IGlioblastoma Multiforme

Uhlobo lomdlavuza olunolaka olubizwa ngokuthi i-glioblastoma lungakhula ebuchosheni noma emgogodleni. Ama-astrocyte, asekela amangqamuzana ezinzwa, abangela i-glioblastoma.

Nakuba i-glioblastoma ingakhula kunoma iyiphi iminyaka, ivamise ukubathinta kaningi abantu abadala. Ukuquleka, isicanucanu, ukuhlanza, nokwanda kwekhanda elibuhlungu konke lokhu kuyimiphumela engenzeka. Kungaba inselele kakhulu ukwelapha i-glioblastoma, eyaziwa nangokuthi i-glioblastoma multiforme, futhi ikhambi ngokuvamile alitholakali. Ukwelashwa komdlavuza kungase kunciphise izimpawu futhi kubambezele ukuqhubeka kwesifo. 

I-Glioblastoma (GBM), ngokuvamile eyaziwa ngokuthi i-astrocytoma yebanga lesi-IV, iyithumba ebuchosheni elinamandla elikhula ngokushesha. Kodwa-ke, ngokuvamile ayifuduki iye ezithweni ezikude, kunalokho ihlasela izicubu zobuchopho eziseduze.

Ama-GBM angathuthuka kusuka kuma-astrocytoma ebanga eliphansi noma athuthuke asuka kumathumba obuchopho amasha. I-cerebral hemispheres yabantu abadala, ikakhulukazi i-frontal and temporal lobes, yilapho i-GBM ikhula khona kakhulu. Kubalulekile ukufuna usizo olukhethekile lwe-neuro-oncological and neurosurgical ngokushesha ngoba i-GBM iwumdlavuza wobuchopho obulalayo, okuthi uma ungelashwa, ubangele ukufa ezinyangeni eziyisithupha noma ngaphansi. Lokhu kungathinta ukusinda sekukonke.

Ama-GBM aletha izinselele zokwelashwa eziyingqayizivele ngenxa:

• Ukwenziwa kwasendaweni kwamathumba ebuchosheni
• Ukumelana ngokwemvelo nokwelashwa okuvamile
• Amandla alinganiselwe wobuchopho ukuzilungisa
• Ukufuduka kwamangqamuzana ayingozi kuzicubu zobuchopho eziseduze
• Okuguquguqukayo kuphazamisekile isisu ukutholakala kwegazi, okuvimbela ukulethwa kwezidakamizwa okuphumelelayo
• Ukuvuza kwe-tumor capillary, okuholela ekuqongeleleni uketshezi oluzungeze isimila, (peritumoral) edema) kanye nomfutho wegazi ophakeme we-intracranial
• Ukuquleka okubangelwa yi-tumor
• Umphumela we-neurotoxicity wezokwelapha eziqondiswe kuwo ama-gliomas

Izimpawu

Izimpawu ziyahlukahluka kuye ngendawo ebuchosheni, kodwa ingafaka noma yikuphi kokulandelayo:

• Ikhanda elibuhlungu elibeleselayo
• Umbono ophindwe kabili noma ofiphele
• Ukuvota
• Ukulahlekelwa kwesifiso
• Ukushintsha kwemizwa nobuntu
• Izinguquko emandleni okucabanga nokufunda
• Ukuqala okusha kokuquleka
• Ubunzima benkulumo bokuqala kancane kancane

Ukuxilongwa kwe-glioblastoma multiforme

Ukuxilongwa kwe-glioblastoma kwenziwa ngokusebenzisa izinqubo ezilandelayo:

Ukuhlolwa kwezinzwa: Udokotela wakho uzobuza ngezimpawu nezimpawu zakho ngenkathi wenza ukuhlolwa kwezinzwa. Amehlo akho, ukuzwa, ibhalansi, ukusebenzisana, amandla, nokukhalipha kungase kuhlolwe. Izinkinga endaweni eyodwa noma ngaphezulu kulezi zingase ziveze ulwazi mayelana nendawo yobuchopho bakho okungase kube nomthelela kuyo isimila sobuchopho.

Ukuhlola ukuhlolwa: Udokotela wakho angahlola indawo nobukhulu besimila ebuchosheni bakho ngosizo lokuhlolwa kwesithombe. Izimila zobuchopho zivame ukutholakala ne-MRI, engase futhi ihlanganiswe nezindlela ezithile zokucabanga ze-MRI ezifana nokusebenza I-MRI kanye ne-resonance magnetic i-spectroscopy.

I-CT kanye ne-positron emission tomography yizibonelo zokuhlolwa okwengeziwe kwe-imaging (PET).

Isidumbu: Kuye ngezimo zakho ezihlukile nendawo yesimila sakho, i-biopsy yenaliti ingenziwa ngaphambi noma phakathi nokuhlinzwa ukuze kukhishwe i-glioblastoma yakho. Izinhlobo zamaseli kanye nezinga lawo lolaka kukhonjwa ngokuhlaziywa kwaselabhorethri kwesampula yezicubu ezingabazekayo.

Udokotela wakho angathola izinhlobo zokuguquka kwesimila amaseli atholwe ngokuhlolwa okukhethekile. Lokhu kunikeza udokotela wakho izeluleko mayelana nesifo sakho futhi kungaba nomthelela endleleni yokwelashwa kwakho.

Ukuhlolwa kwe-glioblastoma

Ukwelashwa kwe-glioblastoma multiforme

Ukuhlinzwa iyisisekelo sokwelashwa kwe-GBM, kulandele imisebe kanye ne-chemotherapy. Umgomo oyinhloko wokuhlinzwa ukunqamula isimila esiningi ngangokunokwenzeka ngaphandle kokulimaza izicubu zobuchopho ezinempilo ezisizungezile futhi ezidingekayo ekusebenzeni okujwayelekile kwezinzwa. Kunzima ukuqeda ngokuphelele i-GBM ngoba isimila sizungezwe indawo ehambayo, ehlasela amaseli wesimila ahlasela izicubu eziseduze. Ukuhlinzwa kunganciphisa inani lezicubu eziqinile zesimila ebuchosheni, kususe amaseli wesimila okungenzeka amelane ne-chemotherapy- kanye ne-radiation esikhungweni sesimila, futhi kwehlise ingcindezi engaphakathi kwe-cranial. Ukuhlinzwa kunamandla okunweba izimpilo zezinye iziguli futhi kuthuthukise ikhwalithi yeminyaka yazo esele ngokususa inqwaba yesimila.

Isikhathi esiningi, a i-craniotomy isetshenziswa odokotela abahlinzayo ukufinyelela indawo yesimila. Izindawo ze-motor, izinzwa, kanye ne-cortex yenkulumo/yolimi ngokuvamile zinqunywa kusetshenziswa isiqondiso sesithombe esisizwa ngekhompuyutha, futhi ngezinye izikhathi kusetshenziswa amasu okwenza imephu phakathi kokusebenza. Imephu ye-intraoperative ngokuvamile ihlanganisa ukuhlinzwa esigulini esiphapheme kuyilapho kuhlelwa i-anatomy yomsebenzi wolimi lwazo. Ngokulandelayo udokotela unquma ukuthi yiziphi izindawo zesimila ezingasuswa ngokuphepha.

Ukwelashwa ngemisebe kungaqala ngemva kokuhlinzwa, uma isilonda sesipholile. Ukwelashwa ngemisebe kuhloswe ukuqeda ngokuqondile noma yimaphi amangqamuzana asele esimila esisabalele esicubungwini sobuchopho esinempilo. Ukwelashwa okujwayelekile kwe-radiation yangaphandle kuhilela izikhathi eziphindaphindiwe “zezingxenyana” zomthamo ojwayelekile wokukhishwa kwemisebe ezinikezwa indawo yesimila kanye nemajini ukuze kuqondiswe kumaseli wesimila angene lapho. Kokubili izicubu ezinempilo nezivamile zonakaliswa ukwelashwa ngakunye.

Amangqamuzana amaningi avamile abe esewupholisile umonakalo ngesikhathi sokwelashwa okulandelayo, kodwa izicubu zesimila azikawupholi. Ngokuya ngohlobo lwesimila, le nqubo iphindwa ngenani lemithi yokwelapha eyi-10 kuye kwezingama-30, ngokuvamile enikezwa kanye ngosuku, izinsuku ezinhlanu ngesonto. Uma kuqhathaniswa nokuhlinzwa kuphela noma ukunakekelwa okukhulu okusekelayo, ukwelashwa ngemisebe kunikeza iningi leziguli imiphumela engcono kanye namazinga okuphila isikhathi eside.

I-Radiosurgery iwuhlobo lwenqubo yezokwelapha egxilisa imisebe esimila kuyilapho iletha inani elincane lemisebe elingatholakala esicutshini sobuchopho esizungezile. Kwezinye izimo, i-radiosurgery ingase isetshenziselwe ukwelapha ukuvela kabusha kwesimila, ngokuvamile ngokusetshenziswa kwedatha eyengeziwe evela kuma-MRS noma ama-PET scan. Ezigabeni zokuqala zokwelashwa kwe-GBM, akuvamile ukusetshenziswa.

Imithi ekhethekile ehloselwe ukubulala amangqamuzana esimila inikezwa iziguli ezithola ukwelashwa ngamakhemikhali. Izinga legolide lamanje lokunakekelwa kwe-GBM libandakanya ukwelashwa ngamakhemikhali nge-temozolomide yomuthi. Ngesikhathi sokwelashwa ngemisebe, umuthi uvame ukunikezwa nsuku zonke, bese kuba imijikelezo eyisithupha ngemuva kwemisebe, phakathi nesigaba sokunakekela. Izinsuku ezinhlanu zokuqala zomjikelezo ngamunye zisetshenziswa kunikezwa i-temozolomide, kulandelwa izinsuku zokuphumula ezingama-23. Umjikelezo ngamunye uthatha izinsuku ezingama-28. Phakathi nesigaba sokunakekela sokwelashwa, izinkambu zokwelapha isimila zethulwa njengohlobo oluhlukile lokwelapha. Izinkambu zikagesi ezishintshanayo ziyakhiqizwa, ezivimba amangqamuzana omdlavuza ukuba ande futhi ahlukane. Lapho isimila sikhula, ikakhulukazi lomustine (chemotherapy) kanye bevacizumab (ukwelashwa okuhlosiwe) kuyasetshenziswa.