Izivivinyo ezisetshenziselwa ukuxilonga umdlavuza we-esophageal zingafaka ingxube ye-barium, i-endoscopy, ne-endoscopic ultrasound, futhi ijwayele ukulalelwa abantu abanenkinga yokugwinya, ukukhwehlela okuqhubekayo, noma izifo ezingezinkinga zesifo ezifana nesimo eside se-acid reflux. Ezinye izinqubo kanye nokuhlolwa kwe-imaging njenge-CT, i-PET, ne-bronchoscopy kungasiza ekunqumeni isigaba sesifo.
Ukuhleleka okuhlelekile nakho kuyadingeka ukuze ukhethe okukhethwa kukho okungcono kakhulu kokwelapha.
Ama-Labs nezivivinyo
Akukho ukuhlolwa kwekhaya lapho kunomdlavuza we-esophageal. Kuwusizo ukuqaphela kokubili izici ezingozini zesifo kanye nezimpawu zokuxwayisa ezingase zibe khona kanye nezimpawu zesifo somdlavuza we-esophageal , ukuze ukwazi ukwenza i-aphoyintimenti nodokotela wakho futhi uphishekele ukuhlolwa okuhle kochwepheshe, uma kudingeka.
Ukuhlola i-Lab akuyona into eqondile ngomdlavuza we-esophageal, kodwa kusetshenziselwa kanye nama-imaging, ukubuyekezwa ngokucophelela komlando womndeni nomuntu siqu, nokuhlola ngokomzimba ukuxilonga lesi sifo. Inani eliphelele legazi (i-CBC) lingabonisa ubufakazi be-anemia (inani elincane elibomvu lamasosha egazi) uma umdlavuza uphala. Izivivinyo zomsebenzi wesibindi zingase ziphakanyiswe uma umdlavuza usakaze esibindi.
Izinqubo
Izinqubo zibaluleke kakhulu ekwenzeni ukuxilongwa komdlavuza we-esophageal futhi zibandakanya:
I-Endoscopy
I- endoscopy ephezulu (i-esophagoscopy noma i-esophagus-gastric-duodenoscopy) iyindlela eyinhloko yokuthola umdlavuza we-esophageal namuhla.
Kule nqubo, ithubhu eliguquguqukayo, elikhanyisiwe lifakwe emlonyeni nasehla ngapha nangapha. I-tube inekhamera ekugcineni evumela ukuthi odokotela bakwazi ukubona ngeso lengqondo ubunikazi bendawo. Uma kungabonakali okungajwayelekile, i-biopsy ingenziwa ngesikhathi esifanayo.
Ngaphambi kwenqubo, abantu banikezwa ukudubula okubangela ukulala, futhi inqubo ivame ukubekezelela kahle.
I-Endoscopic Ultrasound (EUS)
Le nqubo yenziwe ukuze uthole izithombe eziwusizo. Ngesikhathi i-endoscopy yendabuko ephakeme, i-probe ye-ultrasound ekupheleni kwendawo isetshenziselwa ukuvuza amagagasi omsindo aphezulu avela ezingxenyeni zangaphakathi zendawo. Ama-echoes enza i-sonogram, isithombe salezo zicubu. I-EUS iyasiza kakhulu ekunqumeni ukujula kwe-tumor, okubaluleke kakhulu ekuyiseni. Kubuye kusize kakhulu ekuhloleni amakhemikhali e-lymph eseduzane nokuqondisa ama-biopsies nganoma yikuphi okungajwayelekile. Okunye ukuhlolwa kwe-imaging nakho kungacatshangelwa (bheka ngezansi), nakuba lokhu kuyingozi kakhulu.
I-Biopsy
I-biopsy ivame ukuthathwa phakathi ne-endoscopy, kodwa ingenziwa futhi nge-bronchoscopy noma i-thoracoscopy. I-pathologists ibuka lezi zicubu ngaphansi kwe-microscope ukuthola ukuthi izicubu ziwumdlavuza futhi, uma kunjalo, kungakhathaliseki ukuthi i-squamous cell carcinoma noma i-adenocarcinoma. Isampula nayo inikezwa ibanga lesisu, inombolo echaza ukuthi ulaka luvela kanjani.
Ezinye izicubu zemizimba zingenziwa ukuthi zibheke izici ze-molecular of the tumor, ezifana nesimo se-HER2 (njengezincelisi zamabele ezingaba yi- HER2 , ama-cancer angama-esophageal angaba ngu-HER2 positive).
I-bronchoscopy
I- bronchoscopy ivame ukuyenzela izicubu ezingenasifo ezitholakala phakathi kuya kwesithathu kwe-oophagus.
I-bronchoscope (ithambo elincane, elikhanyayo) lifakwe emakhaleni noma emlonyeni ku- trachea (i-tube ehlanganisa umlomo namapapu) kanye ne- bronchi (imimoya emikhulu) yamaphaphu. Le nqubo ivumela udokotela ukuba aqaphe ngokuqondile noma yikuphi okungajwayelekile kulezi zindawo futhi aqoqe amasampula amathishu azo (i-biopsy) uma ekhona.
I-bronchoscopy yenziwa ngaphansi kwe-sedation, ngokuvamile njengendlela yokwelashwa.
I-Thoracoscopy
Phakathi ne-thoracoscopy, i-incision noma ukusika eyenziwa phakathi kwezimbambo ezimbili kanye ne-thoracoscope, okuyinto ithini elincane, elikhanyayo, lifakwe esifubeni. Odokotela basebenzise lokhu ukubuka izitho ngaphakathi kwesifuba futhi bahlole izindawo ezingavamile zomdlavuza.
Amasampuli we-tissue nama-lymph nodes angasuswa nge-biopsy. Kwezinye izimo, le nqubo ingahle isetshenziselwe ukususa izingxenye ze-esophagus noma iphaphu.
I-Laparoscopy
Ku-laparoscopy, ukucutshungulwa okuncane noma ukusikeka kwenziwa emdongeni wesisu. I-laparoscope, enye ithini elincane, elikhanyayo, lifakwe emzimbeni ngokusebenzisa enye yezinto ezihloselwe ukubheka izitho ngaphakathi kwesisu bese uhlola izibonakaliso zesifo. Ezinye izinsimbi zingase zibekwe ngokufanayo noma okunye ukucubungula ukwenza izinqubo ezifana nokususa izitho noma ukuthatha amasampula amathisiphi we-biopsy.
Laryngoscopy
I-tube encane ekhanyisiwe ifakwe phansi emqaleni ukuze ubuke i-larynx noma ibhokisi lezwi. Lokhu kuhlolwa kungathola noma yibuphi ubufakazi bokusakazeka komdlavuza ku-larynx noma pharynx (umphimbo).
Ukucabanga
Ukuhlola ukuhlolwa kungenziwa ekuqaleni njengengxenye yokuphenywa komdlavuza we-esophageal, kodwa ngokuvamile kuvame ukwenza isiteleka esitholakale. Izivivinyo ezingenziwa zingabandakanya:
I-Barium Swallow
Ukuhlolwa kokuqala okwenziwe ukuze kuhlolwe umdlavuza we-esophageal kungenzeka uvame ukugwinya noma ukuphela kwe-endoscopy, nakuba ukuqhubeka ngqo ekupheleni kwe-endoscopy kukhethwa uma umdlavuza wesifo socansi ungasolakala.
Emgodini we-barium (obizwa nangokuthi uchungechunge oluphezulu lwe-GI), umuntu uphuza uketshezi olumhlophe oluqukethe i-barium bese luqala uchungechunge lwe-X ray. Imigqa ye-barium i-esophagus nesisu, okuvumela i-radiologist ukuthi ibone okungajwayelekile emdongeni wesithombe esithombeni.
Ukugwinya kwe-barium kungasiza ekuhloleni izinkinga (izicubu ezibomvu ngaphakathi kwendawo), kepha zisetshenziselwa kancane kunesikhathi esidlule ngoba i-biopsy ayikwazi ukwenza ngesikhathi esifanayo.
I-CT Scan
Ukuskena kwe-CT (tomography yekhompuyutha) isebenzisa isigaba esinqunyiwe sama-X-ray ukudala isithombe se-3D sesitho zangaphakathi. Ngomdlavuza wokuqeda, ukuhlolwa akuvame ukusetshenziselwa njengengxenye yokuxilongwa, kodwa kubalulekile ekutheni isifo sifane. I-CT inhle ngokukhethekile ekufuneni ubufakazi bokuthi noma yikuphi ukusabalalisa (i- metastasis ) ye-tumor kuya kwe-lymph nodes noma ezinye izifunda zomzimba, njengamaphaphu noma isibindi.
I-PET Scan
Izilinganiso ze-PET ziwusizo kakhulu ekufuneni ubufakazi bokusabalalisa ngomdlavuza we-esophageal. Ukuskena kwe-PET kuhluke kwezinye izifundo zokuzicabangela ngoba zilinganisa umsebenzi wezakhi zomzimba esifundeni somzimba. Isamba esincane soshukela emsakazweni sijojelwe egazini futhi kuvunyelwe isikhathi esithathwe ngamaseli. Amaseli asebenza kakhulu, njengamaseli omdlavuza, aboniswa kakhudlwana kunezindawo ezingasebenzi ngokuzenzekelayo.
X-Ray
Ngaphezu kwezivivinyo ezingenhla zokuxilongwa nokuhlola isiteleka sokuqapha, isifo se-X-ray esifubeni sokubheka ukusakazwa emaphashini singenziwa.
Ukuhlonza okuhlukile
Kunemibandela eminingi engabangela izimpawu ezifana nezomdlavuza we-esophageal, njengobunzima bokugwinya. Ezinye zazo zihlanganisa:
- Ukulinganisa okulinganiselwe : Isibalo sinesisindo esinobuhlungu esakhiwa esiteshini esibangela ukunciphisa. Ngokuvamile kubangelwa ukuhlukumezeka, isibonelo, ngenxa yezinkinga ze-endoscopy ye- varopose varices (i-varicose veins ye-esophagus evame ukuhlotshaniswa nokudakwa ngokweqile), emva kokuba umuntu ephethe i-nasogastric tube ( NG tube ) endaweni enwetshiwe , noma ngenxa yokungena ngengozi yokuhlanza ingane njengengane.
- Umdlavuza wesisu ( umdlavuza wesisu): I-Cancer ngaphakathi kwesisu ingabangela izimpawu ezifana nezomdlavuza we-esophageal.
- Izicubu ezinomzimba (ezifana ne-leiomyoma esophageal): Iningi lezicubu zesifo (cishe amaphesenti angu-99) zinomdlavuza. Kodwa izicubu ze-Benign zingase zenzeke, futhi iningi lala yi-leiomyomas.
- I-Achalasia : I-Achalasia yisimo esingavamile lapho i-band of tishu ephakathi kwesisu esingaphansi nesisu (i-sphincter esezansi engezansi) ingaphumuli kahle, okwenza kube nzima ukudla kudlule kusukela ku-esophagus kuya esiswini.
Isiteji
Ukunquma isigaba somdlavuza kubalulekile ekukhetheni ukhetho olungcono kakhulu lwezokwelapha, kuhlanganise nokunquma ukuthi noma cha ukuhlinzwa kungakhathaliseki ukuthi kunjani. Inhlanganisela yokuhlolwa kwe-imaging nemiphumela ye-biopsy ngokuvamile isetshenziselwa ukunquma isiteji.
Odokotela basebenzisa indlela yokuguqula i- TNM ukuze bahlukanise isisu esinesisindo. Le nqubo isetshenziselwa ezinye i-cancer. Ngomdlavuza we-esophageal, noma kunjalo, odokotela bengeze incwadi eyengeziwe ku-gronym-G-kuya-akhawunti ye-tumor grade. Okushiwo yi-staging kuyinkimbinkimbi, kodwa ukufunda ngazo kungakusiza ukuthi uqonde kangcono isifo sakho.
I-T imelela isisu: Inombolo ye-T isekelwe ekujuleni kwe-lining of the esophagus lesi sifo sanda. Ingqimba elingaphakathi (eliseduzane nokudla okudlula ngaphakathi kwesisindo) yi-lamina propria. Izingxenye ezimbili ezilandelayo ziyaziwa njenge-submucosa. Ngaphandle kwalokhu kukhona i-lamina propria, futhi ekugcineni i-adventitia, ungqimba olujulile lwendawo.
- I-Tis: Lokhu kumelela i-carcinoma in situ, i-tumor efaka uhlaka oluphezulu kakhulu lwamaseli endaweni.
- I-T1: I-tumor idlulisa nge-lamina propria ne-submucosa.
- I-T2: I-tumor iye yasakazeka ku-lamina propria, kodwa ayizange ingene ngaphakathi kwe-muscle ye-esophagus.
- I-T3: I-tumor isakazeke kuma-adventitia. Manje sesifinyelele yonke indlela ngokusebenzisa imisipha ibe nezicubu ezizungezile.
- I-T4: I- T4a isho ukuthi lesi sifo sisakaze ngaphesheya kwesigcawu sokubandakanya izakhiwo ezifana ne- pleura (umgqa wamaphaphu), i-pericardium (ubhedu wenhliziyo), isifuba esinegazi, i- diaphragm , ne-peritoneum (ibhande lesisu ). I-T4b isho ukuthi i-tumor isakazeke ku-aorta, vertebrae, noma i- trachea .
I-N imele ama-lymph nodes:
- I-N0: Azikho izitho zamakhansela ezihilelekile.
- I-N1: I-tumor iye yasakazeka ku-1 noma 2 ama-lymph nodes eziseduze (zesifunda).
- I-N2: I-tumor iye yasakazeka ku-3 kuya ku-6.
- I-N3: I-tumor iye yasakazeka ku-7 noma ngaphezulu kwe-lymph nodes.
M imelela imetastasis (ukusakazeka okude) komdlavuza:
- I-M0: Ama- Metastases awakho.
- I-M1 : I-Metastases ikhona.
G imele ibanga:
- I-G1: Amaseli abukeka njengamaseli avamile (ahlukaniswe kahle).
- I-G2: Amaseli abukeka ahlukile kunamaseli avamile (ahlukene kancane)
- I-G3 : Amaseli abukeka ahluke kakhulu kumaseli enempilo (ahluke kahle).
- I-G4: Amaseli awabukeli lutho njengamaseli anempilo enempilo futhi cishe akunakwenzeka ukutshela ukuthi yiyiphi inhlangano abavela kuyo (engafanelekile).
Ukusebenzisa imiphumela ye-TNM no-G ngenhla, i-oncologists bese inikeza isiteji .
Isigaba sesi-0: Umdlavuza utholakala kuphela ngaphakathi kwamangqamuzana ahlanganisa isisindo (Tis, N0, M0). Lokhu kwaziwa nangokuthi i- carcinoma in situ .
Isigaba I: Lesi sigaba singadilizwa sibe sesiteji IA ne-IB.
- Isiteji IA: I-tumor ihlanganisa kuphela izingxenyana zangaphakathi zezicubu (T1, N0, M0, G1).
- Isigaba IB: Kunezimo ezimbili lapho isisu singaba isiteji IB. Enye ifana nesiteji IA, ngaphandle kwamaseli ajwayelekile kakhulu avela (T1, N0, M0, G2 kuya ku-G3). Ngakolunye uhlangothi, i-tumor isendaweni ephansi futhi isakaze ngaphezu kwezingxenye zokuqala zezicubu (T2 noma T3, N0, M0, G1).
Isigaba II: Ngokuya lapho umdlavuza usakazeke khona, umdlavuza wesigaba se-II uhlukaniswe waba yisigaba se-IIA nesigaba se-IIB.
- Isigaba IIA: Kunezimo ezimbili eziyisisekelo ezibandakanya isigaba se-IIA. I-tumor ingase ifake ingxenye engenhla noma ephakathi kwendawo futhi ibe yi-T2 noma i-T3 ne-G1 (kodwa i-N0 ne-M0), noma isisu singabandakanya ingxenye engezansi ye-esophagus ibe yi-T2 noma i-T3 no-G2 noma i-G3, kodwa kukhona akukho bufakazi bokubandakanya lymph node noma metastase (N0, M0).
- Isigaba IIB: Esikhathini se-IIB kunezimo ezimbili eziyisisekelo. Ngenye, lesi sifo sihilela ingxenye engenhla noma ephakathi yendawo, kodwa ngokungafani nesigaba se-IIA, amangqamuzana ahluke kakhulu (G2 noma G3). Noma, umdlavuza ungaphansi kwezingxenye zangaphakathi (T1 noma T2) kodwa usakaze kumlenze owodwa noma amabili we-lymph nodes (N1). Awekho ama-metastases.
Isigaba III: Kunezigaba ezintathu zesigaba III.
- Isigaba IIIA: Lesi sigaba sinamathuba amathathu. I-tumor ingabandakanya izingxenyana zangaphakathi zamangqamuzana namadayimine amathathu kuya kwesithupha (T1 kuya ku-T2, N2, M0, noma yikuphi u-G). Ngaphandle kwalokho, i-tumor kungenzeka isakazele ungqimba lwangaphandle lwamathishu, kodwa kuphela lymph nodes ezimbili (T3, N1, M0, noma yikuphi G). Okokugcina, lesi sifo singase sisakaze emathisini aseduzane, kodwa ayikho i-lymph nodes (T4a, N0, M0, nanoma iyiphi i-G).
- Isigaba IIIB: Umdlavuza usulele emaphethelweni angaphandle, kanye ne-lymph nodes (T3, N2, M0 noma i-G).
- Isigaba IIIC: Kunamathuba amathathu kule sigaba. I-tumor kungenzeka isakaze emathisini aseduzane, kodwa izilonda zamathambo ayisithupha noma ambalwa (T4a, N1 noma i-N2, M0, noma yiliphi i-G). Noma, i-tumor isakaze emathiseni aseduze njenge-aorta, umzimba we-vertebral, noma i-trachea, kangangokuthi ayikwazi ukususwa ngokuhlinzwa (T4b, noma yimuphi u-N, M0, noma yikuphi u-G). Okokugcina, lesi sifo sesifinyelele kuma-lymph nodes ayisikhombisa noma ngaphezulu, kodwa hhayi ezindaweni ezikude zomzimba (noma yimaphi ama-T, N3, M0, noma yi-G).
Isigaba IV: Isiqhumane sisakaze esifundeni esikude somzimba (noma yimuphi u-T, noma yikuphi u-N, M1, noma yikuphi u-G).
Ukuhlola
Izivivinyo zokuhlola i-cancer yizo ezenziwa kubantu abangenazo izimpawu zesifo. (Uma izibonakaliso zikhona, izivivinyo zokuxilonga zenziwa.) Njengamanje, akukho ukuhlolwa kokuhlolwa kwesifo somdlavuza osindayo esitholakalayo emphakathini jikelele.
Njengoba ingozi yomdlavuza we-esophageal iphakanyisiwe kubantu abane-Barrett's emophagus, abanye odokotela baye batusa ukuhlolwa kwesikhashana nge-endoscopy. Umcabango walokhu wukuthi ukuthola i-dysplasia (amangqamuzana angavamile), ikakhulukazi ekubambeni amacala ahlukumezayo ekuqaleni, angavumela ukwelashwa ukususa amaseli angavamile esigabeni esinqunyiwe.
Lokho kuthi, kuze kube manje, akukho bufakazi obuncane bokuthi ukuhlolwa lokhu kunciphisa izinga lokufa kusuka emdlalweni we-esophageal. Ngesikhathi esifanayo, ukuhlola kungabangela ukulimala, njengokuphuma kwegazi, i-perforation ye-esophageal, noma ezinye izinkinga. Kukhona ithemba lokuthi ikusasa lizoletha ubufakazi obuzosiza ukuthi kunqunywe ukuthi ukuhlolwa kwabantu abengozi kakhulu.
> Imithombo:
> Society of American of Clinical Oncology. I-Esophageal Cancer: Ukuxilongwa. Kubuyekezwe i-12/2016.
> Bast, R., Croce, C., Hait, W. et al. Holland-Frei Cancer Medicine. UWiley Blackwell, ngo-2017.
> National Cancer Institute. I-Esophageal Cancer Screening (PDQ) -Health Professional Version. Kubuyekezwe 04/06/18.
> Ilayisi, T., Patil, D., Blackstone, E. et al. Ukukhishwa kwe-8 I-AJCC / I-UICC Ukumiswa Kwemikhakha Ye-Esophagus and Esophagogastric Junction: Isicelo Sokusebenza Kwemitholampilo. Ama-Annal of Surgery Cardiothoracic . 2017. 6 (2): 119-130.