Umdlavuza wesithasiselo

Uyini umdlavuza we-appendix?

Umdlavuza we-appendix uwuhlobo lomdlavuza olungavamile olukhula esithasiselweni. Kunezinhlobo eziningi ezahlukene ze umdlavuza wesithasiselo, nasezigabeni zokuqala, umuntu akabi nazo izimpawu.

Isithasiselo siyisigaxa, cishe amasentimitha amane ubude, isaka elifana nomunwe elinamathela engxenyeni yokuqala yekholoni. Umsebenzi oqondile walesi sitho awaziwa kahle ososayensi. Ngaphandle kwesithasiselo, abantu bazophila impilo ejwayelekile nenempilo.

Umdlavuza wesithasiselo, kwesinye isikhathi obizwa ngokuthi umdlavuza wesithasiselo, uyivelakancane. Ochwepheshe balinganisela ukuthi cishe abantu ababili kuya kwabangu-2 esigidini esisodwa bayathinteka kulolu hlobo lomdlavuza. Eminye imibiko ikhombisa ukuthi noma kunjalo, umdlavuza wesithasiselo kungenzeka ukuthi uyanda.

Ucwaningo lwakamuva olubheke emuva lubike ukuthi lukhuphuke kusuka kubantu ababalelwa ezigidini eziyisithupha kwabayisigidi esisodwa ngo-6 kuya kwabangu-1 kwabayisigidi esisodwa ngo-2000.

Sibhekana namafomu, izimpawu, izimbangela nezici zobungozi zomdlavuza wesithasiselo kule ndatshana. Ukuxilongwa, ukutakula, kanye namazinga okusinda alesi simo nawo kuyambozwa.

Izinhlobo zomdlavuza wesithasiselo

Esithasiselweni, kunezinhlobo ezahlukene zamathumba ezingaqala:

• I-Neuroendocrine isisu : Emangqamuzaneni akhiqiza amahomoni, isimila se-neuroendocrine siqala futhi ngokuvamile sitholakala ngamanani amancane cishe kuzo zonke izitho zomzimba. Lokhu kungabizwa ngokuthi a isimila carcinoid kanjalo. Ngokuvamile, isimila se-neuroendocrine siqala epheshaneni le-GI noma emaphashini, kodwa futhi singenzeka kumanyikwe, amasende, noma ama-ovari. Isimila se-neuroendocrine esithasiselweni ngokuvamile sivela ekugcineni kwe-appendix. Izimila ze-Neuroendocrine zenza cishe amaphesenti angu-50 azo zonke izimila ze-appendix. Umdlavuza we-appendix ngokuvamile awubangeli zimpawu ngaphambi kokuba udlulele kwezinye izitho futhi ngezinye izikhathi awuqashelwa ngaphambi kokuba utholakale ngenjongo ethile phakathi nokuhlolwa noma ukuhlinzwa. Isimila se-neuroendocrine esithasiselweni, esihlala silinganiselwe endaweni lapho saqala khona, sinethuba eliphezulu lokwelashwa okuphumelelayo kokuhlinzwa. Funda kabanzi mayelana ne-GI tract neuroendocrine tumors.
• Ama-mucoceles afakiwe: Ukuvuvukala noma amasaka ngokuvuvukala kodonga lwesithasiselo, imvamisa kugcwaliswa ulwelwesi lwamafinyila, kungama-mucoceles. Kunezimo eziningana ezinobungozi ezimweni ezimbi ezingase zivele zenze i-mucocele esithasiselweni. Ama-mucstous cystadenomas nama-mucinous cystadenocarcinomas akha lezi zinkinga ezimbili. Ama-cystadenomas anomucu anobungozi futhi awasakazeki, futhi ama-polyp adenomatous angavela kukholoni ayafana. Zingasuswa ngokuphelele ngokuhlinzwa njengoba zitholakala kwisithasiselo. Kodwa-ke uma isithasiselo sihlukana, amaseli azosabalala emgodini womzimba bese eqhubeka nokufaka i-mucin, into efana ne-jelly, esiswini. Ukuqoqwa komucu kungaholela ebuhlungwini besisu, ukuqunjelwa kanye nokushintshwa kokusebenza kwamathumbu, kufaka phakathi ukuvinjelwa kwamathumbu (ukuvinjelwa). Ama-mucstous cystadenocarcinomas ane-mucin esiswini angaba nezimpawu ezifanayo, kepha zimbi, okusho ukuthi zingasakazeka nakwezinye izindawo zomzimba.
• Uhlobo lwamakholoni i-adenocarcinoma : I-Adenocarcinoma yefomu yekholoni ihlanganisa cishe amaphesenti angu-10 amathumba e-appendix futhi ngokuvamile ivela kusisekelo se-appendix. Uhlobo oluvame kakhulu lwe umdlavuza colorectal ibukeka futhi yenza njengomdlavuza we-appendix. Ngokuvamile kungabonakali, futhi nge-appendicitis, ukuxilongwa kuvame ukwenziwa ngesikhathi noma ngemva kokuhlinzwa. I-appendicitis ukuvuvukala kwe-appendix okungase kubangele ubuhlungu besisu noma ukuvuvukala, ukungakuthandi ukudla, isicanucanu, ukuhlanza, ukuqunjelwa noma isifo sohudo, ukungakwazi ukudlula igesi noma umkhuhlane ophansi oqala ngemva kokuba ezinye izimpawu sezakhekile.
• Isiginali-indandatho yeseli adenocarcinoma: I-signet-ring cell adenocarcinoma ayivamile futhi yaziwa ngokuba nzima kakhulu kunezinye izinhlobo ze-adenocarcinoma futhi kunzima kakhulu ukuyelapha. Ibizwa ngokuthi i-adenocarcinoma yamaseli endandatho yophawu ngenxa yokuthi iseli libonakala sengathi linendandatho yophawu ngaphakathi kwalo ngaphansi kwesibonakhulu. Fana no umdlavuza colon, lolu hlobo lomdlavuza we-appendix nalo luyaphathwa futhi.
• I-Goblet cell carcinomas / i-Adenoneuroendocrines: Kokubili i-adenocarcinomas kanye nezicubu ze-neuroendocrine zinezici ze-goblet cell carcinomas. Banolaka ngaphezu kwezicubu ze-neuroendocrine futhi baphathwa kakhulu ngendlela efanayo nokwelashwa kwe-adenocarcinoma.
• I-Paraganglioma: Lesi isimila esiyivelakancane esikhula sisuka kumaseli e-paraganglia, iqoqo lamaseli ezicubu zemizwa aphila ngesikhathi sokukhula kombungu (ngaphambi kokuzalwa) kumadiphozithi amancane. I-Paraganglia nayo ikhona eduze nezindlala ze-adrenal kanye nase- ikhanda nentamo izifunda zomzimba, kuhlanganise nemithambo yegazi eminingana nezinzwa. Lolu hlobo lwesimila ngokuvamile lubhekwa njengolulungile futhi ngokuvamile lwelashwa ngempumelelo ngokususwa ngokuphelele kwesimila ngokuhlinzwa. Funda kabanzi mayelana ne-paraganglioma.

 Izimpawu zomdlavuza wesithasiselo

Ekuqaleni, umdlavuza wesithasiselo awunazo izimpawu ezibonakalayo. Imvamisa kuyabonakala kwesinye isifo njenge-appendicitis ngesikhathi sokuhlinzwa noma ngesikhathi sokuhlolwa kwe-imaging.

Ngesikhathi se-colonoscopy ejwayelekile, udokotela angaze akuqaphele. Uma kunezimpawu, noma kunjalo zingabandakanya:

• isisu esiqunjelwe
• uquqaba lwama-ovari
• ubuhlungu obungapheli noma obukhulu besisu
• ukungakhululeki okungafani nesisu esingezansi kwesokudla
• ukuvinjelwa kwamathumbu
• i-hernia
• isifo sohudo

Izici zobungozi zomdlavuza wesithasiselo

Yize abanye ochwepheshe bephawula ukuthi azikho izici eziyingozi zokukhula komdlavuza wesithasiselo eziqinisekisiwe, kuye kwaphakanyiswa ezimbalwa ezingaba khona.

Lezi zihlanganisa:

• i-anemia eyingozi, ukuntuleka kukavithamini B-12
• i-atrophic gastritis, noma ukuvuvukala kwesikhathi eside kolwelwesi lwesisu
• I-Zollinger-Ellison syndrome, isimo sepheshana lokugaya ukudla
• umlando womndeni wezinhlobo eziningi ze-endocrine neoplasia yohlobo 1 (MEN1), ukugula okuholela kwizimila kwizindlala ezikhiqiza amahomoni
• ukubhema

Ukwelashwa komdlavuza wesithasiselo

Ukwelashwa komdlavuza wesithasiselo kuncike kulokhu:

• uhlobo lwesimila
• isigaba somdlavuza
• impilo yomuntu jikelele

Ukwelashwa okuthandwa kakhulu komdlavuza wesithasiselo okwenziwa endaweni ethile ukuhlinzwa. Uma umdlavuza utholakala esithasiselweni kuphela, khona-ke ukwelashwa kuvame ukufaka ukukhipha isithasiselo. Lokhu kubizwa nangokuthi i-appendectomy futhi.

Udokotela wakho angaphakamisa ukuthi ususe ingxenye eyodwa yekholoni yakho ngisho nama-lymph node ezinye izinhlobo zomdlavuza wesithasiselo, noma uma isimila sikhulu. I-hemicolectomy ibizwa ngokuhlinzwa ukukhipha uhhafu wekoloni.

Uma umdlavuza usakazekile, ukuhlinzekwa nge-cytoreductive, okuvame ukubizwa ngokuthi yi-debulking, kungalulekwa ngudokotela wakho. Udokotela ohlinzayo uzosusa isimila, uketshezi oluzungezile, futhi mhlawumbe nanoma yiziphi izitho ezingomakhelwane ezixhunywe kulesimila kule ndlela yokuhlinzwa.

Ukwelashwa kungase kuhlanganise i-chemotherapy ngaphambi noma ngemva kokuhlinzwa uma:

• isimila sikhulu kunamasentimitha ama-2
• umdlavuza ususabalele, ikakhulukazi kuma-lymph node
• umdlavuza unolaka kakhulu

Izinhlobo ze-chemotherapy zifaka:

• i-systemic chemotherapy, enikezwa ngemithambo yegazi noma ngomlomo
• i-chemotherapy yesifunda, enikezwe ngqo esiswini, njenge-intraperitoneal chemotherapy (EPIC) noma i-hyperthermic intraperitoneal chemotherapy (HIPEC)
• inhlanganisela yama-chemotherapies ehlelekile nasesifundeni

Ngemuva kwalokho, udokotela wakho uzolandela ukuhlolwa kwe-imaging, njenge-CT scan noma i-MRI, ukuqinisekisa ukuthi isimila asisekho.

Yini ukuphindaphindeka nokusinda kwezinga?

Ngokomthombo othembekile wokubuyekeza ka-2011, amazinga okusinda yeminyaka emihlanu yomdlavuza wesithasiselo ngemuva kokukhishwa kwesithasiselo yile:

• Amaphesenti angama-94 uma isimila se-carcinoid sigcinelwe isithasiselo
• Amaphesenti angama-85 uma umdlavuza ususabalele kuma-lymph node noma ezindaweni eziseduze
• amaphesenti angu-34 uma umdlavuza ususakazekele ezithweni ezikude, kodwa lokhu akuvamile kakhulu ezimila ze-carcinoid

Izinga lokusinda leminyaka emihlanu liyakhuphuka kwezinye izimo zomdlavuza wesithasiselo lapho ingxenye yekholoni isuswa futhi kusetshenziswa i-chemotherapy. Kodwa-ke, akuzona zonke izimo zomdlavuza wesithasiselo ezidinga lezi zindlela zokwelashwa ezengeziwe.

I-Chemotherapy kumdlavuza wesithasiselo

Ngokuya ngenqubo yokulethwa, izinhlobo ezinkulu zokwelashwa ngamakhemikhali komdlavuza wesithasiselo zihlukaniswa. Kubandakanya:

• I-chemotherapy yasendaweni (intraperitoneal): Udokotela ohlinzayo ufaka ithubhu emgodini wesisu wesiguli ukuvumela ukwelashwa ngamakhemikhali ukuthi kuhlinzekwe ngqo endaweni eqondiwe ngemuva kokuba udokotela ohlinzayo enza ukuhlinzwa kokukhipha isisu ukuze kukhishwe isimila esiningi ngangokunokwenzeka.
• I-Hyperthermic (evuthayo) i-intraperitoneal chemotherapy (HIPEC) : - Izidakamizwa zifudunyezwa kwizinga lokushisa elifinyelela ezingeni lokushisa lomzimba lesiguli ngaphambi kokubeletha; lokhu kuzothuthukisa ikhono le-chemo lokungena kwizicubu eziqukethe amangqamuzana e-tumor.
• I-chemotherapy ehlelekile: Izindlela zokwelashwa zilethwa ngomlomo noma ngemithambo yegazi ukuze i-chemo ingene egazini lesiguli ukuze ifinyelele kumaseli anomdlavuza asabalele emzimbeni wayo wonke.

Inhlanganisela ye- imiphumela emibi yokwelashwa ngamakhemikhali izidakamizwa ezisetshenziswa kakhulu lapho i-chemotherapy ejwayelekile kukhonjisiwe i- umdlavuza wesengezo yilezi:

1. I-FOLFOX
   • LANDELA- I-Folinic acid (Leucovorin)
   • F- I-Fluorouracil (5FU)
   • OX - I-Oxaliplatin (i-Eloxatin)
2. FOLFIRI
   • LANDELA- I-Folinic Acid (Leukovorin)
   • F- I-Fluorouracil (5FU)
   • IRI- I-Irinotecan (Camptosar)
3. XELOX
   • XEL- I-Xeloda (iCapecitabine)
   • OX- I-Oxaliplatin

Eminye imishanguzo engangezwa kulezi zinhlobo zemithi:

• I-Avastin (Bevacizumab) - i-anti-monoclonal antibody ephazamisa ikhono lesimila lokwenza imithambo yegazi
• I-Erbitux (i-Cetuximab): i-anti-monoclonal antibody esetshenziswe umdlavuza we-colorectal
• I-Xaliproden (SR57746A) - isidakamizwa esisha okwamanje esivivinywayo ezivivinyweni zokwelashwa zokuvimbela i-neuropathy ezigulini ezithola i-oxaliplatin.

Ukwelapha ngemisebe yomdlavuza wesithasiselo

Ukusebenzisa ama-x-reyi anamandla amakhulu noma ezinye izinhlayiya ukubulala amangqamuzana omdlavuza ukwelapha ngemisebe. Udokotela ogxile ekwelapheni umdlavuza ngokunikeza i-radiation therapy ubizwa nge-radiation oncologist. Umuthi (uhlelo) lokwelapha ngemisebe ngokuvamile luhlanganisa inombolo egxilile yokwelashwa okunikezwa ngesikhathi esithile.

Ekwelapheni umdlavuza wesithasiselo, ukwelashwa ngemisebe kusetshenziswa uhlelo akuvamile ukusetshenziswa. Kodwa-ke ukusiza ukunciphisa izimpawu, kungasetshenziselwa ukwelapha isifunda esithile lapho umdlavuza ususakazekile, njengethambo (bheka ngezansi.)

Ukukhathala, ukusabela okuncane kwesikhumba, isisu esithukuthele, nokunyakaza kwamathumbu okuxekethile kungafaka imiphumela emibi evela ekwelashweni ngemisebe. Ngokushesha ngemuva kokuphela kokwelashwa, imiphumela emibi eminingi iyaphela.

• Amazwana Avaliwe
• Septhemba 2nd, 2020