30 Kitawonsa 2022 (UTC)
# [[:en:National Alliance of Liberals]] - [[National Alliance of Liberals]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:40, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''2.8marks''' {{done}}
# [[:en:People's Action Party]] [[People's Action Party]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 10:31, 30 Kitawonsa 2022 (UTC)
# [[:en:Progress Party]] - [[Progress Party]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 14:55, 30 Kitawonsa 2022 (UTC)
# [[:en:United Nationalist Party ]] - [[United Nationalist Party ]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 14:55, 30 Kitawonsa 2022 (UTC)
# [[:en:United Party ]] - [[United Party ]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 22:08, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Afia360|Afia360]] gets '''3marks''' {{done}}
# [[:en:United Gold Coast Convention]] - [[United Gold Coast Convention]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:40, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Anlo Youth Organization]] - [[Anlo Youth Organization]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:40, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Federation of Youth Organization]] - [[Federation of Youth Organization]][[Dwumadini:AC Krah|AC Krah]] gets '''2.8marks''' {{done}}
# [[:en:Ghana Congress Party]] - [[Ghana Congress Party]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:14, 9 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''2.8marks''' {{done}}
# [[:en:Muslim Association Party]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 23:14, 5 Kitawonsa 2022 (UTC) - [[Muslim Association Party]][[Dwumadini:Nana Sintim|Nana Sintim]] gets '''2.2marks''' {{done}}
# [[:en:National Liberation Movement ]] - [[National Liberation Movement ]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 23:44, 27 Kitawonsa 2022 (UTC)
# [[:en:Northern People's Party ]] - [[Northern People's Party ]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 22:36, 30 Kitawonsa 2022 (UTC)
# [[:en:Togoland Congress]] - [[Togoland Congress]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 04:31, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''1.6marks''' {{done}}
# [[:en:Greater Accra Region]] - [[Greater Accra Region]]
# [[:en:Eastern Region]] - [[Eastern Region]]
# [[:en:Ahafo Region]] - [[Ahafo Mantam]][[Dwumadini:Rsaawah|Rsaawah]] ([[Dwumadini nkitahode:Rsaawah|Nkitahode beaɛ]]) 12:38, 5 Kitawonsa 2022 (UTC)[[Dwumadini:Rsaawah|Rsaawah]] gets '''4marks''' {{done}}
# [[:en:Ashanti Region]] - [[Ashanti Region]]
# [[:en:Bono East Region]] - [[Bono East Region]][[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Brong Ahafo Region]] - [[Brong Ahafo Mantam]][[Dwumadini:S A Habadah|S A Habadah]] ([[Dwumadini nkitahode:S A Habadah|Nkitahode beaɛ]])[[Dwumadini:S A Habadah|S A Habadah]] gets '''4marks''' {{done}}
# [[:en:Central Region]] - [[Central Region]][[Dwumadini:Rsaawah|Rsaawah]] gets '''4marks''' {{done}}
# [[:en:North-East Region]] - [[North-East Region]]
# [[:en:Northern Region]] - [[Northern Region]]
# [[:en:Oti Region]] - [[Oti Region]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:23, 7 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Savannah Region]] - [[Savannah Region]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:23, 7 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Upper East Region]] - [[Upper East Region]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:23, 7 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Upper West Region]] - [[Upper West Region]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:23, 7 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Western Region]] - [[Western Region]]
# [[:en:Western North Region]] - [[Western North Region]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:23, 7 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Volta Region]] - [[Volta Region]]
# [[:en:Kumasi]] - [[Kumasi]] 
# [[:en:Sunyani]] - [[Sunyani]]
# [[:en:Techiman]] - [[Techiman]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 08:17, 7 Kitawonsa 2022 (UTC)[[Dwumadini:Afia360|Afia360]] gets '''3marks {{not done}}
# [[:en:Goaso]] - [[Goaso]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:05, 5 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Cape Coast]] - [[Cape Coast]][[Dwumadini:Rsaawah|Rsaawah]] ([[Dwumadini nkitahode:Rsaawah|Nkitahode beaɛ]]) 10:32, 7 Kitawonsa 2022 (UTC)[[Dwumadini:Rsaawah|Rsaawah]] gets '''4marks''' {{done}}
# [[:en:Kofiridua]] - [[Kofiridua]]
# [[:en:Accra]] - [[Accra]] 
# [[:en:Tamale]] - [[Tamale]]
# [[:en:Damongo]] - [[Damongo]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:23, 7 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3.6marks''' {{done}}}
# [[:en:Nalerigu]] - [[Nalerigu]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:05, 5 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Bolgatanga]] - [[Bolgatanga]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 22:37, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Wa]] - [[Wa]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 13:36, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Nana Sintim|Nana Sintim]] gets '''3marks''' {{done}}
# [[:en:Ho]] - [[Ho]]
# [[:en:Dambai]] - [[Dambai]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:01, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Takoradi]] - [[Takoradi]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:01, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Wiawso]] - [[Wiawso]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:01, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}

=='''Adwuma ho nsɛmfua (Work related terminologies)'''==
# [[:en:Teacher]] - [[Ɔkyerɛkyerɛni]] [[Dwumadini: Christian|Christian]]
# [[:en:Farmer]] - [[Ɔkuani]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:17, 9 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3marks''' {{done}}
# [[:en:Blacksmith]] - [[Ɔtomfoɔ]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:36, 24 Kitawonsa 2022 (UTC)
# [[:en: Boxer]] - [[Akuturukubɔfoɔ]]
# [[:en:Butcher]] - [[Nankwaaseni]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 18:26, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''3.2marks''' {{done}}
# [[:en:Banker]] - [[Sikakorabea adwumayɛni]]
# [[:en:Wood worker]] - [[Dua dwomfoɔ]][[Dwumadini:AC Krah|AC Krah]] gets '''3marks''' {{done}}
# [[:en:Doctor]] - [[Ɔyaresafoɔ /Dokota]]
# [[:en:Driver]] - [[Ɔhyenkani /Ɔhyenkafoɔ]]
# [[:en:Judge]] - [[Ɔtenmuafoɔ ]]
# [[:en:Jury]] - [[Apamfoɔ]]
# [[:en:Lawyer]] - [[Mmaranimni]]
# [[:en:Mason]] - [[Ɔdansifoɔ]]
# [[:en:Nurse]] - [[Ayaresadwumamu boafoɔ / Nɛɛse]]
# [[:en:Pharmacist]] - [[Oduyɛfoɔ]]
# [[:en:President]] - [[Ɔmanpanin]]
# [[:en:Fashion designer]] - [[Adepamni]]
# [[:en:Seamstress]] - [[Ɔbaa adepamni]][[Dwumadini:Rsaawah|Rsaawah]] gets '''2marks''' {{done}}
# [[:en:Secretary]] - [[Ɔtwerɛtwerɛfoɔ / Ɔtwerɛtwerɛni]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 00:48, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''3marks''' {{done}}
# [[:en:Security]] - [[Ɔwɛnfoɔ]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 00:18, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''3marks''' {{done}}
# [[:en:Trader]] - [[Ɔdwadini]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 00:55, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''2marks''' {{done}}
# [[:en:Secondary School]] - [[Ntoasoɔ Sukuu]] [[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 18:11, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''3marks''' {{done}}
# [[:en:University]] - [[Suapɔn]] [[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 16:22, 17 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''3marks''' {{done}}

=='''Abusuabɔ ho nsɛmfua (Family related terminologies)'''==
# [[:en:Family]] - [[Abusua]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 11:16, 24 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]]gets '''4marks''' {{done}}[[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 00:19, 11 Kitawonsa 2022 (UTC)
# [[:en:Family member]] - [[Abusuani]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 11:18, 24 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]]gets '''4marks''' {{done}}
# [[:en:Family head]] - [[Abusuapanin]]
# [[:en:Parents]] - [[Awofoɔ]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:49, 25 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]]gets '''3marks''' {{done}}
# [[:en:Man]] - [[ɔbarima]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]])[[Dwumadini:Afriyie34|Afriyie34]]gets '''3marks''' {{done}}
# [[:en:Woman]] - [[ɔbaa]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 08:02, 26 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]]gets '''4marks''' {{done}}
# [[:en:Father]] - [[Agya]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 10:52, 26 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]]gets '''4marks''' {{done}}
# [[:en:Mother]] - [[Maame]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 18:29, 26 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3marks''' {{done}}
# [[:en:Baby]] - [[Akwadaa]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 05:27, 28 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]]gets '''4marks''' {{done}}
# [[:en:Siblings]] - [[Anuanom]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 17:38, 28 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]]gets '''4marks''' {{done}}
# [[:en:Sister]] - [[Nua baa]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 18:47, 29 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3marks''' {{done}}
# [[:en:Brother]] - [[Nua bɛrima]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 17:06, 29 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''4marks''' {{done}}
# [[:en:Grandmother]] - [[Nana baa]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 03:45, 30 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''4marks''' {{done}}
# [[:en:Grandfather]] - [[Nana bɛrima]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 14:32, 30 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''4marks''' {{done}}
# [[:en:Sister-inlaw]] - [[Akumaa]]
# [[:en:Rivals]] - [[Akorafoɔ]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 22:19, 29 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3marks''' {{done}}
# [[:en:Boy]] - [[Abɛrimaa]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:01, 28 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3marks''' {{done}}
# [[:en:Girl]] - [[Abaayewa]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:01, 28 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3marks''' {{done}}
# [[:en:Widow]] - [[Okunafoɔ]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:05, 28 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3marks''' {{done}}
# [[:en:Son]] - [[ɔbabɛrima]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:05, 28 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''2.4marks''' {{done}}
# [[:en:Daugther]] - [[ɔbabaa]]
# [[:en:Adopted child]] - [[Abanoma]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 12:19, 31 Kitawonsa 2022 (UTC)
# [[:en:Orphan]] - [[Agyanka]]
# [[:en:Twins]] - [[Ntaafoɔ]]
# [[:en:Triplet]] - [[Ahenasa]]
# [[:en:Friendship]] - [[Adamfofa]]
# [[:en:Dating]] - [[Mpenatweɛ]]
# [[:en:Royal]] - [[Dehyeɛ]]
# [[:en:Old man]] - [[Akɔkora]]
# [[:en:Old woman]] - [[Aberewa]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 01:19, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''2marks''' {{done}}
# [[:en:Firstborn child]] - [[Piesie]]
# [[:en:Lastborn child]] - [[Kaakyire]]
# [[:en:Young woman]] - [[Ababaawa]]
# [[:en:Young man]] - [[Abranteɛ]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 01:08, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''2marks''' {{done}}

=='''Apɔmuden ho nsɛmfua (Health related terminologies)'''==
# [[:en:Health]] - [[Apowmuden]]
# [[:en:Sickness]] - [[Yareɛ]]
# [[:en:Diseases]] - [[Nyarewa]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 18:53, 29 Kitawonsa 2022 (UTC)
# [[:en:Hospital]] - [[Ayaresabea]][[Dwumadini:Antwiaa1996|Antwiaa1996]] ([[Dwumadini nkitahode:Antwiaa1996|Nkitahode beaɛ]]) 10:11, 13 Kitawonsa 2022 (UTC)
# [[:en:Syringe]] - [[Paneɛ]]
# [[:en:Medicine]] - [[Aduro]]
# [[:en:Herbalist]] - [[Odunsini]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:37, 24 Kitawonsa 2022 (UTC)
# [[:en:Itch]] - [[Ahokeka]]
# [[:en:Whooping cough]] - [[Nsamanwa]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 18:31, 26 Kitawonsa 2022 (UTC)
# [[:en:Headache]] - [[Tipayɛ]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 18:53, 29 Kitawonsa 2022 (UTC)
# [[:en:Stomach ache]] - [[Yafunu yareɛ]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 18:31, 26 Kitawonsa 2022 (UTC)
# [[:en:Constipation]] - [[Ayamtim]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 08:58, 11 Kitawonsa 2022 (UTC)
# [[:en:Diabetes]] - [[Asikyireyareɛ]]
# [[:en:Cholera]] - [[Ayamtunini/Kɔlera]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 18:53, 29 Kitawonsa 2022 (UTC)
# [[:en:Goiter]] - [[Kɔmpɔ]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:23, 22 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:22, 22 Kitawonsa 2022 (UTC)
# [[:en:Gonorrhea]] - [[Babaso]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:02, 28 Kitawonsa 2022 (UTC)
# [[:en:Cancer]] - [[Kokoram]]
# [[:en:Rheumatism]] - [[Sasabrɔ]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 18:31, 26 Kitawonsa 2022 (UTC)
# [[:en:Convulsion]] - [[Asensene]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 18:31, 26 Kitawonsa 2022 (UTC)
# [[:en:Asthma]] - [[Ntehyeewa]]
# [[:en:Cripple]] - [[Bafan]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:37, 24 Kitawonsa 2022 (UTC)
# [[:en:Muteness]] - [[Emum]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 16:55, 17 Kitawonsa 2022 (UTC)
# [[:en:Blindness]] - [[Anifra]]
# [[:en:Kwashiokor]] - [[Kwashiokor]]
# [[:en:Malaria]] - [[Atiridii yare]]
# [[:en:Paralysis]] - [[Mmubuo]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:09, 22 Kitawonsa 2022 (UTC)
# [[:en:Vomitting]] - [[Ɛfeɛ]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:09, 22 Kitawonsa 2022 (UTC)
# [[:en:Hypertension]] - [[Mogyamorosoɔ]]
# [[:en:Ulcer]] - [[Ayamkuro]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:09, 22 Kitawonsa 2022 (UTC)
# [[:en:Stroke]] - [[Nnwodwoeɛ]]
# [[:en:Measles]] - [[Ntoboro]]
# [[:en:Eczema]] - [[Ɛkrɔ]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:34, 14 Kitawonsa 2022 (UTC)
# [[:en:Rashes]] - [[Nsawansawa]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 08:58, 11 Kitawonsa 2022 (UTC)
# [[:en:Ringworm]] - [[Kakawirewire]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 16:45, 17 Kitawonsa 2022 (UTC)

=='''Atenaeɛ ho nsɛmfua (Environmental related terminologies)'''==
Environmental related
# [[:en:Buildings]] - [[Adan]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:10, 12 Kitawonsa 2022 (UTC)
# [[:en:Trees]] - [[Nnua]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 18:56, 28 Kitawonsa 2022 (UTC)
# [[:en:Flowers]] - [[Nhweren]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 18:56, 28 Kitawonsa 2022 (UTC)
# [[:en:Animals]] - [[Mmoa]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 18:56, 28 Kitawonsa 2022 (UTC)
# [[:en:Humans]] - [[Nnipa]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:32, 12 Kitawonsa 2022 (UTC)
# [[:en:Clouds]] - [[Ewiem]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 18:56, 28 Kitawonsa 2022 (UTC)
# [[:en:Air]] - [[Nframa]]
# [[:en:Machines]] - [[Afidie]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 05:03, 29 Kitawonsa 2022 (UTC)
# [[:en:River]] - [[Nsutene]][[Dwumadini:Mbaidoo|Mbaidoo]] ([[Dwumadini nkitahode:Mbaidoo|Nkitahode beaɛ]]) 14:43, 14 Kitawonsa 2022 (UTC)
# [[:en:Sea]] - [[Ɛpo]][[Dwumadini:Mbaidoo|Mbaidoo]] ([[Dwumadini nkitahode:Mbaidoo|Nkitahode beaɛ]]) 14:43, 14 Kitawonsa 2022 (UTC)
# [[:en:Car]] - [[Ɛhyɛn]][[Dwumadini:Mbaidoo|Mbaidoo]] ([[Dwumadini nkitahode:Mbaidoo|Nkitahode beaɛ]]) 14:43, 14 Kitawonsa 2022 (UTC)
# [[:en:Train]] - [[Keteke]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 23:01, 20 Kitawonsa 2022 (UTC)
# [[:en:Canoe]] - [[Kudoɔ]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 13:48, 24 Kitawonsa 2022 (UTC)
# [[:en:Ship ]] - [[Suhyɛn]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 13:48, 24 Kitawonsa 2022 (UTC)
# [[:en:Aircraft/aeroplane]] - [[Wiemhyɛn]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 16:50, 19 Kitawonsa 2022 (UTC)
# [[:en:Airport]] - [[Wiemhyɛn gyinabea]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 16:27, 17 Kitawonsa 2022 (UTC)
# [[:en:Port/harbor]] - [[Suhyɛn gyinabea]]
# [[:en:Train station]] - [[Keteke gyinabea]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:34, 14 Kitawonsa 2022 (UTC)
# [[:en:Forest]] - [[Kwaeɛ]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 23:01, 20 Kitawonsa 2022 (UTC)
# [[:en:Court]] - [[Asɛm dibea]]
# [[:en:Church building]] - [[Asɔre dan]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:34, 14 Kitawonsa 2022 (UTC)
# [[:en:Church]] - [[Asɔre]] 
# [[:en:Mosque]] - [[Nkramosom dan]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:38, 24 Kitawonsa 2022 (UTC)
# [[:en:Muslim]] - [[Nkramoni]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:38, 24 Kitawonsa 2022 (UTC)
# [[:en:Islam]] - [[Nkramosom]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:38, 24 Kitawonsa 2022 (UTC)
# [[:en:Christian]] - [[Kristoni]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 13:48, 24 Kitawonsa 2022 (UTC)
# [[:en:Christianity]] - [[Kristosom]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 13:48, 24 Kitawonsa 2022 (UTC)
# [[:en:Rainbow]] - [[Nyankontɔn]]
# [[:en:Gun]] - [[Etuo]]
# [[:en:Water]] - [[Nsuo]]
# [[:en:Railway]] - [[Keteke kwan]]
# [[:en:Road]] - [[Lɔre kwan]]
# [[:en:Stadium]] - [[Agoprama]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 16:50, 19 Kitawonsa 2022 (UTC)
# [[:en:Market]] - [[Aguaso]]
# [[:en:Land]] - [[Asaase]]
# [[:en:Mountain]] - [[Bepɔ]] 
# [[:en:Sun]] - [[Awia]]
# [[:en:Moon]] - [[Bosome]]
# [[:en:Star]] - [[Nsoroma]][[Dwumadini:Ebensarfo|Ebensarfo]] ([[Dwumadini nkitahode:Ebensarfo|Nkitahode beaɛ]]) 16:50, 19 Kitawonsa 2022 (UTC)
# [[:en:Birds]] - [[Nnomaa]][[Dwumadini:Ebensarfo|Ebensarfo]] ([[Dwumadini nkitahode:Ebensarfo|Nkitahode beaɛ]]) 15:39, 19 Kitawonsa 2022 (UTC)</text>
      <sha1>5kv0kdqgsemj5xdgdvs33xmlubq5v9y</sha1>
    </revision>
    <revision>
      <id>132948</id>
      <parentid>132936</parentid>
      <timestamp>2022-07-31T13:04:02Z</timestamp>
      <contributor>
        <username>Afriyie34</username>
        <id>10662</id>
      </contributor>
      <comment>/* Abusuabɔ ho nsɛmfua (Family related terminologies) */</comment>
      <model>wikitext</model>
      <format>text/x-wiki</format>
      <text bytes="38009" xml:space="preserve">=='''Entries'''==
*''Type  '''&lt;nowiki&gt;~~~~&lt;/nowiki&gt;''' next to the article(s) '''you have worked on''' and click '''publish changes'''.''
*A facilitator will review '''Twi Wikipedia, Wikicommons and Wikidata items''' and add {{Wei}} If the entry worked on meets the rules.

=='''Mmarahyɛbadwam ho nsɛm (Parliamentary related terminologies)'''==
# [[:en:Elections]] - [[Abatoɔ]]
# [[:en:Parliament]] - [[Mmarahyɛbadwafie]] [[Dwumadini:Opoku Akaadom Sympathy|Opoku Akaadom Sympathy]] ([[Dwumadini nkitahode:Opoku Akaadom Sympathy|Nkitahode beaɛ]]) 17:11, 4 Kitawonsa 2022 (UTC) [[Dwumadini:Opoku Akaadom Sympathy|Opoku Akaadom Sympathy]] gets '''3marks''' {{not done}}
# [[:en:Member of Parliament]] - [[Mmarahyɛbadwani]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 12:59, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Nana Sintim|Nana Sintim]] gets '''3.6marks''' {{done}}
# [[:en:Law]] - [[Mmara]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 21:37, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Nana Sintim|Nana Sintim]] gets '''3marks''' {{not done}}
# [[:en:Constitution]] - [[Amanmmara]] [[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 19:10, 16 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''3marks''' {{not done}}
# [[:en:Speaker of Parliament]] - [[Mmarahyɛbadwafie Kasamafoɔ]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 06:29, 5 Kitawonsa 2022 (UTC)[[Dwumadini:Nana Sintim|Nana Sintim]] gets '''4marks''' {{done}}
# [[:en:Justice]] - [[Atɛntenee]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:00, 24 Kitawonsa 2022 (UTC)
# [[:en:Corruption]] - [[Porɔɛe]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 23:49, 29 Kitawonsa 2022 (UTC)
# [[:en: Bribery]] - [[Kɛtɛasehyɛ]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 23:49, 29 Kitawonsa 2022 (UTC)
# [[:en: Constituency]] - [[Mpasua]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:40, 4 Kitawonsa 2022 (UTC) [[Dwumadini:AC Krah|AC Krah]] gets '''2.4marks''' {{not done}}
# [[:en: Amendment]] - [[Nsakraeɛ]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 06:58, 8 Kitawonsa 2022 (UTC) [[Dwumadini:Afia360|Afia360]] gets '''3.6marks''' {{done}}
# [[:en: President]] - [[Ɔmanpanin]]
# [[:en: Appoint]] - [[Y'apaw Obi]] [[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 18:09, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] '''2.6marks''' {{not done}}
# [[:en: Bylaws]] - [[Mmaranketewa]]
# [[:en: Minister]] - [[Mansoafoɔ]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 08:49, 30 Kitawonsa 2022 (UTC)
# [[:en:Minority]] - [[Ɛdɔm kumaa]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 07:19, 5 Kitawonsa 2022 (UTC)[[Dwumadini:Afia360|Afia360]]'''3.5marks''' {{done}}
# [[:en:Majority]] - [[Ɛdɔm kɛseɛ]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 23:21, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Nana Sintim|Nana Sintim]] gets '''3.6marks''' {{done}}
# [[:en:Court]] - [[Asɛmdibia]]
# [[:en:Minority Leader]] - [[Ɛdɔm Kumaa Panin]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 07:19, 5 Kitawonsa 2022 (UTC)[[Dwumadini:Afia360|Afia360]] gets '''2.8marks''' [[Dwumadini:Nana Sintim|Nana Sintim]] gets '''0.6marks'''{{not done}}
# [[:en:Majority Leader]] - [[Ɛdɔm kɛseɛ Panin]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 07:19, 5 Kitawonsa 2022 (UTC)[[Dwumadini:Afia360|Afia360]] gets '''2marks''' {{done}}
# [[:en:Democracy]] - [[Kabi-Ma-Menkabi]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 18:35, 27 Kitawonsa 2022 (UTC)
# [[:en:Prime Minister]] - [[Man soafo panyin]]
# [[:en:Municipality ]] - [[Munisipal]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 17:01, 9 Kitawonsa 2022 (UTC)
# [[:en:District]] - [[Mansini]] [[Dwumadini:Afriyie34|Afriyie34]] gets '''3marks''' {{done}}
# [[:en:Deputy Minister]] - [[Soafo Abadiakyiri]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:14, 9 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3marks''' {{done}}
# [[:en:Politician]] - [[Amammuifo]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 08:57, 11 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3.2marks''' {{done}}
# [[:en:Political Party]] - [[Amanyɔ kuo]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 19:13, 13 Kitawonsa 2022 (UTC)[[Dwumadini:Afia360|Afia360]] gets '''2marks''' {{not done}}
# [[:en:New Patriotic Party]] - [[New Patriotic Party (NPP)]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 22:20, 5 Kitawonsa 2022 (UTC)[[Dwumadini:Nana Sintim|Nana Sintim]] gets '''4marks {{done}}
# [[:en:Republic]] - [[Adehyeman]]
# [[:en:National Democratic Congress]] - [[National Democratic Congress (NDC)]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 14:19, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Afia360|Afia360]] gets '''4marks'''{{done}}
# [[:en:Convention People's Party]] - [[Convention People's Party (CPP)]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 11:05, 23 Kitawonsa 2022 (UTC)
# [[:en:People's National Convention]] - [[People's National Convention (PNC)]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 22:47, 3 Kitawonsa 2022 (UTC)[[Dwumadini:Afia360|Afia360]] gets '''2marks''' {{not done}}
# [[:en:All People's Congress]] - [[All People's Congress (APC)]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 10:01, 30 Kitawonsa 2022 (UTC)
# [[:en:Democratic Freedom Party]] - [[Democratic Freedom Party (DFP)]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 23:39, 3 Kitawonsa 2022 (UTC)[[Dwumadini:Afia360|Afia360]] gets '''4marks''' {{done}}
# [[:en:Democratic People's Party]] - [[Democratic People's Party (DPP)]] [[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''4marks''' {{done}}
# [[:en:Every Ghanaian Living Everywhere Party]] - [[Every Ghanaian Living Everywhere Party(EGLEP)]]
# [[:en:Great Consolidated Popular Party]] - [[Great Consolidated Popular Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 23:50, 3 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''3marks''' [[Dwumadini:Opoku Akaadom Sympathy|Opoku Akaadom Sympathy]] gets '''0.6marks''' {{done}}
# [[:en:Ghana Democratic Republican Party]] - [[Ghana Democratic Republican Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 00:27, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''3marks''' {{done}}
# [[:en:Ghana Freedom Party]] - [[Ghana Freedom Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 21:18, 3 Kitawonsa 2022 (UTC) [[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''4marks''' {{done}}
# [[:en:Ghana National Party]] - [[Ghana National Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 00:29, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''3marks''' {{done}}
# [[:en:Ghana Union Movement]] - [[Ghana Union Movement]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 00:57, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''3.8marks''' {{done}}
# [[:en:Liberal Party of Ghana]] - [[Liberal Party of Ghana]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 01:52, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''3.2marks''' {{done}}
# [[:en:National Democratic Party ]] - [[National Democratic Party ]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 03:42, 6 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''3.8marks''' {{done}}
# [[:en:National Reform Party]] - [[National Reform Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 02:23, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''3.2marks''' {{done}}
# [[:en:New Vision Party ]] - [[New Vision Party ]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 02:52, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''2.2marks''' {{done}}
# [[:en:People's Action Party ]] - [[People's Action Party ]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 10:36, 30 Kitawonsa 2022 (UTC)
# [[:en:People's Destiny Party]] - [[People's Destiny Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 01:33, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''2marks''' {{done}}
# [[:en:Power Unity Party]] - [[Power Unity Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 20:06, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''2.2marks''' {{done}}
# [[:en:Progressive People's Party]] - [[Progressive People's Party]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 18:35, 27 Kitawonsa 2022 (UTC)
# [[:en:Reformed Patriotic Democrats]] - [[Reformed Patriotic Democrats]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 04:02, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''2.4marks''' {{done}}
# [[:en:United Democratic Party]] - [[United Democratic Party]]
# [[:en:United Development System Party]] - [[United Development System Party]] [[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 22:50, 3 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''2marks''' {{done}}
# [[:en:United Front Party]] - [[United Front Party]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 14:55, 30 Kitawonsa 2022 (UTC)
# [[:en:United Ghana Movement]] - [[United Ghana Movement]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:23, 7 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3.2marks''' {{done}}
# [[:en:United Progressive Party]] - [[United Progressive Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 08:02, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''3.4marks''' {{done}}
# [[:en:United Renaissance Party]] - [[United Renaissance Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 03:17, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''2marks''' {{done}}
# [[:en:Yes People's Party]] - [[Yes People's Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 19:57, 3 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''2marks''' {{done}}
# [[:en:Ghana Redevelopment Party]] - [[Ghana Redevelopment Party]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:40, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''2marks''' {{done}}
# [[:en:Independent People's Party]] - [[Independent People's Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 23:37, 3 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''2.6marks''' {{done}}
# [[:en:National Convention Party]] - [[National Convention Party]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 06:31, 5 Kitawonsa 2022 (UTC)
# [[:en:National Independence Party ]] - [[National Independence Party ]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 00:59, 9 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''4marks''' {{done}}
# [[:en:People's Convention Party ]] - [[People's Convention Party ]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 06:35, 5 Kitawonsa 2022 (UTC)[[Dwumadini:Nana Sintim|Nana Sintim]] gets '''1.4marks''' {{done}}
# [[:en:People's Heritage Party ]] - [[People's Heritage Party ]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:40, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''2.2marks''' {{done}}
# [[:en:United Love Party ]] - [[United Love Party ]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:45, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3.2marks''' {{done}}
# [[:en:Action Congress Party]] - [[Action Congress Party]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:40, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''2.3marks {{done}}
# [[:en:All People's Party]] - [[All People's Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 14:04, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''3.2marks''' {{done}}
# [[:en:People's National Party]] - [[People's National Party]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 22:36, 30 Kitawonsa 2022 (UTC)
# [[:en:Popular Front Party]] - [[Popular Front Party]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:40, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''2.6marks''' {{done}}
# [[:en:Social Democratic Front ]] - [[Social Democratic Front ]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 00:41, 9 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''1mark''' {{done}}
# [[:en:Third Force Party]] - [[Third Force Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 19:59, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''1mark''' {{done}}
# [[:en:United National Convention ]] - [[United National Convention ]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 23:18, 5 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''1.8marks''' {{done}}
# [[:en:All People's Republican Party ]] - [[All People's Republican Party ]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 00:47, 9 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''1mark''' {{done}}
# [[:en:Justice Party ]] - [[Justice Party ]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 15:04, 30 Kitawonsa 2022 (UTC)
# [[:en:National Alliance of Liberals]] - [[National Alliance of Liberals]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:40, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''2.8marks''' {{done}}
# [[:en:People's Action Party]] [[People's Action Party]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 10:31, 30 Kitawonsa 2022 (UTC)
# [[:en:Progress Party]] - [[Progress Party]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 14:55, 30 Kitawonsa 2022 (UTC)
# [[:en:United Nationalist Party ]] - [[United Nationalist Party ]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 14:55, 30 Kitawonsa 2022 (UTC)
# [[:en:United Party ]] - [[United Party ]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 22:08, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Afia360|Afia360]] gets '''3marks''' {{done}}
# [[:en:United Gold Coast Convention]] - [[United Gold Coast Convention]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:40, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Anlo Youth Organization]] - [[Anlo Youth Organization]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:40, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Federation of Youth Organization]] - [[Federation of Youth Organization]][[Dwumadini:AC Krah|AC Krah]] gets '''2.8marks''' {{done}}
# [[:en:Ghana Congress Party]] - [[Ghana Congress Party]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:14, 9 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''2.8marks''' {{done}}
# [[:en:Muslim Association Party]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 23:14, 5 Kitawonsa 2022 (UTC) - [[Muslim Association Party]][[Dwumadini:Nana Sintim|Nana Sintim]] gets '''2.2marks''' {{done}}
# [[:en:National Liberation Movement ]] - [[National Liberation Movement ]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 23:44, 27 Kitawonsa 2022 (UTC)
# [[:en:Northern People's Party ]] - [[Northern People's Party ]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 22:36, 30 Kitawonsa 2022 (UTC)
# [[:en:Togoland Congress]] - [[Togoland Congress]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 04:31, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''1.6marks''' {{done}}
# [[:en:Greater Accra Region]] - [[Greater Accra Region]]
# [[:en:Eastern Region]] - [[Eastern Region]]
# [[:en:Ahafo Region]] - [[Ahafo Mantam]][[Dwumadini:Rsaawah|Rsaawah]] ([[Dwumadini nkitahode:Rsaawah|Nkitahode beaɛ]]) 12:38, 5 Kitawonsa 2022 (UTC)[[Dwumadini:Rsaawah|Rsaawah]] gets '''4marks''' {{done}}
# [[:en:Ashanti Region]] - [[Ashanti Region]]
# [[:en:Bono East Region]] - [[Bono East Region]][[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Brong Ahafo Region]] - [[Brong Ahafo Mantam]][[Dwumadini:S A Habadah|S A Habadah]] ([[Dwumadini nkitahode:S A Habadah|Nkitahode beaɛ]])[[Dwumadini:S A Habadah|S A Habadah]] gets '''4marks''' {{done}}
# [[:en:Central Region]] - [[Central Region]][[Dwumadini:Rsaawah|Rsaawah]] gets '''4marks''' {{done}}
# [[:en:North-East Region]] - [[North-East Region]]
# [[:en:Northern Region]] - [[Northern Region]]
# [[:en:Oti Region]] - [[Oti Region]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:23, 7 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Savannah Region]] - [[Savannah Region]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:23, 7 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Upper East Region]] - [[Upper East Region]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:23, 7 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Upper West Region]] - [[Upper West Region]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:23, 7 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Western Region]] - [[Western Region]]
# [[:en:Western North Region]] - [[Western North Region]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:23, 7 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Volta Region]] - [[Volta Region]]
# [[:en:Kumasi]] - [[Kumasi]] 
# [[:en:Sunyani]] - [[Sunyani]]
# [[:en:Techiman]] - [[Techiman]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 08:17, 7 Kitawonsa 2022 (UTC)[[Dwumadini:Afia360|Afia360]] gets '''3marks {{not done}}
# [[:en:Goaso]] - [[Goaso]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:05, 5 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Cape Coast]] - [[Cape Coast]][[Dwumadini:Rsaawah|Rsaawah]] ([[Dwumadini nkitahode:Rsaawah|Nkitahode beaɛ]]) 10:32, 7 Kitawonsa 2022 (UTC)[[Dwumadini:Rsaawah|Rsaawah]] gets '''4marks''' {{done}}
# [[:en:Kofiridua]] - [[Kofiridua]]
# [[:en:Accra]] - [[Accra]] 
# [[:en:Tamale]] - [[Tamale]]
# [[:en:Damongo]] - [[Damongo]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:23, 7 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3.6marks''' {{done}}}
# [[:en:Nalerigu]] - [[Nalerigu]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:05, 5 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Bolgatanga]] - [[Bolgatanga]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 22:37, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Wa]] - [[Wa]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 13:36, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Nana Sintim|Nana Sintim]] gets '''3marks''' {{done}}
# [[:en:Ho]] - [[Ho]]
# [[:en:Dambai]] - [[Dambai]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:01, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Takoradi]] - [[Takoradi]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:01, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Wiawso]] - [[Wiawso]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:01, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}

=='''Adwuma ho nsɛmfua (Work related terminologies)'''==
# [[:en:Teacher]] - [[Ɔkyerɛkyerɛni]] [[Dwumadini: Christian|Christian]]
# [[:en:Farmer]] - [[Ɔkuani]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:17, 9 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3marks''' {{done}}
# [[:en:Blacksmith]] - [[Ɔtomfoɔ]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:36, 24 Kitawonsa 2022 (UTC)
# [[:en: Boxer]] - [[Akuturukubɔfoɔ]]
# [[:en:Butcher]] - [[Nankwaaseni]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 18:26, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''3.2marks''' {{done}}
# [[:en:Banker]] - [[Sikakorabea adwumayɛni]]
# [[:en:Wood worker]] - [[Dua dwomfoɔ]][[Dwumadini:AC Krah|AC Krah]] gets '''3marks''' {{done}}
# [[:en:Doctor]] - [[Ɔyaresafoɔ /Dokota]]
# [[:en:Driver]] - [[Ɔhyenkani /Ɔhyenkafoɔ]]
# [[:en:Judge]] - [[Ɔtenmuafoɔ ]]
# [[:en:Jury]] - [[Apamfoɔ]]
# [[:en:Lawyer]] - [[Mmaranimni]]
# [[:en:Mason]] - [[Ɔdansifoɔ]]
# [[:en:Nurse]] - [[Ayaresadwumamu boafoɔ / Nɛɛse]]
# [[:en:Pharmacist]] - [[Oduyɛfoɔ]]
# [[:en:President]] - [[Ɔmanpanin]]
# [[:en:Fashion designer]] - [[Adepamni]]
# [[:en:Seamstress]] - [[Ɔbaa adepamni]][[Dwumadini:Rsaawah|Rsaawah]] gets '''2marks''' {{done}}
# [[:en:Secretary]] - [[Ɔtwerɛtwerɛfoɔ / Ɔtwerɛtwerɛni]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 00:48, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''3marks''' {{done}}
# [[:en:Security]] - [[Ɔwɛnfoɔ]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 00:18, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''3marks''' {{done}}
# [[:en:Trader]] - [[Ɔdwadini]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 00:55, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''2marks''' {{done}}
# [[:en:Secondary School]] - [[Ntoasoɔ Sukuu]] [[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 18:11, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''3marks''' {{done}}
# [[:en:University]] - [[Suapɔn]] [[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 16:22, 17 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''3marks''' {{done}}

=='''Abusuabɔ ho nsɛmfua (Family related terminologies)'''==
# [[:en:Family]] - [[Abusua]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 11:16, 24 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]]gets '''4marks''' {{done}}[[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 00:19, 11 Kitawonsa 2022 (UTC)
# [[:en:Family member]] - [[Abusuani]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 11:18, 24 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]]gets '''4marks''' {{done}}
# [[:en:Family head]] - [[Abusuapanin]]
# [[:en:Parents]] - [[Awofoɔ]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:49, 25 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]]gets '''3marks''' {{done}}
# [[:en:Man]] - [[ɔbarima]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]])[[Dwumadini:Afriyie34|Afriyie34]]gets '''3marks''' {{done}}
# [[:en:Woman]] - [[ɔbaa]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 08:02, 26 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]]gets '''4marks''' {{done}}
# [[:en:Father]] - [[Agya]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 10:52, 26 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]]gets '''4marks''' {{done}}
# [[:en:Mother]] - [[Maame]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 18:29, 26 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3marks''' {{done}}
# [[:en:Baby]] - [[Akwadaa]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 05:27, 28 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]]gets '''4marks''' {{done}}
# [[:en:Siblings]] - [[Anuanom]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 17:38, 28 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]]gets '''4marks''' {{done}}
# [[:en:Sister]] - [[Nua baa]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 18:47, 29 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3marks''' {{done}}
# [[:en:Brother]] - [[Nua bɛrima]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 17:06, 29 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''4marks''' {{done}}
# [[:en:Grandmother]] - [[Nana baa]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 03:45, 30 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''4marks''' {{done}}
# [[:en:Grandfather]] - [[Nana bɛrima]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 14:32, 30 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''4marks''' {{done}}
# [[:en:Sister-inlaw]] - [[Akumaa]]
# [[:en:Rivals]] - [[Akorafoɔ]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 22:19, 29 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3marks''' {{done}}
# [[:en:Boy]] - [[Abɛrimaa]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:01, 28 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3marks''' {{done}}
# [[:en:Girl]] - [[Abaayewa]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:01, 28 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3marks''' {{done}}
# [[:en:Widow]] - [[Okunafoɔ]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:05, 28 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3marks''' {{done}}
# [[:en:Son]] - [[ɔbabɛrima]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:05, 28 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''2.4marks''' {{done}}
# [[:en:Daugther]] - [[ɔbabaa]]
# [[:en:Adopted child]] - [[Abanoma]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 12:19, 31 Kitawonsa 2022 (UTC)
# [[:en:Orphan]] - [[Agyanka]]
# [[:en:Twins]] - [[Ntaafoɔ]]
# [[:en:Triplet]] - [[Ahenasa]]
# [[:en:Friendship]] - [[Adamfofa]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:04, 31 Kitawonsa 2022 (UTC)
# [[:en:Dating]] - [[Mpenatweɛ]]
# [[:en:Royal]] - [[Dehyeɛ]]
# [[:en:Old man]] - [[Akɔkora]]
# [[:en:Old woman]] - [[Aberewa]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 01:19, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''2marks''' {{done}}
# [[:en:Firstborn child]] - [[Piesie]]
# [[:en:Lastborn child]] - [[Kaakyire]]
# [[:en:Young woman]] - [[Ababaawa]]
# [[:en:Young man]] - [[Abranteɛ]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 01:08, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''2marks''' {{done}}

=='''Apɔmuden ho nsɛmfua (Health related terminologies)'''==
# [[:en:Health]] - [[Apowmuden]]
# [[:en:Sickness]] - [[Yareɛ]]
# [[:en:Diseases]] - [[Nyarewa]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 18:53, 29 Kitawonsa 2022 (UTC)
# [[:en:Hospital]] - [[Ayaresabea]][[Dwumadini:Antwiaa1996|Antwiaa1996]] ([[Dwumadini nkitahode:Antwiaa1996|Nkitahode beaɛ]]) 10:11, 13 Kitawonsa 2022 (UTC)
# [[:en:Syringe]] - [[Paneɛ]]
# [[:en:Medicine]] - [[Aduro]]
# [[:en:Herbalist]] - [[Odunsini]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:37, 24 Kitawonsa 2022 (UTC)
# [[:en:Itch]] - [[Ahokeka]]
# [[:en:Whooping cough]] - [[Nsamanwa]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 18:31, 26 Kitawonsa 2022 (UTC)
# [[:en:Headache]] - [[Tipayɛ]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 18:53, 29 Kitawonsa 2022 (UTC)
# [[:en:Stomach ache]] - [[Yafunu yareɛ]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 18:31, 26 Kitawonsa 2022 (UTC)
# [[:en:Constipation]] - [[Ayamtim]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 08:58, 11 Kitawonsa 2022 (UTC)
# [[:en:Diabetes]] - [[Asikyireyareɛ]]
# [[:en:Cholera]] - [[Ayamtunini/Kɔlera]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 18:53, 29 Kitawonsa 2022 (UTC)
# [[:en:Goiter]] - [[Kɔmpɔ]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:23, 22 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:22, 22 Kitawonsa 2022 (UTC)
# [[:en:Gonorrhea]] - [[Babaso]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:02, 28 Kitawonsa 2022 (UTC)
# [[:en:Cancer]] - [[Kokoram]]
# [[:en:Rheumatism]] - [[Sasabrɔ]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 18:31, 26 Kitawonsa 2022 (UTC)
# [[:en:Convulsion]] - [[Asensene]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 18:31, 26 Kitawonsa 2022 (UTC)
# [[:en:Asthma]] - [[Ntehyeewa]]
# [[:en:Cripple]] - [[Bafan]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:37, 24 Kitawonsa 2022 (UTC)
# [[:en:Muteness]] - [[Emum]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 16:55, 17 Kitawonsa 2022 (UTC)
# [[:en:Blindness]] - [[Anifra]]
# [[:en:Kwashiokor]] - [[Kwashiokor]]
# [[:en:Malaria]] - [[Atiridii yare]]
# [[:en:Paralysis]] - [[Mmubuo]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:09, 22 Kitawonsa 2022 (UTC)
# [[:en:Vomitting]] - [[Ɛfeɛ]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:09, 22 Kitawonsa 2022 (UTC)
# [[:en:Hypertension]] - [[Mogyamorosoɔ]]
# [[:en:Ulcer]] - [[Ayamkuro]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:09, 22 Kitawonsa 2022 (UTC)
# [[:en:Stroke]] - [[Nnwodwoeɛ]]
# [[:en:Measles]] - [[Ntoboro]]
# [[:en:Eczema]] - [[Ɛkrɔ]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:34, 14 Kitawonsa 2022 (UTC)
# [[:en:Rashes]] - [[Nsawansawa]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 08:58, 11 Kitawonsa 2022 (UTC)
# [[:en:Ringworm]] - [[Kakawirewire]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 16:45, 17 Kitawonsa 2022 (UTC)

=='''Atenaeɛ ho nsɛmfua (Environmental related terminologies)'''==
Environmental related
# [[:en:Buildings]] - [[Adan]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:10, 12 Kitawonsa 2022 (UTC)
# [[:en:Trees]] - [[Nnua]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 18:56, 28 Kitawonsa 2022 (UTC)
# [[:en:Flowers]] - [[Nhweren]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 18:56, 28 Kitawonsa 2022 (UTC)
# [[:en:Animals]] - [[Mmoa]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 18:56, 28 Kitawonsa 2022 (UTC)
# [[:en:Humans]] - [[Nnipa]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:32, 12 Kitawonsa 2022 (UTC)
# [[:en:Clouds]] - [[Ewiem]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 18:56, 28 Kitawonsa 2022 (UTC)
# [[:en:Air]] - [[Nframa]]
# [[:en:Machines]] - [[Afidie]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 05:03, 29 Kitawonsa 2022 (UTC)
# [[:en:River]] - [[Nsutene]][[Dwumadini:Mbaidoo|Mbaidoo]] ([[Dwumadini nkitahode:Mbaidoo|Nkitahode beaɛ]]) 14:43, 14 Kitawonsa 2022 (UTC)
# [[:en:Sea]] - [[Ɛpo]][[Dwumadini:Mbaidoo|Mbaidoo]] ([[Dwumadini nkitahode:Mbaidoo|Nkitahode beaɛ]]) 14:43, 14 Kitawonsa 2022 (UTC)
# [[:en:Car]] - [[Ɛhyɛn]][[Dwumadini:Mbaidoo|Mbaidoo]] ([[Dwumadini nkitahode:Mbaidoo|Nkitahode beaɛ]]) 14:43, 14 Kitawonsa 2022 (UTC)
# [[:en:Train]] - [[Keteke]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 23:01, 20 Kitawonsa 2022 (UTC)
# [[:en:Canoe]] - [[Kudoɔ]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 13:48, 24 Kitawonsa 2022 (UTC)
# [[:en:Ship ]] - [[Suhyɛn]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 13:48, 24 Kitawonsa 2022 (UTC)
# [[:en:Aircraft/aeroplane]] - [[Wiemhyɛn]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 16:50, 19 Kitawonsa 2022 (UTC)
# [[:en:Airport]] - [[Wiemhyɛn gyinabea]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 16:27, 17 Kitawonsa 2022 (UTC)
# [[:en:Port/harbor]] - [[Suhyɛn gyinabea]]
# [[:en:Train station]] - [[Keteke gyinabea]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:34, 14 Kitawonsa 2022 (UTC)
# [[:en:Forest]] - [[Kwaeɛ]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 23:01, 20 Kitawonsa 2022 (UTC)
# [[:en:Court]] - [[Asɛm dibea]]
# [[:en:Church building]] - [[Asɔre dan]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:34, 14 Kitawonsa 2022 (UTC)
# [[:en:Church]] - [[Asɔre]] 
# [[:en:Mosque]] - [[Nkramosom dan]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:38, 24 Kitawonsa 2022 (UTC)
# [[:en:Muslim]] - [[Nkramoni]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:38, 24 Kitawonsa 2022 (UTC)
# [[:en:Islam]] - [[Nkramosom]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:38, 24 Kitawonsa 2022 (UTC)
# [[:en:Christian]] - [[Kristoni]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 13:48, 24 Kitawonsa 2022 (UTC)
# [[:en:Christianity]] - [[Kristosom]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 13:48, 24 Kitawonsa 2022 (UTC)
# [[:en:Rainbow]] - [[Nyankontɔn]]
# [[:en:Gun]] - [[Etuo]]
# [[:en:Water]] - [[Nsuo]]
# [[:en:Railway]] - [[Keteke kwan]]
# [[:en:Road]] - [[Lɔre kwan]]
# [[:en:Stadium]] - [[Agoprama]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 16:50, 19 Kitawonsa 2022 (UTC)
# [[:en:Market]] - [[Aguaso]]
# [[:en:Land]] - [[Asaase]]
# [[:en:Mountain]] - [[Bepɔ]] 
# [[:en:Sun]] - [[Awia]]
# [[:en:Moon]] - [[Bosome]]
# [[:en:Star]] - [[Nsoroma]][[Dwumadini:Ebensarfo|Ebensarfo]] ([[Dwumadini nkitahode:Ebensarfo|Nkitahode beaɛ]]) 16:50, 19 Kitawonsa 2022 (UTC)
# [[:en:Birds]] - [[Nnomaa]][[Dwumadini:Ebensarfo|Ebensarfo]] ([[Dwumadini nkitahode:Ebensarfo|Nkitahode beaɛ]]) 15:39, 19 Kitawonsa 2022 (UTC)</text>
      <sha1>gmi1xdni69ijxksuo5kuheu5cd8flnk</sha1>
    </revision>
    <revision>
      <id>132952</id>
      <parentid>132948</parentid>
      <timestamp>2022-07-31T13:20:43Z</timestamp>
      <contributor>
        <username>Afriyie34</username>
        <id>10662</id>
      </contributor>
      <comment>/* Atenaeɛ ho nsɛmfua (Environmental related terminologies) */</comment>
      <model>wikitext</model>
      <format>text/x-wiki</format>
      <text bytes="38125" xml:space="preserve">=='''Entries'''==
*''Type  '''&lt;nowiki&gt;~~~~&lt;/nowiki&gt;''' next to the article(s) '''you have worked on''' and click '''publish changes'''.''
*A facilitator will review '''Twi Wikipedia, Wikicommons and Wikidata items''' and add {{Wei}} If the entry worked on meets the rules.

=='''Mmarahyɛbadwam ho nsɛm (Parliamentary related terminologies)'''==
# [[:en:Elections]] - [[Abatoɔ]]
# [[:en:Parliament]] - [[Mmarahyɛbadwafie]] [[Dwumadini:Opoku Akaadom Sympathy|Opoku Akaadom Sympathy]] ([[Dwumadini nkitahode:Opoku Akaadom Sympathy|Nkitahode beaɛ]]) 17:11, 4 Kitawonsa 2022 (UTC) [[Dwumadini:Opoku Akaadom Sympathy|Opoku Akaadom Sympathy]] gets '''3marks''' {{not done}}
# [[:en:Member of Parliament]] - [[Mmarahyɛbadwani]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 12:59, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Nana Sintim|Nana Sintim]] gets '''3.6marks''' {{done}}
# [[:en:Law]] - [[Mmara]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 21:37, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Nana Sintim|Nana Sintim]] gets '''3marks''' {{not done}}
# [[:en:Constitution]] - [[Amanmmara]] [[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 19:10, 16 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''3marks''' {{not done}}
# [[:en:Speaker of Parliament]] - [[Mmarahyɛbadwafie Kasamafoɔ]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 06:29, 5 Kitawonsa 2022 (UTC)[[Dwumadini:Nana Sintim|Nana Sintim]] gets '''4marks''' {{done}}
# [[:en:Justice]] - [[Atɛntenee]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:00, 24 Kitawonsa 2022 (UTC)
# [[:en:Corruption]] - [[Porɔɛe]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 23:49, 29 Kitawonsa 2022 (UTC)
# [[:en: Bribery]] - [[Kɛtɛasehyɛ]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 23:49, 29 Kitawonsa 2022 (UTC)
# [[:en: Constituency]] - [[Mpasua]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:40, 4 Kitawonsa 2022 (UTC) [[Dwumadini:AC Krah|AC Krah]] gets '''2.4marks''' {{not done}}
# [[:en: Amendment]] - [[Nsakraeɛ]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 06:58, 8 Kitawonsa 2022 (UTC) [[Dwumadini:Afia360|Afia360]] gets '''3.6marks''' {{done}}
# [[:en: President]] - [[Ɔmanpanin]]
# [[:en: Appoint]] - [[Y'apaw Obi]] [[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 18:09, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] '''2.6marks''' {{not done}}
# [[:en: Bylaws]] - [[Mmaranketewa]]
# [[:en: Minister]] - [[Mansoafoɔ]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 08:49, 30 Kitawonsa 2022 (UTC)
# [[:en:Minority]] - [[Ɛdɔm kumaa]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 07:19, 5 Kitawonsa 2022 (UTC)[[Dwumadini:Afia360|Afia360]]'''3.5marks''' {{done}}
# [[:en:Majority]] - [[Ɛdɔm kɛseɛ]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 23:21, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Nana Sintim|Nana Sintim]] gets '''3.6marks''' {{done}}
# [[:en:Court]] - [[Asɛmdibia]]
# [[:en:Minority Leader]] - [[Ɛdɔm Kumaa Panin]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 07:19, 5 Kitawonsa 2022 (UTC)[[Dwumadini:Afia360|Afia360]] gets '''2.8marks''' [[Dwumadini:Nana Sintim|Nana Sintim]] gets '''0.6marks'''{{not done}}
# [[:en:Majority Leader]] - [[Ɛdɔm kɛseɛ Panin]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 07:19, 5 Kitawonsa 2022 (UTC)[[Dwumadini:Afia360|Afia360]] gets '''2marks''' {{done}}
# [[:en:Democracy]] - [[Kabi-Ma-Menkabi]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 18:35, 27 Kitawonsa 2022 (UTC)
# [[:en:Prime Minister]] - [[Man soafo panyin]]
# [[:en:Municipality ]] - [[Munisipal]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 17:01, 9 Kitawonsa 2022 (UTC)
# [[:en:District]] - [[Mansini]] [[Dwumadini:Afriyie34|Afriyie34]] gets '''3marks''' {{done}}
# [[:en:Deputy Minister]] - [[Soafo Abadiakyiri]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:14, 9 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3marks''' {{done}}
# [[:en:Politician]] - [[Amammuifo]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 08:57, 11 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3.2marks''' {{done}}
# [[:en:Political Party]] - [[Amanyɔ kuo]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 19:13, 13 Kitawonsa 2022 (UTC)[[Dwumadini:Afia360|Afia360]] gets '''2marks''' {{not done}}
# [[:en:New Patriotic Party]] - [[New Patriotic Party (NPP)]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 22:20, 5 Kitawonsa 2022 (UTC)[[Dwumadini:Nana Sintim|Nana Sintim]] gets '''4marks {{done}}
# [[:en:Republic]] - [[Adehyeman]]
# [[:en:National Democratic Congress]] - [[National Democratic Congress (NDC)]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 14:19, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Afia360|Afia360]] gets '''4marks'''{{done}}
# [[:en:Convention People's Party]] - [[Convention People's Party (CPP)]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 11:05, 23 Kitawonsa 2022 (UTC)
# [[:en:People's National Convention]] - [[People's National Convention (PNC)]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 22:47, 3 Kitawonsa 2022 (UTC)[[Dwumadini:Afia360|Afia360]] gets '''2marks''' {{not done}}
# [[:en:All People's Congress]] - [[All People's Congress (APC)]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 10:01, 30 Kitawonsa 2022 (UTC)
# [[:en:Democratic Freedom Party]] - [[Democratic Freedom Party (DFP)]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 23:39, 3 Kitawonsa 2022 (UTC)[[Dwumadini:Afia360|Afia360]] gets '''4marks''' {{done}}
# [[:en:Democratic People's Party]] - [[Democratic People's Party (DPP)]] [[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''4marks''' {{done}}
# [[:en:Every Ghanaian Living Everywhere Party]] - [[Every Ghanaian Living Everywhere Party(EGLEP)]]
# [[:en:Great Consolidated Popular Party]] - [[Great Consolidated Popular Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 23:50, 3 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''3marks''' [[Dwumadini:Opoku Akaadom Sympathy|Opoku Akaadom Sympathy]] gets '''0.6marks''' {{done}}
# [[:en:Ghana Democratic Republican Party]] - [[Ghana Democratic Republican Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 00:27, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''3marks''' {{done}}
# [[:en:Ghana Freedom Party]] - [[Ghana Freedom Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 21:18, 3 Kitawonsa 2022 (UTC) [[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''4marks''' {{done}}
# [[:en:Ghana National Party]] - [[Ghana National Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 00:29, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''3marks''' {{done}}
# [[:en:Ghana Union Movement]] - [[Ghana Union Movement]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 00:57, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''3.8marks''' {{done}}
# [[:en:Liberal Party of Ghana]] - [[Liberal Party of Ghana]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 01:52, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''3.2marks''' {{done}}
# [[:en:National Democratic Party ]] - [[National Democratic Party ]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 03:42, 6 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''3.8marks''' {{done}}
# [[:en:National Reform Party]] - [[National Reform Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 02:23, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''3.2marks''' {{done}}
# [[:en:New Vision Party ]] - [[New Vision Party ]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 02:52, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''2.2marks''' {{done}}
# [[:en:People's Action Party ]] - [[People's Action Party ]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 10:36, 30 Kitawonsa 2022 (UTC)
# [[:en:People's Destiny Party]] - [[People's Destiny Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 01:33, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''2marks''' {{done}}
# [[:en:Power Unity Party]] - [[Power Unity Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 20:06, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''2.2marks''' {{done}}
# [[:en:Progressive People's Party]] - [[Progressive People's Party]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 18:35, 27 Kitawonsa 2022 (UTC)
# [[:en:Reformed Patriotic Democrats]] - [[Reformed Patriotic Democrats]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 04:02, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''2.4marks''' {{done}}
# [[:en:United Democratic Party]] - [[United Democratic Party]]
# [[:en:United Development System Party]] - [[United Development System Party]] [[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 22:50, 3 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''2marks''' {{done}}
# [[:en:United Front Party]] - [[United Front Party]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 14:55, 30 Kitawonsa 2022 (UTC)
# [[:en:United Ghana Movement]] - [[United Ghana Movement]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:23, 7 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3.2marks''' {{done}}
# [[:en:United Progressive Party]] - [[United Progressive Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 08:02, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''3.4marks''' {{done}}
# [[:en:United Renaissance Party]] - [[United Renaissance Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 03:17, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''2marks''' {{done}}
# [[:en:Yes People's Party]] - [[Yes People's Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 19:57, 3 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''2marks''' {{done}}
# [[:en:Ghana Redevelopment Party]] - [[Ghana Redevelopment Party]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:40, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''2marks''' {{done}}
# [[:en:Independent People's Party]] - [[Independent People's Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 23:37, 3 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''2.6marks''' {{done}}
# [[:en:National Convention Party]] - [[National Convention Party]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 06:31, 5 Kitawonsa 2022 (UTC)
# [[:en:National Independence Party ]] - [[National Independence Party ]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 00:59, 9 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''4marks''' {{done}}
# [[:en:People's Convention Party ]] - [[People's Convention Party ]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 06:35, 5 Kitawonsa 2022 (UTC)[[Dwumadini:Nana Sintim|Nana Sintim]] gets '''1.4marks''' {{done}}
# [[:en:People's Heritage Party ]] - [[People's Heritage Party ]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:40, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''2.2marks''' {{done}}
# [[:en:United Love Party ]] - [[United Love Party ]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:45, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3.2marks''' {{done}}
# [[:en:Action Congress Party]] - [[Action Congress Party]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:40, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''2.3marks {{done}}
# [[:en:All People's Party]] - [[All People's Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 14:04, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''3.2marks''' {{done}}
# [[:en:People's National Party]] - [[People's National Party]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 22:36, 30 Kitawonsa 2022 (UTC)
# [[:en:Popular Front Party]] - [[Popular Front Party]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:40, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''2.6marks''' {{done}}
# [[:en:Social Democratic Front ]] - [[Social Democratic Front ]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 00:41, 9 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''1mark''' {{done}}
# [[:en:Third Force Party]] - [[Third Force Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 19:59, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''1mark''' {{done}}
# [[:en:United National Convention ]] - [[United National Convention ]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 23:18, 5 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''1.8marks''' {{done}}
# [[:en:All People's Republican Party ]] - [[All People's Republican Party ]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 00:47, 9 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''1mark''' {{done}}
# [[:en:Justice Party ]] - [[Justice Party ]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 15:04, 30 Kitawonsa 2022 (UTC)
# [[:en:National Alliance of Liberals]] - [[National Alliance of Liberals]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:40, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''2.8marks''' {{done}}
# [[:en:People's Action Party]] [[People's Action Party]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 10:31, 30 Kitawonsa 2022 (UTC)
# [[:en:Progress Party]] - [[Progress Party]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 14:55, 30 Kitawonsa 2022 (UTC)
# [[:en:United Nationalist Party ]] - [[United Nationalist Party ]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 14:55, 30 Kitawonsa 2022 (UTC)
# [[:en:United Party ]] - [[United Party ]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 22:08, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Afia360|Afia360]] gets '''3marks''' {{done}}
# [[:en:United Gold Coast Convention]] - [[United Gold Coast Convention]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:40, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Anlo Youth Organization]] - [[Anlo Youth Organization]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:40, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Federation of Youth Organization]] - [[Federation of Youth Organization]][[Dwumadini:AC Krah|AC Krah]] gets '''2.8marks''' {{done}}
# [[:en:Ghana Congress Party]] - [[Ghana Congress Party]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:14, 9 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''2.8marks''' {{done}}
# [[:en:Muslim Association Party]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 23:14, 5 Kitawonsa 2022 (UTC) - [[Muslim Association Party]][[Dwumadini:Nana Sintim|Nana Sintim]] gets '''2.2marks''' {{done}}
# [[:en:National Liberation Movement ]] - [[National Liberation Movement ]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 23:44, 27 Kitawonsa 2022 (UTC)
# [[:en:Northern People's Party ]] - [[Northern People's Party ]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 22:36, 30 Kitawonsa 2022 (UTC)
# [[:en:Togoland Congress]] - [[Togoland Congress]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 04:31, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''1.6marks''' {{done}}
# [[:en:Greater Accra Region]] - [[Greater Accra Region]]
# [[:en:Eastern Region]] - [[Eastern Region]]
# [[:en:Ahafo Region]] - [[Ahafo Mantam]][[Dwumadini:Rsaawah|Rsaawah]] ([[Dwumadini nkitahode:Rsaawah|Nkitahode beaɛ]]) 12:38, 5 Kitawonsa 2022 (UTC)[[Dwumadini:Rsaawah|Rsaawah]] gets '''4marks''' {{done}}
# [[:en:Ashanti Region]] - [[Ashanti Region]]
# [[:en:Bono East Region]] - [[Bono East Region]][[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Brong Ahafo Region]] - [[Brong Ahafo Mantam]][[Dwumadini:S A Habadah|S A Habadah]] ([[Dwumadini nkitahode:S A Habadah|Nkitahode beaɛ]])[[Dwumadini:S A Habadah|S A Habadah]] gets '''4marks''' {{done}}
# [[:en:Central Region]] - [[Central Region]][[Dwumadini:Rsaawah|Rsaawah]] gets '''4marks''' {{done}}
# [[:en:North-East Region]] - [[North-East Region]]
# [[:en:Northern Region]] - [[Northern Region]]
# [[:en:Oti Region]] - [[Oti Region]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:23, 7 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Savannah Region]] - [[Savannah Region]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:23, 7 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Upper East Region]] - [[Upper East Region]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:23, 7 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Upper West Region]] - [[Upper West Region]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:23, 7 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Western Region]] - [[Western Region]]
# [[:en:Western North Region]] - [[Western North Region]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:23, 7 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Volta Region]] - [[Volta Region]]
# [[:en:Kumasi]] - [[Kumasi]] 
# [[:en:Sunyani]] - [[Sunyani]]
# [[:en:Techiman]] - [[Techiman]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 08:17, 7 Kitawonsa 2022 (UTC)[[Dwumadini:Afia360|Afia360]] gets '''3marks {{not done}}
# [[:en:Goaso]] - [[Goaso]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:05, 5 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Cape Coast]] - [[Cape Coast]][[Dwumadini:Rsaawah|Rsaawah]] ([[Dwumadini nkitahode:Rsaawah|Nkitahode beaɛ]]) 10:32, 7 Kitawonsa 2022 (UTC)[[Dwumadini:Rsaawah|Rsaawah]] gets '''4marks''' {{done}}
# [[:en:Kofiridua]] - [[Kofiridua]]
# [[:en:Accra]] - [[Accra]] 
# [[:en:Tamale]] - [[Tamale]]
# [[:en:Damongo]] - [[Damongo]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:23, 7 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3.6marks''' {{done}}}
# [[:en:Nalerigu]] - [[Nalerigu]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:05, 5 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Bolgatanga]] - [[Bolgatanga]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 22:37, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Wa]] - [[Wa]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 13:36, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Nana Sintim|Nana Sintim]] gets '''3marks''' {{done}}
# [[:en:Ho]] - [[Ho]]
# [[:en:Dambai]] - [[Dambai]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:01, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Takoradi]] - [[Takoradi]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:01, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Wiawso]] - [[Wiawso]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:01, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}

=='''Adwuma ho nsɛmfua (Work related terminologies)'''==
# [[:en:Teacher]] - [[Ɔkyerɛkyerɛni]] [[Dwumadini: Christian|Christian]]
# [[:en:Farmer]] - [[Ɔkuani]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:17, 9 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3marks''' {{done}}
# [[:en:Blacksmith]] - [[Ɔtomfoɔ]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:36, 24 Kitawonsa 2022 (UTC)
# [[:en: Boxer]] - [[Akuturukubɔfoɔ]]
# [[:en:Butcher]] - [[Nankwaaseni]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 18:26, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''3.2marks''' {{done}}
# [[:en:Banker]] - [[Sikakorabea adwumayɛni]]
# [[:en:Wood worker]] - [[Dua dwomfoɔ]][[Dwumadini:AC Krah|AC Krah]] gets '''3marks''' {{done}}
# [[:en:Doctor]] - [[Ɔyaresafoɔ /Dokota]]
# [[:en:Driver]] - [[Ɔhyenkani /Ɔhyenkafoɔ]]
# [[:en:Judge]] - [[Ɔtenmuafoɔ ]]
# [[:en:Jury]] - [[Apamfoɔ]]
# [[:en:Lawyer]] - [[Mmaranimni]]
# [[:en:Mason]] - [[Ɔdansifoɔ]]
# [[:en:Nurse]] - [[Ayaresadwumamu boafoɔ / Nɛɛse]]
# [[:en:Pharmacist]] - [[Oduyɛfoɔ]]
# [[:en:President]] - [[Ɔmanpanin]]
# [[:en:Fashion designer]] - [[Adepamni]]
# [[:en:Seamstress]] - [[Ɔbaa adepamni]][[Dwumadini:Rsaawah|Rsaawah]] gets '''2marks''' {{done}}
# [[:en:Secretary]] - [[Ɔtwerɛtwerɛfoɔ / Ɔtwerɛtwerɛni]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 00:48, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''3marks''' {{done}}
# [[:en:Security]] - [[Ɔwɛnfoɔ]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 00:18, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''3marks''' {{done}}
# [[:en:Trader]] - [[Ɔdwadini]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 00:55, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''2marks''' {{done}}
# [[:en:Secondary School]] - [[Ntoasoɔ Sukuu]] [[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 18:11, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''3marks''' {{done}}
# [[:en:University]] - [[Suapɔn]] [[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 16:22, 17 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''3marks''' {{done}}

=='''Abusuabɔ ho nsɛmfua (Family related terminologies)'''==
# [[:en:Family]] - [[Abusua]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 11:16, 24 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]]gets '''4marks''' {{done}}[[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 00:19, 11 Kitawonsa 2022 (UTC)
# [[:en:Family member]] - [[Abusuani]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 11:18, 24 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]]gets '''4marks''' {{done}}
# [[:en:Family head]] - [[Abusuapanin]]
# [[:en:Parents]] - [[Awofoɔ]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:49, 25 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]]gets '''3marks''' {{done}}
# [[:en:Man]] - [[ɔbarima]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]])[[Dwumadini:Afriyie34|Afriyie34]]gets '''3marks''' {{done}}
# [[:en:Woman]] - [[ɔbaa]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 08:02, 26 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]]gets '''4marks''' {{done}}
# [[:en:Father]] - [[Agya]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 10:52, 26 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]]gets '''4marks''' {{done}}
# [[:en:Mother]] - [[Maame]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 18:29, 26 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3marks''' {{done}}
# [[:en:Baby]] - [[Akwadaa]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 05:27, 28 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]]gets '''4marks''' {{done}}
# [[:en:Siblings]] - [[Anuanom]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 17:38, 28 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]]gets '''4marks''' {{done}}
# [[:en:Sister]] - [[Nua baa]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 18:47, 29 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3marks''' {{done}}
# [[:en:Brother]] - [[Nua bɛrima]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 17:06, 29 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''4marks''' {{done}}
# [[:en:Grandmother]] - [[Nana baa]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 03:45, 30 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''4marks''' {{done}}
# [[:en:Grandfather]] - [[Nana bɛrima]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 14:32, 30 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''4marks''' {{done}}
# [[:en:Sister-inlaw]] - [[Akumaa]]
# [[:en:Rivals]] - [[Akorafoɔ]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 22:19, 29 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3marks''' {{done}}
# [[:en:Boy]] - [[Abɛrimaa]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:01, 28 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3marks''' {{done}}
# [[:en:Girl]] - [[Abaayewa]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:01, 28 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3marks''' {{done}}
# [[:en:Widow]] - [[Okunafoɔ]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:05, 28 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3marks''' {{done}}
# [[:en:Son]] - [[ɔbabɛrima]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:05, 28 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''2.4marks''' {{done}}
# [[:en:Daugther]] - [[ɔbabaa]]
# [[:en:Adopted child]] - [[Abanoma]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 12:19, 31 Kitawonsa 2022 (UTC)
# [[:en:Orphan]] - [[Agyanka]]
# [[:en:Twins]] - [[Ntaafoɔ]]
# [[:en:Triplet]] - [[Ahenasa]]
# [[:en:Friendship]] - [[Adamfofa]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:04, 31 Kitawonsa 2022 (UTC)
# [[:en:Dating]] - [[Mpenatweɛ]]
# [[:en:Royal]] - [[Dehyeɛ]]
# [[:en:Old man]] - [[Akɔkora]]
# [[:en:Old woman]] - [[Aberewa]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 01:19, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''2marks''' {{done}}
# [[:en:Firstborn child]] - [[Piesie]]
# [[:en:Lastborn child]] - [[Kaakyire]]
# [[:en:Young woman]] - [[Ababaawa]]
# [[:en:Young man]] - [[Abranteɛ]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 01:08, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''2marks''' {{done}}

=='''Apɔmuden ho nsɛmfua (Health related terminologies)'''==
# [[:en:Health]] - [[Apowmuden]]
# [[:en:Sickness]] - [[Yareɛ]]
# [[:en:Diseases]] - [[Nyarewa]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 18:53, 29 Kitawonsa 2022 (UTC)
# [[:en:Hospital]] - [[Ayaresabea]][[Dwumadini:Antwiaa1996|Antwiaa1996]] ([[Dwumadini nkitahode:Antwiaa1996|Nkitahode beaɛ]]) 10:11, 13 Kitawonsa 2022 (UTC)
# [[:en:Syringe]] - [[Paneɛ]]
# [[:en:Medicine]] - [[Aduro]]
# [[:en:Herbalist]] - [[Odunsini]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:37, 24 Kitawonsa 2022 (UTC)
# [[:en:Itch]] - [[Ahokeka]]
# [[:en:Whooping cough]] - [[Nsamanwa]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 18:31, 26 Kitawonsa 2022 (UTC)
# [[:en:Headache]] - [[Tipayɛ]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 18:53, 29 Kitawonsa 2022 (UTC)
# [[:en:Stomach ache]] - [[Yafunu yareɛ]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 18:31, 26 Kitawonsa 2022 (UTC)
# [[:en:Constipation]] - [[Ayamtim]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 08:58, 11 Kitawonsa 2022 (UTC)
# [[:en:Diabetes]] - [[Asikyireyareɛ]]
# [[:en:Cholera]] - [[Ayamtunini/Kɔlera]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 18:53, 29 Kitawonsa 2022 (UTC)
# [[:en:Goiter]] - [[Kɔmpɔ]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:23, 22 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:22, 22 Kitawonsa 2022 (UTC)
# [[:en:Gonorrhea]] - [[Babaso]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:02, 28 Kitawonsa 2022 (UTC)
# [[:en:Cancer]] - [[Kokoram]]
# [[:en:Rheumatism]] - [[Sasabrɔ]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 18:31, 26 Kitawonsa 2022 (UTC)
# [[:en:Convulsion]] - [[Asensene]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 18:31, 26 Kitawonsa 2022 (UTC)
# [[:en:Asthma]] - [[Ntehyeewa]]
# [[:en:Cripple]] - [[Bafan]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:37, 24 Kitawonsa 2022 (UTC)
# [[:en:Muteness]] - [[Emum]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 16:55, 17 Kitawonsa 2022 (UTC)
# [[:en:Blindness]] - [[Anifra]]
# [[:en:Kwashiokor]] - [[Kwashiokor]]
# [[:en:Malaria]] - [[Atiridii yare]]
# [[:en:Paralysis]] - [[Mmubuo]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:09, 22 Kitawonsa 2022 (UTC)
# [[:en:Vomitting]] - [[Ɛfeɛ]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:09, 22 Kitawonsa 2022 (UTC)
# [[:en:Hypertension]] - [[Mogyamorosoɔ]]
# [[:en:Ulcer]] - [[Ayamkuro]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:09, 22 Kitawonsa 2022 (UTC)
# [[:en:Stroke]] - [[Nnwodwoeɛ]]
# [[:en:Measles]] - [[Ntoboro]]
# [[:en:Eczema]] - [[Ɛkrɔ]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:34, 14 Kitawonsa 2022 (UTC)
# [[:en:Rashes]] - [[Nsawansawa]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 08:58, 11 Kitawonsa 2022 (UTC)
# [[:en:Ringworm]] - [[Kakawirewire]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 16:45, 17 Kitawonsa 2022 (UTC)

=='''Atenaeɛ ho nsɛmfua (Environmental related terminologies)'''==
Environmental related
# [[:en:Buildings]] - [[Adan]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:10, 12 Kitawonsa 2022 (UTC)
# [[:en:Trees]] - [[Nnua]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 18:56, 28 Kitawonsa 2022 (UTC)
# [[:en:Flowers]] - [[Nhweren]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 18:56, 28 Kitawonsa 2022 (UTC)
# [[:en:Animals]] - [[Mmoa]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 18:56, 28 Kitawonsa 2022 (UTC)
# [[:en:Humans]] - [[Nnipa]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:32, 12 Kitawonsa 2022 (UTC)
# [[:en:Clouds]] - [[Ewiem]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 18:56, 28 Kitawonsa 2022 (UTC)
# [[:en:Air]] - [[Nframa]]
# [[:en:Machines]] - [[Afidie]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 05:03, 29 Kitawonsa 2022 (UTC)
# [[:en:River]] - [[Nsutene]][[Dwumadini:Mbaidoo|Mbaidoo]] ([[Dwumadini nkitahode:Mbaidoo|Nkitahode beaɛ]]) 14:43, 14 Kitawonsa 2022 (UTC)
# [[:en:Sea]] - [[Ɛpo]][[Dwumadini:Mbaidoo|Mbaidoo]] ([[Dwumadini nkitahode:Mbaidoo|Nkitahode beaɛ]]) 14:43, 14 Kitawonsa 2022 (UTC)
# [[:en:Car]] - [[Ɛhyɛn]][[Dwumadini:Mbaidoo|Mbaidoo]] ([[Dwumadini nkitahode:Mbaidoo|Nkitahode beaɛ]]) 14:43, 14 Kitawonsa 2022 (UTC)
# [[:en:Train]] - [[Keteke]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 23:01, 20 Kitawonsa 2022 (UTC)
# [[:en:Canoe]] - [[Kudoɔ]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 13:48, 24 Kitawonsa 2022 (UTC)
# [[:en:Ship ]] - [[Suhyɛn]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 13:48, 24 Kitawonsa 2022 (UTC)
# [[:en:Aircraft/aeroplane]] - [[Wiemhyɛn]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 16:50, 19 Kitawonsa 2022 (UTC)
# [[:en:Airport]] - [[Wiemhyɛn gyinabea]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 16:27, 17 Kitawonsa 2022 (UTC)
# [[:en:Port/harbor]] - [[Suhyɛn gyinabea]]
# [[:en:Train station]] - [[Keteke gyinabea]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:34, 14 Kitawonsa 2022 (UTC)
# [[:en:Forest]] - [[Kwaeɛ]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 23:01, 20 Kitawonsa 2022 (UTC)
# [[:en:Court]] - [[Asɛm dibea]]
# [[:en:Church building]] - [[Asɔre dan]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:34, 14 Kitawonsa 2022 (UTC)
# [[:en:Church]] - [[Asɔre]] 
# [[:en:Mosque]] - [[Nkramosom dan]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:38, 24 Kitawonsa 2022 (UTC)
# [[:en:Muslim]] - [[Nkramoni]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:38, 24 Kitawonsa 2022 (UTC)
# [[:en:Islam]] - [[Nkramosom]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:38, 24 Kitawonsa 2022 (UTC)
# [[:en:Christian]] - [[Kristoni]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 13:48, 24 Kitawonsa 2022 (UTC)
# [[:en:Christianity]] - [[Kristosom]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 13:48, 24 Kitawonsa 2022 (UTC)
# [[:en:Rainbow]] - [[Nyankontɔn]]
# [[:en:Gun]] - [[Etuo]]
# [[:en:Water]] - [[Nsuo]]
# [[:en:Railway]] - [[Keteke kwan]]
# [[:en:Road]] - [[Lɔre kwan]]
# [[:en:Stadium]] - [[Agoprama]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 16:50, 19 Kitawonsa 2022 (UTC)
# [[:en:Market]] - [[Aguaso]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:20, 31 Kitawonsa 2022 (UTC)
# [[:en:Land]] - [[Asaase]]
# [[:en:Mountain]] - [[Bepɔ]] 
# [[:en:Sun]] - [[Awia]]
# [[:en:Moon]] - [[Bosome]]
# [[:en:Star]] - [[Nsoroma]][[Dwumadini:Ebensarfo|Ebensarfo]] ([[Dwumadini nkitahode:Ebensarfo|Nkitahode beaɛ]]) 16:50, 19 Kitawonsa 2022 (UTC)
# [[:en:Birds]] - [[Nnomaa]][[Dwumadini:Ebensarfo|Ebensarfo]] ([[Dwumadini nkitahode:Ebensarfo|Nkitahode beaɛ]]) 15:39, 19 Kitawonsa 2022 (UTC)</text>
      <sha1>5qnin6b9t1st9cw3f86exlwac1u73le</sha1>
    </revision>
    <revision>
      <id>132980</id>
      <parentid>132952</parentid>
      <timestamp>2022-07-31T15:19:04Z</timestamp>
      <contributor>
        <username>Afriyie34</username>
        <id>10662</id>
      </contributor>
      <comment>/* Apɔmuden ho nsɛmfua (Health related terminologies) */</comment>
      <model>wikitext</model>
      <format>text/x-wiki</format>
      <text bytes="38241" xml:space="preserve">=='''Entries'''==
*''Type  '''&lt;nowiki&gt;~~~~&lt;/nowiki&gt;''' next to the article(s) '''you have worked on''' and click '''publish changes'''.''
*A facilitator will review '''Twi Wikipedia, Wikicommons and Wikidata items''' and add {{Wei}} If the entry worked on meets the rules.

=='''Mmarahyɛbadwam ho nsɛm (Parliamentary related terminologies)'''==
# [[:en:Elections]] - [[Abatoɔ]]
# [[:en:Parliament]] - [[Mmarahyɛbadwafie]] [[Dwumadini:Opoku Akaadom Sympathy|Opoku Akaadom Sympathy]] ([[Dwumadini nkitahode:Opoku Akaadom Sympathy|Nkitahode beaɛ]]) 17:11, 4 Kitawonsa 2022 (UTC) [[Dwumadini:Opoku Akaadom Sympathy|Opoku Akaadom Sympathy]] gets '''3marks''' {{not done}}
# [[:en:Member of Parliament]] - [[Mmarahyɛbadwani]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 12:59, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Nana Sintim|Nana Sintim]] gets '''3.6marks''' {{done}}
# [[:en:Law]] - [[Mmara]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 21:37, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Nana Sintim|Nana Sintim]] gets '''3marks''' {{not done}}
# [[:en:Constitution]] - [[Amanmmara]] [[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 19:10, 16 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''3marks''' {{not done}}
# [[:en:Speaker of Parliament]] - [[Mmarahyɛbadwafie Kasamafoɔ]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 06:29, 5 Kitawonsa 2022 (UTC)[[Dwumadini:Nana Sintim|Nana Sintim]] gets '''4marks''' {{done}}
# [[:en:Justice]] - [[Atɛntenee]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:00, 24 Kitawonsa 2022 (UTC)
# [[:en:Corruption]] - [[Porɔɛe]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 23:49, 29 Kitawonsa 2022 (UTC)
# [[:en: Bribery]] - [[Kɛtɛasehyɛ]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 23:49, 29 Kitawonsa 2022 (UTC)
# [[:en: Constituency]] - [[Mpasua]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:40, 4 Kitawonsa 2022 (UTC) [[Dwumadini:AC Krah|AC Krah]] gets '''2.4marks''' {{not done}}
# [[:en: Amendment]] - [[Nsakraeɛ]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 06:58, 8 Kitawonsa 2022 (UTC) [[Dwumadini:Afia360|Afia360]] gets '''3.6marks''' {{done}}
# [[:en: President]] - [[Ɔmanpanin]]
# [[:en: Appoint]] - [[Y'apaw Obi]] [[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 18:09, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] '''2.6marks''' {{not done}}
# [[:en: Bylaws]] - [[Mmaranketewa]]
# [[:en: Minister]] - [[Mansoafoɔ]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 08:49, 30 Kitawonsa 2022 (UTC)
# [[:en:Minority]] - [[Ɛdɔm kumaa]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 07:19, 5 Kitawonsa 2022 (UTC)[[Dwumadini:Afia360|Afia360]]'''3.5marks''' {{done}}
# [[:en:Majority]] - [[Ɛdɔm kɛseɛ]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 23:21, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Nana Sintim|Nana Sintim]] gets '''3.6marks''' {{done}}
# [[:en:Court]] - [[Asɛmdibia]]
# [[:en:Minority Leader]] - [[Ɛdɔm Kumaa Panin]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 07:19, 5 Kitawonsa 2022 (UTC)[[Dwumadini:Afia360|Afia360]] gets '''2.8marks''' [[Dwumadini:Nana Sintim|Nana Sintim]] gets '''0.6marks'''{{not done}}
# [[:en:Majority Leader]] - [[Ɛdɔm kɛseɛ Panin]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 07:19, 5 Kitawonsa 2022 (UTC)[[Dwumadini:Afia360|Afia360]] gets '''2marks''' {{done}}
# [[:en:Democracy]] - [[Kabi-Ma-Menkabi]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 18:35, 27 Kitawonsa 2022 (UTC)
# [[:en:Prime Minister]] - [[Man soafo panyin]]
# [[:en:Municipality ]] - [[Munisipal]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 17:01, 9 Kitawonsa 2022 (UTC)
# [[:en:District]] - [[Mansini]] [[Dwumadini:Afriyie34|Afriyie34]] gets '''3marks''' {{done}}
# [[:en:Deputy Minister]] - [[Soafo Abadiakyiri]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:14, 9 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3marks''' {{done}}
# [[:en:Politician]] - [[Amammuifo]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 08:57, 11 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3.2marks''' {{done}}
# [[:en:Political Party]] - [[Amanyɔ kuo]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 19:13, 13 Kitawonsa 2022 (UTC)[[Dwumadini:Afia360|Afia360]] gets '''2marks''' {{not done}}
# [[:en:New Patriotic Party]] - [[New Patriotic Party (NPP)]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 22:20, 5 Kitawonsa 2022 (UTC)[[Dwumadini:Nana Sintim|Nana Sintim]] gets '''4marks {{done}}
# [[:en:Republic]] - [[Adehyeman]]
# [[:en:National Democratic Congress]] - [[National Democratic Congress (NDC)]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 14:19, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Afia360|Afia360]] gets '''4marks'''{{done}}
# [[:en:Convention People's Party]] - [[Convention People's Party (CPP)]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 11:05, 23 Kitawonsa 2022 (UTC)
# [[:en:People's National Convention]] - [[People's National Convention (PNC)]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 22:47, 3 Kitawonsa 2022 (UTC)[[Dwumadini:Afia360|Afia360]] gets '''2marks''' {{not done}}
# [[:en:All People's Congress]] - [[All People's Congress (APC)]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 10:01, 30 Kitawonsa 2022 (UTC)
# [[:en:Democratic Freedom Party]] - [[Democratic Freedom Party (DFP)]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 23:39, 3 Kitawonsa 2022 (UTC)[[Dwumadini:Afia360|Afia360]] gets '''4marks''' {{done}}
# [[:en:Democratic People's Party]] - [[Democratic People's Party (DPP)]] [[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''4marks''' {{done}}
# [[:en:Every Ghanaian Living Everywhere Party]] - [[Every Ghanaian Living Everywhere Party(EGLEP)]]
# [[:en:Great Consolidated Popular Party]] - [[Great Consolidated Popular Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 23:50, 3 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''3marks''' [[Dwumadini:Opoku Akaadom Sympathy|Opoku Akaadom Sympathy]] gets '''0.6marks''' {{done}}
# [[:en:Ghana Democratic Republican Party]] - [[Ghana Democratic Republican Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 00:27, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''3marks''' {{done}}
# [[:en:Ghana Freedom Party]] - [[Ghana Freedom Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 21:18, 3 Kitawonsa 2022 (UTC) [[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''4marks''' {{done}}
# [[:en:Ghana National Party]] - [[Ghana National Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 00:29, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''3marks''' {{done}}
# [[:en:Ghana Union Movement]] - [[Ghana Union Movement]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 00:57, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''3.8marks''' {{done}}
# [[:en:Liberal Party of Ghana]] - [[Liberal Party of Ghana]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 01:52, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''3.2marks''' {{done}}
# [[:en:National Democratic Party ]] - [[National Democratic Party ]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 03:42, 6 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''3.8marks''' {{done}}
# [[:en:National Reform Party]] - [[National Reform Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 02:23, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''3.2marks''' {{done}}
# [[:en:New Vision Party ]] - [[New Vision Party ]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 02:52, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''2.2marks''' {{done}}
# [[:en:People's Action Party ]] - [[People's Action Party ]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 10:36, 30 Kitawonsa 2022 (UTC)
# [[:en:People's Destiny Party]] - [[People's Destiny Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 01:33, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''2marks''' {{done}}
# [[:en:Power Unity Party]] - [[Power Unity Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 20:06, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''2.2marks''' {{done}}
# [[:en:Progressive People's Party]] - [[Progressive People's Party]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 18:35, 27 Kitawonsa 2022 (UTC)
# [[:en:Reformed Patriotic Democrats]] - [[Reformed Patriotic Democrats]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 04:02, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''2.4marks''' {{done}}
# [[:en:United Democratic Party]] - [[United Democratic Party]]
# [[:en:United Development System Party]] - [[United Development System Party]] [[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 22:50, 3 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''2marks''' {{done}}
# [[:en:United Front Party]] - [[United Front Party]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 14:55, 30 Kitawonsa 2022 (UTC)
# [[:en:United Ghana Movement]] - [[United Ghana Movement]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:23, 7 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3.2marks''' {{done}}
# [[:en:United Progressive Party]] - [[United Progressive Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 08:02, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''3.4marks''' {{done}}
# [[:en:United Renaissance Party]] - [[United Renaissance Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 03:17, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''2marks''' {{done}}
# [[:en:Yes People's Party]] - [[Yes People's Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 19:57, 3 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''2marks''' {{done}}
# [[:en:Ghana Redevelopment Party]] - [[Ghana Redevelopment Party]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:40, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''2marks''' {{done}}
# [[:en:Independent People's Party]] - [[Independent People's Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 23:37, 3 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''2.6marks''' {{done}}
# [[:en:National Convention Party]] - [[National Convention Party]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 06:31, 5 Kitawonsa 2022 (UTC)
# [[:en:National Independence Party ]] - [[National Independence Party ]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 00:59, 9 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''4marks''' {{done}}
# [[:en:People's Convention Party ]] - [[People's Convention Party ]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 06:35, 5 Kitawonsa 2022 (UTC)[[Dwumadini:Nana Sintim|Nana Sintim]] gets '''1.4marks''' {{done}}
# [[:en:People's Heritage Party ]] - [[People's Heritage Party ]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:40, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''2.2marks''' {{done}}
# [[:en:United Love Party ]] - [[United Love Party ]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:45, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3.2marks''' {{done}}
# [[:en:Action Congress Party]] - [[Action Congress Party]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:40, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''2.3marks {{done}}
# [[:en:All People's Party]] - [[All People's Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 14:04, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''3.2marks''' {{done}}
# [[:en:People's National Party]] - [[People's National Party]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 22:36, 30 Kitawonsa 2022 (UTC)
# [[:en:Popular Front Party]] - [[Popular Front Party]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:40, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''2.6marks''' {{done}}
# [[:en:Social Democratic Front ]] - [[Social Democratic Front ]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 00:41, 9 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''1mark''' {{done}}
# [[:en:Third Force Party]] - [[Third Force Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 19:59, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''1mark''' {{done}}
# [[:en:United National Convention ]] - [[United National Convention ]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 23:18, 5 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''1.8marks''' {{done}}
# [[:en:All People's Republican Party ]] - [[All People's Republican Party ]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 00:47, 9 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''1mark''' {{done}}
# [[:en:Justice Party ]] - [[Justice Party ]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 15:04, 30 Kitawonsa 2022 (UTC)
# [[:en:National Alliance of Liberals]] - [[National Alliance of Liberals]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:40, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''2.8marks''' {{done}}
# [[:en:People's Action Party]] [[People's Action Party]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 10:31, 30 Kitawonsa 2022 (UTC)
# [[:en:Progress Party]] - [[Progress Party]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 14:55, 30 Kitawonsa 2022 (UTC)
# [[:en:United Nationalist Party ]] - [[United Nationalist Party ]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 14:55, 30 Kitawonsa 2022 (UTC)
# [[:en:United Party ]] - [[United Party ]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 22:08, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Afia360|Afia360]] gets '''3marks''' {{done}}
# [[:en:United Gold Coast Convention]] - [[United Gold Coast Convention]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:40, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Anlo Youth Organization]] - [[Anlo Youth Organization]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:40, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Federation of Youth Organization]] - [[Federation of Youth Organization]][[Dwumadini:AC Krah|AC Krah]] gets '''2.8marks''' {{done}}
# [[:en:Ghana Congress Party]] - [[Ghana Congress Party]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:14, 9 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''2.8marks''' {{done}}
# [[:en:Muslim Association Party]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 23:14, 5 Kitawonsa 2022 (UTC) - [[Muslim Association Party]][[Dwumadini:Nana Sintim|Nana Sintim]] gets '''2.2marks''' {{done}}
# [[:en:National Liberation Movement ]] - [[National Liberation Movement ]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 23:44, 27 Kitawonsa 2022 (UTC)
# [[:en:Northern People's Party ]] - [[Northern People's Party ]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 22:36, 30 Kitawonsa 2022 (UTC)
# [[:en:Togoland Congress]] - [[Togoland Congress]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 04:31, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''1.6marks''' {{done}}
# [[:en:Greater Accra Region]] - [[Greater Accra Region]]
# [[:en:Eastern Region]] - [[Eastern Region]]
# [[:en:Ahafo Region]] - [[Ahafo Mantam]][[Dwumadini:Rsaawah|Rsaawah]] ([[Dwumadini nkitahode:Rsaawah|Nkitahode beaɛ]]) 12:38, 5 Kitawonsa 2022 (UTC)[[Dwumadini:Rsaawah|Rsaawah]] gets '''4marks''' {{done}}
# [[:en:Ashanti Region]] - [[Ashanti Region]]
# [[:en:Bono East Region]] - [[Bono East Region]][[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Brong Ahafo Region]] - [[Brong Ahafo Mantam]][[Dwumadini:S A Habadah|S A Habadah]] ([[Dwumadini nkitahode:S A Habadah|Nkitahode beaɛ]])[[Dwumadini:S A Habadah|S A Habadah]] gets '''4marks''' {{done}}
# [[:en:Central Region]] - [[Central Region]][[Dwumadini:Rsaawah|Rsaawah]] gets '''4marks''' {{done}}
# [[:en:North-East Region]] - [[North-East Region]]
# [[:en:Northern Region]] - [[Northern Region]]
# [[:en:Oti Region]] - [[Oti Region]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:23, 7 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Savannah Region]] - [[Savannah Region]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:23, 7 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Upper East Region]] - [[Upper East Region]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:23, 7 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Upper West Region]] - [[Upper West Region]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:23, 7 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Western Region]] - [[Western Region]]
# [[:en:Western North Region]] - [[Western North Region]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:23, 7 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Volta Region]] - [[Volta Region]]
# [[:en:Kumasi]] - [[Kumasi]] 
# [[:en:Sunyani]] - [[Sunyani]]
# [[:en:Techiman]] - [[Techiman]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 08:17, 7 Kitawonsa 2022 (UTC)[[Dwumadini:Afia360|Afia360]] gets '''3marks {{not done}}
# [[:en:Goaso]] - [[Goaso]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:05, 5 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Cape Coast]] - [[Cape Coast]][[Dwumadini:Rsaawah|Rsaawah]] ([[Dwumadini nkitahode:Rsaawah|Nkitahode beaɛ]]) 10:32, 7 Kitawonsa 2022 (UTC)[[Dwumadini:Rsaawah|Rsaawah]] gets '''4marks''' {{done}}
# [[:en:Kofiridua]] - [[Kofiridua]]
# [[:en:Accra]] - [[Accra]] 
# [[:en:Tamale]] - [[Tamale]]
# [[:en:Damongo]] - [[Damongo]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:23, 7 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3.6marks''' {{done}}}
# [[:en:Nalerigu]] - [[Nalerigu]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:05, 5 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Bolgatanga]] - [[Bolgatanga]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 22:37, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Wa]] - [[Wa]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 13:36, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Nana Sintim|Nana Sintim]] gets '''3marks''' {{done}}
# [[:en:Ho]] - [[Ho]]
# [[:en:Dambai]] - [[Dambai]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:01, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Takoradi]] - [[Takoradi]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:01, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Wiawso]] - [[Wiawso]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:01, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}

=='''Adwuma ho nsɛmfua (Work related terminologies)'''==
# [[:en:Teacher]] - [[Ɔkyerɛkyerɛni]] [[Dwumadini: Christian|Christian]]
# [[:en:Farmer]] - [[Ɔkuani]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:17, 9 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3marks''' {{done}}
# [[:en:Blacksmith]] - [[Ɔtomfoɔ]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:36, 24 Kitawonsa 2022 (UTC)
# [[:en: Boxer]] - [[Akuturukubɔfoɔ]]
# [[:en:Butcher]] - [[Nankwaaseni]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 18:26, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''3.2marks''' {{done}}
# [[:en:Banker]] - [[Sikakorabea adwumayɛni]]
# [[:en:Wood worker]] - [[Dua dwomfoɔ]][[Dwumadini:AC Krah|AC Krah]] gets '''3marks''' {{done}}
# [[:en:Doctor]] - [[Ɔyaresafoɔ /Dokota]]
# [[:en:Driver]] - [[Ɔhyenkani /Ɔhyenkafoɔ]]
# [[:en:Judge]] - [[Ɔtenmuafoɔ ]]
# [[:en:Jury]] - [[Apamfoɔ]]
# [[:en:Lawyer]] - [[Mmaranimni]]
# [[:en:Mason]] - [[Ɔdansifoɔ]]
# [[:en:Nurse]] - [[Ayaresadwumamu boafoɔ / Nɛɛse]]
# [[:en:Pharmacist]] - [[Oduyɛfoɔ]]
# [[:en:President]] - [[Ɔmanpanin]]
# [[:en:Fashion designer]] - [[Adepamni]]
# [[:en:Seamstress]] - [[Ɔbaa adepamni]][[Dwumadini:Rsaawah|Rsaawah]] gets '''2marks''' {{done}}
# [[:en:Secretary]] - [[Ɔtwerɛtwerɛfoɔ / Ɔtwerɛtwerɛni]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 00:48, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''3marks''' {{done}}
# [[:en:Security]] - [[Ɔwɛnfoɔ]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 00:18, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''3marks''' {{done}}
# [[:en:Trader]] - [[Ɔdwadini]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 00:55, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''2marks''' {{done}}
# [[:en:Secondary School]] - [[Ntoasoɔ Sukuu]] [[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 18:11, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''3marks''' {{done}}
# [[:en:University]] - [[Suapɔn]] [[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 16:22, 17 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''3marks''' {{done}}

=='''Abusuabɔ ho nsɛmfua (Family related terminologies)'''==
# [[:en:Family]] - [[Abusua]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 11:16, 24 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]]gets '''4marks''' {{done}}[[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 00:19, 11 Kitawonsa 2022 (UTC)
# [[:en:Family member]] - [[Abusuani]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 11:18, 24 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]]gets '''4marks''' {{done}}
# [[:en:Family head]] - [[Abusuapanin]]
# [[:en:Parents]] - [[Awofoɔ]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:49, 25 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]]gets '''3marks''' {{done}}
# [[:en:Man]] - [[ɔbarima]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]])[[Dwumadini:Afriyie34|Afriyie34]]gets '''3marks''' {{done}}
# [[:en:Woman]] - [[ɔbaa]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 08:02, 26 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]]gets '''4marks''' {{done}}
# [[:en:Father]] - [[Agya]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 10:52, 26 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]]gets '''4marks''' {{done}}
# [[:en:Mother]] - [[Maame]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 18:29, 26 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3marks''' {{done}}
# [[:en:Baby]] - [[Akwadaa]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 05:27, 28 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]]gets '''4marks''' {{done}}
# [[:en:Siblings]] - [[Anuanom]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 17:38, 28 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]]gets '''4marks''' {{done}}
# [[:en:Sister]] - [[Nua baa]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 18:47, 29 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3marks''' {{done}}
# [[:en:Brother]] - [[Nua bɛrima]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 17:06, 29 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''4marks''' {{done}}
# [[:en:Grandmother]] - [[Nana baa]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 03:45, 30 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''4marks''' {{done}}
# [[:en:Grandfather]] - [[Nana bɛrima]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 14:32, 30 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''4marks''' {{done}}
# [[:en:Sister-inlaw]] - [[Akumaa]]
# [[:en:Rivals]] - [[Akorafoɔ]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 22:19, 29 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3marks''' {{done}}
# [[:en:Boy]] - [[Abɛrimaa]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:01, 28 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3marks''' {{done}}
# [[:en:Girl]] - [[Abaayewa]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:01, 28 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3marks''' {{done}}
# [[:en:Widow]] - [[Okunafoɔ]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:05, 28 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3marks''' {{done}}
# [[:en:Son]] - [[ɔbabɛrima]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:05, 28 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''2.4marks''' {{done}}
# [[:en:Daugther]] - [[ɔbabaa]]
# [[:en:Adopted child]] - [[Abanoma]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 12:19, 31 Kitawonsa 2022 (UTC)
# [[:en:Orphan]] - [[Agyanka]]
# [[:en:Twins]] - [[Ntaafoɔ]]
# [[:en:Triplet]] - [[Ahenasa]]
# [[:en:Friendship]] - [[Adamfofa]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:04, 31 Kitawonsa 2022 (UTC)
# [[:en:Dating]] - [[Mpenatweɛ]]
# [[:en:Royal]] - [[Dehyeɛ]]
# [[:en:Old man]] - [[Akɔkora]]
# [[:en:Old woman]] - [[Aberewa]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 01:19, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''2marks''' {{done}}
# [[:en:Firstborn child]] - [[Piesie]]
# [[:en:Lastborn child]] - [[Kaakyire]]
# [[:en:Young woman]] - [[Ababaawa]]
# [[:en:Young man]] - [[Abranteɛ]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 01:08, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''2marks''' {{done}}

=='''Apɔmuden ho nsɛmfua (Health related terminologies)'''==
# [[:en:Health]] - [[Apowmuden]]
# [[:en:Sickness]] - [[Yareɛ]]
# [[:en:Diseases]] - [[Nyarewa]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 18:53, 29 Kitawonsa 2022 (UTC)
# [[:en:Hospital]] - [[Ayaresabea]][[Dwumadini:Antwiaa1996|Antwiaa1996]] ([[Dwumadini nkitahode:Antwiaa1996|Nkitahode beaɛ]]) 10:11, 13 Kitawonsa 2022 (UTC)
# [[:en:Syringe]] - [[Paneɛ]]
# [[:en:Medicine]] - [[Aduro]]
# [[:en:Herbalist]] - [[Odunsini]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:37, 24 Kitawonsa 2022 (UTC)
# [[:en:Itch]] - [[Ahokeka]]
# [[:en:Whooping cough]] - [[Nsamanwa]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 18:31, 26 Kitawonsa 2022 (UTC)
# [[:en:Headache]] - [[Tipayɛ]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 18:53, 29 Kitawonsa 2022 (UTC)
# [[:en:Stomach ache]] - [[Yafunu yareɛ]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 18:31, 26 Kitawonsa 2022 (UTC)
# [[:en:Constipation]] - [[Ayamtim]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 08:58, 11 Kitawonsa 2022 (UTC)
# [[:en:Diabetes]] - [[Asikyireyareɛ]]
# [[:en:Cholera]] - [[Ayamtunini/Kɔlera]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 18:53, 29 Kitawonsa 2022 (UTC)
# [[:en:Goiter]] - [[Kɔmpɔ]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:23, 22 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:22, 22 Kitawonsa 2022 (UTC)
# [[:en:Gonorrhea]] - [[Babaso]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:02, 28 Kitawonsa 2022 (UTC)
# [[:en:Cancer]] - [[Kokoram]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 15:19, 31 Kitawonsa 2022 (UTC)
# [[:en:Rheumatism]] - [[Sasabrɔ]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 18:31, 26 Kitawonsa 2022 (UTC)
# [[:en:Convulsion]] - [[Asensene]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 18:31, 26 Kitawonsa 2022 (UTC)
# [[:en:Asthma]] - [[Ntehyeewa]]
# [[:en:Cripple]] - [[Bafan]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:37, 24 Kitawonsa 2022 (UTC)
# [[:en:Muteness]] - [[Emum]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 16:55, 17 Kitawonsa 2022 (UTC)
# [[:en:Blindness]] - [[Anifra]]
# [[:en:Kwashiokor]] - [[Kwashiokor]]
# [[:en:Malaria]] - [[Atiridii yare]]
# [[:en:Paralysis]] - [[Mmubuo]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:09, 22 Kitawonsa 2022 (UTC)
# [[:en:Vomitting]] - [[Ɛfeɛ]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:09, 22 Kitawonsa 2022 (UTC)
# [[:en:Hypertension]] - [[Mogyamorosoɔ]]
# [[:en:Ulcer]] - [[Ayamkuro]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:09, 22 Kitawonsa 2022 (UTC)
# [[:en:Stroke]] - [[Nnwodwoeɛ]]
# [[:en:Measles]] - [[Ntoboro]]
# [[:en:Eczema]] - [[Ɛkrɔ]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:34, 14 Kitawonsa 2022 (UTC)
# [[:en:Rashes]] - [[Nsawansawa]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 08:58, 11 Kitawonsa 2022 (UTC)
# [[:en:Ringworm]] - [[Kakawirewire]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 16:45, 17 Kitawonsa 2022 (UTC)

=='''Atenaeɛ ho nsɛmfua (Environmental related terminologies)'''==
Environmental related
# [[:en:Buildings]] - [[Adan]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:10, 12 Kitawonsa 2022 (UTC)
# [[:en:Trees]] - [[Nnua]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 18:56, 28 Kitawonsa 2022 (UTC)
# [[:en:Flowers]] - [[Nhweren]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 18:56, 28 Kitawonsa 2022 (UTC)
# [[:en:Animals]] - [[Mmoa]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 18:56, 28 Kitawonsa 2022 (UTC)
# [[:en:Humans]] - [[Nnipa]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:32, 12 Kitawonsa 2022 (UTC)
# [[:en:Clouds]] - [[Ewiem]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 18:56, 28 Kitawonsa 2022 (UTC)
# [[:en:Air]] - [[Nframa]]
# [[:en:Machines]] - [[Afidie]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 05:03, 29 Kitawonsa 2022 (UTC)
# [[:en:River]] - [[Nsutene]][[Dwumadini:Mbaidoo|Mbaidoo]] ([[Dwumadini nkitahode:Mbaidoo|Nkitahode beaɛ]]) 14:43, 14 Kitawonsa 2022 (UTC)
# [[:en:Sea]] - [[Ɛpo]][[Dwumadini:Mbaidoo|Mbaidoo]] ([[Dwumadini nkitahode:Mbaidoo|Nkitahode beaɛ]]) 14:43, 14 Kitawonsa 2022 (UTC)
# [[:en:Car]] - [[Ɛhyɛn]][[Dwumadini:Mbaidoo|Mbaidoo]] ([[Dwumadini nkitahode:Mbaidoo|Nkitahode beaɛ]]) 14:43, 14 Kitawonsa 2022 (UTC)
# [[:en:Train]] - [[Keteke]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 23:01, 20 Kitawonsa 2022 (UTC)
# [[:en:Canoe]] - [[Kudoɔ]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 13:48, 24 Kitawonsa 2022 (UTC)
# [[:en:Ship ]] - [[Suhyɛn]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 13:48, 24 Kitawonsa 2022 (UTC)
# [[:en:Aircraft/aeroplane]] - [[Wiemhyɛn]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 16:50, 19 Kitawonsa 2022 (UTC)
# [[:en:Airport]] - [[Wiemhyɛn gyinabea]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 16:27, 17 Kitawonsa 2022 (UTC)
# [[:en:Port/harbor]] - [[Suhyɛn gyinabea]]
# [[:en:Train station]] - [[Keteke gyinabea]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:34, 14 Kitawonsa 2022 (UTC)
# [[:en:Forest]] - [[Kwaeɛ]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 23:01, 20 Kitawonsa 2022 (UTC)
# [[:en:Court]] - [[Asɛm dibea]]
# [[:en:Church building]] - [[Asɔre dan]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:34, 14 Kitawonsa 2022 (UTC)
# [[:en:Church]] - [[Asɔre]] 
# [[:en:Mosque]] - [[Nkramosom dan]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:38, 24 Kitawonsa 2022 (UTC)
# [[:en:Muslim]] - [[Nkramoni]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:38, 24 Kitawonsa 2022 (UTC)
# [[:en:Islam]] - [[Nkramosom]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:38, 24 Kitawonsa 2022 (UTC)
# [[:en:Christian]] - [[Kristoni]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 13:48, 24 Kitawonsa 2022 (UTC)
# [[:en:Christianity]] - [[Kristosom]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 13:48, 24 Kitawonsa 2022 (UTC)
# [[:en:Rainbow]] - [[Nyankontɔn]]
# [[:en:Gun]] - [[Etuo]]
# [[:en:Water]] - [[Nsuo]]
# [[:en:Railway]] - [[Keteke kwan]]
# [[:en:Road]] - [[Lɔre kwan]]
# [[:en:Stadium]] - [[Agoprama]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 16:50, 19 Kitawonsa 2022 (UTC)
# [[:en:Market]] - [[Aguaso]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:20, 31 Kitawonsa 2022 (UTC)
# [[:en:Land]] - [[Asaase]]
# [[:en:Mountain]] - [[Bepɔ]] 
# [[:en:Sun]] - [[Awia]]
# [[:en:Moon]] - [[Bosome]]
# [[:en:Star]] - [[Nsoroma]][[Dwumadini:Ebensarfo|Ebensarfo]] ([[Dwumadini nkitahode:Ebensarfo|Nkitahode beaɛ]]) 16:50, 19 Kitawonsa 2022 (UTC)
# [[:en:Birds]] - [[Nnomaa]][[Dwumadini:Ebensarfo|Ebensarfo]] ([[Dwumadini nkitahode:Ebensarfo|Nkitahode beaɛ]]) 15:39, 19 Kitawonsa 2022 (UTC)</text>
      <sha1>hdipp9ue1vcb76i0dkeqb7a0kuk9efz</sha1>
    </revision>
    <revision>
      <id>133033</id>
      <parentid>132980</parentid>
      <timestamp>2022-08-01T03:21:24Z</timestamp>
      <contributor>
        <username>Nana Sintim</username>
        <id>11223</id>
      </contributor>
      <comment>/* Atenaeɛ ho nsɛmfua (Environmental related terminologies) */</comment>
      <model>wikitext</model>
      <format>text/x-wiki</format>
      <text bytes="38360" xml:space="preserve">=='''Entries'''==
*''Type  '''&lt;nowiki&gt;~~~~&lt;/nowiki&gt;''' next to the article(s) '''you have worked on''' and click '''publish changes'''.''
*A facilitator will review '''Twi Wikipedia, Wikicommons and Wikidata items''' and add {{Wei}} If the entry worked on meets the rules.

=='''Mmarahyɛbadwam ho nsɛm (Parliamentary related terminologies)'''==
# [[:en:Elections]] - [[Abatoɔ]]
# [[:en:Parliament]] - [[Mmarahyɛbadwafie]] [[Dwumadini:Opoku Akaadom Sympathy|Opoku Akaadom Sympathy]] ([[Dwumadini nkitahode:Opoku Akaadom Sympathy|Nkitahode beaɛ]]) 17:11, 4 Kitawonsa 2022 (UTC) [[Dwumadini:Opoku Akaadom Sympathy|Opoku Akaadom Sympathy]] gets '''3marks''' {{not done}}
# [[:en:Member of Parliament]] - [[Mmarahyɛbadwani]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 12:59, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Nana Sintim|Nana Sintim]] gets '''3.6marks''' {{done}}
# [[:en:Law]] - [[Mmara]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 21:37, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Nana Sintim|Nana Sintim]] gets '''3marks''' {{not done}}
# [[:en:Constitution]] - [[Amanmmara]] [[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 19:10, 16 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''3marks''' {{not done}}
# [[:en:Speaker of Parliament]] - [[Mmarahyɛbadwafie Kasamafoɔ]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 06:29, 5 Kitawonsa 2022 (UTC)[[Dwumadini:Nana Sintim|Nana Sintim]] gets '''4marks''' {{done}}
# [[:en:Justice]] - [[Atɛntenee]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:00, 24 Kitawonsa 2022 (UTC)
# [[:en:Corruption]] - [[Porɔɛe]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 23:49, 29 Kitawonsa 2022 (UTC)
# [[:en: Bribery]] - [[Kɛtɛasehyɛ]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 23:49, 29 Kitawonsa 2022 (UTC)
# [[:en: Constituency]] - [[Mpasua]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:40, 4 Kitawonsa 2022 (UTC) [[Dwumadini:AC Krah|AC Krah]] gets '''2.4marks''' {{not done}}
# [[:en: Amendment]] - [[Nsakraeɛ]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 06:58, 8 Kitawonsa 2022 (UTC) [[Dwumadini:Afia360|Afia360]] gets '''3.6marks''' {{done}}
# [[:en: President]] - [[Ɔmanpanin]]
# [[:en: Appoint]] - [[Y'apaw Obi]] [[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 18:09, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] '''2.6marks''' {{not done}}
# [[:en: Bylaws]] - [[Mmaranketewa]]
# [[:en: Minister]] - [[Mansoafoɔ]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 08:49, 30 Kitawonsa 2022 (UTC)
# [[:en:Minority]] - [[Ɛdɔm kumaa]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 07:19, 5 Kitawonsa 2022 (UTC)[[Dwumadini:Afia360|Afia360]]'''3.5marks''' {{done}}
# [[:en:Majority]] - [[Ɛdɔm kɛseɛ]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 23:21, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Nana Sintim|Nana Sintim]] gets '''3.6marks''' {{done}}
# [[:en:Court]] - [[Asɛmdibia]]
# [[:en:Minority Leader]] - [[Ɛdɔm Kumaa Panin]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 07:19, 5 Kitawonsa 2022 (UTC)[[Dwumadini:Afia360|Afia360]] gets '''2.8marks''' [[Dwumadini:Nana Sintim|Nana Sintim]] gets '''0.6marks'''{{not done}}
# [[:en:Majority Leader]] - [[Ɛdɔm kɛseɛ Panin]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 07:19, 5 Kitawonsa 2022 (UTC)[[Dwumadini:Afia360|Afia360]] gets '''2marks''' {{done}}
# [[:en:Democracy]] - [[Kabi-Ma-Menkabi]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 18:35, 27 Kitawonsa 2022 (UTC)
# [[:en:Prime Minister]] - [[Man soafo panyin]]
# [[:en:Municipality ]] - [[Munisipal]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 17:01, 9 Kitawonsa 2022 (UTC)
# [[:en:District]] - [[Mansini]] [[Dwumadini:Afriyie34|Afriyie34]] gets '''3marks''' {{done}}
# [[:en:Deputy Minister]] - [[Soafo Abadiakyiri]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:14, 9 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3marks''' {{done}}
# [[:en:Politician]] - [[Amammuifo]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 08:57, 11 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3.2marks''' {{done}}
# [[:en:Political Party]] - [[Amanyɔ kuo]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 19:13, 13 Kitawonsa 2022 (UTC)[[Dwumadini:Afia360|Afia360]] gets '''2marks''' {{not done}}
# [[:en:New Patriotic Party]] - [[New Patriotic Party (NPP)]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 22:20, 5 Kitawonsa 2022 (UTC)[[Dwumadini:Nana Sintim|Nana Sintim]] gets '''4marks {{done}}
# [[:en:Republic]] - [[Adehyeman]]
# [[:en:National Democratic Congress]] - [[National Democratic Congress (NDC)]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 14:19, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Afia360|Afia360]] gets '''4marks'''{{done}}
# [[:en:Convention People's Party]] - [[Convention People's Party (CPP)]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 11:05, 23 Kitawonsa 2022 (UTC)
# [[:en:People's National Convention]] - [[People's National Convention (PNC)]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 22:47, 3 Kitawonsa 2022 (UTC)[[Dwumadini:Afia360|Afia360]] gets '''2marks''' {{not done}}
# [[:en:All People's Congress]] - [[All People's Congress (APC)]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 10:01, 30 Kitawonsa 2022 (UTC)
# [[:en:Democratic Freedom Party]] - [[Democratic Freedom Party (DFP)]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 23:39, 3 Kitawonsa 2022 (UTC)[[Dwumadini:Afia360|Afia360]] gets '''4marks''' {{done}}
# [[:en:Democratic People's Party]] - [[Democratic People's Party (DPP)]] [[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''4marks''' {{done}}
# [[:en:Every Ghanaian Living Everywhere Party]] - [[Every Ghanaian Living Everywhere Party(EGLEP)]]
# [[:en:Great Consolidated Popular Party]] - [[Great Consolidated Popular Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 23:50, 3 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''3marks''' [[Dwumadini:Opoku Akaadom Sympathy|Opoku Akaadom Sympathy]] gets '''0.6marks''' {{done}}
# [[:en:Ghana Democratic Republican Party]] - [[Ghana Democratic Republican Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 00:27, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''3marks''' {{done}}
# [[:en:Ghana Freedom Party]] - [[Ghana Freedom Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 21:18, 3 Kitawonsa 2022 (UTC) [[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''4marks''' {{done}}
# [[:en:Ghana National Party]] - [[Ghana National Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 00:29, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''3marks''' {{done}}
# [[:en:Ghana Union Movement]] - [[Ghana Union Movement]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 00:57, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''3.8marks''' {{done}}
# [[:en:Liberal Party of Ghana]] - [[Liberal Party of Ghana]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 01:52, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''3.2marks''' {{done}}
# [[:en:National Democratic Party ]] - [[National Democratic Party ]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 03:42, 6 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''3.8marks''' {{done}}
# [[:en:National Reform Party]] - [[National Reform Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 02:23, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''3.2marks''' {{done}}
# [[:en:New Vision Party ]] - [[New Vision Party ]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 02:52, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''2.2marks''' {{done}}
# [[:en:People's Action Party ]] - [[People's Action Party ]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 10:36, 30 Kitawonsa 2022 (UTC)
# [[:en:People's Destiny Party]] - [[People's Destiny Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 01:33, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''2marks''' {{done}}
# [[:en:Power Unity Party]] - [[Power Unity Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 20:06, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''2.2marks''' {{done}}
# [[:en:Progressive People's Party]] - [[Progressive People's Party]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 18:35, 27 Kitawonsa 2022 (UTC)
# [[:en:Reformed Patriotic Democrats]] - [[Reformed Patriotic Democrats]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 04:02, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''2.4marks''' {{done}}
# [[:en:United Democratic Party]] - [[United Democratic Party]]
# [[:en:United Development System Party]] - [[United Development System Party]] [[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 22:50, 3 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''2marks''' {{done}}
# [[:en:United Front Party]] - [[United Front Party]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 14:55, 30 Kitawonsa 2022 (UTC)
# [[:en:United Ghana Movement]] - [[United Ghana Movement]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:23, 7 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3.2marks''' {{done}}
# [[:en:United Progressive Party]] - [[United Progressive Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 08:02, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''3.4marks''' {{done}}
# [[:en:United Renaissance Party]] - [[United Renaissance Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 03:17, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''2marks''' {{done}}
# [[:en:Yes People's Party]] - [[Yes People's Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 19:57, 3 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''2marks''' {{done}}
# [[:en:Ghana Redevelopment Party]] - [[Ghana Redevelopment Party]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:40, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''2marks''' {{done}}
# [[:en:Independent People's Party]] - [[Independent People's Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 23:37, 3 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''2.6marks''' {{done}}
# [[:en:National Convention Party]] - [[National Convention Party]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 06:31, 5 Kitawonsa 2022 (UTC)
# [[:en:National Independence Party ]] - [[National Independence Party ]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 00:59, 9 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''4marks''' {{done}}
# [[:en:People's Convention Party ]] - [[People's Convention Party ]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 06:35, 5 Kitawonsa 2022 (UTC)[[Dwumadini:Nana Sintim|Nana Sintim]] gets '''1.4marks''' {{done}}
# [[:en:People's Heritage Party ]] - [[People's Heritage Party ]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:40, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''2.2marks''' {{done}}
# [[:en:United Love Party ]] - [[United Love Party ]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:45, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3.2marks''' {{done}}
# [[:en:Action Congress Party]] - [[Action Congress Party]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:40, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''2.3marks {{done}}
# [[:en:All People's Party]] - [[All People's Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 14:04, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''3.2marks''' {{done}}
# [[:en:People's National Party]] - [[People's National Party]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 22:36, 30 Kitawonsa 2022 (UTC)
# [[:en:Popular Front Party]] - [[Popular Front Party]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:40, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''2.6marks''' {{done}}
# [[:en:Social Democratic Front ]] - [[Social Democratic Front ]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 00:41, 9 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''1mark''' {{done}}
# [[:en:Third Force Party]] - [[Third Force Party]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 19:59, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''1mark''' {{done}}
# [[:en:United National Convention ]] - [[United National Convention ]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 23:18, 5 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''1.8marks''' {{done}}
# [[:en:All People's Republican Party ]] - [[All People's Republican Party ]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 00:47, 9 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''1mark''' {{done}}
# [[:en:Justice Party ]] - [[Justice Party ]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 15:04, 30 Kitawonsa 2022 (UTC)
# [[:en:National Alliance of Liberals]] - [[National Alliance of Liberals]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:40, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''2.8marks''' {{done}}
# [[:en:People's Action Party]] [[People's Action Party]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 10:31, 30 Kitawonsa 2022 (UTC)
# [[:en:Progress Party]] - [[Progress Party]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 14:55, 30 Kitawonsa 2022 (UTC)
# [[:en:United Nationalist Party ]] - [[United Nationalist Party ]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 14:55, 30 Kitawonsa 2022 (UTC)
# [[:en:United Party ]] - [[United Party ]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 22:08, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Afia360|Afia360]] gets '''3marks''' {{done}}
# [[:en:United Gold Coast Convention]] - [[United Gold Coast Convention]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:40, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Anlo Youth Organization]] - [[Anlo Youth Organization]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:40, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Federation of Youth Organization]] - [[Federation of Youth Organization]][[Dwumadini:AC Krah|AC Krah]] gets '''2.8marks''' {{done}}
# [[:en:Ghana Congress Party]] - [[Ghana Congress Party]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:14, 9 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''2.8marks''' {{done}}
# [[:en:Muslim Association Party]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 23:14, 5 Kitawonsa 2022 (UTC) - [[Muslim Association Party]][[Dwumadini:Nana Sintim|Nana Sintim]] gets '''2.2marks''' {{done}}
# [[:en:National Liberation Movement ]] - [[National Liberation Movement ]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 23:44, 27 Kitawonsa 2022 (UTC)
# [[:en:Northern People's Party ]] - [[Northern People's Party ]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 22:36, 30 Kitawonsa 2022 (UTC)
# [[:en:Togoland Congress]] - [[Togoland Congress]][[Dwumadini:Daniella Damptey|Daniella Damptey]] ([[Dwumadini nkitahode:Daniella Damptey|Nkitahode beaɛ]]) 04:31, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Daniella Damptey|Daniella Damptey]] gets '''1.6marks''' {{done}}
# [[:en:Greater Accra Region]] - [[Greater Accra Region]]
# [[:en:Eastern Region]] - [[Eastern Region]]
# [[:en:Ahafo Region]] - [[Ahafo Mantam]][[Dwumadini:Rsaawah|Rsaawah]] ([[Dwumadini nkitahode:Rsaawah|Nkitahode beaɛ]]) 12:38, 5 Kitawonsa 2022 (UTC)[[Dwumadini:Rsaawah|Rsaawah]] gets '''4marks''' {{done}}
# [[:en:Ashanti Region]] - [[Ashanti Region]]
# [[:en:Bono East Region]] - [[Bono East Region]][[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Brong Ahafo Region]] - [[Brong Ahafo Mantam]][[Dwumadini:S A Habadah|S A Habadah]] ([[Dwumadini nkitahode:S A Habadah|Nkitahode beaɛ]])[[Dwumadini:S A Habadah|S A Habadah]] gets '''4marks''' {{done}}
# [[:en:Central Region]] - [[Central Region]][[Dwumadini:Rsaawah|Rsaawah]] gets '''4marks''' {{done}}
# [[:en:North-East Region]] - [[North-East Region]]
# [[:en:Northern Region]] - [[Northern Region]]
# [[:en:Oti Region]] - [[Oti Region]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:23, 7 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Savannah Region]] - [[Savannah Region]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:23, 7 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Upper East Region]] - [[Upper East Region]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:23, 7 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Upper West Region]] - [[Upper West Region]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:23, 7 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Western Region]] - [[Western Region]]
# [[:en:Western North Region]] - [[Western North Region]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:23, 7 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Volta Region]] - [[Volta Region]]
# [[:en:Kumasi]] - [[Kumasi]] 
# [[:en:Sunyani]] - [[Sunyani]]
# [[:en:Techiman]] - [[Techiman]][[Dwumadini:Afia360|Afia360]] ([[Dwumadini nkitahode:Afia360|Nkitahode beaɛ]]) 08:17, 7 Kitawonsa 2022 (UTC)[[Dwumadini:Afia360|Afia360]] gets '''3marks {{not done}}
# [[:en:Goaso]] - [[Goaso]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:05, 5 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Cape Coast]] - [[Cape Coast]][[Dwumadini:Rsaawah|Rsaawah]] ([[Dwumadini nkitahode:Rsaawah|Nkitahode beaɛ]]) 10:32, 7 Kitawonsa 2022 (UTC)[[Dwumadini:Rsaawah|Rsaawah]] gets '''4marks''' {{done}}
# [[:en:Kofiridua]] - [[Kofiridua]]
# [[:en:Accra]] - [[Accra]] 
# [[:en:Tamale]] - [[Tamale]]
# [[:en:Damongo]] - [[Damongo]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:23, 7 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3.6marks''' {{done}}}
# [[:en:Nalerigu]] - [[Nalerigu]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:05, 5 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Bolgatanga]] - [[Bolgatanga]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 22:37, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Wa]] - [[Wa]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 13:36, 4 Kitawonsa 2022 (UTC)[[Dwumadini:Nana Sintim|Nana Sintim]] gets '''3marks''' {{done}}
# [[:en:Ho]] - [[Ho]]
# [[:en:Dambai]] - [[Dambai]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:01, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Takoradi]] - [[Takoradi]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:01, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}
# [[:en:Wiawso]] - [[Wiawso]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:01, 4 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''4marks''' {{done}}

=='''Adwuma ho nsɛmfua (Work related terminologies)'''==
# [[:en:Teacher]] - [[Ɔkyerɛkyerɛni]] [[Dwumadini: Christian|Christian]]
# [[:en:Farmer]] - [[Ɔkuani]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 00:17, 9 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3marks''' {{done}}
# [[:en:Blacksmith]] - [[Ɔtomfoɔ]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:36, 24 Kitawonsa 2022 (UTC)
# [[:en: Boxer]] - [[Akuturukubɔfoɔ]]
# [[:en:Butcher]] - [[Nankwaaseni]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 18:26, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''3.2marks''' {{done}}
# [[:en:Banker]] - [[Sikakorabea adwumayɛni]]
# [[:en:Wood worker]] - [[Dua dwomfoɔ]][[Dwumadini:AC Krah|AC Krah]] gets '''3marks''' {{done}}
# [[:en:Doctor]] - [[Ɔyaresafoɔ /Dokota]]
# [[:en:Driver]] - [[Ɔhyenkani /Ɔhyenkafoɔ]]
# [[:en:Judge]] - [[Ɔtenmuafoɔ ]]
# [[:en:Jury]] - [[Apamfoɔ]]
# [[:en:Lawyer]] - [[Mmaranimni]]
# [[:en:Mason]] - [[Ɔdansifoɔ]]
# [[:en:Nurse]] - [[Ayaresadwumamu boafoɔ / Nɛɛse]]
# [[:en:Pharmacist]] - [[Oduyɛfoɔ]]
# [[:en:President]] - [[Ɔmanpanin]]
# [[:en:Fashion designer]] - [[Adepamni]]
# [[:en:Seamstress]] - [[Ɔbaa adepamni]][[Dwumadini:Rsaawah|Rsaawah]] gets '''2marks''' {{done}}
# [[:en:Secretary]] - [[Ɔtwerɛtwerɛfoɔ / Ɔtwerɛtwerɛni]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 00:48, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''3marks''' {{done}}
# [[:en:Security]] - [[Ɔwɛnfoɔ]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 00:18, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''3marks''' {{done}}
# [[:en:Trader]] - [[Ɔdwadini]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 00:55, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''2marks''' {{done}}
# [[:en:Secondary School]] - [[Ntoasoɔ Sukuu]] [[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 18:11, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''3marks''' {{done}}
# [[:en:University]] - [[Suapɔn]] [[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 16:22, 17 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''3marks''' {{done}}

=='''Abusuabɔ ho nsɛmfua (Family related terminologies)'''==
# [[:en:Family]] - [[Abusua]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 11:16, 24 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]]gets '''4marks''' {{done}}[[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 00:19, 11 Kitawonsa 2022 (UTC)
# [[:en:Family member]] - [[Abusuani]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 11:18, 24 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]]gets '''4marks''' {{done}}
# [[:en:Family head]] - [[Abusuapanin]]
# [[:en:Parents]] - [[Awofoɔ]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:49, 25 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]]gets '''3marks''' {{done}}
# [[:en:Man]] - [[ɔbarima]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]])[[Dwumadini:Afriyie34|Afriyie34]]gets '''3marks''' {{done}}
# [[:en:Woman]] - [[ɔbaa]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 08:02, 26 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]]gets '''4marks''' {{done}}
# [[:en:Father]] - [[Agya]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 10:52, 26 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]]gets '''4marks''' {{done}}
# [[:en:Mother]] - [[Maame]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 18:29, 26 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3marks''' {{done}}
# [[:en:Baby]] - [[Akwadaa]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 05:27, 28 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]]gets '''4marks''' {{done}}
# [[:en:Siblings]] - [[Anuanom]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 17:38, 28 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]]gets '''4marks''' {{done}}
# [[:en:Sister]] - [[Nua baa]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 18:47, 29 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3marks''' {{done}}
# [[:en:Brother]] - [[Nua bɛrima]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 17:06, 29 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''4marks''' {{done}}
# [[:en:Grandmother]] - [[Nana baa]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 03:45, 30 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''4marks''' {{done}}
# [[:en:Grandfather]] - [[Nana bɛrima]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 14:32, 30 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''4marks''' {{done}}
# [[:en:Sister-inlaw]] - [[Akumaa]]
# [[:en:Rivals]] - [[Akorafoɔ]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 22:19, 29 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3marks''' {{done}}
# [[:en:Boy]] - [[Abɛrimaa]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:01, 28 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3marks''' {{done}}
# [[:en:Girl]] - [[Abaayewa]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:01, 28 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3marks''' {{done}}
# [[:en:Widow]] - [[Okunafoɔ]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:05, 28 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''3marks''' {{done}}
# [[:en:Son]] - [[ɔbabɛrima]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:05, 28 Kitawonsa 2022 (UTC)[[Dwumadini:AC Krah|AC Krah]] gets '''2.4marks''' {{done}}
# [[:en:Daugther]] - [[ɔbabaa]]
# [[:en:Adopted child]] - [[Abanoma]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 12:19, 31 Kitawonsa 2022 (UTC)
# [[:en:Orphan]] - [[Agyanka]]
# [[:en:Twins]] - [[Ntaafoɔ]]
# [[:en:Triplet]] - [[Ahenasa]]
# [[:en:Friendship]] - [[Adamfofa]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:04, 31 Kitawonsa 2022 (UTC)
# [[:en:Dating]] - [[Mpenatweɛ]]
# [[:en:Royal]] - [[Dehyeɛ]]
# [[:en:Old man]] - [[Akɔkora]]
# [[:en:Old woman]] - [[Aberewa]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 01:19, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''2marks''' {{done}}
# [[:en:Firstborn child]] - [[Piesie]]
# [[:en:Lastborn child]] - [[Kaakyire]]
# [[:en:Young woman]] - [[Ababaawa]]
# [[:en:Young man]] - [[Abranteɛ]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 01:08, 11 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] gets '''2marks''' {{done}}

=='''Apɔmuden ho nsɛmfua (Health related terminologies)'''==
# [[:en:Health]] - [[Apowmuden]]
# [[:en:Sickness]] - [[Yareɛ]]
# [[:en:Diseases]] - [[Nyarewa]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 18:53, 29 Kitawonsa 2022 (UTC)
# [[:en:Hospital]] - [[Ayaresabea]][[Dwumadini:Antwiaa1996|Antwiaa1996]] ([[Dwumadini nkitahode:Antwiaa1996|Nkitahode beaɛ]]) 10:11, 13 Kitawonsa 2022 (UTC)
# [[:en:Syringe]] - [[Paneɛ]]
# [[:en:Medicine]] - [[Aduro]]
# [[:en:Herbalist]] - [[Odunsini]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:37, 24 Kitawonsa 2022 (UTC)
# [[:en:Itch]] - [[Ahokeka]]
# [[:en:Whooping cough]] - [[Nsamanwa]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 18:31, 26 Kitawonsa 2022 (UTC)
# [[:en:Headache]] - [[Tipayɛ]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 18:53, 29 Kitawonsa 2022 (UTC)
# [[:en:Stomach ache]] - [[Yafunu yareɛ]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 18:31, 26 Kitawonsa 2022 (UTC)
# [[:en:Constipation]] - [[Ayamtim]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 08:58, 11 Kitawonsa 2022 (UTC)
# [[:en:Diabetes]] - [[Asikyireyareɛ]]
# [[:en:Cholera]] - [[Ayamtunini/Kɔlera]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 18:53, 29 Kitawonsa 2022 (UTC)
# [[:en:Goiter]] - [[Kɔmpɔ]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:23, 22 Kitawonsa 2022 (UTC)[[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:22, 22 Kitawonsa 2022 (UTC)
# [[:en:Gonorrhea]] - [[Babaso]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:02, 28 Kitawonsa 2022 (UTC)
# [[:en:Cancer]] - [[Kokoram]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 15:19, 31 Kitawonsa 2022 (UTC)
# [[:en:Rheumatism]] - [[Sasabrɔ]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 18:31, 26 Kitawonsa 2022 (UTC)
# [[:en:Convulsion]] - [[Asensene]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 18:31, 26 Kitawonsa 2022 (UTC)
# [[:en:Asthma]] - [[Ntehyeewa]]
# [[:en:Cripple]] - [[Bafan]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:37, 24 Kitawonsa 2022 (UTC)
# [[:en:Muteness]] - [[Emum]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 16:55, 17 Kitawonsa 2022 (UTC)
# [[:en:Blindness]] - [[Anifra]]
# [[:en:Kwashiokor]] - [[Kwashiokor]]
# [[:en:Malaria]] - [[Atiridii yare]]
# [[:en:Paralysis]] - [[Mmubuo]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:09, 22 Kitawonsa 2022 (UTC)
# [[:en:Vomitting]] - [[Ɛfeɛ]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:09, 22 Kitawonsa 2022 (UTC)
# [[:en:Hypertension]] - [[Mogyamorosoɔ]]
# [[:en:Ulcer]] - [[Ayamkuro]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:09, 22 Kitawonsa 2022 (UTC)
# [[:en:Stroke]] - [[Nnwodwoeɛ]]
# [[:en:Measles]] - [[Ntoboro]]
# [[:en:Eczema]] - [[Ɛkrɔ]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:34, 14 Kitawonsa 2022 (UTC)
# [[:en:Rashes]] - [[Nsawansawa]][[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 08:58, 11 Kitawonsa 2022 (UTC)
# [[:en:Ringworm]] - [[Kakawirewire]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 16:45, 17 Kitawonsa 2022 (UTC)

=='''Atenaeɛ ho nsɛmfua (Environmental related terminologies)'''==
Environmental related
# [[:en:Buildings]] - [[Adan]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:10, 12 Kitawonsa 2022 (UTC)
# [[:en:Trees]] - [[Nnua]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 18:56, 28 Kitawonsa 2022 (UTC)
# [[:en:Flowers]] - [[Nhweren]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 18:56, 28 Kitawonsa 2022 (UTC)
# [[:en:Animals]] - [[Mmoa]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 18:56, 28 Kitawonsa 2022 (UTC)
# [[:en:Humans]] - [[Nnipa]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:32, 12 Kitawonsa 2022 (UTC)
# [[:en:Clouds]] - [[Ewiem]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 18:56, 28 Kitawonsa 2022 (UTC)
# [[:en:Air]] - [[Nframa]]
# [[:en:Machines]] - [[Afidie]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 05:03, 29 Kitawonsa 2022 (UTC)
# [[:en:River]] - [[Nsutene]][[Dwumadini:Mbaidoo|Mbaidoo]] ([[Dwumadini nkitahode:Mbaidoo|Nkitahode beaɛ]]) 14:43, 14 Kitawonsa 2022 (UTC)
# [[:en:Sea]] - [[Ɛpo]][[Dwumadini:Mbaidoo|Mbaidoo]] ([[Dwumadini nkitahode:Mbaidoo|Nkitahode beaɛ]]) 14:43, 14 Kitawonsa 2022 (UTC)
# [[:en:Car]] - [[Ɛhyɛn]][[Dwumadini:Mbaidoo|Mbaidoo]] ([[Dwumadini nkitahode:Mbaidoo|Nkitahode beaɛ]]) 14:43, 14 Kitawonsa 2022 (UTC)
# [[:en:Train]] - [[Keteke]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 23:01, 20 Kitawonsa 2022 (UTC)
# [[:en:Canoe]] - [[Kudoɔ]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 13:48, 24 Kitawonsa 2022 (UTC)
# [[:en:Ship ]] - [[Suhyɛn]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 13:48, 24 Kitawonsa 2022 (UTC)
# [[:en:Aircraft/aeroplane]] - [[Wiemhyɛn]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 16:50, 19 Kitawonsa 2022 (UTC)
# [[:en:Airport]] - [[Wiemhyɛn gyinabea]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 16:27, 17 Kitawonsa 2022 (UTC)
# [[:en:Port/harbor]] - [[Suhyɛn gyinabea]]
# [[:en:Train station]] - [[Keteke gyinabea]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:34, 14 Kitawonsa 2022 (UTC)
# [[:en:Forest]] - [[Kwaeɛ]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 23:01, 20 Kitawonsa 2022 (UTC)
# [[:en:Court]] - [[Asɛm dibea]]
# [[:en:Church building]] - [[Asɔre dan]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 23:34, 14 Kitawonsa 2022 (UTC)
# [[:en:Church]] - [[Asɔre]] 
# [[:en:Mosque]] - [[Nkramosom dan]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:38, 24 Kitawonsa 2022 (UTC)
# [[:en:Muslim]] - [[Nkramoni]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:38, 24 Kitawonsa 2022 (UTC)
# [[:en:Islam]] - [[Nkramosom]] [[Dwumadini:AC Krah|AC Krah]] ([[Dwumadini nkitahode:AC Krah|Nkitahode beaɛ]]) 20:38, 24 Kitawonsa 2022 (UTC)
# [[:en:Christian]] - [[Kristoni]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 13:48, 24 Kitawonsa 2022 (UTC)
# [[:en:Christianity]] - [[Kristosom]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 13:48, 24 Kitawonsa 2022 (UTC)
# [[:en:Rainbow]] - [[Nyankontɔn]]
# [[:en:Gun]] - [[Etuo]][[Dwumadini:Nana Sintim|Nana Sintim]] ([[Dwumadini nkitahode:Nana Sintim|Nkitahode beaɛ]]) 03:21, 1 Ɔsanaa 2022 (UTC)
# [[:en:Water]] - [[Nsuo]]
# [[:en:Railway]] - [[Keteke kwan]]
# [[:en:Road]] - [[Lɔre kwan]]
# [[:en:Stadium]] - [[Agoprama]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 16:50, 19 Kitawonsa 2022 (UTC)
# [[:en:Market]] - [[Aguaso]][[Dwumadini:Afriyie34|Afriyie34]] ([[Dwumadini nkitahode:Afriyie34|Nkitahode beaɛ]]) 13:20, 31 Kitawonsa 2022 (UTC)
# [[:en:Land]] - [[Asaase]]
# [[:en:Mountain]] - [[Bepɔ]] 
# [[:en:Sun]] - [[Awia]]
# [[:en:Moon]] - [[Bosome]]
# [[:en:Star]] - [[Nsoroma]][[Dwumadini:Ebensarfo|Ebensarfo]] ([[Dwumadini nkitahode:Ebensarfo|Nkitahode beaɛ]]) 16:50, 19 Kitawonsa 2022 (UTC)
# [[:en:Birds]] - [[Nnomaa]][[Dwumadini:Ebensarfo|Ebensarfo]] ([[Dwumadini nkitahode:Ebensarfo|Nkitahode beaɛ]]) 15:39, 19 Kitawonsa 2022 (UTC)</text>
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  </page>
  <page>
    <title>Bono East Region</title>
    <ns>0</ns>
    <id>12326</id>
    <revision>
      <id>133046</id>
      <parentid>132757</parentid>
      <timestamp>2022-08-01T09:43:01Z</timestamp>
      <contributor>
        <username>Robertjamal12</username>
        <id>8680</id>
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      <text bytes="4889" xml:space="preserve">'''Bono East mantam''' a ɛwɔ [[Gaana|Ghana]] yɛ [[Mantamu a ɛwɔ Ghana|mantam]] foforɔ a wayi afiri Brong Ahafo mantam. N'[[ahenkuro]] ne [[Techiman]].&lt;ref&gt;http://ghanaxtra.com/2019/02/confirmed-techiman-is-the-capital-of-bono-east-region.html&lt;/ref&gt; &lt;ref&gt;https://banewsgh.com/techiman-bono-east-capital/56564&lt;/ref&gt; Ɛnam Ɔsono amanyɔkuo [[New Patriotic Party]] bɔ a wɔhyɛ wɔ mfeɛ mpem mmienu ne du nsia abatoɔ mu a wɔpɛ sɛ wɔdi so so na wɔtee. Wɔnyaa aba no Nana Akuffo Addo tee asoeɛ a mantam nhyehyɛeɛ so sɛ ɔnhwɛ ɔkwan a nhyehyɛeɛ no bɛdi dwuma. Mantam nsia na wɔbɛyi afiri mantam du a ɛwɔ Ghana nom. Mantam a aka ne Bono, [[Western North Region|Western North]], [[Ahafo Mantam|Ahafo]], [[Savannah Region|Savannah]], North East ne [[Oti Region|Oti]] mantam.&lt;ref&gt;http://www.presidency.gov.gh/index.php/briefing-room/news-style-2/703-creation-of-6-new-regions-in-the-hands-of-ec-ghanaians-president-akufo-addo&lt;/ref&gt; Asoeɛ foforɔ a wɔtee a wɔfrɛ no mantam ne mpuntuo nhyehyɛeɛ a na Hon Dan Botae no na ɛboa maa mantam foforɔ a wɔpɛ sɛ wɔte no tumi yɛɛ adwuma. Ghana Aban hyɛɛ wɔn ma wɔhwɛ tee mantam foforɔ a ɛwɔ [[Gaana|Ghana]] no.&lt;ref&gt;https://web.archive.org/web/20170731040155/http://www.myjoyonline.com/politics/2017/January-11th/2nd-ministerial-list-out-akufo-addo-creates-new-ministries-re-aligns-old.php&lt;/ref&gt; Wɔ [[ɔbɛnem]] bosome wɔ mfeɛ mpem mmienu ne du nson mu no, asoeɛ no de krataa a yɛatintim so kɔɔ council of State hɔ a ɛkyerɛ sɛ wɔne afoforɔ reebɛte mantam foforɔ no. Ekuo no hyiaa mprɛ aduasa nsia firi berɛ wɔde kɔeɛ de kɔpem ɔsanaa bosome wɔ mfeɛ mpem mmienu ne du nson mu.&lt;ref&gt;https://web.archive.org/web/20171212193348/https://www.ghanacrusader.com/council-of-state-met-36-times-on-creation-of-new-regions-nana-otuo-siriboe-ii/&lt;/ref&gt; Wɔne nnipa a ɛwɔ mantam foforɔ hɔ no too aba ɛda a ɛtwatoɔ a wɔredwene kwan a wɔbɛfa so asi mantam wɔ [[ɔpɛnimaa]] bosome da a ɛtɔ so aduonu nson wɔ mfeɛ mpem mmienu ne du nnwɔtwe.&lt;ref&gt;https://web.archive.org/web/20171211071727/http://presidency.gov.gh/index.php/2017/10/06/creation-of-new-region-in-your-hands-president-akufo-addo-to-nayiri/&lt;/ref&gt;&lt;ref&gt;https://www.ghanaweb.com/GhanaHomePage/NewsArchive/EC-sets-December-27-for-referendum-on-new-regions-678786&lt;/ref&gt;

== Abakɔsɛm ==
Aba a wɔtoo wɔ ɔpɛnimaa bosome da a ɛtɔ so aduonu nson wɔ mfeɛ mpem mmienu ne du nnwɔtwe mu no nnipa mpem nan aduonum, ahannwɔte ne du mmienu na ɛtoo aba a ɛgyina hɔ ma ɔha mu nkyekyem aduowɔtwe num akyiripɔ aduowɔtwe mmienu firii mpem ahanum ne aduonu num, ahanu ne aduoson num a wɔtwerɛ wɔn din.mpem ahanan aduanan nwɔtwe, ahanum ne aduanan num(ɔha mu nkyekyem aduokron nkron akyiripɔ aduonum) na ɛtoo sɛ wɔnte mantam foforɔ a apem, ahasa ne aduowɔtwe nan to tiaa saa anamɔntuo no. Mma ahannwɔte ne aduowɔtwe mmiɛnsa (0.20%) na wɔyi firii mu.&lt;ref&gt;https://www.ghanabusinessnews.com/2018/12/29/all-six-proposed-regions-meet-constitutional-threshold-requirements-ec/&lt;/ref&gt;&lt;ref&gt;https://www.graphic.com.gh/news/politics/confirmed-results-of-the-2018-referendum-on-new-regions.html&lt;/ref&gt;&lt;ref&gt;https://www.pulse.com.gh/news/local/referendum-6-new-regions-get-massive-yes-votes/6l8qds7&lt;/ref&gt;

== Asaase ne emu nnipa ho adesua ne ewiem nsakraeɛ ==
'''Baabi a ɛwɔ ne ne su'''

Bono East mantam wɔ Savannah mantam Atifi hyeɛ so, wɔ atɔeɛ fam no yɛ Bono mantam, wɔ anaafoɔ fam yɛ Asante mantam ɛna Volta lake nso wɔ apueɛ fam.

== Ewiem Nsakraeɛ ==
Bono East mantam ka Ghana mfudeɛ ho, a ɛhɔ deɛ ewiem nsakraeɛ no yɛ wɔ hɔ.  Kwaeɛ ne anhwea paa na ɛka bom yɛ mfudeɛ no wɔ ɔpɛnimaa ne Oforisuo ntam a ɛyɛ ɔpɛ berɛ no.Ɛtɔ da nso nsutɔ berɛ no ba wɔ Kitawonsa ne ahinime bosome ntam a nsuo no tɔ no bɛyɛ sɛ 750 to 1050mm(30-40 inched). Ɛpɛ rekɔ awieeɛ a  na temperature a ano yɛ den ba, nea ɛwɔ fam no ba ɔpɛnimaa ne ɔpɛpɔn bosome mu.  Saa nso na mframa a ano yɛ den a ɛfiri Sahara  no ba wɔ ɔpɛnimaa ne ɔpɛpɔn ahyɛaseɛ ntam a ɛyɛ hye na ano aho. Sɛ ewiem bɛyɛ nwini anaasɛ hye  no tumi sesa wɔ 14°c(59 °F)anadwo ne 40°c(104 °F) ntam anɔpa berɛ.

Nnɔbaeɛ ne mfudeɛBayerɛ dua yɛ adeɛ ɛdi ntontom a wɔ woodland Savannah zone a ɛwɔ Techiman,Yini,Nkoranza, Kintampo, Kwame Danso, Prang ne nea ɛkeka ho.wɔdua adua, aburo, bankye,mankani, ɛmoo, borɔdeɛ ne nnoɔma pii wɔ saa mantam yi mu,saa nso na nsuomunam adwuma nso ka ho.

== Nsrahwɛ ==
Nsrahwɛ bea ahodoɔ pii wɔ hɔ.

* Boabeng Fiema Monkey Sanctuary
* Buoyem Caves and bats colony, which is within the locality of Buoyem in Techiman municipality of a dry semi-deciduous forest, house a large colony of rosetta fruit bats, caves, sandstone rocks and waterfalls.
* Kintampowater fall
* Kintampo fullefall

== Beaɛ a menyaa mmoa firiiɛ ==
&lt;references /&gt;{{Mantamu a ɛwɔ Ghana}}</text>
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  <page>
    <title>Western North Region</title>
    <ns>0</ns>
    <id>12356</id>
    <revision>
      <id>133059</id>
      <parentid>126168</parentid>
      <timestamp>2022-08-01T10:02:59Z</timestamp>
      <contributor>
        <username>Robertjamal12</username>
        <id>8680</id>
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      <text bytes="5945" xml:space="preserve">{{Dialect|Asante}}
'''Western North Region''' yɛ mantam foforɔ nsia a wɔtee wɔ [[Gaana|Ghana]] wɔ mfeɛ mpem mmienu ne du nkron mu.&lt;ref&gt;https://citisportsonline.com/2021/05/21/betway-extends-support-to-volleyball-teams-in-the-western-and-western-north-regions/&lt;/ref&gt; Mantam no bɔ Ivory Coast(come mansini) mu wɔ atɔeɛ fam, mfimfini mantam a ɛwɔ southeast ne [[Asante Mantam|Asante]],Ahafo[[Bono East Region|,Bono East]] ne Bono mantam wɔ North. Western North Region na ɛwɔ nsutene kɛseɛ paa wɔ [[Gaana|Ghana]]., asaase pa ne ludu green Hilla. Wɔwɔ dwumakuo a ɛtu agudeɛ wɔ mantam hɔ. Sefwi na ɛdi abusuakuo no amammerɛ a ɛwɔ mantam hɔ. Kasa titire a wɔka ne, Sefwi,Akan,French ne English.

== Abakɔsɛm ==
Western North Region a ɛwɔ [[Gaana|Ghana]] yɛ mantam foforɔ a woayi afiri Western atɔeɛ mantam a ɛwɔ hɔ dada wɔ [[Gaana|Ghana]]. Ɛnam ɔsono amanyɔkuo New Patriotic Party amanyɔkuo bɔhyɛ a wɔhyɛɛ wɔ mfeɛ mpem mmienu ne du nsia abatoɔ mu a wɔpɛ sɛ wɔdi so nti na wɔtee saa mantam foforɔ yi. Ɔdii nkunim wɔ abatoɔ nom no, ɔmanpanin [[Nana Akufo-Addo|Nana Akuffo Addo]] tee asoeɛ a ɛhwɛ mantam nhyehyɛeɛ so sɛ ɔnhwɛ ɔkwan a wɔbɛfa so ama saa nhyehyɛeɛ no ayɛ adwuma. Mantam nsia na wɔte firii Ghana mantam du a na ɛwɔ hɔ dada no. Mantam foforɔ no ne [[Bono East Region|Bono East]], Ahafo, Savannah, North East ne Oti mantam.&lt;ref&gt;http://www.presidency.gov.gh/index.php/briefing-room/news-style-2/703-creation-of-6-new-regions-in-the-hands-of-ec-ghanaians-president-akufo-addo&lt;/ref&gt;

Hon. Dan Botwe a ɔda asoeɛ foforɔ a wɔtee, asoeɛ a ɛhwɛ mantam nhyehyɛeɛ bio ne ne mpuntuo ho no, &lt;ref name=&quot;:0&quot;&gt;http://www.myjoyonline.com/politics/2017/January-11th/2nd-ministerial-list-out-akufo-addo-creates-new-ministries-re-aligns-old.php&lt;/ref&gt;maa nsusueɛ a wɔsusu faa mantam tee no ho yɛɛ adwuma.&lt;ref name=&quot;:0&quot; /&gt; Wɔ [[ɔbɛnem]] bosome wɔ mfeɛ mpem mmienu ne du nson mu no,asoeɛ no ne afoforɔ bi de krataa a ɛkyerɛ sɛ wɔbɛdi saa dwuma no kɔɔ council of State hɔ. Berɛ a wɔde krataa no kɔeɛ no, agyinatufoɔ no hyiaa bɛboro mpere aduasa nsia kɔpem [[ɔsanaa]] bosome wɔ mfeɛ mpem mmienu ne du nson mu.&lt;ref&gt;https://www.ghanacrusader.com/council-of-state-met-36-times-on-creation-of-new-regions-nana-otuo-siriboe-ii/&lt;/ref&gt; Nnipa a ɛwɔ mantam foforɔ hɔ no too aba dwumadie no awieɛ wɔ [[ɔpɛnimaa]] bosome da a ɛtɔ so aduonu nson wɔ mfeɛ mpem mmienu ne du nnwɔtwe mu dekyerɛ sɛ ɛwɔ sɛ wɔte mantam foforɔ.&lt;ref&gt;http://presidency.gov.gh/index.php/2017/10/06/creation-of-new-region-in-your-hands-president-akufo-addo-to-nayiri/&lt;/ref&gt;&lt;ref&gt;https://www.ghanaweb.com/GhanaHomePage/NewsArchive/EC-sets-December-27-for-referendum-on-new-regions-678786&lt;/ref&gt;

== Nsrahwɛbea ==
Mantam no wɔ kwaeɛ biretuo pii a wɔagyae ato hɔ sɛ nsrahwɛ bea

== Adesua ==
Western North mantam wɔ sukuu a wɔbɛtumi akɔ sɛ wowie ntoasoɔ sukuu a atikyafoɔ ne anɛɛsefoɔ kɔlegyi ka ho

== Apomuden ==
Wɔ ɔsanaa bosome wɔ mfeɛ mpem mmienu ne aduonu baako mu no, mantam no nyaa yareɛ bi a ate atese wɔ hɔ a yɛfrɛ no H5N1 avian influenza.&lt;ref&gt;https://citibusinessnews.com/2021/08/western-north-region-records-bird-flu-cases/&lt;/ref&gt;

== Adwumayɛ nkyekyemu ==
Mantam amanyɔsɛm adwuma no nam mpɔtam amammuo so  Wɔ saa nhyehyɛeɛ yi so no, wakyɛ mantam no mu akɔ MMDA nsia(kabom mayɛ nya mansini mmiɛnsa 6 ordinary Assembly). &lt;ref&gt;https://africafeeds.com/2018/12/28/ghana-six-new-regions-created-after-a-referendum/&lt;/ref&gt;&lt;ref&gt;https://web.archive.org/web/20130118104048/http://www.ghanadistricts.com/region/?r=5&lt;/ref&gt;Mansini, mansini adantam anaa Metropolitan Assembly biara no chiec Executive, a ɔgyina hɔ ma Central government na nso ɔnya ne tumi firi ekuoba bi a ɔmanpanin ayi no wɔ wɔn mu a ɔda Assembly no ano.Edin no na ɛdidisoɔ yi;
[[Image:Districts of the Western North Region (2019).png|thumb|upright=1.5|Districts of the Western North Region]]

{| class=&quot;wikitable sortable&quot;
|+ Districts of the Western North Region&lt;ref&gt;[http://www.geohive.com/cntry/ghana.aspx Western North Region – Districts]&lt;/ref&gt;
|-
! #
! MMDA Name
! Capital
! MMDA Type
! Population&lt;br /&gt;Census 2010&lt;ref name=&quot;Ghana Statistical Service&quot;&gt;Ghana Statistical Service.&lt;/ref&gt;
! Population&lt;br /&gt;2019 Projected&lt;ref name=&quot;Ghana Statistical Service&quot;/&gt;
|-
! 1
| [[Aowin Municipal District|Aowin]]&lt;ref&gt;{{Cite web|title=Residents of Abrokyire carry woman in labour on wooden door due to poor road - MyJoyOnline.com|url=https://www.myjoyonline.com/residents-of-abrokyire-carry-woman-in-labour-on-wooden-door-due-to-poor-road/|access-date=2021-05-19|website=www.myjoyonline.com|language=en-US}}&lt;/ref&gt;
| [[Enchi]]
| Municipal
| align=&quot;right&quot;|117,886
| align=&quot;right&quot;|154,661
|-
! 2
| [[Bia East District|Bia East]]
| [[Adabokrom]]
| Ordinary
| align=&quot;right&quot;|27,393
| align=&quot;right&quot;|37,108
|-
! 3
| [[Bia West District|Bia West]]
| [[Essam, Ghana|Essam]]
| Ordinary
| align=&quot;right&quot;|88,939
| align=&quot;right&quot;|111,355
|-
! 4
| [[Bibiani/Anhwiaso/Bekwai Municipal District|Bibiani/Anhwiaso/Bekwai]]
| [[Bibiani]]
| Municipal
| align=&quot;right&quot;|123,272
| align=&quot;right&quot;|160,844
|-
! 5
| [[Bodi District|Bodi]]
| [[Bodi, Ghana|Bodi]]
| Ordinary
| align=&quot;right&quot;|53,314
| align=&quot;right&quot;|68,055
|-
! 6
| [[Juaboso District|Juaboso]]
| [[Juaboso]]
| Ordinary
| align=&quot;right&quot;|58,435
| align=&quot;right&quot;|77,678
|-
! 7
| [[Sefwi Akontombra District|Sefwi-Akontombra]]
| [[Sefwi Akontombra]]
| Ordinary
| align=&quot;right&quot;|82,467
| align=&quot;right&quot;|108,266
|-
! 8
| [[Sefwi-Wiawso Municipal District|Sefwi-Wiawso]]
| '''[[Wiawso]]'''
| Municipal
| align=&quot;right&quot;|139,200
| align=&quot;right&quot;|182,510
|-
! 9
| [[Suaman District|Suaman]]
| [[Dadieso]]
| Ordinary
| align=&quot;right&quot;|20,529
| align=&quot;right&quot;|27,832
|-
! colspan=&quot;3&quot;|Total 
!
| align=&quot;right&quot;|658,835
| align=&quot;right&quot;|928,309
|}

== Beaɛ a menyaa mmoa firiiɛ ==
&lt;references /&gt;{{Mantamu a ɛwɔ Ghana}}
[[Nkyekyεmu:Mantam a ɛwɔ Ghana]]</text>
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  <page>
    <title>Upper West Region</title>
    <ns>0</ns>
    <id>12357</id>
    <revision>
      <id>133057</id>
      <parentid>132008</parentid>
      <timestamp>2022-08-01T10:00:23Z</timestamp>
      <contributor>
        <username>Robertjamal12</username>
        <id>8680</id>
      </contributor>
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      <text bytes="6210" xml:space="preserve">{{Dialect|Asante}}
'''Upper West region''' wɔ [[Gaana|Ghana]] north-western nkyɛn baabi &lt;ref&gt;https://citinewsroom.com/2021/05/sissala-west-mp-laments-exclusion-of-sissala-areas-from-eu-funded-road-projects/&lt;/ref&gt;na ɛne upper East mantam bɔ hyeɛ kɔ East, atifi mantam nso kɔ South ɛna ɔno Burkina Faso bɔ hyeɛ kɔ west ne North. Upper East mantam ahenkuro ne kuro a ɛso paa ara yɛ Wa. Flight-Lieutenant Jerry Rawlings na ɔtee upper west wɔ afe apem ahankron ne aduowɔtwe mmiɛnsa wɔ Provisional National Defence Council (PNDC) asraafoɔ pɛn so.Wɔyii saa beaɛ no firii ɛnkane Upper Region mu a seisei wɔfrɛ no Upper East Region. Bɛyɛ sɛ mfeɛ aduasa num nie na akɔ so ayɛ mantam a ɛsua koraa wɔ [[Gaana|Ghana]] kɔpem sɛ mfeɛ mpem mmienu ne du nnwɔtwe mu [[Nana Akufo-Addo|Nana Addo Dankwa Akuffo Addo]] bɛtee mantam nsia kaa dada no ho, maa mantam a ɛwɔ ɔman no mu bɛyɛɛ du nsia.

== Asaase ne emu nnipa ne ewiem nsakraeɛ adesua ==
Upper West Region ka mantam du a ɛwɔ [[Gaana|Ghana]]. Ɛwɔ North Western a ɛwɔ [[Gaana|Ghana]] nkyɛn baabi a ɛwɔ latitude 9.8°-11.0° North ne longitude 1.6°-3.0 west, a ɛne Burkina Faso a ɛkɔ North bom. Ɛkata asaase bɛyɛ 18,476square kilometres a ɛne ɔhamu nkyekyɛmu du mmienu akyiripɔ nson asaase a ɛwɔ [[Gaana|Ghana]] yɛ pɛ. Northern Ghana -Burkina Faso ɛne East no bɔ ahyeɛ wɔ upper East mantam ne Northern Region,wɔ South nso ɛne Northern Region ɛne Western Ghana -Burkina Faso wɔ west ɛna upper west Region nso wɔ North. Ɛno ne mantam a ɛwɔ [[Gaana|Ghana]] a ɛso a ɛtɔ so nson na ɛwɔ mantam du baako. Ɛnam baabi a ɛwɔ no nti, ama upper west Region wɔ mmɔdemmɔ a wɔde bɛyɛ amanɔne ne mantam dwadie ne twaka a ɛda wɔn ntam nanso awudie nnoɔma bi te sɛ egya totoɔ, nyarewa, korɔnobɔ ne nea ɛkeka ho a ɛfiri nnipa a ɛwɔ mantam hɔ no nso hunahuna ɔmamfoɔ no.&lt;ref&gt;GOG(MLGRD)&lt;/ref&gt;

== Nsrahwɛ ==
Wechiau Hippipotamus Sanctuary no wɔ southwest a ɛwɔ Wa,ɛwɔ Black Volta River a ɛwɔ Wa West mansini kwan so. Gwollu afasuo a ɛwɔ Sissala mansini no yɛ [[Gaana|Ghana]] Manpanin Dr. Hilla Limann a wanya ne baabi kɔ kurom.&lt;ref&gt;ghanadistricts.com&lt;/ref&gt;

== Nnuane ==
Aduane a ɛhohia a paa a wɔdi wɔ upper west Region ne Aso anaasɛ Tuo Zaafi wɔ yɛn kasa mu, a wɔtwa no tiawa sɛ TZ anaa T-Zed wɔ borɔfo kasa mu.&lt;ref&gt;https://www.tasteatlas.com/tuo-zaafi&lt;/ref&gt;

== Sikasɛm ==
Adwuma titire a upper west Region yɛ a ɛde sika ba ne mfudeɛ. Nnuane a wɔdua ne aburo,ayuo, nkateɛ, nkruma,nkuto dua ne ɛmoo. Wɔyɛn mmoa bi a ɛma wɔn nam te sɛ, odwan, mpɔnkye,nkokɔ, mprako ne akɔmfɛm. Ɛnam sɛ sɛ ɛpɛ ba mantam hɔ a ɛkyɛ na ɛtwe kɔ bɛyɛ sɛ [[ahinime]] bosome dekɔ [[Kɔtɔnimaa|Kotonimaa]] bosome mu nti, nnipa pii firi hɔ kɔ Southern a ɛwɔ [[Gaana|Ghana]] kɔ yɛ adwuma wɔ hɔ bɛyɛ sɛ afe no mu fa.

== Adwumayɛ nkyekyemu ==
Mantam amanyɔsɛm adwuma no nam mpɔtam amammuo so  Wɔ saa nhyehyɛeɛ yi so no, wakyɛ mantam no mu akɔ MMDA du baako (kabom mayɛ nya mansini num, ordinary Assembly num). &lt;ref&gt;https://www.citypopulation.de/en/ghana/admin/10__upper_west/&lt;/ref&gt;Mansini, mansini adantam anaa Metropolitan Assembly biara no chiec Executive, a ɔgyina hɔ ma Central government na nso ɔnya ne tumi firi ekuoba bi a ɔmanpanin ayi no wɔ wɔn mu a ɔda Assembly no ano.Edin no na ɛdidisoɔ yi;
[[Image:Districts of the Upper West Region (2012).svg|thumb|right|500px|Districts of the Upper West Region]]

{| class=&quot;wikitable sortable&quot;
|+ Districts of the Upper West Region&lt;ref&gt;[http://www.geohive.com/cntry/ghana.aspx Upper West Region – Districts]&lt;/ref&gt;
|-
! #
! MMDA Name
! Capital
! MMDA Type
! Population
|-
! 1
| [[Daffiama Bussie Issa District|Daffiama-Bussie-Issa]]
| [[Issa, Ghana|Issa]]
| Ordinary
| 
|-
! 2
| [[Jirapa Municipal District|Jirapa]]
| [[Jirapa]]
| Municipal
| 
|-
! 3
| [[Lambussie Karni District|Lambussie-Karni]] 
| [[Lambussie]]
| Ordinary
| 
|-
! 4
| [[Lawra Municipal District|Lawra]]
| [[Lawra]]
| Municipal
| 
|-
! 5
| [[Nadowli-Kaleo District|Nadowli-Kaleo]]
| [[Nadowli]]
| Ordinary
| 
|-
! 6
| [[Nandom Municipal District|Nandom]]
| [[Nandom]]
| Municipal
| 
|-
! 7
| [[Sissala East Municipal District|Sissala East]]
| [[Tumu, Ghana|Tumu]]
| Municipal
| 
|-
! 8
| [[Sissala West District|Sissala West]]
| [[Gwollu]]
| Ordinary
| 
|-
! 9
| [[Wa East District|Wa East]]
| [[Funsi]]
| Ordinary
| 
|-
! 10
| [[Wa Municipal District|Wa Municipal]]&lt;ref&gt;{{Cite web|title=Contractors who do shoddy work to pay more for maintenance - Roads Minister warns - MyJoyOnline.com|url=https://www.myjoyonline.com/contractors-who-do-shoddy-work-to-pay-more-for-maintenance-roads-minister-warns/|access-date=2021-05-20|website=www.myjoyonline.com|language=en-US}}&lt;/ref&gt;
| '''[[Wa, Ghana|Wa]]'''
| Municipal
| 
|-
! 11
| [[Wa West District|Wa West]]
| [[Wechiau]]
| Ordinary
| 
|-
|}{{clear}}

== Naa Duasini Seidu Pelpuo a ɔtɔ so nan-Wa. ==
Nnipa titire ne akukudamfoɔ a agye din wɔ Upper East Region ne:

* Ɔmanpanin Dr. Hilla Limann a ɔfiri Gwollu,
* Al-Haji Amin Amidu Sulemana a ɔfiri Jawia
* Kuoro E. K. Mumuni Dimbie from Wallenbelle
* Hon. Bede Ziedeng  a ɔfiri Lawra
* Cardinal Peter Poreku Dery  a ɔfiri Nandom,
* Peter Nanfuri  a ɔfiri Jirapa,
* Kwesi Nyantakyi  a ɔfiri Wa,
* Samini from Wa-Sombo,
* Wiyaala  a ɔfiri Funsi
* Naa Polku Konkuu Chiir from Nandom
* Naa (Dr.) Puore Puobe Chiir from Nandom
* Rear Admiral Chemogoh Kevin Dzang (MSG) from Nandom
* Benjamin Kunbuor from Nandom,
* Rt. Hon. Alban Sumana Kingsford Bagbin from Sombo
* Former Deputy Regional Minister Kale Cezario
* Lawyer Wahid Bampuori-Iddrisu from Wa
* Ambrose Dery from Nandom
* Chief Simon Diedong Dombo from Jirapa
* Justice Yonni Kulendi from Issa
* Sangu Delle from Nandom
* Maazu Dramani Bayuoni from Tumu
* Hon.Dr.Rashid Pelpuo from Wa
* Prof. Frederick McBagonluri
* Dr. Samad Dimbie  a ɔfiri Wallenbelle

== Afahyɛ a wɔdi no wɔ Upper West Region ==
Afahyɛ a wɔdi no wɔ Upper West Region ne:&lt;ref&gt;https://touringghana.com/upper-west-region/&lt;/ref&gt;

* Dumba Festival
* Paaragbiele Festival
* Kobine Festival

== Beaɛ a menyaa mmoa firiiɛ ==
&lt;references /&gt;
[[Nkyekyεmu:Mantam a ɛwɔ Ghana]]</text>
      <sha1>f3dl1g99vcsya4aciwqdxtoh9i97a9l</sha1>
    </revision>
    <revision>
      <id>133058</id>
      <parentid>133057</parentid>
      <timestamp>2022-08-01T10:02:05Z</timestamp>
      <contributor>
        <username>Robertjamal12</username>
        <id>8680</id>
      </contributor>
      <model>wikitext</model>
      <format>text/x-wiki</format>
      <text bytes="6235" xml:space="preserve">{{Dialect|Asante}}
'''Upper West region''' wɔ [[Gaana|Ghana]] north-western nkyɛn baabi &lt;ref&gt;https://citinewsroom.com/2021/05/sissala-west-mp-laments-exclusion-of-sissala-areas-from-eu-funded-road-projects/&lt;/ref&gt;na ɛne upper East mantam bɔ hyeɛ kɔ East, atifi mantam nso kɔ South ɛna ɔno Burkina Faso bɔ hyeɛ kɔ west ne North. Upper East mantam ahenkuro ne kuro a ɛso paa ara yɛ Wa. Flight-Lieutenant Jerry Rawlings na ɔtee upper west wɔ afe apem ahankron ne aduowɔtwe mmiɛnsa wɔ Provisional National Defence Council (PNDC) asraafoɔ pɛn so.Wɔyii saa beaɛ no firii ɛnkane Upper Region mu a seisei wɔfrɛ no Upper East Region. Bɛyɛ sɛ mfeɛ aduasa num nie na akɔ so ayɛ mantam a ɛsua koraa wɔ [[Gaana|Ghana]] kɔpem sɛ mfeɛ mpem mmienu ne du nnwɔtwe mu [[Nana Akufo-Addo|Nana Addo Dankwa Akuffo Addo]] bɛtee mantam nsia kaa dada no ho, maa mantam a ɛwɔ ɔman no mu bɛyɛɛ du nsia.

== Asaase ne emu nnipa ne ewiem nsakraeɛ adesua ==
Upper West Region ka mantam du a ɛwɔ [[Gaana|Ghana]]. Ɛwɔ North Western a ɛwɔ [[Gaana|Ghana]] nkyɛn baabi a ɛwɔ latitude 9.8°-11.0° North ne longitude 1.6°-3.0 west, a ɛne Burkina Faso a ɛkɔ North bom. Ɛkata asaase bɛyɛ 18,476square kilometres a ɛne ɔhamu nkyekyɛmu du mmienu akyiripɔ nson asaase a ɛwɔ [[Gaana|Ghana]] yɛ pɛ. Northern Ghana -Burkina Faso ɛne East no bɔ ahyeɛ wɔ upper East mantam ne Northern Region,wɔ South nso ɛne Northern Region ɛne Western Ghana -Burkina Faso wɔ west ɛna upper west Region nso wɔ North. Ɛno ne mantam a ɛwɔ [[Gaana|Ghana]] a ɛso a ɛtɔ so nson na ɛwɔ mantam du baako. Ɛnam baabi a ɛwɔ no nti, ama upper west Region wɔ mmɔdemmɔ a wɔde bɛyɛ amanɔne ne mantam dwadie ne twaka a ɛda wɔn ntam nanso awudie nnoɔma bi te sɛ egya totoɔ, nyarewa, korɔnobɔ ne nea ɛkeka ho a ɛfiri nnipa a ɛwɔ mantam hɔ no nso hunahuna ɔmamfoɔ no.&lt;ref&gt;GOG(MLGRD)&lt;/ref&gt;

== Nsrahwɛ ==
Wechiau Hippipotamus Sanctuary no wɔ southwest a ɛwɔ Wa,ɛwɔ Black Volta River a ɛwɔ Wa West mansini kwan so. Gwollu afasuo a ɛwɔ Sissala mansini no yɛ [[Gaana|Ghana]] Manpanin Dr. Hilla Limann a wanya ne baabi kɔ kurom.&lt;ref&gt;ghanadistricts.com&lt;/ref&gt;

== Nnuane ==
Aduane a ɛhohia a paa a wɔdi wɔ upper west Region ne Aso anaasɛ Tuo Zaafi wɔ yɛn kasa mu, a wɔtwa no tiawa sɛ TZ anaa T-Zed wɔ borɔfo kasa mu.&lt;ref&gt;https://www.tasteatlas.com/tuo-zaafi&lt;/ref&gt;

== Sikasɛm ==
Adwuma titire a upper west Region yɛ a ɛde sika ba ne mfudeɛ. Nnuane a wɔdua ne aburo,ayuo, nkateɛ, nkruma,nkuto dua ne ɛmoo. Wɔyɛn mmoa bi a ɛma wɔn nam te sɛ, odwan, mpɔnkye,nkokɔ, mprako ne akɔmfɛm. Ɛnam sɛ sɛ ɛpɛ ba mantam hɔ a ɛkyɛ na ɛtwe kɔ bɛyɛ sɛ [[ahinime]] bosome dekɔ [[Kɔtɔnimaa|Kotonimaa]] bosome mu nti, nnipa pii firi hɔ kɔ Southern a ɛwɔ [[Gaana|Ghana]] kɔ yɛ adwuma wɔ hɔ bɛyɛ sɛ afe no mu fa.

== Adwumayɛ nkyekyemu ==
Mantam amanyɔsɛm adwuma no nam mpɔtam amammuo so  Wɔ saa nhyehyɛeɛ yi so no, wakyɛ mantam no mu akɔ MMDA du baako (kabom mayɛ nya mansini num, ordinary Assembly num). &lt;ref&gt;https://www.citypopulation.de/en/ghana/admin/10__upper_west/&lt;/ref&gt;Mansini, mansini adantam anaa Metropolitan Assembly biara no chiec Executive, a ɔgyina hɔ ma Central government na nso ɔnya ne tumi firi ekuoba bi a ɔmanpanin ayi no wɔ wɔn mu a ɔda Assembly no ano.Edin no na ɛdidisoɔ yi;
[[Image:Districts of the Upper West Region (2012).svg|thumb|right|500px|Districts of the Upper West Region]]

{| class=&quot;wikitable sortable&quot;
|+ Districts of the Upper West Region&lt;ref&gt;[http://www.geohive.com/cntry/ghana.aspx Upper West Region – Districts]&lt;/ref&gt;
|-
! #
! MMDA Name
! Capital
! MMDA Type
! Population
|-
! 1
| [[Daffiama Bussie Issa District|Daffiama-Bussie-Issa]]
| [[Issa, Ghana|Issa]]
| Ordinary
| 
|-
! 2
| [[Jirapa Municipal District|Jirapa]]
| [[Jirapa]]
| Municipal
| 
|-
! 3
| [[Lambussie Karni District|Lambussie-Karni]] 
| [[Lambussie]]
| Ordinary
| 
|-
! 4
| [[Lawra Municipal District|Lawra]]
| [[Lawra]]
| Municipal
| 
|-
! 5
| [[Nadowli-Kaleo District|Nadowli-Kaleo]]
| [[Nadowli]]
| Ordinary
| 
|-
! 6
| [[Nandom Municipal District|Nandom]]
| [[Nandom]]
| Municipal
| 
|-
! 7
| [[Sissala East Municipal District|Sissala East]]
| [[Tumu, Ghana|Tumu]]
| Municipal
| 
|-
! 8
| [[Sissala West District|Sissala West]]
| [[Gwollu]]
| Ordinary
| 
|-
! 9
| [[Wa East District|Wa East]]
| [[Funsi]]
| Ordinary
| 
|-
! 10
| [[Wa Municipal District|Wa Municipal]]&lt;ref&gt;{{Cite web|title=Contractors who do shoddy work to pay more for maintenance - Roads Minister warns - MyJoyOnline.com|url=https://www.myjoyonline.com/contractors-who-do-shoddy-work-to-pay-more-for-maintenance-roads-minister-warns/|access-date=2021-05-20|website=www.myjoyonline.com|language=en-US}}&lt;/ref&gt;
| '''[[Wa, Ghana|Wa]]'''
| Municipal
| 
|-
! 11
| [[Wa West District|Wa West]]
| [[Wechiau]]
| Ordinary
| 
|-
|}{{clear}}

== Naa Duasini Seidu Pelpuo a ɔtɔ so nan-Wa. ==
Nnipa titire ne akukudamfoɔ a agye din wɔ Upper East Region ne:

* Ɔmanpanin Dr. Hilla Limann a ɔfiri Gwollu,
* Al-Haji Amin Amidu Sulemana a ɔfiri Jawia
* Kuoro E. K. Mumuni Dimbie from Wallenbelle
* Hon. Bede Ziedeng  a ɔfiri Lawra
* Cardinal Peter Poreku Dery  a ɔfiri Nandom,
* Peter Nanfuri  a ɔfiri Jirapa,
* Kwesi Nyantakyi  a ɔfiri Wa,
* Samini from Wa-Sombo,
* Wiyaala  a ɔfiri Funsi
* Naa Polku Konkuu Chiir from Nandom
* Naa (Dr.) Puore Puobe Chiir from Nandom
* Rear Admiral Chemogoh Kevin Dzang (MSG) from Nandom
* Benjamin Kunbuor from Nandom,
* Rt. Hon. Alban Sumana Kingsford Bagbin from Sombo
* Former Deputy Regional Minister Kale Cezario
* Lawyer Wahid Bampuori-Iddrisu from Wa
* Ambrose Dery from Nandom
* Chief Simon Diedong Dombo from Jirapa
* Justice Yonni Kulendi from Issa
* Sangu Delle from Nandom
* Maazu Dramani Bayuoni from Tumu
* Hon.Dr.Rashid Pelpuo from Wa
* Prof. Frederick McBagonluri
* Dr. Samad Dimbie  a ɔfiri Wallenbelle

== Afahyɛ a wɔdi no wɔ Upper West Region ==
Afahyɛ a wɔdi no wɔ Upper West Region ne:&lt;ref&gt;https://touringghana.com/upper-west-region/&lt;/ref&gt;

* Dumba Festival
* Paaragbiele Festival
* Kobine Festival

== Beaɛ a menyaa mmoa firiiɛ ==
&lt;references /&gt;{{Mantamu a ɛwɔ Ghana}}
[[Nkyekyεmu:Mantam a ɛwɔ Ghana]]</text>
      <sha1>qgpyl49bqzvqtqnc8rurb2ipsqlbr08</sha1>
    </revision>
  </page>
  <page>
    <title>Upper East Region</title>
    <ns>0</ns>
    <id>12358</id>
    <revision>
      <id>133055</id>
      <parentid>132415</parentid>
      <timestamp>2022-08-01T09:59:31Z</timestamp>
      <contributor>
        <username>Robertjamal12</username>
        <id>8680</id>
      </contributor>
      <model>wikitext</model>
      <format>text/x-wiki</format>
      <text bytes="9672" xml:space="preserve">{{Dialect|Asante}}
'''Upper East Region''' wɔ North a ɛwɔ [[Gaana|Ghana]] na ɛyɛ mantam a ɛwɔ [[Gaana|Ghana]] &lt;ref&gt;https://citinewsroom.com/2021/05/upper-east-region-group-pushes-for-sex-education-to-reduce-teenage-pregnancies/&lt;/ref&gt;a ɛtɔ mmiɛnsa a ɛsua wɔ mantam du nsia num. Ɛfa mpem nnwɔtwe, ahannwɔte ne aduanan mmienu square kilometres asaase anaa ɔhamu nkyekyɛmu mmienu akyiripɔ nson wɔ [[Gaana|Ghana]]. Upper East Region ahenkuro ne [[Bolgatanga]], a ɛtɔ mmerɛ a wɔfrɛ no Bolga. Nkuro akɛseɛ a ɛwɔ mantam hɔ ne Navrongo, Paga,Bawku ne [[Zebilla (Ghana mmrahyɛbadwam mpɛsoa)|Zebilla]].

== Asaase ne emu nnipa ne ewiem nsakraeɛ ==
'''Baabi a ɛwɔ ne sɛdeɛ ɛteɛ'''

Upper East Region wɔ north-western nkyɛn baabi wɔ [[Gaana|Ghana]] na ɛbɛn Burkina Faso de kɔ North ne [[Togo]] dekɔ East. Ɛwɔ longitude 0°ne 1°west ne latitude 10° 30'N ne 11°N ntam. Mantam no ne Burkina Faso a ɛkɔ North, [[Togo]] a ɛkɔ East, upper West Region a ɛkɔ west ne Northern Region a ɛwɔ South na ɛbɔ ahyeɛ. Wakyɛ upper East Region mu mansini du num, a emu biara district chief Executive na ɛda ano.

== Nsrahwɛ ==

=== Parks ===

* Paga Crocodile Pond
* Sombo Bat Sanctuary
* Jafiiri Sacred Royal Python Sanctuary

=== Baabi a wɔgye wɔn ani ===

* Tongo rocks
* Bongo Rocks
* Tono Dam

=== Beaeɛ a ɛfa abakɔsɛm ho ===

* Naa Gbewaa's abosomdan
* Navrongo's mud-built asɔre
* Pikworo Slave camp

=== Afahyɛ ahodoɔ ===
Mantam no di afa pii afe no mu nyinaa, a pii no ara tumi ma mfudeɛ yɛyie anaa wɔde di afahyɛ no de kae mfudeɛ a wanya.

* Samanpiid afahyɛ 
* Damba afahyɛ (Mamprusi)
* Gologo afahyɛ 
* Fao afahyɛ 
* Paragbiele afahyɛ 
* Willa afahyɛ 
* Zumbenti afahyɛ 
* Feok festival builsa
* Zekula afahyɛ, a Bissafoɔ na ɛdi
* Boaram afahyɛ&lt;ref&gt;{{Cite web |title=Archive copy |url=http://www.ghanaemberlin.de/en/tourism/festivals/festivals-in-the-upper-east-region/index.html |access-date=2022-07-05 |archive-date=2019-04-28 |archive-url=https://web.archive.org/web/20190428214631/http://www.ghanaemberlin.de/en/tourism/festivals/festivals-in-the-upper-east-region/index.html |url-status=dead }}&lt;/ref&gt;
* Bolgatanga International Craft and Arts Festival Organized by TradeAID Integrated*
* Tengana afahyɛ, a nnipa a ɛwɔ Balungu, Winkongo  ne Pwalugu na ɛdie
* Ndaakoya afahyɛ, a nnipa a ɛka frafra, Talensi and Nabdam wɔ mpɔtam hɔ na ɛdie

* Upper East Regional Museum
* Sirigu Pottery and Arts Center
* Bolga market - a market for farmers and livestock, held twice weekly.
* Bolgatanga Craft Village

== Demographics ==
* '''Nnipa dodoɔ a ɛwɔ hɔ'''
* Bolgatanga a ɛwɔ Upper East Region na nnipa pii wɔ. Nnipa dodoɔ a ɛwɔ nkuro nketewa nom no bɛyɛ (79%) na wɔn ato apete mmeaɛ pii. Nnipa a ɛwɔ nkuro akɛseɛ mu bɛyɛ ɔhamu nkyekyɛmu aduowɔtwe nson akyiripɔ baako wɔ afe apem ahankron ne aduowɔtwe nan ne ɔhamu nkyekyɛmu aduowɔtwe nan akyiripɔ mmiɛnsa wɔ mfeɛ mpem mmienu mu. Wɔ afe apem ahankron ne aduowɔtwe nan ne mfeɛ mpem mmienu ntam mu no nnipa a ɛwɔ nkuro nketewa no so tee bɛyɛ sɛ ɔhamu nkyekyɛmu mmienu akyiripɔ nwɔtwe ɛna mfeɛ mpem mmienu ne mfeɛ mpem mmienu ne du ntam no ɛso sane tee bɛyɛ ɔhamu nkyekyɛmu num akyiripɔ mmiɛnsa. &lt;ref&gt;http://www.statsghana.gov.gh/docfiles/2010phc/Census2010_Summary_report_of_final_results.pdf&lt;/ref&gt;Nnipa bɛyɛ sɛ ɔhamu nkyekyɛmu aduonu baako a na wɔte kuro kɛseɛ mu no,  mantam no ne nea ɛwɔ [[Gaana|Ghana]] a ɛwɔ kuro ketewa. Wɔne Upper West kabom a wɔn ne mantam a nnipa a ɛwɔ wɔn kuro akɛseɛ mu sua kyɛn ɔhamu nkyekyɛmu aduonu. [[Gaana|Gha]]&lt;nowiki/&gt;[[Gaana|na]]&lt;nowiki/&gt;foɔ. Wɔn a wɔwoo wɔn wɔ hɔ, wɔn mmɔfrase anaa mpaninnie kabom yɛ ɔhamu nkyekyɛmu aduokron mmienu akyiripɔ num wɔ Upper East Region.  Wɔn a wanwo wɔn wɔ ha na wɔyɛ ɔmanni  nso yɛ ɔhamu nkyekyɛmu num akyiripɔ mmiɛnsa. Nnipa a ɛwɔ Upper East Region yɛ ɔpepepem baako, mpem mmiɛnsa ne baako, ahanu ne aduonu baako wɔ mfeɛ mpem mmienu ne aduonu baako efie ne nnipa akenkan mu.

== Kwan a yɛfa so kɔ hɔ ==
Ɔman no wɔ kwantenpɔn mmiɛnsa -N2, N10 ne N11 ne mantam kwantenpɔn kakra bi a ɛno ne R113,R114,R116 ne R181 a ɛsom mantam no. N10 no firi Yemoransa a ɛwɔ mfimfini mantam na ɛfa [[kumase]] a ɛwɔ [[Asante Mantam|Asante mantam]] na akɔsi paga a ɛwɔ Upper East Region. Ɔman no ahenkuro nso nam N10 so ne ɔman no nya twaka a ɛkɔsi wɔ Kulungugu a ɛwɔ Upper East Region. Ɔman ne akwan mmienu no nam N11 so nya twaka a ɛka [[Bolgatanga]] a ɛyɛ mantam no ahenkuro bom kɔ Bimpiela, a ɛno nso wɔ mantam hɔ.

== Adwumayɛ nkyekyemu ==
Mantam amanyɔsɛm adwuma no nam mpɔtam amammuo so  Wɔ saa nhyehyɛeɛ yi so no, wakyɛ mantam no mu akɔ MMDA du num(kabom mayɛ nya mansini nan, ordinary Assembly du baako). &lt;ref&gt;https://web.archive.org/web/20130118104107/http://www.ghanadistricts.com/region/?r=8&lt;/ref&gt;Mansini, mansini adantam anaa Metropolitan Assembly biara no chief Executive, a ɔgyina hɔ ma Central government na nso ɔnya ne tumi firi ekuoba bi a ɔmanpanin ayi no wɔ wɔn mu a ɔda Assembly no ano.Edin no na ɛdidisoɔ yi;

[[Image:Districts of the Upper East Region (2012).svg|thumb|right|500px|Old Map of the Districts of the Upper East Region (2016)]]

{| class=&quot;wikitable sortable&quot;
|+ Districts of the Upper East Region&lt;ref&gt;[http://www.geohive.com/cntry/ghana.aspx Upper East Region – Districts]&lt;/ref&gt;
|-
! #
! MMDA Name
! Capital
! MMDA Type
! Population
|-
! 1
| [[Bawku Municipal District|Bawku]]
| [[Bawku]]
| Municipal
| 
|-
! 2
| [[Bawku West District|Bawku West]]
| [[Zebilla]]
| Ordinary
| 
|-
! 3
| [[Binduri District|Binduri]]
| [[Binduri]]&lt;ref&gt;{{cite web |url=http://www.ghanadistricts.com/districts/?news&amp;r=8&amp;_=222 |title=Ghana Districts - A repository of all districts in the republic of Ghana |website=www.ghanadistricts.com |url-status=dead |archive-url=https://web.archive.org/web/20121018045229/http://www.ghanadistricts.com/districts/?news&amp;r=8&amp;_=222 |archive-date=2012-10-18}}&lt;/ref&gt;
| Ordinary
| 
|-
! 4
| [[Bolgatanga Municipal District|Bolgatanga]]
| '''[[Bolgatanga]]'''
| Municipal
| 
|-
! 5 
| [[Bolgatanga East District|Bolgatanga East]]
| [[Zuarungu]]
| Ordinary
| 
|-
! 6
| [[Bongo District|Bongo]]
| [[Bongo, Ghana|Bongo]]
| Ordinary
| 
|-
! 7
| [[Builsa North Municipal District|Builsa North]]
| [[Sandema]]
| Municipal
| 
|-
! 8
| [[Builsa South District|Builsa South]]
| [[Fumbisi]]&lt;ref&gt;{{cite web |url=http://www.ghanadistricts.com/districts/?news&amp;r=8&amp;_=223 |title=Ghana Districts - A repository of all districts in the republic of Ghana |website=www.ghanadistricts.com |url-status=dead |archive-url=https://web.archive.org/web/20121018045216/http://www.ghanadistricts.com/districts/?news&amp;r=8&amp;_=223 |archive-date=2012-10-18}}&lt;/ref&gt;
| Ordinary
| 
|-
! 9
| [[Garu District|Garu]]
| [[Garu, Ghana|Garu]]
| Ordinary
| 
|-
! 10
| [[Kassena-Nankana Municipal District|Kassena Nankana East]]
| [[Navrongo]]
| Municipal
| 
|-
! 11
| [[Kassena Nankana West District|Kassena-Nankana West]]
| [[Paga]]
| Ordinary
| 
|-
! 12
| [[Nabdam District|Nabdam]]
| [[Nangodi, Ghana|Nangodi]]
| Ordinary
| 
|-
! 13
| [[Pusiga District|Pusiga]]
| [[Pusiga]]&lt;ref&gt;{{cite web |url=http://www.ghanadistricts.com/districts/?news&amp;r=8&amp;_=221 |title=Ghana Districts - A repository of all districts in the republic of Ghana |website=www.ghanadistricts.com |url-status=dead |archive-url=https://web.archive.org/web/20121018045151/http://www.ghanadistricts.com/districts/?news&amp;r=8&amp;_=221 |archive-date=2012-10-18}}&lt;/ref&gt;
| Ordinary
| 
|-
! 14
| [[Talensi District|Talensi]]
| [[Tongo, Ghana|Tongo]]
| Ordinary
| 
|-
! 15
| [[Tempane District|Tempane]]
| [[Tempane]]
| Ordinary
| 
|}{{clear}}

== Adesua ==
'''Ntoasoɔ sukuu'''

* Awe Senior High/Tech
* Bolga Girls Senior High School
* Awe Senior High/Tech School
* Bawku Senior High/Tech School
* Bolgatanga Senior High School
* Bongo Senior High School
* Chiana Senior High School
* Fumbisi Senior High School
* Gowrie Senior High Tech School
* Gambigo Day Community SHS
* Garu Day Community SHS
* Kongo Senior High School
* Kusanaba Senior High School
* Navrongo Senior High School
* Nabango Senior High
* Notre Dame Sem/ Senior High School
* Mirigu Community Day SHS
* O. L. L. Girls Senior High School
* Paga Senior High School
* Queen Of Peace Senior High School
* Sandema Senior High/Tech School
* Sandema Senior High School
* Sirigu Senior High School
* St John's Integrated Senior High/Tech
* Tempane Senior High School
* Zamse Senior High/Tech School
* Zebilla Senior High/Tech School
* Zorkor Senior High School
* St John's Integrated SHTS
* Zuarungu Senior High School
* Bawku Senior High School
* Bawku Technical School

Tertiary Institutions 1). Bolgatanga Technical University 2). St. John Bosco's College of Education 3). Gbewaa College of Education, Pusiga 4). UDS (University for Applied Science &amp; Technology), Navrongo.

== Amamma a wɔyɛ atitirefoɔ ==
{| class=&quot;wikitable&quot;
|-
! colspan=3 | Notable native citizens of Upper East region
|-
! #
! Citizen
! Settlement
|-
! 1
| [[Joseph Kofi Adda]]
| [[Navrongo]]
|-
! 2
| [[Roland Agambire]]
| [[Sirigu (Ghana)|Sirigu]]
|-
! 3
|[[Roger A. Agana]]
|[[Soe, Ghana|Soe]]
|-
! 4
|[[David Atanga]]
|Namoo
|-
!5
|[[Theresa Lardi Awuni]]
|Winkongo
|-
! 6
| [[Adam Kwarasey]]
| [[Navrongo]]
|-
! 7
| [[Abedi Pele]]
| [[Paga]]
|-
!8
| [[Mark Woyongo]]
| [[Navrongo]]
|-
!9
| [[Hawa Yakubu]] 
| [[Kulungungu]]
|-
! 10
| [[Stephen Yakubu]]
| [[Binduri (district)|Binduri]]
|-
!11
| [[Adabere Adabre Donald]]
| [[Bolgatanga]]
|}{{clear}}

== Beaɛ a menyaa mmoa firiiɛ ==
&lt;references /&gt;
[[Nkyekyεmu:Mantam a ɛwɔ Ghana]]</text>
      <sha1>a36ck8la5hcgx9jmg235w0ofeemdeh5</sha1>
    </revision>
    <revision>
      <id>133056</id>
      <parentid>133055</parentid>
      <timestamp>2022-08-01T10:00:05Z</timestamp>
      <contributor>
        <username>Robertjamal12</username>
        <id>8680</id>
      </contributor>
      <model>wikitext</model>
      <format>text/x-wiki</format>
      <text bytes="9697" xml:space="preserve">{{Dialect|Asante}}
'''Upper East Region''' wɔ North a ɛwɔ [[Gaana|Ghana]] na ɛyɛ mantam a ɛwɔ [[Gaana|Ghana]] &lt;ref&gt;https://citinewsroom.com/2021/05/upper-east-region-group-pushes-for-sex-education-to-reduce-teenage-pregnancies/&lt;/ref&gt;a ɛtɔ mmiɛnsa a ɛsua wɔ mantam du nsia num. Ɛfa mpem nnwɔtwe, ahannwɔte ne aduanan mmienu square kilometres asaase anaa ɔhamu nkyekyɛmu mmienu akyiripɔ nson wɔ [[Gaana|Ghana]]. Upper East Region ahenkuro ne [[Bolgatanga]], a ɛtɔ mmerɛ a wɔfrɛ no Bolga. Nkuro akɛseɛ a ɛwɔ mantam hɔ ne Navrongo, Paga,Bawku ne [[Zebilla (Ghana mmrahyɛbadwam mpɛsoa)|Zebilla]].

== Asaase ne emu nnipa ne ewiem nsakraeɛ ==
'''Baabi a ɛwɔ ne sɛdeɛ ɛteɛ'''

Upper East Region wɔ north-western nkyɛn baabi wɔ [[Gaana|Ghana]] na ɛbɛn Burkina Faso de kɔ North ne [[Togo]] dekɔ East. Ɛwɔ longitude 0°ne 1°west ne latitude 10° 30'N ne 11°N ntam. Mantam no ne Burkina Faso a ɛkɔ North, [[Togo]] a ɛkɔ East, upper West Region a ɛkɔ west ne Northern Region a ɛwɔ South na ɛbɔ ahyeɛ. Wakyɛ upper East Region mu mansini du num, a emu biara district chief Executive na ɛda ano.

== Nsrahwɛ ==

=== Parks ===

* Paga Crocodile Pond
* Sombo Bat Sanctuary
* Jafiiri Sacred Royal Python Sanctuary

=== Baabi a wɔgye wɔn ani ===

* Tongo rocks
* Bongo Rocks
* Tono Dam

=== Beaeɛ a ɛfa abakɔsɛm ho ===

* Naa Gbewaa's abosomdan
* Navrongo's mud-built asɔre
* Pikworo Slave camp

=== Afahyɛ ahodoɔ ===
Mantam no di afa pii afe no mu nyinaa, a pii no ara tumi ma mfudeɛ yɛyie anaa wɔde di afahyɛ no de kae mfudeɛ a wanya.

* Samanpiid afahyɛ 
* Damba afahyɛ (Mamprusi)
* Gologo afahyɛ 
* Fao afahyɛ 
* Paragbiele afahyɛ 
* Willa afahyɛ 
* Zumbenti afahyɛ 
* Feok festival builsa
* Zekula afahyɛ, a Bissafoɔ na ɛdi
* Boaram afahyɛ&lt;ref&gt;{{Cite web |title=Archive copy |url=http://www.ghanaemberlin.de/en/tourism/festivals/festivals-in-the-upper-east-region/index.html |access-date=2022-07-05 |archive-date=2019-04-28 |archive-url=https://web.archive.org/web/20190428214631/http://www.ghanaemberlin.de/en/tourism/festivals/festivals-in-the-upper-east-region/index.html |url-status=dead }}&lt;/ref&gt;
* Bolgatanga International Craft and Arts Festival Organized by TradeAID Integrated*
* Tengana afahyɛ, a nnipa a ɛwɔ Balungu, Winkongo  ne Pwalugu na ɛdie
* Ndaakoya afahyɛ, a nnipa a ɛka frafra, Talensi and Nabdam wɔ mpɔtam hɔ na ɛdie

* Upper East Regional Museum
* Sirigu Pottery and Arts Center
* Bolga market - a market for farmers and livestock, held twice weekly.
* Bolgatanga Craft Village

== Demographics ==
* '''Nnipa dodoɔ a ɛwɔ hɔ'''
* Bolgatanga a ɛwɔ Upper East Region na nnipa pii wɔ. Nnipa dodoɔ a ɛwɔ nkuro nketewa nom no bɛyɛ (79%) na wɔn ato apete mmeaɛ pii. Nnipa a ɛwɔ nkuro akɛseɛ mu bɛyɛ ɔhamu nkyekyɛmu aduowɔtwe nson akyiripɔ baako wɔ afe apem ahankron ne aduowɔtwe nan ne ɔhamu nkyekyɛmu aduowɔtwe nan akyiripɔ mmiɛnsa wɔ mfeɛ mpem mmienu mu. Wɔ afe apem ahankron ne aduowɔtwe nan ne mfeɛ mpem mmienu ntam mu no nnipa a ɛwɔ nkuro nketewa no so tee bɛyɛ sɛ ɔhamu nkyekyɛmu mmienu akyiripɔ nwɔtwe ɛna mfeɛ mpem mmienu ne mfeɛ mpem mmienu ne du ntam no ɛso sane tee bɛyɛ ɔhamu nkyekyɛmu num akyiripɔ mmiɛnsa. &lt;ref&gt;http://www.statsghana.gov.gh/docfiles/2010phc/Census2010_Summary_report_of_final_results.pdf&lt;/ref&gt;Nnipa bɛyɛ sɛ ɔhamu nkyekyɛmu aduonu baako a na wɔte kuro kɛseɛ mu no,  mantam no ne nea ɛwɔ [[Gaana|Ghana]] a ɛwɔ kuro ketewa. Wɔne Upper West kabom a wɔn ne mantam a nnipa a ɛwɔ wɔn kuro akɛseɛ mu sua kyɛn ɔhamu nkyekyɛmu aduonu. [[Gaana|Gha]]&lt;nowiki/&gt;[[Gaana|na]]&lt;nowiki/&gt;foɔ. Wɔn a wɔwoo wɔn wɔ hɔ, wɔn mmɔfrase anaa mpaninnie kabom yɛ ɔhamu nkyekyɛmu aduokron mmienu akyiripɔ num wɔ Upper East Region.  Wɔn a wanwo wɔn wɔ ha na wɔyɛ ɔmanni  nso yɛ ɔhamu nkyekyɛmu num akyiripɔ mmiɛnsa. Nnipa a ɛwɔ Upper East Region yɛ ɔpepepem baako, mpem mmiɛnsa ne baako, ahanu ne aduonu baako wɔ mfeɛ mpem mmienu ne aduonu baako efie ne nnipa akenkan mu.

== Kwan a yɛfa so kɔ hɔ ==
Ɔman no wɔ kwantenpɔn mmiɛnsa -N2, N10 ne N11 ne mantam kwantenpɔn kakra bi a ɛno ne R113,R114,R116 ne R181 a ɛsom mantam no. N10 no firi Yemoransa a ɛwɔ mfimfini mantam na ɛfa [[kumase]] a ɛwɔ [[Asante Mantam|Asante mantam]] na akɔsi paga a ɛwɔ Upper East Region. Ɔman no ahenkuro nso nam N10 so ne ɔman no nya twaka a ɛkɔsi wɔ Kulungugu a ɛwɔ Upper East Region. Ɔman ne akwan mmienu no nam N11 so nya twaka a ɛka [[Bolgatanga]] a ɛyɛ mantam no ahenkuro bom kɔ Bimpiela, a ɛno nso wɔ mantam hɔ.

== Adwumayɛ nkyekyemu ==
Mantam amanyɔsɛm adwuma no nam mpɔtam amammuo so  Wɔ saa nhyehyɛeɛ yi so no, wakyɛ mantam no mu akɔ MMDA du num(kabom mayɛ nya mansini nan, ordinary Assembly du baako). &lt;ref&gt;https://web.archive.org/web/20130118104107/http://www.ghanadistricts.com/region/?r=8&lt;/ref&gt;Mansini, mansini adantam anaa Metropolitan Assembly biara no chief Executive, a ɔgyina hɔ ma Central government na nso ɔnya ne tumi firi ekuoba bi a ɔmanpanin ayi no wɔ wɔn mu a ɔda Assembly no ano.Edin no na ɛdidisoɔ yi;

[[Image:Districts of the Upper East Region (2012).svg|thumb|right|500px|Old Map of the Districts of the Upper East Region (2016)]]

{| class=&quot;wikitable sortable&quot;
|+ Districts of the Upper East Region&lt;ref&gt;[http://www.geohive.com/cntry/ghana.aspx Upper East Region – Districts]&lt;/ref&gt;
|-
! #
! MMDA Name
! Capital
! MMDA Type
! Population
|-
! 1
| [[Bawku Municipal District|Bawku]]
| [[Bawku]]
| Municipal
| 
|-
! 2
| [[Bawku West District|Bawku West]]
| [[Zebilla]]
| Ordinary
| 
|-
! 3
| [[Binduri District|Binduri]]
| [[Binduri]]&lt;ref&gt;{{cite web |url=http://www.ghanadistricts.com/districts/?news&amp;r=8&amp;_=222 |title=Ghana Districts - A repository of all districts in the republic of Ghana |website=www.ghanadistricts.com |url-status=dead |archive-url=https://web.archive.org/web/20121018045229/http://www.ghanadistricts.com/districts/?news&amp;r=8&amp;_=222 |archive-date=2012-10-18}}&lt;/ref&gt;
| Ordinary
| 
|-
! 4
| [[Bolgatanga Municipal District|Bolgatanga]]
| '''[[Bolgatanga]]'''
| Municipal
| 
|-
! 5 
| [[Bolgatanga East District|Bolgatanga East]]
| [[Zuarungu]]
| Ordinary
| 
|-
! 6
| [[Bongo District|Bongo]]
| [[Bongo, Ghana|Bongo]]
| Ordinary
| 
|-
! 7
| [[Builsa North Municipal District|Builsa North]]
| [[Sandema]]
| Municipal
| 
|-
! 8
| [[Builsa South District|Builsa South]]
| [[Fumbisi]]&lt;ref&gt;{{cite web |url=http://www.ghanadistricts.com/districts/?news&amp;r=8&amp;_=223 |title=Ghana Districts - A repository of all districts in the republic of Ghana |website=www.ghanadistricts.com |url-status=dead |archive-url=https://web.archive.org/web/20121018045216/http://www.ghanadistricts.com/districts/?news&amp;r=8&amp;_=223 |archive-date=2012-10-18}}&lt;/ref&gt;
| Ordinary
| 
|-
! 9
| [[Garu District|Garu]]
| [[Garu, Ghana|Garu]]
| Ordinary
| 
|-
! 10
| [[Kassena-Nankana Municipal District|Kassena Nankana East]]
| [[Navrongo]]
| Municipal
| 
|-
! 11
| [[Kassena Nankana West District|Kassena-Nankana West]]
| [[Paga]]
| Ordinary
| 
|-
! 12
| [[Nabdam District|Nabdam]]
| [[Nangodi, Ghana|Nangodi]]
| Ordinary
| 
|-
! 13
| [[Pusiga District|Pusiga]]
| [[Pusiga]]&lt;ref&gt;{{cite web |url=http://www.ghanadistricts.com/districts/?news&amp;r=8&amp;_=221 |title=Ghana Districts - A repository of all districts in the republic of Ghana |website=www.ghanadistricts.com |url-status=dead |archive-url=https://web.archive.org/web/20121018045151/http://www.ghanadistricts.com/districts/?news&amp;r=8&amp;_=221 |archive-date=2012-10-18}}&lt;/ref&gt;
| Ordinary
| 
|-
! 14
| [[Talensi District|Talensi]]
| [[Tongo, Ghana|Tongo]]
| Ordinary
| 
|-
! 15
| [[Tempane District|Tempane]]
| [[Tempane]]
| Ordinary
| 
|}{{clear}}

== Adesua ==
'''Ntoasoɔ sukuu'''

* Awe Senior High/Tech
* Bolga Girls Senior High School
* Awe Senior High/Tech School
* Bawku Senior High/Tech School
* Bolgatanga Senior High School
* Bongo Senior High School
* Chiana Senior High School
* Fumbisi Senior High School
* Gowrie Senior High Tech School
* Gambigo Day Community SHS
* Garu Day Community SHS
* Kongo Senior High School
* Kusanaba Senior High School
* Navrongo Senior High School
* Nabango Senior High
* Notre Dame Sem/ Senior High School
* Mirigu Community Day SHS
* O. L. L. Girls Senior High School
* Paga Senior High School
* Queen Of Peace Senior High School
* Sandema Senior High/Tech School
* Sandema Senior High School
* Sirigu Senior High School
* St John's Integrated Senior High/Tech
* Tempane Senior High School
* Zamse Senior High/Tech School
* Zebilla Senior High/Tech School
* Zorkor Senior High School
* St John's Integrated SHTS
* Zuarungu Senior High School
* Bawku Senior High School
* Bawku Technical School

Tertiary Institutions 1). Bolgatanga Technical University 2). St. John Bosco's College of Education 3). Gbewaa College of Education, Pusiga 4). UDS (University for Applied Science &amp; Technology), Navrongo.

== Amamma a wɔyɛ atitirefoɔ ==
{| class=&quot;wikitable&quot;
|-
! colspan=3 | Notable native citizens of Upper East region
|-
! #
! Citizen
! Settlement
|-
! 1
| [[Joseph Kofi Adda]]
| [[Navrongo]]
|-
! 2
| [[Roland Agambire]]
| [[Sirigu (Ghana)|Sirigu]]
|-
! 3
|[[Roger A. Agana]]
|[[Soe, Ghana|Soe]]
|-
! 4
|[[David Atanga]]
|Namoo
|-
!5
|[[Theresa Lardi Awuni]]
|Winkongo
|-
! 6
| [[Adam Kwarasey]]
| [[Navrongo]]
|-
! 7
| [[Abedi Pele]]
| [[Paga]]
|-
!8
| [[Mark Woyongo]]
| [[Navrongo]]
|-
!9
| [[Hawa Yakubu]] 
| [[Kulungungu]]
|-
! 10
| [[Stephen Yakubu]]
| [[Binduri (district)|Binduri]]
|-
!11
| [[Adabere Adabre Donald]]
| [[Bolgatanga]]
|}{{clear}}

== Beaɛ a menyaa mmoa firiiɛ ==
&lt;references /&gt;{{Mantamu a ɛwɔ Ghana}}
[[Nkyekyεmu:Mantam a ɛwɔ Ghana]]</text>
      <sha1>3qmcdbpsbozgnzmlkkiaibxkfookzu6</sha1>
    </revision>
  </page>
  <page>
    <title>Savannah Region</title>
    <ns>0</ns>
    <id>12362</id>
    <revision>
      <id>133041</id>
      <parentid>126594</parentid>
      <timestamp>2022-08-01T09:36:02Z</timestamp>
      <contributor>
        <username>Robertjamal12</username>
        <id>8680</id>
      </contributor>
      <comment>/* Nnipa titire a ɛwɔ ɔman no mu */</comment>
      <model>wikitext</model>
      <format>text/x-wiki</format>
      <text bytes="6681" xml:space="preserve">{{Dialect|Asante}}
'''Savannah Region'''({{Audio|tw-Savanah Region.ogg|pronounciation of &quot;Savanah Region&quot;}}) ka mantam foforɔ a wate wɔ [[Gaana|Ghana]] no ho ɛna ɛyɛ mantam a ɛso paa wɔ ɔman yi mu. Yagbonwura Tumtum a Boresa Jakpa I a ɔyɛ Gonja Traditional Council a ɔde adesrɛ kɔeɛ maa wɔtee saa mantam no. Berɛ a ɔnyaa mmuaeɛ papa firii mpaninfoɔ a ɛwɔ atifi mantam no(mantam a wɔyi firii mu) Brobbey kɔmisa,(kɔmisa a wahyɛ wɔn sɛ wɔnte mantam foforɔ no),wɔtoo aba wɔ [[ɔpɛnimaa]] bosome da a ɛtɔ so aduonu nson wɔ mfeɛ mpem mmienu ne du nnwɔtwe mu. Wɔn a wɔgye tom no bɛyɛ ɔhamu nkyekyɛmu aduokron nkron akyiripɔ nson. [[Gaana|Ghana]] manpanin tintim so yii amamra 115 kyerɛɛ Yagbonwura wɔ Jubilee House,Nkran  [[Ogyefo|ɔgyefoɔ]] bosome da a ɛtɔ so du mmienu wɔ mfeɛ mpem mmienu ne du nkron mu. Gonjaland mma mmarima ne mma mmaa ne ɛnkane ne ɛnɛ mmarahyɛbadwafoɔ, MDCEs ne wɔn a wayi wɔn nyinaa kɔɔ nhyiamu no ase. Wɔdaa [[Damongo]] adi sɛ ɛno ne Savannah Region a wate no foforɔ no ahenkuro. &lt;ref&gt;https://lgs.gov.gh/index.php/savannah/&lt;/ref&gt;Ɛwɔ ɔman no atifi fam. Wakyɛ Savannah Region no mu mansini nson; Bole, Central Gonja,North Gonja,East Gonja,Sawla)Tuna/Kalba,West Gonja, North East Gonja ne mpesoa nson;Bole/Bamboi, Damongo,Daboya/Mankarigu, Salaga North,Salaga South, Sawla/Tuna/Kalba ne Yapei/Kusawgu. &lt;ref&gt;https://citinewsroom.com/2019/05/20/savannah-will-soon-catch-up-with-other-regions-akufo-addo-assures/&lt;/ref&gt;Bole mansini ahenkuro ne Bole,East Gonja Municipal deɛ ne Salaga,West Gonja mansini nso deɛ ne Damongo; Sawla Tuna Kalba mansini deɛ ne Sawla; Central Gonja yɛ Buipe; North Gonja ahenkuro ne Daboya ɛna North East Gonja deɛ ne Kalba.&lt;ref&gt;https://lgs.gov.gh/index.php/savannah/&lt;/ref&gt;

== Abakɔsɛm ==
Aba a wɔtoo no [[ɔpɛnimaa]] bosome da a ɛtɔ so aduonu nson wɔ mfeɛ mpem mmienu ne du nnwɔtwe mu na wɔgye tomm sɛ wɔnte Savannah Region,a nnipa mpem mmienu ne nsia ne ahasa aduonum a ɛgyina hɔ ma ɔhamu nkyekyɛmu aduokron nkron akyiripɔ aduonum mmienu na ɛtoa so. &lt;ref&gt;https://www.ghanabusinessnews.com/2018/12/29/all-six-proposed-regions-meet-constitutional-threshold-requirements-ec/&lt;/ref&gt;&lt;ref&gt;https://www.graphic.com.gh/news/politics/confirmed-results-of-the-2018-referendum-on-new-regions.html&lt;/ref&gt;CI 115 tintim nkrataa no so dekyerɛ ɔgyefoɔ bosome da a ɛtɔ so du mmienu wɔ mfeɛ mpem mmienu ne du nkron mu.&lt;ref&gt;https://mobile.ghanaweb.com/GhanaHomePage/NewsArchive/Savannah-Region-will-benefit-from-her-natural-resource-deposits-Akufo-Addo-722842&lt;/ref&gt;

== Asaase ne emu nnipa ne ewiem nsakraeɛ nsɛm ==
'''Baabi a ɛwɔ ne sɛdeɛ ɛteɛ''' 

Savannah Region ne North a ɛbɛn upper west Region bɔ ahyeɛ, wɔ west no ɛne [[Gaana|Ghana]] -Vote d'Ivoire na ɛbɔ hyeɛ,ɛne Bono ne [[Bono East Region|Bono East]] mantam bɔ hyeɛ wɔ South ɛna ɛwɔ ɛne North East ne Northern Region. Mansini nson na ɛwɔ Savannah Region.

'''Ewiem Nsakraeɛ ne mfudeɛ'''

Savannah Region yɛ beaɛ ɛpɛ wɔ hɔ paa sene Southern mmeaɛ a ɛwɔ [[Gaana|Ghana,]]&lt;nowiki/&gt;ɛnam sɛ ɛbɛn Sahel ne Sahara nti. Nwura no pii no ara yɛ ɛserɛ ne titire Savannah a ɛwɔ nnua ahodoɔ bi a ɛho yɛ na te sɛ baobab,anaa acacias. Wɔ [[ɔpɛnimaa]] ne Oforisuo bosome ntam na ɛyɛ ɔpɛ berɛ. Nsutɔberɛ no yɛ [[Kitawonsa]] ne [[ahinime]] bosome ntam a nsuo no tɔ no bɛyɛ sɛ 750-1050mm (30-40 inched). Ɛpɛ berɛ na ewiem yɛ hye paa na ano ba fam [[ɔpɛnimaa]] ne [[ɔpɛpɔn]] bosome mu. Saa ara nso ɔpɛ a ano yɛ den mframa firi Sahara na abɔ afiri ɔpɛnimaa ne ɔpɛpɔn ahyɛaseɛ. Ewiem hyeɛ ne ne nwunu no tumi sesa firi 14°c(59°F) anadwo ne 40°c(104°F anɔpa ntam.

== Nsrahwɛbea ==
[[File:Elefant Ghana.jpg|thumb|left|240px|[[Elephant]]s at [[Mole National Park]]]]
* Mole National Park
* Bui National Park&lt;ref&gt;http://ghanawildlife.org/bui.html&lt;/ref&gt; ''(now defunct due to Bui National Dam)''
* Larabanga Historic Mosque&lt;ref&gt;https://haunsinafrica.com/2018/07/24/ghana-historic-mosques-larabanga/&lt;/ref&gt;
* Wechiau Hippo Sanctuary&lt;ref&gt;https://haunsinafrica.com/2018/05/11/visiting-the-wechiau-hippo-sanctuary/&lt;/ref&gt;

== Nnipa dodoɔ a ɛwɔ hɔ ==
Nnipa pii wɔ Savannah Region ɛnam borɔfo kasa a ɛyɛ ɔman no kasa nti, nnipa pii no ara a ɛte hɔ no ka Oti-Volts kasa a ɛyɛ abusua a ɛwɔ Niger-Congo abusua kasa, ebi ne Gonja,Vagla,Dagbani, Mamprusi anaa Tamprusi.

== Ɔsom  ==
Nnipa pii a ɛwɔ Savannah Region yɛ nkramofoɔ&lt;ref&gt;http://www.statsghana.gov.gh/docfiles/2010phc/National_Analytical_Report.pdf&lt;/ref&gt;

== Sukuu a ɛwɔ hɔ  ==
Bole Ntoasoɔ Sukuu.￼&lt;ref&gt;https://www.graphic.com.gh/news/general-news/assistant-headmaster-of-bole-shs-arrested-for-allegedly-raping-student.html&lt;/ref&gt;

== Adwumayɛ nkyekyemu ==
Mantam amanyɔsɛm adwuma no nam mpɔtam amammuo so  Wɔ saa nhyehyɛeɛ yi so no, wakyɛ mantam no mu akɔ MMDA nson(kabom mayɛ nya mansini mmienu,ordinary Assembly num). &lt;ref&gt;https://web.archive.org/web/20130118104026/http://www.ghanadistricts.com/region/?r=6&lt;/ref&gt;Mansini, mansini adantam anaa Metropolitan Assembly biara no chiec Executive, a ɔgyina hɔ ma Central government na nso ɔnya ne tumi firi ekuoba bi a ɔmanpanin ayi no wɔ wɔn mu a ɔda Assembly no ano.Edin no na ɛdidisoɔ yi;
[[File:Districts of the Savannah Region (2018).png|thumb|right|500px|Districts of the Savannah Region]]

{| class=&quot;wikitable sortable&quot;
|+ Districts of the Savannah Region
|-
! #
! MMDA Name
! Capital
! MMDA Type
|-
! 1
| [[Bole District|Bole]]
| [[Bole, Ghana|Bole]]
| Ordinary
|-
! 2
| [[Central Gonja District|Central Gonja]]
| [[Buipe, Ghana|Buipe]]
| Ordinary
|-
! 3
| [[North Gonja District|North Gonja]]
| [[Daboya, Ghana|Daboya]]
| Ordinary
|-
! 4
| [[East Gonja Municipal District|East Gonja]]&lt;ref&gt;{{Cite web|title=MP redeems campaign pledge in donating brand new motorcycles - MyJoyOnline.com|url=https://www.myjoyonline.com/mp-redeems-campaign-pledge-in-donating-brand-new-motorcycles/|access-date=2021-05-20|website=www.myjoyonline.com|language=en-US}}&lt;/ref&gt;
| [[Salaga, Ghana|Salaga]]
| Municipal
|-
! 5
| [[North East Gonja District|North East Gonja]]
| [[Kpalbe]]
| Ordinary
|-
! 6
| [[Sawla-Tuna-Kalba District|Sawla-Tuna-Kalba]]
| [[Sawla, Ghana|Sawla]]
| Ordinary
|-
! 7
| [[West Gonja Municipal District|West Gonja]]&lt;ref&gt;{{Cite web|title=Driver's 'mate' feared dead in accident at Damongo - MyJoyOnline.com|url=https://www.myjoyonline.com/drivers-mate-feared-dead-in-accident-at-damongo/|access-date=2021-05-19|website=www.myjoyonline.com|language=en-US}}&lt;/ref&gt;
| '''[[Damongo]]'''
| Municipal
|-
|}

==Nnipa titire a ɛwɔ ɔman no mu==
[[John Dramani Mahama]]

== Beaɛ a mmoa firii ==</text>
      <sha1>jues0n65czgur28opl82dtzmb8ocnoi</sha1>
    </revision>
    <revision>
      <id>133042</id>
      <parentid>133041</parentid>
      <timestamp>2022-08-01T09:37:10Z</timestamp>
      <contributor>
        <username>Robertjamal12</username>
        <id>8680</id>
      </contributor>
      <comment>/* Beaɛ a mmoa firii */</comment>
      <model>wikitext</model>
      <format>text/x-wiki</format>
      <text bytes="6721" xml:space="preserve">{{Dialect|Asante}}
'''Savannah Region'''({{Audio|tw-Savanah Region.ogg|pronounciation of &quot;Savanah Region&quot;}}) ka mantam foforɔ a wate wɔ [[Gaana|Ghana]] no ho ɛna ɛyɛ mantam a ɛso paa wɔ ɔman yi mu. Yagbonwura Tumtum a Boresa Jakpa I a ɔyɛ Gonja Traditional Council a ɔde adesrɛ kɔeɛ maa wɔtee saa mantam no. Berɛ a ɔnyaa mmuaeɛ papa firii mpaninfoɔ a ɛwɔ atifi mantam no(mantam a wɔyi firii mu) Brobbey kɔmisa,(kɔmisa a wahyɛ wɔn sɛ wɔnte mantam foforɔ no),wɔtoo aba wɔ [[ɔpɛnimaa]] bosome da a ɛtɔ so aduonu nson wɔ mfeɛ mpem mmienu ne du nnwɔtwe mu. Wɔn a wɔgye tom no bɛyɛ ɔhamu nkyekyɛmu aduokron nkron akyiripɔ nson. [[Gaana|Ghana]] manpanin tintim so yii amamra 115 kyerɛɛ Yagbonwura wɔ Jubilee House,Nkran  [[Ogyefo|ɔgyefoɔ]] bosome da a ɛtɔ so du mmienu wɔ mfeɛ mpem mmienu ne du nkron mu. Gonjaland mma mmarima ne mma mmaa ne ɛnkane ne ɛnɛ mmarahyɛbadwafoɔ, MDCEs ne wɔn a wayi wɔn nyinaa kɔɔ nhyiamu no ase. Wɔdaa [[Damongo]] adi sɛ ɛno ne Savannah Region a wate no foforɔ no ahenkuro. &lt;ref&gt;https://lgs.gov.gh/index.php/savannah/&lt;/ref&gt;Ɛwɔ ɔman no atifi fam. Wakyɛ Savannah Region no mu mansini nson; Bole, Central Gonja,North Gonja,East Gonja,Sawla)Tuna/Kalba,West Gonja, North East Gonja ne mpesoa nson;Bole/Bamboi, Damongo,Daboya/Mankarigu, Salaga North,Salaga South, Sawla/Tuna/Kalba ne Yapei/Kusawgu. &lt;ref&gt;https://citinewsroom.com/2019/05/20/savannah-will-soon-catch-up-with-other-regions-akufo-addo-assures/&lt;/ref&gt;Bole mansini ahenkuro ne Bole,East Gonja Municipal deɛ ne Salaga,West Gonja mansini nso deɛ ne Damongo; Sawla Tuna Kalba mansini deɛ ne Sawla; Central Gonja yɛ Buipe; North Gonja ahenkuro ne Daboya ɛna North East Gonja deɛ ne Kalba.&lt;ref&gt;https://lgs.gov.gh/index.php/savannah/&lt;/ref&gt;

== Abakɔsɛm ==
Aba a wɔtoo no [[ɔpɛnimaa]] bosome da a ɛtɔ so aduonu nson wɔ mfeɛ mpem mmienu ne du nnwɔtwe mu na wɔgye tomm sɛ wɔnte Savannah Region,a nnipa mpem mmienu ne nsia ne ahasa aduonum a ɛgyina hɔ ma ɔhamu nkyekyɛmu aduokron nkron akyiripɔ aduonum mmienu na ɛtoa so. &lt;ref&gt;https://www.ghanabusinessnews.com/2018/12/29/all-six-proposed-regions-meet-constitutional-threshold-requirements-ec/&lt;/ref&gt;&lt;ref&gt;https://www.graphic.com.gh/news/politics/confirmed-results-of-the-2018-referendum-on-new-regions.html&lt;/ref&gt;CI 115 tintim nkrataa no so dekyerɛ ɔgyefoɔ bosome da a ɛtɔ so du mmienu wɔ mfeɛ mpem mmienu ne du nkron mu.&lt;ref&gt;https://mobile.ghanaweb.com/GhanaHomePage/NewsArchive/Savannah-Region-will-benefit-from-her-natural-resource-deposits-Akufo-Addo-722842&lt;/ref&gt;

== Asaase ne emu nnipa ne ewiem nsakraeɛ nsɛm ==
'''Baabi a ɛwɔ ne sɛdeɛ ɛteɛ''' 

Savannah Region ne North a ɛbɛn upper west Region bɔ ahyeɛ, wɔ west no ɛne [[Gaana|Ghana]] -Vote d'Ivoire na ɛbɔ hyeɛ,ɛne Bono ne [[Bono East Region|Bono East]] mantam bɔ hyeɛ wɔ South ɛna ɛwɔ ɛne North East ne Northern Region. Mansini nson na ɛwɔ Savannah Region.

'''Ewiem Nsakraeɛ ne mfudeɛ'''

Savannah Region yɛ beaɛ ɛpɛ wɔ hɔ paa sene Southern mmeaɛ a ɛwɔ [[Gaana|Ghana,]]&lt;nowiki/&gt;ɛnam sɛ ɛbɛn Sahel ne Sahara nti. Nwura no pii no ara yɛ ɛserɛ ne titire Savannah a ɛwɔ nnua ahodoɔ bi a ɛho yɛ na te sɛ baobab,anaa acacias. Wɔ [[ɔpɛnimaa]] ne Oforisuo bosome ntam na ɛyɛ ɔpɛ berɛ. Nsutɔberɛ no yɛ [[Kitawonsa]] ne [[ahinime]] bosome ntam a nsuo no tɔ no bɛyɛ sɛ 750-1050mm (30-40 inched). Ɛpɛ berɛ na ewiem yɛ hye paa na ano ba fam [[ɔpɛnimaa]] ne [[ɔpɛpɔn]] bosome mu. Saa ara nso ɔpɛ a ano yɛ den mframa firi Sahara na abɔ afiri ɔpɛnimaa ne ɔpɛpɔn ahyɛaseɛ. Ewiem hyeɛ ne ne nwunu no tumi sesa firi 14°c(59°F) anadwo ne 40°c(104°F anɔpa ntam.

== Nsrahwɛbea ==
[[File:Elefant Ghana.jpg|thumb|left|240px|[[Elephant]]s at [[Mole National Park]]]]
* Mole National Park
* Bui National Park&lt;ref&gt;http://ghanawildlife.org/bui.html&lt;/ref&gt; ''(now defunct due to Bui National Dam)''
* Larabanga Historic Mosque&lt;ref&gt;https://haunsinafrica.com/2018/07/24/ghana-historic-mosques-larabanga/&lt;/ref&gt;
* Wechiau Hippo Sanctuary&lt;ref&gt;https://haunsinafrica.com/2018/05/11/visiting-the-wechiau-hippo-sanctuary/&lt;/ref&gt;

== Nnipa dodoɔ a ɛwɔ hɔ ==
Nnipa pii wɔ Savannah Region ɛnam borɔfo kasa a ɛyɛ ɔman no kasa nti, nnipa pii no ara a ɛte hɔ no ka Oti-Volts kasa a ɛyɛ abusua a ɛwɔ Niger-Congo abusua kasa, ebi ne Gonja,Vagla,Dagbani, Mamprusi anaa Tamprusi.

== Ɔsom  ==
Nnipa pii a ɛwɔ Savannah Region yɛ nkramofoɔ&lt;ref&gt;http://www.statsghana.gov.gh/docfiles/2010phc/National_Analytical_Report.pdf&lt;/ref&gt;

== Sukuu a ɛwɔ hɔ  ==
Bole Ntoasoɔ Sukuu.￼&lt;ref&gt;https://www.graphic.com.gh/news/general-news/assistant-headmaster-of-bole-shs-arrested-for-allegedly-raping-student.html&lt;/ref&gt;

== Adwumayɛ nkyekyemu ==
Mantam amanyɔsɛm adwuma no nam mpɔtam amammuo so  Wɔ saa nhyehyɛeɛ yi so no, wakyɛ mantam no mu akɔ MMDA nson(kabom mayɛ nya mansini mmienu,ordinary Assembly num). &lt;ref&gt;https://web.archive.org/web/20130118104026/http://www.ghanadistricts.com/region/?r=6&lt;/ref&gt;Mansini, mansini adantam anaa Metropolitan Assembly biara no chiec Executive, a ɔgyina hɔ ma Central government na nso ɔnya ne tumi firi ekuoba bi a ɔmanpanin ayi no wɔ wɔn mu a ɔda Assembly no ano.Edin no na ɛdidisoɔ yi;
[[File:Districts of the Savannah Region (2018).png|thumb|right|500px|Districts of the Savannah Region]]

{| class=&quot;wikitable sortable&quot;
|+ Districts of the Savannah Region
|-
! #
! MMDA Name
! Capital
! MMDA Type
|-
! 1
| [[Bole District|Bole]]
| [[Bole, Ghana|Bole]]
| Ordinary
|-
! 2
| [[Central Gonja District|Central Gonja]]
| [[Buipe, Ghana|Buipe]]
| Ordinary
|-
! 3
| [[North Gonja District|North Gonja]]
| [[Daboya, Ghana|Daboya]]
| Ordinary
|-
! 4
| [[East Gonja Municipal District|East Gonja]]&lt;ref&gt;{{Cite web|title=MP redeems campaign pledge in donating brand new motorcycles - MyJoyOnline.com|url=https://www.myjoyonline.com/mp-redeems-campaign-pledge-in-donating-brand-new-motorcycles/|access-date=2021-05-20|website=www.myjoyonline.com|language=en-US}}&lt;/ref&gt;
| [[Salaga, Ghana|Salaga]]
| Municipal
|-
! 5
| [[North East Gonja District|North East Gonja]]
| [[Kpalbe]]
| Ordinary
|-
! 6
| [[Sawla-Tuna-Kalba District|Sawla-Tuna-Kalba]]
| [[Sawla, Ghana|Sawla]]
| Ordinary
|-
! 7
| [[West Gonja Municipal District|West Gonja]]&lt;ref&gt;{{Cite web|title=Driver's 'mate' feared dead in accident at Damongo - MyJoyOnline.com|url=https://www.myjoyonline.com/drivers-mate-feared-dead-in-accident-at-damongo/|access-date=2021-05-19|website=www.myjoyonline.com|language=en-US}}&lt;/ref&gt;
| '''[[Damongo]]'''
| Municipal
|-
|}

==Nnipa titire a ɛwɔ ɔman no mu==
[[John Dramani Mahama]]

== Beaɛ a mmoa firii ==
&lt;references /&gt;{{Mantamu a ɛwɔ Ghana}}</text>
      <sha1>5pl49giby5r4w0clxb7upe07ldq2ol7</sha1>
    </revision>
    <revision>
      <id>133054</id>
      <parentid>133042</parentid>
      <timestamp>2022-08-01T09:59:01Z</timestamp>
      <contributor>
        <username>Robertjamal12</username>
        <id>8680</id>
      </contributor>
      <model>wikitext</model>
      <format>text/x-wiki</format>
      <text bytes="6757" xml:space="preserve">{{Dialect|Asante}}
'''Savannah Region'''({{Audio|tw-Savanah Region.ogg|pronounciation of &quot;Savanah Region&quot;}}) ka mantam foforɔ a wate wɔ [[Gaana|Ghana]] no ho ɛna ɛyɛ mantam a ɛso paa wɔ ɔman yi mu. Yagbonwura Tumtum a Boresa Jakpa I a ɔyɛ Gonja Traditional Council a ɔde adesrɛ kɔeɛ maa wɔtee saa mantam no. Berɛ a ɔnyaa mmuaeɛ papa firii mpaninfoɔ a ɛwɔ atifi mantam no(mantam a wɔyi firii mu) Brobbey kɔmisa,(kɔmisa a wahyɛ wɔn sɛ wɔnte mantam foforɔ no),wɔtoo aba wɔ [[ɔpɛnimaa]] bosome da a ɛtɔ so aduonu nson wɔ mfeɛ mpem mmienu ne du nnwɔtwe mu. Wɔn a wɔgye tom no bɛyɛ ɔhamu nkyekyɛmu aduokron nkron akyiripɔ nson. [[Gaana|Ghana]] manpanin tintim so yii amamra 115 kyerɛɛ Yagbonwura wɔ Jubilee House,Nkran  [[Ogyefo|ɔgyefoɔ]] bosome da a ɛtɔ so du mmienu wɔ mfeɛ mpem mmienu ne du nkron mu. Gonjaland mma mmarima ne mma mmaa ne ɛnkane ne ɛnɛ mmarahyɛbadwafoɔ, MDCEs ne wɔn a wayi wɔn nyinaa kɔɔ nhyiamu no ase. Wɔdaa [[Damongo]] adi sɛ ɛno ne Savannah Region a wate no foforɔ no ahenkuro. &lt;ref&gt;https://lgs.gov.gh/index.php/savannah/&lt;/ref&gt;Ɛwɔ ɔman no atifi fam. Wakyɛ Savannah Region no mu mansini nson; Bole, Central Gonja,North Gonja,East Gonja,Sawla)Tuna/Kalba,West Gonja, North East Gonja ne mpesoa nson;Bole/Bamboi, Damongo,Daboya/Mankarigu, Salaga North,Salaga South, Sawla/Tuna/Kalba ne Yapei/Kusawgu. &lt;ref&gt;https://citinewsroom.com/2019/05/20/savannah-will-soon-catch-up-with-other-regions-akufo-addo-assures/&lt;/ref&gt;Bole mansini ahenkuro ne Bole,East Gonja Municipal deɛ ne Salaga,West Gonja mansini nso deɛ ne Damongo; Sawla Tuna Kalba mansini deɛ ne Sawla; Central Gonja yɛ Buipe; North Gonja ahenkuro ne Daboya ɛna North East Gonja deɛ ne Kalba.&lt;ref&gt;https://lgs.gov.gh/index.php/savannah/&lt;/ref&gt;

== Abakɔsɛm ==
Aba a wɔtoo no [[ɔpɛnimaa]] bosome da a ɛtɔ so aduonu nson wɔ mfeɛ mpem mmienu ne du nnwɔtwe mu na wɔgye tomm sɛ wɔnte Savannah Region,a nnipa mpem mmienu ne nsia ne ahasa aduonum a ɛgyina hɔ ma ɔhamu nkyekyɛmu aduokron nkron akyiripɔ aduonum mmienu na ɛtoa so. &lt;ref&gt;https://www.ghanabusinessnews.com/2018/12/29/all-six-proposed-regions-meet-constitutional-threshold-requirements-ec/&lt;/ref&gt;&lt;ref&gt;https://www.graphic.com.gh/news/politics/confirmed-results-of-the-2018-referendum-on-new-regions.html&lt;/ref&gt;CI 115 tintim nkrataa no so dekyerɛ ɔgyefoɔ bosome da a ɛtɔ so du mmienu wɔ mfeɛ mpem mmienu ne du nkron mu.&lt;ref&gt;https://mobile.ghanaweb.com/GhanaHomePage/NewsArchive/Savannah-Region-will-benefit-from-her-natural-resource-deposits-Akufo-Addo-722842&lt;/ref&gt;

== Asaase ne emu nnipa ne ewiem nsakraeɛ nsɛm ==
'''Baabi a ɛwɔ ne sɛdeɛ ɛteɛ''' 

Savannah Region ne North a ɛbɛn upper west Region bɔ ahyeɛ, wɔ west no ɛne [[Gaana|Ghana]] -Vote d'Ivoire na ɛbɔ hyeɛ,ɛne Bono ne [[Bono East Region|Bono East]] mantam bɔ hyeɛ wɔ South ɛna ɛwɔ ɛne North East ne Northern Region. Mansini nson na ɛwɔ Savannah Region.

'''Ewiem Nsakraeɛ ne mfudeɛ'''

Savannah Region yɛ beaɛ ɛpɛ wɔ hɔ paa sene Southern mmeaɛ a ɛwɔ [[Gaana|Ghana,]]&lt;nowiki/&gt;ɛnam sɛ ɛbɛn Sahel ne Sahara nti. Nwura no pii no ara yɛ ɛserɛ ne titire Savannah a ɛwɔ nnua ahodoɔ bi a ɛho yɛ na te sɛ baobab,anaa acacias. Wɔ [[ɔpɛnimaa]] ne Oforisuo bosome ntam na ɛyɛ ɔpɛ berɛ. Nsutɔberɛ no yɛ [[Kitawonsa]] ne [[ahinime]] bosome ntam a nsuo no tɔ no bɛyɛ sɛ 750-1050mm (30-40 inched). Ɛpɛ berɛ na ewiem yɛ hye paa na ano ba fam [[ɔpɛnimaa]] ne [[ɔpɛpɔn]] bosome mu. Saa ara nso ɔpɛ a ano yɛ den mframa firi Sahara na abɔ afiri ɔpɛnimaa ne ɔpɛpɔn ahyɛaseɛ. Ewiem hyeɛ ne ne nwunu no tumi sesa firi 14°c(59°F) anadwo ne 40°c(104°F anɔpa ntam.

== Nsrahwɛbea ==
[[File:Elefant Ghana.jpg|thumb|left|240px|[[Elephant]]s at [[Mole National Park]]]]
* Mole National Park
* Bui National Park&lt;ref&gt;http://ghanawildlife.org/bui.html&lt;/ref&gt; ''(now defunct due to Bui National Dam)''
* Larabanga Historic Mosque&lt;ref&gt;https://haunsinafrica.com/2018/07/24/ghana-historic-mosques-larabanga/&lt;/ref&gt;
* Wechiau Hippo Sanctuary&lt;ref&gt;https://haunsinafrica.com/2018/05/11/visiting-the-wechiau-hippo-sanctuary/&lt;/ref&gt;

== Nnipa dodoɔ a ɛwɔ hɔ ==
Nnipa pii wɔ Savannah Region ɛnam borɔfo kasa a ɛyɛ ɔman no kasa nti, nnipa pii no ara a ɛte hɔ no ka Oti-Volts kasa a ɛyɛ abusua a ɛwɔ Niger-Congo abusua kasa, ebi ne Gonja,Vagla,Dagbani, Mamprusi anaa Tamprusi.

== Ɔsom  ==
Nnipa pii a ɛwɔ Savannah Region yɛ nkramofoɔ&lt;ref&gt;http://www.statsghana.gov.gh/docfiles/2010phc/National_Analytical_Report.pdf&lt;/ref&gt;

== Sukuu a ɛwɔ hɔ  ==
Bole Ntoasoɔ Sukuu.￼&lt;ref&gt;https://www.graphic.com.gh/news/general-news/assistant-headmaster-of-bole-shs-arrested-for-allegedly-raping-student.html&lt;/ref&gt;

== Adwumayɛ nkyekyemu ==
Mantam amanyɔsɛm adwuma no nam mpɔtam amammuo so  Wɔ saa nhyehyɛeɛ yi so no, wakyɛ mantam no mu akɔ MMDA nson(kabom mayɛ nya mansini mmienu,ordinary Assembly num). &lt;ref&gt;https://web.archive.org/web/20130118104026/http://www.ghanadistricts.com/region/?r=6&lt;/ref&gt;Mansini, mansini adantam anaa Metropolitan Assembly biara no chiec Executive, a ɔgyina hɔ ma Central government na nso ɔnya ne tumi firi ekuoba bi a ɔmanpanin ayi no wɔ wɔn mu a ɔda Assembly no ano.Edin no na ɛdidisoɔ yi;
[[File:Districts of the Savannah Region (2018).png|thumb|right|500px|Districts of the Savannah Region]]

{| class=&quot;wikitable sortable&quot;
|+ Districts of the Savannah Region
|-
! #
! MMDA Name
! Capital
! MMDA Type
|-
! 1
| [[Bole District|Bole]]
| [[Bole, Ghana|Bole]]
| Ordinary
|-
! 2
| [[Central Gonja District|Central Gonja]]
| [[Buipe, Ghana|Buipe]]
| Ordinary
|-
! 3
| [[North Gonja District|North Gonja]]
| [[Daboya, Ghana|Daboya]]
| Ordinary
|-
! 4
| [[East Gonja Municipal District|East Gonja]]&lt;ref&gt;{{Cite web|title=MP redeems campaign pledge in donating brand new motorcycles - MyJoyOnline.com|url=https://www.myjoyonline.com/mp-redeems-campaign-pledge-in-donating-brand-new-motorcycles/|access-date=2021-05-20|website=www.myjoyonline.com|language=en-US}}&lt;/ref&gt;
| [[Salaga, Ghana|Salaga]]
| Municipal
|-
! 5
| [[North East Gonja District|North East Gonja]]
| [[Kpalbe]]
| Ordinary
|-
! 6
| [[Sawla-Tuna-Kalba District|Sawla-Tuna-Kalba]]
| [[Sawla, Ghana|Sawla]]
| Ordinary
|-
! 7
| [[West Gonja Municipal District|West Gonja]]&lt;ref&gt;{{Cite web|title=Driver's 'mate' feared dead in accident at Damongo - MyJoyOnline.com|url=https://www.myjoyonline.com/drivers-mate-feared-dead-in-accident-at-damongo/|access-date=2021-05-19|website=www.myjoyonline.com|language=en-US}}&lt;/ref&gt;
| '''[[Damongo]]'''
| Municipal
|-
|}

==Nnipa titire a ɛwɔ ɔman no mu==
[[John Dramani Mahama]]

== Beaɛ a mmoa firii ==
&lt;references /&gt;{{Mantamu a ɛwɔ Ghana}}
[[Nkyekyεmu:Mantam a ɛwɔ Ghana]]</text>
      <sha1>losp7bd2bw8xjpc54x33i97ltnnkthd</sha1>
    </revision>
  </page>
  <page>
    <title>Oti Region</title>
    <ns>0</ns>
    <id>12367</id>
    <revision>
      <id>133053</id>
      <parentid>132749</parentid>
      <timestamp>2022-08-01T09:58:45Z</timestamp>
      <contributor>
        <username>Robertjamal12</username>
        <id>8680</id>
      </contributor>
      <model>wikitext</model>
      <format>text/x-wiki</format>
      <text bytes="6229" xml:space="preserve">{{Dialect|Asante}}
'''Oti Region'''({{Audio|tw-Oti Region.ogg|sɛnea yɛbɔ  &quot;Oti Region&quot;}}) ka [[Mantamu a ɛwɔ Ghana|mantam]] nsia foforɔ a wɔtee wɔ [[Gaana|Ghana]]&lt;ref&gt;https://www.myjoyonline.com/ncce-urges-protection-of-water-bodies/&lt;/ref&gt; &lt;ref&gt;https://www.graphic.com.gh/news/general-news/new-ghana-map-with-16-regional-capitals.html&lt;/ref&gt; wɔ [[ɔpɛnimaa]] bosome, mfeɛ mpem mmienu ne du nnwɔtwe mu.&lt;ref&gt;https://citinewsroom.com/2018/12/referendum-oti-residents-okay-new-region-with-99-yes-vote/&lt;/ref&gt; Wɔyii mantam no firii atifi fa baabi a ɛwɔ Fram mantam na ɛnam ɔsono amanyɔkuo New Patriotic Party aporɔbɔ bɔhyɛ so na ɛbɛma no aba mu. Wɔ mfeɛ mpem mmienu ne du nsia abatoɔ nom na [[Nana Akufo-Addo|Nana Akuffo Addo]] a na ɔyɛ anamusini kaa sɛ, sɛ wɔto aba yi no sɛ [[Ɔmanpanin (aban abodin)|ɔmanpanin]] a, ɔbɛte mantam foforɔ afiri mantam a ɛwɔ hɔ dada no na ama temamufoɔ abɛn aban no.&lt;ref&gt;https://www.myjoyonline.com/lack-of-facilities-impede-healthcare-service-delivery-in-oti-osei-kufuor-afreh/&lt;/ref&gt;&lt;ref&gt;http://www.presidency.gov.gh/index.php/briefing-room/news-style-2/703-creation-of-6-new-regions-in-the-hands-of-ec-ghanaians-president-akufo-addo&lt;/ref&gt;

== Abakɔsɛm ==
Hon. Dan Botwe a ɔda asoeɛ foforɔ a wɔtee, asoeɛ a ɛhwɛ mantam nhyehyɛeɛ bio ne ne mpuntuo ho no, &lt;ref name=&quot;:0&quot;&gt;https://web.archive.org/web/20170731040155/http://www.myjoyonline.com/politics/2017/January-11th/2nd-ministerial-list-out-akufo-addo-creates-new-ministries-re-aligns-old.php&lt;/ref&gt; maa nsusueɛ a wɔsusu faa mantam tee no ho yɛɛ adwuma.&lt;ref name=&quot;:0&quot;&gt;https://web.archive.org/web/20170731040155/http://www.myjoyonline.com/politics/2017/January-11th/2nd-ministerial-list-out-akufo-addo-creates-new-ministries-re-aligns-old.php&lt;/ref&gt; Wɔ [[ɔbɛnem]] bosome wɔ mfeɛ mpem mmienu ne du nson mu no,asoeɛ no ne afoforɔ bi de krataa a ɛkyerɛ sɛ wɔbɛdi saa dwuma no kɔɔ council of State hɔ. Berɛ a wɔde krataa no kɔeɛ no, agyinatufoɔ no hyiaa bɛboro mpere aduasa nsia kɔpem [[ɔsanaa]] bosome wɔ mfeɛ mpem mmienu ne du nson mu.&lt;ref&gt;https://web.archive.org/web/20171212193348/https://www.ghanacrusader.com/council-of-state-met-36-times-on-creation-of-new-regions-nana-otuo-siriboe-ii/&lt;/ref&gt; Nnipa a ɛwɔ mantam foforɔ hɔ no too aba dwumadie no awieɛ wɔ [[ɔpɛnimaa]] bosome da a ɛtɔ so aduonu nson wɔ mfeɛ mpem mmienu ne du nnwɔtwe mu dekyerɛ sɛ ɛwɔ sɛ wɔte mantam foforɔ&lt;ref&gt;https://www.ghanaweb.com/GhanaHomePage/NewsArchive/Referendum-Massive-YES-votes-for-6-new-regions-711692&lt;/ref&gt; Nnipa mpem ahasa ne aduonu mmiɛnsa, ahanson ne nnwɔtwe na wɔtoo aba nanso nnipa mpem ahasa ne aduosia nsia, ahanan ne aduowɔtwe baako(88.33%) na ɛtwerɛɛ wɔn din. Nnipa dodoɔ bɛyɛ 319,296 (98.64%) too aane ɛna 2878(0.89%) too dabi na aba a wɔyi firii mu yɛ 951(0.24%).&lt;ref&gt;https://www.ghanabusinessnews.com/2018/12/29/all-six-proposed-regions-meet-constitutional-threshold-requirements-ec/&lt;/ref&gt;

== Adwumayɛ nkyekyemu ==
Mantam amanyɔsɛm adwuma no nam mpɔtam amammuo so  Wɔ saa nhyehyɛeɛ yi so no, wakyɛ mantam no mu akɔ MMDA nnwɔtwe (kabom mayɛ nya mansini mmienu,ordinary Assembly nsia). &lt;ref&gt;http://www.1district1factory.gov.gh/list-district?r=11&lt;/ref&gt; Mansini, mansini adantam anaa Metropolitan Assembly biara no chief Executive, a ɔgyina hɔ ma Central government na nso ɔnya ne tumi firi ekuoba bi a ɔmanpanin ayi no wɔ wɔn mu a ɔda Assembly no ano.Edin no na ɛdidisoɔ yi;
[[File:Districts of the Oti Region (2018).png|400px|right]]

{| class=&quot;wikitable sortable&quot;
|+ Districts of the Oti Region
|-
! #
! MMDA Name
! Capital
! MMDA Type
! Chief Executive
|-
! 1
| [[Biakoye District|Biakoye]]
| [[Nkonya Ahenkro]]
| Ordinary
| Comfort Attah
|-
! 2
| [[Jasikan District|Jasikan]]
| [[Jasikan]]
| Ordinary
| Lawrence Aziale
|-
! 3
| [[Kadjebi District|Kadjebi]]
| [[Kadjebi]]
| Ordinary
| Michael Kofi Asiedu
|-
! 4
| [[Krachi East Municipal District|Krachi East]]
| '''[[Dambai]]'''
| Municipal
| Patrick Jilima
|-
! 5
| [[Krachi Nchumuru District|Krachi Nchumuru]]
| [[Chindiri]]
| Ordinary
| Augustine Appiah
|-
! 6
| [[Krachi West District|Krachi West]]
| [[Kete Krachi]]
| Ordinary
| Douglas Osei-Nti
|-
! 7
| [[Nkwanta North District|Nkwanta North]]
| [[Kpassa]]
| Ordinary
| Jakayi Jackson
|-
! 8
| [[Nkwanta South Municipal District|Nkwanta South]]
| [[Nkwanta]]
| Ordinary
| John Tarsun
|-
! 9
| Guan District
| 
| 
| Andrews Teddy Ofori
|-
|}


== Asaase ne emu nnipa ne ewiem nsakraeɛ nsɛm ==
'''Baabi a ɛwɔ ne sɛdeɛ ɛteɛ'''

Oti Region ne North a ɛbɛn Northern Region bɔ ahyeɛ, wɔ south no ɛne Volta Region na ɛbɔ hyeɛ, ɛna wɔ west nso ɛne Volta lake. Mansini nkron na ɛwɔ Oti Region.

'''Ewiem Nsakraeɛ ne mfudeɛ'''

Oti Region yɛ beaɛ ɛpɛ wɔ hɔ paa sene Southern mmeaɛ a ɛwɔ Ghana,ɛnam sɛ ɛbɛn Sahel ne North nti. Nwura no pii no ara yɛ ɛserɛ ne titire Savannah a ɛwɔ nnua ahodoɔ bi a ɛho yɛ na te sɛ baobab,anaa acacias. Wɔ [[ɔpɛnimaa]] ne Oforisuo bosome ntam na ɛyɛ ɔpɛ berɛ. Nsutɔberɛ no yɛ [[Kitawonsa]] ne [[ahinime]] bosome ntam a nsuo no tɔ no bɛyɛ sɛ 750-1050mm (30-40 inched). Ɛpɛ berɛ na ewiem yɛ hye paa na ano ba fam ɔpɛnimaa ne [[ɔpɛpɔn]] bosome mu. Saa ara nso ɔpɛ a ano yɛ den mframa firi Sahara na abɔ afiri [[ɔpɛnimaa]] ne [[ɔpɛpɔn]] ahyɛaseɛ. Ewiem hyeɛ ne ne nwunu no tumi sesa firi 14°c(59°F) anadwo ne 40°c(104°F anɔpa ntam.

'''Abɔdeɛ nnoɔma a ɛwɔ hɔ'''

[[Gaana|Ghana]] Geological Survey Authority ahunu iron ore wɔ Akokrowa, mpɔtam a wɔyɛ kua wɔ Oti mantam a ɛwɔ [[Gaana|Ghana]]. nhwehwɛmu a ɛfiri wɔn hɔ kyerɛ sɛ iron ore no mu duru yɛ ɔhamu nkyekyɛmu aduonum num akyiripɔ aduonu mmienu (Fe) na ne boɔ yɛ den. Wɔkyerɛ sɛ nnipa a wɔde wɔn ho gye mu wɔ iron ore no tuo mu wɔ Oti no bɛboa ama wɔn anya adwuma ayɛ  na ama wɔn ne ɔman no anya sika nso.&lt;ref&gt;https://accramining.net/ghanas-iron-ore-potential-and-the-new-find-in-the-oti-region/&lt;/ref&gt;

== Nsrahwɛbea ==
* Kyabobo National Park
* Lake Volta
* Breast Mountain, Chilinga
* Chaiso Forest Reserve

== Beaeɛ a menyaa mmoa firiiɛ ==
&lt;references /&gt;{{Mantamu a ɛwɔ Ghana}}
[[Nkyekyεmu:Mantam a ɛwɔ Ghana]]</text>
      <sha1>eml1q991iljmsph0wfjhzjktiptg4iy</sha1>
    </revision>
  </page>
  <page>
    <title>Abranteɛ</title>
    <ns>0</ns>
    <id>12390</id>
    <revision>
      <id>132996</id>
      <parentid>126749</parentid>
      <timestamp>2022-08-01T02:09:11Z</timestamp>
      <contributor>
        <username>Afriyie34</username>
        <id>10662</id>
      </contributor>
      <model>wikitext</model>
      <format>text/x-wiki</format>
      <text bytes="1280" xml:space="preserve">{{Dialect|Asante}}


'''Abarimaa'''({{Audio|tw-Abranteɛ.ogg|pronounciation of &quot;Abranteɛ&quot;}}) anaa aberante a wanyin

== Nnwom ==
Young Man (Billy Dean album) anaa dwom a wɔde too gua, 1990

Young Man, album a Jack Ingram yɛe, afe 2004

&quot;Young Man&quot;, dwom a Chicks a ofi Gaslighter yɛe, 2020

&quot;Aberanteɛ&quot;, dwom a Justin Timberlake yɛeɛ a ɛfiri Man of the Woods, 2018

&quot;Young Man&quot;, dwom a Living Color yɛe a ɛfiri The Chair in the Doorway, 2009

== Nneɛma afoforo a wɔde di dwuma ==
Aberante no ayɛsɛm a Botho Strauß kyerɛwee wɔ 1984 mu

Aberante a ofi Arévalo (fl. afeha a ɛto so 16), Spainni Morisco crypto-Nkramofo kyerɛwfo

Aberante Kang (wɔwoo no 1966), South Koreani siniyɛfo

Young Man Lake, ɔtare bi a ɛwɔ Montana, U.S.A

Young Man (sini), [[Russia|Russiafo]] sini bi

o

Nkratafa a asɛmti ahorow a Aberante wom wom nyinaa

Young Mans Butte, bepɔw bi a ɛwɔ North Dakota

Mmabun a wanyin (adwene ne nneyɛe ho nimdeɛ) .

Youngman, Chinafo adwumakuw bi a wɔyɛ bɔs ne lɔre ahorow

Youngman (MC), Britaniafo MC

Youngman (abusua din) .

Saa disambiguation krataafa yi kyerɛ nsɛm a ɛfa asɛmti Aberante no ho.

Sɛ link bi a ɛwɔ mu na ɛde wo baa ha a, ebia wobɛpɛ sɛ wosakra link no ma twe adwene si asɛm a wopɛ sɛ woka no so tẽẽ.</text>
      <sha1>a0bfaa7pa685qfzlk5rbief3430bq5d</sha1>
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  </page>
  <page>
    <title>Central Region</title>
    <ns>0</ns>
    <id>12412</id>
    <revision>
      <id>133047</id>
      <parentid>132687</parentid>
      <timestamp>2022-08-01T09:45:32Z</timestamp>
      <contributor>
        <username>Robertjamal12</username>
        <id>8680</id>
      </contributor>
      <model>wikitext</model>
      <format>text/x-wiki</format>
      <text bytes="9936" xml:space="preserve">'''Central Region (Mfinimfin Mantam)''' ({{Audio|tw-Central Region.ogg|sɛnea yɛbɔ&quot;Central Region&quot;}}) ka Ghana Mantam dunsia no ho. [[Asante Mantam|Asante mantam]] ne [[Apueɛ Mantam|Apueeɛ mantam]] wɔ ne atififam, [[Atɔɛ Mantam|atɔeɛ mantam]] wɔ ne atɔeɛfam, [[Nkran Mantam|Nkran mantam]] wɔ ne apueeɛfam na Gulf of Guinea nso wɔ ne anaafoɔfam. Mfinimfin mantam yɛ mantam bi a agye din wɔ ntoasoɔ sukuu a agye din yiye wɔ ɔman [[Gaana|Ghana]] mu a ɛwɔ ho nti, ne beaeɛ bi a wɔn sikasɛm wɔ soro ɛnam fagudeɛ nnwumakuo ahodoɔ ne mmeaeɛ a nkurɔfoɔ tu kwan bɛhwɛ. Mfinimfin mantam wɔ mmeaeɛ bebere a nnipa tu kwan bɛhwɛ bi te sɛ: castles, forts ne beaches a ɛtwa [[ɛpo]] no ho ahyia wɔ mfinimfin mantam mu.

[[File:Central in Ghana 2018.svg|Central_in_Ghana_2018|thumb]] ''Beaeɛ a wobehunu Mfinimfin mantam wɔ Ghana map so'' 

[[File:Districts of the Central Region (2012).svg|Districts_of_the_Central_Region_(2012)|thumb]] ''Mansini ahodoɔ a ɛwɔ Mfinimfin mantam a ɛwɔ Ghana map so.''

== Nnipa atitire bi a wɔfiri mfinimfin mantam mu ==
{| class=&quot;wikitable&quot;
! colspan=&quot;3&quot; |Nnipa titire bi a wɔfiri mfinimfin mantam mu 
|-
!#
!Mantam no mu nnipa 
!Beaeɛ a wɔte
|-
!1
|Nana Ato Arthur
|Elmina
|-
!2
|George Amoh
|Dunkwa-Offin
|-
!3
|Ishmael Yartei
|Agona Swedru
|-
!4
|Yvonne Nelson
|[[Cape Coast]]
|-
!5
|Jackie Appiah&lt;ref&gt;http://www.peacefmonline.com/ghana/people/moviestars/jackie_appiah/biography/&lt;/ref&gt;
|[[Cape Coast]]
|-
!6
|Menaye Donkor
|Agona Asafo
|-
!7
|Paul Boateng
|Cape Coast
|-
!8
|Van Vicker
|Cape Coast
|-
!9
|Majid Michel
|Cape Coast
|-
!10
|Michael Essien&lt;ref&gt;http://barryhugmansfootballers.com/player/22986&lt;/ref&gt;
|Cape Coast
|-
!11
|John Mensah
|Cape Coast
|-
!12
|Lydia Forson
|Cape Coast
|-
!13
|[[Kwesi Amissah-Arthur]]
|Cape Coast
|-
!14
|Paa Kwesi Nduom
|Elmina
|-
!15
|Asamoah Boateng
|Kormantse
|-
!16
|[[John Evans Atta Mills]]
|Cape Coast
|-
!17
|[[Kwabena Kwabena]]
|Gomoa Mpota
|}

== Sikasɛm ne mmeaeɛ a nkurɔfoɔ tu kwan bɛhwɛ ==
Mfinimfin mantam yɛ mantam bi a nnwomasua ahodoɔ bebere wɔ, a sukuu apapa a ɛwɔ ɔman Ghana mu bebere wɔ. Mantam no sikasɛm pii no ara  gyina fagudeɛ tu ne [[ɛpo]] so. Cape Coast Castle ne  Elmina Castle yɛ mmeaeɛ bi sɛ yɛfa UNESCO World Heritage Sites a adi mu akotene na ɛsan so yɛ beaeɛ bi yɛde kae nkoasom. Central Region yɛ mantam bi a mmeaeɛ ahodoɔ bebere wɔ a nnipa tumi firi mmeaeɛ foforɔ a wɔwɔ ba hɔ bɛhwɛ ne park bi te sɛ Kakum National Park.&lt;ref&gt;https://www.arcgis.com/apps/MapSeries/index.html?appid=3386911906db44db8ce72c5d925caec8&lt;/ref&gt; [[Amerika]] kane  mampanini Barack Obama baa Cape Coast wɔ ne akwantuo a adi kan wɔ Ghana wɔ mfeɛ mpem mmienu ne nkron (2009).

== Nnwomasua ==

=== Aban suapɔn ===

* [[University of Cape Coast]]
* [[University of Education, Winneba]]
* Cape Coast Technical University

=== Ankorɛankorɛ suapɔn ===

* KAAF University College&lt;ref&gt;{{Cite web |title=Archive copy |url=http://www.kaafuniversitycollege.edu.gh/index.php/discover-kaaf/about-us |access-date=2022-07-15 |archive-date=2015-03-26 |archive-url=https://web.archive.org/web/20150326083219/http://www.kaafuniversitycollege.edu.gh/index.php/discover-kaaf/about-us |url-status=dead }}&lt;/ref&gt;
* Marysons College, Cape Coast
* Pan African Christian University College
* Nduom School of Business and Technology

=== Training Colleges and Polytechnics ===

* Ola Training College, Old Elmina Road, Cape Coast
* Presbyterian Women Training College
* Gladmond Vocational Institute, Abura/Asebu/Kwamank
* Methodist Voc Trg Centre, Abura/Asebu/Kwamank
* Archbishop Porter's Polytechnic, Cape Coast
* Fosu College of Education, Assin Fosu.
* Komenda College of Education, Komenda.
* Assinman Nursing and Midwifery Training College
* Cape Coast Nursing and Midwifery Training College
* Police Command and Staff Training College,Winneba
* College of Community Nursing,Winneba

=== Ntoasoɔ sukuu ===

* Aburaman Senior High School, Abura/Asebu/Kwamank
* Academy of Christ the King, Cape Coast
* Adankwaman Sec/Comm, Assin Darman
* Adisadel College
* Aggrey Memorial Senior High School, Cape Coast
* Apam Senior High School
* Assin Manso Senior High School, Assin Manso
* Assin North Sec/Tech, Assin Asempanaye
* Assin Nsuta Senior High School, Assin Nsuta
* Assin State College, Assin Bereku
* Awutu-Winton Senior High School, Awutu/Efutu/Senya
* Besease Sec/Comm, Ajumako Besease
* Boa-Amponsem Senior High School, DUNKWA-ON-OFFIN
* Breman Asikuma Senior High School, Asikuma/Od/Brakwa
* Charity Comm Sch, Twifo Hemang
* Charity International Senior High School, Gomoa Manso
* Diaso Senior High School, Upper Denkyira
* Dunkwa Sec/Tech, Dunkwa -On-Offin
* Edinaman Day Senior School, Edin/Kom/Eguafo
* Effutu Sec/Tech, Cape Coast
* Ekumfi T.I Ahmadiyya Senior High School, Ekumfi Ekroful
* Eguafo-Abrem Senior High School, Edin/Kom/Eguafo
* Enyan Denkyira Senior High, Abura/Asebu/Kwamank
* Eyan Denkyira Senior High School, Ajumako/Enyan/Esiam
* Ghana National College
* Gomoa Sec/Tech, Gomoa
* Holy Child High School, Ghana
* Insaanyya Senior High Business School, Kasoa
* Jukwa Senior High, Twifo Hemang
* Komenda Senior High School Edin/Kom/Eguafo
* kumfi T. I Ahmadiiyya Senior High, Abura/Asebu/Kwamank
* Kwanyako Senior High School, Agona Kwanyako
* Kwegyir Aggrey Senior High School
* Mando Day Senior High School, Ajumako/Enyan/Esiam
* Mankessim Sec/Tech, Mankessim
* Mfantsiman Girls' Secondary School
* Mfantsipim School
* MOSECO, Kasoa
* Nsaba Presby Senior High, Agona Nsaba
* Nyakrom Day Senior High, Agona Nyakrom
* Nyankumase Ahenkro Senior High, Fante Nyankomase
* Obama College, Mankessim
* Obiri Yeboah Senior High, Assin Fosu
* Obrakyere Sec/Tech Awutu/Efutu/Senya
* Odoben Senior High, Asikuma/Od/Brakwa
* Oguaa Sec/Tech, Cape Coast
* Pank Secondary Business College, Awutu Bawjiase
* Potsin T.I Ahm Senior High School, Gomoa Potsin
* S.D.A Senior High School, Gomoa Manso
* Saltpond Meth. Senior High, Saltpond
* Sammo Senior High School, Cape Coast
* Senya Senior High
* St. Augustine's College (Cape Coast)
* Swedru School of Business
* Swedru Senior high, Agona Swedru
* University Practice Senior High School
* Wesley Girls' High School
* Winneba Senior High, Winneba

* Moree Senior High Technical School

== Nnuane ==
Adea a ɛma mfinimfin mantam foɔ agye din bi ne wɔn nnuane. Etsew and Fantefante yɛ wɔn aduane bi a wɔpɛ ne die pa ara. Dokono ne [[Fufu|fufuo]] yɛ nnuane bi a wɔde akadeɛ bi te sɛ: forɔyɛ ne nkwan ka. Nsuo mu nam yɛ aduane bi a wɔtae di pa ara.

== Amammuo nkyekyɛmu ==
Mantam no amammuo yɛ ahemfo amammuo. Wɔ saa amammuo yi ase no, wɔkyɛ mantam no mu aduonu mmienu (22).&lt;ref&gt;http://www.ghanadistricts.com/Home/Region/3&lt;/ref&gt; 
{| class=&quot;wikitable sortable&quot;
![[Mansini]] 
!Mansini ti
!Mpɔtam 
!Mmarahyɛbadwani 
!Amanyɔkuo
|-
|[[Abura-Asebu-Kwamankese (Ghana mmrahyɛbadwam mpɛsoa)|Abura Asebu Kwamankese]]
|Abura-Dunkwa
|Abura-Asebu-Kwamankese
|Elvis Morris Donkoh
|Ɔsono Amanyɔkuo 
([[New Patriotic Party (NPP)|NPP]])
|-
|[[Agona East (Ghana mmrahyɛbadwam mpɛsoa)|Agona East]]
|Nsaba
|Agona East
|[[Queenstar Pokuah Sawyerr|Queenstar Pokua Sawyerr]]
|Kyiniiɛ Amanyɔkuo 
[[National Democratic Congress (Ghana)|(NDC)]] 
|-
|[[Agona West (Ghana mmrahyɛbadwam mpɛsoa)|Agona West]] Municipal
|Agona Swedru
|Agona West
|[[Cynthia Mamle Morrison]]
|NPP
|-
|[[Ajumako-Enyan-Essiam (Ghana mmrahyɛbadwam mpɛsoa)|Ajumako Enyan Essiam]]
|Ajumako
|Ajumako-Enyan-Essiam
|Cassiel Ato Baah Forson
|NDC
|-
|[[Asikuma-Odoben-Brakwa (Ghana mmrahyɛbadwam mpɛsoa)|Asikuma Odoben Brakwa]]
|Breman Asikuma
|Asikuma-Odoben-Brakwa
|Alhassan Kobina Ghansah
|NDC
|-
|[[Assin Central (Ghana mmrahyɛbadwam mpɛsoa)|Assin Central]] Municipal
|Assin Foso
|Assin Central
|Kennedy Ohene Agyapong
|NPP
|-
|[[Assin North (Ghana mmrahyɛbadwam mpɛsoa)|Assin North]]
|Assin Bereku
|Assin North
|James Gyakye Quayson
|NDC
|-
|[[Assin South (Ghana mmrahyɛbadwam mpɛsoa)|Assin South]]
|Nsuaem Kyekyewere
|Assin South
|John Ntim Fordjuor
|NPP
|-
|[[Awutu-Senya East (Ghana mmrahyɛbadwam mpɛsoa)|Awutu Senya East]] Municipal
|Kasoa
|Awutu-Senya East
|Mavis Hawa Koomson
|NPP
|-
|[[Awutu-Senya West (Ghana mmrahyɛbadwam mpɛsoa)|Awutu Senya West]]
|Awutu Breku
|Awutu-Senya West
|Gizella Tetteh Agbotui
|NDC
|-
| rowspan=&quot;2&quot; |Cape Coast Metropolitan
| rowspan=&quot;2&quot; |[[Cape Coast]]
|Cape Coast North
|Kwamena Minta Nyarku
|NDC
|-
|Cape Coast South
|Kweku George Ricketts-Hagan
|NDC
|-
|[[Effutu (Ghana mmrahyɛbadwam mpɛsoa)|Effutu]] Municipal
|[[Winneba]]
|Effutu
|Alexander Afenyo-Markin
(Deputy Majority Leader)
|NPP
|-
|[[Ekumfi (Ghana mmrahyɛbadwam mpɛsoa)|Ekumfi]]
|Apam
|Ekumfi
|Abeiku Crenstil
|NDC
|-
|[[Gomoa East (Ghana mmrahyɛbadwam mpɛsoa)|Gomoa East]]
|Potsin
|Gomoa East
|Desmond De-graft Paitoo
|NDC
|-
|[[Gomoa Central (Ghana mmrahyɛbadwam mpɛsoa)|Gomoa Central]]
|Afransi
|Gomoa Central
|Naana Eyiah Quansah
|NPP
|-
|[[Gomoa West (Ghana mmrahyɛbadwam mpɛsoa)|Gomoa West]]
|Esakyir
|Gomoa West
|Richard Gyan Mensah
|NDC
|-
|[[Komenda-Edina Eguafo-Abbrem (Ghana mmrahyɛbadwam mpɛsoa)|Komenda-Edina-Eguafo-Abirem]] Municipal
|Elmina
|Komenda-Edina-Eguafo-Abirem
|Samuel Atta Mills
|NDC
|-
|[[Mfantseman|Mfantsiman]] Municipal
|Saltpond
|Mfantseman
|Ophelia Hayford
|NPP
|-
|[[Twifo- Atii Morkwa (Ghana mmrahyɛbadwam mpɛsoa)|Twifo Atti Morkwa]]
|Twifo Praso
|Twifo-Atii Morkwaa
|T.D. David Vondee
|NDC
|-
|Twifo/Heman/Lower Denkyira
|[[Hemang Lower Denkyira (Ghana mmrahyɛbadwam mpɛsoa)|Hemang]]
|Hemang Lower Denkyira
|Bright Wireko Brobbey
|NPP
|-
|[[Upper Denkyira East (Ghana mmrahyɛbadwam mpɛsoa)|Upper Denkyira East]] Municipal
|Dunkwa-on-Offin
|Upper Denkyira East
|Festus Awuah Kwofie
|NPP
|-
|[[Upper Denkyira West (Ghana mmrahyɛbadwam mpɛsoa)|Upper Denkyira West]]
|[[Diaso]]
|Upper Denkyira West
|Daniel Ohene Darko
|NDC
|}

== Beaeɛ a menyaa mmoa firiiɛ ==

&lt;references /&gt;{{Mantamu a ɛwɔ Ghana}}</text>
      <sha1>gvwqavzoz8o9o2du67qyrb9npetk14o</sha1>
    </revision>
    <revision>
      <id>133049</id>
      <parentid>133047</parentid>
      <timestamp>2022-08-01T09:51:18Z</timestamp>
      <contributor>
        <username>Robertjamal12</username>
        <id>8680</id>
      </contributor>
      <model>wikitext</model>
      <format>text/x-wiki</format>
      <text bytes="9972" xml:space="preserve">'''Central Region (Mfinimfin Mantam)''' ({{Audio|tw-Central Region.ogg|sɛnea yɛbɔ&quot;Central Region&quot;}}) ka Ghana Mantam dunsia no ho. [[Asante Mantam|Asante mantam]] ne [[Apueɛ Mantam|Apueeɛ mantam]] wɔ ne atififam, [[Atɔɛ Mantam|atɔeɛ mantam]] wɔ ne atɔeɛfam, [[Nkran Mantam|Nkran mantam]] wɔ ne apueeɛfam na Gulf of Guinea nso wɔ ne anaafoɔfam. Mfinimfin mantam yɛ mantam bi a agye din wɔ ntoasoɔ sukuu a agye din yiye wɔ ɔman [[Gaana|Ghana]] mu a ɛwɔ ho nti, ne beaeɛ bi a wɔn sikasɛm wɔ soro ɛnam fagudeɛ nnwumakuo ahodoɔ ne mmeaeɛ a nkurɔfoɔ tu kwan bɛhwɛ. Mfinimfin mantam wɔ mmeaeɛ bebere a nnipa tu kwan bɛhwɛ bi te sɛ: castles, forts ne beaches a ɛtwa [[ɛpo]] no ho ahyia wɔ mfinimfin mantam mu.

[[File:Central in Ghana 2018.svg|Central_in_Ghana_2018|thumb]] ''Beaeɛ a wobehunu Mfinimfin mantam wɔ Ghana map so'' 

[[File:Districts of the Central Region (2012).svg|Districts_of_the_Central_Region_(2012)|thumb]] ''Mansini ahodoɔ a ɛwɔ Mfinimfin mantam a ɛwɔ Ghana map so.''

== Nnipa atitire bi a wɔfiri mfinimfin mantam mu ==
{| class=&quot;wikitable&quot;
! colspan=&quot;3&quot; |Nnipa titire bi a wɔfiri mfinimfin mantam mu 
|-
!#
!Mantam no mu nnipa 
!Beaeɛ a wɔte
|-
!1
|Nana Ato Arthur
|Elmina
|-
!2
|George Amoh
|Dunkwa-Offin
|-
!3
|Ishmael Yartei
|Agona Swedru
|-
!4
|Yvonne Nelson
|[[Cape Coast]]
|-
!5
|Jackie Appiah&lt;ref&gt;http://www.peacefmonline.com/ghana/people/moviestars/jackie_appiah/biography/&lt;/ref&gt;
|[[Cape Coast]]
|-
!6
|Menaye Donkor
|Agona Asafo
|-
!7
|Paul Boateng
|Cape Coast
|-
!8
|Van Vicker
|Cape Coast
|-
!9
|Majid Michel
|Cape Coast
|-
!10
|Michael Essien&lt;ref&gt;http://barryhugmansfootballers.com/player/22986&lt;/ref&gt;
|Cape Coast
|-
!11
|John Mensah
|Cape Coast
|-
!12
|Lydia Forson
|Cape Coast
|-
!13
|[[Kwesi Amissah-Arthur]]
|Cape Coast
|-
!14
|Paa Kwesi Nduom
|Elmina
|-
!15
|Asamoah Boateng
|Kormantse
|-
!16
|[[John Evans Atta Mills]]
|Cape Coast
|-
!17
|[[Kwabena Kwabena]]
|Gomoa Mpota
|}

== Sikasɛm ne mmeaeɛ a nkurɔfoɔ tu kwan bɛhwɛ ==
Mfinimfin mantam yɛ mantam bi a nnwomasua ahodoɔ bebere wɔ, a sukuu apapa a ɛwɔ ɔman Ghana mu bebere wɔ. Mantam no sikasɛm pii no ara  gyina fagudeɛ tu ne [[ɛpo]] so. Cape Coast Castle ne  Elmina Castle yɛ mmeaeɛ bi sɛ yɛfa UNESCO World Heritage Sites a adi mu akotene na ɛsan so yɛ beaeɛ bi yɛde kae nkoasom. Central Region yɛ mantam bi a mmeaeɛ ahodoɔ bebere wɔ a nnipa tumi firi mmeaeɛ foforɔ a wɔwɔ ba hɔ bɛhwɛ ne park bi te sɛ Kakum National Park.&lt;ref&gt;https://www.arcgis.com/apps/MapSeries/index.html?appid=3386911906db44db8ce72c5d925caec8&lt;/ref&gt; [[Amerika]] kane  mampanini Barack Obama baa Cape Coast wɔ ne akwantuo a adi kan wɔ Ghana wɔ mfeɛ mpem mmienu ne nkron (2009).

== Nnwomasua ==

=== Aban suapɔn ===

* [[University of Cape Coast]]
* [[University of Education, Winneba]]
* Cape Coast Technical University

=== Ankorɛankorɛ suapɔn ===

* KAAF University College&lt;ref&gt;{{Cite web |title=Archive copy |url=http://www.kaafuniversitycollege.edu.gh/index.php/discover-kaaf/about-us |access-date=2022-07-15 |archive-date=2015-03-26 |archive-url=https://web.archive.org/web/20150326083219/http://www.kaafuniversitycollege.edu.gh/index.php/discover-kaaf/about-us |url-status=dead }}&lt;/ref&gt;
* Marysons College, Cape Coast
* Pan African Christian University College
* Nduom School of Business and Technology

=== Training Colleges and Polytechnics ===

* Ola Training College, Old Elmina Road, Cape Coast
* Presbyterian Women Training College
* Gladmond Vocational Institute, Abura/Asebu/Kwamank
* Methodist Voc Trg Centre, Abura/Asebu/Kwamank
* Archbishop Porter's Polytechnic, Cape Coast
* Fosu College of Education, Assin Fosu.
* Komenda College of Education, Komenda.
* Assinman Nursing and Midwifery Training College
* Cape Coast Nursing and Midwifery Training College
* Police Command and Staff Training College,Winneba
* College of Community Nursing,Winneba

=== Ntoasoɔ sukuu ===

* Aburaman Senior High School, Abura/Asebu/Kwamank
* Academy of Christ the King, Cape Coast
* Adankwaman Sec/Comm, Assin Darman
* Adisadel College
* Aggrey Memorial Senior High School, Cape Coast
* Apam Senior High School
* Assin Manso Senior High School, Assin Manso
* Assin North Sec/Tech, Assin Asempanaye
* Assin Nsuta Senior High School, Assin Nsuta
* Assin State College, Assin Bereku
* Awutu-Winton Senior High School, Awutu/Efutu/Senya
* Besease Sec/Comm, Ajumako Besease
* Boa-Amponsem Senior High School, DUNKWA-ON-OFFIN
* Breman Asikuma Senior High School, Asikuma/Od/Brakwa
* Charity Comm Sch, Twifo Hemang
* Charity International Senior High School, Gomoa Manso
* Diaso Senior High School, Upper Denkyira
* Dunkwa Sec/Tech, Dunkwa -On-Offin
* Edinaman Day Senior School, Edin/Kom/Eguafo
* Effutu Sec/Tech, Cape Coast
* Ekumfi T.I Ahmadiyya Senior High School, Ekumfi Ekroful
* Eguafo-Abrem Senior High School, Edin/Kom/Eguafo
* Enyan Denkyira Senior High, Abura/Asebu/Kwamank
* Eyan Denkyira Senior High School, Ajumako/Enyan/Esiam
* Ghana National College
* Gomoa Sec/Tech, Gomoa
* Holy Child High School, Ghana
* Insaanyya Senior High Business School, Kasoa
* Jukwa Senior High, Twifo Hemang
* Komenda Senior High School Edin/Kom/Eguafo
* kumfi T. I Ahmadiiyya Senior High, Abura/Asebu/Kwamank
* Kwanyako Senior High School, Agona Kwanyako
* Kwegyir Aggrey Senior High School
* Mando Day Senior High School, Ajumako/Enyan/Esiam
* Mankessim Sec/Tech, Mankessim
* Mfantsiman Girls' Secondary School
* Mfantsipim School
* MOSECO, Kasoa
* Nsaba Presby Senior High, Agona Nsaba
* Nyakrom Day Senior High, Agona Nyakrom
* Nyankumase Ahenkro Senior High, Fante Nyankomase
* Obama College, Mankessim
* Obiri Yeboah Senior High, Assin Fosu
* Obrakyere Sec/Tech Awutu/Efutu/Senya
* Odoben Senior High, Asikuma/Od/Brakwa
* Oguaa Sec/Tech, Cape Coast
* Pank Secondary Business College, Awutu Bawjiase
* Potsin T.I Ahm Senior High School, Gomoa Potsin
* S.D.A Senior High School, Gomoa Manso
* Saltpond Meth. Senior High, Saltpond
* Sammo Senior High School, Cape Coast
* Senya Senior High
* St. Augustine's College (Cape Coast)
* Swedru School of Business
* Swedru Senior high, Agona Swedru
* University Practice Senior High School
* Wesley Girls' High School
* Winneba Senior High, Winneba

* Moree Senior High Technical School

== Nnuane ==
Adea a ɛma mfinimfin mantam foɔ agye din bi ne wɔn nnuane. Etsew and Fantefante yɛ wɔn aduane bi a wɔpɛ ne die pa ara. Dokono ne [[Fufu|fufuo]] yɛ nnuane bi a wɔde akadeɛ bi te sɛ: forɔyɛ ne nkwan ka. Nsuo mu nam yɛ aduane bi a wɔtae di pa ara.

== Amammuo nkyekyɛmu ==
Mantam no amammuo yɛ ahemfo amammuo. Wɔ saa amammuo yi ase no, wɔkyɛ mantam no mu aduonu mmienu (22).&lt;ref&gt;http://www.ghanadistricts.com/Home/Region/3&lt;/ref&gt; 
{| class=&quot;wikitable sortable&quot;
![[Mansini]] 
!Mansini ti
!Mpɔtam 
!Mmarahyɛbadwani 
!Amanyɔkuo
|-
|[[Abura-Asebu-Kwamankese (Ghana mmrahyɛbadwam mpɛsoa)|Abura Asebu Kwamankese]]
|Abura-Dunkwa
|Abura-Asebu-Kwamankese
|Elvis Morris Donkoh
|Ɔsono Amanyɔkuo 
([[New Patriotic Party (NPP)|NPP]])
|-
|[[Agona East (Ghana mmrahyɛbadwam mpɛsoa)|Agona East]]
|Nsaba
|Agona East
|[[Queenstar Pokuah Sawyerr|Queenstar Pokua Sawyerr]]
|Kyiniiɛ Amanyɔkuo 
[[National Democratic Congress (Ghana)|(NDC)]] 
|-
|[[Agona West (Ghana mmrahyɛbadwam mpɛsoa)|Agona West]] Municipal
|Agona Swedru
|Agona West
|[[Cynthia Mamle Morrison]]
|NPP
|-
|[[Ajumako-Enyan-Essiam (Ghana mmrahyɛbadwam mpɛsoa)|Ajumako Enyan Essiam]]
|Ajumako
|Ajumako-Enyan-Essiam
|Cassiel Ato Baah Forson
|NDC
|-
|[[Asikuma-Odoben-Brakwa (Ghana mmrahyɛbadwam mpɛsoa)|Asikuma Odoben Brakwa]]
|Breman Asikuma
|Asikuma-Odoben-Brakwa
|Alhassan Kobina Ghansah
|NDC
|-
|[[Assin Central (Ghana mmrahyɛbadwam mpɛsoa)|Assin Central]] Municipal
|Assin Foso
|Assin Central
|Kennedy Ohene Agyapong
|NPP
|-
|[[Assin North (Ghana mmrahyɛbadwam mpɛsoa)|Assin North]]
|Assin Bereku
|Assin North
|James Gyakye Quayson
|NDC
|-
|[[Assin South (Ghana mmrahyɛbadwam mpɛsoa)|Assin South]]
|Nsuaem Kyekyewere
|Assin South
|John Ntim Fordjuor
|NPP
|-
|[[Awutu-Senya East (Ghana mmrahyɛbadwam mpɛsoa)|Awutu Senya East]] Municipal
|Kasoa
|Awutu-Senya East
|Mavis Hawa Koomson
|NPP
|-
|[[Awutu-Senya West (Ghana mmrahyɛbadwam mpɛsoa)|Awutu Senya West]]
|Awutu Breku
|Awutu-Senya West
|Gizella Tetteh Agbotui
|NDC
|-
| rowspan=&quot;2&quot; |Cape Coast Metropolitan
| rowspan=&quot;2&quot; |[[Cape Coast]]
|Cape Coast North
|Kwamena Minta Nyarku
|NDC
|-
|Cape Coast South
|Kweku George Ricketts-Hagan
|NDC
|-
|[[Effutu (Ghana mmrahyɛbadwam mpɛsoa)|Effutu]] Municipal
|[[Winneba]]
|Effutu
|Alexander Afenyo-Markin
(Deputy Majority Leader)
|NPP
|-
|[[Ekumfi (Ghana mmrahyɛbadwam mpɛsoa)|Ekumfi]]
|Apam
|Ekumfi
|Abeiku Crenstil
|NDC
|-
|[[Gomoa East (Ghana mmrahyɛbadwam mpɛsoa)|Gomoa East]]
|Potsin
|Gomoa East
|Desmond De-graft Paitoo
|NDC
|-
|[[Gomoa Central (Ghana mmrahyɛbadwam mpɛsoa)|Gomoa Central]]
|Afransi
|Gomoa Central
|Naana Eyiah Quansah
|NPP
|-
|[[Gomoa West (Ghana mmrahyɛbadwam mpɛsoa)|Gomoa West]]
|Esakyir
|Gomoa West
|Richard Gyan Mensah
|NDC
|-
|[[Komenda-Edina Eguafo-Abbrem (Ghana mmrahyɛbadwam mpɛsoa)|Komenda-Edina-Eguafo-Abirem]] Municipal
|Elmina
|Komenda-Edina-Eguafo-Abirem
|Samuel Atta Mills
|NDC
|-
|[[Mfantseman|Mfantsiman]] Municipal
|Saltpond
|Mfantseman
|Ophelia Hayford
|NPP
|-
|[[Twifo- Atii Morkwa (Ghana mmrahyɛbadwam mpɛsoa)|Twifo Atti Morkwa]]
|Twifo Praso
|Twifo-Atii Morkwaa
|T.D. David Vondee
|NDC
|-
|Twifo/Heman/Lower Denkyira
|[[Hemang Lower Denkyira (Ghana mmrahyɛbadwam mpɛsoa)|Hemang]]
|Hemang Lower Denkyira
|Bright Wireko Brobbey
|NPP
|-
|[[Upper Denkyira East (Ghana mmrahyɛbadwam mpɛsoa)|Upper Denkyira East]] Municipal
|Dunkwa-on-Offin
|Upper Denkyira East
|Festus Awuah Kwofie
|NPP
|-
|[[Upper Denkyira West (Ghana mmrahyɛbadwam mpɛsoa)|Upper Denkyira West]]
|[[Diaso]]
|Upper Denkyira West
|Daniel Ohene Darko
|NDC
|}

== Beaeɛ a menyaa mmoa firiiɛ ==

&lt;references /&gt;{{Mantamu a ɛwɔ Ghana}}
[[Nkyekyεmu:Mantam a ɛwɔ Ghana]]</text>
      <sha1>hq8talkq8o433d78qetqvv4xyjursy7</sha1>
    </revision>
  </page>
  <page>
    <title>Ayamkuro</title>
    <ns>0</ns>
    <id>12540</id>
    <revision>
      <id>133002</id>
      <parentid>130207</parentid>
      <timestamp>2022-08-01T02:19:10Z</timestamp>
      <contributor>
        <username>Afriyie34</username>
        <id>10662</id>
      </contributor>
      <model>wikitext</model>
      <format>text/x-wiki</format>
      <text bytes="1593" xml:space="preserve">'''Akuru''' yɛ nipadua no mu ntini bi a ɛgyae anaasɛ ɛpaapae a esiw akwaa a ɛka no no dwumadi kwan sɛnea ɛsɛ. Sɛnea Robins yare no kyerɛ no, &quot;akuru yɛ honam ani, epithelium anaa mucous membrane a ɛkɔ so no a ɛpaapae a ɛnam sloughing a efi necrotic tissue a ɛho ayɛ hyew no mu ba no.&quot; Akuru ahorow a wɔtaa hu wɔ nnuruyɛ mu no bi ne:[citation needed].

Akuru (dermatology), honam ani a ɛmma ɛnkɔ so anaasɛ honam ani a ɛpaapae.

Nhyɛso mu akuru, a wɔsan frɛ no mpa so akisikuru

Genital ulcer, akuru a ɛwɔ ɔbarima ne ɔbea nna ho fã

Ulcerative dermatitis, honam ani yare a ɛne ɔyare mmoawa nyin a ɛtaa fi ase denam ne ho a ɛyɛ hu so

Anal fissure, a.k.a. akuru anaa atetew a ɛbɛn akyi anaa akyi berɛmo no mu

Asikreyare nan akisikuru, ɔhaw kɛse a ɛwɔ asikreyare nan no mu

Anim akisikuru, tebea a ɛma obi ho yɛ hyew anaasɛ ɛde ɔyare ba a ɛwɔ ani no mu

Ano mu akisikuru, akisikuru a abue wɔ ano mu.

Aphthous ulcer, anom akisikuru pɔtee bi a wɔsan frɛ no cancer sore

Peptic ulcer, yafunu mu ntini a ɛgyae (yafunu mu akisikuru)[1] .

Venous ulcer, kuru a wosusuw sɛ ɛba esiane ntini ahorow a ɛwɔ ntini no mu a ɛnyɛ adwuma yiye nti

Stress ulcer, akuru a ɛwɔ yafunu no mu ne duodenum a ɛbɛn no mu

Ulcerative sarcoidosis, honam ani yare a ɛka nnipa a wɔwɔ sarcoidosis

Lichen planus a ɛyɛ kuru, a ɛyɛ lichen planus a ɛntaa nsi

Ulcerative colitis, ɔyare bi a ɛma obi ho yɛ hyew (IBD).

Ulcerative disposition, ɔhaw anaa ɔhaw a ɛde yafunu mu haw kɛse ba, a mpɛn pii no ɛne yafunu mu yare a enni sabea wɔ abusuabɔ</text>
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      <text bytes="1575" xml:space="preserve">'''Akuru''' yɛ nipadua no mu ntini bi a ɛgyae anaasɛ ɛpaapae a esiw akwaa a ɛka no no dwumadi kwan sɛnea ɛsɛ. Sɛnea Robins yare no kyerɛ no, &quot;akuru yɛ honam ani, epithelium anaa mucous membrane a ɛkɔ so no a ɛpaapae a ɛnam sloughing a efi necrotic tissue a ɛho ayɛ hyew no mu ba no.&quot; Akuru ahorow a wɔtaa hu wɔ nnuruyɛ mu no bi ne:

Akuru (dermatology), honam ani a ɛmma ɛnkɔ so anaasɛ honam ani a ɛpaapae.

Nhyɛso mu akuru, a wɔsan frɛ no mpa so akisikuru

Genital ulcer, akuru a ɛwɔ ɔbarima ne ɔbea nna ho fã

Ulcerative dermatitis, honam ani yare a ɛne ɔyare mmoawa nyin a ɛtaa fi ase denam ne ho a ɛyɛ hu so

Anal fissure, a.k.a. akuru anaa atetew a ɛbɛn akyi anaa akyi berɛmo no mu

Asikreyare nan akisikuru, ɔhaw kɛse a ɛwɔ asikreyare nan no mu

Anim akisikuru, tebea a ɛma obi ho yɛ hyew anaasɛ ɛde ɔyare ba a ɛwɔ ani no mu

Ano mu akisikuru, akisikuru a abue wɔ ano mu.

Aphthous ulcer, anom akisikuru pɔtee bi a wɔsan frɛ no cancer sore

Peptic ulcer, yafunu mu ntini a ɛgyae (yafunu mu akisikuru)[1] .

Venous ulcer, kuru a wosusuw sɛ ɛba esiane ntini ahorow a ɛwɔ ntini no mu a ɛnyɛ adwuma yiye nti

Stress ulcer, akuru a ɛwɔ yafunu no mu ne duodenum a ɛbɛn no mu

Ulcerative sarcoidosis, honam ani yare a ɛka nnipa a wɔwɔ sarcoidosis

Lichen planus a ɛyɛ kuru, a ɛyɛ lichen planus a ɛntaa nsi

Ulcerative colitis, ɔyare bi a ɛma obi ho yɛ hyew (IBD).

Ulcerative disposition, ɔhaw anaa ɔhaw a ɛde yafunu mu haw kɛse ba, a mpɛn pii no ɛne yafunu mu yare a enni sabea wɔ abusuabɔ</text>
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  <page>
    <title>Abanoma</title>
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      <text bytes="66682" xml:space="preserve">Mmofra a wɔfa wɔn sɛ wɔn mma yɛ adeyɛ a obi fa no sɛ ɔfoforo, mpɛn pii no abofra, awofoyɛ no fi saa onipa no ɔwofo anaa n’awofo a ɔwoo no ankasa anaa mmara kwan so no hɔ. Mmara kwan so mmofra a wɔfa wɔn sɛ wɔn mma no de hokwan ne asɛyɛde ahorow nyinaa, ne ayɔnkofa ho, fi awofo a wɔwoo wɔn no hɔ kɔ awofo a wɔfa wɔn sɛ wɔn mma no so daa.

Nea ɛnte sɛ awɛmfo anaa nhyehyɛe afoforo a wɔayɛ ama mmerante ne mmabaa a wɔbɛhwɛ wɔn no, atirimpɔw ne sɛ wɔbɛma mmofra a wɔfa wɔn sɛ wɔn mma no ayɛ nsakrae a ɛbɛtra hɔ daa wɔ wɔn gyinabea mu na sɛnea ɛte no, ɛhwehwɛ sɛ ɔmanfo gye tom, denam mmara anaa nyamesom mu asotwe so. Abakɔsɛm mu no, fekuw ahorow bi ahyɛ mmara pɔtee bi a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho, bere a afoforo de akwan horow a ɛnyɛ mmara kwan so de dii dwuma (titiriw apam ahorow a ɛkyerɛ agyapade hokwan ahorow ne awofo asɛyɛde ahorow a wɔmfa wɔn a wɔde wɔn ho hyɛ mu foforo nka ho). Nnɛyi nhyehyɛe ahorow a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho, a ɛsɔree wɔ afeha a ɛto so 20 yi mu no taa yɛ nea mmara ne nhyehyɛe ahorow a edi mũ na edi so. 

== Abakɔsɛm ==
'''Tete nneɛma'''

'''Agyede a wogye ma wɔn a wɔawo wɔn yiye'''

Bere a nnɛyi kwan a wɔfa so gye wɔn ba no puei wɔ United States no, adeyɛ no akwan horow puei wɔ abakɔsɛm nyinaa mu.[1] Sɛ nhwɛso no, Hammurabi Mmara no ka hokwan ahorow a wɔn a wɔagye wɔn ayɛ wɔn mma no wɔ ne ankorankoro a wɔagye wɔn ayɛ wɔn mma no asɛyɛde ahorow ho asɛm kɔ akyiri. Wɔakyerɛw adeyɛ a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma wɔ tete Roma no ho asɛm yiye wɔ Codex Justinianus mu.[2][3]

Ɛsono koraa wɔ nnɛyi bere no ho no, tete nneyɛe a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho no si amammui ne sikasɛm mu anigyede a ɛfa nea ɔfaa no ba no ho so dua,[4] na ɛde mmara kwan so adwinnade bi a ɛhyɛɛ amammui mu abusuabɔ a ɛda mmusua a wɔwɔ sika ntam no mu den na ɛmaa mmarima adedifo a wɔhwɛ agyapade so mae. Wɔakyerɛw sɛnea adehye no de di dwuma sɛ wɔn mma no ho asɛm yiye: na Roma ahempɔn no mu pii yɛ mmabarima a wɔafa wɔn ayɛ wɔn mma.[6] Ná adrogation yɛ Romafo a wɔfa wɔn sɛ wɔn mma no bi a onipa a wɔfa no sɛ ne ba no pene so sɛ ɔfoforo begye no ayɛ ne ba.

Ɛte sɛ nea nkokoaa a wɔfa wɔn sɛ wɔn mma wɔ Tete mmere mu no ntaa mma.[4][7] Na wɔtaa fa mmofra a wɔagyaw wɔn hɔ no ma wɔyɛ nkoa[8] na na wɔyɛ Ahemman no nkoa a wɔde ma no ɔha biara mu nkyem kɛse.[9][10] Romafo mmara mu kyerɛwtohɔ ahorow kyerɛ sɛ ɛtɔ mmere bi a na mmusua fa mmofra a wɔahu wɔn no na wɔtete wɔn sɛ ɔbabarima anaa ɔbabea. Ɛwom sɛ wɔtaa mfa wɔn mma wɔ Roma Mmara ase de, nanso wɔtetee mmofra no a wɔfrɛ wɔn alumni no wɔ nhyehyɛe bi a ɛte sɛ ɔhwɛfo mu, na wobuu wɔn sɛ agya a ogyaw wɔn hɔ no agyapade.[11]

Tete anibuei afoforo, titiriw India ne China, de ɔkwan bi a wɔfa so gye wɔn ba nso dii dwuma. Adanse kyerɛ sɛ na adeyɛ yi botae ne sɛ ɛbɛma amammerɛ ne nyamesom nneyɛe akɔ so; nea ɛne Atɔe Famfo adwene a ɛne sɛ wɔbɛtrɛw abusua ahorow mu no bɔ abira. Wɔ tete India no, ɔbabarimayɛ a ɛto so abien, a Rigveda kasa tia no pefee no,[12] kɔɔ so, wɔ ɔkwan a anohyeto wom na ɛyɛ amanne kɛse so, sɛnea ɛbɛyɛ a obi a ɔfa ne ba no betumi anya ayiyɛ ho amanne a ɛho hia a ɔbabarima bɛyɛ. China wɔ adwene a ɛte saa ara a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma a mmarima a wɔfa wɔn sɛ wɔnyɛ wɔn mma sɛ wɔmfa nyɛ nananom som nnwuma nkutoo ho.[14]

Ná adeyɛ a ɛne sɛ wobegye abusua mufo ne nnamfo paa mma ayɛ wɔn mma no abu so wɔ Polynesia amammerɛ ahorow mu a Hawaii a na wɔfrɛ amanne no sɛ hānai ka ho.

'''Mfinimfini mmere kosi nnɛyi bere so'''

Adoption ne nnipa mpapahwekwa

Germanfo, Celtfo, ne Slavfo amammerɛ a na ɛwɔ Europa so wɔ Roma Ahemman no asehwe akyi no anuonyamfo no kasa tiaa adeyɛ a ɛne sɛ wɔfa wɔn sɛ wɔn mma no.[15] Wɔ mfinimfini mmere mu ɔmanfo mu no, na mogya ahorow na ɛho hia sen biara; wɔde ahemman a edi tumi a na onni ɔdedifo a ɛda adi sɛ &quot;wɔwoo no wɔ abɔde mu&quot; no sii ananmu, na ɛne Romafo atetesɛm ahorow bɔ abira koraa. Europa mmara a ɛdannan no da saa akyide a wɔmpɛ sɛ wɔfa wɔn sɛ wɔn mma no adi. Sɛ nhwɛso no, Engiresifo mmara a wɔtaa de di dwuma no amma kwan mma wɔmfa obi mma efisɛ na ɛne agyapade ho mmara a wɔtaa de di dwuma no bɔ abira. Wɔ saa kwan koro no ara so no, France Napoleon Mmara no maa ɛyɛ den sɛ wobegye mmofra ayɛ wɔn ba, na ɛhwehwɛɛ sɛ wɔn a wɔfa no sɛ wɔn ba no di boro mfe 50, wonni mma, anyɛ yiye koraa no, wɔn mfe 15 sen nea wɔagye no ayɛ wɔn ba no, na anyɛ yiye koraa no, wɔatete nea wɔagye no ayɛ wɔn ba no mfe asia. Nanso, mmofra a wɔfa wɔn sɛ wɔn mma no bi kɔɔ so bae, nanso ɛbɛyɛɛ nea ɛnyɛ ɔkwan biara so, a egyina apam ahorow a wɔyɛe bere tiaa bi so. Sɛ nhwɛso no, wɔ afe 737 mu no, wɔ mmara bi a efi Lucca kurow mu mu no, wɔyɛɛ nnipa baasa a wɔagye wɔn ayɛ wɔn mma no agyapade bi adedifo. Te sɛ nhyehyɛe afoforo a ɛwɔ hɔ nnɛ no, apam no sii asɛyɛde a ɛda nea wɔagye no ayɛ ne ba no so dua sen sɛ obegye ne ba no, na ɛtwee adwene sii nokwasɛm a ɛyɛ sɛ, wɔ apam no ase no, na wɔayɛ sɛ wɔbɛhwɛ agya a ɔfaa no ayɛ ne ba no wɔ ne nkwakoraabere mu no so; adwene a ɛte sɛ nsusuwii ahorow a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho wɔ Roma mmara ase no.[17]

Europa amammerɛ mu nsakrae no hyɛɛ bere a wɔyɛɛ nneɛma foforo a ɛho hia a wɔde gye toom no agyirae. Esiane sɛ wɔamfa mmoa a efi atitiriw no hɔ nti, adeyɛ no dan kɔɔ mmofra a wɔagyaw wɔn hɔ no so nkakrankakra. Nnipa a wogyaw wɔn hɔ no kɔɔ soro bere a ahemman no hwee ase no na wogyaw mmofra a wohuu wɔn no pii wɔ Asɔre no pon ano.[18] Mfiase no, asɔfo no yɛɛ wɔn ade denam mmara a wɔhyehyɛe de kyerɛ sɛnea wɔbɛpa mmofra a wɔagyaw wɔn hɔ no ho ntama, atɔn, na wɔatete wɔn no so. Nanso, ade foforo a Asɔre no yɛe ne afɔrebɔ ho adeyɛ, a ɛnam so hyira mmofra so sɛ wɔnyɛ asɔremma asetra wɔ nkokorafie ahyehyɛde ahorow mu na wɔtete wɔn wɔ nkokorafie bi mu. Eyi na ɛde nhyehyɛe a edi kan wɔ Europa abakɔsɛm mu a mmofra a wɔagyaw wɔn hɔ no nni mmara, asetra, anaa abrabɔ mu ɔhaw ahorow. Ne saa nti, Europa mmofra a wɔagyaw wɔn hɔ na wɔayɛ nyisaa no mu pii bɛyɛɛ Asɔre no sukuufo dedaw, na ɛno nso faa dwuma sɛ obi a ɔhwɛ wɔn sɛ wɔn mma. Oblation hyɛ nsakrae a ɛkɔ ahyehyɛde ahorow mu no mfiase agyirae, na awiei koraa no ɛde ayaresabea a wɔde sii hɔ ne nyisaa atrae no sii hɔ.[18]

Bere a adwene a ɛfa ahyehyɛde mu hwɛ ho no nyaa adwene no, mmara a wɔahyɛ da ahyɛ da puei wɔ sɛnea wɔde mmofra bɛto mmusua mu: mmarimaa betumi abɛyɛ obi a osua adwumfo na mmeawa betumi aware wɔ ahyehyɛde no tumi ase. Asoɛe ahorow gyee mmofra nso sɛ wɔn mma wɔ ɔkwan a ɛnyɛ ɔhyɛ so, adwinnade a wɔfaa no sɛ ɔkwan a wɔfa so nya adwumayɛfo a wɔn bo nyɛ den, a nokwasɛm a ɛyɛ sɛ bere a wɔn a wɔagye wɔn ayɛ wɔn mma no wuwu no, abusua no de wɔn afunu san kɔ asoɛe no mu ma wosie no da no adi.

Saa nhyehyɛe a ɛfa adesua ne mmofra a wɔfa wɔn sɛ wɔn mma wɔ ɔkwan a ɛnyɛ ɔkwan pa so ho yi trɛw kɔɔ afeha a ɛto so 19 no mu, a nnɛ wobu no sɛ nsakrae fã ma mmofra a wɔfa wɔn sɛ wɔn mma ho abakɔsɛm. Wɔ asetra mu yiyedi ho adwumayɛfo akwankyerɛ ase no, nyisaa guankɔbea ahorow fii ase hyɛɛ mmofra a wogyina nkate so a wɔfa wɔn sɛ wɔn mma no ho nkuran sen sɛ wɔbɛyɛ adwuma; wɔde mmofra too apam ahorow a wɔde bɛhwɛ wɔn sɛ abusua mufo ase sen sɛ wɔde bɛto apam ahorow a ɛfa adesua ho ase.[21] Wogye di sɛ saa nhwɛso yi nkɔso no na ɛmaa Massachusetts Amanaman Nkabom no hyehyɛɛ nnɛyi mmara a edi kan a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho wɔ 1851 mu, a ɛyɛ soronko wɔ sɛnea ɛhyehyɛɛ adwene a ɛne sɛ &quot;abofra no yiyedi yiye&quot; no. Nanso, ɛmfa ho ne atirimpɔw no, wɔ nneyɛe mu no, nhyehyɛe no yɛɛ adwuma te sɛ honam a edi kan no. Boston Female Asylum (BFA) no suahunu yɛ nhwɛsoɔ pa, a na ɛwɔ ne soboɔ no mu bɛyɛ 30% a wɔagye atom wɔ afe 1888 mu.[24] BFA mpanyimfo kae sɛ, ɛwom sɛ guankɔbea no hyɛɛ ho nkuran sɛ ɛnte saa de, nanso awofo a wɔfa wɔn sɛ wɔn mma no ankyerɛ nsonsonoe a ɛda indenture ne mmofra a wɔfa wɔn sɛ wɔn mma no ntam: &quot;Yegye di,&quot; guankɔbea mpanyimfo no kae sɛ, &quot;sɛ mpɛn pii no, sɛ wɔfa mmofra a wonnii mfe pii sɛ wɔmfa wɔn mma a,... agyede yɛ din foforo a wɔde frɛ ɔsom ara kwa.&quot;[25]

'''Nnɛyi bere'''

Fapem a wɔde bɛbɔ abusua

Nneɛma a edi hɔ a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho no dannan wɔn ho no hwee United States man a na ɛrenya nkɔso no nsam. Atubrafo a wɔbae ntɛmntɛm ne Amerika Ɔmanko no maa nyisaa atrae ne mmofra a wɔahu wɔn afie dɔɔso dodo wɔ afeha a ɛto so dunkron no mfinimfini a ebi mmae da. Charles Loring Brace a na ɔyɛ Protestantfo ɔsomfo no ho dwiriw no wɔ waiffo dɔm a wonni afie a na wɔrekyinkyin New York Kuropɔn no mmɔnten so no ho. Brace buu mmerante ne mmabaa a wɔagyaw wɔn hɔ, titiriw Katolekfo, sɛ wɔyɛ ade a ɛyɛ hu sen biara a ɛrekasa atia kurow no nhyehyɛe.[26][27]

Wɔkaa n’ano aduru ho asɛm wɔ The Best Method of Disposing of Our Pauper and Vagrant Children (1859) a efii Nyisaa Keteke kuw no ase no mu. Awiei koraa no, keteke ahorow a ɛyɛ nyisaa no de mmofra bɛyɛ 200,000 fii Apuei Fam nkurow akɛse mu kɔɔ ɔman no nkuraase.[28] Mpɛn pii no, na wɔde mmofra no ahyɛ mmusua a wɔde wɔn kɔ mu no nsa, sen sɛ wɔbɛfa wɔn ayɛ wɔn mma.[29] Sɛnea na ɛte wɔ mmere a atwam no mu no, na wɔtete mmofra binom sɛ abusua no mufo bere a na afoforo nso yɛ mfuw mu adwumayɛfo ne afie mu asomfo. Nnipa a wɔatu wɔn afi wɔn afie mu no kɛse koraa—mmofra a wotu kɔtra mmeae foforo sen biara wɔ abakɔsɛm mu—ne sɛnea wɔde wɔn dii dwuma ɔkwammɔne so a ɛkɔɔ so no maa wɔhyehyɛɛ nnwumakuw foforo ne mmara ahorow a ɛhyɛɛ nhyehyɛe ahorow a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho nkuran sen sɛ wɔde wɔn ho bɛma. Bere no agyiraehyɛde ne Minnesota mmara a ɛfa mmofra a wɔfaa wɔn mma ho wɔ 1917 mu, a ɛhyɛɛ sɛ wɔnyɛ nhwehwɛmu wɔ mmeae a wɔde wɔn kɔe nyinaa ho na wɔmma wɔn a wɔde wɔn ho hyɛɛ mmofra a wɔfaa wɔn no mu no nnya kyerɛwtohɔ pii.[30][31]

Wɔ saa bere koro no ara mu no, Progressive kuw no faa United States a na botae titiriw ne sɛ ɛbɛma nyisaa atrae nhyehyɛe a na ɛwɔ hɔ no aba awiei. Mmɔdenbɔ a ɛte saa no awiei bae wɔ White House Nhyiam a Edi Kan a Ɛfa Mmofra a Wɔde Wɔn Ho To Wɔn So Hwɛ Ho a Ɔmampanyin Theodore Roosevelt frɛɛ no ​​wɔ 1909 mu,[32] faako a wɔkae sɛ nuklea abusua no gyina hɔ ma &quot;anibuei ade a ɛkorɔn na eye sen biara&quot; na eye sen biara no a otumi som sɛ ɔhwɛfo titiriw ma wɔn a wɔagyaw wɔn hɔ ne wɔn a wɔayɛ nyisaa.[33][34] Wɔ 1923 mu tɔnn no, na mmofra a wɔn awofo nhwɛ wɔn no mu ɔha biara mu abien pɛ na na wɔwɔ afie a wɔhwɛ wɔn sɛ wɔn mma mu, na nea aka no wɔ nhyehyɛe a wɔde hwɛ mmofra ne nyisaa atrae. Annu mfe aduanan akyi no, na ɛkame ayɛ sɛ nkyem abiɛsa mu biako wɔ afie a wɔhwɛ wɔn sɛ wɔn mma mu.[35]

Ne nyinaa mu no, eugenic adwene a agye din wɔ Amerika no de akwanside ahorow bae wɔ mmofra a wɔfa wɔn sɛ wɔn mma no nkɔso mu.[36][37] Na nneɛma a ɛhaw adwene kɛse wɔ mmofra a wɔnyɛ mmara ne ahiafo awosu mu su pa ho, a ebia nea ɛyɛ nhwɛso yiye ne Henry H. Goddard nkyerɛwee a ɛwɔ nkɛntɛnso a ɔkasa tiaa mmofra a wonnim faako a wogye wɔn sɛ wɔn mma no, na ɔkae sɛ, .

Afei ɛba sɛ nnipa binom ani gye adesamma abusua no yiyedi ne nkɔso a ɛkorɔn ho; nanso sɛ yɛde saa nnipa soronko no to nkyɛn a, agyanom ne ɛnanom nyinaa ani gye wɔn ankasa mmusua yiyedi ho. Ade a awofo koma ani gye ho paa ne sɛ wɔbɛma mmofra no aware yiye na wɔatete abusua a ɛkorɔn. Hwɛ sɛnea ɛyɛ adwene tiawa saa bere no sɛ abusua a ɛte saa begye abofra bi a wonnim n’abusua mu abusua koraa no akɔ ne mfinimfini; anaasɛ, baabi a, sɛ wonim no fã bi a, nea ebetumi aba no mu yɛ den sɛ ɛbɛkyerɛ mmoa a wɔyɛ ahiafo na wɔyare, na sɛ ɛsɛ sɛ aware bi kɔ so wɔ saa onipa no ne abusua no muni biara ntam a, asefo no asɛe.

Bere a efi 1945 kosi 1974, nkokoaa a wɔde wɔn gu mu bere no, huu nkɔso ntɛmntɛm na wogyee sɛ wɔfa wɔn sɛ wɔn mma sɛ ɔkwan a wɔfa so kyekye abusua.[39] Awo a mmara mma ho kwan kɔɔ soro mprɛnsa wɔ Wiase Ko II akyi, bere a nna ho nneyɛe sesae no. Bere koro no ara mu no, nyansahufo kuw no fii ase sii so dua sɛ ntetee di awosu so tumi, na wɔde eugenic animtiaabu no fii hɔ.[40][41] Wɔ saa tebea yi mu no, mmofra a wɔfa wɔn sɛ wɔn mma no bɛyɛɛ ano aduru a ɛda adi pefee maa nnipa a wɔnwaree ne awarefo a wontumi nwo nyinaa.[42]

Sɛ wɔka saa nneɛma yi bom a, ɛma wonya Amerikafo nhwɛso foforo a wɔde begye atom. Wɔ Romafo a edii n’anim no akyi no, Amerikafo twaa hokwan ahorow a awofo a wodi kan no wɔ mu bere a wɔmaa wɔn a wɔfa wɔn sɛ wɔn mma no yɛɛ awofo foforo wɔ mmara no ani so no. Wɔde nneɛma foforo abien kaa ho: 1) na atirimpɔw ne sɛ wɔbɛfa mmofra ayɛ wɔn mma sɛ wɔbɛhwɛ ma &quot;abofra no yiyedi a eye sen biara&quot;, wobetumi ahu saa adwene yi aba no afi Amerikafo mmara a edi kan a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho wɔ Massachusetts no mu,[16][23] ne 2) mmofra a wɔfa wɔn sɛ wɔn mma no bɛyɛɛ nea wɔde hyɛɛ mu a ɛyɛ kokoamsɛm, na awiei koraa no ɛmaa wɔsɔɔ mmofra a wɔfaa wɔn sɛ wɔn mma ne awo ho kyerɛwtohɔ ahorow a edi kan no ano wɔ 1945. Charles Loring Brace a ɔde bae sɛnea ɛbɛyɛ a mmofra a wofi Nyisaa Keteke ahorow no mu no rensan nkɔ wɔn awofo nkyɛn anaasɛ wɔbɛsan agye wɔn no mfiase no. Ná Brace suro nkɛntɛnso a awofo no ohia, wɔ ɔkwan a ɛkɔ akyiri so, ne Katolek som titiriw, benya wɔ mmabun no so. Saa atetesɛm a ɛfa kokoamsɛm ho yi, akyiri yi Nkɔsofo nsakraefo no na wɔkɔɔ so bere a wɔreyɛ Amerika mmara ahorow no.[43]

Nnipa dodow a wɔfaa wɔn mma wɔ United States no kɔɔ soro sen biara wɔ 1970 mu.[44] Ɛnyɛ nea wobetumi ahu nea ɛde ɔhwe a edii akyi bae no bae. Nneɛma a ɛbɛyɛ sɛ ɛde bae wɔ 1960 ne 1970 mfe no mu no bi ne awo dodow a ɛso tew, a ɛne aduru no a wɔde bae no wɔ abusuabɔ, akwan a wɔfa so siw awo ano a wɔde ayɛ adwuma a wɔde ahyɛ mmara ase a wɔawie, ɔman no sika a wɔde maa abusua nhyehyɛe ho adwuma a wɔde bɛma mmerante ne mmabaa ne wɔn a wɔba fam no - sika a wonya, ne nyinsɛn a wotu gu ho mmara kwan so. Bio nso, mfeɛ a ɛwɔ 1960 mfeɛ no awieeɛ ne 1970 mfeɛ no mfitiaseɛ no hunuu nsakraeɛ kɛseɛ wɔ ɔmanfoɔ adwene wɔ mmara kwan so ne mmara kwan so hokwan[45] a wɔn a wɔwoo wɔn wɔ awareɛ akyi wɔ no mu. Nea ɛbɛyɛ na wɔabua no, mmɔden a wɔbɔe sɛ wɔbɛkora abusua so no nyaa nkɔanim[46] ma enti mmofra kakraa bi na wɔwo wɔn wɔ aware akyi nnɛ na wɔfa wɔn sɛ wɔn mma. Anwonwasɛm ne sɛ, mmofra a wɔfa wɔn sɛ wɔn mma no da adi kɛse koraa na wɔka ho asɛm wɔ ɔmanfo mu nnɛ, nanso ɛnyɛ nea abu so kɛse.[47]

Awiei koraa no, Amerikafo nhwɛso a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho no dɔɔso wɔ wiase nyinaa. England ne Wales de wɔn mmara a edi kan a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho sii hɔ wɔ 1926. Netherlands too ne mmara wɔ 1956. Sweden maa wɔn a wɔagye wɔn ayɛ wɔn mma no yɛɛ abusua no mufo koraa wɔ 1959. West Germany hyɛɛ ne mmara a edi kan wɔ 1977 mu. Bio nso, Asia tumi ahorow no buee wɔn nyisaa atrae nhyehyɛe ahorow no maa wɔfaa wɔn mma, a Atɔe Famfo adwene a edii atubrafo nniso ne asraafo tumidi akyi nyaa so nkɛntɛnso sɛnea na ɛte no.[49] Wɔ France no, ɔman ahyehyɛde ahorow a ɛwɔ mpɔtam hɔ no ma wɔn a wɔpɛ sɛ wɔfa wɔn sɛ wɔn mma no tom, na afei wobetumi ne nyisaa atrae ahorow a ɛwɔ amannɔne adi nkitaho anaasɛ wɔabisa mmoa afi NGO ahorow hɔ. Nhyehyɛe no mfa sikatua ho, na mmom ɛma tumi kɛse ma asetra mu adwumayɛfo a wɔn gyinaesi ahorow betumi asiw mmofra a wɔfa wɔn sɛ wɔn mma no ano hye wɔ mmusua a &quot;ɛwɔ gyinapɛn&quot; mu (mfinimfini mfe, sika a wonya fi mfinimfini kosi kɛse, mmarima a wɔne wɔn ho da, Caucasianfo).[50]

Wɔyɛ mmofra a wɔfa wɔn sɛ wɔn mma no ho dwuma nnɛ wɔ wiase nyinaa. Nsɛm a ɛwɔ ase ha no de Atɔe Famfo dodow a wɔfa wɔn sɛ wɔn mma no ho mfonini ntɛm ara ma. Mmofra a wɔfa wɔn sɛ wɔn mma wɔ United States no da so ara kɔ so wɔ dodow a ɛreyɛ adu n’atipɛnfo de no mmɔho abiɛsa ɛwom mpo sɛ mmofra dodow a wɔretwɛn sɛ wobegye wɔn ayɛ wɔn mma no akɔ so ayɛ nea ɛkɔ so daa wɔ nnansa yi mfe mu, efi 100,000 kosi 125,000 wɔ bere a efi 2009 kosi 2018 no mu

== Nnɛyi mmofra a wɔfa wɔn sɛ wɔn mma ==
'''Akwan horow a wɔfa so gye wɔn ba'''

Nnɛyi nneyɛe a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho no betumi abue anaasɛ wɔato mu.

Awofo a wɔfa wɔn sɛ wɔn mma ne wɔn a wɔwoo wɔn no ma wotumi hu nsɛm a wɔde di nkitaho wɔ abusuafo ne nea wɔagye no ayɛ wɔn ba no ntam.[70] Awofo a wɔfa wɔn sɛ wɔn mma a wɔn nkutoo na wɔhwɛ abofra no so no betumi ayɛ nhyehyɛe a ɛnyɛ ɔkwan biara so. Wɔ tumidi ahorow bi mu no, awofo a wɔwoo wɔn ne wɔn a wɔagye wɔn ayɛ wɔn mma no betumi ayɛ apam a mmara ma ho kwan na ɛkyekyere wɔn a ɛfa nsrahwɛ, nsɛm a wɔde bɛsesa, anaa nkitahodi foforo a ɛfa abofra no ho.[71] Ɛde besi February 2009 no, U.S. aman 24 maa kwan sɛ wɔde apam ahorow a wɔabue ano a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho apam ahorow a mmara ma ho kwan no kaa mmofra a wɔfa wɔn sɛ wɔn mma no ho nhyehyɛe a etwa to no ho.[72]

Adeyɛ a ɛne sɛ wɔfa wɔn sɛ wɔn mma a wɔato mu (a wɔsan frɛ no kokoam anaasɛ kokoam mmofra a wɔfa wɔn sɛ wɔn mma),[73] a ɛnyɛ nea wɔtaa yɛ wɔ nnɛyi abakɔsɛm fã kɛse no ara mu no,[74] hyɛ nsɛm a ɛma wohu obi nyinaa ano, ɛkora so sɛ ɛyɛ kokoam na esiw awofo a wɔagye wɔn ayɛ wɔn mma no a wɔbɛda no adi no ano’, biological kin’s, ne wɔn a wɔagye wɔn ayɛ wɔn mma no ho nsɛm. Ne nyinaa mu no, agyede a wɔato mu no betumi ama wɔatumi de nsɛm a ɛnyɛ nea ɛkyerɛ sɛ obi yɛ te sɛ aduruyɛ ho abakɔsɛm ne nyamesom ne mmusuakuw a wofi mu akɔma afoforo.[75] Ɛnnɛ, esiane guankɔbea ahobammɔ ho mmara a U.S. aman bi ahyɛ mu nti, kokoam mmofra a wɔfa wɔn sɛ wɔn mma no renya nkɛntɛnso foforo. Wɔ aman a wɔfrɛ no &quot;dan a ahobammɔ wom&quot; mu no, wobetumi agyaw nkokoaa a wɔmmɔ wɔn din wɔ ayaresabea ahorow, odumgyafo adwumayɛbea ahorow, anaa polisifo adwumayɛbea ahorow mu wɔ nna kakraa bi akyi wɔ awo akyi, adeyɛ a ahyehyɛde ahorow bi a wɔkamfo mmofra a wɔfa wɔn sɛ wɔn mma no kasa tia sɛ ɛyɛ nea ɛkɔ akyi na asiane wom.

Sɛnea mmofra a wɔfa wɔn sɛ wɔn mma no fi ase


Mmofra a wɔfa wɔn sɛ wɔn mma no betumi aba wɔ nnipa a wɔyɛ abusuafo anaa wɔn a wɔnyɛ abusuafo ntam. Wɔ abakɔsɛm mu no, na mmofra a wɔfa wɔn sɛ wɔn mma dodow no ara kɔ so wɔ abusua bi mu. Nsɛm a aba nnansa yi ara a efi U.S. kyerɛ sɛ mprempren nnipa a wɔfa wɔn sɛ wɔn mma no mu bɛyɛ fã yɛ nnipa a wɔyɛ abusuafo ntam.[77] Eyi ho nhwɛso a wɔtaa de di dwuma ne &quot;ɔwofo a wɔyɛ mpena a wɔfa wɔn sɛ wɔn mma&quot;, baabi a ɔwofo hokafo foforo no fa abofra bi fi ɔwofo no abusuabɔ a atwam no mu wɔ mmara kwan so. Abusua mu mmofra a wɔfa wɔn sɛ wɔn mma nso betumi aba denam ahofama so, esiane awofo wu nti, anaasɛ bere a wontumi nhwɛ abofra no wɔ ɔkwan foforo so na abusua no muni bi pene so sɛ obegye adwuma no.

Ɛnyɛ bere nyinaa na mmofra a wofi wɔn pɛ mu yɛ ade a wofi wɔn pɛ mu yɛ. Wɔ aman bi mu, sɛ nhwɛso no, wɔ U.K. no, ade titiriw biako a ɛma mmofra a wɔde wɔn to hɔ sɛ wɔmfa wɔn mma no ne sɛ wɔayi wɔn afi baabi a wɔwoo wɔn no, mpɛn pii no aban ahyehyɛde bi te sɛ mpɔtam hɔ atumfoɔ. Nneɛma ahorow bi wɔ hɔ a enti woyi mmofra fi hɔ a ayayade ne anibiannaso ka ho, a ebetumi anya nkɛntɛnso a ɛtra hɔ daa wɔ nea wɔagye no ayɛ ne ba no so. Wɔbɛbɔ asetra mu adwumayɛfo amanneɛ wɔ nsɛm pii mu wɔ ahobammɔ ho asɛm bi a ɛfa abofra bi ho ho na wɔabisabisa abofra no yiyedi ho nsɛm. Mpɛn pii no, asetra mu nsɛm ho adwumayɛfo bɛhwehwɛ akwan a wɔbɛfa so ama abofra bi ne abusua a wɔwoo no no abom, sɛ nhwɛso no, denam mmoa foforo a wɔde bɛma abusua no ansa na wɔasusuw ho sɛ wobeyi abofra bi afi hɔ no so. Afei asɛnnibea bɛtaa asi gyinae ahorow afa abofra no daakye ho, sɛ nhwɛso no, sɛ ebia wobetumi asan akɔ abusua a wɔwoo wɔn no mu, akɔhwɛ mmofra a wɔhwɛ wɔn anaasɛ wɔafa wɔn ayɛ wɔn mma.

Awo a wontumi nwo ne ade titiriw nti a awofo hwehwɛ sɛ wobegye mmofra a wɔne wɔn nni abusuafo no ayɛ wɔn mma. Nhwehwɛmu bi kyerɛ sɛ eyi na ɛmaa nkokoaa a wɔfaa wɔn sɛ wɔn mma a wɔnyɛ abusuabɔ no 80% ne wɔn a wɔfaa wɔn sɛ wɔn mma denam mmofra a wɔhwɛ wɔn so no fã.[78] Akontaabu kyerɛ sɛ Amerikafoɔ a wɔntumi nnyinsɛn anaa wɔmfa nkɔsi wɔn mma no mu 11–24% bɔ mmɔden sɛ wɔbɛkyekyere abusua denam mmofra a wɔbɛfa wɔn ayɛ wɔn mma so, na sɛ Amerikafoɔ mmaa a wɔaware daa a wɔfa wɔn mma no nyinaa dodoɔ bɛyɛ 1.4%.[79][80] Nneɛma afoforo a ɛma nkurɔfo gye tom no dɔɔso ɛwom sɛ wɔankyerɛw ho asɛm yiye de. Ebia eyinom bi ne sɛ wɔbɛpɛ sɛ wɔhyɛ abusua foforo mu den wɔ awaregyae anaa ɔwofo biako wu akyi, ayamhyehye a nyamesom anaa nyansapɛ mu gyidi na ɛkanyan wɔn, na wɔakwati sɛ wɔbɛboa ma nnipa adɔɔso dodo esiane gyidi a ɛne sɛ ɛyɛ asɛyɛde kɛse sɛ wɔbɛhwɛ mmofra a anka awofo nni mu sen sɛ wɔbɛwo nti , de hwɛ hu sɛ wɔremfa nyarewa a wonya fi awo mu (e.g., Tay–Sachs yare) mma obi, ne akwahosan ho haw ahorow a ɛfa nyinsɛn ne awo ho. Ɛwom sɛ nneɛma ahorow bi wɔ hɔ de, nanso nhwehwɛmu a wɔayɛ nnansa yi ara a ɛfa mmea a wɔfa wɔn mma no suahu ahorow ho no kyerɛ sɛ ɛda adi kɛse sɛ wɔadi mfe 40–44, wɔaware mprempren, awo a wontumi nwo, na wonni mma.[81]

Fa akwan horow a edidi so yi so betumi aba mmofra a wɔfa wɔn sɛ wɔn mma a ɛne wɔn ho wɔn ho nni abusuabɔ:

Ankorankoro fie mmofra a wɔfa wɔn sɛ wɔn mma: wɔ nhyehyɛe yi ase no, adɔe akuw ne ahyehyɛde ahorow a wɔhwehwɛ mfaso yɛ adwuma sɛ ntamgyinafo, na wɔka wɔn a wɔpɛ sɛ wɔfa abofra no bom ne mmusua a wɔpɛ sɛ wɔde abofra bi to hɔ, na afã horow no nyinaa yɛ ɔman koro mufo. Sɛnea ɛbɛyɛ foforo no, ɛtɔ mmere bi a wɔn a wɔpɛ sɛ wɔfa wɔn mma no kwati ntamgyinafo na wɔne mmea di nkitaho tẽẽ, na mpɛn pii no wɔde apam a wɔakyerɛw; wɔmma eyi ho kwan wɔ tumidi ahorow bi mu. Ankorankoro fie mmofra a wɔfa wɔn sɛ wɔn mma no yɛ mmofra a wɔfa wɔn sɛ wɔn mma nyinaa mu fã kɛse; sɛ nhwɛso no, wɔ United States no, wobu akontaa sɛ ɛkame ayɛ sɛ wɔyɛ mmofra a wɔfa wɔn sɛ wɔn mma no mu 45% ho nhyehyɛe wɔ kokoam.[82]

Foster care adoption: eyi yɛ ofie adoption bi a mfiase no wɔde abofra bi to ɔmanfo hwɛ mu. Mpɛn pii no, awofo a wɔhwɛ mmofra no gye wɔn sɛ wɔn mma no bere a mmofra no nya ahofadi wɔ mmara kwan so no. Ɛsono sɛnea ɛho hia sɛ ɔkwan a wɔfa so gye wɔn mma no wɔ ɔman biara mu. Wɔ 127,500 a wɔfaa wɔn sɛ wɔn mma wɔ U.S. wɔ afe 2000 mu no,[82] bɛyɛ 51,000 anaa 40% nam mmofra a wɔhwɛ wɔn so nhyehyɛe so.[83]

Amanaman ntam mmofra a wɔfa wɔn sɛ wɔn mma: eyi fa abofra bi a wɔde bɛto ɔman a wɔwoo saa abofra no akyi ma wɔagye no ayɛ ne ba ho. Eyi betumi aba denam ɔman anaa ankorankoro nnwumakuw so. Wɔ aman bi te sɛ Sweden mu no, saa mmofra a wɔfa wɔn sɛ wɔn mma yi na ɛma wonya nsɛm no mu dodow no ara (hwɛ atifi hɔ pon no). Nanso, U.S. nhwɛso no kyerɛ sɛ nsonsonoe kɛse wɔ ɔman biara mu efisɛ mmofra a wɔfa wɔn sɛ wɔn mma fi amannɔne no nnu ne nsɛm no mu 15%.[82] Russiafo mmofra bɛboro 60,000 na wɔagye wɔn ayɛ wɔn mma wɔ United States fi 1992,[84] na wɔfaa Chinafo mmofra dodow a ɛte saa ara sɛ wɔn mma fi 1995 kosi 2005.[85] Aman ahorow mmara gu ahorow wɔ ɔpɛ a wɔwɔ sɛ wɔbɛma kwan ma amanaman ntam agyede no mu. Esiane sɛ Hague Nhyiam a ɛfa Ankorankoro Amanaman Ntam Mmara ho no huu nsɛnnennen ne nsɛnnennen a ɛbata amanaman ntam agyede ho, ne mmɔden a wɔbɔe sɛ wɔbɛbɔ wɔn a wɔde wɔn ho ahyɛ mu no ho ban afi adifudepɛ ne nneɛma a wɔde di dwuma ɔkwammɔne so a ɛtɔ mmere bi a ɛka ho no ho nti, wɔyɛɛ Hague Mmofra a Wɔfa Wɔn Ba no Apam, a efii ase yɛɛ adwuma wɔ May 1, 1995 na aman 85 agye atom de besi November 2011.[86]

Nkwaboaa a wɔfa wɔn sɛ wɔn mma: egyina nkwaboaa a aka a wɔde ma bere a wɔawie awarefo biako aduruyɛ a wɔde nyinsɛn ba wɔ afiri mu no so; wɔde nkwaboaa ma ankorankoro anaa awarefo foforo, na ɛno akyi no wɔde saa nkwaboaa no gu ɔbea a wɔde no ma no no awotwaa mu, na ama nyinsɛn ne awo ayɛ mmerɛw. Wɔ United States no, agyapade ho mmara na ɛkyerɛ mma nkwaboaa a wɔfa wɔn sɛ wɔn mma sen sɛ asɛnnibea nhyehyɛe ahorow na ɛkyerɛ kwan, a ɛne atetesɛm mu mmofra a wɔfa wɔn sɛ wɔn mma no bɔ abira.

Common law adoption: eyi yɛ adoption a asɛnnibea ahorow no nni kan nnye ntom, nanso ɔwofo bi, a ɔmfa ne ho nhyɛ mmara kwan so nhyehyɛe biara mu, gyaw ne mma ma n’adamfo anaa obusuani bi bere tenten ][88] na ɛwɔ hɔ. Sɛ wɔde bere bi a wɔahyɛ ato hɔ a ɛne sɛ wɔbɛtra (a wofi wɔn pɛ mu) bɛtra mu no awiei, sɛnea ɔmanfo di ho adanse no, afei wobu abofra no sɛ ɛyɛ nea ɛhyɛ obi so, wɔ asennibea ahorow bi mu, ɛwom mpo sɛ mfiase no asɛnnibea no amma ho kwan de. Mmara kwan so tumidi biara na ɛkyerɛkyerɛ nsɛm pɔtee a ɛfa mmara kwan so agyede ho. Sɛ nhwɛso no, U.S. mantam California gye mmara kwan so abusuabɔ tom bere a wɔabom atra mfe 2 akyi no. Wɔfrɛ adeyɛ no &quot;private fostering&quot; wɔ Britain.[89]

'''Nneɛma a wɔsɛe no ne nea wɔtetew mu'''

Asɛm titiriw: Nneɛma a wɔsɛe no (fa a wɔfa wɔn sɛ wɔn mma) .

Ɛwom sɛ wɔtaa ka mmofra a wɔfa wɔn sɛ wɔn mma no ho asɛm sɛ ɛyɛ abusua &quot;daa&quot; de, nanso wobetumi de abusuabɔ no aba awiei bere biara. Wɔfrɛ mmara kwan so a wogyae mmofra a wɔfa wɔn sɛ wɔn mma no sɛ ɔhaw. Wɔ U.S. nsɛmfua mu no, sɛ wogyae mmofra a wɔfa wɔn sɛ wɔn mma no ansa na wɔawie a, wɔsɛe wɔn, na sɛ wogyae abusuabɔ no wɔ ɛno akyi a, wogyae. Wobetumi afrɛ no nso sɛ mmofra a wɔfa wɔn sɛ wɔn mma a entumi nyɛ yiye. Bere a wɔawie mmara kwan so a, mpɛn pii no awofo a wɔagye wɔn ayɛ wɔn mma no nam asɛnnibea adesrɛ so na efi ɔhaw no ase na ɛne awaregyae ho nsɛm di nsɛ. Ɛyɛ mmara kwan a ɛyɛ soronko ma awofo a wɔagye wɔn ayɛ wɔn mma efisɛ ɔhaw/nsɛe no mfa abusuafo a wɔwoo wɔn ho, ɛwom sɛ ɛtɔ mmere bi a wɔpow abusua mufo a wɔwo wɔn anaasɛ wogyaw wɔn hɔ de.[90]

Nanso, nhwehwɛmu ahorow a wɔyɛe wɔ bere tiaa bi mu a wɔyɛe wɔ U.S. no kyerɛ sɛ mmofra yiyedi nhyehyɛe no so a wɔfa wɔn sɛ wɔn mma no ɔha biara mu nkyem 10 kosi 25 (sɛ nhwɛso no, nkokoaa a wɔagye wɔn ayɛ wɔn mma a wofi aman afoforo so anaa awofo a wɔyɛ mpena a wogye wɔn mpena mma no nka ho) sɛe ansa na wɔawie wɔ mmara kwan so na efi 1 mu kosi ɔha biara mu nkyem 10 no, wogu bere a wɔawie mmara kwan so no. Gyinapɛn ahorow pii no da nsɛm a ɛfa asɛm no ho ne nnipa dodow te sɛ mfe a wɔadi ho nsɛm kakraa bi na ɛwɔ hɔ adi; wonim sɛ mmabun taa nya wɔn mma a wɔfa wɔn sɛ wɔn mma no mu ɔhaw sen mmofra nkumaa.[90]

Awarefo a wɔne wɔn ho da a wɔfa wɔn sɛ wɔn mma

Mmara kwan so awarefo a wɔne wɔn ho da a wɔbɛbom agye wɔn ayɛ wɔn mma wɔ aman 34 so de besi March 2022, ne nea ɛka ho no wɔ aman nketewa ahorow mu. Awarefo a wɔne wɔn ho da no nso betumi ayɛ mma a wɔfa wɔn sɛ wɔn mma (aman 6 foforo), a ɔhokafo biako a ɔwɔ ɔbarima ne ɔbea nna mu no gye ɔfoforo no ba. Aman dodow no ara a wɔwɔ bɔbeasu koro aware no ma kwan ma saa awarefo no bom gye wɔn mma, nea ɛka ho ne Ecuador (awarefo a wɔne wɔn ho da nnye wɔn mma), Taiwan (awarefo a wɔyɛ mma nkutoo) ne Mexico (wɔ amantam a mmarima ne mmea aware wom no nkyem abiɛsa mu biako mu ). Aman kakraa bi a wɔwɔ ɔmanfo nkabom anaasɛ aware hokwan kakraa bi no nyinaa ma kwan ma wɔfa anammɔn anaa wɔbom yɛ mmofra

== Wɔn a wɔagye wɔn ayɛ wɔn mma no awofoyɛ ==
'''Awofoyɛ'''

Awosu mu abusuabɔ a ɛda ɔwofo ne abofra ntam no ho hia, na wɔn baanu a wɔatew wɔn ho no ama wɔahaw wɔ mmofra a wɔfa wɔn sɛ wɔn mma ho. Atetesɛm mu adwene a ɛfa awofo a wɔfa wɔn sɛ wɔn mma ho no nyaa mmoa a wonya fii Princeton Sukuupɔn nhwehwɛmu bi a wɔyɛe wɔ mmusua 6,000 a wɔfaa wɔn mma, wɔyɛ wɔn mma, na wɔhwɛ wɔn wɔ United States ne South Africa fi 1968 kosi 1985 no hɔ; nhwehwɛmu no kyerɛe sɛ aduan a wɔsɛe no wɔ afie a ɛnanom a wɔn mma a wɔnyɛ awofo wom (bere a wɔhwɛ sika a wonya, ofie dodow, nnɔnhwerew a wɔde yɛ adwuma, mfe a wɔadi, ne nea ɛkeka ho so) no sua koraa ma wɔn a wɔafa wɔn ayɛ wɔn mma, mmanoma mma, ne mmofra a wɔagye wɔn ayɛ wɔn mma, na ɛmaa nhwehwɛmufo no yɛɛ saa kyerɛ sɛ nkurɔfo ani nnye ho kɛse sɛ wɔbɛma afoforo awosu mu nkwaadɔm no atra hɔ.[91] Wɔfoa saa nsusuwii yi so wɔ nhwehwɛmu foforo a ɛfa su ho kɛse a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma a wɔde wɔn ho hyɛ wɔn a wɔpɛ wɔn asɛm, wɔn nipasu, ne wɔn honam ani hwɛbea koro no ara agyirae no, ne wɔn a wɔanyinyin a wɔagye wɔn ayɛ wɔn mma no nyinaa wɔ abusuabɔ ne awofo a wɔagye wɔn ayɛ wɔn mma no bɔ amanneɛ sɛ wɔn ani agye kɛse wɔ mmofra a wɔfa wɔn sɛ wɔn mma no ho.

Nhwehwɛmu afoforo de adanse ma sɛ abusuabɔ a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma no betumi ayɛ nea ɛfata wɔ akwan foforo so. Nhwehwɛmu bi a ɛhwehwɛ sɛnea awofo de wɔn sika hyɛ mu no kyerɛ ahoɔden wɔ mmusua a wɔfa wɔn mma no mu, na ɛkyerɛ sɛ awofo a wɔfa wɔn mma no de bere pii hyɛ wɔn mma mu sen awofo afoforo, na ɛde ba awiei sɛ &quot;...awofo a wɔfa wɔn mma no ma wɔn mma asetra yɛ yiye de tua abusuabɔ a enni awosu mu no ho ka ne the extra challenges of adoption.&quot;[93] Nhwehwɛmu foforo a wɔyɛe nnansa yi kyerɛe sɛ mmusua a wɔfa wɔn mma no de sika kɛse hyɛ wɔn mma a wɔagye wɔn ayɛ wɔn mma no mu, sɛ nhwɛso no, denam nhomasua foforo ne sika fam mmoa a wɔde ma so. Bere a ɛhyɛ no nsow sɛ ɛte sɛ nea wɔn a wɔagye wɔn ayɛ wɔn mma no taa hyia ɔhaw ahorow te sɛ nnubɔne a wɔde di dwuma no, nhwehwɛmu no susuwii sɛ ebia awofo a wɔfa wɔn sɛ wɔn mma no de wɔn sika pii bɛto wɔn a wɔagye wɔn ayɛ wɔn mma no mu ɛnyɛ sɛ wɔpɛ wɔn asɛm nti, na mmom esiane sɛ ɛda adi sɛ wohia mmoa no sen mmofra a wɔwɔ awosu mu nneɛma nti.[94]

Adwene ne nneyɛe ho animdefo hui a ɛfa hia a ɛna ne nkokoaa ntam abusuabɔ ho hia no ho no maa ɛhaw adwene bi sɛ ebia awofo a wogye nkokoaa a wɔanyinyin anaa mmofra a wɔretu mmirika wɔ awo akyi no ayera bere titiriw bi a ɛbɛma abofra no anyin anaa. Nanso, nhwehwɛmu a wɔyɛe wɔ The Mental and Social Life of Babies ho no kyerɛe sɛ &quot;ɔwofo ne nkokoaa nhyehyɛe&quot;, sen sɛ ɛbɛyɛ abusuabɔ a ɛda ankorankoro a wɔne wɔn ho wɔn ho wɔ abusuabɔ ntam no, yɛ ade a ɛdannan a ɛda nnipa nkokoaa nyinaa awosu mu nneyɛe ne mmuae a nnipa a wɔanyinyin de yɛ wɔn ade a ɛkɔ so pɛpɛɛpɛ wɔ ho no ntam saa nkokoaa nneyɛe no. Enti abɔde &quot;hwɛ ma wɔyɛ nsakrae bi a edi kan wɔ obu ma mpanyimfo pɔtee a wogye awofo dwumadi no ho.&quot;[95]

Wɔ nsɛmpɔw atitiriw no akyi no, nsemmisa soronko a wobisa awofo a wɔfa wɔn sɛ wɔn mma no gu ahorow. Nea ɛka ho ne sɛnea wobebua nsusuwii hunu, nsɛmmisa a ɛfa agyapade ho a wobebua, ne ɔkwan a eye sen biara a wɔbɛfa so ne abusuafo a wɔwoo wɔn no anya abusuabɔ bere a wɔwɔ mmofra a wɔabue wɔn mma no mu.[96] Ɔkyerɛwfo biako kyerɛ sɛ asɛmmisa a awofo a wɔfa wɔn sɛ wɔn mma no taa nya ne sɛ: &quot;So yɛbɛdɔ abofra no ɛwom mpo sɛ ɔnyɛ yɛn ba a ɔwoo no no?&quot;[97] Ade pɔtee a ɛhaw awofo pii ne sɛ wɔbɛma obi a wɔagye no ayɛ ne ba no atra sukuu dan mu. Asuade ahorow a wonim te sɛ &quot;twe w'abusua dua&quot; anaa &quot;fa w'awofo ne wo nananom so hwehwɛ w'ani kɔla akyi kɔhwɛ baabi a w'awosu fi&quot; betumi apira mmofra a wɔfaa wɔn sɛ wɔn mma na wonnim saa abɔde mu nsɛm yi. Wɔde nyansahyɛ ahorow pii ama sɛ wɔde besi adesua foforo ananmu, s.e., wɔde wɔn adwene asi &quot;abusua nnuaba turo&quot; so.[99]

Mmofra a wɔanyinyin a wɔfa wɔn sɛ wɔn mma no de awofoyɛ ho nsɛm afoforo ba.[100] Mmofra binom a wofi mmofra a wɔhwɛ wɔn so no wɔ abakɔsɛm a ɛfa ayayade ho, te sɛ honam ne adwene mu anibiannaso, honam fam ayayade, ne nna mu ayayade, na wɔwɔ asiane mu sɛ wobenya adwenemyare ho haw ahorow.[101][102] Mmofra a wɔte saa no wɔ asiane mu sɛ wobenya abusuabɔ a ɛnyɛ nhyehyɛe.[103][104][105] Nhwehwɛmu ahorow a Cicchetti ne afoforo yɛe no. (1990, 1995) hunuu sɛ nkokoaa a wɔyɛɛ wɔn ayayadeɛ na wɔyɛɛ wɔn ayayadeɛ wɔ wɔn nhwɛsoɔ no mu 80% daa abatadeɛ akwan a ɛnyɛ nhyehyɛeɛ adi.[106][107] Bata a wɔanhyehyɛ no ne nkɔso ho haw ahorow bi wɔ abusuabɔ, a nea ɛka ho ne sɛnkyerɛnne ahorow a ɛma obi fi ne ho fi afoforo ho,[108] ne adwenemhaw, dadwen, ne adeyɛ ho sɛnkyerɛnne ahorow.[109][110] &quot;Attachment yɛ adeyɛ a ɛyɛ nnam—ebetumi ayɛ nea ahobammɔ wom anaasɛ enni ahobammɔ, ɛnyɛ nea ɛfata anaasɛ ɛsow aba. Eyi yɛ sikasɛm a ɛnyɛ nokware efisɛ mpɔtam hɔ atumfoɔ hwɛ a wɔhwɛ mmofra yi bo yɛ den yiye.[112]

Ɛdefa nkɔso mu nneɛma atitiriw ho no, nhwehwɛmu ahorow a efi Colorado Adoption Project no mu no hwehwɛɛ awosu mu nkɛntɛnso a ɛwɔ wɔn a wɔagye wɔn ayɛ wɔn mma no onyin so no mu, na ɛde baa awiei sɛ wɔn a wɔagye wɔn ayɛ wɔn mma no adwene tumi da wɔn awofo a wɔfaa wɔn mma no de adi wɔ mmofraase nanso ɛnkyerɛ sɛ ɛne wɔn ho wɔn ho di nsɛ kɛse wɔ mmerantebere ne mmabaabere mu, na ɛte sɛ wɔn awofo a wɔwoo wɔn no de mmom na ɛte sɛ nea ɛte saa ara baabi a ɛkɔ akyiri sɛ atipɛnfo wɔ mmusua a wɔmfa wɔn mma wɔn mma mu.[113]

Ɛte sɛ nea akwan a ɛte saa ara reyɛ adwuma wɔ wɔn a wɔagye wɔn ayɛ wɔn mma no honam fam nkɔso mu. Denmarkfo ne Amerikafo nhwehwɛmufo a wɔreyɛ nhwehwɛmu ahorow a ɛfa awosu mu mmoa a ɛma nipadua no yɛ kɛse ho no huu abusuabɔ a ɛda obi a wɔagye no ayɛ ne ba no mu duru ne n’awofo a wɔwoo no no BMI ntam bere a wɔanhu abusuabɔ biara a ɛda abusua a wɔagye no ayɛ ne ba no ntam no. Bio nso, nsonsonoe a ɛda ankorankoro ntam no bɛyɛ fã fi ankorankoro nkɛntɛnso ahorow a wɔnkyɛ mu.[114][115]

Ɛte sɛ nea nsonsonoe ahorow a ɛwɔ nkɔso mu yi di agoru wɔ ɔkwan a mmerante ne mmabaa a wɔagye wɔn ayɛ wɔn mma no fa so di asetra mu nsɛm atitiriw ho dwuma no mu. Wɔ awofo awaregyae ho no, wɔahu sɛ ɛsono sɛnea wɔn a wɔagye wɔn ayɛ wɔn mma no yɛ wɔn ade wɔ mmofra a wɔannye wɔn mma no ho. Bere a nnipa dodow no ara nyaa suban ho haw pii, nnuru a wɔde di dwuma, sukuu mu nkɔso a ɛba fam, ne asetra mu ahoɔden a asɛe wɔ awofo awaregyae akyi no, ɛte sɛ nea nnipa dodow a wɔagye wɔn ayɛ wɔn mma no annya nkɛntɛnso biara wɔ wɔn abɔnten abusuabɔ ho, titiriw wɔ wɔn sukuu anaa asetra mu tumi mu.

'''Nkɛntɛnso a enya wɔ awofo a wodii kan bae no so'''

Nneɛma pii na ɛka gyinae a wosi sɛ wobegyae abofra no anaasɛ wɔbɛtete no no. Mmabun a wɔyɛ aborɔfo taa de wɔn nkokoaa ma wɔn a wɔnyɛ abusuafo, bere a mmabun a wɔyɛ abibifo taa nya mmoa fi wɔn ankasa mpɔtam hɔfo hɔ wɔ abofra no ntetee mu ne ɔkwan a abusuafo fa so gye wɔn sɛ wɔn mma wɔ ɔkwan a ɛnyɛ ɔhyɛ so nso so. Nhwehwɛmu a Leynes ne Festinger ne Young, Berkman, ne Rehr yɛe no kyerɛe sɛ, wɔ mmabun a wɔyem fam no, gyinae a wosi sɛ wobegyae abofra no ma wagye no ayɛ ne ba no gyina adwene a ɔbabun no maame wɔ wɔ mmofra a wɔfa no sɛ wɔn ba ho no so.[118] Nhwehwɛmu foforo nso kyerɛe sɛ mmabun a wɔyem a wɔn maamenom asua nhoma a ɛkɔ akyiri no taa gyae wɔn mma ma wɔfa wɔn sɛ wɔn mma. Nhwehwɛmu kyerɛ sɛ mmea a wɔpaw sɛ wobegyae wɔn mma ma wɔafa wɔn ayɛ wɔn mma no taa yɛ nkumaa, wɔakyerɛw wɔn din wɔ sukuu mu, na wɔatra awofo baanu fie mu bere a wɔadi mfe 10, sen wɔn a wɔhwɛɛ wɔn mma na wɔtetee wɔn no.[119]

Nhwehwɛmu kakraa bi na wɔayɛ wɔ nea ebefi mmofra a wɔfa wɔn sɛ wɔn mma a wodi kan no so aba no ho, na nea wɔahu no adi afra. Nhwehwɛmu bi kyerɛe sɛ wɔn a wogyaee wɔn mma ma wɔfa wɔn sɛ wɔn mma no ani nnye wɔn gyinaesi no ho kɛse sen wɔn a wɔde wɔn mma siei no. Nanso, na awerɛkyekye dodow a ɛwɔ akuw abien no nyinaa so no dɔɔso, na wɔn a wogyaee wɔn ba no te sɛ wɔn a wɔmaa wɔn ba no siei wɔ asetra mu abotɔyam, abusuabɔ mu abotɔyam, ne daakye ho adwene pa a wɔwɔ wɔ sukuu, adwuma, sikasɛm, ne aware ho nsusuwii ahorow mu ] . Nhwehwɛmu a wɔyɛe akyiri yi kyerɛe sɛ ɛnanom a wɔadu mpanyin afe so a wɔpaw sɛ wobegyae wɔn mma ma wɔagye wɔn ayɛ wɔn mma no taa nya awerɛhow ne ahonu wɔ wɔn gyinaesi no ho sen wɔn a wɔkoraa wɔn mma so no. Nanso, saa nkate ahorow yi so tew kɛse fi afe biako wɔ awo akyi kosii afe a ɛto so abien no awiei.[121]

Nhwehwɛmu a wɔayɛ nnansa yi ara no hui sɛ wɔ ɛnanom a wogyaee wɔn mma sɛ wɔmfa wɔn mma mfe anan kosi 12 ansa na ɛreba no mu no, na obiara a ɔde ne ho hyɛɛ mu no taa susuw wɔn ba a wayera no ho. Wɔ dodow no ara fam no, na nsusuwii ahorow no yɛ nea enye ne nea eye efisɛ na ɛma wonya awerɛhow ne anigye nkate nyinaa. Wɔn a wonyaa nsusuwii pa no fã kɛse no ara mu osuahu ne wɔn a na wɔabue wɔn mma, sen sɛ wɔde ntamgyinafo a wɔato mu anaasɛ bere tiaa bi bɛyɛ wɔn mma.[122]

Wɔ nhwehwɛmu foforo a wɔde ɛnanom a wogyae wɔn mma totoo wɔn a wɔtetee wɔn ho no mu no, ɛnanom a wogyae wɔn mma no taa twentwɛn wɔn nyinsɛn a edi hɔ no ase, wɔtwentwɛn aware ase, na wowie adwuma ho ntetee. Nanso, akuw abien no nyinaa duu nhomasua a ɛba fam sen wɔn atipɛnfo a wɔannyinsɛn da.[123] Nhwehwɛmu foforo nso hui sɛ nneɛma a ɛte saa ara fi mu ba bere a wɔpaw sɛ wobegyae abofra bi ma wɔagye no ayɛ ne ba no. Ná ɛnanom a wɔn mfe akɔ anim a wogyaee wɔn mma no taa nya nhomasua a ɛkorɔn na wonya adwuma sen wɔn a wɔhwɛɛ wɔn mma no. Wɔsan nso twɛn kyɛe ansa na wɔrewo wɔn ba a odi hɔ no.[121] Wɔde mmabun nhwɛso ahorow, anaasɛ mmea a na wɔyɛ mmabun bere a wɔsoa wɔn nkokoaa no yɛɛ nhwehwɛmu a ɛwɔ hɔ wɔ nkɛntɛnso a awofo a wɔfa wɔn sɛ wɔn mma no so nkɛntɛnso ho no mu dodow no ara—nsɛm kakraa bi na ɛwɔ hɔ ma awofo a wɔwoo wɔn a wofi nnipa afoforo mu. Afei nso, nsɛm a wɔde bere tenten ayɛ a ebetumi ama asetra ne adwene mu nsunsuanso a ɛbɛtra hɔ akyɛ ama awofo a wɔwo a wɔpaw sɛ wɔde wɔn mma bɛto hɔ ama wɔagye wɔn ayɛ wɔn mma no nni hɔ.

== Nkɔso a ɛfa wɔn a wɔagye wɔn ayɛ wɔn mma ho ==
Nhwehwɛmu a wɔadi kan ayɛ wɔ mmofra a wɔfa wɔn sɛ wɔn mma ho no ama wɔanya nsusuwii ahorow a ɛkyerɛ sɛ asiane a ɛkɔ soro wɔ adwene mu nkɔso ne asetra mu abusuabɔ mu ma wɔn a wɔagye wɔn ayɛ wɔn mma no. Nanso, wɔama nsusuwii ahorow a ɛtete saa no mu ada hɔ sɛ ɛyɛ mfomso esiane akwan a wɔfa so yɛ adwuma no huammɔdi nti. Nanso nnansa yi nhwehwɛmu ahorow aboa ma wɔakyerɛ nsɛm a ɛyɛ nokware kɛse ne nea efi mu ba a ɛfa nsɛdi, nsonsonoe ne asetra kwan nyinaa a wɔn a wɔafa wɔn ayɛ wɔn mma no asetra kwan ho.[124]

Wobetumi afoa adanse a ɛfa sɛnea wɔn a wɔagye wɔn ayɛ wɔn mma no nkɔso ho wɔ nhwehwɛmu foforo mu. Yebetumi aka sɛ, wɔ ɔkwan bi so no, wɔn a wɔfa wɔn sɛ wɔn mma no taa nya nkɔso wɔ ɔkwan soronko so wɔ nnipa dodow no ara ho. Wobetumi ahu eyi wɔ asetra mu nneɛma pii mu, nanso mpɛn pii no wobetumi ahu sɛ asiane kɛse wɔ hɔ bɛyɛ mmerantebere ne mmabaabere mu. Sɛ nhwɛso no, wɔahu sɛ wɔn a wɔagye wɔn ayɛ wɔn mma no pii hyia ɔhaw wɔ adwene a wɔde besi hɔ a ɛkyerɛ sɛ wɔyɛ wɔn mma no mu.[125]

'''Adida'''

Akwan pii wɔ hɔ a wobetumi afa so akyerɛkyerɛ adwene a ɛfa nipasu ho no mu. Ɛyɛ nokware wɔ nsɛm nyinaa mu sɛ nipasu a wɔde si dan no yɛ adeyɛ a ɛkɔ so a ɛfa nkɔso, nsakrae ne adwene a wɔde si obi ho ne ankasa ho a wɔhwɛ so. Nhwehwɛmu ada no adi sɛ mmerantebere ne mmabaabere yɛ bere a wɔde wɔn ho hyɛ mu sen sɛ wɔbɛsan wɔn akyi.[126] Obi nipasu taa ntumi nnyina wɔ n’asetra mfe a edi kan no mu nanso onya ntease a egyina pintinn kɛse wɔ mmofraberem ne mmerantebere ne mmabaabere mu akyiri yi mu. Mpɛn pii no, wɔde bata bere bi a wɔde sɔ nneɛma hwɛ ho no, nneɛma a enni awiei wɔ hɔ a ɛkɔ obi nipasu a wɔbɛkyekye mu. Nea ɛka nneɛma pii ho no, nipasu ahorow pii wɔ hɔ a obi betumi de abata ho. Nnipa a wɔde wɔn ho hyɛ mu no bi ne ɔbarima ne ɔbea nna, ɔbarima ne ɔbea nna, kuw, abusuakuw ne nyamesom, ne nea ɛkeka ho Wɔ wɔn a wɔafa wɔn ayɛ wɔn mma wɔ mmusuakuw ntam ne amanaman ntam no fam no, mpɛn pii no wohu nhyɛso wɔ mmusuakuw, mmusuakuw ne ɔman a wɔde wɔn ho hyɛ mu no mu. Esiane eyi nti, abusua mu abusuabɔ ahoɔden ne ne dwumadi di dwuma kɛse wɔ ne nkɔso ne nea efi nipasu a wɔkyekye mu ba no mu. Wɔn a wɔfa wɔn sɛ wɔn mma a wofi mmusuakuw ahorow mu ne aman horow so no taa nya nkate a ɛne sɛ wonnye wɔn ntom esiane mmusuakuw, mmusuakuw, ne amammerɛ mu nsonsonoe a ɛte saa nti. Enti, sɛ wɔbɛma wɔn a wɔagye wɔn ayɛ wɔn mma a wofi mmusuakuw ahorow mu ne aman ntam no ahu wɔn &quot;amammerɛ a wofi mu&quot; no ho hia sɛnea ɛbɛyɛ a wobenya adwene a ɛfa wɔn ho ne anisɔ a ɛfa amammerɛ ahorow ho yiye. Nnipa a wɔagye wɔn ayɛ wɔn mma wɔ aman ntam no ho adansedi ne nea wɔsan kyekye no ntɛm ara a wɔfa wɔn sɛ wɔn mma no. Sɛ nhwɛso no, egyina United States mmara ne nhyehyɛe pɔtee so no, Child Citizen Act of 2000 hwɛ hu sɛ wɔbɛma wɔn a wɔagye wɔn ayɛ wɔn mma no U.S. ɔman ba ntɛm ara.[127]

Wɔde nea obi yɛ ne nea ɔnyɛ nyinaa na ɛkyerɛkyerɛ nipasu mu. Wɔn a wɔagye wɔn ayɛ wɔn mma a wɔwo wɔn wɔ abusua biako mu no hwere wɔn din na afei wɔfɛm biako fi abusua a wɔfa wɔn sɛ wɔn mma no hɔ. Nnipa nipasu a wɔhyehyɛ no yɛ adeyɛ a ɛyɛ den na nneɛma pii wɔ hɔ a ɛka nea ebefi mu aba. Sɛ yɛhwɛ nsɛm a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho tebea horow mu a, wobetumi ahu nnipa a wɔfa wɔn sɛ wɔn mma no ka ho na ɛka wɔn (ɔwofo a ɔwoo wɔn, ɔwofo a ɔfaa no sɛ ne ba ne nea wɔagye no ayɛ ne ba) sɛ &quot;triad members and state&quot;. Ebia mmofra a wɔfa wɔn sɛ wɔn mma no de baasakoro no mufo a wɔte nka sɛ wɔyɛ nnipa no to asiane mu. Baasakoro no mufo taa da nkate horow a ɛfa nipasu ne nipasu ho haw ahorow a ɛyɛ basaa ho adi esiane nsonsonoe a ɛwɔ baasakoro no ntam abusuabɔ mu nti. Wɔ ebinom fam no, mmofra a wɔfa wɔn sɛ wɔn mma no mma wonnya wɔn ho ho adwene a edi mũ anaasɛ wɔaka abom. Ebia Baasakoro no mufo behu wɔn ho sɛ wonni mũ, wonni hwee, anaasɛ wonwiei. Wɔka sɛ wonni yiyedi, biakoyɛ, anaa pintinn ho nkate a ɛbata nipasu a anya nkɔso koraa ho.[128]

'''Nkɛntɛnso ahorow'''

Abusua di dwuma titiriw wɔ nipasu a wɔhyehyɛ mu. Ɛnyɛ mmofraberem nko na eyi te saa, na mmom mmerantebere ne mmabaabere mu nso. Nnipa a wɔyɛ wɔn ho (ɔbarima ne ɔbea nna/ɔbarima ne ɔbea nna/abusuakuw/nyamesom/abusua) da so ara reyɛ wɔ mmerantebere ne mmabaabere mu na abusua kura eyi ho safe titiriw. Ɛte sɛ nea nhwehwɛmu no yɛ nea adwene koro yɛ; abusua a ɛyɛ den, ahobammɔ, ɔdɔ, nokwaredi ne mmoa a emufo nyinaa te nka sɛ wɔwɔ ahobammɔ sɛ wɔbɛhwehwɛ wɔn nipasu mu no ho hia na ama wɔatumi ayɛ nipasu a ɛfata. Transracial ne International adoptions yɛ nneɛma bi a edi dwuma titiriw wɔ wɔn a wɔagye wɔn ayɛ wɔn mma no nipasu a wɔkyekye no mu. Ntawntawdi pii fi abusuabɔ a wɔkyekye wɔ nea wɔagye no ayɛ ne ba no ne wɔn abusua ntam no mu. Eyinom bi ne sɛ &quot;wɔyɛ soronko&quot; wɔ ɔwofo (ɔwofo) ho, abusuakuw mu nipasu pa a wobenya, ne mmusuakuw/abusuakuw mu nyiyim a wobedi ho dwuma.[129] Wɔahu sɛ mmerante ne mmabaa a wɔwɔ amammerɛ ahorow ne aman ntam no taa ne wɔn awofo hu amammerɛ ne mmusuakuw a wofi mu ba sen sɛ wɔbɛkyerɛ baabi a wɔte, nanso ɛtɔ mmere bi a ɛyɛ den sɛ wɔbɛkari pɛ wɔ nnipa baanu no ntam efisɛ sukuu tebea horow taa nni nneɛma ahorow ne gye a wogye tom wɔ nsɛmti a ɛtete saa ho .[130] . Saa nhyɛso ahorow yi nso taa ma nsɛmmisa bi ba ma nea wɔagye no ayɛ ne ba no, ne abusua no nso sɛ wobesusuw ho. Nsɛmmisa bi a wɔtaa bisa no bi ne sɛ abusua no yɛ anibiannaso kɛse wɔ asetra mu akwan horow a wɔkyekye no ho a, dɛn na ɛbɛba? So ntawntawdi bɛba sɛ eyi te saa a? Na sɛ nnipa ankasa a wɔkyerɛ sɛ wɔyɛ nipasu a ɛfata ho nhwɛso no ankasa yɛ nea ahobammɔ a enni hɔ ahyɛ mu ma nso ɛ? Ginni Snodgrass bua nsɛmmisa yi wɔ ɔkwan a edidi so yi so. Ahintasɛm a ɛwɔ abusua a wɔma wɔn mma mu ne pow a wɔpow sɛ ɛsono abusua a wɔfa wɔn sɛ wɔn mma no ma adwumayɛ a entumi nyɛ adwuma yiye ba mu. &quot;... asetra mu adwumayɛfo ne awofo a wɔagye wɔn ayɛ wɔn mma a wonni ahobammɔ no ayɛ abusua abusuabɔ a egyina nokwaredi a wonni, kwati ne nneɛma a wɔde di dwuma so. Sɛ́ wubegye adi sɛ abusuabɔ pa bɛkɔ so wɔ fapem a ɛte saa so no nyɛ adwene mu ntease&quot; (Lawrence). Kokoamsɛm si akwanside ahorow a ɛmma wontumi nnya nipasu a ɛfata.[131]

Nhwehwɛmu no ka sɛ ɛnyɛ sɛ adwuma a entumi nyɛ adwuma yiye, nsɛm a ɛnyɛ nokware ne nea wɔkwati a ebetumi aba mmusua a wɔagye wɔn ayɛ wɔn mma no mu no mma ɛnyɛ yiye nko, na mmom ɛyɛ adwuma tia no tẽẽ nso. Sɛ nea wɔagye no ayɛ ne ba no nim sɛ wɔafa wɔn ayɛ wɔn ba nanso onni wɔn awofo a wɔwoo wɔn no ho nsɛm biara a, nkɛntɛnso bɛn na ɛwɔ hɔ wɔ nnipa a wɔyɛ wɔn basaa no so? Silverstein ne Kaplan nhwehwɛmu no ka sɛ nsɛmmisa te sɛ &quot;Hena ne me?&quot; &quot;Dɛn nti na wɔwoo me?&quot; &quot;Dɛn ne m'atirimpɔw?&quot; Saa nipasu a wonni yi betumi ama wɔn a wɔagye wɔn ayɛ wɔn mma, titiriw wɔ mmerantebere ne mmabaabere mu, ahwehwɛ akwan a wɔbɛfa so ayɛ wɔn ho wɔ ɔkwan a ɛtra so so sen wɔn atipɛnfo a wonnye wɔn mma no pii. Mmabun a wɔagye wɔn ayɛ wɔn mma no dɔɔso dodo wɔ wɔn a wɔde wɔn ho hyɛ amammerɛ nketewa mu, guan, wonyinsɛn, anaasɛ wɔpo wɔn mmusua koraa no mu.[132][133]

Ɛdefa nkɔso mu nneɛma atitiriw ho no, nhwehwɛmu ahorow a efi Colorado Adoption Project no mu no hwehwɛɛ awosu mu nkɛntɛnso a ɛwɔ wɔn a wɔagye wɔn ayɛ wɔn mma no onyin so no mu, na ɛde baa awiei sɛ wɔn a wɔagye wɔn ayɛ wɔn mma no adwene tumi da wɔn awofo a wɔfaa wɔn mma no de adi wɔ mmofraase nanso ɛnkyerɛ sɛ ɛne wɔn ho wɔn ho di nsɛ kɛse wɔ mmerantebere ne mmabaabere mu, na ɛte sɛ wɔn awofo a wɔwoo wɔn no de mmom na ɛte sɛ nea ɛte saa ara baabi a ɛkɔ akyiri sɛ atipɛnfo wɔ mmusua a wɔmfa wɔn mma wɔn mma mu.[113]

Ɛte sɛ nea akwan a ɛte saa ara reyɛ adwuma wɔ wɔn a wɔagye wɔn ayɛ wɔn mma no honam fam nkɔso mu. Denmarkfo ne Amerikafo nhwehwɛmufo a wɔreyɛ nhwehwɛmu ahorow a ɛfa awosu mu mmoa a ɛma nipadua no yɛ kɛse ho no huu abusuabɔ a ɛda obi a wɔagye no ayɛ ne ba no mu duru ne n’awofo a wɔwoo no no BMI ntam bere a wɔanhu abusuabɔ biara a ɛda abusua a wɔagye no ayɛ ne ba no ntam no. Bio nso, nsonsonoe a ɛda ankorankoro ntam no bɛyɛ fã fi ankorankoro nkɛntɛnso ahorow a wɔnkyɛ mu.[114][115]

Ɛte sɛ nea nsonsonoe ahorow a ɛwɔ nkɔso mu yi di agoru wɔ ɔkwan a mmerante ne mmabaa a wɔagye wɔn ayɛ wɔn mma no fa so di asetra mu nsɛm atitiriw ho dwuma no mu. Wɔ awofo awaregyae ho no, wɔahu sɛ ɛsono sɛnea wɔn a wɔagye wɔn ayɛ wɔn mma no yɛ wɔn ade wɔ mmofra a wɔannye wɔn mma no ho. Bere a nnipa dodow no ara nyaa suban ho haw pii, nnuru a wɔde di dwuma, sukuu mu nkɔso a ɛba fam, ne asetra mu ahoɔden a asɛe wɔ awofo awaregyae akyi no, ɛte sɛ nea nnipa dodow a wɔagye wɔn ayɛ wɔn mma no annya nkɛntɛnso biara wɔ wɔn abɔnten abusuabɔ ho, titiriw wɔ wɔn sukuu anaa asetra mu tumi mu.

Nanso, ɛte sɛ nea nnipa dodow a wɔagye wɔn ayɛ wɔn mma no wɔ asiane mu kɛse wɔ suban ho nsɛm bi ho. Nhwehwɛmufo a wofi Minnesota Sukuupɔn mu yɛɛ mmabun a wɔafa wɔn ayɛ wɔn mma no ho nhwehwɛmu na wohui sɛ wɔn a wɔagye wɔn ayɛ wɔn mma no betumi anya ɔsɔretia a ɛma obi yɛ ade tra so (ODD) ne adwene a wɔde si biribi so a ɛtra so (ADHD) no mmɔho abien, na ɛyɛ 8% wɔ nnipa dodow no ara mu nnipa dodow.[134][non-primary source needed] Asiane a ɛwɔ hɔ sɛ wobekum wɔn ho nso dɔɔso kɛse sen nnipa dodow no ara. Sweden nhwehwɛmufo hui sɛ amanaman ntam ne ɔman no mufo a wɔagye wɔn ayɛ wɔn mma no nyinaa kum wɔn ho wɔ dodow a ɛkɔ soro sen atipɛnfo a wɔamfa wɔn ayɛ wɔn mma no; a amanaman ntam wɔn a wɔagye wɔn ayɛ wɔn mma ne mmea a wɔagye wɔn ayɛ wɔn mma, titiriw no, wɔ asiane kɛse mu.[135]

Ne nyinaa mu no, adwuma a wɔayɛ wɔ wɔn a wɔanyinyin a wɔagye wɔn ayɛ wɔn mma ho no ahu sɛ asiane foforo a wɔn a wɔagye wɔn ayɛ wɔn mma no hyia no fa mmerantebere ne mmabaabere mu nkutoo. Wɔkyerɛe sɛ mmerante ne mmabaa a wɔanyinyin a wɔagye wɔn ayɛ wɔn mma no ne mpanyimfo a wofi mmusua a wɔwoo wɔn mu no yɛ pɛ na wonyaa nkontaa a eye sen mpanyimfo a wɔtetee wɔn wɔ abusua ahorow foforo a ɔwofo biako ne mmusua a wɔyɛ mpena ka ho mu.[136] Bio nso, bere a mpanyimfo a wɔagye wɔn ayɛ wɔn mma no daa nsakrae kɛse adi sen wɔn atipɛnfo a wɔamfa wɔn ayɛ wɔn mma wɔ adwene ne nneyɛe ho nhyehyɛe ahorow mu no, mpanyimfo a wɔagye wɔn ayɛ wɔn mma no daa nsɛdi pii adi sen nsonsonoe a ɛda mpanyimfo a wɔamfa wɔn ayɛ wɔn mma no ntam. Nsɛm pii aba a ɛfa adwenemhaw a ɛba ntɛm a wɔasiesie anaasɛ wɔasan asan aba ho. Sɛ nhwɛso no, wɔ nhwehwɛmu ahorow a edi kan a wɔyɛe no biako mu no, Ɔbenfo Goldfarb a ɔwɔ England no de baa awiei sɛ mmofra binom sesa wɔn ho yiye wɔ asetra ne nkate fam ɛmfa ho osuahu ahorow a enye a ɛfa ahyehyɛde a wɔde wɔn ho hyɛ mu wɔ mmofraase no ho no. Nhwehwɛmufo afoforo nso hui sɛ ɛnyɛ nea ɛkyerɛ ankasa sɛ mmofra a wɔde wɔn kɔ ayaresabea bere tenten no de nkate fam haw anaa suban mu sintɔ ahorow ba mmofra nyinaa so. Eyi kyerɛ sɛ mmofra binom bɛba bere nyinaa a wɔyɛ yiye, a wotumi gyina ano, a wɔn suahu ahorow wɔ mmofraase mfa ho.[139] Afei nso, nhwehwɛmu a wɔyɛ wɔ adwene mu nneɛma a efi wɔn a wɔagye wɔn ayɛ wɔn mma no ho no mu dodow no ara fi nnipa dodow a wɔwɔ ayaresabea no mu. Eyi kyerɛ sɛ ebia nsɛm a wɔde ba awiei te sɛ nea wɔn a wɔagye wɔn ayɛ wɔn mma no taa nya suban ho haw te sɛ ODD ne ADHD no bɛyɛ nea ɛyɛ animhwɛ. Esiane sɛ wɔn a wɔagye wɔn ayɛ wɔn mma a wɔhwehwɛ adwenemyare ayaresa no sua nti, adwene mu nneɛma a efi wɔn a wɔagye wɔn ayɛ wɔn mma no mu ba sɛ wɔde toto nea ɛwɔ nnipa dodow no ara ho no di nsɛ sen sɛnea nhwehwɛmufo binom kyerɛ no.[140]

'''Adwene mu akwahosan'''

Mmofra a wɔagye wɔn ayɛ wɔn mma no taa nya adwene ne nneyɛe ho haw sen atipɛnfo a wɔamfa wɔn ayɛ wɔn mma.[141] Mmofra a na wɔadi boro anan bere a wɔfaa wɔn sɛ wɔn mma no nya adwene mu haw pii sen wɔn a na wɔyɛ nkumaa no.[142][143]

Sɛnea nhwehwɛmu a wɔyɛe wɔ UK kyerɛ no, mmofra a wɔagye wɔn ayɛ wɔn mma no betumi anya adwenemyare a ɛmma wo de baanan mpo nkɔ yiye bere a wɔafa wɔn ayɛ wɔn mma no akyi. Mmofra a wɔwɔ mmofraberem osuahu ahorow pii a enye no taa nya adwenemyare. Nhwehwɛmu no kyerɛ sɛ sɛnea ɛbɛyɛ a wobehu adwenemyare ho haw ahorow na wɔatiatia so ntɛm no, wɔn a wɔhwɛ mmofra ne awofo a wɔfa wɔn sɛ wɔn mma no hia abofra no asetra ho nsɛm a ɛkɔ akyiri.[142][144] Nhwehwɛmu foforo bi a wɔyɛe wɔ UK kyerɛ sɛ mmofra a wɔagye wɔn ayɛ wɔn mma no taa nya adwenemhaw a ɛba wɔn akyi (PTS) sen nnipa dodow no ara. Wɔn PTS sɛnkyerɛnne no gyina osuahu bɔne ko a wɔfaa mu no so na nimdeɛ a ɛfa wɔn abakɔsɛm ho no ma wonya mmoa a wɔahyɛ da ayɛ.[145][146]

== Adwene a ɔmanfo kura wɔ mmofra a wɔfa wɔn sɛ wɔn mma ho ==
Wɔ Atɔe Famfo amammerɛ mu no, nnipa pii hu sɛ abusua ho mfonini a wɔtaa yɛ no yɛ awarefo a wɔne wɔn ho da a wɔwɔ mma a wɔwoo wɔn no de. Saa adwene yi de abusua ahorow a wɔde di dwuma foforo no si nea wɔtaa yɛ no akyi. Nea efi mu ba – nhwehwɛmu kyerɛ – adwene a ɛbrɛ wɔn ase wɔ mmusua a wɔfa wɔn mma ho no wɔ hɔ, ne adwenem naayɛ a ɛfa sɛnea wɔn abusua mu abusuabɔ mu yɛ den ho.[147][148]

Nhwehwɛmu a wɔyɛe nnansa yi ara wɔ mmofra a wɔfa wɔn sɛ wɔn mma ho adwene a Evan Donaldson Asoɛe no wiei no de saa animtiaabu yi ho adanse foforo ma. Ɛkame ayɛ sɛ nnipa dodow a wobisabisaa wɔn nsɛm no mu nkyem abiɛsa mu biako gye di sɛ wɔn a wɔagye wɔn ayɛ wɔn mma no ntumi nyɛ nsakrae yiye, wɔtaa nya ayaresa ho nsɛm, na wɔtaa nya nnubɔne ne nsa ho haw ahorow. Bio nso, 40–45% susuwii sɛ wɔn a wɔagye wɔn ayɛ wɔn mma no taa nya suban ho haw ne ɔhaw wɔ sukuu mu. Nea ɛne eyi bɔ abira no, nhwehwɛmu koro no ara kyerɛe sɛ wobu awofo a wɔfa wɔn sɛ wɔn mma no yiye, a ɛkame ayɛ sɛ 90% kaa wɔn ho asɛm sɛ &quot;wɔn anigye, wonya mfaso, na wonni pɛsɛmenkominya&quot;.[149]

Nnipa dodow no ara ka sɛ wɔn nsɛm titiriw a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho no fi nnamfo ne abusuafo ne nsɛm ho amanneɛbɔfo hɔ. Ne nyinaa mu no, nnipa dodow no ara bɔ amanneɛ sɛ nsɛm ho amanneɛbɔ ma wonya adwene pa wɔ mmofra a wɔfa wɔn sɛ wɔn mma ho; 72% kyerɛe sɛ wɔanya nsusuwii pa.[150] Nanso, wɔda so ara wɔ ɔkasatia kɛse wɔ nsɛm ho amanneɛbɔfo a wɔka fa mmofra a wɔfa wɔn sɛ wɔn mma ho no ho. Sɛ nhwɛso no, blog ahorow bi a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho no kasa tiaa Meet the Robinsons sɛ wɔde nyisaa atrae mfonini ahorow a ne bere atwam di dwuma[151][152] sɛnea The Evan B. Donaldson Adoption Institute a ɛnyɛ nea wɔde hwehwɛ mfaso a ɛkamfo kyerɛ no yɛe no.

Wɔma animtiaabu a ɛbata mmofra a wɔfa wɔn sɛ wɔn mma ho no yɛ kɛse ma mmofra a wɔwɔ mmofra a wɔhwɛ wɔn sɛ wɔn mma no.[154] Nsusuwii bɔne de gyidi a ɛne sɛ mmofra a wɔte saa no haw araa ma ɛrentumi nyɛ yiye sɛ wobegye wɔn atom na wɔayɛ mmusua a &quot;ɛyɛ daa&quot;.[155] Amanneɛbɔ bi a efi Pew Commission on Children in Foster Care hɔ wɔ afe 2004 mu no ada no adi sɛ mmofra dodow a wɔretwɛn wɔ mmofra a wɔhwɛ wɔn so no abu abɔ ho abien fi 1980 mfe no mu na mprempren ɛda so ara yɛ nea ɛkɔ so yɛ pɛ bɛyɛ ɔpepem fã afe biara.&quot;[156]

Attitude toward Adoption Questionnaire (ATAQ):[157] saa nsɛmmisa yi, Abdollahzadeh, Chaloyi ne Mahmoudi na wɔdii kan yɛɛ ho adwuma(2019).[158] Nkyekyɛm a Edi Kan: Saa nsɛmmisa kratasin yi wɔ nneɛma 23 a egyina Likert nsenia a ɛyɛ 1 (Mempene so koraa) so, kosi 5 (Mepene so koraa) a wonya bere a wɔasiesie nneɛma a wɔayɛ sɛ wɔde bɛyɛ mprempren adwinnade no ne adesua biara adesua no akyi. Adeɛ mu nhwehwɛmu ne adwene mu nhwehwɛmu a ɛdi kan no kyerɛ sɛ nneɛma mmienu na ɛwɔ mu. Wɔdane nneɛma 3-10-11-12-14-15-16-17-19-20-21 no na wɔde nkaeɛ no ahyɛ mu sɛ ɛyɛ papa. Nea efii nhwehwɛmu mu nneɛma nhwehwɛmu a nneɛma atitiriw a ɛwɔ varimax rotation mu bae no kyerɛe sɛ wɔbɔɔ afã abien a ɛfa suban a ɛfa agyede ho no din sɛnea ɛte biara no sɛ adwene mu afã horow ne suban-nkate afã horow a ɛfa suban a ɛfa agyede ho. Saa nneɛma mmienu yi kyerɛkyerɛɛ 43.25% mu wɔ nsonsonoeɛ a ɛwɔ nhwɛsoɔ no nyinaa mu. Wɔde Cronbach alpha coefficient dii dwuma de susuw ahotoso a ɛwɔ nsɛmmisa kratasin no mu. Cronbach alpha coefficient yɛ 0.709 wɔ nsɛmmisa kratasin no nyinaa mu, 0.71 wɔ ade a edi kan no mu, ne 0.713 wɔ nea ɛto so abien no ho. Bio nso, na abusuabɔ pa a ɛho hia wɔ asetra mu su horow a wɔpɛ ne adwene mu afã a ɛfa adwene a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho ne suban -nkate mu afã horow a ɛwɔ adwene a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho no ntam (P ≤ 0.01).

== Ɔsesɛw ne nkabom a ɛrekɔ so ==
Nneyɛe a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma no asesa kɛse wɔ afeha a ɛto so 20 no mu, na wɔafrɛ kuw foforo biara din, wɔ ɔkwan bi so, sɛ nsakrae.[159] Efi 1970 mfe no mu no, mmɔden a wɔbɔe sɛ wɔbɛma mmofra a wɔfa wɔn sɛ wɔn mma no atu mpɔn no bɛyɛɛ nea ɛfa kyerɛwtohɔ ahorow a wobebue ne abusua a wɔbɛkora wɔn so ho nkuranhyɛ ho. Saa nsusuwii ahorow yi fi nyansahyɛ ahorow a ɛkyerɛ sɛ kokoamsɛm a ɛwɔ nnɛyi agyede mu no betumi anya ɔkwan a wɔfa so hyehyɛ nipasu no so nkɛntɛnso,[160][161] ama adwene atu afra wɔ abusua anato ho,[162] na ɛmma kakraa bi wɔ aduruyɛ ho abakɔsɛm kwan so.

Abusua a wɔbɛkora wɔn so: Bere a nsɛm a ɛfa mmara a wɔmfa nni dwuma ho no fii ase kɔɔ fam wɔ 1970 mfe no mfiase no, asetra mu yiyedi ahyehyɛde ahorow fii ase sii so dua sɛ, sɛ ɛbɛyɛ yiye a, ɛsɛ sɛ wɔma ɛnanom ne mmofra bom. Wɔ U.S. no, wɔdaa eyi adi pefee denam nsakrae a ɛbaa nhyehyɛe mu wɔ New York Foundling Home, ahyehyɛde a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma a ɛka ɔman no mu nea akyɛ sen biara ho na ɛyɛɛ kyerɛwtohɔ ahorow a wɔasɔ ano akwampaefo no mu. Ɛde nnyinasosɛm foforo abiɛsa a nea ɛka ho ne &quot;sɛ wobesiw mmofra a wɔde wɔn bɛto afiase...&quot;, a ɛda gyidi a ɛne sɛ mmofra bɛsom wɔn yiye denam wɔn mmusua a wɔwoo wɔn no nkyɛn a wɔbɛtra so no adi, nsakrae a ɛyɛ nwonwa wɔ nhyehyɛe mu a ɛda so ara yɛ adwuma nnɛ. Bio nso, akuw te sɛ Origins USA (a wɔde sii hɔ wɔ 1997 mu) fii ase kaa abusua a wɔbɛkora so ne ɛnanom hokwan ahorow ho asɛm denneennen.[165] Nancy Verrier nhoma The Primal Wound a wotintimii no nyaa ɔsesɛw akuw ahorow yi adwene mu nne so nkɛntɛnso. Wɔka &quot;Primal wound&quot; ho asɛm sɛ &quot;ɔsɛe a akokoaa no te nka esiane sɛ ɔtetew ne ho fi ne maame a ɔwoo no no ho nti. Ɛyɛ atenka a emu dɔ na efi mu ba a ɛne sɛ wɔagyaw no a akokoaa a wɔagye no ayɛ ne ba no te nka bere a wɔafa no ayɛ ne ba no akyi na ebetumi akɔ so wɔ ne nkwa nna nyinaa mu.&quot; &quot;[160] .&quot;

Kyerɛwtohɔ ahorow a wɔabue: Bere a wɔagye obi a wɔagye no ayɛ ne ba wɔ mmara kwan so akyi wɔ United States no, wɔtaa yɛ nsakrae wɔ awo ho adansedi krataa a edi kan no mu na wɔde awo ho adansedi krataa foforo si ananmu. Wɔde awofo biara a wɔwoo abofra no din a wɔakyerɛw wɔ awo ho adansedi krataa a edi kan no so no, wɔde awofo a wɔfaa no sɛ wɔn ba no din si adansedi krataa a wɔayɛ mu nsakrae no ananmu, na ɛma ɛyɛ te sɛ nea awofo a wɔfaa no sɛ wɔn ba no na wɔwoo abofra no. Efi 1930 mfe no awiei na ɛkɔɔ so kosi 1970 mfe no mu no, ɔman mmara maa kwan sɛ wɔbɛsɔ awo ho adansedi nkrataa a edi kan no ano bere a wɔafa no sɛ wɔn ba akyi, na gye sɛ aman bi mu no, ɛmaa awo ho adansedi krataa a edi kan no antumi annye onipa a wɔagye no ayɛ ne ba no bere a wadi mfe pii mpo no ] .

Nnipa a wɔagye wɔn ayɛ wɔn mma no fi bere tenten abɔ mmɔden sɛ wobeyi mmara ahorow yi afi hɔ sɛnea ɛbɛyɛ a wobetumi anya wɔn ankasa awo ho adansedi krataa a edi kan. Nneɛma a wɔyɛe sɛ wobeyi awo ho adansedi nkrataa a edi kan ne mmofra a wɔagye wɔn ayɛ wɔn mma no ho kyerɛwtohɔ afoforo a wɔayɛ ama wɔn no dɔɔso wɔ 1970 mfe no mu a wogye toom kɛse sɛ wɔmfa mmara mma wɔn mma no. Wɔ United States no, Jean Paton hyehyɛɛ Orphan Voyage wɔ afe 1954 mu, na Florence Fisher hyehyɛɛ Adoptees' Liberty Movement Association (ALMA) wɔ afe 1971 mu, na ɔfrɛɛ kyerɛwtohɔ ahorow a wɔasɔ ano no &quot;ade a wɔsɛe nnipa nidi&quot;.[168] Bere a wɔ afe 1975 mu no, Emma May Vilardi yɛɛ kyerɛwtohɔ a edi kan a wɔn nyinaa pene so, Amanaman Ntam Soundex Reunion Registry (ISRR), a ɛmaa wɔn a wɔfaa wɔn sɛ wɔn mma no atetew wɔn ho no tumi huu wɔn ho wɔn ho. na Lee Campbell ne awofo afoforo hyehyɛɛ CUB (Concerned United Birthparents). Na nsusuwii a ɛte saa ara renya nkɔso wɔ wiase nyinaa wɔ ahyehyɛde ahorow a ɛwɔ fam te sɛ Parent Finders a ɛwɔ Canada ne Jigsaw a ɛwɔ Australia no mu. Wɔ afe 1975 mu no, England ne Wales buee kyerɛwtohɔ ahorow a egyina abrabɔ pa so.[170]

Eduu 1979 no, ahyehyɛde ahorow 32 ananmusifo a wofi aman 33 mu, Canada ne Mexico, hyiaam wɔ Washington, DC, sɛ wɔrebɛtew Amerika Awofo Bagua (AAC) a wɔde adwene koro toom sɛ: “Bue Kyerɛwtohɔ ahorow a nsɛm a ɛkyerɛ sɛ wobehu mmofra a wɔfa wɔn sɛ wɔn mma no mufo nyinaa awie, . awofo, awofo a wɔfa wɔn sɛ wɔn ba ne nea wɔfa no sɛ ne ba wɔ mfe a nea wɔagye no ayɛ ne ba no adi (18 anaa 19, a egyina ɔman no so) anaasɛ ansa na ɛreba no sɛ nnipa baasa no mufo nyinaa pene so a.&quot;[171] Mfe a edi hɔ no huu ahyehyɛde ahorow a ɛyɛ akofo pii te sɛ Bastard Nation (a wɔde sii hɔ) no dannan wɔ 1996 mu), akuw a wɔboaa ma wobuu kyerɛwtohɔ ahorow a wɔasɔ ano wɔ Alabama, Delaware, New Hampshire, Oregon, Tennessee, ne Maine.[172][173] New York ne ɔman no mu nnipa a wɔhwehwɛ hokwan ahorow a wɔde gye wɔn ayɛ wɔn mma no nkabom bi yɛɛ adwuma yiye de buu mmara bi a adi mfe 83 a ɛyɛ anohyeto no mu wɔ afe 2019 mu, na nnipa a wɔanyinyin a wɔagye wɔn ayɛ wɔn mma a wɔwoo wɔn wɔ New York, ne wɔn asefo nso, nnɛ wɔ hokwan sɛ wɔbisa na wonya wɔn ankasa de awo ho adansedi nkrataa a edi kan.[174][175] Ɛde besi afe 2021 no, aman du a ɛwɔ United States no gye hokwan a nnipa a wɔanyinyin a wɔagye wɔn ayɛ wɔn mma no wɔ sɛ wonya wɔn ankasa awo ho adansedi krataa a edi kan, a Alabama, Alaska, Colorado, Connecticut, Kansas, Maine, New Hampshire, New York, Oregon ne Rhode Island ka ho. 176] na. Connecticut wɔ afe 2021 mu no bɛyɛɛ ɔman a ɛtɔ so du a ɛsan de hokwan a obi a wɔagye no ayɛ ne ba no wɔ sɛ ɔbisa na ɔnya wɔn awoɔ ho adansedie nkrataa a ɛdi kan no baeɛ.[177][178 

'''Nkabom a wɔsan hyia'''

Akontaabu ahorow a ɛfa baabi a wɔn a wɔagye wɔn ayɛ wɔn mma no suban a wɔhwehwɛ nneɛma mu kodu no ada adi sɛ ɛyɛ nea wontumi nhu; nhwehwɛmu ahorow kyerɛ sɛ nsakrae kɛse wɔ hɔ.[179] Ɔfã bi no, ɔhaw no fi nnipa kakraa bi a wɔagye wɔn ayɛ wɔn mma a ɛma nhwehwɛmu a wɔyɛ no kwa no yɛ den, sɛ ɛnyɛ nea ɛrentumi nyɛ yiye mpo a.

Ne nyinaa mu no, wobetumi anya nneɛma bi a ɛkyerɛ sɛnea wɔn a wɔagye wɔn ayɛ wɔn mma no ani gye ho sɛ wɔbɛhwehwɛ nneɛma mu no afi England ne Wales asɛm a ebuee wɔn a wɔagye wɔn ayɛ wɔn mma no awo ho kyerɛwtohɔ ahorow mu wɔ 1975. U.K. Office for National Statistics no ahyɛ ho nkɔm sɛ awiei koraa no, wɔn a wɔagye wɔn ayɛ wɔn mma no nyinaa mu 33% bɛsrɛ sɛ wɔmfa bi mma wɔn wɔn awo ho kyerɛwtohɔ a edi kan no mu, a ɛboro mfitiase nkɔmhyɛ ahorow a wɔkae wɔ 1975 mu bere a na wogye di sɛ nnipa dodow a wɔagye wɔn ayɛ wɔn mma no mu kakraa bi pɛ na wɔbɛbisa wɔn kyerɛwtohɔ no so no. Nanso, wonim sɛ nsusuwii no bu nhwehwɛmu dodow ankasa no adewa, efisɛ nnipa pii a wɔagye wɔn ayɛ wɔn mma wɔ saa bere no mu no nam akwan foforo so nya wɔn awo ho kyerɛwtohɔ.[180]

Nhwehwɛmu nhoma ahorow no ka sɛ wɔn a wɔagye wɔn ayɛ wɔn mma no de nneɛma anan a enti wɔpɛ sɛ wɔsan hyiam ma: 1) wɔpɛ sɛ wonya abusua anato a edi mũ kɛse, 2) wɔpɛ sɛ wohu nsɛm a esisi a ɛde wɔn nyinsɛn, awo, ne wɔn a wogyae mu no, 3) wɔwɔ anidaso sɛ wɔde nsɛm bɛma wɔn mma , ne 4) wohia abɔde a nkwa wom ho nsɛm a ɛkɔ akyiri, a aduruyɛ ho nsɛm ka ho. Nanso, nhwehwɛmufo a wɔyɛ mmofra a wɔfa wɔn sɛ wɔn mma no susuw sɛ ntease ahorow a wɔde ama no nni mũ: ɛwom sɛ obi a ɔto so abiɛsa betumi de nsɛm a ɛte saa ama de, nanso nsɛm a wobisabisaa wɔn a wɔagye wɔn ayɛ wɔn mma, a wɔhwehwɛɛ sɛ wɔbɛsan ahyiam no, hui sɛ wɔdaa hia a ehia sɛ wodi abɔde mu abusuabɔ ho dwuma ankasa adi.

Ɛte sɛ nea ɔpɛ a ɛwɔ hɔ sɛ wɔbɛsan ahyiam no ne nea wɔagye no ayɛ ne ba no nkitahodi ne ɔmanfo a wogye tom wɔ mpɔtam hɔ no wɔ abusuabɔ. Nsusuwii ahorow a wɔde wɔn adwene si wɔn mu so kyerɛ sɛ wɔn a wɔagye wɔn ayɛ wɔn mma no binom wɔ nsɛm a emu nna hɔ wɔ wɔn ho a wɔte nka no mu, na ɛma wotumi de nipasu a ɛkɔ so daa kyerɛ no sɛe. Reunion boa ma wosiesie ne ho nimdeɛ a wonni no.[182]

Nea ɛne eyi bɔ abira no, nsusuwii ahorow a wɔde wɔn adwene si akyi no kyerɛ sɛ wɔn a wɔagye wɔn ayɛ wɔn mma no fa so di asetra mu animtiaabu so. Goffman na odii kan de nsusuwii no too gua, na ɛwɔ afã anan: 1) wɔn a wɔagye wɔn ayɛ wɔn mma no hu sɛ abɔde mu abusuabɔ a enni hɔ no kyerɛ nsonsonoe a ɛda wɔn abusua a wɔagye wɔn ayɛ wɔn mma no ntam wɔ afoforo ho, 2) osuahu ahorow a wɔn a wɔnnye wɔn mma no kyerɛ sɛ abusuabɔ a wɔde gye wɔn ayɛ wɔn mma no yɛ mmerɛw sen mogya mu abusuabɔ no hyɛ ntease yi mu den, ) sɛ wɔka bom a, saa nneɛma yi ma, wɔ wɔn a wɔagye wɔn ayɛ wɔn mma no binom mu no, wɔte nka sɛ wɔayi wɔn afi asetra mu, na 4) saa wɔn a wɔagye wɔn ayɛ wɔn mma yi yɛ wɔn ade denam mogya a wɔde kyekyere wɔn ho a wɔhwehwɛ a ɛhyɛ wɔn a wɔyɛ ɔmanfo no mu den no so. Ntease a ɛfa akyi a wɔde wɔn adwene si so wɔ sanba ho no kyerɛ sɛ ebia wɔn a wɔagye wɔn ayɛ wɔn mma no bɛyɛ nsakrae yiye na wɔwɔ anigye wɔ wɔn mmusua a wɔagye wɔn ayɛ wɔn mma no mu, nanso wɔbɛhwehwɛ sɛ mmɔden a wɔbɔ sɛ wobesiesie osuahu ahorow a ɛfa asetra mu animtiaabu ho.[181]

Wɔn a wɔagye wɔn ayɛ wɔn mma no bi pow adwene a ɛne sɛ wɔbɛsan ahyiam no. Nanso, nea ɛma ɛsono wɔn a wɔagye wɔn ayɛ wɔn mma a wɔhwehwɛ wɔn no ne wɔn a wɔnhwehwɛ no mu no mu nna hɔ. Krataa biako bɔ nhwehwɛmu no mua, na ɛka sɛ, &quot;...mmɔden a wɔbɔ sɛ wɔbɛma nsonsonoe aba nea ɔhwehwɛ ne nea ɔnyɛ nhwehwɛmu no ntam no nyɛ nea ɛyɛ nea ɛyɛ nokware anaasɛ ɛyɛ nea wotumi de di dwuma wɔ ɔkwan a ɛkɔ akyiri so sen mmɔden a wɔbɔ sɛ wɔbɛkyerɛ ... nsonsonoe a ɛda wɔn a wɔagye wɔn ayɛ wɔn mma ne wɔn a wɔamfa wɔn ayɛ wɔn mma ntam.&quot;[183]

Sɛ yɛbɛka no tiawa a, nhyiam a wɔsan hyia no betumi de nsɛm ahorow aba wɔn a wɔagye wɔn ayɛ wɔn mma ne awofo so. Ne nyinaa mu no, ɛte sɛ nea nea efi mu ba a wɔsan hyiam no mu dodow no ara yɛ nea eye. Wɔ nhwehwɛmu kɛse a wɔayɛ de besi nnɛ (a egyina mmuae a nnipa 1,007 a wɔafa wɔn ayɛ wɔn mma ne awofo a wogyaee no de mae so) 90% buae sɛ sankɔhwɛ yɛ osuahu a mfaso wɔ so. Nanso, eyi nkyerɛ sɛ wɔhyehyɛɛ abusuabɔ a ɛkɔ so wɔ nea wɔagye no ayɛ ne ba ne ɔwofo ntam anaasɛ eyi ne botae no.[184]

'''Nneyɛe a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho a akyinnyegye wom'''

Hwɛ nso: Nsisi a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho

Wɔde mmɔden a wɔbɔ sɛ wɔbɛyɛ nsakrae ne abusua a wɔbɛkora wɔn so no nso abata sɛnea wosusuw sɛ wɔde mmofra a wɔfa wɔn sɛ wɔn mma no di dwuma ɔkwammɔne so no ho denneennen. Wɔ tebea horow bi mu no, wɔagyae awofo hokwan ahorow bere a ɔmanfo abu wɔn mmusuakuw anaa wɔn asetra mu sikasɛm kuw no sɛ wɔmfata no. Ná nnipa pii gye nneyɛe yi bi tom na

== Amammerɛ mu nsakrae ahorow ==

== Da a Wɔde Kɔ Fie ==</text>
      <sha1>rf40ftsrrr4xsz5ou7v28rzj1d1jg4a</sha1>
    </revision>
    <revision>
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      <timestamp>2022-07-31T12:15:43Z</timestamp>
      <contributor>
        <username>Afriyie34</username>
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      <comment>Me de atwerɛ ka ho</comment>
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      <text bytes="67615" xml:space="preserve">Mmofra a wɔfa wɔn sɛ wɔn mma yɛ adeyɛ a obi fa no sɛ ɔfoforo, mpɛn pii no abofra, awofoyɛ no fi saa onipa no ɔwofo anaa n’awofo a ɔwoo no ankasa anaa mmara kwan so no hɔ. Mmara kwan so mmofra a wɔfa wɔn sɛ wɔn mma no de hokwan ne asɛyɛde ahorow nyinaa, ne ayɔnkofa ho, fi awofo a wɔwoo wɔn no hɔ kɔ awofo a wɔfa wɔn sɛ wɔn mma no so daa.

Nea ɛnte sɛ awɛmfo anaa nhyehyɛe afoforo a wɔayɛ ama mmerante ne mmabaa a wɔbɛhwɛ wɔn no, atirimpɔw ne sɛ wɔbɛma mmofra a wɔfa wɔn sɛ wɔn mma no ayɛ nsakrae a ɛbɛtra hɔ daa wɔ wɔn gyinabea mu na sɛnea ɛte no, ɛhwehwɛ sɛ ɔmanfo gye tom, denam mmara anaa nyamesom mu asotwe so. Abakɔsɛm mu no, fekuw ahorow bi ahyɛ mmara pɔtee bi a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho, bere a afoforo de akwan horow a ɛnyɛ mmara kwan so de dii dwuma (titiriw apam ahorow a ɛkyerɛ agyapade hokwan ahorow ne awofo asɛyɛde ahorow a wɔmfa wɔn a wɔde wɔn ho hyɛ mu foforo nka ho). Nnɛyi nhyehyɛe ahorow a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho, a ɛsɔree wɔ afeha a ɛto so 20 yi mu no taa yɛ nea mmara ne nhyehyɛe ahorow a edi mũ na edi so. 

== Abakɔsɛm ==
'''Tete nneɛma'''

'''Agyede a wogye ma wɔn a wɔawo wɔn yiye'''

Bere a nnɛyi kwan a wɔfa so gye wɔn ba no puei wɔ United States no, adeyɛ no akwan horow puei wɔ abakɔsɛm nyinaa mu.[1] Sɛ nhwɛso no, Hammurabi Mmara no ka hokwan ahorow a wɔn a wɔagye wɔn ayɛ wɔn mma no wɔ ne ankorankoro a wɔagye wɔn ayɛ wɔn mma no asɛyɛde ahorow ho asɛm kɔ akyiri. Wɔakyerɛw adeyɛ a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma wɔ tete Roma no ho asɛm yiye wɔ Codex Justinianus mu.[2][3]

Ɛsono koraa wɔ nnɛyi bere no ho no, tete nneyɛe a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho no si amammui ne sikasɛm mu anigyede a ɛfa nea ɔfaa no ba no ho so dua,[4] na ɛde mmara kwan so adwinnade bi a ɛhyɛɛ amammui mu abusuabɔ a ɛda mmusua a wɔwɔ sika ntam no mu den na ɛmaa mmarima adedifo a wɔhwɛ agyapade so mae. Wɔakyerɛw sɛnea adehye no de di dwuma sɛ wɔn mma no ho asɛm yiye: na Roma ahempɔn no mu pii yɛ mmabarima a wɔafa wɔn ayɛ wɔn mma.[6] Ná adrogation yɛ Romafo a wɔfa wɔn sɛ wɔn mma no bi a onipa a wɔfa no sɛ ne ba no pene so sɛ ɔfoforo begye no ayɛ ne ba.

Ɛte sɛ nea nkokoaa a wɔfa wɔn sɛ wɔn mma wɔ Tete mmere mu no ntaa mma.[4][7] Na wɔtaa fa mmofra a wɔagyaw wɔn hɔ no ma wɔyɛ nkoa[8] na na wɔyɛ Ahemman no nkoa a wɔde ma no ɔha biara mu nkyem kɛse.[9][10] Romafo mmara mu kyerɛwtohɔ ahorow kyerɛ sɛ ɛtɔ mmere bi a na mmusua fa mmofra a wɔahu wɔn no na wɔtete wɔn sɛ ɔbabarima anaa ɔbabea. Ɛwom sɛ wɔtaa mfa wɔn mma wɔ Roma Mmara ase de, nanso wɔtetee mmofra no a wɔfrɛ wɔn alumni no wɔ nhyehyɛe bi a ɛte sɛ ɔhwɛfo mu, na wobuu wɔn sɛ agya a ogyaw wɔn hɔ no agyapade.[11]

Tete anibuei afoforo, titiriw India ne China, de ɔkwan bi a wɔfa so gye wɔn ba nso dii dwuma. Adanse kyerɛ sɛ na adeyɛ yi botae ne sɛ ɛbɛma amammerɛ ne nyamesom nneyɛe akɔ so; nea ɛne Atɔe Famfo adwene a ɛne sɛ wɔbɛtrɛw abusua ahorow mu no bɔ abira. Wɔ tete India no, ɔbabarimayɛ a ɛto so abien, a Rigveda kasa tia no pefee no,[12] kɔɔ so, wɔ ɔkwan a anohyeto wom na ɛyɛ amanne kɛse so, sɛnea ɛbɛyɛ a obi a ɔfa ne ba no betumi anya ayiyɛ ho amanne a ɛho hia a ɔbabarima bɛyɛ. China wɔ adwene a ɛte saa ara a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma a mmarima a wɔfa wɔn sɛ wɔnyɛ wɔn mma sɛ wɔmfa nyɛ nananom som nnwuma nkutoo ho.[14]

Ná adeyɛ a ɛne sɛ wobegye abusua mufo ne nnamfo paa mma ayɛ wɔn mma no abu so wɔ Polynesia amammerɛ ahorow mu a Hawaii a na wɔfrɛ amanne no sɛ hānai ka ho.

'''Mfinimfini mmere kosi nnɛyi bere so'''

Adoption ne nnipa mpapahwekwa

Germanfo, Celtfo, ne Slavfo amammerɛ a na ɛwɔ Europa so wɔ Roma Ahemman no asehwe akyi no anuonyamfo no kasa tiaa adeyɛ a ɛne sɛ wɔfa wɔn sɛ wɔn mma no.[15] Wɔ mfinimfini mmere mu ɔmanfo mu no, na mogya ahorow na ɛho hia sen biara; wɔde ahemman a edi tumi a na onni ɔdedifo a ɛda adi sɛ &quot;wɔwoo no wɔ abɔde mu&quot; no sii ananmu, na ɛne Romafo atetesɛm ahorow bɔ abira koraa. Europa mmara a ɛdannan no da saa akyide a wɔmpɛ sɛ wɔfa wɔn sɛ wɔn mma no adi. Sɛ nhwɛso no, Engiresifo mmara a wɔtaa de di dwuma no amma kwan mma wɔmfa obi mma efisɛ na ɛne agyapade ho mmara a wɔtaa de di dwuma no bɔ abira. Wɔ saa kwan koro no ara so no, France Napoleon Mmara no maa ɛyɛ den sɛ wobegye mmofra ayɛ wɔn ba, na ɛhwehwɛɛ sɛ wɔn a wɔfa no sɛ wɔn ba no di boro mfe 50, wonni mma, anyɛ yiye koraa no, wɔn mfe 15 sen nea wɔagye no ayɛ wɔn ba no, na anyɛ yiye koraa no, wɔatete nea wɔagye no ayɛ wɔn ba no mfe asia. Nanso, mmofra a wɔfa wɔn sɛ wɔn mma no bi kɔɔ so bae, nanso ɛbɛyɛɛ nea ɛnyɛ ɔkwan biara so, a egyina apam ahorow a wɔyɛe bere tiaa bi so. Sɛ nhwɛso no, wɔ afe 737 mu no, wɔ mmara bi a efi Lucca kurow mu mu no, wɔyɛɛ nnipa baasa a wɔagye wɔn ayɛ wɔn mma no agyapade bi adedifo. Te sɛ nhyehyɛe afoforo a ɛwɔ hɔ nnɛ no, apam no sii asɛyɛde a ɛda nea wɔagye no ayɛ ne ba no so dua sen sɛ obegye ne ba no, na ɛtwee adwene sii nokwasɛm a ɛyɛ sɛ, wɔ apam no ase no, na wɔayɛ sɛ wɔbɛhwɛ agya a ɔfaa no ayɛ ne ba no wɔ ne nkwakoraabere mu no so; adwene a ɛte sɛ nsusuwii ahorow a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho wɔ Roma mmara ase no.[17]

Europa amammerɛ mu nsakrae no hyɛɛ bere a wɔyɛɛ nneɛma foforo a ɛho hia a wɔde gye toom no agyirae. Esiane sɛ wɔamfa mmoa a efi atitiriw no hɔ nti, adeyɛ no dan kɔɔ mmofra a wɔagyaw wɔn hɔ no so nkakrankakra. Nnipa a wogyaw wɔn hɔ no kɔɔ soro bere a ahemman no hwee ase no na wogyaw mmofra a wohuu wɔn no pii wɔ Asɔre no pon ano.[18] Mfiase no, asɔfo no yɛɛ wɔn ade denam mmara a wɔhyehyɛe de kyerɛ sɛnea wɔbɛpa mmofra a wɔagyaw wɔn hɔ no ho ntama, atɔn, na wɔatete wɔn no so. Nanso, ade foforo a Asɔre no yɛe ne afɔrebɔ ho adeyɛ, a ɛnam so hyira mmofra so sɛ wɔnyɛ asɔremma asetra wɔ nkokorafie ahyehyɛde ahorow mu na wɔtete wɔn wɔ nkokorafie bi mu. Eyi na ɛde nhyehyɛe a edi kan wɔ Europa abakɔsɛm mu a mmofra a wɔagyaw wɔn hɔ no nni mmara, asetra, anaa abrabɔ mu ɔhaw ahorow. Ne saa nti, Europa mmofra a wɔagyaw wɔn hɔ na wɔayɛ nyisaa no mu pii bɛyɛɛ Asɔre no sukuufo dedaw, na ɛno nso faa dwuma sɛ obi a ɔhwɛ wɔn sɛ wɔn mma. Oblation hyɛ nsakrae a ɛkɔ ahyehyɛde ahorow mu no mfiase agyirae, na awiei koraa no ɛde ayaresabea a wɔde sii hɔ ne nyisaa atrae no sii hɔ.[18]

Bere a adwene a ɛfa ahyehyɛde mu hwɛ ho no nyaa adwene no, mmara a wɔahyɛ da ahyɛ da puei wɔ sɛnea wɔde mmofra bɛto mmusua mu: mmarimaa betumi abɛyɛ obi a osua adwumfo na mmeawa betumi aware wɔ ahyehyɛde no tumi ase. Asoɛe ahorow gyee mmofra nso sɛ wɔn mma wɔ ɔkwan a ɛnyɛ ɔhyɛ so, adwinnade a wɔfaa no sɛ ɔkwan a wɔfa so nya adwumayɛfo a wɔn bo nyɛ den, a nokwasɛm a ɛyɛ sɛ bere a wɔn a wɔagye wɔn ayɛ wɔn mma no wuwu no, abusua no de wɔn afunu san kɔ asoɛe no mu ma wosie no da no adi.

Saa nhyehyɛe a ɛfa adesua ne mmofra a wɔfa wɔn sɛ wɔn mma wɔ ɔkwan a ɛnyɛ ɔkwan pa so ho yi trɛw kɔɔ afeha a ɛto so 19 no mu, a nnɛ wobu no sɛ nsakrae fã ma mmofra a wɔfa wɔn sɛ wɔn mma ho abakɔsɛm. Wɔ asetra mu yiyedi ho adwumayɛfo akwankyerɛ ase no, nyisaa guankɔbea ahorow fii ase hyɛɛ mmofra a wogyina nkate so a wɔfa wɔn sɛ wɔn mma no ho nkuran sen sɛ wɔbɛyɛ adwuma; wɔde mmofra too apam ahorow a wɔde bɛhwɛ wɔn sɛ abusua mufo ase sen sɛ wɔde bɛto apam ahorow a ɛfa adesua ho ase.[21] Wogye di sɛ saa nhwɛso yi nkɔso no na ɛmaa Massachusetts Amanaman Nkabom no hyehyɛɛ nnɛyi mmara a edi kan a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho wɔ 1851 mu, a ɛyɛ soronko wɔ sɛnea ɛhyehyɛɛ adwene a ɛne sɛ &quot;abofra no yiyedi yiye&quot; no. Nanso, ɛmfa ho ne atirimpɔw no, wɔ nneyɛe mu no, nhyehyɛe no yɛɛ adwuma te sɛ honam a edi kan no. Boston Female Asylum (BFA) no suahunu yɛ nhwɛsoɔ pa, a na ɛwɔ ne soboɔ no mu bɛyɛ 30% a wɔagye atom wɔ afe 1888 mu.[24] BFA mpanyimfo kae sɛ, ɛwom sɛ guankɔbea no hyɛɛ ho nkuran sɛ ɛnte saa de, nanso awofo a wɔfa wɔn sɛ wɔn mma no ankyerɛ nsonsonoe a ɛda indenture ne mmofra a wɔfa wɔn sɛ wɔn mma no ntam: &quot;Yegye di,&quot; guankɔbea mpanyimfo no kae sɛ, &quot;sɛ mpɛn pii no, sɛ wɔfa mmofra a wonnii mfe pii sɛ wɔmfa wɔn mma a,... agyede yɛ din foforo a wɔde frɛ ɔsom ara kwa.&quot;[25]

'''Nnɛyi bere'''

Fapem a wɔde bɛbɔ abusua

Nneɛma a edi hɔ a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho no dannan wɔn ho no hwee United States man a na ɛrenya nkɔso no nsam. Atubrafo a wɔbae ntɛmntɛm ne Amerika Ɔmanko no maa nyisaa atrae ne mmofra a wɔahu wɔn afie dɔɔso dodo wɔ afeha a ɛto so dunkron no mfinimfini a ebi mmae da. Charles Loring Brace a na ɔyɛ Protestantfo ɔsomfo no ho dwiriw no wɔ waiffo dɔm a wonni afie a na wɔrekyinkyin New York Kuropɔn no mmɔnten so no ho. Brace buu mmerante ne mmabaa a wɔagyaw wɔn hɔ, titiriw Katolekfo, sɛ wɔyɛ ade a ɛyɛ hu sen biara a ɛrekasa atia kurow no nhyehyɛe.[26][27]

Wɔkaa n’ano aduru ho asɛm wɔ The Best Method of Disposing of Our Pauper and Vagrant Children (1859) a efii Nyisaa Keteke kuw no ase no mu. Awiei koraa no, keteke ahorow a ɛyɛ nyisaa no de mmofra bɛyɛ 200,000 fii Apuei Fam nkurow akɛse mu kɔɔ ɔman no nkuraase.[28] Mpɛn pii no, na wɔde mmofra no ahyɛ mmusua a wɔde wɔn kɔ mu no nsa, sen sɛ wɔbɛfa wɔn ayɛ wɔn mma.[29] Sɛnea na ɛte wɔ mmere a atwam no mu no, na wɔtete mmofra binom sɛ abusua no mufo bere a na afoforo nso yɛ mfuw mu adwumayɛfo ne afie mu asomfo. Nnipa a wɔatu wɔn afi wɔn afie mu no kɛse koraa—mmofra a wotu kɔtra mmeae foforo sen biara wɔ abakɔsɛm mu—ne sɛnea wɔde wɔn dii dwuma ɔkwammɔne so a ɛkɔɔ so no maa wɔhyehyɛɛ nnwumakuw foforo ne mmara ahorow a ɛhyɛɛ nhyehyɛe ahorow a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho nkuran sen sɛ wɔde wɔn ho bɛma. Bere no agyiraehyɛde ne Minnesota mmara a ɛfa mmofra a wɔfaa wɔn mma ho wɔ 1917 mu, a ɛhyɛɛ sɛ wɔnyɛ nhwehwɛmu wɔ mmeae a wɔde wɔn kɔe nyinaa ho na wɔmma wɔn a wɔde wɔn ho hyɛɛ mmofra a wɔfaa wɔn no mu no nnya kyerɛwtohɔ pii.[30][31]

Wɔ saa bere koro no ara mu no, Progressive kuw no faa United States a na botae titiriw ne sɛ ɛbɛma nyisaa atrae nhyehyɛe a na ɛwɔ hɔ no aba awiei. Mmɔdenbɔ a ɛte saa no awiei bae wɔ White House Nhyiam a Edi Kan a Ɛfa Mmofra a Wɔde Wɔn Ho To Wɔn So Hwɛ Ho a Ɔmampanyin Theodore Roosevelt frɛɛ no ​​wɔ 1909 mu,[32] faako a wɔkae sɛ nuklea abusua no gyina hɔ ma &quot;anibuei ade a ɛkorɔn na eye sen biara&quot; na eye sen biara no a otumi som sɛ ɔhwɛfo titiriw ma wɔn a wɔagyaw wɔn hɔ ne wɔn a wɔayɛ nyisaa.[33][34] Wɔ 1923 mu tɔnn no, na mmofra a wɔn awofo nhwɛ wɔn no mu ɔha biara mu abien pɛ na na wɔwɔ afie a wɔhwɛ wɔn sɛ wɔn mma mu, na nea aka no wɔ nhyehyɛe a wɔde hwɛ mmofra ne nyisaa atrae. Annu mfe aduanan akyi no, na ɛkame ayɛ sɛ nkyem abiɛsa mu biako wɔ afie a wɔhwɛ wɔn sɛ wɔn mma mu.[35]

Ne nyinaa mu no, eugenic adwene a agye din wɔ Amerika no de akwanside ahorow bae wɔ mmofra a wɔfa wɔn sɛ wɔn mma no nkɔso mu.[36][37] Na nneɛma a ɛhaw adwene kɛse wɔ mmofra a wɔnyɛ mmara ne ahiafo awosu mu su pa ho, a ebia nea ɛyɛ nhwɛso yiye ne Henry H. Goddard nkyerɛwee a ɛwɔ nkɛntɛnso a ɔkasa tiaa mmofra a wonnim faako a wogye wɔn sɛ wɔn mma no, na ɔkae sɛ, .

Afei ɛba sɛ nnipa binom ani gye adesamma abusua no yiyedi ne nkɔso a ɛkorɔn ho; nanso sɛ yɛde saa nnipa soronko no to nkyɛn a, agyanom ne ɛnanom nyinaa ani gye wɔn ankasa mmusua yiyedi ho. Ade a awofo koma ani gye ho paa ne sɛ wɔbɛma mmofra no aware yiye na wɔatete abusua a ɛkorɔn. Hwɛ sɛnea ɛyɛ adwene tiawa saa bere no sɛ abusua a ɛte saa begye abofra bi a wonnim n’abusua mu abusua koraa no akɔ ne mfinimfini; anaasɛ, baabi a, sɛ wonim no fã bi a, nea ebetumi aba no mu yɛ den sɛ ɛbɛkyerɛ mmoa a wɔyɛ ahiafo na wɔyare, na sɛ ɛsɛ sɛ aware bi kɔ so wɔ saa onipa no ne abusua no muni biara ntam a, asefo no asɛe.

Bere a efi 1945 kosi 1974, nkokoaa a wɔde wɔn gu mu bere no, huu nkɔso ntɛmntɛm na wogyee sɛ wɔfa wɔn sɛ wɔn mma sɛ ɔkwan a wɔfa so kyekye abusua.[39] Awo a mmara mma ho kwan kɔɔ soro mprɛnsa wɔ Wiase Ko II akyi, bere a nna ho nneyɛe sesae no. Bere koro no ara mu no, nyansahufo kuw no fii ase sii so dua sɛ ntetee di awosu so tumi, na wɔde eugenic animtiaabu no fii hɔ.[40][41] Wɔ saa tebea yi mu no, mmofra a wɔfa wɔn sɛ wɔn mma no bɛyɛɛ ano aduru a ɛda adi pefee maa nnipa a wɔnwaree ne awarefo a wontumi nwo nyinaa.[42]

Sɛ wɔka saa nneɛma yi bom a, ɛma wonya Amerikafo nhwɛso foforo a wɔde begye atom. Wɔ Romafo a edii n’anim no akyi no, Amerikafo twaa hokwan ahorow a awofo a wodi kan no wɔ mu bere a wɔmaa wɔn a wɔfa wɔn sɛ wɔn mma no yɛɛ awofo foforo wɔ mmara no ani so no. Wɔde nneɛma foforo abien kaa ho: 1) na atirimpɔw ne sɛ wɔbɛfa mmofra ayɛ wɔn mma sɛ wɔbɛhwɛ ma &quot;abofra no yiyedi a eye sen biara&quot;, wobetumi ahu saa adwene yi aba no afi Amerikafo mmara a edi kan a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho wɔ Massachusetts no mu,[16][23] ne 2) mmofra a wɔfa wɔn sɛ wɔn mma no bɛyɛɛ nea wɔde hyɛɛ mu a ɛyɛ kokoamsɛm, na awiei koraa no ɛmaa wɔsɔɔ mmofra a wɔfaa wɔn sɛ wɔn mma ne awo ho kyerɛwtohɔ ahorow a edi kan no ano wɔ 1945. Charles Loring Brace a ɔde bae sɛnea ɛbɛyɛ a mmofra a wofi Nyisaa Keteke ahorow no mu no rensan nkɔ wɔn awofo nkyɛn anaasɛ wɔbɛsan agye wɔn no mfiase no. Ná Brace suro nkɛntɛnso a awofo no ohia, wɔ ɔkwan a ɛkɔ akyiri so, ne Katolek som titiriw, benya wɔ mmabun no so. Saa atetesɛm a ɛfa kokoamsɛm ho yi, akyiri yi Nkɔsofo nsakraefo no na wɔkɔɔ so bere a wɔreyɛ Amerika mmara ahorow no.[43]

Nnipa dodow a wɔfaa wɔn mma wɔ United States no kɔɔ soro sen biara wɔ 1970 mu.[44] Ɛnyɛ nea wobetumi ahu nea ɛde ɔhwe a edii akyi bae no bae. Nneɛma a ɛbɛyɛ sɛ ɛde bae wɔ 1960 ne 1970 mfe no mu no bi ne awo dodow a ɛso tew, a ɛne aduru no a wɔde bae no wɔ abusuabɔ, akwan a wɔfa so siw awo ano a wɔde ayɛ adwuma a wɔde ahyɛ mmara ase a wɔawie, ɔman no sika a wɔde maa abusua nhyehyɛe ho adwuma a wɔde bɛma mmerante ne mmabaa ne wɔn a wɔba fam no - sika a wonya, ne nyinsɛn a wotu gu ho mmara kwan so. Bio nso, mfeɛ a ɛwɔ 1960 mfeɛ no awieeɛ ne 1970 mfeɛ no mfitiaseɛ no hunuu nsakraeɛ kɛseɛ wɔ ɔmanfoɔ adwene wɔ mmara kwan so ne mmara kwan so hokwan[45] a wɔn a wɔwoo wɔn wɔ awareɛ akyi wɔ no mu. Nea ɛbɛyɛ na wɔabua no, mmɔden a wɔbɔe sɛ wɔbɛkora abusua so no nyaa nkɔanim[46] ma enti mmofra kakraa bi na wɔwo wɔn wɔ aware akyi nnɛ na wɔfa wɔn sɛ wɔn mma. Anwonwasɛm ne sɛ, mmofra a wɔfa wɔn sɛ wɔn mma no da adi kɛse koraa na wɔka ho asɛm wɔ ɔmanfo mu nnɛ, nanso ɛnyɛ nea abu so kɛse.[47]

Awiei koraa no, Amerikafo nhwɛso a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho no dɔɔso wɔ wiase nyinaa. England ne Wales de wɔn mmara a edi kan a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho sii hɔ wɔ 1926. Netherlands too ne mmara wɔ 1956. Sweden maa wɔn a wɔagye wɔn ayɛ wɔn mma no yɛɛ abusua no mufo koraa wɔ 1959. West Germany hyɛɛ ne mmara a edi kan wɔ 1977 mu. Bio nso, Asia tumi ahorow no buee wɔn nyisaa atrae nhyehyɛe ahorow no maa wɔfaa wɔn mma, a Atɔe Famfo adwene a edii atubrafo nniso ne asraafo tumidi akyi nyaa so nkɛntɛnso sɛnea na ɛte no.[49] Wɔ France no, ɔman ahyehyɛde ahorow a ɛwɔ mpɔtam hɔ no ma wɔn a wɔpɛ sɛ wɔfa wɔn sɛ wɔn mma no tom, na afei wobetumi ne nyisaa atrae ahorow a ɛwɔ amannɔne adi nkitaho anaasɛ wɔabisa mmoa afi NGO ahorow hɔ. Nhyehyɛe no mfa sikatua ho, na mmom ɛma tumi kɛse ma asetra mu adwumayɛfo a wɔn gyinaesi ahorow betumi asiw mmofra a wɔfa wɔn sɛ wɔn mma no ano hye wɔ mmusua a &quot;ɛwɔ gyinapɛn&quot; mu (mfinimfini mfe, sika a wonya fi mfinimfini kosi kɛse, mmarima a wɔne wɔn ho da, Caucasianfo).[50]

Wɔyɛ mmofra a wɔfa wɔn sɛ wɔn mma no ho dwuma nnɛ wɔ wiase nyinaa. Nsɛm a ɛwɔ ase ha no de Atɔe Famfo dodow a wɔfa wɔn sɛ wɔn mma no ho mfonini ntɛm ara ma. Mmofra a wɔfa wɔn sɛ wɔn mma wɔ United States no da so ara kɔ so wɔ dodow a ɛreyɛ adu n’atipɛnfo de no mmɔho abiɛsa ɛwom mpo sɛ mmofra dodow a wɔretwɛn sɛ wobegye wɔn ayɛ wɔn mma no akɔ so ayɛ nea ɛkɔ so daa wɔ nnansa yi mfe mu, efi 100,000 kosi 125,000 wɔ bere a efi 2009 kosi 2018 no mu

== Nnɛyi mmofra a wɔfa wɔn sɛ wɔn mma ==
'''Akwan horow a wɔfa so gye wɔn ba'''

Nnɛyi nneyɛe a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho no betumi abue anaasɛ wɔato mu.

Awofo a wɔfa wɔn sɛ wɔn mma ne wɔn a wɔwoo wɔn no ma wotumi hu nsɛm a wɔde di nkitaho wɔ abusuafo ne nea wɔagye no ayɛ wɔn ba no ntam.[70] Awofo a wɔfa wɔn sɛ wɔn mma a wɔn nkutoo na wɔhwɛ abofra no so no betumi ayɛ nhyehyɛe a ɛnyɛ ɔkwan biara so. Wɔ tumidi ahorow bi mu no, awofo a wɔwoo wɔn ne wɔn a wɔagye wɔn ayɛ wɔn mma no betumi ayɛ apam a mmara ma ho kwan na ɛkyekyere wɔn a ɛfa nsrahwɛ, nsɛm a wɔde bɛsesa, anaa nkitahodi foforo a ɛfa abofra no ho.[71] Ɛde besi February 2009 no, U.S. aman 24 maa kwan sɛ wɔde apam ahorow a wɔabue ano a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho apam ahorow a mmara ma ho kwan no kaa mmofra a wɔfa wɔn sɛ wɔn mma no ho nhyehyɛe a etwa to no ho.[72]

Adeyɛ a ɛne sɛ wɔfa wɔn sɛ wɔn mma a wɔato mu (a wɔsan frɛ no kokoam anaasɛ kokoam mmofra a wɔfa wɔn sɛ wɔn mma),[73] a ɛnyɛ nea wɔtaa yɛ wɔ nnɛyi abakɔsɛm fã kɛse no ara mu no,[74] hyɛ nsɛm a ɛma wohu obi nyinaa ano, ɛkora so sɛ ɛyɛ kokoam na esiw awofo a wɔagye wɔn ayɛ wɔn mma no a wɔbɛda no adi no ano’, biological kin’s, ne wɔn a wɔagye wɔn ayɛ wɔn mma no ho nsɛm. Ne nyinaa mu no, agyede a wɔato mu no betumi ama wɔatumi de nsɛm a ɛnyɛ nea ɛkyerɛ sɛ obi yɛ te sɛ aduruyɛ ho abakɔsɛm ne nyamesom ne mmusuakuw a wofi mu akɔma afoforo.[75] Ɛnnɛ, esiane guankɔbea ahobammɔ ho mmara a U.S. aman bi ahyɛ mu nti, kokoam mmofra a wɔfa wɔn sɛ wɔn mma no renya nkɛntɛnso foforo. Wɔ aman a wɔfrɛ no &quot;dan a ahobammɔ wom&quot; mu no, wobetumi agyaw nkokoaa a wɔmmɔ wɔn din wɔ ayaresabea ahorow, odumgyafo adwumayɛbea ahorow, anaa polisifo adwumayɛbea ahorow mu wɔ nna kakraa bi akyi wɔ awo akyi, adeyɛ a ahyehyɛde ahorow bi a wɔkamfo mmofra a wɔfa wɔn sɛ wɔn mma no kasa tia sɛ ɛyɛ nea ɛkɔ akyi na asiane wom.

Sɛnea mmofra a wɔfa wɔn sɛ wɔn mma no fi ase


Mmofra a wɔfa wɔn sɛ wɔn mma no betumi aba wɔ nnipa a wɔyɛ abusuafo anaa wɔn a wɔnyɛ abusuafo ntam. Wɔ abakɔsɛm mu no, na mmofra a wɔfa wɔn sɛ wɔn mma dodow no ara kɔ so wɔ abusua bi mu. Nsɛm a aba nnansa yi ara a efi U.S. kyerɛ sɛ mprempren nnipa a wɔfa wɔn sɛ wɔn mma no mu bɛyɛ fã yɛ nnipa a wɔyɛ abusuafo ntam.[77] Eyi ho nhwɛso a wɔtaa de di dwuma ne &quot;ɔwofo a wɔyɛ mpena a wɔfa wɔn sɛ wɔn mma&quot;, baabi a ɔwofo hokafo foforo no fa abofra bi fi ɔwofo no abusuabɔ a atwam no mu wɔ mmara kwan so. Abusua mu mmofra a wɔfa wɔn sɛ wɔn mma nso betumi aba denam ahofama so, esiane awofo wu nti, anaasɛ bere a wontumi nhwɛ abofra no wɔ ɔkwan foforo so na abusua no muni bi pene so sɛ obegye adwuma no.

Ɛnyɛ bere nyinaa na mmofra a wofi wɔn pɛ mu yɛ ade a wofi wɔn pɛ mu yɛ. Wɔ aman bi mu, sɛ nhwɛso no, wɔ U.K. no, ade titiriw biako a ɛma mmofra a wɔde wɔn to hɔ sɛ wɔmfa wɔn mma no ne sɛ wɔayi wɔn afi baabi a wɔwoo wɔn no, mpɛn pii no aban ahyehyɛde bi te sɛ mpɔtam hɔ atumfoɔ. Nneɛma ahorow bi wɔ hɔ a enti woyi mmofra fi hɔ a ayayade ne anibiannaso ka ho, a ebetumi anya nkɛntɛnso a ɛtra hɔ daa wɔ nea wɔagye no ayɛ ne ba no so. Wɔbɛbɔ asetra mu adwumayɛfo amanneɛ wɔ nsɛm pii mu wɔ ahobammɔ ho asɛm bi a ɛfa abofra bi ho ho na wɔabisabisa abofra no yiyedi ho nsɛm. Mpɛn pii no, asetra mu nsɛm ho adwumayɛfo bɛhwehwɛ akwan a wɔbɛfa so ama abofra bi ne abusua a wɔwoo no no abom, sɛ nhwɛso no, denam mmoa foforo a wɔde bɛma abusua no ansa na wɔasusuw ho sɛ wobeyi abofra bi afi hɔ no so. Afei asɛnnibea bɛtaa asi gyinae ahorow afa abofra no daakye ho, sɛ nhwɛso no, sɛ ebia wobetumi asan akɔ abusua a wɔwoo wɔn no mu, akɔhwɛ mmofra a wɔhwɛ wɔn anaasɛ wɔafa wɔn ayɛ wɔn mma.

Awo a wontumi nwo ne ade titiriw nti a awofo hwehwɛ sɛ wobegye mmofra a wɔne wɔn nni abusuafo no ayɛ wɔn mma. Nhwehwɛmu bi kyerɛ sɛ eyi na ɛmaa nkokoaa a wɔfaa wɔn sɛ wɔn mma a wɔnyɛ abusuabɔ no 80% ne wɔn a wɔfaa wɔn sɛ wɔn mma denam mmofra a wɔhwɛ wɔn so no fã.[78] Akontaabu kyerɛ sɛ Amerikafoɔ a wɔntumi nnyinsɛn anaa wɔmfa nkɔsi wɔn mma no mu 11–24% bɔ mmɔden sɛ wɔbɛkyekyere abusua denam mmofra a wɔbɛfa wɔn ayɛ wɔn mma so, na sɛ Amerikafoɔ mmaa a wɔaware daa a wɔfa wɔn mma no nyinaa dodoɔ bɛyɛ 1.4%.[79][80] Nneɛma afoforo a ɛma nkurɔfo gye tom no dɔɔso ɛwom sɛ wɔankyerɛw ho asɛm yiye de. Ebia eyinom bi ne sɛ wɔbɛpɛ sɛ wɔhyɛ abusua foforo mu den wɔ awaregyae anaa ɔwofo biako wu akyi, ayamhyehye a nyamesom anaa nyansapɛ mu gyidi na ɛkanyan wɔn, na wɔakwati sɛ wɔbɛboa ma nnipa adɔɔso dodo esiane gyidi a ɛne sɛ ɛyɛ asɛyɛde kɛse sɛ wɔbɛhwɛ mmofra a anka awofo nni mu sen sɛ wɔbɛwo nti , de hwɛ hu sɛ wɔremfa nyarewa a wonya fi awo mu (e.g., Tay–Sachs yare) mma obi, ne akwahosan ho haw ahorow a ɛfa nyinsɛn ne awo ho. Ɛwom sɛ nneɛma ahorow bi wɔ hɔ de, nanso nhwehwɛmu a wɔayɛ nnansa yi ara a ɛfa mmea a wɔfa wɔn mma no suahu ahorow ho no kyerɛ sɛ ɛda adi kɛse sɛ wɔadi mfe 40–44, wɔaware mprempren, awo a wontumi nwo, na wonni mma.[81]

Fa akwan horow a edidi so yi so betumi aba mmofra a wɔfa wɔn sɛ wɔn mma a ɛne wɔn ho wɔn ho nni abusuabɔ:

Ankorankoro fie mmofra a wɔfa wɔn sɛ wɔn mma: wɔ nhyehyɛe yi ase no, adɔe akuw ne ahyehyɛde ahorow a wɔhwehwɛ mfaso yɛ adwuma sɛ ntamgyinafo, na wɔka wɔn a wɔpɛ sɛ wɔfa abofra no bom ne mmusua a wɔpɛ sɛ wɔde abofra bi to hɔ, na afã horow no nyinaa yɛ ɔman koro mufo. Sɛnea ɛbɛyɛ foforo no, ɛtɔ mmere bi a wɔn a wɔpɛ sɛ wɔfa wɔn mma no kwati ntamgyinafo na wɔne mmea di nkitaho tẽẽ, na mpɛn pii no wɔde apam a wɔakyerɛw; wɔmma eyi ho kwan wɔ tumidi ahorow bi mu. Ankorankoro fie mmofra a wɔfa wɔn sɛ wɔn mma no yɛ mmofra a wɔfa wɔn sɛ wɔn mma nyinaa mu fã kɛse; sɛ nhwɛso no, wɔ United States no, wobu akontaa sɛ ɛkame ayɛ sɛ wɔyɛ mmofra a wɔfa wɔn sɛ wɔn mma no mu 45% ho nhyehyɛe wɔ kokoam.[82]

Foster care adoption: eyi yɛ ofie adoption bi a mfiase no wɔde abofra bi to ɔmanfo hwɛ mu. Mpɛn pii no, awofo a wɔhwɛ mmofra no gye wɔn sɛ wɔn mma no bere a mmofra no nya ahofadi wɔ mmara kwan so no. Ɛsono sɛnea ɛho hia sɛ ɔkwan a wɔfa so gye wɔn mma no wɔ ɔman biara mu. Wɔ 127,500 a wɔfaa wɔn sɛ wɔn mma wɔ U.S. wɔ afe 2000 mu no,[82] bɛyɛ 51,000 anaa 40% nam mmofra a wɔhwɛ wɔn so nhyehyɛe so.[83]

Amanaman ntam mmofra a wɔfa wɔn sɛ wɔn mma: eyi fa abofra bi a wɔde bɛto ɔman a wɔwoo saa abofra no akyi ma wɔagye no ayɛ ne ba ho. Eyi betumi aba denam ɔman anaa ankorankoro nnwumakuw so. Wɔ aman bi te sɛ Sweden mu no, saa mmofra a wɔfa wɔn sɛ wɔn mma yi na ɛma wonya nsɛm no mu dodow no ara (hwɛ atifi hɔ pon no). Nanso, U.S. nhwɛso no kyerɛ sɛ nsonsonoe kɛse wɔ ɔman biara mu efisɛ mmofra a wɔfa wɔn sɛ wɔn mma fi amannɔne no nnu ne nsɛm no mu 15%.[82] Russiafo mmofra bɛboro 60,000 na wɔagye wɔn ayɛ wɔn mma wɔ United States fi 1992,[84] na wɔfaa Chinafo mmofra dodow a ɛte saa ara sɛ wɔn mma fi 1995 kosi 2005.[85] Aman ahorow mmara gu ahorow wɔ ɔpɛ a wɔwɔ sɛ wɔbɛma kwan ma amanaman ntam agyede no mu. Esiane sɛ Hague Nhyiam a ɛfa Ankorankoro Amanaman Ntam Mmara ho no huu nsɛnnennen ne nsɛnnennen a ɛbata amanaman ntam agyede ho, ne mmɔden a wɔbɔe sɛ wɔbɛbɔ wɔn a wɔde wɔn ho ahyɛ mu no ho ban afi adifudepɛ ne nneɛma a wɔde di dwuma ɔkwammɔne so a ɛtɔ mmere bi a ɛka ho no ho nti, wɔyɛɛ Hague Mmofra a Wɔfa Wɔn Ba no Apam, a efii ase yɛɛ adwuma wɔ May 1, 1995 na aman 85 agye atom de besi November 2011.[86]

Nkwaboaa a wɔfa wɔn sɛ wɔn mma: egyina nkwaboaa a aka a wɔde ma bere a wɔawie awarefo biako aduruyɛ a wɔde nyinsɛn ba wɔ afiri mu no so; wɔde nkwaboaa ma ankorankoro anaa awarefo foforo, na ɛno akyi no wɔde saa nkwaboaa no gu ɔbea a wɔde no ma no no awotwaa mu, na ama nyinsɛn ne awo ayɛ mmerɛw. Wɔ United States no, agyapade ho mmara na ɛkyerɛ mma nkwaboaa a wɔfa wɔn sɛ wɔn mma sen sɛ asɛnnibea nhyehyɛe ahorow na ɛkyerɛ kwan, a ɛne atetesɛm mu mmofra a wɔfa wɔn sɛ wɔn mma no bɔ abira.

Common law adoption: eyi yɛ adoption a asɛnnibea ahorow no nni kan nnye ntom, nanso ɔwofo bi, a ɔmfa ne ho nhyɛ mmara kwan so nhyehyɛe biara mu, gyaw ne mma ma n’adamfo anaa obusuani bi bere tenten ][88] na ɛwɔ hɔ. Sɛ wɔde bere bi a wɔahyɛ ato hɔ a ɛne sɛ wɔbɛtra (a wofi wɔn pɛ mu) bɛtra mu no awiei, sɛnea ɔmanfo di ho adanse no, afei wobu abofra no sɛ ɛyɛ nea ɛhyɛ obi so, wɔ asennibea ahorow bi mu, ɛwom mpo sɛ mfiase no asɛnnibea no amma ho kwan de. Mmara kwan so tumidi biara na ɛkyerɛkyerɛ nsɛm pɔtee a ɛfa mmara kwan so agyede ho. Sɛ nhwɛso no, U.S. mantam California gye mmara kwan so abusuabɔ tom bere a wɔabom atra mfe 2 akyi no. Wɔfrɛ adeyɛ no &quot;private fostering&quot; wɔ Britain.[89]

'''Nneɛma a wɔsɛe no ne nea wɔtetew mu'''

Asɛm titiriw: Nneɛma a wɔsɛe no (fa a wɔfa wɔn sɛ wɔn mma) .

Ɛwom sɛ wɔtaa ka mmofra a wɔfa wɔn sɛ wɔn mma no ho asɛm sɛ ɛyɛ abusua &quot;daa&quot; de, nanso wobetumi de abusuabɔ no aba awiei bere biara. Wɔfrɛ mmara kwan so a wogyae mmofra a wɔfa wɔn sɛ wɔn mma no sɛ ɔhaw. Wɔ U.S. nsɛmfua mu no, sɛ wogyae mmofra a wɔfa wɔn sɛ wɔn mma no ansa na wɔawie a, wɔsɛe wɔn, na sɛ wogyae abusuabɔ no wɔ ɛno akyi a, wogyae. Wobetumi afrɛ no nso sɛ mmofra a wɔfa wɔn sɛ wɔn mma a entumi nyɛ yiye. Bere a wɔawie mmara kwan so a, mpɛn pii no awofo a wɔagye wɔn ayɛ wɔn mma no nam asɛnnibea adesrɛ so na efi ɔhaw no ase na ɛne awaregyae ho nsɛm di nsɛ. Ɛyɛ mmara kwan a ɛyɛ soronko ma awofo a wɔagye wɔn ayɛ wɔn mma efisɛ ɔhaw/nsɛe no mfa abusuafo a wɔwoo wɔn ho, ɛwom sɛ ɛtɔ mmere bi a wɔpow abusua mufo a wɔwo wɔn anaasɛ wogyaw wɔn hɔ de.[90]

Nanso, nhwehwɛmu ahorow a wɔyɛe wɔ bere tiaa bi mu a wɔyɛe wɔ U.S. no kyerɛ sɛ mmofra yiyedi nhyehyɛe no so a wɔfa wɔn sɛ wɔn mma no ɔha biara mu nkyem 10 kosi 25 (sɛ nhwɛso no, nkokoaa a wɔagye wɔn ayɛ wɔn mma a wofi aman afoforo so anaa awofo a wɔyɛ mpena a wogye wɔn mpena mma no nka ho) sɛe ansa na wɔawie wɔ mmara kwan so na efi 1 mu kosi ɔha biara mu nkyem 10 no, wogu bere a wɔawie mmara kwan so no. Gyinapɛn ahorow pii no da nsɛm a ɛfa asɛm no ho ne nnipa dodow te sɛ mfe a wɔadi ho nsɛm kakraa bi na ɛwɔ hɔ adi; wonim sɛ mmabun taa nya wɔn mma a wɔfa wɔn sɛ wɔn mma no mu ɔhaw sen mmofra nkumaa.[90]

Awarefo a wɔne wɔn ho da a wɔfa wɔn sɛ wɔn mma

Mmara kwan so awarefo a wɔne wɔn ho da a wɔbɛbom agye wɔn ayɛ wɔn mma wɔ aman 34 so de besi March 2022, ne nea ɛka ho no wɔ aman nketewa ahorow mu. Awarefo a wɔne wɔn ho da no nso betumi ayɛ mma a wɔfa wɔn sɛ wɔn mma (aman 6 foforo), a ɔhokafo biako a ɔwɔ ɔbarima ne ɔbea nna mu no gye ɔfoforo no ba. Aman dodow no ara a wɔwɔ bɔbeasu koro aware no ma kwan ma saa awarefo no bom gye wɔn mma, nea ɛka ho ne Ecuador (awarefo a wɔne wɔn ho da nnye wɔn mma), Taiwan (awarefo a wɔyɛ mma nkutoo) ne Mexico (wɔ amantam a mmarima ne mmea aware wom no nkyem abiɛsa mu biako mu ). Aman kakraa bi a wɔwɔ ɔmanfo nkabom anaasɛ aware hokwan kakraa bi no nyinaa ma kwan ma wɔfa anammɔn anaa wɔbom yɛ mmofra

== Wɔn a wɔagye wɔn ayɛ wɔn mma no awofoyɛ ==
'''Awofoyɛ'''

Awosu mu abusuabɔ a ɛda ɔwofo ne abofra ntam no ho hia, na wɔn baanu a wɔatew wɔn ho no ama wɔahaw wɔ mmofra a wɔfa wɔn sɛ wɔn mma ho. Atetesɛm mu adwene a ɛfa awofo a wɔfa wɔn sɛ wɔn mma ho no nyaa mmoa a wonya fii Princeton Sukuupɔn nhwehwɛmu bi a wɔyɛe wɔ mmusua 6,000 a wɔfaa wɔn mma, wɔyɛ wɔn mma, na wɔhwɛ wɔn wɔ United States ne South Africa fi 1968 kosi 1985 no hɔ; nhwehwɛmu no kyerɛe sɛ aduan a wɔsɛe no wɔ afie a ɛnanom a wɔn mma a wɔnyɛ awofo wom (bere a wɔhwɛ sika a wonya, ofie dodow, nnɔnhwerew a wɔde yɛ adwuma, mfe a wɔadi, ne nea ɛkeka ho so) no sua koraa ma wɔn a wɔafa wɔn ayɛ wɔn mma, mmanoma mma, ne mmofra a wɔagye wɔn ayɛ wɔn mma, na ɛmaa nhwehwɛmufo no yɛɛ saa kyerɛ sɛ nkurɔfo ani nnye ho kɛse sɛ wɔbɛma afoforo awosu mu nkwaadɔm no atra hɔ.[91] Wɔfoa saa nsusuwii yi so wɔ nhwehwɛmu foforo a ɛfa su ho kɛse a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma a wɔde wɔn ho hyɛ wɔn a wɔpɛ wɔn asɛm, wɔn nipasu, ne wɔn honam ani hwɛbea koro no ara agyirae no, ne wɔn a wɔanyinyin a wɔagye wɔn ayɛ wɔn mma no nyinaa wɔ abusuabɔ ne awofo a wɔagye wɔn ayɛ wɔn mma no bɔ amanneɛ sɛ wɔn ani agye kɛse wɔ mmofra a wɔfa wɔn sɛ wɔn mma no ho.

Nhwehwɛmu afoforo de adanse ma sɛ abusuabɔ a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma no betumi ayɛ nea ɛfata wɔ akwan foforo so. Nhwehwɛmu bi a ɛhwehwɛ sɛnea awofo de wɔn sika hyɛ mu no kyerɛ ahoɔden wɔ mmusua a wɔfa wɔn mma no mu, na ɛkyerɛ sɛ awofo a wɔfa wɔn mma no de bere pii hyɛ wɔn mma mu sen awofo afoforo, na ɛde ba awiei sɛ &quot;...awofo a wɔfa wɔn mma no ma wɔn mma asetra yɛ yiye de tua abusuabɔ a enni awosu mu no ho ka ne the extra challenges of adoption.&quot;[93] Nhwehwɛmu foforo a wɔyɛe nnansa yi kyerɛe sɛ mmusua a wɔfa wɔn mma no de sika kɛse hyɛ wɔn mma a wɔagye wɔn ayɛ wɔn mma no mu, sɛ nhwɛso no, denam nhomasua foforo ne sika fam mmoa a wɔde ma so. Bere a ɛhyɛ no nsow sɛ ɛte sɛ nea wɔn a wɔagye wɔn ayɛ wɔn mma no taa hyia ɔhaw ahorow te sɛ nnubɔne a wɔde di dwuma no, nhwehwɛmu no susuwii sɛ ebia awofo a wɔfa wɔn sɛ wɔn mma no de wɔn sika pii bɛto wɔn a wɔagye wɔn ayɛ wɔn mma no mu ɛnyɛ sɛ wɔpɛ wɔn asɛm nti, na mmom esiane sɛ ɛda adi sɛ wohia mmoa no sen mmofra a wɔwɔ awosu mu nneɛma nti.[94]

Adwene ne nneyɛe ho animdefo hui a ɛfa hia a ɛna ne nkokoaa ntam abusuabɔ ho hia no ho no maa ɛhaw adwene bi sɛ ebia awofo a wogye nkokoaa a wɔanyinyin anaa mmofra a wɔretu mmirika wɔ awo akyi no ayera bere titiriw bi a ɛbɛma abofra no anyin anaa. Nanso, nhwehwɛmu a wɔyɛe wɔ The Mental and Social Life of Babies ho no kyerɛe sɛ &quot;ɔwofo ne nkokoaa nhyehyɛe&quot;, sen sɛ ɛbɛyɛ abusuabɔ a ɛda ankorankoro a wɔne wɔn ho wɔn ho wɔ abusuabɔ ntam no, yɛ ade a ɛdannan a ɛda nnipa nkokoaa nyinaa awosu mu nneyɛe ne mmuae a nnipa a wɔanyinyin de yɛ wɔn ade a ɛkɔ so pɛpɛɛpɛ wɔ ho no ntam saa nkokoaa nneyɛe no. Enti abɔde &quot;hwɛ ma wɔyɛ nsakrae bi a edi kan wɔ obu ma mpanyimfo pɔtee a wogye awofo dwumadi no ho.&quot;[95]

Wɔ nsɛmpɔw atitiriw no akyi no, nsemmisa soronko a wobisa awofo a wɔfa wɔn sɛ wɔn mma no gu ahorow. Nea ɛka ho ne sɛnea wobebua nsusuwii hunu, nsɛmmisa a ɛfa agyapade ho a wobebua, ne ɔkwan a eye sen biara a wɔbɛfa so ne abusuafo a wɔwoo wɔn no anya abusuabɔ bere a wɔwɔ mmofra a wɔabue wɔn mma no mu.[96] Ɔkyerɛwfo biako kyerɛ sɛ asɛmmisa a awofo a wɔfa wɔn sɛ wɔn mma no taa nya ne sɛ: &quot;So yɛbɛdɔ abofra no ɛwom mpo sɛ ɔnyɛ yɛn ba a ɔwoo no no?&quot;[97] Ade pɔtee a ɛhaw awofo pii ne sɛ wɔbɛma obi a wɔagye no ayɛ ne ba no atra sukuu dan mu. Asuade ahorow a wonim te sɛ &quot;twe w'abusua dua&quot; anaa &quot;fa w'awofo ne wo nananom so hwehwɛ w'ani kɔla akyi kɔhwɛ baabi a w'awosu fi&quot; betumi apira mmofra a wɔfaa wɔn sɛ wɔn mma na wonnim saa abɔde mu nsɛm yi. Wɔde nyansahyɛ ahorow pii ama sɛ wɔde besi adesua foforo ananmu, s.e., wɔde wɔn adwene asi &quot;abusua nnuaba turo&quot; so.[99]

Mmofra a wɔanyinyin a wɔfa wɔn sɛ wɔn mma no de awofoyɛ ho nsɛm afoforo ba.[100] Mmofra binom a wofi mmofra a wɔhwɛ wɔn so no wɔ abakɔsɛm a ɛfa ayayade ho, te sɛ honam ne adwene mu anibiannaso, honam fam ayayade, ne nna mu ayayade, na wɔwɔ asiane mu sɛ wobenya adwenemyare ho haw ahorow.[101][102] Mmofra a wɔte saa no wɔ asiane mu sɛ wobenya abusuabɔ a ɛnyɛ nhyehyɛe.[103][104][105] Nhwehwɛmu ahorow a Cicchetti ne afoforo yɛe no. (1990, 1995) hunuu sɛ nkokoaa a wɔyɛɛ wɔn ayayadeɛ na wɔyɛɛ wɔn ayayadeɛ wɔ wɔn nhwɛsoɔ no mu 80% daa abatadeɛ akwan a ɛnyɛ nhyehyɛeɛ adi.[106][107] Bata a wɔanhyehyɛ no ne nkɔso ho haw ahorow bi wɔ abusuabɔ, a nea ɛka ho ne sɛnkyerɛnne ahorow a ɛma obi fi ne ho fi afoforo ho,[108] ne adwenemhaw, dadwen, ne adeyɛ ho sɛnkyerɛnne ahorow.[109][110] &quot;Attachment yɛ adeyɛ a ɛyɛ nnam—ebetumi ayɛ nea ahobammɔ wom anaasɛ enni ahobammɔ, ɛnyɛ nea ɛfata anaasɛ ɛsow aba. Eyi yɛ sikasɛm a ɛnyɛ nokware efisɛ mpɔtam hɔ atumfoɔ hwɛ a wɔhwɛ mmofra yi bo yɛ den yiye.[112]

Ɛdefa nkɔso mu nneɛma atitiriw ho no, nhwehwɛmu ahorow a efi Colorado Adoption Project no mu no hwehwɛɛ awosu mu nkɛntɛnso a ɛwɔ wɔn a wɔagye wɔn ayɛ wɔn mma no onyin so no mu, na ɛde baa awiei sɛ wɔn a wɔagye wɔn ayɛ wɔn mma no adwene tumi da wɔn awofo a wɔfaa wɔn mma no de adi wɔ mmofraase nanso ɛnkyerɛ sɛ ɛne wɔn ho wɔn ho di nsɛ kɛse wɔ mmerantebere ne mmabaabere mu, na ɛte sɛ wɔn awofo a wɔwoo wɔn no de mmom na ɛte sɛ nea ɛte saa ara baabi a ɛkɔ akyiri sɛ atipɛnfo wɔ mmusua a wɔmfa wɔn mma wɔn mma mu.[113]

Ɛte sɛ nea akwan a ɛte saa ara reyɛ adwuma wɔ wɔn a wɔagye wɔn ayɛ wɔn mma no honam fam nkɔso mu. Denmarkfo ne Amerikafo nhwehwɛmufo a wɔreyɛ nhwehwɛmu ahorow a ɛfa awosu mu mmoa a ɛma nipadua no yɛ kɛse ho no huu abusuabɔ a ɛda obi a wɔagye no ayɛ ne ba no mu duru ne n’awofo a wɔwoo no no BMI ntam bere a wɔanhu abusuabɔ biara a ɛda abusua a wɔagye no ayɛ ne ba no ntam no. Bio nso, nsonsonoe a ɛda ankorankoro ntam no bɛyɛ fã fi ankorankoro nkɛntɛnso ahorow a wɔnkyɛ mu.[114][115]

Ɛte sɛ nea nsonsonoe ahorow a ɛwɔ nkɔso mu yi di agoru wɔ ɔkwan a mmerante ne mmabaa a wɔagye wɔn ayɛ wɔn mma no fa so di asetra mu nsɛm atitiriw ho dwuma no mu. Wɔ awofo awaregyae ho no, wɔahu sɛ ɛsono sɛnea wɔn a wɔagye wɔn ayɛ wɔn mma no yɛ wɔn ade wɔ mmofra a wɔannye wɔn mma no ho. Bere a nnipa dodow no ara nyaa suban ho haw pii, nnuru a wɔde di dwuma, sukuu mu nkɔso a ɛba fam, ne asetra mu ahoɔden a asɛe wɔ awofo awaregyae akyi no, ɛte sɛ nea nnipa dodow a wɔagye wɔn ayɛ wɔn mma no annya nkɛntɛnso biara wɔ wɔn abɔnten abusuabɔ ho, titiriw wɔ wɔn sukuu anaa asetra mu tumi mu.

'''Nkɛntɛnso a enya wɔ awofo a wodii kan bae no so'''

Nneɛma pii na ɛka gyinae a wosi sɛ wobegyae abofra no anaasɛ wɔbɛtete no no. Mmabun a wɔyɛ aborɔfo taa de wɔn nkokoaa ma wɔn a wɔnyɛ abusuafo, bere a mmabun a wɔyɛ abibifo taa nya mmoa fi wɔn ankasa mpɔtam hɔfo hɔ wɔ abofra no ntetee mu ne ɔkwan a abusuafo fa so gye wɔn sɛ wɔn mma wɔ ɔkwan a ɛnyɛ ɔhyɛ so nso so. Nhwehwɛmu a Leynes ne Festinger ne Young, Berkman, ne Rehr yɛe no kyerɛe sɛ, wɔ mmabun a wɔyem fam no, gyinae a wosi sɛ wobegyae abofra no ma wagye no ayɛ ne ba no gyina adwene a ɔbabun no maame wɔ wɔ mmofra a wɔfa no sɛ wɔn ba ho no so.[118] Nhwehwɛmu foforo nso kyerɛe sɛ mmabun a wɔyem a wɔn maamenom asua nhoma a ɛkɔ akyiri no taa gyae wɔn mma ma wɔfa wɔn sɛ wɔn mma. Nhwehwɛmu kyerɛ sɛ mmea a wɔpaw sɛ wobegyae wɔn mma ma wɔafa wɔn ayɛ wɔn mma no taa yɛ nkumaa, wɔakyerɛw wɔn din wɔ sukuu mu, na wɔatra awofo baanu fie mu bere a wɔadi mfe 10, sen wɔn a wɔhwɛɛ wɔn mma na wɔtetee wɔn no.[119]

Nhwehwɛmu kakraa bi na wɔayɛ wɔ nea ebefi mmofra a wɔfa wɔn sɛ wɔn mma a wodi kan no so aba no ho, na nea wɔahu no adi afra. Nhwehwɛmu bi kyerɛe sɛ wɔn a wogyaee wɔn mma ma wɔfa wɔn sɛ wɔn mma no ani nnye wɔn gyinaesi no ho kɛse sen wɔn a wɔde wɔn mma siei no. Nanso, na awerɛkyekye dodow a ɛwɔ akuw abien no nyinaa so no dɔɔso, na wɔn a wogyaee wɔn ba no te sɛ wɔn a wɔmaa wɔn ba no siei wɔ asetra mu abotɔyam, abusuabɔ mu abotɔyam, ne daakye ho adwene pa a wɔwɔ wɔ sukuu, adwuma, sikasɛm, ne aware ho nsusuwii ahorow mu ] . Nhwehwɛmu a wɔyɛe akyiri yi kyerɛe sɛ ɛnanom a wɔadu mpanyin afe so a wɔpaw sɛ wobegyae wɔn mma ma wɔagye wɔn ayɛ wɔn mma no taa nya awerɛhow ne ahonu wɔ wɔn gyinaesi no ho sen wɔn a wɔkoraa wɔn mma so no. Nanso, saa nkate ahorow yi so tew kɛse fi afe biako wɔ awo akyi kosii afe a ɛto so abien no awiei.[121]

Nhwehwɛmu a wɔayɛ nnansa yi ara no hui sɛ wɔ ɛnanom a wogyaee wɔn mma sɛ wɔmfa wɔn mma mfe anan kosi 12 ansa na ɛreba no mu no, na obiara a ɔde ne ho hyɛɛ mu no taa susuw wɔn ba a wayera no ho. Wɔ dodow no ara fam no, na nsusuwii ahorow no yɛ nea enye ne nea eye efisɛ na ɛma wonya awerɛhow ne anigye nkate nyinaa. Wɔn a wonyaa nsusuwii pa no fã kɛse no ara mu osuahu ne wɔn a na wɔabue wɔn mma, sen sɛ wɔde ntamgyinafo a wɔato mu anaasɛ bere tiaa bi bɛyɛ wɔn mma.[122]

Wɔ nhwehwɛmu foforo a wɔde ɛnanom a wogyae wɔn mma totoo wɔn a wɔtetee wɔn ho no mu no, ɛnanom a wogyae wɔn mma no taa twentwɛn wɔn nyinsɛn a edi hɔ no ase, wɔtwentwɛn aware ase, na wowie adwuma ho ntetee. Nanso, akuw abien no nyinaa duu nhomasua a ɛba fam sen wɔn atipɛnfo a wɔannyinsɛn da.[123] Nhwehwɛmu foforo nso hui sɛ nneɛma a ɛte saa ara fi mu ba bere a wɔpaw sɛ wobegyae abofra bi ma wɔagye no ayɛ ne ba no. Ná ɛnanom a wɔn mfe akɔ anim a wogyaee wɔn mma no taa nya nhomasua a ɛkorɔn na wonya adwuma sen wɔn a wɔhwɛɛ wɔn mma no. Wɔsan nso twɛn kyɛe ansa na wɔrewo wɔn ba a odi hɔ no.[121] Wɔde mmabun nhwɛso ahorow, anaasɛ mmea a na wɔyɛ mmabun bere a wɔsoa wɔn nkokoaa no yɛɛ nhwehwɛmu a ɛwɔ hɔ wɔ nkɛntɛnso a awofo a wɔfa wɔn sɛ wɔn mma no so nkɛntɛnso ho no mu dodow no ara—nsɛm kakraa bi na ɛwɔ hɔ ma awofo a wɔwoo wɔn a wofi nnipa afoforo mu. Afei nso, nsɛm a wɔde bere tenten ayɛ a ebetumi ama asetra ne adwene mu nsunsuanso a ɛbɛtra hɔ akyɛ ama awofo a wɔwo a wɔpaw sɛ wɔde wɔn mma bɛto hɔ ama wɔagye wɔn ayɛ wɔn mma no nni hɔ.

== Nkɔso a ɛfa wɔn a wɔagye wɔn ayɛ wɔn mma ho ==
Nhwehwɛmu a wɔadi kan ayɛ wɔ mmofra a wɔfa wɔn sɛ wɔn mma ho no ama wɔanya nsusuwii ahorow a ɛkyerɛ sɛ asiane a ɛkɔ soro wɔ adwene mu nkɔso ne asetra mu abusuabɔ mu ma wɔn a wɔagye wɔn ayɛ wɔn mma no. Nanso, wɔama nsusuwii ahorow a ɛtete saa no mu ada hɔ sɛ ɛyɛ mfomso esiane akwan a wɔfa so yɛ adwuma no huammɔdi nti. Nanso nnansa yi nhwehwɛmu ahorow aboa ma wɔakyerɛ nsɛm a ɛyɛ nokware kɛse ne nea efi mu ba a ɛfa nsɛdi, nsonsonoe ne asetra kwan nyinaa a wɔn a wɔafa wɔn ayɛ wɔn mma no asetra kwan ho.[124]

Wobetumi afoa adanse a ɛfa sɛnea wɔn a wɔagye wɔn ayɛ wɔn mma no nkɔso ho wɔ nhwehwɛmu foforo mu. Yebetumi aka sɛ, wɔ ɔkwan bi so no, wɔn a wɔfa wɔn sɛ wɔn mma no taa nya nkɔso wɔ ɔkwan soronko so wɔ nnipa dodow no ara ho. Wobetumi ahu eyi wɔ asetra mu nneɛma pii mu, nanso mpɛn pii no wobetumi ahu sɛ asiane kɛse wɔ hɔ bɛyɛ mmerantebere ne mmabaabere mu. Sɛ nhwɛso no, wɔahu sɛ wɔn a wɔagye wɔn ayɛ wɔn mma no pii hyia ɔhaw wɔ adwene a wɔde besi hɔ a ɛkyerɛ sɛ wɔyɛ wɔn mma no mu.[125]

'''Adida'''

Akwan pii wɔ hɔ a wobetumi afa so akyerɛkyerɛ adwene a ɛfa nipasu ho no mu. Ɛyɛ nokware wɔ nsɛm nyinaa mu sɛ nipasu a wɔde si dan no yɛ adeyɛ a ɛkɔ so a ɛfa nkɔso, nsakrae ne adwene a wɔde si obi ho ne ankasa ho a wɔhwɛ so. Nhwehwɛmu ada no adi sɛ mmerantebere ne mmabaabere yɛ bere a wɔde wɔn ho hyɛ mu sen sɛ wɔbɛsan wɔn akyi.[126] Obi nipasu taa ntumi nnyina wɔ n’asetra mfe a edi kan no mu nanso onya ntease a egyina pintinn kɛse wɔ mmofraberem ne mmerantebere ne mmabaabere mu akyiri yi mu. Mpɛn pii no, wɔde bata bere bi a wɔde sɔ nneɛma hwɛ ho no, nneɛma a enni awiei wɔ hɔ a ɛkɔ obi nipasu a wɔbɛkyekye mu. Nea ɛka nneɛma pii ho no, nipasu ahorow pii wɔ hɔ a obi betumi de abata ho. Nnipa a wɔde wɔn ho hyɛ mu no bi ne ɔbarima ne ɔbea nna, ɔbarima ne ɔbea nna, kuw, abusuakuw ne nyamesom, ne nea ɛkeka ho Wɔ wɔn a wɔafa wɔn ayɛ wɔn mma wɔ mmusuakuw ntam ne amanaman ntam no fam no, mpɛn pii no wohu nhyɛso wɔ mmusuakuw, mmusuakuw ne ɔman a wɔde wɔn ho hyɛ mu no mu. Esiane eyi nti, abusua mu abusuabɔ ahoɔden ne ne dwumadi di dwuma kɛse wɔ ne nkɔso ne nea efi nipasu a wɔkyekye mu ba no mu. Wɔn a wɔfa wɔn sɛ wɔn mma a wofi mmusuakuw ahorow mu ne aman horow so no taa nya nkate a ɛne sɛ wonnye wɔn ntom esiane mmusuakuw, mmusuakuw, ne amammerɛ mu nsonsonoe a ɛte saa nti. Enti, sɛ wɔbɛma wɔn a wɔagye wɔn ayɛ wɔn mma a wofi mmusuakuw ahorow mu ne aman ntam no ahu wɔn &quot;amammerɛ a wofi mu&quot; no ho hia sɛnea ɛbɛyɛ a wobenya adwene a ɛfa wɔn ho ne anisɔ a ɛfa amammerɛ ahorow ho yiye. Nnipa a wɔagye wɔn ayɛ wɔn mma wɔ aman ntam no ho adansedi ne nea wɔsan kyekye no ntɛm ara a wɔfa wɔn sɛ wɔn mma no. Sɛ nhwɛso no, egyina United States mmara ne nhyehyɛe pɔtee so no, Child Citizen Act of 2000 hwɛ hu sɛ wɔbɛma wɔn a wɔagye wɔn ayɛ wɔn mma no U.S. ɔman ba ntɛm ara.[127]

Wɔde nea obi yɛ ne nea ɔnyɛ nyinaa na ɛkyerɛkyerɛ nipasu mu. Wɔn a wɔagye wɔn ayɛ wɔn mma a wɔwo wɔn wɔ abusua biako mu no hwere wɔn din na afei wɔfɛm biako fi abusua a wɔfa wɔn sɛ wɔn mma no hɔ. Nnipa nipasu a wɔhyehyɛ no yɛ adeyɛ a ɛyɛ den na nneɛma pii wɔ hɔ a ɛka nea ebefi mu aba. Sɛ yɛhwɛ nsɛm a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho tebea horow mu a, wobetumi ahu nnipa a wɔfa wɔn sɛ wɔn mma no ka ho na ɛka wɔn (ɔwofo a ɔwoo wɔn, ɔwofo a ɔfaa no sɛ ne ba ne nea wɔagye no ayɛ ne ba) sɛ &quot;triad members and state&quot;. Ebia mmofra a wɔfa wɔn sɛ wɔn mma no de baasakoro no mufo a wɔte nka sɛ wɔyɛ nnipa no to asiane mu. Baasakoro no mufo taa da nkate horow a ɛfa nipasu ne nipasu ho haw ahorow a ɛyɛ basaa ho adi esiane nsonsonoe a ɛwɔ baasakoro no ntam abusuabɔ mu nti. Wɔ ebinom fam no, mmofra a wɔfa wɔn sɛ wɔn mma no mma wonnya wɔn ho ho adwene a edi mũ anaasɛ wɔaka abom. Ebia Baasakoro no mufo behu wɔn ho sɛ wonni mũ, wonni hwee, anaasɛ wonwiei. Wɔka sɛ wonni yiyedi, biakoyɛ, anaa pintinn ho nkate a ɛbata nipasu a anya nkɔso koraa ho.[128]

'''Nkɛntɛnso ahorow'''

Abusua di dwuma titiriw wɔ nipasu a wɔhyehyɛ mu. Ɛnyɛ mmofraberem nko na eyi te saa, na mmom mmerantebere ne mmabaabere mu nso. Nnipa a wɔyɛ wɔn ho (ɔbarima ne ɔbea nna/ɔbarima ne ɔbea nna/abusuakuw/nyamesom/abusua) da so ara reyɛ wɔ mmerantebere ne mmabaabere mu na abusua kura eyi ho safe titiriw. Ɛte sɛ nea nhwehwɛmu no yɛ nea adwene koro yɛ; abusua a ɛyɛ den, ahobammɔ, ɔdɔ, nokwaredi ne mmoa a emufo nyinaa te nka sɛ wɔwɔ ahobammɔ sɛ wɔbɛhwehwɛ wɔn nipasu mu no ho hia na ama wɔatumi ayɛ nipasu a ɛfata. Transracial ne International adoptions yɛ nneɛma bi a edi dwuma titiriw wɔ wɔn a wɔagye wɔn ayɛ wɔn mma no nipasu a wɔkyekye no mu. Ntawntawdi pii fi abusuabɔ a wɔkyekye wɔ nea wɔagye no ayɛ ne ba no ne wɔn abusua ntam no mu. Eyinom bi ne sɛ &quot;wɔyɛ soronko&quot; wɔ ɔwofo (ɔwofo) ho, abusuakuw mu nipasu pa a wobenya, ne mmusuakuw/abusuakuw mu nyiyim a wobedi ho dwuma.[129] Wɔahu sɛ mmerante ne mmabaa a wɔwɔ amammerɛ ahorow ne aman ntam no taa ne wɔn awofo hu amammerɛ ne mmusuakuw a wofi mu ba sen sɛ wɔbɛkyerɛ baabi a wɔte, nanso ɛtɔ mmere bi a ɛyɛ den sɛ wɔbɛkari pɛ wɔ nnipa baanu no ntam efisɛ sukuu tebea horow taa nni nneɛma ahorow ne gye a wogye tom wɔ nsɛmti a ɛtete saa ho .[130] . Saa nhyɛso ahorow yi nso taa ma nsɛmmisa bi ba ma nea wɔagye no ayɛ ne ba no, ne abusua no nso sɛ wobesusuw ho. Nsɛmmisa bi a wɔtaa bisa no bi ne sɛ abusua no yɛ anibiannaso kɛse wɔ asetra mu akwan horow a wɔkyekye no ho a, dɛn na ɛbɛba? So ntawntawdi bɛba sɛ eyi te saa a? Na sɛ nnipa ankasa a wɔkyerɛ sɛ wɔyɛ nipasu a ɛfata ho nhwɛso no ankasa yɛ nea ahobammɔ a enni hɔ ahyɛ mu ma nso ɛ? Ginni Snodgrass bua nsɛmmisa yi wɔ ɔkwan a edidi so yi so. Ahintasɛm a ɛwɔ abusua a wɔma wɔn mma mu ne pow a wɔpow sɛ ɛsono abusua a wɔfa wɔn sɛ wɔn mma no ma adwumayɛ a entumi nyɛ adwuma yiye ba mu. &quot;... asetra mu adwumayɛfo ne awofo a wɔagye wɔn ayɛ wɔn mma a wonni ahobammɔ no ayɛ abusua abusuabɔ a egyina nokwaredi a wonni, kwati ne nneɛma a wɔde di dwuma so. Sɛ́ wubegye adi sɛ abusuabɔ pa bɛkɔ so wɔ fapem a ɛte saa so no nyɛ adwene mu ntease&quot; (Lawrence). Kokoamsɛm si akwanside ahorow a ɛmma wontumi nnya nipasu a ɛfata.[131]

Nhwehwɛmu no ka sɛ ɛnyɛ sɛ adwuma a entumi nyɛ adwuma yiye, nsɛm a ɛnyɛ nokware ne nea wɔkwati a ebetumi aba mmusua a wɔagye wɔn ayɛ wɔn mma no mu no mma ɛnyɛ yiye nko, na mmom ɛyɛ adwuma tia no tẽẽ nso. Sɛ nea wɔagye no ayɛ ne ba no nim sɛ wɔafa wɔn ayɛ wɔn ba nanso onni wɔn awofo a wɔwoo wɔn no ho nsɛm biara a, nkɛntɛnso bɛn na ɛwɔ hɔ wɔ nnipa a wɔyɛ wɔn basaa no so? Silverstein ne Kaplan nhwehwɛmu no ka sɛ nsɛmmisa te sɛ &quot;Hena ne me?&quot; &quot;Dɛn nti na wɔwoo me?&quot; &quot;Dɛn ne m'atirimpɔw?&quot; Saa nipasu a wonni yi betumi ama wɔn a wɔagye wɔn ayɛ wɔn mma, titiriw wɔ mmerantebere ne mmabaabere mu, ahwehwɛ akwan a wɔbɛfa so ayɛ wɔn ho wɔ ɔkwan a ɛtra so so sen wɔn atipɛnfo a wonnye wɔn mma no pii. Mmabun a wɔagye wɔn ayɛ wɔn mma no dɔɔso dodo wɔ wɔn a wɔde wɔn ho hyɛ amammerɛ nketewa mu, guan, wonyinsɛn, anaasɛ wɔpo wɔn mmusua koraa no mu.[132][133]

Ɛdefa nkɔso mu nneɛma atitiriw ho no, nhwehwɛmu ahorow a efi Colorado Adoption Project no mu no hwehwɛɛ awosu mu nkɛntɛnso a ɛwɔ wɔn a wɔagye wɔn ayɛ wɔn mma no onyin so no mu, na ɛde baa awiei sɛ wɔn a wɔagye wɔn ayɛ wɔn mma no adwene tumi da wɔn awofo a wɔfaa wɔn mma no de adi wɔ mmofraase nanso ɛnkyerɛ sɛ ɛne wɔn ho wɔn ho di nsɛ kɛse wɔ mmerantebere ne mmabaabere mu, na ɛte sɛ wɔn awofo a wɔwoo wɔn no de mmom na ɛte sɛ nea ɛte saa ara baabi a ɛkɔ akyiri sɛ atipɛnfo wɔ mmusua a wɔmfa wɔn mma wɔn mma mu.[113]

Ɛte sɛ nea akwan a ɛte saa ara reyɛ adwuma wɔ wɔn a wɔagye wɔn ayɛ wɔn mma no honam fam nkɔso mu. Denmarkfo ne Amerikafo nhwehwɛmufo a wɔreyɛ nhwehwɛmu ahorow a ɛfa awosu mu mmoa a ɛma nipadua no yɛ kɛse ho no huu abusuabɔ a ɛda obi a wɔagye no ayɛ ne ba no mu duru ne n’awofo a wɔwoo no no BMI ntam bere a wɔanhu abusuabɔ biara a ɛda abusua a wɔagye no ayɛ ne ba no ntam no. Bio nso, nsonsonoe a ɛda ankorankoro ntam no bɛyɛ fã fi ankorankoro nkɛntɛnso ahorow a wɔnkyɛ mu.[114][115]

Ɛte sɛ nea nsonsonoe ahorow a ɛwɔ nkɔso mu yi di agoru wɔ ɔkwan a mmerante ne mmabaa a wɔagye wɔn ayɛ wɔn mma no fa so di asetra mu nsɛm atitiriw ho dwuma no mu. Wɔ awofo awaregyae ho no, wɔahu sɛ ɛsono sɛnea wɔn a wɔagye wɔn ayɛ wɔn mma no yɛ wɔn ade wɔ mmofra a wɔannye wɔn mma no ho. Bere a nnipa dodow no ara nyaa suban ho haw pii, nnuru a wɔde di dwuma, sukuu mu nkɔso a ɛba fam, ne asetra mu ahoɔden a asɛe wɔ awofo awaregyae akyi no, ɛte sɛ nea nnipa dodow a wɔagye wɔn ayɛ wɔn mma no annya nkɛntɛnso biara wɔ wɔn abɔnten abusuabɔ ho, titiriw wɔ wɔn sukuu anaa asetra mu tumi mu.

Nanso, ɛte sɛ nea nnipa dodow a wɔagye wɔn ayɛ wɔn mma no wɔ asiane mu kɛse wɔ suban ho nsɛm bi ho. Nhwehwɛmufo a wofi Minnesota Sukuupɔn mu yɛɛ mmabun a wɔafa wɔn ayɛ wɔn mma no ho nhwehwɛmu na wohui sɛ wɔn a wɔagye wɔn ayɛ wɔn mma no betumi anya ɔsɔretia a ɛma obi yɛ ade tra so (ODD) ne adwene a wɔde si biribi so a ɛtra so (ADHD) no mmɔho abien, na ɛyɛ 8% wɔ nnipa dodow no ara mu nnipa dodow.[134][non-primary source needed] Asiane a ɛwɔ hɔ sɛ wobekum wɔn ho nso dɔɔso kɛse sen nnipa dodow no ara. Sweden nhwehwɛmufo hui sɛ amanaman ntam ne ɔman no mufo a wɔagye wɔn ayɛ wɔn mma no nyinaa kum wɔn ho wɔ dodow a ɛkɔ soro sen atipɛnfo a wɔamfa wɔn ayɛ wɔn mma no; a amanaman ntam wɔn a wɔagye wɔn ayɛ wɔn mma ne mmea a wɔagye wɔn ayɛ wɔn mma, titiriw no, wɔ asiane kɛse mu.[135]

Ne nyinaa mu no, adwuma a wɔayɛ wɔ wɔn a wɔanyinyin a wɔagye wɔn ayɛ wɔn mma ho no ahu sɛ asiane foforo a wɔn a wɔagye wɔn ayɛ wɔn mma no hyia no fa mmerantebere ne mmabaabere mu nkutoo. Wɔkyerɛe sɛ mmerante ne mmabaa a wɔanyinyin a wɔagye wɔn ayɛ wɔn mma no ne mpanyimfo a wofi mmusua a wɔwoo wɔn mu no yɛ pɛ na wonyaa nkontaa a eye sen mpanyimfo a wɔtetee wɔn wɔ abusua ahorow foforo a ɔwofo biako ne mmusua a wɔyɛ mpena ka ho mu.[136] Bio nso, bere a mpanyimfo a wɔagye wɔn ayɛ wɔn mma no daa nsakrae kɛse adi sen wɔn atipɛnfo a wɔamfa wɔn ayɛ wɔn mma wɔ adwene ne nneyɛe ho nhyehyɛe ahorow mu no, mpanyimfo a wɔagye wɔn ayɛ wɔn mma no daa nsɛdi pii adi sen nsonsonoe a ɛda mpanyimfo a wɔamfa wɔn ayɛ wɔn mma no ntam. Nsɛm pii aba a ɛfa adwenemhaw a ɛba ntɛm a wɔasiesie anaasɛ wɔasan asan aba ho. Sɛ nhwɛso no, wɔ nhwehwɛmu ahorow a edi kan a wɔyɛe no biako mu no, Ɔbenfo Goldfarb a ɔwɔ England no de baa awiei sɛ mmofra binom sesa wɔn ho yiye wɔ asetra ne nkate fam ɛmfa ho osuahu ahorow a enye a ɛfa ahyehyɛde a wɔde wɔn ho hyɛ mu wɔ mmofraase no ho no. Nhwehwɛmufo afoforo nso hui sɛ ɛnyɛ nea ɛkyerɛ ankasa sɛ mmofra a wɔde wɔn kɔ ayaresabea bere tenten no de nkate fam haw anaa suban mu sintɔ ahorow ba mmofra nyinaa so. Eyi kyerɛ sɛ mmofra binom bɛba bere nyinaa a wɔyɛ yiye, a wotumi gyina ano, a wɔn suahu ahorow wɔ mmofraase mfa ho.[139] Afei nso, nhwehwɛmu a wɔyɛ wɔ adwene mu nneɛma a efi wɔn a wɔagye wɔn ayɛ wɔn mma no ho no mu dodow no ara fi nnipa dodow a wɔwɔ ayaresabea no mu. Eyi kyerɛ sɛ ebia nsɛm a wɔde ba awiei te sɛ nea wɔn a wɔagye wɔn ayɛ wɔn mma no taa nya suban ho haw te sɛ ODD ne ADHD no bɛyɛ nea ɛyɛ animhwɛ. Esiane sɛ wɔn a wɔagye wɔn ayɛ wɔn mma a wɔhwehwɛ adwenemyare ayaresa no sua nti, adwene mu nneɛma a efi wɔn a wɔagye wɔn ayɛ wɔn mma no mu ba sɛ wɔde toto nea ɛwɔ nnipa dodow no ara ho no di nsɛ sen sɛnea nhwehwɛmufo binom kyerɛ no.[140]

'''Adwene mu akwahosan'''

Mmofra a wɔagye wɔn ayɛ wɔn mma no taa nya adwene ne nneyɛe ho haw sen atipɛnfo a wɔamfa wɔn ayɛ wɔn mma.[141] Mmofra a na wɔadi boro anan bere a wɔfaa wɔn sɛ wɔn mma no nya adwene mu haw pii sen wɔn a na wɔyɛ nkumaa no.[142][143]

Sɛnea nhwehwɛmu a wɔyɛe wɔ UK kyerɛ no, mmofra a wɔagye wɔn ayɛ wɔn mma no betumi anya adwenemyare a ɛmma wo de baanan mpo nkɔ yiye bere a wɔafa wɔn ayɛ wɔn mma no akyi. Mmofra a wɔwɔ mmofraberem osuahu ahorow pii a enye no taa nya adwenemyare. Nhwehwɛmu no kyerɛ sɛ sɛnea ɛbɛyɛ a wobehu adwenemyare ho haw ahorow na wɔatiatia so ntɛm no, wɔn a wɔhwɛ mmofra ne awofo a wɔfa wɔn sɛ wɔn mma no hia abofra no asetra ho nsɛm a ɛkɔ akyiri.[142][144] Nhwehwɛmu foforo bi a wɔyɛe wɔ UK kyerɛ sɛ mmofra a wɔagye wɔn ayɛ wɔn mma no taa nya adwenemhaw a ɛba wɔn akyi (PTS) sen nnipa dodow no ara. Wɔn PTS sɛnkyerɛnne no gyina osuahu bɔne ko a wɔfaa mu no so na nimdeɛ a ɛfa wɔn abakɔsɛm ho no ma wonya mmoa a wɔahyɛ da ayɛ.[145][146]

== Adwene a ɔmanfo kura wɔ mmofra a wɔfa wɔn sɛ wɔn mma ho ==
Wɔ Atɔe Famfo amammerɛ mu no, nnipa pii hu sɛ abusua ho mfonini a wɔtaa yɛ no yɛ awarefo a wɔne wɔn ho da a wɔwɔ mma a wɔwoo wɔn no de. Saa adwene yi de abusua ahorow a wɔde di dwuma foforo no si nea wɔtaa yɛ no akyi. Nea efi mu ba – nhwehwɛmu kyerɛ – adwene a ɛbrɛ wɔn ase wɔ mmusua a wɔfa wɔn mma ho no wɔ hɔ, ne adwenem naayɛ a ɛfa sɛnea wɔn abusua mu abusuabɔ mu yɛ den ho.[147][148]

Nhwehwɛmu a wɔyɛe nnansa yi ara wɔ mmofra a wɔfa wɔn sɛ wɔn mma ho adwene a Evan Donaldson Asoɛe no wiei no de saa animtiaabu yi ho adanse foforo ma. Ɛkame ayɛ sɛ nnipa dodow a wobisabisaa wɔn nsɛm no mu nkyem abiɛsa mu biako gye di sɛ wɔn a wɔagye wɔn ayɛ wɔn mma no ntumi nyɛ nsakrae yiye, wɔtaa nya ayaresa ho nsɛm, na wɔtaa nya nnubɔne ne nsa ho haw ahorow. Bio nso, 40–45% susuwii sɛ wɔn a wɔagye wɔn ayɛ wɔn mma no taa nya suban ho haw ne ɔhaw wɔ sukuu mu. Nea ɛne eyi bɔ abira no, nhwehwɛmu koro no ara kyerɛe sɛ wobu awofo a wɔfa wɔn sɛ wɔn mma no yiye, a ɛkame ayɛ sɛ 90% kaa wɔn ho asɛm sɛ &quot;wɔn anigye, wonya mfaso, na wonni pɛsɛmenkominya&quot;.[149]

Nnipa dodow no ara ka sɛ wɔn nsɛm titiriw a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho no fi nnamfo ne abusuafo ne nsɛm ho amanneɛbɔfo hɔ. Ne nyinaa mu no, nnipa dodow no ara bɔ amanneɛ sɛ nsɛm ho amanneɛbɔ ma wonya adwene pa wɔ mmofra a wɔfa wɔn sɛ wɔn mma ho; 72% kyerɛe sɛ wɔanya nsusuwii pa.[150] Nanso, wɔda so ara wɔ ɔkasatia kɛse wɔ nsɛm ho amanneɛbɔfo a wɔka fa mmofra a wɔfa wɔn sɛ wɔn mma ho no ho. Sɛ nhwɛso no, blog ahorow bi a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho no kasa tiaa Meet the Robinsons sɛ wɔde nyisaa atrae mfonini ahorow a ne bere atwam di dwuma[151][152] sɛnea The Evan B. Donaldson Adoption Institute a ɛnyɛ nea wɔde hwehwɛ mfaso a ɛkamfo kyerɛ no yɛe no.

Wɔma animtiaabu a ɛbata mmofra a wɔfa wɔn sɛ wɔn mma ho no yɛ kɛse ma mmofra a wɔwɔ mmofra a wɔhwɛ wɔn sɛ wɔn mma no.[154] Nsusuwii bɔne de gyidi a ɛne sɛ mmofra a wɔte saa no haw araa ma ɛrentumi nyɛ yiye sɛ wobegye wɔn atom na wɔayɛ mmusua a &quot;ɛyɛ daa&quot;.[155] Amanneɛbɔ bi a efi Pew Commission on Children in Foster Care hɔ wɔ afe 2004 mu no ada no adi sɛ mmofra dodow a wɔretwɛn wɔ mmofra a wɔhwɛ wɔn so no abu abɔ ho abien fi 1980 mfe no mu na mprempren ɛda so ara yɛ nea ɛkɔ so yɛ pɛ bɛyɛ ɔpepem fã afe biara.&quot;[156]

Attitude toward Adoption Questionnaire (ATAQ):[157] saa nsɛmmisa yi, Abdollahzadeh, Chaloyi ne Mahmoudi na wɔdii kan yɛɛ ho adwuma(2019).[158] Nkyekyɛm a Edi Kan: Saa nsɛmmisa kratasin yi wɔ nneɛma 23 a egyina Likert nsenia a ɛyɛ 1 (Mempene so koraa) so, kosi 5 (Mepene so koraa) a wonya bere a wɔasiesie nneɛma a wɔayɛ sɛ wɔde bɛyɛ mprempren adwinnade no ne adesua biara adesua no akyi. Adeɛ mu nhwehwɛmu ne adwene mu nhwehwɛmu a ɛdi kan no kyerɛ sɛ nneɛma mmienu na ɛwɔ mu. Wɔdane nneɛma 3-10-11-12-14-15-16-17-19-20-21 no na wɔde nkaeɛ no ahyɛ mu sɛ ɛyɛ papa. Nea efii nhwehwɛmu mu nneɛma nhwehwɛmu a nneɛma atitiriw a ɛwɔ varimax rotation mu bae no kyerɛe sɛ wɔbɔɔ afã abien a ɛfa suban a ɛfa agyede ho no din sɛnea ɛte biara no sɛ adwene mu afã horow ne suban-nkate afã horow a ɛfa suban a ɛfa agyede ho. Saa nneɛma mmienu yi kyerɛkyerɛɛ 43.25% mu wɔ nsonsonoeɛ a ɛwɔ nhwɛsoɔ no nyinaa mu. Wɔde Cronbach alpha coefficient dii dwuma de susuw ahotoso a ɛwɔ nsɛmmisa kratasin no mu. Cronbach alpha coefficient yɛ 0.709 wɔ nsɛmmisa kratasin no nyinaa mu, 0.71 wɔ ade a edi kan no mu, ne 0.713 wɔ nea ɛto so abien no ho. Bio nso, na abusuabɔ pa a ɛho hia wɔ asetra mu su horow a wɔpɛ ne adwene mu afã a ɛfa adwene a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho ne suban -nkate mu afã horow a ɛwɔ adwene a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho no ntam (P ≤ 0.01).

== Ɔsesɛw ne nkabom a ɛrekɔ so ==
Nneyɛe a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma no asesa kɛse wɔ afeha a ɛto so 20 no mu, na wɔafrɛ kuw foforo biara din, wɔ ɔkwan bi so, sɛ nsakrae.[159] Efi 1970 mfe no mu no, mmɔden a wɔbɔe sɛ wɔbɛma mmofra a wɔfa wɔn sɛ wɔn mma no atu mpɔn no bɛyɛɛ nea ɛfa kyerɛwtohɔ ahorow a wobebue ne abusua a wɔbɛkora wɔn so ho nkuranhyɛ ho. Saa nsusuwii ahorow yi fi nyansahyɛ ahorow a ɛkyerɛ sɛ kokoamsɛm a ɛwɔ nnɛyi agyede mu no betumi anya ɔkwan a wɔfa so hyehyɛ nipasu no so nkɛntɛnso,[160][161] ama adwene atu afra wɔ abusua anato ho,[162] na ɛmma kakraa bi wɔ aduruyɛ ho abakɔsɛm kwan so.

Abusua a wɔbɛkora wɔn so: Bere a nsɛm a ɛfa mmara a wɔmfa nni dwuma ho no fii ase kɔɔ fam wɔ 1970 mfe no mfiase no, asetra mu yiyedi ahyehyɛde ahorow fii ase sii so dua sɛ, sɛ ɛbɛyɛ yiye a, ɛsɛ sɛ wɔma ɛnanom ne mmofra bom. Wɔ U.S. no, wɔdaa eyi adi pefee denam nsakrae a ɛbaa nhyehyɛe mu wɔ New York Foundling Home, ahyehyɛde a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma a ɛka ɔman no mu nea akyɛ sen biara ho na ɛyɛɛ kyerɛwtohɔ ahorow a wɔasɔ ano akwampaefo no mu. Ɛde nnyinasosɛm foforo abiɛsa a nea ɛka ho ne &quot;sɛ wobesiw mmofra a wɔde wɔn bɛto afiase...&quot;, a ɛda gyidi a ɛne sɛ mmofra bɛsom wɔn yiye denam wɔn mmusua a wɔwoo wɔn no nkyɛn a wɔbɛtra so no adi, nsakrae a ɛyɛ nwonwa wɔ nhyehyɛe mu a ɛda so ara yɛ adwuma nnɛ. Bio nso, akuw te sɛ Origins USA (a wɔde sii hɔ wɔ 1997 mu) fii ase kaa abusua a wɔbɛkora so ne ɛnanom hokwan ahorow ho asɛm denneennen.[165] Nancy Verrier nhoma The Primal Wound a wotintimii no nyaa ɔsesɛw akuw ahorow yi adwene mu nne so nkɛntɛnso. Wɔka &quot;Primal wound&quot; ho asɛm sɛ &quot;ɔsɛe a akokoaa no te nka esiane sɛ ɔtetew ne ho fi ne maame a ɔwoo no no ho nti. Ɛyɛ atenka a emu dɔ na efi mu ba a ɛne sɛ wɔagyaw no a akokoaa a wɔagye no ayɛ ne ba no te nka bere a wɔafa no ayɛ ne ba no akyi na ebetumi akɔ so wɔ ne nkwa nna nyinaa mu.&quot; &quot;[160] .&quot;

Kyerɛwtohɔ ahorow a wɔabue: Bere a wɔagye obi a wɔagye no ayɛ ne ba wɔ mmara kwan so akyi wɔ United States no, wɔtaa yɛ nsakrae wɔ awo ho adansedi krataa a edi kan no mu na wɔde awo ho adansedi krataa foforo si ananmu. Wɔde awofo biara a wɔwoo abofra no din a wɔakyerɛw wɔ awo ho adansedi krataa a edi kan no so no, wɔde awofo a wɔfaa no sɛ wɔn ba no din si adansedi krataa a wɔayɛ mu nsakrae no ananmu, na ɛma ɛyɛ te sɛ nea awofo a wɔfaa no sɛ wɔn ba no na wɔwoo abofra no. Efi 1930 mfe no awiei na ɛkɔɔ so kosi 1970 mfe no mu no, ɔman mmara maa kwan sɛ wɔbɛsɔ awo ho adansedi nkrataa a edi kan no ano bere a wɔafa no sɛ wɔn ba akyi, na gye sɛ aman bi mu no, ɛmaa awo ho adansedi krataa a edi kan no antumi annye onipa a wɔagye no ayɛ ne ba no bere a wadi mfe pii mpo no ] .

Nnipa a wɔagye wɔn ayɛ wɔn mma no fi bere tenten abɔ mmɔden sɛ wobeyi mmara ahorow yi afi hɔ sɛnea ɛbɛyɛ a wobetumi anya wɔn ankasa awo ho adansedi krataa a edi kan. Nneɛma a wɔyɛe sɛ wobeyi awo ho adansedi nkrataa a edi kan ne mmofra a wɔagye wɔn ayɛ wɔn mma no ho kyerɛwtohɔ afoforo a wɔayɛ ama wɔn no dɔɔso wɔ 1970 mfe no mu a wogye toom kɛse sɛ wɔmfa mmara mma wɔn mma no. Wɔ United States no, Jean Paton hyehyɛɛ Orphan Voyage wɔ afe 1954 mu, na Florence Fisher hyehyɛɛ Adoptees' Liberty Movement Association (ALMA) wɔ afe 1971 mu, na ɔfrɛɛ kyerɛwtohɔ ahorow a wɔasɔ ano no &quot;ade a wɔsɛe nnipa nidi&quot;.[168] Bere a wɔ afe 1975 mu no, Emma May Vilardi yɛɛ kyerɛwtohɔ a edi kan a wɔn nyinaa pene so, Amanaman Ntam Soundex Reunion Registry (ISRR), a ɛmaa wɔn a wɔfaa wɔn sɛ wɔn mma no atetew wɔn ho no tumi huu wɔn ho wɔn ho. na Lee Campbell ne awofo afoforo hyehyɛɛ CUB (Concerned United Birthparents). Na nsusuwii a ɛte saa ara renya nkɔso wɔ wiase nyinaa wɔ ahyehyɛde ahorow a ɛwɔ fam te sɛ Parent Finders a ɛwɔ Canada ne Jigsaw a ɛwɔ Australia no mu. Wɔ afe 1975 mu no, England ne Wales buee kyerɛwtohɔ ahorow a egyina abrabɔ pa so.[170]

Eduu 1979 no, ahyehyɛde ahorow 32 ananmusifo a wofi aman 33 mu, Canada ne Mexico, hyiaam wɔ Washington, DC, sɛ wɔrebɛtew Amerika Awofo Bagua (AAC) a wɔde adwene koro toom sɛ: “Bue Kyerɛwtohɔ ahorow a nsɛm a ɛkyerɛ sɛ wobehu mmofra a wɔfa wɔn sɛ wɔn mma no mufo nyinaa awie, . awofo, awofo a wɔfa wɔn sɛ wɔn ba ne nea wɔfa no sɛ ne ba wɔ mfe a nea wɔagye no ayɛ ne ba no adi (18 anaa 19, a egyina ɔman no so) anaasɛ ansa na ɛreba no sɛ nnipa baasa no mufo nyinaa pene so a.&quot;[171] Mfe a edi hɔ no huu ahyehyɛde ahorow a ɛyɛ akofo pii te sɛ Bastard Nation (a wɔde sii hɔ) no dannan wɔ 1996 mu), akuw a wɔboaa ma wobuu kyerɛwtohɔ ahorow a wɔasɔ ano wɔ Alabama, Delaware, New Hampshire, Oregon, Tennessee, ne Maine.[172][173] New York ne ɔman no mu nnipa a wɔhwehwɛ hokwan ahorow a wɔde gye wɔn ayɛ wɔn mma no nkabom bi yɛɛ adwuma yiye de buu mmara bi a adi mfe 83 a ɛyɛ anohyeto no mu wɔ afe 2019 mu, na nnipa a wɔanyinyin a wɔagye wɔn ayɛ wɔn mma a wɔwoo wɔn wɔ New York, ne wɔn asefo nso, nnɛ wɔ hokwan sɛ wɔbisa na wonya wɔn ankasa de awo ho adansedi nkrataa a edi kan.[174][175] Ɛde besi afe 2021 no, aman du a ɛwɔ United States no gye hokwan a nnipa a wɔanyinyin a wɔagye wɔn ayɛ wɔn mma no wɔ sɛ wonya wɔn ankasa awo ho adansedi krataa a edi kan, a Alabama, Alaska, Colorado, Connecticut, Kansas, Maine, New Hampshire, New York, Oregon ne Rhode Island ka ho. 176] na. Connecticut wɔ afe 2021 mu no bɛyɛɛ ɔman a ɛtɔ so du a ɛsan de hokwan a obi a wɔagye no ayɛ ne ba no wɔ sɛ ɔbisa na ɔnya wɔn awoɔ ho adansedie nkrataa a ɛdi kan no baeɛ.[177][178 

'''Nkabom a wɔsan hyia'''

Akontaabu ahorow a ɛfa baabi a wɔn a wɔagye wɔn ayɛ wɔn mma no suban a wɔhwehwɛ nneɛma mu kodu no ada adi sɛ ɛyɛ nea wontumi nhu; nhwehwɛmu ahorow kyerɛ sɛ nsakrae kɛse wɔ hɔ.[179] Ɔfã bi no, ɔhaw no fi nnipa kakraa bi a wɔagye wɔn ayɛ wɔn mma a ɛma nhwehwɛmu a wɔyɛ no kwa no yɛ den, sɛ ɛnyɛ nea ɛrentumi nyɛ yiye mpo a.

Ne nyinaa mu no, wobetumi anya nneɛma bi a ɛkyerɛ sɛnea wɔn a wɔagye wɔn ayɛ wɔn mma no ani gye ho sɛ wɔbɛhwehwɛ nneɛma mu no afi England ne Wales asɛm a ebuee wɔn a wɔagye wɔn ayɛ wɔn mma no awo ho kyerɛwtohɔ ahorow mu wɔ 1975. U.K. Office for National Statistics no ahyɛ ho nkɔm sɛ awiei koraa no, wɔn a wɔagye wɔn ayɛ wɔn mma no nyinaa mu 33% bɛsrɛ sɛ wɔmfa bi mma wɔn wɔn awo ho kyerɛwtohɔ a edi kan no mu, a ɛboro mfitiase nkɔmhyɛ ahorow a wɔkae wɔ 1975 mu bere a na wogye di sɛ nnipa dodow a wɔagye wɔn ayɛ wɔn mma no mu kakraa bi pɛ na wɔbɛbisa wɔn kyerɛwtohɔ no so no. Nanso, wonim sɛ nsusuwii no bu nhwehwɛmu dodow ankasa no adewa, efisɛ nnipa pii a wɔagye wɔn ayɛ wɔn mma wɔ saa bere no mu no nam akwan foforo so nya wɔn awo ho kyerɛwtohɔ.[180]

Nhwehwɛmu nhoma ahorow no ka sɛ wɔn a wɔagye wɔn ayɛ wɔn mma no de nneɛma anan a enti wɔpɛ sɛ wɔsan hyiam ma: 1) wɔpɛ sɛ wonya abusua anato a edi mũ kɛse, 2) wɔpɛ sɛ wohu nsɛm a esisi a ɛde wɔn nyinsɛn, awo, ne wɔn a wogyae mu no, 3) wɔwɔ anidaso sɛ wɔde nsɛm bɛma wɔn mma , ne 4) wohia abɔde a nkwa wom ho nsɛm a ɛkɔ akyiri, a aduruyɛ ho nsɛm ka ho. Nanso, nhwehwɛmufo a wɔyɛ mmofra a wɔfa wɔn sɛ wɔn mma no susuw sɛ ntease ahorow a wɔde ama no nni mũ: ɛwom sɛ obi a ɔto so abiɛsa betumi de nsɛm a ɛte saa ama de, nanso nsɛm a wobisabisaa wɔn a wɔagye wɔn ayɛ wɔn mma, a wɔhwehwɛɛ sɛ wɔbɛsan ahyiam no, hui sɛ wɔdaa hia a ehia sɛ wodi abɔde mu abusuabɔ ho dwuma ankasa adi.

Ɛte sɛ nea ɔpɛ a ɛwɔ hɔ sɛ wɔbɛsan ahyiam no ne nea wɔagye no ayɛ ne ba no nkitahodi ne ɔmanfo a wogye tom wɔ mpɔtam hɔ no wɔ abusuabɔ. Nsusuwii ahorow a wɔde wɔn adwene si wɔn mu so kyerɛ sɛ wɔn a wɔagye wɔn ayɛ wɔn mma no binom wɔ nsɛm a emu nna hɔ wɔ wɔn ho a wɔte nka no mu, na ɛma wotumi de nipasu a ɛkɔ so daa kyerɛ no sɛe. Reunion boa ma wosiesie ne ho nimdeɛ a wonni no.[182]

Nea ɛne eyi bɔ abira no, nsusuwii ahorow a wɔde wɔn adwene si akyi no kyerɛ sɛ wɔn a wɔagye wɔn ayɛ wɔn mma no fa so di asetra mu animtiaabu so. Goffman na odii kan de nsusuwii no too gua, na ɛwɔ afã anan: 1) wɔn a wɔagye wɔn ayɛ wɔn mma no hu sɛ abɔde mu abusuabɔ a enni hɔ no kyerɛ nsonsonoe a ɛda wɔn abusua a wɔagye wɔn ayɛ wɔn mma no ntam wɔ afoforo ho, 2) osuahu ahorow a wɔn a wɔnnye wɔn mma no kyerɛ sɛ abusuabɔ a wɔde gye wɔn ayɛ wɔn mma no yɛ mmerɛw sen mogya mu abusuabɔ no hyɛ ntease yi mu den, ) sɛ wɔka bom a, saa nneɛma yi ma, wɔ wɔn a wɔagye wɔn ayɛ wɔn mma no binom mu no, wɔte nka sɛ wɔayi wɔn afi asetra mu, na 4) saa wɔn a wɔagye wɔn ayɛ wɔn mma yi yɛ wɔn ade denam mogya a wɔde kyekyere wɔn ho a wɔhwehwɛ a ɛhyɛ wɔn a wɔyɛ ɔmanfo no mu den no so. Ntease a ɛfa akyi a wɔde wɔn adwene si so wɔ sanba ho no kyerɛ sɛ ebia wɔn a wɔagye wɔn ayɛ wɔn mma no bɛyɛ nsakrae yiye na wɔwɔ anigye wɔ wɔn mmusua a wɔagye wɔn ayɛ wɔn mma no mu, nanso wɔbɛhwehwɛ sɛ mmɔden a wɔbɔ sɛ wobesiesie osuahu ahorow a ɛfa asetra mu animtiaabu ho.[181]

Wɔn a wɔagye wɔn ayɛ wɔn mma no bi pow adwene a ɛne sɛ wɔbɛsan ahyiam no. Nanso, nea ɛma ɛsono wɔn a wɔagye wɔn ayɛ wɔn mma a wɔhwehwɛ wɔn no ne wɔn a wɔnhwehwɛ no mu no mu nna hɔ. Krataa biako bɔ nhwehwɛmu no mua, na ɛka sɛ, &quot;...mmɔden a wɔbɔ sɛ wɔbɛma nsonsonoe aba nea ɔhwehwɛ ne nea ɔnyɛ nhwehwɛmu no ntam no nyɛ nea ɛyɛ nea ɛyɛ nokware anaasɛ ɛyɛ nea wotumi de di dwuma wɔ ɔkwan a ɛkɔ akyiri so sen mmɔden a wɔbɔ sɛ wɔbɛkyerɛ ... nsonsonoe a ɛda wɔn a wɔagye wɔn ayɛ wɔn mma ne wɔn a wɔamfa wɔn ayɛ wɔn mma ntam.&quot;[183]

Sɛ yɛbɛka no tiawa a, nhyiam a wɔsan hyia no betumi de nsɛm ahorow aba wɔn a wɔagye wɔn ayɛ wɔn mma ne awofo so. Ne nyinaa mu no, ɛte sɛ nea nea efi mu ba a wɔsan hyiam no mu dodow no ara yɛ nea eye. Wɔ nhwehwɛmu kɛse a wɔayɛ de besi nnɛ (a egyina mmuae a nnipa 1,007 a wɔafa wɔn ayɛ wɔn mma ne awofo a wogyaee no de mae so) 90% buae sɛ sankɔhwɛ yɛ osuahu a mfaso wɔ so. Nanso, eyi nkyerɛ sɛ wɔhyehyɛɛ abusuabɔ a ɛkɔ so wɔ nea wɔagye no ayɛ ne ba ne ɔwofo ntam anaasɛ eyi ne botae no.[184]

'''Nneyɛe a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho a akyinnyegye wom'''

Hwɛ nso: Nsisi a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho

Wɔde mmɔden a wɔbɔ sɛ wɔbɛyɛ nsakrae ne abusua a wɔbɛkora wɔn so no nso abata sɛnea wosusuw sɛ wɔde mmofra a wɔfa wɔn sɛ wɔn mma no di dwuma ɔkwammɔne so no ho denneennen. Wɔ tebea horow bi mu no, wɔagyae awofo hokwan ahorow bere a ɔmanfo abu wɔn mmusuakuw anaa wɔn asetra mu sikasɛm kuw no sɛ wɔmfata no. Ná nnipa pii gye nneyɛe yi bi tom na

== Amammerɛ mu nsakrae ahorow ==
Suban ne mmara a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho no gu ahorow kɛse. Bere a amammerɛ nyinaa yɛ nhyehyɛe ahorow a mmofra a wɔn awofo a wɔwoo wɔn no nni hɔ a wobetumi atete wɔn no, afoforo betumi atete wɔn no, ɛnyɛ amammerɛ nyinaa na wɔwɔ adwene a ɛne sɛ wobegye wɔn ayɛ wɔn mma, a ɛne sɛ wɔbɛfa mmofra a wɔne wɔn ho nni abusuabɔ sɛ wɔne awofo a wɔagye wɔn ayɛ wɔn mma no mma a wɔwoo wɔn no yɛ pɛ. Sɛ nhwɛso no, wɔ Nkramofo Mmara ase no, ɛsɛ sɛ mmofra a wɔagye wɔn ayɛ wɔn mma no de wɔn mfitiase abusua din sie na ama wɔahu wɔn ne mogya mu abusuabɔ,[213] na, sɛnea wɔtaa yɛ no, mmea hyɛ hijab wɔ mmarima anim wɔ wɔn afie a wɔagye wɔn ayɛ wɔn mma no mu. Wɔ Egypt no, saa amammerɛ mu nsonsonoe ahorow yi ama wɔayɛ mmofra a wɔfa wɔn sɛ wɔn mma no ayɛ nea mmara mma ho kwan mmom sɛ wɔbɛpaw nhyehyɛe a ɛfa mmofra a wɔhwɛ wɔn wɔ mmofraase ho.[214][215]

== Da a Wɔde Kɔ Fie ==</text>
      <sha1>8mr4p04sw0i1lrwkcta2snnltt02407</sha1>
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      <comment>Mede atwerɛ kaa ho</comment>
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      <text bytes="67793" xml:space="preserve">Mmofra a wɔfa wɔn sɛ wɔn mma yɛ adeyɛ a obi fa no sɛ ɔfoforo, mpɛn pii no abofra, awofoyɛ no fi saa onipa no ɔwofo anaa n’awofo a ɔwoo no ankasa anaa mmara kwan so no hɔ. Mmara kwan so mmofra a wɔfa wɔn sɛ wɔn mma no de hokwan ne asɛyɛde ahorow nyinaa, ne ayɔnkofa ho, fi awofo a wɔwoo wɔn no hɔ kɔ awofo a wɔfa wɔn sɛ wɔn mma no so daa.

Nea ɛnte sɛ awɛmfo anaa nhyehyɛe afoforo a wɔayɛ ama mmerante ne mmabaa a wɔbɛhwɛ wɔn no, atirimpɔw ne sɛ wɔbɛma mmofra a wɔfa wɔn sɛ wɔn mma no ayɛ nsakrae a ɛbɛtra hɔ daa wɔ wɔn gyinabea mu na sɛnea ɛte no, ɛhwehwɛ sɛ ɔmanfo gye tom, denam mmara anaa nyamesom mu asotwe so. Abakɔsɛm mu no, fekuw ahorow bi ahyɛ mmara pɔtee bi a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho, bere a afoforo de akwan horow a ɛnyɛ mmara kwan so de dii dwuma (titiriw apam ahorow a ɛkyerɛ agyapade hokwan ahorow ne awofo asɛyɛde ahorow a wɔmfa wɔn a wɔde wɔn ho hyɛ mu foforo nka ho). Nnɛyi nhyehyɛe ahorow a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho, a ɛsɔree wɔ afeha a ɛto so 20 yi mu no taa yɛ nea mmara ne nhyehyɛe ahorow a edi mũ na edi so. 

== Abakɔsɛm ==
'''Tete nneɛma'''

'''Agyede a wogye ma wɔn a wɔawo wɔn yiye'''

Bere a nnɛyi kwan a wɔfa so gye wɔn ba no puei wɔ United States no, adeyɛ no akwan horow puei wɔ abakɔsɛm nyinaa mu.[1] Sɛ nhwɛso no, Hammurabi Mmara no ka hokwan ahorow a wɔn a wɔagye wɔn ayɛ wɔn mma no wɔ ne ankorankoro a wɔagye wɔn ayɛ wɔn mma no asɛyɛde ahorow ho asɛm kɔ akyiri. Wɔakyerɛw adeyɛ a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma wɔ tete Roma no ho asɛm yiye wɔ Codex Justinianus mu.[2][3]

Ɛsono koraa wɔ nnɛyi bere no ho no, tete nneyɛe a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho no si amammui ne sikasɛm mu anigyede a ɛfa nea ɔfaa no ba no ho so dua,[4] na ɛde mmara kwan so adwinnade bi a ɛhyɛɛ amammui mu abusuabɔ a ɛda mmusua a wɔwɔ sika ntam no mu den na ɛmaa mmarima adedifo a wɔhwɛ agyapade so mae. Wɔakyerɛw sɛnea adehye no de di dwuma sɛ wɔn mma no ho asɛm yiye: na Roma ahempɔn no mu pii yɛ mmabarima a wɔafa wɔn ayɛ wɔn mma.[6] Ná adrogation yɛ Romafo a wɔfa wɔn sɛ wɔn mma no bi a onipa a wɔfa no sɛ ne ba no pene so sɛ ɔfoforo begye no ayɛ ne ba.

Ɛte sɛ nea nkokoaa a wɔfa wɔn sɛ wɔn mma wɔ Tete mmere mu no ntaa mma.[4][7] Na wɔtaa fa mmofra a wɔagyaw wɔn hɔ no ma wɔyɛ nkoa[8] na na wɔyɛ Ahemman no nkoa a wɔde ma no ɔha biara mu nkyem kɛse.[9][10] Romafo mmara mu kyerɛwtohɔ ahorow kyerɛ sɛ ɛtɔ mmere bi a na mmusua fa mmofra a wɔahu wɔn no na wɔtete wɔn sɛ ɔbabarima anaa ɔbabea. Ɛwom sɛ wɔtaa mfa wɔn mma wɔ Roma Mmara ase de, nanso wɔtetee mmofra no a wɔfrɛ wɔn alumni no wɔ nhyehyɛe bi a ɛte sɛ ɔhwɛfo mu, na wobuu wɔn sɛ agya a ogyaw wɔn hɔ no agyapade.[11]

Tete anibuei afoforo, titiriw India ne China, de ɔkwan bi a wɔfa so gye wɔn ba nso dii dwuma. Adanse kyerɛ sɛ na adeyɛ yi botae ne sɛ ɛbɛma amammerɛ ne nyamesom nneyɛe akɔ so; nea ɛne Atɔe Famfo adwene a ɛne sɛ wɔbɛtrɛw abusua ahorow mu no bɔ abira. Wɔ tete India no, ɔbabarimayɛ a ɛto so abien, a Rigveda kasa tia no pefee no,[12] kɔɔ so, wɔ ɔkwan a anohyeto wom na ɛyɛ amanne kɛse so, sɛnea ɛbɛyɛ a obi a ɔfa ne ba no betumi anya ayiyɛ ho amanne a ɛho hia a ɔbabarima bɛyɛ. China wɔ adwene a ɛte saa ara a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma a mmarima a wɔfa wɔn sɛ wɔnyɛ wɔn mma sɛ wɔmfa nyɛ nananom som nnwuma nkutoo ho.[14]

Ná adeyɛ a ɛne sɛ wobegye abusua mufo ne nnamfo paa mma ayɛ wɔn mma no abu so wɔ Polynesia amammerɛ ahorow mu a Hawaii a na wɔfrɛ amanne no sɛ hānai ka ho.

'''Mfinimfini mmere kosi nnɛyi bere so'''

Adoption ne nnipa mpapahwekwa

Germanfo, Celtfo, ne Slavfo amammerɛ a na ɛwɔ Europa so wɔ Roma Ahemman no asehwe akyi no anuonyamfo no kasa tiaa adeyɛ a ɛne sɛ wɔfa wɔn sɛ wɔn mma no.[15] Wɔ mfinimfini mmere mu ɔmanfo mu no, na mogya ahorow na ɛho hia sen biara; wɔde ahemman a edi tumi a na onni ɔdedifo a ɛda adi sɛ &quot;wɔwoo no wɔ abɔde mu&quot; no sii ananmu, na ɛne Romafo atetesɛm ahorow bɔ abira koraa. Europa mmara a ɛdannan no da saa akyide a wɔmpɛ sɛ wɔfa wɔn sɛ wɔn mma no adi. Sɛ nhwɛso no, Engiresifo mmara a wɔtaa de di dwuma no amma kwan mma wɔmfa obi mma efisɛ na ɛne agyapade ho mmara a wɔtaa de di dwuma no bɔ abira. Wɔ saa kwan koro no ara so no, France Napoleon Mmara no maa ɛyɛ den sɛ wobegye mmofra ayɛ wɔn ba, na ɛhwehwɛɛ sɛ wɔn a wɔfa no sɛ wɔn ba no di boro mfe 50, wonni mma, anyɛ yiye koraa no, wɔn mfe 15 sen nea wɔagye no ayɛ wɔn ba no, na anyɛ yiye koraa no, wɔatete nea wɔagye no ayɛ wɔn ba no mfe asia. Nanso, mmofra a wɔfa wɔn sɛ wɔn mma no bi kɔɔ so bae, nanso ɛbɛyɛɛ nea ɛnyɛ ɔkwan biara so, a egyina apam ahorow a wɔyɛe bere tiaa bi so. Sɛ nhwɛso no, wɔ afe 737 mu no, wɔ mmara bi a efi Lucca kurow mu mu no, wɔyɛɛ nnipa baasa a wɔagye wɔn ayɛ wɔn mma no agyapade bi adedifo. Te sɛ nhyehyɛe afoforo a ɛwɔ hɔ nnɛ no, apam no sii asɛyɛde a ɛda nea wɔagye no ayɛ ne ba no so dua sen sɛ obegye ne ba no, na ɛtwee adwene sii nokwasɛm a ɛyɛ sɛ, wɔ apam no ase no, na wɔayɛ sɛ wɔbɛhwɛ agya a ɔfaa no ayɛ ne ba no wɔ ne nkwakoraabere mu no so; adwene a ɛte sɛ nsusuwii ahorow a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho wɔ Roma mmara ase no.[17]

Europa amammerɛ mu nsakrae no hyɛɛ bere a wɔyɛɛ nneɛma foforo a ɛho hia a wɔde gye toom no agyirae. Esiane sɛ wɔamfa mmoa a efi atitiriw no hɔ nti, adeyɛ no dan kɔɔ mmofra a wɔagyaw wɔn hɔ no so nkakrankakra. Nnipa a wogyaw wɔn hɔ no kɔɔ soro bere a ahemman no hwee ase no na wogyaw mmofra a wohuu wɔn no pii wɔ Asɔre no pon ano.[18] Mfiase no, asɔfo no yɛɛ wɔn ade denam mmara a wɔhyehyɛe de kyerɛ sɛnea wɔbɛpa mmofra a wɔagyaw wɔn hɔ no ho ntama, atɔn, na wɔatete wɔn no so. Nanso, ade foforo a Asɔre no yɛe ne afɔrebɔ ho adeyɛ, a ɛnam so hyira mmofra so sɛ wɔnyɛ asɔremma asetra wɔ nkokorafie ahyehyɛde ahorow mu na wɔtete wɔn wɔ nkokorafie bi mu. Eyi na ɛde nhyehyɛe a edi kan wɔ Europa abakɔsɛm mu a mmofra a wɔagyaw wɔn hɔ no nni mmara, asetra, anaa abrabɔ mu ɔhaw ahorow. Ne saa nti, Europa mmofra a wɔagyaw wɔn hɔ na wɔayɛ nyisaa no mu pii bɛyɛɛ Asɔre no sukuufo dedaw, na ɛno nso faa dwuma sɛ obi a ɔhwɛ wɔn sɛ wɔn mma. Oblation hyɛ nsakrae a ɛkɔ ahyehyɛde ahorow mu no mfiase agyirae, na awiei koraa no ɛde ayaresabea a wɔde sii hɔ ne nyisaa atrae no sii hɔ.[18]

Bere a adwene a ɛfa ahyehyɛde mu hwɛ ho no nyaa adwene no, mmara a wɔahyɛ da ahyɛ da puei wɔ sɛnea wɔde mmofra bɛto mmusua mu: mmarimaa betumi abɛyɛ obi a osua adwumfo na mmeawa betumi aware wɔ ahyehyɛde no tumi ase. Asoɛe ahorow gyee mmofra nso sɛ wɔn mma wɔ ɔkwan a ɛnyɛ ɔhyɛ so, adwinnade a wɔfaa no sɛ ɔkwan a wɔfa so nya adwumayɛfo a wɔn bo nyɛ den, a nokwasɛm a ɛyɛ sɛ bere a wɔn a wɔagye wɔn ayɛ wɔn mma no wuwu no, abusua no de wɔn afunu san kɔ asoɛe no mu ma wosie no da no adi.

Saa nhyehyɛe a ɛfa adesua ne mmofra a wɔfa wɔn sɛ wɔn mma wɔ ɔkwan a ɛnyɛ ɔkwan pa so ho yi trɛw kɔɔ afeha a ɛto so 19 no mu, a nnɛ wobu no sɛ nsakrae fã ma mmofra a wɔfa wɔn sɛ wɔn mma ho abakɔsɛm. Wɔ asetra mu yiyedi ho adwumayɛfo akwankyerɛ ase no, nyisaa guankɔbea ahorow fii ase hyɛɛ mmofra a wogyina nkate so a wɔfa wɔn sɛ wɔn mma no ho nkuran sen sɛ wɔbɛyɛ adwuma; wɔde mmofra too apam ahorow a wɔde bɛhwɛ wɔn sɛ abusua mufo ase sen sɛ wɔde bɛto apam ahorow a ɛfa adesua ho ase.[21] Wogye di sɛ saa nhwɛso yi nkɔso no na ɛmaa Massachusetts Amanaman Nkabom no hyehyɛɛ nnɛyi mmara a edi kan a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho wɔ 1851 mu, a ɛyɛ soronko wɔ sɛnea ɛhyehyɛɛ adwene a ɛne sɛ &quot;abofra no yiyedi yiye&quot; no. Nanso, ɛmfa ho ne atirimpɔw no, wɔ nneyɛe mu no, nhyehyɛe no yɛɛ adwuma te sɛ honam a edi kan no. Boston Female Asylum (BFA) no suahunu yɛ nhwɛsoɔ pa, a na ɛwɔ ne soboɔ no mu bɛyɛ 30% a wɔagye atom wɔ afe 1888 mu.[24] BFA mpanyimfo kae sɛ, ɛwom sɛ guankɔbea no hyɛɛ ho nkuran sɛ ɛnte saa de, nanso awofo a wɔfa wɔn sɛ wɔn mma no ankyerɛ nsonsonoe a ɛda indenture ne mmofra a wɔfa wɔn sɛ wɔn mma no ntam: &quot;Yegye di,&quot; guankɔbea mpanyimfo no kae sɛ, &quot;sɛ mpɛn pii no, sɛ wɔfa mmofra a wonnii mfe pii sɛ wɔmfa wɔn mma a,... agyede yɛ din foforo a wɔde frɛ ɔsom ara kwa.&quot;[25]

'''Nnɛyi bere'''

Fapem a wɔde bɛbɔ abusua

Nneɛma a edi hɔ a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho no dannan wɔn ho no hwee United States man a na ɛrenya nkɔso no nsam. Atubrafo a wɔbae ntɛmntɛm ne Amerika Ɔmanko no maa nyisaa atrae ne mmofra a wɔahu wɔn afie dɔɔso dodo wɔ afeha a ɛto so dunkron no mfinimfini a ebi mmae da. Charles Loring Brace a na ɔyɛ Protestantfo ɔsomfo no ho dwiriw no wɔ waiffo dɔm a wonni afie a na wɔrekyinkyin New York Kuropɔn no mmɔnten so no ho. Brace buu mmerante ne mmabaa a wɔagyaw wɔn hɔ, titiriw Katolekfo, sɛ wɔyɛ ade a ɛyɛ hu sen biara a ɛrekasa atia kurow no nhyehyɛe.[26][27]

Wɔkaa n’ano aduru ho asɛm wɔ The Best Method of Disposing of Our Pauper and Vagrant Children (1859) a efii Nyisaa Keteke kuw no ase no mu. Awiei koraa no, keteke ahorow a ɛyɛ nyisaa no de mmofra bɛyɛ 200,000 fii Apuei Fam nkurow akɛse mu kɔɔ ɔman no nkuraase.[28] Mpɛn pii no, na wɔde mmofra no ahyɛ mmusua a wɔde wɔn kɔ mu no nsa, sen sɛ wɔbɛfa wɔn ayɛ wɔn mma.[29] Sɛnea na ɛte wɔ mmere a atwam no mu no, na wɔtete mmofra binom sɛ abusua no mufo bere a na afoforo nso yɛ mfuw mu adwumayɛfo ne afie mu asomfo. Nnipa a wɔatu wɔn afi wɔn afie mu no kɛse koraa—mmofra a wotu kɔtra mmeae foforo sen biara wɔ abakɔsɛm mu—ne sɛnea wɔde wɔn dii dwuma ɔkwammɔne so a ɛkɔɔ so no maa wɔhyehyɛɛ nnwumakuw foforo ne mmara ahorow a ɛhyɛɛ nhyehyɛe ahorow a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho nkuran sen sɛ wɔde wɔn ho bɛma. Bere no agyiraehyɛde ne Minnesota mmara a ɛfa mmofra a wɔfaa wɔn mma ho wɔ 1917 mu, a ɛhyɛɛ sɛ wɔnyɛ nhwehwɛmu wɔ mmeae a wɔde wɔn kɔe nyinaa ho na wɔmma wɔn a wɔde wɔn ho hyɛɛ mmofra a wɔfaa wɔn no mu no nnya kyerɛwtohɔ pii.[30][31]

Wɔ saa bere koro no ara mu no, Progressive kuw no faa United States a na botae titiriw ne sɛ ɛbɛma nyisaa atrae nhyehyɛe a na ɛwɔ hɔ no aba awiei. Mmɔdenbɔ a ɛte saa no awiei bae wɔ White House Nhyiam a Edi Kan a Ɛfa Mmofra a Wɔde Wɔn Ho To Wɔn So Hwɛ Ho a Ɔmampanyin Theodore Roosevelt frɛɛ no ​​wɔ 1909 mu,[32] faako a wɔkae sɛ nuklea abusua no gyina hɔ ma &quot;anibuei ade a ɛkorɔn na eye sen biara&quot; na eye sen biara no a otumi som sɛ ɔhwɛfo titiriw ma wɔn a wɔagyaw wɔn hɔ ne wɔn a wɔayɛ nyisaa.[33][34] Wɔ 1923 mu tɔnn no, na mmofra a wɔn awofo nhwɛ wɔn no mu ɔha biara mu abien pɛ na na wɔwɔ afie a wɔhwɛ wɔn sɛ wɔn mma mu, na nea aka no wɔ nhyehyɛe a wɔde hwɛ mmofra ne nyisaa atrae. Annu mfe aduanan akyi no, na ɛkame ayɛ sɛ nkyem abiɛsa mu biako wɔ afie a wɔhwɛ wɔn sɛ wɔn mma mu.[35]

Ne nyinaa mu no, eugenic adwene a agye din wɔ Amerika no de akwanside ahorow bae wɔ mmofra a wɔfa wɔn sɛ wɔn mma no nkɔso mu.[36][37] Na nneɛma a ɛhaw adwene kɛse wɔ mmofra a wɔnyɛ mmara ne ahiafo awosu mu su pa ho, a ebia nea ɛyɛ nhwɛso yiye ne Henry H. Goddard nkyerɛwee a ɛwɔ nkɛntɛnso a ɔkasa tiaa mmofra a wonnim faako a wogye wɔn sɛ wɔn mma no, na ɔkae sɛ, .

Afei ɛba sɛ nnipa binom ani gye adesamma abusua no yiyedi ne nkɔso a ɛkorɔn ho; nanso sɛ yɛde saa nnipa soronko no to nkyɛn a, agyanom ne ɛnanom nyinaa ani gye wɔn ankasa mmusua yiyedi ho. Ade a awofo koma ani gye ho paa ne sɛ wɔbɛma mmofra no aware yiye na wɔatete abusua a ɛkorɔn. Hwɛ sɛnea ɛyɛ adwene tiawa saa bere no sɛ abusua a ɛte saa begye abofra bi a wonnim n’abusua mu abusua koraa no akɔ ne mfinimfini; anaasɛ, baabi a, sɛ wonim no fã bi a, nea ebetumi aba no mu yɛ den sɛ ɛbɛkyerɛ mmoa a wɔyɛ ahiafo na wɔyare, na sɛ ɛsɛ sɛ aware bi kɔ so wɔ saa onipa no ne abusua no muni biara ntam a, asefo no asɛe.

Bere a efi 1945 kosi 1974, nkokoaa a wɔde wɔn gu mu bere no, huu nkɔso ntɛmntɛm na wogyee sɛ wɔfa wɔn sɛ wɔn mma sɛ ɔkwan a wɔfa so kyekye abusua.[39] Awo a mmara mma ho kwan kɔɔ soro mprɛnsa wɔ Wiase Ko II akyi, bere a nna ho nneyɛe sesae no. Bere koro no ara mu no, nyansahufo kuw no fii ase sii so dua sɛ ntetee di awosu so tumi, na wɔde eugenic animtiaabu no fii hɔ.[40][41] Wɔ saa tebea yi mu no, mmofra a wɔfa wɔn sɛ wɔn mma no bɛyɛɛ ano aduru a ɛda adi pefee maa nnipa a wɔnwaree ne awarefo a wontumi nwo nyinaa.[42]

Sɛ wɔka saa nneɛma yi bom a, ɛma wonya Amerikafo nhwɛso foforo a wɔde begye atom. Wɔ Romafo a edii n’anim no akyi no, Amerikafo twaa hokwan ahorow a awofo a wodi kan no wɔ mu bere a wɔmaa wɔn a wɔfa wɔn sɛ wɔn mma no yɛɛ awofo foforo wɔ mmara no ani so no. Wɔde nneɛma foforo abien kaa ho: 1) na atirimpɔw ne sɛ wɔbɛfa mmofra ayɛ wɔn mma sɛ wɔbɛhwɛ ma &quot;abofra no yiyedi a eye sen biara&quot;, wobetumi ahu saa adwene yi aba no afi Amerikafo mmara a edi kan a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho wɔ Massachusetts no mu,[16][23] ne 2) mmofra a wɔfa wɔn sɛ wɔn mma no bɛyɛɛ nea wɔde hyɛɛ mu a ɛyɛ kokoamsɛm, na awiei koraa no ɛmaa wɔsɔɔ mmofra a wɔfaa wɔn sɛ wɔn mma ne awo ho kyerɛwtohɔ ahorow a edi kan no ano wɔ 1945. Charles Loring Brace a ɔde bae sɛnea ɛbɛyɛ a mmofra a wofi Nyisaa Keteke ahorow no mu no rensan nkɔ wɔn awofo nkyɛn anaasɛ wɔbɛsan agye wɔn no mfiase no. Ná Brace suro nkɛntɛnso a awofo no ohia, wɔ ɔkwan a ɛkɔ akyiri so, ne Katolek som titiriw, benya wɔ mmabun no so. Saa atetesɛm a ɛfa kokoamsɛm ho yi, akyiri yi Nkɔsofo nsakraefo no na wɔkɔɔ so bere a wɔreyɛ Amerika mmara ahorow no.[43]

Nnipa dodow a wɔfaa wɔn mma wɔ United States no kɔɔ soro sen biara wɔ 1970 mu.[44] Ɛnyɛ nea wobetumi ahu nea ɛde ɔhwe a edii akyi bae no bae. Nneɛma a ɛbɛyɛ sɛ ɛde bae wɔ 1960 ne 1970 mfe no mu no bi ne awo dodow a ɛso tew, a ɛne aduru no a wɔde bae no wɔ abusuabɔ, akwan a wɔfa so siw awo ano a wɔde ayɛ adwuma a wɔde ahyɛ mmara ase a wɔawie, ɔman no sika a wɔde maa abusua nhyehyɛe ho adwuma a wɔde bɛma mmerante ne mmabaa ne wɔn a wɔba fam no - sika a wonya, ne nyinsɛn a wotu gu ho mmara kwan so. Bio nso, mfeɛ a ɛwɔ 1960 mfeɛ no awieeɛ ne 1970 mfeɛ no mfitiaseɛ no hunuu nsakraeɛ kɛseɛ wɔ ɔmanfoɔ adwene wɔ mmara kwan so ne mmara kwan so hokwan[45] a wɔn a wɔwoo wɔn wɔ awareɛ akyi wɔ no mu. Nea ɛbɛyɛ na wɔabua no, mmɔden a wɔbɔe sɛ wɔbɛkora abusua so no nyaa nkɔanim[46] ma enti mmofra kakraa bi na wɔwo wɔn wɔ aware akyi nnɛ na wɔfa wɔn sɛ wɔn mma. Anwonwasɛm ne sɛ, mmofra a wɔfa wɔn sɛ wɔn mma no da adi kɛse koraa na wɔka ho asɛm wɔ ɔmanfo mu nnɛ, nanso ɛnyɛ nea abu so kɛse.[47]

Awiei koraa no, Amerikafo nhwɛso a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho no dɔɔso wɔ wiase nyinaa. England ne Wales de wɔn mmara a edi kan a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho sii hɔ wɔ 1926. Netherlands too ne mmara wɔ 1956. Sweden maa wɔn a wɔagye wɔn ayɛ wɔn mma no yɛɛ abusua no mufo koraa wɔ 1959. West Germany hyɛɛ ne mmara a edi kan wɔ 1977 mu. Bio nso, Asia tumi ahorow no buee wɔn nyisaa atrae nhyehyɛe ahorow no maa wɔfaa wɔn mma, a Atɔe Famfo adwene a edii atubrafo nniso ne asraafo tumidi akyi nyaa so nkɛntɛnso sɛnea na ɛte no.[49] Wɔ France no, ɔman ahyehyɛde ahorow a ɛwɔ mpɔtam hɔ no ma wɔn a wɔpɛ sɛ wɔfa wɔn sɛ wɔn mma no tom, na afei wobetumi ne nyisaa atrae ahorow a ɛwɔ amannɔne adi nkitaho anaasɛ wɔabisa mmoa afi NGO ahorow hɔ. Nhyehyɛe no mfa sikatua ho, na mmom ɛma tumi kɛse ma asetra mu adwumayɛfo a wɔn gyinaesi ahorow betumi asiw mmofra a wɔfa wɔn sɛ wɔn mma no ano hye wɔ mmusua a &quot;ɛwɔ gyinapɛn&quot; mu (mfinimfini mfe, sika a wonya fi mfinimfini kosi kɛse, mmarima a wɔne wɔn ho da, Caucasianfo).[50]

Wɔyɛ mmofra a wɔfa wɔn sɛ wɔn mma no ho dwuma nnɛ wɔ wiase nyinaa. Nsɛm a ɛwɔ ase ha no de Atɔe Famfo dodow a wɔfa wɔn sɛ wɔn mma no ho mfonini ntɛm ara ma. Mmofra a wɔfa wɔn sɛ wɔn mma wɔ United States no da so ara kɔ so wɔ dodow a ɛreyɛ adu n’atipɛnfo de no mmɔho abiɛsa ɛwom mpo sɛ mmofra dodow a wɔretwɛn sɛ wobegye wɔn ayɛ wɔn mma no akɔ so ayɛ nea ɛkɔ so daa wɔ nnansa yi mfe mu, efi 100,000 kosi 125,000 wɔ bere a efi 2009 kosi 2018 no mu

== Nnɛyi mmofra a wɔfa wɔn sɛ wɔn mma ==
'''Akwan horow a wɔfa so gye wɔn ba'''

Nnɛyi nneyɛe a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho no betumi abue anaasɛ wɔato mu.

Awofo a wɔfa wɔn sɛ wɔn mma ne wɔn a wɔwoo wɔn no ma wotumi hu nsɛm a wɔde di nkitaho wɔ abusuafo ne nea wɔagye no ayɛ wɔn ba no ntam.[70] Awofo a wɔfa wɔn sɛ wɔn mma a wɔn nkutoo na wɔhwɛ abofra no so no betumi ayɛ nhyehyɛe a ɛnyɛ ɔkwan biara so. Wɔ tumidi ahorow bi mu no, awofo a wɔwoo wɔn ne wɔn a wɔagye wɔn ayɛ wɔn mma no betumi ayɛ apam a mmara ma ho kwan na ɛkyekyere wɔn a ɛfa nsrahwɛ, nsɛm a wɔde bɛsesa, anaa nkitahodi foforo a ɛfa abofra no ho.[71] Ɛde besi February 2009 no, U.S. aman 24 maa kwan sɛ wɔde apam ahorow a wɔabue ano a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho apam ahorow a mmara ma ho kwan no kaa mmofra a wɔfa wɔn sɛ wɔn mma no ho nhyehyɛe a etwa to no ho.[72]

Adeyɛ a ɛne sɛ wɔfa wɔn sɛ wɔn mma a wɔato mu (a wɔsan frɛ no kokoam anaasɛ kokoam mmofra a wɔfa wɔn sɛ wɔn mma),[73] a ɛnyɛ nea wɔtaa yɛ wɔ nnɛyi abakɔsɛm fã kɛse no ara mu no,[74] hyɛ nsɛm a ɛma wohu obi nyinaa ano, ɛkora so sɛ ɛyɛ kokoam na esiw awofo a wɔagye wɔn ayɛ wɔn mma no a wɔbɛda no adi no ano’, biological kin’s, ne wɔn a wɔagye wɔn ayɛ wɔn mma no ho nsɛm. Ne nyinaa mu no, agyede a wɔato mu no betumi ama wɔatumi de nsɛm a ɛnyɛ nea ɛkyerɛ sɛ obi yɛ te sɛ aduruyɛ ho abakɔsɛm ne nyamesom ne mmusuakuw a wofi mu akɔma afoforo.[75] Ɛnnɛ, esiane guankɔbea ahobammɔ ho mmara a U.S. aman bi ahyɛ mu nti, kokoam mmofra a wɔfa wɔn sɛ wɔn mma no renya nkɛntɛnso foforo. Wɔ aman a wɔfrɛ no &quot;dan a ahobammɔ wom&quot; mu no, wobetumi agyaw nkokoaa a wɔmmɔ wɔn din wɔ ayaresabea ahorow, odumgyafo adwumayɛbea ahorow, anaa polisifo adwumayɛbea ahorow mu wɔ nna kakraa bi akyi wɔ awo akyi, adeyɛ a ahyehyɛde ahorow bi a wɔkamfo mmofra a wɔfa wɔn sɛ wɔn mma no kasa tia sɛ ɛyɛ nea ɛkɔ akyi na asiane wom.

Sɛnea mmofra a wɔfa wɔn sɛ wɔn mma no fi ase


Mmofra a wɔfa wɔn sɛ wɔn mma no betumi aba wɔ nnipa a wɔyɛ abusuafo anaa wɔn a wɔnyɛ abusuafo ntam. Wɔ abakɔsɛm mu no, na mmofra a wɔfa wɔn sɛ wɔn mma dodow no ara kɔ so wɔ abusua bi mu. Nsɛm a aba nnansa yi ara a efi U.S. kyerɛ sɛ mprempren nnipa a wɔfa wɔn sɛ wɔn mma no mu bɛyɛ fã yɛ nnipa a wɔyɛ abusuafo ntam.[77] Eyi ho nhwɛso a wɔtaa de di dwuma ne &quot;ɔwofo a wɔyɛ mpena a wɔfa wɔn sɛ wɔn mma&quot;, baabi a ɔwofo hokafo foforo no fa abofra bi fi ɔwofo no abusuabɔ a atwam no mu wɔ mmara kwan so. Abusua mu mmofra a wɔfa wɔn sɛ wɔn mma nso betumi aba denam ahofama so, esiane awofo wu nti, anaasɛ bere a wontumi nhwɛ abofra no wɔ ɔkwan foforo so na abusua no muni bi pene so sɛ obegye adwuma no.

Ɛnyɛ bere nyinaa na mmofra a wofi wɔn pɛ mu yɛ ade a wofi wɔn pɛ mu yɛ. Wɔ aman bi mu, sɛ nhwɛso no, wɔ U.K. no, ade titiriw biako a ɛma mmofra a wɔde wɔn to hɔ sɛ wɔmfa wɔn mma no ne sɛ wɔayi wɔn afi baabi a wɔwoo wɔn no, mpɛn pii no aban ahyehyɛde bi te sɛ mpɔtam hɔ atumfoɔ. Nneɛma ahorow bi wɔ hɔ a enti woyi mmofra fi hɔ a ayayade ne anibiannaso ka ho, a ebetumi anya nkɛntɛnso a ɛtra hɔ daa wɔ nea wɔagye no ayɛ ne ba no so. Wɔbɛbɔ asetra mu adwumayɛfo amanneɛ wɔ nsɛm pii mu wɔ ahobammɔ ho asɛm bi a ɛfa abofra bi ho ho na wɔabisabisa abofra no yiyedi ho nsɛm. Mpɛn pii no, asetra mu nsɛm ho adwumayɛfo bɛhwehwɛ akwan a wɔbɛfa so ama abofra bi ne abusua a wɔwoo no no abom, sɛ nhwɛso no, denam mmoa foforo a wɔde bɛma abusua no ansa na wɔasusuw ho sɛ wobeyi abofra bi afi hɔ no so. Afei asɛnnibea bɛtaa asi gyinae ahorow afa abofra no daakye ho, sɛ nhwɛso no, sɛ ebia wobetumi asan akɔ abusua a wɔwoo wɔn no mu, akɔhwɛ mmofra a wɔhwɛ wɔn anaasɛ wɔafa wɔn ayɛ wɔn mma.

Awo a wontumi nwo ne ade titiriw nti a awofo hwehwɛ sɛ wobegye mmofra a wɔne wɔn nni abusuafo no ayɛ wɔn mma. Nhwehwɛmu bi kyerɛ sɛ eyi na ɛmaa nkokoaa a wɔfaa wɔn sɛ wɔn mma a wɔnyɛ abusuabɔ no 80% ne wɔn a wɔfaa wɔn sɛ wɔn mma denam mmofra a wɔhwɛ wɔn so no fã.[78] Akontaabu kyerɛ sɛ Amerikafoɔ a wɔntumi nnyinsɛn anaa wɔmfa nkɔsi wɔn mma no mu 11–24% bɔ mmɔden sɛ wɔbɛkyekyere abusua denam mmofra a wɔbɛfa wɔn ayɛ wɔn mma so, na sɛ Amerikafoɔ mmaa a wɔaware daa a wɔfa wɔn mma no nyinaa dodoɔ bɛyɛ 1.4%.[79][80] Nneɛma afoforo a ɛma nkurɔfo gye tom no dɔɔso ɛwom sɛ wɔankyerɛw ho asɛm yiye de. Ebia eyinom bi ne sɛ wɔbɛpɛ sɛ wɔhyɛ abusua foforo mu den wɔ awaregyae anaa ɔwofo biako wu akyi, ayamhyehye a nyamesom anaa nyansapɛ mu gyidi na ɛkanyan wɔn, na wɔakwati sɛ wɔbɛboa ma nnipa adɔɔso dodo esiane gyidi a ɛne sɛ ɛyɛ asɛyɛde kɛse sɛ wɔbɛhwɛ mmofra a anka awofo nni mu sen sɛ wɔbɛwo nti , de hwɛ hu sɛ wɔremfa nyarewa a wonya fi awo mu (e.g., Tay–Sachs yare) mma obi, ne akwahosan ho haw ahorow a ɛfa nyinsɛn ne awo ho. Ɛwom sɛ nneɛma ahorow bi wɔ hɔ de, nanso nhwehwɛmu a wɔayɛ nnansa yi ara a ɛfa mmea a wɔfa wɔn mma no suahu ahorow ho no kyerɛ sɛ ɛda adi kɛse sɛ wɔadi mfe 40–44, wɔaware mprempren, awo a wontumi nwo, na wonni mma.[81]

Fa akwan horow a edidi so yi so betumi aba mmofra a wɔfa wɔn sɛ wɔn mma a ɛne wɔn ho wɔn ho nni abusuabɔ:

Ankorankoro fie mmofra a wɔfa wɔn sɛ wɔn mma: wɔ nhyehyɛe yi ase no, adɔe akuw ne ahyehyɛde ahorow a wɔhwehwɛ mfaso yɛ adwuma sɛ ntamgyinafo, na wɔka wɔn a wɔpɛ sɛ wɔfa abofra no bom ne mmusua a wɔpɛ sɛ wɔde abofra bi to hɔ, na afã horow no nyinaa yɛ ɔman koro mufo. Sɛnea ɛbɛyɛ foforo no, ɛtɔ mmere bi a wɔn a wɔpɛ sɛ wɔfa wɔn mma no kwati ntamgyinafo na wɔne mmea di nkitaho tẽẽ, na mpɛn pii no wɔde apam a wɔakyerɛw; wɔmma eyi ho kwan wɔ tumidi ahorow bi mu. Ankorankoro fie mmofra a wɔfa wɔn sɛ wɔn mma no yɛ mmofra a wɔfa wɔn sɛ wɔn mma nyinaa mu fã kɛse; sɛ nhwɛso no, wɔ United States no, wobu akontaa sɛ ɛkame ayɛ sɛ wɔyɛ mmofra a wɔfa wɔn sɛ wɔn mma no mu 45% ho nhyehyɛe wɔ kokoam.[82]

Foster care adoption: eyi yɛ ofie adoption bi a mfiase no wɔde abofra bi to ɔmanfo hwɛ mu. Mpɛn pii no, awofo a wɔhwɛ mmofra no gye wɔn sɛ wɔn mma no bere a mmofra no nya ahofadi wɔ mmara kwan so no. Ɛsono sɛnea ɛho hia sɛ ɔkwan a wɔfa so gye wɔn mma no wɔ ɔman biara mu. Wɔ 127,500 a wɔfaa wɔn sɛ wɔn mma wɔ U.S. wɔ afe 2000 mu no,[82] bɛyɛ 51,000 anaa 40% nam mmofra a wɔhwɛ wɔn so nhyehyɛe so.[83]

Amanaman ntam mmofra a wɔfa wɔn sɛ wɔn mma: eyi fa abofra bi a wɔde bɛto ɔman a wɔwoo saa abofra no akyi ma wɔagye no ayɛ ne ba ho. Eyi betumi aba denam ɔman anaa ankorankoro nnwumakuw so. Wɔ aman bi te sɛ Sweden mu no, saa mmofra a wɔfa wɔn sɛ wɔn mma yi na ɛma wonya nsɛm no mu dodow no ara (hwɛ atifi hɔ pon no). Nanso, U.S. nhwɛso no kyerɛ sɛ nsonsonoe kɛse wɔ ɔman biara mu efisɛ mmofra a wɔfa wɔn sɛ wɔn mma fi amannɔne no nnu ne nsɛm no mu 15%.[82] Russiafo mmofra bɛboro 60,000 na wɔagye wɔn ayɛ wɔn mma wɔ United States fi 1992,[84] na wɔfaa Chinafo mmofra dodow a ɛte saa ara sɛ wɔn mma fi 1995 kosi 2005.[85] Aman ahorow mmara gu ahorow wɔ ɔpɛ a wɔwɔ sɛ wɔbɛma kwan ma amanaman ntam agyede no mu. Esiane sɛ Hague Nhyiam a ɛfa Ankorankoro Amanaman Ntam Mmara ho no huu nsɛnnennen ne nsɛnnennen a ɛbata amanaman ntam agyede ho, ne mmɔden a wɔbɔe sɛ wɔbɛbɔ wɔn a wɔde wɔn ho ahyɛ mu no ho ban afi adifudepɛ ne nneɛma a wɔde di dwuma ɔkwammɔne so a ɛtɔ mmere bi a ɛka ho no ho nti, wɔyɛɛ Hague Mmofra a Wɔfa Wɔn Ba no Apam, a efii ase yɛɛ adwuma wɔ May 1, 1995 na aman 85 agye atom de besi November 2011.[86]

Nkwaboaa a wɔfa wɔn sɛ wɔn mma: egyina nkwaboaa a aka a wɔde ma bere a wɔawie awarefo biako aduruyɛ a wɔde nyinsɛn ba wɔ afiri mu no so; wɔde nkwaboaa ma ankorankoro anaa awarefo foforo, na ɛno akyi no wɔde saa nkwaboaa no gu ɔbea a wɔde no ma no no awotwaa mu, na ama nyinsɛn ne awo ayɛ mmerɛw. Wɔ United States no, agyapade ho mmara na ɛkyerɛ mma nkwaboaa a wɔfa wɔn sɛ wɔn mma sen sɛ asɛnnibea nhyehyɛe ahorow na ɛkyerɛ kwan, a ɛne atetesɛm mu mmofra a wɔfa wɔn sɛ wɔn mma no bɔ abira.

Common law adoption: eyi yɛ adoption a asɛnnibea ahorow no nni kan nnye ntom, nanso ɔwofo bi, a ɔmfa ne ho nhyɛ mmara kwan so nhyehyɛe biara mu, gyaw ne mma ma n’adamfo anaa obusuani bi bere tenten ][88] na ɛwɔ hɔ. Sɛ wɔde bere bi a wɔahyɛ ato hɔ a ɛne sɛ wɔbɛtra (a wofi wɔn pɛ mu) bɛtra mu no awiei, sɛnea ɔmanfo di ho adanse no, afei wobu abofra no sɛ ɛyɛ nea ɛhyɛ obi so, wɔ asennibea ahorow bi mu, ɛwom mpo sɛ mfiase no asɛnnibea no amma ho kwan de. Mmara kwan so tumidi biara na ɛkyerɛkyerɛ nsɛm pɔtee a ɛfa mmara kwan so agyede ho. Sɛ nhwɛso no, U.S. mantam California gye mmara kwan so abusuabɔ tom bere a wɔabom atra mfe 2 akyi no. Wɔfrɛ adeyɛ no &quot;private fostering&quot; wɔ Britain.[89]

'''Nneɛma a wɔsɛe no ne nea wɔtetew mu'''

Asɛm titiriw: Nneɛma a wɔsɛe no (fa a wɔfa wɔn sɛ wɔn mma) .

Ɛwom sɛ wɔtaa ka mmofra a wɔfa wɔn sɛ wɔn mma no ho asɛm sɛ ɛyɛ abusua &quot;daa&quot; de, nanso wobetumi de abusuabɔ no aba awiei bere biara. Wɔfrɛ mmara kwan so a wogyae mmofra a wɔfa wɔn sɛ wɔn mma no sɛ ɔhaw. Wɔ U.S. nsɛmfua mu no, sɛ wogyae mmofra a wɔfa wɔn sɛ wɔn mma no ansa na wɔawie a, wɔsɛe wɔn, na sɛ wogyae abusuabɔ no wɔ ɛno akyi a, wogyae. Wobetumi afrɛ no nso sɛ mmofra a wɔfa wɔn sɛ wɔn mma a entumi nyɛ yiye. Bere a wɔawie mmara kwan so a, mpɛn pii no awofo a wɔagye wɔn ayɛ wɔn mma no nam asɛnnibea adesrɛ so na efi ɔhaw no ase na ɛne awaregyae ho nsɛm di nsɛ. Ɛyɛ mmara kwan a ɛyɛ soronko ma awofo a wɔagye wɔn ayɛ wɔn mma efisɛ ɔhaw/nsɛe no mfa abusuafo a wɔwoo wɔn ho, ɛwom sɛ ɛtɔ mmere bi a wɔpow abusua mufo a wɔwo wɔn anaasɛ wogyaw wɔn hɔ de.[90]

Nanso, nhwehwɛmu ahorow a wɔyɛe wɔ bere tiaa bi mu a wɔyɛe wɔ U.S. no kyerɛ sɛ mmofra yiyedi nhyehyɛe no so a wɔfa wɔn sɛ wɔn mma no ɔha biara mu nkyem 10 kosi 25 (sɛ nhwɛso no, nkokoaa a wɔagye wɔn ayɛ wɔn mma a wofi aman afoforo so anaa awofo a wɔyɛ mpena a wogye wɔn mpena mma no nka ho) sɛe ansa na wɔawie wɔ mmara kwan so na efi 1 mu kosi ɔha biara mu nkyem 10 no, wogu bere a wɔawie mmara kwan so no. Gyinapɛn ahorow pii no da nsɛm a ɛfa asɛm no ho ne nnipa dodow te sɛ mfe a wɔadi ho nsɛm kakraa bi na ɛwɔ hɔ adi; wonim sɛ mmabun taa nya wɔn mma a wɔfa wɔn sɛ wɔn mma no mu ɔhaw sen mmofra nkumaa.[90]

Awarefo a wɔne wɔn ho da a wɔfa wɔn sɛ wɔn mma

Mmara kwan so awarefo a wɔne wɔn ho da a wɔbɛbom agye wɔn ayɛ wɔn mma wɔ aman 34 so de besi March 2022, ne nea ɛka ho no wɔ aman nketewa ahorow mu. Awarefo a wɔne wɔn ho da no nso betumi ayɛ mma a wɔfa wɔn sɛ wɔn mma (aman 6 foforo), a ɔhokafo biako a ɔwɔ ɔbarima ne ɔbea nna mu no gye ɔfoforo no ba. Aman dodow no ara a wɔwɔ bɔbeasu koro aware no ma kwan ma saa awarefo no bom gye wɔn mma, nea ɛka ho ne Ecuador (awarefo a wɔne wɔn ho da nnye wɔn mma), Taiwan (awarefo a wɔyɛ mma nkutoo) ne Mexico (wɔ amantam a mmarima ne mmea aware wom no nkyem abiɛsa mu biako mu ). Aman kakraa bi a wɔwɔ ɔmanfo nkabom anaasɛ aware hokwan kakraa bi no nyinaa ma kwan ma wɔfa anammɔn anaa wɔbom yɛ mmofra

== Wɔn a wɔagye wɔn ayɛ wɔn mma no awofoyɛ ==
'''Awofoyɛ'''

Awosu mu abusuabɔ a ɛda ɔwofo ne abofra ntam no ho hia, na wɔn baanu a wɔatew wɔn ho no ama wɔahaw wɔ mmofra a wɔfa wɔn sɛ wɔn mma ho. Atetesɛm mu adwene a ɛfa awofo a wɔfa wɔn sɛ wɔn mma ho no nyaa mmoa a wonya fii Princeton Sukuupɔn nhwehwɛmu bi a wɔyɛe wɔ mmusua 6,000 a wɔfaa wɔn mma, wɔyɛ wɔn mma, na wɔhwɛ wɔn wɔ United States ne South Africa fi 1968 kosi 1985 no hɔ; nhwehwɛmu no kyerɛe sɛ aduan a wɔsɛe no wɔ afie a ɛnanom a wɔn mma a wɔnyɛ awofo wom (bere a wɔhwɛ sika a wonya, ofie dodow, nnɔnhwerew a wɔde yɛ adwuma, mfe a wɔadi, ne nea ɛkeka ho so) no sua koraa ma wɔn a wɔafa wɔn ayɛ wɔn mma, mmanoma mma, ne mmofra a wɔagye wɔn ayɛ wɔn mma, na ɛmaa nhwehwɛmufo no yɛɛ saa kyerɛ sɛ nkurɔfo ani nnye ho kɛse sɛ wɔbɛma afoforo awosu mu nkwaadɔm no atra hɔ.[91] Wɔfoa saa nsusuwii yi so wɔ nhwehwɛmu foforo a ɛfa su ho kɛse a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma a wɔde wɔn ho hyɛ wɔn a wɔpɛ wɔn asɛm, wɔn nipasu, ne wɔn honam ani hwɛbea koro no ara agyirae no, ne wɔn a wɔanyinyin a wɔagye wɔn ayɛ wɔn mma no nyinaa wɔ abusuabɔ ne awofo a wɔagye wɔn ayɛ wɔn mma no bɔ amanneɛ sɛ wɔn ani agye kɛse wɔ mmofra a wɔfa wɔn sɛ wɔn mma no ho.

Nhwehwɛmu afoforo de adanse ma sɛ abusuabɔ a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma no betumi ayɛ nea ɛfata wɔ akwan foforo so. Nhwehwɛmu bi a ɛhwehwɛ sɛnea awofo de wɔn sika hyɛ mu no kyerɛ ahoɔden wɔ mmusua a wɔfa wɔn mma no mu, na ɛkyerɛ sɛ awofo a wɔfa wɔn mma no de bere pii hyɛ wɔn mma mu sen awofo afoforo, na ɛde ba awiei sɛ &quot;...awofo a wɔfa wɔn mma no ma wɔn mma asetra yɛ yiye de tua abusuabɔ a enni awosu mu no ho ka ne the extra challenges of adoption.&quot;[93] Nhwehwɛmu foforo a wɔyɛe nnansa yi kyerɛe sɛ mmusua a wɔfa wɔn mma no de sika kɛse hyɛ wɔn mma a wɔagye wɔn ayɛ wɔn mma no mu, sɛ nhwɛso no, denam nhomasua foforo ne sika fam mmoa a wɔde ma so. Bere a ɛhyɛ no nsow sɛ ɛte sɛ nea wɔn a wɔagye wɔn ayɛ wɔn mma no taa hyia ɔhaw ahorow te sɛ nnubɔne a wɔde di dwuma no, nhwehwɛmu no susuwii sɛ ebia awofo a wɔfa wɔn sɛ wɔn mma no de wɔn sika pii bɛto wɔn a wɔagye wɔn ayɛ wɔn mma no mu ɛnyɛ sɛ wɔpɛ wɔn asɛm nti, na mmom esiane sɛ ɛda adi sɛ wohia mmoa no sen mmofra a wɔwɔ awosu mu nneɛma nti.[94]

Adwene ne nneyɛe ho animdefo hui a ɛfa hia a ɛna ne nkokoaa ntam abusuabɔ ho hia no ho no maa ɛhaw adwene bi sɛ ebia awofo a wogye nkokoaa a wɔanyinyin anaa mmofra a wɔretu mmirika wɔ awo akyi no ayera bere titiriw bi a ɛbɛma abofra no anyin anaa. Nanso, nhwehwɛmu a wɔyɛe wɔ The Mental and Social Life of Babies ho no kyerɛe sɛ &quot;ɔwofo ne nkokoaa nhyehyɛe&quot;, sen sɛ ɛbɛyɛ abusuabɔ a ɛda ankorankoro a wɔne wɔn ho wɔn ho wɔ abusuabɔ ntam no, yɛ ade a ɛdannan a ɛda nnipa nkokoaa nyinaa awosu mu nneyɛe ne mmuae a nnipa a wɔanyinyin de yɛ wɔn ade a ɛkɔ so pɛpɛɛpɛ wɔ ho no ntam saa nkokoaa nneyɛe no. Enti abɔde &quot;hwɛ ma wɔyɛ nsakrae bi a edi kan wɔ obu ma mpanyimfo pɔtee a wogye awofo dwumadi no ho.&quot;[95]

Wɔ nsɛmpɔw atitiriw no akyi no, nsemmisa soronko a wobisa awofo a wɔfa wɔn sɛ wɔn mma no gu ahorow. Nea ɛka ho ne sɛnea wobebua nsusuwii hunu, nsɛmmisa a ɛfa agyapade ho a wobebua, ne ɔkwan a eye sen biara a wɔbɛfa so ne abusuafo a wɔwoo wɔn no anya abusuabɔ bere a wɔwɔ mmofra a wɔabue wɔn mma no mu.[96] Ɔkyerɛwfo biako kyerɛ sɛ asɛmmisa a awofo a wɔfa wɔn sɛ wɔn mma no taa nya ne sɛ: &quot;So yɛbɛdɔ abofra no ɛwom mpo sɛ ɔnyɛ yɛn ba a ɔwoo no no?&quot;[97] Ade pɔtee a ɛhaw awofo pii ne sɛ wɔbɛma obi a wɔagye no ayɛ ne ba no atra sukuu dan mu. Asuade ahorow a wonim te sɛ &quot;twe w'abusua dua&quot; anaa &quot;fa w'awofo ne wo nananom so hwehwɛ w'ani kɔla akyi kɔhwɛ baabi a w'awosu fi&quot; betumi apira mmofra a wɔfaa wɔn sɛ wɔn mma na wonnim saa abɔde mu nsɛm yi. Wɔde nyansahyɛ ahorow pii ama sɛ wɔde besi adesua foforo ananmu, s.e., wɔde wɔn adwene asi &quot;abusua nnuaba turo&quot; so.[99]

Mmofra a wɔanyinyin a wɔfa wɔn sɛ wɔn mma no de awofoyɛ ho nsɛm afoforo ba.[100] Mmofra binom a wofi mmofra a wɔhwɛ wɔn so no wɔ abakɔsɛm a ɛfa ayayade ho, te sɛ honam ne adwene mu anibiannaso, honam fam ayayade, ne nna mu ayayade, na wɔwɔ asiane mu sɛ wobenya adwenemyare ho haw ahorow.[101][102] Mmofra a wɔte saa no wɔ asiane mu sɛ wobenya abusuabɔ a ɛnyɛ nhyehyɛe.[103][104][105] Nhwehwɛmu ahorow a Cicchetti ne afoforo yɛe no. (1990, 1995) hunuu sɛ nkokoaa a wɔyɛɛ wɔn ayayadeɛ na wɔyɛɛ wɔn ayayadeɛ wɔ wɔn nhwɛsoɔ no mu 80% daa abatadeɛ akwan a ɛnyɛ nhyehyɛeɛ adi.[106][107] Bata a wɔanhyehyɛ no ne nkɔso ho haw ahorow bi wɔ abusuabɔ, a nea ɛka ho ne sɛnkyerɛnne ahorow a ɛma obi fi ne ho fi afoforo ho,[108] ne adwenemhaw, dadwen, ne adeyɛ ho sɛnkyerɛnne ahorow.[109][110] &quot;Attachment yɛ adeyɛ a ɛyɛ nnam—ebetumi ayɛ nea ahobammɔ wom anaasɛ enni ahobammɔ, ɛnyɛ nea ɛfata anaasɛ ɛsow aba. Eyi yɛ sikasɛm a ɛnyɛ nokware efisɛ mpɔtam hɔ atumfoɔ hwɛ a wɔhwɛ mmofra yi bo yɛ den yiye.[112]

Ɛdefa nkɔso mu nneɛma atitiriw ho no, nhwehwɛmu ahorow a efi Colorado Adoption Project no mu no hwehwɛɛ awosu mu nkɛntɛnso a ɛwɔ wɔn a wɔagye wɔn ayɛ wɔn mma no onyin so no mu, na ɛde baa awiei sɛ wɔn a wɔagye wɔn ayɛ wɔn mma no adwene tumi da wɔn awofo a wɔfaa wɔn mma no de adi wɔ mmofraase nanso ɛnkyerɛ sɛ ɛne wɔn ho wɔn ho di nsɛ kɛse wɔ mmerantebere ne mmabaabere mu, na ɛte sɛ wɔn awofo a wɔwoo wɔn no de mmom na ɛte sɛ nea ɛte saa ara baabi a ɛkɔ akyiri sɛ atipɛnfo wɔ mmusua a wɔmfa wɔn mma wɔn mma mu.[113]

Ɛte sɛ nea akwan a ɛte saa ara reyɛ adwuma wɔ wɔn a wɔagye wɔn ayɛ wɔn mma no honam fam nkɔso mu. Denmarkfo ne Amerikafo nhwehwɛmufo a wɔreyɛ nhwehwɛmu ahorow a ɛfa awosu mu mmoa a ɛma nipadua no yɛ kɛse ho no huu abusuabɔ a ɛda obi a wɔagye no ayɛ ne ba no mu duru ne n’awofo a wɔwoo no no BMI ntam bere a wɔanhu abusuabɔ biara a ɛda abusua a wɔagye no ayɛ ne ba no ntam no. Bio nso, nsonsonoe a ɛda ankorankoro ntam no bɛyɛ fã fi ankorankoro nkɛntɛnso ahorow a wɔnkyɛ mu.[114][115]

Ɛte sɛ nea nsonsonoe ahorow a ɛwɔ nkɔso mu yi di agoru wɔ ɔkwan a mmerante ne mmabaa a wɔagye wɔn ayɛ wɔn mma no fa so di asetra mu nsɛm atitiriw ho dwuma no mu. Wɔ awofo awaregyae ho no, wɔahu sɛ ɛsono sɛnea wɔn a wɔagye wɔn ayɛ wɔn mma no yɛ wɔn ade wɔ mmofra a wɔannye wɔn mma no ho. Bere a nnipa dodow no ara nyaa suban ho haw pii, nnuru a wɔde di dwuma, sukuu mu nkɔso a ɛba fam, ne asetra mu ahoɔden a asɛe wɔ awofo awaregyae akyi no, ɛte sɛ nea nnipa dodow a wɔagye wɔn ayɛ wɔn mma no annya nkɛntɛnso biara wɔ wɔn abɔnten abusuabɔ ho, titiriw wɔ wɔn sukuu anaa asetra mu tumi mu.

'''Nkɛntɛnso a enya wɔ awofo a wodii kan bae no so'''

Nneɛma pii na ɛka gyinae a wosi sɛ wobegyae abofra no anaasɛ wɔbɛtete no no. Mmabun a wɔyɛ aborɔfo taa de wɔn nkokoaa ma wɔn a wɔnyɛ abusuafo, bere a mmabun a wɔyɛ abibifo taa nya mmoa fi wɔn ankasa mpɔtam hɔfo hɔ wɔ abofra no ntetee mu ne ɔkwan a abusuafo fa so gye wɔn sɛ wɔn mma wɔ ɔkwan a ɛnyɛ ɔhyɛ so nso so. Nhwehwɛmu a Leynes ne Festinger ne Young, Berkman, ne Rehr yɛe no kyerɛe sɛ, wɔ mmabun a wɔyem fam no, gyinae a wosi sɛ wobegyae abofra no ma wagye no ayɛ ne ba no gyina adwene a ɔbabun no maame wɔ wɔ mmofra a wɔfa no sɛ wɔn ba ho no so.[118] Nhwehwɛmu foforo nso kyerɛe sɛ mmabun a wɔyem a wɔn maamenom asua nhoma a ɛkɔ akyiri no taa gyae wɔn mma ma wɔfa wɔn sɛ wɔn mma. Nhwehwɛmu kyerɛ sɛ mmea a wɔpaw sɛ wobegyae wɔn mma ma wɔafa wɔn ayɛ wɔn mma no taa yɛ nkumaa, wɔakyerɛw wɔn din wɔ sukuu mu, na wɔatra awofo baanu fie mu bere a wɔadi mfe 10, sen wɔn a wɔhwɛɛ wɔn mma na wɔtetee wɔn no.[119]

Nhwehwɛmu kakraa bi na wɔayɛ wɔ nea ebefi mmofra a wɔfa wɔn sɛ wɔn mma a wodi kan no so aba no ho, na nea wɔahu no adi afra. Nhwehwɛmu bi kyerɛe sɛ wɔn a wogyaee wɔn mma ma wɔfa wɔn sɛ wɔn mma no ani nnye wɔn gyinaesi no ho kɛse sen wɔn a wɔde wɔn mma siei no. Nanso, na awerɛkyekye dodow a ɛwɔ akuw abien no nyinaa so no dɔɔso, na wɔn a wogyaee wɔn ba no te sɛ wɔn a wɔmaa wɔn ba no siei wɔ asetra mu abotɔyam, abusuabɔ mu abotɔyam, ne daakye ho adwene pa a wɔwɔ wɔ sukuu, adwuma, sikasɛm, ne aware ho nsusuwii ahorow mu ] . Nhwehwɛmu a wɔyɛe akyiri yi kyerɛe sɛ ɛnanom a wɔadu mpanyin afe so a wɔpaw sɛ wobegyae wɔn mma ma wɔagye wɔn ayɛ wɔn mma no taa nya awerɛhow ne ahonu wɔ wɔn gyinaesi no ho sen wɔn a wɔkoraa wɔn mma so no. Nanso, saa nkate ahorow yi so tew kɛse fi afe biako wɔ awo akyi kosii afe a ɛto so abien no awiei.[121]

Nhwehwɛmu a wɔayɛ nnansa yi ara no hui sɛ wɔ ɛnanom a wogyaee wɔn mma sɛ wɔmfa wɔn mma mfe anan kosi 12 ansa na ɛreba no mu no, na obiara a ɔde ne ho hyɛɛ mu no taa susuw wɔn ba a wayera no ho. Wɔ dodow no ara fam no, na nsusuwii ahorow no yɛ nea enye ne nea eye efisɛ na ɛma wonya awerɛhow ne anigye nkate nyinaa. Wɔn a wonyaa nsusuwii pa no fã kɛse no ara mu osuahu ne wɔn a na wɔabue wɔn mma, sen sɛ wɔde ntamgyinafo a wɔato mu anaasɛ bere tiaa bi bɛyɛ wɔn mma.[122]

Wɔ nhwehwɛmu foforo a wɔde ɛnanom a wogyae wɔn mma totoo wɔn a wɔtetee wɔn ho no mu no, ɛnanom a wogyae wɔn mma no taa twentwɛn wɔn nyinsɛn a edi hɔ no ase, wɔtwentwɛn aware ase, na wowie adwuma ho ntetee. Nanso, akuw abien no nyinaa duu nhomasua a ɛba fam sen wɔn atipɛnfo a wɔannyinsɛn da.[123] Nhwehwɛmu foforo nso hui sɛ nneɛma a ɛte saa ara fi mu ba bere a wɔpaw sɛ wobegyae abofra bi ma wɔagye no ayɛ ne ba no. Ná ɛnanom a wɔn mfe akɔ anim a wogyaee wɔn mma no taa nya nhomasua a ɛkorɔn na wonya adwuma sen wɔn a wɔhwɛɛ wɔn mma no. Wɔsan nso twɛn kyɛe ansa na wɔrewo wɔn ba a odi hɔ no.[121] Wɔde mmabun nhwɛso ahorow, anaasɛ mmea a na wɔyɛ mmabun bere a wɔsoa wɔn nkokoaa no yɛɛ nhwehwɛmu a ɛwɔ hɔ wɔ nkɛntɛnso a awofo a wɔfa wɔn sɛ wɔn mma no so nkɛntɛnso ho no mu dodow no ara—nsɛm kakraa bi na ɛwɔ hɔ ma awofo a wɔwoo wɔn a wofi nnipa afoforo mu. Afei nso, nsɛm a wɔde bere tenten ayɛ a ebetumi ama asetra ne adwene mu nsunsuanso a ɛbɛtra hɔ akyɛ ama awofo a wɔwo a wɔpaw sɛ wɔde wɔn mma bɛto hɔ ama wɔagye wɔn ayɛ wɔn mma no nni hɔ.

== Nkɔso a ɛfa wɔn a wɔagye wɔn ayɛ wɔn mma ho ==
Nhwehwɛmu a wɔadi kan ayɛ wɔ mmofra a wɔfa wɔn sɛ wɔn mma ho no ama wɔanya nsusuwii ahorow a ɛkyerɛ sɛ asiane a ɛkɔ soro wɔ adwene mu nkɔso ne asetra mu abusuabɔ mu ma wɔn a wɔagye wɔn ayɛ wɔn mma no. Nanso, wɔama nsusuwii ahorow a ɛtete saa no mu ada hɔ sɛ ɛyɛ mfomso esiane akwan a wɔfa so yɛ adwuma no huammɔdi nti. Nanso nnansa yi nhwehwɛmu ahorow aboa ma wɔakyerɛ nsɛm a ɛyɛ nokware kɛse ne nea efi mu ba a ɛfa nsɛdi, nsonsonoe ne asetra kwan nyinaa a wɔn a wɔafa wɔn ayɛ wɔn mma no asetra kwan ho.[124]

Wobetumi afoa adanse a ɛfa sɛnea wɔn a wɔagye wɔn ayɛ wɔn mma no nkɔso ho wɔ nhwehwɛmu foforo mu. Yebetumi aka sɛ, wɔ ɔkwan bi so no, wɔn a wɔfa wɔn sɛ wɔn mma no taa nya nkɔso wɔ ɔkwan soronko so wɔ nnipa dodow no ara ho. Wobetumi ahu eyi wɔ asetra mu nneɛma pii mu, nanso mpɛn pii no wobetumi ahu sɛ asiane kɛse wɔ hɔ bɛyɛ mmerantebere ne mmabaabere mu. Sɛ nhwɛso no, wɔahu sɛ wɔn a wɔagye wɔn ayɛ wɔn mma no pii hyia ɔhaw wɔ adwene a wɔde besi hɔ a ɛkyerɛ sɛ wɔyɛ wɔn mma no mu.[125]

'''Adida'''

Akwan pii wɔ hɔ a wobetumi afa so akyerɛkyerɛ adwene a ɛfa nipasu ho no mu. Ɛyɛ nokware wɔ nsɛm nyinaa mu sɛ nipasu a wɔde si dan no yɛ adeyɛ a ɛkɔ so a ɛfa nkɔso, nsakrae ne adwene a wɔde si obi ho ne ankasa ho a wɔhwɛ so. Nhwehwɛmu ada no adi sɛ mmerantebere ne mmabaabere yɛ bere a wɔde wɔn ho hyɛ mu sen sɛ wɔbɛsan wɔn akyi.[126] Obi nipasu taa ntumi nnyina wɔ n’asetra mfe a edi kan no mu nanso onya ntease a egyina pintinn kɛse wɔ mmofraberem ne mmerantebere ne mmabaabere mu akyiri yi mu. Mpɛn pii no, wɔde bata bere bi a wɔde sɔ nneɛma hwɛ ho no, nneɛma a enni awiei wɔ hɔ a ɛkɔ obi nipasu a wɔbɛkyekye mu. Nea ɛka nneɛma pii ho no, nipasu ahorow pii wɔ hɔ a obi betumi de abata ho. Nnipa a wɔde wɔn ho hyɛ mu no bi ne ɔbarima ne ɔbea nna, ɔbarima ne ɔbea nna, kuw, abusuakuw ne nyamesom, ne nea ɛkeka ho Wɔ wɔn a wɔafa wɔn ayɛ wɔn mma wɔ mmusuakuw ntam ne amanaman ntam no fam no, mpɛn pii no wohu nhyɛso wɔ mmusuakuw, mmusuakuw ne ɔman a wɔde wɔn ho hyɛ mu no mu. Esiane eyi nti, abusua mu abusuabɔ ahoɔden ne ne dwumadi di dwuma kɛse wɔ ne nkɔso ne nea efi nipasu a wɔkyekye mu ba no mu. Wɔn a wɔfa wɔn sɛ wɔn mma a wofi mmusuakuw ahorow mu ne aman horow so no taa nya nkate a ɛne sɛ wonnye wɔn ntom esiane mmusuakuw, mmusuakuw, ne amammerɛ mu nsonsonoe a ɛte saa nti. Enti, sɛ wɔbɛma wɔn a wɔagye wɔn ayɛ wɔn mma a wofi mmusuakuw ahorow mu ne aman ntam no ahu wɔn &quot;amammerɛ a wofi mu&quot; no ho hia sɛnea ɛbɛyɛ a wobenya adwene a ɛfa wɔn ho ne anisɔ a ɛfa amammerɛ ahorow ho yiye. Nnipa a wɔagye wɔn ayɛ wɔn mma wɔ aman ntam no ho adansedi ne nea wɔsan kyekye no ntɛm ara a wɔfa wɔn sɛ wɔn mma no. Sɛ nhwɛso no, egyina United States mmara ne nhyehyɛe pɔtee so no, Child Citizen Act of 2000 hwɛ hu sɛ wɔbɛma wɔn a wɔagye wɔn ayɛ wɔn mma no U.S. ɔman ba ntɛm ara.[127]

Wɔde nea obi yɛ ne nea ɔnyɛ nyinaa na ɛkyerɛkyerɛ nipasu mu. Wɔn a wɔagye wɔn ayɛ wɔn mma a wɔwo wɔn wɔ abusua biako mu no hwere wɔn din na afei wɔfɛm biako fi abusua a wɔfa wɔn sɛ wɔn mma no hɔ. Nnipa nipasu a wɔhyehyɛ no yɛ adeyɛ a ɛyɛ den na nneɛma pii wɔ hɔ a ɛka nea ebefi mu aba. Sɛ yɛhwɛ nsɛm a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho tebea horow mu a, wobetumi ahu nnipa a wɔfa wɔn sɛ wɔn mma no ka ho na ɛka wɔn (ɔwofo a ɔwoo wɔn, ɔwofo a ɔfaa no sɛ ne ba ne nea wɔagye no ayɛ ne ba) sɛ &quot;triad members and state&quot;. Ebia mmofra a wɔfa wɔn sɛ wɔn mma no de baasakoro no mufo a wɔte nka sɛ wɔyɛ nnipa no to asiane mu. Baasakoro no mufo taa da nkate horow a ɛfa nipasu ne nipasu ho haw ahorow a ɛyɛ basaa ho adi esiane nsonsonoe a ɛwɔ baasakoro no ntam abusuabɔ mu nti. Wɔ ebinom fam no, mmofra a wɔfa wɔn sɛ wɔn mma no mma wonnya wɔn ho ho adwene a edi mũ anaasɛ wɔaka abom. Ebia Baasakoro no mufo behu wɔn ho sɛ wonni mũ, wonni hwee, anaasɛ wonwiei. Wɔka sɛ wonni yiyedi, biakoyɛ, anaa pintinn ho nkate a ɛbata nipasu a anya nkɔso koraa ho.[128]

'''Nkɛntɛnso ahorow'''

Abusua di dwuma titiriw wɔ nipasu a wɔhyehyɛ mu. Ɛnyɛ mmofraberem nko na eyi te saa, na mmom mmerantebere ne mmabaabere mu nso. Nnipa a wɔyɛ wɔn ho (ɔbarima ne ɔbea nna/ɔbarima ne ɔbea nna/abusuakuw/nyamesom/abusua) da so ara reyɛ wɔ mmerantebere ne mmabaabere mu na abusua kura eyi ho safe titiriw. Ɛte sɛ nea nhwehwɛmu no yɛ nea adwene koro yɛ; abusua a ɛyɛ den, ahobammɔ, ɔdɔ, nokwaredi ne mmoa a emufo nyinaa te nka sɛ wɔwɔ ahobammɔ sɛ wɔbɛhwehwɛ wɔn nipasu mu no ho hia na ama wɔatumi ayɛ nipasu a ɛfata. Transracial ne International adoptions yɛ nneɛma bi a edi dwuma titiriw wɔ wɔn a wɔagye wɔn ayɛ wɔn mma no nipasu a wɔkyekye no mu. Ntawntawdi pii fi abusuabɔ a wɔkyekye wɔ nea wɔagye no ayɛ ne ba no ne wɔn abusua ntam no mu. Eyinom bi ne sɛ &quot;wɔyɛ soronko&quot; wɔ ɔwofo (ɔwofo) ho, abusuakuw mu nipasu pa a wobenya, ne mmusuakuw/abusuakuw mu nyiyim a wobedi ho dwuma.[129] Wɔahu sɛ mmerante ne mmabaa a wɔwɔ amammerɛ ahorow ne aman ntam no taa ne wɔn awofo hu amammerɛ ne mmusuakuw a wofi mu ba sen sɛ wɔbɛkyerɛ baabi a wɔte, nanso ɛtɔ mmere bi a ɛyɛ den sɛ wɔbɛkari pɛ wɔ nnipa baanu no ntam efisɛ sukuu tebea horow taa nni nneɛma ahorow ne gye a wogye tom wɔ nsɛmti a ɛtete saa ho .[130] . Saa nhyɛso ahorow yi nso taa ma nsɛmmisa bi ba ma nea wɔagye no ayɛ ne ba no, ne abusua no nso sɛ wobesusuw ho. Nsɛmmisa bi a wɔtaa bisa no bi ne sɛ abusua no yɛ anibiannaso kɛse wɔ asetra mu akwan horow a wɔkyekye no ho a, dɛn na ɛbɛba? So ntawntawdi bɛba sɛ eyi te saa a? Na sɛ nnipa ankasa a wɔkyerɛ sɛ wɔyɛ nipasu a ɛfata ho nhwɛso no ankasa yɛ nea ahobammɔ a enni hɔ ahyɛ mu ma nso ɛ? Ginni Snodgrass bua nsɛmmisa yi wɔ ɔkwan a edidi so yi so. Ahintasɛm a ɛwɔ abusua a wɔma wɔn mma mu ne pow a wɔpow sɛ ɛsono abusua a wɔfa wɔn sɛ wɔn mma no ma adwumayɛ a entumi nyɛ adwuma yiye ba mu. &quot;... asetra mu adwumayɛfo ne awofo a wɔagye wɔn ayɛ wɔn mma a wonni ahobammɔ no ayɛ abusua abusuabɔ a egyina nokwaredi a wonni, kwati ne nneɛma a wɔde di dwuma so. Sɛ́ wubegye adi sɛ abusuabɔ pa bɛkɔ so wɔ fapem a ɛte saa so no nyɛ adwene mu ntease&quot; (Lawrence). Kokoamsɛm si akwanside ahorow a ɛmma wontumi nnya nipasu a ɛfata.[131]

Nhwehwɛmu no ka sɛ ɛnyɛ sɛ adwuma a entumi nyɛ adwuma yiye, nsɛm a ɛnyɛ nokware ne nea wɔkwati a ebetumi aba mmusua a wɔagye wɔn ayɛ wɔn mma no mu no mma ɛnyɛ yiye nko, na mmom ɛyɛ adwuma tia no tẽẽ nso. Sɛ nea wɔagye no ayɛ ne ba no nim sɛ wɔafa wɔn ayɛ wɔn ba nanso onni wɔn awofo a wɔwoo wɔn no ho nsɛm biara a, nkɛntɛnso bɛn na ɛwɔ hɔ wɔ nnipa a wɔyɛ wɔn basaa no so? Silverstein ne Kaplan nhwehwɛmu no ka sɛ nsɛmmisa te sɛ &quot;Hena ne me?&quot; &quot;Dɛn nti na wɔwoo me?&quot; &quot;Dɛn ne m'atirimpɔw?&quot; Saa nipasu a wonni yi betumi ama wɔn a wɔagye wɔn ayɛ wɔn mma, titiriw wɔ mmerantebere ne mmabaabere mu, ahwehwɛ akwan a wɔbɛfa so ayɛ wɔn ho wɔ ɔkwan a ɛtra so so sen wɔn atipɛnfo a wonnye wɔn mma no pii. Mmabun a wɔagye wɔn ayɛ wɔn mma no dɔɔso dodo wɔ wɔn a wɔde wɔn ho hyɛ amammerɛ nketewa mu, guan, wonyinsɛn, anaasɛ wɔpo wɔn mmusua koraa no mu.[132][133]

Ɛdefa nkɔso mu nneɛma atitiriw ho no, nhwehwɛmu ahorow a efi Colorado Adoption Project no mu no hwehwɛɛ awosu mu nkɛntɛnso a ɛwɔ wɔn a wɔagye wɔn ayɛ wɔn mma no onyin so no mu, na ɛde baa awiei sɛ wɔn a wɔagye wɔn ayɛ wɔn mma no adwene tumi da wɔn awofo a wɔfaa wɔn mma no de adi wɔ mmofraase nanso ɛnkyerɛ sɛ ɛne wɔn ho wɔn ho di nsɛ kɛse wɔ mmerantebere ne mmabaabere mu, na ɛte sɛ wɔn awofo a wɔwoo wɔn no de mmom na ɛte sɛ nea ɛte saa ara baabi a ɛkɔ akyiri sɛ atipɛnfo wɔ mmusua a wɔmfa wɔn mma wɔn mma mu.[113]

Ɛte sɛ nea akwan a ɛte saa ara reyɛ adwuma wɔ wɔn a wɔagye wɔn ayɛ wɔn mma no honam fam nkɔso mu. Denmarkfo ne Amerikafo nhwehwɛmufo a wɔreyɛ nhwehwɛmu ahorow a ɛfa awosu mu mmoa a ɛma nipadua no yɛ kɛse ho no huu abusuabɔ a ɛda obi a wɔagye no ayɛ ne ba no mu duru ne n’awofo a wɔwoo no no BMI ntam bere a wɔanhu abusuabɔ biara a ɛda abusua a wɔagye no ayɛ ne ba no ntam no. Bio nso, nsonsonoe a ɛda ankorankoro ntam no bɛyɛ fã fi ankorankoro nkɛntɛnso ahorow a wɔnkyɛ mu.[114][115]

Ɛte sɛ nea nsonsonoe ahorow a ɛwɔ nkɔso mu yi di agoru wɔ ɔkwan a mmerante ne mmabaa a wɔagye wɔn ayɛ wɔn mma no fa so di asetra mu nsɛm atitiriw ho dwuma no mu. Wɔ awofo awaregyae ho no, wɔahu sɛ ɛsono sɛnea wɔn a wɔagye wɔn ayɛ wɔn mma no yɛ wɔn ade wɔ mmofra a wɔannye wɔn mma no ho. Bere a nnipa dodow no ara nyaa suban ho haw pii, nnuru a wɔde di dwuma, sukuu mu nkɔso a ɛba fam, ne asetra mu ahoɔden a asɛe wɔ awofo awaregyae akyi no, ɛte sɛ nea nnipa dodow a wɔagye wɔn ayɛ wɔn mma no annya nkɛntɛnso biara wɔ wɔn abɔnten abusuabɔ ho, titiriw wɔ wɔn sukuu anaa asetra mu tumi mu.

Nanso, ɛte sɛ nea nnipa dodow a wɔagye wɔn ayɛ wɔn mma no wɔ asiane mu kɛse wɔ suban ho nsɛm bi ho. Nhwehwɛmufo a wofi Minnesota Sukuupɔn mu yɛɛ mmabun a wɔafa wɔn ayɛ wɔn mma no ho nhwehwɛmu na wohui sɛ wɔn a wɔagye wɔn ayɛ wɔn mma no betumi anya ɔsɔretia a ɛma obi yɛ ade tra so (ODD) ne adwene a wɔde si biribi so a ɛtra so (ADHD) no mmɔho abien, na ɛyɛ 8% wɔ nnipa dodow no ara mu nnipa dodow.[134][non-primary source needed] Asiane a ɛwɔ hɔ sɛ wobekum wɔn ho nso dɔɔso kɛse sen nnipa dodow no ara. Sweden nhwehwɛmufo hui sɛ amanaman ntam ne ɔman no mufo a wɔagye wɔn ayɛ wɔn mma no nyinaa kum wɔn ho wɔ dodow a ɛkɔ soro sen atipɛnfo a wɔamfa wɔn ayɛ wɔn mma no; a amanaman ntam wɔn a wɔagye wɔn ayɛ wɔn mma ne mmea a wɔagye wɔn ayɛ wɔn mma, titiriw no, wɔ asiane kɛse mu.[135]

Ne nyinaa mu no, adwuma a wɔayɛ wɔ wɔn a wɔanyinyin a wɔagye wɔn ayɛ wɔn mma ho no ahu sɛ asiane foforo a wɔn a wɔagye wɔn ayɛ wɔn mma no hyia no fa mmerantebere ne mmabaabere mu nkutoo. Wɔkyerɛe sɛ mmerante ne mmabaa a wɔanyinyin a wɔagye wɔn ayɛ wɔn mma no ne mpanyimfo a wofi mmusua a wɔwoo wɔn mu no yɛ pɛ na wonyaa nkontaa a eye sen mpanyimfo a wɔtetee wɔn wɔ abusua ahorow foforo a ɔwofo biako ne mmusua a wɔyɛ mpena ka ho mu.[136] Bio nso, bere a mpanyimfo a wɔagye wɔn ayɛ wɔn mma no daa nsakrae kɛse adi sen wɔn atipɛnfo a wɔamfa wɔn ayɛ wɔn mma wɔ adwene ne nneyɛe ho nhyehyɛe ahorow mu no, mpanyimfo a wɔagye wɔn ayɛ wɔn mma no daa nsɛdi pii adi sen nsonsonoe a ɛda mpanyimfo a wɔamfa wɔn ayɛ wɔn mma no ntam. Nsɛm pii aba a ɛfa adwenemhaw a ɛba ntɛm a wɔasiesie anaasɛ wɔasan asan aba ho. Sɛ nhwɛso no, wɔ nhwehwɛmu ahorow a edi kan a wɔyɛe no biako mu no, Ɔbenfo Goldfarb a ɔwɔ England no de baa awiei sɛ mmofra binom sesa wɔn ho yiye wɔ asetra ne nkate fam ɛmfa ho osuahu ahorow a enye a ɛfa ahyehyɛde a wɔde wɔn ho hyɛ mu wɔ mmofraase no ho no. Nhwehwɛmufo afoforo nso hui sɛ ɛnyɛ nea ɛkyerɛ ankasa sɛ mmofra a wɔde wɔn kɔ ayaresabea bere tenten no de nkate fam haw anaa suban mu sintɔ ahorow ba mmofra nyinaa so. Eyi kyerɛ sɛ mmofra binom bɛba bere nyinaa a wɔyɛ yiye, a wotumi gyina ano, a wɔn suahu ahorow wɔ mmofraase mfa ho.[139] Afei nso, nhwehwɛmu a wɔyɛ wɔ adwene mu nneɛma a efi wɔn a wɔagye wɔn ayɛ wɔn mma no ho no mu dodow no ara fi nnipa dodow a wɔwɔ ayaresabea no mu. Eyi kyerɛ sɛ ebia nsɛm a wɔde ba awiei te sɛ nea wɔn a wɔagye wɔn ayɛ wɔn mma no taa nya suban ho haw te sɛ ODD ne ADHD no bɛyɛ nea ɛyɛ animhwɛ. Esiane sɛ wɔn a wɔagye wɔn ayɛ wɔn mma a wɔhwehwɛ adwenemyare ayaresa no sua nti, adwene mu nneɛma a efi wɔn a wɔagye wɔn ayɛ wɔn mma no mu ba sɛ wɔde toto nea ɛwɔ nnipa dodow no ara ho no di nsɛ sen sɛnea nhwehwɛmufo binom kyerɛ no.[140]

'''Adwene mu akwahosan'''

Mmofra a wɔagye wɔn ayɛ wɔn mma no taa nya adwene ne nneyɛe ho haw sen atipɛnfo a wɔamfa wɔn ayɛ wɔn mma.[141] Mmofra a na wɔadi boro anan bere a wɔfaa wɔn sɛ wɔn mma no nya adwene mu haw pii sen wɔn a na wɔyɛ nkumaa no.[142][143]

Sɛnea nhwehwɛmu a wɔyɛe wɔ UK kyerɛ no, mmofra a wɔagye wɔn ayɛ wɔn mma no betumi anya adwenemyare a ɛmma wo de baanan mpo nkɔ yiye bere a wɔafa wɔn ayɛ wɔn mma no akyi. Mmofra a wɔwɔ mmofraberem osuahu ahorow pii a enye no taa nya adwenemyare. Nhwehwɛmu no kyerɛ sɛ sɛnea ɛbɛyɛ a wobehu adwenemyare ho haw ahorow na wɔatiatia so ntɛm no, wɔn a wɔhwɛ mmofra ne awofo a wɔfa wɔn sɛ wɔn mma no hia abofra no asetra ho nsɛm a ɛkɔ akyiri.[142][144] Nhwehwɛmu foforo bi a wɔyɛe wɔ UK kyerɛ sɛ mmofra a wɔagye wɔn ayɛ wɔn mma no taa nya adwenemhaw a ɛba wɔn akyi (PTS) sen nnipa dodow no ara. Wɔn PTS sɛnkyerɛnne no gyina osuahu bɔne ko a wɔfaa mu no so na nimdeɛ a ɛfa wɔn abakɔsɛm ho no ma wonya mmoa a wɔahyɛ da ayɛ.[145][146]

== Adwene a ɔmanfo kura wɔ mmofra a wɔfa wɔn sɛ wɔn mma ho ==
Wɔ Atɔe Famfo amammerɛ mu no, nnipa pii hu sɛ abusua ho mfonini a wɔtaa yɛ no yɛ awarefo a wɔne wɔn ho da a wɔwɔ mma a wɔwoo wɔn no de. Saa adwene yi de abusua ahorow a wɔde di dwuma foforo no si nea wɔtaa yɛ no akyi. Nea efi mu ba – nhwehwɛmu kyerɛ – adwene a ɛbrɛ wɔn ase wɔ mmusua a wɔfa wɔn mma ho no wɔ hɔ, ne adwenem naayɛ a ɛfa sɛnea wɔn abusua mu abusuabɔ mu yɛ den ho.[147][148]

Nhwehwɛmu a wɔyɛe nnansa yi ara wɔ mmofra a wɔfa wɔn sɛ wɔn mma ho adwene a Evan Donaldson Asoɛe no wiei no de saa animtiaabu yi ho adanse foforo ma. Ɛkame ayɛ sɛ nnipa dodow a wobisabisaa wɔn nsɛm no mu nkyem abiɛsa mu biako gye di sɛ wɔn a wɔagye wɔn ayɛ wɔn mma no ntumi nyɛ nsakrae yiye, wɔtaa nya ayaresa ho nsɛm, na wɔtaa nya nnubɔne ne nsa ho haw ahorow. Bio nso, 40–45% susuwii sɛ wɔn a wɔagye wɔn ayɛ wɔn mma no taa nya suban ho haw ne ɔhaw wɔ sukuu mu. Nea ɛne eyi bɔ abira no, nhwehwɛmu koro no ara kyerɛe sɛ wobu awofo a wɔfa wɔn sɛ wɔn mma no yiye, a ɛkame ayɛ sɛ 90% kaa wɔn ho asɛm sɛ &quot;wɔn anigye, wonya mfaso, na wonni pɛsɛmenkominya&quot;.[149]

Nnipa dodow no ara ka sɛ wɔn nsɛm titiriw a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho no fi nnamfo ne abusuafo ne nsɛm ho amanneɛbɔfo hɔ. Ne nyinaa mu no, nnipa dodow no ara bɔ amanneɛ sɛ nsɛm ho amanneɛbɔ ma wonya adwene pa wɔ mmofra a wɔfa wɔn sɛ wɔn mma ho; 72% kyerɛe sɛ wɔanya nsusuwii pa.[150] Nanso, wɔda so ara wɔ ɔkasatia kɛse wɔ nsɛm ho amanneɛbɔfo a wɔka fa mmofra a wɔfa wɔn sɛ wɔn mma ho no ho. Sɛ nhwɛso no, blog ahorow bi a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho no kasa tiaa Meet the Robinsons sɛ wɔde nyisaa atrae mfonini ahorow a ne bere atwam di dwuma[151][152] sɛnea The Evan B. Donaldson Adoption Institute a ɛnyɛ nea wɔde hwehwɛ mfaso a ɛkamfo kyerɛ no yɛe no.

Wɔma animtiaabu a ɛbata mmofra a wɔfa wɔn sɛ wɔn mma ho no yɛ kɛse ma mmofra a wɔwɔ mmofra a wɔhwɛ wɔn sɛ wɔn mma no.[154] Nsusuwii bɔne de gyidi a ɛne sɛ mmofra a wɔte saa no haw araa ma ɛrentumi nyɛ yiye sɛ wobegye wɔn atom na wɔayɛ mmusua a &quot;ɛyɛ daa&quot;.[155] Amanneɛbɔ bi a efi Pew Commission on Children in Foster Care hɔ wɔ afe 2004 mu no ada no adi sɛ mmofra dodow a wɔretwɛn wɔ mmofra a wɔhwɛ wɔn so no abu abɔ ho abien fi 1980 mfe no mu na mprempren ɛda so ara yɛ nea ɛkɔ so yɛ pɛ bɛyɛ ɔpepem fã afe biara.&quot;[156]

Attitude toward Adoption Questionnaire (ATAQ):[157] saa nsɛmmisa yi, Abdollahzadeh, Chaloyi ne Mahmoudi na wɔdii kan yɛɛ ho adwuma(2019).[158] Nkyekyɛm a Edi Kan: Saa nsɛmmisa kratasin yi wɔ nneɛma 23 a egyina Likert nsenia a ɛyɛ 1 (Mempene so koraa) so, kosi 5 (Mepene so koraa) a wonya bere a wɔasiesie nneɛma a wɔayɛ sɛ wɔde bɛyɛ mprempren adwinnade no ne adesua biara adesua no akyi. Adeɛ mu nhwehwɛmu ne adwene mu nhwehwɛmu a ɛdi kan no kyerɛ sɛ nneɛma mmienu na ɛwɔ mu. Wɔdane nneɛma 3-10-11-12-14-15-16-17-19-20-21 no na wɔde nkaeɛ no ahyɛ mu sɛ ɛyɛ papa. Nea efii nhwehwɛmu mu nneɛma nhwehwɛmu a nneɛma atitiriw a ɛwɔ varimax rotation mu bae no kyerɛe sɛ wɔbɔɔ afã abien a ɛfa suban a ɛfa agyede ho no din sɛnea ɛte biara no sɛ adwene mu afã horow ne suban-nkate afã horow a ɛfa suban a ɛfa agyede ho. Saa nneɛma mmienu yi kyerɛkyerɛɛ 43.25% mu wɔ nsonsonoeɛ a ɛwɔ nhwɛsoɔ no nyinaa mu. Wɔde Cronbach alpha coefficient dii dwuma de susuw ahotoso a ɛwɔ nsɛmmisa kratasin no mu. Cronbach alpha coefficient yɛ 0.709 wɔ nsɛmmisa kratasin no nyinaa mu, 0.71 wɔ ade a edi kan no mu, ne 0.713 wɔ nea ɛto so abien no ho. Bio nso, na abusuabɔ pa a ɛho hia wɔ asetra mu su horow a wɔpɛ ne adwene mu afã a ɛfa adwene a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho ne suban -nkate mu afã horow a ɛwɔ adwene a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho no ntam (P ≤ 0.01).

== Ɔsesɛw ne nkabom a ɛrekɔ so ==
Nneyɛe a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma no asesa kɛse wɔ afeha a ɛto so 20 no mu, na wɔafrɛ kuw foforo biara din, wɔ ɔkwan bi so, sɛ nsakrae.[159] Efi 1970 mfe no mu no, mmɔden a wɔbɔe sɛ wɔbɛma mmofra a wɔfa wɔn sɛ wɔn mma no atu mpɔn no bɛyɛɛ nea ɛfa kyerɛwtohɔ ahorow a wobebue ne abusua a wɔbɛkora wɔn so ho nkuranhyɛ ho. Saa nsusuwii ahorow yi fi nyansahyɛ ahorow a ɛkyerɛ sɛ kokoamsɛm a ɛwɔ nnɛyi agyede mu no betumi anya ɔkwan a wɔfa so hyehyɛ nipasu no so nkɛntɛnso,[160][161] ama adwene atu afra wɔ abusua anato ho,[162] na ɛmma kakraa bi wɔ aduruyɛ ho abakɔsɛm kwan so.

Abusua a wɔbɛkora wɔn so: Bere a nsɛm a ɛfa mmara a wɔmfa nni dwuma ho no fii ase kɔɔ fam wɔ 1970 mfe no mfiase no, asetra mu yiyedi ahyehyɛde ahorow fii ase sii so dua sɛ, sɛ ɛbɛyɛ yiye a, ɛsɛ sɛ wɔma ɛnanom ne mmofra bom. Wɔ U.S. no, wɔdaa eyi adi pefee denam nsakrae a ɛbaa nhyehyɛe mu wɔ New York Foundling Home, ahyehyɛde a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma a ɛka ɔman no mu nea akyɛ sen biara ho na ɛyɛɛ kyerɛwtohɔ ahorow a wɔasɔ ano akwampaefo no mu. Ɛde nnyinasosɛm foforo abiɛsa a nea ɛka ho ne &quot;sɛ wobesiw mmofra a wɔde wɔn bɛto afiase...&quot;, a ɛda gyidi a ɛne sɛ mmofra bɛsom wɔn yiye denam wɔn mmusua a wɔwoo wɔn no nkyɛn a wɔbɛtra so no adi, nsakrae a ɛyɛ nwonwa wɔ nhyehyɛe mu a ɛda so ara yɛ adwuma nnɛ. Bio nso, akuw te sɛ Origins USA (a wɔde sii hɔ wɔ 1997 mu) fii ase kaa abusua a wɔbɛkora so ne ɛnanom hokwan ahorow ho asɛm denneennen.[165] Nancy Verrier nhoma The Primal Wound a wotintimii no nyaa ɔsesɛw akuw ahorow yi adwene mu nne so nkɛntɛnso. Wɔka &quot;Primal wound&quot; ho asɛm sɛ &quot;ɔsɛe a akokoaa no te nka esiane sɛ ɔtetew ne ho fi ne maame a ɔwoo no no ho nti. Ɛyɛ atenka a emu dɔ na efi mu ba a ɛne sɛ wɔagyaw no a akokoaa a wɔagye no ayɛ ne ba no te nka bere a wɔafa no ayɛ ne ba no akyi na ebetumi akɔ so wɔ ne nkwa nna nyinaa mu.&quot; &quot;[160] .&quot;

Kyerɛwtohɔ ahorow a wɔabue: Bere a wɔagye obi a wɔagye no ayɛ ne ba wɔ mmara kwan so akyi wɔ United States no, wɔtaa yɛ nsakrae wɔ awo ho adansedi krataa a edi kan no mu na wɔde awo ho adansedi krataa foforo si ananmu. Wɔde awofo biara a wɔwoo abofra no din a wɔakyerɛw wɔ awo ho adansedi krataa a edi kan no so no, wɔde awofo a wɔfaa no sɛ wɔn ba no din si adansedi krataa a wɔayɛ mu nsakrae no ananmu, na ɛma ɛyɛ te sɛ nea awofo a wɔfaa no sɛ wɔn ba no na wɔwoo abofra no. Efi 1930 mfe no awiei na ɛkɔɔ so kosi 1970 mfe no mu no, ɔman mmara maa kwan sɛ wɔbɛsɔ awo ho adansedi nkrataa a edi kan no ano bere a wɔafa no sɛ wɔn ba akyi, na gye sɛ aman bi mu no, ɛmaa awo ho adansedi krataa a edi kan no antumi annye onipa a wɔagye no ayɛ ne ba no bere a wadi mfe pii mpo no ] .

Nnipa a wɔagye wɔn ayɛ wɔn mma no fi bere tenten abɔ mmɔden sɛ wobeyi mmara ahorow yi afi hɔ sɛnea ɛbɛyɛ a wobetumi anya wɔn ankasa awo ho adansedi krataa a edi kan. Nneɛma a wɔyɛe sɛ wobeyi awo ho adansedi nkrataa a edi kan ne mmofra a wɔagye wɔn ayɛ wɔn mma no ho kyerɛwtohɔ afoforo a wɔayɛ ama wɔn no dɔɔso wɔ 1970 mfe no mu a wogye toom kɛse sɛ wɔmfa mmara mma wɔn mma no. Wɔ United States no, Jean Paton hyehyɛɛ Orphan Voyage wɔ afe 1954 mu, na Florence Fisher hyehyɛɛ Adoptees' Liberty Movement Association (ALMA) wɔ afe 1971 mu, na ɔfrɛɛ kyerɛwtohɔ ahorow a wɔasɔ ano no &quot;ade a wɔsɛe nnipa nidi&quot;.[168] Bere a wɔ afe 1975 mu no, Emma May Vilardi yɛɛ kyerɛwtohɔ a edi kan a wɔn nyinaa pene so, Amanaman Ntam Soundex Reunion Registry (ISRR), a ɛmaa wɔn a wɔfaa wɔn sɛ wɔn mma no atetew wɔn ho no tumi huu wɔn ho wɔn ho. na Lee Campbell ne awofo afoforo hyehyɛɛ CUB (Concerned United Birthparents). Na nsusuwii a ɛte saa ara renya nkɔso wɔ wiase nyinaa wɔ ahyehyɛde ahorow a ɛwɔ fam te sɛ Parent Finders a ɛwɔ Canada ne Jigsaw a ɛwɔ Australia no mu. Wɔ afe 1975 mu no, England ne Wales buee kyerɛwtohɔ ahorow a egyina abrabɔ pa so.[170]

Eduu 1979 no, ahyehyɛde ahorow 32 ananmusifo a wofi aman 33 mu, Canada ne Mexico, hyiaam wɔ Washington, DC, sɛ wɔrebɛtew Amerika Awofo Bagua (AAC) a wɔde adwene koro toom sɛ: “Bue Kyerɛwtohɔ ahorow a nsɛm a ɛkyerɛ sɛ wobehu mmofra a wɔfa wɔn sɛ wɔn mma no mufo nyinaa awie, . awofo, awofo a wɔfa wɔn sɛ wɔn ba ne nea wɔfa no sɛ ne ba wɔ mfe a nea wɔagye no ayɛ ne ba no adi (18 anaa 19, a egyina ɔman no so) anaasɛ ansa na ɛreba no sɛ nnipa baasa no mufo nyinaa pene so a.&quot;[171] Mfe a edi hɔ no huu ahyehyɛde ahorow a ɛyɛ akofo pii te sɛ Bastard Nation (a wɔde sii hɔ) no dannan wɔ 1996 mu), akuw a wɔboaa ma wobuu kyerɛwtohɔ ahorow a wɔasɔ ano wɔ Alabama, Delaware, New Hampshire, Oregon, Tennessee, ne Maine.[172][173] New York ne ɔman no mu nnipa a wɔhwehwɛ hokwan ahorow a wɔde gye wɔn ayɛ wɔn mma no nkabom bi yɛɛ adwuma yiye de buu mmara bi a adi mfe 83 a ɛyɛ anohyeto no mu wɔ afe 2019 mu, na nnipa a wɔanyinyin a wɔagye wɔn ayɛ wɔn mma a wɔwoo wɔn wɔ New York, ne wɔn asefo nso, nnɛ wɔ hokwan sɛ wɔbisa na wonya wɔn ankasa de awo ho adansedi nkrataa a edi kan.[174][175] Ɛde besi afe 2021 no, aman du a ɛwɔ United States no gye hokwan a nnipa a wɔanyinyin a wɔagye wɔn ayɛ wɔn mma no wɔ sɛ wonya wɔn ankasa awo ho adansedi krataa a edi kan, a Alabama, Alaska, Colorado, Connecticut, Kansas, Maine, New Hampshire, New York, Oregon ne Rhode Island ka ho. 176] na. Connecticut wɔ afe 2021 mu no bɛyɛɛ ɔman a ɛtɔ so du a ɛsan de hokwan a obi a wɔagye no ayɛ ne ba no wɔ sɛ ɔbisa na ɔnya wɔn awoɔ ho adansedie nkrataa a ɛdi kan no baeɛ.[177][178 

'''Nkabom a wɔsan hyia'''

Akontaabu ahorow a ɛfa baabi a wɔn a wɔagye wɔn ayɛ wɔn mma no suban a wɔhwehwɛ nneɛma mu kodu no ada adi sɛ ɛyɛ nea wontumi nhu; nhwehwɛmu ahorow kyerɛ sɛ nsakrae kɛse wɔ hɔ.[179] Ɔfã bi no, ɔhaw no fi nnipa kakraa bi a wɔagye wɔn ayɛ wɔn mma a ɛma nhwehwɛmu a wɔyɛ no kwa no yɛ den, sɛ ɛnyɛ nea ɛrentumi nyɛ yiye mpo a.

Ne nyinaa mu no, wobetumi anya nneɛma bi a ɛkyerɛ sɛnea wɔn a wɔagye wɔn ayɛ wɔn mma no ani gye ho sɛ wɔbɛhwehwɛ nneɛma mu no afi England ne Wales asɛm a ebuee wɔn a wɔagye wɔn ayɛ wɔn mma no awo ho kyerɛwtohɔ ahorow mu wɔ 1975. U.K. Office for National Statistics no ahyɛ ho nkɔm sɛ awiei koraa no, wɔn a wɔagye wɔn ayɛ wɔn mma no nyinaa mu 33% bɛsrɛ sɛ wɔmfa bi mma wɔn wɔn awo ho kyerɛwtohɔ a edi kan no mu, a ɛboro mfitiase nkɔmhyɛ ahorow a wɔkae wɔ 1975 mu bere a na wogye di sɛ nnipa dodow a wɔagye wɔn ayɛ wɔn mma no mu kakraa bi pɛ na wɔbɛbisa wɔn kyerɛwtohɔ no so no. Nanso, wonim sɛ nsusuwii no bu nhwehwɛmu dodow ankasa no adewa, efisɛ nnipa pii a wɔagye wɔn ayɛ wɔn mma wɔ saa bere no mu no nam akwan foforo so nya wɔn awo ho kyerɛwtohɔ.[180]

Nhwehwɛmu nhoma ahorow no ka sɛ wɔn a wɔagye wɔn ayɛ wɔn mma no de nneɛma anan a enti wɔpɛ sɛ wɔsan hyiam ma: 1) wɔpɛ sɛ wonya abusua anato a edi mũ kɛse, 2) wɔpɛ sɛ wohu nsɛm a esisi a ɛde wɔn nyinsɛn, awo, ne wɔn a wogyae mu no, 3) wɔwɔ anidaso sɛ wɔde nsɛm bɛma wɔn mma , ne 4) wohia abɔde a nkwa wom ho nsɛm a ɛkɔ akyiri, a aduruyɛ ho nsɛm ka ho. Nanso, nhwehwɛmufo a wɔyɛ mmofra a wɔfa wɔn sɛ wɔn mma no susuw sɛ ntease ahorow a wɔde ama no nni mũ: ɛwom sɛ obi a ɔto so abiɛsa betumi de nsɛm a ɛte saa ama de, nanso nsɛm a wobisabisaa wɔn a wɔagye wɔn ayɛ wɔn mma, a wɔhwehwɛɛ sɛ wɔbɛsan ahyiam no, hui sɛ wɔdaa hia a ehia sɛ wodi abɔde mu abusuabɔ ho dwuma ankasa adi.

Ɛte sɛ nea ɔpɛ a ɛwɔ hɔ sɛ wɔbɛsan ahyiam no ne nea wɔagye no ayɛ ne ba no nkitahodi ne ɔmanfo a wogye tom wɔ mpɔtam hɔ no wɔ abusuabɔ. Nsusuwii ahorow a wɔde wɔn adwene si wɔn mu so kyerɛ sɛ wɔn a wɔagye wɔn ayɛ wɔn mma no binom wɔ nsɛm a emu nna hɔ wɔ wɔn ho a wɔte nka no mu, na ɛma wotumi de nipasu a ɛkɔ so daa kyerɛ no sɛe. Reunion boa ma wosiesie ne ho nimdeɛ a wonni no.[182]

Nea ɛne eyi bɔ abira no, nsusuwii ahorow a wɔde wɔn adwene si akyi no kyerɛ sɛ wɔn a wɔagye wɔn ayɛ wɔn mma no fa so di asetra mu animtiaabu so. Goffman na odii kan de nsusuwii no too gua, na ɛwɔ afã anan: 1) wɔn a wɔagye wɔn ayɛ wɔn mma no hu sɛ abɔde mu abusuabɔ a enni hɔ no kyerɛ nsonsonoe a ɛda wɔn abusua a wɔagye wɔn ayɛ wɔn mma no ntam wɔ afoforo ho, 2) osuahu ahorow a wɔn a wɔnnye wɔn mma no kyerɛ sɛ abusuabɔ a wɔde gye wɔn ayɛ wɔn mma no yɛ mmerɛw sen mogya mu abusuabɔ no hyɛ ntease yi mu den, ) sɛ wɔka bom a, saa nneɛma yi ma, wɔ wɔn a wɔagye wɔn ayɛ wɔn mma no binom mu no, wɔte nka sɛ wɔayi wɔn afi asetra mu, na 4) saa wɔn a wɔagye wɔn ayɛ wɔn mma yi yɛ wɔn ade denam mogya a wɔde kyekyere wɔn ho a wɔhwehwɛ a ɛhyɛ wɔn a wɔyɛ ɔmanfo no mu den no so. Ntease a ɛfa akyi a wɔde wɔn adwene si so wɔ sanba ho no kyerɛ sɛ ebia wɔn a wɔagye wɔn ayɛ wɔn mma no bɛyɛ nsakrae yiye na wɔwɔ anigye wɔ wɔn mmusua a wɔagye wɔn ayɛ wɔn mma no mu, nanso wɔbɛhwehwɛ sɛ mmɔden a wɔbɔ sɛ wobesiesie osuahu ahorow a ɛfa asetra mu animtiaabu ho.[181]

Wɔn a wɔagye wɔn ayɛ wɔn mma no bi pow adwene a ɛne sɛ wɔbɛsan ahyiam no. Nanso, nea ɛma ɛsono wɔn a wɔagye wɔn ayɛ wɔn mma a wɔhwehwɛ wɔn no ne wɔn a wɔnhwehwɛ no mu no mu nna hɔ. Krataa biako bɔ nhwehwɛmu no mua, na ɛka sɛ, &quot;...mmɔden a wɔbɔ sɛ wɔbɛma nsonsonoe aba nea ɔhwehwɛ ne nea ɔnyɛ nhwehwɛmu no ntam no nyɛ nea ɛyɛ nea ɛyɛ nokware anaasɛ ɛyɛ nea wotumi de di dwuma wɔ ɔkwan a ɛkɔ akyiri so sen mmɔden a wɔbɔ sɛ wɔbɛkyerɛ ... nsonsonoe a ɛda wɔn a wɔagye wɔn ayɛ wɔn mma ne wɔn a wɔamfa wɔn ayɛ wɔn mma ntam.&quot;[183]

Sɛ yɛbɛka no tiawa a, nhyiam a wɔsan hyia no betumi de nsɛm ahorow aba wɔn a wɔagye wɔn ayɛ wɔn mma ne awofo so. Ne nyinaa mu no, ɛte sɛ nea nea efi mu ba a wɔsan hyiam no mu dodow no ara yɛ nea eye. Wɔ nhwehwɛmu kɛse a wɔayɛ de besi nnɛ (a egyina mmuae a nnipa 1,007 a wɔafa wɔn ayɛ wɔn mma ne awofo a wogyaee no de mae so) 90% buae sɛ sankɔhwɛ yɛ osuahu a mfaso wɔ so. Nanso, eyi nkyerɛ sɛ wɔhyehyɛɛ abusuabɔ a ɛkɔ so wɔ nea wɔagye no ayɛ ne ba ne ɔwofo ntam anaasɛ eyi ne botae no.[184]

'''Nneyɛe a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho a akyinnyegye wom'''

Hwɛ nso: Nsisi a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho

Wɔde mmɔden a wɔbɔ sɛ wɔbɛyɛ nsakrae ne abusua a wɔbɛkora wɔn so no nso abata sɛnea wosusuw sɛ wɔde mmofra a wɔfa wɔn sɛ wɔn mma no di dwuma ɔkwammɔne so no ho denneennen. Wɔ tebea horow bi mu no, wɔagyae awofo hokwan ahorow bere a ɔmanfo abu wɔn mmusuakuw anaa wɔn asetra mu sikasɛm kuw no sɛ wɔmfata no. Ná nnipa pii gye nneyɛe yi bi tom na

== Amammerɛ mu nsakrae ahorow ==
Suban ne mmara a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho no gu ahorow kɛse. Bere a amammerɛ nyinaa yɛ nhyehyɛe ahorow a mmofra a wɔn awofo a wɔwoo wɔn no nni hɔ a wobetumi atete wɔn no, afoforo betumi atete wɔn no, ɛnyɛ amammerɛ nyinaa na wɔwɔ adwene a ɛne sɛ wobegye wɔn ayɛ wɔn mma, a ɛne sɛ wɔbɛfa mmofra a wɔne wɔn ho nni abusuabɔ sɛ wɔne awofo a wɔagye wɔn ayɛ wɔn mma no mma a wɔwoo wɔn no yɛ pɛ. Sɛ nhwɛso no, wɔ Nkramofo Mmara ase no, ɛsɛ sɛ mmofra a wɔagye wɔn ayɛ wɔn mma no de wɔn mfitiase abusua din sie na ama wɔahu wɔn ne mogya mu abusuabɔ,[213] na, sɛnea wɔtaa yɛ no, mmea hyɛ hijab wɔ mmarima anim wɔ wɔn afie a wɔagye wɔn ayɛ wɔn mma no mu. Wɔ Egypt no, saa amammerɛ mu nsonsonoe ahorow yi ama wɔayɛ mmofra a wɔfa wɔn sɛ wɔn mma no ayɛ nea mmara mma ho kwan mmom sɛ wɔbɛpaw nhyehyɛe a ɛfa mmofra a wɔhwɛ wɔn wɔ mmofraase ho.[214][215]

== Da a Wɔde Kɔ Fie ==


Wɔ aman bi te sɛ United States mu no, &quot;Homecoming Day&quot; yɛ da a obi a wɔagye no ayɛ ne ba no ne wɔn abusua foforo a wɔagye no ayɛ wɔn mma no bom wɔ aban kwan so.[216]</text>
      <sha1>frevwgvvf2j20k7ahcltgrrwhz7ndm5</sha1>
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      <text bytes="67853" xml:space="preserve">'''Mmofra''' ({{Audio|tw-Abanoma.ogg|pronounciation of &quot;Abanoma&quot;}})a wɔfa wɔn sɛ wɔn mma yɛ adeyɛ a obi fa no sɛ ɔfoforo, mpɛn pii no abofra, awofoyɛ no fi saa onipa no ɔwofo anaa n’awofo a ɔwoo no ankasa anaa mmara kwan so no hɔ. Mmara kwan so mmofra a wɔfa wɔn sɛ wɔn mma no de hokwan ne asɛyɛde ahorow nyinaa, ne ayɔnkofa ho, fi awofo a wɔwoo wɔn no hɔ kɔ awofo a wɔfa wɔn sɛ wɔn mma no so daa.

Nea ɛnte sɛ awɛmfo anaa nhyehyɛe afoforo a wɔayɛ ama mmerante ne mmabaa a wɔbɛhwɛ wɔn no, atirimpɔw ne sɛ wɔbɛma mmofra a wɔfa wɔn sɛ wɔn mma no ayɛ nsakrae a ɛbɛtra hɔ daa wɔ wɔn gyinabea mu na sɛnea ɛte no, ɛhwehwɛ sɛ ɔmanfo gye tom, denam mmara anaa nyamesom mu asotwe so. Abakɔsɛm mu no, fekuw ahorow bi ahyɛ mmara pɔtee bi a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho, bere a afoforo de akwan horow a ɛnyɛ mmara kwan so de dii dwuma (titiriw apam ahorow a ɛkyerɛ agyapade hokwan ahorow ne awofo asɛyɛde ahorow a wɔmfa wɔn a wɔde wɔn ho hyɛ mu foforo nka ho). Nnɛyi nhyehyɛe ahorow a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho, a ɛsɔree wɔ afeha a ɛto so 20 yi mu no taa yɛ nea mmara ne nhyehyɛe ahorow a edi mũ na edi so. 

== Abakɔsɛm ==
'''Tete nneɛma'''

'''Agyede a wogye ma wɔn a wɔawo wɔn yiye'''

Bere a nnɛyi kwan a wɔfa so gye wɔn ba no puei wɔ United States no, adeyɛ no akwan horow puei wɔ abakɔsɛm nyinaa mu.[1] Sɛ nhwɛso no, Hammurabi Mmara no ka hokwan ahorow a wɔn a wɔagye wɔn ayɛ wɔn mma no wɔ ne ankorankoro a wɔagye wɔn ayɛ wɔn mma no asɛyɛde ahorow ho asɛm kɔ akyiri. Wɔakyerɛw adeyɛ a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma wɔ tete Roma no ho asɛm yiye wɔ Codex Justinianus mu.[2][3]

Ɛsono koraa wɔ nnɛyi bere no ho no, tete nneyɛe a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho no si amammui ne sikasɛm mu anigyede a ɛfa nea ɔfaa no ba no ho so dua,[4] na ɛde mmara kwan so adwinnade bi a ɛhyɛɛ amammui mu abusuabɔ a ɛda mmusua a wɔwɔ sika ntam no mu den na ɛmaa mmarima adedifo a wɔhwɛ agyapade so mae. Wɔakyerɛw sɛnea adehye no de di dwuma sɛ wɔn mma no ho asɛm yiye: na Roma ahempɔn no mu pii yɛ mmabarima a wɔafa wɔn ayɛ wɔn mma.[6] Ná adrogation yɛ Romafo a wɔfa wɔn sɛ wɔn mma no bi a onipa a wɔfa no sɛ ne ba no pene so sɛ ɔfoforo begye no ayɛ ne ba.

Ɛte sɛ nea nkokoaa a wɔfa wɔn sɛ wɔn mma wɔ Tete mmere mu no ntaa mma.[4][7] Na wɔtaa fa mmofra a wɔagyaw wɔn hɔ no ma wɔyɛ nkoa[8] na na wɔyɛ Ahemman no nkoa a wɔde ma no ɔha biara mu nkyem kɛse.[9][10] Romafo mmara mu kyerɛwtohɔ ahorow kyerɛ sɛ ɛtɔ mmere bi a na mmusua fa mmofra a wɔahu wɔn no na wɔtete wɔn sɛ ɔbabarima anaa ɔbabea. Ɛwom sɛ wɔtaa mfa wɔn mma wɔ Roma Mmara ase de, nanso wɔtetee mmofra no a wɔfrɛ wɔn alumni no wɔ nhyehyɛe bi a ɛte sɛ ɔhwɛfo mu, na wobuu wɔn sɛ agya a ogyaw wɔn hɔ no agyapade.[11]

Tete anibuei afoforo, titiriw India ne China, de ɔkwan bi a wɔfa so gye wɔn ba nso dii dwuma. Adanse kyerɛ sɛ na adeyɛ yi botae ne sɛ ɛbɛma amammerɛ ne nyamesom nneyɛe akɔ so; nea ɛne Atɔe Famfo adwene a ɛne sɛ wɔbɛtrɛw abusua ahorow mu no bɔ abira. Wɔ tete India no, ɔbabarimayɛ a ɛto so abien, a Rigveda kasa tia no pefee no,[12] kɔɔ so, wɔ ɔkwan a anohyeto wom na ɛyɛ amanne kɛse so, sɛnea ɛbɛyɛ a obi a ɔfa ne ba no betumi anya ayiyɛ ho amanne a ɛho hia a ɔbabarima bɛyɛ. China wɔ adwene a ɛte saa ara a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma a mmarima a wɔfa wɔn sɛ wɔnyɛ wɔn mma sɛ wɔmfa nyɛ nananom som nnwuma nkutoo ho.[14]

Ná adeyɛ a ɛne sɛ wobegye abusua mufo ne nnamfo paa mma ayɛ wɔn mma no abu so wɔ Polynesia amammerɛ ahorow mu a Hawaii a na wɔfrɛ amanne no sɛ hānai ka ho.

'''Mfinimfini mmere kosi nnɛyi bere so'''

Adoption ne nnipa mpapahwekwa

Germanfo, Celtfo, ne Slavfo amammerɛ a na ɛwɔ Europa so wɔ Roma Ahemman no asehwe akyi no anuonyamfo no kasa tiaa adeyɛ a ɛne sɛ wɔfa wɔn sɛ wɔn mma no.[15] Wɔ mfinimfini mmere mu ɔmanfo mu no, na mogya ahorow na ɛho hia sen biara; wɔde ahemman a edi tumi a na onni ɔdedifo a ɛda adi sɛ &quot;wɔwoo no wɔ abɔde mu&quot; no sii ananmu, na ɛne Romafo atetesɛm ahorow bɔ abira koraa. Europa mmara a ɛdannan no da saa akyide a wɔmpɛ sɛ wɔfa wɔn sɛ wɔn mma no adi. Sɛ nhwɛso no, Engiresifo mmara a wɔtaa de di dwuma no amma kwan mma wɔmfa obi mma efisɛ na ɛne agyapade ho mmara a wɔtaa de di dwuma no bɔ abira. Wɔ saa kwan koro no ara so no, France Napoleon Mmara no maa ɛyɛ den sɛ wobegye mmofra ayɛ wɔn ba, na ɛhwehwɛɛ sɛ wɔn a wɔfa no sɛ wɔn ba no di boro mfe 50, wonni mma, anyɛ yiye koraa no, wɔn mfe 15 sen nea wɔagye no ayɛ wɔn ba no, na anyɛ yiye koraa no, wɔatete nea wɔagye no ayɛ wɔn ba no mfe asia. Nanso, mmofra a wɔfa wɔn sɛ wɔn mma no bi kɔɔ so bae, nanso ɛbɛyɛɛ nea ɛnyɛ ɔkwan biara so, a egyina apam ahorow a wɔyɛe bere tiaa bi so. Sɛ nhwɛso no, wɔ afe 737 mu no, wɔ mmara bi a efi Lucca kurow mu mu no, wɔyɛɛ nnipa baasa a wɔagye wɔn ayɛ wɔn mma no agyapade bi adedifo. Te sɛ nhyehyɛe afoforo a ɛwɔ hɔ nnɛ no, apam no sii asɛyɛde a ɛda nea wɔagye no ayɛ ne ba no so dua sen sɛ obegye ne ba no, na ɛtwee adwene sii nokwasɛm a ɛyɛ sɛ, wɔ apam no ase no, na wɔayɛ sɛ wɔbɛhwɛ agya a ɔfaa no ayɛ ne ba no wɔ ne nkwakoraabere mu no so; adwene a ɛte sɛ nsusuwii ahorow a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho wɔ Roma mmara ase no.[17]

Europa amammerɛ mu nsakrae no hyɛɛ bere a wɔyɛɛ nneɛma foforo a ɛho hia a wɔde gye toom no agyirae. Esiane sɛ wɔamfa mmoa a efi atitiriw no hɔ nti, adeyɛ no dan kɔɔ mmofra a wɔagyaw wɔn hɔ no so nkakrankakra. Nnipa a wogyaw wɔn hɔ no kɔɔ soro bere a ahemman no hwee ase no na wogyaw mmofra a wohuu wɔn no pii wɔ Asɔre no pon ano.[18] Mfiase no, asɔfo no yɛɛ wɔn ade denam mmara a wɔhyehyɛe de kyerɛ sɛnea wɔbɛpa mmofra a wɔagyaw wɔn hɔ no ho ntama, atɔn, na wɔatete wɔn no so. Nanso, ade foforo a Asɔre no yɛe ne afɔrebɔ ho adeyɛ, a ɛnam so hyira mmofra so sɛ wɔnyɛ asɔremma asetra wɔ nkokorafie ahyehyɛde ahorow mu na wɔtete wɔn wɔ nkokorafie bi mu. Eyi na ɛde nhyehyɛe a edi kan wɔ Europa abakɔsɛm mu a mmofra a wɔagyaw wɔn hɔ no nni mmara, asetra, anaa abrabɔ mu ɔhaw ahorow. Ne saa nti, Europa mmofra a wɔagyaw wɔn hɔ na wɔayɛ nyisaa no mu pii bɛyɛɛ Asɔre no sukuufo dedaw, na ɛno nso faa dwuma sɛ obi a ɔhwɛ wɔn sɛ wɔn mma. Oblation hyɛ nsakrae a ɛkɔ ahyehyɛde ahorow mu no mfiase agyirae, na awiei koraa no ɛde ayaresabea a wɔde sii hɔ ne nyisaa atrae no sii hɔ.[18]

Bere a adwene a ɛfa ahyehyɛde mu hwɛ ho no nyaa adwene no, mmara a wɔahyɛ da ahyɛ da puei wɔ sɛnea wɔde mmofra bɛto mmusua mu: mmarimaa betumi abɛyɛ obi a osua adwumfo na mmeawa betumi aware wɔ ahyehyɛde no tumi ase. Asoɛe ahorow gyee mmofra nso sɛ wɔn mma wɔ ɔkwan a ɛnyɛ ɔhyɛ so, adwinnade a wɔfaa no sɛ ɔkwan a wɔfa so nya adwumayɛfo a wɔn bo nyɛ den, a nokwasɛm a ɛyɛ sɛ bere a wɔn a wɔagye wɔn ayɛ wɔn mma no wuwu no, abusua no de wɔn afunu san kɔ asoɛe no mu ma wosie no da no adi.

Saa nhyehyɛe a ɛfa adesua ne mmofra a wɔfa wɔn sɛ wɔn mma wɔ ɔkwan a ɛnyɛ ɔkwan pa so ho yi trɛw kɔɔ afeha a ɛto so 19 no mu, a nnɛ wobu no sɛ nsakrae fã ma mmofra a wɔfa wɔn sɛ wɔn mma ho abakɔsɛm. Wɔ asetra mu yiyedi ho adwumayɛfo akwankyerɛ ase no, nyisaa guankɔbea ahorow fii ase hyɛɛ mmofra a wogyina nkate so a wɔfa wɔn sɛ wɔn mma no ho nkuran sen sɛ wɔbɛyɛ adwuma; wɔde mmofra too apam ahorow a wɔde bɛhwɛ wɔn sɛ abusua mufo ase sen sɛ wɔde bɛto apam ahorow a ɛfa adesua ho ase.[21] Wogye di sɛ saa nhwɛso yi nkɔso no na ɛmaa Massachusetts Amanaman Nkabom no hyehyɛɛ nnɛyi mmara a edi kan a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho wɔ 1851 mu, a ɛyɛ soronko wɔ sɛnea ɛhyehyɛɛ adwene a ɛne sɛ &quot;abofra no yiyedi yiye&quot; no. Nanso, ɛmfa ho ne atirimpɔw no, wɔ nneyɛe mu no, nhyehyɛe no yɛɛ adwuma te sɛ honam a edi kan no. Boston Female Asylum (BFA) no suahunu yɛ nhwɛsoɔ pa, a na ɛwɔ ne soboɔ no mu bɛyɛ 30% a wɔagye atom wɔ afe 1888 mu.[24] BFA mpanyimfo kae sɛ, ɛwom sɛ guankɔbea no hyɛɛ ho nkuran sɛ ɛnte saa de, nanso awofo a wɔfa wɔn sɛ wɔn mma no ankyerɛ nsonsonoe a ɛda indenture ne mmofra a wɔfa wɔn sɛ wɔn mma no ntam: &quot;Yegye di,&quot; guankɔbea mpanyimfo no kae sɛ, &quot;sɛ mpɛn pii no, sɛ wɔfa mmofra a wonnii mfe pii sɛ wɔmfa wɔn mma a,... agyede yɛ din foforo a wɔde frɛ ɔsom ara kwa.&quot;[25]

'''Nnɛyi bere'''

Fapem a wɔde bɛbɔ abusua

Nneɛma a edi hɔ a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho no dannan wɔn ho no hwee United States man a na ɛrenya nkɔso no nsam. Atubrafo a wɔbae ntɛmntɛm ne Amerika Ɔmanko no maa nyisaa atrae ne mmofra a wɔahu wɔn afie dɔɔso dodo wɔ afeha a ɛto so dunkron no mfinimfini a ebi mmae da. Charles Loring Brace a na ɔyɛ Protestantfo ɔsomfo no ho dwiriw no wɔ waiffo dɔm a wonni afie a na wɔrekyinkyin New York Kuropɔn no mmɔnten so no ho. Brace buu mmerante ne mmabaa a wɔagyaw wɔn hɔ, titiriw Katolekfo, sɛ wɔyɛ ade a ɛyɛ hu sen biara a ɛrekasa atia kurow no nhyehyɛe.[26][27]

Wɔkaa n’ano aduru ho asɛm wɔ The Best Method of Disposing of Our Pauper and Vagrant Children (1859) a efii Nyisaa Keteke kuw no ase no mu. Awiei koraa no, keteke ahorow a ɛyɛ nyisaa no de mmofra bɛyɛ 200,000 fii Apuei Fam nkurow akɛse mu kɔɔ ɔman no nkuraase.[28] Mpɛn pii no, na wɔde mmofra no ahyɛ mmusua a wɔde wɔn kɔ mu no nsa, sen sɛ wɔbɛfa wɔn ayɛ wɔn mma.[29] Sɛnea na ɛte wɔ mmere a atwam no mu no, na wɔtete mmofra binom sɛ abusua no mufo bere a na afoforo nso yɛ mfuw mu adwumayɛfo ne afie mu asomfo. Nnipa a wɔatu wɔn afi wɔn afie mu no kɛse koraa—mmofra a wotu kɔtra mmeae foforo sen biara wɔ abakɔsɛm mu—ne sɛnea wɔde wɔn dii dwuma ɔkwammɔne so a ɛkɔɔ so no maa wɔhyehyɛɛ nnwumakuw foforo ne mmara ahorow a ɛhyɛɛ nhyehyɛe ahorow a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho nkuran sen sɛ wɔde wɔn ho bɛma. Bere no agyiraehyɛde ne Minnesota mmara a ɛfa mmofra a wɔfaa wɔn mma ho wɔ 1917 mu, a ɛhyɛɛ sɛ wɔnyɛ nhwehwɛmu wɔ mmeae a wɔde wɔn kɔe nyinaa ho na wɔmma wɔn a wɔde wɔn ho hyɛɛ mmofra a wɔfaa wɔn no mu no nnya kyerɛwtohɔ pii.[30][31]

Wɔ saa bere koro no ara mu no, Progressive kuw no faa United States a na botae titiriw ne sɛ ɛbɛma nyisaa atrae nhyehyɛe a na ɛwɔ hɔ no aba awiei. Mmɔdenbɔ a ɛte saa no awiei bae wɔ White House Nhyiam a Edi Kan a Ɛfa Mmofra a Wɔde Wɔn Ho To Wɔn So Hwɛ Ho a Ɔmampanyin Theodore Roosevelt frɛɛ no ​​wɔ 1909 mu,[32] faako a wɔkae sɛ nuklea abusua no gyina hɔ ma &quot;anibuei ade a ɛkorɔn na eye sen biara&quot; na eye sen biara no a otumi som sɛ ɔhwɛfo titiriw ma wɔn a wɔagyaw wɔn hɔ ne wɔn a wɔayɛ nyisaa.[33][34] Wɔ 1923 mu tɔnn no, na mmofra a wɔn awofo nhwɛ wɔn no mu ɔha biara mu abien pɛ na na wɔwɔ afie a wɔhwɛ wɔn sɛ wɔn mma mu, na nea aka no wɔ nhyehyɛe a wɔde hwɛ mmofra ne nyisaa atrae. Annu mfe aduanan akyi no, na ɛkame ayɛ sɛ nkyem abiɛsa mu biako wɔ afie a wɔhwɛ wɔn sɛ wɔn mma mu.[35]

Ne nyinaa mu no, eugenic adwene a agye din wɔ Amerika no de akwanside ahorow bae wɔ mmofra a wɔfa wɔn sɛ wɔn mma no nkɔso mu.[36][37] Na nneɛma a ɛhaw adwene kɛse wɔ mmofra a wɔnyɛ mmara ne ahiafo awosu mu su pa ho, a ebia nea ɛyɛ nhwɛso yiye ne Henry H. Goddard nkyerɛwee a ɛwɔ nkɛntɛnso a ɔkasa tiaa mmofra a wonnim faako a wogye wɔn sɛ wɔn mma no, na ɔkae sɛ, .

Afei ɛba sɛ nnipa binom ani gye adesamma abusua no yiyedi ne nkɔso a ɛkorɔn ho; nanso sɛ yɛde saa nnipa soronko no to nkyɛn a, agyanom ne ɛnanom nyinaa ani gye wɔn ankasa mmusua yiyedi ho. Ade a awofo koma ani gye ho paa ne sɛ wɔbɛma mmofra no aware yiye na wɔatete abusua a ɛkorɔn. Hwɛ sɛnea ɛyɛ adwene tiawa saa bere no sɛ abusua a ɛte saa begye abofra bi a wonnim n’abusua mu abusua koraa no akɔ ne mfinimfini; anaasɛ, baabi a, sɛ wonim no fã bi a, nea ebetumi aba no mu yɛ den sɛ ɛbɛkyerɛ mmoa a wɔyɛ ahiafo na wɔyare, na sɛ ɛsɛ sɛ aware bi kɔ so wɔ saa onipa no ne abusua no muni biara ntam a, asefo no asɛe.

Bere a efi 1945 kosi 1974, nkokoaa a wɔde wɔn gu mu bere no, huu nkɔso ntɛmntɛm na wogyee sɛ wɔfa wɔn sɛ wɔn mma sɛ ɔkwan a wɔfa so kyekye abusua.[39] Awo a mmara mma ho kwan kɔɔ soro mprɛnsa wɔ Wiase Ko II akyi, bere a nna ho nneyɛe sesae no. Bere koro no ara mu no, nyansahufo kuw no fii ase sii so dua sɛ ntetee di awosu so tumi, na wɔde eugenic animtiaabu no fii hɔ.[40][41] Wɔ saa tebea yi mu no, mmofra a wɔfa wɔn sɛ wɔn mma no bɛyɛɛ ano aduru a ɛda adi pefee maa nnipa a wɔnwaree ne awarefo a wontumi nwo nyinaa.[42]

Sɛ wɔka saa nneɛma yi bom a, ɛma wonya Amerikafo nhwɛso foforo a wɔde begye atom. Wɔ Romafo a edii n’anim no akyi no, Amerikafo twaa hokwan ahorow a awofo a wodi kan no wɔ mu bere a wɔmaa wɔn a wɔfa wɔn sɛ wɔn mma no yɛɛ awofo foforo wɔ mmara no ani so no. Wɔde nneɛma foforo abien kaa ho: 1) na atirimpɔw ne sɛ wɔbɛfa mmofra ayɛ wɔn mma sɛ wɔbɛhwɛ ma &quot;abofra no yiyedi a eye sen biara&quot;, wobetumi ahu saa adwene yi aba no afi Amerikafo mmara a edi kan a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho wɔ Massachusetts no mu,[16][23] ne 2) mmofra a wɔfa wɔn sɛ wɔn mma no bɛyɛɛ nea wɔde hyɛɛ mu a ɛyɛ kokoamsɛm, na awiei koraa no ɛmaa wɔsɔɔ mmofra a wɔfaa wɔn sɛ wɔn mma ne awo ho kyerɛwtohɔ ahorow a edi kan no ano wɔ 1945. Charles Loring Brace a ɔde bae sɛnea ɛbɛyɛ a mmofra a wofi Nyisaa Keteke ahorow no mu no rensan nkɔ wɔn awofo nkyɛn anaasɛ wɔbɛsan agye wɔn no mfiase no. Ná Brace suro nkɛntɛnso a awofo no ohia, wɔ ɔkwan a ɛkɔ akyiri so, ne Katolek som titiriw, benya wɔ mmabun no so. Saa atetesɛm a ɛfa kokoamsɛm ho yi, akyiri yi Nkɔsofo nsakraefo no na wɔkɔɔ so bere a wɔreyɛ Amerika mmara ahorow no.[43]

Nnipa dodow a wɔfaa wɔn mma wɔ United States no kɔɔ soro sen biara wɔ 1970 mu.[44] Ɛnyɛ nea wobetumi ahu nea ɛde ɔhwe a edii akyi bae no bae. Nneɛma a ɛbɛyɛ sɛ ɛde bae wɔ 1960 ne 1970 mfe no mu no bi ne awo dodow a ɛso tew, a ɛne aduru no a wɔde bae no wɔ abusuabɔ, akwan a wɔfa so siw awo ano a wɔde ayɛ adwuma a wɔde ahyɛ mmara ase a wɔawie, ɔman no sika a wɔde maa abusua nhyehyɛe ho adwuma a wɔde bɛma mmerante ne mmabaa ne wɔn a wɔba fam no - sika a wonya, ne nyinsɛn a wotu gu ho mmara kwan so. Bio nso, mfeɛ a ɛwɔ 1960 mfeɛ no awieeɛ ne 1970 mfeɛ no mfitiaseɛ no hunuu nsakraeɛ kɛseɛ wɔ ɔmanfoɔ adwene wɔ mmara kwan so ne mmara kwan so hokwan[45] a wɔn a wɔwoo wɔn wɔ awareɛ akyi wɔ no mu. Nea ɛbɛyɛ na wɔabua no, mmɔden a wɔbɔe sɛ wɔbɛkora abusua so no nyaa nkɔanim[46] ma enti mmofra kakraa bi na wɔwo wɔn wɔ aware akyi nnɛ na wɔfa wɔn sɛ wɔn mma. Anwonwasɛm ne sɛ, mmofra a wɔfa wɔn sɛ wɔn mma no da adi kɛse koraa na wɔka ho asɛm wɔ ɔmanfo mu nnɛ, nanso ɛnyɛ nea abu so kɛse.[47]

Awiei koraa no, Amerikafo nhwɛso a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho no dɔɔso wɔ wiase nyinaa. England ne Wales de wɔn mmara a edi kan a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho sii hɔ wɔ 1926. Netherlands too ne mmara wɔ 1956. Sweden maa wɔn a wɔagye wɔn ayɛ wɔn mma no yɛɛ abusua no mufo koraa wɔ 1959. West Germany hyɛɛ ne mmara a edi kan wɔ 1977 mu. Bio nso, Asia tumi ahorow no buee wɔn nyisaa atrae nhyehyɛe ahorow no maa wɔfaa wɔn mma, a Atɔe Famfo adwene a edii atubrafo nniso ne asraafo tumidi akyi nyaa so nkɛntɛnso sɛnea na ɛte no.[49] Wɔ France no, ɔman ahyehyɛde ahorow a ɛwɔ mpɔtam hɔ no ma wɔn a wɔpɛ sɛ wɔfa wɔn sɛ wɔn mma no tom, na afei wobetumi ne nyisaa atrae ahorow a ɛwɔ amannɔne adi nkitaho anaasɛ wɔabisa mmoa afi NGO ahorow hɔ. Nhyehyɛe no mfa sikatua ho, na mmom ɛma tumi kɛse ma asetra mu adwumayɛfo a wɔn gyinaesi ahorow betumi asiw mmofra a wɔfa wɔn sɛ wɔn mma no ano hye wɔ mmusua a &quot;ɛwɔ gyinapɛn&quot; mu (mfinimfini mfe, sika a wonya fi mfinimfini kosi kɛse, mmarima a wɔne wɔn ho da, Caucasianfo).[50]

Wɔyɛ mmofra a wɔfa wɔn sɛ wɔn mma no ho dwuma nnɛ wɔ wiase nyinaa. Nsɛm a ɛwɔ ase ha no de Atɔe Famfo dodow a wɔfa wɔn sɛ wɔn mma no ho mfonini ntɛm ara ma. Mmofra a wɔfa wɔn sɛ wɔn mma wɔ United States no da so ara kɔ so wɔ dodow a ɛreyɛ adu n’atipɛnfo de no mmɔho abiɛsa ɛwom mpo sɛ mmofra dodow a wɔretwɛn sɛ wobegye wɔn ayɛ wɔn mma no akɔ so ayɛ nea ɛkɔ so daa wɔ nnansa yi mfe mu, efi 100,000 kosi 125,000 wɔ bere a efi 2009 kosi 2018 no mu

== Nnɛyi mmofra a wɔfa wɔn sɛ wɔn mma ==
'''Akwan horow a wɔfa so gye wɔn ba'''

Nnɛyi nneyɛe a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho no betumi abue anaasɛ wɔato mu.

Awofo a wɔfa wɔn sɛ wɔn mma ne wɔn a wɔwoo wɔn no ma wotumi hu nsɛm a wɔde di nkitaho wɔ abusuafo ne nea wɔagye no ayɛ wɔn ba no ntam.[70] Awofo a wɔfa wɔn sɛ wɔn mma a wɔn nkutoo na wɔhwɛ abofra no so no betumi ayɛ nhyehyɛe a ɛnyɛ ɔkwan biara so. Wɔ tumidi ahorow bi mu no, awofo a wɔwoo wɔn ne wɔn a wɔagye wɔn ayɛ wɔn mma no betumi ayɛ apam a mmara ma ho kwan na ɛkyekyere wɔn a ɛfa nsrahwɛ, nsɛm a wɔde bɛsesa, anaa nkitahodi foforo a ɛfa abofra no ho.[71] Ɛde besi February 2009 no, U.S. aman 24 maa kwan sɛ wɔde apam ahorow a wɔabue ano a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho apam ahorow a mmara ma ho kwan no kaa mmofra a wɔfa wɔn sɛ wɔn mma no ho nhyehyɛe a etwa to no ho.[72]

Adeyɛ a ɛne sɛ wɔfa wɔn sɛ wɔn mma a wɔato mu (a wɔsan frɛ no kokoam anaasɛ kokoam mmofra a wɔfa wɔn sɛ wɔn mma),[73] a ɛnyɛ nea wɔtaa yɛ wɔ nnɛyi abakɔsɛm fã kɛse no ara mu no,[74] hyɛ nsɛm a ɛma wohu obi nyinaa ano, ɛkora so sɛ ɛyɛ kokoam na esiw awofo a wɔagye wɔn ayɛ wɔn mma no a wɔbɛda no adi no ano’, biological kin’s, ne wɔn a wɔagye wɔn ayɛ wɔn mma no ho nsɛm. Ne nyinaa mu no, agyede a wɔato mu no betumi ama wɔatumi de nsɛm a ɛnyɛ nea ɛkyerɛ sɛ obi yɛ te sɛ aduruyɛ ho abakɔsɛm ne nyamesom ne mmusuakuw a wofi mu akɔma afoforo.[75] Ɛnnɛ, esiane guankɔbea ahobammɔ ho mmara a U.S. aman bi ahyɛ mu nti, kokoam mmofra a wɔfa wɔn sɛ wɔn mma no renya nkɛntɛnso foforo. Wɔ aman a wɔfrɛ no &quot;dan a ahobammɔ wom&quot; mu no, wobetumi agyaw nkokoaa a wɔmmɔ wɔn din wɔ ayaresabea ahorow, odumgyafo adwumayɛbea ahorow, anaa polisifo adwumayɛbea ahorow mu wɔ nna kakraa bi akyi wɔ awo akyi, adeyɛ a ahyehyɛde ahorow bi a wɔkamfo mmofra a wɔfa wɔn sɛ wɔn mma no kasa tia sɛ ɛyɛ nea ɛkɔ akyi na asiane wom.

Sɛnea mmofra a wɔfa wɔn sɛ wɔn mma no fi ase


Mmofra a wɔfa wɔn sɛ wɔn mma no betumi aba wɔ nnipa a wɔyɛ abusuafo anaa wɔn a wɔnyɛ abusuafo ntam. Wɔ abakɔsɛm mu no, na mmofra a wɔfa wɔn sɛ wɔn mma dodow no ara kɔ so wɔ abusua bi mu. Nsɛm a aba nnansa yi ara a efi U.S. kyerɛ sɛ mprempren nnipa a wɔfa wɔn sɛ wɔn mma no mu bɛyɛ fã yɛ nnipa a wɔyɛ abusuafo ntam.[77] Eyi ho nhwɛso a wɔtaa de di dwuma ne &quot;ɔwofo a wɔyɛ mpena a wɔfa wɔn sɛ wɔn mma&quot;, baabi a ɔwofo hokafo foforo no fa abofra bi fi ɔwofo no abusuabɔ a atwam no mu wɔ mmara kwan so. Abusua mu mmofra a wɔfa wɔn sɛ wɔn mma nso betumi aba denam ahofama so, esiane awofo wu nti, anaasɛ bere a wontumi nhwɛ abofra no wɔ ɔkwan foforo so na abusua no muni bi pene so sɛ obegye adwuma no.

Ɛnyɛ bere nyinaa na mmofra a wofi wɔn pɛ mu yɛ ade a wofi wɔn pɛ mu yɛ. Wɔ aman bi mu, sɛ nhwɛso no, wɔ U.K. no, ade titiriw biako a ɛma mmofra a wɔde wɔn to hɔ sɛ wɔmfa wɔn mma no ne sɛ wɔayi wɔn afi baabi a wɔwoo wɔn no, mpɛn pii no aban ahyehyɛde bi te sɛ mpɔtam hɔ atumfoɔ. Nneɛma ahorow bi wɔ hɔ a enti woyi mmofra fi hɔ a ayayade ne anibiannaso ka ho, a ebetumi anya nkɛntɛnso a ɛtra hɔ daa wɔ nea wɔagye no ayɛ ne ba no so. Wɔbɛbɔ asetra mu adwumayɛfo amanneɛ wɔ nsɛm pii mu wɔ ahobammɔ ho asɛm bi a ɛfa abofra bi ho ho na wɔabisabisa abofra no yiyedi ho nsɛm. Mpɛn pii no, asetra mu nsɛm ho adwumayɛfo bɛhwehwɛ akwan a wɔbɛfa so ama abofra bi ne abusua a wɔwoo no no abom, sɛ nhwɛso no, denam mmoa foforo a wɔde bɛma abusua no ansa na wɔasusuw ho sɛ wobeyi abofra bi afi hɔ no so. Afei asɛnnibea bɛtaa asi gyinae ahorow afa abofra no daakye ho, sɛ nhwɛso no, sɛ ebia wobetumi asan akɔ abusua a wɔwoo wɔn no mu, akɔhwɛ mmofra a wɔhwɛ wɔn anaasɛ wɔafa wɔn ayɛ wɔn mma.

Awo a wontumi nwo ne ade titiriw nti a awofo hwehwɛ sɛ wobegye mmofra a wɔne wɔn nni abusuafo no ayɛ wɔn mma. Nhwehwɛmu bi kyerɛ sɛ eyi na ɛmaa nkokoaa a wɔfaa wɔn sɛ wɔn mma a wɔnyɛ abusuabɔ no 80% ne wɔn a wɔfaa wɔn sɛ wɔn mma denam mmofra a wɔhwɛ wɔn so no fã.[78] Akontaabu kyerɛ sɛ Amerikafoɔ a wɔntumi nnyinsɛn anaa wɔmfa nkɔsi wɔn mma no mu 11–24% bɔ mmɔden sɛ wɔbɛkyekyere abusua denam mmofra a wɔbɛfa wɔn ayɛ wɔn mma so, na sɛ Amerikafoɔ mmaa a wɔaware daa a wɔfa wɔn mma no nyinaa dodoɔ bɛyɛ 1.4%.[79][80] Nneɛma afoforo a ɛma nkurɔfo gye tom no dɔɔso ɛwom sɛ wɔankyerɛw ho asɛm yiye de. Ebia eyinom bi ne sɛ wɔbɛpɛ sɛ wɔhyɛ abusua foforo mu den wɔ awaregyae anaa ɔwofo biako wu akyi, ayamhyehye a nyamesom anaa nyansapɛ mu gyidi na ɛkanyan wɔn, na wɔakwati sɛ wɔbɛboa ma nnipa adɔɔso dodo esiane gyidi a ɛne sɛ ɛyɛ asɛyɛde kɛse sɛ wɔbɛhwɛ mmofra a anka awofo nni mu sen sɛ wɔbɛwo nti , de hwɛ hu sɛ wɔremfa nyarewa a wonya fi awo mu (e.g., Tay–Sachs yare) mma obi, ne akwahosan ho haw ahorow a ɛfa nyinsɛn ne awo ho. Ɛwom sɛ nneɛma ahorow bi wɔ hɔ de, nanso nhwehwɛmu a wɔayɛ nnansa yi ara a ɛfa mmea a wɔfa wɔn mma no suahu ahorow ho no kyerɛ sɛ ɛda adi kɛse sɛ wɔadi mfe 40–44, wɔaware mprempren, awo a wontumi nwo, na wonni mma.[81]

Fa akwan horow a edidi so yi so betumi aba mmofra a wɔfa wɔn sɛ wɔn mma a ɛne wɔn ho wɔn ho nni abusuabɔ:

Ankorankoro fie mmofra a wɔfa wɔn sɛ wɔn mma: wɔ nhyehyɛe yi ase no, adɔe akuw ne ahyehyɛde ahorow a wɔhwehwɛ mfaso yɛ adwuma sɛ ntamgyinafo, na wɔka wɔn a wɔpɛ sɛ wɔfa abofra no bom ne mmusua a wɔpɛ sɛ wɔde abofra bi to hɔ, na afã horow no nyinaa yɛ ɔman koro mufo. Sɛnea ɛbɛyɛ foforo no, ɛtɔ mmere bi a wɔn a wɔpɛ sɛ wɔfa wɔn mma no kwati ntamgyinafo na wɔne mmea di nkitaho tẽẽ, na mpɛn pii no wɔde apam a wɔakyerɛw; wɔmma eyi ho kwan wɔ tumidi ahorow bi mu. Ankorankoro fie mmofra a wɔfa wɔn sɛ wɔn mma no yɛ mmofra a wɔfa wɔn sɛ wɔn mma nyinaa mu fã kɛse; sɛ nhwɛso no, wɔ United States no, wobu akontaa sɛ ɛkame ayɛ sɛ wɔyɛ mmofra a wɔfa wɔn sɛ wɔn mma no mu 45% ho nhyehyɛe wɔ kokoam.[82]

Foster care adoption: eyi yɛ ofie adoption bi a mfiase no wɔde abofra bi to ɔmanfo hwɛ mu. Mpɛn pii no, awofo a wɔhwɛ mmofra no gye wɔn sɛ wɔn mma no bere a mmofra no nya ahofadi wɔ mmara kwan so no. Ɛsono sɛnea ɛho hia sɛ ɔkwan a wɔfa so gye wɔn mma no wɔ ɔman biara mu. Wɔ 127,500 a wɔfaa wɔn sɛ wɔn mma wɔ U.S. wɔ afe 2000 mu no,[82] bɛyɛ 51,000 anaa 40% nam mmofra a wɔhwɛ wɔn so nhyehyɛe so.[83]

Amanaman ntam mmofra a wɔfa wɔn sɛ wɔn mma: eyi fa abofra bi a wɔde bɛto ɔman a wɔwoo saa abofra no akyi ma wɔagye no ayɛ ne ba ho. Eyi betumi aba denam ɔman anaa ankorankoro nnwumakuw so. Wɔ aman bi te sɛ Sweden mu no, saa mmofra a wɔfa wɔn sɛ wɔn mma yi na ɛma wonya nsɛm no mu dodow no ara (hwɛ atifi hɔ pon no). Nanso, U.S. nhwɛso no kyerɛ sɛ nsonsonoe kɛse wɔ ɔman biara mu efisɛ mmofra a wɔfa wɔn sɛ wɔn mma fi amannɔne no nnu ne nsɛm no mu 15%.[82] Russiafo mmofra bɛboro 60,000 na wɔagye wɔn ayɛ wɔn mma wɔ United States fi 1992,[84] na wɔfaa Chinafo mmofra dodow a ɛte saa ara sɛ wɔn mma fi 1995 kosi 2005.[85] Aman ahorow mmara gu ahorow wɔ ɔpɛ a wɔwɔ sɛ wɔbɛma kwan ma amanaman ntam agyede no mu. Esiane sɛ Hague Nhyiam a ɛfa Ankorankoro Amanaman Ntam Mmara ho no huu nsɛnnennen ne nsɛnnennen a ɛbata amanaman ntam agyede ho, ne mmɔden a wɔbɔe sɛ wɔbɛbɔ wɔn a wɔde wɔn ho ahyɛ mu no ho ban afi adifudepɛ ne nneɛma a wɔde di dwuma ɔkwammɔne so a ɛtɔ mmere bi a ɛka ho no ho nti, wɔyɛɛ Hague Mmofra a Wɔfa Wɔn Ba no Apam, a efii ase yɛɛ adwuma wɔ May 1, 1995 na aman 85 agye atom de besi November 2011.[86]

Nkwaboaa a wɔfa wɔn sɛ wɔn mma: egyina nkwaboaa a aka a wɔde ma bere a wɔawie awarefo biako aduruyɛ a wɔde nyinsɛn ba wɔ afiri mu no so; wɔde nkwaboaa ma ankorankoro anaa awarefo foforo, na ɛno akyi no wɔde saa nkwaboaa no gu ɔbea a wɔde no ma no no awotwaa mu, na ama nyinsɛn ne awo ayɛ mmerɛw. Wɔ United States no, agyapade ho mmara na ɛkyerɛ mma nkwaboaa a wɔfa wɔn sɛ wɔn mma sen sɛ asɛnnibea nhyehyɛe ahorow na ɛkyerɛ kwan, a ɛne atetesɛm mu mmofra a wɔfa wɔn sɛ wɔn mma no bɔ abira.

Common law adoption: eyi yɛ adoption a asɛnnibea ahorow no nni kan nnye ntom, nanso ɔwofo bi, a ɔmfa ne ho nhyɛ mmara kwan so nhyehyɛe biara mu, gyaw ne mma ma n’adamfo anaa obusuani bi bere tenten ][88] na ɛwɔ hɔ. Sɛ wɔde bere bi a wɔahyɛ ato hɔ a ɛne sɛ wɔbɛtra (a wofi wɔn pɛ mu) bɛtra mu no awiei, sɛnea ɔmanfo di ho adanse no, afei wobu abofra no sɛ ɛyɛ nea ɛhyɛ obi so, wɔ asennibea ahorow bi mu, ɛwom mpo sɛ mfiase no asɛnnibea no amma ho kwan de. Mmara kwan so tumidi biara na ɛkyerɛkyerɛ nsɛm pɔtee a ɛfa mmara kwan so agyede ho. Sɛ nhwɛso no, U.S. mantam California gye mmara kwan so abusuabɔ tom bere a wɔabom atra mfe 2 akyi no. Wɔfrɛ adeyɛ no &quot;private fostering&quot; wɔ Britain.[89]

'''Nneɛma a wɔsɛe no ne nea wɔtetew mu'''

Asɛm titiriw: Nneɛma a wɔsɛe no (fa a wɔfa wɔn sɛ wɔn mma) .

Ɛwom sɛ wɔtaa ka mmofra a wɔfa wɔn sɛ wɔn mma no ho asɛm sɛ ɛyɛ abusua &quot;daa&quot; de, nanso wobetumi de abusuabɔ no aba awiei bere biara. Wɔfrɛ mmara kwan so a wogyae mmofra a wɔfa wɔn sɛ wɔn mma no sɛ ɔhaw. Wɔ U.S. nsɛmfua mu no, sɛ wogyae mmofra a wɔfa wɔn sɛ wɔn mma no ansa na wɔawie a, wɔsɛe wɔn, na sɛ wogyae abusuabɔ no wɔ ɛno akyi a, wogyae. Wobetumi afrɛ no nso sɛ mmofra a wɔfa wɔn sɛ wɔn mma a entumi nyɛ yiye. Bere a wɔawie mmara kwan so a, mpɛn pii no awofo a wɔagye wɔn ayɛ wɔn mma no nam asɛnnibea adesrɛ so na efi ɔhaw no ase na ɛne awaregyae ho nsɛm di nsɛ. Ɛyɛ mmara kwan a ɛyɛ soronko ma awofo a wɔagye wɔn ayɛ wɔn mma efisɛ ɔhaw/nsɛe no mfa abusuafo a wɔwoo wɔn ho, ɛwom sɛ ɛtɔ mmere bi a wɔpow abusua mufo a wɔwo wɔn anaasɛ wogyaw wɔn hɔ de.[90]

Nanso, nhwehwɛmu ahorow a wɔyɛe wɔ bere tiaa bi mu a wɔyɛe wɔ U.S. no kyerɛ sɛ mmofra yiyedi nhyehyɛe no so a wɔfa wɔn sɛ wɔn mma no ɔha biara mu nkyem 10 kosi 25 (sɛ nhwɛso no, nkokoaa a wɔagye wɔn ayɛ wɔn mma a wofi aman afoforo so anaa awofo a wɔyɛ mpena a wogye wɔn mpena mma no nka ho) sɛe ansa na wɔawie wɔ mmara kwan so na efi 1 mu kosi ɔha biara mu nkyem 10 no, wogu bere a wɔawie mmara kwan so no. Gyinapɛn ahorow pii no da nsɛm a ɛfa asɛm no ho ne nnipa dodow te sɛ mfe a wɔadi ho nsɛm kakraa bi na ɛwɔ hɔ adi; wonim sɛ mmabun taa nya wɔn mma a wɔfa wɔn sɛ wɔn mma no mu ɔhaw sen mmofra nkumaa.[90]

Awarefo a wɔne wɔn ho da a wɔfa wɔn sɛ wɔn mma

Mmara kwan so awarefo a wɔne wɔn ho da a wɔbɛbom agye wɔn ayɛ wɔn mma wɔ aman 34 so de besi March 2022, ne nea ɛka ho no wɔ aman nketewa ahorow mu. Awarefo a wɔne wɔn ho da no nso betumi ayɛ mma a wɔfa wɔn sɛ wɔn mma (aman 6 foforo), a ɔhokafo biako a ɔwɔ ɔbarima ne ɔbea nna mu no gye ɔfoforo no ba. Aman dodow no ara a wɔwɔ bɔbeasu koro aware no ma kwan ma saa awarefo no bom gye wɔn mma, nea ɛka ho ne Ecuador (awarefo a wɔne wɔn ho da nnye wɔn mma), Taiwan (awarefo a wɔyɛ mma nkutoo) ne Mexico (wɔ amantam a mmarima ne mmea aware wom no nkyem abiɛsa mu biako mu ). Aman kakraa bi a wɔwɔ ɔmanfo nkabom anaasɛ aware hokwan kakraa bi no nyinaa ma kwan ma wɔfa anammɔn anaa wɔbom yɛ mmofra

== Wɔn a wɔagye wɔn ayɛ wɔn mma no awofoyɛ ==
'''Awofoyɛ'''

Awosu mu abusuabɔ a ɛda ɔwofo ne abofra ntam no ho hia, na wɔn baanu a wɔatew wɔn ho no ama wɔahaw wɔ mmofra a wɔfa wɔn sɛ wɔn mma ho. Atetesɛm mu adwene a ɛfa awofo a wɔfa wɔn sɛ wɔn mma ho no nyaa mmoa a wonya fii Princeton Sukuupɔn nhwehwɛmu bi a wɔyɛe wɔ mmusua 6,000 a wɔfaa wɔn mma, wɔyɛ wɔn mma, na wɔhwɛ wɔn wɔ United States ne South Africa fi 1968 kosi 1985 no hɔ; nhwehwɛmu no kyerɛe sɛ aduan a wɔsɛe no wɔ afie a ɛnanom a wɔn mma a wɔnyɛ awofo wom (bere a wɔhwɛ sika a wonya, ofie dodow, nnɔnhwerew a wɔde yɛ adwuma, mfe a wɔadi, ne nea ɛkeka ho so) no sua koraa ma wɔn a wɔafa wɔn ayɛ wɔn mma, mmanoma mma, ne mmofra a wɔagye wɔn ayɛ wɔn mma, na ɛmaa nhwehwɛmufo no yɛɛ saa kyerɛ sɛ nkurɔfo ani nnye ho kɛse sɛ wɔbɛma afoforo awosu mu nkwaadɔm no atra hɔ.[91] Wɔfoa saa nsusuwii yi so wɔ nhwehwɛmu foforo a ɛfa su ho kɛse a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma a wɔde wɔn ho hyɛ wɔn a wɔpɛ wɔn asɛm, wɔn nipasu, ne wɔn honam ani hwɛbea koro no ara agyirae no, ne wɔn a wɔanyinyin a wɔagye wɔn ayɛ wɔn mma no nyinaa wɔ abusuabɔ ne awofo a wɔagye wɔn ayɛ wɔn mma no bɔ amanneɛ sɛ wɔn ani agye kɛse wɔ mmofra a wɔfa wɔn sɛ wɔn mma no ho.

Nhwehwɛmu afoforo de adanse ma sɛ abusuabɔ a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma no betumi ayɛ nea ɛfata wɔ akwan foforo so. Nhwehwɛmu bi a ɛhwehwɛ sɛnea awofo de wɔn sika hyɛ mu no kyerɛ ahoɔden wɔ mmusua a wɔfa wɔn mma no mu, na ɛkyerɛ sɛ awofo a wɔfa wɔn mma no de bere pii hyɛ wɔn mma mu sen awofo afoforo, na ɛde ba awiei sɛ &quot;...awofo a wɔfa wɔn mma no ma wɔn mma asetra yɛ yiye de tua abusuabɔ a enni awosu mu no ho ka ne the extra challenges of adoption.&quot;[93] Nhwehwɛmu foforo a wɔyɛe nnansa yi kyerɛe sɛ mmusua a wɔfa wɔn mma no de sika kɛse hyɛ wɔn mma a wɔagye wɔn ayɛ wɔn mma no mu, sɛ nhwɛso no, denam nhomasua foforo ne sika fam mmoa a wɔde ma so. Bere a ɛhyɛ no nsow sɛ ɛte sɛ nea wɔn a wɔagye wɔn ayɛ wɔn mma no taa hyia ɔhaw ahorow te sɛ nnubɔne a wɔde di dwuma no, nhwehwɛmu no susuwii sɛ ebia awofo a wɔfa wɔn sɛ wɔn mma no de wɔn sika pii bɛto wɔn a wɔagye wɔn ayɛ wɔn mma no mu ɛnyɛ sɛ wɔpɛ wɔn asɛm nti, na mmom esiane sɛ ɛda adi sɛ wohia mmoa no sen mmofra a wɔwɔ awosu mu nneɛma nti.[94]

Adwene ne nneyɛe ho animdefo hui a ɛfa hia a ɛna ne nkokoaa ntam abusuabɔ ho hia no ho no maa ɛhaw adwene bi sɛ ebia awofo a wogye nkokoaa a wɔanyinyin anaa mmofra a wɔretu mmirika wɔ awo akyi no ayera bere titiriw bi a ɛbɛma abofra no anyin anaa. Nanso, nhwehwɛmu a wɔyɛe wɔ The Mental and Social Life of Babies ho no kyerɛe sɛ &quot;ɔwofo ne nkokoaa nhyehyɛe&quot;, sen sɛ ɛbɛyɛ abusuabɔ a ɛda ankorankoro a wɔne wɔn ho wɔn ho wɔ abusuabɔ ntam no, yɛ ade a ɛdannan a ɛda nnipa nkokoaa nyinaa awosu mu nneyɛe ne mmuae a nnipa a wɔanyinyin de yɛ wɔn ade a ɛkɔ so pɛpɛɛpɛ wɔ ho no ntam saa nkokoaa nneyɛe no. Enti abɔde &quot;hwɛ ma wɔyɛ nsakrae bi a edi kan wɔ obu ma mpanyimfo pɔtee a wogye awofo dwumadi no ho.&quot;[95]

Wɔ nsɛmpɔw atitiriw no akyi no, nsemmisa soronko a wobisa awofo a wɔfa wɔn sɛ wɔn mma no gu ahorow. Nea ɛka ho ne sɛnea wobebua nsusuwii hunu, nsɛmmisa a ɛfa agyapade ho a wobebua, ne ɔkwan a eye sen biara a wɔbɛfa so ne abusuafo a wɔwoo wɔn no anya abusuabɔ bere a wɔwɔ mmofra a wɔabue wɔn mma no mu.[96] Ɔkyerɛwfo biako kyerɛ sɛ asɛmmisa a awofo a wɔfa wɔn sɛ wɔn mma no taa nya ne sɛ: &quot;So yɛbɛdɔ abofra no ɛwom mpo sɛ ɔnyɛ yɛn ba a ɔwoo no no?&quot;[97] Ade pɔtee a ɛhaw awofo pii ne sɛ wɔbɛma obi a wɔagye no ayɛ ne ba no atra sukuu dan mu. Asuade ahorow a wonim te sɛ &quot;twe w'abusua dua&quot; anaa &quot;fa w'awofo ne wo nananom so hwehwɛ w'ani kɔla akyi kɔhwɛ baabi a w'awosu fi&quot; betumi apira mmofra a wɔfaa wɔn sɛ wɔn mma na wonnim saa abɔde mu nsɛm yi. Wɔde nyansahyɛ ahorow pii ama sɛ wɔde besi adesua foforo ananmu, s.e., wɔde wɔn adwene asi &quot;abusua nnuaba turo&quot; so.[99]

Mmofra a wɔanyinyin a wɔfa wɔn sɛ wɔn mma no de awofoyɛ ho nsɛm afoforo ba.[100] Mmofra binom a wofi mmofra a wɔhwɛ wɔn so no wɔ abakɔsɛm a ɛfa ayayade ho, te sɛ honam ne adwene mu anibiannaso, honam fam ayayade, ne nna mu ayayade, na wɔwɔ asiane mu sɛ wobenya adwenemyare ho haw ahorow.[101][102] Mmofra a wɔte saa no wɔ asiane mu sɛ wobenya abusuabɔ a ɛnyɛ nhyehyɛe.[103][104][105] Nhwehwɛmu ahorow a Cicchetti ne afoforo yɛe no. (1990, 1995) hunuu sɛ nkokoaa a wɔyɛɛ wɔn ayayadeɛ na wɔyɛɛ wɔn ayayadeɛ wɔ wɔn nhwɛsoɔ no mu 80% daa abatadeɛ akwan a ɛnyɛ nhyehyɛeɛ adi.[106][107] Bata a wɔanhyehyɛ no ne nkɔso ho haw ahorow bi wɔ abusuabɔ, a nea ɛka ho ne sɛnkyerɛnne ahorow a ɛma obi fi ne ho fi afoforo ho,[108] ne adwenemhaw, dadwen, ne adeyɛ ho sɛnkyerɛnne ahorow.[109][110] &quot;Attachment yɛ adeyɛ a ɛyɛ nnam—ebetumi ayɛ nea ahobammɔ wom anaasɛ enni ahobammɔ, ɛnyɛ nea ɛfata anaasɛ ɛsow aba. Eyi yɛ sikasɛm a ɛnyɛ nokware efisɛ mpɔtam hɔ atumfoɔ hwɛ a wɔhwɛ mmofra yi bo yɛ den yiye.[112]

Ɛdefa nkɔso mu nneɛma atitiriw ho no, nhwehwɛmu ahorow a efi Colorado Adoption Project no mu no hwehwɛɛ awosu mu nkɛntɛnso a ɛwɔ wɔn a wɔagye wɔn ayɛ wɔn mma no onyin so no mu, na ɛde baa awiei sɛ wɔn a wɔagye wɔn ayɛ wɔn mma no adwene tumi da wɔn awofo a wɔfaa wɔn mma no de adi wɔ mmofraase nanso ɛnkyerɛ sɛ ɛne wɔn ho wɔn ho di nsɛ kɛse wɔ mmerantebere ne mmabaabere mu, na ɛte sɛ wɔn awofo a wɔwoo wɔn no de mmom na ɛte sɛ nea ɛte saa ara baabi a ɛkɔ akyiri sɛ atipɛnfo wɔ mmusua a wɔmfa wɔn mma wɔn mma mu.[113]

Ɛte sɛ nea akwan a ɛte saa ara reyɛ adwuma wɔ wɔn a wɔagye wɔn ayɛ wɔn mma no honam fam nkɔso mu. Denmarkfo ne Amerikafo nhwehwɛmufo a wɔreyɛ nhwehwɛmu ahorow a ɛfa awosu mu mmoa a ɛma nipadua no yɛ kɛse ho no huu abusuabɔ a ɛda obi a wɔagye no ayɛ ne ba no mu duru ne n’awofo a wɔwoo no no BMI ntam bere a wɔanhu abusuabɔ biara a ɛda abusua a wɔagye no ayɛ ne ba no ntam no. Bio nso, nsonsonoe a ɛda ankorankoro ntam no bɛyɛ fã fi ankorankoro nkɛntɛnso ahorow a wɔnkyɛ mu.[114][115]

Ɛte sɛ nea nsonsonoe ahorow a ɛwɔ nkɔso mu yi di agoru wɔ ɔkwan a mmerante ne mmabaa a wɔagye wɔn ayɛ wɔn mma no fa so di asetra mu nsɛm atitiriw ho dwuma no mu. Wɔ awofo awaregyae ho no, wɔahu sɛ ɛsono sɛnea wɔn a wɔagye wɔn ayɛ wɔn mma no yɛ wɔn ade wɔ mmofra a wɔannye wɔn mma no ho. Bere a nnipa dodow no ara nyaa suban ho haw pii, nnuru a wɔde di dwuma, sukuu mu nkɔso a ɛba fam, ne asetra mu ahoɔden a asɛe wɔ awofo awaregyae akyi no, ɛte sɛ nea nnipa dodow a wɔagye wɔn ayɛ wɔn mma no annya nkɛntɛnso biara wɔ wɔn abɔnten abusuabɔ ho, titiriw wɔ wɔn sukuu anaa asetra mu tumi mu.

'''Nkɛntɛnso a enya wɔ awofo a wodii kan bae no so'''

Nneɛma pii na ɛka gyinae a wosi sɛ wobegyae abofra no anaasɛ wɔbɛtete no no. Mmabun a wɔyɛ aborɔfo taa de wɔn nkokoaa ma wɔn a wɔnyɛ abusuafo, bere a mmabun a wɔyɛ abibifo taa nya mmoa fi wɔn ankasa mpɔtam hɔfo hɔ wɔ abofra no ntetee mu ne ɔkwan a abusuafo fa so gye wɔn sɛ wɔn mma wɔ ɔkwan a ɛnyɛ ɔhyɛ so nso so. Nhwehwɛmu a Leynes ne Festinger ne Young, Berkman, ne Rehr yɛe no kyerɛe sɛ, wɔ mmabun a wɔyem fam no, gyinae a wosi sɛ wobegyae abofra no ma wagye no ayɛ ne ba no gyina adwene a ɔbabun no maame wɔ wɔ mmofra a wɔfa no sɛ wɔn ba ho no so.[118] Nhwehwɛmu foforo nso kyerɛe sɛ mmabun a wɔyem a wɔn maamenom asua nhoma a ɛkɔ akyiri no taa gyae wɔn mma ma wɔfa wɔn sɛ wɔn mma. Nhwehwɛmu kyerɛ sɛ mmea a wɔpaw sɛ wobegyae wɔn mma ma wɔafa wɔn ayɛ wɔn mma no taa yɛ nkumaa, wɔakyerɛw wɔn din wɔ sukuu mu, na wɔatra awofo baanu fie mu bere a wɔadi mfe 10, sen wɔn a wɔhwɛɛ wɔn mma na wɔtetee wɔn no.[119]

Nhwehwɛmu kakraa bi na wɔayɛ wɔ nea ebefi mmofra a wɔfa wɔn sɛ wɔn mma a wodi kan no so aba no ho, na nea wɔahu no adi afra. Nhwehwɛmu bi kyerɛe sɛ wɔn a wogyaee wɔn mma ma wɔfa wɔn sɛ wɔn mma no ani nnye wɔn gyinaesi no ho kɛse sen wɔn a wɔde wɔn mma siei no. Nanso, na awerɛkyekye dodow a ɛwɔ akuw abien no nyinaa so no dɔɔso, na wɔn a wogyaee wɔn ba no te sɛ wɔn a wɔmaa wɔn ba no siei wɔ asetra mu abotɔyam, abusuabɔ mu abotɔyam, ne daakye ho adwene pa a wɔwɔ wɔ sukuu, adwuma, sikasɛm, ne aware ho nsusuwii ahorow mu ] . Nhwehwɛmu a wɔyɛe akyiri yi kyerɛe sɛ ɛnanom a wɔadu mpanyin afe so a wɔpaw sɛ wobegyae wɔn mma ma wɔagye wɔn ayɛ wɔn mma no taa nya awerɛhow ne ahonu wɔ wɔn gyinaesi no ho sen wɔn a wɔkoraa wɔn mma so no. Nanso, saa nkate ahorow yi so tew kɛse fi afe biako wɔ awo akyi kosii afe a ɛto so abien no awiei.[121]

Nhwehwɛmu a wɔayɛ nnansa yi ara no hui sɛ wɔ ɛnanom a wogyaee wɔn mma sɛ wɔmfa wɔn mma mfe anan kosi 12 ansa na ɛreba no mu no, na obiara a ɔde ne ho hyɛɛ mu no taa susuw wɔn ba a wayera no ho. Wɔ dodow no ara fam no, na nsusuwii ahorow no yɛ nea enye ne nea eye efisɛ na ɛma wonya awerɛhow ne anigye nkate nyinaa. Wɔn a wonyaa nsusuwii pa no fã kɛse no ara mu osuahu ne wɔn a na wɔabue wɔn mma, sen sɛ wɔde ntamgyinafo a wɔato mu anaasɛ bere tiaa bi bɛyɛ wɔn mma.[122]

Wɔ nhwehwɛmu foforo a wɔde ɛnanom a wogyae wɔn mma totoo wɔn a wɔtetee wɔn ho no mu no, ɛnanom a wogyae wɔn mma no taa twentwɛn wɔn nyinsɛn a edi hɔ no ase, wɔtwentwɛn aware ase, na wowie adwuma ho ntetee. Nanso, akuw abien no nyinaa duu nhomasua a ɛba fam sen wɔn atipɛnfo a wɔannyinsɛn da.[123] Nhwehwɛmu foforo nso hui sɛ nneɛma a ɛte saa ara fi mu ba bere a wɔpaw sɛ wobegyae abofra bi ma wɔagye no ayɛ ne ba no. Ná ɛnanom a wɔn mfe akɔ anim a wogyaee wɔn mma no taa nya nhomasua a ɛkorɔn na wonya adwuma sen wɔn a wɔhwɛɛ wɔn mma no. Wɔsan nso twɛn kyɛe ansa na wɔrewo wɔn ba a odi hɔ no.[121] Wɔde mmabun nhwɛso ahorow, anaasɛ mmea a na wɔyɛ mmabun bere a wɔsoa wɔn nkokoaa no yɛɛ nhwehwɛmu a ɛwɔ hɔ wɔ nkɛntɛnso a awofo a wɔfa wɔn sɛ wɔn mma no so nkɛntɛnso ho no mu dodow no ara—nsɛm kakraa bi na ɛwɔ hɔ ma awofo a wɔwoo wɔn a wofi nnipa afoforo mu. Afei nso, nsɛm a wɔde bere tenten ayɛ a ebetumi ama asetra ne adwene mu nsunsuanso a ɛbɛtra hɔ akyɛ ama awofo a wɔwo a wɔpaw sɛ wɔde wɔn mma bɛto hɔ ama wɔagye wɔn ayɛ wɔn mma no nni hɔ.

== Nkɔso a ɛfa wɔn a wɔagye wɔn ayɛ wɔn mma ho ==
Nhwehwɛmu a wɔadi kan ayɛ wɔ mmofra a wɔfa wɔn sɛ wɔn mma ho no ama wɔanya nsusuwii ahorow a ɛkyerɛ sɛ asiane a ɛkɔ soro wɔ adwene mu nkɔso ne asetra mu abusuabɔ mu ma wɔn a wɔagye wɔn ayɛ wɔn mma no. Nanso, wɔama nsusuwii ahorow a ɛtete saa no mu ada hɔ sɛ ɛyɛ mfomso esiane akwan a wɔfa so yɛ adwuma no huammɔdi nti. Nanso nnansa yi nhwehwɛmu ahorow aboa ma wɔakyerɛ nsɛm a ɛyɛ nokware kɛse ne nea efi mu ba a ɛfa nsɛdi, nsonsonoe ne asetra kwan nyinaa a wɔn a wɔafa wɔn ayɛ wɔn mma no asetra kwan ho.[124]

Wobetumi afoa adanse a ɛfa sɛnea wɔn a wɔagye wɔn ayɛ wɔn mma no nkɔso ho wɔ nhwehwɛmu foforo mu. Yebetumi aka sɛ, wɔ ɔkwan bi so no, wɔn a wɔfa wɔn sɛ wɔn mma no taa nya nkɔso wɔ ɔkwan soronko so wɔ nnipa dodow no ara ho. Wobetumi ahu eyi wɔ asetra mu nneɛma pii mu, nanso mpɛn pii no wobetumi ahu sɛ asiane kɛse wɔ hɔ bɛyɛ mmerantebere ne mmabaabere mu. Sɛ nhwɛso no, wɔahu sɛ wɔn a wɔagye wɔn ayɛ wɔn mma no pii hyia ɔhaw wɔ adwene a wɔde besi hɔ a ɛkyerɛ sɛ wɔyɛ wɔn mma no mu.[125]

'''Adida'''

Akwan pii wɔ hɔ a wobetumi afa so akyerɛkyerɛ adwene a ɛfa nipasu ho no mu. Ɛyɛ nokware wɔ nsɛm nyinaa mu sɛ nipasu a wɔde si dan no yɛ adeyɛ a ɛkɔ so a ɛfa nkɔso, nsakrae ne adwene a wɔde si obi ho ne ankasa ho a wɔhwɛ so. Nhwehwɛmu ada no adi sɛ mmerantebere ne mmabaabere yɛ bere a wɔde wɔn ho hyɛ mu sen sɛ wɔbɛsan wɔn akyi.[126] Obi nipasu taa ntumi nnyina wɔ n’asetra mfe a edi kan no mu nanso onya ntease a egyina pintinn kɛse wɔ mmofraberem ne mmerantebere ne mmabaabere mu akyiri yi mu. Mpɛn pii no, wɔde bata bere bi a wɔde sɔ nneɛma hwɛ ho no, nneɛma a enni awiei wɔ hɔ a ɛkɔ obi nipasu a wɔbɛkyekye mu. Nea ɛka nneɛma pii ho no, nipasu ahorow pii wɔ hɔ a obi betumi de abata ho. Nnipa a wɔde wɔn ho hyɛ mu no bi ne ɔbarima ne ɔbea nna, ɔbarima ne ɔbea nna, kuw, abusuakuw ne nyamesom, ne nea ɛkeka ho Wɔ wɔn a wɔafa wɔn ayɛ wɔn mma wɔ mmusuakuw ntam ne amanaman ntam no fam no, mpɛn pii no wohu nhyɛso wɔ mmusuakuw, mmusuakuw ne ɔman a wɔde wɔn ho hyɛ mu no mu. Esiane eyi nti, abusua mu abusuabɔ ahoɔden ne ne dwumadi di dwuma kɛse wɔ ne nkɔso ne nea efi nipasu a wɔkyekye mu ba no mu. Wɔn a wɔfa wɔn sɛ wɔn mma a wofi mmusuakuw ahorow mu ne aman horow so no taa nya nkate a ɛne sɛ wonnye wɔn ntom esiane mmusuakuw, mmusuakuw, ne amammerɛ mu nsonsonoe a ɛte saa nti. Enti, sɛ wɔbɛma wɔn a wɔagye wɔn ayɛ wɔn mma a wofi mmusuakuw ahorow mu ne aman ntam no ahu wɔn &quot;amammerɛ a wofi mu&quot; no ho hia sɛnea ɛbɛyɛ a wobenya adwene a ɛfa wɔn ho ne anisɔ a ɛfa amammerɛ ahorow ho yiye. Nnipa a wɔagye wɔn ayɛ wɔn mma wɔ aman ntam no ho adansedi ne nea wɔsan kyekye no ntɛm ara a wɔfa wɔn sɛ wɔn mma no. Sɛ nhwɛso no, egyina United States mmara ne nhyehyɛe pɔtee so no, Child Citizen Act of 2000 hwɛ hu sɛ wɔbɛma wɔn a wɔagye wɔn ayɛ wɔn mma no U.S. ɔman ba ntɛm ara.[127]

Wɔde nea obi yɛ ne nea ɔnyɛ nyinaa na ɛkyerɛkyerɛ nipasu mu. Wɔn a wɔagye wɔn ayɛ wɔn mma a wɔwo wɔn wɔ abusua biako mu no hwere wɔn din na afei wɔfɛm biako fi abusua a wɔfa wɔn sɛ wɔn mma no hɔ. Nnipa nipasu a wɔhyehyɛ no yɛ adeyɛ a ɛyɛ den na nneɛma pii wɔ hɔ a ɛka nea ebefi mu aba. Sɛ yɛhwɛ nsɛm a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho tebea horow mu a, wobetumi ahu nnipa a wɔfa wɔn sɛ wɔn mma no ka ho na ɛka wɔn (ɔwofo a ɔwoo wɔn, ɔwofo a ɔfaa no sɛ ne ba ne nea wɔagye no ayɛ ne ba) sɛ &quot;triad members and state&quot;. Ebia mmofra a wɔfa wɔn sɛ wɔn mma no de baasakoro no mufo a wɔte nka sɛ wɔyɛ nnipa no to asiane mu. Baasakoro no mufo taa da nkate horow a ɛfa nipasu ne nipasu ho haw ahorow a ɛyɛ basaa ho adi esiane nsonsonoe a ɛwɔ baasakoro no ntam abusuabɔ mu nti. Wɔ ebinom fam no, mmofra a wɔfa wɔn sɛ wɔn mma no mma wonnya wɔn ho ho adwene a edi mũ anaasɛ wɔaka abom. Ebia Baasakoro no mufo behu wɔn ho sɛ wonni mũ, wonni hwee, anaasɛ wonwiei. Wɔka sɛ wonni yiyedi, biakoyɛ, anaa pintinn ho nkate a ɛbata nipasu a anya nkɔso koraa ho.[128]

'''Nkɛntɛnso ahorow'''

Abusua di dwuma titiriw wɔ nipasu a wɔhyehyɛ mu. Ɛnyɛ mmofraberem nko na eyi te saa, na mmom mmerantebere ne mmabaabere mu nso. Nnipa a wɔyɛ wɔn ho (ɔbarima ne ɔbea nna/ɔbarima ne ɔbea nna/abusuakuw/nyamesom/abusua) da so ara reyɛ wɔ mmerantebere ne mmabaabere mu na abusua kura eyi ho safe titiriw. Ɛte sɛ nea nhwehwɛmu no yɛ nea adwene koro yɛ; abusua a ɛyɛ den, ahobammɔ, ɔdɔ, nokwaredi ne mmoa a emufo nyinaa te nka sɛ wɔwɔ ahobammɔ sɛ wɔbɛhwehwɛ wɔn nipasu mu no ho hia na ama wɔatumi ayɛ nipasu a ɛfata. Transracial ne International adoptions yɛ nneɛma bi a edi dwuma titiriw wɔ wɔn a wɔagye wɔn ayɛ wɔn mma no nipasu a wɔkyekye no mu. Ntawntawdi pii fi abusuabɔ a wɔkyekye wɔ nea wɔagye no ayɛ ne ba no ne wɔn abusua ntam no mu. Eyinom bi ne sɛ &quot;wɔyɛ soronko&quot; wɔ ɔwofo (ɔwofo) ho, abusuakuw mu nipasu pa a wobenya, ne mmusuakuw/abusuakuw mu nyiyim a wobedi ho dwuma.[129] Wɔahu sɛ mmerante ne mmabaa a wɔwɔ amammerɛ ahorow ne aman ntam no taa ne wɔn awofo hu amammerɛ ne mmusuakuw a wofi mu ba sen sɛ wɔbɛkyerɛ baabi a wɔte, nanso ɛtɔ mmere bi a ɛyɛ den sɛ wɔbɛkari pɛ wɔ nnipa baanu no ntam efisɛ sukuu tebea horow taa nni nneɛma ahorow ne gye a wogye tom wɔ nsɛmti a ɛtete saa ho .[130] . Saa nhyɛso ahorow yi nso taa ma nsɛmmisa bi ba ma nea wɔagye no ayɛ ne ba no, ne abusua no nso sɛ wobesusuw ho. Nsɛmmisa bi a wɔtaa bisa no bi ne sɛ abusua no yɛ anibiannaso kɛse wɔ asetra mu akwan horow a wɔkyekye no ho a, dɛn na ɛbɛba? So ntawntawdi bɛba sɛ eyi te saa a? Na sɛ nnipa ankasa a wɔkyerɛ sɛ wɔyɛ nipasu a ɛfata ho nhwɛso no ankasa yɛ nea ahobammɔ a enni hɔ ahyɛ mu ma nso ɛ? Ginni Snodgrass bua nsɛmmisa yi wɔ ɔkwan a edidi so yi so. Ahintasɛm a ɛwɔ abusua a wɔma wɔn mma mu ne pow a wɔpow sɛ ɛsono abusua a wɔfa wɔn sɛ wɔn mma no ma adwumayɛ a entumi nyɛ adwuma yiye ba mu. &quot;... asetra mu adwumayɛfo ne awofo a wɔagye wɔn ayɛ wɔn mma a wonni ahobammɔ no ayɛ abusua abusuabɔ a egyina nokwaredi a wonni, kwati ne nneɛma a wɔde di dwuma so. Sɛ́ wubegye adi sɛ abusuabɔ pa bɛkɔ so wɔ fapem a ɛte saa so no nyɛ adwene mu ntease&quot; (Lawrence). Kokoamsɛm si akwanside ahorow a ɛmma wontumi nnya nipasu a ɛfata.[131]

Nhwehwɛmu no ka sɛ ɛnyɛ sɛ adwuma a entumi nyɛ adwuma yiye, nsɛm a ɛnyɛ nokware ne nea wɔkwati a ebetumi aba mmusua a wɔagye wɔn ayɛ wɔn mma no mu no mma ɛnyɛ yiye nko, na mmom ɛyɛ adwuma tia no tẽẽ nso. Sɛ nea wɔagye no ayɛ ne ba no nim sɛ wɔafa wɔn ayɛ wɔn ba nanso onni wɔn awofo a wɔwoo wɔn no ho nsɛm biara a, nkɛntɛnso bɛn na ɛwɔ hɔ wɔ nnipa a wɔyɛ wɔn basaa no so? Silverstein ne Kaplan nhwehwɛmu no ka sɛ nsɛmmisa te sɛ &quot;Hena ne me?&quot; &quot;Dɛn nti na wɔwoo me?&quot; &quot;Dɛn ne m'atirimpɔw?&quot; Saa nipasu a wonni yi betumi ama wɔn a wɔagye wɔn ayɛ wɔn mma, titiriw wɔ mmerantebere ne mmabaabere mu, ahwehwɛ akwan a wɔbɛfa so ayɛ wɔn ho wɔ ɔkwan a ɛtra so so sen wɔn atipɛnfo a wonnye wɔn mma no pii. Mmabun a wɔagye wɔn ayɛ wɔn mma no dɔɔso dodo wɔ wɔn a wɔde wɔn ho hyɛ amammerɛ nketewa mu, guan, wonyinsɛn, anaasɛ wɔpo wɔn mmusua koraa no mu.[132][133]

Ɛdefa nkɔso mu nneɛma atitiriw ho no, nhwehwɛmu ahorow a efi Colorado Adoption Project no mu no hwehwɛɛ awosu mu nkɛntɛnso a ɛwɔ wɔn a wɔagye wɔn ayɛ wɔn mma no onyin so no mu, na ɛde baa awiei sɛ wɔn a wɔagye wɔn ayɛ wɔn mma no adwene tumi da wɔn awofo a wɔfaa wɔn mma no de adi wɔ mmofraase nanso ɛnkyerɛ sɛ ɛne wɔn ho wɔn ho di nsɛ kɛse wɔ mmerantebere ne mmabaabere mu, na ɛte sɛ wɔn awofo a wɔwoo wɔn no de mmom na ɛte sɛ nea ɛte saa ara baabi a ɛkɔ akyiri sɛ atipɛnfo wɔ mmusua a wɔmfa wɔn mma wɔn mma mu.[113]

Ɛte sɛ nea akwan a ɛte saa ara reyɛ adwuma wɔ wɔn a wɔagye wɔn ayɛ wɔn mma no honam fam nkɔso mu. Denmarkfo ne Amerikafo nhwehwɛmufo a wɔreyɛ nhwehwɛmu ahorow a ɛfa awosu mu mmoa a ɛma nipadua no yɛ kɛse ho no huu abusuabɔ a ɛda obi a wɔagye no ayɛ ne ba no mu duru ne n’awofo a wɔwoo no no BMI ntam bere a wɔanhu abusuabɔ biara a ɛda abusua a wɔagye no ayɛ ne ba no ntam no. Bio nso, nsonsonoe a ɛda ankorankoro ntam no bɛyɛ fã fi ankorankoro nkɛntɛnso ahorow a wɔnkyɛ mu.[114][115]

Ɛte sɛ nea nsonsonoe ahorow a ɛwɔ nkɔso mu yi di agoru wɔ ɔkwan a mmerante ne mmabaa a wɔagye wɔn ayɛ wɔn mma no fa so di asetra mu nsɛm atitiriw ho dwuma no mu. Wɔ awofo awaregyae ho no, wɔahu sɛ ɛsono sɛnea wɔn a wɔagye wɔn ayɛ wɔn mma no yɛ wɔn ade wɔ mmofra a wɔannye wɔn mma no ho. Bere a nnipa dodow no ara nyaa suban ho haw pii, nnuru a wɔde di dwuma, sukuu mu nkɔso a ɛba fam, ne asetra mu ahoɔden a asɛe wɔ awofo awaregyae akyi no, ɛte sɛ nea nnipa dodow a wɔagye wɔn ayɛ wɔn mma no annya nkɛntɛnso biara wɔ wɔn abɔnten abusuabɔ ho, titiriw wɔ wɔn sukuu anaa asetra mu tumi mu.

Nanso, ɛte sɛ nea nnipa dodow a wɔagye wɔn ayɛ wɔn mma no wɔ asiane mu kɛse wɔ suban ho nsɛm bi ho. Nhwehwɛmufo a wofi Minnesota Sukuupɔn mu yɛɛ mmabun a wɔafa wɔn ayɛ wɔn mma no ho nhwehwɛmu na wohui sɛ wɔn a wɔagye wɔn ayɛ wɔn mma no betumi anya ɔsɔretia a ɛma obi yɛ ade tra so (ODD) ne adwene a wɔde si biribi so a ɛtra so (ADHD) no mmɔho abien, na ɛyɛ 8% wɔ nnipa dodow no ara mu nnipa dodow.[134][non-primary source needed] Asiane a ɛwɔ hɔ sɛ wobekum wɔn ho nso dɔɔso kɛse sen nnipa dodow no ara. Sweden nhwehwɛmufo hui sɛ amanaman ntam ne ɔman no mufo a wɔagye wɔn ayɛ wɔn mma no nyinaa kum wɔn ho wɔ dodow a ɛkɔ soro sen atipɛnfo a wɔamfa wɔn ayɛ wɔn mma no; a amanaman ntam wɔn a wɔagye wɔn ayɛ wɔn mma ne mmea a wɔagye wɔn ayɛ wɔn mma, titiriw no, wɔ asiane kɛse mu.[135]

Ne nyinaa mu no, adwuma a wɔayɛ wɔ wɔn a wɔanyinyin a wɔagye wɔn ayɛ wɔn mma ho no ahu sɛ asiane foforo a wɔn a wɔagye wɔn ayɛ wɔn mma no hyia no fa mmerantebere ne mmabaabere mu nkutoo. Wɔkyerɛe sɛ mmerante ne mmabaa a wɔanyinyin a wɔagye wɔn ayɛ wɔn mma no ne mpanyimfo a wofi mmusua a wɔwoo wɔn mu no yɛ pɛ na wonyaa nkontaa a eye sen mpanyimfo a wɔtetee wɔn wɔ abusua ahorow foforo a ɔwofo biako ne mmusua a wɔyɛ mpena ka ho mu.[136] Bio nso, bere a mpanyimfo a wɔagye wɔn ayɛ wɔn mma no daa nsakrae kɛse adi sen wɔn atipɛnfo a wɔamfa wɔn ayɛ wɔn mma wɔ adwene ne nneyɛe ho nhyehyɛe ahorow mu no, mpanyimfo a wɔagye wɔn ayɛ wɔn mma no daa nsɛdi pii adi sen nsonsonoe a ɛda mpanyimfo a wɔamfa wɔn ayɛ wɔn mma no ntam. Nsɛm pii aba a ɛfa adwenemhaw a ɛba ntɛm a wɔasiesie anaasɛ wɔasan asan aba ho. Sɛ nhwɛso no, wɔ nhwehwɛmu ahorow a edi kan a wɔyɛe no biako mu no, Ɔbenfo Goldfarb a ɔwɔ England no de baa awiei sɛ mmofra binom sesa wɔn ho yiye wɔ asetra ne nkate fam ɛmfa ho osuahu ahorow a enye a ɛfa ahyehyɛde a wɔde wɔn ho hyɛ mu wɔ mmofraase no ho no. Nhwehwɛmufo afoforo nso hui sɛ ɛnyɛ nea ɛkyerɛ ankasa sɛ mmofra a wɔde wɔn kɔ ayaresabea bere tenten no de nkate fam haw anaa suban mu sintɔ ahorow ba mmofra nyinaa so. Eyi kyerɛ sɛ mmofra binom bɛba bere nyinaa a wɔyɛ yiye, a wotumi gyina ano, a wɔn suahu ahorow wɔ mmofraase mfa ho.[139] Afei nso, nhwehwɛmu a wɔyɛ wɔ adwene mu nneɛma a efi wɔn a wɔagye wɔn ayɛ wɔn mma no ho no mu dodow no ara fi nnipa dodow a wɔwɔ ayaresabea no mu. Eyi kyerɛ sɛ ebia nsɛm a wɔde ba awiei te sɛ nea wɔn a wɔagye wɔn ayɛ wɔn mma no taa nya suban ho haw te sɛ ODD ne ADHD no bɛyɛ nea ɛyɛ animhwɛ. Esiane sɛ wɔn a wɔagye wɔn ayɛ wɔn mma a wɔhwehwɛ adwenemyare ayaresa no sua nti, adwene mu nneɛma a efi wɔn a wɔagye wɔn ayɛ wɔn mma no mu ba sɛ wɔde toto nea ɛwɔ nnipa dodow no ara ho no di nsɛ sen sɛnea nhwehwɛmufo binom kyerɛ no.[140]

'''Adwene mu akwahosan'''

Mmofra a wɔagye wɔn ayɛ wɔn mma no taa nya adwene ne nneyɛe ho haw sen atipɛnfo a wɔamfa wɔn ayɛ wɔn mma.[141] Mmofra a na wɔadi boro anan bere a wɔfaa wɔn sɛ wɔn mma no nya adwene mu haw pii sen wɔn a na wɔyɛ nkumaa no.[142][143]

Sɛnea nhwehwɛmu a wɔyɛe wɔ UK kyerɛ no, mmofra a wɔagye wɔn ayɛ wɔn mma no betumi anya adwenemyare a ɛmma wo de baanan mpo nkɔ yiye bere a wɔafa wɔn ayɛ wɔn mma no akyi. Mmofra a wɔwɔ mmofraberem osuahu ahorow pii a enye no taa nya adwenemyare. Nhwehwɛmu no kyerɛ sɛ sɛnea ɛbɛyɛ a wobehu adwenemyare ho haw ahorow na wɔatiatia so ntɛm no, wɔn a wɔhwɛ mmofra ne awofo a wɔfa wɔn sɛ wɔn mma no hia abofra no asetra ho nsɛm a ɛkɔ akyiri.[142][144] Nhwehwɛmu foforo bi a wɔyɛe wɔ UK kyerɛ sɛ mmofra a wɔagye wɔn ayɛ wɔn mma no taa nya adwenemhaw a ɛba wɔn akyi (PTS) sen nnipa dodow no ara. Wɔn PTS sɛnkyerɛnne no gyina osuahu bɔne ko a wɔfaa mu no so na nimdeɛ a ɛfa wɔn abakɔsɛm ho no ma wonya mmoa a wɔahyɛ da ayɛ.[145][146]

== Adwene a ɔmanfo kura wɔ mmofra a wɔfa wɔn sɛ wɔn mma ho ==
Wɔ Atɔe Famfo amammerɛ mu no, nnipa pii hu sɛ abusua ho mfonini a wɔtaa yɛ no yɛ awarefo a wɔne wɔn ho da a wɔwɔ mma a wɔwoo wɔn no de. Saa adwene yi de abusua ahorow a wɔde di dwuma foforo no si nea wɔtaa yɛ no akyi. Nea efi mu ba – nhwehwɛmu kyerɛ – adwene a ɛbrɛ wɔn ase wɔ mmusua a wɔfa wɔn mma ho no wɔ hɔ, ne adwenem naayɛ a ɛfa sɛnea wɔn abusua mu abusuabɔ mu yɛ den ho.[147][148]

Nhwehwɛmu a wɔyɛe nnansa yi ara wɔ mmofra a wɔfa wɔn sɛ wɔn mma ho adwene a Evan Donaldson Asoɛe no wiei no de saa animtiaabu yi ho adanse foforo ma. Ɛkame ayɛ sɛ nnipa dodow a wobisabisaa wɔn nsɛm no mu nkyem abiɛsa mu biako gye di sɛ wɔn a wɔagye wɔn ayɛ wɔn mma no ntumi nyɛ nsakrae yiye, wɔtaa nya ayaresa ho nsɛm, na wɔtaa nya nnubɔne ne nsa ho haw ahorow. Bio nso, 40–45% susuwii sɛ wɔn a wɔagye wɔn ayɛ wɔn mma no taa nya suban ho haw ne ɔhaw wɔ sukuu mu. Nea ɛne eyi bɔ abira no, nhwehwɛmu koro no ara kyerɛe sɛ wobu awofo a wɔfa wɔn sɛ wɔn mma no yiye, a ɛkame ayɛ sɛ 90% kaa wɔn ho asɛm sɛ &quot;wɔn anigye, wonya mfaso, na wonni pɛsɛmenkominya&quot;.[149]

Nnipa dodow no ara ka sɛ wɔn nsɛm titiriw a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho no fi nnamfo ne abusuafo ne nsɛm ho amanneɛbɔfo hɔ. Ne nyinaa mu no, nnipa dodow no ara bɔ amanneɛ sɛ nsɛm ho amanneɛbɔ ma wonya adwene pa wɔ mmofra a wɔfa wɔn sɛ wɔn mma ho; 72% kyerɛe sɛ wɔanya nsusuwii pa.[150] Nanso, wɔda so ara wɔ ɔkasatia kɛse wɔ nsɛm ho amanneɛbɔfo a wɔka fa mmofra a wɔfa wɔn sɛ wɔn mma ho no ho. Sɛ nhwɛso no, blog ahorow bi a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho no kasa tiaa Meet the Robinsons sɛ wɔde nyisaa atrae mfonini ahorow a ne bere atwam di dwuma[151][152] sɛnea The Evan B. Donaldson Adoption Institute a ɛnyɛ nea wɔde hwehwɛ mfaso a ɛkamfo kyerɛ no yɛe no.

Wɔma animtiaabu a ɛbata mmofra a wɔfa wɔn sɛ wɔn mma ho no yɛ kɛse ma mmofra a wɔwɔ mmofra a wɔhwɛ wɔn sɛ wɔn mma no.[154] Nsusuwii bɔne de gyidi a ɛne sɛ mmofra a wɔte saa no haw araa ma ɛrentumi nyɛ yiye sɛ wobegye wɔn atom na wɔayɛ mmusua a &quot;ɛyɛ daa&quot;.[155] Amanneɛbɔ bi a efi Pew Commission on Children in Foster Care hɔ wɔ afe 2004 mu no ada no adi sɛ mmofra dodow a wɔretwɛn wɔ mmofra a wɔhwɛ wɔn so no abu abɔ ho abien fi 1980 mfe no mu na mprempren ɛda so ara yɛ nea ɛkɔ so yɛ pɛ bɛyɛ ɔpepem fã afe biara.&quot;[156]

Attitude toward Adoption Questionnaire (ATAQ):[157] saa nsɛmmisa yi, Abdollahzadeh, Chaloyi ne Mahmoudi na wɔdii kan yɛɛ ho adwuma(2019).[158] Nkyekyɛm a Edi Kan: Saa nsɛmmisa kratasin yi wɔ nneɛma 23 a egyina Likert nsenia a ɛyɛ 1 (Mempene so koraa) so, kosi 5 (Mepene so koraa) a wonya bere a wɔasiesie nneɛma a wɔayɛ sɛ wɔde bɛyɛ mprempren adwinnade no ne adesua biara adesua no akyi. Adeɛ mu nhwehwɛmu ne adwene mu nhwehwɛmu a ɛdi kan no kyerɛ sɛ nneɛma mmienu na ɛwɔ mu. Wɔdane nneɛma 3-10-11-12-14-15-16-17-19-20-21 no na wɔde nkaeɛ no ahyɛ mu sɛ ɛyɛ papa. Nea efii nhwehwɛmu mu nneɛma nhwehwɛmu a nneɛma atitiriw a ɛwɔ varimax rotation mu bae no kyerɛe sɛ wɔbɔɔ afã abien a ɛfa suban a ɛfa agyede ho no din sɛnea ɛte biara no sɛ adwene mu afã horow ne suban-nkate afã horow a ɛfa suban a ɛfa agyede ho. Saa nneɛma mmienu yi kyerɛkyerɛɛ 43.25% mu wɔ nsonsonoeɛ a ɛwɔ nhwɛsoɔ no nyinaa mu. Wɔde Cronbach alpha coefficient dii dwuma de susuw ahotoso a ɛwɔ nsɛmmisa kratasin no mu. Cronbach alpha coefficient yɛ 0.709 wɔ nsɛmmisa kratasin no nyinaa mu, 0.71 wɔ ade a edi kan no mu, ne 0.713 wɔ nea ɛto so abien no ho. Bio nso, na abusuabɔ pa a ɛho hia wɔ asetra mu su horow a wɔpɛ ne adwene mu afã a ɛfa adwene a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho ne suban -nkate mu afã horow a ɛwɔ adwene a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho no ntam (P ≤ 0.01).

== Ɔsesɛw ne nkabom a ɛrekɔ so ==
Nneyɛe a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma no asesa kɛse wɔ afeha a ɛto so 20 no mu, na wɔafrɛ kuw foforo biara din, wɔ ɔkwan bi so, sɛ nsakrae.[159] Efi 1970 mfe no mu no, mmɔden a wɔbɔe sɛ wɔbɛma mmofra a wɔfa wɔn sɛ wɔn mma no atu mpɔn no bɛyɛɛ nea ɛfa kyerɛwtohɔ ahorow a wobebue ne abusua a wɔbɛkora wɔn so ho nkuranhyɛ ho. Saa nsusuwii ahorow yi fi nyansahyɛ ahorow a ɛkyerɛ sɛ kokoamsɛm a ɛwɔ nnɛyi agyede mu no betumi anya ɔkwan a wɔfa so hyehyɛ nipasu no so nkɛntɛnso,[160][161] ama adwene atu afra wɔ abusua anato ho,[162] na ɛmma kakraa bi wɔ aduruyɛ ho abakɔsɛm kwan so.

Abusua a wɔbɛkora wɔn so: Bere a nsɛm a ɛfa mmara a wɔmfa nni dwuma ho no fii ase kɔɔ fam wɔ 1970 mfe no mfiase no, asetra mu yiyedi ahyehyɛde ahorow fii ase sii so dua sɛ, sɛ ɛbɛyɛ yiye a, ɛsɛ sɛ wɔma ɛnanom ne mmofra bom. Wɔ U.S. no, wɔdaa eyi adi pefee denam nsakrae a ɛbaa nhyehyɛe mu wɔ New York Foundling Home, ahyehyɛde a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma a ɛka ɔman no mu nea akyɛ sen biara ho na ɛyɛɛ kyerɛwtohɔ ahorow a wɔasɔ ano akwampaefo no mu. Ɛde nnyinasosɛm foforo abiɛsa a nea ɛka ho ne &quot;sɛ wobesiw mmofra a wɔde wɔn bɛto afiase...&quot;, a ɛda gyidi a ɛne sɛ mmofra bɛsom wɔn yiye denam wɔn mmusua a wɔwoo wɔn no nkyɛn a wɔbɛtra so no adi, nsakrae a ɛyɛ nwonwa wɔ nhyehyɛe mu a ɛda so ara yɛ adwuma nnɛ. Bio nso, akuw te sɛ Origins USA (a wɔde sii hɔ wɔ 1997 mu) fii ase kaa abusua a wɔbɛkora so ne ɛnanom hokwan ahorow ho asɛm denneennen.[165] Nancy Verrier nhoma The Primal Wound a wotintimii no nyaa ɔsesɛw akuw ahorow yi adwene mu nne so nkɛntɛnso. Wɔka &quot;Primal wound&quot; ho asɛm sɛ &quot;ɔsɛe a akokoaa no te nka esiane sɛ ɔtetew ne ho fi ne maame a ɔwoo no no ho nti. Ɛyɛ atenka a emu dɔ na efi mu ba a ɛne sɛ wɔagyaw no a akokoaa a wɔagye no ayɛ ne ba no te nka bere a wɔafa no ayɛ ne ba no akyi na ebetumi akɔ so wɔ ne nkwa nna nyinaa mu.&quot; &quot;[160] .&quot;

Kyerɛwtohɔ ahorow a wɔabue: Bere a wɔagye obi a wɔagye no ayɛ ne ba wɔ mmara kwan so akyi wɔ United States no, wɔtaa yɛ nsakrae wɔ awo ho adansedi krataa a edi kan no mu na wɔde awo ho adansedi krataa foforo si ananmu. Wɔde awofo biara a wɔwoo abofra no din a wɔakyerɛw wɔ awo ho adansedi krataa a edi kan no so no, wɔde awofo a wɔfaa no sɛ wɔn ba no din si adansedi krataa a wɔayɛ mu nsakrae no ananmu, na ɛma ɛyɛ te sɛ nea awofo a wɔfaa no sɛ wɔn ba no na wɔwoo abofra no. Efi 1930 mfe no awiei na ɛkɔɔ so kosi 1970 mfe no mu no, ɔman mmara maa kwan sɛ wɔbɛsɔ awo ho adansedi nkrataa a edi kan no ano bere a wɔafa no sɛ wɔn ba akyi, na gye sɛ aman bi mu no, ɛmaa awo ho adansedi krataa a edi kan no antumi annye onipa a wɔagye no ayɛ ne ba no bere a wadi mfe pii mpo no ] .

Nnipa a wɔagye wɔn ayɛ wɔn mma no fi bere tenten abɔ mmɔden sɛ wobeyi mmara ahorow yi afi hɔ sɛnea ɛbɛyɛ a wobetumi anya wɔn ankasa awo ho adansedi krataa a edi kan. Nneɛma a wɔyɛe sɛ wobeyi awo ho adansedi nkrataa a edi kan ne mmofra a wɔagye wɔn ayɛ wɔn mma no ho kyerɛwtohɔ afoforo a wɔayɛ ama wɔn no dɔɔso wɔ 1970 mfe no mu a wogye toom kɛse sɛ wɔmfa mmara mma wɔn mma no. Wɔ United States no, Jean Paton hyehyɛɛ Orphan Voyage wɔ afe 1954 mu, na Florence Fisher hyehyɛɛ Adoptees' Liberty Movement Association (ALMA) wɔ afe 1971 mu, na ɔfrɛɛ kyerɛwtohɔ ahorow a wɔasɔ ano no &quot;ade a wɔsɛe nnipa nidi&quot;.[168] Bere a wɔ afe 1975 mu no, Emma May Vilardi yɛɛ kyerɛwtohɔ a edi kan a wɔn nyinaa pene so, Amanaman Ntam Soundex Reunion Registry (ISRR), a ɛmaa wɔn a wɔfaa wɔn sɛ wɔn mma no atetew wɔn ho no tumi huu wɔn ho wɔn ho. na Lee Campbell ne awofo afoforo hyehyɛɛ CUB (Concerned United Birthparents). Na nsusuwii a ɛte saa ara renya nkɔso wɔ wiase nyinaa wɔ ahyehyɛde ahorow a ɛwɔ fam te sɛ Parent Finders a ɛwɔ Canada ne Jigsaw a ɛwɔ Australia no mu. Wɔ afe 1975 mu no, England ne Wales buee kyerɛwtohɔ ahorow a egyina abrabɔ pa so.[170]

Eduu 1979 no, ahyehyɛde ahorow 32 ananmusifo a wofi aman 33 mu, Canada ne Mexico, hyiaam wɔ Washington, DC, sɛ wɔrebɛtew Amerika Awofo Bagua (AAC) a wɔde adwene koro toom sɛ: “Bue Kyerɛwtohɔ ahorow a nsɛm a ɛkyerɛ sɛ wobehu mmofra a wɔfa wɔn sɛ wɔn mma no mufo nyinaa awie, . awofo, awofo a wɔfa wɔn sɛ wɔn ba ne nea wɔfa no sɛ ne ba wɔ mfe a nea wɔagye no ayɛ ne ba no adi (18 anaa 19, a egyina ɔman no so) anaasɛ ansa na ɛreba no sɛ nnipa baasa no mufo nyinaa pene so a.&quot;[171] Mfe a edi hɔ no huu ahyehyɛde ahorow a ɛyɛ akofo pii te sɛ Bastard Nation (a wɔde sii hɔ) no dannan wɔ 1996 mu), akuw a wɔboaa ma wobuu kyerɛwtohɔ ahorow a wɔasɔ ano wɔ Alabama, Delaware, New Hampshire, Oregon, Tennessee, ne Maine.[172][173] New York ne ɔman no mu nnipa a wɔhwehwɛ hokwan ahorow a wɔde gye wɔn ayɛ wɔn mma no nkabom bi yɛɛ adwuma yiye de buu mmara bi a adi mfe 83 a ɛyɛ anohyeto no mu wɔ afe 2019 mu, na nnipa a wɔanyinyin a wɔagye wɔn ayɛ wɔn mma a wɔwoo wɔn wɔ New York, ne wɔn asefo nso, nnɛ wɔ hokwan sɛ wɔbisa na wonya wɔn ankasa de awo ho adansedi nkrataa a edi kan.[174][175] Ɛde besi afe 2021 no, aman du a ɛwɔ United States no gye hokwan a nnipa a wɔanyinyin a wɔagye wɔn ayɛ wɔn mma no wɔ sɛ wonya wɔn ankasa awo ho adansedi krataa a edi kan, a Alabama, Alaska, Colorado, Connecticut, Kansas, Maine, New Hampshire, New York, Oregon ne Rhode Island ka ho. 176] na. Connecticut wɔ afe 2021 mu no bɛyɛɛ ɔman a ɛtɔ so du a ɛsan de hokwan a obi a wɔagye no ayɛ ne ba no wɔ sɛ ɔbisa na ɔnya wɔn awoɔ ho adansedie nkrataa a ɛdi kan no baeɛ.[177][178 

'''Nkabom a wɔsan hyia'''

Akontaabu ahorow a ɛfa baabi a wɔn a wɔagye wɔn ayɛ wɔn mma no suban a wɔhwehwɛ nneɛma mu kodu no ada adi sɛ ɛyɛ nea wontumi nhu; nhwehwɛmu ahorow kyerɛ sɛ nsakrae kɛse wɔ hɔ.[179] Ɔfã bi no, ɔhaw no fi nnipa kakraa bi a wɔagye wɔn ayɛ wɔn mma a ɛma nhwehwɛmu a wɔyɛ no kwa no yɛ den, sɛ ɛnyɛ nea ɛrentumi nyɛ yiye mpo a.

Ne nyinaa mu no, wobetumi anya nneɛma bi a ɛkyerɛ sɛnea wɔn a wɔagye wɔn ayɛ wɔn mma no ani gye ho sɛ wɔbɛhwehwɛ nneɛma mu no afi England ne Wales asɛm a ebuee wɔn a wɔagye wɔn ayɛ wɔn mma no awo ho kyerɛwtohɔ ahorow mu wɔ 1975. U.K. Office for National Statistics no ahyɛ ho nkɔm sɛ awiei koraa no, wɔn a wɔagye wɔn ayɛ wɔn mma no nyinaa mu 33% bɛsrɛ sɛ wɔmfa bi mma wɔn wɔn awo ho kyerɛwtohɔ a edi kan no mu, a ɛboro mfitiase nkɔmhyɛ ahorow a wɔkae wɔ 1975 mu bere a na wogye di sɛ nnipa dodow a wɔagye wɔn ayɛ wɔn mma no mu kakraa bi pɛ na wɔbɛbisa wɔn kyerɛwtohɔ no so no. Nanso, wonim sɛ nsusuwii no bu nhwehwɛmu dodow ankasa no adewa, efisɛ nnipa pii a wɔagye wɔn ayɛ wɔn mma wɔ saa bere no mu no nam akwan foforo so nya wɔn awo ho kyerɛwtohɔ.[180]

Nhwehwɛmu nhoma ahorow no ka sɛ wɔn a wɔagye wɔn ayɛ wɔn mma no de nneɛma anan a enti wɔpɛ sɛ wɔsan hyiam ma: 1) wɔpɛ sɛ wonya abusua anato a edi mũ kɛse, 2) wɔpɛ sɛ wohu nsɛm a esisi a ɛde wɔn nyinsɛn, awo, ne wɔn a wogyae mu no, 3) wɔwɔ anidaso sɛ wɔde nsɛm bɛma wɔn mma , ne 4) wohia abɔde a nkwa wom ho nsɛm a ɛkɔ akyiri, a aduruyɛ ho nsɛm ka ho. Nanso, nhwehwɛmufo a wɔyɛ mmofra a wɔfa wɔn sɛ wɔn mma no susuw sɛ ntease ahorow a wɔde ama no nni mũ: ɛwom sɛ obi a ɔto so abiɛsa betumi de nsɛm a ɛte saa ama de, nanso nsɛm a wobisabisaa wɔn a wɔagye wɔn ayɛ wɔn mma, a wɔhwehwɛɛ sɛ wɔbɛsan ahyiam no, hui sɛ wɔdaa hia a ehia sɛ wodi abɔde mu abusuabɔ ho dwuma ankasa adi.

Ɛte sɛ nea ɔpɛ a ɛwɔ hɔ sɛ wɔbɛsan ahyiam no ne nea wɔagye no ayɛ ne ba no nkitahodi ne ɔmanfo a wogye tom wɔ mpɔtam hɔ no wɔ abusuabɔ. Nsusuwii ahorow a wɔde wɔn adwene si wɔn mu so kyerɛ sɛ wɔn a wɔagye wɔn ayɛ wɔn mma no binom wɔ nsɛm a emu nna hɔ wɔ wɔn ho a wɔte nka no mu, na ɛma wotumi de nipasu a ɛkɔ so daa kyerɛ no sɛe. Reunion boa ma wosiesie ne ho nimdeɛ a wonni no.[182]

Nea ɛne eyi bɔ abira no, nsusuwii ahorow a wɔde wɔn adwene si akyi no kyerɛ sɛ wɔn a wɔagye wɔn ayɛ wɔn mma no fa so di asetra mu animtiaabu so. Goffman na odii kan de nsusuwii no too gua, na ɛwɔ afã anan: 1) wɔn a wɔagye wɔn ayɛ wɔn mma no hu sɛ abɔde mu abusuabɔ a enni hɔ no kyerɛ nsonsonoe a ɛda wɔn abusua a wɔagye wɔn ayɛ wɔn mma no ntam wɔ afoforo ho, 2) osuahu ahorow a wɔn a wɔnnye wɔn mma no kyerɛ sɛ abusuabɔ a wɔde gye wɔn ayɛ wɔn mma no yɛ mmerɛw sen mogya mu abusuabɔ no hyɛ ntease yi mu den, ) sɛ wɔka bom a, saa nneɛma yi ma, wɔ wɔn a wɔagye wɔn ayɛ wɔn mma no binom mu no, wɔte nka sɛ wɔayi wɔn afi asetra mu, na 4) saa wɔn a wɔagye wɔn ayɛ wɔn mma yi yɛ wɔn ade denam mogya a wɔde kyekyere wɔn ho a wɔhwehwɛ a ɛhyɛ wɔn a wɔyɛ ɔmanfo no mu den no so. Ntease a ɛfa akyi a wɔde wɔn adwene si so wɔ sanba ho no kyerɛ sɛ ebia wɔn a wɔagye wɔn ayɛ wɔn mma no bɛyɛ nsakrae yiye na wɔwɔ anigye wɔ wɔn mmusua a wɔagye wɔn ayɛ wɔn mma no mu, nanso wɔbɛhwehwɛ sɛ mmɔden a wɔbɔ sɛ wobesiesie osuahu ahorow a ɛfa asetra mu animtiaabu ho.[181]

Wɔn a wɔagye wɔn ayɛ wɔn mma no bi pow adwene a ɛne sɛ wɔbɛsan ahyiam no. Nanso, nea ɛma ɛsono wɔn a wɔagye wɔn ayɛ wɔn mma a wɔhwehwɛ wɔn no ne wɔn a wɔnhwehwɛ no mu no mu nna hɔ. Krataa biako bɔ nhwehwɛmu no mua, na ɛka sɛ, &quot;...mmɔden a wɔbɔ sɛ wɔbɛma nsonsonoe aba nea ɔhwehwɛ ne nea ɔnyɛ nhwehwɛmu no ntam no nyɛ nea ɛyɛ nea ɛyɛ nokware anaasɛ ɛyɛ nea wotumi de di dwuma wɔ ɔkwan a ɛkɔ akyiri so sen mmɔden a wɔbɔ sɛ wɔbɛkyerɛ ... nsonsonoe a ɛda wɔn a wɔagye wɔn ayɛ wɔn mma ne wɔn a wɔamfa wɔn ayɛ wɔn mma ntam.&quot;[183]

Sɛ yɛbɛka no tiawa a, nhyiam a wɔsan hyia no betumi de nsɛm ahorow aba wɔn a wɔagye wɔn ayɛ wɔn mma ne awofo so. Ne nyinaa mu no, ɛte sɛ nea nea efi mu ba a wɔsan hyiam no mu dodow no ara yɛ nea eye. Wɔ nhwehwɛmu kɛse a wɔayɛ de besi nnɛ (a egyina mmuae a nnipa 1,007 a wɔafa wɔn ayɛ wɔn mma ne awofo a wogyaee no de mae so) 90% buae sɛ sankɔhwɛ yɛ osuahu a mfaso wɔ so. Nanso, eyi nkyerɛ sɛ wɔhyehyɛɛ abusuabɔ a ɛkɔ so wɔ nea wɔagye no ayɛ ne ba ne ɔwofo ntam anaasɛ eyi ne botae no.[184]

'''Nneyɛe a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho a akyinnyegye wom'''

Hwɛ nso: Nsisi a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho

Wɔde mmɔden a wɔbɔ sɛ wɔbɛyɛ nsakrae ne abusua a wɔbɛkora wɔn so no nso abata sɛnea wosusuw sɛ wɔde mmofra a wɔfa wɔn sɛ wɔn mma no di dwuma ɔkwammɔne so no ho denneennen. Wɔ tebea horow bi mu no, wɔagyae awofo hokwan ahorow bere a ɔmanfo abu wɔn mmusuakuw anaa wɔn asetra mu sikasɛm kuw no sɛ wɔmfata no. Ná nnipa pii gye nneyɛe yi bi tom na

== Amammerɛ mu nsakrae ahorow ==
Suban ne mmara a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho no gu ahorow kɛse. Bere a amammerɛ nyinaa yɛ nhyehyɛe ahorow a mmofra a wɔn awofo a wɔwoo wɔn no nni hɔ a wobetumi atete wɔn no, afoforo betumi atete wɔn no, ɛnyɛ amammerɛ nyinaa na wɔwɔ adwene a ɛne sɛ wobegye wɔn ayɛ wɔn mma, a ɛne sɛ wɔbɛfa mmofra a wɔne wɔn ho nni abusuabɔ sɛ wɔne awofo a wɔagye wɔn ayɛ wɔn mma no mma a wɔwoo wɔn no yɛ pɛ. Sɛ nhwɛso no, wɔ Nkramofo Mmara ase no, ɛsɛ sɛ mmofra a wɔagye wɔn ayɛ wɔn mma no de wɔn mfitiase abusua din sie na ama wɔahu wɔn ne mogya mu abusuabɔ,[213] na, sɛnea wɔtaa yɛ no, mmea hyɛ hijab wɔ mmarima anim wɔ wɔn afie a wɔagye wɔn ayɛ wɔn mma no mu. Wɔ Egypt no, saa amammerɛ mu nsonsonoe ahorow yi ama wɔayɛ mmofra a wɔfa wɔn sɛ wɔn mma no ayɛ nea mmara mma ho kwan mmom sɛ wɔbɛpaw nhyehyɛe a ɛfa mmofra a wɔhwɛ wɔn wɔ mmofraase ho.[214][215]

== Da a Wɔde Kɔ Fie ==


Wɔ aman bi te sɛ United States mu no, &quot;Homecoming Day&quot; yɛ da a obi a wɔagye no ayɛ ne ba no ne wɔn abusua foforo a wɔagye no ayɛ wɔn mma no bom wɔ aban kwan so.[216]</text>
      <sha1>kh714lwz5e4gg14rg3anha69irfb7cx</sha1>
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      <text bytes="67862" xml:space="preserve">'''Abanoma''' ({{Audio|tw-Abanoma.ogg|pronounciation of &quot;Abanoma&quot;}}) mmɔfra a wɔfa wɔn sɛ wɔn mma yɛ adeyɛ a obi fa no sɛ ɔfoforo, mpɛn pii no abofra, awofoyɛ no fi saa onipa no ɔwofo anaa n’awofo a ɔwoo no ankasa anaa mmara kwan so no hɔ. Mmara kwan so mmofra a wɔfa wɔn sɛ wɔn mma no de hokwan ne asɛyɛde ahorow nyinaa, ne ayɔnkofa ho, fi awofo a wɔwoo wɔn no hɔ kɔ awofo a wɔfa wɔn sɛ wɔn mma no so daa.

Nea ɛnte sɛ awɛmfo anaa nhyehyɛe afoforo a wɔayɛ ama mmerante ne mmabaa a wɔbɛhwɛ wɔn no, atirimpɔw ne sɛ wɔbɛma mmofra a wɔfa wɔn sɛ wɔn mma no ayɛ nsakrae a ɛbɛtra hɔ daa wɔ wɔn gyinabea mu na sɛnea ɛte no, ɛhwehwɛ sɛ ɔmanfo gye tom, denam mmara anaa nyamesom mu asotwe so. Abakɔsɛm mu no, fekuw ahorow bi ahyɛ mmara pɔtee bi a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho, bere a afoforo de akwan horow a ɛnyɛ mmara kwan so de dii dwuma (titiriw apam ahorow a ɛkyerɛ agyapade hokwan ahorow ne awofo asɛyɛde ahorow a wɔmfa wɔn a wɔde wɔn ho hyɛ mu foforo nka ho). Nnɛyi nhyehyɛe ahorow a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho, a ɛsɔree wɔ afeha a ɛto so 20 yi mu no taa yɛ nea mmara ne nhyehyɛe ahorow a edi mũ na edi so.

== Abakɔsɛm ==
'''Tete nneɛma'''

'''Agyede a wogye ma wɔn a wɔawo wɔn yiye'''

Bere a nnɛyi kwan a wɔfa so gye wɔn ba no puei wɔ United States no, adeyɛ no akwan horow puei wɔ abakɔsɛm nyinaa mu.[1] Sɛ nhwɛso no, Hammurabi Mmara no ka hokwan ahorow a wɔn a wɔagye wɔn ayɛ wɔn mma no wɔ ne ankorankoro a wɔagye wɔn ayɛ wɔn mma no asɛyɛde ahorow ho asɛm kɔ akyiri. Wɔakyerɛw adeyɛ a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma wɔ tete Roma no ho asɛm yiye wɔ Codex Justinianus mu.[2][3]

Ɛsono koraa wɔ nnɛyi bere no ho no, tete nneyɛe a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho no si amammui ne sikasɛm mu anigyede a ɛfa nea ɔfaa no ba no ho so dua,[4] na ɛde mmara kwan so adwinnade bi a ɛhyɛɛ amammui mu abusuabɔ a ɛda mmusua a wɔwɔ sika ntam no mu den na ɛmaa mmarima adedifo a wɔhwɛ agyapade so mae. Wɔakyerɛw sɛnea adehye no de di dwuma sɛ wɔn mma no ho asɛm yiye: na Roma ahempɔn no mu pii yɛ mmabarima a wɔafa wɔn ayɛ wɔn mma.[6] Ná adrogation yɛ Romafo a wɔfa wɔn sɛ wɔn mma no bi a onipa a wɔfa no sɛ ne ba no pene so sɛ ɔfoforo begye no ayɛ ne ba.

Ɛte sɛ nea nkokoaa a wɔfa wɔn sɛ wɔn mma wɔ Tete mmere mu no ntaa mma.[4][7] Na wɔtaa fa mmofra a wɔagyaw wɔn hɔ no ma wɔyɛ nkoa[8] na na wɔyɛ Ahemman no nkoa a wɔde ma no ɔha biara mu nkyem kɛse.[9][10] Romafo mmara mu kyerɛwtohɔ ahorow kyerɛ sɛ ɛtɔ mmere bi a na mmusua fa mmofra a wɔahu wɔn no na wɔtete wɔn sɛ ɔbabarima anaa ɔbabea. Ɛwom sɛ wɔtaa mfa wɔn mma wɔ Roma Mmara ase de, nanso wɔtetee mmofra no a wɔfrɛ wɔn alumni no wɔ nhyehyɛe bi a ɛte sɛ ɔhwɛfo mu, na wobuu wɔn sɛ agya a ogyaw wɔn hɔ no agyapade.[11]

Tete anibuei afoforo, titiriw India ne China, de ɔkwan bi a wɔfa so gye wɔn ba nso dii dwuma. Adanse kyerɛ sɛ na adeyɛ yi botae ne sɛ ɛbɛma amammerɛ ne nyamesom nneyɛe akɔ so; nea ɛne Atɔe Famfo adwene a ɛne sɛ wɔbɛtrɛw abusua ahorow mu no bɔ abira. Wɔ tete India no, ɔbabarimayɛ a ɛto so abien, a Rigveda kasa tia no pefee no,[12] kɔɔ so, wɔ ɔkwan a anohyeto wom na ɛyɛ amanne kɛse so, sɛnea ɛbɛyɛ a obi a ɔfa ne ba no betumi anya ayiyɛ ho amanne a ɛho hia a ɔbabarima bɛyɛ. China wɔ adwene a ɛte saa ara a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma a mmarima a wɔfa wɔn sɛ wɔnyɛ wɔn mma sɛ wɔmfa nyɛ nananom som nnwuma nkutoo ho.[14]

Ná adeyɛ a ɛne sɛ wobegye abusua mufo ne nnamfo paa mma ayɛ wɔn mma no abu so wɔ Polynesia amammerɛ ahorow mu a Hawaii a na wɔfrɛ amanne no sɛ hānai ka ho.

'''Mfinimfini mmere kosi nnɛyi bere so'''

Adoption ne nnipa mpapahwekwa

Germanfo, Celtfo, ne Slavfo amammerɛ a na ɛwɔ Europa so wɔ Roma Ahemman no asehwe akyi no anuonyamfo no kasa tiaa adeyɛ a ɛne sɛ wɔfa wɔn sɛ wɔn mma no.[15] Wɔ mfinimfini mmere mu ɔmanfo mu no, na mogya ahorow na ɛho hia sen biara; wɔde ahemman a edi tumi a na onni ɔdedifo a ɛda adi sɛ &quot;wɔwoo no wɔ abɔde mu&quot; no sii ananmu, na ɛne Romafo atetesɛm ahorow bɔ abira koraa. Europa mmara a ɛdannan no da saa akyide a wɔmpɛ sɛ wɔfa wɔn sɛ wɔn mma no adi. Sɛ nhwɛso no, Engiresifo mmara a wɔtaa de di dwuma no amma kwan mma wɔmfa obi mma efisɛ na ɛne agyapade ho mmara a wɔtaa de di dwuma no bɔ abira. Wɔ saa kwan koro no ara so no, France Napoleon Mmara no maa ɛyɛ den sɛ wobegye mmofra ayɛ wɔn ba, na ɛhwehwɛɛ sɛ wɔn a wɔfa no sɛ wɔn ba no di boro mfe 50, wonni mma, anyɛ yiye koraa no, wɔn mfe 15 sen nea wɔagye no ayɛ wɔn ba no, na anyɛ yiye koraa no, wɔatete nea wɔagye no ayɛ wɔn ba no mfe asia. Nanso, mmofra a wɔfa wɔn sɛ wɔn mma no bi kɔɔ so bae, nanso ɛbɛyɛɛ nea ɛnyɛ ɔkwan biara so, a egyina apam ahorow a wɔyɛe bere tiaa bi so. Sɛ nhwɛso no, wɔ afe 737 mu no, wɔ mmara bi a efi Lucca kurow mu mu no, wɔyɛɛ nnipa baasa a wɔagye wɔn ayɛ wɔn mma no agyapade bi adedifo. Te sɛ nhyehyɛe afoforo a ɛwɔ hɔ nnɛ no, apam no sii asɛyɛde a ɛda nea wɔagye no ayɛ ne ba no so dua sen sɛ obegye ne ba no, na ɛtwee adwene sii nokwasɛm a ɛyɛ sɛ, wɔ apam no ase no, na wɔayɛ sɛ wɔbɛhwɛ agya a ɔfaa no ayɛ ne ba no wɔ ne nkwakoraabere mu no so; adwene a ɛte sɛ nsusuwii ahorow a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho wɔ Roma mmara ase no.[17]

Europa amammerɛ mu nsakrae no hyɛɛ bere a wɔyɛɛ nneɛma foforo a ɛho hia a wɔde gye toom no agyirae. Esiane sɛ wɔamfa mmoa a efi atitiriw no hɔ nti, adeyɛ no dan kɔɔ mmofra a wɔagyaw wɔn hɔ no so nkakrankakra. Nnipa a wogyaw wɔn hɔ no kɔɔ soro bere a ahemman no hwee ase no na wogyaw mmofra a wohuu wɔn no pii wɔ Asɔre no pon ano.[18] Mfiase no, asɔfo no yɛɛ wɔn ade denam mmara a wɔhyehyɛe de kyerɛ sɛnea wɔbɛpa mmofra a wɔagyaw wɔn hɔ no ho ntama, atɔn, na wɔatete wɔn no so. Nanso, ade foforo a Asɔre no yɛe ne afɔrebɔ ho adeyɛ, a ɛnam so hyira mmofra so sɛ wɔnyɛ asɔremma asetra wɔ nkokorafie ahyehyɛde ahorow mu na wɔtete wɔn wɔ nkokorafie bi mu. Eyi na ɛde nhyehyɛe a edi kan wɔ Europa abakɔsɛm mu a mmofra a wɔagyaw wɔn hɔ no nni mmara, asetra, anaa abrabɔ mu ɔhaw ahorow. Ne saa nti, Europa mmofra a wɔagyaw wɔn hɔ na wɔayɛ nyisaa no mu pii bɛyɛɛ Asɔre no sukuufo dedaw, na ɛno nso faa dwuma sɛ obi a ɔhwɛ wɔn sɛ wɔn mma. Oblation hyɛ nsakrae a ɛkɔ ahyehyɛde ahorow mu no mfiase agyirae, na awiei koraa no ɛde ayaresabea a wɔde sii hɔ ne nyisaa atrae no sii hɔ.[18]

Bere a adwene a ɛfa ahyehyɛde mu hwɛ ho no nyaa adwene no, mmara a wɔahyɛ da ahyɛ da puei wɔ sɛnea wɔde mmofra bɛto mmusua mu: mmarimaa betumi abɛyɛ obi a osua adwumfo na mmeawa betumi aware wɔ ahyehyɛde no tumi ase. Asoɛe ahorow gyee mmofra nso sɛ wɔn mma wɔ ɔkwan a ɛnyɛ ɔhyɛ so, adwinnade a wɔfaa no sɛ ɔkwan a wɔfa so nya adwumayɛfo a wɔn bo nyɛ den, a nokwasɛm a ɛyɛ sɛ bere a wɔn a wɔagye wɔn ayɛ wɔn mma no wuwu no, abusua no de wɔn afunu san kɔ asoɛe no mu ma wosie no da no adi.

Saa nhyehyɛe a ɛfa adesua ne mmofra a wɔfa wɔn sɛ wɔn mma wɔ ɔkwan a ɛnyɛ ɔkwan pa so ho yi trɛw kɔɔ afeha a ɛto so 19 no mu, a nnɛ wobu no sɛ nsakrae fã ma mmofra a wɔfa wɔn sɛ wɔn mma ho abakɔsɛm. Wɔ asetra mu yiyedi ho adwumayɛfo akwankyerɛ ase no, nyisaa guankɔbea ahorow fii ase hyɛɛ mmofra a wogyina nkate so a wɔfa wɔn sɛ wɔn mma no ho nkuran sen sɛ wɔbɛyɛ adwuma; wɔde mmofra too apam ahorow a wɔde bɛhwɛ wɔn sɛ abusua mufo ase sen sɛ wɔde bɛto apam ahorow a ɛfa adesua ho ase.[21] Wogye di sɛ saa nhwɛso yi nkɔso no na ɛmaa Massachusetts Amanaman Nkabom no hyehyɛɛ nnɛyi mmara a edi kan a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho wɔ 1851 mu, a ɛyɛ soronko wɔ sɛnea ɛhyehyɛɛ adwene a ɛne sɛ &quot;abofra no yiyedi yiye&quot; no. Nanso, ɛmfa ho ne atirimpɔw no, wɔ nneyɛe mu no, nhyehyɛe no yɛɛ adwuma te sɛ honam a edi kan no. Boston Female Asylum (BFA) no suahunu yɛ nhwɛsoɔ pa, a na ɛwɔ ne soboɔ no mu bɛyɛ 30% a wɔagye atom wɔ afe 1888 mu.[24] BFA mpanyimfo kae sɛ, ɛwom sɛ guankɔbea no hyɛɛ ho nkuran sɛ ɛnte saa de, nanso awofo a wɔfa wɔn sɛ wɔn mma no ankyerɛ nsonsonoe a ɛda indenture ne mmofra a wɔfa wɔn sɛ wɔn mma no ntam: &quot;Yegye di,&quot; guankɔbea mpanyimfo no kae sɛ, &quot;sɛ mpɛn pii no, sɛ wɔfa mmofra a wonnii mfe pii sɛ wɔmfa wɔn mma a,... agyede yɛ din foforo a wɔde frɛ ɔsom ara kwa.&quot;[25]

'''Nnɛyi bere'''

Fapem a wɔde bɛbɔ abusua

Nneɛma a edi hɔ a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho no dannan wɔn ho no hwee United States man a na ɛrenya nkɔso no nsam. Atubrafo a wɔbae ntɛmntɛm ne Amerika Ɔmanko no maa nyisaa atrae ne mmofra a wɔahu wɔn afie dɔɔso dodo wɔ afeha a ɛto so dunkron no mfinimfini a ebi mmae da. Charles Loring Brace a na ɔyɛ Protestantfo ɔsomfo no ho dwiriw no wɔ waiffo dɔm a wonni afie a na wɔrekyinkyin New York Kuropɔn no mmɔnten so no ho. Brace buu mmerante ne mmabaa a wɔagyaw wɔn hɔ, titiriw Katolekfo, sɛ wɔyɛ ade a ɛyɛ hu sen biara a ɛrekasa atia kurow no nhyehyɛe.[26][27]

Wɔkaa n’ano aduru ho asɛm wɔ The Best Method of Disposing of Our Pauper and Vagrant Children (1859) a efii Nyisaa Keteke kuw no ase no mu. Awiei koraa no, keteke ahorow a ɛyɛ nyisaa no de mmofra bɛyɛ 200,000 fii Apuei Fam nkurow akɛse mu kɔɔ ɔman no nkuraase.[28] Mpɛn pii no, na wɔde mmofra no ahyɛ mmusua a wɔde wɔn kɔ mu no nsa, sen sɛ wɔbɛfa wɔn ayɛ wɔn mma.[29] Sɛnea na ɛte wɔ mmere a atwam no mu no, na wɔtete mmofra binom sɛ abusua no mufo bere a na afoforo nso yɛ mfuw mu adwumayɛfo ne afie mu asomfo. Nnipa a wɔatu wɔn afi wɔn afie mu no kɛse koraa—mmofra a wotu kɔtra mmeae foforo sen biara wɔ abakɔsɛm mu—ne sɛnea wɔde wɔn dii dwuma ɔkwammɔne so a ɛkɔɔ so no maa wɔhyehyɛɛ nnwumakuw foforo ne mmara ahorow a ɛhyɛɛ nhyehyɛe ahorow a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho nkuran sen sɛ wɔde wɔn ho bɛma. Bere no agyiraehyɛde ne Minnesota mmara a ɛfa mmofra a wɔfaa wɔn mma ho wɔ 1917 mu, a ɛhyɛɛ sɛ wɔnyɛ nhwehwɛmu wɔ mmeae a wɔde wɔn kɔe nyinaa ho na wɔmma wɔn a wɔde wɔn ho hyɛɛ mmofra a wɔfaa wɔn no mu no nnya kyerɛwtohɔ pii.[30][31]

Wɔ saa bere koro no ara mu no, Progressive kuw no faa United States a na botae titiriw ne sɛ ɛbɛma nyisaa atrae nhyehyɛe a na ɛwɔ hɔ no aba awiei. Mmɔdenbɔ a ɛte saa no awiei bae wɔ White House Nhyiam a Edi Kan a Ɛfa Mmofra a Wɔde Wɔn Ho To Wɔn So Hwɛ Ho a Ɔmampanyin Theodore Roosevelt frɛɛ no ​​wɔ 1909 mu,[32] faako a wɔkae sɛ nuklea abusua no gyina hɔ ma &quot;anibuei ade a ɛkorɔn na eye sen biara&quot; na eye sen biara no a otumi som sɛ ɔhwɛfo titiriw ma wɔn a wɔagyaw wɔn hɔ ne wɔn a wɔayɛ nyisaa.[33][34] Wɔ 1923 mu tɔnn no, na mmofra a wɔn awofo nhwɛ wɔn no mu ɔha biara mu abien pɛ na na wɔwɔ afie a wɔhwɛ wɔn sɛ wɔn mma mu, na nea aka no wɔ nhyehyɛe a wɔde hwɛ mmofra ne nyisaa atrae. Annu mfe aduanan akyi no, na ɛkame ayɛ sɛ nkyem abiɛsa mu biako wɔ afie a wɔhwɛ wɔn sɛ wɔn mma mu.[35]

Ne nyinaa mu no, eugenic adwene a agye din wɔ Amerika no de akwanside ahorow bae wɔ mmofra a wɔfa wɔn sɛ wɔn mma no nkɔso mu.[36][37] Na nneɛma a ɛhaw adwene kɛse wɔ mmofra a wɔnyɛ mmara ne ahiafo awosu mu su pa ho, a ebia nea ɛyɛ nhwɛso yiye ne Henry H. Goddard nkyerɛwee a ɛwɔ nkɛntɛnso a ɔkasa tiaa mmofra a wonnim faako a wogye wɔn sɛ wɔn mma no, na ɔkae sɛ, .

Afei ɛba sɛ nnipa binom ani gye adesamma abusua no yiyedi ne nkɔso a ɛkorɔn ho; nanso sɛ yɛde saa nnipa soronko no to nkyɛn a, agyanom ne ɛnanom nyinaa ani gye wɔn ankasa mmusua yiyedi ho. Ade a awofo koma ani gye ho paa ne sɛ wɔbɛma mmofra no aware yiye na wɔatete abusua a ɛkorɔn. Hwɛ sɛnea ɛyɛ adwene tiawa saa bere no sɛ abusua a ɛte saa begye abofra bi a wonnim n’abusua mu abusua koraa no akɔ ne mfinimfini; anaasɛ, baabi a, sɛ wonim no fã bi a, nea ebetumi aba no mu yɛ den sɛ ɛbɛkyerɛ mmoa a wɔyɛ ahiafo na wɔyare, na sɛ ɛsɛ sɛ aware bi kɔ so wɔ saa onipa no ne abusua no muni biara ntam a, asefo no asɛe.

Bere a efi 1945 kosi 1974, nkokoaa a wɔde wɔn gu mu bere no, huu nkɔso ntɛmntɛm na wogyee sɛ wɔfa wɔn sɛ wɔn mma sɛ ɔkwan a wɔfa so kyekye abusua.[39] Awo a mmara mma ho kwan kɔɔ soro mprɛnsa wɔ Wiase Ko II akyi, bere a nna ho nneyɛe sesae no. Bere koro no ara mu no, nyansahufo kuw no fii ase sii so dua sɛ ntetee di awosu so tumi, na wɔde eugenic animtiaabu no fii hɔ.[40][41] Wɔ saa tebea yi mu no, mmofra a wɔfa wɔn sɛ wɔn mma no bɛyɛɛ ano aduru a ɛda adi pefee maa nnipa a wɔnwaree ne awarefo a wontumi nwo nyinaa.[42]

Sɛ wɔka saa nneɛma yi bom a, ɛma wonya Amerikafo nhwɛso foforo a wɔde begye atom. Wɔ Romafo a edii n’anim no akyi no, Amerikafo twaa hokwan ahorow a awofo a wodi kan no wɔ mu bere a wɔmaa wɔn a wɔfa wɔn sɛ wɔn mma no yɛɛ awofo foforo wɔ mmara no ani so no. Wɔde nneɛma foforo abien kaa ho: 1) na atirimpɔw ne sɛ wɔbɛfa mmofra ayɛ wɔn mma sɛ wɔbɛhwɛ ma &quot;abofra no yiyedi a eye sen biara&quot;, wobetumi ahu saa adwene yi aba no afi Amerikafo mmara a edi kan a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho wɔ Massachusetts no mu,[16][23] ne 2) mmofra a wɔfa wɔn sɛ wɔn mma no bɛyɛɛ nea wɔde hyɛɛ mu a ɛyɛ kokoamsɛm, na awiei koraa no ɛmaa wɔsɔɔ mmofra a wɔfaa wɔn sɛ wɔn mma ne awo ho kyerɛwtohɔ ahorow a edi kan no ano wɔ 1945. Charles Loring Brace a ɔde bae sɛnea ɛbɛyɛ a mmofra a wofi Nyisaa Keteke ahorow no mu no rensan nkɔ wɔn awofo nkyɛn anaasɛ wɔbɛsan agye wɔn no mfiase no. Ná Brace suro nkɛntɛnso a awofo no ohia, wɔ ɔkwan a ɛkɔ akyiri so, ne Katolek som titiriw, benya wɔ mmabun no so. Saa atetesɛm a ɛfa kokoamsɛm ho yi, akyiri yi Nkɔsofo nsakraefo no na wɔkɔɔ so bere a wɔreyɛ Amerika mmara ahorow no.[43]

Nnipa dodow a wɔfaa wɔn mma wɔ United States no kɔɔ soro sen biara wɔ 1970 mu.[44] Ɛnyɛ nea wobetumi ahu nea ɛde ɔhwe a edii akyi bae no bae. Nneɛma a ɛbɛyɛ sɛ ɛde bae wɔ 1960 ne 1970 mfe no mu no bi ne awo dodow a ɛso tew, a ɛne aduru no a wɔde bae no wɔ abusuabɔ, akwan a wɔfa so siw awo ano a wɔde ayɛ adwuma a wɔde ahyɛ mmara ase a wɔawie, ɔman no sika a wɔde maa abusua nhyehyɛe ho adwuma a wɔde bɛma mmerante ne mmabaa ne wɔn a wɔba fam no - sika a wonya, ne nyinsɛn a wotu gu ho mmara kwan so. Bio nso, mfeɛ a ɛwɔ 1960 mfeɛ no awieeɛ ne 1970 mfeɛ no mfitiaseɛ no hunuu nsakraeɛ kɛseɛ wɔ ɔmanfoɔ adwene wɔ mmara kwan so ne mmara kwan so hokwan[45] a wɔn a wɔwoo wɔn wɔ awareɛ akyi wɔ no mu. Nea ɛbɛyɛ na wɔabua no, mmɔden a wɔbɔe sɛ wɔbɛkora abusua so no nyaa nkɔanim[46] ma enti mmofra kakraa bi na wɔwo wɔn wɔ aware akyi nnɛ na wɔfa wɔn sɛ wɔn mma. Anwonwasɛm ne sɛ, mmofra a wɔfa wɔn sɛ wɔn mma no da adi kɛse koraa na wɔka ho asɛm wɔ ɔmanfo mu nnɛ, nanso ɛnyɛ nea abu so kɛse.[47]

Awiei koraa no, Amerikafo nhwɛso a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho no dɔɔso wɔ wiase nyinaa. England ne Wales de wɔn mmara a edi kan a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho sii hɔ wɔ 1926. Netherlands too ne mmara wɔ 1956. Sweden maa wɔn a wɔagye wɔn ayɛ wɔn mma no yɛɛ abusua no mufo koraa wɔ 1959. West Germany hyɛɛ ne mmara a edi kan wɔ 1977 mu. Bio nso, Asia tumi ahorow no buee wɔn nyisaa atrae nhyehyɛe ahorow no maa wɔfaa wɔn mma, a Atɔe Famfo adwene a edii atubrafo nniso ne asraafo tumidi akyi nyaa so nkɛntɛnso sɛnea na ɛte no.[49] Wɔ France no, ɔman ahyehyɛde ahorow a ɛwɔ mpɔtam hɔ no ma wɔn a wɔpɛ sɛ wɔfa wɔn sɛ wɔn mma no tom, na afei wobetumi ne nyisaa atrae ahorow a ɛwɔ amannɔne adi nkitaho anaasɛ wɔabisa mmoa afi NGO ahorow hɔ. Nhyehyɛe no mfa sikatua ho, na mmom ɛma tumi kɛse ma asetra mu adwumayɛfo a wɔn gyinaesi ahorow betumi asiw mmofra a wɔfa wɔn sɛ wɔn mma no ano hye wɔ mmusua a &quot;ɛwɔ gyinapɛn&quot; mu (mfinimfini mfe, sika a wonya fi mfinimfini kosi kɛse, mmarima a wɔne wɔn ho da, Caucasianfo).[50]

Wɔyɛ mmofra a wɔfa wɔn sɛ wɔn mma no ho dwuma nnɛ wɔ wiase nyinaa. Nsɛm a ɛwɔ ase ha no de Atɔe Famfo dodow a wɔfa wɔn sɛ wɔn mma no ho mfonini ntɛm ara ma. Mmofra a wɔfa wɔn sɛ wɔn mma wɔ United States no da so ara kɔ so wɔ dodow a ɛreyɛ adu n’atipɛnfo de no mmɔho abiɛsa ɛwom mpo sɛ mmofra dodow a wɔretwɛn sɛ wobegye wɔn ayɛ wɔn mma no akɔ so ayɛ nea ɛkɔ so daa wɔ nnansa yi mfe mu, efi 100,000 kosi 125,000 wɔ bere a efi 2009 kosi 2018 no mu

== Nnɛyi mmofra a wɔfa wɔn sɛ wɔn mma ==
'''Akwan horow a wɔfa so gye wɔn ba'''

Nnɛyi nneyɛe a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho no betumi abue anaasɛ wɔato mu.

Awofo a wɔfa wɔn sɛ wɔn mma ne wɔn a wɔwoo wɔn no ma wotumi hu nsɛm a wɔde di nkitaho wɔ abusuafo ne nea wɔagye no ayɛ wɔn ba no ntam.[70] Awofo a wɔfa wɔn sɛ wɔn mma a wɔn nkutoo na wɔhwɛ abofra no so no betumi ayɛ nhyehyɛe a ɛnyɛ ɔkwan biara so. Wɔ tumidi ahorow bi mu no, awofo a wɔwoo wɔn ne wɔn a wɔagye wɔn ayɛ wɔn mma no betumi ayɛ apam a mmara ma ho kwan na ɛkyekyere wɔn a ɛfa nsrahwɛ, nsɛm a wɔde bɛsesa, anaa nkitahodi foforo a ɛfa abofra no ho.[71] Ɛde besi February 2009 no, U.S. aman 24 maa kwan sɛ wɔde apam ahorow a wɔabue ano a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho apam ahorow a mmara ma ho kwan no kaa mmofra a wɔfa wɔn sɛ wɔn mma no ho nhyehyɛe a etwa to no ho.[72]

Adeyɛ a ɛne sɛ wɔfa wɔn sɛ wɔn mma a wɔato mu (a wɔsan frɛ no kokoam anaasɛ kokoam mmofra a wɔfa wɔn sɛ wɔn mma),[73] a ɛnyɛ nea wɔtaa yɛ wɔ nnɛyi abakɔsɛm fã kɛse no ara mu no,[74] hyɛ nsɛm a ɛma wohu obi nyinaa ano, ɛkora so sɛ ɛyɛ kokoam na esiw awofo a wɔagye wɔn ayɛ wɔn mma no a wɔbɛda no adi no ano’, biological kin’s, ne wɔn a wɔagye wɔn ayɛ wɔn mma no ho nsɛm. Ne nyinaa mu no, agyede a wɔato mu no betumi ama wɔatumi de nsɛm a ɛnyɛ nea ɛkyerɛ sɛ obi yɛ te sɛ aduruyɛ ho abakɔsɛm ne nyamesom ne mmusuakuw a wofi mu akɔma afoforo.[75] Ɛnnɛ, esiane guankɔbea ahobammɔ ho mmara a U.S. aman bi ahyɛ mu nti, kokoam mmofra a wɔfa wɔn sɛ wɔn mma no renya nkɛntɛnso foforo. Wɔ aman a wɔfrɛ no &quot;dan a ahobammɔ wom&quot; mu no, wobetumi agyaw nkokoaa a wɔmmɔ wɔn din wɔ ayaresabea ahorow, odumgyafo adwumayɛbea ahorow, anaa polisifo adwumayɛbea ahorow mu wɔ nna kakraa bi akyi wɔ awo akyi, adeyɛ a ahyehyɛde ahorow bi a wɔkamfo mmofra a wɔfa wɔn sɛ wɔn mma no kasa tia sɛ ɛyɛ nea ɛkɔ akyi na asiane wom.

Sɛnea mmofra a wɔfa wɔn sɛ wɔn mma no fi ase


Mmofra a wɔfa wɔn sɛ wɔn mma no betumi aba wɔ nnipa a wɔyɛ abusuafo anaa wɔn a wɔnyɛ abusuafo ntam. Wɔ abakɔsɛm mu no, na mmofra a wɔfa wɔn sɛ wɔn mma dodow no ara kɔ so wɔ abusua bi mu. Nsɛm a aba nnansa yi ara a efi U.S. kyerɛ sɛ mprempren nnipa a wɔfa wɔn sɛ wɔn mma no mu bɛyɛ fã yɛ nnipa a wɔyɛ abusuafo ntam.[77] Eyi ho nhwɛso a wɔtaa de di dwuma ne &quot;ɔwofo a wɔyɛ mpena a wɔfa wɔn sɛ wɔn mma&quot;, baabi a ɔwofo hokafo foforo no fa abofra bi fi ɔwofo no abusuabɔ a atwam no mu wɔ mmara kwan so. Abusua mu mmofra a wɔfa wɔn sɛ wɔn mma nso betumi aba denam ahofama so, esiane awofo wu nti, anaasɛ bere a wontumi nhwɛ abofra no wɔ ɔkwan foforo so na abusua no muni bi pene so sɛ obegye adwuma no.

Ɛnyɛ bere nyinaa na mmofra a wofi wɔn pɛ mu yɛ ade a wofi wɔn pɛ mu yɛ. Wɔ aman bi mu, sɛ nhwɛso no, wɔ U.K. no, ade titiriw biako a ɛma mmofra a wɔde wɔn to hɔ sɛ wɔmfa wɔn mma no ne sɛ wɔayi wɔn afi baabi a wɔwoo wɔn no, mpɛn pii no aban ahyehyɛde bi te sɛ mpɔtam hɔ atumfoɔ. Nneɛma ahorow bi wɔ hɔ a enti woyi mmofra fi hɔ a ayayade ne anibiannaso ka ho, a ebetumi anya nkɛntɛnso a ɛtra hɔ daa wɔ nea wɔagye no ayɛ ne ba no so. Wɔbɛbɔ asetra mu adwumayɛfo amanneɛ wɔ nsɛm pii mu wɔ ahobammɔ ho asɛm bi a ɛfa abofra bi ho ho na wɔabisabisa abofra no yiyedi ho nsɛm. Mpɛn pii no, asetra mu nsɛm ho adwumayɛfo bɛhwehwɛ akwan a wɔbɛfa so ama abofra bi ne abusua a wɔwoo no no abom, sɛ nhwɛso no, denam mmoa foforo a wɔde bɛma abusua no ansa na wɔasusuw ho sɛ wobeyi abofra bi afi hɔ no so. Afei asɛnnibea bɛtaa asi gyinae ahorow afa abofra no daakye ho, sɛ nhwɛso no, sɛ ebia wobetumi asan akɔ abusua a wɔwoo wɔn no mu, akɔhwɛ mmofra a wɔhwɛ wɔn anaasɛ wɔafa wɔn ayɛ wɔn mma.

Awo a wontumi nwo ne ade titiriw nti a awofo hwehwɛ sɛ wobegye mmofra a wɔne wɔn nni abusuafo no ayɛ wɔn mma. Nhwehwɛmu bi kyerɛ sɛ eyi na ɛmaa nkokoaa a wɔfaa wɔn sɛ wɔn mma a wɔnyɛ abusuabɔ no 80% ne wɔn a wɔfaa wɔn sɛ wɔn mma denam mmofra a wɔhwɛ wɔn so no fã.[78] Akontaabu kyerɛ sɛ Amerikafoɔ a wɔntumi nnyinsɛn anaa wɔmfa nkɔsi wɔn mma no mu 11–24% bɔ mmɔden sɛ wɔbɛkyekyere abusua denam mmofra a wɔbɛfa wɔn ayɛ wɔn mma so, na sɛ Amerikafoɔ mmaa a wɔaware daa a wɔfa wɔn mma no nyinaa dodoɔ bɛyɛ 1.4%.[79][80] Nneɛma afoforo a ɛma nkurɔfo gye tom no dɔɔso ɛwom sɛ wɔankyerɛw ho asɛm yiye de. Ebia eyinom bi ne sɛ wɔbɛpɛ sɛ wɔhyɛ abusua foforo mu den wɔ awaregyae anaa ɔwofo biako wu akyi, ayamhyehye a nyamesom anaa nyansapɛ mu gyidi na ɛkanyan wɔn, na wɔakwati sɛ wɔbɛboa ma nnipa adɔɔso dodo esiane gyidi a ɛne sɛ ɛyɛ asɛyɛde kɛse sɛ wɔbɛhwɛ mmofra a anka awofo nni mu sen sɛ wɔbɛwo nti , de hwɛ hu sɛ wɔremfa nyarewa a wonya fi awo mu (e.g., Tay–Sachs yare) mma obi, ne akwahosan ho haw ahorow a ɛfa nyinsɛn ne awo ho. Ɛwom sɛ nneɛma ahorow bi wɔ hɔ de, nanso nhwehwɛmu a wɔayɛ nnansa yi ara a ɛfa mmea a wɔfa wɔn mma no suahu ahorow ho no kyerɛ sɛ ɛda adi kɛse sɛ wɔadi mfe 40–44, wɔaware mprempren, awo a wontumi nwo, na wonni mma.[81]

Fa akwan horow a edidi so yi so betumi aba mmofra a wɔfa wɔn sɛ wɔn mma a ɛne wɔn ho wɔn ho nni abusuabɔ:

Ankorankoro fie mmofra a wɔfa wɔn sɛ wɔn mma: wɔ nhyehyɛe yi ase no, adɔe akuw ne ahyehyɛde ahorow a wɔhwehwɛ mfaso yɛ adwuma sɛ ntamgyinafo, na wɔka wɔn a wɔpɛ sɛ wɔfa abofra no bom ne mmusua a wɔpɛ sɛ wɔde abofra bi to hɔ, na afã horow no nyinaa yɛ ɔman koro mufo. Sɛnea ɛbɛyɛ foforo no, ɛtɔ mmere bi a wɔn a wɔpɛ sɛ wɔfa wɔn mma no kwati ntamgyinafo na wɔne mmea di nkitaho tẽẽ, na mpɛn pii no wɔde apam a wɔakyerɛw; wɔmma eyi ho kwan wɔ tumidi ahorow bi mu. Ankorankoro fie mmofra a wɔfa wɔn sɛ wɔn mma no yɛ mmofra a wɔfa wɔn sɛ wɔn mma nyinaa mu fã kɛse; sɛ nhwɛso no, wɔ United States no, wobu akontaa sɛ ɛkame ayɛ sɛ wɔyɛ mmofra a wɔfa wɔn sɛ wɔn mma no mu 45% ho nhyehyɛe wɔ kokoam.[82]

Foster care adoption: eyi yɛ ofie adoption bi a mfiase no wɔde abofra bi to ɔmanfo hwɛ mu. Mpɛn pii no, awofo a wɔhwɛ mmofra no gye wɔn sɛ wɔn mma no bere a mmofra no nya ahofadi wɔ mmara kwan so no. Ɛsono sɛnea ɛho hia sɛ ɔkwan a wɔfa so gye wɔn mma no wɔ ɔman biara mu. Wɔ 127,500 a wɔfaa wɔn sɛ wɔn mma wɔ U.S. wɔ afe 2000 mu no,[82] bɛyɛ 51,000 anaa 40% nam mmofra a wɔhwɛ wɔn so nhyehyɛe so.[83]

Amanaman ntam mmofra a wɔfa wɔn sɛ wɔn mma: eyi fa abofra bi a wɔde bɛto ɔman a wɔwoo saa abofra no akyi ma wɔagye no ayɛ ne ba ho. Eyi betumi aba denam ɔman anaa ankorankoro nnwumakuw so. Wɔ aman bi te sɛ Sweden mu no, saa mmofra a wɔfa wɔn sɛ wɔn mma yi na ɛma wonya nsɛm no mu dodow no ara (hwɛ atifi hɔ pon no). Nanso, U.S. nhwɛso no kyerɛ sɛ nsonsonoe kɛse wɔ ɔman biara mu efisɛ mmofra a wɔfa wɔn sɛ wɔn mma fi amannɔne no nnu ne nsɛm no mu 15%.[82] Russiafo mmofra bɛboro 60,000 na wɔagye wɔn ayɛ wɔn mma wɔ United States fi 1992,[84] na wɔfaa Chinafo mmofra dodow a ɛte saa ara sɛ wɔn mma fi 1995 kosi 2005.[85] Aman ahorow mmara gu ahorow wɔ ɔpɛ a wɔwɔ sɛ wɔbɛma kwan ma amanaman ntam agyede no mu. Esiane sɛ Hague Nhyiam a ɛfa Ankorankoro Amanaman Ntam Mmara ho no huu nsɛnnennen ne nsɛnnennen a ɛbata amanaman ntam agyede ho, ne mmɔden a wɔbɔe sɛ wɔbɛbɔ wɔn a wɔde wɔn ho ahyɛ mu no ho ban afi adifudepɛ ne nneɛma a wɔde di dwuma ɔkwammɔne so a ɛtɔ mmere bi a ɛka ho no ho nti, wɔyɛɛ Hague Mmofra a Wɔfa Wɔn Ba no Apam, a efii ase yɛɛ adwuma wɔ May 1, 1995 na aman 85 agye atom de besi November 2011.[86]

Nkwaboaa a wɔfa wɔn sɛ wɔn mma: egyina nkwaboaa a aka a wɔde ma bere a wɔawie awarefo biako aduruyɛ a wɔde nyinsɛn ba wɔ afiri mu no so; wɔde nkwaboaa ma ankorankoro anaa awarefo foforo, na ɛno akyi no wɔde saa nkwaboaa no gu ɔbea a wɔde no ma no no awotwaa mu, na ama nyinsɛn ne awo ayɛ mmerɛw. Wɔ United States no, agyapade ho mmara na ɛkyerɛ mma nkwaboaa a wɔfa wɔn sɛ wɔn mma sen sɛ asɛnnibea nhyehyɛe ahorow na ɛkyerɛ kwan, a ɛne atetesɛm mu mmofra a wɔfa wɔn sɛ wɔn mma no bɔ abira.

Common law adoption: eyi yɛ adoption a asɛnnibea ahorow no nni kan nnye ntom, nanso ɔwofo bi, a ɔmfa ne ho nhyɛ mmara kwan so nhyehyɛe biara mu, gyaw ne mma ma n’adamfo anaa obusuani bi bere tenten ][88] na ɛwɔ hɔ. Sɛ wɔde bere bi a wɔahyɛ ato hɔ a ɛne sɛ wɔbɛtra (a wofi wɔn pɛ mu) bɛtra mu no awiei, sɛnea ɔmanfo di ho adanse no, afei wobu abofra no sɛ ɛyɛ nea ɛhyɛ obi so, wɔ asennibea ahorow bi mu, ɛwom mpo sɛ mfiase no asɛnnibea no amma ho kwan de. Mmara kwan so tumidi biara na ɛkyerɛkyerɛ nsɛm pɔtee a ɛfa mmara kwan so agyede ho. Sɛ nhwɛso no, U.S. mantam California gye mmara kwan so abusuabɔ tom bere a wɔabom atra mfe 2 akyi no. Wɔfrɛ adeyɛ no &quot;private fostering&quot; wɔ Britain.[89]

'''Nneɛma a wɔsɛe no ne nea wɔtetew mu'''

Asɛm titiriw: Nneɛma a wɔsɛe no (fa a wɔfa wɔn sɛ wɔn mma) .

Ɛwom sɛ wɔtaa ka mmofra a wɔfa wɔn sɛ wɔn mma no ho asɛm sɛ ɛyɛ abusua &quot;daa&quot; de, nanso wobetumi de abusuabɔ no aba awiei bere biara. Wɔfrɛ mmara kwan so a wogyae mmofra a wɔfa wɔn sɛ wɔn mma no sɛ ɔhaw. Wɔ U.S. nsɛmfua mu no, sɛ wogyae mmofra a wɔfa wɔn sɛ wɔn mma no ansa na wɔawie a, wɔsɛe wɔn, na sɛ wogyae abusuabɔ no wɔ ɛno akyi a, wogyae. Wobetumi afrɛ no nso sɛ mmofra a wɔfa wɔn sɛ wɔn mma a entumi nyɛ yiye. Bere a wɔawie mmara kwan so a, mpɛn pii no awofo a wɔagye wɔn ayɛ wɔn mma no nam asɛnnibea adesrɛ so na efi ɔhaw no ase na ɛne awaregyae ho nsɛm di nsɛ. Ɛyɛ mmara kwan a ɛyɛ soronko ma awofo a wɔagye wɔn ayɛ wɔn mma efisɛ ɔhaw/nsɛe no mfa abusuafo a wɔwoo wɔn ho, ɛwom sɛ ɛtɔ mmere bi a wɔpow abusua mufo a wɔwo wɔn anaasɛ wogyaw wɔn hɔ de.[90]

Nanso, nhwehwɛmu ahorow a wɔyɛe wɔ bere tiaa bi mu a wɔyɛe wɔ U.S. no kyerɛ sɛ mmofra yiyedi nhyehyɛe no so a wɔfa wɔn sɛ wɔn mma no ɔha biara mu nkyem 10 kosi 25 (sɛ nhwɛso no, nkokoaa a wɔagye wɔn ayɛ wɔn mma a wofi aman afoforo so anaa awofo a wɔyɛ mpena a wogye wɔn mpena mma no nka ho) sɛe ansa na wɔawie wɔ mmara kwan so na efi 1 mu kosi ɔha biara mu nkyem 10 no, wogu bere a wɔawie mmara kwan so no. Gyinapɛn ahorow pii no da nsɛm a ɛfa asɛm no ho ne nnipa dodow te sɛ mfe a wɔadi ho nsɛm kakraa bi na ɛwɔ hɔ adi; wonim sɛ mmabun taa nya wɔn mma a wɔfa wɔn sɛ wɔn mma no mu ɔhaw sen mmofra nkumaa.[90]

Awarefo a wɔne wɔn ho da a wɔfa wɔn sɛ wɔn mma

Mmara kwan so awarefo a wɔne wɔn ho da a wɔbɛbom agye wɔn ayɛ wɔn mma wɔ aman 34 so de besi March 2022, ne nea ɛka ho no wɔ aman nketewa ahorow mu. Awarefo a wɔne wɔn ho da no nso betumi ayɛ mma a wɔfa wɔn sɛ wɔn mma (aman 6 foforo), a ɔhokafo biako a ɔwɔ ɔbarima ne ɔbea nna mu no gye ɔfoforo no ba. Aman dodow no ara a wɔwɔ bɔbeasu koro aware no ma kwan ma saa awarefo no bom gye wɔn mma, nea ɛka ho ne Ecuador (awarefo a wɔne wɔn ho da nnye wɔn mma), Taiwan (awarefo a wɔyɛ mma nkutoo) ne Mexico (wɔ amantam a mmarima ne mmea aware wom no nkyem abiɛsa mu biako mu ). Aman kakraa bi a wɔwɔ ɔmanfo nkabom anaasɛ aware hokwan kakraa bi no nyinaa ma kwan ma wɔfa anammɔn anaa wɔbom yɛ mmofra

== Wɔn a wɔagye wɔn ayɛ wɔn mma no awofoyɛ ==
'''Awofoyɛ'''

Awosu mu abusuabɔ a ɛda ɔwofo ne abofra ntam no ho hia, na wɔn baanu a wɔatew wɔn ho no ama wɔahaw wɔ mmofra a wɔfa wɔn sɛ wɔn mma ho. Atetesɛm mu adwene a ɛfa awofo a wɔfa wɔn sɛ wɔn mma ho no nyaa mmoa a wonya fii Princeton Sukuupɔn nhwehwɛmu bi a wɔyɛe wɔ mmusua 6,000 a wɔfaa wɔn mma, wɔyɛ wɔn mma, na wɔhwɛ wɔn wɔ United States ne South Africa fi 1968 kosi 1985 no hɔ; nhwehwɛmu no kyerɛe sɛ aduan a wɔsɛe no wɔ afie a ɛnanom a wɔn mma a wɔnyɛ awofo wom (bere a wɔhwɛ sika a wonya, ofie dodow, nnɔnhwerew a wɔde yɛ adwuma, mfe a wɔadi, ne nea ɛkeka ho so) no sua koraa ma wɔn a wɔafa wɔn ayɛ wɔn mma, mmanoma mma, ne mmofra a wɔagye wɔn ayɛ wɔn mma, na ɛmaa nhwehwɛmufo no yɛɛ saa kyerɛ sɛ nkurɔfo ani nnye ho kɛse sɛ wɔbɛma afoforo awosu mu nkwaadɔm no atra hɔ.[91] Wɔfoa saa nsusuwii yi so wɔ nhwehwɛmu foforo a ɛfa su ho kɛse a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma a wɔde wɔn ho hyɛ wɔn a wɔpɛ wɔn asɛm, wɔn nipasu, ne wɔn honam ani hwɛbea koro no ara agyirae no, ne wɔn a wɔanyinyin a wɔagye wɔn ayɛ wɔn mma no nyinaa wɔ abusuabɔ ne awofo a wɔagye wɔn ayɛ wɔn mma no bɔ amanneɛ sɛ wɔn ani agye kɛse wɔ mmofra a wɔfa wɔn sɛ wɔn mma no ho.

Nhwehwɛmu afoforo de adanse ma sɛ abusuabɔ a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma no betumi ayɛ nea ɛfata wɔ akwan foforo so. Nhwehwɛmu bi a ɛhwehwɛ sɛnea awofo de wɔn sika hyɛ mu no kyerɛ ahoɔden wɔ mmusua a wɔfa wɔn mma no mu, na ɛkyerɛ sɛ awofo a wɔfa wɔn mma no de bere pii hyɛ wɔn mma mu sen awofo afoforo, na ɛde ba awiei sɛ &quot;...awofo a wɔfa wɔn mma no ma wɔn mma asetra yɛ yiye de tua abusuabɔ a enni awosu mu no ho ka ne the extra challenges of adoption.&quot;[93] Nhwehwɛmu foforo a wɔyɛe nnansa yi kyerɛe sɛ mmusua a wɔfa wɔn mma no de sika kɛse hyɛ wɔn mma a wɔagye wɔn ayɛ wɔn mma no mu, sɛ nhwɛso no, denam nhomasua foforo ne sika fam mmoa a wɔde ma so. Bere a ɛhyɛ no nsow sɛ ɛte sɛ nea wɔn a wɔagye wɔn ayɛ wɔn mma no taa hyia ɔhaw ahorow te sɛ nnubɔne a wɔde di dwuma no, nhwehwɛmu no susuwii sɛ ebia awofo a wɔfa wɔn sɛ wɔn mma no de wɔn sika pii bɛto wɔn a wɔagye wɔn ayɛ wɔn mma no mu ɛnyɛ sɛ wɔpɛ wɔn asɛm nti, na mmom esiane sɛ ɛda adi sɛ wohia mmoa no sen mmofra a wɔwɔ awosu mu nneɛma nti.[94]

Adwene ne nneyɛe ho animdefo hui a ɛfa hia a ɛna ne nkokoaa ntam abusuabɔ ho hia no ho no maa ɛhaw adwene bi sɛ ebia awofo a wogye nkokoaa a wɔanyinyin anaa mmofra a wɔretu mmirika wɔ awo akyi no ayera bere titiriw bi a ɛbɛma abofra no anyin anaa. Nanso, nhwehwɛmu a wɔyɛe wɔ The Mental and Social Life of Babies ho no kyerɛe sɛ &quot;ɔwofo ne nkokoaa nhyehyɛe&quot;, sen sɛ ɛbɛyɛ abusuabɔ a ɛda ankorankoro a wɔne wɔn ho wɔn ho wɔ abusuabɔ ntam no, yɛ ade a ɛdannan a ɛda nnipa nkokoaa nyinaa awosu mu nneyɛe ne mmuae a nnipa a wɔanyinyin de yɛ wɔn ade a ɛkɔ so pɛpɛɛpɛ wɔ ho no ntam saa nkokoaa nneyɛe no. Enti abɔde &quot;hwɛ ma wɔyɛ nsakrae bi a edi kan wɔ obu ma mpanyimfo pɔtee a wogye awofo dwumadi no ho.&quot;[95]

Wɔ nsɛmpɔw atitiriw no akyi no, nsemmisa soronko a wobisa awofo a wɔfa wɔn sɛ wɔn mma no gu ahorow. Nea ɛka ho ne sɛnea wobebua nsusuwii hunu, nsɛmmisa a ɛfa agyapade ho a wobebua, ne ɔkwan a eye sen biara a wɔbɛfa so ne abusuafo a wɔwoo wɔn no anya abusuabɔ bere a wɔwɔ mmofra a wɔabue wɔn mma no mu.[96] Ɔkyerɛwfo biako kyerɛ sɛ asɛmmisa a awofo a wɔfa wɔn sɛ wɔn mma no taa nya ne sɛ: &quot;So yɛbɛdɔ abofra no ɛwom mpo sɛ ɔnyɛ yɛn ba a ɔwoo no no?&quot;[97] Ade pɔtee a ɛhaw awofo pii ne sɛ wɔbɛma obi a wɔagye no ayɛ ne ba no atra sukuu dan mu. Asuade ahorow a wonim te sɛ &quot;twe w'abusua dua&quot; anaa &quot;fa w'awofo ne wo nananom so hwehwɛ w'ani kɔla akyi kɔhwɛ baabi a w'awosu fi&quot; betumi apira mmofra a wɔfaa wɔn sɛ wɔn mma na wonnim saa abɔde mu nsɛm yi. Wɔde nyansahyɛ ahorow pii ama sɛ wɔde besi adesua foforo ananmu, s.e., wɔde wɔn adwene asi &quot;abusua nnuaba turo&quot; so.[99]

Mmofra a wɔanyinyin a wɔfa wɔn sɛ wɔn mma no de awofoyɛ ho nsɛm afoforo ba.[100] Mmofra binom a wofi mmofra a wɔhwɛ wɔn so no wɔ abakɔsɛm a ɛfa ayayade ho, te sɛ honam ne adwene mu anibiannaso, honam fam ayayade, ne nna mu ayayade, na wɔwɔ asiane mu sɛ wobenya adwenemyare ho haw ahorow.[101][102] Mmofra a wɔte saa no wɔ asiane mu sɛ wobenya abusuabɔ a ɛnyɛ nhyehyɛe.[103][104][105] Nhwehwɛmu ahorow a Cicchetti ne afoforo yɛe no. (1990, 1995) hunuu sɛ nkokoaa a wɔyɛɛ wɔn ayayadeɛ na wɔyɛɛ wɔn ayayadeɛ wɔ wɔn nhwɛsoɔ no mu 80% daa abatadeɛ akwan a ɛnyɛ nhyehyɛeɛ adi.[106][107] Bata a wɔanhyehyɛ no ne nkɔso ho haw ahorow bi wɔ abusuabɔ, a nea ɛka ho ne sɛnkyerɛnne ahorow a ɛma obi fi ne ho fi afoforo ho,[108] ne adwenemhaw, dadwen, ne adeyɛ ho sɛnkyerɛnne ahorow.[109][110] &quot;Attachment yɛ adeyɛ a ɛyɛ nnam—ebetumi ayɛ nea ahobammɔ wom anaasɛ enni ahobammɔ, ɛnyɛ nea ɛfata anaasɛ ɛsow aba. Eyi yɛ sikasɛm a ɛnyɛ nokware efisɛ mpɔtam hɔ atumfoɔ hwɛ a wɔhwɛ mmofra yi bo yɛ den yiye.[112]

Ɛdefa nkɔso mu nneɛma atitiriw ho no, nhwehwɛmu ahorow a efi Colorado Adoption Project no mu no hwehwɛɛ awosu mu nkɛntɛnso a ɛwɔ wɔn a wɔagye wɔn ayɛ wɔn mma no onyin so no mu, na ɛde baa awiei sɛ wɔn a wɔagye wɔn ayɛ wɔn mma no adwene tumi da wɔn awofo a wɔfaa wɔn mma no de adi wɔ mmofraase nanso ɛnkyerɛ sɛ ɛne wɔn ho wɔn ho di nsɛ kɛse wɔ mmerantebere ne mmabaabere mu, na ɛte sɛ wɔn awofo a wɔwoo wɔn no de mmom na ɛte sɛ nea ɛte saa ara baabi a ɛkɔ akyiri sɛ atipɛnfo wɔ mmusua a wɔmfa wɔn mma wɔn mma mu.[113]

Ɛte sɛ nea akwan a ɛte saa ara reyɛ adwuma wɔ wɔn a wɔagye wɔn ayɛ wɔn mma no honam fam nkɔso mu. Denmarkfo ne Amerikafo nhwehwɛmufo a wɔreyɛ nhwehwɛmu ahorow a ɛfa awosu mu mmoa a ɛma nipadua no yɛ kɛse ho no huu abusuabɔ a ɛda obi a wɔagye no ayɛ ne ba no mu duru ne n’awofo a wɔwoo no no BMI ntam bere a wɔanhu abusuabɔ biara a ɛda abusua a wɔagye no ayɛ ne ba no ntam no. Bio nso, nsonsonoe a ɛda ankorankoro ntam no bɛyɛ fã fi ankorankoro nkɛntɛnso ahorow a wɔnkyɛ mu.[114][115]

Ɛte sɛ nea nsonsonoe ahorow a ɛwɔ nkɔso mu yi di agoru wɔ ɔkwan a mmerante ne mmabaa a wɔagye wɔn ayɛ wɔn mma no fa so di asetra mu nsɛm atitiriw ho dwuma no mu. Wɔ awofo awaregyae ho no, wɔahu sɛ ɛsono sɛnea wɔn a wɔagye wɔn ayɛ wɔn mma no yɛ wɔn ade wɔ mmofra a wɔannye wɔn mma no ho. Bere a nnipa dodow no ara nyaa suban ho haw pii, nnuru a wɔde di dwuma, sukuu mu nkɔso a ɛba fam, ne asetra mu ahoɔden a asɛe wɔ awofo awaregyae akyi no, ɛte sɛ nea nnipa dodow a wɔagye wɔn ayɛ wɔn mma no annya nkɛntɛnso biara wɔ wɔn abɔnten abusuabɔ ho, titiriw wɔ wɔn sukuu anaa asetra mu tumi mu.

'''Nkɛntɛnso a enya wɔ awofo a wodii kan bae no so'''

Nneɛma pii na ɛka gyinae a wosi sɛ wobegyae abofra no anaasɛ wɔbɛtete no no. Mmabun a wɔyɛ aborɔfo taa de wɔn nkokoaa ma wɔn a wɔnyɛ abusuafo, bere a mmabun a wɔyɛ abibifo taa nya mmoa fi wɔn ankasa mpɔtam hɔfo hɔ wɔ abofra no ntetee mu ne ɔkwan a abusuafo fa so gye wɔn sɛ wɔn mma wɔ ɔkwan a ɛnyɛ ɔhyɛ so nso so. Nhwehwɛmu a Leynes ne Festinger ne Young, Berkman, ne Rehr yɛe no kyerɛe sɛ, wɔ mmabun a wɔyem fam no, gyinae a wosi sɛ wobegyae abofra no ma wagye no ayɛ ne ba no gyina adwene a ɔbabun no maame wɔ wɔ mmofra a wɔfa no sɛ wɔn ba ho no so.[118] Nhwehwɛmu foforo nso kyerɛe sɛ mmabun a wɔyem a wɔn maamenom asua nhoma a ɛkɔ akyiri no taa gyae wɔn mma ma wɔfa wɔn sɛ wɔn mma. Nhwehwɛmu kyerɛ sɛ mmea a wɔpaw sɛ wobegyae wɔn mma ma wɔafa wɔn ayɛ wɔn mma no taa yɛ nkumaa, wɔakyerɛw wɔn din wɔ sukuu mu, na wɔatra awofo baanu fie mu bere a wɔadi mfe 10, sen wɔn a wɔhwɛɛ wɔn mma na wɔtetee wɔn no.[119]

Nhwehwɛmu kakraa bi na wɔayɛ wɔ nea ebefi mmofra a wɔfa wɔn sɛ wɔn mma a wodi kan no so aba no ho, na nea wɔahu no adi afra. Nhwehwɛmu bi kyerɛe sɛ wɔn a wogyaee wɔn mma ma wɔfa wɔn sɛ wɔn mma no ani nnye wɔn gyinaesi no ho kɛse sen wɔn a wɔde wɔn mma siei no. Nanso, na awerɛkyekye dodow a ɛwɔ akuw abien no nyinaa so no dɔɔso, na wɔn a wogyaee wɔn ba no te sɛ wɔn a wɔmaa wɔn ba no siei wɔ asetra mu abotɔyam, abusuabɔ mu abotɔyam, ne daakye ho adwene pa a wɔwɔ wɔ sukuu, adwuma, sikasɛm, ne aware ho nsusuwii ahorow mu ] . Nhwehwɛmu a wɔyɛe akyiri yi kyerɛe sɛ ɛnanom a wɔadu mpanyin afe so a wɔpaw sɛ wobegyae wɔn mma ma wɔagye wɔn ayɛ wɔn mma no taa nya awerɛhow ne ahonu wɔ wɔn gyinaesi no ho sen wɔn a wɔkoraa wɔn mma so no. Nanso, saa nkate ahorow yi so tew kɛse fi afe biako wɔ awo akyi kosii afe a ɛto so abien no awiei.[121]

Nhwehwɛmu a wɔayɛ nnansa yi ara no hui sɛ wɔ ɛnanom a wogyaee wɔn mma sɛ wɔmfa wɔn mma mfe anan kosi 12 ansa na ɛreba no mu no, na obiara a ɔde ne ho hyɛɛ mu no taa susuw wɔn ba a wayera no ho. Wɔ dodow no ara fam no, na nsusuwii ahorow no yɛ nea enye ne nea eye efisɛ na ɛma wonya awerɛhow ne anigye nkate nyinaa. Wɔn a wonyaa nsusuwii pa no fã kɛse no ara mu osuahu ne wɔn a na wɔabue wɔn mma, sen sɛ wɔde ntamgyinafo a wɔato mu anaasɛ bere tiaa bi bɛyɛ wɔn mma.[122]

Wɔ nhwehwɛmu foforo a wɔde ɛnanom a wogyae wɔn mma totoo wɔn a wɔtetee wɔn ho no mu no, ɛnanom a wogyae wɔn mma no taa twentwɛn wɔn nyinsɛn a edi hɔ no ase, wɔtwentwɛn aware ase, na wowie adwuma ho ntetee. Nanso, akuw abien no nyinaa duu nhomasua a ɛba fam sen wɔn atipɛnfo a wɔannyinsɛn da.[123] Nhwehwɛmu foforo nso hui sɛ nneɛma a ɛte saa ara fi mu ba bere a wɔpaw sɛ wobegyae abofra bi ma wɔagye no ayɛ ne ba no. Ná ɛnanom a wɔn mfe akɔ anim a wogyaee wɔn mma no taa nya nhomasua a ɛkorɔn na wonya adwuma sen wɔn a wɔhwɛɛ wɔn mma no. Wɔsan nso twɛn kyɛe ansa na wɔrewo wɔn ba a odi hɔ no.[121] Wɔde mmabun nhwɛso ahorow, anaasɛ mmea a na wɔyɛ mmabun bere a wɔsoa wɔn nkokoaa no yɛɛ nhwehwɛmu a ɛwɔ hɔ wɔ nkɛntɛnso a awofo a wɔfa wɔn sɛ wɔn mma no so nkɛntɛnso ho no mu dodow no ara—nsɛm kakraa bi na ɛwɔ hɔ ma awofo a wɔwoo wɔn a wofi nnipa afoforo mu. Afei nso, nsɛm a wɔde bere tenten ayɛ a ebetumi ama asetra ne adwene mu nsunsuanso a ɛbɛtra hɔ akyɛ ama awofo a wɔwo a wɔpaw sɛ wɔde wɔn mma bɛto hɔ ama wɔagye wɔn ayɛ wɔn mma no nni hɔ.

== Nkɔso a ɛfa wɔn a wɔagye wɔn ayɛ wɔn mma ho ==
Nhwehwɛmu a wɔadi kan ayɛ wɔ mmofra a wɔfa wɔn sɛ wɔn mma ho no ama wɔanya nsusuwii ahorow a ɛkyerɛ sɛ asiane a ɛkɔ soro wɔ adwene mu nkɔso ne asetra mu abusuabɔ mu ma wɔn a wɔagye wɔn ayɛ wɔn mma no. Nanso, wɔama nsusuwii ahorow a ɛtete saa no mu ada hɔ sɛ ɛyɛ mfomso esiane akwan a wɔfa so yɛ adwuma no huammɔdi nti. Nanso nnansa yi nhwehwɛmu ahorow aboa ma wɔakyerɛ nsɛm a ɛyɛ nokware kɛse ne nea efi mu ba a ɛfa nsɛdi, nsonsonoe ne asetra kwan nyinaa a wɔn a wɔafa wɔn ayɛ wɔn mma no asetra kwan ho.[124]

Wobetumi afoa adanse a ɛfa sɛnea wɔn a wɔagye wɔn ayɛ wɔn mma no nkɔso ho wɔ nhwehwɛmu foforo mu. Yebetumi aka sɛ, wɔ ɔkwan bi so no, wɔn a wɔfa wɔn sɛ wɔn mma no taa nya nkɔso wɔ ɔkwan soronko so wɔ nnipa dodow no ara ho. Wobetumi ahu eyi wɔ asetra mu nneɛma pii mu, nanso mpɛn pii no wobetumi ahu sɛ asiane kɛse wɔ hɔ bɛyɛ mmerantebere ne mmabaabere mu. Sɛ nhwɛso no, wɔahu sɛ wɔn a wɔagye wɔn ayɛ wɔn mma no pii hyia ɔhaw wɔ adwene a wɔde besi hɔ a ɛkyerɛ sɛ wɔyɛ wɔn mma no mu.[125]

'''Adida'''

Akwan pii wɔ hɔ a wobetumi afa so akyerɛkyerɛ adwene a ɛfa nipasu ho no mu. Ɛyɛ nokware wɔ nsɛm nyinaa mu sɛ nipasu a wɔde si dan no yɛ adeyɛ a ɛkɔ so a ɛfa nkɔso, nsakrae ne adwene a wɔde si obi ho ne ankasa ho a wɔhwɛ so. Nhwehwɛmu ada no adi sɛ mmerantebere ne mmabaabere yɛ bere a wɔde wɔn ho hyɛ mu sen sɛ wɔbɛsan wɔn akyi.[126] Obi nipasu taa ntumi nnyina wɔ n’asetra mfe a edi kan no mu nanso onya ntease a egyina pintinn kɛse wɔ mmofraberem ne mmerantebere ne mmabaabere mu akyiri yi mu. Mpɛn pii no, wɔde bata bere bi a wɔde sɔ nneɛma hwɛ ho no, nneɛma a enni awiei wɔ hɔ a ɛkɔ obi nipasu a wɔbɛkyekye mu. Nea ɛka nneɛma pii ho no, nipasu ahorow pii wɔ hɔ a obi betumi de abata ho. Nnipa a wɔde wɔn ho hyɛ mu no bi ne ɔbarima ne ɔbea nna, ɔbarima ne ɔbea nna, kuw, abusuakuw ne nyamesom, ne nea ɛkeka ho Wɔ wɔn a wɔafa wɔn ayɛ wɔn mma wɔ mmusuakuw ntam ne amanaman ntam no fam no, mpɛn pii no wohu nhyɛso wɔ mmusuakuw, mmusuakuw ne ɔman a wɔde wɔn ho hyɛ mu no mu. Esiane eyi nti, abusua mu abusuabɔ ahoɔden ne ne dwumadi di dwuma kɛse wɔ ne nkɔso ne nea efi nipasu a wɔkyekye mu ba no mu. Wɔn a wɔfa wɔn sɛ wɔn mma a wofi mmusuakuw ahorow mu ne aman horow so no taa nya nkate a ɛne sɛ wonnye wɔn ntom esiane mmusuakuw, mmusuakuw, ne amammerɛ mu nsonsonoe a ɛte saa nti. Enti, sɛ wɔbɛma wɔn a wɔagye wɔn ayɛ wɔn mma a wofi mmusuakuw ahorow mu ne aman ntam no ahu wɔn &quot;amammerɛ a wofi mu&quot; no ho hia sɛnea ɛbɛyɛ a wobenya adwene a ɛfa wɔn ho ne anisɔ a ɛfa amammerɛ ahorow ho yiye. Nnipa a wɔagye wɔn ayɛ wɔn mma wɔ aman ntam no ho adansedi ne nea wɔsan kyekye no ntɛm ara a wɔfa wɔn sɛ wɔn mma no. Sɛ nhwɛso no, egyina United States mmara ne nhyehyɛe pɔtee so no, Child Citizen Act of 2000 hwɛ hu sɛ wɔbɛma wɔn a wɔagye wɔn ayɛ wɔn mma no U.S. ɔman ba ntɛm ara.[127]

Wɔde nea obi yɛ ne nea ɔnyɛ nyinaa na ɛkyerɛkyerɛ nipasu mu. Wɔn a wɔagye wɔn ayɛ wɔn mma a wɔwo wɔn wɔ abusua biako mu no hwere wɔn din na afei wɔfɛm biako fi abusua a wɔfa wɔn sɛ wɔn mma no hɔ. Nnipa nipasu a wɔhyehyɛ no yɛ adeyɛ a ɛyɛ den na nneɛma pii wɔ hɔ a ɛka nea ebefi mu aba. Sɛ yɛhwɛ nsɛm a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho tebea horow mu a, wobetumi ahu nnipa a wɔfa wɔn sɛ wɔn mma no ka ho na ɛka wɔn (ɔwofo a ɔwoo wɔn, ɔwofo a ɔfaa no sɛ ne ba ne nea wɔagye no ayɛ ne ba) sɛ &quot;triad members and state&quot;. Ebia mmofra a wɔfa wɔn sɛ wɔn mma no de baasakoro no mufo a wɔte nka sɛ wɔyɛ nnipa no to asiane mu. Baasakoro no mufo taa da nkate horow a ɛfa nipasu ne nipasu ho haw ahorow a ɛyɛ basaa ho adi esiane nsonsonoe a ɛwɔ baasakoro no ntam abusuabɔ mu nti. Wɔ ebinom fam no, mmofra a wɔfa wɔn sɛ wɔn mma no mma wonnya wɔn ho ho adwene a edi mũ anaasɛ wɔaka abom. Ebia Baasakoro no mufo behu wɔn ho sɛ wonni mũ, wonni hwee, anaasɛ wonwiei. Wɔka sɛ wonni yiyedi, biakoyɛ, anaa pintinn ho nkate a ɛbata nipasu a anya nkɔso koraa ho.[128]

'''Nkɛntɛnso ahorow'''

Abusua di dwuma titiriw wɔ nipasu a wɔhyehyɛ mu. Ɛnyɛ mmofraberem nko na eyi te saa, na mmom mmerantebere ne mmabaabere mu nso. Nnipa a wɔyɛ wɔn ho (ɔbarima ne ɔbea nna/ɔbarima ne ɔbea nna/abusuakuw/nyamesom/abusua) da so ara reyɛ wɔ mmerantebere ne mmabaabere mu na abusua kura eyi ho safe titiriw. Ɛte sɛ nea nhwehwɛmu no yɛ nea adwene koro yɛ; abusua a ɛyɛ den, ahobammɔ, ɔdɔ, nokwaredi ne mmoa a emufo nyinaa te nka sɛ wɔwɔ ahobammɔ sɛ wɔbɛhwehwɛ wɔn nipasu mu no ho hia na ama wɔatumi ayɛ nipasu a ɛfata. Transracial ne International adoptions yɛ nneɛma bi a edi dwuma titiriw wɔ wɔn a wɔagye wɔn ayɛ wɔn mma no nipasu a wɔkyekye no mu. Ntawntawdi pii fi abusuabɔ a wɔkyekye wɔ nea wɔagye no ayɛ ne ba no ne wɔn abusua ntam no mu. Eyinom bi ne sɛ &quot;wɔyɛ soronko&quot; wɔ ɔwofo (ɔwofo) ho, abusuakuw mu nipasu pa a wobenya, ne mmusuakuw/abusuakuw mu nyiyim a wobedi ho dwuma.[129] Wɔahu sɛ mmerante ne mmabaa a wɔwɔ amammerɛ ahorow ne aman ntam no taa ne wɔn awofo hu amammerɛ ne mmusuakuw a wofi mu ba sen sɛ wɔbɛkyerɛ baabi a wɔte, nanso ɛtɔ mmere bi a ɛyɛ den sɛ wɔbɛkari pɛ wɔ nnipa baanu no ntam efisɛ sukuu tebea horow taa nni nneɛma ahorow ne gye a wogye tom wɔ nsɛmti a ɛtete saa ho .[130] . Saa nhyɛso ahorow yi nso taa ma nsɛmmisa bi ba ma nea wɔagye no ayɛ ne ba no, ne abusua no nso sɛ wobesusuw ho. Nsɛmmisa bi a wɔtaa bisa no bi ne sɛ abusua no yɛ anibiannaso kɛse wɔ asetra mu akwan horow a wɔkyekye no ho a, dɛn na ɛbɛba? So ntawntawdi bɛba sɛ eyi te saa a? Na sɛ nnipa ankasa a wɔkyerɛ sɛ wɔyɛ nipasu a ɛfata ho nhwɛso no ankasa yɛ nea ahobammɔ a enni hɔ ahyɛ mu ma nso ɛ? Ginni Snodgrass bua nsɛmmisa yi wɔ ɔkwan a edidi so yi so. Ahintasɛm a ɛwɔ abusua a wɔma wɔn mma mu ne pow a wɔpow sɛ ɛsono abusua a wɔfa wɔn sɛ wɔn mma no ma adwumayɛ a entumi nyɛ adwuma yiye ba mu. &quot;... asetra mu adwumayɛfo ne awofo a wɔagye wɔn ayɛ wɔn mma a wonni ahobammɔ no ayɛ abusua abusuabɔ a egyina nokwaredi a wonni, kwati ne nneɛma a wɔde di dwuma so. Sɛ́ wubegye adi sɛ abusuabɔ pa bɛkɔ so wɔ fapem a ɛte saa so no nyɛ adwene mu ntease&quot; (Lawrence). Kokoamsɛm si akwanside ahorow a ɛmma wontumi nnya nipasu a ɛfata.[131]

Nhwehwɛmu no ka sɛ ɛnyɛ sɛ adwuma a entumi nyɛ adwuma yiye, nsɛm a ɛnyɛ nokware ne nea wɔkwati a ebetumi aba mmusua a wɔagye wɔn ayɛ wɔn mma no mu no mma ɛnyɛ yiye nko, na mmom ɛyɛ adwuma tia no tẽẽ nso. Sɛ nea wɔagye no ayɛ ne ba no nim sɛ wɔafa wɔn ayɛ wɔn ba nanso onni wɔn awofo a wɔwoo wɔn no ho nsɛm biara a, nkɛntɛnso bɛn na ɛwɔ hɔ wɔ nnipa a wɔyɛ wɔn basaa no so? Silverstein ne Kaplan nhwehwɛmu no ka sɛ nsɛmmisa te sɛ &quot;Hena ne me?&quot; &quot;Dɛn nti na wɔwoo me?&quot; &quot;Dɛn ne m'atirimpɔw?&quot; Saa nipasu a wonni yi betumi ama wɔn a wɔagye wɔn ayɛ wɔn mma, titiriw wɔ mmerantebere ne mmabaabere mu, ahwehwɛ akwan a wɔbɛfa so ayɛ wɔn ho wɔ ɔkwan a ɛtra so so sen wɔn atipɛnfo a wonnye wɔn mma no pii. Mmabun a wɔagye wɔn ayɛ wɔn mma no dɔɔso dodo wɔ wɔn a wɔde wɔn ho hyɛ amammerɛ nketewa mu, guan, wonyinsɛn, anaasɛ wɔpo wɔn mmusua koraa no mu.[132][133]

Ɛdefa nkɔso mu nneɛma atitiriw ho no, nhwehwɛmu ahorow a efi Colorado Adoption Project no mu no hwehwɛɛ awosu mu nkɛntɛnso a ɛwɔ wɔn a wɔagye wɔn ayɛ wɔn mma no onyin so no mu, na ɛde baa awiei sɛ wɔn a wɔagye wɔn ayɛ wɔn mma no adwene tumi da wɔn awofo a wɔfaa wɔn mma no de adi wɔ mmofraase nanso ɛnkyerɛ sɛ ɛne wɔn ho wɔn ho di nsɛ kɛse wɔ mmerantebere ne mmabaabere mu, na ɛte sɛ wɔn awofo a wɔwoo wɔn no de mmom na ɛte sɛ nea ɛte saa ara baabi a ɛkɔ akyiri sɛ atipɛnfo wɔ mmusua a wɔmfa wɔn mma wɔn mma mu.[113]

Ɛte sɛ nea akwan a ɛte saa ara reyɛ adwuma wɔ wɔn a wɔagye wɔn ayɛ wɔn mma no honam fam nkɔso mu. Denmarkfo ne Amerikafo nhwehwɛmufo a wɔreyɛ nhwehwɛmu ahorow a ɛfa awosu mu mmoa a ɛma nipadua no yɛ kɛse ho no huu abusuabɔ a ɛda obi a wɔagye no ayɛ ne ba no mu duru ne n’awofo a wɔwoo no no BMI ntam bere a wɔanhu abusuabɔ biara a ɛda abusua a wɔagye no ayɛ ne ba no ntam no. Bio nso, nsonsonoe a ɛda ankorankoro ntam no bɛyɛ fã fi ankorankoro nkɛntɛnso ahorow a wɔnkyɛ mu.[114][115]

Ɛte sɛ nea nsonsonoe ahorow a ɛwɔ nkɔso mu yi di agoru wɔ ɔkwan a mmerante ne mmabaa a wɔagye wɔn ayɛ wɔn mma no fa so di asetra mu nsɛm atitiriw ho dwuma no mu. Wɔ awofo awaregyae ho no, wɔahu sɛ ɛsono sɛnea wɔn a wɔagye wɔn ayɛ wɔn mma no yɛ wɔn ade wɔ mmofra a wɔannye wɔn mma no ho. Bere a nnipa dodow no ara nyaa suban ho haw pii, nnuru a wɔde di dwuma, sukuu mu nkɔso a ɛba fam, ne asetra mu ahoɔden a asɛe wɔ awofo awaregyae akyi no, ɛte sɛ nea nnipa dodow a wɔagye wɔn ayɛ wɔn mma no annya nkɛntɛnso biara wɔ wɔn abɔnten abusuabɔ ho, titiriw wɔ wɔn sukuu anaa asetra mu tumi mu.

Nanso, ɛte sɛ nea nnipa dodow a wɔagye wɔn ayɛ wɔn mma no wɔ asiane mu kɛse wɔ suban ho nsɛm bi ho. Nhwehwɛmufo a wofi Minnesota Sukuupɔn mu yɛɛ mmabun a wɔafa wɔn ayɛ wɔn mma no ho nhwehwɛmu na wohui sɛ wɔn a wɔagye wɔn ayɛ wɔn mma no betumi anya ɔsɔretia a ɛma obi yɛ ade tra so (ODD) ne adwene a wɔde si biribi so a ɛtra so (ADHD) no mmɔho abien, na ɛyɛ 8% wɔ nnipa dodow no ara mu nnipa dodow.[134][non-primary source needed] Asiane a ɛwɔ hɔ sɛ wobekum wɔn ho nso dɔɔso kɛse sen nnipa dodow no ara. Sweden nhwehwɛmufo hui sɛ amanaman ntam ne ɔman no mufo a wɔagye wɔn ayɛ wɔn mma no nyinaa kum wɔn ho wɔ dodow a ɛkɔ soro sen atipɛnfo a wɔamfa wɔn ayɛ wɔn mma no; a amanaman ntam wɔn a wɔagye wɔn ayɛ wɔn mma ne mmea a wɔagye wɔn ayɛ wɔn mma, titiriw no, wɔ asiane kɛse mu.[135]

Ne nyinaa mu no, adwuma a wɔayɛ wɔ wɔn a wɔanyinyin a wɔagye wɔn ayɛ wɔn mma ho no ahu sɛ asiane foforo a wɔn a wɔagye wɔn ayɛ wɔn mma no hyia no fa mmerantebere ne mmabaabere mu nkutoo. Wɔkyerɛe sɛ mmerante ne mmabaa a wɔanyinyin a wɔagye wɔn ayɛ wɔn mma no ne mpanyimfo a wofi mmusua a wɔwoo wɔn mu no yɛ pɛ na wonyaa nkontaa a eye sen mpanyimfo a wɔtetee wɔn wɔ abusua ahorow foforo a ɔwofo biako ne mmusua a wɔyɛ mpena ka ho mu.[136] Bio nso, bere a mpanyimfo a wɔagye wɔn ayɛ wɔn mma no daa nsakrae kɛse adi sen wɔn atipɛnfo a wɔamfa wɔn ayɛ wɔn mma wɔ adwene ne nneyɛe ho nhyehyɛe ahorow mu no, mpanyimfo a wɔagye wɔn ayɛ wɔn mma no daa nsɛdi pii adi sen nsonsonoe a ɛda mpanyimfo a wɔamfa wɔn ayɛ wɔn mma no ntam. Nsɛm pii aba a ɛfa adwenemhaw a ɛba ntɛm a wɔasiesie anaasɛ wɔasan asan aba ho. Sɛ nhwɛso no, wɔ nhwehwɛmu ahorow a edi kan a wɔyɛe no biako mu no, Ɔbenfo Goldfarb a ɔwɔ England no de baa awiei sɛ mmofra binom sesa wɔn ho yiye wɔ asetra ne nkate fam ɛmfa ho osuahu ahorow a enye a ɛfa ahyehyɛde a wɔde wɔn ho hyɛ mu wɔ mmofraase no ho no. Nhwehwɛmufo afoforo nso hui sɛ ɛnyɛ nea ɛkyerɛ ankasa sɛ mmofra a wɔde wɔn kɔ ayaresabea bere tenten no de nkate fam haw anaa suban mu sintɔ ahorow ba mmofra nyinaa so. Eyi kyerɛ sɛ mmofra binom bɛba bere nyinaa a wɔyɛ yiye, a wotumi gyina ano, a wɔn suahu ahorow wɔ mmofraase mfa ho.[139] Afei nso, nhwehwɛmu a wɔyɛ wɔ adwene mu nneɛma a efi wɔn a wɔagye wɔn ayɛ wɔn mma no ho no mu dodow no ara fi nnipa dodow a wɔwɔ ayaresabea no mu. Eyi kyerɛ sɛ ebia nsɛm a wɔde ba awiei te sɛ nea wɔn a wɔagye wɔn ayɛ wɔn mma no taa nya suban ho haw te sɛ ODD ne ADHD no bɛyɛ nea ɛyɛ animhwɛ. Esiane sɛ wɔn a wɔagye wɔn ayɛ wɔn mma a wɔhwehwɛ adwenemyare ayaresa no sua nti, adwene mu nneɛma a efi wɔn a wɔagye wɔn ayɛ wɔn mma no mu ba sɛ wɔde toto nea ɛwɔ nnipa dodow no ara ho no di nsɛ sen sɛnea nhwehwɛmufo binom kyerɛ no.[140]

'''Adwene mu akwahosan'''

Mmofra a wɔagye wɔn ayɛ wɔn mma no taa nya adwene ne nneyɛe ho haw sen atipɛnfo a wɔamfa wɔn ayɛ wɔn mma.[141] Mmofra a na wɔadi boro anan bere a wɔfaa wɔn sɛ wɔn mma no nya adwene mu haw pii sen wɔn a na wɔyɛ nkumaa no.[142][143]

Sɛnea nhwehwɛmu a wɔyɛe wɔ UK kyerɛ no, mmofra a wɔagye wɔn ayɛ wɔn mma no betumi anya adwenemyare a ɛmma wo de baanan mpo nkɔ yiye bere a wɔafa wɔn ayɛ wɔn mma no akyi. Mmofra a wɔwɔ mmofraberem osuahu ahorow pii a enye no taa nya adwenemyare. Nhwehwɛmu no kyerɛ sɛ sɛnea ɛbɛyɛ a wobehu adwenemyare ho haw ahorow na wɔatiatia so ntɛm no, wɔn a wɔhwɛ mmofra ne awofo a wɔfa wɔn sɛ wɔn mma no hia abofra no asetra ho nsɛm a ɛkɔ akyiri.[142][144] Nhwehwɛmu foforo bi a wɔyɛe wɔ UK kyerɛ sɛ mmofra a wɔagye wɔn ayɛ wɔn mma no taa nya adwenemhaw a ɛba wɔn akyi (PTS) sen nnipa dodow no ara. Wɔn PTS sɛnkyerɛnne no gyina osuahu bɔne ko a wɔfaa mu no so na nimdeɛ a ɛfa wɔn abakɔsɛm ho no ma wonya mmoa a wɔahyɛ da ayɛ.[145][146]

== Adwene a ɔmanfo kura wɔ mmofra a wɔfa wɔn sɛ wɔn mma ho ==
Wɔ Atɔe Famfo amammerɛ mu no, nnipa pii hu sɛ abusua ho mfonini a wɔtaa yɛ no yɛ awarefo a wɔne wɔn ho da a wɔwɔ mma a wɔwoo wɔn no de. Saa adwene yi de abusua ahorow a wɔde di dwuma foforo no si nea wɔtaa yɛ no akyi. Nea efi mu ba – nhwehwɛmu kyerɛ – adwene a ɛbrɛ wɔn ase wɔ mmusua a wɔfa wɔn mma ho no wɔ hɔ, ne adwenem naayɛ a ɛfa sɛnea wɔn abusua mu abusuabɔ mu yɛ den ho.[147][148]

Nhwehwɛmu a wɔyɛe nnansa yi ara wɔ mmofra a wɔfa wɔn sɛ wɔn mma ho adwene a Evan Donaldson Asoɛe no wiei no de saa animtiaabu yi ho adanse foforo ma. Ɛkame ayɛ sɛ nnipa dodow a wobisabisaa wɔn nsɛm no mu nkyem abiɛsa mu biako gye di sɛ wɔn a wɔagye wɔn ayɛ wɔn mma no ntumi nyɛ nsakrae yiye, wɔtaa nya ayaresa ho nsɛm, na wɔtaa nya nnubɔne ne nsa ho haw ahorow. Bio nso, 40–45% susuwii sɛ wɔn a wɔagye wɔn ayɛ wɔn mma no taa nya suban ho haw ne ɔhaw wɔ sukuu mu. Nea ɛne eyi bɔ abira no, nhwehwɛmu koro no ara kyerɛe sɛ wobu awofo a wɔfa wɔn sɛ wɔn mma no yiye, a ɛkame ayɛ sɛ 90% kaa wɔn ho asɛm sɛ &quot;wɔn anigye, wonya mfaso, na wonni pɛsɛmenkominya&quot;.[149]

Nnipa dodow no ara ka sɛ wɔn nsɛm titiriw a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho no fi nnamfo ne abusuafo ne nsɛm ho amanneɛbɔfo hɔ. Ne nyinaa mu no, nnipa dodow no ara bɔ amanneɛ sɛ nsɛm ho amanneɛbɔ ma wonya adwene pa wɔ mmofra a wɔfa wɔn sɛ wɔn mma ho; 72% kyerɛe sɛ wɔanya nsusuwii pa.[150] Nanso, wɔda so ara wɔ ɔkasatia kɛse wɔ nsɛm ho amanneɛbɔfo a wɔka fa mmofra a wɔfa wɔn sɛ wɔn mma ho no ho. Sɛ nhwɛso no, blog ahorow bi a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho no kasa tiaa Meet the Robinsons sɛ wɔde nyisaa atrae mfonini ahorow a ne bere atwam di dwuma[151][152] sɛnea The Evan B. Donaldson Adoption Institute a ɛnyɛ nea wɔde hwehwɛ mfaso a ɛkamfo kyerɛ no yɛe no.

Wɔma animtiaabu a ɛbata mmofra a wɔfa wɔn sɛ wɔn mma ho no yɛ kɛse ma mmofra a wɔwɔ mmofra a wɔhwɛ wɔn sɛ wɔn mma no.[154] Nsusuwii bɔne de gyidi a ɛne sɛ mmofra a wɔte saa no haw araa ma ɛrentumi nyɛ yiye sɛ wobegye wɔn atom na wɔayɛ mmusua a &quot;ɛyɛ daa&quot;.[155] Amanneɛbɔ bi a efi Pew Commission on Children in Foster Care hɔ wɔ afe 2004 mu no ada no adi sɛ mmofra dodow a wɔretwɛn wɔ mmofra a wɔhwɛ wɔn so no abu abɔ ho abien fi 1980 mfe no mu na mprempren ɛda so ara yɛ nea ɛkɔ so yɛ pɛ bɛyɛ ɔpepem fã afe biara.&quot;[156]

Attitude toward Adoption Questionnaire (ATAQ):[157] saa nsɛmmisa yi, Abdollahzadeh, Chaloyi ne Mahmoudi na wɔdii kan yɛɛ ho adwuma(2019).[158] Nkyekyɛm a Edi Kan: Saa nsɛmmisa kratasin yi wɔ nneɛma 23 a egyina Likert nsenia a ɛyɛ 1 (Mempene so koraa) so, kosi 5 (Mepene so koraa) a wonya bere a wɔasiesie nneɛma a wɔayɛ sɛ wɔde bɛyɛ mprempren adwinnade no ne adesua biara adesua no akyi. Adeɛ mu nhwehwɛmu ne adwene mu nhwehwɛmu a ɛdi kan no kyerɛ sɛ nneɛma mmienu na ɛwɔ mu. Wɔdane nneɛma 3-10-11-12-14-15-16-17-19-20-21 no na wɔde nkaeɛ no ahyɛ mu sɛ ɛyɛ papa. Nea efii nhwehwɛmu mu nneɛma nhwehwɛmu a nneɛma atitiriw a ɛwɔ varimax rotation mu bae no kyerɛe sɛ wɔbɔɔ afã abien a ɛfa suban a ɛfa agyede ho no din sɛnea ɛte biara no sɛ adwene mu afã horow ne suban-nkate afã horow a ɛfa suban a ɛfa agyede ho. Saa nneɛma mmienu yi kyerɛkyerɛɛ 43.25% mu wɔ nsonsonoeɛ a ɛwɔ nhwɛsoɔ no nyinaa mu. Wɔde Cronbach alpha coefficient dii dwuma de susuw ahotoso a ɛwɔ nsɛmmisa kratasin no mu. Cronbach alpha coefficient yɛ 0.709 wɔ nsɛmmisa kratasin no nyinaa mu, 0.71 wɔ ade a edi kan no mu, ne 0.713 wɔ nea ɛto so abien no ho. Bio nso, na abusuabɔ pa a ɛho hia wɔ asetra mu su horow a wɔpɛ ne adwene mu afã a ɛfa adwene a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho ne suban -nkate mu afã horow a ɛwɔ adwene a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho no ntam (P ≤ 0.01).

== Ɔsesɛw ne nkabom a ɛrekɔ so ==
Nneyɛe a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma no asesa kɛse wɔ afeha a ɛto so 20 no mu, na wɔafrɛ kuw foforo biara din, wɔ ɔkwan bi so, sɛ nsakrae.[159] Efi 1970 mfe no mu no, mmɔden a wɔbɔe sɛ wɔbɛma mmofra a wɔfa wɔn sɛ wɔn mma no atu mpɔn no bɛyɛɛ nea ɛfa kyerɛwtohɔ ahorow a wobebue ne abusua a wɔbɛkora wɔn so ho nkuranhyɛ ho. Saa nsusuwii ahorow yi fi nyansahyɛ ahorow a ɛkyerɛ sɛ kokoamsɛm a ɛwɔ nnɛyi agyede mu no betumi anya ɔkwan a wɔfa so hyehyɛ nipasu no so nkɛntɛnso,[160][161] ama adwene atu afra wɔ abusua anato ho,[162] na ɛmma kakraa bi wɔ aduruyɛ ho abakɔsɛm kwan so.

Abusua a wɔbɛkora wɔn so: Bere a nsɛm a ɛfa mmara a wɔmfa nni dwuma ho no fii ase kɔɔ fam wɔ 1970 mfe no mfiase no, asetra mu yiyedi ahyehyɛde ahorow fii ase sii so dua sɛ, sɛ ɛbɛyɛ yiye a, ɛsɛ sɛ wɔma ɛnanom ne mmofra bom. Wɔ U.S. no, wɔdaa eyi adi pefee denam nsakrae a ɛbaa nhyehyɛe mu wɔ New York Foundling Home, ahyehyɛde a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma a ɛka ɔman no mu nea akyɛ sen biara ho na ɛyɛɛ kyerɛwtohɔ ahorow a wɔasɔ ano akwampaefo no mu. Ɛde nnyinasosɛm foforo abiɛsa a nea ɛka ho ne &quot;sɛ wobesiw mmofra a wɔde wɔn bɛto afiase...&quot;, a ɛda gyidi a ɛne sɛ mmofra bɛsom wɔn yiye denam wɔn mmusua a wɔwoo wɔn no nkyɛn a wɔbɛtra so no adi, nsakrae a ɛyɛ nwonwa wɔ nhyehyɛe mu a ɛda so ara yɛ adwuma nnɛ. Bio nso, akuw te sɛ Origins USA (a wɔde sii hɔ wɔ 1997 mu) fii ase kaa abusua a wɔbɛkora so ne ɛnanom hokwan ahorow ho asɛm denneennen.[165] Nancy Verrier nhoma The Primal Wound a wotintimii no nyaa ɔsesɛw akuw ahorow yi adwene mu nne so nkɛntɛnso. Wɔka &quot;Primal wound&quot; ho asɛm sɛ &quot;ɔsɛe a akokoaa no te nka esiane sɛ ɔtetew ne ho fi ne maame a ɔwoo no no ho nti. Ɛyɛ atenka a emu dɔ na efi mu ba a ɛne sɛ wɔagyaw no a akokoaa a wɔagye no ayɛ ne ba no te nka bere a wɔafa no ayɛ ne ba no akyi na ebetumi akɔ so wɔ ne nkwa nna nyinaa mu.&quot; &quot;[160] .&quot;

Kyerɛwtohɔ ahorow a wɔabue: Bere a wɔagye obi a wɔagye no ayɛ ne ba wɔ mmara kwan so akyi wɔ United States no, wɔtaa yɛ nsakrae wɔ awo ho adansedi krataa a edi kan no mu na wɔde awo ho adansedi krataa foforo si ananmu. Wɔde awofo biara a wɔwoo abofra no din a wɔakyerɛw wɔ awo ho adansedi krataa a edi kan no so no, wɔde awofo a wɔfaa no sɛ wɔn ba no din si adansedi krataa a wɔayɛ mu nsakrae no ananmu, na ɛma ɛyɛ te sɛ nea awofo a wɔfaa no sɛ wɔn ba no na wɔwoo abofra no. Efi 1930 mfe no awiei na ɛkɔɔ so kosi 1970 mfe no mu no, ɔman mmara maa kwan sɛ wɔbɛsɔ awo ho adansedi nkrataa a edi kan no ano bere a wɔafa no sɛ wɔn ba akyi, na gye sɛ aman bi mu no, ɛmaa awo ho adansedi krataa a edi kan no antumi annye onipa a wɔagye no ayɛ ne ba no bere a wadi mfe pii mpo no ] .

Nnipa a wɔagye wɔn ayɛ wɔn mma no fi bere tenten abɔ mmɔden sɛ wobeyi mmara ahorow yi afi hɔ sɛnea ɛbɛyɛ a wobetumi anya wɔn ankasa awo ho adansedi krataa a edi kan. Nneɛma a wɔyɛe sɛ wobeyi awo ho adansedi nkrataa a edi kan ne mmofra a wɔagye wɔn ayɛ wɔn mma no ho kyerɛwtohɔ afoforo a wɔayɛ ama wɔn no dɔɔso wɔ 1970 mfe no mu a wogye toom kɛse sɛ wɔmfa mmara mma wɔn mma no. Wɔ United States no, Jean Paton hyehyɛɛ Orphan Voyage wɔ afe 1954 mu, na Florence Fisher hyehyɛɛ Adoptees' Liberty Movement Association (ALMA) wɔ afe 1971 mu, na ɔfrɛɛ kyerɛwtohɔ ahorow a wɔasɔ ano no &quot;ade a wɔsɛe nnipa nidi&quot;.[168] Bere a wɔ afe 1975 mu no, Emma May Vilardi yɛɛ kyerɛwtohɔ a edi kan a wɔn nyinaa pene so, Amanaman Ntam Soundex Reunion Registry (ISRR), a ɛmaa wɔn a wɔfaa wɔn sɛ wɔn mma no atetew wɔn ho no tumi huu wɔn ho wɔn ho. na Lee Campbell ne awofo afoforo hyehyɛɛ CUB (Concerned United Birthparents). Na nsusuwii a ɛte saa ara renya nkɔso wɔ wiase nyinaa wɔ ahyehyɛde ahorow a ɛwɔ fam te sɛ Parent Finders a ɛwɔ Canada ne Jigsaw a ɛwɔ Australia no mu. Wɔ afe 1975 mu no, England ne Wales buee kyerɛwtohɔ ahorow a egyina abrabɔ pa so.[170]

Eduu 1979 no, ahyehyɛde ahorow 32 ananmusifo a wofi aman 33 mu, Canada ne Mexico, hyiaam wɔ Washington, DC, sɛ wɔrebɛtew Amerika Awofo Bagua (AAC) a wɔde adwene koro toom sɛ: “Bue Kyerɛwtohɔ ahorow a nsɛm a ɛkyerɛ sɛ wobehu mmofra a wɔfa wɔn sɛ wɔn mma no mufo nyinaa awie, . awofo, awofo a wɔfa wɔn sɛ wɔn ba ne nea wɔfa no sɛ ne ba wɔ mfe a nea wɔagye no ayɛ ne ba no adi (18 anaa 19, a egyina ɔman no so) anaasɛ ansa na ɛreba no sɛ nnipa baasa no mufo nyinaa pene so a.&quot;[171] Mfe a edi hɔ no huu ahyehyɛde ahorow a ɛyɛ akofo pii te sɛ Bastard Nation (a wɔde sii hɔ) no dannan wɔ 1996 mu), akuw a wɔboaa ma wobuu kyerɛwtohɔ ahorow a wɔasɔ ano wɔ Alabama, Delaware, New Hampshire, Oregon, Tennessee, ne Maine.[172][173] New York ne ɔman no mu nnipa a wɔhwehwɛ hokwan ahorow a wɔde gye wɔn ayɛ wɔn mma no nkabom bi yɛɛ adwuma yiye de buu mmara bi a adi mfe 83 a ɛyɛ anohyeto no mu wɔ afe 2019 mu, na nnipa a wɔanyinyin a wɔagye wɔn ayɛ wɔn mma a wɔwoo wɔn wɔ New York, ne wɔn asefo nso, nnɛ wɔ hokwan sɛ wɔbisa na wonya wɔn ankasa de awo ho adansedi nkrataa a edi kan.[174][175] Ɛde besi afe 2021 no, aman du a ɛwɔ United States no gye hokwan a nnipa a wɔanyinyin a wɔagye wɔn ayɛ wɔn mma no wɔ sɛ wonya wɔn ankasa awo ho adansedi krataa a edi kan, a Alabama, Alaska, Colorado, Connecticut, Kansas, Maine, New Hampshire, New York, Oregon ne Rhode Island ka ho. 176] na. Connecticut wɔ afe 2021 mu no bɛyɛɛ ɔman a ɛtɔ so du a ɛsan de hokwan a obi a wɔagye no ayɛ ne ba no wɔ sɛ ɔbisa na ɔnya wɔn awoɔ ho adansedie nkrataa a ɛdi kan no baeɛ.[177][178 

'''Nkabom a wɔsan hyia'''

Akontaabu ahorow a ɛfa baabi a wɔn a wɔagye wɔn ayɛ wɔn mma no suban a wɔhwehwɛ nneɛma mu kodu no ada adi sɛ ɛyɛ nea wontumi nhu; nhwehwɛmu ahorow kyerɛ sɛ nsakrae kɛse wɔ hɔ.[179] Ɔfã bi no, ɔhaw no fi nnipa kakraa bi a wɔagye wɔn ayɛ wɔn mma a ɛma nhwehwɛmu a wɔyɛ no kwa no yɛ den, sɛ ɛnyɛ nea ɛrentumi nyɛ yiye mpo a.

Ne nyinaa mu no, wobetumi anya nneɛma bi a ɛkyerɛ sɛnea wɔn a wɔagye wɔn ayɛ wɔn mma no ani gye ho sɛ wɔbɛhwehwɛ nneɛma mu no afi England ne Wales asɛm a ebuee wɔn a wɔagye wɔn ayɛ wɔn mma no awo ho kyerɛwtohɔ ahorow mu wɔ 1975. U.K. Office for National Statistics no ahyɛ ho nkɔm sɛ awiei koraa no, wɔn a wɔagye wɔn ayɛ wɔn mma no nyinaa mu 33% bɛsrɛ sɛ wɔmfa bi mma wɔn wɔn awo ho kyerɛwtohɔ a edi kan no mu, a ɛboro mfitiase nkɔmhyɛ ahorow a wɔkae wɔ 1975 mu bere a na wogye di sɛ nnipa dodow a wɔagye wɔn ayɛ wɔn mma no mu kakraa bi pɛ na wɔbɛbisa wɔn kyerɛwtohɔ no so no. Nanso, wonim sɛ nsusuwii no bu nhwehwɛmu dodow ankasa no adewa, efisɛ nnipa pii a wɔagye wɔn ayɛ wɔn mma wɔ saa bere no mu no nam akwan foforo so nya wɔn awo ho kyerɛwtohɔ.[180]

Nhwehwɛmu nhoma ahorow no ka sɛ wɔn a wɔagye wɔn ayɛ wɔn mma no de nneɛma anan a enti wɔpɛ sɛ wɔsan hyiam ma: 1) wɔpɛ sɛ wonya abusua anato a edi mũ kɛse, 2) wɔpɛ sɛ wohu nsɛm a esisi a ɛde wɔn nyinsɛn, awo, ne wɔn a wogyae mu no, 3) wɔwɔ anidaso sɛ wɔde nsɛm bɛma wɔn mma , ne 4) wohia abɔde a nkwa wom ho nsɛm a ɛkɔ akyiri, a aduruyɛ ho nsɛm ka ho. Nanso, nhwehwɛmufo a wɔyɛ mmofra a wɔfa wɔn sɛ wɔn mma no susuw sɛ ntease ahorow a wɔde ama no nni mũ: ɛwom sɛ obi a ɔto so abiɛsa betumi de nsɛm a ɛte saa ama de, nanso nsɛm a wobisabisaa wɔn a wɔagye wɔn ayɛ wɔn mma, a wɔhwehwɛɛ sɛ wɔbɛsan ahyiam no, hui sɛ wɔdaa hia a ehia sɛ wodi abɔde mu abusuabɔ ho dwuma ankasa adi.

Ɛte sɛ nea ɔpɛ a ɛwɔ hɔ sɛ wɔbɛsan ahyiam no ne nea wɔagye no ayɛ ne ba no nkitahodi ne ɔmanfo a wogye tom wɔ mpɔtam hɔ no wɔ abusuabɔ. Nsusuwii ahorow a wɔde wɔn adwene si wɔn mu so kyerɛ sɛ wɔn a wɔagye wɔn ayɛ wɔn mma no binom wɔ nsɛm a emu nna hɔ wɔ wɔn ho a wɔte nka no mu, na ɛma wotumi de nipasu a ɛkɔ so daa kyerɛ no sɛe. Reunion boa ma wosiesie ne ho nimdeɛ a wonni no.[182]

Nea ɛne eyi bɔ abira no, nsusuwii ahorow a wɔde wɔn adwene si akyi no kyerɛ sɛ wɔn a wɔagye wɔn ayɛ wɔn mma no fa so di asetra mu animtiaabu so. Goffman na odii kan de nsusuwii no too gua, na ɛwɔ afã anan: 1) wɔn a wɔagye wɔn ayɛ wɔn mma no hu sɛ abɔde mu abusuabɔ a enni hɔ no kyerɛ nsonsonoe a ɛda wɔn abusua a wɔagye wɔn ayɛ wɔn mma no ntam wɔ afoforo ho, 2) osuahu ahorow a wɔn a wɔnnye wɔn mma no kyerɛ sɛ abusuabɔ a wɔde gye wɔn ayɛ wɔn mma no yɛ mmerɛw sen mogya mu abusuabɔ no hyɛ ntease yi mu den, ) sɛ wɔka bom a, saa nneɛma yi ma, wɔ wɔn a wɔagye wɔn ayɛ wɔn mma no binom mu no, wɔte nka sɛ wɔayi wɔn afi asetra mu, na 4) saa wɔn a wɔagye wɔn ayɛ wɔn mma yi yɛ wɔn ade denam mogya a wɔde kyekyere wɔn ho a wɔhwehwɛ a ɛhyɛ wɔn a wɔyɛ ɔmanfo no mu den no so. Ntease a ɛfa akyi a wɔde wɔn adwene si so wɔ sanba ho no kyerɛ sɛ ebia wɔn a wɔagye wɔn ayɛ wɔn mma no bɛyɛ nsakrae yiye na wɔwɔ anigye wɔ wɔn mmusua a wɔagye wɔn ayɛ wɔn mma no mu, nanso wɔbɛhwehwɛ sɛ mmɔden a wɔbɔ sɛ wobesiesie osuahu ahorow a ɛfa asetra mu animtiaabu ho.[181]

Wɔn a wɔagye wɔn ayɛ wɔn mma no bi pow adwene a ɛne sɛ wɔbɛsan ahyiam no. Nanso, nea ɛma ɛsono wɔn a wɔagye wɔn ayɛ wɔn mma a wɔhwehwɛ wɔn no ne wɔn a wɔnhwehwɛ no mu no mu nna hɔ. Krataa biako bɔ nhwehwɛmu no mua, na ɛka sɛ, &quot;...mmɔden a wɔbɔ sɛ wɔbɛma nsonsonoe aba nea ɔhwehwɛ ne nea ɔnyɛ nhwehwɛmu no ntam no nyɛ nea ɛyɛ nea ɛyɛ nokware anaasɛ ɛyɛ nea wotumi de di dwuma wɔ ɔkwan a ɛkɔ akyiri so sen mmɔden a wɔbɔ sɛ wɔbɛkyerɛ ... nsonsonoe a ɛda wɔn a wɔagye wɔn ayɛ wɔn mma ne wɔn a wɔamfa wɔn ayɛ wɔn mma ntam.&quot;[183]

Sɛ yɛbɛka no tiawa a, nhyiam a wɔsan hyia no betumi de nsɛm ahorow aba wɔn a wɔagye wɔn ayɛ wɔn mma ne awofo so. Ne nyinaa mu no, ɛte sɛ nea nea efi mu ba a wɔsan hyiam no mu dodow no ara yɛ nea eye. Wɔ nhwehwɛmu kɛse a wɔayɛ de besi nnɛ (a egyina mmuae a nnipa 1,007 a wɔafa wɔn ayɛ wɔn mma ne awofo a wogyaee no de mae so) 90% buae sɛ sankɔhwɛ yɛ osuahu a mfaso wɔ so. Nanso, eyi nkyerɛ sɛ wɔhyehyɛɛ abusuabɔ a ɛkɔ so wɔ nea wɔagye no ayɛ ne ba ne ɔwofo ntam anaasɛ eyi ne botae no.[184]

'''Nneyɛe a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho a akyinnyegye wom'''

Hwɛ nso: Nsisi a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho

Wɔde mmɔden a wɔbɔ sɛ wɔbɛyɛ nsakrae ne abusua a wɔbɛkora wɔn so no nso abata sɛnea wosusuw sɛ wɔde mmofra a wɔfa wɔn sɛ wɔn mma no di dwuma ɔkwammɔne so no ho denneennen. Wɔ tebea horow bi mu no, wɔagyae awofo hokwan ahorow bere a ɔmanfo abu wɔn mmusuakuw anaa wɔn asetra mu sikasɛm kuw no sɛ wɔmfata no. Ná nnipa pii gye nneyɛe yi bi tom na

== Amammerɛ mu nsakrae ahorow ==
Suban ne mmara a ɛfa mmofra a wɔfa wɔn sɛ wɔn mma ho no gu ahorow kɛse. Bere a amammerɛ nyinaa yɛ nhyehyɛe ahorow a mmofra a wɔn awofo a wɔwoo wɔn no nni hɔ a wobetumi atete wɔn no, afoforo betumi atete wɔn no, ɛnyɛ amammerɛ nyinaa na wɔwɔ adwene a ɛne sɛ wobegye wɔn ayɛ wɔn mma, a ɛne sɛ wɔbɛfa mmofra a wɔne wɔn ho nni abusuabɔ sɛ wɔne awofo a wɔagye wɔn ayɛ wɔn mma no mma a wɔwoo wɔn no yɛ pɛ. Sɛ nhwɛso no, wɔ Nkramofo Mmara ase no, ɛsɛ sɛ mmofra a wɔagye wɔn ayɛ wɔn mma no de wɔn mfitiase abusua din sie na ama wɔahu wɔn ne mogya mu abusuabɔ,[213] na, sɛnea wɔtaa yɛ no, mmea hyɛ hijab wɔ mmarima anim wɔ wɔn afie a wɔagye wɔn ayɛ wɔn mma no mu. Wɔ Egypt no, saa amammerɛ mu nsonsonoe ahorow yi ama wɔayɛ mmofra a wɔfa wɔn sɛ wɔn mma no ayɛ nea mmara mma ho kwan mmom sɛ wɔbɛpaw nhyehyɛe a ɛfa mmofra a wɔhwɛ wɔn wɔ mmofraase ho.[214][215]

== Da a Wɔde Kɔ Fie ==


Wɔ aman bi te sɛ United States mu no, &quot;Homecoming Day&quot; yɛ da a obi a wɔagye no ayɛ ne ba no ne wɔn abusua foforo a wɔagye no ayɛ wɔn mma no bom wɔ aban kwan so.[216]</text>
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      <comment>Created page with &quot;'''Mpenatweɛ''' yɛ ahogorɔ ayɔnkofa a nnipa mmienu ka wɔn ho bom yɛ nnoɔma bom, Mpempii wɔn tirimpɔ ne sɛ wɔbɛyɛ adeɛ a ɛbɛsɔ wɔn mmienu ani na daakye ɛbɛma wɔn ayɔnkofa no ayɛ krabɛhwɛ. Ɛwɔ &quot;courtship&quot; nkyekyɛmu no mu, a mpɔtam dwumadie a awarefoɔ nkoa anaa wɔne afoforɔ di. Mmara ne nneyɔeɛ a ɛwɔ mpenatweɛ ne edin a yɛde kyerɛ aseɛ na amammerɛ, mpɔtam ne mmerɛ da nso. Ɛwɔm sɛ mpenatweɛ yɛ anom nsɛm bi a yɛde kyerɛ nnipa...&quot;</comment>
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      <text bytes="1246" xml:space="preserve">'''Mpenatweɛ''' yɛ ahogorɔ ayɔnkofa a nnipa mmienu ka wɔn ho bom yɛ nnoɔma bom, Mpempii wɔn tirimpɔ ne sɛ wɔbɛyɛ adeɛ a ɛbɛsɔ wɔn mmienu ani na daakye ɛbɛma wɔn ayɔnkofa no ayɛ krabɛhwɛ. Ɛwɔ &quot;courtship&quot; nkyekyɛmu no mu, a mpɔtam dwumadie a awarefoɔ nkoa anaa wɔne afoforɔ di. Mmara ne nneyɔeɛ a ɛwɔ mpenatweɛ ne edin a yɛde kyerɛ aseɛ na amammerɛ, mpɔtam ne mmerɛ da nso. Ɛwɔm sɛ mpenatweɛ yɛ anom nsɛm bi a yɛde kyerɛ nnipa a ɛwuraa mpena mu nneyɛɛ de kyerɛ wɔn ho, mpenatweɛ nso bɛtumi ayɛ nnwuma pii a ɛnkɔ so wɔ mpenatweɛ no mu. Mpenatweɛ nkyerɛase sesaa wɔ 20th century a wɔde kyerɛ sɛ ɔdɔ agodie a ɛnni mmara mu,nna mu agodie ayɔnkofa a ɛboro sɛ obi resɔ no ahwɛ a ɔda ne ho adi. Ɛwɔm sɛ nea ɛnni mmara mu, saa nkyereaseɛ no ho nyɛ na na wɔde di dwuma wɔ kasa ne atwerɛ wɔ ne kwan so. Ɛwɔm sɛ ɛyɛ akyiwadeɛ wɔ aman pii so a ɛbi yɛ abakɔsɛm, sɛ obi bɛdi mpamu agorɔ wɔberɛ a ne mmerɛ nso sɛ ɔyɛ saa yɛ adeɛ a na nnipa yɛ wɔ mfeɛ bi a atwam, a atuateɛ a ɛfa mmaa ne mmarima dikan. Wɔ nnoɔma a wɔda no adi wɔ sini, tɛlɛvihyin ne nnwom,nna nhyiamu abɛyɛ adeɛ a ɛkɔ soro paa a wagye atom sɛ ɛma ayɔnkofa no tu mpɔn.</text>
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      <text bytes="3273" xml:space="preserve">'''Mpenatweɛ''' yɛ ahogorɔ ayɔnkofa a nnipa mmienu ka wɔn ho bom yɛ nnoɔma bom, Mpempii wɔn tirimpɔ ne sɛ wɔbɛyɛ adeɛ a ɛbɛsɔ wɔn mmienu ani na daakye ɛbɛma wɔn ayɔnkofa no ayɛ krabɛhwɛ. Ɛwɔ &quot;courtship&quot; nkyekyɛmu no mu, a mpɔtam dwumadie a awarefoɔ nkoa anaa wɔne afoforɔ di. Mmara ne nneyɔeɛ a ɛwɔ mpenatweɛ ne edin a yɛde kyerɛ aseɛ na amammerɛ, mpɔtam ne mmerɛ da nso. Ɛwɔm sɛ mpenatweɛ yɛ anom nsɛm bi a yɛde kyerɛ nnipa a ɛwuraa mpena mu nneyɛɛ de kyerɛ wɔn ho, mpenatweɛ nso bɛtumi ayɛ nnwuma pii a ɛnkɔ so wɔ mpenatweɛ no mu. Mpenatweɛ nkyerɛase sesaa wɔ 20th century a wɔde kyerɛ sɛ ɔdɔ agodie a ɛnni mmara mu,nna mu agodie ayɔnkofa a ɛboro sɛ obi resɔ no ahwɛ a ɔda ne ho adi. Ɛwɔm sɛ nea ɛnni mmara mu, saa nkyereaseɛ no ho nyɛ na na wɔde di dwuma wɔ kasa ne atwerɛ wɔ ne kwan so. Ɛwɔm sɛ ɛyɛ akyiwadeɛ wɔ aman pii so a ɛbi yɛ abakɔsɛm, sɛ obi bɛdi mpamu agorɔ wɔberɛ a ne mmerɛ nso sɛ ɔyɛ saa yɛ adeɛ a na nnipa yɛ wɔ mfeɛ bi a atwam, a atuateɛ a ɛfa mmaa ne mmarima dikan. Wɔ nnoɔma a wɔda no adi wɔ sini, tɛlɛvihyin ne nnwom,nna nhyiamu abɛyɛ adeɛ a ɛkɔ soro paa a wagye atom sɛ ɛma ayɔnkofa no tu mpɔn.

Abakɔsɛm

Mpenatweɛ a ɛyɛ adeɛ a yɛyɛ no wɔ mmoronosoɔ yɛ adeɛ a abasosɛm, a ɛbaa bɛyɛ mfeɛ kakra bi. Wɔ asetena amamberɛmsɛm ne  asetena mu nsɛm agyinaberɛ mu no, mpenatweɛ ne awareɛ ne abusua asesa koraa,  a wɔde abɛɛfo ne nnuro na atrɛ mu. Sɛdeɛ nnipa mmoronoso asesa afiri  ahayɔ-ne wɔn a wɔboaboa ano dekɔ anibue mu, nnipa de nnoɔma foforɔ abɛwura mu, a wɔnim sɛ ɔbaa ne barima hyiamu a na ɛde ɛba ba. Wɔn a wɔyɛ nnipa nhwehwɛmu kyerɛ sɛ wɔ abakɔsɛm mu no, awofoɔ ne mpanimfoɔ a na ɛhyehyɛ awareɛ a wɔn tirimpɔ nyɛ ɔdɔ na mmom awugyadeɛ ne &quot;sikasɛm ne amanyɔsɛm&quot; ntira.&lt;ref&gt;https://en.wikipedia.org/wiki/CiteSeerX_(identifier)&lt;/ref&gt;  Wɔne kwan so no,  ɛwɔ sɛ wɔtwe mpena kakra ansana na wayɛ nea mpɔtam hɔfoɔ no bɛgye atom sɛ ɔyere ne okunu. Ɛnam sɛ nipa a ɛwɔ mpɔtam na ɛgye awarefoɔ no nkabom tom nti, wɔde awareɛ sii hɔ maa mmaa ne mmarima  na ɛyɛ adeɛ a ɛwɔ hɔ, a  mmaa yɛ agyapadeɛ a agyanom de sesa ma kunu nom, a ne dwumadie ne sɛ ɔde mma ba wiase. Nkuro bi te sɛ Europe, ne China mpɔtam hyɛ nnipa ma wɔnya wɔn hokafoɔ, hyɛ wɔn sɛ wɔn ware ansana wahyiamu.&lt;ref&gt;http://www.chinadaily.com.cn/english/doc/2005-11/11/content_493925.htm&lt;/ref&gt;mpɔtam bi nso hunu sɛ saa nkabom no yɛ adeɛ a ɛyɛ a ɛbɛma watete mma na asane asi mente meho ase ne ntɔkwa kwan ɛnam nnamfofoɔ akansie so. Nhwehwɛmu a wanya afa nnipa anibue ho no, de wura Middle ages wɔ Europe no, na wɔhunu ayeforɔ yɛ sɛ abusuafoɔ na ahyehyɛ adwuma a ɛma sika, na ɔdɔ agodie yɛ adeɛ a na ɛnkɔ so wɔ awareɛ bi te sɛ covert awareɛ.&lt;ref name=&quot;:0&quot;&gt;https://www.theguardian.com/lifeandstyle/2009/jan/24/dating-statistics&lt;/ref&gt; 12th century nwoma The Art of Courtly Love tuufo sɛ &quot; ɔdɔ korɔgyee ntumi ntena okunu ne ɔyere ntam&quot;.&lt;ref name=&quot;:0&quot; /&gt;  Adwene baako kyerɛ sɛ,  mmaa ne mmarima nhyiamu a ɛkɔ so ansana awareɛ aba so no yɛ adeɛ a aduru mpenatweɛ mu nnɛ.&lt;ref name=&quot;:0&quot; /&gt;

== Beaeɛ a menyaa mmoa firiiɛ ==</text>
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    </revision>
    <revision>
      <id>132950</id>
      <parentid>132949</parentid>
      <timestamp>2022-07-31T13:06:47Z</timestamp>
      <contributor>
        <username>AC Krah</username>
        <id>10338</id>
      </contributor>
      <comment>/* Beaeɛ a menyaa mmoa firiiɛ */</comment>
      <model>wikitext</model>
      <format>text/x-wiki</format>
      <text bytes="3278" xml:space="preserve">'''Mpenatweɛ''' yɛ ahogorɔ ayɔnkofa a nnipa mmienu ka wɔn ho bom yɛ nnoɔma bom, Mpempii wɔn tirimpɔ ne sɛ wɔbɛyɛ adeɛ a ɛbɛsɔ wɔn mmienu ani na daakye ɛbɛma wɔn ayɔnkofa no ayɛ krabɛhwɛ. Ɛwɔ &quot;courtship&quot; nkyekyɛmu no mu, a mpɔtam dwumadie a awarefoɔ nkoa anaa wɔne afoforɔ di. Mmara ne nneyɔeɛ a ɛwɔ mpenatweɛ ne edin a yɛde kyerɛ aseɛ na amammerɛ, mpɔtam ne mmerɛ da nso. Ɛwɔm sɛ mpenatweɛ yɛ anom nsɛm bi a yɛde kyerɛ nnipa a ɛwuraa mpena mu nneyɛɛ de kyerɛ wɔn ho, mpenatweɛ nso bɛtumi ayɛ nnwuma pii a ɛnkɔ so wɔ mpenatweɛ no mu. Mpenatweɛ nkyerɛase sesaa wɔ 20th century a wɔde kyerɛ sɛ ɔdɔ agodie a ɛnni mmara mu,nna mu agodie ayɔnkofa a ɛboro sɛ obi resɔ no ahwɛ a ɔda ne ho adi. Ɛwɔm sɛ nea ɛnni mmara mu, saa nkyereaseɛ no ho nyɛ na na wɔde di dwuma wɔ kasa ne atwerɛ wɔ ne kwan so. Ɛwɔm sɛ ɛyɛ akyiwadeɛ wɔ aman pii so a ɛbi yɛ abakɔsɛm, sɛ obi bɛdi mpamu agorɔ wɔberɛ a ne mmerɛ nso sɛ ɔyɛ saa yɛ adeɛ a na nnipa yɛ wɔ mfeɛ bi a atwam, a atuateɛ a ɛfa mmaa ne mmarima dikan. Wɔ nnoɔma a wɔda no adi wɔ sini, tɛlɛvihyin ne nnwom,nna nhyiamu abɛyɛ adeɛ a ɛkɔ soro paa a wagye atom sɛ ɛma ayɔnkofa no tu mpɔn.

== Abakɔsɛm ==
Mpenatweɛ a ɛyɛ adeɛ a yɛyɛ no wɔ mmoronosoɔ yɛ adeɛ a abasosɛm, a ɛbaa bɛyɛ mfeɛ kakra bi. Wɔ asetena amamberɛmsɛm ne  asetena mu nsɛm agyinaberɛ mu no, mpenatweɛ ne awareɛ ne abusua asesa koraa,  a wɔde abɛɛfo ne nnuro na atrɛ mu. Sɛdeɛ nnipa mmoronoso asesa afiri  ahayɔ-ne wɔn a wɔboaboa ano dekɔ anibue mu, nnipa de nnoɔma foforɔ abɛwura mu, a wɔnim sɛ ɔbaa ne barima hyiamu a na ɛde ɛba ba. Wɔn a wɔyɛ nnipa nhwehwɛmu kyerɛ sɛ wɔ abakɔsɛm mu no, awofoɔ ne mpanimfoɔ a na ɛhyehyɛ awareɛ a wɔn tirimpɔ nyɛ ɔdɔ na mmom awugyadeɛ ne &quot;sikasɛm ne amanyɔsɛm&quot; ntira.&lt;ref&gt;https://en.wikipedia.org/wiki/CiteSeerX_(identifier)&lt;/ref&gt;  Wɔne kwan so no,  ɛwɔ sɛ wɔtwe mpena kakra ansana na wayɛ nea mpɔtam hɔfoɔ no bɛgye atom sɛ ɔyere ne okunu. Ɛnam sɛ nipa a ɛwɔ mpɔtam na ɛgye awarefoɔ no nkabom tom nti, wɔde awareɛ sii hɔ maa mmaa ne mmarima  na ɛyɛ adeɛ a ɛwɔ hɔ, a  mmaa yɛ agyapadeɛ a agyanom de sesa ma kunu nom, a ne dwumadie ne sɛ ɔde mma ba wiase. Nkuro bi te sɛ Europe, ne China mpɔtam hyɛ nnipa ma wɔnya wɔn hokafoɔ, hyɛ wɔn sɛ wɔn ware ansana wahyiamu.&lt;ref&gt;http://www.chinadaily.com.cn/english/doc/2005-11/11/content_493925.htm&lt;/ref&gt;mpɔtam bi nso hunu sɛ saa nkabom no yɛ adeɛ a ɛyɛ a ɛbɛma watete mma na asane asi mente meho ase ne ntɔkwa kwan ɛnam nnamfofoɔ akansie so. Nhwehwɛmu a wanya afa nnipa anibue ho no, de wura Middle ages wɔ Europe no, na wɔhunu ayeforɔ yɛ sɛ abusuafoɔ na ahyehyɛ adwuma a ɛma sika, na ɔdɔ agodie yɛ adeɛ a na ɛnkɔ so wɔ awareɛ bi te sɛ covert awareɛ.&lt;ref name=&quot;:0&quot;&gt;https://www.theguardian.com/lifeandstyle/2009/jan/24/dating-statistics&lt;/ref&gt; 12th century nwoma The Art of Courtly Love tuufo sɛ &quot; ɔdɔ korɔgyee ntumi ntena okunu ne ɔyere ntam&quot;.&lt;ref name=&quot;:0&quot; /&gt;  Adwene baako kyerɛ sɛ,  mmaa ne mmarima nhyiamu a ɛkɔ so ansana awareɛ aba so no yɛ adeɛ a aduru mpenatweɛ mu nnɛ.&lt;ref name=&quot;:0&quot; /&gt;

== Beaeɛ a menyaa mmoa firiiɛ ==</text>
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  </page>
  <page>
    <title>Adamfofa</title>
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    <revision>
      <id>132937</id>
      <timestamp>2022-07-31T12:30:26Z</timestamp>
      <contributor>
        <username>Afriyie34</username>
        <id>10662</id>
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      <comment>Mate krataa foforɔ</comment>
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      <text bytes="1589" xml:space="preserve">Adamfofa yɛ abusuabɔ a ɛda ɔdɔ a ɛda nnipa ntam.[1] Ɛyɛ nnipa ntam abusuabɔ a emu yɛ den sen &quot;onimfoɔ&quot; anaa &quot;fekubɔ&quot;, te sɛ sukuuni, ofipamfo, yɔnko dwumayɛni, anaa yɔnko dwumayɛni.

Wɔ amammerɛ ahorow bi mu no, adamfofa ho adwene no yɛ abusuabɔ kakraa bi a emu dɔ yiye nkutoo; wɔ afoforo te sɛ U.S. ne Canada no, obi betumi anya nnamfo pii, na ebia ɔne onipa biako anaa baanu a wobetumi afrɛ wɔn nnamfo pa anaa nnamfo paa benya abusuabɔ a emu yɛ den kɛse. Nsɛmfua afoforo a wɔka wɔ kasa mu ne besties anaa Best Friends Forever (BFFs). Ɛwom sɛ adamfofa ahorow pii wɔ hɔ, a ebia ɛsono emu bi wɔ mmeae ahorow de, nanso su ahorow bi wɔ abusuabɔ a ɛtete saa pii mu. Nneɛma a ɛtete saa no bi ne sɛ wɔbɛpaw sɛ wɔne wɔn ho wɔn ho bɛtra, bere a wɔde bom tra mu anigye, na wobetumi de wɔn ho ahyɛ dwumadi pa a ɛboa wɔn ho wɔn ho mu.[2]

Ɛtɔ da bi a, wɔma nnamfo da nsow wɔ abusua ho, sɛnea ɛte wɔ asɛm a wɔka sɛ &quot;nnamfo ne abusua&quot; mu no, na ɛtɔ da bi nso a wɔda nsow wɔ adɔfo ho (e.g., &quot;adɔfo ne nnamfo&quot;), ɛwom sɛ wɔde nnamfo a wɔwɔ mfaso ahorow no yɛ nea ɛyɛ kusuu de. Adamfo beae no yɛ beae a wɔbara obi sɛ ɔnsɔre nkɔ ɔdɔfo gyinabea (hwɛ Ɔdɔ a wontua ho ka nso).

Wɔasua adamfofa ho ade wɔ nhomasua mu, te sɛ nkitahodi, asetra ho adesua, asetra mu adwene ho nimdeɛ, nnipa ho adesua, ne nyansapɛ mu. Wɔahyɛ adamfofa ho adesua mu nsusuwii ahorow ho nyansa, a nea ɛka ho ne asetra mu nsakrae ho nsusuwii, pɛyɛ ho nsusuwii, abusuabɔ mu nsɛm a wɔka, ne akwan horow a wɔfa so de wɔn ho bata ho.</text>
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    <revision>
      <id>132938</id>
      <parentid>132937</parentid>
      <timestamp>2022-07-31T12:33:18Z</timestamp>
      <contributor>
        <username>Afriyie34</username>
        <id>10662</id>
      </contributor>
      <comment>Me de atwerɛ ka ho</comment>
      <model>wikitext</model>
      <format>text/x-wiki</format>
      <text bytes="1760" xml:space="preserve">Adamfofa yɛ abusuabɔ a ɛda ɔdɔ a ɛda nnipa ntam.[1] Ɛyɛ nnipa ntam abusuabɔ a emu yɛ den sen &quot;onimfoɔ&quot; anaa &quot;fekubɔ&quot;, te sɛ sukuuni, ofipamfo, yɔnko dwumayɛni, anaa yɔnko dwumayɛni.

Wɔ amammerɛ ahorow bi mu no, adamfofa ho adwene no yɛ abusuabɔ kakraa bi a emu dɔ yiye nkutoo; wɔ afoforo te sɛ U.S. ne Canada no, obi betumi anya nnamfo pii, na ebia ɔne onipa biako anaa baanu a wobetumi afrɛ wɔn nnamfo pa anaa nnamfo paa benya abusuabɔ a emu yɛ den kɛse. Nsɛmfua afoforo a wɔka wɔ kasa mu ne besties anaa Best Friends Forever (BFFs). Ɛwom sɛ adamfofa ahorow pii wɔ hɔ, a ebia ɛsono emu bi wɔ mmeae ahorow de, nanso su ahorow bi wɔ abusuabɔ a ɛtete saa pii mu. Nneɛma a ɛtete saa no bi ne sɛ wɔbɛpaw sɛ wɔne wɔn ho wɔn ho bɛtra, bere a wɔde bom tra mu anigye, na wobetumi de wɔn ho ahyɛ dwumadi pa a ɛboa wɔn ho wɔn ho mu.[2]

Ɛtɔ da bi a, wɔma nnamfo da nsow wɔ abusua ho, sɛnea ɛte wɔ asɛm a wɔka sɛ &quot;nnamfo ne abusua&quot; mu no, na ɛtɔ da bi nso a wɔda nsow wɔ adɔfo ho (e.g., &quot;adɔfo ne nnamfo&quot;), ɛwom sɛ wɔde nnamfo a wɔwɔ mfaso ahorow no yɛ nea ɛyɛ kusuu de. Adamfo beae no yɛ beae a wɔbara obi sɛ ɔnsɔre nkɔ ɔdɔfo gyinabea (hwɛ Ɔdɔ a wontua ho ka nso).

Wɔasua adamfofa ho ade wɔ nhomasua mu, te sɛ nkitahodi, asetra ho adesua, asetra mu adwene ho nimdeɛ, nnipa ho adesua, ne nyansapɛ mu. Wɔahyɛ adamfofa ho adesua mu nsusuwii ahorow ho nyansa, a nea ɛka ho ne asetra mu nsakrae ho nsusuwii, pɛyɛ ho nsusuwii, abusuabɔ mu nsɛm a wɔka, ne akwan horow a wɔfa so de wɔn ho bata ho. 

== Nkɔso ho adwene ho nimdeɛ ==

== Nkɔso ho nsɛm ==

== Apomuden ==

== Nneɛma a wɔde gu mu ==

== Nnipa dodow ho nsɛm ==

== Nneɛma ahorow a ɛwɔ hɔ ntam ==</text>
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    </revision>
    <revision>
      <id>132939</id>
      <parentid>132938</parentid>
      <timestamp>2022-07-31T12:39:40Z</timestamp>
      <contributor>
        <username>Afriyie34</username>
        <id>10662</id>
      </contributor>
      <comment>Me de atwerɛ ka ho</comment>
      <model>wikitext</model>
      <format>text/x-wiki</format>
      <text bytes="8697" xml:space="preserve">Adamfofa yɛ abusuabɔ a ɛda ɔdɔ a ɛda nnipa ntam.[1] Ɛyɛ nnipa ntam abusuabɔ a emu yɛ den sen &quot;onimfoɔ&quot; anaa &quot;fekubɔ&quot;, te sɛ sukuuni, ofipamfo, yɔnko dwumayɛni, anaa yɔnko dwumayɛni.

Wɔ amammerɛ ahorow bi mu no, adamfofa ho adwene no yɛ abusuabɔ kakraa bi a emu dɔ yiye nkutoo; wɔ afoforo te sɛ U.S. ne Canada no, obi betumi anya nnamfo pii, na ebia ɔne onipa biako anaa baanu a wobetumi afrɛ wɔn nnamfo pa anaa nnamfo paa benya abusuabɔ a emu yɛ den kɛse. Nsɛmfua afoforo a wɔka wɔ kasa mu ne besties anaa Best Friends Forever (BFFs). Ɛwom sɛ adamfofa ahorow pii wɔ hɔ, a ebia ɛsono emu bi wɔ mmeae ahorow de, nanso su ahorow bi wɔ abusuabɔ a ɛtete saa pii mu. Nneɛma a ɛtete saa no bi ne sɛ wɔbɛpaw sɛ wɔne wɔn ho wɔn ho bɛtra, bere a wɔde bom tra mu anigye, na wobetumi de wɔn ho ahyɛ dwumadi pa a ɛboa wɔn ho wɔn ho mu.[2]

Ɛtɔ da bi a, wɔma nnamfo da nsow wɔ abusua ho, sɛnea ɛte wɔ asɛm a wɔka sɛ &quot;nnamfo ne abusua&quot; mu no, na ɛtɔ da bi nso a wɔda nsow wɔ adɔfo ho (e.g., &quot;adɔfo ne nnamfo&quot;), ɛwom sɛ wɔde nnamfo a wɔwɔ mfaso ahorow no yɛ nea ɛyɛ kusuu de. Adamfo beae no yɛ beae a wɔbara obi sɛ ɔnsɔre nkɔ ɔdɔfo gyinabea (hwɛ Ɔdɔ a wontua ho ka nso).

Wɔasua adamfofa ho ade wɔ nhomasua mu, te sɛ nkitahodi, asetra ho adesua, asetra mu adwene ho nimdeɛ, nnipa ho adesua, ne nyansapɛ mu. Wɔahyɛ adamfofa ho adesua mu nsusuwii ahorow ho nyansa, a nea ɛka ho ne asetra mu nsakrae ho nsusuwii, pɛyɛ ho nsusuwii, abusuabɔ mu nsɛm a wɔka, ne akwan horow a wɔfa so de wɔn ho bata ho. 

== Nkɔso ho adwene ho nimdeɛ ==
'''Mmɔfrabrɛ'''

Ntease a ɛfa adamfofa ho wɔ mmofra mu no taa twe adwene si mmeae te sɛ dwumadi ahorow a wɔtaa yɛ, honam fam a wɔbɛn wɔn ho, ne akwanhwɛ a wɔkyɛ so kɛse.[3]: 498 [a] Saa adamfofa ahorow yi ma wonya hokwan di agoru na wɔde wɔn ho hyɛ mu. 246 Mmofra dodow no ara taa kyerɛkyerɛ adamfofa mu denam nneɛma te sɛ kyɛfa so, na mmofra taa ne obi a wobu no sɛ ɔyɛ adamfo no kyɛ.[4]: 246 [5][6] Bere a mmofra nyin no, wɔnyɛ ankorankoro ho ade pii na no nim afoforo yiye. Wonya tumi a wɔde benya tema ma wɔn nnamfo, na wɔn ani gye ho sɛ wobedi agoru wɔ akuw mu. Wonya atipɛnfo a wɔpow wɔn nso bere a wɔrekɔ so wɔ mmofraberem mfe no mfinimfini no. Nnamfo pa a obenya wɔ ne mmofraase no boa ma abofra nya ne ho yiye wɔ ɔmanfo mu akyiri yi wɔ n’asetra mu.[5]

Sɛ wogyina akyerɛkyerɛfo ne ɛnanom amanneɛbɔ so a, anyɛ yiye koraa no, mmofra a wonnya nkɔɔ sukuu no mu 75% wɔ adamfo biako. Saa dodow yi kɔɔ soro koduu 78% kosii adesuakuw a ɛto so anum no mu, sɛnea wɔde co-nomination sɛ nnamfo susuw no, na 55% wɔ mutual adamfo paa.[4]: 247 Wohui sɛ mmofra bɛyɛ 15% nni adamfo a enni sabea, bɔɔ amanneɛ sɛ wɔmfa wɔn ho wɔn ho nkɔ nnamfo anyɛ yiye koraa no asram asia.[4]: 250

Mfaso a ebetumi aba wɔ adamfofa so no bi ne hokwan a wobenya de asua tema ne ɔhaw ahorow ano aduru ho ade.[7] Ntetee a awofo de ma no betumi ayɛ nea mfaso wɔ so wɔ mmofra a wɔbɛboa wɔn ma wɔanya nnamfo no mu. Eileen Kennedy-Moore ka nneɛma atitiriw abiɛsa a ɛma mmofra nya adamfofa ho asɛm: (1) wobue wɔn ani, (2) nsɛdi, ne (3) anigye a wɔkyɛ.[8][9][10] Awofoɔ nso bɛtumi aboa mmofra ama wɔate asetena mu akwankyerɛ a wɔn ankasa nsuaa no ase.[11] Kennedy-Moore retwe adwene asi nhwehwɛmu a Robert Selman[12] ne afoforo yɛe mu no, ɔkyerɛkyerɛ nkɔso fã ahorow wɔ mmofra adamfofa mu, a ɛda tumi a ɛrenya nkɔanim a ɛma wɔte afoforo adwene ase adi: &quot;Mepɛ Ɛyɛ Me Kwan&quot;, &quot;Dɛn na Ɛwɔ Mu Ma Me?&quot;, Ɛdenam Mmara no so&quot;, &quot;Adwene ne Kyɛfa&quot;, ne &quot;Nnamfo a Wɔnam Thick ne Thin So.&quot;[13]

'''Mmabunbere'''

Wɔ mmerantebere ne mmabaabere mu no, nnamfofa bɛyɛ “ade a ɛma ade kɛse, nea ɛkyɛ, nea ɛka no pen, ɛboa, na ɛba ara kwa.” Mmabun taa hwehwɛ atipɛnfo a wobetumi de su horow a ɛte saa ama wɔ abusuabɔ a ɛda wɔn ho wɔn ho ntam, na wɔkwati atipɛnfo a wɔn nneyɛe a ɛyɛ ɔhaw no kyerɛ sɛ ebia wɔrentumi nni saa ahiade ahorow yi ho dwuma.[14] Ankorankoro su ne ne su nso yɛ nneɛma a mmabun hwehwɛ, bere a wɔrepaw nea wɔne no befi ase afa adamfo no.[15] Abusuabɔ fi ase kɔ so de wɔn adwene si gyinapɛn ahorow a wɔkyɛ, nokwaredi, ne nneɛma a wɔn nyinaa ani gye ho so, sen sɛ wɔde wɔn adwene besi honam fam nneɛma te sɛ bɛn a wɔbɛn wɔn ho ne sɛnea wobetumi adi agoru nneɛma a ɛkyerɛ mmofraberem kɛse.[4]: 246

Nhwehwɛmu bi a wɔyɛe wɔ Texas Sukuupɔn a ɛwɔ Austin mu no hwehwɛɛ Amerikafo mmabun bɛboro 9,000 mu de huu sɛnea wɔn ho a wɔde hyɛ nneyɛe a ɛhaw adwene (te sɛ korɔnbɔ, ntɔkwaw, ne sukuu a wonkɔ sukuu) mu no ne wɔn nnamfofa no wɔ abusuabɔ. Nneɛma a wohui kyerɛe sɛ mmabun ntaa mfa wɔn ho nhyɛ ɔhaw mu nneyɛe mu bere a wɔn nnamfonom yɛ ade yiye wɔ sukuu mu, wɔde wɔn ho hyɛ sukuu dwumadi ahorow mu, wɔkwati nsanom, na wɔwɔ adwenemyare pa no. Wohuu nea ɛne eyi bɔ abira wɔ mmabun a wɔde wɔn ho hyɛɛ nneyɛe a ɔhaw wom mu ampa no ho. Sɛ́ ebia mmabun nyaa wɔn nnamfo so nkɛntɛnso ma wɔde wɔn ho hyɛ ɔhaw suban mu no gyina sɛnea wɔde wɔn ho hyɛɛ saa nnamfo no mu, ne sɛ ebia wɔne wɔn adamfofa akuw ahorow no &quot;fata&quot; wɔ sukuu mu no so.[16]

Nhwehwɛmu bi a nhwehwɛmufo a wofi Purdue Sukuupɔn mu yɛe no kyerɛe sɛ nnamfo a wonyae wɔ ntoaso sukuu akyi adesua mu no kyɛ sen nnamfo a wonyae kan no.[17] Wɔ mmerantebere ne mmabaabere awiei mu no, mmusuakuw ntam adamfofa taa yɛ nea ɛntaa nsi, na ɛbɛyɛ sɛ efi adwemmɔne ne amammerɛ mu nsonsonoe.[15]

'''Mpanyimfoyɛ'''

.

Adamfofa a wonya wɔ mpanyin afe so no ma wonya ayɔnkofa, ɔdɔ, ne nkate mu mmoa, na ɛboa yiye ma adwene mu yiyedi ne nipadua akwahosan tu mpɔn.[18]: 426

Ebia ɛbɛyɛ den ama mpanyimfo titiriw sɛ wobenya nnamfo a mfaso wɔ so wɔ adwumam. &quot;Adwumam betumi ayɛ krak esiane akansi nti, enti nkurɔfo sua sɛ wɔde mmerɛwyɛ ne nneɛma a ɛyɛ nwonwa besie mfɛfo adwumayɛfo. Adwuma mu adamfofa taa nya nkitahodi ho nkate; ɛyɛ den sɛ wobɛka baabi a nkitahodi ba awiei na adamfofa ankasa fi ase.&quot;[19] Mpanyimfo dodow no ara bu sikasɛm sɛ ɛsom bo wɔn nnwuma ahobammɔ sen adamfofa a wɔne wɔn mfɛfo adwumayɛfo benya.[20]

Sɛ wɔkyekyem pɛpɛɛpɛ a, mpanyimfo dodow no ara wɔ nnamfo paa baanu.[21] Nhwehwɛmu pii a wɔyɛe wɔ mpanyimfo ho no kyerɛ sɛ adamfofa ne abusuabɔ afoforo a ɛboa ma obu a obi wɔ ma ne ho no yɛ kɛse ampa.[22]

Mpanyimfo a wɔn mfe akɔ anim

Mpanyimfo a wɔn mfe akɔ anim kɔ so bɔ amanneɛ sɛ wonya ankorankoro abotɔyam kɛse wɔ wɔn nnamfofa mu bere a wɔrenyin no, bere mpo a nnamfo dodow nyinaa taa so tew no. Saa abotɔyam yi ne tumi a ɛma wotumi yɛ da biara da asetra mu dwumadi ahorow a ɛkɔ soro, ne adwene mu tumi a ɛso tew, ayaresabea a wɔde obi kɔ no a ɛso tew, ne nea efi mu ba a eye a ɛfa ahosiesie ho no wɔ abusuabɔ.[18]: 427 Nnamfo dodow a wɔbɔɔ ho amanneɛ wɔ akyiri yi mu no nyinaa asetra betumi ayɛ ntamgyinafo denam pefeeyɛ a ɛkɔ soro, kasa ne anisoadehu a eye, ne aware mu tebea so.[23]: 53 Nnamfo dodow a ankorankoro bi nya bere a wɔrenyin no so tew no, wɔde Carstensen Socioemotional Selectivity Theory a ɛkyerɛkyerɛ nsakrae a ɛba wɔ mu no akyerɛkyerɛ mu nkannyan a mpanyimfo nya bere a wɔrebɔ fekuw no. Nsusuwii no ka sɛ mfe a obi adi a ɛkɔ soro no yɛ nsakrae a ɛba fi nsɛm a wɔboaboa ano so kɔ nkate mu nhyehyɛe so; sɛnea ɛbɛyɛ a wobetumi akura nkate pa mu no, mpanyimfo a wɔn mfe akɔ anim no de wɔn asetra mu akuw no to wɔn a wɔwɔ nkate mu abusuabɔ bi nkutoo so.[24]

''Sɛnea nhwehwɛmu bi kae no'':

Nhwehwɛmu a wɔayɛ wɔ mfe aduanan a atwam no mu no ahu bere nyinaa mprempren sɛ mpanyimfo a wɔn mfe akɔ anim a wɔbɔ amanneɛ sɛ wɔwɔ anigye ne yiyedi a ɛkɔ soro sen biara no nso bɔ amanneɛ sɛ wɔne nnamfo pii wɔ abusuabɔ a emu yɛ den na emu yɛ den.[25]

Bere a abusua mu asɛyɛde ne adwumayɛ ho nhyɛso so tew no, nnamfofa bɛyɛ nea ɛho hia kɛse. Wɔ nkwakoraa ne mmerewa mu no, adamfofa betumi ama wɔanya abusuabɔ a ɛda ɔmanfo kɛse no ntam, ayɛ ade a ɛbɔ wɔn ho ban fi adwenemhaw ne ankonamyɛ ho, na atua nneɛma a ebetumi ahwere wɔ asetra mu mmoa a abusua no mufo adi kan de ama no ho ka.[26]: 32–33 Titiriw ma nnipa a wontumi nkɔ out sɛnea ɛtaa ba no, nkitahodi a wɔne nnamfo di no ma kwan ma wɔkɔ so nya ɔmanfo nkitahodi. Bio nso, mpanyimfo a wɔn mfe akɔ anim a wɔn akwahosan rekɔ fam a wɔda so ara ne wɔn nnamfo di nkitaho no kyerɛ sɛ wɔn adwene mu yiyedi atu mpɔn.[27

== Nkɔso ho nsɛm ==

== Apomuden ==

== Nneɛma a wɔde gu mu ==

== Nnipa dodow ho nsɛm ==

== Nneɛma ahorow a ɛwɔ hɔ ntam ==</text>
      <sha1>foubdekvc3wq6r1256abhg6uptusi84</sha1>
    </revision>
    <revision>
      <id>132940</id>
      <parentid>132939</parentid>
      <timestamp>2022-07-31T12:43:34Z</timestamp>
      <contributor>
        <username>Afriyie34</username>
        <id>10662</id>
      </contributor>
      <comment>Mede atwerɛ kaa ho</comment>
      <model>wikitext</model>
      <format>text/x-wiki</format>
      <text bytes="12384" xml:space="preserve">Adamfofa yɛ abusuabɔ a ɛda ɔdɔ a ɛda nnipa ntam.[1] Ɛyɛ nnipa ntam abusuabɔ a emu yɛ den sen &quot;onimfoɔ&quot; anaa &quot;fekubɔ&quot;, te sɛ sukuuni, ofipamfo, yɔnko dwumayɛni, anaa yɔnko dwumayɛni.

Wɔ amammerɛ ahorow bi mu no, adamfofa ho adwene no yɛ abusuabɔ kakraa bi a emu dɔ yiye nkutoo; wɔ afoforo te sɛ U.S. ne Canada no, obi betumi anya nnamfo pii, na ebia ɔne onipa biako anaa baanu a wobetumi afrɛ wɔn nnamfo pa anaa nnamfo paa benya abusuabɔ a emu yɛ den kɛse. Nsɛmfua afoforo a wɔka wɔ kasa mu ne besties anaa Best Friends Forever (BFFs). Ɛwom sɛ adamfofa ahorow pii wɔ hɔ, a ebia ɛsono emu bi wɔ mmeae ahorow de, nanso su ahorow bi wɔ abusuabɔ a ɛtete saa pii mu. Nneɛma a ɛtete saa no bi ne sɛ wɔbɛpaw sɛ wɔne wɔn ho wɔn ho bɛtra, bere a wɔde bom tra mu anigye, na wobetumi de wɔn ho ahyɛ dwumadi pa a ɛboa wɔn ho wɔn ho mu.[2]

Ɛtɔ da bi a, wɔma nnamfo da nsow wɔ abusua ho, sɛnea ɛte wɔ asɛm a wɔka sɛ &quot;nnamfo ne abusua&quot; mu no, na ɛtɔ da bi nso a wɔda nsow wɔ adɔfo ho (e.g., &quot;adɔfo ne nnamfo&quot;), ɛwom sɛ wɔde nnamfo a wɔwɔ mfaso ahorow no yɛ nea ɛyɛ kusuu de. Adamfo beae no yɛ beae a wɔbara obi sɛ ɔnsɔre nkɔ ɔdɔfo gyinabea (hwɛ Ɔdɔ a wontua ho ka nso).

Wɔasua adamfofa ho ade wɔ nhomasua mu, te sɛ nkitahodi, asetra ho adesua, asetra mu adwene ho nimdeɛ, nnipa ho adesua, ne nyansapɛ mu. Wɔahyɛ adamfofa ho adesua mu nsusuwii ahorow ho nyansa, a nea ɛka ho ne asetra mu nsakrae ho nsusuwii, pɛyɛ ho nsusuwii, abusuabɔ mu nsɛm a wɔka, ne akwan horow a wɔfa so de wɔn ho bata ho. 

== Nkɔso ho adwene ho nimdeɛ ==
'''Mmɔfrabrɛ'''

Ntease a ɛfa adamfofa ho wɔ mmofra mu no taa twe adwene si mmeae te sɛ dwumadi ahorow a wɔtaa yɛ, honam fam a wɔbɛn wɔn ho, ne akwanhwɛ a wɔkyɛ so kɛse.[3]: 498 [a] Saa adamfofa ahorow yi ma wonya hokwan di agoru na wɔde wɔn ho hyɛ mu. 246 Mmofra dodow no ara taa kyerɛkyerɛ adamfofa mu denam nneɛma te sɛ kyɛfa so, na mmofra taa ne obi a wobu no sɛ ɔyɛ adamfo no kyɛ.[4]: 246 [5][6] Bere a mmofra nyin no, wɔnyɛ ankorankoro ho ade pii na no nim afoforo yiye. Wonya tumi a wɔde benya tema ma wɔn nnamfo, na wɔn ani gye ho sɛ wobedi agoru wɔ akuw mu. Wonya atipɛnfo a wɔpow wɔn nso bere a wɔrekɔ so wɔ mmofraberem mfe no mfinimfini no. Nnamfo pa a obenya wɔ ne mmofraase no boa ma abofra nya ne ho yiye wɔ ɔmanfo mu akyiri yi wɔ n’asetra mu.[5]

Sɛ wogyina akyerɛkyerɛfo ne ɛnanom amanneɛbɔ so a, anyɛ yiye koraa no, mmofra a wonnya nkɔɔ sukuu no mu 75% wɔ adamfo biako. Saa dodow yi kɔɔ soro koduu 78% kosii adesuakuw a ɛto so anum no mu, sɛnea wɔde co-nomination sɛ nnamfo susuw no, na 55% wɔ mutual adamfo paa.[4]: 247 Wohui sɛ mmofra bɛyɛ 15% nni adamfo a enni sabea, bɔɔ amanneɛ sɛ wɔmfa wɔn ho wɔn ho nkɔ nnamfo anyɛ yiye koraa no asram asia.[4]: 250

Mfaso a ebetumi aba wɔ adamfofa so no bi ne hokwan a wobenya de asua tema ne ɔhaw ahorow ano aduru ho ade.[7] Ntetee a awofo de ma no betumi ayɛ nea mfaso wɔ so wɔ mmofra a wɔbɛboa wɔn ma wɔanya nnamfo no mu. Eileen Kennedy-Moore ka nneɛma atitiriw abiɛsa a ɛma mmofra nya adamfofa ho asɛm: (1) wobue wɔn ani, (2) nsɛdi, ne (3) anigye a wɔkyɛ.[8][9][10] Awofoɔ nso bɛtumi aboa mmofra ama wɔate asetena mu akwankyerɛ a wɔn ankasa nsuaa no ase.[11] Kennedy-Moore retwe adwene asi nhwehwɛmu a Robert Selman[12] ne afoforo yɛe mu no, ɔkyerɛkyerɛ nkɔso fã ahorow wɔ mmofra adamfofa mu, a ɛda tumi a ɛrenya nkɔanim a ɛma wɔte afoforo adwene ase adi: &quot;Mepɛ Ɛyɛ Me Kwan&quot;, &quot;Dɛn na Ɛwɔ Mu Ma Me?&quot;, Ɛdenam Mmara no so&quot;, &quot;Adwene ne Kyɛfa&quot;, ne &quot;Nnamfo a Wɔnam Thick ne Thin So.&quot;[13]

'''Mmabunbere'''

Wɔ mmerantebere ne mmabaabere mu no, nnamfofa bɛyɛ “ade a ɛma ade kɛse, nea ɛkyɛ, nea ɛka no pen, ɛboa, na ɛba ara kwa.” Mmabun taa hwehwɛ atipɛnfo a wobetumi de su horow a ɛte saa ama wɔ abusuabɔ a ɛda wɔn ho wɔn ho ntam, na wɔkwati atipɛnfo a wɔn nneyɛe a ɛyɛ ɔhaw no kyerɛ sɛ ebia wɔrentumi nni saa ahiade ahorow yi ho dwuma.[14] Ankorankoro su ne ne su nso yɛ nneɛma a mmabun hwehwɛ, bere a wɔrepaw nea wɔne no befi ase afa adamfo no.[15] Abusuabɔ fi ase kɔ so de wɔn adwene si gyinapɛn ahorow a wɔkyɛ, nokwaredi, ne nneɛma a wɔn nyinaa ani gye ho so, sen sɛ wɔde wɔn adwene besi honam fam nneɛma te sɛ bɛn a wɔbɛn wɔn ho ne sɛnea wobetumi adi agoru nneɛma a ɛkyerɛ mmofraberem kɛse.[4]: 246

Nhwehwɛmu bi a wɔyɛe wɔ Texas Sukuupɔn a ɛwɔ Austin mu no hwehwɛɛ Amerikafo mmabun bɛboro 9,000 mu de huu sɛnea wɔn ho a wɔde hyɛ nneyɛe a ɛhaw adwene (te sɛ korɔnbɔ, ntɔkwaw, ne sukuu a wonkɔ sukuu) mu no ne wɔn nnamfofa no wɔ abusuabɔ. Nneɛma a wohui kyerɛe sɛ mmabun ntaa mfa wɔn ho nhyɛ ɔhaw mu nneyɛe mu bere a wɔn nnamfonom yɛ ade yiye wɔ sukuu mu, wɔde wɔn ho hyɛ sukuu dwumadi ahorow mu, wɔkwati nsanom, na wɔwɔ adwenemyare pa no. Wohuu nea ɛne eyi bɔ abira wɔ mmabun a wɔde wɔn ho hyɛɛ nneyɛe a ɔhaw wom mu ampa no ho. Sɛ́ ebia mmabun nyaa wɔn nnamfo so nkɛntɛnso ma wɔde wɔn ho hyɛ ɔhaw suban mu no gyina sɛnea wɔde wɔn ho hyɛɛ saa nnamfo no mu, ne sɛ ebia wɔne wɔn adamfofa akuw ahorow no &quot;fata&quot; wɔ sukuu mu no so.[16]

Nhwehwɛmu bi a nhwehwɛmufo a wofi Purdue Sukuupɔn mu yɛe no kyerɛe sɛ nnamfo a wonyae wɔ ntoaso sukuu akyi adesua mu no kyɛ sen nnamfo a wonyae kan no.[17] Wɔ mmerantebere ne mmabaabere awiei mu no, mmusuakuw ntam adamfofa taa yɛ nea ɛntaa nsi, na ɛbɛyɛ sɛ efi adwemmɔne ne amammerɛ mu nsonsonoe.[15]

'''Mpanyimfoyɛ'''

.

Adamfofa a wonya wɔ mpanyin afe so no ma wonya ayɔnkofa, ɔdɔ, ne nkate mu mmoa, na ɛboa yiye ma adwene mu yiyedi ne nipadua akwahosan tu mpɔn.[18]: 426

Ebia ɛbɛyɛ den ama mpanyimfo titiriw sɛ wobenya nnamfo a mfaso wɔ so wɔ adwumam. &quot;Adwumam betumi ayɛ krak esiane akansi nti, enti nkurɔfo sua sɛ wɔde mmerɛwyɛ ne nneɛma a ɛyɛ nwonwa besie mfɛfo adwumayɛfo. Adwuma mu adamfofa taa nya nkitahodi ho nkate; ɛyɛ den sɛ wobɛka baabi a nkitahodi ba awiei na adamfofa ankasa fi ase.&quot;[19] Mpanyimfo dodow no ara bu sikasɛm sɛ ɛsom bo wɔn nnwuma ahobammɔ sen adamfofa a wɔne wɔn mfɛfo adwumayɛfo benya.[20]

Sɛ wɔkyekyem pɛpɛɛpɛ a, mpanyimfo dodow no ara wɔ nnamfo paa baanu.[21] Nhwehwɛmu pii a wɔyɛe wɔ mpanyimfo ho no kyerɛ sɛ adamfofa ne abusuabɔ afoforo a ɛboa ma obu a obi wɔ ma ne ho no yɛ kɛse ampa.[22]

Mpanyimfo a wɔn mfe akɔ anim

Mpanyimfo a wɔn mfe akɔ anim kɔ so bɔ amanneɛ sɛ wonya ankorankoro abotɔyam kɛse wɔ wɔn nnamfofa mu bere a wɔrenyin no, bere mpo a nnamfo dodow nyinaa taa so tew no. Saa abotɔyam yi ne tumi a ɛma wotumi yɛ da biara da asetra mu dwumadi ahorow a ɛkɔ soro, ne adwene mu tumi a ɛso tew, ayaresabea a wɔde obi kɔ no a ɛso tew, ne nea efi mu ba a eye a ɛfa ahosiesie ho no wɔ abusuabɔ.[18]: 427 Nnamfo dodow a wɔbɔɔ ho amanneɛ wɔ akyiri yi mu no nyinaa asetra betumi ayɛ ntamgyinafo denam pefeeyɛ a ɛkɔ soro, kasa ne anisoadehu a eye, ne aware mu tebea so.[23]: 53 Nnamfo dodow a ankorankoro bi nya bere a wɔrenyin no so tew no, wɔde Carstensen Socioemotional Selectivity Theory a ɛkyerɛkyerɛ nsakrae a ɛba wɔ mu no akyerɛkyerɛ mu nkannyan a mpanyimfo nya bere a wɔrebɔ fekuw no. Nsusuwii no ka sɛ mfe a obi adi a ɛkɔ soro no yɛ nsakrae a ɛba fi nsɛm a wɔboaboa ano so kɔ nkate mu nhyehyɛe so; sɛnea ɛbɛyɛ a wobetumi akura nkate pa mu no, mpanyimfo a wɔn mfe akɔ anim no de wɔn asetra mu akuw no to wɔn a wɔwɔ nkate mu abusuabɔ bi nkutoo so.[24]

''Sɛnea nhwehwɛmu bi kae no'':

Nhwehwɛmu a wɔayɛ wɔ mfe aduanan a atwam no mu no ahu bere nyinaa mprempren sɛ mpanyimfo a wɔn mfe akɔ anim a wɔbɔ amanneɛ sɛ wɔwɔ anigye ne yiyedi a ɛkɔ soro sen biara no nso bɔ amanneɛ sɛ wɔne nnamfo pii wɔ abusuabɔ a emu yɛ den na emu yɛ den.[25]

Bere a abusua mu asɛyɛde ne adwumayɛ ho nhyɛso so tew no, nnamfofa bɛyɛ nea ɛho hia kɛse. Wɔ nkwakoraa ne mmerewa mu no, adamfofa betumi ama wɔanya abusuabɔ a ɛda ɔmanfo kɛse no ntam, ayɛ ade a ɛbɔ wɔn ho ban fi adwenemhaw ne ankonamyɛ ho, na atua nneɛma a ebetumi ahwere wɔ asetra mu mmoa a abusua no mufo adi kan de ama no ho ka.[26]: 32–33 Titiriw ma nnipa a wontumi nkɔ out sɛnea ɛtaa ba no, nkitahodi a wɔne nnamfo di no ma kwan ma wɔkɔ so nya ɔmanfo nkitahodi. Bio nso, mpanyimfo a wɔn mfe akɔ anim a wɔn akwahosan rekɔ fam a wɔda so ara ne wɔn nnamfo di nkitaho no kyerɛ sɛ wɔn adwene mu yiyedi atu mpɔn.[27

== Nkɔso ho nsɛm ==
'''Adwene a ɛmma obi ntumi nyɛ hwee a ɛma obi yɛ ade tra so'''

Ebia ɛbɛyɛ den ama mmofra a wɔwɔ adwene a wɔde si biribi so a ɛtra so (ADHD) no sɛ wɔbɛfa nnamfo na wɔakura mu, esiane sɛ wontumi mfa adesua a wɔde hwɛ ade so nkyekye asetra mu nimdeɛ pii nti, nsɛnnennen a ɛwɔ wɔn asetram nsɛnkyerɛnne a wɔde wɔn adwene si so, ne nkɛntɛnso a nneyɛe a wɔde wɔn ho hyɛ mu no nya wɔ asetra mu ne su kɛse a ɛne sɛ wɔbɛyɛ saa nti de wɔn ho hyɛ nneyɛe a ebia wɔn atipɛnfo behu sɛ ɛhaw adwene mu.[28][29] Wɔ afe 2007 nhwehwɛmu bi mu no, wɔanhunu ayaresa biara a ɛdi atipɛnfoɔ dwumadie ho dwuma yie wɔ mmofra a wɔwɔ ADHD mu, na wɔanhunu ayaresa a ɛdi ɔhaw no afã foforɔ ho dwuma no yi nsɛm a ɛfa atipɛnfoɔ dwumadie ho no firi hɔ.

'''Autism a ɛyɛ hu'''

Autism spectrum disorders ho sɛnkyerɛnne ahorow bi betumi asiw nnipa ntam abusuabɔ a ɛbɛba no kwan, te sɛ nneyɛe a wɔtaa yɛ a wɔpɛ, nsakrae a wɔko tia, nneɛma pɔtee bi a n’ani gye ho anaa amanne ahorow a wɔde wɔn ho hyɛ mu, ne asetra mu nimdeɛ a wonni. Wɔahu sɛ mmofra a wɔwɔ autism no taa yɛ onipa biako nnamfo paa, sen sɛ wobenya nnamfo akuw. Bio nso, wɔtaa yɛ mmofra afoforo a wɔadi dɛm bi nnamfo paa.[30] Awofo a wɔde wɔn ho abɔ wɔn ho ho adwene boa ma mmofra a wɔwɔ autism spectrum disorders no adamfofa yɛ papa; obi a ɔte nka sɛ ɔne n’awofo wɔ abusuabɔ no tua ayɔnkofa ho nimdeɛ a onni a mpɛn pii no ebesiw adamfofa kwan no so ka.[31]

Nhwehwɛmu bi a Frankel ne afoforo yɛe no. kyerɛe sɛ awofo de wɔn ho gye mu ne nkyerɛkyerɛ di dwuma titiriw wɔ mmofra a wɔte saa a wonya adamfofa mu.[32] Nea ɛka awofo a wɔde wɔn ho hyɛ mu ho no, sukuu mu adwumayɛfo di dwuma titiriw wɔ asetra mu nimdeɛ ne atipɛnfo nkitahodi a wɔkyerɛkyerɛ mu. Wɔtaa de paraprofessionals, titiriw no, obiakofo aboafo ne adesuadan mu aboafo, kɔ mmofra a wɔwɔ autism spectrum disorders nkyɛn sɛnea ɛbɛyɛ a wɔbɛma nnamfofa ayɛ mmerɛw na wɔakyerɛ abofra no kwan wɔ adamfofa a ɛho hia a ɔbɛfa na wakura mu.

Ɛwom sɛ asuade ne ntetee betumi aboa mmofra a wɔwɔ autism atipɛnfo de, nanso ayayade da so ara yɛ ade titiriw a ɛhaw adwene wɔ asetra mu tebea horow mu. Sɛnea Anahad O’Connor a ɔwɔ The New York Times mu kyerɛ no, ɛda adi kɛse sɛ ayayade bɛba mmofra a wɔwɔ autism spectrum disorders a wobetumi atra ase a wɔde wɔn ho no so kɛse. Mmofra a wɔte saa no wɔ asiane mu kɛse efisɛ wɔwɔ amanne ahorow no pii ne asetra mu nimdeɛ a wonni te sɛ mmofra a ɛda adi sɛ wɔwɔ autism no, nanso ɛda adi sɛ wɔde wɔn bɛhyɛ sukuu mu titiriw. Mmofra a wɔwɔ autism no wɔ ɔhaw kɛse sɛ wɔbɛhwɛ asetra mu nsɛnkyerɛnne so, na enti ebia ɛnyɛ bere nyinaa na wobehu bere a wɔresisi wɔn.[34]

'''Down yare no ho yare'''

Mmofra a wɔwɔ Down syndrome no ayɛ den kɛse sɛ wɔbɛfa nnamfo. Wohyia kasa a ɛkyɛ a ɛma ɛyɛ den ma wɔn sɛ wɔne mmofra afoforo bedi agoru. Ebia mmofra dodow no ara a wɔwɔ Down syndrome no bɛpɛ sɛ wɔhwɛ sukuufo afoforo na wɔne wɔn adamfo di agoru nanso wɔne wɔn nni agoru, titiriw esiane sɛ wɔte ase sen sɛnea wobetumi ada no adi wɔ akyi nti. Wɔ mfe a wonnya nkɔɔ sukuu mu no, mmofra a wɔwɔ Down syndrome no betumi anya adesuadan mu tebea no so mfaso, a mmofra afoforo atwa wɔn ho ahyia na wɔmfa wɔn ho nto mpanyimfo mmoa so kɛse. Mmofra a wɔadi dɛm yi nya mfaso fi nkitahodi ahorow a wɔne mpanyimfo ne mmofra nyinaa nya no mu. Wɔ sukuu mu no, hwɛ a wɔbɛhwɛ ma wɔanya tebea a obiara bɛka ho wɔ adesuadan mu no betumi ayɛ den, nanso nnamfo a wɔbɛn a wɔbɛn wɔn no betumi ayɛ ade titiriw ama asetra mu nkɔso.[35][36]

== Apomuden ==

== Nneɛma a wɔde gu mu ==

== Nnipa dodow ho nsɛm ==

== Nneɛma ahorow a ɛwɔ hɔ ntam ==</text>
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      <text bytes="15098" xml:space="preserve">Adamfofa yɛ abusuabɔ a ɛda ɔdɔ a ɛda nnipa ntam.[1] Ɛyɛ nnipa ntam abusuabɔ a emu yɛ den sen &quot;onimfoɔ&quot; anaa &quot;fekubɔ&quot;, te sɛ sukuuni, ofipamfo, yɔnko dwumayɛni, anaa yɔnko dwumayɛni.

Wɔ amammerɛ ahorow bi mu no, adamfofa ho adwene no yɛ abusuabɔ kakraa bi a emu dɔ yiye nkutoo; wɔ afoforo te sɛ U.S. ne Canada no, obi betumi anya nnamfo pii, na ebia ɔne onipa biako anaa baanu a wobetumi afrɛ wɔn nnamfo pa anaa nnamfo paa benya abusuabɔ a emu yɛ den kɛse. Nsɛmfua afoforo a wɔka wɔ kasa mu ne besties anaa Best Friends Forever (BFFs). Ɛwom sɛ adamfofa ahorow pii wɔ hɔ, a ebia ɛsono emu bi wɔ mmeae ahorow de, nanso su ahorow bi wɔ abusuabɔ a ɛtete saa pii mu. Nneɛma a ɛtete saa no bi ne sɛ wɔbɛpaw sɛ wɔne wɔn ho wɔn ho bɛtra, bere a wɔde bom tra mu anigye, na wobetumi de wɔn ho ahyɛ dwumadi pa a ɛboa wɔn ho wɔn ho mu.[2]

Ɛtɔ da bi a, wɔma nnamfo da nsow wɔ abusua ho, sɛnea ɛte wɔ asɛm a wɔka sɛ &quot;nnamfo ne abusua&quot; mu no, na ɛtɔ da bi nso a wɔda nsow wɔ adɔfo ho (e.g., &quot;adɔfo ne nnamfo&quot;), ɛwom sɛ wɔde nnamfo a wɔwɔ mfaso ahorow no yɛ nea ɛyɛ kusuu de. Adamfo beae no yɛ beae a wɔbara obi sɛ ɔnsɔre nkɔ ɔdɔfo gyinabea (hwɛ Ɔdɔ a wontua ho ka nso).

Wɔasua adamfofa ho ade wɔ nhomasua mu, te sɛ nkitahodi, asetra ho adesua, asetra mu adwene ho nimdeɛ, nnipa ho adesua, ne nyansapɛ mu. Wɔahyɛ adamfofa ho adesua mu nsusuwii ahorow ho nyansa, a nea ɛka ho ne asetra mu nsakrae ho nsusuwii, pɛyɛ ho nsusuwii, abusuabɔ mu nsɛm a wɔka, ne akwan horow a wɔfa so de wɔn ho bata ho. 

== Nkɔso ho adwene ho nimdeɛ ==
'''Mmɔfrabrɛ'''

Ntease a ɛfa adamfofa ho wɔ mmofra mu no taa twe adwene si mmeae te sɛ dwumadi ahorow a wɔtaa yɛ, honam fam a wɔbɛn wɔn ho, ne akwanhwɛ a wɔkyɛ so kɛse.[3]: 498 [a] Saa adamfofa ahorow yi ma wonya hokwan di agoru na wɔde wɔn ho hyɛ mu. 246 Mmofra dodow no ara taa kyerɛkyerɛ adamfofa mu denam nneɛma te sɛ kyɛfa so, na mmofra taa ne obi a wobu no sɛ ɔyɛ adamfo no kyɛ.[4]: 246 [5][6] Bere a mmofra nyin no, wɔnyɛ ankorankoro ho ade pii na no nim afoforo yiye. Wonya tumi a wɔde benya tema ma wɔn nnamfo, na wɔn ani gye ho sɛ wobedi agoru wɔ akuw mu. Wonya atipɛnfo a wɔpow wɔn nso bere a wɔrekɔ so wɔ mmofraberem mfe no mfinimfini no. Nnamfo pa a obenya wɔ ne mmofraase no boa ma abofra nya ne ho yiye wɔ ɔmanfo mu akyiri yi wɔ n’asetra mu.[5]

Sɛ wogyina akyerɛkyerɛfo ne ɛnanom amanneɛbɔ so a, anyɛ yiye koraa no, mmofra a wonnya nkɔɔ sukuu no mu 75% wɔ adamfo biako. Saa dodow yi kɔɔ soro koduu 78% kosii adesuakuw a ɛto so anum no mu, sɛnea wɔde co-nomination sɛ nnamfo susuw no, na 55% wɔ mutual adamfo paa.[4]: 247 Wohui sɛ mmofra bɛyɛ 15% nni adamfo a enni sabea, bɔɔ amanneɛ sɛ wɔmfa wɔn ho wɔn ho nkɔ nnamfo anyɛ yiye koraa no asram asia.[4]: 250

Mfaso a ebetumi aba wɔ adamfofa so no bi ne hokwan a wobenya de asua tema ne ɔhaw ahorow ano aduru ho ade.[7] Ntetee a awofo de ma no betumi ayɛ nea mfaso wɔ so wɔ mmofra a wɔbɛboa wɔn ma wɔanya nnamfo no mu. Eileen Kennedy-Moore ka nneɛma atitiriw abiɛsa a ɛma mmofra nya adamfofa ho asɛm: (1) wobue wɔn ani, (2) nsɛdi, ne (3) anigye a wɔkyɛ.[8][9][10] Awofoɔ nso bɛtumi aboa mmofra ama wɔate asetena mu akwankyerɛ a wɔn ankasa nsuaa no ase.[11] Kennedy-Moore retwe adwene asi nhwehwɛmu a Robert Selman[12] ne afoforo yɛe mu no, ɔkyerɛkyerɛ nkɔso fã ahorow wɔ mmofra adamfofa mu, a ɛda tumi a ɛrenya nkɔanim a ɛma wɔte afoforo adwene ase adi: &quot;Mepɛ Ɛyɛ Me Kwan&quot;, &quot;Dɛn na Ɛwɔ Mu Ma Me?&quot;, Ɛdenam Mmara no so&quot;, &quot;Adwene ne Kyɛfa&quot;, ne &quot;Nnamfo a Wɔnam Thick ne Thin So.&quot;[13]

'''Mmabunbere'''

Wɔ mmerantebere ne mmabaabere mu no, nnamfofa bɛyɛ “ade a ɛma ade kɛse, nea ɛkyɛ, nea ɛka no pen, ɛboa, na ɛba ara kwa.” Mmabun taa hwehwɛ atipɛnfo a wobetumi de su horow a ɛte saa ama wɔ abusuabɔ a ɛda wɔn ho wɔn ho ntam, na wɔkwati atipɛnfo a wɔn nneyɛe a ɛyɛ ɔhaw no kyerɛ sɛ ebia wɔrentumi nni saa ahiade ahorow yi ho dwuma.[14] Ankorankoro su ne ne su nso yɛ nneɛma a mmabun hwehwɛ, bere a wɔrepaw nea wɔne no befi ase afa adamfo no.[15] Abusuabɔ fi ase kɔ so de wɔn adwene si gyinapɛn ahorow a wɔkyɛ, nokwaredi, ne nneɛma a wɔn nyinaa ani gye ho so, sen sɛ wɔde wɔn adwene besi honam fam nneɛma te sɛ bɛn a wɔbɛn wɔn ho ne sɛnea wobetumi adi agoru nneɛma a ɛkyerɛ mmofraberem kɛse.[4]: 246

Nhwehwɛmu bi a wɔyɛe wɔ Texas Sukuupɔn a ɛwɔ Austin mu no hwehwɛɛ Amerikafo mmabun bɛboro 9,000 mu de huu sɛnea wɔn ho a wɔde hyɛ nneyɛe a ɛhaw adwene (te sɛ korɔnbɔ, ntɔkwaw, ne sukuu a wonkɔ sukuu) mu no ne wɔn nnamfofa no wɔ abusuabɔ. Nneɛma a wohui kyerɛe sɛ mmabun ntaa mfa wɔn ho nhyɛ ɔhaw mu nneyɛe mu bere a wɔn nnamfonom yɛ ade yiye wɔ sukuu mu, wɔde wɔn ho hyɛ sukuu dwumadi ahorow mu, wɔkwati nsanom, na wɔwɔ adwenemyare pa no. Wohuu nea ɛne eyi bɔ abira wɔ mmabun a wɔde wɔn ho hyɛɛ nneyɛe a ɔhaw wom mu ampa no ho. Sɛ́ ebia mmabun nyaa wɔn nnamfo so nkɛntɛnso ma wɔde wɔn ho hyɛ ɔhaw suban mu no gyina sɛnea wɔde wɔn ho hyɛɛ saa nnamfo no mu, ne sɛ ebia wɔne wɔn adamfofa akuw ahorow no &quot;fata&quot; wɔ sukuu mu no so.[16]

Nhwehwɛmu bi a nhwehwɛmufo a wofi Purdue Sukuupɔn mu yɛe no kyerɛe sɛ nnamfo a wonyae wɔ ntoaso sukuu akyi adesua mu no kyɛ sen nnamfo a wonyae kan no.[17] Wɔ mmerantebere ne mmabaabere awiei mu no, mmusuakuw ntam adamfofa taa yɛ nea ɛntaa nsi, na ɛbɛyɛ sɛ efi adwemmɔne ne amammerɛ mu nsonsonoe.[15]

'''Mpanyimfoyɛ'''

.

Adamfofa a wonya wɔ mpanyin afe so no ma wonya ayɔnkofa, ɔdɔ, ne nkate mu mmoa, na ɛboa yiye ma adwene mu yiyedi ne nipadua akwahosan tu mpɔn.[18]: 426

Ebia ɛbɛyɛ den ama mpanyimfo titiriw sɛ wobenya nnamfo a mfaso wɔ so wɔ adwumam. &quot;Adwumam betumi ayɛ krak esiane akansi nti, enti nkurɔfo sua sɛ wɔde mmerɛwyɛ ne nneɛma a ɛyɛ nwonwa besie mfɛfo adwumayɛfo. Adwuma mu adamfofa taa nya nkitahodi ho nkate; ɛyɛ den sɛ wobɛka baabi a nkitahodi ba awiei na adamfofa ankasa fi ase.&quot;[19] Mpanyimfo dodow no ara bu sikasɛm sɛ ɛsom bo wɔn nnwuma ahobammɔ sen adamfofa a wɔne wɔn mfɛfo adwumayɛfo benya.[20]

Sɛ wɔkyekyem pɛpɛɛpɛ a, mpanyimfo dodow no ara wɔ nnamfo paa baanu.[21] Nhwehwɛmu pii a wɔyɛe wɔ mpanyimfo ho no kyerɛ sɛ adamfofa ne abusuabɔ afoforo a ɛboa ma obu a obi wɔ ma ne ho no yɛ kɛse ampa.[22]

Mpanyimfo a wɔn mfe akɔ anim

Mpanyimfo a wɔn mfe akɔ anim kɔ so bɔ amanneɛ sɛ wonya ankorankoro abotɔyam kɛse wɔ wɔn nnamfofa mu bere a wɔrenyin no, bere mpo a nnamfo dodow nyinaa taa so tew no. Saa abotɔyam yi ne tumi a ɛma wotumi yɛ da biara da asetra mu dwumadi ahorow a ɛkɔ soro, ne adwene mu tumi a ɛso tew, ayaresabea a wɔde obi kɔ no a ɛso tew, ne nea efi mu ba a eye a ɛfa ahosiesie ho no wɔ abusuabɔ.[18]: 427 Nnamfo dodow a wɔbɔɔ ho amanneɛ wɔ akyiri yi mu no nyinaa asetra betumi ayɛ ntamgyinafo denam pefeeyɛ a ɛkɔ soro, kasa ne anisoadehu a eye, ne aware mu tebea so.[23]: 53 Nnamfo dodow a ankorankoro bi nya bere a wɔrenyin no so tew no, wɔde Carstensen Socioemotional Selectivity Theory a ɛkyerɛkyerɛ nsakrae a ɛba wɔ mu no akyerɛkyerɛ mu nkannyan a mpanyimfo nya bere a wɔrebɔ fekuw no. Nsusuwii no ka sɛ mfe a obi adi a ɛkɔ soro no yɛ nsakrae a ɛba fi nsɛm a wɔboaboa ano so kɔ nkate mu nhyehyɛe so; sɛnea ɛbɛyɛ a wobetumi akura nkate pa mu no, mpanyimfo a wɔn mfe akɔ anim no de wɔn asetra mu akuw no to wɔn a wɔwɔ nkate mu abusuabɔ bi nkutoo so.[24]

''Sɛnea nhwehwɛmu bi kae no'':

Nhwehwɛmu a wɔayɛ wɔ mfe aduanan a atwam no mu no ahu bere nyinaa mprempren sɛ mpanyimfo a wɔn mfe akɔ anim a wɔbɔ amanneɛ sɛ wɔwɔ anigye ne yiyedi a ɛkɔ soro sen biara no nso bɔ amanneɛ sɛ wɔne nnamfo pii wɔ abusuabɔ a emu yɛ den na emu yɛ den.[25]

Bere a abusua mu asɛyɛde ne adwumayɛ ho nhyɛso so tew no, nnamfofa bɛyɛ nea ɛho hia kɛse. Wɔ nkwakoraa ne mmerewa mu no, adamfofa betumi ama wɔanya abusuabɔ a ɛda ɔmanfo kɛse no ntam, ayɛ ade a ɛbɔ wɔn ho ban fi adwenemhaw ne ankonamyɛ ho, na atua nneɛma a ebetumi ahwere wɔ asetra mu mmoa a abusua no mufo adi kan de ama no ho ka.[26]: 32–33 Titiriw ma nnipa a wontumi nkɔ out sɛnea ɛtaa ba no, nkitahodi a wɔne nnamfo di no ma kwan ma wɔkɔ so nya ɔmanfo nkitahodi. Bio nso, mpanyimfo a wɔn mfe akɔ anim a wɔn akwahosan rekɔ fam a wɔda so ara ne wɔn nnamfo di nkitaho no kyerɛ sɛ wɔn adwene mu yiyedi atu mpɔn.[27

== Nkɔso ho nsɛm ==
'''Adwene a ɛmma obi ntumi nyɛ hwee a ɛma obi yɛ ade tra so'''

Ebia ɛbɛyɛ den ama mmofra a wɔwɔ adwene a wɔde si biribi so a ɛtra so (ADHD) no sɛ wɔbɛfa nnamfo na wɔakura mu, esiane sɛ wontumi mfa adesua a wɔde hwɛ ade so nkyekye asetra mu nimdeɛ pii nti, nsɛnnennen a ɛwɔ wɔn asetram nsɛnkyerɛnne a wɔde wɔn adwene si so, ne nkɛntɛnso a nneyɛe a wɔde wɔn ho hyɛ mu no nya wɔ asetra mu ne su kɛse a ɛne sɛ wɔbɛyɛ saa nti de wɔn ho hyɛ nneyɛe a ebia wɔn atipɛnfo behu sɛ ɛhaw adwene mu.[28][29] Wɔ afe 2007 nhwehwɛmu bi mu no, wɔanhunu ayaresa biara a ɛdi atipɛnfoɔ dwumadie ho dwuma yie wɔ mmofra a wɔwɔ ADHD mu, na wɔanhunu ayaresa a ɛdi ɔhaw no afã foforɔ ho dwuma no yi nsɛm a ɛfa atipɛnfoɔ dwumadie ho no firi hɔ.

'''Autism a ɛyɛ hu'''

Autism spectrum disorders ho sɛnkyerɛnne ahorow bi betumi asiw nnipa ntam abusuabɔ a ɛbɛba no kwan, te sɛ nneyɛe a wɔtaa yɛ a wɔpɛ, nsakrae a wɔko tia, nneɛma pɔtee bi a n’ani gye ho anaa amanne ahorow a wɔde wɔn ho hyɛ mu, ne asetra mu nimdeɛ a wonni. Wɔahu sɛ mmofra a wɔwɔ autism no taa yɛ onipa biako nnamfo paa, sen sɛ wobenya nnamfo akuw. Bio nso, wɔtaa yɛ mmofra afoforo a wɔadi dɛm bi nnamfo paa.[30] Awofo a wɔde wɔn ho abɔ wɔn ho ho adwene boa ma mmofra a wɔwɔ autism spectrum disorders no adamfofa yɛ papa; obi a ɔte nka sɛ ɔne n’awofo wɔ abusuabɔ no tua ayɔnkofa ho nimdeɛ a onni a mpɛn pii no ebesiw adamfofa kwan no so ka.[31]

Nhwehwɛmu bi a Frankel ne afoforo yɛe no. kyerɛe sɛ awofo de wɔn ho gye mu ne nkyerɛkyerɛ di dwuma titiriw wɔ mmofra a wɔte saa a wonya adamfofa mu.[32] Nea ɛka awofo a wɔde wɔn ho hyɛ mu ho no, sukuu mu adwumayɛfo di dwuma titiriw wɔ asetra mu nimdeɛ ne atipɛnfo nkitahodi a wɔkyerɛkyerɛ mu. Wɔtaa de paraprofessionals, titiriw no, obiakofo aboafo ne adesuadan mu aboafo, kɔ mmofra a wɔwɔ autism spectrum disorders nkyɛn sɛnea ɛbɛyɛ a wɔbɛma nnamfofa ayɛ mmerɛw na wɔakyerɛ abofra no kwan wɔ adamfofa a ɛho hia a ɔbɛfa na wakura mu.

Ɛwom sɛ asuade ne ntetee betumi aboa mmofra a wɔwɔ autism atipɛnfo de, nanso ayayade da so ara yɛ ade titiriw a ɛhaw adwene wɔ asetra mu tebea horow mu. Sɛnea Anahad O’Connor a ɔwɔ The New York Times mu kyerɛ no, ɛda adi kɛse sɛ ayayade bɛba mmofra a wɔwɔ autism spectrum disorders a wobetumi atra ase a wɔde wɔn ho no so kɛse. Mmofra a wɔte saa no wɔ asiane mu kɛse efisɛ wɔwɔ amanne ahorow no pii ne asetra mu nimdeɛ a wonni te sɛ mmofra a ɛda adi sɛ wɔwɔ autism no, nanso ɛda adi sɛ wɔde wɔn bɛhyɛ sukuu mu titiriw. Mmofra a wɔwɔ autism no wɔ ɔhaw kɛse sɛ wɔbɛhwɛ asetra mu nsɛnkyerɛnne so, na enti ebia ɛnyɛ bere nyinaa na wobehu bere a wɔresisi wɔn.[34]

'''Down yare no ho yare'''

Mmofra a wɔwɔ Down syndrome no ayɛ den kɛse sɛ wɔbɛfa nnamfo. Wohyia kasa a ɛkyɛ a ɛma ɛyɛ den ma wɔn sɛ wɔne mmofra afoforo bedi agoru. Ebia mmofra dodow no ara a wɔwɔ Down syndrome no bɛpɛ sɛ wɔhwɛ sukuufo afoforo na wɔne wɔn adamfo di agoru nanso wɔne wɔn nni agoru, titiriw esiane sɛ wɔte ase sen sɛnea wobetumi ada no adi wɔ akyi nti. Wɔ mfe a wonnya nkɔɔ sukuu mu no, mmofra a wɔwɔ Down syndrome no betumi anya adesuadan mu tebea no so mfaso, a mmofra afoforo atwa wɔn ho ahyia na wɔmfa wɔn ho nto mpanyimfo mmoa so kɛse. Mmofra a wɔadi dɛm yi nya mfaso fi nkitahodi ahorow a wɔne mpanyimfo ne mmofra nyinaa nya no mu. Wɔ sukuu mu no, hwɛ a wɔbɛhwɛ ma wɔanya tebea a obiara bɛka ho wɔ adesuadan mu no betumi ayɛ den, nanso nnamfo a wɔbɛn a wɔbɛn wɔn no betumi ayɛ ade titiriw ama asetra mu nkɔso.[35][36]

== Apomuden ==
Nhwehwɛmu ahorow ada no adi sɛ asetra mu mmoa a emu yɛ den ma obi nya akwahosan pa ne nkwa tenten ho anidaso tu mpɔn. Nea ɛne no bɔ abira no, wɔde ankonamyɛ ne asetra mu mmoa a wonnya no abata asiane a ɛkɔ soro a ɛne sɛ wobenya komayare, mmoawa a wɔde nyarewa ba, ne kokoram, ne nnipa dodow a wowuwu wɔ ne nyinaa mu no ho. Nhwehwɛmufoɔ mmienu mpo afrɛ adamfofa nkitahodiɛ sɛ &quot;suban ho aduru&quot; a ɛma nipadua ne adwene mu akwahosan nyinaa nya nkɔsoɔ.[37]

Nhwehwɛmu pii wɔ hɔ a ɛde adamfofa ne akwahosan bata ho, nanso nea enti pɔtee a ɛde abusuabɔ no ba no da so ara yɛ nea wontumi nhu. Nhwehwɛmu dodow no ara a ɛwɔ saa beae yi yɛ nhwehwɛmu akɛse a wɔhwɛ kwan a edi nnipa akyi bere tenten, na bere a ebia abusuabɔ bi wɔ nneɛma abien a ɛsakra (adamfofa ne akwahosan tebea) no ntam no, nhwehwɛmufo da so ara nnim sɛ ebia abusuabɔ bi wɔ hɔ a ɛde ba ne nea efi mu ba, te sɛ sɛ adwene a ɛne sɛ adamfofa pa ma akwahosan tu mpɔn ankasa. Nsusuwii ahorow bi abɔ mmɔden sɛ wɔbɛkyerɛkyerɛ saa abusuabɔ yi mu. Nea ɛka saa nsusuwii ahorow yi ho ne sɛ nnamfo pa hyɛ wɔn nnamfo nkuran ma wɔbɔ asetra a ahoɔden wom kɛse; sɛ nnamfo pa hyɛ wɔn nnamfo nkuran sɛ wɔnhwehwɛ mmoa na wonnya nnwuma bere a ɛho hia no; sɛ nnamfo pa ma wɔn nnamfonom tumi gyina yare ne akwahosan ho haw afoforo ho dwuma no yɛ kɛse; na sɛ nnamfo pa nya nipadua mu akwan a ɛbɔ akwahosan ho ban no so nkɛntɛnso ankasa.[38]

'''Adwene mu haw'''

Wɔahu sɛ adamfofa a wonni no di dwuma ma asiane a ɛkɔ soro sɛ mmea a wɔrebɛn mpanyin afe so benya adwene a ɛne sɛ wobekum wɔn ho no mu, a nea ɛka ho ne sɛ wobenya nnamfo pii a wɔn ankasa nyɛ wɔn ho wɔn ho nnamfo. Nanso, wɔanhu nkɛntɛnso a ɛte saa ara wɔ mmarima ho.[39][40] Nnamfo kakraa bi a wubenya anaasɛ wunni bi no yɛ ade titiriw a ɛkyerɛ sɛ obi anya adwenemyare ahorow pii.[14]

Adamfofa su a ɛkorɔn no boa tẽẽ ma wonya obu ma wɔn ho, wonya wɔn ho mu ahotoso, na wonya asetra mu nkɔso.[22] World Happiness Database nhwehwɛmu bi kyerɛe sɛ nnipa a wɔwɔ nnamfo paa no ani gye kɛse, ɛwom sɛ nnamfo dodow koraa no amma anigye no ankɔ soro de.[41] Nhwehwɛmu afoforo akyerɛ sɛ mmofra a wɔwɔ adamfofa a ɛkorɔn no betumi abɔ wɔn ho ban afi ɔhaw ahorow bi te sɛ dadwen ne adwenemhaw ho.[42][43] Nea ɛne no bɔ abira no, nnamfo kakraa bi a wubenya no ne sukuu a wogyae, ne basabasayɛ, ne mpanyimfo nsɛmmɔnedi nso wɔ abusuabɔ.[3]: 500 Atipɛnfo a wɔpow wɔn no nso ne akyi apɛde a ɛba fam wɔ adwumayɛfo mu, ne asetra mu dwumadi ahorow mu kyɛfa a wonya, bere a dodow a ɛkɔ soro no wɔ abusuabɔ na adamfofa ne mpanyimfo bu wɔn ho a ɛkorɔn wɔ abusuabɔ.[3]: 500–01

== Nneɛma a wɔde gu mu ==

== Nnipa dodow ho nsɛm ==

== Nneɛma ahorow a ɛwɔ hɔ ntam ==</text>
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      <text bytes="15600" xml:space="preserve">Adamfofa yɛ abusuabɔ a ɛda ɔdɔ a ɛda nnipa ntam.[1] Ɛyɛ nnipa ntam abusuabɔ a emu yɛ den sen &quot;onimfoɔ&quot; anaa &quot;fekubɔ&quot;, te sɛ sukuuni, ofipamfo, yɔnko dwumayɛni, anaa yɔnko dwumayɛni.

Wɔ amammerɛ ahorow bi mu no, adamfofa ho adwene no yɛ abusuabɔ kakraa bi a emu dɔ yiye nkutoo; wɔ afoforo te sɛ U.S. ne Canada no, obi betumi anya nnamfo pii, na ebia ɔne onipa biako anaa baanu a wobetumi afrɛ wɔn nnamfo pa anaa nnamfo paa benya abusuabɔ a emu yɛ den kɛse. Nsɛmfua afoforo a wɔka wɔ kasa mu ne besties anaa Best Friends Forever (BFFs). Ɛwom sɛ adamfofa ahorow pii wɔ hɔ, a ebia ɛsono emu bi wɔ mmeae ahorow de, nanso su ahorow bi wɔ abusuabɔ a ɛtete saa pii mu. Nneɛma a ɛtete saa no bi ne sɛ wɔbɛpaw sɛ wɔne wɔn ho wɔn ho bɛtra, bere a wɔde bom tra mu anigye, na wobetumi de wɔn ho ahyɛ dwumadi pa a ɛboa wɔn ho wɔn ho mu.[2]

Ɛtɔ da bi a, wɔma nnamfo da nsow wɔ abusua ho, sɛnea ɛte wɔ asɛm a wɔka sɛ &quot;nnamfo ne abusua&quot; mu no, na ɛtɔ da bi nso a wɔda nsow wɔ adɔfo ho (e.g., &quot;adɔfo ne nnamfo&quot;), ɛwom sɛ wɔde nnamfo a wɔwɔ mfaso ahorow no yɛ nea ɛyɛ kusuu de. Adamfo beae no yɛ beae a wɔbara obi sɛ ɔnsɔre nkɔ ɔdɔfo gyinabea (hwɛ Ɔdɔ a wontua ho ka nso).

Wɔasua adamfofa ho ade wɔ nhomasua mu, te sɛ nkitahodi, asetra ho adesua, asetra mu adwene ho nimdeɛ, nnipa ho adesua, ne nyansapɛ mu. Wɔahyɛ adamfofa ho adesua mu nsusuwii ahorow ho nyansa, a nea ɛka ho ne asetra mu nsakrae ho nsusuwii, pɛyɛ ho nsusuwii, abusuabɔ mu nsɛm a wɔka, ne akwan horow a wɔfa so de wɔn ho bata ho. 

== Nkɔso ho adwene ho nimdeɛ ==
'''Mmɔfrabrɛ'''

Ntease a ɛfa adamfofa ho wɔ mmofra mu no taa twe adwene si mmeae te sɛ dwumadi ahorow a wɔtaa yɛ, honam fam a wɔbɛn wɔn ho, ne akwanhwɛ a wɔkyɛ so kɛse.[3]: 498 [a] Saa adamfofa ahorow yi ma wonya hokwan di agoru na wɔde wɔn ho hyɛ mu. 246 Mmofra dodow no ara taa kyerɛkyerɛ adamfofa mu denam nneɛma te sɛ kyɛfa so, na mmofra taa ne obi a wobu no sɛ ɔyɛ adamfo no kyɛ.[4]: 246 [5][6] Bere a mmofra nyin no, wɔnyɛ ankorankoro ho ade pii na no nim afoforo yiye. Wonya tumi a wɔde benya tema ma wɔn nnamfo, na wɔn ani gye ho sɛ wobedi agoru wɔ akuw mu. Wonya atipɛnfo a wɔpow wɔn nso bere a wɔrekɔ so wɔ mmofraberem mfe no mfinimfini no. Nnamfo pa a obenya wɔ ne mmofraase no boa ma abofra nya ne ho yiye wɔ ɔmanfo mu akyiri yi wɔ n’asetra mu.[5]

Sɛ wogyina akyerɛkyerɛfo ne ɛnanom amanneɛbɔ so a, anyɛ yiye koraa no, mmofra a wonnya nkɔɔ sukuu no mu 75% wɔ adamfo biako. Saa dodow yi kɔɔ soro koduu 78% kosii adesuakuw a ɛto so anum no mu, sɛnea wɔde co-nomination sɛ nnamfo susuw no, na 55% wɔ mutual adamfo paa.[4]: 247 Wohui sɛ mmofra bɛyɛ 15% nni adamfo a enni sabea, bɔɔ amanneɛ sɛ wɔmfa wɔn ho wɔn ho nkɔ nnamfo anyɛ yiye koraa no asram asia.[4]: 250

Mfaso a ebetumi aba wɔ adamfofa so no bi ne hokwan a wobenya de asua tema ne ɔhaw ahorow ano aduru ho ade.[7] Ntetee a awofo de ma no betumi ayɛ nea mfaso wɔ so wɔ mmofra a wɔbɛboa wɔn ma wɔanya nnamfo no mu. Eileen Kennedy-Moore ka nneɛma atitiriw abiɛsa a ɛma mmofra nya adamfofa ho asɛm: (1) wobue wɔn ani, (2) nsɛdi, ne (3) anigye a wɔkyɛ.[8][9][10] Awofoɔ nso bɛtumi aboa mmofra ama wɔate asetena mu akwankyerɛ a wɔn ankasa nsuaa no ase.[11] Kennedy-Moore retwe adwene asi nhwehwɛmu a Robert Selman[12] ne afoforo yɛe mu no, ɔkyerɛkyerɛ nkɔso fã ahorow wɔ mmofra adamfofa mu, a ɛda tumi a ɛrenya nkɔanim a ɛma wɔte afoforo adwene ase adi: &quot;Mepɛ Ɛyɛ Me Kwan&quot;, &quot;Dɛn na Ɛwɔ Mu Ma Me?&quot;, Ɛdenam Mmara no so&quot;, &quot;Adwene ne Kyɛfa&quot;, ne &quot;Nnamfo a Wɔnam Thick ne Thin So.&quot;[13]

'''Mmabunbere'''

Wɔ mmerantebere ne mmabaabere mu no, nnamfofa bɛyɛ “ade a ɛma ade kɛse, nea ɛkyɛ, nea ɛka no pen, ɛboa, na ɛba ara kwa.” Mmabun taa hwehwɛ atipɛnfo a wobetumi de su horow a ɛte saa ama wɔ abusuabɔ a ɛda wɔn ho wɔn ho ntam, na wɔkwati atipɛnfo a wɔn nneyɛe a ɛyɛ ɔhaw no kyerɛ sɛ ebia wɔrentumi nni saa ahiade ahorow yi ho dwuma.[14] Ankorankoro su ne ne su nso yɛ nneɛma a mmabun hwehwɛ, bere a wɔrepaw nea wɔne no befi ase afa adamfo no.[15] Abusuabɔ fi ase kɔ so de wɔn adwene si gyinapɛn ahorow a wɔkyɛ, nokwaredi, ne nneɛma a wɔn nyinaa ani gye ho so, sen sɛ wɔde wɔn adwene besi honam fam nneɛma te sɛ bɛn a wɔbɛn wɔn ho ne sɛnea wobetumi adi agoru nneɛma a ɛkyerɛ mmofraberem kɛse.[4]: 246

Nhwehwɛmu bi a wɔyɛe wɔ Texas Sukuupɔn a ɛwɔ Austin mu no hwehwɛɛ Amerikafo mmabun bɛboro 9,000 mu de huu sɛnea wɔn ho a wɔde hyɛ nneyɛe a ɛhaw adwene (te sɛ korɔnbɔ, ntɔkwaw, ne sukuu a wonkɔ sukuu) mu no ne wɔn nnamfofa no wɔ abusuabɔ. Nneɛma a wohui kyerɛe sɛ mmabun ntaa mfa wɔn ho nhyɛ ɔhaw mu nneyɛe mu bere a wɔn nnamfonom yɛ ade yiye wɔ sukuu mu, wɔde wɔn ho hyɛ sukuu dwumadi ahorow mu, wɔkwati nsanom, na wɔwɔ adwenemyare pa no. Wohuu nea ɛne eyi bɔ abira wɔ mmabun a wɔde wɔn ho hyɛɛ nneyɛe a ɔhaw wom mu ampa no ho. Sɛ́ ebia mmabun nyaa wɔn nnamfo so nkɛntɛnso ma wɔde wɔn ho hyɛ ɔhaw suban mu no gyina sɛnea wɔde wɔn ho hyɛɛ saa nnamfo no mu, ne sɛ ebia wɔne wɔn adamfofa akuw ahorow no &quot;fata&quot; wɔ sukuu mu no so.[16]

Nhwehwɛmu bi a nhwehwɛmufo a wofi Purdue Sukuupɔn mu yɛe no kyerɛe sɛ nnamfo a wonyae wɔ ntoaso sukuu akyi adesua mu no kyɛ sen nnamfo a wonyae kan no.[17] Wɔ mmerantebere ne mmabaabere awiei mu no, mmusuakuw ntam adamfofa taa yɛ nea ɛntaa nsi, na ɛbɛyɛ sɛ efi adwemmɔne ne amammerɛ mu nsonsonoe.[15]

'''Mpanyimfoyɛ'''

.

Adamfofa a wonya wɔ mpanyin afe so no ma wonya ayɔnkofa, ɔdɔ, ne nkate mu mmoa, na ɛboa yiye ma adwene mu yiyedi ne nipadua akwahosan tu mpɔn.[18]: 426

Ebia ɛbɛyɛ den ama mpanyimfo titiriw sɛ wobenya nnamfo a mfaso wɔ so wɔ adwumam. &quot;Adwumam betumi ayɛ krak esiane akansi nti, enti nkurɔfo sua sɛ wɔde mmerɛwyɛ ne nneɛma a ɛyɛ nwonwa besie mfɛfo adwumayɛfo. Adwuma mu adamfofa taa nya nkitahodi ho nkate; ɛyɛ den sɛ wobɛka baabi a nkitahodi ba awiei na adamfofa ankasa fi ase.&quot;[19] Mpanyimfo dodow no ara bu sikasɛm sɛ ɛsom bo wɔn nnwuma ahobammɔ sen adamfofa a wɔne wɔn mfɛfo adwumayɛfo benya.[20]

Sɛ wɔkyekyem pɛpɛɛpɛ a, mpanyimfo dodow no ara wɔ nnamfo paa baanu.[21] Nhwehwɛmu pii a wɔyɛe wɔ mpanyimfo ho no kyerɛ sɛ adamfofa ne abusuabɔ afoforo a ɛboa ma obu a obi wɔ ma ne ho no yɛ kɛse ampa.[22]

Mpanyimfo a wɔn mfe akɔ anim

Mpanyimfo a wɔn mfe akɔ anim kɔ so bɔ amanneɛ sɛ wonya ankorankoro abotɔyam kɛse wɔ wɔn nnamfofa mu bere a wɔrenyin no, bere mpo a nnamfo dodow nyinaa taa so tew no. Saa abotɔyam yi ne tumi a ɛma wotumi yɛ da biara da asetra mu dwumadi ahorow a ɛkɔ soro, ne adwene mu tumi a ɛso tew, ayaresabea a wɔde obi kɔ no a ɛso tew, ne nea efi mu ba a eye a ɛfa ahosiesie ho no wɔ abusuabɔ.[18]: 427 Nnamfo dodow a wɔbɔɔ ho amanneɛ wɔ akyiri yi mu no nyinaa asetra betumi ayɛ ntamgyinafo denam pefeeyɛ a ɛkɔ soro, kasa ne anisoadehu a eye, ne aware mu tebea so.[23]: 53 Nnamfo dodow a ankorankoro bi nya bere a wɔrenyin no so tew no, wɔde Carstensen Socioemotional Selectivity Theory a ɛkyerɛkyerɛ nsakrae a ɛba wɔ mu no akyerɛkyerɛ mu nkannyan a mpanyimfo nya bere a wɔrebɔ fekuw no. Nsusuwii no ka sɛ mfe a obi adi a ɛkɔ soro no yɛ nsakrae a ɛba fi nsɛm a wɔboaboa ano so kɔ nkate mu nhyehyɛe so; sɛnea ɛbɛyɛ a wobetumi akura nkate pa mu no, mpanyimfo a wɔn mfe akɔ anim no de wɔn asetra mu akuw no to wɔn a wɔwɔ nkate mu abusuabɔ bi nkutoo so.[24]

''Sɛnea nhwehwɛmu bi kae no'':

Nhwehwɛmu a wɔayɛ wɔ mfe aduanan a atwam no mu no ahu bere nyinaa mprempren sɛ mpanyimfo a wɔn mfe akɔ anim a wɔbɔ amanneɛ sɛ wɔwɔ anigye ne yiyedi a ɛkɔ soro sen biara no nso bɔ amanneɛ sɛ wɔne nnamfo pii wɔ abusuabɔ a emu yɛ den na emu yɛ den.[25]

Bere a abusua mu asɛyɛde ne adwumayɛ ho nhyɛso so tew no, nnamfofa bɛyɛ nea ɛho hia kɛse. Wɔ nkwakoraa ne mmerewa mu no, adamfofa betumi ama wɔanya abusuabɔ a ɛda ɔmanfo kɛse no ntam, ayɛ ade a ɛbɔ wɔn ho ban fi adwenemhaw ne ankonamyɛ ho, na atua nneɛma a ebetumi ahwere wɔ asetra mu mmoa a abusua no mufo adi kan de ama no ho ka.[26]: 32–33 Titiriw ma nnipa a wontumi nkɔ out sɛnea ɛtaa ba no, nkitahodi a wɔne nnamfo di no ma kwan ma wɔkɔ so nya ɔmanfo nkitahodi. Bio nso, mpanyimfo a wɔn mfe akɔ anim a wɔn akwahosan rekɔ fam a wɔda so ara ne wɔn nnamfo di nkitaho no kyerɛ sɛ wɔn adwene mu yiyedi atu mpɔn.[27

== Nkɔso ho nsɛm ==
'''Adwene a ɛmma obi ntumi nyɛ hwee a ɛma obi yɛ ade tra so'''

Ebia ɛbɛyɛ den ama mmofra a wɔwɔ adwene a wɔde si biribi so a ɛtra so (ADHD) no sɛ wɔbɛfa nnamfo na wɔakura mu, esiane sɛ wontumi mfa adesua a wɔde hwɛ ade so nkyekye asetra mu nimdeɛ pii nti, nsɛnnennen a ɛwɔ wɔn asetram nsɛnkyerɛnne a wɔde wɔn adwene si so, ne nkɛntɛnso a nneyɛe a wɔde wɔn ho hyɛ mu no nya wɔ asetra mu ne su kɛse a ɛne sɛ wɔbɛyɛ saa nti de wɔn ho hyɛ nneyɛe a ebia wɔn atipɛnfo behu sɛ ɛhaw adwene mu.[28][29] Wɔ afe 2007 nhwehwɛmu bi mu no, wɔanhunu ayaresa biara a ɛdi atipɛnfoɔ dwumadie ho dwuma yie wɔ mmofra a wɔwɔ ADHD mu, na wɔanhunu ayaresa a ɛdi ɔhaw no afã foforɔ ho dwuma no yi nsɛm a ɛfa atipɛnfoɔ dwumadie ho no firi hɔ.

'''Autism a ɛyɛ hu'''

Autism spectrum disorders ho sɛnkyerɛnne ahorow bi betumi asiw nnipa ntam abusuabɔ a ɛbɛba no kwan, te sɛ nneyɛe a wɔtaa yɛ a wɔpɛ, nsakrae a wɔko tia, nneɛma pɔtee bi a n’ani gye ho anaa amanne ahorow a wɔde wɔn ho hyɛ mu, ne asetra mu nimdeɛ a wonni. Wɔahu sɛ mmofra a wɔwɔ autism no taa yɛ onipa biako nnamfo paa, sen sɛ wobenya nnamfo akuw. Bio nso, wɔtaa yɛ mmofra afoforo a wɔadi dɛm bi nnamfo paa.[30] Awofo a wɔde wɔn ho abɔ wɔn ho ho adwene boa ma mmofra a wɔwɔ autism spectrum disorders no adamfofa yɛ papa; obi a ɔte nka sɛ ɔne n’awofo wɔ abusuabɔ no tua ayɔnkofa ho nimdeɛ a onni a mpɛn pii no ebesiw adamfofa kwan no so ka.[31]

Nhwehwɛmu bi a Frankel ne afoforo yɛe no. kyerɛe sɛ awofo de wɔn ho gye mu ne nkyerɛkyerɛ di dwuma titiriw wɔ mmofra a wɔte saa a wonya adamfofa mu.[32] Nea ɛka awofo a wɔde wɔn ho hyɛ mu ho no, sukuu mu adwumayɛfo di dwuma titiriw wɔ asetra mu nimdeɛ ne atipɛnfo nkitahodi a wɔkyerɛkyerɛ mu. Wɔtaa de paraprofessionals, titiriw no, obiakofo aboafo ne adesuadan mu aboafo, kɔ mmofra a wɔwɔ autism spectrum disorders nkyɛn sɛnea ɛbɛyɛ a wɔbɛma nnamfofa ayɛ mmerɛw na wɔakyerɛ abofra no kwan wɔ adamfofa a ɛho hia a ɔbɛfa na wakura mu.

Ɛwom sɛ asuade ne ntetee betumi aboa mmofra a wɔwɔ autism atipɛnfo de, nanso ayayade da so ara yɛ ade titiriw a ɛhaw adwene wɔ asetra mu tebea horow mu. Sɛnea Anahad O’Connor a ɔwɔ The New York Times mu kyerɛ no, ɛda adi kɛse sɛ ayayade bɛba mmofra a wɔwɔ autism spectrum disorders a wobetumi atra ase a wɔde wɔn ho no so kɛse. Mmofra a wɔte saa no wɔ asiane mu kɛse efisɛ wɔwɔ amanne ahorow no pii ne asetra mu nimdeɛ a wonni te sɛ mmofra a ɛda adi sɛ wɔwɔ autism no, nanso ɛda adi sɛ wɔde wɔn bɛhyɛ sukuu mu titiriw. Mmofra a wɔwɔ autism no wɔ ɔhaw kɛse sɛ wɔbɛhwɛ asetra mu nsɛnkyerɛnne so, na enti ebia ɛnyɛ bere nyinaa na wobehu bere a wɔresisi wɔn.[34]

'''Down yare no ho yare'''

Mmofra a wɔwɔ Down syndrome no ayɛ den kɛse sɛ wɔbɛfa nnamfo. Wohyia kasa a ɛkyɛ a ɛma ɛyɛ den ma wɔn sɛ wɔne mmofra afoforo bedi agoru. Ebia mmofra dodow no ara a wɔwɔ Down syndrome no bɛpɛ sɛ wɔhwɛ sukuufo afoforo na wɔne wɔn adamfo di agoru nanso wɔne wɔn nni agoru, titiriw esiane sɛ wɔte ase sen sɛnea wobetumi ada no adi wɔ akyi nti. Wɔ mfe a wonnya nkɔɔ sukuu mu no, mmofra a wɔwɔ Down syndrome no betumi anya adesuadan mu tebea no so mfaso, a mmofra afoforo atwa wɔn ho ahyia na wɔmfa wɔn ho nto mpanyimfo mmoa so kɛse. Mmofra a wɔadi dɛm yi nya mfaso fi nkitahodi ahorow a wɔne mpanyimfo ne mmofra nyinaa nya no mu. Wɔ sukuu mu no, hwɛ a wɔbɛhwɛ ma wɔanya tebea a obiara bɛka ho wɔ adesuadan mu no betumi ayɛ den, nanso nnamfo a wɔbɛn a wɔbɛn wɔn no betumi ayɛ ade titiriw ama asetra mu nkɔso.[35][36]

== Apomuden ==
Nhwehwɛmu ahorow ada no adi sɛ asetra mu mmoa a emu yɛ den ma obi nya akwahosan pa ne nkwa tenten ho anidaso tu mpɔn. Nea ɛne no bɔ abira no, wɔde ankonamyɛ ne asetra mu mmoa a wonnya no abata asiane a ɛkɔ soro a ɛne sɛ wobenya komayare, mmoawa a wɔde nyarewa ba, ne kokoram, ne nnipa dodow a wowuwu wɔ ne nyinaa mu no ho. Nhwehwɛmufoɔ mmienu mpo afrɛ adamfofa nkitahodiɛ sɛ &quot;suban ho aduru&quot; a ɛma nipadua ne adwene mu akwahosan nyinaa nya nkɔsoɔ.[37]

Nhwehwɛmu pii wɔ hɔ a ɛde adamfofa ne akwahosan bata ho, nanso nea enti pɔtee a ɛde abusuabɔ no ba no da so ara yɛ nea wontumi nhu. Nhwehwɛmu dodow no ara a ɛwɔ saa beae yi yɛ nhwehwɛmu akɛse a wɔhwɛ kwan a edi nnipa akyi bere tenten, na bere a ebia abusuabɔ bi wɔ nneɛma abien a ɛsakra (adamfofa ne akwahosan tebea) no ntam no, nhwehwɛmufo da so ara nnim sɛ ebia abusuabɔ bi wɔ hɔ a ɛde ba ne nea efi mu ba, te sɛ sɛ adwene a ɛne sɛ adamfofa pa ma akwahosan tu mpɔn ankasa. Nsusuwii ahorow bi abɔ mmɔden sɛ wɔbɛkyerɛkyerɛ saa abusuabɔ yi mu. Nea ɛka saa nsusuwii ahorow yi ho ne sɛ nnamfo pa hyɛ wɔn nnamfo nkuran ma wɔbɔ asetra a ahoɔden wom kɛse; sɛ nnamfo pa hyɛ wɔn nnamfo nkuran sɛ wɔnhwehwɛ mmoa na wonnya nnwuma bere a ɛho hia no; sɛ nnamfo pa ma wɔn nnamfonom tumi gyina yare ne akwahosan ho haw afoforo ho dwuma no yɛ kɛse; na sɛ nnamfo pa nya nipadua mu akwan a ɛbɔ akwahosan ho ban no so nkɛntɛnso ankasa.[38]

'''Adwene mu haw'''

Wɔahu sɛ adamfofa a wonni no di dwuma ma asiane a ɛkɔ soro sɛ mmea a wɔrebɛn mpanyin afe so benya adwene a ɛne sɛ wobekum wɔn ho no mu, a nea ɛka ho ne sɛ wobenya nnamfo pii a wɔn ankasa nyɛ wɔn ho wɔn ho nnamfo. Nanso, wɔanhu nkɛntɛnso a ɛte saa ara wɔ mmarima ho.[39][40] Nnamfo kakraa bi a wubenya anaasɛ wunni bi no yɛ ade titiriw a ɛkyerɛ sɛ obi anya adwenemyare ahorow pii.[14]

Adamfofa su a ɛkorɔn no boa tẽẽ ma wonya obu ma wɔn ho, wonya wɔn ho mu ahotoso, na wonya asetra mu nkɔso.[22] World Happiness Database nhwehwɛmu bi kyerɛe sɛ nnipa a wɔwɔ nnamfo paa no ani gye kɛse, ɛwom sɛ nnamfo dodow koraa no amma anigye no ankɔ soro de.[41] Nhwehwɛmu afoforo akyerɛ sɛ mmofra a wɔwɔ adamfofa a ɛkorɔn no betumi abɔ wɔn ho ban afi ɔhaw ahorow bi te sɛ dadwen ne adwenemhaw ho.[42][43] Nea ɛne no bɔ abira no, nnamfo kakraa bi a wubenya no ne sukuu a wogyae, ne basabasayɛ, ne mpanyimfo nsɛmmɔnedi nso wɔ abusuabɔ.[3]: 500 Atipɛnfo a wɔpow wɔn no nso ne akyi apɛde a ɛba fam wɔ adwumayɛfo mu, ne asetra mu dwumadi ahorow mu kyɛfa a wonya, bere a dodow a ɛkɔ soro no wɔ abusuabɔ na adamfofa ne mpanyimfo bu wɔn ho a ɛkorɔn wɔ abusuabɔ.[3]: 500–01

== Nneɛma a wɔde gu mu ==
Wobetumi abu adamfofa bi a wobegu no sɛ ankorankoro pow, anaasɛ ebetumi afi abɔde mu nsakrae a ɛba bere a bere kɔ so no mu aba, bere a nnamfo kɔ akyirikyiri kɛse wɔ honam ne nkate fam no. Wɔde adamfofa a wɔsɛe no no ne afobu, abufuw ne adwenemhaw a ɛkɔ soro no wɔ abusuabɔ, na ebetumi ayɛ nsɛm a ɛhaw adwene kɛse, titiriw wɔ mmofraase. Nanso, wobetumi abrɛ nsunsuanso bɔne a ebetumi aba no ase sɛ wɔde abusuabɔ foforo a emu yɛ den si adamfofa bi a wobegu no ananmu a.[4]: 248

== Nnipa dodow ho nsɛm ==

== Nneɛma ahorow a ɛwɔ hɔ ntam ==</text>
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      <text bytes="19007" xml:space="preserve">Adamfofa yɛ abusuabɔ a ɛda ɔdɔ a ɛda nnipa ntam.[1] Ɛyɛ nnipa ntam abusuabɔ a emu yɛ den sen &quot;onimfoɔ&quot; anaa &quot;fekubɔ&quot;, te sɛ sukuuni, ofipamfo, yɔnko dwumayɛni, anaa yɔnko dwumayɛni.

Wɔ amammerɛ ahorow bi mu no, adamfofa ho adwene no yɛ abusuabɔ kakraa bi a emu dɔ yiye nkutoo; wɔ afoforo te sɛ U.S. ne Canada no, obi betumi anya nnamfo pii, na ebia ɔne onipa biako anaa baanu a wobetumi afrɛ wɔn nnamfo pa anaa nnamfo paa benya abusuabɔ a emu yɛ den kɛse. Nsɛmfua afoforo a wɔka wɔ kasa mu ne besties anaa Best Friends Forever (BFFs). Ɛwom sɛ adamfofa ahorow pii wɔ hɔ, a ebia ɛsono emu bi wɔ mmeae ahorow de, nanso su ahorow bi wɔ abusuabɔ a ɛtete saa pii mu. Nneɛma a ɛtete saa no bi ne sɛ wɔbɛpaw sɛ wɔne wɔn ho wɔn ho bɛtra, bere a wɔde bom tra mu anigye, na wobetumi de wɔn ho ahyɛ dwumadi pa a ɛboa wɔn ho wɔn ho mu.[2]

Ɛtɔ da bi a, wɔma nnamfo da nsow wɔ abusua ho, sɛnea ɛte wɔ asɛm a wɔka sɛ &quot;nnamfo ne abusua&quot; mu no, na ɛtɔ da bi nso a wɔda nsow wɔ adɔfo ho (e.g., &quot;adɔfo ne nnamfo&quot;), ɛwom sɛ wɔde nnamfo a wɔwɔ mfaso ahorow no yɛ nea ɛyɛ kusuu de. Adamfo beae no yɛ beae a wɔbara obi sɛ ɔnsɔre nkɔ ɔdɔfo gyinabea (hwɛ Ɔdɔ a wontua ho ka nso).

Wɔasua adamfofa ho ade wɔ nhomasua mu, te sɛ nkitahodi, asetra ho adesua, asetra mu adwene ho nimdeɛ, nnipa ho adesua, ne nyansapɛ mu. Wɔahyɛ adamfofa ho adesua mu nsusuwii ahorow ho nyansa, a nea ɛka ho ne asetra mu nsakrae ho nsusuwii, pɛyɛ ho nsusuwii, abusuabɔ mu nsɛm a wɔka, ne akwan horow a wɔfa so de wɔn ho bata ho. 

== Nkɔso ho adwene ho nimdeɛ ==
'''Mmɔfrabrɛ'''

Ntease a ɛfa adamfofa ho wɔ mmofra mu no taa twe adwene si mmeae te sɛ dwumadi ahorow a wɔtaa yɛ, honam fam a wɔbɛn wɔn ho, ne akwanhwɛ a wɔkyɛ so kɛse.[3]: 498 [a] Saa adamfofa ahorow yi ma wonya hokwan di agoru na wɔde wɔn ho hyɛ mu. 246 Mmofra dodow no ara taa kyerɛkyerɛ adamfofa mu denam nneɛma te sɛ kyɛfa so, na mmofra taa ne obi a wobu no sɛ ɔyɛ adamfo no kyɛ.[4]: 246 [5][6] Bere a mmofra nyin no, wɔnyɛ ankorankoro ho ade pii na no nim afoforo yiye. Wonya tumi a wɔde benya tema ma wɔn nnamfo, na wɔn ani gye ho sɛ wobedi agoru wɔ akuw mu. Wonya atipɛnfo a wɔpow wɔn nso bere a wɔrekɔ so wɔ mmofraberem mfe no mfinimfini no. Nnamfo pa a obenya wɔ ne mmofraase no boa ma abofra nya ne ho yiye wɔ ɔmanfo mu akyiri yi wɔ n’asetra mu.[5]

Sɛ wogyina akyerɛkyerɛfo ne ɛnanom amanneɛbɔ so a, anyɛ yiye koraa no, mmofra a wonnya nkɔɔ sukuu no mu 75% wɔ adamfo biako. Saa dodow yi kɔɔ soro koduu 78% kosii adesuakuw a ɛto so anum no mu, sɛnea wɔde co-nomination sɛ nnamfo susuw no, na 55% wɔ mutual adamfo paa.[4]: 247 Wohui sɛ mmofra bɛyɛ 15% nni adamfo a enni sabea, bɔɔ amanneɛ sɛ wɔmfa wɔn ho wɔn ho nkɔ nnamfo anyɛ yiye koraa no asram asia.[4]: 250

Mfaso a ebetumi aba wɔ adamfofa so no bi ne hokwan a wobenya de asua tema ne ɔhaw ahorow ano aduru ho ade.[7] Ntetee a awofo de ma no betumi ayɛ nea mfaso wɔ so wɔ mmofra a wɔbɛboa wɔn ma wɔanya nnamfo no mu. Eileen Kennedy-Moore ka nneɛma atitiriw abiɛsa a ɛma mmofra nya adamfofa ho asɛm: (1) wobue wɔn ani, (2) nsɛdi, ne (3) anigye a wɔkyɛ.[8][9][10] Awofoɔ nso bɛtumi aboa mmofra ama wɔate asetena mu akwankyerɛ a wɔn ankasa nsuaa no ase.[11] Kennedy-Moore retwe adwene asi nhwehwɛmu a Robert Selman[12] ne afoforo yɛe mu no, ɔkyerɛkyerɛ nkɔso fã ahorow wɔ mmofra adamfofa mu, a ɛda tumi a ɛrenya nkɔanim a ɛma wɔte afoforo adwene ase adi: &quot;Mepɛ Ɛyɛ Me Kwan&quot;, &quot;Dɛn na Ɛwɔ Mu Ma Me?&quot;, Ɛdenam Mmara no so&quot;, &quot;Adwene ne Kyɛfa&quot;, ne &quot;Nnamfo a Wɔnam Thick ne Thin So.&quot;[13]

'''Mmabunbere'''

Wɔ mmerantebere ne mmabaabere mu no, nnamfofa bɛyɛ “ade a ɛma ade kɛse, nea ɛkyɛ, nea ɛka no pen, ɛboa, na ɛba ara kwa.” Mmabun taa hwehwɛ atipɛnfo a wobetumi de su horow a ɛte saa ama wɔ abusuabɔ a ɛda wɔn ho wɔn ho ntam, na wɔkwati atipɛnfo a wɔn nneyɛe a ɛyɛ ɔhaw no kyerɛ sɛ ebia wɔrentumi nni saa ahiade ahorow yi ho dwuma.[14] Ankorankoro su ne ne su nso yɛ nneɛma a mmabun hwehwɛ, bere a wɔrepaw nea wɔne no befi ase afa adamfo no.[15] Abusuabɔ fi ase kɔ so de wɔn adwene si gyinapɛn ahorow a wɔkyɛ, nokwaredi, ne nneɛma a wɔn nyinaa ani gye ho so, sen sɛ wɔde wɔn adwene besi honam fam nneɛma te sɛ bɛn a wɔbɛn wɔn ho ne sɛnea wobetumi adi agoru nneɛma a ɛkyerɛ mmofraberem kɛse.[4]: 246

Nhwehwɛmu bi a wɔyɛe wɔ Texas Sukuupɔn a ɛwɔ Austin mu no hwehwɛɛ Amerikafo mmabun bɛboro 9,000 mu de huu sɛnea wɔn ho a wɔde hyɛ nneyɛe a ɛhaw adwene (te sɛ korɔnbɔ, ntɔkwaw, ne sukuu a wonkɔ sukuu) mu no ne wɔn nnamfofa no wɔ abusuabɔ. Nneɛma a wohui kyerɛe sɛ mmabun ntaa mfa wɔn ho nhyɛ ɔhaw mu nneyɛe mu bere a wɔn nnamfonom yɛ ade yiye wɔ sukuu mu, wɔde wɔn ho hyɛ sukuu dwumadi ahorow mu, wɔkwati nsanom, na wɔwɔ adwenemyare pa no. Wohuu nea ɛne eyi bɔ abira wɔ mmabun a wɔde wɔn ho hyɛɛ nneyɛe a ɔhaw wom mu ampa no ho. Sɛ́ ebia mmabun nyaa wɔn nnamfo so nkɛntɛnso ma wɔde wɔn ho hyɛ ɔhaw suban mu no gyina sɛnea wɔde wɔn ho hyɛɛ saa nnamfo no mu, ne sɛ ebia wɔne wɔn adamfofa akuw ahorow no &quot;fata&quot; wɔ sukuu mu no so.[16]

Nhwehwɛmu bi a nhwehwɛmufo a wofi Purdue Sukuupɔn mu yɛe no kyerɛe sɛ nnamfo a wonyae wɔ ntoaso sukuu akyi adesua mu no kyɛ sen nnamfo a wonyae kan no.[17] Wɔ mmerantebere ne mmabaabere awiei mu no, mmusuakuw ntam adamfofa taa yɛ nea ɛntaa nsi, na ɛbɛyɛ sɛ efi adwemmɔne ne amammerɛ mu nsonsonoe.[15]

'''Mpanyimfoyɛ'''

.

Adamfofa a wonya wɔ mpanyin afe so no ma wonya ayɔnkofa, ɔdɔ, ne nkate mu mmoa, na ɛboa yiye ma adwene mu yiyedi ne nipadua akwahosan tu mpɔn.[18]: 426

Ebia ɛbɛyɛ den ama mpanyimfo titiriw sɛ wobenya nnamfo a mfaso wɔ so wɔ adwumam. &quot;Adwumam betumi ayɛ krak esiane akansi nti, enti nkurɔfo sua sɛ wɔde mmerɛwyɛ ne nneɛma a ɛyɛ nwonwa besie mfɛfo adwumayɛfo. Adwuma mu adamfofa taa nya nkitahodi ho nkate; ɛyɛ den sɛ wobɛka baabi a nkitahodi ba awiei na adamfofa ankasa fi ase.&quot;[19] Mpanyimfo dodow no ara bu sikasɛm sɛ ɛsom bo wɔn nnwuma ahobammɔ sen adamfofa a wɔne wɔn mfɛfo adwumayɛfo benya.[20]

Sɛ wɔkyekyem pɛpɛɛpɛ a, mpanyimfo dodow no ara wɔ nnamfo paa baanu.[21] Nhwehwɛmu pii a wɔyɛe wɔ mpanyimfo ho no kyerɛ sɛ adamfofa ne abusuabɔ afoforo a ɛboa ma obu a obi wɔ ma ne ho no yɛ kɛse ampa.[22]

Mpanyimfo a wɔn mfe akɔ anim

Mpanyimfo a wɔn mfe akɔ anim kɔ so bɔ amanneɛ sɛ wonya ankorankoro abotɔyam kɛse wɔ wɔn nnamfofa mu bere a wɔrenyin no, bere mpo a nnamfo dodow nyinaa taa so tew no. Saa abotɔyam yi ne tumi a ɛma wotumi yɛ da biara da asetra mu dwumadi ahorow a ɛkɔ soro, ne adwene mu tumi a ɛso tew, ayaresabea a wɔde obi kɔ no a ɛso tew, ne nea efi mu ba a eye a ɛfa ahosiesie ho no wɔ abusuabɔ.[18]: 427 Nnamfo dodow a wɔbɔɔ ho amanneɛ wɔ akyiri yi mu no nyinaa asetra betumi ayɛ ntamgyinafo denam pefeeyɛ a ɛkɔ soro, kasa ne anisoadehu a eye, ne aware mu tebea so.[23]: 53 Nnamfo dodow a ankorankoro bi nya bere a wɔrenyin no so tew no, wɔde Carstensen Socioemotional Selectivity Theory a ɛkyerɛkyerɛ nsakrae a ɛba wɔ mu no akyerɛkyerɛ mu nkannyan a mpanyimfo nya bere a wɔrebɔ fekuw no. Nsusuwii no ka sɛ mfe a obi adi a ɛkɔ soro no yɛ nsakrae a ɛba fi nsɛm a wɔboaboa ano so kɔ nkate mu nhyehyɛe so; sɛnea ɛbɛyɛ a wobetumi akura nkate pa mu no, mpanyimfo a wɔn mfe akɔ anim no de wɔn asetra mu akuw no to wɔn a wɔwɔ nkate mu abusuabɔ bi nkutoo so.[24]

''Sɛnea nhwehwɛmu bi kae no'':

Nhwehwɛmu a wɔayɛ wɔ mfe aduanan a atwam no mu no ahu bere nyinaa mprempren sɛ mpanyimfo a wɔn mfe akɔ anim a wɔbɔ amanneɛ sɛ wɔwɔ anigye ne yiyedi a ɛkɔ soro sen biara no nso bɔ amanneɛ sɛ wɔne nnamfo pii wɔ abusuabɔ a emu yɛ den na emu yɛ den.[25]

Bere a abusua mu asɛyɛde ne adwumayɛ ho nhyɛso so tew no, nnamfofa bɛyɛ nea ɛho hia kɛse. Wɔ nkwakoraa ne mmerewa mu no, adamfofa betumi ama wɔanya abusuabɔ a ɛda ɔmanfo kɛse no ntam, ayɛ ade a ɛbɔ wɔn ho ban fi adwenemhaw ne ankonamyɛ ho, na atua nneɛma a ebetumi ahwere wɔ asetra mu mmoa a abusua no mufo adi kan de ama no ho ka.[26]: 32–33 Titiriw ma nnipa a wontumi nkɔ out sɛnea ɛtaa ba no, nkitahodi a wɔne nnamfo di no ma kwan ma wɔkɔ so nya ɔmanfo nkitahodi. Bio nso, mpanyimfo a wɔn mfe akɔ anim a wɔn akwahosan rekɔ fam a wɔda so ara ne wɔn nnamfo di nkitaho no kyerɛ sɛ wɔn adwene mu yiyedi atu mpɔn.[27

== Nkɔso ho nsɛm ==
'''Adwene a ɛmma obi ntumi nyɛ hwee a ɛma obi yɛ ade tra so'''

Ebia ɛbɛyɛ den ama mmofra a wɔwɔ adwene a wɔde si biribi so a ɛtra so (ADHD) no sɛ wɔbɛfa nnamfo na wɔakura mu, esiane sɛ wontumi mfa adesua a wɔde hwɛ ade so nkyekye asetra mu nimdeɛ pii nti, nsɛnnennen a ɛwɔ wɔn asetram nsɛnkyerɛnne a wɔde wɔn adwene si so, ne nkɛntɛnso a nneyɛe a wɔde wɔn ho hyɛ mu no nya wɔ asetra mu ne su kɛse a ɛne sɛ wɔbɛyɛ saa nti de wɔn ho hyɛ nneyɛe a ebia wɔn atipɛnfo behu sɛ ɛhaw adwene mu.[28][29] Wɔ afe 2007 nhwehwɛmu bi mu no, wɔanhunu ayaresa biara a ɛdi atipɛnfoɔ dwumadie ho dwuma yie wɔ mmofra a wɔwɔ ADHD mu, na wɔanhunu ayaresa a ɛdi ɔhaw no afã foforɔ ho dwuma no yi nsɛm a ɛfa atipɛnfoɔ dwumadie ho no firi hɔ.

'''Autism a ɛyɛ hu'''

Autism spectrum disorders ho sɛnkyerɛnne ahorow bi betumi asiw nnipa ntam abusuabɔ a ɛbɛba no kwan, te sɛ nneyɛe a wɔtaa yɛ a wɔpɛ, nsakrae a wɔko tia, nneɛma pɔtee bi a n’ani gye ho anaa amanne ahorow a wɔde wɔn ho hyɛ mu, ne asetra mu nimdeɛ a wonni. Wɔahu sɛ mmofra a wɔwɔ autism no taa yɛ onipa biako nnamfo paa, sen sɛ wobenya nnamfo akuw. Bio nso, wɔtaa yɛ mmofra afoforo a wɔadi dɛm bi nnamfo paa.[30] Awofo a wɔde wɔn ho abɔ wɔn ho ho adwene boa ma mmofra a wɔwɔ autism spectrum disorders no adamfofa yɛ papa; obi a ɔte nka sɛ ɔne n’awofo wɔ abusuabɔ no tua ayɔnkofa ho nimdeɛ a onni a mpɛn pii no ebesiw adamfofa kwan no so ka.[31]

Nhwehwɛmu bi a Frankel ne afoforo yɛe no. kyerɛe sɛ awofo de wɔn ho gye mu ne nkyerɛkyerɛ di dwuma titiriw wɔ mmofra a wɔte saa a wonya adamfofa mu.[32] Nea ɛka awofo a wɔde wɔn ho hyɛ mu ho no, sukuu mu adwumayɛfo di dwuma titiriw wɔ asetra mu nimdeɛ ne atipɛnfo nkitahodi a wɔkyerɛkyerɛ mu. Wɔtaa de paraprofessionals, titiriw no, obiakofo aboafo ne adesuadan mu aboafo, kɔ mmofra a wɔwɔ autism spectrum disorders nkyɛn sɛnea ɛbɛyɛ a wɔbɛma nnamfofa ayɛ mmerɛw na wɔakyerɛ abofra no kwan wɔ adamfofa a ɛho hia a ɔbɛfa na wakura mu.

Ɛwom sɛ asuade ne ntetee betumi aboa mmofra a wɔwɔ autism atipɛnfo de, nanso ayayade da so ara yɛ ade titiriw a ɛhaw adwene wɔ asetra mu tebea horow mu. Sɛnea Anahad O’Connor a ɔwɔ The New York Times mu kyerɛ no, ɛda adi kɛse sɛ ayayade bɛba mmofra a wɔwɔ autism spectrum disorders a wobetumi atra ase a wɔde wɔn ho no so kɛse. Mmofra a wɔte saa no wɔ asiane mu kɛse efisɛ wɔwɔ amanne ahorow no pii ne asetra mu nimdeɛ a wonni te sɛ mmofra a ɛda adi sɛ wɔwɔ autism no, nanso ɛda adi sɛ wɔde wɔn bɛhyɛ sukuu mu titiriw. Mmofra a wɔwɔ autism no wɔ ɔhaw kɛse sɛ wɔbɛhwɛ asetra mu nsɛnkyerɛnne so, na enti ebia ɛnyɛ bere nyinaa na wobehu bere a wɔresisi wɔn.[34]

'''Down yare no ho yare'''

Mmofra a wɔwɔ Down syndrome no ayɛ den kɛse sɛ wɔbɛfa nnamfo. Wohyia kasa a ɛkyɛ a ɛma ɛyɛ den ma wɔn sɛ wɔne mmofra afoforo bedi agoru. Ebia mmofra dodow no ara a wɔwɔ Down syndrome no bɛpɛ sɛ wɔhwɛ sukuufo afoforo na wɔne wɔn adamfo di agoru nanso wɔne wɔn nni agoru, titiriw esiane sɛ wɔte ase sen sɛnea wobetumi ada no adi wɔ akyi nti. Wɔ mfe a wonnya nkɔɔ sukuu mu no, mmofra a wɔwɔ Down syndrome no betumi anya adesuadan mu tebea no so mfaso, a mmofra afoforo atwa wɔn ho ahyia na wɔmfa wɔn ho nto mpanyimfo mmoa so kɛse. Mmofra a wɔadi dɛm yi nya mfaso fi nkitahodi ahorow a wɔne mpanyimfo ne mmofra nyinaa nya no mu. Wɔ sukuu mu no, hwɛ a wɔbɛhwɛ ma wɔanya tebea a obiara bɛka ho wɔ adesuadan mu no betumi ayɛ den, nanso nnamfo a wɔbɛn a wɔbɛn wɔn no betumi ayɛ ade titiriw ama asetra mu nkɔso.[35][36]

== Apomuden ==
Nhwehwɛmu ahorow ada no adi sɛ asetra mu mmoa a emu yɛ den ma obi nya akwahosan pa ne nkwa tenten ho anidaso tu mpɔn. Nea ɛne no bɔ abira no, wɔde ankonamyɛ ne asetra mu mmoa a wonnya no abata asiane a ɛkɔ soro a ɛne sɛ wobenya komayare, mmoawa a wɔde nyarewa ba, ne kokoram, ne nnipa dodow a wowuwu wɔ ne nyinaa mu no ho. Nhwehwɛmufoɔ mmienu mpo afrɛ adamfofa nkitahodiɛ sɛ &quot;suban ho aduru&quot; a ɛma nipadua ne adwene mu akwahosan nyinaa nya nkɔsoɔ.[37]

Nhwehwɛmu pii wɔ hɔ a ɛde adamfofa ne akwahosan bata ho, nanso nea enti pɔtee a ɛde abusuabɔ no ba no da so ara yɛ nea wontumi nhu. Nhwehwɛmu dodow no ara a ɛwɔ saa beae yi yɛ nhwehwɛmu akɛse a wɔhwɛ kwan a edi nnipa akyi bere tenten, na bere a ebia abusuabɔ bi wɔ nneɛma abien a ɛsakra (adamfofa ne akwahosan tebea) no ntam no, nhwehwɛmufo da so ara nnim sɛ ebia abusuabɔ bi wɔ hɔ a ɛde ba ne nea efi mu ba, te sɛ sɛ adwene a ɛne sɛ adamfofa pa ma akwahosan tu mpɔn ankasa. Nsusuwii ahorow bi abɔ mmɔden sɛ wɔbɛkyerɛkyerɛ saa abusuabɔ yi mu. Nea ɛka saa nsusuwii ahorow yi ho ne sɛ nnamfo pa hyɛ wɔn nnamfo nkuran ma wɔbɔ asetra a ahoɔden wom kɛse; sɛ nnamfo pa hyɛ wɔn nnamfo nkuran sɛ wɔnhwehwɛ mmoa na wonnya nnwuma bere a ɛho hia no; sɛ nnamfo pa ma wɔn nnamfonom tumi gyina yare ne akwahosan ho haw afoforo ho dwuma no yɛ kɛse; na sɛ nnamfo pa nya nipadua mu akwan a ɛbɔ akwahosan ho ban no so nkɛntɛnso ankasa.[38]

'''Adwene mu haw'''

Wɔahu sɛ adamfofa a wonni no di dwuma ma asiane a ɛkɔ soro sɛ mmea a wɔrebɛn mpanyin afe so benya adwene a ɛne sɛ wobekum wɔn ho no mu, a nea ɛka ho ne sɛ wobenya nnamfo pii a wɔn ankasa nyɛ wɔn ho wɔn ho nnamfo. Nanso, wɔanhu nkɛntɛnso a ɛte saa ara wɔ mmarima ho.[39][40] Nnamfo kakraa bi a wubenya anaasɛ wunni bi no yɛ ade titiriw a ɛkyerɛ sɛ obi anya adwenemyare ahorow pii.[14]

Adamfofa su a ɛkorɔn no boa tẽẽ ma wonya obu ma wɔn ho, wonya wɔn ho mu ahotoso, na wonya asetra mu nkɔso.[22] World Happiness Database nhwehwɛmu bi kyerɛe sɛ nnipa a wɔwɔ nnamfo paa no ani gye kɛse, ɛwom sɛ nnamfo dodow koraa no amma anigye no ankɔ soro de.[41] Nhwehwɛmu afoforo akyerɛ sɛ mmofra a wɔwɔ adamfofa a ɛkorɔn no betumi abɔ wɔn ho ban afi ɔhaw ahorow bi te sɛ dadwen ne adwenemhaw ho.[42][43] Nea ɛne no bɔ abira no, nnamfo kakraa bi a wubenya no ne sukuu a wogyae, ne basabasayɛ, ne mpanyimfo nsɛmmɔnedi nso wɔ abusuabɔ.[3]: 500 Atipɛnfo a wɔpow wɔn no nso ne akyi apɛde a ɛba fam wɔ adwumayɛfo mu, ne asetra mu dwumadi ahorow mu kyɛfa a wonya, bere a dodow a ɛkɔ soro no wɔ abusuabɔ na adamfofa ne mpanyimfo bu wɔn ho a ɛkorɔn wɔ abusuabɔ.[3]: 500–01

== Nneɛma a wɔde gu mu ==
Wobetumi abu adamfofa bi a wobegu no sɛ ankorankoro pow, anaasɛ ebetumi afi abɔde mu nsakrae a ɛba bere a bere kɔ so no mu aba, bere a nnamfo kɔ akyirikyiri kɛse wɔ honam ne nkate fam no. Wɔde adamfofa a wɔsɛe no no ne afobu, abufuw ne adwenemhaw a ɛkɔ soro no wɔ abusuabɔ, na ebetumi ayɛ nsɛm a ɛhaw adwene kɛse, titiriw wɔ mmofraase. Nanso, wobetumi abrɛ nsunsuanso bɔne a ebetumi aba no ase sɛ wɔde abusuabɔ foforo a emu yɛ den si adamfofa bi a wobegu no ananmu a.[4]: 248

== Nnipa dodow ho nsɛm ==
Nnamfo taa yɛ wɔn ho sɛ wɔn ho wɔn ho kɛse wɔ mfe a wɔadi, ɔbarima ne ɔbea nna, suban, nnuru a wɔde di dwuma ɔkwammɔne so, ankorankoro su, ne adesua mu mmɔdenbɔ mu.[4]: 248 [18]: 426 [25]: 55–56 Wɔ aman a mmusuakuw ahorow gu ahorow mu no, adanse a ɛtrɛw wɔ hɔ a ɛkyerɛ sɛ mmofra ne mmabun taa ne afoforo a wofi mmusuakuw anaa mmusuakuw koro mu fa adamfo, efi ase wɔ mmofra a wonnya nkɔɔ sukuu mu, na ɛkɔ soro wɔ mmofraberem mfinimfini anaa awiei mu hɔ.[4]: 264

Nsonsonoe a ɛwɔ mmarima ne mmea ntam

Mpɛn pii no, mmea ne mmea adamfofa nkitahodi a ɛda mmofra ntam no taa twe adwene si nnipa ntam abusuabɔ ne mmoa a wɔde ma wɔn ho wɔn ho so. Nea ɛne eyi bɔ abira no, ɔbarima ne ɔbarima ntam nkitahodi taa twe adwene si asetra mu tebea so kɛse. Nea ebefi mu aba ne sɛ, wobetumi de nsiyɛ abu nkate mu ahiade ahorow a wɔda no adi no abam.[44]: 320–02

Mmea bɔ amanneɛ sɛ dadwen, ahoɔyaw, ne abusuabɔ mu ayayade pii na wonnya pintinn pii wɔ wɔn nnamfofa ho. Nanso mmarima de, wɔbɔ amanneɛ sɛ wɔyɛ wɔn honam fam ayayade pii. Ne nyinaa mu no, mmarima ne mmea taa bɔ amanneɛ sɛ wɔanya abotɔyam kakra wɔ wɔn nnamfofa ho.[4]: 249–50

Mmea taa da wɔn ho adi kɛse na wɔda wɔn ho adi kɛse wɔ wɔn bɔbeasu koro adamfofa mu na wɔwɔ nnamfo kakraa bi.[15] Mmarima taa kyerɛkyerɛ abusuabɔ a emu yɛ den mu denam honam fam osuahu ahorow a wɔkyɛ so. Nea ɛne eyi bɔ abira no, mmea taa kyerɛkyerɛ mu kɛse wɔ nkate mu de a wɔkyɛ mu. Mmarima ntaa nna nkate anaa wɔn ankasa nsɛm adi nkyerɛ mmarima afoforo efisɛ wobetumi de saa nsɛm yi adi dwuma atia wɔn. Nanso, wɔbɛda saa nsɛm yi adi akyerɛ mmea (sɛnea wɔne wɔn nni akan), na mmarima taa bu adamfofa a wɔne mmea nya no sɛ nea ntease wom kɛse, emu yɛ den, na ɛyɛ anigye. Mpɛn pii no, mmarima ne mmarima adamfofa te sɛ apam kɛse, bere a mmea ne mmea adamfofa gyina abusuabɔ so kɛse. Nea ɛde ba ne sɛ, eyi nso kyerɛ sɛ ɔbarima ne ɔbarima adamfofa a ɛba awiei no taa yɛ nea ɛhaw nkate kɛse te sɛ ɔbea ne ɔbea adamfofa no.[45][46]

Mmea taa yɛ wɔn a wɔn ho akokwaw wɔ asetra mu sen wɔn atipɛnfo mmarima wɔ mpanyimfo a wɔn mfe akɔ anim mu. Nea afi mu aba ne sɛ, mmarima a wɔn mfe akɔ anim pii betumi de wɔn ho ato ɔhokafo a ɔyɛ ɔbea te sɛ ɔhokafo so de atua wɔn asetra mu nimdeɛ a wonni no ho ka.[25]: 55 Nhwehwɛmu bi kyerɛe sɛ mmea a wɔwɔ Europa ne Amerika Atifi fam no na ɛtaa yɛ kɛse kakra sen mmarima sɛ ɔno ankasa bɛbɔ amanneɛ sɛ ɔwɔ adamfo paa.[47]

Amammerɛ

Abusuabɔ ahorow a wobu no sɛ nokware adamfofa, sen sɛ ɛbɛyɛ obi a onim no anaa obi a ɔne no yɛ adwuma no gu ahorow sɛnea amammerɛ te. Wɔ amammerɛ a wɔka Borɔfo kasa mu no, ɛnyɛ ade foforo sɛ nkurɔfo de abusuabɔ a ɛyɛ mmerɛw bɛka ho sɛ nnamfo.[48] Wɔ amammerɛ afoforo te sɛ Russiafo ne Polandfo amammerɛ mu no, abusuabɔ a ɛho hia sen biara nkutoo na wobu no sɛ nnamfo. Ebia Russiani benya nnamfo biako anaa baanu a wɔde &quot;pals&quot; anaa nnipa pii a onim wɔn aka ho; Canadani a ɔwɔ tebea a ɛte saa ara mu no betumi abu saa abusuabɔ ahorow yi nyinaa sɛ nnamfo.[48]

Wɔ Atɔe Famfo amammerɛ mu no, wɔtaa bu adamfofa sɛ ɛyɛ ketewaa bi sen abusua anaa ɔdɔ.[49]

Bere a wɔreka adamfofa ho ahyɛde ahorow ho asɛm no wohui sɛ Chinafo a wobisabisaa wɔn nsɛm no huu pii sen wɔn mfɛfo Britaniafo no.[15][ambiguous]

== Nneɛma ahorow a ɛwɔ hɔ ntam ==</text>
      <sha1>kcmton01piw4lr0pt4vhibn3zz01qdu</sha1>
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      <text bytes="22426" xml:space="preserve">Adamfofa yɛ abusuabɔ a ɛda ɔdɔ a ɛda nnipa ntam.[1] Ɛyɛ nnipa ntam abusuabɔ a emu yɛ den sen &quot;onimfoɔ&quot; anaa &quot;fekubɔ&quot;, te sɛ sukuuni, ofipamfo, yɔnko dwumayɛni, anaa yɔnko dwumayɛni.

Wɔ amammerɛ ahorow bi mu no, adamfofa ho adwene no yɛ abusuabɔ kakraa bi a emu dɔ yiye nkutoo; wɔ afoforo te sɛ U.S. ne Canada no, obi betumi anya nnamfo pii, na ebia ɔne onipa biako anaa baanu a wobetumi afrɛ wɔn nnamfo pa anaa nnamfo paa benya abusuabɔ a emu yɛ den kɛse. Nsɛmfua afoforo a wɔka wɔ kasa mu ne besties anaa Best Friends Forever (BFFs). Ɛwom sɛ adamfofa ahorow pii wɔ hɔ, a ebia ɛsono emu bi wɔ mmeae ahorow de, nanso su ahorow bi wɔ abusuabɔ a ɛtete saa pii mu. Nneɛma a ɛtete saa no bi ne sɛ wɔbɛpaw sɛ wɔne wɔn ho wɔn ho bɛtra, bere a wɔde bom tra mu anigye, na wobetumi de wɔn ho ahyɛ dwumadi pa a ɛboa wɔn ho wɔn ho mu.[2]

Ɛtɔ da bi a, wɔma nnamfo da nsow wɔ abusua ho, sɛnea ɛte wɔ asɛm a wɔka sɛ &quot;nnamfo ne abusua&quot; mu no, na ɛtɔ da bi nso a wɔda nsow wɔ adɔfo ho (e.g., &quot;adɔfo ne nnamfo&quot;), ɛwom sɛ wɔde nnamfo a wɔwɔ mfaso ahorow no yɛ nea ɛyɛ kusuu de. Adamfo beae no yɛ beae a wɔbara obi sɛ ɔnsɔre nkɔ ɔdɔfo gyinabea (hwɛ Ɔdɔ a wontua ho ka nso).

Wɔasua adamfofa ho ade wɔ nhomasua mu, te sɛ nkitahodi, asetra ho adesua, asetra mu adwene ho nimdeɛ, nnipa ho adesua, ne nyansapɛ mu. Wɔahyɛ adamfofa ho adesua mu nsusuwii ahorow ho nyansa, a nea ɛka ho ne asetra mu nsakrae ho nsusuwii, pɛyɛ ho nsusuwii, abusuabɔ mu nsɛm a wɔka, ne akwan horow a wɔfa so de wɔn ho bata ho. 

== Nkɔso ho adwene ho nimdeɛ ==
'''Mmɔfrabrɛ'''

Ntease a ɛfa adamfofa ho wɔ mmofra mu no taa twe adwene si mmeae te sɛ dwumadi ahorow a wɔtaa yɛ, honam fam a wɔbɛn wɔn ho, ne akwanhwɛ a wɔkyɛ so kɛse.[3]: 498 [a] Saa adamfofa ahorow yi ma wonya hokwan di agoru na wɔde wɔn ho hyɛ mu. 246 Mmofra dodow no ara taa kyerɛkyerɛ adamfofa mu denam nneɛma te sɛ kyɛfa so, na mmofra taa ne obi a wobu no sɛ ɔyɛ adamfo no kyɛ.[4]: 246 [5][6] Bere a mmofra nyin no, wɔnyɛ ankorankoro ho ade pii na no nim afoforo yiye. Wonya tumi a wɔde benya tema ma wɔn nnamfo, na wɔn ani gye ho sɛ wobedi agoru wɔ akuw mu. Wonya atipɛnfo a wɔpow wɔn nso bere a wɔrekɔ so wɔ mmofraberem mfe no mfinimfini no. Nnamfo pa a obenya wɔ ne mmofraase no boa ma abofra nya ne ho yiye wɔ ɔmanfo mu akyiri yi wɔ n’asetra mu.[5]

Sɛ wogyina akyerɛkyerɛfo ne ɛnanom amanneɛbɔ so a, anyɛ yiye koraa no, mmofra a wonnya nkɔɔ sukuu no mu 75% wɔ adamfo biako. Saa dodow yi kɔɔ soro koduu 78% kosii adesuakuw a ɛto so anum no mu, sɛnea wɔde co-nomination sɛ nnamfo susuw no, na 55% wɔ mutual adamfo paa.[4]: 247 Wohui sɛ mmofra bɛyɛ 15% nni adamfo a enni sabea, bɔɔ amanneɛ sɛ wɔmfa wɔn ho wɔn ho nkɔ nnamfo anyɛ yiye koraa no asram asia.[4]: 250

Mfaso a ebetumi aba wɔ adamfofa so no bi ne hokwan a wobenya de asua tema ne ɔhaw ahorow ano aduru ho ade.[7] Ntetee a awofo de ma no betumi ayɛ nea mfaso wɔ so wɔ mmofra a wɔbɛboa wɔn ma wɔanya nnamfo no mu. Eileen Kennedy-Moore ka nneɛma atitiriw abiɛsa a ɛma mmofra nya adamfofa ho asɛm: (1) wobue wɔn ani, (2) nsɛdi, ne (3) anigye a wɔkyɛ.[8][9][10] Awofoɔ nso bɛtumi aboa mmofra ama wɔate asetena mu akwankyerɛ a wɔn ankasa nsuaa no ase.[11] Kennedy-Moore retwe adwene asi nhwehwɛmu a Robert Selman[12] ne afoforo yɛe mu no, ɔkyerɛkyerɛ nkɔso fã ahorow wɔ mmofra adamfofa mu, a ɛda tumi a ɛrenya nkɔanim a ɛma wɔte afoforo adwene ase adi: &quot;Mepɛ Ɛyɛ Me Kwan&quot;, &quot;Dɛn na Ɛwɔ Mu Ma Me?&quot;, Ɛdenam Mmara no so&quot;, &quot;Adwene ne Kyɛfa&quot;, ne &quot;Nnamfo a Wɔnam Thick ne Thin So.&quot;[13]

'''Mmabunbere'''

Wɔ mmerantebere ne mmabaabere mu no, nnamfofa bɛyɛ “ade a ɛma ade kɛse, nea ɛkyɛ, nea ɛka no pen, ɛboa, na ɛba ara kwa.” Mmabun taa hwehwɛ atipɛnfo a wobetumi de su horow a ɛte saa ama wɔ abusuabɔ a ɛda wɔn ho wɔn ho ntam, na wɔkwati atipɛnfo a wɔn nneyɛe a ɛyɛ ɔhaw no kyerɛ sɛ ebia wɔrentumi nni saa ahiade ahorow yi ho dwuma.[14] Ankorankoro su ne ne su nso yɛ nneɛma a mmabun hwehwɛ, bere a wɔrepaw nea wɔne no befi ase afa adamfo no.[15] Abusuabɔ fi ase kɔ so de wɔn adwene si gyinapɛn ahorow a wɔkyɛ, nokwaredi, ne nneɛma a wɔn nyinaa ani gye ho so, sen sɛ wɔde wɔn adwene besi honam fam nneɛma te sɛ bɛn a wɔbɛn wɔn ho ne sɛnea wobetumi adi agoru nneɛma a ɛkyerɛ mmofraberem kɛse.[4]: 246

Nhwehwɛmu bi a wɔyɛe wɔ Texas Sukuupɔn a ɛwɔ Austin mu no hwehwɛɛ Amerikafo mmabun bɛboro 9,000 mu de huu sɛnea wɔn ho a wɔde hyɛ nneyɛe a ɛhaw adwene (te sɛ korɔnbɔ, ntɔkwaw, ne sukuu a wonkɔ sukuu) mu no ne wɔn nnamfofa no wɔ abusuabɔ. Nneɛma a wohui kyerɛe sɛ mmabun ntaa mfa wɔn ho nhyɛ ɔhaw mu nneyɛe mu bere a wɔn nnamfonom yɛ ade yiye wɔ sukuu mu, wɔde wɔn ho hyɛ sukuu dwumadi ahorow mu, wɔkwati nsanom, na wɔwɔ adwenemyare pa no. Wohuu nea ɛne eyi bɔ abira wɔ mmabun a wɔde wɔn ho hyɛɛ nneyɛe a ɔhaw wom mu ampa no ho. Sɛ́ ebia mmabun nyaa wɔn nnamfo so nkɛntɛnso ma wɔde wɔn ho hyɛ ɔhaw suban mu no gyina sɛnea wɔde wɔn ho hyɛɛ saa nnamfo no mu, ne sɛ ebia wɔne wɔn adamfofa akuw ahorow no &quot;fata&quot; wɔ sukuu mu no so.[16]

Nhwehwɛmu bi a nhwehwɛmufo a wofi Purdue Sukuupɔn mu yɛe no kyerɛe sɛ nnamfo a wonyae wɔ ntoaso sukuu akyi adesua mu no kyɛ sen nnamfo a wonyae kan no.[17] Wɔ mmerantebere ne mmabaabere awiei mu no, mmusuakuw ntam adamfofa taa yɛ nea ɛntaa nsi, na ɛbɛyɛ sɛ efi adwemmɔne ne amammerɛ mu nsonsonoe.[15]

'''Mpanyimfoyɛ'''

.

Adamfofa a wonya wɔ mpanyin afe so no ma wonya ayɔnkofa, ɔdɔ, ne nkate mu mmoa, na ɛboa yiye ma adwene mu yiyedi ne nipadua akwahosan tu mpɔn.[18]: 426

Ebia ɛbɛyɛ den ama mpanyimfo titiriw sɛ wobenya nnamfo a mfaso wɔ so wɔ adwumam. &quot;Adwumam betumi ayɛ krak esiane akansi nti, enti nkurɔfo sua sɛ wɔde mmerɛwyɛ ne nneɛma a ɛyɛ nwonwa besie mfɛfo adwumayɛfo. Adwuma mu adamfofa taa nya nkitahodi ho nkate; ɛyɛ den sɛ wobɛka baabi a nkitahodi ba awiei na adamfofa ankasa fi ase.&quot;[19] Mpanyimfo dodow no ara bu sikasɛm sɛ ɛsom bo wɔn nnwuma ahobammɔ sen adamfofa a wɔne wɔn mfɛfo adwumayɛfo benya.[20]

Sɛ wɔkyekyem pɛpɛɛpɛ a, mpanyimfo dodow no ara wɔ nnamfo paa baanu.[21] Nhwehwɛmu pii a wɔyɛe wɔ mpanyimfo ho no kyerɛ sɛ adamfofa ne abusuabɔ afoforo a ɛboa ma obu a obi wɔ ma ne ho no yɛ kɛse ampa.[22]

Mpanyimfo a wɔn mfe akɔ anim

Mpanyimfo a wɔn mfe akɔ anim kɔ so bɔ amanneɛ sɛ wonya ankorankoro abotɔyam kɛse wɔ wɔn nnamfofa mu bere a wɔrenyin no, bere mpo a nnamfo dodow nyinaa taa so tew no. Saa abotɔyam yi ne tumi a ɛma wotumi yɛ da biara da asetra mu dwumadi ahorow a ɛkɔ soro, ne adwene mu tumi a ɛso tew, ayaresabea a wɔde obi kɔ no a ɛso tew, ne nea efi mu ba a eye a ɛfa ahosiesie ho no wɔ abusuabɔ.[18]: 427 Nnamfo dodow a wɔbɔɔ ho amanneɛ wɔ akyiri yi mu no nyinaa asetra betumi ayɛ ntamgyinafo denam pefeeyɛ a ɛkɔ soro, kasa ne anisoadehu a eye, ne aware mu tebea so.[23]: 53 Nnamfo dodow a ankorankoro bi nya bere a wɔrenyin no so tew no, wɔde Carstensen Socioemotional Selectivity Theory a ɛkyerɛkyerɛ nsakrae a ɛba wɔ mu no akyerɛkyerɛ mu nkannyan a mpanyimfo nya bere a wɔrebɔ fekuw no. Nsusuwii no ka sɛ mfe a obi adi a ɛkɔ soro no yɛ nsakrae a ɛba fi nsɛm a wɔboaboa ano so kɔ nkate mu nhyehyɛe so; sɛnea ɛbɛyɛ a wobetumi akura nkate pa mu no, mpanyimfo a wɔn mfe akɔ anim no de wɔn asetra mu akuw no to wɔn a wɔwɔ nkate mu abusuabɔ bi nkutoo so.[24]

''Sɛnea nhwehwɛmu bi kae no'':

Nhwehwɛmu a wɔayɛ wɔ mfe aduanan a atwam no mu no ahu bere nyinaa mprempren sɛ mpanyimfo a wɔn mfe akɔ anim a wɔbɔ amanneɛ sɛ wɔwɔ anigye ne yiyedi a ɛkɔ soro sen biara no nso bɔ amanneɛ sɛ wɔne nnamfo pii wɔ abusuabɔ a emu yɛ den na emu yɛ den.[25]

Bere a abusua mu asɛyɛde ne adwumayɛ ho nhyɛso so tew no, nnamfofa bɛyɛ nea ɛho hia kɛse. Wɔ nkwakoraa ne mmerewa mu no, adamfofa betumi ama wɔanya abusuabɔ a ɛda ɔmanfo kɛse no ntam, ayɛ ade a ɛbɔ wɔn ho ban fi adwenemhaw ne ankonamyɛ ho, na atua nneɛma a ebetumi ahwere wɔ asetra mu mmoa a abusua no mufo adi kan de ama no ho ka.[26]: 32–33 Titiriw ma nnipa a wontumi nkɔ out sɛnea ɛtaa ba no, nkitahodi a wɔne nnamfo di no ma kwan ma wɔkɔ so nya ɔmanfo nkitahodi. Bio nso, mpanyimfo a wɔn mfe akɔ anim a wɔn akwahosan rekɔ fam a wɔda so ara ne wɔn nnamfo di nkitaho no kyerɛ sɛ wɔn adwene mu yiyedi atu mpɔn.[27

== Nkɔso ho nsɛm ==
'''Adwene a ɛmma obi ntumi nyɛ hwee a ɛma obi yɛ ade tra so'''

Ebia ɛbɛyɛ den ama mmofra a wɔwɔ adwene a wɔde si biribi so a ɛtra so (ADHD) no sɛ wɔbɛfa nnamfo na wɔakura mu, esiane sɛ wontumi mfa adesua a wɔde hwɛ ade so nkyekye asetra mu nimdeɛ pii nti, nsɛnnennen a ɛwɔ wɔn asetram nsɛnkyerɛnne a wɔde wɔn adwene si so, ne nkɛntɛnso a nneyɛe a wɔde wɔn ho hyɛ mu no nya wɔ asetra mu ne su kɛse a ɛne sɛ wɔbɛyɛ saa nti de wɔn ho hyɛ nneyɛe a ebia wɔn atipɛnfo behu sɛ ɛhaw adwene mu.[28][29] Wɔ afe 2007 nhwehwɛmu bi mu no, wɔanhunu ayaresa biara a ɛdi atipɛnfoɔ dwumadie ho dwuma yie wɔ mmofra a wɔwɔ ADHD mu, na wɔanhunu ayaresa a ɛdi ɔhaw no afã foforɔ ho dwuma no yi nsɛm a ɛfa atipɛnfoɔ dwumadie ho no firi hɔ.

'''Autism a ɛyɛ hu'''

Autism spectrum disorders ho sɛnkyerɛnne ahorow bi betumi asiw nnipa ntam abusuabɔ a ɛbɛba no kwan, te sɛ nneyɛe a wɔtaa yɛ a wɔpɛ, nsakrae a wɔko tia, nneɛma pɔtee bi a n’ani gye ho anaa amanne ahorow a wɔde wɔn ho hyɛ mu, ne asetra mu nimdeɛ a wonni. Wɔahu sɛ mmofra a wɔwɔ autism no taa yɛ onipa biako nnamfo paa, sen sɛ wobenya nnamfo akuw. Bio nso, wɔtaa yɛ mmofra afoforo a wɔadi dɛm bi nnamfo paa.[30] Awofo a wɔde wɔn ho abɔ wɔn ho ho adwene boa ma mmofra a wɔwɔ autism spectrum disorders no adamfofa yɛ papa; obi a ɔte nka sɛ ɔne n’awofo wɔ abusuabɔ no tua ayɔnkofa ho nimdeɛ a onni a mpɛn pii no ebesiw adamfofa kwan no so ka.[31]

Nhwehwɛmu bi a Frankel ne afoforo yɛe no. kyerɛe sɛ awofo de wɔn ho gye mu ne nkyerɛkyerɛ di dwuma titiriw wɔ mmofra a wɔte saa a wonya adamfofa mu.[32] Nea ɛka awofo a wɔde wɔn ho hyɛ mu ho no, sukuu mu adwumayɛfo di dwuma titiriw wɔ asetra mu nimdeɛ ne atipɛnfo nkitahodi a wɔkyerɛkyerɛ mu. Wɔtaa de paraprofessionals, titiriw no, obiakofo aboafo ne adesuadan mu aboafo, kɔ mmofra a wɔwɔ autism spectrum disorders nkyɛn sɛnea ɛbɛyɛ a wɔbɛma nnamfofa ayɛ mmerɛw na wɔakyerɛ abofra no kwan wɔ adamfofa a ɛho hia a ɔbɛfa na wakura mu.

Ɛwom sɛ asuade ne ntetee betumi aboa mmofra a wɔwɔ autism atipɛnfo de, nanso ayayade da so ara yɛ ade titiriw a ɛhaw adwene wɔ asetra mu tebea horow mu. Sɛnea Anahad O’Connor a ɔwɔ The New York Times mu kyerɛ no, ɛda adi kɛse sɛ ayayade bɛba mmofra a wɔwɔ autism spectrum disorders a wobetumi atra ase a wɔde wɔn ho no so kɛse. Mmofra a wɔte saa no wɔ asiane mu kɛse efisɛ wɔwɔ amanne ahorow no pii ne asetra mu nimdeɛ a wonni te sɛ mmofra a ɛda adi sɛ wɔwɔ autism no, nanso ɛda adi sɛ wɔde wɔn bɛhyɛ sukuu mu titiriw. Mmofra a wɔwɔ autism no wɔ ɔhaw kɛse sɛ wɔbɛhwɛ asetra mu nsɛnkyerɛnne so, na enti ebia ɛnyɛ bere nyinaa na wobehu bere a wɔresisi wɔn.[34]

'''Down yare no ho yare'''

Mmofra a wɔwɔ Down syndrome no ayɛ den kɛse sɛ wɔbɛfa nnamfo. Wohyia kasa a ɛkyɛ a ɛma ɛyɛ den ma wɔn sɛ wɔne mmofra afoforo bedi agoru. Ebia mmofra dodow no ara a wɔwɔ Down syndrome no bɛpɛ sɛ wɔhwɛ sukuufo afoforo na wɔne wɔn adamfo di agoru nanso wɔne wɔn nni agoru, titiriw esiane sɛ wɔte ase sen sɛnea wobetumi ada no adi wɔ akyi nti. Wɔ mfe a wonnya nkɔɔ sukuu mu no, mmofra a wɔwɔ Down syndrome no betumi anya adesuadan mu tebea no so mfaso, a mmofra afoforo atwa wɔn ho ahyia na wɔmfa wɔn ho nto mpanyimfo mmoa so kɛse. Mmofra a wɔadi dɛm yi nya mfaso fi nkitahodi ahorow a wɔne mpanyimfo ne mmofra nyinaa nya no mu. Wɔ sukuu mu no, hwɛ a wɔbɛhwɛ ma wɔanya tebea a obiara bɛka ho wɔ adesuadan mu no betumi ayɛ den, nanso nnamfo a wɔbɛn a wɔbɛn wɔn no betumi ayɛ ade titiriw ama asetra mu nkɔso.[35][36]

== Apomuden ==
Nhwehwɛmu ahorow ada no adi sɛ asetra mu mmoa a emu yɛ den ma obi nya akwahosan pa ne nkwa tenten ho anidaso tu mpɔn. Nea ɛne no bɔ abira no, wɔde ankonamyɛ ne asetra mu mmoa a wonnya no abata asiane a ɛkɔ soro a ɛne sɛ wobenya komayare, mmoawa a wɔde nyarewa ba, ne kokoram, ne nnipa dodow a wowuwu wɔ ne nyinaa mu no ho. Nhwehwɛmufoɔ mmienu mpo afrɛ adamfofa nkitahodiɛ sɛ &quot;suban ho aduru&quot; a ɛma nipadua ne adwene mu akwahosan nyinaa nya nkɔsoɔ.[37]

Nhwehwɛmu pii wɔ hɔ a ɛde adamfofa ne akwahosan bata ho, nanso nea enti pɔtee a ɛde abusuabɔ no ba no da so ara yɛ nea wontumi nhu. Nhwehwɛmu dodow no ara a ɛwɔ saa beae yi yɛ nhwehwɛmu akɛse a wɔhwɛ kwan a edi nnipa akyi bere tenten, na bere a ebia abusuabɔ bi wɔ nneɛma abien a ɛsakra (adamfofa ne akwahosan tebea) no ntam no, nhwehwɛmufo da so ara nnim sɛ ebia abusuabɔ bi wɔ hɔ a ɛde ba ne nea efi mu ba, te sɛ sɛ adwene a ɛne sɛ adamfofa pa ma akwahosan tu mpɔn ankasa. Nsusuwii ahorow bi abɔ mmɔden sɛ wɔbɛkyerɛkyerɛ saa abusuabɔ yi mu. Nea ɛka saa nsusuwii ahorow yi ho ne sɛ nnamfo pa hyɛ wɔn nnamfo nkuran ma wɔbɔ asetra a ahoɔden wom kɛse; sɛ nnamfo pa hyɛ wɔn nnamfo nkuran sɛ wɔnhwehwɛ mmoa na wonnya nnwuma bere a ɛho hia no; sɛ nnamfo pa ma wɔn nnamfonom tumi gyina yare ne akwahosan ho haw afoforo ho dwuma no yɛ kɛse; na sɛ nnamfo pa nya nipadua mu akwan a ɛbɔ akwahosan ho ban no so nkɛntɛnso ankasa.[38]

'''Adwene mu haw'''

Wɔahu sɛ adamfofa a wonni no di dwuma ma asiane a ɛkɔ soro sɛ mmea a wɔrebɛn mpanyin afe so benya adwene a ɛne sɛ wobekum wɔn ho no mu, a nea ɛka ho ne sɛ wobenya nnamfo pii a wɔn ankasa nyɛ wɔn ho wɔn ho nnamfo. Nanso, wɔanhu nkɛntɛnso a ɛte saa ara wɔ mmarima ho.[39][40] Nnamfo kakraa bi a wubenya anaasɛ wunni bi no yɛ ade titiriw a ɛkyerɛ sɛ obi anya adwenemyare ahorow pii.[14]

Adamfofa su a ɛkorɔn no boa tẽẽ ma wonya obu ma wɔn ho, wonya wɔn ho mu ahotoso, na wonya asetra mu nkɔso.[22] World Happiness Database nhwehwɛmu bi kyerɛe sɛ nnipa a wɔwɔ nnamfo paa no ani gye kɛse, ɛwom sɛ nnamfo dodow koraa no amma anigye no ankɔ soro de.[41] Nhwehwɛmu afoforo akyerɛ sɛ mmofra a wɔwɔ adamfofa a ɛkorɔn no betumi abɔ wɔn ho ban afi ɔhaw ahorow bi te sɛ dadwen ne adwenemhaw ho.[42][43] Nea ɛne no bɔ abira no, nnamfo kakraa bi a wubenya no ne sukuu a wogyae, ne basabasayɛ, ne mpanyimfo nsɛmmɔnedi nso wɔ abusuabɔ.[3]: 500 Atipɛnfo a wɔpow wɔn no nso ne akyi apɛde a ɛba fam wɔ adwumayɛfo mu, ne asetra mu dwumadi ahorow mu kyɛfa a wonya, bere a dodow a ɛkɔ soro no wɔ abusuabɔ na adamfofa ne mpanyimfo bu wɔn ho a ɛkorɔn wɔ abusuabɔ.[3]: 500–01

== Nneɛma a wɔde gu mu ==
Wobetumi abu adamfofa bi a wobegu no sɛ ankorankoro pow, anaasɛ ebetumi afi abɔde mu nsakrae a ɛba bere a bere kɔ so no mu aba, bere a nnamfo kɔ akyirikyiri kɛse wɔ honam ne nkate fam no. Wɔde adamfofa a wɔsɛe no no ne afobu, abufuw ne adwenemhaw a ɛkɔ soro no wɔ abusuabɔ, na ebetumi ayɛ nsɛm a ɛhaw adwene kɛse, titiriw wɔ mmofraase. Nanso, wobetumi abrɛ nsunsuanso bɔne a ebetumi aba no ase sɛ wɔde abusuabɔ foforo a emu yɛ den si adamfofa bi a wobegu no ananmu a.[4]: 248

== Nnipa dodow ho nsɛm ==
Nnamfo taa yɛ wɔn ho sɛ wɔn ho wɔn ho kɛse wɔ mfe a wɔadi, ɔbarima ne ɔbea nna, suban, nnuru a wɔde di dwuma ɔkwammɔne so, ankorankoro su, ne adesua mu mmɔdenbɔ mu.[4]: 248 [18]: 426 [25]: 55–56 Wɔ aman a mmusuakuw ahorow gu ahorow mu no, adanse a ɛtrɛw wɔ hɔ a ɛkyerɛ sɛ mmofra ne mmabun taa ne afoforo a wofi mmusuakuw anaa mmusuakuw koro mu fa adamfo, efi ase wɔ mmofra a wonnya nkɔɔ sukuu mu, na ɛkɔ soro wɔ mmofraberem mfinimfini anaa awiei mu hɔ.[4]: 264

Nsonsonoe a ɛwɔ mmarima ne mmea ntam

Mpɛn pii no, mmea ne mmea adamfofa nkitahodi a ɛda mmofra ntam no taa twe adwene si nnipa ntam abusuabɔ ne mmoa a wɔde ma wɔn ho wɔn ho so. Nea ɛne eyi bɔ abira no, ɔbarima ne ɔbarima ntam nkitahodi taa twe adwene si asetra mu tebea so kɛse. Nea ebefi mu aba ne sɛ, wobetumi de nsiyɛ abu nkate mu ahiade ahorow a wɔda no adi no abam.[44]: 320–02

Mmea bɔ amanneɛ sɛ dadwen, ahoɔyaw, ne abusuabɔ mu ayayade pii na wonnya pintinn pii wɔ wɔn nnamfofa ho. Nanso mmarima de, wɔbɔ amanneɛ sɛ wɔyɛ wɔn honam fam ayayade pii. Ne nyinaa mu no, mmarima ne mmea taa bɔ amanneɛ sɛ wɔanya abotɔyam kakra wɔ wɔn nnamfofa ho.[4]: 249–50

Mmea taa da wɔn ho adi kɛse na wɔda wɔn ho adi kɛse wɔ wɔn bɔbeasu koro adamfofa mu na wɔwɔ nnamfo kakraa bi.[15] Mmarima taa kyerɛkyerɛ abusuabɔ a emu yɛ den mu denam honam fam osuahu ahorow a wɔkyɛ so. Nea ɛne eyi bɔ abira no, mmea taa kyerɛkyerɛ mu kɛse wɔ nkate mu de a wɔkyɛ mu. Mmarima ntaa nna nkate anaa wɔn ankasa nsɛm adi nkyerɛ mmarima afoforo efisɛ wobetumi de saa nsɛm yi adi dwuma atia wɔn. Nanso, wɔbɛda saa nsɛm yi adi akyerɛ mmea (sɛnea wɔne wɔn nni akan), na mmarima taa bu adamfofa a wɔne mmea nya no sɛ nea ntease wom kɛse, emu yɛ den, na ɛyɛ anigye. Mpɛn pii no, mmarima ne mmarima adamfofa te sɛ apam kɛse, bere a mmea ne mmea adamfofa gyina abusuabɔ so kɛse. Nea ɛde ba ne sɛ, eyi nso kyerɛ sɛ ɔbarima ne ɔbarima adamfofa a ɛba awiei no taa yɛ nea ɛhaw nkate kɛse te sɛ ɔbea ne ɔbea adamfofa no.[45][46]

Mmea taa yɛ wɔn a wɔn ho akokwaw wɔ asetra mu sen wɔn atipɛnfo mmarima wɔ mpanyimfo a wɔn mfe akɔ anim mu. Nea afi mu aba ne sɛ, mmarima a wɔn mfe akɔ anim pii betumi de wɔn ho ato ɔhokafo a ɔyɛ ɔbea te sɛ ɔhokafo so de atua wɔn asetra mu nimdeɛ a wonni no ho ka.[25]: 55 Nhwehwɛmu bi kyerɛe sɛ mmea a wɔwɔ Europa ne Amerika Atifi fam no na ɛtaa yɛ kɛse kakra sen mmarima sɛ ɔno ankasa bɛbɔ amanneɛ sɛ ɔwɔ adamfo paa.[47]

Amammerɛ

Abusuabɔ ahorow a wobu no sɛ nokware adamfofa, sen sɛ ɛbɛyɛ obi a onim no anaa obi a ɔne no yɛ adwuma no gu ahorow sɛnea amammerɛ te. Wɔ amammerɛ a wɔka Borɔfo kasa mu no, ɛnyɛ ade foforo sɛ nkurɔfo de abusuabɔ a ɛyɛ mmerɛw bɛka ho sɛ nnamfo.[48] Wɔ amammerɛ afoforo te sɛ Russiafo ne Polandfo amammerɛ mu no, abusuabɔ a ɛho hia sen biara nkutoo na wobu no sɛ nnamfo. Ebia Russiani benya nnamfo biako anaa baanu a wɔde &quot;pals&quot; anaa nnipa pii a onim wɔn aka ho; Canadani a ɔwɔ tebea a ɛte saa ara mu no betumi abu saa abusuabɔ ahorow yi nyinaa sɛ nnamfo.[48]

Wɔ Atɔe Famfo amammerɛ mu no, wɔtaa bu adamfofa sɛ ɛyɛ ketewaa bi sen abusua anaa ɔdɔ.[49]

Bere a wɔreka adamfofa ho ahyɛde ahorow ho asɛm no wohui sɛ Chinafo a wobisabisaa wɔn nsɛm no huu pii sen wɔn mfɛfo Britaniafo no.[15][ambiguous]

== Nneɛma ahorow a ɛwɔ hɔ ntam ==
Nnamfo taa yɛ wɔn ho sɛ wɔn ho wɔn ho kɛse wɔ mfe a wɔadi, ɔbarima ne ɔbea nna, suban, nnuru a wɔde di dwuma ɔkwammɔne so, ankorankoro su, ne adesua mu mmɔdenbɔ mu.[4]: 248 [18]: 426 [25]: 55–56 Wɔ aman a mmusuakuw ahorow gu ahorow mu no, adanse a ɛtrɛw wɔ hɔ a ɛkyerɛ sɛ mmofra ne mmabun taa ne afoforo a wofi mmusuakuw anaa mmusuakuw koro mu fa adamfo, efi ase wɔ mmofra a wonnya nkɔɔ sukuu mu, na ɛkɔ soro wɔ mmofraberem mfinimfini anaa awiei mu hɔ.[4]: 264

'''Nsonsonoe a ɛwɔ mmarima ne mmea ntam'''

Mpɛn pii no, mmea ne mmea adamfofa nkitahodi a ɛda mmofra ntam no taa twe adwene si nnipa ntam abusuabɔ ne mmoa a wɔde ma wɔn ho wɔn ho so. Nea ɛne eyi bɔ abira no, ɔbarima ne ɔbarima ntam nkitahodi taa twe adwene si asetra mu tebea so kɛse. Nea ebefi mu aba ne sɛ, wobetumi de nsiyɛ abu nkate mu ahiade ahorow a wɔda no adi no abam.[44]: 320–02

Mmea bɔ amanneɛ sɛ dadwen, ahoɔyaw, ne abusuabɔ mu ayayade pii na wonnya pintinn pii wɔ wɔn nnamfofa ho. Nanso mmarima de, wɔbɔ amanneɛ sɛ wɔyɛ wɔn honam fam ayayade pii. Ne nyinaa mu no, mmarima ne mmea taa bɔ amanneɛ sɛ wɔanya abotɔyam kakra wɔ wɔn nnamfofa ho.[4]: 249–50

Mmea taa da wɔn ho adi kɛse na wɔda wɔn ho adi kɛse wɔ wɔn bɔbeasu koro adamfofa mu na wɔwɔ nnamfo kakraa bi.[15] Mmarima taa kyerɛkyerɛ abusuabɔ a emu yɛ den mu denam honam fam osuahu ahorow a wɔkyɛ so. Nea ɛne eyi bɔ abira no, mmea taa kyerɛkyerɛ mu kɛse wɔ nkate mu de a wɔkyɛ mu. Mmarima ntaa nna nkate anaa wɔn ankasa nsɛm adi nkyerɛ mmarima afoforo efisɛ wobetumi de saa nsɛm yi adi dwuma atia wɔn. Nanso, wɔbɛda saa nsɛm yi adi akyerɛ mmea (sɛnea wɔne wɔn nni akan), na mmarima taa bu adamfofa a wɔne mmea nya no sɛ nea ntease wom kɛse, emu yɛ den, na ɛyɛ anigye. Mpɛn pii no, mmarima ne mmarima adamfofa te sɛ apam kɛse, bere a mmea ne mmea adamfofa gyina abusuabɔ so kɛse. Nea ɛde ba ne sɛ, eyi nso kyerɛ sɛ ɔbarima ne ɔbarima adamfofa a ɛba awiei no taa yɛ nea ɛhaw nkate kɛse te sɛ ɔbea ne ɔbea adamfofa no.[45][46]

Mmea taa yɛ wɔn a wɔn ho akokwaw wɔ asetra mu sen wɔn atipɛnfo mmarima wɔ mpanyimfo a wɔn mfe akɔ anim mu. Nea afi mu aba ne sɛ, mmarima a wɔn mfe akɔ anim pii betumi de wɔn ho ato ɔhokafo a ɔyɛ ɔbea te sɛ ɔhokafo so de atua wɔn asetra mu nimdeɛ a wonni no ho ka.[25]: 55 Nhwehwɛmu bi kyerɛe sɛ mmea a wɔwɔ Europa ne Amerika Atifi fam no na ɛtaa yɛ kɛse kakra sen mmarima sɛ ɔno ankasa bɛbɔ amanneɛ sɛ ɔwɔ adamfo paa.[47]

'''Amammerɛ'''

Abusuabɔ ahorow a wobu no sɛ nokware adamfofa, sen sɛ ɛbɛyɛ obi a onim no anaa obi a ɔne no yɛ adwuma no gu ahorow sɛnea amammerɛ te. Wɔ amammerɛ a wɔka Borɔfo kasa mu no, ɛnyɛ ade foforo sɛ nkurɔfo de abusuabɔ a ɛyɛ mmerɛw bɛka ho sɛ nnamfo.[48] Wɔ amammerɛ afoforo te sɛ Russiafo ne Polandfo amammerɛ mu no, abusuabɔ a ɛho hia sen biara nkutoo na wobu no sɛ nnamfo. Ebia Russiani benya nnamfo biako anaa baanu a wɔde &quot;pals&quot; anaa nnipa pii a onim wɔn aka ho; Canadani a ɔwɔ tebea a ɛte saa ara mu no betumi abu saa abusuabɔ ahorow yi nyinaa sɛ nnamfo.[48]

Wɔ Atɔe Famfo amammerɛ mu no, wɔtaa bu adamfofa sɛ ɛyɛ ketewaa bi sen abusua anaa ɔdɔ.[49]

Bere a wɔreka adamfofa ho ahyɛde ahorow ho asɛm no wohui sɛ Chinafo a wobisabisaa wɔn nsɛm no huu pii sen wɔn mfɛfo Britaniafo no.[15][ambiguous]</text>
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      <text bytes="22438" xml:space="preserve">Adamfofa yɛ abusuabɔ a ɛda ɔdɔ a ɛda nnipa ntam.[1] Ɛyɛ nnipa ntam abusuabɔ a emu yɛ den sen &quot;onimfoɔ&quot; anaa &quot;fekubɔ&quot;, te sɛ sukuuni, ofipamfo, yɔnko dwumayɛni, anaa yɔnko dwumayɛni.

Wɔ amammerɛ ahorow bi mu no, adamfofa ho adwene no yɛ abusuabɔ kakraa bi a emu dɔ yiye nkutoo; wɔ afoforo te sɛ U.S. ne Canada no, obi betumi anya nnamfo pii, na ebia ɔne onipa biako anaa baanu a wobetumi afrɛ wɔn nnamfo pa anaa nnamfo paa benya abusuabɔ a emu yɛ den kɛse. Nsɛmfua afoforo a wɔka wɔ kasa mu ne besties anaa Best Friends Forever (BFFs). Ɛwom sɛ adamfofa ahorow pii wɔ hɔ, a ebia ɛsono emu bi wɔ mmeae ahorow de, nanso su ahorow bi wɔ abusuabɔ a ɛtete saa pii mu. Nneɛma a ɛtete saa no bi ne sɛ wɔbɛpaw sɛ wɔne wɔn ho wɔn ho bɛtra, bere a wɔde bom tra mu anigye, na wobetumi de wɔn ho ahyɛ dwumadi pa a ɛboa wɔn ho wɔn ho mu.[2]

Ɛtɔ da bi a, wɔma nnamfo da nsow wɔ abusua ho, sɛnea ɛte wɔ asɛm a wɔka sɛ &quot;nnamfo ne abusua&quot; mu no, na ɛtɔ da bi nso a wɔda nsow wɔ adɔfo ho (e.g., &quot;adɔfo ne nnamfo&quot;), ɛwom sɛ wɔde nnamfo a wɔwɔ mfaso ahorow no yɛ nea ɛyɛ kusuu de. Adamfo beae no yɛ beae a wɔbara obi sɛ ɔnsɔre nkɔ ɔdɔfo gyinabea (hwɛ Ɔdɔ a wontua ho ka nso).

Wɔasua adamfofa ho ade wɔ nhomasua mu, te sɛ nkitahodi, asetra ho adesua, asetra mu adwene ho nimdeɛ, nnipa ho adesua, ne nyansapɛ mu. Wɔahyɛ adamfofa ho adesua mu nsusuwii ahorow ho nyansa, a nea ɛka ho ne asetra mu nsakrae ho nsusuwii, pɛyɛ ho nsusuwii, abusuabɔ mu nsɛm a wɔka, ne akwan horow a wɔfa so de wɔn ho bata ho. 

== Nkɔso ho adwene ho nimdeɛ ==
'''Mmɔfrabrɛ'''

Ntease a ɛfa adamfofa ho wɔ mmofra mu no taa twe adwene si mmeae te sɛ dwumadi ahorow a wɔtaa yɛ, honam fam a wɔbɛn wɔn ho, ne akwanhwɛ a wɔkyɛ so kɛse.[3]: 498 [a] Saa adamfofa ahorow yi ma wonya hokwan di agoru na wɔde wɔn ho hyɛ mu. 246 Mmofra dodow no ara taa kyerɛkyerɛ adamfofa mu denam nneɛma te sɛ kyɛfa so, na mmofra taa ne obi a wobu no sɛ ɔyɛ adamfo no kyɛ.[4]: 246 [5][6] Bere a mmofra nyin no, wɔnyɛ ankorankoro ho ade pii na no nim afoforo yiye. Wonya tumi a wɔde benya tema ma wɔn nnamfo, na wɔn ani gye ho sɛ wobedi agoru wɔ akuw mu. Wonya atipɛnfo a wɔpow wɔn nso bere a wɔrekɔ so wɔ mmofraberem mfe no mfinimfini no. Nnamfo pa a obenya wɔ ne mmofraase no boa ma abofra nya ne ho yiye wɔ ɔmanfo mu akyiri yi wɔ n’asetra mu.[5]

Sɛ wogyina akyerɛkyerɛfo ne ɛnanom amanneɛbɔ so a, anyɛ yiye koraa no, mmofra a wonnya nkɔɔ sukuu no mu 75% wɔ adamfo biako. Saa dodow yi kɔɔ soro koduu 78% kosii adesuakuw a ɛto so anum no mu, sɛnea wɔde co-nomination sɛ nnamfo susuw no, na 55% wɔ mutual adamfo paa.[4]: 247 Wohui sɛ mmofra bɛyɛ 15% nni adamfo a enni sabea, bɔɔ amanneɛ sɛ wɔmfa wɔn ho wɔn ho nkɔ nnamfo anyɛ yiye koraa no asram asia.[4]: 250

Mfaso a ebetumi aba wɔ adamfofa so no bi ne hokwan a wobenya de asua tema ne ɔhaw ahorow ano aduru ho ade.[7] Ntetee a awofo de ma no betumi ayɛ nea mfaso wɔ so wɔ mmofra a wɔbɛboa wɔn ma wɔanya nnamfo no mu. Eileen Kennedy-Moore ka nneɛma atitiriw abiɛsa a ɛma mmofra nya adamfofa ho asɛm: (1) wobue wɔn ani, (2) nsɛdi, ne (3) anigye a wɔkyɛ.[8][9][10] Awofoɔ nso bɛtumi aboa mmofra ama wɔate asetena mu akwankyerɛ a wɔn ankasa nsuaa no ase.[11] Kennedy-Moore retwe adwene asi nhwehwɛmu a Robert Selman[12] ne afoforo yɛe mu no, ɔkyerɛkyerɛ nkɔso fã ahorow wɔ mmofra adamfofa mu, a ɛda tumi a ɛrenya nkɔanim a ɛma wɔte afoforo adwene ase adi: &quot;Mepɛ Ɛyɛ Me Kwan&quot;, &quot;Dɛn na Ɛwɔ Mu Ma Me?&quot;, Ɛdenam Mmara no so&quot;, &quot;Adwene ne Kyɛfa&quot;, ne &quot;Nnamfo a Wɔnam Thick ne Thin So.&quot;[13]

'''Mmabunbere'''

Wɔ mmerantebere ne mmabaabere mu no, nnamfofa bɛyɛ “ade a ɛma ade kɛse, nea ɛkyɛ, nea ɛka no pen, ɛboa, na ɛba ara kwa.” Mmabun taa hwehwɛ atipɛnfo a wobetumi de su horow a ɛte saa ama wɔ abusuabɔ a ɛda wɔn ho wɔn ho ntam, na wɔkwati atipɛnfo a wɔn nneyɛe a ɛyɛ ɔhaw no kyerɛ sɛ ebia wɔrentumi nni saa ahiade ahorow yi ho dwuma.[14] Ankorankoro su ne ne su nso yɛ nneɛma a mmabun hwehwɛ, bere a wɔrepaw nea wɔne no befi ase afa adamfo no.[15] Abusuabɔ fi ase kɔ so de wɔn adwene si gyinapɛn ahorow a wɔkyɛ, nokwaredi, ne nneɛma a wɔn nyinaa ani gye ho so, sen sɛ wɔde wɔn adwene besi honam fam nneɛma te sɛ bɛn a wɔbɛn wɔn ho ne sɛnea wobetumi adi agoru nneɛma a ɛkyerɛ mmofraberem kɛse.[4]: 246

Nhwehwɛmu bi a wɔyɛe wɔ Texas Sukuupɔn a ɛwɔ Austin mu no hwehwɛɛ Amerikafo mmabun bɛboro 9,000 mu de huu sɛnea wɔn ho a wɔde hyɛ nneyɛe a ɛhaw adwene (te sɛ korɔnbɔ, ntɔkwaw, ne sukuu a wonkɔ sukuu) mu no ne wɔn nnamfofa no wɔ abusuabɔ. Nneɛma a wohui kyerɛe sɛ mmabun ntaa mfa wɔn ho nhyɛ ɔhaw mu nneyɛe mu bere a wɔn nnamfonom yɛ ade yiye wɔ sukuu mu, wɔde wɔn ho hyɛ sukuu dwumadi ahorow mu, wɔkwati nsanom, na wɔwɔ adwenemyare pa no. Wohuu nea ɛne eyi bɔ abira wɔ mmabun a wɔde wɔn ho hyɛɛ nneyɛe a ɔhaw wom mu ampa no ho. Sɛ́ ebia mmabun nyaa wɔn nnamfo so nkɛntɛnso ma wɔde wɔn ho hyɛ ɔhaw suban mu no gyina sɛnea wɔde wɔn ho hyɛɛ saa nnamfo no mu, ne sɛ ebia wɔne wɔn adamfofa akuw ahorow no &quot;fata&quot; wɔ sukuu mu no so.[16]

Nhwehwɛmu bi a nhwehwɛmufo a wofi Purdue Sukuupɔn mu yɛe no kyerɛe sɛ nnamfo a wonyae wɔ ntoaso sukuu akyi adesua mu no kyɛ sen nnamfo a wonyae kan no.[17] Wɔ mmerantebere ne mmabaabere awiei mu no, mmusuakuw ntam adamfofa taa yɛ nea ɛntaa nsi, na ɛbɛyɛ sɛ efi adwemmɔne ne amammerɛ mu nsonsonoe.[15]

'''Mpanyimfoyɛ'''

.

Adamfofa a wonya wɔ mpanyin afe so no ma wonya ayɔnkofa, ɔdɔ, ne nkate mu mmoa, na ɛboa yiye ma adwene mu yiyedi ne nipadua akwahosan tu mpɔn.[18]: 426

Ebia ɛbɛyɛ den ama mpanyimfo titiriw sɛ wobenya nnamfo a mfaso wɔ so wɔ adwumam. &quot;Adwumam betumi ayɛ krak esiane akansi nti, enti nkurɔfo sua sɛ wɔde mmerɛwyɛ ne nneɛma a ɛyɛ nwonwa besie mfɛfo adwumayɛfo. Adwuma mu adamfofa taa nya nkitahodi ho nkate; ɛyɛ den sɛ wobɛka baabi a nkitahodi ba awiei na adamfofa ankasa fi ase.&quot;[19] Mpanyimfo dodow no ara bu sikasɛm sɛ ɛsom bo wɔn nnwuma ahobammɔ sen adamfofa a wɔne wɔn mfɛfo adwumayɛfo benya.[20]

Sɛ wɔkyekyem pɛpɛɛpɛ a, mpanyimfo dodow no ara wɔ nnamfo paa baanu.[21] Nhwehwɛmu pii a wɔyɛe wɔ mpanyimfo ho no kyerɛ sɛ adamfofa ne abusuabɔ afoforo a ɛboa ma obu a obi wɔ ma ne ho no yɛ kɛse ampa.[22]

Mpanyimfo a wɔn mfe akɔ anim

Mpanyimfo a wɔn mfe akɔ anim kɔ so bɔ amanneɛ sɛ wonya ankorankoro abotɔyam kɛse wɔ wɔn nnamfofa mu bere a wɔrenyin no, bere mpo a nnamfo dodow nyinaa taa so tew no. Saa abotɔyam yi ne tumi a ɛma wotumi yɛ da biara da asetra mu dwumadi ahorow a ɛkɔ soro, ne adwene mu tumi a ɛso tew, ayaresabea a wɔde obi kɔ no a ɛso tew, ne nea efi mu ba a eye a ɛfa ahosiesie ho no wɔ abusuabɔ.[18]: 427 Nnamfo dodow a wɔbɔɔ ho amanneɛ wɔ akyiri yi mu no nyinaa asetra betumi ayɛ ntamgyinafo denam pefeeyɛ a ɛkɔ soro, kasa ne anisoadehu a eye, ne aware mu tebea so.[23]: 53 Nnamfo dodow a ankorankoro bi nya bere a wɔrenyin no so tew no, wɔde Carstensen Socioemotional Selectivity Theory a ɛkyerɛkyerɛ nsakrae a ɛba wɔ mu no akyerɛkyerɛ mu nkannyan a mpanyimfo nya bere a wɔrebɔ fekuw no. Nsusuwii no ka sɛ mfe a obi adi a ɛkɔ soro no yɛ nsakrae a ɛba fi nsɛm a wɔboaboa ano so kɔ nkate mu nhyehyɛe so; sɛnea ɛbɛyɛ a wobetumi akura nkate pa mu no, mpanyimfo a wɔn mfe akɔ anim no de wɔn asetra mu akuw no to wɔn a wɔwɔ nkate mu abusuabɔ bi nkutoo so.[24]

''Sɛnea nhwehwɛmu bi kae no'':

Nhwehwɛmu a wɔayɛ wɔ mfe aduanan a atwam no mu no ahu bere nyinaa mprempren sɛ mpanyimfo a wɔn mfe akɔ anim a wɔbɔ amanneɛ sɛ wɔwɔ anigye ne yiyedi a ɛkɔ soro sen biara no nso bɔ amanneɛ sɛ wɔne nnamfo pii wɔ abusuabɔ a emu yɛ den na emu yɛ den.[25]

Bere a abusua mu asɛyɛde ne adwumayɛ ho nhyɛso so tew no, nnamfofa bɛyɛ nea ɛho hia kɛse. Wɔ nkwakoraa ne mmerewa mu no, adamfofa betumi ama wɔanya abusuabɔ a ɛda ɔmanfo kɛse no ntam, ayɛ ade a ɛbɔ wɔn ho ban fi adwenemhaw ne ankonamyɛ ho, na atua nneɛma a ebetumi ahwere wɔ asetra mu mmoa a abusua no mufo adi kan de ama no ho ka.[26]: 32–33 Titiriw ma nnipa a wontumi nkɔ out sɛnea ɛtaa ba no, nkitahodi a wɔne nnamfo di no ma kwan ma wɔkɔ so nya ɔmanfo nkitahodi. Bio nso, mpanyimfo a wɔn mfe akɔ anim a wɔn akwahosan rekɔ fam a wɔda so ara ne wɔn nnamfo di nkitaho no kyerɛ sɛ wɔn adwene mu yiyedi atu mpɔn.[27

== Nkɔso ho nsɛm ==
'''Adwene a ɛmma obi ntumi nyɛ hwee a ɛma obi yɛ ade tra so'''

Ebia ɛbɛyɛ den ama mmofra a wɔwɔ adwene a wɔde si biribi so a ɛtra so (ADHD) no sɛ wɔbɛfa nnamfo na wɔakura mu, esiane sɛ wontumi mfa adesua a wɔde hwɛ ade so nkyekye asetra mu nimdeɛ pii nti, nsɛnnennen a ɛwɔ wɔn asetram nsɛnkyerɛnne a wɔde wɔn adwene si so, ne nkɛntɛnso a nneyɛe a wɔde wɔn ho hyɛ mu no nya wɔ asetra mu ne su kɛse a ɛne sɛ wɔbɛyɛ saa nti de wɔn ho hyɛ nneyɛe a ebia wɔn atipɛnfo behu sɛ ɛhaw adwene mu.[28][29] Wɔ afe 2007 nhwehwɛmu bi mu no, wɔanhunu ayaresa biara a ɛdi atipɛnfoɔ dwumadie ho dwuma yie wɔ mmofra a wɔwɔ ADHD mu, na wɔanhunu ayaresa a ɛdi ɔhaw no afã foforɔ ho dwuma no yi nsɛm a ɛfa atipɛnfoɔ dwumadie ho no firi hɔ.

'''Autism a ɛyɛ hu'''

Autism spectrum disorders ho sɛnkyerɛnne ahorow bi betumi asiw nnipa ntam abusuabɔ a ɛbɛba no kwan, te sɛ nneyɛe a wɔtaa yɛ a wɔpɛ, nsakrae a wɔko tia, nneɛma pɔtee bi a n’ani gye ho anaa amanne ahorow a wɔde wɔn ho hyɛ mu, ne asetra mu nimdeɛ a wonni. Wɔahu sɛ mmofra a wɔwɔ autism no taa yɛ onipa biako nnamfo paa, sen sɛ wobenya nnamfo akuw. Bio nso, wɔtaa yɛ mmofra afoforo a wɔadi dɛm bi nnamfo paa.[30] Awofo a wɔde wɔn ho abɔ wɔn ho ho adwene boa ma mmofra a wɔwɔ autism spectrum disorders no adamfofa yɛ papa; obi a ɔte nka sɛ ɔne n’awofo wɔ abusuabɔ no tua ayɔnkofa ho nimdeɛ a onni a mpɛn pii no ebesiw adamfofa kwan no so ka.[31]

Nhwehwɛmu bi a Frankel ne afoforo yɛe no. kyerɛe sɛ awofo de wɔn ho gye mu ne nkyerɛkyerɛ di dwuma titiriw wɔ mmofra a wɔte saa a wonya adamfofa mu.[32] Nea ɛka awofo a wɔde wɔn ho hyɛ mu ho no, sukuu mu adwumayɛfo di dwuma titiriw wɔ asetra mu nimdeɛ ne atipɛnfo nkitahodi a wɔkyerɛkyerɛ mu. Wɔtaa de paraprofessionals, titiriw no, obiakofo aboafo ne adesuadan mu aboafo, kɔ mmofra a wɔwɔ autism spectrum disorders nkyɛn sɛnea ɛbɛyɛ a wɔbɛma nnamfofa ayɛ mmerɛw na wɔakyerɛ abofra no kwan wɔ adamfofa a ɛho hia a ɔbɛfa na wakura mu.

Ɛwom sɛ asuade ne ntetee betumi aboa mmofra a wɔwɔ autism atipɛnfo de, nanso ayayade da so ara yɛ ade titiriw a ɛhaw adwene wɔ asetra mu tebea horow mu. Sɛnea Anahad O’Connor a ɔwɔ The New York Times mu kyerɛ no, ɛda adi kɛse sɛ ayayade bɛba mmofra a wɔwɔ autism spectrum disorders a wobetumi atra ase a wɔde wɔn ho no so kɛse. Mmofra a wɔte saa no wɔ asiane mu kɛse efisɛ wɔwɔ amanne ahorow no pii ne asetra mu nimdeɛ a wonni te sɛ mmofra a ɛda adi sɛ wɔwɔ autism no, nanso ɛda adi sɛ wɔde wɔn bɛhyɛ sukuu mu titiriw. Mmofra a wɔwɔ autism no wɔ ɔhaw kɛse sɛ wɔbɛhwɛ asetra mu nsɛnkyerɛnne so, na enti ebia ɛnyɛ bere nyinaa na wobehu bere a wɔresisi wɔn.[34]

'''Down yare no ho yare'''

Mmofra a wɔwɔ Down syndrome no ayɛ den kɛse sɛ wɔbɛfa nnamfo. Wohyia kasa a ɛkyɛ a ɛma ɛyɛ den ma wɔn sɛ wɔne mmofra afoforo bedi agoru. Ebia mmofra dodow no ara a wɔwɔ Down syndrome no bɛpɛ sɛ wɔhwɛ sukuufo afoforo na wɔne wɔn adamfo di agoru nanso wɔne wɔn nni agoru, titiriw esiane sɛ wɔte ase sen sɛnea wobetumi ada no adi wɔ akyi nti. Wɔ mfe a wonnya nkɔɔ sukuu mu no, mmofra a wɔwɔ Down syndrome no betumi anya adesuadan mu tebea no so mfaso, a mmofra afoforo atwa wɔn ho ahyia na wɔmfa wɔn ho nto mpanyimfo mmoa so kɛse. Mmofra a wɔadi dɛm yi nya mfaso fi nkitahodi ahorow a wɔne mpanyimfo ne mmofra nyinaa nya no mu. Wɔ sukuu mu no, hwɛ a wɔbɛhwɛ ma wɔanya tebea a obiara bɛka ho wɔ adesuadan mu no betumi ayɛ den, nanso nnamfo a wɔbɛn a wɔbɛn wɔn no betumi ayɛ ade titiriw ama asetra mu nkɔso.[35][36]

== Apomuden ==
Nhwehwɛmu ahorow ada no adi sɛ asetra mu mmoa a emu yɛ den ma obi nya akwahosan pa ne nkwa tenten ho anidaso tu mpɔn. Nea ɛne no bɔ abira no, wɔde ankonamyɛ ne asetra mu mmoa a wonnya no abata asiane a ɛkɔ soro a ɛne sɛ wobenya komayare, mmoawa a wɔde nyarewa ba, ne kokoram, ne nnipa dodow a wowuwu wɔ ne nyinaa mu no ho. Nhwehwɛmufoɔ mmienu mpo afrɛ adamfofa nkitahodiɛ sɛ &quot;suban ho aduru&quot; a ɛma nipadua ne adwene mu akwahosan nyinaa nya nkɔsoɔ.[37]

Nhwehwɛmu pii wɔ hɔ a ɛde adamfofa ne akwahosan bata ho, nanso nea enti pɔtee a ɛde abusuabɔ no ba no da so ara yɛ nea wontumi nhu. Nhwehwɛmu dodow no ara a ɛwɔ saa beae yi yɛ nhwehwɛmu akɛse a wɔhwɛ kwan a edi nnipa akyi bere tenten, na bere a ebia abusuabɔ bi wɔ nneɛma abien a ɛsakra (adamfofa ne akwahosan tebea) no ntam no, nhwehwɛmufo da so ara nnim sɛ ebia abusuabɔ bi wɔ hɔ a ɛde ba ne nea efi mu ba, te sɛ sɛ adwene a ɛne sɛ adamfofa pa ma akwahosan tu mpɔn ankasa. Nsusuwii ahorow bi abɔ mmɔden sɛ wɔbɛkyerɛkyerɛ saa abusuabɔ yi mu. Nea ɛka saa nsusuwii ahorow yi ho ne sɛ nnamfo pa hyɛ wɔn nnamfo nkuran ma wɔbɔ asetra a ahoɔden wom kɛse; sɛ nnamfo pa hyɛ wɔn nnamfo nkuran sɛ wɔnhwehwɛ mmoa na wonnya nnwuma bere a ɛho hia no; sɛ nnamfo pa ma wɔn nnamfonom tumi gyina yare ne akwahosan ho haw afoforo ho dwuma no yɛ kɛse; na sɛ nnamfo pa nya nipadua mu akwan a ɛbɔ akwahosan ho ban no so nkɛntɛnso ankasa.[38]

'''Adwene mu haw'''

Wɔahu sɛ adamfofa a wonni no di dwuma ma asiane a ɛkɔ soro sɛ mmea a wɔrebɛn mpanyin afe so benya adwene a ɛne sɛ wobekum wɔn ho no mu, a nea ɛka ho ne sɛ wobenya nnamfo pii a wɔn ankasa nyɛ wɔn ho wɔn ho nnamfo. Nanso, wɔanhu nkɛntɛnso a ɛte saa ara wɔ mmarima ho.[39][40] Nnamfo kakraa bi a wubenya anaasɛ wunni bi no yɛ ade titiriw a ɛkyerɛ sɛ obi anya adwenemyare ahorow pii.[14]

Adamfofa su a ɛkorɔn no boa tẽẽ ma wonya obu ma wɔn ho, wonya wɔn ho mu ahotoso, na wonya asetra mu nkɔso.[22] World Happiness Database nhwehwɛmu bi kyerɛe sɛ nnipa a wɔwɔ nnamfo paa no ani gye kɛse, ɛwom sɛ nnamfo dodow koraa no amma anigye no ankɔ soro de.[41] Nhwehwɛmu afoforo akyerɛ sɛ mmofra a wɔwɔ adamfofa a ɛkorɔn no betumi abɔ wɔn ho ban afi ɔhaw ahorow bi te sɛ dadwen ne adwenemhaw ho.[42][43] Nea ɛne no bɔ abira no, nnamfo kakraa bi a wubenya no ne sukuu a wogyae, ne basabasayɛ, ne mpanyimfo nsɛmmɔnedi nso wɔ abusuabɔ.[3]: 500 Atipɛnfo a wɔpow wɔn no nso ne akyi apɛde a ɛba fam wɔ adwumayɛfo mu, ne asetra mu dwumadi ahorow mu kyɛfa a wonya, bere a dodow a ɛkɔ soro no wɔ abusuabɔ na adamfofa ne mpanyimfo bu wɔn ho a ɛkorɔn wɔ abusuabɔ.[3]: 500–01

== Nneɛma a wɔde gu mu ==
Wobetumi abu adamfofa bi a wobegu no sɛ ankorankoro pow, anaasɛ ebetumi afi abɔde mu nsakrae a ɛba bere a bere kɔ so no mu aba, bere a nnamfo kɔ akyirikyiri kɛse wɔ honam ne nkate fam no. Wɔde adamfofa a wɔsɛe no no ne afobu, abufuw ne adwenemhaw a ɛkɔ soro no wɔ abusuabɔ, na ebetumi ayɛ nsɛm a ɛhaw adwene kɛse, titiriw wɔ mmofraase. Nanso, wobetumi abrɛ nsunsuanso bɔne a ebetumi aba no ase sɛ wɔde abusuabɔ foforo a emu yɛ den si adamfofa bi a wobegu no ananmu a.[4]: 248

== Nnipa dodow ho nsɛm ==
Nnamfo taa yɛ wɔn ho sɛ wɔn ho wɔn ho kɛse wɔ mfe a wɔadi, ɔbarima ne ɔbea nna, suban, nnuru a wɔde di dwuma ɔkwammɔne so, ankorankoro su, ne adesua mu mmɔdenbɔ mu.[4]: 248 [18]: 426 [25]: 55–56 Wɔ aman a mmusuakuw ahorow gu ahorow mu no, adanse a ɛtrɛw wɔ hɔ a ɛkyerɛ sɛ mmofra ne mmabun taa ne afoforo a wofi mmusuakuw anaa mmusuakuw koro mu fa adamfo, efi ase wɔ mmofra a wonnya nkɔɔ sukuu mu, na ɛkɔ soro wɔ mmofraberem mfinimfini anaa awiei mu hɔ.[4]: 264

'''Nsonsonoe a ɛwɔ mmarima ne mmea ntam'''

Mpɛn pii no, mmea ne mmea adamfofa nkitahodi a ɛda mmofra ntam no taa twe adwene si nnipa ntam abusuabɔ ne mmoa a wɔde ma wɔn ho wɔn ho so. Nea ɛne eyi bɔ abira no, ɔbarima ne ɔbarima ntam nkitahodi taa twe adwene si asetra mu tebea so kɛse. Nea ebefi mu aba ne sɛ, wobetumi de nsiyɛ abu nkate mu ahiade ahorow a wɔda no adi no abam.[44]: 320–02

Mmea bɔ amanneɛ sɛ dadwen, ahoɔyaw, ne abusuabɔ mu ayayade pii na wonnya pintinn pii wɔ wɔn nnamfofa ho. Nanso mmarima de, wɔbɔ amanneɛ sɛ wɔyɛ wɔn honam fam ayayade pii. Ne nyinaa mu no, mmarima ne mmea taa bɔ amanneɛ sɛ wɔanya abotɔyam kakra wɔ wɔn nnamfofa ho.[4]: 249–50

Mmea taa da wɔn ho adi kɛse na wɔda wɔn ho adi kɛse wɔ wɔn bɔbeasu koro adamfofa mu na wɔwɔ nnamfo kakraa bi.[15] Mmarima taa kyerɛkyerɛ abusuabɔ a emu yɛ den mu denam honam fam osuahu ahorow a wɔkyɛ so. Nea ɛne eyi bɔ abira no, mmea taa kyerɛkyerɛ mu kɛse wɔ nkate mu de a wɔkyɛ mu. Mmarima ntaa nna nkate anaa wɔn ankasa nsɛm adi nkyerɛ mmarima afoforo efisɛ wobetumi de saa nsɛm yi adi dwuma atia wɔn. Nanso, wɔbɛda saa nsɛm yi adi akyerɛ mmea (sɛnea wɔne wɔn nni akan), na mmarima taa bu adamfofa a wɔne mmea nya no sɛ nea ntease wom kɛse, emu yɛ den, na ɛyɛ anigye. Mpɛn pii no, mmarima ne mmarima adamfofa te sɛ apam kɛse, bere a mmea ne mmea adamfofa gyina abusuabɔ so kɛse. Nea ɛde ba ne sɛ, eyi nso kyerɛ sɛ ɔbarima ne ɔbarima adamfofa a ɛba awiei no taa yɛ nea ɛhaw nkate kɛse te sɛ ɔbea ne ɔbea adamfofa no.[45][46]

Mmea taa yɛ wɔn a wɔn ho akokwaw wɔ asetra mu sen wɔn atipɛnfo mmarima wɔ mpanyimfo a wɔn mfe akɔ anim mu. Nea afi mu aba ne sɛ, mmarima a wɔn mfe akɔ anim pii betumi de wɔn ho ato ɔhokafo a ɔyɛ ɔbea te sɛ ɔhokafo so de atua wɔn asetra mu nimdeɛ a wonni no ho ka.[25]: 55 Nhwehwɛmu bi kyerɛe sɛ mmea a wɔwɔ Europa ne Amerika Atifi fam no na ɛtaa yɛ kɛse kakra sen mmarima sɛ ɔno ankasa bɛbɔ amanneɛ sɛ ɔwɔ adamfo paa.[47]

'''Amammerɛ'''

Abusuabɔ ahorow a wobu no sɛ nokware adamfofa, sen sɛ ɛbɛyɛ obi a onim no anaa obi a ɔne no yɛ adwuma no gu ahorow sɛnea amammerɛ te. Wɔ amammerɛ a wɔka Borɔfo kasa mu no, ɛnyɛ ade foforo sɛ nkurɔfo de abusuabɔ a ɛyɛ mmerɛw bɛka ho sɛ nnamfo.[48] Wɔ amammerɛ afoforo te sɛ Russiafo ne Polandfo amammerɛ mu no, abusuabɔ a ɛho hia sen biara nkutoo na wobu no sɛ nnamfo. Ebia Russiani benya nnamfo biako anaa baanu a wɔde &quot;pals&quot; anaa nnipa pii a onim wɔn aka ho; Canadani a ɔwɔ tebea a ɛte saa ara mu no betumi abu saa abusuabɔ ahorow yi nyinaa sɛ nnamfo.[48]

Wɔ Atɔe Famfo amammerɛ mu no, wɔtaa bu adamfofa sɛ ɛyɛ ketewaa bi sen abusua anaa ɔdɔ.[49]

Bere a wɔreka adamfofa ho ahyɛde ahorow ho asɛm no wohui sɛ Chinafo a wobisabisaa wɔn nsɛm no huu pii sen wɔn mfɛfo Britaniafo no.[15][ambiguous]

== Nneɛma ahorow a ɛwɔ hɔ ntam ==
Nnamfo taa yɛ wɔn ho sɛ wɔn ho wɔn ho kɛse wɔ mfe a wɔadi, ɔbarima ne ɔbea nna, suban, nnuru a wɔde di dwuma ɔkwammɔne so, ankorankoro su, ne adesua mu mmɔdenbɔ mu.[4]: 248 [18]: 426 [25]: 55–56 Wɔ aman a mmusuakuw ahorow gu ahorow mu no, adanse a ɛtrɛw wɔ hɔ a ɛkyerɛ sɛ mmofra ne mmabun taa ne afoforo a wofi mmusuakuw anaa mmusuakuw koro mu fa adamfo, efi ase wɔ mmofra a wonnya nkɔɔ sukuu mu, na ɛkɔ soro wɔ mmofraberem mfinimfini anaa awiei mu hɔ.[4]: 264

'''Nsonsonoe a ɛwɔ mmarima ne mmea ntam'''

Mpɛn pii no, mmea ne mmea adamfofa nkitahodi a ɛda mmofra ntam no taa twe adwene si nnipa ntam abusuabɔ ne mmoa a wɔde ma wɔn ho wɔn ho so. Nea ɛne eyi bɔ abira no, ɔbarima ne ɔbarima ntam nkitahodi taa twe adwene si asetra mu tebea so kɛse. Nea ebefi mu aba ne sɛ, wobetumi de nsiyɛ abu nkate mu ahiade ahorow a wɔda no adi no abam.[44]: 320–02

Mmea bɔ amanneɛ sɛ dadwen, ahoɔyaw, ne abusuabɔ mu ayayade pii na wonnya pintinn pii wɔ wɔn nnamfofa ho. Nanso mmarima de, wɔbɔ amanneɛ sɛ wɔyɛ wɔn honam fam ayayade pii. Ne nyinaa mu no, mmarima ne mmea taa bɔ amanneɛ sɛ wɔanya abotɔyam kakra wɔ wɔn nnamfofa ho.[4]: 249–50

Mmea taa da wɔn ho adi kɛse na wɔda wɔn ho adi kɛse wɔ wɔn bɔbeasu koro adamfofa mu na wɔwɔ nnamfo kakraa bi.[15] Mmarima taa kyerɛkyerɛ abusuabɔ a emu yɛ den mu denam honam fam osuahu ahorow a wɔkyɛ so. Nea ɛne eyi bɔ abira no, mmea taa kyerɛkyerɛ mu kɛse wɔ nkate mu de a wɔkyɛ mu. Mmarima ntaa nna nkate anaa wɔn ankasa nsɛm adi nkyerɛ mmarima afoforo efisɛ wobetumi de saa nsɛm yi adi dwuma atia wɔn. Nanso, wɔbɛda saa nsɛm yi adi akyerɛ mmea (sɛnea wɔne wɔn nni akan), na mmarima taa bu adamfofa a wɔne mmea nya no sɛ nea ntease wom kɛse, emu yɛ den, na ɛyɛ anigye. Mpɛn pii no, mmarima ne mmarima adamfofa te sɛ apam kɛse, bere a mmea ne mmea adamfofa gyina abusuabɔ so kɛse. Nea ɛde ba ne sɛ, eyi nso kyerɛ sɛ ɔbarima ne ɔbarima adamfofa a ɛba awiei no taa yɛ nea ɛhaw nkate kɛse te sɛ ɔbea ne ɔbea adamfofa no.[45][46]

Mmea taa yɛ wɔn a wɔn ho akokwaw wɔ asetra mu sen wɔn atipɛnfo mmarima wɔ mpanyimfo a wɔn mfe akɔ anim mu. Nea afi mu aba ne sɛ, mmarima a wɔn mfe akɔ anim pii betumi de wɔn ho ato ɔhokafo a ɔyɛ ɔbea te sɛ ɔhokafo so de atua wɔn asetra mu nimdeɛ a wonni no ho ka.[25]: 55 Nhwehwɛmu bi kyerɛe sɛ mmea a wɔwɔ Europa ne Amerika Atifi fam no na ɛtaa yɛ kɛse kakra sen mmarima sɛ ɔno ankasa bɛbɔ amanneɛ sɛ ɔwɔ adamfo paa.[47]

'''Amammerɛ'''

Abusuabɔ ahorow a wobu no sɛ nokware adamfofa, sen sɛ ɛbɛyɛ obi a onim no anaa obi a ɔne no yɛ adwuma no gu ahorow sɛnea amammerɛ te. Wɔ amammerɛ a wɔka Borɔfo kasa mu no, ɛnyɛ ade foforo sɛ nkurɔfo de abusuabɔ a ɛyɛ mmerɛw bɛka ho sɛ nnamfo.[48] Wɔ amammerɛ afoforo te sɛ Russiafo ne Polandfo amammerɛ mu no, abusuabɔ a ɛho hia sen biara nkutoo na wobu no sɛ nnamfo. Ebia Russiani benya nnamfo biako anaa baanu a wɔde &quot;pals&quot; anaa nnipa pii a onim wɔn aka ho; Canadani a ɔwɔ tebea a ɛte saa ara mu no betumi abu saa abusuabɔ ahorow yi nyinaa sɛ nnamfo.[48]

Wɔ Atɔe Famfo amammerɛ mu no, wɔtaa bu adamfofa sɛ ɛyɛ ketewaa bi sen abusua anaa ɔdɔ.[49]

Bere a wɔreka adamfofa ho ahyɛde ahorow ho asɛm no wohui sɛ Chinafo a wobisabisaa wɔn nsɛm no huu pii sen wɔn mfɛfo Britaniafo no.[15][ambiguous]</text>
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      <text bytes="19019" xml:space="preserve">Adamfofa yɛ abusuabɔ a ɛda ɔdɔ a ɛda nnipa ntam.[1] Ɛyɛ nnipa ntam abusuabɔ a emu yɛ den sen &quot;onimfoɔ&quot; anaa &quot;fekubɔ&quot;, te sɛ sukuuni, ofipamfo, yɔnko dwumayɛni, anaa yɔnko dwumayɛni.

Wɔ amammerɛ ahorow bi mu no, adamfofa ho adwene no yɛ abusuabɔ kakraa bi a emu dɔ yiye nkutoo; wɔ afoforo te sɛ U.S. ne Canada no, obi betumi anya nnamfo pii, na ebia ɔne onipa biako anaa baanu a wobetumi afrɛ wɔn nnamfo pa anaa nnamfo paa benya abusuabɔ a emu yɛ den kɛse. Nsɛmfua afoforo a wɔka wɔ kasa mu ne besties anaa Best Friends Forever (BFFs). Ɛwom sɛ adamfofa ahorow pii wɔ hɔ, a ebia ɛsono emu bi wɔ mmeae ahorow de, nanso su ahorow bi wɔ abusuabɔ a ɛtete saa pii mu. Nneɛma a ɛtete saa no bi ne sɛ wɔbɛpaw sɛ wɔne wɔn ho wɔn ho bɛtra, bere a wɔde bom tra mu anigye, na wobetumi de wɔn ho ahyɛ dwumadi pa a ɛboa wɔn ho wɔn ho mu.[2]

Ɛtɔ da bi a, wɔma nnamfo da nsow wɔ abusua ho, sɛnea ɛte wɔ asɛm a wɔka sɛ &quot;nnamfo ne abusua&quot; mu no, na ɛtɔ da bi nso a wɔda nsow wɔ adɔfo ho (e.g., &quot;adɔfo ne nnamfo&quot;), ɛwom sɛ wɔde nnamfo a wɔwɔ mfaso ahorow no yɛ nea ɛyɛ kusuu de. Adamfo beae no yɛ beae a wɔbara obi sɛ ɔnsɔre nkɔ ɔdɔfo gyinabea (hwɛ Ɔdɔ a wontua ho ka nso).

Wɔasua adamfofa ho ade wɔ nhomasua mu, te sɛ nkitahodi, asetra ho adesua, asetra mu adwene ho nimdeɛ, nnipa ho adesua, ne nyansapɛ mu. Wɔahyɛ adamfofa ho adesua mu nsusuwii ahorow ho nyansa, a nea ɛka ho ne asetra mu nsakrae ho nsusuwii, pɛyɛ ho nsusuwii, abusuabɔ mu nsɛm a wɔka, ne akwan horow a wɔfa so de wɔn ho bata ho. 

== Nkɔso ho adwene ho nimdeɛ ==
'''Mmɔfrabrɛ'''

Ntease a ɛfa adamfofa ho wɔ mmofra mu no taa twe adwene si mmeae te sɛ dwumadi ahorow a wɔtaa yɛ, honam fam a wɔbɛn wɔn ho, ne akwanhwɛ a wɔkyɛ so kɛse.[3]: 498 [a] Saa adamfofa ahorow yi ma wonya hokwan di agoru na wɔde wɔn ho hyɛ mu. 246 Mmofra dodow no ara taa kyerɛkyerɛ adamfofa mu denam nneɛma te sɛ kyɛfa so, na mmofra taa ne obi a wobu no sɛ ɔyɛ adamfo no kyɛ.[4]: 246 [5][6] Bere a mmofra nyin no, wɔnyɛ ankorankoro ho ade pii na no nim afoforo yiye. Wonya tumi a wɔde benya tema ma wɔn nnamfo, na wɔn ani gye ho sɛ wobedi agoru wɔ akuw mu. Wonya atipɛnfo a wɔpow wɔn nso bere a wɔrekɔ so wɔ mmofraberem mfe no mfinimfini no. Nnamfo pa a obenya wɔ ne mmofraase no boa ma abofra nya ne ho yiye wɔ ɔmanfo mu akyiri yi wɔ n’asetra mu.[5]

Sɛ wogyina akyerɛkyerɛfo ne ɛnanom amanneɛbɔ so a, anyɛ yiye koraa no, mmofra a wonnya nkɔɔ sukuu no mu 75% wɔ adamfo biako. Saa dodow yi kɔɔ soro koduu 78% kosii adesuakuw a ɛto so anum no mu, sɛnea wɔde co-nomination sɛ nnamfo susuw no, na 55% wɔ mutual adamfo paa.[4]: 247 Wohui sɛ mmofra bɛyɛ 15% nni adamfo a enni sabea, bɔɔ amanneɛ sɛ wɔmfa wɔn ho wɔn ho nkɔ nnamfo anyɛ yiye koraa no asram asia.[4]: 250

Mfaso a ebetumi aba wɔ adamfofa so no bi ne hokwan a wobenya de asua tema ne ɔhaw ahorow ano aduru ho ade.[7] Ntetee a awofo de ma no betumi ayɛ nea mfaso wɔ so wɔ mmofra a wɔbɛboa wɔn ma wɔanya nnamfo no mu. Eileen Kennedy-Moore ka nneɛma atitiriw abiɛsa a ɛma mmofra nya adamfofa ho asɛm: (1) wobue wɔn ani, (2) nsɛdi, ne (3) anigye a wɔkyɛ.[8][9][10] Awofoɔ nso bɛtumi aboa mmofra ama wɔate asetena mu akwankyerɛ a wɔn ankasa nsuaa no ase.[11] Kennedy-Moore retwe adwene asi nhwehwɛmu a Robert Selman[12] ne afoforo yɛe mu no, ɔkyerɛkyerɛ nkɔso fã ahorow wɔ mmofra adamfofa mu, a ɛda tumi a ɛrenya nkɔanim a ɛma wɔte afoforo adwene ase adi: &quot;Mepɛ Ɛyɛ Me Kwan&quot;, &quot;Dɛn na Ɛwɔ Mu Ma Me?&quot;, Ɛdenam Mmara no so&quot;, &quot;Adwene ne Kyɛfa&quot;, ne &quot;Nnamfo a Wɔnam Thick ne Thin So.&quot;[13]

'''Mmabunbere'''

Wɔ mmerantebere ne mmabaabere mu no, nnamfofa bɛyɛ “ade a ɛma ade kɛse, nea ɛkyɛ, nea ɛka no pen, ɛboa, na ɛba ara kwa.” Mmabun taa hwehwɛ atipɛnfo a wobetumi de su horow a ɛte saa ama wɔ abusuabɔ a ɛda wɔn ho wɔn ho ntam, na wɔkwati atipɛnfo a wɔn nneyɛe a ɛyɛ ɔhaw no kyerɛ sɛ ebia wɔrentumi nni saa ahiade ahorow yi ho dwuma.[14] Ankorankoro su ne ne su nso yɛ nneɛma a mmabun hwehwɛ, bere a wɔrepaw nea wɔne no befi ase afa adamfo no.[15] Abusuabɔ fi ase kɔ so de wɔn adwene si gyinapɛn ahorow a wɔkyɛ, nokwaredi, ne nneɛma a wɔn nyinaa ani gye ho so, sen sɛ wɔde wɔn adwene besi honam fam nneɛma te sɛ bɛn a wɔbɛn wɔn ho ne sɛnea wobetumi adi agoru nneɛma a ɛkyerɛ mmofraberem kɛse.[4]: 246

Nhwehwɛmu bi a wɔyɛe wɔ Texas Sukuupɔn a ɛwɔ Austin mu no hwehwɛɛ Amerikafo mmabun bɛboro 9,000 mu de huu sɛnea wɔn ho a wɔde hyɛ nneyɛe a ɛhaw adwene (te sɛ korɔnbɔ, ntɔkwaw, ne sukuu a wonkɔ sukuu) mu no ne wɔn nnamfofa no wɔ abusuabɔ. Nneɛma a wohui kyerɛe sɛ mmabun ntaa mfa wɔn ho nhyɛ ɔhaw mu nneyɛe mu bere a wɔn nnamfonom yɛ ade yiye wɔ sukuu mu, wɔde wɔn ho hyɛ sukuu dwumadi ahorow mu, wɔkwati nsanom, na wɔwɔ adwenemyare pa no. Wohuu nea ɛne eyi bɔ abira wɔ mmabun a wɔde wɔn ho hyɛɛ nneyɛe a ɔhaw wom mu ampa no ho. Sɛ́ ebia mmabun nyaa wɔn nnamfo so nkɛntɛnso ma wɔde wɔn ho hyɛ ɔhaw suban mu no gyina sɛnea wɔde wɔn ho hyɛɛ saa nnamfo no mu, ne sɛ ebia wɔne wɔn adamfofa akuw ahorow no &quot;fata&quot; wɔ sukuu mu no so.[16]

Nhwehwɛmu bi a nhwehwɛmufo a wofi Purdue Sukuupɔn mu yɛe no kyerɛe sɛ nnamfo a wonyae wɔ ntoaso sukuu akyi adesua mu no kyɛ sen nnamfo a wonyae kan no.[17] Wɔ mmerantebere ne mmabaabere awiei mu no, mmusuakuw ntam adamfofa taa yɛ nea ɛntaa nsi, na ɛbɛyɛ sɛ efi adwemmɔne ne amammerɛ mu nsonsonoe.[15]

'''Mpanyimfoyɛ'''

.

Adamfofa a wonya wɔ mpanyin afe so no ma wonya ayɔnkofa, ɔdɔ, ne nkate mu mmoa, na ɛboa yiye ma adwene mu yiyedi ne nipadua akwahosan tu mpɔn.[18]: 426

Ebia ɛbɛyɛ den ama mpanyimfo titiriw sɛ wobenya nnamfo a mfaso wɔ so wɔ adwumam. &quot;Adwumam betumi ayɛ krak esiane akansi nti, enti nkurɔfo sua sɛ wɔde mmerɛwyɛ ne nneɛma a ɛyɛ nwonwa besie mfɛfo adwumayɛfo. Adwuma mu adamfofa taa nya nkitahodi ho nkate; ɛyɛ den sɛ wobɛka baabi a nkitahodi ba awiei na adamfofa ankasa fi ase.&quot;[19] Mpanyimfo dodow no ara bu sikasɛm sɛ ɛsom bo wɔn nnwuma ahobammɔ sen adamfofa a wɔne wɔn mfɛfo adwumayɛfo benya.[20]

Sɛ wɔkyekyem pɛpɛɛpɛ a, mpanyimfo dodow no ara wɔ nnamfo paa baanu.[21] Nhwehwɛmu pii a wɔyɛe wɔ mpanyimfo ho no kyerɛ sɛ adamfofa ne abusuabɔ afoforo a ɛboa ma obu a obi wɔ ma ne ho no yɛ kɛse ampa.[22]

Mpanyimfo a wɔn mfe akɔ anim

Mpanyimfo a wɔn mfe akɔ anim kɔ so bɔ amanneɛ sɛ wonya ankorankoro abotɔyam kɛse wɔ wɔn nnamfofa mu bere a wɔrenyin no, bere mpo a nnamfo dodow nyinaa taa so tew no. Saa abotɔyam yi ne tumi a ɛma wotumi yɛ da biara da asetra mu dwumadi ahorow a ɛkɔ soro, ne adwene mu tumi a ɛso tew, ayaresabea a wɔde obi kɔ no a ɛso tew, ne nea efi mu ba a eye a ɛfa ahosiesie ho no wɔ abusuabɔ.[18]: 427 Nnamfo dodow a wɔbɔɔ ho amanneɛ wɔ akyiri yi mu no nyinaa asetra betumi ayɛ ntamgyinafo denam pefeeyɛ a ɛkɔ soro, kasa ne anisoadehu a eye, ne aware mu tebea so.[23]: 53 Nnamfo dodow a ankorankoro bi nya bere a wɔrenyin no so tew no, wɔde Carstensen Socioemotional Selectivity Theory a ɛkyerɛkyerɛ nsakrae a ɛba wɔ mu no akyerɛkyerɛ mu nkannyan a mpanyimfo nya bere a wɔrebɔ fekuw no. Nsusuwii no ka sɛ mfe a obi adi a ɛkɔ soro no yɛ nsakrae a ɛba fi nsɛm a wɔboaboa ano so kɔ nkate mu nhyehyɛe so; sɛnea ɛbɛyɛ a wobetumi akura nkate pa mu no, mpanyimfo a wɔn mfe akɔ anim no de wɔn asetra mu akuw no to wɔn a wɔwɔ nkate mu abusuabɔ bi nkutoo so.[24]

''Sɛnea nhwehwɛmu bi kae no'':

Nhwehwɛmu a wɔayɛ wɔ mfe aduanan a atwam no mu no ahu bere nyinaa mprempren sɛ mpanyimfo a wɔn mfe akɔ anim a wɔbɔ amanneɛ sɛ wɔwɔ anigye ne yiyedi a ɛkɔ soro sen biara no nso bɔ amanneɛ sɛ wɔne nnamfo pii wɔ abusuabɔ a emu yɛ den na emu yɛ den.[25]

Bere a abusua mu asɛyɛde ne adwumayɛ ho nhyɛso so tew no, nnamfofa bɛyɛ nea ɛho hia kɛse. Wɔ nkwakoraa ne mmerewa mu no, adamfofa betumi ama wɔanya abusuabɔ a ɛda ɔmanfo kɛse no ntam, ayɛ ade a ɛbɔ wɔn ho ban fi adwenemhaw ne ankonamyɛ ho, na atua nneɛma a ebetumi ahwere wɔ asetra mu mmoa a abusua no mufo adi kan de ama no ho ka.[26]: 32–33 Titiriw ma nnipa a wontumi nkɔ out sɛnea ɛtaa ba no, nkitahodi a wɔne nnamfo di no ma kwan ma wɔkɔ so nya ɔmanfo nkitahodi. Bio nso, mpanyimfo a wɔn mfe akɔ anim a wɔn akwahosan rekɔ fam a wɔda so ara ne wɔn nnamfo di nkitaho no kyerɛ sɛ wɔn adwene mu yiyedi atu mpɔn.[27

== Nkɔso ho nsɛm ==
'''Adwene a ɛmma obi ntumi nyɛ hwee a ɛma obi yɛ ade tra so'''

Ebia ɛbɛyɛ den ama mmofra a wɔwɔ adwene a wɔde si biribi so a ɛtra so (ADHD) no sɛ wɔbɛfa nnamfo na wɔakura mu, esiane sɛ wontumi mfa adesua a wɔde hwɛ ade so nkyekye asetra mu nimdeɛ pii nti, nsɛnnennen a ɛwɔ wɔn asetram nsɛnkyerɛnne a wɔde wɔn adwene si so, ne nkɛntɛnso a nneyɛe a wɔde wɔn ho hyɛ mu no nya wɔ asetra mu ne su kɛse a ɛne sɛ wɔbɛyɛ saa nti de wɔn ho hyɛ nneyɛe a ebia wɔn atipɛnfo behu sɛ ɛhaw adwene mu.[28][29] Wɔ afe 2007 nhwehwɛmu bi mu no, wɔanhunu ayaresa biara a ɛdi atipɛnfoɔ dwumadie ho dwuma yie wɔ mmofra a wɔwɔ ADHD mu, na wɔanhunu ayaresa a ɛdi ɔhaw no afã foforɔ ho dwuma no yi nsɛm a ɛfa atipɛnfoɔ dwumadie ho no firi hɔ.

'''Autism a ɛyɛ hu'''

Autism spectrum disorders ho sɛnkyerɛnne ahorow bi betumi asiw nnipa ntam abusuabɔ a ɛbɛba no kwan, te sɛ nneyɛe a wɔtaa yɛ a wɔpɛ, nsakrae a wɔko tia, nneɛma pɔtee bi a n’ani gye ho anaa amanne ahorow a wɔde wɔn ho hyɛ mu, ne asetra mu nimdeɛ a wonni. Wɔahu sɛ mmofra a wɔwɔ autism no taa yɛ onipa biako nnamfo paa, sen sɛ wobenya nnamfo akuw. Bio nso, wɔtaa yɛ mmofra afoforo a wɔadi dɛm bi nnamfo paa.[30] Awofo a wɔde wɔn ho abɔ wɔn ho ho adwene boa ma mmofra a wɔwɔ autism spectrum disorders no adamfofa yɛ papa; obi a ɔte nka sɛ ɔne n’awofo wɔ abusuabɔ no tua ayɔnkofa ho nimdeɛ a onni a mpɛn pii no ebesiw adamfofa kwan no so ka.[31]

Nhwehwɛmu bi a Frankel ne afoforo yɛe no. kyerɛe sɛ awofo de wɔn ho gye mu ne nkyerɛkyerɛ di dwuma titiriw wɔ mmofra a wɔte saa a wonya adamfofa mu.[32] Nea ɛka awofo a wɔde wɔn ho hyɛ mu ho no, sukuu mu adwumayɛfo di dwuma titiriw wɔ asetra mu nimdeɛ ne atipɛnfo nkitahodi a wɔkyerɛkyerɛ mu. Wɔtaa de paraprofessionals, titiriw no, obiakofo aboafo ne adesuadan mu aboafo, kɔ mmofra a wɔwɔ autism spectrum disorders nkyɛn sɛnea ɛbɛyɛ a wɔbɛma nnamfofa ayɛ mmerɛw na wɔakyerɛ abofra no kwan wɔ adamfofa a ɛho hia a ɔbɛfa na wakura mu.

Ɛwom sɛ asuade ne ntetee betumi aboa mmofra a wɔwɔ autism atipɛnfo de, nanso ayayade da so ara yɛ ade titiriw a ɛhaw adwene wɔ asetra mu tebea horow mu. Sɛnea Anahad O’Connor a ɔwɔ The New York Times mu kyerɛ no, ɛda adi kɛse sɛ ayayade bɛba mmofra a wɔwɔ autism spectrum disorders a wobetumi atra ase a wɔde wɔn ho no so kɛse. Mmofra a wɔte saa no wɔ asiane mu kɛse efisɛ wɔwɔ amanne ahorow no pii ne asetra mu nimdeɛ a wonni te sɛ mmofra a ɛda adi sɛ wɔwɔ autism no, nanso ɛda adi sɛ wɔde wɔn bɛhyɛ sukuu mu titiriw. Mmofra a wɔwɔ autism no wɔ ɔhaw kɛse sɛ wɔbɛhwɛ asetra mu nsɛnkyerɛnne so, na enti ebia ɛnyɛ bere nyinaa na wobehu bere a wɔresisi wɔn.[34]

'''Down yare no ho yare'''

Mmofra a wɔwɔ Down syndrome no ayɛ den kɛse sɛ wɔbɛfa nnamfo. Wohyia kasa a ɛkyɛ a ɛma ɛyɛ den ma wɔn sɛ wɔne mmofra afoforo bedi agoru. Ebia mmofra dodow no ara a wɔwɔ Down syndrome no bɛpɛ sɛ wɔhwɛ sukuufo afoforo na wɔne wɔn adamfo di agoru nanso wɔne wɔn nni agoru, titiriw esiane sɛ wɔte ase sen sɛnea wobetumi ada no adi wɔ akyi nti. Wɔ mfe a wonnya nkɔɔ sukuu mu no, mmofra a wɔwɔ Down syndrome no betumi anya adesuadan mu tebea no so mfaso, a mmofra afoforo atwa wɔn ho ahyia na wɔmfa wɔn ho nto mpanyimfo mmoa so kɛse. Mmofra a wɔadi dɛm yi nya mfaso fi nkitahodi ahorow a wɔne mpanyimfo ne mmofra nyinaa nya no mu. Wɔ sukuu mu no, hwɛ a wɔbɛhwɛ ma wɔanya tebea a obiara bɛka ho wɔ adesuadan mu no betumi ayɛ den, nanso nnamfo a wɔbɛn a wɔbɛn wɔn no betumi ayɛ ade titiriw ama asetra mu nkɔso.[35][36]

== Apomuden ==
Nhwehwɛmu ahorow ada no adi sɛ asetra mu mmoa a emu yɛ den ma obi nya akwahosan pa ne nkwa tenten ho anidaso tu mpɔn. Nea ɛne no bɔ abira no, wɔde ankonamyɛ ne asetra mu mmoa a wonnya no abata asiane a ɛkɔ soro a ɛne sɛ wobenya komayare, mmoawa a wɔde nyarewa ba, ne kokoram, ne nnipa dodow a wowuwu wɔ ne nyinaa mu no ho. Nhwehwɛmufoɔ mmienu mpo afrɛ adamfofa nkitahodiɛ sɛ &quot;suban ho aduru&quot; a ɛma nipadua ne adwene mu akwahosan nyinaa nya nkɔsoɔ.[37]

Nhwehwɛmu pii wɔ hɔ a ɛde adamfofa ne akwahosan bata ho, nanso nea enti pɔtee a ɛde abusuabɔ no ba no da so ara yɛ nea wontumi nhu. Nhwehwɛmu dodow no ara a ɛwɔ saa beae yi yɛ nhwehwɛmu akɛse a wɔhwɛ kwan a edi nnipa akyi bere tenten, na bere a ebia abusuabɔ bi wɔ nneɛma abien a ɛsakra (adamfofa ne akwahosan tebea) no ntam no, nhwehwɛmufo da so ara nnim sɛ ebia abusuabɔ bi wɔ hɔ a ɛde ba ne nea efi mu ba, te sɛ sɛ adwene a ɛne sɛ adamfofa pa ma akwahosan tu mpɔn ankasa. Nsusuwii ahorow bi abɔ mmɔden sɛ wɔbɛkyerɛkyerɛ saa abusuabɔ yi mu. Nea ɛka saa nsusuwii ahorow yi ho ne sɛ nnamfo pa hyɛ wɔn nnamfo nkuran ma wɔbɔ asetra a ahoɔden wom kɛse; sɛ nnamfo pa hyɛ wɔn nnamfo nkuran sɛ wɔnhwehwɛ mmoa na wonnya nnwuma bere a ɛho hia no; sɛ nnamfo pa ma wɔn nnamfonom tumi gyina yare ne akwahosan ho haw afoforo ho dwuma no yɛ kɛse; na sɛ nnamfo pa nya nipadua mu akwan a ɛbɔ akwahosan ho ban no so nkɛntɛnso ankasa.[38]

'''Adwene mu haw'''

Wɔahu sɛ adamfofa a wonni no di dwuma ma asiane a ɛkɔ soro sɛ mmea a wɔrebɛn mpanyin afe so benya adwene a ɛne sɛ wobekum wɔn ho no mu, a nea ɛka ho ne sɛ wobenya nnamfo pii a wɔn ankasa nyɛ wɔn ho wɔn ho nnamfo. Nanso, wɔanhu nkɛntɛnso a ɛte saa ara wɔ mmarima ho.[39][40] Nnamfo kakraa bi a wubenya anaasɛ wunni bi no yɛ ade titiriw a ɛkyerɛ sɛ obi anya adwenemyare ahorow pii.[14]

Adamfofa su a ɛkorɔn no boa tẽẽ ma wonya obu ma wɔn ho, wonya wɔn ho mu ahotoso, na wonya asetra mu nkɔso.[22] World Happiness Database nhwehwɛmu bi kyerɛe sɛ nnipa a wɔwɔ nnamfo paa no ani gye kɛse, ɛwom sɛ nnamfo dodow koraa no amma anigye no ankɔ soro de.[41] Nhwehwɛmu afoforo akyerɛ sɛ mmofra a wɔwɔ adamfofa a ɛkorɔn no betumi abɔ wɔn ho ban afi ɔhaw ahorow bi te sɛ dadwen ne adwenemhaw ho.[42][43] Nea ɛne no bɔ abira no, nnamfo kakraa bi a wubenya no ne sukuu a wogyae, ne basabasayɛ, ne mpanyimfo nsɛmmɔnedi nso wɔ abusuabɔ.[3]: 500 Atipɛnfo a wɔpow wɔn no nso ne akyi apɛde a ɛba fam wɔ adwumayɛfo mu, ne asetra mu dwumadi ahorow mu kyɛfa a wonya, bere a dodow a ɛkɔ soro no wɔ abusuabɔ na adamfofa ne mpanyimfo bu wɔn ho a ɛkorɔn wɔ abusuabɔ.[3]: 500–01

== Nneɛma a wɔde gu mu ==
Wobetumi abu adamfofa bi a wobegu no sɛ ankorankoro pow, anaasɛ ebetumi afi abɔde mu nsakrae a ɛba bere a bere kɔ so no mu aba, bere a nnamfo kɔ akyirikyiri kɛse wɔ honam ne nkate fam no. Wɔde adamfofa a wɔsɛe no no ne afobu, abufuw ne adwenemhaw a ɛkɔ soro no wɔ abusuabɔ, na ebetumi ayɛ nsɛm a ɛhaw adwene kɛse, titiriw wɔ mmofraase. Nanso, wobetumi abrɛ nsunsuanso bɔne a ebetumi aba no ase sɛ wɔde abusuabɔ foforo a emu yɛ den si adamfofa bi a wobegu no ananmu a.[4]: 248

== Nnipa dodow ho nsɛm ==
Nnamfo taa yɛ wɔn ho sɛ wɔn ho wɔn ho kɛse wɔ mfe a wɔadi, ɔbarima ne ɔbea nna, suban, nnuru a wɔde di dwuma ɔkwammɔne so, ankorankoro su, ne adesua mu mmɔdenbɔ mu.[4]: 248 [18]: 426 [25]: 55–56 Wɔ aman a mmusuakuw ahorow gu ahorow mu no, adanse a ɛtrɛw wɔ hɔ a ɛkyerɛ sɛ mmofra ne mmabun taa ne afoforo a wofi mmusuakuw anaa mmusuakuw koro mu fa adamfo, efi ase wɔ mmofra a wonnya nkɔɔ sukuu mu, na ɛkɔ soro wɔ mmofraberem mfinimfini anaa awiei mu hɔ.[4]: 264

'''Nsonsonoe a ɛwɔ mmarima ne mmea ntam'''

Mpɛn pii no, mmea ne mmea adamfofa nkitahodi a ɛda mmofra ntam no taa twe adwene si nnipa ntam abusuabɔ ne mmoa a wɔde ma wɔn ho wɔn ho so. Nea ɛne eyi bɔ abira no, ɔbarima ne ɔbarima ntam nkitahodi taa twe adwene si asetra mu tebea so kɛse. Nea ebefi mu aba ne sɛ, wobetumi de nsiyɛ abu nkate mu ahiade ahorow a wɔda no adi no abam.[44]: 320–02

Mmea bɔ amanneɛ sɛ dadwen, ahoɔyaw, ne abusuabɔ mu ayayade pii na wonnya pintinn pii wɔ wɔn nnamfofa ho. Nanso mmarima de, wɔbɔ amanneɛ sɛ wɔyɛ wɔn honam fam ayayade pii. Ne nyinaa mu no, mmarima ne mmea taa bɔ amanneɛ sɛ wɔanya abotɔyam kakra wɔ wɔn nnamfofa ho.[4]: 249–50

Mmea taa da wɔn ho adi kɛse na wɔda wɔn ho adi kɛse wɔ wɔn bɔbeasu koro adamfofa mu na wɔwɔ nnamfo kakraa bi.[15] Mmarima taa kyerɛkyerɛ abusuabɔ a emu yɛ den mu denam honam fam osuahu ahorow a wɔkyɛ so. Nea ɛne eyi bɔ abira no, mmea taa kyerɛkyerɛ mu kɛse wɔ nkate mu de a wɔkyɛ mu. Mmarima ntaa nna nkate anaa wɔn ankasa nsɛm adi nkyerɛ mmarima afoforo efisɛ wobetumi de saa nsɛm yi adi dwuma atia wɔn. Nanso, wɔbɛda saa nsɛm yi adi akyerɛ mmea (sɛnea wɔne wɔn nni akan), na mmarima taa bu adamfofa a wɔne mmea nya no sɛ nea ntease wom kɛse, emu yɛ den, na ɛyɛ anigye. Mpɛn pii no, mmarima ne mmarima adamfofa te sɛ apam kɛse, bere a mmea ne mmea adamfofa gyina abusuabɔ so kɛse. Nea ɛde ba ne sɛ, eyi nso kyerɛ sɛ ɔbarima ne ɔbarima adamfofa a ɛba awiei no taa yɛ nea ɛhaw nkate kɛse te sɛ ɔbea ne ɔbea adamfofa no.[45][46]

Mmea taa yɛ wɔn a wɔn ho akokwaw wɔ asetra mu sen wɔn atipɛnfo mmarima wɔ mpanyimfo a wɔn mfe akɔ anim mu. Nea afi mu aba ne sɛ, mmarima a wɔn mfe akɔ anim pii betumi de wɔn ho ato ɔhokafo a ɔyɛ ɔbea te sɛ ɔhokafo so de atua wɔn asetra mu nimdeɛ a wonni no ho ka.[25]: 55 Nhwehwɛmu bi kyerɛe sɛ mmea a wɔwɔ Europa ne Amerika Atifi fam no na ɛtaa yɛ kɛse kakra sen mmarima sɛ ɔno ankasa bɛbɔ amanneɛ sɛ ɔwɔ adamfo paa.[47]

'''Amammerɛ'''

Abusuabɔ ahorow a wobu no sɛ nokware adamfofa, sen sɛ ɛbɛyɛ obi a onim no anaa obi a ɔne no yɛ adwuma no gu ahorow sɛnea amammerɛ te. Wɔ amammerɛ a wɔka Borɔfo kasa mu no, ɛnyɛ ade foforo sɛ nkurɔfo de abusuabɔ a ɛyɛ mmerɛw bɛka ho sɛ nnamfo.[48] Wɔ amammerɛ afoforo te sɛ Russiafo ne Polandfo amammerɛ mu no, abusuabɔ a ɛho hia sen biara nkutoo na wobu no sɛ nnamfo. Ebia Russiani benya nnamfo biako anaa baanu a wɔde &quot;pals&quot; anaa nnipa pii a onim wɔn aka ho; Canadani a ɔwɔ tebea a ɛte saa ara mu no betumi abu saa abusuabɔ ahorow yi nyinaa sɛ nnamfo.[48]

Wɔ Atɔe Famfo amammerɛ mu no, wɔtaa bu adamfofa sɛ ɛyɛ ketewaa bi sen abusua anaa ɔdɔ.[49]

Bere a wɔreka adamfofa ho ahyɛde ahorow ho asɛm no wohui sɛ Chinafo a wobisabisaa wɔn nsɛm no huu pii sen wɔn mfɛfo Britaniafo no.[15][ambiguous]

== Nneɛma ahorow a ɛwɔ hɔ ntam ==</text>
      <sha1>pbepb5c294g27ueqjb8vbugiygx1ktl</sha1>
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      <text bytes="19276" xml:space="preserve">Adamfofa yɛ abusuabɔ a ɛda ɔdɔ a ɛda nnipa ntam.[1] Ɛyɛ nnipa ntam abusuabɔ a emu yɛ den sen &quot;onimfoɔ&quot; anaa &quot;fekubɔ&quot;, te sɛ sukuuni, ofipamfo, yɔnko dwumayɛni, anaa yɔnko dwumayɛni.

Wɔ amammerɛ ahorow bi mu no, adamfofa ho adwene no yɛ abusuabɔ kakraa bi a emu dɔ yiye nkutoo; wɔ afoforo te sɛ U.S. ne Canada no, obi betumi anya nnamfo pii, na ebia ɔne onipa biako anaa baanu a wobetumi afrɛ wɔn nnamfo pa anaa nnamfo paa benya abusuabɔ a emu yɛ den kɛse. Nsɛmfua afoforo a wɔka wɔ kasa mu ne besties anaa Best Friends Forever (BFFs). Ɛwom sɛ adamfofa ahorow pii wɔ hɔ, a ebia ɛsono emu bi wɔ mmeae ahorow de, nanso su ahorow bi wɔ abusuabɔ a ɛtete saa pii mu. Nneɛma a ɛtete saa no bi ne sɛ wɔbɛpaw sɛ wɔne wɔn ho wɔn ho bɛtra, bere a wɔde bom tra mu anigye, na wobetumi de wɔn ho ahyɛ dwumadi pa a ɛboa wɔn ho wɔn ho mu.[2]

Ɛtɔ da bi a, wɔma nnamfo da nsow wɔ abusua ho, sɛnea ɛte wɔ asɛm a wɔka sɛ &quot;nnamfo ne abusua&quot; mu no, na ɛtɔ da bi nso a wɔda nsow wɔ adɔfo ho (e.g., &quot;adɔfo ne nnamfo&quot;), ɛwom sɛ wɔde nnamfo a wɔwɔ mfaso ahorow no yɛ nea ɛyɛ kusuu de. Adamfo beae no yɛ beae a wɔbara obi sɛ ɔnsɔre nkɔ ɔdɔfo gyinabea (hwɛ Ɔdɔ a wontua ho ka nso).

Wɔasua adamfofa ho ade wɔ nhomasua mu, te sɛ nkitahodi, asetra ho adesua, asetra mu adwene ho nimdeɛ, nnipa ho adesua, ne nyansapɛ mu. Wɔahyɛ adamfofa ho adesua mu nsusuwii ahorow ho nyansa, a nea ɛka ho ne asetra mu nsakrae ho nsusuwii, pɛyɛ ho nsusuwii, abusuabɔ mu nsɛm a wɔka, ne akwan horow a wɔfa so de wɔn ho bata ho. 

== Nkɔso ho adwene ho nimdeɛ ==
'''Mmɔfrabrɛ'''

Ntease a ɛfa adamfofa ho wɔ mmofra mu no taa twe adwene si mmeae te sɛ dwumadi ahorow a wɔtaa yɛ, honam fam a wɔbɛn wɔn ho, ne akwanhwɛ a wɔkyɛ so kɛse.[3]: 498 [a] Saa adamfofa ahorow yi ma wonya hokwan di agoru na wɔde wɔn ho hyɛ mu. 246 Mmofra dodow no ara taa kyerɛkyerɛ adamfofa mu denam nneɛma te sɛ kyɛfa so, na mmofra taa ne obi a wobu no sɛ ɔyɛ adamfo no kyɛ.[4]: 246 [5][6] Bere a mmofra nyin no, wɔnyɛ ankorankoro ho ade pii na no nim afoforo yiye. Wonya tumi a wɔde benya tema ma wɔn nnamfo, na wɔn ani gye ho sɛ wobedi agoru wɔ akuw mu. Wonya atipɛnfo a wɔpow wɔn nso bere a wɔrekɔ so wɔ mmofraberem mfe no mfinimfini no. Nnamfo pa a obenya wɔ ne mmofraase no boa ma abofra nya ne ho yiye wɔ ɔmanfo mu akyiri yi wɔ n’asetra mu.[5]

Sɛ wogyina akyerɛkyerɛfo ne ɛnanom amanneɛbɔ so a, anyɛ yiye koraa no, mmofra a wonnya nkɔɔ sukuu no mu 75% wɔ adamfo biako. Saa dodow yi kɔɔ soro koduu 78% kosii adesuakuw a ɛto so anum no mu, sɛnea wɔde co-nomination sɛ nnamfo susuw no, na 55% wɔ mutual adamfo paa.[4]: 247 Wohui sɛ mmofra bɛyɛ 15% nni adamfo a enni sabea, bɔɔ amanneɛ sɛ wɔmfa wɔn ho wɔn ho nkɔ nnamfo anyɛ yiye koraa no asram asia.[4]: 250

Mfaso a ebetumi aba wɔ adamfofa so no bi ne hokwan a wobenya de asua tema ne ɔhaw ahorow ano aduru ho ade.[7] Ntetee a awofo de ma no betumi ayɛ nea mfaso wɔ so wɔ mmofra a wɔbɛboa wɔn ma wɔanya nnamfo no mu. Eileen Kennedy-Moore ka nneɛma atitiriw abiɛsa a ɛma mmofra nya adamfofa ho asɛm: (1) wobue wɔn ani, (2) nsɛdi, ne (3) anigye a wɔkyɛ.[8][9][10] Awofoɔ nso bɛtumi aboa mmofra ama wɔate asetena mu akwankyerɛ a wɔn ankasa nsuaa no ase.[11] Kennedy-Moore retwe adwene asi nhwehwɛmu a Robert Selman[12] ne afoforo yɛe mu no, ɔkyerɛkyerɛ nkɔso fã ahorow wɔ mmofra adamfofa mu, a ɛda tumi a ɛrenya nkɔanim a ɛma wɔte afoforo adwene ase adi: &quot;Mepɛ Ɛyɛ Me Kwan&quot;, &quot;Dɛn na Ɛwɔ Mu Ma Me?&quot;, Ɛdenam Mmara no so&quot;, &quot;Adwene ne Kyɛfa&quot;, ne &quot;Nnamfo a Wɔnam Thick ne Thin So.&quot;[13]

'''Mmabunbere'''

Wɔ mmerantebere ne mmabaabere mu no, nnamfofa bɛyɛ “ade a ɛma ade kɛse, nea ɛkyɛ, nea ɛka no pen, ɛboa, na ɛba ara kwa.” Mmabun taa hwehwɛ atipɛnfo a wobetumi de su horow a ɛte saa ama wɔ abusuabɔ a ɛda wɔn ho wɔn ho ntam, na wɔkwati atipɛnfo a wɔn nneyɛe a ɛyɛ ɔhaw no kyerɛ sɛ ebia wɔrentumi nni saa ahiade ahorow yi ho dwuma.[14] Ankorankoro su ne ne su nso yɛ nneɛma a mmabun hwehwɛ, bere a wɔrepaw nea wɔne no befi ase afa adamfo no.[15] Abusuabɔ fi ase kɔ so de wɔn adwene si gyinapɛn ahorow a wɔkyɛ, nokwaredi, ne nneɛma a wɔn nyinaa ani gye ho so, sen sɛ wɔde wɔn adwene besi honam fam nneɛma te sɛ bɛn a wɔbɛn wɔn ho ne sɛnea wobetumi adi agoru nneɛma a ɛkyerɛ mmofraberem kɛse.[4]: 246

Nhwehwɛmu bi a wɔyɛe wɔ Texas Sukuupɔn a ɛwɔ Austin mu no hwehwɛɛ Amerikafo mmabun bɛboro 9,000 mu de huu sɛnea wɔn ho a wɔde hyɛ nneyɛe a ɛhaw adwene (te sɛ korɔnbɔ, ntɔkwaw, ne sukuu a wonkɔ sukuu) mu no ne wɔn nnamfofa no wɔ abusuabɔ. Nneɛma a wohui kyerɛe sɛ mmabun ntaa mfa wɔn ho nhyɛ ɔhaw mu nneyɛe mu bere a wɔn nnamfonom yɛ ade yiye wɔ sukuu mu, wɔde wɔn ho hyɛ sukuu dwumadi ahorow mu, wɔkwati nsanom, na wɔwɔ adwenemyare pa no. Wohuu nea ɛne eyi bɔ abira wɔ mmabun a wɔde wɔn ho hyɛɛ nneyɛe a ɔhaw wom mu ampa no ho. Sɛ́ ebia mmabun nyaa wɔn nnamfo so nkɛntɛnso ma wɔde wɔn ho hyɛ ɔhaw suban mu no gyina sɛnea wɔde wɔn ho hyɛɛ saa nnamfo no mu, ne sɛ ebia wɔne wɔn adamfofa akuw ahorow no &quot;fata&quot; wɔ sukuu mu no so.[16]

Nhwehwɛmu bi a nhwehwɛmufo a wofi Purdue Sukuupɔn mu yɛe no kyerɛe sɛ nnamfo a wonyae wɔ ntoaso sukuu akyi adesua mu no kyɛ sen nnamfo a wonyae kan no.[17] Wɔ mmerantebere ne mmabaabere awiei mu no, mmusuakuw ntam adamfofa taa yɛ nea ɛntaa nsi, na ɛbɛyɛ sɛ efi adwemmɔne ne amammerɛ mu nsonsonoe.[15]

'''Mpanyimfoyɛ'''

.

Adamfofa a wonya wɔ mpanyin afe so no ma wonya ayɔnkofa, ɔdɔ, ne nkate mu mmoa, na ɛboa yiye ma adwene mu yiyedi ne nipadua akwahosan tu mpɔn.[18]: 426

Ebia ɛbɛyɛ den ama mpanyimfo titiriw sɛ wobenya nnamfo a mfaso wɔ so wɔ adwumam. &quot;Adwumam betumi ayɛ krak esiane akansi nti, enti nkurɔfo sua sɛ wɔde mmerɛwyɛ ne nneɛma a ɛyɛ nwonwa besie mfɛfo adwumayɛfo. Adwuma mu adamfofa taa nya nkitahodi ho nkate; ɛyɛ den sɛ wobɛka baabi a nkitahodi ba awiei na adamfofa ankasa fi ase.&quot;[19] Mpanyimfo dodow no ara bu sikasɛm sɛ ɛsom bo wɔn nnwuma ahobammɔ sen adamfofa a wɔne wɔn mfɛfo adwumayɛfo benya.[20]

Sɛ wɔkyekyem pɛpɛɛpɛ a, mpanyimfo dodow no ara wɔ nnamfo paa baanu.[21] Nhwehwɛmu pii a wɔyɛe wɔ mpanyimfo ho no kyerɛ sɛ adamfofa ne abusuabɔ afoforo a ɛboa ma obu a obi wɔ ma ne ho no yɛ kɛse ampa.[22]

Mpanyimfo a wɔn mfe akɔ anim

Mpanyimfo a wɔn mfe akɔ anim kɔ so bɔ amanneɛ sɛ wonya ankorankoro abotɔyam kɛse wɔ wɔn nnamfofa mu bere a wɔrenyin no, bere mpo a nnamfo dodow nyinaa taa so tew no. Saa abotɔyam yi ne tumi a ɛma wotumi yɛ da biara da asetra mu dwumadi ahorow a ɛkɔ soro, ne adwene mu tumi a ɛso tew, ayaresabea a wɔde obi kɔ no a ɛso tew, ne nea efi mu ba a eye a ɛfa ahosiesie ho no wɔ abusuabɔ.[18]: 427 Nnamfo dodow a wɔbɔɔ ho amanneɛ wɔ akyiri yi mu no nyinaa asetra betumi ayɛ ntamgyinafo denam pefeeyɛ a ɛkɔ soro, kasa ne anisoadehu a eye, ne aware mu tebea so.[23]: 53 Nnamfo dodow a ankorankoro bi nya bere a wɔrenyin no so tew no, wɔde Carstensen Socioemotional Selectivity Theory a ɛkyerɛkyerɛ nsakrae a ɛba wɔ mu no akyerɛkyerɛ mu nkannyan a mpanyimfo nya bere a wɔrebɔ fekuw no. Nsusuwii no ka sɛ mfe a obi adi a ɛkɔ soro no yɛ nsakrae a ɛba fi nsɛm a wɔboaboa ano so kɔ nkate mu nhyehyɛe so; sɛnea ɛbɛyɛ a wobetumi akura nkate pa mu no, mpanyimfo a wɔn mfe akɔ anim no de wɔn asetra mu akuw no to wɔn a wɔwɔ nkate mu abusuabɔ bi nkutoo so.[24]

''Sɛnea nhwehwɛmu bi kae no'':

Nhwehwɛmu a wɔayɛ wɔ mfe aduanan a atwam no mu no ahu bere nyinaa mprempren sɛ mpanyimfo a wɔn mfe akɔ anim a wɔbɔ amanneɛ sɛ wɔwɔ anigye ne yiyedi a ɛkɔ soro sen biara no nso bɔ amanneɛ sɛ wɔne nnamfo pii wɔ abusuabɔ a emu yɛ den na emu yɛ den.[25]

Bere a abusua mu asɛyɛde ne adwumayɛ ho nhyɛso so tew no, nnamfofa bɛyɛ nea ɛho hia kɛse. Wɔ nkwakoraa ne mmerewa mu no, adamfofa betumi ama wɔanya abusuabɔ a ɛda ɔmanfo kɛse no ntam, ayɛ ade a ɛbɔ wɔn ho ban fi adwenemhaw ne ankonamyɛ ho, na atua nneɛma a ebetumi ahwere wɔ asetra mu mmoa a abusua no mufo adi kan de ama no ho ka.[26]: 32–33 Titiriw ma nnipa a wontumi nkɔ out sɛnea ɛtaa ba no, nkitahodi a wɔne nnamfo di no ma kwan ma wɔkɔ so nya ɔmanfo nkitahodi. Bio nso, mpanyimfo a wɔn mfe akɔ anim a wɔn akwahosan rekɔ fam a wɔda so ara ne wɔn nnamfo di nkitaho no kyerɛ sɛ wɔn adwene mu yiyedi atu mpɔn.[27

== Nkɔso ho nsɛm ==
'''Adwene a ɛmma obi ntumi nyɛ hwee a ɛma obi yɛ ade tra so'''

Ebia ɛbɛyɛ den ama mmofra a wɔwɔ adwene a wɔde si biribi so a ɛtra so (ADHD) no sɛ wɔbɛfa nnamfo na wɔakura mu, esiane sɛ wontumi mfa adesua a wɔde hwɛ ade so nkyekye asetra mu nimdeɛ pii nti, nsɛnnennen a ɛwɔ wɔn asetram nsɛnkyerɛnne a wɔde wɔn adwene si so, ne nkɛntɛnso a nneyɛe a wɔde wɔn ho hyɛ mu no nya wɔ asetra mu ne su kɛse a ɛne sɛ wɔbɛyɛ saa nti de wɔn ho hyɛ nneyɛe a ebia wɔn atipɛnfo behu sɛ ɛhaw adwene mu.[28][29] Wɔ afe 2007 nhwehwɛmu bi mu no, wɔanhunu ayaresa biara a ɛdi atipɛnfoɔ dwumadie ho dwuma yie wɔ mmofra a wɔwɔ ADHD mu, na wɔanhunu ayaresa a ɛdi ɔhaw no afã foforɔ ho dwuma no yi nsɛm a ɛfa atipɛnfoɔ dwumadie ho no firi hɔ.

'''Autism a ɛyɛ hu'''

Autism spectrum disorders ho sɛnkyerɛnne ahorow bi betumi asiw nnipa ntam abusuabɔ a ɛbɛba no kwan, te sɛ nneyɛe a wɔtaa yɛ a wɔpɛ, nsakrae a wɔko tia, nneɛma pɔtee bi a n’ani gye ho anaa amanne ahorow a wɔde wɔn ho hyɛ mu, ne asetra mu nimdeɛ a wonni. Wɔahu sɛ mmofra a wɔwɔ autism no taa yɛ onipa biako nnamfo paa, sen sɛ wobenya nnamfo akuw. Bio nso, wɔtaa yɛ mmofra afoforo a wɔadi dɛm bi nnamfo paa.[30] Awofo a wɔde wɔn ho abɔ wɔn ho ho adwene boa ma mmofra a wɔwɔ autism spectrum disorders no adamfofa yɛ papa; obi a ɔte nka sɛ ɔne n’awofo wɔ abusuabɔ no tua ayɔnkofa ho nimdeɛ a onni a mpɛn pii no ebesiw adamfofa kwan no so ka.[31]

Nhwehwɛmu bi a Frankel ne afoforo yɛe no. kyerɛe sɛ awofo de wɔn ho gye mu ne nkyerɛkyerɛ di dwuma titiriw wɔ mmofra a wɔte saa a wonya adamfofa mu.[32] Nea ɛka awofo a wɔde wɔn ho hyɛ mu ho no, sukuu mu adwumayɛfo di dwuma titiriw wɔ asetra mu nimdeɛ ne atipɛnfo nkitahodi a wɔkyerɛkyerɛ mu. Wɔtaa de paraprofessionals, titiriw no, obiakofo aboafo ne adesuadan mu aboafo, kɔ mmofra a wɔwɔ autism spectrum disorders nkyɛn sɛnea ɛbɛyɛ a wɔbɛma nnamfofa ayɛ mmerɛw na wɔakyerɛ abofra no kwan wɔ adamfofa a ɛho hia a ɔbɛfa na wakura mu.

Ɛwom sɛ asuade ne ntetee betumi aboa mmofra a wɔwɔ autism atipɛnfo de, nanso ayayade da so ara yɛ ade titiriw a ɛhaw adwene wɔ asetra mu tebea horow mu. Sɛnea Anahad O’Connor a ɔwɔ The New York Times mu kyerɛ no, ɛda adi kɛse sɛ ayayade bɛba mmofra a wɔwɔ autism spectrum disorders a wobetumi atra ase a wɔde wɔn ho no so kɛse. Mmofra a wɔte saa no wɔ asiane mu kɛse efisɛ wɔwɔ amanne ahorow no pii ne asetra mu nimdeɛ a wonni te sɛ mmofra a ɛda adi sɛ wɔwɔ autism no, nanso ɛda adi sɛ wɔde wɔn bɛhyɛ sukuu mu titiriw. Mmofra a wɔwɔ autism no wɔ ɔhaw kɛse sɛ wɔbɛhwɛ asetra mu nsɛnkyerɛnne so, na enti ebia ɛnyɛ bere nyinaa na wobehu bere a wɔresisi wɔn.[34]

'''Down yare no ho yare'''

Mmofra a wɔwɔ Down syndrome no ayɛ den kɛse sɛ wɔbɛfa nnamfo. Wohyia kasa a ɛkyɛ a ɛma ɛyɛ den ma wɔn sɛ wɔne mmofra afoforo bedi agoru. Ebia mmofra dodow no ara a wɔwɔ Down syndrome no bɛpɛ sɛ wɔhwɛ sukuufo afoforo na wɔne wɔn adamfo di agoru nanso wɔne wɔn nni agoru, titiriw esiane sɛ wɔte ase sen sɛnea wobetumi ada no adi wɔ akyi nti. Wɔ mfe a wonnya nkɔɔ sukuu mu no, mmofra a wɔwɔ Down syndrome no betumi anya adesuadan mu tebea no so mfaso, a mmofra afoforo atwa wɔn ho ahyia na wɔmfa wɔn ho nto mpanyimfo mmoa so kɛse. Mmofra a wɔadi dɛm yi nya mfaso fi nkitahodi ahorow a wɔne mpanyimfo ne mmofra nyinaa nya no mu. Wɔ sukuu mu no, hwɛ a wɔbɛhwɛ ma wɔanya tebea a obiara bɛka ho wɔ adesuadan mu no betumi ayɛ den, nanso nnamfo a wɔbɛn a wɔbɛn wɔn no betumi ayɛ ade titiriw ama asetra mu nkɔso.[35][36]

== Apomuden ==
Nhwehwɛmu ahorow ada no adi sɛ asetra mu mmoa a emu yɛ den ma obi nya akwahosan pa ne nkwa tenten ho anidaso tu mpɔn. Nea ɛne no bɔ abira no, wɔde ankonamyɛ ne asetra mu mmoa a wonnya no abata asiane a ɛkɔ soro a ɛne sɛ wobenya komayare, mmoawa a wɔde nyarewa ba, ne kokoram, ne nnipa dodow a wowuwu wɔ ne nyinaa mu no ho. Nhwehwɛmufoɔ mmienu mpo afrɛ adamfofa nkitahodiɛ sɛ &quot;suban ho aduru&quot; a ɛma nipadua ne adwene mu akwahosan nyinaa nya nkɔsoɔ.[37]

Nhwehwɛmu pii wɔ hɔ a ɛde adamfofa ne akwahosan bata ho, nanso nea enti pɔtee a ɛde abusuabɔ no ba no da so ara yɛ nea wontumi nhu. Nhwehwɛmu dodow no ara a ɛwɔ saa beae yi yɛ nhwehwɛmu akɛse a wɔhwɛ kwan a edi nnipa akyi bere tenten, na bere a ebia abusuabɔ bi wɔ nneɛma abien a ɛsakra (adamfofa ne akwahosan tebea) no ntam no, nhwehwɛmufo da so ara nnim sɛ ebia abusuabɔ bi wɔ hɔ a ɛde ba ne nea efi mu ba, te sɛ sɛ adwene a ɛne sɛ adamfofa pa ma akwahosan tu mpɔn ankasa. Nsusuwii ahorow bi abɔ mmɔden sɛ wɔbɛkyerɛkyerɛ saa abusuabɔ yi mu. Nea ɛka saa nsusuwii ahorow yi ho ne sɛ nnamfo pa hyɛ wɔn nnamfo nkuran ma wɔbɔ asetra a ahoɔden wom kɛse; sɛ nnamfo pa hyɛ wɔn nnamfo nkuran sɛ wɔnhwehwɛ mmoa na wonnya nnwuma bere a ɛho hia no; sɛ nnamfo pa ma wɔn nnamfonom tumi gyina yare ne akwahosan ho haw afoforo ho dwuma no yɛ kɛse; na sɛ nnamfo pa nya nipadua mu akwan a ɛbɔ akwahosan ho ban no so nkɛntɛnso ankasa.[38]

'''Adwene mu haw'''

Wɔahu sɛ adamfofa a wonni no di dwuma ma asiane a ɛkɔ soro sɛ mmea a wɔrebɛn mpanyin afe so benya adwene a ɛne sɛ wobekum wɔn ho no mu, a nea ɛka ho ne sɛ wobenya nnamfo pii a wɔn ankasa nyɛ wɔn ho wɔn ho nnamfo. Nanso, wɔanhu nkɛntɛnso a ɛte saa ara wɔ mmarima ho.[39][40] Nnamfo kakraa bi a wubenya anaasɛ wunni bi no yɛ ade titiriw a ɛkyerɛ sɛ obi anya adwenemyare ahorow pii.[14]

Adamfofa su a ɛkorɔn no boa tẽẽ ma wonya obu ma wɔn ho, wonya wɔn ho mu ahotoso, na wonya asetra mu nkɔso.[22] World Happiness Database nhwehwɛmu bi kyerɛe sɛ nnipa a wɔwɔ nnamfo paa no ani gye kɛse, ɛwom sɛ nnamfo dodow koraa no amma anigye no ankɔ soro de.[41] Nhwehwɛmu afoforo akyerɛ sɛ mmofra a wɔwɔ adamfofa a ɛkorɔn no betumi abɔ wɔn ho ban afi ɔhaw ahorow bi te sɛ dadwen ne adwenemhaw ho.[42][43] Nea ɛne no bɔ abira no, nnamfo kakraa bi a wubenya no ne sukuu a wogyae, ne basabasayɛ, ne mpanyimfo nsɛmmɔnedi nso wɔ abusuabɔ.[3]: 500 Atipɛnfo a wɔpow wɔn no nso ne akyi apɛde a ɛba fam wɔ adwumayɛfo mu, ne asetra mu dwumadi ahorow mu kyɛfa a wonya, bere a dodow a ɛkɔ soro no wɔ abusuabɔ na adamfofa ne mpanyimfo bu wɔn ho a ɛkorɔn wɔ abusuabɔ.[3]: 500–01

== Nneɛma a wɔde gu mu ==
Wobetumi abu adamfofa bi a wobegu no sɛ ankorankoro pow, anaasɛ ebetumi afi abɔde mu nsakrae a ɛba bere a bere kɔ so no mu aba, bere a nnamfo kɔ akyirikyiri kɛse wɔ honam ne nkate fam no. Wɔde adamfofa a wɔsɛe no no ne afobu, abufuw ne adwenemhaw a ɛkɔ soro no wɔ abusuabɔ, na ebetumi ayɛ nsɛm a ɛhaw adwene kɛse, titiriw wɔ mmofraase. Nanso, wobetumi abrɛ nsunsuanso bɔne a ebetumi aba no ase sɛ wɔde abusuabɔ foforo a emu yɛ den si adamfofa bi a wobegu no ananmu a.[4]: 248

== Nnipa dodow ho nsɛm ==
Nnamfo taa yɛ wɔn ho sɛ wɔn ho wɔn ho kɛse wɔ mfe a wɔadi, ɔbarima ne ɔbea nna, suban, nnuru a wɔde di dwuma ɔkwammɔne so, ankorankoro su, ne adesua mu mmɔdenbɔ mu.[4]: 248 [18]: 426 [25]: 55–56 Wɔ aman a mmusuakuw ahorow gu ahorow mu no, adanse a ɛtrɛw wɔ hɔ a ɛkyerɛ sɛ mmofra ne mmabun taa ne afoforo a wofi mmusuakuw anaa mmusuakuw koro mu fa adamfo, efi ase wɔ mmofra a wonnya nkɔɔ sukuu mu, na ɛkɔ soro wɔ mmofraberem mfinimfini anaa awiei mu hɔ.[4]: 264

'''Nsonsonoe a ɛwɔ mmarima ne mmea ntam'''

Mpɛn pii no, mmea ne mmea adamfofa nkitahodi a ɛda mmofra ntam no taa twe adwene si nnipa ntam abusuabɔ ne mmoa a wɔde ma wɔn ho wɔn ho so. Nea ɛne eyi bɔ abira no, ɔbarima ne ɔbarima ntam nkitahodi taa twe adwene si asetra mu tebea so kɛse. Nea ebefi mu aba ne sɛ, wobetumi de nsiyɛ abu nkate mu ahiade ahorow a wɔda no adi no abam.[44]: 320–02

Mmea bɔ amanneɛ sɛ dadwen, ahoɔyaw, ne abusuabɔ mu ayayade pii na wonnya pintinn pii wɔ wɔn nnamfofa ho. Nanso mmarima de, wɔbɔ amanneɛ sɛ wɔyɛ wɔn honam fam ayayade pii. Ne nyinaa mu no, mmarima ne mmea taa bɔ amanneɛ sɛ wɔanya abotɔyam kakra wɔ wɔn nnamfofa ho.[4]: 249–50

Mmea taa da wɔn ho adi kɛse na wɔda wɔn ho adi kɛse wɔ wɔn bɔbeasu koro adamfofa mu na wɔwɔ nnamfo kakraa bi.[15] Mmarima taa kyerɛkyerɛ abusuabɔ a emu yɛ den mu denam honam fam osuahu ahorow a wɔkyɛ so. Nea ɛne eyi bɔ abira no, mmea taa kyerɛkyerɛ mu kɛse wɔ nkate mu de a wɔkyɛ mu. Mmarima ntaa nna nkate anaa wɔn ankasa nsɛm adi nkyerɛ mmarima afoforo efisɛ wobetumi de saa nsɛm yi adi dwuma atia wɔn. Nanso, wɔbɛda saa nsɛm yi adi akyerɛ mmea (sɛnea wɔne wɔn nni akan), na mmarima taa bu adamfofa a wɔne mmea nya no sɛ nea ntease wom kɛse, emu yɛ den, na ɛyɛ anigye. Mpɛn pii no, mmarima ne mmarima adamfofa te sɛ apam kɛse, bere a mmea ne mmea adamfofa gyina abusuabɔ so kɛse. Nea ɛde ba ne sɛ, eyi nso kyerɛ sɛ ɔbarima ne ɔbarima adamfofa a ɛba awiei no taa yɛ nea ɛhaw nkate kɛse te sɛ ɔbea ne ɔbea adamfofa no.[45][46]

Mmea taa yɛ wɔn a wɔn ho akokwaw wɔ asetra mu sen wɔn atipɛnfo mmarima wɔ mpanyimfo a wɔn mfe akɔ anim mu. Nea afi mu aba ne sɛ, mmarima a wɔn mfe akɔ anim pii betumi de wɔn ho ato ɔhokafo a ɔyɛ ɔbea te sɛ ɔhokafo so de atua wɔn asetra mu nimdeɛ a wonni no ho ka.[25]: 55 Nhwehwɛmu bi kyerɛe sɛ mmea a wɔwɔ Europa ne Amerika Atifi fam no na ɛtaa yɛ kɛse kakra sen mmarima sɛ ɔno ankasa bɛbɔ amanneɛ sɛ ɔwɔ adamfo paa.[47]

'''Amammerɛ'''

Abusuabɔ ahorow a wobu no sɛ nokware adamfofa, sen sɛ ɛbɛyɛ obi a onim no anaa obi a ɔne no yɛ adwuma no gu ahorow sɛnea amammerɛ te. Wɔ amammerɛ a wɔka Borɔfo kasa mu no, ɛnyɛ ade foforo sɛ nkurɔfo de abusuabɔ a ɛyɛ mmerɛw bɛka ho sɛ nnamfo.[48] Wɔ amammerɛ afoforo te sɛ Russiafo ne Polandfo amammerɛ mu no, abusuabɔ a ɛho hia sen biara nkutoo na wobu no sɛ nnamfo. Ebia Russiani benya nnamfo biako anaa baanu a wɔde &quot;pals&quot; anaa nnipa pii a onim wɔn aka ho; Canadani a ɔwɔ tebea a ɛte saa ara mu no betumi abu saa abusuabɔ ahorow yi nyinaa sɛ nnamfo.[48]

Wɔ Atɔe Famfo amammerɛ mu no, wɔtaa bu adamfofa sɛ ɛyɛ ketewaa bi sen abusua anaa ɔdɔ.[49]

Bere a wɔreka adamfofa ho ahyɛde ahorow ho asɛm no wohui sɛ Chinafo a wobisabisaa wɔn nsɛm no huu pii sen wɔn mfɛfo Britaniafo no.[15][ambiguous]

== Nneɛma ahorow a ɛwɔ hɔ ntam ==
Wohu adamfofa wɔ mmoa a wɔn nyansa kɔ soro te sɛ mmoa a wɔnom nufusu a wɔkorɔn ne nnomaa binom mu. Nnamfofa a ɛda nnipa ne afieboa ntam abu so. Mmoa abien a wɔnyɛ nnipa te sɛ akraman ne mpɔtorɔ nso betumi anya adamfofa a ɛda mmoa ahorow ntam.</text>
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      <text bytes="19282" xml:space="preserve">'''Adamfofa''' yɛ abusuabɔ a ɛda ɔdɔ a ɛda nnipa ntam.[1] Ɛyɛ nnipa ntam abusuabɔ a emu yɛ den sen &quot;onimfoɔ&quot; anaa &quot;fekubɔ&quot;, te sɛ sukuuni, ofipamfo, yɔnko dwumayɛni, anaa yɔnko dwumayɛni.

Wɔ amammerɛ ahorow bi mu no, adamfofa ho adwene no yɛ abusuabɔ kakraa bi a emu dɔ yiye nkutoo; wɔ afoforo te sɛ U.S. ne Canada no, obi betumi anya nnamfo pii, na ebia ɔne onipa biako anaa baanu a wobetumi afrɛ wɔn nnamfo pa anaa nnamfo paa benya abusuabɔ a emu yɛ den kɛse. Nsɛmfua afoforo a wɔka wɔ kasa mu ne besties anaa Best Friends Forever (BFFs). Ɛwom sɛ adamfofa ahorow pii wɔ hɔ, a ebia ɛsono emu bi wɔ mmeae ahorow de, nanso su ahorow bi wɔ abusuabɔ a ɛtete saa pii mu. Nneɛma a ɛtete saa no bi ne sɛ wɔbɛpaw sɛ wɔne wɔn ho wɔn ho bɛtra, bere a wɔde bom tra mu anigye, na wobetumi de wɔn ho ahyɛ dwumadi pa a ɛboa wɔn ho wɔn ho mu.[2]

Ɛtɔ da bi a, wɔma nnamfo da nsow wɔ abusua ho, sɛnea ɛte wɔ asɛm a wɔka sɛ &quot;nnamfo ne abusua&quot; mu no, na ɛtɔ da bi nso a wɔda nsow wɔ adɔfo ho (e.g., &quot;adɔfo ne nnamfo&quot;), ɛwom sɛ wɔde nnamfo a wɔwɔ mfaso ahorow no yɛ nea ɛyɛ kusuu de. Adamfo beae no yɛ beae a wɔbara obi sɛ ɔnsɔre nkɔ ɔdɔfo gyinabea (hwɛ Ɔdɔ a wontua ho ka nso).

Wɔasua adamfofa ho ade wɔ nhomasua mu, te sɛ nkitahodi, asetra ho adesua, asetra mu adwene ho nimdeɛ, nnipa ho adesua, ne nyansapɛ mu. Wɔahyɛ adamfofa ho adesua mu nsusuwii ahorow ho nyansa, a nea ɛka ho ne asetra mu nsakrae ho nsusuwii, pɛyɛ ho nsusuwii, abusuabɔ mu nsɛm a wɔka, ne akwan horow a wɔfa so de wɔn ho bata ho. 

== Nkɔso ho adwene ho nimdeɛ ==
'''Mmɔfrabrɛ'''

Ntease a ɛfa adamfofa ho wɔ mmofra mu no taa twe adwene si mmeae te sɛ dwumadi ahorow a wɔtaa yɛ, honam fam a wɔbɛn wɔn ho, ne akwanhwɛ a wɔkyɛ so kɛse.[3]: 498 [a] Saa adamfofa ahorow yi ma wonya hokwan di agoru na wɔde wɔn ho hyɛ mu. 246 Mmofra dodow no ara taa kyerɛkyerɛ adamfofa mu denam nneɛma te sɛ kyɛfa so, na mmofra taa ne obi a wobu no sɛ ɔyɛ adamfo no kyɛ.[4]: 246 [5][6] Bere a mmofra nyin no, wɔnyɛ ankorankoro ho ade pii na no nim afoforo yiye. Wonya tumi a wɔde benya tema ma wɔn nnamfo, na wɔn ani gye ho sɛ wobedi agoru wɔ akuw mu. Wonya atipɛnfo a wɔpow wɔn nso bere a wɔrekɔ so wɔ mmofraberem mfe no mfinimfini no. Nnamfo pa a obenya wɔ ne mmofraase no boa ma abofra nya ne ho yiye wɔ ɔmanfo mu akyiri yi wɔ n’asetra mu.[5]

Sɛ wogyina akyerɛkyerɛfo ne ɛnanom amanneɛbɔ so a, anyɛ yiye koraa no, mmofra a wonnya nkɔɔ sukuu no mu 75% wɔ adamfo biako. Saa dodow yi kɔɔ soro koduu 78% kosii adesuakuw a ɛto so anum no mu, sɛnea wɔde co-nomination sɛ nnamfo susuw no, na 55% wɔ mutual adamfo paa.[4]: 247 Wohui sɛ mmofra bɛyɛ 15% nni adamfo a enni sabea, bɔɔ amanneɛ sɛ wɔmfa wɔn ho wɔn ho nkɔ nnamfo anyɛ yiye koraa no asram asia.[4]: 250

Mfaso a ebetumi aba wɔ adamfofa so no bi ne hokwan a wobenya de asua tema ne ɔhaw ahorow ano aduru ho ade.[7] Ntetee a awofo de ma no betumi ayɛ nea mfaso wɔ so wɔ mmofra a wɔbɛboa wɔn ma wɔanya nnamfo no mu. Eileen Kennedy-Moore ka nneɛma atitiriw abiɛsa a ɛma mmofra nya adamfofa ho asɛm: (1) wobue wɔn ani, (2) nsɛdi, ne (3) anigye a wɔkyɛ.[8][9][10] Awofoɔ nso bɛtumi aboa mmofra ama wɔate asetena mu akwankyerɛ a wɔn ankasa nsuaa no ase.[11] Kennedy-Moore retwe adwene asi nhwehwɛmu a Robert Selman[12] ne afoforo yɛe mu no, ɔkyerɛkyerɛ nkɔso fã ahorow wɔ mmofra adamfofa mu, a ɛda tumi a ɛrenya nkɔanim a ɛma wɔte afoforo adwene ase adi: &quot;Mepɛ Ɛyɛ Me Kwan&quot;, &quot;Dɛn na Ɛwɔ Mu Ma Me?&quot;, Ɛdenam Mmara no so&quot;, &quot;Adwene ne Kyɛfa&quot;, ne &quot;Nnamfo a Wɔnam Thick ne Thin So.&quot;[13]

'''Mmabunbere'''

Wɔ mmerantebere ne mmabaabere mu no, nnamfofa bɛyɛ “ade a ɛma ade kɛse, nea ɛkyɛ, nea ɛka no pen, ɛboa, na ɛba ara kwa.” Mmabun taa hwehwɛ atipɛnfo a wobetumi de su horow a ɛte saa ama wɔ abusuabɔ a ɛda wɔn ho wɔn ho ntam, na wɔkwati atipɛnfo a wɔn nneyɛe a ɛyɛ ɔhaw no kyerɛ sɛ ebia wɔrentumi nni saa ahiade ahorow yi ho dwuma.[14] Ankorankoro su ne ne su nso yɛ nneɛma a mmabun hwehwɛ, bere a wɔrepaw nea wɔne no befi ase afa adamfo no.[15] Abusuabɔ fi ase kɔ so de wɔn adwene si gyinapɛn ahorow a wɔkyɛ, nokwaredi, ne nneɛma a wɔn nyinaa ani gye ho so, sen sɛ wɔde wɔn adwene besi honam fam nneɛma te sɛ bɛn a wɔbɛn wɔn ho ne sɛnea wobetumi adi agoru nneɛma a ɛkyerɛ mmofraberem kɛse.[4]: 246

Nhwehwɛmu bi a wɔyɛe wɔ Texas Sukuupɔn a ɛwɔ Austin mu no hwehwɛɛ Amerikafo mmabun bɛboro 9,000 mu de huu sɛnea wɔn ho a wɔde hyɛ nneyɛe a ɛhaw adwene (te sɛ korɔnbɔ, ntɔkwaw, ne sukuu a wonkɔ sukuu) mu no ne wɔn nnamfofa no wɔ abusuabɔ. Nneɛma a wohui kyerɛe sɛ mmabun ntaa mfa wɔn ho nhyɛ ɔhaw mu nneyɛe mu bere a wɔn nnamfonom yɛ ade yiye wɔ sukuu mu, wɔde wɔn ho hyɛ sukuu dwumadi ahorow mu, wɔkwati nsanom, na wɔwɔ adwenemyare pa no. Wohuu nea ɛne eyi bɔ abira wɔ mmabun a wɔde wɔn ho hyɛɛ nneyɛe a ɔhaw wom mu ampa no ho. Sɛ́ ebia mmabun nyaa wɔn nnamfo so nkɛntɛnso ma wɔde wɔn ho hyɛ ɔhaw suban mu no gyina sɛnea wɔde wɔn ho hyɛɛ saa nnamfo no mu, ne sɛ ebia wɔne wɔn adamfofa akuw ahorow no &quot;fata&quot; wɔ sukuu mu no so.[16]

Nhwehwɛmu bi a nhwehwɛmufo a wofi Purdue Sukuupɔn mu yɛe no kyerɛe sɛ nnamfo a wonyae wɔ ntoaso sukuu akyi adesua mu no kyɛ sen nnamfo a wonyae kan no.[17] Wɔ mmerantebere ne mmabaabere awiei mu no, mmusuakuw ntam adamfofa taa yɛ nea ɛntaa nsi, na ɛbɛyɛ sɛ efi adwemmɔne ne amammerɛ mu nsonsonoe.[15]

'''Mpanyimfoyɛ'''

.

Adamfofa a wonya wɔ mpanyin afe so no ma wonya ayɔnkofa, ɔdɔ, ne nkate mu mmoa, na ɛboa yiye ma adwene mu yiyedi ne nipadua akwahosan tu mpɔn.[18]: 426

Ebia ɛbɛyɛ den ama mpanyimfo titiriw sɛ wobenya nnamfo a mfaso wɔ so wɔ adwumam. &quot;Adwumam betumi ayɛ krak esiane akansi nti, enti nkurɔfo sua sɛ wɔde mmerɛwyɛ ne nneɛma a ɛyɛ nwonwa besie mfɛfo adwumayɛfo. Adwuma mu adamfofa taa nya nkitahodi ho nkate; ɛyɛ den sɛ wobɛka baabi a nkitahodi ba awiei na adamfofa ankasa fi ase.&quot;[19] Mpanyimfo dodow no ara bu sikasɛm sɛ ɛsom bo wɔn nnwuma ahobammɔ sen adamfofa a wɔne wɔn mfɛfo adwumayɛfo benya.[20]

Sɛ wɔkyekyem pɛpɛɛpɛ a, mpanyimfo dodow no ara wɔ nnamfo paa baanu.[21] Nhwehwɛmu pii a wɔyɛe wɔ mpanyimfo ho no kyerɛ sɛ adamfofa ne abusuabɔ afoforo a ɛboa ma obu a obi wɔ ma ne ho no yɛ kɛse ampa.[22]

Mpanyimfo a wɔn mfe akɔ anim

Mpanyimfo a wɔn mfe akɔ anim kɔ so bɔ amanneɛ sɛ wonya ankorankoro abotɔyam kɛse wɔ wɔn nnamfofa mu bere a wɔrenyin no, bere mpo a nnamfo dodow nyinaa taa so tew no. Saa abotɔyam yi ne tumi a ɛma wotumi yɛ da biara da asetra mu dwumadi ahorow a ɛkɔ soro, ne adwene mu tumi a ɛso tew, ayaresabea a wɔde obi kɔ no a ɛso tew, ne nea efi mu ba a eye a ɛfa ahosiesie ho no wɔ abusuabɔ.[18]: 427 Nnamfo dodow a wɔbɔɔ ho amanneɛ wɔ akyiri yi mu no nyinaa asetra betumi ayɛ ntamgyinafo denam pefeeyɛ a ɛkɔ soro, kasa ne anisoadehu a eye, ne aware mu tebea so.[23]: 53 Nnamfo dodow a ankorankoro bi nya bere a wɔrenyin no so tew no, wɔde Carstensen Socioemotional Selectivity Theory a ɛkyerɛkyerɛ nsakrae a ɛba wɔ mu no akyerɛkyerɛ mu nkannyan a mpanyimfo nya bere a wɔrebɔ fekuw no. Nsusuwii no ka sɛ mfe a obi adi a ɛkɔ soro no yɛ nsakrae a ɛba fi nsɛm a wɔboaboa ano so kɔ nkate mu nhyehyɛe so; sɛnea ɛbɛyɛ a wobetumi akura nkate pa mu no, mpanyimfo a wɔn mfe akɔ anim no de wɔn asetra mu akuw no to wɔn a wɔwɔ nkate mu abusuabɔ bi nkutoo so.[24]

''Sɛnea nhwehwɛmu bi kae no'':

Nhwehwɛmu a wɔayɛ wɔ mfe aduanan a atwam no mu no ahu bere nyinaa mprempren sɛ mpanyimfo a wɔn mfe akɔ anim a wɔbɔ amanneɛ sɛ wɔwɔ anigye ne yiyedi a ɛkɔ soro sen biara no nso bɔ amanneɛ sɛ wɔne nnamfo pii wɔ abusuabɔ a emu yɛ den na emu yɛ den.[25]

Bere a abusua mu asɛyɛde ne adwumayɛ ho nhyɛso so tew no, nnamfofa bɛyɛ nea ɛho hia kɛse. Wɔ nkwakoraa ne mmerewa mu no, adamfofa betumi ama wɔanya abusuabɔ a ɛda ɔmanfo kɛse no ntam, ayɛ ade a ɛbɔ wɔn ho ban fi adwenemhaw ne ankonamyɛ ho, na atua nneɛma a ebetumi ahwere wɔ asetra mu mmoa a abusua no mufo adi kan de ama no ho ka.[26]: 32–33 Titiriw ma nnipa a wontumi nkɔ out sɛnea ɛtaa ba no, nkitahodi a wɔne nnamfo di no ma kwan ma wɔkɔ so nya ɔmanfo nkitahodi. Bio nso, mpanyimfo a wɔn mfe akɔ anim a wɔn akwahosan rekɔ fam a wɔda so ara ne wɔn nnamfo di nkitaho no kyerɛ sɛ wɔn adwene mu yiyedi atu mpɔn.[27

== Nkɔso ho nsɛm ==
'''Adwene a ɛmma obi ntumi nyɛ hwee a ɛma obi yɛ ade tra so'''

Ebia ɛbɛyɛ den ama mmofra a wɔwɔ adwene a wɔde si biribi so a ɛtra so (ADHD) no sɛ wɔbɛfa nnamfo na wɔakura mu, esiane sɛ wontumi mfa adesua a wɔde hwɛ ade so nkyekye asetra mu nimdeɛ pii nti, nsɛnnennen a ɛwɔ wɔn asetram nsɛnkyerɛnne a wɔde wɔn adwene si so, ne nkɛntɛnso a nneyɛe a wɔde wɔn ho hyɛ mu no nya wɔ asetra mu ne su kɛse a ɛne sɛ wɔbɛyɛ saa nti de wɔn ho hyɛ nneyɛe a ebia wɔn atipɛnfo behu sɛ ɛhaw adwene mu.[28][29] Wɔ afe 2007 nhwehwɛmu bi mu no, wɔanhunu ayaresa biara a ɛdi atipɛnfoɔ dwumadie ho dwuma yie wɔ mmofra a wɔwɔ ADHD mu, na wɔanhunu ayaresa a ɛdi ɔhaw no afã foforɔ ho dwuma no yi nsɛm a ɛfa atipɛnfoɔ dwumadie ho no firi hɔ.

'''Autism a ɛyɛ hu'''

Autism spectrum disorders ho sɛnkyerɛnne ahorow bi betumi asiw nnipa ntam abusuabɔ a ɛbɛba no kwan, te sɛ nneyɛe a wɔtaa yɛ a wɔpɛ, nsakrae a wɔko tia, nneɛma pɔtee bi a n’ani gye ho anaa amanne ahorow a wɔde wɔn ho hyɛ mu, ne asetra mu nimdeɛ a wonni. Wɔahu sɛ mmofra a wɔwɔ autism no taa yɛ onipa biako nnamfo paa, sen sɛ wobenya nnamfo akuw. Bio nso, wɔtaa yɛ mmofra afoforo a wɔadi dɛm bi nnamfo paa.[30] Awofo a wɔde wɔn ho abɔ wɔn ho ho adwene boa ma mmofra a wɔwɔ autism spectrum disorders no adamfofa yɛ papa; obi a ɔte nka sɛ ɔne n’awofo wɔ abusuabɔ no tua ayɔnkofa ho nimdeɛ a onni a mpɛn pii no ebesiw adamfofa kwan no so ka.[31]

Nhwehwɛmu bi a Frankel ne afoforo yɛe no. kyerɛe sɛ awofo de wɔn ho gye mu ne nkyerɛkyerɛ di dwuma titiriw wɔ mmofra a wɔte saa a wonya adamfofa mu.[32] Nea ɛka awofo a wɔde wɔn ho hyɛ mu ho no, sukuu mu adwumayɛfo di dwuma titiriw wɔ asetra mu nimdeɛ ne atipɛnfo nkitahodi a wɔkyerɛkyerɛ mu. Wɔtaa de paraprofessionals, titiriw no, obiakofo aboafo ne adesuadan mu aboafo, kɔ mmofra a wɔwɔ autism spectrum disorders nkyɛn sɛnea ɛbɛyɛ a wɔbɛma nnamfofa ayɛ mmerɛw na wɔakyerɛ abofra no kwan wɔ adamfofa a ɛho hia a ɔbɛfa na wakura mu.

Ɛwom sɛ asuade ne ntetee betumi aboa mmofra a wɔwɔ autism atipɛnfo de, nanso ayayade da so ara yɛ ade titiriw a ɛhaw adwene wɔ asetra mu tebea horow mu. Sɛnea Anahad O’Connor a ɔwɔ The New York Times mu kyerɛ no, ɛda adi kɛse sɛ ayayade bɛba mmofra a wɔwɔ autism spectrum disorders a wobetumi atra ase a wɔde wɔn ho no so kɛse. Mmofra a wɔte saa no wɔ asiane mu kɛse efisɛ wɔwɔ amanne ahorow no pii ne asetra mu nimdeɛ a wonni te sɛ mmofra a ɛda adi sɛ wɔwɔ autism no, nanso ɛda adi sɛ wɔde wɔn bɛhyɛ sukuu mu titiriw. Mmofra a wɔwɔ autism no wɔ ɔhaw kɛse sɛ wɔbɛhwɛ asetra mu nsɛnkyerɛnne so, na enti ebia ɛnyɛ bere nyinaa na wobehu bere a wɔresisi wɔn.[34]

'''Down yare no ho yare'''

Mmofra a wɔwɔ Down syndrome no ayɛ den kɛse sɛ wɔbɛfa nnamfo. Wohyia kasa a ɛkyɛ a ɛma ɛyɛ den ma wɔn sɛ wɔne mmofra afoforo bedi agoru. Ebia mmofra dodow no ara a wɔwɔ Down syndrome no bɛpɛ sɛ wɔhwɛ sukuufo afoforo na wɔne wɔn adamfo di agoru nanso wɔne wɔn nni agoru, titiriw esiane sɛ wɔte ase sen sɛnea wobetumi ada no adi wɔ akyi nti. Wɔ mfe a wonnya nkɔɔ sukuu mu no, mmofra a wɔwɔ Down syndrome no betumi anya adesuadan mu tebea no so mfaso, a mmofra afoforo atwa wɔn ho ahyia na wɔmfa wɔn ho nto mpanyimfo mmoa so kɛse. Mmofra a wɔadi dɛm yi nya mfaso fi nkitahodi ahorow a wɔne mpanyimfo ne mmofra nyinaa nya no mu. Wɔ sukuu mu no, hwɛ a wɔbɛhwɛ ma wɔanya tebea a obiara bɛka ho wɔ adesuadan mu no betumi ayɛ den, nanso nnamfo a wɔbɛn a wɔbɛn wɔn no betumi ayɛ ade titiriw ama asetra mu nkɔso.[35][36]

== Apomuden ==
Nhwehwɛmu ahorow ada no adi sɛ asetra mu mmoa a emu yɛ den ma obi nya akwahosan pa ne nkwa tenten ho anidaso tu mpɔn. Nea ɛne no bɔ abira no, wɔde ankonamyɛ ne asetra mu mmoa a wonnya no abata asiane a ɛkɔ soro a ɛne sɛ wobenya komayare, mmoawa a wɔde nyarewa ba, ne kokoram, ne nnipa dodow a wowuwu wɔ ne nyinaa mu no ho. Nhwehwɛmufoɔ mmienu mpo afrɛ adamfofa nkitahodiɛ sɛ &quot;suban ho aduru&quot; a ɛma nipadua ne adwene mu akwahosan nyinaa nya nkɔsoɔ.[37]

Nhwehwɛmu pii wɔ hɔ a ɛde adamfofa ne akwahosan bata ho, nanso nea enti pɔtee a ɛde abusuabɔ no ba no da so ara yɛ nea wontumi nhu. Nhwehwɛmu dodow no ara a ɛwɔ saa beae yi yɛ nhwehwɛmu akɛse a wɔhwɛ kwan a edi nnipa akyi bere tenten, na bere a ebia abusuabɔ bi wɔ nneɛma abien a ɛsakra (adamfofa ne akwahosan tebea) no ntam no, nhwehwɛmufo da so ara nnim sɛ ebia abusuabɔ bi wɔ hɔ a ɛde ba ne nea efi mu ba, te sɛ sɛ adwene a ɛne sɛ adamfofa pa ma akwahosan tu mpɔn ankasa. Nsusuwii ahorow bi abɔ mmɔden sɛ wɔbɛkyerɛkyerɛ saa abusuabɔ yi mu. Nea ɛka saa nsusuwii ahorow yi ho ne sɛ nnamfo pa hyɛ wɔn nnamfo nkuran ma wɔbɔ asetra a ahoɔden wom kɛse; sɛ nnamfo pa hyɛ wɔn nnamfo nkuran sɛ wɔnhwehwɛ mmoa na wonnya nnwuma bere a ɛho hia no; sɛ nnamfo pa ma wɔn nnamfonom tumi gyina yare ne akwahosan ho haw afoforo ho dwuma no yɛ kɛse; na sɛ nnamfo pa nya nipadua mu akwan a ɛbɔ akwahosan ho ban no so nkɛntɛnso ankasa.[38]

'''Adwene mu haw'''

Wɔahu sɛ adamfofa a wonni no di dwuma ma asiane a ɛkɔ soro sɛ mmea a wɔrebɛn mpanyin afe so benya adwene a ɛne sɛ wobekum wɔn ho no mu, a nea ɛka ho ne sɛ wobenya nnamfo pii a wɔn ankasa nyɛ wɔn ho wɔn ho nnamfo. Nanso, wɔanhu nkɛntɛnso a ɛte saa ara wɔ mmarima ho.[39][40] Nnamfo kakraa bi a wubenya anaasɛ wunni bi no yɛ ade titiriw a ɛkyerɛ sɛ obi anya adwenemyare ahorow pii.[14]

Adamfofa su a ɛkorɔn no boa tẽẽ ma wonya obu ma wɔn ho, wonya wɔn ho mu ahotoso, na wonya asetra mu nkɔso.[22] World Happiness Database nhwehwɛmu bi kyerɛe sɛ nnipa a wɔwɔ nnamfo paa no ani gye kɛse, ɛwom sɛ nnamfo dodow koraa no amma anigye no ankɔ soro de.[41] Nhwehwɛmu afoforo akyerɛ sɛ mmofra a wɔwɔ adamfofa a ɛkorɔn no betumi abɔ wɔn ho ban afi ɔhaw ahorow bi te sɛ dadwen ne adwenemhaw ho.[42][43] Nea ɛne no bɔ abira no, nnamfo kakraa bi a wubenya no ne sukuu a wogyae, ne basabasayɛ, ne mpanyimfo nsɛmmɔnedi nso wɔ abusuabɔ.[3]: 500 Atipɛnfo a wɔpow wɔn no nso ne akyi apɛde a ɛba fam wɔ adwumayɛfo mu, ne asetra mu dwumadi ahorow mu kyɛfa a wonya, bere a dodow a ɛkɔ soro no wɔ abusuabɔ na adamfofa ne mpanyimfo bu wɔn ho a ɛkorɔn wɔ abusuabɔ.[3]: 500–01

== Nneɛma a wɔde gu mu ==
Wobetumi abu adamfofa bi a wobegu no sɛ ankorankoro pow, anaasɛ ebetumi afi abɔde mu nsakrae a ɛba bere a bere kɔ so no mu aba, bere a nnamfo kɔ akyirikyiri kɛse wɔ honam ne nkate fam no. Wɔde adamfofa a wɔsɛe no no ne afobu, abufuw ne adwenemhaw a ɛkɔ soro no wɔ abusuabɔ, na ebetumi ayɛ nsɛm a ɛhaw adwene kɛse, titiriw wɔ mmofraase. Nanso, wobetumi abrɛ nsunsuanso bɔne a ebetumi aba no ase sɛ wɔde abusuabɔ foforo a emu yɛ den si adamfofa bi a wobegu no ananmu a.[4]: 248

== Nnipa dodow ho nsɛm ==
Nnamfo taa yɛ wɔn ho sɛ wɔn ho wɔn ho kɛse wɔ mfe a wɔadi, ɔbarima ne ɔbea nna, suban, nnuru a wɔde di dwuma ɔkwammɔne so, ankorankoro su, ne adesua mu mmɔdenbɔ mu.[4]: 248 [18]: 426 [25]: 55–56 Wɔ aman a mmusuakuw ahorow gu ahorow mu no, adanse a ɛtrɛw wɔ hɔ a ɛkyerɛ sɛ mmofra ne mmabun taa ne afoforo a wofi mmusuakuw anaa mmusuakuw koro mu fa adamfo, efi ase wɔ mmofra a wonnya nkɔɔ sukuu mu, na ɛkɔ soro wɔ mmofraberem mfinimfini anaa awiei mu hɔ.[4]: 264

'''Nsonsonoe a ɛwɔ mmarima ne mmea ntam'''

Mpɛn pii no, mmea ne mmea adamfofa nkitahodi a ɛda mmofra ntam no taa twe adwene si nnipa ntam abusuabɔ ne mmoa a wɔde ma wɔn ho wɔn ho so. Nea ɛne eyi bɔ abira no, ɔbarima ne ɔbarima ntam nkitahodi taa twe adwene si asetra mu tebea so kɛse. Nea ebefi mu aba ne sɛ, wobetumi de nsiyɛ abu nkate mu ahiade ahorow a wɔda no adi no abam.[44]: 320–02

Mmea bɔ amanneɛ sɛ dadwen, ahoɔyaw, ne abusuabɔ mu ayayade pii na wonnya pintinn pii wɔ wɔn nnamfofa ho. Nanso mmarima de, wɔbɔ amanneɛ sɛ wɔyɛ wɔn honam fam ayayade pii. Ne nyinaa mu no, mmarima ne mmea taa bɔ amanneɛ sɛ wɔanya abotɔyam kakra wɔ wɔn nnamfofa ho.[4]: 249–50

Mmea taa da wɔn ho adi kɛse na wɔda wɔn ho adi kɛse wɔ wɔn bɔbeasu koro adamfofa mu na wɔwɔ nnamfo kakraa bi.[15] Mmarima taa kyerɛkyerɛ abusuabɔ a emu yɛ den mu denam honam fam osuahu ahorow a wɔkyɛ so. Nea ɛne eyi bɔ abira no, mmea taa kyerɛkyerɛ mu kɛse wɔ nkate mu de a wɔkyɛ mu. Mmarima ntaa nna nkate anaa wɔn ankasa nsɛm adi nkyerɛ mmarima afoforo efisɛ wobetumi de saa nsɛm yi adi dwuma atia wɔn. Nanso, wɔbɛda saa nsɛm yi adi akyerɛ mmea (sɛnea wɔne wɔn nni akan), na mmarima taa bu adamfofa a wɔne mmea nya no sɛ nea ntease wom kɛse, emu yɛ den, na ɛyɛ anigye. Mpɛn pii no, mmarima ne mmarima adamfofa te sɛ apam kɛse, bere a mmea ne mmea adamfofa gyina abusuabɔ so kɛse. Nea ɛde ba ne sɛ, eyi nso kyerɛ sɛ ɔbarima ne ɔbarima adamfofa a ɛba awiei no taa yɛ nea ɛhaw nkate kɛse te sɛ ɔbea ne ɔbea adamfofa no.[45][46]

Mmea taa yɛ wɔn a wɔn ho akokwaw wɔ asetra mu sen wɔn atipɛnfo mmarima wɔ mpanyimfo a wɔn mfe akɔ anim mu. Nea afi mu aba ne sɛ, mmarima a wɔn mfe akɔ anim pii betumi de wɔn ho ato ɔhokafo a ɔyɛ ɔbea te sɛ ɔhokafo so de atua wɔn asetra mu nimdeɛ a wonni no ho ka.[25]: 55 Nhwehwɛmu bi kyerɛe sɛ mmea a wɔwɔ Europa ne Amerika Atifi fam no na ɛtaa yɛ kɛse kakra sen mmarima sɛ ɔno ankasa bɛbɔ amanneɛ sɛ ɔwɔ adamfo paa.[47]

'''Amammerɛ'''

Abusuabɔ ahorow a wobu no sɛ nokware adamfofa, sen sɛ ɛbɛyɛ obi a onim no anaa obi a ɔne no yɛ adwuma no gu ahorow sɛnea amammerɛ te. Wɔ amammerɛ a wɔka Borɔfo kasa mu no, ɛnyɛ ade foforo sɛ nkurɔfo de abusuabɔ a ɛyɛ mmerɛw bɛka ho sɛ nnamfo.[48] Wɔ amammerɛ afoforo te sɛ Russiafo ne Polandfo amammerɛ mu no, abusuabɔ a ɛho hia sen biara nkutoo na wobu no sɛ nnamfo. Ebia Russiani benya nnamfo biako anaa baanu a wɔde &quot;pals&quot; anaa nnipa pii a onim wɔn aka ho; Canadani a ɔwɔ tebea a ɛte saa ara mu no betumi abu saa abusuabɔ ahorow yi nyinaa sɛ nnamfo.[48]

Wɔ Atɔe Famfo amammerɛ mu no, wɔtaa bu adamfofa sɛ ɛyɛ ketewaa bi sen abusua anaa ɔdɔ.[49]

Bere a wɔreka adamfofa ho ahyɛde ahorow ho asɛm no wohui sɛ Chinafo a wobisabisaa wɔn nsɛm no huu pii sen wɔn mfɛfo Britaniafo no.[15][ambiguous]

== Nneɛma ahorow a ɛwɔ hɔ ntam ==
Wohu adamfofa wɔ mmoa a wɔn nyansa kɔ soro te sɛ mmoa a wɔnom nufusu a wɔkorɔn ne nnomaa binom mu. Nnamfofa a ɛda nnipa ne afieboa ntam abu so. Mmoa abien a wɔnyɛ nnipa te sɛ akraman ne mpɔtorɔ nso betumi anya adamfofa a ɛda mmoa ahorow ntam.</text>
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  <page>
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      <comment>Created page with &quot;Gua yɛ asɛmfua a wɔde kyerɛkyerɛ nsusuwii ahorow te sɛ:  Guadidan (sikasɛm) .  Guadi mu sikasɛm  Guadidan, gua a ɛwɔ hɔ ankasa anaa ɔmanfo gua  == Asase ho nsɛm == Märket, supɔw a Finland ne Sweden kyɛ  Adwinni, anigyede, ne nsɛm ho amanneɛbɔ  == Sini ahorow == Market (1965 sini), 1965 South Korea sini  Market (2003 sini), 2003 Hindi sini  The Market: A Tale of Trade, Turkeyfo sini bi  == Television so hwɛ == The Market (TV so dwumadi ahorow), New Zea...&quot;</comment>
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      <text bytes="2447" xml:space="preserve">Gua yɛ asɛmfua a wɔde kyerɛkyerɛ nsusuwii ahorow te sɛ:

Guadidan (sikasɛm) .

Guadi mu sikasɛm

Guadidan, gua a ɛwɔ hɔ ankasa anaa ɔmanfo gua

== Asase ho nsɛm ==
Märket, supɔw a Finland ne Sweden kyɛ

Adwinni, anigyede, ne nsɛm ho amanneɛbɔ

== Sini ahorow ==
Market (1965 sini), 1965 South Korea sini

Market (2003 sini), 2003 Hindi sini

The Market: A Tale of Trade, Turkeyfo sini bi

== Television so hwɛ ==
The Market (TV so dwumadi ahorow), New Zealand television so drama

Nneɛma a wɔde yɛ nneɛma anaa nnwuma ahorow

The Market (adwumakuw), Farm Fresh Supermarket adwene sotɔɔ

The Market, Safeway sotɔɔ titiriw bi

Sikasɛm mu gua ahorow

Kuadwuma ho aguadi

Guadidan a ɛrenya nkɔso

Ahoɔden ho gua

Sikasɛm ho gua so

Amannɔne sikasesɛw ho gua

Gray gua so

Nsɛm ho amanneɛbɔfo gua

Niche gua so

Guadidan a wɔabue mu, sikasɛm a wɔde di gua a wɔde wɔn ho to so; asɛmfua a ɛne gua a wɔato mu no bɔ abira

Nkɔmhyɛ gua so

Adan ne afie ho gua

Sikakorabea ahorow

Nneɛma a wɔtɔn no kɛse

== Sikasɛm mu gua ahorow no afã horow ==
Efficient-market hypothesis a ɛyɛ adwuma yiye

Mark-to-market akontaabu ho akontaabu

Guadi mu sika a wɔde di dwuma

Guadi mu sikasɛm

Guadi mu huammɔdi

Guadidan mu adwumayɛfo

Guadidan mu nhyehyɛe nketenkete

Guadi ho nhwehwɛmu

Guadi fã bi

Guadi mu kyɛfa

Guadi mu su a ɛrekɔ so

Bo a ɛsom wɔ gua so

Guadidan biako pɛ

Fa w’ani si gua so

Honam fam gua ahorow ahorow

Bazaar a ɛwɔ hɔ

Bazaar Titiriw

Akuafo gua, a wɔde wɔn adwene si nnuan a wɔayɛ no foforo so

Mpataa gua so

Flea gua so

Guadi a ɛsensɛn nsu so

Adetɔnbea a wɔtɔn nneɛma wom

Guadidan mu abɔnten so

Guadidan mu kurow

Guadibea

Anadwo gua so

Ɔmanfo gua (disambiguation) .

Souq na ɛwɔ hɔ

Mmɔnten so gua, a aguadidan ahorow wɔ ɔmanfo mmɔnten biako anaa nea ɛboro saa so

Adetɔnbea kɛse bi

Guadi a ɛyɛ nsu, a wɔde wɔn adwene si nam a wɔayɛ no foforo, mpataa, nneɛma a wɔyɛ, ne nneɛma afoforo a ɛporɔw so

== Hwɛ nso ==
Wikiquote wɔ nsɛm a wɔafa aka a ɛfa Market ho.

Nkratafa a ɛwɔ asɛmti ahorow a Market wom nyinaa

Guadibea (disambiguation), asɛmfua a ɛtɔ da bi a wotumi sesa ne &quot;gua so&quot;.

Markt (asɛm a wɔka no pefee) .

Marquette (nsɛm a wɔde kyerɛkyerɛ mu) .

Mercado (disambiguation), Spania ne Portugal asɛmfua a wɔde gyina hɔ ma gua

Marketts no

The Title Market (1909), nhoma a Emily Post kyerɛwee</text>
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  <page>
    <title>Mmaranketewa</title>
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      <timestamp>2022-07-31T13:24:14Z</timestamp>
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        <id>10338</id>
      </contributor>
      <comment>Created page with &quot;'''Mmaranketewa''' anaa nea United States frɛ no &quot;Bylaws&quot; yɛ mmara ahodoɔ bi a dwumakuo anaa mpɔtam bi ahyehyɛ na wɔde ayɛ adwuma sɛdeɛ mpaninfoɔ binom ama ho kwan.  Wɔn a wɔwɔ diberɛ kɛseɛ, ne titire wɔn a wɔhyɛ mmara anaa aban bi de nea ɛbɛtenetene mmara nketewa sɛdeɛ ɛbɛtumi adi dwuma. Nnipa ɛbɛtumi ayɛ mmaranketewa no bi ne nnwumakuo, neighborhood Association, a ɛgyina baabi a  wɔn tumi kɔpem, mansini adantam. Wɔ United Kingdom ne comm...&quot;</comment>
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      <text bytes="958" xml:space="preserve">'''Mmaranketewa''' anaa nea United States frɛ no &quot;Bylaws&quot; yɛ mmara ahodoɔ bi a dwumakuo anaa mpɔtam bi ahyehyɛ na wɔde ayɛ adwuma sɛdeɛ mpaninfoɔ binom ama ho kwan.  Wɔn a wɔwɔ diberɛ kɛseɛ, ne titire wɔn a wɔhyɛ mmara anaa aban bi de nea ɛbɛtenetene mmara nketewa sɛdeɛ ɛbɛtumi adi dwuma. Nnipa ɛbɛtumi ayɛ mmaranketewa no bi ne nnwumakuo, neighborhood Association, a ɛgyina baabi a  wɔn tumi kɔpem, mansini adantam. Wɔ United Kingdom ne commonweath aman ahodoɔ mu no, mmara a asoafeɛ no hyehyɛ no wɔfrɛ no &quot;by(e)- kawa&quot; ɛfiri sɛ Central government no na ɔkyerɛ ɛkwan saa aman no mfa so nyɛ no. Nea ɛhyɛ ma wɔdi mmaranketewa no so no yɛ Canada a ɛne American COde Enforcement officer.  Wɔ United States Federal Government ne aban a ɛwɔ nkuro so nni tumi sɛ wɔma mansini adantam mmara no yɛ adwuma. Ne saa nti, sɛ ɛnyɛ mmara a edin bi te sɛ ''code'', ''ordinance'', anaa ''regulation nyɛ na koraa.''</text>
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      <timestamp>2022-07-31T13:41:23Z</timestamp>
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        <username>AC Krah</username>
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      <text bytes="1827" xml:space="preserve">'''Mmaranketewa''' anaa nea United States frɛ no &quot;Bylaws&quot; yɛ mmara ahodoɔ bi a dwumakuo anaa mpɔtam bi ahyehyɛ na wɔde ayɛ adwuma sɛdeɛ mpaninfoɔ binom ama ho kwan.  Wɔn a wɔwɔ diberɛ kɛseɛ, ne titire wɔn a wɔhyɛ mmara anaa aban bi de nea ɛbɛtenetene mmara nketewa sɛdeɛ ɛbɛtumi adi dwuma. Nnipa ɛbɛtumi ayɛ mmaranketewa no bi ne nnwumakuo, neighborhood Association, a ɛgyina baabi a  wɔn tumi kɔpem, mansini adantam. Wɔ United Kingdom ne commonweath aman ahodoɔ mu no, mmara a asoafeɛ no hyehyɛ no wɔfrɛ no &quot;by(e)- kawa&quot; ɛfiri sɛ Central government no na ɔkyerɛ ɛkwan saa aman no mfa so nyɛ no. Nea ɛhyɛ ma wɔdi mmaranketewa no so no yɛ Canada a ɛne American COde Enforcement officer.  Wɔ United States Federal Government ne aban a ɛwɔ nkuro so nni tumi sɛ wɔma mansini adantam mmara no yɛ adwuma. Ne saa nti, sɛ ɛnyɛ mmara a edin bi te sɛ ''code'', ''ordinance'', anaa ''regulation nyɛ na koraa.''

N'abɔseɛ

Merriam -Webster Dictionary kyerɛɛ sɛ mmara ketewa firi borɔfo din bilade, a ɛfiri Old Norse *bylog, firi Old Norse ''bȳr'' town + ''lag-, lǫg'' mmara.&lt;ref&gt;https://www.merriam-webster.com/dictionary/bylaw&lt;/ref&gt;Deina wɔdiikan de dii dwuma a ɛfiri Coming kuro mmara wɔ Danelaw,  a by yɛ Old Norse din ma baabi a ɛhɔ so wɔ whitby ne Derby(sɛ wode toto Modern Danish-Norwegian din by a ɛkyerɛ kuro anaasɛ modern Swedish din by a ɛkyerɛ akurase).&lt;ref name=&quot;:0&quot;&gt;https://www.merriam-webster.com/dictionary/bylaw&lt;/ref&gt; Ne saa nti, ɛbɛtumi aba sɛ wɔn werɛ fii saa din no na wɔnam adeyɛ kyerɛfoɔ by a asekyerɛ ne mmara a yɛate so anaa nea ɛda nkyɛn(byway) sane de baa biom wɔ ɛnnɛ mmerɛ mu.&lt;ref name=&quot;:0&quot; /&gt; Wɔ saa kwan mmienu no nyinaa mu no, ɛntwa kwan sɛ obi bɛka sɛ baabi a edin no firi no yɛ kasatɔmmɛ mmaranketewa.</text>
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    <revision>
      <id>132960</id>
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      <timestamp>2022-07-31T13:42:53Z</timestamp>
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        <username>AC Krah</username>
        <id>10338</id>
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      <text bytes="1831" xml:space="preserve">'''Mmaranketewa''' anaa nea United States frɛ no &quot;Bylaws&quot; yɛ mmara ahodoɔ bi a dwumakuo anaa mpɔtam bi ahyehyɛ na wɔde ayɛ adwuma sɛdeɛ mpaninfoɔ binom ama ho kwan.  Wɔn a wɔwɔ diberɛ kɛseɛ, ne titire wɔn a wɔhyɛ mmara anaa aban bi de nea ɛbɛtenetene mmara nketewa sɛdeɛ ɛbɛtumi adi dwuma. Nnipa ɛbɛtumi ayɛ mmaranketewa no bi ne nnwumakuo, neighborhood Association, a ɛgyina baabi a  wɔn tumi kɔpem, mansini adantam. Wɔ United Kingdom ne commonweath aman ahodoɔ mu no, mmara a asoafeɛ no hyehyɛ no wɔfrɛ no &quot;by(e)- kawa&quot; ɛfiri sɛ Central government no na ɔkyerɛ ɛkwan saa aman no mfa so nyɛ no. Nea ɛhyɛ ma wɔdi mmaranketewa no so no yɛ Canada a ɛne American COde Enforcement officer.  Wɔ United States Federal Government ne aban a ɛwɔ nkuro so nni tumi sɛ wɔma mansini adantam mmara no yɛ adwuma. Ne saa nti, sɛ ɛnyɛ mmara a edin bi te sɛ ''code'', ''ordinance'', anaa ''regulation nyɛ na koraa.''

== N'abɔseɛ ==
Merriam -Webster Dictionary kyerɛɛ sɛ mmara ketewa firi borɔfo din bilade, a ɛfiri Old Norse *bylog, firi Old Norse ''bȳr'' town + ''lag-, lǫg'' mmara.&lt;ref&gt;https://www.merriam-webster.com/dictionary/bylaw&lt;/ref&gt;Deina wɔdiikan de dii dwuma a ɛfiri Coming kuro mmara wɔ Danelaw,  a by yɛ Old Norse din ma baabi a ɛhɔ so wɔ whitby ne Derby(sɛ wode toto Modern Danish-Norwegian din by a ɛkyerɛ kuro anaasɛ modern Swedish din by a ɛkyerɛ akurase).&lt;ref name=&quot;:0&quot;&gt;https://www.merriam-webster.com/dictionary/bylaw&lt;/ref&gt; Ne saa nti, ɛbɛtumi aba sɛ wɔn werɛ fii saa din no na wɔnam adeyɛ kyerɛfoɔ by a asekyerɛ ne mmara a yɛate so anaa nea ɛda nkyɛn(byway) sane de baa biom wɔ ɛnnɛ mmerɛ mu.&lt;ref name=&quot;:0&quot; /&gt; Wɔ saa kwan mmienu no nyinaa mu no, ɛntwa kwan sɛ obi bɛka sɛ baabi a edin no firi no yɛ kasatɔmmɛ mmaranketewa</text>
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    <revision>
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      <timestamp>2022-08-01T02:09:38Z</timestamp>
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        <username>AC Krah</username>
        <id>10338</id>
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      <text bytes="2185" xml:space="preserve">'''Mmaranketewa''' anaa nea United States frɛ no &quot;Bylaws&quot; yɛ mmara ahodoɔ bi a dwumakuo anaa mpɔtam bi ahyehyɛ na wɔde ayɛ adwuma sɛdeɛ mpaninfoɔ binom ama ho kwan.  Wɔn a wɔwɔ diberɛ kɛseɛ, ne titire wɔn a wɔhyɛ mmara anaa aban bi de nea ɛbɛtenetene mmara nketewa sɛdeɛ ɛbɛtumi adi dwuma. Nnipa ɛbɛtumi ayɛ mmaranketewa no bi ne nnwumakuo, neighborhood Association, a ɛgyina baabi a  wɔn tumi kɔpem, mansini adantam. Wɔ United Kingdom ne commonweath aman ahodoɔ mu no, mmara a asoafeɛ no hyehyɛ no wɔfrɛ no &quot;by(e)- kawa&quot; ɛfiri sɛ Central government no na ɔkyerɛ ɛkwan saa aman no mfa so nyɛ no. Nea ɛhyɛ ma wɔdi mmaranketewa no so no yɛ Canada a ɛne American COde Enforcement officer.  Wɔ United States Federal Government ne aban a ɛwɔ nkuro so nni tumi sɛ wɔma mansini adantam mmara no yɛ adwuma. Ne saa nti, sɛ ɛnyɛ mmara a edin bi te sɛ ''code'', ''ordinance'', anaa ''regulation nyɛ na koraa.''

== N'abɔseɛ ==
Merriam -Webster Dictionary kyerɛɛ sɛ mmara ketewa firi borɔfo din bilade, a ɛfiri Old Norse *bylog, firi Old Norse ''bȳr'' town + ''lag-, lǫg'' mmara.&lt;ref&gt;https://www.merriam-webster.com/dictionary/bylaw&lt;/ref&gt;Deina wɔdiikan de dii dwuma a ɛfiri Coming kuro mmara wɔ Danelaw,  a by yɛ Old Norse din ma baabi a ɛhɔ so wɔ whitby ne Derby(sɛ wode toto Modern Danish-Norwegian din by a ɛkyerɛ kuro anaasɛ modern Swedish din by a ɛkyerɛ akurase).&lt;ref name=&quot;:0&quot;&gt;https://www.merriam-webster.com/dictionary/bylaw&lt;/ref&gt; Ne saa nti, ɛbɛtumi aba sɛ wɔn werɛ fii saa din no na wɔnam adeyɛ kyerɛfoɔ by a asekyerɛ ne mmara a yɛate so anaa nea ɛda nkyɛn(byway) sane de baa biom wɔ ɛnnɛ mmerɛ mu.&lt;ref name=&quot;:0&quot; /&gt; Wɔ saa kwan mmienu no nyinaa mu no, ɛntwa kwan sɛ obi bɛka sɛ baabi a edin no firi no yɛ kasatɔmmɛ mmaranketewa

vehicle parking and stopping regulations, animal control, building and construction, licensing, noise, zoning and business regulation, and management of public recreation areasvehicle parking and stopping regulations, animal control, building and construction, licensing, noise, zoning and business regulation, and management of public recreation areas</text>
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    <revision>
      <id>132998</id>
      <parentid>132997</parentid>
      <timestamp>2022-08-01T02:11:25Z</timestamp>
      <contributor>
        <username>AC Krah</username>
        <id>10338</id>
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      <comment>/* N'abɔseɛ */</comment>
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      <text bytes="2859" xml:space="preserve">'''Mmaranketewa''' anaa nea United States frɛ no &quot;Bylaws&quot; yɛ mmara ahodoɔ bi a dwumakuo anaa mpɔtam bi ahyehyɛ na wɔde ayɛ adwuma sɛdeɛ mpaninfoɔ binom ama ho kwan.  Wɔn a wɔwɔ diberɛ kɛseɛ, ne titire wɔn a wɔhyɛ mmara anaa aban bi de nea ɛbɛtenetene mmara nketewa sɛdeɛ ɛbɛtumi adi dwuma. Nnipa ɛbɛtumi ayɛ mmaranketewa no bi ne nnwumakuo, neighborhood Association, a ɛgyina baabi a  wɔn tumi kɔpem, mansini adantam. Wɔ United Kingdom ne commonweath aman ahodoɔ mu no, mmara a asoafeɛ no hyehyɛ no wɔfrɛ no &quot;by(e)- kawa&quot; ɛfiri sɛ Central government no na ɔkyerɛ ɛkwan saa aman no mfa so nyɛ no. Nea ɛhyɛ ma wɔdi mmaranketewa no so no yɛ Canada a ɛne American COde Enforcement officer.  Wɔ United States Federal Government ne aban a ɛwɔ nkuro so nni tumi sɛ wɔma mansini adantam mmara no yɛ adwuma. Ne saa nti, sɛ ɛnyɛ mmara a edin bi te sɛ ''code'', ''ordinance'', anaa ''regulation nyɛ na koraa.''

== N'abɔseɛ ==
Merriam -Webster Dictionary kyerɛɛ sɛ mmara ketewa firi borɔfo din bilade, a ɛfiri Old Norse *bylog, firi Old Norse ''bȳr'' town + ''lag-, lǫg'' mmara.&lt;ref&gt;https://www.merriam-webster.com/dictionary/bylaw&lt;/ref&gt;Deina wɔdiikan de dii dwuma a ɛfiri Coming kuro mmara wɔ Danelaw,  a by yɛ Old Norse din ma baabi a ɛhɔ so wɔ whitby ne Derby(sɛ wode toto Modern Danish-Norwegian din by a ɛkyerɛ kuro anaasɛ modern Swedish din by a ɛkyerɛ akurase).&lt;ref name=&quot;:0&quot;&gt;https://www.merriam-webster.com/dictionary/bylaw&lt;/ref&gt; Ne saa nti, ɛbɛtumi aba sɛ wɔn werɛ fii saa din no na wɔnam adeyɛ kyerɛfoɔ by a asekyerɛ ne mmara a yɛate so anaa nea ɛda nkyɛn(byway) sane de baa biom wɔ ɛnnɛ mmerɛ mu.&lt;ref name=&quot;:0&quot; /&gt; Wɔ saa kwan mmienu no nyinaa mu no, ɛntwa kwan sɛ obi bɛka sɛ baabi a edin no firi no yɛ kasatɔmmɛ mmaranketewa

== Mansini Adantam mmaranketewa ==
Mansini Adantam mmaranketewa yɛ amansan mmara a wɔde di dwuma wɔ mmaeɛ bi. Ɛnsonsoneɛ a ɛda mmaranketewa ne mmaraɔman no gye tom ne sɛ, ɛnyɛ obiara na ɔyɛɛ mmaranketewa a ɛgye firi aban foforɔ hɔ, na gyesɛ ɛgyina asɛm bi so ansa na watumi ayɛ. Mansini Adantam aban anaa mantam aban a ɛkyerɛ nnoɔma a kuro bi bɛyɛ ɛnam mmaranketewa no so. Ɛyɛ ntamgyinafoɔ mmara. Wɔ ne tumi mu ne beaɛ pɔtee a mpaninfoɔ no ahyɛ ama wɔn no, mansini adantam mmaranketewa no nna nso mfiri mmara a ɛwɔ hɔ no, na wɔbɛtumi de mmara no atwe wɔn aso, wone kɔɔto twe so na ɛne mmara foforɔ bi te sɛ ɔman amammra a ɛwɔ asaase no so na ɛkɔ. Mansini mmaranketewa no fa Public Justice system no mu, na wɔn a wɔtia mmara nso yɛ bɔne a wayɛ atia aban. Mmaranketewa a ɛnyɛ na no bi ne vehicle parking baabi a wɔde ahyɛn so na wɔbu mmara so, animal control, adansie, ɛhyɛn adanseɛ krataaa,dede,zoning and business regulation, ne sɛ wototo amansan nsrahwɛ bea.</text>
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    <revision>
      <id>133000</id>
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      <timestamp>2022-08-01T02:17:34Z</timestamp>
      <contributor>
        <username>AC Krah</username>
        <id>10338</id>
      </contributor>
      <comment>/* Mansini Adantam mmaranketewa */</comment>
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      <text bytes="2887" xml:space="preserve">'''Mmaranketewa''' anaa nea United States frɛ no &quot;Bylaws&quot; yɛ mmara ahodoɔ bi a dwumakuo anaa mpɔtam bi ahyehyɛ na wɔde ayɛ adwuma sɛdeɛ mpaninfoɔ binom ama ho kwan.  Wɔn a wɔwɔ diberɛ kɛseɛ, ne titire wɔn a wɔhyɛ mmara anaa aban bi de nea ɛbɛtenetene mmara nketewa sɛdeɛ ɛbɛtumi adi dwuma. Nnipa ɛbɛtumi ayɛ mmaranketewa no bi ne nnwumakuo, neighborhood Association, a ɛgyina baabi a  wɔn tumi kɔpem, mansini adantam. Wɔ United Kingdom ne commonweath aman ahodoɔ mu no, mmara a asoafeɛ no hyehyɛ no wɔfrɛ no &quot;by(e)- kawa&quot; ɛfiri sɛ Central government no na ɔkyerɛ ɛkwan saa aman no mfa so nyɛ no. Nea ɛhyɛ ma wɔdi mmaranketewa no so no yɛ Canada a ɛne American COde Enforcement officer.  Wɔ United States Federal Government ne aban a ɛwɔ nkuro so nni tumi sɛ wɔma mansini adantam mmara no yɛ adwuma. Ne saa nti, sɛ ɛnyɛ mmara a edin bi te sɛ ''code'', ''ordinance'', anaa ''regulation nyɛ na koraa.''

== N'abɔseɛ ==
Merriam -Webster Dictionary kyerɛɛ sɛ mmara ketewa firi borɔfo din bilade, a ɛfiri Old Norse *bylog, firi Old Norse ''bȳr'' town + ''lag-, lǫg'' mmara.&lt;ref&gt;https://www.merriam-webster.com/dictionary/bylaw&lt;/ref&gt;Deina wɔdiikan de dii dwuma a ɛfiri Coming kuro mmara wɔ Danelaw,  a by yɛ Old Norse din ma baabi a ɛhɔ so wɔ whitby ne Derby(sɛ wode toto Modern Danish-Norwegian din by a ɛkyerɛ kuro anaasɛ modern Swedish din by a ɛkyerɛ akurase).&lt;ref name=&quot;:0&quot;&gt;https://www.merriam-webster.com/dictionary/bylaw&lt;/ref&gt; Ne saa nti, ɛbɛtumi aba sɛ wɔn werɛ fii saa din no na wɔnam adeyɛ kyerɛfoɔ by a asekyerɛ ne mmara a yɛate so anaa nea ɛda nkyɛn(byway) sane de baa biom wɔ ɛnnɛ mmerɛ mu.&lt;ref name=&quot;:0&quot; /&gt; Wɔ saa kwan mmienu no nyinaa mu no, ɛntwa kwan sɛ obi bɛka sɛ baabi a edin no firi no yɛ kasatɔmmɛ mmaranketewa

== Mansini Adantam mmaranketewa ==
Mansini Adantam mmaranketewa yɛ amansan mmara a wɔde di dwuma wɔ mmaeɛ bi. Ɛnsonsoneɛ a ɛda mmaranketewa ne mmaraɔman no gye tom ne sɛ, ɛnyɛ obiara na ɔyɛɛ mmaranketewa a ɛgye firi aban foforɔ hɔ, na gyesɛ ɛgyina asɛm bi so ansa na watumi ayɛ. Mansini Adantam aban anaa mantam aban a ɛkyerɛ nnoɔma a kuro bi bɛyɛ ɛnam mmaranketewa no so. Ɛyɛ ntamgyinafoɔ mmara. Wɔ ne tumi mu ne beaɛ pɔtee a mpaninfoɔ no ahyɛ ama wɔn no, mansini adantam mmaranketewa no nna nso mfiri mmara a ɛwɔ hɔ no, na wɔbɛtumi de mmara no atwe wɔn aso, wone kɔɔto twe so na ɛne mmara foforɔ bi te sɛ ɔman amammra a ɛwɔ asaase no so na ɛkɔ. Mansini mmaranketewa no fa Public Justice system no mu, na wɔn a wɔtia mmara nso yɛ bɔne a wayɛ atia aban. Mmaranketewa a ɛnyɛ na no bi ne vehicle parking baabi a wɔde ahyɛn so na wɔbu mmara so, animal control, adansie, ɛhyɛn adanseɛ krataaa,dede,zoning and business regulation, ne sɛ wototo amansan nsrahwɛ bea.

Mmaranketewa a ɛwɔ Japan</text>
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      <timestamp>2022-08-01T02:17:53Z</timestamp>
      <contributor>
        <username>AC Krah</username>
        <id>10338</id>
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      <text bytes="3240" xml:space="preserve">'''Mmaranketewa''' anaa nea United States frɛ no &quot;Bylaws&quot; yɛ mmara ahodoɔ bi a dwumakuo anaa mpɔtam bi ahyehyɛ na wɔde ayɛ adwuma sɛdeɛ mpaninfoɔ binom ama ho kwan.  Wɔn a wɔwɔ diberɛ kɛseɛ, ne titire wɔn a wɔhyɛ mmara anaa aban bi de nea ɛbɛtenetene mmara nketewa sɛdeɛ ɛbɛtumi adi dwuma. Nnipa ɛbɛtumi ayɛ mmaranketewa no bi ne nnwumakuo, neighborhood Association, a ɛgyina baabi a  wɔn tumi kɔpem, mansini adantam. Wɔ United Kingdom ne commonweath aman ahodoɔ mu no, mmara a asoafeɛ no hyehyɛ no wɔfrɛ no &quot;by(e)- kawa&quot; ɛfiri sɛ Central government no na ɔkyerɛ ɛkwan saa aman no mfa so nyɛ no. Nea ɛhyɛ ma wɔdi mmaranketewa no so no yɛ Canada a ɛne American COde Enforcement officer.  Wɔ United States Federal Government ne aban a ɛwɔ nkuro so nni tumi sɛ wɔma mansini adantam mmara no yɛ adwuma. Ne saa nti, sɛ ɛnyɛ mmara a edin bi te sɛ ''code'', ''ordinance'', anaa ''regulation nyɛ na koraa.''

== N'abɔseɛ ==
Merriam -Webster Dictionary kyerɛɛ sɛ mmara ketewa firi borɔfo din bilade, a ɛfiri Old Norse *bylog, firi Old Norse ''bȳr'' town + ''lag-, lǫg'' mmara.&lt;ref&gt;https://www.merriam-webster.com/dictionary/bylaw&lt;/ref&gt;Deina wɔdiikan de dii dwuma a ɛfiri Coming kuro mmara wɔ Danelaw,  a by yɛ Old Norse din ma baabi a ɛhɔ so wɔ whitby ne Derby(sɛ wode toto Modern Danish-Norwegian din by a ɛkyerɛ kuro anaasɛ modern Swedish din by a ɛkyerɛ akurase).&lt;ref name=&quot;:0&quot;&gt;https://www.merriam-webster.com/dictionary/bylaw&lt;/ref&gt; Ne saa nti, ɛbɛtumi aba sɛ wɔn werɛ fii saa din no na wɔnam adeyɛ kyerɛfoɔ by a asekyerɛ ne mmara a yɛate so anaa nea ɛda nkyɛn(byway) sane de baa biom wɔ ɛnnɛ mmerɛ mu.&lt;ref name=&quot;:0&quot; /&gt; Wɔ saa kwan mmienu no nyinaa mu no, ɛntwa kwan sɛ obi bɛka sɛ baabi a edin no firi no yɛ kasatɔmmɛ mmaranketewa

== Mansini Adantam mmaranketewa ==
Mansini Adantam mmaranketewa yɛ amansan mmara a wɔde di dwuma wɔ mmaeɛ bi. Ɛnsonsoneɛ a ɛda mmaranketewa ne mmaraɔman no gye tom ne sɛ, ɛnyɛ obiara na ɔyɛɛ mmaranketewa a ɛgye firi aban foforɔ hɔ, na gyesɛ ɛgyina asɛm bi so ansa na watumi ayɛ. Mansini Adantam aban anaa mantam aban a ɛkyerɛ nnoɔma a kuro bi bɛyɛ ɛnam mmaranketewa no so. Ɛyɛ ntamgyinafoɔ mmara. Wɔ ne tumi mu ne beaɛ pɔtee a mpaninfoɔ no ahyɛ ama wɔn no, mansini adantam mmaranketewa no nna nso mfiri mmara a ɛwɔ hɔ no, na wɔbɛtumi de mmara no atwe wɔn aso, wone kɔɔto twe so na ɛne mmara foforɔ bi te sɛ ɔman amammra a ɛwɔ asaase no so na ɛkɔ. Mansini mmaranketewa no fa Public Justice system no mu, na wɔn a wɔtia mmara nso yɛ bɔne a wayɛ atia aban. Mmaranketewa a ɛnyɛ na no bi ne vehicle parking baabi a wɔde ahyɛn so na wɔbu mmara so, animal control, adansie, ɛhyɛn adanseɛ krataaa,dede,zoning and business regulation, ne sɛ wototo amansan nsrahwɛ bea.

Mmaranketewa a ɛwɔ JapanWɔ article 94 wɔ Japan amammra mu no, aban a ɔwɔ mantam no ɔgyina ne ho sone tumi wɔ mmara mu a ɔde bɛte mmaranketewa.Wɔ ne dwumadie mu no, saa mmara yi ne Local Autonomy Law na ɛkɔ. Mmaranketewa mu no, mmara a yɛagye atom ma Japanese amammra ka ho.Wɔ ne tumi a ɛhyɛ nnipa ne ne dwumadie mu no, ɛno na ɛsua koraa wɔ mmara no nyinaa mu.</text>
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      <text bytes="3611" xml:space="preserve">'''Mmaranketewa''' anaa nea United States frɛ no &quot;Bylaws&quot; yɛ mmara ahodoɔ bi a dwumakuo anaa mpɔtam bi ahyehyɛ na wɔde ayɛ adwuma sɛdeɛ mpaninfoɔ binom ama ho kwan.  Wɔn a wɔwɔ diberɛ kɛseɛ, ne titire wɔn a wɔhyɛ mmara anaa aban bi de nea ɛbɛtenetene mmara nketewa sɛdeɛ ɛbɛtumi adi dwuma. Nnipa ɛbɛtumi ayɛ mmaranketewa no bi ne nnwumakuo, neighborhood Association, a ɛgyina baabi a  wɔn tumi kɔpem, mansini adantam. Wɔ United Kingdom ne commonweath aman ahodoɔ mu no, mmara a asoafeɛ no hyehyɛ no wɔfrɛ no &quot;by(e)- kawa&quot; ɛfiri sɛ Central government no na ɔkyerɛ ɛkwan saa aman no mfa so nyɛ no. Nea ɛhyɛ ma wɔdi mmaranketewa no so no yɛ Canada a ɛne American COde Enforcement officer.  Wɔ United States Federal Government ne aban a ɛwɔ nkuro so nni tumi sɛ wɔma mansini adantam mmara no yɛ adwuma. Ne saa nti, sɛ ɛnyɛ mmara a edin bi te sɛ ''code'', ''ordinance'', anaa ''regulation nyɛ na koraa.''

== N'abɔseɛ ==
Merriam -Webster Dictionary kyerɛɛ sɛ mmara ketewa firi borɔfo din bilade, a ɛfiri Old Norse *bylog, firi Old Norse ''bȳr'' town + ''lag-, lǫg'' mmara.&lt;ref&gt;https://www.merriam-webster.com/dictionary/bylaw&lt;/ref&gt;Deina wɔdiikan de dii dwuma a ɛfiri Coming kuro mmara wɔ Danelaw,  a by yɛ Old Norse din ma baabi a ɛhɔ so wɔ whitby ne Derby(sɛ wode toto Modern Danish-Norwegian din by a ɛkyerɛ kuro anaasɛ modern Swedish din by a ɛkyerɛ akurase).&lt;ref name=&quot;:0&quot;&gt;https://www.merriam-webster.com/dictionary/bylaw&lt;/ref&gt; Ne saa nti, ɛbɛtumi aba sɛ wɔn werɛ fii saa din no na wɔnam adeyɛ kyerɛfoɔ by a asekyerɛ ne mmara a yɛate so anaa nea ɛda nkyɛn(byway) sane de baa biom wɔ ɛnnɛ mmerɛ mu.&lt;ref name=&quot;:0&quot; /&gt; Wɔ saa kwan mmienu no nyinaa mu no, ɛntwa kwan sɛ obi bɛka sɛ baabi a edin no firi no yɛ kasatɔmmɛ mmaranketewa

== Mansini Adantam mmaranketewa ==
Mansini Adantam mmaranketewa yɛ amansan mmara a wɔde di dwuma wɔ mmaeɛ bi. Ɛnsonsoneɛ a ɛda mmaranketewa ne mmaraɔman no gye tom ne sɛ, ɛnyɛ obiara na ɔyɛɛ mmaranketewa a ɛgye firi aban foforɔ hɔ, na gyesɛ ɛgyina asɛm bi so ansa na watumi ayɛ. Mansini Adantam aban anaa mantam aban a ɛkyerɛ nnoɔma a kuro bi bɛyɛ ɛnam mmaranketewa no so. Ɛyɛ ntamgyinafoɔ mmara. Wɔ ne tumi mu ne beaɛ pɔtee a mpaninfoɔ no ahyɛ ama wɔn no, mansini adantam mmaranketewa no nna nso mfiri mmara a ɛwɔ hɔ no, na wɔbɛtumi de mmara no atwe wɔn aso, wone kɔɔto twe so na ɛne mmara foforɔ bi te sɛ ɔman amammra a ɛwɔ asaase no so na ɛkɔ. Mansini mmaranketewa no fa Public Justice system no mu, na wɔn a wɔtia mmara nso yɛ bɔne a wayɛ atia aban. Mmaranketewa a ɛnyɛ na no bi ne vehicle parking baabi a wɔde ahyɛn so na wɔbu mmara so, animal control, adansie, ɛhyɛn adanseɛ krataaa,dede,zoning and business regulation, ne sɛ wototo amansan nsrahwɛ bea.

Mmaranketewa a ɛwɔ Japan

Wɔ article 94 wɔ Japan amammra mu no, aban a ɔwɔ mantam no ɔgyina ne ho sone tumi wɔ mmara mu a ɔde bɛte mmaranketewa.Wɔ ne dwumadie mu no, saa mmara yi ne Local Autonomy Law na ɛkɔ. Mmaranketewa mu no, mmara a yɛagye atom ma Japanese amammra ka ho.Wɔ ne tumi a ɛhyɛ nnipa ne ne dwumadie mu no, ɛno na ɛsua koraa wɔ mmara no nyinaa mu.

Saa tumi yi na yɛde bu nea ɛdidisoɔ yi:

* Baabi a aban no akonnwa no wɔ a ɛfata ɔnikorɔ
* Nhyiamudie a wɔyɛ no dabiara
* Nea ɛsɛ no no aban ne nkurase ntamgyinafoɔ abɛdiakyire dodoɔ.
* Nnipa dodoɔ ba ɛyɛ adwuma a yɛde wɔn aka adwumantotoeɛ ho.
* Baabi a yɛde mmeaɛ a ɛwɔ mantam a ɛgyina wɔn ho so ato.
* Mansini Adantam bi sikasɛm ntotoeɛ</text>
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    <revision>
      <id>133008</id>
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      <timestamp>2022-08-01T02:27:43Z</timestamp>
      <contributor>
        <username>AC Krah</username>
        <id>10338</id>
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      <text bytes="3647" xml:space="preserve">'''Mmaranketewa''' anaa nea United States frɛ no &quot;Bylaws&quot; yɛ mmara ahodoɔ bi a dwumakuo anaa mpɔtam bi ahyehyɛ na wɔde ayɛ adwuma sɛdeɛ mpaninfoɔ binom ama ho kwan.  Wɔn a wɔwɔ diberɛ kɛseɛ, ne titire wɔn a wɔhyɛ mmara anaa aban bi de nea ɛbɛtenetene mmara nketewa sɛdeɛ ɛbɛtumi adi dwuma. Nnipa ɛbɛtumi ayɛ mmaranketewa no bi ne nnwumakuo, neighborhood Association, a ɛgyina baabi a  wɔn tumi kɔpem, mansini adantam. Wɔ United Kingdom ne commonweath aman ahodoɔ mu no, mmara a asoafeɛ no hyehyɛ no wɔfrɛ no &quot;by(e)- kawa&quot; ɛfiri sɛ Central government no na ɔkyerɛ ɛkwan saa aman no mfa so nyɛ no. Nea ɛhyɛ ma wɔdi mmaranketewa no so no yɛ Canada a ɛne American COde Enforcement officer.  Wɔ United States Federal Government ne aban a ɛwɔ nkuro so nni tumi sɛ wɔma mansini adantam mmara no yɛ adwuma. Ne saa nti, sɛ ɛnyɛ mmara a edin bi te sɛ ''code'', ''ordinance'', anaa ''regulation nyɛ na koraa.''

== N'abɔseɛ ==
Merriam -Webster Dictionary kyerɛɛ sɛ mmara ketewa firi borɔfo din bilade, a ɛfiri Old Norse *bylog, firi Old Norse ''bȳr'' town + ''lag-, lǫg'' mmara.&lt;ref&gt;https://www.merriam-webster.com/dictionary/bylaw&lt;/ref&gt;Deina wɔdiikan de dii dwuma a ɛfiri Coming kuro mmara wɔ Danelaw,  a by yɛ Old Norse din ma baabi a ɛhɔ so wɔ whitby ne Derby(sɛ wode toto Modern Danish-Norwegian din by a ɛkyerɛ kuro anaasɛ modern Swedish din by a ɛkyerɛ akurase).&lt;ref name=&quot;:0&quot;&gt;https://www.merriam-webster.com/dictionary/bylaw&lt;/ref&gt; Ne saa nti, ɛbɛtumi aba sɛ wɔn werɛ fii saa din no na wɔnam adeyɛ kyerɛfoɔ by a asekyerɛ ne mmara a yɛate so anaa nea ɛda nkyɛn(byway) sane de baa biom wɔ ɛnnɛ mmerɛ mu.&lt;ref name=&quot;:0&quot; /&gt; Wɔ saa kwan mmienu no nyinaa mu no, ɛntwa kwan sɛ obi bɛka sɛ baabi a edin no firi no yɛ kasatɔmmɛ mmaranketewa

== Mansini Adantam mmaranketewa ==
Mansini Adantam mmaranketewa yɛ amansan mmara a wɔde di dwuma wɔ mmaeɛ bi. Ɛnsonsoneɛ a ɛda mmaranketewa ne mmaraɔman no gye tom ne sɛ, ɛnyɛ obiara na ɔyɛɛ mmaranketewa a ɛgye firi aban foforɔ hɔ, na gyesɛ ɛgyina asɛm bi so ansa na watumi ayɛ. Mansini Adantam aban anaa mantam aban a ɛkyerɛ nnoɔma a kuro bi bɛyɛ ɛnam mmaranketewa no so. Ɛyɛ ntamgyinafoɔ mmara. Wɔ ne tumi mu ne beaɛ pɔtee a mpaninfoɔ no ahyɛ ama wɔn no, mansini adantam mmaranketewa no nna nso mfiri mmara a ɛwɔ hɔ no, na wɔbɛtumi de mmara no atwe wɔn aso, wone kɔɔto twe so na ɛne mmara foforɔ bi te sɛ ɔman amammra a ɛwɔ asaase no so na ɛkɔ. Mansini mmaranketewa no fa Public Justice system no mu, na wɔn a wɔtia mmara nso yɛ bɔne a wayɛ atia aban. Mmaranketewa a ɛnyɛ na no bi ne vehicle parking baabi a wɔde ahyɛn so na wɔbu mmara so, animal control, adansie, ɛhyɛn adanseɛ krataaa,dede,zoning and business regulation, ne sɛ wototo amansan nsrahwɛ bea.

Mmaranketewa a ɛwɔ Japan

Wɔ article 94 wɔ Japan amammra mu no, aban a ɔwɔ mantam no ɔgyina ne ho sone tumi wɔ mmara mu a ɔde bɛte mmaranketewa.Wɔ ne dwumadie mu no, saa mmara yi ne Local Autonomy Law na ɛkɔ. Mmaranketewa mu no, mmara a yɛagye atom ma Japanese amammra ka ho.Wɔ ne tumi a ɛhyɛ nnipa ne ne dwumadie mu no, ɛno na ɛsua koraa wɔ mmara no nyinaa mu.

Saa tumi yi na yɛde bu nea ɛdidisoɔ yi:

* Baabi a aban no akonnwa no wɔ a ɛfata ɔnikorɔ
* Nhyiamudie a wɔyɛ no dabiara
* Nea ɛsɛ no no aban ne nkurase ntamgyinafoɔ abɛdiakyire dodoɔ.
* Nnipa dodoɔ ba ɛyɛ adwuma a yɛde wɔn aka adwumantotoeɛ ho.
* Baabi a yɛde mmeaɛ a ɛwɔ mantam a ɛgyina wɔn ho so ato.
* Mansini Adantam bi sikasɛm ntotoeɛ

== Beaeɛ a menyaa mmoa firiiɛ ==</text>
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      <id>133010</id>
      <parentid>133008</parentid>
      <timestamp>2022-08-01T02:32:14Z</timestamp>
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        <username>AC Krah</username>
        <id>10338</id>
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      <text bytes="3842" xml:space="preserve">'''Mmaranketewa''' anaa nea United States frɛ no &quot;Bylaws&quot; yɛ mmara ahodoɔ bi a dwumakuo anaa mpɔtam bi ahyehyɛ na wɔde ayɛ adwuma sɛdeɛ mpaninfoɔ binom ama ho kwan.  Wɔn a wɔwɔ diberɛ kɛseɛ, ne titire wɔn a wɔhyɛ mmara anaa aban bi de nea ɛbɛtenetene mmara nketewa sɛdeɛ ɛbɛtumi adi dwuma. Nnipa ɛbɛtumi ayɛ mmaranketewa no bi ne nnwumakuo, neighborhood Association, a ɛgyina baabi a  wɔn tumi kɔpem, mansini adantam. Wɔ United Kingdom ne commonweath aman ahodoɔ mu no, mmara a asoafeɛ no hyehyɛ no wɔfrɛ no &quot;by(e)- kawa&quot; ɛfiri sɛ Central government no na ɔkyerɛ ɛkwan saa aman no mfa so nyɛ no. Nea ɛhyɛ ma wɔdi mmaranketewa no so no yɛ Canada a ɛne American COde Enforcement officer.  Wɔ United States Federal Government ne aban a ɛwɔ nkuro so nni tumi sɛ wɔma mansini adantam mmara no yɛ adwuma. Ne saa nti, sɛ ɛnyɛ mmara a edin bi te sɛ ''code'', ''ordinance'', anaa ''regulation nyɛ na koraa.''

== N'abɔseɛ ==
Merriam -Webster Dictionary kyerɛɛ sɛ mmara ketewa firi borɔfo din bilade, a ɛfiri Old Norse *bylog, firi Old Norse ''bȳr'' town + ''lag-, lǫg'' mmara.&lt;ref&gt;https://www.merriam-webster.com/dictionary/bylaw&lt;/ref&gt;Deina wɔdiikan de dii dwuma a ɛfiri Coming kuro mmara wɔ Danelaw,  a by yɛ Old Norse din ma baabi a ɛhɔ so wɔ whitby ne Derby(sɛ wode toto Modern Danish-Norwegian din by a ɛkyerɛ kuro anaasɛ modern Swedish din by a ɛkyerɛ akurase).&lt;ref name=&quot;:0&quot;&gt;https://www.merriam-webster.com/dictionary/bylaw&lt;/ref&gt; Ne saa nti, ɛbɛtumi aba sɛ wɔn werɛ fii saa din no na wɔnam adeyɛ kyerɛfoɔ by a asekyerɛ ne mmara a yɛate so anaa nea ɛda nkyɛn(byway) sane de baa biom wɔ ɛnnɛ mmerɛ mu.&lt;ref name=&quot;:0&quot; /&gt; Wɔ saa kwan mmienu no nyinaa mu no, ɛntwa kwan sɛ obi bɛka sɛ baabi a edin no firi no yɛ kasatɔmmɛ mmaranketewa

== Mansini Adantam mmaranketewa ==
Mansini Adantam mmaranketewa yɛ amansan mmara a wɔde di dwuma wɔ mmaeɛ bi. Ɛnsonsoneɛ a ɛda mmaranketewa ne mmaraɔman no gye tom ne sɛ, ɛnyɛ obiara na ɔyɛɛ mmaranketewa a ɛgye firi aban foforɔ hɔ, na gyesɛ ɛgyina asɛm bi so ansa na watumi ayɛ. Mansini Adantam aban anaa mantam aban a ɛkyerɛ nnoɔma a kuro bi bɛyɛ ɛnam mmaranketewa no so. Ɛyɛ ntamgyinafoɔ mmara. Wɔ ne tumi mu ne beaɛ pɔtee a mpaninfoɔ no ahyɛ ama wɔn no, mansini adantam mmaranketewa no nna nso mfiri mmara a ɛwɔ hɔ no, na wɔbɛtumi de mmara no atwe wɔn aso, wone kɔɔto twe so na ɛne mmara foforɔ bi te sɛ ɔman amammra a ɛwɔ asaase no so na ɛkɔ. Mansini mmaranketewa no fa Public Justice system no mu, na wɔn a wɔtia mmara nso yɛ bɔne a wayɛ atia aban. Mmaranketewa a ɛnyɛ na no bi ne vehicle parking baabi a wɔde ahyɛn so na wɔbu mmara so, animal control, adansie, ɛhyɛn adanseɛ krataaa,dede,zoning and business regulation, ne sɛ wototo amansan nsrahwɛ bea.

'''Mmaranketewa a ɛwɔ Japan'''

Wɔ article 94 wɔ Japan amammra mu no, aban a ɔwɔ mantam no ɔgyina ne ho sone tumi wɔ mmara mu a ɔde bɛte mmaranketewa.Wɔ ne dwumadie mu no, saa mmara yi ne Local Autonomy Law na ɛkɔ. Mmaranketewa mu no, mmara a yɛagye atom ma Japanese amammra ka ho.Wɔ ne tumi a ɛhyɛ nnipa ne ne dwumadie mu no, ɛno na ɛsua koraa wɔ mmara no nyinaa mu.

Saa tumi yi na yɛde bu nea ɛdidisoɔ yi:

* Baabi a aban no akonnwa no wɔ a ɛfata ɔnikorɔ
* Nhyiamudie a wɔyɛ no dabiara
* Nea ɛsɛ no no aban ne nkurase ntamgyinafoɔ abɛdiakyire dodoɔ.
* Nnipa dodoɔ ba ɛyɛ adwuma a yɛde wɔn aka adwumantotoeɛ ho.
* Baabi a yɛde mmeaɛ a ɛwɔ mantam a ɛgyina wɔn ho so ato.
* Mansini Adantam bi sikasɛm ntotoeɛ
Wɔ United Kingdom no, mmaranketewa yɛ mmara a yɛde mampɔtam anaasɛ kakraabi a Local council no yɛɛ, a ɔde tumi a mmarahyɛbedwa Act de maa wɔn  na saa na mmara ntamgyinafoɔ teɛ.

== Beaeɛ a menyaa mmoa firiiɛ ==</text>
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      <timestamp>2022-08-01T02:33:13Z</timestamp>
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        <username>AC Krah</username>
        <id>10338</id>
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      <text bytes="3867" xml:space="preserve">'''Mmaranketewa''' anaa nea United States frɛ no &quot;Bylaws&quot; yɛ mmara ahodoɔ bi a dwumakuo anaa mpɔtam bi ahyehyɛ na wɔde ayɛ adwuma sɛdeɛ mpaninfoɔ binom ama ho kwan.  Wɔn a wɔwɔ diberɛ kɛseɛ, ne titire wɔn a wɔhyɛ mmara anaa aban bi de nea ɛbɛtenetene mmara nketewa sɛdeɛ ɛbɛtumi adi dwuma. Nnipa ɛbɛtumi ayɛ mmaranketewa no bi ne nnwumakuo, neighborhood Association, a ɛgyina baabi a  wɔn tumi kɔpem, mansini adantam. Wɔ United Kingdom ne commonweath aman ahodoɔ mu no, mmara a asoafeɛ no hyehyɛ no wɔfrɛ no &quot;by(e)- kawa&quot; ɛfiri sɛ Central government no na ɔkyerɛ ɛkwan saa aman no mfa so nyɛ no. Nea ɛhyɛ ma wɔdi mmaranketewa no so no yɛ Canada a ɛne American COde Enforcement officer.  Wɔ United States Federal Government ne aban a ɛwɔ nkuro so nni tumi sɛ wɔma mansini adantam mmara no yɛ adwuma. Ne saa nti, sɛ ɛnyɛ mmara a edin bi te sɛ ''code'', ''ordinance'', anaa ''regulation nyɛ na koraa.''

== N'abɔseɛ ==


Merriam -Webster Dictionary kyerɛɛ sɛ mmara ketewa firi borɔfo din bilade, a ɛfiri Old Norse *bylog, firi Old Norse ''bȳr'' town + ''lag-, lǫg'' mmara.&lt;ref&gt;https://www.merriam-webster.com/dictionary/bylaw&lt;/ref&gt;Deina wɔdiikan de dii dwuma a ɛfiri Coming kuro mmara wɔ Danelaw,  a by yɛ Old Norse din ma baabi a ɛhɔ so wɔ whitby ne Derby(sɛ wode toto Modern Danish-Norwegian din by a ɛkyerɛ kuro anaasɛ modern Swedish din by a ɛkyerɛ akurase).&lt;ref name=&quot;:0&quot;&gt;https://www.merriam-webster.com/dictionary/bylaw&lt;/ref&gt; Ne saa nti, ɛbɛtumi aba sɛ wɔn werɛ fii saa din no na wɔnam adeyɛ kyerɛfoɔ by a asekyerɛ ne mmara a yɛate so anaa nea ɛda nkyɛn(byway) sane de baa biom wɔ ɛnnɛ mmerɛ mu.&lt;ref name=&quot;:0&quot; /&gt; Wɔ saa kwan mmienu no nyinaa mu no, ɛntwa kwan sɛ obi bɛka sɛ baabi a edin no firi no yɛ kasatɔmmɛ mmaranketewa

== Mansini Adantam mmaranketewa ==
Mansini Adantam mmaranketewa yɛ amansan mmara a wɔde di dwuma wɔ mmaeɛ bi. Ɛnsonsoneɛ a ɛda mmaranketewa ne mmaraɔman no gye tom ne sɛ, ɛnyɛ obiara na ɔyɛɛ mmaranketewa a ɛgye firi aban foforɔ hɔ, na gyesɛ ɛgyina asɛm bi so ansa na watumi ayɛ. Mansini Adantam aban anaa mantam aban a ɛkyerɛ nnoɔma a kuro bi bɛyɛ ɛnam mmaranketewa no so. Ɛyɛ ntamgyinafoɔ mmara. Wɔ ne tumi mu ne beaɛ pɔtee a mpaninfoɔ no ahyɛ ama wɔn no, mansini adantam mmaranketewa no nna nso mfiri mmara a ɛwɔ hɔ no, na wɔbɛtumi de mmara no atwe wɔn aso, wone kɔɔto twe so na ɛne mmara foforɔ bi te sɛ ɔman amammra a ɛwɔ asaase no so na ɛkɔ. Mansini mmaranketewa no fa Public Justice system no mu, na wɔn a wɔtia mmara nso yɛ bɔne a wayɛ atia aban. Mmaranketewa a ɛnyɛ na no bi ne vehicle parking baabi a wɔde ahyɛn so na wɔbu mmara so, animal control, adansie, ɛhyɛn adanseɛ krataaa,dede,zoning and business regulation, ne sɛ wototo amansan nsrahwɛ bea.

'''Mmaranketewa a ɛwɔ Japan'''

Wɔ article 94 wɔ Japan amammra mu no, aban a ɔwɔ mantam no ɔgyina ne ho sone tumi wɔ mmara mu a ɔde bɛte mmaranketewa.Wɔ ne dwumadie mu no, saa mmara yi ne Local Autonomy Law na ɛkɔ. Mmaranketewa mu no, mmara a yɛagye atom ma Japanese amammra ka ho.Wɔ ne tumi a ɛhyɛ nnipa ne ne dwumadie mu no, ɛno na ɛsua koraa wɔ mmara no nyinaa mu.

Saa tumi yi na yɛde bu nea ɛdidisoɔ yi:

* Baabi a aban no akonnwa no wɔ a ɛfata ɔnikorɔ
* Nhyiamudie a wɔyɛ no dabiara
* Nea ɛsɛ no no aban ne nkurase ntamgyinafoɔ abɛdiakyire dodoɔ.
* Nnipa dodoɔ ba ɛyɛ adwuma a yɛde wɔn aka adwumantotoeɛ ho.
* Baabi a yɛde mmeaɛ a ɛwɔ mantam a ɛgyina wɔn ho so ato.
* Mansini Adantam bi sikasɛm ntotoeɛ
'''United Kingdom''' 

Wɔ United Kingdom no, mmaranketewa yɛ mmara a yɛde mampɔtam anaasɛ kakraabi a Local council no yɛɛ, a ɔde tumi a mmarahyɛbedwa Act de maa wɔn  na saa na mmara ntamgyinafoɔ teɛ.

== Beaeɛ a menyaa mmoa firiiɛ ==</text>
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  <page>
    <title>Kokoram</title>
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      <text bytes="552" xml:space="preserve">Kokoram yɛ nyarewa kuw bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Eyinom ne akisikuru a ɛnyɛ hu a ɛntrɛw no bɔ abira.[7] 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.[1] Bere a saa sɛnkyerɛnne ahorow yi betumi akyerɛ sɛ kokoram de, nanso ebetumi de nneɛma afoforo nso aba.[1] Kokoram ahorow bɛboro 100 na ɛka nnipa.[7]</text>
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      <text bytes="4259" xml:space="preserve">Kokoram yɛ nyarewa kuw bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Eyinom ne akisikuru a ɛnyɛ hu a ɛntrɛw no bɔ abira.[7] 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.[1] Bere a saa sɛnkyerɛnne ahorow yi betumi akyerɛ sɛ kokoram de, nanso ebetumi de nneɛma afoforo nso aba.[1] Kokoram ahorow bɛboro 100 na ɛka nnipa.[7] 

Tawa a wɔde di dwuma no na ɛde kokoram wuwu bɛyɛ 22% ba.[2] 10% foforo nso fi kɛseyɛ mmoroso, aduan pa a wonni, apɔw-mu-teɛteɛ a wonnya anaasɛ nsa a wɔnom boro so.[2][8][9] 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 efĩ ba.[3] 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).[2] Anyɛ yiye koraa no, saa nneɛma yi yɛ adwuma, ne fã bi, denam nkwammoaa bi awosu mu nkwaadɔm a wɔsakra no so.[10] Mpɛn pii no, ɛho hia sɛ wɔyɛ nsakrae pii wɔ awosu mu ansa na kokoram aba.[10] Bɛyɛ kokoram 5–10% fi awosu mu sintɔ ahorow a wonya fi awo mu.[11] Wobetumi de nsɛnkyerɛnne ne sɛnkyerɛnne ahorow bi anaa nhwehwɛmu a wɔde hwehwɛ kokoram mu ahu kokoram.[2] Afei wɔtaa de nnuruyɛ mu mfoniniyɛ hwehwɛ mu bio na wɔde nipadua mu nhwehwɛmu si so dua.[12]

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.[13][14] Sɛ wohu ntɛm denam nhwehwɛmu so a, ɛho wɔ mfaso ma awotwaa ne akyi berɛmo mu kokoram.[15] Mfaso a ɛwɔ nufu mu kokoram a wɔhwehwɛ mu no yɛ nea akyinnyegye wom.[15][16] 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.[2][4] Ɛyaw ne sɛnkyerɛnne ahorow a wɔde di dwuma no yɛ ɔhwɛ no fã titiriw.[2] Ayaresa a ɛma obi ho dwo no ho hia titiriw wɔ nnipa a wɔwɔ yare a emu yɛ den no mu.[2] 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%.[17] Wɔ kokoram ho wɔ United States no, sɛ wɔkyekyem pɛpɛɛpɛ a, mfe anum a wɔde tra ase no yɛ 66%.[5]

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.[6][19]

Kokoram ahorow a ɛtaa ba mmarima so ne ahurututu mu kokoram, prostate kokoram, akyi berɛmo mu kokoram, ne yafunu mu kokoram.[20] Wɔ mmea mu no, nea ɛtaa ba ne nufu mu kokoram, kokoram a ɛwɔ akyi berɛmo mu, ahurututu mu kokoram, ne awotwaa mu kokoram.[10] 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%.[21][22] 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.[17] Wɔ afe 2012 mu no, mmofra bɛyɛ 165,000 a wonnii mfe 15 na wohui sɛ wɔwɔ kokoram.[20] Kokoram ho asiane no kɔ soro kɛse bere a obi nyin no, na kokoram pii taa ba aman a wɔanya nkɔso no mu.[10] 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.[23] 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.[24]</text>
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      <text bytes="4677" xml:space="preserve">Kokoram yɛ nyarewa kuw bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Eyinom ne akisikuru a ɛnyɛ hu a ɛntrɛw no bɔ abira.[7] 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.[1] Bere a saa sɛnkyerɛnne ahorow yi betumi akyerɛ sɛ kokoram de, nanso ebetumi de nneɛma afoforo nso aba.[1] Kokoram ahorow bɛboro 100 na ɛka nnipa.[7] 

Tawa a wɔde di dwuma no na ɛde kokoram wuwu bɛyɛ 22% ba.[2] 10% foforo nso fi kɛseyɛ mmoroso, aduan pa a wonni, apɔw-mu-teɛteɛ a wonnya anaasɛ nsa a wɔnom boro so.[2][8][9] 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 efĩ ba.[3] 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).[2] Anyɛ yiye koraa no, saa nneɛma yi yɛ adwuma, ne fã bi, denam nkwammoaa bi awosu mu nkwaadɔm a wɔsakra no so.[10] Mpɛn pii no, ɛho hia sɛ wɔyɛ nsakrae pii wɔ awosu mu ansa na kokoram aba.[10] Bɛyɛ kokoram 5–10% fi awosu mu sintɔ ahorow a wonya fi awo mu.[11] Wobetumi de nsɛnkyerɛnne ne sɛnkyerɛnne ahorow bi anaa nhwehwɛmu a wɔde hwehwɛ kokoram mu ahu kokoram.[2] Afei wɔtaa de nnuruyɛ mu mfoniniyɛ hwehwɛ mu bio na wɔde nipadua mu nhwehwɛmu si so dua.[12]

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.[13][14] Sɛ wohu ntɛm denam nhwehwɛmu so a, ɛho wɔ mfaso ma awotwaa ne akyi berɛmo mu kokoram.[15] Mfaso a ɛwɔ nufu mu kokoram a wɔhwehwɛ mu no yɛ nea akyinnyegye wom.[15][16] 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.[2][4] Ɛyaw ne sɛnkyerɛnne ahorow a wɔde di dwuma no yɛ ɔhwɛ no fã titiriw.[2] Ayaresa a ɛma obi ho dwo no ho hia titiriw wɔ nnipa a wɔwɔ yare a emu yɛ den no mu.[2] 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%.[17] Wɔ kokoram ho wɔ United States no, sɛ wɔkyekyem pɛpɛɛpɛ a, mfe anum a wɔde tra ase no yɛ 66%.[5]

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.[6][19]

Kokoram ahorow a ɛtaa ba mmarima so ne ahurututu mu kokoram, prostate kokoram, akyi berɛmo mu kokoram, ne yafunu mu kokoram.[20] Wɔ mmea mu no, nea ɛtaa ba ne nufu mu kokoram, kokoram a ɛwɔ akyi berɛmo mu, ahurututu mu kokoram, ne awotwaa mu kokoram.[10] 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%.[21][22] 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.[17] Wɔ afe 2012 mu no, mmofra bɛyɛ 165,000 a wonnii mfe 15 na wohui sɛ wɔwɔ kokoram.[20] Kokoram ho asiane no kɔ soro kɛse bere a obi nyin no, na kokoram pii taa ba aman a wɔanya nkɔso no mu.[10] 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.[23] 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.[24] 

== Etymology ne nkyerɛase ahorow ==

== Nsɛnkyerɛnne ne sɛnkyerɛnne ahorow ==

== Nneɛma a ɛde ba ==

== Pathophysiology ho adesua ==

== Nhwehwɛmu a wɔyɛe ==

== Nkyekyɛmu ==

== Siw a wosiw ano ==

== Nhwehwɛmu a wɔyɛ ==

== Ntotoeɛ ==

== Nsɛm a Wɔka Kyerɛ ==

== Nyarewa a Ɛtrɛw Ho Adesua ==

== Abakɔsɛm ==

== Ɔmanfo ne amammerɛ ==

== Hwehwɛ mu ==

== Nyinsɛn ==

== Mmoa afoforo ==</text>
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      <format>text/x-wiki</format>
      <text bytes="5976" xml:space="preserve">Kokoram yɛ nyarewa kuw bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Eyinom ne akisikuru a ɛnyɛ hu a ɛntrɛw no bɔ abira.[7] 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.[1] Bere a saa sɛnkyerɛnne ahorow yi betumi akyerɛ sɛ kokoram de, nanso ebetumi de nneɛma afoforo nso aba.[1] Kokoram ahorow bɛboro 100 na ɛka nnipa.[7] 

Tawa a wɔde di dwuma no na ɛde kokoram wuwu bɛyɛ 22% ba.[2] 10% foforo nso fi kɛseyɛ mmoroso, aduan pa a wonni, apɔw-mu-teɛteɛ a wonnya anaasɛ nsa a wɔnom boro so.[2][8][9] 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 efĩ ba.[3] 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).[2] Anyɛ yiye koraa no, saa nneɛma yi yɛ adwuma, ne fã bi, denam nkwammoaa bi awosu mu nkwaadɔm a wɔsakra no so.[10] Mpɛn pii no, ɛho hia sɛ wɔyɛ nsakrae pii wɔ awosu mu ansa na kokoram aba.[10] Bɛyɛ kokoram 5–10% fi awosu mu sintɔ ahorow a wonya fi awo mu.[11] Wobetumi de nsɛnkyerɛnne ne sɛnkyerɛnne ahorow bi anaa nhwehwɛmu a wɔde hwehwɛ kokoram mu ahu kokoram.[2] Afei wɔtaa de nnuruyɛ mu mfoniniyɛ hwehwɛ mu bio na wɔde nipadua mu nhwehwɛmu si so dua.[12]

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.[13][14] Sɛ wohu ntɛm denam nhwehwɛmu so a, ɛho wɔ mfaso ma awotwaa ne akyi berɛmo mu kokoram.[15] Mfaso a ɛwɔ nufu mu kokoram a wɔhwehwɛ mu no yɛ nea akyinnyegye wom.[15][16] 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.[2][4] Ɛyaw ne sɛnkyerɛnne ahorow a wɔde di dwuma no yɛ ɔhwɛ no fã titiriw.[2] Ayaresa a ɛma obi ho dwo no ho hia titiriw wɔ nnipa a wɔwɔ yare a emu yɛ den no mu.[2] 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%.[17] Wɔ kokoram ho wɔ United States no, sɛ wɔkyekyem pɛpɛɛpɛ a, mfe anum a wɔde tra ase no yɛ 66%.[5]

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.[6][19]

Kokoram ahorow a ɛtaa ba mmarima so ne ahurututu mu kokoram, prostate kokoram, akyi berɛmo mu kokoram, ne yafunu mu kokoram.[20] Wɔ mmea mu no, nea ɛtaa ba ne nufu mu kokoram, kokoram a ɛwɔ akyi berɛmo mu, ahurututu mu kokoram, ne awotwaa mu kokoram.[10] 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%.[21][22] 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.[17] Wɔ afe 2012 mu no, mmofra bɛyɛ 165,000 a wonnii mfe 15 na wohui sɛ wɔwɔ kokoram.[20] Kokoram ho asiane no kɔ soro kɛse bere a obi nyin no, na kokoram pii taa ba aman a wɔanya nkɔso no mu.[10] 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.[23] 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.[24] 

== 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.[25]

Kokoram yɛ nyarewa abusua kɛse bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Wɔyɛ neoplasm ahorow no fã 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.[26][27]

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:[28] .

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[28] .

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.[28][29]

== Nsɛnkyerɛnne ne sɛnkyerɛnne ahorow ==

== Nneɛma a ɛde ba ==

== Pathophysiology ho adesua ==

== Nhwehwɛmu a wɔyɛe ==

== Nkyekyɛmu ==

== Siw a wosiw ano ==

== Nhwehwɛmu a wɔyɛ ==

== Ntotoeɛ ==

== Nsɛm a Wɔka Kyerɛ ==

== Nyarewa a Ɛtrɛw Ho Adesua ==

== Abakɔsɛm ==

== Ɔmanfo ne amammerɛ ==

== Hwehwɛ mu ==

== Nyinsɛn ==

== Mmoa afoforo ==</text>
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    </revision>
    <revision>
      <id>132959</id>
      <parentid>132957</parentid>
      <timestamp>2022-07-31T13:42:46Z</timestamp>
      <contributor>
        <username>Afriyie34</username>
        <id>10662</id>
      </contributor>
      <comment>Me de atwerɛ ka ho</comment>
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      <text bytes="9434" xml:space="preserve">Kokoram yɛ nyarewa kuw bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Eyinom ne akisikuru a ɛnyɛ hu a ɛntrɛw no bɔ abira.[7] 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.[1] Bere a saa sɛnkyerɛnne ahorow yi betumi akyerɛ sɛ kokoram de, nanso ebetumi de nneɛma afoforo nso aba.[1] Kokoram ahorow bɛboro 100 na ɛka nnipa.[7] 

Tawa a wɔde di dwuma no na ɛde kokoram wuwu bɛyɛ 22% ba.[2] 10% foforo nso fi kɛseyɛ mmoroso, aduan pa a wonni, apɔw-mu-teɛteɛ a wonnya anaasɛ nsa a wɔnom boro so.[2][8][9] 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 efĩ ba.[3] 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).[2] Anyɛ yiye koraa no, saa nneɛma yi yɛ adwuma, ne fã bi, denam nkwammoaa bi awosu mu nkwaadɔm a wɔsakra no so.[10] Mpɛn pii no, ɛho hia sɛ wɔyɛ nsakrae pii wɔ awosu mu ansa na kokoram aba.[10] Bɛyɛ kokoram 5–10% fi awosu mu sintɔ ahorow a wonya fi awo mu.[11] Wobetumi de nsɛnkyerɛnne ne sɛnkyerɛnne ahorow bi anaa nhwehwɛmu a wɔde hwehwɛ kokoram mu ahu kokoram.[2] Afei wɔtaa de nnuruyɛ mu mfoniniyɛ hwehwɛ mu bio na wɔde nipadua mu nhwehwɛmu si so dua.[12]

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.[13][14] Sɛ wohu ntɛm denam nhwehwɛmu so a, ɛho wɔ mfaso ma awotwaa ne akyi berɛmo mu kokoram.[15] Mfaso a ɛwɔ nufu mu kokoram a wɔhwehwɛ mu no yɛ nea akyinnyegye wom.[15][16] 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.[2][4] Ɛyaw ne sɛnkyerɛnne ahorow a wɔde di dwuma no yɛ ɔhwɛ no fã titiriw.[2] Ayaresa a ɛma obi ho dwo no ho hia titiriw wɔ nnipa a wɔwɔ yare a emu yɛ den no mu.[2] 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%.[17] Wɔ kokoram ho wɔ United States no, sɛ wɔkyekyem pɛpɛɛpɛ a, mfe anum a wɔde tra ase no yɛ 66%.[5]

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.[6][19]

Kokoram ahorow a ɛtaa ba mmarima so ne ahurututu mu kokoram, prostate kokoram, akyi berɛmo mu kokoram, ne yafunu mu kokoram.[20] Wɔ mmea mu no, nea ɛtaa ba ne nufu mu kokoram, kokoram a ɛwɔ akyi berɛmo mu, ahurututu mu kokoram, ne awotwaa mu kokoram.[10] 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%.[21][22] 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.[17] Wɔ afe 2012 mu no, mmofra bɛyɛ 165,000 a wonnii mfe 15 na wohui sɛ wɔwɔ kokoram.[20] Kokoram ho asiane no kɔ soro kɛse bere a obi nyin no, na kokoram pii taa ba aman a wɔanya nkɔso no mu.[10] 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.[23] 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.[24] 

== 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.[25]

Kokoram yɛ nyarewa abusua kɛse bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Wɔyɛ neoplasm ahorow no fã 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.[26][27]

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:[28] .

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[28] .

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.[28][29]

== 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 &quot;ɔsuasua kɛse.&quot;[30]

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.[31]

'''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.[30]

'''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.[32] 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.[33]

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.[30]

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 fĩ, anaasɛ hyponatremia, a ɛno nso betumi ama adwene mu tebea asakra, ɔfe, tiyɛ, anaa akisikuru.[34]

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 fã 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 ɛde ba ==

== Pathophysiology ho adesua ==

== Nhwehwɛmu a wɔyɛe ==

== Nkyekyɛmu ==

== Siw a wosiw ano ==

== Nhwehwɛmu a wɔyɛ ==

== Ntotoeɛ ==

== Nsɛm a Wɔka Kyerɛ ==

== Nyarewa a Ɛtrɛw Ho Adesua ==

== Abakɔsɛm ==

== Ɔmanfo ne amammerɛ ==

== Hwehwɛ mu ==

== Nyinsɛn ==

== Mmoa afoforo ==</text>
      <sha1>midfaup046cmq0ltegjhx95w8e7lpq9</sha1>
    </revision>
    <revision>
      <id>132962</id>
      <parentid>132959</parentid>
      <timestamp>2022-07-31T13:51:11Z</timestamp>
      <contributor>
        <username>Afriyie34</username>
        <id>10662</id>
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      <comment>Me de atwerɛ ka ho</comment>
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      <text bytes="24313" xml:space="preserve">Kokoram yɛ nyarewa kuw bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Eyinom ne akisikuru a ɛnyɛ hu a ɛntrɛw no bɔ abira.[7] 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.[1] Bere a saa sɛnkyerɛnne ahorow yi betumi akyerɛ sɛ kokoram de, nanso ebetumi de nneɛma afoforo nso aba.[1] Kokoram ahorow bɛboro 100 na ɛka nnipa.[7] 

Tawa a wɔde di dwuma no na ɛde kokoram wuwu bɛyɛ 22% ba.[2] 10% foforo nso fi kɛseyɛ mmoroso, aduan pa a wonni, apɔw-mu-teɛteɛ a wonnya anaasɛ nsa a wɔnom boro so.[2][8][9] 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 efĩ ba.[3] 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).[2] Anyɛ yiye koraa no, saa nneɛma yi yɛ adwuma, ne fã bi, denam nkwammoaa bi awosu mu nkwaadɔm a wɔsakra no so.[10] Mpɛn pii no, ɛho hia sɛ wɔyɛ nsakrae pii wɔ awosu mu ansa na kokoram aba.[10] Bɛyɛ kokoram 5–10% fi awosu mu sintɔ ahorow a wonya fi awo mu.[11] Wobetumi de nsɛnkyerɛnne ne sɛnkyerɛnne ahorow bi anaa nhwehwɛmu a wɔde hwehwɛ kokoram mu ahu kokoram.[2] Afei wɔtaa de nnuruyɛ mu mfoniniyɛ hwehwɛ mu bio na wɔde nipadua mu nhwehwɛmu si so dua.[12]

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.[13][14] Sɛ wohu ntɛm denam nhwehwɛmu so a, ɛho wɔ mfaso ma awotwaa ne akyi berɛmo mu kokoram.[15] Mfaso a ɛwɔ nufu mu kokoram a wɔhwehwɛ mu no yɛ nea akyinnyegye wom.[15][16] 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.[2][4] Ɛyaw ne sɛnkyerɛnne ahorow a wɔde di dwuma no yɛ ɔhwɛ no fã titiriw.[2] Ayaresa a ɛma obi ho dwo no ho hia titiriw wɔ nnipa a wɔwɔ yare a emu yɛ den no mu.[2] 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%.[17] Wɔ kokoram ho wɔ United States no, sɛ wɔkyekyem pɛpɛɛpɛ a, mfe anum a wɔde tra ase no yɛ 66%.[5]

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.[6][19]

Kokoram ahorow a ɛtaa ba mmarima so ne ahurututu mu kokoram, prostate kokoram, akyi berɛmo mu kokoram, ne yafunu mu kokoram.[20] Wɔ mmea mu no, nea ɛtaa ba ne nufu mu kokoram, kokoram a ɛwɔ akyi berɛmo mu, ahurututu mu kokoram, ne awotwaa mu kokoram.[10] 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%.[21][22] 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.[17] Wɔ afe 2012 mu no, mmofra bɛyɛ 165,000 a wonnii mfe 15 na wohui sɛ wɔwɔ kokoram.[20] Kokoram ho asiane no kɔ soro kɛse bere a obi nyin no, na kokoram pii taa ba aman a wɔanya nkɔso no mu.[10] 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.[23] 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.[24] 

== 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.[25]

Kokoram yɛ nyarewa abusua kɛse bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Wɔyɛ neoplasm ahorow no fã 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.[26][27]

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:[28] .

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[28] .

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.[28][29]

== 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 &quot;ɔsuasua kɛse.&quot;[30]

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.[31]

'''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.[30]

'''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.[32] 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.[33]

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.[30]

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 fĩ, anaasɛ hyponatremia, a ɛno nso betumi ama adwene mu tebea asakra, ɔfe, tiyɛ, anaa akisikuru.[34]

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 fã 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 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.[3] 5–10% a aka no fi awosu mu nneɛma.[3] 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 efĩ ara kwa.[38] 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 efĩ.[3][39] Ɛte sɛ nea adwene mu nhyɛso nyɛ asiane a ɛma kokoram fi ase,[40][41] ɛwom sɛ ebetumi ama nea efi mu ba no asɛe wɔ wɔn a wɔwɔ kokoram dedaw no mu de.[40]

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,[42] 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: Nsã 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.[43] Ɛsan nso de kokoram ba anom, ti, kɔn, yafunu, akisikuru, asaabo, ɛwo ne dwensɔtwaa mu.[44] Tawa wusiw wɔ nneɛma bɛboro aduonum a wonim sɛ ɛde kokoram ba, a nitrosamines ne polycyclic aromatic hydrocarbons ka ho.[45]

Tawa na ɛde kokoram wuwu bɛyɛ nnipa baanum biara mu biako wɔ wiase nyinaa[45] ne bɛyɛ baasa biara mu biako wɔ aman a wɔanya nkɔso no mu.[46] 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 .[47][48] 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.[49] Kokoram a efi nnuru a wɔde di dwuma wɔ adwuma mu mu ba no betumi ama wɔanya nsɛm no mu 2 kosi 20%,[50] anyɛ yiye koraa no, ebetumi ama nnipa 200,000 awuwu.[51] 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.[51]

Wonim sɛ sɛ obi nya perfluorooctanoic acid (PFOA) a wɔde di dwuma titiriw wɔ Teflon a wɔyɛ mu a, ɛde kokoram ahorow abien ba.[52][53]

'''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 fã 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 efĩ 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 fã 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.[3] Saa dodow yi fi 25% a ɛkorɔn wɔ Afrika kosi nea ennu 10% wɔ aman a wɔanya nkɔso no mu.[3] 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).[61]

'''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.[62][63][64] Honam ani kokoram pii a ɛnyɛ melanoma no fi mframa a ano yɛ den a ɛbɔ, a ne fã kɛse no ara fi owia hann mu.[63] Nneɛma a ɛma mframa bɔne a ɛma ɛyɛ hyew ba no bi ne aduruyɛ mu mfoninitwa ne radon mframa.[63]

Ionizing radiation nyɛ mutagen a ɛyɛ den titiriw.[65] 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.[65] Mframa a ɛbɔ no betumi de kokoram aba nipadua no afã 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.[66]

Sɛ obi nya ultraviolet mframa a efi owia mu bere tenten a, ebetumi ama wanya melanoma ne honam ani yare afoforo.[67] 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.[67]

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.[69] [62] 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.[70]

'''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.[71] 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,[71] 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,[72] 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.[73] Asiane a ɛne no hyia no yɛ 1.5 ma ahurututu mu kokoram,[74] ne 1.9 ma prostate kokoram.[75] 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.[76]

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.[77]

'''Honam fam nneɛma a wɔde yɛ nneɛma'''

Nneɛma bi de kokoram ba titiriw denam ne honam fam nkɛntɛnso so, sen sɛ ɛbɛyɛ nnuru.[78] 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.[78] Nneɛma nketenkete a ɛnyɛ fibrous a ɛde kokoram ba no bi ne powder metallic cobalt ne nickel ne crystalline silica (quartz, cristobalite ne tridymite).[78] 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.[78]

Nipadua mu apirakuru a ɛde kokoram ba no ntaa mma.[79] Sɛ nhwɛso no, wonnya nkyerɛɛ nsɛm a wɔka sɛ nnompe a ebubui no maa nnompe mu kokoram bae.[79] Saa ara nso na wonnye nipadua mu apirakuru ntom sɛ ɛde awotwaa mu kokoram, nufu mu kokoram anaa amemene mu kokoram ba.[79] Fibea biako a wogye tom ne nneɛma a ɛyɛ hyew a wɔtaa de gu nipadua no so bere tenten. Ebetumi aba sɛ nipadua no fã 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.[79] Sɛ wɔtaa nom tii a ɛyɛ hyew a ɛyɛ hyew a, ebetumi ama woanya kokoram wɔ aduan mu.[79] 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.[79][80] Ɔfe betumi aboa ma kokoram nkwammoaa no adɔɔso, atra ase, angiogenesis ne atutra denam nkɛntɛnso a enya wɔ tumor microenvironment no so.[81][82] Oncogenes no kyekye pro-tumorigenic microenvironment a ɛma ɔhyew.[83]

'''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.[85]

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.[84] 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.[84] 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.[84] 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 ==

== Nhwehwɛmu a wɔyɛe ==

== Nkyekyɛmu ==

== Siw a wosiw ano ==

== Nhwehwɛmu a wɔyɛ ==

== Ntotoeɛ ==

== Nsɛm a Wɔka Kyerɛ ==

== Nyarewa a Ɛtrɛw Ho Adesua ==

== Abakɔsɛm ==

== Ɔmanfo ne amammerɛ ==

== Hwehwɛ mu ==

== Nyinsɛn ==

== Mmoa afoforo ==</text>
      <sha1>odu9mtt943iz8pc3ppn9eq0g6k6xs97</sha1>
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      <text bytes="29350" xml:space="preserve">Kokoram yɛ nyarewa kuw bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Eyinom ne akisikuru a ɛnyɛ hu a ɛntrɛw no bɔ abira.[7] 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.[1] Bere a saa sɛnkyerɛnne ahorow yi betumi akyerɛ sɛ kokoram de, nanso ebetumi de nneɛma afoforo nso aba.[1] Kokoram ahorow bɛboro 100 na ɛka nnipa.[7] 

Tawa a wɔde di dwuma no na ɛde kokoram wuwu bɛyɛ 22% ba.[2] 10% foforo nso fi kɛseyɛ mmoroso, aduan pa a wonni, apɔw-mu-teɛteɛ a wonnya anaasɛ nsa a wɔnom boro so.[2][8][9] 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 efĩ ba.[3] 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).[2] Anyɛ yiye koraa no, saa nneɛma yi yɛ adwuma, ne fã bi, denam nkwammoaa bi awosu mu nkwaadɔm a wɔsakra no so.[10] Mpɛn pii no, ɛho hia sɛ wɔyɛ nsakrae pii wɔ awosu mu ansa na kokoram aba.[10] Bɛyɛ kokoram 5–10% fi awosu mu sintɔ ahorow a wonya fi awo mu.[11] Wobetumi de nsɛnkyerɛnne ne sɛnkyerɛnne ahorow bi anaa nhwehwɛmu a wɔde hwehwɛ kokoram mu ahu kokoram.[2] Afei wɔtaa de nnuruyɛ mu mfoniniyɛ hwehwɛ mu bio na wɔde nipadua mu nhwehwɛmu si so dua.[12]

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.[13][14] Sɛ wohu ntɛm denam nhwehwɛmu so a, ɛho wɔ mfaso ma awotwaa ne akyi berɛmo mu kokoram.[15] Mfaso a ɛwɔ nufu mu kokoram a wɔhwehwɛ mu no yɛ nea akyinnyegye wom.[15][16] 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.[2][4] Ɛyaw ne sɛnkyerɛnne ahorow a wɔde di dwuma no yɛ ɔhwɛ no fã titiriw.[2] Ayaresa a ɛma obi ho dwo no ho hia titiriw wɔ nnipa a wɔwɔ yare a emu yɛ den no mu.[2] 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%.[17] Wɔ kokoram ho wɔ United States no, sɛ wɔkyekyem pɛpɛɛpɛ a, mfe anum a wɔde tra ase no yɛ 66%.[5]

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.[6][19]

Kokoram ahorow a ɛtaa ba mmarima so ne ahurututu mu kokoram, prostate kokoram, akyi berɛmo mu kokoram, ne yafunu mu kokoram.[20] Wɔ mmea mu no, nea ɛtaa ba ne nufu mu kokoram, kokoram a ɛwɔ akyi berɛmo mu, ahurututu mu kokoram, ne awotwaa mu kokoram.[10] 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%.[21][22] 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.[17] Wɔ afe 2012 mu no, mmofra bɛyɛ 165,000 a wonnii mfe 15 na wohui sɛ wɔwɔ kokoram.[20] Kokoram ho asiane no kɔ soro kɛse bere a obi nyin no, na kokoram pii taa ba aman a wɔanya nkɔso no mu.[10] 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.[23] 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.[24] 

== 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.[25]

Kokoram yɛ nyarewa abusua kɛse bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Wɔyɛ neoplasm ahorow no fã 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.[26][27]

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:[28] .

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[28] .

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.[28][29]

== 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 &quot;ɔsuasua kɛse.&quot;[30]

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.[31]

'''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.[30]

'''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.[32] 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.[33]

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.[30]

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 fĩ, anaasɛ hyponatremia, a ɛno nso betumi ama adwene mu tebea asakra, ɔfe, tiyɛ, anaa akisikuru.[34]

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 fã 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 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.[3] 5–10% a aka no fi awosu mu nneɛma.[3] 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 efĩ ara kwa.[38] 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 efĩ.[3][39] Ɛte sɛ nea adwene mu nhyɛso nyɛ asiane a ɛma kokoram fi ase,[40][41] ɛwom sɛ ebetumi ama nea efi mu ba no asɛe wɔ wɔn a wɔwɔ kokoram dedaw no mu de.[40]

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,[42] 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: Nsã 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.[43] Ɛsan nso de kokoram ba anom, ti, kɔn, yafunu, akisikuru, asaabo, ɛwo ne dwensɔtwaa mu.[44] Tawa wusiw wɔ nneɛma bɛboro aduonum a wonim sɛ ɛde kokoram ba, a nitrosamines ne polycyclic aromatic hydrocarbons ka ho.[45]

Tawa na ɛde kokoram wuwu bɛyɛ nnipa baanum biara mu biako wɔ wiase nyinaa[45] ne bɛyɛ baasa biara mu biako wɔ aman a wɔanya nkɔso no mu.[46] 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 .[47][48] 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.[49] Kokoram a efi nnuru a wɔde di dwuma wɔ adwuma mu mu ba no betumi ama wɔanya nsɛm no mu 2 kosi 20%,[50] anyɛ yiye koraa no, ebetumi ama nnipa 200,000 awuwu.[51] 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.[51]

Wonim sɛ sɛ obi nya perfluorooctanoic acid (PFOA) a wɔde di dwuma titiriw wɔ Teflon a wɔyɛ mu a, ɛde kokoram ahorow abien ba.[52][53]

'''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 fã 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 efĩ 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 fã 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.[3] Saa dodow yi fi 25% a ɛkorɔn wɔ Afrika kosi nea ennu 10% wɔ aman a wɔanya nkɔso no mu.[3] 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).[61]

'''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.[62][63][64] Honam ani kokoram pii a ɛnyɛ melanoma no fi mframa a ano yɛ den a ɛbɔ, a ne fã kɛse no ara fi owia hann mu.[63] Nneɛma a ɛma mframa bɔne a ɛma ɛyɛ hyew ba no bi ne aduruyɛ mu mfoninitwa ne radon mframa.[63]

Ionizing radiation nyɛ mutagen a ɛyɛ den titiriw.[65] 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.[65] Mframa a ɛbɔ no betumi de kokoram aba nipadua no afã 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.[66]

Sɛ obi nya ultraviolet mframa a efi owia mu bere tenten a, ebetumi ama wanya melanoma ne honam ani yare afoforo.[67] 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.[67]

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.[69] [62] 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.[70]

'''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.[71] 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,[71] 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,[72] 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.[73] Asiane a ɛne no hyia no yɛ 1.5 ma ahurututu mu kokoram,[74] ne 1.9 ma prostate kokoram.[75] 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.[76]

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.[77]

'''Honam fam nneɛma a wɔde yɛ nneɛma'''

Nneɛma bi de kokoram ba titiriw denam ne honam fam nkɛntɛnso so, sen sɛ ɛbɛyɛ nnuru.[78] 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.[78] Nneɛma nketenkete a ɛnyɛ fibrous a ɛde kokoram ba no bi ne powder metallic cobalt ne nickel ne crystalline silica (quartz, cristobalite ne tridymite).[78] 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.[78]

Nipadua mu apirakuru a ɛde kokoram ba no ntaa mma.[79] Sɛ nhwɛso no, wonnya nkyerɛɛ nsɛm a wɔka sɛ nnompe a ebubui no maa nnompe mu kokoram bae.[79] Saa ara nso na wonnye nipadua mu apirakuru ntom sɛ ɛde awotwaa mu kokoram, nufu mu kokoram anaa amemene mu kokoram ba.[79] Fibea biako a wogye tom ne nneɛma a ɛyɛ hyew a wɔtaa de gu nipadua no so bere tenten. Ebetumi aba sɛ nipadua no fã 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.[79] Sɛ wɔtaa nom tii a ɛyɛ hyew a ɛyɛ hyew a, ebetumi ama woanya kokoram wɔ aduan mu.[79] 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.[79][80] Ɔfe betumi aboa ma kokoram nkwammoaa no adɔɔso, atra ase, angiogenesis ne atutra denam nkɛntɛnso a enya wɔ tumor microenvironment no so.[81][82] Oncogenes no kyekye pro-tumorigenic microenvironment a ɛma ɔhyew.[83]

'''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.[85]

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.[84] 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.[84] 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.[84] 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 fã 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'''

== Nhwehwɛmu a wɔyɛe ==

== Nkyekyɛmu ==

== Siw a wosiw ano ==

== Nhwehwɛmu a wɔyɛ ==

== Ntotoeɛ ==

== Nsɛm a Wɔka Kyerɛ ==

== Nyarewa a Ɛtrɛw Ho Adesua ==

== Abakɔsɛm ==

== Ɔmanfo ne amammerɛ ==

== Hwehwɛ mu ==

== Nyinsɛn ==

== Mmoa afoforo ==</text>
      <sha1>5is0po4cg7gej9q0jsyb7fjypb6xfcm</sha1>
    </revision>
    <revision>
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        <username>Afriyie34</username>
        <id>10662</id>
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      <comment>Mede atwerɛ kaa ho</comment>
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      <text bytes="36590" xml:space="preserve">Kokoram yɛ nyarewa kuw bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Eyinom ne akisikuru a ɛnyɛ hu a ɛntrɛw no bɔ abira.[7] 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.[1] Bere a saa sɛnkyerɛnne ahorow yi betumi akyerɛ sɛ kokoram de, nanso ebetumi de nneɛma afoforo nso aba.[1] Kokoram ahorow bɛboro 100 na ɛka nnipa.[7] 

Tawa a wɔde di dwuma no na ɛde kokoram wuwu bɛyɛ 22% ba.[2] 10% foforo nso fi kɛseyɛ mmoroso, aduan pa a wonni, apɔw-mu-teɛteɛ a wonnya anaasɛ nsa a wɔnom boro so.[2][8][9] 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 efĩ ba.[3] 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).[2] Anyɛ yiye koraa no, saa nneɛma yi yɛ adwuma, ne fã bi, denam nkwammoaa bi awosu mu nkwaadɔm a wɔsakra no so.[10] Mpɛn pii no, ɛho hia sɛ wɔyɛ nsakrae pii wɔ awosu mu ansa na kokoram aba.[10] Bɛyɛ kokoram 5–10% fi awosu mu sintɔ ahorow a wonya fi awo mu.[11] Wobetumi de nsɛnkyerɛnne ne sɛnkyerɛnne ahorow bi anaa nhwehwɛmu a wɔde hwehwɛ kokoram mu ahu kokoram.[2] Afei wɔtaa de nnuruyɛ mu mfoniniyɛ hwehwɛ mu bio na wɔde nipadua mu nhwehwɛmu si so dua.[12]

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.[13][14] Sɛ wohu ntɛm denam nhwehwɛmu so a, ɛho wɔ mfaso ma awotwaa ne akyi berɛmo mu kokoram.[15] Mfaso a ɛwɔ nufu mu kokoram a wɔhwehwɛ mu no yɛ nea akyinnyegye wom.[15][16] 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.[2][4] Ɛyaw ne sɛnkyerɛnne ahorow a wɔde di dwuma no yɛ ɔhwɛ no fã titiriw.[2] Ayaresa a ɛma obi ho dwo no ho hia titiriw wɔ nnipa a wɔwɔ yare a emu yɛ den no mu.[2] 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%.[17] Wɔ kokoram ho wɔ United States no, sɛ wɔkyekyem pɛpɛɛpɛ a, mfe anum a wɔde tra ase no yɛ 66%.[5]

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.[6][19]

Kokoram ahorow a ɛtaa ba mmarima so ne ahurututu mu kokoram, prostate kokoram, akyi berɛmo mu kokoram, ne yafunu mu kokoram.[20] Wɔ mmea mu no, nea ɛtaa ba ne nufu mu kokoram, kokoram a ɛwɔ akyi berɛmo mu, ahurututu mu kokoram, ne awotwaa mu kokoram.[10] 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%.[21][22] 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.[17] Wɔ afe 2012 mu no, mmofra bɛyɛ 165,000 a wonnii mfe 15 na wohui sɛ wɔwɔ kokoram.[20] Kokoram ho asiane no kɔ soro kɛse bere a obi nyin no, na kokoram pii taa ba aman a wɔanya nkɔso no mu.[10] 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.[23] 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.[24] 

== 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.[25]

Kokoram yɛ nyarewa abusua kɛse bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Wɔyɛ neoplasm ahorow no fã 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.[26][27]

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:[28] .

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[28] .

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.[28][29]

== 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 &quot;ɔsuasua kɛse.&quot;[30]

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.[31]

'''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.[30]

'''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.[32] 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.[33]

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.[30]

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 fĩ, anaasɛ hyponatremia, a ɛno nso betumi ama adwene mu tebea asakra, ɔfe, tiyɛ, anaa akisikuru.[34]

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 fã 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 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.[3] 5–10% a aka no fi awosu mu nneɛma.[3] 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 efĩ ara kwa.[38] 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 efĩ.[3][39] Ɛte sɛ nea adwene mu nhyɛso nyɛ asiane a ɛma kokoram fi ase,[40][41] ɛwom sɛ ebetumi ama nea efi mu ba no asɛe wɔ wɔn a wɔwɔ kokoram dedaw no mu de.[40]

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,[42] 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: Nsã 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.[43] Ɛsan nso de kokoram ba anom, ti, kɔn, yafunu, akisikuru, asaabo, ɛwo ne dwensɔtwaa mu.[44] Tawa wusiw wɔ nneɛma bɛboro aduonum a wonim sɛ ɛde kokoram ba, a nitrosamines ne polycyclic aromatic hydrocarbons ka ho.[45]

Tawa na ɛde kokoram wuwu bɛyɛ nnipa baanum biara mu biako wɔ wiase nyinaa[45] ne bɛyɛ baasa biara mu biako wɔ aman a wɔanya nkɔso no mu.[46] 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 .[47][48] 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.[49] Kokoram a efi nnuru a wɔde di dwuma wɔ adwuma mu mu ba no betumi ama wɔanya nsɛm no mu 2 kosi 20%,[50] anyɛ yiye koraa no, ebetumi ama nnipa 200,000 awuwu.[51] 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.[51]

Wonim sɛ sɛ obi nya perfluorooctanoic acid (PFOA) a wɔde di dwuma titiriw wɔ Teflon a wɔyɛ mu a, ɛde kokoram ahorow abien ba.[52][53]

'''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 fã 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 efĩ 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 fã 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.[3] Saa dodow yi fi 25% a ɛkorɔn wɔ Afrika kosi nea ennu 10% wɔ aman a wɔanya nkɔso no mu.[3] 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).[61]

'''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.[62][63][64] Honam ani kokoram pii a ɛnyɛ melanoma no fi mframa a ano yɛ den a ɛbɔ, a ne fã kɛse no ara fi owia hann mu.[63] Nneɛma a ɛma mframa bɔne a ɛma ɛyɛ hyew ba no bi ne aduruyɛ mu mfoninitwa ne radon mframa.[63]

Ionizing radiation nyɛ mutagen a ɛyɛ den titiriw.[65] 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.[65] Mframa a ɛbɔ no betumi de kokoram aba nipadua no afã 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.[66]

Sɛ obi nya ultraviolet mframa a efi owia mu bere tenten a, ebetumi ama wanya melanoma ne honam ani yare afoforo.[67] 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.[67]

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.[69] [62] 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.[70]

'''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.[71] 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,[71] 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,[72] 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.[73] Asiane a ɛne no hyia no yɛ 1.5 ma ahurututu mu kokoram,[74] ne 1.9 ma prostate kokoram.[75] 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.[76]

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.[77]

'''Honam fam nneɛma a wɔde yɛ nneɛma'''

Nneɛma bi de kokoram ba titiriw denam ne honam fam nkɛntɛnso so, sen sɛ ɛbɛyɛ nnuru.[78] 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.[78] Nneɛma nketenkete a ɛnyɛ fibrous a ɛde kokoram ba no bi ne powder metallic cobalt ne nickel ne crystalline silica (quartz, cristobalite ne tridymite).[78] 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.[78]

Nipadua mu apirakuru a ɛde kokoram ba no ntaa mma.[79] Sɛ nhwɛso no, wonnya nkyerɛɛ nsɛm a wɔka sɛ nnompe a ebubui no maa nnompe mu kokoram bae.[79] Saa ara nso na wonnye nipadua mu apirakuru ntom sɛ ɛde awotwaa mu kokoram, nufu mu kokoram anaa amemene mu kokoram ba.[79] Fibea biako a wogye tom ne nneɛma a ɛyɛ hyew a wɔtaa de gu nipadua no so bere tenten. Ebetumi aba sɛ nipadua no fã 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.[79] Sɛ wɔtaa nom tii a ɛyɛ hyew a ɛyɛ hyew a, ebetumi ama woanya kokoram wɔ aduan mu.[79] 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.[79][80] Ɔfe betumi aboa ma kokoram nkwammoaa no adɔɔso, atra ase, angiogenesis ne atutra denam nkɛntɛnso a enya wɔ tumor microenvironment no so.[81][82] Oncogenes no kyekye pro-tumorigenic microenvironment a ɛma ɔhyew.[83]

'''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.[85]

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.[84] 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.[84] 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.[84] 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 fã 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 fã 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 &quot;de wɔn ani asi&quot; 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 &quot;draiver&quot; mu nsakrae na nea aka no betumi ayɛ &quot;akwantufo&quot; 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 fã 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 fã 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 ==

== Nkyekyɛmu ==

== Siw a wosiw ano ==

== Nhwehwɛmu a wɔyɛ ==

== Ntotoeɛ ==

== Nsɛm a Wɔka Kyerɛ ==

== Nyarewa a Ɛtrɛw Ho Adesua ==

== Abakɔsɛm ==

== Ɔmanfo ne amammerɛ ==

== Hwehwɛ mu ==

== Nyinsɛn ==

== Mmoa afoforo ==</text>
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      <format>text/x-wiki</format>
      <text bytes="36594" xml:space="preserve">Kokoram yɛ nyarewa kuw bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Eyinom ne akisikuru a ɛnyɛ hu a ɛntrɛw no bɔ abira.[7] 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.[1] Bere a saa sɛnkyerɛnne ahorow yi betumi akyerɛ sɛ kokoram de, nanso ebetumi de nneɛma afoforo nso aba.[1] Kokoram ahorow bɛboro 100 na ɛka nnipa.[7] 

Tawa a wɔde di dwuma no na ɛde kokoram wuwu bɛyɛ 22% ba.[2] 10% foforo nso fi kɛseyɛ mmoroso, aduan pa a wonni, apɔw-mu-teɛteɛ a wonnya anaasɛ nsa a wɔnom boro so.[2][8][9] 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 efĩ ba.[3] 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).[2] Anyɛ yiye koraa no, saa nneɛma yi yɛ adwuma, ne fã bi, denam nkwammoaa bi awosu mu nkwaadɔm a wɔsakra no so.[10] Mpɛn pii no, ɛho hia sɛ wɔyɛ nsakrae pii wɔ awosu mu ansa na kokoram aba.[10] Bɛyɛ kokoram 5–10% fi awosu mu sintɔ ahorow a wonya fi awo mu.[11] Wobetumi de nsɛnkyerɛnne ne sɛnkyerɛnne ahorow bi anaa nhwehwɛmu a wɔde hwehwɛ kokoram mu ahu kokoram.[2] Afei wɔtaa de nnuruyɛ mu mfoniniyɛ hwehwɛ mu bio na wɔde nipadua mu nhwehwɛmu si so dua.[12]

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.[13][14] Sɛ wohu ntɛm denam nhwehwɛmu so a, ɛho wɔ mfaso ma awotwaa ne akyi berɛmo mu kokoram.[15] Mfaso a ɛwɔ nufu mu kokoram a wɔhwehwɛ mu no yɛ nea akyinnyegye wom.[15][16] 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.[2][4] Ɛyaw ne sɛnkyerɛnne ahorow a wɔde di dwuma no yɛ ɔhwɛ no fã titiriw.[2] Ayaresa a ɛma obi ho dwo no ho hia titiriw wɔ nnipa a wɔwɔ yare a emu yɛ den no mu.[2] 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%.[17] Wɔ kokoram ho wɔ United States no, sɛ wɔkyekyem pɛpɛɛpɛ a, mfe anum a wɔde tra ase no yɛ 66%.[5]

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.[6][19]

Kokoram ahorow a ɛtaa ba mmarima so ne ahurututu mu kokoram, prostate kokoram, akyi berɛmo mu kokoram, ne yafunu mu kokoram.[20] Wɔ mmea mu no, nea ɛtaa ba ne nufu mu kokoram, kokoram a ɛwɔ akyi berɛmo mu, ahurututu mu kokoram, ne awotwaa mu kokoram.[10] 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%.[21][22] 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.[17] Wɔ afe 2012 mu no, mmofra bɛyɛ 165,000 a wonnii mfe 15 na wohui sɛ wɔwɔ kokoram.[20] Kokoram ho asiane no kɔ soro kɛse bere a obi nyin no, na kokoram pii taa ba aman a wɔanya nkɔso no mu.[10] 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.[23] 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.[24] 

== 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.[25]

Kokoram yɛ nyarewa abusua kɛse bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Wɔyɛ neoplasm ahorow no fã 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.[26][27]

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:[28] .

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[28] .

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.[28][29]

== 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 &quot;ɔsuasua kɛse.&quot;[30]

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.[31]

'''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.[30]

'''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.[32] 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.[33]

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.[30]

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 fĩ, anaasɛ hyponatremia, a ɛno nso betumi ama adwene mu tebea asakra, ɔfe, tiyɛ, anaa akisikuru.[34]

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 fã 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 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.[3] 5–10% a aka no fi awosu mu nneɛma.[3] 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 efĩ ara kwa.[38] 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 efĩ.[3][39] Ɛte sɛ nea adwene mu nhyɛso nyɛ asiane a ɛma kokoram fi ase,[40][41] ɛwom sɛ ebetumi ama nea efi mu ba no asɛe wɔ wɔn a wɔwɔ kokoram dedaw no mu de.[40]

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,[42] 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: Nsã 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.[43] Ɛsan nso de kokoram ba anom, ti, kɔn, yafunu, akisikuru, asaabo, ɛwo ne dwensɔtwaa mu.[44] Tawa wusiw wɔ nneɛma bɛboro aduonum a wonim sɛ ɛde kokoram ba, a nitrosamines ne polycyclic aromatic hydrocarbons ka ho.[45]

Tawa na ɛde kokoram wuwu bɛyɛ nnipa baanum biara mu biako wɔ wiase nyinaa[45] ne bɛyɛ baasa biara mu biako wɔ aman a wɔanya nkɔso no mu.[46] 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 .[47][48] 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.[49] Kokoram a efi nnuru a wɔde di dwuma wɔ adwuma mu mu ba no betumi ama wɔanya nsɛm no mu 2 kosi 20%,[50] anyɛ yiye koraa no, ebetumi ama nnipa 200,000 awuwu.[51] 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.[51]

Wonim sɛ sɛ obi nya perfluorooctanoic acid (PFOA) a wɔde di dwuma titiriw wɔ Teflon a wɔyɛ mu a, ɛde kokoram ahorow abien ba.[52][53]

'''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 fã 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 efĩ 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 fã 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.[3] Saa dodow yi fi 25% a ɛkorɔn wɔ Afrika kosi nea ennu 10% wɔ aman a wɔanya nkɔso no mu.[3] 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).[61]

'''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.[62][63][64] Honam ani kokoram pii a ɛnyɛ melanoma no fi mframa a ano yɛ den a ɛbɔ, a ne fã kɛse no ara fi owia hann mu.[63] Nneɛma a ɛma mframa bɔne a ɛma ɛyɛ hyew ba no bi ne aduruyɛ mu mfoninitwa ne radon mframa.[63]

Ionizing radiation nyɛ mutagen a ɛyɛ den titiriw.[65] 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.[65] Mframa a ɛbɔ no betumi de kokoram aba nipadua no afã 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.[66]

Sɛ obi nya ultraviolet mframa a efi owia mu bere tenten a, ebetumi ama wanya melanoma ne honam ani yare afoforo.[67] 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.[67]

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.[69] [62] 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.[70]

'''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.[71] 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,[71] 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,[72] 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.[73] Asiane a ɛne no hyia no yɛ 1.5 ma ahurututu mu kokoram,[74] ne 1.9 ma prostate kokoram.[75] 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.[76]

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.[77]

'''Honam fam nneɛma a wɔde yɛ nneɛma'''

Nneɛma bi de kokoram ba titiriw denam ne honam fam nkɛntɛnso so, sen sɛ ɛbɛyɛ nnuru.[78] 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.[78] Nneɛma nketenkete a ɛnyɛ fibrous a ɛde kokoram ba no bi ne powder metallic cobalt ne nickel ne crystalline silica (quartz, cristobalite ne tridymite).[78] 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.[78]

Nipadua mu apirakuru a ɛde kokoram ba no ntaa mma.[79] Sɛ nhwɛso no, wonnya nkyerɛɛ nsɛm a wɔka sɛ nnompe a ebubui no maa nnompe mu kokoram bae.[79] Saa ara nso na wonnye nipadua mu apirakuru ntom sɛ ɛde awotwaa mu kokoram, nufu mu kokoram anaa amemene mu kokoram ba.[79] Fibea biako a wogye tom ne nneɛma a ɛyɛ hyew a wɔtaa de gu nipadua no so bere tenten. Ebetumi aba sɛ nipadua no fã 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.[79] Sɛ wɔtaa nom tii a ɛyɛ hyew a ɛyɛ hyew a, ebetumi ama woanya kokoram wɔ aduan mu.[79] 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.[79][80] Ɔfe betumi aboa ma kokoram nkwammoaa no adɔɔso, atra ase, angiogenesis ne atutra denam nkɛntɛnso a enya wɔ tumor microenvironment no so.[81][82] Oncogenes no kyekye pro-tumorigenic microenvironment a ɛma ɔhyew.[83]

'''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.[85]

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.[84] 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.[84] 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.[84] 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 fã 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 fã 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 &quot;de wɔn ani asi&quot; 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 &quot;draiver&quot; mu nsakrae na nea aka no betumi ayɛ &quot;akwantufo&quot; 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 fã 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 fã 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 ==

== Nkyekyɛmu ==

== Siw a wosiw ano ==

== Nhwehwɛmu a wɔyɛ ==

== Ntotoeɛ ==

== Nsɛm a Wɔka Kyerɛ ==

== Nyarewa a Ɛtrɛw Ho Adesua ==

== Abakɔsɛm ==

== Ɔmanfo ne amammerɛ ==

== Hwehwɛ mu ==

== Nyinsɛn ==

== Mmoa afoforo ==</text>
      <sha1>07po7audjfouy9k276ef733jbm3d3yh</sha1>
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    <revision>
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        <username>Afriyie34</username>
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      <comment>Me de atwerɛ ka ho</comment>
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      <text bytes="37705" xml:space="preserve">Kokoram yɛ nyarewa kuw bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Eyinom ne akisikuru a ɛnyɛ hu a ɛntrɛw no bɔ abira.[7] 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.[1] Bere a saa sɛnkyerɛnne ahorow yi betumi akyerɛ sɛ kokoram de, nanso ebetumi de nneɛma afoforo nso aba.[1] Kokoram ahorow bɛboro 100 na ɛka nnipa.[7] 

Tawa a wɔde di dwuma no na ɛde kokoram wuwu bɛyɛ 22% ba.[2] 10% foforo nso fi kɛseyɛ mmoroso, aduan pa a wonni, apɔw-mu-teɛteɛ a wonnya anaasɛ nsa a wɔnom boro so.[2][8][9] 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 efĩ ba.[3] 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).[2] Anyɛ yiye koraa no, saa nneɛma yi yɛ adwuma, ne fã bi, denam nkwammoaa bi awosu mu nkwaadɔm a wɔsakra no so.[10] Mpɛn pii no, ɛho hia sɛ wɔyɛ nsakrae pii wɔ awosu mu ansa na kokoram aba.[10] Bɛyɛ kokoram 5–10% fi awosu mu sintɔ ahorow a wonya fi awo mu.[11] Wobetumi de nsɛnkyerɛnne ne sɛnkyerɛnne ahorow bi anaa nhwehwɛmu a wɔde hwehwɛ kokoram mu ahu kokoram.[2] Afei wɔtaa de nnuruyɛ mu mfoniniyɛ hwehwɛ mu bio na wɔde nipadua mu nhwehwɛmu si so dua.[12]

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.[13][14] Sɛ wohu ntɛm denam nhwehwɛmu so a, ɛho wɔ mfaso ma awotwaa ne akyi berɛmo mu kokoram.[15] Mfaso a ɛwɔ nufu mu kokoram a wɔhwehwɛ mu no yɛ nea akyinnyegye wom.[15][16] 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.[2][4] Ɛyaw ne sɛnkyerɛnne ahorow a wɔde di dwuma no yɛ ɔhwɛ no fã titiriw.[2] Ayaresa a ɛma obi ho dwo no ho hia titiriw wɔ nnipa a wɔwɔ yare a emu yɛ den no mu.[2] 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%.[17] Wɔ kokoram ho wɔ United States no, sɛ wɔkyekyem pɛpɛɛpɛ a, mfe anum a wɔde tra ase no yɛ 66%.[5]

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.[6][19]

Kokoram ahorow a ɛtaa ba mmarima so ne ahurututu mu kokoram, prostate kokoram, akyi berɛmo mu kokoram, ne yafunu mu kokoram.[20] Wɔ mmea mu no, nea ɛtaa ba ne nufu mu kokoram, kokoram a ɛwɔ akyi berɛmo mu, ahurututu mu kokoram, ne awotwaa mu kokoram.[10] 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%.[21][22] 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.[17] Wɔ afe 2012 mu no, mmofra bɛyɛ 165,000 a wonnii mfe 15 na wohui sɛ wɔwɔ kokoram.[20] Kokoram ho asiane no kɔ soro kɛse bere a obi nyin no, na kokoram pii taa ba aman a wɔanya nkɔso no mu.[10] 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.[23] 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.[24] 

== 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.[25]

Kokoram yɛ nyarewa abusua kɛse bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Wɔyɛ neoplasm ahorow no fã 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.[26][27]

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:[28] .

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[28] .

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.[28][29]

== 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 &quot;ɔsuasua kɛse.&quot;[30]

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.[31]

'''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.[30]

'''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.[32] 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.[33]

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.[30]

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 fĩ, anaasɛ hyponatremia, a ɛno nso betumi ama adwene mu tebea asakra, ɔfe, tiyɛ, anaa akisikuru.[34]

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 fã 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 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.[3] 5–10% a aka no fi awosu mu nneɛma.[3] 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 efĩ ara kwa.[38] 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 efĩ.[3][39] Ɛte sɛ nea adwene mu nhyɛso nyɛ asiane a ɛma kokoram fi ase,[40][41] ɛwom sɛ ebetumi ama nea efi mu ba no asɛe wɔ wɔn a wɔwɔ kokoram dedaw no mu de.[40]

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,[42] 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: Nsã 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.[43] Ɛsan nso de kokoram ba anom, ti, kɔn, yafunu, akisikuru, asaabo, ɛwo ne dwensɔtwaa mu.[44] Tawa wusiw wɔ nneɛma bɛboro aduonum a wonim sɛ ɛde kokoram ba, a nitrosamines ne polycyclic aromatic hydrocarbons ka ho.[45]

Tawa na ɛde kokoram wuwu bɛyɛ nnipa baanum biara mu biako wɔ wiase nyinaa[45] ne bɛyɛ baasa biara mu biako wɔ aman a wɔanya nkɔso no mu.[46] 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 .[47][48] 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.[49] Kokoram a efi nnuru a wɔde di dwuma wɔ adwuma mu mu ba no betumi ama wɔanya nsɛm no mu 2 kosi 20%,[50] anyɛ yiye koraa no, ebetumi ama nnipa 200,000 awuwu.[51] 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.[51]

Wonim sɛ sɛ obi nya perfluorooctanoic acid (PFOA) a wɔde di dwuma titiriw wɔ Teflon a wɔyɛ mu a, ɛde kokoram ahorow abien ba.[52][53]

'''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 fã 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 efĩ 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 fã 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.[3] Saa dodow yi fi 25% a ɛkorɔn wɔ Afrika kosi nea ennu 10% wɔ aman a wɔanya nkɔso no mu.[3] 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).[61]

'''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.[62][63][64] Honam ani kokoram pii a ɛnyɛ melanoma no fi mframa a ano yɛ den a ɛbɔ, a ne fã kɛse no ara fi owia hann mu.[63] Nneɛma a ɛma mframa bɔne a ɛma ɛyɛ hyew ba no bi ne aduruyɛ mu mfoninitwa ne radon mframa.[63]

Ionizing radiation nyɛ mutagen a ɛyɛ den titiriw.[65] 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.[65] Mframa a ɛbɔ no betumi de kokoram aba nipadua no afã 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.[66]

Sɛ obi nya ultraviolet mframa a efi owia mu bere tenten a, ebetumi ama wanya melanoma ne honam ani yare afoforo.[67] 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.[67]

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.[69] [62] 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.[70]

'''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.[71] 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,[71] 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,[72] 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.[73] Asiane a ɛne no hyia no yɛ 1.5 ma ahurututu mu kokoram,[74] ne 1.9 ma prostate kokoram.[75] 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.[76]

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.[77]

'''Honam fam nneɛma a wɔde yɛ nneɛma'''

Nneɛma bi de kokoram ba titiriw denam ne honam fam nkɛntɛnso so, sen sɛ ɛbɛyɛ nnuru.[78] 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.[78] Nneɛma nketenkete a ɛnyɛ fibrous a ɛde kokoram ba no bi ne powder metallic cobalt ne nickel ne crystalline silica (quartz, cristobalite ne tridymite).[78] 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.[78]

Nipadua mu apirakuru a ɛde kokoram ba no ntaa mma.[79] Sɛ nhwɛso no, wonnya nkyerɛɛ nsɛm a wɔka sɛ nnompe a ebubui no maa nnompe mu kokoram bae.[79] Saa ara nso na wonnye nipadua mu apirakuru ntom sɛ ɛde awotwaa mu kokoram, nufu mu kokoram anaa amemene mu kokoram ba.[79] Fibea biako a wogye tom ne nneɛma a ɛyɛ hyew a wɔtaa de gu nipadua no so bere tenten. Ebetumi aba sɛ nipadua no fã 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.[79] Sɛ wɔtaa nom tii a ɛyɛ hyew a ɛyɛ hyew a, ebetumi ama woanya kokoram wɔ aduan mu.[79] 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.[79][80] Ɔfe betumi aboa ma kokoram nkwammoaa no adɔɔso, atra ase, angiogenesis ne atutra denam nkɛntɛnso a enya wɔ tumor microenvironment no so.[81][82] Oncogenes no kyekye pro-tumorigenic microenvironment a ɛma ɔhyew.[83]

'''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.[85]

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.[84] 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.[84] 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.[84] 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 fã 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 fã 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 &quot;de wɔn ani asi&quot; 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 &quot;draiver&quot; mu nsakrae na nea aka no betumi ayɛ &quot;akwantufo&quot; 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 fã 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 fã 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 ==

== Siw a wosiw ano ==

== Nhwehwɛmu a wɔyɛ ==

== Ntotoeɛ ==

== Nsɛm a Wɔka Kyerɛ ==

== Nyarewa a Ɛtrɛw Ho Adesua ==

== Abakɔsɛm ==

== Ɔmanfo ne amammerɛ ==

== Hwehwɛ mu ==

== Nyinsɛn ==

== Mmoa afoforo ==</text>
      <sha1>tnk9p13luvwo5cezpowu3gsqz5w9vt6</sha1>
    </revision>
    <revision>
      <id>132967</id>
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      <timestamp>2022-07-31T14:15:52Z</timestamp>
      <contributor>
        <username>Afriyie34</username>
        <id>10662</id>
      </contributor>
      <comment>Me de atwerɛ ka ho</comment>
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      <format>text/x-wiki</format>
      <text bytes="40175" xml:space="preserve">Kokoram yɛ nyarewa kuw bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Eyinom ne akisikuru a ɛnyɛ hu a ɛntrɛw no bɔ abira.[7] 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.[1] Bere a saa sɛnkyerɛnne ahorow yi betumi akyerɛ sɛ kokoram de, nanso ebetumi de nneɛma afoforo nso aba.[1] Kokoram ahorow bɛboro 100 na ɛka nnipa.[7] 

Tawa a wɔde di dwuma no na ɛde kokoram wuwu bɛyɛ 22% ba.[2] 10% foforo nso fi kɛseyɛ mmoroso, aduan pa a wonni, apɔw-mu-teɛteɛ a wonnya anaasɛ nsa a wɔnom boro so.[2][8][9] 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 efĩ ba.[3] 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).[2] Anyɛ yiye koraa no, saa nneɛma yi yɛ adwuma, ne fã bi, denam nkwammoaa bi awosu mu nkwaadɔm a wɔsakra no so.[10] Mpɛn pii no, ɛho hia sɛ wɔyɛ nsakrae pii wɔ awosu mu ansa na kokoram aba.[10] Bɛyɛ kokoram 5–10% fi awosu mu sintɔ ahorow a wonya fi awo mu.[11] Wobetumi de nsɛnkyerɛnne ne sɛnkyerɛnne ahorow bi anaa nhwehwɛmu a wɔde hwehwɛ kokoram mu ahu kokoram.[2] Afei wɔtaa de nnuruyɛ mu mfoniniyɛ hwehwɛ mu bio na wɔde nipadua mu nhwehwɛmu si so dua.[12]

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.[13][14] Sɛ wohu ntɛm denam nhwehwɛmu so a, ɛho wɔ mfaso ma awotwaa ne akyi berɛmo mu kokoram.[15] Mfaso a ɛwɔ nufu mu kokoram a wɔhwehwɛ mu no yɛ nea akyinnyegye wom.[15][16] 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.[2][4] Ɛyaw ne sɛnkyerɛnne ahorow a wɔde di dwuma no yɛ ɔhwɛ no fã titiriw.[2] Ayaresa a ɛma obi ho dwo no ho hia titiriw wɔ nnipa a wɔwɔ yare a emu yɛ den no mu.[2] 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%.[17] Wɔ kokoram ho wɔ United States no, sɛ wɔkyekyem pɛpɛɛpɛ a, mfe anum a wɔde tra ase no yɛ 66%.[5]

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.[6][19]

Kokoram ahorow a ɛtaa ba mmarima so ne ahurututu mu kokoram, prostate kokoram, akyi berɛmo mu kokoram, ne yafunu mu kokoram.[20] Wɔ mmea mu no, nea ɛtaa ba ne nufu mu kokoram, kokoram a ɛwɔ akyi berɛmo mu, ahurututu mu kokoram, ne awotwaa mu kokoram.[10] 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%.[21][22] 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.[17] Wɔ afe 2012 mu no, mmofra bɛyɛ 165,000 a wonnii mfe 15 na wohui sɛ wɔwɔ kokoram.[20] Kokoram ho asiane no kɔ soro kɛse bere a obi nyin no, na kokoram pii taa ba aman a wɔanya nkɔso no mu.[10] 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.[23] 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.[24] 

== 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.[25]

Kokoram yɛ nyarewa abusua kɛse bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Wɔyɛ neoplasm ahorow no fã 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.[26][27]

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:[28] .

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[28] .

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.[28][29]

== 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 &quot;ɔsuasua kɛse.&quot;[30]

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.[31]

'''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.[30]

'''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.[32] 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.[33]

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.[30]

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 fĩ, anaasɛ hyponatremia, a ɛno nso betumi ama adwene mu tebea asakra, ɔfe, tiyɛ, anaa akisikuru.[34]

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 fã 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 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.[3] 5–10% a aka no fi awosu mu nneɛma.[3] 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 efĩ ara kwa.[38] 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 efĩ.[3][39] Ɛte sɛ nea adwene mu nhyɛso nyɛ asiane a ɛma kokoram fi ase,[40][41] ɛwom sɛ ebetumi ama nea efi mu ba no asɛe wɔ wɔn a wɔwɔ kokoram dedaw no mu de.[40]

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,[42] 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: Nsã 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.[43] Ɛsan nso de kokoram ba anom, ti, kɔn, yafunu, akisikuru, asaabo, ɛwo ne dwensɔtwaa mu.[44] Tawa wusiw wɔ nneɛma bɛboro aduonum a wonim sɛ ɛde kokoram ba, a nitrosamines ne polycyclic aromatic hydrocarbons ka ho.[45]

Tawa na ɛde kokoram wuwu bɛyɛ nnipa baanum biara mu biako wɔ wiase nyinaa[45] ne bɛyɛ baasa biara mu biako wɔ aman a wɔanya nkɔso no mu.[46] 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 .[47][48] 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.[49] Kokoram a efi nnuru a wɔde di dwuma wɔ adwuma mu mu ba no betumi ama wɔanya nsɛm no mu 2 kosi 20%,[50] anyɛ yiye koraa no, ebetumi ama nnipa 200,000 awuwu.[51] 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.[51]

Wonim sɛ sɛ obi nya perfluorooctanoic acid (PFOA) a wɔde di dwuma titiriw wɔ Teflon a wɔyɛ mu a, ɛde kokoram ahorow abien ba.[52][53]

'''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 fã 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 efĩ 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 fã 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.[3] Saa dodow yi fi 25% a ɛkorɔn wɔ Afrika kosi nea ennu 10% wɔ aman a wɔanya nkɔso no mu.[3] 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).[61]

'''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.[62][63][64] Honam ani kokoram pii a ɛnyɛ melanoma no fi mframa a ano yɛ den a ɛbɔ, a ne fã kɛse no ara fi owia hann mu.[63] Nneɛma a ɛma mframa bɔne a ɛma ɛyɛ hyew ba no bi ne aduruyɛ mu mfoninitwa ne radon mframa.[63]

Ionizing radiation nyɛ mutagen a ɛyɛ den titiriw.[65] 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.[65] Mframa a ɛbɔ no betumi de kokoram aba nipadua no afã 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.[66]

Sɛ obi nya ultraviolet mframa a efi owia mu bere tenten a, ebetumi ama wanya melanoma ne honam ani yare afoforo.[67] 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.[67]

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.[69] [62] 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.[70]

'''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.[71] 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,[71] 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,[72] 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.[73] Asiane a ɛne no hyia no yɛ 1.5 ma ahurututu mu kokoram,[74] ne 1.9 ma prostate kokoram.[75] 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.[76]

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.[77]

'''Honam fam nneɛma a wɔde yɛ nneɛma'''

Nneɛma bi de kokoram ba titiriw denam ne honam fam nkɛntɛnso so, sen sɛ ɛbɛyɛ nnuru.[78] 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.[78] Nneɛma nketenkete a ɛnyɛ fibrous a ɛde kokoram ba no bi ne powder metallic cobalt ne nickel ne crystalline silica (quartz, cristobalite ne tridymite).[78] 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.[78]

Nipadua mu apirakuru a ɛde kokoram ba no ntaa mma.[79] Sɛ nhwɛso no, wonnya nkyerɛɛ nsɛm a wɔka sɛ nnompe a ebubui no maa nnompe mu kokoram bae.[79] Saa ara nso na wonnye nipadua mu apirakuru ntom sɛ ɛde awotwaa mu kokoram, nufu mu kokoram anaa amemene mu kokoram ba.[79] Fibea biako a wogye tom ne nneɛma a ɛyɛ hyew a wɔtaa de gu nipadua no so bere tenten. Ebetumi aba sɛ nipadua no fã 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.[79] Sɛ wɔtaa nom tii a ɛyɛ hyew a ɛyɛ hyew a, ebetumi ama woanya kokoram wɔ aduan mu.[79] 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.[79][80] Ɔfe betumi aboa ma kokoram nkwammoaa no adɔɔso, atra ase, angiogenesis ne atutra denam nkɛntɛnso a enya wɔ tumor microenvironment no so.[81][82] Oncogenes no kyekye pro-tumorigenic microenvironment a ɛma ɔhyew.[83]

'''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.[85]

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.[84] 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.[84] 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.[84] 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 fã 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 fã 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 &quot;de wɔn ani asi&quot; 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 &quot;draiver&quot; mu nsakrae na nea aka no betumi ayɛ &quot;akwantufo&quot; 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 fã 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 fã 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 &quot;precursor&quot; 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 ==

== Nhwehwɛmu a wɔyɛ ==

== Ntotoeɛ ==

== Nsɛm a Wɔka Kyerɛ ==

== Nyarewa a Ɛtrɛw Ho Adesua ==

== Abakɔsɛm ==

== Ɔmanfo ne amammerɛ ==

== Hwehwɛ mu ==

== Nyinsɛn ==

== Mmoa afoforo ==</text>
      <sha1>e9dxohfrnho3trb0vc3i0marsleoa9n</sha1>
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      <text bytes="44951" xml:space="preserve">Kokoram yɛ nyarewa kuw bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Eyinom ne akisikuru a ɛnyɛ hu a ɛntrɛw no bɔ abira.[7] 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.[1] Bere a saa sɛnkyerɛnne ahorow yi betumi akyerɛ sɛ kokoram de, nanso ebetumi de nneɛma afoforo nso aba.[1] Kokoram ahorow bɛboro 100 na ɛka nnipa.[7] 

Tawa a wɔde di dwuma no na ɛde kokoram wuwu bɛyɛ 22% ba.[2] 10% foforo nso fi kɛseyɛ mmoroso, aduan pa a wonni, apɔw-mu-teɛteɛ a wonnya anaasɛ nsa a wɔnom boro so.[2][8][9] 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 efĩ ba.[3] 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).[2] Anyɛ yiye koraa no, saa nneɛma yi yɛ adwuma, ne fã bi, denam nkwammoaa bi awosu mu nkwaadɔm a wɔsakra no so.[10] Mpɛn pii no, ɛho hia sɛ wɔyɛ nsakrae pii wɔ awosu mu ansa na kokoram aba.[10] Bɛyɛ kokoram 5–10% fi awosu mu sintɔ ahorow a wonya fi awo mu.[11] Wobetumi de nsɛnkyerɛnne ne sɛnkyerɛnne ahorow bi anaa nhwehwɛmu a wɔde hwehwɛ kokoram mu ahu kokoram.[2] Afei wɔtaa de nnuruyɛ mu mfoniniyɛ hwehwɛ mu bio na wɔde nipadua mu nhwehwɛmu si so dua.[12]

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.[13][14] Sɛ wohu ntɛm denam nhwehwɛmu so a, ɛho wɔ mfaso ma awotwaa ne akyi berɛmo mu kokoram.[15] Mfaso a ɛwɔ nufu mu kokoram a wɔhwehwɛ mu no yɛ nea akyinnyegye wom.[15][16] 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.[2][4] Ɛyaw ne sɛnkyerɛnne ahorow a wɔde di dwuma no yɛ ɔhwɛ no fã titiriw.[2] Ayaresa a ɛma obi ho dwo no ho hia titiriw wɔ nnipa a wɔwɔ yare a emu yɛ den no mu.[2] 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%.[17] Wɔ kokoram ho wɔ United States no, sɛ wɔkyekyem pɛpɛɛpɛ a, mfe anum a wɔde tra ase no yɛ 66%.[5]

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.[6][19]

Kokoram ahorow a ɛtaa ba mmarima so ne ahurututu mu kokoram, prostate kokoram, akyi berɛmo mu kokoram, ne yafunu mu kokoram.[20] Wɔ mmea mu no, nea ɛtaa ba ne nufu mu kokoram, kokoram a ɛwɔ akyi berɛmo mu, ahurututu mu kokoram, ne awotwaa mu kokoram.[10] 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%.[21][22] 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.[17] Wɔ afe 2012 mu no, mmofra bɛyɛ 165,000 a wonnii mfe 15 na wohui sɛ wɔwɔ kokoram.[20] Kokoram ho asiane no kɔ soro kɛse bere a obi nyin no, na kokoram pii taa ba aman a wɔanya nkɔso no mu.[10] 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.[23] 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.[24] 

== 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.[25]

Kokoram yɛ nyarewa abusua kɛse bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Wɔyɛ neoplasm ahorow no fã 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.[26][27]

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:[28] .

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[28] .

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.[28][29]

== 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 &quot;ɔsuasua kɛse.&quot;[30]

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.[31]

'''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.[30]

'''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.[32] 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.[33]

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.[30]

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 fĩ, anaasɛ hyponatremia, a ɛno nso betumi ama adwene mu tebea asakra, ɔfe, tiyɛ, anaa akisikuru.[34]

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 fã 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 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.[3] 5–10% a aka no fi awosu mu nneɛma.[3] 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 efĩ ara kwa.[38] 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 efĩ.[3][39] Ɛte sɛ nea adwene mu nhyɛso nyɛ asiane a ɛma kokoram fi ase,[40][41] ɛwom sɛ ebetumi ama nea efi mu ba no asɛe wɔ wɔn a wɔwɔ kokoram dedaw no mu de.[40]

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,[42] 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: Nsã 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.[43] Ɛsan nso de kokoram ba anom, ti, kɔn, yafunu, akisikuru, asaabo, ɛwo ne dwensɔtwaa mu.[44] Tawa wusiw wɔ nneɛma bɛboro aduonum a wonim sɛ ɛde kokoram ba, a nitrosamines ne polycyclic aromatic hydrocarbons ka ho.[45]

Tawa na ɛde kokoram wuwu bɛyɛ nnipa baanum biara mu biako wɔ wiase nyinaa[45] ne bɛyɛ baasa biara mu biako wɔ aman a wɔanya nkɔso no mu.[46] 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 .[47][48] 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.[49] Kokoram a efi nnuru a wɔde di dwuma wɔ adwuma mu mu ba no betumi ama wɔanya nsɛm no mu 2 kosi 20%,[50] anyɛ yiye koraa no, ebetumi ama nnipa 200,000 awuwu.[51] 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.[51]

Wonim sɛ sɛ obi nya perfluorooctanoic acid (PFOA) a wɔde di dwuma titiriw wɔ Teflon a wɔyɛ mu a, ɛde kokoram ahorow abien ba.[52][53]

'''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 fã 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 efĩ 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 fã 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.[3] Saa dodow yi fi 25% a ɛkorɔn wɔ Afrika kosi nea ennu 10% wɔ aman a wɔanya nkɔso no mu.[3] 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).[61]

'''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.[62][63][64] Honam ani kokoram pii a ɛnyɛ melanoma no fi mframa a ano yɛ den a ɛbɔ, a ne fã kɛse no ara fi owia hann mu.[63] Nneɛma a ɛma mframa bɔne a ɛma ɛyɛ hyew ba no bi ne aduruyɛ mu mfoninitwa ne radon mframa.[63]

Ionizing radiation nyɛ mutagen a ɛyɛ den titiriw.[65] 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.[65] Mframa a ɛbɔ no betumi de kokoram aba nipadua no afã 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.[66]

Sɛ obi nya ultraviolet mframa a efi owia mu bere tenten a, ebetumi ama wanya melanoma ne honam ani yare afoforo.[67] 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.[67]

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.[69] [62] 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.[70]

'''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.[71] 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,[71] 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,[72] 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.[73] Asiane a ɛne no hyia no yɛ 1.5 ma ahurututu mu kokoram,[74] ne 1.9 ma prostate kokoram.[75] 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.[76]

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.[77]

'''Honam fam nneɛma a wɔde yɛ nneɛma'''

Nneɛma bi de kokoram ba titiriw denam ne honam fam nkɛntɛnso so, sen sɛ ɛbɛyɛ nnuru.[78] 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.[78] Nneɛma nketenkete a ɛnyɛ fibrous a ɛde kokoram ba no bi ne powder metallic cobalt ne nickel ne crystalline silica (quartz, cristobalite ne tridymite).[78] 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.[78]

Nipadua mu apirakuru a ɛde kokoram ba no ntaa mma.[79] Sɛ nhwɛso no, wonnya nkyerɛɛ nsɛm a wɔka sɛ nnompe a ebubui no maa nnompe mu kokoram bae.[79] Saa ara nso na wonnye nipadua mu apirakuru ntom sɛ ɛde awotwaa mu kokoram, nufu mu kokoram anaa amemene mu kokoram ba.[79] Fibea biako a wogye tom ne nneɛma a ɛyɛ hyew a wɔtaa de gu nipadua no so bere tenten. Ebetumi aba sɛ nipadua no fã 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.[79] Sɛ wɔtaa nom tii a ɛyɛ hyew a ɛyɛ hyew a, ebetumi ama woanya kokoram wɔ aduan mu.[79] 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.[79][80] Ɔfe betumi aboa ma kokoram nkwammoaa no adɔɔso, atra ase, angiogenesis ne atutra denam nkɛntɛnso a enya wɔ tumor microenvironment no so.[81][82] Oncogenes no kyekye pro-tumorigenic microenvironment a ɛma ɔhyew.[83]

'''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.[85]

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.[84] 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.[84] 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.[84] 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 fã 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 fã 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 &quot;de wɔn ani asi&quot; 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 &quot;draiver&quot; mu nsakrae na nea aka no betumi ayɛ &quot;akwantufo&quot; 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 fã 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 fã 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 &quot;precursor&quot; 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 ==

== Ntotoeɛ ==

== Nsɛm a Wɔka Kyerɛ ==

== Nyarewa a Ɛtrɛw Ho Adesua ==

== Abakɔsɛm ==

== Ɔmanfo ne amammerɛ ==

== Hwehwɛ mu ==

== Nyinsɛn ==

== Mmoa afoforo ==</text>
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      <text bytes="48112" xml:space="preserve">Kokoram yɛ nyarewa kuw bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Eyinom ne akisikuru a ɛnyɛ hu a ɛntrɛw no bɔ abira.[7] 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.[1] Bere a saa sɛnkyerɛnne ahorow yi betumi akyerɛ sɛ kokoram de, nanso ebetumi de nneɛma afoforo nso aba.[1] Kokoram ahorow bɛboro 100 na ɛka nnipa.[7] 

Tawa a wɔde di dwuma no na ɛde kokoram wuwu bɛyɛ 22% ba.[2] 10% foforo nso fi kɛseyɛ mmoroso, aduan pa a wonni, apɔw-mu-teɛteɛ a wonnya anaasɛ nsa a wɔnom boro so.[2][8][9] 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 efĩ ba.[3] 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).[2] Anyɛ yiye koraa no, saa nneɛma yi yɛ adwuma, ne fã bi, denam nkwammoaa bi awosu mu nkwaadɔm a wɔsakra no so.[10] Mpɛn pii no, ɛho hia sɛ wɔyɛ nsakrae pii wɔ awosu mu ansa na kokoram aba.[10] Bɛyɛ kokoram 5–10% fi awosu mu sintɔ ahorow a wonya fi awo mu.[11] Wobetumi de nsɛnkyerɛnne ne sɛnkyerɛnne ahorow bi anaa nhwehwɛmu a wɔde hwehwɛ kokoram mu ahu kokoram.[2] Afei wɔtaa de nnuruyɛ mu mfoniniyɛ hwehwɛ mu bio na wɔde nipadua mu nhwehwɛmu si so dua.[12]

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.[13][14] Sɛ wohu ntɛm denam nhwehwɛmu so a, ɛho wɔ mfaso ma awotwaa ne akyi berɛmo mu kokoram.[15] Mfaso a ɛwɔ nufu mu kokoram a wɔhwehwɛ mu no yɛ nea akyinnyegye wom.[15][16] 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.[2][4] Ɛyaw ne sɛnkyerɛnne ahorow a wɔde di dwuma no yɛ ɔhwɛ no fã titiriw.[2] Ayaresa a ɛma obi ho dwo no ho hia titiriw wɔ nnipa a wɔwɔ yare a emu yɛ den no mu.[2] 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%.[17] Wɔ kokoram ho wɔ United States no, sɛ wɔkyekyem pɛpɛɛpɛ a, mfe anum a wɔde tra ase no yɛ 66%.[5]

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.[6][19]

Kokoram ahorow a ɛtaa ba mmarima so ne ahurututu mu kokoram, prostate kokoram, akyi berɛmo mu kokoram, ne yafunu mu kokoram.[20] Wɔ mmea mu no, nea ɛtaa ba ne nufu mu kokoram, kokoram a ɛwɔ akyi berɛmo mu, ahurututu mu kokoram, ne awotwaa mu kokoram.[10] 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%.[21][22] 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.[17] Wɔ afe 2012 mu no, mmofra bɛyɛ 165,000 a wonnii mfe 15 na wohui sɛ wɔwɔ kokoram.[20] Kokoram ho asiane no kɔ soro kɛse bere a obi nyin no, na kokoram pii taa ba aman a wɔanya nkɔso no mu.[10] 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.[23] 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.[24] 

== 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.[25]

Kokoram yɛ nyarewa abusua kɛse bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Wɔyɛ neoplasm ahorow no fã 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.[26][27]

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:[28] .

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[28] .

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.[28][29]

== 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 &quot;ɔsuasua kɛse.&quot;[30]

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.[31]

'''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.[30]

'''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.[32] 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.[33]

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.[30]

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 fĩ, anaasɛ hyponatremia, a ɛno nso betumi ama adwene mu tebea asakra, ɔfe, tiyɛ, anaa akisikuru.[34]

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 fã 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 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.[3] 5–10% a aka no fi awosu mu nneɛma.[3] 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 efĩ ara kwa.[38] 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 efĩ.[3][39] Ɛte sɛ nea adwene mu nhyɛso nyɛ asiane a ɛma kokoram fi ase,[40][41] ɛwom sɛ ebetumi ama nea efi mu ba no asɛe wɔ wɔn a wɔwɔ kokoram dedaw no mu de.[40]

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,[42] 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: Nsã 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.[43] Ɛsan nso de kokoram ba anom, ti, kɔn, yafunu, akisikuru, asaabo, ɛwo ne dwensɔtwaa mu.[44] Tawa wusiw wɔ nneɛma bɛboro aduonum a wonim sɛ ɛde kokoram ba, a nitrosamines ne polycyclic aromatic hydrocarbons ka ho.[45]

Tawa na ɛde kokoram wuwu bɛyɛ nnipa baanum biara mu biako wɔ wiase nyinaa[45] ne bɛyɛ baasa biara mu biako wɔ aman a wɔanya nkɔso no mu.[46] 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 .[47][48] 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.[49] Kokoram a efi nnuru a wɔde di dwuma wɔ adwuma mu mu ba no betumi ama wɔanya nsɛm no mu 2 kosi 20%,[50] anyɛ yiye koraa no, ebetumi ama nnipa 200,000 awuwu.[51] 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.[51]

Wonim sɛ sɛ obi nya perfluorooctanoic acid (PFOA) a wɔde di dwuma titiriw wɔ Teflon a wɔyɛ mu a, ɛde kokoram ahorow abien ba.[52][53]

'''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 fã 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 efĩ 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 fã 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.[3] Saa dodow yi fi 25% a ɛkorɔn wɔ Afrika kosi nea ennu 10% wɔ aman a wɔanya nkɔso no mu.[3] 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).[61]

'''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.[62][63][64] Honam ani kokoram pii a ɛnyɛ melanoma no fi mframa a ano yɛ den a ɛbɔ, a ne fã kɛse no ara fi owia hann mu.[63] Nneɛma a ɛma mframa bɔne a ɛma ɛyɛ hyew ba no bi ne aduruyɛ mu mfoninitwa ne radon mframa.[63]

Ionizing radiation nyɛ mutagen a ɛyɛ den titiriw.[65] 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.[65] Mframa a ɛbɔ no betumi de kokoram aba nipadua no afã 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.[66]

Sɛ obi nya ultraviolet mframa a efi owia mu bere tenten a, ebetumi ama wanya melanoma ne honam ani yare afoforo.[67] 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.[67]

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.[69] [62] 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.[70]

'''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.[71] 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,[71] 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,[72] 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.[73] Asiane a ɛne no hyia no yɛ 1.5 ma ahurututu mu kokoram,[74] ne 1.9 ma prostate kokoram.[75] 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.[76]

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.[77]

'''Honam fam nneɛma a wɔde yɛ nneɛma'''

Nneɛma bi de kokoram ba titiriw denam ne honam fam nkɛntɛnso so, sen sɛ ɛbɛyɛ nnuru.[78] 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.[78] Nneɛma nketenkete a ɛnyɛ fibrous a ɛde kokoram ba no bi ne powder metallic cobalt ne nickel ne crystalline silica (quartz, cristobalite ne tridymite).[78] 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.[78]

Nipadua mu apirakuru a ɛde kokoram ba no ntaa mma.[79] Sɛ nhwɛso no, wonnya nkyerɛɛ nsɛm a wɔka sɛ nnompe a ebubui no maa nnompe mu kokoram bae.[79] Saa ara nso na wonnye nipadua mu apirakuru ntom sɛ ɛde awotwaa mu kokoram, nufu mu kokoram anaa amemene mu kokoram ba.[79] Fibea biako a wogye tom ne nneɛma a ɛyɛ hyew a wɔtaa de gu nipadua no so bere tenten. Ebetumi aba sɛ nipadua no fã 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.[79] Sɛ wɔtaa nom tii a ɛyɛ hyew a ɛyɛ hyew a, ebetumi ama woanya kokoram wɔ aduan mu.[79] 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.[79][80] Ɔfe betumi aboa ma kokoram nkwammoaa no adɔɔso, atra ase, angiogenesis ne atutra denam nkɛntɛnso a enya wɔ tumor microenvironment no so.[81][82] Oncogenes no kyekye pro-tumorigenic microenvironment a ɛma ɔhyew.[83]

'''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.[85]

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.[84] 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.[84] 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.[84] 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 fã 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 fã 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 &quot;de wɔn ani asi&quot; 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 &quot;draiver&quot; mu nsakrae na nea aka no betumi ayɛ &quot;akwantufo&quot; 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 fã 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 fã 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 &quot;precursor&quot; 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

== Ntotoeɛ ==

== Nsɛm a Wɔka Kyerɛ ==

== Nyarewa a Ɛtrɛw Ho Adesua ==

== Abakɔsɛm ==

== Ɔmanfo ne amammerɛ ==

== Hwehwɛ mu ==

== Nyinsɛn ==

== Mmoa afoforo ==</text>
      <sha1>es6dvc1l4bc6w2b2kfk53l22th8ikcv</sha1>
    </revision>
    <revision>
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        <username>Afriyie34</username>
        <id>10662</id>
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      <comment>Mede atwerɛ kaa ho</comment>
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      <text bytes="48463" xml:space="preserve">Kokoram yɛ nyarewa kuw bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Eyinom ne akisikuru a ɛnyɛ hu a ɛntrɛw no bɔ abira.[7] 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.[1] Bere a saa sɛnkyerɛnne ahorow yi betumi akyerɛ sɛ kokoram de, nanso ebetumi de nneɛma afoforo nso aba.[1] Kokoram ahorow bɛboro 100 na ɛka nnipa.[7] 

Tawa a wɔde di dwuma no na ɛde kokoram wuwu bɛyɛ 22% ba.[2] 10% foforo nso fi kɛseyɛ mmoroso, aduan pa a wonni, apɔw-mu-teɛteɛ a wonnya anaasɛ nsa a wɔnom boro so.[2][8][9] 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 efĩ ba.[3] 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).[2] Anyɛ yiye koraa no, saa nneɛma yi yɛ adwuma, ne fã bi, denam nkwammoaa bi awosu mu nkwaadɔm a wɔsakra no so.[10] Mpɛn pii no, ɛho hia sɛ wɔyɛ nsakrae pii wɔ awosu mu ansa na kokoram aba.[10] Bɛyɛ kokoram 5–10% fi awosu mu sintɔ ahorow a wonya fi awo mu.[11] Wobetumi de nsɛnkyerɛnne ne sɛnkyerɛnne ahorow bi anaa nhwehwɛmu a wɔde hwehwɛ kokoram mu ahu kokoram.[2] Afei wɔtaa de nnuruyɛ mu mfoniniyɛ hwehwɛ mu bio na wɔde nipadua mu nhwehwɛmu si so dua.[12]

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.[13][14] Sɛ wohu ntɛm denam nhwehwɛmu so a, ɛho wɔ mfaso ma awotwaa ne akyi berɛmo mu kokoram.[15] Mfaso a ɛwɔ nufu mu kokoram a wɔhwehwɛ mu no yɛ nea akyinnyegye wom.[15][16] 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.[2][4] Ɛyaw ne sɛnkyerɛnne ahorow a wɔde di dwuma no yɛ ɔhwɛ no fã titiriw.[2] Ayaresa a ɛma obi ho dwo no ho hia titiriw wɔ nnipa a wɔwɔ yare a emu yɛ den no mu.[2] 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%.[17] Wɔ kokoram ho wɔ United States no, sɛ wɔkyekyem pɛpɛɛpɛ a, mfe anum a wɔde tra ase no yɛ 66%.[5]

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.[6][19]

Kokoram ahorow a ɛtaa ba mmarima so ne ahurututu mu kokoram, prostate kokoram, akyi berɛmo mu kokoram, ne yafunu mu kokoram.[20] Wɔ mmea mu no, nea ɛtaa ba ne nufu mu kokoram, kokoram a ɛwɔ akyi berɛmo mu, ahurututu mu kokoram, ne awotwaa mu kokoram.[10] 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%.[21][22] 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.[17] Wɔ afe 2012 mu no, mmofra bɛyɛ 165,000 a wonnii mfe 15 na wohui sɛ wɔwɔ kokoram.[20] Kokoram ho asiane no kɔ soro kɛse bere a obi nyin no, na kokoram pii taa ba aman a wɔanya nkɔso no mu.[10] 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.[23] 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.[24] 

== 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.[25]

Kokoram yɛ nyarewa abusua kɛse bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Wɔyɛ neoplasm ahorow no fã 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.[26][27]

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:[28] .

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[28] .

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.[28][29]

== 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 &quot;ɔsuasua kɛse.&quot;[30]

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.[31]

'''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.[30]

'''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.[32] 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.[33]

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.[30]

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 fĩ, anaasɛ hyponatremia, a ɛno nso betumi ama adwene mu tebea asakra, ɔfe, tiyɛ, anaa akisikuru.[34]

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 fã 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 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.[3] 5–10% a aka no fi awosu mu nneɛma.[3] 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 efĩ ara kwa.[38] 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 efĩ.[3][39] Ɛte sɛ nea adwene mu nhyɛso nyɛ asiane a ɛma kokoram fi ase,[40][41] ɛwom sɛ ebetumi ama nea efi mu ba no asɛe wɔ wɔn a wɔwɔ kokoram dedaw no mu de.[40]

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,[42] 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: Nsã 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.[43] Ɛsan nso de kokoram ba anom, ti, kɔn, yafunu, akisikuru, asaabo, ɛwo ne dwensɔtwaa mu.[44] Tawa wusiw wɔ nneɛma bɛboro aduonum a wonim sɛ ɛde kokoram ba, a nitrosamines ne polycyclic aromatic hydrocarbons ka ho.[45]

Tawa na ɛde kokoram wuwu bɛyɛ nnipa baanum biara mu biako wɔ wiase nyinaa[45] ne bɛyɛ baasa biara mu biako wɔ aman a wɔanya nkɔso no mu.[46] 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 .[47][48] 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.[49] Kokoram a efi nnuru a wɔde di dwuma wɔ adwuma mu mu ba no betumi ama wɔanya nsɛm no mu 2 kosi 20%,[50] anyɛ yiye koraa no, ebetumi ama nnipa 200,000 awuwu.[51] 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.[51]

Wonim sɛ sɛ obi nya perfluorooctanoic acid (PFOA) a wɔde di dwuma titiriw wɔ Teflon a wɔyɛ mu a, ɛde kokoram ahorow abien ba.[52][53]

'''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 fã 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 efĩ 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 fã 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.[3] Saa dodow yi fi 25% a ɛkorɔn wɔ Afrika kosi nea ennu 10% wɔ aman a wɔanya nkɔso no mu.[3] 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).[61]

'''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.[62][63][64] Honam ani kokoram pii a ɛnyɛ melanoma no fi mframa a ano yɛ den a ɛbɔ, a ne fã kɛse no ara fi owia hann mu.[63] Nneɛma a ɛma mframa bɔne a ɛma ɛyɛ hyew ba no bi ne aduruyɛ mu mfoninitwa ne radon mframa.[63]

Ionizing radiation nyɛ mutagen a ɛyɛ den titiriw.[65] 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.[65] Mframa a ɛbɔ no betumi de kokoram aba nipadua no afã 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.[66]

Sɛ obi nya ultraviolet mframa a efi owia mu bere tenten a, ebetumi ama wanya melanoma ne honam ani yare afoforo.[67] 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.[67]

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.[69] [62] 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.[70]

'''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.[71] 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,[71] 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,[72] 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.[73] Asiane a ɛne no hyia no yɛ 1.5 ma ahurututu mu kokoram,[74] ne 1.9 ma prostate kokoram.[75] 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.[76]

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.[77]

'''Honam fam nneɛma a wɔde yɛ nneɛma'''

Nneɛma bi de kokoram ba titiriw denam ne honam fam nkɛntɛnso so, sen sɛ ɛbɛyɛ nnuru.[78] 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.[78] Nneɛma nketenkete a ɛnyɛ fibrous a ɛde kokoram ba no bi ne powder metallic cobalt ne nickel ne crystalline silica (quartz, cristobalite ne tridymite).[78] 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.[78]

Nipadua mu apirakuru a ɛde kokoram ba no ntaa mma.[79] Sɛ nhwɛso no, wonnya nkyerɛɛ nsɛm a wɔka sɛ nnompe a ebubui no maa nnompe mu kokoram bae.[79] Saa ara nso na wonnye nipadua mu apirakuru ntom sɛ ɛde awotwaa mu kokoram, nufu mu kokoram anaa amemene mu kokoram ba.[79] Fibea biako a wogye tom ne nneɛma a ɛyɛ hyew a wɔtaa de gu nipadua no so bere tenten. Ebetumi aba sɛ nipadua no fã 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.[79] Sɛ wɔtaa nom tii a ɛyɛ hyew a ɛyɛ hyew a, ebetumi ama woanya kokoram wɔ aduan mu.[79] 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.[79][80] Ɔfe betumi aboa ma kokoram nkwammoaa no adɔɔso, atra ase, angiogenesis ne atutra denam nkɛntɛnso a enya wɔ tumor microenvironment no so.[81][82] Oncogenes no kyekye pro-tumorigenic microenvironment a ɛma ɔhyew.[83]

'''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.[85]

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.[84] 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.[84] 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.[84] 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 fã 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 fã 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 &quot;de wɔn ani asi&quot; 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 &quot;draiver&quot; mu nsakrae na nea aka no betumi ayɛ &quot;akwantufo&quot; 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 fã 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 fã 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 &quot;precursor&quot; 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 ==

== Nsɛm a Wɔka Kyerɛ ==

== Nyarewa a Ɛtrɛw Ho Adesua ==

== Abakɔsɛm ==

== Ɔmanfo ne amammerɛ ==

== Hwehwɛ mu ==

== Nyinsɛn ==

== Mmoa afoforo ==</text>
      <sha1>ebl7nvl2kqfqi2ul6ymbxvkuuugig93</sha1>
    </revision>
    <revision>
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      <comment>Me de atwerɛ ka ho</comment>
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      <text bytes="58274" xml:space="preserve">Kokoram yɛ nyarewa kuw bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Eyinom ne akisikuru a ɛnyɛ hu a ɛntrɛw no bɔ abira.[7] 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.[1] Bere a saa sɛnkyerɛnne ahorow yi betumi akyerɛ sɛ kokoram de, nanso ebetumi de nneɛma afoforo nso aba.[1] Kokoram ahorow bɛboro 100 na ɛka nnipa.[7] 

Tawa a wɔde di dwuma no na ɛde kokoram wuwu bɛyɛ 22% ba.[2] 10% foforo nso fi kɛseyɛ mmoroso, aduan pa a wonni, apɔw-mu-teɛteɛ a wonnya anaasɛ nsa a wɔnom boro so.[2][8][9] 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 efĩ ba.[3] 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).[2] Anyɛ yiye koraa no, saa nneɛma yi yɛ adwuma, ne fã bi, denam nkwammoaa bi awosu mu nkwaadɔm a wɔsakra no so.[10] Mpɛn pii no, ɛho hia sɛ wɔyɛ nsakrae pii wɔ awosu mu ansa na kokoram aba.[10] Bɛyɛ kokoram 5–10% fi awosu mu sintɔ ahorow a wonya fi awo mu.[11] Wobetumi de nsɛnkyerɛnne ne sɛnkyerɛnne ahorow bi anaa nhwehwɛmu a wɔde hwehwɛ kokoram mu ahu kokoram.[2] Afei wɔtaa de nnuruyɛ mu mfoniniyɛ hwehwɛ mu bio na wɔde nipadua mu nhwehwɛmu si so dua.[12]

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.[13][14] Sɛ wohu ntɛm denam nhwehwɛmu so a, ɛho wɔ mfaso ma awotwaa ne akyi berɛmo mu kokoram.[15] Mfaso a ɛwɔ nufu mu kokoram a wɔhwehwɛ mu no yɛ nea akyinnyegye wom.[15][16] 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.[2][4] Ɛyaw ne sɛnkyerɛnne ahorow a wɔde di dwuma no yɛ ɔhwɛ no fã titiriw.[2] Ayaresa a ɛma obi ho dwo no ho hia titiriw wɔ nnipa a wɔwɔ yare a emu yɛ den no mu.[2] 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%.[17] Wɔ kokoram ho wɔ United States no, sɛ wɔkyekyem pɛpɛɛpɛ a, mfe anum a wɔde tra ase no yɛ 66%.[5]

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.[6][19]

Kokoram ahorow a ɛtaa ba mmarima so ne ahurututu mu kokoram, prostate kokoram, akyi berɛmo mu kokoram, ne yafunu mu kokoram.[20] Wɔ mmea mu no, nea ɛtaa ba ne nufu mu kokoram, kokoram a ɛwɔ akyi berɛmo mu, ahurututu mu kokoram, ne awotwaa mu kokoram.[10] 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%.[21][22] 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.[17] Wɔ afe 2012 mu no, mmofra bɛyɛ 165,000 a wonnii mfe 15 na wohui sɛ wɔwɔ kokoram.[20] Kokoram ho asiane no kɔ soro kɛse bere a obi nyin no, na kokoram pii taa ba aman a wɔanya nkɔso no mu.[10] 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.[23] 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.[24] 

== 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.[25]

Kokoram yɛ nyarewa abusua kɛse bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Wɔyɛ neoplasm ahorow no fã 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.[26][27]

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:[28] .

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[28] .

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.[28][29]

== 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 &quot;ɔsuasua kɛse.&quot;[30]

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.[31]

'''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.[30]

'''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.[32] 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.[33]

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.[30]

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 fĩ, anaasɛ hyponatremia, a ɛno nso betumi ama adwene mu tebea asakra, ɔfe, tiyɛ, anaa akisikuru.[34]

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 fã 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 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.[3] 5–10% a aka no fi awosu mu nneɛma.[3] 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 efĩ ara kwa.[38] 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 efĩ.[3][39] Ɛte sɛ nea adwene mu nhyɛso nyɛ asiane a ɛma kokoram fi ase,[40][41] ɛwom sɛ ebetumi ama nea efi mu ba no asɛe wɔ wɔn a wɔwɔ kokoram dedaw no mu de.[40]

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,[42] 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: Nsã 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.[43] Ɛsan nso de kokoram ba anom, ti, kɔn, yafunu, akisikuru, asaabo, ɛwo ne dwensɔtwaa mu.[44] Tawa wusiw wɔ nneɛma bɛboro aduonum a wonim sɛ ɛde kokoram ba, a nitrosamines ne polycyclic aromatic hydrocarbons ka ho.[45]

Tawa na ɛde kokoram wuwu bɛyɛ nnipa baanum biara mu biako wɔ wiase nyinaa[45] ne bɛyɛ baasa biara mu biako wɔ aman a wɔanya nkɔso no mu.[46] 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 .[47][48] 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.[49] Kokoram a efi nnuru a wɔde di dwuma wɔ adwuma mu mu ba no betumi ama wɔanya nsɛm no mu 2 kosi 20%,[50] anyɛ yiye koraa no, ebetumi ama nnipa 200,000 awuwu.[51] 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.[51]

Wonim sɛ sɛ obi nya perfluorooctanoic acid (PFOA) a wɔde di dwuma titiriw wɔ Teflon a wɔyɛ mu a, ɛde kokoram ahorow abien ba.[52][53]

'''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 fã 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 efĩ 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 fã 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.[3] Saa dodow yi fi 25% a ɛkorɔn wɔ Afrika kosi nea ennu 10% wɔ aman a wɔanya nkɔso no mu.[3] 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).[61]

'''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.[62][63][64] Honam ani kokoram pii a ɛnyɛ melanoma no fi mframa a ano yɛ den a ɛbɔ, a ne fã kɛse no ara fi owia hann mu.[63] Nneɛma a ɛma mframa bɔne a ɛma ɛyɛ hyew ba no bi ne aduruyɛ mu mfoninitwa ne radon mframa.[63]

Ionizing radiation nyɛ mutagen a ɛyɛ den titiriw.[65] 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.[65] Mframa a ɛbɔ no betumi de kokoram aba nipadua no afã 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.[66]

Sɛ obi nya ultraviolet mframa a efi owia mu bere tenten a, ebetumi ama wanya melanoma ne honam ani yare afoforo.[67] 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.[67]

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.[69] [62] 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.[70]

'''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.[71] 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,[71] 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,[72] 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.[73] Asiane a ɛne no hyia no yɛ 1.5 ma ahurututu mu kokoram,[74] ne 1.9 ma prostate kokoram.[75] 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.[76]

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.[77]

'''Honam fam nneɛma a wɔde yɛ nneɛma'''

Nneɛma bi de kokoram ba titiriw denam ne honam fam nkɛntɛnso so, sen sɛ ɛbɛyɛ nnuru.[78] 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.[78] Nneɛma nketenkete a ɛnyɛ fibrous a ɛde kokoram ba no bi ne powder metallic cobalt ne nickel ne crystalline silica (quartz, cristobalite ne tridymite).[78] 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.[78]

Nipadua mu apirakuru a ɛde kokoram ba no ntaa mma.[79] Sɛ nhwɛso no, wonnya nkyerɛɛ nsɛm a wɔka sɛ nnompe a ebubui no maa nnompe mu kokoram bae.[79] Saa ara nso na wonnye nipadua mu apirakuru ntom sɛ ɛde awotwaa mu kokoram, nufu mu kokoram anaa amemene mu kokoram ba.[79] Fibea biako a wogye tom ne nneɛma a ɛyɛ hyew a wɔtaa de gu nipadua no so bere tenten. Ebetumi aba sɛ nipadua no fã 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.[79] Sɛ wɔtaa nom tii a ɛyɛ hyew a ɛyɛ hyew a, ebetumi ama woanya kokoram wɔ aduan mu.[79] 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.[79][80] Ɔfe betumi aboa ma kokoram nkwammoaa no adɔɔso, atra ase, angiogenesis ne atutra denam nkɛntɛnso a enya wɔ tumor microenvironment no so.[81][82] Oncogenes no kyekye pro-tumorigenic microenvironment a ɛma ɔhyew.[83]

'''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.[85]

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.[84] 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.[84] 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.[84] 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 fã 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 fã 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 &quot;de wɔn ani asi&quot; 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 &quot;draiver&quot; mu nsakrae na nea aka no betumi ayɛ &quot;akwantufo&quot; 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 fã 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 fã 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 &quot;precursor&quot; 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 fã. 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 fã 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 fã 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 fã 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 fã.[190] &quot;Aduru a wɔde ka ho&quot; kyerɛ akwan ne nneɛma a wɔde di dwuma ka nnuru a wɔde di dwuma ho, bere a &quot;aduru foforo&quot; 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, &quot;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'.&quot;[192]

== Nsɛm a Wɔka Kyerɛ ==

== Nyarewa a Ɛtrɛw Ho Adesua ==

== Abakɔsɛm ==

== Ɔmanfo ne amammerɛ ==

== Hwehwɛ mu ==

== Nyinsɛn ==

== Mmoa afoforo ==</text>
      <sha1>54sbyen5zf3yyx4hh6fh7u3oro1396r</sha1>
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    <revision>
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      <comment>Mede atwerɛ kaa ho</comment>
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      <text bytes="60876" xml:space="preserve">Kokoram yɛ nyarewa kuw bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Eyinom ne akisikuru a ɛnyɛ hu a ɛntrɛw no bɔ abira.[7] 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.[1] Bere a saa sɛnkyerɛnne ahorow yi betumi akyerɛ sɛ kokoram de, nanso ebetumi de nneɛma afoforo nso aba.[1] Kokoram ahorow bɛboro 100 na ɛka nnipa.[7] 

Tawa a wɔde di dwuma no na ɛde kokoram wuwu bɛyɛ 22% ba.[2] 10% foforo nso fi kɛseyɛ mmoroso, aduan pa a wonni, apɔw-mu-teɛteɛ a wonnya anaasɛ nsa a wɔnom boro so.[2][8][9] 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 efĩ ba.[3] 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).[2] Anyɛ yiye koraa no, saa nneɛma yi yɛ adwuma, ne fã bi, denam nkwammoaa bi awosu mu nkwaadɔm a wɔsakra no so.[10] Mpɛn pii no, ɛho hia sɛ wɔyɛ nsakrae pii wɔ awosu mu ansa na kokoram aba.[10] Bɛyɛ kokoram 5–10% fi awosu mu sintɔ ahorow a wonya fi awo mu.[11] Wobetumi de nsɛnkyerɛnne ne sɛnkyerɛnne ahorow bi anaa nhwehwɛmu a wɔde hwehwɛ kokoram mu ahu kokoram.[2] Afei wɔtaa de nnuruyɛ mu mfoniniyɛ hwehwɛ mu bio na wɔde nipadua mu nhwehwɛmu si so dua.[12]

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.[13][14] Sɛ wohu ntɛm denam nhwehwɛmu so a, ɛho wɔ mfaso ma awotwaa ne akyi berɛmo mu kokoram.[15] Mfaso a ɛwɔ nufu mu kokoram a wɔhwehwɛ mu no yɛ nea akyinnyegye wom.[15][16] 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.[2][4] Ɛyaw ne sɛnkyerɛnne ahorow a wɔde di dwuma no yɛ ɔhwɛ no fã titiriw.[2] Ayaresa a ɛma obi ho dwo no ho hia titiriw wɔ nnipa a wɔwɔ yare a emu yɛ den no mu.[2] 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%.[17] Wɔ kokoram ho wɔ United States no, sɛ wɔkyekyem pɛpɛɛpɛ a, mfe anum a wɔde tra ase no yɛ 66%.[5]

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.[6][19]

Kokoram ahorow a ɛtaa ba mmarima so ne ahurututu mu kokoram, prostate kokoram, akyi berɛmo mu kokoram, ne yafunu mu kokoram.[20] Wɔ mmea mu no, nea ɛtaa ba ne nufu mu kokoram, kokoram a ɛwɔ akyi berɛmo mu, ahurututu mu kokoram, ne awotwaa mu kokoram.[10] 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%.[21][22] 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.[17] Wɔ afe 2012 mu no, mmofra bɛyɛ 165,000 a wonnii mfe 15 na wohui sɛ wɔwɔ kokoram.[20] Kokoram ho asiane no kɔ soro kɛse bere a obi nyin no, na kokoram pii taa ba aman a wɔanya nkɔso no mu.[10] 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.[23] 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.[24] 

== 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.[25]

Kokoram yɛ nyarewa abusua kɛse bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Wɔyɛ neoplasm ahorow no fã 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.[26][27]

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:[28] .

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[28] .

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.[28][29]

== 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 &quot;ɔsuasua kɛse.&quot;[30]

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.[31]

'''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.[30]

'''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.[32] 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.[33]

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.[30]

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 fĩ, anaasɛ hyponatremia, a ɛno nso betumi ama adwene mu tebea asakra, ɔfe, tiyɛ, anaa akisikuru.[34]

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 fã 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 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.[3] 5–10% a aka no fi awosu mu nneɛma.[3] 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 efĩ ara kwa.[38] 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 efĩ.[3][39] Ɛte sɛ nea adwene mu nhyɛso nyɛ asiane a ɛma kokoram fi ase,[40][41] ɛwom sɛ ebetumi ama nea efi mu ba no asɛe wɔ wɔn a wɔwɔ kokoram dedaw no mu de.[40]

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,[42] 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: Nsã 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.[43] Ɛsan nso de kokoram ba anom, ti, kɔn, yafunu, akisikuru, asaabo, ɛwo ne dwensɔtwaa mu.[44] Tawa wusiw wɔ nneɛma bɛboro aduonum a wonim sɛ ɛde kokoram ba, a nitrosamines ne polycyclic aromatic hydrocarbons ka ho.[45]

Tawa na ɛde kokoram wuwu bɛyɛ nnipa baanum biara mu biako wɔ wiase nyinaa[45] ne bɛyɛ baasa biara mu biako wɔ aman a wɔanya nkɔso no mu.[46] 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 .[47][48] 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.[49] Kokoram a efi nnuru a wɔde di dwuma wɔ adwuma mu mu ba no betumi ama wɔanya nsɛm no mu 2 kosi 20%,[50] anyɛ yiye koraa no, ebetumi ama nnipa 200,000 awuwu.[51] 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.[51]

Wonim sɛ sɛ obi nya perfluorooctanoic acid (PFOA) a wɔde di dwuma titiriw wɔ Teflon a wɔyɛ mu a, ɛde kokoram ahorow abien ba.[52][53]

'''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 fã 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 efĩ 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 fã 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.[3] Saa dodow yi fi 25% a ɛkorɔn wɔ Afrika kosi nea ennu 10% wɔ aman a wɔanya nkɔso no mu.[3] 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).[61]

'''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.[62][63][64] Honam ani kokoram pii a ɛnyɛ melanoma no fi mframa a ano yɛ den a ɛbɔ, a ne fã kɛse no ara fi owia hann mu.[63] Nneɛma a ɛma mframa bɔne a ɛma ɛyɛ hyew ba no bi ne aduruyɛ mu mfoninitwa ne radon mframa.[63]

Ionizing radiation nyɛ mutagen a ɛyɛ den titiriw.[65] 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.[65] Mframa a ɛbɔ no betumi de kokoram aba nipadua no afã 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.[66]

Sɛ obi nya ultraviolet mframa a efi owia mu bere tenten a, ebetumi ama wanya melanoma ne honam ani yare afoforo.[67] 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.[67]

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.[69] [62] 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.[70]

'''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.[71] 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,[71] 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,[72] 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.[73] Asiane a ɛne no hyia no yɛ 1.5 ma ahurututu mu kokoram,[74] ne 1.9 ma prostate kokoram.[75] 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.[76]

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.[77]

'''Honam fam nneɛma a wɔde yɛ nneɛma'''

Nneɛma bi de kokoram ba titiriw denam ne honam fam nkɛntɛnso so, sen sɛ ɛbɛyɛ nnuru.[78] 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.[78] Nneɛma nketenkete a ɛnyɛ fibrous a ɛde kokoram ba no bi ne powder metallic cobalt ne nickel ne crystalline silica (quartz, cristobalite ne tridymite).[78] 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.[78]

Nipadua mu apirakuru a ɛde kokoram ba no ntaa mma.[79] Sɛ nhwɛso no, wonnya nkyerɛɛ nsɛm a wɔka sɛ nnompe a ebubui no maa nnompe mu kokoram bae.[79] Saa ara nso na wonnye nipadua mu apirakuru ntom sɛ ɛde awotwaa mu kokoram, nufu mu kokoram anaa amemene mu kokoram ba.[79] Fibea biako a wogye tom ne nneɛma a ɛyɛ hyew a wɔtaa de gu nipadua no so bere tenten. Ebetumi aba sɛ nipadua no fã 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.[79] Sɛ wɔtaa nom tii a ɛyɛ hyew a ɛyɛ hyew a, ebetumi ama woanya kokoram wɔ aduan mu.[79] 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.[79][80] Ɔfe betumi aboa ma kokoram nkwammoaa no adɔɔso, atra ase, angiogenesis ne atutra denam nkɛntɛnso a enya wɔ tumor microenvironment no so.[81][82] Oncogenes no kyekye pro-tumorigenic microenvironment a ɛma ɔhyew.[83]

'''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.[85]

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.[84] 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.[84] 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.[84] 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 fã 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 fã 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 &quot;de wɔn ani asi&quot; 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 &quot;draiver&quot; mu nsakrae na nea aka no betumi ayɛ &quot;akwantufo&quot; 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 fã 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 fã 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 &quot;precursor&quot; 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 fã. 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 fã 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 fã 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 fã 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 fã.[190] &quot;Aduru a wɔde ka ho&quot; kyerɛ akwan ne nneɛma a wɔde di dwuma ka nnuru a wɔde di dwuma ho, bere a &quot;aduru foforo&quot; 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, &quot;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'.&quot;[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 fã 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 fã 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 ==

== Abakɔsɛm ==

== Ɔmanfo ne amammerɛ ==

== Hwehwɛ mu ==

== Nyinsɛn ==

== Mmoa afoforo ==</text>
      <sha1>3tfawgxii8s3ja74ogrchc8c42wktxb</sha1>
    </revision>
    <revision>
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      <contributor>
        <username>Afriyie34</username>
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      <comment>Me de atwerɛ ka ho</comment>
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      <format>text/x-wiki</format>
      <text bytes="63714" xml:space="preserve">Kokoram yɛ nyarewa kuw bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Eyinom ne akisikuru a ɛnyɛ hu a ɛntrɛw no bɔ abira.[7] 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.[1] Bere a saa sɛnkyerɛnne ahorow yi betumi akyerɛ sɛ kokoram de, nanso ebetumi de nneɛma afoforo nso aba.[1] Kokoram ahorow bɛboro 100 na ɛka nnipa.[7] 

Tawa a wɔde di dwuma no na ɛde kokoram wuwu bɛyɛ 22% ba.[2] 10% foforo nso fi kɛseyɛ mmoroso, aduan pa a wonni, apɔw-mu-teɛteɛ a wonnya anaasɛ nsa a wɔnom boro so.[2][8][9] 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 efĩ ba.[3] 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).[2] Anyɛ yiye koraa no, saa nneɛma yi yɛ adwuma, ne fã bi, denam nkwammoaa bi awosu mu nkwaadɔm a wɔsakra no so.[10] Mpɛn pii no, ɛho hia sɛ wɔyɛ nsakrae pii wɔ awosu mu ansa na kokoram aba.[10] Bɛyɛ kokoram 5–10% fi awosu mu sintɔ ahorow a wonya fi awo mu.[11] Wobetumi de nsɛnkyerɛnne ne sɛnkyerɛnne ahorow bi anaa nhwehwɛmu a wɔde hwehwɛ kokoram mu ahu kokoram.[2] Afei wɔtaa de nnuruyɛ mu mfoniniyɛ hwehwɛ mu bio na wɔde nipadua mu nhwehwɛmu si so dua.[12]

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.[13][14] Sɛ wohu ntɛm denam nhwehwɛmu so a, ɛho wɔ mfaso ma awotwaa ne akyi berɛmo mu kokoram.[15] Mfaso a ɛwɔ nufu mu kokoram a wɔhwehwɛ mu no yɛ nea akyinnyegye wom.[15][16] 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.[2][4] Ɛyaw ne sɛnkyerɛnne ahorow a wɔde di dwuma no yɛ ɔhwɛ no fã titiriw.[2] Ayaresa a ɛma obi ho dwo no ho hia titiriw wɔ nnipa a wɔwɔ yare a emu yɛ den no mu.[2] 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%.[17] Wɔ kokoram ho wɔ United States no, sɛ wɔkyekyem pɛpɛɛpɛ a, mfe anum a wɔde tra ase no yɛ 66%.[5]

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.[6][19]

Kokoram ahorow a ɛtaa ba mmarima so ne ahurututu mu kokoram, prostate kokoram, akyi berɛmo mu kokoram, ne yafunu mu kokoram.[20] Wɔ mmea mu no, nea ɛtaa ba ne nufu mu kokoram, kokoram a ɛwɔ akyi berɛmo mu, ahurututu mu kokoram, ne awotwaa mu kokoram.[10] 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%.[21][22] 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.[17] Wɔ afe 2012 mu no, mmofra bɛyɛ 165,000 a wonnii mfe 15 na wohui sɛ wɔwɔ kokoram.[20] Kokoram ho asiane no kɔ soro kɛse bere a obi nyin no, na kokoram pii taa ba aman a wɔanya nkɔso no mu.[10] 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.[23] 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.[24] 

== 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.[25]

Kokoram yɛ nyarewa abusua kɛse bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Wɔyɛ neoplasm ahorow no fã 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.[26][27]

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:[28] .

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[28] .

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.[28][29]

== 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 &quot;ɔsuasua kɛse.&quot;[30]

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.[31]

'''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.[30]

'''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.[32] 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.[33]

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.[30]

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 fĩ, anaasɛ hyponatremia, a ɛno nso betumi ama adwene mu tebea asakra, ɔfe, tiyɛ, anaa akisikuru.[34]

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 fã 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 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.[3] 5–10% a aka no fi awosu mu nneɛma.[3] 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 efĩ ara kwa.[38] 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 efĩ.[3][39] Ɛte sɛ nea adwene mu nhyɛso nyɛ asiane a ɛma kokoram fi ase,[40][41] ɛwom sɛ ebetumi ama nea efi mu ba no asɛe wɔ wɔn a wɔwɔ kokoram dedaw no mu de.[40]

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,[42] 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: Nsã 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.[43] Ɛsan nso de kokoram ba anom, ti, kɔn, yafunu, akisikuru, asaabo, ɛwo ne dwensɔtwaa mu.[44] Tawa wusiw wɔ nneɛma bɛboro aduonum a wonim sɛ ɛde kokoram ba, a nitrosamines ne polycyclic aromatic hydrocarbons ka ho.[45]

Tawa na ɛde kokoram wuwu bɛyɛ nnipa baanum biara mu biako wɔ wiase nyinaa[45] ne bɛyɛ baasa biara mu biako wɔ aman a wɔanya nkɔso no mu.[46] 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 .[47][48] 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.[49] Kokoram a efi nnuru a wɔde di dwuma wɔ adwuma mu mu ba no betumi ama wɔanya nsɛm no mu 2 kosi 20%,[50] anyɛ yiye koraa no, ebetumi ama nnipa 200,000 awuwu.[51] 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.[51]

Wonim sɛ sɛ obi nya perfluorooctanoic acid (PFOA) a wɔde di dwuma titiriw wɔ Teflon a wɔyɛ mu a, ɛde kokoram ahorow abien ba.[52][53]

'''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 fã 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 efĩ 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 fã 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.[3] Saa dodow yi fi 25% a ɛkorɔn wɔ Afrika kosi nea ennu 10% wɔ aman a wɔanya nkɔso no mu.[3] 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).[61]

'''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.[62][63][64] Honam ani kokoram pii a ɛnyɛ melanoma no fi mframa a ano yɛ den a ɛbɔ, a ne fã kɛse no ara fi owia hann mu.[63] Nneɛma a ɛma mframa bɔne a ɛma ɛyɛ hyew ba no bi ne aduruyɛ mu mfoninitwa ne radon mframa.[63]

Ionizing radiation nyɛ mutagen a ɛyɛ den titiriw.[65] 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.[65] Mframa a ɛbɔ no betumi de kokoram aba nipadua no afã 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.[66]

Sɛ obi nya ultraviolet mframa a efi owia mu bere tenten a, ebetumi ama wanya melanoma ne honam ani yare afoforo.[67] 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.[67]

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.[69] [62] 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.[70]

'''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.[71] 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,[71] 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,[72] 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.[73] Asiane a ɛne no hyia no yɛ 1.5 ma ahurututu mu kokoram,[74] ne 1.9 ma prostate kokoram.[75] 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.[76]

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.[77]

'''Honam fam nneɛma a wɔde yɛ nneɛma'''

Nneɛma bi de kokoram ba titiriw denam ne honam fam nkɛntɛnso so, sen sɛ ɛbɛyɛ nnuru.[78] 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.[78] Nneɛma nketenkete a ɛnyɛ fibrous a ɛde kokoram ba no bi ne powder metallic cobalt ne nickel ne crystalline silica (quartz, cristobalite ne tridymite).[78] 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.[78]

Nipadua mu apirakuru a ɛde kokoram ba no ntaa mma.[79] Sɛ nhwɛso no, wonnya nkyerɛɛ nsɛm a wɔka sɛ nnompe a ebubui no maa nnompe mu kokoram bae.[79] Saa ara nso na wonnye nipadua mu apirakuru ntom sɛ ɛde awotwaa mu kokoram, nufu mu kokoram anaa amemene mu kokoram ba.[79] Fibea biako a wogye tom ne nneɛma a ɛyɛ hyew a wɔtaa de gu nipadua no so bere tenten. Ebetumi aba sɛ nipadua no fã 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.[79] Sɛ wɔtaa nom tii a ɛyɛ hyew a ɛyɛ hyew a, ebetumi ama woanya kokoram wɔ aduan mu.[79] 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.[79][80] Ɔfe betumi aboa ma kokoram nkwammoaa no adɔɔso, atra ase, angiogenesis ne atutra denam nkɛntɛnso a enya wɔ tumor microenvironment no so.[81][82] Oncogenes no kyekye pro-tumorigenic microenvironment a ɛma ɔhyew.[83]

'''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.[85]

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.[84] 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.[84] 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.[84] 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 fã 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 fã 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 &quot;de wɔn ani asi&quot; 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 &quot;draiver&quot; mu nsakrae na nea aka no betumi ayɛ &quot;akwantufo&quot; 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 fã 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 fã 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 &quot;precursor&quot; 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 fã. 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 fã 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 fã 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 fã 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 fã.[190] &quot;Aduru a wɔde ka ho&quot; kyerɛ akwan ne nneɛma a wɔde di dwuma ka nnuru a wɔde di dwuma ho, bere a &quot;aduru foforo&quot; 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, &quot;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'.&quot;[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 fã 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 fã 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 fã 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, &quot;Sɛ yɛtra ase kyɛ a, anka yɛn nyinaa benya kokoram.&quot;[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 fã wɔ afe 1975 ne 2010 ntam wɔ United States.[212]

== Abakɔsɛm ==

== Ɔmanfo ne amammerɛ ==

== Hwehwɛ mu ==

== Nyinsɛn ==

== Mmoa afoforo ==</text>
      <sha1>tn0x3ly2768amxollun6bk4an88st3d</sha1>
    </revision>
    <revision>
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      <comment>Me de atwerɛ ka ho ne paragraph</comment>
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      <text bytes="63716" xml:space="preserve">Kokoram yɛ nyarewa kuw bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Eyinom ne akisikuru a ɛnyɛ hu a ɛntrɛw no bɔ abira.[7] 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.[1] Bere a saa sɛnkyerɛnne ahorow yi betumi akyerɛ sɛ kokoram de, nanso ebetumi de nneɛma afoforo nso aba.[1] Kokoram ahorow bɛboro 100 na ɛka nnipa.[7] 

Tawa a wɔde di dwuma no na ɛde kokoram wuwu bɛyɛ 22% ba.[2] 10% foforo nso fi kɛseyɛ mmoroso, aduan pa a wonni, apɔw-mu-teɛteɛ a wonnya anaasɛ nsa a wɔnom boro so.[2][8][9] 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 efĩ ba.[3] 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).[2] Anyɛ yiye koraa no, saa nneɛma yi yɛ adwuma, ne fã bi, denam nkwammoaa bi awosu mu nkwaadɔm a wɔsakra no so.[10] Mpɛn pii no, ɛho hia sɛ wɔyɛ nsakrae pii wɔ awosu mu ansa na kokoram aba.[10] Bɛyɛ kokoram 5–10% fi awosu mu sintɔ ahorow a wonya fi awo mu.[11] Wobetumi de nsɛnkyerɛnne ne sɛnkyerɛnne ahorow bi anaa nhwehwɛmu a wɔde hwehwɛ kokoram mu ahu kokoram.[2] Afei wɔtaa de nnuruyɛ mu mfoniniyɛ hwehwɛ mu bio na wɔde nipadua mu nhwehwɛmu si so dua.[12]

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.[13][14] Sɛ wohu ntɛm denam nhwehwɛmu so a, ɛho wɔ mfaso ma awotwaa ne akyi berɛmo mu kokoram.[15] Mfaso a ɛwɔ nufu mu kokoram a wɔhwehwɛ mu no yɛ nea akyinnyegye wom.[15][16] 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.[2][4] Ɛyaw ne sɛnkyerɛnne ahorow a wɔde di dwuma no yɛ ɔhwɛ no fã titiriw.[2] Ayaresa a ɛma obi ho dwo no ho hia titiriw wɔ nnipa a wɔwɔ yare a emu yɛ den no mu.[2] 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%.[17] Wɔ kokoram ho wɔ United States no, sɛ wɔkyekyem pɛpɛɛpɛ a, mfe anum a wɔde tra ase no yɛ 66%.[5]

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.[6][19]

Kokoram ahorow a ɛtaa ba mmarima so ne ahurututu mu kokoram, prostate kokoram, akyi berɛmo mu kokoram, ne yafunu mu kokoram.[20] Wɔ mmea mu no, nea ɛtaa ba ne nufu mu kokoram, kokoram a ɛwɔ akyi berɛmo mu, ahurututu mu kokoram, ne awotwaa mu kokoram.[10] 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%.[21][22] 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.[17] Wɔ afe 2012 mu no, mmofra bɛyɛ 165,000 a wonnii mfe 15 na wohui sɛ wɔwɔ kokoram.[20] Kokoram ho asiane no kɔ soro kɛse bere a obi nyin no, na kokoram pii taa ba aman a wɔanya nkɔso no mu.[10] 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.[23] 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.[24] 

== 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.[25]

Kokoram yɛ nyarewa abusua kɛse bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Wɔyɛ neoplasm ahorow no fã 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.[26][27]

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:[28] .

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[28] .

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.[28][29]

== 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 &quot;ɔsuasua kɛse.&quot;[30]

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.[31]

'''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.[30]

'''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.[32] 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.[33]

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.[30]

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 fĩ, anaasɛ hyponatremia, a ɛno nso betumi ama adwene mu tebea asakra, ɔfe, tiyɛ, anaa akisikuru.[34]

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 fã 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 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.[3] 5–10% a aka no fi awosu mu nneɛma.[3] 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 efĩ ara kwa.[38] 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 efĩ.[3][39] Ɛte sɛ nea adwene mu nhyɛso nyɛ asiane a ɛma kokoram fi ase,[40][41] ɛwom sɛ ebetumi ama nea efi mu ba no asɛe wɔ wɔn a wɔwɔ kokoram dedaw no mu de.[40]

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,[42] 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: Nsã 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.[43] Ɛsan nso de kokoram ba anom, ti, kɔn, yafunu, akisikuru, asaabo, ɛwo ne dwensɔtwaa mu.[44] Tawa wusiw wɔ nneɛma bɛboro aduonum a wonim sɛ ɛde kokoram ba, a nitrosamines ne polycyclic aromatic hydrocarbons ka ho.[45]

Tawa na ɛde kokoram wuwu bɛyɛ nnipa baanum biara mu biako wɔ wiase nyinaa[45] ne bɛyɛ baasa biara mu biako wɔ aman a wɔanya nkɔso no mu.[46] 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 .[47][48] 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.[49] Kokoram a efi nnuru a wɔde di dwuma wɔ adwuma mu mu ba no betumi ama wɔanya nsɛm no mu 2 kosi 20%,[50] anyɛ yiye koraa no, ebetumi ama nnipa 200,000 awuwu.[51] 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.[51]

Wonim sɛ sɛ obi nya perfluorooctanoic acid (PFOA) a wɔde di dwuma titiriw wɔ Teflon a wɔyɛ mu a, ɛde kokoram ahorow abien ba.[52][53]

'''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 fã 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 efĩ 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 fã 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.[3] Saa dodow yi fi 25% a ɛkorɔn wɔ Afrika kosi nea ennu 10% wɔ aman a wɔanya nkɔso no mu.[3] 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).[61]

'''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.[62][63][64] Honam ani kokoram pii a ɛnyɛ melanoma no fi mframa a ano yɛ den a ɛbɔ, a ne fã kɛse no ara fi owia hann mu.[63] Nneɛma a ɛma mframa bɔne a ɛma ɛyɛ hyew ba no bi ne aduruyɛ mu mfoninitwa ne radon mframa.[63]

Ionizing radiation nyɛ mutagen a ɛyɛ den titiriw.[65] 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.[65] Mframa a ɛbɔ no betumi de kokoram aba nipadua no afã 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.[66]

Sɛ obi nya ultraviolet mframa a efi owia mu bere tenten a, ebetumi ama wanya melanoma ne honam ani yare afoforo.[67] 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.[67]

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.[69] [62] 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.[70]

'''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.[71] 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,[71] 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,[72] 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.[73] Asiane a ɛne no hyia no yɛ 1.5 ma ahurututu mu kokoram,[74] ne 1.9 ma prostate kokoram.[75] 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.[76]

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.[77]

'''Honam fam nneɛma a wɔde yɛ nneɛma'''

Nneɛma bi de kokoram ba titiriw denam ne honam fam nkɛntɛnso so, sen sɛ ɛbɛyɛ nnuru.[78] 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.[78] Nneɛma nketenkete a ɛnyɛ fibrous a ɛde kokoram ba no bi ne powder metallic cobalt ne nickel ne crystalline silica (quartz, cristobalite ne tridymite).[78] 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.[78]

Nipadua mu apirakuru a ɛde kokoram ba no ntaa mma.[79] Sɛ nhwɛso no, wonnya nkyerɛɛ nsɛm a wɔka sɛ nnompe a ebubui no maa nnompe mu kokoram bae.[79] Saa ara nso na wonnye nipadua mu apirakuru ntom sɛ ɛde awotwaa mu kokoram, nufu mu kokoram anaa amemene mu kokoram ba.[79] Fibea biako a wogye tom ne nneɛma a ɛyɛ hyew a wɔtaa de gu nipadua no so bere tenten. Ebetumi aba sɛ nipadua no fã 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.[79] Sɛ wɔtaa nom tii a ɛyɛ hyew a ɛyɛ hyew a, ebetumi ama woanya kokoram wɔ aduan mu.[79] 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.[79][80] Ɔfe betumi aboa ma kokoram nkwammoaa no adɔɔso, atra ase, angiogenesis ne atutra denam nkɛntɛnso a enya wɔ tumor microenvironment no so.[81][82] Oncogenes no kyekye pro-tumorigenic microenvironment a ɛma ɔhyew.[83]

'''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.[85]

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.[84] 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.[84] 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.[84] 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 fã 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 fã 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 &quot;de wɔn ani asi&quot; 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 &quot;draiver&quot; mu nsakrae na nea aka no betumi ayɛ &quot;akwantufo&quot; 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 fã 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 fã 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 &quot;precursor&quot; 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 fã. 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 fã 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 fã 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 fã 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 fã.[190] &quot;Aduru a wɔde ka ho&quot; kyerɛ akwan ne nneɛma a wɔde di dwuma ka nnuru a wɔde di dwuma ho, bere a &quot;aduru foforo&quot; 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, &quot;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'.&quot;[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 fã 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 fã 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 fã 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, &quot;Sɛ yɛtra ase kyɛ a, anka yɛn nyinaa benya kokoram.&quot;[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 fã wɔ afe 1975 ne 2010 ntam wɔ United States.[212]

== Abakɔsɛm ==
K

== Ɔmanfo ne amammerɛ ==

== Hwehwɛ mu ==

== Nyinsɛn ==

== Mmoa afoforo ==</text>
      <sha1>cnz4uiife6w4ro2y3uuzwg4i8phh02g</sha1>
    </revision>
    <revision>
      <id>132975</id>
      <parentid>132974</parentid>
      <timestamp>2022-07-31T14:59:01Z</timestamp>
      <contributor>
        <username>Afriyie34</username>
        <id>10662</id>
      </contributor>
      <comment>Me de atwerɛ ka ho</comment>
      <model>wikitext</model>
      <format>text/x-wiki</format>
      <text bytes="65900" xml:space="preserve">Kokoram yɛ nyarewa kuw bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Eyinom ne akisikuru a ɛnyɛ hu a ɛntrɛw no bɔ abira.[7] 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.[1] Bere a saa sɛnkyerɛnne ahorow yi betumi akyerɛ sɛ kokoram de, nanso ebetumi de nneɛma afoforo nso aba.[1] Kokoram ahorow bɛboro 100 na ɛka nnipa.[7] 

Tawa a wɔde di dwuma no na ɛde kokoram wuwu bɛyɛ 22% ba.[2] 10% foforo nso fi kɛseyɛ mmoroso, aduan pa a wonni, apɔw-mu-teɛteɛ a wonnya anaasɛ nsa a wɔnom boro so.[2][8][9] 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 efĩ ba.[3] 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).[2] Anyɛ yiye koraa no, saa nneɛma yi yɛ adwuma, ne fã bi, denam nkwammoaa bi awosu mu nkwaadɔm a wɔsakra no so.[10] Mpɛn pii no, ɛho hia sɛ wɔyɛ nsakrae pii wɔ awosu mu ansa na kokoram aba.[10] Bɛyɛ kokoram 5–10% fi awosu mu sintɔ ahorow a wonya fi awo mu.[11] Wobetumi de nsɛnkyerɛnne ne sɛnkyerɛnne ahorow bi anaa nhwehwɛmu a wɔde hwehwɛ kokoram mu ahu kokoram.[2] Afei wɔtaa de nnuruyɛ mu mfoniniyɛ hwehwɛ mu bio na wɔde nipadua mu nhwehwɛmu si so dua.[12]

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.[13][14] Sɛ wohu ntɛm denam nhwehwɛmu so a, ɛho wɔ mfaso ma awotwaa ne akyi berɛmo mu kokoram.[15] Mfaso a ɛwɔ nufu mu kokoram a wɔhwehwɛ mu no yɛ nea akyinnyegye wom.[15][16] 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.[2][4] Ɛyaw ne sɛnkyerɛnne ahorow a wɔde di dwuma no yɛ ɔhwɛ no fã titiriw.[2] Ayaresa a ɛma obi ho dwo no ho hia titiriw wɔ nnipa a wɔwɔ yare a emu yɛ den no mu.[2] 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%.[17] Wɔ kokoram ho wɔ United States no, sɛ wɔkyekyem pɛpɛɛpɛ a, mfe anum a wɔde tra ase no yɛ 66%.[5]

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.[6][19]

Kokoram ahorow a ɛtaa ba mmarima so ne ahurututu mu kokoram, prostate kokoram, akyi berɛmo mu kokoram, ne yafunu mu kokoram.[20] Wɔ mmea mu no, nea ɛtaa ba ne nufu mu kokoram, kokoram a ɛwɔ akyi berɛmo mu, ahurututu mu kokoram, ne awotwaa mu kokoram.[10] 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%.[21][22] 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.[17] Wɔ afe 2012 mu no, mmofra bɛyɛ 165,000 a wonnii mfe 15 na wohui sɛ wɔwɔ kokoram.[20] Kokoram ho asiane no kɔ soro kɛse bere a obi nyin no, na kokoram pii taa ba aman a wɔanya nkɔso no mu.[10] 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.[23] 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.[24] 

== 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.[25]

Kokoram yɛ nyarewa abusua kɛse bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Wɔyɛ neoplasm ahorow no fã 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.[26][27]

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:[28] .

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[28] .

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.[28][29]

== 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 &quot;ɔsuasua kɛse.&quot;[30]

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.[31]

'''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.[30]

'''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.[32] 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.[33]

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.[30]

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 fĩ, anaasɛ hyponatremia, a ɛno nso betumi ama adwene mu tebea asakra, ɔfe, tiyɛ, anaa akisikuru.[34]

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 fã 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 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.[3] 5–10% a aka no fi awosu mu nneɛma.[3] 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 efĩ ara kwa.[38] 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 efĩ.[3][39] Ɛte sɛ nea adwene mu nhyɛso nyɛ asiane a ɛma kokoram fi ase,[40][41] ɛwom sɛ ebetumi ama nea efi mu ba no asɛe wɔ wɔn a wɔwɔ kokoram dedaw no mu de.[40]

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,[42] 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: Nsã 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.[43] Ɛsan nso de kokoram ba anom, ti, kɔn, yafunu, akisikuru, asaabo, ɛwo ne dwensɔtwaa mu.[44] Tawa wusiw wɔ nneɛma bɛboro aduonum a wonim sɛ ɛde kokoram ba, a nitrosamines ne polycyclic aromatic hydrocarbons ka ho.[45]

Tawa na ɛde kokoram wuwu bɛyɛ nnipa baanum biara mu biako wɔ wiase nyinaa[45] ne bɛyɛ baasa biara mu biako wɔ aman a wɔanya nkɔso no mu.[46] 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 .[47][48] 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.[49] Kokoram a efi nnuru a wɔde di dwuma wɔ adwuma mu mu ba no betumi ama wɔanya nsɛm no mu 2 kosi 20%,[50] anyɛ yiye koraa no, ebetumi ama nnipa 200,000 awuwu.[51] 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.[51]

Wonim sɛ sɛ obi nya perfluorooctanoic acid (PFOA) a wɔde di dwuma titiriw wɔ Teflon a wɔyɛ mu a, ɛde kokoram ahorow abien ba.[52][53]

'''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 fã 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 efĩ 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 fã 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.[3] Saa dodow yi fi 25% a ɛkorɔn wɔ Afrika kosi nea ennu 10% wɔ aman a wɔanya nkɔso no mu.[3] 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).[61]

'''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.[62][63][64] Honam ani kokoram pii a ɛnyɛ melanoma no fi mframa a ano yɛ den a ɛbɔ, a ne fã kɛse no ara fi owia hann mu.[63] Nneɛma a ɛma mframa bɔne a ɛma ɛyɛ hyew ba no bi ne aduruyɛ mu mfoninitwa ne radon mframa.[63]

Ionizing radiation nyɛ mutagen a ɛyɛ den titiriw.[65] 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.[65] Mframa a ɛbɔ no betumi de kokoram aba nipadua no afã 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.[66]

Sɛ obi nya ultraviolet mframa a efi owia mu bere tenten a, ebetumi ama wanya melanoma ne honam ani yare afoforo.[67] 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.[67]

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.[69] [62] 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.[70]

'''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.[71] 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,[71] 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,[72] 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.[73] Asiane a ɛne no hyia no yɛ 1.5 ma ahurututu mu kokoram,[74] ne 1.9 ma prostate kokoram.[75] 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.[76]

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.[77]

'''Honam fam nneɛma a wɔde yɛ nneɛma'''

Nneɛma bi de kokoram ba titiriw denam ne honam fam nkɛntɛnso so, sen sɛ ɛbɛyɛ nnuru.[78] 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.[78] Nneɛma nketenkete a ɛnyɛ fibrous a ɛde kokoram ba no bi ne powder metallic cobalt ne nickel ne crystalline silica (quartz, cristobalite ne tridymite).[78] 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.[78]

Nipadua mu apirakuru a ɛde kokoram ba no ntaa mma.[79] Sɛ nhwɛso no, wonnya nkyerɛɛ nsɛm a wɔka sɛ nnompe a ebubui no maa nnompe mu kokoram bae.[79] Saa ara nso na wonnye nipadua mu apirakuru ntom sɛ ɛde awotwaa mu kokoram, nufu mu kokoram anaa amemene mu kokoram ba.[79] Fibea biako a wogye tom ne nneɛma a ɛyɛ hyew a wɔtaa de gu nipadua no so bere tenten. Ebetumi aba sɛ nipadua no fã 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.[79] Sɛ wɔtaa nom tii a ɛyɛ hyew a ɛyɛ hyew a, ebetumi ama woanya kokoram wɔ aduan mu.[79] 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.[79][80] Ɔfe betumi aboa ma kokoram nkwammoaa no adɔɔso, atra ase, angiogenesis ne atutra denam nkɛntɛnso a enya wɔ tumor microenvironment no so.[81][82] Oncogenes no kyekye pro-tumorigenic microenvironment a ɛma ɔhyew.[83]

'''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.[85]

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.[84] 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.[84] 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.[84] 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 fã 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 fã 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 &quot;de wɔn ani asi&quot; 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 &quot;draiver&quot; mu nsakrae na nea aka no betumi ayɛ &quot;akwantufo&quot; 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 fã 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 fã 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 &quot;precursor&quot; 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 fã. 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 fã 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 fã 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 fã 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 fã.[190] &quot;Aduru a wɔde ka ho&quot; kyerɛ akwan ne nneɛma a wɔde di dwuma ka nnuru a wɔde di dwuma ho, bere a &quot;aduru foforo&quot; 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, &quot;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'.&quot;[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 fã 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 fã 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 fã 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, &quot;Sɛ yɛtra ase kyɛ a, anka yɛn nyinaa benya kokoram.&quot;[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 fã 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 &quot;ntini no trɛw wɔ afã nyinaa sɛnea aboa a krak no wɔ ne nan, baabi a onyaa ne din no&quot;.[215] Galen kae sɛ &quot;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&quot;.[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. Ná 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 (&quot;metastasis&quot;). Engiresini oduruyɛfo Campbell De Morgan na odii kan hyehyɛɛ yare no ho adwene yi wɔ 1871 ne 1874 ntam.[220]

== Ɔmanfo ne amammerɛ ==

== Hwehwɛ mu ==

== Nyinsɛn ==

== Mmoa afoforo ==</text>
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      <text bytes="72803" xml:space="preserve">Kokoram yɛ nyarewa kuw bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Eyinom ne akisikuru a ɛnyɛ hu a ɛntrɛw no bɔ abira.[7] 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.[1] Bere a saa sɛnkyerɛnne ahorow yi betumi akyerɛ sɛ kokoram de, nanso ebetumi de nneɛma afoforo nso aba.[1] Kokoram ahorow bɛboro 100 na ɛka nnipa.[7] 

Tawa a wɔde di dwuma no na ɛde kokoram wuwu bɛyɛ 22% ba.[2] 10% foforo nso fi kɛseyɛ mmoroso, aduan pa a wonni, apɔw-mu-teɛteɛ a wonnya anaasɛ nsa a wɔnom boro so.[2][8][9] 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 efĩ ba.[3] 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).[2] Anyɛ yiye koraa no, saa nneɛma yi yɛ adwuma, ne fã bi, denam nkwammoaa bi awosu mu nkwaadɔm a wɔsakra no so.[10] Mpɛn pii no, ɛho hia sɛ wɔyɛ nsakrae pii wɔ awosu mu ansa na kokoram aba.[10] Bɛyɛ kokoram 5–10% fi awosu mu sintɔ ahorow a wonya fi awo mu.[11] Wobetumi de nsɛnkyerɛnne ne sɛnkyerɛnne ahorow bi anaa nhwehwɛmu a wɔde hwehwɛ kokoram mu ahu kokoram.[2] Afei wɔtaa de nnuruyɛ mu mfoniniyɛ hwehwɛ mu bio na wɔde nipadua mu nhwehwɛmu si so dua.[12]

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.[13][14] Sɛ wohu ntɛm denam nhwehwɛmu so a, ɛho wɔ mfaso ma awotwaa ne akyi berɛmo mu kokoram.[15] Mfaso a ɛwɔ nufu mu kokoram a wɔhwehwɛ mu no yɛ nea akyinnyegye wom.[15][16] 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.[2][4] Ɛyaw ne sɛnkyerɛnne ahorow a wɔde di dwuma no yɛ ɔhwɛ no fã titiriw.[2] Ayaresa a ɛma obi ho dwo no ho hia titiriw wɔ nnipa a wɔwɔ yare a emu yɛ den no mu.[2] 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%.[17] Wɔ kokoram ho wɔ United States no, sɛ wɔkyekyem pɛpɛɛpɛ a, mfe anum a wɔde tra ase no yɛ 66%.[5]

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.[6][19]

Kokoram ahorow a ɛtaa ba mmarima so ne ahurututu mu kokoram, prostate kokoram, akyi berɛmo mu kokoram, ne yafunu mu kokoram.[20] Wɔ mmea mu no, nea ɛtaa ba ne nufu mu kokoram, kokoram a ɛwɔ akyi berɛmo mu, ahurututu mu kokoram, ne awotwaa mu kokoram.[10] 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%.[21][22] 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.[17] Wɔ afe 2012 mu no, mmofra bɛyɛ 165,000 a wonnii mfe 15 na wohui sɛ wɔwɔ kokoram.[20] Kokoram ho asiane no kɔ soro kɛse bere a obi nyin no, na kokoram pii taa ba aman a wɔanya nkɔso no mu.[10] 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.[23] 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.[24] 

== 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.[25]

Kokoram yɛ nyarewa abusua kɛse bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Wɔyɛ neoplasm ahorow no fã 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.[26][27]

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:[28] .

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[28] .

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.[28][29]

== 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 &quot;ɔsuasua kɛse.&quot;[30]

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.[31]

'''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.[30]

'''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.[32] 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.[33]

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.[30]

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 fĩ, anaasɛ hyponatremia, a ɛno nso betumi ama adwene mu tebea asakra, ɔfe, tiyɛ, anaa akisikuru.[34]

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 fã 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 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.[3] 5–10% a aka no fi awosu mu nneɛma.[3] 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 efĩ ara kwa.[38] 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 efĩ.[3][39] Ɛte sɛ nea adwene mu nhyɛso nyɛ asiane a ɛma kokoram fi ase,[40][41] ɛwom sɛ ebetumi ama nea efi mu ba no asɛe wɔ wɔn a wɔwɔ kokoram dedaw no mu de.[40]

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,[42] 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: Nsã 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.[43] Ɛsan nso de kokoram ba anom, ti, kɔn, yafunu, akisikuru, asaabo, ɛwo ne dwensɔtwaa mu.[44] Tawa wusiw wɔ nneɛma bɛboro aduonum a wonim sɛ ɛde kokoram ba, a nitrosamines ne polycyclic aromatic hydrocarbons ka ho.[45]

Tawa na ɛde kokoram wuwu bɛyɛ nnipa baanum biara mu biako wɔ wiase nyinaa[45] ne bɛyɛ baasa biara mu biako wɔ aman a wɔanya nkɔso no mu.[46] 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 .[47][48] 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.[49] Kokoram a efi nnuru a wɔde di dwuma wɔ adwuma mu mu ba no betumi ama wɔanya nsɛm no mu 2 kosi 20%,[50] anyɛ yiye koraa no, ebetumi ama nnipa 200,000 awuwu.[51] 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.[51]

Wonim sɛ sɛ obi nya perfluorooctanoic acid (PFOA) a wɔde di dwuma titiriw wɔ Teflon a wɔyɛ mu a, ɛde kokoram ahorow abien ba.[52][53]

'''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 fã 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 efĩ 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 fã 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.[3] Saa dodow yi fi 25% a ɛkorɔn wɔ Afrika kosi nea ennu 10% wɔ aman a wɔanya nkɔso no mu.[3] 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).[61]

'''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.[62][63][64] Honam ani kokoram pii a ɛnyɛ melanoma no fi mframa a ano yɛ den a ɛbɔ, a ne fã kɛse no ara fi owia hann mu.[63] Nneɛma a ɛma mframa bɔne a ɛma ɛyɛ hyew ba no bi ne aduruyɛ mu mfoninitwa ne radon mframa.[63]

Ionizing radiation nyɛ mutagen a ɛyɛ den titiriw.[65] 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.[65] Mframa a ɛbɔ no betumi de kokoram aba nipadua no afã 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.[66]

Sɛ obi nya ultraviolet mframa a efi owia mu bere tenten a, ebetumi ama wanya melanoma ne honam ani yare afoforo.[67] 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.[67]

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.[69] [62] 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.[70]

'''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.[71] 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,[71] 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,[72] 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.[73] Asiane a ɛne no hyia no yɛ 1.5 ma ahurututu mu kokoram,[74] ne 1.9 ma prostate kokoram.[75] 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.[76]

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.[77]

'''Honam fam nneɛma a wɔde yɛ nneɛma'''

Nneɛma bi de kokoram ba titiriw denam ne honam fam nkɛntɛnso so, sen sɛ ɛbɛyɛ nnuru.[78] 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.[78] Nneɛma nketenkete a ɛnyɛ fibrous a ɛde kokoram ba no bi ne powder metallic cobalt ne nickel ne crystalline silica (quartz, cristobalite ne tridymite).[78] 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.[78]

Nipadua mu apirakuru a ɛde kokoram ba no ntaa mma.[79] Sɛ nhwɛso no, wonnya nkyerɛɛ nsɛm a wɔka sɛ nnompe a ebubui no maa nnompe mu kokoram bae.[79] Saa ara nso na wonnye nipadua mu apirakuru ntom sɛ ɛde awotwaa mu kokoram, nufu mu kokoram anaa amemene mu kokoram ba.[79] Fibea biako a wogye tom ne nneɛma a ɛyɛ hyew a wɔtaa de gu nipadua no so bere tenten. Ebetumi aba sɛ nipadua no fã 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.[79] Sɛ wɔtaa nom tii a ɛyɛ hyew a ɛyɛ hyew a, ebetumi ama woanya kokoram wɔ aduan mu.[79] 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.[79][80] Ɔfe betumi aboa ma kokoram nkwammoaa no adɔɔso, atra ase, angiogenesis ne atutra denam nkɛntɛnso a enya wɔ tumor microenvironment no so.[81][82] Oncogenes no kyekye pro-tumorigenic microenvironment a ɛma ɔhyew.[83]

'''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.[85]

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.[84] 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.[84] 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.[84] 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 fã 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 fã 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 &quot;de wɔn ani asi&quot; 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 &quot;draiver&quot; mu nsakrae na nea aka no betumi ayɛ &quot;akwantufo&quot; 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 fã 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 fã 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 &quot;precursor&quot; 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 fã. 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 fã 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 fã 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 fã 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 fã.[190] &quot;Aduru a wɔde ka ho&quot; kyerɛ akwan ne nneɛma a wɔde di dwuma ka nnuru a wɔde di dwuma ho, bere a &quot;aduru foforo&quot; 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, &quot;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'.&quot;[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 fã 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 fã 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 fã 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, &quot;Sɛ yɛtra ase kyɛ a, anka yɛn nyinaa benya kokoram.&quot;[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 fã 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 &quot;ntini no trɛw wɔ afã nyinaa sɛnea aboa a krak no wɔ ne nan, baabi a onyaa ne din no&quot;.[215] Galen kae sɛ &quot;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&quot;.[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. Ná 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 (&quot;metastasis&quot;). 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 &quot;yare tenten&quot; 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 &quot;C-asɛmfua&quot;;[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 &quot;yare a wontumi nsa&quot;.[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 &quot;wɔko&quot; na ama &quot;ɔmanfo atuatew&quot; 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 &quot;kokoram nipasu&quot;—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 &quot;ɔpɛ&quot; 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 fã 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 ==

== Nyinsɛn ==

== Mmoa afoforo ==</text>
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      <text bytes="75647" xml:space="preserve">Kokoram yɛ nyarewa kuw bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Eyinom ne akisikuru a ɛnyɛ hu a ɛntrɛw no bɔ abira.[7] 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.[1] Bere a saa sɛnkyerɛnne ahorow yi betumi akyerɛ sɛ kokoram de, nanso ebetumi de nneɛma afoforo nso aba.[1] Kokoram ahorow bɛboro 100 na ɛka nnipa.[7] 

Tawa a wɔde di dwuma no na ɛde kokoram wuwu bɛyɛ 22% ba.[2] 10% foforo nso fi kɛseyɛ mmoroso, aduan pa a wonni, apɔw-mu-teɛteɛ a wonnya anaasɛ nsa a wɔnom boro so.[2][8][9] 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 efĩ ba.[3] 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).[2] Anyɛ yiye koraa no, saa nneɛma yi yɛ adwuma, ne fã bi, denam nkwammoaa bi awosu mu nkwaadɔm a wɔsakra no so.[10] Mpɛn pii no, ɛho hia sɛ wɔyɛ nsakrae pii wɔ awosu mu ansa na kokoram aba.[10] Bɛyɛ kokoram 5–10% fi awosu mu sintɔ ahorow a wonya fi awo mu.[11] Wobetumi de nsɛnkyerɛnne ne sɛnkyerɛnne ahorow bi anaa nhwehwɛmu a wɔde hwehwɛ kokoram mu ahu kokoram.[2] Afei wɔtaa de nnuruyɛ mu mfoniniyɛ hwehwɛ mu bio na wɔde nipadua mu nhwehwɛmu si so dua.[12]

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.[13][14] Sɛ wohu ntɛm denam nhwehwɛmu so a, ɛho wɔ mfaso ma awotwaa ne akyi berɛmo mu kokoram.[15] Mfaso a ɛwɔ nufu mu kokoram a wɔhwehwɛ mu no yɛ nea akyinnyegye wom.[15][16] 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.[2][4] Ɛyaw ne sɛnkyerɛnne ahorow a wɔde di dwuma no yɛ ɔhwɛ no fã titiriw.[2] Ayaresa a ɛma obi ho dwo no ho hia titiriw wɔ nnipa a wɔwɔ yare a emu yɛ den no mu.[2] 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%.[17] Wɔ kokoram ho wɔ United States no, sɛ wɔkyekyem pɛpɛɛpɛ a, mfe anum a wɔde tra ase no yɛ 66%.[5]

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.[6][19]

Kokoram ahorow a ɛtaa ba mmarima so ne ahurututu mu kokoram, prostate kokoram, akyi berɛmo mu kokoram, ne yafunu mu kokoram.[20] Wɔ mmea mu no, nea ɛtaa ba ne nufu mu kokoram, kokoram a ɛwɔ akyi berɛmo mu, ahurututu mu kokoram, ne awotwaa mu kokoram.[10] 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%.[21][22] 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.[17] Wɔ afe 2012 mu no, mmofra bɛyɛ 165,000 a wonnii mfe 15 na wohui sɛ wɔwɔ kokoram.[20] Kokoram ho asiane no kɔ soro kɛse bere a obi nyin no, na kokoram pii taa ba aman a wɔanya nkɔso no mu.[10] 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.[23] 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.[24] 

== 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.[25]

Kokoram yɛ nyarewa abusua kɛse bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Wɔyɛ neoplasm ahorow no fã 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.[26][27]

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:[28] .

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[28] .

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.[28][29]

== 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 &quot;ɔsuasua kɛse.&quot;[30]

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.[31]

'''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.[30]

'''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.[32] 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.[33]

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.[30]

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 fĩ, anaasɛ hyponatremia, a ɛno nso betumi ama adwene mu tebea asakra, ɔfe, tiyɛ, anaa akisikuru.[34]

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 fã 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 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.[3] 5–10% a aka no fi awosu mu nneɛma.[3] 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 efĩ ara kwa.[38] 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 efĩ.[3][39] Ɛte sɛ nea adwene mu nhyɛso nyɛ asiane a ɛma kokoram fi ase,[40][41] ɛwom sɛ ebetumi ama nea efi mu ba no asɛe wɔ wɔn a wɔwɔ kokoram dedaw no mu de.[40]

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,[42] 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: Nsã 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.[43] Ɛsan nso de kokoram ba anom, ti, kɔn, yafunu, akisikuru, asaabo, ɛwo ne dwensɔtwaa mu.[44] Tawa wusiw wɔ nneɛma bɛboro aduonum a wonim sɛ ɛde kokoram ba, a nitrosamines ne polycyclic aromatic hydrocarbons ka ho.[45]

Tawa na ɛde kokoram wuwu bɛyɛ nnipa baanum biara mu biako wɔ wiase nyinaa[45] ne bɛyɛ baasa biara mu biako wɔ aman a wɔanya nkɔso no mu.[46] 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 .[47][48] 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.[49] Kokoram a efi nnuru a wɔde di dwuma wɔ adwuma mu mu ba no betumi ama wɔanya nsɛm no mu 2 kosi 20%,[50] anyɛ yiye koraa no, ebetumi ama nnipa 200,000 awuwu.[51] 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.[51]

Wonim sɛ sɛ obi nya perfluorooctanoic acid (PFOA) a wɔde di dwuma titiriw wɔ Teflon a wɔyɛ mu a, ɛde kokoram ahorow abien ba.[52][53]

'''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 fã 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 efĩ 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 fã 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.[3] Saa dodow yi fi 25% a ɛkorɔn wɔ Afrika kosi nea ennu 10% wɔ aman a wɔanya nkɔso no mu.[3] 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).[61]

'''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.[62][63][64] Honam ani kokoram pii a ɛnyɛ melanoma no fi mframa a ano yɛ den a ɛbɔ, a ne fã kɛse no ara fi owia hann mu.[63] Nneɛma a ɛma mframa bɔne a ɛma ɛyɛ hyew ba no bi ne aduruyɛ mu mfoninitwa ne radon mframa.[63]

Ionizing radiation nyɛ mutagen a ɛyɛ den titiriw.[65] 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.[65] Mframa a ɛbɔ no betumi de kokoram aba nipadua no afã 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.[66]

Sɛ obi nya ultraviolet mframa a efi owia mu bere tenten a, ebetumi ama wanya melanoma ne honam ani yare afoforo.[67] 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.[67]

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.[69] [62] 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.[70]

'''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.[71] 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,[71] 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,[72] 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.[73] Asiane a ɛne no hyia no yɛ 1.5 ma ahurututu mu kokoram,[74] ne 1.9 ma prostate kokoram.[75] 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.[76]

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.[77]

'''Honam fam nneɛma a wɔde yɛ nneɛma'''

Nneɛma bi de kokoram ba titiriw denam ne honam fam nkɛntɛnso so, sen sɛ ɛbɛyɛ nnuru.[78] 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.[78] Nneɛma nketenkete a ɛnyɛ fibrous a ɛde kokoram ba no bi ne powder metallic cobalt ne nickel ne crystalline silica (quartz, cristobalite ne tridymite).[78] 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.[78]

Nipadua mu apirakuru a ɛde kokoram ba no ntaa mma.[79] Sɛ nhwɛso no, wonnya nkyerɛɛ nsɛm a wɔka sɛ nnompe a ebubui no maa nnompe mu kokoram bae.[79] Saa ara nso na wonnye nipadua mu apirakuru ntom sɛ ɛde awotwaa mu kokoram, nufu mu kokoram anaa amemene mu kokoram ba.[79] Fibea biako a wogye tom ne nneɛma a ɛyɛ hyew a wɔtaa de gu nipadua no so bere tenten. Ebetumi aba sɛ nipadua no fã 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.[79] Sɛ wɔtaa nom tii a ɛyɛ hyew a ɛyɛ hyew a, ebetumi ama woanya kokoram wɔ aduan mu.[79] 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.[79][80] Ɔfe betumi aboa ma kokoram nkwammoaa no adɔɔso, atra ase, angiogenesis ne atutra denam nkɛntɛnso a enya wɔ tumor microenvironment no so.[81][82] Oncogenes no kyekye pro-tumorigenic microenvironment a ɛma ɔhyew.[83]

'''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.[85]

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.[84] 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.[84] 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.[84] 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 fã 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 fã 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 &quot;de wɔn ani asi&quot; 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 &quot;draiver&quot; mu nsakrae na nea aka no betumi ayɛ &quot;akwantufo&quot; 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 fã 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 fã 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 &quot;precursor&quot; 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 fã. 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 fã 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 fã 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 fã 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 fã.[190] &quot;Aduru a wɔde ka ho&quot; kyerɛ akwan ne nneɛma a wɔde di dwuma ka nnuru a wɔde di dwuma ho, bere a &quot;aduru foforo&quot; 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, &quot;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'.&quot;[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 fã 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 fã 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 fã 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, &quot;Sɛ yɛtra ase kyɛ a, anka yɛn nyinaa benya kokoram.&quot;[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 fã 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 &quot;ntini no trɛw wɔ afã nyinaa sɛnea aboa a krak no wɔ ne nan, baabi a onyaa ne din no&quot;.[215] Galen kae sɛ &quot;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&quot;.[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. Ná 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 (&quot;metastasis&quot;). 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 &quot;yare tenten&quot; 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 &quot;C-asɛmfua&quot;;[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 &quot;yare a wontumi nsa&quot;.[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 &quot;wɔko&quot; na ama &quot;ɔmanfo atuatew&quot; 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 &quot;kokoram nipasu&quot;—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 &quot;ɔpɛ&quot; 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 fã 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 &quot;kokoram aduru&quot; 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 &quot;dwetɛ tuo&quot; 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 &quot;Kokoram Ko&quot; 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 ==

== Mmoa afoforo ==</text>
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      <text bytes="78094" xml:space="preserve">Kokoram yɛ nyarewa kuw bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Eyinom ne akisikuru a ɛnyɛ hu a ɛntrɛw no bɔ abira.[7] 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.[1] Bere a saa sɛnkyerɛnne ahorow yi betumi akyerɛ sɛ kokoram de, nanso ebetumi de nneɛma afoforo nso aba.[1] Kokoram ahorow bɛboro 100 na ɛka nnipa.[7] 

Tawa a wɔde di dwuma no na ɛde kokoram wuwu bɛyɛ 22% ba.[2] 10% foforo nso fi kɛseyɛ mmoroso, aduan pa a wonni, apɔw-mu-teɛteɛ a wonnya anaasɛ nsa a wɔnom boro so.[2][8][9] 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 efĩ ba.[3] 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).[2] Anyɛ yiye koraa no, saa nneɛma yi yɛ adwuma, ne fã bi, denam nkwammoaa bi awosu mu nkwaadɔm a wɔsakra no so.[10] Mpɛn pii no, ɛho hia sɛ wɔyɛ nsakrae pii wɔ awosu mu ansa na kokoram aba.[10] Bɛyɛ kokoram 5–10% fi awosu mu sintɔ ahorow a wonya fi awo mu.[11] Wobetumi de nsɛnkyerɛnne ne sɛnkyerɛnne ahorow bi anaa nhwehwɛmu a wɔde hwehwɛ kokoram mu ahu kokoram.[2] Afei wɔtaa de nnuruyɛ mu mfoniniyɛ hwehwɛ mu bio na wɔde nipadua mu nhwehwɛmu si so dua.[12]

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.[13][14] Sɛ wohu ntɛm denam nhwehwɛmu so a, ɛho wɔ mfaso ma awotwaa ne akyi berɛmo mu kokoram.[15] Mfaso a ɛwɔ nufu mu kokoram a wɔhwehwɛ mu no yɛ nea akyinnyegye wom.[15][16] 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.[2][4] Ɛyaw ne sɛnkyerɛnne ahorow a wɔde di dwuma no yɛ ɔhwɛ no fã titiriw.[2] Ayaresa a ɛma obi ho dwo no ho hia titiriw wɔ nnipa a wɔwɔ yare a emu yɛ den no mu.[2] 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%.[17] Wɔ kokoram ho wɔ United States no, sɛ wɔkyekyem pɛpɛɛpɛ a, mfe anum a wɔde tra ase no yɛ 66%.[5]

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.[6][19]

Kokoram ahorow a ɛtaa ba mmarima so ne ahurututu mu kokoram, prostate kokoram, akyi berɛmo mu kokoram, ne yafunu mu kokoram.[20] Wɔ mmea mu no, nea ɛtaa ba ne nufu mu kokoram, kokoram a ɛwɔ akyi berɛmo mu, ahurututu mu kokoram, ne awotwaa mu kokoram.[10] 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%.[21][22] 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.[17] Wɔ afe 2012 mu no, mmofra bɛyɛ 165,000 a wonnii mfe 15 na wohui sɛ wɔwɔ kokoram.[20] Kokoram ho asiane no kɔ soro kɛse bere a obi nyin no, na kokoram pii taa ba aman a wɔanya nkɔso no mu.[10] 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.[23] 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.[24] 

== 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.[25]

Kokoram yɛ nyarewa abusua kɛse bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Wɔyɛ neoplasm ahorow no fã 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.[26][27]

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:[28] .

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[28] .

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.[28][29]

== 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 &quot;ɔsuasua kɛse.&quot;[30]

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.[31]

'''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.[30]

'''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.[32] 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.[33]

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.[30]

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 fĩ, anaasɛ hyponatremia, a ɛno nso betumi ama adwene mu tebea asakra, ɔfe, tiyɛ, anaa akisikuru.[34]

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 fã 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 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.[3] 5–10% a aka no fi awosu mu nneɛma.[3] 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 efĩ ara kwa.[38] 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 efĩ.[3][39] Ɛte sɛ nea adwene mu nhyɛso nyɛ asiane a ɛma kokoram fi ase,[40][41] ɛwom sɛ ebetumi ama nea efi mu ba no asɛe wɔ wɔn a wɔwɔ kokoram dedaw no mu de.[40]

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,[42] 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: Nsã 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.[43] Ɛsan nso de kokoram ba anom, ti, kɔn, yafunu, akisikuru, asaabo, ɛwo ne dwensɔtwaa mu.[44] Tawa wusiw wɔ nneɛma bɛboro aduonum a wonim sɛ ɛde kokoram ba, a nitrosamines ne polycyclic aromatic hydrocarbons ka ho.[45]

Tawa na ɛde kokoram wuwu bɛyɛ nnipa baanum biara mu biako wɔ wiase nyinaa[45] ne bɛyɛ baasa biara mu biako wɔ aman a wɔanya nkɔso no mu.[46] 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 .[47][48] 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.[49] Kokoram a efi nnuru a wɔde di dwuma wɔ adwuma mu mu ba no betumi ama wɔanya nsɛm no mu 2 kosi 20%,[50] anyɛ yiye koraa no, ebetumi ama nnipa 200,000 awuwu.[51] 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.[51]

Wonim sɛ sɛ obi nya perfluorooctanoic acid (PFOA) a wɔde di dwuma titiriw wɔ Teflon a wɔyɛ mu a, ɛde kokoram ahorow abien ba.[52][53]

'''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 fã 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 efĩ 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 fã 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.[3] Saa dodow yi fi 25% a ɛkorɔn wɔ Afrika kosi nea ennu 10% wɔ aman a wɔanya nkɔso no mu.[3] 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).[61]

'''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.[62][63][64] Honam ani kokoram pii a ɛnyɛ melanoma no fi mframa a ano yɛ den a ɛbɔ, a ne fã kɛse no ara fi owia hann mu.[63] Nneɛma a ɛma mframa bɔne a ɛma ɛyɛ hyew ba no bi ne aduruyɛ mu mfoninitwa ne radon mframa.[63]

Ionizing radiation nyɛ mutagen a ɛyɛ den titiriw.[65] 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.[65] Mframa a ɛbɔ no betumi de kokoram aba nipadua no afã 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.[66]

Sɛ obi nya ultraviolet mframa a efi owia mu bere tenten a, ebetumi ama wanya melanoma ne honam ani yare afoforo.[67] 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.[67]

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.[69] [62] 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.[70]

'''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.[71] 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,[71] 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,[72] 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.[73] Asiane a ɛne no hyia no yɛ 1.5 ma ahurututu mu kokoram,[74] ne 1.9 ma prostate kokoram.[75] 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.[76]

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.[77]

'''Honam fam nneɛma a wɔde yɛ nneɛma'''

Nneɛma bi de kokoram ba titiriw denam ne honam fam nkɛntɛnso so, sen sɛ ɛbɛyɛ nnuru.[78] 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.[78] Nneɛma nketenkete a ɛnyɛ fibrous a ɛde kokoram ba no bi ne powder metallic cobalt ne nickel ne crystalline silica (quartz, cristobalite ne tridymite).[78] 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.[78]

Nipadua mu apirakuru a ɛde kokoram ba no ntaa mma.[79] Sɛ nhwɛso no, wonnya nkyerɛɛ nsɛm a wɔka sɛ nnompe a ebubui no maa nnompe mu kokoram bae.[79] Saa ara nso na wonnye nipadua mu apirakuru ntom sɛ ɛde awotwaa mu kokoram, nufu mu kokoram anaa amemene mu kokoram ba.[79] Fibea biako a wogye tom ne nneɛma a ɛyɛ hyew a wɔtaa de gu nipadua no so bere tenten. Ebetumi aba sɛ nipadua no fã 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.[79] Sɛ wɔtaa nom tii a ɛyɛ hyew a ɛyɛ hyew a, ebetumi ama woanya kokoram wɔ aduan mu.[79] 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.[79][80] Ɔfe betumi aboa ma kokoram nkwammoaa no adɔɔso, atra ase, angiogenesis ne atutra denam nkɛntɛnso a enya wɔ tumor microenvironment no so.[81][82] Oncogenes no kyekye pro-tumorigenic microenvironment a ɛma ɔhyew.[83]

'''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.[85]

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.[84] 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.[84] 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.[84] 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 fã 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 fã 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 &quot;de wɔn ani asi&quot; 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 &quot;draiver&quot; mu nsakrae na nea aka no betumi ayɛ &quot;akwantufo&quot; 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 fã 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 fã 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 &quot;precursor&quot; 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 fã. 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 fã 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 fã 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 fã 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 fã.[190] &quot;Aduru a wɔde ka ho&quot; kyerɛ akwan ne nneɛma a wɔde di dwuma ka nnuru a wɔde di dwuma ho, bere a &quot;aduru foforo&quot; 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, &quot;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'.&quot;[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 fã 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 fã 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 fã 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, &quot;Sɛ yɛtra ase kyɛ a, anka yɛn nyinaa benya kokoram.&quot;[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 fã 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 &quot;ntini no trɛw wɔ afã nyinaa sɛnea aboa a krak no wɔ ne nan, baabi a onyaa ne din no&quot;.[215] Galen kae sɛ &quot;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&quot;.[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. Ná 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 (&quot;metastasis&quot;). 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 &quot;yare tenten&quot; 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 &quot;C-asɛmfua&quot;;[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 &quot;yare a wontumi nsa&quot;.[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 &quot;wɔko&quot; na ama &quot;ɔmanfo atuatew&quot; 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 &quot;kokoram nipasu&quot;—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 &quot;ɔpɛ&quot; 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 fã 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 &quot;kokoram aduru&quot; 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 &quot;dwetɛ tuo&quot; 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 &quot;Kokoram Ko&quot; 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 fã 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 fã 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]

== Mmoa afoforo ==</text>
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      <text bytes="78096" xml:space="preserve">Kokoram yɛ nyarewa kuw bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Eyinom ne akisikuru a ɛnyɛ hu a ɛntrɛw no bɔ abira.[7] 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.[1] Bere a saa sɛnkyerɛnne ahorow yi betumi akyerɛ sɛ kokoram de, nanso ebetumi de nneɛma afoforo nso aba.[1] Kokoram ahorow bɛboro 100 na ɛka nnipa.[7] 

Tawa a wɔde di dwuma no na ɛde kokoram wuwu bɛyɛ 22% ba.[2] 10% foforo nso fi kɛseyɛ mmoroso, aduan pa a wonni, apɔw-mu-teɛteɛ a wonnya anaasɛ nsa a wɔnom boro so.[2][8][9] 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 efĩ ba.[3] 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).[2] Anyɛ yiye koraa no, saa nneɛma yi yɛ adwuma, ne fã bi, denam nkwammoaa bi awosu mu nkwaadɔm a wɔsakra no so.[10] Mpɛn pii no, ɛho hia sɛ wɔyɛ nsakrae pii wɔ awosu mu ansa na kokoram aba.[10] Bɛyɛ kokoram 5–10% fi awosu mu sintɔ ahorow a wonya fi awo mu.[11] Wobetumi de nsɛnkyerɛnne ne sɛnkyerɛnne ahorow bi anaa nhwehwɛmu a wɔde hwehwɛ kokoram mu ahu kokoram.[2] Afei wɔtaa de nnuruyɛ mu mfoniniyɛ hwehwɛ mu bio na wɔde nipadua mu nhwehwɛmu si so dua.[12]

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.[13][14] Sɛ wohu ntɛm denam nhwehwɛmu so a, ɛho wɔ mfaso ma awotwaa ne akyi berɛmo mu kokoram.[15] Mfaso a ɛwɔ nufu mu kokoram a wɔhwehwɛ mu no yɛ nea akyinnyegye wom.[15][16] 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.[2][4] Ɛyaw ne sɛnkyerɛnne ahorow a wɔde di dwuma no yɛ ɔhwɛ no fã titiriw.[2] Ayaresa a ɛma obi ho dwo no ho hia titiriw wɔ nnipa a wɔwɔ yare a emu yɛ den no mu.[2] 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%.[17] Wɔ kokoram ho wɔ United States no, sɛ wɔkyekyem pɛpɛɛpɛ a, mfe anum a wɔde tra ase no yɛ 66%.[5]

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.[6][19]

Kokoram ahorow a ɛtaa ba mmarima so ne ahurututu mu kokoram, prostate kokoram, akyi berɛmo mu kokoram, ne yafunu mu kokoram.[20] Wɔ mmea mu no, nea ɛtaa ba ne nufu mu kokoram, kokoram a ɛwɔ akyi berɛmo mu, ahurututu mu kokoram, ne awotwaa mu kokoram.[10] 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%.[21][22] 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.[17] Wɔ afe 2012 mu no, mmofra bɛyɛ 165,000 a wonnii mfe 15 na wohui sɛ wɔwɔ kokoram.[20] Kokoram ho asiane no kɔ soro kɛse bere a obi nyin no, na kokoram pii taa ba aman a wɔanya nkɔso no mu.[10] 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.[23] 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.[24] 

== 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.[25]

Kokoram yɛ nyarewa abusua kɛse bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Wɔyɛ neoplasm ahorow no fã 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.[26][27]

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:[28] .

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[28] .

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.[28][29]

== 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 &quot;ɔsuasua kɛse.&quot;[30]

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.[31]

'''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.[30]

'''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.[32] 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.[33]

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.[30]

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 fĩ, anaasɛ hyponatremia, a ɛno nso betumi ama adwene mu tebea asakra, ɔfe, tiyɛ, anaa akisikuru.[34]

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 fã 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 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.[3] 5–10% a aka no fi awosu mu nneɛma.[3] 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 efĩ ara kwa.[38] 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 efĩ.[3][39] Ɛte sɛ nea adwene mu nhyɛso nyɛ asiane a ɛma kokoram fi ase,[40][41] ɛwom sɛ ebetumi ama nea efi mu ba no asɛe wɔ wɔn a wɔwɔ kokoram dedaw no mu de.[40]

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,[42] 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: Nsã 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.[43] Ɛsan nso de kokoram ba anom, ti, kɔn, yafunu, akisikuru, asaabo, ɛwo ne dwensɔtwaa mu.[44] Tawa wusiw wɔ nneɛma bɛboro aduonum a wonim sɛ ɛde kokoram ba, a nitrosamines ne polycyclic aromatic hydrocarbons ka ho.[45]

Tawa na ɛde kokoram wuwu bɛyɛ nnipa baanum biara mu biako wɔ wiase nyinaa[45] ne bɛyɛ baasa biara mu biako wɔ aman a wɔanya nkɔso no mu.[46] 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 .[47][48] 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.[49] Kokoram a efi nnuru a wɔde di dwuma wɔ adwuma mu mu ba no betumi ama wɔanya nsɛm no mu 2 kosi 20%,[50] anyɛ yiye koraa no, ebetumi ama nnipa 200,000 awuwu.[51] 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.[51]

Wonim sɛ sɛ obi nya perfluorooctanoic acid (PFOA) a wɔde di dwuma titiriw wɔ Teflon a wɔyɛ mu a, ɛde kokoram ahorow abien ba.[52][53]

'''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 fã 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 efĩ 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 fã 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.[3] Saa dodow yi fi 25% a ɛkorɔn wɔ Afrika kosi nea ennu 10% wɔ aman a wɔanya nkɔso no mu.[3] 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).[61]

'''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.[62][63][64] Honam ani kokoram pii a ɛnyɛ melanoma no fi mframa a ano yɛ den a ɛbɔ, a ne fã kɛse no ara fi owia hann mu.[63] Nneɛma a ɛma mframa bɔne a ɛma ɛyɛ hyew ba no bi ne aduruyɛ mu mfoninitwa ne radon mframa.[63]

Ionizing radiation nyɛ mutagen a ɛyɛ den titiriw.[65] 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.[65] Mframa a ɛbɔ no betumi de kokoram aba nipadua no afã 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.[66]

Sɛ obi nya ultraviolet mframa a efi owia mu bere tenten a, ebetumi ama wanya melanoma ne honam ani yare afoforo.[67] 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.[67]

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.[69] [62] 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.[70]

'''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.[71] 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,[71] 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,[72] 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.[73] Asiane a ɛne no hyia no yɛ 1.5 ma ahurututu mu kokoram,[74] ne 1.9 ma prostate kokoram.[75] 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.[76]

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.[77]

'''Honam fam nneɛma a wɔde yɛ nneɛma'''

Nneɛma bi de kokoram ba titiriw denam ne honam fam nkɛntɛnso so, sen sɛ ɛbɛyɛ nnuru.[78] 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.[78] Nneɛma nketenkete a ɛnyɛ fibrous a ɛde kokoram ba no bi ne powder metallic cobalt ne nickel ne crystalline silica (quartz, cristobalite ne tridymite).[78] 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.[78]

Nipadua mu apirakuru a ɛde kokoram ba no ntaa mma.[79] Sɛ nhwɛso no, wonnya nkyerɛɛ nsɛm a wɔka sɛ nnompe a ebubui no maa nnompe mu kokoram bae.[79] Saa ara nso na wonnye nipadua mu apirakuru ntom sɛ ɛde awotwaa mu kokoram, nufu mu kokoram anaa amemene mu kokoram ba.[79] Fibea biako a wogye tom ne nneɛma a ɛyɛ hyew a wɔtaa de gu nipadua no so bere tenten. Ebetumi aba sɛ nipadua no fã 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.[79] Sɛ wɔtaa nom tii a ɛyɛ hyew a ɛyɛ hyew a, ebetumi ama woanya kokoram wɔ aduan mu.[79] 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.[79][80] Ɔfe betumi aboa ma kokoram nkwammoaa no adɔɔso, atra ase, angiogenesis ne atutra denam nkɛntɛnso a enya wɔ tumor microenvironment no so.[81][82] Oncogenes no kyekye pro-tumorigenic microenvironment a ɛma ɔhyew.[83]

'''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.[85]

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.[84] 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.[84] 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.[84] 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 fã 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 fã 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 &quot;de wɔn ani asi&quot; 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 &quot;draiver&quot; mu nsakrae na nea aka no betumi ayɛ &quot;akwantufo&quot; 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 fã 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 fã 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 &quot;precursor&quot; 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 fã. 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 fã 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 fã 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 fã 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 fã.[190] &quot;Aduru a wɔde ka ho&quot; kyerɛ akwan ne nneɛma a wɔde di dwuma ka nnuru a wɔde di dwuma ho, bere a &quot;aduru foforo&quot; 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, &quot;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'.&quot;[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 fã 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 fã 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 fã 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, &quot;Sɛ yɛtra ase kyɛ a, anka yɛn nyinaa benya kokoram.&quot;[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 fã 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 &quot;ntini no trɛw wɔ afã nyinaa sɛnea aboa a krak no wɔ ne nan, baabi a onyaa ne din no&quot;.[215] Galen kae sɛ &quot;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&quot;.[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. Ná 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 (&quot;metastasis&quot;). 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 &quot;yare tenten&quot; 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 &quot;C-asɛmfua&quot;;[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 &quot;yare a wontumi nsa&quot;.[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 &quot;wɔko&quot; na ama &quot;ɔmanfo atuatew&quot; 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 &quot;kokoram nipasu&quot;—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 &quot;ɔpɛ&quot; 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 fã 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 &quot;kokoram aduru&quot; 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 &quot;dwetɛ tuo&quot; 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 &quot;Kokoram Ko&quot; 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 fã 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 fã 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]

== Mmoa afoforo ==
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      <text bytes="78158" xml:space="preserve">Kokoram yɛ nyarewa kuw bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Eyinom ne akisikuru a ɛnyɛ hu a ɛntrɛw no bɔ abira.[7] 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.[1] Bere a saa sɛnkyerɛnne ahorow yi betumi akyerɛ sɛ kokoram de, nanso ebetumi de nneɛma afoforo nso aba.&lt;ref&gt;http://www.nhs.uk/Conditions/Cancer/Pages/Symptoms.aspx&lt;/ref&gt;Kokoram ahorow bɛboro 100 na ɛka nnipa.[7] 

Tawa a wɔde di dwuma no na ɛde kokoram wuwu bɛyɛ 22% ba.[2] 10% foforo nso fi kɛseyɛ mmoroso, aduan pa a wonni, apɔw-mu-teɛteɛ a wonnya anaasɛ nsa a wɔnom boro so.[2][8][9] 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 efĩ ba.[3] 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).[2] Anyɛ yiye koraa no, saa nneɛma yi yɛ adwuma, ne fã bi, denam nkwammoaa bi awosu mu nkwaadɔm a wɔsakra no so.[10] Mpɛn pii no, ɛho hia sɛ wɔyɛ nsakrae pii wɔ awosu mu ansa na kokoram aba.[10] Bɛyɛ kokoram 5–10% fi awosu mu sintɔ ahorow a wonya fi awo mu.[11] Wobetumi de nsɛnkyerɛnne ne sɛnkyerɛnne ahorow bi anaa nhwehwɛmu a wɔde hwehwɛ kokoram mu ahu kokoram.[2] Afei wɔtaa de nnuruyɛ mu mfoniniyɛ hwehwɛ mu bio na wɔde nipadua mu nhwehwɛmu si so dua.[12]

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.[13][14] Sɛ wohu ntɛm denam nhwehwɛmu so a, ɛho wɔ mfaso ma awotwaa ne akyi berɛmo mu kokoram.[15] Mfaso a ɛwɔ nufu mu kokoram a wɔhwehwɛ mu no yɛ nea akyinnyegye wom.[15][16] 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.[2][4] Ɛyaw ne sɛnkyerɛnne ahorow a wɔde di dwuma no yɛ ɔhwɛ no fã titiriw.[2] Ayaresa a ɛma obi ho dwo no ho hia titiriw wɔ nnipa a wɔwɔ yare a emu yɛ den no mu.[2] 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%.[17] Wɔ kokoram ho wɔ United States no, sɛ wɔkyekyem pɛpɛɛpɛ a, mfe anum a wɔde tra ase no yɛ 66%.[5]

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.[6][19]

Kokoram ahorow a ɛtaa ba mmarima so ne ahurututu mu kokoram, prostate kokoram, akyi berɛmo mu kokoram, ne yafunu mu kokoram.[20] Wɔ mmea mu no, nea ɛtaa ba ne nufu mu kokoram, kokoram a ɛwɔ akyi berɛmo mu, ahurututu mu kokoram, ne awotwaa mu kokoram.[10] 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%.[21][22] 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.[17] Wɔ afe 2012 mu no, mmofra bɛyɛ 165,000 a wonnii mfe 15 na wohui sɛ wɔwɔ kokoram.[20] Kokoram ho asiane no kɔ soro kɛse bere a obi nyin no, na kokoram pii taa ba aman a wɔanya nkɔso no mu.[10] 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.[23] 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.[24] 

== 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.[25]

Kokoram yɛ nyarewa abusua kɛse bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Wɔyɛ neoplasm ahorow no fã 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.[26][27]

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:[28] .

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[28] .

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.[28][29]

== 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 &quot;ɔsuasua kɛse.&quot;[30]

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.[31]

'''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.[30]

'''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.[32] 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.[33]

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.[30]

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 fĩ, anaasɛ hyponatremia, a ɛno nso betumi ama adwene mu tebea asakra, ɔfe, tiyɛ, anaa akisikuru.[34]

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 fã 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 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.[3] 5–10% a aka no fi awosu mu nneɛma.[3] 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 efĩ ara kwa.[38] 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 efĩ.[3][39] Ɛte sɛ nea adwene mu nhyɛso nyɛ asiane a ɛma kokoram fi ase,[40][41] ɛwom sɛ ebetumi ama nea efi mu ba no asɛe wɔ wɔn a wɔwɔ kokoram dedaw no mu de.[40]

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,[42] 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: Nsã 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.[43] Ɛsan nso de kokoram ba anom, ti, kɔn, yafunu, akisikuru, asaabo, ɛwo ne dwensɔtwaa mu.[44] Tawa wusiw wɔ nneɛma bɛboro aduonum a wonim sɛ ɛde kokoram ba, a nitrosamines ne polycyclic aromatic hydrocarbons ka ho.[45]

Tawa na ɛde kokoram wuwu bɛyɛ nnipa baanum biara mu biako wɔ wiase nyinaa[45] ne bɛyɛ baasa biara mu biako wɔ aman a wɔanya nkɔso no mu.[46] 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 .[47][48] 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.[49] Kokoram a efi nnuru a wɔde di dwuma wɔ adwuma mu mu ba no betumi ama wɔanya nsɛm no mu 2 kosi 20%,[50] anyɛ yiye koraa no, ebetumi ama nnipa 200,000 awuwu.[51] 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.[51]

Wonim sɛ sɛ obi nya perfluorooctanoic acid (PFOA) a wɔde di dwuma titiriw wɔ Teflon a wɔyɛ mu a, ɛde kokoram ahorow abien ba.[52][53]

'''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 fã 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 efĩ 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 fã 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.[3] Saa dodow yi fi 25% a ɛkorɔn wɔ Afrika kosi nea ennu 10% wɔ aman a wɔanya nkɔso no mu.[3] 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).[61]

'''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.[62][63][64] Honam ani kokoram pii a ɛnyɛ melanoma no fi mframa a ano yɛ den a ɛbɔ, a ne fã kɛse no ara fi owia hann mu.[63] Nneɛma a ɛma mframa bɔne a ɛma ɛyɛ hyew ba no bi ne aduruyɛ mu mfoninitwa ne radon mframa.[63]

Ionizing radiation nyɛ mutagen a ɛyɛ den titiriw.[65] 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.[65] Mframa a ɛbɔ no betumi de kokoram aba nipadua no afã 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.[66]

Sɛ obi nya ultraviolet mframa a efi owia mu bere tenten a, ebetumi ama wanya melanoma ne honam ani yare afoforo.[67] 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.[67]

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.[69] [62] 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.[70]

'''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.[71] 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,[71] 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,[72] 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.[73] Asiane a ɛne no hyia no yɛ 1.5 ma ahurututu mu kokoram,[74] ne 1.9 ma prostate kokoram.[75] 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.[76]

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.[77]

'''Honam fam nneɛma a wɔde yɛ nneɛma'''

Nneɛma bi de kokoram ba titiriw denam ne honam fam nkɛntɛnso so, sen sɛ ɛbɛyɛ nnuru.[78] 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.[78] Nneɛma nketenkete a ɛnyɛ fibrous a ɛde kokoram ba no bi ne powder metallic cobalt ne nickel ne crystalline silica (quartz, cristobalite ne tridymite).[78] 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.[78]

Nipadua mu apirakuru a ɛde kokoram ba no ntaa mma.[79] Sɛ nhwɛso no, wonnya nkyerɛɛ nsɛm a wɔka sɛ nnompe a ebubui no maa nnompe mu kokoram bae.[79] Saa ara nso na wonnye nipadua mu apirakuru ntom sɛ ɛde awotwaa mu kokoram, nufu mu kokoram anaa amemene mu kokoram ba.[79] Fibea biako a wogye tom ne nneɛma a ɛyɛ hyew a wɔtaa de gu nipadua no so bere tenten. Ebetumi aba sɛ nipadua no fã 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.[79] Sɛ wɔtaa nom tii a ɛyɛ hyew a ɛyɛ hyew a, ebetumi ama woanya kokoram wɔ aduan mu.[79] 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.[79][80] Ɔfe betumi aboa ma kokoram nkwammoaa no adɔɔso, atra ase, angiogenesis ne atutra denam nkɛntɛnso a enya wɔ tumor microenvironment no so.[81][82] Oncogenes no kyekye pro-tumorigenic microenvironment a ɛma ɔhyew.[83]

'''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.[85]

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.[84] 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.[84] 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.[84] 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 fã 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 fã 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 &quot;de wɔn ani asi&quot; 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 &quot;draiver&quot; mu nsakrae na nea aka no betumi ayɛ &quot;akwantufo&quot; 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 fã 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 fã 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 &quot;precursor&quot; 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 fã. 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 fã 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 fã 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 fã 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 fã.[190] &quot;Aduru a wɔde ka ho&quot; kyerɛ akwan ne nneɛma a wɔde di dwuma ka nnuru a wɔde di dwuma ho, bere a &quot;aduru foforo&quot; 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, &quot;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'.&quot;[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 fã 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 fã 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 fã 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, &quot;Sɛ yɛtra ase kyɛ a, anka yɛn nyinaa benya kokoram.&quot;[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 fã 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 &quot;ntini no trɛw wɔ afã nyinaa sɛnea aboa a krak no wɔ ne nan, baabi a onyaa ne din no&quot;.[215] Galen kae sɛ &quot;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&quot;.[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. Ná 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 (&quot;metastasis&quot;). 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 &quot;yare tenten&quot; 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 &quot;C-asɛmfua&quot;;[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 &quot;yare a wontumi nsa&quot;.[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 &quot;wɔko&quot; na ama &quot;ɔmanfo atuatew&quot; 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 &quot;kokoram nipasu&quot;—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 &quot;ɔpɛ&quot; 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 fã 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 &quot;kokoram aduru&quot; 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 &quot;dwetɛ tuo&quot; 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 &quot;Kokoram Ko&quot; 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 fã 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 fã 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]

== Mmoa afoforo ==
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      <text bytes="78164" xml:space="preserve">'''Kokoram''' yɛ nyarewa kuw bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Eyinom ne akisikuru a ɛnyɛ hu a ɛntrɛw no bɔ abira.[7] 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.[1] Bere a saa sɛnkyerɛnne ahorow yi betumi akyerɛ sɛ kokoram de, nanso ebetumi de nneɛma afoforo nso aba.&lt;ref&gt;http://www.nhs.uk/Conditions/Cancer/Pages/Symptoms.aspx&lt;/ref&gt;Kokoram ahorow bɛboro 100 na ɛka nnipa.[7] 

Tawa a wɔde di dwuma no na ɛde kokoram wuwu bɛyɛ 22% ba.[2] 10% foforo nso fi kɛseyɛ mmoroso, aduan pa a wonni, apɔw-mu-teɛteɛ a wonnya anaasɛ nsa a wɔnom boro so.[2][8][9] 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 efĩ ba.[3] 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).[2] Anyɛ yiye koraa no, saa nneɛma yi yɛ adwuma, ne fã bi, denam nkwammoaa bi awosu mu nkwaadɔm a wɔsakra no so.[10] Mpɛn pii no, ɛho hia sɛ wɔyɛ nsakrae pii wɔ awosu mu ansa na kokoram aba.[10] Bɛyɛ kokoram 5–10% fi awosu mu sintɔ ahorow a wonya fi awo mu.[11] Wobetumi de nsɛnkyerɛnne ne sɛnkyerɛnne ahorow bi anaa nhwehwɛmu a wɔde hwehwɛ kokoram mu ahu kokoram.[2] Afei wɔtaa de nnuruyɛ mu mfoniniyɛ hwehwɛ mu bio na wɔde nipadua mu nhwehwɛmu si so dua.[12]

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.[13][14] Sɛ wohu ntɛm denam nhwehwɛmu so a, ɛho wɔ mfaso ma awotwaa ne akyi berɛmo mu kokoram.[15] Mfaso a ɛwɔ nufu mu kokoram a wɔhwehwɛ mu no yɛ nea akyinnyegye wom.[15][16] 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.[2][4] Ɛyaw ne sɛnkyerɛnne ahorow a wɔde di dwuma no yɛ ɔhwɛ no fã titiriw.[2] Ayaresa a ɛma obi ho dwo no ho hia titiriw wɔ nnipa a wɔwɔ yare a emu yɛ den no mu.[2] 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%.[17] Wɔ kokoram ho wɔ United States no, sɛ wɔkyekyem pɛpɛɛpɛ a, mfe anum a wɔde tra ase no yɛ 66%.[5]

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.[6][19]

Kokoram ahorow a ɛtaa ba mmarima so ne ahurututu mu kokoram, prostate kokoram, akyi berɛmo mu kokoram, ne yafunu mu kokoram.[20] Wɔ mmea mu no, nea ɛtaa ba ne nufu mu kokoram, kokoram a ɛwɔ akyi berɛmo mu, ahurututu mu kokoram, ne awotwaa mu kokoram.[10] 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%.[21][22] 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.[17] Wɔ afe 2012 mu no, mmofra bɛyɛ 165,000 a wonnii mfe 15 na wohui sɛ wɔwɔ kokoram.[20] Kokoram ho asiane no kɔ soro kɛse bere a obi nyin no, na kokoram pii taa ba aman a wɔanya nkɔso no mu.[10] 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.[23] 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.[24] 

== 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.[25]

Kokoram yɛ nyarewa abusua kɛse bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Wɔyɛ neoplasm ahorow no fã 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.[26][27]

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:[28] .

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[28] .

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.[28][29]

== 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 &quot;ɔsuasua kɛse.&quot;[30]

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.[31]

'''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.[30]

'''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.[32] 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.[33]

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.[30]

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 fĩ, anaasɛ hyponatremia, a ɛno nso betumi ama adwene mu tebea asakra, ɔfe, tiyɛ, anaa akisikuru.[34]

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 fã 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 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.[3] 5–10% a aka no fi awosu mu nneɛma.[3] 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 efĩ ara kwa.[38] 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 efĩ.[3][39] Ɛte sɛ nea adwene mu nhyɛso nyɛ asiane a ɛma kokoram fi ase,[40][41] ɛwom sɛ ebetumi ama nea efi mu ba no asɛe wɔ wɔn a wɔwɔ kokoram dedaw no mu de.[40]

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,[42] 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: Nsã 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.[43] Ɛsan nso de kokoram ba anom, ti, kɔn, yafunu, akisikuru, asaabo, ɛwo ne dwensɔtwaa mu.[44] Tawa wusiw wɔ nneɛma bɛboro aduonum a wonim sɛ ɛde kokoram ba, a nitrosamines ne polycyclic aromatic hydrocarbons ka ho.[45]

Tawa na ɛde kokoram wuwu bɛyɛ nnipa baanum biara mu biako wɔ wiase nyinaa[45] ne bɛyɛ baasa biara mu biako wɔ aman a wɔanya nkɔso no mu.[46] 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 .[47][48] 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.[49] Kokoram a efi nnuru a wɔde di dwuma wɔ adwuma mu mu ba no betumi ama wɔanya nsɛm no mu 2 kosi 20%,[50] anyɛ yiye koraa no, ebetumi ama nnipa 200,000 awuwu.[51] 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.[51]

Wonim sɛ sɛ obi nya perfluorooctanoic acid (PFOA) a wɔde di dwuma titiriw wɔ Teflon a wɔyɛ mu a, ɛde kokoram ahorow abien ba.[52][53]

'''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 fã 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 efĩ 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 fã 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.[3] Saa dodow yi fi 25% a ɛkorɔn wɔ Afrika kosi nea ennu 10% wɔ aman a wɔanya nkɔso no mu.[3] 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).[61]

'''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.[62][63][64] Honam ani kokoram pii a ɛnyɛ melanoma no fi mframa a ano yɛ den a ɛbɔ, a ne fã kɛse no ara fi owia hann mu.[63] Nneɛma a ɛma mframa bɔne a ɛma ɛyɛ hyew ba no bi ne aduruyɛ mu mfoninitwa ne radon mframa.[63]

Ionizing radiation nyɛ mutagen a ɛyɛ den titiriw.[65] 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.[65] Mframa a ɛbɔ no betumi de kokoram aba nipadua no afã 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.[66]

Sɛ obi nya ultraviolet mframa a efi owia mu bere tenten a, ebetumi ama wanya melanoma ne honam ani yare afoforo.[67] 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.[67]

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.[69] [62] 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.[70]

'''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.[71] 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,[71] 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,[72] 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.[73] Asiane a ɛne no hyia no yɛ 1.5 ma ahurututu mu kokoram,[74] ne 1.9 ma prostate kokoram.[75] 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.[76]

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.[77]

'''Honam fam nneɛma a wɔde yɛ nneɛma'''

Nneɛma bi de kokoram ba titiriw denam ne honam fam nkɛntɛnso so, sen sɛ ɛbɛyɛ nnuru.[78] 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.[78] Nneɛma nketenkete a ɛnyɛ fibrous a ɛde kokoram ba no bi ne powder metallic cobalt ne nickel ne crystalline silica (quartz, cristobalite ne tridymite).[78] 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.[78]

Nipadua mu apirakuru a ɛde kokoram ba no ntaa mma.[79] Sɛ nhwɛso no, wonnya nkyerɛɛ nsɛm a wɔka sɛ nnompe a ebubui no maa nnompe mu kokoram bae.[79] Saa ara nso na wonnye nipadua mu apirakuru ntom sɛ ɛde awotwaa mu kokoram, nufu mu kokoram anaa amemene mu kokoram ba.[79] Fibea biako a wogye tom ne nneɛma a ɛyɛ hyew a wɔtaa de gu nipadua no so bere tenten. Ebetumi aba sɛ nipadua no fã 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.[79] Sɛ wɔtaa nom tii a ɛyɛ hyew a ɛyɛ hyew a, ebetumi ama woanya kokoram wɔ aduan mu.[79] 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.[79][80] Ɔfe betumi aboa ma kokoram nkwammoaa no adɔɔso, atra ase, angiogenesis ne atutra denam nkɛntɛnso a enya wɔ tumor microenvironment no so.[81][82] Oncogenes no kyekye pro-tumorigenic microenvironment a ɛma ɔhyew.[83]

'''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.[85]

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.[84] 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.[84] 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.[84] 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 fã 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 fã 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 &quot;de wɔn ani asi&quot; 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 &quot;draiver&quot; mu nsakrae na nea aka no betumi ayɛ &quot;akwantufo&quot; 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 fã 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 fã 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 &quot;precursor&quot; 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 fã. 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 fã 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 fã 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 fã 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 fã.[190] &quot;Aduru a wɔde ka ho&quot; kyerɛ akwan ne nneɛma a wɔde di dwuma ka nnuru a wɔde di dwuma ho, bere a &quot;aduru foforo&quot; 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, &quot;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'.&quot;[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 fã 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 fã 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 fã 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, &quot;Sɛ yɛtra ase kyɛ a, anka yɛn nyinaa benya kokoram.&quot;[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 fã 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 &quot;ntini no trɛw wɔ afã nyinaa sɛnea aboa a krak no wɔ ne nan, baabi a onyaa ne din no&quot;.[215] Galen kae sɛ &quot;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&quot;.[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. Ná 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 (&quot;metastasis&quot;). 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 &quot;yare tenten&quot; 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 &quot;C-asɛmfua&quot;;[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 &quot;yare a wontumi nsa&quot;.[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 &quot;wɔko&quot; na ama &quot;ɔmanfo atuatew&quot; 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 &quot;kokoram nipasu&quot;—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 &quot;ɔpɛ&quot; 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 fã 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 &quot;kokoram aduru&quot; 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 &quot;dwetɛ tuo&quot; 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 &quot;Kokoram Ko&quot; 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 fã 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 fã 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]

== Mmoa afoforo ==
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      <text bytes="78230" xml:space="preserve">'''Kokoram''' yɛ nyarewa kuw bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.&lt;ref&gt;https://www.who.int/en/news-room/fact-sheets/detail/cancer&lt;/ref&gt;[7] Eyinom ne akisikuru a ɛnyɛ hu a ɛntrɛw no bɔ abira.[7] 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.[1] Bere a saa sɛnkyerɛnne ahorow yi betumi akyerɛ sɛ kokoram de, nanso ebetumi de nneɛma afoforo nso aba.&lt;ref&gt;http://www.nhs.uk/Conditions/Cancer/Pages/Symptoms.aspx&lt;/ref&gt;Kokoram ahorow bɛboro 100 na ɛka nnipa.[7] 

Tawa a wɔde di dwuma no na ɛde kokoram wuwu bɛyɛ 22% ba.[2] 10% foforo nso fi kɛseyɛ mmoroso, aduan pa a wonni, apɔw-mu-teɛteɛ a wonnya anaasɛ nsa a wɔnom boro so.[2][8][9] 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 efĩ ba.[3] 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).[2] Anyɛ yiye koraa no, saa nneɛma yi yɛ adwuma, ne fã bi, denam nkwammoaa bi awosu mu nkwaadɔm a wɔsakra no so.[10] Mpɛn pii no, ɛho hia sɛ wɔyɛ nsakrae pii wɔ awosu mu ansa na kokoram aba.[10] Bɛyɛ kokoram 5–10% fi awosu mu sintɔ ahorow a wonya fi awo mu.[11] Wobetumi de nsɛnkyerɛnne ne sɛnkyerɛnne ahorow bi anaa nhwehwɛmu a wɔde hwehwɛ kokoram mu ahu kokoram.[2] Afei wɔtaa de nnuruyɛ mu mfoniniyɛ hwehwɛ mu bio na wɔde nipadua mu nhwehwɛmu si so dua.[12]

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.[13][14] Sɛ wohu ntɛm denam nhwehwɛmu so a, ɛho wɔ mfaso ma awotwaa ne akyi berɛmo mu kokoram.[15] Mfaso a ɛwɔ nufu mu kokoram a wɔhwehwɛ mu no yɛ nea akyinnyegye wom.[15][16] 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.[2][4] Ɛyaw ne sɛnkyerɛnne ahorow a wɔde di dwuma no yɛ ɔhwɛ no fã titiriw.[2] Ayaresa a ɛma obi ho dwo no ho hia titiriw wɔ nnipa a wɔwɔ yare a emu yɛ den no mu.[2] 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%.[17] Wɔ kokoram ho wɔ United States no, sɛ wɔkyekyem pɛpɛɛpɛ a, mfe anum a wɔde tra ase no yɛ 66%.[5]

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.[6][19]

Kokoram ahorow a ɛtaa ba mmarima so ne ahurututu mu kokoram, prostate kokoram, akyi berɛmo mu kokoram, ne yafunu mu kokoram.[20] Wɔ mmea mu no, nea ɛtaa ba ne nufu mu kokoram, kokoram a ɛwɔ akyi berɛmo mu, ahurututu mu kokoram, ne awotwaa mu kokoram.[10] 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%.[21][22] 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.[17] Wɔ afe 2012 mu no, mmofra bɛyɛ 165,000 a wonnii mfe 15 na wohui sɛ wɔwɔ kokoram.[20] Kokoram ho asiane no kɔ soro kɛse bere a obi nyin no, na kokoram pii taa ba aman a wɔanya nkɔso no mu.[10] 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.[23] 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.[24] 

== 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.[25]

Kokoram yɛ nyarewa abusua kɛse bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Wɔyɛ neoplasm ahorow no fã 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.[26][27]

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:[28] .

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[28] .

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.[28][29]

== 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 &quot;ɔsuasua kɛse.&quot;[30]

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.[31]

'''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.[30]

'''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.[32] 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.[33]

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.[30]

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 fĩ, anaasɛ hyponatremia, a ɛno nso betumi ama adwene mu tebea asakra, ɔfe, tiyɛ, anaa akisikuru.[34]

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 fã 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 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.[3] 5–10% a aka no fi awosu mu nneɛma.[3] 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 efĩ ara kwa.[38] 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 efĩ.[3][39] Ɛte sɛ nea adwene mu nhyɛso nyɛ asiane a ɛma kokoram fi ase,[40][41] ɛwom sɛ ebetumi ama nea efi mu ba no asɛe wɔ wɔn a wɔwɔ kokoram dedaw no mu de.[40]

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,[42] 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: Nsã 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.[43] Ɛsan nso de kokoram ba anom, ti, kɔn, yafunu, akisikuru, asaabo, ɛwo ne dwensɔtwaa mu.[44] Tawa wusiw wɔ nneɛma bɛboro aduonum a wonim sɛ ɛde kokoram ba, a nitrosamines ne polycyclic aromatic hydrocarbons ka ho.[45]

Tawa na ɛde kokoram wuwu bɛyɛ nnipa baanum biara mu biako wɔ wiase nyinaa[45] ne bɛyɛ baasa biara mu biako wɔ aman a wɔanya nkɔso no mu.[46] 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 .[47][48] 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.[49] Kokoram a efi nnuru a wɔde di dwuma wɔ adwuma mu mu ba no betumi ama wɔanya nsɛm no mu 2 kosi 20%,[50] anyɛ yiye koraa no, ebetumi ama nnipa 200,000 awuwu.[51] 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.[51]

Wonim sɛ sɛ obi nya perfluorooctanoic acid (PFOA) a wɔde di dwuma titiriw wɔ Teflon a wɔyɛ mu a, ɛde kokoram ahorow abien ba.[52][53]

'''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 fã 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 efĩ 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 fã 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.[3] Saa dodow yi fi 25% a ɛkorɔn wɔ Afrika kosi nea ennu 10% wɔ aman a wɔanya nkɔso no mu.[3] 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).[61]

'''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.[62][63][64] Honam ani kokoram pii a ɛnyɛ melanoma no fi mframa a ano yɛ den a ɛbɔ, a ne fã kɛse no ara fi owia hann mu.[63] Nneɛma a ɛma mframa bɔne a ɛma ɛyɛ hyew ba no bi ne aduruyɛ mu mfoninitwa ne radon mframa.[63]

Ionizing radiation nyɛ mutagen a ɛyɛ den titiriw.[65] 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.[65] Mframa a ɛbɔ no betumi de kokoram aba nipadua no afã 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.[66]

Sɛ obi nya ultraviolet mframa a efi owia mu bere tenten a, ebetumi ama wanya melanoma ne honam ani yare afoforo.[67] 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.[67]

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.[69] [62] 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.[70]

'''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.[71] 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,[71] 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,[72] 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.[73] Asiane a ɛne no hyia no yɛ 1.5 ma ahurututu mu kokoram,[74] ne 1.9 ma prostate kokoram.[75] 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.[76]

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.[77]

'''Honam fam nneɛma a wɔde yɛ nneɛma'''

Nneɛma bi de kokoram ba titiriw denam ne honam fam nkɛntɛnso so, sen sɛ ɛbɛyɛ nnuru.[78] 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.[78] Nneɛma nketenkete a ɛnyɛ fibrous a ɛde kokoram ba no bi ne powder metallic cobalt ne nickel ne crystalline silica (quartz, cristobalite ne tridymite).[78] 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.[78]

Nipadua mu apirakuru a ɛde kokoram ba no ntaa mma.[79] Sɛ nhwɛso no, wonnya nkyerɛɛ nsɛm a wɔka sɛ nnompe a ebubui no maa nnompe mu kokoram bae.[79] Saa ara nso na wonnye nipadua mu apirakuru ntom sɛ ɛde awotwaa mu kokoram, nufu mu kokoram anaa amemene mu kokoram ba.[79] Fibea biako a wogye tom ne nneɛma a ɛyɛ hyew a wɔtaa de gu nipadua no so bere tenten. Ebetumi aba sɛ nipadua no fã 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.[79] Sɛ wɔtaa nom tii a ɛyɛ hyew a ɛyɛ hyew a, ebetumi ama woanya kokoram wɔ aduan mu.[79] 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.[79][80] Ɔfe betumi aboa ma kokoram nkwammoaa no adɔɔso, atra ase, angiogenesis ne atutra denam nkɛntɛnso a enya wɔ tumor microenvironment no so.[81][82] Oncogenes no kyekye pro-tumorigenic microenvironment a ɛma ɔhyew.[83]

'''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.[85]

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.[84] 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.[84] 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.[84] 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 fã 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 fã 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 &quot;de wɔn ani asi&quot; 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 &quot;draiver&quot; mu nsakrae na nea aka no betumi ayɛ &quot;akwantufo&quot; 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 fã 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 fã 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 &quot;precursor&quot; 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 fã. 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 fã 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 fã 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 fã 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 fã.[190] &quot;Aduru a wɔde ka ho&quot; kyerɛ akwan ne nneɛma a wɔde di dwuma ka nnuru a wɔde di dwuma ho, bere a &quot;aduru foforo&quot; 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, &quot;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'.&quot;[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 fã 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 fã 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 fã 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, &quot;Sɛ yɛtra ase kyɛ a, anka yɛn nyinaa benya kokoram.&quot;[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 fã 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 &quot;ntini no trɛw wɔ afã nyinaa sɛnea aboa a krak no wɔ ne nan, baabi a onyaa ne din no&quot;.[215] Galen kae sɛ &quot;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&quot;.[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. Ná 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 (&quot;metastasis&quot;). 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 &quot;yare tenten&quot; 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 &quot;C-asɛmfua&quot;;[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 &quot;yare a wontumi nsa&quot;.[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 &quot;wɔko&quot; na ama &quot;ɔmanfo atuatew&quot; 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 &quot;kokoram nipasu&quot;—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 &quot;ɔpɛ&quot; 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 fã 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 &quot;kokoram aduru&quot; 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 &quot;dwetɛ tuo&quot; 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 &quot;Kokoram Ko&quot; 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 fã 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 fã 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]

== Mmoa afoforo ==
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      <text bytes="78452" xml:space="preserve">'''Kokoram''' yɛ nyarewa kuw bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.&lt;ref name=&quot;:0&quot;&gt;https://www.who.int/en/news-room/fact-sheets/detail/cancer&lt;/ref&gt; &lt;ref name=&quot;:1&quot;&gt;https://www.cancer.gov/about-cancer/understanding/what-is-cancer&lt;/ref&gt;Eyinom ne akisikuru a ɛnyɛ hu a ɛntrɛw no bɔ abira.&lt;ref name=&quot;:1&quot; /&gt;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.&lt;ref name=&quot;:2&quot; /&gt;Bere a saa sɛnkyerɛnne ahorow yi betumi akyerɛ sɛ kokoram de, nanso ebetumi de nneɛma afoforo nso aba.&lt;ref name=&quot;:2&quot;&gt;http://www.nhs.uk/Conditions/Cancer/Pages/Symptoms.aspx&lt;/ref&gt;Kokoram ahorow bɛboro 100 na ɛka nnipa.&lt;ref name=&quot;:1&quot; /&gt; 

Tawa a wɔde di dwuma no na ɛde kokoram wuwu bɛyɛ 22% ba.&lt;ref name=&quot;:0&quot; /&gt;10% foforo nso fi kɛseyɛ mmoroso, aduan pa a wonni, apɔw-mu-teɛteɛ a wonnya anaasɛ nsa a wɔnom boro so.&lt;ref name=&quot;:0&quot; /&gt;[8][9] 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 efĩ ba.[3] 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).&lt;ref name=&quot;:0&quot; /&gt;Anyɛ yiye koraa no, saa nneɛma yi yɛ adwuma, ne fã bi, denam nkwammoaa bi awosu mu nkwaadɔm a wɔsakra no so.[10] Mpɛn pii no, ɛho hia sɛ wɔyɛ nsakrae pii wɔ awosu mu ansa na kokoram aba.[10] Bɛyɛ kokoram 5–10% fi awosu mu sintɔ ahorow a wonya fi awo mu.[11] Wobetumi de nsɛnkyerɛnne ne sɛnkyerɛnne ahorow bi anaa nhwehwɛmu a wɔde hwehwɛ kokoram mu ahu kokoram.[2] Afei wɔtaa de nnuruyɛ mu mfoniniyɛ hwehwɛ mu bio na wɔde nipadua mu nhwehwɛmu si so dua.[12]

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.[13][14] Sɛ wohu ntɛm denam nhwehwɛmu so a, ɛho wɔ mfaso ma awotwaa ne akyi berɛmo mu kokoram.[15] Mfaso a ɛwɔ nufu mu kokoram a wɔhwehwɛ mu no yɛ nea akyinnyegye wom.[15][16] 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.&lt;ref name=&quot;:2&quot; /&gt;[4] Ɛyaw ne sɛnkyerɛnne ahorow a wɔde di dwuma no yɛ ɔhwɛ no fã titiriw.&lt;ref name=&quot;:0&quot; /&gt;Ayaresa a ɛma obi ho dwo no ho hia titiriw wɔ nnipa a wɔwɔ yare a emu yɛ den no mu.&lt;ref name=&quot;:1&quot; /&gt;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%.[17] Wɔ kokoram ho wɔ United States no, sɛ wɔkyekyem pɛpɛɛpɛ a, mfe anum a wɔde tra ase no yɛ 66%.[5]

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.[6][19]

Kokoram ahorow a ɛtaa ba mmarima so ne ahurututu mu kokoram, prostate kokoram, akyi berɛmo mu kokoram, ne yafunu mu kokoram.[20] Wɔ mmea mu no, nea ɛtaa ba ne nufu mu kokoram, kokoram a ɛwɔ akyi berɛmo mu, ahurututu mu kokoram, ne awotwaa mu kokoram.[10] 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%.[21][22] 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.[17] Wɔ afe 2012 mu no, mmofra bɛyɛ 165,000 a wonnii mfe 15 na wohui sɛ wɔwɔ kokoram.[20] Kokoram ho asiane no kɔ soro kɛse bere a obi nyin no, na kokoram pii taa ba aman a wɔanya nkɔso no mu.[10] 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.[23] 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.[24] 

== 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.[25]

Kokoram yɛ nyarewa abusua kɛse bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Wɔyɛ neoplasm ahorow no fã 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.[26][27]

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:[28] .

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[28] .

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.[28][29]

== 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 &quot;ɔsuasua kɛse.&quot;[30]

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.[31]

'''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.[30]

'''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.[32] 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.[33]

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.[30]

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 fĩ, anaasɛ hyponatremia, a ɛno nso betumi ama adwene mu tebea asakra, ɔfe, tiyɛ, anaa akisikuru.[34]

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 fã 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 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.[3] 5–10% a aka no fi awosu mu nneɛma.[3] 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 efĩ ara kwa.[38] 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 efĩ.[3][39] Ɛte sɛ nea adwene mu nhyɛso nyɛ asiane a ɛma kokoram fi ase,[40][41] ɛwom sɛ ebetumi ama nea efi mu ba no asɛe wɔ wɔn a wɔwɔ kokoram dedaw no mu de.[40]

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,[42] 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: Nsã 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.[43] Ɛsan nso de kokoram ba anom, ti, kɔn, yafunu, akisikuru, asaabo, ɛwo ne dwensɔtwaa mu.[44] Tawa wusiw wɔ nneɛma bɛboro aduonum a wonim sɛ ɛde kokoram ba, a nitrosamines ne polycyclic aromatic hydrocarbons ka ho.[45]

Tawa na ɛde kokoram wuwu bɛyɛ nnipa baanum biara mu biako wɔ wiase nyinaa[45] ne bɛyɛ baasa biara mu biako wɔ aman a wɔanya nkɔso no mu.[46] 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 .[47][48] 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.[49] Kokoram a efi nnuru a wɔde di dwuma wɔ adwuma mu mu ba no betumi ama wɔanya nsɛm no mu 2 kosi 20%,[50] anyɛ yiye koraa no, ebetumi ama nnipa 200,000 awuwu.[51] 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.[51]

Wonim sɛ sɛ obi nya perfluorooctanoic acid (PFOA) a wɔde di dwuma titiriw wɔ Teflon a wɔyɛ mu a, ɛde kokoram ahorow abien ba.[52][53]

'''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 fã 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 efĩ 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 fã 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.[3] Saa dodow yi fi 25% a ɛkorɔn wɔ Afrika kosi nea ennu 10% wɔ aman a wɔanya nkɔso no mu.[3] 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).[61]

'''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.[62][63][64] Honam ani kokoram pii a ɛnyɛ melanoma no fi mframa a ano yɛ den a ɛbɔ, a ne fã kɛse no ara fi owia hann mu.[63] Nneɛma a ɛma mframa bɔne a ɛma ɛyɛ hyew ba no bi ne aduruyɛ mu mfoninitwa ne radon mframa.[63]

Ionizing radiation nyɛ mutagen a ɛyɛ den titiriw.[65] 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.[65] Mframa a ɛbɔ no betumi de kokoram aba nipadua no afã 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.[66]

Sɛ obi nya ultraviolet mframa a efi owia mu bere tenten a, ebetumi ama wanya melanoma ne honam ani yare afoforo.[67] 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.[67]

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.[69] [62] 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.[70]

'''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.[71] 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,[71] 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,[72] 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.[73] Asiane a ɛne no hyia no yɛ 1.5 ma ahurututu mu kokoram,[74] ne 1.9 ma prostate kokoram.[75] 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.[76]

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.[77]

'''Honam fam nneɛma a wɔde yɛ nneɛma'''

Nneɛma bi de kokoram ba titiriw denam ne honam fam nkɛntɛnso so, sen sɛ ɛbɛyɛ nnuru.[78] 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.[78] Nneɛma nketenkete a ɛnyɛ fibrous a ɛde kokoram ba no bi ne powder metallic cobalt ne nickel ne crystalline silica (quartz, cristobalite ne tridymite).[78] 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.[78]

Nipadua mu apirakuru a ɛde kokoram ba no ntaa mma.[79] Sɛ nhwɛso no, wonnya nkyerɛɛ nsɛm a wɔka sɛ nnompe a ebubui no maa nnompe mu kokoram bae.[79] Saa ara nso na wonnye nipadua mu apirakuru ntom sɛ ɛde awotwaa mu kokoram, nufu mu kokoram anaa amemene mu kokoram ba.[79] Fibea biako a wogye tom ne nneɛma a ɛyɛ hyew a wɔtaa de gu nipadua no so bere tenten. Ebetumi aba sɛ nipadua no fã 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.[79] Sɛ wɔtaa nom tii a ɛyɛ hyew a ɛyɛ hyew a, ebetumi ama woanya kokoram wɔ aduan mu.[79] 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.[79][80] Ɔfe betumi aboa ma kokoram nkwammoaa no adɔɔso, atra ase, angiogenesis ne atutra denam nkɛntɛnso a enya wɔ tumor microenvironment no so.[81][82] Oncogenes no kyekye pro-tumorigenic microenvironment a ɛma ɔhyew.[83]

'''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.[85]

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.[84] 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.[84] 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.[84] 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 fã 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 fã 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 &quot;de wɔn ani asi&quot; 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 &quot;draiver&quot; mu nsakrae na nea aka no betumi ayɛ &quot;akwantufo&quot; 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 fã 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 fã 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 &quot;precursor&quot; 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 fã. 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 fã 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 fã 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 fã 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 fã.[190] &quot;Aduru a wɔde ka ho&quot; kyerɛ akwan ne nneɛma a wɔde di dwuma ka nnuru a wɔde di dwuma ho, bere a &quot;aduru foforo&quot; 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, &quot;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'.&quot;[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 fã 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 fã 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 fã 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, &quot;Sɛ yɛtra ase kyɛ a, anka yɛn nyinaa benya kokoram.&quot;[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 fã 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 &quot;ntini no trɛw wɔ afã nyinaa sɛnea aboa a krak no wɔ ne nan, baabi a onyaa ne din no&quot;.[215] Galen kae sɛ &quot;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&quot;.[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. Ná 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 (&quot;metastasis&quot;). 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 &quot;yare tenten&quot; 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 &quot;C-asɛmfua&quot;;[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 &quot;yare a wontumi nsa&quot;.[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 &quot;wɔko&quot; na ama &quot;ɔmanfo atuatew&quot; 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 &quot;kokoram nipasu&quot;—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 &quot;ɔpɛ&quot; 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 fã 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 &quot;kokoram aduru&quot; 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 &quot;dwetɛ tuo&quot; 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 &quot;Kokoram Ko&quot; 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 fã 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 fã 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]

== Mmoa afoforo ==
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      <text bytes="78547" xml:space="preserve">'''Kokoram''' yɛ nyarewa kuw bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.&lt;ref name=&quot;:0&quot;&gt;https://www.who.int/en/news-room/fact-sheets/detail/cancer&lt;/ref&gt; &lt;ref name=&quot;:1&quot;&gt;https://www.cancer.gov/about-cancer/understanding/what-is-cancer&lt;/ref&gt;Eyinom ne akisikuru a ɛnyɛ hu a ɛntrɛw no bɔ abira.&lt;ref name=&quot;:1&quot; /&gt;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.&lt;ref name=&quot;:2&quot; /&gt;Bere a saa sɛnkyerɛnne ahorow yi betumi akyerɛ sɛ kokoram de, nanso ebetumi de nneɛma afoforo nso aba.&lt;ref name=&quot;:2&quot;&gt;http://www.nhs.uk/Conditions/Cancer/Pages/Symptoms.aspx&lt;/ref&gt;Kokoram ahorow bɛboro 100 na ɛka nnipa.&lt;ref name=&quot;:1&quot; /&gt; 

Tawa a wɔde di dwuma no na ɛde kokoram wuwu bɛyɛ 22% ba.&lt;ref name=&quot;:0&quot; /&gt;10% foforo nso fi kɛseyɛ mmoroso, aduan pa a wonni, apɔw-mu-teɛteɛ a wonnya anaasɛ nsa a wɔnom boro so.&lt;ref&gt;http://www.cancer.gov/about-cancer/causes-prevention/risk/obesity/obesity-fact-sheet#q3&lt;/ref&gt;&lt;ref name=&quot;:0&quot; /&gt;[9] 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 efĩ ba.[3] 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).&lt;ref name=&quot;:0&quot; /&gt;Anyɛ yiye koraa no, saa nneɛma yi yɛ adwuma, ne fã bi, denam nkwammoaa bi awosu mu nkwaadɔm a wɔsakra no so.[10] Mpɛn pii no, ɛho hia sɛ wɔyɛ nsakrae pii wɔ awosu mu ansa na kokoram aba.[10] Bɛyɛ kokoram 5–10% fi awosu mu sintɔ ahorow a wonya fi awo mu.[11] Wobetumi de nsɛnkyerɛnne ne sɛnkyerɛnne ahorow bi anaa nhwehwɛmu a wɔde hwehwɛ kokoram mu ahu kokoram.[2] Afei wɔtaa de nnuruyɛ mu mfoniniyɛ hwehwɛ mu bio na wɔde nipadua mu nhwehwɛmu si so dua.[12]

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.[13][14] Sɛ wohu ntɛm denam nhwehwɛmu so a, ɛho wɔ mfaso ma awotwaa ne akyi berɛmo mu kokoram.[15] Mfaso a ɛwɔ nufu mu kokoram a wɔhwehwɛ mu no yɛ nea akyinnyegye wom.[15][16] 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.&lt;ref name=&quot;:2&quot; /&gt;[4] Ɛyaw ne sɛnkyerɛnne ahorow a wɔde di dwuma no yɛ ɔhwɛ no fã titiriw.&lt;ref name=&quot;:0&quot; /&gt;Ayaresa a ɛma obi ho dwo no ho hia titiriw wɔ nnipa a wɔwɔ yare a emu yɛ den no mu.&lt;ref name=&quot;:1&quot; /&gt;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%.[17] Wɔ kokoram ho wɔ United States no, sɛ wɔkyekyem pɛpɛɛpɛ a, mfe anum a wɔde tra ase no yɛ 66%.[5]

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.[6][19]

Kokoram ahorow a ɛtaa ba mmarima so ne ahurututu mu kokoram, prostate kokoram, akyi berɛmo mu kokoram, ne yafunu mu kokoram.[20] Wɔ mmea mu no, nea ɛtaa ba ne nufu mu kokoram, kokoram a ɛwɔ akyi berɛmo mu, ahurututu mu kokoram, ne awotwaa mu kokoram.[10] 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%.[21][22] 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.[17] Wɔ afe 2012 mu no, mmofra bɛyɛ 165,000 a wonnii mfe 15 na wohui sɛ wɔwɔ kokoram.[20] Kokoram ho asiane no kɔ soro kɛse bere a obi nyin no, na kokoram pii taa ba aman a wɔanya nkɔso no mu.[10] 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.[23] 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.[24] 

== 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.[25]

Kokoram yɛ nyarewa abusua kɛse bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Wɔyɛ neoplasm ahorow no fã 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.[26][27]

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:[28] .

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[28] .

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.[28][29]

== 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 &quot;ɔsuasua kɛse.&quot;[30]

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.[31]

'''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.[30]

'''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.[32] 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.[33]

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.[30]

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 fĩ, anaasɛ hyponatremia, a ɛno nso betumi ama adwene mu tebea asakra, ɔfe, tiyɛ, anaa akisikuru.[34]

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 fã 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 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.[3] 5–10% a aka no fi awosu mu nneɛma.[3] 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 efĩ ara kwa.[38] 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 efĩ.[3][39] Ɛte sɛ nea adwene mu nhyɛso nyɛ asiane a ɛma kokoram fi ase,[40][41] ɛwom sɛ ebetumi ama nea efi mu ba no asɛe wɔ wɔn a wɔwɔ kokoram dedaw no mu de.[40]

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,[42] 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: Nsã 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.[43] Ɛsan nso de kokoram ba anom, ti, kɔn, yafunu, akisikuru, asaabo, ɛwo ne dwensɔtwaa mu.[44] Tawa wusiw wɔ nneɛma bɛboro aduonum a wonim sɛ ɛde kokoram ba, a nitrosamines ne polycyclic aromatic hydrocarbons ka ho.[45]

Tawa na ɛde kokoram wuwu bɛyɛ nnipa baanum biara mu biako wɔ wiase nyinaa[45] ne bɛyɛ baasa biara mu biako wɔ aman a wɔanya nkɔso no mu.[46] 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 .[47][48] 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.[49] Kokoram a efi nnuru a wɔde di dwuma wɔ adwuma mu mu ba no betumi ama wɔanya nsɛm no mu 2 kosi 20%,[50] anyɛ yiye koraa no, ebetumi ama nnipa 200,000 awuwu.[51] 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.[51]

Wonim sɛ sɛ obi nya perfluorooctanoic acid (PFOA) a wɔde di dwuma titiriw wɔ Teflon a wɔyɛ mu a, ɛde kokoram ahorow abien ba.[52][53]

'''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 fã 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 efĩ 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 fã 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.[3] Saa dodow yi fi 25% a ɛkorɔn wɔ Afrika kosi nea ennu 10% wɔ aman a wɔanya nkɔso no mu.[3] 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).[61]

'''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.[62][63][64] Honam ani kokoram pii a ɛnyɛ melanoma no fi mframa a ano yɛ den a ɛbɔ, a ne fã kɛse no ara fi owia hann mu.[63] Nneɛma a ɛma mframa bɔne a ɛma ɛyɛ hyew ba no bi ne aduruyɛ mu mfoninitwa ne radon mframa.[63]

Ionizing radiation nyɛ mutagen a ɛyɛ den titiriw.[65] 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.[65] Mframa a ɛbɔ no betumi de kokoram aba nipadua no afã 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.[66]

Sɛ obi nya ultraviolet mframa a efi owia mu bere tenten a, ebetumi ama wanya melanoma ne honam ani yare afoforo.[67] 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.[67]

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.[69] [62] 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.[70]

'''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.[71] 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,[71] 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,[72] 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.[73] Asiane a ɛne no hyia no yɛ 1.5 ma ahurututu mu kokoram,[74] ne 1.9 ma prostate kokoram.[75] 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.[76]

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.[77]

'''Honam fam nneɛma a wɔde yɛ nneɛma'''

Nneɛma bi de kokoram ba titiriw denam ne honam fam nkɛntɛnso so, sen sɛ ɛbɛyɛ nnuru.[78] 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.[78] Nneɛma nketenkete a ɛnyɛ fibrous a ɛde kokoram ba no bi ne powder metallic cobalt ne nickel ne crystalline silica (quartz, cristobalite ne tridymite).[78] 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.[78]

Nipadua mu apirakuru a ɛde kokoram ba no ntaa mma.[79] Sɛ nhwɛso no, wonnya nkyerɛɛ nsɛm a wɔka sɛ nnompe a ebubui no maa nnompe mu kokoram bae.[79] Saa ara nso na wonnye nipadua mu apirakuru ntom sɛ ɛde awotwaa mu kokoram, nufu mu kokoram anaa amemene mu kokoram ba.[79] Fibea biako a wogye tom ne nneɛma a ɛyɛ hyew a wɔtaa de gu nipadua no so bere tenten. Ebetumi aba sɛ nipadua no fã 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.[79] Sɛ wɔtaa nom tii a ɛyɛ hyew a ɛyɛ hyew a, ebetumi ama woanya kokoram wɔ aduan mu.[79] 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.[79][80] Ɔfe betumi aboa ma kokoram nkwammoaa no adɔɔso, atra ase, angiogenesis ne atutra denam nkɛntɛnso a enya wɔ tumor microenvironment no so.[81][82] Oncogenes no kyekye pro-tumorigenic microenvironment a ɛma ɔhyew.[83]

'''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.[85]

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.[84] 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.[84] 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.[84] 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 fã 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 fã 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 &quot;de wɔn ani asi&quot; 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 &quot;draiver&quot; mu nsakrae na nea aka no betumi ayɛ &quot;akwantufo&quot; 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 fã 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 fã 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 &quot;precursor&quot; 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 fã. 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 fã 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 fã 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 fã 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 fã.[190] &quot;Aduru a wɔde ka ho&quot; kyerɛ akwan ne nneɛma a wɔde di dwuma ka nnuru a wɔde di dwuma ho, bere a &quot;aduru foforo&quot; 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, &quot;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'.&quot;[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 fã 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 fã 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 fã 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, &quot;Sɛ yɛtra ase kyɛ a, anka yɛn nyinaa benya kokoram.&quot;[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 fã 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 &quot;ntini no trɛw wɔ afã nyinaa sɛnea aboa a krak no wɔ ne nan, baabi a onyaa ne din no&quot;.[215] Galen kae sɛ &quot;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&quot;.[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. Ná 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 (&quot;metastasis&quot;). 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 &quot;yare tenten&quot; 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 &quot;C-asɛmfua&quot;;[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 &quot;yare a wontumi nsa&quot;.[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 &quot;wɔko&quot; na ama &quot;ɔmanfo atuatew&quot; 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 &quot;kokoram nipasu&quot;—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 &quot;ɔpɛ&quot; 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 fã 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 &quot;kokoram aduru&quot; 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 &quot;dwetɛ tuo&quot; 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 &quot;Kokoram Ko&quot; 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 fã 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 fã 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]

== Mmoa afoforo ==
M</text>
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      <comment>Me de reference ka ho</comment>
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      <text bytes="78610" xml:space="preserve">'''Kokoram''' yɛ nyarewa kuw bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.&lt;ref name=&quot;:0&quot;&gt;https://www.who.int/en/news-room/fact-sheets/detail/cancer&lt;/ref&gt; &lt;ref name=&quot;:1&quot;&gt;https://www.cancer.gov/about-cancer/understanding/what-is-cancer&lt;/ref&gt;Eyinom ne akisikuru a ɛnyɛ hu a ɛntrɛw no bɔ abira.&lt;ref name=&quot;:1&quot; /&gt;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.&lt;ref name=&quot;:2&quot; /&gt;Bere a saa sɛnkyerɛnne ahorow yi betumi akyerɛ sɛ kokoram de, nanso ebetumi de nneɛma afoforo nso aba.&lt;ref name=&quot;:2&quot;&gt;http://www.nhs.uk/Conditions/Cancer/Pages/Symptoms.aspx&lt;/ref&gt;Kokoram ahorow bɛboro 100 na ɛka nnipa.&lt;ref name=&quot;:1&quot; /&gt; 

Tawa a wɔde di dwuma no na ɛde kokoram wuwu bɛyɛ 22% ba.&lt;ref name=&quot;:0&quot; /&gt;10% foforo nso fi kɛseyɛ mmoroso, aduan pa a wonni, apɔw-mu-teɛteɛ a wonnya anaasɛ nsa a wɔnom boro so.&lt;ref&gt;http://www.cancer.gov/about-cancer/causes-prevention/risk/obesity/obesity-fact-sheet#q3&lt;/ref&gt;&lt;ref name=&quot;:0&quot; /&gt; &lt;ref&gt;https://doi.org/10.1093%2Falcalc%2Fagv110&lt;/ref&gt;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 efĩ ba.&lt;ref name=&quot;:2&quot; /&gt; 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).&lt;ref name=&quot;:0&quot; /&gt;Anyɛ yiye koraa no, saa nneɛma yi yɛ adwuma, ne fã bi, denam nkwammoaa bi awosu mu nkwaadɔm a wɔsakra no so.[10] Mpɛn pii no, ɛho hia sɛ wɔyɛ nsakrae pii wɔ awosu mu ansa na kokoram aba.[10] Bɛyɛ kokoram 5–10% fi awosu mu sintɔ ahorow a wonya fi awo mu.[11] Wobetumi de nsɛnkyerɛnne ne sɛnkyerɛnne ahorow bi anaa nhwehwɛmu a wɔde hwehwɛ kokoram mu ahu kokoram.[2] Afei wɔtaa de nnuruyɛ mu mfoniniyɛ hwehwɛ mu bio na wɔde nipadua mu nhwehwɛmu si so dua.[12]

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.[13][14] Sɛ wohu ntɛm denam nhwehwɛmu so a, ɛho wɔ mfaso ma awotwaa ne akyi berɛmo mu kokoram.[15] Mfaso a ɛwɔ nufu mu kokoram a wɔhwehwɛ mu no yɛ nea akyinnyegye wom.[15][16] 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.&lt;ref name=&quot;:2&quot; /&gt;[4] Ɛyaw ne sɛnkyerɛnne ahorow a wɔde di dwuma no yɛ ɔhwɛ no fã titiriw.&lt;ref name=&quot;:0&quot; /&gt;Ayaresa a ɛma obi ho dwo no ho hia titiriw wɔ nnipa a wɔwɔ yare a emu yɛ den no mu.&lt;ref name=&quot;:1&quot; /&gt;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%.[17] Wɔ kokoram ho wɔ United States no, sɛ wɔkyekyem pɛpɛɛpɛ a, mfe anum a wɔde tra ase no yɛ 66%.[5]

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.[6][19]

Kokoram ahorow a ɛtaa ba mmarima so ne ahurututu mu kokoram, prostate kokoram, akyi berɛmo mu kokoram, ne yafunu mu kokoram.[20] Wɔ mmea mu no, nea ɛtaa ba ne nufu mu kokoram, kokoram a ɛwɔ akyi berɛmo mu, ahurututu mu kokoram, ne awotwaa mu kokoram.[10] 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%.[21][22] 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.[17] Wɔ afe 2012 mu no, mmofra bɛyɛ 165,000 a wonnii mfe 15 na wohui sɛ wɔwɔ kokoram.[20] Kokoram ho asiane no kɔ soro kɛse bere a obi nyin no, na kokoram pii taa ba aman a wɔanya nkɔso no mu.[10] 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.[23] 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.[24] 

== 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.[25]

Kokoram yɛ nyarewa abusua kɛse bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Wɔyɛ neoplasm ahorow no fã 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.[26][27]

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:[28] .

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[28] .

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.[28][29]

== 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 &quot;ɔsuasua kɛse.&quot;[30]

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.[31]

'''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.[30]

'''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.[32] 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.[33]

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.[30]

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 fĩ, anaasɛ hyponatremia, a ɛno nso betumi ama adwene mu tebea asakra, ɔfe, tiyɛ, anaa akisikuru.[34]

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 fã 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 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.[3] 5–10% a aka no fi awosu mu nneɛma.[3] 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 efĩ ara kwa.[38] 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 efĩ.[3][39] Ɛte sɛ nea adwene mu nhyɛso nyɛ asiane a ɛma kokoram fi ase,[40][41] ɛwom sɛ ebetumi ama nea efi mu ba no asɛe wɔ wɔn a wɔwɔ kokoram dedaw no mu de.[40]

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,[42] 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: Nsã 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.[43] Ɛsan nso de kokoram ba anom, ti, kɔn, yafunu, akisikuru, asaabo, ɛwo ne dwensɔtwaa mu.[44] Tawa wusiw wɔ nneɛma bɛboro aduonum a wonim sɛ ɛde kokoram ba, a nitrosamines ne polycyclic aromatic hydrocarbons ka ho.[45]

Tawa na ɛde kokoram wuwu bɛyɛ nnipa baanum biara mu biako wɔ wiase nyinaa[45] ne bɛyɛ baasa biara mu biako wɔ aman a wɔanya nkɔso no mu.[46] 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 .[47][48] 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.[49] Kokoram a efi nnuru a wɔde di dwuma wɔ adwuma mu mu ba no betumi ama wɔanya nsɛm no mu 2 kosi 20%,[50] anyɛ yiye koraa no, ebetumi ama nnipa 200,000 awuwu.[51] 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.[51]

Wonim sɛ sɛ obi nya perfluorooctanoic acid (PFOA) a wɔde di dwuma titiriw wɔ Teflon a wɔyɛ mu a, ɛde kokoram ahorow abien ba.[52][53]

'''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 fã 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 efĩ 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 fã 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.[3] Saa dodow yi fi 25% a ɛkorɔn wɔ Afrika kosi nea ennu 10% wɔ aman a wɔanya nkɔso no mu.[3] 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).[61]

'''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.[62][63][64] Honam ani kokoram pii a ɛnyɛ melanoma no fi mframa a ano yɛ den a ɛbɔ, a ne fã kɛse no ara fi owia hann mu.[63] Nneɛma a ɛma mframa bɔne a ɛma ɛyɛ hyew ba no bi ne aduruyɛ mu mfoninitwa ne radon mframa.[63]

Ionizing radiation nyɛ mutagen a ɛyɛ den titiriw.[65] 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.[65] Mframa a ɛbɔ no betumi de kokoram aba nipadua no afã 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.[66]

Sɛ obi nya ultraviolet mframa a efi owia mu bere tenten a, ebetumi ama wanya melanoma ne honam ani yare afoforo.[67] 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.[67]

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.[69] [62] 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.[70]

'''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.[71] 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,[71] 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,[72] 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.[73] Asiane a ɛne no hyia no yɛ 1.5 ma ahurututu mu kokoram,[74] ne 1.9 ma prostate kokoram.[75] 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.[76]

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.[77]

'''Honam fam nneɛma a wɔde yɛ nneɛma'''

Nneɛma bi de kokoram ba titiriw denam ne honam fam nkɛntɛnso so, sen sɛ ɛbɛyɛ nnuru.[78] 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.[78] Nneɛma nketenkete a ɛnyɛ fibrous a ɛde kokoram ba no bi ne powder metallic cobalt ne nickel ne crystalline silica (quartz, cristobalite ne tridymite).[78] 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.[78]

Nipadua mu apirakuru a ɛde kokoram ba no ntaa mma.[79] Sɛ nhwɛso no, wonnya nkyerɛɛ nsɛm a wɔka sɛ nnompe a ebubui no maa nnompe mu kokoram bae.[79] Saa ara nso na wonnye nipadua mu apirakuru ntom sɛ ɛde awotwaa mu kokoram, nufu mu kokoram anaa amemene mu kokoram ba.[79] Fibea biako a wogye tom ne nneɛma a ɛyɛ hyew a wɔtaa de gu nipadua no so bere tenten. Ebetumi aba sɛ nipadua no fã 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.[79] Sɛ wɔtaa nom tii a ɛyɛ hyew a ɛyɛ hyew a, ebetumi ama woanya kokoram wɔ aduan mu.[79] 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.[79][80] Ɔfe betumi aboa ma kokoram nkwammoaa no adɔɔso, atra ase, angiogenesis ne atutra denam nkɛntɛnso a enya wɔ tumor microenvironment no so.[81][82] Oncogenes no kyekye pro-tumorigenic microenvironment a ɛma ɔhyew.[83]

'''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.[85]

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.[84] 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.[84] 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.[84] 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 fã 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 fã 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 &quot;de wɔn ani asi&quot; 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 &quot;draiver&quot; mu nsakrae na nea aka no betumi ayɛ &quot;akwantufo&quot; 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 fã 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 fã 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 &quot;precursor&quot; 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 fã. 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 fã 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 fã 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 fã 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 fã.[190] &quot;Aduru a wɔde ka ho&quot; kyerɛ akwan ne nneɛma a wɔde di dwuma ka nnuru a wɔde di dwuma ho, bere a &quot;aduru foforo&quot; 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, &quot;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'.&quot;[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 fã 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 fã 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 fã 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, &quot;Sɛ yɛtra ase kyɛ a, anka yɛn nyinaa benya kokoram.&quot;[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 fã 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 &quot;ntini no trɛw wɔ afã nyinaa sɛnea aboa a krak no wɔ ne nan, baabi a onyaa ne din no&quot;.[215] Galen kae sɛ &quot;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&quot;.[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. Ná 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 (&quot;metastasis&quot;). 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 &quot;yare tenten&quot; 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 &quot;C-asɛmfua&quot;;[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 &quot;yare a wontumi nsa&quot;.[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 &quot;wɔko&quot; na ama &quot;ɔmanfo atuatew&quot; 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 &quot;kokoram nipasu&quot;—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 &quot;ɔpɛ&quot; 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 fã 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 &quot;kokoram aduru&quot; 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 &quot;dwetɛ tuo&quot; 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 &quot;Kokoram Ko&quot; 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 fã 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 fã 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]

== Mmoa afoforo ==
M</text>
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      <text bytes="78678" xml:space="preserve">'''Kokoram''' yɛ nyarewa kuw bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.&lt;ref name=&quot;:0&quot;&gt;https://www.who.int/en/news-room/fact-sheets/detail/cancer&lt;/ref&gt; &lt;ref name=&quot;:1&quot;&gt;https://www.cancer.gov/about-cancer/understanding/what-is-cancer&lt;/ref&gt;Eyinom ne akisikuru a ɛnyɛ hu a ɛntrɛw no bɔ abira.&lt;ref name=&quot;:1&quot; /&gt;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.&lt;ref name=&quot;:2&quot; /&gt;Bere a saa sɛnkyerɛnne ahorow yi betumi akyerɛ sɛ kokoram de, nanso ebetumi de nneɛma afoforo nso aba.&lt;ref name=&quot;:2&quot;&gt;http://www.nhs.uk/Conditions/Cancer/Pages/Symptoms.aspx&lt;/ref&gt;Kokoram ahorow bɛboro 100 na ɛka nnipa.&lt;ref name=&quot;:1&quot; /&gt; 

Tawa a wɔde di dwuma no na ɛde kokoram wuwu bɛyɛ 22% ba.&lt;ref name=&quot;:0&quot; /&gt;10% foforo nso fi kɛseyɛ mmoroso, aduan pa a wonni, apɔw-mu-teɛteɛ a wonnya anaasɛ nsa a wɔnom boro so.&lt;ref&gt;http://www.cancer.gov/about-cancer/causes-prevention/risk/obesity/obesity-fact-sheet#q3&lt;/ref&gt;&lt;ref name=&quot;:0&quot; /&gt; &lt;ref&gt;https://doi.org/10.1093%2Falcalc%2Fagv110&lt;/ref&gt;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 efĩ ba.&lt;ref name=&quot;:2&quot; /&gt; 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).&lt;ref name=&quot;:0&quot; /&gt;Anyɛ yiye koraa no, saa nneɛma yi yɛ adwuma, ne fã bi, denam nkwammoaa bi awosu mu nkwaadɔm a wɔsakra no so.&lt;ref&gt;https://en.m.wikipedia.org/wiki/Cancer#cite_note-WCR2014Bio-10&lt;/ref&gt;Mpɛn pii no, ɛho hia sɛ wɔyɛ nsakrae pii wɔ awosu mu ansa na kokoram aba.[10] Bɛyɛ kokoram 5–10% fi awosu mu sintɔ ahorow a wonya fi awo mu.[11] Wobetumi de nsɛnkyerɛnne ne sɛnkyerɛnne ahorow bi anaa nhwehwɛmu a wɔde hwehwɛ kokoram mu ahu kokoram.[2] Afei wɔtaa de nnuruyɛ mu mfoniniyɛ hwehwɛ mu bio na wɔde nipadua mu nhwehwɛmu si so dua.[12]

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.[13][14] Sɛ wohu ntɛm denam nhwehwɛmu so a, ɛho wɔ mfaso ma awotwaa ne akyi berɛmo mu kokoram.[15] Mfaso a ɛwɔ nufu mu kokoram a wɔhwehwɛ mu no yɛ nea akyinnyegye wom.[15][16] 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.&lt;ref name=&quot;:2&quot; /&gt;[4] Ɛyaw ne sɛnkyerɛnne ahorow a wɔde di dwuma no yɛ ɔhwɛ no fã titiriw.&lt;ref name=&quot;:0&quot; /&gt;Ayaresa a ɛma obi ho dwo no ho hia titiriw wɔ nnipa a wɔwɔ yare a emu yɛ den no mu.&lt;ref name=&quot;:1&quot; /&gt;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%.[17] Wɔ kokoram ho wɔ United States no, sɛ wɔkyekyem pɛpɛɛpɛ a, mfe anum a wɔde tra ase no yɛ 66%.[5]

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.[6][19]

Kokoram ahorow a ɛtaa ba mmarima so ne ahurututu mu kokoram, prostate kokoram, akyi berɛmo mu kokoram, ne yafunu mu kokoram.[20] Wɔ mmea mu no, nea ɛtaa ba ne nufu mu kokoram, kokoram a ɛwɔ akyi berɛmo mu, ahurututu mu kokoram, ne awotwaa mu kokoram.[10] 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%.[21][22] 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.[17] Wɔ afe 2012 mu no, mmofra bɛyɛ 165,000 a wonnii mfe 15 na wohui sɛ wɔwɔ kokoram.[20] Kokoram ho asiane no kɔ soro kɛse bere a obi nyin no, na kokoram pii taa ba aman a wɔanya nkɔso no mu.[10] 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.[23] 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.[24] 

== 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.[25]

Kokoram yɛ nyarewa abusua kɛse bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Wɔyɛ neoplasm ahorow no fã 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.[26][27]

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:[28] .

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[28] .

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.[28][29]

== 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 &quot;ɔsuasua kɛse.&quot;[30]

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.[31]

'''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.[30]

'''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.[32] 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.[33]

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.[30]

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 fĩ, anaasɛ hyponatremia, a ɛno nso betumi ama adwene mu tebea asakra, ɔfe, tiyɛ, anaa akisikuru.[34]

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 fã 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 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.[3] 5–10% a aka no fi awosu mu nneɛma.[3] 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 efĩ ara kwa.[38] 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 efĩ.[3][39] Ɛte sɛ nea adwene mu nhyɛso nyɛ asiane a ɛma kokoram fi ase,[40][41] ɛwom sɛ ebetumi ama nea efi mu ba no asɛe wɔ wɔn a wɔwɔ kokoram dedaw no mu de.[40]

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,[42] 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: Nsã 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.[43] Ɛsan nso de kokoram ba anom, ti, kɔn, yafunu, akisikuru, asaabo, ɛwo ne dwensɔtwaa mu.[44] Tawa wusiw wɔ nneɛma bɛboro aduonum a wonim sɛ ɛde kokoram ba, a nitrosamines ne polycyclic aromatic hydrocarbons ka ho.[45]

Tawa na ɛde kokoram wuwu bɛyɛ nnipa baanum biara mu biako wɔ wiase nyinaa[45] ne bɛyɛ baasa biara mu biako wɔ aman a wɔanya nkɔso no mu.[46] 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 .[47][48] 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.[49] Kokoram a efi nnuru a wɔde di dwuma wɔ adwuma mu mu ba no betumi ama wɔanya nsɛm no mu 2 kosi 20%,[50] anyɛ yiye koraa no, ebetumi ama nnipa 200,000 awuwu.[51] 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.[51]

Wonim sɛ sɛ obi nya perfluorooctanoic acid (PFOA) a wɔde di dwuma titiriw wɔ Teflon a wɔyɛ mu a, ɛde kokoram ahorow abien ba.[52][53]

'''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 fã 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 efĩ 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 fã 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.[3] Saa dodow yi fi 25% a ɛkorɔn wɔ Afrika kosi nea ennu 10% wɔ aman a wɔanya nkɔso no mu.[3] 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).[61]

'''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.[62][63][64] Honam ani kokoram pii a ɛnyɛ melanoma no fi mframa a ano yɛ den a ɛbɔ, a ne fã kɛse no ara fi owia hann mu.[63] Nneɛma a ɛma mframa bɔne a ɛma ɛyɛ hyew ba no bi ne aduruyɛ mu mfoninitwa ne radon mframa.[63]

Ionizing radiation nyɛ mutagen a ɛyɛ den titiriw.[65] 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.[65] Mframa a ɛbɔ no betumi de kokoram aba nipadua no afã 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.[66]

Sɛ obi nya ultraviolet mframa a efi owia mu bere tenten a, ebetumi ama wanya melanoma ne honam ani yare afoforo.[67] 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.[67]

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.[69] [62] 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.[70]

'''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.[71] 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,[71] 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,[72] 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.[73] Asiane a ɛne no hyia no yɛ 1.5 ma ahurututu mu kokoram,[74] ne 1.9 ma prostate kokoram.[75] 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.[76]

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.[77]

'''Honam fam nneɛma a wɔde yɛ nneɛma'''

Nneɛma bi de kokoram ba titiriw denam ne honam fam nkɛntɛnso so, sen sɛ ɛbɛyɛ nnuru.[78] 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.[78] Nneɛma nketenkete a ɛnyɛ fibrous a ɛde kokoram ba no bi ne powder metallic cobalt ne nickel ne crystalline silica (quartz, cristobalite ne tridymite).[78] 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.[78]

Nipadua mu apirakuru a ɛde kokoram ba no ntaa mma.[79] Sɛ nhwɛso no, wonnya nkyerɛɛ nsɛm a wɔka sɛ nnompe a ebubui no maa nnompe mu kokoram bae.[79] Saa ara nso na wonnye nipadua mu apirakuru ntom sɛ ɛde awotwaa mu kokoram, nufu mu kokoram anaa amemene mu kokoram ba.[79] Fibea biako a wogye tom ne nneɛma a ɛyɛ hyew a wɔtaa de gu nipadua no so bere tenten. Ebetumi aba sɛ nipadua no fã 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.[79] Sɛ wɔtaa nom tii a ɛyɛ hyew a ɛyɛ hyew a, ebetumi ama woanya kokoram wɔ aduan mu.[79] 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.[79][80] Ɔfe betumi aboa ma kokoram nkwammoaa no adɔɔso, atra ase, angiogenesis ne atutra denam nkɛntɛnso a enya wɔ tumor microenvironment no so.[81][82] Oncogenes no kyekye pro-tumorigenic microenvironment a ɛma ɔhyew.[83]

'''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.[85]

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.[84] 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.[84] 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.[84] 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 fã 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 fã 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 &quot;de wɔn ani asi&quot; 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 &quot;draiver&quot; mu nsakrae na nea aka no betumi ayɛ &quot;akwantufo&quot; 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 fã 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 fã 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 &quot;precursor&quot; 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 fã. 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 fã 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 fã 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 fã 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 fã.[190] &quot;Aduru a wɔde ka ho&quot; kyerɛ akwan ne nneɛma a wɔde di dwuma ka nnuru a wɔde di dwuma ho, bere a &quot;aduru foforo&quot; 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, &quot;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'.&quot;[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 fã 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 fã 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 fã 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, &quot;Sɛ yɛtra ase kyɛ a, anka yɛn nyinaa benya kokoram.&quot;[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 fã 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 &quot;ntini no trɛw wɔ afã nyinaa sɛnea aboa a krak no wɔ ne nan, baabi a onyaa ne din no&quot;.[215] Galen kae sɛ &quot;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&quot;.[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. Ná 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 (&quot;metastasis&quot;). 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 &quot;yare tenten&quot; 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 &quot;C-asɛmfua&quot;;[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 &quot;yare a wontumi nsa&quot;.[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 &quot;wɔko&quot; na ama &quot;ɔmanfo atuatew&quot; 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 &quot;kokoram nipasu&quot;—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 &quot;ɔpɛ&quot; 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 fã 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 &quot;kokoram aduru&quot; 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 &quot;dwetɛ tuo&quot; 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 &quot;Kokoram Ko&quot; 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 fã 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 fã 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]

== Mmoa afoforo ==
M</text>
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      <text bytes="78741" xml:space="preserve">'''Kokoram''' yɛ nyarewa kuw bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.&lt;ref name=&quot;:0&quot;&gt;https://www.who.int/en/news-room/fact-sheets/detail/cancer&lt;/ref&gt; &lt;ref name=&quot;:1&quot;&gt;https://www.cancer.gov/about-cancer/understanding/what-is-cancer&lt;/ref&gt;Eyinom ne akisikuru a ɛnyɛ hu a ɛntrɛw no bɔ abira.&lt;ref name=&quot;:1&quot; /&gt;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.&lt;ref name=&quot;:2&quot; /&gt;Bere a saa sɛnkyerɛnne ahorow yi betumi akyerɛ sɛ kokoram de, nanso ebetumi de nneɛma afoforo nso aba.&lt;ref name=&quot;:2&quot;&gt;http://www.nhs.uk/Conditions/Cancer/Pages/Symptoms.aspx&lt;/ref&gt;Kokoram ahorow bɛboro 100 na ɛka nnipa.&lt;ref name=&quot;:1&quot; /&gt; 

Tawa a wɔde di dwuma no na ɛde kokoram wuwu bɛyɛ 22% ba.&lt;ref name=&quot;:0&quot; /&gt;10% foforo nso fi kɛseyɛ mmoroso, aduan pa a wonni, apɔw-mu-teɛteɛ a wonnya anaasɛ nsa a wɔnom boro so.&lt;ref&gt;http://www.cancer.gov/about-cancer/causes-prevention/risk/obesity/obesity-fact-sheet#q3&lt;/ref&gt;&lt;ref name=&quot;:0&quot; /&gt; &lt;ref&gt;https://doi.org/10.1093%2Falcalc%2Fagv110&lt;/ref&gt;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 efĩ ba.&lt;ref name=&quot;:2&quot; /&gt; 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).&lt;ref name=&quot;:0&quot; /&gt;Anyɛ yiye koraa no, saa nneɛma yi yɛ adwuma, ne fã bi, denam nkwammoaa bi awosu mu nkwaadɔm a wɔsakra no so.&lt;ref&gt;https://en.m.wikipedia.org/wiki/Cancer#cite_note-WCR2014Bio-10&lt;/ref&gt;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.&lt;ref&gt;http://www.cancer.org/cancer/cancercauses/geneticsandcancer/heredity-and-cancer&lt;/ref&gt;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.[15] Mfaso a ɛwɔ nufu mu kokoram a wɔhwehwɛ mu no yɛ nea akyinnyegye wom.[15][16] 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.&lt;ref name=&quot;:2&quot; /&gt;[4] Ɛyaw ne sɛnkyerɛnne ahorow a wɔde di dwuma no yɛ ɔhwɛ no fã titiriw.&lt;ref name=&quot;:0&quot; /&gt;Ayaresa a ɛma obi ho dwo no ho hia titiriw wɔ nnipa a wɔwɔ yare a emu yɛ den no mu.&lt;ref name=&quot;:1&quot; /&gt;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%.[17] Wɔ kokoram ho wɔ United States no, sɛ wɔkyekyem pɛpɛɛpɛ a, mfe anum a wɔde tra ase no yɛ 66%.[5]

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.[6][19]

Kokoram ahorow a ɛtaa ba mmarima so ne ahurututu mu kokoram, prostate kokoram, akyi berɛmo mu kokoram, ne yafunu mu kokoram.[20] Wɔ mmea mu no, nea ɛtaa ba ne nufu mu kokoram, kokoram a ɛwɔ akyi berɛmo mu, ahurututu mu kokoram, ne awotwaa mu kokoram.[10] 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%.[21][22] 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.[17] Wɔ afe 2012 mu no, mmofra bɛyɛ 165,000 a wonnii mfe 15 na wohui sɛ wɔwɔ kokoram.[20] Kokoram ho asiane no kɔ soro kɛse bere a obi nyin no, na kokoram pii taa ba aman a wɔanya nkɔso no mu.[10] 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.[23] 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.[24] 

== 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.[25]

Kokoram yɛ nyarewa abusua kɛse bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Wɔyɛ neoplasm ahorow no fã 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.[26][27]

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:[28] .

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[28] .

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.[28][29]

== 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 &quot;ɔsuasua kɛse.&quot;[30]

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.[31]

'''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.[30]

'''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.[32] 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.[33]

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.[30]

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 fĩ, anaasɛ hyponatremia, a ɛno nso betumi ama adwene mu tebea asakra, ɔfe, tiyɛ, anaa akisikuru.[34]

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 fã 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 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.[3] 5–10% a aka no fi awosu mu nneɛma.[3] 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 efĩ ara kwa.[38] 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 efĩ.[3][39] Ɛte sɛ nea adwene mu nhyɛso nyɛ asiane a ɛma kokoram fi ase,[40][41] ɛwom sɛ ebetumi ama nea efi mu ba no asɛe wɔ wɔn a wɔwɔ kokoram dedaw no mu de.[40]

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,[42] 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: Nsã 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.[43] Ɛsan nso de kokoram ba anom, ti, kɔn, yafunu, akisikuru, asaabo, ɛwo ne dwensɔtwaa mu.[44] Tawa wusiw wɔ nneɛma bɛboro aduonum a wonim sɛ ɛde kokoram ba, a nitrosamines ne polycyclic aromatic hydrocarbons ka ho.[45]

Tawa na ɛde kokoram wuwu bɛyɛ nnipa baanum biara mu biako wɔ wiase nyinaa[45] ne bɛyɛ baasa biara mu biako wɔ aman a wɔanya nkɔso no mu.[46] 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 .[47][48] 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.[49] Kokoram a efi nnuru a wɔde di dwuma wɔ adwuma mu mu ba no betumi ama wɔanya nsɛm no mu 2 kosi 20%,[50] anyɛ yiye koraa no, ebetumi ama nnipa 200,000 awuwu.[51] 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.[51]

Wonim sɛ sɛ obi nya perfluorooctanoic acid (PFOA) a wɔde di dwuma titiriw wɔ Teflon a wɔyɛ mu a, ɛde kokoram ahorow abien ba.[52][53]

'''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 fã 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 efĩ 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 fã 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.[3] Saa dodow yi fi 25% a ɛkorɔn wɔ Afrika kosi nea ennu 10% wɔ aman a wɔanya nkɔso no mu.[3] 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).[61]

'''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.[62][63][64] Honam ani kokoram pii a ɛnyɛ melanoma no fi mframa a ano yɛ den a ɛbɔ, a ne fã kɛse no ara fi owia hann mu.[63] Nneɛma a ɛma mframa bɔne a ɛma ɛyɛ hyew ba no bi ne aduruyɛ mu mfoninitwa ne radon mframa.[63]

Ionizing radiation nyɛ mutagen a ɛyɛ den titiriw.[65] 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.[65] Mframa a ɛbɔ no betumi de kokoram aba nipadua no afã 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.[66]

Sɛ obi nya ultraviolet mframa a efi owia mu bere tenten a, ebetumi ama wanya melanoma ne honam ani yare afoforo.[67] 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.[67]

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.[69] [62] 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.[70]

'''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.[71] 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,[71] 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,[72] 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.[73] Asiane a ɛne no hyia no yɛ 1.5 ma ahurututu mu kokoram,[74] ne 1.9 ma prostate kokoram.[75] 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.[76]

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.[77]

'''Honam fam nneɛma a wɔde yɛ nneɛma'''

Nneɛma bi de kokoram ba titiriw denam ne honam fam nkɛntɛnso so, sen sɛ ɛbɛyɛ nnuru.[78] 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.[78] Nneɛma nketenkete a ɛnyɛ fibrous a ɛde kokoram ba no bi ne powder metallic cobalt ne nickel ne crystalline silica (quartz, cristobalite ne tridymite).[78] 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.[78]

Nipadua mu apirakuru a ɛde kokoram ba no ntaa mma.[79] Sɛ nhwɛso no, wonnya nkyerɛɛ nsɛm a wɔka sɛ nnompe a ebubui no maa nnompe mu kokoram bae.[79] Saa ara nso na wonnye nipadua mu apirakuru ntom sɛ ɛde awotwaa mu kokoram, nufu mu kokoram anaa amemene mu kokoram ba.[79] Fibea biako a wogye tom ne nneɛma a ɛyɛ hyew a wɔtaa de gu nipadua no so bere tenten. Ebetumi aba sɛ nipadua no fã 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.[79] Sɛ wɔtaa nom tii a ɛyɛ hyew a ɛyɛ hyew a, ebetumi ama woanya kokoram wɔ aduan mu.[79] 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.[79][80] Ɔfe betumi aboa ma kokoram nkwammoaa no adɔɔso, atra ase, angiogenesis ne atutra denam nkɛntɛnso a enya wɔ tumor microenvironment no so.[81][82] Oncogenes no kyekye pro-tumorigenic microenvironment a ɛma ɔhyew.[83]

'''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.[85]

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.[84] 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.[84] 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.[84] 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 fã 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 fã 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 &quot;de wɔn ani asi&quot; 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 &quot;draiver&quot; mu nsakrae na nea aka no betumi ayɛ &quot;akwantufo&quot; 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 fã 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 fã 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 &quot;precursor&quot; 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 fã. 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 fã 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 fã 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 fã 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 fã.[190] &quot;Aduru a wɔde ka ho&quot; kyerɛ akwan ne nneɛma a wɔde di dwuma ka nnuru a wɔde di dwuma ho, bere a &quot;aduru foforo&quot; 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, &quot;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'.&quot;[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 fã 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 fã 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 fã 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, &quot;Sɛ yɛtra ase kyɛ a, anka yɛn nyinaa benya kokoram.&quot;[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 fã 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 &quot;ntini no trɛw wɔ afã nyinaa sɛnea aboa a krak no wɔ ne nan, baabi a onyaa ne din no&quot;.[215] Galen kae sɛ &quot;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&quot;.[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. Ná 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 (&quot;metastasis&quot;). 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 &quot;yare tenten&quot; 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 &quot;C-asɛmfua&quot;;[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 &quot;yare a wontumi nsa&quot;.[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 &quot;wɔko&quot; na ama &quot;ɔmanfo atuatew&quot; 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 &quot;kokoram nipasu&quot;—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 &quot;ɔpɛ&quot; 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 fã 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 &quot;kokoram aduru&quot; 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 &quot;dwetɛ tuo&quot; 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 &quot;Kokoram Ko&quot; 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 fã 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 fã 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]

== Mmoa afoforo ==
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      <text bytes="78794" xml:space="preserve">'''Kokoram'''({{Audio|tw-Kokoram.ogg|pronounciation of &quot;kokoram&quot;}}) yɛ nyarewa kuw bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.&lt;ref name=&quot;:0&quot;&gt;https://www.who.int/en/news-room/fact-sheets/detail/cancer&lt;/ref&gt; &lt;ref name=&quot;:1&quot;&gt;https://www.cancer.gov/about-cancer/understanding/what-is-cancer&lt;/ref&gt;Eyinom ne akisikuru a ɛnyɛ hu a ɛntrɛw no bɔ abira.&lt;ref name=&quot;:1&quot; /&gt;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.&lt;ref name=&quot;:2&quot; /&gt;Bere a saa sɛnkyerɛnne ahorow yi betumi akyerɛ sɛ kokoram de, nanso ebetumi de nneɛma afoforo nso aba.&lt;ref name=&quot;:2&quot;&gt;http://www.nhs.uk/Conditions/Cancer/Pages/Symptoms.aspx&lt;/ref&gt;Kokoram ahorow bɛboro 100 na ɛka nnipa.&lt;ref name=&quot;:1&quot; /&gt; 

Tawa a wɔde di dwuma no na ɛde kokoram wuwu bɛyɛ 22% ba.&lt;ref name=&quot;:0&quot; /&gt;10% foforo nso fi kɛseyɛ mmoroso, aduan pa a wonni, apɔw-mu-teɛteɛ a wonnya anaasɛ nsa a wɔnom boro so.&lt;ref&gt;http://www.cancer.gov/about-cancer/causes-prevention/risk/obesity/obesity-fact-sheet#q3&lt;/ref&gt;&lt;ref name=&quot;:0&quot; /&gt; &lt;ref&gt;https://doi.org/10.1093%2Falcalc%2Fagv110&lt;/ref&gt;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 efĩ ba.&lt;ref name=&quot;:2&quot; /&gt; 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).&lt;ref name=&quot;:0&quot; /&gt;Anyɛ yiye koraa no, saa nneɛma yi yɛ adwuma, ne fã bi, denam nkwammoaa bi awosu mu nkwaadɔm a wɔsakra no so.&lt;ref&gt;https://en.m.wikipedia.org/wiki/Cancer#cite_note-WCR2014Bio-10&lt;/ref&gt;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.&lt;ref&gt;http://www.cancer.org/cancer/cancercauses/geneticsandcancer/heredity-and-cancer&lt;/ref&gt;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.[15] Mfaso a ɛwɔ nufu mu kokoram a wɔhwehwɛ mu no yɛ nea akyinnyegye wom.[15][16] 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.&lt;ref name=&quot;:2&quot; /&gt;[4] Ɛyaw ne sɛnkyerɛnne ahorow a wɔde di dwuma no yɛ ɔhwɛ no fã titiriw.&lt;ref name=&quot;:0&quot; /&gt;Ayaresa a ɛma obi ho dwo no ho hia titiriw wɔ nnipa a wɔwɔ yare a emu yɛ den no mu.&lt;ref name=&quot;:1&quot; /&gt;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%.[17] Wɔ kokoram ho wɔ United States no, sɛ wɔkyekyem pɛpɛɛpɛ a, mfe anum a wɔde tra ase no yɛ 66%.[5]

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.[6][19]

Kokoram ahorow a ɛtaa ba mmarima so ne ahurututu mu kokoram, prostate kokoram, akyi berɛmo mu kokoram, ne yafunu mu kokoram.[20] Wɔ mmea mu no, nea ɛtaa ba ne nufu mu kokoram, kokoram a ɛwɔ akyi berɛmo mu, ahurututu mu kokoram, ne awotwaa mu kokoram.[10] 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%.[21][22] 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.[17] Wɔ afe 2012 mu no, mmofra bɛyɛ 165,000 a wonnii mfe 15 na wohui sɛ wɔwɔ kokoram.[20] Kokoram ho asiane no kɔ soro kɛse bere a obi nyin no, na kokoram pii taa ba aman a wɔanya nkɔso no mu.[10] 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.[23] 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.[24]

== 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.[25]

Kokoram yɛ nyarewa abusua kɛse bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Wɔyɛ neoplasm ahorow no fã 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.[26][27]

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:[28] .

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[28] .

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.[28][29]

== 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 &quot;ɔsuasua kɛse.&quot;[30]

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.[31]

'''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.[30]

'''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.[32] 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.[33]

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.[30]

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 fĩ, anaasɛ hyponatremia, a ɛno nso betumi ama adwene mu tebea asakra, ɔfe, tiyɛ, anaa akisikuru.[34]

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 fã 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 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.[3] 5–10% a aka no fi awosu mu nneɛma.[3] 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 efĩ ara kwa.[38] 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 efĩ.[3][39] Ɛte sɛ nea adwene mu nhyɛso nyɛ asiane a ɛma kokoram fi ase,[40][41] ɛwom sɛ ebetumi ama nea efi mu ba no asɛe wɔ wɔn a wɔwɔ kokoram dedaw no mu de.[40]

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,[42] 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: Nsã 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.[43] Ɛsan nso de kokoram ba anom, ti, kɔn, yafunu, akisikuru, asaabo, ɛwo ne dwensɔtwaa mu.[44] Tawa wusiw wɔ nneɛma bɛboro aduonum a wonim sɛ ɛde kokoram ba, a nitrosamines ne polycyclic aromatic hydrocarbons ka ho.[45]

Tawa na ɛde kokoram wuwu bɛyɛ nnipa baanum biara mu biako wɔ wiase nyinaa[45] ne bɛyɛ baasa biara mu biako wɔ aman a wɔanya nkɔso no mu.[46] 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 .[47][48] 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.[49] Kokoram a efi nnuru a wɔde di dwuma wɔ adwuma mu mu ba no betumi ama wɔanya nsɛm no mu 2 kosi 20%,[50] anyɛ yiye koraa no, ebetumi ama nnipa 200,000 awuwu.[51] 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.[51]

Wonim sɛ sɛ obi nya perfluorooctanoic acid (PFOA) a wɔde di dwuma titiriw wɔ Teflon a wɔyɛ mu a, ɛde kokoram ahorow abien ba.[52][53]

'''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 fã 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 efĩ 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 fã 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.[3] Saa dodow yi fi 25% a ɛkorɔn wɔ Afrika kosi nea ennu 10% wɔ aman a wɔanya nkɔso no mu.[3] 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).[61]

'''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.[62][63][64] Honam ani kokoram pii a ɛnyɛ melanoma no fi mframa a ano yɛ den a ɛbɔ, a ne fã kɛse no ara fi owia hann mu.[63] Nneɛma a ɛma mframa bɔne a ɛma ɛyɛ hyew ba no bi ne aduruyɛ mu mfoninitwa ne radon mframa.[63]

Ionizing radiation nyɛ mutagen a ɛyɛ den titiriw.[65] 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.[65] Mframa a ɛbɔ no betumi de kokoram aba nipadua no afã 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.[66]

Sɛ obi nya ultraviolet mframa a efi owia mu bere tenten a, ebetumi ama wanya melanoma ne honam ani yare afoforo.[67] 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.[67]

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.[69] [62] 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.[70]

'''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.[71] 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,[71] 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,[72] 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.[73] Asiane a ɛne no hyia no yɛ 1.5 ma ahurututu mu kokoram,[74] ne 1.9 ma prostate kokoram.[75] 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.[76]

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.[77]

'''Honam fam nneɛma a wɔde yɛ nneɛma'''

Nneɛma bi de kokoram ba titiriw denam ne honam fam nkɛntɛnso so, sen sɛ ɛbɛyɛ nnuru.[78] 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.[78] Nneɛma nketenkete a ɛnyɛ fibrous a ɛde kokoram ba no bi ne powder metallic cobalt ne nickel ne crystalline silica (quartz, cristobalite ne tridymite).[78] 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.[78]

Nipadua mu apirakuru a ɛde kokoram ba no ntaa mma.[79] Sɛ nhwɛso no, wonnya nkyerɛɛ nsɛm a wɔka sɛ nnompe a ebubui no maa nnompe mu kokoram bae.[79] Saa ara nso na wonnye nipadua mu apirakuru ntom sɛ ɛde awotwaa mu kokoram, nufu mu kokoram anaa amemene mu kokoram ba.[79] Fibea biako a wogye tom ne nneɛma a ɛyɛ hyew a wɔtaa de gu nipadua no so bere tenten. Ebetumi aba sɛ nipadua no fã 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.[79] Sɛ wɔtaa nom tii a ɛyɛ hyew a ɛyɛ hyew a, ebetumi ama woanya kokoram wɔ aduan mu.[79] 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.[79][80] Ɔfe betumi aboa ma kokoram nkwammoaa no adɔɔso, atra ase, angiogenesis ne atutra denam nkɛntɛnso a enya wɔ tumor microenvironment no so.[81][82] Oncogenes no kyekye pro-tumorigenic microenvironment a ɛma ɔhyew.[83]

'''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.[85]

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.[84] 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.[84] 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.[84] 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 fã 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 fã 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 &quot;de wɔn ani asi&quot; 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 &quot;draiver&quot; mu nsakrae na nea aka no betumi ayɛ &quot;akwantufo&quot; 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 fã 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 fã 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 &quot;precursor&quot; 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 fã. 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 fã 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 fã 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 fã 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 fã.[190] &quot;Aduru a wɔde ka ho&quot; kyerɛ akwan ne nneɛma a wɔde di dwuma ka nnuru a wɔde di dwuma ho, bere a &quot;aduru foforo&quot; 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, &quot;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'.&quot;[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 fã 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 fã 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 fã 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, &quot;Sɛ yɛtra ase kyɛ a, anka yɛn nyinaa benya kokoram.&quot;[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 fã 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 &quot;ntini no trɛw wɔ afã nyinaa sɛnea aboa a krak no wɔ ne nan, baabi a onyaa ne din no&quot;.[215] Galen kae sɛ &quot;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&quot;.[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. Ná 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 (&quot;metastasis&quot;). 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 &quot;yare tenten&quot; 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 &quot;C-asɛmfua&quot;;[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 &quot;yare a wontumi nsa&quot;.[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 &quot;wɔko&quot; na ama &quot;ɔmanfo atuatew&quot; 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 &quot;kokoram nipasu&quot;—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 &quot;ɔpɛ&quot; 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 fã 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 &quot;kokoram aduru&quot; 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 &quot;dwetɛ tuo&quot; 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 &quot;Kokoram Ko&quot; 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 fã 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 fã 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]

== Mmoa afoforo ==
M</text>
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      <text bytes="78775" xml:space="preserve">'''Kokoram'''({{Audio|tw-Kokoram.ogg|pronounciation of &quot;kokoram&quot;}}) yɛ nyarewa kuw bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.&lt;ref name=&quot;:0&quot;&gt;https://www.who.int/en/news-room/fact-sheets/detail/cancer&lt;/ref&gt; &lt;ref name=&quot;:1&quot;&gt;https://www.cancer.gov/about-cancer/understanding/what-is-cancer&lt;/ref&gt;Eyinom ne akisikuru a ɛnyɛ hu a ɛntrɛw no bɔ abira.&lt;ref name=&quot;:1&quot; /&gt;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.&lt;ref name=&quot;:2&quot; /&gt;Bere a saa sɛnkyerɛnne ahorow yi betumi akyerɛ sɛ kokoram de, nanso ebetumi de nneɛma afoforo nso aba.&lt;ref name=&quot;:2&quot;&gt;http://www.nhs.uk/Conditions/Cancer/Pages/Symptoms.aspx&lt;/ref&gt;Kokoram ahorow bɛboro 100 na ɛka nnipa.&lt;ref name=&quot;:1&quot; /&gt; 

Tawa a wɔde di dwuma no na ɛde kokoram wuwu bɛyɛ 22% ba.&lt;ref name=&quot;:0&quot; /&gt;10% foforo nso fi kɛseyɛ mmoroso, aduan pa a wonni, apɔw-mu-teɛteɛ a wonnya anaasɛ nsa a wɔnom boro so.&lt;ref&gt;http://www.cancer.gov/about-cancer/causes-prevention/risk/obesity/obesity-fact-sheet#q3&lt;/ref&gt;&lt;ref name=&quot;:0&quot; /&gt; &lt;ref&gt;https://doi.org/10.1093%2Falcalc%2Fagv110&lt;/ref&gt;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 efĩ ba.&lt;ref name=&quot;:2&quot; /&gt; 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).&lt;ref name=&quot;:0&quot; /&gt;Anyɛ yiye koraa no, saa nneɛma yi yɛ adwuma, ne fã bi, denam nkwammoaa bi awosu mu nkwaadɔm a wɔsakra no so.&lt;ref&gt;https://en.m.wikipedia.org/wiki/Cancer#cite_note-WCR2014Bio-10&lt;/ref&gt;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.&lt;ref&gt;http://www.cancer.org/cancer/cancercauses/geneticsandcancer/heredity-and-cancer&lt;/ref&gt;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.&lt;ref name=&quot;:2&quot; /&gt;[4] Ɛyaw ne sɛnkyerɛnne ahorow a wɔde di dwuma no yɛ ɔhwɛ no fã titiriw.&lt;ref name=&quot;:0&quot; /&gt;Ayaresa a ɛma obi ho dwo no ho hia titiriw wɔ nnipa a wɔwɔ yare a emu yɛ den no mu.&lt;ref name=&quot;:1&quot; /&gt;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%.[5]

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.[6][19]

Kokoram ahorow a ɛtaa ba mmarima so ne ahurututu mu kokoram, prostate kokoram, akyi berɛmo mu kokoram, ne yafunu mu kokoram.[20] Wɔ mmea mu no, nea ɛtaa ba ne nufu mu kokoram, kokoram a ɛwɔ akyi berɛmo mu, ahurututu mu kokoram, ne awotwaa mu kokoram.[10] 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%.[21][22] 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.[17] Wɔ afe 2012 mu no, mmofra bɛyɛ 165,000 a wonnii mfe 15 na wohui sɛ wɔwɔ kokoram.[20] Kokoram ho asiane no kɔ soro kɛse bere a obi nyin no, na kokoram pii taa ba aman a wɔanya nkɔso no mu.[10] 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.[23] 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.[24]

== 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.[25]

Kokoram yɛ nyarewa abusua kɛse bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Wɔyɛ neoplasm ahorow no fã 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.[26][27]

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:[28] .

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[28] .

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.[28][29]

== 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 &quot;ɔsuasua kɛse.&quot;[30]

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.[31]

'''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.[30]

'''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.[32] 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.[33]

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.[30]

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 fĩ, anaasɛ hyponatremia, a ɛno nso betumi ama adwene mu tebea asakra, ɔfe, tiyɛ, anaa akisikuru.[34]

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 fã 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 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.[3] 5–10% a aka no fi awosu mu nneɛma.[3] 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 efĩ ara kwa.[38] 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 efĩ.[3][39] Ɛte sɛ nea adwene mu nhyɛso nyɛ asiane a ɛma kokoram fi ase,[40][41] ɛwom sɛ ebetumi ama nea efi mu ba no asɛe wɔ wɔn a wɔwɔ kokoram dedaw no mu de.[40]

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,[42] 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: Nsã 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.[43] Ɛsan nso de kokoram ba anom, ti, kɔn, yafunu, akisikuru, asaabo, ɛwo ne dwensɔtwaa mu.[44] Tawa wusiw wɔ nneɛma bɛboro aduonum a wonim sɛ ɛde kokoram ba, a nitrosamines ne polycyclic aromatic hydrocarbons ka ho.[45]

Tawa na ɛde kokoram wuwu bɛyɛ nnipa baanum biara mu biako wɔ wiase nyinaa[45] ne bɛyɛ baasa biara mu biako wɔ aman a wɔanya nkɔso no mu.[46] 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 .[47][48] 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.[49] Kokoram a efi nnuru a wɔde di dwuma wɔ adwuma mu mu ba no betumi ama wɔanya nsɛm no mu 2 kosi 20%,[50] anyɛ yiye koraa no, ebetumi ama nnipa 200,000 awuwu.[51] 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.[51]

Wonim sɛ sɛ obi nya perfluorooctanoic acid (PFOA) a wɔde di dwuma titiriw wɔ Teflon a wɔyɛ mu a, ɛde kokoram ahorow abien ba.[52][53]

'''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 fã 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 efĩ 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 fã 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.[3] Saa dodow yi fi 25% a ɛkorɔn wɔ Afrika kosi nea ennu 10% wɔ aman a wɔanya nkɔso no mu.[3] 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).[61]

'''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.[62][63][64] Honam ani kokoram pii a ɛnyɛ melanoma no fi mframa a ano yɛ den a ɛbɔ, a ne fã kɛse no ara fi owia hann mu.[63] Nneɛma a ɛma mframa bɔne a ɛma ɛyɛ hyew ba no bi ne aduruyɛ mu mfoninitwa ne radon mframa.[63]

Ionizing radiation nyɛ mutagen a ɛyɛ den titiriw.[65] 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.[65] Mframa a ɛbɔ no betumi de kokoram aba nipadua no afã 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.[66]

Sɛ obi nya ultraviolet mframa a efi owia mu bere tenten a, ebetumi ama wanya melanoma ne honam ani yare afoforo.[67] 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.[67]

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.[69] [62] 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.[70]

'''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.[71] 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,[71] 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,[72] 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.[73] Asiane a ɛne no hyia no yɛ 1.5 ma ahurututu mu kokoram,[74] ne 1.9 ma prostate kokoram.[75] 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.[76]

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.[77]

'''Honam fam nneɛma a wɔde yɛ nneɛma'''

Nneɛma bi de kokoram ba titiriw denam ne honam fam nkɛntɛnso so, sen sɛ ɛbɛyɛ nnuru.[78] 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.[78] Nneɛma nketenkete a ɛnyɛ fibrous a ɛde kokoram ba no bi ne powder metallic cobalt ne nickel ne crystalline silica (quartz, cristobalite ne tridymite).[78] 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.[78]

Nipadua mu apirakuru a ɛde kokoram ba no ntaa mma.[79] Sɛ nhwɛso no, wonnya nkyerɛɛ nsɛm a wɔka sɛ nnompe a ebubui no maa nnompe mu kokoram bae.[79] Saa ara nso na wonnye nipadua mu apirakuru ntom sɛ ɛde awotwaa mu kokoram, nufu mu kokoram anaa amemene mu kokoram ba.[79] Fibea biako a wogye tom ne nneɛma a ɛyɛ hyew a wɔtaa de gu nipadua no so bere tenten. Ebetumi aba sɛ nipadua no fã 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.[79] Sɛ wɔtaa nom tii a ɛyɛ hyew a ɛyɛ hyew a, ebetumi ama woanya kokoram wɔ aduan mu.[79] 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.[79][80] Ɔfe betumi aboa ma kokoram nkwammoaa no adɔɔso, atra ase, angiogenesis ne atutra denam nkɛntɛnso a enya wɔ tumor microenvironment no so.[81][82] Oncogenes no kyekye pro-tumorigenic microenvironment a ɛma ɔhyew.[83]

'''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.[85]

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.[84] 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.[84] 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.[84] 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 fã 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 fã 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 &quot;de wɔn ani asi&quot; 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 &quot;draiver&quot; mu nsakrae na nea aka no betumi ayɛ &quot;akwantufo&quot; 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 fã 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 fã 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 &quot;precursor&quot; 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 fã. 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 fã 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 fã 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 fã 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 fã.[190] &quot;Aduru a wɔde ka ho&quot; kyerɛ akwan ne nneɛma a wɔde di dwuma ka nnuru a wɔde di dwuma ho, bere a &quot;aduru foforo&quot; 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, &quot;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'.&quot;[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 fã 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 fã 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 fã 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, &quot;Sɛ yɛtra ase kyɛ a, anka yɛn nyinaa benya kokoram.&quot;[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 fã 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 &quot;ntini no trɛw wɔ afã nyinaa sɛnea aboa a krak no wɔ ne nan, baabi a onyaa ne din no&quot;.[215] Galen kae sɛ &quot;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&quot;.[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. Ná 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 (&quot;metastasis&quot;). 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 &quot;yare tenten&quot; 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 &quot;C-asɛmfua&quot;;[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 &quot;yare a wontumi nsa&quot;.[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 &quot;wɔko&quot; na ama &quot;ɔmanfo atuatew&quot; 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 &quot;kokoram nipasu&quot;—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 &quot;ɔpɛ&quot; 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 fã 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 &quot;kokoram aduru&quot; 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 &quot;dwetɛ tuo&quot; 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 &quot;Kokoram Ko&quot; 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 fã 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 fã 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]

== Mmoa afoforo ==
M</text>
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      <comment>Me de reference ka ho</comment>
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      <text bytes="78815" xml:space="preserve">'''Kokoram'''({{Audio|tw-Kokoram.ogg|pronounciation of &quot;kokoram&quot;}}) yɛ nyarewa kuw bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.&lt;ref name=&quot;:0&quot;&gt;https://www.who.int/en/news-room/fact-sheets/detail/cancer&lt;/ref&gt; &lt;ref name=&quot;:1&quot;&gt;https://www.cancer.gov/about-cancer/understanding/what-is-cancer&lt;/ref&gt;Eyinom ne akisikuru a ɛnyɛ hu a ɛntrɛw no bɔ abira.&lt;ref name=&quot;:1&quot; /&gt;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.&lt;ref name=&quot;:2&quot; /&gt;Bere a saa sɛnkyerɛnne ahorow yi betumi akyerɛ sɛ kokoram de, nanso ebetumi de nneɛma afoforo nso aba.&lt;ref name=&quot;:2&quot;&gt;http://www.nhs.uk/Conditions/Cancer/Pages/Symptoms.aspx&lt;/ref&gt;Kokoram ahorow bɛboro 100 na ɛka nnipa.&lt;ref name=&quot;:1&quot; /&gt; 

Tawa a wɔde di dwuma no na ɛde kokoram wuwu bɛyɛ 22% ba.&lt;ref name=&quot;:0&quot; /&gt;10% foforo nso fi kɛseyɛ mmoroso, aduan pa a wonni, apɔw-mu-teɛteɛ a wonnya anaasɛ nsa a wɔnom boro so.&lt;ref&gt;http://www.cancer.gov/about-cancer/causes-prevention/risk/obesity/obesity-fact-sheet#q3&lt;/ref&gt;&lt;ref name=&quot;:0&quot; /&gt; &lt;ref&gt;https://doi.org/10.1093%2Falcalc%2Fagv110&lt;/ref&gt;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 efĩ ba.&lt;ref name=&quot;:2&quot; /&gt; 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).&lt;ref name=&quot;:0&quot; /&gt;Anyɛ yiye koraa no, saa nneɛma yi yɛ adwuma, ne fã bi, denam nkwammoaa bi awosu mu nkwaadɔm a wɔsakra no so.&lt;ref&gt;https://en.m.wikipedia.org/wiki/Cancer#cite_note-WCR2014Bio-10&lt;/ref&gt;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.&lt;ref&gt;http://www.cancer.org/cancer/cancercauses/geneticsandcancer/heredity-and-cancer&lt;/ref&gt;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.&lt;ref name=&quot;:2&quot; /&gt;[4] Ɛyaw ne sɛnkyerɛnne ahorow a wɔde di dwuma no yɛ ɔhwɛ no fã titiriw.&lt;ref name=&quot;:0&quot; /&gt;Ayaresa a ɛma obi ho dwo no ho hia titiriw wɔ nnipa a wɔwɔ yare a emu yɛ den no mu.&lt;ref name=&quot;:1&quot; /&gt;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%.[5]

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.[6][19]

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.&lt;ref&gt;https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5055577&lt;/ref&gt; 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.[20] Kokoram ho asiane no kɔ soro kɛse bere a obi nyin no, na kokoram pii taa ba aman a wɔanya nkɔso no mu.[10] 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.[23] 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.[24]

== 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.[25]

Kokoram yɛ nyarewa abusua kɛse bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Wɔyɛ neoplasm ahorow no fã 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.[26][27]

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:[28] .

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[28] .

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.[28][29]

== 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 &quot;ɔsuasua kɛse.&quot;[30]

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.[31]

'''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.[30]

'''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.[32] 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.[33]

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.[30]

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 fĩ, anaasɛ hyponatremia, a ɛno nso betumi ama adwene mu tebea asakra, ɔfe, tiyɛ, anaa akisikuru.[34]

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 fã 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 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.[3] 5–10% a aka no fi awosu mu nneɛma.[3] 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 efĩ ara kwa.[38] 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 efĩ.[3][39] Ɛte sɛ nea adwene mu nhyɛso nyɛ asiane a ɛma kokoram fi ase,[40][41] ɛwom sɛ ebetumi ama nea efi mu ba no asɛe wɔ wɔn a wɔwɔ kokoram dedaw no mu de.[40]

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,[42] 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: Nsã 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.[43] Ɛsan nso de kokoram ba anom, ti, kɔn, yafunu, akisikuru, asaabo, ɛwo ne dwensɔtwaa mu.[44] Tawa wusiw wɔ nneɛma bɛboro aduonum a wonim sɛ ɛde kokoram ba, a nitrosamines ne polycyclic aromatic hydrocarbons ka ho.[45]

Tawa na ɛde kokoram wuwu bɛyɛ nnipa baanum biara mu biako wɔ wiase nyinaa[45] ne bɛyɛ baasa biara mu biako wɔ aman a wɔanya nkɔso no mu.[46] 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 .[47][48] 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.[49] Kokoram a efi nnuru a wɔde di dwuma wɔ adwuma mu mu ba no betumi ama wɔanya nsɛm no mu 2 kosi 20%,[50] anyɛ yiye koraa no, ebetumi ama nnipa 200,000 awuwu.[51] 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.[51]

Wonim sɛ sɛ obi nya perfluorooctanoic acid (PFOA) a wɔde di dwuma titiriw wɔ Teflon a wɔyɛ mu a, ɛde kokoram ahorow abien ba.[52][53]

'''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 fã 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 efĩ 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 fã 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.[3] Saa dodow yi fi 25% a ɛkorɔn wɔ Afrika kosi nea ennu 10% wɔ aman a wɔanya nkɔso no mu.[3] 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).[61]

'''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.[62][63][64] Honam ani kokoram pii a ɛnyɛ melanoma no fi mframa a ano yɛ den a ɛbɔ, a ne fã kɛse no ara fi owia hann mu.[63] Nneɛma a ɛma mframa bɔne a ɛma ɛyɛ hyew ba no bi ne aduruyɛ mu mfoninitwa ne radon mframa.[63]

Ionizing radiation nyɛ mutagen a ɛyɛ den titiriw.[65] 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.[65] Mframa a ɛbɔ no betumi de kokoram aba nipadua no afã 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.[66]

Sɛ obi nya ultraviolet mframa a efi owia mu bere tenten a, ebetumi ama wanya melanoma ne honam ani yare afoforo.[67] 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.[67]

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.[69] [62] 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.[70]

'''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.[71] 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,[71] 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,[72] 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.[73] Asiane a ɛne no hyia no yɛ 1.5 ma ahurututu mu kokoram,[74] ne 1.9 ma prostate kokoram.[75] 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.[76]

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.[77]

'''Honam fam nneɛma a wɔde yɛ nneɛma'''

Nneɛma bi de kokoram ba titiriw denam ne honam fam nkɛntɛnso so, sen sɛ ɛbɛyɛ nnuru.[78] 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.[78] Nneɛma nketenkete a ɛnyɛ fibrous a ɛde kokoram ba no bi ne powder metallic cobalt ne nickel ne crystalline silica (quartz, cristobalite ne tridymite).[78] 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.[78]

Nipadua mu apirakuru a ɛde kokoram ba no ntaa mma.[79] Sɛ nhwɛso no, wonnya nkyerɛɛ nsɛm a wɔka sɛ nnompe a ebubui no maa nnompe mu kokoram bae.[79] Saa ara nso na wonnye nipadua mu apirakuru ntom sɛ ɛde awotwaa mu kokoram, nufu mu kokoram anaa amemene mu kokoram ba.[79] Fibea biako a wogye tom ne nneɛma a ɛyɛ hyew a wɔtaa de gu nipadua no so bere tenten. Ebetumi aba sɛ nipadua no fã 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.[79] Sɛ wɔtaa nom tii a ɛyɛ hyew a ɛyɛ hyew a, ebetumi ama woanya kokoram wɔ aduan mu.[79] 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.[79][80] Ɔfe betumi aboa ma kokoram nkwammoaa no adɔɔso, atra ase, angiogenesis ne atutra denam nkɛntɛnso a enya wɔ tumor microenvironment no so.[81][82] Oncogenes no kyekye pro-tumorigenic microenvironment a ɛma ɔhyew.[83]

'''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.[85]

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.[84] 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.[84] 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.[84] 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 fã 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 fã 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 &quot;de wɔn ani asi&quot; 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 &quot;draiver&quot; mu nsakrae na nea aka no betumi ayɛ &quot;akwantufo&quot; 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 fã 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 fã 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 &quot;precursor&quot; 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 fã. 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 fã 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 fã 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 fã 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 fã.[190] &quot;Aduru a wɔde ka ho&quot; kyerɛ akwan ne nneɛma a wɔde di dwuma ka nnuru a wɔde di dwuma ho, bere a &quot;aduru foforo&quot; 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, &quot;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'.&quot;[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 fã 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 fã 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 fã 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, &quot;Sɛ yɛtra ase kyɛ a, anka yɛn nyinaa benya kokoram.&quot;[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 fã 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 &quot;ntini no trɛw wɔ afã nyinaa sɛnea aboa a krak no wɔ ne nan, baabi a onyaa ne din no&quot;.[215] Galen kae sɛ &quot;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&quot;.[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. Ná 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 (&quot;metastasis&quot;). 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 &quot;yare tenten&quot; 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 &quot;C-asɛmfua&quot;;[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 &quot;yare a wontumi nsa&quot;.[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 &quot;wɔko&quot; na ama &quot;ɔmanfo atuatew&quot; 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 &quot;kokoram nipasu&quot;—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 &quot;ɔpɛ&quot; 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 fã 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 &quot;kokoram aduru&quot; 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 &quot;dwetɛ tuo&quot; 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 &quot;Kokoram Ko&quot; 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 fã 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 fã 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]

== Mmoa afoforo ==
M</text>
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      <text bytes="78869" xml:space="preserve">'''Kokoram'''({{Audio|tw-Kokoram.ogg|pronounciation of &quot;kokoram&quot;}}) yɛ nyarewa kuw bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.&lt;ref name=&quot;:0&quot;&gt;https://www.who.int/en/news-room/fact-sheets/detail/cancer&lt;/ref&gt; &lt;ref name=&quot;:1&quot;&gt;https://www.cancer.gov/about-cancer/understanding/what-is-cancer&lt;/ref&gt;Eyinom ne akisikuru a ɛnyɛ hu a ɛntrɛw no bɔ abira.&lt;ref name=&quot;:1&quot; /&gt;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.&lt;ref name=&quot;:2&quot; /&gt;Bere a saa sɛnkyerɛnne ahorow yi betumi akyerɛ sɛ kokoram de, nanso ebetumi de nneɛma afoforo nso aba.&lt;ref name=&quot;:2&quot;&gt;http://www.nhs.uk/Conditions/Cancer/Pages/Symptoms.aspx&lt;/ref&gt;Kokoram ahorow bɛboro 100 na ɛka nnipa.&lt;ref name=&quot;:1&quot; /&gt; 

Tawa a wɔde di dwuma no na ɛde kokoram wuwu bɛyɛ 22% ba.&lt;ref name=&quot;:0&quot; /&gt;10% foforo nso fi kɛseyɛ mmoroso, aduan pa a wonni, apɔw-mu-teɛteɛ a wonnya anaasɛ nsa a wɔnom boro so.&lt;ref&gt;http://www.cancer.gov/about-cancer/causes-prevention/risk/obesity/obesity-fact-sheet#q3&lt;/ref&gt;&lt;ref name=&quot;:0&quot; /&gt; &lt;ref name=&quot;:3&quot;&gt;https://doi.org/10.1093%2Falcalc%2Fagv110&lt;/ref&gt;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 efĩ ba.&lt;ref name=&quot;:2&quot; /&gt; 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).&lt;ref name=&quot;:0&quot; /&gt;Anyɛ yiye koraa no, saa nneɛma yi yɛ adwuma, ne fã bi, denam nkwammoaa bi awosu mu nkwaadɔm a wɔsakra no so.&lt;ref name=&quot;:4&quot;&gt;https://en.m.wikipedia.org/wiki/Cancer#cite_note-WCR2014Bio-10&lt;/ref&gt;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.&lt;ref&gt;http://www.cancer.org/cancer/cancercauses/geneticsandcancer/heredity-and-cancer&lt;/ref&gt;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.&lt;ref name=&quot;:2&quot; /&gt;&lt;ref name=&quot;:3&quot; /&gt; Ɛyaw ne sɛnkyerɛnne ahorow a wɔde di dwuma no yɛ ɔhwɛ no fã titiriw.&lt;ref name=&quot;:0&quot; /&gt;Ayaresa a ɛma obi ho dwo no ho hia titiriw wɔ nnipa a wɔwɔ yare a emu yɛ den no mu.&lt;ref name=&quot;:1&quot; /&gt;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%.&lt;ref name=&quot;:3&quot; /&gt;

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.&lt;ref name=&quot;:4&quot; /&gt;

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.&lt;ref&gt;https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5055577&lt;/ref&gt; 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 no mu.[10] 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.[23] 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.[24]

== 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.[25]

Kokoram yɛ nyarewa abusua kɛse bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Wɔyɛ neoplasm ahorow no fã 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.[26][27]

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:[28] .

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[28] .

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.[28][29]

== 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 &quot;ɔsuasua kɛse.&quot;[30]

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.[31]

'''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.[30]

'''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.[32] 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.[33]

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.[30]

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 fĩ, anaasɛ hyponatremia, a ɛno nso betumi ama adwene mu tebea asakra, ɔfe, tiyɛ, anaa akisikuru.[34]

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 fã 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 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.[3] 5–10% a aka no fi awosu mu nneɛma.[3] 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 efĩ ara kwa.[38] 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 efĩ.[3][39] Ɛte sɛ nea adwene mu nhyɛso nyɛ asiane a ɛma kokoram fi ase,[40][41] ɛwom sɛ ebetumi ama nea efi mu ba no asɛe wɔ wɔn a wɔwɔ kokoram dedaw no mu de.[40]

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,[42] 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: Nsã 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.[43] Ɛsan nso de kokoram ba anom, ti, kɔn, yafunu, akisikuru, asaabo, ɛwo ne dwensɔtwaa mu.[44] Tawa wusiw wɔ nneɛma bɛboro aduonum a wonim sɛ ɛde kokoram ba, a nitrosamines ne polycyclic aromatic hydrocarbons ka ho.[45]

Tawa na ɛde kokoram wuwu bɛyɛ nnipa baanum biara mu biako wɔ wiase nyinaa[45] ne bɛyɛ baasa biara mu biako wɔ aman a wɔanya nkɔso no mu.[46] 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 .[47][48] 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.[49] Kokoram a efi nnuru a wɔde di dwuma wɔ adwuma mu mu ba no betumi ama wɔanya nsɛm no mu 2 kosi 20%,[50] anyɛ yiye koraa no, ebetumi ama nnipa 200,000 awuwu.[51] 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.[51]

Wonim sɛ sɛ obi nya perfluorooctanoic acid (PFOA) a wɔde di dwuma titiriw wɔ Teflon a wɔyɛ mu a, ɛde kokoram ahorow abien ba.[52][53]

'''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 fã 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 efĩ 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 fã 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.[3] Saa dodow yi fi 25% a ɛkorɔn wɔ Afrika kosi nea ennu 10% wɔ aman a wɔanya nkɔso no mu.[3] 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).[61]

'''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.[62][63][64] Honam ani kokoram pii a ɛnyɛ melanoma no fi mframa a ano yɛ den a ɛbɔ, a ne fã kɛse no ara fi owia hann mu.[63] Nneɛma a ɛma mframa bɔne a ɛma ɛyɛ hyew ba no bi ne aduruyɛ mu mfoninitwa ne radon mframa.[63]

Ionizing radiation nyɛ mutagen a ɛyɛ den titiriw.[65] 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.[65] Mframa a ɛbɔ no betumi de kokoram aba nipadua no afã 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.[66]

Sɛ obi nya ultraviolet mframa a efi owia mu bere tenten a, ebetumi ama wanya melanoma ne honam ani yare afoforo.[67] 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.[67]

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.[69] [62] 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.[70]

'''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.[71] 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,[71] 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,[72] 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.[73] Asiane a ɛne no hyia no yɛ 1.5 ma ahurututu mu kokoram,[74] ne 1.9 ma prostate kokoram.[75] 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.[76]

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.[77]

'''Honam fam nneɛma a wɔde yɛ nneɛma'''

Nneɛma bi de kokoram ba titiriw denam ne honam fam nkɛntɛnso so, sen sɛ ɛbɛyɛ nnuru.[78] 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.[78] Nneɛma nketenkete a ɛnyɛ fibrous a ɛde kokoram ba no bi ne powder metallic cobalt ne nickel ne crystalline silica (quartz, cristobalite ne tridymite).[78] 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.[78]

Nipadua mu apirakuru a ɛde kokoram ba no ntaa mma.[79] Sɛ nhwɛso no, wonnya nkyerɛɛ nsɛm a wɔka sɛ nnompe a ebubui no maa nnompe mu kokoram bae.[79] Saa ara nso na wonnye nipadua mu apirakuru ntom sɛ ɛde awotwaa mu kokoram, nufu mu kokoram anaa amemene mu kokoram ba.[79] Fibea biako a wogye tom ne nneɛma a ɛyɛ hyew a wɔtaa de gu nipadua no so bere tenten. Ebetumi aba sɛ nipadua no fã 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.[79] Sɛ wɔtaa nom tii a ɛyɛ hyew a ɛyɛ hyew a, ebetumi ama woanya kokoram wɔ aduan mu.[79] 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.[79][80] Ɔfe betumi aboa ma kokoram nkwammoaa no adɔɔso, atra ase, angiogenesis ne atutra denam nkɛntɛnso a enya wɔ tumor microenvironment no so.[81][82] Oncogenes no kyekye pro-tumorigenic microenvironment a ɛma ɔhyew.[83]

'''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.[85]

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.[84] 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.[84] 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.[84] 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 fã 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 fã 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 &quot;de wɔn ani asi&quot; 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 &quot;draiver&quot; mu nsakrae na nea aka no betumi ayɛ &quot;akwantufo&quot; 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 fã 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 fã 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 &quot;precursor&quot; 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 fã. 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 fã 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 fã 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 fã 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 fã.[190] &quot;Aduru a wɔde ka ho&quot; kyerɛ akwan ne nneɛma a wɔde di dwuma ka nnuru a wɔde di dwuma ho, bere a &quot;aduru foforo&quot; 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, &quot;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'.&quot;[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 fã 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 fã 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 fã 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, &quot;Sɛ yɛtra ase kyɛ a, anka yɛn nyinaa benya kokoram.&quot;[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 fã 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 &quot;ntini no trɛw wɔ afã nyinaa sɛnea aboa a krak no wɔ ne nan, baabi a onyaa ne din no&quot;.[215] Galen kae sɛ &quot;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&quot;.[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. Ná 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 (&quot;metastasis&quot;). 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 &quot;yare tenten&quot; 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 &quot;C-asɛmfua&quot;;[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 &quot;yare a wontumi nsa&quot;.[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 &quot;wɔko&quot; na ama &quot;ɔmanfo atuatew&quot; 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 &quot;kokoram nipasu&quot;—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 &quot;ɔpɛ&quot; 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 fã 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 &quot;kokoram aduru&quot; 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 &quot;dwetɛ tuo&quot; 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 &quot;Kokoram Ko&quot; 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 fã 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 fã 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]

== Mmoa afoforo ==
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      <text bytes="78912" xml:space="preserve">'''Kokoram'''({{Audio|tw-Kokoram.ogg|pronounciation of &quot;kokoram&quot;}}) yɛ nyarewa kuw bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.&lt;ref name=&quot;:0&quot;&gt;https://www.who.int/en/news-room/fact-sheets/detail/cancer&lt;/ref&gt; &lt;ref name=&quot;:1&quot;&gt;https://www.cancer.gov/about-cancer/understanding/what-is-cancer&lt;/ref&gt;Eyinom ne akisikuru a ɛnyɛ hu a ɛntrɛw no bɔ abira.&lt;ref name=&quot;:1&quot; /&gt;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.&lt;ref name=&quot;:2&quot; /&gt;Bere a saa sɛnkyerɛnne ahorow yi betumi akyerɛ sɛ kokoram de, nanso ebetumi de nneɛma afoforo nso aba.&lt;ref name=&quot;:2&quot;&gt;http://www.nhs.uk/Conditions/Cancer/Pages/Symptoms.aspx&lt;/ref&gt;Kokoram ahorow bɛboro 100 na ɛka nnipa.&lt;ref name=&quot;:1&quot; /&gt; 

Tawa a wɔde di dwuma no na ɛde kokoram wuwu bɛyɛ 22% ba.&lt;ref name=&quot;:0&quot; /&gt;10% foforo nso fi kɛseyɛ mmoroso, aduan pa a wonni, apɔw-mu-teɛteɛ a wonnya anaasɛ nsa a wɔnom boro so.&lt;ref&gt;http://www.cancer.gov/about-cancer/causes-prevention/risk/obesity/obesity-fact-sheet#q3&lt;/ref&gt;&lt;ref name=&quot;:0&quot; /&gt; &lt;ref name=&quot;:3&quot;&gt;https://doi.org/10.1093%2Falcalc%2Fagv110&lt;/ref&gt;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 efĩ ba.&lt;ref name=&quot;:2&quot; /&gt; 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).&lt;ref name=&quot;:0&quot; /&gt;Anyɛ yiye koraa no, saa nneɛma yi yɛ adwuma, ne fã bi, denam nkwammoaa bi awosu mu nkwaadɔm a wɔsakra no so.&lt;ref name=&quot;:4&quot;&gt;https://en.m.wikipedia.org/wiki/Cancer#cite_note-WCR2014Bio-10&lt;/ref&gt;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.&lt;ref&gt;http://www.cancer.org/cancer/cancercauses/geneticsandcancer/heredity-and-cancer&lt;/ref&gt;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.&lt;ref name=&quot;:2&quot; /&gt;&lt;ref name=&quot;:3&quot; /&gt; Ɛyaw ne sɛnkyerɛnne ahorow a wɔde di dwuma no yɛ ɔhwɛ no fã titiriw.&lt;ref name=&quot;:0&quot; /&gt;Ayaresa a ɛma obi ho dwo no ho hia titiriw wɔ nnipa a wɔwɔ yare a emu yɛ den no mu.&lt;ref name=&quot;:1&quot; /&gt;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%.&lt;ref name=&quot;:3&quot; /&gt;

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.&lt;ref name=&quot;:4&quot; /&gt;

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.&lt;ref&gt;https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5055577&lt;/ref&gt; 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 .&lt;ref&gt;https://doi.org/10.3322%2Fcaac.20107&lt;/ref&gt;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.[23] 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.[24]

== 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.[25]

Kokoram yɛ nyarewa abusua kɛse bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Wɔyɛ neoplasm ahorow no fã 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.[26][27]

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:[28] .

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[28] .

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.[28][29]

== 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 &quot;ɔsuasua kɛse.&quot;[30]

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.[31]

'''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.[30]

'''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.[32] 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.[33]

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.[30]

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 fĩ, anaasɛ hyponatremia, a ɛno nso betumi ama adwene mu tebea asakra, ɔfe, tiyɛ, anaa akisikuru.[34]

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 fã 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 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.[3] 5–10% a aka no fi awosu mu nneɛma.[3] 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 efĩ ara kwa.[38] 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 efĩ.[3][39] Ɛte sɛ nea adwene mu nhyɛso nyɛ asiane a ɛma kokoram fi ase,[40][41] ɛwom sɛ ebetumi ama nea efi mu ba no asɛe wɔ wɔn a wɔwɔ kokoram dedaw no mu de.[40]

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,[42] 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: Nsã 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.[43] Ɛsan nso de kokoram ba anom, ti, kɔn, yafunu, akisikuru, asaabo, ɛwo ne dwensɔtwaa mu.[44] Tawa wusiw wɔ nneɛma bɛboro aduonum a wonim sɛ ɛde kokoram ba, a nitrosamines ne polycyclic aromatic hydrocarbons ka ho.[45]

Tawa na ɛde kokoram wuwu bɛyɛ nnipa baanum biara mu biako wɔ wiase nyinaa[45] ne bɛyɛ baasa biara mu biako wɔ aman a wɔanya nkɔso no mu.[46] 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 .[47][48] 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.[49] Kokoram a efi nnuru a wɔde di dwuma wɔ adwuma mu mu ba no betumi ama wɔanya nsɛm no mu 2 kosi 20%,[50] anyɛ yiye koraa no, ebetumi ama nnipa 200,000 awuwu.[51] 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.[51]

Wonim sɛ sɛ obi nya perfluorooctanoic acid (PFOA) a wɔde di dwuma titiriw wɔ Teflon a wɔyɛ mu a, ɛde kokoram ahorow abien ba.[52][53]

'''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 fã 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 efĩ 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 fã 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.[3] Saa dodow yi fi 25% a ɛkorɔn wɔ Afrika kosi nea ennu 10% wɔ aman a wɔanya nkɔso no mu.[3] 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).[61]

'''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.[62][63][64] Honam ani kokoram pii a ɛnyɛ melanoma no fi mframa a ano yɛ den a ɛbɔ, a ne fã kɛse no ara fi owia hann mu.[63] Nneɛma a ɛma mframa bɔne a ɛma ɛyɛ hyew ba no bi ne aduruyɛ mu mfoninitwa ne radon mframa.[63]

Ionizing radiation nyɛ mutagen a ɛyɛ den titiriw.[65] 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.[65] Mframa a ɛbɔ no betumi de kokoram aba nipadua no afã 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.[66]

Sɛ obi nya ultraviolet mframa a efi owia mu bere tenten a, ebetumi ama wanya melanoma ne honam ani yare afoforo.[67] 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.[67]

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.[69] [62] 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.[70]

'''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.[71] 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,[71] 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,[72] 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.[73] Asiane a ɛne no hyia no yɛ 1.5 ma ahurututu mu kokoram,[74] ne 1.9 ma prostate kokoram.[75] 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.[76]

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.[77]

'''Honam fam nneɛma a wɔde yɛ nneɛma'''

Nneɛma bi de kokoram ba titiriw denam ne honam fam nkɛntɛnso so, sen sɛ ɛbɛyɛ nnuru.[78] 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.[78] Nneɛma nketenkete a ɛnyɛ fibrous a ɛde kokoram ba no bi ne powder metallic cobalt ne nickel ne crystalline silica (quartz, cristobalite ne tridymite).[78] 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.[78]

Nipadua mu apirakuru a ɛde kokoram ba no ntaa mma.[79] Sɛ nhwɛso no, wonnya nkyerɛɛ nsɛm a wɔka sɛ nnompe a ebubui no maa nnompe mu kokoram bae.[79] Saa ara nso na wonnye nipadua mu apirakuru ntom sɛ ɛde awotwaa mu kokoram, nufu mu kokoram anaa amemene mu kokoram ba.[79] Fibea biako a wogye tom ne nneɛma a ɛyɛ hyew a wɔtaa de gu nipadua no so bere tenten. Ebetumi aba sɛ nipadua no fã 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.[79] Sɛ wɔtaa nom tii a ɛyɛ hyew a ɛyɛ hyew a, ebetumi ama woanya kokoram wɔ aduan mu.[79] 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.[79][80] Ɔfe betumi aboa ma kokoram nkwammoaa no adɔɔso, atra ase, angiogenesis ne atutra denam nkɛntɛnso a enya wɔ tumor microenvironment no so.[81][82] Oncogenes no kyekye pro-tumorigenic microenvironment a ɛma ɔhyew.[83]

'''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.[85]

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.[84] 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.[84] 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.[84] 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 fã 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 fã 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 &quot;de wɔn ani asi&quot; 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 &quot;draiver&quot; mu nsakrae na nea aka no betumi ayɛ &quot;akwantufo&quot; 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 fã 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 fã 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 &quot;precursor&quot; 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 fã. 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 fã 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 fã 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 fã 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 fã.[190] &quot;Aduru a wɔde ka ho&quot; kyerɛ akwan ne nneɛma a wɔde di dwuma ka nnuru a wɔde di dwuma ho, bere a &quot;aduru foforo&quot; 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, &quot;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'.&quot;[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 fã 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 fã 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 fã 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, &quot;Sɛ yɛtra ase kyɛ a, anka yɛn nyinaa benya kokoram.&quot;[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 fã 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 &quot;ntini no trɛw wɔ afã nyinaa sɛnea aboa a krak no wɔ ne nan, baabi a onyaa ne din no&quot;.[215] Galen kae sɛ &quot;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&quot;.[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. Ná 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 (&quot;metastasis&quot;). 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 &quot;yare tenten&quot; 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 &quot;C-asɛmfua&quot;;[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 &quot;yare a wontumi nsa&quot;.[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 &quot;wɔko&quot; na ama &quot;ɔmanfo atuatew&quot; 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 &quot;kokoram nipasu&quot;—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 &quot;ɔpɛ&quot; 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 fã 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 &quot;kokoram aduru&quot; 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 &quot;dwetɛ tuo&quot; 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 &quot;Kokoram Ko&quot; 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 fã 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 fã 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]

== Mmoa afoforo ==
M</text>
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      <comment>Me de reference ka ho</comment>
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      <text bytes="79034" xml:space="preserve">'''Kokoram'''({{Audio|tw-Kokoram.ogg|pronounciation of &quot;kokoram&quot;}}) yɛ nyarewa kuw bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.&lt;ref name=&quot;:0&quot;&gt;https://www.who.int/en/news-room/fact-sheets/detail/cancer&lt;/ref&gt; &lt;ref name=&quot;:1&quot;&gt;https://www.cancer.gov/about-cancer/understanding/what-is-cancer&lt;/ref&gt;Eyinom ne akisikuru a ɛnyɛ hu a ɛntrɛw no bɔ abira.&lt;ref name=&quot;:1&quot; /&gt;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.&lt;ref name=&quot;:2&quot; /&gt;Bere a saa sɛnkyerɛnne ahorow yi betumi akyerɛ sɛ kokoram de, nanso ebetumi de nneɛma afoforo nso aba.&lt;ref name=&quot;:2&quot;&gt;http://www.nhs.uk/Conditions/Cancer/Pages/Symptoms.aspx&lt;/ref&gt;Kokoram ahorow bɛboro 100 na ɛka nnipa.&lt;ref name=&quot;:1&quot; /&gt; 

Tawa a wɔde di dwuma no na ɛde kokoram wuwu bɛyɛ 22% ba.&lt;ref name=&quot;:0&quot; /&gt;10% foforo nso fi kɛseyɛ mmoroso, aduan pa a wonni, apɔw-mu-teɛteɛ a wonnya anaasɛ nsa a wɔnom boro so.&lt;ref&gt;http://www.cancer.gov/about-cancer/causes-prevention/risk/obesity/obesity-fact-sheet#q3&lt;/ref&gt;&lt;ref name=&quot;:0&quot; /&gt; &lt;ref name=&quot;:3&quot;&gt;https://doi.org/10.1093%2Falcalc%2Fagv110&lt;/ref&gt;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 efĩ ba.&lt;ref name=&quot;:2&quot; /&gt; 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).&lt;ref name=&quot;:0&quot; /&gt;Anyɛ yiye koraa no, saa nneɛma yi yɛ adwuma, ne fã bi, denam nkwammoaa bi awosu mu nkwaadɔm a wɔsakra no so.&lt;ref name=&quot;:4&quot;&gt;https://en.m.wikipedia.org/wiki/Cancer#cite_note-WCR2014Bio-10&lt;/ref&gt;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.&lt;ref&gt;http://www.cancer.org/cancer/cancercauses/geneticsandcancer/heredity-and-cancer&lt;/ref&gt;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.&lt;ref name=&quot;:2&quot; /&gt;&lt;ref name=&quot;:3&quot; /&gt; Ɛyaw ne sɛnkyerɛnne ahorow a wɔde di dwuma no yɛ ɔhwɛ no fã titiriw.&lt;ref name=&quot;:0&quot; /&gt;Ayaresa a ɛma obi ho dwo no ho hia titiriw wɔ nnipa a wɔwɔ yare a emu yɛ den no mu.&lt;ref name=&quot;:1&quot; /&gt;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%.&lt;ref name=&quot;:3&quot; /&gt;

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.&lt;ref name=&quot;:4&quot; /&gt;

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.&lt;ref&gt;https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5055577&lt;/ref&gt; 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 .&lt;ref&gt;https://doi.org/10.3322%2Fcaac.20107&lt;/ref&gt;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.[23] 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.&lt;ref&gt;https://web.archive.org/web/20170712114430/http://www.searo.who.int/publications/bookstore/documents/9283204298/en/&lt;/ref&gt;

== 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.[25]

Kokoram yɛ nyarewa abusua kɛse bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Wɔyɛ neoplasm ahorow no fã 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.[26][27]

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:[28] .

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[28] .

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.[28][29]

== 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 &quot;ɔsuasua kɛse.&quot;[30]

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.[31]

'''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.[30]

'''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.[32] 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.[33]

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.[30]

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 fĩ, anaasɛ hyponatremia, a ɛno nso betumi ama adwene mu tebea asakra, ɔfe, tiyɛ, anaa akisikuru.[34]

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 fã 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 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.[3] 5–10% a aka no fi awosu mu nneɛma.[3] 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 efĩ ara kwa.[38] 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 efĩ.[3][39] Ɛte sɛ nea adwene mu nhyɛso nyɛ asiane a ɛma kokoram fi ase,[40][41] ɛwom sɛ ebetumi ama nea efi mu ba no asɛe wɔ wɔn a wɔwɔ kokoram dedaw no mu de.[40]

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,[42] 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: Nsã 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.[43] Ɛsan nso de kokoram ba anom, ti, kɔn, yafunu, akisikuru, asaabo, ɛwo ne dwensɔtwaa mu.[44] Tawa wusiw wɔ nneɛma bɛboro aduonum a wonim sɛ ɛde kokoram ba, a nitrosamines ne polycyclic aromatic hydrocarbons ka ho.[45]

Tawa na ɛde kokoram wuwu bɛyɛ nnipa baanum biara mu biako wɔ wiase nyinaa[45] ne bɛyɛ baasa biara mu biako wɔ aman a wɔanya nkɔso no mu.[46] 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 .[47][48] 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.[49] Kokoram a efi nnuru a wɔde di dwuma wɔ adwuma mu mu ba no betumi ama wɔanya nsɛm no mu 2 kosi 20%,[50] anyɛ yiye koraa no, ebetumi ama nnipa 200,000 awuwu.[51] 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.[51]

Wonim sɛ sɛ obi nya perfluorooctanoic acid (PFOA) a wɔde di dwuma titiriw wɔ Teflon a wɔyɛ mu a, ɛde kokoram ahorow abien ba.[52][53]

'''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 fã 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 efĩ 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 fã 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.[3] Saa dodow yi fi 25% a ɛkorɔn wɔ Afrika kosi nea ennu 10% wɔ aman a wɔanya nkɔso no mu.[3] 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).[61]

'''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.[62][63][64] Honam ani kokoram pii a ɛnyɛ melanoma no fi mframa a ano yɛ den a ɛbɔ, a ne fã kɛse no ara fi owia hann mu.[63] Nneɛma a ɛma mframa bɔne a ɛma ɛyɛ hyew ba no bi ne aduruyɛ mu mfoninitwa ne radon mframa.[63]

Ionizing radiation nyɛ mutagen a ɛyɛ den titiriw.[65] 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.[65] Mframa a ɛbɔ no betumi de kokoram aba nipadua no afã 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.[66]

Sɛ obi nya ultraviolet mframa a efi owia mu bere tenten a, ebetumi ama wanya melanoma ne honam ani yare afoforo.[67] 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.[67]

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.[69] [62] 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.[70]

'''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.[71] 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,[71] 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,[72] 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.[73] Asiane a ɛne no hyia no yɛ 1.5 ma ahurututu mu kokoram,[74] ne 1.9 ma prostate kokoram.[75] 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.[76]

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.[77]

'''Honam fam nneɛma a wɔde yɛ nneɛma'''

Nneɛma bi de kokoram ba titiriw denam ne honam fam nkɛntɛnso so, sen sɛ ɛbɛyɛ nnuru.[78] 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.[78] Nneɛma nketenkete a ɛnyɛ fibrous a ɛde kokoram ba no bi ne powder metallic cobalt ne nickel ne crystalline silica (quartz, cristobalite ne tridymite).[78] 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.[78]

Nipadua mu apirakuru a ɛde kokoram ba no ntaa mma.[79] Sɛ nhwɛso no, wonnya nkyerɛɛ nsɛm a wɔka sɛ nnompe a ebubui no maa nnompe mu kokoram bae.[79] Saa ara nso na wonnye nipadua mu apirakuru ntom sɛ ɛde awotwaa mu kokoram, nufu mu kokoram anaa amemene mu kokoram ba.[79] Fibea biako a wogye tom ne nneɛma a ɛyɛ hyew a wɔtaa de gu nipadua no so bere tenten. Ebetumi aba sɛ nipadua no fã 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.[79] Sɛ wɔtaa nom tii a ɛyɛ hyew a ɛyɛ hyew a, ebetumi ama woanya kokoram wɔ aduan mu.[79] 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.[79][80] Ɔfe betumi aboa ma kokoram nkwammoaa no adɔɔso, atra ase, angiogenesis ne atutra denam nkɛntɛnso a enya wɔ tumor microenvironment no so.[81][82] Oncogenes no kyekye pro-tumorigenic microenvironment a ɛma ɔhyew.[83]

'''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.[85]

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.[84] 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.[84] 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.[84] 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 fã 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 fã 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 &quot;de wɔn ani asi&quot; 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 &quot;draiver&quot; mu nsakrae na nea aka no betumi ayɛ &quot;akwantufo&quot; 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 fã 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 fã 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 &quot;precursor&quot; 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 fã. 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 fã 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 fã 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 fã 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 fã.[190] &quot;Aduru a wɔde ka ho&quot; kyerɛ akwan ne nneɛma a wɔde di dwuma ka nnuru a wɔde di dwuma ho, bere a &quot;aduru foforo&quot; 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, &quot;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'.&quot;[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 fã 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 fã 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 fã 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, &quot;Sɛ yɛtra ase kyɛ a, anka yɛn nyinaa benya kokoram.&quot;[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 fã 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 &quot;ntini no trɛw wɔ afã nyinaa sɛnea aboa a krak no wɔ ne nan, baabi a onyaa ne din no&quot;.[215] Galen kae sɛ &quot;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&quot;.[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. Ná 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 (&quot;metastasis&quot;). 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 &quot;yare tenten&quot; 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 &quot;C-asɛmfua&quot;;[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 &quot;yare a wontumi nsa&quot;.[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 &quot;wɔko&quot; na ama &quot;ɔmanfo atuatew&quot; 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 &quot;kokoram nipasu&quot;—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 &quot;ɔpɛ&quot; 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 fã 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 &quot;kokoram aduru&quot; 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 &quot;dwetɛ tuo&quot; 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 &quot;Kokoram Ko&quot; 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 fã 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 fã 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]

== Mmoa afoforo ==
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      <text bytes="79029" xml:space="preserve">'''Kokoram'''({{Audio|tw-Kokoram.ogg|pronounciation of &quot;kokoram&quot;}}) yɛ nyarewa kuw bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.&lt;ref name=&quot;:0&quot;&gt;https://www.who.int/en/news-room/fact-sheets/detail/cancer&lt;/ref&gt; &lt;ref name=&quot;:1&quot;&gt;https://www.cancer.gov/about-cancer/understanding/what-is-cancer&lt;/ref&gt;Eyinom ne akisikuru a ɛnyɛ hu a ɛntrɛw no bɔ abira.&lt;ref name=&quot;:1&quot; /&gt;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.&lt;ref name=&quot;:2&quot; /&gt;Bere a saa sɛnkyerɛnne ahorow yi betumi akyerɛ sɛ kokoram de, nanso ebetumi de nneɛma afoforo nso aba.&lt;ref name=&quot;:2&quot;&gt;http://www.nhs.uk/Conditions/Cancer/Pages/Symptoms.aspx&lt;/ref&gt;Kokoram ahorow bɛboro 100 na ɛka nnipa.&lt;ref name=&quot;:1&quot; /&gt; 

Tawa a wɔde di dwuma no na ɛde kokoram wuwu bɛyɛ 22% ba.&lt;ref name=&quot;:0&quot; /&gt;10% foforo nso fi kɛseyɛ mmoroso, aduan pa a wonni, apɔw-mu-teɛteɛ a wonnya anaasɛ nsa a wɔnom boro so.&lt;ref&gt;http://www.cancer.gov/about-cancer/causes-prevention/risk/obesity/obesity-fact-sheet#q3&lt;/ref&gt;&lt;ref name=&quot;:0&quot; /&gt; &lt;ref name=&quot;:3&quot;&gt;https://doi.org/10.1093%2Falcalc%2Fagv110&lt;/ref&gt;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 efĩ ba.&lt;ref name=&quot;:2&quot; /&gt; 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).&lt;ref name=&quot;:0&quot; /&gt;Anyɛ yiye koraa no, saa nneɛma yi yɛ adwuma, ne fã bi, denam nkwammoaa bi awosu mu nkwaadɔm a wɔsakra no so.&lt;ref name=&quot;:4&quot;&gt;https://en.m.wikipedia.org/wiki/Cancer#cite_note-WCR2014Bio-10&lt;/ref&gt;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.&lt;ref&gt;http://www.cancer.org/cancer/cancercauses/geneticsandcancer/heredity-and-cancer&lt;/ref&gt;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.&lt;ref name=&quot;:2&quot; /&gt;&lt;ref name=&quot;:3&quot; /&gt; Ɛyaw ne sɛnkyerɛnne ahorow a wɔde di dwuma no yɛ ɔhwɛ no fã titiriw.&lt;ref name=&quot;:0&quot; /&gt;Ayaresa a ɛma obi ho dwo no ho hia titiriw wɔ nnipa a wɔwɔ yare a emu yɛ den no mu.&lt;ref name=&quot;:1&quot; /&gt;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%.&lt;ref name=&quot;:3&quot; /&gt;

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.&lt;ref name=&quot;:4&quot; /&gt;

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.&lt;ref&gt;https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5055577&lt;/ref&gt; 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 .&lt;ref&gt;https://doi.org/10.3322%2Fcaac.20107&lt;/ref&gt;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.&lt;ref&gt;https://web.archive.org/web/20170712114430/http://www.searo.who.int/publications/bookstore/documents/9283204298/en/&lt;/ref&gt;

== 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.[25]

Kokoram yɛ nyarewa abusua kɛse bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Wɔyɛ neoplasm ahorow no fã 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.[26][27]

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:[28] .

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[28] .

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.[28][29]

== 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 &quot;ɔsuasua kɛse.&quot;[30]

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.[31]

'''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.[30]

'''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.[32] 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.[33]

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.[30]

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 fĩ, anaasɛ hyponatremia, a ɛno nso betumi ama adwene mu tebea asakra, ɔfe, tiyɛ, anaa akisikuru.[34]

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 fã 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 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.[3] 5–10% a aka no fi awosu mu nneɛma.[3] 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 efĩ ara kwa.[38] 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 efĩ.[3][39] Ɛte sɛ nea adwene mu nhyɛso nyɛ asiane a ɛma kokoram fi ase,[40][41] ɛwom sɛ ebetumi ama nea efi mu ba no asɛe wɔ wɔn a wɔwɔ kokoram dedaw no mu de.[40]

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,[42] 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: Nsã 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.[43] Ɛsan nso de kokoram ba anom, ti, kɔn, yafunu, akisikuru, asaabo, ɛwo ne dwensɔtwaa mu.[44] Tawa wusiw wɔ nneɛma bɛboro aduonum a wonim sɛ ɛde kokoram ba, a nitrosamines ne polycyclic aromatic hydrocarbons ka ho.[45]

Tawa na ɛde kokoram wuwu bɛyɛ nnipa baanum biara mu biako wɔ wiase nyinaa[45] ne bɛyɛ baasa biara mu biako wɔ aman a wɔanya nkɔso no mu.[46] 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 .[47][48] 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.[49] Kokoram a efi nnuru a wɔde di dwuma wɔ adwuma mu mu ba no betumi ama wɔanya nsɛm no mu 2 kosi 20%,[50] anyɛ yiye koraa no, ebetumi ama nnipa 200,000 awuwu.[51] 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.[51]

Wonim sɛ sɛ obi nya perfluorooctanoic acid (PFOA) a wɔde di dwuma titiriw wɔ Teflon a wɔyɛ mu a, ɛde kokoram ahorow abien ba.[52][53]

'''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 fã 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 efĩ 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 fã 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.[3] Saa dodow yi fi 25% a ɛkorɔn wɔ Afrika kosi nea ennu 10% wɔ aman a wɔanya nkɔso no mu.[3] 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).[61]

'''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.[62][63][64] Honam ani kokoram pii a ɛnyɛ melanoma no fi mframa a ano yɛ den a ɛbɔ, a ne fã kɛse no ara fi owia hann mu.[63] Nneɛma a ɛma mframa bɔne a ɛma ɛyɛ hyew ba no bi ne aduruyɛ mu mfoninitwa ne radon mframa.[63]

Ionizing radiation nyɛ mutagen a ɛyɛ den titiriw.[65] 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.[65] Mframa a ɛbɔ no betumi de kokoram aba nipadua no afã 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.[66]

Sɛ obi nya ultraviolet mframa a efi owia mu bere tenten a, ebetumi ama wanya melanoma ne honam ani yare afoforo.[67] 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.[67]

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.[69] [62] 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.[70]

'''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.[71] 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,[71] 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,[72] 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.[73] Asiane a ɛne no hyia no yɛ 1.5 ma ahurututu mu kokoram,[74] ne 1.9 ma prostate kokoram.[75] 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.[76]

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.[77]

'''Honam fam nneɛma a wɔde yɛ nneɛma'''

Nneɛma bi de kokoram ba titiriw denam ne honam fam nkɛntɛnso so, sen sɛ ɛbɛyɛ nnuru.[78] 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.[78] Nneɛma nketenkete a ɛnyɛ fibrous a ɛde kokoram ba no bi ne powder metallic cobalt ne nickel ne crystalline silica (quartz, cristobalite ne tridymite).[78] 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.[78]

Nipadua mu apirakuru a ɛde kokoram ba no ntaa mma.[79] Sɛ nhwɛso no, wonnya nkyerɛɛ nsɛm a wɔka sɛ nnompe a ebubui no maa nnompe mu kokoram bae.[79] Saa ara nso na wonnye nipadua mu apirakuru ntom sɛ ɛde awotwaa mu kokoram, nufu mu kokoram anaa amemene mu kokoram ba.[79] Fibea biako a wogye tom ne nneɛma a ɛyɛ hyew a wɔtaa de gu nipadua no so bere tenten. Ebetumi aba sɛ nipadua no fã 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.[79] Sɛ wɔtaa nom tii a ɛyɛ hyew a ɛyɛ hyew a, ebetumi ama woanya kokoram wɔ aduan mu.[79] 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.[79][80] Ɔfe betumi aboa ma kokoram nkwammoaa no adɔɔso, atra ase, angiogenesis ne atutra denam nkɛntɛnso a enya wɔ tumor microenvironment no so.[81][82] Oncogenes no kyekye pro-tumorigenic microenvironment a ɛma ɔhyew.[83]

'''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.[85]

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.[84] 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.[84] 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.[84] 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 fã 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 fã 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 &quot;de wɔn ani asi&quot; 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 &quot;draiver&quot; mu nsakrae na nea aka no betumi ayɛ &quot;akwantufo&quot; 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 fã 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 fã 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 &quot;precursor&quot; 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 fã. 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 fã 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 fã 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 fã 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 fã.[190] &quot;Aduru a wɔde ka ho&quot; kyerɛ akwan ne nneɛma a wɔde di dwuma ka nnuru a wɔde di dwuma ho, bere a &quot;aduru foforo&quot; 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, &quot;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'.&quot;[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 fã 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 fã 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 fã 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, &quot;Sɛ yɛtra ase kyɛ a, anka yɛn nyinaa benya kokoram.&quot;[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 fã 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 &quot;ntini no trɛw wɔ afã nyinaa sɛnea aboa a krak no wɔ ne nan, baabi a onyaa ne din no&quot;.[215] Galen kae sɛ &quot;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&quot;.[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. Ná 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 (&quot;metastasis&quot;). 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 &quot;yare tenten&quot; 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 &quot;C-asɛmfua&quot;;[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 &quot;yare a wontumi nsa&quot;.[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 &quot;wɔko&quot; na ama &quot;ɔmanfo atuatew&quot; 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 &quot;kokoram nipasu&quot;—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 &quot;ɔpɛ&quot; 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 fã 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 &quot;kokoram aduru&quot; 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 &quot;dwetɛ tuo&quot; 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 &quot;Kokoram Ko&quot; 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 fã 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 fã 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]

== Mmoa afoforo ==
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      <text bytes="79037" xml:space="preserve">'''Kokoram'''({{Audio|tw-Kokoram.ogg|pronounciation of &quot;kokoram&quot;}}) yɛ nyarewa kuw bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.&lt;ref name=&quot;:0&quot;&gt;https://www.who.int/en/news-room/fact-sheets/detail/cancer&lt;/ref&gt; &lt;ref name=&quot;:1&quot;&gt;https://www.cancer.gov/about-cancer/understanding/what-is-cancer&lt;/ref&gt;Eyinom ne akisikuru a ɛnyɛ hu a ɛntrɛw no bɔ abira.&lt;ref name=&quot;:1&quot; /&gt;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.&lt;ref name=&quot;:2&quot; /&gt;Bere a saa sɛnkyerɛnne ahorow yi betumi akyerɛ sɛ kokoram de, nanso ebetumi de nneɛma afoforo nso aba.&lt;ref name=&quot;:2&quot;&gt;http://www.nhs.uk/Conditions/Cancer/Pages/Symptoms.aspx&lt;/ref&gt;Kokoram ahorow bɛboro 100 na ɛka nnipa.&lt;ref name=&quot;:1&quot; /&gt; 

Tawa a wɔde di dwuma no na ɛde kokoram wuwu bɛyɛ 22% ba.&lt;ref name=&quot;:0&quot; /&gt;10% foforo nso fi kɛseyɛ mmoroso, aduan pa a wonni, apɔw-mu-teɛteɛ a wonnya anaasɛ nsa a wɔnom boro so.&lt;ref&gt;http://www.cancer.gov/about-cancer/causes-prevention/risk/obesity/obesity-fact-sheet#q3&lt;/ref&gt;&lt;ref name=&quot;:0&quot; /&gt; &lt;ref name=&quot;:3&quot;&gt;https://doi.org/10.1093%2Falcalc%2Fagv110&lt;/ref&gt;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 efĩ ba.&lt;ref name=&quot;:2&quot; /&gt; 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).&lt;ref name=&quot;:0&quot; /&gt;Anyɛ yiye koraa no, saa nneɛma yi yɛ adwuma, ne fã bi, denam nkwammoaa bi awosu mu nkwaadɔm a wɔsakra no so.&lt;ref name=&quot;:4&quot;&gt;https://en.m.wikipedia.org/wiki/Cancer#cite_note-WCR2014Bio-10&lt;/ref&gt;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.&lt;ref&gt;http://www.cancer.org/cancer/cancercauses/geneticsandcancer/heredity-and-cancer&lt;/ref&gt;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.&lt;ref name=&quot;:2&quot; /&gt;&lt;ref name=&quot;:3&quot; /&gt; Ɛyaw ne sɛnkyerɛnne ahorow a wɔde di dwuma no yɛ ɔhwɛ no fã titiriw.&lt;ref name=&quot;:0&quot; /&gt;Ayaresa a ɛma obi ho dwo no ho hia titiriw wɔ nnipa a wɔwɔ yare a emu yɛ den no mu.&lt;ref name=&quot;:1&quot; /&gt;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%.&lt;ref name=&quot;:3&quot; /&gt;

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.&lt;ref name=&quot;:4&quot; /&gt;

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.&lt;ref&gt;https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5055577&lt;/ref&gt; 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 .&lt;ref&gt;https://doi.org/10.3322%2Fcaac.20107&lt;/ref&gt;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.&lt;ref&gt;https://web.archive.org/web/20170712114430/http://www.searo.who.int/publications/bookstore/documents/9283204298/en/&lt;/ref&gt;

== 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.[25]

Kokoram yɛ nyarewa abusua kɛse bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.[2][7] Wɔyɛ neoplasm ahorow no fã 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.[26][27]

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:[28] .

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[28] .

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.[28][29]

== 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 &quot;ɔsuasua kɛse.&quot;[30]

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.[31]

'''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.[30]

'''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.[32] 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.[33]

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.[30]

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 fĩ, anaasɛ hyponatremia, a ɛno nso betumi ama adwene mu tebea asakra, ɔfe, tiyɛ, anaa akisikuru.[34]

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 fã 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 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.[3] 5–10% a aka no fi awosu mu nneɛma.[3] 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 efĩ ara kwa.[38] 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 efĩ.[3][39] Ɛte sɛ nea adwene mu nhyɛso nyɛ asiane a ɛma kokoram fi ase,[40][41] ɛwom sɛ ebetumi ama nea efi mu ba no asɛe wɔ wɔn a wɔwɔ kokoram dedaw no mu de.[40]

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,[42] 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: Nsã 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.[43] Ɛsan nso de kokoram ba anom, ti, kɔn, yafunu, akisikuru, asaabo, ɛwo ne dwensɔtwaa mu.[44] Tawa wusiw wɔ nneɛma bɛboro aduonum a wonim sɛ ɛde kokoram ba, a nitrosamines ne polycyclic aromatic hydrocarbons ka ho.[45]

Tawa na ɛde kokoram wuwu bɛyɛ nnipa baanum biara mu biako wɔ wiase nyinaa[45] ne bɛyɛ baasa biara mu biako wɔ aman a wɔanya nkɔso no mu.[46] 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 .[47][48] 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.[49] Kokoram a efi nnuru a wɔde di dwuma wɔ adwuma mu mu ba no betumi ama wɔanya nsɛm no mu 2 kosi 20%,[50] anyɛ yiye koraa no, ebetumi ama nnipa 200,000 awuwu.[51] 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.[51]

Wonim sɛ sɛ obi nya perfluorooctanoic acid (PFOA) a wɔde di dwuma titiriw wɔ Teflon a wɔyɛ mu a, ɛde kokoram ahorow abien ba.[52][53]

'''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 fã 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 efĩ 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 fã 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.[3] Saa dodow yi fi 25% a ɛkorɔn wɔ Afrika kosi nea ennu 10% wɔ aman a wɔanya nkɔso no mu.[3] 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).[61]

'''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.[62][63][64] Honam ani kokoram pii a ɛnyɛ melanoma no fi mframa a ano yɛ den a ɛbɔ, a ne fã kɛse no ara fi owia hann mu.[63] Nneɛma a ɛma mframa bɔne a ɛma ɛyɛ hyew ba no bi ne aduruyɛ mu mfoninitwa ne radon mframa.[63]

Ionizing radiation nyɛ mutagen a ɛyɛ den titiriw.[65] 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.[65] Mframa a ɛbɔ no betumi de kokoram aba nipadua no afã 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.[66]

Sɛ obi nya ultraviolet mframa a efi owia mu bere tenten a, ebetumi ama wanya melanoma ne honam ani yare afoforo.[67] 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.[67]

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.[69] [62] 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.[70]

'''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.[71] 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,[71] 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,[72] 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.[73] Asiane a ɛne no hyia no yɛ 1.5 ma ahurututu mu kokoram,[74] ne 1.9 ma prostate kokoram.[75] 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.[76]

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.[77]

'''Honam fam nneɛma a wɔde yɛ nneɛma'''

Nneɛma bi de kokoram ba titiriw denam ne honam fam nkɛntɛnso so, sen sɛ ɛbɛyɛ nnuru.[78] 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.[78] Nneɛma nketenkete a ɛnyɛ fibrous a ɛde kokoram ba no bi ne powder metallic cobalt ne nickel ne crystalline silica (quartz, cristobalite ne tridymite).[78] 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.[78]

Nipadua mu apirakuru a ɛde kokoram ba no ntaa mma.[79] Sɛ nhwɛso no, wonnya nkyerɛɛ nsɛm a wɔka sɛ nnompe a ebubui no maa nnompe mu kokoram bae.[79] Saa ara nso na wonnye nipadua mu apirakuru ntom sɛ ɛde awotwaa mu kokoram, nufu mu kokoram anaa amemene mu kokoram ba.[79] Fibea biako a wogye tom ne nneɛma a ɛyɛ hyew a wɔtaa de gu nipadua no so bere tenten. Ebetumi aba sɛ nipadua no fã 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.[79] Sɛ wɔtaa nom tii a ɛyɛ hyew a ɛyɛ hyew a, ebetumi ama woanya kokoram wɔ aduan mu.[79] 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.[79][80] Ɔfe betumi aboa ma kokoram nkwammoaa no adɔɔso, atra ase, angiogenesis ne atutra denam nkɛntɛnso a enya wɔ tumor microenvironment no so.[81][82] Oncogenes no kyekye pro-tumorigenic microenvironment a ɛma ɔhyew.[83]

'''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.[85]

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.[84] 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.[84] 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.[84] 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 fã 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 fã 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 &quot;de wɔn ani asi&quot; 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 &quot;draiver&quot; mu nsakrae na nea aka no betumi ayɛ &quot;akwantufo&quot; 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 fã 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 fã 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 &quot;precursor&quot; 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 fã. 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 fã 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 fã 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 fã 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 fã.[190] &quot;Aduru a wɔde ka ho&quot; kyerɛ akwan ne nneɛma a wɔde di dwuma ka nnuru a wɔde di dwuma ho, bere a &quot;aduru foforo&quot; 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, &quot;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'.&quot;[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 fã 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 fã 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 fã 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, &quot;Sɛ yɛtra ase kyɛ a, anka yɛn nyinaa benya kokoram.&quot;[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 fã 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 &quot;ntini no trɛw wɔ afã nyinaa sɛnea aboa a krak no wɔ ne nan, baabi a onyaa ne din no&quot;.[215] Galen kae sɛ &quot;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&quot;.[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. Ná 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 (&quot;metastasis&quot;). 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 &quot;yare tenten&quot; 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 &quot;C-asɛmfua&quot;;[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 &quot;yare a wontumi nsa&quot;.[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 &quot;wɔko&quot; na ama &quot;ɔmanfo atuatew&quot; 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 &quot;kokoram nipasu&quot;—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 &quot;ɔpɛ&quot; 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 fã 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 &quot;kokoram aduru&quot; 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 &quot;dwetɛ tuo&quot; 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 &quot;Kokoram Ko&quot; 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 fã 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 fã 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]

== Beaɛ a Menye firiɛ ==
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      <text bytes="79119" xml:space="preserve">'''Kokoram'''({{Audio|tw-Kokoram.ogg|pronounciation of &quot;kokoram&quot;}}) yɛ nyarewa kuw bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.&lt;ref name=&quot;:0&quot;&gt;https://www.who.int/en/news-room/fact-sheets/detail/cancer&lt;/ref&gt; &lt;ref name=&quot;:1&quot;&gt;https://www.cancer.gov/about-cancer/understanding/what-is-cancer&lt;/ref&gt;Eyinom ne akisikuru a ɛnyɛ hu a ɛntrɛw no bɔ abira.&lt;ref name=&quot;:1&quot; /&gt;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.&lt;ref name=&quot;:2&quot; /&gt;Bere a saa sɛnkyerɛnne ahorow yi betumi akyerɛ sɛ kokoram de, nanso ebetumi de nneɛma afoforo nso aba.&lt;ref name=&quot;:2&quot;&gt;http://www.nhs.uk/Conditions/Cancer/Pages/Symptoms.aspx&lt;/ref&gt;Kokoram ahorow bɛboro 100 na ɛka nnipa.&lt;ref name=&quot;:1&quot; /&gt; 

Tawa a wɔde di dwuma no na ɛde kokoram wuwu bɛyɛ 22% ba.&lt;ref name=&quot;:0&quot; /&gt;10% foforo nso fi kɛseyɛ mmoroso, aduan pa a wonni, apɔw-mu-teɛteɛ a wonnya anaasɛ nsa a wɔnom boro so.&lt;ref&gt;http://www.cancer.gov/about-cancer/causes-prevention/risk/obesity/obesity-fact-sheet#q3&lt;/ref&gt;&lt;ref name=&quot;:0&quot; /&gt; &lt;ref name=&quot;:3&quot;&gt;https://doi.org/10.1093%2Falcalc%2Fagv110&lt;/ref&gt;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 efĩ ba.&lt;ref name=&quot;:2&quot; /&gt; 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).&lt;ref name=&quot;:0&quot; /&gt;Anyɛ yiye koraa no, saa nneɛma yi yɛ adwuma, ne fã bi, denam nkwammoaa bi awosu mu nkwaadɔm a wɔsakra no so.&lt;ref name=&quot;:4&quot;&gt;https://en.m.wikipedia.org/wiki/Cancer#cite_note-WCR2014Bio-10&lt;/ref&gt;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.&lt;ref name=&quot;:5&quot;&gt;http://www.cancer.org/cancer/cancercauses/geneticsandcancer/heredity-and-cancer&lt;/ref&gt;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.&lt;ref name=&quot;:2&quot; /&gt;&lt;ref name=&quot;:3&quot; /&gt; Ɛyaw ne sɛnkyerɛnne ahorow a wɔde di dwuma no yɛ ɔhwɛ no fã titiriw.&lt;ref name=&quot;:0&quot; /&gt;Ayaresa a ɛma obi ho dwo no ho hia titiriw wɔ nnipa a wɔwɔ yare a emu yɛ den no mu.&lt;ref name=&quot;:1&quot; /&gt;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%.&lt;ref name=&quot;:3&quot; /&gt;

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.&lt;ref name=&quot;:4&quot; /&gt;

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.&lt;ref&gt;https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5055577&lt;/ref&gt; 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 .&lt;ref&gt;https://doi.org/10.3322%2Fcaac.20107&lt;/ref&gt;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.&lt;ref&gt;https://web.archive.org/web/20170712114430/http://www.searo.who.int/publications/bookstore/documents/9283204298/en/&lt;/ref&gt;

== 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.&lt;ref&gt;https://www.etymonline.com/word/cancer&lt;/ref&gt;

Kokoram yɛ nyarewa abusua kɛse bi a ɛfa nkwammoaa nyin a ɛnteɛ a ebetumi akɔ nipadua no afã afoforo so anaasɛ ɛbɛtrɛw mu.&lt;ref name=&quot;:1&quot; /&gt;&lt;ref name=&quot;:5&quot; /&gt;Wɔyɛ neoplasm ahorow no fã 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.[26][27]

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:[28] .

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[28] .

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.[28][29]

== 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 &quot;ɔsuasua kɛse.&quot;[30]

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.[31]

'''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.[30]

'''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.[32] 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.[33]

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.[30]

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 fĩ, anaasɛ hyponatremia, a ɛno nso betumi ama adwene mu tebea asakra, ɔfe, tiyɛ, anaa akisikuru.[34]

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 fã 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 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.[3] 5–10% a aka no fi awosu mu nneɛma.[3] 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 efĩ ara kwa.[38] 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 efĩ.[3][39] Ɛte sɛ nea adwene mu nhyɛso nyɛ asiane a ɛma kokoram fi ase,[40][41] ɛwom sɛ ebetumi ama nea efi mu ba no asɛe wɔ wɔn a wɔwɔ kokoram dedaw no mu de.[40]

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,[42] 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: Nsã 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.[43] Ɛsan nso de kokoram ba anom, ti, kɔn, yafunu, akisikuru, asaabo, ɛwo ne dwensɔtwaa mu.[44] Tawa wusiw wɔ nneɛma bɛboro aduonum a wonim sɛ ɛde kokoram ba, a nitrosamines ne polycyclic aromatic hydrocarbons ka ho.[45]

Tawa na ɛde kokoram wuwu bɛyɛ nnipa baanum biara mu biako wɔ wiase nyinaa[45] ne bɛyɛ baasa biara mu biako wɔ aman a wɔanya nkɔso no mu.[46] 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 .[47][48] 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.[49] Kokoram a efi nnuru a wɔde di dwuma wɔ adwuma mu mu ba no betumi ama wɔanya nsɛm no mu 2 kosi 20%,[50] anyɛ yiye koraa no, ebetumi ama nnipa 200,000 awuwu.[51] 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.[51]

Wonim sɛ sɛ obi nya perfluorooctanoic acid (PFOA) a wɔde di dwuma titiriw wɔ Teflon a wɔyɛ mu a, ɛde kokoram ahorow abien ba.[52][53]

'''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 fã 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 efĩ 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 fã 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.[3] Saa dodow yi fi 25% a ɛkorɔn wɔ Afrika kosi nea ennu 10% wɔ aman a wɔanya nkɔso no mu.[3] 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).[61]

'''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.[62][63][64] Honam ani kokoram pii a ɛnyɛ melanoma no fi mframa a ano yɛ den a ɛbɔ, a ne fã kɛse no ara fi owia hann mu.[63] Nneɛma a ɛma mframa bɔne a ɛma ɛyɛ hyew ba no bi ne aduruyɛ mu mfoninitwa ne radon mframa.[63]

Ionizing radiation nyɛ mutagen a ɛyɛ den titiriw.[65] 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.[65] Mframa a ɛbɔ no betumi de kokoram aba nipadua no afã 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.[66]

Sɛ obi nya ultraviolet mframa a efi owia mu bere tenten a, ebetumi ama wanya melanoma ne honam ani yare afoforo.[67] 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.[67]

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.[69] [62] 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.[70]

'''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.[71] 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,[71] 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,[72] 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.[73] Asiane a ɛne no hyia no yɛ 1.5 ma ahurututu mu kokoram,[74] ne 1.9 ma prostate kokoram.[75] 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.[76]

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.[77]

'''Honam fam nneɛma a wɔde yɛ nneɛma'''

Nneɛma bi de kokoram ba titiriw denam ne honam fam nkɛntɛnso so, sen sɛ ɛbɛyɛ nnuru.[78] 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.[78] Nneɛma nketenkete a ɛnyɛ fibrous a ɛde kokoram ba no bi ne powder metallic cobalt ne nickel ne crystalline silica (quartz, cristobalite ne tridymite).[78] 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.[78]

Nipadua mu apirakuru a ɛde kokoram ba no ntaa mma.[79] Sɛ nhwɛso no, wonnya nkyerɛɛ nsɛm a wɔka sɛ nnompe a ebubui no maa nnompe mu kokoram bae.[79] Saa ara nso na wonnye nipadua mu apirakuru ntom sɛ ɛde awotwaa mu kokoram, nufu mu kokoram anaa amemene mu kokoram ba.[79] Fibea biako a wogye tom ne nneɛma a ɛyɛ hyew a wɔtaa de gu nipadua no so bere tenten. Ebetumi aba sɛ nipadua no fã 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.[79] Sɛ wɔtaa nom tii a ɛyɛ hyew a ɛyɛ hyew a, ebetumi ama woanya kokoram wɔ aduan mu.[79] 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.[79][80] Ɔfe betumi aboa ma kokoram nkwammoaa no adɔɔso, atra ase, angiogenesis ne atutra denam nkɛntɛnso a enya wɔ tumor microenvironment no so.[81][82] Oncogenes no kyekye pro-tumorigenic microenvironment a ɛma ɔhyew.[83]

'''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.[85]

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.[84] 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.[84] 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.[84] 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 fã 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 fã 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 &quot;de wɔn ani asi&quot; 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 &quot;draiver&quot; mu nsakrae na nea aka no betumi ayɛ &quot;akwantufo&quot; 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 fã 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 fã 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 &quot;precursor&quot; 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 fã. 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 fã 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 fã 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 fã 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 fã.[190] &quot;Aduru a wɔde ka ho&quot; kyerɛ akwan ne nneɛma a wɔde di dwuma ka nnuru a wɔde di dwuma ho, bere a &quot;aduru foforo&quot; 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, &quot;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'.&quot;[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 fã 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 fã 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 fã 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, &quot;Sɛ yɛtra ase kyɛ a, anka yɛn nyinaa benya kokoram.&quot;[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 fã 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 &quot;ntini no trɛw wɔ afã nyinaa sɛnea aboa a krak no wɔ ne nan, baabi a onyaa ne din no&quot;.[215] Galen kae sɛ &quot;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&quot;.[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. Ná 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 (&quot;metastasis&quot;). 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 &quot;yare tenten&quot; 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 &quot;C-asɛmfua&quot;;[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 &quot;yare a wontumi nsa&quot;.[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 &quot;wɔko&quot; na ama &quot;ɔmanfo atuatew&quot; 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 &quot;kokoram nipasu&quot;—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 &quot;ɔpɛ&quot; 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 fã 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 &quot;kokoram aduru&quot; 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 &quot;dwetɛ tuo&quot; 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 &quot;Kokoram Ko&quot; 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 fã 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 fã 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]

== Beaɛ a Menye firiɛ ==
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      <text bytes="978" xml:space="preserve">Nkran pupuni mantam mantam du nsia a ɛwɔ Ghana no mu ketewa,a ɛgye asaase bɛyɛ mpem mmiɛnsa,ahanu ne aduanan num.&lt;ref&gt;http://www.ghanahealthservice.org/ghs-region.php?ghs&amp;ghsrid=1&lt;/ref&gt; Wei yɛ asaase a ɛwɔ Ghana no mu ɔhamu nkyekyɛmu baako akyiripɔ nan. Ɛyɛ mantam a ɛtɔso mmienu a ɛwɔ nnipa dɔm paa ara, ɛkyɛn Asante Mantam a ɛwɔ nnipa bɛyɛ ɔpepem num, ahanan ne aduonum num, ahansia aduokron mmienu wɔ mfeɛ mpem mmienu ne aduonu baako a ɛyɛ ɔhamu nkyekyɛmu du nson akyiripɔ nson.&lt;ref&gt;http://statsghana.gov.gh/docfiles/2010phc/Census2010_Summary_report_of_final_results.pdf&lt;/ref&gt; Nkran pupuni mantam yɛ mantam a ɛwɔ kurom wɔ ɔman no mu a wɔn dodoɔ yɛ ɔhamu nkyekyɛmu aduowɔtwe nson akyiripɔ nan a wɔte kurom.&lt;ref&gt;http://pubs.iied.org/pdfs/G02540.pdf&lt;/ref&gt;Nkran pupuni mantam ahenkuro ne Nkran a ɛno ara na ɛyɛ Ghana ahenkuro.

&lt;ref&gt;https://web.archive.org/web/20101102185900/http://www.ghanadistricts.com/region/?r=1&amp;sa=26&lt;/ref&gt;</text>
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      <text bytes="1360" xml:space="preserve">Nkran pupuni mantam mantam du nsia a ɛwɔ Ghana no mu ketewa,a ɛgye asaase bɛyɛ mpem mmiɛnsa,ahanu ne aduanan num.&lt;ref&gt;http://www.ghanahealthservice.org/ghs-region.php?ghs&amp;ghsrid=1&lt;/ref&gt; Wei yɛ asaase a ɛwɔ Ghana no mu ɔhamu nkyekyɛmu baako akyiripɔ nan. Ɛyɛ mantam a ɛtɔso mmienu a ɛwɔ nnipa dɔm paa ara, ɛkyɛn Asante Mantam a ɛwɔ nnipa bɛyɛ ɔpepem num, ahanan ne aduonum num, ahansia aduokron mmienu wɔ mfeɛ mpem mmienu ne aduonu baako a ɛyɛ ɔhamu nkyekyɛmu du nson akyiripɔ nson.&lt;ref&gt;http://statsghana.gov.gh/docfiles/2010phc/Census2010_Summary_report_of_final_results.pdf&lt;/ref&gt; Nkran pupuni mantam yɛ mantam a ɛwɔ kurom wɔ ɔman no mu a wɔn dodoɔ yɛ ɔhamu nkyekyɛmu aduowɔtwe nson akyiripɔ nan a wɔte kurom.&lt;ref&gt;http://pubs.iied.org/pdfs/G02540.pdf&lt;/ref&gt;Nkran pupuni mantam ahenkuro ne Nkran a ɛno ara na ɛyɛ Ghana ahenkuro.

== Abakɔsɛm ==
Wɔ afe apem ahankron ne aduosia mu no, Nkran pupuni mantam a na wɔfrɛ no Accra capital District, na ɛka apueɛ mantam ho. Ɔsoafoɔ a ɔhwɛ nkurase so no tee mu. Ɛhyɛɛ aseɛ firii ɔsanaa bosome da a ɛtɔ so aduonu mmienu mu no, Greater Accra Region Law(PNDCL 26) na ɔtee nkran mantam sɛ mantam a wɔnam mmara kwan so ate mu.&lt;ref name=&quot;:0&quot; /&gt;

&lt;ref name=&quot;:0&quot;&gt;https://web.archive.org/web/20101102185900/http://www.ghanadistricts.com/region/?r=1&amp;sa=26&lt;/ref&gt;</text>
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      <text bytes="1371" xml:space="preserve">Nkran pupuni mantam mantam du nsia a ɛwɔ Ghana no mu ketewa,a ɛgye asaase bɛyɛ mpem mmiɛnsa,ahanu ne aduanan num.&lt;ref&gt;http://www.ghanahealthservice.org/ghs-region.php?ghs&amp;ghsrid=1&lt;/ref&gt; Wei yɛ asaase a ɛwɔ Ghana no mu ɔhamu nkyekyɛmu baako akyiripɔ nan. Ɛyɛ mantam a ɛtɔso mmienu a ɛwɔ nnipa dɔm paa ara, ɛkyɛn Asante Mantam a ɛwɔ nnipa bɛyɛ ɔpepem num, ahanan ne aduonum num, ahansia aduokron mmienu wɔ mfeɛ mpem mmienu ne aduonu baako a ɛyɛ ɔhamu nkyekyɛmu du nson akyiripɔ nson.&lt;ref&gt;http://statsghana.gov.gh/docfiles/2010phc/Census2010_Summary_report_of_final_results.pdf&lt;/ref&gt; Nkran pupuni mantam yɛ mantam a ɛwɔ kurom wɔ ɔman no mu a wɔn dodoɔ yɛ ɔhamu nkyekyɛmu aduowɔtwe nson akyiripɔ nan a wɔte kurom.&lt;ref&gt;http://pubs.iied.org/pdfs/G02540.pdf&lt;/ref&gt;Nkran pupuni mantam ahenkuro ne Nkran a ɛno ara na ɛyɛ Ghana ahenkuro.

== Abakɔsɛm ==
Wɔ afe apem ahankron ne aduosia mu no, Nkran pupuni mantam a na wɔfrɛ no Accra capital District, na ɛka apueɛ mantam ho. Ɔsoafoɔ a ɔhwɛ nkurase so no tee mu. Ɛhyɛɛ aseɛ firii ɔsanaa bosome da a ɛtɔ so aduonu mmienu mu no, Greater Accra Region Law(PNDCL 26) na ɔtee nkran mantam sɛ mantam a wɔnam mmara kwan so ate mu.&lt;ref name=&quot;:0&quot; /&gt;

&lt;ref name=&quot;:0&quot;&gt;https://web.archive.org/web/20101102185900/http://www.ghanadistricts.com/region/?r=1&amp;sa=26&lt;/ref&gt;

Geography</text>
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      <text bytes="1582" xml:space="preserve">Nkran pupuni mantam mantam du nsia a ɛwɔ Ghana no mu ketewa,a ɛgye asaase bɛyɛ mpem mmiɛnsa,ahanu ne aduanan num.&lt;ref&gt;http://www.ghanahealthservice.org/ghs-region.php?ghs&amp;ghsrid=1&lt;/ref&gt; Wei yɛ asaase a ɛwɔ Ghana no mu ɔhamu nkyekyɛmu baako akyiripɔ nan. Ɛyɛ mantam a ɛtɔso mmienu a ɛwɔ nnipa dɔm paa ara, ɛkyɛn Asante Mantam a ɛwɔ nnipa bɛyɛ ɔpepem num, ahanan ne aduonum num, ahansia aduokron mmienu wɔ mfeɛ mpem mmienu ne aduonu baako a ɛyɛ ɔhamu nkyekyɛmu du nson akyiripɔ nson.&lt;ref&gt;http://statsghana.gov.gh/docfiles/2010phc/Census2010_Summary_report_of_final_results.pdf&lt;/ref&gt; Nkran pupuni mantam yɛ mantam a ɛwɔ kurom wɔ ɔman no mu a wɔn dodoɔ yɛ ɔhamu nkyekyɛmu aduowɔtwe nson akyiripɔ nan a wɔte kurom.&lt;ref&gt;http://pubs.iied.org/pdfs/G02540.pdf&lt;/ref&gt;Nkran pupuni mantam ahenkuro ne Nkran a ɛno ara na ɛyɛ Ghana ahenkuro.

== Abakɔsɛm ==
Wɔ afe apem ahankron ne aduosia mu no, Nkran pupuni mantam a na wɔfrɛ no Accra capital District, na ɛka apueɛ mantam ho. Ɔsoafoɔ a ɔhwɛ nkurase so no tee mu. Ɛhyɛɛ aseɛ firii ɔsanaa bosome da a ɛtɔ so aduonu mmienu mu no, Greater Accra Region Law(PNDCL 26) na ɔtee nkran mantam sɛ mantam a wɔnam mmara kwan so ate mu.&lt;ref name=&quot;:0&quot; /&gt;

&lt;ref name=&quot;:0&quot;&gt;https://web.archive.org/web/20101102185900/http://www.ghanadistricts.com/region/?r=1&amp;sa=26&lt;/ref&gt;

Geography

Location and size

Nkran pupuni mantam ne apueɛ mantam North, Fram mantam wɔ East, Gulf of Gyinae wɔ south na mfimfini mantam wɔ west na ɛbɔ ahyeɛ. Ɛyɛ mantam a ɛsua wɔ Ghana na ɛwɔ mmaeɛ du nsia</text>
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      <text bytes="2383" xml:space="preserve">Nkran pupuni mantam mantam du nsia a ɛwɔ Ghana no mu ketewa,a ɛgye asaase bɛyɛ mpem mmiɛnsa,ahanu ne aduanan num.&lt;ref&gt;http://www.ghanahealthservice.org/ghs-region.php?ghs&amp;ghsrid=1&lt;/ref&gt; Wei yɛ asaase a ɛwɔ Ghana no mu ɔhamu nkyekyɛmu baako akyiripɔ nan. Ɛyɛ mantam a ɛtɔso mmienu a ɛwɔ nnipa dɔm paa ara, ɛkyɛn Asante Mantam a ɛwɔ nnipa bɛyɛ ɔpepem num, ahanan ne aduonum num, ahansia aduokron mmienu wɔ mfeɛ mpem mmienu ne aduonu baako a ɛyɛ ɔhamu nkyekyɛmu du nson akyiripɔ nson.&lt;ref&gt;http://statsghana.gov.gh/docfiles/2010phc/Census2010_Summary_report_of_final_results.pdf&lt;/ref&gt; Nkran pupuni mantam yɛ mantam a ɛwɔ kurom wɔ ɔman no mu a wɔn dodoɔ yɛ ɔhamu nkyekyɛmu aduowɔtwe nson akyiripɔ nan a wɔte kurom.&lt;ref&gt;http://pubs.iied.org/pdfs/G02540.pdf&lt;/ref&gt;Nkran pupuni mantam ahenkuro ne Nkran a ɛno ara na ɛyɛ Ghana ahenkuro.

== Abakɔsɛm ==
Wɔ afe apem ahankron ne aduosia mu no, Nkran pupuni mantam a na wɔfrɛ no Accra capital District, na ɛka apueɛ mantam ho. Ɔsoafoɔ a ɔhwɛ nkurase so no tee mu. Ɛhyɛɛ aseɛ firii ɔsanaa bosome da a ɛtɔ so aduonu mmienu mu no, Greater Accra Region Law(PNDCL 26) na ɔtee nkran mantam sɛ mantam a wɔnam mmara kwan so ate mu.&lt;ref name=&quot;:0&quot; /&gt;

&lt;ref name=&quot;:0&quot;&gt;https://web.archive.org/web/20101102185900/http://www.ghanadistricts.com/region/?r=1&amp;sa=26&lt;/ref&gt;

== Geography ==
'''Location and size'''

Nkran pupuni mantam ne apueɛ mantam North, Fram mantam wɔ East, Gulf of Gyinae wɔ south na mfimfini mantam wɔ west na ɛbɔ ahyeɛ. Ɛyɛ mantam a ɛsua wɔ Ghana na ɛwɔ mmaeɛ du nsia

== Nsrahwɛ ==

=== Parks ===

* Shai Reserve
* Lakeside Marina Park&lt;ref&gt;https://beautifulghana.com/listing/lakeside-marina-park/&lt;/ref&gt;
* Kwame Nkrumah Memorial Park
* Efua Sutherland Children's Park

=== Recreation areas ===

* National Museum
* La Pleasure Beach
* Kokrobite Beach
* Coco Beach Resort
* Cocoloco Beach
* Korle Beach Resort
* Next Door Beach Resort
* Manet Paradise
* Ada Paradise Beach
* Ningo-Prampram Beach
* Rufus Green Parks
* Labadi Beach
* Laboma Beach
* Titanic Beach
* Bojo Beach
* Sandbox beach Club
* Afrikiko
* Bloombar

=== National monuments ===

* National Theater
* Independence Square
* Accra International Conference Center
* Center for National Culture

=== National historic sites ===

* Kwame Nkrumah Mausoleum
* Osu Castle
* National Museum of Ghana</text>
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      <comment>Created page with &quot;{{Infobox medical condition (new)|name=Itch|synonyms=|image=Itch 01.JPG|caption=A man scratching his back|pronounce=|field=[[Dermatology]]|symptoms=[[Scratch reflex|Compulsion to scratch]] an irritated area of skin|complications=|onset=|duration=|types=|causes=Various skin disorders, environmental factors, allergy, skin infections, reduced excretion behaviour other medical conditions|risks=[[Dry skin]]|diagnosis=Often based on the causes of itching|differential=[[Pain]]|...&quot;</comment>
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      <text bytes="576" xml:space="preserve">{{Infobox medical condition (new)|name=Itch|synonyms=|image=Itch 01.JPG|caption=A man scratching his back|pronounce=|field=[[Dermatology]]|symptoms=[[Scratch reflex|Compulsion to scratch]] an irritated area of skin|complications=|onset=|duration=|types=|causes=Various skin disorders, environmental factors, allergy, skin infections, reduced excretion behaviour other medical conditions|risks=[[Dry skin]]|diagnosis=Often based on the causes of itching|differential=[[Pain]]|prevention=|treatment=[[Antipruritic]]s, [[phototherapy]]|medication=|prognosis=|frequency=|deaths=}}</text>
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'''Itch''' (also known as '''pruritus''') is a sensation that causes the desire or [[reflex]] to scratch.&lt;ref name=&quot;andersen&quot;&gt;{{cite journal|vauthors=Andersen HH, Elberling J, Arendt-Nielsen L|title=Human surrogate models of histaminergic and non-histaminergic itch|journal=Acta Dermato-Venereologica|volume=95|issue=7|pages=771–777|date=September 2015|pmid=26015312|doi=10.2340/00015555-2146|doi-access=free}}&lt;/ref&gt; Itch has resisted many attempts to be classified as any one type of [[Sensory system|sensory]] experience. Itch has many similarities to [[pain]], and while both are unpleasant [[Sensory system|sensory]] experiences, their behavioral response patterns are different. Pain creates a [[withdrawal reflex]], whereas itch leads to a [[scratch reflex]].&lt;ref name=&quot;ikoma&quot;&gt;{{cite journal|vauthors=Ikoma A, Steinhoff M, Ständer S, Yosipovitch G, Schmelz M|display-authors=3|title=The neurobiology of itch|journal=Nature Reviews. Neuroscience|volume=7|issue=7|pages=535–547|date=July 2006|pmid=16791143|doi=10.1038/nrn1950|s2cid=9373105}}&lt;/ref&gt;

Unmyelinated [[nerve fibers]] for itch and pain both originate in the [[skin]]; however, information for them is conveyed centrally in two distinct systems that both use the same [[nerve]] bundle and [[spinothalamic tract]].&lt;ref&gt;{{cite journal|vauthors=Greaves MW, Khalifa N|title=Itch: more than skin deep|journal=International Archives of Allergy and Immunology|volume=135|issue=2|pages=166–172|date=October 2004|pmid=15375326|doi=10.1159/000080898|s2cid=13376216}}&lt;/ref&gt;</text>
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'''Itch''' (also known as '''pruritus''') is a sensation that causes the desire or [[reflex]] to scratch.&lt;ref name=&quot;andersen&quot;&gt;{{cite journal|vauthors=Andersen HH, Elberling J, Arendt-Nielsen L|title=Human surrogate models of histaminergic and non-histaminergic itch|journal=Acta Dermato-Venereologica|volume=95|issue=7|pages=771–777|date=September 2015|pmid=26015312|doi=10.2340/00015555-2146|doi-access=free}}&lt;/ref&gt; Itch has resisted many attempts to be classified as any one type of [[Sensory system|sensory]] experience. Itch has many similarities to [[pain]], and while both are unpleasant [[Sensory system|sensory]] experiences, their behavioral response patterns are different. Pain creates a [[withdrawal reflex]], whereas itch leads to a [[scratch reflex]].&lt;ref name=&quot;ikoma&quot;&gt;{{cite journal|vauthors=Ikoma A, Steinhoff M, Ständer S, Yosipovitch G, Schmelz M|display-authors=3|title=The neurobiology of itch|journal=Nature Reviews. Neuroscience|volume=7|issue=7|pages=535–547|date=July 2006|pmid=16791143|doi=10.1038/nrn1950|s2cid=9373105}}&lt;/ref&gt;

Unmyelinated [[nerve fibers]] for itch and pain both originate in the [[skin]]; however, information for them is conveyed centrally in two distinct systems that both use the same [[nerve]] bundle and [[spinothalamic tract]].&lt;ref&gt;{{cite journal|vauthors=Greaves MW, Khalifa N|title=Itch: more than skin deep|journal=International Archives of Allergy and Immunology|volume=135|issue=2|pages=166–172|date=October 2004|pmid=15375326|doi=10.1159/000080898|s2cid=13376216}}&lt;/ref&gt;

== Classification ==
Most commonly, an itch is felt in one place. If it is felt all over the body, then it is called ''generalized itch'' or ''generalized pruritus''.&lt;ref name=&quot;:0&quot;&gt;{{cite journal|vauthors=Molkara S, Sabourirad S, Molooghi K|title=Infectious differential diagnosis of chronic generalized pruritus without primary cutaneous lesions: a review of the literature|journal=International Journal of Dermatology|volume=59|pages=30–36|date=July 2019|pmid=31364165|doi=10.1111/ijd.14587|s2cid=198998956}}&lt;/ref&gt;

If the sensation of itching persists for six weeks or longer, then it is called ''chronic itch'' or ''chronic pruritus''.&lt;ref name=&quot;:0&quot;&gt;{{cite journal|vauthors=Molkara S, Sabourirad S, Molooghi K|title=Infectious differential diagnosis of chronic generalized pruritus without primary cutaneous lesions: a review of the literature|journal=International Journal of Dermatology|volume=59|pages=30–36|date=July 2019|pmid=31364165|doi=10.1111/ijd.14587|s2cid=198998956}}&lt;/ref&gt;&lt;ref&gt;{{cite journal|vauthors=Harrison IP, Spada F|title=Breaking the Itch-Scratch Cycle: Topical Options for the Management of Chronic Cutaneous Itch in Atopic Dermatitis|journal=Medicines|volume=6|issue=3|page=76|date=July 2019|pmid=31323753|pmc=6789602|doi=10.3390/medicines6030076|doi-access=free}}&lt;/ref&gt; ''Chronic idiopathic pruritus'' or ''essential pruritus'' is a rare form of itch that persists for longer than six weeks, and for which [[Idiopathic disease|no clear cause can be identified]].&lt;ref&gt;{{cite journal|vauthors=Erickson S, Nahmias Z, Rosman IS, Kim BS|title=Immunomodulating Agents as Antipruritics|journal=Dermatologic Clinics|volume=36|issue=3|pages=325–334|date=July 2018|pmid=29929604|doi=10.1016/j.det.2018.02.014|s2cid=49336771}}&lt;/ref&gt;&lt;ref&gt;{{Cite book|vauthors=Hinkle JL, Cheever KH|url=https://books.google.com/books?id=yS7vDwAAQBAJ&amp;pg=PA1269|title=Brunner and Suddarth's Textbook of Medical-Surgical Nursing|date=2018-08-30|publisher=Wolters kluwer india Pvt Ltd|isbn=978-93-87963-72-6|pages=1269|language=en}}&lt;/ref&gt;</text>
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'''Itch''' (also known as '''pruritus''') is a sensation that causes the desire or [[reflex]] to scratch.&lt;ref name=&quot;andersen&quot;&gt;{{cite journal|vauthors=Andersen HH, Elberling J, Arendt-Nielsen L|title=Human surrogate models of histaminergic and non-histaminergic itch|journal=Acta Dermato-Venereologica|volume=95|issue=7|pages=771–777|date=September 2015|pmid=26015312|doi=10.2340/00015555-2146|doi-access=free}}&lt;/ref&gt; Itch has resisted many attempts to be classified as any one type of [[Sensory system|sensory]] experience. Itch has many similarities to [[pain]], and while both are unpleasant [[Sensory system|sensory]] experiences, their behavioral response patterns are different. Pain creates a [[withdrawal reflex]], whereas itch leads to a [[scratch reflex]].&lt;ref name=&quot;ikoma&quot;&gt;{{cite journal|vauthors=Ikoma A, Steinhoff M, Ständer S, Yosipovitch G, Schmelz M|display-authors=3|title=The neurobiology of itch|journal=Nature Reviews. Neuroscience|volume=7|issue=7|pages=535–547|date=July 2006|pmid=16791143|doi=10.1038/nrn1950|s2cid=9373105}}&lt;/ref&gt;

Unmyelinated [[nerve fibers]] for itch and pain both originate in the [[skin]]; however, information for them is conveyed centrally in two distinct systems that both use the same [[nerve]] bundle and [[spinothalamic tract]].&lt;ref&gt;{{cite journal|vauthors=Greaves MW, Khalifa N|title=Itch: more than skin deep|journal=International Archives of Allergy and Immunology|volume=135|issue=2|pages=166–172|date=October 2004|pmid=15375326|doi=10.1159/000080898|s2cid=13376216}}&lt;/ref&gt;

== Classification ==
Most commonly, an itch is felt in one place. If it is felt all over the body, then it is called ''generalized itch'' or ''generalized pruritus''.&lt;ref name=&quot;:0&quot;&gt;{{cite journal|vauthors=Molkara S, Sabourirad S, Molooghi K|title=Infectious differential diagnosis of chronic generalized pruritus without primary cutaneous lesions: a review of the literature|journal=International Journal of Dermatology|volume=59|pages=30–36|date=July 2019|pmid=31364165|doi=10.1111/ijd.14587|s2cid=198998956}}&lt;/ref&gt;

If the sensation of itching persists for six weeks or longer, then it is called ''chronic itch'' or ''chronic pruritus''.&lt;ref name=&quot;:0&quot;&gt;{{cite journal|vauthors=Molkara S, Sabourirad S, Molooghi K|title=Infectious differential diagnosis of chronic generalized pruritus without primary cutaneous lesions: a review of the literature|journal=International Journal of Dermatology|volume=59|pages=30–36|date=July 2019|pmid=31364165|doi=10.1111/ijd.14587|s2cid=198998956}}&lt;/ref&gt;&lt;ref&gt;{{cite journal|vauthors=Harrison IP, Spada F|title=Breaking the Itch-Scratch Cycle: Topical Options for the Management of Chronic Cutaneous Itch in Atopic Dermatitis|journal=Medicines|volume=6|issue=3|page=76|date=July 2019|pmid=31323753|pmc=6789602|doi=10.3390/medicines6030076|doi-access=free}}&lt;/ref&gt; ''Chronic idiopathic pruritus'' or ''essential pruritus'' is a rare form of itch that persists for longer than six weeks, and for which [[Idiopathic disease|no clear cause can be identified]].&lt;ref&gt;{{cite journal|vauthors=Erickson S, Nahmias Z, Rosman IS, Kim BS|title=Immunomodulating Agents as Antipruritics|journal=Dermatologic Clinics|volume=36|issue=3|pages=325–334|date=July 2018|pmid=29929604|doi=10.1016/j.det.2018.02.014|s2cid=49336771}}&lt;/ref&gt;&lt;ref&gt;{{Cite book|vauthors=Hinkle JL, Cheever KH|url=https://books.google.com/books?id=yS7vDwAAQBAJ&amp;pg=PA1269|title=Brunner and Suddarth's Textbook of Medical-Surgical Nursing|date=2018-08-30|publisher=Wolters kluwer india Pvt Ltd|isbn=978-93-87963-72-6|pages=1269|language=en}}&lt;/ref&gt;

== Causes ==
[[File:Scabies-burrow.jpg|link=https://en.wikipedia.org/wiki/File:Scabies-burrow.jpg|thumb|[[Scabies]] is one cause of itching.]]
[[File:CercariaDermatitis.JPG|link=https://en.wikipedia.org/wiki/File:CercariaDermatitis.JPG|thumb|[[Swimmer's itch]]]]
[[File:Tinea_pedis_interdigitalis.jpg|link=https://en.wikipedia.org/wiki/File:Tinea_pedis_interdigitalis.jpg|thumb|[[Athlete's foot]] (showing the toes from below plus the front part of the sole)]]

=== Infections ===

* [[Body louse]], found in substandard living conditions
* [[Cutaneous larva migrans]], a skin disease
* [[Head lice]], if limited to the neck and scalp
* [[Herpes]], a viral disease
* [[Insect bite|Insect bites]], such as those from [[mosquitos]] or [[chiggers]]
* [[Pubic lice]], if limited to the [[genital area]]
* [[Scabies]], especially when several other persons in close contact also itch
* [[Shaving#Razor%20burn|Shaving]], which may irritate the skin
* [[Swimmer's itch]], a short-term immune reaction
* [[Chickenpox|Varicella]]&amp;nbsp;– i.e. chickenpox, prevalent among young children and highly contagious
* [[Tungiasis]], ectoparasite of skin

=== Environmental and allergic ===

* [[Allergic reaction]] to contact with specific chemicals, such as [[urushiol]], derived from [[poison ivy]] or [[poison oak]], or [[Balsam of Peru]], found in many foods and fragrances.&lt;ref&gt;{{cite journal|vauthors=Pfützner W, Thomas P, Niedermeier A, Pfeiffer C, Sander C, Przybilla B|display-authors=3|title=Systemic contact dermatitis elicited by oral intake of Balsam of Peru|journal=Acta Dermato-Venereologica|volume=83|issue=4|pages=294–295|date=2003-02-20|pmid=12926805|doi=10.1080/00015550310016599|doi-access=free}}&lt;/ref&gt;&lt;ref&gt;{{cite journal|vauthors=Usatine RP, Riojas M|title=Diagnosis and management of contact dermatitis|journal=American Family Physician|volume=82|issue=3|pages=249–255|date=August 2010|pmid=20672788|url=http://www.aafp.org/afp/2010/0801/p249.html|access-date=2014-04-09|publisher=Aafp.org}}&lt;/ref&gt; Certain allergens may be diagnosed in a [[patch test]].&lt;ref&gt;{{cite book|url=https://books.google.com/books?id=QhWgKgiT6FoC&amp;pg=PA329|title=Metalworking Fluids|edition=Second|publisher=CRC Press|isbn=142001773X|date=2006|author=Byers, Jerry P.}}&lt;/ref&gt;&lt;ref&gt;{{cite book|url=https://books.google.com/books?id=Me5rAAAAMAAJ&amp;q=pruritus+%22patch+test%22|title=Introduction to clinical allergy|vauthors=Feingold BF|veditors=Byers JP|publisher=the University of Michigan|date=1973|isbn=0398027978}}&lt;/ref&gt;
* [[Foreign Body|Foreign objects]] on the skin are the most common cause of non-pathological itching.
* [[Photodermatitis]]&amp;nbsp;– [[sunlight]] reacts with chemicals in the skin, leading to the formation of irritant metabolites.
* [[Urticaria]] (also called [[hives]]) usually causes itching.

=== Skin disorders ===

* [[Dandruff]]; an unusually large amount of flaking is associated with this sensation.
* [[Punctate palmoplantar keratoderma]], a group of disorders characterized by abnormal thickening of the palms and soles.
* [[Skin condition|Skin conditions]] (such as [[psoriasis]], [[eczema]], [[seborrhoeic dermatitis]], [[sunburn]], [[athlete's foot]], and [[hidradenitis suppurativa]]). Most are of an inflammatory nature.
* [[Wound healing|Scab]] healing, [[scar]] growth, and the development or emergence of [[Melanocytic nevus|moles]], [[Pimple|pimples]], and [[Ingrown hair|ingrown hairs]] from below the epidermis.
* [[Xerosis]]: dry skin, frequently seen in the winter and also associated with older age, frequent bathing in hot showers or baths, and high-temperature and low-humidity environments.

=== Other medical disorders ===

* [[Diabetes mellitus]], a group of metabolic diseases in which a person has high blood sugar
* [[Hyperparathyroidism]], overactivity of the parathyroid glands resulting in excess production of parathyroid hormone (PTH)&lt;ref&gt;LaBagnara, James. [http://www.emedicine.com/ent/TOPIC299.HTM eMedicine&amp;nbsp;–Hyperparathyroidism]. emedicine.com&lt;/ref&gt;
* [[Iron deficiency anemia]], a common anemia (low red blood cell or hemoglobin levels)
* [[Cholestasis]], where bile acids leaking into the serum activate peripheral opioid receptors, resulting in the characteristic generalized, severe itching
* [[Jaundice]], where excess bilirubin (hyperbilirubinemia) irritates nerves in the skin{{Citation needed|date=September 2021}}
* [[Malignancy]] or internal cancer, such as [[lymphoma]] or [[Hodgkin's disease]]&lt;ref name=&quot;ReferenceA&quot;&gt;{{cite journal|vauthors=Botero F|title=Pruritus as a manifestation of systemic disorders|journal=Cutis|volume=21|issue=6|pages=873–880|date=June 1978|pmid=657843}}&lt;/ref&gt;
* [[Polycythemia]], which can cause generalized itching due to increased histamines
* [[Psychiatric]] disease (&quot;[[Psychogenic disease|psychogenic]] itch&quot;, as may be seen in [[delusional parasitosis]])
* [[Thyroid]] illness
* [[Uraemia]]&amp;nbsp;– the itching sensation this causes is known as [[uremic pruritus]]

=== Medication ===

* Drugs (such as [[opioids]]) that activate histamine (H1) receptors or trigger histamine release
* [[Chloroquine]], a drug used in the treatment and prevention of [[malaria]]
* [[Bile acid]] congeners such as obeticholic acid

=== Related to pregnancy ===

* [[Gestational pemphigoid]], a dermatosis of pregnancy
* [[Intrahepatic cholestasis of pregnancy]], a medical condition in which cholestasis occurs
* [[Pruritic urticarial papules and plaques of pregnancy]] (PUPPP), a chronic hives-like rash

=== Other ===

* [[Menopause]], or changes in hormonal balances associated with aging
* [[Terminal illness]]&lt;ref name=&quot;:1&quot;&gt;{{cite journal|vauthors=Siemens W, Xander C, Meerpohl JJ, Buroh S, Antes G, Schwarzer G, Becker G|display-authors=3|title=Pharmacological interventions for pruritus in adult palliative care patients|journal=The Cochrane Database of Systematic Reviews|volume=11|issue=11|pages=CD008320|date=November 2016|pmid=27849111|pmc=6734122|doi=10.1002/14651858.CD008320.pub3}}&lt;/ref&gt;</text>
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'''Itch''' (also known as '''pruritus''') is a sensation that causes the desire or [[reflex]] to scratch.&lt;ref name=&quot;andersen&quot;&gt;{{cite journal|vauthors=Andersen HH, Elberling J, Arendt-Nielsen L|title=Human surrogate models of histaminergic and non-histaminergic itch|journal=Acta Dermato-Venereologica|volume=95|issue=7|pages=771–777|date=September 2015|pmid=26015312|doi=10.2340/00015555-2146|doi-access=free}}&lt;/ref&gt; Itch has resisted many attempts to be classified as any one type of [[Sensory system|sensory]] experience. Itch has many similarities to [[pain]], and while both are unpleasant [[Sensory system|sensory]] experiences, their behavioral response patterns are different. Pain creates a [[withdrawal reflex]], whereas itch leads to a [[scratch reflex]].&lt;ref name=&quot;ikoma&quot;&gt;{{cite journal|vauthors=Ikoma A, Steinhoff M, Ständer S, Yosipovitch G, Schmelz M|display-authors=3|title=The neurobiology of itch|journal=Nature Reviews. Neuroscience|volume=7|issue=7|pages=535–547|date=July 2006|pmid=16791143|doi=10.1038/nrn1950|s2cid=9373105}}&lt;/ref&gt;

Unmyelinated [[nerve fibers]] for itch and pain both originate in the [[skin]]; however, information for them is conveyed centrally in two distinct systems that both use the same [[nerve]] bundle and [[spinothalamic tract]].&lt;ref&gt;{{cite journal|vauthors=Greaves MW, Khalifa N|title=Itch: more than skin deep|journal=International Archives of Allergy and Immunology|volume=135|issue=2|pages=166–172|date=October 2004|pmid=15375326|doi=10.1159/000080898|s2cid=13376216}}&lt;/ref&gt;

== Classification ==
Most commonly, an itch is felt in one place. If it is felt all over the body, then it is called ''generalized itch'' or ''generalized pruritus''.&lt;ref name=&quot;:0&quot;&gt;{{cite journal|vauthors=Molkara S, Sabourirad S, Molooghi K|title=Infectious differential diagnosis of chronic generalized pruritus without primary cutaneous lesions: a review of the literature|journal=International Journal of Dermatology|volume=59|pages=30–36|date=July 2019|pmid=31364165|doi=10.1111/ijd.14587|s2cid=198998956}}&lt;/ref&gt;

If the sensation of itching persists for six weeks or longer, then it is called ''chronic itch'' or ''chronic pruritus''.&lt;ref name=&quot;:0&quot;&gt;{{cite journal|vauthors=Molkara S, Sabourirad S, Molooghi K|title=Infectious differential diagnosis of chronic generalized pruritus without primary cutaneous lesions: a review of the literature|journal=International Journal of Dermatology|volume=59|pages=30–36|date=July 2019|pmid=31364165|doi=10.1111/ijd.14587|s2cid=198998956}}&lt;/ref&gt;&lt;ref&gt;{{cite journal|vauthors=Harrison IP, Spada F|title=Breaking the Itch-Scratch Cycle: Topical Options for the Management of Chronic Cutaneous Itch in Atopic Dermatitis|journal=Medicines|volume=6|issue=3|page=76|date=July 2019|pmid=31323753|pmc=6789602|doi=10.3390/medicines6030076|doi-access=free}}&lt;/ref&gt; ''Chronic idiopathic pruritus'' or ''essential pruritus'' is a rare form of itch that persists for longer than six weeks, and for which [[Idiopathic disease|no clear cause can be identified]].&lt;ref&gt;{{cite journal|vauthors=Erickson S, Nahmias Z, Rosman IS, Kim BS|title=Immunomodulating Agents as Antipruritics|journal=Dermatologic Clinics|volume=36|issue=3|pages=325–334|date=July 2018|pmid=29929604|doi=10.1016/j.det.2018.02.014|s2cid=49336771}}&lt;/ref&gt;&lt;ref&gt;{{Cite book|vauthors=Hinkle JL, Cheever KH|url=https://books.google.com/books?id=yS7vDwAAQBAJ&amp;pg=PA1269|title=Brunner and Suddarth's Textbook of Medical-Surgical Nursing|date=2018-08-30|publisher=Wolters kluwer india Pvt Ltd|isbn=978-93-87963-72-6|pages=1269|language=en}}&lt;/ref&gt;

== Causes ==
[[File:Scabies-burrow.jpg|link=https://en.wikipedia.org/wiki/File:Scabies-burrow.jpg|thumb|[[Scabies]] is one cause of itching.]]
[[File:CercariaDermatitis.JPG|link=https://en.wikipedia.org/wiki/File:CercariaDermatitis.JPG|thumb|[[Swimmer's itch]]]]
[[File:Tinea_pedis_interdigitalis.jpg|link=https://en.wikipedia.org/wiki/File:Tinea_pedis_interdigitalis.jpg|thumb|[[Athlete's foot]] (showing the toes from below plus the front part of the sole)]]

=== Infections ===

* [[Body louse]], found in substandard living conditions
* [[Cutaneous larva migrans]], a skin disease
* [[Head lice]], if limited to the neck and scalp
* [[Herpes]], a viral disease
* [[Insect bite|Insect bites]], such as those from [[mosquitos]] or [[chiggers]]
* [[Pubic lice]], if limited to the [[genital area]]
* [[Scabies]], especially when several other persons in close contact also itch
* [[Shaving#Razor%20burn|Shaving]], which may irritate the skin
* [[Swimmer's itch]], a short-term immune reaction
* [[Chickenpox|Varicella]]&amp;nbsp;– i.e. chickenpox, prevalent among young children and highly contagious
* [[Tungiasis]], ectoparasite of skin

=== Environmental and allergic ===

* [[Allergic reaction]] to contact with specific chemicals, such as [[urushiol]], derived from [[poison ivy]] or [[poison oak]], or [[Balsam of Peru]], found in many foods and fragrances.&lt;ref&gt;{{cite journal|vauthors=Pfützner W, Thomas P, Niedermeier A, Pfeiffer C, Sander C, Przybilla B|display-authors=3|title=Systemic contact dermatitis elicited by oral intake of Balsam of Peru|journal=Acta Dermato-Venereologica|volume=83|issue=4|pages=294–295|date=2003-02-20|pmid=12926805|doi=10.1080/00015550310016599|doi-access=free}}&lt;/ref&gt;&lt;ref&gt;{{cite journal|vauthors=Usatine RP, Riojas M|title=Diagnosis and management of contact dermatitis|journal=American Family Physician|volume=82|issue=3|pages=249–255|date=August 2010|pmid=20672788|url=http://www.aafp.org/afp/2010/0801/p249.html|access-date=2014-04-09|publisher=Aafp.org}}&lt;/ref&gt; Certain allergens may be diagnosed in a [[patch test]].&lt;ref&gt;{{cite book|url=https://books.google.com/books?id=QhWgKgiT6FoC&amp;pg=PA329|title=Metalworking Fluids|edition=Second|publisher=CRC Press|isbn=142001773X|date=2006|author=Byers, Jerry P.}}&lt;/ref&gt;&lt;ref&gt;{{cite book|url=https://books.google.com/books?id=Me5rAAAAMAAJ&amp;q=pruritus+%22patch+test%22|title=Introduction to clinical allergy|vauthors=Feingold BF|veditors=Byers JP|publisher=the University of Michigan|date=1973|isbn=0398027978}}&lt;/ref&gt;
* [[Foreign Body|Foreign objects]] on the skin are the most common cause of non-pathological itching.
* [[Photodermatitis]]&amp;nbsp;– [[sunlight]] reacts with chemicals in the skin, leading to the formation of irritant metabolites.
* [[Urticaria]] (also called [[hives]]) usually causes itching.

=== Skin disorders ===

* [[Dandruff]]; an unusually large amount of flaking is associated with this sensation.
* [[Punctate palmoplantar keratoderma]], a group of disorders characterized by abnormal thickening of the palms and soles.
* [[Skin condition|Skin conditions]] (such as [[psoriasis]], [[eczema]], [[seborrhoeic dermatitis]], [[sunburn]], [[athlete's foot]], and [[hidradenitis suppurativa]]). Most are of an inflammatory nature.
* [[Wound healing|Scab]] healing, [[scar]] growth, and the development or emergence of [[Melanocytic nevus|moles]], [[Pimple|pimples]], and [[Ingrown hair|ingrown hairs]] from below the epidermis.
* [[Xerosis]]: dry skin, frequently seen in the winter and also associated with older age, frequent bathing in hot showers or baths, and high-temperature and low-humidity environments.

=== Other medical disorders ===

* [[Diabetes mellitus]], a group of metabolic diseases in which a person has high blood sugar
* [[Hyperparathyroidism]], overactivity of the parathyroid glands resulting in excess production of parathyroid hormone (PTH)&lt;ref&gt;LaBagnara, James. [http://www.emedicine.com/ent/TOPIC299.HTM eMedicine&amp;nbsp;–Hyperparathyroidism]. emedicine.com&lt;/ref&gt;
* [[Iron deficiency anemia]], a common anemia (low red blood cell or hemoglobin levels)
* [[Cholestasis]], where bile acids leaking into the serum activate peripheral opioid receptors, resulting in the characteristic generalized, severe itching
* [[Jaundice]], where excess bilirubin (hyperbilirubinemia) irritates nerves in the skin{{Citation needed|date=September 2021}}
* [[Malignancy]] or internal cancer, such as [[lymphoma]] or [[Hodgkin's disease]]&lt;ref name=&quot;ReferenceA&quot;&gt;{{cite journal|vauthors=Botero F|title=Pruritus as a manifestation of systemic disorders|journal=Cutis|volume=21|issue=6|pages=873–880|date=June 1978|pmid=657843}}&lt;/ref&gt;
* [[Polycythemia]], which can cause generalized itching due to increased histamines
* [[Psychiatric]] disease (&quot;[[Psychogenic disease|psychogenic]] itch&quot;, as may be seen in [[delusional parasitosis]])
* [[Thyroid]] illness
* [[Uraemia]]&amp;nbsp;– the itching sensation this causes is known as [[uremic pruritus]]

=== Medication ===

* Drugs (such as [[opioids]]) that activate histamine (H1) receptors or trigger histamine release
* [[Chloroquine]], a drug used in the treatment and prevention of [[malaria]]
* [[Bile acid]] congeners such as obeticholic acid

=== Related to pregnancy ===

* [[Gestational pemphigoid]], a dermatosis of pregnancy
* [[Intrahepatic cholestasis of pregnancy]], a medical condition in which cholestasis occurs
* [[Pruritic urticarial papules and plaques of pregnancy]] (PUPPP), a chronic hives-like rash

=== Other ===

* [[Menopause]], or changes in hormonal balances associated with aging
* [[Terminal illness]]&lt;ref name=&quot;:1&quot;&gt;{{cite journal|vauthors=Siemens W, Xander C, Meerpohl JJ, Buroh S, Antes G, Schwarzer G, Becker G|display-authors=3|title=Pharmacological interventions for pruritus in adult palliative care patients|journal=The Cochrane Database of Systematic Reviews|volume=11|issue=11|pages=CD008320|date=November 2016|pmid=27849111|pmc=6734122|doi=10.1002/14651858.CD008320.pub3}}&lt;/ref&gt;

== Treatment ==
{{Main|Antipruritic}}

A variety of over-the-counter and prescription anti-itch drugs are available. Some plant products have been found to be effective anti-pruritics, others not. Non-chemical remedies include cooling, warming, soft stimulation.

[[Topical]] antipruritics in the form of [[Cream (pharmaceutical)|creams]] and [[Spray (liquid drop)|sprays]] are often available [[Over-the-counter drugs|over-the-counter]]. [[Mouth|Oral]] anti-itch drugs also exist and are usually [[Prescription drug|prescription drugs]]. The [[Active ingredient|active ingredients]] usually belong to the following classes:

* [[Antihistamine|Antihistamines]], such as [[diphenhydramine]] (Benadryl)&lt;ref name=&quot;:2&quot;&gt;{{cite journal|vauthors=Andrade A, Kuah CY, Martin-Lopez JE, Chua S, Shpadaruk V, Sanclemente G, Franco JV|display-authors=3|title=Interventions for chronic pruritus of unknown origin|journal=The Cochrane Database of Systematic Reviews|volume=1|pages=CD013128|date=January 2020|pmid=31981369|pmc=6984650|doi=10.1002/14651858.CD013128.pub2|collaboration=Cochrane Skin Group}}&lt;/ref&gt;
* [[Corticosteroid|Corticosteroids]], such as [[hydrocortisone]] topical cream; ''see'' [[topical steroid]]
* [[Counterirritant|Counterirritants]], such as [[Mentha|mint oil]], [[menthol]], or [[camphor]]&lt;ref&gt;{{cite journal|vauthors=Hercogová J|title=Topical anti-itch therapy|journal=Dermatologic Therapy|volume=18|issue=4|pages=341–343|year=2005|pmid=16297007|doi=10.1111/j.1529-8019.2005.00033.x|s2cid=31573591}}&lt;/ref&gt;
* [[Crotamiton]] (trade name Eurax) is an antipruritic agent available as a cream or lotion, often used to treat [[scabies]]. Its mechanism of action remains unknown.
* [[Local anesthetic|Local anesthetics]], such as [[benzocaine]] topical cream (Lanacane)

[[Phototherapy]] is helpful for severe itching, especially if caused by [[kidney failure]]. The common type of light used is [[UVB]].&lt;ref name=&quot;ReferenceA2&quot;&gt;{{cite journal|vauthors=Botero F|title=Pruritus as a manifestation of systemic disorders|journal=Cutis|volume=21|issue=6|pages=873–880|date=June 1978|pmid=657843}}&lt;/ref&gt;</text>
      <sha1>k9jbuuergph0a8qfctlqix6431tgh26</sha1>
    </revision>
    <revision>
      <id>133039</id>
      <parentid>133038</parentid>
      <timestamp>2022-08-01T03:40:55Z</timestamp>
      <contributor>
        <username>Nana Sintim</username>
        <id>11223</id>
      </contributor>
      <comment>I creat reference</comment>
      <model>wikitext</model>
      <format>text/x-wiki</format>
      <text bytes="11696" xml:space="preserve">

'''Itch''' (also known as '''pruritus''') is a sensation that causes the desire or [[reflex]] to scratch.&lt;ref name=&quot;andersen&quot;&gt;{{cite journal|vauthors=Andersen HH, Elberling J, Arendt-Nielsen L|title=Human surrogate models of histaminergic and non-histaminergic itch|journal=Acta Dermato-Venereologica|volume=95|issue=7|pages=771–777|date=September 2015|pmid=26015312|doi=10.2340/00015555-2146|doi-access=free}}&lt;/ref&gt; Itch has resisted many attempts to be classified as any one type of [[Sensory system|sensory]] experience. Itch has many similarities to [[pain]], and while both are unpleasant [[Sensory system|sensory]] experiences, their behavioral response patterns are different. Pain creates a [[withdrawal reflex]], whereas itch leads to a [[scratch reflex]].&lt;ref name=&quot;ikoma&quot;&gt;{{cite journal|vauthors=Ikoma A, Steinhoff M, Ständer S, Yosipovitch G, Schmelz M|display-authors=3|title=The neurobiology of itch|journal=Nature Reviews. Neuroscience|volume=7|issue=7|pages=535–547|date=July 2006|pmid=16791143|doi=10.1038/nrn1950|s2cid=9373105}}&lt;/ref&gt;

Unmyelinated [[nerve fibers]] for itch and pain both originate in the [[skin]]; however, information for them is conveyed centrally in two distinct systems that both use the same [[nerve]] bundle and [[spinothalamic tract]].&lt;ref&gt;{{cite journal|vauthors=Greaves MW, Khalifa N|title=Itch: more than skin deep|journal=International Archives of Allergy and Immunology|volume=135|issue=2|pages=166–172|date=October 2004|pmid=15375326|doi=10.1159/000080898|s2cid=13376216}}&lt;/ref&gt;

== Classification ==
Most commonly, an itch is felt in one place. If it is felt all over the body, then it is called ''generalized itch'' or ''generalized pruritus''.&lt;ref name=&quot;:0&quot;&gt;{{cite journal|vauthors=Molkara S, Sabourirad S, Molooghi K|title=Infectious differential diagnosis of chronic generalized pruritus without primary cutaneous lesions: a review of the literature|journal=International Journal of Dermatology|volume=59|pages=30–36|date=July 2019|pmid=31364165|doi=10.1111/ijd.14587|s2cid=198998956}}&lt;/ref&gt;

If the sensation of itching persists for six weeks or longer, then it is called ''chronic itch'' or ''chronic pruritus''.&lt;ref name=&quot;:0&quot;&gt;{{cite journal|vauthors=Molkara S, Sabourirad S, Molooghi K|title=Infectious differential diagnosis of chronic generalized pruritus without primary cutaneous lesions: a review of the literature|journal=International Journal of Dermatology|volume=59|pages=30–36|date=July 2019|pmid=31364165|doi=10.1111/ijd.14587|s2cid=198998956}}&lt;/ref&gt;&lt;ref&gt;{{cite journal|vauthors=Harrison IP, Spada F|title=Breaking the Itch-Scratch Cycle: Topical Options for the Management of Chronic Cutaneous Itch in Atopic Dermatitis|journal=Medicines|volume=6|issue=3|page=76|date=July 2019|pmid=31323753|pmc=6789602|doi=10.3390/medicines6030076|doi-access=free}}&lt;/ref&gt; ''Chronic idiopathic pruritus'' or ''essential pruritus'' is a rare form of itch that persists for longer than six weeks, and for which [[Idiopathic disease|no clear cause can be identified]].&lt;ref&gt;{{cite journal|vauthors=Erickson S, Nahmias Z, Rosman IS, Kim BS|title=Immunomodulating Agents as Antipruritics|journal=Dermatologic Clinics|volume=36|issue=3|pages=325–334|date=July 2018|pmid=29929604|doi=10.1016/j.det.2018.02.014|s2cid=49336771}}&lt;/ref&gt;&lt;ref&gt;{{Cite book|vauthors=Hinkle JL, Cheever KH|url=https://books.google.com/books?id=yS7vDwAAQBAJ&amp;pg=PA1269|title=Brunner and Suddarth's Textbook of Medical-Surgical Nursing|date=2018-08-30|publisher=Wolters kluwer india Pvt Ltd|isbn=978-93-87963-72-6|pages=1269|language=en}}&lt;/ref&gt;

== Causes ==
[[File:Scabies-burrow.jpg|link=https://en.wikipedia.org/wiki/File:Scabies-burrow.jpg|thumb|[[Scabies]] is one cause of itching.]]
[[File:CercariaDermatitis.JPG|link=https://en.wikipedia.org/wiki/File:CercariaDermatitis.JPG|thumb|[[Swimmer's itch]]]]
[[File:Tinea_pedis_interdigitalis.jpg|link=https://en.wikipedia.org/wiki/File:Tinea_pedis_interdigitalis.jpg|thumb|[[Athlete's foot]] (showing the toes from below plus the front part of the sole)]]

=== Infections ===

* [[Body louse]], found in substandard living conditions
* [[Cutaneous larva migrans]], a skin disease
* [[Head lice]], if limited to the neck and scalp
* [[Herpes]], a viral disease
* [[Insect bite|Insect bites]], such as those from [[mosquitos]] or [[chiggers]]
* [[Pubic lice]], if limited to the [[genital area]]
* [[Scabies]], especially when several other persons in close contact also itch
* [[Shaving#Razor%20burn|Shaving]], which may irritate the skin
* [[Swimmer's itch]], a short-term immune reaction
* [[Chickenpox|Varicella]]&amp;nbsp;– i.e. chickenpox, prevalent among young children and highly contagious
* [[Tungiasis]], ectoparasite of skin

=== Environmental and allergic ===

* [[Allergic reaction]] to contact with specific chemicals, such as [[urushiol]], derived from [[poison ivy]] or [[poison oak]], or [[Balsam of Peru]], found in many foods and fragrances.&lt;ref&gt;{{cite journal|vauthors=Pfützner W, Thomas P, Niedermeier A, Pfeiffer C, Sander C, Przybilla B|display-authors=3|title=Systemic contact dermatitis elicited by oral intake of Balsam of Peru|journal=Acta Dermato-Venereologica|volume=83|issue=4|pages=294–295|date=2003-02-20|pmid=12926805|doi=10.1080/00015550310016599|doi-access=free}}&lt;/ref&gt;&lt;ref&gt;{{cite journal|vauthors=Usatine RP, Riojas M|title=Diagnosis and management of contact dermatitis|journal=American Family Physician|volume=82|issue=3|pages=249–255|date=August 2010|pmid=20672788|url=http://www.aafp.org/afp/2010/0801/p249.html|access-date=2014-04-09|publisher=Aafp.org}}&lt;/ref&gt; Certain allergens may be diagnosed in a [[patch test]].&lt;ref&gt;{{cite book|url=https://books.google.com/books?id=QhWgKgiT6FoC&amp;pg=PA329|title=Metalworking Fluids|edition=Second|publisher=CRC Press|isbn=142001773X|date=2006|author=Byers, Jerry P.}}&lt;/ref&gt;&lt;ref&gt;{{cite book|url=https://books.google.com/books?id=Me5rAAAAMAAJ&amp;q=pruritus+%22patch+test%22|title=Introduction to clinical allergy|vauthors=Feingold BF|veditors=Byers JP|publisher=the University of Michigan|date=1973|isbn=0398027978}}&lt;/ref&gt;
* [[Foreign Body|Foreign objects]] on the skin are the most common cause of non-pathological itching.
* [[Photodermatitis]]&amp;nbsp;– [[sunlight]] reacts with chemicals in the skin, leading to the formation of irritant metabolites.
* [[Urticaria]] (also called [[hives]]) usually causes itching.

=== Skin disorders ===

* [[Dandruff]]; an unusually large amount of flaking is associated with this sensation.
* [[Punctate palmoplantar keratoderma]], a group of disorders characterized by abnormal thickening of the palms and soles.
* [[Skin condition|Skin conditions]] (such as [[psoriasis]], [[eczema]], [[seborrhoeic dermatitis]], [[sunburn]], [[athlete's foot]], and [[hidradenitis suppurativa]]). Most are of an inflammatory nature.
* [[Wound healing|Scab]] healing, [[scar]] growth, and the development or emergence of [[Melanocytic nevus|moles]], [[Pimple|pimples]], and [[Ingrown hair|ingrown hairs]] from below the epidermis.
* [[Xerosis]]: dry skin, frequently seen in the winter and also associated with older age, frequent bathing in hot showers or baths, and high-temperature and low-humidity environments.

=== Other medical disorders ===

* [[Diabetes mellitus]], a group of metabolic diseases in which a person has high blood sugar
* [[Hyperparathyroidism]], overactivity of the parathyroid glands resulting in excess production of parathyroid hormone (PTH)&lt;ref&gt;LaBagnara, James. [http://www.emedicine.com/ent/TOPIC299.HTM eMedicine&amp;nbsp;–Hyperparathyroidism]. emedicine.com&lt;/ref&gt;
* [[Iron deficiency anemia]], a common anemia (low red blood cell or hemoglobin levels)
* [[Cholestasis]], where bile acids leaking into the serum activate peripheral opioid receptors, resulting in the characteristic generalized, severe itching
* [[Jaundice]], where excess bilirubin (hyperbilirubinemia) irritates nerves in the skin{{Citation needed|date=September 2021}}
* [[Malignancy]] or internal cancer, such as [[lymphoma]] or [[Hodgkin's disease]]&lt;ref name=&quot;ReferenceA&quot;&gt;{{cite journal|vauthors=Botero F|title=Pruritus as a manifestation of systemic disorders|journal=Cutis|volume=21|issue=6|pages=873–880|date=June 1978|pmid=657843}}&lt;/ref&gt;
* [[Polycythemia]], which can cause generalized itching due to increased histamines
* [[Psychiatric]] disease (&quot;[[Psychogenic disease|psychogenic]] itch&quot;, as may be seen in [[delusional parasitosis]])
* [[Thyroid]] illness
* [[Uraemia]]&amp;nbsp;– the itching sensation this causes is known as [[uremic pruritus]]

=== Medication ===

* Drugs (such as [[opioids]]) that activate histamine (H1) receptors or trigger histamine release
* [[Chloroquine]], a drug used in the treatment and prevention of [[malaria]]
* [[Bile acid]] congeners such as obeticholic acid

=== Related to pregnancy ===

* [[Gestational pemphigoid]], a dermatosis of pregnancy
* [[Intrahepatic cholestasis of pregnancy]], a medical condition in which cholestasis occurs
* [[Pruritic urticarial papules and plaques of pregnancy]] (PUPPP), a chronic hives-like rash

=== Other ===

* [[Menopause]], or changes in hormonal balances associated with aging
* [[Terminal illness]]&lt;ref name=&quot;:1&quot;&gt;{{cite journal|vauthors=Siemens W, Xander C, Meerpohl JJ, Buroh S, Antes G, Schwarzer G, Becker G|display-authors=3|title=Pharmacological interventions for pruritus in adult palliative care patients|journal=The Cochrane Database of Systematic Reviews|volume=11|issue=11|pages=CD008320|date=November 2016|pmid=27849111|pmc=6734122|doi=10.1002/14651858.CD008320.pub3}}&lt;/ref&gt;

== Treatment ==
{{Main|Antipruritic}}

A variety of over-the-counter and prescription anti-itch drugs are available. Some plant products have been found to be effective anti-pruritics, others not. Non-chemical remedies include cooling, warming, soft stimulation.

[[Topical]] antipruritics in the form of [[Cream (pharmaceutical)|creams]] and [[Spray (liquid drop)|sprays]] are often available [[Over-the-counter drugs|over-the-counter]]. [[Mouth|Oral]] anti-itch drugs also exist and are usually [[Prescription drug|prescription drugs]]. The [[Active ingredient|active ingredients]] usually belong to the following classes:

* [[Antihistamine|Antihistamines]], such as [[diphenhydramine]] (Benadryl)&lt;ref name=&quot;:2&quot;&gt;{{cite journal|vauthors=Andrade A, Kuah CY, Martin-Lopez JE, Chua S, Shpadaruk V, Sanclemente G, Franco JV|display-authors=3|title=Interventions for chronic pruritus of unknown origin|journal=The Cochrane Database of Systematic Reviews|volume=1|pages=CD013128|date=January 2020|pmid=31981369|pmc=6984650|doi=10.1002/14651858.CD013128.pub2|collaboration=Cochrane Skin Group}}&lt;/ref&gt;
* [[Corticosteroid|Corticosteroids]], such as [[hydrocortisone]] topical cream; ''see'' [[topical steroid]]
* [[Counterirritant|Counterirritants]], such as [[Mentha|mint oil]], [[menthol]], or [[camphor]]&lt;ref&gt;{{cite journal|vauthors=Hercogová J|title=Topical anti-itch therapy|journal=Dermatologic Therapy|volume=18|issue=4|pages=341–343|year=2005|pmid=16297007|doi=10.1111/j.1529-8019.2005.00033.x|s2cid=31573591}}&lt;/ref&gt;
* [[Crotamiton]] (trade name Eurax) is an antipruritic agent available as a cream or lotion, often used to treat [[scabies]]. Its mechanism of action remains unknown.
* [[Local anesthetic|Local anesthetics]], such as [[benzocaine]] topical cream (Lanacane)

[[Phototherapy]] is helpful for severe itching, especially if caused by [[kidney failure]]. The common type of light used is [[UVB]].&lt;ref name=&quot;ReferenceA2&quot;&gt;{{cite journal|vauthors=Botero F|title=Pruritus as a manifestation of systemic disorders|journal=Cutis|volume=21|issue=6|pages=873–880|date=June 1978|pmid=657843}}&lt;/ref&gt;

Beaeɛ a menyaa mmoa firiiɛ</text>
      <sha1>p5h3hrwmwkzcv84v8wmnsau51rvq1lx</sha1>
    </revision>
    <revision>
      <id>133040</id>
      <parentid>133039</parentid>
      <timestamp>2022-08-01T03:41:39Z</timestamp>
      <contributor>
        <username>Nana Sintim</username>
        <id>11223</id>
      </contributor>
      <comment>Me sesaa atwerɛdeɛ</comment>
      <model>wikitext</model>
      <format>text/x-wiki</format>
      <text bytes="11697" xml:space="preserve">
'''Ahokeka'''(also known as '''pruritus''') is a sensation that causes the desire or [[reflex]] to scratch.&lt;ref name=&quot;andersen&quot;&gt;{{cite journal|vauthors=Andersen HH, Elberling J, Arendt-Nielsen L|title=Human surrogate models of histaminergic and non-histaminergic itch|journal=Acta Dermato-Venereologica|volume=95|issue=7|pages=771–777|date=September 2015|pmid=26015312|doi=10.2340/00015555-2146|doi-access=free}}&lt;/ref&gt; Itch has resisted many attempts to be classified as any one type of [[Sensory system|sensory]] experience. Itch has many similarities to [[pain]], and while both are unpleasant [[Sensory system|sensory]] experiences, their behavioral response patterns are different. Pain creates a [[withdrawal reflex]], whereas itch leads to a [[scratch reflex]].&lt;ref name=&quot;ikoma&quot;&gt;{{cite journal|vauthors=Ikoma A, Steinhoff M, Ständer S, Yosipovitch G, Schmelz M|display-authors=3|title=The neurobiology of itch|journal=Nature Reviews. Neuroscience|volume=7|issue=7|pages=535–547|date=July 2006|pmid=16791143|doi=10.1038/nrn1950|s2cid=9373105}}&lt;/ref&gt;

Unmyelinated [[nerve fibers]] for itch and pain both originate in the [[skin]]; however, information for them is conveyed centrally in two distinct systems that both use the same [[nerve]] bundle and [[spinothalamic tract]].&lt;ref&gt;{{cite journal|vauthors=Greaves MW, Khalifa N|title=Itch: more than skin deep|journal=International Archives of Allergy and Immunology|volume=135|issue=2|pages=166–172|date=October 2004|pmid=15375326|doi=10.1159/000080898|s2cid=13376216}}&lt;/ref&gt;

== Classification ==
Most commonly, an itch is felt in one place. If it is felt all over the body, then it is called ''generalized itch'' or ''generalized pruritus''.&lt;ref name=&quot;:0&quot;&gt;{{cite journal|vauthors=Molkara S, Sabourirad S, Molooghi K|title=Infectious differential diagnosis of chronic generalized pruritus without primary cutaneous lesions: a review of the literature|journal=International Journal of Dermatology|volume=59|pages=30–36|date=July 2019|pmid=31364165|doi=10.1111/ijd.14587|s2cid=198998956}}&lt;/ref&gt;

If the sensation of itching persists for six weeks or longer, then it is called ''chronic itch'' or ''chronic pruritus''.&lt;ref name=&quot;:0&quot;&gt;{{cite journal|vauthors=Molkara S, Sabourirad S, Molooghi K|title=Infectious differential diagnosis of chronic generalized pruritus without primary cutaneous lesions: a review of the literature|journal=International Journal of Dermatology|volume=59|pages=30–36|date=July 2019|pmid=31364165|doi=10.1111/ijd.14587|s2cid=198998956}}&lt;/ref&gt;&lt;ref&gt;{{cite journal|vauthors=Harrison IP, Spada F|title=Breaking the Itch-Scratch Cycle: Topical Options for the Management of Chronic Cutaneous Itch in Atopic Dermatitis|journal=Medicines|volume=6|issue=3|page=76|date=July 2019|pmid=31323753|pmc=6789602|doi=10.3390/medicines6030076|doi-access=free}}&lt;/ref&gt; ''Chronic idiopathic pruritus'' or ''essential pruritus'' is a rare form of itch that persists for longer than six weeks, and for which [[Idiopathic disease|no clear cause can be identified]].&lt;ref&gt;{{cite journal|vauthors=Erickson S, Nahmias Z, Rosman IS, Kim BS|title=Immunomodulating Agents as Antipruritics|journal=Dermatologic Clinics|volume=36|issue=3|pages=325–334|date=July 2018|pmid=29929604|doi=10.1016/j.det.2018.02.014|s2cid=49336771}}&lt;/ref&gt;&lt;ref&gt;{{Cite book|vauthors=Hinkle JL, Cheever KH|url=https://books.google.com/books?id=yS7vDwAAQBAJ&amp;pg=PA1269|title=Brunner and Suddarth's Textbook of Medical-Surgical Nursing|date=2018-08-30|publisher=Wolters kluwer india Pvt Ltd|isbn=978-93-87963-72-6|pages=1269|language=en}}&lt;/ref&gt;

== Causes ==
[[File:Scabies-burrow.jpg|link=https://en.wikipedia.org/wiki/File:Scabies-burrow.jpg|thumb|[[Scabies]] is one cause of itching.]]
[[File:CercariaDermatitis.JPG|link=https://en.wikipedia.org/wiki/File:CercariaDermatitis.JPG|thumb|[[Swimmer's itch]]]]
[[File:Tinea_pedis_interdigitalis.jpg|link=https://en.wikipedia.org/wiki/File:Tinea_pedis_interdigitalis.jpg|thumb|[[Athlete's foot]] (showing the toes from below plus the front part of the sole)]]

=== Infections ===

* [[Body louse]], found in substandard living conditions
* [[Cutaneous larva migrans]], a skin disease
* [[Head lice]], if limited to the neck and scalp
* [[Herpes]], a viral disease
* [[Insect bite|Insect bites]], such as those from [[mosquitos]] or [[chiggers]]
* [[Pubic lice]], if limited to the [[genital area]]
* [[Scabies]], especially when several other persons in close contact also itch
* [[Shaving#Razor%20burn|Shaving]], which may irritate the skin
* [[Swimmer's itch]], a short-term immune reaction
* [[Chickenpox|Varicella]]&amp;nbsp;– i.e. chickenpox, prevalent among young children and highly contagious
* [[Tungiasis]], ectoparasite of skin

=== Environmental and allergic ===

* [[Allergic reaction]] to contact with specific chemicals, such as [[urushiol]], derived from [[poison ivy]] or [[poison oak]], or [[Balsam of Peru]], found in many foods and fragrances.&lt;ref&gt;{{cite journal|vauthors=Pfützner W, Thomas P, Niedermeier A, Pfeiffer C, Sander C, Przybilla B|display-authors=3|title=Systemic contact dermatitis elicited by oral intake of Balsam of Peru|journal=Acta Dermato-Venereologica|volume=83|issue=4|pages=294–295|date=2003-02-20|pmid=12926805|doi=10.1080/00015550310016599|doi-access=free}}&lt;/ref&gt;&lt;ref&gt;{{cite journal|vauthors=Usatine RP, Riojas M|title=Diagnosis and management of contact dermatitis|journal=American Family Physician|volume=82|issue=3|pages=249–255|date=August 2010|pmid=20672788|url=http://www.aafp.org/afp/2010/0801/p249.html|access-date=2014-04-09|publisher=Aafp.org}}&lt;/ref&gt; Certain allergens may be diagnosed in a [[patch test]].&lt;ref&gt;{{cite book|url=https://books.google.com/books?id=QhWgKgiT6FoC&amp;pg=PA329|title=Metalworking Fluids|edition=Second|publisher=CRC Press|isbn=142001773X|date=2006|author=Byers, Jerry P.}}&lt;/ref&gt;&lt;ref&gt;{{cite book|url=https://books.google.com/books?id=Me5rAAAAMAAJ&amp;q=pruritus+%22patch+test%22|title=Introduction to clinical allergy|vauthors=Feingold BF|veditors=Byers JP|publisher=the University of Michigan|date=1973|isbn=0398027978}}&lt;/ref&gt;
* [[Foreign Body|Foreign objects]] on the skin are the most common cause of non-pathological itching.
* [[Photodermatitis]]&amp;nbsp;– [[sunlight]] reacts with chemicals in the skin, leading to the formation of irritant metabolites.
* [[Urticaria]] (also called [[hives]]) usually causes itching.

=== Skin disorders ===

* [[Dandruff]]; an unusually large amount of flaking is associated with this sensation.
* [[Punctate palmoplantar keratoderma]], a group of disorders characterized by abnormal thickening of the palms and soles.
* [[Skin condition|Skin conditions]] (such as [[psoriasis]], [[eczema]], [[seborrhoeic dermatitis]], [[sunburn]], [[athlete's foot]], and [[hidradenitis suppurativa]]). Most are of an inflammatory nature.
* [[Wound healing|Scab]] healing, [[scar]] growth, and the development or emergence of [[Melanocytic nevus|moles]], [[Pimple|pimples]], and [[Ingrown hair|ingrown hairs]] from below the epidermis.
* [[Xerosis]]: dry skin, frequently seen in the winter and also associated with older age, frequent bathing in hot showers or baths, and high-temperature and low-humidity environments.

=== Other medical disorders ===

* [[Diabetes mellitus]], a group of metabolic diseases in which a person has high blood sugar
* [[Hyperparathyroidism]], overactivity of the parathyroid glands resulting in excess production of parathyroid hormone (PTH)&lt;ref&gt;LaBagnara, James. [http://www.emedicine.com/ent/TOPIC299.HTM eMedicine&amp;nbsp;–Hyperparathyroidism]. emedicine.com&lt;/ref&gt;
* [[Iron deficiency anemia]], a common anemia (low red blood cell or hemoglobin levels)
* [[Cholestasis]], where bile acids leaking into the serum activate peripheral opioid receptors, resulting in the characteristic generalized, severe itching
* [[Jaundice]], where excess bilirubin (hyperbilirubinemia) irritates nerves in the skin{{Citation needed|date=September 2021}}
* [[Malignancy]] or internal cancer, such as [[lymphoma]] or [[Hodgkin's disease]]&lt;ref name=&quot;ReferenceA&quot;&gt;{{cite journal|vauthors=Botero F|title=Pruritus as a manifestation of systemic disorders|journal=Cutis|volume=21|issue=6|pages=873–880|date=June 1978|pmid=657843}}&lt;/ref&gt;
* [[Polycythemia]], which can cause generalized itching due to increased histamines
* [[Psychiatric]] disease (&quot;[[Psychogenic disease|psychogenic]] itch&quot;, as may be seen in [[delusional parasitosis]])
* [[Thyroid]] illness
* [[Uraemia]]&amp;nbsp;– the itching sensation this causes is known as [[uremic pruritus]]

=== Medication ===

* Drugs (such as [[opioids]]) that activate histamine (H1) receptors or trigger histamine release
* [[Chloroquine]], a drug used in the treatment and prevention of [[malaria]]
* [[Bile acid]] congeners such as obeticholic acid

=== Related to pregnancy ===

* [[Gestational pemphigoid]], a dermatosis of pregnancy
* [[Intrahepatic cholestasis of pregnancy]], a medical condition in which cholestasis occurs
* [[Pruritic urticarial papules and plaques of pregnancy]] (PUPPP), a chronic hives-like rash

=== Other ===

* [[Menopause]], or changes in hormonal balances associated with aging
* [[Terminal illness]]&lt;ref name=&quot;:1&quot;&gt;{{cite journal|vauthors=Siemens W, Xander C, Meerpohl JJ, Buroh S, Antes G, Schwarzer G, Becker G|display-authors=3|title=Pharmacological interventions for pruritus in adult palliative care patients|journal=The Cochrane Database of Systematic Reviews|volume=11|issue=11|pages=CD008320|date=November 2016|pmid=27849111|pmc=6734122|doi=10.1002/14651858.CD008320.pub3}}&lt;/ref&gt;

== Treatment ==
{{Main|Antipruritic}}

A variety of over-the-counter and prescription anti-itch drugs are available. Some plant products have been found to be effective anti-pruritics, others not. Non-chemical remedies include cooling, warming, soft stimulation.

[[Topical]] antipruritics in the form of [[Cream (pharmaceutical)|creams]] and [[Spray (liquid drop)|sprays]] are often available [[Over-the-counter drugs|over-the-counter]]. [[Mouth|Oral]] anti-itch drugs also exist and are usually [[Prescription drug|prescription drugs]]. The [[Active ingredient|active ingredients]] usually belong to the following classes:

* [[Antihistamine|Antihistamines]], such as [[diphenhydramine]] (Benadryl)&lt;ref name=&quot;:2&quot;&gt;{{cite journal|vauthors=Andrade A, Kuah CY, Martin-Lopez JE, Chua S, Shpadaruk V, Sanclemente G, Franco JV|display-authors=3|title=Interventions for chronic pruritus of unknown origin|journal=The Cochrane Database of Systematic Reviews|volume=1|pages=CD013128|date=January 2020|pmid=31981369|pmc=6984650|doi=10.1002/14651858.CD013128.pub2|collaboration=Cochrane Skin Group}}&lt;/ref&gt;
* [[Corticosteroid|Corticosteroids]], such as [[hydrocortisone]] topical cream; ''see'' [[topical steroid]]
* [[Counterirritant|Counterirritants]], such as [[Mentha|mint oil]], [[menthol]], or [[camphor]]&lt;ref&gt;{{cite journal|vauthors=Hercogová J|title=Topical anti-itch therapy|journal=Dermatologic Therapy|volume=18|issue=4|pages=341–343|year=2005|pmid=16297007|doi=10.1111/j.1529-8019.2005.00033.x|s2cid=31573591}}&lt;/ref&gt;
* [[Crotamiton]] (trade name Eurax) is an antipruritic agent available as a cream or lotion, often used to treat [[scabies]]. Its mechanism of action remains unknown.
* [[Local anesthetic|Local anesthetics]], such as [[benzocaine]] topical cream (Lanacane)

[[Phototherapy]] is helpful for severe itching, especially if caused by [[kidney failure]]. The common type of light used is [[UVB]].&lt;ref name=&quot;ReferenceA2&quot;&gt;{{cite journal|vauthors=Botero F|title=Pruritus as a manifestation of systemic disorders|journal=Cutis|volume=21|issue=6|pages=873–880|date=June 1978|pmid=657843}}&lt;/ref&gt;

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