Iyini i-Transitional Cell Carcinoma (TCC)?

I-carrooma i-urothelial, uhlobo oluvame kakhulu lomdlavuza wesinye, oluhlobene nokubhema

Nakuba umdlavuza wesisu akuyona uhlobo lomdlavuza esikukhulumayo mayelana nokuthi, umdlavuza wamaphaphu, umdlavuza webele, noma i-melanoma, empeleni, umdlavuza wesine ovame kakhulu emadodeni aseMelika kanye neyesishiyagalolunye kakhulu kunabesifazane baseMelika. Ngokusho kwedatha evela ku-Centers for Disease Control and Prevention, amadoda angaphezu kuka-55 000 nabesifazane abangu-17 000 bathola umdlavuza wesibeletho e-US minyaka yonke.

Kulaba, abangaba ngu-16 000-ngaphezu kweyodwa kwabayisine-bazofa ngenxa yokulimala.

Uhlobo oluvame kakhulu lomdlavuza wesisu lubizwa ngokuthi i-transitional cell carcinoma (TCC). Eyaziwa nangokuthi i-urothelial carcinoma (UCC), i-TCC ivela emgqeni wangaphakathi we-urinary tract okuthiwa, ngokufanele, i-urothelium yesikhashana.

I-TCC ingahlakulela ngezicubu kusuka kunoma yikuphi eduze kwepheshana, kufaka phakathi:

• I-sinus ye-renal (isikhumba ngaphakathi kwezinso)
• I-ureter (ama-tubes axhumanisa izinso kuya kwesinye)
• I-innermost lining of the shingeni
• I-urethra (i-tube lapho umchamo ixoshwa khona emzimbeni)
• I-urachus (insali yomzila wesisu phakathi kwesigqila nesigodi)

I-TCC ibhekwa njengesizathu esivamile kakhulu somdlavuza wezinso lapho kuhilela isono senkunzi.

Izimpawu Nezibonakaliso

Izimpawu ze-TCC zizohluka ngendawo yesikhumba. Ngokuvamile izikhathi zifana nezibonakaliso zokutheleleka kwezinso ezinzima lapho umuntu eyobhekana nokuvuthwa okubuhlungu nokuphuza okuphansi emuva / kwezinso.

Ngenxa yokuthi lesi sifo silingisa ezinye izimbangela eziningi (kubandakanya i- cystitis , isifo sofuba, nesinye isisu), ukuxilongwa kuvame ukwenziwa lapho umdlavuza usukhulile.

Ngesikhathi esifanayo, i-TCC iyinomdlavuza ophuthumayo onesikhathini se-latency noma yikuphi ukufika eminyakeni engu-14.5, ngokusho kweNational Cancer Institute.

Esikhathini esingaphambili, isigaba se-precancer, izimpawu zivame ukungaqondakali ukuthi azikho. Kuvame ukuphela lapho ukuqhuma kwesifo esibucayi kuqhuma ukuthi eziningi zezibikezelo zivela.

Kungenxa yezizathu ukuthi amaphesenti angama-89 okuxilongwa akwenziwa ngamadoda ama-50 nangaphezulu. Kulezi zinsuku, amaphesenti angu-20 azotholakala enomdlavuza wesigaba sesi-3, kanti cishe eyodwa kwezine izoba nesifo se-metastatic (lapho umdlavuza usakaze kwezinye izingxenye zomzimba).

Kuye ngesigaba sesifo, izimpawu ze-TCC zingafaka:

• Igazi elibonakalayo emcimbini (i- hematuria ephelele )
• Ukuvuthwa okubuhlungu noma okunzima (i- dysuria )
• Ukuvuthwa njalo
• Isifiso esinamandla sokuvuthwa kepha ukungakwazi ukwenza kanjalo
• Ubuhlungu be-Flank ngakunye uhlangothi ngemuva ngemuva kwezimbambo
• Ukukhathala
• Ukulahlekelwa kwesisindo
• Ukulahlekelwa kwesifiso
• I-fever ephezulu enezikhukhula ezinzima
• Ukuvuvukala okuphansi (i- edema ), ngokuvamile kulesi sifo esilandelayo

Izimbangela Nezici Zengozi

Abantu bavame ukucabanga ukuthi umdlavuza wesifiso noma izinso kubangelwa ukuvezwa yi-toxins esiyidlayo, kungakhathaliseki ukuthi amanzi angcolile noma amakhemikhali ekudleni kwethu. Ngokuyinhloko, lokhu akunjalo. Nakuba izinhlayiya zihlobene nakanjani nokuthuthukiswa kwe-TCC, ngokuvamile ziyizinhlobo esizifakela isikhathi eside.

Oyinhloko phakathi kwalawo ugwayi ugwayi .

Eqinisweni, ngaphezu kwengxenye yazo zonke izifo ze-TCC ezingamadoda nangaphezulu kweyesithathu kwabafazi zihlobene nokubhema okukhulu. Ngaphezu kwalokho, ingozi nesigaba sesifo sibonakala ngokuqondile nenani leminyaka umuntu obhemayo nemvamisa yansuku zonke yokubhema.

Ngokusho kocwaningo oluvela eSikhumbuzweni SeCreattering-Kettering Cancer eNew York, umdlavuza wesibeletho obhemayo awukhona nje kuphela ovame kakhulu kodwa ngokuvamile uvame kakhulu kunabangaboni.

Isizathu salokhu kubambisana asicacile ngokuphelele, kodwa abanye baye bacabanga ukuthi ukuvezwa kwesikhashana ngotshani kubangela ushintsho lwe-chromosomal ezinhlobonhlobo ze-epithelial ezenza izilonda namagciwane.

Ingozi ibonakala ingaphezulu kunazo zonke kubantu ababhema ugwayi ongaphezu kuka-15 ngosuku.

Ezinye izinto eziyingozi kwi-TCC zihlanganisa:

• Ubudala obudala, ngamacala angu-90 amacala avela kubantu abangaphezu kuka-55
• Ukuba yindoda, ngenxa yokuthi i-androgen esebenzayo (i-hormone yesilisa yama-sex receptors) edlala indima ebalulekile ekuthuthukiseni i-TCC
• Ukuba mhlophe, okuyizindawo ozibeka kabili engozini uma kuqhathaniswa ne-African American and Latinos
• I-genetics yomndeni, ikakhulukazi ehilela ukuguquka komzimba okuhlobene nesifo seCowden (i-PTEN gene), i- Lynch syndrome (i-HPNCC gene), noma i- retinoblastoma (i-RB1 gene)
• Ukukhuluphala, ingozi ekhulayo ngamaphesenti angu-10 kuya kwangu-20
• Ukuvezwa komsebenzi kuma-amine aphunga asetshenziselwa ukudayisa kanye nezimboni zokunyathelisa kanye nokukhiqizwa kwenjoloba, isikhumba, upende, nemikhiqizo ye-textile
• Ukusetshenziswa kwangaphambili kwe-chemotherapy drug Cytoxan (cyclophosphamide)
• Ukusetshenziswa kwemithi yesifo sikashukela i- Actos (pioglitazone) okungaphezulu konyaka
• Ukusetshenziswa kwe-herbal supplements equkethe i- aristolochic acid (eyaziwa nangokuthi i- Pin Yin emtholampilo wendabuko wase-Chinese)

Ukuxilongwa

Ngokuvamile, isibonakaliso sokuqala sokuxilongwa kwe-TCC sizoba igazi emcinini. Ngezinye izikhathi ngeke kubonakale kodwa kungatholakala kalula ku- urinalysis (ukuhlolwa komchamo) .

I-cytology yomchamo ingasetshenziselwa ukuhlola amangqamuzana omdlavuza kumchamo, nakuba lokhu kuyindlela engathembeki yokuxilongwa. Ngokuphambene, ubuchwepheshe obusha bukwazi ukubona amaprotheni nezinye izinto emcintini ohlobene ne-TCC. Lokhu kufaka phakathi ukuhlolwa okuyaziwayo okubizwa ngokuthi i-Urovysion ne-Immunocyt. Kukhona ngisho nokuhlolwa kwekhaya okudokotela okubizwa ngokuthi i-Bladderchek engayithola iphrotheni ebizwa ngokuthi i-NMP22 esivame ukutholakala kumazinga aphezulu kubantu abanomdlavuza wesibeletho.

Inqubo yamanje yegolide yokuxilongwa yi-biopsy etholakala yi-cystoscopy. I-cystoscope iyithuluzi elide eliguquguqukayo elinekhamera encane elifakwe ku-urethra ukuze ubuke isilonda. I-biopsy ihilela ukukhishwa kwezicubu ezisolisayo zokuhlolwa ngumuntu wezokwelapha.

Ngokuya ngohlobo lwe-cystoscope elisetshenziswayo, inqubo ingenziwa ngaphansi kwe-anesthesia yendawo noma ejwayelekile. Kuyinto engavamile ukusebenzisa i-anesthesia ejwayelekile emadodeni njengoba inqubo ingaba buhlungu kakhulu kunikezwa ukuthi i-urethra yesilisa isinde futhi incane kunabesifazane.

Ukunyathelisa umdlavuza

Uma kutholakala ukuxilongwa komdlavuza, i-oncologist izohlukanisa ukulimala ngesigaba. Udokotela uzokwenza kanjalo besebenzisa uhlelo lwe-TNM lwesiteji esichaza ubukhulu besisu sokuqala ("T"), ukungenelela komdlavuza kube yilapho lymph nodes eziseduze ("N"), kanye nobukhulu be- metastasis ("M").

Inhloso yaloluhlelo ukukhomba inkambo efanele yezenzo ngenhloso yokungenzi noma ukunqoba umdlavuza. Ngokusekelwe kulokho okutholwe, udokotela uzokwethula isifo ngale ndlela elandelayo:

• Isiteji sesi-0 yilapho kunobunye bokufakazela ukuthi kunesibindi kodwa kungabandakanyeki kwe-lymph node noma i-metastasis.
• Isigaba I sichazwa ukusakazeka komdlavuza kusuka emgqeni we-epithelial kuya ezicubu ezixhunyaniswe ngezansi kepha ngaphandle kokubandakanyeka kwe-lymph node noma imetastasis.
• Isigaba II yilona lapho umdlavuza usakaze ngisho nakakhulu emgqeni wesisindo ngezansi kodwa awuzange udlule odongeni lombutho. Noma kunjalo, akukho ukubandakanyeka kwe-lymph node noma i-metastasis.
• Isigaba III yilapho umdlavuza usukhulile ngaphesheya kwodonga lwezitho kodwa awusakazelanga kuma-lymph nodes eseduze.
• Isigaba IV yilona lapho umdlavuza usakazeke ezithombeni ezikude, usakaze ezithombeni eziseduze, noma kokubili.

Isigaba sinikeza futhi udokotela nomuntu umqondo ongcono wokuphila izikhathi. Lezi zibalo azisetshenziswanga ngamatshe, futhi abanye abantu abanomdlavuza ophakeme bangakwazi ukufezekisa ukukhipha okuphelele kungakhathaliseki ukuthi kutholakala yini.

Uma kuthiwa, ukuxilongwa kwangaphambili kuhlale kuhlotshaniswa nemiphumela engcono. Abantu abatholakala benesigaba 0, isigaba I, noma isigaba II TCC banamathuba angu-90 okuthola ukwelashwa. Labo abanesiteji III banethuba elingamaphesenti angu-50. Ngisho nalabo abanesifo somdlavuza wesigaba IV banamaphesenti angu-10 namaphesenti angu-15 amathuba okuxoxwa okuqhubekayo, ngokweNational Cancer Society.

Ukwelashwa Okusondelayo

Ukwelashwa kwe-TCC kuxhomeke kakhulu esigabeni sesifo, izinga umdlavuza usakaze ngayo, kanye nohlobo lwezinhlaka ezibandakanyekile. Ezinye zezokwelapha zilula kakhulu ngamazinga aphezulu okuphulukisa. Ezinye ziningi futhi zingadinga izindlela zokwelapha eziyisisekelo neziyisithupha. Phakathi kwazo:

• Isiteji esingu-0 nesinezicubu ezingakafinyeleleki kumgca we-muscle ngokuvamile "zihlutshiwe" ngedivayisi ye-electrocautery ehlanganiswe ekupheleni kwe-cystoscope. Inqubo ingalandelwa ngeklasi elifushane le-chemotherapy. Imithi ye- Immunotherapy esebenzisa umuthi obizwa ngokuthi yi-Bacillus Calmette-Guérin (BCG) nayo inganciphisa ingozi yokuphindaphinda kwamacala amabili kwamathathu.
• Izifo ze-Stage II no-III zinzima kakhulu ukuphatha . Bayafuna ukususwa okukhulu kwanoma yisiphi isisindo esithintekayo. Endabeni yesisu, kungadinga inqubo yokuhlinzwa eyaziwa ngokuthi i-cystectomy eqinile lapho isisindo sonke sisusiwe khona. I-cystectomy encane ingenziwa enkundleni encane yesigaba sesibili II kodwa ayikho isigaba III. I-Chemotherapy inganikezwa ngaphambi noma ngemva kokuhlinzwa, kuye ngokuthi ubukhulu besisu. I-radiation ingase isetshenziswe njenge-adjuvant therapy kodwa cishe ayisetshenziswanga yedwa.
• Amagciwane e-Stage IV anzima kakhulu ukuqeda. I-Chemotherapy noma ngaphandle kwemisebe ngokuvamile imithi yokwelapha yokuqala ngenhloso yokwehlisa ubukhulu bezinsalela. Ezimweni eziningi, ukuhlinzwa ngeke ukwazi ukususa wonke umdlavuza kodwa kungasetshenziswa uma kungenweba impilo yomuntu kanye nekhwalithi yokuphila .

Imithi yokwelashwa

Imithi yokwelapha yamakhemikhali efana ne- methotrexate , i-vinblastine, i-doxorubicin, ne-cisplatin isetshenziswa ngokujwayelekile ekwelashweni okuhlangene. Ziyi-cytotoxic (okusho inhlamba kumaseli aphilayo) futhi isebenza ngokubhekisa amangqamuzana okuphindaphindiwe okufana nomdlavuza. Njengomphumela walesi senzo, bangaphinda babulale amaseli aphilile asheshayo-aphindaphindiwe afana nalawo ematheni, izinwele, namathumbu amancane.

Izizukulwane ezishaya izidakamizwa ezifana ne- Opdivo (nivolumab) , i-Yervoy (ipilimumab), ne-Tecentriq (i-atezolizumab) isebenza ngokuhlukile ngokugqugquzela amasosha omzimba ukulwa nomdlavuza. Lezi zinhlobo ezibizwa ngokuthi i- monoclonal antibodies zijoqelwa emzimbeni bese zifuna ngokushesha amangqamuzana omdlavuza, zibophezele futhi zisayine amanye amasosha omzimba ukuhlasela.

Le ndlela ehlosiwe ye- immunotherapy inganciphisa izicubu futhi ivimbele umdlavuza ukuba ungaqhubeki. Zisetshenziswa ngokuyinhloko ukukhulisa impilo yabantu abane-advanced, abangasebenzi, noma i-TCC ye-metastatic. Imiphumela emibi kakhulu yezidakamizwa ezivuselela umzimba zibandakanya:

• Ukukhathala
• Ukuphelelwa umoya
• Ubuhlungu obuhlangene noma obunamahloni
• Ukunciphisa ukudla
• Rash
• Uhudo
• Isikhukhula
• Ukuqokwa
• Isikhumba noma isikhumba esilula
• I-nausea

Inhlanganisela ye-Opdivo ne-Yervoy isiye yaziwayo eminyakeni yamuva ezimweni ze-TCC ezithuthukile. Ukwelashwa kunikezwa ngaphakathi kwangaphakathi kwemizuzu engama-60, ngokuvamile njalo ngemva kwamasonto amabili. Ukulinganisa nokuvama kuncike ekutheni umdlavuza usabela kanjani ekwelapheni kanye nokuqina kwemiphumela emibi.

Ukuvimbela

Ukuvimbela i-TCC kuqala ngezici ongazilawula. Kulawa, ugwayi uhlale ugxile kakhulu. Amaqiniso alula: Umdlavuza wesibeletho nanamuhla ukulimala okuhlobene nokubhema okuvame ukubhema ngemuva komdlavuza wamaphaphu. Ukushiya hhayi nje kuphela kunciphisa ingozi yomuntu we-TCC kodwa kungavimbela ukuphindaphindiwe komdlavuza kulabo abaphathwa ngokuphumelelayo.

Ukuyeka kungase kube nzima futhi kuvame ukufuna imizamo eminingi, kodwa izinhlelo eziningi zomshuwalense namuhla zihlanganisa ezinye noma zonke izindleko zokuphuza ukubhema.

Ezinye izici ezingaguquguqukayo nazo zingasiza ekunciphiseni ingozi. Ucwaningo olulodwa lwezinyanga eziyishumi olubandakanya amadoda angu-48 000 lathola ukuthi labo abaphuza amathani angu-1.44 wamanzi (amagalabu angama-8) nsuku zonke babe nomphumela ophansi wesifo somdlavuza wesinye isikhathi uma kuqhathaniswa nalabo abaphuza kancane. Ngenkathi kusekhona ukulinganiselwa okuphawulekayo mayelana nokuthola (kunikezwe ukuthi ezinye izici, ezifana nokubhema kanye nobudala, azifakiwe), ukuhlaziywa kwe-meta ka-2012 kuphakamisa ukuthi ukungenisa okuketshezi kuhlinzeka ngenzuzo yokuzivikela, ikakhulukazi kumadoda amancane.

Ngesikhathi ukuphuza amanzi yedwa kungasakwazi ukukhipha imiphumela yokubhema, kufakazela izinzuzo zokukhetha impilo enempilo ehlanganisa ukuhlunga kahle kanye nesimiso sokuhlekelwa kwesisindo uma ukhuluphele.

> Imithombo:

> I-American Cancer Society. "Ukwelashwa Kwesifo Somdlavuza, ngesigaba." I-Atlanta, Georgia; buyekeza ngoMeyi 18, 2017.

> Burger, M .; I-Catto, J .; I-Dalbagni, G .; et al. "Izifo ze-Epidemiology nezingozi ze-cancer ye-vestial". Eur Urol. 2013; 63 (2): 34-41. I-DOI: 10.1016 / j.eureo.2012.7.033.

> Amasevisi Okulawula Nokuvimbela Izifo. "" Cancer Cancer. " I-Atlanta, Georgia; ibuyekezwe ngoJuni 6, 2017.

> Jiang, X .; I-Castaleo, J .; Yuan, J. et al. "Ukubhema Ugwayi Nezingxenye Zomdlavuza Wegciwane." Int J Cancer. 2012; 130 (4): 896-901. I-DOI: 10.1002 / ijc.26068.

> National Cancer Institute: Izikhungo Zikazwelonke Zempilo. "Isibilini kanye nezinye izifo zokuhlukunyezwa komdlavuza (PDQ) -Health Professional Version." Washington, DC; ibuyekeziwe ngomhla ka-22 Februwari, 2017.