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Chithandizo cha Intraocular (Uveal) Melanoma Treatment Version

Zambiri Zokhudza Intraocular (Uveal) Melanoma

MFUNDO ZOFUNIKA

• Intraocular melanoma ndi matenda omwe mumakhala maselo owopsa (khansa) m'matumba a diso.

• Kukhala wachikulire komanso kukhala ndi khungu loyera kumawonjezera chiopsezo cha khansa yapakhosi ya intraocular.

• Zizindikiro za intraocular melanoma zimaphatikizapo kusawona bwino kapena malo amdima pa iris.

• Kuyesa komwe kumayang'ana diso kumagwiritsidwa ntchito kuthandizira (kupeza) ndikuzindikira khansa yapakhungu ya intraocular.

• Chidziwitso cha chotupacho sichimafunikira kawirikawiri kuti chipeze khansa yapakhungu ya intraocular.

• Zinthu zina zimakhudzanso madandaulo (mwayi wochira) ndi njira zamankhwala.

Intraocular melanoma ndi matenda omwe mumakhala maselo owopsa (khansa) m'matumba a diso.

Intraocular khansa ya pakhungu imayamba pakati pa zigawo zitatu za khoma la diso. Mbali yakunja imaphatikizapo sclera yoyera ("yoyera ya diso") ndi khungu loyera kutsogolo kwa diso. M'kati mwake mumakhala minyewa ya minyewa, yotchedwa retina, yomwe imamva kuwala ndipo imatumiza zithunzi pamodzi ndi minyewa ya kuwala kupita ku ubongo.

Mzere wapakati, womwe umayambitsa matenda a khansa ya m'mimba, umatchedwa uvea kapena thirakiti, ndipo uli ndi magawo atatu akuluakulu:

Iris

Iris ndiye malo achikuda kutsogolo kwa diso ("mtundu wamaso"). Zitha kuwonedwa kudzera mu cornea yoyera. Wophunzirayo ali pakatikati pa iris ndipo amasintha kukula kuti kuwala kocheperako kudikire. Intraocular melanoma ya iris nthawi zambiri imakhala chotupa chaching'ono chomwe chimakula pang'onopang'ono ndipo sichimafalikira kwambiri mbali zina za thupi.

Ciliary thupi

Thupi la ciliary ndi mphete ya minofu yokhala ndi ulusi wa minofu yomwe imasintha kukula kwa mwana wasukulu ndi mawonekedwe a mandala. Amapezeka kuseri kwa iris. Kusintha kwa mawonekedwe a mandala kumathandizira kuyang'ana kwa diso. Thupi la ciliary limapanganso madzimadzi omveka bwino omwe amadzaza malo pakati pa cornea ndi iris. Intraocular melanoma ya thupi la ciliary nthawi zambiri amakhala wokulirapo ndipo amatha kufalikira mbali zina za thupi kuposa intraocular melanoma ya iris.

Choroid

Choroid ndi mitsempha yamagazi yomwe imabweretsa mpweya ndi michere m'diso. Matenda ambiri a m'mimba amayamba mu choroid. Intraocular melanoma ya choroid nthawi zambiri imakhala yayikulu ndipo imatha kufalikira mbali zina za thupi kuposa intraocular melanoma ya iris.

Kutuluka kwa diso, kuwonetsa kunja ndi mkati kwa diso kuphatikiza sclera, cornea, iris, thupi la ciliary, choroid, retina, vitreous humor, ndi optic nerve. Vitreous kuseka ndi madzi omwe amadzaza pakatikati pa diso.

Intraocular melanoma ndi khansa yosawerengeka yomwe imapangidwa kuchokera m'maselo omwe amapanga melanin mu iris, thupi la ciliary, ndi choroid. Ndi khansa yofala kwambiri m'maso mwa akuluakulu.

Kukhala wachikulire komanso kukhala ndi khungu loyera kumawonjezera chiopsezo cha khansa yapakhosi ya intraocular.

Chilichonse chomwe chimakulitsa chiopsezo chotenga matenda chimatchedwa chiopsezo. Kukhala ndi chiwopsezo sikutanthauza kuti udzakhala ndi khansa; kusakhala ndi zoopsa sikutanthauza kuti simudzakhala ndi khansa. Lankhulani ndi dokotala ngati mukuganiza kuti mutha kukhala pachiwopsezo.

Zowopsa za khansa ya m'mimba ndi izi:

• Kukhala ndi mawonekedwe owoneka bwino, omwe akuphatikizapo izi:

• Khungu loyera lomwe limagundagunda ndikuwotcha mosavuta, siliongola, kapena kusanjika bwino.

• Buluu kapena wobiriwira kapena maso ena owala.

• Ukalamba.

• Kukhala mzungu.

Zizindikiro za intraocular melanoma zimaphatikizapo kusawona bwino kapena malo amdima pa iris.

Matenda a khansa ya m'mimba sangayambitse zizindikiro kapena zizindikiro zoyambirira. Nthawi zina amapezeka pakuyesedwa kwamaso nthawi zonse pomwe dokotala amatulutsa mwana ndikuyang'ana m'maso. Zizindikiro zimatha kuyambitsidwa ndi intraocular melanoma kapena zinthu zina. Funsani dokotala ngati muli ndi izi:

• Masomphenya olakwika kapena kusintha kwina kwamasomphenya.

• Ma floater (mawanga omwe amayenda m'munda wanu wamasomphenya) kapena kuwala kwa kuwala.

• Malo amdima pa iris.

• Kusintha kwa kukula kapena mawonekedwe a mwana wasukulu.

• Kusintha kwa malo a diso m'maso mwake.

Kuyesa komwe kumayang'ana diso kumagwiritsidwa ntchito kuthandizira (kupeza) ndikuzindikira khansa yapakhungu ya intraocular.

Mayeso ndi njira zotsatirazi zitha kugwiritsidwa ntchito:

• Kuwunika kwakuthupi ndi mbiri: Kuyesedwa kwa thupi kuti muwone zizindikiritso zaumoyo, kuphatikiza kuyang'ana ngati pali matenda, monga zotupa kapena china chilichonse chomwe chikuwoneka chachilendo. Mbiri yokhudzana ndi thanzi la wodwalayo komanso matenda am'mbuyomu komanso chithandizo chamankhwala adzachitidwanso.

• Kuyezetsa diso ndi mwana wochepetsedwa: Kuyesa kwa diso komwe mwana amatambasula (kukulitsidwa) ndimadontho amaso amankhwala kuti alole dokotala kuti ayang'ane kudzera mu disolo ndi mwana wa diso. Mkati mwa diso, kuphatikiza diso ndi mitsempha yamawonedwe, amayang'aniridwa. Zithunzi zitha kutengedwa pakapita nthawi kuti zizindikire kusintha kwakukula kwa chotupacho. Pali mitundu ingapo ya mayeso amaso:

• Ophthalmoscopy: Kuyesa mkatikati mwa diso kuti muwone diso ndi mitsempha yamawonedwe pogwiritsa ntchito mandala ang'onoang'ono ndi kuwala.

• Slit-lamp biomicroscopy: Kuyesa mkatikati mwa diso kuti muwone diso, mitsempha yamawonedwe, ndi mbali zina za diso pogwiritsa ntchito kuwala kolimba ndi microscope.

• Gonioscopy: Kuyesa mbali yakutsogolo ya diso pakati pa cornea ndi iris. Chida chapadera chimagwiritsidwa ntchito kuti muwone ngati malo omwe madzi amatuluka m'maso atsekedwa.

• Kupenda kwa diso la Ultrasound: Njira yomwe mafunde amawu amphamvu (ultrasound) amachotsedwa pamatumba amkati a diso kuti apange ma echoes. Madontho a diso amagwiritsidwa ntchito kufafaniza diso ndipo kafukufuku wocheperako yemwe amatumiza ndikulandila mafunde amawu amayikidwa pang'ono pamwamba pa diso. Ma echoes amapanga chithunzi cha mkati mwa diso ndipo mtunda wochokera ku cornea kupita ku diso umayezedwa. Chithunzicho, chotchedwa sonogram, chikuwonetsa pazenera la chowunikira cha ultrasound.

• High-resolution ultrasound biomicroscopy: Njira yomwe mafunde amphamvu kwambiri (ultrasound) amachotsedwa m'kati mwa diso kuti apange ma echoes. Madontho a diso amagwiritsidwa ntchito kufafaniza diso ndipo kafukufuku wocheperako yemwe amatumiza ndikulandila mafunde amawu amayikidwa pang'ono pamwamba pa diso. Ma echoes amapanga chithunzi chatsatanetsatane cha mkati mwa diso kuposa ultrasound wamba. Chotupacho chimayang'aniridwa kukula kwake, kapangidwe kake, ndi makulidwe ake, komanso ngati pali zisonyezo zakuti chotupacho chafalikira kumatenda apafupi.

• Kusintha kwa dziko lapansi ndi iris: Kuyesa kwa iris, cornea, mandala, ndi thupi la ciliary ndi kuwala komwe kumayikidwa pachikuto chapamwamba kapena chakumunsi.

• Fluorescein angiography: Njira yoyang'ana mitsempha yamagazi ndi kutuluka kwa magazi mkati mwa diso. Utoto wa lalanje wa fulorosenti (fluorescein) umalowetsedwa mumtsuko wamagazi padzanja ndikulowa m'magazi. Utoto ukuyenda m'mitsempha yamagazi ya diso, kamera yapadera imatenga chithunzi cha diso ndi choroid kuti ipeze malo aliwonse otseka kapena otuluka.

• Indocyanine angiography yobiriwira: Njira yoyang'ana mitsempha yamagazi m'chigawo cha diso. Utoto wobiriwira (indocyanine wobiriwira) umalowetsedwa mumtsuko wamagazi padzanja ndikulowa m'magazi. Utoto ukuyenda m'mitsempha yamagazi ya diso, kamera yapadera imatenga chithunzi cha diso ndi choroid kuti ipeze malo aliwonse otseka kapena otuluka.

• Ocular coherence tomography: Kuyesa kojambula komwe kumagwiritsa ntchito mafunde owala kuti ajambule zithunzi za diso, ndipo nthawi zina choroid, kuti awone ngati pali kutupa kapena madzi pansi pa diso.

Chidziwitso cha chotupacho sichimafunikira kawirikawiri kuti chipeze khansa yapakhungu ya intraocular.

Biopsy ndikuchotsa kwa maselo kapena ziphuphu kotero kuti amatha kuwonedwa pansi pa microscope kuti aone ngati ali ndi khansa. Kawirikawiri, chidziwitso cha chotupacho chimafunika kuti tipeze matenda a khansa ya m'mimba. Minofu yomwe imachotsedwa pachimake kapena kuchitidwa opaleshoni kuti ichotse chotupacho imatha kuyesedwa kuti ipeze zambiri zamankhwala omwe angatchulidwe komanso njira zomwe zingathandize.

Mayesero otsatirawa atha kuchitika pazitsanzo za minofu:

• Kusanthula kwa cytogenetic: Kuyesa kwa labotale komwe ma chromosomes am'maselo amtundu wa minofu amawerengedwa ndikuwunika ngati pali kusintha kulikonse, monga kusweka, kusowa, kukonzedwanso, kapena ma chromosomes owonjezera. Kusintha kwa ma chromosomes ena kungakhale chizindikiro cha khansa. Kusanthula kwa cytogenetic kumagwiritsidwa ntchito kuthandizira kuzindikira khansa, kukonzekera chithandizo, kapena kudziwa momwe chithandizo chikuyendera.

• Gene expression profiling: Kuyesa kwa labotale komwe kumazindikiritsa majini onse mu khungu kapena minofu yomwe ikupanga (kufotokozera) messenger RNA. Mamolekyu a Messenger RNA amakhala ndi zidziwitso za majini zomwe zimafunikira kuti apange mapuloteni ochokera ku DNA yomwe ili mkati mwa khungu mpaka makina opangira mapuloteni mu cytoplasm ya cell.

Biopsy imatha kubweretsa kupindika kwa diso (diso limasiyanitsidwa ndi ziwalo zina m'maso). Izi zikhoza kukonzedwa ndi opaleshoni.

Zinthu zina zimakhudzanso madandaulo (mwayi wochira) ndi njira zamankhwala.

Kulosera (mwayi wochira) ndi njira zamankhwala zimadalira izi:

• Momwe maselo a khansa ya khansa amawonekera pansi pa microscope.

• Kukula ndi makulidwe a chotupacho.

• Gawo la diso chotupacho chili (iris, thupi la ciliary, kapena choroid).

• Kaya chotupacho chafalikira m'maso kapena m'malo ena m'thupi.

• Kaya pali masinthidwe ena amtundu womwe umalumikizidwa ndi intraocular melanoma.

• Msinkhu wa wodwalayo komanso thanzi lake lonse.

• Kaya chotupacho chayambiranso (kubwerera) mutalandira chithandizo.

Magawo a Intraocular (Uveal) Melanoma

MFUNDO ZOFUNIKA

• Pambuyo pa khansa yapakhungu yotchedwa intraocular melanoma yapezeka, amayesedwa kuti apeze ngati maselo a khansa afalikira mbali zina za thupi.

• Miyeso yotsatirayi imagwiritsidwa ntchito kufotokoza intraocular melanoma ndikukonzekera chithandizo:

• Zing'onozing'ono

• Zamkatimu

• Zazikulu

• Pali njira zitatu zomwe khansa imafalikira mthupi.

• Khansa imatha kufalikira pomwe idayamba kupita mbali zina za thupi.

• Magawo otsatirawa amagwiritsidwa ntchito pa intraocular melanoma ya thupi la ciliary ndi choroid:

• Gawo I

• Gawo II

• Gawo III

• Gawo IV

• Palibe njira yokhazikitsira melanoma ya intraocular ya iris.

Pambuyo pa khansa yapakhungu yotchedwa intraocular melanoma yapezeka, amayesedwa kuti apeze ngati maselo a khansa afalikira mbali zina za thupi.

Njira yomwe imagwiritsidwa ntchito pofufuza ngati khansa yafalikira mbali zina za thupi imatchedwa staging. Zomwe amapeza kuchokera pakukonzekera zimatsimikizira gawo la matendawa. Ndikofunikira kudziwa siteji kuti mukonzekere chithandizo.

Mayeso ndi njira zotsatirazi zitha kugwiritsidwa ntchito pokonza:

• Kafukufuku wamagazi: Njira yoyeserera magazi kuti ayese kuchuluka kwa zinthu zina zomwe zimatulutsidwa m'magazi ndi ziwalo ndi minyewa mthupi. Kuchuluka kwazinthu zosazolowereka (zakumwamba kapena zochepa) kungakhale chizindikiro cha matenda.

• Kuyesa kwa chiwindi: Njira yoyeserera magazi kuti ayese kuchuluka kwa zinthu zina zomwe zimatulutsidwa m'magazi ndi chiwindi. Katundu wopitilira muyeso amatha kukhala chizindikiro kuti khansa yafalikira pachiwindi.

• Kuyesa kwa Ultrasound: Njira yomwe mafunde amawu amphamvu (ultrasound) amachotsedwa pamatumba kapena ziwalo zamkati, monga chiwindi, ndikupanga mawonekedwe. Zolembawo amapanga chithunzi cha matupi amthupi otchedwa sonogram.

• X-ray pachifuwa : X-ray ya ziwalo ndi mafupa mkati mwa chifuwa. X-ray ndi mtundu wa mphamvu yamphamvu yomwe imatha kupyola thupi ndikupita mufilimu, ndikupanga chithunzi cha madera omwe ali mthupi.

• MRI (magnetic resonance imaging): Njira yomwe imagwiritsa ntchito maginito, mafunde a wailesi, komanso kompyuta kuti ipange zithunzi zingapo za magawo amkati mwa thupi, monga chiwindi. Njirayi imatchedwanso nuclear magnetic resonance imaging (NMRI).

• CT scan (CAT scan): Njira yomwe imapanga zithunzi zingapo zamkati mwa thupi, monga chifuwa, pamimba, kapena m'chiuno, zotengedwa mbali zosiyanasiyana. Zithunzizo zimapangidwa ndi kompyuta yolumikizidwa ndi makina a x-ray. Utoto ukhoza kulowetsedwa mumtsempha kapena kumeza kuti ziwalo kapena ziwalo ziwoneke bwino. Njirayi imatchedwanso computed tomography, kompyuta tomography, kapena kompyuta axial tomography.

• PET scan (positron emission tomography scan): Njira yopezera maselo oyipa mthupi. Gulu lochepa kwambiri la shuga (radio) imayikidwa mumtsinje. Chojambulira cha PET chimazungulira thupi ndikupanga chithunzi cha komwe glucose imagwiritsidwa ntchito mthupi. Maselo otupa owopsa amawonekera pachithunzichi chifukwa amakhala otanganidwa ndipo amatenga shuga wambiri kuposa momwe maselo amachitira. Nthawi zina kuwunika kwa PET ndi CT scan kumachitika nthawi yomweyo. Ngati pali khansa, izi zimawonjezera mwayi woti zipezeke.

Miyeso yotsatirayi imagwiritsidwa ntchito kufotokoza intraocular melanoma ndikukonzekera chithandizo:

Zing'onozing'ono

Chotupacho chili ndi mamilimita 5 mpaka 16 m'mimba mwake komanso kuyambira 1 mpaka 3 millimeter wokulirapo.

Mamilimita (mm). Pensulo yakuthwa ili pafupifupi 1 mm, krayoni yatsopano ndi pafupifupi 2 mm, ndipo chofufutira pensulo chatsopano ndi pafupifupi 5 mm.

Zamkatimu

Chotupacho chili ndi mamilimita 16 kapena ocheperako ndipo kuyambira mainchesi 3.1 mpaka 8 ndikulimba.

Zazikulu

Chotupacho ndi:

• kuposa 8 millimeters wandiweyani ndi mulitali mwake; kapena

• osachepera 2 millimeter wandiweyani komanso opitilira 16 millimeters m'mimba mwake.

Ngakhale zotupa zambiri za khansa ya khansa ya m'mimba imakulira, ina imakhala yosalala. Zotupa izi zimakula kwambiri pamtambo.

Pali njira zitatu zomwe khansa imafalikira mthupi.

Khansa imatha kufalikira kudzera mu minofu, ma lymph system, ndi magazi:

• Minofu. Khansara imafalikira kuchokera pomwe idayamba ndikukula kupita kumadera oyandikana nawo.

• Lymph dongosolo. Khansara imafalikira kuchokera pomwe idayamba polowa m'mitsempha. Khansara imadutsa m'mitsempha yamafuta kupita mbali zina za thupi.

• Magazi. Khansara imafalikira kuchokera pomwe idayamba ndikulowa m'magazi. Khansara imadutsa m'mitsempha yamagazi kupita mbali zina za thupi.

Ngati intraocular melanoma imafalikira ku mitsempha yamawonedwe kapena minofu yoyandikira ya diso, imatchedwa kuwonjezera kwina.

Khansa imatha kufalikira pomwe idayamba kupita mbali zina za thupi.

Khansa ikafalikira mbali ina ya thupi, imatchedwa metastasis. Maselo a khansa amachoka pomwe adayamba (chotupa choyambirira) ndikuyenda mumitsempha kapena magazi.

• Lymph dongosolo. Khansara imalowa mumitsempha, imadutsa m'mitsempha yamafuta, ndikupanga chotupa (chotupa cha metastatic) gawo lina la thupi.

• Magazi. Khansara imalowa m'magazi, imadutsa m'mitsempha yamagazi, ndikupanga chotupa (chotupa cha metastatic) gawo lina la thupi.

Chotupa cha metastatic ndi khansa yofanana ndi chotupa chachikulu. Mwachitsanzo, ngati intraocular melanoma imafalikira pachiwindi, maselo a khansa pachiwindi ndi maselo am'mimba a khansa ya khansa. Matendawa ndi metastatic intraocular melanoma, osati khansa ya chiwindi.

Magawo otsatirawa amagwiritsidwa ntchito pa intraocular melanoma ya thupi la ciliary ndi choroid:

Intraocular melanoma ya ciliary thupi ndi choroid ili ndi magulu anayi kukula. Gawoli limadalira kukula kwake ndi kukula kwake kwa chotupacho. Zotupa za m'gulu 1 ndizazing'ono kwambiri ndipo gulu lachinayi ndi zotupa zazikulu kwambiri.

Gawo 1:

• Chotupacho sichikuposa mamilimita 12 ndipo sichikula kuposa mamilimita atatu; kapena

• chotupacho sichikuposa mamilimita 9 m'lifupi ndi mamilimita 3.1 mpaka 6 makulidwe.

Gawo 2:

• Chotupacho ndi chachikulu mamilimita 12.1 mpaka 18 osapitilira mamilimita atatu; kapena

• chotupacho ndi 9.1 mpaka 15 millimeters m'lifupi ndi 3.1 mpaka 6 millimeters wandiweyani; kapena

• chotupacho sichepera mamilimita 12 komanso 6.1 mpaka 9 millimeter wokulirapo.

Gawo 3:

• Chotupacho chili ndi mamilimita 15.1 mpaka 18 m'lifupi ndi mamilimita 3.1 mpaka 6 makulidwe; kapena

• chotupacho chili ndi mamilimita 12.1 mpaka 18 m'lifupi ndi mamilimita 6.1 mpaka 9 makulidwe; kapena

• chotupacho sichikuposa mamilimita 18 m'lifupi ndi 9.1 mpaka 12 millimeter wokulirapo; kapena

• Chotupacho sichikuposa mamilimita 15 ndikutalika kwa milimita 12.1 mpaka 15.

Gawo 4:

• Chotupacho chimakhala chopitilira mamilimita 18 ndipo chimatha kukhala cholimba; kapena

• chotupacho chili ndi mamilimita 15.1 mpaka 18 m'lifupi komanso kuposa mamilimita 12; kapena

• chotupacho sichikuposa mamilimita 15 ndipo chimakulirapo kuposa mamilimita 15.

Gawo I

Pachigawo choyamba, chotupacho ndi chachikulu 1 ndipo chili mu choroid chokha.

Gawo II

Gawo II lidagawika magawo IIA ndi IIB.

• Mu gawo IIA, chotupacho:

• ndi gawo 1 ndikufalikira ku thupi la ciliary; kapena

• ndi gawo loyamba 1 ndipo lafalikira kudzera pa sclera mpaka kunja kwa diso. Gawo la chotupacho kunja kwa eyeball silikupitilira mamilimita 5 kunenepa. Chotupacho chimatha kufalikira * ku thupi la ciliary; kapena

• ndi kukula kwa gulu 2 ndipo ili mu choroid yokha.

• Mu gawo IIB, chotupacho:

• ndi gawo lachiwiri ndipo lafalikira ku thupi la ciliary; kapena

• ndi kukula m'gulu 3 ndipo ili mu choroid yokha.

Gawo III

Gawo lachitatu lagawidwa magawo IIIA, IIIB, ndi IIIC.

• Mu gawo IIIA, chotupacho:

• ndi gawo lachiwiri ndipo lafalikira kudzera pa sclera mpaka kunja kwa diso. Gawo la chotupacho kunja kwa eyeball silikupitilira mamilimita 5 kunenepa. Chotupacho chimatha kufalikira ku thupi la ciliary; kapena

• ndi gawo lachitatu ndipo lafalikira ku thupi la ciliary; kapena

• ndi gawo lachitatu ndipo lafalikira kudzera pa sclera mpaka kunja kwa diso. Gawo la chotupacho kunja kwa eyeball silikupitilira mamilimita 5 kunenepa. Chotupacho sichinafalikire m'thupi la ciliary; kapena

• ali kukula m'gulu 4 ndipo ali mu choroid yekha.

• Mu gawo IIIB, chotupacho:

• ndi gawo lachitatu ndipo lafalikira kudzera pa sclera mpaka kunja kwa diso. Gawo la chotupacho kunja kwa eyeball silikupitilira mamilimita 5 kunenepa. Chotupacho chafalikira ku thupi la ciliary; kapena

• ndi gawo lachinayi ndipo lafalikira ku thupi la ciliary; kapena

• ndi gawo lachinayi ndipo lafalikira kudzera pa sclera mpaka kunja kwa diso. Gawo la chotupacho kunja kwa eyeball silikupitilira mamilimita 5 kunenepa. Chotupacho sichinafalikire m'thupi la ciliary.

• Mu gawo IIIC, chotupacho:

• ndi gawo lachinayi ndipo lafalikira kudzera pa sclera mpaka kunja kwa diso. Gawo la chotupacho kunja kwa eyeball silikupitilira mamilimita 5 kunenepa. Chotupacho chafalikira ku thupi la ciliary; kapena

• itha kukhala yayikulu iliyonse ndipo yafalikira kudzera pa sclera mpaka kunja kwa diso. Gawo la chotupa kunja kwa diso ndilopyola mamilimita 5.

Gawo IV

Pa gawo IV, chotupacho chimatha kukula ndipo chafalikira:

• kupita ku malo amodzi kapena angapo apafupi kapena ku bowo limodzi losiyana ndi chotupa choyambirira; kapena

• mbali zina za thupi, monga chiwindi, mapapo, fupa, ubongo, kapena minofu pansi pa khungu.

Palibe njira yokhazikitsira melanoma ya intraocular ya iris.

Melanoma Yomwe Imapezeka Nthawi Zonse (Uveal)

Matenda a khansa yapakhungu omwe amapezeka mobwerezabwereza ndi khansa yomwe yabwereranso (kubwerera) itachiritsidwa. Khansa ya pakhungu imatha kubwerera m'maso kapena mbali zina za thupi.

Chithandizo Chosankha Mwachidule

MFUNDO ZOFUNIKA

• Pali mitundu yosiyanasiyana ya chithandizo kwa odwala omwe ali ndi khansa yapakhosi ya intraocular.

• Mitundu isanu yamankhwala amtundu uliwonse imagwiritsidwa ntchito:

• Opaleshoni

• Kudikira Modikira

• Thandizo la radiation

• Kujambula zithunzi

• Thermotherapy

• Mitundu yatsopano yamankhwala ikuyesedwa m'mayesero azachipatala.

• Chithandizo cha intraocular (uveal) melanoma chitha kuyambitsa mavuto.

• Odwala angaganize zopita nawo kukayezetsa.

• Odwala amatha kulowa m'mayesero azachipatala asanayambe, asanayambe, kapena atayamba kulandira chithandizo cha khansa.

• Mayeso otsatirawa angafunike.

Pali mitundu yosiyanasiyana ya chithandizo kwa odwala omwe ali ndi khansa yapakhosi ya intraocular.

Pali mitundu ingapo yamankhwala othandizira odwala omwe ali ndi khansa yapakhosi ya intraocular. Mankhwala ena ndi ofanana (mankhwala omwe akugwiritsidwa ntchito pano), ndipo ena akuyesedwa m'mayesero azachipatala. Kuyesedwa kwachipatala ndi kafukufuku wofufuza wothandizira kusintha chithandizo chamakono kapena kupeza zidziwitso zamankhwala atsopano kwa odwala khansa. Pamene mayesero azachipatala awonetsa kuti chithandizo chatsopano ndichabwino kuposa chithandizo chamankhwala, chithandizocho chitha kukhala chamankhwala wamba. Odwala angaganize zopita nawo kukayezetsa. Mayesero ena azachipatala ndi otseguka kwa odwala omwe sanayambe kulandira chithandizo.

Mitundu isanu yamankhwala amtundu uliwonse imagwiritsidwa ntchito:

Opaleshoni

Opaleshoni ndi njira yodziwika bwino yothandizira khansa ya khansa ya m'mimba. Mitundu yotsatirayi ingagwiritsidwe ntchito:

• Kubwezeretsa: Kuchita opareshoni kuti muchotse chotupacho komanso pang'ono pathupi pake.

• Nyukiliya: Kuchita opaleshoni kuti muchotse diso ndi gawo lina la mitsempha ya optic. Izi zimachitika ngati masomphenya sangathe kupulumutsidwa ndipo chotupacho ndi chachikulu, chafalikira ku mitsempha yamawonedwe, kapena chimayambitsa kuthamanga kwambiri mkati mwa diso. Pambuyo pa opareshoni, wodwalayo nthawi zambiri amakonzedwa kuti diso lochita kupanga lifanane ndi kukula ndi mtundu wa diso linalo.

• Exenteration: Opaleshoni kuchotsa diso ndi chikope, ndi minofu, misempha, ndi mafuta mu soketi diso. Pambuyo pa opareshoni, wodwalayo amatha kupangidwira diso lochita kupanga kuti lifanane ndi kukula ndi mtundu wa diso linalo kapena chiwalo chakumaso.

Kudikira Modikira

Kuyembekezera mwachidwi kumayang'anitsitsa matenda a wodwalayo osamupatsa chithandizo chilichonse mpaka zizindikilo kapena zizindikiritso zikuwoneka kapena kusintha. Zithunzi zimatengedwa pakapita nthawi kuti zizindikire kusintha kwa kukula kwa chotupacho komanso kuti chikukula msanga.

Kuyembekezera mwachidwi kumagwiritsidwa ntchito kwa odwala omwe alibe zizindikilo ndipo chotupacho sichikukula. Amagwiritsidwanso ntchito ngati chotupacho chili m'diso lokha chokhala ndi masomphenya othandiza.

Thandizo la radiation

Thandizo la radiation ndi chithandizo cha khansa chomwe chimagwiritsa ntchito ma x-ray amphamvu kapena mitundu ina ya radiation kuti iphe ma cell a khansa kapena kuti asakule. Pali mitundu iwiri ya mankhwala a radiation:

• Mankhwala ochiritsira akunja amagwiritsa ntchito makina kunja kwa thupi kuti atumize cheza chaku khansa. Njira zina zoperekera mankhwala a radiation zitha kuthandiza kuti ma radiation asawononge minofu yabwinobwino yapafupi. Mitundu iyi yothandizira ma radiation yakunja imaphatikizapo izi:

• Mankhwala opangira ma radiation olipiritsa omwe ali ndi mtundu wina wamankhwala opitilira kunja. Makina apadera a radiation radiation amalunjika tinthu tating'onoting'ono, tosaoneka, tomwe timatchedwa ma proton kapena helium ions, m'maselo a khansa kuti tiwaphe osawononga pang'ono ziwalo zabwinobwino. Mankhwala a radiation omwe amalipiritsa amagwiritsa ntchito mtundu wina wa radiation poyerekeza ndi mtundu wa X-ray wamankhwala opangira radiation.

• Mankhwala a Gamma Knife ndi mtundu wa ma stereotactic ma radiosurgery omwe amagwiritsidwa ntchito ma melanomas ena. Mankhwalawa atha kuperekedwa ngati chithandizo chimodzi. Imayang'ana kunyezimira kwa gamma molunjika pachotupa kotero kuti kuwonongeka kochepa kwa minofu yabwinobwino. Mankhwala a Gamma Knife sagwiritsa ntchito mpeni kuchotsa chotupacho ndipo siopaleshoni.

• Njira yothandizira poizoniyu yamkati imagwiritsa ntchito mankhwala a radioactive otsekedwa ndi singano, njere, mawaya, kapena ma catheters omwe amayikidwa mwachindunji kapena pafupi ndi khansa. Njira zina zoperekera mankhwalawa zimathandizira kuti ma radiation asawononge minofu yathanzi. Mtundu wamachiritso amkati amtunduwu ungaphatikizepo izi:

• Mankhwala opatsirana pogwiritsa ntchito mankhwalawa ndi mtundu wa mankhwala amkati omwe angagwiritsidwe ntchito pazotupa za diso. Mbeu zotulutsa ma radiation zimaphatikizidwa mbali imodzi ya disk, yotchedwa chipika, ndikuiyika molunjika kukhoma lakunja la diso pafupi ndi chotupacho. Mbali yolembapo yomwe ili ndi nthanga imayang'anizana ndi diso, ndikulinga ndi radiation pa chotupacho. Mwalawo umateteza minofu ina yapafupi ndi ma radiation.

Chidutswa cha radiotherapy cha diso. Mtundu wa mankhwala a radiation omwe amagwiritsidwa ntchito pochizira zotupa m'maso. Mbeu zamagetsi zimaikidwa mbali imodzi yachitsulo (nthawi zambiri chagolide) chotchedwa chipika. Chipikacho chasokedwa kukhoma lakunja la diso. Mbeu zimatulutsa cheza chomwe chimapha khansa. Chikwangwani chimachotsedwa kumapeto kwa chithandizo, chomwe nthawi zambiri chimakhala masiku angapo.

Momwe mankhwala a radiation amaperekedwera zimadalira mtundu ndi gawo la khansa yomwe ikuthandizidwa. Mankhwala akunja amkati ndi amkati amagwiritsidwa ntchito pochiza khansa yapakhosi ya intraocular.

Kujambula zithunzi

Photocoagulation ndi njira yomwe imagwiritsa ntchito kuwala kwa laser kuwononga mitsempha yamagazi yomwe imabweretsa michere pachotupacho, ndikupangitsa kuti ma chotupawo afe. Photocoagulation itha kugwiritsidwa ntchito pochiza zotupa zazing'ono. Izi zimatchedwanso kuwala kozizira.

Thermotherapy

Thermotherapy ndikugwiritsa ntchito kutentha kwa laser kuwononga maselo a khansa ndikuchepetsa chotupacho.

Mitundu yatsopano yamankhwala ikuyesedwa m'mayesero azachipatala.

Zambiri zamayeso azachipatala zimapezeka patsamba la NCI.

Chithandizo cha intraocular (uveal) melanoma chitha kuyambitsa mavuto.

Kuti mumve zambiri zamankhwala obwera chifukwa cha khansa, onani tsamba lathu la Zotsatira Zotsatira.

Odwala angaganize zopita nawo kukayezetsa.

Kwa odwala ena, kutenga nawo mbali pakuyesa chithandizo chachipatala kungakhale njira yabwino kwambiri yothandizira. Mayesero azachipatala ndi gawo limodzi la kafukufuku wa khansa. Mayesero azachipatala amachitika kuti apeze ngati mankhwala atsopano a khansa ndi otetezeka komanso ogwira ntchito kapena abwinoko kuposa mankhwala wamba.

Njira zambiri zamankhwala zochiritsira khansa zimachokera kumayeso am'mbuyomu azachipatala. Odwala omwe amatenga nawo mbali pachipatala atha kulandira chithandizo chofananira kapena kukhala oyamba kulandira chithandizo chatsopano.

Odwala omwe amatenga nawo mbali pazoyeserera zamankhwala amathandizanso kukonza momwe khansa idzathandizire mtsogolo. Ngakhale mayesero azachipatala satsogolera kuchipatala chatsopano, nthawi zambiri amayankha mafunso ofunikira ndikuthandizira kupititsa patsogolo kafukufuku.

Odwala amatha kulowa m'mayesero azachipatala asanayambe, asanayambe, kapena atayamba kulandira chithandizo cha khansa.

Mayesero ena azachipatala amangophatikizapo odwala omwe sanalandire chithandizo. Mayesero ena amayesa chithandizo kwa odwala omwe khansa yawo sinakhale bwino. Palinso mayesero azachipatala omwe amayesa njira zatsopano zothetsera khansa kuti isabwererenso (kubwerera) kapena kuchepetsa zovuta zoyambitsidwa ndi khansa.

Mayesero azachipatala akuchitika m'malo ambiri mdziko muno. Zambiri zamayeso azachipatala othandizidwa ndi NCI zitha kupezeka patsamba lofufuza zamankhwala la NCI. Mayesero azachipatala othandizidwa ndi mabungwe ena amapezeka patsamba la ClinicalTrials.gov.

Mayeso otsatirawa angafunike.

Ena mwa mayesero omwe adachitika kuti apeze khansa kapena kuti adziwe momwe khansa iliri angabwerezedwenso. Mayesero ena adzabwerezedwa kuti awone momwe mankhwalawa akugwirira ntchito. Zisankho zakuti mupitilize, kusintha, kapena kusiya kulandira chithandizo zitha kutengera zotsatira za mayeso awa.

Kuyesaku kumangopitilira kuchitika nthawi ndi nthawi mankhwala atatha. Zotsatira zamayesowa zitha kuwonetsa ngati vuto lanu lasintha kapena ngati khansa yabwereranso (bwererani). Mayesowa nthawi zina amatchedwa kuyesa kutsata kapena kukayezetsa.

Njira Zothandizira Kuchiza Khansa ya M'mimba (Uveal) Melanoma

M'chigawo chino

• Iris Melanoma

• Ciliary Thupi khansa ya pakhungu

• Choroid Melanoma

• Extraocular Extension Melanoma ndi Metastatic Intraocular (Uveal) Melanoma

• Melanoma Yomwe Imapezeka Nthawi Zonse (Uveal)

Kuti mumve zambiri zamankhwala omwe atchulidwa pansipa, onani gawo la Chisankho Chachidule.

Iris Melanoma

Chithandizo cha iris melanoma chingaphatikizepo izi:

• Kudikira kudikira.

• Opaleshoni (resection kapena enucleation).

• Thandizo la radiation, la zotupa zomwe sizingachotsedwe ndi opaleshoni.

Gwiritsani ntchito kusaka kwathu kwamankhwala kuti mupeze mayesero azachipatala omwe amathandizidwa ndi NCI omwe akulandira odwala. Mutha kusaka mayesero kutengera mtundu wa khansa, zaka za wodwalayo, komanso komwe mayeserowo akuchitika. Zambiri pazokhudza mayesero azachipatala zimapezekanso.

Ciliary Thupi khansa ya pakhungu

Chithandizo cha khansa ya khansa ya khansa imatha kukhala ndi izi:

• Thandizo la radiation.

• Kulipira-tinthu tating'onoting'ono ta radiation.

• Opaleshoni (resection kapena enucleation).

Gwiritsani ntchito kusaka kwathu kwamankhwala kuti mupeze mayesero azachipatala omwe amathandizidwa ndi NCI omwe akulandira odwala. Mutha kusaka mayesero kutengera mtundu wa khansa, zaka za wodwalayo, komanso komwe mayeserowo akuchitika. Zambiri pazokhudza mayesero azachipatala zimapezekanso.

Choroid Melanoma

Chithandizo cha khansa ya khansa ingaphatikizepo izi:

• Kudikira kudikira.

• Thandizo la radiation.

• Kulipira-tinthu tating'onoting'ono ta radiation.

• Chithandizo cha Gamma Knife.

• Thermotherapy.

• Opaleshoni (resection kapena enucleation).

Chithandizo cha melanoma yapakatikati ya choroid chingaphatikizepo izi:

• Thandizo la radiation pogwiritsa ntchito kapena popanda photocoagulation kapena thermotherapy.

• Kulipira-tinthu tating'onoting'ono ta radiation.

• Opaleshoni (resection kapena enucleation).

Chithandizo cha khansa yayikulu ya khansa ingaphatikizepo izi:

• Kukhazikika pamene chotupacho ndi chachikulu kwambiri kuposa mankhwala omwe angapulumutse diso.

Gwiritsani ntchito kusaka kwathu kwamankhwala kuti mupeze mayesero azachipatala omwe amathandizidwa ndi NCI omwe akulandira odwala. Mutha kusaka mayesero kutengera mtundu wa khansa, zaka za wodwalayo, komanso komwe mayeserowo akuchitika. Zambiri pazokhudza mayesero azachipatala zimapezekanso.

Extraocular Extension Melanoma ndi Metastatic Intraocular (Uveal) Melanoma

Chithandizo cha melanoma yowonjezerapo yomwe yafalikira kumafupa ozungulira diso ingaphatikizepo izi:

• Opaleshoni (kukwiya).

• Kuyesedwa kwachipatala.

Chithandizo chothandiza cha khansa yapakhosi ya intraocular khansa sichinapezeke. Kuyesedwa kwachipatala itha kukhala njira yothandizira. Lankhulani ndi dokotala wanu za zomwe mungachite.

Gwiritsani ntchito kusaka kwathu kwamankhwala kuti mupeze mayesero azachipatala omwe amathandizidwa ndi NCI omwe akulandira odwala. Mutha kusaka mayesero kutengera mtundu wa khansa, zaka za wodwalayo, komanso komwe mayeserowo akuchitika. Zambiri pazokhudza mayesero azachipatala zimapezekanso.

Melanoma Yomwe Imapezeka Nthawi Zonse (Uveal)

Chithandizo chothandiza cha khansa yapakhosi ya intraocular sichinapezeke. Kuyesedwa kwachipatala itha kukhala njira yothandizira. Lankhulani ndi dokotala wanu za zomwe mungachite.

Gwiritsani ntchito kusaka kwathu kwamankhwala kuti mupeze mayesero azachipatala omwe amathandizidwa ndi NCI omwe akulandira odwala. Mutha kusaka mayesero kutengera mtundu wa khansa, zaka za wodwalayo, komanso komwe mayeserowo akuchitika. Zambiri pazokhudza mayesero azachipatala zimapezekanso.

Kuti mudziwe Zambiri Zokhudza Intraocular (Uveal) Melanoma

Kuti mumve zambiri kuchokera ku National Cancer Institute yokhudzana ndi intraocular (uveal) melanoma, onani tsamba la Intraocular (Eye) Melanoma Home Page.

Kuti mumve zambiri za khansa ndi zinthu zina zochokera ku National Cancer Institute, onani izi:

• Za Khansa

• Kusinthana

• Chemotherapy and You: Kuthandiza Anthu Omwe Ali Ndi Khansa

• Thandizo la Radiation ndi Inu: Thandizo kwa Anthu Omwe Ali ndi Khansa

• Kulimbana ndi khansa

• Mafunso oti mufunse dokotala wanu za khansa

• Kwa Opulumuka ndi Owasamalira