Izinhlobo / ikhanda-nentamo / isiguli / umuntu omdala / i-oropharyngeal-treatment-pdq

Ukwelashwa Komdlavuza we-Oropharyngeal (Abadala) (®) –Patient Version

Imininingwane Jikelele Ngomdlavuza we-Oropharyngeal

AMAPHUZU ASEMQOKA

• Umdlavuza we-Oropharyngeal yisifo lapho amangqamuzana abulalayo (umdlavuza) akha izicubu ze-oropharynx.

• Ukubhema noma ukutheleleka nge-human papillomavirus (HPV) kungakhuphula ingozi yomdlavuza we-oropharyngeal.

• Izimpawu nezimpawu zomdlavuza we-oropharyngeal zifaka phakathi isigaxa entanyeni nomphimbo obuhlungu.

• Izivivinyo ezihlola umlomo nomphimbo zisetshenziselwa ukusiza ukuxilonga nokukhulisa umdlavuza we-oropharyngeal.

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

Umdlavuza we-Oropharyngeal yisifo lapho amangqamuzana abulalayo (umdlavuza) akha izicubu ze-oropharynx.

I-oropharynx yingxenye emaphakathi yepharynx (umphimbo), ngemuva komlomo. Ipharynx yishubhu elingenalutho elingaba ngamasentimitha ama-5 ubude eliqala ngemuva kwekhala bese liphela lapho kuqalwa khona uqhoqhoqho (i-windpipe) kanye nomphimbo (ishubhu elisuka emphinjeni kuye esiswini). Umoya nokudla kudlula kwi-pharynx endleleni eya ku-trachea noma i-esophagus.

I-anatomy yepharynx (umphimbo). Umphimbo uyishubhu elingenalutho eliqala ngemuva kwekhala, lehle entanyeni, bese liphelela phezulu koqhoqhoqho nomphimbo. Izingxenye ezintathu ze-pharynx yi-nasopharynx, i-oropharynx, ne-hypopharynx.

I-oropharynx ifaka okulandelayo:

• Ulwanga oluthambile.

• Izindonga ezinhlangothini nangemuva zomphimbo.

• Amathani.

• Emuva ingxenye eyodwa kwezintathu zolimi.

Izingxenye ze-oropharynx. I-oropharynx ifaka phakathi ulwanga oluthambile, uhlangothi nodonga lwangemuva lomphimbo, amalaka, nengxenye yesithathu engemuva yethong

Umdlavuza we-Oropharyngeal wuhlobo lomdlavuza wekhanda nentamo. Kwesinye isikhathi kungenzeka umdlavuza ongaphezu kowodwa ku-oropharynx nakwezinye izingxenye zomlomo womlomo, impumulo, ipharynx, i-larynx (ibhokisi lezwi), i-trachea, noma i-esophagus ngasikhathi sinye.

Iningi lomdlavuza we-oropharyngeal yi-squamous cell carcinomas. Amaseli we-squamous amangqamuzana amancane, acabalele angaphakathi kwe-oropharynx.

Bona izifinyezo ezilandelayo ze- ukuthola eminye imininingwane mayelana nezinye izinhlobo zomdlavuza wekhanda nentamo:

• Ukwelashwa Komdlavuza We-Hypopharyngeal (Wabantu Abadala)

• Ukwelashwa Komdlavuza Wezindebe Nomlomo (Umuntu Omdala)

• I-Oral Cavity, Pharyngeal, kanye neLaryngeal Cancer Prevention

• Umlomo we-Oral Cavity, Pharyngeal, kanye neLaryngeal Cancer

Ukubhema noma ukutheleleka nge-human papillomavirus (HPV) kungakhuphula ingozi yomdlavuza we-oropharyngeal.

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 eziyingozi kakhulu zomdlavuza we-oropharyngeal zifaka okulandelayo:

• Umlando wokubhema osikilidi iminyaka engaphezu kwengu-10 yamaphakethe nokunye ukusetshenziswa kukagwayi.

• Ukutheleleka nge-human papillomavirus (HPV), ikakhulukazi uhlobo lwe-HPV 16. Isibalo samacala omdlavuza we-oropharyngeal axhumene nokutheleleka kwe-HPV siyanda.

• Umlando womuntu siqu womdlavuza wekhanda nentamo.

• Ukuphuza kakhulu utshwala.

• Ukuhlafuna i-betel quid, isikhuthazi esivame ukusetshenziswa ezingxenyeni ezithile zase-Asia.

Izimpawu nezimpawu zomdlavuza we-oropharyngeal zifaka phakathi isigaxa entanyeni nomphimbo obuhlungu.

Lezi kanye nezinye izimpawu nezimpawu zingabangelwa umdlavuza we-oropharyngeal noma ezinye izimo. Buza nodokotela wakho uma unokunye kwalokhu okulandelayo:

• Umphimbo obuhlungu ongapheli.

• Inkinga yokugwinya.

• Inkinga yokuvula umlomo ngokugcwele.

• Inkinga yokuhambisa ulimi.

• Ukwehla kwesisindo ngaphandle kwesizathu esaziwayo.

• Ubuhlungu bendlebe.

• Isigaxa ngemuva komlomo, umphimbo, noma intamo.

• Isiqephu esimhlophe olimini noma ulwelwesi lomlomo olungapheli.

• Akhwehlele igazi.

Kwesinye isikhathi umdlavuza we-oropharyngeal awubangeli izimpawu noma izimpawu zakuqala.

Izivivinyo ezihlola umlomo nomphimbo zisetshenziselwa ukusiza ukuxilonga nokukhulisa umdlavuza we-oropharyngeal.

Lezi zivivinyo nezinqubo ezilandelayo zingasetshenziswa:

• Ukuhlolwa komzimba kanye nomlando wezempilo: Ukuhlolwa komzimba ukuhlola izimpawu ezijwayelekile zempilo, kufaka phakathi ukuhlola izimpawu zesifo, njengokuvuvukala kwama-lymph node entanyeni noma yini enye ebonakala ingajwayelekile. Udokotela noma udokotela wamazinyo uhlola ngokuphelele umlomo nentamo bese ebheka ngaphansi kolimi nangaphansi komphimbo ngesibuko esincane, esiphatha isikhathi eside ukubheka izindawo ezingejwayelekile. Kuzothathwa nomlando wemikhuba yezempilo yesiguli kanye nokugula nokwelashwa kwangaphambilini.

• Ukuhlolwa kwe-Neurological: Uchungechunge lwemibuzo novivinyo lokuhlola ubuchopho, umgogodla nokusebenza kwe-nerve. Isivivinyo sihlola isimo somuntu somqondo, ukusebenzisana, kanye nekhono lokuhamba ngokujwayelekile, nokuthi izicubu, izinzwa, nokucabanga kusebenza kahle kangakanani. Lokhu kungabizwa nangokuthi ukuhlolwa kwe-neuro noma ukuhlolwa kwe-neurologic.

• I-PET-CT scan: Inqubo ehlanganisa izithombe kusuka kuskena se-positron emission tomography (PET) kanye nokuskena kwe-computed tomography (CT). Izikena ze-PET ne-CT zenziwa ngasikhathi sinye ngomshini ofanayo. Izikena ezihlanganisiwe zinikeza izithombe ezinemininingwane eminingi yezindawo ezingaphakathi komzimba kunalokho ukuskena okunikezayo ngokwakho. Ukuskena kwe-PET-CT kungasetshenziselwa ukuxilonga izifo, njengomdlavuza, ukuhlela ukwelashwa, noma ukuthola ukuthi ukwelashwa kusebenza kahle kangakanani.

• I-CT scan (i-CAT scan): Inqubo eyenza uchungechunge lwezithombe eziningiliziwe zezindawo ezingaphakathi komzimba, ezinjengekhanda, intamo, isifuba nama-lymph node, athathwe ezinhlangothini ezahlukene. Izithombe zenziwa yikhompyutha exhunywe kumshini we-x-ray. Idayi ifakwa emthanjeni noma igwinywe ukusiza izitho noma izicubu zivele kahle. Le nqubo ibizwa nangokuthi i-computed tomography, i-computerized tomography, noma i-computer axial tomography.

Iskena sekhompiyutha (CT) sekhanda nentamo. Isiguli silele etafuleni elishibilika ngesithwebuli se-CT, esithatha izithombe ze-x-ray ezingaphakathi kwekhanda nentamo.

• 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.

Iskena se-PET (positron emission tomography). Isiguli silele etafuleni elihamba ngomshini we-PET. Ukuphumula kwekhanda nomucu omhlophe kusiza isiguli ukuba silele singanyakazi. Inani elincane le-glucose enemisebe (ushukela) lifakwa emthanjeni wesiguli, 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, amagagasi omsakazo, nekhompyutha ukwenza uchungechunge lwezithombe ezinemininingwane yezindawo ezingaphakathi komzimba. Le nqubo ibizwa nangokuthi i-nuclear magnetic resonance imaging (i-NMRI).

• I-Biopsy: Ukususwa kwamaseli noma izicubu ukuze kubhekwe ngaphansi kwesibonakhulu ngudokotela wezifo ukuhlola izimpawu zomdlavuza. I-biopsy yenaliti enhle ivame ukwenziwa ukususa isampula lezicubu kusetshenziswa inaliti ezacile.

Izinqubo ezilandelayo zingasetshenziswa ukususa amasampula amaseli noma izicubu:

• I-Endoscopy: Inqubo yokubheka izitho nezicubu ngaphakathi komzimba ukubheka izindawo ezingajwayelekile. I-endoscope ifakwa ngokusika (ukusika) esikhunjeni noma ekuvulekeni emzimbeni, njengomlomo noma ikhala. I-endoscope iyinsimbi encane, efana nethubhu enokukhanya nelensi yokubuka. Kungaba futhi nethuluzi lokususa izicubu ezingajwayelekile noma amasampula e-lymph node, ahlolwe ngaphansi kwesibonakhulu ukuthola izimpawu zesifo. Kuzobhekwa ikhala, umphimbo, emuva kolimi, iminjunju, isisu, umphimbo, i-windpipe, nemigwaqo emikhulu yomoya. Uhlobo lwe-endoscopy lubizwa ngengxenye yomzimba ehlolwayo. Isibonelo, i-pharyngoscopy ukuhlolwa ukuhlola i-pharynx.

• I-Laryngoscopy: Inqubo lapho udokotela ehlola i-larynx (ibhokisi lezwi) ngesibuko noma nge-laryngoscope ukubheka izindawo ezingejwayelekile. I-laryngoscope iyinsimbi encane, efana nethubhu enokukhanya nelensi yokubuka ingaphakathi lomphimbo nebhokisi lezwi. Kungaba futhi nethuluzi lokususa amasampula wezicubu, ahlolwe ngaphansi kwesibonakhulu ukuthola izimpawu zomdlavuza.

Uma umdlavuza utholakala, lokhu kuhlolwa okulandelayo kungenziwa ukutadisha amaseli womdlavuza:

• Ukuhlolwa kwe-HPV (ukuhlolwa kwe-human papillomavirus test): Ukuhlolwa kwaselabhorethri okusetshenziselwa ukuhlola isampula lezicubu ezinhlotsheni ezithile zokutheleleka nge-HPV, njengeHPV uhlobo 16. Lokhu kuhlolwa kwenziwa ngoba umdlavuza we-oropharyngeal ungabangelwa ukutheleleka kwe-HPV. Lokhu kubalulekile ngoba umdlavuza we-HPV-positive oropharyngeal unesibikezelo esingcono futhi uphathwa ngokuhlukile kunomdlavuza we-HPV-negative oropharyngeal.

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

Isibikezelo sincike kulokhu okulandelayo:

• Ukuthi isiguli sine-HPV ukutheleleka kwe-oropharynx.

• Ukuthi isiguli sinomlando wokubhema osikilidi iminyaka eyishumi noma ngaphezulu yamaphakethe.

• Isigaba somdlavuza.

• Inani nosayizi wama-lymph node anomdlavuza.

Izicubu ze-Oropharyngeal ezihlobene nokutheleleka kwe-HPV zinokubikezela okungcono futhi mancane amathuba okuthi ziphinde zibuye ngaphandle kwezicubu ezingaxhunywanga nokutheleleka kwe-HPV.

Izinketho zokwelashwa zincike kokulandelayo:

• Isigaba somdlavuza.

• Ukugcina amandla esiguli okukhuluma nokugwinya njengokujwayelekile ngangokunokwenzeka.

• Impilo ejwayelekile yesiguli.

Iziguli ezinomdlavuza we-oropharyngeal zinengozi eyengeziwe yomunye umdlavuza ekhanda noma entanyeni. Le ngozi inyuka ezigulini eziqhubeka nokubhema noma ukuphuza utshwala ngemuva kokwelashwa.

Bona isifinyezo se- Ukubhema Ugwayi: Izingozi Zezempilo nokuthi Ungakuyeka Kanjani ukuthola eminye imininingwane.

Izigaba zeCancer Oropharyngeal

AMAPHUZU ASEMQOKA

• Ngemuva kokutholakala komdlavuza we-oropharyngeal, kwenziwa ukuhlolwa ukuthola ukuthi amangqamuzana omdlavuza asakazekile ngaphakathi kwe-oropharynx noma kwezinye izingxenye zomzimba.

• Zintathu izindlela umdlavuza osakazeka ngayo emzimbeni.

• Umdlavuza ungasakazeka usuka lapho uqale khona kwezinye izingxenye zomzimba.

• Lezi zigaba ezilandelayo zisetshenziselwa i-HPV-positive oropharyngeal cancer:

• Isiteji I

• Isigaba II

• Isigaba III

• Isigaba IV

• Lezi zigaba ezilandelayo zisetshenziselwa i-HPV-negative oropharyngeal cancer:

• Isigaba 0 (I-Carcinoma eSitu)

• Isiteji I

• Isigaba II

• Isigaba III

• Isigaba IV

Ngemuva kokutholakala komdlavuza we-oropharyngeal, kwenziwa ukuhlolwa ukuthola ukuthi amangqamuzana omdlavuza asakazekile ngaphakathi kwe-oropharynx noma kwezinye izingxenye zomzimba.

Inqubo esetshenziselwa ukuthola ukuthi umdlavuza usakaze ngaphakathi kwe-oropharynx noma kwezinye izingxenye zomzimba ibizwa nge-staging. Imininingwane eqoqwe kusuka kusistimu yesiteji inquma isigaba sesifo. Kubalulekile ukwazi isigaba ukuze uhlele ukwelashwa. Imiphumela yolunye uvivinyo olusetshenziselwa ukuxilonga umdlavuza we-oropharyngeal luvame ukusetshenziselwa ukubeka lesi sifo.

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-oropharyngeal usakazeka uye emaphashini, amangqamuzana omdlavuza amaphaphu empeleni angamaseli omdlavuza we-oropharyngeal. Lesi sifo umdlavuza we-metastatic oropharyngeal, hhayi umdlavuza wamaphaphu.

Lezi zigaba ezilandelayo zisetshenziselwa i-HPV-positive oropharyngeal cancer:

Isiteji I

Esigabeni I, okukodwa kokulandelayo kuyiqiniso:

• kutholakala i-lymph node eyodwa noma amaningi anomdlavuza okuyi-HPV p16-positive kodwa indawo lapho umdlavuza waqala khona ayaziwa. Ama-lymph node anomdlavuza angamasentimitha ayi-6 noma amancane, kolunye uhlangothi lwentamo; noma

• umdlavuza utholakala ku-oropharynx (emphinjeni) kuthi isimila sibe ngamasentimitha amane noma ngaphansi. Umdlavuza kungenzeka usabalalele ku-lymph node eyodwa noma amaningi angamasentimitha ayi-6 noma amancane, ohlangothini olufanayo lwentamo njengesimila sokuqala.

Osayizi bezicubu bavame ukulinganiswa ngamasentimitha (cm) noma amasentimitha. Izinto zokudla ezijwayelekile ezingasetshenziswa ukukhombisa usayizi wesimila ngo-cm zifaka: ipea (1 cm), iphenathi (2 cm), umvini (3 cm), i-walnut (4 cm), umcako (5 cm noma 2) amasentimitha), iqanda (6 cm), ipentshisi (7 cm), ne-grapefruit (10 cm noma 4 inches).

Isigaba II

Esigabeni II, okunye kokulandelayo kuyiqiniso:

• kutholakala i-lymph node eyodwa noma amaningi anomdlavuza okuyi-HPV p16-positive kodwa indawo lapho umdlavuza waqala khona ayaziwa. Ama-lymph node anomdlavuza angamasentimitha ayi-6 noma amancane, kolunye noma ezinhlangothini zombili zentamo; noma

• isimila singamasentimitha amane noma sincane. Umdlavuza usabalalele kuma-lymph node angamasentimitha ayi-6 noma amancane, kolunye uhlangothi lwentamo njengesimila sokuqala noma ezinhlangothini zombili zentamo; noma

• isimila sikhulu kunamasentimitha ama-4 noma umdlavuza usabalele phezulu kwe-epiglottis (ichopho elihlanganisa uqhoqhoqho ngesikhathi sokugwinya). Umdlavuza kungenzeka usabalalele ku-lymph node eyodwa noma amaningi angamasentimitha ayi-6 noma amancane, noma yikuphi entanyeni.

Isigaba III

Esigabeni III, okukodwa kokulandelayo kuyiqiniso:

• umdlavuza usabalalele emphinjeni (izwi lezwi), engxenyeni engaphambili yophahla lomlomo, umhlathi ophansi, imisipha ehambisa ulimi, noma kwezinye izingxenye zekhanda noma zentamo. Umdlavuza kungenzeka usabalalele kuma-lymph node entanyeni; noma

• isimila sinobukhulu buphi kanti umdlavuza kungenzeka ukuthi usabalalele emphinjeni, engxenyeni engaphambili yophahla lomlomo, umhlathi ophansi, imisipha ehambisa ulimi, noma kwezinye izingxenye zekhanda noma zentamo. Umdlavuza usabalalele ku-lymph node eyodwa noma ngaphezulu amakhulu kunamasentimitha ayisithupha, noma kuphi entanyeni.

Isigaba IV

Esigabeni IV, umdlavuza usabalalele kwezinye izingxenye zomzimba, njengephaphu noma ithambo.

Lezi zigaba ezilandelayo zisetshenziselwa i-HPV-negative oropharyngeal cancer:

Isigaba 0 (I-Carcinoma eSitu)

Esigabeni 0, amangqamuzana angajwayelekile atholakala kulayini we-oropharynx (umphimbo). Lawa maseli angajwayelekile angaba ngumdlavuza futhi asabalale abe izicubu ezijwayelekile eziseduze. Isigaba 0 sibizwa nangokuthi i-carcinoma in situ.

Isiteji I

Esigabeni I, umdlavuza wakhekile. Isimila singamasentimitha amabili noma sincane.

Osayizi bezicubu bavame ukulinganiswa ngamasentimitha (cm) noma amasentimitha. Izinto zokudla ezijwayelekile ezingasetshenziswa ukukhombisa usayizi wesimila ngo-cm zifaka: ipea (1 cm), iphenathi (2 cm), umvini (3 cm), i-walnut (4 cm), umcako (5 cm noma 2) amasentimitha), iqanda (6 cm), ipentshisi (7 cm), ne-grapefruit (10 cm noma 4 inches).

Isigaba II

Esigabeni II, isimila sikhulu kunamasentimitha ama-2 kepha asisikhulu kunamasentimitha ama-4.

Isigaba III

Esigabeni III, umdlavuza:

• likhulu ngaphezu kwamasentimitha ama-4 noma lisabalale ngaphezulu kwe-epiglottis (i-flap emboza i-trachea ngesikhathi sokugwinya); noma

• noma yimuphi usayizi. Umdlavuza usabalalele ku-lymph node eyodwa engamasentimitha ama-3 noma amancane, ohlangothini olufanayo lwentamo njengesimila sokuqala.

Isigaba IV

Isigaba IV sihlukaniswe ngezigaba ze-IVA, IVB, ne-IVC.

• Esigabeni IVA, umdlavuza:

• selisabalele emphinjeni (izwi lezwi), engxenyeni engaphambili yophahla lomlomo, umhlathi ophansi, noma imisipha ehambisa ulimi. Umdlavuza kungenzeka usabalalele ku-lymph node eyodwa engamasentimitha ama-3 noma amancane, ohlangothini olufanayo lwentamo njengesimila sokuqala; noma

• yinoma yisiphi isayizi futhi kungenzeka ukuthi usabalale waya phezulu kwe-epiglottis, umphimbo, ingxenye engaphambili yophahla lomlomo, umhlathi ophansi, noma imisipha ehambisa ulimi. Umdlavuza usabalalele kokukodwa kokulandelayo:

• i-lymph node eyodwa engaphezulu kwamasentimitha ama-3 kepha ayinkulu kunamasentimitha ayisithupha, ohlangothini olufanayo lwentamo njengesimila sokuqala; noma

• ngaphezu kweyodwa i-lymph node engamasentimitha ayi-6 noma amancane, noma yikuphi entanyeni.

• Esigabeni IVB, umdlavuza:

• selinabele emsipheni ohambisa umhlathi ongezansi, ithambo elixhunywe emsipheni elihambisa umhlathi ongezansi, isisekelo sogebhezi, noma indawo engemuva kwekhala noma ezungeze umthambo we-carotid. Umdlavuza kungenzeka usabalalele kuma-lymph node entanyeni; noma

• ingahle ibe ngosayizi futhi kungenzeka ukuthi isabalalele nakwezinye izingxenye zekhanda noma kwentamo. Umdlavuza usabalalele endaweni eyi-lymph node engaphezulu kwamasentimitha ayisithupha noma isabalale ngesembozo sangaphandle se-lymph node ezicutshini eziseduze.

• Esigabeni IVC, umdlavuza usabalalele kwezinye izingxenye zomzimba, njengephaphu, isibindi, noma ithambo.

Uhlolojikelele lwenketho yokwelashwa

AMAPHUZU ASEMQOKA

• Kunezinhlobo ezahlukene zokwelashwa kweziguli ezinomdlavuza we-oropharyngeal.

• Iziguli ezinomdlavuza we-oropharyngeal kufanele ukwelashwa kwazo kuhlelwe yiqembu lodokotela abanolwazi lokwelapha umdlavuza wekhanda nowentamo.

• Izinhlobo ezine zokwelashwa ezijwayelekile zisetshenzisiwe:

• Ukuhlinzwa

• Ukwelashwa ngemisebe

• Ukwelashwa ngamakhemikhali

• Ukwelashwa okuhlosiwe

• Izinhlobo ezintsha zokwelashwa ziyahlolwa ezivivinyweni zokwelashwa.

• I-Immunotherapy

• Ukwelashwa komdlavuza we-oropharyngeal 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 ezahlukene zokwelashwa kweziguli ezinomdlavuza we-oropharyngeal.

Izinhlobo ezahlukene zokwelashwa ziyatholakala ezigulini ezinomdlavuza we-oropharyngeal. 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.

Iziguli ezinomdlavuza we-oropharyngeal kufanele ukwelashwa kwazo kuhlelwe yiqembu lodokotela abanolwazi lokwelapha umdlavuza wekhanda nowentamo.

Ukwelashwa kwesiguli kuzobhekwa ngudokotela oncologist, udokotela ogxile ekwelapheni abantu abanomdlavuza. Ngoba i-oropharynx isiza ekuphefumuleni, ekudleni nasekukhulumeni, iziguli zingadinga usizo olukhethekile lokuzivumelanisa nemiphumela emibi yomdlavuza nokwelashwa kwawo. Udokotela oncologist angadlulisela isiguli kwabanye ochwepheshe bezempilo ngokuqeqeshwa okukhethekile ekwelapheni iziguli ezinomdlavuza wekhanda nentamo. Lokhu kungafaka ongoti abalandelayo:

• Udokotela ohlinzayo wekhanda nentamo.

• I-radiation oncologist.

• Udokotela ohlinzayo wePlastiki.

• Udokotela wamazinyo.

• I-Dietitian.

• Isazi sokusebenza kwengqondo.

• Uchwepheshe wokuvuselelwa.

• Umelaphi wenkulumo.

Izinhlobo ezine zokwelashwa ezijwayelekile zisetshenzisiwe:

Ukuhlinzwa

Ukuhlinzwa (ukususa umdlavuza lapho usebenza) ukwelashwa okuvamile kwazo zonke izigaba zomdlavuza we-oropharyngeal. Udokotela ohlinzayo angawususa umdlavuza kanye nezinye izicubu ezinempilo ezungeze umdlavuza. Ngemuva kokuthi udokotela ohlinzayo 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.

Izinhlobo ezintsha zokuhlinzwa, kufaka phakathi i-transotic robotic surgery, ziyafundelwa ukwelashwa komdlavuza we-oropharyngeal. Ukuhlinzwa okwenziwa ngamarobhothi kungasetshenziselwa ukususa umdlavuza ezindaweni okunzima ukufinyelela kuzo emlonyeni nasemphinjeni. Amakhamera anamathiselwe kurobhothi anika isithombe esilinganisa ubukhulu obungu-3 (3D) udokotela ohlinzayo asibonayo. Esebenzisa ikhompyutha, udokotela ohlinzayo uqondisa amathuluzi amancane kakhulu ekugcineni kwezingalo zamarobhothi ukuze asuse umdlavuza. Le nqubo ingenziwa futhi kusetshenziswa i-endoscope.

Ukwelashwa ngemisebe

Ukwelashwa ngemisebe ukwelashwa komdlavuza okusebenzisa amandla amakhulu ama-x-ray noma ezinye izinhlobo zemisebe ukubulala amangqamuzana omdlavuza noma ukuwagcina ekukhuleni. Ukwelashwa kwemisebe kwangaphandle kusebenzisa umshini ongaphandle komzimba ukuthumela imisebe ebheke endaweni yomzimba enomdlavuza.

Ukwelashwa kwemisebe yangaphandle yegundane lekhanda nentamo. Kusetshenziswa umshini ukukhomba imisebe ephezulu yamandla emdlavuza. Umshini ungazungeza isiguli, uhambise imisebe evela ezinhlangothini eziningi ezahlukahlukene ukuhlinzeka ukwelashwa okufana kakhulu. Isifihla mesh sisiza ukugcina ikhanda nentamo yesiguli kunganyakazi ngesikhathi sokwelashwa. Omaki abancane bakayinki bafakwa kumaskhi. Amaki oyinki asetshenziselwa ukulinganisa umshini wemisebe endaweni efanayo ngaphambi kokwelashwa ngakunye.

Izindlela ezithile zokunikeza ukwelashwa ngemisebe kungasiza ukugcina imisebe ekulimaleni izicubu ezinempilo eziseduze. Lezi zinhlobo zokwelashwa ngemisebe zifaka okulandelayo:

• Ukwelashwa kwemisebe ye-intension-modulated (IMRT): I-IMRT uhlobo lokwelashwa kwemisebe ka-3-dimensional (3-D) esebenzisa ikhompyutha ukwenza izithombe zosayizi nokuma kwesimila. Imishayo emincane yemisebe yamandla ahlukene (amandla) ihloselwe isimila ezinhlangothini eziningi.

• Ukwelashwa kwemisebe yomzimba we-stereotactic: Ukwelashwa kwemisebe yomzimba we-stereotactic uhlobo lwezokwelapha ngemisebe yangaphandle. Kusetshenziswa imishini ekhethekile ukubeka isiguli endaweni efanayo ekwelashweni kwemisebe ngayinye. Kanye ngosuku izinsuku eziningana, umshini wemisebe uhlose umthamo omkhulu kunokwejwayelekile wemisebe ngqo esihlahleni. Ngokuba nesiguli endaweni efanayo ekwelashweni ngakunye, kunomonakalo omncane ezicutshini eziseduze ezinempilo. Le nqubo ibizwa nangokuthi i-stereotactic external-beam radiation therapy kanye ne-stereotaxic radiation therapy.

Esikhathini somdlavuza we-oropharyngeal othuthukile, ukuhlukanisa umthamo wansuku zonke wemisebe emithini yokwelashwa okuncane kuthuthukisa indlela isimila esiphendula ngayo ekwelashweni. Lokhu kubizwa ngokuthi yi-hyperfractionated radiation therapy.

Ukwelashwa ngemisebe kungasebenza kangcono ezigulini eziyeke ukubhema ngaphambi kokuqala ukwelashwa.

Uma i-thyroid noma i-pituitary gland iyingxenye yendawo yokwelashwa ngemisebe, isiguli sinengozi eyengeziwe ye-hypothyroidism (i-hormone ye-thyroid encane kakhulu). Ukuhlolwa kwegazi ukuhlola izinga le-hormone yegilo emzimbeni kufanele kwenziwe ngaphambi nangemva kokwelashwa.

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).

Bheka Izidakamizwa ezivunyelwe i-Head and Neck Cancer ukuthola eminye imininingwane. (Umdlavuza we-Oropharyngeal wuhlobo lomdlavuza wekhanda nentamo.)

Ukwelashwa okuhlosiwe

Ukwelashwa okuhlosiwe uhlobo lokwelashwa olusebenzisa izidakamizwa noma ezinye izinto ukuhlasela amangqamuzana omdlavuza athile. Izindlela zokwelashwa ezihlosiwe zivame ukudala ukulimala okuncane kumaseli ajwayelekile kunokwelashwa ngamakhemikhali noma ukwelashwa ngemisebe. Ama-antibody e-monoclonal awuhlobo lwezokwelapha ezihlosiwe ezisetshenziselwa ukwelashwa komdlavuza we-oropharyngeal.

I-monoclonal antibody therapy iyindlela yokwelapha umdlavuza esebenzisa amasosha omzimba enziwe elebhu evela ohlotsheni olulodwa lwamaseli omzimba. La ma-antibody angakhomba izinto kumaseli womdlavuza noma ezintweni ezijwayelekile egazini noma kwizicubu 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-Cetuximab wuhlobo lwe-anti-monoclonal antibody esebenza ngokubopha iprotheni ebusweni bamaseli omdlavuza futhi amise amaseli ekukhuleni nasekuhlukaniseni. Isetshenziselwa ukwelashwa komdlavuza ophindaphindiwe kanye ne-metastatic oropharyngeal.

Bheka Izidakamizwa ezivunyelwe i-Head and Neck Cancer ukuthola eminye imininingwane. (Umdlavuza we-Oropharyngeal wuhlobo lomdlavuza wekhanda nentamo.)

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.

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.

Ama-PD-1 inhibitors awuhlobo lwe-immunotherapy olubizwa ngokuthi yi-immune checkpoint inhibitor therapy. 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.

I-Pembrolizumab ne-nivolumab yizinhlobo ze-PD-1 inhibitors ezifundwayo ekwelapheni umdlavuza we-oropharnygeal.

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 komdlavuza we-oropharyngeal 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.

Ukulandela ukwelashwa, kubalulekile ukuthi ube nokuhlolwa kwekhanda nentamo ngokucophelela ukubheka izimpawu zokuthi umdlavuza ubuyile. Ukuhlolwa kuzokwenziwa njalo emavikini ayisithupha kuya kwayi-12 ngonyaka wokuqala, njalo ezinyangeni ezintathu onyakeni wesibili, njalo ezinyangeni ezi-3 kuye kwezi-4 ngonyaka wesithathu, futhi njalo ezinyangeni eziyisithupha ngemuva kwalokho.

Izinketho Zokwelapha ngeStage

Kulesi Sigaba

• Isigaba I kanye neSigaba II somdlavuza we-Oropharyngeal

• Isigaba III nomdlavuza weSigaba IV se-Oropharyngeal

• I-Metastatic and Recurrent Cancer ye-Oropharyngeal

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

Isigaba I kanye neSigaba II somdlavuza we-Oropharyngeal

Ukwelashwa kwesigaba esisha esisanda kutholakala kanye nesigaba II somdlavuza we-oropharyngeal kungafaka okulandelayo:

• Ukwelashwa ngemisebe.

• Ukuhlinzwa.

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.

Isigaba III nomdlavuza weSigaba IV se-Oropharyngeal

Ukwelashwa komdlavuza osanda kutholakala wesigaba III somdlavuza we-oropharyngeal kanye nesigaba IV somdlavuza we-oropharyngeal kungafaka okulandelayo:

• Ezigulini ezinomdlavuza osuthuthukile endaweni, ukuhlinzwa kulandelwa ukwelashwa ngemisebe. I-Chemotherapy nayo inganikezwa ngasikhathi sinye njengokwelashwa ngemisebe.

• Ukwelashwa ngemisebe kuphela kweziguli ezingakwazi ukuthola i-chemotherapy.

• I-Chemotherapy enikezwa ngasikhathi sinye njengokwelashwa ngemisebe.

• I-Chemotherapy ilandelwa ukwelashwa ngemisebe okunikezwa ngasikhathi sinye nokwelashwa ngamakhemikhali amaningi.

• Isivivinyo somtholampilo se-chemotherapy esilandelwa ukuhlinzwa noma ukwelashwa ngemisebe.

• Isivivinyo somtholampilo sokwelapha okuqondisiwe (i-nivolumab) nge-chemotherapy enikezwe ngasikhathi sinye njengokwelashwa kwemisebe ezigulini ezinomdlavuza we-HPV-positive oropharyngeal advanced.

• Isivivinyo somtholampilo sokwelapha ngemisebe nge-chemotherapy noma ngaphandle kwayo.

• Isivivinyo somtholampilo sokuhlinzwa okwenziwa okwesikhashana kulandelwa ukwelashwa ngemisebe ejwayelekile noma ephansi noma nge-chemotherapy ezigulini ezinomdlavuza we-HPV-positive oropharyngeal.

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-Metastatic and Recurrent Cancer ye-Oropharyngeal

Umdlavuza ophindaphindiwe we-oropharyngeal ubuyile ku-oropharynx noma kwezinye izingxenye zomzimba ngemuva kokuphathwa. Ukwelashwa komdlavuza we-oropharyngeal osetshenzisiwe (osakazeka kwezinye izingxenye zomzimba) noma ophindwe ku-oropharynx ungafaka okulandelayo:

• Ukuhlinzwa, uma isimila singaphenduli ekwelashweni ngemisebe.

• Ukwelashwa ngemisebe, uma isimila singazange sisuswe ngokuphelele ngokuhlinzwa nangemisebe yangaphambilini ayinikiwe.

• Ukuhlinzwa kwesibili, uma isimila singasuswanga ngokuphelele ngokuhlinzwa kokuqala.

• I-Chemotherapy yeziguli ezinomdlavuza ophindayo ezingasuswa ngokuhlinzwa.

• Ukwelashwa ngemisebe okunikezwa ngasikhathi sinye njenge-chemotherapy.

• Ukwelashwa kwemisebe yomzimba we-stereotactic okunikezwa ngasikhathi sinye njengokwelashwa okuqondisiwe (i-cetuximab).

• Izilingo zomtholampilo zokwelashwa okuqondisiwe, ukwelashwa ngemisebe yomzimba okushintshashintshayo, noma ukwelashwa ngemisebe okunamafutha okunikezwa ngasikhathi sinye njenge-chemotherapy.

• Isivivinyo somtholampilo se-immunotherapy (nivolumab noma i-pembrolizumab).

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 Ngomdlavuza we-Oropharyngeal

Ngeminye imininingwane evela ku-National Cancer Institute mayelana nomdlavuza we-oropharyngeal, bheka okulandelayo:

• Ikhasi Lasekhaya Lomdlavuza Wekhanda Nentamo

• I-Oral Cavity, Pharyngeal, kanye neLaryngeal Cancer Prevention

• Umlomo we-Oral Cavity, Pharyngeal, kanye neLaryngeal Cancer

• Izinkinga zomlomo zeChemotherapy kanye neNhloko / Intamo Yemisebe

• I-HPV neCancer

• Izidakamizwa zivunyelwe i-Head and Neck Cancer

• Umdlavuza Wekhanda Nentamo

• Ugwayi (uhlanganisa usizo ngokuyeka)

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