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Unyango lweCancer Cancer yabantu abadala

Ulwazi ngokubanzi malunga nomhlaza wesibindi sabantu abadala

IINGONGOMA EZIPHAMBILI

• Umhlaza wesibindi sokuqala wabantu abadala sisifo apho iiseli ezibi (zomhlaza) zeeseli zenzeka kwizicubu zesibindi.

• Zimbini iintlobo zomhlaza wesibindi sokuqala.

• Ukuba ne-hepatitis okanye i-cirrhosis inokuchaphazela umngcipheko wesifo somhlaza esidala sesibindi.

• Iimpawu kunye neempawu zesifo somhlaza esidala sesibindi kubandakanya iqhuma okanye iintlungu kwicala lasekunene.

• Uvavanyo oluvavanya isibindi kunye negazi zisetyenziselwa ukukhangela (ukufumana) kunye nokuchonga umhlaza wesibindi sokuqala.

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

Umhlaza wesibindi sokuqala wabantu abadala sisifo apho iiseli ezibi (zomhlaza) zeeseli zenzeka kwizicubu zesibindi.

Isibindi lelinye lawona malungu makhulu emzimbeni. Inamacala amabini kwaye igcwalisa icala lasekunene lesisu ngaphakathi kwimbambo. Emithathu yemisebenzi emininzi ebalulekileyo yesibindi yile:

• Ukucoca izinto eziyingozi egazini ukuze zidluliswe zisuka emzimbeni kwilindle nasemchameni.

• Ukwenza i-bile yokunceda ukwetyisa amanqatha avela kukutya.

• Ukugcina i-glycogen (iswekile), esetyenziswa ngumzimba ukwenza amandla.

Umzimba wesibindi. Isibindi sisesiswini esingasentla kufuphi nesisu, amathumbu, i-gallbladder kunye ne-pancreas. Isibindi sine-lobe yasekunene kunye ne-lobe yasekhohlo. I-lobe nganye yahlulwe yangamacandelo amabini (ayiboniswanga).

Zimbini iintlobo zomhlaza wesibindi sokuqala.

Ezi ntlobo zimbini zomhlaza wesibindi esisisiseko kubantu abadala zezi:

• I-hepatocellular carcinoma.

• I-Cholangiocarcinoma (umhlaza womhlaza wenyongo). (Jonga isishwankathelo se- kwi-Bile Duct Cancer (Cholangiocarcinoma) Unyango ngolwazi oluthe kratya.)

Olona hlobo luqhelekileyo lomhlaza wesibindi esisisiseko sabantu abadala yi-hepatocellular carcinoma. Olu hlobo lomhlaza wesibindi ngunobangela wesithathu ophambili wokusweleka okunxulumene nomhlaza kwihlabathi liphela.

Esi sishwankathelo simalunga nokunyangwa komhlaza wokuqala wesibindi (umhlaza oqala esibindini). Unyango lomhlaza oluqala kwamanye amalungu omzimba kwaye lusasazeka esibindini alugutyungelwanga kwesi sishwankathelo.

Umhlaza wesibindi wokuqala unokwenzeka kubantu abadala nakubantwana. Nangona kunjalo, unyango lwabantwana lwahlukile kunonyango lwabantu abadala. (Jonga isishwankathelo se kunyango lomhlaza kwisibindi sabantwana ngolwazi oluthe kratya.)

Ukuba ne-hepatitis okanye i-cirrhosis inokuchaphazela umngcipheko wesifo somhlaza esidala sesibindi.

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 usengozini yomhlaza wesibindi.

Imiba yomngcipheko wesifo somhlaza wesibindi ibandakanya oku kulandelayo:

• Ukuba ne-hepatitis B okanye usulelo lwe-hepatitis C. Ukuba ne-hepatitis B kunye ne-hepatitis C kwandisa umngcipheko ngakumbi.

Ukuba nesibindi.

• Ukusetyenziswa kotywala kakhulu. Ukusetyenziswa kotywala kakhulu kunye nosulelo lwe-hepatitis B lonyusa umngcipheko ngakumbi.

• Ukutya ukutya okutyhefe nge-aflatoxin (ityhefu evela kwifungus enokukhula ekutyeni, okufana neenkozo namandongomane, okungagcinwanga ngokufanelekileyo).

• Ukuba ne-nonatoxic steatohepatitis (NASH), imeko apho amanqatha akhula khona esibindini kwaye inokuqhubela phambili kukudumba kwesibindi kunye nomonakalo weseli yesibindi.

• Sebenzisa icuba, njengokutshaya icuba.

• Ukuba neengxaki ezithile ezizuze njengelifa okanye ezinqabileyo ezonakalisa isibindi, kubandakanya oku kulandelayo:

• I-hemochromatosis yelifa, isifo esizuzwe njengelifa apho umzimba ugcina khona intsimbi engaphezulu kunaleyo uyifunayo. Isinyithi esongezelelweyo sigcinwa ikakhulu esibindini, entliziyweni, kwipancreas, kulusu kunye nakumalungu.

• Ukusilela kwe-alpha-1 antitrypsin, isifo esizuzwe njengelifa esinokubangela isifo sesibindi nemiphunga.

• Isifo sokugcina iGlycogen, sisifo esifa njengelifa apho kukho iingxaki ngendlela ifom yeswekile (iswekile) ebizwa ngokuba yi-glycogen egcinwe kwaye isetyenziswe emzimbeni.

• I-Porphyria cutanea tarda, isifo esinqabileyo esichaphazela ulusu kunye nesibetho esibuhlungu kumalungu omzimba abekwe elangeni, njengezandla, iingalo nobuso. Iingxaki zesibindi zinokwenzeka.

• Isifo sikaWilson, isifo esinqabileyo esifa njengelifa apho umzimba ugcina ubhedu oluninzi kunokuba ludinga. Ubhedu olongezelelweyo lugcinwa esibindini, kwingqondo, emehlweni nakwamanye amalungu.

Ukwaluphala yeyona nto iphambili kumngcipheko womhlaza. Ithuba lokufumana umhlaza liyonyuka njengokuba usiya ukhula.

Iimpawu kunye neempawu zesifo somhlaza esidala sesibindi kubandakanya iqhuma okanye iintlungu kwicala lasekunene.

Ezi kunye neminye imiqondiso kunye neempawu zinokubangelwa ngumhlaza wesibindi wokuqala okanye ezinye iimeko. Jonga ugqirha wakho ukuba unayo nayiphi na kwezi zinto zilandelayo:

• Isigaxa esilukhuni kwicala lasekunene ngezantsi nje kokhokho.

• Ukuphazamiseka kwisisu esingaphezulu kwicala lasekunene.

• Isisu esidumbileyo.

• Intlungu ecaleni kwegxalaba lasekunene okanye ngasemva.

• IJaundice (ukuba tyheli kolusu kunye namhlophe ngamehlo).

• Ukutyumza okulula okanye ukopha.

• Ukudinwa okungaqhelekanga okanye ubuthathaka.

• Isicaphucaphu nokugabha.

• Ukuphelelwa ngumdla wokutya okanye uvakalelo lokugcwala emva kokutya isidlo esincinci.

• Ukwehla kwesisindo ngaphandle kwesizathu esaziwayo.

• Pale, ukushukuma kokuhamba kwamathumbu kunye nomchamo omnyama.

• Ifiva.

Uvavanyo oluvavanya isibindi kunye negazi zisetyenziselwa ukukhangela (ukufumana) kunye nokuchonga umhlaza wesibindi sokuqala.

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 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. Inqanaba elonyukayo le-alpha-fetoprotein (AFP) egazini linokuba luphawu lomhlaza wesibindi. Eminye imihlaza kunye neemeko ezithile ezingenabungozi, kubandakanya i-cirrhosis kunye ne-hepatitis, zinokunyusa amanqanaba e-AFP. Ngamanye amaxesha inqanaba le-AFP liqhelekile nokuba kukho umhlaza wesibindi.

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

• Ukuskena i-CT (ukuskena i-CAT): Inkqubo eyenza uthotho lwemifanekiso eneenkcukacha zeendawo ezingaphakathi emzimbeni, ezinje ngesisu, esithathwe 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 yicompography tomography, ikhompyuter yeTomography, okanye ikhompyuter ye-axial tomography Imifanekiso ingathathwa ngamaxesha amathathu ahlukeneyo emva kokuba idayi ifakiwe, ukufumana owona mfanekiso ubalaseleyo weendawo ezingaqhelekanga esibindini. Oku kubizwa ngokuba yi-CT yesigaba esithathu. I-spiral okanye i-helical CT scan yenza uthotho lwemifanekiso eneenkcukacha zeendawo ezingaphakathi komzimba usebenzisa umatshini we-x-ray ojonga umzimba kwindlela ejikelezayo.

• 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). Ukwenza imifanekiso eneenkcukacha zemithambo yegazi ngaphakathi nakufuphi nesibindi, idayi iyafakwa emthanjeni. Le nkqubo ibizwa ngokuba yi-MRA (magnetic resonance angiography). Imifanekiso ingathathwa ngamaxesha amathathu ahlukeneyo emva kokuba idayi ifakiwe, ukufumana owona mfanekiso ubalaseleyo weendawo ezingaqhelekanga esibindini. Oku kubizwa ngokuba yi-MRI yesigaba esithathu.

• 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.

• Biopsy: Ukususwa kweeseli okanye izicwili ukuze zijongwe ngemicroscope ngugqirha wezilwanyana ukujonga imiqondiso yomhlaza. Iinkqubo ezisetyenziselwa ukuqokelela isampulu yeeseli okanye izicwili zibandakanya oku kulandelayo:

• Fine-inaliti aspiration biopsy: Ukususwa kweeseli, izicwili okanye ulwelo kusetyenziswa inaliti ebhityileyo.

• Iinaliti eziphambili: Ukususwa kweeseli okanye izicwili kusetyenziswa inaliti ebanzi kancinane.

• 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. Esinye isixhobo sifakwa ngendlela enye okanye enye yokususa iisampulu zethishu.

I-biopsy ayisoloko ifuneka ukuze kufunyaniswe isifo somhlaza wesibindi sokuqala.

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

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

• Inqanaba lomhlaza (ubukhulu besisu, nokuba sichaphazela inxenye okanye sonke isibindi, okanye sinwenwele nakwezinye iindawo emzimbeni).

• Isibindi sisebenza kakuhle kangakanani.

• Impilo yomguli ngokubanzi, kubandakanya nokuba kukho isifo sesibindi.

Amanqanaba eCancer Cancer yabantu abadala

IINGONGOMA EZIPHAMBILI

• Emva kokuba kufunyenwe isifo somhlaza wesibindi sokuqala, kuvavanywa ukwenziwa ukufumanisa ukuba ngaba iiseli zomhlaza zisasazekile ngaphakathi kwesibindi okanye kwamanye amalungu omzimba.

• Zintathu iindlela umhlaza onwenwa ngayo emzimbeni.

• Umhlaza unokusasazeka ukusuka apho waqala khona kwamanye amalungu omzimba.

• Inkqubo yokuGcinwa kweCancer yeBarcel Clinic inokusetyenziselwa ukubeka umhlaza kubantu abadala abadala.

• La maqela alandelayo asetyenziselwa ukucwangcisa unyango.

• Amanqanaba e-BCLC 0, A, kunye no-B

• Amanqanaba e-BCLC C no-D

Emva kokuba kufunyenwe isifo somhlaza wesibindi sokuqala, kuvavanywa ukwenziwa ukufumanisa ukuba ngaba iiseli zomhlaza zisasazekile ngaphakathi kwesibindi okanye kwamanye amalungu omzimba.

Inkqubo esetyenziselwa ukufumanisa ukuba ngaba umhlaza usasazekile esibindini okanye kwamanye amalungu omzimba kuthiwa yistage. Ulwazi oluqokelelwe kwinkqubo yokubeka inqanaba lesifo. Kubalulekile ukwazi inqanaba ukuze ucwangcise unyango. Ezi mvavanyo zilandelayo kunye neenkqubo zinokusetyenziswa kwinkqubo yokubeka esiteji:

• Ukuskena i-CT (ukuskena i-CAT): Inkqubo eyenza uthotho lwemifanekiso eneenkcukacha zeendawo ezingaphakathi emzimbeni, ezinje ngesifuba, isisu, kunye nesinqe, 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 yi-computed tomography, ikhompyuter ye-tomography, okanye ikhompyuter ye-axial tomography.

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

• 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.

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. 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 wokuqala wesibindi usasazeka emiphungeni, iiseli zomhlaza emiphungeni ziiseli zomhlaza wesibindi. Esi sifo sisifo somhlaza wesibindi, hayi umhlaza wemiphunga.

Inkqubo yokuGcinwa kweCancer yeBarcel Clinic inokusetyenziselwa ukubeka umhlaza kubantu abadala abadala.

Kukho iinkqubo ezininzi zokubeka umhlaza wesibindi. Inkqubo yeStage yeCancer Barcelona Cancer Cancer (BCLC) isetyenziswa ngokubanzi kwaye ichazwe ngezantsi. Le nkqubo isetyenziselwa ukuqikelela ithuba lesigulana lokuchacha kunye nokucwangcisa unyango, ngokusekwe koku kulandelayo:

• Nokuba umhlaza usasazekile esibindini okanye kwamanye amalungu omzimba.

• Isibindi sisebenza kakuhle kangakanani.

• Impilo kunye nokuphila kakuhle kwesigulana.

• Iimpawu ezibangelwa ngumhlaza.

Inkqubo yokubeka i-BCLC inezigaba ezintlanu:

• Inqanaba 0: Kwangoko kakhulu

• Inqanaba A: Kwangoko

• IBakala B: Ephakathi

• Inqanaba C: Phambili

• Inqanaba D: Inqanaba lokugqibela

La maqela alandelayo asetyenziselwa ukucwangcisa unyango.

Amanqanaba e-BCLC 0, A, kunye no-B

Unyango lokunyanga umhlaza lunikwa amanqanaba e-BCLC 0, A, kunye no-B.

Amanqanaba e-BCLC C no-D

Unyango lokuphelisa iimpawu ezibangelwa ngumhlaza wesibindi kunye nokuphucula umgangatho wobomi wesigulana unikwa amanqanaba e-BCLC C no-D. Unyango alunakho ukunyanga umhlaza.

Umhlaza wamanqindi wabantu abadala aQalayo

Umhlaza ophindaphindiweyo wesifo sabantu abadala ngumhlaza ophindaphindiweyo (ubuyile) emva kokuba unyangwe. Umhlaza ungabuya ubuye esibindini okanye kwamanye amalungu omzimba.

Unyango ngoKhetho lonyango

IINGONGOMA EZIPHAMBILI

• Kukho iintlobo ezahlukeneyo zonyango kwizigulana ezinomhlaza wesibindi wokuqala wesibindi.

• Izigulana ezinomhlaza wesibindi ziphathwa liqela leengcali eziziingcali kunyango lomhlaza wesibindi.

• Iindidi ezisibhozo zonyango olusemgangathweni zisetyenziswa:

• Ukujonga

• Ugqirha

• Ukufakelwa kwesibindi

• Unyango lwe-Ablation

• Unyango lokudibanisa

• Unyango ekujoliswe kulo

• Unyango lwe-Immunotherapy

• Unyango ngemitha

• Iindidi ezintsha zonyango ziyavavanywa kuvavanyo lweklinikhi.

• Unyango lomhlaza wesibindi wokuqala wesidala kunokubangela 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 ezinomhlaza wesibindi wokuqala wesibindi.

Iindidi ezahlukeneyo zonyango ziyafumaneka kwizigulana ezinomhlaza wesibindi wokuqala wesibindi. 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.

Izigulana ezinomhlaza wesibindi ziphathwa liqela leengcali eziziingcali kunyango lomhlaza wesibindi.

Unyango lwesigulana luya kujongwa ngugqirha oncologist, ugqirha ogxile ekunyangeni abantu abanomhlaza. Ugqirha wezonyango onokuthi athumele isigulana kwabanye oochwephesha abaqeqeshiweyo ekunyangeni abaguli abanomhlaza wesibindi. Oku kunokubandakanya ezi ngcali zilandelayo:

• I-hepatologist (ingcali yesifo sesibindi).

• Oncologist yotyando.

• Ugqirha wotyando.

• Imitha ye-oncologist.

• I-radiologist engenelela (ingcali efumanisa kwaye inyanga izifo isebenzisa imaging kunye nezona zinto zincinci zinokwenzeka).

• Ugqirha wezifo.

Iindidi ezisibhozo zonyango olusemgangathweni zisetyenziswa:

Ukujonga

Ukujongwa kwezilonda ezincinci kune-1 sentimitha efunyenwe ngexesha lokujonga. Ukulandelelwa rhoqo kwiinyanga ezintathu kuqhelekile.

Utyando Inxenye ye-hepatectomy (utyando lokususa inxenye yesibindi apho umhlaza ufumaneka khona) inokwenziwa. Isuntswana leethishu, i-lobe epheleleyo, okanye indawo enkulu yesibindi, kunye nezinye izicwili ezisempilweni ziyasuswa. Izicubu zesibindi eseleyo zithatha imisebenzi yesibindi kwaye zinokuphinda zibuye.

Ukufakelwa kwesibindi

Kufakelo lwesibindi, isibindi sonke siyasuswa kwaye kufakwe isibindi esisempilweni esisikelweyo. Ukufakelwa kwesibindi kunokwenziwa xa isifo sisesibindi kuphela kwaye isibindi esinikezelweyo sinokufunyanwa. Ukuba isigulana kufuneka silinde isibindi esinikelwe, olunye unyango luyanikwa xa kufuneka njalo.

Unyango lwe-Ablation

Unyango lwe-Ablation lususa okanye lutshabalalise izicwili. Iindidi ezahlukeneyo zonyango lokunyanga zisetyenziselwa umhlaza wesibindi:

• Ukurhoxiswa kweRadiofrequency: Ukusetyenziswa kweinaliti ezizodwa ezifakwe ngqo kulusu okanye ngokusebenzisa isisu esiswini ukufikelela kwisisu. Amandla amaza erediyo aphezulu afudumeza iinaliti kunye nethumba elibulala iiseli zomhlaza.

• Unyango lweMicrowave: Uhlobo lonyango apho ithumba libonakaliswe kubushushu obuphezulu obenziwe zii-microwave. Oku kungonakalisa kwaye kubulale iiseli zomhlaza okanye kuzenze zibuthathaka ngakumbi kwiziphumo zemitha kunye neziyobisi ezithile ze-anticancer.

• Inaliti ye-ethanol: Unyango lomhlaza apho inaliti encinci isetyenziselwa ukutofa i-ethanol (utywala obusulungekileyo) ngqo kwisisu sokubulala iiseli zomhlaza. Unyango oluninzi lunokufuneka. Ngokwesiqhelo kusetyenziswa i-anesthesia yendawo, kodwa ukuba isigulana sinamathumba amaninzi esibindini, i-anesthesia ngokubanzi inokusetyenziswa.

• Cryoablation: Unyango olusebenzisa isixhobo ukukhenkcezisa kunye nokutshabalalisa iiseli zomhlaza. Olu hlobo lonyango lukwabizwa ngokuba yi-cryotherapy kunye ne-cryosurgery. Ugqirha unokusebenzisa i-ultrasound ukukhokela isixhobo.

• Unyango lwe-Electroporation: Unyango oluthumela iimpompo zombane nge-electrode efakwe kwithumba ukubulala iiseli zomhlaza. Unyango lokunyanga umbane luyafundwa kuvavanyo lweklinikhi.

Unyango lokudibanisa

Unyango lokudibanisa kukusetyenziswa kwezinto ukuvimba okanye ukunciphisa ukuhamba kwegazi nge-hepatic artery to the tumor. Xa ithumba lingayifumani ioksijini kunye nezakhamzimba eziyifunayo, alizukuqhubeka nokukhula. Unyango lwe-embolization lusetyenziselwa abaguli abangakwaziyo ukwenza utyando ukususa ithumba okanye unyango lwe-ablation kwaye isisu sayo asinwenwanga ngaphandle kwesibindi.

Isibindi sifumana igazi kwi-hepatic portal vein kunye ne-hepatic artery. Igazi elingena esibindini lisuka kumthambo we-portatic vein lihlala lisiya kwizicwili ezinesibindi. Igazi eliphuma kwimithambo ye-hepatic lidla ngokuya kwi-tumor. Xa umthambo we-hepatic uvaliwe ngexesha lonyango lokuqinisa, izicwili ezinesibindi zisempilweni ziyaqhubeka nokufumana igazi kwi-hepatic portal vein.

Zimbini iintlobo eziphambili zonyango lokunyanga:

• Ukudityaniswa kweTransarterial (TAE): Ukusikwa okuncinci (ukusikwa) kwenziwa kwithanga langaphakathi kunye necatheter (ityhubhu ecekeceke, eguqukayo) ifakwe kwaye ifakwe kumjelo we-hepatic. Nje ukuba i-catheter ibekhona, into ethintela umthambo we-hepatic kwaye iyeke ukuhamba kwegazi kwi-tumor itofwe.

• I-transmoverial chemoembolization (TACE): Le nkqubo ifana ne-TAE ngaphandle kwesiyobisi se-anticancer. Inkqubo inokwenziwa ngokuncamathisela ichiza le-anticancer kumaso amancinci atofelweyo kwimithambo ye-hepatic okanye ngokufaka inaliti ye-anticancer nge-catheter kumthambo we-hepatic emva koko utofe into ukuvimba umthambo we-hepatic. Uninzi lweziyobisi ze-anticancer zibanjelwe kufutshane nethumba kwaye kuphela sisixa esincinci sesiyobisi esifikelela kwamanye amalungu omzimba. Olu hlobo lonyango lubizwa ngokuba yi-chemoembolization.

Unyango ekujoliswe kulo

Unyango ekujoliswe kulo lunyango olusebenzisa iziyobisi okanye ezinye izinto ukuchonga nokuhlasela iiseli ezithile zomhlaza ngaphandle kokonakalisa iiseli eziqhelekileyo. I-Tyrosine kinase inhibitors luhlobo lonyango ekujoliswe kulo olusetyenziswa kunyango lomhlaza wesibindi sokuqala.

I-Tyrosine kinase inhibitors ngamachiza amancinci eemolekyuli ahamba ngenwebu yeseli kwaye asebenze ngaphakathi kwiiseli zomhlaza ukuvimba imiqondiso yokuba iiseli zomhlaza kufuneka zikhule kwaye zahlule. Ezinye i-tyrosine kinase inhibitors zikwanazo neziphumo ze-angiogenesis inhibitor. I-Sorafenib, i-lenvatinib, kunye ne-regorafenib ziindidi ze-tyrosine kinase inhibitors.

Jonga iziyobisi ezivunyiweyo zomhlaza wesibindi ngolwazi oluthe kratya.

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.

Unyango lwe-immune checkpoint inhibitor luhlobo lwe-immunotherapy.

• Unyango lwe-immune checkpoint inhibitor: 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. I-Nivolumab luhlobo lwe-immune checkpoint inhibitor.

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).

Jonga iziyobisi ezivunyiweyo zomhlaza wesibindi 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. Iindlela ezithile zokunika unyango ngemitha kunokunceda ukugcina imitha ingonakalisi izicubu ezisempilweni ezikufutshane. Ezi ntlobo zonyango lwangaphandle lwemitha zibandakanya oku kulandelayo:

• Unyango lwe-radiation oluguquguqukayo: Unyango lwe-radiation oluguquguqukayo luhlobo lonyango lwangaphandle lwemitha olusebenzisa ikhompyuter ukwenza umfanekiso we-3-dimensional (3-D) yesisu kunye nokuma kwemitha yemitha ukuze ilingane nethumba. Oku kuvumela idosi ephezulu yemitha ukuba ifikelele kwithumba kwaye ibangele umonakalo omncinci kwizicubu ezisempilweni ezikufutshane.

• Unyango lwe-stereotactic radiation: Unyango lwe-stereotactic radiation luhlobo lonyango lwangaphandle lwemitha. Izixhobo ezikhethekileyo zisetyenziselwa ukubeka isigulana kwindawo enye kunyango ngalunye lwemitha. Kanye ngemini kangangeentsuku ezininzi, umatshini wemitha ujolise kwidosi enkulu kunesiqhelo yemitha ngokuthe ngqo kwi-tumor. Ngokuba nesigulana kwindawo efanayo kunyango ngalunye, akukho monakalo mncinci kwizicubu ezisempilweni ezikufutshane. Le nkqubo ikwabizwa ngokuba yinyango ye-stereotactic yangaphandle ye-radiation kunye nonyango lwe-stereotaxic radiation.

• Unyango lwe-Proton beam radiation: Unyango lwe-Proton-beam 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 etywinwe kwiinaliti, iimbewu, iingcingo, okanye iicatheters ezibekwe ngqo okanye kufutshane nomhlaza.

Indlela unyango lwe-radiation olunikezelwa ngayo ixhomekeke kuhlobo kunye nenqanaba lomhlaza ophathwayo. Unyango lwangaphandle lwemitha lusetyenziselwa ukunyanga abantu abadala abanomdlavuza wesibindi.

Iindidi ezintsha zonyango ziyavavanywa kuvavanyo lweklinikhi.

Ulwazi malunga novavanyo lweklinikhi luyafumaneka kwiwebhusayithi yeNCI.

Unyango lomhlaza wesibindi wokuqala wesidala kunokubangela 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 lweCancer Cancer yabantu abadala

Kweli Candelo

• Amanqanaba 0, A, kunye no-B abaDala abaPrayimari beSibindi

• Amanqanaba C kunye no-D abaDala abaPrayimari beSibindi

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

Amanqanaba 0, A, kunye no-B abaDala abaPrayimari beSibindi

Unyango lwamanqanaba e-0, A, kunye no-B abadala abanomdlavuza wesibindi unokubandakanya oku kulandelayo:

• Ukujongwa kwezilonda ezincinci kune-1 sentimitha.

• Inxalenye ye-hepatectomy.

• Iyonke i-hepatectomy kunye nokufakelwa kwesibindi.

• Ukurhoxiswa kwethumba kusetyenziswa enye yezi ndlela zilandelayo:

• Ukupheliswa kwemitha rhoqo.

• Unyango lweMicrowave.

• Inaliti yeethanol.

• Cryoablation.

• Uvavanyo lweklinikhi yonyango lwe-electroporation.

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.

Amanqanaba C kunye no-D abaDala abaPrayimari beSibindi

Unyango lwenqanaba C kunye no-D lomhlaza wesibindi wokuqala ungabandakanya oku kulandelayo:

• Unyango lokudibanisa usebenzisa enye yezi ndlela zilandelayo:

• Ukudityaniswa kweTransterterial embolization (TAE).

• Ukutshintsha kwemeko yovuyo (chemoembolization) (TACE).

• Unyango olujolise kwi-tyrosine kinase inhibitor.

• Unyango lwe-Immunotherapy.

• Unyango ngemitha.

• Uvavanyo lweklinikhi yonyango ekujolise kulo emva kwe-chemoembolization okanye ngokudityaniswa ne-chemotherapy.

• Uvavanyo lweklinikhi yamayeza amatsha ekujoliswe kuwo.

• Uvavanyo lwezonyango lwe-immunotherapy.

• Uvavanyo lweklinikhi lwe-immunotherapy edibene nonyango ekujoliswe kulo.

• Uvavanyo lweklinikhi yonyango lwemitha ye-stereotactic okanye unyango lwe-proton-beam radiation.

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.

Unyango lweCancer Cancer yaBantu abaDala abaDala

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

Ukhetho kunyango lomhlaza ophindaphindiweyo wesifo somhlaza sesibindi sinokubandakanya oku kulandelayo:

• Iyonke i-hepatectomy kunye nokufakelwa kwesibindi.

• Inxalenye ye-hepatectomy.

• Ukunciphisa

• I-transmoversion chemoembolization kunye nonyango olujolisiweyo kunye ne-sorafenib, njengonyango lokuthomalalisa iimpawu kunye nokuphucula umgangatho wobomi.

• Uvavanyo lweklinikhi yonyango olutsha.

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 nomhlaza wesibindi sabantu abadala

Ngolwazi oluthe kratya kwiZiko leSizwe loMhlaza malunga nomhlaza wesibindi esisisiseko sabantu abadala, bona oku kulandelayo:

• Iphepha lasekhaya lesifo somhlaza kunye nesibilini

• Isibindi (iHepatocellular) Uthintelo lomhlaza

• Isibindi (iHepatocellular) Ukuvavanywa komhlaza

• I-Cryosurgery kunyango lweCancer

• Iziyobisi ezivunyiweyo zomhlaza wesibindi

• Iithagethi zoMhlaza ezijolise kuko

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