Izinhlobo / isitho sangasese / isiguli / ukwelashwa kwesifazane-pdq

Ukwelashwa Komdlavuza Wesitho Sangasese (®) –Patient Version

Imininingwane Ejwayelekile Mayelana Nomdlavuza Wesitho Sangasese

AMAPHUZU ASEMQOKA

• Umdlavuza wesitho sangasese sowesifazane yisifo lapho amangqamuzana abulalayo (umdlavuza) akha khona esithweni sangasese.

• Ukuguga nokuba nokutheleleka nge-HPV kuyizinto eziyingozi yomdlavuza wesitho sangasese sowesifazane.

• Izimpawu nezimpawu zomdlavuza wesitho sangasese sowesifazane zibandakanya ubuhlungu noma ukuphuma kwegazi ngokungajwayelekile.

• Ukuhlola okuhlola isitho sangasese kanye nezinye izitho ezinqeni kusetshenziselwa ukuthola umdlavuza wesitho sangasese sowesifazane.

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

Umdlavuza wesitho sangasese sowesifazane yisifo lapho amangqamuzana abulalayo (umdlavuza) akha khona esithweni sangasese.

Isitho sangasese sangasese ngumsele oholela kusuka emlonyeni wesibeletho (ukuvulwa kwesibeletho) uye ngaphandle komzimba. Lapho izalwa, ingane idlula emzimbeni iye esithweni sangasese (esibizwa nangokuthi umsele wokuzalwa).

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 wesitho sowesifazane awuvamile. Kunezinhlobo ezimbili eziyinhloko zomdlavuza wesitho sangasese sowesifazane:

• I-squamous cell carcinoma: Umdlavuza owakhiwa kumaseli amancane, ayizicaba angena ngaphakathi esithweni sangasese sowesifazane. Umdlavuza wesitho sangasese sowesifazane oyisikwele usakazeka kancane futhi uvame ukuhlala eduze kwesitho sangasese sowesifazane, kodwa ungadlulela emaphashini, esibindini noma ethanjeni. Lolu uhlobo oluvame kakhulu lomdlavuza wesitho sangasese sowesifazane.

• I-Adenocarcinoma: Umdlavuza oqala kumaseli wezindlala. Amaseli endlala asemgqeni wesitho sangasese sowesifazane enza futhi akhiphe uketshezi olufana namafinyila. I-Adenocarcinoma inamathuba amaningi kunomdlavuza we-squamous cell ukusabalala emaphashini nakuma-lymph node. Uhlobo olungajwayelekile lwe-adenocarcinoma (clear cell adenocarcinoma) luxhumene nokuvezwa yi-diethylstilbestrol (DES) ngaphambi kokuzalwa. I-Adenocarcinomas engaxhunyaniswa nokuvezwa yi-DES ivame kakhulu kwabesifazane ngemuva kokunqamuka kokuya esikhathini.

Ukuguga nokuba nokutheleleka nge-HPV kuyizinto eziyingozi yomdlavuza wesitho sangasese sowesifazane.

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

• Ukuba neminyaka engama-60 noma ngaphezulu.

• Ukuba nokutheleleka ngegciwane le-human papilloma virus (HPV). I-squamous cell carcinoma (SCC) yesitho sowesifazane sangasese ixhunyaniswe nokutheleleka nge-HPV futhi inezici eziningi zobungozi ezifana ne-SCC yomlomo wesibeletho.

• Ukudalulwa ku-DES ngenkathi usesibelethweni sikamama. Ngawo-1950, umuthi i-DES wanikezwa abanye besifazane abakhulelwe ukuvimbela ukuphuphuma kwesisu (ukuzalwa ngaphambi kwesikhathi kombungu ongakwazi ukuphila). Lokhu kuxhunyaniswa nohlobo lomdlavuza wesitho sowesifazane olungajwayelekile olubizwa nge-clear cell adenocarcinoma. Amanani alesi sifo ayephakeme kakhulu phakathi nawo-1970, futhi asivamile kakhulu manje.

• Ukuba ne-hysterectomy yamathumba ayenobungozi (hhayi umdlavuza) noma umdlavuza.

Izimpawu nezimpawu zomdlavuza wesitho sangasese sowesifazane zibandakanya ubuhlungu noma ukuphuma kwegazi ngokungajwayelekile.

Umdlavuza wesitho sangasese sowesifazane kaningi awubangeli zimpawu zokuqala noma izimpawu. Ingatholwa ngesikhathi sokuhlolwa okwejwayelekile kwe-pelvic nokuhlolwa kwe-Pap. Izimpawu nezimpawu zingadalwa ngumdlavuza wesitho sangasese sowesifazane noma ngezinye izimo. Buza nodokotela wakho uma unokunye kwalokhu okulandelayo:

• Ukopha noma ukukhipha akuhlobene nezikhathi zokuya esikhathini.

• Ubuhlungu ngesikhathi sokuya ocansini.

• Ubuhlungu endaweni ye-pelvic.

• Isigaxa esithweni sangasese.

• Ubuhlungu lapho uchama.

• Ukuqunjelwa.

Ukuhlola okuhlola isitho sangasese kanye nezinye izitho ezinqeni kusetshenziselwa ukuthola umdlavuza wesitho sangasese sowesifazane.

Lezi zivivinyo nezinqubo ezilandelayo zingasetshenziswa:

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

• Ukuhlolwa kwe-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.

• Ukuhlolwa kwe-Pap: Inqubo yokuqoqa amaseli ebusweni bomlomo wesibeletho nowesifazane. Ucezu lukakotini, ibhulashi, noma induku encane yokhuni kusetshenziselwa ukukhuhla ngobumnene amaseli omlomo wesibeletho nowesifazane. Amaseli abhekwa ngaphansi kwesibonakhulu ukuthola ukuthi awajwayelekile yini. Le nqubo ibizwa nangokuthi iPap smear.

Ukuhlolwa kwePap. Kufakwa i-speculum esithweni sangasese ukuyikhulisa. Ngemuva kwalokho, kufakwa ibhulashi esithweni sangasese ukuze kuthathwe amaseli emlonyeni wesibeletho. Amaseli ahlolwa ngaphansi kwesibonakhulu ukuthola izimpawu zesifo.

• Ukuhlolwa kwe-human papillomavirus (HPV): Ukuhlolwa kwelabhorethri okusetshenziselwa ukuhlola i-DNA noma i-RNA ngezinhlobo ezithile zokutheleleka nge-HPV. Amaseli aqoqwa emlomo wesibeletho bese kuhlolwe i-DNA noma i-RNA kumaseli ukuthola ukuthi ngabe ukutheleleka kubangelwa yini uhlobo lwe-HPV oluxhunyaniswe nomdlavuza wesibeletho. Lokhu kuhlolwa kungenziwa kusetshenziswa isampula lamaseli akhishwe ngesikhathi sokuhlolwa kwePap. Lokhu kuhlolwa kungenziwa futhi uma imiphumela yokuhlolwa kwePap ibonisa amaseli athile omlomo wesibeletho angajwayelekile.

• IColposcopy: Inqubo lapho kusetshenziswa khona i-colposcope (ithuluzi elikhanyisiwe, elikhulisayo) ukuhlola isitho sangasese sowesifazane nomlomo wesibeletho ezindaweni ezingejwayelekile. Amasampula amathishu angathathwa kusetshenziswa i-curette (insimbi emise okwe-spoon) noma ibhulashi futhi kuhlolwe ngaphansi kwesibonakhulu ukuthola izimpawu zesifo.

• I-Biopsy: Ukususwa kwamaseli noma izicubu esithweni sangasese kanye nomlomo wesibeletho ukuze kubhekwe ngaphansi kwesibonakhulu ngudokotela wezifo ukuze ahlole izimpawu zomdlavuza. Uma ukuhlolwa kwePap kukhombisa amaseli angajwayelekile esithweni sangasese, i-biopsy ingenziwa ngesikhathi se-colposcopy.

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

Isibikezelo sincike kulokhu okulandelayo:

• Isigaba somdlavuza (noma ngabe sisesitho sangasese kuphela noma sesisabalele nakwezinye izindawo).

• Usayizi wesimila.

• Ibanga lamangqamuzana wesimila (ukuthi ahluke kanjani kumaseli avamile ngaphansi kwesibonakhulu).

• Lapho umdlavuza ungaphakathi kwesitho sangasese sowesifazane.

• Ukuthi kunezimpawu noma izimpawu ekuxilongweni.

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

Izinketho zokwelashwa zincike kokulandelayo:

• Isiteji nosayizi womdlavuza.

• Noma ngabe umdlavuza useduze nezinye izitho ezingalimala ngokwelashwa.

• Ukuthi isimila sakhiwe ngamangqamuzana angama-squamous noma yi-adenocarcinoma.

• Ukuthi isiguli sinesibeletho noma sike sathola isibeletho.

• Ukuthi isiguli sesikade sathola ukwelashwa ngemisebe okhalweni.

Izigaba zomdlavuza wesitho sangasese sowesifazane

AMAPHUZU ASEMQOKA

• Ngemuva kokutholakala komdlavuza wesitho sangasese sowesifazane, kwenziwa ukuhlolwa ukuthola ukuthi ngabe amangqamuzana omdlavuza asabalala ngaphakathi esithweni sangasese noma kwezinye izingxenye zomzimba.

• Zintathu izindlela umdlavuza osakazeka ngayo emzimbeni.

• Umdlavuza ungasakazeka usuka lapho uqale khona kwezinye izingxenye zomzimba.

• Ku-neoplasia ye-vaginal intraepithelial neoplasia (VaIN), amaseli angajwayelekile atholakala ezicutshini ezingena ngaphakathi esithweni sangasese.

• Lezi zigaba ezilandelayo zisetshenziselwa umdlavuza wesitho sangasese sowesifazane:

• Isiteji I

• Isigaba II

• Isigaba III

• Isigaba IV

• Umdlavuza wesitho sangasese sowesifazane ungaphinde ubuye (ubuye) ngemuva kokuba welashwe.

Ngemuva kokutholakala komdlavuza wesitho sangasese sowesifazane, kwenziwa ukuhlolwa ukuthola ukuthi ngabe amangqamuzana omdlavuza asabalala ngaphakathi esithweni sangasese noma kwezinye izingxenye zomzimba.

Inqubo esetshenziswayo ukuthola ukuthi umdlavuza ususabalele ngaphakathi esithweni sangasese noma kwezinye izingxenye zomzimba ibizwa ngokuthi yi-staging. Imininingwane eqoqwe kusuka kusistimu yesiteji inquma isigaba sesifo. Kubalulekile ukwazi isigaba ukuze uhlele ukwelashwa. Izinqubo ezilandelayo zingasetshenziswa kunqubo yokubeka iziteji:

• 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 eziningiliziwe zezindawo ezingaphakathi komzimba ezifana nesisu 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-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-cystoscopy: Inqubo yokubheka ngaphakathi kwesinye kanye nomchamo ukubheka izindawo ezingajwayelekile. I-cystoscope ifakwa nge-urethra iye esinyeni. I-cystoscope iyinsimbi encane, efana nethubhu enokukhanya nelensi yokubuka. Kungaba futhi nethuluzi lokususa amasampula wezicubu, ahlolwe ngaphansi kwesibonakhulu ukuthola izimpawu zomdlavuza.

I-cystoscopy. I-cystoscope (insimbi encane, efana nethubhu enokukhanya nelensi yokubuka) ifakwa ngomchamo ungene esinyeni. Uketshezi lusetshenziselwa ukugcwalisa isinye. Udokotela ubheka isithombe sodonga lwangaphakathi lwesinye kumqapha wekhompyutha.

• I-Proctoscopy: Inqubo yokubheka ngaphakathi kwe-rectum ne-anus ukuhlola izindawo ezingavamile, usebenzisa i-proctoscope. I-proctoscope iyinsimbi encane, efana nethubhu enokukhanya nelensi yokubuka ingaphakathi le-rectum ne-anus. Kungaba futhi nethuluzi lokususa amasampula wezicubu, ahlolwe ngaphansi kwesibonakhulu ukuthola izimpawu zomdlavuza.

• I-Biopsy: I-biopsy ingenziwa ukuthola ukuthi umdlavuza ususabalele yini emgodini wesibeletho. Isampula lezicubu liyasuswa emlonyeni wesibeletho bese libhekwa ngaphansi kwesibonakhulu. I-biopsy esusa inani elincane kuphela lezicubu ivame ukwenziwa ehhovisi likadokotela. I-cone biopsy (ukususwa kwesicubu esikhudlwana, esimise okwenziwe ngesigaxa somlomo wesibeletho nomsele wesibeletho) kuvame ukwenziwa esibhedlela. I-biopsy ye-vulva nayo ingenziwa ukubona ukuthi umdlavuza usakaze lapho.

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 wesitho sangasese sowesifazane usakazeka uye emaphashini, amangqamuzana omdlavuza asephashini empeleni angamaseli omdlavuza wesitho sangasese sowesifazane. Lesi sifo umdlavuza wesitho sangasese sowesifazane, hhayi umdlavuza wamaphaphu.

Ku-neoplasia ye-vaginal intraepithelial neoplasia (VaIN), amaseli angajwayelekile atholakala ezicutshini ezingena ngaphakathi esithweni sangasese.

Lawa maseli angajwayelekile akuwona umdlavuza. I-vaginal intraepithelial neoplasia (VaIN) iqoqwe ngokususelwa ekujuleni kwamangqamuzana angajwayelekile ezicutshini ezingena esithweni sangasese:

• I-VaIN 1: Amaseli angajwayelekile atholakala engxenyeni engaphezulu kwengxenye yesithathu yezicubu ezigcwele isitho sangasese sowesifazane.

• I-VaIN 2: Amaseli angajwayelekile atholakala engxenyeni engaphezulu kokuthathu kwezintathu zezicubu ezigcwele isitho sangasese sowesifazane.

• I-VaIN 3: Amaseli angajwayelekile atholakala kokungaphezulu kokuthathu kokuthathu kwezicubu ezigcwele isitho sangasese sowesifazane. Lapho izilonda ze-VaIN 3 zitholakala ebugqineni obugcwele bezicubu ezigcwele isitho sangasese sowesifazane, ibizwa ngokuthi i-carcinoma in situ.

I-VaIN ingaba ngumdlavuza bese isakazeka odongeni lwesitho sangasese sowesifazane.

Lezi zigaba ezilandelayo zisetshenziselwa umdlavuza wesitho sangasese sowesifazane:

Isiteji I

Esigabeni I, umdlavuza utholakala kuphela odongeni lwesitho sangasese sowesifazane.

Isigaba II

Esigabeni II, umdlavuza usabalele odongeni lwesitho sangasese sowesifazane waya ezicutshini ezizungeze isitho sangasese sowesifazane. Umdlavuza awusabalalanga udonga lwekhanda.

Isigaba III

Esigabeni III, umdlavuza ususabalele odongeni lwesikhumba.

Isigaba IV

Isigaba IV sihlukaniswe ngezigaba IVA nesigaba IVB:

• Isigaba IVA: Umdlavuza kungenzeka usabalalele endaweni eyodwa noma eziningi kulezi ezilandelayo:

• Ulwelwesi lwesinye.

• Ulwelwesi lwe-rectum.

• Ngaphandle kwendawo ye-pelvis enesinye, isibeletho, ama-ovari, nomlomo wesibeletho.

• Isigaba IVB: Umdlavuza usabalalele ezingxenyeni zomzimba ezingekho eduze kwesitho sowesifazane sangasese, njengephaphu noma ithambo.

Umdlavuza wesitho sangasese sowesifazane ungaphinde ubuye (ubuye) ngemuva kokuba welashwe.

Umdlavuza ungabuyela esithweni sangasese noma kwezinye izingxenye zomzimba.

Uhlolojikelele lwenketho yokwelashwa

AMAPHUZU ASEMQOKA

• Kunezinhlobo ezahlukene zokwelashwa kweziguli ezinomdlavuza wesitho sangasese sowesifazane.

• Izinhlobo ezintathu zokwelashwa okujwayelekile zisetshenzisiwe:

• Ukuhlinzwa

• Ukwelashwa ngemisebe

• Ukwelashwa ngamakhemikhali

• Izinhlobo ezintsha zokwelashwa ziyahlolwa ezivivinyweni zokwelashwa.

• I-Immunotherapy

• Ama-Radiosensitizers

• Ukwelashwa komdlavuza wesitho sangasese sowesifazane 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 wesitho sangasese sowesifazane.

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

Izinhlobo ezintathu zokwelashwa okujwayelekile zisetshenzisiwe:

Ukuhlinzwa

Ukuhlinzwa kuyindlela yokwelashwa ejwayelekile yomabili we-vaginal intraepithelial neoplasia (VaIN) nomdlavuza wesitho sangasese sowesifazane.

Izinhlobo ezilandelayo zokuhlinzwa zingasetshenziswa ukwelapha i-VaIN:

• Ukuhlinzwa nge-Laser: Inqubo yokuhlinza esebenzisa umsebe we-laser (umsebe omncane wokukhanya okukhulu) njengommese ukwenza ukusikeka ngaphandle kwegazi ezicutshini noma ukususa isilonda esingaphezulu njengesimila.

• Ukusikwa kwendawo yonke: Inqubo yokuhlinza ekhipha umdlavuza kanye nezinye izicubu ezinempilo ezizungezile.

• I-Vaginectomy: Ukuhlinzwa ukususa konke noma ingxenye yesitho sangasese sowesifazane. Ukufakwa esikhunjeni okuvela kwezinye izingxenye zomzimba kungadingeka ukwakha kabusha isitho sangasese sowesifazane.

Izinhlobo ezilandelayo zokuhlinzwa zingasetshenziswa ukwelapha umdlavuza wesitho sangasese sowesifazane:

• Ukusikwa kwendawo yonke: Inqubo yokuhlinza ekhipha umdlavuza kanye nezinye izicubu ezinempilo ezizungezile.

• I-Vaginectomy: Ukuhlinzwa ukususa konke noma ingxenye yesitho sangasese sowesifazane. Ukufakwa esikhunjeni okuvela kwezinye izingxenye zomzimba kungadingeka ukwakha kabusha isitho sangasese sowesifazane.

• 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 ngokusebenzisa imbobo encane 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 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-lymph node dissection: Inqubo yokuhlinza lapho kukhishwa khona ama-lymph node futhi kuhlolwe isampula lezicubu ngaphansi kwesibonakhulu ukuthola izimpawu zomdlavuza. Le nqubo ibizwa nangokuthi i-lymphadenectomy. Uma umdlavuza ungaphakathi kwesitho sangasese sangaphezulu, ama-lymph node we-pelvic angasuswa. Uma umdlavuza usesitho sangasese sangasese esingezansi, ama-lymph node ku-groin angasuswa.

• Ukuqina kwepelvic: Ukuhlinzwa ukususa ikholoni engezansi, i-rectum, isinye, umlomo wesibeletho, isitho sangasese sowesifazane, nama-ovari. Ama-lymph node aseduze nawo asuswa. Ukuvulwa kokufakelwa (stoma) kwenzelwa umchamo nesitulo ukugeleza kusuka emzimbeni kuya esikhwameni sokuqoqa.

Ngemuva kokuthi udokotela awususe wonke umdlavuza ongabonakala ngesikhathi sokuhlinzwa, ezinye iziguli zinganikezwa ukwelashwa ngemisebe 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 endaweni yomzimba enomdlavuza.

• 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 wesitho sangasese sowesifazane, 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 ngokuwavimba ekuhlukaniseni. Lapho i-chemotherapy ithathwa ngomlomo noma ifakwa emthanjeni noma emisipheni, izidakamizwa zingena egazini futhi zingathinta amangqamuzana omdlavuza 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 ngamakhemikhali ngezihloko komdlavuza wesitho sangasese sowesifazane ongasetshenziswa kungasetshenziswa esithweni sangasese kukhilimu noma elangeni.

Izinhlobo ezintsha zokwelashwa ziyahlolwa ezivivinyweni zokwelashwa.

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

I-Immunotherapy

I-Immunotherapy yimithi esebenzisa amasosha omzimba esiguli ukulwa nomdlavuza. Izinto ezenziwe ngumzimba noma ezenziwe elabhoratri zisetshenziselwa ukukhulisa, ukuqondisa, noma ukubuyisa izivikelo zemvelo zomzimba kumdlavuza. Lolu hlobo lokwelashwa komdlavuza lubizwa nangokuthi i-biotherapy noma i-biologic therapy.

I-Imiquimod iyindlela yokulungisa izimpendulo zomzimba efundelwa ukwelapha izilonda zangasese futhi isetshenziswa esikhumbeni kukhilimu.

Ama-Radiosensitizers

Ama-radiosensitizers yizidakamizwa ezenza amangqamuzana ama-tumor azwele kakhulu ekwelashweni kwemisebe. Ukuhlanganisa ukwelashwa ngemisebe ngama-radiosensitizers kungabulala amangqamuzana amaningi wesimila.

Ukwelashwa komdlavuza wesitho sangasese sowesifazane 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.

Ukwelashwa kwe-Vaginal Intraepithelial Neoplasia (VaIN)

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

Ukwelashwa kwe-neoplasia ye-intraepithelial neoplasia (VaIN) kungafaka okulandelayo:

• Ukuhlinzwa (ukuhlinzwa nge-laser ngemuva kwe-biopsy).

• Ukuhlinzwa (ukusikwa kwendawo okubanzi) ngokuxhunyelelwa kwesikhumba.

• Ukuhlinzwa (i-vaginectomy engaphelele noma ephelele) noma ngaphandle kwesikhumba.

• I-topical chemotherapy.

• Ukwelashwa kwemisebe yangaphakathi.

• Isivivinyo somtholampilo se-immunotherapy (imiquimod) esisetshenziswa esikhumbeni.

Ukwelashwa Kwe-Stage I Cancer Yobulili

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

Ukwelashwa kwesigaba I squamous cell umdlavuza wesitho sowesifazane sangasese esingaphansi kwamasentimitha angu-0.5 ubukhulu kungafaka okulandelayo:

• Ukwelashwa kwemisebe yangaphandle, ikakhulukazi izicubu ezinkulu noma ama-lymph node eduze kwezicubu engxenyeni engezansi yesitho sangasese sowesifazane.

• Ukwelashwa kwemisebe yangaphakathi.

• Ukuhlinzwa (ukusikwa kwendawo okubanzi noma i-vaginectomy nokwakhiwa kabusha kwesitho sangasese). Ukwelashwa ngemisebe kunganikezwa ngemuva kokuhlinzwa.

Ukwelashwa kwesigaba I squamous cell umdlavuza wesisu izilonda ezingaphezulu kuka-0.5 amasentimitha ubukhulu kungafaka okulandelayo:

• Ukuhlinzwa:

• Ezilondeni ezingxenyeni ezingenhla zesithathu sowesifazane, i-vaginectomy ne-lymph node dissection, enokwakhiwa kwesitho sangasese sowesifazane noma ngaphandle kwaso.

• Ngezilonda engxenyeni engezansi yesithathu yowesifazane, i-lymph node dissection.

• Ukwelashwa ngemisebe kunganikezwa ngemuva kokuhlinzwa, okungafaka:

• Ukwelashwa kwemisebe kwangaphandle noma ngaphandle kwemithi yokwelashwa ngemisebe.

• Ukwelashwa kwemisebe yangaphakathi.

• Ngezilonda engxenyeni engezansi yesitho sangasese sowesifazane, ukwelashwa ngemisebe kunganikezwa kuma-lymph node eduze kwezicubu.

Ukwelashwa kwesigaba I sangasese adenocarcinoma kungafaka okulandelayo:

• Ukuhlinzwa (i-vaginectomy ne-hysterectomy ene-lymph node dissection). Lokhu kungalandelwa ukwakhiwa kabusha kwesitho sangasese sowesifazane kanye / noma ukwelashwa ngemisebe.

• Ukwelashwa kwemisebe yangaphakathi. Ukwelashwa kwemisebe yangaphandle kunganikezwa futhi kuma-lymph node eduze kwezicubu engxenyeni engezansi yesitho sangasese sowesifazane.

• Inhlanganisela yezindlela zokwelashwa ezingabandakanya ukusikwa kwendawo okubanzi noma ngaphandle kwe-lymph node dissection kanye nokwelashwa ngemisebe kwangaphakathi.

Ukwelashwa kweSigaba II, iSigaba III, kanye neSigaba IVa Umdlavuza Wesitho Sangasese

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

Ukwelashwa kwesigaba II, isigaba III, nesigaba IVa somdlavuza wesitho sangasese sowesifazane kufana nomdlavuza weseli squamous kanye ne-adenocarcinoma. Ukwelashwa kungafaka okulandelayo:

• Ukwelashwa kwemisebe yangaphakathi kanye / noma yangaphandle esithweni sangasese. Ukwelashwa ngemisebe nakho kunganikezwa ama-lymph node eduze kwezicubu engxenyeni engezansi yesitho sangasese sowesifazane.

• Ukuhlinzwa (i-vaginectomy noma i-pelvic exenteration) noma ngaphandle kwemithi yokwelashwa ngemisebe.

• I-Chemotherapy enikezwa ngemithi yokwelashwa ngemisebe.

Ukwelashwa Komdlavuza Wesitho Sangasese Sesigaba IVb

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

Ukwelashwa komdlavuza wesitho sangasese sowesifazane wesigaba IV kuyafana komdlavuza weseli squamous kanye ne-adenocarcinoma. Ukwelashwa kungafaka okulandelayo:

Ukwelashwa ngemisebe njengokwelashwa okunciphisayo, ukukhulula izimpawu nokuthuthukisa ikhwalithi yempilo. I-Chemotherapy nayo inganikezwa. Yize ingekho imishanguzo yokulwa nomdlavuza ekhonjisiwe ukusiza iziguli ezinomdlavuza wesitho sangasese se-IVB ukuthi ziphile isikhathi eside, zivame ukuphathwa ngemithi esetshenziselwa umdlavuza womlomo wesibeletho. (Bheka isifinyezo se- mayelana nokwelashwa komdlavuza womlomo wesibeletho.)

Ukwelashwa Komdlavuza Ophindayo Wesitho Sangasese

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

Ukwelashwa komdlavuza ophindaphindiwe wesitho sangasese sowesifazane kungafaka okulandelayo:

• Ukuhlinzwa (ukufutheka okhalweni).

• Ukwelashwa ngemisebe.

Yize kungekho mithi elwa nomdlavuza ekhonjisiwe ukusiza iziguli ezinomdlavuza ophindaphindayo wesitho sangasese ukuba ziphile isikhathi eside, zivame ukwelashwa ngemithi esetshenziselwa umdlavuza womlomo wesibeletho. (Bheka isifinyezo se- mayelana nokwelashwa komdlavuza womlomo wesibeletho.)

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 wesitho sangasese sowesifazane

Ukuthola eminye imininingwane ngeNational Cancer Institute mayelana nomdlavuza wesitho sangasese sowesifazane, bheka okulandelayo:

• Ikhasi Lasekhaya Lomdlavuza Wesitho Sangasese

• Ikhasi Lasekhaya Lomdlavuza Wesibeletho

• Ama-Lasers ekwelashweni komdlavuza

• I-Computed Tomography (CT) Iskena Nomdlavuza

• Izindlela Zokwelapha Zomdlavuza

• Ama-Modulators Esistimu Yomzimba

• I-HPV 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

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