Izinyango zokwelapha umhlaza wesisu zixhomekeke kwinqanaba lomhlaza kwaye zingabandakanya ukuhlinzwa (ukususa inxalenye okanye yonke inkunkuma), i-chemotherapy, unyango lwe-radiation, unyango olujoliswe kuyo, okanye ukuhlanganiswa kovavanyo lwezonyango zezi zixhobo okanye unyango olutsha.
Noko ke, unyango, luya ngaphaya kwelokuphelisa umhlaza, kunye nokunyanga okunyamekelayo okanye unyango olujolise ekuncedeni abantu ukuba bajamelane nemiphumo yomzimba, yemoya, nangokomoya yomdlavuza-ibaluleke kakhulu.
Ukukhetha iZiko loLonyango
Enoba uza kuba notyando okanye ezinye iindlela zokufumana unyango, kubalulekile ukuba ufumane isikhungo esihle somhlaza. Ucwaningo lwe-2017 kwi- Annals of Surgery luqinisekisile ukuba zeziphi izifundo eziboniswe ngaphambili. Abaphandi bafumene ukuba abantu abanomdlavuza osisigxina abahamba ngeemimandla emide ukuya kumaziko omhlaza we-high volume volume bafumana unyango ogqithisileyo kwaye baneziphumo ezingcono kunabo bahlala kufuphi nekhaya kumaziko omhlaza abaphatha abantu abancinci ngesifo.
Unokucinga ukuba ukhetha ukufuna uluvo kwinqanaba elikhulu leNational Cancer Institute-izikhungo zomhlaza ezikhethiweyo; amaziko aphatha amanani amaninzi abantu abanomdlavuza osisigxina (kunye nalabo baqhutywe ukuhlinzwa, benza okungakumbi kwezo zonyango).
Izinyango Zonyango ngeSigaba
Ngaphambi kokungena kwiinketho ezithile zonyango ezikhoyo, kunceda ukuxoxa ngokunyanga okuqhelekileyo kusetyenziswa kwizigaba ezahlukeneyo zesifo.
Ziyakwazi ukuhluka ngokukrakra.
Abantu ababini abanesigaba esifanayo sesifo, umzekelo, banokuba neekliniki kwimimandla eyahlukeneyo eya kufuna iindlela ezahlukeneyo zonyango. Kwanokuba neengqungquthela ezifana nendawo, isigaba, kunye nabantu abaneempilo ezifanayo, kubalulekile ukuba uqaphele ukuba akukho zithandana zomdlavuza ezifanayo.
Oku kuthetha, indlela eqhelekileyo yile ndlela ilandelayo.
Isigaba 0
Isigaba 0 (i- carcinoma in situ ) okanye isigaba esincinci kakhulu se-1A ngamanye amaxesha angasuswa nge-endoscopy. E-United States (ngokungafani nezinye iindawo zehlabathi), umdlavuza wesisu awuqhelekanga kwaye awufumaneki kangangoko kwisigaba kwangoko ukwenzela ukuba ukususwa kwe-endoscopic kunokwenzeka. Ukuhlinzwa kungasetyenziselwa ezi zicubu.
Isigaba 1
Ukuvuthwa ngokuqhelekileyo unyango olukhethiweyo kwi-stage 1 kancers kwaye lunokuba luncedo kuphela olufunekayo kwezinye iimeko.
Isigaba 2 no-3
I-Chemotherapy kunye ne-radiation (okanye i-chemotherapy yedwa) elandelwa nguvulindlela yindlela eqhelekileyo, nangona amaxesha athile ukuhlinzwa kuphela, okanye i-chemotherapy yedwa, isenokusetyenziswa. Kukho ukuphikisana ngokungakhathaliseki ukuba abantu abane-squamous cell carcinomas of oopopus abanempendulo epheleleyo (akukho ubungqina besisu) emva kokuba i-chemotherapy ifuna ukuhlinzwa.
Isigaba 4
Ngesigaba 4A segciwane, i-chemotherapy kunye neyeza zonyango ngamanye amaxesha kulandelwa utyando (ukuba i-tumor iyaphendula kakuhle). Kwimigangatho yesifo se-4B, i-chemotherapy ngamanye amaxesha ingabangela impendulo.
Abanye abantu banenkxalabo yokuba, ngenxa yobudala, unyango luya kuba nobudlova, kodwa abantu abadala (abangaphezu kweminyaka engama-80) abanempilo ebonakalayo ebonakalayo bayabonisa ukunyamezela unyango ngokunyamekela kwaye banokulingana namazinga afana nalawa bantu abatsha.
Ukuhlinzwa
Xa ufunyanwe kwisigaba sokuqala sesifo, ukuhlinzwa kunokunika ithuba lokunyanga. Ngaphambi kokuqwalasela ukuhlinzwa, ukucwangcisa ngokucophelela kubaluleke kakhulu. Ngelishwa, ukuba umhlaza usasazeke ngaphaya kwesigxina, ukuhlinzwa akuphuculisi ukusinda kodwa kunciphisa umgangatho wobomi. Ngoko ke kubalulekile ukuchonga ngubani oza kuzuza ngokuhlinzwa.
Kubaluleke kakhulu ukufumana ugqirha onobuchule obuninzi ekusebenzeni le misebenzi. Nangona amaziko amakhulu omhlaza angaphinda abe noogqirha abanamava amaninzi, kubalulekile ukuthatha ixesha "lokudliwano" nodokotela ogqirha malunga nolwazi lwakhe olwenziwe ngophenyo olunzulu.
Iinkqubo
I-esophagectomy, utyando olwenziwe ukususa umhlaza wesisu, libhekisela ekususweni kwayo yonke into okanye inxalenye yesigxina. Kwezinye iintsholongwane, ngokukodwa ezo zisezantsi, inxalenye yesisu isuswe kwakhona. Ukongeza, i-lymph nodes esondeleyo isuswe kwaye ithunyelwe kwibhuleji yokugula ukuze ikhangele naluphi na ubungqina bomhlaza.
Emva kokuba icandelo le-esophagus lisuswe, isisu siphinde sithintele kwisigxina esiphezulu (igama elichaza ukuthunga ndawonye "i-anastomosis"). Ukuba inxalenye enkulu ye-esophagus isuswe ukwenzela ukuba i-attachment ayinzima okanye ayinakwenzeka, icandelo lomathumbu lingasuswa kwaye lifakwe phakathi kwe-oop top and esiswini.
I-esophagectomy ingenziwa ngeendlela ezimbini ezahlukeneyo:
- Vula i-esophagectomy: Kwindlela evulekileyo, inkolelo enkulu yendabuko yenziwa kwintamo, esifubeni, okanye esiswini (okanye ngamanye amaxesha ziquka zonke iintathu) apho i-esopha ifumaneka khona.
- I-esophagectomy encinci ye-invasive: Kwinkqubo encinci ye-invasive, i-incision encane encane ifakwa entanyeni nasesifuba. Ububanzi (kunye nekhamera) lufakwe ngolu xwebhu kwaye utyando lwenziwa ngokubanzi. Utyando oluncinci oluvakalayo luvame ukuba lunokwenzeka ngeentsholongwane ezincinci.
Iziphumo eziPhakathi kunye neengxaki
Ukususa inxalenye yesigxina kukuhlinzwa okukhulu kunye neengxaki aziqhelekanga. Ngexesha lotyando, iingozi eziqhelekileyo ziquka ukuphuma kwegazi kunye ne-anesthesia ezinokukhathazeka njengeengxaki zesimo senhliziyo kunye neengxaki zemiphunga.
Kwiintsuku ezilandelayo ukuhlinzwa, iingubo zegazi zixhaphake kakhulu ( iimbandezelo ezinzulu ) kwaye ngezinye izihlandlo zingaphula kwaye zihambe ziye emiphakeni (i- pulmonary emboli ). Izifo ezinjenge-pneumonia ziqhelekileyo ngexesha lokuphulukana nokuvuza (kunye nosulelo olusukelayo kunye nokuvuvukala) lingahle lwenzeke apho i-esophagus ifakwa khona.
Ixesha elide, abanye abantu baqhubeka bexhala ngenxa yokulimala kwiisondlo esifubeni ngexesha lotyando. Umonakalo wemisipha ungakhokelela ekutshintsheni kwimeko yokutya yokutya okungaholele ekufubeni isicupunu kunye nokuhlanza. Ekubeni i-sphincter esezantsi (i-band of muscle ephantsi kwe-esophagus evimbela ukuba isisu esiswini singagxinwa kwi-esophagus) isoloko isuswe okanye isonakaliswe, ukutshabalalisa iqhelekile, kwaye abantu abaninzi baya kufuna imithi ye-acid reflux.
Chemotherapy
I-Chemotherapy isebenza ngokuhlasela iiseli ngokukhawuleza kwaye iya kunikwa ngenye yezindlela eziliqela ngomhlaza wesisu. Ezi ziquka:
- I-chemotherapy ye-Neoadjuvant: I- neoadjuvant chemotherapy ibhekisela ekusebenziseni i-chemotherapy phambi kokuhlinzwa ukuze unciphise ubukhulu besisu.
- I-chemotherapy ye-Adjuvant: I- adjuvant chemotherapy ibhekisela kwikhemotherapy enikwe emva kokuhlinzwa. Nangona kungabonakali ukuba kukho umhlaza osele emva kokuhlinzwa, amaqoqo amancinci amaseli omhlaza angasala kwaye adala ukuphindaphinda emva koko. I-Chemotherapy emva kokuhlinzwa kunokunciphisa umngcipheko wokuphindaphinda nokuphucula ubomi kwabanye abantu.
- I-chemotherapy ehambayo: Palotherapy chemotherapy ibhekisela ekusebenziseni i-chemotherapy ukulawula iimpawu kunye nokwandisa ubomi kunye nesigaba se-4, kodwa kungekhona ukuphilisa eso sifo. Ngexesha langoku, i-chemotherapy (nangona xa ihlanganiswe nemitha) iyakwandisa ubude bokuphila kodwa akunakwenzeka ukuphilisa eso sifo.
Ukuba ukugqithwa kuqwalaselwa, indlela eqhelekileyo yindlela yokunika i-chemotherapy (okanye ngaphandle kwonyango lwamayeza) ngaphambi kokuhlinzwa (i-acjuvant chemotherapy okanye i-chemoradiation). Kukho izizathu ezininzi zezi.
- Ugqirha wakho unokuqinisekisa ukuba i-chemotherapy iyasebenza kunokuba ufunde emva kokuhlinzwa ukuba akunjalo.
- I-Chemotherapy ivame ukunyamezela ngakumbi ngaphambi kokuhlinzwa ngaphezu kokuhlinzwa.
- I-chemotherapy ye-Neoadjuvant inganciphisa i-tumor (yenza ibe yincinci) ukwenzela ukuba ukuhlinzwa kulula ukwenza.
- Ekugqibeleni, kubantu abathile (ngokukodwa abo bane-squamous cell carcinomas), i-tumor ingasweleka ukuze kungabikho ukuhlinzwa.
Amachiza e-Chemotherapy asetyenziswa rhoqo aquka inhlanganisela yeParaplatin (carboplatin) kunye ne-Taxol (paclitaxel) okanye iPlatatin (cisplatin) kunye neCamptosar (irinotecan). Kwixesha elidlulileyo, amayeza ama-5-FU (5 fluorouracil) ayesetyenziselwa ukusetyenziswa, kodwa iyancipha ngakumbi.
Iimiphumo zangaphandle zeKhemotherapy
Njengoko kunonyango oluninzi lomhlaza, kubalulekile ukukhumbula ukuba iimiphumo eziyingozi zonyango umhlobo okanye ilungu lentsapho elinokuba nalo elidlulileyo, akufuneki ukusetyenziswa kunyango lwangoku. Izidakamizwa ze-Chemotherapy zivame ukunikezelwa ngemigudu (umzekelo, iiveki ezintathu), kwiinyanga ezine ukuya ezintandathu.
Uninzi lweempembelelo ezibangelwa yimichiza ekubulaweni kweeseli eziqhelekileyo ezahlukana ngokukhawuleza kunye neeseli zomhlaza. Iziphumo eziqhelekileyo ziquka:
- Igazi elichanekileyo libala: Ukubala okuphantsi kwegazi ( ukunyuswa komnkantso wethambo ) okubangelwa ukubala kwe-cell cell count ( neutropenia ), isibalo se-red cells ( redemeter ), kunye nesibalo esiphantsi seplatelet ( thrombocytopenia ).
- Ukulahleka kweenwele: Izidakamizwa ezinokubangela ukuba iintlungu zenzeke ngokuqhelekileyo zingasetyenziswanga ngumhlaza wesisu (ngaphandle kweCamptosar) kodwa ngokuphindaphindiweyo kubangela ukuba iinwele zincinci.
Isihlunu kunye nokuhlanza : Jonga ngezantsi.
- I-peripheral neuropathy: Ukulinganisa, ukuphazamiseka, kunye nentlungu, kaninzi kwi-"stocking and glove".
- Izilonda zomlomo kunye nokutshintsha kweendlebe
- Ukukhathala
Kanye nje ngokuba izidakamizwa ezisetyenziselwa ukusetyenziswa kwezidakamizwa zisetyenzisiwe, ukulawulwa kwemiphumo emibi kuye kwaphucula kakhulu. Abantu abaninzi bananto encinci okanye akukho ncwangu kunye nokuhlanza ngamachiza okukhusela. Kukho ama-injections akhona ukwenyusa inani lamaseli omhlophe xa kufuneka (nangona kubalulekile ukufunda ngeendlela zokunciphisa umngcipheko wokusuleleka ngexesha lokukhupha i-chemotherapy ).
I-peripheral neuropathy (PN), enye yeempawu ezivuthayo zonyango lwe-chemotherapy ngenxa yesifo somhlaza kwaye ihlala isigxina. Amachiza anxulumene kakhulu kunye ne-PN abandakanya i-taxanes (njenge-Taxol), kunye neziyobisi zeplatinum (njengePlatinol neParaplatin). Ekubeni ukuhlanganiswa kwezi zinto kusetyenziswa rhoqo, isiphumo sinokukhuliswa.
Kukho izifundo ezininzi eziqhubekayo zijonga iindlela zokunciphisa le mpawu (njengokusebenzisa i- L-glutamine ngethuba lokunyanga), kwaye abantu bafanele bathethe noogqirha babo malunga nophando olutshanje ngaphambi kokuqalisa i-chemotherapy.
Utyando lweyeza
Ukunyangwa kwamayeza kusetyenziswa imitha ephezulu yamandla ukunyanga iiseli zeomhlaza kwaye isetyenziswa rhoqo kunye ne-chemotherapy. Ukunyangwa kwamayeza kunokusetyenziswa kwakhona ukwenzela ukuthatha i-palliation (jonga ngezantsi). Inikwa ngeendlela ezimbini ezibalulekileyo:
- Ukukhanya kwemitha yangaphandle : Ukugqithiswa kwemitha yangaphandle yindlela abantu abaninzi abajwayelene nabo, kwaye banokunikwa imihla ngemihla iintsuku okanye iiveki ezimbalwa.
- I-Brachytherapy (yangaphakathi) unyango lwe-radiation: Nge-brachytherapy, i-endoscopy yenziwe ukuze i-radiation ibekwe kufuphi ne-tumor ngaphakathi kwendawo. Yenza rhoqo ngokuphindaphindiweyo njengonyango olusisigxina ukunceda ngokugwinya.
Iimiphumo zecala lomlilo
Imiphumo echaphazelekayo yonyango ye-radiation kwi-esifubeni yinto evuywayo yesikhumba kunye nokukhawuleza kwisiza semisebe (njengokufana nokushisa kwelanga) kunye nokukhathala . Ukuphuphuma kwesikhumbuzo kwisifuba kungabangela ukuvuvukala kwemiphunga (i- radiation pneumonitis ). Ukuba ungakhange uxoxwe ungakhokelela kwi-fibrosis yamaphaphu. Ukuvuvukala kwe-esophagus ( pulmonary fibrosis ) nayo ingenzeka.
Unyango olujoliswe
Ulwaphulo olulindelekileyo lusebenzisa iziyobisi njengokhemotherapy, kodwa iziyobisi "zijoliswe" kwindlela ethile ekukhuleni kwamaseli omhlaza. Ngenxa yesi sizathu bahlala benemiphumo embalwa yecala kunezidakamizwa zamachiza zendalo.
I-Cyramza (ramucirumab)
I-Cyramza yi-anti-monoglonal antibody ethathwa njenge-angiogenesis inhibitor. Ukuze i-tumors ikhule, kufuneka ivelise imitsha yegazi ( angiogenesis ). Isiza lithintela inyathelo elifunekayo ukwenza iinqwelo ezintsha.
I-Cyramza isetyenziswa rhoqo xa ezinye iindlela zonyango zingasasebenzi kwaye zingasetyenziselwa kunye okanye ngaphandle kwe-chemotherapy. Imiphumo emibi ingabandakanya intloko yesifo kunye nengcinezelo ephezulu yegazi kodwa ngezinye iziganeko ezinzima, ezifana nokuphuma kwegazi okanye ukunyuka kwamathumbu emathunjini, kuya kwenzeka.
Ngokwezifundo zango-2017, kuzo zonke i-chemotherapy kunye nonyango olujoliswe kunyango, i-Cyramza ibonisa ngokucacileyo ikhono lokuphucula kokubili ukuqhubekeka kokungabikho kokuqhubekayo kunye nokuphila ngokubanzi kubantu abaneziphumo eziphambili (isigaba se-4) se-adenocarcinoma esophageal.
Herceptin (trastuzumab)
I-Herceptin isetyenziselwa ngezinye izihlandlo ze-adenocarcinomas eziphambili ze-esophageal ezi-HER2 ezichanekileyo (ezifana ne-HER2 yomhlaza wesifuba esihle).
Uvavanyo lweHER2 lwenziwe kwisampuli yesisu esiyifumene ngexesha lovavanyo okanye utyando. Ezi khansela zineeprotheyini HER2 ngaphezulu kweseli, apho kukho ukukhula okubambisanayo kunye nokwenza ukukhula. U-Herceptin ubophelela kula ma-receptors ukwenzela ukuba izinto zokukhula zingakwazi, ngokukodwa zilambile umdlavuza.
Imiphumo emibi isoloko imnene, njengentloko kunye nomkhuhlane, kwaye ngokuqhelekileyo iphucula ngexesha. Isiyobisi, ngamanye amaxesha, sinokulimaza intliziyo. Ugqirha wakho uya kuxubusha umngcipheko wale.
Uvavanyo lweZliniki
Kukho okwangoku izilingo zeklinikhi ziqhubeka zijonga ukudibanisa kwezi zonyango zingentla, kunye neendlela ezitsha zonyango ezifana neyeza- immunotherapy .
Nangona uthabatheka kuphando lokuphanda lunokubangela abanye abantu, kunceda ukugcina engqondweni ukuba yonke imithi esiyiyo ngomhlaza wesifo esasisigxininiso yayisetyenziswe kwimeko yesilingo.
I-Medicine Complementary (CAM)
Ngexesha langoku, akukho "iindlela" zokwelapha ezandisa ulondolozo okanye kubangele unyango kubantu abanomdlavuza wesisu. Oko kwathiwa, unyango oluthile lunokukunceda ngeempawu zomhlaza kunye nezokwelapha zonyango xa zidibene neyeza eziqhelekileyo.
Uninzi lwamasebe aphezulu emhlaza kananjalo anikezela le mithi yokwelapha engasetyenziswayo kunye nezokwelapha eziqhelekileyo zomhlaza. Iipilisi ezinjengokucamngca, i-yoga, i-acupuncture, i-massage yonyango, kunye nokunye ngamanye amaxesha kunokunceda abantu bajamelane neengxaki zomzimba nezomzwelo ezihamba kunye nokuxilongwa komhlaza.
Unonophelo loLuntu
Unonophelo olulinganisiweyo luhluke kwiinkathalo zokubhedlele kwi-hospice ukuze lusetyenziswe ngisho nakubantu abalindele ukuphiliswa emdlalweni wabo. Kuyinkathalo ejolise ekuncedeni abantu ukulawula iimpawu zomzimba kunye neemvakalelo ezinxulumene nomhlaza kunye nomhlaza wonyango, ukususela kwiintlungu zomhlaza ukuya ekudakaleni.
Ubunzima bokugwinya ngenxa yokuvinjelwa kwesisu ngokwemvumbo kuqhelekileyo ngumhlaza wesisu kwaye uphazamise ukutya okunomsoco. Ukuba isifo sikhulu kakhulu ukuhlinzwa (esophagectomy) kukho iindlela zokunciphisa iingxaki ngokugwinya. Ezinye zezi ziquka:
- Ukubeka i-stent kwi-esophagus (nge-endoscopy) ukugcina i-oopopus ivulekile.
- I-Brachytherapy (i-radiation yangaphakathi) ekhankanywe ngasentla.
- Ulwaphulo lwe-radiation lwangaphandle.
- I-Electrocoagulation (ukutshisa indawo yesikhumba esinobungozi).
- Unyango lwe laser.
Amanqanaba omhlaza amaninzi ngoku anikezela iqela leqela lokunyamekela. Ukusebenza kunye neengcali zokunakekelwa kwenkcenkceshe ngokugqithiseleyo kuninzi kunika ithuba lokuba iimpawu zakho ziya kulawulwa kakuhle kwaye umgangatho wakho wobomi unokuba lukhulu kangangoko kunokwenzeka xa uhlala nomhlaza.
> Imithombo:
> Bast, R., Croce, C., Hait, W. et al. I-Holland-Frei Cancer Medicine. Wiley Blackwell, ngo-2017.
> Janmaat, V., Steverberg, E., van der Gaast, A. et al. I-Palliative Chemotherapy kunye neTransed Treatment ye-Esophageal ne-Gastroesophageal Junction Cancer. I-Cochrane Database yeeNkqubo eziPhezulu . 2017. 11: CD004063.
> INational Cancer Institute. Ukwelashwa kweCeophageal Cancer (PDQ) -Ingcali yeNgcali yezobuNtu. Ukuhlaziywa nge- 02/06/18.
> Speicher, P., Englum, B., Ganapathi, A. et al. Ukuya kwiCandelo eliPhezulu leMqulu lidibaniswa nokuPhucula okuPhucukileyo kwizigulane ezine-Canophageal Cancer. Annals of Surgery . 2017. 265 (4): 743-749.