Umdlavuza we-Ovarian

-Delile

• Izimpawu zomdlavuza we-ovari
• Izimbangela zomdlavuza wesibeletho
• Izinhlobo zomdlavuza we-ovari
• I-epithelial carcinoma ye-ovary
• Izici zofuzo
• Izici ezixhunyaniswe nokusinda okwandayo
• Umdlavuza wamangqamuzana wesakhi esibelethweni
• Umdlavuza weseli we-Stromal we-ovary
• Ukwelashwa komdlavuza we-ovari
• Ukuhlinzwa
• Ukuhlinzwa komdlavuza we-ovarian okuthuthukile
• Ukwelashwa ngamakhemikhali
• Ukwelashwa kwezimpawu
• Ukuhlonza umdlavuza we-ovari
• Isidumbu
• Ukuhlola ukuhlolwa
• Ukuhlola i-metastasis
• Izici zomdlavuza we-Ovarian
• Izigaba zomdlavuza wesibeletho
• Izinga lokusinda komdlavuza we-Ovarian
• Ingabe umdlavuza we-ovari ungavinjelwa?
• Isibikezelo somdlavuza we-Ovarian
• Iribhoni lomdlavuza we-ovari
• Izibalo zomdlavuza we-Ovarian

Umdlavuza we-Ovarian

Ama-ovari amancane, izitho ezimile okwe-alimondi ezitholakala ngapha nangapha kwesibeletho. Amaqanda akhiqizwa kuma-ovari. Umdlavuza we-Ovarian ungavela ezingxenyeni ezahlukahlukene ze-ovary.

Umdlavuza we-Ovarian ungaqala kumaseli wegciwane le-ovary, stromal, noma epithelial. Amaseli amaGerm amangqamuzana aphenduka amaqanda. Amaseli we-Stromal akha into ye-ovary. Amaseli we-Epithelial ayingqimba yangaphandle ye-ovary.

I-American Cancer Society ilinganisela ukuthi abesifazane abangu-22,240 bazotholakala benomdlavuza we-ovarian e-United States ngo-2018, kanti kuzofa abangu-14,070 kulolu hlobo lomdlavuza ngo-2018. Cishe uhhafu wawo wonke amacala ayenzeka kubantu besifazane abaneminyaka engaphezu kwengama-63.

Izimpawu zomdlavuza we-ovari

Umdlavuza we-ovarian wesigaba sokuqala ungahle ungabi nazimpawu. Lokho kungenza kube nzima kakhulu ukukuthola. Noma kunjalo, ezinye izimpawu zingafaka:

• ukuqunjelwa njalo
• uzizwe usuthi ngokushesha lapho udla
• ubunzima bokudla
• njalo, isidingo esiphuthumayo sokuchama
• ubuhlungu noma ukungaphatheki kahle esiswini noma okhalweni

Lezi zimpawu ziqala ngokungazelelwe. Bazizwa behlukile kokugaya okujwayelekile noma ukungakhululeki kokuya esikhathini. Nazo azihambi. Funda kabanzi mayelana nokuthi lezi zimpawu zokuqala zomdlavuza we-ovari zingazizwa kanjani nokuthi yini okufanele uyenze uma ucabanga ukuthi ungaba nale fomu yomdlavuza.

Ezinye izimpawu zomdlavuza we-ovari zingafaka:

• ubuhlungu beqolo
• ubuhlungu ngesikhathi sokuya ocansini
• ukuqunjelwa
• ukugaya ukudla
• ukukhathala
• ushintsho kumjikelezo wokuya esikhathini
• ukuzuza kwesisindo
• ukuncipha komzimba
• ukopha esithweni sangasese
• induna
• Ubuhlungu beqolo obukhula

Uma unalezi zimpawu isikhathi esingaphezu kwamasonto amabili, kufanele ufune usizo lwezempilo.

Izimbangela zomdlavuza wesibeletho

Abaphenyi abakaqondi okwamanje ukuthi yini ebanga umdlavuza wama-ovari. Izici ezibeka engcupheni ezehlukene zingakhuphula amathuba abesifazane okuthuthukisa lolu hlobo lomdlavuza, kodwa ukuba nalezo zinto eziyingozi akusho ukuthi uzoba nomdlavuza. Funda mayelana nengcuphe ngayinye nendima yayo ekunqumeni ubungozi bomdlavuza we-ovari.

Umdlavuza wakheka lapho amaseli emzimbeni eqala ukukhula nokuphindaphindeka ngokungajwayelekile. Abaphenyi abacwaninga ngomdlavuza we-ovari bazama ukuthola ukuthi iziphi izinguquko zofuzo ezibangela umdlavuza.

Lezi zinguquko zingazuzwa njengefa kumzali noma zingatholakala. Lokho wukuthi, zenzeka ngesikhathi sokuphila kwakho.

Izinhlobo zomdlavuza we-ovari

I-epithelial carcinoma ye-ovary

I-Epithelial cell carcinoma uhlobo oluvame kakhulu lomdlavuza wesibeletho. Kwakha amaphesenti angama-85 kuya kwangu-89 omdlavuza wama-ovari. Kuyimbangela yesine ejwayelekile yokufa komdlavuza kwabesifazane.

Lolu hlobo ngokuvamile alunazo izimpawu ezigabeni zokuqala. Iningi labantu alitholakali kuze kube yilapho lisezigabeni eziphambili zesifo.

Izici zofuzo

Lolu hlobo lomdlavuza we-ovari lungasebenza emindenini futhi luvame kakhulu kwabesifazane abanomlando womndeni we:

• umdlavuza we-ovari nomdlavuza webele
• umdlavuza we-ovari ngaphandle komdlavuza webele
• umdlavuza we-ovari kanye nomdlavuza wekoloni

Abesifazane abanezihlobo zokuqala ezimbili noma ngaphezulu, njengomzali, ingane yakini, noma ingane, abanomdlavuza we-ovari basengozini enkulu. Kodwa-ke, ukuba nesihlobo esisodwa sokuqala esinomdlavuza we-ovari kwandisa ingozi."Izakhi zofuzo zomdlavuza webele" i-BRCA1 ne-BRCA2 nazo zihlotshaniswa nengozi yomdlavuza we-ovari.

Izici ezixhunyaniswe nokusinda okwandayo

Izici eziningana zixhunyaniswa nokusinda okwandayo kwabesifazane abane-epithelial carcinoma ye-ovary:

• ukuthola ukuxilongwa ekuqaleni
• ukuba mncane ngeminyaka
• ukuba nesimila esihlukaniswe kahle, noma amangqamuzana omdlavuza asacishe afane namaseli enempilo
• ukuba nesimila esincane ngesikhathi sokususwa
• ukuba nomdlavuza obangelwa yizakhi zofuzo ze-BRCA1 ne-BRCA2

Umdlavuza wamangqamuzana wesakhi esibelethweni

"Umdlavuza weseli lesandulela ngculaza" igama elichaza izinhlobo ezahlukene zomdlavuza. Lawa mdlavuza akhula kusuka kumaseli akha amaqanda. Imvamisa zenzeka kwabesifazane abasebasha nasebusheni futhi zivame kakhulu kwabesifazane abaseminyakeni yama-20.

Le mdlavuza ingaba mikhulu, futhi ijwayele ukukhula ngokushesha. Kwesinye isikhathi, izicubu zikhiqiza i-chorionic gonadotropin (HCG) yomuntu. Lokhu kungadala ukuhlolwa kokukhulelwa okungelona iqiniso.

Umdlavuza wamangqamuzana amaGerm uvame ukwelashwa kakhulu. Ukuhlinzwa ukwelashwa komugqa wokuqala. I-Chemotherapy ngemuva kokuhlinzwa inconywa kakhulu.

Umdlavuza weseli we-Stromal we-ovary

Umdlavuza wamaseli we-Stromal ukhula kusuka kumaseli ama-ovari. Amanye alawa maseli abuye akhiqize ama-hormone e-ovari kufaka phakathi i-estrogen, i-progesterone, ne-testosterone.

Umdlavuza wamaseli we-Stromal wamaqanda awutholakali futhi ukhula kancane. Bakhipha i-estrogen ne-testosterone. I-testosterone eyeqile ingadala ukukhula kwezinduna nobuso ebusweni. I-estrogen eningi ingadala ukopha kwesibeletho. Lezi zimpawu zingabonakala impela.

Lokhu kwenza umdlavuza wamaseli we-stromal ube sethubeni lokutholakala kusenesikhathi. Abantu abanomdlavuza we-stromal cell bavame ukuba nombono omuhle. Lolu hlobo lomdlavuza luvame ukuphathwa ngokuhlinzwa.

Ukwelashwa komdlavuza we-ovari

Ukwelashwa komdlavuza we-ovari kuncike ohlotsheni, esiteji, nokuthi ngabe ufuna ukuba nezingane ngokuzayo.

Ukuhlinzwa

Ukuhlinzwa kungenziwa ukuqinisekisa ukuxilongwa, ukuthola isigaba somdlavuza, futhi nokuwususa umdlavuza.

Ngesikhathi sokuhlinzwa, udokotela wakho ohlinzayo uzozama ukususa zonke izicubu ezinomdlavuza. Bangathatha futhi i-biopsy ukubona ukuthi umdlavuza ususakazekile yini. Izinga lokuhlinzwa lingaxhomeka ekutheni uyafuna yini ukukhulelwa esikhathini esizayo.

Uma ufuna ukukhulelwa ngokuzayo futhi unomdlavuza wesigaba 1, ukuhlinzwa kungafaka:

• ukususwa kwe-ovary okunomdlavuza kanye ne-biopsy yelinye i-ovary
• ukususwa kwezicubu ezinamafutha, noma i-omentum enamathiselwe kwezinye izitho zesisu
• ukususwa kwamangqamuzana esisu nasesiswini
• ama-biopsies ezinye izicubu nokuqoqwa koketshezi ngaphakathi kwesisu

Ukuhlinzwa komdlavuza we-ovarian okuthuthukile

Ukuhlinzwa kukhulu kakhulu uma ungafuni ukuba nezingane. Ungadinga nokuhlinzwa okwengeziwe uma unomdlavuza wesigaba 2, 3, noma 4. Ukususwa ngokuphelele kwazo zonke izindawo ezibandakanyeka nomdlavuza kungakuvimbela ekukhulelweni ngokuzayo. Lokhu kufaka:

• ukususwa kwesibeletho
• ukususwa kwawo womabili ama-ovari kanye namashubhu we-fallopian
• ukususwa kwe-omentum
• ukususwa kwezicubu eziningi ezinamaseli omdlavuza ngangokunokwenzeka
• ama-biopsies anoma yiziphi izicubu ezingaba nomdlavuza

Ukwelashwa ngamakhemikhali

Ukuhlinzwa kuvame ukulandela ukwelashwa ngamakhemikhali. Imithi inganikezwa ngemithambo yegazi noma ngesisu. Lokhu kubizwa ngokuthi ukwelashwa kwe-intraperitoneal. Imiphumela emibi ye-chemotherapy ingafaka:

• isicanucanu
• ukuhlanza
• ukulahleka kwezinwele
• ukukhathala
• izinkinga zokulala

Ukwelashwa kwezimpawu

Ngenkathi udokotela wakho elungiselela ukwelapha noma ukususa umdlavuza, ungadinga ukwelashwa okwengeziwe ngezimpawu ezibangelwa umdlavuza. Ubuhlungu abuvamile ngomdlavuza we-ovari.

Isimila singabeka ingcindezi ezithweni eziseduze, emisipheni, emithanjeni, nasemathanjeni. Uma umdlavuza ukhula, ubuhlungu bungaba bukhulu kakhulu.

Ubuhlungu bungaba futhi umphumela wokwelashwa. Ukwelashwa ngamakhemikhali, imisebe, nokuhlinzwa kungakushiya ebuhlungwini futhi ungakhululeki. Khuluma nodokotela wakho ngezindlela ongalawula ngazo ubuhlungu bomdlavuza we-ovari.

Ukuhlonza umdlavuza we-ovari

Ukuhlonza umdlavuza we-ovari kuqala ngomlando wezokwelapha nokuhlolwa komzimba. Ukuhlolwa komzimba kufanele kufaka ukuhlolwa kwe-pelvic kanye ne-rectal. Ukuhlolwa kwegazi okukodwa noma okuningi kungasetshenziselwa ukuxilonga lesi simo.

Ukuhlolwa kwaminyaka yonke kwe-pap smear akuwutholi umdlavuza wesibeletho. Izivivinyo ezingasetshenziswa ukuthola umdlavuza we-ovari zifaka:

• inani eliphelele legazi
• ukuhlolwa kwamazinga omdlavuza we-antigen 125, angaphakanyiswa uma unomdlavuza we-ovari
• ukuhlolwa kwamazinga e-HCG, angaphakanyiswa uma unesimila segciwane lesigciwane
• ukuhlolwa kwe-alpha-fetoprotein, engahle ikhiqizwe yizimila zamagciwane
• ukuhlolwa kwamazinga e-lactate dehydrogenase, angaphakanyiswa uma unesimila segciwane lesigciwane
• ukuhlolwa kwamazinga e-inhibin, i-estrogen, ne-testosterone, angaphakanyiswa uma une-stromal cell tumor
• ukuhlolwa kwesibindi ukusebenza ukuthola ukuthi umdlavuza ususakazekile yini
• ukuhlolwa kwezinso ukuthola ukuthi ngabe umdlavuza uphazamise ukugeleza komchamo wakho noma usabalalele esinyeni nasezinsweni

Ezinye izifundo zokuxilonga zingasetshenziselwa ukubheka izimpawu zomdlavuza we-ovari:

Isidumbu

I-biopsy ibalulekile ekunqumeni ukuthi umdlavuza ukhona yini. Ngesikhathi senqubo, kuthathwa isampula lezicubu ezincane kuma-ovari ukuyobheka amangqamuzana omdlavuza.

Lokhu kungenziwa ngenaliti eqondiswa yi-CT scan noma nge-ultrasound. Kungenziwa futhi nge-laparoscope. Uma kukhona uketshezi esiswini, isampula ingahlolwa amaseli womdlavuza.

Ukuhlola ukuhlolwa

Kunezinhlobo eziningi zokuhlolwa kwe-imaging ezingabheka ushintsho kuma-ovari nakwezinye izitho ezibangelwa umdlavuza. Lokhu kufaka phakathi i-CT scan, i-MRI, ne-PET scan.

Ukuhlola i-metastasis

Uma udokotela wakho esola umdlavuza we-ovari, banga-oda ezinye izivivinyo ukubona ukuthi umdlavuza ususabalele yini kwezinye izitho. Lezi zivivinyo zingafaka okulandelayo:

• Ukuhlolwa komchamo kungenziwa ukubheka izimpawu zokutheleleka noma igazi emchameni. Lokhu kungenzeka uma umdlavuza usakazekela esinyeni nasezinsweni.
• I-X-ray yesifuba ingenziwa ukuthola lapho izimila zisabalele emaphashini.
• I-enema ye-barium ingenziwa ukubona ukuthi isimila sesisakazele kukholoni noma i-rectum.

Ukuhlolwa komdlavuza ojwayelekile we-ovarian akukhuthazwa. Njengamanje, ochwepheshe bezokwelapha bakholelwa ukuthi babuyisa imiphumela eminingi kakhulu yamanga. Kodwa-ke, uma unomlando womndeni webele, i-ovari, i-fallopian tube, noma umdlavuza we-peritoneal, ungahle uthande ukuhlolelwa ushintsho oluthile lwezakhi zofuzo futhi uhlolwe njalo. Nquma ukuthi ngabe ukuhlolwa komdlavuza we-ovarian kukulungele yini.

Izici zomdlavuza we-Ovarian

Yize kungaziwa imbangela yomdlavuza we-ovari, abacwaningi bathole izici eziningana zobungozi ezingakhuphula ubungozi bokuthuthukisa lolu hlobo lomdlavuza. Kubandakanya:

• Izakhi zofuzo: Uma unomlando womndeni we-ovarian, webele, ishubhu le-fallopian, noma umdlavuza we-colorectal, izingozi zakho zokuba nomdlavuza we-ovari ziphakeme. Lokho kungenxa yokuthi abacwaningi bathole izinguquko ezithile zofuzo ezibhekene nale mdlavuza. Zingadluliselwa zisuke kumzali ziye enganeni.
• Umlando wezokwelapha womuntu siqu: Uma unomlando womuntu siqu womdlavuza webele, ingozi yakho yokuba nomdlavuza we-ovari iphezulu. Ngokunjalo, uma utholwe unezimo ezithile zohlelo lokuzala, amathuba akho okuba nomdlavuza we-ovari aphezulu. Lezi zimo zibandakanya i-polycystic ovary syndrome ne-endometriosis, phakathi kwabanye.
• Umlando wokuzala: Abesifazane abasebenzisa ukulawulwa kokubeletha empeleni banengozi encane yomdlavuza we-ovari, kepha abesifazane abasebenzisa imishanguzo yokuzala bangaba nengozi enkulu. Ngokufanayo, abesifazane abaye bakhulelwa futhi bancelisa izingane zabo ezincelisayo bangaba nengozi ephansi, kodwa abesifazane abangakaze bakhulelwe basengozini eyengeziwe.
• Ubudala: Umdlavuza we-Ovarian uvame kakhulu kwabesifazane asebekhulile; akuvamile ukutholakala kwabesifazane abangaphansi kweminyaka engama-40. Eqinisweni, maningi amathuba okuthi utholwe unomdlavuza we-ovari ngemuva kokunqamuka kokuya esikhathini.
• Ubuhlanga: Abesifazane abamhlophe abangewona amaSpanishi nabo basengozini enkulu yomdlavuza we-ovari. Bayalandelwa abesifazane baseSpain nabesifazane abamnyama.
• Usayizi womzimba: Abesifazane abanenkomba yomzimba engaphezu kuka-30 basengozini enkulu yomdlavuza we-ovari.

Izigaba zomdlavuza wesibeletho

Isigaba somdlavuza we-ovari sinqunywa yizici ezintathu:

• ubukhulu besimila
• noma ngabe isimila singenile yini ezicutshini esizalweni se-ovary noma esiseduzane
• ngabe umdlavuza ususabalalise kwezinye izindawo zomzimba

Lapho nje lezi zinto sezaziwa, umdlavuza we-ovary uhlelwa ngokwezinqubo ezilandelayo:

• Umdlavuza weSigaba 1 uvalelwe kowodwa noma kuwo womabili amaqanda.
• Umdlavuza weSigaba 2 uvalelwe ethangeni.
• Umdlavuza wesigaba 3 ususabalele esiswini.
• Umdlavuza weSigaba 4 usabalale ngaphandle kwesisu noma kwezinye izitho eziqinile.

Esigabeni ngasinye kunezikhala ezingezansi. Lezi zingxenye zitshela udokotela wakho kancane ngomdlavuza wakho. Isibonelo, isigaba 1A somdlavuza we-ovari ngumdlavuza othuthukiswe ku-ovary eyodwa kuphela. Umdlavuza wesigaba 1B ukuwo womabili amaqanda. Isigaba ngasinye somdlavuza sinencazelo ethile kanye nombono oyingqayizivele.

Izinga lokusinda komdlavuza we-Ovarian

Izinga lokusinda liyinkomba yokuthi bangaki abantu abanohlobo olufanayo lomdlavuza abaphilayo ngemuva kwesikhathi esithile. Amanani amaningi okusinda asuselwa eminyakeni emihlanu. Yize lezi zinombolo zingakutsheli ukuthi ungaphila isikhathi esingakanani, kepha zinikeza umbono wokuthi ukwelashwa kohlobo oluthile lomdlavuza kuphumelela kangakanani.

Kuzo zonke izinhlobo zomdlavuza we-ovari, isilinganiso seminyaka emihlanu sokusinda singamaphesenti angama-47. Kodwa-ke, uma umdlavuza we-ovari utholakala futhi welashwa ngaphambi kokuba usabalale ngaphandle kwama-ovari, isilinganiso seminyaka emihlanu sokusinda singamaphesenti angama-92.

Kodwa-ke, ngaphansi kwengxenye eyodwa kwezine, amaphesenti ayi-15, awo wonke umdlavuza wama-ovari atholakala kulesi sigaba sokuqala. Funda kabanzi mayelana nokubukwa ngakunye kohlobo ngalunye nesigaba somdlavuza we-ovari.

Ingabe umdlavuza we-ovari ungavinjelwa?

Umdlavuza we-Ovarian awuvezi izimpawu ezinyathelweni zokuqala. Ngenxa yalokhu, imvamisa ayitholakali ize iqhubekele ezigabeni ezithuthukile. Okwamanje ayikho indlela yokuvimbela umdlavuza wama-ovari, kepha odokotela bayazi ngezinto ezinciphisa ubungozi bokuthola umdlavuza we-ovari.

Lezi zinto zifaka:

• ukuthatha amaphilisi okuvimbela inzalo
• ebelethile
• ukuncelisa ibele
• i-tubal ligation (eyaziwa nangokuthi "ukubopha amashubhu akho")
• isibeletho

I-Tubal ligation ne-hysterectomy kufanele yenziwe kuphela ngezizathu ezizwakalayo zezokwelapha. Kwabanye, isizathu esivumelekile sezokwelapha singanciphisa ingozi yokuba nomdlavuza we-ovari. Kodwa-ke, wena nodokotela wakho kufanele nixoxe ngezinye izindlela zokuvimbela kuqala.

Kufanele ukhulume nodokotela wakho ngokuhlolwa kokuqala komdlavuza we-ovari uma unomlando wawo womndeni. Ukuguqulwa kwezakhi zofuzo ezithile kungakubeka engcupheni yomdlavuza we-ovari kamuva. Ukwazi uma unalezi zinguquko kungasiza wena nodokotela wakho ukuthi nihlale niqaphele izinguquko.

Isibikezelo somdlavuza we-Ovarian

Isibikezelo sabantu abatholakala benomdlavuza we-ovarian sincike ekutheni umdlavuza usuthuthuke kangakanani lapho utholakala nokuthi kusebenza kanjani ukwelashwa. Isigaba sokuqala somdlavuza sinesibikezelo esingcono kunesifo somdlavuza esibelethweni sekwephuzile.

Kodwa-ke, amaphesenti ayi-15 kuphela omdlavuza wama-ovari otholakala esigabeni sokuqala. Abesifazane abangaphezu kwamaphesenti angama-80 abanomdlavuza we-ovari batholakala lapho umdlavuza usesigabeni esithuthukile.

Iribhoni lomdlavuza we-ovari

USepthemba yinyanga Kazwelonke Yokuqwashisa Ngomdlavuza We-Ovarian. Ngalesi sikhathi sonyaka, ungaqaphela abantu abaningi abagqoke itiye, umbala osemthethweni wenhlangano yokuqwashisa ngomdlavuza we-ovari. Amaribhoni wetiye awuphawu lokuqwashisa ngomdlavuza we-ovari.

Izibalo zomdlavuza we-Ovarian

Ngenkathi ama-ovari angaba isitho esisodwa nje, kunezinhlobo ezingaphezu kuka-30 zomdlavuza wama-ovari. Zihlukaniswa ngohlobo lweseli lapho umdlavuza uqala khona, kanye nesigaba somdlavuza.

Uhlobo oluvame kakhulu lomdlavuza we-ovari yizicubu ze-epithelial. Amaphesenti angaphezu kwama-85 omdlavuza we-ovari uqala ukuvela kumaseli abamba ingxenye engaphandle yama-ovari.

Umdlavuza we-Ovarian uphakathi kwesihlanu kwababulawa umdlavuza kwabesifazane baseMelika. Kubangela ukufa okuningi kunanoma yimuphi omunye umdlavuza wohlelo lokuzala lwabesifazane.

Oyedwa kwabesifazane abangama-78 uzotholakala ukuthi unomdlavuza we-ovari esikhathini sabo sokuphila.

Abesifazane asebekhulile maningi amathuba okuthi batholwe benomdlavuza we-ovari. Isilinganiso seminyaka sokuxilongwa komdlavuza we-ovari sineminyaka engama-63 ubudala.

Amaphesenti ayi-15 kuphela wamacala omdlavuza we-ovari atholakala kusenesikhathi.

Abesifazane abanomdlavuza otholakala besenesikhathi banesilinganiso seminyaka emihlanu sokusinda samaphesenti angama-92. Kuzo zonke izinhlobo nezigaba zomdlavuza, isilinganiso seminyaka emihlanu sokusinda esihlobene singamaphesenti angama-47.

Ku-2018, i-22,240 izotholakala inomdlavuza we-ovari. Abanye abangu-14,070 bazobulawa yilolu hlobo lomdlavuza.

Ngokujabulisayo, i-American Cancer Society ithi izinga lapho abesifazane betholakala benalolu hlobo lomdlavuza behle eminyakeni engamashumi amabili edlule. Funda kabanzi mayelana nokuthi ngubani ongahle atholakale enomdlavuza we-ovari, ukuthi izindlela zokwelashwa ziphumelela kanjani, nokuningi.