Izigaba Zomdlavuza Wesikhumba: Zisho Ukuthini?

-Delile

• Yini okufanele uyazi ngezigaba zomdlavuza
• Isigaba somdlavuza wesikhumba se-basal ne-squamous
• Izinketho zokwelashwa
• Izigaba ze-Melanoma
• Ukwelashwa kwe-Melanoma
• Okubalulekile

Izigaba zomdlavuza zichaza ubukhulu besimila sokuqala nokuthi umdlavuza ususabalale kangakanani ukusuka lapho uqale khona. Kunemikhombandlela ehlukene yeziteji yezinhlobo ezahlukene zomdlavuza.

Isiteji sinikeza ukubuka konke okulindelwe. Udokotela wakho uzosebenzisa lolu lwazi ukuletha uhlelo lokwelashwa olungcono kakhulu kuwe.

Kule ndatshana, sizobheka ngokuningiliziwe ukuthi umdlavuza wesikhumba we-basal, cell squamous, nomdlavuza wesikhumba we-melanoma uhlelwa kanjani.

Yini okufanele uyazi ngezigaba zomdlavuza

Umdlavuza yisifo esiqala endaweni eyodwa encane yomzimba, njengesikhumba. Uma ingelashwa kusenesikhathi, ingase isabalalele nakwezinye izingxenye zomzimba.

Odokotela basebenzisa imininingwane yesiteji ukuqonda:

• ungakanani umdlavuza osemzimbeni womuntu
• lapho umdlavuza utholakala khona
• ngabe umdlavuza usabalele ngalé kwalapho uqale khona
• welashwa kanjani umdlavuza
• uyini umbono noma ukubikezelwa

Yize umdlavuza uvame ukwehluka kuwo wonke umuntu, umdlavuza onesigaba esifanayo ujwayele ukuphathwa ngendlela efanayo futhi uvame ukuba nemibono efanayo.

Odokotela basebenzisa ithuluzi elaziwa nge-TNM classification system ukufaka izinhlobo ezahlukene zomdlavuza. Lolu hlelo lokubeka umdlavuza lubandakanya amaphuzu amathathu alandelayo:

• T:tusayizi we-umor nokuthi ujule kangakanani esikhunjeni
• N: i-lymph nukubandakanyeka kwe-ode
• M:mi-etastasis noma ngabe umdlavuza ususakazekile yini

Umdlavuza wesikhumba uhlelwe kusuka ku-0 kuye ku-4. Njengomthetho ojwayelekile, ukwehla kwenani lesiteji, umdlavuza usakazeke kancane.

Isibonelo, isigaba 0, noma i-carcinoma in situ, kusho amaseli angajwayelekile, anamandla okuba nomdlavuza, akhona. Kepha lawa maseli ahlala kumaseli lapho aqala khona ukwakheka. Azikakhuli zibe izicubu eziseduze noma zisakazekele kwezinye izindawo.

Isigaba 4, ngakolunye uhlangothi, sihamba phambili kakhulu. Kulesi sigaba, umdlavuza ususabalele kwezinye izitho noma izingxenye zomzimba.

Isigaba somdlavuza wesikhumba se-basal ne-squamous

Isiteji ngokuvamile asidingeki kumdlavuza wesikhumba wesisekelo se-basal. Lokho kungenxa yokuthi lawa mdlavuza uvame ukwelashwa ngaphambi kokuba usabalalele kwezinye izindawo.

Umdlavuza wesikhumba se-squamous unamathuba aphezulu okusabalala, yize ingozi isephansi impela.

Ngalezi zinhlobo zomdlavuza wesikhumba, izici ezithile zingenza amangqamuzana anomdlavuza abe sethubeni lokusabalala noma abuye uma esusiwe. Lezi zici ezinobungozi obukhulu zifaka:

• i-carcinoma (amaseli anomdlavuza) mkhulu kune-2 mm (millimeters)
• ukungena emithanjeni yesikhumba
• Ukuhlasela ezingxenyeni ezingezansi zesikhumba
• indawo endebeni noma endlebeni

Umdlavuza we-squamous cell kanye ne-basal cell cancer uhlelwe kanjena:

• Isigaba 0: Amaseli anomdlavuza atholakala kuphela engxenyeni engenhla yesikhumba (i-epidermis) futhi awazange asakaze ngokujulile esikhunjeni.
• Isigaba 1: Isimila singu-2 cm (amasentimitha) noma ngaphansi, asisakazekele kuma-lymph node aseduze, futhi sinesici esisodwa noma ezimbalwa zobungozi obuphezulu.
• Isigaba 2: Isimila siyi-2 kuye ku-4 cm, asisakazekanga kuma-lymph node aseduze, noma isimila sinobukhulu obunjani futhi sinezici ezimbili noma ngaphezulu zobungozi obukhulu.
• Isigaba 3: Isimila singaphezu kuka-4 cm, noma sisabalalele kokunye kokulandelayo:
  • izicubu ezingaphansi kwesikhumba, okuyisendlalelo esijule kakhulu, esingaphakathi kakhulu sesikhumba esifaka imithambo yegazi, ukuphela kwezinzwa nezinwele zezinwele
  • ithambo, lapho lidale umonakalo omncane
  • i-lymph node eseduze
• Isigaba 4: I-tumor ingaba yinoma yisiphi isayizi futhi isakaze ku:
  • i-lymph node eyodwa noma ngaphezulu, amakhulu kuno-3 cm
  • umnkantsha noma ithambo
  • ezinye izitho emzimbeni

Izinketho zokwelashwa

Uma i-squamous cell noma i-basal cell cancer ibanjwa kusenesikhathi, iyelapheka kakhulu. Izindlela ezahlukahlukene zokuhlinza zivame ukusetshenziselwa ukususa amangqamuzana anomdlavuza.

Lezi zinqubo zokuhlinza zivame ukwenziwa ehhovisi likadokotela noma emtholampilo wabangalaliswa ngaphansi kwe-anesthesia yendawo. Lokhu kusho ukuthi uzobe uphapheme, futhi kuphela indawo ezungeze umdlavuza wesikhumba ozobanjwa izinzwa. Uhlobo lwenqubo yokuhlinza olwenziwe luzoncika ku:

• uhlobo lomdlavuza wesikhumba
• ubukhulu bomdlavuza
• lapho umdlavuza utholakala khona

Uma umdlavuza ususabalele esikhunjeni noma usengozini enkulu yokusabalala, ezinye izindlela zokwelashwa zingadingeka ngemuva kokuhlinzwa, njengemisebe noma i-chemotherapy.

Ezinye zezinketho zokwelashwa ezivame kakhulu zamaseli omdlavuza wesikhumba noma i-squamous cell cancer zihlanganisa okulandelayo:

• Ukuzikhandla: Ngokukhipha, udokotela wakho uzosebenzisa insingo ebukhali noma isikhumba ukuze asuse izicubu zomdlavuza nezinye izicubu ezinempilo ezizungezile. Izicubu ezisusiwe zizobe sezithunyelwa elabhorethri ukuze ziyohlaziywa.
• Ukuhlinzwa kwamandla kagesi: Eyaziwa nangokuthi i-curettage ne-electrodeiccation, le nqubo ifaneleka kakhulu kumdlavuza wesikhumba ongaphezulu kakhulu kwesikhumba. Udokotela wakho uzosebenzisa insimbi ekhethekile ebizwa ngokuthi i-curette ukususa umdlavuza. Isikhumba bese sishiswa nge-electrode ukuqeda noma yimuphi umdlavuza osele. Le nqubo ivame ukuphindwa kaningana ngesikhathi sokuvakasha okufanayo kwehhovisi ukuqinisekisa ukuthi wonke umdlavuza uyasuswa.
• Ukuhlinzwa kukaMohs: Ngale nqubo, udokotela wakho usebenzisa i-scalpel ukususa ngokucophelela isikhumba esingajwayelekile emigqeni evundlile kanye nezinye izicubu ezizungezile. Isikhumba sihlolwa ngaphansi kwesibonakhulu ngokushesha nje lapho sikhishwa. Uma kutholakala amangqamuzana omdlavuza, kususwa olunye ungqimba lwesikhumba ngokushesha kuze kungatholakali amangqamuzana omdlavuza.
• I-Cryosurgery: Nge-cryosurgery, i-nitrogen ewuketshezi isetshenziselwa ukuqandisa nokubhubhisa izicubu ezinomdlavuza. Lokhu kwelashwa kuyaphindwa kaningana ngesikhathi sokuvakasha okufanayo kwehhovisi ukuqinisekisa ukuthi zonke izicubu ezinomdlavuza sezonakele.

Izigaba ze-Melanoma

Yize i-melanoma ingajwayelekile kakhulu kunomdlavuza wesisekelo se-basal noma i-squamous cell cancer, inolaka kakhulu. Lokhu kusho ukuthi kunamathuba amaningi okusabalala ezicutshini eziseduze, ama-lymph node, nakwezinye izingxenye zomzimba, uma kuqhathaniswa nomdlavuza wesikhumba we-nonmelanoma.

I-Melanoma ihlelwe kanjena:

• Isigaba 0: Amaseli anomdlavuza atholakala kuphela engxenyeni engaphandle yesikhumba futhi awazange ahlasele izicubu eziseduze. Kulesi sigaba esingahlaseli, umdlavuza ungasuswa ngokuhlinzwa wedwa.
• Isigaba 1A: Isigaxa asidluli ku-1 mm ubukhulu. Kungenzeka noma kungabi nesilonda (ikhefu esikhunjeni esivumela ukuthi izicubu ezingezansi zibonise).
• Isigaba 1B: Ukuqina kwesimila kungu-1 kuya ku-2 mm, futhi akukho zilonda.
• Isigaba 2A: Isimila siyi-1 kuya ku-2 mm ubukhulu futhi sinesilonda, noma siyi-2 kuye ku-4 mm futhi asinaso isilonda.
• Isigaba 2B: Isimila sino-2 kuye ku-4 mm ubukhulu futhi sinesilonda, noma singaphezu kuka-4 mm futhi asinaso isilonda.
• Isigaba 2C: Isimila singaphezu kuka-4mm ubukhulu futhi sinesilonda.
• Isigaba 3A: Ukuqina kwesimila akukhona ngaphezu kwe-1 mm futhi kune-ulceration, noma kungu-1 kuya ku-2 mm futhi akunasilonda. Umdlavuza utholakala ku-1 kuya ku-3 sentinel lymph node.
• Isigaba 3B: I-tumor ifinyelela ku-2 mm ubukhulu nge-ulceration, noma i-2 kuya ku-4mm ngaphandle kwesilonda, kanye nomdlavuza ukhona kwenye yalezi:
  • i-lymph node eyodwa kuya kwamathathu
  • emaqenjini amancane amangqamuzana ezinwele, abizwa ngokuthi ama-microsatellite tumors, eduze kwesimila sokuqala
  • emaqenjini amancane amangqamuzana wesimila ngaphakathi kuka-2 cm wesimila sokuqala, esibizwa ngokuthi izicubu zesathelayithi
  • kumaseli asabalale ezitsheni ze-lymph eziseduze, ezaziwa ngokuthi yi-in-transit metastases
• Isigaba 3C: I-tumor ifinyelela ku-4 mm ubukhulu nge-ulceration, noma i-4 mm noma enkulu ngaphandle kwesilonda, kanye nomdlavuza ukhona kwenye yalezi:
  • ama-lymph node amabili kuya kwamathathu
  • i-node eyodwa noma amaningi, futhi kukhona izicubu ze-microsatellite, izicubu ze-satellite, noma ama-metastases asendleleni
  • amaqhuqhuva amane noma ngaphezulu noma noma iyiphi inombolo yezindawo ezihlanganisiwe
• Isigaba 3D: Ukuqina kwesimila kungaphezu kuka-4 mm futhi kunesilonda. Amaseli womdlavuza atholakala kunoma iyiphi yalezi zindawo:
  • ama-lymph node amane noma ngaphezulu noma noma iyiphi inombolo yezindawo ezihlanganisiwe
  • ama-node amabili noma amaningi noma noma yiliphi inani lama-node ahlanganisiwe, futhi kukhona izicubu ze-microsatellite, izicubu ze-satellite, noma ama-metastases asendleleni
• Isigaba 4: Umdlavuza usabalalele ezingxenyeni ezikude zomzimba. Lokhu kungafaka ama-lymph node noma izitho ezinjengesibindi, amaphaphu, ithambo, ubuchopho noma umgudu wokugaya ukudla.

Ukwelashwa kwe-Melanoma

Nge-melanoma, ukwelashwa kuzoxhomeka kakhulu esigabeni nasendaweni yokukhula komdlavuza. Kodwa-ke, ezinye izinto zinganquma nokuthi yiluphi uhlobo lokwelashwa olusetshenziswayo.

• Isigaba 0 no-1: Uma i-melanoma itholwa kusenesikhathi, ukukhishwa kokuhlinzwa kwesimila nezicubu ezizungezile imvamisa kuyikho okudingekayo. Ukuhlolwa kwesikhumba njalo kunconywa ukuqinisekisa ukuthi awukho umdlavuza omusha oba khona.
• Isigaba 2: I-melanoma nezicubu ezizungezile zizosuswa ngokuhlinzwa.Udokotela wakho futhi angancoma i-sentinel lymph node biopsy ukuqinisekisa ukuthi umdlavuza awusabalalanga kuma-lymph node aseduze. Uma i-lymph node biopsy ithola amangqamuzana omdlavuza, udokotela wakho angancoma ukususwa kokuhlinzwa kwama-lymph node kuleyo ndawo. Lokhu kwaziwa njenge-lymph node dissection.
• Isigaba 3: I-melanoma izosuswa ngokuhlinzwa kanye nenqwaba yezicubu ezizungezile. Ngoba umdlavuza ususabalele kuma-lymph node ngalesi sigaba, ukwelashwa kuzofaka phakathi ukusakazeka kwe-lymph node. Ngemuva kokuhlinzwa, kuzonconywa ukwelashwa okwengeziwe. Zingafaka:
  • imishanguzo ye-immunotherapy esiza ukukhulisa impendulo yamasosha akho omzimba kumdlavuza
  • imithi yokwelashwa ehlosiwe evimba amaprotheni athile, ama-enzyme, nezinye izinto ezisiza umdlavuza ukuba ukhule
  • ukwelashwa ngemisebe okugxile ezindaweni lapho kukhishwa khona ama-lymph node
  • i-chemotherapy ehlukanisiwe, efaka ukufaka nje indawo lapho umdlavuza wawutholakala khona
• Isigaba 4: Ukususwa kokuhlinzwa kwesimila nama-lymph node kuvame ukunconywa. Ngoba umdlavuza ususabalele ezithweni ezikude, ukwelashwa okungeziwe kungahle kufake okukodwa noma okuningi kokulandelayo:
  • izidakamizwa ze-immunotherapy ezaziwa ngokuthi i-checkpoint inhibitors
  • izidakamizwa zokwelashwa ezihlosiwe
  • ukwelashwa ngamakhemikhali

Okubalulekile

Izigaba zomdlavuza wesikhumba zingakutshela okuningi ngokuthi isifo sesikhule kangakanani. Udokotela wakho uzocubungula uhlobo oluthile lomdlavuza wesikhumba kanye nesiteji ukunquma ukwelashwa okufanele kuwe.

Ukutholwa kusenesikhathi nokwelashwa ngokuvamile kunikeza umbono omuhle kakhulu. Uma usengozini enkulu yomdlavuza wesikhumba noma ubona okuthile okungajwayelekile esikhumbeni sakho, hlela ukuhlolwa komdlavuza wesikhumba ngokushesha okukhulu.