Izigaba zomdlavuza wamathumbu

Uhlelo lwesiteji se-TNM

Ithuluzi elilodwa odokotela abalisebenzisayo ukuchaza ukuhlelwa komdlavuza uhlelo lwe-TNM. Odokotela basebenzisa imiphumela yezivivinyo zokuxilonga kanye nokuskena ukuphendula imibuzo elandelayo:

• Isigaxa (iT): Ingabe isimila siyakhula odongeni lwekholoni noma i-rectum? Zingaki izendlalelo ezephulwayo?

• Lymph nodes (N): Has the isisu spread to the lymph nodes? If so, where and how much?

• I-Metastasis (M): Ngabe umdlavuza ususabalalele kwezinye izitho zomzimba? Uma kunjalo, kuphi futhi kangakanani?

Hlanganisa imiphumela engenhla ukuthola isigaba somdlavuza somuntu ngamunye.

Kunezigaba ezinhlanu: isigaba 0 (zero) nezigaba I kuya ku-IV (1 kuye ku-4). Lesi sigaba sinikeza indlela ejwayelekile yokuchaza umdlavuza, ngakho-ke odokotela bangasebenzisana ukuhlela ukwelashwa okungcono kakhulu.

Okulandelayo imininingwane eyengeziwe yengxenye ngayinye yohlelo lwe-TNM lwe umdlavuza colorectal :

Isimila (iTrojan)

Usebenzisa uhlelo lwe-TNM, sebenzisa u- “T” kanye nencwadi noma inombolo (0 kuye ku-4) ukuchaza ukuthi isimila sokuqala singena kanjani emathunjini. Ezinye izigaba zihlukaniswe ngamaqembu amancane, angachaza izicubu ngokuningiliziwe. Imininingwane ethile yesimila imi kanjena.

I-TX: Isigaxa esiyinhloko asikwazi ukuhlolwa.

I-T0: Abukho ubufakazi bomdlavuza kukholoni noma kunxande.

Tis: refers to i-carcinoma endaweni (also called carcinoma in situ). Cancer cells are only found in the epithelium or primary layer, they are the top layer arranged inside the colon or rectum.

I-T1: Isimila sikhule saba yi-submucosa.

I-T2: Isimila sesikhule saba ungqimba lwemisipha, ungqimba olujiyile futhi olujiyile, oluhlasela imisipha.

I-T3: Isimila sikhula nge-muscularis bese singena ku-serosa. Ungqimba oluncane lwezicubu ezixhuma ngaphansi kohlaka lwangaphandle lwezingxenye ezithile zamathumbu amakhulu, noma selukhule lwaba izicubu ezizungeze ikholoni noma i-rectum.

I-T4a: Isimila sikhule safinyelela ebusweni be-visceral peritoneum, okusho ukuthi singene kuzo zonke izingqimba zekoloni ukuze sikhule.

I-T4b: Isimila sikhulile noma sinamathiselwe kwezinye izitho noma izakhiwo.

I-lymph node (N)

I- “N” ohlelweni lwe-TNM imele ama-lymph node. Ama-lymph node yizitho ezincane ezimise okabhontshisi ezitholakala kuwo wonke umzimba, ezisiza umzimba ukulwa nezifo njengengxenye yamasosha omzimba. Ama-lymph node aseduze kwekholoni kanye ne-rectum abizwa ngokuthi ama-lymph node asendaweni. Zonke ezinye zingama-lymph node akude atholakala kwezinye izingxenye zomzimba.

I-NX: Ama-lymph node wesifunda awakwazi ukuhlolwa.

I-N0 (N plus zero): Akukho ukusakazeka kuma-lymph node wesifunda.

I-N1a: Kunamaseli wesimila endaweni eyi-1 yama-lymph node.

I-N1b: Kunamaseli we-tumor kuma-lymph node wesifunda 2 kuya ku-3.

I-N1c: Amaqhuqhuva esitokisi esigaxa atholakala ezakhiweni eziseduze nekholoni awabukeki njengama-lymph node, kepha amaqhubu.

I-N2a: Kunamaseli wesimila ezindaweni ezine kuya kweziyisithupha ze-lymph node.

I-N2b: Kukhona amangqamuzana e-tumor kuma-lymph node angama-7 noma ngaphezulu.

Dlulisa (M)

I- “M” ohlelweni lwe-TNM ichaza umdlavuza osudlulele kwezinye izingxenye zomzimba, njengesibindi noma amaphaphu. Lokhu kubizwa ngokuthi ukudluliselwa okude.

I-MX: Ukudluliswa kwesilawuli kude akunakubuyekezwa.

M0: Lesi sifo asisakazekanga kude nasemzimbeni.

I-M1a: Umdlavuza usabalalele kwezinye izingxenye zomzimba ngaphandle kwekoloni noma i-rectum.

I-M1b: Umdlavuza ususabalalise ngaphezu kwengxenye eyodwa yomzimba ngaphandle kwekholoni noma i-rectum.

Izinga (G)

Odokotela babuye bachaza lolu hlobo lomdlavuza ngokufaka i-grading (G), echaza ukufana kwamangqamuzana omdlavuza namaseli aphilile uma ebukwa ngaphansi kwesibonakhulu.

Udokotela uqhathanisa izicubu zomdlavuza nezicubu ezinempilo. Izicubu ezinempilo ngokuvamile ziqukethe izinhlobo eziningi zamaseli aqoqelwe ndawonye. Uma umdlavuza ubukeka ufana nezicubu ezinempilo futhi uqukethe amaqembu amaseli ahlukene, ubizwa ngokuthi isimila esihlukanisiwe noma esisezingeni eliphansi. Uma izicubu zomdlavuza zibukeka zehluke kakhulu ezicutshini ezinempilo, zibizwa ngokuthi isimila esihlukaniswe kabi noma esisezingeni eliphakeme. Izinga lomdlavuza lingasiza odokotela ukubikezela izinga lokukhula komdlavuza. Ngokuvamile, ukwehla kwesigaba se-tumor, kungcono ukubikezela.

I-GX: Ayikwazi ukunquma ibanga lesimila.

I-G1: Amaseli afana namaseli aphilile (abizwa ngokuthi umehluko omuhle).

I-G2: Amaseli afana namangqamuzana aphilile (abizwa ngokuhlukaniswa okulingene).

I-G3: Amaseli awabukeki njengamaseli anempilo (abizwa ngokwahlukaniswa kabi).

I-G4: Amaseli cishe awafani namaseli aphilile (abizwa ngokungafani).

Isiteji somdlavuza ocacile

Udokotela unikeza izigaba zomdlavuza ngokuhlanganisa ukuhlukaniswa kwe-T, N no-M.

Isigaba 0: Lokhu kubizwa ngokuthi i-carcinoma in situ. Amaseli womdlavuza akulwelwesi lwamafinyila kuphela noma ulwelwesi lwekholoni noma i-rectum.

Isigaba I: Umdlavuza ukhule ngokusebenzisa i-mucosa futhi wahlasela imisipha yekoloni noma i-rectum. Ayizange isakaze ezicutshini eziseduze noma kuma-lymph node (T1 noma T2, N0, M0).

Isigaba I Umdlavuza ocacile

Isigaba IIA: Umdlavuza ukhule ngodonga lwamakholoni noma unxande futhi awusakazekanga ezicutshini eziseduze noma kuma-lymph node aseduze (T3, N0, M0).

Isigaba IIB: Umdlavuza ukhule ngokusebenzisa ungqimba lwemisipha kuya esiswini sesisu, esibizwa nge-visceral peritoneum. Ayisakazekanga kuma-lymph node aseduze noma kwezinye izindawo (T4a, N0, M0).

Isigaba IIC: Isimila sisabalale odongeni lwekholoni noma i-rectum futhi sikhule saba izakhiwo eziseduze. Ayisakazekanga kuma-lymph node aseduze noma kwezinye izindawo (T4b, N0, M0).

Isigaba IIIA: Umdlavuza usukhulile ngokusebenzisa ungqimba lwemisipha lwengqimba yangaphakathi noma ithumbu, futhi selusabalele nezicubu ezizungeze ikholoni noma i-rectum. Ama-lymph node noma amaqhuqhuva wesimila avela ku-colorectum, kepha akukho ukusabalala kwezinye izingxenye zomzimba (T1 noma T3, N1 noma N2c, M1; noma i-T1, N0a, M1).

Isigaba IIIB: Umdlavuza ukhule ngodonga lwamathumbu noma izitho ezizungezile, futhi usukhule waba yi-1 kuya ku-3 i-lymph node noma amaqhuqhuva wesimila ezicutshini ezizungeze ikholoni noma i-rectum. Ayisakazekanga kwezinye izingxenye zomzimba (T3 noma T4a, N1 noma N1c, M0; T2 noma T3, N2a, M0; noma i-T1 noma i-T2, i-N2b, i-M0).

Isigaba IIIC: Umdlavuza weColon, no matter how deep it grows, has spread to 4 or more lymph nodes, but has not spread to other distant parts of the body (T4a, N2a,
M0; T3 noma T4a, N2b, M0; noma i-T4b, N1, N2, M0).

Isigaba IVA: Umdlavuza usabalalele engxenyeni eyodwa ekude yomzimba, njengesibindi noma amaphaphu (noma iyiphi i-T, noma iyiphi i-N, i-M1a).

Isigaba IVB: Umdlavuza ususabalele ngaphezu kwengxenye yomzimba (noma iyiphi i-T, noma iyiphi i-N, M1b).

Umdlavuza ophindaphindiwe: Umdlavuza ophindaphindiwe ngumdlavuza ovela emuva kokwelashwa. Lesi sifo sitholakala ku-colon, rectum, noma kwenye ingxenye yomzimba. Uma umdlavuza uphindeka, kuzoba nomunye umzuliswano wokuhlolwa ukuqonda ubukhulu bokuphindeka. Lezi zivivinyo kanye nokuskena kuvame ukufana nalokho okwenziwe ngesikhathi kutholakala ukuxilongwa kwasekuqaleni.

Umdlavuza we-Colorectal: izindlela zokwelashwa

Ukubuka konke ukwelashwa

Ekuxilongweni nasekwelashweni komdlavuza, odokotela bezinhlobo ezahlukahlukene bavamise ukusebenza ndawonye ukwakha uhlelo lokwelashwa jikelele oluvame ukufaka noma ukuhlanganisa iziguli ezinezinhlobo ezahlukene zokwelashwa. Lokhu kubizwa ngethimba lemikhakha ehlukahlukene. Ngomdlavuza omnyama, lokhu kuvame ukufaka odokotela abahlinzayo, oncologists, radiation oncologists, kanye ne-gastroenterologists. Ama-gastroenterologists odokotela abagxile ekusebenzeni kwamathumbu kanye nokuphazamiseka. Ithimba lokunakekela umdlavuza lifaka nabanye abaqeqeshiwe bezempilo abahlukahlukene, kufaka phakathi abasizi bodokotela, abahlengikazi be-oncology, osonhlalakahle, osokhemisi, abeluleki, izazi zokudla, njll.

Okulandelayo incazelo yezinketho zokwelashwa komdlavuza ezijwayeleke kakhulu, kulandelwe incazelo emfushane yezindlela zokwelashwa ezibhalwe esigabeni. Izinketho zokwelashwa nezincomo kuncike ezicini eziningana, kufaka phakathi uhlobo nesigaba somdlavuza, imiphumela emibi engaba khona, kanye nokuthandwa yisiguli kanye nempilo yonke. Uhlelo lwakho lokunakekelwa lungafaka nokwelashwa kwezimpawu nemiphumela emibi, okuyingxenye ebalulekile yokunakekelwa komdlavuza. Zinike isikhathi sokuqonda zonke izinketho zakho zokwelashwa bese ukhuluma nodokotela wakho ngezinhloso zokwelashwa ngakunye nokuthi yini ongayilindela lapho uthola ukwelashwa.

Ucwaningo lukhombisile ukuthi izindlela ezahlukahlukene zokwelashwa zinikeza izinzuzo ezifanayo ezigulini kungakhathalekile ukuthi zineminyaka emingaki. Kodwa-ke, iziguli esezikhulile zingaba nezinselele zokwelashwa ezihlukile. Ukuze welaphe isiguli ngasinye, zonke izinqumo zokwelashwa kufanele zibheke lezi zinto ezilandelayo:

• Isimo sempilo yesiguli

• Impilo ephelele yesiguli

• Imiphumela engemihle engaba khona yohlelo lokwelashwa

• Eminye imithi isiguli eyiphuzile

• Isimo sesondlo sesiguli kanye nokwesekwa emphakathini

Ukuhlinzwa ngokwebala

Ukuhlinzwa ukususwa kwezimila nezinye izicubu ezinempilo ezizungezile ngesikhathi sokuhlinzwa. Lokhu ukwelashwa okuvame kakhulu komdlavuza onobala futhi kuvame ukubizwa ngokuthi ukuvuselelwa kokuhlinzwa. Ingxenye yekholoni enempilo noma i-rectum nama-lymph node aseduze nayo izosuswa. Udokotela ohlinzayo womdlavuza ungudokotela ogxile ekwelapheni umdlavuza ngokuhlinzwa. Udokotela ohlinzayo ongumbala uchwepheshe oqeqeshelwe ukwelapha izifo zekholoni, i-rectum ne-anus.

Ngaphezu kokuhlinzwa okuhlinzekwayo, ezinye izinketho zokuhlinzwa komdlavuza obala zibandakanya:

Ukuhlinzwa kwe-Laparoscopic yomdlavuza onobala

Ezinye iziguli zingase zikwazi ukuhlinzwa ngomdlavuza we-laparoscopic colorectal cancer. Ngale ndlela, ukusikeka kuncane futhi isikhathi sokutakula ngokuvamile sifushane kunokuhlinzwa okujwayelekile kwamakholoni. Ukuhlinzwa nge-laparoscopic kuyasebenza njengokuhlinzwa kwamakholoni okuvamile ukususa umdlavuza. Odokotela abahlinzayo abahlinza i-laparoscopic baye baqeqeshwa ngokukhethekile kule nqubo.

Umdlavuza wesifo somdlavuza

A small percentage of patients with rectal cancer may require colostomy. This is a surgical procedure that connects the colon to the abdomen to provide a way for excreta to leave the body. This excrement is collected in a pouch worn by the patient. Sometimes, a colostomy is only temporary to help the rectal wound heal, but it may also be permanent. Using modern surgical techniques, using radiation therapy and chemotherapy before surgery, most people undergoing rectal cancer treatment do not need a permanent colostomy.

Ukuqedwa kwemvamisa yomsakazo (RFA) noma i-cryoablation

Some patients may be able to perform radiofrequency ablation on the liver or lungs to remove tumors that have spread to these organs. Other methods include the use of energy heating in the form of radio frequency waves called RFA, or cryoablation. Not all liver or lung tumors can be treated with these methods. RFA can be performed through skin or surgery.

Imiphumela emibi yokuhlinzwa ngokwebala

Xhumana nodokotela wakho kusengaphambili ngemiphumela engemihle yokuhlinzwa okuthile bese ubuza ukuthi ungakuvimbela kanjani noma ukukwehlise. Ngokuvamile, imiphumela emibi yokuhlinzwa ifaka phakathi ubuhlungu nobumnene endaweni yokuhlinzwa. Ukuhlinzwa nakho kungadala ukuqunjelwa noma uhudo, okuvame ukunyamalala. Abantu abane-colostomy bangaba nokucasuka ezungeze i-stoma. Uma udinga ukuba ne-colostomy, udokotela noma umhlengikazi oyingcweti ekuphathweni kwe-colostomy angakufundisa ukuthi ungayihlanza kanjani indawo futhi uvikele ukutheleleka.

Abantu abaningi badinga ukuba nokuhamba kwamathumbu futhi ngemuva kokuhlinzwa, okungathatha isikhathi nokusiza. Uma ungeke uphinde uthole ukulawula okuhle kokusebenza kwamathumbu, kufanele ukhulume nodokotela wakho.

Ukwelashwa ngemisebe emdlavuzeni obomvu

Ukwelapha ngemisebe kusebenzisa amandla aphezulu ama-x-ray ukubhubhisa amangqamuzana omdlavuza. Ngokuvamile isetshenziselwa ukwelapha umdlavuza wamabele, ngoba lesi simila sivame ukuvela lapho saqala khona. Odokotela abagxile ekwelapheni umdlavuza ngemisebe babizwa ngama-radiation oncologists. Izinhlelo (izinhlelo) zokwelapha ngemisebe ngokuvamile zinikezwa inombolo ethile yokwelashwa futhi ziphinde zisetshenziswe esikhathini esithile.

• Ukwelashwa kwemisebe yangaphandle. I-radiotherapy yangaphandle isebenzisa umshini ukukhipha ama-X-ray lapho umdlavuza ukhona. Ukwelashwa ngemisebe ngokuvamile kuthatha izinsuku ezinhlanu ngesonto amasonto ambalwa.

• Stereotactic radiotherapy. Stereotactic radiotherapy is an exogenous radiation therapy that can be used if the tumor has spread to the liver or lungs. This type of radiation therapy can provide a large, precise dose of radiation to a small area of ​​focus. This technique can avoid normal liver and lung tissue that may be removed during surgery. However, not all cancers that spread to the liver or lungs can be treated in this way.

• Ezinye izinhlobo zokwelashwa ngemisebe.

Kwabanye abantu, amasu akhethekile we-radiotherapy, njenge-intraoperative radiotherapy noma i-brachytherapy, kungasiza ekuqedeni ingxenye encane yomdlavuza ongenakuqedwa phakathi nokuhlinzwa.

• Ukwelashwa kwemisebe yokuhlinzwa.

I-radiotherapy ye-intraoperative isebenzisa i-radiotherapy eyodwa yesilinganiso esiphakeme ngesikhathi sokuhlinzwa.

I-Brachytherapy kumdlavuza we-colorectal

I-Brachytherapy isebenzisa “imbewu” enemisebe efakwa emzimbeni. Ku-brachytherapy, umkhiqizo obizwa nge-SIR-Spheres, inani elincane lezinto ezinemisebe ebizwa nge-yttrium-90 lifakwa esibindini ukwelapha umdlavuza obala osabalalele esibindini ngoba ukuhlinzwa akusafaneleki, kanti ezinye izifundo zikhombisile ukuthi i-yttrium -90 kungasiza ukwehlisa ukukhula kwamangqamuzana omdlavuza.

I-Neoadjuvant radiotherapy yomdlavuza we-rectal

Ngomdlavuza we-rectal, ukwelashwa ngemisebe okuthiwa i-neoadjuvant therapy kungasetshenziswa ngaphambi kokuhlinzwa ukunciphisa isimila, okwenza kube lula ukukhipha isimila. Ingasetshenziswa futhi ukubhubhisa noma yimaphi amangqamuzana omdlavuza asele ngemuva kokuhlinzwa. Zombili izindlela ziyasebenza ekwelapheni lesi sifo. I-Chemotherapy ivame ukusetshenziswa ngasikhathi sinye njengokwelashwa kwemisebe, okubizwa nge-radiochemotherapy ehlangene ukwenza ngcono i-t
ukuphumelela kokwelashwa ngemisebe. I-Chemotherapy kanye ne-radiotherapy kuvame ukusetshenziselwa umdlavuza we-rectal ngaphambi kokuhlinzwa ukuze kugwenywe i-colostomy noma kunciphise ithuba lokuphindeka komdlavuza. Ucwaningo oluthile lwathola ukuthi ukwelashwa ngemisebe kanye nokwelashwa ngamakhemikhali ngaphambi kokuhlinzwa kwaba nemiphumela engcono futhi kwaba nemiphumela emibi embalwa kunokwelashwa ngemisebe okwenziwa ngemva kokuhlinzwa kanye nokwelashwa ngamakhemikhali. Izinzuzo ezinkulu zifaka inani eliphansi lokuphindaphinda komdlavuza kanye nokulimala okuncane kwamathumbu nge-radiation therapy.

Imiphumela emibi yokwelashwa ngemisebe

Imiphumela emibi yokwelashwa ngemisebe ingafaka ukukhathala, ukusabela okuncane kwesikhumba, isisu esithukuthele, nobunzima bokuzikhulula. Kungadala nezitulo ezinegazi ngokusebenzisa ukuphuma kwegazi noma ukuvinjelwa kwamathumbu. Ngemuva kokwelashwa, imiphumela emibi eminingi izonyamalala.

Ukwelashwa ngamakhemikhali emdlavuzeni obala

I-Chemotherapy isebenzisa izidakamizwa ukuqeda amangqamuzana omdlavuza, imvamisa ngokuvimbela amangqamuzana omdlavuza ukuthi angakhuli futhi ahlukane. I-Chemotherapy ivame ukunikezwa yi-oncologist yezokwelapha, udokotela ogxile ekwelapheni umdlavuza ngezidakamizwa.

Izidakamizwa zamakhemikhali zesistimu zingena egazini futhi zifinyelele kumaseli omdlavuza emzimbeni wonke. Izindlela ezijwayelekile zokuphatha i-chemotherapy zibandakanya ukuphathwa ngemithambo yegazi noma ukugwinya (ngomlomo) amaphilisi noma amaphilisi.

Uhlobo lwemithi yokwelashwa ngamakhemikhali luvame ukuba nenombolo ethile yemijikelezo yokwelashwa enikezwe esikhathini esithile. Iziguli zingathola umuthi owodwa noma inhlanganisela yezidakamizwa ezahlukahlukene ngasikhathi sinye.

I-Chemotherapy inganikezwa ngemuva kokuhlinzwa ukuqeda noma yimaphi amangqamuzana omdlavuza asele. Kwezinye iziguli ezinomdlavuza we-rectal, odokotela bazokwenza i-chemotherapy kanye ne-radiation therapy ngaphambi kokuhlinzwa ukuze banciphise ubukhulu bezicubu zomzimba futhi banciphise nethuba lokuphindeka komdlavuza.

Izinhlobo zemithi yokwelashwa ngamakhemikhali e-colorectal cancer

Njengamanje, i-US Food and Drug Administration (i-FDA) ivume imishanguzo eminingana yokwelashwa komdlavuza obala ngokocansi. Udokotela wakho angancoma isigaba 1 noma izidakamizwa eziningana ngezikhathi ezahlukahlukene ngesikhathi sokwelashwa. Kwesinye isikhathi le mithi isetshenziswa ngokuhlangana nemithi yokwelashwa ebhekiswe (bheka “Ukwelashwa Okuhlosiwe” ngezansi).

• Xeloda

I-Fluorouracil (5-FU, i-Adrucil)

• I-Irinotecan (iCamptosar)

• I-Eloxatin

• Trifluorouridine / Tiracilidine (TAS-102, Lonsurf)

Ezinye izinketho zokwelashwa ezivamile zokusebenzisa le mithi zifaka:

• 5-FU

• I-5-FU ne-Wellcovorin (Wellcovorin), amavithamini akhulisa ukusebenza kwe-5-FU

• I-Capecitabine, ifomu lomlomo le-5-FU

• I-5-FU ene-leucovorin ne-oxaliplatin (ebizwa nge-FOLFOX)

• I-5-FU ene-leucovorin ne-irinotecan (ebizwa nge-FOLFIRI)

• Irinotecan isetshenziswe yodwa

I-Capecitabine ne-irinotecan (ebizwa nge-XELIRI noma i-CAPIRI) noma i-oxaliplatin (ebizwa nge-XELOX noma i-CAPEOX)

• Any of the above drugs combined with the following targeted drugs (see below): cetuximab, bevacizumab or panitumumab

• I-FOLFIRI ihlangene nezidakamizwa ezihlosiwe (bheka ngezansi): ziv-aflibercept noma i-lamucirumab

Imiphumela emibi ye-Chemotherapy

I-Chemotherapy ingadala ukuhlanza, isicanucanu, isifo sohudo, i-neuropathy, noma izilonda ze-aphthous. Noma kunjalo, izidakamizwa ezivimbela le miphumela emibi zingasetshenziswa. Ngenxa yezinguquko ezindleleni zokuphatha, le miphumela emibi ezigulini eziningi ayinzima njengakudala. Ngaphezu kwalokho, iziguli zingakhathala ngokweqile futhi ingozi yokutheleleka iyanda. Eminye imithi ingadala neuropathy, ukudikiza noma ukuba ndikindiki ezinyaweni noma ezandleni nasezinyaweni. Ukulahleka kwezinwele kungumphumela ongejwayelekile wezidakamizwa ezisetshenziselwa ukwelapha umdlavuza obala ngokwebala.

Uma imiphumela emibi iba mibi kakhulu, umthamo wesidakamizwa ungancishiswa noma ukwelashwa kungabambezeleka. Uma uthola i-chemotherapy, kufanele uxhumane nethimba lakho lezokwelapha ukuze uqonde ukuthi ungamvumela nini udokotela wakho ukuthi alaphe imiphumela emibi. Lapho ukwelashwa sekuphelile, imiphumela emibi ye-chemotherapy izonyamalala.

Ukwelashwa kwezidakamizwa okuhlosiwe kumdlavuza we-colorectal

Ukwelashwa okuhlosiwe ukwelashwa kwezakhi zofuzo eziqondene nomdlavuza, amaprotheni, noma izindawo zezicubu ezinomthelela ekukhuleni komdlavuza nasekusindeni. Lokhu kwelashwa kuvimbela ukukhula nokusabalala kwamangqamuzana omdlavuza ngenkathi kunciphisa ukulimala kwamaseli aphilile.

Izifundo zakamuva zikhombisile ukuthi akuzona zonke izicubu ezinenhloso efanayo. Ukuze uthole ukwelashwa okuphumelela kunazo zonke, udokotela wakho angenza izivivinyo zofuzo ukunquma izakhi zofuzo, amaprotheni, nezinye izinto kulesimila. Lokhu kusiza odokotela ukufanisa kangcono isiguli ngasinye nokwelashwa okuphumelela kakhulu. Ngaphezu kwalokho, kwenziwa ucwaningo oluningi lokufunda kabanzi ngamatshegethi athile kanye nokwelashwa okusha okubhekiswe kubo. Le mithi iya ngokuya ibaluleke ngokwengeziwe ekwelapheni umdlavuza onamabala amabi.

Ucwaningo lukhombisile ukuthi iziguli ezindala zingazuza ekwelashweni okuqondisiwe okufana neziguli ezisencane. Ngaphezu kwalokho, imiphumela emibi elindelekile iyalawuleka ezigulini esezikhulile nasezigulini ezisencane.

Ukwahlukaniswa kokwelapha okuhlosiwe

Ngomdlavuza we-colorectal, izindlela zokwelashwa ezihlosiwe ezilandelayo ziyatholakala.

Ukwelashwa kwe-anti-angiogenesis kumdlavuza we-colorectal

Ukwelashwa kwe-anti-angiogenesis ukwelashwa okuhlosiwe. Igxile ekuvikeleni i-angiogenesis, okuyinqubo lapho izicubu zakha khona imithambo yegazi emisha. Njengoba izicubu zidinga i-angiogenesis futhi zinikeze izakhamzimba, inhloso yokwelashwa kwe-anti-angiogenesis "ukulamba" isimila.

• Bevacizumab (Avastin)

Lapho i-bevacizumab ihlanganiswa ne-chemotherapy, izokwandisa isikhathi sokusinda kweziguli ezinomdlavuza we-colorectal osezingeni eliphakeme. Ngo-2004, i-FDA yamukela i-bevacizumab ehlanganiswe ne-chemotherapy njengokhetho lokuqala noma ukwelashwa komugqa wokuqala komdlavuza we-colorectal osezingeni eliphezulu. Ucwaningo lwakamuva lukhombisa ukuthi luyasebenza futhi njengokwelashwa kolayini wesibili.

I-Sikarga (Stivarga)

Lesi sidakamizwa savunywa ngo-2012 ezigulini ezinomdlavuza we-metastatic colorectal ezitholile izinhlobo ezithile ze-chemotherapy nezinye izindlela zokwelashwa eziqondisiwe.

I-Ziv-aflibercept (i-Zaltrap) ne-lamucirumab (i-Cyramza)

Noma iyiphi yale mithi ingasetshenziswa ngokuhlanganiswa ne-FOLFIRI chemotherapy njengokwelashwa komugqa wesibili komdlavuza we-metastatic colorectal.

Epidermal growth factor receptor (EGFR) inhibitor.

I-EGFR inhibitor iyindlela yokwelashwa eqondisiwe. Abaphenyi bathola ukuthi izidakamizwa ezivimbela i-EGFR zingavimbela ngempumelelo noma zinciphise ukukhula komdlavuza obala ngokwebala.

• ICetuximab (i-Erbitux). I-Cetuximab i-antibody eyenziwe ngamaseli wegundane, asesenokwakheka okuthile kwezicubu zegundane.

• IPanitumumab (Vectibix). I-Panitumumab yenziwa ngokuphelele ngamaprotheni womuntu futhi ayibangeli ukusabela okweqile njenge-cetuximab.

Ucwaningo lwakamuva lukhombisile ukuthi i-cetuximab ne-panitumumab akunamphumela kwizicubu ezinokuguqulwa kwezakhi zofuzo ze-RAS noma izinguquko. I-ASCO incoma ukuthi zonke iziguli ezinomdlavuza we-metastatic colorectal ezingathola ukwelashwa kwe-anti-EFGR, njenge-cetuximab ne-panitumumab, zingathola ukuguqulwa kwezakhi zofuzo ze-RAS. Uma isimila sesiguli sinokuguquka kofuzo ku-RAS, i-ASCO incoma ukwelashwa ngokwenziwa ngama-anti-EFGR antibodies.

Your tumor may also be tested for other molecular markers, including BRAF, HER2 overexpression, microsatellite instability, etc. These markers have not yet been approved by the FDA for targeted therapy, but there may be therapeutic opportunities in clinical trials that study these molecular changes.

Imiphumela emibi yokwelashwa okuqondisiwe

Imiphumela emibi yokwelashwa okuqondisiwe ingafaka ukuqubuka kwesikhumba ebusweni nasemzimbeni ongaphezulu, okungavinjelwa noma kwehliswe izindlela ezahlukahlukene zokwelapha.

Ukwelashwa kwezimpawu zomdlavuza nemiphumela engemihle

Umdlavuza nokwelashwa kwawo kuvame ukudala imiphumela emibi. Ngaphezu kokwehlisa ukukhula komdlavuza noma ukuqeda umdlavuza, ingxenye ebalulekile yokwelashwa komdlavuza ukuqeda izimpawu zomuntu nemiphumela engemihle yakhe. Le ndlela ibizwa ngokuthi ukwelashwa okunciphisayo noma ukwelashwa okusekelayo, futhi ifaka phakathi ukusekela izidingo zomzimba, ezingokomzwelo nezenhlalo zesiguli.

Ukwelashwa nge-palliative kuyindlela yokwelashwa egxile ekwehliseni izimpawu, ekwenzeni ngcono impilo, nasekusekeleni iziguli nemindeni yazo. Noma ngubani, kungakhathalekile ukuthi uneminyaka emingaki, uhlobo kanye nesigaba somdlavuza, udinga ukunakekelwa okunciphisayo. Lapho i-palliative t
ukuphinda kuqalwe kabusha kuqalwe ngokushesha ngangokunokwenzeka ngesikhathi sokwelashwa komdlavuza, umphumela ungcono kakhulu. Abantu bavame ukuthola ukwelashwa nokwelashwa komdlavuza ukuqeda imiphumela emibi ngasikhathi sinye. Eqinisweni, iziguli ezithola lezi zindlela zokwelashwa ezimbili zivame ukuba nezimpawu ezinzima kanye nempilo engcono, futhi zibike ukuthi ziyaneliseka ngokwelashwa.

Ukunakekelwa kwe-palliative kuyehluka kakhulu futhi kuvame ukufaka imithi, izinguquko zokudla okunempilo, amasu okuphumula, ukusekelwa ngokomzwelo nezinye izindlela zokwelapha. Ungathola futhi izinketho zokwelashwa ezifana nokuqeda umdlavuza, njenge-chemotherapy, ukuhlinzwa, noma ukwelashwa ngemisebe.

Izinketho ezahlukahlukene zokwelashwa komdlavuza

Ngokuvamile, izigaba 0, I, II, no-III ziyelapheka ngokuhlinzwa. Kodwa-ke, iziguli eziningi ezinesifo somdlavuza esigabeni sesithathu se-colorectal kanye nezigaba zesigaba II zithola ukwelashwa ngamakhemikhali ngemuva kokuhlinzwa ukwandisa amathuba okwelapha lesi sifo. Iziguli ezinesifo sesibili somdlavuza wesigaba sesibili kanye nesigaba III zithole i-radiotherapy kanye ne-chemotherapy ngaphambi noma ngemuva kokuhlinzwa. ISigaba IV imvamisa aselapheki, kodwa siyelapheka futhi singalawula ukukhula komdlavuza kanye nezimpawu zesifo. Ukubamba iqhaza ezivivinyweni zokwelashwa nakho kuyindlela yokwelashwa kwesiguli ngasinye esigabeni.

Isigaba 0 umdlavuza obala ngokwebala

Ukwelashwa okujwayelekile yi-polypectomy noma ukususwa kwe-polyp ngesikhathi se-colonoscopy. Ngaphandle kokuthi ama-polyps angeke asuswe ngokuphelele, akukho ukuhlinzwa okwengeziwe okudingekayo.

Isigaba I umdlavuza ocacile

Ukususwa kokuhlinzwa kwezimila nama-lymph node ngokuvamile kuyindlela yokwelashwa.

Isifo somdlavuza wesigaba II

Ukuhlinzwa kuvame ukwelashwa kokuqala. Iziguli ezinesifo somdlavuza wesigaba II esimhlophe kufanele zikhulume nodokotela bazo ngokuthi ngabe zidinga ukwelashwa okwengeziwe ngemuva kokuhlinzwa, ngoba ezinye iziguli zithola i-adjuvant chemotherapy. I-Adjuvant chemotherapy yindlela yokwelashwa ngemuva kokuhlinzwa eyenzelwe ukubhubhisa noma yimaphi amangqamuzana omdlavuza asele. Kodwa-ke, izinga lokwelashwa lokuhlinzwa lilodwa lihle impela, futhi ezigulini ezinalesi sigaba somdlavuza obala kakhulu, inzuzo yokwelashwa okungeziwe incane kakhulu. Ezigulini ezinomdlavuza wesigaba sesibili se-rectal, ukwelashwa ngemisebe kuvame ukuhlanganiswa ne-chemotherapy ngaphambi noma ngemuva kokuhlinzwa. Ukwelashwa ngamakhemikhali okungeziwe kunganikezwa ngemuva kokuhlinzwa.

Isifo somdlavuza wesigaba III

Ukwelashwa kuvame ukufaka ukususwa kokuhlinzwa kwesimila okulandelwa yi-adjuvant chemotherapy. Ukuhlolwa kwemitholampilo nakho kuyatholakala. Ezigulini ezinomdlavuza we-rectal, ukwelashwa ngemisebe kungenziwa ngaphambi nangemva kokuhlinzwa.

I-Metastatic (isigaba IV) umdlavuza wombala

Uma umdlavuza usakazeka usuka endaweni yawo eyinhloko uye kwenye ingxenye yomzimba, odokotela bawubiza ngomdlavuza we-metastatic. Umdlavuza ocacile ungasakazekela ezithweni ezikude, njengesibindi, amaphaphu, ne-peritoneum, okungukuthi, isisu noma amaqanda abesifazane. Uma lokhu kwenzeka, odokotela bangaba nemibono eyehlukene ngohlelo oluhle kakhulu lwezokwelapha. Ngaphezu kwalokho, ukubamba iqhaza ezivivinyweni zokwelashwa kungaba yindlela.

Uhlelo lwakho lokwelashwa lungafaka inhlanganisela yokuhlinzwa, ukwelashwa ngemisebe nokwelashwa ngamakhemikhali, okungasetshenziswa ukubambezela ukukhula kwesifo futhi kaningi kunciphise isimila. Ukunakekelwa kwe-palliative kubalulekile ukusiza ukukhulula izimpawu nemiphumela emibi.

Kulesi sigaba, ukusetshenziswa kokuhlinzwa ukususa ingxenye yekholoni lapho umdlavuza uvela khona akuwulaphi umdlavuza, kepha kungasiza ekunciphiseni ukuvinjelwa kwamakholoni noma ezinye izinkinga ezihlobene nomdlavuza. Kungenzeka futhi ukuthi usebenzise ukuhlinza ukukhipha izingxenye zezinye izitho eziqukethe umdlavuza, okuthiwa i-resection. Uma inani elilinganiselwe lomdlavuza lisakazeka emzimbeni owodwa, njengesibindi noma amaphaphu, abanye abantu bangalapheka.

Emdlavuzweni ongafani nhlobo, uma umdlavuza ususabalele esibindini, uma ukuhlinzwa kungenzeka (ngaphambi noma ngemuva kwe-chemotherapy), kunethuba lokwelashwa okuphelele. Noma kungenakwenzeka ukwelapha umdlavuza, ukuhlinzwa kungakhuphula ukusinda izinyanga noma ngisho neminyaka. Ukunquma ukuthi iziphi iziguli ezingasizakala ngokuhlinzwa komdlavuza okudluliselwe esibindini imvamisa kuyinkqubo eyinkimbinkimbi ebandakanya ongoti abaningi abasebenzisanayo ukuhlela uhlelo oluhle kakhulu lokwelashwa.

Amathuba okuxolelwa komdlavuza nokubuyela emuva

Ukuthethelelwa komdlavuza kulapho umzimba ungakwazi ukuthola umdlavuza futhi ungenazimpawu. Lokhu kungabizwa futhi ngokuthi "abukho ubufakazi besifo" noma i-NED.

Ukukhululwa kungaba okwesikhashana noma unomphela. Lokhu kungaqiniseki sekudale abantu abaningi bakhathazeke ngokuthi umdlavuza uzobuya. Yize ukukhishwa okuningi kungunaphakade, kubalulekile ukukhuluma nodokotela wakho mayelana nokuthi kungenzeka yini ukuthi umdlavuza uphinde uvele. Ukuqonda ubungozi bakho bokubuyela emuva kanye nezindlela zokwelashwa kungakusiza ukuthi ulungiselele ukubuyela komdlavuza ngempumelelo.

Uma umdlavuza ubuya emuva kokwelashwa, ubizwa ngokuthi umdlavuza ophindaphindiwe. Kungabuya endaweni efanayo (ebizwa ngokuthi ukuphindeka kwendawo), okuseduze (ukuphindeka kwesifunda) noma kwenye indawo (ukuphindaphinda okukude).

Lapho lokhu kwenzeka, umjikelezo wokuhlola uzoqala futhi ukuqonda okuningi ngangokunokwenzeka mayelana nokubuyela emuva. Ngemuva kokuphothulwa kokuhlolwa, uhlelo lokwelashwa luvame ukufaka izindlela zokwelapha ezingenhla, njengokuhlinzwa, ukwelashwa ngamakhemikhali kanye nokwelashwa ngemisebe, kepha zingasetshenziswa ezinhlanganisweni ezahlukahlukene noma zinikezwe ngamanani ahlukile. Udokotela wakho futhi angancoma ukuthi uhlanganyele esivivinyweni somtholampilo esifundela ukwelashwa kwalomdlavuza ophindaphindiwe. Ngokuvamile, izinketho zokwelashwa komdlavuza ophindaphindiwe ziyefana nezomdlavuza we-metastatic (bheka ngenhla), kufaka phakathi ukuhlinzwa, ukwelashwa ngemisebe, nokwelashwa ngamakhemikhali. Akunandaba ukuthi ukhetha luphi uhlelo lokwelashwa, ukunakekelwa okunciphisayo kuzobaluleka ekunciphiseni izimpawu nemiphumela engemihle.