Types/eye/patient/intraocular-melanoma-treatment-pdq

I-Intraocular (Uveal) Inguqulo Yokwelashwa Kwe-Melanoma

Imininingwane ejwayelekile Mayelana ne-Intraocular (Uveal) Melanoma

AMAPHUZU ASEMQOKA

• I-intraocular melanoma yisifo lapho amangqamuzana abulalayo (umdlavuza) akha izicubu zeso.

• Ukuba mdala nokuba nesikhumba esifanele kungakhuphula ubungozi be-intraocular melanoma.

• Izimpawu ze-melanoma ye-intraocular zifaka ukungaboni kahle noma indawo emnyama ku-iris.

• Ukuhlolwa okuhlola iso kusetshenziselwa ukusiza ukuthola (ukuthola) nokuxilonga i-melanoma ye-intraocular.

• I-biopsy ye-tumor ayidingeki kangako ukuthola i-intraocular melanoma.

• Izici ezithile zithinta ukubikezela (ithuba lokululama) kanye nezinketho zokwelashwa.

I-intraocular melanoma yisifo lapho amangqamuzana abulalayo (umdlavuza) akha izicubu zeso.

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

I-iris yindawo enemibala ngaphambili kweso ("umbala wamehlo"). Kungabonakala nge-cornea ecacile. Umfundi uphakathi nendawo ye-iris futhi ushintsha usayizi ukuvumela ukukhanya okuncane noma okuncane esweni. I-intraocular melanoma ye-iris imvamisa isimila esincane esikhula kancane futhi esingajwayele ukusabalala kwezinye izingxenye zomzimba.

Umzimba we-Ciliary

Umzimba we-ciliary uyindandatho yezicubu ezinemicu yemisipha eshintsha usayizi womfundi nokuma kwelensi. Itholakala ngemuva kwe-iris. Izinguquko ekubunjweni kwelensi zisiza ukugxila kwamehlo. Umzimba we-ciliary wenza futhi uketshezi olucacile olugcwalisa isikhala phakathi kwe-cornea ne-iris. I-intraocular melanoma yomzimba we-ciliary ivame ukuba nkulu futhi ibe sethubeni lokusakazeka kwezinye izingxenye zomzimba kune-intraocular melanoma ye-iris.

I-Choroid

I-choroid ungqimba lwemithambo yegazi eletha umoya-mpilo nezakhamzimba esweni. Ama-melanomas amaningi we-intraocular aqala ku-choroid. I-intraocular melanoma ye-choroid ivame ukuba nkulu futhi inamathuba amaningi okusabalala kwezinye izingxenye zomzimba kune-intraocular melanoma ye-iris.

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.

I-intraocular melanoma ngumdlavuza ongavamile owakhiwa ngamaseli enza i-melanin ku-iris, emzimbeni we-ciliary, naku-choroid. Ngumdlavuza wamehlo ovame kakhulu kubantu abadala.

Ukuba mdala nokuba nesikhumba esifanele kungakhuphula ubungozi be-intraocular melanoma.

Noma yini enyusa ubungozi bokuthola isifo ibizwa ngokuthi ingozi. Ukuba nengcuphe akusho ukuthi uzothola umdlavuza; ukungabi nezici zobungozi akusho ukuthi ngeke uthole umdlavuza. Khuluma nodokotela wakho uma ucabanga ukuthi ungaba sengozini.

Izici ezinobungozi be-intraocular melanoma zifaka okulandelayo:

• 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.

• Ukuguga.

• Ukuba mhlophe.

Izimpawu ze-melanoma ye-intraocular zifaka ukungaboni kahle noma indawo emnyama ku-iris.

I-intraocular melanoma kungenzeka ingabangeli izimpawu noma izimpawu zakuqala. Kwesinye isikhathi kutholakala ngesikhathi sokuhlolwa kwamehlo okujwayelekile lapho udokotela ekhulisa umfundi futhi abheke iso. Izimpawu nezimpawu zingabangelwa i-intraocular melanoma noma ezinye izimo. Buza nodokotela wakho uma unokunye kwalokhu okulandelayo:

• Ukubona okufiphele noma olunye ushintsho kumbono.

• Izikhukhula (izindawo ezihamba emkhakheni wakho wokubuka) noma ukukhanya kokukhanya.

• Indawo emnyama ku-iris.

• Ushintsho kusayizi noma ukuma komfundi.

• Ushintsho esimweni senhlamvu yeso esokeni leso.

Ukuhlolwa okuhlola iso kusetshenziselwa ukusiza ukuthola (ukuthola) nokuxilonga i-melanoma ye-intraocular.

Lezi zivivinyo nezinqubo ezilandelayo zingasetshenziswa:

• Ukuhlolwa komzimba kanye nomlando: 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.

• Ukuhlolwa kwamehlo ngomfundi ohluziwe: Ukuhlolwa kweso lapho umfundi enwetshwa khona (enwetshiwe) ngamaconsi wamehlo afakwe umuthi ukuvumela udokotela ukuthi abheke ngaphakathi kwelensi nomfundi kwi-retina. Ingaphakathi leso, kufaka phakathi i-retina kanye ne-optic nerve, kuyahlolwa. Izithombe zingathathwa ngokuhamba kwesikhathi ukugcina ithrekhi yezinguquko ngosayizi wesimila. Kunezinhlobo eziningi zezivivinyo zamehlo:

• I-Ophthalmoscopy: Ukuhlolwa kwengaphakathi langemuva kweso ukubheka i-retina ne-optic nerve kusetshenziswa ilensi encane yokukhulisa nokukhanya.

• I-slit-lamp biomicroscopy: Ukuhlolwa kwengaphakathi leso ukuhlola i-retina, i-optic nerve, nezinye izingxenye zeso kusetshenziswa umsebe wokukhanya oqinile nesibonakhulu.

• I-Gonioscopy: Ukuhlolwa kwengxenye engaphambili yeso phakathi kwe-cornea ne-iris. Ithuluzi elikhethekile lisetshenziselwa ukubona ukuthi ngabe indawo lapho uketshezi oluphuma khona esweni ivaliwe yini.

• Ukuhlolwa kweso kwe-Ultrasound: Inqubo lapho amagagasi omsindo wamandla aphezulu (i-ultrasound) ehlaselwa izicubu zangaphakathi zeso ukwenza ama-echoes. Amaconsi wamehlo asetshenziselwa ukuqaqamba iso futhi iphenyo elincane elithumela futhi lamukele amagagasi omsindo libekwa kahle ebusweni beso. Ama-echoes enza isithombe sangaphakathi leso futhi ibanga elisuka ku-cornea liye ku-retina liyalinganiswa. Isithombe, esibizwa nge-sonogram, sikhombisa esikrinini se-ultrasound monitor.

• I-high-resolution ultrasound biomicroscopy: Inqubo lapho amagagasi omsindo wamandla aphezulu (i-ultrasound) ehlaselwa izicubu zangaphakathi zeso ukwenza ama-echoes. Amaconsi wamehlo asetshenziselwa ukuqaqamba iso futhi iphenyo elincane elithumela futhi lamukele amagagasi omsindo libekwa kahle ebusweni beso. Ama-echoes enza isithombe esinemininingwane engaphezulu yeso kune-ultrasound ejwayelekile. Isimila sihlolwa ubukhulu baso, ukuma kwaso nobukhulu baso, kanye nezimpawu zokuthi isimila sesisabalalele ezicutshini eziseduze.

• Ukuguqulwa komhlaba kanye ne-iris: Ukuhlolwa kwe-iris, i-cornea, i-lens, nomzimba we-ciliaryal ngokukhanya okubekwe ku-lid ephezulu noma ephansi.

• I-Fluorescein angiography: Inqubo yokubheka imithambo yegazi nokugeleza kwegazi ngaphakathi kweso. Idayi ye-orange fluorescent (i-fluorescein) ijojowe emthanjeni wegazi engalweni bese ingena egazini. Njengoba udayi udabula emithanjeni yegazi yeso, ikhamera ekhethekile ithwebula izithombe ze-retina ne-choroid ukuthola noma yiziphi izindawo ezivinjiwe noma ezivuzayo.

• I-Indocyanine angiography eluhlaza: Inqubo yokubheka imithambo yegazi kusendlalelo lwe-choroid yeso. Idayi eluhlaza (i-indocyanine green) ijojowe emthanjeni wegazi engalweni bese ingena egazini. Njengoba udayi udabula emithanjeni yegazi yeso, ikhamera ekhethekile ithwebula izithombe ze-retina ne-choroid ukuthola noma yiziphi izindawo ezivinjiwe noma ezivuzayo.

• I-Ocular coherence tomography: Isivivinyo sokuthatha izithombe esisebenzisa amagagasi okukhanya ukuthatha izithombe ezihamba phambili ze-retina, kwesinye isikhathi ne-choroid, ukubona ukuthi kukhona ukuvuvukala noma uketshezi ngaphansi kwe-retina.

I-biopsy ye-tumor ayidingeki kangako ukuthola i-intraocular melanoma.

I-biopsy ukususwa kwamaseli noma izicubu ukuze kubhekwe ngaphansi kwesibonakhulu ukuhlola izimpawu zomdlavuza. Ngokuvamile, kudingeka i-biopsy ye-tumor ukuze kuhlolwe i-melanoma ye-intraocular. Izicubu ezisuswa ngesikhathi se-biopsy noma ukuhlinzwa ukuze kususwe isimila zingahlolwa ukuze zithole ulwazi oluthe xaxa mayelana nokubikezela nokuthi yiziphi izindlela zokwelashwa ezingcono kakhulu.

Ukuhlolwa okulandelayo kungenziwa kusampula lezicubu:

• Ukuhlaziywa kwe-cytogenetic: Ukuhlolwa kwelabhoratri lapho ama-chromosomes amaseli esampula yezicubu abalwa khona futhi ahlolwe noma yiziphi izinguquko, ezinjengama-chromosomes aphukile, alahlekile, ahlelwe kabusha, noma amanye. Izinguquko kuma-chromosomes athile kungaba luphawu lomdlavuza. Ukuhlaziywa kwe-cytogenetic kusetshenziselwa ukuxilonga umdlavuza, ukuhlela ukwelashwa, noma ukuthola ukuthi ukwelashwa kusebenza kahle kangakanani.

• Ukuphrinta kwenkulumo kaGene: Isivivinyo selabhorethri esikhomba zonke izinhlobo zofuzo eziseli noma izicubu ezenza (ukuveza) i-RNA yesithunywa. Ama-molecule e-Messenger RNA aphethe imininingwane yezofuzo edingekayo ukwenza amaprotheni asuka ku-DNA akwi-cell nucleus aye emishinini yokwenza amaprotheni ku-cytoplasm yeseli.

I-biopsy ingaholela ekuhlukanisweni kwe-retinal (i-retina ihlukanisa nezinye izicubu esweni). Lokhu kungalungiswa ngokuhlinzwa.

Izici ezithile zithinta ukubikezela (ithuba lokululama) kanye nezinketho zokwelashwa.

Isibikezelo (ithuba lokululama) nezinketho zokwelashwa zincike kokulandelayo:

• Amangqamuzana e-melanoma abukeka kanjani ngaphansi kwesibonakhulu.

• Usayizi nobukhulu besimila.

• Ingxenye yeso isimila siku (iris, umzimba we-ciliary, noma i-choroid).

• Ukuthi isimila sisabalale ngaphakathi kweso noma kwezinye izindawo emzimbeni.

• Noma ngabe kukhona ushintsho oluthile kwizakhi zofuzo ezixhunywe kwi-intraocular melanoma.

• Iminyaka yesiguli nempilo ejwayelekile.

• Ukuthi isimila sesiphindile yini (sibuya) ngemuva kokwelashwa.

Izigaba ze-Intraocular (Uveal) Melanoma

AMAPHUZU ASEMQOKA

• Ngemuva kokutholakala kwe-intraocular melanoma, kwenziwa ukuhlolwa ukuthola ukuthi amangqamuzana omdlavuza asenabele yini kwezinye izingxenye zomzimba.

• Amasayizi alandelayo asetshenziselwa ukuchaza i-melanoma ye-intraocular nokuhlela ukwelashwa:

• Encane

• Okulingene

• Okukhulu

• Zintathu izindlela umdlavuza osakazeka ngayo emzimbeni.

• Umdlavuza ungasakazeka usuka lapho uqale khona kwezinye izingxenye zomzimba.

• Izigaba ezilandelayo zisetshenziselwa i-melanoma ye-intraocular yomzimba we-ciliary kanye ne-choroid:

• Isiteji I

• Isigaba II

• Isigaba III

• Isigaba IV

• Akunasistimu yokubeka i-intraocular melanoma ye-iris.

Ngemuva kokutholakala kwe-intraocular melanoma, kwenziwa ukuhlolwa ukuthola ukuthi amangqamuzana omdlavuza asenabele yini kwezinye izingxenye zomzimba.

Inqubo esetshenzisiwe ukuthola ukuthi umdlavuza ususabalele kwezinye izingxenye zomzimba ibizwa ngokuthi yi-staging. Imininingwane eqoqwe kusuka kusistimu yesiteji inquma isigaba sesifo. Kubalulekile ukwazi isigaba ukuze uhlele ukwelashwa.

Lezi zivivinyo nezinqubo ezilandelayo zingasetshenziswa kunqubo yokubeka iziteji:

• 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.

• Ukuhlolwa kokusebenza kwesibindi: Inqubo lapho kuhlolwe khona isampula segazi ukukala inani lezinto ezithile ezikhishwe egazini yisibindi. Inani eliphakeme kunelivamile lezinto kungaba uphawu lokuthi umdlavuza usakaze esibindini.

• Ukuhlolwa kwe-Ultrasound: Inqubo lapho amaza omsindo wamandla aphezulu (i-ultrasound) ehlaselwa izicubu zangaphakathi noma izitho, njengesibindi, futhi enze ama-echoes. Ama-echoes akha isithombe sezicubu zomzimba esibizwa nge-sonogram.

• I-x-ray yesifuba: I-x-ray yezitho namathambo ngaphakathi kwesifuba. I-x-ray uhlobo lwesigongolo samandla esingangena emzimbeni nasefilimini, lwenze isithombe sezindawo ezingaphakathi komzimba.

• I-MRI (imaging resonance imaging): Inqubo esebenzisa uzibuthe, amagagasi omsakazo nekhompyutha ukwenza uchungechunge lwezithombe ezinemininingwane yezindawo ezingaphakathi komzimba, njengesibindi. Le nqubo ibizwa nangokuthi i-nuclear magnetic resonance imaging (i-NMRI).

• I-CT scan (i-CAT scan): Inqubo eyenza uchungechunge lwezithombe ezinemininingwane yezindawo ezingaphakathi komzimba, njengesifuba, isisu, noma ukhalo, ezithathwe ezinhlangothini ezahlukene. Izithombe zenziwa yikhompyutha exhunywe kumshini we-x-ray. Idayi ingajovwa emthanjeni noma igwinywe ukusiza izitho noma izicubu zivele kahle. Le nqubo ibizwa nangokuthi i-computed tomography, i-computer ene-tomography, noma i-computer axial tomography.

• I-PET scan (i-positron emission tomography scan): Inqubo yokuthola amangqamuzana abulalayo omzimba emzimbeni. Inani elincane kakhulu 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. Kwesinye isikhathi kwenziwa i-PET scan ne-CT scan ngasikhathi sinye. Uma kukhona umdlavuza, lokhu kwandisa amathuba okuthi utholakale.

Amasayizi alandelayo asetshenziselwa ukuchaza i-melanoma ye-intraocular nokuhlela ukwelashwa:

Encane

Isimila sinobubanzi obungamamilimitha angu-5 kuye kwayi-16 futhi sisuka kumamilimitha ayi-1 kuye kwayi-3 siwugqinsi.

Amamilimitha (mm). Iphoyinti elibukhali elicishe libe yi-1 mm, iphoyinti elisha lekhrayoni cishe lingu-2 mm, futhi i-eraser entsha yepensela icishe ibe yi-5 mm.

Okulingene

Isimila singamamilimitha ayi-16 noma sincane ububanzi futhi sisuka kumamilimitha ayi-3.1 kuye kwayi-8 ubukhulu.

Okukhulu

Isimila yilesi:

• ngaphezu kwamamilimitha ayi-8 ubukhulu nanoma yimuphi ububanzi; noma

• okungenani amamilimitha ama-2 ubukhulu nokungaphezulu kwamamilimitha ayi-16 ububanzi.

Yize izicubu eziningi ze-intraocular melanoma ziphakanyiswa, ezinye ziyisicaba. Lezi zicubu ezisakazeka zikhula kabanzi kuyo yonke i-uvea.

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.

Uma i-melanoma ye-intraocular isakazeka emthanjeni we-optic noma izicubu eziseduze zesokhethi yamehlo, ibizwa ngokuthi i-extraocular extension.

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 i-intraocular melanoma isakazekela esibindi, amangqamuzana omdlavuza esesibindi empeleni angamaseli e-intraocular melanoma. Lesi sifo yi-metastatic intraocular melanoma, hhayi umdlavuza wesibindi.

Izigaba ezilandelayo zisetshenziselwa i-melanoma ye-intraocular yomzimba we-ciliary kanye ne-choroid:

I-melanoma ye-intraocular yomzimba we-ciliary kanye ne-choroid inezigaba ezine zosayizi. Isigaba sincike ekutheni ububanzi nobukhulu besimila bunjani. Izicubu zesigaba 1 yizicubu ezincane kakhulu kanti isigaba 4 yizona ezinkulu kakhulu.

Isigaba 1:

• Isimila asikho ngaphezu kwamamilimitha ayi-12 ububanzi futhi asiqi ngaphezu kwamamilimitha amathathu; noma

• isimila asikho ngaphezu kwamamilimitha ayi-9 ububanzi no-3.1 kuya ku-6 millimeters ubukhulu.

Isigaba 2:

• Isimila sinobubanzi obungamamilimitha ayi-12.1 kuye kwayi-18 hhayi ubukhulu obungaphezu kwamamilimitha amathathu; noma

• isimila singamamilimitha ayi-9.1 kuye kwayi-15 ububanzi namamilimitha ayi-3.1 kuye kwayi-6 ubukhulu; noma

• isimila asikho ngaphezu kwamamilimitha ayi-12 ububanzi nangu-6.1 kuye kumamilimitha ayi-9 ubukhulu.

Isigaba 3:

• Isimila singamamilimitha ayi-15.1 kuye kwayi-18 ububanzi namamilimitha ayi-3.1 kuye kwayi-6 ubukhulu; noma

• isimila singamamilimitha ayi-12.1 kuye kwayi-18 ububanzi namamilimitha ayi-6.1 kuye kwayi-9 ubukhulu; noma

• isimila asingedluli kwamamilimitha ayi-18 ububanzi namamilimitha ayi-9.1 kuye kwayi-12 ubukhulu; noma

• isimila asikho ngaphezu kwamamilimitha ayi-15 ububanzi namamilimitha ayi-12.1 kuye kwayi-15 ukushuba.

Isigaba 4:

• Isimila singaphezu kwamamilimitha ayi-18 ububanzi futhi singaba yinoma ikuphi ukushuba; noma

• isimila singamamilimitha ayi-15.1 kuye kwayi-18 ububanzi futhi singaphezulu kwamamilimitha ayi-12 ubukhulu; noma

• isimila asikho ngaphezu kwamamilimitha ayi-15 ububanzi futhi singaphezu kwamamilimitha ayi-15 ukushuba.

Isiteji I

Esigabeni I, isimila silingana nesigaba 1 futhi sise-choroid kuphela.

Isigaba II

Isigaba II sihlukaniswe ngezigaba IIA no-IIB.

• Esigabeni IIA, isimila:

• isigaba sosayizi 1 futhi sisabalalele emzimbeni we-ciliary; noma

• Isigaba sesayizi 1 futhi sisabalale nge-sclera saya ngaphandle kwenhlamvu yeso. Ingxenye yesimila engaphandle kwenhlamvu yeso ayinkulu ngaphezu kwamamilimitha ayi-5. Kungenzeka ukuthi isimila sisabalalele emzimbeni we-ciliary; noma

• usayizi wesigaba 2 futhi uku-choroid kuphela.

• Esigabeni IIB, isimila:

• Isigaba sesayizi 2 futhi sesisabalele emzimbeni we-ciliary; noma

• usayizi wesigaba 3 futhi uku-choroid kuphela.

Isigaba III

Isigaba III sihlukaniswe izigaba IIIA, IIIB, kanye IIIC.

• Esigabeni IIIA, isimila:

• Isigaba sesayizi 2 futhi sisabalale nge-sclera saya ngaphandle kwenhlamvu yeso. Ingxenye yesimila engaphandle kwenhlamvu yeso ayinkulu ngaphezu kwamamilimitha ayi-5. Kungenzeka ukuthi isimila sisabalalele emzimbeni we-ciliary; noma

• isigaba sosayizi 3 futhi sesisabalele emzimbeni we-ciliary; noma

• Isigaba sesayizi 3 futhi sisabalale nge-sclera saya ngaphandle kwenhlamvu yeso. Ingxenye yesimila engaphandle kwenhlamvu yeso ayinkulu ngaphezu kwamamilimitha ayi-5. Isimila asisabalalanga emzimbeni we-ciliary; noma

• usayizi wesigaba 4 futhi uku-choroid kuphela.

• Esigabeni IIIB, isimila:

• Isigaba sesayizi 3 futhi sisabalale nge-sclera saya ngaphandle kwenhlamvu yeso. Ingxenye yesimila engaphandle kwenhlamvu yeso ayinkulu ngaphezu kwamamilimitha ayi-5. Isimila sisabalalele emzimbeni we-ciliary; noma

• isigaba sosayizi 4 futhi sisabalalele emzimbeni we-ciliary; noma

• usayizi wesigaba sesi-4 futhi usabalale nge-sclera waya ngaphandle kwamehlo esiso. Ingxenye yesimila engaphandle kwenhlamvu yeso ayinkulu ngaphezu kwamamilimitha ayi-5. Isimila asisabalalanga emzimbeni we-ciliary.

• Esigabeni IIIC, isimila:

• usayizi wesigaba sesi-4 futhi usabalale nge-sclera waya ngaphandle kwamehlo esiso. Ingxenye yesimila engaphandle kwenhlamvu yeso ayinkulu ngaphezu kwamamilimitha ayi-5. Isimila sisabalalele emzimbeni we-ciliary; noma

• ingahle ibe usayizi futhi isabalale nge-sclera iye ngaphandle kwenhlamvu yeso. Ingxenye yesimila engaphandle kwenhlamvu yeso ingaphezulu kwamamilimitha ayi-5 ubukhulu.

Isigaba IV

Esigabeni IV, isimila singaba bukhulu futhi sisakazeke

• kuma-lymph node eyodwa noma amaningi aseduze noma esokeni leso elihlukile kwesimila sokuqala; noma

• kwezinye izingxenye zomzimba, njengesibindi, amaphaphu, ithambo, ubuchopho, noma izicubu ngaphansi kwesikhumba.

Akunasistimu yokubeka i-intraocular melanoma ye-iris.

I-Melanoma Ephindaphindiwe Yangaphakathi (Uveal)

I-melanoma yangaphakathi yangaphakathi umdlavuza ophindwe (wabuya) ngemuva kokuba welashwe. I-melanoma ingabuya esweni noma kwezinye izingxenye zomzimba.

Uhlolojikelele lwenketho yokwelashwa

AMAPHUZU ASEMQOKA

• Kunezinhlobo ezahlukahlukene zokwelashwa kweziguli ezine-melanoma ye-intraocular.

• Izinhlobo ezinhlanu zokwelashwa okujwayelekile zisetshenzisiwe:

• Ukuhlinzwa

• Ukulinda Ngokuqapha

• Ukwelashwa ngemisebe

• I-Photocoagulation

• I-Thermotherapy

• Izinhlobo ezintsha zokwelashwa ziyahlolwa ezivivinyweni zokwelashwa.

• Ukwelashwa kwe-intraocular (uveal) melanoma kungadala imiphumela emibi.

• Iziguli zingafuna ukucabanga ngokubamba iqhaza esivivinyweni somtholampilo.

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

• Ukuhlolwa kokulandelela kungadingeka.

Kunezinhlobo ezahlukahlukene zokwelashwa kweziguli ezine-melanoma ye-intraocular.

Izinhlobo ezahlukene zokwelashwa ziyatholakala ezigulini ezine-melanoma ye-intraocular. 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. Iziguli zingafuna ukucabanga ngokubamba iqhaza esivivinyweni somtholampilo. Ezinye izivivinyo zokwelashwa zivulekele kuphela iziguli ezingakaqali ukwelashwa.

Izinhlobo ezinhlanu zokwelashwa okujwayelekile zisetshenzisiwe:

Ukuhlinzwa

Ukuhlinzwa kuyindlela yokwelashwa ejwayelekile kakhulu ye-intraocular melanoma. Izinhlobo ezilandelayo zokuhlinzwa zingasetshenziswa:

• Ukutholakala kabusha: Ukuhlinzwa ukukhipha isimila nenani elincane lezicubu ezinempilo elizungezile.

• I-Enucleation: Ukuhlinzwa ukususa iso nengxenye yomthambo we-optic. Lokhu kwenziwa uma umbono ungeke usindiswe futhi isimila sikhulu, sesisabalele emithanjeni ye-optic, noma senza ingcindezi ephezulu ngaphakathi esweni. Ngemuva kokuhlinzwa, isiguli sivamise ukufakwa iso lokufakelwa ukulingana nosayizi nombala welinye iso.

• Ukuzivocavoca: Ukuhlinza ukususa iso nejwabu leso, nemisipha, izinzwa, namafutha esokeni leso. Ngemuva kokuhlinzwa, isiguli singalungiselelwa iso lokufakelwa ukuze lilingane nosayizi nombala welinye iso noma isitho sokufakelwa sobuso.

Ukulinda Ngokuqapha

Ukulinda ngokuqapha kusibhekisisa isimo sesiguli ngaphandle kokunikeza ukwelashwa kuze kuvele izimpawu noma izimpawu. Izithombe zithathwa ngokuhamba kwesikhathi ukugcina ithrekhi yezinguquko ngosayizi we-tumor nokuthi ikhula ngokushesha kangakanani.

Ukulinda ngokuqapha kusetshenziselwa iziguli ezingenazo izimpawu noma izimpawu futhi isimila asikhuli. Iphinde isetshenziswe lapho isimila siso kuphela esinombono owusizo.

Ukwelashwa ngemisebe

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

• Ukwelashwa kwemisebe kwangaphandle kusebenzisa umshini ongaphandle komzimba ukuthumela imisebe ebheke emdlavuzeni. Izindlela ezithile zokunikeza ukwelashwa ngemisebe kungasiza ukugcina imisebe ekulimaleni izicubu ezinempilo eziseduze. Lezi zinhlobo zokwelashwa ngemisebe yangaphandle zifaka okulandelayo:

• Ukwelashwa kwemisebe yemishayo yangaphandle ekhokhisiwe kuyindlela yokwelashwa kwemisebe yangaphandle. Umshini okhethekile wokwelapha imisebe uhlose izinhlayiya ezincane ezingabonakali, ezibizwa ngokuthi ama-proton noma ama-helium ions, kumaseli womdlavuza ukuze ziwabulale ngomonakalo omncane ezicutshini ezivamile eziseduze. Ukwelashwa kwemisebe ekhokhisiwe kusetshenziswa uhlobo oluhlukile lwemisebe kunohlobo lwe-x-ray lokwelashwa ngemisebe.

• Ukwelashwa kweGamma Knife uhlobo lwama-radiosurgery e-stereotactic asetshenziselwa amanye ama-melanomas. Lokhu kwelashwa kunganikezwa ekwelashweni okukodwa. Ihlose ngemisebe ye-gamma egxilwe ngqo esihlahleni ngakho-ke akukho monakalo omncane ezicutshini ezinempilo. Ukwelashwa kweGamma Knife akusebenzisi ummese ukususa isimila futhi akuwona umsebenzi.

• Ukwelashwa kwemisebe kwangaphakathi kusebenzisa into enemisebe eboshwe ngezinaliti, izimbewu, izintambo, noma ama-catheters abekwe ngqo noma eduze komdlavuza. Izindlela ezithile zokunikeza ukwelashwa ngemisebe kungasiza ukugcina imisebe ingalimazi izicubu ezinempilo. Lolu hlobo lwezokwelapha ngemisebe yangaphakathi lungafaka okulandelayo:

• Ukwelashwa kwemisebe ye-plaque yendawo kunguhlobo lokwelashwa ngemisebe kwangaphakathi okungasetshenziselwa izicubu zeso. Imbewu enemisebe inamathiselwe kolunye uhlangothi lwediski, olubizwa ngoqwembe, bese ibekwa ngqo odongeni olungaphandle lweso eduze kwesimila. Uhlangothi loqwembe olunembewu kulo lubhekene nenhlamvu yeso, kuhloswe ngemisebe kulesimila. Lolu qweqwe lusiza ukuvikela ezinye izicubu eziseduze emisebeni.

I-Plaque radiotherapy yeso. Uhlobo lokwelashwa ngemisebe okusetshenziselwa ukwelapha izicubu zamehlo. Imbewu enemisebe ibekwa ohlangothini olulodwa lwensimbi ezacile (imvamisa igolide) ebizwa ngoqwembe. Lolu qweqwe luthungwe odongeni olungaphandle lweso. Izinhlamvu zikhipha imisebe ebulala umdlavuza. Lolu qweqwe luyasuswa ekupheleni kokwelashwa, okuvame ukuhlala izinsuku ezimbalwa.

Indlela okunikezwa ngayo ukwelashwa ngemisebe kuya ngohlobo nesigaba somdlavuza owelashwa. Ukwelashwa kwemisebe yangaphandle neyangaphakathi kusetshenziselwa ukwelapha i-melanoma ye-intraocular.

I-Photocoagulation

I-Photocoagulation inqubo esebenzisa ukukhanya kwe-laser ukuqeda imithambo yegazi eletha izakhamzimba ku-tumor, okwenza ukuthi amangqamuzana e-tumor afe. I-Photocoagulation ingasetshenziselwa ukwelapha izicubu ezincane. Lokhu kubizwa nangokuthi ukukhanya okubandayo.

I-Thermotherapy

I-Thermotherapy ukusetshenziswa kokushisa okuvela kwi-laser ukuqeda amangqamuzana omdlavuza nokunciphisa isimila.

Izinhlobo ezintsha zokwelashwa ziyahlolwa ezivivinyweni zokwelashwa.

Imininingwane mayelana nokuhlolwa kwemitholampilo iyatholakala kuwebhusayithi ye-NCI.

Ukwelashwa kwe-intraocular (uveal) melanoma kungadala imiphumela emibi.

Ngemininingwane ngemiphumela engemihle ebangelwe ukwelashwa komdlavuza, bheka ikhasi lethu le-Side Effects.

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 sakho sishintshile noma uma umdlavuza ubuyile (buyela emuva). Lezi zivivinyo kwesinye isikhathi zibizwa ngokuthi izivivinyo zokulandelela noma ukuhlolwa.

Izinketho Zokwelapha i-Intraocular (Uveal) Melanoma

Kulesi Sigaba

• Iris Melanoma

• I-Ciliary Body Melanoma

• I-Choroid Melanoma

• I-Extraocular Extension Melanoma ne-Metastatic Intraocular (Uveal) Melanoma

• I-Melanoma Ephindaphindiwe Yangaphakathi (Uveal)

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

Iris Melanoma

Ukwelashwa kwe-iris melanoma kungafaka okulandelayo:

• Ukulinda okulindile.

• Ukuhlinzwa (resection noma enucleation).

• Ukwelashwa kwemisebe ye-Plaque, yamathumba angenakususwa ngokuhlinzwa.

Sebenzisa ukusesha kwethu kokuhlolwa komtholampilo ukuthola izivivinyo zomtholampilo ezisekelwa yi-NCI ezamukela iziguli. Ungasesha izivivinyo ngokususelwa ohlotsheni lomdlavuza, iminyaka yesiguli, nalapho kwenziwa khona izivivinyo. Imininingwane ejwayelekile mayelana nokuhlolwa kwemitholampilo iyatholakala.

I-Ciliary Body Melanoma

Ukwelashwa kwe-ciliary body melanoma kungafaka okulandelayo:

• Ukwelashwa kwemisebe ye-Plaque.

• Ukwelashwa kwemisebe yemisebe ekhokhisiwe engaphandle.

• Ukuhlinzwa (resection noma enucleation).

Sebenzisa ukusesha kwethu kokuhlolwa komtholampilo ukuthola izivivinyo zomtholampilo ezisekelwa yi-NCI ezamukela iziguli. Ungasesha izivivinyo ngokususelwa ohlotsheni lomdlavuza, iminyaka yesiguli, nalapho kwenziwa khona izivivinyo. Imininingwane ejwayelekile mayelana nokuhlolwa kwemitholampilo iyatholakala.

I-Choroid Melanoma

Ukwelashwa kwe-melanoma encane ye-choroid kungafaka okulandelayo:

• Ukulinda okulindile.

• Ukwelashwa kwemisebe ye-Plaque.

• Ukwelashwa kwemisebe yemisebe ekhokhisiwe engaphandle.

• Ukwelashwa kweGamma Knife.

• I-Thermotherapy.

• Ukuhlinzwa (resection noma enucleation).

Ukwelashwa kwe-melanoma ephakathi kwe-choroid kungafaka okulandelayo:

• Ukwelashwa kwemisebe ye-Plaque nge noma ngaphandle kwe-photocoagulation noma i-thermotherapy.

• Ukwelashwa kwemisebe yemisebe ekhokhisiwe engaphandle.

• Ukuhlinzwa (resection noma enucleation).

Ukwelashwa kwe-melanoma enkulu ye-choroid kungafaka okulandelayo:

• I-enucleation lapho isimila sikhulu kakhulu ukwelashwa okusindisa iso.

Sebenzisa ukusesha kwethu kokuhlolwa komtholampilo ukuthola izivivinyo zomtholampilo ezisekelwa yi-NCI ezamukela iziguli. Ungasesha izivivinyo ngokususelwa ohlotsheni lomdlavuza, iminyaka yesiguli, nalapho kwenziwa khona izivivinyo. Imininingwane ejwayelekile mayelana nokuhlolwa kwemitholampilo iyatholakala.

I-Extraocular Extension Melanoma ne-Metastatic Intraocular (Uveal) Melanoma

Ukwelashwa kwe-extraocular extension melanoma eye yasakazekela ethanjeni elizungeze iso ingafaka okulandelayo:

• Ukuhlinzwa (umfutho).

• Isivivinyo somtholampilo.

Ukwelashwa okusebenzayo kwe-metastatic intraocular melanoma akutholakalanga. Isivivinyo somtholampilo kungaba yindlela yokwelashwa. Khuluma nodokotela wakho ngezinketho zakho zokwelashwa.

Sebenzisa ukusesha kwethu kokuhlolwa komtholampilo ukuthola izivivinyo zomtholampilo ezisekelwa yi-NCI ezamukela iziguli. Ungasesha izivivinyo ngokususelwa ohlotsheni lomdlavuza, iminyaka yesiguli, nalapho kwenziwa khona izivivinyo. Imininingwane ejwayelekile mayelana nokuhlolwa kwemitholampilo iyatholakala.

I-Melanoma Ephindaphindiwe Yangaphakathi (Uveal)

Ukwelashwa okusebenzayo kwe-melanoma yangaphakathi kwe-intraocular akutholakalanga. Isivivinyo somtholampilo kungaba yindlela yokwelashwa. Khuluma nodokotela wakho ngezinketho zakho zokwelashwa.

Sebenzisa ukusesha kwethu kokuhlolwa komtholampilo ukuthola izivivinyo zomtholampilo ezisekelwa yi-NCI ezamukela iziguli. Ungasesha izivivinyo ngokususelwa ohlotsheni lomdlavuza, iminyaka yesiguli, nalapho kwenziwa khona izivivinyo. Imininingwane ejwayelekile mayelana nokuhlolwa kwemitholampilo iyatholakala.

Ukuze ufunde kabanzi nge-Intraocular (Uveal) Melanoma

Ukuthola eminye imininingwane ngeNational Cancer Institute mayelana ne-intraocular (uveal) melanoma, bheka ikhasi lasekhaya le-Intraocular (Eye) Melanoma.

Ngemininingwane ejwayelekile yomdlavuza nezinye izinsiza ezivela ku-National Cancer Institute, bheka okulandelayo:

• Mayelana Nomdlavuza

• Isiteji

• I-Chemotherapy kanye Nawe: Ukusekelwa Kwabantu Abanomdlavuza

• Ukwelashwa Kwemisebe Nawe: Ukusekelwa Kwabantu Abanomdlavuza

• Ukubhekana Nomdlavuza

• Imibuzo Ongayibuza Udokotela Wakho mayelana Nomdlavuza

• Kwabasindile Nabanakekeli