Kunezinhlobo ezingaphezu kuka-50 zama-sarcomas ezithambile zezicubu
Ama- sarcomas ashubile ayiqembu elihluke kakhulu lamagciwane angamafutha, ama-muscle, tendon, u-cartilage, ama-tissue e-lymphoid, imikhumbi nokunye. Kunezinhlobo ezingaphezu kuka-50 ze-sarcoma yezicubu ezithambile. Nakuba ama-sarcomas amaningi ayimifucumfucu enesisindo esincane, ngomqondo ovamile, ama-sarcomas nawo angathinta ithambo.
Ukuxilongwa nokwelashwa kwama-sarcomas amathanga amancane kuhilelekile futhi kuhilelekile emininingwaneni eminingi, okudinga ukufakelwa kwe- oncologists , i-oncologists yokuhlinza, i-radiologists, i-radiologists engenelela nokuningi.
Ukwelashwa kuhlanganisa ukuhlinzwa, i-radiotherapy futhi, kwezinye izimo, i-chemotherapy.
Yiziphi Izicubu Zama-Sarcomas?
Ama-sarcomas amancane amancane ayingqayizivele ye-neoplasm futhi i-akhawunti engaphansi kwamaphesenti angaphansi kwe-khansa kubantu abadala. I-American Cancer Society ilinganisa ukuthi amacala amasha angu-12 310 amathisipula azinyopho azotholakala ngo-2016 (amacala angu-6 980 amadoda namacala angu-5,330 kwabesifazane). Ezinganeni, ama-sarcomas amancane anesisindo amelela amaphesenti angu-15 ama-cancer.
Isizathu esiqondile sezinambuzane eziningi ezithambile zezicubu aziwa, futhi lezi zilonda zivele zingekho isizathu esicacile. Kodwa-ke, kwezinye izimo ze-tissue sarcoma, ukuguquguquka kwe-DNA okutholakele ngemva kokuzalwa nokusikhipha emisebeni yomswakama noma i-carcinogen kungadlala indima epathogenesis.
Ama-sarcomas ajwayelekile kakhulu amathishu ama- sarcoma (ama- sarcoma e-pleomorphic) (abizwa ngokuthi i-hertiocytoma ebulalayo), i- liposarcoma ne- leiomyosarcoma . I-Liposarcomas kanye nama-sarcomas angenawo ama-plemorphic ngokuvamile akhona emilenzeni, futhi i-leiomyosarcomas yi-sarcomas evame kakhulu yesisu.
Ezinganeni, uhlobo oluvame kakhulu lwesisindo esithambile sarcoma yi-rhabdomyosarcoma, echaphazela isisipha samathambo.
Ama-sarcomas ashubile angasongela ukuphila, kanti abantu abangamaphesenti angu-50 kuya kwangu-60 kuphela abaphila iminyaka emihlanu ngemuva kokutholwa ukuthi baphathwa noma baphathwe, isilinganiso esithathwa ngokuthi isilinganiso seminyaka emihlanu yokusinda. Phakathi kwalabo bantu abafa nge-softar sarcoma, i-metastasis, noma isakazeka, emaphashini yiyona imbangela evamile yokufa.
Ezingamaphesenti angu-80 zeziguli ezithintekile, lezi zinsalela zokusaphazamisa amaphaphu zenzeka phakathi kweminyaka emibili nantathu ngemva kokuxilongwa.
Ukunikezwa Kwemitholampilo Ye-Soft Tissue Sarcomas
Ngokuvamile, i-sarcoma yesisindo esithambile ibonakala njengesisindo esingabangela izimpawu (okungukuthi, i-asymptomatic). Zingafana ne- lipomas, noma izicubu ezingenabungozi ezenziwe ngamafutha. Eqinisweni, i-lipomas iphindwe izikhathi eziyi-100 ngaphezu kwezicathulo ezithambile futhi kufanele kubhekwe njengengxenye yokwahlukana okuhlukile. Ngamanye amazwi, isikhumba sesikhumba esisesandleni sakho noma umlenze kungenzeka kakhulu ukuba i-lipoma engenangqondo kune-sarcoma yezicubu ezithambile.
Cishe izingxenye ezimbili kwezintathu zamathambo ezincane ezithambile zivela ezingeni nasemilenzeni. Enye yesithathu ivela ekhanda, esiswini, i-trunk, intamo, kanye ne-retroperitoneum. I- retroperitoneum yindawo ekhona ngemuva kwodonga lwesisu esisinezinso nama-pancre kanye nengxenye ye-aorta ne-vena cava engaphansi.
Ngenxa yokuthi ama-sarcomas amancane amancane adala izimpawu, ngokuvamile ayaqaphela nje kuphela ngemva kwesenzakalo esibuhlungu esidinga ukunakekelwa kwezempilo esiletha umuntu esibhedlela. Ama-sarcomas amancane asohlangothini (izingxenye zengalo nomlenze okwedlula i-torso) zivame ukuba zincane lapho zifundwa.
Nakuba, ama-sarcomas amancane amancane ayenzeka ku-retroperitoneum noma izingxenyana ezithandwayo zomkhawulo (lezo eziseduze ne-torso) zingakhula kakhulu ngaphambi kokuqaphela.
Uma i-sarcoma yezicubu ezithambile ziba zikhulu ngokwanele, zingabangela izakhi ezizungezile, ezifana nethambo, izinzwa nemithambo yegazi, futhi kubangele izimpawu, kuhlanganise nobuhlungu, ukuvuvukala, ne-edema. Kuye indawo, ama-sarcomas amakhulu angavimbela ukuhamba kwamathumbu futhi abangele izimpawu zamathumbu, njenge-cramps, ukuqotshwa, nokulahlekelwa ukudla. Ama-sarcomas amakhulu angaphinda afinyelele emithonjeni ye-lumbar ne-pelvic ngaleyo ndlela eholela ezinkingeni ze-neurological.
Okokugcina, ama-sarcomas asemaphethelweni (izingalo nemilenze) angabonisa njenge-thrombosis ejulile.
Ukuxilongwa kanye nokuHlelwa kweSoft Tissue Sarcomas
Izinqwaba ezincane zezicubu ezithambile ezishaya, ezingakhuliswa, ezingekho ngaphansi kwamasentimitha angamatshumi amahlanu ngosayizi zingabonwa ngumtholampilo ongekho ukwelashwa okusheshayo. Ukwandisa izixuku ezijulile noma ezinkulu kunamamentimitha amahlanu zidinga ukuphinda okugcwele: umlando, ukucabanga, kanye ne- biopsy .
Ngaphambi kwe-biopsy, ukuhlolwa kokuxilongwa kusetshenziselwa ukuhlola isisindo soscoma esithambile. I-imagery resonance imaging (i-MRI) iyasiza kakhulu lapho kubonwa ama-sarcomas asobukhoma obuncane emaphethelweni. Ngokuphathelene nezicubu ezitholakalayo, i-intra-esiswini (ngaphakathi kwesisu) noma i-truncal, i-computed tomography (CT) iyasiza kakhulu. Ezinye izindlela zokuxilonga ezingabamba iqhaza ekuxilongweni yi-positron emission tomography (PET) ne-ultrasound. Imidwebo ye-ray (x-ray) ayiwusizo lapho uthola izicubu ezinesisindo esithambile.
Ngemuva kokuhlolwa kwe-diagnostic, i-biopsy yenziwa ukuze ihlolwe isisu somzimba we-tumor. Ngokomlando, ama- biopsies avulekile , okuyizinhlinzeko ezidinga i-anesthesia ejwayelekile, kuye kwaba yindinganiso yegolide lapho bethola amasampuli okwanele okuxilongwa ngegazi lakhe. Nokho, maduzane, nokho, i- biopsy eyinhloko eyisisekelo , engavamile kakhulu futhi ephephile, enembile futhi ebiza imali, isuke ibe uhlobo oluthandwayo lwe-biopsy. Isifiso esihle senaliti yinye inhlobo ye-biopsy. Okokugcina, lapho lesi sifo sincane futhi sisondela phezulu, i- biopsy ye-excisional ingenziwa.
Nakuba i-biopsy ye-tumor engaphezulu kakhulu ingenziwa kumuntu ophelelwa yisikhathi noma ehhovisi, izicubu ezijulile kudingeka zifakwe esibhedlela ngomoya osebenzayo osebenzisa i-ultrasound noma i-CT ukuze uthole isiqondiso.
Ukuhlolwa okuncane kwamathambo ama-tissue sarcomas kuyinkimbinkimbi, futhi ngisho nabachwepheshe be-sarcoma pathologists bayavumelani nokuxilongwa kwe-histologic kanye nebanga lesisu phakathi kwama-25 no-40 amaphesenti wesikhathi. Noma kunjalo, ukuxilongwa kwe-histologic yisici esibaluleke kunazo zonke lapho ubeka isisu futhi unquma ukuhlukumezeka kwesisu nokuguliswa kwesiguli, noma ukulindela imiphumela yomtholampilo. Ezinye izici ezibalulekile lapho kunquma isiteji sesisu kuyisayizi nendawo. Ukusetshenziswa kwesiteji kusetshenziswe ochwepheshe ukuhlela ukwelashwa.
Ngama-sarcomas amathanga aphansi, ama-metastases noma asakazeka kuma-lymph nodes akavamile. Esikhundleni salokho, izicubu ngokuvamile zanda emaphashini. Ezinye izindawo ze-metastase zihlanganisa ithambo, isibindi, nobuchopho.
Ukwelashwa kwe-Soft Tissue Sarcoma
Ukwelashwa ukukhipha isisu kuyindlela yokwelapha evame ukwedlula zonke ama-sarcomas ezithambile zesisindo. Ngezinye izikhathi, ukuhlinzeka konke okudingekayo.
Ngesinye isikhathi, ukuxoshwa kwakuvame ukuqhutshwa ukuphatha ama-sarcomas wezingalo nemilenze. Ngenhlanhla, namuhla, ukuhlinzeka ngokuhlinzwa okuyisilwane kuvame kakhulu.
Uma ususa i-sarcoma yezicubu ezithambile, ukucubungula okubanzi kwendawo kwenziwa lapho i-tumor kanye nezinye izicubu eziphilile, noma umkhawulo, isusiwe. Uma izicubu zisuswe ekhanda, entanyeni, esiswini noma esihlahleni, i-oncologist yokuhlinza izama ukukhawulela ubukhulu bezintambo bese zigcina izicubu ezinempilo ezinamandla ngendlela ekhona. Noma kunjalo, akukho mbono yokuvumelanisa ekhona kulokho ubungakanani bomkhawulo "omuhle".
Ngaphandle kokuhlinzwa, i-radiotherapy, esebenzisa ama-ray-ray noma ama-ray angaphezulu, ingasetshenziswa ukubulala amaseli we-tumor noma ukulinganisela ukukhula kwabo. I-Radiotherapy ivame ukuhlanganiswa nokuhlinzwa futhi inganikezwa ngaphambi kokuhlinzwa (okungukuthi, i-neoadjuvant therapy) ukuze unciphise ubukhulu besisu noma ngemuva kokuhlinzwa (isib. Ukwelashwa kwe-adjuvant) ukunciphisa ingozi yokuphindaphinda umdlavuza. Kokubili ukwelashwa kwe-neoadjuvant kanye ne-adjuvant kunezinzuzo nezinkinga, futhi kukhona ukuphikisana mayelana nesikhathi esiphezulu sokuphatha ama-sarcomas amathanga aphansi usebenzisa i-radiotherapy.
Izinhlobo ezimbili eziyinhloko ze-radiotherapy yizokwelapha zangaphandle zemisebe kanye nokwelashwa kwemisebe yangaphakathi . Ngokwelashwa kwangaphandle kwemisebe, umshini otholakale ngaphandle komzimba ukhulula imisebe ku-tumor. Ngokwelashwa kwangaphakathi kwemishanguzo, izinto ezinomsakazo ezivaliwe ngezintambo, izinaliti, ama-catheter noma imbewu zifakwa ngaphakathi noma eduze kwesikhumba.
Uhlobo olusha lwe-radiotherapy yi-radiotherapy enamandla kakhulu (IMRT). I-IMRT isebenzisa ikhompyutha ukuthatha izithombe bese ivuselela isimo nesimo esiyi-tumor. Imisindvo yemisebe yezinhloso ezihlukahlukene isuke ihloselwe isisu kusuka kuma-angles amaningi. Loluhlobo lwemithi yokwelashwa luveza umonakalo ophansi emathanjeni enomakhelwane anempilo futhi ibeke isiguli engozini engaphansi kwemiphumela emibi, njengomlomo owomile, inkinga yokugwinya nokulimala kesikhumba.
Ngaphandle kwe-radiotherapy, i-chemotherapy ingasetshenziswa futhi ukubulala amangqamuzana omdlavuza noma ukuvimbela ukuba bangakhuli. I-Chemotherapy ihilela ukuphathwa kwama-chemotherapeutic agents noma izidakamizwa ngomlomo noma nge-vein noma imisipha (ukuphathwa kwama-parenteral). Okuphawulayo, ukusetshenziswa kwe-chemotherapy ukuphatha ama-sarcomas alula kakhulu nakho kuyaphazamiseka.
Izidakamizwa ezihlukahlukene zivunyelwe ukuphatha izicubu ezincane zezicathulo ezibandakanya lokhu okulandelayo:
- doxorubicin hydrochloride
- i-dactinomycin (i-Cosmegen)
- i-imatinib mesylate (i-Gleevec)
- i-eribulin mesylate (i-Halaven)
- i-olaratumab (i-Lartruvo)
- i-trabectedin
Okokugcina, i-sarcoma yesisindo esithambile esivamile iyisisindo esithambile se-sarcoma ebuyela emuva ngemuva kokwelashwa. Kungabuya noma kumathambo afanayo alula noma izicubu ezithambile ezikhona kwenye ingxenye yomzimba.
Ngaphansi
Sicela uhlale ukhumbule ukuthi ama-sarcomas amancane amathanga ajwayelekile. Konke okulinganayo, ithuba lokuthi noma yikuphi ukuqhuma noma ukuqhuma emzimbeni wakho umdlavuza uphansi. Noma kunjalo, kufanele uzizwe ukhululekile ukuhlela i-aphoyintimenti nodokotela wakho ukuhlola noma yikuphi okuphathelene nokulima noma ukushaya-ikakhulukazi uma kubangela ubuhlungu, ubuthakathaka noma okunye.
Uma wena noma othandekayo usuvele uthola ukuthi une-tissue sarcoma esithambile, sicela ulandele ngokucophelela ukuqondiswa kochwepheshe bakho. Nakuba ukuphila okwesabisa cishe engxenyeni yalabo abatholakalisiwe, eziningi, ama-sarcomas amancane amancane angaphathwa.
Okokugcina, ukwelashwa okusha kwezinshukela ezinomsoco kuvela. Isibonelo, i- chemotherapy yesifunda , okuyi-chemotherapy ehlose izingxenye zomzimba ezinjengezikhali noma imilenze, yindawo esebenzayo yokucwaninga. Wena noma othandekayo ungase uvumelekile ukuba ubambe iqhaza esilingo somtholampilo. Ungathola ukuhlolwa okusemtholampilo okusekelwe yi-National Cancer Institute (NCI) eseduze nawe.
> Imithombo:
> Ukwelashwa kwe-Adult Soft Tissue Sarcoma (PDQ®) -Isiguli Somzimba. I-National Cancer Institute. https://www.cancer.gov/about-cancer/treatment/clinical-trials/search.
> Cormier JN, Gronchi A, Pollock RE. I-Soft Tissue Sarcomas. Ku: Brunicardi F, Andersen DK, B Billiar, Dunn DL, Hunter JG, Matthews JB, Pollock RE. ama-eds. Izimiso Zokuhlinza Schwartz, 10e . ENew York, NY: McGraw-Hill; 2014.
> Hoefkens F, et al. I-sarcoma ye-tissue ye-sarcoma yamaphethelo: imibuzo elindile ekuhlinzekeni nase-radiotherapy. I-Radiation Oncology. 2016; 11: 136.
> Sabel MS. I-oncology. Ku: Doherty GM. ama-eds. Ukuqaphela Kokuqala Nokuphathwa: Ukuhlinzwa, 14e . ENew York, NY: McGraw-Hill; 2015.