Iindidi / iliso / isigulana / unyango lwe-intraocular-melanoma-treatment-pdq

Intraocular (Uveal) Unyango lweMelanoma

Ulwazi ngokubanzi malunga ne-Intraocular (Uveal) Melanoma

IINGONGOMA EZIPHAMBILI

• I-intraocular melanoma sisifo apho iiseli ezibi (zomhlaza) zenza izicwili zamehlo.

• Ukuba mdala nokuba nolusu olufanelekileyo kunokunyusa umngcipheko we-intraocular melanoma.

• Iimpawu ze-intraocular melanoma zibandakanya ukungaboni kakuhle okanye indawo emnyama kwi-iris.

• Uvavanyo oluvavanya iliso lusetyenziselwa ukufumanisa (ukufumana) kunye nokufumanisa isifo se-melanoma ye-intraocular.

• I-biopsy ye-tumor ayidingeki ukuba ichonge i-intraocular melanoma.

• Izinto ezithile zichaphazela ukuxela kwangaphambili (ithuba lokufumana kwakhona) kunye nokhetho lonyango.

I-intraocular melanoma sisifo apho iiseli ezibi (zomhlaza) zenza izicwili zamehlo.

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 inamalungu amathathu aphambili:

Iris

Iris yindawo enemibala ngaphambili kweliso ("umbala wamehlo"). Ingabonakala kwi-cornea ecacileyo. Umfundi usembindini we-iris kwaye utshintsha ubungakanani ukuvumela ukukhanya okungaphezulu okanye okuncinci kwiso. I-intraocular melanoma ye-iris ihlala isisu esincinci esikhula kancinci kwaye kunqabile sinwenwele kwamanye amalungu omzimba.

Umzimba weCiliary

Umzimba we-ciliary yiringi yethishu enemicu yemisipha etshintsha ubungakanani bomfundi kunye nokumila kwelensi. Itholakala emva kwe-iris. Utshintsho kwimilo ye-lens lunceda ukujonga kwamehlo. Umzimba we-ciliary wenza ulwelo olucacileyo oluzalisa indawo phakathi kwe-cornea kunye ne-iris. I-intraocular melanoma yomzimba we-ciliary ihlala inkulu kwaye kunokwenzeka ukuba isasazeke kwamanye amalungu omzimba kune-intraocular melanoma ye-iris.

Choroid

I-choroid ngumaleko wemithambo yegazi ezisa ioksijini kunye nezondlo kwiliso. Uninzi lwe-intraocular melanomas luqala kwi-choroid. I-intraocular melanoma ye-choroid ihlala inkulu kwaye kunokwenzeka ukuba isasazeke kwamanye amalungu omzimba kune-intraocular melanoma ye-iris.

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.

I-Intraocular melanoma ngumhlaza onqabileyo ovela kwiiseli ezenza i-melanin kwi-iris, umzimba we-ciliary, kunye ne-choroid. Ngumhlaza wamehlo oqhelekileyo kubantu abadala.

Ukuba mdala nokuba nolusu olufanelekileyo kunokunyusa umngcipheko we-intraocular melanoma.

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

Izinto ezinobungozi be-intraocular melanoma zibandakanya oku kulandelayo:

• 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.

• Ukwaluphala.

• Ukuba mhlophe.

Iimpawu ze-intraocular melanoma zibandakanya ukungaboni kakuhle okanye indawo emnyama kwi-iris.

I-intraocular melanoma ayinakubangela iimpawu okanye iimpawu zokuqala. Ngamanye amaxesha kufunyanwa kuvavanyo lwamehlo oluqhelekileyo xa ugqirha evula umfundi kwaye ejonge emehlweni. Iimpawu kunye neempawu zinokubangelwa yi-intraocular melanoma okanye ngezinye iimeko. Jonga ugqirha wakho ukuba unayo nayiphi na kwezi zinto zilandelayo:

• Umbono ongacacanga okanye olunye utshintsho kumbono.

• Iifreyithi (amabala ahamba kwindawo yakho yombono) okanye ukukhanya kokukhanya.

• Indawo emnyama kwi-iris.

• Utshintsho kubukhulu okanye imilo yomfundi.

• Utshintsho kwindawo ye-eyeball kwisokethi yamehlo.

Uvavanyo oluvavanya iliso lusetyenziselwa ukufumanisa (ukufumana) kunye nokufumanisa isifo se-melanoma ye-intraocular.

Ezi mvavanyo zilandelayo kunye neenkqubo zinokusetyenziswa:

• Uvavanyo lomzimba kunye nembali: 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.

• Uvavanyo lwamehlo kunye nomfundi ohlaziyiweyo: Uvavanyo lweliso apho umfundi enyinyisiwe (andisiwe) ngamagqabi wamehlo amayeza ukuvumela ugqirha ukuba ajonge ilensi kunye nomfundi kwi-retina. Ingaphakathi leliso, kubandakanya i-retina kunye ne-optic nerve, ihlolwe. Imifanekiso inokuthi ithathe ixesha ukugcina umkhondo wotshintsho kubungakanani beethumba. Kukho iintlobo ezininzi zeemviwo zamehlo:

• I-Ophthalmoscopy: Uvavanyo lwangaphakathi lweliso ukujonga i-retina kunye ne-optic nerve usebenzisa i-lens encinci yokukhulisa kunye nokukhanya.

• Isilayiti se-biomicroscopy: Uvavanyo lwangaphakathi lweliso ukujonga i-retina, i-optic nerve, kunye nezinye iinxalenye zeliso usebenzisa ukukhanya okuqinileyo kunye nemicroscope.

• I-Gonioscopy: Uvavanyo lwenxalenye engaphambili yamehlo phakathi kwe-cornea kunye ne-iris. Isixhobo esikhethekileyo sisetyenziselwa ukubona ukuba indawo apho amanzi aphuma khona esweni avaliwe.

• Uvavanyo lwe-Ultrasound lweliso: Inkqubo apho amaza esandi aphakamileyo amandla (i-ultrasound) ehlaselwa kwizicwili zangaphakathi zeliso ukwenza i-echoes. Amaconsi wamehlo asetyenziselwa ukubamba ilihlo kwaye iprosesa encinci ethumela kunye nokufumana amaza esandi ibekwa kakuhle kumphezulu wamehlo. I-echoes yenza umfanekiso wangaphakathi wamehlo kwaye umgama ukusuka kwi-cornea ukuya kwi-retina ulinganiswa. Umfanekiso obizwa ngokuba yi-sonogram, uboniswa kwiscreen se-ultrasound monitor.

• Isisombululo esiphakamileyo se-ultrasound biomicroscopy: Inkqubo apho amaza esandi aphakamileyo amandla (i-ultrasound) ehlaselwa kwizicubu zangaphakathi zamehlo ukwenza i-echoes. Amaconsi wamehlo asetyenziselwa ukubamba ilihlo kwaye iprosesa encinci ethumela kunye nokufumana amaza esandi ibekwa kakuhle kumphezulu wamehlo. I-echoes yenza umfanekiso ocacileyo wangaphakathi kweliso kune-ultrasound eqhelekileyo. I-tumor ihlolwe ubungakanani bayo, imilo, kunye nobukhulu bayo, kunye neempawu zokuba eli thumba linwenwele nakwizicubu ezikufutshane.

• Ukuguqulwa komhlaba kunye ne-iris: Uvavanyo lwe-iris, i-cornea, i-lens, kunye nomzimba we-ciliaryal ngokukhanya okubekwe kwisiciko esingasentla okanye esisezantsi.

• I-Fluorescein angiography: Inkqubo yokujonga imithambo yegazi kunye nokuhamba kwegazi ngaphakathi kwiso. Idayi ye-orange fluorescent (i-fluorescein) ifakwe kwisitya segazi engalweni kwaye ingena kwigazi. Njengoko idayi ihamba kwimithambo yegazi yamehlo, ikhamera ekhethekileyo ithatha imifanekiso ye-retina kunye ne-choroid ukufumana nayiphi na indawo evaliweyo okanye evuzayo.

• I-Indocyanine angiography eluhlaza: Inkqubo yokujonga kwimithambo yegazi kumaleko we-choroid wamehlo. Idayi eluhlaza (indocyanine green) itofwa kwimithambo yegazi engalweni ize ingene egazini. Njengoko idayi ihamba kwimithambo yegazi yamehlo, ikhamera ekhethekileyo ithatha imifanekiso ye-retina kunye ne-choroid ukufumana nayiphi na indawo evaliweyo okanye evuzayo.

• Ukuhambelana kwe-Ocular tomography: Uvavanyo lokucinga olusebenzisa amaza okukhanya ukuthatha imifanekiso enqamlezileyo ye-retina, kwaye ngamanye amaxesha i-choroid, ukubona ukuba kukho ukudumba okanye ulwelo phantsi kweretina.

I-biopsy ye-tumor ayidingeki ukuba ichonge i-intraocular melanoma.

I-biopsy kukususwa kweeseli okanye izicwili ukuze zijongwe phantsi kwemicroscope ukujonga imiqondiso yomhlaza. Ngokuqhelekileyo, i-biopsy ye-tumor iyadingeka ukuxilonga i-intraocular melanoma. Izicubu ezisuswe ngexesha le-biopsy okanye utyando lokususa ithumba zinokuvavanywa ukuze zifumane ulwazi oluthe kratya malunga nokuxela kwaye zeziphi iindlela zonyango ezingcono.

Olu vavanyo lulandelayo lunokwenziwa kwisampulu yethishu:

• Uhlalutyo lweCytogenetic: Uvavanyo lwaselebhu apho ii-chromosomes zeeseli kwisampulu yethishu zibalwa kwaye zijongwa kulo naluphi na utshintsho, njengokwaphuka, ukulahleka, ukulungiswa ngokutsha, okanye ii-chromosomes ezongezelelweyo. Utshintsho kwii-chromosomes ezithile kunokuba luphawu lomhlaza. Uhlalutyo lweCytogenetic lusetyenziselwa ukunceda ekuchongeni umhlaza, ukucwangcisa unyango, okanye ukufumanisa ukuba lusebenza njani unyango.

• Ukuchazwa kwe-Gene expression: Uvavanyo lwaselabhoratri oluchaza zonke izakhi zofuzo kwiseli okanye izicwili ezenza (zibonisa) umthunywa weRNA. Iimolekyuli ze-RNA zeMessenger zineenkcukacha zemfuza ezifunekayo ukwenza iiproteni ezivela kwi-DNA ekwiseli yeseli ukuya koomatshini abenza iiprotein kwisisele secytoplasm.

I-biopsy inokubangela ukuba i-retinal detachment (i-retina ihluke kwezinye izicubu esweni). Oku kunokulungiswa ngotyando.

Izinto ezithile zichaphazela ukuxela kwangaphambili (ithuba lokufumana kwakhona) kunye nokhetho lonyango.

Ukuxela kwangaphambili (ithuba lokufumana kwakhona) kunye nokhetho lonyango luxhomekeke koku kulandelayo:

• Zijonga njani iiseli ze-melanoma phantsi kwemicroscope.

• Ubungakanani kunye nobukhulu beethumba.

• Inxalenye yamehlo ithumba likuyo (i-iris, umzimba we-ciliary, okanye i-choroid).

• Nokuba ithumba lisasazekile ngaphakathi kweliso okanye kwezinye iindawo emzimbeni.

• Nokuba kukho utshintsho oluthile kwimfuza enxulunyaniswe ne-intraocular melanoma.

• Iminyaka yesigulana kunye nempilo ngokubanzi.

• Nokuba ithumba liphindile (libuya) emva konyango.

Amanqanaba e-Intraocular (Uveal) iMelanoma

IINGONGOMA EZIPHAMBILI

• Emva kokuba kufunyaniswe isifo se-melanoma ye-intraocular, kuvavanyo kuyenziwa ukufumanisa ukuba iiseli zomhlaza zisasazekile na kwamanye amalungu omzimba.

• Ezi zinto zilandelayo zisetyenziselwa ukuchaza i-intraocular melanoma kunye nocwangciso lonyango:

• Incinci

• Phakathi

• Enkulu

• Zintathu iindlela umhlaza onwenwa ngayo emzimbeni.

• Umhlaza unokusasazeka ukusuka apho waqala khona kwamanye amalungu omzimba.

• La manqanaba alandelayo asetyenziselwa i-intraocular melanoma yomzimba we-ciliary kunye ne-choroid:

• Inqanaba I

• Inqanaba II

• Inqanaba III

• Inqanaba IV

• Akukho nkqubo yenkqubo ye-intraocular melanoma ye-iris.

Emva kokuba kufunyaniswe isifo se-melanoma ye-intraocular, kuvavanyo kuyenziwa ukufumanisa ukuba iiseli zomhlaza zisasazekile na kwamanye amalungu omzimba.

Inkqubo esetyenziselwa ukufumanisa ukuba ngaba umhlaza sele usasazekile na kwamanye amalungu omzimba kuthiwa yi-staging. Ulwazi oluqokelelwe kwinkqubo yokubeka inqanaba lesifo. Kubalulekile ukwazi inqanaba ukuze ucwangcise unyango.

Ezi mvavanyo zilandelayo kunye neenkqubo zinokusetyenziswa kwinkqubo yokubeka esiteji:

• 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.

• Uvavanyo lomsebenzi wesibindi: Inkqubo apho kuvavanywa isampulu yegazi ukulinganisa izixa zezinto ezithile ezikhutshelwe egazini sisibindi. Ixabiso elingaphezulu kwesiqhelo kwento inokuba luphawu lokuba umhlaza usasazekile esibindini.

• Uvavanyo lwe-Ultrasound: Inkqubo apho amaza esandi aphembelela amandla aphezulu (i-ultrasound) akhutshelwa ngaphandle kwizicubu zangaphakathi okanye kwizitho, ezinjengesibindi, kwaye zenza i-echoes. Iingqungquthela zenza umfanekiso wezicubu zomzimba ezibizwa ngokuba yi-sonogram.

• I-x-ray yesifuba: IX-reyi yamalungu namathambo ngaphakathi kwesifuba. IX-reyi luhlobo lwe-beam yamandla enokuhamba emzimbeni nakwifilimu, yenza umfanekiso weendawo ezingaphakathi komzimba.

• I-MRI (imaging resonance imaging): Inkqubo esebenzisa umazibuthe, amaza erediyo kunye nekhompyuter ukwenza uthotho lwemifanekiso eneenkcukacha zeendawo ezingaphakathi emzimbeni, ezifana nesibindi. Le nkqubo ikwabizwa ngokuba yimifanekiso yenyukliya yokujonga umfanekiso (i-NMRI).

• I-CT scan (i-CAT scan): Inkqubo eyenza uthotho lwemifanekiso eneenkcukacha zeendawo ezingaphakathi emzimbeni, ezinje ngesifuba, isisu, okanye isinqe, esithathwe kwiimbombo ezahlukeneyo. Imifanekiso yenziwe yikhompyuter edityaniswe kumatshini we-x-ray. Idayi inokufakwa ngaphakathi emthanjeni okanye iginywe ukunceda amalungu okanye izicwili zibonise ngokucacileyo. Le nkqubo ikwabizwa ngokuba yicompography tomography, ikhompyuter yeTomography, okanye ikhompyuter ye-axial tomography

• Ukuskena i-PET (positron emission tomography scan) Inkqubo yokufumana iiseli zethumba ezinobungozi emzimbeni. Inani elincinci kakhulu leswekile ye-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. Ngamanye amaxesha i-PET scan kunye ne-CT scan zenziwa ngaxeshanye. Ukuba kukho nawuphi na umhlaza, oku kwandisa amathuba okuba kufumaneke.

Ezi zinto zilandelayo zisetyenziselwa ukuchaza i-intraocular melanoma kunye nocwangciso lonyango:

Incinci

Ithumba liyi-5 ukuya kwi-16 yeemilimitha ububanzi kwaye ukusuka kwi-1 ukuya kwi-3 yeemilimitha ubukhulu.

Iimilimitha (mm). Indawo ebukhali yepensile imalunga ne-1 mm, indawo entsha yekhrayoni imalunga ne-2 mm, kwaye irabha entsha yeepensile imalunga ne-5 mm.

Phakathi

Ithumba liziimilimitha ezili-16 okanye lincinci ngobubanzi kwaye ukusuka kwi-3.1 ukuya kwi-8 yeemilimitha ubukhulu.

Enkulu

Ithumba yile:

• ngaphezu kwe-8 millimeters ubukhulu kunye nayiphi na ububanzi; okanye

• Ubuncinci i-2 millimeters ubukhulu kwaye ngaphezulu kwe-16 millimeters ububanzi.

Nangona uninzi lwe-intraocular melanoma tumors luphakanyisiwe, ezinye zithe tyaba. Ezi tumors zisasazekayo zikhula ngokubanzi kwi-uvea.

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.

Ukuba i-intraocular melanoma isasazeka kwi-optic nererve okanye izicubu ezikufutshane zesokethi yamehlo, ibizwa ngokuba kukwandiswa okungaphezulu.

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 i-intraocular melanoma isasazeka esibindini, iiseli zomhlaza esibindini ziiseli ze-intraocular melanoma. Esi sifo siyi-metastatic intraocular melanoma, hayi umhlaza wesibindi.

La manqanaba alandelayo asetyenziselwa i-intraocular melanoma yomzimba we-ciliary kunye ne-choroid:

I-melanoma ye-intraocular yomzimba we-ciliary kunye ne-choroid ineendidi ezine zesayizi. Udidi luxhomekeke kubungakanani kwaye bunzima kwi-tumor. Icandelo 1 lamathumba lelona lincinci kwaye udidi lwe-4 amathumba lelona likhulu.

Udidi 1:

• Ithumba alikho ngaphezulu kweemilimitha ezili-12 ububanzi kwaye lingabi ngaphezu kweemilimitha ezi-3 ubukhulu; okanye

• Ithumba alikho ngaphezulu kweemilimitha ezili-9 ububanzi kunye ne-3.1 ukuya kwi-6 yeemilimitha ubukhulu.

Udidi 2:

• Ithumba liyi-12.1 ukuya kwi-18 yeemilimitha ububanzi kwaye hayi ngaphezulu kweemilimitha ezi-3 ubukhulu; okanye

• I-tumor i-9.1 ukuya kwi-15 millimeters ububanzi kunye no-3.1 ukuya ku-6 millimeters ubukhulu; okanye

• Ithumba alikho ngaphezulu kweemilimitha ezili-12 ububanzi kunye neemitha eziyi-6.1 ukuya kwezi-9 ubukhulu.

Udidi 3:

• Ithumba liyi-15.1 ukuya kwi-18 yeemilimitha ububanzi kunye no-3.1 ukuya ku-6 weemilimitha ubukhulu; okanye

• ithumba liyi-12.1 ukuya kwi-18 yeemilimitha ububanzi kunye ne-6.1 ukuya kwi-9 yeemilimitha ubukhulu; okanye

• ithumba alikho ngaphezulu kweemilimitha ezili-18 ububanzi kunye ne-9.1 ukuya kwi-12 yeemilimitha ubukhulu; okanye

• ithumba alikho ngaphezulu kweemilimitha ezili-15 ububanzi kunye ne-12.1 ukuya kwi-15 leemilimitha ubukhulu.

Udidi 4:

• Ithumba lingaphezulu kweemilimitha ezili-18 ububanzi kwaye linokuba siso nasiphi na ubukhulu; okanye

• I-tumor i-15.1 ukuya kwi-18 millimeters ububanzi kwaye ngaphezu kwe-12 millimeters ubukhulu; okanye

• Ithumba alikho ngaphezulu kweemilimitha ezili-15 ububanzi kwaye lingaphezulu kweemilimitha ezili-15 ubukhulu.

Inqanaba I

Kwinqanaba loku-1, ithumba linobukhulu kudidi 1 kwaye likwi-choroid kuphela.

Inqanaba II

Inqanaba II lahlulwe ngokwamanqanaba IIA kunye ne-IIB.

• Kwinqanaba IIA, ithumba:

• udidi lobungakanani 1 kwaye lusasazekile emzimbeni we-ciliary; okanye

• ubukhulu becandelo 1 kwaye isasazekile nge-sclera ukuya ngaphandle kwibhola yamehlo. Inxalenye yethumba engaphandle kwebhola yamehlo ayikho ngaphezulu kweemilimitha ezi-5 ubukhulu. Ithumba lisenokudlulela kumzimba we-ciliary; okanye

• kudidi lwesibini kwaye lukwichoroid kuphela.

• Kwinqanaba le-IIB, ithumba:

• udidi lobungakanani 2 kwaye lusasazekile emzimbeni we-ciliary; okanye

• kudidi lwesithathu kwaye lukwichoroid kuphela.

Inqanaba III

Inqanaba III lahlulwe ngokwamanqanaba IIIA, IIIB, kunye IIIC.

• Kwinqanaba IIIA, ithumba:

• ubukhulu becandelo 2 kwaye sele isasazekile ngesklera ukuya ngaphandle kwibhola yamehlo. Inxalenye yethumba engaphandle kwebhola yamehlo ayikho ngaphezulu kweemilimitha ezi-5 ubukhulu. Ithumba lisenokusasazeka emzimbeni we-ciliary; okanye

• udidi lobungakanani 3 kwaye lusasazekile emzimbeni we-ciliary; okanye

• Inqanaba lesithathu kwaye lisasazekile ngesclera ukuya ngaphandle kwibhola yamehlo. Inxalenye yethumba engaphandle kwebhola yamehlo ayikho ngaphezulu kweemilimitha ezi-5 ubukhulu. Ithumba alinwenwanga emzimbeni we-ciliary; okanye

• kudidi lobungakanani 4 kwaye likwichoroid kuphela.

• Kwinqanaba IIIB, ithumba:

• Inqanaba lesithathu kwaye lisasazekile ngesclera ukuya ngaphandle kwibhola yamehlo. Inxalenye yethumba engaphandle kwebhola yamehlo ayikho ngaphezulu kweemilimitha ezi-5 ubukhulu. Ithumba linwenwele emzimbeni we-ciliary; okanye

• udidi lobungakanani 4 kwaye lusasazekile emzimbeni we-ciliary; okanye

• inqanaba lodidi lwe-4 kwaye isasazekile nge-sclera ukuya ngaphandle kwibhola yamehlo. Inxalenye yethumba engaphandle kwebhola yamehlo ayikho ngaphezulu kweemilimitha ezi-5 ubukhulu. Ithumba alinwenwanga emzimbeni we-ciliary.

• Kwinqanaba IIIC, ithumba:

• inqanaba lodidi lwe-4 kwaye isasazekile nge-sclera ukuya ngaphandle kwibhola yamehlo. Inxalenye yethumba engaphandle kwebhola yamehlo ayikho ngaphezulu kweemilimitha ezi-5 ubukhulu. Ithumba linwenwele emzimbeni we-ciliary; okanye

• inokuba nabuphi na ubungakanani kwaye isasazekile ngesklera ukuya ngaphandle kwibhola yamehlo. Inxalenye yethumba engaphandle kwamehlo akho ingaphezulu kweemilimitha ezi-5 ubukhulu.

Inqanaba IV

Kwinqanaba le-IV, ithumba inokuba nabuphi na ubungakanani kwaye isasazekile:

• ukuya kwenye okanye kwezinye iindawo ezikufutshane okanye kwiindawo ezikwiliso ezahlukileyo kwisisu sokuqala; okanye

• kwamanye amalungu omzimba, njengesibindi, imiphunga, ithambo, ingqondo, okanye izicwili phantsi kolusu.

Akukho nkqubo yenkqubo ye-intraocular melanoma ye-iris.

Ukuphindaphindeka kwe-Intraocular (Uveal) iMelanoma

I-melanoma yangaphakathi ye-intraocular ngumhlaza ophindaphindiweyo (ubuye) emva kokuba unyangiwe. I-melanoma inokubuyela esweni okanye kwamanye amalungu omzimba.

Unyango ngoKhetho lonyango

IINGONGOMA EZIPHAMBILI

• Kukho iintlobo ezahlukeneyo zonyango kwizigulana ezine-melanoma ye-intraocular.

• Iindidi ezintlanu zonyango olusetyenziswayo zisetyenziswa:

• Ugqirha

• Ukulinda

• Unyango ngemitha

• Ifotokoko

• Unyango

• Iindidi ezintsha zonyango ziyavavanywa kuvavanyo lweklinikhi.

• Unyango lwe-intraocular (uveal) melanoma lunokubangela iziphumo ebezingalindelekanga.

• Izigulana zinokufuna ukucinga ngokuthatha inxaxheba kuvavanyo lweklinikhi.

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

• Iimvavanyo zokulandelela zisenokufuneka.

Kukho iintlobo ezahlukeneyo zonyango kwizigulana ezine-melanoma ye-intraocular.

Iindidi ezahlukeneyo zonyango ziyafumaneka kwizigulana ezine-melanoma ye-intraocular. 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. Izigulana zinokufuna ukucinga ngokuthatha inxaxheba kuvavanyo lweklinikhi. Olunye uvavanyo lwezonyango luvuleleke kuphela kwizigulana ezingaluqalanga unyango.

Iindidi ezintlanu zonyango olusetyenziswayo zisetyenziswa:

Ugqirha

Utyando lolona nyango luqhelekileyo kwi-intraocular melanoma. Ezi ndidi zilandelayo zotyando zinokusetyenziswa:

• Ukuphinda ubuye: Utyando lokususa ithumba kunye nenani elincinci lezicubu ezisempilweni ezingqonge lona.

• Inyukliya: Utyando lokususa iliso kunye nenxalenye ye-optic nerve. Oku kuyenziwa ukuba umbono awunakugcinwa kwaye ithumba likhulu, lisasazeke kwi-optic nerve, okanye libangela uxinzelelo oluphezulu ngaphakathi kwiso. Emva kotyando, isigulana sihlala silungiselelwa iliso lokufakelwa ukuze lilingane nobungakanani kunye nombala welinye iliso.

• Uxolelo: Utyando lokususa iliso kunye nenkophe, kunye nezihlunu, imithambo-luvo, kunye namafutha kwisokethi yamehlo. Emva kotyando, isigulana sinokulungiselelwa iliso lokufakelwa ukuze lilingane nobukhulu kunye nombala welinye iliso okanye ilungu lokufakelwa lobuso.

Ukulinda

Ukuhlala ulindile kubeka esweni imeko yesigulana ngaphandle kokunikezela ngonyango de kuvele iimpawu okanye utshintsho. Imifanekiso ithathwa ixesha ukugcina umkhondo wotshintsho kubungakanani besisu kunye nokukhula kwayo ngokukhawuleza.

Ukulinda ngokubukhali kusetyenziselwa abaguli abangenazo iimpawu okanye iimpawu kwaye ithumba alikhuli. Iyasetyenziswa xa ithumba likwisiso kuphela elinombono oluncedo.

Unyango ngemitha

Unyango ngemitha lunyango olusebenzisa amandla e-x-reyi okanye ezinye iintlobo zemitha yokubulala iiseli zomhlaza okanye ukuzigcina zikhula. Zimbini iintlobo zonyango lwe-radiation:

• Unyango lwangaphandle lwemitha lusebenzisa umatshini ngaphandle komzimba ukuthumela imitha kumhlaza. Iindlela ezithile zokunika unyango ngemitha kunokunceda ukugcina imitha ingonakalisi izicubu ezisempilweni ezikufutshane. Ezi ntlobo zonyango lwangaphandle lwemitha zibandakanya oku kulandelayo:

• Itheyibhile yonyango yemitha ehlawulelwayo engaphandle luhlobo lonyango lwe-radiation engaphandle. Umatshini okhethekileyo wonyango wemitha ujolisa amasuntswana amancinci, angabonakaliyo, abizwa ngokuba ziiproton okanye i-helium ions, kwiiseli zomhlaza ukubabulala ngomonakalo omncinci kwizicubu eziqhelekileyo ezikufutshane. Unyango lwe-radiation oluhlawulelwayo lusebenzisa uhlobo olwahlukileyo lwemitha kunohlobo lwe-x-ray yonyango lwemitha.

• Unyango lweGamma Knife luhlobo lweeradiosurgery yestereotactic esetyenziselwa ezinye i-melanomas. Olu nyango lunokunikwa kunyango olunye. Ijolise ngqo kwimitha ye-gamma ngokuthe ngqo kwi-tumor ngoko ke akukho monakalo mncinci kwizicubu ezisempilweni. Unyango lweGamma Knife alusebenzisi imela ukususa ithumba kwaye ayisiyo utyando.

• Unyango lwangaphakathi lwemitha lusebenzisa into enemitha ye-radio etywinwe kwiinaliti, iimbewu, iingcingo, okanye iicatheters ezibekwe ngqo okanye kufutshane nomhlaza. Iindlela ezithile zokunika unyango ngemitha kunokunceda ukugcina imitha ekonakaliseni izicwili ezisempilweni. Olu hlobo lonyango lwangaphakathi lwemitha lunokubandakanya oku kulandelayo:

• Unyango lwasekhaya lwe-plaque radiation luhlobo lonyango lwangaphakathi lwemitha olunokuthi lusetyenziselwe izicubu zamehlo. Imbewu enemitha yeathomathikhi iqhotyoshelwe kwelinye icala lediski, ebizwa ngokuba lilitye, kwaye ibekwe ngqo kudonga olungaphandle lweliso kufutshane nethumba. Icala le-plaque kunye nembewu kuyo lijongene nebhola leliso, lijolise kwimitha kwi-tumor. Ilitye likhusela ezinye izicubu ezikufutshane kwimitha.

I-Plaque radiotherapy yamehlo. Uhlobo lonyango lwemitha olusetyenziselwa ukunyanga amathumba wamehlo. Imbewu enemitha ye radioactive ibekwa kwicala elinye lesinyithi (esoloko si golide) esibizwa ngokuba yi plaque. I-plaque ithungelwe kudonga lwangaphandle lweliso. Imbewu ikhupha imitha ebulala umhlaza. I-plaque iyasuswa ekupheleni konyango, ehlala ihlala iintsuku ezimbalwa.

Indlela unyango lwe-radiation olunikezelwa ngayo ixhomekeke kuhlobo kunye nenqanaba lomhlaza ophathwayo. Unyango lwangaphandle nolwangaphakathi lusetyenziselwa ukunyanga i-intraocular melanoma.

Ifotokoko

I-Photocoagulation yinkqubo esebenzisa ukukhanya kwe-laser ukutshabalalisa imithambo yegazi ezisa izakha mzimba kwi-tumor, ebangela ukuba iiseli zethumba zife. I-Photocoagulation ingasetyenziselwa ukunyanga izicubu ezincinci. Oku kukwabizwa ngokuba kukukhanya okuxineneyo.

Unyango

I-Thermotherapy kukusetyenziswa kobushushu obuvela kwi-laser ukutshabalalisa iiseli zomhlaza kunye nokunciphisa ithumba.

Iindidi ezintsha zonyango ziyavavanywa kuvavanyo lweklinikhi.

Ulwazi malunga novavanyo lweklinikhi luyafumaneka kwiwebhusayithi yeNCI.

Unyango lwe-intraocular (uveal) melanoma lunokubangela iziphumo ebezingalindelekanga.

Ngolwazi malunga neziphumo ebezingalindelekanga ezibangelwa lunyango lomhlaza, jonga iphepha lethu Iziphumo ezingalunganga.

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 yakho itshintshile okanye ukuba umhlaza ubuyile (buyela). Olu vavanyo ngamanye amaxesha lubizwa ngokuba luvavanyo olulandelayo okanye ukuhlolwa.

Ukhetho kunyango lwe-Intraocular (Uveal) Melanoma

Kweli Candelo

• Iris Melanoma

• I-Ciliary Body iMelanoma

• I-Choroid Melanoma

• I-Extraocular Extension Melanoma kunye neMetastatic Intraocular (Uveal) iMelanoma

• Ukuphindaphindeka kwe-Intraocular (Uveal) iMelanoma

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

Iris Melanoma

Unyango lwe-iris melanoma lunokubandakanya oku kulandelayo:

• Ukulinda ulindile.

• Utyando (ukuphinda usebenze okanye ukwenza inyukliya).

• Unyango lwe-Plaque radiation, lwamathumba angenakususwa ngotyando.

Sebenzisa uvavanyo lwethu lweklinikhi ukufumana ulingo lweklinikhi oluxhaswayo lwekliniki olwamkela izigulana. Unokukhangela izilingo ngokusekwe kuhlobo lomhlaza, ubudala besigulana, kwaye nokuba zenziwa phi izilingo. Ulwazi ngokubanzi malunga novavanyo lweklinikhi luyafumaneka.

I-Ciliary Body iMelanoma

Unyango lwe-ciliary body melanoma inokubandakanya oku kulandelayo:

• Unyango lwe-Plaque radiation.

• Itheyibhile yonyango lwemitha engaphandle ehlawulelwayo.

• Utyando (ukuphinda usebenze okanye ukwenza inyukliya).

Sebenzisa uvavanyo lwethu lweklinikhi ukufumana ulingo lweklinikhi oluxhaswayo lwekliniki olwamkela izigulana. Unokukhangela izilingo ngokusekwe kuhlobo lomhlaza, ubudala besigulana, kwaye nokuba zenziwa phi izilingo. Ulwazi ngokubanzi malunga novavanyo lweklinikhi luyafumaneka.

I-Choroid Melanoma

Unyango lwe-choroid melanoma encinci inokubandakanya oku kulandelayo:

• Ukulinda ulindile.

• Unyango lwe-Plaque radiation.

• Itheyibhile yonyango lwemitha engaphandle ehlawulelwayo.

• Unyango lweGamma Knife.

• Unyango.

• Utyando (ukuphinda usebenze okanye ukwenza inyukliya).

Unyango lwe-melanoma ye-choroid ephakathi inokubandakanya oku kulandelayo:

• Unyango lwe-Plaque radiation kunye okanye ngaphandle kwe-photocoagulation okanye i-thermotherapy.

• Itheyibhile yonyango lwemitha engaphandle ehlawulelwayo.

• Utyando (ukuphinda usebenze okanye ukwenza inyukliya).

Unyango lwe-choroid melanoma enkulu inokubandakanya oku kulandelayo:

• Inyukliya xa ithumba likhulu kakhulu kunyango olusindisa iliso.

Sebenzisa uvavanyo lwethu lweklinikhi ukufumana ulingo lweklinikhi oluxhaswayo lwekliniki olwamkela izigulana. Unokukhangela izilingo ngokusekwe kuhlobo lomhlaza, ubudala besigulana, kwaye nokuba zenziwa phi izilingo. Ulwazi ngokubanzi malunga novavanyo lweklinikhi luyafumaneka.

I-Extraocular Extension Melanoma kunye neMetastatic Intraocular (Uveal) iMelanoma

Unyango lwe-extraocular extension melanoma ethe yasasazeka kwithambo elijikeleze iliso inokubandakanya oku kulandelayo:

• Utyando (uqhushululu).

• Uvavanyo lweklinikhi.

Unyango olusebenzayo lwe-metastatic intraocular melanoma alufumanekanga. Uvavanyo lweklinikhi lunokuba lukhetho lonyango. Thetha nogqirha wakho malunga nokhetho lwakho lonyango.

Sebenzisa uvavanyo lwethu lweklinikhi ukufumana ulingo lweklinikhi oluxhaswayo lwekliniki olwamkela izigulana. Unokukhangela izilingo ngokusekwe kuhlobo lomhlaza, ubudala besigulana, kwaye nokuba zenziwa phi izilingo. Ulwazi ngokubanzi malunga novavanyo lweklinikhi luyafumaneka.

Ukuphindaphindeka kwe-Intraocular (Uveal) iMelanoma

Unyango olusebenzayo lwe-intraocular melanoma alufumanekanga. Uvavanyo lweklinikhi lunokuba lukhetho lonyango. Thetha nogqirha wakho malunga nokhetho lwakho lonyango.

Sebenzisa uvavanyo lwethu lweklinikhi ukufumana ulingo lweklinikhi oluxhaswayo lwekliniki olwamkela izigulana. Unokukhangela izilingo ngokusekwe kuhlobo lomhlaza, ubudala besigulana, kwaye nokuba zenziwa phi izilingo. Ulwazi ngokubanzi malunga novavanyo lweklinikhi luyafumaneka.

Ukufunda ngakumbi malunga ne-Intraocular (Uveal) iMelanoma

Ngolwazi oluthe kratya kwiZiko leSizwe loMhlaza malunga ne-intraocular (uveal) melanoma, jonga kwi-Intraocular (Eye) Iphepha lasekhaya leMelanoma.

Ngolwazi lomhlaza ngokubanzi kunye nezinye izixhobo ezivela kwiNational Cancer Institute, jonga oku kulandelayo:

• Malunga noMhlaza

• Ukuqokelela

• I-Chemotherapy kunye nawe: Inkxaso yabantu abanomdlavuza

• Unyango ngemitha kunye nawe: Inkxaso yabantu abanomhlaza

• Ukujamelana noMhlaza

• Imibuzo yokubuza ugqirha wakho malunga neCancer

• Abasindileyo kunye nabaNonopheli