Umdlavuza wesitho sangasese sowesifazane

Ukwanda okungavamile kwamaseli ayingozi (umdlavuza) esithweni sangasese kwaziwa ngokuthi umdlavuza wesitho sangasese sowesifazane. I-squamous cell carcinomas yenza cishe amaphesenti angama-85 ezinsikazi ze-vagin. Lezi zikhula "esikhumbeni" sangasese (i-epithelial lining). Zivame ukutholakala eduze komlomo wesibeletho endaweni engenhla yesitho sangasese sowesifazane. Bakhula besuka ezindaweni eziyingozi ezibizwa ngokuthi i-vaginal intraepithelial neoplasia ngokuhamba kwesikhathi eside (VAIN).

I-Adenocarcinomas yenza i-5-10% yomdlavuza wesitho sangasese sowesifazane. Lezi zivela ezicutshini zezindlala. Sula iseli i-adenocarcinoma iwuhlobo oluncane lwale midlavuza. Lokhu kuvame kakhulu kwabesifazane abasebasha omama babo abasebenzisa ihomoni i-diethylstilbestrol (DES) ngenkathi bekhulelwe.

Ama-melanoma (amaphesenti angu-2-3), avela engxenyeni engezansi noma engaphandle yesitho sangasese sowesifazane, ama-sarcomas (amaphesenti angu-2-3), ngisho nezinhlobo ezingavamile njengengqamuzana elincane, i-lymphoma, nomdlavuza we-carcinoid zonke ziyizinhlobo ezingavamile zomdlavuza wesitho sangasese sowesifazane. Lesi sihloko asifaki lezi zinhlobo ezincane.

Izifo eziningi ezithinta isitho sangasese sowesifazane ama-metastases, hhayi izimila “eziyinhloko” (izimila eziqala esithweni sangasese) (umdlavuza osusabalala usuka kwenye indawo emzimbeni uye esithweni sangasese). Lokhu kungabangelwa isimila esikhulela ngqo esithweni sangasese sowesifazane (isibonelo, sisuka ku-endometrium, i-rectum, noma esinyeni) noma isimila esifuduka ngohlelo lwegazi noma i-lymph sisuka endaweni ekude (isibonelo, sisuka ebeleni noma esibelethweni) .

Umdlavuza wesitho sangasese sowesifazane wuhlobo lomdlavuza oluyivelakancane oluqala esithweni sangasese sowesifazane. Ibalelwa kumaphesenti ama-2 togqwalile uMthombo zomdlavuza wezitho zangasese zabesifazane, izilinganiso zeNational Cancer Institute (NCI).

Kunezinhlobo ezimbalwa eziyinhloko zomdlavuza wesitho sangasese sowesifazane, okuhlanganisa:

• I-squamous cell. Lolu hlobo lomdlavuza luqala olwelweni lwesitho sangasese sowesifazane bese lukhula kancane. Ibalelwa ku-9 kwabayi-10Umthombo Othembekile amacala omdlavuza wesitho sangasese sowesifazane, ngokusho kwe-American Cancer Society (ACS).
• I-Adenocarcinoma. Lolu hlobo lomdlavuza luqala emangqamuzaneni endlala yesitho sangasese sowesifazane. Uhlobo lwesibili oluvame kakhulu lomdlavuza wesitho sangasese sowesifazane futhi luvame kakhulu kwabesifazane abangaphezu kweminyaka engama-50.
• I-melanoma. Njengohlobo lomdlavuza wesikhumba oluvame kakhulu i-melanoma, lolu hlobo lomdlavuza luqala emangqamuzaneni anikeza umbala wesikhumba.
• I-Sarcoma. Lokhu kuqala ezindongeni zesitho sangasese sowesifazane futhi kubala iphesenti elincane kuphela lomdlavuza wesitho sangasese sowesifazane.

Ezigabeni zokuqala, ukwelashwa komdlavuza wesitho sangasese sowesifazane kunezinga eliphezulu lempumelelo.

Izici eziyingozi zomdlavuza wesitho sangasese sowesifazane

Isici esiyingozi yinto ethuthukisa amathuba akho okuthola isifo. Ukuba sengozini akuqinisekisi ukuthi uzoba nomdlavuza; ngokufanayo, ukungabi sengozini akuqinisekisi ukuthi uzohlala ungenawo umdlavuza. Uma ucabanga ukuthi ungaba sengozini, khuluma nodokotela wakho. Okulandelayo ezinye zezinto eziyingozi yomdlavuza wesitho sangasese sowesifazane:

• Ukuba neminyaka engama-60 noma ngaphezulu.
• Ukuba negciwane le-human papilloma virus (HPV). I-squamous cell carcinoma (SCC) yesitho sangasese sowesifazane ixhunyaniswe nokutheleleka nge-HPV futhi inezici eziningi zobungozi ezifanayo njenge-SCC yomlomo wesibeletho.
• Ukuchayeka ku-DES ngenkathi usesibelethweni sikamama. Ngawo-1950, isidakamizwa i-DES sanikezwa abanye besifazane abakhulelwe ukuvimbela ukuphuphuma kwesisu (ukuzalwa ngaphambi kwesikhathi kombungu ongakwazi ukuphila). Lokhu kuhlotshaniswa nohlobo olungavamile lomdlavuza wesitho sangasese sowesifazane okuthiwa i-clear cell adenocarcinoma. Amazinga alesi sifo ayephakeme kakhulu maphakathi nawo-1970, futhi ayivelakancane kakhulu manje.
• Ngemva kokwenza i-hysterectomy yezimila ezazinempilo (hhayi umdlavuza) noma umdlavuza.

Izimpawu nezimpawu zomdlavuza wesitho sangasese sowesifazane

Ukopha okungenabuhlungu kwesitho sangasese sowesifazane okungahlobene nemijikelezo yokuya esikhathini kuwuphawu oluvame kakhulu. Ukopha ngemva kokuya ocansini kungase kube uphawu lomdlavuza wesitho sangasese sowesifazane. Ukopha esithweni sangasese sowesifazane osesithweni sangasese sokuya esikhathini kuyethusa futhi kufanele kuxazululwe ngokushesha ngangokunokwenzeka. Ukukhipha isitho sangasese sowesifazane kanye nokuya ocansini okubuhlungu kuyizimpawu ezimbili ezingaba khona. Ngenxa yokuhlasela kwesimila ku-rectum, izinkinga ezithuthuke kakhulu zesitho sangasese sowesifazane zingase futhi zibangele izimpawu zokugaya ukudla njengegazi esitokisini, ukunyakaza kwamathumbu okubuhlungu, noma ukuqunjelwa. Izifo zesitho sangasese sowesifazane kwesinye isikhathi zingaya esinyeni, okwenza ukuchama kungabi lula noma kube nzima.

Okuvame kakhulu ukopha okungavamile esithweni sangasese.

Lokhu kuhlanganisa ukopha ngemva:

• menopause
• ukopha ngesikhathi noma ngemva kocansi
• ukopha phakathi kokuya esikhathini

Ukopha kungase kube nzima kakhulu noma kuqhubeke isikhathi eside togqwalile uMthombo kunokujwayelekile.

Ezinye izimpawu zifaka:

• uketshezi oluphuma esithweni sangasese olunamanzi, olunukayo, noma olunegazi
• ukuchama okubuhlungu noma kaningi
• ubuhlungu be-pelvic, ikakhulukazi ngesikhathi socansi
• isigaxa noma isisindo esithweni sangasese
• ukulunywa njalo esithweni sangasese
• ukuqunjelwa
• igazi esitulweni noma emchameni
• ukuhlungu obusemhlane
• imilenze evuvukele
• fistula, esigabeni sakamuva somdlavuza

Ukuxilongwa komdlavuza wesitho sangasese sowesifazane

Ukuhlolwa kwe-pelvic kungenye yezinyathelo ezibaluleke kakhulu ekuhloleni owesifazane onenkinga ye-gynecologic. Uchwepheshe wezokunakekelwa kwempilo (HCP) uhlola isibeletho, ama-ovari, amashubhu e-fallopian, nesitho sangasese sowesifazane ngokuzwa izindawo ngezandla zabo nokubheka izindawo ezibonakalayo phakathi nalokhu kuhlolwa. Noma yikuphi ukungahambi kahle kwesinye kanye ne-rectum kufanele kuhlolwe futhi. Lokhu kungase kudinge i-cystoscopy noma i-proctosigmoidoscopy, lapho ikhamera isetshenziswa khona ukuhlola ingaphakathi lesinye kanye ne-rectum/amathumbu, ngokulandelana.

Ukuhlolwa kwe-radiology, okufana nama-CT scan, ama-MRIs, nama-PET scans, kungasetshenziswa ukuhlola ama-lymph nodes akhulisiwe, izinkinga zezinso/sesinye, ukungahambi kahle kwesibindi, nezinye izindawo lapho umdlavuza ungabhebhetheka khona (i-metastasis).

Kunconywa ukuthi kwenziwe ukuhlolwa kwe-Pap. Insimbi iklwebha ingaphandle lomlomo wesibeletho nesitho sangasese sowesifazane ngesikhathi sokuhlolwa kwe-Pap. Amasampula ahlolwa ngesibonakhulu bese kwenziwa ukuhlolwa kwe-HPV. Ngisho noma udokotela wakho esola ukuthi unomdlavuza wesitho sangasese sowesifazane, i-Pap smear iyadingeka ukuze ugweme umdlavuza wesibeletho. Ukuhlolwa komdlavuza womlomo wesibeletho kusetshenziswa i-Pap smear kungathola umdlavuza wesitho sangasese esingafika ku-20%.

Kungenzeka ukwenza i-colposcopy. Umshini onamalensi wokukhuliswa kwebinocular ufakwa esithweni sangasese ukuze ubuke umlomo wesibeletho kanye nengaphakathi lesitho sangasese ngesikhathi se-colposcopy. Ama-Biopsies ezindawo ezikhathazayo emlonyeni wesibeletho kanye/noma eduze kwezindonga zesitho sangasese sowesifazane kufanele athathwe futhi athunyelwe elebhu ukuze ahlolwe nge-microscopic. Ukufaka isixazululo se-acetic acid kunoma yiziphi izindawo okusoleka kuzo kufanele kuhlolwe. Ngokuvamile, izindawo ezingavamile ziphenduka zibe mhlophe, okwenza kube lula ukuzibona kanye ne-biopsy.

Izigaba zomdlavuza wesitho sangasese sowesifazane

Ukwelashwa komdlavuza wesitho sangasese sowesifazane

Izindlela zokwelapha ezivame kakhulu ukuhlinzwa, ukwelashwa ngemisebe, kanye nokwelashwa ngamakhemikhali. Lezi zingasetshenziswa njengemodi eyodwa noma yokwelapha enezindlela eziningi.

Ayikho into ebizwa ngokuthi ukwelashwa “okujwayelekile” komdlavuza wesitho sangasese sowesifazane, futhi ukwelashwa kowesifazane ngamunye kufanele kuhambisane nesimo sakhe esithile. Izinketho zokwelapha kufanele zibandakanye isigaba sesifo sesiguli, ubudala, umlando wezokwelapha, kanye nezinketho zomuntu siqu, phakathi kwezinye izici.

Ukuhlinzwa kungase kusetshenziselwe ukususa ingxenye noma zonke izicubu zesitho sangasese sowesifazane (okuthiwa i-vaginectomy). Izilonda ezincane endaweni engenhla yesitho sangasese sowesifazane ngokuvamile yizo ezingcono kakhulu zokuhlinzwa. I-Hysterectomy kanye nokukhishwa kwama-lymph nodes esithweni sangasese sangasese sangasese kanye nendawo kuphakathi kwezinqubo ezingenziwa. Ukwelashwa ngemisebe kuyindlela esebenzayo yokuhlinzwa ezimweni eziningi. I-Chemotherapy (ngezinye izikhathi eyaziwa ngokuthi i-neoadjuvant chemotherapy) ingase isetshenziselwe ukunciphisa isimila ngaphambi kokuba sikhishwe kwezinye izimo. Ukwakhiwa kabusha kwesitho sangasese sowesifazane kungase kube inketho kwabesifazane abaye baba ne-vaginectomy. Umsele wesitho sangasese sowesifazane udalwa udokotela ohlinzayo esebenzisa i-flap yesikhumba noma yemisipha ethathwe kwenye ingxenye yomzimba.

Imisebe enamandla amakhulu isetshenziswa ekwelapheni ngemisebe ukuze kuqedwe amangqamuzana omdlavuza. Kuyindlela yokwelapha ekhethwa iningi leziguli ezinomdlavuza wesitho sangasese sowesifazane ohlaselayo, ikakhulukazi lezo ezinesigaba II noma ukugula okuphezulu. Inganikezwa njengemisebe yemishayo yangaphandle (esuka emshinini), i-brachytherapy (kusetshenziswa “imbewu” enemisebe etholakala ngamashubhu epulasitiki amancane afika ngqo endaweni enesifo), noma inhlanganisela yakho kokubili. Amagciwane amancane engxenyeni engenhla yomsele wesitho sangasese sowesifazane ngezinye izikhathi angelashwa ngawo i-brachytherapy yedwa. Lapho iziguli zithola ukuphindaphinda kulandela imisebe, ukuhlinzwa ngokuvamile kuyinketho ekhethiwe.

I-Chemotherapy iwukwelashwa okusebenzisa izidakamizwa ukubulala amangqamuzana omdlavuza. Ayikho idatha yocwaningo lomtholampilo olungahleliwe olusekela ukusetshenziswa kwe-chemotherapy kanye nemisebe yomdlavuza wesitho sangasese sowesifazane ngenxa yokungavamile kwalesi sifo. Ama-HCP amaningi anquma ukwelapha ngemisebe kanye ne-cisplatin-based chemotherapy ezigulini ezisengozini enkulu yomdlavuza wesitho sangasese sowesifazane, ngokusekelwe ocwaningweni oluningi lomdlavuza womlomo wesibeletho olubonisa imiphumela engcono ngenhlanganisela uma kuqhathaniswa nemisebe yodwa. I-Carboplatin, i-fluorouracil, i-paclitaxel, ne-docetaxel ngezinye zemithi eyengeziwe yokwelapha ngamakhemikhali esetshenziselwa ukwelapha umdlavuza wesitho sangasese sowesifazane. I-Chemotherapy ingasetshenziswa futhi ukuphatha (kunokwelapha) ukugula okuphindaphindiwe noma okusabalele.