Iindidi / zomhlaza-somhlaza / somonde / somhlaza-esingaqhelekanga-somhlaza-pdq

Umhlaza ongaqhelekanga woNyango lwaBantwana (?)

Ulwazi ngokubanzi malunga neMihlaza engaqhelekanga yoBuntwana

IINGONGOMA EZIPHAMBILI

• Umhlaza ongaqhelekanga wobuntwana ngumhlaza kunqabile ukuba ubonwe ebantwaneni.

• Uvavanyo lusetyenziselwa ukufumanisa (ukufumana), ukufumanisa isifo, kunye nenqanaba lomhlaza ongaqhelekanga wobuntwana.

• Zintathu iindlela umhlaza onwenwa ngayo emzimbeni.

• Umhlaza unokusasazeka ukusuka apho waqala khona kwamanye amalungu omzimba.

Umhlaza ongaqhelekanga wobuntwana ngumhlaza kunqabile ukuba ubonwe ebantwaneni.

Umhlaza ebantwaneni nakwishumi elivisayo unqabile. Ukusukela ngo-1975, inani lezehlo ezitsha zomhlaza wabantwana liye lenyuka kancinci. Ukusukela ngo-1975, inani labantu abaswelekileyo ngenxa yomhlaza wobuntwana lehle ngaphezulu kwesiqingatha.

Iimpawu zomhlaza ezingaqhelekanga ekuxoxwe ngazo kwesi sishwankathelo zinqabile kangangokuba uninzi lwezibhedlele zabantwana kunokwenzeka ukuba zibone ngaphantsi kweqaqobana lweentlobo ezithile kwiminyaka eliqela. Ngenxa yokuba umhlaza ongaqhelekanga unqabile, akukho lwazi luninzi malunga nokuba loluphi unyango olusebenza kakuhle. Unyango lomntwana luhlala lusekwe kwinto efundwe kunyango lwabanye abantwana. Ngamanye amaxesha, ulwazi lufumaneka kuphela kwiingxelo zokuxilongwa, unyango, kunye nokulandelwa komntwana omnye okanye iqela elincinci labantwana abanikwe uhlobo olufanayo lonyango.

Zininzi iintlobo zomhlaza ezigutyungelwe kwesi sishwankathelo. Baqokelelwe ngokokufumaneka kwabo emzimbeni.

Uvavanyo lusetyenziselwa ukufumanisa (ukufumana), ukufumanisa isifo, kunye nenqanaba lomhlaza ongaqhelekanga wobuntwana.

Uvavanyo lwenziwa ukufumanisa, ukufumanisa isifo, kunye nomhlaza kwinqanaba. Iimvavanyo ezisetyenzisiweyo zixhomekeke kuhlobo lomhlaza. Emva kokufunyaniswa komhlaza, kwenziwa uvavanyo lokufumanisa ukuba iiseli zomhlaza zisasazekile ukusuka apho umhlaza uqale khona kwamanye amalungu omzimba. Inkqubo esetyenziselwa ukufumanisa ukuba ngaba iiseli zomhlaza zisasazekile kwamanye amalungu omzimba kuthiwa yi-staging. Ulwazi oluqokelelwe kwinkqubo yokubeka inqanaba lesifo. Kubalulekile ukwazi inqanaba ukuze ucwangcise olona nyango lululo.

Olu vavanyo lulandelayo kunye neenkqubo zinokusetyenziselwa ukufumanisa, ukufumanisa isifo, kunye nomhlaza kwinqanaba:

• Uvavanyo lomzimba kunye nembali yezempilo: Uvavanyo lomzimba ukukhangela iimpawu zempilo ngokubanzi, kubandakanya nokujonga iimpawu zesifo, ezinje ngamaqhuma okanye nayiphi na into ebonakala ingaqhelekanga. Imbali yemikhwa yempilo yesigulana kunye nezifo zangaphambili kunye nonyango ziya kuthathwa.

• Izifundo ze-chemistry yegazi: Inkqubo apho kuvavanywa khona isampulu yegazi ukulinganisa izixa zezinto ezithile ezikhutshelwe egazini ngamalungu kunye nezicubu zomzimba. Inani elingaqhelekanga (eliphezulu okanye elisezantsi kunesiqhelo) lwento elinokuba ngumqondiso wesifo.

• IX-reyi: IX-reyi luhlobo lombane wamandla onokuthi uhambe emzimbeni nakwifilimu.

• Ukuskena i-CT (ukuskena i-CAT): Inkqubo eyenza uthotho lwemifanekiso eneenkcukacha zeendawo ezingaphakathi emzimbeni, ezithathwe kwii-engile ezahlukeneyo. Imifanekiso yenziwe yikhompyuter edityaniswe kumatshini we-x-ray. Le nkqubo ikwabizwa ngokuba yi-computed tomography, ikhompyuter ye-tomography, okanye ikhompyuter ye-axial tomography.

Ikhompyuter ye-tomography (CT) yesisu. Umntwana ulele phezu kwetafile etyibilika ngesikena se-CT, esithatha imifanekiso ye-x-ray engaphakathi esiswini.

• Ukuskena i-PET (positron emission tomography scan) Inkqubo yokufumana iiseli zethumba ezinobungozi emzimbeni. Inani elincinci leswekile ene-radioactive (iswekile) itofelwe emthanjeni. Iskena se-PET sijikeleza ujikeleze umzimba kwaye senze umfanekiso wendawo esetyenziswa kuyo iswekile emzimbeni. Iiseli zethumba ezinobungozi zibonakala ziqaqambile emfanekisweni kuba ziyasebenza kwaye zithatha iswekile eninzi kuneseli eziqhelekileyo.

Ukuskena i-Positron emission tomography (PET). Umntwana ulele phezu kwetafile etyibilika kwisikena sePET. Ukuphumla kwentloko kunye nomtya omhlophe kunceda umntwana ukuba alale. Inani elincinci leswekile ene-radioactive (iswekile) itofwe emthanjeni womntwana, kwaye iskena senza umfanekiso apho iswekile isetyenziswa khona emzimbeni. Iiseli zomhlaza zibonakala ziqaqambile emfanekisweni kuba zithatha iswekile eninzi kuneseli eziqhelekileyo.

• I-MRI (imaging resonance imaging): Inkqubo esebenzisa umazibuthe kunye namaza erediyo ukwenza uthotho lwemifanekiso eneenkcukacha yeendawo ezingaphakathi komzimba. Imifanekiso yenziwe yikhompyuter. Le nkqubo ikwabizwa ngokuba yimifanekiso yenyukliya yokujonga umfanekiso (i-NMRI).

Imagnetic resonance imaging (MRI) yesisu. Umntwana ulele phezu kwetafile etyibilika kwisikena se-MRI, esithatha imifanekiso engaphakathi komzimba. Iphedi esiswini somntwana inceda ukwenza imifanekiso icace gca.

• Uvavanyo lwe-Ultrasound: Inkqubo apho amaza esandi aphembelela amandla aphezulu (i-ultrasound) akhutshelwa ngaphandle kwizicubu zangaphakathi okanye kwizitho zokwenza i-echoes. Iingqungquthela zenza umfanekiso wezicubu zomzimba ezibizwa ngokuba yi-sonogram. Umfanekiso unokuprintwa ukuze ujongwe kamva.

I-ultrasound yesisu. I-ultrasound transducer edityaniswe kwikhompyuter icinezelwe kulusu lwesisu. I-transducer igxotha amaza esandi kumalungu angaphakathi nakwizicubu ukwenza ii-echoes ezenza i-sonogram (umfanekiso wekhompyuter).

• I-Endoscopy: Inkqubo yokujonga amalungu kunye nezicubu ngaphakathi komzimba ukukhangela iindawo ezingaqhelekanga. I-endoscope ifakwa ngokusikwa (ukusika) kulusu okanye ukuvula emzimbeni, njengomlomo okanye i-rectum. I-endoscope sisixhobo esibhityileyo, esifana netyhubhu esinokukhanya kunye nelensi yokujonga. Inokuba nesixhobo sokususa iisampulu zethishu okanye i-lymph node, ezijongwa phantsi kwemicroscope kwimpawu zesifo.

Endoscopy ephezulu. Umbhobho omncinci, okhanyisiweyo ufakwa emlonyeni ukujonga iindawo ezingaqhelekanga kwindawo yomqala, esiswini, nakwinxalenye yokuqala yamathumbu amancinci.

• Ukuskena amathambo: Inkqubo yokujonga ukuba ngaba kukho iiseli ezahlula ngokukhawuleza, ezinje ngeeseli zomhlaza, emathanjeni. Inani elincinci kakhulu lezinto ezisasazeka ngemitha lifakwa emthanjeni kwaye lihamba ngokuhamba kwegazi. Izinto ezinemitha eqhumayo ziqokelela emathanjeni anomhlaza kwaye zifunyenwe siskena.

Ukuskena amathambo. Inani elincinci lezinto ezinemitha eqhumayo lifakwe kumthambo womntwana kwaye lihamba ngegazi. Izinto ezinemitha yeathomathizi eziqokelela emathanjeni. Njengokuba umntwana elele phezu kwetafile eslayidayo phantsi kweskena, kufunyanwa into enemitha ye-radio kunye nemifanekiso yenziwe kwikhompyuter.

• Biopsy: Ukususwa kweeseli okanye izicwili ukuze zijongwe ngemicroscope ngugqirha wezilwanyana ukujonga imiqondiso yomhlaza. Zininzi iintlobo ezahlukeneyo zenkqubo ye-biopsy. Ezona ntlobo zixhaphakileyo zibandakanya oku kulandelayo:

• Fine-inaliti aspiration (FNA) biopsy: Ukususwa kwethishu okanye ulwelo kusetyenziswa inaliti encinci.

• I-biopsy engundoqo: Ukususwa kwezicubu kusetyenziswa inaliti ebanzi.

• I-biopsy ye-incisional: Ukususwa kwenxalenye yesigaxa okanye isampulu yethishu engabonakali njengeqhelekileyo.

• I-biopsy ekhethekileyo: Ukususwa kwesigaxa esipheleleyo okanye indawo yeethishu engabonakali njengeqhelekileyo.

Zintathu iindlela umhlaza onwenwa ngayo emzimbeni.

Umhlaza unokusasazeka ngezicubu, inkqubo ye-lymph, kunye negazi:

• Izicubu. Umhlaza usasazeka ukusuka apho waqala ngokukhula waya kwiindawo ezikufuphi.

• Inkqubo yeLymph. Umhlaza usasazeka ukusuka apho waqala ngokungena kwinkqubo ye-lymph. Umhlaza uhamba ngemithambo ye-lymph ukuya kwamanye amalungu omzimba.

• Igazi. Umhlaza usasazeka ukusuka apho waqala ngokungena egazini. Umhlaza uhamba ngemithambo yegazi uye kwamanye amalungu omzimba.

Umhlaza unokusasazeka ukusuka apho waqala khona kwamanye amalungu omzimba.

Xa umhlaza usasazeka kwelinye ilungu lomzimba, ubizwa ngokuba yi-metastasis. Iiseli zomhlaza ziyaphuma apho ziqale khona (ithumba lokuqala) kwaye zihamba ngenkqubo ye-lymph okanye igazi.

• Inkqubo yeLymph. Umhlaza ungena kwinkqubo ye-lymph, uhamba kwiinqanawa ze-lymph, kwaye wenze i-tumor (i-metastatic tumor) kwenye indawo yomzimba.

• Igazi. Umhlaza ungena egazini, uhambe kwimithambo yegazi, kwaye wenze ithumba (metastatic tumor) kwelinye ilungu lomzimba.

I-tumor ye-metastatic yinto efanayo yomhlaza njenge-tumor yokuqala. Umzekelo, ukuba umhlaza wedlala lengqula usasazeka ukuya emiphungeni, iiseli zomhlaza emiphungeni ziyiseli zomhlaza wedlala lengqula. Esi sifo ngumhlaza wedlala lengqula, hayi umhlaza wemiphunga.

Ukufa kwabantu abaninzi abanomdlavuza kubangelwa xa umhlaza usuka kwi-tumor yokuqala kwaye usasazeka kwezinye izicubu kunye namalungu. Oku kubizwa ngokuba ngumhlaza wemastastatic. Oopopayi babonisa indlela iiseli zomhlaza ezihamba ngayo ukusuka kwindawo yomzimba apho zaqala khona ukwakheka kwamanye amalungu omzimba.

Unyango ngoKhetho lonyango

IINGONGOMA EZIPHAMBILI

• Kukho iintlobo ezahlukeneyo zonyango lwabantwana abanomhlaza ongaqhelekanga.

• Abantwana abanomhlaza ongaqhelekanga kufuneka ukuba unyango lwabo lucwangciswe liqela lababoneleli ngezempilo abaziingcali kunyango lomhlaza ebantwaneni.

• Iindidi ezisithoba zonyango olusetyenziswayo:

• Ugqirha

• Unyango ngemitha

• Unyango ngamayeza

• Unyango oluphezulu lwe-chemotherapy ene-autologous stem cell Rescue

• Unyango lweHormone

• Unyango lwe-Immunotherapy

• Ukulinda ulindile

• Unyango ekujoliswe kulo

• Ukudibanisa

• Iindidi ezintsha zonyango ziyavavanywa kuvavanyo lweklinikhi.

• Unyango lwe-Gene

• Izigulana zinokufuna ukucinga ngokuthatha inxaxheba kuvavanyo lweklinikhi.

• Izigulana zinokungena kuvavanyo lweklinikhi ngaphambi, ngexesha, okanye emva kokuqala unyango lomhlaza.

• Iimvavanyo zokulandelela zisenokufuneka.

• Unyango lomhlaza ongaqhelekanga wobuntwana unokubangela iziphumo ebezingalindelekanga.

Kukho iintlobo ezahlukeneyo zonyango lwabantwana abanomhlaza ongaqhelekanga.

Iindidi ezahlukeneyo zonyango ziyafumaneka kubantwana abanomhlaza. Olunye unyango lusemgangathweni (unyango olusetyenziswayo ngoku), kwaye olunye luvavanywa kuvavanyo lweklinikhi. Uvavanyo lweklinikhi yonyango luphononongo olwenzelwe ukunceda ukuphucula unyango lwangoku okanye ukufumana ulwazi kunyango olutsha kwizigulana ezinomhlaza. Xa uvavanyo lwezonyango lubonisa ukuba unyango olutsha lungcono kunonyango oluqhelekileyo, unyango olutsha kunokuba lunyango olusemgangathweni.

Kuba umhlaza ebantwaneni unqabile, ukuthatha inxaxheba kuvavanyo lweklinikhi kufuneka kuthathelwe ingqalelo. Olunye uvavanyo lwezonyango luvuleleke kuphela kwizigulana ezingaluqalanga unyango.

Abantwana abanomhlaza ongaqhelekanga kufuneka ukuba unyango lwabo lucwangciswe liqela lababoneleli ngezempilo abaziingcali kunyango lomhlaza ebantwaneni.

Unyango luya kujongwa yi-oncologist yabantwana, ugqirha ogxile ekunyangeni abantwana abanomhlaza. I-oncologist yabantwana isebenza nabanye ababoneleli ngononophelo lwempilo yabantwana abaziingcali ekunyangeni abantwana abanomhlaza kwaye begxile kwiindawo ezithile zonyango. Oku kunokubandakanya ezi ngcali zilandelayo:

• Ugqirha wabantwana.

• Ugqirha wabantwana.

• I-hematologist yezilwanyana.

• Imitha ye-oncologist.

• Ingcali yomongikazi wabantwana.

• Ingcali yokuvuselela.

• Ingcali yezigulana.

• Unontlalontle.

• Ingcali yeengqondo.

Iindidi ezisithoba zonyango olusetyenziswayo:

Ugqirha

Utyando yinkqubo esetyenziselwa ukufumanisa ukuba umhlaza ukhona, ukususa umhlaza emzimbeni, okanye ukulungisa ilungu lomzimba. Utyando lokunyanga lwenziwa ukunciphisa iimpawu ezibangelwa ngumhlaza. Utyando lukwabizwa ngokuba lunyango.

Emva kokuba ugqirha ewususile wonke umhlaza onokubonakala ngexesha lotyando, ezinye izigulana zinokunikwa ichemotherapy okanye unyango lweradiation emva kotyando lokubulala naziphi na iiseli zomhlaza ezisele. Unyango olunikezwe emva kotyando, ukunciphisa umngcipheko wokuba umhlaza ubuye kwakhona, lubizwa ngokuba lunyango oluncedisayo.

Unyango ngemitha

Unyango ngemitha lunyango olusebenzisa amandla aphezulu e-x-reyi okanye ezinye iintlobo zemitha yokubulala iiseli zomhlaza okanye ukuzigcina zikhula. Kukho iintlobo ezahlukeneyo zonyango lwemitha:

• Unyango lwangaphandle lwemitha lusebenzisa umatshini ngaphandle komzimba ukuthumela imitha kumhlaza.

Unyango lwe-Proton beam radiation luhlobo lwamandla amakhulu, unyango lwangaphandle lwemitha. Umatshini wonyango wemitha ujolise kwimilambo yeeproton (ezincinci, ezingabonakaliyo, amasuntswana ahlawuliswe ngokuqinisekileyo) kwiiseli zomhlaza ukuze zibabulale. Olu hlobo lonyango lubangela umonakalo omncinci kwizicubu ezisempilweni ezikufutshane.

• Unyango lwangaphakathi lwemitha lusebenzisa into enemitha ye-radio efakwe emzimbeni okanye etywiniweyo kwiinaliti, iimbewu, iingcingo, okanye iicatheters ezibekwe ngqo okanye kufutshane nomhlaza.

• Unyango lwe-131I-MIBG (i-radioactive iodine) luhlobo lonyango lwangaphakathi lwemitha olusetyenziselwa ukunyanga i-pheochromocytoma kunye neparaganglioma. Iodine eqhumayo inikwa ngokufakwa. Ingena egazini ize iqokelele kwiintlobo ezithile zeeseli zethumba, ibabulale ngemitha enikwayo.

Indlela unyango lwe-radiation olunikezelwa ngayo ixhomekeke kuhlobo lomhlaza ophathwayo.

Unyango ngamayeza

I-Chemotherapy yonyango lomhlaza olusebenzisa iziyobisi ukunqanda ukukhula kweeseli zomhlaza, nokuba zibulale iiseli okanye uziyekise ekwahlukaneni. Xa i-chemotherapy ithathwa ngomlomo okanye ifakwe kwi-vein okanye kwimisipha, amachiza angena kwigazi kwaye anokuchaphazela iiseli zomhlaza kuwo wonke umzimba (systemic chemotherapy). Xa i-chemotherapy ibekwe ngqo kulwelo lwe-cerebrospinal, indawo yomzimba efana nesisu, okanye ilungu, la machiza achaphazela ikakhulu iiseli zomhlaza kwezo ndawo. Umdibaniso wekhemotherapy yonyango olusebenzisa ngaphezulu kwesiyobisi esinye somhlaza. Indlela i-chemotherapy enikezelwa ngayo ixhomekeke kuhlobo kunye nenqanaba lomhlaza ophathwayo.

Unyango oluphezulu lwe-chemotherapy ene-autologous stem cell Rescue

Amanqanaba aphezulu e-chemotherapy anikezelwa ukubulala iiseli zomhlaza. Iiseli ezisempilweni, kubandakanya iiseli ezenza igazi, nazo ziyatshatyalaliswa lunyango lomhlaza. Ukuhlangulwa kweseli kwistem lunyango lokutshintsha iiseli ezenza igazi. Iiseli zesinti (iiseli zegazi ezingafakwanga) ziyasuswa egazini okanye kumongo wethambo wesigulana kwaye ziyabanda zigcinwe. Emva kokuba isiguli sigqibe i-chemotherapy, iiseli ezigciniweyo ezigciniweyo ziyanyibilika kwaye zibuyiselwe kwisigulana ngokufakwa. Ezi seli ze-stem ziphinde zafakwa zikhula ziye (kwaye zibuyisele) iiseli zegazi lomzimba.

Unyango lweHormone

Unyango lweHormone lunyango lomhlaza olususa iincindi zamadlala okanye ibhlokhe isenzo sabo kwaye luyekise iiseli zomhlaza ekukhuleni. IiHormone zizinto ezenziwe ngamadlala emzimbeni kwaye zihamba ngokuhamba kwegazi. Ezinye iihormoni zinokubangela ukuba ezinye iintlobo zomhlaza zikhule. Ukuba iimvavanyo zibonisa ukuba iiseli zomhlaza zineendawo apho iihormone zinokuncamathisela (ii-receptors), iziyobisi, utyando, okanye unyango lwemitha lusetyenziselwa ukunciphisa ukuveliswa kwehomoni okanye ukubathintela ekusebenzeni. Unyango lweHormone ngamachiza abizwa ngokuba yi-corticosteroids anokusetyenziselwa ukunyanga i-thymoma okanye i-thymic carcinoma.

Unyango lwehormone nge-somatostatin analogue (octreotide okanye lanreotide) inokusetyenziselwa ukunyanga amathumba asasazeke okanye angenakususwa ngotyando. I-Octreotide inokusetyenziselwa ukunyanga i-thymoma engaphenduliyo kolunye unyango. Olu nyango luyeka iihormoni ezongezelelweyo ekubeni zenziwe lithumba le-neuroendocrine. I-Octreotide okanye i-lanreotide zii-somatostatin analogue ezifakwe phantsi kolusu okanye kwimisipha. Ngamanye amaxesha intwana encinci yento eqhumayo iqhotyoshelwe kwichiza kwaye imitha iyabulala neeseli zomhlaza. Oku kubizwa ngokuba yipeptide receptor radionuclide yonyango.

Unyango lwe-Immunotherapy

I-Immunotherapy lunyango olusebenzisa amajoni omzimba omzimba ukulwa nomhlaza. Izinto ezenziwe ngumzimba okanye ezenziwe elebhu zisetyenziselwa ukonyusa, ukuqondisa, okanye ukubuyisela ukhuseleko lwendalo lomzimba kumhlaza. Olu hlobo lonyango lomhlaza lukwabizwa ngokuba yi-biotherapy okanye unyango lwe-biologic.

• I-Interferon: I-Interferon ichaphazela ukwahlulwa kweeseli zomhlaza kwaye inokunciphisa ukukhula kwethumba. Isetyenziselwa ukunyanga umhlaza wamanopharyngeal kunye nepapillomatosis.

• I-Epstein-Barr virus (EBV) -ikhethekileyo cytotoxic T-lymphocyte: Iiseli ezimhlophe zegazi (T-lymphocyte) zinyangwa elebhu kunye ne-Epstein-Barr virus zize zinikwe isiguli ukukhuthaza amajoni omzimba kunye nokulwa nomhlaza. I-EBV-ekhethekileyo i-cytotoxic T-lymphocyte ifundelwa unyango lwe-nasopharyngeal cancer.

• Unyango lwe-Vaccine: Unyango lomhlaza olusebenzisa into okanye iqela lezinto ukukhuthaza amajoni omzimba ukuba afumane ithumba alibulale. Unyango lwe-vaccine lusetyenziselwa ukunyanga i-papillomatosis.

• Unyango lwe-immune checkpoint inhibitor: Ezinye iintlobo zeeseli zomzimba, ezinje ngeeseli ze-T, kunye nezinye iiseli zomhlaza zineeproteni ezithile, ezibizwa ngokuba ziiprotein zokujonga, kumphezulu wazo ezigcina iimpendulo zomzimba zijongiwe. Xa iiseli zomhlaza zinezixa ezikhulu zezi proteni, aziyi kuhlaselwa zibulawe ziiseli T. Amajoni okuvavanywa kwamajoni omzimba athintela ezi proteni kwaye amandla eeseli T okubulala iiseli zomhlaza ayonyuswa.

Zimbini iintlobo zonyango lwe-immune checkpoint inhibitor.

• I-CTLA-4 yiprotein ebusweni beeseli ze-T ezinceda ukugcina iimpendulo zomzimba zomzimba zijongiwe. Xa i-CTLA-4 incamathele kwenye iprotein ebizwa ngokuba yi-B7 kwiseli yomhlaza, iyeka i-T cell ekubulaleni iseli yomhlaza. I-CTLA-4 inhibitors inamathela kwi-CTLA-4 kwaye ivumela iiseli ze-T ukuba zibulale iiseli zomhlaza. I-Ipilimumab luhlobo lwe-CTLA-4 inhibitor. I-Ipilimumab inokuqwalaselwa kunyango lwe-melanoma enobungozi obukhulu obususwe ngokupheleleyo ngexesha lotyando. I-Ipilimumab ikwasetyenziswa kunye ne-nivolumab ukunyanga abantwana abathile abanesifo somhlaza.

Isithinteli sokujonga ukungasebenzi komzimba. Iiproteni zokujonga, ezinje nge-B7-1 / B7-2 kwiiseli ezibonisa i-antigen (APC) kunye ne-CTLA-4 kwiiseli ze-T, zinceda ukugcina iimpendulo zomzimba zomzimba zijongiwe. Xa i-T-cell receptor (TCR) ibophelela kwi-antigen kunye ne-histocompatibility complex (MHC) protein kwi-APC kunye ne-CD28 ebopha kwi-B7-1 / B7-2 kwi-APC, iseli ye-T inokusebenza. Nangona kunjalo, ukubopha kwe-B7-1 / B7-2 ukuya kwi-CTLA-4 kugcina iiseli ze-T zikwimeko yokungasebenzi ukuze bangakwazi ukubulala iiseli zethumba emzimbeni (iphaneli yasekhohlo). Ukuthintela ukubopha kwe-B7-1 / B7-2 ukuya kwi-CTLA-4 nge-immune checkpoint inhibitor (anti-CTLA-4 antibody) ivumela iiseli ze-T ukuba zisebenze kwaye zibulale iiseli zesisu (iphaneli esekunene).

• I-PD-1 yiprotein kumphezulu weeseli ze-T ezinceda ukugcina iimpendulo zomzimba zomzimba zijongiwe. Xa i-PD-1 incamathele kwenye iprotein ebizwa ngokuba yi-PDL-1 kwiseli yomhlaza, iyeka i-T cell ekubulaleni iseli yomhlaza. PD-1 inhibitors zinamathele kwi-PDL-1 kwaye zivumele iiseli ze-T ukuba zibulale iiseli zomhlaza. INivolumab luhlobo lwe-PD-1 inhibitor. I-Nivolumab isetyenziswa nge-ipilimumab ukunyanga abantwana abathile abanesifo somhlaza. I-Pembrolizumab kunye ne-nivolumab zisetyenziselwa ukunyanga i-melanoma ethe yasasazeka kwamanye amalungu omzimba. I-Nivolumab kunye ne-pembrolizumab ziyafundwa kunyango lwe-melanoma yabantwana nakwishumi elivisayo. Unyango ngala machiza mabini kufundwe ikakhulu kubantu abadala.

Isithinteli sokujonga ukungasebenzi komzimba. Iiproteni zokujonga, ezinje nge-PD-L1 kwiiseli zethumba kunye ne-PD-1 kwiiseli ze-T, zinceda ukugcina iimpendulo ze-immune zitshekishwe. Ukubopha kwe-PD-L1 ukuya kwi-PD-1 kugcina iiseli ze-T ekubulaleni iiseli zethumba emzimbeni (iphaneli yasekhohlo). Ukuthintela ukubopha kwe-PD-L1 ukuya kwi-PD-1 nge-immune checkpoint inhibitor (anti-PD-L1 okanye anti-PD-1) ivumela iiseli ze-T ukuba zibulale iiseli zesisu (iphaneli esekunene).

• Unyango lwe-BRAF kinase inhibitor: I-BRAF kinase inhibitors ibhloka yeprotein ye-BRAF. Iiproteni ze-BRAF zinceda ukulawula ukukhula kweseli kwaye zinokuguqulwa (zitshintshwe) kwezinye iintlobo zomhlaza. Ukuthintela ukuguqulwa kweeproteni ze-BRAF kunokunceda ukugcina iiseli zomhlaza zingakhuli. I-Dabrafenib, vemurafenib, kunye ne-encorafenib zisetyenziselwa ukunyanga i-melanoma. I-dabrafenib yomlomo ifundwa kubantwana nakwishumi elivisayo nge-melanoma. Unyango ngala machiza mathathu ubukhulu becala luye lwafundwa kubantu abadala.

Ukulinda ulindile

Ukuhlala ulindile kubeka esweni imeko yesigulana ngaphandle kokunikezela ngonyango de kuvele iimpawu okanye utshintsho. Ukulinda ngokubukhali kunokusetyenziswa xa ithumba likhula kancinci okanye xa kunokwenzeka eliqhuma linganyamalala ngaphandle konyango.

Unyango ekujoliswe kulo

Unyango ekujoliswe kulo lunyango olusebenzisa iziyobisi okanye ezinye izinto ukuchonga nokuhlasela iiseli ezithile zomhlaza ngaphandle kokonakalisa iiseli eziqhelekileyo. Iindidi zonyango olujolisiweyo olusetyenziselwa ukunyanga umhlaza wabantwana ongaqhelekanga lubandakanya oku kulandelayo:

• I-Tyrosine kinase inhibitors: Ezi ziyobisi zijolise kunyango lweempawu ezifunekayo ekukhuleni kwamathumba. IVandetanib kunye necabozantinib zisetyenziselwa ukunyanga umhlaza we-thyroid. I-Sunitinib isetyenziselwa ukunyanga i-pheochromocytoma, paraganglioma, neuroendocrine tumors, thymoma, kunye ne-thymic carcinoma. I-Crizotinib isetyenziselwa ukunyanga izicubu zetracheobronchial.

• I-mTOR inhibitors: Uhlobo lonyango ekujoliswe kulo olunqanda iprotheyini enceda iiseli zahlule kwaye zisinde. I-Everolimus isetyenziselwa ukunyanga i-cardiac, neuroendocrine, kunye ne-islet cell tumors.

• Iintsholongwane zeMonoclonal: Olu nyango lujolisiweyo lusebenzisa ii-antibodies ezenziwe elebhu, ukusuka kuhlobo olunye lweeseli zomzimba. Ezi antibodies zinokuchonga izinto ezikumhlaza iiseli okanye izinto eziqhelekileyo ezinokunceda iiseli zomhlaza zikhule. Amachiza omzimba ancamathele kwizinto kwaye abulale iiseli zomhlaza, athintele ukukhula kwazo, okanye azigcine zisasazeka. Iintsholongwane zeMonoclonal zinikezelwa ngokufakwa. Zingasetyenziselwa zodwa okanye ukuphatha iziyobisi, ityhefu, okanye izinto ezinemitha yeathom ngqo kwiiseli zomhlaza. I-Bevacizumab yi-monoclonal antibody esetyenziselwa ukunyanga i-papillomatosis.

• Imbali ye-methyltransferase inhibitors: Olu hlobo lonyango ekujoliswe kulo lucebisa amandla eseli yomhlaza ukukhula nokwahlulahlula. I-Tazemetostat isetyenziselwa ukunyanga umhlaza we-ovari. I-Tazemetostat ifundwa kunyango lwe-chordomas eziphindaphindileyo emva konyango.

• I-MEK inhibitors: Olu hlobo lonyango ekujoliswe kulo luthintela imiqondiso efunekayo ukuze kukhule amathumba. I-Trametinib kunye ne-binimetinib zisetyenziselwa ukunyanga i-melanoma ethe yasasazeka kwamanye amalungu omzimba. Unyango nge-trametinib okanye i-binimetinib ifundwe ikakhulu kubantu abadala.

Unyango ekujoliswe kulo luyafundwa kunyango lwezinye iintlobo zomhlaza ezingaqhelekanga zobuntwana.

Ukudibanisa

Ukudibanisa lunyango apho idayi eyahlukileyo kunye namasuntswana afakwa kwi-hepatic artery ngokusebenzisa i-catheter (ityhubhu encinci). Amasuntswana athintela umthambo, asika ukuhamba kwegazi kwithumba. Ngamanye amaxesha inani elincinci lezinto ezinemitha yeathomathikhi liqhotyoshelwe kumasuntswana. Uninzi lwemitha lubotshelelwe kufutshane nethumba ukubulala iiseli zomhlaza. Oku kubizwa ngokuba yi-radioembolization.

Iindidi ezintsha zonyango ziyavavanywa kuvavanyo lweklinikhi.

Eli candelo lesishwankathelo lichaza unyango olufundwayo kuvavanyo lweklinikhi. Isenokungakhankanyi lonke unyango olutsha olufundwayo. Ulwazi malunga novavanyo lweklinikhi luyafumaneka kwiwebhusayithi yeNCI.

Unyango lwe-Gene

Unyango lwe-Gene lunyango apho kufakwa khona izinto zemvelo zemvelo (i-DNA okanye i-RNA) kwiiseli zomntu ukukhusela okanye ukulwa nezifo. Unyango lwe-Gene lufundwa kunyango lwe-papillomatosis.

Izigulana zinokufuna ukucinga ngokuthatha inxaxheba kuvavanyo lweklinikhi.

Kwezinye izigulana, ukuthatha inxaxheba kuvavanyo lweklinikhi kunokuba lolona khetho lonyango lufanelekileyo. Uvavanyo lwezonyango luyinxalenye yenkqubo yophando ngomhlaza. Uvavanyo lwezonyango luyenziwa ukufumanisa ukuba unyango lomhlaza olutsha lukhuselekile kwaye luyasebenza okanye lungcono kunonyango oluqhelekileyo.

Uninzi lonyango oluqhelekileyo lwanamhlanje lomhlaza lusekwe kuvavanyo lweklinikhi lwangaphambili. Izigulana ezithatha inxaxheba kuvavanyo lweklinikhi zingafumana unyango olusemgangathweni okanye zibe phakathi kwabokuqala ukufumana unyango olutsha.

Izigulana ezithatha inxaxheba kuvavanyo lweklinikhi zikwanceda ukuphucula indlela umhlaza oza kunyangwa ngayo kwixa elizayo. Nokuba uvavanyo lwezonyango alukhokeleli kunyango olusebenzayo, bahlala bephendula imibuzo ebalulekileyo kwaye bancedisa ukuqhubela phambili uphando.

Izigulana zinokungena kuvavanyo lweklinikhi ngaphambi, ngexesha, okanye emva kokuqala unyango lomhlaza.

Olunye uvavanyo lwezonyango lubandakanya kuphela izigulana ezingekafumani unyango. Olunye uvavanyo lokuvavanywa kunyango kwizigulana ezinomhlaza ongakhange ubengcono. Kukwakho nezilingo zeklinikhi ezivavanya iindlela ezintsha zokumisa umhlaza ekubuyeleni (ekubuyeni) okanye ukunciphisa iziphumo ebezingalindelekanga zonyango lomhlaza.

Uvavanyo lwezonyango lwenzeka kwiindawo ezininzi zelizwe. Ulwazi malunga novavanyo lweklinikhi oluxhaswe yi-NCI lunokufumaneka kwiphepha lewebhu le-NCI. Uvavanyo lwezonyango oluxhaswa yiminye imibutho lunokufumaneka kwiwebhusayithi yeClinicalTrials.gov.

Iimvavanyo zokulandelela zisenokufuneka.

Ezinye zeemvavanyo ezenziweyo ukufumanisa umhlaza okanye ukufumanisa inqanaba lomhlaza zinokuphindwa. Olunye uvavanyo luya kuphindwa ukuze kubonwe ukuba lusebenza njani unyango. Izigqibo malunga nokuqhubeka, ukutshintsha, okanye ukuyeka unyango zinokusekwa kwiziphumo zolu vavanyo.

Ezinye zeemvavanyo ziya kuqhubeka ukwenziwa amaxesha ngamaxesha emva kokuba unyango luphelile. Iziphumo zolu vavanyo zingabonisa ukuba imeko yomntwana wakho itshintshile okanye ukuba umhlaza ubuye wabuya (buyela). Olu vavanyo ngamanye amaxesha lubizwa ngokuba luvavanyo olulandelayo okanye ukuhlolwa.

Unyango lomhlaza ongaqhelekanga wobuntwana unokubangela iziphumo ebezingalindelekanga.

Ngolwazi malunga neziphumo ebezingalindelekanga eziqala ngexesha lonyango lomhlaza, jonga iphepha lethu Iziphumo ezingalunganga.

Iziphumo ebezingalindelekanga ezivela kunyango lomhlaza eziqala emva konyango kwaye ziqhubeke iinyanga okanye iminyaka zibizwa ngokuba ziziphumo ezifike kade. Iziphumo zokunyanga komhlaza zingabandakanya oku kulandelayo:

• Iingxaki zomzimba.

• Utshintsho kwiimvakalelo, iimvakalelo, ukucinga, ukufunda, okanye inkumbulo.

• Umhlaza wesibini (iintlobo ezintsha zomhlaza).

Ezinye iziphumo ezinokufika emva kwexesha zinokunyangwa okanye zilawulwe. Kubalulekile ukuba uthethe noogqirha bomntwana wakho malunga neziphumo ezinokubakho emva kwexesha ezibangelwa ngumhlaza kunye nonyango lomhlaza. (Jonga isishwankathelo se- malunga neZiphumo eziMva zaNyango zoMhlaza woMntwana ngolwazi oluthe kratya).

Umhlaza ongaqhelekanga weNtloko kunye neNtamo

Kweli Candelo

• Umhlaza weNasopharyngeal

• I-Esthesioneuroblastoma

• Ukudumba kwamathumba

• Umhlaza womlomo womlomo

• Amathumba endlala yamathe

• Umhlaza weLaryngeal kunye nePapillomatosis

• Umhlaza we-Midline Tract Cancer kunye ne-NUT Gene Changes (NUT Midline Carcinoma)

Umhlaza weNasopharyngeal

Jonga isishwankathelo se kunyango lweCancer yeNasopharyngeal yeCancer ngolwazi oluthe kratya.

I-Esthesioneuroblastoma

Jonga isishwankathelo se- soNyango lwe-Esthesioneuroblastoma yoBuntwana ngolwazi oluthe kratya.

Ukudumba kwamathumba

Jonga isishwankathelo se- soNyango lweCancer ye-Thyroid ukuze ufumane ulwazi oluthe kratya.

Umhlaza womlomo womlomo

Jonga isishwankathelo se- soNyango lweCancerity Cancer yoBuntwana ngolwazi oluthe kratya.

Amathumba endlala yamathe

Jonga isishwankathelo se kwi-Childhood Salivary Gland Tumors Treatment ngolwazi oluthe kratya.

Umhlaza weLaryngeal kunye nePapillomatosis

Jonga isishwankathelo se- kunyango lwe-Laryngeal Tumors Treatment ngolwazi oluthe kratya.

Umhlaza we-Midline Tract Cancer kunye ne-NUT Gene Changes (NUT Midline Carcinoma)

Jonga isishwankathelo se- kwi-Childhood Midline Tract Carcinoma ene-NUT Gene Changes Treatment ngolwazi oluthe kratya.

Umhlaza ongaqhelekanga wesifuba

Kweli Candelo

• Umhlaza webele

• Umhlaza wemiphunga

• Ukudumba kwamathambo

• I-Thymoma kunye ne-Thymic Carcinoma

• Intliziyo (Intliziyo) Ukudumba

• Mesothelioma

Umhlaza webele

Jonga isishwankathelo se kunyango lomhlaza webele kubantwana ngolwazi oluthe kratya.

Umhlaza wemiphunga

Jonga ezi zishwankathelo zilandelayo ze- ngolwazi oluthe kratya:

• Unyango lwe-Tracheobronchial Tumors yoNyango

• Unyango lweBlastoma yoNyango lwabantwana

Ukudumba kwamathambo

Jonga isishwankathelo se- soNyango lweCancer Esophageal Cancer Treatment ngolwazi oluthe kratya.

I-Thymoma kunye ne-Thymic Carcinoma

Jonga isishwankathelo se- malunga ne-Childhood Thymoma kunye ne-Thymic Carcinoma Treatment ngolwazi oluthe kratya.

Intliziyo (Intliziyo) Ukudumba

Jonga isishwankathelo se kwi-Cardiac yaBantwana (Intliziyo) yoNyango lweeTumors ngolwazi oluthe kratya.

Mesothelioma

Jonga isishwankathelo se kunyango lweMesothelioma yoBuntwana ngolwazi oluthe kratya.

Umhlaza ongaqhelekanga wesisu

Kweli Candelo

• Isisu (isisu) somhlaza

• Umhlaza wePancreatic

• Umhlaza weColorectal

• Izidumbu ze-Neuroendocrine (iCarcinoid Tumors)

• Amathumba eSisu eSisu

Iadrenocortical Carcinoma

I-adrenocortical carcinoma sisifo apho iiseli ezibi (zomhlaza) zakha umaleko ongaphandle wedlala ye-adrenal. Kukho amadlala amabini adrenal. Amadlala adrenal amancinci kwaye amile okonxantathu. Enye ye-adrenal gland ihleli phezulu kwintso nganye. Idlala ngalinye leadrenal linamalungu amabini. Iziko le-adrenal gland yi-adrenal medulla. Uluhlu lwangaphandle lwe-adrenal gland yi-adrenal cortex. I-adrenocortical carcinoma ikwabizwa ngokuba ngumhlaza wecortex yeadrenal.

I-carrenoma ye-adrenocortical carcinoma yenzeka kakhulu kwizigulana ezingaphantsi kweminyaka emi-6 okanye kwiminyaka yeshumi elivisayo, kwaye rhoqo kubantu basetyhini.

I-adrenal cortex yenza iihormone ezibalulekileyo ezenza oku kulandelayo:

• Ukulinganisa amanzi kunye netyuwa emzimbeni.

• Nceda ugcine uxinzelelo lwegazi luqhelekile.

• Nceda ukulawula ukusetyenziswa komzimba, iiprotein, kunye neecarbohydrate.

• Yenza ukuba umzimba ube neempawu zobudoda okanye zowasetyhini.

Izinto zomngcipheko, imiqondiso kunye neempawu, kunye nokuchongwa kunye nokuvavanywa kwenqanaba

Umngcipheko we-adrenocortical carcinoma uyonyuswa ngokuba notshintsho oluthile (utshintsho) kuhlobo okanye nayiphi na kwezi syndromes zilandelayo:

• Isifo seLi-Fraumeni.

• Isifo se-Beckwith-Wiedemann.

• IHemihypertrophy.

I-adrenocortical carcinoma inokubangela nayiphi na imiqondiso neempawu zilandelayo. Jonga kugqirha womntwana wakho ukuba umntwana wakho unayo nayiphi na kwezi zinto zilandelayo:

• Isigaxa esiswini.

• Intlungu esiswini okanye ngasemva.

• Ukuziva ugcwele kwisisu.

Kwakhona, ithumba le-adrenal cortex linokusebenza (lenza iihomoni ezininzi kunesiqhelo) okanye lingasebenzi (alwenzi iihormoni zongezelelekileyo). Uninzi lwamathumba e-adrenal cortex ebantwaneni asebenza amathumba. Iihormoni ezongezelelekileyo ezenziwe kukusebenza kwamathumba zinokubangela iimpawu ezithile okanye iimpawu zesifo kwaye ezi zixhomekeke kuhlobo lwehomoni eyenziwe lityum. Umzekelo, ihomoni ye-androgen eyongezelelweyo inokubangela abantwana abangamadoda nabasetyhini ukuba bahlakulele iimpawu zobudoda, ezinje ngeenwele zomzimba okanye ilizwi elinzulu, zikhule ngokukhawuleza, kwaye zine-acne. Ihomoni ye-estrogen eyongezelelweyo inokubangela ukukhula kwezicubu zamabele kubantwana abangamadoda. Ihomoni eyongezelelweyo yecortisol inokubangela isifo seCushing (hypercortisolism).

(Jonga isishwankathelo se- kunyango lwabantu abadala i-Adrenocortical Carcinoma ngolwazi oluthe kratya malunga neempawu kunye neempawu ze-adrenocortical carcinoma.)

Uvavanyo kunye neenkqubo ezisetyenziselwa ukuxilonga kunye nenqanaba le-adrenocortical carcinoma lixhomekeke kwiimpawu zesigulana. Olu vavanyo kunye neenkqubo zinokubandakanya oku kulandelayo:

• Uvavanyo lomzimba kunye nembali yezempilo.

• Izifundo ze-chemistry yegazi.

• I-X-ray yesifuba, isisu, okanye amathambo.

• Ukuskena i-CT.

• IMRI.

• Ukuskena iPET.

• I-Ultrasound.

• I-Biopsy (ubunzima buyasuswa ngexesha lotyando kwaye emva koko isampulu ihlolwe kwiimpawu zomhlaza).

Jonga icandelo loLwazi ngokubanzi malunga nenkcazo yezi mvavanyo kunye neenkqubo.

Ezinye iimvavanyo ezisetyenziselwa ukufumanisa i-adrenocortical carcinoma zibandakanya oku kulandelayo:

• Uvavanyo lomchamo lweeyure ezingamashumi amabini anesine: Uvavanyo apho kuqokelelwa khona umchamo iiyure ezingama-24 ukulinganisa isixa se-cortisol okanye i-17-ketosteroids. Ixabiso elingaphezulu kwesiqhelo kwezi zinto kumchamo kunokuba luphawu lwesifo kwi-adrenal cortex.

• Uvavanyo lokucinezelwa lwedosi ephantsi: Uvavanyo olunikwa idosi enye okanye nangaphezulu yeedeksethasone. Inqanaba le-cortisol lihlolwe kwisampulu yegazi okanye kumchamo oqokelelwa iintsuku ezintathu. Olu vavanyo lwenziwa ukujonga ukuba i-adrenal gland yenza i-cortisol eninzi kakhulu.

• Uvavanyo lwe-dexamethasone yedosi ephezulu yovavanyo: Uvavanyo apho kunikwa idosi enye okanye nangaphezulu yeedeksethasone. Inqanaba le-cortisol lihlolwe kwisampulu yegazi okanye kumchamo oqokelelwa iintsuku ezintathu. Olu vavanyo lwenziwa ukujonga ukuba i-adrenal gland yenza i-cortisol eninzi kakhulu okanye ukuba i-pituitary gland ixelela i-adrenal gland ukuba yenze i-cortisol eninzi kakhulu.

• Izifundo zehomoni yegazi: Inkqubo apho kuvavanywa isampulu yegazi ukulinganisa izixa zehomoni ezithile ezikhutshelwe egazini ngamalungu kunye nezicubu zomzimba. Inani elingaqhelekanga (eliphezulu okanye elisezantsi kunesiqhelo) lexabiso linokuba luphawu lwesifo kwilungu okanye kwithishu eyenzayo. Igazi linokukhangelwa kwi-testosterone okanye kwi-estrogen. Ixabiso elingaphezulu kwesiqhelo kula mahomoni angangumqondiso we-adrenocortical carcinoma.

• I-adrenal angiography: Inkqubo yokujonga imithambo kunye nokuhamba kwegazi kufutshane nedlala leadrenal. Idayi eyahlukileyo itofelwe kwimithambo yeadrenal. Njengoko idayi ihamba kwisitya segazi, kuthathwa uthotho lwee-x-ray ukujonga ukuba akukho mibhobho ivalelweyo na.

• I-adrenal venography: Inkqubo yokujonga imithambo yeadrenal kunye nokuhamba kwegazi kufutshane namadlala eadrenal. Idayi eyahlukileyo itofelwe kwi-adrenal vein. Njengoko idayi eyahlukileyo idlula emthanjeni, uthotho lwee-x-reyi zithathwa ukubona ukuba ngaba ikhona na imithambo evaliweyo. I-catheter (ityhubhu ebhityileyo) inokufakwa emthanjeni ukuze kuthathwe isampulu yegazi, evavanywa amanqanaba ehomoni angaqhelekanga.

Ukuxela kwangaphambili

Ukuxela kwangaphambili (ithuba lokuchacha) kulungile kwizigulana ezinamathumba amancinci asuswe ngokupheleleyo ngotyando. Kwezinye izigulana, ukuxela kwangaphambili kuxhomekeke koku kulandelayo:

• Ubungakanani besisu.

• Ukhula ngokukhawuleza kangakanani umhlaza.

• Nokuba kukho utshintsho kwiijeni ezithile.

• Nokuba eli thumba sele linwenwele nakwamanye amalungu omzimba, kubandakanya ne-lymph node.

• Iminyaka yomntwana.

• Nokuba isigqubuthelo esijikeleze ithumba savuleka ngexesha lotyando ukususa ithumba.

• Nokuba ithumba lisuswe ngokupheleleyo ngexesha lotyando.

• Nokuba umntwana unazo iimpawu zobudoda.

I-adrenocortical carcinoma inokusasazeka kwisibindi, imiphunga, izintso, okanye ithambo.

Unyango

Ngolwazi malunga nonyango oludweliswe ngezantsi, jonga kwiCandelo loKhetho ngokujonga uKhetho.

Unyango lwe-adrenocortical carcinoma ebantwaneni inokubandakanya oku kulandelayo:

• Utyando lokususa i-adrenal gland kwaye, ukuba kukho imfuneko, umhlaza osasazeke kwamanye amalungu omzimba. Ngamanye amaxesha kunikwa ichemotherapy.

Unyango lwe-carrenoma ye-adrenocortical carcinoma ebantwaneni inokubandakanya oku kulandelayo:

• Uvavanyo lweklinikhi olujonga isampulu yethumba lesigulana kutshintsho oluthile kwimfuza. Uhlobo lonyango ekujoliswe kulo oluya kunikwa isigulana luxhomekeke kuhlobo lotshintsho lwemfuza.

Jonga isishwankathelo se- kunyango lwabantu abadala i-Adrenocortical Carcinoma ngolwazi oluthe kratya.

Isisu (isisu) somhlaza

Umhlaza wesisu sisifo apho iiseli ezibi (umhlaza) zeeseli zenzeka kulusu lwesisu. Isisu lilungu elime oku-J kwisisu esingaphezulu. Inxalenye yenkqubo yokwetyisa, eqhuba izakhamzimba (iivithamini, iiminerali, iikhabhohayidrethi, amafutha, iiproteni, kunye namanzi) kukutya okutywayo kwaye kunceda ukuhambisa inkunkuma ngaphandle komzimba. Ukutya kuhamba ukusuka emqaleni kuye esiswini ngombhobho, umsipha obizwa ngokuba yi-esophagus. Emva kokushiya isisu, ukutya okwetyiswe ngokuyinxenye kudlulela emathunjini amancinci kuze kuye kungena emathunjini amakhulu.

Umqala kunye nesisu yinxalenye yenkqubo ephezulu yesisu (yokwetyisa).

Izinto ezinobungozi kunye neempawu kunye neempawu

Umngcipheko womhlaza wesisu unyuswe ngoku kulandelayo:

• Ukuba nosulelo kwi-Helicobacter pylori (H. pylori) ibacteria, efumaneka esiswini.

• Ukuba nemeko yelifa elibizwa ngokuba ngumhlaza osasazeka ngumhlaza esiswini.

Izigulana ezininzi azinazimpawu de umhlaza usasazeke. Umhlaza wesisu unokubangela nayiphi na imiqondiso kunye neempawu ezilandelayo. Jonga kugqirha womntwana wakho ukuba umntwana wakho unayo nayiphi na kwezi zinto zilandelayo:

• I-Anemia (ukudinwa, isiyezi, ukubetha kwentliziyo okukhawulezayo okanye okungaqhelekanga, umphefumlo omfutshane, ulusu olumhlophe)

• Intlungu yesisu.

• Ukuphelelwa ngumdla wokutya.

• Ukwehla kwesisindo ngaphandle kwesizathu esaziwayo.

• Isicaphucaphu.

• Ukuhlanza.

• Ukuqunjelwa okanye urhudo.

• Ubuthathaka.

Ezinye iimeko ezingengomhlaza wesisu zinokubangela ezi mpawu kunye neempawu ezifanayo.

Uvavanyo lokuchonga kunye nokulinganisa

Uvavanyo lokuchonga kunye nenqanaba lomhlaza wesisu lunokubandakanya oku kulandelayo:

• Uvavanyo lomzimba kunye nembali yezempilo.

• X-reyi yesisu.

• Izifundo ze-chemistry yegazi.

• Ukuskena i-CT.

• Uqhaqho.

Jonga icandelo loLwazi ngokubanzi malunga nenkcazo yezi mvavanyo kunye neenkqubo.

Olunye uvavanyo olusetyenziselwa ukufumanisa isifo somhlaza kunye nesigaba somhlaza kubandakanya oku kulandelayo:

• I-endoscopy ephezulu: Inkqubo yokujonga ngaphakathi kwesisu, isisu, kunye ne-duodenum (icandelo lokuqala lamathumbu amancinci) ukukhangela iindawo ezingaqhelekanga. I-endoscope idluliselwa ngomlomo ize yehle umqala uye kwi-esophagus. I-endoscope sisixhobo esibhityileyo, esifana netyhubhu esinokukhanya kunye nelensi yokujonga. Inokuba nesixhobo sokususa iisampulu zethishu okanye i-lymph node, ezijongwa phantsi kwemicroscope kwimpawu zesifo.

• Ukuginya kweBarium: Uthotho lwee-x-reyi zomqala nesisu. Isigulana sisela ulwelo oluqukethe i-barium (ikhompawundi yesilivere emhlophe). Ulwelo ludibanisa umqala kunye nesisu, kwaye ii-x-reyi zithathiwe. Le nkqubo ikwabizwa ngokuba luchungechunge oluphezulu lwe-GI.

• Gcwalisa ubalo lwegazi (i-CBC): Inkqubo apho kuthathwa khona isampulu yegazi kwaye ihlolwe oku kulandelayo:

• Inani leeseli ezibomvu zegazi, iiseli ezimhlophe zegazi kunye neeplatelets.

• Isixa sehemoglobin (iprotein ethwala ioksijini) kwiiseli ezibomvu zegazi.

• Inxalenye yesampulu yegazi eyenziwe ziiseli ezibomvu zegazi.

Ukuxela kwangaphambili

Ukuxela kwangaphambili (ithuba lokuchacha kwakhona) kuxhomekeke ekubeni umhlaza usasazekile ngexesha lokuchongwa kunye nokuba umhlaza usabela njani kunyango.

Umhlaza wesisu unokusasazeka kwisibindi, imiphunga, iperitoneum, okanye amanye amalungu omzimba.

Unyango

Ngolwazi malunga nonyango oludweliswe ngezantsi, jonga kwiCandelo loKhetho ngokujonga uKhetho.

Unyango lomhlaza wesisu ebantwaneni unokubandakanya oku kulandelayo:

• Ugqirha lokususa umhlaza kunye nezicubu ezinempilo ezijikelezileyo.

• Ugqirha lokususa umhlaza kangangoko kunokwenzeka, kulandelwa unyango ngemitha kunye nonyango ngamayeza.

Unyango lomhlaza ophindayo wesisu ebantwaneni unokubandakanya oku kulandelayo:

• Uvavanyo lweklinikhi olujonga isampulu yethumba lesigulana kutshintsho oluthile kwimfuza. Uhlobo lonyango ekujoliswe kulo oluya kunikwa isigulana luxhomekeke kuhlobo lotshintsho lwemfuza.

Jonga icandelo leSisu seStromal Tumors (GIST) sesi sishwankathelo kunye ne-Neuroendocrine Tumors (Carcinoids) yecandelo lesisishwankathelo solwazi malunga ne-carcinoids zesisu kunye neuroendocrine tumors.

Umhlaza wePancreatic

Umhlaza wepancreatic sisifo apho iiseli ezibi (zomhlaza) zeeseli zenzeka kwizicwili zepancreas. Ipancreas yintsimbi emile okwepeyari malunga nee-intshi ezi-6 ubude. Umphetho obanzi wepancreas ubizwa ngokuba yintloko, icandelo eliphakathi libizwa ngokuba ngumzimba, kwaye isiphelo esimxinwa sibizwa ngokuba ngumsila. Zininzi iintlobo zamathumba ezinokuthi zenze iipancreas. Ezinye izicubu zinobungozi (hayi umhlaza).

I-Anatomy yepancreas. Ipancreas ineendawo ezintathu: intloko, umzimba, kunye nomsila. Ifunyanwa esiswini kufutshane nesisu, amathumbu, kunye namanye amalungu.

Ipancreas inemisebenzi emibini ephambili emzimbeni:

• Ukwenza iijusi ezincedisa ukwetyisa (ukwahlula) ukutya. Ezi jusi zifihlwa emathunjini amancinci.

• Ukwenza iihormoni ezinceda ukulawula iswekile kunye namanqanaba etyuwa egazini. Ezi hormone zifihlwa kwigazi.

Zine iindidi zomhlaza wepancreatic ebantwaneni:

• Isisu esiqinileyo sepseudopapillary zepancreas. Olu lolona hlobo luqhelekileyo lwepancreatic tumor. Ichaphazela ikakhulu abantu ababhinqileyo abakwishumi elivisayo abadala kunye nabantu abadala abancinci. Ezi tumors zikhula kancinci zinee-cyst-like and solid parts. Isisu esomeleleyo sepseudopapillary zepancreas akunakulingani ukuba sisasazeke kwamanye amalungu omzimba kwaye ukuxela kwangaphambili kulungile kakhulu. Ngamaxesha athile, ithumba linokusasazeka kwisibindi, imiphunga, okanye ii-lymph node.

• IPancreatoblastoma. Ihlala ivela kubantwana abaneminyaka eli-10 okanye ngaphezulu. Abantwana abane-Beckwith-Wiedemann syndrome kunye nosapho lwe-adenomatous polyposis (FAP) syndrome banomngcipheko okhulayo we-pancreatoblastoma. Ezi tumors zikhula kancinci zihlala zenza uphawu lwe-tumor alpha-fetoprotein. Ezi tumors zinokwenza iadrenocorticotropic hormone (ACTH) kunye ne-antidiuretic hormone (ADH). I-Pancreatoblastoma ingasasazeka kwisibindi, imiphunga kunye ne-lymph nodes. Ukuxela kwabantwana abane-pancreatoblastoma kulungile.

• Islet cell tumors. Ezi tumors aziqhelekanga ebantwaneni kwaye zinokuba nobungozi okanye zibe mbi. Islet cell tumors kungenzeka kubantwana abane-endocrine neoplasia type 1 (MEN1) syndrome. Ezona ntlobo zixhaphakileyo zamathumba eslet yeseli yi-insulinomas kunye negastrinomas. Ezinye iintlobo zamathumba eslet yeseli yi-ACTHoma kunye neVIPoma. Ezi tumors zinokwenza iihormoni, ezinje nge-insulin, i-gastrin, i-ACTH, okanye i-ADH. Xa kusenziwa ihomoni eninzi, iimpawu kunye neempawu zezifo zenzeka.

• Ipancreatic carcinoma. I-Pancreatic carcinoma inqabile kakhulu ebantwaneni. Iindidi ezimbini zepancreatic carcinoma zii-acinar cell carcinoma kunye ne-ductal adenocarcinoma.

Iimpawu kunye neMpawu

Iimpawu kunye neempawu zomhlaza wepancreatic zinokubandakanya oku kulandelayo:

• Ukudinwa.

• Ukwehla kwesisindo ngaphandle kwesizathu esaziwayo.

• Ukuphelelwa ngumdla wokutya.

• Ukuphazamiseka esiswini.

• Isigaxa esiswini.

Kubantwana, ezinye izicwili zepancreatic azifihli iihomoni kwaye akukho zimpawu zesifo. Oku kwenza ukuba kube nzima ukufumanisa umhlaza wepancreatic kwangoko.

Izidumba zepancreatic ezenza iihomoni ezifihlakeleyo zinokubangela iimpawu kunye neempawu. Iimpawu kunye neempawu zixhomekeke kuhlobo lwehomoni eyenziweyo.

Ukuba ithumba lifihla i-insulin, iimpawu kunye neempawu ezinokubakho zibandakanya oku kulandelayo:

• Iswekile esezantsi yegazi. Oku kunokubangela ukungaboni kakuhle, intloko ebuhlungu, kunye nokuziva unentloko elula, udiniwe, ubuthathaka, uyangcangcazela, unovalo, uyacaphuka, uyajuluka,

• ndibhidekile, okanye ndilambile.

• Utshintsho kwindlela yokuziphatha.

• Ukuxhuzula.

• Coma.

Ukuba ithumba lifihla i-gastrin, iimpawu kunye neempawu ezinokubakho zibandakanya oku kulandelayo:

• Izilonda zesisu ezihlala zibuya.

• Intlungu esiswini, enokuthi isasaze ngasemva. Intlungu inokuza idlule kwaye inokuhamba emva kokuthatha i-antacid.

• Ukuhamba kokuqulathwe sisisu kubuyela emva kwi-esophagus (gastroesophageal reflux).

• Urhudo.

Iimpawu kunye neempawu ezibangelwa ngamathumba enza ezinye iintlobo zehomoni, ezinje nge-ACTH okanye i-ADH, inokubandakanya oku kulandelayo:

• Urhudo lwamanzi.

• Ukuphelelwa ngamanzi emzimbeni (ukuziva unxaniwe, ukwenza umchamo omncinci, isikhumba nomlomo owomileyo, intloko ebuhlungu, isiyezi, okanye ukudinwa).

• Inqanaba le-sodium ephantsi (ityuwa) egazini (ukudideka, ukulala, ubuthathaka bemisipha kunye nokubanjwa).

• Ukwehla kobunzima okanye ukuzuza ngaphandle kwesizathu esaziwayo.

• Ubuso obujikelezileyo kunye neengalo nemilenze ebhityileyo.

• Ndiziva ndidiniwe kwaye ndibuthathaka.

• Igazi elonyukayo.

• Amachaphaza amdaka okanye apinki kulusu.

Jonga ugqirha womntwana wakho ukuba ubona naziphi na kwezi ngxaki emntwaneni wakho. Ezinye iimeko ezingengawo umhlaza wepancreatic zinokubangela ezi mpawu kunye neempawu ezifanayo.

Uvavanyo lokuchonga kunye nokulinganisa

Uvavanyo lokuchonga kunye nenqanaba lomhlaza wepancreatic lunokubandakanya oku kulandelayo:

• Uvavanyo lomzimba kunye nembali yezempilo.

• X-ray esifubeni.

• Ukuskena i-CT.

• IMRI.

• Ukuskena iPET.

• Uqhaqho.

• I-biopsy yenaliti: Ukususwa kwethishu kusetyenziswa inaliti ebanzi.

• I-Laparoscopy: Inkqubo yotyando yokujonga amalungu ngaphakathi kwesisu ukukhangela iimpawu zesifo. Ukucuthwa okuncinci (ukusika) kwenziwa eludongeni lwesisu kunye ne-laparoscope (ityhubhu encinci, ekhanyisiweyo) ifakwe kwenye yeendlela. Ezinye izixhobo zinokufakwa ngendlela efanayo okanye ezinye iindlela zokwenza iinkqubo ezinjengokususa amalungu okanye ukuthatha iisampuli zethishu eziza kujongwa ngemicroscope kwimpawu zesifo.

• I-Laparotomy: Inkqubo yotyando apho kusikwa khona (ukusikwa) eludongeni lwesisu ukujonga ngaphakathi esiswini ukuba akukho zimpawu zezifo. Ubungakanani bokubanjwa kuxhomekeke kwisizathu sokuba kwenziwe i-laparotomy. Ngamanye amaxesha amalungu ayasuswa okanye kuthathwe iisampulu zeethishu zihlolwe ngemicroscope kukhangelwe iimpawu zesifo.

Jonga icandelo loLwazi ngokubanzi malunga nenkcazo yezi mvavanyo kunye neenkqubo.

Olunye uvavanyo olusetyenziselwa ukufumanisa umhlaza wepancreatic lubandakanya oku kulandelayo:

• I-Endoscopic ultrasound (EUS): Inkqubo apho i-endoscope ifakwe khona emzimbeni, ngesiqhelo ngomlomo okanye ngexande. I-endoscope sisixhobo esibhityileyo, esifana netyhubhu esinokukhanya kunye nelensi yokujonga. Iprojekhthi ekupheleni kwe-endoscope isetyenziselwa ukubuyisa amaza esandi aphezulu (i-ultrasound) kwizicubu zangaphakathi okanye kwizitho kunye nokwenza i-echoes. Iingqungquthela zenza umfanekiso wezicubu zomzimba ezibizwa ngokuba yi-sonogram. Le nkqubo ikwabizwa ngokuba yi-endosonografi.

• I-Somatostatin receptor scintigraphy: Uhlobo lwe-radionuclide scan esetyenziselwa ukufumana izicwili zepancreatic. Inani elincinci kakhulu le-octreotide ene-radioactive (i-hormone ebambelela kwizicubu ze-carcinoid) ifakwe kwi-vein kwaye ihamba ngegazi. I-octreotide enemitha ye-radio inamathela kwi-tumor kwaye ikhamera ekhethekileyo efumanisa i-radioactivity isetyenziselwa ukubonisa ukuba ziphi na izidumbu emzimbeni. Le nkqubo isetyenziselwa ukufumanisa i-islet cell tumors.

Unyango

Ngolwazi malunga nonyango oludweliswe ngezantsi, jonga kwiCandelo loKhetho ngokujonga uKhetho.

Unyango lwe-pseudopapillary tumor e-pancreas ebantwaneni inokubandakanya oku kulandelayo:

• Utyando lokususa ithumba.

• I-Chemotherapy yamathumba angenakususwa ngotyando okanye asasazeke kwamanye amalungu omzimba.

Unyango lwe-pancreatoblastoma ebantwaneni lunokubandakanya oku kulandelayo:

• Utyando lokususa ithumba. Inkqubo ye-Whipple inokwenziwa ngamathumba entloko yepancreas.

• I-Chemotherapy inokunikwa ukunciphisa ithumba ngaphambi kotyando. Unyango lwe-chemotherapy luya kunikwa emva kotyando kumathumba amakhulu, amathumba angenakuqala ukususwa ngotyando, kunye nezilonda ezisasazeke kwamanye amalungu omzimba.

• I-Chemotherapy inokunikwa ukuba i-tumor ayiphenduli kunyango okanye ibuye.

Unyango lwezihlunu zeselelet kubantwana kunokubandakanya iziyobisi ukunyanga iimpawu ezibangelwa zihomoni kunye noku kulandelayo:

• Utyando lokususa ithumba.

• I-Chemotherapy kunye nonyango ekujoliswe kulo (unyango lwe-mTOR inhibitor) yamathumba angenakususwa ngotyando okanye athe asasazeka kwamanye amalungu omzimba.

Jonga isishwankathelo se- kubantu abadala bePancreatic Neuroendocrine Tumors (Islet Cell Tumors) Unyango ngolwazi oluthe kratya malunga nezidumba zepancreatic.

Kukho iimeko ezimbalwa ezichaziweyo zepancreatic carcinoma ebantwaneni. )

Unyango lwe-pancreatic carcinoma ephindaphindayo ebantwaneni inokubandakanya oku kulandelayo:

• Uvavanyo lweklinikhi olujonga isampulu yethumba lesigulana kutshintsho oluthile kwimfuza. Uhlobo lonyango ekujoliswe kulo oluya kunikwa isigulana luxhomekeke kuhlobo lotshintsho lwemfuza.

Jonga isishwankathelo se- kunyango lweCancreatic Cancer yabantu abadala kunye nePancreatic Neuroendocrine Tumors yabantu abadala (Islet Cell Tumors) Unyango ngolwazi oluthe kratya malunga nezidumba zepancreatic.

Umhlaza weColorectal

Umhlaza omdaka sisifo apho umhlaza (umhlaza) weeseli zenzeka kwizicubu zekolon okanye kwi-rectum. Ikholoni yinxalenye yenkqubo yokwetyisa yomzimba. Inkqubo yokwetyisa isusa kwaye isebenze izakhamzimba (iivithamini, iiminerali, iikhabhohayidrethi, amafutha, iiproteni, kunye namanzi) ekutyeni kwaye inceda ukukhupha inkunkuma ngaphandle komzimba. Inkqubo yokwetyisa yenziwe ngumqala, isisu, kunye namathumbu amancinci kunye amakhulu. Ikholoni (enkulu yamathumbu) yinxalenye yokuqala yamathumbu amakhulu kwaye imalunga neenyawo ezintlanu ubude. Ngokudibeneyo, i-rectum kunye ne-canal canal zenza icandelo lokugqibela lamathumbu amakhulu kwaye zii-intshi ezi-6-8 ubude. Umsele wamva uphela kwi-anus (ukuvulwa kwethumbu elikhulu ukuya ngaphandle komzimba).

Inkqubo yokwetyisa esezantsi, ebonisa ikholoni kunye namanye amalungu.

Izinto zomngcipheko, imiqondiso kunye neempawu, kunye nokuchongwa kunye nokuvavanywa kwenqanaba

Umhlaza womhlaza wobuntwana onokuba yinxalenye yesifo esizuze ilifa. Eminye imihlaza enomdla kubantu abancinci inxulunyaniswa notshintsho olwenza ukuba ii-polyps (ukukhula kwenwebu yangaphakathi ebeka ikholoni) ukuba yenze umhlaza kamva.

Umngcipheko wesifo somhlaza wesifo esinyukayo ukwanda ngokuba neemeko ezithile ezizuze ilifa, njenge:

• I-adenomatous polyposis eqhelekileyo (FAP).

• Ukuhlawulwa kweFAP.

• I-polyposis enxulumene ne-MUTYH.

• Isifo seLynch.

• Oligopolyposis.

• Utshintsho kuhlobo lwe-NTHL1.

• Ingxaki yolutsha lwepolyposis.

• Isifo seCowden.

• Isifo sePeutz-Jeghers.

• Uhlobo lwe-Neurofibromatosis 1 (NF1).

Iipolyp polyp ezenza kubantwana abangenayo i-syndrome ezuzwe njengelifa azidibananga nomngcipheko owandayo womhlaza.

Iimpawu kunye neempawu zesifo somhlaza wobuntwana esiqhelekileyo zihlala zixhomekeke kwindawo apho ithumba lenza khona. Umhlaza ongalunganga unokubangela nayiphi na imiqondiso kunye neempawu ezilandelayo. Jonga kugqirha womntwana wakho ukuba umntwana wakho unayo nayiphi na kwezi zinto zilandelayo:

• Amathumba e-rectum okanye ikholoni esezantsi kunokubangela iintlungu esiswini, ukuqhinwa, okanye ukuhambisa.

• Izidumbu kwinxalenye yekholoni kwicala lasekhohlo lomzimba zinokubangela:

• Isigaxa esiswini.

• Ukwehla kwesisindo ngaphandle kwesizathu esaziwayo.

• Isicaphucaphu nokugabha.

• Ukuphelelwa ngumdla wokutya.

• Igazi esitulweni.

• I-Anemia (ukudinwa, isiyezi, ukubetha kwentliziyo okukhawulezayo okanye okungaqhelekanga, umphefumlo omfutshane, ulusu olumhlophe)

• Izidumbu kwinxalenye yekholoni kwicala lasekunene lomzimba zinokubangela:

• Intlungu esiswini.

• Igazi esitulweni.

• Ukuqunjelwa okanye urhudo.

• Isihlunu okanye ukugabha.

• Ukwehla kwesisindo ngaphandle kwesizathu esaziwayo.

Eminye imiqathango engengawo umhlaza ongalunganga inokubangela ezi mpawu kunye neempawu ezifanayo.

Uvavanyo lokuchonga kunye nenqanaba lomhlaza ongalunganga lunokubandakanya oku kulandelayo:

• Uvavanyo lomzimba kunye nembali yezempilo.

• X-ray esifubeni.

• Ukuxilongwa kwe-CT kwesifuba, isisu kunye nesinqe.

• Ukuskena iPET.

• IMRI.

• Ukuskena amathambo.

• Uqhaqho.

Olunye uvavanyo oluye lwasetyenziselwa ukufumanisa isifo somhlaza kubandakanya ezi zilandelayo:

• IColonoscopy: Inkqubo yokujonga ngaphakathi kwi-rectum kunye ne-colon yee-polyps, iindawo ezingaqhelekanga, okanye umhlaza. I-colonoscope ifakwe kwi-rectum kwi-colon. Ikholonoscope sisixhobo esibhityileyo, esifana netyhubhu esinesibane kunye neelensi zokujonga. Isenokuba nesixhobo sokususa iipolyps okanye iisampulu zethishu, ezijongwa phantsi kwemicroscope kwimpawu zomhlaza.

• I-enema ye-Barium: Uthotho lwee-x-reyi zendlela engezantsi yesisu. Umbane oqukethe i-barium (i-silver-white metallic compound) ifakwe kwi-rectum. Iingubo ze-barium zincinci zesisu kunye ne-x-ray zithathwa. Le nkqubo ikwabizwa ngokuba luluhlu olusezantsi lwe-GI.

• Uvavanyo lwegazi lokungcola kwegazi: Uvavanyo lokujonga isitulo (inkunkuma eqinileyo) yegazi elinokubonwa kuphela ngemicroscope. Iisampulu ezincinci zesitulo zibekwa kumakhadi akhethekileyo kwaye zibuyiselwe kugqirha okanye elebhu kuvavanyo.

• Gcwalisa ubalo lwegazi (i-CBC): Inkqubo apho kuthathwa khona isampulu yegazi kwaye ihlolwe oku kulandelayo:

• Inani leeseli ezibomvu zegazi, iiseli ezimhlophe zegazi kunye neeplatelets.

• Isixa sehemoglobin (iprotein ethwala ioksijini) kwiiseli ezibomvu zegazi.

• Inxalenye yesampulu yegazi eyenziwe ziiseli ezibomvu zegazi.

• Uvavanyo lomsebenzi weentso: Uvavanyo apho iisampulu zegazi okanye umchamo zijongwa khona izixa zezinto ezithile ezikhutshwe zizintso. Inani eliphezulu okanye elingaphantsi kwesiqhelo kwinto leyo inokuba luphawu lokuba izintso azisebenzi ngendlela ebekufanele ukuba zisebenza ngayo. Oku kukwabizwa ngokuba luvavanyo lomsebenzi wezintso.

• Uvavanyo lomsebenzi wesibindi: Uvavanyo lwegazi ukulinganisa amanqanaba egazi lezinto ezithile ezikhutshwe sisibindi. Inqanaba eliphezulu okanye eliphantsi lezinto ezithile linokuba luphawu lwesifo sesibindi.

• Uvavanyo lweCarcinoembryonic antigen (CEA): Uvavanyo olulinganisa inqanaba le-CEA egazini. I-CEA ikhutshwa kwigazi ukusuka kumaseli omhlaza kunye nakwiiseli eziqhelekileyo. Xa ifunyenwe kumanqanaba aphezulu kunesiqhelo, inokuba luphawu lomhlaza obomvu okanye ezinye iimeko.

Ukuxela kwangaphambili

Ukuxela kwangaphambili (ithuba lokuchacha) kuxhomekeke koku kulandelayo:

• Nokuba ithumba lonke lisuswe ngotyando.

• Nokuba umhlaza unwenwele kwamanye amalungu omzimba, anje ngee-lymph node, isibindi, i-pelvis, okanye ii-ovari.

Unyango

Ngolwazi malunga nonyango oludweliswe ngezantsi, jonga kwiCandelo loKhetho ngokujonga uKhetho.

Unyango lwesifo somhlaza kubantwana unokubandakanya oku kulandelayo:

• Utyando lokususa ithumba ukuba alinwenwanga.

• Unyango lwe-radiation kunye ne-chemotherapy yamathumba kwi-rectum okanye kwi-colon esezantsi.

• Umdibaniso wechemotherapy, yomhlaza ogqithileyo wemibala.

• I-Immunotherapy ene-immune checkpoint inhibitors (ipilimumab kunye ne-nivolumab).

Unyango lomhlaza ophindaphindayo onomhlaza ebantwaneni unokubandakanya oku kulandelayo:

• Uvavanyo lweklinikhi olujonga isampulu yethumba lesigulana kutshintsho oluthile kwimfuza. Uhlobo lonyango ekujoliswe kulo oluya kunikwa isigulana luxhomekeke kuhlobo lotshintsho lwemfuza.

Abantwana abaneempawu ezithile zomhlaza we-colorectal cancer syndromes banokuphathwa nge:

• Ugqirha lokususa ikholoni ngaphambi kweefom zomhlaza.

• Iyeza lokunciphisa inani leepolyps kwikholoni.

Izidumbu ze-Neuroendocrine (iCarcinoid Tumors)

Iiseli ze-Neuroendocrine zinokusebenza njengeeseli zemithambo-luvo okanye iiseli zokwenza iihomoni. Iiseli zisasazeke kumalungu onke anje ngemiphunga (i-tracheobronchial) okanye indlela yokugaya.

Amathumba e-Neuroendocrine (kubandakanya amathumba e-carcinoid) ahlala esenza ulusu lwesisu okanye amathumbu (kubandakanya isihlomelo), kodwa zinokubakho kwamanye amalungu, njengepancreas, imiphunga, okanye isibindi. Ezi tumors zihlala zincinci, zikhula kancinci, kwaye zinobungozi (hayi umhlaza). Ezinye ze-neuroendocrine tumors ziyingozi (umhlaza) kwaye zisasazeka kwezinye iindawo emzimbeni.

Uninzi lwezidumba ze-neuroendocrine ebantwaneni zenzeka kwisihlomelo (isingxobo esincamathela kwinxalenye yokuqala yamathumbu amakhulu kufutshane nesiphelo samathumbu amancinci). I-tumor ihlala ifunyanwa ngexesha lotyando ukususa isihlomelo.

Iimpawu kunye neMpawu

Iimpawu kunye neempawu zesisu se-neuroendocrine zixhomekeke apho i-tumor yenzeka khona. Amathumba e-neuroendocrine kwisihlomelo anokubangela le miqondiso neempawu zilandelayo:

• Iintlungu zesisu, ngakumbi kwicala lasekunene lesisu.

• Ifiva.

• Isicaphucaphu nokugabha.

• Urhudo.

Amathumba e-Neuroendocrine angekho kwisihlomelo anokukhupha iihomoni kunye nezinye izinto. Isifo seCarcinoid esibangelwa yihomoni ye-serotonin kunye nezinye iihormoni, sinokubangela nayiphi na imiqondiso kunye neempawu zilandelayo. Jonga kugqirha womntwana wakho ukuba umntwana wakho unayo nayiphi na kwezi zinto zilandelayo:

• Ubomvu kunye nemvakalelo efudumeleyo ebusweni, entanyeni, nakwisifuba esingaphezulu.

• Ukubetha kwentliziyo okukhawulezayo.

• Ingxaki yokuphefumla.

• Ukuhla ngesiquphe koxinzelelo lwegazi (ukungazinzi, ukudideka, ubuthathaka, isiyezi, kunye nolusu olumhlophe, olupholileyo, kunye nolusu).

• Urhudo.

Ezinye iimeko ezingezizo izicubu ze-neuroendocrine zinokubangela ezi mpawu kunye neempawu ezifanayo.

Uvavanyo lokuchonga kunye nokulinganisa

Uvavanyo olujonga imiqondiso yomhlaza lusetyenziselwa ukufumanisa isifo kunye ne-neuroendocrine tumors. Banokubandakanya:

• Uvavanyo lomzimba kunye nembali yezempilo.

• Izifundo ze-chemistry yegazi.

• IMRI.

• Ukuskena iPET.

• Ukuskena i-CT.

• I-Ultrasound.

Jonga icandelo loLwazi ngokubanzi malunga nenkcazo yezi mvavanyo kunye neenkqubo.

Olunye uvavanyo olusetyenziselwe ukufumanisa isifo se-neuroendocrine kubandakanya oku kulandelayo:

• Uvavanyo lomchamo lweeyure ezingamashumi amabini anesine: Uvavanyo apho kuqokelelwa khona umchamo iiyure ezingama-24 ukulinganisa ubungakanani bezinto ezithile, ezinje ngehomoni. Inani elingaqhelekanga (eliphezulu okanye elisezantsi kunesiqhelo) lexabiso linokuba luphawu lwesifo kwilungu okanye kwithishu eyenzayo. Isampulu yomchamo ijongiwe ukubona ukuba iqulethe i-5-HIAA (imveliso eyaphukileyo ye-hormone serotonin enokwenziwa ngamathumba e-carcinoid). Olu vavanyo lusetyenziselwa ukunceda ukufumanisa isifo se-carcinoid.

• I-Somatostatin receptor scintigraphy: Uhlobo lwe-radionuclide scan olunokusetyenziselwa ukufumana amathumba. Inani elincinci kakhulu le-octreotide enemithambo-luvo (ihomoni ebambelela kwizidumba) itofelwe emthanjeni kwaye ihamba ngegazi. I-octreotide enemitha ye-radio inamathela kwi-tumor kwaye ikhamera ekhethekileyo efumanisa i-radioactivity isetyenziselwa ukubonisa ukuba ziphi na izidumbu emzimbeni. Le nkqubo ikwabizwa ngokuba yi-octreotide scan kunye ne-SRS.

Ukuxela kwangaphambili

Ukuxelwa kwangaphambili kwezidumba ze-neuroendocrine kwisihlomelo ebantwaneni kuhlala kulunge kakhulu emva kotyando ukususa ithumba. Izidumba ze-Neuroendocrine ezingekho kwisihlomelo zihlala zikhulu okanye zisasazeke kwamanye amalungu omzimba ngexesha lokuchongwa kwaye aziphenduli kakuhle kwi-chemotherapy. Amathumba amakhulu kunokwenzeka ukuba aphinde abuye (abuye).

Unyango

Ngolwazi malunga nonyango oludweliswe ngezantsi, jonga kwiCandelo loKhetho ngokujonga uKhetho.

Unyango lwamathumba e-neuroendocrine kwisihlomelo ebantwaneni sinokubandakanya oku kulandelayo:

• Utyando lokususa isihlomelo.

Unyango lwamathumba e-neuroendocrine athe asasazeka emathunjini amakhulu, iipancreas, okanye isisu sihlala sityandwa. Unyango lwamathumba angenakususwa ngotyando, amathumba amaninzi, okanye amathumba athe asasazeka anokubandakanya oku kulandelayo:

• Ukudibanisa.

• Unyango lwe-analogue ye-Somatostatin (octreotide okanye i-lanreotide).

• Unyango lwe-Peptide receptor radionuclide.

• Unyango olujolise kwi-tyrosine kinase inhibitor (sunitinib) okanye i-mTOR inhibitor (everolimus).

Unyango lwamathumba aphindaphindiweyo e-neuroendocrine ebantwaneni anokubandakanya oku kulandelayo:

• Uvavanyo lweklinikhi olujonga isampulu yethumba lesigulana kutshintsho oluthile kwimfuza. Uhlobo lonyango ekujoliswe kulo oluya kunikwa isigulana luxhomekeke kuhlobo lotshintsho lwemfuza.

Jonga isishwankathelo se- kunyango lwabantu abadala besisu seCarcinoid Tumors ngolwazi oluthe kratya.

Amathumba eSisu eSisu

Izisu zesisu zesisu esiswini (GIST) zihlala ziqala kwiiseli eludongeni lwesisu okanye amathumbu. Ii-GISTs zinokuba zilungile (hayi umhlaza) okanye isifo esibi (umhlaza). Ii-GIST zobuntwana zixhaphake kakhulu kumantombazana, kwaye zihlala zibonakala kwiminyaka yeshumi elivisayo.

Izinto ezinobungozi kunye neempawu kunye neempawu

I-GISTs kubantwana azifani neze-GISTs kubantu abadala. Izigulana kufuneka zibonwe kumaziko agxile kunyango lwe-GISTs kwaye amathumba kufuneka avavanywe kutshintsho lwemfuzo. Inani elincinci labantwana linamathumba aneenguqu kwimfuzo ezinjengezo zifunyanwa kwizigulana zabantu abadala. Umngcipheko we-GIST unyuswe ngezi ngxaki zilandelayo zemfuzo:

• ICarney triad.

• Isifo seCarney-Stratakis.

Uninzi lwabantwana abane-GIST banamathumba esiswini kwaye baba ne-anemia ebangelwa kukopha. Iimpawu kunye neempawu ze-anemia zibandakanya oku kulandelayo:

• Ukudinwa.

• Ukuba nesiyezi.

• Ukubetha kwentliziyo okukhawulezayo okanye okungaqhelekanga.

• Ukuqhawukelwa ngumphefumlo.

• Ulusu oluthuthu.

Isigaxa esiswini okanye ukuvaleka kwamathumbu (iintlungu esiswini esiswini, isicaphucaphu, ukugabha, urhudo, ukuqhina, nokudumba kwesisu) ikwayimpawu zeGIST.

Ezinye iimeko ezingezizo i-anemia ezibangelwa yi-GIST zinokubangela ezi mpawu kunye neempawu ezifanayo.

Uvavanyo lokuchonga kunye nokulinganisa

Uvavanyo olujonga imiqondiso yomhlaza lusetyenziselwa ukufumanisa isifo kunye nenqanaba le-GISTs. Banokubandakanya:

• Uvavanyo lomzimba kunye nembali yezempilo.

• IMRI.

• Ukuskena i-CT.

• Ukuskena iPET.

• X-reyi yesisu.

• Uqhaqho.

• Umnqweno wenaliti entle: Ukususwa kwethishu kusetyenziswa inaliti ebhityileyo.

Jonga icandelo loLwazi ngokubanzi malunga nenkcazo yezi mvavanyo kunye neenkqubo.

Olunye uvavanyo olusetyenziselwa ukufumanisa isifo se-GIST lubandakanya oku kulandelayo:

• I-Endoscopy: Inkqubo yokujonga amalungu kunye nezicubu ngaphakathi komzimba ukukhangela iindawo ezingaqhelekanga. I-endoscope ifakwe kwi-incision (cut) elukhumbeni okanye ekuvulekeni emzimbeni, njengomlomo okanye kwi-anus. I-endoscope sisixhobo esibhityileyo, esifana netyhubhu esinokukhanya kunye nelensi yokujonga. Inokuba nesixhobo sokususa iisampulu zethishu okanye i-lymph node, ezijongwa phantsi kwemicroscope kwimpawu zesifo.

Unyango

Ngolwazi malunga nonyango oludweliswe ngezantsi, jonga kwiCandelo loKhetho ngokujonga uKhetho.

Unyango lwabantwana abanamathumba kunye notshintsho lwemfuzo njengolo lufunyenwe kwizigulana zabantu abadala lujolise kunyango nge-tyrosine kinase inhibitor (imatinib okanye sunitinib).

Unyango lwabantwana abanamathumba abonakalisi utshintsho kwimfuzo kunokubandakanya oku kulandelayo:

• Utyando lokususa ithumba. Unyango olungakumbi lunokufuneka ukuba kukho ukuphazamiseka kwamathumbu okanye ukopha.

Unyango lwe-GIST ephindaphindiweyo ebantwaneni inokubandakanya oku kulandelayo:

• Uvavanyo lweklinikhi olujonga isampulu yethumba lesigulana kutshintsho oluthile kwimfuza. Uhlobo lonyango ekujoliswe kulo oluya kunikwa isigulana luxhomekeke kuhlobo lotshintsho lwemfuza.

• Uvavanyo lweklinikhi yeyeza elitsha le-chemotherapy.

Umhlaza ongaqhelekanga weNkqubo yokuzala kunye neeNkqubo zeUchamo

Kweli Candelo

• Umhlaza wesinyi

• Umhlaza wamatyhalarha

• Umhlaza we-Ovarian

• Umhlaza womlomo wesibeleko kunye nowasetyhini

Umhlaza wesinyi

Umhlaza wesinyi sisifo apho iiseli ezimbi (zomhlaza) zeeseli zenzeka kwizicubu zesinyi. Isinyi lilungu lomngxunya emazantsi esisu. Yenziwe njengebhaluni encinci kwaye inodonga lwezihlunu oluyivumela ukuba ibe nkulu okanye incinci. Iityhubhu ezincinci kwizicoca izintso kwaye zicoca igazi. Bakhupha iimveliso zenkunkuma benze umchamo. Umchamo uvela kwizintso nganye ngetyhubhu ende ebizwa ngokuba yi-ureter kwisinyi. Isinyi sibamba umchamo de udlule kwi-urethra kwaye ushiye umzimba.

I-Anatomy yenkqubo yabasetyhini yokuchama ebonisa izintso, iidrenal gland, ureters, bladder, kunye urethra. Umchamo wenziwe ngee-tubules zezintso kwaye uqokelela kwi-renal pelvis yezintso nganye. Umchamo uqukuqela uphuma kwizintso udlula kwizicwili uze uye kwesinye. Umchamo ugcinwe esinyini de ushiye umzimba kwi-urethra.

Uhlobo oluqhelekileyo lomhlaza wesinyi ngumhlaza weseli wotshintsho. Iseli esine squamous kunye nezinye iintlobo zomhlaza wesinyi azixhaphakanga.

Izinto zomngcipheko, imiqondiso kunye neempawu, kunye nokuchongwa kunye nokuvavanywa kwenqanaba

Umngcipheko womhlaza wesinyi uyanda kubantwana abaye baphathwa umhlaza ngamachiza athile e-anticancer, abizwa ngokuba ziiarhente ze-alkylating, ezibandakanya i-cyclophosphamide, ifosfamide, busulfan, kunye ne-temozolomide.

Umhlaza wesinyi unokubangela nayiphi na imiqondiso neempawu ezilandelayo. Jonga kugqirha womntwana wakho ukuba umntwana wakho unayo nayiphi na kwezi zinto zilandelayo:

• Igazi kumchamo (umhlwa omncinci ukuba bomvu ngombala oqaqambileyo).

• Ukuchama rhoqo okanye ukuziva isidingo sokuchama ngaphandle kokwenza njalo.

• Ubuhlungu ngexesha lokuchama.

• Isisu okanye iintlungu ezisezantsi.

Ezinye iimeko ezingengomhlaza wesinyi zinokubangela iimpawu ezifanayo.

Uvavanyo lokuchonga kunye nomhlaza webala lesinyi unokubandakanya oku kulandelayo:

• Uvavanyo lomzimba kunye nembali yezempilo.

• Ukuskena i-CT.

• I-Ultrasound yesinyi.

• Uqhaqho.

• ICystoscopy: Inkqubo yokujonga ngaphakathi kwesinyi kunye nerethra ukujonga iindawo ezingaqhelekanga. I-cystoscope ifakwe kwi-urethra kwisinyi. I-cystoscope sisixhobo esibhityileyo, esifana netyhubhu esinokukhanya kunye nelensi yokujonga. Inokuba nesixhobo sokususa iisampulu zethishu, ezijongwa phantsi kwemicroscope kwimpawu zomhlaza. Ukuba i-cystoscopy ayenziwa ekuchongeni, iisampulu zethishu ziyasuswa kwaye zijongwe umhlaza ngexesha lotyando ukususa konke okanye inxenye yesinyi.

Jonga icandelo loLwazi ngokubanzi malunga nenkcazo yezi mvavanyo kunye neenkqubo.

Ukuxela kwangaphambili

Kubantwana, umhlaza wesinyi uhlala uphantsi (awunakwenzeka ukuba usasazeke) kwaye isifo sisoloko sihle kakhulu emva kotyando ukususa ithumba.

Unyango

Ngolwazi malunga nonyango oludweliswe ngezantsi, jonga kwiCandelo loKhetho ngokujonga uKhetho.

Unyango lomhlaza wesinyi ebantwaneni luhlala lulandelayo:

• Utyando lokususa inxenye yesinyi. I-Transurethral resection (TUR) yinkqubo yotyando yokususa izicwili kwisinyi usebenzisa i-resectoscope efakwe kwisinyi ngokusebenzisa umchamo. I-resectoscope sisixhobo esibhityileyo, esifana netyhubhu esinokukhanya, ilensi yokujonga, kunye nesixhobo sokususa izicwili kunye nokutshisa naziphi na iiseli zethumba ezisele. Iisampulu zeethishu ezivela kwindawo esuswe kuyo ithumba zijongwa phantsi kwemicroscope kwimpawu zomhlaza.

• Utyando lokususa isinyi (kunqabile)

Thetha nogqirha womntwana wakho malunga nokuba olu hlobo lotyando lunokuchaphazela njani ukuchama, ukusebenza ngokwesondo kunye nokuzala.

Unyango lomhlaza wesinyi rhoqo kubantwana unokubandakanya oku kulandelayo:

• Uvavanyo lweklinikhi olujonga isampulu yethumba lesigulana kutshintsho oluthile kwimfuza. Uhlobo lonyango ekujoliswe kulo oluya kunikwa isigulana luxhomekeke kuhlobo lotshintsho lwemfuza.

Jonga isishwankathelo se- kunyango lomhlaza wesinyi sabadala ngolwazi olungaphezulu.

Umhlaza wamatyhalarha

Umhlaza wamatyhalarha sisifo apho iiseli ezinobungozi (zomhlaza) zibumba kwizicwili zelinye okanye omabini amasende. Amasende ngamadlala amile okweqanda amabini abekwe ngaphakathi kwisingxobo samatyhalarha (ingxowa yolusu olukhululekileyo elele ngqo ezantsi kwepenisi). Amatyhalarha agcinwa ngaphakathi kwisingxobo samatyhalarha ngentambo ye-spermatic, ekwaqulathe i-vas deferens kunye neenqanawa kunye nemithambo-luvo yamatyhalarha.

I-anatomy yeenkqubo zokuzala kunye nokuchama kwendoda, ebonisa iprotate, amasende, isinyi kunye namanye amalungu.

Zimbini iintlobo zamathumba wamatyhalarha:

• Izidumba zeseli zeGerm: Izidumba eziqala kwiiseli zedoda emadodeni. Iimvumba zentsholongwane yeseli inokuba yingozi (hayi umhlaza) okanye isifo esibi (umhlaza). Ezona ndawo zixhaphakileyo zamatyhalarha ethumba kumakhwenkwe amancinci zii-teratomas ezinobungozi kunye ne-nonseminomas enobungozi. Iisemina zihlala zivela kubafana kwaye zinqabile kubafana. Jonga isishwankathelo se- soNyango lweeNtsholongwane zeSeli zoNyango lweeNtsana ngolwazi oluthe kratya malunga nesisu seentsholongwane.

• Izidumba zeseli ezingezizo iintsholongwane: Amathumba aqala kwizicubu ezijikeleze kwaye axhase amasende. Ezi tumors zinokuba zilungile okanye zibi. Amathumba eseli yolutsha i-granulosa kunye ne-Sertoli-Leydig tumors zeseli ziindidi ezimbini zezidumba ezingezizo ezesifo.

Iimpawu kunye neempawu kunye noVavanyo kunye novavanyo lweSiteji

Umhlaza wamatyhalarha nokusasazeka kwawo kwamanye amalungu omzimba kunokubangela nayiphi na imiqondiso okanye imiqondiso elandelayo. Jonga kugqirha womntwana wakho ukuba umntwana wakho unayo nayiphi na kwezi zinto zilandelayo:

• Isigaqa esingenabuhlungu kumasende.

• Iimpawu zokuqala zokufikisa.

• Amabele andisiweyo.

Isigaqa esingenabuhlungu kumatyhalarha singangumqondiso wamathumba wamatyhalarha. Ezinye iimeko zinokubangela ukuba kubekho iqhuma kumasende.

Uvavanyo lokuchonga kunye nenqanaba lomhlaza wamasende omhlaza ongaqukiyo unokubandakanya oku kulandelayo:

• Uvavanyo lomzimba kunye nembali yezempilo.

• Ukuxilongwa kwe-CT kwesifuba, isisu, okanye isinqe.

• I-MRI yesifuba, isisu, okanye isinqe.

• I-Ultrasound.

• Uqhaqho. Izicubu ezisuswe ngexesha lotyando zijongwa ngemicroscope ngugqirha wezilwanyana ukujonga imiqondiso yomhlaza.

Jonga icandelo loLwazi ngokubanzi malunga nenkcazo yezi mvavanyo kunye neenkqubo.

Olunye uvavanyo olusetyenziselwa ukufumanisa amathumba wamatyhalarha lubandakanya oku kulandelayo:

• Uvavanyo lwe-serum tumor marker: Inkqubo apho kuvavanywa khona isampulu yegazi ukulinganisa izixa zezinto ezithile ezikhutshelwe egazini ngamalungu, izicwili, okanye iiseli zethumba emzimbeni. Izinto ezithile zinxulunyaniswa neentlobo ezithile zomhlaza xa zifunyenwe kumanqanaba anyukayo egazini. Oku kubizwa ngokuba kukuphawula amathumba. Isiphawuli se-alpha-fetoprotein sisetyenziselwa ukufumanisa isifo se-germ tumors.

Ukuxela kwangaphambili

Kubantwana, ukuxela kwangaphambili kuhlala kulunge kakhulu emva kotyando ukususa ithumba.

Unyango

Ngolwazi malunga nonyango oludweliswe ngezantsi, jonga kwiCandelo loKhetho ngokujonga uKhetho.

Unyango lwe-non-germ cell testicular cancer ebantwaneni inokubandakanya oku kulandelayo:

• Ugqirha lokususa ithumba kwityhalarha.

• Ugqirha lokususa isende elinye okanye omabini.

Unyango lomhlaza wamatyhalarha weseli ongafakwanga yintsholongwane ebantwaneni unokubandakanya oku kulandelayo:

• Uvavanyo lweklinikhi olujonga isampulu yethumba lesigulana kutshintsho oluthile kwimfuza. Uhlobo lonyango ekujoliswe kulo oluya kunikwa isigulana luxhomekeke kuhlobo lotshintsho lwemfuza.

Jonga isishwankathelo se- soNyango lweeNtsholongwane zeSeli zoNyango lweeNtsana ngolwazi oluthe kratya malunga nesisu seentsholongwane.

Umhlaza we-Ovarian

Umhlaza we-Ovarian sisifo apho iiseli ezinobungozi (zomhlaza) zakha kwi-ovary. Ii-ovari zizibini zamalungu kwinkqubo yokuzala yabasetyhini. Zibekwe kwisinqe, elinye kwicala ngalinye lesibeleko (umngxunya, ilungu elimile okwepeyari apho kukhula umbungu). Isibeleko ngasinye simalunga nobukhulu kunye nokumila kweamangile kumfazi omdala. Ama-ovari avelisa amaqanda kunye neehomoni zabasetyhini (iikhemikhali ezilawula indlela iiseli ezithile okanye amalungu asebenza ngayo).

I-Anatomy yenkqubo yokuzala yabasetyhini. Amalungu kwinkqubo yokuzala yabasetyhini afaka isibeleko, amaqanda, imibhobho yesibeleko, umlomo wesibeleko, kunye nelungu lobufazi. Isibeleko sinomaleko ongaphandle wemisipha obizwa ngokuba yi-myometrium kunye nelining yangaphakathi ebizwa ngokuba yi-endometrium.

Uninzi lwamathumba e-ovari ebantwaneni alunabungozi (hayi umhlaza). Zenzeka rhoqo kubantu basetyhini abaneminyaka eli-15 ukuya kweli-19 ubudala.

Kukho iintlobo ezahlukeneyo zomhlaza (umhlaza) we-ovari tumors:

• Izidumba zeseli zentsholongwane: Amathumba aqala kwiiseli zamaqanda kwabasetyhini. Ezi zezona tumors zixhaphakileyo ze-ovari kumantombazana. )

• Izidumba ze-epithelial: Izidumba eziqala kwinyama egubungele i-ovary. Esi sesona sihlunu sesibini sixhaphake kakhulu kumantombazana.

• Amathumba eStromal: Amathumba aqala kwiiseli ezomeleleyo, ezenza izicwili ezijikeleze kwaye zixhase ii-ovari. Izidumba zeseli yolutsha i-granulosa kunye ne-Sertoli-Leydig tumors zeseli ziindidi ezimbini zamathumba aqinileyo.

• Iseli encinci carcinoma ye-ovary: Umhlaza oqala kwi-ovary kwaye unokusasazeka kwisisu, isinqe, okanye amanye amalungu omzimba. Olu hlobo lomhlaza we-ovari lukhula ngokukhawuleza kwaye unesifo esingalunganga.

Izinto zomngcipheko, imiqondiso kunye neempawu, kunye nokuchongwa kunye nokuvavanywa kwenqanaba

Umngcipheko womhlaza wesibeleko uyonyuswa ngokuba kwezi meko zilandelayo:

• Isifo i-Ollier (sisifo esibangela ukukhula okungaqhelekanga kwe-cartilage ekupheleni kwamathambo amade).

• Isifo seMaffucci (ingxaki ebangela ukukhula okungaqhelekanga kwe-cartilage ekupheleni kwamathambo amade kunye nemithambo yegazi kulusu).

• I-Peutz-Jeghers syndrome (ingxaki ebangela ukuba iipolyps zenze amathumbu kunye namabala amnyama ukuba enze emlonyeni naseminweni).

• I-Pleuropulmonary blastoma syndrome (isifo esinokubangela i-cystic nephroma, i-cysts kwimiphunga, iingxaki ze-thyroid, kunye nezinye izifo zomhlaza wezintso, i-ovary kunye nezicubu ezithambileyo).

• I-DICER1 syndrome (ingxaki enokubangela i-goiter, iipolyps kwikholoni, kunye nezicubu ze-ovary, umlomo wesibeleko, ityhalarikhi, izintso, ingqondo, iliso kunye nokufakwa komphunga).

Umhlaza we-Ovarian unokubangela nayiphi na imiqondiso kunye neempawu ezilandelayo. Jonga kugqirha womntwana wakho ukuba umntwana wakho unayo nayiphi na kwezi zinto zilandelayo:

• Intlungu okanye ukudumba esiswini.

• Isigaxa esiswini.

• Ukuqunjelwa.

• Iintlungu okanye ukuphoswa lixesha lokuya exesheni.

• Ukopha okungaqhelekanga kwilungu lobufazi.

• Iimpawu zesini samadoda, ezinjengeenwele zomzimba okanye ilizwi elinzulu.

• Iimpawu zokuqala zokufikisa.

Ezinye iimeko ezingengawo umhlaza we-ovari zinokubangela ezi mpawu kunye neempawu ezifanayo.

Uvavanyo lokuchonga kunye nenqanaba lomhlaza we-ovari unokubandakanya oku kulandelayo:

• Uvavanyo lomzimba kunye nembali yezempilo.

• Ukuskena i-CT.

• IMRI.

• I-Ultrasound.

• Uqhaqho. Izicubu ezisuswe ngexesha lotyando zijongwa ngemicroscope ngugqirha wezilwanyana ukujonga imiqondiso yomhlaza.

Jonga icandelo loLwazi ngokubanzi malunga nenkcazo yezi mvavanyo kunye neenkqubo.

Olunye uvavanyo olusetyenziselwa ukufumanisa amathumba e-ovari lubandakanya oku kulandelayo:

• Uvavanyo lwe-serum tumor marker: Inkqubo apho kuvavanywa khona isampulu yegazi ukulinganisa izixa zezinto ezithile ezikhutshelwe egazini ngamalungu, izicwili, okanye iiseli zethumba emzimbeni. Izinto ezithile zinxulunyaniswa neentlobo ezithile zomhlaza xa zifunyenwe kumanqanaba anyukayo egazini. Oku kubizwa ngokuba kukuphawula amathumba. Amanqaku ethumba alpha-fetoprotein, beta-chorionic gonadotropin (β-hCG), CEA, CA-125, kunye nezinye zisetyenziselwa ukufumanisa umhlaza we-ovari.

Ngexesha lotyando lokususa ithumba, ulwelo esiswini luza kujongwa ukuba luneempawu zomhlaza.

Ukuxela kwangaphambili

Umhlaza we-Ovarian epithelial umhlaza uhlala ufumaneka kwinqanaba lokuqala ebantwaneni kwaye kulula ukunyanga kunakwizigulana zabantu abadala.

Unyango

Ngolwazi malunga nonyango oludweliswe ngezantsi, jonga kwiCandelo loKhetho ngokujonga uKhetho.

Unyango lwezihlunu ezinobungozi kubantwana kunokubandakanya oku kulandelayo:

• Ugqirha.

Unyango lwe-ovarian epithelial cancer ebantwaneni inokubandakanya oku kulandelayo:

• Ugqirha.

• Unyango ngemitha.

• Unyango ngamayeza.

Unyango lwamathumba e-ovarian stromal, kubandakanya ulutsha lwe-granulosa tumors kunye ne-Sertoli-Leydig tumors, kubantwana kunokubandakanya oku kulandelayo:

• Ugqirha lokususa i-ovary kunye ne-tube enye ye-fallopian yomhlaza wokuqala.

• Utyando olulandelwa yichemotherapy yomhlaza oqhubele phambili.

• I-Chemotherapy yomhlaza ophindaphindiweyo (ubuye).

Unyango lwe-cell carcinoma encinci ye -ovary inokubandakanya oku kulandelayo:

• Utyando olulandelwa yi-chemotherapy kunye ne-high-dose chemotherapy kunye nokuhlangulwa kweseli.

• Unyango ekujoliswe kulo (tazemetostat).

Unyango lomhlaza ophindaphindeneyo womhlaza kubantwana unokubandakanya oku kulandelayo:

• Uvavanyo lweklinikhi olujonga isampulu yethumba lesigulana kutshintsho oluthile kwimfuza. Uhlobo lonyango ekujoliswe kulo oluya kunikwa isigulana luxhomekeke kuhlobo lotshintsho lwemfuza.

Jonga ezi zishwankathelo zilandelayo ze- ngolwazi oluthe kratya:

• Unyango lwe-germ yamaseli ekhula ngaphandle kwentsholongwane
• I-Ovarian Epithelial, iTropopian Tube, kunye nonyango lweCeritoneal Cancer
• Unyango lwe-Ovarian Germ Cell Tumors

Umhlaza womlomo wesibeleko kunye nowasetyhini

Umhlaza womlomo wesibeleko sisifo apho iiseli ezinobungozi (zomhlaza) zenzeka kumlomo wesibeleko. Umlomo wesibeleko sisiphelo esisezantsi, esimxinwa sesibeleko (umngxunya, ilungu elimile okwamapere apho kukhula khona usana). Umlomo wesibeleko ukhokelela kwisibeleko uye kwilungu lobufazi (umjelo wokuzalwa). Iifom zomhlaza welungu lobufazi kwilungu lobufazi. Ubufazi ngumjelo ohamba ukusuka kumlomo wesibeleko ukuya ngaphandle komzimba. Ekuzalweni, umntwana uphumela ngaphandle kwelungu lobufazi (ekwabizwa ngokuba ngumjelo wokuzalwa).

I-Anatomy yenkqubo yokuzala yabasetyhini. Amalungu kwinkqubo yokuzala yabasetyhini afaka isibeleko, amaqanda, imibhobho yesibeleko, umlomo wesibeleko, kunye nelungu lobufazi. Isibeleko sinomaleko ongaphandle wemisipha obizwa ngokuba yi-myometrium kunye nelining yangaphakathi ebizwa ngokuba yi-endometrium.

Olona phawu luxhaphakileyo lomhlaza womlomo wesibeleko nowelungu lobufazi kukopha kwilungu lobufazi. Ezinye iimeko zinokubangela ukopha kwilungu lobufazi. Abantwana bahlala befunyaniswe benesifo esihambele phambili.

Uvavanyo lokuchonga kunye nokulinganisa

Uvavanyo lokuchonga kunye nenqanaba lomhlaza wesibeleko kunye nelungu lobufazi kunokubandakanya oku kulandelayo:

• Uvavanyo lomzimba kunye nembali yezempilo.

• I-Ultrasound.

• IMRI.

• Ukuskena i-CT.

• Uqhaqho. I-biopsy yenaliti engaphaya kokugqibela kukususwa kwezicubu kusetyenziswa inaliti ekhokelwa yi-ultrasound.

• Ukuskena amathambo.

Jonga icandelo loLwazi ngokubanzi malunga nenkcazo yezi mvavanyo kunye neenkqubo.

Olunye uvavanyo olusetyenziselwa ukufumanisa isifo somlomo wesibeleko kunye nobufazi kubandakanya oku kulandelayo:

• Uvavanyo lwe-serum tumor marker: Inkqubo apho kuvavanywa khona isampulu yegazi ukulinganisa izixa zezinto ezithile ezikhutshelwe egazini ngamalungu, izicwili, okanye iiseli zethumba emzimbeni. Izinto ezithile zinxulunyaniswa neentlobo ezithile zomhlaza xa zifunyenwe kumanqanaba anyukayo egazini. Oku kubizwa ngokuba kukuphawula amathumba.

• Uvavanyo lwePAP: Inkqubo yokuqokelela iiseli kumphezulu wesibeleko nakwilungu lobufazi. Isiqwenga somqhaphu, ibrashi, okanye intonga encinci esetyenziselwa ukukrwela ngobunono iiseli zomlomo wesibeleko kunye nelungu lobufazi. Iiseli zijongwa phantsi kwemicroscope ukufumanisa ukuba aziqhelekanga. Le nkqubo ikwabizwa ngokuba yiPap smear.

• ICystoscopy: Inkqubo yokujonga ngaphakathi kwesinyi kunye nerethra ukujonga iindawo ezingaqhelekanga. I-cystoscope ifakwe kwi-urethra kwisinyi. I-cystoscope sisixhobo esibhityileyo, esifana netyhubhu esinokukhanya kunye nelensi yokujonga. Inokuba nesixhobo sokususa iisampulu zethishu, ezijongwa phantsi kwemicroscope kwimpawu zomhlaza.

• Iproctoscopy: Inkqubo yokujonga ngaphakathi kwi-rectum kunye ne-anus ukujonga iindawo ezingaqhelekanga, usebenzisa iproctoscope. Iproctoscope sisixhobo esibhityileyo, esifana netyhubhu esinesibane kunye neelensi zokujonga ngaphakathi kwe-rectum kunye ne-anus. Inokuba nesixhobo sokususa iisampulu zethishu, ezijongwa phantsi kwemicroscope kwimpawu zomhlaza.

Unyango

Ngolwazi malunga nonyango oludweliswe ngezantsi, jonga kwiCandelo loKhetho ngokujonga uKhetho.

Unyango lomhlaza womlomo wesibeleko kunye nelungu lobufazi lunokubandakanya oku kulandelayo:

• Ugqirha lokususa umhlaza kangangoko kunokwenzeka, kulandele unyango lwemitha, ukuba iiseli zomhlaza zihlala emva kotyando okanye umhlaza usasazekile kwii-lymph node.

• I-Chemotherapy inokusetyenziswa kodwa ayaziwa ukuba lonyango lusebenza njani.

Unyango lomhlaza ophindaphindayo wesibeleko kunye nelungu lobufazi ebantwaneni lunokubandakanya oku kulandelayo:

• Uvavanyo lweklinikhi olujonga isampulu yethumba lesigulana kutshintsho oluthile kwimfuza. Uhlobo lonyango ekujoliswe kulo oluya kunikwa isigulana luxhomekeke kuhlobo lotshintsho lwemfuza.

Eminye imihlaza engaqhelekanga engaqhelekanga yoBuntwana

Kweli Candelo

• Iindidi ezininzi ze-Endocrine Neoplasia Syndromes

• IPheochromocytoma kunye neParaganglioma

• Umhlaza wolusu (iMelanoma, iSmamous Cell Cancer, iBasal Cell Cancer)

• I-Intraocular (Uveal) iMelanoma

• Chordoma

• Umhlaza weSiza saBaqalayo esingaziwayo

Iindidi ezininzi ze-Endocrine Neoplasia Syndromes

Uninzi lwee-endocrine neoplasia (MEN) syndromes zizifo ezizuzwe njengelifa ezichaphazela inkqubo ye-endocrine. Inkqubo ye-endocrine yenziwe ngamadlala kunye neeseli ezenza iihomoni kwaye zizikhuphele egazini. I-MEN syndromes inokubangela i-hyperplasia (ukukhula kweeseli ezininzi eziqhelekileyo) okanye izicubu ezinokuba nobungozi (hayi umhlaza) okanye umhlaza (umhlaza).

Kukho iintlobo ezahlukeneyo ze-MEN syndromes kwaye uhlobo ngalunye lunokubangela iimeko ezahlukeneyo okanye umhlaza. Ukutshintsha kohlobo lwe-RET kuhlala kunxulunyaniswa nomhlaza we-medullary cancer kwi-MEN2 syndrome. Ukuba kurhanelwa isifo se-MEN2 kurhanelwa umntwana okanye ilungu losapho kufunyaniswe ukuba une-MEN2 syndrome, abazali kufuneka bafumane iingcebiso ngemfuzo ngaphambi kokuba kwenziwe uvavanyo lwemfuza emntwaneni. Ingcebiso ngemfuzo ibandakanya nengxoxo yomngcipheko wesifo se-MEN2 somntwana kunye namanye amalungu osapho.

Ezi ntlobo zimbini ziphambili ze-MEN syndromes zi-MEN1 kunye neMEN2:

Isifo seMEN1 sisaziwa ngokuba sisifo seWermer. Esi sifo sihlala sibangela amathumba kwi-parathyroid gland, i-pituitary gland, okanye i-islet cell kwi-pancreas. Ukuchongwa kwesifo se-MEN1 kwenziwa xa kufunyanwa izicubu ezibini kula madlala okanye kumalungu. Ukuxela kwangaphambili (ithuba lokuchacha) kuhlala kulungile.

Ezi tumors zinokwenza iihormoni ezongezelelweyo kwaye zibangele iimpawu okanye iimpawu ezithile zesifo. Iimpawu kunye neempawu zixhomekeke kuhlobo lwehomoni eyenziwe lityum. Ngamanye amaxesha akukho zimpawu zomhlaza.

Eyona meko ixhaphakileyo enxulunyaniswa nesifo se-MEN1 yi-hyperparathyroidism. Iimpawu kunye neempawu zehyperparathyroidism (i-hormone eninzi kakhulu) ibandakanya oku kulandelayo:

• Ukuba nelitye lezintso.

• Ndiziva ndibuthathaka okanye ndidiniwe.

• Intlungu yethambo.

Ezinye iimeko ezinxulunyaniswa ne-MEN1 syndrome kunye neempawu kunye neempawu eziqhelekileyo zezi:

• I-pituitary adenoma (intloko ebuhlungu, ukungabikho kwamaxesha ngexesha lokufikisa, ukwenza ubisi lwebele ngaphandle kwesizathu esaziwayo).

• Pancreatic neuroendocrine tumors (iswekile esezantsi yegazi [ubuthathaka, ukulahleka kwengqondo, okanye isiqaqa], iintlungu esiswini, ukugabha kunye norhudo).

Izifo ezinobungozi zeengqungquthela ze-adrenal, i-bronchi, i-thymus, i-fibrous tissue, okanye iiseli ezinamafutha nazo ziya kwenzeka.

Abantwana abane-hyperparathyroidism ephambili, izicubu ezinxulunyaniswa nesifo se-MEN1, okanye imbali yosapho ye-hypercalcemia okanye isifo se-MEN1 banokufumana uvavanyo lwemfuzo ukujonga utshintsho (utshintsho) kuhlobo lwe-MEN1. Abazali kufuneka bafumane iingcebiso ngezofuzo (ingxoxo nengcali eqeqeshiweyo malunga nomngcipheko wezifo zemfuzo) ngaphambi kokuba kwenziwe uvavanyo lwemfuzo. Ingcebiso ngemfuzo ibandakanya nengxoxo yomngcipheko wesifo se-MEN1 somntwana kunye namanye amalungu osapho.

Abantwana abafunyaniswe ukuba bane-MEN1 syndrome bajongiwe ukuba banempawu zomhlaza eziqala kwiminyaka emi-5 ubudala kwaye baqhubeka ubomi babo bonke. Thetha nogqirha womntwana wakho malunga neemvavanyo kunye neenkqubo ezifunekayo zokujonga iimpawu zomhlaza kunye nokuba kufuneka zenziwe kangaphi.

Isifo seMEN2 sibandakanya amaqela amancinci amabini aphambili: iMEN2A kunye neMEN2B.

• Isifo seMEN2A

Isifo seMEN2A sibizwa ngokuba yiSipple syndrome. Ukuchongwa kwesifo se-MEN2A kunokwenziwa xa isiguli okanye abazali besigulana, abantakwabo, oodade wabo, okanye abantwana benezinto ezimbini okanye ezingaphezulu kwezi zilandelayo:

• Umhlaza womhlaza wamadlala (umhlaza owenza iiseli ze-parafollicular C kwi-thyroid). Iimpawu kunye neempawu zomhlaza wamadlala we-medullary unokubandakanya:

• Isigaqa emqaleni okanye entanyeni.

• Ingxaki yokuphefumla.

• Ingxaki yokuginya.

• Ukurhabaxa.

• Pheochromocytoma (ithumba le ndlala adrenal). Iimpawu kunye neempawu zepheochromocytoma zinokubandakanya:

• Intlungu esiswini okanye esifubeni.

• Intliziyo eyomeleleyo, ekhawulezayo, okanye engaqhelekanga.

• Intloko ebuhlungu.

• Ukubila ngamandla ngaphandle kwesizathu esaziwayo.

• Ukuba nesiyezi.

• Ndiziva ndingcangcazela.

• Ukuba nomsindo okanye uvalo.

• Isifo se-parathyroid gland (i-tumor enobungozi ye-parathyroid gland okanye ukwanda ngobukhulu be-parathyroid gland). Iimpawu kunye neempawu zesifo separathyroid kunokubandakanya

• Hypercalcemia.

• Intlungu esiswini, ecaleni, okanye ngasemva engahambi.

• Ubuhlungu emathanjeni.

• Ithambo elaphukileyo.

• Isigaqa entanyeni.

• Ingxaki yokuthetha.

• Ingxaki yokuginya.

Ezinye i-cancer ze-thyroid ze-medullary zenzeka kunye nesifo se-Hirschsprung (ukuqunjelwa okungapheliyo okuqala xa umntwana elusana), efunyenwe kwezinye iintsapho ezine-MEN2A syndrome. Isifo seHirschsprung sinokuvela ngaphambi kokuba kwenziwe ezinye iimpawu zeMEN2A syndrome. Izigulana ezifunyaniswe zinesifo seHirschsprung kufuneka zijongwe kutshintsho lwe-RET yemfuza enxulunyaniswa nomhlaza wedlala lengqula kunye ne-MEN2A syndrome.

I-medullary carcinoma ye-thyroid (FMTC) luhlobo lwe-MEN2A syndrome ebangela umhlaza we-medullary cancer. Ukuchongwa kwe-FMTC kunokwenziwa xa amalungu osapho amabini okanye nangaphezulu enesifo somhlaza we-thyroid kwaye kungekho lungu losapho lineengxaki ze-parathyroid okanye ze-adrenal gland.

• Isifo seMEN2B

Izigulana ezine-MEN2B syndrome zinokuba nomzimba omncinci owakhiwe ngeengalo ezinde, ezibhityileyo kunye nemilenze. Imilebe isenokubonakala inkulu kwaye inamaqhuqhuva ngenxa yamathumba abuhlungu kwiimbumba ezinomqolo. Isifo seMEN2B sinokubangela le miqathango ilandelayo:

• Umhlaza womhlaza wamadlala (ukukhula ngokukhawuleza).

• I-Parathyroid hyperplasia.

• Adenomas.

• Pheochromocytoma.

• Izidumbu zeseli zemithambo-luvo kwiimbumba ezinomhlana okanye kwezinye iindawo.

Uvavanyo olusetyenziselwa ukufumanisa isifo kunye nenqanaba le-MEN syndromes lixhomekeke kwiimpawu kunye neempawu kunye nembali yosapho yesigulana. Banokubandakanya:

• Uvavanyo lomzimba kunye nembali yezempilo.

• Izifundo ze-chemistry yegazi.

• I-Ultrasound.

• IMRI.

• Ukuskena i-CT.

• Ukuskena iPET.

• Intsingiselo yenaliti entle (i-FNA) okanye i-biopsy yotyando.

Jonga icandelo loLwazi ngokubanzi malunga nenkcazo yezi mvavanyo kunye neenkqubo.

Olunye uvavanyo kunye neenkqubo ezisetyenziselwa ukufumanisa isifo se-MEN syndromes zibandakanya oku kulandelayo:

• Uvavanyo lwe-Genetic: Uvavanyo lwelabhoratri apho iiseli okanye izicwili zihlalutywa ukujonga utshintsho kwiijethi okanye kwii-chromosomes. Olu tshintsho lunokuba luphawu lokuba umntu unesifo okanye usesichengeni sokuba nesifo okanye imeko ethile. Isampulu yegazi ihlolwe kwi-MEN1 gene ukuze ichonge isifo se-MEN1 kunye ne-RET yemfuza yokufumanisa isifo se-MEN2.

• Izifundo zehomoni yegazi: Inkqubo apho kuvavanywa isampulu yegazi ukulinganisa izixa zehomoni ezithile ezikhutshelwe egazini ngamalungu kunye nezicubu zomzimba. Inani elingaqhelekanga (eliphezulu okanye elisezantsi kunesiqhelo) lexabiso linokuba luphawu lwesifo kwilungu okanye kwithishu eyenzayo. Igazi linokujongwa kwakhona kumanqanaba aphezulu ehomoni ye-calcitonin okanye ihomoni yeparathyroid (PTH).

• Ndlala yokuskena: A imali encinane Radioactive kufincelwe okanye zifakwa. Izinto eziqhumayo ziqokelela kwiiseli ze-thyroid gland. Ikhamera ekhethekileyo enxulunyaniswe nekhompyuter ibhaqa imitha ekhutshiweyo kwaye yenza imifanekiso ebonisa indlela idlala lengqula elisebenza ngayo kunye nokuba umhlaza unwenwele na ngaphaya kwedlala lengqula. Ukuba inani lehomoni ekhuthaza idlala lengqula kwigazi lomntwana liphantsi, ukuskena ukwenza imifanekiso ye-thyroid kunokwenziwa ngaphambi kotyando.

• Ukuskena kweSestamibi: Uhlobo lwe-radionuclide scan esetyenziselwa ukufumana i-parathyroid gland egqithisileyo. Inani elincinci kakhulu le-radioactive ebizwa ngokuba yi-technetium 99 lifakwe kwi-vein kwaye lihamba ngegazi ukuya kwi-parathyroid gland. Izinto ezinokusasazeka ngemitha ziya kuqokelela kwindlala egqithisileyo kwaye zibonise ngokuqaqambileyo kwikhamera ekhethekileyo efumanisa i-radioactivity.

• Isampulu ye-venous ye-parathyroid gland engaphaya: Inkqubo apho isampulu yegazi ithathwa kwimithambo ecaleni kwamadlala e-parathyroid. Isampulu ihlolwe ukulinganisa ubungakanani behomoni yeparathyroid ekhutshwe egazini ngendlala nganye. Isampulu ye-venous inokwenziwa ukuba uvavanyo lwegazi lubonisa ukuba kukho isifo se-parathyroid gland esingaphaya kodwa iimvavanyo zokucinga azibonisi ukuba yeyiphi.

• I-Somatostatin receptor scintigraphy: Uhlobo lwe-radionuclide scan olunokusetyenziselwa ukufumana amathumba. Inani elincinci kakhulu le-octreotide enemithambo-luvo (ihomoni ebambelela kwizidumba) itofelwe emthanjeni kwaye ihamba ngegazi. I-octreotide enemitha ye-radio inamathela kwi-tumor kunye nekhamera ekhethekileyo efumanisa i-radioactivity isetyenziselwa ukubonisa ukuba ngaba zikhona na iziqhuma zeseli zesele kwiipancreas. Le nkqubo ikwabizwa ngokuba yi-octreotide scan kunye ne-SRS.

• Ukuskena kwe-MIBG: Inkqubo esetyenziselwa ukufumana amathumba e-neuroendocrine, anje nge-pheochromocytoma. Inani elincinci kakhulu lezinto ezibizwa ngokuba yi-radioactive MIBG litofelwe kumthambo kwaye lihamba ngokuhamba kwegazi. Iiseli zesisu se-Neuroendocrine zithatha i-MIBG enemitha kwaye zifunyenwe siskena. Ukuskena kungathathwa ngaphezulu kweentsuku ezi-1-3. Isisombululo se-iodine sinokunikwa ngaphambi okanye ngexesha lovavanyo ukugcina i-thyroid gland ingafaki kakhulu kwi-MIBG.

• Uvavanyo lomchamo lweeyure ezingamashumi amabini anesine: Inkqubo esetyenziselwa ukufumanisa amathumba e-neuroendocrine, anje nge-pheochromocytoma. Umchamo uqokelelwa iiyure ezingama-24 ukulinganisa ixabiso leekatecholamines kumchamo. Izinto ezibangelwa kukophuka kwezi katecholamines nazo ziyalinganiswa. Inani elingaqhelekanga (eliphezulu okanye elisezantsi kunesiqhelo) lexabiso linokuba luphawu lwesifo kwilungu okanye kwithishu eyenzayo. Phezulu kunexabiso eliqhelekileyo kunokuba ngumqondiso we-pheochromocytoma.

• Uvavanyo lokukhuthaza lwePentagastrin: Uvavanyo ekujongwa kulo iisampulu zegazi ukulinganisa inani lecalcitonin egazini. I-calcium gluconate kunye ne-pentagastrin zifakwe egazini kwaye emva koko kuthathwa iisampulu zegazi kwimizuzu emi-5 elandelayo. Ukuba inqanaba le-calcitonin egazini liyonyuka, inokuba luphawu lomhlaza we-medullary cancer.

Unyango

Ngolwazi malunga nonyango oludweliswe ngezantsi, jonga kwiCandelo loKhetho ngokujonga uKhetho.

Kukho iintlobo ezininzi ze-MEN syndrome, kwaye uhlobo ngalunye lunokudinga unyango olwahlukileyo:

• Izigulana ezine-MEN1 syndrome zinyangwa ngeparathyroid, pancreatic, kunye ne-pituitary tumors.

• Izigulana ezine-MEN1 syndrome kunye ne-hyperparathyroidism ephambili zinokuthi zenziwe utyando ukuze zisuse ubuncinci iincindi ezintathu zeparathyroid kunye ne-thymus.

• Izigulana ezine-MEN2A syndrome zihlala zenziwa utyando ukususa i-thyroid ngeminyaka emi-5 okanye ngaphambili ukuba iimvavanyo zemfuzo zibonisa utshintsho oluthile kuhlobo lwe-RET. Utyando lwenziwe ukufumanisa umhlaza okanye ukunciphisa amathuba omhlaza oza kubakho okanye ukusasazeka.

• Iintsana ezine-MEN2B syndrome zinokuthi zenziwe utyando ukususa i-thyroid ukunciphisa umhlaza womngcipheko oza kubakho okanye ukusasazeka.

• Abantwana abane-MEN2B syndrome abanomdlavuza we-thyroid we-medullary banokunyangwa ngonyango ekujoliswe kulo (i-kinase inhibitor ebizwa ngokuba yi-vandetanib).

Unyango lwezigulana ezine-Hirschsprung isifo kunye notshintsho oluthile lwe-RET gene lubandakanya oku kulandelayo:

• I-thyroidectomy iyonke ukunciphisa ithuba lokuba umhlaza uza kubakho.

Unyango lwe-MEN syndrome ephindaphindiweyo ebantwaneni inokubandakanya oku kulandelayo:

• Uvavanyo lweklinikhi olujonga isampulu yethumba lesigulana kutshintsho oluthile kwimfuza. Uhlobo lonyango ekujoliswe kulo oluya kunikwa isigulana luxhomekeke kuhlobo lotshintsho lwemfuza.

IPheochromocytoma kunye neParaganglioma

I-Pheochromocytoma kunye neparaganglioma ngamathumba anqabileyo avela kuhlobo olunye lwethishu yentliziyo. Uninzi lwala mathumba asingomhlaza.

• Iifom ze- Pheochromocytoma kwiidrenal gland. Kukho amadlala amabini adrenal, enye ngaphezulu kwezintso nganye ngasemva kwesisu esingaphezulu. Idlala ngalinye leadrenal linezahlulo ezibini. Uluhlu lwangaphandle lwe-adrenal gland yi-adrenal cortex. Iziko le-adrenal gland yi-adrenal medulla. I-Pheochromocytoma sisisu se-adrenal medulla.

Amadlala adrenal enza iihormone ezibalulekileyo ezibizwa ngokuba zii-catecholamines. I-Adrenaline (epinephrine) kunye ne-noradrenaline (norepinephrine) ziindidi ezimbini zeekatecholamines ezinceda ukulawula ukubetha kwentliziyo, uxinzelelo lwegazi, iswekile yegazi, kunye nendlela umzimba ophendula ngayo kuxinzelelo. Ezinye i-pheochromocytomas zikhupha i-adrenaline kunye ne-noradrenaline egazini kwaye zibangele iimpawu.

• Iifomathi zeParaganglioma ngaphandle kwamadlala eadrenal kufutshane nomthambo wecarotid, ecaleni kwendlela entloko nasentanyeni, nakwezinye iindawo zomzimba. Ezinye iiparagangliomas zenza ii-catecholamines ezongezelelweyo ezibizwa ngokuba yi-adrenaline kunye ne-noradrenaline. Ukukhutshwa kweadrenaline eyongezelelweyo kunye nenoradrenaline egazini kunokubangela iimpawu.

Izinto zomngcipheko, imiqondiso kunye neempawu, kunye nokuchongwa kunye nokuvavanywa kwenqanaba

Nantoni na eyandisa amathuba akho okufumana isifo ibizwa ngokuba yingozi. Ukuba nomngcipheko akuthethi ukuba uza kuba nomhlaza; ukungabinamngcipheko oko akuthethi ukuba awuzukufumana umhlaza. Thetha nogqirha wakho ukuba ucinga ukuba umntwana wakho usengozini.

Umngcipheko we-pheochromocytoma okanye i-paraganglioma uyonyuswa ngokufumana naziphi na kwezi zinto zilandelayo njengelifa okanye iinguqu zofuzo:

• Uhlobo lwe-endocrine neoplasia yohlobo 1 (MEN1) yesifo. Esi sifo sinokubandakanya amathumba kwi-parathyroid gland, i-pituitary gland, okanye i-islet cell kwi-pancreas, kwaye kunqabile, i-pheochromocytoma.

• Uhlobo lwe-endocrine neoplasia yohlobo lwe-2A syndrome. Esi sifo sinokubandakanya i-pheochromocytoma, umhlaza we-medullary cancer, kunye nesifo se-parathyroid.

• Uhlobo lwe-endocrine neoplasia yohlobo lwe-2B syndrome. Esi sifo sinokubandakanya i-pheochromocytoma, umhlaza womhlaza we-thyroid, i-parathyroid hyperplasia kunye nezinye iimeko.

• Isifo se-von Hippel-Lindau (VHL). Esi sifo sinokubandakanya i-pheochromocytoma, paraganglioma, hemangioblastoma, icacisa i-cell renal carcinoma, i-pancreatic neuroendocrine tumors, kunye nezinye iimeko.

• Uhlobo lwe-Neurofibromatosis 1 (NF1). Esi sifo sinokubandakanya i-neurofibromas, izicubu zobuchopho, i-pheochromocytoma, kunye nezinye iimeko.

• ICarney-Stratakis dyad. Esi sifo sinokubandakanya iparaganglioma kunye nesisu esibuhlungu sesisu (GIST).

• ICarney triad. Esi sifo sinokubandakanya iparaganglioma, i-GIST, kunye ne-chondroma yemiphunga.

• I-pheochromocytoma eqhelekileyo okanye iparaganglioma.

Ngaphezulu kwesiqingatha sabantwana nakwishumi elivisayo abafunyaniswe benesifo i-pheochromocytoma okanye i-paraganglioma bane-syndrome ezuzwe njengelifa okanye utshintsho lothile olwonyuse umngcipheko womhlaza. Ingcebiso ngemfuzo (ingxoxo nengcali eqeqeshiweyo malunga nezifo ezizuzwe njengelifa) kunye novavanyo yinxalenye ebalulekileyo yesicwangciso sonyango.

Ezinye izicubu azenzi i-adrenaline okanye i-noradrenaline kwaye ayibangeli zimpawu. Ezi tumors zingafunyanwa xa kukho isigaxa entanyeni okanye xa kuvavanywa okanye kwenziwa inkqubo ngesinye isizathu. Iimpawu kunye neempawu zepheochromocytoma kunye neparaganglioma zenzeka xa i-adrenaline okanye i-noradrenaline ininzi ikhutshelwa egazini. Ezi kunye nezinye iimpawu kunokubangelwa yi-pheochromocytoma, paraganglioma, okanye ezinye iimeko. Jonga kugqirha womntwana wakho ukuba umntwana wakho unayo nayiphi na kwezi zinto zilandelayo:

• Igazi elonyukayo.

• Intloko ebuhlungu.

• Ukubila ngamandla ngaphandle kwesizathu esaziwayo.

• Intliziyo eyomeleleyo, ekhawulezayo, okanye engaqhelekanga.

• Ndiziva ndingcangcazela.

• Ukuba luthuthu kakhulu.

• Ukuba nesiyezi.

• Ukuba nomsindo okanye uvalo.

Le miqondiso kunye neempawu zinokuza zihambe kodwa uxinzelelo lwegazi oluphezulu kunokwenzeka ukuba lubekho ixesha elide kwizigulana ezisencinci. Le miqondiso kunye neempawu zinokuthi zenzeke ngomsebenzi womzimba, ukulimala, i-anesthesia, utyando lokususa i-tumor, ukutya ukutya okufana ne-tshokoleta kunye noshizi, okanye ngelixa udlula umchamo (ukuba i-tumor isesinye).

Uvavanyo olusetyenziselwa ukufumanisa isifo kunye nenqanaba le-pheochromocytoma kunye neparaganglioma zixhomekeke kwiimpawu kunye neempawu kunye nembali yosapho yesigulana. Banokubandakanya:

• Uvavanyo lomzimba kunye nembali yezempilo.

• Ukuskena iPET.

• Ukuskena i-CT (ukuskena i-CAT).

• I-MRI (imaging resonance imaging).

Jonga icandelo loLwazi ngokubanzi malunga nenkcazo yezi mvavanyo kunye neenkqubo.

Olunye uvavanyo kunye neenkqubo ezisetyenziselwa ukuxilonga i-pheochromocytoma kunye neparaganglioma zibandakanya oku kulandelayo:

• Uvavanyo lwe-metanephrines lwe-Plasma-free: Uvavanyo lwegazi olulinganisa inani le-metanephrines egazini. I-Metanephrines zizinto ezenziwa xa umzimba wophula i-adrenaline okanye i-noradrenaline. I-Pheochromocytomas kunye neparagangliomas zinokwenza isixa esikhulu se-adrenaline kunye ne-noradrenaline kwaye zibangele amanqanaba aphezulu e-metanephrines kwigazi nomchamo.

• Izifundo ze-catecholamine yegazi: Inkqubo apho kuvavanywa isampulu yegazi ukulinganisa inani leetekaminesini (i-adrenaline okanye i-noradrenaline) ekhutshelwe egazini. Izinto ezibangelwa kukophuka kwezi katecholamines nazo ziyalinganiswa. Inani elingaqhelekanga (elingaqhelekanga liphezulu okanye liphantsi kunesiqhelo) lexabiso linokuba luphawu lwesifo kwilungu okanye kwithishu eyenzayo. Amanqanaba aphezulu kunesiqhelo anokuba luphawu lwe-pheochromocytoma okanye iparganglioma.

• Uvavanyo lomchamo lweeyure ezingamashumi amabini anesine: Uvavanyo apho kuqokelelwa khona umchamo iiyure ezingama-24 ukulinganisa izixa zeekatecholamines (adrenaline okanye noradrenaline) okanye i-metanephrines kumchamo. Izinto ezibangelwa kukophuka kwezi katecholamines nazo ziyalinganiswa. Inani elingaqhelekanga (elingaphezulu kwesiqhelo) lexabiso linokuba luphawu lwesifo kwilungu okanye kwithishu eyenzayo. Amanqanaba aphezulu kunesiqhelo anokuba luphawu lwe-pheochromocytoma okanye iparganglioma.

• Iskena se-MIBG: Inkqubo esetyenziselwa ukufumana amathumba e-neuroendocrine, anje nge-pheochromocytoma kunye neparaganglioma. Inani elincinci kakhulu lezinto ezibizwa ngokuba yi-radioactive MIBG litofelwe kumthambo kwaye lihamba ngokuhamba kwegazi. Iiseli zesisu se-Neuroendocrine zithatha i-MIBG enemitha kwaye zifunyenwe siskena. Ukuskena kungathathwa ngaphezulu kweentsuku ezi-1-3. Isisombululo se-iodine sinokunikwa ngaphambi okanye ngexesha lovavanyo ukugcina i-thyroid gland ingafaki kakhulu kwi-MIBG.

• I-Somatostatin receptor scintigraphy: Uhlobo lwe-radionuclide scan olunokusetyenziselwa ukufumana amathumba. Inani elincinci kakhulu le-octreotide enemithambo-luvo (ihomoni ebambelela kwizidumba) itofelwe emthanjeni kwaye ihamba ngegazi. I-octreotide enemitha ye-radio inamathela kwi-tumor kwaye ikhamera ekhethekileyo efumanisa i-radioactivity isetyenziselwa ukubonisa ukuba ziphi na izidumbu emzimbeni. Le nkqubo ikwabizwa ngokuba yi-octreotide scan kunye ne-SRS.

• Uvavanyo lwe-Genetic: Uvavanyo lwelabhoratri apho iiseli okanye izicwili zihlalutywa ukujonga utshintsho kwiijethi okanye kwii-chromosomes. Olu tshintsho lunokuba luphawu lokuba umntu unesifo okanye usesichengeni sokuba nesifo okanye imeko ethile. Oku kulandelayo yimfuza enokuvavanywa kubantwana abane-pheochromocytoma okanye i-paraganglioma: i-VHL, i-NF1, i-RET, i-SDHD, i-SDHB, i-SDHA, i-MAX, kunye ne-TMEM127 yemfuza.

Unyango

Ngolwazi malunga nonyango oludweliswe ngezantsi, jonga kwiCandelo loKhetho ngokujonga uKhetho.

Unyango lwe-pheochromocytoma kunye neparaganglioma ebantwaneni kunokubandakanya oku kulandelayo:

• Ugqirha lokususa ngokupheleleyo ithumba.

• Ukudibanisa i-chemotherapy, idosi ephezulu ye-131I-MIBG yonyango, okanye unyango ekujolise kulo kwizisu ezisasazeke kwamanye amalungu omzimba.

Ngaphambi kotyando, unyango lweziyobisi kunye ne-alpha-blockers yokulawula uxinzelelo lwegazi kunye ne-beta-blockers yokulawula ukubetha kwentliziyo kunikezelwa. Ukuba zombini iincindi zamadlala zisusiwe, unyango lobomi lwehomoni oluya kuhlala ixesha elide lubuyisela iihomoni ezenziwe ngamadlala adrenal luyafuneka emva kotyando.

Unyango lwe-pheochromocytoma ephindaphindiweyo kunye neparaganglioma ebantwaneni inokubandakanya oku kulandelayo:

• Uvavanyo lweklinikhi olujonga isampulu yethumba lesigulana kutshintsho oluthile kwimfuza. Uhlobo lonyango ekujoliswe kulo oluya kunikwa isigulana luxhomekeke kuhlobo lotshintsho lwemfuza.

• Uvavanyo lweklinikhi yonyango lwe-131I-MIBG.

• Uvavanyo lweklinikhi yonyango ekujolise kulo kunye ne-DNA methyltransferase inhibitor.

Umhlaza wolusu (iMelanoma, iSmamous Cell Cancer, iBasal Cell Cancer)

Umhlaza wolusu sisifo apho iiseli ezibi (zomhlaza) zeeseli zenzeka kwizihlunu zolusu. Ulusu lelona lungu lomzimba likhulu. Ikhusela kubushushu, ukukhanya kwelanga, ukwenzakala kunye nosulelo. Ulusu lukwanceda ukulawula ubushushu bomzimba kunye nokugcina amanzi, amanqatha, kunye novithamini D. Ulusu lunamacandelo aliqela, kodwa amacandelo amabini aphambili yi-epidermis (umaleko ongaphezulu okanye ongaphandle) kunye nedermis (umaleko osezantsi okanye ongaphakathi). Umhlaza wolusu uqala kwi-epidermis, eyenziwe ziintlobo ezintathu zeeseli:

• I-Melanocytes: Ifunyenwe kumazantsi e-epidermis, ezi seli zenza i-melanin, i-pigment enika ulusu umbala wayo wendalo. Xa ulusu luvezwa lilanga, ii-melanocytes zenza i-pigment ngakumbi kwaye zibangele ulusu lube mnyama.

• Iiseli zeSquamous: Zincinci, ziiseli ezithe tyaba ezenza umaleko ophezulu wesikhumba.

• Iiseli ezisisiseko: Iiseli ezijikelezileyo phantsi kweeseli ezinobunzima

I-Anatomy yolusu, ebonisa i-epidermis, i-dermis, kunye nezicubu ezingaphantsi. IiMelanocytes zikuluhlu lweeseli ezisisiseko kweyona ndawo inzulu ye-epidermis.

Zintathu iintlobo zomhlaza wolusu:

• Melanoma.

• Umhlaza wesikhumba esine squamous.

• Umhlaza wesikhumba osisiseko.

Melanoma

Nangona i-melanoma inqabile, ngowona mhlaza wolusu uqhelekileyo ebantwaneni. Kwenzeka rhoqo kulutsha oluneminyaka eli-15 ukuya kweli-19 ubudala.

Umngcipheko wokuba ne-melanoma uyanda ngokuba nale miqathango ilandelayo:

• I-nevi enkulu ye-melanocytic (amabala amnyama amakhulu, anokugubungela umboko kunye nethanga).

• I-neurocutaneous melanosis (i-melanocytic nevi yokuzalwa kwesikhumba kunye nengqondo).

• Xeroderma pigmentosum.

• I-retinoblastoma yelifa.

• Amajoni omzimba abuthathaka.

Ezinye izinto ezinobungozi be-melanoma kuwo onke amaqela abandakanya:

• Ukuba nebala elifanelekileyo, elibandakanya oku kulandelayo:

• Ulusu olumenyezelayo olujiyayo kwaye lutshise ngokulula, alusuki, okanye alwenzi kakuhle.

• Luhlaza okwesibhakabhaka okanye luhlaza okanye amanye amehlo anombala okhanyayo.

• Izinwele ezibomvu okanye ezimhlophe.

• Ukuvezwa kukukhanya kwelanga kwendalo okanye ukukhanya kwelanga okungekuko (njengokuvela kwiibhedi zokususa) ixesha elide.

• Ukuba neentsumpa ezininzi okanye ezininzi ezincinci.

• Ukuba nembali yosapho okanye imbali yobuqu yeentsumpa ezingaqhelekanga (atypical nevus syndrome).

• Ukuba nembali yosapho ye-melanoma.

Iimpawu zempawu ze-melanoma zibandakanya oku kulandelayo:

• Imole:

• utshintsho kubukhulu, imilo, okanye umbala.

• inemiphetho okanye imida engaqhelekanga.

• ingaphezulu kombala omnye.

• i-asymmetrical (ukuba i-mole yahlulwe ngesiqingatha, iihafu ezi-2 zahlukile kubukhulu okanye imilo).

• ukurhawuzelela.

• iyopha, yopha, okanye unezilonda (imeko apho umaleko ophezulu wolusu uqhekeka kwaye izicwili ezingezantsi zibonisa).

• Utshintsho kulusu olunombala.

• IiMoles zeSatellite (iizele ezintsha ezikhula kufutshane nemole esele ikho).

Uvavanyo lokuchonga kunye nenqanaba le-melanoma linokubandakanya oku kulandelayo:

• Uvavanyo lomzimba kunye nembali yezempilo.

• X-ray esifubeni.

• Ukuskena i-CT.

• IMRI.

• Ukuskena iPET.

• I-Ultrasound.

Jonga icandelo loLwazi ngokubanzi malunga nenkcazo yezi mvavanyo kunye neenkqubo.

Olunye uvavanyo kunye neenkqubo ezisetyenziselwa ukufumanisa isifo se-melanoma zibandakanya oku kulandelayo:

• Uvavanyo lolusu : Ugqirha okanye umongikazi ukhangela ulusu ukuba lunamaqhuma okanye amabala abonakala engaqhelekanga ngombala, ubungakanani, imilo, okanye ubume.

• I-Biopsy: Yonke okanye inxalenye yokukhula okungaqhelekanga iyanqunyulwa elukhumbeni kwaye ibonwa phantsi kwe-microscope yi-pathologist ukujonga iiseli zomhlaza. Zine iintlobo eziphambili zezinto eziphilayo zolusu:

• Shave i-biopsy: I-razor blade esetyenzisiweyo isetyenziselwa "ukucheba" ukukhula okungaqhelekanga.

• I-Punch biopsy: Isixhobo esikhethekileyo esibizwa ngokuba yi-punch okanye i-trephine sisetyenziselwa ukususa isangqa sethishu ekukhuleni okungaqhelekanga.

• I-biopsy ye-incisional: I-scalpel isetyenziselwa ukususa inxenye yokukhula okungaqhelekanga.

• I-biopsy ekhethekileyo: I-scalpel isetyenziselwa ukususa ukukhula konke.

• I-Sentinel lymph node biopsy: Ukususwa kwe-sentinel lymph node ngexesha lotyando. I-lymph node ye-sentinel yindawo yokuqala ye-lymph kwiqela le-lymph node ukufumana i-lymphatic drainage kwi-tumor yokuqala. Yeyona nkovu node yokuqala ukuba umhlaza kunokwenzeka ukuba usasazeke ukusuka kwithumba lokuqala. Into ene-radioactive kunye / okanye idayi eblowu ifakwe kwisitofu kufutshane nethumba. Isixhobo okanye idayi ihamba ngee-lymph ducts ukuya kwii-lymph nodes. I-lymph node yokuqala yokufumana into okanye idayi isuswe. Ugqirha wezifo ujonga izicwili phantsi kwemicroscope ukukhangela iiseli zomhlaza. Ukuba iiseli zomhlaza azifumaneki, kusenokungabikho mfuneko yokususa ii-lymph node. Ngamanye amaxesha, i-lymph node ye-sentinel ifunyanwa ngaphezulu kweqela elinye lendawo.

• I-lymph node dissection: Inkqubo yokuhlinzwa apho i-lymph nodes isuswe khona kwaye isampuli yezicubu ihlolwe phantsi kwe-microscope kwiimpawu zomhlaza. Kwindawo yokuqhekeka kwe-lymph node yommandla, ezinye ze-lymph node kwindawo yethumba ziyasuswa. Kwindawo yokuqhekeka kwe-lymph node, uninzi lwazo okanye zonke ii-lymph node kwindawo yethumba ziyasuswa. Le nkqubo ikwabizwa ngokuba yi-lymphadenectomy.

Unyango lweMelanoma

Ngolwazi malunga nonyango oludweliswe ngezantsi, jonga kwiCandelo loKhetho ngokujonga uKhetho.

Unyango lwe-melanoma olungasasazekanga kwii-lymph node okanye amanye amalungu omzimba kubandakanya oku kulandelayo:

• Ugqirha lokususa ithumba kunye nezinye izicubu ezisempilweni.

Unyango lwe-melanoma oluye lwasasazeka kwii-lymph node ezikufutshane luquka oku kulandelayo:

• Utyando lokususa ithumba kunye ne-lymph node ezinomhlaza.

• I-Immunotherapy ene-immune checkpoint inhibitors (pembrolizumab, ipilimumab, kunye nivolumab).

• Unyango olujolise kwi-BRAF inhibitors (vemurafenib, dabrafenib, encorafenib) iyodwa okanye nge-MEK inhibitors (trametinib, binimetinib).

Unyango lwe-melanoma oluye lwasasazeka ngaphaya kwee-lymph nodes lungabandakanya oku kulandelayo:

• Unyango lwe-Immunotherapy (ipilimumab).

• Uvavanyo lweklinikhi yonyango ekujoliswe kulo ngomlomo (dabrafenib) ebantwaneni nakwishumi elivisayo.

Unyango lwe-melanoma ephindaphindayo ebantwaneni inokubandakanya oku kulandelayo:

• Uvavanyo lweklinikhi olujonga isampulu yethumba lesigulana kutshintsho oluthile kwimfuza. Uhlobo lonyango ekujoliswe kulo oluya kunikwa isigulana luxhomekeke kuhlobo lotshintsho lwemfuza.

• Uvavanyo lweklinikhi lwe-immunotherapy ene-immune checkpoint inhibitors (pembrolizumab, nivolumab, ipilimumab) ebantwaneni nakwishumi elivisayo.

Jonga isishwankathelo se- kunyango lweMelanoma yabantu abadala ngolwazi oluthe kratya.

Iseli esine squamous kunye nomhlaza wesikhumba esisezantsi

I-nonmelanoma yomhlaza wolusu (iiseli zomzimba kunye nomhlaza weeseli) zinqabile kakhulu kubantwana nakwishumi elivisayo. Umngcipheko weseli e-squamous okanye umhlaza we-basal cell unyuswe ngoku kulandelayo:

• Ukuvezwa kukukhanya kwelanga kwendalo okanye ukukhanya kwelanga okungekuko (njengokuvela kwiibhedi zokususa) ixesha elide.
• Ukuba nebala elifanelekileyo, elibandakanya oku kulandelayo:

• Ulusu olumenyezelayo olujiyayo kwaye lutshise ngokulula, alusuki, okanye alwenzi kakuhle.

• Luhlaza okwesibhakabhaka okanye luhlaza okanye amanye amehlo anombala okhanyayo.

• Izinwele ezibomvu okanye ezimhlophe.

• Ukuba ne-keratosis ye-actinic.

• Ukuba nesifo seGorlin.

• Unyango oludlulileyo ngemitha.

• Ukuba namajoni omzimba abuthathaka.

Iimpawu zeseli squamous kunye nomhlaza wesiseko somhlaza wesikhumba kubandakanya oku kulandelayo:

• Isilonda esingapholiyo.

• Iindawo zolusu ezi:

• Incinci, iphakanyisiwe, igudile, iyakhazimla, kwaye iyayekisa.

• Incinci, iphakanyisiwe, kwaye ibomvu okanye bomvu-bomdaka.

• Flat, erhabaxa, ebomvu okanye emdaka, kunye namaxolo.

• I-Scaly, ukuphuma kwegazi, okanye i-crusty.

• Iyafana nesiva kunye nokuqina.

Uvavanyo lokufumanisa isifo somhlaza weseli kunye ne-basal cell cancer zibandakanya oku kulandelayo:

• Uvavanyo lolusu : Ugqirha okanye umongikazi ukhangela ulusu ukuba lunamaqhuma okanye amabala abonakala engaqhelekanga ngombala, ubungakanani, imilo, okanye ubume.

• I-Biopsy: Yonke into okanye inxalenye yokukhula engabonakali kakuhle iyanqunyulwa kwesikhumba kwaye ibonwa phantsi kwe-microscope yi-pathologist ukujonga iimpawu zomhlaza. Zintathu iintlobo eziphambili zezinto eziphilayo zolusu:

• Shave i-biopsy: I-razor blade esetyenzisiweyo isetyenziselwa "ukucheba" ukukhula okungajongi njengesiqhelo.

• I-Punch biopsy: Isixhobo esikhethekileyo esibizwa ngokuba yi-punch okanye i-trephine sisetyenziselwa ukususa isangqa sethishu ekukhuleni engakhange ibonakale iqhelekile.

• I-biopsy ye-Incisional: I-scalpel isetyenziselwa ukususa inxenye yokukhula okungaqhelekanga.

• I-biopsy ekhethekileyo: I-scalpel isetyenziselwa ukususa ukukhula konke.

Unyango lweSquamous Cell kunye neBasal Cell Umhlaza wolusu

Ngolwazi malunga nonyango oludweliswe ngezantsi, jonga kwiCandelo loKhetho ngokujonga uKhetho.

Unyango lweesquamous cell kunye ne-basal cell cancer ebantwaneni inokubandakanya oku kulandelayo:

• Utyando lokususa ithumba. Oku kunokubandakanya utyando lwe-Mohs micographic.

U-Mohs utyando lwe-micrographic luhlobo lotyando olusetyenziselwa umhlaza wolusu. Ithumba lisikiwe kulusu kumanqanaba amancinci. Ngexesha lotyando, imiphetho yethumba kunye noluhlu ngalunye lwethumba elisusiweyo lijongwa ngemicroscope ukujonga iiseli zomhlaza. Iingqimba ziyaqhubeka zisuswe kude kungabikho iiseli zomhlaza. Olu hlobo lotyando lususa izicwili ezincinci njengesiqhelo kwaye luhlala lusetyenziselwa ukususa umhlaza wolusu ebusweni.

Unyango lweseli ephindaphindayo yeseli kunye nomhlaza wesiseko kubantwana unokubandakanya oku kulandelayo:

• Uvavanyo lweklinikhi olujonga isampulu yethumba lesigulana kutshintsho oluthile kwimfuza. Uhlobo lonyango ekujoliswe kulo oluya kunikwa isigulana luxhomekeke kuhlobo lotshintsho lwemfuza.

Jonga isishwankathelo se- kunyango lomhlaza wolusu lwabantu abadala ngolwazi oluthe kratya.

I-Intraocular (Uveal) iMelanoma

I-melanoma ye-intraocular iqala embindini weehlo ezintathu zodonga lweliso. Uluhlu lwangaphandle lubandakanya i-sclera emhlophe ("emhlophe yamehlo") kunye ne-cornea ecacileyo ngaphambili kwiliso. Uluhlu lwangaphakathi lunoludwe lweethambo zemithambo-luvo, olubizwa ngokuba yretina, oluva ukukhanya luze luthumele imifanekiso ecaleni kwethambo le-optic kwingqondo. Uluhlu oluphakathi, apho iifom ze-intraocular melanoma, zibizwa ngokuba yi-uvea okanye i-uveal tract, kwaye inezinto ezintathu eziphambili: i-iris, umzimba we-ciliary, kunye ne-choroid.

I-anatomy yamehlo, ebonisa ngaphandle nangaphakathi kweliso kubandakanya i-sclera, i-cornea, iris, umzimba we-ciliary, i-choroid, i-retina, i-vitreous humor, kunye ne-optic nerve. I-vitreous humor lulwelo oluzalisa umbindi wamehlo.

Izinto zomngcipheko

Umngcipheko we-intraocular melanoma wonyuswa yiyo nayiphi na kwezi zinto zilandelayo:

• Umbala wamehlo okhanyayo.

• Umbala wesikhumba olungileyo.

• Ayikwazi ukwenza itan.

• I-Oculodermal melanocytosis.

• Nevi esisikiweyo.

Uvavanyo lokufumanisa isifo kunye ne-intraocular melanoma inokubandakanya oku kulandelayo:

• Uvavanyo lomzimba kunye nembali yezempilo.

• I-Ultrasound.

Olunye uvavanyo kunye neenkqubo ezisetyenziselwa ukuxilonga i-intraocular melanoma zibandakanya oku kulandelayo:

• I-Fluorescein angiography: Uvavanyo olusetyenziselwa ukuthatha imifanekiso ye-retina esweni. Idayi emthubi itofelwe emthanjeni kwaye ihamba emzimbeni wonke kubandakanya imithambo yegazi esweni. Idayi etyheli ibangela ukuba iinqanawa esweni zibengezele xa kuthathwa umfanekiso.

Unyango

Ngolwazi malunga nonyango oludweliswe ngezantsi, jonga kwiCandelo loKhetho ngokujonga uKhetho.

Unyango lwe-intraocular melanoma ebantwaneni lufana nonyango lwabantu abadala kwaye lunokubandakanya oku kulandelayo:

• Utyando lokususa ithumba.

• Unyango ngemitha.

• Utyando lweLaser

. Unyango lwe-melanoma yangaphakathi ye-intraocular ebantwaneni inokubandakanya oku kulandelayo:

• Uvavanyo lweklinikhi olujonga isampulu yethumba lesigulana kutshintsho oluthile kwimfuza. Uhlobo lonyango ekujoliswe kulo oluya kunikwa isigulana luxhomekeke kuhlobo lotshintsho lwemfuza.

Jonga isishwankathelo se- kunyango lwabantu abadala lwe-Intraocular (Uveal) lweMelanoma ngolwazi oluthe kratya.

Chordoma

I-Chordoma luhlobo olunqabileyo kakhulu lwethambo elikhula kancinci elenza naphina emqolo ukusuka kwisiseko solukakayi (ithambo elibizwa ngokuba yi-clivus) ukuya kwi-tailbone. Kubantwana nakwishumi elivisayo, ii-chordomas zenza rhoqo emathanjeni kwisiseko solukakayi okanye kufutshane nomsila wethambo, zisenza ukuba kube nzima ukuzisusa ngokupheleleyo ngotyando.

I-chordoma yobuntwana inxulunyaniswa nemeko ye-tuberous sclerosis, isifo semfuza apho amathumba anobungozi (hayi umhlaza) kwizintso, kwingqondo, ngamehlo, entliziyweni, emiphungeni nakwisikhumba.

Iimpawu kunye neMpawu

Iimpawu kunye neempawu ze-chordoma zixhomekeke apho i-tumor yenzeka khona. IChordoma inokubangela nayiphi na imiqondiso kunye neempawu zilandelayo. Jonga kugqirha womntwana wakho ukuba umntwana wakho unayo nayiphi na kwezi zinto zilandelayo:

• Intloko ebuhlungu.

• Umbono kabini.

• Impumlo evaliweyo okanye exineneyo.

• Ingxaki yokuthetha.

• Ingxaki yokuginya.

• Intamo okanye iintlungu zomqolo.

• Ubuhlungu phantsi komva wemilenze.

• Ubudenge, ukubetha, okanye ubuthathaka beengalo kunye nemilenze.

• Utshintsho kwimikhwa yamathumbu okanye esinyi.

Ezinye iimeko ezingenayo i-chordoma zingabangela iimpawu kunye neempawu ezifanayo.

Iimvavanyo zokufumanisa i-chordoma okanye ukubona ukuba isasazekile zibandakanya oku kulandelayo:

• I-MRI yomqolo wonke.
• Ukuxilongwa kwe-CT kwesifuba, isisu kunye nesinqe.
• Uqhaqho. Isampulu yethishu iyasuswa kwaye ihlolwe inqanaba eliphezulu leprotein ebizwa ngokuba yi-brachyury.

I-Chordomas inokuphinda ibuye (ibuye), ihlala kwindawo enye, kodwa ngamanye amaxesha iphinda ibuye kwezinye iindawo zethambo okanye kwimiphunga.

Ukuxela kwangaphambili

Ukuxela kwangaphambili (ithuba lokuchacha) kuxhomekeke koku kulandelayo:

• Iminyaka yomntwana.

• Apho ithumba lenza kunye nomqolo.

• Indlela ithumba eliphendula ngayo kunyango.

• Nokuba lukhona utshintsho kwiindlela zesisu okanye kwisinyi xa kufunyaniswa isifo.

• Nokuba ithumba lisandula ukufumanisa ukuba likhe lafunyaniswa okanye laphinda labuya (buyela).

Unyango

Ngolwazi malunga nonyango oludweliswe ngezantsi, jonga kwiCandelo loKhetho ngokujonga uKhetho.

Unyango lwe-chordoma ebantwaneni lunokubandakanya oku kulandelayo:

• Utyando lokususa ithumba kangangoko kunokwenzeka, kulandele unyango lwemitha. Unyango lwe-Proton beam radiation lungasetyenziselwa izicubu ezikufutshane nekhakhayi.

Unyango lwe-chordoma ephindaphindayo ebantwaneni inokubandakanya oku kulandelayo:

• Uvavanyo lweklinikhi olujonga isampulu yethumba lesigulana kutshintsho oluthile kwimfuza. Uhlobo lonyango ekujoliswe kulo oluya kunikwa isigulana luxhomekeke kuhlobo lotshintsho lwemfuza. Izigulana ezinotshintsho kwi-gene ye-SMARCB1 zinokunyangwa nge-tazemetostat kolu vavanyo lweklinikhi.

Umhlaza weSiza saBaqalayo esingaziwayo

Umhlaza wesiseko esingaziwayo sisifo apho iiseli ezibi (zomhlaza) zifunyanwa emzimbeni kodwa indawo owaqala kuyo umhlaza ayaziwa. Umhlaza unokwenza nakweyiphi na inyama yomzimba. Umhlaza oyintloko (umhlaza owaqala ukubakho) unokusasazeka kwamanye amalungu omzimba. Le nkqubo ibizwa ngokuba yi-metastasis. Iiseli zomhlaza zihlala zikhangeleka njengeeseli zohlobo lwethishu aqala kuyo umhlaza. Umzekelo, iiseli zomhlaza wamabele zinokusasazeka ziye emiphungeni. Ngenxa yokuba umhlaza waqala ebeleni, iiseli zomhlaza emphungeni zibukeka njengeeseli zomhlaza wamabele.

Ngamanye amaxesha oogqirha bafumanisa apho umhlaza usasazeke khona kodwa bangafumani apho umhlaza waqala khona ukukhula emzimbeni. Olu hlobo lomhlaza lubizwa ngokuba ngumhlaza ongaziwayo okanye ithumba eliphambili.

Kwi-carcinoma yeziprayimari ezingaziwayo, iiseli zomhlaza zisasazekile emzimbeni kodwa indawo aqala kuyo umhlaza wokuqala ayaziwa.

Uvavanyo lwenziwa ukufumana apho umhlaza wokuqala waqala khona kunye nokufumana ulwazi malunga nokuba umhlaza usasazeke phi. Xa iimvavanyo zikwazi ukufumana umhlaza oyintloko, umhlaza awuseyena umhlaza wezinto ezingaziwayo kwaye unyango lusekwe kuhlobo lomhlaza wokuqala.

Kuba indawo owawuqale kuyo umhlaza awaziwa, uninzi lweemvavanyo ezahlukeneyo kunye neenkqubo, kubandakanya ukubonakaliswa kofuzo kunye nokuvavanywa kofuzo, kunokufuneka ukuze kufunyanwe ukuba uluhlobo luni lomhlaza. Ukuba iimvavanyo zibonisa ukuba kunokubakho umhlaza, kwenziwa i-biopsy. I-biopsy kukususwa kweeseli okanye izicwili ukuze zijongwe phantsi kwemicroscope ngugqirha wezifo. Ugqirha wezifo ujonga izicwili ukujonga iiseli zomhlaza kunye nokufumanisa uhlobo lomhlaza. Uhlobo lwe-biopsy olwenziwe luxhomekeke kwinxalenye yomzimba kuvavanywa umhlaza. Enye yezi ndlela zilandelayo zinokusetyenziswa:

• Fine-inaliti aspiration (FNA) biopsy: Ukususa izicwili okanye ulwelo usebenzisa inaliti encinci.

• I-biopsy engundoqo: Ukususwa kwezicubu kusetyenziswa inaliti ebanzi.

• I-incisional biopsy: Ukususwa kwenxalenye yesigaxa okanye isampulu yethishu.

• I-biopsy ekhethekileyo: Ukususwa kwesigaxa sezicubu.

Xa uhlobo lweeseli zomhlaza okanye izicwili ezisusiweyo zahlukile kuhlobo lweeseli zomhlaza ekulindeleke ukuba zifunyanwe, ukufumanisa isifo somhlaza seprayimari engaziwayo kunokwenziwa. Iiseli emzimbeni zinembonakalo ethile exhomekeke kuhlobo lwethishu ezivela kuyo. Umzekelo, isampulu yomhlaza womzimba othathwe ebeleni kulindeleke ukuba wenziwe ziiseli zebele. Nangona kunjalo, ukuba isampulu yethishu luhlobo olwahlukileyo lweseli (olungenziwanga ngeeseli zebele), kunokwenzeka ukuba iiseli zisasazeke ebeleni zisuka kwelinye ilungu lomzimba.

Xa kungaziwa apho umhlaza waqala khona ekuchongeni, i-adenocarcinomas, i-melanomas, kunye ne-embryonal tumors (ezinje nge-rhabdomyosarcoma okanye i-neuroblastoma) ziintlobo zethumba ezihlala zichongwa kamva kubantwana nakwishumi elivisayo.

Unyango

Ngolwazi malunga nonyango oludweliswe ngezantsi, jonga kwiCandelo loKhetho ngokujonga uKhetho.

Unyango luxhomekeke ekubeni iiseli zomhlaza zijongeka njani phantsi kwemicroscope, ubudala besigulana, iimpawu kunye neempawu zalo, kwaye nalapho umhlaza usasazeke emzimbeni. Unyango luhlala lulandelayo:

• Unyango ngamayeza.

• Unyango ekujoliswe kulo.

• Unyango ngemitha.

Unyango lomhlaza ophindaphindiweyo wesiseko esaziwa kubantwana kunokubandakanya oku kulandelayo:

• Uvavanyo lweklinikhi olujonga isampulu yethumba lesigulana kutshintsho oluthile kwimfuza. Uhlobo lonyango ekujoliswe kulo oluya kunikwa isigulana luxhomekeke kuhlobo lotshintsho lwemfuza.

Jonga isishwankathelo se kwiCarcinoma yabantu abadala ye-Unknown Primary ngolwazi oluthe kratya.

Ukufunda ngakumbi malunga noMhlaza woMntwana

Ngolwazi oluthe kratya kwiZiko leSizwe loMhlaza malunga nomhlaza ongaqhelekanga wobuntwana, bona oku kulandelayo:

• Uvavanyo lweMfuzo kwii-Syndromes eziSebenzayo zoMhlaza

• Ikhompyuter yeTomography (CT) kunye noMhlaza

• I-MyPART-Unxibelelwano lwam lwaBantwana kunye naBantu abaDala abaNinzi

Ngolwazi oluthe kratya lomhlaza wabantwana kunye nezinye izixhobo zomhlaza ngokubanzi, jonga oku kulandelayo:

• Malunga noMhlaza

• Umhlaza wabantwana

• Unyango lokuKhangela uMhlaza waBantwanaPhuma kwiNgcazelo yokuzihlangula

• Iziphumo zokugqibela zonyango lweCancer yoMntwana

• Abafikisayo kunye naBantu abaDala abaDala abanomhlaza

• Abantwana abanomhlaza: Isikhokelo sabazali

• Umhlaza kuBantwana nakwishumi elivisayo

• Ukuqokelela

• Ukujamelana noMhlaza

• Imibuzo yokubuza ugqirha wakho malunga neCancer

• Abasindileyo kunye nabaNonopheli

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