Umdlavuza wezinso (i-renal cell carcinoma) uvame ukutholakala usebenzisa inhlanganisela ye-ultrasound, i-CT, ne-MRI, kanye nomlando oqaphile, ukuhlola ngokomzimba, ukuhlolwa kwegazi, nokuhlolwa kwamanzi. Uma sekutholakala umdlavuza, i-tumor kudingeka ihlelwe ngokucophelela ukuze inqume ukwelashwa okufanele kakhulu.
Ukubhekana nenqubo yokuxilonga kuvame ukucindezeleka-ungase uzwe ukwesaba nokukhathazeka.
Ukwazi ukuthi yini ongayilindela nokuthi ungabhekana kanjani nesikhathi sokulinda nemiphumela kungasiza ekunciphiseni imizwa ethile.
Ukuhlola ukuhlola nokuhlola kwekhaya
Umdlavuza wezinso awukwazi ukutholakala ekhaya, kodwa njengoba kungakabi khona ukuhlolwa kokuhlolwa okwamanje, ukuqaphela izibonakaliso nezifo zesifo kungukuthi wonke umuntu angayenza.
Ngokuyinhloko, uma uqaphele ukuthi unegazi emcinini wakho (noma yiliphi inani), ubuhlungu beflewu, umthamo womzimba, uzizwa ukhathele noma ulahlekelwe isifiso sakho, noma ulahlekelwe isisindo ngaphandle kokuzama, qiniseka ukuthi ubona udokotela wakho.
Ama-Labs nezivivinyo
Ukuhlolwa komdlavuza wezinso kuvame ukuqala ngomlando oqaphileyo, ukubuka izici eziyingozi zaleso sifo, ukuhlolwa ngokomzimba, nokuhlolwa kwebhola.
Ukuhlolwa Kwemvelo
Ukuhlolwa komzimba kwenziwa ngokukhethekile ngokubhekisisa isisindo esiswini, emgodini, noma emuva, kanye nokuhlola ukucindezeleka kwegazi. Izinso zidlala indima ebalulekile ekulawuleni ukucindezeleka kwegazi, kanti izicubu zingabangela ukucindezela kwegazi okuqhubekayo okuvame ukuphakama ngokweqile (ukucindezeleka okubi kakhulu).
Ukuhlolwa kuhlanganisa nokuhlaziywa kwama-genitalia kubantu besilisa. Umdlavuza wezinso uhlukile ngoba kungabangela i-varicocele, i-vein evulekile (varicose vein) ku-scrotum noma i-testicle. Ngokungafani nezimbangela eziningi ze-varicocele, lezo ezibangelwa umdlavuza wezinso azihambi uma umuntu elala (ethatha isikhundla se-supine).
Izivivinyo ze-Lab
Umsebenzi wokuthola ukuhlolwa komdlavuza wezinso ngokuvamile uqala nge- urinalysis , ukuhlolwa okwenziwe hhayi kuphela ukufuna igazi emcinini wakho, kodwa izimpawu zokutheleleka, amaprotheni, nokuningi. Cishe ingxenye yabantu abanomdlavuza wezinso bazoba negazi elithile emcinini wabo.
Inani eliphelele legazi (i-CBC) luhlolo olubalulekile, njengoba i- anemia (isibalo esiphansi se-cell cell) njengamanje isibonakaliso esivamile kakhulu sesifo. Izivivinyo zomsebenzi wezinso zibalulekile, nakuba lezi zingase zijwayelekile.
Umdlavuza wezinso nawo uhlukile ngoba ungabangela ukuphakama kokuhlolwa kwesibindi, ngisho nangomdlavuza osakaze esibindi. Lesi sibonakaliso singenye yezimpawu ze- paraneoplastic ezingase zenzeke uma la maseli omzimba ehlanganisa izinto noma ama-hormone. Izimpawu ze-paraneoplastic zingase zihlanganise nezinga eliphakeme le-calcium egazini ( hypercalcemia ), nakuba lokhu kungase kwenzeke lapho umdlavuza usakazeka emathanjeni.
Ukucabanga
Izindlela eziningi ezahlukene zokucabanga zengqondo zingase zisetshenziselwe kokubili ukuxilongwa kanye nesiteleka somdlavuza wezinso.
I-Ultrasound
I-Ultrasound isebenzisa amagagasi omsindo ukunikeza isithombe kwezakhiwo esiswini. Ngokuvamile ukuhlolwa kokuqala kwenziwa futhi kusiza ngokukhethekile ukuhlukanisa ama-cysts alula (ahlale eshaya njalo), avela emathunjini aqinile noma amathumba aqinile ngezingxenye ze-cystic.
I-CT Scan
Izikrini ze-CT zisebenzisa uchungechunge lwe-x-ray ukuze unikeze isithombe esithintekayo sesifunda somzimba njengezinso. Ngaphezu kokuchaza umdlavuza wezinso, i-CT scan inganikeza ulwazi olubalulekile lokuhlola ngokuhlola ukuthi ngabe kubonakala sengathi umdlavuza usakazeke ngaphandle kwezinso noma ku-lymph nodes.
I-scan ye-CT ivame ukuqala kuqala ngaphandle kokuphambene, bese ihamba ngombala we-radiocontrast. Idayi ngezinye izikhathi ingabangela ukukhathazeka ngabantu abanezinkinga zokushaya izinso, lapho kwenzeka ukuhlolwa okuhlukile kwesithombe kungasetshenziswa.
I-CT yilezi zivivinyo ezinhle kakhulu zokuhlukanisa izifo ze-kidney kodwa ngokuvamile azikwazi ukuthola ukuthi umdlavuza usakaze yini emthanjeni we-renal, umvuthwandaba omkhulu ophuma ezinso ezihambisana ne-inferior vena cava (umvuthwandaba omkhulu oletha igazi emzimbeni ongaphansi enhliziyweni).
I-MRI Scan
I- scan ye-MRI isebenzisa ukucabanga kwe-magnetic kunokuba ubuchwepheshe be-x-ray ukudala isithombe sezakhiwo esiswini. Kulokusiza ngokukhethekile ukuchaza "izicubu ezithambile" ezingavamile. Ngokuvamile, i-CT scan iyilingo elingcono lokuhlola umdlavuza wezinso, kodwa i-MRI ingadingeka kulabo abanesimo sokusebenza okungavamile kwezinso noma abanomdlavuza wokuqhathanisa idayi.
I-MRI ingacatshangelwa ukuthi uma umdlavuza wezinso kucatshangwa ukuthi usakaze emgodini we-renal kanye ne-inferior vena cava, njengoba izinqubo ezikhethekile kungadingeka ngesikhathi sokuhlinzwa. I-MRI ayikwazi ukusetshenziselwa abantu abanesisindo emzimbeni wabo, njenge-pacemaker, shrapnel, noma izingcezu zezinhlamvu, njengoba amakhompi aqinile angaholela ekuhambeni kwalezi zinto.
I-MRI yobuchopho ingenziwa ukuze ifune ubufakazi bokuthi isifo somdlavuza sisakazeka ebuchosheni, indawo yesithathu evame kakhulu lapho umdlavuza wezinso usakazeka khona.
I-PET Scan
Ukuhlolwa kwe-PET kusetshenziselwa njalo ekuhloleni kwesifo somdlavuza, kodwa kancane kakhulu lapho kutholakala umdlavuza wezinso. Ngesikhathi isithwebuli se-PET, isamba esincane soshukela olushukela emzimbeni lujojelwa emzimbeni kanye nemifanekiso (ngokuvamile ihlangene ne-CT) ithathwa ngemuva kokuba ushukela linesikhathi sokubanjwa.
Ngokungafani ne-CT ne-MRI, kubhekwa njengesivivinyo sokusebenza esikhundleni sokuhlolwa kwesakhiwo futhi kungasiza ekuhlukaniseni izindawo zokukhula kwe-tumor ezivela ezindaweni ezifana nezicubu ezinzima.
I-Pyelogram ye-Intravenous (IVP)
I-IVP yisifo lapho idayi ijojelwa khona. Izinso zithatha le dye, zivumela ama-radiologists ukuthi abheke izinso, ikakhulukazi i-renal pelvis.
I-IVPs yenziwa njalo lapho isifo somdlavuza wezinso kodwa singasetshenziselwa i-urothelial cell cancers (amathrekhi esitokisini esesiguli njengama-cancers yesigqila nesiguli kunokuba ngezinye izikhathi angafaka ingxenye engaphakathi yezinso, i-renal pelvis).
I-Renal Angiography
I-Angiography ivame ukuhlanganiswa ne-CT scan futhi ihlanganisa ukujoya idayi emgodini we-renal ukuchaza imithwalo yegazi yezinso. Lokhu kuhlolwa ngezinye izikhathi kusetshenziselwa ukusiza ukuhlela ukuhlinzeka ngesisu.
I-Cystoscopy ne-Nephro-Ureteroscopy
Lezi zivivinyo zazibandakanya ukufaka i-catheter ekhanyayo emgodleni, ngokusebenzisa i-ureter, kuze kube se-renal pelvis ("isikhungo" sezinso). Isetshenziswa ngokuyinhloko uma kunesisindo esiswini noma isilonda, njenge-transitional cell carcinoma.
I-Biopsy
Nakuba i-biopsy ibalulekile ekuhloleni ama-cancer amaningi, ngokuvamile akudingekile ukuxilongwa komdlavuza wezinso. Ngaphezu kwalokho, kunengozi nge-biopsies enhle ye-sindle (i-biopsies eyenziwe ngenaliti encane efakwe esikhumbeni nasezinsweni) ukuthi inqubo "ingaba" inhlamba (isakaze isisu kuphela yindlela yensilinga).
Ama-samples of tumor abalulekile ekuhleleni ukwelashwa, njengezinqubo ezithintekayo, kepha ngokuvamile atholakala ngesikhathi sokuhlinzwa kunokuba kube ne-biopsy.
Uvivinyo lweMetastases
Umdlavuza wezinso ungasakaza noma ngegazi noma nge-lymphatic vessels, futhi amasayithi ajwayelekile kakhulu we-metastase amaphaphu, amathambo nobuchopho, ngaleyo ndlela. I-x-ray yesifuba (noma isifuba CT) ingenziwa ukuze ifune amaphesenti amaphaphu .
Noma ukuskena kwamathambo noma ukuhlolwa kwe- PET kunganquma ukuthi kukhona yini i-metastases yethambo. I-MRI yobuchopho yilona uvivinyo oluhle lokubheka ubuchopho be-brain.
Ukuhlonza okuhlukile
Ngokungafani namakondomu amaningi, kunezimbangela ezimbalwa zobuningi ezintsheni. Kodwa-ke, ukuxilongwa kokuhlukana kungaba nzima nakakhulu uma isisindo esincane sitholakala ezinso, ngokuvamile lapho kwenzeka ukuhlolwa kwesinye isizathu.
Ezinye izimbangela ezibangelwa ubukhulu bezintambo zihlanganisa:
- Ama-cysts ama-renal (izinso): Ama- cysts angavame ukuhlukaniswa nge-ultrasound futhi ngokuvamile atholakala ngesifo sezinso ze-polycystic .
- Ama-Angiomyolipomas: I-angiomyolipoma ingahlukaniswa nomdlavuza wezinso ngenkathi i-CT scan (ngenxa yobuningi bamafutha). Lezi yizicubu ezinobuthi.
- Ama-oncocytomas: I- Oncocytomas nayo ivame ukuhlukaniswa ngokususelwa ekutholeni kwe-CT. Lezi zicubu ezinomzimba ngezinye izikhathi zilinganisa umdlavuza wezinso emiphumeleni ye-imaging.
- I-adenomas enamahloni: Lezi yizicubu ezinobungozi ezivame ukutholakala okungaqondakali ekuhloleni izithombe.
- Amagciwane angasetshenziselwa ukwelapha ( amasondo omzimba wesiguli, isifo sezinyosi, futhi ngezinye izikhathi udlame lwe-renal): Lezi zomshukela zakha cishe amaphesenti angu-15 ezinqamule zezinso futhi ngokuvamile zikhona phakathi kwezinso futhi zibandakanya uhlelo lokuqoqa. Amaseli e-Cancer angaba khona ku-urinalysis.
- Izicubu ezinzima: Ama-gland ase-adrenal ahlala phezulu kwezinso futhi ngokuvamile angahlukaniswa ngemifanekiso. Izifo ezivame kakhulu ezidalwa yi- adrenal tumoral are metastases eziyingozi kusuka kumdlavuza njengomdlavuza wamaphaphu.
- I-abscess ye-Renal: I-abscess iyinkila yokutheleleka.
- I-metastases yezinso: Izinhlobo eziningi zomdlavuza zingasakazeka ezinso. Lokhu kuvame ukubangela izindawo ezimbalwa ezincane kune-tumor enkulu. Amanqamu angase asakaze ezintsheni ahlanganisa umdlavuza wamaphaphu, umdlavuza webele, umdlavuza wesisu, i-melanoma, kanye ne-khansa yezinye izinso.
- I-lodphokin ye-Hodgkin kanye ne-non-Hodgkin's lymphoma: Kokubili lokhu okuhlobene negazi kungase kubandakanye nezinso, kepha kuvame ukuhlotshaniswa nezicubu (nakwezinye izingxenye zomzimba) nakwezinye izingxenye zomzimba.
- I-renal ehlukumezayo: I-infarct ibhekisela ekuntulekeni kwegazi. Lokhu kufana nokuhlaselwa kwenhliziyo kwezinso, futhi izicubu ezifile (izicubu zesisu) ngezinye izikhathi zingabonakala njengezinqwaba ezithombeni.
- I-Sarcomas: Lezi zingqimba ezingavamile eziqala emathanjeni athambile ajikelezayo izinso.
Ukuphazamisa umdlavuza wezinso
Ukugxilisa umdlavuza wezinso kuvame ukwenziwa ngemuva kokuhlinzwa futhi kuhlanganisa imiphumela yokuhlolwa kwe-imaging kanye nezici ze-tumor ezithunyelwa ku-pathology ngemuva kokuhlinzwa, kanye nokuthola ngesikhathi sokuhlinzwa.
I-Tumor Grade
Amagciwane ekhanda anikezwa ibanga loku-1 kuya ku-4, elibizwa ngebanga le-Fuhrman, okuyisilinganiso sokuhlukumeza kwesisu.
I-grade 1 isetshenziselwa ukuchaza izicubu ezincane kakhulu futhi zibe namaseli ahluke kakhulu (bheka okufana namaseli avamile wezinso). Ngokuphambene nalokho, ibanga lesi-4 linikezwa ukuchaza izimbala ezibonakala zihlukumeza kakhulu, lezo ezingabonakali kakhulu futhi zibukeka zihluke kakhulu kumaseli ajwayelekile ezinso.
I-TNM Isiteji
Izifo zezinso nazo zihlolwe besebenzisa into ebizwa ngokuthi uhlelo lwe-TNM. Lokhu kungadideka ekuqaleni kodwa kulula ukuyiqonda uma sichaza lezi zincwadi nokuthi izinombolo zisho ukuthini.
- T imelela isisu. Izinombolo ezilandelayo T zikhombisa ubukhulu besisu. Izicubu ze-T1 zingaphansi kuka-7 cm ububanzi. Izicubu ze-T2 ziyi-7 ukuya ku-10 cm ububanzi. Izitholampilo ze-T3 sezikhulile ngaphesheya kwezinso noma zingene emthanjeni, kodwa zingena ezigulini ezingaphezu kwe-adrenal noma ngaphezulu kwe-fascia ye-fascia (ubuningi bezincubu ezizungeze izinso). Izifo ze-T4 sezikhulile ngaphesheya kwe-Gerota's or fasrenal gland.
- N imelela izinombolo. Incazelo ye-N0 ingasho ukuthi umdlavuza awusakazeki kunoma iyiphi i-lymph nodes. I-N1 ingasho ukuthi umdlavuza usakazelele kuma-lymph nodes eduzane.
- I-M imelela ama-metastase futhi i-0 noma i-1 kuye ngokuthi imilashini ikhona yini (ngabe umdlavuza usakaze emaphashini, amathambo, ubuchopho, noma ezinye izifunda). I-M0 isho ukuthi akukho metastases ekhona. I-M1 isho ukuthi i-metastases ikhona.
I-Tx (noma i-Nx noma i-Mx) isho ukuthi i-tumor (noma ama-nodes noma ama-metastases) ayikwazi ukuhlolwa. I-T0 isho ukuthi akukho bufakazi besisu esiyisisekelo futhi sisetshenzisiwe uma i-metastases yezinso itholakele, kodwa isisu esiyisisekelo asikwazi ukutholakala.
Izigaba
Ukusebenzisa izinhlamvu ezingenhla, izifo ze-isondo zihlukaniswe zibe yizigaba ezine:
- Isigaba sokuqala: Amagciwane wezinso ze-Stage 1 (T1, N0, M0) angaphansi kuka-7 cm ububanzi futhi atholakala ezinso (azange zisakaze kuma-lymph nodes noma ezinye izici zomzimba).
- Isigaba sesi-2: Kulesi sigaba (esichazwa njenge-T2, N0, M0) umdlavuza ungase ube mkhulu kunama-7 cm ububanzi noma usakaze emthonjeni omkhulu oseduze njengemvini ye-renal noma ngaphansi kwe-vena cava. Kodwa-ke, ayihambanga nanoma yiziphi izilonda ze-lymph, izigulane eziyingozi, i-Gercia's fascia, noma izindawo ezikude.
- Isigaba sesi-3: Izicubu zesigaba sesi-3 (okungaba yi-T1 noma i-T2, N1, i-M0, noma i-T3, nanoma iyiphi i-N, M0) ingaba yisayizi kodwa ayizange isakaze ngaphezu kwe-Gerota. Lesi sigaba sihlanganisa nezicubu ezingakaze zikhule ngaphesheya kwezinso, kodwa zisakaze emaphethini angama-lymph eseduze.
- Isigaba 4: Isigaba 4 sichazwa ngezindlela ezimbili eziyinhloko. Ngesinye isilungiselelo, lesi sifo singase sisakaze ngaphezu kwe-Gerota's fascia nakuma-lymph nodes eseduze, kodwa hhayi kwezinye izifunda zomzimba. Noma kungenzeka ukuthi kunoma yisiphi isayizi, isakaze kunoma iyiphi i-nodes, futhi isakaze kwezinye izifunda zomzimba (Noma yikuphi T, Noma yikuphi, M1).
I-Cancer ejwayelekile ejwayelekile
Umdlavuza wezinso ovame ukubhekisela kunoma imuphi umdlavuza obuyele emuva, kungakhathaliseki ukuthi usezinso, ezinhlotsheni ezizungezile, ezinkundleni zamakhemikhali noma ezindaweni ezikude.
Zonke izivivinyo zokuxilongwa ezenziweyo zizosiza udokotela wakho ngokunembile ahlele isisu sakho. Ngokusekelwe emiphumeleni, uzokwazi kangcono ukukhetha ukwelashwa okuhambisana nesimo sakho.
> Imithombo:
> Society of American of Clinical Oncology. I-Cancer.Net. I-Cancer Cancer: Ukuxilongwa. Kubuyekeziwe ngo-08/17. https://www.cancer.net/cancer-types/kidney-cancer/diagnosis
> Lara, Primo N., no-Eric Jonasch. Izimiso Nezenzo Zomdlavuza Wezinso. I-Springer International Publishing, 2015.
> Pieroazio, P., noSampbell. Indlela Yokuxilonga, Ukuhlonza Okuhlukile, Nokuphathwa KweMisa Eliyingqayizivele. UpToDate . Kubuyekezwe 03/02/18.