Types/uterine/patient/endometrial-treatment-pdq

Ukwelashwa Komdlavuza we-Endometrial (®) –Patient Version

Imininingwane Jikelele Ngomdlavuza we-Endometrial

AMAPHUZU ASEMQOKA

• Umdlavuza we-Endometrial yisifo lapho amangqamuzana abulalayo (umdlavuza) akha izicubu ze-endometrium.

• Ukukhuluphala nokuba ne-metabolic syndrome kungakhuphula ubungozi bomdlavuza we-endometrium.

• Ukuthatha i-tamoxifen yomdlavuza webele noma ukuthatha i-estrogen yodwa (ngaphandle kweprogesterone) kungandisa ingozi yomdlavuza we-endometrium.

• Izimpawu nezimpawu zomdlavuza we-endometrial zifaka ukopha okungavamile kwesitho sangasese sowesifazane noma ubuhlungu okhalweni.

• Ukuhlolwa okuhlola i-endometrium kusetshenziselwa ukuthola (ukuthola) nokuthola umdlavuza we-endometrium.

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

Umdlavuza we-Endometrial yisifo lapho amangqamuzana abulalayo (umdlavuza) akha izicubu ze-endometrium.

I-endometrium ulwelwesi lwesibeletho, isitho esingenalutho, semisipha ethangeni lesifazane. Isibeletho kulapho ingane ikhula khona. Kwabesifazane abaningi abangakhulelwe, isibeletho singamasentimitha amathathu ubude. Umphetho ongaphansi, omncane wesibeletho umlomo wesibeletho, oholela esithweni sangasese sowesifazane.

I-anatomy yohlelo lokuzala lwabesifazane. Izitho ezisehlelweni lokuzala labesifazane zifaka phakathi isibeletho, amaqanda, amashubhu e-fallopian, umlomo wesibeletho, kanye nesitho sangasese sowesifazane. Isibeletho sinolwelwesi olungaphandle lwemisipha olubizwa ngokuthi i-myometrium nolwelwesi lwangaphakathi olubizwa ngokuthi i-endometrium.

Umdlavuza we-endometrium wehlukile kumdlavuza wesicubu sesibeletho, obizwa nge-sarcoma yesibeletho. Bona isifinyezo se- ku-Uterine Sarcoma Treatment ukuthola eminye imininingwane nge-uterine sarcoma.

Ukukhuluphala nokuba ne-metabolic syndrome kungakhuphula ubungozi bomdlavuza we-endometrium.

Noma yini eyandisa amathuba akho okuthola 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 yomdlavuza we-endometrium.

Izici zobungozi zomdlavuza we-endometrial zifaka okulandelayo:

• Ukuthatha i-estrogen-only hormone replacement therapy (HRT) ngemuva kokunqamuka kokuya esikhathini.

• Ukuthatha i-tamoxifen ukuvimbela noma ukwelapha umdlavuza webele.

• Ukukhuluphala ngokweqile.

• Ukuba ne-metabolic syndrome.

• Ukuba nohlobo 2 sikashukela.

• Ukuvezwa kwezicubu ze-endometrium ku-estrogen eyenziwe ngumzimba. Lokhu kungabangelwa:

• Ungalokothi ubelethe.

• Ukuya esikhathini usemncane.

• Ukuqala ukuya esikhathini esikhathini esizayo.

• Ukuba ne-polycystic ovarian syndrome.

• Ukuba nomlando womndeni womdlavuza we-endometrial esihlotsheni sokuqala (umama, udadewabo, noma indodakazi).

• Ukuba nezimo ezithile zofuzo, njenge-Lynch syndrome.

• Ukuba ne-endometrial hyperplasia.

Ukuguga kuyisici esiyinhloko sengozi yomdlavuza amaningi. Ithuba lokuthola umdlavuza liyakhula njengoba ukhula.

Ukuthatha i-tamoxifen yomdlavuza webele noma ukuthatha i-estrogen yodwa (ngaphandle kweprogesterone) kungandisa ingozi yomdlavuza we-endometrium.

Umdlavuza we-Endometrial ungakhula ezigulini zomdlavuza webele ezelashwa nge-tamoxifen. Isiguli esisebenzisa lo muthi futhi esopha ngokweqile esithweni sangasese kufanele sibe nokuhlolwa kokulandelwa kanye ne-biopsy of the endometrial lining uma kudingeka. Abesifazane abathatha i-estrogen (i-hormone engathinta ukukhula kwamanye umdlavuza) bebodwa futhi banengozi eyengeziwe yomdlavuza we-endometrium. Ukuthatha i-estrogen kuhlanganiswe ne-progesterone (enye i-hormone) akukhuphuli ingozi yowesifazane yokuba nomdlavuza we-endometrium.

Izimpawu nezimpawu zomdlavuza we-endometrial zifaka ukopha okungavamile kwesitho sangasese sowesifazane noma ubuhlungu okhalweni.

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

• Ukopha kwesitho sangasese sowesifazane noma ukuphuma kungahlobene nokuya esikhathini (izikhathi).

• Ukopha kwesitho sangasese sowesifazane ngemuva kokunqamuka kokuya esikhathini.

• Ukuchama okunzima noma okubuhlungu.

• Ubuhlungu ngesikhathi sokuya ocansini.

• Ubuhlungu endaweni ye-pelvic.

Ukuhlolwa okuhlola i-endometrium kusetshenziselwa ukuthola (ukuthola) nokuthola umdlavuza we-endometrium.

Ngoba umdlavuza we-endometrial uqala ngaphakathi kwesibeletho, akuvamile ukuvela emiphumeleni yokuhlolwa kwePap. Ngalesi sizathu, isampula lezicubu ze-endometrium kufanele lisuswe futhi lihlolwe ngaphansi kwesibonakhulu ukubheka amangqamuzana omdlavuza. Enye yezinqubo ezilandelayo ingasetshenziswa:

• I-Endometrial biopsy: Ukususwa kwezicubu ku-endometrium (ulwelwesi lwangaphakathi lwesibeletho) ngokufaka ishubhu elincane, eliguquguqukayo ngomlomo wesibeletho kanye nasesibelethweni. Ishubhu lisetshenziselwa ukukhuhla ngobunono inani elincane lezicubu kwi-endometrium bese ususa amasampula ezicubu. Isazi sezifo sibheka izicubu ngaphansi kwesibonakhulu ukubheka amangqamuzana omdlavuza.

• Ukwehliswa kanye ne-curettage: Inqubo yokususa amasampula wezicubu kulolwelwesi lwangaphakathi lwesibeletho. Umlomo wesibeletho uyahlulwa bese kufakwa i-curette (insimbi emise okwe-spoon) esibelethweni ukuze kususwe izicubu. Amasampula wezicubu ahlolwa ngaphansi kwesibonakhulu ukuthola izimpawu zesifo. Le nqubo ibizwa nangokuthi i-D & C.

Ukwehlukaniswa nokwelashwa (D no-C). Kufakwa i-speculum esithweni sangasese ukuyikhulisa ukuze kubhekwe umlomo wesibeletho (iphaneli yokuqala). I-dilator isetshenziselwa ukunweba umlomo wesibeletho (iphaneli eliphakathi nendawo). I-curette ifakwa ngomlomo wesibeletho iye esibelethweni ukuze kukhuculwe izicubu ezingajwayelekile (iphaneli lokugcina).

• I-Hysteroscopy: Inqubo yokubheka ngaphakathi kwesibeletho ngezindawo ezingajwayelekile. I-hysteroscope ifakwa esithweni sangasese kanye nomlomo wesibeletho esibelethweni. I-hysteroscope iyinsimbi encane, efana nethubhu enokukhanya nelensi yokubuka. Kungaba futhi nethuluzi lokususa amasampula wezicubu, ahlolwe ngaphansi kwesibonakhulu ukuthola izimpawu zomdlavuza.

Ezinye izivivinyo nezinqubo ezisetshenziselwa ukuxilonga umdlavuza we-endometrial zifaka okulandelayo:

• 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.

• Ukuhlolwa kwe-Transvaginal ultrasound: Inqubo esetshenziselwa ukuhlola isitho sangasese sowesifazane, isibeletho, amashubhu ezulu, nesinye. I-ultrasound transducer (iphenyo) ifakwa esithweni sangasese futhi isetshenziselwe ukubhebhethekisa amaza omsindo aphezulu (i-ultrasound) ezicutshini zangaphakathi noma ezithweni bese yenza ama-echoes. Ama-echoes akha isithombe sezicubu zomzimba esibizwa nge-sonogram. Udokotela angabona izimila ngokubheka i-sonogram.

I-ultrasound yangaphambilini. Uphenyo lwe-ultrasound oluxhunywe kwikhompyutha lufakwa esithweni sangasese futhi lushukumiswe ngobumnene ukukhombisa izitho ezahlukahlukene. I-probe iqhuma amaza omsindo ezithweni zangaphakathi nezicubu ukwenza ama-echoes akha i-sonogram (isithombe sekhompyutha).

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

Isibikezelo (ithuba lokululama) nezinketho zokwelashwa zincike kokulandelayo:

• Isigaba somdlavuza (noma ngabe sise-endometrium kuphela, sifaka udonga lwesibeletho, noma sisabalalele kwezinye izindawo emzimbeni).

• Amangqamuzana omdlavuza abukeka kanjani ngaphansi kwesibonakhulu.

• Ukuthi amaseli womdlavuza athintekile yi-progesterone.

Umdlavuza we-Endometrial uvame ukwelashwa ngoba uvame ukutholakala kusenesikhathi.

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

Isibikezelo (ithuba lokululama) nezinketho zokwelashwa zincike kokulandelayo:

• Isigaba somdlavuza (noma ngabe sise-endometrium kuphela, sifaka udonga lwesibeletho, noma sisabalalele kwezinye izindawo emzimbeni).

• Amangqamuzana omdlavuza abukeka kanjani ngaphansi kwesibonakhulu.

• Ukuthi amaseli womdlavuza athintekile yi-progesterone.

Umdlavuza we-Endometrial uvame ukwelashwa ngoba uvame ukutholakala kusenesikhathi.

Izigaba zomdlavuza we-Endometrial

AMAPHUZU ASEMQOKA

• Ngemuva kokutholakala komdlavuza we-endometrium, kwenziwa ukuhlolwa ukuthola ukuthi amangqamuzana omdlavuza asabalale ngaphakathi kwesibeletho noma kwezinye izingxenye zomzimba.

• Zintathu izindlela umdlavuza osakazeka ngayo emzimbeni.

• Umdlavuza ungasakazeka usuka lapho uqale khona kwezinye izingxenye zomzimba.

• Lezi zigaba ezilandelayo zisetshenziselwa umdlavuza we-endometrium:

• Isiteji I

• Isigaba II

• Isigaba III

• Isigaba IV

• Umdlavuza we-Endometrial ungahle uqoqelwe ukwelashwa ngale ndlela elandelayo:

• Umdlavuza we-endometrial onobungozi obuphansi

• Umdlavuza we-endometrial onobungozi obukhulu

Ngemuva kokutholakala komdlavuza we-endometrium, kwenziwa ukuhlolwa ukuthola ukuthi amangqamuzana omdlavuza asabalale ngaphakathi kwesibeletho noma kwezinye izingxenye zomzimba.

Inqubo esetshenziswayo ukuthola ukuthi umdlavuza ususabalele ngaphakathi kwesibeletho noma kwezinye izingxenye zomzimba ibizwa ngokuthi yi-staging. Imininingwane eqoqwe kusuka kusistimu yesiteji inquma isigaba sesifo. Kubalulekile ukwazi isigaba ukuze uhlele ukwelashwa. Ukuhlolwa nezinqubo ezithile kuyasetshenziswa kunqubo yesiteji. I-hysterectomy (ukusebenza lapho kukhishwa khona isibeletho) imvamisa izokwenziwa ukwelapha umdlavuza we-endometrium. Amasampula amathishu athathwa endaweni ezungeze isibeletho ahlolwe ngaphansi kwesibonakhulu ukuthola izimpawu zomdlavuza ukusiza ukuthola ukuthi umdlavuza ususabalalisile yini.

Izinqubo ezilandelayo zingasetshenziswa kunqubo yokubeka iziteji:

• Ukuhlolwa kwe-pelvic: Ukuhlolwa kwesitho sangasese sowesifazane, umlomo wesibeletho, isibeletho, amashubhu e-fallopian, ama-ovari, ne-rectum. Kufakwa i-speculum esithweni sangasese bese udokotela noma umhlengikazi ebheka esithweni sangasese kanye nomlomo wesibeletho ukuthola izimpawu zesifo. Kuvame ukwenziwa ukuhlolwa kwesibeletho sePap. Udokotela noma umhlengikazi uphinde afake umunwe owodwa noma emibili ethanjisiwe, efakwe igilavu ​​yesandla esisodwa esithweni sangasese bese ebeka esinye isandla phezu kwesisu esingezansi ukuze ezwe ubukhulu, ukuma, nokuma kwesibeletho namaqanda. Udokotela noma umhlengikazi uphinde afake umunwe othanjisiwe, ofakwe igilavu ​​ku-rectum ukuzwa izigaxa noma izindawo ezingejwayelekile.

Ukuhlolwa kwepelvic. Udokotela noma umhlengikazi ufaka umunwe owodwa noma emibili ethanjisiwe, efakwe igilavu ​​yesandla esisodwa esithweni sangasese bese ucindezela esiswini esingezansi ngesinye isandla. Lokhu kwenzelwa ukuzwa ubukhulu, ukuma, nokuma kwesibeletho namaqanda. Isitho sowesifazane sangasese, umlomo wesibeletho, amashubhu okuya emithanjeni, kanye nengxenyenamba iyahlolwa.

• 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.

• 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-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.

• Ukuhlukaniswa kwe-lymph node: Inqubo yokuhlinza lapho kukhishwa khona ama-lymph node endaweni ye-pelvic futhi isampula lezicubu lihlolwe ngaphansi kwesibonakhulu ukuthola izimpawu zomdlavuza. Le nqubo ibizwa nangokuthi i-lymphadenectomy.

Zintathu izindlela umdlavuza osakazeka ngayo emzimbeni.

Umdlavuza ungasakazeka ngezicubu, uhlelo lwe-lymph, kanye negazi:

• Izicubu. Umdlavuza usakazeka lapho uqale khona ngokukhulela ezindaweni eziseduze.

• Uhlelo lweLymph. Umdlavuza usakazeka lapho uqale khona ngokungena ohlelweni lwe-lymph. Umdlavuza udabula imithambo ye-lymph uye kwezinye izingxenye zomzimba.

• Igazi. Umdlavuza usakazeka lapho uqale khona ngokungena egazini. Umdlavuza uhamba ngemithambo yegazi uye kwezinye izingxenye zomzimba.

Umdlavuza ungasakazeka usuka lapho uqale khona kwezinye izingxenye zomzimba.

Lapho umdlavuza usakazekela kolunye uhlangothi lomzimba, ubizwa ngokuthi yi-metastasis. Amaseli womdlavuza aqhamuka lapho aqale khona (isimila sokuqala) futhi ahamba ngohlelo lwe-lymph noma igazi.

• Uhlelo lweLymph. Umdlavuza ungena ohlelweni lwe-lymph, udabule emithanjeni ye-lymph, bese wenza isimila (isimila se-metastatic) kwenye ingxenye yomzimba.

• Igazi. Umdlavuza ungena egazini, udabule emithanjeni yegazi, bese wenza isimila (isimila se-metastatic) kwenye ingxenye yomzimba.

Isigaxa se-metastatic luhlobo olufanayo lomdlavuza njengesimila sokuqala. Isibonelo, uma umdlavuza we-endometrial usakazeka uye emaphashini, amangqamuzana omdlavuza amaphaphu empeleni angamaseli omdlavuza we-endometrium. Lesi sifo umdlavuza we-endometrium we-metastatic, hhayi umdlavuza wamaphaphu.

Lezi zigaba ezilandelayo zisetshenziselwa umdlavuza we-endometrium:

Isiteji I

Isigaba IA nomdlavuza wesigaba IB endometrium. Esigabeni IA, umdlavuza uku-endometrium kuphela noma ngaphansi kwesigamu se-myometrium (ungqimba lwemisipha yesibeletho). Esigabeni IB, umdlavuza usakaze phakathi noma ngaphezulu ku-myometrium.

Esigabeni I, umdlavuza utholakala esibelethweni kuphela. Isigaba I sihlukaniswe izigaba IA ne-IB, ngokuya ngokuthi umdlavuza ususabalale kangakanani.

• Isigaba IA: Umdlavuza use-endometrium kuphela noma ngaphansi kwengxenye ye-myometrium (ungqimba lwemisipha yesibeletho).

• Isigaba IB: Umdlavuza usakaze phakathi noma ngaphezulu ku-myometrium.

Isigaba II

Umdlavuza wesigaba II se-endometrium. Umdlavuza ususabalele kwezicubu zomlomo wesibeletho, kepha awusakazekanga ngaphandle kwesibeletho.

Esigabeni II, umdlavuza ususabalele kwezicubu zomlomo wesibeletho, kepha awusakazekanga ngaphandle kwesibeletho.

Isigaba III

Esigabeni III, umdlavuza usabalele ngaphesheya kwesibeletho nomlomo wesibeletho, kepha awusakazekanga ngaphesheya kwesikhumba. Isigaba III sihlukaniswe ngezigaba IIIA, IIIB, kanye ne-IIIC, ngokuya ngokuthi umdlavuza usabalale kangakanani ngaphakathi kwesikhumba.

• Isigaba IIIA: Umdlavuza usabalalele kungqimba olungaphandle lwesibeletho kanye / noma kumashubhu we-fallopian, ama-ovari, kanye nemisipha yesibeletho.

Isigaba IIIA somdlavuza we-endometrium. Umdlavuza usabalalele kungqimba olungaphandle lwesibeletho kanye / noma kumashubhu e-fallopian, amaqanda, noma imisipha yesibeletho.

• Isigaba IIIB: Umdlavuza ususabalele esithweni sangasese kanye / noma kwi-parametrium (izicubu ezihlangene namafutha azungeze isibeletho).

Isigaba IIIB umdlavuza we-endometrial. Umdlavuza usabalalele esithweni sangasese kanye / noma kwi-parametrium (izicubu ezihlangene namafutha azungeze isibeletho nomlomo wesibeletho).

• Isigaba IIIC: Umdlavuza usabalalele kuma-lymph node ku-pelvis kanye / noma nxazonke ze-aorta (umthambo omkhulu emzimbeni, osusa igazi enhliziyweni).

Isigaba IIIC umdlavuza we-endometrium. Umdlavuza usabalalele kuma-lymph node ku-pelvis kanye / noma ezungeze i-aorta (umthambo omkhulu kunayo yonke emzimbeni, osusa igazi enhliziyweni).

Isigaba IV

Esigabeni IV, umdlavuza usabalele ngaphesheya kwesikhumba. Isigaba IV sihlukaniswe ngezigaba ze-IVA ne-IVB, ngokuya ngokuthi umdlavuza ususabalale kangakanani.

• Isigaba IVA: Umdlavuza usabalalele esinyeni kanye / noma odongeni lwamathumbu.

Isigaba somdlavuza we-endometrial we-IVA. Umdlavuza ususabalele esinyeni kanye / noma emathunjini.

• Isigaba IVB: I-Cancer isakaze kwezinye izingxenye zomzimba ngaphesheya kwesikhumba, kufaka phakathi isisu kanye / noma ama-lymph node ku-groin.

Umdlavuza wesigaba se-IVB endometrial. Umdlavuza usabalalele ezingxenyeni zomzimba ngaphandle kwesinqe, njengesisu kanye / noma ama-lymph node ku-groin.

Umdlavuza we-Endometrial ungahle uqoqelwe ukwelashwa ngale ndlela elandelayo:

Umdlavuza we-endometrial onobungozi obuphansi

Izimila zebanga loku-1 nele-2 zivame ukubhekwa njengengozi ephansi. Imvamisa azisabalali ziye kwezinye izitho zomzimba.

Umdlavuza we-endometrial onobungozi obukhulu

Izimila zebanga lesi-3 zibhekwa njengengozi enkulu. Zivame ukusabalala kwezinye izitho zomzimba. I-uterine papillary serous, iseli ecacile, ne-carcinosarcoma yizinhlobo ezintathu zomdlavuza we-endometrial obhekwa njengebanga lesi-3.

Umdlavuza Ophindaphindiwe We-Endometrial

Umdlavuza ophindaphindiwe we-endometrium ngumdlavuza obuye wabuya (ubuye) ngemuva kokuba welashwe. Umdlavuza ungabuya esibelethweni, ekhalweni, kuma-lymph node esiswini, noma kwezinye izingxenye zomzimba

Uhlolojikelele lwenketho yokwelashwa

AMAPHUZU ASEMQOKA

• Kunezinhlobo ezahlukene zokwelashwa kweziguli ezinomdlavuza we-endometrial.

• Izinhlobo ezinhlanu zokwelashwa okujwayelekile zisetshenzisiwe:

• Ukuhlinzwa

• Ukwelashwa ngemisebe

• Ukwelashwa ngamakhemikhali

• Ukwelashwa kweHormone

• Ukwelashwa okuhlosiwe

• Izinhlobo ezintsha zokwelashwa ziyahlolwa ezivivinyweni zokwelashwa.

• Ukwelashwa komdlavuza we-endometrial kungadala imiphumela emibi.

• Iziguli zingafuna ukucabanga ngokubamba iqhaza esivivinyweni somtholampilo.

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

• Ukuhlolwa kokulandelela kungadingeka.

Kunezinhlobo ezahlukene zokwelashwa kweziguli ezinomdlavuza we-endometrial.

Izinhlobo ezahlukene zokwelashwa ziyatholakala ezigulini ezinomdlavuza we-endometrial. 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 ezinhlanu zokwelashwa okujwayelekile zisetshenzisiwe:

Ukuhlinzwa

Ukuhlinzwa (ukususa umdlavuza lapho usebenza) yindlela yokwelashwa ejwayelekile yomdlavuza we-endometrial. Izinqubo ezilandelayo zokuhlinza zingasetshenziswa:

• I-hysterectomy ephelele: Ukuhlinzwa ukususa isibeletho, kufaka phakathi umlomo wesibeletho. Uma isibeletho nomlomo wesibeletho kukhishwa ngesitho sangasese sowesifazane, ukuhlinzwa kubizwa nge-hysterectomy yesitho sangasese sowesifazane. Uma isibeletho nomlomo wesibeletho kukhishwa ngokusebenzisa ukusikeka okukhulu esiswini, ukuhlinzwa kubizwa ngokuthi yi-hysterectomy ephelele yesisu. Uma isibeletho nomlomo wesibeletho kukhishwa ngesikezi esincane (esisikiwe) esiswini kusetshenziswa i-laparoscope, ukuhlinzwa kubizwa ngokuthi yi-laparoscopic hysterectomy ephelele.

I-Hysterectomy. Isibeletho sisuswa ngokuhlinzwa noma ngaphandle kwezinye izitho noma izicubu. Ku-hysterectomy ephelele, isibeletho nomlomo wesibeletho kuyasuswa. Ku-hysterectomy ephelele ene-salpingo-oophorectomy, (a) kukhishwa isibeletho kanye ne-one (unilateral) ovary kanye ne-fallopian tube; noma (b) kukhishwe isibeletho kanye nawo womabili (amabhilidi) amaqanda kanye namashubhu e-fallopian. Ku-hysterectomy enamandla, kukhishwa isibeletho, umlomo wesibeletho, womabili amaqanda, amashubhu womabili, nezicubu eziseduze. Lezi zinqubo zenziwa kusetshenziswa imbobo ephansi enqamulelayo noma imbobo ebheke phezulu.

• I-bilateral salpingo-oophorectomy: Ukuhlinzwa ukususa womabili amaqanda kanye namashubhu womabili.

• I-Radical hysterectomy: Ukuhlinzwa ukususa isibeletho, umlomo wesibeletho, nengxenye yesitho sangasese sowesifazane. Ama-ovari, amashubhu we-fallopian, noma ama-lymph node aseduze nawo angasuswa.

• Ukuhlukaniswa kwe-lymph node: Inqubo yokuhlinza lapho kukhishwa khona ama-lymph node endaweni ye-pelvic futhi isampula lezicubu lihlolwe ngaphansi kwesibonakhulu ukuthola izimpawu zomdlavuza. Le nqubo ibizwa nangokuthi i-lymphadenectomy.

Ngemuva kokuthi udokotela awususe wonke umdlavuza ongabonakala ngesikhathi sokuhlinzwa, ezinye iziguli zinganikezwa ukwelashwa ngemisebe noma ukwelashwa ngamahomoni 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.

• 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 ngemisebe kwangaphandle nangaphakathi kusetshenziselwa ukwelapha umdlavuza we-endometrium, futhi kungasetshenziswa futhi njengokwelapha okunciphisayo ukukhulula izimpawu nokuthuthukisa ikhwalithi yempilo.

Ukwelashwa ngamakhemikhali

I-Chemotherapy yindlela yokwelapha umdlavuza esebenzisa izidakamizwa ukuvimba ukukhula kwamangqamuzana omdlavuza, kungaba ngokubulala amaseli noma ngokuvimba amaseli ukuthi angahlukani. 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.

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.

Ukwelashwa okuhlosiwe

Ukwelashwa okuhlosiwe uhlobo lokwelashwa olusebenzisa izidakamizwa noma ezinye izinto ukukhomba nokuhlasela amangqamuzana omdlavuza athile ngaphandle kokulimaza amaseli ajwayelekile. Ama-antibody e-monoclonal, i-mTOR inhibitors, kanye ne-signal transduction inhibitors yizinhlobo ezintathu zokwelashwa okuqondisiwe okusetshenziselwa ukwelapha umdlavuza we-endometrium.

• I-monoclonal antibody therapy iyindlela yokwelapha umdlavuza esebenzisa amasosha omzimba enziwe elebhu evela ohlotsheni olulodwa lweseli lomzimba. 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 okokusebenza okukhipha imisebe ngqo kumaseli womdlavuza. I-Bevacizumab isetshenziselwa ukwelapha isigaba III, isigaba IV, nomdlavuza ophindaphindiwe we-endometrium.

• Ama-mTOR inhibitors avimba iprotheni ebizwa ngokuthi i-mTOR, esiza ukulawula ukwahlukana kwamaseli. Ama-mTOR inhibitors angagcina amangqamuzana omdlavuza angakhuli futhi avimbele ukukhula kwemithambo yegazi emisha okudingeka ukuthi izimila zikhule. I-Everolimus ne-ridaforalimus zisetshenziselwa ukwelapha isigaba III, isigaba IV, nomdlavuza ophindaphindiwe we-endometrium.

• Ama-inhibitors wokudluliswa kwesiginali avimba amasiginali adluliswa esuka ku-molecule eyodwa aye kwenye ngaphakathi kweseli. Ukuvimba lezi zimpawu kungabulala amangqamuzana omdlavuza. IMetformin isafundelwa ukwelapha isigaba III, isigaba IV, nomdlavuza ophindaphindiwe we-endometrium.

Izinhlobo ezintsha zokwelashwa ziyahlolwa ezivivinyweni zokwelashwa.

Imininingwane mayelana nokuhlolwa kwemitholampilo iyatholakala kuwebhusayithi ye-NCI.

Ukwelashwa komdlavuza we-endometrial 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 Zokwelapha ngeStage

Kulesi Sigaba

• Isigaba I kanye neSigaba II Somdlavuza we-Endometrial

• Isigaba III, Isigaba IV, kanye Nomdlavuza Oqhubekayo We-Endometrial

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

Isigaba I kanye neSigaba II Somdlavuza we-Endometrial

Umdlavuza we-endometrial onobungozi obuphansi (ibanga 1 noma ibanga 2)

Ukwelashwa kwesigaba esinobungozi obuphansi I umdlavuza we-endometrial kanye nomdlavuza wesigaba II we-endometrial ungafaka okulandelayo:

• Ukuhlinzwa (i-hysterectomy ephelele kanye ne-bilpal salpingo-oophorectomy). Ama-lymph node ku-pelvis nasesiswini nawo angasuswa futhi abhekwe ngaphansi kwesibonakhulu ukuhlola amaseli omdlavuza.

• Ukuhlinzwa (inani eliphelele le-hysterectomy kanye ne-bilateral salpingo-oophorectomy, ngokususwa noma ngaphandle kwama-lymph node ku-pelvis nasesiswini) kulandelwa ukwelashwa kwemisebe yangaphakathi. Ezimweni ezithile, ukwelashwa ngemisebe kwangaphandle okhalweni kungasetshenziswa esikhundleni sokwelapha ngemisebe yangaphakathi.

• Ukwelashwa ngemisebe kuphela kweziguli ezingakwazi ukuhlinzwa.

• Isivivinyo somtholampilo sohlobo olusha lwe-chemotherapy regimen.

Uma umdlavuza usabalalele emgodini wesibeletho, kungenziwa i-hysterectomy enamandla nge-bilpal salpingo-oophorectomy.

Umdlavuza we-endometrial onobungozi obukhulu (ibanga 3)

Ukwelashwa kwesigaba esinobungozi obukhulu Umdlavuza we-endometrial kanye nomdlavuza wesigaba II we-endometrial ungafaka okulandelayo:

• Ukuhlinzwa (i-radical hysterectomy kanye ne-bilateral salpingo-oophorectomy). Ama-lymph node ku-pelvis nasesiswini nawo angasuswa futhi abhekwe ngaphansi kwesibonakhulu ukuhlola amaseli omdlavuza.

• Ukuhlinzwa (i-radical hysterectomy kanye ne-bilateral salpingo-oophorectomy) kulandelwa ukwelashwa ngamakhemikhali kwesinye isikhathi nokwelashwa ngemisebe.

• Isivivinyo somtholampilo sohlobo olusha lwe-chemotherapy regimen.

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, Isigaba IV, kanye Nomdlavuza Oqhubekayo We-Endometrial

Ukwelashwa komdlavuza wesigaba sesithathu we-endometrium, umdlavuza wesigaba se-IV endometrial, kanye nomdlavuza ophindaphindiwe we-endometrium kungafaka okulandelayo:

• Ukuhlinzwa (i-radical hysterectomy nokususwa kwama-lymph node okhalweni ukuze bakwazi ukubukwa ngaphansi kwesibonakhulu ukuhlola amaseli omdlavuza) kulandelwe i-adjuvant chemotherapy kanye / noma i-radiation therapy.

• I-Chemotherapy kanye nokwelashwa ngemisebe kwangaphakathi nangaphandle kweziguli ezingakwazi ukuhlinzwa.

• Ukwelashwa kweHormone kweziguli ezingakwazi ukuhlinzwa noma ukwelashwa ngemisebe.

• Ukwelashwa okuqondisiwe nge-mTOR inhibitors (i-everolimus noma i-ridaforolimus) noma i-antibody monoclonal (bevacizumab).

• Isivivinyo somtholampilo sohlobo olusha lokwelashwa olungafaka inhlanganisela yamakhemikhali, ukwelashwa okuqondisiwe, njenge-mTOR inhibitor (everolimus) noma isignali transduction inhibitor (metformin), kanye / noma ukwelashwa kwamahomoni, ezigulini ezinomdlavuza ophakeme noma ophindaphindiwe we-endometrium.

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-Endometrial

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

• Ikhasi Lasekhaya Lomdlavuza Wesibeletho

• Ukuvimbela Umdlavuza we-Endometrial

• Ukuhlolwa Komdlavuza we-Endometrial

• Ukwelashwa KweHormone Komdlavuza Webele

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