I-Hodgkin lymphoma (HL) ngumdlavuza wamangqamuzana egazi elimhlophe ongathinta abantu abasha abasebaneminyaka yokuzala. Eqinisweni, nakuba i-HL imelela ngamaphesenti angu-10 kuphela e- lymphomas , ingenye ye-lymphoma subtypes evame ukutholakala ngesikhathi sokukhulelwa. Lokhu kungenxa yokuthi isigameko esikhulu se-HL sihambisana nonyaka wesifazane wokuzala.
Ukugcina i-Fetus Safe
Ezinye zezibonakaliso nezimpawu ezivela ku-HL, njengokukhathala nokuphefumula, zingaba nezibonakaliso ezivamile ezibonakalayo ngesikhathi sokukhulelwa, okungenza kube nzima ukwenza izinto, kodwa ukufakwa kwe-HL kwenziwa ukuze unikeze ulwazi olwanele lokuqondisa ukuphathwa ngenkathi ukunciphisa izingozi ezinganeni.
Isibonelo, uma i-x-ray isifuba isenziwe, isisu sisilondolozwe ukuze sivikele ingane. Ukuhlola isisu, i-MRI ne-ultrasound ingenziwa. I- bone marrow biopsy isengenziwa ngokuphepha ngesikhathi sokukhulelwa uma kudingeka.
Ukuphathwa kwe-HL ngesikhathi sokukhulelwa kusho ukulinganisa ithuba lokuphulukiswa nokunciphisa ingozi engaba khona kumntwana okhulayo. Abesifazane abaningi abakhulelwe abane-HL abaxilongwe ngesikhathi sokukhulelwa baphathwa ukwelashwa. I-chemotherapy ehlanganiswa njenge-ABVD iye yenziwa ngokuphumelelayo ku-trimester yokuqala. Ucwaningo olubheke emiphumeleni yokubeletha kumama abathintekayo ngenxa ye-HL belokhu ekhuthaza, engabonisi umehluko ekutheni isisindo sokuzalwa noma izinkinga zokuzalwa ezingenangqondo uma kuqhathaniswa nezinsana ezazalwa ngonina ezingekho ukwelashwa. Kulabo besifazane abakhethiwe, ukwelashwa kungahle kulandwe kuze kube yilapho ingane ingathunyelwa ngokuphepha.
Ukuzala emva kokulashwa kwe-Hodgkin Lymphoma
Ngokwe-athikili eyanyatheliswa kuyi-"Haematologica" ka-November 2011, into ethiwa ukuhluleka kwe-ovarian ngaphambi kwesikhathi-ngokuyinhloko kokuya esikhathini sokuqala-ingaba ngamaphesenti angu-5 kuya kwangu-25 kwabesifazane abaphathwa ukwelashwa abangaphansi kweminyaka engama-30.
Ingozi yokungabi nabantwana iyanda ngenani elikhulayo lamakhemikhali okuthiwa yi-alkylating agents.
I-Chemotherapy nayo ihlanganiswe nomonakalo kuma-ovari. Ukwelashwa okubizwa nge-myeloablative kwandisa ingozi yokuthi owesifazane ngeke akwazi ukukhulelwa ngemva kokwelashwa. Le ndlela yokwelapha isebenzisa i-high-dose chemotherapy ebulala amakhemikhali emnothweni wethambo, kuhlanganise namaseli omdlavuza.
Liphinde linciphise izibalo zamaseli avamile okwenza igazi emnothweni wamathambo, okungabangela imiphumela emibi kakhulu. Uma i-myeloablative chemotherapy isetshenziselwa, lokhu kuvame ukulandelwa umnkantso wesitembu noma ukufakelwa kwe-stem cell ukubuyisela ukusebenza komnkantso wethambo.
Ucwaningo olwenziwa nguMeirow nozakwabo lubonise ukuthi ukuhluleka kwe-ovarian ngaphambi kwesikhathi kuvame kakhulu kubafazi abangaphezu kweminyaka engama-30 ubudala, nokuthi imithi ethile ye-chemotherapeutic kanye nomthamo othile we-irradiation ye-pelvic yizici eziphathelene nokuzala. I-toxic ikakhulukazi ezicukwaneni ze-ovari ziyama-alkylating agents.
Ucwaningo oluningi luye lwabheka ukwanda kweziguli ezilandela ukwelashwa kwe-HL. Omunye okutholile ukuthi umthamo we-BEACOPP owenziwe umthamo uhlotshaniswe nendawo ephakeme ye-amenorrhea yesibili kune-ABVD regimen. I-amenorrhea yesibili ichazwa njengokungabikho kokuphuma kwesikhashana kumfazi owaye esikhathini ukuya esikhathini kodwa kamuva uyeka ukuya esikhathini ezinyangeni ezintathu noma ngaphezulu- futhi ukungabi nesikhathi sokuya esikhathini akukona ngenxa yokukhulelwa, ukuncelisa usana, ukususwa komjikelezo nge-systemic ye-hormonal contraceptive (ukulawula ukubeletha) amaphilisi, noma ukuyeka esikhathini.
Izingxenye zemihla engenhla yilezi:
- I-BEACOPP (i-bleomycin, etoposide, doxorubicin, i-cyclophosphamide, i-vincristine, i-procarbazine, ne-prednisone, lapho ama-alkylating agents e-cyclophosphamide ne-procarbazine)
- I-ABVD (i-doxorubicin, i-vinblastine, i-dacarbazine, ne-bleomycin, lapho i-alkylating agent i-dacarbazine)
Nakuba lezo zindlela zokwelashwa zanamuhla zivame ukuphumelela ngokumelene ne-HL, zingathatha ama-gonads kanye nama-ovari ikakhulukazi. Odokotela abahlola lesi simo, isimo sivame ukuchazwa ngokuthi "indawo yokugcina i-ovarian", noma i-chDOR ekhishwe ngamakhemikhali.
I-chDOR ihilela ukuba nenani eliphansi lamaqanda emaqanda omama kodwa kungathinta nokuthuthukiswa kwamaqanda akhona. Izimpawu zihlanganisa i-amenorrhea yesibili kanye nokungasebenzi. Ukuqedwa kwe-follicles kuma-ovari kungaphinde kuholele ekubhekaneni nokuhluleka kwe-ovarian ngaphambi kwesikhathi, okuchazwa ngokweqile njengokulahlekelwa komsebenzi we-ovarian ngaphambi kweminyaka engu-40.
Kunobunye ubufakazi bokuthi ukuphathwa kwe-gonadotropin-ukukhipha ama-hormone analogues (GnRH-a) ngesikhathi samakhemikhali kungasiza ukuvikela ama-ovari. Indlela yokwenza lokhu kungase kusebenze, noma kunjalo, isaqondakali ngokuphelele.
Ukuzala Kwesilisa
Iziguli zesilisa azikho umthelela wokuzala , noma. I-testes iyakwazi ukubhekana nemiphumela enobuthi yesifo somdlavuza kuzo zonke izigaba zokuphila. Ngokusho kocwaningo olwenziwa nguJahnukainen kanye nosebenza nabo, abasindile abesilisa abanomdlavuza wesilisa cishe cishe okungenani isigamu njengoba abantwana babo bebeletha ukukhulelwa. Iphepha elifanayo lisho ukwelashwa kwama-radiation kuma-testes kanye nomthamo ophakeme wokusebenza kwama-alkylating agents njengoba izimbangela ezinkulu zinciphisa amathuba okuzala.
Izwi elivela
Insimu yokwelashwa komdlavuza kanye nokulondolozwa kokuzala kukhula ngokushesha. Imishanguzo emisha yokulwa nomdlavuza ivela kaningi kakhulu, ngakho-ke kokubili ukwelashwa kwe-lymphoma kanye nokuphathwa kwemiphumela emibi, okubandakanya ukungabikho komzimba, kusesimeni sokuziphendukela kwemvelo. Khuluma nodokotela wakho ukuthola ukuthi iyiphi indlela yokwelapha engcono kakhulu.
Imithombo:
Harel S, Fermé C, Poirot C. Ukuphathwa kokuzala kulabo abaphathwa nge-Hodgkin's lymphoma. Haematologica . 2011; 96 (11): 1692-1699.
Hutchings M. Kanjani usizo lwe-PET / CT ekukhetheni ukwelashwa kweziguli ezine-Hodgkin lymphoma? Uhlelo lwe-Hematology Uhlelo lwe-Soc Hematol Educ Educator. 2012; 2012: 322-7.
Meirow D, uBeederman H, Anderson RA, Wallace WH. Ukwehla kwesifo samakhemikhali kanye nemisebe yokukhiqiza abesifazane. I-Clin Obstet Gynecol. 2010; 53: 727-39.