Types/retinoblastoma/patient/retinoblastoma-treatment-pdq

Inguqulelo yeRetinoblastoma yoNyango

Ulwazi ngokubanzi malunga neRetinoblastoma

IINGONGOMA EZIPHAMBILI

• I-Retinoblastoma sisifo apho iiseli ezinobungozi (zomhlaza) zenzeka kwizicubu zeretina.

• I-Retinoblastoma yenzeka ngeendlela ezinokuzuzwa kunye nokungafumani lifa.

• Unyango lwazo zombini ezi ntlobo ze-retinoblastoma kufuneka lubandakanye neengcebiso zemfuzo.

• Abantwana abanembali yosapho ye-retinoblastoma kufuneka babe novavanyo lwamehlo ukujonga i-retinoblastoma.

• Umntwana ophethe i-retinoblastoma enobungozi unomngcipheko okhulayo we-retinoblastoma kunye nezinye i-cancer.

• Iimpawu kunye neempawu ze-retinoblastoma zibandakanya "umfundi omhlophe" kunye nentlungu yamehlo okanye ubomvu.

• Uvavanyo oluvavanya i-retina lusetyenziselwa ukufumanisa (ukufumana) kunye nokuchonga i-retinoblastoma.

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

I-Retinoblastoma sisifo apho iiseli ezinobungozi (zomhlaza) zenzeka kwizicubu zeretina.

I-retina sisihlunu semithambo-luvo esibeka ngaphakathi ngasemva kweliso. I-retina yaziva ukukhanya kwaye ithumela imifanekiso kwingqondo ngendlela ye-optic nerve.

I-anatomy yamehlo, ebonisa ngaphandle nangaphakathi kweliso kubandakanya i-sclera, i-cornea, iris, umzimba we-ciliary, i-choroid, i-retina, i-vitreous humor, kunye ne-optic nerve. I-vitreous humor yijeli egcwalisa embindini wamehlo.

Nangona i-retinoblastoma inokwenzeka nanini na, ixhaphakile ebantwaneni abangaphantsi kweminyaka emi-2. Umhlaza unokuba kwiliso elinye (unilateral) okanye emehlweni omabini (omabini). I-Retinoblastoma inqabile ukuba isasazeka ukusuka kwiliso iye kwiithishu ezikufuphi okanye amanye amalungu omzimba.

I-retinoblastoma yomzimba luhlobo olunqabileyo lwe-retinoblastoma apho imingxunya (izithuba ezingenanto) zenza ngaphakathi kwethumba.

I-Retinoblastoma yenzeka ngeendlela ezinokuzuzwa kunye nokungafumani lifa.

Umntwana kucingelwa ukuba unohlobo olufunyanwa njenge-retinoblastoma xa enye yezi zinto iyinyani:

• Kukho imbali yosapho ye-retinoblastoma.

• Kukho utshintsho oluthile (utshintsho) kuhlobo lweRB1. Utshintsho kuhlobo lwe-RB1 lunokudluliselwa lusuka kumzali luye emntwaneni okanye lunokwenzeka kwiqanda okanye kwisidoda ngaphambi kokumitha okanye kungekudala emva kokumitha.

• Kukho ngaphezulu kwethumba elinye kwiliso okanye kukho ithumba emehlweni omabini.

• Kukho ithumba kwiliso elinye kwaye umntwana ungaphantsi konyaka omnye.

Emva kokuba i-retinoblastoma efumanekayo ifunyenwe kwaye yanyangwa, amathumba amatsha anokuqhubeka nokwakheka iminyaka embalwa. Ukuhlolwa kwamehlo rhoqo ukujonga amathumba amatsha kuhlala kwenziwa rhoqo kwiinyanga ezi-2 ukuya kwezi-4 okungenani iinyanga ezingama-28.

I-retinoblastoma engafumanekiyo i-retinoblastoma ayisiyo ifomu eyifa. Uninzi lweziganeko ze-retinoblastoma zezona zifom zingafumanekiyo.

Unyango lwazo zombini ezi ntlobo ze-retinoblastoma kufuneka lubandakanye neengcebiso zemfuzo.

Abazali kufuneka bafumane iingcebiso ngemfuzo (ingxoxo nengcali eqeqeshiweyo malunga nomngcipheko wezifo zemfuzo) ukuxoxa ngokuvavanywa kwemfuzo ukujonga utshintsho (utshintsho) kuhlobo lweRB1. Ingcebiso ngemfuzo ikwabandakanya nengxoxo yomngcipheko we-retinoblastoma yomntwana kunye nabantakwabo okanye oodadewabo.

Abantwana abanembali yosapho ye-retinoblastoma kufuneka babe novavanyo lwamehlo ukujonga i-retinoblastoma.

Umntwana onembali yosapho ye-retinoblastoma kufuneka abe novavanyo lwamehlo rhoqo ukuqala kwasebomini ukukhangela i-retinoblastoma, ngaphandle kokuba kuyaziwa ukuba umntwana akanalo utshintsho lwe-RB1. Ukuchongwa kwangoko kwe-retinoblastoma kunokuthetha ukuba umntwana uya kufuna unyango olunzulu.

Abantakwabo okanye oodade bomntwana one-retinoblastoma kufuneka babe novavanyo lwamehlo rhoqo ngugqirha wamehlo kude kube yiminyaka emi-3 ukuya kwemi-5, ngaphandle kokuba kuyaziwa ukuba umzalwana okanye udade akanalo utshintsho lwe-RB1.

Umntwana ophethe i-retinoblastoma enobungozi unomngcipheko okhulayo we-retinoblastoma kunye nezinye i-cancer.

Umntwana one-retinoblastoma efumanekayo unobungozi obunokwanda kwesifo sepineal kwingqondo. Xa i-retinoblastoma kunye ne-tumor ebuchosheni kwenzeka ngaxeshanye, ibizwa ngokuba yi-retinoblastoma enxantathu. Ithumba lobuchopho lihlala lifunyaniswa phakathi kweenyanga ezingama-20 ukuya kuma-36 ubudala. Ukuvavanywa rhoqo kusetyenziswa i-MRI (imaging resonance imaging) inokwenziwa kumntwana ekucingelwa ukuba une-retinoblastoma efumanekayo okanye umntwana one-retinoblastoma kwiliso elinye kunye nembali yosapho yesi sifo. I-CT (ikhompyuter ye-tomography) ukuskena kuhlala kungasetyenziselwa ukuhlolwa rhoqo ukuze kuthintelwe ukuveza umntwana kwimitha ye-ionizing.

I-retinoblastoma efumanekayo yonyusa umngcipheko womntwana kwezinye iintlobo zomhlaza njengomhlaza wemiphunga, umhlaza wesinyi, okanye imelanoma kwiminyaka edlulileyo. Iimviwo zokulandelela rhoqo zibalulekile.

Iimpawu kunye neempawu ze-retinoblastoma zibandakanya "umfundi omhlophe" kunye nentlungu yamehlo okanye ubomvu.

Ezi kunye nezinye iimpawu kunye neempawu zinokubangelwa yi-retinoblastoma okanye ezinye iimeko. Jonga kugqirha ukuba umntwana wakho unazo ezi zinto zilandelayo:

• Umfundi weliso ubonakala emhlophe endaweni ebomvu xa ukukhanya kukhanya kuyo. Oku kunokubonwa kwiifoto zomntwana.

• Amehlo abonakala ejonge kumacala ahlukeneyo (iliso elonqenayo).

• Intlungu okanye ubomvu kwiliso.

• Usulelo olujikeleze iliso.

• I-eyeball inkulu kunesiqhelo.

• Inxalenye enemibala yamehlo kunye nomfundi ubonakala ngathi kunamafu.

Uvavanyo oluvavanya i-retina lusetyenziselwa ukufumanisa (ukufumana) kunye nokuchonga i-retinoblastoma.

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. Ugqirha uya kubuza ukuba kukho imbali yosapho ye-retinoblastoma.

• Uvavanyo lwamehlo kunye nomfundi ohlaziyiweyo: Uvavanyo lweliso apho umfundi ahluthwe khona (avuleke banzi) ngamachiza wamehlo amayeza ukuvumela ugqirha ukuba ajonge iilensi kunye nomfundi kwi-retina. Ingaphakathi leliso, kubandakanya i-retina kunye ne-optic nerve, ziyavavanywa ngokukhanya. Kuxhomekeke kubudala bomntwana, olu vavanyo lunokwenziwa phantsi kwe-anesthesia.

Kukho iintlobo ezininzi zeemviwo zamehlo ezenziwa kunye nomfundi ohlaziyiweyo:

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

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

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

• Uvavanyo lwe-RB1 yemfuza: Uvavanyo lwaselebhu apho kuvavanywa khona isampulu yegazi okanye izicwili zotshintsho kuhlobo lwe-RB1.

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

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

• Ukuskena i-CT (ukuskena i-CAT): Inkqubo eyenza uthotho lwemifanekiso eneenkcukacha zeendawo ezingaphakathi emzimbeni, ezinjengeeliso, 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) yentloko nentamo. Umntwana ulele phezu kwetafile etyibilika ngesikena se-CT, esithatha imifanekiso ye-x-ray ngaphakathi kwentloko nentamo.

I-Retinoblastoma ihlala ifunyaniswa ngaphandle kwe-biopsy.

Xa i-retinoblastoma ikwelinye iliso, ngamanye amaxesha iba kwelinye iliso. Uvavanyo lweliso elingachaphazelekiyo lwenziwa de kwaziwe ukuba i-retinoblastoma yeyona fomu ifanelekileyo.

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

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

• Nokuba umhlaza ukwamehlo omnye okanye omabini.

• Ubungakanani kunye nenani lamathumba.

• Nokuba ithumba lisasazekile kwindawo ejikeleze iliso, kwingqondo, okanye kwamanye amalungu omzimba.

• Nokuba zikhona iimpawu ngexesha lokuchongwa, kwi-trinatal retinoblastoma.

• Ubudala bomntwana.

• Kungenzeka kangakanani ukuba umbono ungagcinwa kwiliso elinye okanye kokubini.

• Nokuba ngaba uhlobo lwesibini lomhlaza sele lwenziwe.

Amanqanaba eRetinoblastoma

IINGONGOMA EZIPHAMBILI

• Emva kokuba i-retinoblastoma ifunyenwe, kuvavanywa ukwenziwa ukufumanisa ukuba ngaba iiseli zomhlaza zisasazekile ngaphakathi kweliso okanye kwamanye amalungu omzimba.

• Inkqubo yeHlabathi yeRetinoblastoma Staging System (IRSS) inokusetyenziselwa ukubeka i-retinoblastoma kwinqanaba.

• Inqanaba 0

• Inqanaba I

• Inqanaba II

• Inqanaba III

• Inqanaba IV

• Zintathu iindlela umhlaza onwenwa ngayo emzimbeni.

• Umhlaza unokusasazeka ukusuka apho waqala khona kwamanye amalungu omzimba.

• Unyango lwe-retinoblastoma luxhomekeke ekubeni yi-intraocular (ngaphakathi kwamehlo) okanye i-extraocular (ngaphandle kweliso).

• I-retinoblastoma yangaphakathi

• I-retinoblastoma eyongezelelweyo (i-metastatic)

Emva kokuba i-retinoblastoma ifunyenwe, kuvavanywa ukwenziwa ukufumanisa ukuba ngaba iiseli zomhlaza zisasazekile ngaphakathi kweliso okanye kwamanye amalungu omzimba.

Inkqubo esetyenziselwa ukufumanisa ukuba umhlaza usasazekile ngaphakathi kweliso okanye kwamanye amalungu omzimba kuthiwa yistage. Ulwazi oluqokelelwe kwinkqubo yokumisela lumisela ukuba i-retinoblastoma ikwisiso (intraocular) kuphela okanye isasazekile ngaphandle kwamehlo (i-extraocular). Kubalulekile ukwazi inqanaba ukuze ucwangcise unyango. Iziphumo zovavanyo ezisetyenziselwa ukufumanisa umhlaza zihlala zisetyenziselwa ukubeka isifo. (Jonga icandelo loLwazi ngokubanzi.)

Ezi mvavanyo zilandelayo kunye neenkqubo zinokusetyenziswa kwinkqubo yokubeka esiteji:

• Ukuskena amathambo: Inkqubo yokujonga ukuba ngaba kukho iiseli ezahlula ngokukhawuleza, ezinje ngeeseli zomhlaza, emathanjeni. Inani elincinci kakhulu lezinto ezisasazeka ngemitha lifakwa emthanjeni kwaye lihamba ngokuhamba kwegazi. Izinto ezinemitha yeathomathizi ziqokelela emathanjeni ezinomhlaza kwaye zifunyenwe siskena esithatha umfanekiso womzimba. Iindawo zethambo ezinomhlaza zibonakala ziqaqambile emfanekisweni kuba zithatha izinto ezinemitha ye-radioactive kuneeseli zethambo eziqhelekileyo.

Ukuskena amathambo. Inani elincinci lezinto ezinemitha eqhumayo lifakwe kumthambo womntwana kwaye lihamba ngegazi. Izinto ezinemitha yeathomathizi eziqokelela emathanjeni. Njengokuba umntwana elele phezu kwetafile eslayidayo phantsi kweskena, kufunyanwa into enemitha ye-radio kunye nemifanekiso yenziwe kwikhompyuter.

• Umnqweno wethambo kunye ne-biopsy: Ukususwa komongo wethambo kunye neqhekeza elincinci lokufaka inaliti engenamathambo kwi-hipbone okanye kwi-breastbone. Ugqirha wezifo ujonga umongo wethambo phantsi kwemicroscope ukukhangela imiqondiso yomhlaza. Umnqweno wethambo kunye ne-biopsy yenziwa ukuba ugqirha ucinga ukuba umhlaza usasazekile ngaphandle kwamehlo.

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

Inkqubo yeHlabathi yeRetinoblastoma Staging System (IRSS) inokusetyenziselwa ukubeka i-retinoblastoma kwinqanaba.

Kukho iinkqubo ezininzi zokubeka i-retinoblastoma. Amanqanaba e-IRSS asekwe ekuhlaleni komhlaza emva kotyando lokususa ithumba kwaye nokuba umhlaza usasazekile.

Inqanaba 0

Ithumba likwisiso kuphela. Iliso alikasuswa kwaye ithumba lanyangwa ngaphandle kotyando.

Inqanaba I

Ithumba likwisiso kuphela. Iliso lisusiwe kwaye akukho maseli omhlaza ahlala.

Inqanaba II

Ithumba likwisiso kuphela. Iliso lisusiwe kwaye kukho iiseli zomhlaza ezishiyekileyo ezinokubonwa kuphela ngemicroscope.

Inqanaba III

Inqanaba III lahlulwe ngokwamanqanaba IIIa kunye no-IIIb:

• Kwinqanaba le-IIIa, umhlaza usasazekile ukusuka elisweni ukuya kwizicubu ezijikeleze isokethi yamehlo.

• Kwinqanaba le-IIIb, umhlaza usasazekile ukusuka kwiliso ukuya kwii-lymph node kufutshane nendlebe okanye entanyeni.

Inqanaba IV

Isigaba IV sahlulwe sangamanqanaba IVa kunye no-IVb:

• Kwinqanaba le-IVa, umhlaza usasazeke waya egazini kodwa hayi kwingqondo okanye kwintambo yomqolo. Isidumbu esinye okanye nangaphezulu sinokusasazeka kwamanye amalungu omzimba anjengethambo okanye isibindi.

• Kwinqanaba le-IVb, umhlaza usasazeke kwingqondo okanye kumqolo womqolo. Ikwanokusasazeka kwamanye amalungu omzimba.

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-retinoblastoma isasazeka ithambo, iiseli zomhlaza ezisethanjeni ziiseli ze-retinoblastoma. Esi sifo siyi-retinoblastoma ye-metastatic, hayi umhlaza wamathambo.

Unyango lwe-retinoblastoma luxhomekeke ekubeni yi-intraocular (ngaphakathi kwamehlo) okanye i-extraocular (ngaphandle kweliso).

I-retinoblastoma yangaphakathi

Kwi-retinoblastoma ye-intraocular, umhlaza ufumaneka kwiliso elinye okanye omabini kwaye unokuba kwi-retina kuphela okanye unokubakho nakwezinye iindawo zeliso ezifana ne-choroid, umzimba we-ciliary, okanye inxenye ye-optic nerve. Umhlaza awusasazekanga kwizihlunu ezingaphandle kweliso okanye kwezinye iinxalenye zomzimba.

I-retinoblastoma eyongezelelweyo (i-metastatic)

Kwi-extrainobular retinoblastoma, umhlaza usasazeke ngaphaya kwamehlo. Inokufumaneka kwizicubu ezijikeleze iliso (i-orbital retinoblastoma) okanye inokuthi isasazeke kwinkqubo ye-nervous system (ingqondo kunye nomqolo womqolo) okanye kwamanye amalungu omzimba anjengesibindi, amathambo, umongo wethambo, okanye ii-lymph node.

Inkqubela phambili kunye neRetinoblastoma eqhubekayo

Inkqubela phambili ye-retinoblastoma yi-retinoblastoma engaphenduliyo kunyango. Endaweni yokuba umhlaza ukhule, usasazeke, okanye uye usiba mandundu.

I-retinoblastoma ephindaphindayo ngumhlaza ophindaphindiweyo (ubuyile) emva kokuba unyangiwe. Umhlaza unokuphinda ubonakale kwiliso, kwizicubu ezijikeleze iliso, okanye kwezinye iindawo emzimbeni.

Unyango ngoKhetho lonyango

IINGONGOMA EZIPHAMBILI

• Kukho iintlobo ezahlukeneyo zonyango kwizigulana ezine-retinoblastoma.

• Abantwana abane-retinoblastoma kufuneka unyango lwabo lucwangciswe liqela lababoneleli ngezempilo abaziingcali kunyango lomhlaza ebantwaneni.

• Unyango lwe-retinoblastoma lunokubangela iziphumo ebezingalindelekanga.

• Iindidi ezintandathu zonyango zisetyenziswa:

• ICryotherapy

• Unyango

• Unyango ngamayeza

• Unyango ngemitha

• I-dose ephezulu ye-chemotherapy kunye nokuhlangulwa kweseli

• Ugqirha (inyukliya)

• Iindidi ezintsha zonyango ziyavavanywa kuvavanyo lweklinikhi.

• Unyango ekujoliswe kulo

• 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-retinoblastoma.

Iindidi ezahlukeneyo zonyango ziyafumaneka kwizigulana ezine-retinoblastoma. 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-retinoblastoma kufuneka unyango lwabo lucwangciswe liqela lababoneleli ngezempilo abaziingcali kunyango lomhlaza ebantwaneni.

Iinjongo zonyango kukugcina ubomi bomntwana, ukugcina umbono kunye neliso, kunye nokuthintela iziphumo ebezingalindelekanga ezibi. Unyango luya kujongwa yi-oncologist yabantwana, ugqirha ogxile ekunyangeni abantwana abanomhlaza. I-oncologist yabantwana isebenza nabanye ababoneleli ngezempilo abaziingcali ekunyangeni abantwana abanomhlaza wamehlo kwaye begxile kwiindawo ezithile zamayeza. Oku kunokubandakanya i-ophthalmologist yabantwana (ugqirha wamehlo abantwana) onamava amaninzi kunyango lwe-retinoblastoma kunye nezi ngcali zilandelayo:

• Ugqirha wabantwana.

• Imitha ye-oncologist.

• Ugqirha wabantwana.

• Ingcali yomongikazi wabantwana.

• Ingcali yokuvuselela.

• Unontlalontle.

• I-Geneticist okanye umcebisi wezofuzo.

Unyango lwe-retinoblastoma lunokubangela iziphumo ebezingalindelekanga.

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 zokugqibela zonyango lwe-retinoblastoma zingabandakanya oku kulandelayo:

• Iingxaki zomzimba ezinje ngokubona okanye ukuva iingxaki okanye, ukuba iliso lisusiwe, utshintsho kubume kunye nobungakanani bethambo elijikeleze iliso.

• Utshintsho kwiimvakalelo, iimvakalelo, ukucinga, ukufunda, okanye inkumbulo.

• Umhlaza wesibini (iintlobo ezintsha zomhlaza), ezinje ngomhlaza wemiphunga kunye nesinyi, i-osteosarcoma, ithambo le-sarcoma ethambileyo, okanye i-melanoma.

Ezi zinto zilandelayo zomngcipheko zinokunyusa umngcipheko wokuba nomnye umhlaza:

• Ukuba nohlobo olufanelekileyo lwe-retinoblastoma.

• Unyango lwangaphambili ngonyango lwemitha, ngakumbi ngaphambi kobudala bonyaka.

• Sele ndinomhlaza wesibini odlulileyo.

Kubalulekile ukuba uthethe noogqirha bomntwana wakho malunga nefuthe unyango lomhlaza olunokuba nalo emntwaneni wakho. Ukulandelelwa rhoqo ngabaqeqeshi bezempilo abaziingcali ekuchongeni nasekunyangeni iziphumo zasemva kwexesha kubalulekile. Jonga isishwankathelo se- malunga neZiphumo eziMva zaNyango zoMhlaza woMntwana ngolwazi oluthe kratya.

Iindidi ezintandathu zonyango zisetyenziswa:

ICryotherapy

I-Cryotherapy lunyango olusebenzisa isixhobo ukukhenkceza kunye nokutshabalalisa izicwili ezingaqhelekanga. Olu hlobo lonyango lukwabizwa ngokuba yi-cryosurgery.

Unyango

I-Thermotherapy kukusetyenziswa kobushushu ukutshabalalisa iiseli zomhlaza. Unyango lwe-Thermotherapy lunokunikwa kusetyenziswa umqadi we-laser ojolise kumfundi ohlaziyiweyo okanye ngaphandle kwamehlo aliso. I-Thermotherapy ingasetyenziselwa yodwa kwizicubu ezincinci okanye idityaniswe nechemotherapy kwizidumbu ezikhulu. Olu nyango luhlobo lonyango lwe-laser.

Unyango ngamayeza

I-Chemotherapy yonyango lomhlaza olusebenzisa iziyobisi ukunqanda ukukhula kweeseli zomhlaza, nokuba zibulale iiseli okanye uziyekise ekwahlukaneni. Indlela i-chemotherapy enikezelwa ngayo ixhomekeke kwinqanaba lomhlaza kwaye apho umhlaza ukhona emzimbeni.

Kukho iintlobo ezahlukeneyo ze-chemotherapy:

• I-chemotherapy yenkqubo: Xa ichemotherapy ithathwa ngomlomo okanye ifakwe ngaphakathi emthanjeni okanye kwimisipha, amachiza angena kwigazi kwaye anokufikelela kwiiseli zomhlaza kuwo wonke umzimba. Inkqubo ye-chemotherapy inikezelwa ukunciphisa i-tumor (i-chemoreduction) kwaye ugweme ukuhlinzwa ukususa iso. Emva kokufakwa kwemichiza, ezinye iindlela zonyango zingabandakanya unyango lwemitha, i-cryotherapy, unyango lwe-laser, okanye i-chemotherapy yengingqi.

Inkqubo ye-chemotherapy inokunikwa nokubulala nayiphi na iiseli zomhlaza ezisele emva konyango lokuqala okanye kwizigulana ezine-retinoblastoma eyenzeka ngaphandle kwamehlo. Unyango olunikwe emva konyango lokuqala, ukunciphisa umngcipheko wokuba umhlaza uza kubuya, lubizwa ngokuba lunyango oluncedisayo.

• I-chemotherapy yengingqi: Xa ichemotherapy ibekwa ngqo kwi-cerebrospinal fluid (intrathecal chemotherapy), ilungu (elifana nelihlo), okanye indawo yomzimba, iziyobisi zichaphazela iiseli zomhlaza kwezo ndawo. Iindidi ezininzi ze-chemotherapy yengingqi zisetyenziselwa ukunyanga i-retinoblastoma.

• Ophthalmic artery infusion chemotherapy: Ophthalmic artery infusion chemotherapy ithwala amachiza e-anticancer ngqo emehlweni. I-catheter ifakwe kumthambo okhokelela kwiliso kwaye iyeza le-anticancer linikezelwa nge-catheter. Emva kokuba iyeza linikiwe, ibhaluni encinci inokufakwa kumthambo ukuyivimba kwaye igcine uninzi lweziyobisi ze-anticancer zibanjwe kufutshane nethumba. Olu hlobo lwe-chemotherapy lunokunikwa njengonyango lokuqala xa ithumba lisemehlweni kuphela okanye xa ithumba lingaphendulanga kwezinye iintlobo zonyango. I-Ophthalmic artery infusion chemotherapy inikezelwa kumaziko onyango akhethekileyo e-retinoblastoma.

• I-Intravitreal chemotherapy: I-Intravitreal chemotherapy yilenaliti yamachiza e-anticancer ngqo kwi-vitreous humor (into efana ne-jelly) ngaphakathi kwiso. Isetyenziselwa ukunyanga umhlaza osasazeke kwi-vitreous humor kwaye ayiphendulanga kunyango okanye ibuyile emva konyango.

Jonga iziyobisi ezivunyiweyo zeRetinoblastoma 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 lwe-radiation lwangaphandle lusebenzisa umatshini ngaphandle komzimba ukuthumela imitha kumhlaza. Iindlela ezithile zokunika unyango ngemitha kunokunceda ukugcina imitha ingonakalisi izicubu ezisempilweni ezikufutshane. Ezi ntlobo zonyango lwe-radiation zibandakanya oku kulandelayo:

• Unyango lwe-radiation ye-intension-modulated (IMRT): I-IMRT luhlobo lonyango lwe-3-dimensional (3-D) lwangaphandle olusebenzisa ikhompyuter ukwenza imifanekiso yobukhulu kunye nemilo yethumba. Iintsika ezincinci zemitha yokuqina okuhlukeneyo (amandla) zijolise kwithumba kumacala amaninzi.

• Unyango lwe-Proton-beam yonyango: 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.

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

• I-Plaque radiotherapy: Imbewu ye-radioactive iqhotyoshelwe kwelinye icala lediski, ebizwa ngokuba yi-plaque, kwaye ibekwe ngqo kudonga olungaphandle lweliso kufutshane nethumba. Icala le-plaque kunye nembewu kuyo lijongene nebhola leliso, lijolise kwimitha kwi-tumor. Ilitye likhusela ezinye izicubu ezikufutshane kwimitha.

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

Indlela unyango lwe-radiation olunikezelwa ngayo ixhomekeke kuhlobo kunye nenqanaba lomhlaza ophathwayo kunye nendlela umhlaza ophendule ngayo kolunye unyango. Unyango lwangaphandle kunye nolwangaphakathi lwasetyenziselwa ukunyanga i-retinoblastoma.

I-dose ephezulu ye-chemotherapy kunye nokuhlangulwa kweseli

Amanqanaba aphezulu e-chemotherapy anikezelwa ukubulala iiseli zomhlaza. 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, iiseli ezigciniweyo ezigciniweyo ziyanyibilika kwaye zibuyiselwe kwisigulana ngokufakwa. Ezi seli ze-stem ziphinde zafakwa zikhula ziye (kwaye zibuyisele) iiseli zegazi lomzimba.

Jonga iziyobisi ezivunyiweyo zeRetinoblastoma ngolwazi oluthe kratya.

Ugqirha (inyukliya)

Inyukliya ngotyando lokususa iliso kunye nenxalenye ye-optic nerve. Isampulu yethishu yamehlo esusiweyo iya kujongwa phantsi kwemicroscope ukubona ukuba ngaba akukho miqondiso yokuba umhlaza kungenzeka ukuba usasazeke kwamanye amalungu omzimba. Oku kufuneka kwenziwe ngugqirha onamava, oqhelene ne-retinoblastoma kunye nezinye izifo zamehlo. Inyukliya yenziwa ukuba akukho thuba lincinci okanye akukho thuba lokuba umbono ungagcinwa kwaye xa ithumba likhulu, lingaphendulanga kunyango, okanye libuye emva konyango. Isigulana siya kulungiselelwa iliso elingelolokwenyani.

Vala ukulandelela kuyafuneka kangangeminyaka emi-2 okanye nangaphezulu ukujonga iimpawu zokuphindeka kwindawo ejikeleze iliso elichaphazelekayo nokujonga elinye iliso.

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 ekujoliswe kulo

Unyango ekujoliswe kulo luhlobo lonyango olusebenzisa iziyobisi okanye ezinye izinto ukuhlasela iiseli zomhlaza. Unyango ekujoliswe kulo lubangela ukwenzakala okuncinci kwiiseli eziqhelekileyo kunonyango lwechemotherapy okanye unyango ngemitha.

Unyango ekujoliswe kulo lisafundelwa unyango lwe-retinoblastoma ephindileyo (ebuyayo).

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.

Ukhetho kunyango lweRetinoblastoma

Kweli Candelo

• Unyango lwe-Unilateral, Bilateral, kunye neCavitary Retinoblastoma

• Unyango lwe-Retinoblastoma ye-Extraocular

• Unyango lwe-Retinoblastoma eqhubekayo okanye eQhubekayo

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

Unyango lwe-Unilateral, Bilateral, kunye neCavitary Retinoblastoma

Ukuba kunokwenzeka ukuba iliso linokugcinwa, unyango lunokubandakanya oku kulandelayo:

• Inkqubo yechemotherapy okanye i-ophthalmic artery infusion chemotherapy, kunye okanye ngaphandle kwe-intravitreal chemotherapy, ukunciphisa ithumba. Oku kungalandelwa yenye okanye nangaphezulu koku kulandelayo:

• ICryotherapy.

• Unyango.

• Unyango lwe-Plaque radiotherapy.

• Unyango lwangaphandle lwemitha yelanga lwangaphandle lwe-retinoblastoma engaphenduli kolunye unyango.

Ukuba ithumba likhulu kwaye akunakulindeleka ukuba iliso ligcinwe, unyango lunokubandakanya oku kulandelayo:

• Utyando (inyukliya). Emva kotyando, inkqubo ichemotherapy inokunikwa ukunciphisa umngcipheko wokuba umhlaza usasazeke kwamanye amalungu omzimba.

Xa i-retinoblastoma isemehlweni omabini, unyango lweliso ngalinye lungahluka, kuxhomekeka kubungakanani besisu kwaye nokuba kunokwenzeka ukuba iliso linokugcinwa. Umthamo we-chemotherapy yenkqubo ihlala isekwe kwiliso elinomhlaza ongaphezulu.

Unyango lwe-retinoblastoma yomzimba, uhlobo lwe-retinoblastoma ye-intraocular, inokubandakanya oku kulandelayo:

• Inkqubo yekhemotherapy okanye i-ophthalmic artery infusion chemotherapy.

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

Unyango lwe-Retinoblastoma ye-Extraocular

Unyango lwe-retinoblastoma eyongezelelekileyo ethe yanwenwela kwindawo ejikeleze iliso inokubandakanya oku kulandelayo:

• Inkqubo ye-chemotherapy kunye nonyango lwangaphandle lwe-radiation.

• Inkqubo yechemotherapy elandelwa luqhaqho (inyukliya). Unyango lwe-radiation lwangaphandle kunye nolunye unyango lwe-chemotherapy lunokunikwa emva kotyando.

Unyango lwe-retinoblastoma eyongezelelekileyo ethe yanwenwela kwingqondo inokubandakanya oku kulandelayo:

• Inkqubo yenkqubo okanye i-intrathecal chemotherapy.

• Unyango lwe-radiation lwangaphandle lwengqondo kunye nentambo yomqolo.

• I-Chemotherapy elandelwa yidosi ephezulu yedosi yokuhlangula iseli.

Akucaci ukuba unyango lwe-chemotherapy, unyango lwe-radiation, okanye i-chemotherapy yedosi ephezulu kunye nokuhlangulwa kweseli ye-stem kunceda izigulana ezine-extrainobular retinoblastoma zihlala ixesha elide.

Kwi-trinatal retinoblastoma, unyango lunokubandakanya oku kulandelayo:

• Inkqubo yechemotherapy elandelwa yidosi ephezulu yedosi yokuhlangula iseli.

• Inkqubo yekhemotherapy elandelwa luqhaqho kunye nonyango lwemitha engaphandle.

Kwi-retinoblastoma ethe yasasazeka kwamanye amalungu omzimba, kodwa hayi kwingqondo, unyango lunokubandakanya oku kulandelayo:

• I-Chemotherapy ilandelwa yidosi ephezulu yedosi yokuhlangula iseli kunye nonyango lwemitha lwangaphandle.

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-Retinoblastoma eqhubekayo okanye eQhubekayo

Unyango lwe-retinoblastoma eqhubekayo okanye eqhubekayo ye-intraocular inokubandakanya oku kulandelayo:

• Unyango lwangaphandle lwe-radiation okanye iplaotherapy radiotherapy.

• ICryotherapy.

• Unyango.

• Inkqubo yekhemotherapy okanye i-ophthalmic artery infusion chemotherapy.

• Unyango lwe-Intravitreal chemotherapy.

• Utyando (inyukliya).

Uvavanyo lweklinikhi olujonga isampulu yethumba lesigulana kutshintsho oluthile kwimfuza. Uhlobo lonyango ekujoliswe kulo oluya kunikwa isigulana luxhomekeke kuhlobo lotshintsho lwemfuza. Unyango lwe-retinoblastoma eqhubekayo okanye ephindaphindayo inokubandakanya oku kulandelayo:

• Inkqubo yonyango lwe-chemotherapy kunye nonyango lwe-radiation engaphandle ye-retinoblastoma ebuya emva kotyando ukususa iliso.

• I-chemotherapy yenkqubo elandelwa yidosi ephezulu yedosi yokuhlangula iseli kunye nonyango lwemitha engaphandle.

• Uvavanyo lweklinikhi olujonga isampulu yethumba lesigulana kutshintsho oluthile kwimfuza. Uhlobo lonyango ekujoliswe kulo oluya kunikwa isigulana luxhomekeke kuhlobo lotshintsho lwemfuza.

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 woMntwana

Ngolwazi oluthe kratya kwiZiko leSizwe loMhlaza malunga nonyango lwe-retinoblastoma, jonga oku kulandelayo:

• Iphepha lasekhaya leRetinoblastoma

• Ikhompyuter yeTomography (CT) kunye noMhlaza

• I-Cryosurgery kunyango lomhlaza: Imibuzo kunye neempendulo

• Iziyobisi ezivunyiweyo zeRetinoblastoma

• Uvavanyo lweMfuzo kwii-Syndromes eziSebenzayo zoMhlaza

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