Izilingo ezisetyenziselwa ukuxilonga umhlaza we-esophageal zingabandakanya ingxube ye-barium, i-endoscopy, kunye ne-endoscopic ultrasound, yaye ijwayele ukulawulwa ngabantu abanobunzima bokugwinya, ukukhwehlela okuqhubekayo, okanye iimeko zokubeka ingozi kwisifo esifana ne-acid-long reflux. Ezinye iinkqubo kunye neemvavanyo zengcamango ezifana ne-CT, i-PET kunye ne-bronchoscopy zinokukunceda ekuqaliseni isigaba sesifo.
I-staging efanelekileyo, kwakhona, iyadingeka ukuze ukhethe okukhethwa kukho unyango olungcono.
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Akukho luvavanyo lwangaphakathi kwikhaya lomhlaza wesisu. Kunceda ukuba uqaphele zombini iziganeko zobungozi kunye nezibonakaliso ezinokubakholisa kunye nempawu zesifo somhlaza , ukuze wenze isigqibo kunye nogqirha wakho kwaye uphumelele uvavanyo olufanelekileyo loqeqesho, ukuba luyimfuneko.
Iimvavanyo zeebhanki azihambelani ngqo nomhlaza wesisu, kodwa zisetyenziselwa kunye nokucinga, ukuphononongwa ngokucophelela kwimbali yentsapho kunye nempilo yomntu, kunye nokuhlolwa ngokomzimba ukuxilonga kwesi sifo. Inani elipheleleyo legazi (i-CBC) lingabonisa ubungqina be-anemia (inani elibomvu lentsholongwane legazi) xa umhlaza uphala. Izilingo zomsebenzi zentsholongwane zinokuphakanyiswa ukuba umhlaza usasazeke kwisibindi.
Iinkqubo
Iinkqubo zibaluleke kakhulu ekwenzeni ukuxilongwa kwesifo somhlaza kunye nokuquka:
Endoscopy
I- endoscopy ephezulu (i-esophagoscopy okanye isophagus-gastric-duodenoscopy) yindlela yokuqala yokuhlola umhlaza wesifo somdlavuza namhlanje.
Kule nkqubo, ityhubhu eguquguqukayo, ekhanyisiweyo ifakwe emlonyeni nasemzantsi ngaphantsi kwe-oopopus. I-tube ithole ikhamera ekupheleni evumela ukuba oogqirha babone ngokucacileyo umgca we-esophagus. Ukuba ukungaqhelekanga kuphawulwe, i-biopsy ingenziwa ngexesha elifanayo.
Ngaphambi kwenkqubo, abantu banikwa ukukhusela okubangela ukulala, kwaye imigaqo ixhomekeke kakuhle.
I-Endoscopic Ultrasound (EUS)
Le nkqubo yenziwe ngenjongo yokufumana i-imaging encedo. Ngethuba le-endoscopy yendabuko ephezulu, iprojekthi ye-ultrasound ekupheleni kwendawo isetyenziselwa ukuxhamla amaza omsindo aphezulu avela kwiisisu zangaphakathi zesisu. I-echoes yakha i-sonogram, umfanekiso wezo zicubu. I-EUS inceda kakhulu ekunqumeni ubunzulu be-tumor, ebaluleke kakhulu ekumisekeni. Kwakhona kunceda kakhulu ekuhloleni i-lymph node kunye ne-biopsies ekhokelela kuyo nayiphi na into engafanelekanga. Ezinye iimvavanyo zengcamango nazo ziyakucingwa (jonga ngezantsi), nangona oku kungowona mngcipheko.
Biopsy
I-biopsy idlalwa rhoqo ngexesha lokugcina i-endoscopy, kodwa ingenziwa kwakhona nge-bronchoscopy okanye i-thoracoscopy. Iipathologists zijonge ezi zicubu ngaphantsi kwe-microscope ukuba zibone ukuba izicubu zinomdlavuza kwaye, ukuba kunjalo, nokuba yi-squamous cell carcinoma okanye i-adenocarcinoma. Isampuli kwakhona inikezwa ibanga le-tumor, inombolo echaza indlela enobudlova obubonakala ngayo.
Ezinye iimvavanyo zezicubu zinokwenziwa ukuba zijonge iimpawu ze-molecule zesisu, njengesimo se-HER2 (njengama-cancer ebelekileyo anokuba i- HER2 enokuthi , i-cancer ye-esophageal ikwaba yi-HER2 positive).
Bronchoscopy
I- bronchoscopy idla ngokuqhutyelwa kwiimvumba ezingasondeliyo eziphakathi kwinqanaba elingaphezulu kweyesithathu.
I-bronchoscope (ithambo elincinci, elikhanyayo) lifakwe kwimpumlo okanye emlonyeni kwi- trachea (ityhubhu edibanisa umlomo kwimiphunga) kunye ne- bronchi (i-airways enkulu) yemiphunga. Inqubo ivumela ugqirha ukuba acaphele ngokuthe ngqo nayiphi na into engafanelekanga kule mimandla aze aqokelele iisampula zamathambo (i-biopsy) ukuba kukho.
I-bronchoscopy yenziwe phantsi kwe-sedation, ngokuqhelekileyo njengenkqubo yonyango.
ITraracoscopy
Ngexesha le-thoracoscopy, i-incision or cut cut is made between two nervous and thoracoscope, ityhubhu elincinci, elikhanyayo, ifakwe kwisifuba. Oogqirha basebenzisa le nto ukujonga kwiingcingo ngaphakathi kwesifuba kwaye bajonga indawo ezingavumelekanga zomhlaza.
Iisampuli zeTisue kunye ne-lymph nodes zingasuswa kwi-biopsy. Kwezinye iimeko, le nqubo ingasetyenziselwa ukususa isahluko se-esopha okanye imiphunga.
Laparoscopy
Kwi-laparoscopy, ukubonakala okuncinci okanye ukusika kwenziwa kwidonga lesisu. I-laparoscope, enye ityhubhu encinci, ekhanyayo, ifakwe emzimbeni ngenye yezinto ezibonakalayo ukuba zijonge izitho ngaphakathi kwesisu kwaye zikhangele iimpawu zesifo. Ezinye izixhobo zingeniswa ngolu hlobo okanye ezinye izinto ezibandakanyekayo ukwenza iinkqubo ezifana nokususa izitho okanye ukuthatha iisampuli zamathambo kwi-biopsy.
Laryngoscopy
Iibhubhu ezincinci zifakwe phantsi komqala ukuba zikhangele i-larynx okanye ibhokisi lezwi. Olu vavanyo lunokufumanisa naluphi na ubungqina bokusasazeka komhlaza kwi-larynx okanye pharynx (umqala).
Ukucinga
Imvavanyo yokucinga ingenziwa ekuqaleni njengenxalenye yesifo sokuxilongwa komhlaza wesisu, kodwa isenziwa ngokuqhelekileyo ukubeka umhlaza oye wafunyanwa. Uvavanyo olunokwenziwa luquka:
Barium Swallow
Uvavanyo lokuqala olwenziweyo ukuvavanya umdlavuza ongasophageal ngokuqhelekileyo ugosa lokugaya okanye i-endoscopy ephezulu, nangona uhamba ngokuthe ngqo kwi-endoscopy ukhethwa ukuba umkhwa wesifo se-esophageal ukhunjulwe.
Kwimitshini ye-Barium (ebizwa ngokuba yi-GI series series), umntu usela isiselo esinehlophe esine-barium aze aqhube uluhlu lwe-X-ray. I-barium igxininisa isisu kunye nesisu, ukuvumela i-radiologist ukuba ibone ukungaqhelekanga eludongeni lwe-esophagus kwimifanekiso ethathwe.
Ingxube ye-barium ingakunceda ekufumaneni izigulane (izibilini ezibomvu ngaphakathi kwimizi), kodwa isetyenziswe ngaphantsi kwexesha elidlulileyo kuba i-biops ayikwazi ukwenza ngexesha elifanayo.
CT Scan
I-CT scan (ikhompyutha ye-tomography) isebenzisa i-cross-section ye-X-ray ukudala umfanekiso we-3D wezitho zangaphakathi. Ngomdlavuza wesisu, uvavanyo aluqhelekanga lusetyenziswe njengenxalenye yokuxilongwa, kodwa kubalulekile ekugxilweni kwesi sifo. I-CT ibaluleke kakhulu ekukhangekeni ubungqina bokuba nayiphi na isasaza (i- metastasis ) ye-tumor ukuya kwiimfucu okanye ezinye iindawo zomzimba, njengemiphunga okanye isibindi.
PET scan
I-PET i-scans iyanceda kakhulu ekukhangekeni ubungqina bokusasazeka ngomhlaza wesisu. I-PET yokuphenya ihluke kwezinye iifundo zengcamango ngoxa lilinganisa umsebenzi wendlela yokusebenza emzimbeni womzimba. Inani elincinci le-sugarac acid ishiyiwe kwigazi kwaye ivumelekile ukuba ithathwe ngamaseli. Iiseli ezisebenzayo, ezinjengeeseli zeengqambela, zibonakaliswa ngakumbi kuneendawo ezingekho phantsi komzimba.
X-Ray
Ukongezelela kwiimvavanyo ezingentla ngasentla zokuxilonga kunye nesigxina somhlaza wesisu, i-X-ray esifubeni ukujonga ukusasazeka kwimpompo ingaqhutyelwa.
Ukuxilongwa okuhlukeneyo
Kukho inani leemeko ezinokubangela iimpawu ezifana nezo zomhlaza wesisu, njengobunzima bokugwinya. Ezinye zezi ziquka:
- Ukuqhathaniswa kwe-Esophageal : I-stricture i-tissu ebomvu eyenza i-inophagus ebangela ukunciphisa. Ngokuqhelekileyo kubangelwa ngenxa yentlekele, umzekelo, ngenxa yeengxaki ze-endoscopy zokugonywa kwezilwanyana (i-varicose veins of the epopus edibaniswa nokusela utywala), emva kokuba umntu ephethe ithubhu ye-nasogastric ( NG tube ) kwindawo , okanye ngenxa yokungena ngengozi ngokucoca ukucoceka njengomntwana.
- Umhlaza wesisu ( umhlaza wesisu): Iiscaka zesisu zingabangela iimpawu ezifana nezo zomhlaza wesisu.
- Izilonda ze-Benign esophageal (ezinjenge-leophygeal leiomyoma): Uninzi lwezicubu zesisu (malunga neepesenti ezingama-99) zinomdlavuza. Iimvumba zeBenign ziyakwenzeka, nangona kunjalo, kwaye uninzi lwaba yi-leiomyomas.
- I-Achalasia : I-Achalasia yimeko engavumelekanga apho ibhungu leethambo phakathi kwesisu esezantsi kunye nesisu (isisiphageal sphincter) esingaphantsi kakuhle, okwenza kube nzima ukuba ukutya kudlule kwipopu ukuya kwisisu.
Ukucwangcisa
Ukuqaphela isigaba somhlaza kubalulekile ekukhetheni ukhetho olungcono lwezokwelapha, kuquka ukugqiba nokuba ngaba utyando lungenakukhetha. Ukuhlanganiswa kweemvavanyo zengcamango kunye neziphumo ze-biops ziqhelekileyo zisetyenziselwa ukuchonga isigaba.
Oogqirha basebenzisa indlela yokuguqula i- TNM ukuze bahlule i-tumor esophageal. Le nkqubo isetyenziselwa ezinye i-cancer. Nangomdlavuza we-esophageal, ke ke, oogqirha bongeza enye incwadi ebhaliweyo-G-kwi-akhawunti yebanga le-tumor. Iimpawu ezithile zesiteji ziyinkimbinkimbi, kodwa ukufunda malunga nabo kunokukunceda uqonde ngakumbi isifo sakho.
T imela i-tumor: Inombolo ye-T isekelwe ekungeneni kwinqanaba le-esophagus i-tumor iyanda. Ubunzulu obuphakathi (esondele kunokutya okudlula kwi-esophagus) yi-lamina propria. Ezi zimbini ezilandelayo zibizwa ngokuba yi-submucosa. Ngaphandle koko kukho i-lamina propria, kwaye ekugqibeleni i-adventitia, ungqongqo obunzulu kakhulu.
- I-Tis: Oku kumela i-carcinoma in situ, i-tumor equka kuphela uluhlu oluphezulu kakhulu lweeseli kwi-oopopus.
- I-T1: I-tumor ihamba nge-lamina propria kunye ne-submucosa.
- I-T2: I-tumor isasazeke kwi-lamina propria, kodwa ayizange ingene kwi-muscle ye-esophagus.
- I-T3: I-tumor isasazeke kwi-adventitia. Ngoku sele idlulele yonke indlela ngokusebenzisa i-muscle ibe yimizimba ejikelezileyo.
- I-T4: I- T4a ithetha ukuba i-tumor isasaze ngaphaya kwesigxina ukubandakanya izakhiwo ezinjenge- pleura (umgca wemiphunga), i-pericardium (i-lining of heart), umlenze we-azyg, i- diaphragm , kunye ne-peritoneum (ibini lesisu ). I-T4b ithetha ukuba i-tumor isasazeke kwi-aorta, vertebrae, okanye i- trachea .
I-N imele i-lymph nodes:
- I-N0: Akunakho i-lymph nodes ezibandakanyekayo.
- I-N1: I-tumor isasaze kwi-1 okanye kwi-2 ye-lymph nodes ezikufutshane.
- I-N2: I-tumor isasazeke kwi-3 ukuya kwi-6 i-lymph node.
- I-N3: I-tumor isasazeke kwi-7 ye-lymph nodes.
M imelela i-metastasis (ukusasazeka kude) komhlaza:
- M0: I- Metastases ayikho.
- I-M1 : I-Metastase ikhona.
G ibanga kwibakala:
- G1: Iiseli zibukeka njengeeseli eziqhelekileyo (zahluke kakhulu).
- I-G2: Iiseli zibukeka zincinane kuneeseli eziqhelekileyo (ezahlukileyo)
- G3 : Iiseli zibukeka zihluke kakhulu kwiiseli eziphilileyo (ezingafani kakuhle).
- I-G4: Iiseli azibukeli into efana neeseli ezisemgangathweni kunye nokuba akunakwenzeka ukutshilo luluphi iqumrhu abavela kulo (ukungabonakaliyo).
Ukusebenzisa iziphumo ze-TNM kunye no-G ngasentla, ii-oncologists zinika isigaba .
Isigaba se-0: Umhlaza ufunyenwe kuphela kwisalathiso esingaphakathi kweeseli ezibandakanya isisu (Tis, N0, M0). Oku kwaziwa nangokuthi i- carcinoma in situ .
Isigaba I: Esi sigaba sinokuphulwa kwisigaba se-IA kunye ne-IB.
- Isigaba IA: I-tumor iquka kuphela izicatshulwa ezingaphakathi (T1, N0, M0, G1).
- Isigaba IB: Kukho imeko ezimbini apho i-tumor ingaba isigaba IB. Omnye ufana nesigaba se-IA, ngaphandle kokuba iiseli zibonakala zingavamile (T1, N0, M0, G2 ukuya ku-G3). Kwesinye, i-tumor isesigxina esezantsi kwaye isasaze ngaphaya kweendlela zokuqala zezicubu (T2 okanye T3, N0, M0, G1).
Isigaba II: Ngokuxhomekeka apho umhlaza usasazeke khona, umhlaza wesigaba se-II unophageal uhlukaniswe kwisigaba se-IIA kunye ne-IIB yesigaba.
- Isigaba IIA: Kukho imeko ezimbini ezibalulekileyo ezibandakanya isigaba se-IIA. I-tumor ingabandakanya inxalenye engaphezulu okanye ephakathi kwendawo kwaye ibe yi-T2 okanye i-T3 kunye ne-G1 (kodwa i-N0 ne-M0), okanye i-tumor ingaquka inxalenye engezantsi ye-esophagus ibe yi-T2 okanye i-T3 ne-G2 okanye i-G3, kodwa kukho akukho ubungqina bokubandakanyeka kwe-lymph node okanye i-metastase (N0, M0).
- Isigaba IIB: Kwinqanaba le-IIB kukho iimeko ezimbini ezibalulekileyo. Ngenye, i-tumor iquka inxalenye ephezulu okanye ephakathi kwendawo, kodwa ngokungafani nesigaba se-IIA, iiseli zihluke kakhulu (G2 okanye G3). Okanye, umhlaza ungowomgca wecala (T1 okanye T2) kodwa usasazeka kwenye okanye i-lymph nodes (N1). Akukho ziphumo zokuhlaziya.
Isigaba se-III: Kukho indawo emithathu yesigaba III.
- Isigaba IIIA: Eli nqanaba linamathuba amathathu. Isisu singabandakanya iintlobo zangaphakathi zeeseli kunye neesithathu zeclimph nodes (T1 ukuya kwi-T2, i-N2, i-M0, nayiphi na i-G). Ngaphandle koko, i-tumor ingasasazeka kwinqanaba lesangaphandle, kodwa enye kuphela kwi-lymph nodes (T3, N1, M0, nayiphi na i-G). Ekugqibeleni, i-tumor ingasasazeka kwiimpawu ezikufuphi, kodwa akukho lymph nodes (T4a, N0, M0, nayiphi na i-G).
- Isigaba IIIB: Umhlaza usasazeke kwiindawo ezingaphandle ze-esophagus, kunye ne-lymph nodes (T3, N2, M0, nayiphi na i-G).
- I-Phase IIIC: Kukho iindlela ezintathu kule nqanaba. Isisu singasasazeka kwimizimba esondeleyo, kodwa i-lymph nodes (T4a, N1 okanye i-N2, i-M0, nayiphi na i-G). Okanye, i-tumor iye yasasazeka kwimizimba esondeleyo efana ne-aorta, umzimba we-vertebral, okanye i-trachea, kangangokuba ayikwazi ukususwa ngokuhlinzwa (T4b, nayiphi na i-N, M0, nayiphi na i-G). Ekugqibeleni, i-tumor iye yasasazeka kwii-7 ze-lymph nodes, kodwa ingabi kwiindawo ezikude zomzimba (nayiphi na iT, N3, M0, nayiphi na i-G).
Isigaba IV: Isiqhumane sisasaze kwingingqi esemide yomzimba (naliphi i-T, nayiphi na i-N, M1, nayiphi na i-G).
Ukuhlola
Iimvavanyo zokuhlola i-cancer yilezo ezenziwa kubantu abangenazo iimpawu zesifo. (Ukuba iimpawu zikhoyo, iimvavanyo zokuxilongwa zenziwa.) Okwangoku, akukho vavanyo lovavanyo lwe-esophagusal cancer efumaneka kuluntu jikelele.
Ekubeni umngcipheko wesifo somdlavuza usuphakanyisiwe kubantu abane-Barrett's oopopus, amanye amagqirha aye ancoma ukucoca rhoqo nge-endoscopy. Ingcamango elandelayo kukuba ukufumana i-dysplasia (iiseli ezingaqhelekanga), ngokukodwa ekubanjeni amatyala amaninzi kwangaphambili, kunokuvumela ukuba unyango lukhuphe iiseli ezingaqhelekanga kwinqanaba le- precancerous .
Oku kwathiwa, ngoku kubekho ubuncinane ukuba abukho ubungqina bokuba ukuhlola oku kunciphisa izinga lokufa kumdlavuza wesisu. Ngexesha elifanayo, ukuphonononga kunokwenzakalisa ingozi, njengokwigazi, ukuphazamiseka kwamanzi okanye ezinye iingxaki. Kukho ithemba lokuba ikamva liza kuzisa ubungqina obuya kukunceda ukuba kuqwalaselwe ukuba kuhloliswe abantu abasengozini enkulu.
> Imithombo:
> I-American Society of Clinic Oncology. I-Esophageal Cancer: Ukuchonga. Updated 12/2016.
> Bast, R., Croce, C., Hait, W. et al. I-Holland-Frei Cancer Medicine. Wiley Blackwell, ngo-2017.
> INational Cancer Institute. Ukuhlola i-Esophageal Cancer Screening (PDQ) -I-Professional Professional Version. Ukuhlaziywa 04/06/18.
> Ilayisi, T., Patil, D., Blackstone, E. et al. I-8th Edition I-AJCC / i-UICC Inkcazo yeCancer ye-Esophagus ne-Esophagogastric Junction: Isicelo kwiNkqubo yeZiklinikhi. Iingxelo zeCardiothoracic Surgery . 2017. 6 (2): 119-130.