Iindidi / i-neuroblastoma / isigulana / unyango lwe-neuroblastoma-pdq

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Unyango lwe-Neuroblastoma (®) –uPawu lwePatient

Ulwazi ngokubanzi malunga neNeuroblastoma

IINGONGOMA EZIPHAMBILI

  • I-Neuroblastoma sisifo apho iiseli ezibi (zomhlaza) zeeseli zenzeka kwi-neuroblast (izicwili zemithambo ezingafakwanga) kwiincindi zamadlala, entanyeni, esifubeni, okanye emqolo.
  • I-Neuroblastoma ngamanye amaxesha ibangelwa kukutshintsha kwemfuza (utshintsho) oludluliselwe lusuka kumzali luye emntwaneni.
  • Iimpawu kunye neempawu ze-neuroblastoma zibandakanya isigaxa esiswini, entanyeni, okanye esifubeni okanye kwithambo.
  • Uvavanyo oluvavanya izicubu zomzimba ezahlukeneyo kunye nolwelo zisetyenziselwa ukufumanisa isifo se-neuroblastoma.
  • I-biopsy yenziwa ukufumanisa i-neuroblastoma.
  • Izinto ezithile zichaphazela ukuxela kwangaphambili (ithuba lokufumana kwakhona) kunye nokhetho lonyango.

I-Neuroblastoma sisifo apho iiseli ezibi (zomhlaza) zeeseli zenzeka kwi-neuroblast (izicwili zemithambo ezingafakwanga) kwiincindi zamadlala, entanyeni, esifubeni, okanye emqolo.

I-Neuroblastoma ihlala iqala kwizicubu zemithambo-luvo yamadlala adrenal. Kukho amadlala amabini adrenal, enye ngaphezulu kwezintso nganye ngasemva kwesisu esingaphezulu. Amadlala adrenal enza iihormone ezibalulekileyo ezinceda ukulawula ukubetha kwentliziyo, uxinzelelo lwegazi, iswekile yegazi, kunye nendlela umzimba ophendula ngayo kuxinzelelo. I-Neuroblastoma inokuthi iqale nakwizicubu zomzimba entanyeni, esifubeni, esiswini, okanye kwi-pelvis.

I-Neuroblastoma inokufumaneka kwi-adrenal gland kunye ne-paraspinal nerve tissue ukusuka entanyeni ukuya kwi-pelvis.

I-Neuroblastoma ihlala iqala ebusaneni. Ihlala ichongwa phakathi kwenyanga yokuqala yobomi kunye neminyaka emihlanu ubudala. Kufunyanwa xa ithumba liqala ukukhula kwaye libangele iimpawu okanye iimpawu. Ngamanye amaxesha ifom ngaphambi kokuzalwa kwaye ifunyenwe ngexesha le-ultrasound yomntwana.

Ngexesha lokufunyaniswa komhlaza, ihlala isasazeka (isasazeka). I-Neuroblastoma isasazeka rhoqo kwii-lymph node, amathambo, umongo wethambo, isibindi kunye nolusu kwiintsana nasebantwaneni. Abafikisayo banokuba ne-metastasis kwimiphunga nakwingqondo.

I-Neuroblastoma ngamanye amaxesha ibangelwa kukutshintsha kwemfuza (utshintsho) oludluliselwe lusuka kumzali luye emntwaneni.

Ukutshintsha kwemfuza okwandisa umngcipheko we-neuroblastoma ngamanye amaxesha kuzuzwa njengelifa (kudluliselwe ukusuka kumzali kuye emntwaneni). Kubantwana abanokutshintsha kwemfuza, i-neuroblastoma ihlala isencinci kwaye ngaphezulu kwesinye ithumba inokubumba kwi-adrenal gland okanye kwithishu yentliziyo entanyeni, esifubeni, esiswini, okanye kwi-pelvis.

Abantwana abane-gene gene okanye i-syndromes yelifa (elifa) kufuneka bahlolwe iimpawu ze-neuroblastoma de babe neminyaka eli-10 ubudala. Olu vavanyo lulandelayo lunokusetyenziswa:

  • I-ultrasound yasesiswini: Uvavanyo apho amaza esandi aphembelela amandla aphezulu (i-ultrasound) akhutshwa esiswini enze ii-echoes. Ama-echoes enza umfanekiso wesisu obizwa ngokuba yi-sonogram. Umfanekiso unokuprintwa ukuze ujongwe kamva.
  • Izifundo ze-Urine catecholamine: Uvavanyo apho isampulu yomchamo ihlolwe ukulinganisa inani lezinto ezithile, i-vanillylmandelic acid (VMA) kunye ne-homovanillic acid (HVA), ezenziwa xa iicatecholamines zisaphuka kwaye zikhutshelwa emchameni. Ixabiso eliphezulu kune-VMA okanye i-HVA inokuba luphawu lwe-neuroblastoma.
  • I-x-ray yesifuba: IX-reyi yamalungu namathambo ngaphakathi kwesifuba. IX-reyi luhlobo lwe-beam yamandla enokuhamba emzimbeni nakwifilimu, yenza umfanekiso weendawo ezingaphakathi komzimba.

Thetha nogqirha womntwana wakho malunga nokuba kufuneka kwenziwe rhoqo kangaphi kwezi mvavanyo.

Iimpawu kunye neempawu ze-neuroblastoma zibandakanya isigaxa esiswini, entanyeni, okanye esifubeni okanye kwithambo.

Ezona mpawu zixhaphakileyo kunye neempawu ze-neuroblastoma zibangelwa kukuqunjelwa kwethumba kwizicubu ezikufutshane njengoko ikhula okanye ngumhlaza usasazeka kwithambo. Ezi kunye nezinye iimpawu kunye neempawu zinokubangelwa yi-neuroblastoma okanye ezinye iimeko.

Jonga kugqirha womntwana wakho ukuba umntwana wakho unayo nayiphi na kwezi zinto zilandelayo:

  • Isigaxa esiswini, entanyeni, okanye esifubeni.
  • Intlungu yethambo.
  • Isisu esidumbileyo kunye nengxaki yokuphefumla (kwiintsana).
  • Amehlo aqhumayo.
  • Izangqa ezimnyama ezijikeleze amehlo ("amehlo amnyama").
  • Amabala angenabala, aluhlaza phantsi kolusu (kwiintsana).
  • Ubuthathaka okanye ukukhubazeka (ukuphulukana namandla okuhambisa ilungu lomzimba).

Iimpawu kunye neempawu eziqhelekileyo ze-neuroblastoma zibandakanya oku kulandelayo:

  • Ifiva.
  • Ukuqhawukelwa ngumphefumlo.
  • Ndiziva ndidiniwe.
  • Ukutyumza okulula okanye ukopha.
  • I-Petechiae (tyaba, khomba amabala phantsi kolusu okubangelwa kukopha).
  • Igazi elonyukayo.
  • Urhudo olunamandla.
  • Isifo se-Horner (ijwabu leso eline-droopy, umfundi omncinci, kunye nokubila kancinci kwicala elinye lobuso).
  • Ukuhamba kwemisipha kaJerky.
  • Ukuhamba okungalawulwayo kwamehlo.

Uvavanyo oluvavanya izicubu zomzimba ezahlukeneyo kunye nolwelo zisetyenziselwa ukufumanisa isifo se-neuroblastoma.

Ezi mvavanyo zilandelayo kunye neenkqubo zinokusetyenziselwa ukufumanisa i-neuroblastoma:

  • Uvavanyo lomzimba kunye nembali yezempilo: Uvavanyo lomzimba ukukhangela iimpawu zempilo ngokubanzi, kubandakanya nokujonga iimpawu zesifo, ezinje ngamaqhuma okanye nayiphi na into ebonakala ingaqhelekanga. Imbali yemikhwa yempilo yesigulana kunye nezifo zangaphambili kunye nonyango ziya kuthathwa.
  • Uvavanyo lwe-Neurological: Uthotho lwemibuzo kunye novavanyo lokujonga ubuchopho, intambo yomqolo kunye nokusebenza kwentliziyo. Uvavanyo lujonga imeko yomntu ngokwengqondo, ulungelelwaniso, amandla okuhamba ngesiqhelo, kunye nendlela esebenza ngayo izihlunu, imizwa kunye nengqondo. Oku kunokubizwa ngokuba luvavanyo lwe-neuro okanye uvavanyo lwe-neurologic.
  • Izifundo ze-Urine catecholamine: Uvavanyo apho isampulu yomchamo ihlolwe ukulinganisa inani lezinto ezithile, i-vanillylmandelic acid (VMA) kunye ne-homovanillic acid (HVA), ezenziwa xa iicatecholamines zisaphuka kwaye zikhutshelwa emchameni. Ixabiso eliphezulu kune-VMA okanye i-HVA inokuba luphawu lwe-neuroblastoma.
  • Izifundo ze-chemistry yegazi: Uvavanyo apho kuvavanywa khona isampulu yegazi ukulinganisa izixa zezinto ezithile ezikhutshelwe egazini ngamalungu kunye nezicubu zomzimba. Inani eliphezulu okanye elingaphantsi kwesiqhelo kwinto leyo inokuba luphawu lwesifo.
  • Ukuskena kwe-MIBG: Inkqubo esetyenziselwa ukufumana amathumba e-neuroendocrine, njenge-neuroblastoma. Inani elincinci kakhulu lezinto ezibizwa ngokuba yi-radioactive MIBG litofelwe kumthambo kwaye lihamba ngokuhamba kwegazi. Iiseli zesisu se-Neuroendocrine zithatha i-MIBG enemitha kwaye zifunyenwe siskena. Ukuskena kungathathwa ngaphezulu kweentsuku ezi-1-3. Isisombululo se-iodine sinokunikwa ngaphambi okanye ngexesha lovavanyo ukugcina i-thyroid gland ingafaki kakhulu kwi-MIBG. Olu vavanyo lusetyenziselwa ukufumanisa ukuba ithumba liphendula njani kunyango. I-MIBG isetyenziswa kwiidosi eziphezulu ukunyanga i-neuroblastoma.
  • 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.
Ikhompyuter ye-tomography (CT) yesisu. Umntwana ulele phezu kwetafile etyibilika ngesikena se-CT, esithatha imifanekiso ye-x-ray engaphakathi esiswini.
  • I-MRI (imaging resonance imaging) enegadolinium: Inkqubo esebenzisa umazibuthe, amaza erediyo kunye nekhompyuter ukwenza uthotho lwemifanekiso eneenkcukacha yeendawo ezingaphakathi komzimba. 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).
Imagnetic resonance imaging (MRI) yesisu. Umntwana ulele phezu kwetafile etyibilika kwisikena se-MRI, esithatha imifanekiso engaphakathi komzimba. Iphedi esiswini somntwana inceda ukwenza imifanekiso icace gca.
  • 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.
  • I-X-ray yesifuba okanye ithambo: IX-reyi luhlobo lwe-beam yamandla enokuhamba emzimbeni nakwifilimu, yenza umfanekiso weendawo ezingaphakathi komzimba.
  • 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. Uvavanyo lwe-ultrasound alwenziwa ukuba kwenziwe i-CT / MRI.
I-ultrasound yesisu. I-ultrasound transducer edityaniswe kwikhompyuter icinezelwe kulusu lwesisu. I-transducer igxotha amaza esandi kumalungu angaphakathi nakwizicubu ukwenza ii-echoes ezenza i-sonogram (umfanekiso wekhompyuter).

I-biopsy yenziwa ukufumanisa i-neuroblastoma.

Iiseli kunye nezicubu ziyasuswa ngexesha le-biopsy ukuze zibonwe phantsi kwemicroscope ngugqirha wezilwanyana ukujonga imiqondiso yomhlaza. Indlela eyenziwa ngayo i-biopsy ixhomekeke apho i-tumor ikhona emzimbeni. Ngamanye amaxesha lonke ithumba lisuswa ngaxeshanye kwenziwa i-biopsy.

Olu vavanyo lulandelayo lunokwenziwa kwizicubu ezisusiweyo:

  • Uhlalutyo lweCytogenetic: Uvavanyo lwaselebhu apho ii-chromosomes zeeseli kwisampulu yethishu zibalwa kwaye zijongwa kulo naluphi na utshintsho, njengokwaphuka, ukulahleka, ukulungiswa ngokutsha, okanye ii-chromosomes ezongezelelweyo. Utshintsho kwii-chromosomes ezithile kunokuba luphawu lomhlaza. Uhlalutyo lweCytogenetic lusetyenziselwa ukunceda ekuchongeni umhlaza, ukucwangcisa unyango, okanye ukufumanisa ukuba lusebenza njani unyango.
  • Imicroscopy ekhanyayo: Uvavanyo lwaselebhu apho iiseli ezikwisampulu yethishu zijongwa phantsi kwemicroscopes eqhelekileyo kunye nephakamileyo ukujonga utshintsho oluthile kwiiseli.
  • 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.
  • Isifundo sokunyusa i-MYCN: Uphononongo lwaselebhu apho iiseli zethumba okanye zomongo wethambo zijongwa kwinqanaba le-MYCN. I-MYCN ibalulekile ekukhuleni kweseli. Inqanaba eliphezulu le-MYCN (ngaphezulu kwe-10 iikopi zemfuza) ibizwa ngokuba yi-MYCN amplification. I-Neuroblastoma ene-MYCN yokukhulisa kunokwenzeka ukuba isasazeke emzimbeni kwaye kuncinci ukuba iphendule kunyango.

Abantwana ukuya kwiinyanga ezi-6 ubudala abanakudinga i-biopsy okanye utyando ukususa ithumba kuba ithumba linganyamalala ngaphandle konyango.

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

Ukuxela kwangaphambili kunye nokhetho lonyango luxhomekeke koku kulandelayo:

  • Ubudala ngexesha lokuchongwa.
  • I-tumor histology (imilo, ukusebenza, kunye nolwakhiwo lweeseli zethumba).
  • Iqela lomngcipheko womntwana.
  • Nokuba kukho utshintsho oluthile kwimfuza.
  • Apho emzimbeni laqala khona ithumba.
  • Inqanaba lomhlaza.
  • Indlela ithumba eliphendula ngayo kunyango.
  • Lingakanani ixesha elidlulileyo phakathi kokuchongwa kwaye xa umhlaza ubuyile (kumhlaza ophindaphindiweyo).

Ukuqikelela kunye nokhetho kunyango lwe-neuroblastoma nazo zichaphazeleka yi-tumor biology, ebandakanya oku kulandelayo:

  • Iipateni zeeseli zethumba.
  • Zahluke njani iiseli zethumba kwiiseli eziqhelekileyo.
  • Kukhawuleza kangakanani ukukhula kweeseli zethumba.
  • Nokuba ithumba libonisa ukukhula kwe-MYCN.
  • Nokuba i-tumor inalo utshintsho kuhlobo lwe-ALK.

I-tumor biology kuthiwa iyathandeka okanye ayithandeki, kuxhomekeke kwezi zinto. Umntwana onebhayoloji entle yethumba unethuba elingcono lokuchacha.

Kwabanye abantwana ukuya kwiinyanga ezi-6 ubudala, i-neuroblastoma inokunyamalala ngaphandle konyango. Oku kubizwa ngokuba kukuhlehla okuzenzekelayo. Umntwana ujonge ngononophelo iimpawu okanye iimpawu ze-neuroblastoma. Ukuba iimpawu okanye iimpawu zenzeka, unyango lunokufuneka.

Amanqanaba eNeuroblastoma

IINGONGOMA EZIPHAMBILI

  • Emva kokuba i-neuroblastoma ifunyenwe, kuvavanywa ukwenziwa 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.
  • Amanqanaba alandelayo asetyenziselwa i-neuroblastoma:
  • Inqanaba 1
  • Inqanaba 2
  • Inqanaba 3
  • Inqanaba 4
  • Unyango lwe-neuroblastoma lusekwe kumaqela omngcipheko.
  • Ngamanye amaxesha i-neuroblastoma ayiphenduli kunyango okanye ibuye emva konyango.

Emva kokuba i-neuroblastoma ifunyenwe, kuvavanywa ukwenziwa ukufumanisa ukuba ngaba umhlaza sele usasazekile na ukusuka apho uqale kwamanye amalungu omzimba.

Inkqubo esetyenziselwa ukufumanisa ubungakanani okanye ukusasazeka komhlaza ibizwa ngokuba yistage. Ulwazi oluqokelelwe kwinkqubo yokuqokelela lunceda ukumisela inqanaba lesi sifo. Kwi-neuroblastoma, inqanaba lesifo lichaphazela ukuba ngaba umhlaza ungumngcipheko ophantsi, umngcipheko ophakathi, okanye umngcipheko omkhulu. Ikwachaphazela isicwangciso sonyango. Iziphumo zovavanyo kunye neenkqubo ezisetyenziselwa ukuxilonga i-neuroblastoma zinokusetyenziselwa ukubekwa eqongeni. Jonga icandelo loLwazi ngokubanzi malunga nenkcazo yezi mvavanyo kunye neenkqubo.

Ezi mvavanyo zilandelayo kunye neenkqubo zinokusetyenziselwa ukumisela inqanaba:

  • Umnqweno womongo wethambo kunye ne-biopsy: Ukususwa komongo wethambo, igazi, kunye nesiqwenga samathambo ngokufaka inaliti engenanto kumqolo okanye ithambo lesifuba. Ugqirha wezifo ujonga umongo wethambo, igazi kunye nethambo phantsi kwemicroscope ukukhangela iimpawu zomhlaza.
Umnqweno wethambo lomnqweno kunye ne-biopsy. Emva kokuba indawo encinci yolusu iphonyiwe, inaliti yomongo wethambo ifakwa kwithambo lesinqe somntwana. 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 izicubu ze-lymph node phantsi kwemicroscope ukujonga 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.
  • Fine-inaliti aspiration (FNA) biopsy: Ukususwa kwethishu okanye ulwelo kwi-lymph node usebenzisa inaliti encinci.

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-neuroblastoma isasazeka esibindini, iiseli zomhlaza esibindini ziiseli ze-neuroblastoma. Esi sifo yi-metastatic neuroblastoma, hayi umhlaza wesibindi.

Amanqanaba alandelayo asetyenziselwa i-neuroblastoma:

Inqanaba 1

Kwinqanaba 1, umhlaza ukwindawo enye kuphela kwaye wonke umhlaza onokubonwa ususwe ngokupheleleyo ngexesha lotyando.

Inqanaba 2

Inqanaba 2 lahlulwe ngokwamanqanaba 2A kunye 2B.

  • Isigaba 2A: Umhlaza ukwindawo enye kuphela kwaye wonke umhlaza obonakalayo awususwanga ngokupheleleyo ngexesha lotyando.
  • Isigaba 2B: Umhlaza ukwindawo enye kuphela kwaye wonke umhlaza onokubonwa unokususwa ngokupheleleyo ngexesha lotyando. Iiseli zomhlaza zifumaneka kwii-lymph node ezikufutshane nethumba.

Inqanaba 3

Kwinqanaba 3, enye yezi zinto zilandelayo iyinyani:

  • umhlaza awunakususwa ngokupheleleyo ngexesha lotyando kwaye usasazeke usuka kwelinye icala lomzimba uye kwelinye kwaye usenokuthi nosasazeke kwii-lymph node ezikufutshane okanye
  • umhlaza ukwelinye icala lomzimba kwaye uye wanwenwela kwii-lymph node kwelinye icala lomzimba; okanye
  • umhlaza uphakathi emzimbeni kwaye usasazeke kwizicwili okanye ii-lymph node kumacala omabini omzimba, kwaye umhlaza awunakususwa ngotyando.

Inqanaba 4

Isigaba 4 sahlulwe sangamanqanaba 4 no 4S.

  • Kwinqanaba le-4, umhlaza usasazeke kwii-lymph node ezikude okanye kwamanye amalungu omzimba.
  • Kwinqanaba 4S, umntwana ungaphantsi kweenyanga ezili-12, kwaye:
  • umhlaza usasazekile kulusu, isibindi, kunye / okanye umongo wethambo; okanye
  • umhlaza ukwindawo enye kuphela kwaye wonke umhlaza obonakalayo unokususwa okanye ungasuswa ngokupheleleyo ngexesha lotyando; okanye
  • iiseli zomhlaza zinokufunyanwa kwii-lymph node ezikufuphi nethumba.

Unyango lwe-neuroblastoma lusekwe kumaqela omngcipheko.

Kwiintlobo ezininzi zomhlaza, amanqanaba asetyenziselwa ukucwangcisa unyango. Kwi-neuroblastoma, unyango luxhomekeke kwiqela lomngcipheko lomguli. Inqanaba le-neuroblastoma yenye yezinto ezisetyenziselwa ukumisela iqela lomngcipheko. Eminye imibandela bubudala, ithumba histology, kunye nethumba biology.

Kukho amaqela omngcipheko amathathu: umngcipheko ophantsi, umngcipheko ophakathi kunye nomngcipheko omkhulu.

  • Umngcipheko ophantsi kunye nomngcipheko ophakathi we-neuroblastoma unethuba elihle lokuphiliswa.
  • Umngcipheko ophezulu we-neuroblastoma kunokuba nzima ukunyanga.

Ngamanye amaxesha i-neuroblastoma ayiphenduli kunyango okanye ibuye emva konyango.

I-Refractory neuroblastoma sisisu esingaphenduliyo kunyango.

Ukuphinda-phinda i-neuroblastoma ngumhlaza ophindaphindiweyo (ubuye) emva kokuba unyangiwe. Ithumba linokuphinda libuyele kwindawo apho liqale khona okanye kwinkqubo ye-nervous system.

Unyango ngoKhetho lonyango

IINGONGOMA EZIPHAMBILI

  • Kukho iintlobo ezahlukeneyo zonyango kwizigulana ezine-neuroblastoma.
  • Abantwana abane-neuroblastoma kufuneka unyango lwabo lucwangciswe liqela loogqirha abaziingcali kunyango lomhlaza wabantwana, ngakumbi i-neuroblastoma.
  • Iindlela ezisixhenxe zonyango olusetyenziswayo:
  • Ukujonga
  • Ugqirha
  • Unyango ngemitha
  • Unyango lweIodine 131-MIBG
  • Unyango ngamayeza
  • Unyango oluphezulu lwe-chemotherapy kunye nonyango ngemitha ngokuhlangulwa kweseli ye-stem
  • Unyango ekujoliswe kulo
  • Iindidi ezintsha zonyango ziyavavanywa kuvavanyo lweklinikhi.
  • Unyango lwe-Immunotherapy
  • Unyango lwe-neuroblastoma lubangela iziphumo ebezingalindelekanga kunye neziphumo zasemva kwexesha.
  • 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-neuroblastoma.

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

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

Abantwana abane-neuroblastoma kufuneka unyango lwabo lucwangciswe liqela loogqirha abaziingcali kunyango lomhlaza wabantwana, ngakumbi i-neuroblastoma.

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

  • Ugqirha wabantwana.
  • I-oncologist yemitha yabantwana.
  • Ingcali yezigulana.
  • Ingcali yonyango.
  • Isilwanyana se-neuropathologist.
  • Neuroradiologist.
  • Ugqirha wabantwana.
  • Ingcali yomongikazi wabantwana.
  • Unontlalontle.
  • Umsebenzi wobomi bomntwana.
  • Ingcali yeengqondo.

Iindlela ezisixhenxe zonyango olusetyenziswayo:

Ukujonga

Ukujongwa kujongwa ngononophelo kwimeko yesigulana ngaphandle kokunika unyango de kuvele iimpawu okanye utshintsho.

Ugqirha

Utyando lusetyenziselwa ukunyanga i-neuroblastoma engasasazekanga kwamanye amalungu omzimba. Uninzi lwethumba njengoko kunokwenzeka ngokukhuselekileyo luyasuswa. Iimpawu ze-lymph nazo zisuswe kwaye zihlolwe iimpawu zomhlaza.

Ukuba ithumba alinakususwa, kungenziwa i-biopsy endaweni yoko.

Unyango ngemitha

Unyango ngemitha lunyango olusebenzisa amandla e-x-reyi okanye ezinye iintlobo zemitha yokubulala iiseli zomhlaza okanye ukuzigcina zikhula. Unyango lwangaphandle lwemitha lusebenzisa umatshini ongaphandle komzimba ukuthumela imitha kwindawo yomzimba enomhlaza.

Unyango lweIodine 131-MIBG

Unyango lwe-Iodine 131-MIBG lunyango oluneradio radio iodine. Iodine ene-radioactive inikwa nge-intravenous (IV) kwaye ingene kwigazi eligcina imitha ngqo kwiiseli zethumba. Iodine eqhumayo iqokelela iiseli ze-neuroblastoma kwaye iyazibulala ngemitha ekhutshiweyo. Unyango lwe-Iodine 131-MIBG ngamanye amaxesha lusetyenziselwa ukunyanga umngcipheko we-neuroblastoma obuya emva konyango lokuqala.

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).

Ukusetyenziswa kwamachiza amabini okanye nangaphezulu abizwa ngokuba yi-chemotherapy.

Jonga iziyobisi ezivunyiweyo zeNeuroblastoma ngolwazi oluthe kratya.

Unyango oluphezulu lwe-chemotherapy kunye nonyango ngemitha ngokuhlangulwa kweseli ye-stem

Unyango oluphezulu lwe-chemotherapy kunye nonyango lwemitha lunikezelwa ukubulala naziphi na iiseli zomhlaza ezinokuthi ziphinde zibuye zibangele umhlaza ubuye. Iiseli ezisempilweni, kubandakanya iiseli ezenza igazi, nazo ziyatshatyalaliswa lunyango lomhlaza. Ukuhlangulwa kweseli kwistem lunyango lokutshintsha iiseli ezenza igazi. Iiseli zesinti (iiseli zegazi ezingafakwanga) ziyasuswa egazini okanye kumongo wethambo wesigulana kwaye ziyabanda zigcinwe. Emva kokuba isiguli sigqibe i-chemotherapy kunye nonyango lwe-radiation, iiseli ezigciniweyo ezigciniweyo ziyanyibilika kwaye zibuyiselwe kwisigulana ngokufakwa. Ezi seli ze-stem ziphinde zafakwa zikhula ziye (kwaye zibuyisele) iiseli zegazi lomzimba.

Unyango lwesondlo lunikwa emva kwedosi ephezulu yonyango ngamayeza kunye nonyango lwemitha ngokuhlangulwa kweseli ye-stem kwiinyanga ezi-6 kwaye kubandakanya unyango olulandelayo:

  • Isotretinoin: Iyeza elinjengevithamini elinciphisa amandla omhlaza okwenza iiseli zomhlaza ngakumbi kwaye litshintshe indlela ezijongeka ngayo kunye nokusebenza kwazo. Eli chiza lithathwa ngomlomo.
  • I-Dinutuximab: Uhlobo lonyango lwe-monoclonal antibody esebenzisa i-antibody eyenziwe elebhu evela kuhlobo olunye lweeseli zomzimba. I-Dinutuximab ichonga kwaye incamathele kwinto, ebizwa ngokuba yi-GD2, kumphezulu weeseli ze-neuroblastoma. Nje ukuba i-dinutuximab inamathele kwi-GD2, umqondiso uthunyelwa kumajoni omzimba ukuba kufunyenwe into yelinye ilizwe kwaye kufuneka ibulawe. Emva koko amajoni omzimba abulala iseli ye-neuroblastoma. I-Dinutuximab inikwa ngokufakwa. Luhlobo lonyango ekujoliswe kulo.
  • I-Granulocyte-macrophage colony-stimulating factor (GM-CSF): I-cytokine enceda ukwenza amaseli omzimba amaninzi, ngakumbi ii-granulocytes kunye nee-macrophage (iiseli ezimhlophe zegazi), ezinokuhlasela zibulale iiseli zomhlaza.
  • I-Interleukin-2 (IL-2): Uhlobo lwe-immunotherapy olonyusa ukukhula kunye nokusebenza kweeseli ezininzi zomzimba, ngakumbi ii-lymphocyte (uhlobo lweseli emhlophe yegazi). I-lymphocyte inokuhlasela kwaye ibulale iiseli zomhlaza.

Jonga iziyobisi ezivunyiweyo zeNeuroblastoma ngolwazi oluthe kratya.

Unyango ekujoliswe kulo

Unyango ekujoliswe kulo luhlobo lonyango olusebenzisa iziyobisi okanye ezinye izinto ukuchonga nokuhlasela iiseli ezithile zomhlaza. Unyango ekujoliswe kulo lubangela ukwenzakala okuncinci kwiiseli eziqhelekileyo kunonyango lwechemotherapy okanye unyango ngemitha. Kukho iintlobo ezahlukeneyo zonyango ekujoliswe kuzo:

  • Unyango lwe-monoclonal antibody: ii-antibodies zeMonoclonal ziinkqubo zomzimba zomzimba ezenzelwe elebhu ukunyanga izifo ezininzi, kubandakanya nomhlaza. Njengonyango lomhlaza, ezi ntsholongwane zinokuncamathisela kwithagethi ethile kwiiseli zomhlaza okanye ezinye iiseli ezinokunceda iiseli zomhlaza zikhule. Amachiza omzimba ayakwazi ukuzibulala iiseli zomhlaza, athintele ukukhula kwazo, okanye azigcine zisasazeke. Iintsholongwane zeMonoclonal zinikezelwa ngokufakwa. Zingasetyenziselwa zodwa okanye ukuphatha iziyobisi, ityhefu, okanye izinto ezinemitha yeathom ngqo kwiiseli zomhlaza.

I-Pembrolizumab kunye ne-dinutuximab zii-antibodies ze-monoclonal ezifundwayo ukunyanga i-neuroblastoma ebuyileyo emva konyango okanye engaphendulanga kunyango.

  • Unyango lweTyrosine kinase inhibitor: Ezi ziyobisi zijolise kunyango lweempawu ezifunekayo ekukhuleni kwamathumba.

ICrizotinib yi-tyrosine kinase inhibitor esetyenziselwa ukunyanga i-neuroblastoma ebuyileyo emva konyango. I-AZD1775 kunye ne-lorlatinib zi-tyrosine kinase inhibitors ezifundwayo ukunyanga i-neuroblastoma ebuyileyo emva konyango okanye engaphendulanga kunyango.

  • Imbali yonyango lwe-deacetylase inhibitor: Olu nyango lubangela utshintsho lweekhemikhali olunqanda iiseli zomhlaza ekukhuleni nasekuhlukaniseni.

IVorinostat luhlobo lwe-histone deacetylase inhibitor efundwayo ukunyanga i-neuroblastoma ebuyileyo emva konyango okanye engaphendulanga kunyango.

  • Unyango lwe-Ornithine decarboxylase inhibitor: Olu nyango lucutha ukukhula kunye nokwahlulahlula iiseli zomhlaza.

I-Eflornithine luhlobo lwe-ornithine decarboxylase inhibitor efundwayo ukunyanga i-neuroblastoma ebuyileyo emva konyango okanye engaphendulanga kunyango.

Iindidi ezintsha zonyango ziyavavanywa kuvavanyo lweklinikhi.

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

Unyango lwe-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 nyango lomhlaza luhlobo lonyango lwebhayoloji.

  • Unyango lwe-CAR T-cell: Iiseli ze-T zesigulana (uhlobo lweseli yomzimba yokuzikhusela) ziyatshintshwa ukuze zihlasele iiproteni ezithile ngaphezulu kweeseli zomhlaza. Iiseli ze-T zithathwa kwisigulana kwaye ii-receptors ezizodwa zongezwa kumphezulu wazo kwilabhoratri. Iiseli eziguqulweyo zibizwa ngokuba ziiseli ze-chimeric antigen receptor (CAR) T. Iiseli ze-CAR T zikhula elebhu kwaye zinikwa isigulana ngokufakwa. Iiseli ze-CAR T ziphindaphindeka kwigazi lesigulana kwaye zihlasela iiseli zomhlaza.
Unyango lwe-CAR T-cell. Uhlobo lonyango apho iiseli ze-T zesigulana (uhlobo lweseli yomzimba yokuzikhusela) ziguqulwa kwilabhoratri ukuze zibophelele kwiiseli zomhlaza kwaye zibabulale. Igazi eliphuma emthanjeni engalweni yesigulana lihamba lingena kwityhubhu lisiya kumatshini weapheresis (ongaboniswanga), osusa iiseli ezimhlophe zegazi, kubandakanya neeseli zeT, kwaye uthumele lonke igazi libuyele kwisigulana. Emva koko, i-gene ye-receptor ekhethekileyo ebizwa ngokuba yi-chimeric antigen receptor (CAR) ifakwe kwiiseli ze-T elebhu. Izigidi zeeseli ze-CAR T zikhuliswa elebhu zize zinikwe isigulana ngokufakwa. Iiseli ze-CAR T ziyakwazi ukubopha kwi-antigen kwiiseli zomhlaza kwaye zibabulale.

Unyango lwe-CAR T-cell lufundwa ukunyanga i-neuroblastoma ebuyileyo emva konyango okanye engaphendulanga kunyango.

Unyango lwe-neuroblastoma lubangela iziphumo ebezingalindelekanga kunye neziphumo zasemva kwexesha.

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

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

  • Iingxaki zomzimba.
  • Uphuhliso lwezinyo.
  • Ukuvaleka kwamathumbu emathunjini (isithintelo).
  • Ukukhula kwethambo kunye ne-cartilage.
  • Umsebenzi wokuva.
  • Isifo seMetabolic syndrome (uxinzelelo lwegazi oluphakamileyo, i-triglycerides ephezulu, i-cholesterol ephakanyisiweyo, ukwanda kwepesenti yamafutha omzimba).
  • Utshintsho kwiimvakalelo, iimvakalelo, ukucinga, ukufunda, okanye inkumbulo.
  • Umhlaza wesibini (iintlobo ezintsha zomhlaza).

Ezinye iziphumo ezinokufika emva kwexesha zinokunyangwa okanye zilawulwe. Kubalulekile ukuba uthethe noogqirha bomntwana wakho malunga nefuthe unyango lomhlaza olunokuba nalo emntwaneni wakho. Jonga isishwankathelo se- malunga neZiphumo eziMva zaNyango zoMhlaza woMntwana ngolwazi oluthe kratya.

Izigulana zinokufuna ukucinga ngokuthatha inxaxheba kuvavanyo lweklinikhi.

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

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

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

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

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

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

Iimvavanyo zokulandelela zisenokufuneka.

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

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

Uvavanyo olulandelayo kwizigulana ezine-neuroblastoma lubandakanya oku kulandelayo:

  • Umchamo wezifundo zekatecholamine.
  • Ukuskena kweMIBG.

Unyango lwe-Neuroblastoma yomngcipheko osezantsi

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

Unyango lwe-neuroblastoma esandula ukufumanisa ukuba iphantsi komngcipheko unokubandakanya oku kulandelayo:

  • Utyando olulandelwa kukubona.
  • I-Chemotherapy kunye nokuhlinzwa, kubantwana abaneempawu okanye abantwana abane-tumor eqhubekile nokukhula kwaye ayinakususwa ngoqhaqho.
  • I-Chemotherapy, kwizigulana ezithile.
  • Ukuqwalaselwa kuphela kwiintsana ezingaphantsi kweenyanga ezi-6 ezinezicubu ezincinci ze-adrenal okanye iintsana ezingenazo iimpawu okanye iimpawu ze-neuroblastoma.
  • Unyango lwe-radiation ukunyanga amathumba abangela iingxaki ezinkulu kwaye awuphenduli ngokukhawuleza kwi-chemotherapy okanye uqhaqho.
  • Uvavanyo lweklinikhi yonyango olusekwe kwimpendulo yesifo kunyango nakwibhayoloji yethumba.

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 lwe-Neuroblastoma ephakathi

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

Unyango lwe-neuroblastoma yomngcipheko ophakathi osanda kufunyaniswa unokubandakanya oku kulandelayo:

  • I-Chemotherapy kubantwana abaneempawu okanye ukunciphisa ithumba elingenakususwa ngotyando. Ugqirha lungenziwa emva kwekhemotherapy.
  • Utyando ndedwa kwiintsana.
  • Ukuqwalaselwa kuphela kwiintsana.
  • Unyango lwe-radiation ukunyanga amathumba aqhubekile nokukhula ngexesha lonyango nge-chemotherapy okanye amathumba angenakususwa ngotyando kwaye aqhubeke nokukhula emva konyango nge-chemotherapy.
  • Uvavanyo lweklinikhi yonyango olusekwe kwimpendulo yesifo kunyango nakwibhayoloji yethumba.

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 lwe-Neuroblastoma ephezulu yomngcipheko

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

Unyango lwe-neuroblastoma esemngciphekweni omkhulu inokubandakanya oku kulandelayo:

  • Irejimeni yonyango olulandelayo:
  • Ukudibanisa i-chemotherapy.
  • Ugqirha.
  • Iikhosi ezimbini zedosi ephezulu yokudibanisa ichemotherapy elandelwa kukuhlangulwa kweseli.
  • Unyango ngemitha.
  • Unyango lwe-Monoclonal antibody (dinutuximab) kunye ne-interleukin-2 (IL-2), i-granulocyte-macrophage colony-stimulating factor (GM-CSF), kunye ne-isotretinoin.
  • Uvavanyo lweklinikhi yonyango i-iodine 131-MIBG yonyango okanye unyango ekujolise kulo (crizotinib) kunye nolunye unyango.
  • Uvavanyo lweklinikhi yonyango lwe-monoclonal antibody (dinutuximab), GM-CSF, kunye nokudityaniswa kwekhemotherapy.

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 lweNqanaba 4S Neuroblastoma

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

Akukho lonyango luqhelekileyo kwinqanaba le-4S le-neuroblastoma kodwa ukhetho kunyango lubandakanya oku kulandelayo:

  • Ukujongwa kunye nokhathalelo oluxhasayo lwabantwana abane-tumor biology efanelekileyo kwaye abanazimpawu.
  • I-Chemotherapy, yabantwana abaneempawu okanye iimpawu, kwiintsana ezincinci kakhulu, okanye kubantwana abane-tumor biology.
  • Unyango ngemitha yabantwana abane-neuroblastoma ethe yasasazeka kwisibindi.
  • Uvavanyo lweklinikhi yonyango olusekwe kwimpendulo yesifo kunyango nakwibhayoloji yethumba.

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 lwe-Neuroblastoma eQhelekileyo

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

Izigulana ziNyangiwe okokuqala kwiNeuroblastoma yomngcipheko osezantsi

Unyango lwe-neuroblastoma ephindaphindayo ebuyela kwindawo apho umhlaza waqala khona unokubandakanya oku kulandelayo:

  • Ugqirha olulandelwa kukubona okanye unyango lwe-chemotherapy.
  • I-Chemotherapy enokuthi ilandelwe ngotyando.

Unyango lwe-neuroblastoma ephindaphindayo ebuya kwamanye amalungu omzimba okanye engaphendulanga kunyango inokubandakanya oku kulandelayo:

  • Ukujonga.
  • Unyango ngamayeza.
  • Utyando olulandelwa yichemotherapy.
  • Unyango njenge-neuroblastoma esemngciphekweni omkhulu, kubantwana abadala kunonyaka omnye.

Izigulana ziNyangwa okokuqala kwiNegoblastoma ephakathi

Unyango lwe-neuroblastoma ephindaphindayo ebuyela kwindawo apho umhlaza waqala khona unokubandakanya oku kulandelayo:

  • Ugqirha olunokuthi lulandelwe yichemotherapy.
  • Unyango lwe-radiation kubantwana abanesifo esiye sanda ngakumbi emva konyango kunye nokuhlinzwa kwakhona.

Unyango lwe-neuroblastoma ephindaphindayo ebuya kwamanye amalungu omzimba inokubandakanya oku kulandelayo:

  • Unyango njenge-neuroblastoma esemngciphekweni omkhulu, kubantwana abadala kunonyaka omnye.

Izigulana ziNyangwa okokuqala ngeNeobobasta ephezulu yomngcipheko

Akukho lunyango lusemgangathweni lwe-neuroblastoma ephindaphindayo kwizigulana ezanyangwa kuqala kwi-neuroblastoma yomngcipheko omkhulu. Unyango lunokubandakanya oku kulandelayo:

  • Unyango ngamayeza.
  • Ukudibanisa i-chemotherapy kunye ne-monoclonal antibody therapy (dinutuximab).
  • Unyango lweIodine 131-MIBG yokunciphisa iimpawu kunye nokuphucula umgangatho wobomi. Inokunikwa yodwa okanye idityaniswe nechemotherapy.
  • Unyango olujolise kwi-crizotinib okanye ezinye i-ALK inhibitors, kwizigulana ezinotshintsho kuhlobo lwe-ALK.

Ngenxa yokuba akukho lonyango lusemgangathweni, abaguli baqala unyango lwe-neuroblastoma yomngcipheko omkhulu banokufuna ukuqaphela ulingo lweklinikhi. Ngolwazi malunga novavanyo lweklinikhi, nceda ubone iwebhusayithi ye-NCI.

Izigulana ezine-CNS Neuroblastoma

Unyango lwe-neuroblastoma ephindayo (ebuyayo) kwinkqubo ye-nervous system (i-CNS; ingqondo kunye nentambo yomqolo) inokubandakanya oku kulandelayo:

  • Utyando lokususa ithumba kwi-CNS elandelwa lonyango lwe-radiation.
  • Uvavanyo lweklinikhi yonyango olutsha.

Unyango lufundelwa i-Neuroblastoma eqhubekayo / eqhubekayo

Olunye lonyango olufundwayo kuvavanyo lweklinikhi lwe-neuroblastoma ephindaphindayo (ebuyayo) okanye eqhubela phambili (ekhulayo, esasazekayo, okanye engaphenduliyo kunyango) ibandakanya oku kulandelayo:

  • I-Chemotherapy kunye nonyango ekujoliswe kulo (dinutuximab kunye okanye ngaphandle kwe-eflornithine).
  • Ukujonga isampulu yethumba lesigulana kwiinguqu ezithile zofuzo. Uhlobo lonyango ekujoliswe kulo oluya kunikwa isigulana luxhomekeke kuhlobo lotshintsho lwemfuza.
  • Unyango ekujoliswe kulo (AZD1775) kunye nekhemotherapy.
  • Unyango ekujoliswe kulo (pembrolizumab okanye lorlatinib).
  • Unyango lwe-Immunotherapy (unyango lwe-CAR T-cell).
  • Unyango lwe-Iodine 131-MIBG lunikwe lodwa okanye nezinye iziyobisi ezichaphazela umhlaza.
  • Unyango lwe-Iodine 131-MIBG kunye nonyango ekujoliswe kulo (dinutuximab).

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 ngeNeuroblastoma

Ngolwazi oluthe kratya kwiZiko leSizwe loMhlaza malunga ne-neuroblastoma, bona oku kulandelayo:

  • Iphepha lasekhaya le-Neuroblastoma
  • Uvavanyo lweNeuroblastoma
  • Ikhompyuter yeTomography (CT) kunye noMhlaza
  • Iziyobisi ezivunyiweyo ze-Neuroblastoma
  • Iithagethi zoMhlaza ezijolise kuko
  • Unyango lwe-Immunotherapy ukunyanga uMhlaza
  • Iindlela ezintsha zeNeuroblastoma Therapy (NANT) Phuma kwisikhanyeli

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

  • Malunga noMhlaza
  • Umhlaza wabantwana
  • Unyango lokuKhangela uMhlaza waBantwanaPhuma kwiNgcazelo yokuzihlangula
  • Iziphumo zokugqibela zonyango lweCancer yoMntwana
  • Abafikisayo kunye naBantu abaDala abaDala abanomhlaza
  • Abantwana abanomhlaza: Isikhokelo sabazali
  • Umhlaza kuBantwana nakwishumi elivisayo
  • Ukuqokelela
  • Ukujamelana noMhlaza
  • Imibuzo yokubuza ugqirha wakho malunga neCancer
  • Abasindileyo kunye nabaNonopheli


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