Uyini umdlavuza wesibeletho?

Lapho amangqamuzana emzimbeni eqala ukukhula engalawuleki, kuba nomdlavuza. Amangqamuzana omdlavuza angavela cishe kunoma iyiphi indawo yomzimba futhi asakazeke kuwo wonke umzimba. Ukuze uthole ukuqonda kangcono ukuthi umdlavuza uqala futhi usakazeka kanjani.

Ama-ovarian malignancies kwake kwacatshangwa ukuthi avela kuma-ovari kuphela, kodwa ucwaningo olusha lwembula ukuthi umdlavuza wama-ovarian amaningi angase aqale kumaseli asekupheleni (okukude) kwamashubhu e-fallopian.

Umdlavuza we-Ovarian ukuthuthukiswa komdlavuza kwamangqamuzana kuma-ovari. Amaseli azala ngokushesha futhi abe nekhono lokungena futhi abulale izicubu zomzimba ezinempilo.

Amaqanda amabili, elinye ohlangothini ngalunye lwesibeletho, akha uhlelo lokuzala lwabesifazane. I-ovary ngayinye, elingana ne-alimondi, ikhiqiza amaqanda (ova) kanye namahomoni e-estrogen ne-progesterone. Ukuhlinzwa kanye ne-chemotherapy ngokuvamile kusetshenziselwa ukwelapha umdlavuza wesibeletho.

Izimila ze-ovarian epithelial

Umdlavuza we-ovarian epithelial uqala endaweni engaphandle yama-ovari. Lezi zimila zingaba yingozi (ezingezona umdlavuza), zibe umngcele (mhlawumbe umdlavuza), noma zibe yingozi (umdlavuza) (umdlavuza).

I-Benign epithelial ovarian tumors

I-Benign epithelial ovarian tumors ayisakazeki futhi ngokuvamile ayibangeli ukugula okukhulu. I-serous cystadenomas, i-mucinous cystadenomas, kanye nama-Brenner tumors zonke ziyizibonelo zama-benign epithelial tumors.

I-Borderline epithelial ovarian tumors

Ezinye izimila ze-ovarian epithelial azibonakali ziyingozi lapho zihlolwa elebhu, futhi zibizwa ngokuthi umdlavuza we-ovarian we-borderline epithelial. I-Atypical proliferative serous carcinoma kanye ne-atypical proliferative mucinous carcinoma yizindlela ezimbili ezivame kakhulu. Ngaphambilini, lezi zicubu zaziwa njengezimila ezinamandla amancane (LMP tumors). Lezi zifo ezimbi zihlukile kumdlavuza wendabuko wesibeletho ngoba azisakazeki esithweni esisekelayo se-ovary (ebizwa ngokuthi i-ovarian stroma). Zingase zikhule olwelweni lwesisu kodwa hhayi ngaphakathi kwalo uma zisakazeka ngaphandle kwe-ovary, isibonelo, zingene emgodini wesisu (isisu).

Izimila ezisemngceleni zivame kakhulu kwabesifazane abasebancane kunama-ovarian malignancies. Lezi zimila zikhula kancane futhi zibeka engcupheni encane yokufa kuneningi lama-ovarian malignancies.

Izimila eziyingozi ze-epithelial ovarian

Izimila ze-Cancer epithelial zibizwa umdlavuza. Cishe i-85% kuya ku-90% yomdlavuza we-ovarian oyingozi yi-epithelial ovarian carcinomas. Lezi isisu amaseli anezici ezimbalwa (uma zibhekwa elebhu) ezingasetshenziswa ukuhlukanisa i-epithelial ovarian carcinomas zibe izinhlobo ezahlukene. I i-serous uhlobo yilona oluvame kakhulu, futhi lungabandakanya amathumba ebanga eliphezulu kanye nebanga eliphansi. Ezinye izinhlobo eziyinhloko zihlanganisa mucinous, i-endometrioid, Futhi sula iseli.

• I-Serous carcinomas (52%)
• Sula i-cell carcinoma (6%)
• I-mucinous carcinoma (6%)
• I-Endometrioid carcinoma (10%)

Umdlavuza we-ovarian ngamunye unikezwa ibanga, ngokusekelwe ekutheni amangqamuzana e-tumor abukeka njengezicubu ezivamile:

• I-epithelial ovarian carcinomas yeBanga loku-1 ibukeka njengezicubu ezijwayelekile futhi ijwayele ukuba nesibikezelo esingcono (umbono).
• I-epithelial ovarian carcinomas yeBanga lesi-3 ibukeka ingaphansi njengezicubu ezijwayelekile futhi imvamisa inombono omubi kakhulu.

Ezinye izici nazo ziyacatshangelwa, njengokuthi amangqamuzana omdlavuza akhula ngokushesha kangakanani nokuthi asabela kahle kangakanani ekwelapheni ngamakhemikhali, ukuze aqhamuke nesimila. Uhlobo:

• Izimila zohlobo I zivame ukukhula kancane futhi zidale izimpawu ezimbalwa. Lezi zimila nazo zibonakala zingaphenduli kahle ku-chemotherapy. Ibanga eliphansi (ibanga loku-1) i-serous carcinoma, i-clear cell carcinoma, i-mucinous carcinoma kanye ne-endometrioid carcinoma yizibonelo zamathumba ohlobo I.
• Izimila zohlobo lwe-II zikhula ngokushesha futhi zivame ukusabalala ngokushesha. Lezi zimila zivame ukuphendula kangcono ku-chemotherapy. Ibanga eliphezulu (ibanga lesi-3) i-serous carcinoma iyisibonelo sohlobo lwesimila sohlobo lwe-II.

Izimpawu zomdlavuza wesibeletho

Lapho umdlavuza wesibeletho uqala ukuvela, ungase ungabonisi zimpawu noma izimpawu. Uma izimpawu zomdlavuza wesibeletho zivela, ngezinye izikhathi ziphutha njengezimpawu zezinye, izifo ezingathí sina kakhulu.

Izimpawu nezimpawu zomdlavuza we-ovarian zingafaka:

• Ukuqhakaza esiswini noma ukuvuvukala
• Ngokushesha uzizwe ugcwele lapho udla
• Ukwehla kwesisindo
• Ukuphazamiseka endaweni yangasese
• Ukukhathala
• Ukuhlungu obusemhlane
• Izinguquko emikhayeni yamathumbu, njengokuqunjelwa
• Isidingo esijwayelekile sokuchama

Izimbangela zomdlavuza wesibeletho

Umdlavuza wesibeletho kusamele ubonwe njengembangela, nokho ososayensi bathole izici ezingase zinyuse ingozi yalesi sifo.

Umdlavuza wesibeletho uqala lapho amangqamuzana angaphakathi noma eduze namaqanda anezinguquko (ukuguqulwa) ku-DNA yawo, ngokusho kodokotela. I-DNA yengqamuzana ihlanganisa neziqondiso ezilitshela ukuthi yenzeni. Izinguquko zenza amangqamuzana azalane futhi athuthuke ngokushesha, okuholela ebuningini (isimila) samangqamuzana omdlavuza. Lapho amangqamuzana anempilo efa, amangqamuzana ayingozi ayaqhubeka ephila. Bangakwazi ukuthelela izicubu eziseduze futhi bahlukane nesimila esiyinhloko ukuze baye kwezinye izingxenye zomzimba (metastasize).

Izici eziyingozi zomdlavuza we-ovarian

Izinto ezingandisa ingozi yomdlavuza we-ovarian zihlanganisa:

• Ukuguga. Ingozi yomdlavuza we-ovarian iyanda njengoba ukhula. Ivame ukutholakala kubantu abadala.

• Izinguquko zofuzo ngefa. Iphesenti elincane lomdlavuza wesibeletho libangelwa izinguquko zofuzo ozizuza kubazali bakho. Izakhi zofuzo ezandisa ingozi yomdlavuza we-ovarian zihlanganisa BRCA1 futhi BRCA2. Lezi zakhi zofuzo zandisa ingozi yoku umdlavuza webele.

  Ezinye izinguquko zezakhi zofuzo ziyaziwa ukwandisa ingozi yomdlavuza we-ovarian, kuhlanganise nezinguquko zofuzo ezihlobene ne-Lynch syndrome kanye nezakhi zofuzo. I-BRIP1, I-RAD51C futhi I-RAD51D.

• Umlando womndeni womdlavuza wesibeletho. Uma unezihlobo zegazi eziye zatholakala ukuthi zinomdlavuza we-ovarian, ungase ube nengozi eyengeziwe yesifo.
• Ukukhuluphala ngokweqile noma ukukhuluphala ngokweqile. Ukukhuluphala ngokweqile noma ukukhuluphala ngokweqile kwandisa ingozi yomdlavuza wesibeletho.
• I-Postmenopausal hormone replacement therapy. Ukuthatha i-hormone replacement therapy ukulawula izimpawu nezimpawu zokunqamuka kokuya esikhathini kungase kwandise ingozi yomdlavuza wesibeletho.
• I-Endometriosis. I-Endometriosis isifo esivame ukuba buhlungu lapho izicubu ezifana nezicubu ezingaphakathi kwesibeletho sakho zikhula ngaphandle kwesibeletho sakho.
• Iminyaka lapho ukuya esikhathini kwaqala futhi kwaphela. Ukuqala ukuya esikhathini usemncane noma ukuqala ukuya esikhathini lapho usumdala, noma kokubili, kungandisa ingozi yomdlavuza wesibeletho.
• Engakaze akhulelwe. Uma ungakaze ukhulelwe, ungase ube nengozi eyengeziwe yomdlavuza we-ovarian.

Ukuvimbela umdlavuza wesibeletho

Umdlavuza wesibeletho awukwazi ukugwenywa ngokuphelele. Nokho, kungase kube nezinyathelo zokunciphisa ubungozi bakho:

Thatha amaphilisi okulawula inzalo uma ucabanga ngakho. Xhumana nodokotela wakho ukuze ubone ukuthi izivimbela-nzalo ezithathwa ngomlomo (amaphilisi okulawula ukubeletha) zikulungele yini. Ingozi yomdlavuza wesibeletho iyancipha ngokusebenzisa amaphilisi okulawula inzalo. Nokho, ngenxa yokuthi eminye imithi inezingozi, khuluma nodokotela wakho mayelana nokuthi izinzuzo ziyazidlula yini izingozi zesimo sakho.
Xhumana nodokotela wakho mayelana nezici zakho eziyingozi. Yazisa udokotela wakho uma unomlando womndeni we-breast and ovarian malignancies. Udokotela wakho angakutshela ukuthi lokhu kusho ukuthini ngengozi yakho yomdlavuza. Umeluleki wezofuzo angase athunyelwe kuwe ukuze akusize unqume ukuthi ukuhlolwa kofuzo kukulungele yini. Uma unokuguqulwa kofuzo okuphakamisa ithuba lakho lomdlavuza we-ovarian, ungase ufune ukuthi ama-ovari akho asuswe ukuze ugweme umdlavuza.

Ukuxilongwa komdlavuza we-ovarian

Ukuhlolwa nezinqubo ezisetshenziselwa ukuxilonga umdlavuza we-ovarian zihlanganisa:

• Ukuhlolwa kwe-pelvic. Ngesikhathi sokuhlolwa kwe-pelvic, udokotela wakho ufaka iminwe eglavu esithweni sangasese sowesifazane bese ngesikhathi esifanayo ecindezela isandla esiswini sakho ukuze ezwe (palpate) izitho zakho ze-pelvic. Udokotela uphinde ahlole izitho zakho zangasese zangaphandle, isitho sangasese sowesifazane kanye nomlomo wesibeletho.
• Ukuhlola ukuhlolwa. Ukuhlolwa, okufana ne-ultrasound noma i-CT scans yesisu sakho kanye ne-pelvis, kungasiza ekunqumeni ubukhulu, ukwakheka kanye nokwakheka kwama-ovari akho.

• Ukuhlolwa kwegazi. Ukuhlolwa kwegazi kungase kuhlanganise ukuhlola ukusebenza kwesitho esingasiza ukunquma impilo yakho yonke.

   

  Udokotela wakho angase futhi ahlole igazi lakho ukuthola izimpawu zesimila ezibonisa umdlavuza wesibeletho. Isibonelo, ukuhlolwa kwe-cancer antigen (CA) 125 kungathola iphrotheni evame ukutholakala phezu kwamangqamuzana omdlavuza wesibeletho. Lezi zivivinyo azikwazi ukutshela udokotela wakho ukuthi unomdlavuza, kodwa zingase zinikeze izinkomba mayelana nokuxilongwa kwakho kanye nesifo sokubikezela.

• Ukuhlinzwa. Ngezinye izikhathi udokotela wakho akakwazi ukuqiniseka ngokuxilongwa kwakho kuze kube yilapho uhlinzwa ukuze ukhiphe i-ovary futhi ihlolwe izimpawu zomdlavuza.
• Ukuhlolwa kofuzo. Udokotela wakho angase atuse ukuhlola isampula yegazi lakho ukuze ubheke izinguquko zofuzo ezandisa ingozi umdlavuza wesibeletho. Ukwazi ukuthi unoshintsho oluzuzwe njengefa ku-DNA yakho kusiza udokotela wakho enze izinqumo mayelana nohlelo lwakho lokwelapha. Ungase ufise ukwabelana ngolwazi nezihlobo zakho zegazi, njengezingane zakini kanye nezingane zakho, njengoba nazo zingase zibe sengozini yokuba nalezo zinguquko zofuzo.

Uma usutholwe ukuthi unomdlavuza we-ovarian, udokotela wakho uzokwabela isigaba somdlavuza wakho ngokusekelwe emiphumeleni yokuhlolwa kwakho nezinqubo. Umdlavuza wesibeletho uhlukaniswa ngezigaba ezine, ezivame ukuchazwa ngezinombolo zamaRoma I kuya ku-IV. Isigaba sokuqala somdlavuza siphakamisa ukuthi usabalale kuma-ovari kuphela. Umdlavuza ususabalele kwezinye izingxenye zomzimba esigabeni sesi-4.

Ukwelashwa komdlavuza wesibeletho

Ukuhlinzwa

I-ovary ehlukumezekile kanye neshubhu layo le-fallopian kungase kukhishwe ngesikhathi sokuhlinzwa ngenxa yomdlavuza wesigaba sangaphambi kwesikhathi ongakaqhubekeli ngaphezu kweqanda elilodwa. Lokhu kuhlinzwa kungase kukusize ugcine amakhono akho okuzala.

Uma womabili ama-ovari akho anomdlavuza futhi zingekho ezinye izinkomba zobungozi, udokotela wakho ohlinzayo angase asuse womabili ama-ovari akho namashubhu e-fallopian. Ngenxa yokuthi isibeletho sakho sishiywe siphelele, usengakwazi ukukhulelwa usebenzisa ama-embryo akho aqandisiwe noma amaqanda, noma amaqanda avela kumnikeli.

Udokotela wakho ohlinzayo uzosusa ama-ovari, amashubhu e-fallopian, isibeletho, ama-lymph nodes aseduze, kanye nokugoqa kwezicubu zesisu ezinamafutha uma umdlavuza wakho usuthuthuke kakhulu noma ungafuni ukugcina ikhono lakho lokuba nezingane (i-omentum).

Udokotela wakho angase aphakamise ukuthi uhlinzwe ukuze kukhishwe umdlavuza omningi ngangokunokwenzeka uma umdlavuza wakho usuthuthukile. Kulokhu, i-chemotherapy inganikezwa ngaphambi noma ngemva kokuhlinzwa.

Ukwelashwa ngamakhemikhali

I-Chemotherapy iwukwelapha ngemithi esebenzisa amakhemikhali ukuze kuqedwe amaseli anda ngokushesha emzimbeni, njengamaseli omdlavuza. Imithi yokwelapha ngamakhemikhali inganikezwa ngomthambo noma ngomlomo.

I-Chemotherapy ivame ukulawulwa ngemva kokuhlinzwa ukuze kuqedwe noma yimaphi amangqamuzana omdlavuza asele. Kungumqondo omuhle futhi ukuwusebenzisa ngaphambi kokuhlinzwa.

Imithi yokwelapha ngamakhemikhali ingase ifudumale futhi ifakwe esiswini ngesikhathi sokuhlinzwa kwezinye izimo (i-hyperthermic intraperitoneal chemotherapy). Ngaphambi kokukhishwa, imithi ishiywa endaweni isikhathi esithile. Ukuhlinzwa bese kwenziwa.

Ukwelapha okuhlosiwe

Ukwelashwa kwemithi okuhlosiwe kugxile emaphutheni athile atholakala kumaseli omdlavuza. Amangqamuzana omdlavuza angabulawa imithi yokwelapha eqondiswe kulawa maphutha.

Uma ucabangela ukwelashwa okuhlosiwe komdlavuza we-ovarian, udokotela wakho angase ahlole amangqamuzana omdlavuza wakho ukuze abone ukuthi yikuphi ukwelashwa okuhlosiwe okungenzeka kusebenze.

Ukwelashwa kweHormone

Izidakamizwa ezivimbela imiphumela ye-hormone estrogen kumaseli omdlavuza wesibeletho zisetshenziswa ekwelapheni kwamahomoni. Ngenxa yokuthi amanye amangqamuzana omdlavuza wesibeletho athembele ku-estrogen ukuze athuthuke, ukuvimbela i-estrogen kungase kusize ekulawuleni umdlavuza.

Ukwelashwa ngama-hormone kungase kusetshenziselwe ukwelapha ezinye izinhlobo zezifo ezikhula kancane ze-ovarian. Kungenzeka futhi uma umdlavuza ubuya ngemva kokwelashwa kokuqala.

immunotherapy

I-Immunotherapy uhlobo lokwelashwa komdlavuza olusebenzisa amasosha omzimba. Ngenxa yokuthi amangqamuzana omdlavuza akha amaprotheni awasiza ukuba afihle amangqamuzana amasosha omzimba, amasosha omzimba alwa nesifo angase angawahlaseli. I-Immunotherapy isebenza ngokuphazamisa izinqubo zemvelo zamasosha omzimba.

Kwezinye izimo, i-immunotherapy ingase ibe inketho yokwelapha umdlavuza we-ovarian.

I-CAR T-Cell therapy yokwelapha umdlavuza wesibeletho

Okusanda kwakhiwa immunotherapy yokwelapha izimila kubizwa ngokuthi i-chimeric antigen receptor-engineered T-cell (CAR-T) therapy. Ukusetshenziswa kwayo ekwelapheni izimila eziqinile, njengomdlavuza wesibeletho, kuye kwaphenywa ngoba ukwelashwa kwe-CAR-T kubonise ukusebenza kahle okuphawulekayo ekwelapheni i-CD19-positive haematological malignancies.

Isicelo se Ukwelashwa kwe-CAR T-Cell isiqalile futhi lokhu kunikeza ithemba elisha ezigulini eziphethwe umdlavuza wesibeletho sezinga eliphezulu.