Ikhansela emathanjeni livame ukusakazwa, noma i-metastasis, kwesinye isifo somdlavuza we-bone- bones osuka kumdlavuza wamaphaphu noma umdlavuza webele. Ukuthatha isampula, noma i- biopsy , endaweni ethintekile yethambo akusebenzi nje ukuhlukanisa phakathi komdlavuza wethambo kanye nemetastasis kusuka kwamanye amagciwane kodwa futhi kusiza ukukhomba uhlobo oluthile lomdlavuza wethambo.
Lapho kutholakala umdlavuza wethambo, ithambo elithile elithintekayo-futhi indawo yesikhumba ngaphakathi kwethambo elithile-kungaba kokubili okubalulekile.
I-osteosarcoma, i-chondrosarcoma, ne-Ewing sarcoma ziphakathi kwamathambo amaningi avame uketshezi. Kodwa-ke, umdlavuza we-bone awuyona umdlavuza ovame kakhulu, nhlobo: i-cancer eyinhloko yamathambo ibheka ngaphansi kwamaphesenti angaphansi kuka-0.2 yawo wonke amagciwane.
Ukuhlola Ukuhlola / Ukuhlolwa Kwekhaya
Ngalesi sikhathi, izivivinyo zasekhaya zokuxilongwa komdlavuza wethambo azange zenziwe. Ngaphezu kwalokho, izibonakaliso zokuqala zomdlavuza wezasheshe zidideka kalula ngezinye izimo ezivame kakhulu ezifana nokulimala kwezemidlalo, noma kungase kuthiwa kuthiwa zibangelwa ama-aches and pain.
Ekugcineni, izifo eziningi zomdlavuza wezitho zomzimba zithola usizo lwezokwelapha ngenxa yezibonakaliso nezimpawu ezifaka ubuhlungu besifuba obuqhubekayo ngokuhamba kwesikhathi. Ubuhlungu besifo somdlavuza we-bone ngokuvamile bubi kakhulu ebusuku futhi kuvame ukuhambisana nokuvuvukala kwendawo ethintekile.
Ama-Labs nezivivinyo
Ukuhlolwa Kwemvelo
Ezimweni zomdlavuza wamathambo, ukuhlolwa ngokomzimba okwenziwa udokotela kuyoba okuvamile ngaphandle kwale "tissue mass mass" okungase kuvezwe endaweni yokuqala yomdlavuza. Lokhu kungase kubonakale njengenhlama, isilonda, noma ukuvuvukala okuphuma ethambo.
Umsebenzi wegazi
Ukuhlolwa kwebholabhuthi, noma umsebenzi wegazi , kungasiza, nakuba kungavamile ukuveza ukuxilongwa okuthile. Amazinga amabhilikhali amabili-ikakhulukazi-alkali phosphatase kanye ne-lactate dehydrogenase-aphakanyiswe ngenani elikhulu leziguli ezine-cancer yomuthi. Noma kunjalo, la mazinga awahambelani kahle kakhulu nokuthi isifo sisakaze kangakanani emzimbeni.
I-Biopsy
Endabeni ye-biopsy, ithambo elincane le-tumor liyosuswa futhi lihlolwe ngaphansi kwe-microscope. Kucatshangwa ukuthi ukuhlinzwa okulula, kwenziwa ngaphansi kokuhlinzekwa kwezifo ezijwayelekile, futhi uzoxoxwa ngakho ngaphambi nangenkathi yenqubo. I-biopsy izoveza ukuthi ngabe amangqamuzana anomdlavuza ayenjani emathanjeni.
Ukucabanga
X-ray
Ukusola kwe-osteosarcoma kuvame ukuvela ekubukeni kwethambo elithintekile ekucabangeni.
I-osteosarcoma ingaba nokubonakala okuhlukile kumfanekiso wokucabangela: ukucwiliswa noma "ukudliwa" okuvela ezindaweni zethambo kubizwa ngokuthi i-lytic pattern. Ngaphandle kwalokho, ithambo lingabonakala linyanyisiwe, njengokungathi liqiniswa ngamakhemende engeziwe, futhi lokhu kubhekiswa njengesibonelo se-sclerotic. Umdlavuza we-bone ungase udale iphethini elixubekile (lytic-sclerotic) ekucabangeni.
Odokotela bafunda nge-radial yangempela noma "i-sunburst" 'iphethini ye-osteosarcoma, lapho izicubu ezizungezile zithatha ukubonakala okukhulu kwethambo endaweni ekhanyayo, i-spokes-from-the-hub, i-sunburst pattern; Kodwa lokhu okutholakele akuyona into ecacile kwi-osteosarcoma futhi akuwona wonke ama-osteosarcomas azobonisa iphethini elinjalo.
I-CT ne-MRI
Ngokuvamile ukuhlinzwa kuyingxenye yokwelashwa, ngakho-ke kubalulekile ukubona ukuthi i-osteosarcoma ithatha kanjani amathambo nezicubu ezithambile. Lokhu kubonakala ngokuhle ngamasu okucabanga okuhlukanisa izigaba ezifana ne-computed tomography (CT) noma i-imagery magnetic resonance (MRI).
I-MRI yinkqubo esebenzisa i-magnet, amagagasi omsakazo, kanye nekhompiyutha ukwenza uchungechunge lwezithombe ezinemininingwane yezigaba zomzimba, kuhlanganise nendawo yokwakheka kwesisu. Ukusebenzisa i-MRI ukuchaza ubukhulu be-tumor kuye kwaboniswa ukuthi kunengqondo ecacile ye-tumor yangempela njengoba kunqunywe ngesikhathi sokuhlinzwa.
I-Radionuclide Bone Scan
Kusetshenziselwa izifundo ezihlukahlukene ze-radiographic njengengxenye yokuhlolwa kwe-diagnostic yomdlavuza wezintana ukucacisa ubukhulu bendawo kanye nobude besifo ngesikhathi sokuxilongwa.
I-radionuclide ithebhu scan, besebenzisa inani elincane lama-radioactive technetium 99m lijojelwe emvuthweni, lisetshenziselwa ukuchaza ubukhulu be-tumor oyinhloko. Futhi, njengoba ukuvuthwa kwalo kuvame ukuqhubeka kancane kancane kunomkhawulo we-tumor, kusiza odokotela abahlinzayo ukuba bahlele ukususwa kwesisu.
Loluhlobo lwe-radionuclide ukuskena kwethambo lubuye luzuze ekutholeni izindawo ezengeziwe zomdlavuza ngaphakathi kwethambo elifanayo (okuthiwa yi-skip lesions) kanye nama-metastases asele kude. Lokhu kuhlolwa kuyasiza ngoba kungabonisa wonke ama-skeleton ngesikhathi esisodwa. Ukuskena kwe-positron emission tomography (PET) kungase kuhlinzeke ngolwazi olufanayo, ngakho-ke ukuskenwa kwethambo kungadingeki uma iskena se-PET senziwa.
I-Positron Emission Tomography (PET) Skena
Kulayini lwe-PET, uhlobo lweshukela oluvuthayo (olubizwa ngokuthi i- FDG ) lufakwe egazini. Izikhathi eziningi amangqamuzana omdlavuza emzimbeni akhula masinyane futhi athole inani elikhulu likashukela, okwenza isithombe sibonise ukutholakala kwe-FDG emzimbeni ezindaweni zokubandakanyeka komdlavuza. Isithombe asihlosiwe njenge-CT noma i-MRI scan, kodwa inikeza ulwazi oluwusizo ngomzimba wonke.
Ukuhlola kwe-PET kungasiza ekuboniseni ukusabalala kwe-osteosarcomas emaphashini, kwamanye amathambo, noma kwezinye izingxenye zomzimba, futhi kungasiza ekuboneni ukuthi umdlavuza uphendule kangakanani empilweni.
Ngokuvamile amaphuzu e-PET ne-CT azohlanganiswa ngesikhathi esifanayo (i- PET / CT scan ) ukuvumela izindawo zomsakazo ophezulu kwi-scan ye-PET ukuqhathaniswa nokubukeka okuningiliziwe kwalowo ndawo ku-CT scan.
Iskena seMetastases
Nakuba isifuba se-X-ray sivumela ukutholakala kwamaphasimase amaphaphu emanzini amanengi, i-CT ibuhlungu kakhulu ekutholeni amaminerase amaphaphu futhi isuke inqubo yokuzikhethela. Kungenzeka kube nama-positi amanga, noma kunjalo, ikakhulu lapho kunemiphumela encane kakhulu emaphashini, ngakho-ke i-biopsy yokuqinisekisa ingadingeka.
Ukuhlonza okuhlukile
Ukuhlonza ukuhlukana kwezifo zethambo zalolu hlobo kufaka lokhu okulandelayo:
- Ukutheleleka
- Ezinye izicubu:
- Aneurysmal bone cyst
- Ewing sarcoma
- I-Chondrosarcoma
Indawo yesikhumba emathanjeni nasezindaweni zamathambo kusiza ukuhlukanisa i-osteosarcoma ne-Ewing sarcoma, okuyi-tumor yesibili evame kakhulu eqenjini elidala.
Ububanzi bezinto ezingase ziphinde zithonywe indawo yesikhumba esikhulu. Isibonelo, ukuhlukana kokuhlukana kwesilonda esincane semisipha kuhlanganisa izinhlobo ezihlukahlukene zezinyosi zinozinyo, i-osteomyelitis (ukutheleleka) kwethambo lesifuba, nezinye zezifo ezingavamile ezingavamile (njenge-ossification fibromas kanye nezicubu ezinsundu ze-hyperparathyroidism).
Ukubukwa kokubheka
Ingxenye yokuthola umdlavuza wethambo ihilela isiteji. Ukuthungatha kusho ukuhlola usayizi nendawo ye-tumor enkulu, uma isakazeke, nalapho usakaze khona. Ukuncintisana kusiza ukunquma ukwelashwa, futhi odokotela nabo babheka isiteleka somdlavuza lapho bexoxa ngezibalo zokusinda.
I-localized vs. Metastatic
Ukumiswa kwesisekelo kuncike ekuhlolweni ngokomzimba, ukuhlolwa kwe-imaging, nanoma yimaphi ama-biopsies ayenziwe. I-osteosarcoma ingaba isigaba I, II, noma II ngezigaba ezincane.
Okunye okucatshangelwayo ekugxilweni ukuthi ngabe umdlavuza "wendawo" noma "i-metastatic." Uma indawo yakhiwe, i-osteosarcoma ibonakala kuphela kuthethini eqala kuwo futhi mhlawumbe izicubu eziseduze nethambo, njenge-muscle, tendon, noma amafutha.
Ngokusho kwe-American Cancer Society, cishe ama-osteosarcomas angaba ngu-4 kuma-5 avela lapho etholakala khona okokuqala. Kodwa-ke, ngisho nalapho ukuhlolwa kwe-imaging kungabonakali ukuthi umdlavuza usakaze ezindaweni ezikude, iziguli eziningi cishe zinezindawo ezincane kakhulu zokusabalalisa umdlavuza ezingenakutholwa ngokuhlolwa.
Ukutholakala kwe-metastases encane kungenye yezizathu zokuthi i-chemotherapy iyingxenye ebalulekile yokwelapha ama-osteosarcomas amaningi. Okusho ukuthi umdlavuza kungenzeka ukuthi ubuyele emuva ngemuva kokuhlinzwa uma kungenayo i-chemotherapy enikeziwe.
Ama-osteosarcomas asendaweni aphinde ahlukaniswe ngamaqembu amabili:
- Amanqamu aphethwe yilezi lapho zonke izicubu ezibonakalayo zingasuswa ngokuhlinzwa.
- Ama-osteosarcomas angenakutholakali (noma angenakunyakaziswa) angeke asuswe ngokuphelele ngokuhlinzwa.
Ukubamba
Ukubamba kungase kuhlanganiswe kwisiteji futhi kubhekisela ekubukeni kwamangqamuzana omdlavuza ngaphansi kwe-microscope. Ukubamba kunika umqondo wokuthi ngokushesha umdlavuza ungaqala kanjani.
- Amaseli omdlavuza wezinga elincane avame ukukhula kancane futhi amathuba okusabalalisa.
- Ama- tumors aphezulu ahlanganisa amangqamuzana omdlavuza angase akhule ngokushesha futhi angase asakazeke.
Ama-osteosarcomas amaningi aphezulu, kodwa uhlobo olubizwa ngokuthi i-parosteal osteosarcoma ngokuvamile luphansi.
Izinhlelo zokugxila
Uhlelo olusetshenziselwa ukusetshenziswa kakhulu lwe-osteosarcoma luhlukanisa izicubu zomzimba ezibulalayo zendawo ngamabanga amabili nangama-anatomiki.
Ibanga
Ibanga eliphansi futhi eliphakeme lingabonisa isiteji.
- Ibanga eliphansi = isigaba I
- Ibanga eliphezulu = isigaba II
Isilinganiso se-Anatomic yendawo
- Isimo sendawo sendawo sinqunywe ukuthi noma ngabe lesi sifo siphumelela nge-cortex, indawo engaphandle enesithambo esithemba esakhiweni esivikelekile esizungeze umgudu wangaphakathi
- Intracompartmental (ayikho isandiso nge-cortex) = A
- Okungeziweko (isandiso nge-cortex) = B
Kulesi simiso, lokhu okulandelayo kuyiqiniso:
- Amabanga aphansi, amakhanda asemasimini ayesiteji I.
- Amabanga aphakeme kakhulu, amakhemikhali angama-stage II.
- Izicubu ze-Metastatic (kungakhathaliseki ukuthi yiliphi ibanga) ziyisigaba sesi-III.
Kunezilonda ezincane kakhulu eziphezulu ze-intracompartmental (isigaba se-IIA) ngoba ama-osteosarcomas amaningi aphezulu aphuma e-cortex yethambo ngaphambi kokuthuthukiswa kwawo.
Emaqenjini amancane, iningi lama-osteosarcomas liphakeme kakhulu; ngakho-ke, cishe zonke iziguli ziyi-IIB noma i-III yesigaba, kuye ngokuthi kukhona noma ngabe kukhona ukutholakala kwesifo se-metastatic.
Izibonelo ngesiteji
- Isigaba IA: Umdlavuza ungaphansi kwebanga futhi utholakala kuphela ngaphakathi kwengubo enzima yethambo.
- Isigaba IB: Umdlavuza ungezingeni eliphansi, ophuma ngaphandle kwethambo nasesikhaleni esithambile sezicubu ezinemizwa nemithambo yegazi.
- Isiteji IIA: Umdlavuza uphezulu futhi uqukethe ngaphakathi kokugqoka okweqile kwethambo.
- Isigaba IIB: Umdlavuza uphakeme kakhulu futhi usakaze ngaphandle kwethambo nasendaweni ezungezile zezicubu zomzimba eziqukethe imizwa nemithambo yegazi. Ama-osteosarcomas amaningi asezingeni 2B.
- Isigaba III: Umdlavuza ungaba ophansi noma ophezulu futhi ungatholakala ngaphakathi kwethambo noma uvele ngaphandle kwethambo. Umdlavuza usakaze kwezinye izingxenye zomzimba, noma kwamanye amathambo angaxhunyiwe ngokuqondile ethempheni lapho kuqale khona isisu.
Uma umdlavuza ubuya ngemuva kokwelashwa kokuqala, lokhu kwaziwa ngokuthi umdlavuza ophindaphindiwe noma ophindaphindiwe.
> Imithombo:
> I-American Cancer Society. Izivivinyo ze-Osteosarcoma. https://www.cancer.org/cancer/osteosarcoma/detection-diagnosis-staging/how-diagnosed.html.
> National Caner Institute. I-Osteosarcoma kanye ne-Histiocytoma e-Malignant Fibrous ye-Bone Treatment (PDQ®) -Health Professional Version. https://www.cancer.gov/types/bone/hp/osteosarcoma-treatment-pdq.