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Ukwelashwa kwe-Neuroblastoma (®) –Patient Version

Imininingwane ejwayelekile NgeNeuroblastoma

AMAPHUZU ASEMQOKA

  • I-Neuroblastoma yisifo lapho amangqamuzana abulalayo (umdlavuza) akha khona kuma-neuroblast (izicubu zemizwa ezingavuthiwe) kwizindlala ze-adrenal, entanyeni, esifubeni noma emgogodleni.
  • I-Neuroblastoma kwesinye isikhathi ibangelwa ukuguqulwa kwezakhi zofuzo (ushintsho) okudluliselwe kusuka kumzali kuya enganeni.
  • Izimpawu nezimpawu ze-neuroblastoma zifaka isigaxa esiswini, entanyeni, noma esifubeni noma ebuhlungwini bethambo.
  • Ukuhlolwa okuhlola izicubu zomzimba ezahlukahlukene kanye noketshezi kusetshenziselwa ukuxilonga i-neuroblastoma.
  • I-biopsy yenziwa ukuthola i-neuroblastoma.
  • Izici ezithile zithinta ukubikezela (ithuba lokululama) kanye nezinketho zokwelashwa.

I-Neuroblastoma yisifo lapho amangqamuzana abulalayo (umdlavuza) akha khona kuma-neuroblast (izicubu zemizwa ezingavuthiwe) kwizindlala ze-adrenal, entanyeni, esifubeni noma emgogodleni.

I-Neuroblastoma ivame ukuqala kwezicubu zomzimba zezindlala ze-adrenal. Kunezindlala ezimbili ze-adrenal, eyodwa ngaphezulu kwesinso ngasinye ngemuva kwesisu esingenhla. Izindlala ze-adrenal zenza ama-hormone abalulekile asiza ukulawula ukushaya kwenhliziyo, umfutho wegazi, ushukela wegazi, nendlela umzimba ophendula ngayo ekucindezelekeni. I-Neuroblastoma nayo ingaqala ezicutshini zemizwa entanyeni, esifubeni, esiswini, noma okhalo.

I-Neuroblastoma ingatholakala kwizindlala ze-adrenal kanye nezicubu zemizwa ye-paraspinal kusuka entanyeni kuye okhalweni.

I-Neuroblastoma ivame ukuqala ebuntwaneni. Imvamisa kutholakala ukuthi phakathi kwenyanga yokuqala yokuphila neminyaka emihlanu. Kutholakala lapho isimila siqala ukukhula futhi sidale izimpawu noma izimpawu. Kwesinye isikhathi yakha ngaphambi kokuzalwa futhi itholakala ngesikhathi se-ultrasound yengane.

Ngesikhathi umdlavuza utholakala, uvame ukusabalalisa (ukusabalala). I-Neuroblastoma isakazeka kaningi kuma-lymph node, amathambo, umnkantsha, isibindi, nesikhumba ezinganeni nasezinganeni. Intsha futhi ingaba ne-metastasis emaphashini nasebuchosheni.

I-Neuroblastoma kwesinye isikhathi ibangelwa ukuguqulwa kwezakhi zofuzo (ushintsho) okudluliselwe kusuka kumzali kuya enganeni.

Ukuguqulwa kwezakhi zofuzo okwandisa ubungozi be-neuroblastoma kwesinye isikhathi kutholwa njengefa (kudluliselwa kusuka kumzali kuye enganeni). Ezinganeni ezinokushintshwa kwezakhi zofuzo, i-neuroblastoma ivame ukwenzeka isencane futhi kungenzeka kube nesimila esingaphezu kwesisodwa ezingxenyeni ze-adrenal noma ezicutshini zemizwa entanyeni, esifubeni, esiswini noma okhalweni.

Izingane ezinokushintshwa okuthile kwezakhi zofuzo noma ama-syndromes wefa (okufanele zizuzwe njengefa) kufanele zihlolwe izimpawu ze-neuroblastoma zize zibe neminyaka eyishumi. Lezi zivivinyo ezilandelayo zingasetshenziswa:

  • I-ultrasound yesisu: Isivivinyo lapho amaza omsindo wamandla aphezulu (i-ultrasound) ehlaselwa esiswini bese enza ama-echoes. Ama-echoes akha isithombe sesisu esibizwa nge-sonogram. Isithombe singaphrintwa ukuze sibhekwe ngokuhamba kwesikhathi.
  • Izifundo ze-Urine catecholamine: Isivivinyo lapho kuhlolwe khona isampula yomchamo ukukala inani lezinto ezithile, i-vanillylmandelic acid (VMA) ne-homovanillic acid (HVA), ezenziwa lapho ama-catecholamine ehla futhi ekhishwa emchameni. Inani eliphakeme kunejwayelekile le-VMA noma i-HVA kungaba uphawu lwe-neuroblastoma.
  • 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.

Khuluma nodokotela wengane yakho mayelana nokuthi lezi zivivinyo zidinga ukwenziwa kangaki.

Izimpawu nezimpawu ze-neuroblastoma zifaka isigaxa esiswini, entanyeni, noma esifubeni noma ebuhlungwini bethambo.

Izimpawu nezimpawu ezivame kakhulu ze-neuroblastoma kubangelwa isimila sicindezela izicubu eziseduze njengoba sikhula noma umdlavuza usabalalela ethanjeni. Lezi kanye nezinye izimpawu nezimpawu zingabangelwa yi-neuroblastoma noma ezinye izimo.

Buza kudokotela wengane yakho uma ingane yakho inokunye kwalokhu okulandelayo:

  • Isigaxa esiswini, entanyeni, noma esifubeni.
  • Ubuhlungu bamathambo.
  • Isisu esivuvukele nenkinga yokuphefumula (ezinganeni).
  • Amehlo aqhamukayo.
  • Imibuthano emnyama ezungeze amehlo ("amehlo amnyama").
  • Izigaxa ezingenabuhlungu, eziluhlaza okwesibhakabhaka ngaphansi kwesikhumba (ezinganeni).
  • Ubuthakathaka noma ukukhubazeka (ukulahlekelwa amandla okuhambisa ingxenye yomzimba).

Izimpawu nezimpawu ezijwayelekile ze-neuroblastoma zifaka okulandelayo:

  • Imfiva.
  • Ukuphelelwa umoya.
  • Ukuzizwa ngikhathele.
  • Ukulinyazwa okulula noma ukopha.
  • I-Petechiae (izindawo ezicabalele, ezikhomba ngaphansi kwesikhumba ezibangelwa ukopha).
  • Umfutho wegazi ophezulu.
  • Uhudo olunamandla lwamanzi.
  • I-Horner syndrome (ijwabu leso elime droopy, umfundi omncane, nokujuluka okuncane ohlangothini lobuso).
  • Ukunyakaza kwemisipha kaJerky.
  • Ukunyakaza kwamehlo okungalawulwa.

Ukuhlolwa okuhlola izicubu zomzimba ezahlukahlukene kanye noketshezi kusetshenziselwa ukuxilonga i-neuroblastoma.

Ukuhlolwa nezinqubo ezilandelayo kungasetshenziselwa ukuxilonga i-neuroblastoma:

  • Ukuhlolwa komzimba kanye nomlando wezempilo: Ukuhlolwa komzimba ukuhlola izimpawu ezijwayelekile zempilo, kufaka phakathi nokuhlola izimpawu zezifo, njengezigaxa noma yini enye ebonakala ingajwayelekile. Kuzothathwa nomlando wemikhuba yezempilo yesiguli kanye nokugula nokwelashwa kwangaphambilini.
  • Ukuhlolwa kwe-Neurological: Uchungechunge lwemibuzo novivinyo lokuhlola ubuchopho, umgogodla nokusebenza kwe-nerve. Isivivinyo sihlola isimo somuntu ngokomqondo, ukusebenzisana, ikhono lokuhamba ngokujwayelekile, nokuthi izicubu, izinzwa, nokucabanga kusebenza kahle kangakanani. Lokhu kungabizwa nangokuthi ukuhlolwa kwe-neuro noma ukuhlolwa kwe-neurologic.
  • Izifundo ze-Urine catecholamine: Isivivinyo lapho kuhlolwe khona isampula yomchamo ukukala inani lezinto ezithile, i-vanillylmandelic acid (VMA) ne-homovanillic acid (HVA), ezenziwa lapho ama-catecholamine ehla futhi ekhishwa emchameni. Inani eliphakeme kunejwayelekile le-VMA noma i-HVA kungaba uphawu lwe-neuroblastoma.
  • Izifundo ze-chemistry yegazi: Isivivinyo lapho kuhlolwe khona isampula segazi ukukala inani lezinto ezithile ezikhishwe egazini ngezitho nezicubu zomzimba. Inani eliphakeme noma elingaphansi kwenani elijwayelekile lezinto kungaba uphawu lwesifo.
  • Ukuskena kwe-MIBG: Inqubo esetshenziselwa ukuthola izicubu ze-neuroendocrine, njenge-neuroblastoma. Inani elincane kakhulu lezinto ezibizwa nge-radioactive MIBG lifakwa emthanjeni futhi lihamba egazini. Amaseli we-Neuroendocrine tumor athatha i-MIBG enemisebe futhi atholwa isithwebuli. Ukuskena kungathathwa ngaphezu kwezinsuku eziyi-1-3. Isixazululo se-iodine singanikezwa ngaphambi noma ngesikhathi sokuhlolwa ukugcina indlala yegilo ingamunci iMIBG eningi kakhulu. Lokhu kuhlolwa kusetshenziselwa nokuthola ukuthi isimila sisabela kanjani ekwelashweni. I-MIBG isetshenziswa ngemithamo ephezulu yokwelapha i-neuroblastoma.
  • 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.
Iskena se-computed tomography (CT) sesisu. Ingane ilele etafuleni elishibilika ngesithwebuli se-CT, esithatha izithombe ze-x-ray zangaphakathi kwesisu.
  • I-MRI (imaging resonance imaging) ene-gadolinium: Inqubo esebenzisa uzibuthe, amagagasi omsakazo, nekhompyutha ukwenza uchungechunge lwezithombe ezinemininingwane yezindawo ezingaphakathi komzimba. 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).
I-Magnetic resonance imaging (MRI) yesisu. Ingane ilele etafuleni elingena kuskena seMRI, esithwebula izithombe zangaphakathi komzimba. Iphedi esiswini sengane isiza ukwenza izithombe zicace bha.
  • 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.
  • I-X-ray yesifuba noma yethambo: I-x-ray uhlobo lwensimbi yamandla engangena emzimbeni ifike kwifilimu, yenze isithombe sezindawo ezingaphakathi komzimba.
  • Ukuhlolwa kwe-Ultrasound: Inqubo lapho amaza omsindo wamandla aphezulu (i-ultrasound) ehlaselwa izicubu zangaphakathi noma izitho bese enza ama-echoes. Ama-echoes akha isithombe sezicubu zomzimba esibizwa nge-sonogram. Isithombe singaphrintwa ukuze sibhekwe ngokuhamba kwesikhathi. Ukuhlolwa kwe-ultrasound akwenziwa uma kwenziwa i-CT / MRI.
I-ultrasound yesisu. I-ultrasound transducer exhunywe kwikhompyutha icindezelwa esikhunjeni sesisu. I-transducer igxilisa amaza omsindo ezithweni zangaphakathi nezicubu zayo ukuze yenze ama-echoes akha isithombe (sekhompyutha).

I-biopsy yenziwa ukuthola i-neuroblastoma.

Amaseli nezicubu kuyasuswa ngesikhathi se-biopsy ukuze zibukwe ngaphansi kwesibonakhulu ngudokotela wezifo ukuze ahlole izimpawu zomdlavuza. Indlela okwenziwa ngayo i-biopsy incike ekutheni isisu sikuphi emzimbeni. Kwesinye isikhathi sonke isimila sisuswa ngasikhathi sinye kwenziwa i-biopsy.

Ukuhlolwa okulandelayo kungenziwa kuzicubu ezisuswe:

  • 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.
  • I-microscopy ekhanyayo: Isivivinyo selabhorethri lapho amaseli esampula yezicubu abukwa khona ngaphansi kwama-microscopes avamile futhi anamandla aphezulu ukubheka ushintsho oluthile kumaseli.
  • I-Immunohistochemistry: Isivivinyo selabhorethri esisebenzisa amasosha omzimba ukubheka ama-antigen (amakaki) athile kusampula yezicubu zesiguli. Amasosha omzimba avamise ukuhlanganiswa ne-enzyme noma udayi we-fluorescent. Ngemuva kokuthi ama-antibody abophele kwi-antigen ethile kusampula yezicubu, i-enzyme noma idayi iyasebenza, bese kuthi i-antigen ibonakale ngaphansi kwesibonakhulu. Lolu hlobo lokuhlola lusetshenziselwa ukuxilonga umdlavuza nokusiza ukutshela uhlobo oluthile lomdlavuza kolunye uhlobo lomdlavuza.
  • Ucwaningo lwe-MYCN lokukhulisa: Ucwaningo lwelabhoratri lapho kuhlolwe khona amaseli wesimila noma umnkantsha wezinga le-MYCN. I-MYCN ibalulekile ekukhuleni kwamaseli. Izinga eliphakeme le-MYCN (ngaphezu kwamakhophi ayi-10 ohlobo) libizwa ngokuthi yi-MYCN amplification. I-Neuroblastoma ene-MYCN yokukhulisa kungenzeka kakhulu ukuthi isabalale emzimbeni futhi mancane amathuba okuthi iphendule ekwelashweni.

Izingane ezifika ezinyangeni eziyisithupha ubudala kungenzeka zingadingi i-biopsy noma ukuhlinzwa ukuze kususwe isimila ngoba isimila singanyamalala ngaphandle kokwelashwa.

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

Izinketho zokubikezela nokwelashwa zincike kokulandelayo:

  • Ubudala ngesikhathi sokuxilongwa.
  • I-tumor histology (ukuma, ukusebenza, nokwakheka kwamangqamuzana wesimila).
  • Iqembu lengcuphe yengane.
  • Ukuthi kunezinguquko ezithile yini kwizakhi zofuzo.
  • Lapho emzimbeni kuqale isimila.
  • Isigaba somdlavuza.
  • Indlela isimila esiphendula ngayo ekwelashweni.
  • Singakanani isikhathi esidlulile phakathi kokuxilongwa nalapho umdlavuza uphinde wabuya (ngomdlavuza ophindaphindiwe).

Izinketho zokubikezela nokwelashwa kwe-neuroblastoma nazo zithinteka yi-tumor biology, efaka okulandelayo:

  • Amaphethini amaseli wesimila.
  • Ahluke kanjani amangqamuzana ezimila kumaseli ajwayelekile.
  • Ashesha kangakanani amangqamuzana amathumba akhula.
  • Ukuthi isimila sikhombisa ukukhuliswa kwe-MYCN.
  • Ukuthi isimila sinezinguquko yini kuhlobo lwe-ALK.

Isimila sebhayoloji kuthiwa siyathandeka noma asivumi, kuya ngalezi zici. Ingane ene-tumor biology evumayo inethuba elingcono lokululama.

Kwezinye izingane kuze kufike ezinyangeni eziyisithupha ubudala, i-neuroblastoma inganyamalala ngaphandle kokwelashwa. Lokhu kubizwa ngokuthi ukuhlehla okuzenzakalelayo. Ingane ibhekelwe eduze izimpawu noma izimpawu ze-neuroblastoma. Uma kwenzeka izimpawu noma izimpawu, ukwelashwa kungadingeka.

Izigaba zeNeuroblastoma

AMAPHUZU ASEMQOKA

  • Ngemuva kokutholakala kwe-neuroblastoma, kwenziwa ukuhlolwa ukuthola ukuthi umdlavuza ususabalele lapho uqale khona kwezinye izingxenye zomzimba.
  • Zintathu izindlela umdlavuza osakazeka ngayo emzimbeni.
  • Umdlavuza ungasakazeka usuka lapho uqale khona kwezinye izingxenye zomzimba.
  • Lezi zigaba ezilandelayo zisetshenziselwa i-neuroblastoma:
  • Isigaba 1
  • Isigaba 2
  • Isigaba 3
  • Isigaba 4
  • Ukwelashwa kwe-neuroblastoma kusekelwe emaqenjini anobungozi.
  • Kwesinye isikhathi i-neuroblastoma ayiphenduli ekwelashweni noma ibuye emuva kokwelashwa.

Ngemuva kokutholakala kwe-neuroblastoma, kwenziwa ukuhlolwa ukuthola ukuthi umdlavuza ususabalele lapho uqale khona kwezinye izingxenye zomzimba.

Inqubo esetshenzisiwe ukuthola ubukhulu noma ukusabalala komdlavuza ibizwa ngokuthi yi-staging. Imininingwane eqoqwe kusuka kusistimu yokusiza isiza ukunquma isigaba sesifo. Nge-neuroblastoma, isigaba sesifo sithinta ukuthi umdlavuza ubungozi obuncane, ubungozi obuphakathi, noma ubungozi obukhulu. Iphinde ibe nomthelela ohlelweni lokwelashwa. Imiphumela yezinye izivivinyo nezinqubo ezisetshenziselwa ukuxilonga i-neuroblastoma ingasetshenziselwa ukwenza isiteji. Bheka isigaba solwazi jikelele ukuthola incazelo yalezi zivivinyo nezinqubo.

Lezi zivivinyo nezinqubo ezilandelayo zingasetshenziswa ukunquma isiteji:

  • Isifiso somnkantsha we-Bone kanye ne-biopsy: Ukususwa komnkantsha wethambo, igazi, nocezu oluncane lwethambo ngokufaka inaliti engenalutho ethangeni noma emathanjeni esifuba. Isazi sezifo sibheka umnkantsha, igazi, nethambo ngaphansi kwesibonakhulu ukuze kubhekwe izimpawu zomdlavuza.
Ukufiswa komnkantsha we-Bone kanye ne-biopsy. Ngemuva kokuthi indawo encane yesikhumba iboshwe, kufakwa inaliti yomnkantsha ethanjeni lesinqe sengane. Amasampula egazi, amathambo, nomnkantsha uyasuswa ukuze kuhlolwe ngaphansi kwesibonakhulu.
  • I-lymph node biopsy: Ukususwa kwakho konke noma ingxenye ye-lymph node. Isazi sezifo sibheka izicubu ze-lymph node ngaphansi kwesibonakhulu ukuhlola amaseli omdlavuza. Olunye lwezinhlobo ezilandelayo ze-biopsies lungenziwa:
  • I-Biopsy e-Excisional: Ukususwa kwayo yonke i-lymph node.
  • I-incisional biopsy: Ukususwa kwengxenye ye-lymph node.
  • I-Core biopsy: Ukususwa kwezicubu ku-lymph node kusetshenziswa inaliti ebanzi.
  • I-Fine-needle aspiration (FNA) biopsy: Ukususwa kwezicubu noma uketshezi ku-lymph node kusetshenziswa inaliti ezacile.

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-neuroblastoma isakazekela esibindi, amangqamuzana omdlavuza wesibindi empeleni angamaseli e-neuroblastoma. Lesi sifo yi-metastatic neuroblastoma, hhayi umdlavuza wesibindi.

Lezi zigaba ezilandelayo zisetshenziselwa i-neuroblastoma:

Isigaba 1

Esigabeni 1, umdlavuza usendaweni eyodwa kuphela futhi wonke umdlavuza ongabonakala ususwa ngokuphelele ngesikhathi sokuhlinzwa.

Isigaba 2

Isigaba 2 sehlukaniswe izigaba 2A no-2B.

  • Isigaba 2A: Umdlavuza usendaweni eyodwa kuphela futhi wonke umdlavuza ongabonakala awususwa ngokuphelele ngesikhathi sokuhlinzwa.
  • Isigaba 2B: Umdlavuza usendaweni eyodwa kuphela futhi wonke umdlavuza ongabonakala ungasuswa ngokuphelele noma ungahle ususwe ngokuphelele ngesikhathi sokuhlinzwa. Amaseli womdlavuza atholakala kuma-lymph node eduze kwesimila.

Isigaba 3

Esigabeni 3, okukodwa kokulandelayo kuyiqiniso:

  • umdlavuza awukwazi ukususwa ngokuphelele ngesikhathi sokuhlinzwa futhi usabalale kusuka kolunye uhlangothi lomzimba uye kolunye uhlangothi futhi kungenzeka ukuthi usabalalele nakuma-lymph node aseduze; noma
  • umdlavuza ungakolunye uhlangothi lomzimba futhi ususabalele kuma-lymph node kolunye uhlangothi lomzimba; noma
  • umdlavuza uphakathi komzimba futhi ususabalele ezicutshini noma kuma-lymph node ezinhlangothini zombili zomzimba, kanti umdlavuza awukwazi ukususwa ngokuhlinzwa.

Isigaba 4

Isigaba 4 sehlukaniswe ngezigaba 4 no-4S.

  • Esigabeni 4, umdlavuza usabalalele kuma-lymph node akude noma kwezinye izingxenye zomzimba.
  • Esigabeni 4S, ingane ingaphansi kwezinyanga eziyi-12, futhi:
  • umdlavuza usabalalele esikhunjeni, esibindi, kanye / noma emnkantsheni wethambo; noma
  • umdlavuza usendaweni eyodwa kuphela futhi wonke umdlavuza ongabonakala ungasuswa ngokuphelele noma ungasuswa ngokuphelele ngesikhathi sokuhlinzwa; noma
  • amangqamuzana omdlavuza angatholakala kuma-lymph node eduze kwesimila.

Ukwelashwa kwe-neuroblastoma kusekelwe emaqenjini anobungozi.

Ezinhlotsheni eziningi zomdlavuza, kusetshenziswa izigaba ukuhlela ukwelashwa. Nge-neuroblastoma, ukwelashwa kuncike eqenjini eliyingozi lesiguli. Isigaba se-neuroblastoma yisici esisodwa esisetshenziselwa ukunquma iqembu eliyingozi. Ezinye izici iminyaka yobudala, i-tumor histology, ne-tumor biology.

Kunamaqembu amathathu anobungozi: ubungozi obuphansi, ubungozi obuphakathi, nobungozi obukhulu.

  • I-neuroblastoma enobungozi obuphansi nobuphakathi nendawo inethuba elihle lokulashwa.
  • I-neuroblastoma enobungozi obukhulu kungaba nzima ukuyelapha.

Kwesinye isikhathi i-neuroblastoma ayiphenduli ekwelashweni noma ibuye emuva kokwelashwa.

I-Refractory neuroblastoma iyisimila esingaphenduli ekwelashweni.

I-neuroblastoma ephindaphindayo ngumdlavuza ophindile (wabuya) ngemuva kokuba welashwe. Isimila singabuya esizeni lapho siqale khona noma ohlelweni lwemizwa oluphakathi nendawo.

Uhlolojikelele lwenketho yokwelashwa

AMAPHUZU ASEMQOKA

  • Kunezinhlobo ezahlukahlukene zokwelashwa kweziguli ezine-neuroblastoma.
  • Izingane ezine-neuroblastoma kufanele zihlelelwe ukwelashwa kwazo yiqembu lodokotela abangochwepheshe ekwelapheni umdlavuza wezingane, ikakhulukazi i-neuroblastoma.
  • Izinhlobo eziyisikhombisa zokwelashwa okujwayelekile zisetshenzisiwe:
  • Ukuqaphela
  • Ukuhlinzwa
  • Ukwelashwa ngemisebe
  • Ukwelashwa kwe-Iodine 131-MIBG
  • Ukwelashwa ngamakhemikhali
  • I-chemotherapy ephezulu kanye nokwelashwa ngemisebe okusindisa nge-stem cell
  • Ukwelashwa okuhlosiwe
  • Izinhlobo ezintsha zokwelashwa ziyahlolwa ezivivinyweni zokwelashwa.
  • I-Immunotherapy
  • Ukwelashwa kwe-neuroblastoma kubangela imiphumela emibi kanye nemiphumela yamuva.
  • 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-neuroblastoma.

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

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

Izingane ezine-neuroblastoma kufanele zihlelelwe ukwelashwa kwazo yiqembu lodokotela abangochwepheshe ekwelapheni umdlavuza wezingane, ikakhulukazi i-neuroblastoma.

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

  • Udokotela ohlinzayo wezingane.
  • I-oncologist yemisebe yezingane.
  • Isazi se-endocrinologist.
  • Isazi sezinzwa.
  • I-neuropathologist yezingane.
  • Isazi se-Neuroradiologist.
  • Udokotela wezingane.
  • Umhlengikazi ongumhlengikazi.
  • Usonhlala kahle.
  • Uchwepheshe wempilo yengane.
  • Isazi sokusebenza kwengqondo.

Izinhlobo eziyisikhombisa zokwelashwa okujwayelekile zisetshenzisiwe:

Ukuqaphela

Ukuqaphelisisa kusibhekisisa isimo sesiguli ngaphandle kokunikeza ukwelashwa kuze kuvele izimpawu noma izimpawu noma ushintsho.

Ukuhlinzwa

Ukuhlinzwa kusetshenziselwa ukwelapha i-neuroblastoma engakaze isabalale kwezinye izingxenye zomzimba. Kususwa isimila esiningi ngangokunokwenzeka ngokuphepha. Ama-lymph node nawo ayasuswa futhi ahlolwe izimpawu zomdlavuza.

Uma isimila singenakususwa, kungenziwa i-biopsy esikhundleni salokho.

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 kwe-Iodine 131-MIBG

Ukwelashwa kwe-Iodine 131-MIBG ukwelashwa nge-iodine enemisebe. Iodine enemisebe inikezwa ngomugqa we-intravenous (IV) bese ingena egazini eligcina imisebe ngqo kumaseli wesimila. Iodine enemisebe iqoqa kumaseli e-neuroblastoma bese iwabulala ngemisebe enikezwayo. Ukwelashwa kwe-Iodine 131-MIBG kwesinye isikhathi kusetshenziselwa ukwelapha i-neuroblastoma enobungozi obuya emuva ngemuva kokwelashwa kokuqala.

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).

Ukusetshenziswa kwemithi emibili noma ngaphezulu elwa nomdlavuza kubizwa ngokuthi inhlanganisela yamakhemikhali.

Bheka Izidakamizwa ezivunyelwe i-Neuroblastoma ukuthola eminye imininingwane.

I-chemotherapy ephezulu kanye nokwelashwa ngemisebe okusindisa nge-stem cell

I-chemotherapy ephezulu kanye ne-radiation therapy inikezwa ukubulala noma yimaphi amangqamuzana omdlavuza angahle abuye futhi abangele umdlavuza ukuthi ubuye. Amaseli aphilile, kufaka phakathi amaseli akha igazi, nawo abhujiswa ukwelashwa komdlavuza. Ukutakulwa kwamaseli esiqu kuyindlela yokwelapha yokushintsha amaseli akha igazi. Ama-stem cells (amangqamuzana egazi angavuthiwe) ayasuswa egazini noma emnkantsheni wethambo lesiguli futhi afriziwe futhi agcinwe. Ngemuva kokuthi isiguli siqede ukwelashwa ngamakhemikhali nokwelashwa ngemisebe, amangqamuzana eziqu agciniwe ancibilika abuyiselwa esigulini ngokumnika. Lawa maseli wesiqu abuyisiwe akhula abe (futhi abuyisele) amangqamuzana egazi omzimba.

Ukwelashwa kwesondlo kunikezwa ngemuva kokwelapha ngamakhemikhali aphezulu kanye nokwelashwa ngemisebe ngokusindiswa kwe-stem cell izinyanga eziyisithupha futhi kufaka phakathi izindlela ezilandelayo:

  • Isotretinoin: Isidakamizwa esinjengevithamini esinciphisa amandla omdlavuza wokwenza amangqamuzana omdlavuza amaningi futhi sishintshe ukuthi la maseli abukeka kanjani futhi enza kanjani. Lesi sidakamizwa sithathwa ngomlomo.
  • I-Dinutuximab: Uhlobo lwe-monoclonal antibody therapy esebenzisa i-antibody eyenziwe elebhu kusuka ohlotsheni olulodwa lwamaseli omzimba. I-Dinutuximab ikhomba futhi inamathisele entweni ethile, ebizwa nge-GD2, ebusweni bamaseli e-neuroblastoma. Lapho i-dinutuximab isinamathele ku-GD2, kuthunyelwa isignali emasosheni omzimba ukuthi kutholakala into engaphandle futhi edinga ukubulawa. Lapho-ke amasosha omzimba abulala iseli le-neuroblastoma. I-Dinutuximab inikezwa ngokumnika. Luhlobo lwezokwelapha ezihlosiwe.
  • I-Granulocyte-macrophage colony-stimulating factor (GM-CSF): I-cytokine esiza ukwenza amaseli omzimba amaningi, ikakhulukazi ama-granulocyte nama-macrophage (amaseli amhlophe egazi), angahlasela futhi abulale amangqamuzana omdlavuza.
  • I-Interleukin-2 (IL-2): Uhlobo lwe-immunotherapy olukhulisa ukukhula nokusebenza kwamaseli amaningi omzimba, ikakhulukazi ama-lymphocyte (uhlobo lweseli elimhlophe). Ama-lymphocyte angahlasela futhi abulale amangqamuzana omdlavuza.

Bheka Izidakamizwa ezivunyelwe i-Neuroblastoma ukuthola eminye imininingwane.

Ukwelashwa okuhlosiwe

Ukwelashwa okuhlosiwe uhlobo lwezokwelapha olusebenzisa izidakamizwa noma ezinye izinto ukukhomba nokuhlasela amaseli womdlavuza athile. Izindlela zokwelashwa ezihlosiwe zivame ukudala ukulimala okuncane kumaseli ajwayelekile kunokwelashwa ngamakhemikhali noma ukwelashwa ngemisebe. Kunezinhlobo ezahlukene zokwelashwa okuqondisiwe:

  • Ukwelashwa kwe-monoclonal antibody: Ama-antibody e-monoclonal amaprotheni omzimba omzimba enziwe elebhu ukwelapha izifo eziningi, kufaka phakathi umdlavuza. Njengokwelashwa komdlavuza, la ma-antibodies anganamathela kokuhlosiwe okuthile kumaseli womdlavuza noma amanye amaseli angasiza amangqamuzana omdlavuza ukuthi akhule. Amasosha omzimba akwazi ukubulala 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-Pembrolizumab ne-dinutuximab ngama-antibody monoclonal afundelwa ukwelapha i-neuroblastoma ebuye ngemuva kokwelashwa noma engaphendulanga ekwelashweni.

  • Ukwelashwa kwe-Tyrosine kinase inhibitor: Le mithi yokwelashwa eqondisiwe ivimba amasiginali adingekayo ukuze izimila zikhule.

ICrizotinib iyi-tyrosine kinase inhibitor esetshenziselwa ukwelapha i-neuroblastoma ebuyile ngemuva kokwelashwa. I-AZD1775 ne-lorlatinib ngama-tyrosine kinase inhibitors afundelwa ukwelapha i-neuroblastoma ebuyile ngemuva kokwelashwa noma engaphendulanga ekwelashweni.

  • Ukwelashwa kwe-histone deacetylase inhibitor: Lokhu kwelashwa kubangela ushintsho lwamakhemikhali oluvimba amangqamuzana omdlavuza ukuthi angakhuli futhi ahlukane.

IVorinostat uhlobo lwe-histone deacetylase inhibitor efundwayo ukwelapha i-neuroblastoma ebuyile ngemuva kokwelashwa noma engaphendulanga ekwelashweni.

  • Ukwelashwa kwe-Ornithine decarboxylase inhibitor: Lokhu kwelashwa kubambezela ukukhula nokuhlukaniswa kwamaseli womdlavuza.

I-Eflornithine uhlobo lwe-ornithine decarboxylase inhibitor efundwayo ukwelapha i-neuroblastoma ebuyile ngemuva kokwelashwa noma engaphendulanga ekwelashweni.

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. Lokhu kwelashwa komdlavuza uhlobo lwezokwelapha ze-biologic.

  • Ukwelashwa kwe-CAR T-cell: Ama-T cell wesiguli (uhlobo lweseli lomzimba) ayashintshwa ukuze ahlasele amaprotheni athile ebusweni bamangqamuzana omdlavuza. Amaseli we-T athathwa esigulini futhi ama-receptors akhethekile afakwa ebusweni bawo elabhoratri. Amaseli aguqukile abizwa ngamaseli we-chimeric antigen receptor (CAR) T. Amaseli e-CAR T akhuliswa elabhorethri futhi anikezwa isiguli ngokufakwa. Amaseli e-CAR T ayanda egazini lesiguli bese ehlasela amangqamuzana omdlavuza.
Ukwelashwa kwe-CAR T-cell. Uhlobo lokwelashwa lapho kuguqulwa khona ama-T cell wesiguli (uhlobo lwamaseli omzimba) elabhoratri ngakho-ke azobopha amaseli womdlavuza futhi awabulale. Igazi elivela emthanjeni engalweni yesiguli ligeleza ngeshubhu liye emshinini we-apheresis (ongakhonjisiwe), osusa amangqamuzana amhlophe egazi, kufaka phakathi ama-T cell, bese lithumela lonke igazi emuva esigulini. Ngemuva kwalokho, kufakwa isakhi sofuzo se-receptor ekhethekile ebizwa nge-chimeric antigen receptor (CAR) kumaseli we-T elabhorethri. Izigidi zamaseli e-CAR T zikhuliswa elabhoratri bese zinikezwa isiguli ngokumnika. Amaseli e-CAR T akwazi ukubopha i-antigen kumaseli womdlavuza futhi awabulale.

Ukwelashwa kwe-CAR T-cell kusetshenziselwa ukwelapha i-neuroblastoma ebuyile ngemuva kokwelashwa noma engaphendulanga ekwelashweni.

Ukwelashwa kwe-neuroblastoma kubangela imiphumela emibi kanye nemiphumela yamuva.

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

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

  • Izinkinga zomzimba.
  • Ukuthuthukiswa kwamazinyo.
  • Ukuvinjelwa kwamathumbu (ukuvinjelwa).
  • Ukukhula kwamathambo noqwanga.
  • Umsebenzi wokuzwa.
  • I-Metabolic syndrome (umfutho wegazi ophakeme, ama-triglycerides aphakeme, i-cholesterol ephakeme, ukwanda kwamaphesenti amafutha emzimbeni).
  • Izinguquko zemizwa, imizwa, ukucabanga, ukufunda, noma inkumbulo.
  • Umdlavuza wesibili (izinhlobo ezintsha zomdlavuza).

Eminye imiphumela yesikhashana ingalashwa noma ilawulwe. Kubalulekile ukukhuluma nodokotela bengane yakho ngemiphumela yokwelashwa komdlavuza engaba nayo enganeni yakho. Bona isifinyezo se- ngemiphumela yamuva yokwelashwa komdlavuza wezingane ukuthola eminye imininingwane.

Iziguli zingafuna ukucabanga ngokubamba iqhaza esivivinyweni somtholampilo.

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

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

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

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

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

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

Ukuhlolwa kokulandelela kungadingeka.

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

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

Ukuhlolwa kokulandelwa kweziguli ezine-neuroblastoma kufaka okulandelayo:

  • Izifundo ze-urine catecholamine.
  • Ukuskena kwe-MIBG.

Ukwelashwa kwe-Neuroblastoma Engcupheni Ephansi

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

Ukwelashwa kwe-neuroblastoma esengozini esanda kutholakala kungafaka okulandelayo:

  • Ukuhlinzwa kulandelwa ukubonwa.
  • Ukwelashwa ngamakhemikhali nokuhlinzwa, kwezingane ezinezimpawu noma izingane isimila esiqhubeke nokukhula futhi ezingasuswa ngokuhlinzwa.
  • I-Chemotherapy, yeziguli ezithile.
  • Ukubheka kuphela izinsana ezingaphansi kwezinyanga eziyisithupha ezinezicubu ezincane ze-adrenal noma izinsana ezingenazo izimpawu noma izimpawu ze-neuroblastoma.
  • Ukwelashwa ngemisebe yokwelapha izicubu ezidala izinkinga ezinkulu futhi ezingaphenduli ngokushesha ekhemotherapy noma ekuhlinzweni.
  • Isivivinyo somtholampilo sokwelashwa esuselwa ekuphenduleni kwesimila ekwelashweni nakwisigaxa sebhayoloji.

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.

Ukwelashwa kwe-Intermediate-Risk Neuroblastoma

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

Ukwelashwa kwe-neuroblastoma esengozini esanda kutholakala kungafaka okulandelayo:

  • Ukwelashwa ngamakhemikhali kwezingane ezinezimpawu noma ukunciphisa isimila esingasuswa ngokuhlinzwa. Ukuhlinzwa kungenziwa ngemuva kokwelashwa ngamakhemikhali.
  • Ukuhlinzwa kuphela kwezinsana.
  • Ukubheka kuphela izinsana.
  • Ukwelashwa ngemisebe yokwelapha izicubu eziqhubeke nokukhula ngesikhathi sokwelashwa ngamakhemikhali noma izicubu ezingenakususwa ngokuhlinzwa futhi ziqhubeke nokukhula ngemuva kokwelashwa ngamakhemikhali.
  • Isivivinyo somtholampilo sokwelashwa esuselwa ekuphenduleni kwesimila ekwelashweni nakwisigaxa sebhayoloji.

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.

Ukwelashwa kwe-High-Risk Neuroblastoma

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

Ukwelashwa kwe-neuroblastoma esengozini enkulu esanda kutholakala kungafaka okulandelayo:

  • Uhlobo lwemithi elandelayo:
  • Inhlanganisela chemotherapy.
  • Ukuhlinzwa.
  • Izifundo ezimbili zenhlanganisela yamakhemikhali ephezulu elandelwa ukusindiswa kweseli.
  • Ukwelashwa ngemisebe.
  • I-Monoclonal antibody therapy (dinutuximab) ene-interleukin-2 (IL-2), i-granulocyte-macrophage colony-stimulating factor (GM-CSF), ne-isotretinoin.
  • Isivivinyo somtholampilo sokwelapha iodine 131-MIBG noma ukwelashwa okuhlosiwe (crizotinib) nokunye ukwelashwa.
  • Isivivinyo somtholampilo se-monoclonal antibody therapy (dinutuximab), GM-CSF, kanye nenhlanganisela yamakhemikhali.

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.

Ukwelashwa kweSigaba 4S Neuroblastoma

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

Akukho ukwelashwa okujwayelekile kwesigaba esanda kutholakala se-4S neuroblastoma kepha izinketho zokwelashwa zifaka okulandelayo:

  • Ukuqaphela nokunakekela okusekela izingane ezine-tumor biology enhle futhi ezingenazo izimpawu noma izimpawu.
  • I-Chemotherapy, yezingane ezinezimpawu noma izimpawu, ezinganeni ezisencane kakhulu, noma ezinganeni ezine-tumor biology engathandeki.
  • Ukwelashwa ngemisebe yezingane ezine-neuroblastoma eselusakaze esibindini.
  • Isivivinyo somtholampilo sokwelashwa esuselwa ekuphenduleni kwesimila ekwelashweni nakwisigaxa sebhayoloji.

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.

Ukwelashwa kwe-Neuroblastoma Ephindaphindiwe

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

Iziguli Zelashwa Okokuqala nge-Neuroblastoma Engcupheni Ephansi

Ukwelashwa kwe-neuroblastoma ephindaphindayo ebuya endaweni lapho umdlavuza waqala khona kungafaka okulandelayo:

  • Ukuhlinzwa okulandelwa ukubonwa noma ukwelashwa ngamakhemikhali.
  • I-Chemotherapy engalandelwa ukuhlinzwa.

Ukwelashwa kwe-neuroblastoma ephindaphindayo ebuya kwezinye izingxenye zomzimba noma engaphendulanga ekwelashweni kungafaka okulandelayo:

  • Ukuqaphela.
  • Ukwelashwa ngamakhemikhali.
  • Ukuhlinzwa kwalandelwa ukwelashwa ngamakhemikhali.
  • Ukwelashwa njenge-neuroblastoma esengozini enkulu esanda kutholakala, ezinganeni ezineminyaka engaphezu konyaka owodwa.

Iziguli Zelashwa Okokuqala nge-Intermediate-Risk Neuroblastoma

Ukwelashwa kwe-neuroblastoma ephindaphindayo ebuya endaweni lapho umdlavuza waqala khona kungafaka okulandelayo:

  • Ukuhlinzwa okungalandelwa ukwelashwa ngamakhemikhali.
  • Ukwelashwa ngemisebe yezingane ezinesifo esibe sibi kakhulu ngemuva kokuhlinzwa ngamakhemikhali kanye nokuhlinzwa kwesibili.

Ukwelashwa kwe-neuroblastoma ephindaphindayo ebuya kwezinye izingxenye zomzimba kungafaka okulandelayo:

  • Ukwelashwa njenge-neuroblastoma esengozini enkulu esanda kutholakala, ezinganeni ezineminyaka engaphezu konyaka owodwa.

Iziguli Zelashwa Okokuqala nge-High-Risk Neuroblastoma

Akukho ukwelashwa okujwayelekile kwe-neuroblastoma ephindaphindwayo ezigulini ezelashwa kuqala nge-neuroblastoma enobungozi obukhulu. Ukwelashwa kungafaka okulandelayo:

  • Ukwelashwa ngamakhemikhali.
  • Inhlanganisela ye-chemotherapy ne-monoclonal antibody therapy (dinutuximab).
  • Ukwelashwa kwe-Iodine 131-MIBG ukuqeda izimpawu nokuthuthukisa ikhwalithi yempilo. Inganikezwa yodwa noma ihlanganiswe ne-chemotherapy.
  • Ukwelashwa okubhekiswe ku-crizotinib noma amanye ama-ALK inhibitors, ezigulini ezinoshintsho kuhlobo lwe-ALK.

Ngenxa yokuthi alukho ukwelashwa okujwayelekile, iziguli eziqale zaphathwa nge-neuroblastoma enobungozi obukhulu zingafuna ukubheka isilingo somtholampilo. Ngemininingwane mayelana nokuhlolwa kwemitholampilo, sicela ubheke iwebhusayithi ye-NCI.

Iziguli ezine-CNS Neuroblastoma Ephindaphindayo

Ukwelashwa kwe-neuroblastoma ephindayo (ebuya emuva) ohlelweni lwezinzwa oluphakathi (i-CNS; ubuchopho nomgogodla) kungafaka okulandelayo:

  • Ukuhlinzwa ukususa isimila ku-CNS kulandelwe ukwelashwa ngemisebe.
  • Isivivinyo somtholampilo sokwelapha okusha.

Imithi Efundelwa I-Neuroblastoma Eqhubekayo / Ephindaphindayo

Ezinye izindlela zokwelashwa ezifundwa ekuhlolweni kwemitholampilo ye-neuroblastoma ephindayo (ebuya emuva) noma eqhubekayo (ikhula, isakaze, noma ingaphenduli ekwelashweni) ifaka okulandelayo:

  • I-Chemotherapy kanye nokwelashwa okuhlosiwe (dinutuximab nge-eflornithine noma ngaphandle kwayo).
  • Ukuhlola isampula lesimila sesiguli ngezinguquko ezithile zofuzo. Uhlobo lokwelashwa okuqondisiwe oluzonikezwa isiguli kuncike ohlotsheni lokushintsha kofuzo.
  • Ukwelashwa okuhlosiwe (AZD1775) kanye nokwelashwa ngamakhemikhali.
  • Ukwelashwa okuhlosiwe (i-pembrolizumab noma i-lorlatinib).
  • I-Immunotherapy (Ukwelashwa kwe-CAR T-cell).
  • Ukwelashwa kwe-Iodine 131-MIBG okunikezwe kukodwa noma ngeminye imishanguzo yokulwa nomdlavuza.
  • Ukwelashwa kwe-Iodine 131-MIBG kanye nokwelashwa okuhlosiwe (dinutuximab).

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 ngeNeuroblastoma

Ngemininingwane engaphezulu evela ku-National Cancer Institute mayelana ne-neuroblastoma, bona okulandelayo:

  • Ikhasi lasekhaya le-Neuroblastoma
  • Ukuhlolwa kwe-Neuroblastoma
  • I-Computed Tomography (CT) Iskena Nomdlavuza
  • Izidakamizwa ezivunyelwe i-Neuroblastoma
  • Izindlela Zokwelapha Zomdlavuza
  • I-Immunotherapy Yokwelapha Umdlavuza
  • Izindlela Ezintsha ze-Neuroblastoma Therapy (NANT) Exit Disclaimer

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

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


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