Iindidi / ityhalarha / isigulana / unyango lwamatyhalarha-pdq

Inguqulelo yoNyango loMhlaza

Ulwazi ngokubanzi malunga noMhlaza wamatyhalarha

IINGONGOMA EZIPHAMBILI

• Umhlaza wamatyhalarha sisifo apho iiseli ezinobungozi (zomhlaza) zibumba kwizicwili zelinye okanye omabini amasende.

• Imbali yezempilo inokuchaphazela umngcipheko womhlaza wamatyhalarha.

• Iimpawu kunye neempawu zomhlaza wamatyhalarha zibandakanya ukudumba okanye ukungonwabi kwisingxobo samatyhalarha.

• Iimvavanyo ezivavanya amasende kunye negazi zisetyenziselwa ukufumanisa (ukufumana) kunye nokufumanisa umhlaza wamatyhalarha.

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

• Unyango lomhlaza wamatyhalarha lunokubangela ukungachumi.

Umhlaza wamatyhalarha sisifo apho iiseli ezinobungozi (zomhlaza) zibumba kwizicwili zelinye okanye omabini amasende.

Amasende ngamadlala amile okweqanda amabini abekwe ngaphakathi kwisingxobo samatyhalarha (ingxowa yolusu olukhululekileyo elele ngqo ezantsi kwepenisi). Amatyhalarha agcinwa ngaphakathi kwisingxobo samatyhalarha ngentambo ye-spermatic, ekwaqulathe i-vas deferens kunye neenqanawa kunye nemithambo-luvo yamatyhalarha.

I-Anatomy yeenkqubo zokuzala kunye nokuchama kwendoda, ebonisa amasende, iprostate, isinyi kunye namanye amalungu.

Amatyhalarha ngamadlala esini endoda kwaye avelisa i-testosterone kunye nesidoda. Iiseli zeGerm ngaphakathi kwamatyhalarha zivelisa amadlozi angavuthwanga ahamba ngenethiwekhi yeetyhubhu (iityhubhu ezincinci) kunye nemibhobho emikhulu kwi-epididymis (ityhubhu ende ebhijelweyo ecaleni kwamatyhalarha) apho amadlozi akhula khona aze agcinwe.

Phantse yonke imihlaza yamatyhalarha iqala kwiiseli zentsholongwane. Ezona ntlobo zimbini ziphambili zamatyhalarha eeseli zentsholongwane ziiseminomas kunye nonseminomas. Ezi ntlobo zimbini zikhula kwaye zisasazeka ngokwahlukileyo kwaye ziphathwa ngokwahlukileyo. I-Nonseminomas ihlala ikhula kwaye isasazeka ngokukhawuleza kuneeminomas. Iiseminomas zibuthathaka ngakumbi kwimitha. I-tumor yamatyhalarha equlathe iiseminoma kunye neeseli ze-nonseminoma ziphathwa njenge-nonseminoma.

Umhlaza wamatyhalarha ngowona mhlaza uqhelekileyo emadodeni aneminyaka engama-20 ukuya kwengama-35 ubudala.

Imbali yezempilo inokuchaphazela umngcipheko womhlaza wamatyhalarha.

Nantoni na eyonyusa ithuba lokufumana isifo ibizwa ngokuba yingozi. Ukuba nomngcipheko akuthethi ukuba uza kuba nomhlaza; ukungabinamngcipheko oko akuthethi ukuba awuzukufumana umhlaza. Thetha nogqirha wakho ukuba ucinga ukuba usengozini. Imiba yomngcipheko womhlaza wamatyhalarha ibandakanya:

• Ukuba une-testicle engafunekiyo.

• Ukuba nokukhula okungaqhelekanga kwamatyhalarha.

• Ukuba nembali yobuqu yomhlaza wamatyhalarha.

• Ukuba nembali yosapho yomhlaza wamatyhalarha (ngakumbi kutata okanye umntakwabo).

• Ukuba mhlophe.

Iimpawu kunye neempawu zomhlaza wamatyhalarha zibandakanya ukudumba okanye ukungonwabi kwisingxobo samatyhalarha.

Ezi kunye nezinye iimpawu kunye neempawu zinokubangelwa ngumhlaza wamatyhalarha okanye ngezinye iimeko. Jonga ugqirha wakho ukuba unayo nayiphi na kwezi zinto zilandelayo:

• Isigaqa esingenabuhlungu okanye ukudumba kulo naliphi na ityhalarha.

• Utshintsho kwindlela ivakalelwa ngayo ityhalarha.

• Ukuqaqanjelwa sisisu emazantsi esisu okanye kwi-groin.

• Ukwakhiwa ngesiquphe kolwelo kwisingxobo samatyhalarha.

• Ubuhlungu okanye ukungonwabi kwitestamente okanye kwisingxobo samatyhalarha.

Iimvavanyo ezivavanya amasende kunye negazi zisetyenziselwa ukufumanisa (ukufumana) kunye nokufumanisa umhlaza wamatyhalarha.

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. Amasende aya kuvavanywa ukujonga amaqhuma, ukudumba, okanye iintlungu. Imbali yemikhwa yempilo yesigulana kunye nezifo zangaphambili kunye nonyango ziya kuthathwa.

• Uvavanyo lwe-Ultrasound lwee-testes: Inkqubo apho amaza esandi aphakamileyo amandla (i-ultrasound) ehlaselwa kwizicubu zangaphakathi okanye kwizitho zokwenza i-echoes. Iingqungquthela zenza umfanekiso wezicubu zomzimba ezibizwa ngokuba yi-sonogram.

• Uvavanyo lwe-serum tumor marker: Inkqubo apho kuvavanywa khona isampulu yegazi ukulinganisa izixa zezinto ezithile ezikhutshelwe egazini ngamalungu, izicwili, okanye iiseli zethumba emzimbeni. Izinto ezithile zinxulunyaniswa neentlobo ezithile zomhlaza xa zifunyenwe kumanqanaba anyukayo egazini. Oku kubizwa ngokuba kukuphawula amathumba. Amanqaku alandelayo ethumba asetyenziselwa ukufumanisa umhlaza wamatyhalarha:

• I-Alpha-fetoprotein (AFP).

• I-beta-chorionic gonadotropin yabantu (β-hCG).

Amanqanaba okuphawula i-tumor alinganiswa ngaphambi kwe-inguinal orchiectomy kunye ne-biopsy, ukunceda ukufumanisa umhlaza wamatyhalarha.

• I-orchiectomy ye-Inguinal: Inkqubo yokususa lonke ityhalarha ngokusikwa kwindawo yokuchopha. Isampulu yethishu yamatyhalarha iyajongwa ngemicroscope ukujonga iiseli zomhlaza. (Ugqirha wotyando akasikeli kwisikhalazo esiya kumasende ukuze asuse isampulu yethishu kwi-biopsy, kuba ukuba umhlaza ukhona, le nkqubo inokubangela ukuba isasazeke kwisingxobo samatyhalarha nee-lymph nodes. Kubalulekile ukukhetha ugqirha onamava Olu hlobo lotyando.) Ukuba umhlaza ufumanekile, uhlobo lweseli (seminoma okanye nonseminoma) lizimisele ukunceda ukucwangcisa unyango.

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

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

• Isigaba somhlaza (nokuba sikufuphi okanye kufutshane netyhalarha okanye sinwenwele kwezinye iindawo emzimbeni, kunye namanqanaba egazi e-AFP, β-hCG, kunye ne-LDH).

• Uhlobo lomhlaza.

• Ubungakanani besisu.

• Inani kunye nobungakanani bee-lymph node ze-retroperitoneal.

Umhlaza wamatyhalarha unokunyangeka kwizigulana ezifumana i-adjuvant chemotherapy okanye unyango ngemitha emva konyango lwazo oluphambili.

Unyango lomhlaza wamatyhalarha lunokubangela ukungachumi.

Unyango oluthile lomhlaza wamatyhalarha lunokubangela ukungachumi okunokuba sisigxina. Izigulana ezinokuba nomnqweno wokuba nabantwana kufuneka ziqwalasele ukubhenka kwesidoda ngaphambi kokuba zifumane unyango. Idloba lokugcina imali yinkqubo yokuqandisa amadlozi kunye nokuwagcina ukuze asetyenziswe kamva.

Amanqanaba oMhlaza wamatyhalarha

IINGONGOMA EZIPHAMBILI

• Emva kokuba kufunyaniswe isifo somhlaza wamatyhalarha, kwenziwa iimvavanyo zokufumanisa ukuba ingaba iiseli zomhlaza zisasazekile phakathi kwamatyhalarha okanye kwamanye amalungu omzimba.

• Zintathu iindlela umhlaza onwenwa ngayo emzimbeni.

• Umhlaza unokusasazeka ukusuka apho waqala khona kwamanye amalungu omzimba.

• I-orchiectomy ye-inguinal yenziwa ngenjongo yokwazi inqanaba lesi sifo.

• La manqanaba alandelayo asetyenziselwa umhlaza wamatyhalarha:

• Inqanaba 0

• Inqanaba I

• Inqanaba II

• Inqanaba III

Emva kokuba kufunyaniswe isifo somhlaza wamatyhalarha, kwenziwa iimvavanyo zokufumanisa ukuba ingaba iiseli zomhlaza zisasazekile phakathi kwamatyhalarha okanye kwamanye amalungu omzimba.

Inkqubo esetyenziselwa ukufumanisa ukuba ngaba umhlaza usasazekile phakathi kwamasende okanye kwamanye amalungu omzimba kuthiwa yistage. Ulwazi oluqokelelwe kwinkqubo yokubeka inqanaba lesifo. Kubalulekile ukwazi inqanaba ukuze ucwangcise unyango.

Ezi mvavanyo zilandelayo kunye neenkqubo zinokusetyenziswa kwinkqubo yokubeka esiteji:

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

• Ukuskena i-CT (ukuskena i-CAT): Inkqubo eyenza uthotho lwemifanekiso eneenkcukacha zeendawo ezingaphakathi emzimbeni, ezinje ngesisu, esithathwe kwii-engile ezahlukeneyo. Imifanekiso yenziwe yikhompyuter edityaniswe kumatshini we-x-ray. Idayi inokufakwa ngaphakathi emthanjeni okanye iginywe ukunceda amalungu okanye izicwili zibonise ngokucacileyo. Le nkqubo ikwabizwa ngokuba yi-computed tomography, ikhompyuter ye-tomography, okanye ikhompyuter ye-axial tomography.

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

• Isisu se-lymph node dissection: Inkqubo yotyando apho iiseli zesisu esiswini zisuswe kwaye isampulu yethishu ihlolwe phantsi kwemicroscope kwimpawu zomhlaza. Le nkqubo ikwabizwa ngokuba yi-lymphadenectomy. Kwizigulana ezine-nonseminoma, ukususa ii-lymph node kunokunceda ukunqanda ukusasazeka kwezifo. Iiseli zomhlaza kwii-lymph node zezigulana ze-seminoma zinokunyangwa ngonyango lwemitha.

• Uvavanyo lwe-serum tumor marker: Inkqubo apho kuvavanywa khona isampulu yegazi ukulinganisa izixa zezinto ezithile ezikhutshelwe egazini ngamalungu, izicwili, okanye iiseli zethumba emzimbeni. Izinto ezithile zinxulunyaniswa neentlobo ezithile zomhlaza xa zifunyenwe kumanqanaba anyukayo egazini. Oku kubizwa ngokuba kukuphawula amathumba. Amanqaku amathathu alandelayo ethumba asetyenziselwa ukubeka umhlaza wamatyhalarha:

• I-Alpha-fetoprotein (AFP)

• I-beta-chorionic gonadotropin yabantu (β-hCG).

• Lactate dehydrogenase (LDH).

Amanqanaba okuphawula i-tumor alinganiswa kwakhona, emva kwe-inguinal orchiectomy kunye ne-biopsy, ukulungiselela ukumisela inqanaba lomhlaza. Oku kunceda ukubonisa ukuba wonke umhlaza ususiwe okanye ukuba unyango oluninzi luyafuneka. Amanqanaba okuphawula amathumba nawo alinganiswa ngexesha lokulandelwa njengendlela yokujonga ukuba umhlaza ubuyile na.

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

I-orchiectomy ye-inguinal yenziwa ngenjongo yokwazi inqanaba lesi sifo.

La manqanaba alandelayo asetyenziselwa umhlaza wamatyhalarha:

Inqanaba 0

Kwinqanaba le-0, iiseli ezingaqhelekanga zifumaneka kwiityhubhu ezincinci apho iiseli zedoda ziqala ukukhula. Ezi seli zingaqhelekanga zinokuba ngumhlaza kwaye zisasazeke kwizicubu eziqhelekileyo ezikufutshane. Onke amanqanaba okuphawula amathumba aqhelekileyo. Isigaba 0 sikwabizwa ngokuba yi-germ cell neoplasia in situ.

Inqanaba I

Kwinqanaba I, umhlaza wenziwe. Inqanaba I lahlulwe ngokwamanqanaba IA, IB, kunye no-IS.

• Kwinqanaba le-IA, umhlaza ufumaneka kwitestamente, kubandakanya i-rete testis, kodwa ayisasazekanga kwimithambo yegazi okanye kwimithambo ye-lymph kwitestamente.

Onke amanqanaba okuphawula amathumba aqhelekileyo.

• Kwinqanaba IB, umhlaza:

• ifumaneka kwityhalarha, kubandakanywa i-rete testis, kwaye iye yanwenwela kwimithambo yegazi okanye kwimithambo ye-lymph kwityhalarha; okanye

• sele isasazeke kwithishu ethambileyo ye-hilar (izicwili ezenziwe ngemicu kunye namanqatha ngemithambo yegazi kunye nemithambo ye-lymph), i-epididymis, okanye inwebu engaphandle ejikeleze ityhalarha; okanye

• isasazekile kwintambo yesidoda; okanye

• isasazekile kwisingxobo samatyhalarha.

Onke amanqanaba okuphawula amathumba aqhelekileyo.

• Kwinqanaba le-IS, umhlaza ufumaneka naphi na kwi-testicle kwaye unokuthi usasazeke kwintambo yesidoda okanye kwisingxobo samatyhalarha.

Amanqanaba okuphawula i-Tumor asusela kancinane ngaphezulu kwesiqhelo ukuya phezulu.

Ubungakanani beethumba zihlala zilinganiswa ngeesentimitha (cm) okanye ii-intshi. Ukutya okuqhelekileyo okunokusetyenziselwa ukubonisa ubungakanani bethumba nge-cm kubandakanya: ipea (1 cm), ipeanut (2 cm), umdiliya (3 cm), i-walnut (4 cm), ikalika (5 cm okanye 2) I-intshi), iqanda (i-6 cm), ipesika (i-7 cm), kunye ne-grapefruit (i-10 cm okanye ii-intshi ezine).

Inqanaba II

Inqanaba II lahlulwe ngokwamanqanaba IIA, IIB, kunye ne-IIC.

• Kwinqanaba IIA, umhlaza ufumaneka naphi na kwitestamente kwaye unokusasazeka ungene kwintambo yesidoda okanye kwisingxobo samatyhalarha. Umhlaza usasazeke kwi-1 ukuya kwi-5 ye-lymph node ezikufuphi kwaye ii-lymph node ziisentimitha ezi-2 okanye zincinci.

Onke amanqanaba okumakisha amatyala aqhelekile okanye kancinci ngaphezulu kwesiqhelo.

• Kwinqanaba le-IIB, umhlaza ufumaneka naphi na kwitestamente kwaye unokusasazeka kwintambo yesidoda okanye kwisingxobo samatyhalarha. Umhlaza usasazeke waya:

• I-1 lymph node ekufutshane kunye ne-lymph node inkulu kune-2 centimeters kodwa ayinkulu kune-5 centimeters; okanye

• ngaphezu kwe-5 i-lymph node ezikufutshane kunye ne-lymph node azikho ngaphezu kweesentimitha ezi-5; okanye

• i-lymph node ekufuphi kwaye umhlaza usasazeke ngaphandle kwe-lymph node.

Onke amanqanaba okumakisha amatyala aqhelekile okanye kancinci ngaphezulu kwesiqhelo.

• Kwinqanaba le-IIC, umhlaza ufumaneka naphi na kwitestamente kwaye usenokusasazeka kwintambo yesidoda okanye kwisingxobo samatyhalarha. Umhlaza unwenwele kwi-lymph node ekufuphi kwaye i-lymph node inkulu kuneesentimitha ezi-5.

Onke amanqanaba okumakisha amatyala aqhelekile okanye kancinci ngaphezulu kwesiqhelo.

Inqanaba III

Inqanaba III lahlulwe ngokwamanqanaba IIIA, IIIB, kunye IIIC.

• Kwinqanaba le-IIIA, umhlaza ufumaneka naphi na kwitestamente kwaye usenokusasazeka kwintambo yesidoda okanye kwisingxobo samatyhalarha. Umhlaza usenokusasazeka kwenye okanye kwiindawo ezikufutshane. Umhlaza uye wasasazeka kwii-lymph node ezikude okanye kwimiphunga.

Onke amanqanaba okumakisha amatyala aqhelekile okanye kancinci ngaphezulu kwesiqhelo.

• Kwinqanaba le-IIIB, umhlaza ufumaneka naphi na kwitestamente kwaye usenokusasazeka kwintambo yesidoda okanye iscrotum. Umhlaza usasazekile:

• ukuya kwenye okanye kwiindawo ezikufutshane kwaye azange zisasazeke kwamanye amalungu omzimba; okanye

• kwindawo enye okanye ezingaphezulu ezikufutshane. Umhlaza uye wasasazeka kwii-lymph node ezikude okanye kwimiphunga.

Inqanaba lesimakishi elinye okanye nangaphezulu kwethumba liphakathi ngokungaphezulu kwesiqhelo.

• Kwinqanaba le-IIIC, umhlaza ufumaneka naphi na kwitestamente kwaye unokusasazeka kwintambo yesidoda okanye kwisingxobo samatyhalarha. Umhlaza usasazekile:

• ukuya kwenye okanye kwiindawo ezikufutshane kwaye azange zisasazeke kwamanye amalungu omzimba; okanye

• kwindawo enye okanye ezingaphezulu ezikufutshane. Umhlaza uye wasasazeka kwii-lymph node ezikude okanye kwimiphunga.

Inqanaba lesimakishi esinye okanye nangaphezulu liphakamile.

okanye

Umhlaza ufumaneka naphi na kwitestamente kwaye unokusasazeka ungene kwintambo yesidoda okanye kwisirhabaxa. Umhlaza awusasazekanga kwii-lymph node okanye kwimiphunga ekude, kodwa usasazeke nakwamanye amalungu omzimba, njengesibindi okanye ithambo.

Amanqanaba okuphawula i-tumor ahluka ukusuka kwesiqhelekileyo ukuya phezulu.

Umhlaza wamatyhalarha oqhelekileyo

Umhlaza wamatyhalarha owenzeka rhoqo ngumhlaza obuye wabuya (ubuye) emva kokuba unyangiwe. Umhlaza ungabuya emva kweminyaka emininzi umhlaza wokuqala, kwelinye ityhalarha okanye kwamanye amalungu omzimba.

Unyango ngoKhetho lonyango

IINGONGOMA EZIPHAMBILI

• Kukho iintlobo ezahlukeneyo zonyango kwizigulana ezinomhlaza wamatyhalarha.

• Iimvumba zamatyhalarha zahlulwe zangamaqela ama-3, ngokusekwe kwindlela ekulindeleke ukuba luphendule ngayo unyango.

• Ukuxela okuhle

• Ukuxela okuphakathi

• Ukuxela kakubi

• Iindidi ezintlanu zonyango olusetyenziswayo zisetyenziswa:

• Ugqirha

• Unyango ngemitha

• Unyango ngamayeza

• Ukujonga

• I-dose ephezulu ye-chemotherapy kunye nokufakelwa kweseli

• Iindidi ezintsha zonyango ziyavavanywa kuvavanyo lweklinikhi.

• Unyango lomhlaza wamatyhalarha 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 ezinomhlaza wamatyhalarha.

Iindidi ezahlukeneyo zonyango ziyafumaneka kwizigulana ezinomhlaza wamatyhalarha. 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.

Iimvumba zamatyhalarha zahlulwe zangamaqela ama-3, ngokusekwe kwindlela ekulindeleke ukuba luphendule ngayo unyango.

Ukuxela okuhle

Kwi-nonseminoma, zonke ezi zinto zilandelayo kufuneka ziyinyani:

• Ithumba lifumaneka kuphela kumatyhalarha okanye kwi-retroperitoneum (indawo engaphandle okanye emva kodonga lwesisu); kwaye

• Ithumba alinwenwanga kwamanye amalungu ngaphandle kwemiphunga; kwaye

• Amanqanaba abo bonke abamakishi beethumba angaphezulu kancinci kunesiqhelo.

Kwi-seminoma, konke oku kulandelayo kufuneka kuyinyani:

• Ithumba alinwenwanga kwamanye amalungu ngaphandle kwemiphunga; kwaye

• Inqanaba le-alpha-fetoprotein (AFP) liqhelekile. I-beta-chorionic gonadotropin (β-hCG) kunye ne-lactate dehydrogenase (LDH) inokuba kulo naliphi na inqanaba.

• Ukuxela okuphakathi

Kwi-nonseminoma, zonke ezi zinto zilandelayo kufuneka ziyinyani:

• Ithumba lifumaneka kwityhalarha elinye kuphela okanye kwi-retroperitoneum (indawo engaphandle okanye ngasemva kodonga lwesisu); kwaye

• Ithumba alinwenwanga kwamanye amalungu ngaphandle kwemiphunga; kwaye

• Inqanaba lalo naliphi na uphawu lwethumba lingaphezulu kancinane ngaphezulu kwesiqhelo.

Kwi-seminoma, konke oku kulandelayo kufuneka kuyinyani:

• Ithumba linwenwele nakwamanye amalungu ngaphandle kwemiphunga; kwaye

• Inqanaba le-AFP liqhelekile. I-C-hCG kunye ne-LDH banokuba kulo naliphi na inqanaba.

Ukuxela kakubi

Kwi-nonseminoma, enye yezi zinto zilandelayo mayibe yinyani:

• Ithumba likumbindi wesifuba phakathi kwemiphunga; okanye

• Ithumba linwenwele nakwamanye amalungu ngaphandle kwemiphunga; okanye

• Inqanaba lalo naliphi na uphawu lwethumba liphezulu.

Akukho qela lingalunganga lokuxela kwangaphambili kwizilonda zamatyhalarha eseminoma.

Iindidi ezintlanu zonyango olusetyenziswayo zisetyenziswa:

Ugqirha

Utyando lokususa ityhalarha (inguinal orchiectomy) kunye nezinye zeendawo ezinesingqi ezinokuthi zenziwe xa kufunyaniswa isifo. (Jonga icandelo loLwazi ngokubanzi kunye namanqanaba esi sishwankathelo.) Izidumbu ezisasazeke kwezinye iindawo emzimbeni zinokususwa ngokuyinxenye okanye zisuswe ngokupheleleyo ngotyando.

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

Unyango ngemitha

Unyango ngemitha lunyango olusebenzisa amandla e-x-reyi okanye ezinye iintlobo zemitha yokubulala iiseli zomhlaza okanye ukuzigcina zikhula. Zimbini iintlobo zonyango lwe-radiation:

• Unyango lwangaphandle lwemitha lusebenzisa umatshini ngaphandle komzimba ukuthumela imitha kumhlaza.

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

Indlela unyango lwe-radiation olunikezelwa ngayo ixhomekeke kuhlobo kunye nenqanaba lomhlaza ophathwayo. Unyango lwangaphandle lwemitha lusetyenziselwa ukunyanga umhlaza wamatyhalarha.

Unyango ngamayeza

I-Chemotherapy yonyango lomhlaza olusebenzisa iziyobisi ukunqanda ukukhula kweeseli zomhlaza, nokuba kungokubulala iiseli okanye kukumisa iiseli zahlule. Xa i-chemotherapy ithathwa ngomlomo okanye ifakwe kwi-vein okanye kwimisipha, amachiza angena kwigazi kwaye anokufikelela kwiiseli zomhlaza kuwo wonke umzimba (systemic chemotherapy). Xa i-chemotherapy ibekwa ngqo kwi-cerebrospinal fluid, ilungu, okanye indawo yomzimba efana nesisu, iziyobisi zichaphazela kakhulu iiseli zomhlaza kwezo ndawo (chemotherapy yengingqi). Indlela i-chemotherapy enikezelwa ngayo ixhomekeke kuhlobo kunye nenqanaba lomhlaza ophathwayo.

Jonga iziyobisi ezivunyiweyo zomhlaza wamatyhalarha ngolwazi oluthe kratya.

Ukujonga

Ukujongwa kulandela imeko yesigulana ngaphandle kokunika naluphi na unyango ngaphandle kokuba kukho utshintsho kwiziphumo zovavanyo. Isetyenziselwa ukufumana iimpawu zokuqala zokuba umhlaza ubuyile (buyela). Ekugadweni, abaguli banikwa iimviwo ezithile kunye novavanyo kwishedyuli eqhelekileyo.

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 zeziqu (iiseli zegazi ezingafakwanga) ziyasuswa egazini okanye kumongo wethambo wesigulana okanye somnikeli kwaye zibandisiwe kwaye 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 zomhlaza wamatyhalarha ngolwazi oluthe kratya.

Ukufakelwa kweseli. (Inyathelo 1): Igazi lithathwa emthanjeni engalweni yomnikeli. Isigulana okanye omnye umntu angangumnikeli. Igazi lihamba ngomatshini osusa iiseli zeziqu. Emva koko igazi libuyiselwa kulowo unikeleyo ngomthambo okwenye ingalo. (Inyathelo 2): Isigulana sifumana ichemotherapy yokubulala iiseli ezenza igazi. Isigulana sinokufumana unyango ngemitha (engaboniswanga). (Inyathelo 3): Isigulana sifumana iiseli zeziqu ngokusebenzisa ipayinti ebekwe kwisitya segazi esifubeni.

Iindidi ezintsha zonyango ziyavavanywa kuvavanyo lweklinikhi.

Ulwazi malunga novavanyo lweklinikhi luyafumaneka kwiwebhusayithi yeNCI.

Unyango lomhlaza wamatyhalarha 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.

Amadoda anomhlaza wamatyhalarha anomngcipheko okhulayo wokuba nomhlaza kwelinye ityhalarha. Isigulana sicetyiswa ukuba sihlale sijonga elinye ityhalarha size sixele kwangoko naziphi na iimpawu ezingaqhelekanga kugqirha.

Iimviwo zeklinikhi zexesha elide zibaluleke kakhulu. Isigulana sinokuphinda sihlolwe rhoqo kunyaka wokuqala emva kotyando kwaye kunqabile emva koko.

Ukhetho lonyango ngeSigaba

Kweli Candelo

• Isigaba 0 (iTesticular Intraepithelial Neoplasia)

• Isigaba I Umhlaza wamatyhalarha

• Isigaba II somhlaza wamatyhalarha

• Inqanaba lesithathu lomhlaza wamatyhalarha

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

Isigaba 0 (iTesticular Intraepithelial Neoplasia)

Unyango lwenqanaba 0 lunokubandakanya oku kulandelayo:

• Unyango ngemitha.

• Ukujonga.

• Utyando lokususa ityhalarha.

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.

Isigaba I Umhlaza wamatyhalarha

Unyango lwenqanaba lomhlaza wamatyhalarha kuxhomekeke ekubeni umhlaza yi-seminoma okanye i-nonseminoma.

Unyango lwe-seminoma lunokubandakanya oku kulandelayo:

• Utyando lokususa ityhalarha, kulandelwe kukujonga.

• Kwizigulana ezifuna unyango olusebenzayo endaweni yokujonga, unyango lunokubandakanya:

• Utyando lokususa ityhalarha, kulandele ichemotherapy.

Unyango lwe-nonseminoma lunokubandakanya oku kulandelayo:

• Ugqirha lokususa ityhalarha, kunye nokulandela ixesha elide.

• Ugqirha lokususa ityhalarho kunye ne-lymph node esiswini, kunye nokulandela ixesha elide.

• Ugqirha olulandelwa yichemotherapy kwizigulana ezisemngciphekweni omkhulu wokuphindaphinda, kunye nokulandela ixesha elide.

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.

Isigaba II somhlaza wamatyhalarha

Unyango lwesigaba II somhlaza wamatyhalarha luxhomekeke ekubeni umhlaza yi-seminoma okanye yi-nonseminoma.

Unyango lwe-seminoma lunokubandakanya oku kulandelayo:

• Xa ithumba liziisentimitha ezi-5 okanye zincinci:

• Utyando lokususa ityhalarha, elandelwa lonyango ngemitha kwii-lymph node esiswini nakwisinqe.

• Ukudibanisa i-chemotherapy.

• Utyando lokususa ityhalarha kunye ne-lymph node esiswini.

• Xa ithumba likhulu kuneesentimitha ezi-5:

• Utyando lokususa ityhalarha, elandelwa ngokudityaniswa kweekhemotherapy okanye unyango ngemitha kwii-lymph node esiswini nakwisinqe, kunye nokulandela ixesha elide.

Unyango lwe-nonseminoma lunokubandakanya oku kulandelayo:

• Ugqirha lokususa ityhalarho kunye ne-lymph node, kunye nokulandela ixesha elide.

• Ugqirha lokususa ityhalarho kunye ne-lymph node, kulandelwe ngokudityaniswa kwekhemotherapy kunye nokulandelwa kwexesha elide.

• Ugqirha lokususa ityhalarha, lilandelwe ngokudityaniswa kweekhemotherapy kunye notyando lwesibini ukuba umhlaza uhlala, kunye nokulandela ixesha elide.

• Ukudityaniswa kwekhemotherapy ngaphambi kotyando ukususa ityhalarha, umhlaza osasazekile kwaye kucingelwa ukuba usongela ubomi.

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.

Inqanaba lesithathu lomhlaza wamatyhalarha

Unyango lwesigaba sesithathu somhlaza wamatyhalarha luxhomekeke ekubeni umhlaza yi-seminoma okanye yi-nonseminoma.

Unyango lwe-seminoma lunokubandakanya oku kulandelayo:

• Ugqirha lokususa ityhalarha, lilandelwe ngokudityaniswa kweekhemotherapy. Ukuba kukho amathumba ashiyekileyo emva kwekhemotherapy, unyango lunokuba koku kulandelayo:

• Ukujongwa kungekho lunyango ngaphandle kokuba amathumba akhula.

• Ukujongwa kwamathumba amancinci kuneesentimitha ezi-3 kunye notyando lokususa amathumba amakhulu kuneesentimitha ezi-3.

• Ukuvavanywa kwe-PET kwiinyanga ezimbini emva kwechemotherapy kunye notyando lokususa amathumba abonisa umhlaza kwiskeni.

• Uvavanyo lweklinikhi lwe-chemotherapy.

Unyango lwe-nonseminoma lunokubandakanya oku kulandelayo:

• Ugqirha lokususa ityhalarha, lilandelwe ngokudityaniswa kweekhemotherapy.

• Umdibaniso wechemotherapy elandelwa lutyando lokususa ityhalarha nawo onke amathumba ashiyekileyo. Unyango lwe-chemotherapy olongezelelekileyo lunokunikwa ukuba izicubu zethumba ezisusiweyo ziqulathe iiseli zomhlaza ezikhulayo okanye ukuba iimvavanyo zokulandela zibonisa ukuba umhlaza uyaqhubeka.

• Ukudityaniswa kwekhemotherapy ngaphambi kotyando ukususa ityhalarha, umhlaza osasazekile kwaye kucingelwa ukuba usongela ubomi.

• Uvavanyo lweklinikhi lwe-chemotherapy.

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

Iinketho zonyango kunyango lomhlaza wamatyhalarha

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

Unyango lomhlaza wamatyhalarha ophindaphindiweyo unokubandakanya oku kulandelayo:

• Ukudibanisa i-chemotherapy.

• I-dose ephezulu ye-chemotherapy kunye nokufakelwa kweseli.

• Ugqirha lokususa umhlaza onokuthi:

• Buya ngaphezulu kweminyaka emi-2 emva kokuxolelwa ngokupheleleyo; okanye

• buya endaweni enye kuphela kwaye ayiphenduli kwi-chemotherapy.

• Uvavanyo lweklinikhi yonyango olutsha.

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

Ukufunda ngakumbi malunga noMhlaza wamatyhalarha

Ngolwazi oluthe kratya kwiZiko leSizwe loMhlaza malunga nomhlaza wamatyhalarha, jonga oku kulandelayo:

• Umhlaza wamatyhalarha Ikhasi Lasekhaya

• Uvavanyo loMhlaza

• Iziyobisi ezivunyiweyo zomhlaza wamatyhalarha

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