Njengoba uhlola ukuhlolwa kwakho, ukuqhubeka phambili nokwelashwa kubalulekile ekuthuthukiseni impilo yakho nokuthola impilo yakho. Uhlelo lomuthi lomdlavuza lomdlavuza womuntu wesibindi luzoxhomekeka eziningana zezici, ikakhulukazi isiteleka somdlavuza (ukuthi usakaze kangakanani) kanye nesigaba somdlavuza (indlela engavamile ngayo amangqamuzana omdlavuza).
Ukuhlinzwa
Ake siqale ngokuxoxa ngezinketho zenqubo yokwelashwa komdlavuza wesisu.
Isisindo sokuthola isifo se-Transurethral Isisu (TURBT)
Isinyathelo sokuqala ekwelapheni umdlavuza wesibeletho esingenayo imisipha-okusho ukuthi i-tumor iqukethe ngaphakathi kwesinye isisu futhi ayifinyelelanga ungqimba lwayo lwesisindo obukhulu-luhlobo lohlinzekwa olubizwa ngokuthi i-transurethral resection tumor swelling chest, noma i-TURBT. Le nqubo isusa isisu kusuka kwesinye.
Ngesikhathi se-TURBT, i- urologist ibeka ithuluzi eliqinile, elincanyana elinokukhanya nekhamera kuwo (resectoscope) ngokusebenzisa i-urethra yomuntu esesiswini sakhe. I-resectoscope iqukethe i-wire loop evumela udokotela ukuba asuse lesi sifo.
Le nqubo ivame ukuqhutshwa ekamelweni lokusebenza futhi ngezinye izikhathi i-TURBT yesibili idinga amasonto adingekayo ngemuva kokuqala ukuqinisekisa ukuthi ayikho isidumbu esiphuthelwe. Izindaba ezinhle ukuthi abantu abaningi bangaya ekhaya ngosuku olufanayo noma ngosuku olulandelayo. Futhi, imiphumela emibi, njengokuphuma kwegazi noma ukungakhululeki lapho uchama, ngokuvamile iphila isikhathi esifushane futhi imnene.
I-Cystectomy enamandla
Ukwelashwa okujwayelekile komdlavuza wesisu womzimba wesisindo-okusho ukuthi i-tumor ayifakiwe futhi ingena emgqeni we-muscular thickness-is a operation ebizwa ngokuthi i-cystectomy enkulu. Le nqubo ihlanganisa ukukhipha izitho zangasese nezizungezile- isicathulo kanye nama -vesicles emiswini emadodeni; isisu, umlomo wesibeletho, amashubhu ama-fallopian, ama-ovaries, kanye nengxenyeni engenhla yowesifazane ngaphakathi kwabesifazane .
Ngesinye isikhathi i-cystectomy enkulu kakhulu ekhuthazwa umdlavuza wesisu ongakaze uhlasele umcabisho wesisu kodwa unezinye izici ezibuhlungu, ezinobudlova. Kubuye kuphakanyiswe ngokujwayelekile kubantu abanomdlavuza wesibindi ongapheli noma wamasosha ongapheliyo ngemuva kokuthola ukwelashwa nge-intravesical immunotherapy (bheka ngezansi).
Ukususwa kwe-Urinary nokuvuselelwa kabusha
Ngemuva kokuthi isisu sisusiwe, udokotela ohlinzayo kumele ahlele indawo entsha yomchamo ukuze igcinwe. Kunezinketho ezimbalwa okufanele uzicabangele:
- Isibilini esisha singadalwa kusukela emathunjini omuntu (i-neobladder) exhunyiwe ku-urethra yomuntu ukuze ikwazi ukuvuthwa njengangaphambili.
- Isikhwama singadalwa ngaphakathi emzimbeni besebenzisa izicubu kusuka esiswini noma emathunjini. Ukuphela komunye kuxhunywe ku-ureters kanti omunye kuya ekuvukeni esikhumbeni edongeni lomzimba (stoma). I-catheter ingasetshenziselwa ukuchitha umchamo ngokusebenzisa i-stoma emini, kodwa isikhwama sigcina umchamo, njengesivinya.
- Esikhundleni sekhanda, isilwane samathumbu sixhunywe kumagundane. Ngalolu hlobo lokuhlinzeka, umchamo ugeleza kusuka ezinsweni kuya ezigumbini ngokusebenzisa ucezu lwamathumbu kuze kube se-stoma. Ekugcineni, liwela esikhwameni seqoqo elincane elingaphandle komzimba.
Izingozi Ezenzekayo Zokuhlinzwa
I-cystectomy enkulu futhi ekwakheni isirasha esisha noma isikhwama esikhombisa ukuhlinzwa okuyinkimbinkimbi. Ngamanye amazwi, kuyinto enkulu. Ngakho-ke, kubalulekile ukuthi uqonde zonke izingozi nezinzuzo ezihilelekile-okuhle nokubi, okushoyo.
Ngalokho, amathuba okuba nezinkinga zokuhlinzwa ancike ezintweni eziningana, njengokuhlangenwe nakho kohlinzayo, iminyaka yesiguli, nokuthi ngabe isiguli sinezinkinga zezokwelapha ezisemqoka. Noma kunjalo, izibonelo zezinkinga zokuhlinzwa ezingase zibe khona zihlanganisa:
- Ukuphuza
- Ukutheleleka
- Ukweqa igazi emaphashini
Enye inkinga yokubhekana nodokotela wakho ohlinzayo kungabangela imiphumela emibi yezocansi, njengokungasebenzi kahle kwe-erectile noma ukuvusa ucansi, nokuthi ungayibhekana kanjani nayo.
I-Chemotherapy Ngaphambi Kokuhlinzwa
Uma umuntu enempilo ngokwanele, uzophinde athole i- chemotherapy ngaphambi kokuhlinzwa ukuze athuthukise amathuba akhe okusinda. Inhloso ye-chemotherapy ukubulala amangqamuzana omdlavuza emzimbeni kodwa angabonakali.
Imithi emibili ejwayelekile ye-chemotherapy esetshenziselwa ukuhlinzwa ngaphambi kokuhlinzwa kwamagciwane e-isrothelial yesinye isifo:
- I-MVAC (methotrexate, i-vinblastine, i-doxorubicin, ne-cisplatin)
- I-GC (i-cisplatin ne-gemcitabine)
I-oncologist yakho, noma udokotela wesifo somdlavuza, uzophatha lezi zithimikhali emjikelezweni. Lokhu kusho, ukuthi emva kokwelashwa ngalunye, uzophumula futhi uhlolwe nganoma yimiphi imiphumela emibi emibi. Izibonelo zemiphumela emibi engase ibonwe nemigomo engenhla ifaka:
- Ukukhathala
- Ingozi eyengeziwe yokutheleleka
- Ukuphuza noma ukulimaza kalula
- Ukulahlekelwa izinwele
- Izilonda zomlomo
- I-nausea nokuhlanza
- Ukuzwa ukulahlekelwa
- Ubumbulu nokukhawula ezandleni noma ezinyaweni
- Igazi emcimbini
Umjikelezo ngamunye uhlala amasonto ambalwa futhi, ngokuvamile, imijikelezo emithathu kunconywa ngaphambi kokuhlinzwa kwesisu.
Ukwelapha Okungenayo
Ngisho noma izinga lokusinda lithandekayo kubantu abanomdlavuza we-vestiva ongenawo umzimba, izimpikiswano ezimbili ezibalulekile odokotela ngisho nangemva kokuba isisu sisusiwe yizi:
- Ukuphindaphinda (umdlavuza ubuya)
- Ukuqhubekela phambili (umdlavuza usakazeka emzimbeni noma emzimbeni)
Ngakho-ke, ake sibheke izinketho zokwelashwa okungezona ukuhlinzwa.
I-intravesical Chemotherapy
Lezi zizathu ezimbili ezingenhla yingakho iziguli eziningi zithola ukwelashwa okungeziwe emva kokususwa kwesisu ngokungenelela okuthiwa i-intravesical chemotherapy. Ngaloluhlobo lwama-treatment, imithi ilawulwa ngokuqondile emgodleni ngokusebenzisa i-catheter. Inhloso ye-chemotherapy ukubhubhisa noma yikuphi okusalayo, amangqamuzana omdlavuza angabonakali.
Kuncike engozini yomuntu yokuphindaphinda umdlavuza wesibeletho (okuyinto udokotela ahlola njengephansi, ephakathi, noma ephezulu), uzothola umthamo owodwa ngesikhathi sokuqala kwe-TURBT noma amanani amaningi esikhathini esingamaviki ayisithupha i-intravesical chemotherapy.
I-Mitomycin ngokuvamile i-chemotherapy yokuzikhethela ephathwayo. Kungabangela ukushisa kwesinye isisu kanye nokuvuthwa okuvamile kanye / noma okubuhlungu.
I-Intravesical Immunotherapy
Ngezinye izikhathi, esikhundleni se-chemotherapy ye-intravesical, umuntu uzothola i-immunotherapy immravesical ebizwa ngokuthi iBillus Calmette-Guerin (BCG). Lolu hlobo lwe-thérapie lubangela isimiso somzimba sokuzivikela somuntu ukubulala amangqamuzana omdlavuza.
Kuyathakazelisa ukuqaphela ukuthi i-Bacillus Calmette-Guerin (BCG) yaqala ukuthuthukiswa njengomuthi wokugoma kwesifo sofuba. Kodwa, ngawo-1970 nangama-1980, kwafunyanwa ukubulala amangqamuzana omdlavuza wesisu.
Ngenkathi iphumelela kakhulu, i-intravesical BCG ingabangela imiphumela emibi kuze kube yizinsuku ezimbili ezingabandakanya:
- I-fever, ama-chills, nama-body aches
- Ukukhathala
- Ukuvuthwa ngokweqile
- Igazi emcimbini
- Ubuhlungu lapho uchama
- Ukuvutha ngaphakathi kwesikhumba
Ngokuvamile, i-BCG ingasakazeka emzimbeni. Lokhu kungabangela ukutheleleka komzimba wonke, okungase kubonakaliswe umkhuhlane okwenzeka izinsuku ezingaphezu kwezinsuku ezimbili noma umkhuhlane ongaphuculanga ngemithi. Ukutheleleka komzimba wonke kuyisimo esiphuthumayo sezokwelapha futhi sidinga ukwelashwa ngokushesha.
Ukulondolozwa kwesibindi
Naphezu kwe-cystectomy eqinile njengokwelashwa okujwayelekile komdlavuza wesisu wesifo sofuba, ngezinye izikhathi umuntu onomdlavuza wesifo sofuba angenaso isisu sabo sonke. Esikhundleni salokho, bangase basuswe ngokwengxenye kwesikhumba sabo noma i-TURBT eyengeziwe. Njenganoma yiluphi uhlobo lwezokwelapha, kulezi zimo ezihlukile, izingozi nezinzuzo kudingeka zihlaziywe ngokucophelela.
I-Radiation Therapy
Ukwelashwa kwezidakamizwa, okuhlinzekwa yi-oncologist yemisebe, ngokuvamile kuhlanganiswa ne-chemotherapy kanye ne-TURBT emiphakathini yokulondoloza isisu, njengoba kungabhekwa njengendlela yokwelapha yodwa eyaneleyo. I-radiation ibulala amangqamuzana omdlavuza kanye nezikhathi zokwelashwa ngokuvamile zihlala izinsuku ezinhlanu ngesonto amasonto amaningana.
Ukuqapha Ngemva Kwokwelashwa
Cishe ngemva kwezinyanga ezintathu ukwelashwa nge-intravesical therapy (futhi ngezikhathi ezithile emva kwalokho), udokotela uzokwenza i- cystoscopy ukuqinisekisa ukuthi ayikho imdlavuza yomdlavuza wesibeletho. Ukuze iziguli eziphakathi kakhulu zibe yingozi, ukuguqulwa kwamagciwane ukuhlola amangqamuzana omdlavuza kanye nokucabangela kwe-upper tract urinary (ie CT scan) kuzophinde kwenziwe njalo ngezikhathi ezithile njengendlela yokuqhubeka yokuqapha.
Uma indawo esolisayo yesambatho ibonakala, izokwenziwa futhi ikhishwe nge-TURBT. Uma umdlavuza ubuye waphindela emuva, umuntu uyovama ukwelashwa okungaphezulu kwe-intravesical noma abe nesisu sakhe esuswe ngokuhlinzeka nge-cystectomy.
Uma kungekho bufakazi bokuphindaphindiwe, umuntu angathola ukwelashwa kwesondlo nge-BCG ukuze aqhubeke nokuvimbela noma yisiphi isifo somdlavuza. Isikhathi sokwelashwa kwesondlo (isibonelo, ngonyaka owodwa kuya kweminyaka emithathu) kuncike engozini yomuntu, ehlolwe yiqembu lakhe lomdlavuza.
I-Metastatic Cancer Cancer
Ngomdlavuza wesisu oye wasakazeka kwezinye izingxenye zomzimba, njengezitho zamagciwane noma ezinye izitho (amaphaphu, isibindi, kanye / noma amathambo), i-chemotherapy ingaba yindlela yokunciphisa ukukhula komdlavuza. Ucwaningo olwenziwe nge-immunotherapy lomdlavuza ophezulu wesisu luphenywayo okwamanje.
Ngezinye izikhathi, ukunikezwa kwemisebe noma ukuhlinzwa (i-TURBT noma i-cystectomy) kwenziwa kumuntu onomdlavuza we-metastatic yesinye, nayo. Kubalulekile ukuqonda ukuthi lezi zindlela zokwelashwa zenziwa njengendlela yokunakekelwa ngokucophelela-indlela yokunciphisa izimpawu eziphazamisayo ezihlobene nomdlavuza.
Lokho kusho, uma kwenzeka umdlavuza we-metastatic isifo somdlavuza wesibindi, kubalulekile ukuhlala njalo ubheke ukuthi ngabe ukwelashwa okuhlukahlukene kuphazamisa ngaphezu kokuthuthukisa izinga lakho lokuphila. Kulesi sibonelo, yazi ukuthi kulungile ukuthumela imicabango yakho kumndeni wakho naku- oncologist .
Ngamanye amazwi, isikhathi esincane esifushane singase sigcwalise kakhulu kunesikhathi eside sokwelashwa okungakhululekile. Lokhu, yiqiniso, isinqumo esiyingqayizivele somuntu siqu nesingqayizivele.
> Imithombo:
> Abt D, Bywater M, Engeler DS, Schmid HP. Izinketho zokwelapha ze-hematuria ezingenakunqanda emdlalweni ophezulu wekhanda. Int J Urol. 2013 Jul; 20 (7): 651-60.
> I-American Cancer Society. Ngenyanga ka-2016. Ukwelapha I-Cancer Cancer.
> Babjuk et al. Imihlahlandlela ye-EAU nge-non-muscle-invasive urothelial carcinoma yesibindi: Buyekeza 2016. Eur Urol. 2017 Mar; 71 (3): 447-61.
> Chang et al. Ukuxilongwa nokwelashwa komdlavuza wesibeletho esingenayo imisipha: Isiqondiso se-AUA / SUO. J Urol. 2016 Okthoba; 196 (4): 1021-9.
> Stephenson AJ. Disemba 2016. Sibutsetelo endleleni yokuqala kanye nokuphathwa komdlavuza wesibeletho. Ku: UpToDate, uLerner SP, Ross ME (Eds), UpToDate, Waltham, MA.