Iimpawu, unyango, kunye neNgcaciso ye-Neuroblastoma
Ukuba umntwana wakho okanye umntwana womngane ufumene ukuba une-neuroblastoma, kuyintoni okufuneka uyifumane? Kufana kangakanani na olu hlobo lwesifo somhlaza? Unokuphathwa njani kwaye yintoni na ukuchazwa?
Yintoni i-Neuroblastoma?
Njengenye yezona zihlobo eziqhelekileyo zomhlaza ebusaneni, i-neuroblastoma ngumhlaza ofumaneka kubantwana abancinci. Isisu siqala kwi-neuroblasts (amangqamuzana omzimba omzimba) wesistim se-central central.
Ngokukodwa, i-neuroblastoma iquka iiseliti zeengqungquthela eziyingxenye yesistim se-nervous sympathetic system. Iinkqubo zentsholongwane kunye neengxaki ze-nervympathetic zizinto zombini zenkqubo ye-nervous autonomic system, inkqubo elawula iinkqubo emzimbeni esingafanekiyo ukuba sicinge ngazo njengokuphefumla kunye nokutya. Inkqubo yentsholongwane enobubele inoxanduva lokuphendula okanye "ukulwa okanye ukundiza" okwenzekayo xa sigxininiswe okanye sinoyiki.
Inkqubo yeentlonelo zentlungu ineendawo ezibhekiswe kuzo njenge-ganglia, ezifumaneka kumanqanaba ahlukeneyo omzimba. Ngokuxhomekeka kwimeko ye-neuroblastoma eqala kuyo, kule nto ingaqala kwi-adrenal glands (malunga neyesithathu yamatyala), isisu, i-pelvis, isifuba okanye intamo.
Izibalo malunga Neuroblastoma
I-neuroblastoma ngumhlaza wesiqhelo somntwana , i-7% yeekwere ezineminyaka engaphantsi kwe-15, kunye neepesenti ezingama-25 zamanomdla okukhusela kunyaka wokuqala wokuphila.
Ngaloo ndlela, luhlobo oluqhelekileyo lomhlaza kwiintsana. Kuyinto eqhelekileyo kakhulu kwindoda kunabesifazane. Phantse iipesenti ezingama-65 ze-neuroblastomas ziyaxilongwa phambi kweenyanga ezili-6, kwaye olu hlobo lomhlaza aluba ludla emva kweminyaka eyi-10. I-neuroblastoma inoxanduva lokufa kwabantu abachaphazeleka ngumhlaza okwangama-15 ekhulwini.
Iimpawu kunye neempawu ze-Neuroblastoma
Iimpawu kunye neempawu ze-neuroblastoma ziyahlukahluka kuxhomekeke ekubeni ziphi na emzimbeni nokuba ingaba umhlaza usasazeke kwezinye iindawo.
Isibonakaliso esibonakalayo esona siqhele kakhulu sisininzi esikhulu esiswini. Ubunzima buya kwenzeka nakweminye imimandla apho i-ganglia ikhona njengesifuba, i-pelvis, okanye intamo. Kukho umkhuhlane kwaye abantwana banokubandezeleka ngokulahlekelwa kwesisindo okanye "ukungaphumeleli."
Xa umhlaza usasazeke (ngokuqhelekileyo kwintolongo yesibindi, isibindi, okanye amathambo) ezinye iimpawu zikhona. Iimetastases emva nangaphezulu kwamehlo (i-periorbital metastases) ingabangela ukuba usana lugxumeke (i- proptosis ) kunye nezibonda ezimnyama phantsi kwamehlo akhe. I-Metastases kwesikhumba inokubangela iibluki ezimnyama eziluhlaza (i-ecchymoses) eziye zaphakamisa igama elithi "blueberry muffin baby." Uxinzelelo emgodini kwi-boneast metasisase kungabangela isilonda okanye iimpawu zesisu. Ama-metastases amathambo amathambo avame ukubangela ubuhlungu kwaye angabangela ukuphulwa kwethambo (ukuphulwa kwethambo ebuthathaka ngenxa yobomi bomhlaza esithambo).
Kuphi i-Neuroblastomas Spread (Metastasize)?
I-neuroblastomas inokusasazeka kwiziko eliphambili ngegazi okanye inkqubo ye-lymphatic.
Imimandla yomzimba esasazeka ngokuqhelekileyo iquka:
- Amathambo (obangela intlungu yesifuba nokuqhawula)
- Ibindi
- Imiba (kubangela ukuphefumla okufutshane okanye ukuphefumula ubunzima)
- Umnkantso we-Bone (obangela ukugqithisa kunye nobuthakathaka ngenxa ye-anemia)
- Ummandla wePeriorbital (ecaleni kwamehlo obangela ukugquma)
- Ikhumba (kubangela ukubukeka kwe-blueberry muffin)
Ukuxilongwa kwe-Neuroblastoma
Ukuxilongwa kwe-neuroblastoma ngokuqhelekileyo kufaka phakathi iimvavanyo zegazi ezikhangela amanqaku (izinto ezisetyenziselwa iiseli zomhlaza) kunye nezifundo zokucinga.
Njengenxalenye yesimiso se-nervous sympathetic, iisensi ze-neuroblastoma zithengisa ama-hormone aziwa njengama-catecholamines. Ezi ziquka ama-hormone afana ne-epinephrine, i-norepinephrin, ne-dopamine.
Izinto ezisoloko zilinganiselwe ekwenzeni ukuxilongwa kwe-neuroblastoma ziquka i-homovanillic acid (HVA) kunye ne-vanillylmandelic acid (VMA). I-HVA kunye ne-VMA zi-metabolites (iimveliso eziphazamisayo) ze- norepinephrin kunye ne-dopamine.
Ukuhlola iimvavanyo ezenzelwe ukuhlola i-tumor (kunye nokujonga i-metastases) kunokubandakanya i-CT scans, i-MRIs kunye ne- PET scan . Ngokungafani ne-CT kunye ne-MRI ezi "zifundo" zengqungquthela, i-PET ihlola "izifundo" zokusebenza. Kule vavanyo, ixabiso elincinci lomshukela omshubileyo lijongelwa kumlambo wegazi. Iiseli ezikhulayo ngokukhawuleza, ezifana neeseli zesisu, zithatha ngaphezulu kwolu ushukela kwaye zifumaneke ngokucinga.
I- bone brass biopsy ivame ukuqhutyelwa kakuhle ukususela ekubeni ezi zicubu zixhaphaka kwi-bone.
Uvavanyo oluthile lwe-neuroblastomas yi-MIBG yokuhlola. I-MIBG imele i-meta-iodobenzylguanidine. Iiseli ze-neuroblastoma zithatha i-MIBG edibene ne-iodine ye-radioactive. Ezi zifundo zinceda ekuhloliseni i-metastases yeethambo kunye nokubandakanyeka komnxeba wethambo.
Olunye uvavanyo olwenziwa rhoqo luhlolisiso lwe-MYCN. I-MYCN yimizimba ebalulekileyo ekukhuleni kweseli. Ezinye i-neuroblastomas zinemifanekiso engaphezulu kwelo geni (iikopi ezingaphezulu kwe-10), ukufumana okubhekiselwe kuthiwa "I-MYCH amplification." I-neuroblastomas kunye ne-MYCN ukukhulisa akunakwenzeka ukuba baphendule unyango lwe-neuroblastoma kwaye banokuthi bangene kwiindawo ezithile zomzimba.
I-Neuroblastoma yokuCoca
Ekubeni amazinga omlambo i-vanillylmandelic acid kunye ne-homovanillic acid elula kakhulu ukufumana kunye namanqanaba angavamile aphakathi kwama-75 ukuya kuma-90 ekhulwini lwe-neuroblastomas, ukuhlaziywa kwabantwana bonke kwesi sifo kuye kwaxutyushwa.
Izifundo zijonge ukuhlolisiswa kwezi mvavanyo, ngokuqhelekileyo kwiinyanga ezili-6 ubudala. Ngoxa ukuhlolwa kuthatha abantwana abangaphezulu kwinqanaba lokuqala le-neuroblastoma, akubonakali ukuba naluphi na umphumo kwisantya sokufa kwesi sifo kwaye akukhuthazwa kwangoku.
Isiteji se-Neuroblastoma
Njengamanye amaninzi emdlavuza, i-neuroblastoma ihlukaniswe phakathi kwamanqanaba I kunye ne-IV kuxhomekeke kwinqanaba lokusasazeka komhlaza. Amanqanaba afaka:
- Isigaba I - Kwinqanaba lesiganeko i-tumor ilapha, nangona ingaba isasazeka kwii-lymph nodes eziseduze. Kule nqanaba, i-tumor ingasuswa ngokupheleleyo ngexesha lotyando.
- Isigaba II - I-tumor ivalwe kwindawo eyaqala ngayo kwaye i-lymph nodes esondeleyo inokuchaphazeleka, kodwa i-tumor ayikwazi ukususwa ngokupheleleyo ngokuhlinzwa.
- Isigaba III - I-tumor ayikwazi ukususwa kwi-surgically (ingenakwenzeka). Kusenokwenzeka ukuba isasaze kwii-lymph nodes eziseduze okanye zommandla, kodwa kungekhona kwezinye iindawo zomzimba.
- Isigaba IV - Isigaba IV sichaza nayiphi na isisu esiphi na isayizi kunye okanye esingenazo i-lymph node esasasazeka kwithambo, emathambo esifuba, isibindi okanye isikhumba.
- Isigaba IV-S - Udidi olukhethekileyo lwesigaba IV-S lwenziwe malunga neengcambu ezisekuhlaleni, kodwa nangona oku kwasasazeka kumnxeba wethambo, isikhumba okanye isibindi kwiintsana ezingaphantsi komnyaka omnye ubudala. Umongo wethambo ungabandakanyeka, kodwa i-tumor ibakho ngaphantsi kwama-10 ekhulwini lomongo wethambo.
Iipesenti ezingama-60 ukuya kuma-80 yabantwana ziyafumaneka xa umhlaza wesigaba se-IV.
I-International Neuroblastoma Group Risk System (INRGSS)
I-International Neuroblastoma Group Risk Staging System yindlela enye apho i-neuroblastomas ichazwa kwaye inikezela ngolwazi "ngengozi" yomhlaza, ngamanye amazwi, ukuba kwenzeka njani ukuba i-tumor iphiliswe.
Ukusebenzisa le nkqubo, iimvumi zihlelwe njengengozi ephezulu okanye ingozi ephantsi, enceda ukukhokela unyango.
Izizathu kunye neengozi zeNewblastoma
Uninzi lwabantwana abane-neuroblastoma abanalo intsapho yembali yesifo. Oko kwathiwa, ukuguqulwa kofuzo kuthathwa njengexanduva malunga neepesenti ezili-10 ze-neuroblastomas.
Ukuguqulwa kwimizimba kwi-ALK (i-amaplastic lymphoma kinase) yemfuza yimbangela enkulu ye-neuroblastoma yomndeni. Ukuguqulwa kwesigxina kwi-PHOX2B sele kuchongwe kwi-subset ye-neuroblastoma yomndeni.
Eminye imingcipheko enokuthi iphakanyisiwe iquka ukutshaya komzali, ukusetyenziswa kotywala, ezinye iilwimi ngexesha lokukhulelwa kunye nokuvezwa kweekhemikhali ezithile, kodwa ngeli xesha akuqinisekanga ukuba ngaba badlala indima okanye hayi.
Unyango lwe-Neuroblastoma
Kukho iindlela ezininzi zokonyango kwi-neuroblastoma. Ukukhethwa kwezi zinto kuya kuxhomekeka ekubeni ngaba ukuhlinzwa kungenzeka kunye nezinye izinto. Ingaba okanye ingekho isifo "ingozi enkulu" ngokwe-INCRSS nayo idlala indima ekukhethweni kwonyango, kwaye ukhetho luhlala lwenziwa ngokusekelwe ekubeni i-tumor ingozi enkulu okanye ingozi ephantsi. Khetha ziquka:
- Ugqirha - Ngaphandle kokuba i-neuroblastoma isasazeke (isigaba IV), utyando luvame ukusenziwa ukususa ubuninzi be-tumor ngangokunokwenzeka. Ukuba utyando alukwazi ukususa zonke i-tumor, unyango olongezelelweyo kunye ne-chemotherapy kunye ne-rayation kudla ngokucetyiswa.
- I-Chemotherapy - I-Chemotherapy ibandakanya ukusetyenziswa kwezidakamizwa ezibulala iiseli ngokukhawuleza. Ngaloo ndlela, kunokuphumela kwimiphumo emibi ngenxa yeempembelelo kwiiseli eziqhelekileyo emzimbeni owahlukana ngokukhawuleza njengaleyo emnzini wethambo, iifollic hair and tractes tract. Izidakamizwa ze-Chemotherapy eziqhelekileyo ezisetyenziselwa ukwelapha i-neuroblastoma ziquka i-cytoxan (cyclophosphamide), i-Adriamycin (doxorubicin), i-Platinol (i-cisplatin) kunye ne-etoposide. Izidakamizwa ezongezelelweyo ziqhelekileyo zisetyenziswe ukuba i-tumor ithathwa njengengozi enkulu.
- Ukutshintshwa kwe-stem cell - I-high-dose ye-chemotherapy kunye neyeza zonyango ezilandelwa yi- stem cell transplant enye yindlela yokwenza unyango. Ezi zigulo zingabonakala zizenzekelayo (usebenzisa iiseli zomntwana ezixotshiwe ngaphambi kwe-chemotherapy) okanye i-allogeneic (isebenzisa iiseli kumniki-mnikelo onjengomzali okanye umxhasi ongahambelaniyo).
- Ezinye izigulane - Kuba iimvumi eziphinda zibuyele, ezinye iindidi zonyango ezinokuqwalaselwa ziquka i-retinoid therapy, i- immunotherapy , kunye neyeza ekujoliswe kuzo nge-ALK inhibitors kunye nezinye iindlela zokwelapha, ezifana nokusebenzisa izixhobo ezithathwe ngama-neuroblastoma amangqamuzana afakwe kwiintlobo ze-radioactive.
Ukuxolelwa okuqhelekileyo kwe-Neuroblastoma
Ingqungquthela ebhekiswe njengokuba ukuxolelwa ngokukhawuleza kwenzeka, ingakumbi kulabo bantwana abaneemvumi ezingaphantsi kwama-5 cm (2 ½ amasentimitha ubukhulu,) ziyi-stage okanye isigaba II, kwaye zingaphantsi komnyaka weminyaka.
Ukuxolelwa ngokukhawuleza kwenzeka xa izidumbu "zinyamalala" zodwa ngaphandle kwonyango. Nangona le nto ingabonakaliyo kunye nezinye iisomdlavuza, akuqhelekanga nge-neuroblastoma, mhlawumbi kwiimvumi eziphambili okanye i-metastases. Asiqinisekanga oko kubangela ukuba ezinye zezicubu zihambe nje, kodwa zixhomekeke kumasosha omzimba ngendlela ethile.
Ukugqitywa kwe-Neuroblastoma
Ukugxekwa kwe-neuroblastoma kunokwahluka kakhulu phakathi kwabantwana abahlukeneyo. Ubudala kwi-diagnostic yiyona nxalenye enye echaphazela ukuhlaziya. Abantwana abafunyaniswa phambi kokuba abaneminyaka engama-70 ubudala banesiprofeto esihle kakhulu, kwanezigaba eziphambili ze-neuroblastoma.
Izinto ezihambelana nokuxeliswa kwe-neuroblastoma ziquka:
- Ubudala bokuxilongwa
- Isigaba sesi sifo
- Iziphumo ze-Genetic ezifana ne-ploidy kunye nokukhulisa
- Ibinzana le-tumor yeeprotheni ezithile
Ukufumana inkxaso
Omnye uthe wathi into eyona yimbi ngaphezu kokuba nomhlaza kukuba umntwana wakho abhekane nomhlaza, kwaye kukho inyaniso eninzi kuloo mazwi. Njengabazali, sifuna ukunceda abantwana bethu ubuhlungu. Ngethamsanqa, iimfuno zabazali babantwana abanomhlaza baye bafumana ingqwalasela eninzi kwiminyaka yamuva. Kukho imibutho emininzi eyenzelwe ukuxhasa abazali abanabantwana abanomdlavuza, kwaye baninzi abanomntu kunye namaqela enkxaso ye-intanethi kunye noluntu. La maqela akuvumela ukuba uxoxe nabanye abazali abajongene nemingeni efanayo kwaye bafumane inkxaso evela ekubeni wazi ukuba awodwa. Thatha isikhashana ukujonga ezinye zeemibutho ezixhasa abazali abanomdlavuza.
Kubalulekile ukukhankanya nabantakwabo kunye nabantwana abakwazi ukujamelana neemvakalelo zokuba nomntakwabo onomdlavuza ngelixa beba nexesha elininzi kunye nabazali babo. Kukho imibutho yoxhaso kunye neenkampu ezenzelwe ukuhlangabezana neemfuno zabantwana abajongene nento eninzi abahlobo babo abayi kukwazi ukuyiqonda. I-CancerCare inezincedisi zokunceda abantakwabo bomntwana abanomdlavuza. I-SuperSibs izinikezele ukuthuthuzela nokuxhobisa abantwana abanomntwana onomdlavuza kwaye ineenkqubo ezininzi ezahlukeneyo ukuhlangabezana neemfuno zala bantwana. Unokufisa ukujonga iinkampu kunye nokubuyela kwiintsapho kunye nabantwana abachaphazeleka ngumhlaza.
ILizwi
I-neuroblastoma yona hlobo oluqhelekileyo lomhlaza kubantwana ngunyaka wokuqala wobomi kodwa unqabile kamva ebuntwaneni okanye emdala. Iimpawu zihlala ziquka ukufumana ubunzima besisu, okanye iimpawu ezifana ne "blueberry muffin".
Uninzi lwezonyango zonyango zifumaneka zombini ze-neuroblastomas ezithe zafunyaniswa okanye eziye zaphindaphinda. Ukuxhaswa kwezixhomekeke kuxhomekeke kwiimeko ezininzi, kodwa ukusinda kuphezulu xa isifo sifumaneka kunyaka wokuqala wobomi, nokuba sisasazeka ngokubanzi. Enyanisweni, ezinye i-neuroblastomas, ingakumbi kwiintsana ezisencinane, zinyamalalala ngaphandle kwonyango.
Nangona xa i-prognosis ihamba kakuhle, i-neuroblastoma ixilongo oluphazamisayo kubazali, ngubani na oya kuba noxilongo ngokwabo kunokuba babe neengxaki zomntwana. Ngenhlanhla, kukho uphando olunzulu kunye nenkqubela phambili kunyango lwemhlaza yengane kwiminyaka yakutshanje, kwaye iindlela ezintsha zonyango ziphuhliswa rhoqo ngonyaka.
> Imithombo:
> Berlanga, P., Canete, A., noV. Castel. Ukuqhubela phambili kwiiNyango eziPhakamisayo kwiNyango ye-Neuroblastoma. Iingcamango zengcali malunga nezidakamizwa ezikhulayo . 2017. 22 (1): 63-75.
> Esposito, M., Aveic, S., Seydel, A., kunye noG. Tonini. Neuroblastoma Ukwelashwa kwi-Post-Genomic Era. I-Journal ye-Biomedical Science . 2017. 24 (1): 14.
> INational Cancer Institute. Ukwelashwa kwe-Neuroblastoma (PDQ) - I-Health Professional Version. Ukuhlaziywa 06/21/17. https://www.cancer.gov/types/neuroblastoma/hp/neuroblastoma-treatment-pdq