Izinhlobo / izicubu ezithambile-i-sarcoma / isiguli / ukwelashwa kwezicubu zomuntu omdala-pdq

Ukwelashwa Kwe-Adult Soft Tissue Sarcoma (®) –Patient Version

Imininingwane ejwayelekile Mayelana Ne-Adult Soft Tissue Sarcoma

I-sarcoma yezicubu ezithambile zabantu abadala yisifo lapho amangqamuzana abulalayo (umdlavuza) akha izicubu zomzimba ezithambile.

Izicubu ezithambile zomzimba zifaka imisipha, imisipha (amabhande we-fiber axhuma imisipha emathanjeni), amafutha, imithambo yegazi, imithambo yegazi, izinzwa nezicubu ezizungeze amalunga. Ama-sarcomas wezicubu ezithambile ezindala angakha cishe noma yikuphi emzimbeni, kepha ajwayelekile ekhanda, entanyeni, ezingalweni, emilenzeni, esiqwini, esiswini nase-retroperitoneum.

Izicubu ezithambile ze-sarcoma ezicutshini ezithambile zomzimba, kufaka phakathi imisipha, imisipha, amanoni, imithambo yegazi, imithambo ye-lymph, izinzwa nezicubu ezizungeze amalunga.

Kunezinhlobo eziningi ze-sarcoma yezicubu ezithambile. Amaseli ohlobo ngalunye lwe-sarcoma abukeka ehlukile ngaphansi kwesibonakhulu, ngokuya ngohlobo lwezicubu ezithambile lapho umdlavuza waqala khona.

Bona izifinyezo ezilandelayo ze- ukuthola eminye imininingwane ngama-sarcomas wezicubu ezithambile:

• Ukwelashwa Kwe-Sarcoma Tissue Tissue Tissue

• Ukwelashwa kwe-Ewing Sarcoma

• Ukwelashwa Kwamathumbu Okuqina Kwamathumbu

• Ukwelashwa kweKaposi Sarcoma

• Ukwelashwa kwesibeletho

Ukuba nezinkinga ezithile ezizuzwe njengefa kungakhuphula ubungozi be-sarcoma yabantu abadala ethambile.

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 zobungozi besicubu esithambile sarcoma zifaka ukuphazamiseka okulandelayo okuzuzwe njengefa:

• I-Retinoblastoma.

• Uhlobo lwe-Neurofibromatosis 1 (NF1; isifo se-Recklinghausen).

• I-Tuberous sclerosis (isifo saseBourneville).

• I-adenomatous polyposis ejwayelekile (i-FAP; i-Gardner syndrome).

• Isifo se-Li-Fraumeni.

• I-Werner syndrome (i-progeria yabantu abadala).

• I-Nevoid basal cell carcinoma syndrome (i-Gorlin syndrome).

Ezinye izinto eziyingozi ze-sarcoma yezicubu ezithambile zifaka okulandelayo:

• Ukwelashwa kwangaphambilini ngemithi yokwelapha ngemisebe ethile.

• Ukuchayeka kumakhemikhali athile, njengeThorotrast (thorium dioxide), i-vinyl chloride, noma i-arsenic.

• Ukuba nokuvuvukala (i-lymphedema) ezingalweni noma emilenzeni isikhathi eside.

Uphawu lwesicubu somuntu omdala esithambile siyiqhubu noma ukuvuvukala kwezicubu ezithambile zomzimba.

I-sarcoma ingavela njengesigaxa esingenabuhlungu ngaphansi kwesikhumba, imvamisa engalweni noma emlenzeni. AmaSarcomas aqala esiswini kungenzeka angabangeli

izimpawu noma izimpawu zize zikhule kakhulu. Njengoba i-sarcoma ikhula futhi icindezela ezithweni eziseduze, izinzwa, imisipha, noma imithambo yegazi, izimpawu nezimpawu zingafaka:

• Ubuhlungu.

• Ukuphefumula kanzima.

Ezinye izimo zingadala izimpawu nezimpawu ezifanayo. Buza nodokotela wakho uma unanoma iyiphi yalezi zinkinga.

I-sarcoma yabantu abadala ethambile itholakala ukuthi ine-biopsy.

Uma udokotela wakho ecabanga ukuthi ungaba nesarcoma yezicubu ezithambile, kuzokwenziwa i-biopsy. Uhlobo lwe-biopsy luzosuselwa kusayizi wesimila nokuthi sikuphi emzimbeni. Kunezinhlobo ezintathu ze-biopsy ezingasetshenziswa:

• I-incisional biopsy: Ukususwa kwengxenye yesigaxa noma isampula lezicubu.

• I-Core biopsy: Ukususwa kwezicubu kusetshenziswa inaliti ebanzi.

• I-Biopsy e-Excisional: Ukususwa kwesigaxa sonke noma indawo yezicubu ezingabonakali zijwayelekile.

Amasampula azothathwa kwisimila sokuqala, ama-lymph node, nakwezinye izindawo ezisolisayo. Isazi sezifo sibheka izicubu ngaphansi kwesibonakhulu ukuze sibheke amangqamuzana omdlavuza nokuthola ibanga lesimila. Izinga lesimila lincike ekutheni amangqamuzana omdlavuza abukeka ngendlela engavamile kanjani ngaphansi kwesibonakhulu nokuthi amaseli ahlukana ngokushesha kangakanani. Izicubu ezisezingeni eliphakeme zivame ukukhula futhi zisabalale ngokushesha ukwedlula izicubu ezisezingeni eliphansi.

Ngoba izicubu ezithambile ze-sarcoma kungaba nzima ukuyixilonga, iziguli kufanele zibuze ukuthi amasampula ezicubu ahlolwe ngudokotela wezifo onolwazi lokuthola izicubu ezithambile ze-sarcoma.

Ukuhlolwa okulandelayo kungenziwa kuzicubu ezisuswe:

• 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.

• I-light and electron microscopy: Isivivinyo selabhorethri lapho amaseli esampula yezicubu abukwa khona ngaphansi kwama-microscopes avamile futhi anamandla aphezulu ukubheka ushintsho oluthile kumaseli.

• 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-FISH (i-fluorescence in situ hybridization): Ukuhlolwa kwaselebhu okusetshenziselwa ukubuka nokubala izakhi zofuzo noma ama-chromosomes kumaseli nezicubu. Izingcezu ze-DNA ezinodayi we-fluorescent zenziwa elabhoratri bese zengezwa kusampula yamaseli noma izicubu zesiguli. Lapho lezi zingcezu zeDNA ezidayiwe zinamathela kuzakhi zofuzo ezithile noma ezindaweni ezithile zama-chromosomes kusampula, ziyakhanya lapho zibhekwa ngaphansi kwesibonakhulu se-fluorescent. Ukuhlolwa kwe-FISH kusetshenziselwa ukusiza ukuthola umdlavuza nokusiza ukuhlela ukwelashwa.

• Flow cytometry: Isivivinyo selabhorethri esikala inani lamaseli esampula, iphesenti lamaseli abukhoma kusampula, kanye nezici ezithile zamaseli, njengosayizi, umumo, nokuba khona komaka be-tumor (noma okunye) ubuso beseli. Amaseli avela kusampula yegazi lesiguli, umnkantsha, noma ezinye izicubu anamabala ombala we-fluorescent, afakwa kuketshezi, abese edluliswa ngalinye ngesikhathi emgqeni wokukhanya. Imiphumela yokuhlolwa isuselwa ekutheni amangqamuzana abenebala lodayi we-fluorescent asabela kanjani oshalweni lokukhanya.

Izici ezithile zithinta izinketho zokwelashwa nokubikezela (ithuba lokululama).

Izinketho zokwelashwa nokubikezela (ithuba lokululama) kuncike kokulandelayo:

• Uhlobo lwe-sarcoma yezicubu ezithambile.

• Usayizi, ibanga, nesigaba sesimila.

• Ashesha kangakanani amangqamuzana omdlavuza akhula futhi ahlukane.

• Lapho isimila sikhona emzimbeni.

• Ukuthi sonke isimila sisuswa ngokuhlinzwa.

• Iminyaka yesiguli nempilo ejwayelekile.

• Ukuthi umdlavuza ubuyile yini (buyela emuva).

Izigaba ze-Adult Soft Tissue Sarcoma

AMAPHUZU ASEMQOKA

• Ngemuva kokutholakala kwezicubu zomzimba ezithambile zabantu abadala, kwenziwa ukuhlolwa ukuze kutholakale ukuthi amangqamuzana omdlavuza asakazekile ngaphakathi kwezicubu ezithambile noma kwezinye izingxenye zomzimba.

• Zintathu izindlela umdlavuza osakazeka ngayo emzimbeni.

• Umdlavuza ungasakazeka usuka lapho uqale khona kwezinye izingxenye zomzimba.

• Izinga lesimila nalo lisetshenziselwa ukuchaza umdlavuza nokuhlela ukwelashwa.

• Ukuze kusetshenziswe i-sarcoma yabantu abadala esithambile, izingalo nemilenze, kusetshenziswa lezi zigaba ezilandelayo:

• Isiteji I

• Isigaba II

• Isigaba III

• Isigaba IV

• Kwi-sarcoma yabantu abadala ethambile ye-retroperitoneum, kusetshenziswa lezi zigaba ezilandelayo:

• Isiteji I

• Isigaba II

• Isigaba III

• Isigaba IV

• Alukho uhlelo olujwayelekile lokubeka izitaki ezithambile zekhanda, intamo, isifuba noma isisu.

Ngemuva kokutholakala kwezicubu zomzimba ezithambile zabantu abadala, kwenziwa ukuhlolwa ukuze kutholakale ukuthi amangqamuzana omdlavuza asakazekile ngaphakathi kwezicubu ezithambile noma kwezinye izingxenye zomzimba.

Inqubo esetshenziswayo ukuthola ukuthi umdlavuza ususabalele ngaphakathi kwezicubu ezithambile noma kwezinye izingxenye zomzimba ibizwa ngokuthi yi-staging. Ukuhlukaniswa kwezicubu zomzimba ezithambile kubuye kusekelwe ebangeni nasosayizi wesimila, nokuthi ngabe sisabalalele kuma-lymph node noma kwezinye izingxenye zomzimba. Imininingwane eqoqwe kusuka kusistimu yesiteji inquma isigaba sesifo. Kubalulekile ukwazi isigaba ukuze uhlele ukwelashwa.

Lezi zivivinyo nezinqubo ezilandelayo zingasetshenziswa kunqubo yokubeka iziteji:

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

• 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.

• 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.

• Qedela ukubalwa kwegazi (i-CBC): Inqubo lapho kukhishwa khona isampula legazi futhi lihlolwe lokhu okulandelayo:

• Inani lamaseli abomvu egazi, amaseli amhlophe egazi, nama-platelets.

• Inani le-hemoglobin (iprotheni ethwala umoya-mpilo) kumaseli abomvu egazi.

• Ingxenye yesampula yegazi eyenziwe ngamaseli abomvu egazi.

• I-CT scan (i-CAT scan): Inqubo eyenza uchungechunge lwezithombe eziningiliziwe zezindawo ezingaphakathi komzimba, njengephaphu nesisu, 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): 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-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.

Imiphumela yalokhu kuhlolwa ibukwa kanye nemiphumela yesimila ukuthola ukuthi isigaba se-sarcoma esithambile sezicubu ngaphambi kokuba kunikezwe ukwelashwa. Kwesinye isikhathi ukwelashwa ngamakhemikhali noma ukwelashwa ngemisebe kunikezwa njengokwelashwa kokuqala futhi ngemuva kwalokho i-sarcoma ethambile yezicubu iphinde iboniswe.

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 izicubu ezithambile sarcoma zisakazeka ziye emaphashini, amangqamuzana omdlavuza emaphashini empeleni angamaseli wezicubu ze-sarcoma ezithambile. Lesi sifo siyi-metastatic soft tissue sarcoma, hhayi umdlavuza wamaphaphu.

Izinga lesimila nalo lisetshenziselwa ukuchaza umdlavuza nokuhlela ukwelashwa.

Izinga lesimila lichaza ukuthi amaseli omdlavuza abukeka ngendlela engavamile kanjani ngaphansi kwesibonakhulu nokuthi kungenzeka kanjani ukuthi isimila sikhule futhi sisakazeke ngokushesha. Ibanga eliphansi, ibanga eliphakathi, kanye nebanga eliphakeme lisetshenziselwa ukuchaza izicubu ezithambile sarcoma:

• Ibanga eliphansi: Ku-sarcoma yezicubu ezithambile ezisezingeni eliphansi, amaseli womdlavuza abukeka njengamaseli ajwayelekile ngaphansi kwe-microscope futhi akhula futhi asakazeke kancane kancane kunaphakathi kwezinga eliphakathi naphakathi kanye nezinga eliphakeme le-sarcoma.

• Ibanga eliphakathi: Ephakathi naphakathi kwebanga izicubu ezithambile sarcoma, amangqamuzana omdlavuza abukeka engajwayelekile ngaphansi kwemicroscope futhi akhule futhi asakazeke ngokushesha okukhulu kune-low grade grade soft sarcoma.

• Ibanga eliphakeme: Ku-sarcoma yezicubu ezithambile ezisezingeni eliphakeme, amangqamuzana omdlavuza abukeka engajwayelekile ngaphansi kwe-microscope futhi akhula futhi asabalale ngokushesha okukhulu kunasesibhakabhakeni esithambile esiphakathi naphakathi naphakathi.

Ukuze kusetshenziswe i-sarcoma yabantu abadala esithambile, izingalo nemilenze, kusetshenziswa lezi zigaba ezilandelayo:

Isiteji I

Isiteji I-sarcoma yezicubu ezithambile zabantu abadala besiqu, izingalo nemilenze ihlukaniswe ngezigaba IA ne-IB:

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).

• Esigabeni IA, isimila singamasentimitha ama-5 noma sincane futhi sisezingeni eliphansi noma lelo banga alaziwa.

• Esigabeni IB, isimila sikhulu kunamasentimitha ama-5 futhi sisezingeni eliphansi noma lelo banga alaziwa.

Isigaba II

Esigabeni II izicubu zomzimba ezithambile zabantu abadala besiqu, izingalo nemilenze, isimila singamasentimitha ama-5 noma sincane futhi siphakathi nendawo noma ibanga eliphakeme.

Isigaba III

Isigaba III sezicubu zomzimba ezithambile zabantu abadala, izingalo, nemilenze ihlukaniswe ngezigaba IIIA kanye ne-IIIB:

• Esigabeni IIIA, isimila sikhulu kunamasentimitha ama-5 kepha asisikhulu kunamasentimitha ayi-10 futhi sisebangeni eliphakathi noma ibanga eliphakeme.

• Esigabeni IIIB, isimila sikhulu kunamasentimitha ayi-10 futhi sisebangeni eliphakathi noma ebangeni eliphakeme.

Isigaba IV

Esigabeni IV izicubu ezithambile zabantu abadala besiqu, izingalo nemilenze, kutholakala okukodwa kokulandelayo:

• isimila sinanoma yisiphi isayizi, noma iliphi ibanga, futhi sesisabalalele kuma-lymph node aseduze; noma

• isimila sinanoma yisiphi isayizi, noma iliphi ibanga, futhi kungenzeka ukuthi sisabalalele kuma-lymph node aseduze. Umdlavuza ususabalele nakwezinye izingxenye zomzimba, njengephaphu.

Kwi-sarcoma yabantu abadala ethambile ye-retroperitoneum, kusetshenziswa lezi zigaba ezilandelayo:

Isiteji I

Isiteji I-sarcoma yezicubu ezithambile zabantu abadala ye-retroperitoneum ihlukaniswe ngezigaba IA ne-IB:

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).

• Esigabeni IA, isimila singamasentimitha ama-5 noma sincane futhi sisezingeni eliphansi noma lelo banga alaziwa.

• Esigabeni IB, isimila sikhulu kunamasentimitha ama-5 futhi sisezingeni eliphansi noma lelo banga alaziwa.

Isigaba II

Esigabeni II izicubu zomzimba ezithambile zabantu abadala ze-retroperitoneum, isimila singamasentimitha ama-5 noma sincane futhi siphakathi nendawo noma ibanga eliphakeme.

Isigaba III

Isigaba III sezicubu ezithambile zabantu abadala se-retroperitoneum sehlukaniswe ngezigaba IIIA ne-IIIB:

• Esigabeni IIIA, isimila sikhulu kunamasentimitha ama-5 kepha asisikhulu kunamasentimitha ayi-10 futhi sisebangeni eliphakathi noma ibanga eliphakeme.

• Esigabeni IIIB, okukodwa kokulandelayo kuyatholakala:

• isimila sikhulu kunamasentimitha ayi-10 futhi sisebangeni eliphakathi noma ibanga eliphakeme; noma

• isimila sinanoma yisiphi isayizi, noma iliphi ibanga, futhi sesisabalalele kuma-lymph node aseduze.

Isigaba IV

Esigabeni IV izicubu ezithambile zabantu abadala ze-retroperitoneum, isimila sinanoma yisiphi isayizi, noma iliphi ibanga, futhi kungenzeka ukuthi sisabalalele kuma-lymph node aseduze. Umdlavuza ususabalele nakwezinye izingxenye zomzimba, njengephaphu.

Alukho uhlelo olujwayelekile lokubeka izitaki ezithambile zekhanda, intamo, isifuba noma isisu.

Izicubu Zesikhumba Esithambile Zabantu Abadala

I-sarcoma yezicubu zabantu abadala ephindaphindayo ngumdlavuza ophindile (wabuya) ngemuva kokuba welashwe. Umdlavuza ungabuya izicubu ezifanayo ezithambile noma kwezinye izingxenye zomzimba.

Uhlolojikelele lwenketho yokwelashwa

AMAPHUZU ASEMQOKA

• Kunezinhlobo ezahlukahlukene zokwelashwa kweziguli ezine-sarcoma yabantu abadala ethambile.

• Izinhlobo ezintathu zokwelashwa okujwayelekile zisetshenzisiwe:

• Ukuhlinzwa

• Ukwelashwa ngemisebe

• Ukwelashwa ngamakhemikhali

• Izinhlobo ezintsha zokwelashwa ziyahlolwa ezivivinyweni zokwelashwa.

• Ukwelashwa ngamakhemikhali kwesifunda

• Ukwelashwa kwe-sarcoma yabantu abadala ethambile 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-sarcoma yabantu abadala ethambile.

Izinhlobo ezahlukene zokwelashwa ziyatholakala ezigulini ezine-sarcoma yabantu abadala ethambile. Ezinye izindlela zokwelapha zijwayelekile (indlela esetshenziswa njengamanje), kanti ezinye ziyahlolwa ezivivinyweni zokwelashwa. Isivivinyo somtholampilo wokwelashwa isifundo socwaningo esihloselwe ukusiza ukuthuthukisa ukwelashwa kwamanje noma ukuthola ulwazi ngezindlela zokwelashwa ezintsha zeziguli ezinomdlavuza. Lapho izivivinyo zokwelashwa zibonisa ukuthi ukwelashwa okusha kungcono kunokwelashwa okujwayelekile, ukwelashwa okusha kungaba ukwelashwa okujwayelekile. Iziguli zingafuna ukucabanga ngokubamba iqhaza esivivinyweni somtholampilo. Ezinye izivivinyo zokwelashwa zivulekele kuphela iziguli ezingakaqali ukwelashwa.

Izinhlobo ezintathu zokwelashwa okujwayelekile zisetshenzisiwe:

Ukuhlinzwa

Ukuhlinzwa ukwelashwa okuvame kakhulu kwe-sarcoma yabantu abadala ethambile. Kweminye i-sarcomas yezicubu ezithambile, ukususwa kwesimila ekuhlinzweni kungaba ukuphela kwokwelapha okudingekayo. Izinqubo ezilandelayo zokuhlinza zingasetshenziswa:

I-Mohs microsurgery: Inqubo lapho kusikwa khona isimila esikhunjeni ngezingqimba ezincane. Ngesikhathi sokuhlinzwa, imiphetho yesimila kanye noqweqwe ngalunye lwesimila olususiwe kubukwa ngesibonakhulu ukuhlola amaseli omdlavuza. Izendlalelo ziyaqhubeka nokususwa kuze kungabonakali amangqamuzana omdlavuza. Lolu hlobo lokuhlinzwa lususa izicubu ezincane ezijwayelekile ngangokunokwenzeka futhi luvame ukusetshenziselwa lapho ukubukeka kubalulekile, njengesikhumba.

Mohs ukuhlinzwa. Inqubo yokuhlinza ukususa isilonda esibonakalayo esikhumbeni ngezinyathelo eziningana. Okokuqala, ungqimba oluncane lwezicubu ezinomdlavuza luyasuswa. Ngemuva kwalokho, ungqimba lwesibili lwesicubu luyasuswa lubukwe ngaphansi kwesibonakhulu ukuhlola amaseli omdlavuza. Izendlalelo eziningi zisuswa ngamunye ngamunye kuze kube yilapho izicubu ezibhekwa ngaphansi kwesibonakhulu zingakhombisi ukuthi awunawo umdlavuza osele. Lolu hlobo lokuhlinzwa lusetshenziselwa ukususa izicubu ezincane ezijwayelekile ngangokunokwenzeka.

• Ukukhishwa kwendawo yonke: Ukususwa kwesimila kanye nezicubu ezithile ezijwayelekile ezisizungezile. Kwizicubu zekhanda, intamo, isisu, nesiqu, kususwa izicubu ezijwayelekile ezincane ngangokunokwenzeka.

• Ukuhlinzwa okonga amalunga: Ukususwa kwesimila engalweni noma emlenzeni ngaphandle kokunqunywa, ngakho-ke ukusetshenziswa nokubukeka kwesitho kuyagcinwa. Ukwelashwa ngemisebe noma i-chemotherapy kunganikezwa kuqala ukunciphisa isimila. Isigaxa sikhishwa lapho kususwe indawo ebanzi. Izicubu namathambo okususiwe kungashintshwa kufakwe okuxhunywe kusetshenziswa izicubu namathambo athathwe kwenye ingxenye yomzimba wesiguli, noma ngokufakwa okufana nethambo lokufakelwa.

• Ukunqunywa: Ukuhlinzwa ukususa ingxenye noma wonke umlenze noma okokufaka, okufana nengalo noma umlenze. Ukunqunywa akuvamile ukusetshenziselwa ukwelapha i-sarcoma yezicubu ezithambile zengalo noma yomlenze.

• I-Lymphadenectomy: Inqubo yokuhlinza lapho kukhishwa khona ama-lymph node futhi kuhlolwe isampula lezicubu ngaphansi kwesibonakhulu ukuthola izimpawu zomdlavuza. Le nqubo ibizwa nangokuthi i-lymph node dissection.

Ukwelashwa ngemisebe noma i-chemotherapy kunganikezwa ngaphambi noma ngemuva kokuhlinzwa ukuze kususwe isimila. Lapho unikezwa ngaphambi kokuhlinzwa, ukwelashwa ngemisebe noma i-chemotherapy kuzokwenza isimila sibe sincane futhi kunciphise inani lezicubu ezidinga ukususwa ngesikhathi sokuhlinzwa. Ukwelashwa okunikezwa ngaphambi kokuhlinzwa kubizwa ngokuthi ukwelashwa kwe-neoadjuvant. Lapho unikezwa ngemuva kokuhlinzwa ukususa sonke isimila esingabonakala, ukwelashwa ngemisebe noma i-chemotherapy kuzobulala noma yimaphi amaseli omdlavuza asele. Ukwelashwa okunikezwe ngemuva kokuhlinzwa, ukwehlisa ubungozi bokuthi umdlavuza uzobuya, kubizwa ngokuthi yi-adjuvant therapy.

Ukwelashwa ngemisebe

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

I-intension-modulated radiation therapy (IMRT) wuhlobo lokwelashwa ngemisebe okuyi-3-dimensional (3-D) esebenzisa ikhompyutha ukwenza izithombe zosayizi nokuma kwesimila. Imishayo emincane yemisebe yamandla ahlukene (amandla) ihloselwe isimila ezinhlangothini eziningi. Lolu hlobo lokwelashwa ngemisebe lwangaphandle lubangela ukulimala okuncane ezicutshini eziseduze ezinempilo futhi mancane amathuba okuthi kubangele umlomo owomile, inkinga yokugwinya, nokulimaza isikhumba.

Indlela okunikezwa ngayo ukwelashwa ngemisebe kuya ngohlobo nesigaba somdlavuza owelashwa. Ukwelashwa kwemisebe yangaphandle nokwelashwa ngemisebe kwangaphakathi kungasetshenziswa ukwelapha i-sarcoma yabantu abadala ethambile.

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). Indlela i-chemotherapy enikezwa ngayo incike ohlotsheni nesigaba somdlavuza owelashwa.

Bheka Izidakamizwa Ezivunyelwe I-Soft Tissue Sarcoma ukuthola eminye imininingwane.

Izinhlobo ezintsha zokwelashwa ziyahlolwa ezivivinyweni zokwelashwa.

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

Ukwelashwa ngamakhemikhali kwesifunda

Ukuhlolwa kwemitholampilo kutadisha izindlela zokwenza ngcono umphumela we-chemotherapy kumaseli we-tumor, kufaka phakathi okulandelayo:

• Ukwelashwa kwe-hyperthermia yesifunda: Ukwelashwa lapho izicubu ezizungeze isimila zivezwa khona emazingeni okushisa aphezulu ukuze zilimaze futhi zibulale amangqamuzana omdlavuza noma zenze amangqamuzana omdlavuza azwele kakhulu ekhemotherapy.

• I-perfusion yezitho ezihlukanisiwe: Inqubo ethumela i-chemotherapy ngqo engalweni noma emlenzeni lapho umdlavuza wakhe khona. Ukugeleza kwegazi kuya nokubuya emlenzeni kumiswa okwesikhashana nge-tourniquet, futhi izidakamizwa ze-anticancer zifakwa ngqo egazini lomlenze. Lokhu kuthumela umthamo omkhulu wezidakamizwa ku-tumor.

Ukwelashwa kwe-sarcoma yabantu abadala ethambile kungadala imiphumela emibi.

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

Iziguli zingafuna ukucabanga ngokubamba iqhaza esivivinyweni somtholampilo.

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

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

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

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

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

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

Ukuhlolwa kokulandelela kungadingeka.

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

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

Izinketho zokwelashwa ze-Adult Soft Tissue Sarcoma

Kulesi Sigaba

• Isiteji I-Adult Soft Tissue Sarcoma

• Isigaba II Izicubu Zabantu Abancane Abathambile I-Sarcoma ne-Stage III I-Adult Tissue Sarcoma Engakaze Isabalalele Ku-Lymph Node

• Isigaba III I-Sarcoma Yezicubu Zabantu Abadala Esithambile Esisabalalele Ku-Lymph Node (Kuthuthukile)

• Isigaba IV Isicubu Sabantu Abancane Esithambile Sarcoma

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

Isiteji I-Adult Soft Tissue Sarcoma

Ukwelashwa kwesigaba I sarcoma esithambile sezicubu kungafaka okulandelayo:

• Ukuhlinzwa ukukhipha isimila, njenge-Mohs microsurgery yama-sarcomas amancane esikhumba, ukusikwa okubanzi kwendawo, noma ukuhlinzwa kokuvikela izitho.

• Ukwelashwa ngemisebe ngaphambi kanye / noma ngemuva kokuhlinzwa.

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 II Izicubu Zabantu Abancane Abathambile I-Sarcoma ne-Stage III I-Adult Tissue Sarcoma Engakaze Isabalalele Ku-Lymph Node

Ukwelashwa kwesigaba II sesicubu somuntu omdala esithambile nesigaba III sesicubu somuntu omdala esingasabalalanga kuma-lymph node kungafaka okulandelayo:

• Ukuhlinzwa ukukhipha isimila, njengokuhlinzekwa okubanzi kwendawo noma ukuhlinzwa kwezitho.

• Ukwelashwa ngemisebe ngaphambi kokuhlinzwa noma ngemuva kokuhlinzwa.

• Ukwelashwa ngemisebe noma i-chemotherapy ngaphambi kokuhlinzwa okonga izitho. Ukwelashwa ngemisebe nakho kunganikezwa ngemuva kokuhlinzwa.

• Ukwelashwa kwemisebe ephezulu yezimila ezingenakususwa ngokuhlinzwa.

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

Isigaba III I-Sarcoma Yezicubu Zabantu Abadala Esithambile Esisabalalele Ku-Lymph Node (Kuthuthukile)

Ukwelashwa kwesigaba sesithathu sesicubu somuntu omdala esithambile esisakazekele kuma-lymph node (athuthukile) kungafaka okulandelayo:

• Ukuhlinzwa (ukusikwa kwendawo okubanzi) nge-lymphadenectomy. Ukwelashwa ngemisebe nakho kunganikezwa ngemuva kokuhlinzwa.

• Isivivinyo somtholampilo sokuhlinzwa silandelwa ukwelashwa ngamakhemikhali.

• Isivivinyo somtholampilo sokwelashwa kwe-hyperthermia yesifunda.

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 IV Isicubu Sabantu Abancane Esithambile Sarcoma

Ukwelashwa kwesigaba IV sabantu abadala izicubu ezithambile kungafaka okulandelayo:

• Ukwelashwa ngamakhemikhali.

• Ukuhlinzwa kususa umdlavuza osudlulele emaphashini.

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.

Izinketho Zokwelashwa Kwe-Sarcoma Tissue Sarcoma

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

Ukwelashwa kwe-sarcoma yezicubu zabantu abadala eziphindaphindayo kungafaka okulandelayo:

• Ukuhlinzwa (ukusikwa kwendawo okubanzi) kulandelwe ukwelashwa ngemisebe.

• Ukuhlinzwa (ukunqunywa; akuvamile ukwenziwa).

• Ukuhlinza ukususa umdlavuza ophindwe wabuya emaphashini.

• Ukwelashwa ngamakhemikhali.

• Isivivinyo somtholampilo sokuthanjiswa kwezitho ezikude.

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.

Ukufunda Kabanzi Nge-Adult Soft Tissue Sarcoma

Ngemininingwane engaphezulu evela ku-National Cancer Institute mayelana nezicubu zomzimba ezithambile, bheka okulandelayo:

• Ikhasi lasekhaya le-Soft Tissue Sarcoma

• Ukwelashwa Kwe-Sarcoma Tissue Tissue Tissue

• Ukwelashwa kwe-Ewing Sarcoma

• Ukwelashwa Kwamathumbu Okuqina Kwamathumbu

• Ukwelashwa kweKaposi Sarcoma

• Ukwelashwa kwesibeletho

• Izidakamizwa zivunyelwe i-Soft Tissue Sarcoma

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