Izimila ze-stromal zamathumbu

Izimila ze-Gastrointestinal stromal (GISTs) ziqala ngezigaba zakuqala kakhulu kumaseli e-interstitial e-Cajal, uhlobo oluthile lweseli olutholakala odongeni lwepheshana le-GI (ICCs). Ngenxa yokuthi atshela imisipha yepheshana le-GI ukuthi ivume ukuthutha ukudla noketshezi, ama-ICC avame ukubizwa ngokuthi “ama-pacemaker” esistimu yokugaya ukudla.

Esiswini, ngaphezu kwesigamu sama-GIST aqala. Ama-GIST angaqala noma yikuphi kulo lonke ipheshana le-GI, ngokungafani nezinye izinhlobo zomdlavuza, ezivame ukuqala emathunjini amancane. Iphesenti elincane lama-GIST liqala ngaphandle kwepheshana le-GI ezifundeni ezizungezile njenge-peritoneum noma i-omentum, okuwungqimba lwamafutha olunwebeka ezithweni zesisu njengephinifa (ulwelwesi oluncane phezu kwezitho nezindonga ngaphakathi kwesisu).

Amanye ama-GIST abonakala esemathubeni amaningi okuthi akhule abe kwezinye izindawo noma asakazekele kwezinye izingxenye zomzimba. Odokotela babheka izici ezithile ukusiza ukubona ukuthi i-GIST kungenzeka yini ikhule futhi isakazeke ngokushesha, njengalezi:

• Usayizi we isisu
• Lapho itholakala khona epheshaneni le-GI
• Amaseli wesimila ahlukana ngokushesha kangakanani.

Izimpawu ze-GSIT

Isisu noma udonga lwamathumbu amancane yilapho iningi lamathumba e-gastrointestinal stromal (GISTs) liqala ukukhula. Lezi zimila zivame ukunwetshwa endaweni yamahhala yepheshana le-GI, ngakho-ke ngaphandle kokuthi zisendaweni ethile noma zifinyelele usayizi othize, zingase zingadali izimpawu ngokushesha.

Izimila ezincane zingase zingabonisi noma yiziphi izimpawu futhi zingatholwa udokotela ngokungenhloso lapho ehlola enye inkinga. Lezi zimila ezincane zivame ukukhula kancane.

Small HLALANIs ingase ingabi nazimpawu, futhi ingase ikhule kancane kangangokuthi ingabangeli izinkinga ekuqaleni. Njenge HLALANI iyakhula, ingabangela izimpawu nezimpawu. Angase ahlanganise:

• Ubuhlungu besisu
• Ukukhula ongakuzwa esiswini sakho
• Ukukhathala
• I-nausea
• Ukuvota
• Ubuhlungu be-Cramping esiswini ngemuva kokudla
• Ukungazizwa ulambile ngesikhathi obungakulindela
• Ukuzizwa usuthi uma udla ukudla okuncane nje
• Indle enombala omnyama ebangelwa ukopha ohlelweni lokugaya ukudla

HLALANIs zingenzeka kubantu kunoma ibuphi ubudala, kodwa zivame kakhulu kubantu abadala futhi azivamile kakhulu ezinganeni. Imbangela yabaningi HLALANIs akwaziwa. Inani elincane libangelwa izakhi zofuzo ezisuka kubazali ziye ezinganeni.

Izimpawu ngenxa yokulahlekelwa igazi

Ama-GIST avame ukuba izimila ezintekenteke ezingopha kalula. Eqinisweni, zivame ukutholakala ngoba zibangela ukopha kupheshana le-GI. Izimpawu nezimpawu zalokhu kopha zincike ekutheni kwenzeka ngokushesha kangakanani nokuthi isimila sitholakala kuphi.

• Ukopha ngokushesha kummizo noma esiswini kungase kubangele umuntu ukuba enze kanjalo chitha igazi. Lapho igazi lilahlwa lingase ligaywe kancane, ngakho lingase libukeke njengezindawo zekhofi. 
• Ukopha ngokushesha esiswini noma emathunjini amancane kungenza ukunyakaza kwamathumbu (indle) emnyama futhi ehlala njalo.
• Ukopha ngokushesha emathunjini amakhulu kungenzeka shintsha isihlalo sibe bomvu ngegazi elibonakalayo.
• Uma ukopha kuhamba kancane, ngokuvamile akubangeli ukuthi umuntu achithe igazi noma ashintshe indle. Nokho, ngokuhamba kwesikhathi ukopha kancane kungaholela ekwehliseni inani lamangqamuzana abomvu egazi ( anemia ), okungenza umuntu azizwe ukhathele futhi ubuthakathaka.

Ukopha epheshaneni le-GI kungaba kubi kakhulu. Uma unesinye salezi zimpawu noma izimpawu, bonana nodokotela ngokushesha.

Ukuxilongwa kwe-GIST

Ama-GIST (izimila ze-stromal emathunjini) avame ukutholwa ngenxa yezimpawu noma izimpawu. Ezinye izindaba zitholwa ngezivivinyo noma ukuhlolwa. Nokho, akwenzeki ngaso sonke isikhathi ukunquma ngokuqiniseka okuphelele uma umuntu ene-GIST noma olunye uhlobo lwesimila esiswini (GI) esivela kulezi zimpawu noma ukuhlolwa kokuqala. Uma kusolwa isimila se-GI, kuzodingeka ukuhlolwa okwengeziwe ukuze usihlonze.

Umlando wezokwelapha kanye nokuhlolwa komzimba

Umlando wakho wezempilo, okuhlanganisa nezimpawu zakho, izinto ezingaba yingozi, umlando womndeni, nanoma yiziphi izinkinga zezokwelapha, kuzoxoxwa ngakho nodokotela.

Ukuze ufunde kabanzi mayelana nanoma yiziphi izimpawu ezingokomzimba zesimila se-GI, njengesisindo sesisu, noma ezinye izindaba zezempilo, udokotela wakho uzokuhlola ngokomzimba.

Udokotela uzokwenza izivivinyo ze-imaging noma izivivinyo ze-endoscopy uma kunesizathu sokukholelwa ukuthi ungase ube ne-GIST (noma olunye uhlobo lwesimila se-GI) ukusiza ukunquma ukuthi umdlavuza noma enye into. Ungathunyelwa kuchwepheshe ngenkathi ubona udokotela wakho oyinhloko, njenge-gastroenterologist (udokotela owelapha izifo zesimiso sokugaya ukudla).

Uma kutholwa i-GIST, cishe uzohlolwa okwengeziwe ukuze usize ukuhlonza isigaba somdlavuza (izinga).

Ukuhlola ukuhlolwa

Ukuhlolwa kwesithombe kusebenzisa ama-x-reyi, amandla kazibuthe, noma izinto ezikhipha imisebe ukuze kwakhe izithombe zangaphakathi emzimbeni. Ukuhlolwa kwesithombe kwenziwa ngenxa yezizathu eziningi, ezihlanganisa:

• Ukusiza ukuthola ukuthi indawo esolisayo ingaba umdlavuza
• Ukuze ufunde ukuthi umdlavuza ususabalele kangakanani
• Ukusiza ukunquma ukuthi ukwelashwa kube yimpumelelo yini
• Ukubheka izimpawu zokuthi umdlavuza usubuyile

Iningi labantu okucatshangwa ukuthi line-GI tumor lizothola okukodwa noma ngaphezulu kwalokhu kuhlolwa.

Icwecwe le-computer tomography (CT)

I-CT scan idala izithombe ezinemininingwane emihle yezingxenye ezihlukene zomzimba wakho kusetshenziswa ama-x-ray. I-CT scan ikhiqiza izithombe ezinembile zezicubu ezithambile zomzimba, ngokungafani ne-x-ray evamile.

Iziguli (noma ezisengozini) ye-GIST zingazuza kuma-CT scan ukuze zinqume usayizi nendawo yesimila kanye nokunquma ukuthi sithuthele kwezinye izindawo zomzimba.

Kwezinye izimo, ama-CT scans angasetshenziswa futhi ukuqondisa ngokunembile inaliti ye-biopsy endaweni engase ibe nomdlavuza. Lezi zinhlobo ze-biopsies zivame ukwenziwa kuphela uma imiphumela ingaba nomthelela ekukhethweni kokwelashwa. Kodwa-ke, lokhu kungaba yinkinga uma isimila singase sibe yi-GIST (ngenxa yengozi yokopha kanye nengozi ekhulayo yokusabalala kwesimila). 

I-Magnetic resonance imaging (MRI) scan

Ama-MRI scan akhiqiza izithombe ezinemininingwane yezicubu ezithambile zomzimba, njengoba kwenza ama-CT scan. Nokho, I-MRI iskena amaza omsakazo angena esikhundleni nozibuthe abanamandla ngama-x-ray.

Nakuba ama-CT scan anele isikhathi esiningi, izikena ze-MRI ngezinye izikhathi zingaba usizo ekutholeni izinga lomdlavuza esiswini kubantu abane-GIST. Ama-MRIs angasetshenziswa futhi ukuhlola umdlavuza okungenzeka ukuthi ubuyile (uphindekile) noma wasakazeka (umetastasized), ikakhulukazi ebuchosheni noma emgogodleni.

I-X-ray ye-Barium

Uma kuqhathaniswa nezikhathi zangaphambili, ama-x-ray e-barium awasasetshenziswa kaningi. Aye athathelwa indawo kakhulu yi-endoscopy kanye ne-CT/MRI (lapho udokotela empeleni ebheka ngaphakathi kommizo wakho, isisu, namathumbu enobubanzi obuncane be-fiberoptic - bheka ngezansi).

Kulezi zinhlobo zama-x-reyi, ulwelwesi lwangaphakathi lomminzo, isisu, namathumbu lumbozwe ngoketshezi oluchaki oluqukethe i-barium. Lokhu kwenza kube lula ukubona izingxenye zolayini ezingajwayelekile ku-x-ray. Lezi zivivinyo zisetshenziselwa ukukhomba izifo ze-GI, kodwa ngezinye izikhathi ziyehluleka ukubona izimila zamathumbu amancane.

Ngokunokwenzeka, uzodinga ukuqala ukuzila ukudla kusihlwa ngaphambi kokuhlolwa. Kungase kudingeke ukuthi uphuze ama-laxative kanye/noma ama-enema ukuze uhlanze amathumbu ngobusuku bangaphambili noma ekuseni yokuhlolwa uma ikholoni lakho lihlolwa.

Ukugwinya kwe-barium

Uma othile enenkinga yokugwinya, ngokuvamile lokhu kuwukuhlola kokuqala okwenziwayo. Uphuza isiphuzo esine-barium ukuze uvale ulwelwesi lomgudu wakho ukuze ulungiselele lokhu kuhlolwa. Imizuzu embalwa elandelayo ichithwa kuthathwa uchungechunge lwama-x-reyi.

Upper GI uchungechunge

Ngaphandle kokuthi ama-x-ray athathwa ngemva kokuba i-barium ibe nesikhathi sokuvala isisu kanye nengxenye yokuqala yamathumbu amancane, lokhu kuhlolwa kuqhathaniswa nokugwinya kwe-barium. Ama-x-reyi amaningi angathathwa phakathi namahora ambalwa alandelayo njengoba i-barium ihamba ukuze ihlole izinkinga emathunjini amancane asele. Isibonelo salokhu wukulandela amathumbu amancane.

I-Enteroclysis

Umlomo wakho noma ikhala, umminzo, isisu, kanye nesiqalo samathumbu amancane konke kungena ngeshubhu elincane. Into enyusa umthamo womoya emathunjini futhi ibangele ukuthi ande iphinde ihanjiswe ngeshubhu eline-barium. Amathumbu abe esekhishwa nge-radiograph ngemva kwalokho. Uma kuqhathaniswa nokulandela amathumbu amancane, lokhu kuhlola kunganikeza imibono engcono yamathumbu amancane kodwa futhi kubuhlungu kakhulu.

I-enema ye-barium

Lokhu kuhlola, ngezinye izikhathi okubizwa ngokuthi uchungechunge lwe-GI ephansi, kuhlola indawo yangaphakathi yamathumbu amakhulu (ikholoni kanye ne-rectum). Ngenkathi uhlezi etafuleni le-x-ray, ishubhu elifushane, eligobekayo lifakwa endunu ukuze linikeze isisombululo se-barium salokhu kuhlolwa. Ukusiza ukuhambisa i-barium iye odongeni lwekholoni futhi kuvale kangcono indawo engaphakathi, umoya uvame ukumpontshelwa ngeshubhu futhi. I-barium enema ye-air-contrast noma i-barium enema ephindwe kabili yilokho okuyikho. Ukusiza ukusabalalisa i-barium kanye nokuthola imibono eminingi yekholoni, ungacelwa ukuthi ulungise indawo yakho. Ngemuva kwalokho, ama-x-ray athathwa esethi eyodwa noma ngaphezulu.

Ukuskena kwe-Positron emission tomography (PET)

Uthola umjovo onoshukela omncane onemisebe ogxile kakhulu kumaseli omdlavuza ukuze ube ne-PET scan. Khona-ke, isithombe sezindawo ezikhipha imisebe emzimbeni senziwa kusetshenziswa ikhamera ethile. Nakuba i-PET scan ingenakukwazi ukunikeza izinga lolwazi elilingana ne-CT noma i-MRI scan, ingase ihlole ngesikhathi esisodwa umdlavuza ongase usakazeke kuwo wonke umzimba.

Namuhla, izikhungo eziningi zinemishini ekwazi ukwenza i-PET ne-CT scan kanyekanye (PET/CT scan). Lokhu kwenza udokotela akwazi ukubhekisisa noma yiziphi izifunda “ezikhanya” ku-PET scan.

Uma imiphumela ye-CT noma ye-MRI scan ingacacile, ama-PET scan angasiza ekuhloleni ama-GIST. Lokhu kuhlola kungenziwa futhi ukucinga izindawo ezingase zibe khona lapho umdlavuza ungase ube ne-metastasized ukuze kuhlolwe ukuthi ingabe ukuhlinzwa kuyindlela yokuzikhethela.

Ukusebenza kokwelashwa kwemithi nakho kunganqunywa kusetshenziswa ama-PET scan, avame ukunikeza imiphumela ngokushesha kune-CT noma i-MRI scan. Ukuskena kuvame ukwenziwa emasontweni ambalwa ngemva kokuba umuthi uthathwe okokuqala. Isimila sizoyeka ukumunca ushukela okhipha imisebe uma umuthi usebenza. Udokotela wakho angase anqume ukushintsha indlela yokwelapha uma isimila siqhubeka nokumunca ushukela.

I-Endoscopy

Ishubhu eguquguqukayo, ekhanyisiwe enekhamera yevidiyo encane ekugcineni ibizwa ngokuthi i-endoscope, futhi ifakwa emzimbeni ngesikhathi se-endoscopy ukuze ibuke uhlaka lwangaphakathi lwepheshana le-GI. Izingcezu ezincane zingacutshungulwa (zisuswe) nge-endoscope uma kutholakala izindawo ezingavamile. Ukunquma ukuthi amasampula e-biopsy anomdlavuza futhi, uma kunjalo, hlobo luni lomdlavuza, luzohlolwa ngesibonakhulu.

Ama-GIST avame ukubonakala ngaphansi kwe-mucosa, noma ungqimba lwangaphandle, lolwelwesi lwangaphakathi lwepheshana le-GI. Ngokuphambene nezimila zepheshana le-GI ezivamile, ezivame ukuqala ku-mucosa, kungase kube nzima kakhulu ukuzibona nge-endoscopy. Uma kukhona i-GIST, udokotela angase akwazi ukubona iqhubu ngaphansi kwendawo ngokuvamile ebushelelezi. Ukwengeza, ama-GIST angaphansi kwe-mucosa anzima kakhulu ukuwahlola nge-endoscope. Lesi ngesinye sezimbangela eziyinhloko ze-GIST engaxilongwa ngaphambi kokuhlinzwa.

Kunamathuba aphezulu okuthi i-GIST izosabalala iye kwezinye izingxenye zomzimba uma isimila singene olwembeni lwangaphakathi lwepheshana le-GI futhi sibonakala ku-endoscopy.

I-endoscopy ephezulu

Kulokhu kuhlinzwa, ulwelwesi lwangaphakathi lomgudu womphimbo, isisu, nengxenye yokuqala yamathumbu amancane kuhlolwa kusetshenziswa i-endoscope eyethulwa ngomlomo futhi yehle entanyeni. Noma yiziphi izingosi eziphambukayo zingaba yisihloko samasampula e-biopsy.

Isibhedlela, isikhungo sokuhlinza ngaphandle, noma ihhovisi likadokotela konke kungenza i-endoscopy ephezulu. Ngokuvamile, uthola imithi ngomugqa we-intravenous (IV) ukuze ubangele ukulala ngaphambi kokuhlolwa. Ukuhlola ngokwako ngokuvamile kuthatha phakathi kwemizuzu eyi-10 nengama-20, kodwa uma kutholwa isimila noma kudingeka amasampula e-biopsy aqoqwe, isikhathi singase sikhuphuke.

I-Colonoscopy

I-colonoscopy, uhlobo oluthile lwe-endoscope, yethulwa nge-anus futhi ikhuphukele ekoloni ngesikhathi se-colonoscopy. Lokhu kusiza udokotela ukuthi ahlole ulwelwesi lwangaphakathi lwekholoni kanye ne-rectum futhi aqoqe amasampula e-biopsy kunoma yiziphi izindawo ezingavamile.

Kufanele ihlanzwe kahle ngaphambi kokuhlolwa ukuze uthole umbono ocacile wengaphakathi lekholoni. Uzothola imiyalelo enemininingwane evela kudokotela wakho. Ngaphambi kokuhlolwa, kungase kudingeke unamathele ekudleni okuthile usuku noma ngaphezulu. Ukwengeza, kungase kudingeke ukuthi udle inani elikhulu le-laxative ewuketshezi ngobusuku bangaphambilini, okuzodinga ukuthi uchithe isikhathi esiningi endlini yangasese.

Isikhungo sokuhlinza iziguli zangaphandle, ihhovisi likadokotela, noma isibhedlela yizo zonke izindawo okungenzeka ukuthi kwenziwe i-colonoscopy. Ngokunokwenzeka, umuthi ofakwa emthanjeni (IV) uzonikezwa ngaphambi kokwelashwa ukuze ukusize uzizwe ukhululekile futhi ulele. Kancane kancane, i-anesthesia ejwayelekile ingase inikezwe ukuze ulale kakhulu. Ukuhlolwa kuvame ukuthatha imizuzu eyi-15 kuye kwengama-30, kodwa uma kutholwa isimila noma kudingeka isampula, isikhathi singanwetshwa.

I-capsule endoscopy

Kokubili i-colonoscopy ne-endoscopy ephezulu azikwazi ukufinyelela wonke amathumbu amancane. Enye indlela yokubuka amathumbu amancane nge-capsule endoscope.

I-endoscope empeleni ayisetshenziswa kule nqubo. Esikhundleni salokho, umthombo wokukhanya nekhamera encane kufakwe ku-capsule oyingenisayo. Le capsule ilingana nethebhulethi enkulu yamavithamini. I-capsule idlula esiswini futhi iye emathunjini amancane njenganoma yiliphi elinye iphilisi. Ithwebula izinkulungwane zezithombe ngenkathi idlula emathunjini, ngokuvamile okuthatha cishe amahora angu-8. Lezi zithombe zidluliselwa nge-elekthronikhi kudivayisi ekhalwe. Udokotela angakwazi ukuhlola izithombe njengevidiyo ngemva kokuzilanda ekhompyutheni. Ngesikhathi sokunyakaza kwamathumbu okujwayelekile, i-capsule ishiya umzimba futhi ikhishwe.

Ungaqhubeka nemisebenzi yakho yansuku zonke ngenkathi i-capsule idlula ipheshana le-GI njengoba lokhu kuhlolwa akudingi ukuthuliswa. Izicelo eziphumelela kakhulu zale ndlela entsha uma kuqhathaniswa zisacwaningwa. Enye i-drawback ukuthi kulo lonke uvivinyo, noma yiziphi izifunda eziphambukayo ezibonakalayo azikwazi ukwenziwa nge-biopsy.

I-Enteroscopy yebhaluni ephindwe kabili (i-endoscopy)

Lona umbono ohlukile emathunjini amancane. I-endoscopy evamile ayikwazi ukunikeza ukuhlolwa okuphelele kwamathumbu amancane ngenxa yobude nokuyinkimbinkimbi. Kodwa-ke, le ndlela iyabagwema ngokusebenzisa i-endoscope eyingqayizivele enamashubhu ama-2, elinye ngaphakathi kwelinye.

Uthola imishanguzo ejwayelekile yokubulala izinzwa noma yomjovo (IV) ukukusiza uphumule (ukuze ulele). Ngokuya nganoma yisiphi isigaba samathumbu amancane okudingeka sihlolwe, i-endoscope kamuva ifakwa ngomlomo noma nge-anus.

Ishubhu elingaphakathi elinekhamera lihamba phambili cishe izinyawo uma selingaphakathi emathunjini amancane njengoba udokotela ehlola ulwelwesi. I-endoscope ibe isiqiniswa ngokufutha ibhaluni esihlokweni sayo. Ibhaluni lesibili lisetshenziselwa ukuvikela ishubhu elingaphandle lapho selithuthukile ukuze licishe lifinyelele ekugcineni kweshubhu elingaphakathi. I-endoscope iphinde ithuthuke ngemva kokuba ibhaluni lokuqala selivuthelwe umoya. Udokotela angakwazi ukubona ngeso lengqondo amathumbu unyawo olulodwa ngesikhathi ngokwenza ngokuphindaphindiwe le nqubo. Kungathatha amahora ukuqeda ukuhlolwa.

Kanye ne-capsule endoscopy, lokhu kuhlolwa kungenziwa. Inzuzo eyinhloko yalokhu kuhlolwa nge-capsule endoscopy yikhono likadokotela lokwenza i-biopsy uma kutholakala okungavamile. Ngoba unikezwa imithi yokukugcina wozele ngenqubo, efana nezinye izinhlobo ze-endoscopy.

I-endoscopic ultrasound (EUS)

Lolu hlobo lokuhlolwa kwesithombe lisebenzisa i-endoscope. Amaza omsindo asetshenziswa kuyi-ultrasound ukuthatha izithombe zezitho zomzimba. I-transducer-i-wand-like probe-isetshenziswa esikhumbeni ngesikhathi sokuhlolwa okuningi kwe-ultrasonic. I-probe ikhipha amaza omsindo, abese ethathwa yiphethini yama-echoes.

I-ultrasonic probe ye-EUS itholakala ekugcineni kwe-endoscope. Lokhu kwenza i-probe ibekwe eduze kakhulu (noma ngaphezulu) kwethumba lepheshana le-GI. I-probe ikhipha amaza omsindo bese ilalela ama-echo abuyayo, njenge-ultrasound evamile. Amananela abe eseguqulwa yikhompyutha abe isithombe sendawo ehlolwayo.

Indawo ethile kanye nosayizi we-GIST kungatholwa kusetshenziswa i-EUS. Kuyasiza ekunqumeni ukuthi isimila singene kude kangakanani odongeni lwepheshana le-GI (noma ngaphesheya kwalo futhi singene esithweni esiseduze). Uma isimila sithuthele kuma-lymph nodes angomakhelwane, ukuhlolwa kungasiza futhi ukukhomba lawo ma-node. I-biopsy yenaliti ingabuye iqondiswe ngosizo lwayo (bheka ngezansi). Ngaphambi kwalokhu kwelashwa, ngokuvamile uzothola imithi ezokulalisa.

Biopsy

Ngisho noma ukungavamile kubonakala ekuhlolweni kwesithombe, njenge-CT scan noma i-x-ray ye-barium, lezi zinqubo ngokuvamile azikwazi ukunquma ngokuqiniseka ukuthi ukungavamile kuyi-GIST, olunye uhlobo lwesimila (olubi noma olunomdlavuza), noma esinye isifo. (njengesifo). Ukukhipha amaseli endaweni kuwukuphela kwendlela yokuqiniseka ukuthi iyini. Le nqubo yaziwa ngokuthi i-biopsy. Amaseli abe eseyiswa elebhu, lapho udokotela wezifo ewahlola ngesibonakhulu futhi angase enze ukuhlolwa okwengeziwe kuwo.

Akuzona zonke iziguli ezinamathumba okungenzeka ukuthi ama-GIST ezidinga i-biopsy ngaphambi kokwelashwa. I-biopsy ngokuvamile yenziwa kuphela uma izosiza ekunqumeni ukukhetha kokwelashwa uma udokotela esola ukuthi isimila siyi-GIST. Ama-GIST ngokuvamile amathumba abuthakathaka ajwayele ukuhlakazeka futhi ophe ngokushesha. Noma iyiphi i-biopsy kufanele yenziwe ngokuqapha okukhulu ngenxa yokuthi ingase ibangele ukopha noma mhlawumbe inyuse ingozi yokusabalala komdlavuza.

I-Endoscopic biopsy

I-endoscope ingasetshenziswa ukuqoqa amasampula e-biopsy. Ukuze kutholwe isampula elincane lesimila lapho umuntu etholwa, udokotela angadlulisela i-biopsy forceps (izikhonkwane noma izindlawu) ngeshubhu.

Naphezu kosayizi wesampula omncane, odokotela bangase banikeze ukuxilongwa okuthembekile. Kodwa-ke, ngama-GISTs, isimila kwesinye isikhathi singase sifihlwe ngaphansi kolwelwesi lwangaphakathi lwesisu noma amathumbu, kuvinjwe amabutho e-biopsy ukuthi angangeni ajule ngokwanele ukuze afinyelele kuwo.

Nakuba kuvamile, ukopha okuvela ku-GIST okulandela i-biopsy kungaba yinkinga enkulu. Uma lokhu kwenzeka, ochwepheshe bezokwelapha bangasebenzisa i-endoscope ukujova imithi esimila ukuze kunciphe imithambo yegazi futhi kumise ukopha.

I-biopsy yenaliti

Isampula encane yendawo nayo ingathathwa kusetshenziswa inaliti encane, engenalutho ngesikhathi sokuhlolwa kwe-biopsy. Lapho wenza i-endoscopic ultrasound iyindlela ejwayelekile kakhulu yokufeza lokhu (echazwe ngenhla). Inaliti esiphundu se-endoscope iholwa esimila ngudokotela esebenzisa isithombe se-ultrasound njengesiqondiso. I-endoscopic ultrasound-guided nele aspiration iyini lena (EUS-FNA).

Kancane kancane, udokotela angase asebenzise ukuhlola kwesithombe njenge-CT scan ukuze aqondise ukubekwa kwenaliti esikhumbeni nasesimila. I-Percutaneous biopsy igama elisetshenziselwa lokhu.

I-biopsy yokuhlinzwa

Udokotela angakwazi ukweluleka ukulinda kuze kube yilapho ukuhlinzwa ukuze kukhishwe isimila ukuze kuqoqwe isampula uma i-endoscopic noma i-need biopsy ingenakwenzeka noma uma umphumela we-biopsy ungeke ube nomthelela ongakhetha zokwelapha.

Inqubo yaziwa ngokuthi i-laparotomy uma kusetshenziswa ukusika kwesisu okubalulekile ukwenza ukuhlinzwa. Kwesinye isikhathi, isimila singathathwa (noma kukhishwe izimila ezincane) kusetshenziswa i-laparoscope, ishubhu elincane elikhanyayo elivumela udokotela ohlinzayo ukuthi abone ngaphakathi kwesisu ngokusikwa okuncane. Esebenzisa amathuluzi okuhlinza amade, azacile afakwa ngezimbotshana zesisu ezengeziwe, udokotela ohlinzayo angakwazi ukusampula (noma asuse) isimila. I-Laparoscopic noma ukuhlinzwa kwe-keyhole yigama elisetshenziselwa lokhu.

Ukuhlolwa kwelebhu

Uma amasampula esimila etholakele, udokotela wezifo angase akwazi ukusho ukuthi isimila cishe siyi-GIST ngokubheka amaseli ngesibonakhulu. Kepha kwesinye isikhathi kungadingeka ukuhlolwa okwengeziwe kwelebhu ukuze uqiniseke.

I-Immunohistochemistry: Kulokhu kuhlolwa, ingxenye yesampula iphathwa ngamasosha omzimba enziwe umuntu azonamathela kuphela kuphrotheni ethile kumaseli. Amasosha omzimba abangela ukushintsha kombala uma iphrotheni ikhona, engabonwa ngesibonakhulu.

Uma i-GIST isolwa, amanye amaprotheni avame ukuhlolelwa i-KIT (eyaziwa nangokuthi i-CD117) kanye ne-DOG1. Amangqamuzana amaningi e-GIST analawa maprotheni, kodwa amaseli ezinye izinhlobo eziningi zomdlavuza awanawo, ngakho ukuhlolwa kwalawa maprotheni kungasiza ukubona ukuthi isimila se-GI siyi-GIST noma cha. Amanye amaprotheni, njenge-CD34, angase ahlolwe nawo.

Ukuhlolwa kofuzo lwamangqamuzana: Ukuhlola kungenziwa futhi ukuze kubhekwe izinguquko ku- I-KIT or I-PDGFRA izakhi zofuzo, njengoba amaseli amaningi e-GIST enoguquko kwelinye noma kwelinye. Ukuhlola ukuguqulwa kwezakhi zofuzo kungasiza ekunqumeni ukuthi imithi ethile yokwelapha okuhlosiwe ingase ibe usizo yini ekwelapheni umdlavuza. 

Kancane kancane, ukuhlolwa kungenziwa ukuze kubhekwe izinguquko kwezinye izakhi zofuzo, njenge I-SDH ufuzo.

Izinga le-Mitotic: Uma i-GIST ixilongwa, udokotela uzophinde abheke amaseli omdlavuza kusampula ukuze abone ukuthi mangaki ahlukana abe amaseli amasha. Lokhu kwaziwa ngokuthi yi- isilinganiso se-mitotic (noma inkomba ye-mitotic). Izinga eliphansi le-mitotic lisho ukuthi amangqamuzana omdlavuza akhula futhi ahlukana kancane, kuyilapho izinga eliphezulu lisho ukuthi akhula ngokushesha. Izinga le-mitotic liyingxenye ebalulekile yokunquma isigaba somdlavuza. 

Ukuhlolwa kwegazi

Udokotela wakho anga-oda ukuhlolwa kwegazi uma ecabanga ukuthi une-GIST.

Akukho ukuhlolwa kwegazi okungabonisa ngokuqinisekile ukuthi umuntu une-GIST. Kodwa ukuhlolwa kwegazi ngezinye izikhathi kungakhomba isimila esingase sibe khona (noma ekusakazekeni kwaso). Ngokwesibonelo:

• A isibalo segazi esiphelele (CBC) ingabonisa ukuthi unenani eliphansi lamangqamuzana abomvu egazi (okungukuthi, uma une-anemia). Abanye abantu abane-GIST bangase babe ne-anemia ngenxa yokopha esimila.
• Okungajwayelekile ukuhlolwa kwesibindi kungase kusho ukuthi i-GIST isisabalele esibindini sakho.

Ukuhlolwa kwegazi kwenziwa futhi ukuze kuhlolwe impilo yakho yonke ngaphambi kokuhlinzwa noma ngenkathi uthola ezinye izindlela zokwelapha, njengokwelashwa okuhlosiwe.

Ukwelashwa kwama-GIST

Ukuhlinzwa kwe-GIST

Uma isimila sisincane, kuvame ukukwazi ukusikhipha kanye nesiqephu esincane sesicubu esinempilo esisizungezile. Lokhu kufezwa ngokusika esikhunjeni. Njengoba ama-GIST ecishe angalokothi athuthele kuma-lymph nodes, ngokungafani nezinye izifo eziningi ezibulalayo, ngokuvamile asikho isidingo sokususa ama-lymph nodes endaweni.

Ukuhlinza “Imbobo Eyisihluthulelo” (i-laparoscopic) kuyinketho yezifo ezithile ezincane. Ukuze kukhishwe isimila, kwenziwa imisikwa eminingi emincane kuneyodwa enkulu. I-laparoscope, ishubhu elincane, elikhanyayo elinekhamera yevidiyo encane ekugcineni, ifakwa udokotela ohlinzayo ngeyodwa yazo. Lokhu kubenza bakwazi ukubuka isisu. Isimila sibe sesikhishwa kusetshenziswa amathuluzi okuhlinza amade, azacile kwamanye amanxeba. Iziguli zijwayele ukululama ngokushesha kulolu hlobo lokuhlinzwa kunokuhlinzwa okuvamile, okudinga ukusika okukhudlwana, ngoba ukusika kuncane.

Ukuhlinzwa kwama-GIST amakhulu

Udokotela ohlinzayo usengakwazi ukusikhipha ngokuphelele isimila ngisho noma sikhulu noma sisakazekela kwezinye izitho zomzimba. Kungase kudingeke ukukhipha ingxenye yamathumbu noma esinye isitho ukwenza lokhu. Ukwengeza, udokotela ohlinzayo angase asuse izifo eziye zathuthela esibindini noma kwezinye izitho ezisesiswini.

Ukuphuza imithi ehlosiwe i-imatinib (Gleevec) ekuqaleni, ngokuvamile okungenani izinyanga ezimbalwa, kungase kube enye inketho yomdlavuza omkhulu noma osabalele ezindaweni ezingomakhelwane. I-Neoadjuvant therapy, njengoba kwaziwa kanjalo, imvamisa yenza isimila sishwabane, okwenza ukuhlinzwa ukusikhipha kube lula.

Ukuhlinzwa kwe-GIST ye-metastatic

Ku-GIST enwetshiwe (eyenziwe i-metastasized) yaya kwezinye izindawo zomzimba, ukuhlinzwa akuyona indlela yokwelapha evamile. Umugqa wokuqala wokwelapha we-metastatic GIST ngokuvamile uyimithi yokwelapha eqondiwe. Kodwa-ke, abanye ochwepheshe bezokwelapha bangaphakamisa ukuhlinzwa ukuze kukhishwe izimila ze-metastatic uma kukhona ezimbalwa zazo futhi zisabela kahle ekwelashweni okuhlosiwe. Nakuba lungekho ucwaningo olukhulu olwenziwe ukukhombisa ukuthi lokhu kuwusizo kangakanani, kungase kube ukukhetha. Uma udokotela wakho encoma le nqubo, qiniseka ukuthi uyazazi izinjongo zayo nanoma yimiphi imiphumela emibi engaba khona.

Ezinye izindlela zokwelapha ezingase zibandakanye izindlela zokwelapha zendawo ezifana ne-embolization noma ukukhishwa kwe-ablation uma izifo ezibangelwa yisibindi kunzima ukuzisusa.

I-Ablation kanye ne-embolization ukwelapha izimila ze-stromal zamathumbu

Ukwelashwa okufana nokukhishwa kwesisu kanye nokubopha kungasetshenziswa uma isimila se-gastrointestinal stromal (GIST) sithuthukele esibindini, ikakhulukazi uma ukuhlinzwa kungakwazi ukuqeda izimila.

Ukususwa kwemali

I-Ablation igama lokususwa kwezimila ngokusebenzisa amakhemikhali, izinga lokushisa eliphezulu, noma kokubili. Ingasetshenziswa ngezikhathi ezithile ukuze kuqedwe ama-GIST asungule izimila ezimbalwa esibindini. Ukukhipha isisu kungase kungabi yindlela engcono kakhulu yokwelapha izimila eziseduze nezakhiwo ezibucayi njengemithambo yegazi emikhulu, i-diaphragm (umsipha omncane ophefumulayo ongaphezu kwesibindi), noma imigudu emikhulu esibindini ngoba ngokuvamile ibulala ezinye zezicubu ezivamile ezizungeze isimila.

Kunezinhlobo eziningana zokukhishwa:

• Ukukhishwa kwe-Radiofrequency (RFA), esebenzisa amaza omsakazo anamandla amakhulu ukushisa isimila futhi acekele phansi amangqamuzana omdlavuza
• Ukukhishwa kwe-Ethanol (utshwala)., lapho utshwala obugxilile bujovwa ngqo esimila ukuze kubulawe amangqamuzana omdlavuza
• I-Microwave thermotherapy, lapho ama-microwave asakazwa nge-probe efakwe esimila asetshenziselwa ukushisa nokucekela phansi amangqamuzana omdlavuza
• I-Cryosurgery (i-cryotherapy), ecekela phansi isimila ngokusiqandisa kusetshenziswa i-probe yensimbi encane,. Le ndlela ngezinye izikhathi idinga i-anesthesia jikelele (ulele ubuthongo obukhulu futhi awukwazi ukuzwa ubuhlungu)

Ukuhlanganisa

I-Embolization yindlela yokwelapha lapho udokotela enikeza khona imithi ngomzamo wokumisa noma ukunciphisa ukugeleza kwegazi kuya kumdlavuza amaseli esibindi.

Njengoba kunikezwe ukuthi iqukethe igazi elibili, isibindi asivamile. Amagatsha e-portal vein ondla iningi lamangqamuzana esibindi avamile, kanti amagatsha omthambo we-hepatic ngokuvamile ondla iningi lamaseli esibindi. isibindi somdlavuza amaseli. Iningi lamangqamuzana esibindi anempilo awonakele ngoba athola igazi lawo nge-portal vein; kodwa-ke, ukuvimba igatsha lomthambo we-hepatic odla isimila kuyasiza ekufeni kwamangqamuzana omdlavuza.

I-Embolization ikhawulela ingxenye yokugeleza kwegazi esicutshini sesibindi esinempilo, ngakho-ke kungase kungabi inketho enhle kwabanye abantu izibindi zabo esezivele zilimele ngenxa yezimo ezifana ne-cirrhosis noma i-hepatitis.

Ukwelashwa okuhlosiwe kwama-GIST

Amaprotheni athile asiza ekuhlukaniseni amaseli nasekukhuleni kwamaseli e-gastrointestinal stromal tumor (GIST) angaqondiswa eminye imithi. Lapho welapha ama-GIST, le mithi egxilile—eyaziwa nangokuthi imithi enembile—ivame ukuzuzisa kakhulu. Zisebenza ngendlela ehlukile kunemithi evamile ye-chemotherapy (chemo), ngokuvamile engasebenzi.

I-Tyrosine kinase inhibitors (TKIs) igama elinikezwe emithini ehlosiwe esetshenziselwa ukwelapha ama-GIST ngoba aqondise ngokuqondile amaprotheni aziwa ngokuthi i-KIT ne-PDGFRA, okuyi-tyrosine kinases.

Le mithi ehlosiwe yonke inikezwa ngomlomo, ngokuvamile kanye ngosuku.

Imithi yokwelapha ehlosiwe esetshenziselwa ukwelashwa kwe-GIST:

• I-Imatinib
• I-Sunitinib
• I-Regorafenib
• I-Ripretinib
• I-Avapritinib
• I-Sorafenib (Nexavar)
• I-Nilotinib (Tasigna)
• I-Dasatinib (Sprycel)
• I-Pazopanib (I-Votrient)

Ukwelashwa ngamakhemikhali

Izidakamizwa zisetshenziswa ku-chemotherapy, eyaziwa nangokuthi "i-chemo," ukwelapha umdlavuza. Le mithi ivamise ukulawulwa nge-intravenously (IV) noma ngomlomo. Lo muthi ungaba usizo ezenzweni ezimbi ezisabalele zadlula isitho ezisuka kuso ngoba zingena egazini futhi zizungeza umzimba wonke.

I-Chemotherapy ibhekisela ekusetshenzisweni kwanoma yimuphi umuthi ukwelapha umdlavuza, okuhlanganisa nemithi yokwelapha eqondiwe njenge-imatinib (Gleevec), manje esetshenziswa kaningi ukwelapha izimila ze-gastrointestinal stromal (GISTs). Kodwa-ke, igama elithi "chemo" livame ukusetshenziselwa ukubhekisela emithini ethile eqondise amangqamuzana akhula ngokushesha noma kuphi emzimbeni, kuhlanganise namaseli omdlavuza.

Ukwelashwa ngemisebe yokwelashwa kwe-GIST

Ama-x-ray anamandla amakhulu (noma ezinye izinhlayiya) asetshenziswa ekwelapheni ngemisebe ukubulala amangqamuzana omdlavuza. Imisebe ayisetshenziswa kaningi njengoba ingasebenzi kakhulu ekwelapheni izimila ze-gastrointestinal stromal (GISTs). Kodwa-ke, ngezinye izikhathi ingasetshenziswa ukwelapha izimpawu ezinjengokungakhululeki kwamathambo.

Ochwepheshe bemisebe bazothatha izilinganiso ezinembile ngaphambi kokuqala kokwelashwa kwakho ukuze banqume ama-engeli alungile okukhomba imishayo yemisebe kanye nenani elilungile lemisebe. Ukuhlolwa kwesithombe okufana nokuskena kwe-CT noma kwe-MRI kuvame ukwenziwa njengengxenye yale seshini yokuhlela, eyaziwa ngokuthi ukulingisa.

Ngokufana nokuthola i-x-ray, ukwelashwa ngemisebe kusebenzisa imisebe emikhulu. Inqubo yangempela ayinabuhlungu. Ngisho noma inqubo yokusetha—yokukwenza ube sendaweni yokwelashwa—ngokuvamile ithatha isikhathi eside, ithatha imizuzu embalwa kuphela. Ukwelashwa ngemisebe kungase kuthathe izinsuku ezimbalwa ziqondile.