Iindidi / ukukhulelwa-trophoblastic / isigulana / unyango lwe-gtd-unyango-pdq

Unyango lweSifo seTrophoblastic seZifo (®) -Unguqulelo lwesigulana

Ulwazi ngokubanzi malunga neSifo seGestational Trophoblastic Disease

IINGONGOMA EZIPHAMBILI

• Isifo se-Gestational trophoblastic disease (GTD) liqela lezifo ezinqabileyo apho iiseli ze-trophoblast ezingaqhelekanga zikhula ngaphakathi kwesibeleko emva kokumitha.

• I-Hydatidiform mole (HM) lolona hlobo luqhelekileyo lwe-GTD.

• I-Gestational trophoblastic neoplasia (GTN) luhlobo lwesifo se-gestational trophoblastic disease (GTD) esiphantse sibe sibi.

• Iimolekyuli ezingafunekiyo

• IiChoriocarcinomas

• Indawo yesifo seplacental trophoblastic tumors

• Izidumba ze-Epithelioid trophoblastic

• Ubudala kunye nokukhulelwa kwangaphambili kwe-molar kuchaphazela umngcipheko we-GTD.

• Iimpawu ze-GTD zibandakanya ukopha okungaqhelekanga kwilungu lobufazi kunye nesibeleko esikhulu kunesiqhelo.

• Uvavanyo oluvavanya isibeleko lusetyenziselwa ukufumanisa (ukufumana) kunye nokufumanisa isifo se-trophoblastic.

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

Isifo se-Gestational trophoblastic disease (GTD) liqela lezifo ezinqabileyo apho iiseli ze-trophoblast ezingaqhelekanga zikhula ngaphakathi kwesibeleko emva kokumitha.

Kwisifo se-gestational trophoblastic disease (GTD), ithumba likhula ngaphakathi kwisibeleko ukusuka kwizicwili ezenzeka emva kokumitha (ukujoyina isidoda kunye neqanda). Esi sihlunu senziwe ngeeseli ze-trophoblast kwaye zihlala zijikeleza iqanda elichumileyo esibelekweni. Iiseli zeTrophoblast zinceda ukudibanisa iqanda elichumileyo eludongeni lwesibeleko kwaye liyinxalenye yeplacenta (ilungu elidlulisa izondlo ukusuka kumama liye emntwaneni).

Ngamanye amaxesha kukho ingxaki ngeqanda elichunyisiweyo kunye neeseli ze-trophoblast. Esikhundleni sokukhula komntwana osempilweni, iifom zenzeka. Kuze kubekho iimpawu okanye iimpawu zethumba, ukukhulelwa kuya kubonakala ngathi kukukhulelwa okuqhelekileyo.

Uninzi lwe-GTD lulungile (hayi umhlaza) kwaye alusasazeki, kodwa ezinye iintlobo ziyingozi (umhlaza) kwaye zisasazeke kwizicwili ezikufutshane okanye kwiindawo ezikude zomzimba.

Isifo se-Gestational trophoblastic disease (GTD) ligama eliqhelekileyo elibandakanya iintlobo ezahlukeneyo zezifo:

• Iimpawu zeHydatidiform Moles (HM)

• Gcwalisa i-HM.

• HM ekhethekileyo.

• Isisu seTrophoblastic Neoplasia (GTN)

• Iimolekyuli ezingafunekiyo.

• IiChoriocarcinomas.

• Indawo yamathambo e-trophoblastic tumors (PSTT; kunqabile kakhulu).

• Izidumba ze-Epithelioid trophoblastic (ETT; ngakumbi ezinqabileyo).

I-Hydatidiform mole (HM) lolona hlobo luqhelekileyo lwe-GTD.

Ii-HMs ngamathumba akhula kancinci abonakala ngathi ziingxowa zolwelo. I-HM ikwabizwa ngokuba kukukhulelwa kwe-molar. Isizathu se-hydatidiform moles asiyazi.

Ii-HMs zinokugqibezeleka okanye zingaphelelanga:

• Iifom ze-HM ezipheleleyo xa isidoda sichumisa iqanda elingenayo i-DNA kanina. Iqanda lineDNA evela kutata kwaye iiseli ebezenzelwe ukuba ziqheleke ziqhelekile.

• Iifom zeHM ezithile xa isidoda sichumisa iqanda eliqhelekileyo kwaye kukho iiseti ezimbini zeDNA kutata okwiqanda elichumileyo. Inxalenye kuphela yeefom ezingekazalwa kunye neeseli ezazenzelwe ukuba zi-placenta aziqhelekanga.

Uninzi lwee-moles ze-hydatidiform zilungile, kodwa ngamanye amaxesha ziba ngumhlaza. Ukuba nenye okanye ezingaphezulu kwezi zinto zilandelayo zomngcipheko zonyusa umngcipheko wokuba i-hydatidiform mole ibe ngumhlaza:

• Ukukhulelwa ngaphambi kwama-20 okanye emva kweminyaka engama-35 ubudala.

• Inqanaba eliphezulu kakhulu le-beta chorionic gonadotropin (β-hCG), ihomoni eyenziwa ngumzimba ngexesha lokukhulelwa.

• Ithumba elikhulu esibelekweni.

• I-ovary cyst enkulu kuneesentimitha ezi-6.

• Uxinzelelo lwegazi xa ukhulelwe.

• Idlala lengqula eligqithisileyo (eyongezelelweyo idlala lengqula).

• Isicaphucaphu esiqatha nokugabha ngexesha lokukhulelwa.

• Iiseli zeTrophoblastic egazini, ezinokuthintela imithambo yegazi encinci.

• Iingxaki ezinzima zokuvala igazi ezibangelwa yi-HM.

I-Gestational trophoblastic neoplasia (GTN) luhlobo lwesifo se-gestational trophoblastic disease (GTD) esiphantse sibe sibi.

I-neoplasia ye-Gestational trophoblastic neoplasia (GTN) ibandakanya oku kulandelayo:

Iimolekyuli ezingafunekiyo

Ii-moles ezihlaselayo zenziwe ngeeseli ze-trophoblast ezikhula zibe ngumaleko wesibeleko. I-moles ehlaselayo inokuthi ikhule kwaye isasazeke kune-hydatidiform mole. Rhoqo, i-HM epheleleyo okanye eyinxalenye inokuba yimole ehlaselayo. Ngamanye amaxesha i-mole engenayo iya kulahleka ngaphandle kwonyango.

IiChoriocarcinomas

I-choriocarcinoma sisisu esibi esivela kwiiseli ze-trophoblast kwaye sisasazeka kumaleko wesibeleko nakwimithambo yegazi ekufutshane. Inokusasazeka nakwezinye iindawo zomzimba, ezinje ngengqondo, imiphunga, isibindi, izintso, udakada, amathumbu, isinqe, okanye ubufazi. I-choriocarcinoma kunokwenzeka ukuba yenze kwabasetyhini abaye banakho oku kulandelayo:

• Ukukhulelwa kwe-Molar, ngakumbi ngemole epheleleyo ye-hydatidiform.

• Ukukhulelwa okuqhelekileyo.

• Ukukhulelwa kwe-Tubal (ukufakelwa kweqanda okuchunyisiweyo kwityhubhu yokuya endaweni yesibeleko).

• Ukuphuma kwesisu.

Indawo yesifo seplacental trophoblastic tumors

I-placental-site trophoblastic tumor (PSTT) luhlobo olunqabileyo lwe-gestational trophoblastic neoplasia eyenza apho i-placenta inamathela kwisibeleko. Iifom zivela kwiiseli ze-trophoblast kwaye zisasazeka kwimisipha yesibeleko nakwimithambo yegazi. Ingasasazeka kwimiphunga, i-pelvis, okanye i-lymph nodes. I-PSTT ikhula kancinci kwaye iimpawu okanye iimpawu zinokubonakala iinyanga okanye iminyaka emva kokukhulelwa okuqhelekileyo.

Izidumba ze-Epithelioid trophoblastic

I-epithelioid trophoblastic tumor (ETT) luhlobo olunqabileyo kakhulu lwe-gestational trophoblastic neoplasia enokuba nobungozi okanye enobungozi. Xa ithumba libi, linokusasazeka liye emiphungeni.

Ubudala kunye nokukhulelwa kwangaphambili kwe-molar kuchaphazela umngcipheko we-GTD.

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 unokuba semngciphekweni. Imiba yomngcipheko kwi-GTD ibandakanya oku kulandelayo:

• Ukukhulelwa xa umncinci kunama-20 okanye ngaphezulu kweminyaka eyi-35.

• Ukuba nembali yobuqu ye-hydatidiform mole.

Iimpawu ze-GTD zibandakanya ukopha okungaqhelekanga kwilungu lobufazi kunye nesibeleko esikhulu kunesiqhelo.

Ezi kunye neminye imiqondiso kunye neempawu zinokubangelwa sisifo se-trophoblastic sesifo okanye ngezinye iimeko. Jonga ugqirha wakho ukuba unayo nayiphi na kwezi zinto zilandelayo:

• Ukopha kwilungu lobufazi akuhambelani nokuya exesheni.

• Isibeleko esikhulu kunokuba besilindelekile ngexesha lokukhulelwa.

• Ubuhlungu okanye uxinzelelo kwi-pelvis.

• Isicaphucaphu esiqatha nokugabha ngexesha lokukhulelwa.

• Uxinzelelo lwegazi oluphezulu ngentloko kunye nokudumba kweenyawo nezandla kwasekuqaleni kokukhulelwa.

• Ukopha kwilungu lobufazi okuqhubeka ixesha elide kunesiqhelo emva kokubeleka.

• Ukudinwa, ukuphefumla kancinci, isiyezi, kunye nokubetha kwentliziyo okukhawulezayo okanye okungaqhelekanga okubangelwa yi-anemia.

Ngamanye amaxesha i-GTD ibangela i-thyroid engasebenzi. Iimpawu kunye neempawu ze-thyroid engasebenzi zibandakanya oku kulandelayo:

• Ukukhawuleza okanye ukungahambi kakuhle kwentliziyo.

• Ukuxakeka.

• Ukubila.

• Ukuhamba kwamathumbu rhoqo.

• Ingxaki yokulala.

• Ukuziva uxhalabile okanye ucaphukile.

• Ukuhla ukusinda.

Uvavanyo oluvavanya isibeleko lusetyenziselwa ukufumanisa (ukufumana) kunye nokufumanisa isifo se-trophoblastic.

Ezi mvavanyo zilandelayo kunye neenkqubo zinokusetyenziswa:

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

• Uvavanyo lwePelvic: Uvavanyo lwelungu lobufazi, umlomo wesibeleko, isibeleko, iityhubhu zesibeleko, ii-ovari, kunye neethanga. I-speculum ifakwe kwilungu lobufazi kwaye ugqirha okanye umongikazi ujonga kwilungu lobufazi kunye nomlomo wesibeleko ngeempawu zesifo. Uvavanyo lomlomo womlomo wesibeleko luqhele ukwenziwa. Ugqirha okanye umongikazi ukwengeza into enye okanye emibini ethanjisiweyo, iminwe egotyiweyo yesandla esinye kwilungu lobufazi aze abeke esinye isandla phezu kwesisu esisezantsi ukuva ubungakanani, imilo, kunye nokuma kwesibeleko kunye namaqanda. Ugqirha okanye umongikazi ukwangenisa umnwe othanjisiweyo, ofakwe iglavu kwi-rectum ukuze uve amaqhuma okanye iindawo ezingaqhelekanga.

Uvavanyo lwePelvic. Ugqirha okanye umongikazi ufaka i-lubricated, iiglavu zeminwe yesandla esinye kwilungu lobufazi kwaye ucinezela emazantsi esisu ngesinye isandla. Oku kwenzelwa ukuziva ubungakanani, imilo, kunye nokuma kwesibeleko kunye namaqanda. Ilungu lobufazi, umlomo wesibeleko, imibhobho yesibeleko, kunye nomqolo nawo ayajongwa.

• Uvavanyo lwe-Ultrasound lwe-pelvis: Inkqubo apho amaza esandi aphakamileyo amandla (i-ultrasound) ehlaselwa kwizicwili zangaphakathi okanye kumalungu esinqeni kunye nokwenza i-echoes. Iingqungquthela zenza umfanekiso wezicubu zomzimba ezibizwa ngokuba yi-sonogram. Ngamanye amaxesha i-transvaginal ultrasound (TVUS) iya kwenziwa. Kwi-TVUS, kufakwa i-ultrasound transducer (iprobe) kwilungu lobufazi ukwenza i-sonogram.

• 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. Igazi liyavavanywa ukujonga isibindi, izintso kunye nomongo wethambo.

• Uvavanyo lwe-serum tumor marker: Inkqubo apho kuvavanywa khona isampulu yegazi ukulinganisa izixa zezinto ezithile ezenziwe ngamalungu, izicwili, okanye iiseli zethumba emzimbeni. Izinto ezithile zinxulunyaniswa neentlobo ezithile zomhlaza xa zifunyenwe kumanqanaba anyukayo emzimbeni. Oku kubizwa ngokuba kukuphawula amathumba. Kwi-GTD, igazi lijongwa kwinqanaba le-beta chorionic gonadotropin (β-hCG), ihomoni eyenziwa ngumzimba ngexesha lokukhulelwa. I-β-hCG egazini lowasetyhini ongakhulelwanga inokuba luphawu lwe-GTD.

• Urinalysis: Uvavanyo lokujonga umbala womchamo kunye neziqulatho zawo, ezinje ngeswekile, iprotein, igazi, ibacteria kunye nenqanaba le-β-hCG.

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

Isifo se-Gestational trophoblastic isifo sinokunyanga. Unyango kunye nokuxela kwangaphambili kuxhomekeke koku kulandelayo:

• Uhlobo lwe-GTD.

• Nokuba ithumba lisasazekile kwisibeleko, i-lymph node, okanye iindawo ezikude zomzimba.

• Inani lamathumba kunye nokuba akuphi emzimbeni.

• Ubungakanani ithumba inkulu.

• Inqanaba le-β-hCG egazini.

• Kungekudala ithumba lafunyaniswa emva kokuqala kokukhulelwa.

• Nokuba i-GTD yenzekile emva kokukhulelwa kwe-molar, ukuphuma kwesisu, okanye ukukhulelwa okuqhelekileyo.

• Unyango lwangaphambili lwe-neopasia yokukhulelwa kwangaphambi kokukhulelwa.

Ukhetho kunyango luxhomekeke ekubeni ngaba umfazi unqwenela ukukhulelwa kwixa elizayo.

Amanqanaba eGestational Trophoblastic Tumors kunye neNeoplasia

IINGONGOMA EZIPHAMBILI

• Emva kokuba kufunyaniswe isifo se-trophoblastic neoplasia, kuvavanyo lwenziwa ukufumanisa ukuba ngaba umhlaza sele usasazekile na ukusuka apho uqale kwamanye amalungu omzimba.

• Zintathu iindlela umhlaza onwenwa ngayo emzimbeni.

• Umhlaza unokusasazeka ukusuka apho waqala khona kwamanye amalungu omzimba.

• Akukho nkqubo yokuqokelelwa kwee-moles hydatidiform.

• La manqanaba alandelayo asetyenziselwa i-GTN:

• Inqanaba I

• Inqanaba II

• Inqanaba III

• Inqanaba IV

• Unyango lwe-trophoblastic neoplasia isekwe kudidi lwesifo, inqanaba, okanye iqela lomngcipheko.

Emva kokuba kufunyaniswe isifo se-trophoblastic neoplasia, kuvavanyo lwenziwa ukufumanisa ukuba ngaba umhlaza sele usasazekile na ukusuka apho uqale kwamanye amalungu omzimba.

Inkqubo esetyenziselwa ukufumanisa ubungakanani okanye ukusasazeka komhlaza ibizwa ngokuba yi-staging, Ulwazi oluqokelelwe kwinkqubo yokuqokelela lunceda ukumisela inqanaba lesifo. Kwi-GTN, inqanaba yenye yezinto ezisetyenziselwa ukucwangcisa unyango.

Ezi mvavanyo zilandelayo kunye neenkqubo zinokwenziwa ukunceda ukufumanisa inqanaba lesi sifo:

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

• 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. Idayi inokufakwa ngaphakathi emthanjeni okanye iginywe ukunceda amalungu okanye izicwili zibonise ngokucacileyo. Le nkqubo ikwabizwa ngokuba yi-computed tomography, ikhompyuter ye-tomography, okanye ikhompyuter ye-axial tomography.

• I-MRI (imaging resonance imaging) enegadolinium: Inkqubo esebenzisa umazibuthe, amaza erediyo kunye nekhompyuter ukwenza uthotho lwemifanekiso eneenkcukacha zeendawo ezingaphakathi emzimbeni, ezinje ngengqondo kunye nomqolo. Into ebizwa ngokuba yi-gadolinium itofelwe emthanjeni. I-gadolinium iqokelela malunga neeseli zomhlaza ukuze zibonakale zikhanya emfanekisweni. Le nkqubo ikwabizwa ngokuba yimifanekiso yenyukliya yokujonga umfanekiso (i-NMRI).

• Ukugqobhoza iLumbar: Inkqubo esetyenziselwa ukuqokelela i-cerebrospinal fluid (CSF) ukusuka kumqolo womqolo. Oku kwenziwa ngokubeka inaliti phakathi kwamathambo amabini emqolo kunye nakwi-CSF ejikeleze intambo yomqolo kunye nokususa isampulu yolwelo. Isampulu ye-CSF ihlolwe phantsi kwemicroscope ngeempawu zokuba umhlaza usasazekile waya kwingqondo nakumqolo. Le nkqubo ikwabizwa ngokuba yi-LP okanye impompo yomqolo.

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 i-choriocarcinoma isasazeka emiphungeni, iiseli zomhlaza emiphungeni ziiseli ze-choriocarcinoma. Esi sifo siyi-metastatic choriocarcinoma, hayi umhlaza wemiphunga.

Akukho nkqubo yokuqokelelwa kwee-moles hydatidiform.

I-Hydatidiform moles (HM) ifumaneka kwisibeleko kuphela kwaye ayisasazeki kwamanye amalungu omzimba.

La manqanaba alandelayo asetyenziselwa i-GTN:

Inqanaba I

Kwinqanaba I, ithumba likwisibeleko kuphela.

Inqanaba II

Kwinqanaba II, umhlaza usasazekile ngaphandle kwesibeleko uye kwi-ovary, ityhubhu yobufazi, ubufazi, kunye / okanye iigaments ezixhasa isibeleko.

Inqanaba III

Kwinqanaba le-III, umhlaza usasazeke waya emiphungeni.

Inqanaba IV

Kwinqanaba IV, umhlaza usasazeke kwiindawo ezikude zomzimba ngaphandle kwemiphunga.

Unyango lwe-trophoblastic neoplasia isekwe kudidi lwesifo, inqanaba, okanye iqela lomngcipheko.

Ii-moles ezingenayo kunye ne-choriocarcinomas ziphathwa ngokusekwe kumaqela omngcipheko. Inqanaba le-mole engenayo okanye i-choriocarcinoma yenye yezinto ezisetyenziselwa ukumisela iqela lomngcipheko. Ezinye izinto zibandakanya oku kulandelayo:

• Ubudala besigulana xa kufunyaniswa isifo.

• Nokuba i-GTN yenzeke emva kokukhulelwa kwe-molar, ukuphuma kwesisu, okanye ukukhulelwa okuqhelekileyo.

• Kungekudala ithumba lafunyaniswa emva kokuqala kokukhulelwa.

• Inqanaba le-beta chorionic gonadotropin (β-hCG) egazini.

• Ubungakanani ithumba inkulu.

• Apho ithumba lisasazeke khona kunye nenani lamathumba emzimbeni.

• Zingaphi iziyobisi ze-chemotherapy ithumba eliye laphathwa ngalo (ngenxa yamathumba aphindaphindiweyo okanye anganyangekiyo).

Kukho amaqela amabini omngcipheko we-moles engenayo kunye ne-choriocarcinomas: umngcipheko ophantsi kunye nomngcipheko omkhulu. Izigulana ezinesifo esinomngcipheko ophantsi zihlala zifumana unyango olunoburhalarhume kunezigulana ezinesifo esisesichengeni.

I-Placental-site trophoblastic tumor (PSTT) kunye ne-epithelioid trophoblastic tumor (ETT) yonyango ixhomekeke kwinqanaba lesifo.

Ukuphindaphindiweyo kunye nokuXhathisa ubuGcisa boBuNtu beNtsholongwane

Ukuphindaphindeka kwesifo se-trophoblastic neoplasia (GTN) ngumhlaza ophindaphindiweyo (ubuyile) emva kokuba unyangiwe. Umhlaza ungabuyela esibelekweni okanye kwamanye amalungu omzimba.

I-neoplasia engaphenduliyo kunyango ibizwa ngokuba yi-GTN enganyangekiyo.

Unyango ngoKhetho lonyango

IINGONGOMA EZIPHAMBILI

• Kukho iintlobo ezahlukeneyo zonyango kwizigulana ezinesifo se-gestational trophoblastic disease.

• Zintathu iintlobo zonyango olusetyenziswayo:

• Ugqirha

• Unyango ngamayeza

• Unyango ngemitha

• Iindidi ezintsha zonyango ziyavavanywa kuvavanyo lweklinikhi.

• Unyango lwesifo se-gestational trophoblastic isifo esinokubangela 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 ezinesifo se-gestational trophoblastic disease.

Iindidi ezahlukeneyo zonyango ziyafumaneka kwizigulana ezinesifo se-gestational trophoblastic disease. Olunye unyango lusemgangathweni (unyango olusetyenziswayo ngoku), kwaye olunye luvavanywa kuvavanyo lweklinikhi. Phambi kokuqala unyango, abaguli banokufuna ukucinga ngokuthatha inxaxheba 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.

Uvavanyo lwezonyango lwenzeka kwiindawo ezininzi zelizwe. Ulwazi malunga novavanyo oluqhubekayo lwezonyango luyafumaneka kwiwebhusayithi ye-NCI. Ukukhetha olona nyango lufanelekileyo lomhlaza sisigqibo esibandakanya isigulana, usapho kunye neqela lokhathalelo lwempilo.

Zintathu iintlobo zonyango olusetyenziswayo:

Ugqirha

Ugqirha angawususa umhlaza usebenzisa enye yezi zinto zilandelayo:

• Ukuqaqanjelwa kunye nokunyanga (i-D & C) kunye nokukhutshwa ngobushushu: Inkqubo yotyando lokususa izicwili ezingaqhelekanga kunye namacandelo embindi wangaphakathi wesibeleko. Umlomo wesibeleko uyahlanjululwa kwaye izinto ezingaphakathi kwesibeleko ziyasuswa ngesixhobo esincinci esifana nomshini. Iindonga zesibeleko emva koko zitshitshisiwe ngobushushu ngesixhobo esime okwecephe) ukususa nayiphi na into enokuhlala esibelekweni. Le nkqubo inokusetyenziselwa ukukhulelwa kwe-molar.

Ukwahlula kunye nokunyanga (D no-C). I-speculum ifakwe kwilungu lobufazi ukuyandisa ukuze ujonge umlomo wesibeleko (ipaneli yokuqala). I-dilator isetyenziselwa ukwandisa umlomo wesibeleko (iphaneli esembindini). Iyeza lokunyanga lifakwa emlonyeni wesibeleko ukukhupha izicwili ezingaqhelekanga (iphaneli yokugqibela).

• IHysterectomy: Utyando lokususa isibeleko, kwaye ngamanye amaxesha umlomo wesibeleko. Ukuba isibeleko kunye nomlomo wesibeleko ukhutshiwe kwilungu lobufazi, utyando lubizwa ngokuba yi-hysterectomy yelungu lobufazi. Ukuba isibeleko kunye nomlomo wesibeleko ukhutshwa ngokusikwa okukhulu (okusikiweyo) esiswini, utyando lubizwa ngokuba sisisu esiswini sisonke. Ukuba isibeleko kunye nomlomo wesibeleko zithathwa ngokusikwa kancinane (okusikiweyo) esiswini kusetyenziswa i-laparoscope, utyando lubizwa ngokuba yi-laparoscopic hysterectomy iyonke.

Uhlobo lweHysterectomy. Isibeleko siyasuswa ngotyando kunye okanye ngaphandle kwamanye amalungu okanye izicwili. Kwi-hysterectomy iyonke, isibeleko kunye nomlomo wesibeleko ziyasuswa. Kwi-hysterectomy iyonke ene-salpingo-oophorectomy, (a) isibeleko kunye nesinye (unilateral) isibeleko kunye ne-fallopian tube ziyasuswa; okanye (b) isibeleko kunye (zombini) iiqanda kunye nemibhobho yesibeleko iyasuswa. Kwi-hysterectomy egqibeleleyo, isibeleko, umlomo wesibeleko, omabini amaqanda, zombini ii-fallopian tubes, kunye nezicubu ezikufutshane ziyasuswa. Ezi nkqubo zenziwa kusetyenziswa ukusika okunqamlezayo okuphantsi okanye ukusikwa okuthe nkqo.

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

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 anokufikelela kwiiseli zomhlaza kuwo wonke umzimba (systemic chemotherapy). Xa i-chemotherapy ibekwa ngqo kwi-cerebrospinal fluid, ilungu, okanye indawo yomzimba efana nesisu, iziyobisi zichaphazela kakhulu iiseli zomhlaza kwezo ndawo (chemotherapy yengingqi). Indlela i-chemotherapy enikezelwa ngayo ixhomekeke kuhlobo kunye nenqanaba lomhlaza ophathwayo, okanye nokuba ngaba eli thumba lisesichengeni okanye ingozi ephezulu.

Umdibaniso wekhemotherapy yonyango olusebenzisa ngaphezulu kwesiyobisi esinye somhlaza.

Jonga iziyobisi ezivunyiweyo kwisifo seGestational Trophoblastic Disease ngolwazi oluthe kratya.

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.

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

Indlela unyango lwe-radiation olunikezelwa ngayo ixhomekeke kuhlobo lwesifo se-gestational trophoblastic isifo esinyangiweyo. Unyango lwangaphandle lwemitha lusetyenziselwa ukunyanga isifo se-trophoblastic.

Iindidi ezintsha zonyango ziyavavanywa kuvavanyo lweklinikhi.

Ulwazi malunga novavanyo oluqhubekayo lwezonyango luyafumaneka kwiwebhusayithi ye-NCI.

Unyango lwesifo se-gestational trophoblastic isifo esinokubangela 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.

Amanqanaba egazi e-beta chorionic gonadotropin yabantu (β-hCG) aya kujongwa ukuya kuthi ga kwiinyanga ezi-6 emva kokuba unyango luphelile. Kungenxa yokuba inqanaba le-β-hCG elingaphezulu kwesiqhelo kunokuthetha ukuba ithumba aliphendulanga kunyango okanye libe ngumhlaza.

Ukhetho kunyango lweSifo seTrophoblastic seGestational

Kweli Candelo

• Iimpawu zeHydatidiform

• Isisu seTrophoblastic Neoplasia

• Umngcipheko ophantsi weGestational Trophoblastic Neoplasia

• Umngcipheko ophezulu weMetastatic Gestational Trophoblastic Neoplasia

• I-Placental-Site Gestational Trophoblastic Tumors kunye ne-Epithelioid Trophoblastic Tumors

• Ukuphindaphindwa okanye ukuHanjiswa kweGestational Trophoblastic Neoplasia

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

Iimpawu zeHydatidiform

Unyango lwe-hydatidiform mole lunokubandakanya oku kulandelayo:

• Utyando (Ukuhlanjululwa kunye nokunyangwa ngokufuduswa) ukususa ithumba.

Emva koqhaqho, i-beta chorionic gonadotropin (β-hCG) yovavanyo lwegazi lwenziwa veki nganye de inqanaba le-β-hCG libuyele esiqhelweni. Izigulana zikwanokutyelelwa ngogqirha rhoqo ngenyanga ukuya kuthi ga kwiinyanga ezi-6. Ukuba inqanaba le-β-hCG alibuyeli kwinto yesiqhelo okanye inyuke, oko kunokuthetha ukuba i-hydatidiform mole ayizange isuswe ngokupheleleyo kwaye ibe ngumhlaza. Ukukhulelwa kubangela amanqanaba e-C-hCG ukuba ande, ke ugqirha wakho uya kukucela ukuba ungakhulelwa de kugqitywe ukulandelelwa.

Kwisifo esisele emva kotyando, unyango luhlala lunyango lwe-chemotherapy.

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- Neoplasia yoBuchule beTrophoblastic

Umngcipheko ophantsi weGestational Trophoblastic Neoplasia

Unyango lwe-neoplasia ye-trophoblastic neoplasia (GTN) enobungozi obuphantsi (i-mole engenayo okanye i-choriocarcinoma) inokubandakanya oku kulandelayo:

• I-Chemotherapy ngeyeza elinye okanye nangaphezulu. Unyango lunikwa kude kube kwinqanaba le-beta chorionic gonadotropin (β-hCG) eliqhelekileyo kwiveki ezintathu ubuncinci emva kokuphela konyango.

Ukuba inqanaba le-β-hCG egazini alibuyeli kwinto yesiqhelo okanye ithumba lisasazeka kwiindawo ezikude zomzimba, iirejimeni zekhemotherapy ezisetyenziselwa umngcipheko we-metastatic GTN.

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.

Umngcipheko ophezulu weMetastatic Gestational Trophoblastic Neoplasia

Unyango lwe-metastatic metastatic gestational trophoblastic neoplasia (i-mole engenayo okanye i-choriocarcinoma) inokubandakanya oku kulandelayo:

• Ukudibanisa i-chemotherapy.

• I-Intrathecal chemotherapy kunye nonyango ngemitha kwingqondo (yomhlaza osasazeke waya emiphungeni, ukuyigcina isasazeka kwingqondo).

• I-dose ephezulu ye-chemotherapy okanye i-intrathecal chemotherapy kunye / okanye unyango lwe-radiation kwingqondo (yomhlaza osasazeke kwingqondo).

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-Placental-Site Gestational Trophoblastic Tumors kunye ne-Epithelioid Trophoblastic Tumors

Unyango lwenqanaba lesiza se-placental-trophoblastic tumors kunye ne-epithelioid trophoblastic tumors inokubandakanya oku kulandelayo:

• Utyando lokususa isibeleko.

Unyango lwenqanaba lesibini le-placental-site gestational trophoblastic tumors kunye ne-epithelioid trophoblastic tumors inokubandakanya oku kulandelayo:

• Utyando lokususa ithumba, elinokuthi lilandelwe ngokudityaniswa kwekhemotherapy.

Unyango lwenqanaba lesithathu kunye ne-IV le-placental-site ye-gestational trophoblastic tumors kunye ne-epithelioid trophoblastic tumors inokubandakanya oku kulandelayo:

• Ukudibanisa i-chemotherapy.

• Ugqirha lokususa umhlaza osele usasazekile nakwezinye iindawo, njengomphunga okanye isisu.

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.

Ukuphindaphindwa okanye ukuHanjiswa kweGestational Trophoblastic Neoplasia

Unyango lwethumba elivela rhoqo okanye elinganyangekiyo lesisu esinokubandakanya kunokubandakanya oku kulandelayo:

• I-Chemotherapy ngeyeza elinye okanye nangaphezulu kumachiza anyangiweyo ngaphambili anyangiweyo ngotyando.

• Ukudityaniswa kwekhemotherapy kwizidumba ezanyangwa ngaphambili ngekhemotherapy.

• Utyando lwamathumba angayiphenduliyo ikhemotherapy.

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.

Ukuze ufunde okungakumbi malunga neSifo seGestational Trophoblastic Disease

Ngolwazi oluthe kratya kwiZiko leSizwe loMhlaza malunga nokukhulelwa kwesisu kunye neoplasia, jonga oku kulandelayo:

• Iphepha lasekhaya lesifo seTrophoblastic seZifo

• Iziyobisi ezivunyiweyo kwiSifo seGestational Trophoblastic

• Umhlaza weMetastatic

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

Malunga nesi Shwankathelo se

Malunga ne

Umbuzo woGqirha weDatha (i-) liZiko leSizwe likaMhlaza (i-NCI's) olunolwazi lweenkcukacha zomhlaza. Isiseko sedatha se siqulethe isishwankathelo solwazi olupapashiweyo kutshanje malunga nothintelo lomhlaza, ukufumanisa, ufuzo, unyango, ukhathalelo oluxhasayo, kunye nonyango olongezelelweyo nolunye. Uninzi lwezishwankathelo ziza kwiinguqulelo ezimbini. Iinguqulelo zobungcali kwezempilo zinolwazi oluneenkcukacha ezibhalwe ngolwimi lobugcisa. Iinguqulelo zezigulana zibhalwe ngokuqondakala ngokulula, nangolwimi olungenabugcisa. Zombini ezi nguqulelo zinolwazi lomhlaza oluchanekileyo kwaye luhlaziyiwe kwaye uninzi lweenguqulelo ziyafumaneka ngeSpanish.

I- yinkonzo ye-NCI. I-NCI yinxalenye yamaZiko ezeMpilo kaZwelonke (NIH). I-NIH liziko likarhulumente womanyano lophando lwezinto eziphilayo. Isishwankathelo se- sisekwe kuphononongo oluzimeleyo loncwadi lwezonyango. Ayizizo iingxelo zomgaqo-nkqubo ze-NCI okanye i-NIH.

Injongo yesi Sishwankathelo

Isishwankathelo solwazi lomhlaza se- sinolwazi lwangoku malunga nokunyangwa kwesifo se-trophoblastic. Yenzelwe ukwazisa kunye nokunceda abaguli, iintsapho kunye nabakhathaleli. Ayiboneleli ngezikhokelo ezisesikweni okanye izindululo zokwenza izigqibo malunga nokhathalelo lwempilo.

Abaphononongi kunye noHlaziyo

Iibhodi zokuhlela zibhala isishwankathelo solwazi ngomhlaza se- kwaye uzigcine zihlaziyiwe. Ezi Bhodi zenziwe ziingcali kunyango lomhlaza kunye nezinye izinto ezinxulumene nomhlaza. Izishwankathelo zijongwa rhoqo kwaye utshintsho lwenziwa xa kukho ulwazi olutsha. Umhla kwisishwankathelo ngasinye ("Uhlaziyiwe") ngumhla wotshintsho lwamva nje.

Ingcaciso kwesi sishwankathelo sesigulana yathathwa kuhlobo lobungcali kwezempilo, olujongwa rhoqo kwaye luhlaziywe njengoko kufuneka, yiBhodi yabaHleli yoNyango lwaBadala yokuNyanga.

Ulwazi lovavanyo lweklinikhi

Uvavanyo lweklinikhi luphononongo lokuphendula umbuzo wesayensi, onjengokuba unyango olunye lubhetele kunolunye. Izilingo zisekwe kwizifundo zangaphambili nakwinto efundwe elebhu. Uvavanyo ngalunye luphendula imibuzo ethile yesayensi ukulungiselela ukufumana iindlela ezintsha nezingcono zokunceda abaguli abanomhlaza. Ngexesha lonyango kuvavanyo lweklinikhi, ulwazi luyaqokelelwa malunga neziphumo zonyango olutsha kunye nokuba lusebenza njani. Ukuba uvavanyo lwezonyango lubonisa ukuba unyango olutsha lungcono kunolo lusetyenziswayo ngoku, unyango olutsha lunokuba "ngumgangatho." Izigulana zinokufuna ukucinga ngokuthatha inxaxheba kuvavanyo lweklinikhi. Olunye uvavanyo lwezonyango luvuleleke kuphela kwizigulana ezingaluqalanga unyango.

Uvavanyo lwezonyango lunokufumaneka kwi-Intanethi kwiwebhusayithi ye-NCI. Ngolwazi oluthe kratya, tsalela umnxeba i-Cancer Information Service (CIS), iziko loqhagamshelwano le-NCI, 1-800-4-CANCER (1-800-422-6237).

Imvume yokusebenzisa esi sishwankathelo

I- luphawu lwentengiso olubhalisiweyo. Umxholo wamaxwebhu e- unokusetyenziswa ngokukhululekileyo njengombhalo. Ayinakuchongwa njengesishwankathelo solwazi ngomhlaza se-NCI ngaphandle kokuba sonke isishwankathelo sibonisiwe kwaye sihlaziywa rhoqo. Nangona kunjalo, umsebenzisi uya kuvunyelwa ukuba abhale isivakalisi esifana nesithi "Isishwankathelo solwazi lomhlaza se-PDI malunga nesifo somhlaza wamabele sichaza umngcipheko ngale ndlela ilandelayo: [kubandakanya isicatshulwa kwisishwankathelo]."

Eyona ndlela yokuchaza esi sishwankathelo se zezi:

Imifanekiso kwesi sishwankathelo isetyenziswe ngemvume yombhali, yomculi, kunye / okanye yomshicileli ukuze isetyenziswe kwizishwankathelo ze kuphela. Ukuba ufuna ukusebenzisa umfanekiso kwisishwankathelo se kwaye awusebenzisi isishwankathelo esipheleleyo, kuya kufuneka ufumane imvume kumniniyo. Ayinakunikwa liZiko leSizwe loMhlaza. Ulwazi malunga nokusebenzisa imifanekiso kwesi sishwankathelo, kunye neminye imifanekiso emininzi enxulumene nomhlaza inokufumaneka kwiiVenkile ezikwi-Intanethi. Izinto ezibonwayo kwi-Intanethi yingqokelela yemifanekiso engaphezulu kwe-3,000 yesayensi.

Ukuziphendulela

Ulwazi olukuzi shwankathelo akufuneki lusetyenziselwe ukwenza izigqibo malunga nokubuyiselwa kwemali ye-inshurensi. Ulwazi oluthe kratya malunga ne-inshurensi luyafumaneka kwiCancer.gov kwiphepha lokuLawula uMhlaza.

Qhagamshelana nathi

Olunye ulwazi malunga nokunxibelelana nathi okanye ukufumana uncedo ngewebhusayithi yeCancer.gov inokufumaneka kuthi Nxibelelana nathi ngoncedo iphepha. Imibuzo ingangeniswa kwiCancer.gov ngokusebenzisa i-imeyile kuthi yewebhusayithi

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