Izinhlobo / isisu / isiguli / ukwelashwa kwesisu-pdq

Inguqulo Yokwelapha Umdlavuza Wesisu

Imininingwane Ejwayelekile Mayelana Nomdlavuza Wesisu

AMAPHUZU ASEMQOKA

• Umdlavuza wesisu yisifo lapho amangqamuzana abulalayo (umdlavuza) akha ulwelwesi lwesisu.

• Iminyaka yobudala, ukudla, nesifo sesisu kungathinta ubungozi bokuba nomdlavuza wesisu.

• Izimpawu zomdlavuza wesisu zibandakanya ukungagayeki kwesisu nokungakhululeki esiswini noma ubuhlungu.

• Ukuhlolwa okuhlola isisu kanye nomphimbo kusetshenziselwa ukuthola (ukuthola) nokuthola umdlavuza wesisu.

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

Umdlavuza wesisu yisifo lapho amangqamuzana abulalayo (umdlavuza) akha ulwelwesi lwesisu.

Isisu isitho esime ngo-J esiswini esingenhla. Kuyingxenye yohlelo lokugaya ukudla, olucubungula izakhamzimba (amavithamini, amaminerali, ama-carbohydrate, amafutha, amaprotheni, namanzi) ekudleni okudliwayo futhi kusiza ukukhipha imfucuza emzimbeni. Ukudla kuhamba kusuka emphinjeni kuya esiswini ngeshubhu elingenalutho, elinemisipha elibizwa ngokuthi umqala. Ngemuva kokushiya isisu, ukudla okugaywe ngokwengxenye kudlulela emathunjini amancane bese kungena emathunjini amakhulu.

I-esophagus nesisu kuyingxenye yesistimu ephezulu yamathumbu (wokugaya ukudla).

Udonga lwesisu lwakhiwe izingqimba ezi-5 zezicubu. Kusuka kungqimba lwangaphakathi kuya kusendlalelo esingaphandle, izingqimba zodonga lwesisu yilezi: i-mucosa, i-submucosa, imisipha, i-subserosa (izicubu ezixhuma), ne-serosa. Umdlavuza we-gastric uqala ku-mucosa futhi usabalale ungqimba lwangaphandle njengoba lukhula.

Izicubu zomzimba zesisu ziqala ukusekela izicubu ezixhunyiwe futhi ziphathwa ngokuhlukile kunomdlavuza wesisu. Bona isifinyezo se- ku-Gastrointestinal Stromal Tumors Treatment ukuthola eminye imininingwane.

Ngeminye imininingwane mayelana nomdlavuza wesisu, bheka izifinyezo ezilandelayo ze-:

• Umdlavuza Ongajwayelekile Wokwelashwa Kwezingane

• Isisu (Gastric) Ukuvimbela umdlavuza

• Ukuhlolwa Komdlavuza Wesisu (Wesisu)

Iminyaka yobudala, ukudla, nesifo sesisu kungathinta ubungozi bokuba nomdlavuza wesisu.

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

• Ukuba nanoma yiziphi izimo ezilandelayo zezokwelapha:

• Helicobacter pylori (H. pylori) ukutheleleka kwesisu.

• I-gastritis engapheli (ukuvuvukala kwesisu).

• I-anaemia ekhathazayo.

• I-metaplasia yamathumbu (isimo lapho ulwelwesi olujwayelekile lwesisu luthathelwa indawo ngamaseli agudle amathumbu).

• Ama-polyps esiswini.

• Igciwane le-Epstein-Barr.

• Ama-syndromes womndeni (kufaka phakathi i-familia adenomatous polyposis).

• Ukudla ukudla okunokudla okunosawoti, okubhemayo kanye nezithelo nemifino ephansi.

• Ukudla ukudla okungalungiswanga noma okungagcinwanga kahle.

• Ukuba mdala noma owesilisa.

• Ukubhema osikilidi.

• Ukuba nomama, ubaba, udadewabo, noma umfowethu onomdlavuza wesisu.

Izimpawu zomdlavuza wesisu zibandakanya ukungagayeki kwesisu nokungakhululeki esiswini noma ubuhlungu.

Lezi kanye nezinye izimpawu nezimpawu zingabangelwa umdlavuza wesisu noma ezinye izimo.

Ezigabeni zokuqala zomdlavuza wesisu, izimpawu ezilandelayo zingavela:

• Ukugaya isisu nokungakhululeki.

• Umuzwa oqumbile ngemuva kokudla.

• Isicanucanu esimnene.

• Ukuphelelwa isifiso sokudla.

• Isilungulela.

Ezigabeni ezithuthuke kakhulu zomdlavuza wesisu, kungavela lezi zimpawu nezimpawu ezilandelayo:

• Igazi esitulweni.

• Ukuhlanza.

• Ukwehla kwesisindo ngaphandle kwesizathu esaziwayo.

• Ubuhlungu besisu.

• I-jaundice (umbala ophuzi ngamehlo nesikhumba).

• Ama-Ascites (ukwakha uketshezi esiswini).

• Inkinga yokugwinya.

Buza nodokotela wakho uma unanoma iyiphi yalezi zinkinga.

Ukuhlolwa okuhlola isisu kanye nomphimbo kusetshenziselwa ukuthola (ukuthola) nokuthola umdlavuza wesisu.

Lezi zivivinyo nezinqubo ezilandelayo zingasetshenziswa:

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

• 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 eyenziwe ngamaseli abomvu egazi.

• I-endoscopy ephezulu: Inqubo yokubheka ngaphakathi kwesisu, isisu, ne-duodenum (ingxenye yokuqala yamathumbu amancane) ukuhlola izindawo ezingavamile. I-endoscope (ishubhu elincane elikhanyisiwe) idluliswa ngomlomo yehle ngomphimbo iye emphinjeni.

I-endoscopy ephezulu. Ishubhu elincane, elikhanyisiwe lifakwa ngomlomo ukubheka izindawo ezingajwayelekile emqaleni, esiswini, nasengxenyeni yokuqala yamathumbu amancane.

• Ukugwinya kwe-Barium: Uchungechunge lwama-x-ray we-esophagus nesisu. Isiguli siphuza uketshezi oluqukethe i-barium (insimbi eyinsimbi emhlophe). Uketshezi kugqoka umphimbo nesisu, nama-x-ray ayathathwa. Le nqubo ibizwa nangokuthi uchungechunge oluphezulu lwe-GI.

Ukugwinya kwe-Barium ngomdlavuza wesisu. Isiguli sigwinya uketshezi lwe-barium bese sigeleza ngomphimbo singene esiswini. Ama-X-ray ayathathwa ukuyobheka izindawo ezingajwayelekile.

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

• I-Biopsy: Ukususwa kwamaseli noma izicubu ukuze kubhekwe ngaphansi kwesibonakhulu ukuhlola izimpawu zomdlavuza. I-biopsy yesisu ivame ukwenziwa ngesikhathi se-endoscopy.

Isampula lezicubu lingahlolwa ukukala ukuthi mangaki ama-HER2 genes akhona nokuthi angakanani amaprotheni e-HER2 enziwa. Uma kunezakhi zofuzo eziningi ze-HER2 noma amazinga aphezulu amaprotheni we-HER2 kunokujwayelekile, umdlavuza ubizwa nge-HER2 positive. Umdlavuza wesisu esiswini se-HER2 ungaphathwa nge-anti-monoclonal antibody ehlose iphrotheni ye-HER2.

Isampula lezicubu lingahlolwa nokutheleleka ngeHelicobacter pylori (H. pylori).

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

Isibikezelo (ithuba lokululama) nezinketho zokwelashwa zincike kokulandelayo:

• Isigaba somdlavuza (noma ngabe sisesiswini kuphela noma sesisabalele kuma-lymph node noma kwezinye izindawo emzimbeni).

• Impilo ejwayelekile yesiguli.

Lapho umdlavuza wesisu utholakala kusenesikhathi, kunethuba elingcono lokululama. Umdlavuza wesisu uvame ukuba sesigabeni esithuthukile lapho utholakala. Ezinyangeni ezizayo, umdlavuza wesisu ungalashwa kepha kuyaqabukela ukwelashwa. Ukubamba iqhaza kolunye lwezivivinyo zokwelashwa ezenziwa ukwenza ngcono ukwelashwa kufanele kubhekwe. Imininingwane mayelana nokuhlolwa kwemitholampilo okuqhubekayo iyatholakala kuwebhusayithi ye-NCI.

Izigaba Zomdlavuza Wesisu

AMAPHUZU ASEMQOKA

• Ngemuva kokutholakala komdlavuza wesisu, kwenziwa ukuhlolwa ukuze kutholakale ukuthi ngabe amangqamuzana omdlavuza asabalale esiswini noma kwezinye izingxenye zomzimba.

• Zintathu izindlela umdlavuza osakazeka ngayo emzimbeni.

• Umdlavuza ungasakazeka usuka lapho uqale khona kwezinye izingxenye zomzimba.

• Lezi zigaba ezilandelayo zisetshenziselwa umdlavuza wesisu:

• Isigaba 0 (I-Carcinoma eSitu)

• Isiteji I

• Isigaba II

• Isigaba III

• Isigaba IV

Ngemuva kokutholakala komdlavuza wesisu, kwenziwa ukuhlolwa ukuze kutholakale ukuthi ngabe amangqamuzana omdlavuza asabalale esiswini noma kwezinye izingxenye zomzimba.

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

Lezi zivivinyo nezinqubo ezilandelayo zingasetshenziswa kunqubo yokubeka iziteji:

• I-endoscopic ultrasound (EUS): Inqubo lapho kufakwa khona i-endoscope emzimbeni, imvamisa ngomlomo noma nge-rectum. I-endoscope iyinsimbi encane, efana nethubhu enokukhanya nelensi yokubuka. Iphenyo ekugcineni kwe-endoscope isetshenziselwa ukuqhuma amaza omsindo wamandla aphezulu (i-ultrasound) ezicutshini zangaphakathi noma ezithweni futhi enze ama-echoes. Ama-echoes akha isithombe sezicubu zomzimba esibizwa nge-sonogram. Le nqubo ibizwa nangokuthi i-endosonography.

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

• I-PET scan (i-positron emission tomography scan): Inqubo yokuthola amangqamuzana abulalayo omzimba emzimbeni. Inani elincane 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. Ukuskena i-PET ne-CT scan kungenziwa ngasikhathi sinye. Lokhu kubizwa nge-PET-CT.

• 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-Laparoscopy: Inqubo yokuhlinza ukubheka izitho ezingaphakathi esiswini ukubheka izimpawu zesifo. Ukusikeka okuncane (ukusikeka) kwenziwa odongeni lwesisu bese kufakwa i-laparoscope (ithubhu elincane elikhanyisiwe) kokunye okusikiwe. Ezinye izinsimbi zingafakwa ngendlela efanayo noma enye indlela yokwenza izinqubo ezifana nokususa izitho noma ukuthatha amasampula ezicubu ukuze zihlolwe ngaphansi kwesibonakhulu ukuthola izimpawu zomdlavuza. Isixazululo singagezwa ngaphezulu kobuso bezitho esiswini bese sisuswa ukuqoqa amaseli. Lawa maseli abhekwa futhi ngaphansi kwesibonakhulu ukubheka izimpawu zomdlavuza.

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 wesisu usakazekela esibindi, amangqamuzana omdlavuza wesibindi empeleni angamaseli omdlavuza wesisu. Lesi sifo umdlavuza wesisu esiswini, hhayi umdlavuza wesibindi.

Lezi zigaba ezilandelayo zisetshenziselwa umdlavuza wesisu:

Isigaba 0 (I-Carcinoma eSitu)

Esigabeni 0, kutholakala amaseli angajwayelekile ku-mucosa (ungqimba lwangaphakathi) odongeni lwesisu. Lawa maseli angajwayelekile angaba ngumdlavuza futhi asabalale abe izicubu ezijwayelekile eziseduze. Isigaba 0 sibizwa nangokuthi i-carcinoma in situ.

Izendlalelo zodonga lwesisu. Udonga lwesisu lwakhiwa yi-mucosa (ungqimba lwangaphakathi), i-submucosa, ungqimba lwemisipha, i-subserosa, ne-serosa (ungqimba olungaphandle kakhulu). Isisu isitho esiswini esingenhla.

Isiteji I

Isigaba I sihlukaniswe izigaba IA ne-IB.

• I-Stage IA: Umdlavuza wakheke ku-mucosa (ungqimba lwangaphakathi) odongeni lwesisu futhi kungenzeka ukuthi usabalalele ku-submucosa (ungqimba lwezicubu eduze kwe-mucosa).

• Isigaba IB: Umdlavuza:

• yakhe ku-mucosa (ungqimba olungaphakathi impela) lwodonga lwesisu futhi kungenzeka ukuthi yasakazekela kwi-submucosa (ungqimba lwezicubu eduze kwe-mucosa). Umdlavuza usabalalele ku-1 noma 2 e-lymph node eseduze; noma

• yakhe ku-mucosa wodonga lwesisu futhi yasakazeka kungqimba lwemisipha.

Isigaba II

Umdlavuza wesisu sesigaba II uhlukaniswe ngezigaba IIA no-IIB.

• Isigaba IIA: Umdlavuza:

• kungenzeka ukuthi isakaze ku-submucosa (ungqimba lwezicubu eduze kwe-mucosa) kodonga lwesisu. Umdlavuza usabalalele kuma-lymph node aseduze ama-3 kuye kwayisithupha; noma

• selusabalele kungqimba yemisipha yodonga lwesisu. Umdlavuza usabalalele ku-1 noma 2 e-lymph node eseduze; noma

• selinabele ku-subserosa (ungqimba lwezicubu ezixhuma eduze kongqimba lwezicubu) kodonga lwesisu.

• Isigaba IIB: Umdlavuza:

• kungenzeka ukuthi isakaze ku-submucosa (ungqimba lwezicubu eduze kwe-mucosa) kodonga lwesisu. Umdlavuza usabalalele ezindaweni ezingama-7 kuya kwezingu-15 eziseduze; noma

• selusabalele kungqimba yemisipha yodonga lwesisu. Umdlavuza usabalalele kuma-lymph node aseduze ama-3 kuye kwayisithupha; noma

• selinabele ku-subserosa (ungqimba lwezicubu ezixhuma eduze kongqimba lwezicubu) kodonga lwesisu. Umdlavuza usabalalele ku-1 noma 2 e-lymph node eseduze; noma

• selusabalalele ku-serosa (ungqimba olungaphandle kakhulu) lwodonga lwesisu.

Isigaba III

Umdlavuza wesigaba sesithathu III uhlukaniswe ngezigaba IIIA, IIIB, kanye ne-IIIC.

• Isigaba IIIA: Umdlavuza usabalale:

• ungqimba lwemisipha yodonga lwesisu. Umdlavuza usabalalele ezindaweni ezingama-7 kuya kwezingu-15 eziseduze; noma

• ku-subserosa (ungqimba lwezicubu ezixhuma eduze kongqimba lwezicubu) kodonga lwesisu. Umdlavuza usabalalele kuma-lymph node aseduze ama-3 kuye kwayisithupha; noma

• ku-serosa (ungqimba olungaphandle kakhulu) lwodonga lwesisu. Umdlavuza usabalalele kuma-lymph node aseduze nangu-6; noma

• ezithombeni eziseduze, njenge-spleen, colon, isibindi, i-diaphragm, amanyikwe, udonga lwesisu, i-adrenal gland, izinso, noma amathumbu amancane, noma emuva kwesisu.

• Isigaba IIIB: Umdlavuza:

• kungenzeka ukuthi isakaze ku-submucosa (ungqimba lwezicubu eduze kwe-mucosa) noma kusendlalelo semisipha yodonga lwesisu. Umdlavuza usabalalele kuma-lymph node aseduze ayi-16 noma ngaphezulu; noma

• isakazekele ku-subserosa (ungqimba lwezicubu ezixhuma eduze kongqimba lwemisipha) noma ku-serosa (ungqimba olungaphandle kakhulu) lwodonga lwesisu. Umdlavuza usabalalele ezindaweni ezingama-7 kuya kwezingu-15 eziseduze; noma

• selisabalale esiswini laya ezingalweni eziseduze, njengobende, ikholoni, isibindi, uvalo, amanyikwe, udonga lwesisu, i-adrenal gland, izinso, noma amathumbu amancane, noma emuva kwesisu.

Umdlavuza usabalalele kuma-lymph node aseduze kuya kwayisithupha.

• Isigaba IIIC: Umdlavuza usabalale:

• ku-subserosa (ungqimba lwezicubu ezixhuma eduze kongqimba lwezicubu) noma i-serosa (ungqimba olungaphandle kakhulu) lwodonga lwesisu. Umdlavuza usabalalele kuma-lymph node aseduze ayi-16 noma ngaphezulu; noma

• kusuka esiswini kungena ezithweni eziseduze, njengobende, ikholoni, isibindi, uvalo, amanyikwe, udonga lwesisu, indlala ye-adrenal, izinso, noma amathumbu amancane, noma emuva kwesisu. Umdlavuza usabalalele ezindaweni ezingama-7 noma ngaphezulu eziseduze.

Isigaba IV

Esigabeni IV, umdlavuza usabalalele kwezinye izingxenye zomzimba, njengamaphaphu, isibindi, ama-lymph node akude, nezicubu ezibeka udonga lwesisu.

Umdlavuza Wesisu Ovamile

Umdlavuza ophuma esiswini wumdlavuza obuye wabuya (ubuye) ngemuva kokuba welashwe. Umdlavuza ungabuya esiswini noma kwezinye izingxenye zomzimba njengesibindi noma ama-lymph node.

Uhlolojikelele lwenketho yokwelashwa

AMAPHUZU ASEMQOKA

• Kunezinhlobo ezahlukahlukene zokwelashwa kweziguli ezinomdlavuza wesisu.

• Izinhlobo eziyisikhombisa zokwelashwa okujwayelekile zisetshenzisiwe:

• Ukuhlinzwa

• Ukuthengiswa kwe-mucos endoscopic

• Ukwelashwa ngamakhemikhali

• Ukwelashwa ngemisebe

• I-Chemoradiation

• Ukwelashwa okuhlosiwe

• I-Immunotherapy

• Izinhlobo ezintsha zokwelashwa ziyahlolwa ezivivinyweni zokwelashwa.

• Ukwelashwa komdlavuza wesisu 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 ezinomdlavuza wesisu.

Izinhlobo ezahlukene zokwelashwa ziyatholakala ezigulini ezinomdlavuza wesisu. 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 eziyisikhombisa zokwelashwa okujwayelekile zisetshenzisiwe:

Ukuhlinzwa

Ukuhlinzwa ukwelashwa okuvamile kwazo zonke izigaba zomdlavuza wesisu. Izinhlobo ezilandelayo zokuhlinzwa zingasetshenziswa:

• I-subtotal gastrectomy: Ukususwa kwengxenye yesisu equkethe umdlavuza, ama-lymph node aseduze, nezingxenye zezinye izicubu nezitho eduze kwesimila. Ubende bungasuswa. Ubende yisitho esenza ama-lymphocyte, sigcine amaseli abomvu egazi nama-lymphocyte, sihlunge igazi, futhi siqede amangqamuzana egazi amadala. Ubende lusehlangothini lwesobunxele sesisu eduze kwesisu.

• Ingqikithi ye-gastrectomy: Ukususwa kwaso sonke isisu, ama-lymph node aseduze, nezingxenye zomzimba, ithumbu elincane, nezinye izicubu eziseduze nesimila. Ubende bungasuswa. I-esophagus ixhunywe emathunjini amancane ukuze isiguli sikwazi ukuqhubeka nokudla nokugwinya.

Uma isimila sivimba isisu kodwa umdlavuza ungeke ususwe ngokuphelele ngokuhlinzwa okujwayelekile, izinqubo ezilandelayo zingasetshenziswa:

• Ukubekwa kwe-endoluminal stent: Inqubo yokufaka i-stent (ithubhu elincane, elinwebekayo) ukuze kugcinwe indawo (efana nemithambo yegazi noma indawo) evulekile. Kwezimila ezivimbela ukungena noma ukuphuma kwesisu, kungenziwa ukuhlinzwa ukubeka isitofu esisuka esiswini kuya esiswini noma esiswini kuya emathunjini amancane ukuvumela isiguli ukuthi sidle ngokujwayelekile.

• Ukwelashwa kwe-Endoluminal laser: Inqubo lapho kufakwa khona i-endoscope (ishubhu elincane elikhanyisiwe) eline-laser emzimbeni. I-laser wumsebe omkhulu wokukhanya ongasetshenziswa njengommese.

• I-Gastrojejunostomy: Ukuhlinzwa ukususa ingxenye yesisu ngomdlavuza ovimba ukuvula emathunjini amancane. Isisu sixhunywe kwi-jejunum (ingxenye yamathumbu amancane) ukuvumela ukudla nemithi kudlule kusuka esiswini kuya emathunjini amancane.

Ukuthengiswa kwe-mucos endoscopic

I-endoscopic mucosal resection inqubo esebenzisa i-endoscope ukususa umdlavuza wesigaba sokuqala kanye nokukhula okungaxubeki emgqeni wepheshana lokugaya ngaphandle kokuhlinzwa. I-endoscope iyinsimbi encane, efana nethubhu enokukhanya nelensi yokubuka. Kungafaka futhi amathuluzi okususa ukukhula kulwelwesi lwendlela yokugaya ukudla.

Ukwelashwa ngamakhemikhali

I-Chemotherapy yindlela yokwelapha umdlavuza esebenzisa izidakamizwa ukuvimba ukukhula kwamangqamuzana omdlavuza, kungaba ngokubulala amaseli noma ngokuwavimba ekuhlukaniseni. Lapho i-chemotherapy ithathwa ngomlomo noma ifakwa emthanjeni noma emisipheni, izidakamizwa zingena egazini futhi zingafinyelela kumaseli womdlavuza emzimbeni wonke (systemic chemotherapy). Lapho i-chemotherapy ifakwa ngqo ku-cerebrospinal fluid, isitho, noma umgodi womzimba njengesisu, izidakamizwa zithinta kakhulu amangqamuzana omdlavuza kulezo zindawo (i-chemotherapy yesifunda). Indlela i-chemotherapy enikezwa ngayo incike ohlotsheni nesigaba somdlavuza owelashwa.

Uhlobo lokwelashwa ngamakhemikhali esifundeni ukwelapha umdlavuza wesisu yi-intraperitoneal (IP) chemotherapy. Ku-IP chemotherapy, imishanguzo elwa nomdlavuza ithwalwa iye ngqo emgodini we-peritoneal (isikhala esiqukethe izitho zesisu) ngethumbu elincanyana.

I-Hyperthermic intraperitoneal chemotherapy (HIPEC) yindlela yokwelashwa esetshenziswa ngesikhathi sokuhlinzwa efundelwa umdlavuza wesisu. Ngemuva kokuthi udokotela ohlinzayo esuse izicubu zomzimba ngangokunokwenzeka, i-chemotherapy efudumele ithunyelwa ngqo emgodini we-peritoneal.

Bheka Umdlavuza Wezidakamizwa Ovunyelwe Isisu (Gastric) Cancer ukuthola eminye imininingwane.

Ukwelashwa ngemisebe

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

• Ukwelashwa kwemisebe kwangaphandle kusebenzisa umshini ongaphandle komzimba ukuthumela imisebe ebheke emdlavuzeni.

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

Indlela okunikezwa ngayo ukwelashwa ngemisebe kuya ngohlobo nesigaba somdlavuza owelashwa. Ukwelashwa kwemisebe yangaphandle kusetshenziselwa ukwelapha umdlavuza wesisu.

I-Chemoradiation

Ukwelashwa kweChemoradiation kuhlanganisa ukwelashwa ngamakhemikhali nokwelashwa ngemisebe ukukhulisa imiphumela yakho kokubili. I-Chemoradiation enikezwe ngemuva kokuhlinzwa, ukwehlisa ubungozi bokuthi umdlavuza uzobuya, ibizwa ngokuthi yi-adjuvant therapy. I-Chemoradiation enikezwe ngaphambi kokuhlinzwa, ukunciphisa isimila (i-neoadjuvant therapy), iyafundwa.

Ukwelashwa okuhlosiwe

Ukwelashwa okuhlosiwe uhlobo lokwelashwa olusebenzisa izidakamizwa noma ezinye izinto ukukhomba nokuhlasela amangqamuzana omdlavuza athile ngaphandle kokulimaza amaseli ajwayelekile. Ama-antibody e-monoclonal kanye nama-multikinase inhibitors yizinhlobo zokwelashwa okuqondisiwe okusetshenziselwa ukwelashwa komdlavuza wesisu.

• Ukwelashwa kwe-monoclonal antibody: Lolu hlobo lwezokwelapha lusebenzisa amasosha omzimba enziwe elebhu evela ohlotsheni olulodwa lwamaseli omzimba. La ma-antibody angakhomba izinto kumaseli womdlavuza noma ezintweni ezijwayelekile 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.

Kunezinhlobo ezahlukahlukene zemithi elwa ne-monoclonal antibody:

• I-Trastuzumab ivimba umphumela weprotheyini yokukhula kwe-HER2, ethumela izimpawu zokukhula kumaseli womdlavuza wesisu.

• I-Ramucirumab ivimba umphumela wamaprotheni athile, kufaka phakathi isici se-vasot endothelial grow factor. Lokhu kungasiza ukugcina amangqamuzana omdlavuza angakhuli futhi angawabulala. Kungavimbela nokukhula kwemithambo yegazi emisha okudingeka ukuthi izimila zikhule.

I-Trastuzumab ne-ramucirumab zisetshenziselwa ukwelashwa komdlavuza wesisu esiteji IV nomdlavuza wesisu ongakwazi ukususwa ngokuhlinzwa noma okuphinde kwabuya.

• Ama-multikinase inhibitors: Lezi yizidakamizwa ezincane ezinama-molecule angena kulwelwesi lweseli futhi zisebenza ngaphakathi kwamangqamuzana omdlavuza ukuvimba amasignali amaningi wamaprotheni ukuthi amangqamuzana omdlavuza adinga ukukhula nokukhula. Amanye ama-multikinase inhibitors nawo anemiphumela ye-angiogenesis inhibitor. Ama-angiogenesis inhibitors amisa ukukhula kwemithambo yegazi emisha okudingeka ukuthi izimila zikhule.

Kunezinhlobo ezahlukahlukene zemithi ye-multikinase inhibitor:

• I-Regorafenib iyi-multikinase inhibitor ne-angiogenesis inhibitor evimba imiphumela yamaprotheni amaningi ngaphakathi kwamangqamuzana wesimila. I-Regorafenib iyacwaningwa ekwelashweni komdlavuza wesisu wesigaba IV nomdlavuza wesisu ongakwazi ukususwa ngokuhlinzwa noma okuphinde kwavela.

Bheka Umdlavuza Wezidakamizwa Ovunyelwe Isisu (Gastric) Cancer ukuthola eminye imininingwane.

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. Lolu hlobo lokwelashwa komdlavuza lubizwa nangokuthi i-biotherapy noma i-biologic therapy.

Ukwelashwa kwe-immune checkpoint inhibitor therapy uhlobo lwe-immunotherapy.

• Ukwelashwa kwe-inhibitor yokuhlola amasosha omzimba: I-PD-1 yiprotheni ebusweni bamaseli we-T asiza ukugcina izimpendulo zomzimba wokuzivikela. 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 uhlobo lwe-immune checkpoint inhibitor.

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).

Bheka Umdlavuza Wezidakamizwa Ovunyelwe Isisu (Gastric) Cancer ukuthola eminye imininingwane.

Izinhlobo ezintsha zokwelashwa ziyahlolwa ezivivinyweni zokwelashwa.

Imininingwane mayelana nokuhlolwa kwemitholampilo iyatholakala kuwebhusayithi ye-NCI.

Ukwelashwa komdlavuza wesisu 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.

Olunye uvivinyo lungenziwa futhi:

• Isilingo seCarcinoembryonic antigen (CEA) kanye ne-CA 19-9 assay: Inqubo lapho kuhlolwa khona izicubu zesampula ukukala inani lezinto ezithile ezenziwe izitho, izicubu, noma amaseli wesimila emzimbeni. Izinto ezithile zixhunyaniswe nezinhlobo ezithile zomdlavuza lapho zitholakala emazingeni akhuphukile emzimbeni. Lokhu kubizwa ngokuthi yizimpawu zesimila. Amazinga aphakeme kunamazinga ajwayelekile we-carcinoembryonic antigen (CEA) ne-CA 19-9 kungasho ukuthi umdlavuza wesisu ubuyile ngemuva kokwelashwa.

Izinketho Zokwelapha ngeStage

Kulesi Sigaba

• Isigaba 0 (I-Carcinoma eSitu)

• Isigaba I Umdlavuza Wesisu

• Izigaba II no-III Umdlavuza Wesisu

• Isigaba IV Umdlavuza Wesisu, Umdlavuza Wesisu Ongasuswa Ngokuhlinzwa, Nomdlavuza Ophindaphindayo Womdlavuza Wesisu

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

Isigaba 0 (I-Carcinoma eSitu)

Ukwelashwa kwesigaba 0 kungafaka okulandelayo:

• Ukuhlinzwa (inani eliphelele noma elincane le-gastrectomy).

• Ukuthengiswa kwe-mucos endoscopic.

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 I Umdlavuza Wesisu

Ukwelashwa kwesigaba somdlavuza wesisu kungafaka okulandelayo:

• Ukuhlinzwa (inani eliphelele noma elincane le-gastrectomy).

• I-endoscopic resection mucosal yeziguli ezithile ezinesifo somdlavuza wesisu se-IA.

• Ukuhlinzwa (i-gastrectomy ephelele noma engaphansi) elandelwa ukwelashwa ngamakhemikhali.

• Isivivinyo somtholampilo sokwelashwa ngamakhemikhali asetshenziswe ngaphambi 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.

Izigaba II no-III Umdlavuza Wesisu

Ukwelashwa komdlavuza wesisu wesigaba II kanye nomdlavuza wesisu wesigaba III kungafaka okulandelayo:

• Ukuhlinzwa (inani eliphelele noma elincane le-gastrectomy).

• Ukwelashwa ngamakhemikhali kunikezwa ngaphambi kokuhlinzwa.

• Ukuhlinzwa (i-gastrectomy ephelele noma engaphansi) elandelwa ukwelashwa ngamakhemikhali noma i-chemotherapy.

• Isivivinyo somtholampilo sokwelashwa ngamakhemikhali asetshenziswe ngaphambi kokuhlinzwa.

• Isivivinyo somtholampilo se-chemotherapy esinikezwe ngaphambi 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 IV Umdlavuza Wesisu, Umdlavuza Wesisu Ongasuswa Ngokuhlinzwa, Nomdlavuza Ophindaphindayo Womdlavuza Wesisu

Ukwelashwa komdlavuza wesisu wesigaba IV, umdlavuza wesisu ongasuswa ngokuhlinzwa, noma umdlavuza ophindayo wesisu ungafaka okulandelayo:

• I-Chemotherapy njengokwelashwa okunciphisayo ukukhulula izimpawu nokuthuthukisa ikhwalithi yempilo.

• Ukwelashwa okuqondisiwe nge-anti-monoclonal antibody noma ngaphandle kwe-chemotherapy.

• I-Immunotherapy.

• Ukwelashwa kwe-Endoluminal laser noma ukubekwa kwe-endoluminal stent ukunciphisa ukuvinjelwa esiswini, noma i-gastrojejunostomy ukudlula ukuvinjelwa.

• Ukwelashwa ngemisebe njengokwelashwa okunciphisayo kokuyeka ukopha, ukudambisa izinhlungu, noma ukuncipha isimila esivimba isisu.

• Ukuhlinzwa njengokwelashwa okunciphisayo kokuyeka ukopha noma ukunciphisa isimila esivimba isisu.

• Isivivinyo somtholampilo senhlanganisela entsha ye-chemotherapy njengokwelashwa okunciphisayo ukukhulula izimpawu nokuthuthukisa ikhwalithi yempilo.

• Isivivinyo somtholampilo sokwelapha okuqondisiwe nge-multikinase inhibitor.

• Isivivinyo somtholampilo sokuhlinzwa kanye ne-hyperthermic intraperitoneal chemotherapy (HIPEC).

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-Gastric

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

• Ikhasi Lasekhaya Lesifo Somdlavuza (Wesisu)

• Isisu (Gastric) Ukuvimbela umdlavuza

• Ukuhlolwa Komdlavuza Wesisu (Wesisu)

• Umdlavuza Ongajwayelekile Wokwelashwa Kwezingane

• Ama-Lasers ekwelashweni komdlavuza

• Izidakamizwa zivunyelwe umdlavuza wesisu (Gastric) Cancer

• Ugwayi (uhlanganisa usizo ngokuyeka)

• I-Helicobacter pylori neCancer

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