Umdlavuza we-Esophageal awuqhelekanga, kodwa enye yezona zizathu eziphezulu ezili-10 zokufa komdlavuza e-United States, ekubeni idla ngokuphindaphindiweyo kwisigaba xa ingasaphili. Kwixesha elidlulileyo, i-squamous cell carcinoma ye-esophagus-ehambelana nokutshaya kunye nokusetyenziswa ngokweqile kotywala-yayinguhlobo oluqhelekileyo. Kodwa kwiminyaka yakutshanje, iye yagqithiswa yi-adenocarcinoma, ngokuqhelekileyo idibaniswa nexesha elide le-aclux reflux kunye nokukhuluphala.
Ubunzima ngokugwinya kudla ngokuba ngumqondiso wokuqala wesifo somhlaza, kwaye iimvavanyo ezinjenge-endoscopy uncedo luqinisekisa ukuxilongwa. Xa kuthathwa kwangethuba, utyando lonyango lunokuphilisa eso sifo, kodwa ngokuqhelekileyo isifo siphambili, kunye ne-chemotherapy kunye nokunyanga kwamayeza kube yinto eyenzayo yokonyango.
Umhlaza we-Esophageal uhluka kakhulu kwihlabathi jikelele, zombini kwiziganeko kunye nemeko yengozi. Ngexesha langoku, i-adenocarcinoma i-esophageal iyanda kwi-United States nakwamanye amazwe athuthukileyo, nangona izizathu eziqinisekileyo aziqinisekanga.
Ukuqonda i-Esophagus
I- esophagus ishubhu ye-muscular edibanisa umlomo kwisisu. Kukho emva kwesifuba kunye ne- trachea (ityhubhu apho umoya uhamba khona ukuya emiphakeni), nangaphambi kwesihluma soguqu. Ummandla ophakathi kwesibhobho ekugqithweni kwe-oopu kubizwa ngokuba yi- mediastinum , isikhala esinezinye izakhiwo ezinjengentliziyo, imithana yegazi enkulu (i-aorta), kunye ne-lymph nodes ezininzi.
Ngaphakathi kwesisu, kukho izakhiwo ezimbalwa ezibalulekileyo ezilawula ukuba iziqulatho kunye nezidakamizwa zidlule emlonyeni wakho ukuya kwisisu ngexesha lokugwinya. I- sphincter ephezulu ye-esophageal iyimisipha ye-muscular kufuphi nomphezulu we-esophagus evimba ukubuya kwe-food from the hoop to the mouth, kwaye inokunceda ukunqanda ukuthanda (ukuphefumula ukutya kwi-trachea).
I-sphincter engaphantsi kwe-esophageal sphincter ibhanti lamathambo kufuphi nomxube we-esophagus ngesisu. Xa ithoni yale sphincter iphakamileyo okanye iphantsi (ngenxa yeemeko zonyango okanye amayeza), inokuchaphazela indlela ukutya kudlula ngayo isisu ukuya kwisisu. Ngaphambi kokuba sifinyelele esiswini, i-esophagus iyadlula kwisithintelo . Ukuba le ndawo yintlupheko ibuthakathaka (i-hernia hiatal), isisu singasenyuka ukuya phezulu kwisibilini.
Ubuninzi bobude beesopha buhlanganiswe neeseli ezibizwa ngokuba yii-cell squamous, uhlobo olufanayo lweeseli ezifunyenwe emlonyeni, ezinkulu zomoya, kunye nesikhumba. Ukuba isifo esiqalile kule ndawo siyaziwa njenge- squamous cell carcinoma . Indawo ephantsi kwe-oopopus, kwaye apho i-esophagus ihlangene nesisu, iqulethwe ngamaseli e-columnar. Ukuba i-tumor ebulalayo iqala kule ndawo, ibizwa ngokuba yi- adenocarcinoma .
I-squamous cell carcinomas yayisoloko iqhelekileyo e-United States, kwaye ihlala yindlela eqhelekileyo yomhlaza womhlaba wonke. Ngeli xesha, i-adenocarcinomas ixhaphake kakhulu eUnited States nakwamanye amazwe athile aphuhlisiwe.
Iimpawu
Izibonakaliso zesifo somhlaza wesifo sokutshatyalaliswa komzimba zidla ngokubonakalayo kuphela xa umhlaza uphumelele.
Oko kwathiwa, ngokuphindaphindiweyo, abaninzi abantu bafumanisa ukuba baye bafumana iimpawu kwexesha elithile, kodwa bebengakwazi ukuvumelanisa nale miqondiso (ngokutya ukutya okunomsoco, umzekelo).
Iimpawu zokulumkisa zibandakanya:
- Ubunzima bokugwinya (i-dysphagia): Uphawu oluqhelekileyo, oku kudla ngokuqala ngokutya okuqinileyo kwaye ekugqibeleni kuqhubela phambili ukuquka utywala. Ubuhlungu buya kwenzeka kwakhona ngokugwinya, kunye nokuvalelwa kokutya okubanjwe kwisigxu.
- Ukulahlekelwa kwesisindo esingachazwanga (ukulahleka kwesisindo ngaphandle kokuzama)
- Ukuphindaphinda kokutya okungaphelelwanga
- Ukutshaya (ukutshisa okanye uxinzelelo emva kwesifuba)
- Ukugawula igazi okanye ukuguqula igazi elidala kunye nokunyakaza kwamathumbu ( amnyama amnyama )
- Ukukhwehlela okuqhubekayo
- Intlungu ebuyela emva phakathi kwamagxa ehlombe
- Ukuphazamiseka okanye ukulahleka kwezwi
Ekubeni ezinye zezi zimpawu zenzeka nge-reflux ye-asidi, kwaye ekubeni i-acid reflux ingumngcipheko wesifo somhlaza, kubalulekile ukuba abantu bangaqapheli kuphela iimpawu ezintsha abazifumanayo, kodwa nangayiphi na inguqu kwimpawu zabo ezingapheliyo.
Izizathu kunye neengozi
Asizi izizathu ezichanekileyo, nangona i-genetics ibonakala ithatha indima. Kuye kwafumanisa iziganeko ezinomngcipheko womhlaza we-esophageal kwaye ziyahluka ngohlobo oluthile lomhlaza wesisu.
I-Squamous cell carcinoma ye-esopha idla ngokudibanisa nokutshaya nokudakwa ngokweqile, nangona kukho nezinye izinto ezinobungozi. Ehlabathini lonke, umhlaza wesifo somdlavuza uqheleke kakhulu kumadoda kunabesifazana, kodwa i-squamous cell carcinoma ixhaphake kakhulu kwabasetyhini baseUnited States. Kuqheleke kakhulu kubantu abamnyama kunabamhlophe. Ukutya okunotye kwizityalo kunye nemifuno kunye nezantsi ebomvu kunye nokusetyenziswa kwezilwanyana kunokuba nefuthe lokukhusela.
I-Adenocarcinoma ye-esopha idla ngokuxhamla ne-reflux engapheliyo (isifo se-reflux ye-gastroesophageal, okanye i- GERD ), kunye ne- Barrett kunye nokukhuluphala. E-United States, ixhaphake kakhulu kumadoda kunabasetyhini, kwaye ixhaphakile kumhlophe kunabamnyama.
Ukuxilongwa
Uninzi lweemvavanyo ezahlukeneyo lungasetyenziselwa ukuxilonga umhlaza wesisu . Amaxesha amaninzi, uvavanyo lokuqala luyalwa ngumngxube we- barium . Ukuba isifo somhlaza sisisigxina, kodwa ke, i- endoscopy ephezulu (i-esophago-gastric-duodenoscopy) iyona vavanyo eliphambili elisetyenziselwa ukuxilongwa. Kule nkqubo, ityhubhu ifakwe emlonyeni nasemgodini. Ikhamera ekupheleni kwiphubhu ivumela oogqirha ukuba bajonge ngokucacileyo ngaphakathi kwendawo yesifo kwaye bathathe i-biopsy, ukuba kuyimfuneko.
Ukubaluleka kubaluleke kakhulu ekukhetheni unyango olufanelekileyo lwesifo. Izilingo eziqhelekileyo ezisetyenziselwa ukufakwa kwisiteji ziquka i-CT, i-PET, kunye nezinye izifundo ezongezelelweyo ezifana ne- bronchoscopy , thoracoscopy, nabanye.
Unyango
Iindlela zokonyango zomhlaza wesisu ziya kuxhomekeka kwisigaba somhlaza, apho sikhona khona, kunye nezinye izinto.
Kwiintsuku zokuqala, ukuhlinzwa (esophagectomy) kunokunika ithuba lokunyanga. Oko kwathiwa, kukuhlinzwa okukhulu okubandakanya ukususa isahluko se-esophagus nokubuyisela isisu kwisisombululo esiphezulu (okanye ukongeza isigaba samathumbu xa isahlulo esikhulu sopopu sisuswa). I-Chemotherapy kunye neyeza zonyango zidlalwa ngaphambi kokuhlinzwa (i-neoadjuvant chemotherapy) ukuze ihlaziye isisu, kodwa ingasetyenziselwa emva kokutyunjwa ukuqinisekisa ukuba nayiphi na iseli yomhlaza iselapha.
Kulabo abangenayo imvume yokuhlinzwa, kusekho ukhetho. I-Chemotherapy kunye nokudibanisa iziyobisi kunokunyusa ubomi. Ukunyanga kwamayeza kusetyenziswa rhoqo kunye ne-chemotherapy, mhlawumbi ngaphambi kokuhlinzwa, emva kokuhlinzwa, okanye kunye ne-chemotherapy xa ukuhlinzwa kungenakwenzeka.
Iipilisi ezijoliswe kuzo zinokukunceda ukulawula eso sifo, umzekelo, kubantu abaneemvumi ezithandekayo kwi-HER2 (efana nomhlaza wesibeleko). I-Immunotherapy iquka iindlela ezahlukeneyo zonyango ezibandakanya ukuqhubela umzimba womzimba ukulwa nomdlavuza, kwaye ngamanye amaxesha unokulawula i-cancer. Kwakhona kukho unyango oluninzi olufundiswa kwizilingo zonyango ezinika ithemba lokuba unyango olungcono luya kufumaneka kwixesha elizayo.
Kulabo abaneengqungquthela eziphezulu, unyango lokuphucula umgangatho wobomi xa uhlala nomhlaza awunakuncipha, kwaye ukunyamekela ngokunyamekela kudla ngokuba yinjongo yonyango. Ukunyamekela okuqhelekileyo akufani ne-hospice (ingasetyenziselwa abantu abaneemathunga ezinokuthi zinyangeke), kwaye ijolise ukulawula iimpawu zomzimba kunye neemvakalelo zokuphila nomhlaza. Sifunda ukuba ukunakekelwa ngokunyamezelayo akuphucula kuphela umgangatho wobomi, kodwa kunokuphucula ukuphila kubantu abaneengcingo eziphezulu.
Ukujamelana
Ukujamelana nomdlavuza ongasondekayo kunzima kakhulu. Ngokwenyama, ubunzima ngokugwinya akusikhathazi nje kuphela kodwa kunokuphazamisa kakhulu ngokutya. Emotionally, idumela lomhlaza wesifo somhlaza njengesiqhumane esinamandla kunye nesifo esilungileyo siphakamisa imiba emininzi, kuquka ukukhathazeka kokuphela kokuphila. Ngokwentlalo, ukuxilongwa komhlaza wesifo sokutshatyalaliswa kwesisu kudala kukhokelela ekutshintsheni okungathandekiyo kwiindima kwintsapho. Imiba ebonakalayo evela kwiinkxalabo ze-inshorensi ukuya kwiimali zongeza umthwalo.
Ukujamelana nokuxilongwa komhlaza wesifo sokutshatyalaliswa komdla kuthatha idolophana, kwaye kubalulekile ukuqokelela inkqubo yakho yokuxhasa. Ukufumana uxhasano phakathi komdla woluntu wesiqhelo kwi-intanethi kunokuba luncedo olukhulu, njengoko luzisa ithuba lokuthetha nabanye abantu kunye nabanonophelo babo bentsapho abajongene nomngeni ofanayo.
Ukuthatha inxaxheba echaphazelekayo kunyango ngokuba ngummeli wakho kumnonophelo wakho womhlaza kunokunciphisa kuphela ukuxhalabisa malunga nokungaziwa, kodwa kwezinye iimeko kunokukwenza umpembelelo kwisiphumo ngokunjalo.
ILizwi
Umdlavuza we-Esophageal uvame ukuphulukana nokuxilongwa kuze kube yimiqathango kamva yesifo, kodwa abaninzi abantu bayavuma ukuba baneempawu ixesha elide ngaphambi kokuba bafumaneke. Ukuba nolwazi ngeempawu kunye neempawu nokuba ukwazi ukuba unomngcipheko ungasinceda ekufumaneni isifo ngokukhawuleza. Kubalulekile ukuba uqaphele, nangona kunjalo ukuba nangona eso sifo singabanjwanga kusasa kwaye ukuhlinzwa singenakwenzeka, kusekho unyango olufumanekayo olunokuthi lunciphise iimpawu kwaye luhlala lunweba ubomi.
> Imithombo:
> I-American Society of Clinic Oncology. I-Esophageal Cancer: Iimpawu kunye neMpawu. Updated 12/2016.
> Bast, R., Croce, C., Hait, W. et al. I-Holland-Frei Cancer Medicine. Wiley Blackwell, ngo-2017.
> INational Cancer Institute. Ukwelashwa kweCeophageal Cancer (PDQ) -Ingcali yeNgcali yezobuNtu. Ukuhlaziywa nge- 02/06/18.