Umdlavuza wesinye

Umdlavuza wesinye ngumdlavuza oqala esinyeni. Isinye yingxenye yomzimba ebamba futhi ikhiphe umchamo. Kusenkabeni yesisu esingezansi.

Umdlavuza wesinye uvame ukuqala emangqamuzaneni agqoke isinye. Lawa maseli abizwa ngokuthi amaseli wesikhashana.

Lezi zicubu zihlukaniswa ngendlela ezikhula ngayo:

• Izicubu zepapillary zibukeka njengezinsumpa futhi zinamathiselwe ohlangeni.
• I-Carcinoma in tum tumors iyisicaba. Zijwayelekile kakhulu. Kepha ziyahlasela kakhulu futhi zinomphumela omubi kakhulu.

Imbangela ngqo yomdlavuza wesinye ayaziwa. Kepha izinto eziningana ezingakwenza ube sethubeni lokuyithuthukisa zifaka:

• Ukubhema ugwayi - Ukubhema kukhulisa kakhulu amathuba okuba nomdlavuza wesinye. Kuze kube uhhafu wawo wonke umdlavuza wesinye ungabangelwa intuthu kagwayi.
• Umlando womuntu siqu noma womndeni womdlavuza wesinye - Ukuba nothile emndenini onomdlavuza wesinye kwandisa ingozi yokuwukhulisa.
• Ukuvezwa ngamakhemikhali emsebenzini - Umdlavuza wesinye ungabangelwa ukuhlangana namakhemikhali abangela umdlavuza emsebenzini. Lawa makhemikhali abizwa ngama-carcinogens. Abasebenzi bakadayi, abasebenza ngenjoloba, abasebenza nge-aluminium, abasebenza ngezikhumba, abashayeli bamaloli nabafaka izicelo zokubulala izinambuzane basengozini enkulu.
• I-Chemotherapy - Isidakamizwa samakhemikhali i-cyclophosphamide singandisa ingozi yomdlavuza wesinye.
• Ukwelashwa ngemisebe - Ukwelashwa ngemisebe esifundeni se-pelvis ukwelashwa komdlavuza we-prostate, amasende, umlomo wesibeletho, noma isibeletho kwandisa ingozi yokuba nomdlavuza wesinye.
• Ukutheleleka kwesinye - Ukutheleleka kwesinye isikhathi isikhathi eside (okungapheli) noma ukucasuka kungaholela ohlotsheni oluthile lomdlavuza wesinye.

Ucwaningo alukhombisanga bufakazi obusobala bokuthi ukusebenzisa okokunandisa okufakelwayo kuholela kumdlavuza wesinye.

Izimpawu zomdlavuza wesisu zingabandakanya:

• Ubuhlungu besisu
• Igazi emchameni
• Ubuhlungu bamathambo noma isisa uma umdlavuza usakazekela ethanjeni
• Ukukhathala
• Ukuchama kabuhlungu
• Imvamisa ye-Urinary nokuphuthuma
• Ukuvuza komchamo (ukungasebenzi)
• Ukwehla kwesisindo

Ezinye izifo nemibandela kungadala izimpawu ezifanayo. Kubalulekile ukubona umhlinzeki wakho wezokunakekelwa kwempilo ukuze akhiphe zonke ezinye izimbangela ezingaba khona.

Umhlinzeki uzokwenza ukuhlolwa komzimba, kufaka phakathi ukuhlolwa kwe-rectal kanye ne-pelvic.

Ukuhlolwa okungenziwa kufaka phakathi:

• Isisu se-CT esiswini kanye nesisu
• Ukuskena kwe-MRI yesisu
• ICystoscopy (ihlola ingaphakathi lesinye ngekhamera), ine-biopsy
• I-pyelogram efakwa ngaphakathi - IVP
• Ukuhlolwa komchamo
• I-cytology yomchamo

Uma izivivinyo ziqinisekisa ukuthi unomdlavuza wesinye, kuzokwenziwa ezinye izivivinyo ukubona ukuthi umdlavuza ususakazekile yini. Lokhu kubizwa ngokuthi isiteji. Isiteji sisiza ukuhola ukwelashwa kwesikhathi esizayo nokulandelela futhi sikunikeze umbono wokuthi yini ongayilindela ngokuzayo.

Uhlelo lwe-TNM (isimila, ama-node, i-metastasis) lusetshenziselwa ukufaka umdlavuza wesinye:

• Ta - Umdlavuza usesendleni sesinye kuphela futhi awusakazekanga.
• I-T1 - Umdlavuza udlula ulwelwesi lwesinye, kepha awufinyeleli emisipheni yesinye.
• I-T2 - Umdlavuza usakazekela emisipheni yesinye.
• I-T3 - Umdlavuza usakazeka udlule esinyeni ungene ezicutshini ezinamafutha ezizungezile.
• I-T4 - Umdlavuza usabalalele ezakhiweni eziseduze ezifana ne-prostate gland, isibeletho, isitho sangasese sowesifazane, i-rectum, udonga lwesisu, noma udonga lwe-pelvic.

Izicubu nazo ziqoqwe ngokususelwa ekutheni zivela kanjani ngaphansi kwesibonakhulu. Lokhu kubizwa ngokuthi ukugaya isimila. Isimila sebanga eliphakeme sikhula ngokushesha futhi maningi amathuba okusabalala. Umdlavuza wesinye ungasakazeka ezindaweni eziseduze, kufaka phakathi:

• Ama-lymph node ku-pelvis
• Amathambo
• Isibindi
• Amaphaphu

Ukwelashwa kuncike esigabeni somdlavuza, ukuqina kwezimpawu zakho, kanye nempilo yakho yonke.

Ukwelashwa kwesigaba 0 kanye nami:

• Ukuhlinzwa ukukhipha isimila ngaphandle kokukhipha sonke isinye
• I-Chemotherapy noma i-immunotherapy efakwe ngqo esinyeni
• I-immunotherapy inikezwa ngemithambo yegazi nge-pembrolizumab (Keytruda) uma umdlavuza uqhubeka nokubuyela ngemuva kwezinyathelo ezingenhla

Ukwelashwa kwesigaba II no-III:

• Ukuhlinzwa ukukhipha isinye sonke (i-radical cystectomy) nama-lymph node aseduze
• Ukuhlinzwa kususwa ingxenye kuphela yesinye, kulandelwe imisebe kanye nokwelashwa ngamakhemikhali
• I-Chemotherapy yokunciphisa isimila ngaphambi kokuhlinzwa
• Inhlanganisela yamakhemikhali kanye nemisebe (kubantu abakhetha ukungavami ukuhlinzwa noma abangakwazi ukuhlinzwa)

Iningi labantu abanezicubu zesigaba IV alelapheki futhi ukuhlinzwa akulungile. Kulaba bantu, i-chemotherapy ivame ukucatshangelwa.

I-CHEMOTHERAPY

I-Chemotherapy inganikezwa kubantu abanesifo sesigaba II no-III ngaphambi noma ngemuva kokuhlinzwa ukusiza ukuvimbela isimila ukuthi singabuyi.

Ngezifo zokuqala (izigaba 0 no-I), i-chemotherapy ivame ukunikezwa ngqo esinyeni.

IMUNUNUEDAPY

Umdlavuza wesinye uvame ukwelashwa nge-immunotherapy. Kulokhu kwelashwa, umuthi udala ukuthi amasosha omzimba wakho ahlasele abulale amangqamuzana omdlavuza. I-Immunotherapy yomdlavuza wesisu esesikhathini sokuqala ivame ukwenziwa kusetshenziswa umuthi wokugoma we-BacilleCalmette-Guerin (owaziwa kakhulu nge-BCG). Uma umdlavuza ubuya ngemuva kokusetshenziswa kwe-BCG, ama-ejenti amasha angasetshenziswa.

Njengazo zonke izindlela zokwelapha, imiphumela emibi kungenzeka. Buza umhlinzeki wakho ukuthi yimiphi imiphumela emibi ongayilindela, nokuthi wenzeni uma kwenzeka.

UKUHLINZA

Ukuhlinzwa komdlavuza wesisu kufaka:

• Ukudluliswa kabusha kwesinye kwe-Transurethral (TURB) - Izicubu zesikhumba ezinomdlavuza zisuswa ngomchamo.
• Ukususwa kwesinye okwesikhashana noma okuphelele - Abantu abaningi abanesifo somdlavuza wesigaba sesibili noma sesithathu bangadinga ukukhishwa esinyeni (i-radical cystectomy). Kwesinye isikhathi kususwa ingxenye yesinye kuphela. I-Chemotherapy inganikezwa ngaphambi noma ngemuva kwalokhu kuhlinzwa.

Ukuhlinzwa kungenziwa futhi ukusiza umzimba wakho ukukhipha umchamo ngemuva kokukhishwa kwesinye. Lokhu kungafaka:

• Umsele we-Ileal - Idamu elincane lomchamo lenziwa ngokuhlinzwa kusuka esiqeshini esifushane samathumbu akho amancane. Ama-ureters akhipha umchamo ezinso afakwe kolunye uhlangothi lwalesi siqephu. Omunye umkhawulo ukhishwa ngokuvula esikhunjeni (i-stoma). I-stoma ivumela umuntu ukuthi akhiphe umchamo oqoqiwe aphume echibini.
• Izwekazi lokugcina umchamo - Isikhwama sokuqoqa umchamo senziwa ngaphakathi komzimba wakho sisebenzisa ucezu lwamathumbu akho. Uzodinga ukufaka ithubhu embobeni yesikhumba sakho (stoma) kulesi sikhwama ukukhipha umchamo.
• I-Orthotopic neobladder - Lokhu kuhlinzwa kuya ngokuya kujwayelekile kubantu abakhishwe isinye. Ingxenye yamathumbu akho iyagoqeka ukwenza isikhwama esiqoqa umchamo. Inamathiselwe endaweni emzimbeni lapho umchamo uvame ukuphuma khona esinyeni. Le nqubo ikuvumela ukuthi ugcine ukulawulwa okuvamile komchamo.

Unganciphisa ukucindezela kokugula ngokujoyina iqembu lokusekela umdlavuza. Ukwabelana nabanye abanokuhlangenwe nakho okuvamile nezinkinga kungakusiza ungazizwa uwedwa.

Ngemuva kokwelashwa komdlavuza wesinye, uzobhekwa ngeso lokhozi ngudokotela. Lokhu kungafaka:

• Ukuhlolwa kwe-CT ukuhlola ukusabalala noma ukubuya komdlavuza
• Izimpawu zokuqapha ezingase ziphakamise ukuthi lesi sifo siya ngokuya siba sibi, njengokukhathala, ukuncipha, ukwanda kobuhlungu, ukwehla kwamathumbu nokusebenza kwesisu, nobuthakathaka
• Qedela ukubalwa kwegazi (CBC) ukuqapha i-anemia
• Ukuhlolwa kwesinye njalo ezinyangeni ezintathu kuya kweziyisithupha emva kokwelashwa
• Ukuhlolwa komchamo uma ungakhishwanga isinye

Ukuthi umuntu onomdlavuza wesinye wenza kahle kangakanani kuncike esigabeni sokuqala nasempendulweni yokwelashwa komdlavuza wesinye.

Umbono wesigaba 0 noma umdlavuza ngihle impela. Yize ingozi yokubuya komdlavuza iphezulu, iningi lomdlavuza wesinye obuyayo ungasuswa ngokuhlinzwa futhi welapheke.

Amanani okwelashwa kwabantu abanezicubu zesigaba III angaphansi kwama-50%. Abantu abanomdlavuza wesigaba IV wesinye abavame ukwelashwa.

Umdlavuza wesinye ungasabalala ungene ezithweni eziseduze. Bangaphinde bahambe ngama-lymph node futhi basakaze esibindi, emaphashini nasemathanjeni. Izinkinga ezengeziwe zomdlavuza wesisu zihlanganisa:

• Ukushoda kwegazi
• Ukuvuvukala kwama-ureters (hydronephrosis)
• Ukuqina kwe-Urethral
• Ukungakwazi ukubamba umchamo
• Ukungasebenzi kwe-Erectile emadodeni
• Ukungasebenzi ngokocansi kwabesifazane
  

Shayela umhlinzeki wakho uma unegazi kumchamo wakho noma ezinye izimpawu zomdlavuza wesinye, kufaka phakathi:

• Ukuchama njalo
• Ukuchama kabuhlungu
• Isidingo esiphuthumayo sokuchama

Uma ubhema, yeka. Ukubhema kungakhuphula ingozi yokuba nomdlavuza wesinye. Gwema ukuvezwa amakhemikhali axhumene nomdlavuza wesinye.

I-carcinoma yesikhashana yesinye; Umdlavuza we-Urothelial

• I-cystoscopy
• Umgudu womchamo wabesifazane
• Umgudu womchamo wabesilisa

ICumberbatch MGK, uJubber I, iBlack PC, et al. I-Epidemiology yomdlavuza wesinye: ukubuyekezwa okuhlelekile nokuvuselelwa kwesimanje kwezinto ezinobungozi ku-2018. I-Eur Urol. 2018; 74 (6): 784-795. I-PMID: 30268659 pubmed.ncbi.nlm.nih.gov/30268659/.

Iwebhusayithi yeNational Cancer Institute. Ukwelashwa komdlavuza wesinye (PDQ) - inguqulo yezempilo. www.cancer.gov/types/bladder/hp/bladder-treatment-pdq. Kubuyekezwe uJanuwari 22, 2020. Kufinyelelwe ngoFebhuwari 26, 2020.

Iwebhusayithi ye-National Comprehensive Cancer Network. Imikhombandlela ye-NCCN yokwenza imitholampilo ku-oncology (imihlahlandlela ye-NCCN): Umdlavuza wesinye. Inguqulo 3.2020. www.nccn.org/professionals/physician_gls/pdf/bladder.pdf. Kubuyekezwe uJanuwari 17, 2020. Kufinyelelwe ngoFebhuwari 26, 2020.

USmith AB, uBalar AV, uMilowsky MI, uChen RC. I-Carcinoma yesinye. Ku: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, abahleli. I-Abeloff’s Clinical Oncology. Umhlaka 6. IPhiladelphia, PA: Elsevier; 2020: isahluko 80.