Izicubu ze-carcinoid (emathunjini omzimba)

Yini i-carcinoid tumors (amathumbu)?

Izimila ze-Carcinoid zepheshana lesisu (GI) wuhlobo lomdlavuza olukhula olwelweni lwepheshana le-GI. Lapho amangqamuzana anda ngendlela engalawuleki, umdlavuza ukhula.

Izicubu ze-carcinoid ziyisifo esikhula kancane esingakhula ezindaweni ezahlukahlukene kuwo wonke umzimba. Izicubu ze-carcinoid, uhlobo lwesimila se-neuroendocrine, imvamisa ziqala emgudwini wokugaya (isisu, isithasiselo, amathumbu amancane, ikholoni, noma i-rectum) noma emaphashini.

Izicubu ze-carcinoid kaningi azibonisi zimpawu kuze kube sekupheleni kwesikhathi sesifo. Izicubu ze-carcinoid zingenza futhi zikhiphe ama-hormone adala izimpawu nezimpawu ezifana nohudo nokuqubuka kwesikhumba.

Ukuhlinzwa kuvame ukusetshenziselwa ukwelapha izicubu ze-carcinoid, kepha imithi ingasetshenziswa futhi.

Izimila ze-Carcinoid ze-gastrointestinal ipheshana lakhiwe uhlobo oluthile lweseli ye-neuroendocrine (uhlobo lweseli olufana nengqamuzana lomthambo kanye neseli elenza amahomoni). Lawa maseli angatholakala kuwo wonke esifubeni nasesiswini, kodwa iningi litholakala emgudwini wamathumbu. Amahomoni akhiqizwa amaseli e-neuroendocrine asiza ekulawuleni uketshezi lokugaya ukudla kanye nemisipha ehambisa ukudla esiswini nasemathunjini. Amahomoni angase akhiqizwe yisimila se-GI carcinoid futhi akhishwe emzimbeni.

Izicubu ze-carcinoid ezisemgodini wamathumbu azivamile, futhi iningi likhula kancane. Amathumbu amancane, i-rectum, ne-appendix yizindawo ezivame kakhulu. Izicubu eziningi zingavela ngasikhathi sinye.

Lapho i-DNA yamaseli aphilile iphazamiseka, amaseli ayashintsha futhi ande angalawuleki, okuholela ekwakhekeni kwesimila. Izicubu zingaba yingozi noma zingabi nomdlavuza. Uma isimila esibi singatholakali futhi silashwe kusenesikhathi, singakhula futhi sisabalale nakwezinye izingxenye zomzimba. Lokhu kubizwa ngokuthi isimila esibi. Igama elithi "isimila esibi" lisho isimila esingakhula kodwa singasakazeki. I-tumor enobungozi ngokuvamile ingasuswa ngaphandle kokubangela umonakalo omkhulu. Izicubu ze-NET zonke izicubu ezimbi.

Isigaxa se-neuroendocrine (NET) siqala kumaseli akhethekile ohlelo lomzimba lwe-neuroendocrine. Lawa maseli anezici zombili ezikhiqiza i-endocrine nezinzwa zamangqamuzana ezinzwa. Atholakala kuzo zonke izitho zomzimba futhi asiza ekulawuleni imisebenzi eminingi yomzimba. AmaHormone ngamangqamuzana amakhemikhali ahamba egazini futhi athonya ukusebenza kwezitho namaseli ahlukahlukene emzimbeni. Iningi lama-NET lithatha iminyaka ukukhula nokukhula. Amanye ama-NET, ngakolunye uhlangothi, angakhula ngokushesha.

Izimpawu zezicubu ze-carcinoid

• Ubuhlungu besisu
• Uhudo
• Isicanucanu, ukuhlanza nokungakwazi ukwedlula indle ngenxa yokuvaleka kwamathumbu (ukuvimbeleka kwamathumbu)
• Ukuphuma kwegazi
• Ubuhlungu obukhulu
• Ubomvu noma umuzwa wemfudumalo ebusweni nasentanyeni (ukuqhuma isikhumba)

Ukuxilongwa kwezicubu ze-carcinoid

Lezi zivivinyo nezinqubo ezilandelayo zingasetshenziswa:

Ukuhlolwa Komzimba: Ukuhlolwa komzimba ukubheka izimpawu ezijwayelekile zempilo, kanye nezimpawu zezifo, njengezicubu noma yini enye ebonakala ingajwayelekile. Kuzotholakala umlando wezokwelapha wemikhuba yezempilo yesiguli, kanye nezifo nokwelashwa kwangaphambilini.

Amakhemikhali egazi: Isampula yegazi ihlolwa ukuthola amazinga ezinhlanganisela ezithile ezikhiqizelwa egazini ngezitho nezicubu emzimbeni, njengamahomoni. Inani elingajwayelekile lezinto (ezinkulu noma eziphansi kunokujwayelekile) kungaba uphawu lokugula. Isampula yegazi ihlolwe ubukhona behomoni ekhiqizwa izicubu ze-carcinoid. Lokhu kuhlolwa kwenziwa ukunquma ukuthi une-carcinoid syndrome noma cha.

I-Tumor izivivinyo zikamaka: Inqubo lapho kuhlolwe khona isampula yegazi, umchamo, noma isicubu ukuthola amazinga amakhemikhali athile akhiqizwa izitho zomzimba, izicubu, noma amangqamuzana omzimba emzimbeni, njenge-chromogranin A. Isimila se-tumor yi-chromogranin A. Lapho kutholakala ku ukugxila okuphezulu emzimbeni, kuhlobene nezicubu ze-neuroendocrine. 

Ukuhlolwa komchamo: Ukuhlolwa lapho kuthathwa khona umchamo amahora angama-24 ukuthola inani lamakhemikhali athile, njenge-5-HIAA noma i-serotonin (i-hormone). Izinga eliphakeme ngokungajwayelekile noma eliphansi lekhemikhali lingakhombisa ukugula esithombeni noma esikhunjeni esikukhiqizayo. Lokhu kuhlolwa kwenziwa ukunquma ukuthi une-carcinoid syndrome noma cha.

Ukuskena kwe-MIBG: Indlela yokuthola umdlavuza we-neuroendocrine njengezicubu ze-carcinoid. I-MIBG (metaiodobenzylguanidine) yinto enemisebe efakwa emthanjeni futhi edlula ekusakazeni. Izicubu ze-carcinoid zimunca okokusebenza okukhipha imisebe, okutholwa umtshina wemisebe.

Ukuskena kwe-CT: Iskena se-CT (esaziwa nangokuthi yi-CAT scan) inqubo ebandakanya ukuthatha ukulandelana kwezithombe eziningiliziwe zezitho ezihlukene zomzimba ezinhlangothini ezahlukahlukene. Ikhompyutha exhunywe kwimishini ye-x-ray idala izithombe. Ukwenza izitho noma izicubu zivele ngokucacile, idayi ingafakwa emthanjeni noma ifakwe. I-computed tomography, i-computer ene-tomography, kanye ne-computer axial tomography wonke amagama asetshenziselwa ukuchaza lo msebenzi.

I-MRI (imaging resonance imaging): I-MRI iyindlela ehilela ukusetshenziswa kukazibuthe, amaza omsakazo, nekhompyutha ukuze kwakheke uchungechunge lwezithombe ezinemininingwane yezitho zangaphakathi. Nuclear imaging resonance magnetic elinye igama lalokhu kwelashwa.

Iskena se-PET (scan positron emission tomography): Inqubo esetshenziselwa ukuthola amangqamuzana amabi esigaxa emzimbeni wonke. Umthambo ufakwa ngenani elincane le-glucose enemisebe (ushukela). Isithwebuli se-PET sijikeleza umzimba wonke, sakha isithombe lapho kusetshenziswa khona i-glucose. Ngoba amangqamuzana amabi esigaxa asebenza kakhulu futhi athatha i-glucose eningi kunamaseli ajwayelekile, abonakala ekhanya esithombeni.

I-endoscopic ultrasonography (EUS) inqubo ebandakanya ukufaka i-endoscope emzimbeni ngomlomo noma nge-rectum. Imishini emincane, efana nethubhu equkethe ukukhanya nelensi yokubuka yaziwa njenge-endoscope. Amagagasi omsindo anamandla aphakeme (i-ultrasound) ahlaselwa izicubu zangaphakathi noma izitho, ezifana nesisu, amathumbu amancane, ikholoni, noma i-rectum, futhi ama-echoes akhiqizwa ngophenyo ekugcineni kwe-endoscope. Ama-echoes ahlangana akhiqize i-sonogram, ekhombisa izicubu zomzimba. I-Endosonography elinye igama lalokhu kuhlinzwa.

I-endoscopy ephezulu ukwelashwa okubandakanya ukubona ezithweni zomzimba nezicubu zomzimba ukubheka okungajwayelekile. I-endoscope ingeniswa esiswini ngomlomo bese idlulela engqungqutheleni. I-endoscope kwesinye isikhathi idluliselwa kusuka esiswini iye emathunjini amancane. Imishini emincane, efana nethubhu equkethe ukukhanya nelensi yokubuka yaziwa njenge-endoscope. Kungafaka futhi ithuluzi lokususa amasampula wezicubu noma ama-lymph node, ahlolwe ngaphansi kwesibonakhulu ukuthola izimpawu zokugula.

I-Colonoscopy: Ukuhlolwa kwe-rectum ne-colon yama-polyps, izifunda ezingavamile, noma umdlavuza. I-colonoscope ifakwa kukholoni ngokusebenzisa i-rectum. I-colonoscope iyithuluzi elincane, elifana nethubhu elinokukhanya okubukwayo nelensi. Kungafaka futhi ithuluzi lokususa ama-polyps noma amasampuli wezicubu, abuye ahlolwe ngaphansi kwesibonakhulu sezimpawu zomdlavuza.

I-capsule endoscopy kuyindlela ekuvumela ukuthi ubone lonke ithumbu elincane. Iphilisi eliqukethe ikhamera encane ligwinya isiguli. Ikhamera iqoqa izithombe ngenkathi i-capsule idlula emgodini wamathumbu bese izithumela kusamukeli engaphandle komzimba.
I-Biopsy inqubo yokususa amaseli noma izicubu ukuze zihlolwe ngaphansi kwesibonakhulu ukuthola izimpawu zomdlavuza. Ngesikhathi se-endoscopy ne-colonoscopy, amasampula wezicubu angaqoqwa.

Ukwelashwa kwezicubu ze-carcinoid

Ukwelashwa kwesimila se-carcinoid kunqunywa indawo okukhona kuyo isimila, noma ngabe umdlavuza ususabalele kwezinye izingxenye zomzimba, amahomoni akhishwa yilesi sifo, impilo yakho yonke, kanye nezinto ozithandayo.

Izinketho zokwelashwa zezicubu ze-carcinoid zingafaka:

Ukuhlinzwa: Isigaxa se-carcinoid singasuswa ngokuhlinzwa ngokuphelele uma sibanjwe kusenesikhathi. Lapho kutholakala izicubu ze-carcinoid esigabeni esithuthukile, ukususwa ngokuphelele kungahle kungenzeki. Ukusiza ukuphatha izinkomba nezimpawu, odokotela abahlinzayo bangahlose ukususa isimila esiningi ngendlela engenzeka kwezinye izimo.
Ama-hormone amaningi angalawulwa ngemithi. Ukuvimbela ama-hormone akhishwe yisimila ngezidakamizwa kunganciphisa izimpawu nezimpawu zesifo se-carcinoid ngenkathi futhi kunciphisa ukukhula kwesimila.

Ngaphansi kwesikhumba, i-octreotide (iSandostatin, iBynfezia Pen) ne-lanreotide (iSomatuline Depot) iyajova. Ubuhlungu besisu, ukuqunjelwa, nohudo yonke imiphumela engemihle yemithi yomibili. I-Telotristat (i-Xermelo) ithebhulethi ethathwa ngezikhathi ezithile ngokuhlangana ne-octreotide noma i-lanreotide ukusiza ngezimpawu zesifo se-carcinoid.

I-Chemotherapy: Ukwelashwa ngamakhemikhali ukwelashwa okusebenzisa imithi enamandla ukuqeda amangqamuzana e-tumor. Kungaba kufakwa emthanjeni engalweni yakho noma kugwinywe njengephilisi. I-Chemotherapy kwesinye isikhathi isetshenziselwa ukwelapha izicubu ezisezingeni eliphakeme ze-carcinoid ezingasuswa ngokuhlinzwa.
Ukwelashwa kwezidakamizwa okuhlosiwe: Ukwelashwa kwezidakamizwa ngenhloso ethile engqondweni. Imithi yokwelashwa ehlosiwe yenzelwe ukukhomba ukungajwayelekile okuthile okutholakala kumaseli wesimila. Ukwelashwa kwemithi okuhlosiwe kungabulala amangqamuzana e-tumor ngokuvimbela lokhu okungahambi kahle. Ngezicubu eziphambili ze-carcinoid, ukwelashwa kwemithi okuhlosiwe kuvame ukubhangqwa ne-chemotherapy.

Ukwelashwa ngemisebe: Izidakamizwa ezinikeza imisebe emangqamuzaneni omdlavuza ngqo. I-PRRT (peptide receptor radionuclide therapy) ukwelashwa okuhlanganisa umuthi okhomba amangqamuzana omdlavuza ngento enemisebe ewaqothulayo. Umuthi ufakwa emzimbeni wakho, lapho uhambela khona amangqamuzana omdlavuza, unamathele kuwo, futhi uhambise imisebe ngqo kubo ku-PRRT yamathumba e-carcinoid. Abantu abanezicubu ezisezingeni eliphakeme ze-carcinoid bangakwazi ukuzuza kulokhu kwelashwa.

Umdlavuza osusabalele esibindini uyalashwa. Izimila ze-carcinoid zivame ukungena esibindini. Ukuhlinzwa ukuze kukhishwe ingxenye yesibindi, ukunciphisa ukugeleza kwegazi esibindini (i-hepatic artery embolization), kanye nokusebenzisa ukushisa nokubanda ukucekela phansi amangqamuzana omdlavuza kuyizindlela zokwelapha ezingenzeka.

Ukuqothulwa kwemisebe ye-Radiofrequency isebenzisa ukushisa okuphezulu ukubulala amangqamuzana e-carcinoid tumor esibindi.

I-Cryoablation ubulala amangqamuzana omdlavuza ngokuwaqanda futhi awancibilikise ephindelela.