Umdlavuza wesibeletho

Uyini umdlavuza wesinye?

• Umdlavuza wesinye yisimo lapho izicubu zesinye ziba namaseli ayingozi (umdlavuza).
• Ingozi yomdlavuza wesinye ingase ithonywe ukubhema.
•  Izimpawu nezimpawu zomdlavuza wesinye zihlanganisa igazi emchameni kanye nobuhlungu lapho uchama.
•  Ukuze usize ukuhlonza (ukuthola) nokuxilonga umdlavuza wesinye, kusetshenziswa izivivinyo ezihlaziya umchamo nesinye.
• Ukubikezela (ithuba lokululama) nokukhetha ukwelashwa kuthonywa izici eziningana.

Omunye umdlavuza ovame kakhulu umdlavuza wesinye, ohlasela abantu abadala abangaba ngu-68,000 ngonyaka e-United States. Umdlavuza wesinye wenziwa kaningi kwabesilisa kunabesifazane futhi uvame ukuhlasela abantu abadala, nakuba ungenzeka kunoma iyiphi iminyaka.

Emangqamuzaneni (amangqamuzana e-urothelial) aphakathi kwesinye esinyeni, isitho esinezihlunu esingezansi kwesisu sakho esigcina umchamo, umdlavuza wesinye uvame ukuqala. Lolu hlobo lomdlavuza lungenzeka kwezinye izingxenye zohlelo lokudonsa amanzi emgudwini womchamo, kodwa luvame kakhulu esinyeni.

Uma umdlavuza wesinye welapheka kakhulu, cishe i-10 kwayi-XNUMX yomdlavuza wesinye etholakala kusenesikhathi. Esinye, nokho-ke ngisho nomdlavuza wesinye ungaphinde uvele. Ngenxa yalesi sizathu, iminyaka ngemva kokwelashwa, abantu abanomdlavuza wesinye ngokuvamile badinga ukuhlolwa kokulandelela ukuze bahlole umdlavuza wesinye obuyayo noma odlulela ezingeni eliphezulu.

Ungathanda ukufunda : Izindleko zokwelashwa komdlavuza wesinye eNdiya

Izimpawu zomdlavuza wesinye

Izimpawu zomdlavuza wesinye nezimpawu zingabandakanya:

• Igazi emchameni (hematuria)
• Ukuchama kabuhlungu
• Ubuhlungu be-pelvic

Umchamo wakho ungabonakala ubomvu ngokugqamile noma unombala we-cola uma une-hematuria. Ngokuvamile, umchamo awubonakali ngendlela ehlukile, kodwa ngesikhathi sokuhlolwa komchamo omncane, igazi emcinini lingabonwa.

Abantu abanomdlavuza wesinye bangase babe:

• Ukuhlungu obusemhlane
• Ukuvuthwa njalo

Kodwa ngenxa yokunye ngaphandle komdlavuza wesinye, lezi zimpawu ziyenzeka.

Izimbangela zomdlavuza wesinye

Lapho amaseli esinyeni eqala ukukhula ngendlela engavamile, umdlavuza wesinye uyakhula. Lawa mangqamuzana athuthukisa izakhi zofuzo eziwabangela ukuba akhule angalawuleki futhi angafi, kunokuba akhule futhi ahlukane ngendlela ehlelekile. A isisu idalwa yilawa maseli angajwayelekile.

Phakathi kwezimbangela zomdlavuza wesinye yilezi:

• Ukubhema nokunye ukusetshenziswa kukagwayi
• Ukuchayeka kumakhemikhali, ikakhulukazi ukusebenza emsebenzini odinga ukuchayeka kumakhemikhali
• Ukuchayeka emisebeni edlule
• Ukucasuka okungapheli kolwelwesi lwesinye
• Ukutheleleka nge-Parasitic, ikakhulukazi kubantu abavela noma abake bavakashela izindawo ezithile ngaphandle kwe-United States

Akuqondakali ngaso sonke isikhathi ukuthi yini ebangela umdlavuza wesinye, futhi abanye abantu abanomdlavuza wesinye abanazo izici zobungozi ezisobala.

Izinhlobo zomdlavuza wesinye

Izinhlobo ezahlukene zamaseli zingaba nomdlavuza esinyeni sakho. Uhlobo lweseli yesinye lapho umdlavuza uqala khona lunquma uhlobo lomdlavuza esinyeni. Uhlobo lomdlavuza wesinye luchaza ukuthi yiziphi izindlela zokwelapha ezikufanele kakhulu.

Izinhlobo zomdlavuza wesinye zihlanganisa:

• Urothelial carcinoma:Kumaseli agudle ingaphakathi lesinye, kwenzeka i-urothelial carcinoma, ngokomlando ebizwa ngokuthi i-transitional cell carcinoma. Uma esinyeni sakho sigcwele, amaseli e-urothelial anda futhi ayafinyela lapho esinyeni sakho singenalutho. Ingaphakathi le-ureter kanye ne-urethra kukleliswe kulawa maseli afanayo, futhi kungase kwakheke izimila kulezo zindawo. Uhlobo oluvame kakhulu lomdlavuza wesinye e-United States i-urothelial carcinoma.
• I-squamous cell carcinoma:I-squamous cell carcinoma ihlotshaniswa nokucasuka kwesinye isikhathi okubangelwa ukutheleleka noma ukusetshenziswa isikhathi eside kwe-catheter yomchamo, isibonelo. Kuvame kakhulu ezindaweni zomhlaba lapho izifo zesinye ziyimbangela evamile yesifo esithile se-parasitic (schistosomiasis).
• I-Adenocarcinoma iqala emangqamuzaneni akha izindlala ezikhiqiza amafinyila esinyeni.

Izici eziyingozi zomdlavuza wesinye

Izinto ezingase zandise ingozi yomdlavuza wesinye zihlanganisa:

• Ngokuvumela amakhemikhali anobuthi anqwabelene emchamweni, ukubhema ugwayi, ugwayi noma amapayipi kungandisa ingozi yomdlavuza wesinye. Umzimba wakho ucubungula amakhemikhali asentuthuni njengoba ubhema futhi amanye awo uwakhiphela emchamweni wakho. Ulwelwesi lwesinye sakho lungalinyazwa yilawa makhemikhali anobuthi, angandisa ingozi yomdlavuza.
• Ukukhula kweminyaka yobudala :Njengoba ukhula, ingozi yomdlavuza wesinye iyanda. Umdlavuza wesinye ungenzeka kunoma ibuphi ubudala, kodwa kubantu abangaphansi kweminyaka engama-40, awuvamile ukuhlonzwa.
• Ukuba mhlophe :Abantu abamhlophe basengozini enkulu yokuba nomdlavuza wesinye kunabantu bezinye izinhlanga.
• Ukuba yindoda:Amadoda maningi amathuba okuba abe nomdlavuza wesinye kunabesifazane.
• Ukuchayeka kumakhemikhali athile :Ekuhlungeni amakhemikhali anobuthi egazini lakho bese ewadlulisela esinyeni sakho, izinso zakho zinendima ebalulekile. Kusolwa ukuthi ukuba eduze kwalawa makhemikhali kuzonyusa amathuba okuba nomdlavuza wesinye ngenxa yalokhu. I-arsenic namakhemikhali asetshenziswa ekwenzeni udayi, irabha, isikhumba, izindwangu, nemikhiqizo kapende amakhemikhali axhumene nengozi yomdlavuza wesinye.
• Ukwelashwa komdlavuza kwangaphambilini :Amathuba okuba nomdlavuza wesinye aphakanyiswa ukwelashwa ngemithi elwa nomdlavuza i-cyclophosphamide. Abantu abake bathola ukwelashwa ngemisebe ye-pelvic ngomdlavuza wangaphambili banethuba elikhulu lokuba nomdlavuza wesinye.
• Ukuvuvukala kwesinye okungapheli : Ingozi yomdlavuza wesinye i-squamous cell inganyuswa yizifo ezingelapheki noma eziphindelelayo zomchamo noma ukuvuvukala (cystitis), njengoba kungenzeka ngokusetshenziswa isikhathi eside kwe-catheter yomchamo. I-squamous cell carcinoma kwezinye izingxenye zomhlaba ihlobene nokuvuvukala okungapheli kwesinye okubangelwa ukutheleleka kwebhaktheriya okwaziwa nge-schistosomiasis.
• Umlando womuntu siqu noma womndeni womdlavuza :Kungenzeka ukuthi uphinde uwuthole uma unomdlavuza wesinye. Uma umzali, ingane yakini noma ingane inomlando womdlavuza wesinye kwesinye sezihlobo zakho zokuqala, ungaba sengozini enkulu yokugula, kuyilapho ukugijima emindenini kuyivelakancane kumdlavuza wesinye. Umlando womndeni wefa umdlavuza colorectal ngaphandle kwe-polyposis, eyaziwa nangokuthi i-Lynch syndrome, ingase ikhulise ingozi yomdlavuza wesistimu yomchamo, ikholoni, isibeletho, ama-ovari, nezinye izitho.

Ukuvimbela umdlavuza wesinye

Nakuba ingekho indlela eqinisekisiwe yokuvimbela umdlavuza wesinye, ungathatha izinyathelo zokusiza ukunciphisa ubungozi bakho. Ngokwesibonelo:

• Ungabhemi : Ukungabhemi kusho ukuthi esinyeni asikwazi ukuqoqa amakhemikhali adala umdlavuza emsini. Ungaqali uma ungabhemi. Khuluma nodokotela wakho uma ubhema mayelana necebo lokukusiza ukuba uyeke. Ungakhuthazwa ukuthi uhambe ngamaqembu okusekelana, izidakamizwa nezinye izindlela.
• Qaphela amakhemikhali :Landela yonke imihlahlandlela yokuphepha ukuze uvimbele ukusuleleka uma usebenzisana namakhemikhali.
• Khetha izinhlobonhlobo zezithelo nemifino : Khetha ukudla okunothe ngezinhlobonhlobo zemifino nezithelo ezimibalabala. Ezithelo nasemifino, ama-antioxidants angasiza ekunciphiseni ingozi yomdlavuza wakho.

Ukuxilonga umdlavuza wesinye

Ukuhlolwa nezinqubo ezisetshenziselwa ukuxilonga umdlavuza wesinye zingabandakanya:

• I-cystoscopy : Udokotela wakho uzofaka ishubhu elincane eliwumngcingo (cystoscope) nge-urethra ukuze aqhube i-cystoscopy. I-cystoscope ine-lens esiza udokotela wakho ukuthi abone ingaphakathi le-urethra nesinye futhi ahlole izimpawu zesifo kulezi zakhiwo.
• Udokotela wakho angahambisa ithuluzi elithile nge-scope nasesinyeni sakho ngesikhathi se-cystoscopy ukuze aqoqe isampula yeseli (i-biopsy) ukuze ihlolwe. Lokhu kuhlinzwa kubizwa nangokuthi isimila esinyeni i-transurethral resection (TURBT). Ukuze welaphe umdlavuza wesinye, i-TURBT ingasetshenziswa.
• I-cytology yomchamo:Endleleni ebizwa ngokuthi i-urine cytology, isampula yomchamo ihlolwa ngesibonakhulu ukuze kuphenywe amaseli omdlavuza.
• Ukuhlola ukuhlolwa:Ukuhlolwa kwezithombe, njenge-computed tomography (CT) urogram noma i-retrograde pyelogram, vumela udokotela wakho ukuthi ahlole izakhiwo zakho zomgudu womchamo.

Umbala ohlukile ojovwe emthanjeni osesandleni sakho kancane kancane ugelezela ezinso, ureter, kanye nesinye ngesikhathi se-CT urogram. Izithombe ze-X-ray ezithathwe phakathi nokuhlolwa zinikeza umgudu wakho womchamo umbono ocacile futhi zisize udokotela athole noma yiziphi izindawo okungenzeka ukuthi zinomdlavuza.

Ukuhlolwa kwe-X-ray okusetshenziselwa ukuhlola kahle umgudu womchamo ongenhla kuyi-retrograde pyelogram. Udokotela wakho uzofaka ishubhu elincanyana (i-catheter) nge-urethra nasesinyeni sakho phakathi nale nqubo ukuze ajove udayi ohlukile ku-ureter yakho. Nakuba izithombe ze-X-ray zithathwa, udayi ube usugelezela ezinso.

Ukunquma izinga lomdlavuza

Udokotela wakho angase atuse ukuhlolwa okwengeziwe ukuze anqume ukuthi umdlavuza wakho ususabalele yini kuma-lymph nodes noma kwezinye izindawo zomzimba wakho ngemva kokuqinisekisa ukuthi unomdlavuza wesinye.

Ukuhlola kungase kuhlanganise:

• CT scan
• I-imaging resonance ye-magnetic (MRI)
• Ukuskena kweBone
• I-X-ray yesifuba

Ukwabela isiteji somdlavuza wakho, udokotela wakho usebenzisa imininingwane yalezi zinqubo. Izinombolo zamaRoma ezisukela ku-0 kuye ku-IV zibonisa izigaba zomdlavuza wesinye. Umdlavuza okhawulelwe ezingqimbeni zangaphakathi zesinye futhi ongakakhuli ukuthi uthinte udonga lwesinye olunemisipha ukhonjiswa ezigabeni eziphansi kakhulu. Isigaba esiphezulu, isigaba IV, sisikisela ukuthi ezindaweni ezikude zomzimba, umdlavuza ususakazekele kuma-lymph nodes noma ezithweni.

Njengoba odokotela beba nokuxilongwa nokunakekelwa komdlavuza, uhlelo lokugadla komdlavuza luyaqhubeka nokuvela futhi luba nzima kakhulu. Udokotela wakho usebenzisa isigaba somdlavuza wakho ukukhetha ukuthi yiziphi izindlela zokwelapha ezikulungele.

Ibanga lomdlavuza wesinye

Izimila zomdlavuza wesinye zihlukaniswa futhi ngokuya ngokuthi, uma zibhekwa ngesibonakhulu, amangqamuzana omdlavuza abukeka kanjani. Lokhu kwaziwa njengebanga lesimila, futhi umdlavuza wesinye ungakhonjwa udokotela wakho njengebanga eliphansi noma eliphakeme:

• Isimila sesinye esisezingeni eliphansi:Lolu hlobo lwesimila lunamaseli afana namaseli avamile ngokubukeka nokuhleleka (ahluke kahle). Isimila esisezingeni eliphansi ngokuvamile sikhula kancane futhi mancane amathuba okuthi kunesimila sezinga eliphezulu singene odongeni lwemisipha lwesinye.
• I-tumor yesinye sezinga eliphezulu: Lolu hlobo lwesimila lunamaseli abukeka ngendlela engavamile angafani nezicubu ezibonakala zivamile (ahlukene kabi). Isimila sezinga eliphezulu sibonakala sikhula ngokushesha kakhulu kunesimila esisezingeni eliphansi futhi singase sisakazekele odongeni lwemisipha yesinye nakwezinye izicubu nezitho.

Ukwelashwa komdlavuza wesinye

Izinketho zokunakekelwa komdlavuza wesinye zincike ezintweni ezihlukahlukene ezicatshangelwayo kanye nempilo yakho jikelele kanye nezinto ozikhethayo zokwelashwa, okuhlanganisa uhlobo lomdlavuza, izinga lomdlavuza kanye nesigaba somdlavuza.

Ukwelashwa komdlavuza wesinye kungabandakanya:

• Ukuhlinzwa ukususa izicubu ezinomdlavuza
• I-chemotherapy yesinye (i-intravesical chemotherapy), ukwelapha izimila ezivaleleke olwelweni lwesinye kodwa zibe sengozini enkulu yokuphinda noma yokuqhubekela phambili ziye esigabeni esiphezulu
• Ukwakha kabusha ukwakha indlela entsha yokuthi umchamo uphume emzimbeni ngemva kokukhishwa kwesinye
• I-Chemotherapy yomzimba wonke (i-systemic chemotherapy), ukwandisa ithuba lokwelashwa kumuntu ohlinzwa ukuze kukhishwe esinyeni, noma njengokwelashwa okuyinhloko ezimeni lapho ukuhlinzwa kungeyona inketho
• Ukwelashwa kwamafutha ukucekela phansi amangqamuzana omdlavuza, ngokuvamile njengokwelashwa okuyinhloko ezimeni lapho ukuhlinzwa kungeyona inketho noma kungafunwa
• immunotherapy ukucupha amasosha omzimba ukuthi alwe namaseli omdlavuza, kungaba esinyeni noma kuwo wonke umzimba

Udokotela wakho kanye namalungu ethimba lakho lokunakekela angase anikeze izindlela ezihlukahlukene zokwelapha.

Ukuhlinzwa komdlavuza wesinye

Izindlela zokuhlinzwa komdlavuza wesinye zingabandakanya:

• Ukukhishwa kwe-Transurethral kwe-tumor esinyeni (TURBT):I-TURBT kuyindlela yokuqeda umdlavuza wesinye nawo angewona umdlavuza ohlasela imisipha, olinganiselwe ezingqimbeni zangaphakathi zesinye. Udokotela ohlinzayo udlulisa iluphu yocingo emfushane ku-cystoscope futhi angene esinyeni ngesikhathi sokuhlinzwa. Isebenzisa amandla kagesi, iluphu yocingo ishisa amaseli omdlavuza. Ngaphandle kwalokho, amangqamuzana omdlavuza angabulawa kusetshenziswa i-laser enamandla kakhulu.I-TURBT yenziwa ngaphansi kwe-anesthesia yesifunda lapho noma ingxenye engezansi yomzimba inikezwa ama-nubs emithi noma i-anesthesia evamile lapho imithi ikwenza ulale ngesikhathi senqubo. Ubungeke ube nokusikeka (izimboko) esiswini sakho ngoba odokotela benza ukuhlinzwa ngomgudu womchamo.

  Njengengxenye yokwelashwa kwe-TURBT, udokotela wakho angase akunikeze umjovo wesikhathi esisodwa womuthi obulala umdlavuza (i-chemotherapy) esinyeni sakho ukuze kuqedwe noma yimaphi amangqamuzana omdlavuza asele kanye nokuvimbela isimila ukuthi singabuyi. Kuze kube yihora, umuthi uhlala esinyeni sakho bese uyaphuma.

• I-cystectomy ukuhlinzwa ukuze kukhishwe yonke noma ingxenye yesinye. Ngesikhathi se-cystectomy eyingxenye, udokotela wakho ohlinzayo ususa kuphela ingxenye yesinye equkethe isimila esisodwa somdlavuza. Ingxenye ye-cystectomy ingase ibe inketho kuphela uma umdlavuza ulinganiselwe endaweni eyodwa yesinye engasuswa kalula ngaphandle kokulimaza ukusebenza kwesinye.

Ukuhlinzwa ukuze kukhishwe sonke esinye isinye, ingxenye ye-ureter kanye nama-lymph nodes azungezile kuyi-radical cystectomy. Kwabesilisa, ukususwa kwe-prostate kanye nama-seminal vesicles ngokuvamile kudinga i-cystectomy enkulu. Kwabesifazane, ukukhishwa kwesibeletho, ama-ovari kanye nengxenye yesitho sangasese sowesifazane nakho kuhileleke ekususweni kwe-cystectomy enkulu.

Hlola : Izindleko zokuhlinzwa umdlavuza wesinye eNdiya

I-Radical cystectomy ingenziwa kusetshenziswa ukuhlinza ngerobhothi ngokusika okukodwa engxenyeni engezansi yesisu noma ngezimbobo ezincane ezimbalwa. Udokotela ohlinzayo uhlala kukhonsoli eseduze phakathi nokuhlinzwa kwerobhothi futhi usebenzisa izilawuli zesandla ukuze ahambise kahle amathuluzi okuhlinza erobhothi.

I-cystectomy inengozi yokopha kanye nokutheleleka. Kwabesilisa, ukungasebenzi kahle kwe-erectile kungabangelwa ukukhishwa kwe-prostate kanye ne-seminal vesicle. Udokotela wakho ohlinzayo angase akwazi ukusindisa izinzwa ezidingekayo ukuze umiswe. Kwabesifazane, ukukhishwa kwe-ovarian kubangela ukuyeka ukuya esikhathini ngaphambi kwesikhathi kanye nokungazali.

• Ukwakhiwa kabusha kwe-Neobladder:Udokotela wakho ohlinzayo kufanele asungule indlela entsha yokuthi umchamo wakho uphume emzimbeni wakho ngemva kwe-radical cystectomy (ukuphambukiswa komchamo). Ukwakhiwa kabusha kwe-neobladder kungenye yezindlela zokuphambukisa umchamo. Ngocezu lwamathumbu akho, udokotela wakho ohlinzayo wakha ichibi elimise okwendilinga. Ngezinye izikhathi kuthiwa i-neobladder, leli chibi lihlala ngaphakathi komzimba wakho futhi linamathele ku-urethra yakho. I-neobladder ikusiza ukuthi uchame ngokujwayelekile, ezimweni eziningi. Inani elincane labantu abane-neobladder banenkinga yokukhipha i-neobladder futhi kuzodingeka basebenzise i-catheter njalo ukuze bakhiphe wonke umchamo ku-neobladder.
• I-Ileal conduit:Udokotela wakho ohlinzayo wakha ishubhu (ileal conduit) esebenzisa ingxenye yamathumbu akho kulolu hlobo lokuphambukiswa komchamo. Ishubhu lisuka ezinso zakho ezikhipha ureter liye ngaphandle komzimba wakho lapho umchamo uthululelwa esikhwameni (isikhwama se-urostomy) osithwele esiswini sakho.
• I-Continent urinary reservoir:Udokotela wakho ohlinzayo usebenzisa ingxenye yamathumbu ukuze akhe isikhwama esincane (indawo yokugcina amanzi) ukuze athwale umchamo ongaphakathi emzimbeni wakho ngale ndlela yokuphambukisa umchamo. Ngokusebenzisa i-catheter izikhathi ezimbalwa ngosuku, ukhipha umchamo ethangini ngembobo esesiswini sakho.

I-Immunotherapy kumdlavuza wesinye

I-Immunotherapy, ebizwa nangokuthi i-biological therapy, ihlose ukusiza ukulwa namangqamuzana omdlavuza ngokubonisa amasosha omzimba.

Umdlavuza wesibeletho immunotherapy kuvame ukulethwa nge-urethra futhi iqonde esinyeni (i-intravesical therapy). I-Bacillus Calmette-Guerin (BCG), okuwumuthi wokugoma osetshenziselwa ukuvikela isifo sofuba, iwumuthi onjalo wokuzivikela komzimba osetshenziselwa ukwelapha umdlavuza wesinye. Uhlobo lokwenziwa lwe-interferon, okuyiprotheyini ekhiqizwa amasosha omzimba wakho ukusiza ukulwa nezifo, ingomunye umuthi we-immunotherapy. Ngokuhambisana ne-BCG, okuhlukile kokwenziwa, okubizwa ngokuthi i-interferon alfa-2b (Intron A), nayo isetshenziswa.

I-Atezolizumab (Tecentriq) iyindlela entsha yokwelapha amasosha omzimba yomdlavuza wesinye osethuthuke kakhulu noma we-metastatic wesinye okuthe ngemva kokwelashwa ngamakhemikhali, ungazange uphendule noma ube mubi kakhulu. Umuthi, umuthi ofakwa emthanjeni (IV), usebenza ngokwenza amasosha omzimba ahlasele isimila esinomdlavuza.

I-Atezolizumab nayo isacwaningwa njengendlela yokwelapha yomugqa wokuqala kubantu abanomdlavuza wesinye abangafaneleki ukuthola i-chemotherapy.

Ukulondolozwa kwesinye

Isinye singagcinwa ezinhlotsheni ezithile zesifo esihlasela imisipha ngokusebenzisa isu lokwelapha elinezingxenye ezintathu. Okuhlonzwe njengokwelashwa kwe-trimodality, i-TURBT, ukwelashwa ngamakhemikhali kanye nokwelashwa ngemisebe kuyingxenye yesu lokwelapha.

Okulandelayo ukuhlinzwa kwe-TURBT kwenziwa udokotela wakho ohlinzayo ukuze akhiphe izicubu ezinomdlavuza esinyeni sakho ngangokunokwenzeka, kuyilapho elondoloza ukusebenza kwesinye. Uthola uhlobo lwemithi yokwelapha ngamakhemikhali kanye nokwelashwa ngemisebe ngemva kwe-TURBT, konke okwenzeka emasontweni ambalwa okuqala ngemva kokuhlinzwa.

Uma ungewona wonke umdlavuza onyamalele noma unokuphindelela komdlavuza ohlasela imisipha ngemva kokuzama ukwelashwa kwe-trimodality, udokotela wakho ohlinzayo angakunikeza i-cystectomy enkulu.

Isifo somgudu womchamo ophezulu

Emgudwini womchamo ophezulu, uhlobo olufanayo lomdlavuza (umdlavuza we-urothelial) obangela iningi lomdlavuza wesinye kungenzeka futhi, okuthinta:

• Amashubhu azacile akhipha umchamo ezinsoni zakho aye esinyeni sakho (ama-ureters)
• Indawo engaphakathi kwezinso zakho lapho umchamo uqoqa khona ngaphambi kokuthulula ku-ureter (i-renal pelvis)
• Ezinye izakhiwo zomgudu womchamo ekujuleni kwezinso lapho inqubo yokukhiqiza umchamo iqala

Ukwelashwa komdlavuza womchamo ophezulu, okufana nokwelashwa komdlavuza wesinye, kuncike ezicini eziningana ezifana nobukhulu besimila, ukuma kwesimila, impilo jikelele kanye nezifiso zakho.

Umdlavuza womchamo ophezulu ngokuvamile udinga ukuhlinzwa ukuze kukhishwe umdlavuza ukuze kucekelwe noma yimaphi amangqamuzana omdlavuza ayinsalela futhi kugwenywe ukuphindelela, kanye nokwelashwa ngamakhemikhali noma ngemisebe njengezindlela zokwelapha ezilandelayo.

Uma enye yezinso zakho idinga ukukhishwa, ukuhlinzwa kungase kukushiye nenso eyodwa kuphela esebenzayo. Uma lokhu kwenzeka, kungenzeka ukuthi udokotela wakho uzokunikeza ukuhlolwa okujwayelekile kokusebenza kwezinso ukuze aqaphe ukuthi izinso zakho ezisele zenza kahle kangakanani.

Ngemva kokwelashwa komdlavuza wesinye

Umdlavuza wesinye ungaphindela. Ngenxa yalokhu, iminyaka eminingi ngemva kokwelashwa okuphumelelayo, abantu abanomdlavuza wesinye badinga ukuqapha okulandelwayo. Iziphi izivivinyo ozozenza futhi kangaki, phakathi kokunye, kuncike ohlotsheni lomdlavuza wesinye kanye nendlela oselashwe ngayo.

Cela udokotela wakho ukuthi akwakhele uhlelo lokulandelela. Ngokuvamile, eminyakeni embalwa yokuqala ngemva kokwelashwa komdlavuza wesinye, odokotela banikeza inqubo yokuhlola ingaphakathi le-urethra nesinye (cystoscopy) njalo ezinyangeni ezintathu kuya kweziyisithupha. Ungase udinge ukuhlolwa kwe-cystoscopy kanye kuphela ngonyaka ngemva kweminyaka embalwa yokugada ngaphandle kokuthola ukubuya komdlavuza. Ngezikhathi ezijwayelekile, udokotela wakho angakuyalela nezinye izivivinyo.

Ukuqapha kaningi kungenziwa kubantu abanomdlavuza ohlaselayo. Labo abanomdlavuza ongenalo ulaka bangahlolwa izikhathi ezimbalwa.

Hlola : Izindleko ze-chemotherapy yomdlavuza wesinye eNdiya

I-Intravesical Chemotherapy for Non-Muscle-Invasive Bladder Cancer

Imithi ye-intravesical ijova umuthi nge-catheter efakwe ku-urethra (umgudu ophuma umchamo emzimbeni) ngqo esinyeni esikhundleni somlomo noma ngomthambo. Ihora elilodwa kuya kwamabili, umuthi uhlala esinyeni. Ibe isikhishelwa ku-catheter noma emchamweni. Singanikeza i-intravesical chemotherapy ngemva kokuhlinzwa kwe-transurethral yomdlavuza wesinye ongewona ohlasela imisipha) wesigaba sangaphambi kwesikhathi ukuze kwehliswe ingozi yokuthi umdlavuza uzobuya. Ukwelapha ngamakhemikhali e-intravesical, ngokuvamile sisebenzisa imithi i-mitomycin (Mitosol®).

I-Chemotherapy ngaphambi Kokuhlinzwa Kwe-Muscle-Invasive Bladder Cancer

Odokotela bethu bangase banikeze i-chemotherapy ngaphambi kokuhlinzwa umdlavuza wesinye ohlasela imisipha. Le ndlela yokwelashwa ibizwa nge-neoadjuvant chemotherapy. Izivivinyo ezinkulu zemitholampilo zibonise ukuthi kubantu abanomdlavuza wesinye ohlasela imisipha, le ndlela ithuthukisa amazinga okwelapha nokuphila isikhathi eside. Ukuze uthole i-neoadjuvant chemotherapy, ngokuvamile sisebenzisa imithi ye-gemcitabine (Gemzar®) ne-cisplatin.

I-Chemotherapy Ngemva Kokuhlinzwa Kwe-Muscle-Invasive Bladder Cancer

Ngaphandle kwe-neoadjuvant chemotherapy, abanye abantu bazohlinzwa. Kulesi simo, noma yimaphi amangqamuzana omdlavuza asele angacekelwa phansi yi-chemotherapy ngemva kokuhlinzwa (i-adjuvant chemotherapy) futhi amathuba okuthi lamangqamuzana omdlavuza abe nezimila ezintsha angancipha. Sisebenzisa imithi efanayo, i-gemcitabine ne-cisplatin, ukuze uthole ukwelashwa ngamakhemikhali kwe-adjuvant asetshenziselwa i-neoadjuvant chemotherapy.

I-Chemotherapy yomdlavuza wesinye osusabalele

Imithi evamile yokwelapha ngamakhemikhali kanye nokwelashwa kwe-immunotherapy kanye nezindlela ezicwaningwayo ezivivinyweni zomtholampilo zifaka phakathi izindlela zokwelapha ezijwayelekile zomdlavuza wesinye osusabalele. Amasu anjalo ahloselwe ukucindezela izimila kanye nokunciphisa izimpawu ngenkathi kugcinwa izinga lempilo.

Imiphumela emibi ye-chemotherapy

Ngokwelashwa ngamakhemikhali esinyeni sakho, unemiphumela emibi emincane kunaleyo ongaba nayo nge-chemotherapy emthanjeni. Lokhu kungenxa yokuthi ibonakala ihlala esinyeni ngenxa yomuthi. Futhi ingena kancane kakhulu egazini lakho.

Noma yikuphi ukusabela okungekuhle kungabandakanya:

Ukucasuka kwesinye 

I-Chemotherapy ingacasula isinye sakho. Ungase uzizwe sengathi unesifo esibi somchamo (cystitis). Lokhu kungakwenza:

• phuma umchamo kaningi
• khipha umchamo ngokushesha
• uzizwa ungakhululekile
• ukuzwa ubuhlungu

Igazi emcimbini wakho

Ungase ube nenani elincane lokopha. Thinta isibhedlela ngokushesha uma:

• ukopha kuya ngokuba kubi kakhulu
• kukhona amahlule egazi emchameni wakho
• uba nobuhlungu obukhulu lapho uphuma umchamo
• awukwazi ukukhipha umchamo futhi ube nezinhlungu ezinzima

Ukuqubuka kwesikhumba nokuluma

Ngemva kokuthola lokhu kwelashwa, ungase uthole ukuqubuka ezandleni noma ezinyaweni zakho isikhathi esifushane. Okunye ukuqubuka esikhumbeni kungase kube bomvu, kube buhlungu, futhi kuvuvuke. Abanye abantu bathola ukulunywa okukhulu. Uma uthola noma yiziphi zalezi zimpawu, shayela udokotela wakho.

Ukutheleleka

Ingozi yakho yokuba nokutheleleka ingakhula nge-chemotherapy ethile. Futhi unengozi eyengeziwe yokutheleleka ngenxa yokufakwa kwe-catheter. Xhumana nodokotela wakho uma ngokuvamile uzizwa ungaphilile, unezinhlungu ezidlulele, umchamo onuka kabi noma uphuma umchamo, noma uma unomkhuhlane.

Ukusabela okweqile

Kungenzeka ukuthi kube khona ukusabela kokwelashwa ngamakhemikhali okuguliswayo. Kodwa akuvamile. Umhlengikazi ukunika izidakamizwa ukulawula ukusabela uma kwenzeka. Uma uzizwa ungaphilile noma nini, yazisa udokotela noma unesi.

I-Radiotherapy ekwelapheni umdlavuza wesinye

Kusetshenziswa nini ukwelashwa ngemisebe?

I-radiation therapy ingasetshenziswa:

• Njengengxenye yokwelashwa kwezinhlobo ezithile zomdlavuza wesinye esigabeni sokuqala , ngemva kokuhlinzwa okungasisusi sonke isinye (njenge-TURBT)
• Njengokwelashwa okuyinhloko kwabantu abanomdlavuza wesigaba sangaphambili abangakwazi ukuhlinzwa noma ukwelashwa ngamakhemikhali
• Ukuzama ukugwema i-cystectomy (ukuhlinzwa ukukhipha esinyeni)
• Njengengxenye yokwelashwa komdlavuza wesinye osethuthukile (umdlavuza osusakazeke wadlula esinyeni)
• Ukusiza ukuvimbela noma ukwelapha izimpawu ezibangelwa umdlavuza wesinye osedlulele

Ukwelashwa ngemisebe kuvame ukunikezwa kanye ne-chemotherapy ukusiza imisebe isebenze kangcono. Lokhu kubizwa i-chemoradiation.

Emnyangweni we-radiotherapy esibhedlela, unokwelashwa nge-radiotherapy. Ngokuvamile uba nayo kusukela ngoMsombuluko kuya kuLwesihlanu, futhi ngezimpelasonto, uba nekhefu.

Ukunakekelwa kwe-radiotherapy kungaba kubanzi kakhulu ukuzama ukwelapha umdlavuza wesinye. Kungathatha amaviki ama-4 kuye kwayi-7. Udokotela wakho uzokutshela ukuthi mingaki imithamo oyidingayo ye-radiotherapy.

Ngokuvamile une-radiotherapy yangaphandle, ngakho awudingi ukuhlala esibhedlela. Isikhathi ngasinye lapho uhlinzwa, kuyodingeka ushayele uye esibhedlela. Uma unendlela ende okufanele uhambe, izibhedlela ezimbalwa zinamagumbi eduze lapho ungahlala khona.

Uma usala esibhedlela, usuka ewodini lakho uye emnyangweni we-radiotherapy (isiguli esigulayo).

Kuzodingeka usule esinyeni namathumbu ngaphambi kwesikhathi ngasinye se-radiotherapy. Uzoba ne-enema (umuthi) ozoyijova ngaphansi kwakho. Uma usunalokhu, kuwumqondo omuhle ukunamathela eduze nendlu yokugezela njengoba uzodinga ukusebenzisa indlu yangasese ngokushesha ngemva kwalokho.

Ukwelapha ngemisebe kusebenzisa imishayo enamandla amakhulu egxile ngokunembile ukubulala amangqamuzana omdlavuza. Odokotela bethu baletha ukwelashwa ngemisebe ngezindlela ezihlukahlukene. Ifomu esilincomayo lincike ohlotsheni lomdlavuza, indawo yesimila, nokuthi isisabalele yini.

Hlola : Izindleko ze-radiotherapy yomdlavuza wesinye eNdiya

Njengengxenye yokwelashwa kwakho umdlavuza wesinye, ungase uthole ukwelashwa ngemisebe ngaphambi, phakathi, noma ngemva kokuhlinzwa. Lokhu kungashwabanisa amathumba noma kucekele phansi noma yimaphi amangqamuzana omdlavuza asele. Kwabanye abantu, singase sisebenzise imisebe, ngokuvamile ehlanganiswe nesilinganiso esincane se-chemotherapy, esikhundleni sokuhlinzwa ngokuphelele.

Odokotela bethu be-radiation oncologists basebenzisa amasu athuthukile ukukhomba izindawo ezisengozini kuyilapho benciphisa ukuchayeka emisebeni ezicutshini ezivamile.

I-Intraoperative Radiation Therapy ngesikhathi Sokuhlinzwa Komdlavuza Wesinye

I-Intraoperative radiation therapy iwukwelapha okunikezwayo ukunciphisa ithuba lokubuya komdlavuza ngesikhathi sokuhlinzwa komdlavuza wesinye. Le ndlela inikeza imisebe enamandla efakwa ngqo esicutshini ngamashubhu amancane abizwa ngokuthi ama-catheter. Lokhu kungase kubhubhise amangqamuzana omdlavuza angase asale ngemva kokususwa kwesimila. Uma umdlavuza usungene esinyeni, ngokuvamile uyanqunywa.

Kuphephile ukusebenzisa umthamo ophezulu kunokuvamile wemisebe njengoba lo muthi wenziwa ngesikhathi sokuhlinzwa futhi unganikezwa endaweni ecacisiwe. Izicubu ezijwayelekile, ikakhulukazi amathumbu, zingasuswa okwesikhashana endaweni yokwelashwa noma zivikelwe ngezinto ezivikelayo ngesikhathi sokulethwa kwemisebe.

Phakathi nenqubo yokuhlinzwa, ukwelashwa ngemisebe ye-intraoperative ngokuvamile kuthatha imizuzu embalwa kuphela. Zonke izinto ezihlobene nemisebe ziyasuswa kuze kube yilapho kunikezwa umthamo wemisebe, futhi inqubo iyaqhubeka.

I-External-Beam Radiation Therapy yomdlavuza wesinye

Indlela evame kakhulu yokwelapha ngemisebe ukwelapha ngemisebe yangaphandle. Ilethwa yikhompyutha evela ngaphandle komzimba. Futhi ngokuvamile, imisebe isesimweni se-X-ray. Izinhlayiya ezishajwayo ezibizwa ngokuthi ama-proton noma ezinye izinhlobo zamandla nazo ziyasetshenziswa. Njengenye indlela ye-cystectomy, odokotela bethu bangasinikeza ukwelashwa ngemisebe yangaphandle okuhambisana ne-chemotherapy enedosi ephansi (ukususwa kwesinye). Lokhu kusho ukuthi isimila siyabulawa, kodwa isinye sisala siphelele.

I-Image-Guided Radiation Therapy yomdlavuza wesinye

Sisebenzisa uhlobo lokwelapha ngemisebe yangaphandle olubizwa nge-photo-guided radiation therapy ukuze sihlole indawo yesimila kanye nokuma kwesinye ngaphambi nangesikhathi sokulethwa kokwelashwa ngemisebe. Obunye ubunzima ekuhlinzekeni ukwelashwa ngemisebe yomdlavuza wesinye ukuthi isinye siyanyakaza njengoba sithulula futhi sigcwala umchamo. Sifaka omaka begolide ukuze sibonise indawo okuyiyonayona yesimila futhi siqaphe ukunyakaza kwesinye usuku nosuku ukuze siqondise kahle izimila ekwelapheni kwemisebe eminingana.

Sivamise ukusebenzisa izikena ze-CT ezinamathiselwe emishinini yokuletha imisebe. Izithwebuli zisivumela ukuba sibone ngeso lengqondo isinye, njengamathumbu ne-rectum, kanye nezicubu ezizungezile ezivamile. Sizofinyelela amazinga aphezulu okwelapha futhi sithuthukise amathuba okugcina esinyeni sinempilo ngokusebenzisa lezi zindlela ezithuthukisiwe.

I-Intensity-Modulated Radiation Therapy Yomdlavuza Wesinye

Lapho silungiselela ukwelashwa, izindlela eziqondile zokuthwebula esizisebenzisayo zisivumela ukuthi sisebenzise ukwelapha ngemisebe okuguquguquka ngamandla ngokuphepha nangempumelelo. Le ndlela isebenzisa izinhlelo zekhompiyutha ukuze ilinganise futhi inikeze imithamo ehlukahlukene yemisebe esuka ema-engeli ahlukahlukene ukuya ngqo esimila. Odokotela bethu be-radiation oncologists babambe iqhaza eliphambili ekudaleni lolu hlobo lokwelapha ngemisebe, ngokubambisana eduze nethimba le-medical physics.

Imiphumela emibi yokwelashwa ngemisebe

Ukwelashwa ngemisebe yomdlavuza wesinye kungabangela imiphumela engemihle yesikhashana, okuhlanganisa ukuchama kaningi futhi ngokushesha okukhulu, ukushisa lapho uchama, isicanucanu, ukungakuthandi ukudla, isifo sohudo, nobuhlungu eduze kwedidi. Phakathi nokunakekelwa, izimpawu zibonakala zakha futhi ngokuvamile ziqhubeka ziba ngcono phakathi namasonto ambalwa ngemva kokuphela kokwelashwa.

Kancane kancane, amathumbu noma esinyeni singalimala unomphela ngokwelashwa ngemisebe. Ukukhipha amathumbu kungase kujwayeleke futhi kuxege futhi kungase kubangele igazi emchamweni kulimaze ulwelwesi lwesinye (radiation cystitis). Ukwelashwa ngemisebe nakho kungabangela ukuchama okubuthakathaka futhi izinyanga ezithile ngemva kokwelashwa, kwenze ukuqhanyelwa kubuhlungu.