Izikhokelo zeZikliniki zoLonyango lweNtloko kunye neCeck Cancer
Ukusetyenziswa kwedatha ukuqhuba izigqibo ezibalulekileyo kukhombise i-leitmotif ngekhulu lama-21. Ukusebenza kweyeza akufani kwaye kuxhomekeke kwidata; ngokufanelekileyo, unyango lufanele lukhokelwe ubungqina kungekhona ngethuba, intuition okanye ukubonwa nje. Imibutho emininzi ibandakanyeka ekuphuhliseni izikhokelo zenkxaso-kliniki esekelwe kwiinkqubo ezibandakanya iNethiwekhi ye-Scottish Intercollegiate Network Network (SIGN).
Ngokwe-website yeSIGN:
"Izikhokelo ze-ISIGN zivela kuhlolisiso oluchanekileyo lweencwadi zenzululwazi kwaye zenziwe njengezithuthi zokukhawuleza ukuguqulelwa kolwazi olutsha ukuze lufezekise injongo yethu yokunciphisa ukuhlukahluka kokusebenza, nokuphucula iziphumo ezibalulekileyo zesigulane."
Nceda uqaphele ukuba i-SIGN yinkqubo enye kuphela ebonisa izikhokelo ezisekelwe kubungqina, kwaye kukho enye imibutho evelele eyenzayo. Ngokomzekelo, i-United States yokuSebenzela iNkonzo yokuSebenza (USPSTF) yenza kwakhona iziphakamiso ezisekelwe kubungcali bonyango.
Kule nqaku, siza kuhlola izikhokelo zenkxaso-klinikhi enokwinkcazo yomhlaza wesihloko nentamo ngokwempawu zomhlaza. Ezi zonyango zisekelwe kwiingcebiso zeSIGN okanye iziphakamiso ze-European Society ye-Medical Oncology (ESMO). Ukongezelela, ngokubhekiselele kwiidlingozi eziphambili ezibhalwe apha ngezantsi, nceda uqaphele ukuba sichaza iinkcazo zonyango lokuqala kunye nomhlaza osemgangathweni osendaweni ekhoyo entanyeni.
Ngokubanzi, ikhanda kunye nentamo yengqungquthela iqela lezifo ezihlukeneyo, kwaye unyango oluthile lusekelwe kwindawo yomhlaza kunye nesigaba. Ngaphambi kokuba kuthathwa ingqalelo kwonyango, i-lymph nodes entanyeni ihlolwe ngobungqina bomdlavuza, kwaye ubukho beemastastases ezikude bulawulwa ngaphandle.
Ekugqibeleni, kweli nqaku sibhekisela kwisifo somhlaza (TNM).
Ukuze ufumane inkcazo ebanzi yokwenza isiteji, nceda ulandele iinqununu kule nqaku.
Unyango lweCancer Stage Oral Cancer
Nazi iziphakamiso ezisekelwe ku-SIGN zokwenza unyango lokuqala (iSigaba I kunye neSigaba II) somhlaza womlomo:
- ukususwa kokutyunjwa (resection) ye-tumor yokuqala
- ukunyuka kwentamo kwi-N0 i-lymph nodes
- xa kuninzi i-lymph nodes ibonisa ubungqina bomdlavuza okanye ukusasazeka kuninzi, kwaye unyango lwe-radiation lunconywa
Ukuchithwa kwentamo ekhethiweyo kubandakanya ukugcinwa kwamaqela angama-lymphatic angaphezu kweyodwa. Khetha amaqela e-lymph node asuswe ngokubhekiselele kumaphethini aqikelelweyo weemastastases.
Olunye ukhokelo olusisekelwe kubungqina bonyango lokuqala lomdlavuza ngomlomo lujolise ekusebenziseni kwentamo yesantsi okanye ukususwa kweethambo zellymatic entanyeni. Okokuqala, kubantu abangakhange bafumane unyango lomhlaza womlomo (unyango-naïve) kunye ne-tumori encinci okanye encinane kakhulu (T1 kunye ne-T2, ngokulandelanayo) ye-cell squamous, ukuchithwa kwentamo (ngokuzithandela) ukutshatyalaliswa kwentamo kunokulondoloza ixesha lokuphila. Okwesibini, ukutshatyalaliswa kwentamo kunganciphisa ingozi yokuphindaphinda nokufa komdlavuza (ukufa kwabantu) kubantu abanezitho zengqamane ezingabonakali ubungqina bomhlaza.
Unyango lwe-Can-Stage Oral Cancer
Ngokwe-SIGN, umdlavuza womlomo ophakamileyo kufuneka uphinde ususwe.
Ukongezelela, ukuchithwa kwentamo yokuguquka kwentamo kunconywa. Ngomtsalane wokuguquka kwentamo, yonke i-lymph nodes entanyeni isuswe kwaye enye izakhiwo zelphatic zigcinwa.
Ukuba umntu onomdlavuza womlomo ophezulu akanako ukusebenza (akuyiyo umgqatswa ogqityiweyo), i-chemoradiation kunye ne-cisplatin regimen kunye ne-radiational irradiation yentamo (oko kukuthi, unyango lwe-radiation kumacala omabini entanyeni) luyanconywa.
Unyango lweNqanaba lokuQala laseNasopharyngeal Cancer
Nazi iziphakamiso ze-ESMO zonyango lokuqala lomhlaza we-nasopharyngeal:
- unyango lwamayeza kuphela lusetyenziselwa ukunyanga umhlaza wesigaba
- i-chemoradiation efanayo (i-cisplatin kunye neyeza zonyango) ingasetyenziselwa ukunyanga umdlavuza wesi-II
- ukwelashwa kwemitha yonyango ehambelanayo (IMRT) luhlobo oluthandwayo lonyango lwe-radiation ekuqaleni komhlaza wesifo se-nasopharyngeal
Unyango lwe-Advanced-Stage I-Nasopharyngeal Cancer
Nazi iziphakamiso ze-ESMO zonyango lomhlaza wesifo se-nasopharyngeal:
- Isigaba III, i-IVA kunye ne-IVA kancers baphathwa nge-chemoradiation efanayo (i-cisplatin yi-ejenti ye-chemotherapy esebenzisiweyo)
- I-IMRT yindlela ephakanyiswayo yonyango
Unyango lweNqanaba lokuQala laseKhaya le-Oropharyngeal
ISIHLOKO sincoma ukuba umhlaza wesifo se-oropharyngeal ukuphathwa ngonyango kunye nentambo ye-dissection okanye i-external radiation ye-radiation ye-radiation ye-tumor ne-lymph nodes entanyeni.
Unyango lwe-Can-Advanced Oropharyngeal Cancer
Ngokwe-SIGN, abantu abanomdlavuza womlomo ophezulu bangaphathwa ngeendlela ezimbini: ukuhlinzwa okuphambili okanye ukugcinwa kwamalungu. Ngokuhlinzwa okuphambili, i-tumor yokuqala isuswe kwaye i-dissection eyenziwe yintamo yokuguqula ishintshe. Ngendlela yokulondolozwa kwilungu, i-chemoradiation ne-cisplatin isetyenzisiwe, kwaye i-lymph nodes kumacala omabini entanyeni (i-bilateral) i-irradiated.
Emva kokuhlinzwa okuphambili okanye ukulondolozwa kwamalungu, i-chemoradiation ne-cisplatin yenzelwa izigulana ezifumana ama-extracapsular Kukho umda ogqityiweyo wokuhlinzwa okhoyo xa i-pathologist ibona ukuba iiseli emngceleni weethambo ezisuswe zisengomdlavuza.
Unyango lwe-Can-Stage Hypopharyngeal Cancer
I-SIGN yenza iingcebiso ezintathu zonyango kubantu abanomdlavuza wokuqala we-hypopharyngeal. Okokuqala, ukusetyenziswa kwe-cisplatin chemoradiation kunye neprophylactic yonyango ingasetyenziswa. Okwesibini, utyando oluqhotyoshelweyo kunye ne-necktic dissection ekhethiweyo. Okwesithathu, kubantu abangengabathengi kwaye abanako ukungena kwi-chemoradiation, unyango lonyango kuphela lusetyenziswa.
Unyango lwe-Advanced-Stage Hypopharyngeal Cancer
Ngokwe-SIGN, ukuba i-tumor iyatshatyalaliswa (oko kukuthi, isuswe), ngoko nayiphi na indlela yeendlela ezimbini ingazama: mhlawumbi utyando ukususa i-tumor okanye ukulondolozwa kwamalungu. Ngokulondolozwa komzimba, unyango lwe-radiation yangaphandle kunye ne-chemoradiation efanayo. I-lymph nodes ezithandekayo zomhlaza zingaphathwa ngokusetyenziswa kwentamo ye-necksediation okanye ngaphandle kwe-chemoradiation.
Ukuba iyakunyamezela isigulane, abo abaneemvumi ezingenako ukurhoxiswa okanye ukususwa banokuphathwa nge-cisplatin chemoradiation.
Unyango lweCatrice-Stage Glottic Cancer
Ngokwe-SIGN, umhlaza ongaphambili unokuphathwa ngoncedo lolondolozo lolondolozo okanye ulwaphulo lwe-radiation lwangaphandle. Ukongezelela, utyando lwe-transoral laser lungasebenza nje njengonyango lwe-radiation
Ngogqirha we-transoral microsurgery, udokotela ohlinzayo ulawula i-laser phantsi kwe-microscope ngaloo ndlela ukunyuka kwenyameko. Le nkqubo ivumela ukuba ugqirha ukuba asuse kuphela iiseli zomhlaza ezivela kwiisistim eziphilileyo kwaye zisetyenziswe xa kulondolozwa kwilungu kubalulekile emlonyeni, i-larynx kunye nophando lwe-pharynx. Ukuhlinzwa okunjalo kunokukhokelela ekuphuculeni umgangatho wobomi. Ngokomzekelo, usebenzisa i-transoral laser microsurgery, ugqirha unokugcina i-larynx okanye ibhokisi lebhokisi yezwi kulabo abanomdlavuza okanye i-cancer ekhoyo emqaleni.
Unyango lweCancer-Stage Supraglottic Cancer
Ngokwe-SIGN, unyango lomhlaza wesantya ogqithisileyo ufana nomdlavuza wokuqala we-glottis, kunye nokuhlinzwa okongiwayo okanye uphando lwe-radium yangaphandle. Utyando olulondolozayo luya kulandelwa yintambo yokukhethwa kwentamo. Ezi zikhetho zonyango zijolise kwii-lymph nodes phakathi kweNqanaba II kunye neNqanaba III lentamo.
Unyango lweCanceral Stage Laryngeal Cancer
Ngokutsho kwe-SIGN, nantsi indlela umhlaza wesibeleko esilula ngokukhawuleza ungaphathwa ngayo:
- ukususwa ngokupheleleyo kwe-larynx (i-laryngectomy) kunye okanye ngaphandle kwe-anti-concomitant (adjuvant) yonyango
- indlela yokulondolozwa kwilungu iquka ukusetyenziswa kwe-cisplatin chemoradiation elandelelweyo elandelwa ukuhlinzwa ngonyango xa kufuneka
- njengendlela yokulondolozwa komzimba, ukuba i-tumor ingenakuphikiswa, ulawulo lubandakanya i-cisplatin chemoradiation elandelwayo ngokulandelelweyo xa kufuneka
- i-lymph nodes ezikhuselweyo zisuswe ngentamo yentambo ngokuphathelele okanye ngaphandle kwe-chemoradiation
I-General Chemotherapy Iingcebiso
Nazi ezinye izikhokelo ezisisiseko esisekelwe kwisigxina malunga nokunyangwa komhlaza wesihloko nentamo:
- ukulawulwa rhoqo kwe-chemotherapy ngaphambi kokuba unyango lwe-radiation (okt, i-neoadjuvant therapy) alucebisi
- ukulawulwa rhoqo kwe-chemotherapy emva kokuba unyango lwe-radiation (unyango lwe-adjuvant) alukhuthazwa
- i-neoadjuvant okanye i-chemotherapy ene-adjuvant ayixhaswanga ngokuqhelekileyo kunye nokunyangwa ngonyango
Okubalulekileyo, ezi khokelo ze-chemotherapy zincoma ukuba abantu abanomdla womlomo, i-oropharyngeal okanye i-laryngeal umdlavuza abazitholi ngokuzenzekelayo okanye i-chemoradiation phambi okanye emva kokunyangwa ngonyango okanye unyango lwe-radiation. Ngamanye amazwi, unyango lwe-radiation okanye utyando lunokuba luncedo ngokwaneleyo unyango.
Isiphelo
Nceda uqonde ukuba nangona uninzi lweziphakamiso ezingentla ziziphakamiso eziphezulu kakhulu ezixhaswa ngumzimba wobungqina obunokukholisa, izilingo ezilawulwa ngandlela-thile, ukuhlaziywa kweemeta kunye nokunye, akuzona zonke ezi ziphakamiso ziphezulu kwibakala kwaye ezinye zixhaswa ngokungathanga ubungqina. Ukuxoxa ngamabakala athile obubungqina kwisiphakamiso ngasinye ngaphandle kobubanzi beli nqaku.
Nangona kunjalo, ukuba unemibuzo malunga namabanga okanye ezinye iinkxalabo malunga nomhlaza wesihloko nentamo, nceda uxoxe ngale ngxakini ngudokotela wakho wengcali. Unyango lomhlaza womhlaza nentamo luyinkimbinkimbi, kwaye iingcebiso ezinamandla ezivela kumgqirha wakho zixabiso elixabisekileyo ngexesha lwenkqubo yokwenza izigqibo.
> Imithombo:
> Unyango kunye neNycer Cancer Treatment. Dynamed Plus. www.dynamed.com
> I-NCI Dictionary yeMigqaliselo yeCancer. www.cancer.gov
> SIGN website. http://sign.ac.uk/about/index.html
> Unyango lweNtloko kunye neCeck Cancer: I-Diseck Dissection. Dynamed Plus. www.dynamed.com.