Umdlavuza weColorectal (Colon)

-Delile

• Uyini umdlavuza obala ibala?
• Ziyini izimpawu zomdlavuza obala?
• Izimpawu zesigaba sesi-3 noma sesi-4 (izimpawu zesigaba sekwephuzile)
• Ingabe kunezinhlobo ezahlukene zomdlavuza obala ngokobulili?
• Yini ebangela umdlavuza obala?
• Ubani osengozini yomdlavuza obala?
• Izici ezinobungozi ezingaguquki
• Izici zengozi eguqukayo
• Utholakala kanjani umdlavuza we-colorectal?
• Ukuhlolwa kwendle
• Ukuhlolwa kwegazi lokucwaninga ngegazi kwe-guaiac (gFOBT)
• Ukuhlolwa kwe-Fecal immunochemical (FIT)
• Ukuhlolwa kwasekhaya
• Imikhiqizo ukuzama
• Ukuhlolwa kwegazi
• I-Sigmoidoscopy
• Colonoscopy
• I-X-ray
• Iskena se-CT
• Yiziphi izinketho zokwelashwa zomdlavuza obomvu?
• Ukuhlinzwa
• Ukwelashwa ngamakhemikhali
• Imisebe
• Eminye imithi
• Lithini inani lokusinda labantu abanomdlavuza onombala?
• Ngabe umdlavuza obala ubala ungavinjelwa?
• Uyini umbono wesikhathi eside?

Sifaka imikhiqizo esicabanga ukuthi ilusizo kubafundi bethu. Uma uthenga ngezixhumanisi ezikuleli khasi, singathola ikhomishini encane. Nansi inqubo yethu.

Uyini umdlavuza obala ibala?

Umdlavuza we-Colorectal umdlavuza oqala kukholoni (amathumbu amakhulu) noma i-rectum. Zombili lezi zitho zisengxenyeni engezansi yohlelo lwakho lokugaya ukudla. I-rectum is sekupheleni kwekholoni.

I-American Cancer Society (ACS) ilinganisela ukuthi cishe owesilisa oyedwa kwabangu-23 nowesifazane oyedwa kwabangu-25 bazoba nomdlavuza obala ngesikhathi sokuphila kwabo.

Udokotela wakho angasebenzisa isiteji njengesiqondiso sokuthola ukuthi umdlavuza ungakanani. Kubalulekile ukuthi udokotela wakho azi isigaba somdlavuza ukuze bakwazi ukuza nohlelo lokwelashwa olungcono kakhulu futhi bakunikeze nesilinganiso sombono wakho wesikhathi eside.

Umdlavuza wesigaba esingu-0 obucayi yisigaba sokuqala, kanti isigaba 4 yisigaba esithuthuke kakhulu:

• Isigaba 0. Eyaziwa nangokuthi i-carcinoma in situ, kulesi sigaba amangqamuzana angavamile atholakala kuphela ngaphakathi kwendwangu noma i-rectum.
• Isigaba 1. Umdlavuza ungene ngaphakathi kolwelwesi, noma i-mucosa, yekoloni noma i-rectum futhi kungenzeka ukuthi ukhule waba ungqimba lwemisipha. Akusakazekanga kuma-lymph node aseduze noma kwezinye izingxenye zomzimba.
• Isigaba 2. Umdlavuza usabalalele ezindongeni zekholoni noma i-rectum noma udonga waya ezicutshini eziseduze kodwa awuzange uthinte ama-lymph node.
• Isigaba 3. Umdlavuza udlulele kuma-lymph node kepha hhayi kwezinye izitho zomzimba.
• Isigaba 4. Umdlavuza udlulele kwezinye izitho ezikude, njengesibindi noma amaphaphu.

Ziyini izimpawu zomdlavuza obala?

Umdlavuza we-Colorectal kungenzeka ungabonakali nganoma yiziphi izimpawu, ikakhulukazi ezigabeni zokuqala. Uma uhlangabezana nezimpawu ngesikhathi sokuqala, zingafaka:

• ukuqunjelwa
• isifo sohudo
• izinguquko kumbala wendle
• izinguquko esimweni sesitulo, njengesitokisi esincane
• igazi esitokisini
• ukuphuma kwegazi
• igesi eyeqile
• amajaqamba esiswini
• ubuhlungu besisu

Uma ubona noma iyiphi yalezi zimpawu, yenza i-aphoyintimenti nodokotela wakho ukuze nixoxe ngokuthola ukuhlolwa komdlavuza okukhanyayo.

Izimpawu zesigaba sesi-3 noma sesi-4 (izimpawu zesigaba sekwephuzile)

Izimpawu zomdlavuza we-Colorectal zibonakala kakhulu ezigabeni zakamuva (izigaba 3 no-4). Ngaphezu kwezimpawu ezingenhla, ungahle uzwe:

• ukukhathala ngokweqile
• ubuthakathaka obungachazeki
• ukuncipha kwesisindo ngokungenhloso
• izinguquko esitokisini sakho esihlala isikhathi esingaphezu kwenyanga
• umuzwa wokuthi izibilini zakho ngeke ziphele ngokuphelele
• ukuhlanza

Uma umdlavuza obomvu usakazeka kwezinye izingxenye zomzimba wakho, ungahle uzwe:

• i-jaundice, noma amehlo nesikhumba esiphuzi
• ukuvuvukala ezandleni noma ezinyaweni
• ubunzima bokuphefumula
• ikhanda elingapheli
• ukungaboni kahle
• ukuphuka kwamathambo

Ingabe kunezinhlobo ezahlukene zomdlavuza obala ngokobulili?

Ngenkathi umdlavuza obala umbala uzwakala uzichaza, empeleni kukhona uhlobo olungaphezu kolulodwa. Umehluko uhlobene nezinhlobo zamaseli eziphenduka zibe nomdlavuza nokuthi zakha kuphi.

Uhlobo oluvame kakhulu lomdlavuza obala ngokwebala luqala kusuka ku-adenocarcinomas. Ngokusho kwe-ACS, i-adenocarcinomas yakha amacala amaningi omdlavuza. Ngaphandle kokuthi udokotela wakho asho okuhlukile, umdlavuza wakho obala ngokombala kungenzeka ukuthi lolu hlobo.

I-Adenocarcinomas yakha ngaphakathi kwamaseli enza i-mucus ku-colon noma ku-rectum.

Ngokuvamile, umdlavuza obala obomvu ubangelwa ezinye izinhlobo zamathumba, njenge:

• ama-lymphomas, angakha ama-lymph node noma kukholoni kuqala
• ama-carcinoids, aqala kumaseli okwenza ama-hormone ngaphakathi kwamathumbu akho
• ama-sarcomas, akha izicubu ezithambile njengemisipha kukholoni
• izicubu zomzimba ezisemathunjini, ezingaqala njengezinobungozi bese ziba nomdlavuza (Imvamisa zakha umgudu wokugaya ukudla, kepha kuyaqabukela kukholoni.)

Yini ebangela umdlavuza obala?

Abaphenyi basacwaninga ngezimbangela zomdlavuza onemibala.

Umdlavuza ungabangelwa ukuguqulwa kwezakhi zofuzo, kungaba ngofuzo noma okutholwe. Lokhu kuguqulwa kwezakhi akuqinisekisi ukuthi uzoba nomdlavuza onemibala, kepha kukhulisa amathuba akho.

Ezinye izinguquko zingadala ukuthi amangqamuzana angajwayelekile anqwabelane kulayini wekoloni, kwakheke ama-polyps. Lokhu ukukhula okuncane, okuhle.

Ukususa lokhu kukhula ngokuhlinzwa kungaba yindlela yokuvimbela. Ama-polyps angalashiwe angaba nomdlavuza.

Ubani osengozini yomdlavuza obala?

Kunohlu olukhulayo lwezinto ezinobungozi ezisebenza zodwa noma ezihlangene ukukhulisa amathuba omuntu okuba nomdlavuza wobala.

Izici ezinobungozi ezingaguquki

Ezinye izinto ezandisa ubungozi bokuba nomdlavuza obala ngokwebala azigwemeki futhi azinakushintshwa. Ubudala bungomunye wabo. Amathuba akho okuba nalo mdlavuza akhula ngemuva kokufinyelela eminyakeni engama-50.

Ezinye izinto ezinobungozi ezihleliwe yilezi:

• umlando wangaphambilini wama-colon polyps
• umlando wangaphambilini wezifo zamathumbu
• umlando womndeni womdlavuza obomvu
• ukuba nama-syndromes athile wezakhi zofuzo, njenge-adenomatous polyposis (FAP) yomndeni
• ongowokudabuka eMpumalanga Yurophu yamaJuda noma e-Afrika

Izici zengozi eguqukayo

Ezinye izinto ezinobungozi ziyagwenywa. Lokhu kusho ukuthi ungazishintsha ukuze unciphise ubungozi bakho bokuba nomdlavuza wobala. Izici ezinobungozi ezingagwemeka zifaka:

• ukukhuluphala ngokweqile noma ukukhuluphala ngokweqile
• ukubhema
• ukuba yisidakwa
• ukuba nohlobo 2 sikashukela
• ukuba nokuhlala phansi
• kudla ukudla okuphezulu enyameni elungisiwe

Utholakala kanjani umdlavuza we-colorectal?

Ukuxilongwa kusenesikhathi komdlavuza onemibala kukunikeza ithuba elihle lokuwelapha.

I-American College of Physicians (ACP) incoma ukuhlolwa kwabantu abaneminyaka engama-50 kuya kwengama-75 ubudala, engcupheni yokuthola lesi simo, futhi babe neminyaka yokuphila okungenani engu-10.

Lokhu kuncoma ukuhlolwa kwabantu abaneminyaka engama-50 kuya kwengama-79 ubudala futhi engcupheni yabo yeminyaka engu-15 yokuthola lesi sifo okungenani amaphesenti ama-3.

Udokotela wakho uzoqala ngokuthola imininingwane ngomlando wakho wezokwelapha nowomndeni. Bazophinda futhi benze ukuhlolwa komzimba. Bangacindezela esiswini sakho noma benze ukuhlolwa kwamakholomu ukuthola ukuthi kukhona izigaxa noma ama-polyps.

Ukuhlolwa kwendle

Ungahlolwa ukuhlolwa kwendle njalo eminyakeni eyi-1 kuye kwengu-2. Ukuhlolwa kwe-Fecal kusetshenziselwa ukuthola igazi elifihlekile esitokisini sakho. Kunezinhlobo ezimbili ezinkulu, i-guaiac-based fecal occult blood test (gFOBT) kanye ne-fecal immunochemical test (FIT).

Ukuhlolwa kwegazi lokucwaninga ngegazi kwe-guaiac (gFOBT)

I-Guaiac yinto esuselwa esitshalweni esetshenziselwa ukumboza ikhadi eliqukethe isampula yakho yendle. Uma kukhona igazi elikhona esitokisini sakho, ikhadi lizoshintsha umbala.

Kuzofanele ugweme ukudla okuthile nemithi ethile, njengenyama ebomvu nemithi elwa nokuvuvukala (ama-NSAID), ngaphambi kwalokhu kuhlolwa. Zingaphazamisa imiphumela yakho yokuhlolwa.

Ukuhlolwa kwe-Fecal immunochemical (FIT)

I-FIT ithola i-hemoglobin, iphrotheni etholakala egazini. Kubhekwa njengokunembe kakhulu kunokuhlolwa okususelwa ku-guaiac.

Lokho kungenxa yokuthi i-FIT mancane amathuba okuthi ithole ukopha kumgogodla ongaphezulu wamathumbu (uhlobo lokopha olungavamisile ukubangelwa ngumdlavuza obomvu). Ngaphezu kwalokho, imiphumela yalolu vivinyo ayithinteki ngokudla nangemithi.

Ukuhlolwa kwasekhaya

Ngenxa yokuthi amasampula esitokisi amaningi ayadingeka kulezi zivivinyo, udokotela wakho cishe uzokunikeza amakhithi okuhlola ozowasebenzisa ekhaya ngokungafani nokuthi uyohlolwa ehhovisi.

Zombili lezi zivivinyo zingenziwa futhi ngamakhithi okuhlola asekhaya athengwe ku-inthanethi ezinkampanini ezinjengeLetsGetChecked ne-Everlywell.

Amakhithi amaningi athengwe ku-inthanethi adinga ukuthi uthumele isampula yezitulo ebhodini ukuze liyohlolwa. Imiphumela yakho yokuhlolwa kufanele itholakale ku-inthanethi zingakapheli izinsuku eziyi-5 zebhizinisi. Ngemuva kwalokho, uzoba nenketho yokubonisana nethimba lezokunakekelwa kwezokwelapha mayelana nemiphumela yakho yokuhlolwa.

I-Second Generation FIT nayo ingathengwa ku-inthanethi, kepha isampula yendle akudingeki ithunyelwe elebhu. Imiphumela yokuhlolwa iyatholakala kungakapheli imizuzu emihlanu. Lokhu kuhlolwa kunembile, kuvunyelwe i-FDA, futhi kuyakwazi ukuthola izimo ezingeziwe njenge-colitis. Kodwa-ke, alikho iqembu lokunakekelwa kwezokwelapha ongafinyelela kulo uma unemibuzo ngemiphumela yakho.

Imikhiqizo ukuzama

Ukuhlolwa kwasekhaya kungasetshenziselwa ukuthola igazi esitokisini, uphawu olubalulekile lomdlavuza obala. Bathengele ku-inthanethi:

• I-LetsGetChecked Testing Screening Testing
• Ukuhlolwa Kokuhlolwa Komdlavuza we-Everlywell FIT Colon
• Isizukulwane sesibili i-FIT (Ukuhlolwa kwe-Fecal Immunochemical Test)

Ukuhlolwa kwegazi

Udokotela wakho angahle ahlole ukuhlolwa kwegazi ukuze athole umbono ongcono wokuthi yini ebangela izimpawu zakho. Ukuhlolwa kokusebenza kwesibindi nokubala okuphelele kwegazi kungakhipha ezinye izifo nokuphazamiseka.

I-Sigmoidoscopy

Ukuhlasela okuncane, i-sigmoidoscopy ivumela udokotela wakho ukuthi ahlole isigaba sokugcina sekholoni yakho, esaziwa njenge-sigmoid colon, ngokungajwayelekile. Inqubo, eyaziwa nangokuthi i-sigmoidoscopy eguquguqukayo, ifaka ishubhu eliguquguqukayo elinokukhanya kuyo.

I-ACP incoma i-sigmoidoscopy njalo eminyakeni eyi-10, ngenkathi iBMJ incoma i-sigmoidoscopy yesikhathi esisodwa.

Colonoscopy

I-colonoscopy ifaka ukusetshenziswa kweshubhu ende enekhamera encane enamathiselwe. Le nqubo ivumela udokotela wakho ukuthi abone ngaphakathi kwekholoni yakho kanye ne-rectum ukubheka noma yini engavamile. Kuvame ukwenziwa ngemuva kokuhlolwa kokuhlolwa okungahlaseli okuncane okukhombisa ukuthi ungahle ube nomdlavuza obala.

Ngesikhathi se-colonoscopy, udokotela wakho angasusa nezicubu ezindaweni ezingavamile. Lezi sampuli zezicubu zingathunyelwa elabhorethri ziyohlaziywa.

Ngaphandle kwezindlela zokuxilonga ezikhona, ama-sigmoidoscopies nama-colonoscopies asebenza kakhulu ekutholeni ukukhula okungenabungozi okungakhula kube ngumdlavuza obala ngokweqile.

I-ACP incoma i-colonoscopy njalo eminyakeni eyishumi, kuyilapho iBMJ incoma i-colonoscopy yesikhathi esisodwa.

I-X-ray

Udokotela wakho angalawula i-X-ray esebenzisa isixazululo sokuqhathanisa semisebe equkethe i-chemical element barium.

Udokotela wakho ufaka lolu ketshezi emathunjini akho ngokusebenzisa i-barium enema. Uma usukhona, isixazululo se-barium sigqoka ulwelwesi lwekholoni. Lokhu kusiza ukuthuthukisa ikhwalithi yezithombe ze-X-ray.

Iskena se-CT

Izikena ze-CT zinikeza udokotela wakho isithombe esinemininingwane sekholoni yakho. I-CT scan esetshenziselwa ukuxilonga umdlavuza ongumbala kwesinye isikhathi ibizwa ngokuthi yi-virtual colonoscopy.

Yiziphi izinketho zokwelashwa zomdlavuza obomvu?

Ukwelashwa komdlavuza obala ngokweqile kuncike ezicini ezahlukahlukene. Isimo sempilo yakho yonke kanye nesigaba somdlavuza wakho obala kakhulu kuzosiza udokotela wakho ukuthi enze uhlelo lokwelashwa.

Ukuhlinzwa

Ezigabeni zokuqala zomdlavuza obomvu, kungenzeka ukuthi udokotela wakho ohlinzayo asuse ama-polyps anomdlavuza ngokuhlinzwa. Uma i-polyp inganamathiseli odongeni lwamathumbu, ungahle ube nombono omuhle kakhulu.

Uma umdlavuza wakho usakaze ezindongeni zakho zamathumbu, udokotela wakho ohlinzayo angadinga ukususa ingxenye yekholoni noma i-rectum kanye nanoma yimaphi ama-lymph node angomakhelwane. Uma kungenzeka, udokotela wakho ohlinzayo uzonamathisela ingxenye esele yekholoni esele engxenyeni engaphezulu.

Uma lokhu kungenakwenzeka, bangenza i-colostomy. Lokhu kuhilela ukudala ukuvula odongeni lwesisu ukuze kukhishwe imfucuza. I-colostomy ingaba yesikhashana noma ehlala njalo.

Ukwelashwa ngamakhemikhali

I-Chemotherapy ihilela ukusetshenziswa kwezidakamizwa ukubulala amangqamuzana omdlavuza. Kubantu abanomdlavuza ogqamile, i-chemotherapy ivame ukwenzeka ngemuva kokuhlinzwa, lapho isetshenziselwa ukubhubhisa noma yimaphi amangqamuzana omdlavuza ahlala isikhathi eside. I-Chemotherapy ibuye ilawule ukukhula kwezimila.

Imithi yokwelashwa ngamakhemikhali esetshenziselwa ukwelapha umdlavuza obala ibala ifaka:

• i-capecitabine (Xeloda)
• I-fluorouracil
• i-oxaliplatin (Eloxatin)
• i-irinotecan (Camptosar)

I-Chemotherapy ivame ukuza nemiphumela emibi edinga ukulawulwa ngemithi eyengeziwe.

Imisebe

Imisebe isebenzisa umsebe onamandla wamandla, ofana nalowo osetshenziswe kuma-X-ray, ukukhomba nokubhubhisa amangqamuzana anomdlavuza ngaphambi nangemva kokuhlinzwa. Ukwelashwa kwemisebe kuvame ukwenzeka eceleni kwe-chemotherapy.

Eminye imithi

Izindlela zokwelashwa ezihlosiwe kanye nama-immunotherapies nakho kunganconywa. Izidakamizwa ezivunyiwe yi-Food and Drug Administration (FDA) ukwelapha umdlavuza obala okubandakanya:

• i-bevacizumab (Avastin)
• i-ramucirumab (i-Cyramza)
• ziv-aflibercept (Zaltrap)
• i-cetuximab (Erbitux)
• i-panitumumab (i-Vectibix)
• regorafenib (Stivarga)
• i-pembrolizumab (Keytruda)
• i-nivolumab (Opdivo)
• ipilimumab (Yervoy)

Bangakwazi ukwelapha umdlavuza we-metastatic, noma we-late-colorectal, ongaphenduli kwezinye izinhlobo zokwelashwa futhi usabalale kwezinye izingxenye zomzimba.

Lithini inani lokusinda labantu abanomdlavuza onombala?

Ukuthola ukuthi unomdlavuza obala kangakanani kungakhathaza, kepha lolu hlobo lomdlavuza luyelapheka kakhulu, ikakhulukazi lapho lubanjwa kusenesikhathi.

Izinga lokusinda leminyaka emihlanu yazo zonke izigaba zomdlavuza wamathumbu kulinganiselwa ukuthi lingamaphesenti angama-63 ngokususelwa kwimininingwane esukela kowezi-2009 kuya kowezi-2015. Kumdlavuza wesibeletho, izinga lokusinda kweminyaka emihlanu lingamaphesenti angama-67.

Izinga lokusinda leminyaka emihlanu likhombisa iphesenti labantu abasinda okungenani eminyakeni emihlanu ngemuva kokuxilongwa.

Izindlela zokwelashwa zibuye zaze ibanga elide emacaleni aphakeme kakhulu womdlavuza wekoloni.

Ngokusho kwe-University of Texas Southwestern Medical Center, ngo-2015, isikhathi sokusinda esijwayelekile somdlavuza wesigaba sesine sasicishe sibe yizinyanga ezingama-30. Ngawo-1990, isilinganiso sasiyizinyanga eziyisithupha kuya kwezi-8.

Ngasikhathi sinye, odokotela manje sebebona umdlavuza obala ngokobulili kubantu abasha. Okunye kwalokhu kungabangelwa ukukhetha impilo okungenampilo.

Ngokusho kwe-ACS, ngenkathi ukufa kwabantu abanomdlavuza onqabile kwehlile kubantu abadala, ukufa kwabantu abangaphansi kweminyaka engama-50 kwanda phakathi kuka-2008 no-2017.

Ngabe umdlavuza obala ubala ungavinjelwa?

Izici ezithile zobungozi zomdlavuza onemibala, njengomlando womndeni nobudala, azivikeleki.

Kodwa-ke, izinto zokuphila ezinganikela ngomdlavuza obala kukhona kuyavikeleka, futhi kungasiza ekunciphiseni ubungozi bakho bokuba nalesi sifo.

Ungathatha izinyathelo manje ukunciphisa ubungozi bakho ngo:

• ukunciphisa inani lenyama ebomvu oyidlayo
• ukugwema inyama esetshenzwe, njengezinja ezishisayo nenyama yokudla
• ukudla ukudla okuningi okususelwa ezitshalweni
• ukunciphisa amafutha ekudleni
• ukuzivocavoca nsuku zonke
• ukuncipha, uma udokotela wakho ekuncoma
• ukuyeka ukubhema
• ukunciphisa ukusetshenziswa kotshwala
• ukuncipha kwengcindezi
• ukuphatha isifo sikashukela esesivele sikhona

Enye indlela yokuvikela ukwenza isiqiniseko sokuthi uthola i-colonoscopy noma okunye ukuhlolwa komdlavuza ngemuva kweminyaka yobudala engama-50. Uma umdlavuza utholakala ngaphambi kwesikhathi, umphumela uba ngcono.

Uyini umbono wesikhathi eside?

Uma ubanjwe kusenesikhathi, umdlavuza onamabala ayelapheka.

Ngokutholwa kwangaphambi kwesikhathi, iningi labantu lihlala okungenani eminye iminyaka emihlanu ngemuva kokuxilongwa. Uma umdlavuza ungabuyi ngaleso sikhathi, kunethuba eliphansi kakhulu lokuphindaphinda, ikakhulukazi uma ubunesifo sokuqala.