Types/gestational-trophoblastic/patient/gtd-treatment-pdq

Ukwelashwa Kwezifo Ze-Gestational Trophoblastic (®) –Patient Version

Imininingwane ejwayelekile mayelana nezifo zeGestational Trophoblastic

AMAPHUZU ASEMQOKA

• Isifo i-Gestational trophoblastic disease (GTD) yiqembu lezifo ezingavamile lapho amangqamuzana angavamile e-trophoblast ekhula khona ngaphakathi kwesibeletho ngemuva kokukhulelwa.

• I-Hydatidiform mole (HM) uhlobo oluvame kakhulu lwe-GTD.

• I-Gestational trophoblastic neoplasia (i-GTN) uhlobo lwesifo se-gestational trophoblastic disease (GTD) cishe esibi ngaso sonke isikhathi.

• Izimvukuzane ezihlaselayo

• Ama-Choriocarcinomas

• Izicubu ze-trophoblastic zesayithi le-Placental

• Izicubu ze-Epithelioid trophoblastic

• Ubudala nokukhulelwa kwe-molar kwangaphambilini kuthinta ubungozi be-GTD.

• Izimpawu ze-GTD zifaka ukopha okungavamile kwesitho sangasese sowesifazane kanye nesibeletho esikhudlwana kunokujwayelekile.

• Ukuhlolwa okuhlola isibeletho kusetshenziselwa ukuthola (ukuthola) nokuxilonga isifo se-gestational trophoblastic disease.

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

Isifo i-Gestational trophoblastic disease (GTD) yiqembu lezifo ezingavamile lapho amangqamuzana angavamile e-trophoblast ekhula khona ngaphakathi kwesibeletho ngemuva kokukhulelwa.

Esikhathini sokukhulelwa kwe-trophoblastic disease (GTD), isimila sivela ngaphakathi kwesibeletho sisuka ezicutshini ezakha ngemuva kokukhulelwa (ukuhlanganiswa kwesidoda neqanda). Lesi sicubu senziwa ngamaseli we-trophoblast futhi ngokuvamile sizungeza iqanda elikhulelwe esibelethweni. Amaseli weTrophoblast asiza ukuxhuma iqanda elikhulelwe odongeni lwesibeletho futhi abe yingxenye ye-placenta (isitho esidlulisa izakhi ezisuka kumama ziye embungwini).

Kwesinye isikhathi kunenkinga ngeqanda elikhulelisiwe namaseli e-trophoblast. Esikhundleni sokukhula kombungu onempilo, kuba nesimila. Kuze kube khona izimpawu noma izimpawu zesimila, ukukhulelwa kuzobukeka njengokukhulelwa okujwayelekile.

Iningi le-GTD linobungozi (hhayi umdlavuza) futhi alisakazeki, kepha ezinye izinhlobo ziba yingozi (umdlavuza) bese zisakazeka ezicutshini eziseduze noma ezingxenyeni ezikude zomzimba.

I-Gestational trophoblastic disease (GTD) yigama elijwayelekile elihlanganisa izinhlobo ezahlukene zezifo:

• Izimvukuzane ze-Hydatidiform (HM)

• Qedela i-HM.

• HM kancane.

• I-Gestational Trophoblastic Neoplasia (GTN)

• Izimvukuzane ezihlaselayo.

• Ama-Choriocarcinomas.

• Izicubu ze-trophoblastic zesayithi le-Placental (PSTT; ezingavamile kakhulu).

• Izicubu ze-Epithelioid trophoblastic (ETT; ezingavamile kakhulu).

I-Hydatidiform mole (HM) uhlobo oluvame kakhulu lwe-GTD.

Ama-HMs izicubu ezikhula kancane ezibukeka njengezikhwama zoketshezi. I-HM ibizwa nangokuthi ukukhulelwa kwe-molar. Imbangela yama-hydatidiform moles ayaziwa.

Ama-HM angaqedwa noma ahlukaniswe:

• I-HM ephelele lapho isidoda sivundisa iqanda elingenayo i-DNA kamama. Iqanda line-DNA evela kubaba futhi amangqamuzana obekufanele abe yi-placenta ahlukile.

• Amafomu we-HM ayingxenye lapho isidoda sivundisa iqanda elijwayelekile futhi kunezinhlobo ezimbili ze-DNA evela kubaba eqandeni elikhulelwe. Ingxenye kuphela yamafomu embungu kanye namaseli obekufanele abe yi-placenta angajwayelekile.

Iningi lama-moles e-hydatidiform alinangozi, kepha kwesinye isikhathi liba ngumdlavuza. Ukuba nesici esisodwa noma eziningi ezilandelayo kubeka engcupheni yokuthi imvukuzane ye-hydatidiform izoba ngumdlavuza:

• Ukukhulelwa ngaphambi kweminyaka engama-20 noma ngemuva kweminyaka engama-35.

• Izinga eliphakeme kakhulu le-beta chorionic gonadotropin (β-hCG), i-hormone eyenziwe ngumzimba ngesikhathi sokukhulelwa.

• Isigaxa esikhulu esibelethweni.

• I-cyst ovarian enkulu kunamasentimitha ayisithupha.

• Umfutho wegazi ophakeme ngesikhathi sokukhulelwa.

• Indlala yegilo engasebenzi ngokweqile (kwenziwa i-hormone eyengeziwe ye-thyroid).

• Isicanucanu esikhulu nokuhlanza ngesikhathi sokukhulelwa.

• Amaseli we-trophoblastic egazini, angavimba imithambo yegazi emincane.

• Izinkinga ezinkulu zokuvala igazi ezibangelwa yi-HM.

I-Gestational trophoblastic neoplasia (i-GTN) uhlobo lwesifo se-gestational trophoblastic disease (GTD) cishe esibi ngaso sonke isikhathi.

I-Gestational trophoblastic neoplasia (GTN) ifaka okulandelayo:

Izimvukuzane ezihlaselayo

Izimvukuzane ezihlaselayo zakhiwa ngamaseli we-trophoblast akhula abe ungqimba lwemisipha yesibeletho. Izimvukuzane ezihlaselayo zinamathuba amaningi okukhula nokusakazeka kunemvukuzane ye-hydatidiform. Ngokuvamile, i-HM ephelele noma engaphelele ingaba yi-mole engenayo. Kwesinye isikhathi imvukuzane ehlaselayo izonyamalala ngaphandle kokwelashwa.

Ama-Choriocarcinomas

I-choriocarcinoma iyisimila esibi esivela kumaseli we-trophoblast bese sisakazeka kungqimba lwemisipha yesibeletho nemithambo yegazi eseduze. Ingasakazeka nakwezinye izingxenye zomzimba, njengobuchopho, amaphaphu, isibindi, izinso, ubende, amathumbu, ukhalo noma isitho sangasese sowesifazane. I-choriocarcinoma kungenzeka ukuthi yakheke kwabesifazane abake baba nalokhu okulandelayo:

• Ukukhulelwa kwe-Molar, ikakhulukazi ngemvukuzane ephelele ye-hydatidiform.

• Ukukhulelwa okuvamile.

• Ukukhulelwa kwesisu

• Ukuphuphuma kwesisu.

Izicubu ze-trophoblastic zesayithi le-Placental

I-placental-site trophoblastic tumor (PSTT) uhlobo olungajwayelekile lwe-gestational trophoblastic neoplasia eyakha lapho i-placenta inamathela esibelethweni. Isimila sakha kusuka kumaseli we-trophoblast bese sisakazekela emisipheni yesibeletho nasemithanjeni yegazi. Kungasakazeka nasemaphashini, okhalweni, noma kuma-lymph node. I-PSTT ikhula kancane kakhulu futhi izimpawu noma izimpawu zingabonakala ezinyangeni noma eminyakeni ngemuva kokukhulelwa okujwayelekile.

Izicubu ze-Epithelioid trophoblastic

I-epithelioid trophoblastic tumor (ETT) uhlobo olungajwayelekile kakhulu lwe-gestational trophoblastic neoplasia engaba yingozi noma ibe yimbi. Lapho isimila sibi, singasakazekela emaphashini.

Ubudala nokukhulelwa kwe-molar kwangaphambilini kuthinta ubungozi be-GTD.

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 ze-GTD zifaka okulandelayo:

• Ukukhulelwa lapho uneminyaka engaphansi kuka-20 noma ngaphezulu kuneminyaka engama-35 ubudala.

• Ukuba nomlando womuntu siqu wemvukuzane ye-hydatidiform.

Izimpawu ze-GTD zifaka ukopha okungavamile kwesitho sangasese sowesifazane kanye nesibeletho esikhudlwana kunokujwayelekile.

Lezi kanye nezinye izimpawu nezimpawu zingabangelwa yisifo sokukhulelwa se-trophoblastic noma ngezinye izimo. Buza nodokotela wakho uma unokunye kwalokhu okulandelayo:

• Ukopha kwesitho sangasese sangasese akuhlobene nokuya esikhathini.

• Isibeletho esikhudlwana kunokulindelekile ngesikhathi sokukhulelwa.

• Ubuhlungu noma ingcindezi ethangeni.

• Isicanucanu esikhulu nokuhlanza ngesikhathi sokukhulelwa.

• Umfutho wegazi ophakeme ngekhanda nokuvuvukala kwezinyawo nezandla ekuqaleni kokukhulelwa.

• Ukopha kwesitho sangasese sowesifazane okuqhubeka isikhathi eside kunokujwayelekile ngemuva kokubeletha.

• Ukukhathala, ukuphefumula, isiyezi, nokushaya kwenhliziyo okusheshayo noma okungajwayelekile okubangelwa i-anemia.

I-GTD kwesinye isikhathi ibangela i-thyroid eyeqile. Izimpawu nezimpawu ze-thyroid engasebenzi ngokweqile zifaka okulandelayo:

• Ukushaya kwenhliziyo okusheshayo noma okungajwayelekile.

• Ukuthuthumela.

• Ukujuluka.

• Ukuhamba kwamathumbu kaningi.

• Inkinga yokulala.

• Ukuzizwa ukhathazekile noma ucasukile.

• Ukwehla kwesisindo.

Ukuhlolwa okuhlola isibeletho kusetshenziselwa ukuthola (ukuthola) nokuxilonga isifo se-gestational trophoblastic disease.

Lezi zivivinyo nezinqubo ezilandelayo zingasetshenziswa:

• Ukuhlolwa komzimba kanye nomlando: Ukuhlolwa komzimba ukuhlola izimpawu ezijwayelekile zempilo, kufaka phakathi ukuhlola izimpawu zesifo, njengezigaxa noma yini enye ebonakala ingajwayelekile. Kuzothathwa nomlando wemikhuba yezempilo yesiguli kanye nokugula nokwelashwa kwangaphambilini.

• Ukuhlolwa kwe-pelvic: Ukuhlolwa kwesitho sangasese sowesifazane, umlomo wesibeletho, isibeletho, amashubhu e-fallopian, ama-ovari, ne-rectum. Kufakwa i-speculum esithweni sangasese bese udokotela noma umhlengikazi ebheka esithweni sangasese kanye nomlomo wesibeletho ukuthola izimpawu zesifo. Kuvame ukwenziwa ukuhlolwa kwesibeletho sePap. Udokotela noma umhlengikazi uphinde afake umunwe owodwa noma emibili ethanjisiwe, efakwe igilavu ​​yesandla esisodwa esithweni sangasese bese ebeka esinye isandla phezu kwesisu esingezansi ukuze ezwe ubukhulu, ukuma, nokuma kwesibeletho namaqanda. Udokotela noma umhlengikazi uphinde afake umunwe othanjisiwe, ofakwe igilavu ​​ku-rectum ukuzwa izigaxa noma izindawo ezingejwayelekile.

Ukuhlolwa kwepelvic. Udokotela noma umhlengikazi ufaka umunwe owodwa noma emibili ethanjisiwe, efakwe igilavu ​​yesandla esisodwa esithweni sangasese bese ucindezela esiswini esingezansi ngesinye isandla. Lokhu kwenzelwa ukuzwa ubukhulu, ukuma, nokuma kwesibeletho namaqanda. Isitho sowesifazane sangasese, umlomo wesibeletho, amashubhu okuya emithanjeni, kanye nengxenyenamba iyahlolwa.

• Ukuhlolwa kwe-Ultrasound okhalweni: Inqubo lapho amaza omsindo wamandla aphezulu (i-ultrasound) ehlaselwa izicubu zangaphakathi noma izitho ezithangeni bese enza ama-echoes. Ama-echoes akha isithombe sezicubu zomzimba esibizwa nge-sonogram. Kwesinye isikhathi kwenziwa i-transvaginal ultrasound (TVUS). Kwi-TVUS, kufakwa i-ultrasound transducer (iphenyo) esithweni sangasese sokwenza i-sonogram.

• 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. Kuhlolwa negazi nokuhlolwa isibindi, izinso nomnkantsha.

• Ukuhlolwa komaka weSerum tumor: Inqubo lapho kuhlolwe khona isampula legazi ukukala inani lezinto ezithile ezenziwe izitho zomzimba, izicubu, noma amaseli wesimila emzimbeni. Izinto ezithile zixhunyaniswe nezinhlobo ezithile zomdlavuza lapho zitholakala emazingeni akhuphukile emzimbeni. Lokhu kubizwa ngokuthi yizimpawu zesimila. Ku-GTD, igazi lihlolwe izinga le-beta human chorionic gonadotropin (β-hCG), i-hormone eyenziwe ngumzimba ngesikhathi sokukhulelwa. I-β-hCG egazini lowesifazane ongakhulelwe ingaba uphawu lwe-GTD.

• I-Urinalysis: Isivivinyo sokubheka umbala womchamo nokuqukethwe kuwo, njengoshukela, amaprotheni, igazi, amabhaktheriya nezinga le-β-hCG.

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

Isifo se-Gestational trophoblastic ngokuvamile singelapheka. Ukwelashwa nokubikezelwa kuncike kulokhu okulandelayo:

• Uhlobo lwe-GTD.

• Noma ngabe isimila sesisakazekele esibelethweni, kuma-lymph node, noma ezingxenyeni ezikude zomzimba.

• Inani lamathumba nokuthi likuphi emzimbeni.

• Usayizi wesimila esikhulu kunazo zonke.

• Izinga le-β-hCG egazini.

• Kusheshe kwatholakala ukuthi isimila ngemuva kokuqala kokukhulelwa.

• Ukuthi i-GTD yenzeke ngemuva kokukhulelwa kwe-molar, ukukhulelwa kwesisu, noma ukukhulelwa okujwayelekile.

• Ukwelashwa kwangaphambilini kokukhulelwa kwe-trophoblastic neoplasia.

Izinketho zokwelashwa zincike nokuthi owesifazane ufisa yini ukukhulelwa esikhathini esizayo.

Izigaba zeGestational Trophoblastic Tumors ne-Neoplasia

AMAPHUZU ASEMQOKA

• Ngemuva kokutholakala kwe-gestational trophoblastic neoplasia, kwenziwa ukuhlolwa ukuze kutholakale ukuthi umdlavuza ususakazekile yini ukusuka lapho uqale kwezinye izingxenye zomzimba.

• Zintathu izindlela umdlavuza osakazeka ngayo emzimbeni.

• Umdlavuza ungasakazeka usuka lapho uqale khona kwezinye izingxenye zomzimba.

• Akunasistimu yokubeka ama-hydatidiform moles.

• Lezi zigaba ezilandelayo zisetshenziselwa i-GTN:

• Isiteji I

• Isigaba II

• Isigaba III

• Isigaba IV

• Ukwelashwa kwe-neoplasia ye-gestational trophoblastic neoplasia kusekelwe ohlotsheni lwesifo, isigaba, noma iqembu lobungozi.

Ngemuva kokutholakala kwe-gestational trophoblastic neoplasia, kwenziwa ukuhlolwa ukuze kutholakale ukuthi umdlavuza ususakazekile yini ukusuka lapho uqale kwezinye izingxenye zomzimba.

Inqubo esetshenzisiwe ukuthola ubukhulu noma ukusabalala komdlavuza ibizwa ngokuthi isiteji, Ulwazi oluqoqwe kusuka kusistimu yesiteji lusiza ukunquma isigaba sesifo. Kwi-GTN, isigaba singesinye sezici ezisetshenziselwa ukuhlela ukwelashwa.

Lezi zivivinyo nezinqubo ezilandelayo zingenziwa ukusiza ukuthola isigaba sesifo:

• I-x-ray yesifuba: I-x-ray yezitho namathambo ngaphakathi kwesifuba. I-x-ray uhlobo lwesigongolo samandla esingangena emzimbeni kwifilimu, senze izithombe zezindawo ezingaphakathi komzimba.

• 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. Idayi ingajovwa emthanjeni noma igwinywe ukusiza izitho noma izicubu zivele kahle. Le nqubo ibizwa nangokuthi i-computed tomography, i-computerized tomography, noma i-computer axial tomography.

• I-MRI (imaging resonance imaging) ene-gadolinium: Inqubo esebenzisa uzibuthe, amagagasi omsakazo, nekhompyutha ukwenza uchungechunge lwezithombe ezinemininingwane yezindawo ezingaphakathi komzimba, njengobuchopho nomgogodla. Into ebizwa ngokuthi i-gadolinium ijojowe emthanjeni. I-gadolinium iqoqa izungeze amangqamuzana omdlavuza ukuze akhanye ngokugqamile esithombeni. Le nqubo ibizwa nangokuthi i-nuclear magnetic resonance imaging (i-NMRI).

• Ukubhoboza i-Lumbar: Inqubo esetshenziselwa ukuqoqa i-cerebrospinal fluid (CSF) kusuka kukholamu lomgogodla. Lokhu kwenziwa ngokubeka inaliti phakathi kwamathambo amabili emgogodleni naku-CSF ezungeze umgogodla nokususa isampula loketshezi. Isampula le-CSF lihlolwe ngaphansi kwesibonakhulu ukuthola izimpawu zokuthi umdlavuza ususabalele ebuchosheni nasentanyeni yomgogodla. Le nqubo ibizwa nangokuthi i-LP noma umpompi womgogodla.

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 i-choriocarcinoma isakazekela emaphashini, amangqamuzana omdlavuza asephashini empeleni angamaseli e-choriocarcinoma. Lesi sifo yi-metastatic choriocarcinoma, hhayi umdlavuza wamaphaphu.

Akunasistimu yokubeka ama-hydatidiform moles.

Ama-moles e-Hydatidiform (HM) atholakala esibelethweni kuphela futhi awasabalali aye kwezinye izingxenye zomzimba.

Lezi zigaba ezilandelayo zisetshenziselwa i-GTN:

Isiteji I

Esigabeni I, isimila sisesibelethweni kuphela.

Isigaba II

Esigabeni II, umdlavuza usabalale ngaphandle kwesibeletho uye esibelethweni, ishubhu lesizalo, isitho sangasese sowesifazane, kanye / noma imigudu esekela isibeletho.

Isigaba III

Esigabeni III, umdlavuza ususabalele emaphashini.

Isigaba IV

Esigabeni IV, umdlavuza usabalalele ezingxenyeni ezikude zomzimba ngaphandle kwamaphaphu.

Ukwelashwa kwe-neoplasia ye-gestational trophoblastic neoplasia kusekelwe ohlotsheni lwesifo, isigaba, noma iqembu lobungozi.

Izimvukuzane ezihlaselayo nama-choriocarcinomas ziphathwa ngokuya ngamaqembu engcuphe. Isigaba semvukuzane engenayo noma i-choriocarcinoma yisici esisodwa esisetshenziselwa ukunquma iqembu eliyingozi. Ezinye izinto zifaka okulandelayo:

• Iminyaka yesiguli lapho kutholakala ukuxilongwa.

• Ukuthi i-GTN yenzeke ngemuva kokukhulelwa kwe-molar, ukukhulelwa kwesisu, noma ukukhulelwa okujwayelekile.

• Kusheshe kwatholakala ukuthi isimila ngemuva kokuqala kokukhulelwa.

• Izinga le-beta chorionic gonadotropin (β-hCG) egazini.

• Usayizi wesimila esikhulu kunazo zonke.

• Lapho isimila sisabalalele khona kanye nenani lezimila emzimbeni.

• Zingaki izidakamizwa zokwelashwa ngamakhemikhali lesi sifo eselashwe ngaso (ngezimila eziphindaphindayo noma ezingazweli).

Kunamaqembu amabili engcuphe yezimvukuzane ezingenayo kanye nama-choriocarcinomas: ubungozi obuphansi nobungozi obukhulu. Iziguli ezinezifo ezinobungozi obuphansi zivame ukuthola ukwelashwa okuncane kakhulu kuneziguli ezinezifo ezinobungozi obukhulu.

Ukwelashwa kwe-Placental-site trophoblastic tumor (PSTT) kanye nokwelashwa kwe-epithelioid trophoblastic tumor (ETT) kuncike esigabeni sesifo.

I-Neoplasia ye-Gestational Trophoblastic ejwayelekile futhi ephikisayo

I-neoplasia ejwayelekile ye-gestational trophoblastic neoplasia (i-GTN) umdlavuza ophindile (wabuya) ngemuva kokwelashwa. Umdlavuza ungabuya esibelethweni noma kwezinye izingxenye zomzimba.

I-Gestational trophoblastic neoplasia engaphenduli ekwelashweni ibizwa nge-resistant GTN.

Uhlolojikelele lwenketho yokwelashwa

AMAPHUZU ASEMQOKA

• Kunezinhlobo ezahlukahlukene zokwelashwa kweziguli ezine-gestational trophoblastic disease.

• Izinhlobo ezintathu zokwelashwa okujwayelekile zisetshenzisiwe:

• Ukuhlinzwa

• Ukwelashwa ngamakhemikhali

• Ukwelashwa ngemisebe

• Izinhlobo ezintsha zokwelashwa ziyahlolwa ezivivinyweni zokwelashwa.

• Ukwelashwa kwesifo se-gestational trophoblastic 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-gestational trophoblastic disease.

Izinhlobo ezahlukene zokwelashwa ziyatholakala ezigulini ezinesifo sokukhulelwa kwe-trophoblastic. Ezinye izindlela zokwelapha zijwayelekile (indlela esetshenziswa njengamanje), kanti ezinye ziyahlolwa ezivivinyweni zokwelashwa. Ngaphambi kokuqala ukwelashwa, iziguli zingafuna ukucabanga ngokubamba iqhaza esivivinyweni somtholampilo. 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.

Ukuhlolwa kwemitholampilo kuyenzeka ezingxenyeni eziningi zezwe. Imininingwane mayelana nokuhlolwa kwemitholampilo okuqhubekayo iyatholakala kuwebhusayithi ye-NCI. Ukukhetha ukwelashwa komdlavuza okufanele kunazo zonke kuyisinqumo esithinta kahle isiguli, umndeni kanye neqembu lokunakekelwa kwezempilo.

Izinhlobo ezintathu zokwelashwa okujwayelekile zisetshenzisiwe:

Ukuhlinzwa

Udokotela angawususa umdlavuza esebenzisa eyodwa yalezi zinto ezilandelayo:

• Ukwehliswa kanye ne-curettage (i-D & C) ngokukhishwa kokudonswa: Inqubo yokuhlinza ukususa izicubu ezingejwayelekile nezingxenye zolwelwesi lwangaphakathi lwesibeletho. Umlomo wesibeletho uyanwetshwa bese okususwa ngaphakathi kwesibeletho kukhishwe ngethuluzi elincane elifana ne-vacuum. Izindonga zesibeletho bese zisongwa ngobumnene nge-curette (insimbi emise okwe-spoon) ukususa noma yini engase ihlale esibelethweni. Le nqubo ingasetshenziselwa ukukhulelwa kwe-molar.

Ukwehlukaniswa nokwelashwa (D no-C). Kufakwa i-speculum esithweni sangasese ukuyikhulisa ukuze kubhekwe umlomo wesibeletho (iphaneli yokuqala). I-dilator isetshenziselwa ukunweba umlomo wesibeletho (iphaneli eliphakathi nendawo). I-curette ifakwa ngomlomo wesibeletho iye esibelethweni ukuze kukhuculwe izicubu ezingajwayelekile (iphaneli lokugcina).

• I-Hysterectomy: Ukuhlinzwa ukususa isibeletho, kwesinye isikhathi umlomo wesibeletho. Uma isibeletho nomlomo wesibeletho kukhishwa ngesitho sangasese sowesifazane, ukuhlinzwa kubizwa nge-hysterectomy yesitho sangasese sowesifazane. Uma isibeletho nomlomo wesibeletho kukhishwa ngokusebenzisa ukusikeka okukhulu esiswini, ukuhlinzwa kubizwa ngokuthi yi-hysterectomy ephelele yesisu. Uma isibeletho nomlomo wesibeletho kukhishwa ngesikezi esincane (esisikiwe) esiswini kusetshenziswa i-laparoscope, ukuhlinzwa kubizwa ngokuthi yi-laparoscopic hysterectomy ephelele.

I-Hysterectomy. Isibeletho sisuswa ngokuhlinzwa noma ngaphandle kwezinye izitho noma izicubu. Ku-hysterectomy ephelele, isibeletho nomlomo wesibeletho kuyasuswa. Ku-hysterectomy ephelele ene-salpingo-oophorectomy, (a) kukhishwa isibeletho kanye ne-one (unilateral) ovary kanye ne-fallopian tube; noma (b) kukhishwe isibeletho kanye nawo womabili (amabhilidi) amaqanda kanye namashubhu e-fallopian. Ku-hysterectomy enamandla, kukhishwa isibeletho, umlomo wesibeletho, womabili amaqanda, amashubhu womabili, nezicubu eziseduze. Lezi zinqubo zenziwa kusetshenziswa imbobo ephansi enqamulelayo noma imbobo ebheke phezulu.

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

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 zingafinyelela kumaseli womdlavuza emzimbeni wonke (systemic chemotherapy). Lapho i-chemotherapy ifakwa ngqo ku-cerebrospinal fluid, isitho, noma umgodi womzimba njengesisu, izidakamizwa zithinta kakhulu amangqamuzana omdlavuza kulezo zindawo (i-chemotherapy yesifunda). Indlela i-chemotherapy enikezwa ngayo incike ohlotsheni nesigaba somdlavuza owelashwa, noma ngabe isimila sinengozi encane noma sengozini enkulu.

Inhlanganisela yamakhemikhali ukwelashwa kusetshenziswa izidakamizwa ezingaphezu kwesisodwa ze-anticancer.

Bheka Izidakamizwa Kuvunyelwe Izifo Ze-Gestational Trophoblastic ukuthola eminye imininingwane.

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.

• Ukwelashwa kwemisebe kwangaphakathi kusebenzisa into enemisebe eboshwe ngezinaliti, izimbewu, izintambo, noma ama-catheters abekwe ngqo noma eduze komdlavuza.

Indlela okunikezwa ngayo ukwelashwa ngemisebe kuncike ohlotsheni lwesifo se-gestational trophoblastic isifo eselaphwayo. Ukwelashwa kwemisebe yangaphandle kusetshenziselwa ukwelapha isifo se-gestational trophoblastic.

Izinhlobo ezintsha zokwelashwa ziyahlolwa ezivivinyweni zokwelashwa.

Imininingwane mayelana nokuhlolwa kwemitholampilo okuqhubekayo iyatholakala kuwebhusayithi ye-NCI.

Ukwelashwa kwesifo se-gestational trophoblastic 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.

Amazinga egazi we-beta chorionic gonadotropin (β-hCG) azohlolwa izinyanga ezi-6 ngemuva kokuphela kokwelashwa. Lokhu kungenxa yokuthi izinga le-β-hCG eliphakeme kunokujwayelekile lingasho ukuthi isimila asiphendulanga ekwelashweni noma sesibe ngumdlavuza.

Izinketho Zokwelashwa Kwezifo ZaseGestational Trophoblastic

Kulesi Sigaba

• Izimvukuzane ze-Hydatidiform

• I-Gestational Trophoblastic Neoplasia

• Ingozi ephansi ye-Gestational Trophoblastic Neoplasia

• Ingozi ephezulu yeMetastatic Gestational Trophoblastic Neoplasia

• Amathumba we-Placental-Site Gestational Trophoblastic Tumors kanye ne-Epithelioid Trophoblastic Tumors

• I-Neoplasia ye-Gestational Trophoblastic ejwayelekile noma ephikisayo

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

Izimvukuzane ze-Hydatidiform

Ukwelashwa kwemvukuzane ye-hydatidiform kungafaka okulandelayo:

• Ukuhlinzwa (Ukwehliswa kanye ne-curettage ngokususwa kokudonswa) ukususa isimila.

Ngemuva kokuhlinzwa, ukuhlolwa kwegazi kwe-beta human chorionic gonadotropin (β-hCG) kwenziwa njalo ngesonto kuze kube izinga le-β-hCG libuyela kokujwayelekile. Iziguli zinokuvakashelwa kodokotela okulandelwayo njalo ngenyanga kuze kube izinyanga eziyisithupha. Uma izinga le-β-hCG lingabuyeli kokujwayelekile noma linyuke, kungasho ukuthi imvukuzane ye-hydatidiform ayisuswanga ngokuphelele futhi isiphenduke umdlavuza. Ukukhulelwa kubangela amazinga e-β-hCG akhule, ngakho-ke udokotela wakho uzokucela ukuthi ungakhulelwa kuze kube yilapho ukulandelwa sekuqedile.

Ngokwesifo esisele ngemuva kokuhlinzwa, ukwelashwa imvamisa kuyikhemotherapy.

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-Gestational Trophoblastic Neoplasia

Ingozi ephansi ye-Gestational Trophoblastic Neoplasia

Ukwelashwa kwe-neoplasia ye-trophoblastic neoplasia (GTN) enobungozi obuphansi (imvukuzane engenayo noma i-choriocarcinoma) kungafaka okulandelayo:

• I-Chemotherapy ngomuthi owodwa noma ngaphezulu we-anticancer. Ukwelashwa kunikezwa kuze kufike ezingeni le-beta human chorionic gonadotropin (β-hCG) elejwayelekile okungenani amasonto ama-3 ngemuva kokuphela kokwelashwa.

Uma izinga le-β-hCG egazini lingabuyeli kwesejwayelekile noma isimila sisakazekela ezingxenyeni ezikude zomzimba, kunikezwa izinhlobo zamakhemikhali ezisetshenziselwa ingozi yemetastatic GTN.

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.

Ingozi ephezulu yeMetastatic Gestational Trophoblastic Neoplasia

Ukwelashwa kwe-metastatic metastatic gestational trophoblastic neoplasia (imvukuzane engenayo noma i-choriocarcinoma) kungafaka okulandelayo:

• Inhlanganisela chemotherapy.

• I-Intrathecal chemotherapy kanye nokwelashwa ngemisebe ebuchosheni (ngomdlavuza osabalalele emaphashini, ukuwugcina ungasabalali ubuchopho).

• I-chemotherapy ephezulu noma i-intrathecal chemotherapy kanye / noma i-radiation therapy ebuchosheni (yomdlavuza osakaze ebuchosheni).

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.

Amathumba we-Placental-Site Gestational Trophoblastic Tumors kanye ne-Epithelioid Trophoblastic Tumors

Ukwelashwa kwezicubu zesiteji se-placental-site gestational trophoblastic and epithelioid trophoblastic tumors kungafaka okulandelayo:

• Ukuhlinzwa ukususa isibeletho.

Ukwelashwa kwesigaba sesibili se-placental-site gestational trophoblastic tumors kanye ne-epithelioid trophoblastic tumors kungafaka okulandelayo:

• Ukuhlinzwa kususwe isimila, esingalandelwa yinhlanganisela yamakhemikhali.

Ukwelashwa kwesigaba sesithathu se-III kanye ne-IV se-placental-site gestational trophoblastic tumors kanye ne-epithelioid trophoblastic tumors kungafaka okulandelayo:

• Inhlanganisela chemotherapy.

• Ukuhlinzwa ukususa umdlavuza osusabalale wahambela kwezinye izindawo, njengamaphaphu noma isisu.

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-Neoplasia ye-Gestational Trophoblastic ejwayelekile noma ephikisayo

Ukwelashwa kwesimila esivela njalo noma esiphikisayo sokukhulelwa kungafaka okulandelayo:

• I-Chemotherapy ngomuthi owodwa noma ngaphezulu we-anticancer yamathumba aphathwa ngaphambilini ngokuhlinzwa.

• Inhlanganisela yamakhemikhali ngamathumba aphathwa ngaphambilini ngamakhemikhali.

• Ukuhlinzwa kwezicubu ezingaphenduli ekhemotherapy.

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 mayelana nezifo ze-Gestational Trophoblastic

Ngemininingwane engaphezulu evela ku-National Cancer Institute mayelana nezimila zokukhulelwa kanye neoplasia, bheka okulandelayo:

• Ikhasi lasekhaya le-Gestational Trophoblastic Page

• Izidakamizwa Zivunyelwe Isifo Sokukhulelwa Kokukhulelwa

• I-Metastatic Cancer

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

Mayelana Nesi Sifinyezo se-

Mayelana ne-

I-Physician Data Query () yi-National Cancer Institute's (NCI's) yemininingwane ephelele yomdlavuza. Idathabheyisi ye- iqukethe ukufingqwa kolwazi olushicilelwe lwakamuva ngokuvikela umdlavuza, ukuthola, ufuzo, ukwelashwa, ukunakekelwa okusekelayo, kanye nomuthi ohambisanayo neminye. Ukufingqa okuningi kuza ngezinhlobo ezimbili. Izinhlobo zezempilo zinemininingwane ebhalwe ngolimi lobuchwepheshe. Izinhlobo zesiguli zibhalwe ngolimi olulula ukuluqonda nolungebona ubuchwepheshe. Zombili izinguqulo zinolwazi lomdlavuza olunembile nolusesikhathini futhi izinhlobo eziningi ziyatholakala ngeSpanishi.

I- iyinsizakalo ye-NCI. I-NCI iyingxenye yeNational Institutes of Health (NIH). I-NIH iyisikhungo sikahulumeni wesifundazwe sokucwaninga ngemvelo. Ukufingqwa kwe- kusekelwe ekubuyekezweni okuzimele kwemibhalo yezokwelapha. Akuzona izitatimende zenqubomgomo ze-NCI noma i-NIH.

Inhloso yalesi Sifinyezo

Lesi sifinyezo solwazi lomdlavuza se- sinemininingwane yamanje mayelana nokwelashwa kwesifo se-gestational trophoblastic. Yenzelwe ukwazisa nokusiza iziguli, imindeni, nabanakekeli. Ayinikezi imihlahlandlela esemthethweni noma izincomo zokwenza izinqumo mayelana nokunakekelwa kwezempilo.

Ababuyekezi nezibuyekezo

Amabhodi Wokuhlela abhala izifinyezo zolwazi lomdlavuza we- futhi azigcine zisesikhathini. Lawa maBhodi akhiwe ngochwepheshe bezokwelapha umdlavuza nezinye izinto ezihlobene nomdlavuza. Ukufingqwa kubuyekezwa njalo futhi kwenziwa izinguquko uma kunolwazi olusha. Idethi yesifinyezo ngasinye ("Kubuyekezwe") idethi yoshintsho lwakamuva kakhulu.

Imininingwane ekulesi sifinyeto sesiguli ithathwe enguqulweni yezempilo, ebuyekezwa njalo futhi ivuselelwe njengoba kudingeka, yiBhodi labahleli bezokwelashwa kwe- Adult Treatment.

Imininingwane Yesivivinyo Somtholampilo

Isivivinyo somtholampilo yisifundo sokuphendula umbuzo wesayensi, njengokuthi ngabe ukwelashwa okukodwa kungcono yini kunokunye. Izilingo zisuselwa ezifundweni ezedlule nakulokho okufundiwe elebhu. Isivivinyo ngasinye siphendula imibuzo ethile yesayensi ukuze kutholakale izindlela ezintsha nezingcono zokusiza iziguli ezinomdlavuza. Ngesikhathi sokuhlolwa kwemitholampilo yokwelashwa, ulwazi luyaqoqwa ngemiphumela yokwelashwa okusha nokuthi kusebenza kanjani kahle. Uma ukuhlolwa komtholampilo kukhombisa ukuthi ukwelashwa okusha kungcono kunalokho okusetshenziswayo njengamanje, ukwelashwa okusha kungaba "okujwayelekile." Iziguli zingafuna ukucabanga ngokubamba iqhaza esivivinyweni somtholampilo. Ezinye izivivinyo zokwelashwa zivulekele kuphela iziguli ezingakaqali ukwelashwa.

Ukuhlolwa kwemitholampilo kungatholakala ku-inthanethi kuwebhusayithi ye-NCI. Ngeminye imininingwane, shayela iCancer Information Service (CIS), isikhungo sokuxhumana se-NCI, ku-1-800-4-CANCER (1-800-422-6237).

Imvume yokusebenzisa lesi sifinyezo

I- wuphawu lokuhweba olubhalisiwe. Okuqukethwe kwemibhalo ye- kungasetshenziswa ngokukhululeka njengombhalo. Ayikwazi ukubonwa njengesifinyezo solwazi lomdlavuza se-NCI ngaphandle kokuthi sonke isifinyezo sikhonjiswe futhi sibuyekezwa njalo. Kodwa-ke, umsebenzisi angavunyelwa ukuthi abhale umusho onjengokuthi “Isifinyezo solwazi lomdlavuza se-NCI sika-NCI mayelana nokuvinjelwa umdlavuza webele sichaza izingozi ngale ndlela elandelayo: [faka nengcaphuno yesifinyezo].”

Indlela enhle yokusho lesi sifinyezo se- yile:

Izithombe ezikulesi sifinyezo zisetshenziswa ngemvume yombhali, yomculi, kanye / noma yomshicileli ukuze zisetshenziswe kwizifinyezo ze- kuphela. Uma ufuna ukusebenzisa isithombe kusuka kusifinyezo se- futhi awusisebenzisi isifinyezo sonke, kufanele uthole imvume kumnikazi. Ayikwazi ukunikezwa yiNational Cancer Institute. Imininingwane yokusebenzisa izithombe ezikulesi sifinyezo, kanye nezinye izithombe eziningi ezihlobene nomdlavuza zingatholakala ku-Visuals Online. I-Visuals Online iqoqo lezithombe zesayensi ezingaphezu kuka-3,000.

Ukuzikhulula

Imininingwane ekulezi zifinyezo akufanele isetshenziselwe ukwenza izinqumo mayelana nokubuyiselwa kwemali yomshuwalense. Imininingwane engaphezulu ngokutholakala komshuwalense iyatholakala kuCancer.gov ekhasini elithi Managing Cancer Care.

Xhumana nathi

Imininingwane engaphezulu ngokuxhumana nathi noma ukuthola usizo ngewebhusayithi yeCancer.gov ingatholakala ekhasini lethu Xhumana nathi ukuze uthole usizo. Imibuzo ingathunyelwa nakuCancer.gov nge-imeyili Ewebhusayithi yethu

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