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Umdlavuza Ongajwayelekile Wokwelashwa Kwezingane (?)

Imininingwane ejwayelekile Mayelana Nomdlavuza Ongavamile Wobuntwana

AMAPHUZU ASEMQOKA

  • Umdlavuza ongajwayelekile wobuntwana ngumdlavuza ongabonakali ezinganeni.
  • Ukuhlolwa kusetshenziselwa ukuthola (ukuthola), ukuxilonga, kanye nokwakha umdlavuza ongajwayelekile wobuntwana.
  • Zintathu izindlela umdlavuza osakazeka ngayo emzimbeni.
  • Umdlavuza ungasakazeka usuka lapho uqale khona kwezinye izingxenye zomzimba.

Umdlavuza ongajwayelekile wobuntwana ngumdlavuza ongabonakali ezinganeni.

Umdlavuza ezinganeni nasebusheni uyivelakancane. Kusukela ngo-1975, inani lamacala amasha omdlavuza wezingane liye lenyuka kancane. Kusukela ngo-1975, inani labantu abashona ngenxa yomdlavuza wezingane lehle ngaphezu kwengxenye.

Imidlavuza engajwayelekile okukhulunywe ngayo kulesi sifinyeto ayivelakancane kangangoba izibhedlela zezingane eziningi kungenzeka zibone ngaphansi kwezinhlobo ezimbalwa zezinhlobo ezithile eminyakeni eminingana. Ngoba umdlavuza ongajwayelekile uyivelakancane, alukho ulwazi oluningi mayelana nokuthi yiluphi ukwelashwa olusebenza kahle kakhulu. Impatho yengane imvamisa isuselwa kulokho okufundwe ekwelapheni ezinye izingane. Kwesinye isikhathi, imininingwane itholakala kuphela emibikweni yokuxilongwa, ukwelashwa, nokulandelwa kwengane eyodwa noma iqembu elincane lezingane elinikezwe uhlobo olufanayo lokwelashwa.

Izinhlobo eziningi zomdlavuza zimbozwe kulesi sifinyezo. Ziqoqwe lapho zitholakala khona emzimbeni.

Ukuhlolwa kusetshenziselwa ukuthola (ukuthola), ukuxilonga, kanye nokwakha umdlavuza ongajwayelekile wobuntwana.

Ukuhlolwa kwenziwa ukuthola, ukuxilonga, kanye nomdlavuza wasesiteji. Ukuhlolwa okusetshenzisiwe kuncike ohlotsheni lomdlavuza. Ngemuva kokutholakala komdlavuza, kwenziwa ukuhlolwa ukuthola ukuthi ngabe amangqamuzana omdlavuza asabalale lapho umdlavuza waqala khona kwezinye izingxenye zomzimba. Inqubo esetshenzisiwe ukuthola ukuthi ngabe amangqamuzana omdlavuza asenabele yini kwezinye izingxenye zomzimba ibizwa nge-staging. Imininingwane eqoqwe kusuka kusistimu yesiteji inquma isigaba sesifo. Kubalulekile ukwazi isigaba ukuze uhlele ukwelashwa okuhle kakhulu.

Lezi zivivinyo nezinqubo ezilandelayo zingasetshenziswa ukuthola, ukuxilonga, nomdlavuza wasesiteji:

  • Ukuhlolwa komzimba kanye nomlando wezempilo: Ukuhlolwa komzimba ukuhlola izimpawu ezijwayelekile zempilo, kufaka phakathi nokuhlola izimpawu zezifo, njengezigaxa noma yini enye ebonakala ingajwayelekile. Kuzothathwa nomlando wemikhuba yezempilo yesiguli kanye nokugula nokwelashwa kwangaphambilini.
  • Izifundo ze-chemistry yegazi: Inqubo lapho kuhlolwe khona isampula segazi ukukala inani lezinto ezithile ezikhishwe egazini ngezitho nezicubu zomzimba. Inani elingavamile (eliphakeme noma eliphansi kunokujwayelekile) lezinto kungaba uphawu lwesifo.
  • I-X-ray: I-x-ray uhlobo lwensimbi yamandla engadlula emzimbeni iye kwifilimu.
  • I-CT scan (i-CAT scan): Inqubo eyenza uchungechunge lwezithombe ezinemininingwane yezindawo ezingaphakathi komzimba, ezithathwe ezinhlangothini ezahlukene. Izithombe zenziwa yikhompyutha exhunywe kumshini we-x-ray. Le nqubo ibizwa nangokuthi i-computed tomography, i-computerized tomography, noma i-computer axial tomography.
Iskena se-computed tomography (CT) sesisu. Ingane ilele etafuleni elishibilika ngesithwebuli se-CT, esithatha izithombe ze-x-ray zangaphakathi kwesisu.
  • I-PET scan (i-positron emission tomography scan): Inqubo yokuthola amangqamuzana abulalayo omzimba emzimbeni. Inani elincane le-glucose enemisebe (ushukela) lifakwa emthanjeni. Isithwebuli se-PET sizungeza umzimba futhi senze isithombe lapho i-glucose isetshenziswa khona emzimbeni. Amaseli amathumba amabi abonakala ekhanya esithombeni ngoba ayasebenza futhi athatha i-glucose eningi kunamaseli avamile.
Ukuskena kwePositron emission tomography (PET). Ingane ilele phezu kwetafula elishibilika ngesithwebuli se-PET. Ukuphumula kwekhanda nomucu omhlophe kusiza ingane ukuba ilele inganyakazi. Inani elincane le-glucose enemisebe (ushukela) lifakwa emthanjeni wengane, futhi isithwebuli senza isithombe sokuthi i-glucose isetshenziswa kuphi emzimbeni. Amaseli womdlavuza avela ngokugqamile esithombeni ngoba athatha i-glucose eningi kunamaseli avamile.
  • I-MRI (imaging resonance imaging): Inqubo esebenzisa uzibuthe namagagasi omsakazo ukwenza uchungechunge lwezithombe eziningiliziwe zezindawo ezingaphakathi komzimba. Izithombe zenziwe yikhompyutha. Le nqubo ibizwa nangokuthi i-nuclear magnetic resonance imaging (i-NMRI).
I-Magnetic resonance imaging (MRI) yesisu. Ingane ilele etafuleni elingena kuskena seMRI, esithwebula izithombe zangaphakathi komzimba. Iphedi esiswini sengane isiza ukwenza izithombe zicace bha.
  • Ukuhlolwa kwe-Ultrasound: Inqubo lapho amaza omsindo wamandla aphezulu (i-ultrasound) ehlaselwa izicubu zangaphakathi noma izitho bese enza ama-echoes. Ama-echoes akha isithombe sezicubu zomzimba esibizwa nge-sonogram. Isithombe singaphrintwa ukuze sibhekwe ngokuhamba kwesikhathi.
I-ultrasound yesisu. I-ultrasound transducer exhunywe kwikhompyutha icindezelwa esikhunjeni sesisu. I-transducer igxilisa amaza omsindo ezithweni zangaphakathi nezicubu zayo ukuze yenze ama-echoes akha isithombe (sekhompyutha).
  • I-Endoscopy: Inqubo yokubheka izitho nezicubu ngaphakathi komzimba ukubheka izindawo ezingajwayelekile. I-endoscope ifakwa ngokusika (ukusika) esikhunjeni noma ekuvulekeni emzimbeni, njengomlomo noma i-rectum. I-endoscope iyinsimbi encane, efana nethubhu enokukhanya nelensi yokubuka. Kungaba futhi nethuluzi lokususa amasampula wezicubu noma ama-lymph node, ahlolwe ngaphansi kwesibonakhulu ukuthola izimpawu zesifo.
I-endoscopy ephezulu. Ishubhu elincane, elikhanyisiwe lifakwa ngomlomo ukubheka izindawo ezingajwayelekile emqaleni, esiswini, nasengxenyeni yokuqala yamathumbu amancane.
  • Ukuskena kwamathambo: Inqubo yokubheka ukuthi kunamaseli ahlukanisa ngokushesha yini, njengamaseli womdlavuza, ethanjeni. Inani elincane kakhulu lezinto ezinomsakazo lifakwa emthanjeni futhi lihambe phakathi kwegazi. Izinto ezinemisebe eqoqa emathanjeni ezinomdlavuza futhi zitholwa isithwebuli.
Ukuskena kwamathambo. Inani elincane lezinto ezikhipha imisebe lifakwa emthanjeni wengane futhi lihamba egazini. Izinto ezinemisebe eqoqa emathanjeni. Ngenkathi ingane ilele etafuleni elishibilika ngaphansi kwesithwebuli, kutholwa okokusebenza okukhipha imisebe bese kwenziwa izithombe esikrinini sekhompyutha.
  • I-Biopsy: Ukususwa kwamaseli noma izicubu ukuze kubhekwe ngaphansi kwesibonakhulu ngudokotela wezifo ukuhlola izimpawu zomdlavuza. Kunezinhlobo eziningi zezinqubo ze-biopsy. Izinhlobo ezivame kakhulu zifaka okulandelayo:
  • I-Fine-needle aspiration (FNA) biopsy: Ukususwa kwezicubu noma uketshezi kusetshenziswa inaliti ezacile.
  • I-Core biopsy: Ukususwa kwezicubu kusetshenziswa inaliti ebanzi.
  • I-incisional biopsy: Ukususwa kwengxenye yesigaxa noma isampula lezicubu ezingabukeki zijwayelekile.
  • I-Biopsy e-Excisional: Ukususwa kwesigaxa sonke noma indawo yezicubu ezingabonakali zijwayelekile.

Zintathu izindlela umdlavuza osakazeka ngayo emzimbeni.

Umdlavuza ungasakazeka ngezicubu, uhlelo lwe-lymph, kanye negazi:

  • Izicubu. Umdlavuza usakazeka lapho uqale khona ngokukhulela ezindaweni eziseduze.
  • Uhlelo lweLymph. Umdlavuza usakazeka lapho uqale khona ngokungena ohlelweni lwe-lymph. Umdlavuza udabula imithambo ye-lymph uye kwezinye izingxenye zomzimba.
  • Igazi. Umdlavuza usakazeka lapho uqale khona ngokungena egazini. Umdlavuza uhamba ngemithambo yegazi uye kwezinye izingxenye zomzimba.

Umdlavuza ungasakazeka usuka lapho uqale khona kwezinye izingxenye zomzimba.

Lapho umdlavuza usakazekela kolunye uhlangothi lomzimba, ubizwa ngokuthi yi-metastasis. Amaseli womdlavuza aqhamuka lapho aqale khona (isimila sokuqala) futhi ahamba ngohlelo lwe-lymph noma igazi.

  • Uhlelo lweLymph. Umdlavuza ungena ohlelweni lwe-lymph, udabule emithanjeni ye-lymph, bese wenza isimila (isimila se-metastatic) kwenye ingxenye yomzimba.
  • Igazi. Umdlavuza ungena egazini, udabule emithanjeni yegazi, bese wenza isimila (isimila se-metastatic) kwenye ingxenye yomzimba.

Isigaxa se-metastatic luhlobo olufanayo lomdlavuza njengesimila sokuqala. Isibonelo, uma umdlavuza we-thyroid usakazeka uye emaphashini, amangqamuzana omdlavuza asephashini empeleni angamaseli omdlavuza wegilo. Lesi sifo umdlavuza wegilo we-metastatic, hhayi umdlavuza wamaphaphu.

Ukufa komdlavuza okuningi kubangelwa lapho umdlavuza usuka esiswini sokuqala futhi usakazekela kwezinye izicubu nezitho. Lokhu kubizwa ngokuthi umdlavuza we-metastatic. Lokhu kugqama kukhombisa ukuthi amangqamuzana omdlavuza ahamba kanjani esuka emzimbeni lapho aqala khona ukwakheka kwezinye izingxenye zomzimba.

Uhlolojikelele lwenketho yokwelashwa

AMAPHUZU ASEMQOKA

  • Kunezinhlobo ezahlukene zokwelashwa kwezingane ezinomdlavuza ongajwayelekile.
  • Izingane ezinomdlavuza ongajwayelekile kufanele zihlelelwe ukwelashwa kwazo yiqembu labahlinzeki bezempilo abangongoti ekwelapheni umdlavuza ezinganeni.
  • Izinhlobo eziyisishiyagalolunye zokwelashwa okujwayelekile zisetshenzisiwe:
  • Ukuhlinzwa
  • Ukwelashwa ngemisebe
  • Ukwelashwa ngamakhemikhali
  • I-chemotherapy ephezulu ene-autologous stem cell rescue
  • Ukwelashwa kweHormone
  • I-Immunotherapy
  • Ukulinda okulindile
  • Ukwelashwa okuhlosiwe
  • Ukuhlanganisa
  • Izinhlobo ezintsha zokwelashwa ziyahlolwa ezivivinyweni zokwelashwa.
  • Ukwelashwa kwe-Gene
  • Iziguli zingafuna ukucabanga ngokubamba iqhaza esivivinyweni somtholampilo.
  • Iziguli zingangena ezivivinyweni zokwelashwa ngaphambi, ngesikhathi, noma ngemuva kokuqala ukwelashwa kwazo komdlavuza.
  • Ukuhlolwa kokulandelela kungadingeka.
  • Ukwelashwa komdlavuza ongajwayelekile wobuntwana kungadala imiphumela emibi.

Kunezinhlobo ezahlukene zokwelashwa kwezingane ezinomdlavuza ongajwayelekile.

Izinhlobo ezahlukene zokwelashwa ziyatholakala ezinganeni ezinomdlavuza. Ezinye izindlela zokwelapha zijwayelekile (indlela esetshenziswa njengamanje), kanti ezinye ziyahlolwa ezivivinyweni zokwelashwa. Isivivinyo somtholampilo wokwelashwa isifundo socwaningo esihloselwe ukusiza ukuthuthukisa ukwelashwa kwamanje noma ukuthola ulwazi ngezindlela zokwelashwa ezintsha zeziguli ezinomdlavuza. Lapho izivivinyo zokwelashwa zibonisa ukuthi ukwelashwa okusha kungcono kunokwelashwa okujwayelekile, ukwelashwa okusha kungaba ukwelashwa okujwayelekile.

Ngoba umdlavuza ezinganeni uyivelakancane, ukubamba iqhaza esivivinyweni somtholampilo kufanele kubhekwe. Ezinye izivivinyo zokwelashwa zivulekele kuphela iziguli ezingakaqali ukwelashwa.

Izingane ezinomdlavuza ongajwayelekile kufanele zihlelelwe ukwelashwa kwazo yiqembu labahlinzeki bezempilo abangongoti ekwelapheni umdlavuza ezinganeni.

Ukwelashwa kuzobhekwa ngudokotela wezingane oncologist, udokotela ogxile ekwelapheni izingane ezinomdlavuza. I-oncologist yezingane isebenza nabanye abahlinzeki bezokunakekelwa kwempilo yezingane abangongoti ekwelapheni izingane ezinomdlavuza futhi abagxile ezindaweni ezithile zemithi. Lokhu kungafaka ongoti abalandelayo:

  • Udokotela wezingane.
  • Udokotela ohlinzayo wezingane.
  • I-hematologist yezingane.
  • I-radiation oncologist.
  • Umhlengikazi ongumhlengikazi.
  • Uchwepheshe wokuvuselelwa.
  • Isazi se-endocrinologist.
  • Usonhlala kahle.
  • Isazi sokusebenza kwengqondo.

Izinhlobo eziyisishiyagalolunye zokwelashwa okujwayelekile zisetshenzisiwe:

Ukuhlinzwa

Ukuhlinzwa inqubo esetshenziselwa ukuthola ukuthi ngabe umdlavuza ukhona yini, ukukhipha umdlavuza emzimbeni, noma ukulungisa ingxenye yomzimba. Ukuhlinzwa nge-palliative kwenziwa ukukhulula izimpawu ezibangelwa umdlavuza. Ukuhlinzwa kubizwa nangokuthi ukuhlinzwa.

Ngemuva kokuthi udokotela awususe wonke umdlavuza ongabonakala ngesikhathi sokuhlinzwa, ezinye iziguli zinganikezwa i-chemotherapy noma i-radiation therapy ngemuva kokuhlinzwa ukubulala noma yimaphi amangqamuzana omdlavuza asele. Ukwelashwa okunikezwe ngemuva kokuhlinzwa, ukwehlisa ubungozi bokuthi umdlavuza uzobuya, kubizwa ngokuthi yi-adjuvant therapy.

Ukwelashwa ngemisebe

Ukwelashwa ngemisebe ukwelashwa komdlavuza okusebenzisa amandla amakhulu ama-x-ray noma ezinye izinhlobo zemisebe ukubulala amangqamuzana omdlavuza noma ukuwagcina ekukhuleni. Kunezinhlobo ezahlukahlukene zokwelashwa ngemisebe:

  • Ukwelashwa kwemisebe kwangaphandle kusebenzisa umshini ongaphandle komzimba ukuthumela imisebe ebheke emdlavuzeni.
Ukwelashwa kwemisebe ye-Proton beam uhlobo lwamandla amakhulu, ukwelashwa kwemisebe yangaphandle. Umshini wokwelapha ngemisebe uhlose imifudlana yama-proton (izinhlayiya ezincane, ezingabonakali, ezishajwa kahle) kumaseli womdlavuza ukuwabulala. Lolu hlobo lwezokwelapha lubangela ukulimala okuncane ezicutshini eziseduze ezinempilo.
  • Ukwelashwa kwemisebe yangaphakathi kusebenzisa into enemisebe ejojowe emzimbeni noma evalwe ngezinaliti, imbewu, izintambo, noma ama-catheters abekwe ngqo noma eduze komdlavuza.
  • Ukwelashwa kwe-131I-MIBG (iodine enemisebe) uhlobo oluthile lwokwelapha ngemisebe kwangaphakathi okusetshenziselwa ukwelapha i-pheochromocytoma ne-paraganglioma. Iodine enemisebe inikezwa ngokumnika. Ingena egazini iqoqele ezinhlotsheni ezithile zamangqamuzana ezimila, iwabulale ngemisebe enikezwayo.

Indlela yokwelashwa ngemisebe enikezwa ngayo incike ohlotsheni lomdlavuza olashwa.

Ukwelashwa ngamakhemikhali

I-Chemotherapy yindlela yokwelapha umdlavuza esebenzisa izidakamizwa ukuvimba ukukhula kwamangqamuzana omdlavuza, kungaba ngokubulala amaseli noma ngokuwavimba ekuhlukaniseni. Lapho i-chemotherapy ithathwa ngomlomo noma ifakwa emthanjeni noma emisipheni, izidakamizwa zingena egazini futhi zingathinta amangqamuzana omdlavuza emzimbeni wonke (systemic chemotherapy). Lapho i-chemotherapy ifakwa ngqo ku-cerebrospinal fluid, umgodi womzimba njengesisu, noma isitho, izidakamizwa zithinta kakhulu amangqamuzana omdlavuza kulezo zindawo. Inhlanganisela yamakhemikhali ukwelashwa kusetshenziswa izidakamizwa ezingaphezu kwesisodwa ze-anticancer. Indlela i-chemotherapy enikezwa ngayo incike ohlotsheni nesigaba somdlavuza owelashwa.

I-chemotherapy ephezulu ene-autologous stem cell rescue

Imithamo ephezulu yokwelashwa ngamakhemikhali inikezwa ukubulala amangqamuzana omdlavuza. Amaseli aphilile, kufaka phakathi amaseli akha igazi, nawo abhujiswa ukwelashwa komdlavuza. Ukutakulwa kwamaseli esiqu kuyindlela yokwelapha yokushintsha amaseli akha igazi. Ama-stem cells (amangqamuzana egazi angavuthiwe) ayasuswa egazini noma emnkantsheni wethambo lesiguli futhi afriziwe futhi agcinwe. Ngemuva kokuthi isiguli siqede i-chemotherapy, amangqamuzana eziqu agciniwe ancibilika abuyiselwa esigulini ngokumnika. Lawa maseli wesiqu abuyisiwe akhula abe (futhi abuyisele) amangqamuzana egazi omzimba.

Ukwelashwa kweHormone

Ukwelashwa kweHormone ukwelashwa komdlavuza okususa ama-hormone noma kuvimbe isenzo sabo futhi kumise amangqamuzana omdlavuza ukuthi angakhuli. AmaHormone yizinto ezenziwa yizindlala emzimbeni futhi zigeleza egazini. Amanye ama-hormone angadala ukuthi umdlavuza othile ukhule. Uma ukuhlolwa kukhombisa ukuthi amangqamuzana omdlavuza anezindawo lapho ama-hormone anganamathisela khona (ama-receptors), izidakamizwa, ukuhlinzwa, noma ukwelashwa ngemisebe kusetshenziselwa ukunciphisa ukukhiqizwa kwamahomoni noma ukuwavimba ekusebenzeni. Ukwelashwa kweHormone ngezidakamizwa ezibizwa ngokuthi i-corticosteroids kungasetshenziswa ukwelapha i-thymoma noma i-thymic carcinoma.

Ukwelashwa kweHormone nge-somatostatin analogue (octreotide noma i-lanreotide) kungasetshenziswa ukwelapha izicubu ze-neuroendocrine ezisakazeke noma ezingasuswa ngokuhlinzwa. I-Octreotide nayo ingasetshenziselwa ukwelapha i-thymoma engaphenduli kolunye ukwelashwa. Lokhu kwelashwa kumisa ama-hormone angeziwe ukuthi enziwe isimila se-neuroendocrine. I-Octreotide noma i-lanreotide ngama-somatostatin analogue ajovwe ngaphansi kwesikhumba noma emisipheni. Kwesinye isikhathi inani elincanyana lezinto ezinemisebe enamathiselwe emithini futhi imisebe nayo ibulala amangqamuzana omdlavuza. Lokhu kubizwa ngokuthi ukwelashwa kwe-peptide receptor radionuclide.

I-Immunotherapy

I-Immunotherapy yimithi esebenzisa amasosha omzimba esiguli ukulwa nomdlavuza. Izinto ezenziwe ngumzimba noma ezenziwe elabhoratri zisetshenziselwa ukukhulisa, ukuqondisa, noma ukubuyisa izivikelo zemvelo zomzimba kumdlavuza. Lolu hlobo lokwelashwa komdlavuza lubizwa nangokuthi i-biotherapy noma i-biologic therapy.

  • I-Interferon: I-Interferon ithinta ukuhlukaniswa kwamangqamuzana omdlavuza futhi inganciphisa ukukhula kwesimila. Isetshenziselwa ukwelapha umdlavuza we-nasopharyngeal kanye ne-papillomatosis.
  • Igciwane le-Epstein-Barr (EBV) -i-cytotoxic T-lymphocyte: Amaseli amhlophe egazi (ama-T-lymphocyte) ayelashwa elabhorethri enegciwane le-Epstein-Barr bese enikezwa isiguli ukuze ivuselele amasosha omzimba futhi alwe nomdlavuza. Ama-cytotoxic T-lymphocyte aqondene ne-EBV afundelwa ukwelashwa komdlavuza we-nasopharyngeal.
  • Ukwelapha umuthi wokugoma: Ukwelashwa komdlavuza osebenzisa into noma iqembu lezinto ukukhuthaza amasosha omzimba ukuthi athole isimila asibulale. Ukwelapha umuthi wokugoma kusetshenziselwa ukwelapha i-papillomatosis.
  • Ukwelashwa kwe-immune checkpoint inhibitor therapy: Ezinye izinhlobo zamaseli omzimba, njengama-T cell, namanye amangqamuzana omdlavuza anamaprotheni athile, abizwa ngokuthi amaprotheni wokuhlola, ebusweni bawo agcina izimpendulo zomzimba zibheke. Lapho amangqamuzana omdlavuza enenqwaba yalawa maprotheni, ngeke ahlaselwe futhi abulawe ngamaseli we-T. Amasosha omzimba okuhlola izivikeli mzimba avimba lawa maprotheni futhi kwanda ikhono lamaseli T ukubulala amangqamuzana omdlavuza.


Kunezinhlobo ezimbili zokwelashwa kwama-immune checkpoint inhibitor therapy:
  • I-CTLA-4 yiprotheni ebusweni bamaseli we-T asiza ukugcina izimpendulo zomzimba womzimba zihloliwe. Lapho i-CTLA-4 inamathela kwenye iphrotheni ebizwa nge-B7 esitokisini somdlavuza, iyamisa i-T cell ekubulaleni iseli lomdlavuza. I-CTLA-4 inhibitors inamathela ku-CTLA-4 futhi ivumela amaseli we-T ukuthi abulale amangqamuzana omdlavuza. I-Ipilimumab uhlobo lwe-CTLA-4 inhibitor. I-Ipilimumab ingacatshangelwa ukwelashwa kwe-melanoma enobungozi obukhulu esuswe ngokuphelele ngesikhathi sokuhlinzwa. I-Ipilimumab ibuye isetshenziswe ne-nivolumab ukwelapha izingane ezithile ezinomdlavuza obala ngokwebala.
Isithiyo sokuhlola izivikeli mzimba. Amaprotheni e-Checkpoint, afana ne-B7-1 / B7-2 kumaseli we-antigen-presenting (APC) kanye ne-CTLA-4 kuma-T cell, asiza ukugcina izimpendulo zomzimba womzimba zibheke. Lapho i-T-cell receptor (TCR) ibophezela kuma-antigen kanye namaprotheni amakhulu we-histocompatibility complex (MHC) ku-APC naku-CD28 ibopha ku-B7-1 / B7-2 ku-APC, i-T cell ingasebenza. Kodwa-ke, ukubopha kwe-B7-1 / B7-2 kuya ku-CTLA-4 kugcina amaseli we-T esesimweni sokungasebenzi ngakho-ke awakwazi ukubulala amangqamuzana e-tumor emzimbeni (iphaneli langakwesobunxele). Ukuvimba ukubopha kwe-B7-1 / B7-2 kuya ku-CTLA-4 nge-immune checkpoint inhibitor (anti-CTLA-4 antibody) kuvumela ama-T cell ukuthi asebenze futhi abulale amangqamuzana wesimila (iphaneli lesokudla).
  • I-PD-1 yiprotheni ebusweni bamaseli we-T asiza ukugcina izimpendulo zomzimba womzimba zihloliwe. Lapho i-PD-1 inamathela kwenye iprotheni ebizwa nge-PDL-1 kuseli lomdlavuza, iyeka i-T cell ekubulaleni iseli lomdlavuza. Ama-PD-1 inhibitors anamathisela ku-PDL-1 futhi avumela amaseli we-T ukuthi abulale amangqamuzana omdlavuza. INivolumab uhlobo lwe-PD-1 inhibitor. INivolumab isetshenziswa ne-ipilimumab ukwelapha izingane ezithile ezinomdlavuza obala ngokwebala. I-Pembrolizumab ne-nivolumab kusetshenziselwa ukwelapha i-melanoma esabalele kwezinye izingxenye zomzimba. INivolumab ne-pembrolizumab ziyafundwa ekwelapheni i-melanoma yezingane nentsha. Ukwelashwa ngalezi zidakamizwa ezimbili kufundwe kakhulu kubantu abadala.
Isithiyo sokuhlola izivikeli mzimba. Amaprotheni wokuhlola, njenge-PD-L1 kumaseli we-tumor ne-PD-1 kumaseli we-T, asiza ukugcina izimpendulo ze-immune zihlolwe. Ukubopha kwe-PD-L1 kuya ku-PD-1 kugcina amaseli we-T ekubulaleni amangqamuzana omzimba emzimbeni (iphaneli engakwesobunxele). Ukuvimba ukubopha kwe-PD-L1 kuya ku-PD-1 nge-immune checkpoint inhibitor (i-anti-PD-L1 noma i-anti-PD-1) ivumela amaseli we-T ukuthi abulale amangqamuzana wesimila (iphaneli elifanele).
  • Ukwelashwa kwe-BRAF kinase inhibitor: I-BRAF kinase inhibitors ivimba iprotheni ye-BRAF. Amaprotheni e-BRAF asiza ukulawula ukukhula kwamaseli futhi angaguqulwa (aguqulwe) kwezinye izinhlobo zomdlavuza. Ukuvimba amaprotheni we-BRAF aguqukile kungasiza ukugcina amangqamuzana omdlavuza angakhuli. I-Dabrafenib, vemurafenib, ne-encorafenib isetshenziselwa ukwelapha i-melanoma. I-Oral dabrafenib ifundwa ezinganeni nasebusheni abane-melanoma. Ukwelashwa ngalezi zidakamizwa ezintathu kufundwe kakhulu kubantu abadala.

Ukulinda okulindile

Ukulinda ngokuqapha kusibhekisisa isimo sesiguli ngaphandle kokunikeza ukwelashwa kuze kuvele izimpawu noma izimpawu. Ukulinda okubukhali kungasetshenziswa lapho isimila sikhula kancane noma lapho kungenzeka isimila singanyamalala ngaphandle kokwelashwa.

Ukwelashwa okuhlosiwe

Ukwelashwa okuhlosiwe ukwelashwa okusebenzisa izidakamizwa noma ezinye izinto ukukhomba nokuhlasela amangqamuzana omdlavuza athile ngaphandle kokulimaza amaseli ajwayelekile. Izinhlobo zezindlela zokwelashwa eziqondisiwe ezisetshenziselwa ukwelapha umdlavuza wezingane ongajwayelekile zifaka okulandelayo:

  • I-Tyrosine kinase inhibitors: Le mithi yokwelashwa ehlosiwe ivimba amasiginali adingekayo ukuze izicubu zikhule. IVandetanib ne-cabozantinib kusetshenziselwa ukwelapha umdlavuza wegciwane le-medullary. ISunitinib isetshenziselwa ukwelapha i-pheochromocytoma, paraganglioma, izicubu ze-neuroendocrine, i-thymoma, ne-thymic carcinoma. I-Crizotinib isetshenziselwa ukwelapha izicubu ze-tracheobronchial.
  • I-mTOR inhibitors: Uhlobo lokwelashwa okuqondisiwe okumisa amaprotheni asiza amaseli ahlukane futhi aphile. I-Everolimus isetshenziselwa ukwelapha izinhliziyo, i-neuroendocrine, kanye nezicubu zeseli ze-islet.
  • Ama-antibody e-monoclonal: Le therapy ehlosiwe isebenzisa amasosha omzimba enziwe elebhu, evela ohlotsheni olulodwa lwamaseli omzimba. La ma-antibody angakhomba izinto kumaseli womdlavuza noma ezintweni ezijwayelekile ezingasiza amangqamuzana omdlavuza ukuthi akhule. Amasosha omzimba anamathela ezintweni futhi abulale amangqamuzana omdlavuza, avimbe ukukhula kwawo, noma awagcine ekusakazekeni. Ama-antibody e-monoclonal anikezwa ngokumnika. Zingasetshenziswa zodwa noma ukuphatha izidakamizwa, ubuthi, noma okokukhipha imisebe ngqo emangqamuzaneni omdlavuza. I-Bevacizumab i-anti-monoclonal antibody esetshenziselwa ukwelapha i-papillomatosis.
  • I-Histone methyltransferase inhibitors: Lolu hlobo lwezokwelapha oluhlosiwe lubambezela ikhono leseli lomdlavuza lokukhula nokuhlukanisa. I-Tazemetostat isetshenziselwa ukwelapha umdlavuza we-ovari. I-Tazemetostat ifundwa ekwelapheni ama-chordomas abuye ngemuva kokwelashwa.
  • I-MEK inhibitors: Lolu hlobo lwezokwelapha oluhlosiwe luvimba amasiginali adingekayo ukuze izicubu zikhule. I-Trametinib ne-binimetinib zisetshenziselwa ukwelapha i-melanoma esabalele kwezinye izingxenye zomzimba. Ukwelashwa nge-trametinib noma i-binimetinib sekufundwe kakhulu kubantu abadala.

Imithi ehlosiwe iyafundwa ekwelapheni eminye imidlavuza engavamile yobuntwana.

Ukuhlanganisa

Ukuhlanganiswa kuyindlela yokwelashwa lapho kufakwa idayi nezinhlayiya emthanjeni we-hepatic ngokusebenzisa ipayipi (ithubhu elincanyana). Izinhlayiya zivimba umthambo, zinqamule ukugeleza kwegazi liye esihlahleni. Kwesinye isikhathi inani elincani lezinto ezinemisebe ye-radio elinamathiselwe ezinhlayiyeni. Imisebe eminingi ibhajwe eduze kwesimila ukubulala amangqamuzana omdlavuza. Lokhu kubizwa ngokuthi yi-radioembolization.

Izinhlobo ezintsha zokwelashwa ziyahlolwa ezivivinyweni zokwelashwa.

Lesi sigaba esifingqiwe sichaza izindlela zokwelashwa ezicwaningwa ekuhlolweni kwemitholampilo. Kungenzeka kungasho yonke imishanguzo emisha efundwayo. Imininingwane mayelana nokuhlolwa kwemitholampilo iyatholakala kuwebhusayithi ye-NCI.

Ukwelashwa kwe-Gene

Ukwelashwa kwe-Gene ukwelashwa lapho kufakwa khona izinto zofuzo zangaphandle (i-DNA noma i-RNA) kumaseli omuntu ukuvikela noma ukulwa nezifo. Ukwelashwa kwe-Gene kufundwa ekwelapheni i-papillomatosis.

Iziguli zingafuna ukucabanga ngokubamba iqhaza esivivinyweni somtholampilo.

Kwezinye iziguli, ukubamba iqhaza esivivinyweni somtholampilo kungaba yindlela engcono kakhulu yokwelashwa. Ukuhlolwa kwemitholampilo kuyingxenye yenqubo yocwaningo lomdlavuza. Ukuhlolwa komtholampilo kuyenziwa ukuthola ukuthi ngabe ukwelashwa komdlavuza okusha kuphephile futhi kuyasebenza yini noma kungcono kunokwelashwa okujwayelekile.

Eziningi zezindlela zokwelashwa ezijwayelekile zomdlavuza zisuselwa ekuhlolweni kokuqala komtholampilo. Iziguli ezibamba iqhaza esivivinyweni somtholampilo zingathola ukwelashwa okujwayelekile noma zibe phakathi kwabokuqala ukuthola ukwelashwa okusha.

Iziguli ezibamba iqhaza ezivivinyweni zokwelashwa zisiza nokwenza ngcono indlela umdlavuza ozophathwa ngayo ngokuzayo. Noma izilingo zomtholampilo zingaholeli ekwelashweni okusha okusebenzayo, zivame ukuphendula imibuzo ebalulekile futhi zisize ukuqhubela phambili ucwaningo.

Iziguli zingangena ezivivinyweni zokwelashwa ngaphambi, ngesikhathi, noma ngemuva kokuqala ukwelashwa kwazo komdlavuza.

Ezinye izivivinyo zokwelashwa zifaka kuphela iziguli ezingakatholi ukwelashwa. Ezinye izilingo zivivinya ukwelashwa kweziguli ezinomdlavuza ongakabi ngcono. Kukhona nokuhlolwa komtholampilo okuhlola izindlela ezintsha zokunqanda umdlavuza ukuthi ungaphindi (ubuye) noma kunciphise imiphumela emibi yokwelashwa komdlavuza.

Ukuhlolwa kwemitholampilo kuyenzeka ezingxenyeni eziningi zezwe. Imininingwane mayelana nokuhlolwa kwemitholampilo esekelwa yi-NCI ingatholakala ekhasini lewebhu le-NCI lokuhlolwa kokuhlolwa kwemitholampilo. Izivivinyo zomtholampilo ezisekelwa ezinye izinhlangano zingatholakala kuwebhusayithi yeClinicalTrials.gov.

Ukuhlolwa kokulandelela kungadingeka.

Olunye uvivinyo olwenziwe ukuxilonga umdlavuza noma ukuthola isigaba somdlavuza lungaphindwa. Olunye uvivinyo luzophindwa ukuze kubonakale ukuthi umuthi usebenza kanjani. Izinqumo mayelana nokuthi uqhubeke, ushintshe, noma umise ukwelashwa zingasuselwa emiphumeleni yalezi zivivinyo.

Ezinye zezivivinyo zizoqhubeka ukwenziwa ngezikhathi ezithile ngemuva kokuphela kokwelashwa. Imiphumela yalezi zivivinyo ingakhombisa ukuthi ngabe isimo sengane yakho sishintshile noma uma umdlavuza ubuyile (buyela emuva). Lezi zivivinyo kwesinye isikhathi zibizwa ngokuthi izivivinyo zokulandelela noma ukuhlolwa.

Ukwelashwa komdlavuza ongajwayelekile wobuntwana kungadala imiphumela emibi.

Ngemininingwane ngemiphumela emibi eqala ukwelashwa komdlavuza, bheka ikhasi lethu le-Side Effects.

Imiphumela emibi yokwelashwa komdlavuza eqala ngemuva kokwelashwa futhi iqhubeke izinyanga noma iminyaka ibizwa ngemiphumela ephuzile. Imiphumela yamuva yokwelashwa komdlavuza ingafaka okulandelayo:

  • Izinkinga zomzimba.
  • Izinguquko zemizwa, imizwa, ukucabanga, ukufunda, noma inkumbulo.
  • Umdlavuza wesibili (izinhlobo ezintsha zomdlavuza).

Eminye imiphumela yesikhashana ingalashwa noma ilawulwe. Kubalulekile ukuthi ukhulume nodokotela bengane yakho ngemiphumela engemuva kwesikhathi engabangelwa eminye imidlavuza nokwelashwa komdlavuza. (Bheka isifinyezo se- ngemiphumela yamuva yokwelashwa komdlavuza wezingane ukuthola eminye imininingwane).

Umdlavuza Ongajwayelekile Wekhanda Nentamo

Kulesi Sigaba

  • Umdlavuza weNasopharyngeal
  • I-Esthesioneuroblastoma
  • Izimila Zendlala
  • Umdlavuza Womlomo Womlomo
  • Amathumba endlala yamathe
  • I-Laryngeal Cancer ne-Papillomatosis
  • I-Midline Tract Cancer enezinguquko ze-NUT Gene (NUT Midline Carcinoma)

Umdlavuza weNasopharyngeal

Bona isifinyezo se- ku-Childhood Nasopharyngeal Cancer Treatment ukuthola eminye imininingwane.

I-Esthesioneuroblastoma

Bona isifinyezo se- ku-Childhood Esthesioneuroblastoma Treatment ukuthola eminye imininingwane.

Izimila Zendlala

Bona isifinyezo se- ku-Childhood Thyroid Cancer Treatment ukuthola eminye imininingwane.

Umdlavuza Womlomo Womlomo

Bona isifinyezo se- ku-Childhood Oral Cavity Cancer Treatment ukuthola eminye imininingwane.

Amathumba endlala yamathe

Bona isifinyezo se- ku-Childhood Salivary Gland Tumors Treatment ukuthola eminye imininingwane.

I-Laryngeal Cancer ne-Papillomatosis

Bona isifinyezo se- ku-Childhood Laryngeal Tumors Treatment ukuthola eminye imininingwane.

I-Midline Tract Cancer enezinguquko ze-NUT Gene (NUT Midline Carcinoma)

Bona isifinyezo se- ku-Childhood Midline Tract Carcinoma ne-NUT Gene Changes Treatment ukuthola eminye imininingwane.

Umdlavuza Ongavamile Wesifuba

Kulesi Sigaba

  • Umdlavuza Webele
  • Umdlavuza Wamaphaphu
  • Ama-Esophageal Tumors
  • I-Thymoma ne-Thymic Carcinoma
  • Izimila Zenhliziyo (Inhliziyo)
  • I-Mesothelioma

Umdlavuza Webele

Bona isifinyezo se- se-Childhood Breast Cancer Treatment ukuthola eminye imininingwane.

Umdlavuza Wamaphaphu

Bona izifinyezo ezilandelayo ze- ukuthola eminye imininingwane:

  • Ukwelashwa Kwe-Tracheobronchial Tumors Treatment
  • Ukwelashwa Kwe-Blastoma Yobuntwana

Ama-Esophageal Tumors

Bona isifinyezo se- se-Childhood Esophageal Cancer Treatment ukuthola eminye imininingwane.

I-Thymoma ne-Thymic Carcinoma

Bona isifinyezo se- ku-Childhood Thymoma kanye ne-Thymic Carcinoma Treatment ukuthola eminye imininingwane.

Izimila Zenhliziyo (Inhliziyo)

Bona isifinyezo se- ku-Childhood Cardiac (Heart) Tumors Treatment ukuthola eminye imininingwane.

I-Mesothelioma

Bona isifinyezo se- ku-Childhood Mesothelioma Treatment ukuthola eminye imininingwane.

Umdlavuza Ongajwayelekile Wesisu

Kulesi Sigaba

  • Umdlavuza Wesisu (Wesisu)
  • Umdlavuza wePancreatic
  • I-Colorectal Cancer
  • Ama-Neuroendocrine Tumors (Carcinoid Tumors)
  • Izimila Zamathumbu Ezisemathunjini

I-Adrenocortical Carcinoma

I-adrenocortical carcinoma yisifo lapho amangqamuzana abulalayo (umdlavuza) akha ungqimba olungaphandle lwendlala ye-adrenal. Kukhona izindlala ezimbili adrenal. Izindlala ze-adrenal zincane futhi zimise okonxantathu. Indlala eyodwa ye-adrenal ihlezi phezu kwenso ngalinye. Indlala ngayinye ye-adrenal inezingxenye ezimbili. Isikhungo sendlala ye-adrenal yi-adrenal medulla. Isendlalelo sangaphandle sendlala ye-adrenal yi-adrenal cortex. I-adrenocortical carcinoma ibizwa nangokuthi umdlavuza we-adrenal cortex.

I-adrenocortical carcinoma yobuntwana yenzeka kakhulu ezigulini ezingaphansi kweminyaka eyi-6 noma eminyakeni yentsha, futhi kaningi kwabesifazane.

I-adrenal cortex yenza ama-hormone abalulekile enza lokhu okulandelayo:

  • Linganisa amanzi nosawoti emzimbeni.
  • Siza ukugcina umfutho wegazi uvamile.
  • Siza ukulawula ukusetshenziswa komzimba kwamaprotheni, amafutha, kanye nama-carbohydrate.
  • Yenza ukuthi umzimba ube nezici zesilisa noma zesifazane.

Izici Zobungozi, Izimpawu Nezimpawu, kanye Nezivivinyo Zokuxilonga Nezesiteji

Ingozi ye-adrenocortical carcinoma yanda ngokuba nokuguquka okuthile (ushintsho) kuhlobo noma amanye ama-syndromes alandelayo:

  • Isifo se-Li-Fraumeni.
  • Isifo se-Beckwith-Wiedemann.
  • I-Hemihypertrophy.

I-adrenocortical carcinoma ingadala noma yiziphi zalezi zimpawu nezimpawu ezilandelayo. Buza kudokotela wengane yakho uma ingane yakho inokunye kwalokhu okulandelayo:

  • Isigaxa esiswini.
  • Ubuhlungu esiswini noma emuva.
  • Ukuzwa ukugcwala esiswini.

Futhi, isimila se-adrenal cortex kungenzeka sisebenze (senza ama-hormone amaningi kunokujwayelekile) noma singasebenzi (asenzi ama-hormone angeziwe). Izicubu eziningi ze-adrenal cortex ezinganeni zisebenza izicubu. Ama-hormone angeziwe enziwe ngokusebenza kwezicubu angadala izimpawu noma izimpawu ezithile zesifo futhi lokhu kuncike ohlotsheni lwehomoni olwenziwe isimila. Isibonelo, i-hormone eyengeziwe ye-androgen ingadala ukuthi zombili izingane zesilisa nezesifazane zikhule izici zobudoda, ezinjengezinwele zomzimba noma izwi elijulile, zikhule ngokushesha, futhi zibe nezinduna. Ihomoni ye-estrogen eyengeziwe ingadala ukukhula kwezicubu zamabele ezinganeni zesilisa. Ihomoni eyengeziwe ye-cortisol ingadala i-Cushing syndrome (hypercortisolism).

(Bheka isifinyezo se- ekwelashweni kwe-Adrenocortical Carcinoma yabantu abadala ukuthola eminye imininingwane ngezibonakaliso nezimpawu ze-adrenocortical carcinoma.)

Ukuhlolwa nezinqubo ezisetshenziselwa ukuxilonga nokukala i-adrenocortical carcinoma zincike ezimpawu zesiguli. Lezi zivivinyo nezinqubo zingafaka okulandelayo:

  • Ukuhlolwa komzimba kanye nomlando wezempilo.
  • Izifundo ze-chemistry yegazi.
  • I-X-ray yesifuba, isisu, noma amathambo.
  • Iskena se-CT.
  • I-MRI.
  • Ukuskena kwe-PET.
  • I-Ultrasound.
  • I-Biopsy (isisindo sisuswa ngesikhathi sokuhlinzwa bese kuthi isampula lihlolwe izimpawu zomdlavuza).

Bheka isigaba solwazi jikelele ukuthola incazelo yalezi zivivinyo nezinqubo.

Ezinye izivivinyo ezisetshenziselwa ukuxilonga i-adrenocortical carcinoma zifaka okulandelayo:

  • Ukuhlolwa komchamo wamahora angamashumi amabili nane: Isivivinyo lapho kuqoqwa khona umchamo amahora angama-24 ukukala inani le-cortisol noma le-17-ketosteroids. Inani eliphakeme kunalelejwayelekile lalezi zinto ezisemchameni kungaba uphawu lwesifo ku-adrenal cortex.
  • Ukuhlolwa kokucindezela komthamo ophansi we-dexamethasone: Isivivinyo lapho kunikezwa umthamo owodwa noma ngaphezulu we-dexamethasone. Izinga le-cortisol lihlolwe kusuka kusampula yegazi noma kumchamo oqoqwa izinsuku ezintathu. Lokhu kuhlolwa kwenziwa ukubheka ukuthi ngabe indlala ye-adrenal yenza i-cortisol eningi kakhulu.
  • Isivivinyo sokucindezela i-dexamethasone esilinganiselwe kakhulu: Isivivinyo lapho kunikezwa isilinganiso esisodwa noma ngaphezulu se-dexamethasone. Izinga le-cortisol lihlolwe kusuka kusampula yegazi noma kumchamo oqoqwa izinsuku ezintathu. Lokhu kuhlolwa kwenziwa ukubheka ukuthi ngabe indlala ye-adrenal yenza i-cortisol eningi kakhulu noma ngabe indlala yebhande itshela izindlala ze-adrenal ukuthi zenze i-cortisol eningi kakhulu.
  • Izifundo zehomoni yegazi: Inqubo lapho kuhlolwe khona isampula segazi ukukala inani lamahomoni athile akhishwe egazini ngezitho nezicubu zomzimba. Inani elingajwayelekile (eliphakeme noma eliphansi kunokujwayelekile) lento kungaba uphawu lwesifo esithweni noma esikhunjeni esisenzayo. Igazi lingahlolwa i-testosterone noma i-estrogen. Inani eliphakeme kunalelo elijwayelekile lala mahomoni kungaba uphawu lwe-adrenocortical carcinoma.
  • I-adrenal angiography: Inqubo yokubheka imithambo nokugeleza kwegazi eduze kwendlala ye-adrenal. Idayi ehlukile ifakwa emithanjeni ye-adrenal. Njengoba udayi unqamula emthanjeni wegazi, kuthathwa uchungechunge lwama-x-ray ukubona ukuthi ayikho yini imithambo evinjiwe.
  • I-adrenal venography: Inqubo yokubheka imithambo ye-adrenal nokugeleza kwegazi eduze kwezindlala ze-adrenal. Idayi ehlukile ifakwa emthanjeni we-adrenal. Njengoba udayi wokuqhathanisa udlula emthanjeni, kuthathwa uchungechunge lwama-x-ray ukubona ukuthi ayikho yini imithambo evinjiwe. Ipayipi (ithubhu elincanyana kakhulu) lingafakwa emthanjeni ukuze kuthathwe isampula segazi, elihlolelwa amazinga angajwayelekile wehomoni.

Isibikezelo

Ukubikezela (ithuba lokululama) kuhle ezigulini ezinamathumba amancane asuswe ngokuphelele ngokuhlinzwa. Kwezinye iziguli, isibikezelo sincike kokulandelayo:

  • Usayizi wesimila.
  • Ukhula ngokushesha kangakanani umdlavuza.
  • Ukuthi kukhona yini ukushintsha kwezakhi zofuzo ezithile.
  • Ukuthi isimila sesisabalalele yini kwezinye izingxenye zomzimba, kufaka phakathi ama-lymph node.
  • Iminyaka yengane.
  • Ukuthi isembozo esizungeze isimila savuleka yini ngesikhathi sokuhlinzwa ukuze sisuse isimila.
  • Ukuthi isimila sisuswe ngokuphelele yini ngesikhathi sokuhlinzwa.
  • Ukuthi ingane inezici zobudoda yini.

I-adrenocortical carcinoma ingasakazekela esibindi, emaphashini, ezinso, noma ethanjeni.

Ukwelashwa

Ngemininingwane mayelana nokwelashwa okubalwe ngezansi, bheka isigaba se-Treatment Option Overview section.

Ukwelashwa kwe-adrenocortical carcinoma ezinganeni kungafaka okulandelayo:

  • Ukuhlinzwa ukususa i-adrenal gland futhi, uma kudingeka, umdlavuza osakaze kwezinye izingxenye zomzimba. Ngezinye izikhathi kunikezwa i-chemotherapy.

Ukwelashwa kwe-carrenoma ephindaphindekayo ye-adrenocortical ezinganeni kungafaka okulandelayo:

  • Isivivinyo somtholampilo esihlola isampula lesimila sesiguli ukuthola izinguquko ezithile zofuzo. Uhlobo lokwelashwa okuqondisiwe oluzonikezwa isiguli kuncike ohlotsheni lokushintsha kofuzo.

Bona isifinyezo se- mayelana nokwelashwa kwabantu abadala i-Adrenocortical Carcinoma ukuthola eminye imininingwane.

Umdlavuza Wesisu (Wesisu)

Umdlavuza wesisu yisifo lapho amangqamuzana amabi (umdlavuza) akha khona ulwelwesi lwesisu. Isisu isitho esime ngo-J esiswini esingenhla. Kuyingxenye yohlelo lokugaya ukudla, olucubungula izakhamzimba (amavithamini, amaminerali, ama-carbohydrate, amafutha, amaprotheni, namanzi) ekudleni okudliwayo futhi kusiza ukukhipha imfucuza emzimbeni. Ukudla kuhamba kusuka emphinjeni kuya esiswini ngeshubhu elingenalutho, elinemisipha elibizwa ngokuthi umqala. Ngemuva kokushiya isisu, ukudla okugaywe ngokwengxenye kudlulela emathunjini amancane bese kungena emathunjini amakhulu.

I-esophagus nesisu kuyingxenye yesistimu ephezulu yamathumbu (wokugaya ukudla).

Izici Zengozi Nezimpawu Nezimpawu

Ingozi yomdlavuza wesisu inyuswa ngalokhu okulandelayo:

  • Ukuba nokutheleleka ngegciwane le-Helicobacter pylori (H. pylori), elitholakala esiswini.
  • Ukuba nesimo esizuzwe njengefa esibizwa ngomdlavuza womndeni esisakazeka esiswini.

Iziguli eziningi azinazo izimpawu nezimpawu kuze kube yilapho umdlavuza usakazeka. Umdlavuza wesisu ungadala noma yiziphi zalezi zimpawu nezimpawu ezilandelayo. Buza kudokotela wengane yakho uma ingane yakho inokunye kwalokhu okulandelayo:

  • I-anemia (ukukhathala, isiyezi, ukushaya kwenhliziyo okusheshayo noma okungajwayelekile, ukuphefumula okuncane, isikhumba esiphaphathekile).
  • Ubuhlungu besisu.
  • Ukuphelelwa isifiso sokudla.
  • Ukwehla kwesisindo ngaphandle kwesizathu esaziwayo.
  • Isicanucanu.
  • Ukuhlanza.
  • Ukuqunjelwa noma uhudo.
  • Ubuthakathaka.

Ezinye izimo ezingewona umdlavuza wesisu zingadala lezi zimpawu nezimpawu ezifanayo.

Izivivinyo Zokuxilonga Nezesiteji

Ukuhlolwa kokuthola umdlavuza wesisu kungafaka okulandelayo:

  • Ukuhlolwa komzimba kanye nomlando wezempilo.
  • I-X-ray yesisu.
  • Izifundo ze-chemistry yegazi.
  • Iskena se-CT.
  • Isidumbu.

Bheka isigaba solwazi jikelele ukuthola incazelo yalezi zivivinyo nezinqubo.

Olunye uvivinyo olusetshenziselwa ukuxilonga nokukala umdlavuza wesisu lubandakanya okulandelayo:

  • I-endoscopy ephezulu: Inqubo yokubheka ngaphakathi kwesisu, isisu, ne-duodenum (ingxenye yokuqala yamathumbu amancane) ukuhlola izindawo ezingavamile. I-endoscope idluliswa ngomlomo bese yehla ngomphimbo iye emphinjeni. I-endoscope iyinsimbi encane, efana nethubhu enokukhanya nelensi yokubuka. Kungaba futhi nethuluzi lokususa amasampula wezicubu noma ama-lymph node, ahlolwe ngaphansi kwesibonakhulu ukuthola izimpawu zesifo.
  • Ukugwinya kwe-Barium: Uchungechunge lwama-x-ray we-esophagus nesisu. Isiguli siphuza uketshezi oluqukethe i-barium (insimbi eyinsimbi emhlophe). Uketshezi kugqoka umphimbo nesisu, nama-x-ray ayathathwa. Le nqubo ibizwa nangokuthi uchungechunge oluphezulu lwe-GI.
  • Qedela ukubalwa kwegazi (i-CBC): Inqubo lapho kukhishwa khona isampula legazi futhi lihlolwe lokhu okulandelayo:
  • Inani lamaseli abomvu egazi, amaseli amhlophe egazi, nama-platelets.
  • Inani le-hemoglobin (iprotheni ethwala umoya-mpilo) kumaseli abomvu egazi.
  • Ingxenye yesampula yegazi eyenziwe ngamaseli abomvu egazi.

Isibikezelo

Ukubikezela (ithuba lokululama) kuncike ekutheni umdlavuza ususabalele ngesikhathi sokutholakala nokuthi umdlavuza usabela kahle kanjani ekwelashweni.

Umdlavuza wesisu ungasakazekela esibindini, emaphashini, e-peritoneum, noma kwezinye izingxenye zomzimba.

Ukwelashwa

Ngemininingwane mayelana nokwelashwa okubalwe ngezansi, bheka isigaba se-Treatment Option Overview section.

Ukwelashwa komdlavuza wesisu ezinganeni kungafaka okulandelayo:

  • Ukuhlinzwa ukukhipha umdlavuza nezinye izicubu ezinempilo ezizungezile.
  • Ukuhlinzwa ukukhipha umdlavuza omkhulu ngangokunokwenzeka, kulandelwe ukwelashwa ngemisebe nokwelashwa ngamakhemikhali.

Ukwelashwa komdlavuza ophindayo wesisu ezinganeni kungafaka okulandelayo:

  • Isivivinyo somtholampilo esihlola isampula lesimila sesiguli ukuthola izinguquko ezithile zofuzo. Uhlobo lokwelashwa okuqondisiwe oluzonikezwa isiguli kuncike ohlotsheni lokushintsha kofuzo.

Bheka isigaba se-Gastrointestinal Stromal Tumors (GIST) salesi sifinyezo kanye nengxenye ye-Neuroendocrine Tumors (Carcinoids) yalesi sifinyeto ukuze uthole ulwazi mayelana namathumbu omzimba namathumba we-neuroendocrine.

Umdlavuza wePancreatic

Umdlavuza wepancreatic yisifo lapho amangqamuzana abulalayo (umdlavuza) akha izicubu zepancreas. Ama-pancreas yindlala emise okwepheya engamasentimitha ayisithupha ubude. Umkhawulo obanzi wamanyikwe ubizwa ngokuthi inhloko, isigaba esiphakathi sibizwa ngomzimba, kuthi ukuphela okuncane kubizwe umsila. Izinhlobo eziningi ezahlukahlukene zezimila zingakha kumanyikwe. Ezinye izicubu ziyingozi (hhayi umdlavuza).

I-anatomy yamanyikwe. Ama-pancreas anezindawo ezintathu: ikhanda, umzimba, nomsila. Itholakala esiswini eduze kwesisu, amathumbu, nezinye izitho.

Ama-pancreas anemisebenzi emibili esemqoka emzimbeni:

  • Ukwenza amajusi asiza ukugaya (ukudiliza) ukudla. La majusi afakwa emathunjini amancane.
  • Ukwenza ama-hormone asiza ukulawula amazinga kashukela nosawoti osegazini. La mahomoni akhishwa egazini.

Kunezinhlobo ezine zomdlavuza wepancreatic ezinganeni:

  • Isimila esiqinile se-pseudopapillary samanyikwe. Lolu uhlobo oluvame kakhulu lwesimila se-pancreatic. Ngokuvamile kuthinta abesifazane abasebasha asebekhulile kanye nabantu abadala. Lezi zicubu ezikhula kancane zinezingxenye zombili ezinjenge-cyst nezinamandla. Isimila esiqinile se-pseudopapillary samanyikwe akunakwenzeka ukuthi sisabalalele kwezinye izingxenye zomzimba futhi ukubikezela okuhle kakhulu. Ngesinye isikhathi, isimila singasakazeka esibindini, emaphashini, noma kuma-lymph node.
  • I-Pancreatoblastoma. Imvamisa kwenzeka ezinganeni ezineminyaka eyi-10 noma ngaphansi. Izingane ezine-Beckwith-Wiedemann syndrome kanye ne-familial adenomatous polyposis (FAP) syndrome zinengozi enkulu yokuthola i-pancreatoblastoma. Lezi zicubu ezikhula kancane zivame ukwenza isimila se-alpha-fetoprotein. Lezi zicubu zingenza futhi i-adrenocorticotropic hormone (ACTH) ne-antidiuretic hormone (ADH). I-Pancreatoblastoma ingasakazeka esibindi, emaphashini nakuma-lymph node. Isibikezelo sezingane ezine-pancreatoblastoma sihle.
  • Izicubu zeseli ze-Islet. Lezi zicubu azivamile ezinganeni futhi zingaba nobungozi noma zibe yingozi. Izicubu zeseli ze-Islet zingenzeka ezinganeni ezine-endocrine neoplasia type 1 (MEN1) syndrome. Izinhlobo ezivame kakhulu zezicubu ze-islet cell yi-insulinomas kanye ne-gastrinomas. Ezinye izinhlobo zezicubu zamaseli we-islet yi-ACTHoma ne-VIPoma. Lezi zicubu zingenza ama-hormone, njenge-insulin, i-gastrin, i-ACTH, noma i-ADH. Lapho kwenziwa i-hormone eningi kakhulu, izimpawu nezimpawu zesifo kuyenzeka.
  • I-Pancreatic carcinoma. I-Pancreatic carcinoma ayivamile kakhulu ezinganeni. Izinhlobo ezimbili ze-pancreatic carcinoma yi-acinar cell carcinoma ne-ductal adenocarcinoma.

Izimpawu Nezimpawu

Izimpawu nezimpawu zomdlavuza wepancreatic zingafaka okulandelayo:

  • Ukukhathala.
  • Ukwehla kwesisindo ngaphandle kwesizathu esaziwayo.
  • Ukuphelelwa isifiso sokudla.
  • Ukungakhululeki esiswini.
  • Isigaxa esiswini.

Ezinganeni, ezinye izicubu ze-pancreatic azikhiphi ama-hormone futhi azikho izimpawu nezimpawu zesifo. Lokhu kwenza kube nzima ukuthola umdlavuza wepancreatic kusenesikhathi.

Izimila zepancreatic ezenza ama-hormone akhiphe zingadala izimpawu nezimpawu. Izimpawu nezimpawu zixhomeke ohlotsheni lwamahomoni enziwa.

Uma isimila sikhipha i-insulin, izimpawu nezimpawu ezingenzeka zibandakanya okulandelayo:

  • Ushukela wegazi ophansi. Lokhu kungadala ukungaboni kahle, ukuphathwa ikhanda, nokuzizwa unekhanda elincane, ukhathele, ubuthakathaka, uthuthumela, unovalo, uthukuthele, ujuluke,
  • udidekile, noma ulambile.
  • Izinguquko ekuziphatheni.
  • Ukuquleka.
  • I-Coma.

Uma isimila sikhipha i-gastrin, izimpawu nezimpawu ezingenzeka zibandakanya okulandelayo:

  • Izilonda zesisu ezilokhu zibuya.
  • Ubuhlungu esiswini, obungasakazeka emuva. Ubuhlungu bungafika budlule futhi bungaphela ngemuva kokuthatha i-antacid.
  • Ukugeleza kokuqukethwe kwesisu kubuyela emuva ku-esophagus (gastroesophageal reflux).
  • Uhudo.

Izimpawu nezimpawu ezibangelwa izicubu ezenza ezinye izinhlobo zamahomoni, njenge-ACTH noma i-ADH, zingafaka okulandelayo:

  • Uhudo lwamanzi.
  • Ukuphelelwa ngamanzi emzimbeni (ukuzizwa womile, ukwenza umchamo omncane, isikhumba nomlomo owomile, ikhanda elibuhlungu, isiyezi, noma ukuzizwa ukhathele).
  • Izinga eliphansi le-sodium (usawoti) egazini (ukudideka, ukulala, ubuthakathaka bemisipha, nokuquleka).
  • Ukwehla kwesisindo noma ukuzuza ngaphandle kwesizathu esaziwayo.
  • Ubuso obuzungezile nezingalo nemilenze emincane.
  • Ukuzizwa ngikhathele futhi ngibuthakathaka.
  • Umfutho wegazi ophezulu.
  • Uphawu olubomvu noma olubomvana esikhunjeni.

Hlola nodokotela wengane yakho uma ubona noma iyiphi yalezi zinkinga enganeni yakho. Ezinye izimo ezingawona umdlavuza we-pancreatic zingadala lezi zimpawu nezimpawu ezifanayo.

Izivivinyo Zokuxilonga Nezesiteji

Ukuhlolwa kokuthola umdlavuza we-pancreatic kungafaka okulandelayo:

  • Ukuhlolwa komzimba kanye nomlando wezempilo.
  • I-X-ray yesifuba.
  • Iskena se-CT.
  • I-MRI.
  • Ukuskena kwe-PET.
  • Isidumbu.
  • I-Core-needle biopsy: Ukususwa kwezicubu kusetshenziswa inaliti ebanzi.
  • I-Laparoscopy: Inqubo yokuhlinza ukubheka izitho ezingaphakathi esiswini ukubheka izimpawu zesifo. Ukusikeka okuncane (ukusikeka) kwenziwa odongeni lwesisu bese kufakwa i-laparoscope (ishubhu elincane elikhanyisiwe) kokunye okusikiwe. Ezinye izinsimbi zingafakwa ngendlela efanayo noma eminye imigudu yokwenza izinqubo ezifana nokususa izitho noma ukuthatha amasampula ezicubu ukuze zihlolwe ngaphansi kwesibonakhulu ukuthola izimpawu zesifo.
  • I-Laparotomy: Inqubo yokuhlinza lapho kwenziwa ukusikeka (ukusika) odongeni lwesisu ukubheka ngaphakathi kwesisu ukuthi asinazo yini izimpawu zesifo. Ubukhulu bokusikwa buxhomeke ekutheni kungani i-laparotomy yenziwa. Kwesinye isikhathi izitho ziyasuswa noma amasampula wezicubu athathwe ahlolwe ngaphansi kwesibonakhulu ukuthola izimpawu zesifo.

Bheka isigaba solwazi jikelele ukuthola incazelo yalezi zivivinyo nezinqubo.

Ezinye izivivinyo ezisetshenziselwa ukuxilonga umdlavuza we-pancreatic zifaka okulandelayo:

  • I-endoscopic ultrasound (EUS): Inqubo lapho kufakwa khona i-endoscope emzimbeni, imvamisa ngomlomo noma nge-rectum. I-endoscope iyinsimbi encane, efana nethubhu enokukhanya nelensi yokubuka. Iphenyo ekugcineni kwe-endoscope isetshenziselwa ukuqhuma amaza omsindo wamandla aphezulu (i-ultrasound) ezicutshini zangaphakathi noma ezithweni futhi enze ama-echoes. Ama-echoes akha isithombe sezicubu zomzimba esibizwa nge-sonogram. Le nqubo ibizwa nangokuthi i-endosonography.
  • I-Somatostatin receptor scintigraphy: Uhlobo lwe-radionuclide scan olusetshenziselwa ukuthola izicubu ze-pancreatic. Inani elincane kakhulu le-octreotide enemisebe (i-hormone enamathela kwizicubu ze-carcinoid) lijojelwa emthanjeni futhi lihambe phakathi kwegazi. I-octreotide enemisebe inamathela kulesimila nekhamera ekhethekile ethola ukusebenza kwemisebe ye-radioactivity isetshenziselwa ukukhombisa ukuthi izicubu zikuphi emzimbeni. Le nqubo isetshenziselwa ukuxilonga izicubu ze-islet cell.

Ukwelashwa

Ngemininingwane mayelana nokwelashwa okubalwe ngezansi, bheka isigaba se-Treatment Option Overview section.

Ukwelashwa kwesimila esiqinile se-pseudopapillary samanyikwe ezinganeni kungafaka okulandelayo:

  • Ukuhlinzwa ukukhipha isimila.
  • I-Chemotherapy yamathumba angenakususwa ngokuhlinzwa noma asakaze kwezinye izingxenye zomzimba.

Ukwelashwa kwe-pancreatoblastoma ezinganeni kungafaka okulandelayo:

  • Ukuhlinzwa ukukhipha isimila. Inqubo ye-Whipple ingenziwa ngamathumba ekhanda lamanyikwe.
  • I-Chemotherapy inganikezwa ukunciphisa isimila ngaphambi kokuhlinzwa. Ukwelashwa ngamakhemikhali okuningi kunganikezwa ngemuva kokuhlinzwa kwezicubu ezinkulu, izicubu ebezingenakususwa ekuqaleni ngokuhlinzwa, nezicubu ezisabalalele kwezinye izingxenye zomzimba.
  • I-Chemotherapy inganikezwa uma isimila singaphenduli ekwelashweni noma sibuya.

Ukwelashwa kwezicubu ze-islet ezinganeni kungafaka nemithi yokwelapha izimpawu ezibangelwa ama-hormone nokulandelayo:

  • Ukuhlinzwa ukukhipha isimila.
  • I-Chemotherapy kanye nokwelashwa okuqondisiwe (i-mTOR inhibitor therapy) yamathumba angenakususwa ngokuhlinzwa noma asabalale kwezinye izingxenye zomzimba.

Bona isifinyezo se- mayelana nokwelashwa kwabantu abadala bePancreatic Neuroendocrine Tumors (Islet Cell Tumors) ukuthola eminye imininingwane ngezimila zepancreatic.

Kunamacala ambalwa abikiwe epancreatic carcinoma ezinganeni. (Bheka isifinyezo se- mayelana nokwelashwa komdlavuza omdala we-Pancreatic ukuthola izinketho zokwelashwa ezingase zivele.)

Ukwelashwa kwe-pancreatic carcinoma ephindaphindayo ezinganeni kungafaka okulandelayo:

  • Isivivinyo somtholampilo esihlola isampula lesimila sesiguli ukuthola izinguquko ezithile zofuzo. Uhlobo lokwelashwa okuqondisiwe oluzonikezwa isiguli kuncike ohlotsheni lokushintsha kofuzo.

Bona izifinyezo ze- mayelana nokwelashwa kwabantu abadala be-Pancreatic Cancer kanye ne-Pancreatic Neuroendocrine Tumors yabantu abadala (i-Islet Cell Tumors) Ukwelashwa ukuthola eminye imininingwane ngezimila zepancreatic.

I-Colorectal Cancer

Umdlavuza we-Colorectal yisifo lapho amangqamuzana abulalayo (umdlavuza) akha izicubu zekholoni noma i-rectum. Ikholoni liyingxenye yohlelo lokugaya ukudla lomzimba. Uhlelo lokugaya lususa futhi lucubungule izakhamzimba (amavithamini, amaminerali, ama-carbohydrate, amafutha, amaprotheni, namanzi) ekudleni futhi kusiza ukudlulisa imfucuza emzimbeni. Uhlelo lokugaya ukudla lwakhiwa ngumphimbo, isisu, namathumbu amancane namakhulu. Ikholoni (amathumbu amakhulu) ingxenye yokuqala yamathumbu amakhulu futhi ingamamitha amahlanu ubude. Ngokubambisana, i-rectum ne-canal canal yakha ingxenye yokugcina yamathumbu amakhulu futhi ingamasentimitha ayi-6-8 ubude. Umsele wangemuva uphelela endunu (ukuvuleka kwamathumbu amakhulu kuya ngaphandle komzimba).

I-anatomy yesistimu yokugaya engezansi, ekhombisa ikholoni nezinye izitho.

Izici Zobungozi, Izimpawu Nezimpawu, kanye Nezivivinyo Zokuxilonga Nezesiteji

Umdlavuza obala ngokobuntwana ungaba yingxenye yesifo esizuzwe njengefa. Eminye imidlavuza e-colorectal kubantu abasha ixhunywe ekuguqulweni kwezakhi zofuzo okubangela ama-polyps (ukukhula kolwelwesi lwamafinyila olwela ikholoni) ukwakha okungaphenduka kube umdlavuza ngokuhamba kwesikhathi.

Ingozi yomdlavuza obala ngokobuhlanga inyuswa ngokuba nezimo ezithile ezizuzwe njengefa, njenge:

  • I-adenomatous polyposis (FAP) ejwayelekile.
  • I-FAP etholakele.
  • I-polyposis ehlobene ne-MUTYH.
  • I-Lynch syndrome.
  • I-Oligopolyposis.
  • Shintsha kuhlobo lwe-NTHL1.
  • I-juvenile polyposis syndrome.
  • Isifo seCowden.
  • I-Peutz-Jeghers syndrome.
  • Uhlobo lwe-Neurofibromatosis 1 (NF1).

Ama-polyp polyp akha ezinganeni ezingenayo i-syndrome ezuzwe njengefa awaxhunyaniswa nengozi eyengeziwe yomdlavuza.

Izimpawu nezimpawu zomdlavuza obala ngokobuntwana zivame ukuncika lapho kwenzeka khona isimila. Umdlavuza we-Colorectal ungadala noma yiziphi zalezi zimpawu nezimpawu ezilandelayo. Buza kudokotela wengane yakho uma ingane yakho inokunye kwalokhu okulandelayo:

  • Izicubu ze-rectum noma i-colon engezansi zingadala ubuhlungu esiswini, ukuqunjelwa, noma isifo sohudo.
  • Izimila engxenyeni yekholoni ohlangothini lwesobunxele lomzimba zingadala:
  • Isigaxa esiswini.
  • Ukwehla kwesisindo ngaphandle kwesizathu esaziwayo.
  • Isicanucanu nokuhlanza.
  • Ukuphelelwa isifiso sokudla.
  • Igazi esitulweni.
  • I-anemia (ukukhathala, isiyezi, ukushaya kwenhliziyo okusheshayo noma okungajwayelekile, ukuphefumula okuncane, isikhumba esiphaphathekile).
  • Izimila engxenyeni yekholoni engakwesokudla komzimba zingadala:
  • Ubuhlungu esiswini.
  • Igazi esitulweni.
  • Ukuqunjelwa noma uhudo.
  • Isicanucanu noma ukuhlanza.
  • Ukwehla kwesisindo ngaphandle kwesizathu esaziwayo.

Ezinye izimo ezingewona umdlavuza obala zingadala lezi zimpawu nezimpawu ezifanayo.

Ukuvivinywa kokuthola nokwelapha umdlavuza obala ngokwezifo kungafaka okulandelayo:

  • Ukuhlolwa komzimba kanye nomlando wezempilo.
  • I-X-ray yesifuba.
  • Ukuhlolwa kwe-CT kwesifuba, kwesisu, kanye nesinqe.
  • Ukuskena kwe-PET.
  • I-MRI.
  • Ukuskena kwamathambo.
  • Isidumbu.

Olunye uvivinyo olusetshenziselwa ukuxilonga umdlavuza ongafani namabala lubandakanya okulandelayo:

  • I-Colonoscopy: Inqubo yokubheka ngaphakathi kwe-rectum ne-colon yama-polyps, izindawo ezingavamile, noma umdlavuza. I-colonoscope ifakwa nge-rectum kukholoni. I-colonoscope iyinsimbi encane, efana nethubhu enokukhanya nelensi yokubuka. Kungaba futhi nethuluzi lokususa ama-polyps noma amasampuli wezicubu, ahlolwe ngaphansi kwesibonakhulu ukuthola izimpawu zomdlavuza.
  • I-Barium enema: Uchungechunge lwama-x-ray wepheshana elingezansi lamathumbu. Uketshezi oluqukethe i-barium (i-metallic compound eyinsimbi emhlophe) ifakwa engxenyeni. Ama-barium agqoka umgudu ophansi wamathumbu nama-x-ray athathiwe. Le nqubo ibizwa nangokuthi uchungechunge oluphansi lwe-GI.
  • Ukuhlolwa kwegazi lokulingwa kwe-Fecal: Isivivinyo sokuhlola indle (imfucumfucu eqinile) yegazi elingabonakala ngemicroscope kuphela. Amasampula amancane endle abekwa emakhadini akhethekile abuyiselwe kudokotela noma elabhorethri ukuze ahlolwe.
  • Qedela ukubalwa kwegazi (i-CBC): Inqubo lapho kukhishwa khona isampula legazi futhi lihlolwe lokhu okulandelayo:
  • Inani lamaseli abomvu egazi, amaseli amhlophe egazi, nama-platelets.
  • Inani le-hemoglobin (iprotheni ethwala umoya-mpilo) kumaseli abomvu egazi.
  • Ingxenye yesampula yegazi eyenziwe ngamaseli abomvu egazi.
  • Ukuhlolwa kokusebenza kwezinso: Isivivinyo lapho amasampula egazi noma omchamo ahlolwe khona inani lezinto ezithile ezikhishwe izinso. Inani eliphakeme noma elingaphansi kwenani elijwayelekile lezinto kungaba uphawu lokuthi izinso azisebenzi ngendlela obekufanele zisebenze ngayo. Lokhu kubizwa nangokuthi ukuhlolwa komsebenzi wezinso.
  • Isivivinyo somsebenzi wesibindi : Ukuhlolwa kwegazi ukukala amazinga egazi wezinto ezithile ezikhishwe isibindi. Izinga eliphakeme noma eliphansi lezinto ezithile kungaba uphawu lwesifo sesibindi.
  • Isilingo seCarcinoembryonic antigen (CEA): Isivivinyo esikala izinga le-CEA egazini. I-CEA ikhishwa ingene egazini kusuka kumaseli womdlavuza namaseli ajwayelekile. Lapho kutholakala ngamanani aphakeme kunejwayelekile, kungaba luphawu lomdlavuza obomvu noma ezinye izimo.

Isibikezelo

Isibikezelo (ithuba lokululama) sincike kokulandelayo:

  • Ukuthi sonke isimila sisuswe yini ngokuhlinzwa.
  • Ukuthi umdlavuza ususabalele kwezinye izingxenye zomzimba, njengama-lymph node, isibindi, ukhalo, noma amaqanda.

Ukwelashwa

Ngemininingwane mayelana nokwelashwa okubalwe ngezansi, bheka isigaba se-Treatment Option Overview section.

Ukwelashwa komdlavuza obomvu ezinganeni kungabandakanya okulandelayo:

  • Ukuhlinzwa ukukhipha isimila uma kungasakazekanga.
  • Ukwelashwa ngemisebe nokwelashwa ngamakhemikhali kwezimila ku-rectum noma colon ephansi.
  • Inhlanganisela yamakhemikhali, yomdlavuza othuthukile okhanyayo
  • I-Immunotherapy enama-immune checkpoint inhibitors (ipilimumab ne-nivolumab).

Ukwelashwa komdlavuza ophindaphindiwe obala ezinganeni kungabandakanya okulandelayo:

  • Isivivinyo somtholampilo esihlola isampula lesimila sesiguli ukuthola izinguquko ezithile zofuzo. Uhlobo lokwelashwa okuqondisiwe oluzonikezwa isiguli kuncike ohlotsheni lokushintsha kofuzo.

Izingane ezinama-syndromes omdlavuza othile wemibala ethile zingaphathwa nge:

  • Ukuhlinzwa ukususa ikholoni ngaphambi kwamafomu omdlavuza.
  • Umuthi wokwehlisa inani lama-polyps kukholoni.

Ama-Neuroendocrine Tumors (Carcinoid Tumors)

Amaseli we-Neuroendocrine angenza njengamaseli ezinzwa noma amangqamuzana enza ama-hormone. Amaseli asakazeke kuzitho zonke ezifana namaphaphu (tracheobronchial) noma umgudu wokugaya ukudla.

Izicubu ze-Neuroendocrine (kufaka phakathi izicubu ze-carcinoid) zivamise ukwakheka esiswini noma emathunjini (kufaka nesithasiselo), kepha zingakha kwezinye izitho, njengamanyikwe, amaphaphu noma isibindi. Lezi zicubu zivame ukuba zincane, zikhule kancane, futhi zibe nobungozi (hhayi umdlavuza). Ezinye izicubu ze-neuroendocrine ziyingozi (umdlavuza) futhi zisakazeka kwezinye izindawo emzimbeni.

Izicubu eziningi ze-neuroendocrine ezinganeni zakha esithasiselweni (isikhwama esiphuma engxenyeni yokuqala yamathumbu amakhulu ngasekupheleni kwethumbu elincane). Isimila sivame ukutholakala ngesikhathi sokuhlinzwa ukususa isithasiselo.

Izimpawu Nezimpawu

Izimpawu nezimpawu zamathumba we-neuroendocrine ancike lapho kwenzeka khona isimila. Izicubu ze-Neuroendocrine kusithasiselo zingadala izimpawu nezimpawu ezilandelayo:

  • Ubuhlungu besisu, ikakhulukazi ohlangothini olungezansi kwesisu.
  • Imfiva.
  • Isicanucanu nokuhlanza.
  • Uhudo.

Izicubu ze-Neuroendocrine ezingekho esithasiselweni zingakhipha ama-hormone nezinye izinto. I-Carcinoid syndrome ebangelwa i-hormone serotonin namanye ama-hormone, ingadala noma yiziphi izimpawu nezimpawu ezilandelayo. Buza kudokotela wengane yakho uma ingane yakho inokunye kwalokhu okulandelayo:

  • Ububomvu nomuzwa ofudumele ebusweni, entanyeni, nasesifubeni esingaphezulu.
  • Ukushaya kwenhliziyo okusheshayo.
  • Ukuphefumula kanzima.
  • Ukwehla okungazelelwe kwengcindezi yegazi (ukungahlaliseki, ukudideka, ubuthakathaka, isiyezi, nesikhumba esiphaphathekile, esipholile nesicoboshayo).
  • Uhudo.

Ezinye izimo ezingezona izicubu ze-neuroendocrine zingadala lezi zimpawu nezimpawu ezifanayo.

Izivivinyo Zokuxilonga Nezesiteji

Izivivinyo ezihlola izimpawu zomdlavuza zisetshenziselwa ukuxilonga kanye nokwakha izicubu ze-neuroendocrine. Zingafaka:

  • Ukuhlolwa komzimba kanye nomlando wezempilo.
  • Izifundo ze-chemistry yegazi.
  • I-MRI.
  • Ukuskena kwe-PET.
  • Iskena se-CT.
  • I-Ultrasound.

Bheka isigaba solwazi jikelele ukuthola incazelo yalezi zivivinyo nezinqubo.

Ezinye izivivinyo ezisetshenziselwa ukuxilonga izicubu ze-neuroendocrine zifaka okulandelayo:

  • Ukuhlolwa komchamo wamahora angamashumi amabili nane: Isivivinyo lapho kuqoqwa khona umchamo amahora angama-24 ukukala inani lezinto ezithile, njengamahomoni. Inani elingajwayelekile (eliphakeme noma eliphansi kunokujwayelekile) lento kungaba uphawu lwesifo esithweni noma esikhunjeni esisenzayo. Isampula yomchamo iyahlolwa ukubona ukuthi ayiqukethe yini i-5-HIAA (umkhiqizo wokuwohloka we-hormone serotonin engenziwa izicubu ze-carcinoid). Lokhu kuhlolwa kusetshenziselwa ukuxilonga i-carcinoid syndrome.
  • I-Somatostatin receptor scintigraphy: Uhlobo lwe-radionuclide scan olungasetshenziswa ukuthola izicubu. Inani elincane kakhulu le-octreotide enemisebe (i-hormone enamathela kwizicubu) lifakwa emthanjeni futhi lihambe ngegazi. I-octreotide enemisebe inamathela kulesimila nekhamera ekhethekile ethola ukusebenza kwemisebe ye-radioactivity isetshenziselwa ukukhombisa ukuthi izicubu zikuphi emzimbeni. Le nqubo ibizwa nangokuthi i-octreotide scan ne-SRS.

Isibikezelo

Isibikezelo samathumba we-neuroendocrine esithasiselweni ezinganeni kuvame ukuba sihle kakhulu ngemuva kokuhlinzwa ukususa isimila. Izicubu ze-Neuroendocrine ezingekho esithasiselweni zivame ukuba zinkulu noma zisabalalele kwezinye izingxenye zomzimba ngesikhathi sokuxilongwa futhi aziphenduli kahle ekhemotherapy. Izicubu ezinkulu maningi amathuba okuthi ziphinde zibuye (zibuye).

Ukwelashwa

Ngemininingwane mayelana nokwelashwa okubalwe ngezansi, bheka isigaba se-Treatment Option Overview section.

Ukwelashwa kwezimila ze-neuroendocrine kusithasiselo ezinganeni kungafaka okulandelayo:

  • Ukuhlinzwa ukususa isithasiselo.

Ukwelashwa kwezimila ze-neuroendocrine ezisabalalele emathunjini amakhulu, amanyikwe, noma isisu kuvame ukuhlinzwa. Ukwelashwa kwezimila ezingenakususwa ngokuhlinzwa, izicubu eziningi, noma izicubu ezisakazekile zingafaka okulandelayo:

  • Ukuhlanganisa.
  • Ukwelashwa kwe-analogue ye-Somatostatin (octreotide noma i-lanreotide).
  • Ukwelashwa kwe-Peptide receptor radionuclide.
  • Ukwelashwa okuqondisiwe nge-tyrosine kinase inhibitor (sunitinib) noma i-mTOR inhibitor (everolimus).

Ukwelashwa kwezimila eziphindaphindayo ze-neuroendocrine ezinganeni kungafaka okulandelayo:

  • Isivivinyo somtholampilo esihlola isampula lesimila sesiguli ukuthola izinguquko ezithile zofuzo. Uhlobo lokwelashwa okuqondisiwe oluzonikezwa isiguli kuncike ohlotsheni lokushintsha kofuzo.

Bona isifinyezo se- mayelana nokwelashwa kwabantu abadala emathunjini okwelashwa kwamathumbu ukuthola eminye imininingwane.

Izimila Zamathumbu Ezisemathunjini

Izicubu zamangqamuzana emathunjini (GIST) emathunjini zivame ukuqala kumaseli odongeni lwesisu noma amathumbu. Ama-GIST angahle abe nobungozi (hhayi umdlavuza) noma amabi (umdlavuza). Ama-GISTs ezingane ajwayelekile kakhulu emantombazaneni, futhi imvamisa avela eminyakeni yobusha.

Izici Zengozi Nezimpawu Nezimpawu

Ama-GIST ezinganeni awafani nama-GIST kubantu abadala. Iziguli kufanele zibonakale ezikhungweni ezigxile ekwelapheni ama-GIST futhi izicubu kufanele zihlolelwe izinguquko zofuzo. Inani elincane lezingane linezimila ezinezinguquko zofuzo njengalezo ezitholakala ezigulini zabantu abadala. Ubungozi be-GIST bukhuphuka ngezifo ezilandelayo zofuzo:

  • UCarney triad.
  • Isifo seCarney-Stratakis.

Iningi lezingane ezine-GIST linezimila esiswini futhi ziba ne-anemia ebangelwa ukopha. Izimpawu nezimpawu ze-anemia zifaka okulandelayo:

  • Ukukhathala.
  • Isiyezi.
  • Ukushaya kwenhliziyo okusheshayo noma okungajwayelekile.
  • Ukuphelelwa umoya.
  • Isikhumba esiphaphathekile.

Isigaxa esiswini noma ukuvaleka kwamathumbu (izinhlungu ezibuhlungu esiswini, isicanucanu, ukuhlanza, uhudo, ukuqunjelwa, nokuvuvukala kwesisu) nakho kuyizimpawu ze-GIST.

Ezinye izimo ezingezona i-anemia ezibangelwa i-GIST zingadala lezi zimpawu nezimpawu ezifanayo.

Izivivinyo Zokuxilonga Nezesiteji

Ukuhlolwa okuhlola izimpawu zomdlavuza kusetshenziselwa ukuxilonga kanye nama-GISTs esiteji. Zingafaka:

  • Ukuhlolwa komzimba kanye nomlando wezempilo.
  • I-MRI.
  • Iskena se-CT.
  • Ukuskena kwe-PET.
  • I-X-ray yesisu.
  • Isidumbu.
  • Isifiso senalidi enhle: Ukususwa kwezicubu kusetshenziswa inaliti ezacile.

Bheka isigaba solwazi jikelele ukuthola incazelo yalezi zivivinyo nezinqubo.

Ezinye izivivinyo ezisetshenziselwa ukuxilonga i-GIST zifaka okulandelayo:

  • I-Endoscopy: Inqubo yokubheka izitho nezicubu ngaphakathi komzimba ukubheka izindawo ezingajwayelekile. I-endoscope ifakwa ngokusika (ukusika) esikhunjeni noma ekuvulekeni emzimbeni, njengomlomo noma ingquza. I-endoscope iyinsimbi encane, efana nethubhu enokukhanya nelensi yokubuka. Kungaba futhi nethuluzi lokususa amasampula wezicubu noma ama-lymph node, ahlolwe ngaphansi kwesibonakhulu ukuthola izimpawu zesifo.

Ukwelashwa

Ngemininingwane mayelana nokwelashwa okubalwe ngezansi, bheka isigaba se-Treatment Option Overview section.

Ukwelashwa kwezingane ezinamathumba anezinguquko zofuzo njengalezo ezitholakala ezigulini zabantu abadala kuhloswe ukwelashwa nge-tyrosine kinase inhibitor (imatinib noma i-sunitinib).

Ukwelashwa kwezingane ezinamathumba angakhombisi izinguquko zofuzo kungafaka okulandelayo:

  • Ukuhlinzwa ukukhipha isimila. Ukuhlinzwa okuningi kungadingeka uma ukuvinjelwa kwamathumbu noma ukuphuma kwegazi kwenzeka.

Ukwelashwa kwe-GIST ephindayo ezinganeni kungafaka okulandelayo:

  • Isivivinyo somtholampilo esihlola isampula lesimila sesiguli ukuthola izinguquko ezithile zofuzo. Uhlobo lokwelashwa okuqondisiwe oluzonikezwa isiguli kuncike ohlotsheni lokushintsha kofuzo.
  • Isivivinyo somtholampilo somuthi omusha we-chemotherapy.

Umdlavuza Ongajwayelekile Wezinhlelo Zokuzala Nezomchamo

Kulesi Sigaba

  • Umdlavuza Wesinye
  • Umdlavuza Wamasende
  • Umdlavuza we-Ovarian
  • Umdlavuza Womlomo Womlomo Wesibeletho nowangasese

Umdlavuza Wesinye

Umdlavuza wesinye yisifo lapho amangqamuzana abulalayo (umdlavuza) akha izicubu zesinye. Isinye isitho esingenalutho engxenyeni engezansi yesisu. Yakheke njengebhaluni elincane futhi inodonga lwemisipha oluyivumela ukuthi ikhule noma ibe ncanyana. Amashubhu amancane ezinso ahlunga futhi ahlanze igazi. Bakhipha imfucuza benze umchamo. Umchamo udlula usuka ezinso ngalunye ngebhubhu ende ebizwa nge-ureter iye esinyeni. Isinye sigcina umchamo uze udlule kumchamo bese ushiya umzimba.

I-anatomy yesistimu yomchamo yabesifazane ekhombisa izinso, izindlala ze-adrenal, ureters, isinye, ne-urethra. Umchamo wenziwa kuma-tubules wezinso futhi uqoqwa ku-pelvis ye-renal yenso ngalinye. Umchamo ugeleza kusuka ezinso udabule ureters uye esinyeni. Umchamo ugcinwa esinyeni uze ushiye umzimba ngomchamo.

Uhlobo oluvame kakhulu lomdlavuza wesinye umdlavuza weseli wesikhashana. Iseli le-squamous nezinye izinhlobo ezinomdlavuza wesinye esibi akuvamile.

Izici Zobungozi, Izimpawu Nezimpawu, kanye Nezivivinyo Zokuxilonga Nezesiteji

Ingozi yomdlavuza wesinye iyakhuliswa ezinganeni ezilashelwe umdlavuza ngemithi ethile yokulwa nomdlavuza, ebizwa ngama-alkylating agents, okubandakanya i-cyclophosphamide, ifosfamide, busulfan, ne-temozolomide.

Umdlavuza wesinye ungadala noma yiziphi zalezi zimpawu nezimpawu ezilandelayo. Buza kudokotela wengane yakho uma ingane yakho inokunye kwalokhu okulandelayo:

  • Igazi emchameni (ngokugqwala okumbala obomvu ngokugqamile ngombala obomvu).
  • Ukuchama kaningi noma ukuzwa isidingo sokuchama ngaphandle kokwenza lokho.
  • Ubuhlungu ngesikhathi sokuchama.
  • Ubuhlungu besisu noma beqolo.

Ezinye izimo ezingewona umdlavuza wesinye zingadala izimpawu nezimpawu ezifanayo.

Ukuhlolwa kokuthola umdlavuza wesisu kanye nesigaba kungafaka okulandelayo:

  • Ukuhlolwa komzimba kanye nomlando wezempilo.
  • Iskena se-CT.
  • I-Ultrasound yesinye.
  • Isidumbu.
  • I-cystoscopy: Inqubo yokubheka ngaphakathi kwesinye kanye nomchamo ukubheka izindawo ezingajwayelekile. I-cystoscope ifakwa nge-urethra iye esinyeni. I-cystoscope iyinsimbi encane, efana nethubhu enokukhanya nelensi yokubuka. Kungaba futhi nethuluzi lokususa amasampula wezicubu, ahlolwe ngaphansi kwesibonakhulu ukuthola izimpawu zomdlavuza. Uma i-cystoscopy ingenziwa lapho kutholakala ukuxilongwa, amasampula wezicubu ayasuswa futhi ahlolwe umdlavuza ngesikhathi sokuhlinzwa ukuze kususwe konke noma ingxenye yesinye.

Bheka isigaba solwazi jikelele ukuthola incazelo yalezi zivivinyo nezinqubo.

Isibikezelo

Ezinganeni, umdlavuza wesinye uvame ukuba sezingeni eliphansi (akunakwenzeka ukuthi usabalale) kanti ukubikezelwa kuvame ukuba kuhle kakhulu ngemuva kokuhlinzwa ukususa isimila.

Ukwelashwa

Ngemininingwane mayelana nokwelashwa okubalwe ngezansi, bheka isigaba se-Treatment Option Overview section.

Ukwelashwa komdlavuza wesinye ezinganeni kuvame ukulandelayo:

  • Ukuhlinzwa ukususa ingxenye yesinye. I-Transurethral resection (TUR) inqubo yokuhlinza ukususa izicubu esinyeni usebenzisa i-resectoscope efakwe esinyeni nge-urethra. I-resectoscope iyinsimbi encane, efana nethubhu enelambu, ilensi yokubuka, kanye nethuluzi lokususa izicubu nokushisa noma yimaphi amangqamuzana e-tumor asele. Amasampula amathishu avela endaweni lapho kukhishwe khona isimila ayahlolwa ngaphansi kwesibonakhulu ukuthola izimpawu zomdlavuza.
  • Ukuhlinzwa ukukhipha isinye (okungajwayelekile).

Khuluma nodokotela wengane yakho mayelana nokuthi lolu hlobo lokuhlinzwa lungathinta kanjani ukuchama, ukusebenza kocansi nokuzala.

Ukwelashwa komdlavuza wesisu ophindayo ezinganeni kungafaka okulandelayo:

  • Isivivinyo somtholampilo esihlola isampula lesimila sesiguli ukuthola izinguquko ezithile zofuzo. Uhlobo lokwelashwa okuqondisiwe oluzonikezwa isiguli kuncike ohlotsheni lokushintsha kofuzo.

Bheka isifinyezo se- mayelana nokwelashwa komdlavuza wesinye sabantu abadala ukuze uthole eminye imininingwane.

Umdlavuza Wamasende

Umdlavuza wamasende yisifo lapho amangqamuzana abulalayo (umdlavuza) akha izicubu zesende elilodwa noma womabili. Amasende yizindlala ezi-2 ezimise okweqanda ezitholakala ngaphakathi kwesikhotha (isaka lesikhumba elixegayo elilele ngaphansi ngqo kwepipi). Amasende agcinwa ngaphakathi kwesikhotha ngentambo yesidoda, equkethe nama-vas deferens nemithambo nezinzwa zamasende.

I-anatomy yezinhlelo zesilisa zokuzala nezomchamo, ezibonisa indlala, amasende, isinye nezinye izitho.

Kunezinhlobo ezimbili zezicubu zamasende:

  • Izimila zeseli lamaGerm: Izicubu eziqala kumaseli wesidoda emadodeni. Izicubu zesigciwane samasende zingaba yingozi (hhayi umdlavuza) noma zibe yingozi (umdlavuza). Izicubu zesigciwane samasende ezijwayeleke kakhulu kubafana abancane ama-teratomas anobungozi nama-nonseminomas amabi. Ama-Seminomas avame ukwenzeka ezinsizweni futhi akuvamile kubafana. Bona isifinyezo se- se-Childhood Extracranial Germ Cell Tumors Treatment ukuze uthole imininingwane engaphezulu ngamathumba amaseli wegciwane lesende.
  • Izicubu zamangqamuzana ezingelona igciwane: Izicubu eziqala ezicutshini ezizungeze futhi zisekele amasende. Lezi zicubu zingase zibe yingozi noma zibe yimbi. Izicubu zeseli lezinsizwa i-granulosa kanye nezicubu zeseli le-Sertoli-Leydig yizinhlobo ezimbili zezicubu zeseli ezingeyona igciwane.

Izimpawu Nezimpawu kanye Nezivivinyo Zokuxilonga Nezesiteji

Umdlavuza wamasende nokusabalala kwawo kwezinye izingxenye zomzimba kungadala noma yiziphi zalezi zimpawu nezimpawu ezilandelayo. Buza kudokotela wengane yakho uma ingane yakho inokunye kwalokhu okulandelayo:

  • Isigaxa esibuhlungu emasendeni.
  • Izimpawu zokuqala zokuthomba.
  • Amabele akhulisiwe.

Isigaxa esingenabuhlungu emasendeni singaba wuphawu lwesimila samasende. Ezinye izimo zingadala nesigaxa emasendeni.

Ukuvivinywa kokuxilongwa nokukala umdlavuza wamasende okungewona owamagciwane kungafaka okulandelayo:

  • Ukuhlolwa komzimba kanye nomlando wezempilo.
  • Ukuhlolwa kwe-CT kwesifuba, kwesisu, noma kwesinqe.
  • I-MRI yesifuba, isisu, noma i-pelvis.
  • I-Ultrasound.
  • Isidumbu. Izicubu ezisuswe ngesikhathi sokuhlinzwa zibhekwa ngaphansi kwesibonakhulu ngudokotela wezifo ezihlola izimpawu zomdlavuza.

Bheka isigaba solwazi jikelele ukuthola incazelo yalezi zivivinyo nezinqubo.

Ezinye izivivinyo ezisetshenziselwa ukuxilonga izicubu zamasende zifaka okulandelayo:

  • Isivivinyo se-serum tumor marker: Inqubo lapho kuhlolwa khona isampula yegazi ukukala inani lezinto ezithile ezikhishwe egazini ngezitho, izicubu, noma amaseli wesimila emzimbeni. Izinto ezithile zixhunyaniswe nezinhlobo ezithile zomdlavuza lapho zitholakala emazingeni akhuphukile egazini. Lokhu kubizwa ngokuthi yizimpawu zesimila. Isimila se-tumor alpha-fetoprotein sisetshenziselwa ukuxilonga izicubu zesifo segciwane.

Isibikezelo

Ezinganeni, isibikezelo ngokuvamile sihle kakhulu ngemuva kokuhlinzwa ukususa isimila.

Ukwelashwa

Ngemininingwane mayelana nokwelashwa okubalwe ngezansi, bheka isigaba se-Treatment Option Overview section.

Ukwelashwa komdlavuza wamasende okungewona owamagciwane ezinganeni kungafaka okulandelayo:

  • Ukuhlinzwa ukuze kususwe isimila esisesendeni.
  • Kuhlinzwa ukukhipha isende elilodwa noma womabili.

Ukwelashwa komdlavuza we-testicular non-germ cell testicular ezinganeni kungafaka okulandelayo:

  • Isivivinyo somtholampilo esihlola isampula lesimila sesiguli ukuthola izinguquko ezithile zofuzo. Uhlobo lokwelashwa okuqondisiwe oluzonikezwa isiguli kuncike ohlotsheni lokushintsha kofuzo.

Bona isifinyezo se- se-Childhood Extracranial Germ Cell Tumors Treatment ukuze uthole imininingwane engaphezulu ngamathumba amaseli wegciwane lesende.

Umdlavuza we-Ovarian

Umdlavuza we-Ovarian yisifo lapho amangqamuzana abulalayo (umdlavuza) akha khona esibelethweni. Ama-ovari ayizitho zombili ohlelweni lokuzala lwabesifazane. Zitholakala okhalweni, olunye ohlangothini ngalunye lwesibeletho (isitho esingelutho, esimise okwamapheya lapho kukhula umbungu). I-ovary ngayinye icishe ilingane nobukhulu be-alimondi kowesifazane osekhulile. Amaqanda akhiqiza amaqanda namahomoni abesifazane (amakhemikhali alawula indlela amaseli noma izitho ezithile ezisebenza ngayo).

I-anatomy yohlelo lokuzala lwabesifazane. Izitho ezisehlelweni lokuzala labesifazane zifaka phakathi isibeletho, amaqanda, amashubhu e-fallopian, umlomo wesibeletho, kanye nesitho sangasese sowesifazane. Isibeletho sinolwelwesi olungaphandle lwemisipha olubizwa ngokuthi i-myometrium nolwelwesi lwangaphakathi olubizwa ngokuthi i-endometrium.

Izicubu eziningi zama-ovari ezinganeni zinobungozi (hhayi umdlavuza). Zenzeka kakhulu kwabesifazane abaneminyaka engu-15 kuye kwengu-19.

Kunezinhlobo eziningana zamathumba ama-ovarian amabi (umdlavuza):

  • Izimila zamangqamuzana amaGerm: Izicubu eziqala kumaseli amaqanda kwabesifazane. Lezi yizicubu ezivame kakhulu kuma-ovari kumantombazane. (Bheka isifinyezo se- ku-Childhood Extracranial Germ Cell Tumors Treatment ukuthola eminye imininingwane ngamangqamuzana ama-germ cell cell.)
  • Izicubu ze-Epithelial: Izicubu eziqala ezicutshini ezimboza isizalo. Lezi yizicubu zesibili zama-ovari ezivame kakhulu emantombazaneni.
  • Izicubu ze-Stromal: Izicubu eziqala kumaseli we-stromal, akha izicubu ezizungeze futhi zisekele ama-ovari. Izicubu zeseli lezinsizwa i-granulosa kanye nezicubu zeseli le-Sertoli-Leydig yizinhlobo ezimbili zezicubu zomzimba.
  • I-cell cell carcinoma encane esibelethweni: Umdlavuza oqala esibelethweni futhi kungenzeka ukuthi usabalalele esiswini, okhalweni, noma kwezinye izingxenye zomzimba. Lolu hlobo lomdlavuza we-ovari lukhula ngokushesha futhi lunokubikezela okubi.

Izici Zobungozi, Izimpawu Nezimpawu, kanye Nezivivinyo Zokuxilonga Nezesiteji

Ingozi yomdlavuza we-ovari yanda ngokuba nalezi zimo ezilandelayo:

  • Isifo i-Ollier (ukuphazamiseka okubangela ukukhula okungajwayelekile koqwanga ekugcineni kwamathambo amade).
  • I-Maffucci syndrome (isifo esidala ukukhula okungajwayelekile koqwanga ekugcineni kwamathambo amade nemithambo yegazi esikhunjeni).
  • I-Peutz-Jeghers syndrome (isifo esidala ukuthi ama-polyps akhe emathunjini nasemabala amnyama akhe emlonyeni naseminwe).
  • I-Pleuropulmonary blastoma syndrome (ukugula okungadala i-cystic nephroma, ama-cysts emaphashini, izinkinga ze-thyroid, neminye imidlavuza yezinso, i-ovary, nezicubu ezithambile).
  • I-DICER1 syndrome (isifo esingahle sidale i-goiter, ama-polyps kukholoni, nezicubu ze-ovary, umlomo wesibeletho, isende, izinso, ubuchopho, iso kanye nolwelwesi lwephaphu).

Umdlavuza we-Ovarian ungadala noma yiziphi zalezi zimpawu nezimpawu ezilandelayo. Buza kudokotela wengane yakho uma ingane yakho inokunye kwalokhu okulandelayo:

  • Ubuhlungu noma ukuvuvukala esiswini.
  • Isigaxa esiswini.
  • Ukuqunjelwa.
  • Izikhathi ezibuhlungu noma ezingabanjwanga zokuya esikhathini.
  • Ukopha okungavamile kwesitho sangasese sowesifazane.
  • Izici zobulili besilisa, njengezinwele zomzimba noma izwi elijulile.
  • Izimpawu zokuqala zokuthomba.

Ezinye izimo ezingawona umdlavuza we-ovari zingadala lezi zimpawu nezimpawu ezifanayo.

Ukuhlolwa kokuthola umdlavuza wesigaba se-ovari kungafaka okulandelayo:

  • Ukuhlolwa komzimba kanye nomlando wezempilo.
  • Iskena se-CT.
  • I-MRI.
  • I-Ultrasound.
  • Isidumbu. Izicubu ezisuswe ngesikhathi sokuhlinzwa zibhekwa ngaphansi kwesibonakhulu ngudokotela wezifo ezihlola izimpawu zomdlavuza.

Bheka isigaba solwazi jikelele ukuthola incazelo yalezi zivivinyo nezinqubo.

Ezinye izivivinyo ezisetshenziselwa ukuxilonga izicubu ze-ovari zifaka okulandelayo:

  • Isivivinyo se-serum tumor marker: Inqubo lapho kuhlolwa khona isampula yegazi ukukala inani lezinto ezithile ezikhishwe egazini ngezitho, izicubu, noma amaseli wesimila emzimbeni. Izinto ezithile zixhunyaniswe nezinhlobo ezithile zomdlavuza lapho zitholakala emazingeni akhuphukile egazini. Lokhu kubizwa ngokuthi yizimpawu zesimila. Izimpawu zesimila i-alpha-fetoprotein, i-beta-human chorionic gonadotropin (β-hCG), i-CEA, i-CA-125, nezinye zisetshenziselwa ukuthola umdlavuza we-ovari.

Ngesikhathi sokuhlinzwa ukuze kususwe isimila, kuzohlolwa uketshezi esiswini ukuze kutholakale izimpawu zomdlavuza.

Isibikezelo

Umdlavuza we-ovarian epithelial uvame ukutholakala zisencane ezinganeni futhi kulula ukuwelapha kuneziguli zabantu abadala.

Ukwelashwa

Ngemininingwane mayelana nokwelashwa okubalwe ngezansi, bheka isigaba se-Treatment Option Overview section.

Ukwelashwa kwezimila ezivundile ezinganeni kungafaka okulandelayo:

  • Ukuhlinzwa.

Ukwelashwa komdlavuza we-ovarian epithelial ezinganeni kungafaka okulandelayo:

  • Ukuhlinzwa.
  • Ukwelashwa ngemisebe.
  • Ukwelashwa ngamakhemikhali.

Ukwelashwa kwezimila ezi-ovarian stromal, kufaka phakathi izicubu zezinsizwa ze- granulosa kanye ne-Sertoli-Leydig cell tumors, ezinganeni kungafaka okulandelayo:

  • Ukuhlinzwa ukususa i-ovary eyodwa kanye ne-tube fallopian eyodwa yomdlavuza wokuqala.
  • Ukuhlinzwa okulandelwa ukwelashwa ngamakhemikhali komdlavuza osekuthuthukile.
  • I-Chemotherapy yomdlavuza ophindile (buyela emuva).

Ukwelashwa kwe-cell carcinoma encane ye -ovary kungafaka okulandelayo:

  • Ukuhlinzwa kulandelwa yi-chemotherapy kanye ne-high-dose chemotherapy nge-stem cell rescue.
  • Ukwelashwa okuhlosiwe (tazemetostat).

Ukwelashwa komdlavuza ovamile we-ovari ezinganeni kungafaka okulandelayo:

  • Isivivinyo somtholampilo esihlola isampula lesimila sesiguli ukuthola izinguquko ezithile zofuzo. Uhlobo lokwelashwa okuqondisiwe oluzonikezwa isiguli kuncike ohlotsheni lokushintsha kofuzo.

Bona izifinyezo ezilandelayo ze- ukuthola eminye imininingwane:

  • Ukwelashwa Kwama-Extracranial Germ Cell Tumors Treatment
  • I-Ovarian Epithelial, Fallopian Tube, kanye ne-Primary Peritoneal Cancer Treatment
  • Ukwelashwa Kwe-Ovarian Germ Cell Tumors

Umdlavuza Womlomo Womlomo Wesibeletho nowangasese

Umdlavuza womlomo wesibeletho yisifo lapho amangqamuzana abulalayo (umdlavuza) akha khona emlomo wesibeletho. Umlomo wesibeletho ukuphela okuphansi, okuncane kwesibeletho (okuyisitho esingenalutho, esimise okwamapheya lapho kukhula khona ingane). Umlomo wesibeletho uhola kusuka esibelethweni uye esithombeni sangasese (umsele wokuzalwa). Amafomu omdlavuza wesitho sangasese sowesifazane esithweni sangasese. Isitho sangasese sowesifazane ngumsele oholela kusuka emlonyeni wesibeletho uye ngaphandle komzimba. Lapho izalwa, ingane idlula emzimbeni iye esithweni sangasese (esibizwa nangokuthi umsele wokuzalwa).

I-anatomy yohlelo lokuzala lwabesifazane. Izitho ezisehlelweni lokuzala labesifazane zifaka phakathi isibeletho, amaqanda, amashubhu e-fallopian, umlomo wesibeletho, kanye nesitho sangasese sowesifazane. Isibeletho sinolwelwesi olungaphandle lwemisipha olubizwa ngokuthi i-myometrium nolwelwesi lwangaphakathi olubizwa ngokuthi i-endometrium.

Uphawu oluvame kakhulu lomdlavuza womlomo wesibeletho nowangasese ukuphuma kwegazi esithweni sangasese. Ezinye izimo zingadala ukopha kwesitho sangasese sowesifazane. Izingane zivame ukutholakala zinesifo esithuthukile.

Izivivinyo Zokuxilonga Nezesiteji

Ukuhlolwa kokuthola kanye nokwakha umdlavuza wesibeletho nowesifazane sangasese kungafaka okulandelayo:

  • Ukuhlolwa komzimba kanye nomlando wezempilo.
  • I-Ultrasound.
  • I-MRI.
  • Iskena se-CT.
  • Isidumbu. I-needle transvaginal biopsy ukususwa kwezicubu kusetshenziswa inaliti eqondiswa yi-ultrasound.
  • Ukuskena kwamathambo.

Bheka isigaba solwazi jikelele ukuthola incazelo yalezi zivivinyo nezinqubo.

Ezinye izivivinyo ezisetshenziselwa ukuxilonga izicubu zomlomo wesibeletho nezangasese zifaka okulandelayo:

  • Isivivinyo se-serum tumor marker: Inqubo lapho kuhlolwa khona isampula yegazi ukukala inani lezinto ezithile ezikhishwe egazini ngezitho, izicubu, noma amaseli wesimila emzimbeni. Izinto ezithile zixhunyaniswe nezinhlobo ezithile zomdlavuza lapho zitholakala emazingeni akhuphukile egazini. Lokhu kubizwa ngokuthi yizimpawu zesimila.
  • Ukuhlolwa kwe-PAP: Inqubo yokuqoqa amaseli ebusweni bomlomo wesibeletho nowesifazane. Ucezu lukakotini, ibhulashi, noma induku encane yokhuni kusetshenziselwa ukukhuhla ngobumnene amaseli omlomo wesibeletho nowesifazane. Amaseli abhekwa ngaphansi kwesibonakhulu ukuthola ukuthi awajwayelekile yini. Le nqubo ibizwa nangokuthi iPap smear.
  • I-cystoscopy: Inqubo yokubheka ngaphakathi kwesinye kanye nomchamo ukubheka izindawo ezingajwayelekile. I-cystoscope ifakwa nge-urethra iye esinyeni. I-cystoscope iyinsimbi encane, efana nethubhu enokukhanya nelensi yokubuka. Kungaba futhi nethuluzi lokususa amasampula wezicubu, ahlolwe ngaphansi kwesibonakhulu ukuthola izimpawu zomdlavuza.
  • I-Proctoscopy: Inqubo yokubheka ngaphakathi kwe-rectum ne-anus ukuhlola izindawo ezingavamile, usebenzisa i-proctoscope. I-proctoscope iyinsimbi encane, efana nethubhu enokukhanya nelensi yokubuka ingaphakathi le-rectum ne-anus. Kungaba futhi nethuluzi lokususa amasampula wezicubu, ahlolwe ngaphansi kwesibonakhulu ukuthola izimpawu zomdlavuza.

Ukwelashwa

Ngemininingwane mayelana nokwelashwa okubalwe ngezansi, bheka isigaba se-Treatment Option Overview section.

Ukwelashwa komdlavuza wesibeletho kanye nowesifazane sangasese kungafaka okulandelayo:

  • Ukuhlinzwa ukususa umdlavuza omningi ngangokunokwenzeka, kulandelwe ukwelashwa ngemisebe, uma amangqamuzana omdlavuza ahlala ngemuva kokuhlinzwa noma umdlavuza ususabalele kuma-lymph node.
  • I-Chemotherapy nayo ingasetshenziswa kepha akwaziwa ukuthi isebenza kanjani kahle le ndlela yokwelapha.

Ukwelashwa komdlavuza ophindayo wesibeletho nowesifazane esithweni sangasese ezinganeni kungafaka okulandelayo:

  • Isivivinyo somtholampilo esihlola isampula lesimila sesiguli ukuthola izinguquko ezithile zofuzo. Uhlobo lokwelashwa okuqondisiwe oluzonikezwa isiguli kuncike ohlotsheni lokushintsha kofuzo.

Eminye Imdlavuza Engavamile Yobuntwana

Kulesi Sigaba

  • Ama-Endndine Neoplasia Syndromes amaningi
  • IPheochromocytoma neParaganglioma
  • Umdlavuza Wesikhumba (Melanoma, Squamous Cell Cancer, Basal Cell Cancer)
  • I-Intraocular (Uveal) I-Melanoma
  • Chordoma
  • Umdlavuza Wendawo Eyisisekelo Engaziwa

Ama-Endndine Neoplasia Syndromes amaningi

Ama-syndromes amaningi we-endocrine neoplasia (MEN) yizinkinga ezitholwe njengefa ezithinta uhlelo lwe-endocrine. Uhlelo lwe-endocrine lwakhiwe ngezindlala namaseli akha ama-hormone futhi awadedele angene egazini. Ama-syndromes ama-MEN angadala i-hyperplasia (ukukhula kwamaseli amaningi ajwayelekile) noma izicubu ezingaba nobungozi (hhayi umdlavuza) noma umdlavuza (umdlavuza).

Kunezinhlobo eziningi zama-MEN syndromes futhi uhlobo ngalunye lungadala izimo ezahlukahlukene noma umdlavuza. Ukuguqulwa kohlobo lwe-RET kuvame ukuxhumaniswa nomdlavuza we-thyroid we-medullary ku-MEN2 syndrome. Uma kusolakala ukuthi kutholakala ukuthi kune-MEN2 syndrome yengane noma yelungu lomndeni eline-MEN2 syndrome, abazali kufanele bathole ukwelulekwa ngezakhi zofuzo ngaphambi kokuba kwenziwe ukuhlolwa kofuzo enganeni. Ukwelulekwa ngofuzo kufaka phakathi ingxoxo ngobungozi be-MEN2 syndrome yengane namanye amalungu omndeni.

Izinhlobo ezimbili eziyinhloko zama-MEN syndromes yi-MEN1 ne-MEN2:

I-MEN1 syndrome ibizwa nangokuthi i-Wermer syndrome. Le syndrome imvamisa idala izicubu emgodini we-parathyroid, i-pituitary gland, noma amaseli we-islet kuma-pancreas. Ukuxilongwa kwe-MEN1 syndrome kwenziwa lapho izicubu zitholakala kulezi ezimbili zezindlala noma izitho. Isibikezelo (ithuba lokululama) ngokuvamile sihle.

Lezi zicubu zingenza ama-hormone angeziwe futhi zidale izimpawu noma izimpawu ezithile zesifo. Izimpawu nezimpawu zincike ohlotsheni lwehomoni olwenziwe isimila. Kwesinye isikhathi azikho izimpawu noma izimpawu zomdlavuza.

Isimo esivame kakhulu esihlotshaniswa ne-MEN1 syndrome yi-hyperparathyroidism. Izimpawu nezimpawu ze-hyperparathyroidism (i-hormone eningi kakhulu) ifaka okulandelayo:

  • Ukuba netshe lezinso.
  • Ukuzizwa ubuthakathaka noma ukhathele kakhulu.
  • Ubuhlungu bamathambo.

Ezinye izimo ezihlotshaniswa ne-MEN1 syndrome kanye nezimpawu nezimpawu zazo ezivamile yilezi:

  • I-pituitary adenoma (ikhanda elibuhlungu, ukungabikho kwama-mens ngesikhathi noma ngemuva kokuthomba, okwenza ubisi lwebele ngaphandle kwesizathu esaziwayo).
  • Izimila zepancreatic neuroendocrine (ushukela ophansi wegazi [ubuthakathaka, ukulahlekelwa ukwazi, noma ikhoma], ubuhlungu besisu, ukuhlanza, nohudo).

Kungabuye kwenzeke izimila ezimbi zezindlala ze-adrenal, i-bronchi, i-thymus, izicubu ezinemicu, noma amaseli amafutha.

Izingane ezine-hyperparathyroidism eyinhloko, izicubu ezihlotshaniswa ne-MEN1 syndrome, noma umlando womndeni we-hypercalcemia noma i-MEN1 syndrome ingaba nokuhlolwa kofuzo ukuhlola ushintsho (ushintsho) kuhlobo lwe-MEN1. Abazali kufanele bathole ukwelulekwa ngezakhi zofuzo (ingxoxo nochwepheshe oqeqeshiwe ngengozi yezifo zofuzo) ngaphambi kokwenziwa kofuzo. Ukwelulekwa ngofuzo kufaka phakathi ingxoxo ngobungozi be-MEN1 syndrome yengane namanye amalungu omndeni.

Izingane ezitholwa zine-MEN1 syndrome zihlolelwa izimpawu zomdlavuza eziqala eminyakeni yobudala eyi-5 futhi ziqhubeke impilo yazo yonke. Khuluma nodokotela wengane yakho mayelana nokuhlolwa nezinqubo ezidingekayo ukuze uhlole izimpawu zomdlavuza nokuthi kufanele zenziwe kangaki.

I-MEN2 syndrome ifaka amaqenjana amabili amakhulu: i-MEN2A ne-MEN2B.

  • Isifo se-MEN2A

I-MEN2A syndrome ibizwa nangokuthi iSipple syndrome. Ukuxilongwa kwe-MEN2A syndrome kungenziwa lapho isiguli noma abazali besiguli, abafowabo, odadewabo, noma izingane zinezinto ezimbili noma ngaphezulu ezilandelayo:

  • Umdlavuza we-Medullary thyroid (umdlavuza owakhiwa kumaseli we-parafollicular C ku-thyroid). Izimpawu nezimpawu zomdlavuza we-thyroid we-medullary zingafaka:
  • Isigaxa emphinjeni noma entanyeni.
  • Ukuphefumula kanzima.
  • Inkinga yokugwinya.
  • Ukungahambi kahle.
  • Pheochromocytoma (isimila se-adrenal gland). Izimpawu nezimpawu ze-pheochromocytoma zingafaka:
  • Ubuhlungu esiswini noma esifubeni.
  • Ukushaya kwenhliziyo okuqinile, okusheshayo, noma okungajwayelekile.
  • Ubuhlungu bekhanda.
  • Ukujuluka okukhulu ngaphandle kwesizathu esaziwayo.
  • Isiyezi.
  • Ukuzizwa uthuthumela.
  • Ukuthukuthela noma ukwethuka.
  • Isifo se-Parathyroid gland (isimila esibi se-parathyroid gland noma sanda ngosayizi wendlala ye-parathyroid). Izimpawu nezimpawu zesifo i-parathyroid zingafaka:
  • I-Hypercalcemia.
  • Ubuhlungu esiswini, ohlangothini, noma emuva abupheli.
  • Ubuhlungu emathanjeni.
  • Ithambo eliphukile.
  • Isigaxa entanyeni.
  • Inkinga yokukhuluma.
  • Inkinga yokugwinya.

Eminye imidlavuza ye-thyroid ye-medullary yenzeka kanye nesifo i-Hirschsprung (ukuqunjelwa okungapheli okuqala lapho ingane isewusana), okutholakale kweminye imindeni ene-MEN2A syndrome. Isifo se-Hirschsprung singavela ngaphambi kokuba kwenzeke ezinye izimpawu ze-MEN2A syndrome. Iziguli ezitholwa zinesifo se-Hirschsprung kufanele zihlolwe izinguquko zofuzo ze-RET ezixhunyaniswe nomdlavuza wegciwane le-medullary kanye ne-MEN2A syndrome.

I-carcinoma ye-medullary carcinoma yegilo (FMTC) uhlobo lwe-MEN2A syndrome oludala umdlavuza we-medullary thyroid. Ukuxilongwa kwe-FMTC kungenziwa lapho amalungu omndeni amabili noma ngaphezulu enomdlavuza we-thyroid we-medullary futhi kungekho amalungu omndeni anenkinga ye-parathyroid noma ye-adrenal gland.

  • Isifo se-MEN2B

Iziguli ezine-MEN2B syndrome zingaba nomzimba omncane owakhiwe ngezingalo nemilenze emide, emincane. Izindebe zingahle zibonakale zinkulu futhi zishwabene ngenxa yamathumba amabi ezilwaneni. I-MEN2B syndrome ingadala izimo ezilandelayo:

  • Umdlavuza we-Medullary thyroid (okhula ngokushesha)
  • I-Parathyroid hyperplasia.
  • Adenomas.
  • Pheochromocytoma.
  • Izilonda zamaseli emizwa ezinhlakeni zomlomo noma kwezinye izindawo.

Ukuhlolwa okusetshenziselwa ukuxilonga nokubeka isigaba se-MEN syndromes kuncike kwizimpawu nezimpawu kanye nomlando womndeni wesiguli. Zingafaka:

  • Ukuhlolwa komzimba kanye nomlando wezempilo.
  • Izifundo ze-chemistry yegazi.
  • I-Ultrasound.
  • I-MRI.
  • Iskena se-CT.
  • Ukuskena kwe-PET.
  • I-Fine-needle aspiration (FNA) noma i-biopsy yokuhlinzwa.

Bheka isigaba solwazi jikelele ukuthola incazelo yalezi zivivinyo nezinqubo.

Ezinye izivivinyo nezinqubo ezisetshenziselwa ukuxilonga ama-MEN syndromes zifaka okulandelayo:

  • Ukuhlolwa kofuzo: Ukuhlolwa kwelabhorethri lapho kuhlaziywa amaseli noma izicubu ukubheka ushintsho kuzakhi zofuzo noma kuma-chromosomes. Lezi zinguquko zingaba wuphawu lokuthi umuntu unesifo noma isimo esithile noma usengozini yokuba nesifo esithile. Isampula yegazi lihlolwe isakhi sofuzo se-MEN1 ukuze kuhlolwe i-MEN1 syndrome kanye nohlobo lwe-RET ukuthola i-MEN2 syndrome.
  • Izifundo zehomoni yegazi: Inqubo lapho kuhlolwe khona isampula segazi ukukala inani lamahomoni athile akhishwe egazini ngezitho nezicubu zomzimba. Inani elingajwayelekile (eliphakeme noma eliphansi kunokujwayelekile) lento kungaba uphawu lwesifo esithweni noma esikhunjeni esisenzayo. Igazi lingabuye lihlolwe amazinga aphezulu we-hormone calcitonin noma i-parathyroid hormone (PTH).
  • Ukuskena kwe-thyroid: Inani elincane lezinto ezinemisebe eginywayo liyagwinywa noma lijojowe. Izinto ezinemisebe eqoqa amaseli endlala yegilo. Ikhamera ekhethekile exhunywe kwikhompyutha ithola imisebe ekhishiwe futhi yenza izithombe ezibonisa ukuthi igilo libukeka kanjani nokuthi lisebenza kanjani nokuthi umdlavuza ususabalele yini ngale kwendlala yegilo. Uma inani le-hormone evuselela i-thyroid egazini lengane liphansi, ukuskena ukwenza izithombe ze-thyroid kungenziwa ngaphambi kokuhlinzwa.
  • Ukuskena kweSestamibi: Uhlobo lwe-radionuclide scan olusetshenziselwe ukuthola indlala engasebenzi ngokweqile ye-parathyroid. Inani elincane kakhulu lezinto ezinemisebe ebizwa nge-technetium 99 lijovwa emthanjeni futhi lihambe lingene egazini liye endlaleni ye-parathyroid. Into ekhipha imisebe eqoqayo iyoqoqeka endlaleni engasebenzi ngokweqile bese ikhanya ngokukhanyayo kukhamera ekhethekile ethola ukusebenza kwe-radioactivity.
  • Isampula ye-venous yesifo esisebenza ngokweqile se-parathyroid gland: Inqubo lapho kuthathwa khona isampula segazi emithanjeni eseduze nezindlala ze-parathyroid. Isampula lihlolwe ukukala inani le-hormone ye-parathyroid ekhishwe egazini ngendlala ngayinye. Isampula ye-venous ingenziwa uma ukuhlolwa kwegazi kukhombisa ukuthi kukhona indlala engasebenzi ngokweqile kodwa ukuhlolwa kwe-imaging akubonisi ukuthi ikuphi.
  • I-Somatostatin receptor scintigraphy: Uhlobo lwe-radionuclide scan olungasetshenziswa ukuthola izicubu. Inani elincane kakhulu le-octreotide enemisebe (i-hormone enamathela kwizicubu) lifakwa emthanjeni futhi lihambe ngegazi. I-octreotide enemisebe inamathela kulesimila futhi nekhamera ekhethekile ethola ukusebenza kwemisebe ye-radioactivity isetshenziselwa ukukhombisa ukuthi akhona yini ama-islet cell tumors kumanyikwe. Le nqubo ibizwa nangokuthi i-octreotide scan ne-SRS.
  • Ukuskena kwe-MIBG: Inqubo esetshenziselwa ukuthola izicubu ze-neuroendocrine, njenge-pheochromocytoma. Inani elincane kakhulu lezinto ezibizwa nge-radioactive MIBG lifakwa emthanjeni futhi lihamba egazini. Amaseli we-Neuroendocrine tumor athatha i-MIBG enemisebe futhi atholwa isithwebuli. Ukuskena kungathathwa ngaphezu kwezinsuku eziyi-1-3. Isixazululo se-iodine singanikezwa ngaphambi noma ngesikhathi sokuhlolwa ukugcina indlala yegilo ingamunci iMIBG eningi kakhulu.
  • Ukuhlolwa komchamo wamahora angamashumi amabili nane: Inqubo esetshenziselwa ukuxilonga izicubu ze-neuroendocrine, njenge-pheochromocytoma. Umchamo uqoqwa amahora angama-24 ukukala inani lama-catecholamines emchameni. Izilinganiso ezibangelwa ukuwohloka kwalawa ma-catecholamine nazo ziyalinganiswa. Inani elingajwayelekile (eliphakeme noma eliphansi kunokujwayelekile) lento kungaba uphawu lwesifo esithweni noma esikhunjeni esisenzayo. Inani elingaphezu kwamanani ajwayelekile kungaba uphawu lwe-pheochromocytoma.
  • Ukuhlolwa kokukhuthaza iPentagastrin: Isivivinyo lapho kuhlolwe khona amasampula egazi ukukala inani le-calcitonin egazini. I-calcium gluconate ne-pentagastrin kufakwa egazini bese kuthathwa amasampula egazi amaningana emizuzwini emihlanu elandelayo. Uma izinga le-calcitonin egazini landa, kungaba uphawu lomdlavuza wegilo we-medullary.

Ukwelashwa

Ngemininingwane mayelana nokwelashwa okubalwe ngezansi, bheka isigaba se-Treatment Option Overview section.

Kunezinhlobo eziningana ze-MEN syndrome, futhi uhlobo ngalunye lungadinga ukwelashwa okuhlukile:

  • Iziguli ezine-MEN1 syndrome zelashwa ngamaphaphu we-parathyroid, pancreatic, kanye ne-pituitary.
  • Iziguli ezine-MEN1 syndrome kanye ne-primary hyperparathyroidism zingase zihlinzwe ukususa okungenani izindlala ezintathu ze-parathyroid ne-thymus.
  • Iziguli ezine-MEN2A syndrome zivame ukuhlinzwa ukuze zisuse i-thyroid ngeminyaka engu-5 noma ngaphezulu uma ukuhlolwa kofuzo kukhombisa ushintsho oluthile kuhlobo lwe-RET. Ukuhlinzwa kwenzelwa ukuxilonga umdlavuza noma ukunciphisa amathuba okuba umdlavuza wakheke noma usabalale.
  • Izinsana ezine-MEN2B syndrome zingase zihlinzwe kususwe i-thyroid ukunciphisa umdlavuza ozokwenzeka noma usabalale.
  • Izingane ezine-MEN2B syndrome ezinomdlavuza we-medullary thyroid zingaphathwa nge-targeted therapy (i-kinase inhibitor ebizwa nge-vandetanib).

Ukwelashwa kweziguli ezine-Hirschsprung isifo kanye nezinguquko ezithile zofuzo ze-RET kufaka okulandelayo:

  • I-thyroidectomy ephelele ukunciphisa amathuba okuthi umdlavuza uzokwakheka.

Ukwelashwa kwesifo esivela njalo se-MEN ezinganeni kungafaka okulandelayo:

  • Isivivinyo somtholampilo esihlola isampula lesimila sesiguli ukuthola izinguquko ezithile zofuzo. Uhlobo lokwelashwa okuqondisiwe oluzonikezwa isiguli kuncike ohlotsheni lokushintsha kofuzo.

IPheochromocytoma neParaganglioma

I-Pheochromocytoma ne-paraganglioma yizicubu ezingavamile ezivela kuhlobo olufanayo lwezicubu zomzimba. Iningi lalezi zicubu akuwona umdlavuza.

  • Amafomu e- Pheochromocytoma kwizindlala ze-adrenal. Kunezindlala ezimbili ze-adrenal, eyodwa ngaphezulu kwesinso ngasinye ngemuva kwesisu esingenhla. Indlala ngayinye ye-adrenal inezingxenye ezimbili. Isendlalelo sangaphandle sendlala ye-adrenal yi-adrenal cortex. Isikhungo sendlala ye-adrenal yi-adrenal medulla. I-Pheochromocytoma yisimila se-adrenal medulla.

Izindlala ze-adrenal zenza ama-hormone abalulekile abizwa ngama-catecholamines. I-Adrenaline (epinephrine) ne-noradrenaline (norepinephrine) yizinhlobo ezimbili zama-catecholamine ezisiza ukulawula ukushaya kwenhliziyo, umfutho wegazi, ushukela wegazi, kanye nendlela umzimba ophendula ngayo ekucindezelekeni. Amanye ama-pheochromocytomas akhipha i-adrenaline ne-noradrenaline eyengeziwe egazini futhi ibangele izimpawu.

  • I-Paraganglioma yakha ngaphandle kwezindlala ze-adrenal eduze nomthambo we-carotid, ezindleleni zemizwa ekhanda nasentanyeni, nakwezinye izingxenye zomzimba. Amanye ama-paragangliomas enza ama-catecholamines angeziwe okuthiwa i-adrenaline ne-noradrenaline. Ukukhishwa kwe-adrenaline eyengeziwe ne-noradrenaline egazini kungadala izimpawu.

Izici Zobungozi, Izimpawu Nezimpawu, kanye Nezivivinyo Zokuxilonga Nezesiteji

Noma yini eyandisa amathuba akho okuthola isifo ibizwa ngokuthi ingozi. Ukuba nengcuphe akusho ukuthi uzothola umdlavuza; ukungabi nezici zobungozi akusho ukuthi ngeke uthole umdlavuza. Khuluma nodokotela wengane yakho uma ucabanga ukuthi ingane yakho ingaba sengcupheni.

Ubungozi be-pheochromocytoma noma i-paraganglioma bunyuswa ngokuba nanoma yimaphi ama-syndromes noma izakhi zofuzo ezilandelayo:

  • Izinhlobo eziningi ze-endocrine neoplasia type 1 (MEN1) syndrome. Lesi sifo singafaka izicubu endlaleni ye-parathyroid, i-pituitary gland, noma amaseli we-islet kuma-pancreas, futhi kuyaqabukela, i-pheochromocytoma.
  • Izinhlobo eziningi ze-endocrine neoplasia type 2A syndrome. Lesi sifo singafaka i-pheochromocytoma, umdlavuza wegciwane le-medullary, nesifo sezindlala ze-parathyroid.
  • Izinhlobo eziningi ze-endocrine neoplasia type 2B syndrome. Le syndrome ingafaka i-pheochromocytoma, umdlavuza wegciwane le-medullary, i-parathyroid hyperplasia, nezinye izimo.
  • Isifo se-von Hippel-Lindau (VHL). Le syndrome ingafaka i-pheochromocytoma, i-paraganglioma, i-hemangioblastoma, i-clear cell renal carcinoma, i-pancreatic neuroendocrine tumors, nezinye izimo.
  • Uhlobo lwe-Neurofibromatosis 1 (NF1). Le syndrome ingafaka i-neurofibromas, izicubu zobuchopho, i-pheochromocytoma, nezinye izimo.
  • ICarney-Stratakis dyad. Le syndrome ingafaka i-paraganglioma kanye ne-gastrointestinal stromal tumor (GIST).
  • UCarney triad. Le syndrome ingafaka i-paraganglioma, i-GIST, ne-chondroma yamaphaphu.
  • I-pheochromocytoma yomndeni noma i-paraganglioma.

Ngaphezu kwengxenye yezingane nentsha etholakale ine-pheochromocytoma noma i-paraganglioma ine-syndrome ezuzwe njengefa noma ushintsho lofuzo olwenyuse ingozi yomdlavuza. Ukwelulekwa ngofuzo (ingxoxo nochwepheshe oqeqeshiwe mayelana nezifo ezizuzwe njengefa) nokuhlolwa kuyingxenye ebalulekile yohlelo lokwelashwa.

Ezinye izicubu azenzi i-adrenaline noma i-noradrenaline eyengeziwe futhi azibangeli zimpawu. Lezi zicubu zingatholakala lapho kutholakala isigaxa entanyeni noma lapho kwenziwa noma kwenziwa inqubo ngesinye isizathu. Izimpawu nezimpawu ze-pheochromocytoma ne-paraganglioma zenzeka lapho i-adrenaline noma i-noradrenaline eningi kakhulu ikhishelwa egazini. Lezi nezinye izimpawu zingabangelwa yi-pheochromocytoma, paraganglioma, noma ezinye izimo. Buza kudokotela wengane yakho uma ingane yakho inokunye kwalokhu okulandelayo:

  • Umfutho wegazi ophezulu.
  • Ubuhlungu bekhanda.
  • Ukujuluka okukhulu ngaphandle kwesizathu esaziwayo.
  • Ukushaya kwenhliziyo okuqinile, okusheshayo, noma okungajwayelekile.
  • Ukuzizwa uthuthumela.
  • Ukuba mhlophe ngokwedlulele.
  • Isiyezi.
  • Ukuthukuthela noma ukwethuka.

Lezi zimpawu nezimpawu zingase zifike zidlule kepha umfutho wegazi ophakeme kungenzeka ukwenzeka isikhathi eside ezigulini ezisencane. Lezi zimpawu zingavela futhi ngokuzivocavoca umzimba, ukulimala, i-anesthesia, ukuhlinzwa ukuze ususe isimila, ukudla ukudla okufana noshokoledi noshizi, noma ngenkathi udlulisa umchamo (uma isimila sisisesinyeni).

Ukuhlolwa okusetshenziselwa ukuxilonga nokubeka isigaba se-pheochromocytoma ne-paraganglioma kuncike kwizimpawu nezimpawu kanye nomlando womndeni wesiguli. Zingafaka:

  • Ukuhlolwa komzimba kanye nomlando wezempilo.
  • Ukuskena kwe-PET.
  • I-CT scan (i-CAT scan).
  • I-MRI (imaging resonance imaging).

Bheka isigaba solwazi jikelele ukuthola incazelo yalezi zivivinyo nezinqubo.

Ezinye izivivinyo nezinqubo ezisetshenziselwa ukuxilonga i-pheochromocytoma ne-paraganglioma zifaka okulandelayo:

  • Ukuhlolwa kwama-metanephrines angenayo i-Plasma: Ukuhlolwa kwegazi okukala inani le-metanephrines egazini. Ama-Metanephrines yizinto ezenziwe lapho umzimba wephula i-adrenaline noma i-noradrenaline. I-Pheochromocytomas ne-paragangliomas zingenza inani elikhulu le-adrenaline ne-noradrenaline futhi zidale amazinga aphezulu emethanephrines egazini nasemchameni.
  • Ucwaningo lwe-catecholamine yegazi: Inqubo lapho kuhlolwe khona isampula segazi ukukala inani lama-catecholamines (adrenaline noma noradrenaline) athile akhishwe egazini. Izilinganiso ezibangelwa ukuwohloka kwalawa ma-catecholamine nazo ziyalinganiswa. Inani elingavamile (elingavamile eliphakeme noma elingaphansi kokujwayelekile) lwento kungaba uphawu lwesifo esithweni noma esikhunjeni esisenzayo. Inani eliphakeme kunelivamile kungaba uphawu lwe-pheochromocytoma noma i-paraganglioma.
  • Ukuhlolwa komchamo wamahora angamashumi amabili nane: Isivivinyo lapho kuqoqwa khona umchamo amahora angama-24 ukukala amanani ama-catecholamines (adrenaline noma noradrenaline) noma ama-metanephrines emchameni. Izilinganiso ezibangelwa ukuwohloka kwalawa ma-catecholamine nazo ziyalinganiswa. Inani elingajwayelekile (eliphakeme kunokujwayelekile) lezinto kungaba uphawu lwesifo esithweni noma esikhunjeni esisenzayo. Inani eliphakeme kunelivamile kungaba uphawu lwe-pheochromocytoma noma i-paraganglioma.
  • Ukuskena kwe-MIBG: Inqubo esetshenziselwa ukuthola izicubu ze-neuroendocrine, njenge-pheochromocytoma ne-paraganglioma. Inani elincane kakhulu lezinto ezibizwa nge-radioactive MIBG lifakwa emthanjeni futhi lihamba egazini. Amaseli we-Neuroendocrine tumor athatha i-MIBG enemisebe futhi atholwa isithwebuli. Ukuskena kungathathwa ngaphezu kwezinsuku eziyi-1-3. Isixazululo se-iodine singanikezwa ngaphambi noma ngesikhathi sokuhlolwa ukugcina indlala yegilo ingamunci iMIBG eningi kakhulu.
  • I-Somatostatin receptor scintigraphy: Uhlobo lwe-radionuclide scan olungasetshenziswa ukuthola izicubu. Inani elincane kakhulu le-octreotide enemisebe (i-hormone enamathela kwizicubu) lifakwa emthanjeni futhi lihambe ngegazi. I-octreotide enemisebe inamathela kulesimila nekhamera ekhethekile ethola ukusebenza kwemisebe ye-radioactivity isetshenziselwa ukukhombisa ukuthi izicubu zikuphi emzimbeni. Le nqubo ibizwa nangokuthi i-octreotide scan ne-SRS.
  • Ukuhlolwa kofuzo: Ukuhlolwa kwelabhorethri lapho kuhlaziywa amaseli noma izicubu ukubheka ushintsho kuzakhi zofuzo noma kuma-chromosomes. Lezi zinguquko zingaba wuphawu lokuthi umuntu unesifo noma isimo esithile noma usengozini yokuba nesifo esithile. Okulandelayo yizakhi zofuzo ezingahlolwa ezinganeni ezine-pheochromocytoma noma i-paraganglioma: i-VHL, i-NF1, i-RET, i-SDHD, i-SDHB, i-SDHA, i-MAX, ne-TMEM127 zofuzo.

Ukwelashwa

Ngemininingwane mayelana nokwelashwa okubalwe ngezansi, bheka isigaba se-Treatment Option Overview section.

Ukwelashwa kwe-pheochromocytoma ne-paraganglioma ezinganeni kungafaka okulandelayo:

  • Ukuhlinzwa ukususa ngokuphelele isimila.
  • Inhlanganisela yamakhemikhali, ukwelashwa okuphezulu kwe-131I-MIBG, noma ukwelashwa okuhlosiwe kwezicubu ezisabalalele kwezinye izingxenye zomzimba.

Ngaphambi kokuhlinzwa, ukwelashwa ngezidakamizwa ngama-alpha-blockers okulawula ukucindezelwa kwegazi kanye ne-beta-blockers ukulawula ukushaya kwenhliziyo kunikezwa. Uma zombili izindlala ze-adrenal zisuswa, ukwelashwa kwama-hormone okuphila impilo yonke ukufaka esikhundleni samahomoni enziwa yizindlala ze-adrenal kuyadingeka ngemuva kokuhlinzwa.

Ukwelashwa kwe-pheochromocytoma ephindaphindwayo ne-paraganglioma ezinganeni kungafaka okulandelayo:

  • Isivivinyo somtholampilo esihlola isampula lesimila sesiguli ukuthola izinguquko ezithile zofuzo. Uhlobo lokwelashwa okuqondisiwe oluzonikezwa isiguli kuncike ohlotsheni lokushintsha kofuzo.
  • Isivivinyo somtholampilo sokwelapha i-131I-MIBG.
  • Isivivinyo somtholampilo sokwelapha okuqondisiwe nge-DNA methyltransferase inhibitor.

Umdlavuza Wesikhumba (Melanoma, Squamous Cell Cancer, Basal Cell Cancer)

Umdlavuza wesikhumba yisifo lapho amangqamuzana abulalayo (umdlavuza) akha izicubu zesikhumba. Isikhumba isitho esikhulu somzimba. Kuvikela ekushiseni, elangeni, ekulimaleni nasekuthelelekeni. Isikhumba sisiza nasekulawuleni ukushisa komzimba futhi sigcine amanzi, amafutha, kanye novithamini D. Isikhumba sinezingqimba eziningana, kepha izingqimba ezimbili eziyinhloko yi-epidermis (ungqimba olungaphezulu noma olungaphandle) nesikhumba (ungqimba oluphansi noma lwangaphakathi). Umdlavuza wesikhumba uqala ku-epidermis, eyakhiwa izinhlobo ezintathu zamaseli:

  • Ama-Melanocyte: Atholakala engxenyeni engezansi ye-epidermis, lawa maseli enza i-melanin, i-pigment enikeza isikhumba umbala wayo wemvelo. Lapho isikhumba sivezwa yilanga, ama-melanocyte enza i-pigment eningi futhi enze ukuthi isikhumba sibe mnyama.
  • Amaseli we-squamous: Amangqamuzana amancanyana, amancanyana akha ungqimba oluphezulu lwe-epidermis
  • Amaseli we-Basal: Amaseli ajikelezayo ngaphansi kwamaseli we-squamous.
I-anatomy yesikhumba, ekhombisa i-epidermis, i-dermis, nezicubu ezingaphansi. Ama-Melanocyte asesendlaleni samaseli we-basal engxenyeni ejulile ye-epidermis.

Kunezinhlobo ezintathu zomdlavuza wesikhumba:

  • I-Melanoma.
  • Umdlavuza wesikhumba ogcwele squamous.
  • Umdlavuza wesikhumba wesisekelo se-Basal.

I-Melanoma

Yize i-melanoma ingandile, wumdlavuza wesikhumba ovame kakhulu ezinganeni. Kwenzeka kaningi ezinganeni ezineminyaka yobudala eyi-15 kuye kwengu-19.

Ingozi yokuba ne-melanoma yanda ngokuba nale mibandela elandelayo:

  • I-Giant melanocytic nevi (izindawo ezinkulu ezimnyama, ezingamboza isiqu nethanga).
  • I-neurocutaneous melanosis (i-congenital melanocytic nevi esikhumbeni nasebuchosheni).
  • I-Xeroderma pigmentosum.
  • I-retinoblastoma eyifa.
  • Amasosha omzimba abuthakathaka.

Ezinye izinto ezinobungozi be-melanoma kuyo yonke iminyaka yobudala zifaka:

  • Ukuba nebala elifanele, okubandakanya okulandelayo:
  • Isikhumba esilungile esibhodlokayo futhi esivutha kalula, asishiyi, noma asithontisi kahle.
  • Luhlaza okwesibhakabhaka noma oluhlaza okotshani noma amanye amehlo anombala okhanyayo.
  • Izinwele ezibomvu noma ezimhlophe.
  • Ukuvezwa ukukhanya kwelanga kwemvelo noma ukukhanya kwelanga okufakelwayo (njengokuvela emibhedeni yokushuka) isikhathi eside.
  • Ukuba nezimvukuzane eziningana ezinkulu noma eziningi.
  • Ukuba nomlando womndeni noma umlando wakho wezinsumpa ezingavamile (i-atypical nevus syndrome).
  • Ukuba nomlando womndeni we-melanoma.

Izimpawu nezimpawu ze-melanoma zifaka okulandelayo:

  • Imvukuzane ethi:
  • izinguquko ngosayizi, ukuma, noma umbala.
  • inemiphetho noma imingcele engajwayelekile.
  • ungaphezu kombala owodwa.
  • i-asymmetrical (uma imvukuzane ihlukaniswe phakathi, ama-2 halves ahlukile ngosayizi noma ukuma).
  • ukunwaya.
  • kuqhuma, kuphume igazi, noma kube nezilonda (isimo lapho ungqimba oluphezulu lwesikhumba lwehla futhi izicubu ezingezansi zibonisa).
  • Shintsha esikhunjeni esinemibala (enemibala).
  • Ama-satellite moles (ama-moles amasha akhula eduze kwemvukuzane ekhona).

Ukuhlolwa kokuxilonga nokwakha i-melanoma kungafaka okulandelayo:

  • Ukuhlolwa komzimba kanye nomlando wezempilo.
  • I-X-ray yesifuba.
  • Iskena se-CT.
  • I-MRI.
  • Ukuskena kwe-PET.
  • I-Ultrasound.

Bheka isigaba solwazi jikelele ukuthola incazelo yalezi zivivinyo nezinqubo.

Ezinye izivivinyo nezinqubo ezisetshenziselwa ukuxilonga i-melanoma zifaka okulandelayo:

  • Ukuhlolwa kwesikhumba: Udokotela noma umhlengikazi ubheka isikhumba ukuthi asinawo yini amaqhubu noma amabala abukeka angajwayelekile ngombala, usayizi, ukuma, noma ukuthungwa.
  • I-Biopsy: Konke noma ingxenye yokukhula okubukeka ngokungajwayelekile kusikwa esikhunjeni bese kubhekwa ngaphansi kwesibonakhulu ngudokotela wezifo ukuze ahlole amangqamuzana omdlavuza. Kunezinhlobo ezine eziyinhloko ze-biopsies zesikhumba:
  • Shave biopsy: I-razor blade blade isetshenziselwa "ukushefa" ukukhula okubukeka ngokungajwayelekile.
  • I-Punch biopsy: Ithuluzi elikhethekile elibizwa nge-punch noma i-trephine lisetshenziselwa ukususa isiyingi sezicubu ekukhuleni okubukeka ngokungajwayelekile.
  • I-incisional biopsy: I-scalpel isetshenziselwa ukususa ingxenye yokukhula okubukeka ngokungajwayelekile.
  • I-Biopsy e-Excisional: I-scalpel isetshenziselwa ukususa konke ukukhula.
  • I-Sentinel lymph node biopsy: Ukususwa kwe-sentinel lymph node ngesikhathi sokuhlinzwa. I-sentinel lymph node iyisakhi sokuqala se-lymph eqenjini lama-lymph node ukuthola i-lymphatic drainage evela ku-tumor yokuqala. Kuyi-lymph node yokuqala umdlavuza ongahle usabalale uye kusukela kusimila sokuqala. Kufakwa into enemisebe kanye / noma udayi oluhlaza okwesibhakabhaka eduze kwesimila. Into noma udayi ugeleza ngemigudu ye-lymph uye kuma-lymph node. I-lymph node yokuqala yokwamukela into noma udayi iyasuswa. Isazi sezifo sibheka izicubu ngaphansi kwesibonakhulu ukubheka amangqamuzana omdlavuza. Uma amangqamuzana omdlavuza engatholakali, kungahle kungadingeki ukususa ama-lymph node amaningi. Kwesinye isikhathi, i-sentinel lymph node itholakala eqenjini elingaphezu kwelilodwa lama-node.
  • I-lymph node dissection: Inqubo yokuhlinza lapho kukhishwa khona ama-lymph node futhi kuhlolwe isampula lezicubu ngaphansi kwesibonakhulu ukuthola izimpawu zomdlavuza. Okwehlukaniswa kwe-lymph node yesifunda, amanye ama-lymph node asendaweni yesimila ayasuswa. Ngokuqhekeka okukhulu kwe-lymph node, iningi noma wonke ama-lymph node asendaweni yesimila ayasuswa. Le nqubo ibizwa nangokuthi i-lymphadenectomy.

Ukwelashwa kwe-Melanoma

Ngemininingwane mayelana nokwelashwa okubalwe ngezansi, bheka isigaba se-Treatment Option Overview section.

Ukwelashwa kwe-melanoma engakaze isakaze kuma-lymph node noma kwezinye izingxenye zomzimba kufaka okulandelayo:

  • Ukuhlinzwa ukukhipha isimila nezinye izicubu ezinempilo ezizungezile.

Ukwelashwa kwe-melanoma okusakazekele kuma-lymph node aseduze kufaka lokhu okulandelayo:

  • Ukuhlinzwa ukususa isimila kanye nezindawo ezinomdlavuza.
  • I-Immunotherapy enama-immune checkpoint inhibitors (i-pembrolizumab, i-ipilimumab, ne-nivolumab).
  • Ukwelashwa okuqondisiwe nge-BRAF inhibitors (vemurafenib, dabrafenib, encorafenib) kuphela noma nge-MEK inhibitors (trametinib, binimetinib).

Ukwelashwa kwe-melanoma okusakazeke ngaphesheya kwama-lymph node kungafaka okulandelayo:

  • I-Immunotherapy (ipilimumab).
  • Isivivinyo somtholampilo somuthi wokwelashwa ohlosiwe ngomlomo (dabrafenib) ezinganeni nasebusheni.

Ukwelashwa kwe-melanoma ephindaphindiwe ezinganeni kungafaka okulandelayo:

  • Isivivinyo somtholampilo esihlola isampula lesimila sesiguli ukuthola izinguquko ezithile zofuzo. Uhlobo lokwelashwa okuqondisiwe oluzonikezwa isiguli kuncike ohlotsheni lokushintsha kofuzo.
  • Isivivinyo somtholampilo se-immunotherapy esine-immune checkpoint inhibitors (pembrolizumab, nivolumab, ipilimumab) ezinganeni nasebusheni.

Bona isifinyezo se- mayelana nokwelashwa kwabantu abadala be-Melanoma ukuthola eminye imininingwane

I-squamous Cell ne-Basal Cell Skin Cancer

Umdlavuza wesikhumba we-Nonmelanoma (squamous cell kanye ne-basal cell cancer) akuvamile kakhulu ezinganeni nasebusheni. Ubungozi besifo se-squamous cell noma i-basal cell cancer banda ngalezi ezilandelayo:

  • Ukuvezwa ukukhanya kwelanga kwemvelo noma ukukhanya kwelanga okufakelwayo (njengokuvela emibhedeni yokushuka) isikhathi eside.
  • Ukuba nebala elifanele, okubandakanya okulandelayo:
  • Isikhumba esilungile esibhodlokayo futhi esivutha kalula, asishiyi, noma asithontisi kahle.
  • Luhlaza okwesibhakabhaka noma oluhlaza okotshani noma amanye amehlo anombala okhanyayo.
  • Izinwele ezibomvu noma ezimhlophe.
  • Ukuba ne-actinic keratosis.
  • Ukuba ne-Gorlin syndrome.
  • Ukwelashwa kwangaphambilini ngemisebe.
  • Ukuba namasosha omzimba abuthakathaka.

Izimpawu zesifo se-squamous cell kanye ne-basal cell cancer zifaka okulandelayo:

  • Isilonda esingapholi.
  • Izindawo zesikhumba ezi:
  • Encane, ephakanyisiwe, ebushelelezi, ecwebezelayo, futhi emanzi.
  • Incane, iphakanyisiwe, futhi ibomvu noma nsundu ngokubomvu.
  • Flat, rough, red noma nsundu, futhi scaly.
  • Isikhumba, ukopha, noma uqweqwe.
  • Ifana nesibazi futhi iqinile.

Ukuvivinywa kokuthola umdlavuza wesikhumba esibuhlungu kanye nomdlavuza wesikhumba webasal kufaka phakathi okulandelayo:

  • Ukuhlolwa kwesikhumba: Udokotela noma umhlengikazi ubheka isikhumba ukuthi asinawo yini amaqhubu noma amabala abukeka angajwayelekile ngombala, usayizi, ukuma, noma ukuthungwa.
  • I-Biopsy: Konke noma ingxenye yokukhula engabukeki ijwayelekile isikwa esikhunjeni futhi ibukwe ngaphansi kwesibonakhulu ngudokotela wezifo ukuze ahlole izimpawu zomdlavuza. Kunezinhlobo ezintathu eziyinhloko ze-biopsies zesikhumba:
  • Shave biopsy: I-razor blade blade isetshenziselwa "ukushefa" ukukhula okungabukeki kujwayelekile.
  • I-Punch biopsy: Ithuluzi elikhethekile elibizwa nge-punch noma i-trephine lisetshenziselwa ukususa isiyingi sezicubu ekukhuleni okungabukeki kujwayelekile.
  • I-incisional biopsy: I-scalpel isetshenziselwa ukususa ingxenye yokukhula okubukeka ngokungajwayelekile.
  • I-Biopsy e-Excisional: I-scalpel isetshenziselwa ukususa konke ukukhula.

Ukwelashwa Komdlavuza Wesikhumba Esikhulukazi kanye Nomdlavuza Wesikhumba Wesikhumba Esisisekelo

Ngemininingwane mayelana nokwelashwa okubalwe ngezansi, bheka isigaba se-Treatment Option Overview section.

Ukwelashwa komdlavuza we-squamous cell kanye ne-basal cell ezinganeni kungafaka okulandelayo:

  • Ukuhlinzwa ukukhipha isimila. Lokhu kungafaka ukuhlinzwa kwe-Mohs micrographic.

Ukuhlinzwa kwe-Mohs micrographic uhlobo lokuhlinzwa olusetshenziselwa umdlavuza wesikhumba. Isigaxa sinqunywa esikhunjeni ngezingqimba ezincane. Ngesikhathi sokuhlinzwa, imiphetho yesimila kanye noqweqwe ngalunye lwesimila olususiwe kubukwa ngesibonakhulu ukuhlola amaseli omdlavuza. Izendlalelo ziyaqhubeka nokususwa kuze kungabonakali amangqamuzana omdlavuza. Lolu hlobo lokuhlinzwa lususa izicubu ezincane ezijwayelekile ngangokunokwenzeka futhi luvame ukusetshenziselwa ukususa umdlavuza wesikhumba ebusweni.

Ukwelashwa komdlavuza ophindaphindiwe weseli nomdlavuza weseli ezinganeni kungafaka okulandelayo:

  • Isivivinyo somtholampilo esihlola isampula lesimila sesiguli ukuthola izinguquko ezithile zofuzo. Uhlobo lokwelashwa okuqondisiwe oluzonikezwa isiguli kuncike ohlotsheni lokushintsha kofuzo.

Bona isifinyezo se- mayelana nokwelashwa komdlavuza wesikhumba sabantu abadala ukuze uthole eminye imininingwane.

I-Intraocular (Uveal) I-Melanoma

I-melanoma ye-intraocular iqala phakathi kwezingqimba ezintathu zodonga lweso. Isendlalelo sangaphandle sifaka phakathi i-sclera emhlophe ("okumhlophe kweso") ne-cornea ecacile ngaphambili kweso. Isendlalelo sangaphakathi sinolwelwesi lwezicubu zemizwa, ezibizwa ngokuthi i-retina, ezwa ukukhanya futhi ithumele izithombe kanye nomthambo wamehlo ebuchosheni. Isendlalelo esiphakathi, lapho amafomu e-intraocular melanoma, abizwa ngokuthi yi-uvea noma i-uveal tract, futhi inezingxenye ezintathu eziyinhloko: i-iris, umzimba we-ciliary, ne-choroid.

I-anatomy yeso, ekhombisa ngaphandle nangaphakathi kweso kufaka phakathi i-sclera, i-cornea, i-iris, umzimba we-ciliary, i-choroid, i-retina, i-vitreous humor, ne-optic nerve. I-vitreous humor iwuketshezi olugcwele maphakathi neso.

Izici Zengozi

Ingozi ye-melanoma ye-intraocular yanda nganoma yikuphi okulandelayo:

  • Umbala wamehlo okhanyayo.
  • Umbala wesikhumba olungile.
  • Ukungakwazi ukushuka.
  • I-Oculodermal melanocytosis.
  • I-nevi enqamulelayo.

Ukuhlolwa kokuthola nokwelapha i-melanoma ye-intraocular kungafaka okulandelayo:

  • Ukuhlolwa komzimba kanye nomlando wezempilo.
  • I-Ultrasound.

Ezinye izivivinyo nezinqubo ezisetshenziselwa ukuxilonga i-intraocular melanoma zifaka okulandelayo:

  • I-Fluorescein angiography: Isivivinyo esisetshenziselwa ukuthatha izithombe ze-retina esweni. Idayi ephuzi ifakwa emthanjeni futhi ihamba umzimba wonke kubandakanya nemithambo yegazi esweni. Idayi ephuzi ibangela ukuthi imikhumbi esweni ikwazi ukukhazimula lapho kuthathwa isithombe.

Ukwelashwa

Ngemininingwane mayelana nokwelashwa okubalwe ngezansi, bheka isigaba se-Treatment Option Overview section.

Ukwelashwa kwe-melanoma ye-intraocular ezinganeni kufana nokwelashwa kwabantu abadala futhi kungafaka okulandelayo:

  • Ukuhlinzwa ukukhipha isimila.
  • Ukwelashwa ngemisebe.
  • Ukuhlinzwa kwe-Laser

. Ukwelashwa kwe-melanoma yangaphakathi kwe-intraocular ezinganeni kungafaka okulandelayo:

  • Isivivinyo somtholampilo esihlola isampula lesimila sesiguli ukuthola izinguquko ezithile zofuzo. Uhlobo lokwelashwa okuqondisiwe oluzonikezwa isiguli kuncike ohlotsheni lokushintsha kofuzo.

Bona isifinyezo se- ekwelashweni kwabantu abadala i-Intraocular (Uveal) Melanoma Treatment ukuthola eminye imininingwane.

Chordoma

I-Chordoma uhlobo olungajwayelekile kakhulu lwesimila samathambo esikhula kancane esakha noma yikuphi lapho kugudla khona umgogodla kusuka phansi kogebhezi (ithambo elibizwa ngokuthi i-clivus) kuya emsileni. Ezinganeni nasebusheni, ama-chordomas akha kakhulu emathanjeni phansi kogebhezi noma eduze kwethambo lomsila, okwenza kube nzima ukususa ngokuphelele ngokuhlinzwa.

I-chordoma yobuntwana ixhunyaniswe nesimo se-tuberous sclerosis, isifo sofuzo lapho izicubu ezinobungozi (hhayi umdlavuza) zakha ezinso, ebuchosheni, emehlweni, enhliziyweni, emaphashini nasesikhunjeni.

Izimpawu Nezimpawu

Izimpawu nezimpawu ze-chordoma zixhomeke lapho kwenzeka khona isimila. I-Chordoma ingadala noma yiziphi izimpawu nezimpawu ezilandelayo. Buza kudokotela wengane yakho uma ingane yakho inokunye kwalokhu okulandelayo:

  • Ubuhlungu bekhanda.
  • Umbono ophindwe kabili.
  • Ikhala elivinjiwe noma eligcwele.
  • Inkinga yokukhuluma.
  • Inkinga yokugwinya.
  • Intamo noma ubuhlungu beqolo.
  • Ubuhlungu phansi emuva kwemilenze.
  • Ubuntofontofo, ukuncinza, noma ubuthakathaka bezingalo nemilenze.
  • Ushintsho emikhubeni yamathumbu noma esinyeni.

Ezinye izimo ezingezona i-chordoma zingadala lezi zimpawu nezimpawu ezifanayo.

Izivivinyo zokuxilonga i-chordoma noma ukubona ukuthi isakazekile zibandakanya okulandelayo:

  • I-MRI yomgogodla wonke.
  • Ukuhlolwa kwe-CT kwesifuba, kwesisu, kanye nesinqe.
  • Isidumbu. Isampula lezicubu liyasuswa futhi lihlolwe izinga eliphezulu leprotheyini elibizwa nge-brachyury.

Ama-Chordomas angaphinde abuye (abuye), imvamisa asendaweni efanayo, kepha kwesinye isikhathi abuye abuyele kwezinye izindawo zethambo noma emaphashini.

Isibikezelo

Isibikezelo (ithuba lokululama) sincike kokulandelayo:

  • Iminyaka yengane.
  • Lapho isimila sakha khona ngomgogodla.
  • Indlela isimila esiphendula ngayo ekwelashweni.
  • Ukuthi ngabe kube nezinguquko yini emikhubeni yamathumbu noma yesinye ekuxilongweni.
  • Ukuthi isimila sisanda kutholakala yini noma sesiphindile (buyela emuva).

Ukwelashwa

Ngemininingwane mayelana nokwelashwa okubalwe ngezansi, bheka isigaba se-Treatment Option Overview section.

Ukwelashwa kwe-chordoma ezinganeni kungafaka okulandelayo:

  • Ukuhlinzwa ukukhipha isimila ngangokunokwenzeka, kulandelwe ukwelashwa ngemisebe. Ukwelashwa kwemisebe ye-Proton beam kungasetshenziselwa izicubu eziseduze nogebhezi.

Ukwelashwa kwe-chordoma ephindaphindiwe ezinganeni kungafaka okulandelayo:

  • Isivivinyo somtholampilo esihlola isampula lesimila sesiguli ukuthola izinguquko ezithile zofuzo. Uhlobo lokwelashwa okuqondisiwe oluzonikezwa isiguli kuncike ohlotsheni lokushintsha kofuzo. Iziguli ezinezinguquko kuhlobo lwe-SMARCB1 zingalashwa nge-tazemetostat kulesi silingo somtholampilo.

Umdlavuza Wendawo Eyisisekelo Engaziwa

Umdlavuza wamaprimary angaziwa yisifo lapho kutholakala khona amangqamuzana abulalayo (umdlavuza) emzimbeni kodwa indawo owaqala umdlavuza kuyo akwaziwa. Umdlavuza ungakheka kunoma yisiphi isicubu somzimba. Umdlavuza oyinhloko (umdlavuza owaqala ukwakheka) ungadlulela nakwezinye izingxenye zomzimba. Le nqubo ibizwa ngokuthi i-metastasis. Amaseli womdlavuza ngokuvamile abukeka njengamaseli ohlobo lwezicubu lapho umdlavuza waqala khona. Isibonelo, amangqamuzana omdlavuza webele angadlulela emaphashini. Ngoba umdlavuza uqale ebeleni, amangqamuzana omdlavuza asephashini abukeka njengamaseli womdlavuza webele.

Kwesinye isikhathi odokotela bathola lapho umdlavuza usabalale khona kodwa bangatholi lapho umdlavuza uqale khona ukukhula emzimbeni. Lolu hlobo lomdlavuza lubizwa ngokuthi umdlavuza wesimila sokuqala esingaziwa noma semilingo.

E-carcinoma yamabanga aphansi angaziwa, amangqamuzana omdlavuza asabalale emzimbeni kodwa indawo lapho umdlavuza wokuqala waqala khona ayaziwa.

Ukuhlolwa kwenziwa ukuthola ukuthi umdlavuza oyinhloko uqale kuphi futhi uthole ulwazi ngokuthi umdlavuza usabalale kuphi. Lapho izivivinyo zikwazi ukuthola umdlavuza oyinhloko, umdlavuza awuseyona umdlavuza weprimary engaziwa futhi ukwelashwa kusekelwe ohlotsheni lomdlavuza oyinhloko.

Ngoba indawo lapho umdlavuza uqalile khona akwaziwa, ukuhlolwa nezinqubo eziningi ezahlukahlukene, kufaka phakathi ukuvezwa kwezakhi zofuzo nokuhlolwa kofuzo, kungadingeka ukuthola ukuthi hlobo luni lomdlavuza. Uma ukuhlolwa kukhombisa ukuthi kungaba nomdlavuza, kwenziwa i-biopsy. I-biopsy ukususwa kwamaseli noma izicubu ukuze kubhekwe ngaphansi kwesibonakhulu ngudokotela wezifo. Isazi sezifo sibheka izicubu ukubheka amangqamuzana omdlavuza nokuthola uhlobo lomdlavuza. Uhlobo lwe-biopsy olwenziwe luxhomeke engxenyeni yomzimba ehlolelwa umdlavuza. Olunye lwezinhlobo ezilandelayo ze-biopsies lungasetshenziswa:

  • I-Fine-needle aspiration (FNA) biopsy: Izicubu zokususa noma uketshezi kusetshenziswa inaliti ezacile.
  • I-Core biopsy: Ukususwa kwezicubu kusetshenziswa inaliti ebanzi.
  • I-incisional biopsy: Ukususwa kwengxenye yesigaxa noma isampula lezicubu.
  • I-Biopsy e-Excisional: Ukususwa kwesigaxa sonke sezicubu.

Lapho uhlobo lwamangqamuzana omdlavuza noma izicubu ezisusiwe zihlukile kunhlobo yamangqamuzana omdlavuza okulindeleke ukuthi atholakale, kungenzeka ukuthi kutholakale umdlavuza wamaphrimiyali angaziwa. Amaseli emzimbeni anokubukeka okuthile okuncike ohlotsheni lwezicubu ezivela kuzo. Isibonelo, isampula lezicubu zomdlavuza ezithathwe esifubeni kulindeleke ukuthi zenziwe ngamaseli ebele. Kodwa-ke, uma isampula lezicubu luhlobo oluthile lweseli (olungenziwanga ngamangqamuzana webele), kungenzeka ukuthi amaseli asabalalele ebeleni evela kwenye ingxenye yomzimba.

Lapho kungaziwa ukuthi umdlavuza waqala kuphi lapho kutholakala ukuxilongwa, i-adenocarcinomas, i-melanomas, kanye nezicubu zombungu (njenge-rhabdomyosarcoma noma i-neuroblastoma) yizinhlobo zezicubu ezivame ukutholwa ezinganeni nasebusheni.

Ukwelashwa

Ngemininingwane mayelana nokwelashwa okubalwe ngezansi, bheka isigaba se-Treatment Option Overview section.

Ukwelashwa kuya ngokuthi amangqamuzana omdlavuza abukeka kanjani ngaphansi kwesibonakhulu, iminyaka yesiguli, izimpawu nezimpawu zaso, nokuthi umdlavuza usabalale emzimbeni. Ukwelashwa kuvame ukulandelayo:

  • Ukwelashwa ngamakhemikhali.
  • Ukwelashwa okuhlosiwe.
  • Ukwelashwa ngemisebe.

Ukwelashwa komdlavuza ophindaphindwayo ongaziwa okuyinhloko ezinganeni kungafaka okulandelayo:

  • Isivivinyo somtholampilo esihlola isampula lesimila sesiguli ukuthola izinguquko ezithile zofuzo. Uhlobo lokwelashwa okuqondisiwe oluzonikezwa isiguli kuncike ohlotsheni lokushintsha kofuzo.

Bona isifinyezo se- kumuntu omdala weCarcinoma of Unknown Primary ukuthola eminye imininingwane.

Ukufunda Okwengeziwe Ngomdlavuza Wezingane

Ngemininingwane engaphezulu evela ku-National Cancer Institute mayelana nomdlavuza ongajwayelekile wobuntwana, bheka okulandelayo:

  • Ukuhlolwa Kofuzo Kwezifo Ezizuzwayo Zokuthola Umdlavuza
  • I-Computed Tomography (CT) Iskena Nomdlavuza
  • I-MyPART - Inethiwekhi Yami Yezingane ne-Adult Rare Tumor Network

Ngemininingwane eminingi yomdlavuza wezingane nezinye izinsiza zomdlavuza ezijwayelekile, bheka okulandelayo:

  • Mayelana Nomdlavuza
  • Umdlavuza Wezingane
  • I-CureSearch ye-Cancer YezinganePhuma Ukuzikhulula
  • Imiphumela Emuva Yokwelapha Yomdlavuza Wezingane
  • Intsha kanye nabantu abadala abancane abaneCancer
  • Izingane Ezinomdlavuza: Umhlahlandlela Wabazali
  • Umdlavuza Ezinganeni Nasebusheni
  • Isiteji
  • Ukubhekana Nomdlavuza
  • Imibuzo Ongayibuza Udokotela Wakho mayelana Nomdlavuza
  • Kwabasindile Nabanakekeli



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