Njengoko uhlola ukuxilongwa kwakho, ukuqhubela phambili kunyango kubalulekile ekuphuculeni impilo yakho kunye nokubuyisela. Isicwangciso sonyango sonyango lomhlaza wesibhedlele siya kuxhomekeke kumanani amaninzi, ngokukodwa kwisigaba somdlavuza (ukuba sele sisabele kangakanani) kunye nomgangatho womhlaza (indlela engafanelekanga ngayo iiseli zomhlaza).
Ukuhlinzwa
Masiqale ngokuxoxa ngeendlela zokwenza unyango lomhlaza wesibeleko.
Ukufunyanwa kweTransurethral Isikhokelo sokugqithisa (TURBT)
Isinyathelo sokuqala ekuphatheni umhlaza wesibeleko esingenasiphako-esichaza ukuba i-tumor iqulethwe ngaphakathi kwesibhanxa kwaye ayifumene nomgca we-muscular we-thickness-uhlobo lonyango olubizwa ngokuba yi-transurethral resection bladder tumor, okanye i-TURBT. Le nqubo iyakususa i-tumor kwi-bladder.
Ngexesha le-TURBT, i- urologist ifaka isixhobo esinqabileyo, esincinci esinokukhanya kunye nekhamera kuyo (resectoscope) ngokusebenzisa i-urethra yomntu kwisitya sayo. I-resectoscope iqulethe i-wire loop evumela ugqirha ukuba asuse isisu.
Le nqubo ivame ukuqhutyelwa kwigumbi lokusebenza kwaye ngamanye amaxesha i-TURBT yesibini iyafuneka emva kweeyokuqala ukuqinisekisa ukuba akukho nto ilahlekile. Iindaba ezilungileyo kukuba abantu abaninzi banokubuyela ekhaya ngaloo mini okanye ngosuku olulandelayo. Kwakhona, iimiphumo zecala, njengegazi okanye ukuphazamiseka xa ujikeleza, zihlala zifutshane kwaye zincinci.
Radical Cystectomy
Ukunyanga okuqhelekileyo ngumhlaza womhlaza wesifo-umonakalo-okuchaza ukuba i-tumor ayifumanekanga kwaye sele ingena kwi-bladder's muscular layer-is a surgery ebizwa ngokuba yi-cystectomy. Le nkqubo ibandakanya ukususa i-vestile kunye nezitho ezizungezile-i- prostate kunye nama- vesicles eminzini kumadoda; uterus, i-cervix, i-tublopian tubes, i-ovaries, kunye neyona nxalenye yebhinqa kubasetyhini .
Ngamanye amaxesha i-cystectomy ephakamileyo ikhuthazwa ngumhlaza wesibeleko ongazange ungenelele kwisalathisi semisipha kodwa inezinye iinkalo ezibuhlungu, ezinobundlobongela. Kwakhona kukwacetyiswa ngokubanzi kubantu abanomdlavuza ongapheliyo okanye osisigxina umhlaza wesibeleko emva kokunyanga nge-intravesical immunotherapy (jonga ngezantsi).
UkuHlukiswa kweeUriary kunye nokuQalwa kwakhona
Emva kokuba isisu sisusiwe, ugqirha kufuneka enze icebo elitsha lomchamo ukuba ligcinwe. Kukho iindlela ezimbalwa zokuqwalasela:
- Isilwanyana esitsha singadalwa kwinqanaba lomathumbu womntu (i-neobladder) edibene nomlenze womntu ukuze bakwazi ukuchukumisa kwangaphambili.
- Ingxowa ingadalwa ngaphakathi emzimbeni isebenzisa izicubu ukusuka esiswini okanye emathunjini. Esinye isiphelo sidibaniswe kwi-ureters enye enye ibe yindawo evulekileyo elukhumbeni kwindonga yesisu (stoma). I-catheter ingasetyenziselwa ukukhupha umchamo ngokusebenzisa i-stoma emini, kodwa isikhwama sagcina kugcina umchamo.
- Endaweni yesikhwama, isalathisi samathumbu sixhunyiwe kuma-ureters. Ngolu hlobo lotyando, umchamo ugeleza ukusuka kwiintso ukuya kwi-ureters ngokusebenzisa isiqulatho samathumbu nase-stoma. Ekugqibeleni, iqhubela kwingxowa encinci yeqoqo elingaphandle komzimba.
Ubungozi bokuhlinzwa
I-cystectomy ephezulu kunye nokudala i-bladder entsha okanye isikhwama se-intanethi. Ngamanye amazwi, yinto enkulu. Ngoko, kubalulekile ukuba uqonde zonke iingozi kunye neenzuzo ezibandakanyekayo-ezilungileyo kunye ezimbi, ukuthetha.
Ngaloo ndlela, amathuba okubambisana nokuxhatshazwa kuxhomekeke kwizinto ezininzi, njengamava ogqirha, ubudala kunye nokuba ngaba isiguli sinengxaki yezokwelapha. Sekunjalo, imizekelo yeengxaki ezinokuthi zenziwe ngophando zibandakanya:
- Ukuhlamba
- Sulelo
- Ukugawula ngegazi emiphakeni
Olunye umba ekujonganeni kunye nodokotela wakho ogqirha lunokubangela iziphumo zecala zesondo, njengokwenza i-erectile dysfunction okanye ukuvuswa kwesondo, nendlela yokujamelana nayo.
I-Chemotherapy Ngaphambi Kokugqirha
Ukuba umntu unempilo ngokwaneleyo, uya kufumana i- chemotherapy phambi kokuhlinzwa ukuze aphucule amathuba akhe okusinda. Injongo yekhemotherapy kukubulala amangqamuzana omhlaza omzimba kodwa angabonakali.
Iimpawu eziqhelekileyo eziqhelekileyo zokusebenzisa i-chemotherapy regimens ezisetyenziswe ngaphambi kokuba utyando lwe-cancer ye-broderal ye-bladder yilezi:
- I-MVAC (methotrexate, vinblastine, doxorubicin, kunye ne-cisplatin)
- I-GC (i-cisplatin kunye ne-gemcitabine)
I-oncologist yakho, okanye ugqirha wesifo somhlaza, uya kulawula le michemotherapies kwimijikelezo. Oku kuthetha ukuba, emva kwonyango ngamnye, uya kuphumla kwaye uhlolwe kuyo nayiphina imiphumo emibi. Imizekelo yemiphumo emibi engabonwa ngolu hlobo lulapha:
- Ukukhathala
- Umngcipheko ophezulu wokusuleleka
- Ukuhlamba okanye ukubetha ngokulula
- Ukulahleka kweenwele
- Izilonda zomlomo
- Isihlunu kunye nokuhlanza
- Ukulahleka kokuva
- Ubungqina kunye nokubetha ezandleni okanye ezinyaweni
- Igazi kumchamo
Umjikelo ngamnye uhlala kwiiveki ezimbalwa kwaye, ngokubanzi, iisondo ezintathu zicetyiswa ngaphambi kokuba utyando lwe-bladder.
Ulwaphulo lwezonyango
Nangona amazinga okusinda ayenomdla kubantu abanomdlavuza ongenawo umzimba ongenawo umzimba, izixhala ezibini ezinkulu oogqirha nazo emva kokuba isisu sisuswe ngu:
- Ukuphindaphinda (umhlaza ubuya)
- Ukuqhubela phambili (umhlaza usasazeka kwisisipha okanye ngokuya emzimbeni)
Ngoko, makhe sijonge kwiindlela zokunyanga ezingekho ngonyango.
Intravesical Chemotherapy
Ezi zizathu zilapha ngasentla zezizathu zokuthi izigulane ezininzi zifumana unyango olongezelelweyo emva kokususwa kwesisu kunye nokungenelela okubizwa ngokuba yi-intravesical chemotherapy. Ngoluhlobo lwamayeza, amayeza alawulwa ngqo kwi-bladder ngokusebenzisa ikathitter. Injongo ye-chemotherapy kukutshabalalisa nayiphi na iseleyo, iiseli zomhlaza ezingabonakaliyo.
Ngokuxhomekeke kwingozi yomntu yokuphindaphinda umdlavuza wesibeleko (apho ugqirha uvavanya njengomgangatho ophantsi, ophakathi, okanye ophakamileyo), uya kufumana idosi enye ngexesha le-TURBT yokuqala okanye amanqanaba amaninzi kwixesha leveki ezintandathu. i-chemotherapy intravesical.
I-Mitomycin idla ngokuba yi-chemotherapy ekhethiweyo. Kungabangela ukutshisa okunye kwisibindi kunye nokuhamba okuqhelekileyo kunye / okanye ukuhluma okubuhlungu.
Intravesical Immunotherapy
Ngamanye amaxesha, endaweni ye-intravesical chemotherapy, umntu uya kufumana i-immraotheical immunotherapy ebizwa ngokuthi iBillill Calmette-Guerin (BCG). Olu hlobo lonyango lubangela isistim somzimba somntu ukubulala amangqamuzana omhlaza.
Kuyathakazelisa ukuqaphela ukuba iBillillus Calmette-Guerin (BCG) yaqala ukuphuhliswa njengesigontsho sesifo sofuba. Kodwa, ngowe-1970 kunye no-1980, kwafunyanwa ukubulala amangqamuzana omhlaza wesibeleko, nayo.
Nangona iphumelele kakhulu, i-intravesical BCG ingabangela iziphumo ezizeleyo ukuya kwiintsuku ezimbini ezingabandakanya:
- I-Fever, i-chills, kunye nomzimba womzimba
- Ukukhathala
- Ukugqithisa ngokweqile
- Igazi kumchamo
- Ubuhlungu xa uchama
- Ukuvutha ngaphakathi kwesikhumba
Ngokuqhelekileyo, i-BCG ingasasazeka kumzimba. Oku kunokubangela ukutheleleka komzimba wonke, onokuthi ibonakaliswe yimfiva eyenzeka iintsuku ezingaphezu kweentsuku okanye umkhuhlane ongaphuculanga ngamayeza. Utsholongwane lomzimba wonke luyingozi yonyango kwaye lufuna unyango lwangonyango.
UkuLondolozwa kweBladder
Nangona i-cystectomy ekhuselekileyo yinkqubo eqhelekileyo yonyango lomhlaza we-muscle-invasive, ngamanye amaxesha umntu onomhlaza wesibeleko esingahlaliyo akanakususwa. Kunoko, banokutshatyalaliswa ngokukhawuleza kwesikhumba sabo okanye i-TURBT eninzi. Njengawo nawaphi na uhlobo lwenyango, kula maxesha athile, ingozi kunye nezibonelelo kufuneka zihlalutwe ngokucokisekileyo.
Utyando lweyeza
Ulwaphulo lwe-radiation, olunikezwa ngonyango lwe-oncologist, luvame ukudibaniswa kunye ne-chemotherapy kunye ne-TURBT kwiinkqubo zokulondoloza i-bladder, njengoko kungathiwa yindlela efanelekileyo yonyango. Izaphulo zibulala amangqamuzana omhlaza kunye neeseshoni zonyango zihlala iintsuku ezintlanu ngeveki kwiiveki ezimbalwa.
Ukubeka iliso emva kokunyanga
Kwiinyanga ezintathu emva kokunyanga nge-intravesical therapy (kunye nexesha elithile emva koko), ugqirha uya kwenza i- cystoscopy ukuqinisekisa ukuba akukho mdlavuza wesibeleko. Kuphakathi kwezigulane eziphezulu, i-urtolo cytology ukukhangela amangqamuzana omhlaza kunye nokucinga ngeendlela eziphezulu ze-urinary (oko kukuthi i-CT scan) kuya kudlalwa rhoqo ngezinye iindlela njengendlela enye yokubeka iliso.
Ukuba indawo ebhenkcelayo yesibonakaliso ibonakala, iya kukhankanywa kwaye isuswe nge-TURBT. Ukuba umhlaza uye waphinda wabuyela, umntu uya kuphelelwa unyango olungakumbi lwe-intravesical okanye apheliswe isisu sakhe nge-cystectomy.
Ukuba abukho ubungqina bokuphindaphinda, umntu unokufumana unyango lokulondoloza kunye ne-BCG ukwenzela ukukhusela nayiphi na into yokuphindaphinda umhlaza. Ubungakanani bonyango lokulondolozwa (umzekelo, unyaka omnye ukuya kwiminyaka emithathu) kuxhomekeke engozini yomntu, ehlolwe liqela lakhe lomdlavuza.
I-Metastatic Bladder Cancer
Umhlaza wesibeleko oye wasasazeka kwezinye iindawo zomzimba, njengemilenze okanye ezinye izitho (imiphunga, isibindi kunye / okanye amathambo), i-chemotherapy ingaba yindlela yokunciphisa ukukhula komhlaza. Uphando olwenziwe kwi-immunotherapy lomdlavuza osiswini oluphambili luphandwa ngoku.
Ngamanye amaxesha, i- radiation inikezwa okanye utyando (i-TURBT okanye i-cystectomy) eyenziwa kumntu onomdlavuza wesisu se-metastatic, nayo. Kubalulekile ukuqonda, nangona kunjalo, ukuba ezi zonyango zenziwa njengendlela yokunyamekela-indlela yokunciphisa iimpawu ezixhalabisayo ezinxulumene nomhlaza.
Oko kwathiwa, kwimeko yesifo somhlaza wesifo se-metastatic, kubalulekile ukuba ulandele ngokukhawuleza ukuba unyango oluninzi luyingozi kunokuphucula umgangatho wobomi. Kulo mzekelo, yazi ukuba kulungile ukuhambisa iingcinga zakho kwintsapho yakho kunye ne- oncologist .
Ngamanye amazwi, ixesha elifutshane elifutshane linokuthi lizalise ngakumbi kunexesha elide lonyango olungenakulungeleka. Oku, ngokuqinisekileyo, isigqibo esicacileyo kunye nesigqabileyo.
> Imithombo:
> Abt D, Bywater M, Engeler DS, Schmid HP. Izinyathelo zokwelapha ze-hematuria ezingenakunqandwa kwisifo somhlaza wesisu. Int J Urol. 2013 Julayi; 20 (7): 651-60.
> I-American Cancer Society. NgoMeyi 2016. Ukwelapha umdlavuza weBladder.
> Babjuk et al. Izikhokelo ze-EAU malunga ne-non-muscle-invasive urothelial carcinoma ye-vestile: Ukuhlaziywa ngo-2016. Eur Urol. Ngo-2017 uMar; 71 (3): 447-61.
> Chang et al. Ukuxilongwa kunye nokunyangwa komhlaza ongenawo umzimba ongenawo umzimba: Umkhokelo we-AUA / SUO. J Urol. 2016 Oct; 196 (4): 1021-9.
> Stephenson AJ. Disemba 2016. Inkcazo yeendlela zokuqala kunye nokulawulwa komhlaza wesibeleko. Ku: U-UpToDate, uLerner SP, uRoss ME (Eds), UpToDate, Waltham, MA.