Iindidi / i-lymphoma / isigulana / unyango olunxulumene noncedo-pdq

Unyango olunxulumene noGawulayo lweLymphoma (®) -Unguqulelo lwesigulana

Ulwazi ngokubanzi malunga ne-Lymphoma enxulumene noGawulayo

IINGONGOMA EZIPHAMBILI

• I-lymphoma enxulumene noGawulayo sisifo apho umhlaza (umhlaza) weeseli zenzeka kwinkqubo ye-lymph yezigulana ezifumene isifo se-immunodeficiency syndrome (i-AIDS).

• Zininzi iintlobo ezahlukeneyo zelymphoma.

• Iimpawu ze-lymphoma ezinxulumene noGawulayo ziquka ukulahleka kwesisindo, umkhuhlane kunye nokujuluka ebusuku.

• Uvavanyo oluvavanya inkqubo ye-lymph kunye namanye amalungu omzimba asetyenziselwa ukunceda ukufumana (ukufumana) kunye nokuchonga i-lymphoma enxulumene noGawulayo.

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

I-lymphoma enxulumene noGawulayo sisifo apho umhlaza (umhlaza) weeseli zenzeka kwinkqubo ye-lymph yezigulana ezifumene isifo se-immunodeficiency syndrome (i-AIDS).

UGAWULAYO ​​ubangelwa yintsholongwane (i-HIV), ehlasela yenze buthathaka amajoni omzimba. Amajoni omzimba abuthathaka akakwazi ukulwa nosulelo kunye nezifo. Abantu abanesifo se-HIV banomngcipheko owandayo wosulelo kunye ne-lymphoma okanye ezinye iintlobo zomhlaza. Umntu one-HIV kunye neentlobo ezithile zosulelo okanye umhlaza, njenge-lymphoma, ufunyaniswa ukuba une-AIDS. Ngamanye amaxesha, abantu bafumanisa ukuba bane-AIDS kunye ne-lymphoma enxulumene ne-AIDS ngaxeshanye. Ngolwazi malunga ne-AIDS kunye nonyango lwayo, nceda ubone iwebhusayithi ye-AIDSinfo.

I-lymphoma enxulumene noGawulayo luhlobo lomhlaza oluchaphazela inkqubo ye-lymph. Inkqubo ye-lymph yinxalenye yenkqubo yomzimba yokuzikhusela. Inceda ukukhusela umzimba kusulelo nakwizifo.

Inkqubo ye-lymph yenziwe ngezi zinto zilandelayo:

• Lymph: Umbala, ulwelo olunamanzi oluhamba ngemithambo ye-lymph kwaye luphethe ii-lymphocyte ze-T kunye ne-B. IiLymphocyte ziluhlobo lweeseli ezimhlophe zegazi.

• Imikhumbi ye-Lymph: Uthungelwano lweetyhubhu ezibhityileyo eziqokelela i-lymph kwiindawo ezahlukeneyo zomzimba kwaye ziyibuyisele kwigazi.

• Iimpawu zeLymph: ezincinci, ezimilise ubhontshisi ezicoca ulusu kwaye zigcine iiseli ezimhlophe zegazi ezinceda ukulwa usulelo kunye nezifo. Iimpawu ze-lymph zifunyenwe kunye nenethiwekhi yemithambo ye-lymph kuwo wonke umzimba. Amaqela e-lymph node afunyanwa entanyeni, ngaphantsi kwekhwapha, kwi-mediastinum, kwisisu, kwi-pelvis, nakwi-groin.

• I-Spleen: Ilungu elenza ii-lymphocyte, ligcina iiseli ezibomvu zegazi kunye nee-lymphocyte, zihluza igazi, zitshabalalise iiseli zegazi ezindala. I-spleen ikwicala lasekhohlo lesisu kufutshane nesisu.

• I-Thymus: Ilungu apho ii-lymphocyte ze-T zikhula kwaye zanda. I-thymus isesifubeni emva kwethambo lesifuba.

• Iitoni: Amabini amancinci amancinci e-lymph emva komqala. Kukho itoni enye kwicala ngalinye lomqala.

• Umongo wethambo: Isithambo esithambileyo, esinesiponji embindini wamathambo athile, anjengethambo lesinqe kunye nethambo lesifuba. Iiseli ezimhlophe zegazi, iiseli ezibomvu zegazi, kunye neeplatelets zenziwe kumongo wethambo.

Izicubu zeLymph ziyafumaneka nakwezinye iindawo zomzimba ezinje ngengqondo, isisu, idlala lengqula kunye nolusu.

Ngamanye amaxesha i-lymphoma enxulumene noGawulayo ivela ngaphandle kwe-lymph nodes kumongo wethambo, isibindi, i-meninges (iimbumba ezincinci ezigubungela ubuchopho) kunye neendlela zesisu. Ngaphantsi kakhulu, inokwenzeka kwi-anus, intliziyo, i-bile duct, i-gingiva, kunye nezihlunu.

I-Anatomy yenkqubo ye-lymph, ebonisa iinqanawa ze-lymph kunye nezitho ze-lymph ezibandakanya i-lymph nodes, i-tonsils, i-thymus, i-spleen kunye nomongo wethambo. I-Lymph (i-fluid ecacileyo) kunye nee-lymphocyte zihamba kwiinqanawa ze-lymph nakwii-lymph nodes apho i-lymphocytes zitshabalalisa izinto ezinobungozi. I-lymph ingena egazini ngomthambo omkhulu kufutshane nentliziyo.

Zininzi iintlobo ezahlukeneyo zelymphoma.

IiLymphomas zahlulwe zaziindidi ezimbini ngokubanzi:

• IHodgkin lymphoma.

• I-non-Hodgkin lymphoma.

Zombini i-non-Hodgkin lymphoma kunye ne-Hodgkin lymphoma zinokwenzeka kwizigulana ezine-AIDS, kodwa i-non-Hodgkin lymphoma ixhaphake kakhulu. Xa umntu one-AIDS ene-non-Hodgkin lymphoma, ibizwa ngokuba yi-lymphoma enxulumene noGawulayo. Xa i-lymphoma enxulumene noGawulayo ivela kwinkqubo ye-nervous system (CNS), ibizwa ngokuba yi-CNS lymphoma.

I-non-Hodgkin lymphomas ziqokelelwe ngendlela iiseli zazo ezibukeka ngayo phantsi kwemicroscope. Banokuba ngamavila (ukukhula kancinci) okanye ukuba ndlongondlongo (ukukhula ngokukhawuleza). Ii-lymphomas ezinxulumene noGawulayo zinoburharha. Zimbini iintlobo eziphambili ze-AIDS engeyiyo iHodgkin lymphoma:

• Ukusasaza i-B-cell lymphoma enkulu (kubandakanya iB-cell cell immunoblastic lymphoma).

• Burkitt okanye iBurkitt-efana ne-lymphoma.

Ngolwazi oluthe kratya malunga ne-lymphoma okanye i-cancer enxulumene noGawulayo, jonga oku kulandelayo:

• Unyango lwabantu abadala abanga-Hodgkin Lymphoma

• Unyango lwe-Hodgkin Lymphoma yoBuntwana

• Unyango lwe-CNS lweLymphoma

• Unyango lweKaposi Sarcoma

Iimpawu ze-lymphoma ezinxulumene noGawulayo ziquka ukulahleka kwesisindo, umkhuhlane kunye nokujuluka ebusuku.

Ezi kunye nezinye iimpawu kunye neempawu zingabangelwa yi-lymphoma ehlobene noGawulayo okanye ngezinye iimeko. Jonga ugqirha wakho ukuba unayo nayiphi na kwezi zinto zilandelayo:

• Ukwehla kobunzima okanye umkhuhlane ngaphandle kwesizathu esaziwayo.

• Ukubila ebusuku.

• Iintlungu ezingenantlungu, i-lymph nodes edumbileyo entanyeni, esifubeni, ngaphantsi kwekhwapha, okanye kwi-groin.

• Imvakalelo yokugcwala ezantsi kweembambo.

Uvavanyo oluvavanya inkqubo ye-lymph kunye namanye amalungu omzimba asetyenziselwa ukunceda ukufumana (ukufumana) kunye nokuchonga i-lymphoma enxulumene noGawulayo.

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 yempilo yesigulana, kubandakanya umkhuhlane, ukubila ebusuku, kunye nokwehla kwesisindo, imikhwa yezempilo, kunye nezifo zangaphambili kunye nonyango ziya kuthathwa.

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

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

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

• Inxalenye yesampulu eyenziwe ngeeseli ezibomvu zegazi.

Gcwalisa ubalo lwegazi (CBC). Igazi liqokelelwa ngokufaka inaliti emthanjeni kwaye livumele igazi ukuba lingene kumbhobho. Isampulu yegazi ithunyelwa elebhu kwaye iiseli ezibomvu zegazi, iiseli ezimhlophe zegazi kunye neeplatelets kubalwa. I-CBC isetyenziselwa ukuvavanya, ukufumanisa isifo, kunye nokubeka iliso kwiimeko ezininzi ezahlukeneyo.

• 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 lwe-LDH: Inkqubo apho kuvavanywa isampulu yegazi ukulinganisa isixa se-lactic dehydrogenase. Inani elonyukayo le-LDH egazini linokuba luphawu lomonakalo wethishu, i-lymphoma, okanye ezinye izifo.

• Uvavanyo lwe-Hepatitis B kunye nohlobo lwe-hepatitis C: Inkqubo apho kuvavanywa isampuli yegazi ukulinganisa izixa ze-antigen ezithile ze-hepatitis B kunye / okanye ii-antibodies kunye nezixa ezithile ze-hepatitis C. Ezi antijeni okanye izilwa-buhlungu kuthiwa ziziphawuli. Iimpawu zokumakisha ezahlukeneyo okanye indibaniselwano yamakishi zisetyenziselwa ukumisela ukuba ngaba isigulana sinesifo se-hepatitis B okanye i-C, sinokosulelwa ngaphambili okanye isitofu sokugonya, okanye sisengozini yosulelo.

• Uvavanyo lwe-HIV: Uvavanyo lokulinganisa inqanaba leentsholongwane ze-HIV kwisampulu yegazi. Ii-antibodies zenziwa ngumzimba xa uhlaselwe yinto yasemzini. Inqanaba eliphezulu lee-antibodies ze-HIV linokuthetha ukuba umzimba wosulelwe yi-HIV.

• Ukuskena i-CT (ukuskena i-CAT): Inkqubo eyenza uthotho lwemifanekiso eneenkcukacha zeendawo ezingaphakathi emzimbeni, ezinjengentamo, isifuba, isisu, isinqe, kunye ne-lymph node, ezithathwe kwiiangile 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.

• 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.

• Umnqweno wethambo kunye ne-biopsy: Ukususwa komongo wethambo kunye neqhekeza elincinci lokufaka inaliti engenamathambo kwi-hipbone okanye kwi-breastbone. Ugqirha wezifo ujonga umongo wethambo kunye nethambo phantsi kwemicroscope ukukhangela iimpawu zomhlaza.

Umnqweno wethambo lomnqweno kunye ne-biopsy. Emva kokuba indawo encinci yolusu iphonyiwe, inaliti yomongo wethambo ifakwa kwisithambo sethambo lesigulana. Iisampulu zegazi, ithambo, kunye nomongo wethambo ziyasuswa ukuze zihlolwe phantsi kwemicroscope.

• I-lymph node biopsy: Ukususwa kwayo yonke into okanye inxalenye ye-lymph node. Ugqirha wezifo ujonga izicwili phantsi kwemicroscope ukukhangela iiseli zomhlaza. Enye yezi ndlela zilandelayo zinokwenziwa:

• I-biopsy ekhethekileyo: Ukususwa kwe-lymph node yonke.

• Incinci ye-biopsy: Ukususwa kwenxalenye ye-lymph node.

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

Eminye imimandla yomzimba, enjengesibindi, imiphunga, ithambo, umongo wethambo kunye nengqondo, inokuba nayo isampulu yethishu esuswe kwaye ihlolwe ngugqirha wezifo ukuba ngaba uneempawu zomhlaza.

Ukuba umhlaza ufumanekile, kungenziwa ezi mvavanyo zilandelayo ukufundisisa iiseli zomhlaza:

• I-Immunohistochemistry: Uvavanyo lwaselebhu olusebenzisa ii-antibodies ukukhangela ii-antigen ezithile (iimpawu) kwisampulu yesicwili somguli. Amachiza omzimba ahlala enxulunyaniswa ne-enzyme okanye idayi ye-fluorescent. Emva kokuba ii-antibodies zibophelela kwi-antigen ethile kwisampulu yethishu, i-enzyme okanye idayi iyasebenza, kwaye i-antigen iya kuthi emva koko ibonwe phantsi kwemicroscope. Olu hlobo lovavanyo lusetyenziselwa ukufumanisa isifo somhlaza kunye nokunceda uxelele olunye uhlobo lomhlaza kolunye uhlobo lomhlaza.

• Uhlalutyo lweCytogenetic: Uvavanyo lwaselebhu apho ii-chromosomes zeeseli kwisampulu yegazi okanye umongo wethambo 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.

• I-FISH (i-fluorescence in situ hybridization): Uvavanyo lwaselebhu olusetyenziselwa ukujonga nokubala ii-genes okanye ii-chromosomes kwiiseli nakwizicubu. Amacandelo e-DNA aqukethe idayi ye-fluorescent yenziwa elebhu kwaye yongezwa kwisampulu yeeseli zomguli okanye izicwili. Xa ezi ziqwenga zeDNA zidayiweyo zinamathela kwimfuza ethile okanye kwiindawo zechromosomes kwisampulu, ziyakhanya xa zijongwa phantsi kwemicroscope ebengezelayo. Uvavanyo lwe-FISH lusetyenziselwa ukunceda ekuchongeni umhlaza kunye nokunceda ekucwangciseni unyango.

• Immunophenotyping: Uvavanyo lwaselabhoratri olusebenzisa izilwa-buhlungu ukufumanisa iiseli zomhlaza ngokusekwe kwiindidi zeantigens okanye iimpawu zokumakisha phezu kweeseli. Olu vavanyo lusetyenziselwa ukunceda ukufumanisa iintlobo ezithile ze-lymphoma.

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

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

• Inqanaba lomhlaza.

• Ubudala besigulana.

• Inani leeLymphocyte ze-CD4 (uhlobo lweseli emhlophe egazini) egazini.

• Inani leendawo emzimbeni we-lymphoma lifumaneka ngaphandle kwenkqubo ye-lymph.

• Nokuba isigulana sinembali yokusebenzisa iziyobisi ngaphakathi (IV).

• Isigulana ukukwazi ukwenza imisebenzi yesiqhelo yemihla ngemihla.

Amanqanaba eLymphoma enxulumene noGawulayo

IINGONGOMA EZIPHAMBILI

• Emva kokuba i-lymphoma enxulumene noGawulayo ifunyenwe, iimvavanyo zenziwa ukufumanisa ukuba ngaba iiseli zomhlaza zisasazekile ngaphakathi kwinkqubo ye-lymph okanye kwezinye iindawo zomzimba.

• Zintathu iindlela umhlaza onwenwa ngayo emzimbeni.

• Amanqanaba alandelayo asetyenziselwa i-lymphoma enxulumene noGawulayo:

• Inqanaba I

• Inqanaba II

• Inqanaba III

• Inqanaba IV

• Kunyango, ii-lymphomas ezinxulumene noGawulayo ziqokelelwe ngokwamaqela aqala emzimbeni, ngolu hlobo lulandelayo:

• Umda / inkqubo ye-lymphoma

• Iiprayimari ze-CNS eziphambili

Emva kokuba i-lymphoma enxulumene noGawulayo ifunyenwe, iimvavanyo zenziwa ukufumanisa ukuba ngaba iiseli zomhlaza zisasazekile ngaphakathi kwinkqubo ye-lymph okanye kwezinye iindawo zomzimba.

Inkqubo esetyenziselwa ukufumanisa ukuba iiseli zomhlaza zisasazekile ngaphakathi kwenkqubo ye-lymph okanye kwamanye amalungu omzimba kuthiwa yi-staging. Ulwazi oluqokelelwe kwinkqubo yokubeka inqanaba lesifo. Kubalulekile ukwazi inqanaba ukuze ucwangcise unyango, kodwa i-lymphoma enxulumene noGawulayo ihlala iqhubela phambili xa ifunyaniswa.

Ezi mvavanyo zilandelayo kunye neenkqubo zinokusetyenziswa kwinkqubo yokubeka esiteji:

• I-MRI (imaging resonance imaging) enegadolinium: Inkqubo esebenzisa umazibuthe, amaza erediyo kunye nekhompyuter ukwenza uthotho lwemifanekiso eneenkcukacha zeendawo ezingaphakathi emzimbeni, ezinjengengqondo kunye nomqolo. Into ebizwa ngokuba yi-gadolinium itofelwe kwisigulana ngomthambo. 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. Isampulu inokujongwa kwintsholongwane ka-Epstein-Barr. Le nkqubo ikwabizwa ngokuba yi-LP okanye impompo yomqolo.

Ukugqobhoza iLumbar. Isigulana silele endaweni egobileyo phezu kwetafile. Emva kokuba indawo encinci kumqolo ongezantsi ifakwe inaliti, inaliti yomgogodla (inaliti ende, ebhityileyo) ifakwe kwinxalenye esezantsi yomqolo womqolo ukususa ulwelo lwe-cerebrospinal fluid (CSF, eboniswe ngombala oluhlaza okwesibhakabhaka). Ulwelo lunokuthunyelwa kwilabhoratri kuvavanyo.

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.

Amanqanaba alandelayo asetyenziselwa i-lymphoma enxulumene noGawulayo:

Inqanaba I

Isigaba I-lymphoma yabantu abadala. I-Cancer ifunyenwe kwi-lymph node enye okanye ngaphezulu kwiqela le-lymph nodes okanye, kwiimeko ezinqabileyo, umhlaza ufunyanwa kwindandatho kaWaldeyer, i-thymus, okanye i-spleen. Kwinqanaba le-IE (aliboniswanga), umhlaza usasazeke kwindawo enye ngaphandle kwenkqubo ye-lymph.

Isigaba I-lymphoma enxulumene noGawulayo ihlukaniswe ngamanqanaba mna kunye ne-IE.

• Kwinqanaba I, umhlaza ufumaneka kwenye yezi ndawo zilandelayo kwinkqubo ye-lymph:

• Enye okanye ezinye iindawo nkovu kwiqela nkovu iindawo.

• Umsesane kaWaldeyer.

• Thymus.

• Udaka.

• Kwinqanaba le-IE, umhlaza ufumaneka kwindawo enye ngaphandle kwenkqubo ye-lymph.

• Inqanaba II

• Isigaba II i-lymphoma enxulumene noGawulayo yahlulwe yangamanqanaba II kunye ne-IIE.

• Kwinqanaba II, umhlaza ufumaneka kumaqela amabini okanye nangaphezulu ee-lymph node ezingaphezulu kwesithambisi okanye ezantsi kwidayaphragm.

Isigaba II se-lymphoma yabantu abadala. Umhlaza ufumaneka kumaqela amabini okanye nangaphezulu ee-lymph node ezingaphezulu kwesithambisi okanye ezantsi kwidayaphragm.

• Kwinqanaba le-IIE, umhlaza usasazekile kwiqela le-lymph node ukuya kwindawo ekufutshane engaphandle kwenkqubo ye-lymph. Umhlaza usenokuthi usasazeke kwamanye amaqela e-lymph node kwicala elinye ledyaphragm.

Inqanaba IIE yabantu abadala i-lymphoma. Umhlaza usasazekile ukusuka kwiqela le-lymph node ukuya kwindawo ekufutshane engaphandle kwenkqubo ye-lymph. Umhlaza usenokuthi usasazeke kwamanye amaqela e-lymph node kwicala elinye ledyaphragm.

Kwinqanaba II, igama elithi bulky disease libhekisa kubunzima obukhulu besisu. Ubungakanani besisu esibizwa ngokuba sisifo esinamandla siyahluka ngohlobo lwe-lymphoma.

Inqanaba III

Isigaba III se-lymphoma yabantu abadala. Umhlaza ufunyanwa ngokwamaqela e-lymph node zombini ngasentla nangaphantsi kwesithambiso; okanye kwiqela le-lymph nodes ngaphezu kwesithambiso kunye nodaka.

Kwinqanaba III i-lymphoma enxulumene noGawulayo, umhlaza ufumaneka:

• kumaqela e-lymph nodes ngasentla nangaphantsi kwe-diaphragm; okanye

• kwii-lymph node ngaphezulu kwesithambisi nakwipeni.

Inqanaba IV

Isigaba IV se-lymphoma yabantu abadala. Umhlaza (a) usasazeke kwilungu elinye okanye ngaphezulu ngaphandle kwenkqubo ye-lymph; okanye (b) ifumaneka kumaqela amabini okanye nangaphezulu ee-lymph node ezingaphezulu kovalo okanye ezantsi kwidayaphragm nakwelinye ilungu elingaphandle kwenkqubo ye-lymph kwaye hayi kufutshane ne-lymph node ezichaphazelekayo; okanye (c) ifunyanwa ngokwamaqela ezele nkovu ngaphezulu kwesithambo nangaphantsi kwesithambiso nakulo naliphi na ilungu elingaphandle kwenkqubo ye-lymph; okanye (d) ifumaneka esibindini, kumongo wethambo, ngaphezulu kwendawo enye emphungeni, okanye kwi-cerebrospinal fluid (CSF). Umhlaza awusasazekanga ngokuthe ngqo kwisibindi, umongo wethambo, imiphunga, okanye i-CSF kwii-lymph node ezikufutshane.

Kwinqanaba IV i-lymphoma enxulumene noGawulayo, umhlaza:

• isasazeke kwilungu elinye okanye nangaphezulu ngaphandle kwenkqubo ye-lymph; okanye

• ifumaneka kumaqela amabini okanye nangaphezulu ee-lymph node ezingaphezulu kwesithambisi okanye ezantsi kwidayaphragm nakwelinye ilungu elingaphandle kwenkqubo ye-lymph kwaye hayi kufutshane ne-lymph node ezichaphazelekayo; okanye

• ifumaneka kumaqela e-lymph nodes zombini ngasentla nangaphantsi kwesithambisi nakweliphi na ilungu elingaphandle kwenkqubo ye-lymph; okanye

• ifumaneka kwisibindi, umongo wethambo, ngaphezu kwendawo enye emiphungeni, okanye kwi-cerebrospinal fluid (CSF). Umhlaza awusasazekanga ngokuthe ngqo kwisibindi, umongo wethambo, imiphunga, okanye i-CSF kwii-lymph node ezikufutshane.

Izigulana ezosulelwe yintsholongwane ye-Epstein-Barr okanye isifo sayo esinxulumene ne-lymphoma sichaphazela umongo wethambo banomngcipheko wokuba nomhlaza usasazeke kwinkqubo ye-nervous system (CNS).

Kunyango, ii-lymphomas ezinxulumene noGawulayo ziqokelelwe ngokwamaqela aqala emzimbeni, ngolu hlobo lulandelayo:

Umda / inkqubo ye-lymphoma

I-Lymphoma eqala kwinkqubo ye-lymph okanye kwenye indawo emzimbeni, ngaphandle kwengqondo, ibizwa ngokuba yipheripheral / systemic lymphoma. Isenokusasazeka emzimbeni wonke, kubandakanya nengqondo okanye umongo wethambo. Ihlala ifunyaniswa kwinqanaba eliphambili.

Iiprayimari ze-CNS eziphambili

I-CNS ye-primary lymphoma iqala kwinkqubo ye-nervous system (ubuchopho kunye nentambo yomgogodla). Inxulunyaniswe nentsholongwane ka-Epstein-Barr. I-Lymphoma eqala kwenye indawo emzimbeni kwaye isasazeka kwinkqubo ye-nervous central ayisiyiyo eyona CNS lymphoma.

Unyango ngoKhetho lonyango

IINGONGOMA EZIPHAMBILI

• Kukho iintlobo ezahlukeneyo zonyango kwizigulana ezine-lymphoma enxulumene noGawulayo.

• Unyango lwe-lymphoma enxulumene noGawulayo ludibanisa unyango lwe-lymphoma kunye nonyango lwe-AIDS.

• Iindidi ezine zonyango olusetyenziswayo zisetyenziswa:

• Unyango ngamayeza

• Unyango ngemitha

• I-dose ephezulu ye-chemotherapy kunye nokufakelwa kweseli

• Unyango ekujoliswe kulo

• Iindidi ezintsha zonyango ziyavavanywa kuvavanyo lweklinikhi.

• Unyango lwe-lymphoma enxulumene noGawulayo 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-lymphoma enxulumene noGawulayo.

Iindidi ezahlukeneyo zonyango ziyafumaneka kwizigulana ezine-lymphoma enxulumene noGawulayo. 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.

Unyango lwe-lymphoma enxulumene noGawulayo ludibanisa unyango lwe-lymphoma kunye nonyango lwe-AIDS.

Izigulana ezine-AIDS ziye zawenza buthathaka amajoni omzimba kwaye unyango lunokubangela ukuba amajoni omzimba abe buthathaka ngakumbi. Ngesi sizathu, ukunyanga abaguli abane-lymphoma enxulumene noGawulayo kunzima kwaye ezinye izigulana zinokunyangwa ngamayeza asezantsi kunezigulana ezingena-lymphoma ezingenayo i-AIDS.

Unyango olusebenzayo lwe-antiretroviral (HAART) lusetyenziselwa ukunciphisa ukonakala kumajoni omzimba abangelwa yi-HIV. Unyango nge-HAART lunokuvumela ezinye izigulana ezine-lymphoma ezinxulumene noGawulayo ukuba zifumane ngokukhuselekileyo iziyobisi ezichasayo kumanqanaba asemgangathweni okanye aphezulu. Kwezi zigulana, unyango lunokusebenza kunye njengoko lusenza kwizigulana ezingena-lymphoma ezingenayo i-AIDS. Iyeza lokuthintela nokunyanga usulelo, olunokuba mandundu, luyasetyenziswa.

Ngolwazi oluthe kratya malunga ne-AIDS kunye nonyango lwayo, nceda ubone iwebhusayithi ye-AIDSinfo.

Iindidi ezine zonyango olusetyenziswayo zisetyenziswa:

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 (i-intrathecal chemotherapy), ilungu, okanye isinqe somzimba esifana nesisu, amachiza ikakhulu achaphazela iiseli zomhlaza kwezo ndawo (i-chemotherapy yengingqi). Umdibaniso wekhemotherapy yonyango olusebenzisa ngaphezulu kwesiyobisi esinye somhlaza.

Indlela i-chemotherapy enikezelwa ngayo ixhomekeke apho umhlaza wenziwe khona. I-intrathecal chemotherapy ingasetyenziselwa kwizigulana ezinokuthi zibe ne-lymphoma kwinkqubo ye-nervous system (CNS).

Unyango lwe-chemotherapy. Amachiza e-anticancer afakwe kwisithuba se-intrathecal, esi sithuba esigcina i-cerebrospinal fluid (CSF, eboniswe ngombala oluhlaza okwesibhakabhaka). Zimbini iindlela zokwenza oku. Enye indlela, eboniswe kwinxalenye ephezulu yomzobo, kukujova amachiza kwindawo yokugcina izilwanyana i-Ommaya (isikhongozeli esimile okomgangatho obekwe phantsi kwentloko entloko ngexesha lotyando; ibamba amachiza njengoko ehamba ngombhobho omncinci esiya kwingqondo ). Enye indlela, eboniswe kwinxalenye esezantsi yomzobo, kukujova amachiza ngqo kwi-CSF kwinxalenye esezantsi yomqolo womqolo, emva kokuba indawo encinci kumqolo ongezantsi ifakwe amanxeba.

I-Chemotherapy isetyenziselwa unyango lwe-peripheral / systemic lymphoma. Akukaziwa ukuba kungcono na ukunika i-HAART ngaxeshanye njenge-chemotherapy okanye emva kokuphela kwe-chemotherapy.

Izinto ezikhuthazayo ze-Colony ngamanye amaxesha zinikezelwa kunye ne-chemotherapy. Oku kunceda ukunciphisa iziphumo ebezingalindelekanga ze-chemotherapy ezinokuba nazo kumongo wethambo.

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 apho umhlaza uye khona. Unyango lwangaphandle lwemitha lusetyenziselwa ukunyanga i-CNS lymphoma.

I-dose ephezulu ye-chemotherapy kunye nokufakelwa kweseli

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

Unyango ekujoliswe kulo

Unyango ekujoliswe kulo luhlobo lonyango olusebenzisa iziyobisi okanye ezinye izinto ukuchonga nokuhlasela iiseli ezithile zomhlaza ngaphandle kokonakalisa iiseli eziqhelekileyo. Unyango lwe-monoclonal antibody luhlobo lonyango ekujoliswe kulo.

Unyango lwe-monoclonal antibody yonyango lomhlaza olusebenzisa ii-antibodies ezenziwe elebhu ezivela kuhlobo olunye lweeseli zomzimba. Ezi antibodies zinokuchonga izinto ezikumhlaza iiseli okanye izinto eziqhelekileyo ezinokunceda iiseli zomhlaza zikhule. Amachiza omzimba ancamathele kwizinto kwaye abulale iiseli zomhlaza, athintele ukukhula kwazo, okanye azigcine zisasazeka. Iintsholongwane zeMonoclonal zinikezelwa ngokufakwa. Ezi zinokusetyenziswa zodwa okanye ukuphatha iziyobisi, ityhefu, okanye izinto ezinemitha yeathom ngqo kwiiseli zomhlaza. I-Rituximab isetyenziselwa unyango lwe-peripheral / systemic lymphoma.

Iindidi ezintsha zonyango ziyavavanywa kuvavanyo lweklinikhi.

Ulwazi malunga novavanyo lweklinikhi luyafumaneka kwiwebhusayithi yeNCI.

Unyango lwe-lymphoma enxulumene noGawulayo 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-Lymphoma enxulumene noGawulayo

Kweli Candelo

• Umda ohambelana noGawulayo / inkqubo yeLymphoma

• Inkqubo yaseNervous yeNervous System yeNervous Lymphoma

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

Umda ohambelana noGawulayo / inkqubo yeLymphoma

Unyango lwe-peripheral / systemic lymphoma enxulumene noGawulayo inokubandakanya oku kulandelayo:

• Ukudibanisa i-chemotherapy kunye okanye ngaphandle kwonyango ekujoliswe kulo.

• I-high-dose chemotherapy kunye ne-stem cell transplant, ye-lymphoma engaphendulanga kunyango okanye ibuyile.

• I-intrathecal chemotherapy ye-lymphoma enokuthi isasazeke kwinkqubo ye-nervous system (CNS).

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.

Inkqubo yaseNervous yeNervous System yeNervous Lymphoma

Unyango lwe-system ephambili ye-nervous system ye-lymphoma inokubandakanya oku kulandelayo:

• Unyango lwangaphandle lwemitha.

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-Lymphoma enxulumene noGawulayo

Ukufumana ulwazi oluthe vetshe kwi-National Cancer Institute malunga ne-lymphoma ehlobene ne-AIDS, jonga oku kulandelayo:

• Utyando lweSeli oluQulunqwe ngegazi

• 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