Izinkombandlela Zemitholampilo Yokunakekelwa Kwekhanda Elikhulu neNeck Cancer
Ukusetshenziswa kwedatha ukushayela izinqumo ezibalulekile kuveze i-leitmotif phakathi nekhulu lama-21. Umkhuba wezokwelapha awufani futhi uncike ekutheni; ngokufanele, ukwelashwa kufanele kuqondiswe ubufakazi hhayi ngengozi, intuition noma ukubona nje. Izinhlangano eziningana zihlanganyela ekuthuthukiseni imihlahlandlela yomtholampilo esekelwe ebufakazini, kufaka phakathi uhlelo lweScottle Intercollegiate Guidelines Network (SIGN).
Ngokwe-website yeSIGN:
"Imikhombandlela ye-SIGN itholakala ekubuyekezweni okuhlelekile kwezincwadi zesayensi futhi yenzelwe imoto yokusheshisa ukuhumusha kolwazi olusha ukuze lisebenze ukuze sihlangabezane nenhloso yethu yokunciphisa ukuhlukahluka kokusebenza, nokuthuthukisa imiphumela ebalulekile yesiguli."
Sicela uqaphele ukuthi isignali yinhlangano eyodwa kuphela ephethe imihlahlandlela esekelwe ebufakazini, futhi kunezinye izinhlangano ezivelele ezenza okufanayo. Isibonelo, i-United States Preventive Service Task Force (USPSTF) nayo yenza iziphakamiso ngokusekelwe ebufakazini bezokwelapha.
Kulesi sihloko, sizohlola iziqondiso zomtholampilo ezisekelwe emibhalweni yokwelapha umdlavuza wekhanda nentamo ngokusho komdlavuza. Lezi zokwelapha zisekelwe kunoma yiziphi izincomo zeSIGN noma izincomo ze-European Society ye-Medical Oncology (ESMO). Ngaphezu kwalokho, ngokuphathelene namagciwane asezingeni eliphezulu asebalwe ngezansi, sicela uqaphele ukuthi siyizincomo zokwelapha ezibhekene nomdlavuza we-early-and-advanced stage, ongenakuthola entanyeni, engenazo izidakamizwa ezikude.
Konke, ikhanda nezintamo zamanqamu yizinhlobo ezihlukahlukene zezifo, futhi ukwelashwa okuqondile kusekelwe endaweni yomdlavuza nesiteji. Ngaphambi kokukhethwa kokunakekelwa kokwelapha, izitho zamakhemikhali entanyeni ziyahlolwa ngenxa yobufakazi bomdlavuza, futhi ukutholakala kwemithambo yezinyawo ezikude kuphelelwa ngaphandle.
Okokugcina, kulesi sihloko sibhekisela emdlalweni wesifo somdlavuza (TNM).
Ukuze uthole incazelo eyengeziwe enemininingwane yesiteji, sicela ulandele izixhumanisi kulesi sihloko.
Ukwelapha I-Canal Stage Oral Canal
Nazi izincomo ezisekelwe e-SIGN zokwelulekwa kwesigaba sokuqala (Isigaba I no-Stage II) umdlavuza womlomo:
- ukususwa okuhlinzekwayo (ukuguqulwa) kwe-tumor oyinhloko
- ukukhetha izintambo zezintambo ze-N0
- uma kwenzeka izinyathelo eziningana ze-lymph nodes zifakazela ubufakazi bomdlavuza noma ukusakazeka kukhulu, khona-ke kunconywa ukwelashwa kwemishanguzo
Ukuhlukaniswa kwentamo ekhethiwe kuhilela ukulondolozwa kwamaqembu angaphezu kweyodwa lymphatic. Khetha amaqembu e-lymph node asuswe ngokusekelwe emaphethini alinganiselwe we-metastases.
Olunye umhlahlandlela olususelwa ebufakazini bokuphathwa kokwelashwa komlomo wesandulela-ngculaza kugxile ekusetshenzisweni komswakama wezintanyeni noma ukukhishwa kwezicubu ze-lymphatic entanyeni. Okokuqala, kubantu abangakayitholi ukwelashwa ngomdlavuza womlomo (ukwelashwa-naïve) nge-tumor encane noma ekulu kakhulu (T1 no-T2, ngokulandelana) kwe-squamous cell origin, ukukhethwa kwe-neck dissection (okuzithandela) kungasindisa isikhathi eside. Okwesibili, ukuxoshwa kwentamo kunganciphisa ingozi yokuphindaphinda kanye nokufa okuqondene nomdlavuza (ukufa) kubantu abanezinhlanzi ezingabonakali ubufakazi bomdlavuza.
Ukwelashwa kwe-Can-Advanced Canal Oral Cancer
NgokweSIGN, umdlavuza womlomo ophuthumayo kufanele ususwe futhi.
Ngaphezu kwalokho, kunconywa ukuguqulwa kwensimu yokususwa kwentamo. Njengoba i-dissection eguquguqukile yentamo ishintshiwe, wonke ama-lymph nodes entanyeni asuswa futhi izakhiwo ezilodwa noma ngaphezulu zelphythi zigcinwa.
Uma umuntu onomdlavuza omlomo owedlule engakwazi ukusebenza (akuyona ukhetho lokuhlinzeka), ukukhipha imithi nge-cisplatin regimen kanye ne-radiational irradiation yentamo (okungukuthi, ukwelapha imisebe emaceleni omabili entanyeni) kunconywa.
Ukwelapha I-Nasopharyngeal Cancer St-Early
Nazi izincomo ze-ESMO zokwelashwa komdlavuza wokuqala we-nasopharyngeal:
- Ukwelashwa kwemisebe yodwa kusetshenziselwa ukwelapha umdlavuza wesigaba
- i-chemoradiation ehambisanayo (cisplatin kanye nokwelashwa kwemisebe) ingasetshenziselwa ukwelapha umdlavuza wesigaba II
- ukwelashwa kwemisebe eguquguqukayo emisebeni (IMRT) uhlobo oluthandwayo lwezokwelapha emisebeni yesifo somdlavuza osenesikhathi sokuqala
Ukwelashwa Kwe-Canopharyngeal Cancer Ehamba phambili
Nazi izincomo ze-ESMO zokwelapha umdlavuza we-nasopharyngeal advanced:
- Isigaba III, i-IVA kanye ne-IVA kansela iphathwa nge-chemoradiation ehambisanayo (i-cisplatin yi-agent ye-chemotherapy esebenzayo)
- I-IMRT imodi ethandwa yindlela yokwelashwa kwemisebe
Ukwelapha I-Oropharyngeal Cancer Yokuqala
ISIGN sigunyaza ukuthi umdlavuza we-oropharyngeal wokuqala uphathwe ngukuhlinzwa noma kwintamo ye-neck dissection noma ukwelashwa kwemisebe yangaphandle ye-radium kokubili i-tumor nama-lymph nodes entanyeni.
Ukwelashwa kwe-Can-Advanced Oropharyngeal Cancer
NgokweSIGN, abantu abanomdlavuza womlomo ophuthumayo bangaphathwa ngezindlela ezimbili: ukuhlinzwa okuyisisekelo noma ukulondolozwa komzimba. Ngokuhlinzwa okuyisisekelo, i-tumor yokuqala isusiwe futhi kushintshaniswa kwe-dissection yentamo eguquguqukayo. Ngendlela yokulondoloza isilwane, i-chemoradiation ne-cisplatin iyasetshenziswa, futhi ama-lymph nodes emaceleni omabili entanyeni (amazwe amabili) aphilisiwe.
Ngemuva kokuhlinzwa okuyisisekelo noma ukulondolozwa komzimba, uketshezi lwe-cisplatin yenzelwa iziguli ezithola ukusabalalisa okungeziwe (extra extens) kanye nama-positive margins. Kukhona umkhawulo ohlinzekwa kahle uma udokotela wezilwane ebona ukuthi amangqamuzana emngceleni wezicubu ezisusiwe namanje ayengumdlavuza.
Ukwelapha I-Can-Stage Hypopharyngeal Cancer
I-SIGN yenza izincomo zokwelapha ezintathu kubantu abanomdlavuza wokuqala we-hypopharyngeal. Okokuqala, ukwelashwa kwe-cisplatin kanye ne-prophylactic ye-radiation ingasetshenziswa. Okwesibili, ukuhlinzeka ngokucophelela nge-colateral selective dissection kungenziwa. Okwesithathu, kubantu abangewona abahlinzekwayo futhi abangakwazi ukungena ngaphansi kwe-chemoradiation, ukwelapha imishanguzo yedwa kungasetshenziswa.
Ukwelapha I-Advanced-Stage Hypopharyngeal Cancer
Ngokwe-SIGN, uma i-tumor ingathengiswa (okungukuthi, ingasuswa), ngabe noma yiziphi izindlela ezimbili zingahlolwa: noma ukuhlinzwa ukukhipha isisu noma ukulondolozwa komzimba. Ngokulondolozwa komzimba, ukwelashwa kwemisebe yangaphandle ye-radium kanye nokukhipha imithi ehambisanayo. Ama-lymph nodes ayenomphumela womdlavuza angaphathwa ngokusebenzisa i-neck dissection noma ngaphandle kwe-chemoradiation.
Uma ukubekezeleleka kwesiguli, labo abanezinambuzane ezingenakwenziwa kabusha noma abasuswe bangaphathwa nge-cisplatin chemoradiation.
Ukwelashwa Kwegciwane Lokuqala Lasegciwane Lokuqala
NgokweSIGN, umdlavuza wokuqala wokugaya ungaphathwa ngokuhlinzwa okulondolozwayo noma ukwelashwa kwemisebe yangaphandle. Ngaphezu kwalokho, ukwelashwa kwe-transoral laser kungase kusebenze njengendlela yokwelashwa kwemisebe
Njengoba i-transoral laser microsurgery, udokotela ohlinzayo uqondisa i-laser ngaphansi kwe-microscope kanjalo ukuqhubekela phambili kwanda ngokucacile. Le nqubo ivumela udokotela ohlinzayo ukuthi asuse kuphela amangqamuzana anomdlavuza avela ezicubu ezinempilo ezizungezile futhi isetshenziswe lapho ukugcinwa kwesitho kubalulekile ngesikhathi somlomo, i-larynx nokuhlinzwa okuphakade. Ukuhlinzwa okunjalo kungaholela ekwenzeni ngcono izinga lokuphila. Isibonelo, usebenzisa i-transoral laser microsurgery, udokotela ohlinzayo angakwazi ukugcina umsebenzi we-larynx noma ibhokisi lezwi kulabo abanomdlavuza we-laryngeal noma amagciwane angaphansi komphimbo ophansi.
Ukwelapha I-Can-Stage Supraglottic Cancer
Ngokwe-SIGN, ukwelashwa komdlavuza wokuqala we-supraglot kufana nomdlavuza wokuqala we-glottis, noma ukuhlinzekwa kokulondolozwa noma ukwelashwa kwama-radium wangaphandle. Ukuhlinzekwa kokuqapha kungalandelwa ukukhethwa kwezintambo ezikhethiwe. Lezi zindlela zokwelapha zigxile kuma-lymph nodes phakathi kwezinga II nezinga III entanyeni.
Ukwelashwa Kwe-Canary Advanced Stage Laryngeal Cancer
Ngokwe-SIGN, nansi indlela umdlavuza we-laryngeal ophuthumayo ongaphathwa ngayo:
- ukususwa ngokuphelele kwe-larynx (i-laryngectomy) nge-ortho ngaphandle kwe-concomitant (adjuvant) yokwelashwa kwemisebe
- indlela yokulondolozwa komzimba ihilela ukusetshenziswa kwe-cisplatin chemoradiation elandelwayo okulandelwa ukuhlinzeka ngo-salvage uma kudingeka
- njengendlela yokulondoloza isilwane, uma i-tumor ingenakuphelelwa yisikhathi, abaphathi futhi bahlanganisa ukuphathwa kwemithi ye-cisplatin elandelwayo okulandelwa ukuhlinzwa okubuhlungu uma kudingeka
- I-lymph nodes engumdlavuza isuswa nge-neck dissection noma nge-without chemoridiation
I-General Chemotherapy Izincomo
Nansi esinye isiqondiso esiphezulu esisekelwe ebufakazini esivela ku-SIGN mayelana nokuphathwa komdlavuza wekhanda nentamo:
- ukuphathwa komzimba we-chemotherapy ngaphambi kokukhipha imishanguzo (ie, neoadjuvant therapy) akukhuthazwa
- Ukulawulwa kwemithi ye-chemotherapy emva kokudonswa kwe-radiation (i-adjuvant therapy) ayikhuthazwa
- i-neoadjuvant noma i-adjuvant chemotherapy ayinconywa njalo kanye nokwelashwa okuhlinzekwayo
Ngokuyinhloko, lezi ziqondiso ze-chemotherapy zincoma ukuthi abantu abanomdlavuza womlomo, i-oropharyngeal noma umdlavuza we-laryngeal abazitholi ngokuzenzakalelayo noma ukukhipha imithi ngaphambi noma ngemuva kokwelashwa ngokuhlinzwa noma ukukhipha imithi. Ngamanye amazwi, ukwelapha imishanguzo noma ukuhlinzwa kungase kube nokwelashwa ngokwanele ngokwabo.
Isiphetho
Sicela uqonde ukuthi nakuba izincomo eziningi ezingenhla ziyizincomo eziphezulu eziphezulu ezisekelwa ubufakazi obuqinekayo bokufakaza, izilingo ezilawulwa ngokungahleliwe, ukuhlaziywa kwe-meta nokunye, akuzona zonke lezi zincomo ezisezingeni eliphezulu kakhulu kanti ezinye zisekelwa ngokungaqondakali okuncane ubufakazi. Ukuxoxa ngezibalo ezithile zobufakazi zinconywa ngayinye kungaphandle kobubanzi balesi sihloko.
Noma kunjalo, uma unemibuzo mayelana namamaki noma okunye okukhathazayo mayelana nomdlavuza wekhanda nentamo, sicela uxoxe ngalezi zikhathazo nodokotela wakho ochwepheshe. Ukwelashwa komdlavuza wekhanda nentamo kuyinkimbinkimbi, futhi iseluleko esinamandla esivela kudokotela wakho kuyinzuzo ebalulekile ngesikhathi senqubo yokwenza izinqumo.
> Imithombo:
> Ukwelashwa Kwekhanda Nekhanda Lekhanda. I-Dynamed Plus. www.dynamed.com
> I-NCI Dictionary yeMigomo yeCanscer. www.cancer.gov
> SIGN iwebhusayithi. http://sign.ac.uk/about/index.html
> Ukwelashwa kwekhanda nekhanda lomgogodla: i-neck dissection. I-Dynamed Plus. www.dynamed.com.