Yintoni i-Transitional Cell Carcinoma (TCC)?

I-urothelial carcinoma, uhlobo oluqhelekileyo lomhlaza wesisu, oludibene nokutshaya

Nangona umhlaza wesibeleko awukho uhlobo lomhlaza esithetha ngawo ngokubanzi, njengokuba umdlavuza wemiphunga, umdlavuza webele, okanye i-melanoma, ngokwenene, ngumdla wesine oqhelekileyo kumadoda aseMelika kunye neyesithoba eyona exhaphakileyo kuma-American. Ngokweenkcukacha ezivela kumaziko okuLawula nokuLawula izifo, amadoda angaphezu kwama-55,000 kunye nabafazi abangama-17 000 bafumana umdlavuza wesibeleko e-US minyaka yonke.

Kule ndawo, phantse i-16,000-ngaphezu kweyodwa kwizine-iya kufa ngenxa yokugula.

Uhlobo oluqhelekileyo lomhlaza wesisu lubizwa ngokuba yi-transitional cell carcinoma (TCC). Eyaziwa nangokuthi i-urothelial carcinoma (UCC), i-TCC ivela kwinqanaba elingaphakathi kwiphepha le-urinary elibizwa ngokuthi, ngokufanelekileyo, i-urothelium yenguqu.

I-TCC ingahlakulela kwiisishu ukusuka naphina kwiphepha, kuquka:

• Sinus ye-renal (isango ngaphakathi kweentso)
• I-ureter (ii-tubes ezidibanisa iintso kwi-bladder)
• Ingxube yangaphakathi yesikhumba
• I-urethra (ityhubhu apho umchamo ukhutshwa khona emzimbeni)
• I-urachus (intsalela yomgca we-fetal phakathi kwesikhumba kunye nemikhosi)

I-TCC ithathwa njengesiqhelo sesibini esibangela isifo somhlaza xa ushicilela isono senkunzi.

Izimpawu kunye neMpawu

Iimpawu zeTCC ziya kuhluka ngendawo yesikhumba. Ngokuqhelekileyo amaxesha afana neempawu zentsholongwane ekhuhlane yezintso apho umntu uya kuba neentlungu ezimnandi kunye nokunciphisa intlungu emva kweentliziyo.

Ngenxa yokuba eso sifo silinganisa ezinye izinto ezibangelwayo (kubandakanya i- cystitis , isifo sesifo seprotate, kunye nesantya esingasebenzi ngokweqile), ukuxilongwa kuthatha xa kwenziwa umhlaza.

Ngexesha elifanayo, i-TCC ngumhlaza osakhulayo ohamba ngokukhawuleza unamaxesha angama-14.5 ubudala, ngokutsho kweNational Cancer Institute.

Ngaphambili, isigaba se-precancer, iimpawu zisoloko zingacacanga ukuba azikho. Ngokuqhelekileyo kuphela xa kuqhuma isifo esibuhlungu kangangokuthi ezininzi ziyavela.

Kungenxa yezi zizathu ukuba iipesenti ezingama-89 zezixilongo zenziwa ngamadoda ama-50 nangaphezulu. Kule mivuzo, iipesenti ezingama-20 ziya kufumaneka ukuba nomhlaza wesiqendu se-III, kanti phantse enye kwisine iza kuba nezifo zesifo (apho umhlaza usasazeke kwezinye iindawo zomzimba).

Ngokuxhomekeka kwisigaba sesifo, iimpawu zeTCC zingaquka:

• Igazi elibonakalayo kumchamo (i- hematuria epheleleyo )
• Ukuhluma okubuhlungu okanye okunzima (i- dysuria )
• Ukuvuthwa rhoqo
• Unqwenela ngamandla ukuvota kodwa ungakwazi ukwenza njalo
• Ubuhlungu bePlank kwelinye icala langemva emva kwembambo
• Ukukhathala
• Ukuhla ukusinda
• Ukuphelelwa kwesidlo
• Umkhuhlane ophezulu kunye nokujuluka okukhulu
• Ukuguqulwa kwamazantsi (i- edema ), ngokuqhelekileyo kwisifo esilandelayo

Izizathu kunye neengozi

Abantu badla ngokucinga ukuba umdlavuza wesibindi okanye izintso kubangelwa ukutyhila kwiibhokhwe esizidlayo, nokuba ngaba zingcoliswe ngamanzi okanye iikhemikhali ekudleni kwethu. Ngona kunjalo, oku akunjalo. Nangona i-toxins ixhomekeke ngokuqinisekileyo ekuphuhlisweni kwe-TCC, ngokuqhelekileyo iindidi esizixhaphaza ixesha elide.

Oyintloko phakathi kwezi zinto ngumsi wecuba .

Enyanisweni, ngaphezu kwesiqingatha sazo zonke i-TCC ukuxilongwa kumadoda kunye nangaphezulu kweyesithathu kwabasetyhini banxulumene nokutshaya. Ukongezelela, umngcipheko kunye nesigaba sesifo sifana ngqo nombolo yeminyaka umntu utshayile kunye nexesha lokutya.

Ngokomphando kwiSikhumbuzo seSikhumbuzo seSikhumbuzo se-Memorial Sloane-Kettering eNew York, umhlaza wesibindi ekubhemeni awukho nje kuphela oqhelekileyo kodwa ngokuqhelekileyo unomdla ngaphezu kokungaboni.

Isizathu salolu dlelane asilucaciswanga ngokupheleleyo, kodwa abanye baye baxhomekeka ukuba ukutshatyalaliswa kwexesha elide ngotshani kubangela ukuba utshintsho lwama-chromosomal kwiisisu eziphefumulayo ezenza izilonda kunye neentsholongwane.

Umngcipheko ubonakala ungaphezulu kunazo zonke kubantu abatshisa ngaphezu kwe-15 cigarettes ngosuku.

Ezinye izinto ezinobungozi kwiTCC ziquka:

• Ubudala obudala, malunga neepesenti ezingama-90 zamatyala ezenzeka kubantu abangaphezulu kwama-55
• Ukuba yindoda, ngenxa yokuba i-androgen esebenzayo (i-hormone yesini yamadoda) edlala indima ephambili ekuphuhliseni iTCC
• Ukuba ngumhlophe, apho ubeka emngciphekweni kabini xa kuthelekiswa ne-Afrika yamaMerika kunye neLatinos
• I-genetics yentsapho, ingakumbi echaphazela ukuguquka komzimba ohlanganiswe nesifo seCowden (i-PTEN gene), i- Lynch syndrome (i-HPNCC gene), okanye i- retinoblastoma (i-RB1 gene)
• Ukunyamekela, ukwanda komngcipheko ngama-10 ukuya kuma-20 ekhulwini
• Indawo yokusebenzela kwiimine ezimnandi ezisetyenzisiweyo kumashishini kunye nokushicilela kumashishini kunye nokuveliswa kweerubha, isikhumba, upende kunye nemveliso yengubo
• Ukusetyenziswa kwangaphambili kwechiza ye-chemotherapy Cytoxan (cyclophosphamide)
• Ukusetyenziswa kwonyango yesifo sikashukela i- Actos (pioglitazone) ngaphezu konyaka
• Ukusetyenziswa kwezilwanyana ezinamachiza ezinama- aristolochic acid (eyaziwayo njengePin Yin kwiidakamizwa zesiTshayina)

Ukuxilongwa

Ngokuqhelekileyo, isalathisi sokuqala sokuxilongwa kweTCC siya kuba ngegazi kumchamo. Ngamanye amaxesha akuyi kubonakala kodwa ingafumaneka kalula kwi- urinalysis (uvavanyo lomchamo) .

I-cytology yomchamo ingasetyenziselwa ukukhangela amangqamuzana omhlaza kumchamo, nangona le yindlela engathembekiyo yokuxilongwa. Ngokwahlukileyo, ubuchwepheshe obutsha bunokufumanisa iiprotheni kunye nezinye izinto kumchamo ohambelana neTCC. Ezi zibandakanya iimvavanyo ezibizwa ngokuba yi-Urovysion kunye ne-Immunocyt. Kukho uvavanyo lwekhaya oluya kuthiwa yi-Bladderchek olungakwazi ukubona iprotheni ebizwa ngokuba yi-NMP22 efumaneka rhoqo kumazinga aphezulu kubantu abanomdlavuza wesisu.

Umgangatho okhoyo wamanje wegolide wokuxilongwa yi-biopsy efunyenwe yi-cystoscopy. I-cystoscope yile ityhubhu ende ende ifakwe ikhamera encinci efakwe kwi-urethra ukujonga i-bladder. I-biopsy ibandakanya ukukhutshwa kwezicubu ezisolisayo kwiimviwo ze-pathologist.

Ngokuxhomekeke kuhlobo lwe-cystoscope elisetyenzisiweyo, inqubo ingenziwa phantsi kwe-aneshesia yendawo okanye jikelele. Akuqhelekanga ukusebenzisa i-anesthesia jikelele kumadoda njengoko inqubo ingaba buhlungu kakhulu kunikwa ukuba i-urethra yindoda isinde kwaye ilula kunabesifazane.

Ukunyanzela umdlavuza

Ukuba kukho ukuxilongwa komhlaza, i-oncologist iya kubeka ulwaphulo olubi ngesigaba. Ugqirha uya kwenza njalo usebenzisa uhlelo lwe-TNM lwesigxina esichaza ubukhulu be-tumor yangempela ("T"), ukungena komhlaza kwii -lymph nodes ezikufuphi ("N"), kunye nobukhulu bemetastasis ("M").

Injongo yohlengahlengiso kukuqinisekisa inkqubo yesenzo esifanelekileyo ngenjongo yokungazibandakanyi okanye ungaphaya komhlaza. Ngokusekelwe kwezi ziphumo, ugqirha uya kufaka isifo ngale ndlela ilandelayo:

• Isigaba se-0 kukubakho ubungqina bokungena kwinqanaba kodwa kungabandakanyeka kwe-lymph node okanye i-metastasis.
• I-Stage I ichazwa ngokusasazeka komhlaza kwimbali ye-epithelial ukuya kwiisisi ezixhamlayo ngaphantsi kodwa ngaphandle kokubandakanyeka kwe-lymph node okanye i-metastasis.
• Isigaba II yilapho umhlaza sele usasazeka ngakumbi kwinqanaba lezansi ngaphantsi kodwa ungadluli udonga lombutho. Sekunjalo, akukho ukubandakanyeka kwe-lymph node okanye i-metastasis.
• Isigaba III yilapho umhlaza usukhulile ngaphaya kwodonga lwasemzimbeni kodwa awusasazekanga kwii-lymph nodes eziseduze.
• Isigaba IV yilapho umhlaza usasazeka kwizitho ezikude, usasaze kwii-lymph nodes ezikufutshane, okanye zombini.

Isiteji sinikezela ugqirha nomntu ngengqondo engcono yokuphila kwamaxesha. La manani ayilwanga kwilitye, kwaye abanye abantu abanomdlavuza ophezulu bangakwazi ukufezekisa ukuxolelwa okupheleleyo kungakhathaliseki ukuba kuxilongwa.

Xa kuthethwa oko, ukuxilongwa kwangaphambili kuphantse kuhlanganiswe neziphumo ezingcono. Abantu abafumene isigaba se-0, isigaba se-I, okanye isigaba II TCC sinamaqondo angama-90 enyango yokunyanga. Abo banesigaba se-III banethuba elingama-50 ekhulwini. Nabo abanomdlavuza wesigaba se-IV banama-10 ekhulwini kunye neepesenti ezingama-15 ithuba lokuxolelwa ngokuqhubekayo, ngokweNational Cancer Society.

Indlela yokwelapha

Unyango lwe-TCC luxhomekeka kakhulu kwisigaba sesi sifo, umlinganiselo umhlaza usasaze ngayo, kunye nohlobo lwezitho ezibandakanyekayo. Ezinye zezonyango zilula kunye namazinga aphezulu okunyanga. Abanye baninzi kakhulu kwaye banokufuna zombini iziqulatho zeprayimari neziphambili . Phakathi kwabo:

• Isigaba se-0 kwaye iimvumi ezingasifinyelelanga kumgca we-muscle zihlala "zihlanjululwe" kunye nefowuni ye-electrocautery eqhotyoshelweyo ekupheleni kwe-cystoscope. Inkqubo inokulandelwa kunye nekhosi emfutshane yekhemotherapy. Ukunyanga kwe- Immunotherapy usebenzisa igonyo ebizwa ngokuba nguBacillus Calmette-Guérin (BCG) kunokunciphisa ingozi yokuphindaphinda kwiimeko ezimbini kwiimeko ezintathu.
• Amagciwane e-Stage II ne-III anzima ukunyanga . Baya kufuna ukususwa okukhulu kwiphina isistim echaphazelekayo. Kwimeko ye-bladder, kungadinga inkqubo yokucubungula eyaziwa ngokuba yi-cystectomy enkulu ekhutshwa kuyo. I-cystectomy encinci ingenziwa kwinqanaba elincinci lezithuba ze-II kodwa akukho nqanaba III. I-Chemotherapy inokunikwa ngaphambi okanye emva kokuhlinzwa, kuxhomekeka ngokukhulu ngokubaluleka kwesisu. Izaphulo zingasetyenziselwa nje ngokuba unyango olungummiselo kodwa azizange zisetyenziswe ngokwazo.
• Amanqwanqatha eSigaba IV anzima kakhulu ukuwususa. I-Chemotherapy kunye okanye ngaphandle kwemisebe ngokuqhelekileyo yonyango lokuqala lokuqala ngenjongo yokunciphisa ubukhulu beentlungu. Kwiimeko ezininzi, utyando aluyi kukwazi ukususa wonke umhlaza kodwa lungasetyenziselwa ukuba lunokwandisa ubomi bomntu kwakunye nomgangatho wobomi .

LwezoPilisi

Amachiza e-chemotherapy endabuko afana ne- methotrexate , i-vinblastine, i-doxorubicin kunye ne-cisplatin aqhelekileyo asetyenziselwa ukuxilongwa. Ziyi-cytotoxic (ithetha inetyhefu kumaseli aphilayo) kwaye isebenze ngokujolisa ngokukhawuleza kweeseli ezifana nomhlaza. Njengomphumo wale nyathelo, banokubulala amaseli aphilileyo anokukhawuleza-aphindaphinda afana nalawo asematyeni, amathambo kunye namathumbu amancinci.

Izizukulwana ezitsha zifana ne- Opdivo (nivolumab) , i-Yervoy (ipilimumab), kunye neTecentriq (i-atezolizumab) isebenza ngokwahlukileyo ngokuvuselela isistim somzimba sokulwa nomhlaza. Ezi zibizwa ngokuba yi- monoclonal antibodies zijoqelwe emzimbeni kwaye zikhawuleza zifuna iiseli zomhlaza, zibopha kwaye zibonakalise ezinye iiseli ze-immune ukuhlasela.

Le ndlela yokujoliswa kwe- immunotherapy iyakwehla izibilini kwaye ikhusele umhlaza ukuba uphumelele. Zisetyenziswe ngokuyinhloko ukwandisa ubomi babantu abaneziphumo eziphambili, ezingasebenzi, okanye i-TCC ye-metastatic. Iziphumo eziqhelekileyo ezichaphazelekayo kulezi zi yobisi zibandakanya:

• Ukukhathala
• Ukuqhawukelwa ngumphefumlo
• Intlungu ehlangeneyo okanye emisipha
• Ukunciphisa ukutya
• Rash
• Uhudo
• Isiqhamo
• Ukutyunjwa
• I-Rash okanye isikhumba esilula
• I sizathu

Ukudibanisa kwe-Opdivo kunye ne-Yervoy uye wafumana udumo kwiminyaka yamuva kwiimeko ze-TCC eziphambili. Unyango lunikezwa nge-intravenously ngaphezu kwemizuzu engama-60, ngokuqhelekileyo nganye iveki ezimbini. Umyinge kunye nexesha elixhomekeka kakhulu kuxhomekeka ngokukodwa kwindlela umhlaza usabela ngayo kunyango kunye nobukhulu beempembelelo.

Thintelo

Ukuthintela i-TCC kuqala ngezinto onokuzilawula. Kule mijelo, i-cigarettes isala njongo. Iinyaniso zilula: Umhlaza wesisu ngumhla wesibini oqhelekileyo ochaphazeleka ukubhema umhlaza wemiphunga. Ukuyeka nje kungekudala kunciphise umngcipheko womntu we-TCC kodwa kunokuthintela ukuphindaphinda komhlaza kulabo baphathwa ngempumelelo.

Ukuyeka kunokuba nzima kwaye kaninzi kufuna iimvavanyo eziliqela, kodwa ezininzi izicwangciso ze-inshorensi zihlanganisa ezinye okanye zonke iindleko zokuyeka ukutshaya.

Ezinye izinto ezinokuguqulwa nazo zinokufaka isandla ekunciphiseni umngcipheko. Uvavanyo olulodwa lweminyaka eli-10 olubandakanya amadoda angama-48 000 lubone ukuba abo basela i-1.44 ilitha amanzi (iiglasi ezilishumi elinesibhozo) imihla ngemihla babe neengcipheko ezincinci zomhlaza wesibeleko xa kuthelekiswa nabancinci. Nangona kusekho ukukhawuleka okubalulekileyo malunga neziphumo (kunikwe ukuba ezinye izinto ezifana nokutshaya kunye nobudala, azibandakanyi), uhlalutyo lwe-meta lwango-2012 lucacise ukuba ukungena kwamanzi okubonelela kunikezela ngenzuzo yokukhusela, ngakumbi kubafana abancinci.

Nangona ukusela amanzi kuphela akunakucima imiphumo yokutshaya, kuqukumbela izibonelelo zokukhetha impilo enempilo ezibandakanya i-hydration efanelekileyo kunye neprogram yokulahlekelwa kwesisindo esilungeleyo xa kunzima.

> Imithombo:

> I-American Cancer Society. "Unyango lweNtsholongwane yeKhansela, ngeSigaba." Atlanta, Georgia; Ukuhlaziywa ngoMeyi 18, 2017.

> Burger, M .; Catto, J .; Dalbagni, G; okqhubekayo. "I-Epidemiology kunye nemingcipheko yesifo sengqondo somhlaza wesisu." Eur Urol. 2013; 63 (2): 34-41. INGXELO: 10.1016 / j.eureo.2012.7.033.

> Amacandelo okuLawula nokuLawula izifo. "" I-Cancer Cancer ". Atlanta, Georgia; hlaziywa ngoJuni 6, 2017.

> Jiang, X; Castaleo, J .; Yuan, J. et al. "I-cigarette Ukubhema kunye neengxenyana zengculaza ye-Bladder." Int J Cancer. 2012; 130 (4): 896-901. INGXELO: 10.1002 / ijc.26068.

> I-National Cancer Institute: iiNational Institutes of Health. "I-Bladder kunye nezinye i-Cancers Screening Screening (PDQ) -I-Professional Professional Version." EWashington, DC; hlaziywa ngoFebhuwari 22, 2017.