Umdlavuza we-Esophageal awuvamile, kodwa ungenye yezimbangela eziphezulu eziyishumi zokufa komdlavuza e-United States, ngoba ngokuvamile kutholakala esiteji uma singasaphili. Esikhathini esidlule, i-squamous cell carcinoma ye-esophagus-ehlotshaniswa nokubhema nokusetshenziswa ngokweqile kotshwala-yayiyinto ejwayelekile kakhulu. Kodwa eminyakeni yamuva, ibilokhu idlula i-adenocarcinoma, evame ukuhlotshaniswa ne-long-term acid reflux nokukhuluphala.
Ukulukhuni ngokugwinya ngokuvamile kuyisibonakaliso sokuqala somdlavuza we-esophageal, futhi ukuhlolwa okufana nokuphela kwe-endoscopy kusiza ukuqinisekiswa. Lapho ebanjwa ngokushesha, ukuhlinzwa kungase kuphulukise lesi sifo, kodwa ngokuvamile kuvame ukuthi lesi sifo sithuthuke, futhi i-chemotherapy kanye nokwelapha imishanguzo kube yindlela yokwelashwa okuyisisekelo.
Umdlavuza we-Esophageal uhluka kakhulu emhlabeni jikelele, kokubili ngezigameko nakwezinye izinto eziyingozi. Ngesikhathi samanje, i-adenocarcinoma esophageal iyanda e-United States nakwamanye amazwe athuthukile, nakuba izizathu eziqondile aziqiniseki.
Ukuqonda i-Esophagus
I- hoop isishubhu se-muscular esihlanganisa umlomo nesisu. Lihle ngemuva kwesifuba ne- trachea (i-tube lapho umoya uhamba khona eya emaphashini), nangaphambi komgudu we-thoracic. Indawo engaphakathi kwesifuba esidluliselwa kuyo i-mediopinus ibizwa ngokuthi i- mediastinum , isikhala esinezinye izakhiwo ezinjengenhliziyo, imithanjeni yegazi emikhulu (i-aorta), namanothi amaningi we-lymph.
Ngaphakathi kwendawo, kunezakhiwo ezimbalwa ezibalulekile ezilawula ukuthi izidakamizwa nezidakamizwa zidlula kanjani emlonyeni wakho kuya esiswini sakho ngesikhathi sokugwinya. I- sphincter ephezulu ye-esophageal iyinhlangano ye-muscular eduze ne-top of the esophagus evimbela ukubuyela emuva kokudla okuvela emlonyeni kuya emlonyeni, futhi kusiza ukuvimbela isifiso (ukuphefumula ukudla ku-trachea).
I-sphincter esezansi ephansi iyingxube yezincubu eduze kwesikhombisi sesisu nesisu. Uma ithoni yaleli sphincter liphakeme noma liphansi (ngenxa yezimo zempilo noma imithi), lingathinta indlela ukudla kudlula ngayo isisu kuya esiswini. Ngaphambi kokufika esiswini, i-esophagus iyadlula ku- diaphragm . Uma le ndawo ye-diaphragm ibuthakathaka (i-hernia hiatal), isisu singasenyuka phezulu siye emgodini wesifuba.
Iningi lobude bendawo lihlanganiswe namaseli aziwa ngokuthi amangqamuzana a-squamous, uhlobo olufanayo lwamaseli atholakele emlonyeni, ezindizeni ezinkulu, ngisho nangesikhumba. Uma i-tumor iqala kule ndawo ibizwa ngokuthi i- squamous cell carcinoma . Indawo engaphansi kwe-esophagus, nalapho i-esophagus ijoyina isisu, ihlanganiswe namaseli e-columnar. Uma i-tumor ebulalayo iqala kule ndawo, ibizwa ngokuthi i- adenocarcinoma .
I-Squamous cell carcinomas yavame ukuvame kakhulu e-United States, futhi ihlala yindlela ejwayelekile kunazo zonke zomdlavuza we-esophageal emhlabeni jikelele. Ngesikhathi samanje, i-adenocarcinomas ivame kakhulu e-United States nakwamanye amazwe amaningana athuthukile.
Izimpawu
Izimpawu zesifo somdlavuza we-esophageal zivame ukucaca kuphela uma umdlavuza uphumelele kahle.
Lokhu kusho ukuthi, abantu abaningi bathola ukuthi babelokhu bephethe izimpawu isikhathi esithile, kodwa bebengakwazi ukujwayela lezi zibonakaliso (ngokudla ukudla okunomsoco, isibonelo).
Izimpawu zokuxwayisa ezingenzeka zihlanganisa:
- Ukunzima ukugwinya (dysphagia): Uphawu oluvame kakhulu, lokhu kuvame ukuqala ngokudla okuqinile bese ekugcineni kuqhubekela phambili ukufaka iziphuzo. Ubuhlungu bungase buvele futhi ngokugwinya, kanye nokuzwa kokudla okunamathela endaweni.
- Ukulahleka kwesisindo esingachaziwe (ukulahlekelwa kwesisindo ngaphandle kokuzama)
- Ukuphindaphinda kokudla okungaxhunyiwe
- Ukushisa (ukushisa noma ukucindezela ngemuva kwesifuba)
- Ukushaya igazi noma ukudlulisa igazi elidala ngezimpawu zokuhamba kwamathumbu ( amnyama amnyama )
- Ukukhwehlela okuqhubekayo
- Ubuhlungu obubuyela emuva phakathi kwama-shoulder blade
- Ukuthuka noma ukulahlekelwa kwezwi
Njengoba ezinye zalezi zimpawu zingase zivele nge-acid reflux, futhi njengoba i-acid reflux iyinhloko engozini yomdlavuza we-esophageal, kubalulekile ukuthi abantu bangaqapheli kuphela izimpawu ezintsha ababhekana nazo, kodwa kunoma yikuphi ukushintsha emibhalweni yabo engapheli.
Izimbangela Nezici Zengozi
Asazi izimbangela eziqondile, nakuba izakhi zofuzo zibonakala zidlala indima. Kunezici eziningana zokubeka ingozi yomdlavuza we-esophageal ziye zabonakala futhi ziyahlukahluka kuye ngokuthi uhlobo oluthile lomdlavuza wokuqeda.
I-squamous cell carcinoma ye-esophagus ivame ukuhlanganiswa nokuhlanganiswa kokubhema nokudla ngokweqile, nakuba kunezinye izici eziyingozi. Emhlabeni wonke, umdlavuza wesifo sofuba uvame kakhulu kubantu kunabesifazane, kodwa i-squamous cell carcinoma ivame kakhulu kwabesifazane e-United States. Kuvame kakhulu kulabo abamnyama kunabamhlophe. Ukudla okucebile izithelo nemifino kanye nokudla okuncane okubomvu futhi okusetshenzisiwe kungase kube nomthelela wokuvikela.
I-Adenocarcinoma ye-esopha ivame ukuhlotshaniswa ne-reflux engavamile (isifo se-reflux se-gastroesophageal, noma i- GERD ), kanye nesifo se-Barrett nokukhuluphala. E-United States, kuvame kakhulu emadodeni kunabesifazane, futhi kuvame kakhulu kulabo abamhlophe kunabamnyama.
Ukuxilongwa
Izivivinyo eziningi ezahlukene zingase zisetshenziselwe ukuxilonga umdlavuza we-osophageal . Izikhathi ezivame, ukuhlolwa kokuqala okubekiwe kuyinkimbinkimbi ye- barium . Uma ngabe umdlavuza we-esophageal uyasolwa, noma kunjalo, i- endoscopy engenayo (i-esophago-gastric-duodenoscopy) iyilingo eliyinhloko elisetshenziselwa ukuxilongwa. Kule nqubo, i-tube itholakala emlonyeni nasesigxwini. Ikhamera ekupheleni kwebhulegi ivumela odokotela ukuba bacabange ngokuqondile ngaphakathi kwendawo futhi bathathe i-biopsy, uma kudingeka.
Ukugxila kubaluleke kakhulu ekukhetheni ukwelashwa okungcono kwesifo. Izivivinywa ezivame ukusetshenziselwa ukufakwa kwesiteji zihlanganisa i-CT, i-PET, futhi ngezikhathi ezithile izifundo ezengeziwe ezifana ne- bronchoscopy , thoracoscopy, nabanye.
Ukwelapha
Izinketho zokwelashwa zomdlavuza we-esophageal ziyoxhomekeka esigabeni somdlavuza, lapho sitholakala khona, nezinye izinto eziningi.
Ukuze i-tumors yokuqala, isifo (esophagectomy) singanikeza ithuba lokuthola ukwelashwa. Lokho kusho ukuthi ukuhlinzeka okukhulu okuhilela ukukhipha ingxenye yesiguli futhi ukuxhuma kabusha isisu kunoma yini eseleyo engaphezulu (noma ukwengeza isigaba samathumbu uma ingxenye enkulu yesiguli isusiwe). I-Chemotherapy ne-radiation therapy ngokuvamile iyenziwa ngaphambi kokuhlinzwa (i-neoadjuvant chemotherapy) ukuze igweme isisu, kodwa ingasetshenziswa ngemva kokuhlinzwa ukuze kuqinisekiswe ukuthi noma yimaphi amangqamuzana omdlavuza ayenziwa.
Kulabo abangabhalwanga ukuhlinzwa, kusekhona izinketho. I-Chemotherapy enezinhlanganisela zezidakamizwa zingase zandise ukuphila. Ukwelashwa kwezidakamizwa kuvame ukusetshenziswa kanye ne-chemotherapy, ngaphambi kokuhlinzwa, ngemuva kokuhlinzwa, noma nge-chemotherapy lapho ukuhlinzwa kungenzeki.
Izindlela zokwelashwa ezihlosiwe zingasiza futhi ukulawula lesi sifo, isibonelo, kubantu abanezinambuzane ezihle ku-HER2 (ezifana nomdlavuza webele). I-Immunotherapy ihlanganisa izindlela ezihlukahlukene zokwelashwa ezibandakanya ukuqinisa umzimba wesimiso somzimba ukuze ulwa nomdlavuza, futhi ngezinye izikhathi ungayilawula ngisho namagciwane aphakeme kakhulu. Kunezindlela eziningi zokwelashwa ezifundiswayo ezivivinyweni zomtholampilo ezinikeza ithemba lokuthi ukwelashwa okungcono kuzotholakala esikhathini esizayo.
Kulabo abane-cancer ephakeme, ukwelashwa ukuthuthukisa ikhwalithi yokuphila ngenkathi uhlala nomdlavuza awukwazi ukuguqulwa, futhi ukunakekelwa ngokucophelela kuvame ukuba umgomo wezokwelapha. Ukunakekelwa kwe-palliative akufani ne-hospice (ingasetshenziselwa ngisho nabantu abanezinambuzane okungenzeka baphulukiswe), futhi ihlose ukulawula izimpawu zomzimba nezingokomzwelo zokuphila nomdlavuza. Sifunda ukuthi ukunakekelwa okunamandla akugcini nje ngokuthuthukisa ikhwalithi yokuphila, kodwa kungase kuthuthukise ukusinda kwabantu abane-cancer ephakeme.
Ukubhekana
Ukubhekana nomdlavuza we-esophageal kungaba nzima kakhulu. Ngokwemvelo, ubunzima ngokugwinya akugcini nje kuphela kodwa kungaphazamisa kakhulu ngokudla okunomsoco. Ngomzwelo, idumela lomdlavuza wesifo sokugonywa njengesiyaluyalu esinobudlova esinokuhlukumezeka kabi kuphakamisa izinkinga eziningi, kuhlanganise nokukhathazeka kokuphela kokuphila. Ngokomphakathi, ukuxilongwa komdlavuza we-esophageal ngokuvamile kuholela ekushintsheni okungavumelekile emisebenzini emndenini. Futhi izindaba ezingokoqobo ezivela ezikhathazayo zomshuwalense ezomali zengeze emithwalweni.
Ukubhekana nokuxilongwa komdlavuza wesifo esithathelwanayo kuthatha umzana, futhi kubalulekile ukuqoqa uhlelo lwakho lokusekela eduze. Ukuthola ukwesekwa phakathi komphakathi wesifo somdlavuza osengcupheni kungase kube nenzuzo enkulu, ngoba kuletha ithuba lokukhuluma nabanye abantu nabanakekeli bomndeni ababhekene nenselele efanayo.
Ukuthatha ingxenye ekhuthele ekwelapheni kwakho ngokuba ngummeli wakho siqu ekunakekelweni komdlavuza wakho kunganciphisa nje ukukhathazeka okwakungaziwa, kodwa kwezinye izimo kungenza umehluko nomphumela.
Izwi elivela
Umdlavuza we-Esophageal uvame ukuhluleka ukuxilongwa kuze kube yizinyathelo ezilandelayo zesifo, kodwa abantu abaningi bayavuma ukuthi banezibonakaliso eside ngaphambi kokuthi bathole. Ukuqaphela izibonakaliso nezimpawu nokwazi ukuthi unayo yini engozini noma kungabi usizo ekutholeni lesi sifo ngokushesha ngangokunokwenzeka. Kubalulekile ukuthi uqaphele ukuthi ngisho noma lesi sifo singabanjwanga kusenesikhathi futhi ukuhlinzeka akunakwenzeka, kunamaphilisi atholakalayo anganciphisa izimpawu futhi avame ukwandisa ukuphila.
> Imithombo:
> Society of American of Clinical Oncology. I-Cancer Esophageal: Izimpawu Nezibonakaliso. 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 Treatment (PDQ) -Health Professional Version. Kubuyekezwe 02/06/18.