Izinhlobo / okungaziwa-okuyinhloko / isiguli / okungaziwa-okuyisisekelo-ukwelashwa-pdq

ICarcinoma Yenguqulo Yokwelapha Eyisisekelo Engaziwa

Imininingwane ejwayelekile Mayelana neCarcinoma yase-Unknown Primary

AMAPHUZU ASEMQOKA

• ICarcinoma yesisekelo esingaziwa (i-CUP) yisifo esingajwayelekile lapho kutholakala khona amangqamuzana abulalayo (umdlavuza) emzimbeni kodwa indawo owaqala umdlavuza kuyo akwaziwa.

• Kwesinye isikhathi umdlavuza oyinhloko awutholakali.

• Izimpawu nezimpawu ze-CUP zehlukile, kuya ngokuthi umdlavuza usabalale kuphi emzimbeni.

• Kusetshenziswa izivivinyo ezehlukene ukuthola umdlavuza (ukuthola).

• Uma ukuhlolwa kukhombisa ukuthi kungaba nomdlavuza, kwenziwa i-biopsy.

• Uma uhlobo lwamangqamuzana omdlavuza noma izicubu ezisusiwe zihlukile kunhlobo yamangqamuzana omdlavuza okulindeleke ukuthi atholakale, kungenziwa ukuxilongwa kweCUP.

• Ukuhlolwa nezinqubo ezisetshenziselwa ukuthola umdlavuza oyinhloko kuncike lapho umdlavuza usabalale khona.

• Izici ezithile zithinta ukubikezela (ithuba lokululama).

ICarcinoma yesisekelo esingaziwa (i-CUP) yisifo esingajwayelekile lapho kutholakala khona amangqamuzana abulalayo (umdlavuza) emzimbeni kodwa indawo owaqala umdlavuza kuyo akwaziwa.

Umdlavuza ungakheka kunoma yisiphi isicubu somzimba. Umdlavuza oyinhloko (umdlavuza owaqala ukwakheka) ungadlulela nakwezinye izingxenye zomzimba. Le nqubo ibizwa ngokuthi i-metastasis. Amaseli womdlavuza ngokuvamile abukeka njengamaseli ohlobo lwezicubu lapho umdlavuza waqala khona. Isibonelo, amangqamuzana omdlavuza webele angadlulela emaphashini. Ngoba umdlavuza uqale ebeleni, amangqamuzana omdlavuza asephashini abukeka njengamaseli womdlavuza webele.

Kwesinye isikhathi odokotela bathola lapho umdlavuza usabalale khona kodwa bangatholi lapho umdlavuza uqale khona ukukhula emzimbeni. Lolu hlobo lomdlavuza lubizwa ngokuthi umdlavuza wesisekelo samabanga aphansi esingaziwa (i-CUP) noma isimila sokuqala semimoya.

E-carcinoma yamabanga aphansi angaziwa, amangqamuzana omdlavuza asabalale emzimbeni kodwa indawo lapho umdlavuza wokuqala waqala khona ayaziwa.

Ukuhlolwa kwenziwa ukuthola ukuthi umdlavuza oyinhloko uqale kuphi futhi uthole ulwazi ngokuthi umdlavuza usabalale kuphi. Lapho izivivinyo zikwazi ukuthola umdlavuza oyinhloko, umdlavuza awuseyona i-CUP kanti ukwelashwa kususelwa ohlotsheni lomdlavuza oyinhloko.

Kwesinye isikhathi umdlavuza oyinhloko awutholakali.

Umdlavuza oyinhloko (umdlavuza owaqala ukwakheka) awutholakali ngesinye sezizathu ezilandelayo:

• Umdlavuza oyinhloko mncane kakhulu futhi ukhula kancane.

• Amasosha omzimba abulale umdlavuza oyinhloko.

• Umdlavuza oyinhloko ususwe ngesikhathi sokuhlinzwa kwesinye isimo futhi odokotela bebengazi ukuthi umdlavuza wakhekile. Isibonelo, isibeletho esinomdlavuza singasuswa ngesikhathi se-hysterectomy ukwelapha ukutheleleka okubi.

Izimpawu nezimpawu ze-CUP zehlukile, kuya ngokuthi umdlavuza usabalale kuphi emzimbeni.

Kwesinye isikhathi i-CUP ayibangeli zimpawu noma zimpawu. Izimpawu nezimpawu zingabangelwa yi-CUP noma ezinye izimo. Buza nodokotela wakho uma unokunye kwalokhu okulandelayo:

• Isigaxa noma ukuqina kunoma iyiphi ingxenye yomzimba.

• Ubuhlungu obukwelinye ilungu lomzimba futhi abupheli.

• Ukukhwehlela okungapheli noma ukuduma kwezwi.

• Shintsha imikhuba yamathumbu noma yesinye, njengokuqunjelwa, uhudo, noma ukuchama njalo.

• Ukopha okungavamile noma ukukhishwa.

• Imfiva ngaphandle kwesizathu esaziwayo engapheli.

• Ukujuluka ebusuku.

• Ukwehla kwesisindo ngaphandle kwesizathu esaziwayo noma ukulahlekelwa isifiso sokudla.

Kusetshenziswa izivivinyo ezehlukene ukuthola umdlavuza (ukuthola).

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.

I-Urinalysis: Isivivinyo sokubheka umbala womchamo nokuqukethwe kuwo, njengoshukela, amaprotheni, igazi, namagciwane.

• 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: 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.

• Ukuhlolwa kwegazi lokulingwa kwe-Fecal: Isivivinyo sokuhlola indle (imfucumfucu eqinile) yegazi elingabonakala ngemicroscope kuphela. Amasampula amancane endle abekwa emakhadini akhethekile abuyiselwe kudokotela noma elabhorethri ukuze ahlolwe. Ngenxa yokuthi eminye imidlavuza yopha, igazi elisesitokisini lingaba wuphawu lomdlavuza kukholoni noma engxenyeni.

Uma ukuhlolwa kukhombisa ukuthi kungaba nomdlavuza, kwenziwa i-biopsy.

I-biopsy ukususwa kwamaseli noma izicubu ukuze kubhekwe ngaphansi kwesibonakhulu ngudokotela wezifo. Udokotela wezifo ubheka izicubu ngaphansi kwesibonakhulu ukuze abheke amangqamuzana omdlavuza nokuthola uhlobo lomdlavuza. Uhlobo lwe-biopsy olwenziwe luxhomeke engxenyeni yomzimba ehlolelwa umdlavuza. Olunye lwezinhlobo ezilandelayo ze-biopsies lungasetshenziswa:

• I-Biopsy e-Excisional: Ukususwa kwesigaxa sonke sezicubu.

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

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

• I-Fine-needle aspiration (FNA) biopsy: Izicubu zokususa noma uketshezi kusetshenziswa inaliti ezacile.

Uma umdlavuza utholakala, ukuhlolwa okukodwa noma okungaphezulu kwelabhorethri okulandelayo kungasetshenziswa ukutadisha amasampula wezicubu nokuthola uhlobo lomdlavuza

• Ukuhlaziywa kwezakhi zofuzo: Ukuhlolwa kwelabhorethri lapho kufundwa khona i-DNA kusampula yamangqamuzana omdlavuza noma izicubu ukubheka ukuguquka kwezakhi zofuzo (izinguquko) ezingasiza ukubikezela ukwelashwa okungcono kakhulu kwe-carcinoma okuyinhloko engaziwa.

• Ucwaningo lwe-Histologic: Ukuhlolwa kwelabhorethri lapho kufakwa khona amabala kusampula yamangqamuzana omdlavuza noma izicubu futhi kubhekwe ngaphansi kwesibonakhulu ukubheka ushintsho oluthile kumaseli. Izinguquko ezithile kumaseli zixhunyaniswe nezinhlobo ezithile zomdlavuza.

• I-Immunohistochemistry: Isivivinyo selabhorethri esisebenzisa amasosha omzimba ukubheka ama-antigen athile (omaka) kusampula lezicubu zesiguli. Amasosha omzimba avamise ukuhlanganiswa ne-enzyme noma udayi we-fluorescent. Ngemuva kokuthi ama-antibody abophe i-antigen ethile kusampula yezicubu, i-enzyme noma idayi iyasebenza, bese i-antigen bese ibonwa ngaphansi kwesibonakhulu. Lolu hlobo lokuhlola lusetshenziselwa ukuxilonga umdlavuza nokusiza ukutshela uhlobo oluthile lomdlavuza kolunye uhlobo lomdlavuza.

• Reverse transcription – polymerase chain reaction (RT – PCR) test: Isivivinyo selabhorethri lapho kulinganiswa inani lezinto zofuzo ezibizwa nge-mRNA ezenziwe ngofuzo oluthile. Kusetshenziswa i-enzyme ebizwa nge-reverse transcriptase ukuguqula ucezu oluthile lwe-RNA lube ucezu olufanayo lwe-DNA, olungakhuliswa (lwenziwe ngamanani amakhulu) ngenye i-enzyme ebizwa nge-DNA polymerase. Amakhophi we-DNA akhulisiwe asiza ukusho ukuthi ngabe i-mRNA ethile yenziwa ngofuzo. I-RT – PCR ingasetshenziswa ukuhlola ukwenziwa kwezakhi zofuzo ezithile ezingakhombisa ukuba khona kwamangqamuzana omdlavuza. Lokhu kuhlolwa kungasetshenziselwa ukubheka ushintsho oluthile ku-gene noma i-chromosome, engasiza ukuthola umdlavuza.

• Ukuhlaziywa kwe-cytogenetic: Ukuhlolwa kwelabhoratri lapho ama-chromosomes wamaseli esampula yesicubu se-tumor abalwa 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. Izinguquko kuma-chromosomes athile zixhumene nezinhlobo ezithile zomdlavuza.

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

Uma uhlobo lwamangqamuzana omdlavuza noma izicubu ezisusiwe zihlukile kunhlobo yamangqamuzana omdlavuza okulindeleke ukuthi atholakale, kungenziwa ukuxilongwa kweCUP.

Amaseli emzimbeni anokubukeka okuthile okuncike ohlotsheni lwezicubu ezivela kuzo. Isibonelo, isampula lezicubu zomdlavuza ezithathwe esifubeni kulindeleke ukuthi zenziwe ngamaseli ebele. Kodwa-ke, uma isampula lezicubu luhlobo oluthile lweseli (olungenziwanga ngamangqamuzana webele), kungenzeka ukuthi amaseli asabalalele ebeleni evela kwenye ingxenye yomzimba. Ukuze bahlele ukwelashwa, odokotela baqala bazame ukuthola umdlavuza oyinhloko (umdlavuza owaqala ukwakhiwa).

Ukuhlolwa nezinqubo ezisetshenziselwa ukuthola umdlavuza oyinhloko kuncike lapho umdlavuza usabalale khona.

Kwezinye izimo, ingxenye yomzimba lapho kutholakala khona amangqamuzana omdlavuza kuqala isiza udokotela anqume ukuthi iziphi izivivinyo zokuxilonga ezizosiza kakhulu.

• Lapho umdlavuza utholakala ngenhla kwesifo (umsipha omncane ngaphansi kwamaphaphu osiza ngokuphefumula), indawo yomdlavuza eyinhloko kungenzeka ibe engxenyeni engenhla yomzimba, njengasemaphashini noma esifubeni.

• Lapho umdlavuza utholakala ngaphansi kwesifafazi, indawo yokuqala yomdlavuza kungenzeka ibe sengxenyeni engezansi yomzimba, njengamanyikwe, isibindi, noma esinye isitho esiswini.

• Eminye imidlavuza ivame ukusabalala ezindaweni ezithile zomzimba. Ngomdlavuza otholakala kuma-lymph node entanyeni, indawo yomdlavuza oyinhloko kungenzeka ukuthi isekhanda noma entanyeni, ngoba umdlavuza wekhanda nentamo uvame ukusabalala kuma-lymph node entanyeni.

Ukuhlolwa nezinqubo ezilandelayo kungenziwa ukuthola ukuthi umdlavuza uqale kuphi:

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

• I-Mammogram: I-x-ray yebele.

• I-Endoscopy: Inqubo yokubheka izitho nezicubu ngaphakathi komzimba ukubheka izindawo ezingajwayelekile. I-endoscope ifakwa ngokusika (ukusika) esikhunjeni noma ekuvulekeni emzimbeni, njengomlomo. I-endoscope iyinsimbi encane, efana nethubhu enokukhanya nelensi yokubuka. Kungaba futhi nethuluzi lokususa amasampula wezicubu noma ama-lymph node, ahlolwe ngaphansi kwesibonakhulu ukuthola izimpawu zesifo. Isibonelo, i-colonoscopy ingenziwa.

• Isivivinyo sesimila: Inqubo lapho kuhlolwe khona isampula legazi, umchamo, noma izicubu ukukala inani lezinto ezithile ezenziwe izitho zomzimba, izicubu, noma amaseli omzimba emzimbeni. Izinto ezithile zixhunyaniswe nezinhlobo ezithile zomdlavuza lapho zitholakala emazingeni akhuphukile emzimbeni. Lokhu kubizwa ngokuthi yizimpawu zesimila. Igazi lingahlolwa amazinga we-CA-125, CgA, alpha-fetoprotein (AFP), i-beta human chorionic gonadotropin (β-hCG), noma i-antigen eqondene ne-prostate (PSA).

Kwesinye isikhathi, azikho izivivinyo ezingathola indawo yokuqala yomdlavuza. Kulezi zimo, ukwelashwa kungasuselwa kulokho udokotela acabanga ukuthi uhlobo lomdlavuza olungenzeka kakhulu.

Izici ezithile zithinta ukubikezela (ithuba lokululama).

Isibikezelo (ithuba lokululama) sincike kokulandelayo:

• Lapho umdlavuza uqale khona emzimbeni nalapho usabalale khona.

• Inani lezitho ezinomdlavuza kuzo.

• Indlela amangqamuzana ezimila abukeka ngayo lapho ebukwa ngaphansi kwesibonakhulu.

• Ukuthi isiguli kungowesilisa noma owesifazane.

• Ukuthi umdlavuza usanda kutholakala noma usuphindile (buyela emuva).

Ezigulini eziningi ezine-CUP, ukwelashwa kwamanje akuwelaphi umdlavuza. Iziguli zingafuna ukubamba iqhaza kolunye lwezivivinyo zokwelashwa eziningi ezenziwayo ukwenza ngcono ukwelashwa. Ukuhlolwa kwemitholampilo kweCUP kuyenzeka ezingxenyeni eziningi zezwe. Imininingwane mayelana nokuhlolwa kwemitholampilo iyatholakala kuwebhusayithi ye-NCI.

Izigaba zeCarcinoma of Unknown Primary

AMAPHUZU ASEMQOKA

• Akunasistimu ye-carcinoma ye-primary primary engaziwa (CUP).

• Imininingwane eyaziwayo ngomdlavuza isetshenziselwa ukuhlela ukwelashwa.

Akunasistimu ye-carcinoma ye-primary primary engaziwa (CUP).

Izinga noma ukusabalala komdlavuza kuvame ukuchazwa njengezigaba. Isigaba somdlavuza sivame ukusetshenziselwa ukuhlela ukwelashwa. Kodwa-ke, iCUP isivele isabalalele nakwezinye izingxenye zomzimba lapho itholakala.

Imininingwane eyaziwayo ngomdlavuza isetshenziselwa ukuhlela ukwelashwa.

Odokotela basebenzisa lezi zinhlobo zolwazi ezilandelayo ukuhlela ukwelashwa:

• Indawo emzimbeni lapho umdlavuza utholakala khona, njenge-peritoneum noma umlomo wesibeletho (intamo), i-axillary (armpit), noma i-inguinal (groin) lymph node.

• Uhlobo lweseli lomdlavuza, njenge-melanoma.

• Ukuthi iseli lomdlavuza lihlukaniswe kabi yini (kubukeka kwehluke kakhulu kumaseli ajwayelekile lapho kubhekwa ngaphansi kwesibonakhulu).

• Izimpawu nezimpawu ezibangelwa umdlavuza.

• Imiphumela yezivivinyo nezinqubo.

• Noma ngabe umdlavuza usanda kutholakala noma usuphindile (buyela emuva).

Uhlolojikelele lwenketho yokwelashwa

AMAPHUZU ASEMQOKA

• Kunezinhlobo ezahlukahlukene zokwelashwa kweziguli ezine-carcinoma ye-primary primary engaziwa (i-CUP).

• Izinhlobo ezine zokwelashwa ezijwayelekile zisetshenzisiwe:

• Ukuhlinzwa

• Ukwelashwa ngemisebe

• Ukwelashwa ngamakhemikhali

• Ukwelashwa kweHormone

• Izinhlobo ezintsha zokwelashwa ziyahlolwa ezivivinyweni zokwelashwa.

• Ukwelashwa kwe-carcinoma eyinhloko engaziwa kungadala imiphumela emibi.

• Iziguli zingafuna ukucabanga ngokubamba iqhaza esivivinyweni somtholampilo.

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

Kunezinhlobo ezahlukahlukene zokwelashwa kweziguli ezine-carcinoma ye-primary primary engaziwa (i-CUP).

Izinhlobo ezahlukene zokwelashwa ziyatholakala ezigulini ezine-CUP. 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 ezine zokwelashwa ezijwayelekile zisetshenzisiwe:

Ukuhlinzwa

Ukuhlinzwa ukwelashwa okuvamile kweCUP. Udokotela angawususa umdlavuza nezinye izicubu ezinempilo ezizungezile.

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

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. Izindlela ezithile zokunikeza ukwelashwa ngemisebe kungasiza ukugcina imisebe ekulimaleni izicubu ezinempilo eziseduze. Lolu hlobo lokwelashwa ngemisebe lungafaka okulandelayo:

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

• 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 neyangaphakathi kusetshenziselwa ukwelapha i-carcinoma yamaphrimiyamu angaziwa.

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). Inhlanganisela yamakhemikhali ukusetshenziswa kwezidakamizwa ezimbili noma ngaphezulu ezilwa nomdlavuza.

Ukwelashwa kweHormone

Ukwelashwa kweHormone ukwelashwa komdlavuza okususa ama-hormone noma kuvimbe isenzo sabo futhi kumise amangqamuzana omdlavuza ukuthi angakhuli. AmaHormone yizinto ezenziwe yizindlala emzimbeni futhi zisatshalaliswa egazini. Amanye ama-hormone angadala ukuthi umdlavuza othile ukhule. Uma ukuhlolwa kukhombisa ukuthi amangqamuzana omdlavuza anezindawo lapho ama-hormone anganamathisela khona (ama-receptors), izidakamizwa, ukuhlinzwa, noma ukwelashwa ngemisebe kusetshenziselwa ukunciphisa ukukhiqizwa kwamahomoni noma ukuwavimba ekusebenzeni.

Izinhlobo ezintsha zokwelashwa ziyahlolwa ezivivinyweni zokwelashwa.

Imininingwane mayelana nokuhlolwa kwemitholampilo iyatholakala kuwebhusayithi ye-NCI.

Ukwelashwa kwe-carcinoma eyinhloko engaziwa 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.

Izinketho Zokwelashwa kweCarcinoma yePrayimari Engaziwa

Kulesi Sigaba

• I-Carcinoma Esanda Kutholwa Yesisekelo Esingaziwa

• Umlomo Wesibeletho (Intamo) AmaLymph Node

• I-Carcinomas Ehluke Kakhulu

• Abesifazane abanePeritoneal Cancer

• Isolated Axillary Lymph Node Metastasis

• Inguinal Lymph Node Metastasis

• I-Melanoma endaweni eyi-Lymph Node Area

• Ukubandakanya okuningi

• I-Carcinoma Ephindaphindayo Yesisekelo Esingaziwa

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

I-Carcinoma Esanda Kutholwa Yesisekelo Esingaziwa

Umlomo Wesibeletho (Intamo) AmaLymph Node

Umdlavuza otholakala kuma-lymph node wesibeletho (entanyeni) kungenzeka ukuthi usakazeke usuka isimila ekhanda noma entanyeni. Ukwelashwa kwe-lymph node carcinoma yomlomo wesibeletho engaziwa (i-CUP) kungafaka okulandelayo:

• Ukuhlinzwa ukususa amalaka.

• Ukwelashwa ngemisebe kukodwa. I-intension-modulated radiation therapy (IMRT) ingasetshenziswa.

• Ukwelashwa ngemisebe kulandelwa ukuhlinzwa ukuze kususwe ama-lymph node.

• Ukuhlinzwa ukususa ama-lymph node, noma ngemithi yokwelashwa ngemisebe noma ngaphandle kwayo.

• Isivivinyo somtholampilo sezinhlobo ezintsha zokwelashwa.

Bona isifinyezo se- kuMetastatic Squamous Neck Cancer nge-Occult Primary Treatment (Adult) ukuthola eminye imininingwane.

I-Carcinomas Ehluke Kakhulu

Amaseli womdlavuza ahlukaniswe kabi abukeka ehluke kakhulu kumaseli ajwayelekile. Uhlobo lweseli abaqhamuka kulo alwaziwa. Ukwelashwa kwe-carcinoma ehlukaniswe kabi engaziwa okuyisisekelo, kufaka phakathi izicubu ohlelweni lwe-neuroendocrine (ingxenye yobuchopho elawula izindlala ezikhiqiza ama-hormone emzimbeni wonke) kungafaka okulandelayo:

• Inhlanganisela chemotherapy.

• Isivivinyo somtholampilo sezinhlobo ezintsha zokwelashwa.

Abesifazane abanePeritoneal Cancer

Ukwelashwa kwabesifazane abane-peritoneal (ulwelwesi lwesisu) i-carcinoma yamaphrimiyamu angaziwa kungafana nomdlavuza we-ovari. Ukwelashwa kungafaka okulandelayo:

• Ukwelashwa ngamakhemikhali.

• Isivivinyo somtholampilo sezinhlobo ezintsha zokwelashwa.

Bona isifinyezo se- ku-Ovarian Epithelial, Fallopian Tube, kanye ne-Primary Peritoneal Cancer Treatment ukuthola eminye imininingwane.

Isolated Axillary Lymph Node Metastasis

Umdlavuza otholakala kuphela kuma-lymph node e-axillary (armpit) kungenzeka ukuthi usakazeke usuka isimila esifubeni.

Ukwelashwa kwe-axillary lymph node metastasis imvamisa:

• Ukuhlinzwa ukususa ama-lymph node.

Ukwelashwa nakho kungafaka okukodwa noma okuningi kokulandelayo:

• Ukuhlinzwa ukususa ibele.

• Ukwelashwa ngemisebe esifubeni.

• Ukwelashwa ngamakhemikhali.

• Isivivinyo somtholampilo sezinhlobo ezintsha zokwelashwa.

Inguinal Lymph Node Metastasis

Umdlavuza otholakala kuphela kuma-lymph node angama-inguinal (groin) okungenzeka ukuthi aqala esithweni sangasese, esidlangalaleni, noma esiyi-rectal. Ukwelashwa kwe-inguinal lymph node metastasis kungafaka okulandelayo:

• Ukuhlinzwa ukususa umdlavuza kanye / noma ama-lymph node ku-groin.

• Ukuhlinzwa ukususa umdlavuza kanye / noma ama-lymph node ku-groin, kulandelwe ukwelashwa ngemisebe noma i-chemotherapy.

I-Melanoma endaweni eyi-Lymph Node Area

Ukwelashwa kwe-melanoma etholakala kuphela endaweni eyodwa ye-lymph node ngokuvamile:

• Ukuhlinzwa ukususa ama-lymph node.

Bona isifinyezo se- ku-Melanoma Treatment ukuthola eminye imininingwane.

Ukubandakanya okuningi

Akukho ukwelashwa okujwayelekile kwe-carcinoma yamaprimary angaziwa atholakala ezindaweni ezahlukahlukene zomzimba. Ukwelashwa kungafaka okulandelayo:

• Ukwelashwa kweHormone.

• Ukwelashwa kwemisebe yangaphakathi.

• I-Chemotherapy ngomuthi owodwa noma ngaphezulu we-anticancer.

• Isivivinyo somtholampilo.

I-Carcinoma Ephindaphindayo Yesisekelo Esingaziwa

Ukwelashwa kwe-carcinoma ephindaphindwayo eyinhloko engaziwa kuvame ukuba sesivivinyo somtholampilo. Ukwelashwa kuncike kulokhu okulandelayo:

• Uhlobo lomdlavuza.

• Welashwa kanjani umdlavuza phambilini.

• Lapho umdlavuza ubuyile emzimbeni.

• Isimo nezifiso zesiguli.

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.

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 Okwengeziwe NgeCarcinoma yase-Unknown Primary

Ngeminye imininingwane evela ku-National Cancer Institute mayelana ne-carcinoma yamabanga aphansi angaziwa, bheka okulandelayo:

• ICarcinoma Yekhasi Lasekhaya Eliyinhloko elingaziwa

• I-Metastatic Cancer

Ngemininingwane ejwayelekile yomdlavuza nezinye izinsiza ezivela ku-National Cancer Institute, bheka okulandelayo:

• Mayelana Nomdlavuza

• Isiteji

• I-Chemotherapy kanye Nawe: Ukusekelwa Kwabantu Abanomdlavuza

• Ukwelashwa Kwemisebe Nawe: Ukusekelwa Kwabantu Abanomdlavuza

• Ukubhekana Nomdlavuza

• Imibuzo Ongayibuza Udokotela Wakho mayelana Nomdlavuza

• Kwabasindile Nabanakekeli