Types/bone/bone-fact-sheet

Umhlaza wamathambo ePrayimari

Yintoni amathumba?

Iindidi ezahlukeneyo zamathumba zinokukhula emathanjeni: amathumba aphambili amathambo, avela kwizicubu zethambo kwaye anokuba sisifo esibuhlungu (somhlaza) okanye esibi (hayi esomhlaza), kunye nezidumba zemastastatic (amathumba aphuma kumaseli omhlaza awakhe kwenye indawo emzimbeni kwaye emva koko usasaze ufikelele kwithambo). Izilonda zamathambo eziphambili (izilonda zomhlaza wamathambo) aziqhelekanga kunezicubu ezinobungozi. Zombini ezi ntlobo zamathumba amathambo zisenokukhula kwaye zicinezele izicwili zethambo ezisempilweni, kodwa izicubu ezinobungozi zihlala zingasasazi okanye zonakalise izicwili zethambo kwaye kunqabile ukuba zibe sisoyikiso ebomini.

Umhlaza wamathambo wokuqala ubandakanyiwe kudidi olubanzi lwee-cancer ezibizwa ngokuba yi-sarcomas. (Ii-sarcomas ze-soft-tissue-sarcomas eziqala kwimisipha, kumanqatha, kwizicubu ezinemicu, kwimithambo yegazi, okanye kwezinye izihlunu ezixhasayo zomzimba, kubandakanya ne-synovial sarcoma-ayibhekiswa kweli phepha.)

Umhlaza wamathambo wokuqala unqabile. Inika ingxelo engaphantsi kakhulu kwe-1% yazo zonke iintlobo zomhlaza ezintsha ezifunyanisiweyo. Kwi-2018, kuqikelelwa ukuba ngamatyala amatsha angama-3,450 omhlaza wamathambo aphambili aya kufunyanwa e-United States (1).

Umhlaza osasazeka (usasazeka) emathanjeni usuka kwamanye amalungu omzimba ubizwa ngokuba ngumhlaza wamathambo (okanye owesibini) kwaye ubhekiswa kuwo lilungu okanye kwithishu eqale kuyo-umzekelo, njengomhlaza wamabele osele wenziwe ithambo . Kubantu abadala, izicwili ezinomhlaza eziye zadityaniswa nethambo zixhaphake kakhulu kunomhlaza wamathambo wokuqala. Umzekelo, ekupheleni kuka-2008, abantu abadala abamalunga nama-280,000 abaneminyaka eli-18-64 ubudala eUnited States babehlala nomhlaza wemastastatic emathanjeni (2).

Nangona uninzi lweentlobo zomhlaza zinokusasazeka ziye emathanjeni, imethastasis yethambo ikakhulu inokwenzeka ngomhlaza othile, kubandakanya nomhlaza webele kunye neprostate. Amathumba e-Metastatic kwithambo angabangela ukwaphuka, iintlungu, kunye namanqanaba aphezulu ngokungaqhelekanga e-calcium egazini, imeko ebizwa ngokuba yi-hypercalcemia.

Zithini iintlobo ezahlukeneyo zomhlaza wamathambo wokuqala?

Iindidi zomhlaza wamathambo wokuqala zichazwa ziziphi iiseli zethambo ezizivelelayo.

Osteosarcoma

I-Osteosarcoma ivela kwiiseli ezenza amathambo ezibizwa ngokuba yi-osteoblasts kwi-osteoid tissue (izicubu zethambo ezingafakwanga). Eli thumba livela engalweni ecaleni kwegxalaba nasemlenzeni kufutshane nedolo ebantwaneni, abakwishumi elivisayo nakubantu abadala abancinci (3) kodwa linokwenzeka nakweliphi na ithambo, ngakumbi kubantu abadala abadala. Ihlala ikhula ngokukhawuleza kwaye isasazeka kwamanye amalungu omzimba, kubandakanya nemiphunga. Umngcipheko we-osteosarcoma uphezulu phakathi kwabantwana nakwishumi elivisayo abaneminyaka eli-10 neli-19. Amadoda kunokwenzeka ngakumbi kunabafazi ukuba baphuhlise i-osteosarcoma. Phakathi kwabantwana, i-osteosarcoma ixhaphake kakhulu kwabantsundu nakwezinye iintlanga okanye ubuhlanga kunakwabamhlophe, kodwa kubantu abadala ixhaphake kakhulu kwabamhlophe kunakwamanye amaqela obuhlanga / obuhlanga.

IChondrosarcoma

I-Chondrosarcoma iqala kwizicubu ze-cartilaginous. I-Cartilage luhlobo lwezicubu ezihlanganayo ezigquma iziphelo zamathambo kunye nemigca yamalungu. I-Chondrosarcoma ihlala ifom kwi-pelvis, emlenzeni ongasentla nasegxalabeni kwaye ihlala ikhula kancinci, nangona ngamanye amaxesha ingakhula ngokukhawuleza kwaye isasazeke kwamanye amalungu omzimba. I-Chondrosarcoma yenzeka ikakhulu kubantu abadala (ngaphezulu kweminyaka engama-40). Umngcipheko uyanda ngokwanda kweminyaka. Uhlobo olunqabileyo lwe-chondrosarcoma olubizwa ngokuba yi-extraskeletal chondrosarcoma alubikho kwi-cartilage yethambo. Endaweni yoko, yenzeka kwizicwili ezithambileyo zenxalenye ephezulu yeengalo nemilenze.

Ukufumana isarcoma

I-sarcoma ye-Ewing ihlala ivela ethanjeni kodwa isenokungafane ivela kwizicwili ezithambileyo (izihlunu, amanqatha, izicwili ezinemicu, imithambo yegazi, okanye ezinye izicubu ezixhasayo). Ukuthenga ii-sarcomas ngokwesiqhelo kwifom ye-pelvis, emilenzeni, okanye kwiimbambo, kodwa inokwenza naliphi na ithambo (3). Eli thumba lihlala likhula ngokukhawuleza kwaye lisasazeka kwamanye amalungu omzimba, kubandakanya nemiphunga. Umngcipheko we-Ewing sarcoma uphezulu ebantwaneni nakwishumi elivisayo abangaphantsi kweminyaka eyi-19. Amakhwenkwe kunokwenzeka ukuba aphuhlise i-Ewing sarcoma kunamantombazana. Ukuthenga i-sarcoma kuxhaphake kakhulu kwabamhlophe kunakubantu abamnyama okanye kuma-Asiya.

Chordoma

IChordoma sisisu esinqabileyo kakhulu esenza kumathambo omqolo. Ezi tumors zihlala zenzeka kubantu abadala kwaye zihlala zenziwe kumqolo (i-sacrum) nakwisiseko sokhakhayi. Phantse kabini kunamadoda njengabafazi bafunyaniswe ukuba bane-chordoma. Xa zisenzeka kubantu abancinci nakubantwana, zihlala zifumaneka emazantsi okhakhayi nakumqolo wesibeleko (entanyeni).

Iindidi ezininzi zamathumba enesibindi zinokuthi, kwiimeko ezinqabileyo, zibe mandundu kwaye zisasazeke kwamanye amalungu omzimba (4). Oku kubandakanya i-tumor enkulu yeseli yethambo (ekwabizwa ngokuba yi-osteoclastoma) kunye ne-osteoblastoma. Isisu esikhulu sethumba senzeka ikakhulu kwiziphelo zamathambo amade ezingalo nemilenze, zihlala zisondele edolweni (5). Ezi tumors, zihlala zikhona kubantu abadala nakwabadala abaphakathi, zinokuba ndlongondlongo ekuhlaleni, zibangele ukutshatyalaliswa kwethambo. Kwiimeko ezinqabileyo banokusasazeka (metastasize), rhoqo kwimiphunga. I-Osteoblastoma ithatha indawo yesiqhelo kwithambo eliqinileyo kunye nefom ebuthathaka ebizwa ngokuba yi-osteoid. Eli thumba livela ikakhulu emqolo (6). Iyakhula kancinci kwaye yenzeka kubantu abadala nakwabadala abaphakathi. Iimeko ezinqabileyo zeli thumba ziba mbi ziye zaxelwa.

Zeziphi izinto ezinokubangela umhlaza wamathambo?

Nangona umhlaza wamathambo wokuqala ungenaso isizathu esichazwe ngokucacileyo, abaphandi bafumanise izinto ezininzi ezonyusa amathuba okuphuhlisa ezi tumors.

• Unyango lwangaphambili lomhlaza kunye ne-radiation, chemotherapy, okanye ukufakelwa kweseli ye-stem. I-Osteosarcoma yenzeka rhoqo kubantu abaye bafumana unyango lwedosi ephezulu yedosi (ngakumbi kwindawo emzimbeni apho kunikwe khona imitha) okanye unyango ngamachiza athile e-anticancer, ngakumbi iiarhente zealkylating; abo baphathwa ngexesha lobuntwana basemngciphekweni othile. Ukongeza, i-osteosarcoma ikhula ngepesenti encinci (malunga ne-5%) yabantwana abafumana ukufakelwa kweseli ye-heeloopoatic.

• Iimeko ezithile ezizuzwe njengelifa.Inani elincinci lomhlaza wamathambo ngenxa yeemeko zofuzo (3). Umzekelo, abantwana abanelifa le-retinoblastoma (umhlaza ongaqhelekanga wamehlo) basemngciphekweni omkhulu wokufumana i-osteosarcoma, ngakumbi ukuba baphathwa ngemitha. Amalungu eentsapho ezine-Li-Fraumeni syndrome asengozini yokwanda kwe-osteosarcoma kunye ne-chondrosarcoma kunye nezinye iintlobo zomhlaza. Ukongeza, abantu abaneziphene kwilifa banomngcipheko okhulayo wokuphila njengechondrosarcoma. I-chordoma yobuntwana inxulunyaniswa nesifo se-tuberous sclerosis, isifo semfuza apho izicubu ezinobungozi zenza izintso, ingqondo, amehlo, intliziyo, imiphunga kunye nolusu. Nangona i-Ewing sarcoma ayinxulunyaniswa kakhulu nayo nayiphi na i-syndromes yomhlaza wemfuza okanye izifo zokuzalwa komntwana (7, 8),

• Iimeko ezithile zethambo ezinobungozi. Abantu abangaphezu kweminyaka engama-40 abanesifo sePaget samathambo (imeko enobungozi ebonakaliswa kukukhula ngokungaqhelekanga kweeseli zethambo) basemngciphekweni omkhulu wokukhula kwe-osteosarcoma.

Zithini iimpawu zomhlaza wamathambo?

Ubuhlungu luphawu oluqhelekileyo lomhlaza wamathambo, kodwa ayizizo zonke iintsholongwane zomhlaza ezibangela iintlungu. Iintlungu eziqhubekayo okanye ezingaqhelekanga okanye ukudumba ngaphakathi okanye kufutshane nethambo kunokubangelwa ngumhlaza okanye ngezinye iimeko. Ezinye iimpawu zomhlaza wamathambo zibandakanya iqhuma (elinokuziva lithambile kwaye lifudumele) ezingalweni, emilenzeni, esifubeni, okanye esinqeni; umkhuhlane ongachazwanga; kunye nethambo elophuka ngaphandle kwesizathu esaziwayo. Kubalulekile ukuba ubone ugqirha ukufumanisa unobangela wazo naziphi na iimpawu zethambo.

Ufunyanwa njani umhlaza wamathambo?

Ukunceda ukufumanisa isifo somhlaza wamathambo, ugqirha ubuza malunga nembali yesigulana kunye nentsapho. Ugqirha wenza uvavanyo lomzimba kwaye unoku-odola elebhu kunye nolunye uvavanyo lokuqonda. Olu vavanyo lunokubandakanya oku kulandelayo:

• IX-reyi, enokubonisa indawo, ubungakanani, kunye nemilo yethumba. Ukuba i-x-ray iphakamisa ukuba indawo engaqhelekanga inokuba ngumhlaza, ugqirha unokucebisa uvavanyo olukhethekileyo lokucinga. Nokuba ii-x-reyi zibonisa ukuba indawo engaqhelekanga ilungile, ugqirha unokufuna ukwenza olunye uvavanyo, ngakumbi ukuba isigulana siva iintlungu ezingaqhelekanga okanye ezingapheliyo.

• Ukuvavanywa kwethambo, oluvavanyo apho inani elincinci lezinto ezisasaza ngemitha lifakwa kwisitya segazi kwaye lihamba ngokuhamba kwegazi; emva koko iqokelela emathanjeni kwaye ifunyenwe siskena.

• Iskena sekhompyuter ye-tomography (i-CT okanye ye-CAT), eluluhlu lwemifanekiso eneenkcukacha zeendawo ezingaphakathi emzimbeni, ezithathwe kwii-engile ezahlukeneyo, ezenziwa yikhompyuter edityaniswe kumatshini we-x-ray.

• Inkqubo yokucinga ngemagneti (i-MRI), esebenzisa umazibuthe onamandla odityaniswe nekhompyuter ukwenza imifanekiso eneenkcukacha yeendawo ezingaphakathi komzimba ngaphandle kokusebenzisa i-x-reyi.

• Iskena se-positron emission tomography (PET), apho inani elincinci leswekile ene-radioactive (iswekile) lifakwa emthanjeni, kwaye iskena sisetyenziselwa ukwenza imifanekiso eneenkcukacha, eyikhompyuter yeendawo ezingaphakathi emzimbeni apho kusetyenziswa khona iswekile. Ngenxa yokuba iiseli zomhlaza zihlala zisebenzisa iswekile eninzi kuneeseli eziqhelekileyo, imifanekiso inokusetyenziselwa ukufumana iiseli zomhlaza emzimbeni.

• I-angiogram, eyi-x-ray yemithambo yegazi.

• Uqhaqho (ukususwa kwesampulu yethishu kwi-tumor yamathambo) ukumisela ukuba umhlaza ukhona na. Ugqirha angenza ialiti biopsy, i-biopsy ekhethiweyo, okanye i-biopsy engacaciswanga. Ngexesha le-biopsy yenaliti, ugqirha wotyando wenza umngxunya omncinci kwithambo kwaye asuse isampulu yethishu kwithumba ngesixhobo esifana nenaliti. Ngokunyanga i-biopsy, ugqirha ususa lonke iqhuma okanye indawo ekrokrisayo yokufumanisa isifo. Kwi-biopsy ye-incisional, ugqirha wotyando usika isisu kwaye asuse isampulu yethishu. Ii-Biopsies zenziwe ngcono ngugqirha wamathambo (ugqirha onamava kunyango lomhlaza wamathambo) kuba ukubekwa kwe-biopsy incision kunokuchaphazela ukhetho olulandelayo. Ugqirha wezifo (ugqirha ochonga isifo ngokufunda iiseli kunye nezicubu phantsi kwemicroscope) uvavanya izicwili ukufumanisa ukuba ingaba zinomhlaza na.

• Uvavanyo lwegazi ukumisela amanqanaba ee-enzymes ezimbini ezibizwa ngokuba yialkaline phosphatase kunye ne-lactate dehydrogenase. Izixa ezikhulu zezi enzymes zinokubakho egazini labantu abane-osteosarcoma okanye i-Ewing sarcoma. Amanqanaba aphezulu egazi e-alkaline phosphatase ayenzeka xa iiseli ezenza izicwili zethambo zisebenza kakhulu-xa abantwana bekhula, xa ithambo elaphukileyo lilungisiwe, okanye xa isifo okanye ithumba libangela ukuveliswa kwethambo elingaqhelekanga. Kuba amanqanaba aphezulu e-alkaline phosphatase aqhelekile ekukhuleni kwabantwana nakwishumi elivisayo, olu vavanyo alusosalathiso somhlaza wamathambo.

Unyangwa njani umhlaza wamathambo wokuqala?

Ukhetho lonyango luxhomekeke kuhlobo, ubungakanani, indawo, kunye nenqanaba lomhlaza, kunye nobudala bomntu kunye nempilo ngokubanzi. Ukhetho kunyango lomhlaza wamathambo lubandakanya utyando, ichemotherapy, unyango ngemitha, i-cryosurgery, kunye nonyango ekujolise kulo.

• Utyando lunyango oluqhelekileyo lomhlaza wamathambo. Ugqirha ususa lonke ithumba elinemida engeyiyo (Oko kukuthi, akukho iiseli zomhlaza zifunyanwa emaphethelweni esihlunu esisuswe ngexesha lotyando). Ugqirha usenokusebenzisa iindlela ezizodwa zotyando ukunciphisa isixa sezicubu ezisempilweni ezisusiweyo kunye nethumba. (Oko kukuthi, ukususwa kwelungu lonke). Nangona kunjalo, uninzi lwezigulana ezenziwa utyando lokuthintela imilenze zifuna utyando lokwakha ngokutsha ukuze iphinde iphinde isebenze (3).

• I-Chemotherapy kukusetyenziswa kwamayeza okubulala iiseli zomhlaza. Izigulana ezine-Ewing sarcoma (esandula ukufunyanwa kunye nokuphindaphindeka) okanye i-osteosarcoma esandula kufunyaniswa ifumana indibaniselwano yamachiza e-anticancer ngaphambi kokuba kwenziwe utyando. I-Chemotherapy ayisetyenziselwa ukunyanga i-chondrosarcoma okanye i-chordoma.

• Unyango ngemitha, ekwabizwa ngokuba yiradiotherapy, lubandakanya ukusetyenziswa kwe-x-reyi enamandla amakhulu ukubulala iiseli zomhlaza. Olu nyango lunokusetyenziswa ngokudibeneyo notyando. Ihlala isetyenziselwa ukunyanga i-Ewing sarcoma (3). Ingasetyenziselwa olunye unyango lwe-osteosarcoma, i-chondrosarcoma, kunye ne-chordoma, ngakumbi xa inani elincinci lomhlaza lihlala emva kotyando. Into enokusasazeka eqokeleleni emathanjeni, ebizwa ngokuba yi-samarium, luhlobo lwangaphakathi lonyango lwemitha olunokusetyenziselwa wedwa okanye ukufakelwa kweseli ye-stem ukunyanga i-osteosarcoma ebuyileyo emva konyango kwithambo elahlukileyo.

• I-Cryosurgery kukusetyenziswa kwenitrojeni engamanzi ukubanda nokubulala iiseli zomhlaza. Obu buchule ngamanye amaxesha bunokusetyenziselwa endaweni yotyando oluqhelekileyo ukutshabalalisa amathumba kwithambo (10).

• Unyango ekujoliswe kulo kukusetyenziswa kweziyobisi eziyilelwe ukunxibelelana nemolekyuli ethile ebandakanyekayo ekukhuleni nasekusasazeni kweeseli zomhlaza. I-monoclonal antibody denosumab (Xgeva®) lonyango ekujoliswe kulo oluvunyiweyo lokunyanga abantu abadala kunye nolutsha olufikisayo lwamathambo ngesisu esikhulu sesithambo esingenakususwa ngotyando. Ithintela ukutshatyalaliswa kwethambo okubangelwa luhlobo lweseli lesithambo elibizwa ngokuba yi-osteoclast.

Olunye ulwazi malunga nonyango lweentlobo ezithile zomhlaza wamathambo lunokufumaneka kwezi zishwankathelo zonyango ze-®:

• Unyango lwe-Ewing Sarcoma

• I-Osteosarcoma kunye ne-Malignant Fibrous Histiocytoma yonyango lwe-Bone

• Umhlaza ongaqhelekanga woNyango lwaBantwana (icandelo kwiChordoma)

Ziziphi iziphumo ebezingalindelekanga zonyango lomhlaza wamathambo?

Abantu abaye banyangwa umhlaza wamathambo banamathuba okonyuka kokuvela kwexesha kunyango njengoko bekhula. Ezi ziphumo zasemva kwexesha zixhomekeke kunyango kunye nobudala besigulana kunyango kwaye zibandakanya iingxaki zomzimba ezibandakanya intliziyo, umphunga, ukuva, ukuchuma, kunye nethambo; iingxaki zemithambo-luvo; kunye nomhlaza wesibini (i-acute myeloid leukemia, myelodysplastic syndrome, kunye ne-sarcoma ebangelwa yimitha). Unyango lwethambo kunye ne-cryosurgery kungakhokelela ekutshatyalalisweni kwethambo elikufuphi kwaye kubangele ukwaphuka, kodwa ezi ziphumo azinakubonwa kangangexesha elithile emva konyango lokuqala.

Umhlaza wethambo ngamanye amaxesha uhlangana, ngakumbi kwimiphunga, okanye unokuphinda ubuye (ubuye), nokuba kukwindawo enye okanye kwamanye amathambo emzimbeni. Abantu abanomhlaza wamathambo kufuneka babone ugqirha wabo rhoqo kwaye kufuneka baxele naziphi na iimpawu ezingaqhelekanga kwangoko. Ukulandelwa kuyahluka ngokweentlobo ezahlukeneyo kunye namanqanaba omhlaza wamathambo. Ngokubanzi, abaguli bahlolwa rhoqo ngugqirha kwaye baneemvavanyo zegazi rhoqo kunye ne-x-ray. Unonophelo olulandelayo olulandelayo luqinisekisa ukuba utshintsho kwimpilo luyaxoxwa kwaye iingxaki zinyangwa ngokukhawuleza.

Izalathiso ezikhethiweyo '

1. USiegel RL, uMiller KD, uJemal A. Amanani omhlaza, 2018. I-CA: Ijenali yoMhlaza yeeKlinikhi ze2018; Isiqendu 68 (1): 7-30. [PubMed Abstract]
2. U-Li S, uPeng Y, u-Weinhandl ED, et al. Inani eliqikelelweyo leemeko ezixhaphakileyo zesifo samathambo kubantu abadala base-US. Iklinikhi Epidemiology 2012; 4: 87-93. [PubMed Abstract]
3. U-O'Donnell RJ, uDuBois SG, uHaas-Kogan DA. USarcomas wethambo. Ku: DeVita, Hellman, kunye neRosenberg's Cancer: Imigaqo kunye nokuziqhelanisa neOncology. Ushicilelo lwe-10. IPhiladelphia: Lippincott Williams kunye noWilkins, 2015. Ukuhlaziywa kukaJulayi 26, 2017.
4. IHakim DN, uPelly T, uKulendran M, uCaris JA. Izilonda zeBenign zethambo: Ukuphononongwa. Ijenali ye-Bone Oncology 2015; (2): 37-41. [PubMed Abstract]
5. I-Sobti A, i-Agrawal P, i-Agarwala S, i-Agarwal M.I-tumor enkulu yeseli yethambo-Isishwankathelo. Ugcino lwamathambo kunye nokuhlinzwa ngokuhlangeneyo ngo-2016; 4 (1): 2-9. [PubMed Abstract]
6. UZhang Y, uRosenberg AE. Amathumba enza amathambo. Iiklinikhi zePathology zoNyango 2017 I-10 (3): 513-535. [PubMed Abstract]
7. UMirabello L, uC Curtis RE, uSavage SA. Umhlaza wamathambo. Ku: Michael Thun M, Linet MS, Cerhan JR, Haiman CA, Schottenfeld D, abahleli. ISchottenfeld kunye neFraumeni, iCancer Epidemiology kunye noThintelo. Uhlelo lwesine. ENew York: IYunivesithi yaseOxford Press, ngo-2018.
8. I-E yamaRoma, i-Lightfoot T, iPicton S Kinsey S. yomhlaza wobuntwana. Ku: Michael Thun M, Linet MS, Cerhan JR, Haiman CA, Schottenfeld D, abahleli. ISchottenfeld kunye neFraumeni, iCancer Epidemiology kunye noThintelo. Uhlelo lwesine. ENew York: IYunivesithi yaseOxford Press, ngo-2018.
9. UMachiela MJ, uGrünewald TGP, uSurdez D, et al. Isifundo sobumbano esibanzi sichaza indawo ezininzi ezinxulunyaniswa nokuchaphazeleka kwe-sarcoma. Unxibelelwano lweNdalo 2018; 9 (1): 3184. [PubMed Abstract]
10. U-Chen C, uGarlich J, uVincent K, uBrien E. Ubunzima bokusebenza kunye ne-cryotherapy kwizicubu zethambo. Ijenali ye-Bone Oncology 2017; 7: 13-17. [PubMed Abstract]

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