Umhlaza wesifo (i-renal cell carcinoma) ngokuqhelekileyo ifunyenwe usebenzisa inhlanganisela ye-ultrasound, i-CT, kunye ne-MRI, kunye nomlando oqinileyo, ukuhlolwa ngokomzimba, iimvavanyo zegazi kunye neemvavanyo zomchamo. Emva kokuba umhlaza ufumaniswe, i-tumor kufuneka ihlolwe ngokucophelela ukwenzela ukuba ichanele unyango olufanelekileyo.
Ukuhamba kwinkqubo yokuxilonga kudla ngokuxinzelelekileyo-unokuvakalelwa ukwesaba nokuxhalabisa.
Ukwazi oko kukulindela kunye nendlela yokujamelana nexesha lokulinda kunye neziphumo kunokunceda ukuphucula ezinye iimvakalelo.
Uhlolo lokuzihlola kunye noVavanyo lweNdlu
Umhlaza wesifo ungeke ufumaneke ekhaya, kodwa ekubeni kungengoku uvavanyo lokuvavanya, ukuqonda ngezibonakaliso kunye nezibonakaliso zezifo yinto umntu onokuyenza.
Ngokukodwa, ukuba uyaphawula ukuba unegazi kumchamo wakho (nayiphi na isixa), ubuhlungu beflegi, ubukhulu bomnxeba, uzive ukhathele okanye ulahlekelwe isondlo sakho, okanye ulahlekelwe isisindo ngaphandle kokuzama, qiniseka ukuba ubone ugqirha wakho.
IiLabs kunye novavanyo
Uvavanyo lomdlavuza weengtso luqala ngokuqaqambileyo kwimbali, ukukhangela iziganeko zengozi yesifo, ukuhlolwa komzimba kunye neemvavanyo zelabhoratri.
Uvavanyo lweMzimba
Uvavanyo lomzimba lwenziwe ngqalelo ekhethekileyo yokujonga ubunzima kwisisu, kwi-flank, okanye ngasemva, kunye nokujonga ingcinezelo yegazi. Iinjongo zibambe indima ebalulekileyo ekulawuleni uxinzelelo lwegazi, kwaye izicubu zingabangela ukunyanzeliswa kwegazi okuqhubekayo okwezinye iingozi kakhulu (ingozi ephezulu yegazi).
Uvavanyo luquka ukuvavanya kohlobo lwe-genitalia kumadoda. Umhlaza wesifo uyingqayizivele kuba kungabangela i-varicocele, i-vein wided vein (veicose vein) kwi-scrotum okanye itekisi. Ngokungafani nezimbangela ezininzi ze-varicocele, abo ngenxa yomdlavuza weengtso abahambi xa umntu elala (uthatha isikhundla se-supine).
Uvavanyo lweBeb
Umsebenzi wokuxilonga wesifo somhlaza weengxaki uqala ngokuvuthwa kwe- urinalysis , uvavanyo olungenziwanga kuphela ukukhangela igazi kumchamo wakho, kodwa iimpawu zentsholongwane, iiprotheyini kunye nokunye. Phantse isiqingatha sabantu abanomdlavuza weengtso baya kuba negazi elithile emcinini wabo.
Inani elipheleleyo legazi (iCBC) luvavanyo olubalulekileyo, njengokuba i- anemia (inani elibomvu lamaseli egazi elibomvu) okwangoku libonakalisa uphawu lokuqala lwesifo. Iimvavanyo zomsebenzi weezintso zibalulekile, nangona ezi ziqhelekileyo.
Umdlavuza weezinso uphelelekile ukuba ungabangela ukuphakama kwezilingo zomsebenzi wentsholongwane, nangaphandle kokuba umhlaza usasazeka esibindi. Esi sibonakaliso sisinye sezibonakaliso ze- paraneoplastic ezinokuthi zenzeke xa ezi iiseli zesisu zidibanisa izinto okanye i-hormone. Izibonakaliso zeParanoplastic zingaphinde zibe nezinga eliphezulu le-calcium egazini ( hypercalcemia ), nangona oku kuya kwenzeka xa umdlavuza usasazeka emathanjeni.
Ukucinga
Uninzi lweendlela ezahlukeneyo zokucatshulwa zingasetyenziselwa ukuxilongwa kunye nesigxina somdlavuza wezintso.
Ultrasound
I-ultrasound isebenzisa amagagasi omsindo ukubonelela umfanekiso wesakhiwo kwisisu. Ngokuqhelekileyo uvavanyo lokuqala luyenziwa kwaye luncedo ngokukhethekileyo ekuhlukaniseni i-cysts elula (ephantse ihlala ingenangxaki), ukusuka kwiimvumi eziqinileyo okanye kwiimvumi eziqinile kunye neengxenye ze-cystic.
CT Scan
Iimvavanyo ze-CT zisebenzisa uchungechunge lwe-x-ray ukunika umfanekiso wesigcawu sommandla womzimba onjengeentso. Ukongezelela ekuchazeni umdlavuza weengso, i-CT scan inganika ulwazi olubalulekileyo ekuqhubeni isistim ngokuvavanya ukuba kubonakala ukuba umhlaza usasazeke ngaphandle kweentso okanye kwi-lymph nodes.
I-scan ye-CT idlalwa kuqala ngaphandle kokungafani, kwaye emva koko idayi ye-radiocontrast. Idayi ngamanye amaxesha inokubangela inkxalabo kubantu abanentsholongwane engasebenzi, kwimeko apho uvavanyo oluthile lweemifanekiso lunokusetyenziswa.
I-CT yolu vavanyo olubalaseleyo lokubaluleka kweentsholongwane zentsholongwane kodwa kaninzi akwazi ukufumanisa ukuba umhlaza usasazeke kwi-veal veal, i-vein enkulu ephuma kwiintso ezidibene ne-inferior vena cava (umvuthwandaba omkhulu ozisa igazi kumzimba osezantsi. entliziyweni).
MRI Scan
Iskrini se-MRI sisebenzisa i-imagination magnetic esikhundleni se-teknoloji ye-x ukudala umfanekiso wezakhiwo esiswini. Kukunceda ngokukhethekileyo ukuchaza "izicubu ezithambileyo" ezingaqhelekanga. Ngokuqhelekileyo, i-CT scan iyilinga elingcono lokuhlola umhlaza weengtso, kodwa i-MRI ingadingeka kulabo abaneemvavanyo zentsholongwane ezingavamile okanye abanomdla wokungafani nomdaka.
I-MRI ingaqwalaselwa kwakhona ukuba umhlaza wengqondo uthathwa ukuba usasaze kwi-vein ye-renal kunye ne-inferior vena cava, njengeenkqubo ezizodwa zingafuneka ngexesha lotyando. I-MRI ayikwazi ukusetyenziswa ngabantu abanesinyithi emzimbeni wabo, njenge-pacemaker, shrapnel, okanye iinqununu ze-bullet, njengoko iimakethi ezinamandla zingakhokelela ekuhambeni kwezi zinto.
I-MRI yengqondo ingenziwa ukukhangela ubungqina beemastastase (ukusasazeka) komhlaza kwingqondo, kwindawo yesithathu eqhelekileyo apho umhlaza wesifo usasazeka khona.
PET scan
I-PET i-scans isetyenziswe rhoqo kwi-diagnostic, kodwa kakhulu kuncinci ekuxilongweni komhlaza wengqondo. Ngexesha lokutshintshwa kwe-PET, inani elincinci le-sugaractive ejoyiweyo lijongene emzimbeni kunye nemifanekiso (ngokuqhelekileyo ihlanganiswe ne-CT) ithathwa emva kokuba ushukela linalo ixesha lokubanjwa.
Ngokungafani ne-CT ne-MRI, kuthathwa njengolu vavanyo olusebenzayo kunokuba luvavanyo lwezakhiwo kwaye lunokuba luncedo kwimimandla yokukhula kwe-tumor ukusuka kwimimandla enjenge-tissue.
Intravenous Pyelogram (IVP)
I-IVP ngumvavanyo apho idayi ifakwe kwi-vein. Iintliziyo zithatha le dye, zivumela ii-radiologists ukuba zijonge iintso, ingakumbi i-pelal pelvis.
Ii-IVP zenziwa ngokuthe rhoqo kwi-diagnostic yomhlaza weengtso kodwa zingasetyenziselwa i-cancer ye-cell (i-cell transcers cancers ezifana ne-cancer ye-vestile kunye ne-ureter kunokuba ngamanye amaxesha ibandakanye inxalenye ebalulekileyo yezintso, i-pelal pelvis).
I-Renal Angiography
I-Angiography idla ngokudibeneyo kunye ne-CT scan kwaye iquka ukufaka idayi kwi-artic artery ukuze ichaze imithwalo yegazi yeentso. Ngamanye amaxesha uvavanyo lusetyenziselwa ukunceda ukucwangcisa utywala.
I-Cystoscopy ne-Nephro-Ureteroscopy
Ezi mvavanyo zibandakanya ukufaka i-catheter ekhanyayo kwi-bladder, ngokusebenzisa i-ureter, kunye ne-renal pelvis ("isikhungo" seentso). Isetyenziswe ngokuyinhloko ukuba kukho ubuninzi kwi-bladder okanye ureter, njenge-transitional cell carcinoma.
Biopsy
Nangona i-biopsy ibalulekile ekuxilongeni amaninzi emdlavuza, akusoloko kuyimfuneko ukuxilonga umhlaza wengqondo. Ukongezelela, kukho umngcipheko nge-biopsies enesilengwane enhle (i-biopsies eyenziwe ngenaliti encinci efakwe elukhumbeni nasezintsheni) ukuba le nkqubo inokuthi "inzalo" isisu (isasaza i-tumor yodwa indlela yentsaliti).
Iimvavanyo ze-tumor zibalulekile ekucwangciseni unyango, njengazo zonyango ezijoliswe kuzo, kodwa zifumaneka rhoqo ngexesha lotyando kunokuba lube ne-biopsy.
Uvavanyo lweMetastases
Umdlavuza weengso unokusasaza ngegazi okanye kwiinqanawa ze-lymphatic, kwaye iindawo eziqhelekileyo zeemastastases ziyimiphunga, amathambo kunye nengqondo, ngaloo ndlela. I-x-ray yesifuba (okanye i-chest CT) inokwenziwa ukuba ikhangele imiphunga yemiphunga .
Ukuba i- scan scan okanye i-PET scan ingacinga ukuba i-boneastases ye-bone ikhona. I-MRI yengqondo iyona vavanyo elungileyo ukujonga ubuchopho be-brain.
Ukuxilongwa ngokungafani
Ngokungafani namaninzi emdlavuza, kukho izimbalwa ezimbalwa ezibangela ubunzima kwizintso. Noko ke, ukuxilongwa ngokungafani, kunokuba kunzima xa ubunzima obuncinane bufumaneka kwiimpongo, ngokuqhelekileyo xa kwenzeka uvavanyo kwisinye isizathu.
Ezinye izizathu ezinokubangela ubunzima be-renal ziquka:
- I-Renal (iinjongo) ii-cysts: I- Cysts ihlala ihluke ngohlobo lwe-ultrasound kwaye isoloko ifunyanwa ngesifo sezintso ze-polycystic .
- I-Angiomyolipomas: I-angiomyolipoma ingahlukaniswa nomdlavuza wengqondo ngexesha le-CT scan (ngenxa yobuninzi beoli). Lezi zicubu ezinobungozi.
- I-Oncocytomas: I- Oncocytomas ikwahlula ngokubanzi ngokusekelwe kwiziphumo ze-CT. Ezi zicubu ezinobungozi ngamanye amaxesha zihlala zifana nomdlavuza weengtso kwimigangatho yokucinga.
- I-renal adenomas: Ezi ziimvumi ezinobunzima eziqhelekileyo zifumana ukuhlolwa kweengcinga.
- Iingcingo zesifo somzimba ( iintsholongwane zentsholongwane yeengqungquthela ze-bladder, ureters, kwaye ngamanye amaxesha i-pelal pelvis): Ezi khansela zenza malunga neepesenti ezingama-15 zeentsholongwane zeentso kwaye zivame ukuba zihlala ngaphakathi kwiintso kwaye zibandakanya inkqubo yokuqokelela. Amaseli e-Cancer angabikho kwi-urinalysis.
- Izibilini ze-Adrenal: Iingqungqa ze-adrenal zihlala phezu kweentso kwaye ziyakwazi ukwahlukana kwi-imaging. Izifo eziqhelekileyo ze-adrenal ziyi- adrenal metastases ezivela kumdlavuza ezinjengomdlavuza wamaphaphu.
- Ikhefu le-Renal: I-abscess iyinqwelwe yesifo.
- Iinqunta zesinstas: Zininzi iintlobo zomhlaza zingasasazeka kwiintso. Oku kubangele kubangele amabala amancinci kunokuba i-tumor enkulu. Iintsholongwane ezingasasazeka kwizintso ziquka umhlaza wamaphaphu, umdlavuza webele, umdlavuza wesisu, i-melanoma, kunye neentsholongwane zezinye iinjongo.
- I-lodphokin ye-Hodgkin kunye ne-non-Hodgkin's lymphoma: Ezi zombini ezihlobene negazi zingabandakanyeka neentso, kodwa zidla ngokudibanisa nezicubu (kunye neendlovu ezandisiweyo) kwezinye iindawo zomzimba ngokunjalo.
- I-Renal ephazamisayo: I-infarct ibhekisele ekungabikho kwegazi. Oku kufana ne "intliziyo yokuhlaselwa" yeengtso, kunye nezicubu ezifileyo (izicubu ezinobungozi) ngamanye amaxesha zingabonakala njengebunzima kwi-imaging.
- I-Sarcomas: Ezi ziqhekeza ezinqabileyo eziqala kwiisisu eziluhlaza ezijikeleza iinjongo.
Inkcazo yesifo seNtliziyo
Ukugxininisa umdlavuza wezintso ngokuqhelekileyo kwenziwa emva kokuhlinzwa kwaye udibanisa iziphumo zokuvavanya iifoto kunye neempawu zesifo esithunywe kwi-pathology emva kokuhlinzwa, kunye nokufunyaniswa ngexesha lotyando.
Iphunga leBakala
Iingqungqele zeezintso zinikwe ibakala eli-1 ukuya ku-4, elibizwa ngokuba yiBakala le-Fuhrman, elona lingumlinganiselo wobugwenxa besisu.
Ibanga le-1 lisetyenziselwa ukuchaza izicubu ezincinci kwaye zineeseli ezahluke kakhulu (jonga iinjongo eziqhelekileyo zesifo). Ngokwahlukileyo, ibakala lesi-4 linikezelwa ukuchaza izidumbu ezibonakalayo ezinobundlobongela, ezo zingabonakaliyo kwaye zibukeka zihluke kakhulu kwiiseli eziqhelekileyo zezintso.
TNM
Iimvumi zeengso zivandlakisiwe zisebenzisa into ebizwa ngokuba yi-TNM. Oku kungadideka ekuqaleni kodwa kulula kakhulu ukuyiqonda ukuba sichaza ezi ncwadi kunye nantoni na iinombolo.
- T imela i-tumor. Amanani alandelayo ku-T abonisa ubukhulu besisu. Iimvumi ze-T1 zingaphantsi kwama-7 cm ububanzi. Iimvumi ze-T2 zi-7 ukuya kwi-10 cm ububanzi. Iimvumi ze-T3 ziye zanda ngaphaya kweentso okanye zingena emthanjeni, kodwa kungekhona kwiingqungquthela ze-adrenal okanye ngaphaya kwe-fascia ye-fascia (ubuninzi beethambo ezijikeleze iinjongo). Iimvumi ze-T4 zikhule ngaphaya kwe-fascia ye-fascia okanye kwi-adrenal gland.
- I imele iindawo. Inkcazo ye-N0 ithetha ukuba umhlaza awusasazekanga nakweyiphi i-lymph nodes. I-N1 ithetha ukuba umhlaza usasazeke kwii-lymph nodes kufuphi.
- M imelela i-metastase kwaye i-0 okanye 1 kuxhomekeke ekubeni ingaba i-metastases ikhona (nokuba umhlaza usasazeke kwimiphunga, amathambo, ingqondo okanye enye imimandla). I-M0 ithetha ukuba akukho metastase ekhoyo. I-M1 ithetha i-metastase zikhoyo.
I-Tx (okanye i-Nx okanye i-Mx) ithetha ukuba i-tumor (okanye i-nodes okanye i-metastases) ayikwazi ukuhlolwa. I-T0 ithetha ukuba akukho ubungqina besikhomba esisisiseko kwaye sisetyenziswe ukuba i-kidastas i-kidastases ifunyenwe, kodwa i-tumor yokuqala ayikwazi ukufumaneka.
Amanqanaba
Ukusebenzisa iileta ezingentla, iisondo zeengso ziyahlukana zibe zigaba ezi-4:
- Isigaba soku-1: I- Stage 1 kanomdlavuza wezintso (T1, N0, M0) zingaphantsi kwe-7 cm ububanzi kwaye zifumaneka kwizintso (azizange zisasaze kwi-lymph nodes okanye nayiphi na indawo yomzimba).
- Isigaba sesi-2: Kule nqanaba (kuchazwe njenge-T2, N0, M0) umhlaza unokuba mkhulu kune-7 cm ububanzi okanye usasaze kwi-vein enkulu esondeleyo njenge-veal renal okanye i-vena cava ephantsi. Nangona kunjalo, ayizange isakaze nakweyiphi i-lymph nodes, i-adrenal glands, i-fascia ye-fascia, okanye iindawo ezikude.
- Isigaba sesi-3: Iimpawu ze-Stage 3 (ezinokuba yi-T1 okanye i-T2, i-N1, i-M0, okanye i-T3, nayiphina i-N, i-M0) ingaba nayiphi na ubukhulu kodwa ayizange isasaze ngaphaya kwe-fascia ye-fascia. Eli nqanaba libandakanya nezicubu ezingazange zikhule ngaphaya kweentso, kodwa zisasazeka kwii-lymph nodes eziseduze.
- Isigaba sesi-4: Isigaba se-4 sichazwa kwiindlela ezimbini eziphambili. Kwimeko enye, i-tumor ingasasazeka ngaphaya kwe-fascia ye-fascia kunye ne-lymph nodes eseduze, kodwa ingabi kwezinye iindawo zomzimba. Okanye kunokuba nayiphi na ubukhulu, basasazeka nakweyiphi na imihlaba, kwaye basasazeka nakweminye imimandla yomzimba (nayiphina i-T, nayiphina i-N, M1).
Iintsholongwane zeNtsholongwane
Umdlavuza weentsholongwane oqhelekileyo ubhekisela kuyo nayiphi na umdlavuza obuye ubuye, nokuba ngaba ngaphakathi kweentliziyo, kwiintlobo ezizungezile, kwii-lymph nodes, okanye kwiindawo ezikude.
Zonke iimvavanyo zokuxilongwa ezenzelwe ziza kunceda ugqirha wakho ngokuchanekileyo enze isisu sakho. Ngokusekelwe kwiziphumo, uya kukwazi ukukhetha unyango olulungelelene nemeko yakho.
> Imithombo:
> I-American Society of Clinic Oncology. Cancer.Net. I-Cancer Cancer: Ukuchonga. Ukuhlaziywa 08/17. https://www.cancer.net/cancer-types/kidney-cancer/diagnosis
> Lara, Primo N., no-Eric Jonasch. Iinqununu zeChincer Cancer and Practice. I-Springer International Publishing, 2015.
> Pieroazio, P., noSampbell. Indlela yokuThengisa, ukuSasaza okuMahlukileyo, kunye nokuLawula iMisa encinci. UpToDate . Ukuhlaziywa 03/02/18.