Izimpawu, Ukuxilongwa, Ukwelashwa, Nokuguqulwa
I-Retinoblastoma ingumdlavuza wehlo futhi yenza cishe amaphesenti angu-3 kuya kwangu-4 e-kansa yengane. Itholakale kaningi emntwaneni nasezinsaneni ezisencane, kanti nakuba ukubikezela kwakungenalutho esikhathini esedlule, iningi lezingane manje lisinda kulesi sifo.
Ukubukezwa kwe-Retinoblastoma
I-Retinoblastoma ingumdlavuza ongabonakali ebuntwaneni owenzeka cishe ezinganeni ezingama-20,000.
Iqala emathisheni omzimba wokukhanya okukhanyayo ngemuva kwehlo (i-retina) kanye namaphesenti angu-80 amacala ezenzeka ezinganeni ezingaphansi kweminyaka engu-3. Umdlavuza awutholakali kakhulu ezinganeni ezingaphezu kweminyaka emihlanu.
Ngesikhathi i-retinoblastoma ihlehlisiwe kakhulu, cishe izingane ezingu-9 kwabangu-10 ziyaphila, kanti abaningi sebebona futhi balondolozwe. Lokho kusho ukuthi ukwelashwa kungaba nzima kubazali ababhekene nalesi simo ezinganeni zabo, futhi ukusekela kuyadingeka kakhulu.
Ake sibuke izimpawu ezivamile nokuthi i-retinoblastoma iphathwa kanjani. Njengoba isimo ngesinye isikhathi sifa, sizokhuluma ngezofuzo ze-retinoblastoma nokuthi yini okufanele uyazi uma ingane isetshenziswe.
I-Anatomy ye-Eye ne-Retina
Ukuqonda izimpawu ze-retinoblastoma kulula ukuyiqonda uma ucabanga ukuthi i-anatomy ikhona kanjani.
I- retina ihlanganisa ungqimba lwangaphakathi lwesobunxele futhi lenziwe ngamaseli we-nerve-detection (photoreceptors) abizwa ngokuthi ama-rod kanye nama-cones.
I-retina inomzimba omncane kakhulu, cishe u-1/5 we-millimeter ubukhulu, futhi ubude nobukhulu bekota.
Uma ubona isithombe, isithombe siqondiswa ngumfundi wakho futhi sigxile kwi-retina. Lawa maseli omzimba ayesehambisa isignali kagesi yalowo mfanekiso engxenyeni yobuchopho obandakanya umbono (i-occipital lobes).
Izimpawu ze-Retinoblastoma
I-retinoblastoma ivame ukutholakala ngesikhathi sokuvakashela ingane kahle ingane yakho, noma ngisho nangemva kokuba esinye sezibonakaliso zokuxilonga kuphawulwe esithombeni. Izimpawu zingafaka:
- I-white pupillary reflex (leukocoria): Uma udokotela wezingane ekhanyisa ukukhanya futhi ebheka amehlo omntanakho ubona okuthiwa "i-reflex ebomvu." I-retina ilayishwe imithwalo yegazi eyenza indawo ibone ngaphesheya komfundi ibonakale ebomvu. Uma i-retinoblastoma ikhona, le ndawo ingase ibonakale imhlophe kunalokho. Ngezinye izikhathi isimo sikholelwa ukuthi isithombe somama wengane sibonisa ukucubungula okumhlophe.
- Ivila (i-strabismus): Amehlo wengane angase avele ebuka ngezindlela ezihlukile noma abe nokubonakala okuphambene naso. Khumbula ukuthi ukubuka amehlo obala ezinsana kungase kube okujwayelekile kuze kuphele iminyaka engu-3 noma izinyanga ezine. Ezinye izingane ezine-retinoblastoma nazo zibonakala zigcwala ngokweqile.
- I-reflex yokukhanya engabonakali: Izingane zakho zizokhanyisa abafundi bezingane zakho ukuthi babone ukuthi bayavumelana yini. Uma i-retinoblastoma ikhona, lokhu kungase kungabikho ngeso elilodwa.
- Ukuthungatha iso, ubomvu, ubuhlungu, noma ukuvuvukala
- I-glaucoma (ukucindezela okwandayo emehlweni): I- glaucoma ingase ivele lapho amangqamuzana amathumba avimbela imigwaqo evamile yamehlo.
Ukuxilongwa kwe-Retinoblastoma
Ukuxilongwa kwe-retinoblastoma kuvame ukusola ngokusekelwe kumcwaningi omhlophe we-pupillary ngesikhathi sokuhlolwa kwengane. (Kwabantwana abathwala ukuguquka, bheka ngezansi). Njengoba kuphawuliwe ngenhla, abazali ngezinye izikhathi bacabanga ukuthi kukhona okungalungile uma bebona umfundi omhlophe we-reflex esithombeni somntwana. Kukhona ngisho ne-app ye-smartphone etholakalayo ukukrinta le-reflex.
Ukucwaninga ukucwaninga kuvame ukwenziwa ngokulandelayo. I-ultrasound noma i-OCT (ukuhambelana kokubambisana kwe-tomography) ivame ukuhlolwa kokuqala futhi inganikeza ulwazi olubalulekile ngobukhulu besisu. Lolu cwaningo lubuye luvimbele ingane ingozi yemisakazo.
I-MRI ivame ukuphakanyiswa njalo, ukuqhubeka nokuhlola le ndawo, futhi kuyisivivinyo esihle kakhulu sokubona izifo ezincane ezifana nesifo se-retinoblastoma. Ngezinye izikhathi i-CT iyadingeka njengoba kubalwa ukuthi kulula ukutholakala ku-CT, kodwa ibonisa ingane engozini yokushisa imisebe, ngakho-ke ngokuvamile akuyona ukuhlolwa okuyinhloko kokulandelwa.
Ngokungafani ne-kansa eminingi, i-biopsy ye-tumor ngokuvamile ayidingi njengoba ukuhlolwa okufundwayo kuphela okuvame ukwenza ukuxilongwa (kunezimo ezimbalwa kakhulu ezibonakalayo). Ingozi ye-biopsy ingabandakanya ukulimala iso ne-optic nerve kanye nethuba lokuthi amangqamuzana omdlavuza angahlwanyelwa, okuholela ekusakazeni komdlavuza.
Uma kukhona ukukhathazeka ukuthi umdlavuza usakaze ngaphesheya kweso, izivivinyo ezenzelwe ukucinga izifo zamathambo zingenziwa. Lokhu kungabandakanya ukukhishwa kwe-lumbar (ukubhekisisa amangqamuzana omdlavuza emthonjeni wamagogasi), ukutadisha umthambo wamathambo (ukufuna ubufakazi bomdlavuza wamangqamuzana emnothweni wamathambo), noma ukuskena kwethambo (ukubhekisisa ama-metastases amathambo).
Ezinye izingane nazo zinama-tumor gland (i-retinoblastoma ye-trilateral), ngakho-ke izifundo zokucabanga ukuze zihlolwe le ngxenye yobuchopho (njenge-MRI) ingabalulekile.
Ukuthola Ukuhlukana Okuhlukile-Kungaba Kanjani?
Kukhona ngempela izimo ezimbalwa kakhulu ezifana ne-retinoblastoma, okwenze kube lula ukwenza ukuxilongwa ngokusekelwe ekuhloleni nasekuhloleni iziqu kuphela. Ezinye izimo ezingabonakala ezifanayo zihlanganisa:
- Isifo se-coates: I-Coates isifo esiyingqayizivele (kodwa esingenalo ifa) esichazwe yimithwalo engavamile yegazi ngemuva kwe-retina. Izitsha ezingavamile zidala igazi ukuvuza ngemuva kweso. Ukuvuza kwegazi kungabangela izicubu ezinamafutha ukwakha (okubonakala okubukeka okwesibhakabhaka) okungahle kube iphutha nge-retinoblastoma.
- I-Toxocara Canis: I-Toxocara Canis iyi-roundworm yenja evame ukudluliselwa kubantu ezinja ezigciwane. I-parasite ikhula ekugcineni kweso (kanye nezinye izindawo) futhi ingaholela ekuthunjweni kwe-retinal .
- I-Retinopathy ye-prematurity: I- Retinopathy ye-prematurity yinkinga ehlobene nokweqa kwemithambo yegazi esweni futhi ivame ukutholakala ezinganeni ezizalwe ngaphambi kwamasonto angu-31 ukubeletha.
- I-vitreous eyinhloko engapheliyo ye-vitreous (PHPV): I-PHPV iyinkinga engavamile yokuzalwa enganeni ebangelwa imithwalo yegazi eyisisu engavamile emehlweni.
- I-epithelioma ye-intraocular: I-medra-llepithelioma ye-tradoular isifo esiyingqayizivele esingazalwa esiqala emzimbeni we-ciliary kune-retina.
Izimbangela Nezici Zengozi
Akuqiniseki ukuthi yini eyenza ushintsho olubhekene nokuthuthukiswa kwe-retinoblastoma. Ngama-cancer amaningi, ukudla, ukuzivocavocavoca, nokuzibandakanya kwemvelo kudlala indima, kodwa njengoba i-retinoblastoma iqala ngokushesha nje, noma ngaphambi kokuzalwa, lezi zici cishe zidlala indima encane kakhulu. Siyazi ukuthi izakhi zofuzo zidlala indima ephesenti elikhulu lalezi zicubu.
I-Genetics ye-Retinoblastoma
I-retinoblastoma ingase ivele ngenxa yokuguquguquka kwesakhi segesi eyaziwa ngokuthi i-RB1 etholakala ku-chromosome yesi-13. Lezi zakhi zofuzo ziyisisindo sokucindezela i- tumor , okuyimikhodi yama-protein anciphisa ukukhula kwamaseli. Lokhu kuzuzwa ngefosimasi evelele futhi ifuzo elingavamile lingase lizuze ifa kusukela kumama noma ubaba. Kukhona nezinye izinguquko, ezifana nalawo ase-MYCN ahlobene nesifo.
Ngezinguquko ze-RB1 kucatshangwa ukuthi cishe amaphesenti angama-25 aguquguquke ngamagciwane (azuzwe kumzali oyedwa) kanti amanye amaphesenti angama-75 athola (izinguquko ezenzeka ngesikhathi sokuthuthukiswa komntwana). Kuzingane ezinokuguqulwa kwe-RB1 (noma ifa elivela kumzali noma uma ukuguqulwa kwegazi kwenzeka ngaphambi kokubeletha) ithuba lokuthuthukisa i-retinoblastoma (ukungena) kungamaphesenti angu-90.
I-retinoblastoma ene-hereditary ivame ukungena embusweni futhi iyenzeka ngesikhathi esincane kunayo i-retinoblastoma esincane. I-retinoblastoma ene-Hereditary ingase ibuye ibe ne-multitifocal, enezinambuzane eziningana ezikhula ngesikhathi esisodwa. Izingane ezine-retinoblastoma enezifo nazo zisengozini yokuthuthukisa ezinye umdlavuza esikhathini esizayo.
I-Retinoblastoma yokufaka isiteji
Izigaba ze-retinoblastoma zingahlukaniswa ngezigaba I kuya kwezingu-4 njengezinye izifo zomdlavuza, kodwa izinhlelo eziningi zokuhlukanisa zivame ukusetshenziswa. (Isigaba I sibhekisela kumdlavuza lapho ilanga lingagcinwa khona, futhi isigaba II kuya ku-IV yimilavuza lapho iso lisusiwe khona). Njengoba lesi sifo sivame ukubanjwa ekuqaleni emazweni athuthukile, ezinye izinhlelo zesiteji zivame ukusetshenziswa.
Kunezigaba ezimbili eziyinhloko zesifo:
- I-intraocular-Tumors esezweni
- I-Extraocular-Izicubu ezidlulela ngaphesheya kweso. Lezi ziphinde ziphulwe zibe izidumbu ezingaphezu komzimba ezidalwa yi-extraocular tumors lapho zisakazwa kuyo yonke indawo yesibindi (i-orbit) kanye nezicubu ze-extraocular zemetastatic ezisakaze ebuchosheni, emashumini, emathambo, noma kwezinye izifunda.
E-United States nakwamanye amazwe athuthukile, i-retinoblastoma ivame ukutholakala esiteji se-intraocular.
Izicubu ze-intraocular zihlukaniswa ngezigaba ezilandelayo:
- A-Kuhlanganisa izicubu ezingaphansi kwama-3 mm (millimeters) ububanzi futhi azibandakanyi i-optic disc (maphakathi nombono)
- B-Mkhulu kunama-3 mm ububanzi
- C-Noma yisiphi isisu esincane esichazwe kahle esasakazwa ngaphansi kwe-retina noma kwi-vitreous humor
- D-Noma yikuphi isifo esikhulu noma esichazwe kabi esasakazeka ngaphansi kwe-retina noma kwi-vitreous humor
- Ama-tumor e-E-Large asakaze phambili ebusweni, anzima yi-glaucoma, noma imishini yokubuyisela. Ngezicubu zingase kube nzima ukusindisa iso.
Lapho i-retinoblastoma isakazeka, ingase ihlasele izindawo ezisele zaso (i-globe). Izingosi ezivame kakhulu ezithinta izidakamizwa ezikude zihlanganisa i-lymph nodes, ubuchopho nomgogodla, isibindi, umnkantsha namathambo.
I-Retinoblastoma Izinketho zokwelapha
Imithi yokwelapha ye-retinoblastoma ixhomeke esiteji somdlavuza, indawo yesikhumba, kungakhathaliseki ukuthi i-tumor ayihambisani noma iphakathi, nezinye izici. Izifo ezincane, i-chemotherapy kanye nezindlela zokugulisa ezivame ukuvame ukusetshenziswa.
Izinhloso zokwelapha zifaka:
- Ilondoloza impilo yengane
- Ukulondoloza iso (noma amehlo) uma kungenzeka
- Ukulondoloza umbono obanzi ngangokunokwenzeka
- Ukunciphisa imiphumela emibi yesikhathi eside ehlobene nokuphathwa
Izinketho zokwelapha zihlanganisa:
- I-Chemotherapy: I- Chemotherapy ingase isetshenziswe yedwa noma iyancipha ubukhulu besisu ngaphambi kokuhlinzwa. Izinhlobo ezahlukene ze-chemotherapy zingasetshenziswa nge-intra-arteriolar chemotherapy evame ukusetshenziswa. Kule nqubo, imithi ye-chemotherapy ihanjiswa ngqo emthini ohlinzeka iso, ukunciphisa umphumela wezidakamizwa kwezinye izicubu. Ukusetshenziswa kwamakhemikhali e-intravenous ingasetshenziswa futhi. Ukuze izicubu ezinkulu noma lezo eziye zaphindaphindiwe noma eziphindaphindiwe, i-high-dose chemotherapy ne- stem cell rescue ingasetshenziswa.
- Izindlela zokwelapha zendawo: Kunezinhlobo ezahlukene zezindlela zokwelapha zendawo ezingasetshenziswa ukuphatha i-retinoblastoma. Lokhu kuholela ekususweni kwamangqamuzana omdlavuza kodwa kungenasiphelo esingaphansi kokuhlinzwa ukuze kususwe iso. Lezi zifaka phakathi i-cryotherapy (ipholisa i-tumor) i-thermography (ukushisa isisu), ukuhlinzwa kwe-laser (photocoagulation), nabanye.
- Ukwelashwa kwezidakamizwa: Ukwelashwa kwezidakamizwa kungasetshenziswa ngaphandle (ukwelashwa kwangaphandle kwemishanguzo), noma ngaphakathi (brachytherapy) lapho imisebe ibekwa khona ngaphakathi komzimba eduze kwe-tumor. Ukwelashwa kwe-proton yegobolondo kuhlolwe njengenye indlela yokwelashwa kwemisebe yendabuko njengoba kungase kube namandla okubangela ukwelashwa okubili.
- Ukuhlinzwa (i-enucleation): Ngokuba izicubu ezincane, amakhemikhali kanye nezinqubo zendawo zenziwa ngezifiso zokulondoloza iso. Ukuze izicubu ezinkulu, noma lezo eziqhubekayo noma eziqhubekayo, ukususwa kweso kanye nengxenye ye-optic nerve (i-enucleation) ingadingeka. Ukufakelwa kweso kuvame ukufakwa ngesikhathi sokuhlinzwa, ngeso lengqondo elifakwe phezulu phezulu kokufakelwa esikhathini esilandelayo.
- Ukuhlolwa kwemitholampilo: Kunezinhlobo eziningi zezindlela zokwelashwa ezihlukene ezicwaningwa ekuhlolweni kwamakhambi, kusukela ku-nanoparticulate chemotherapy kuya kwezinhlobo ezintsha zelashwa zendawo.
Ukulandela emva kokwelapha
Ama-retinoblastomas amaningi angaphulukiswa ngemithi yokwelashwa, kodwa ukulandelwa kubalulekile kakhulu. Lezi zicubu zingase ziphinde zibuyele, futhi ama-MRIs alandelayo avame ukusetshenziswa. Ukuhlolwa nokulandelwa kombono, uma kugcinwa, kudinga ukunakwa okukhethekile. Ngaphezu kwalokho, ukubambezeleka kokuthuthukiswa akuvamile. Ukulandelwa kubaluleke kakhulu futhi kunakekelwa ngokukhethekile emiphumeleni yamuva yokwelapha. Izingane ze-Oncology Group (COG) IziLondolozo ZokuPhepha ziveza eziningi zezimpikiswano.
Imiphumela Yesikhashana namaKhansela Okubili
Imiphumela emisiwe yokulashwa komdlavuza ibhekisela ezimweni ezibangelwa ukwelashwa komdlavuza okungase kuthuthuke iminyaka kuya emashumi emva kokwelashwa. Sifunda ukuthi abasindile benomdlavuza yengane banomngcipheko wezokwelapha ezivela ezifweni zenhliziyo (okuvame ukuhlobene ne-chemotherapy), ukungabi nabantwana, ezinganeni zamagciwane.
Esicwaningweni esibheka imiphumela yesikhathi eside yezingane ezine-retinoblastoma, kwafunyanwa ukuthi eminyakeni engamashumi eminyaka kamuva (isilinganiso seminyaka engama-42 kulesi sifundo), amaphesenti angu-87 ezingane ezazisinda ku-retinoblastoma zinesimo esisodwa sezokwelapha ezihlobene nokwelapha. Nakuba lokhu kungadangalisa ukuxoxa, lolu lwazi lubonisa ukuthi kubaluleke kangakanani ukuthi abasindile benomdlavuza bezingane babe nokulandela isikhathi eside nodokotela owazi kahle ukuthola nokuphatha imiphumela yesikhathi eside yokwelashwa.
Izingane eziye zasinda i-retinoblastoma zinomngcipheko owengeziwe wokuthuthukisa ukwelashwa wesibili (amasha kagciwane amancane) phansi komgwaqo. Ngokuthola i-retinoblastoma yefa, ingxenye yalokhu kwanda ingenxa yokungasebenzi komzimba wegciwane lesisindo kwezinye izicubu. Nge-retinoblastoma engeyona ifa, lezi zifo zomshuwalense wesibili zingase zibe nomthelela ohlangothini lwe-chemotherapy noma ukwelashwa kwamafutha. Amagciwane wesibili ajwayelekile kakhulu ahlanganisa i- osteosarcoma (umdlavuza wesifuba), ama-sarcomas ashubile, i- melanoma , umdlavuza wamaphaphu , ne-lymphoma.
Ngaphezu kwamagciwane wesibili, imiphumela emide yesikhathi eside ye-chemotherapy kanye nemiphumela emibi yesikhathi eside yokwelashwa kwemishanguzo kubaluleke kakhulu ngoba abaningi balaba bantwana bazophila nalezi zikhathi eziphuthumayo noma engozini yemiphumela esiphundu cishe isikhathi esithile sokuphila.
Isibikezelo
Iningi lezingane ezixilongwa nge-retinoblastoma manje zizokwelashwa. Inani leminyaka engu-5 lokusinda i-retinoblastoma e-United States yayingamaphesenti angu-97.3 ebheka isikhathi esiphakathi kuka-2000 no-2012, kanti ukwelashwa kuyaqhubeka nokuthuthukisa. Ngisho nezingane ezine-metastase ezifundeni ezingaphandle kobuchopho (njenge-bone marrow) zivame ukuphulukiswa. Lokho kusho ukuthi, ukusakazwa ngaphakathi kwengqondo (isifo sofuba) kuhlobene nomphumela ompofu.
Ezinye izimo ezibikezelayo ezimbi zihlanganisa ukuthuthukisa umdlavuza ezweni eliphuthumayo (lapho kunezinkinga eziningi ze-Cancer). I-retinoblastoma yezidakamizwa ibangela ukufa okuningi okuvela ku-retinoblastoma emazweni athuthukile.
Ukutholwa Kwangaphambili Kwezingane Ezinezakhi Zama-Germination Line
Njengamanje asikho indlela yokuvimbela ukuthuthukiswa kwe-retinoblastoma, kepha izingane ezisengozini enkulu ngenxa yokuguquguquka kwegciwane lesigciwane noma umlando womndeni wesifo kungabuye ihlolwe ngokubamba isisu ngokushesha kungenzeka. Ukuhlolwa kwe-Funduscopic (ukuhlolwa kweso ukubuka i-retina) ngaphansi kwe-anesthesia jikelele ngokushesha ngemuva kokuzalwa futhi nyangazonke ngonyaka wokuqala wokuphila kuvame ukuphakanyiswa. Izakhi zingatholakala ku-amniotic fluid, futhi abantwana abathintekayo nabo bangaqapha futhi banikwe ngokushesha uma izimpawu zomdlavuza ziphawulwa.
Uma ingane iqala i-retinoblastoma, ezinye izingane kanye namalungu omndeni nazo zingabuye zihlolwe ukuze zibone ukuthi zinegciwane lesisulu.
Ukubhekana nokusekela
Njengomzali, ulwazi lunamandla ngempela, futhi kuyasiza ukufunda konke ongakwenza.
Ukusekela nakho kuyinhloko. Ngenxa yobunzima be-tumor, imiphakathi eminingi ayinayo amaqembu wokusekela i-retinoblastoma, kodwa kunemiphakathi ewusizo kakhulu ku-intanethi naku-Facebook. Ukuzibandakanya kule miphakathi akuhlinzeki nje kuphela ngenkathi ubhekana nokungena nokuphuma kokuba ngumzali wengane enomdlavuza, kodwa kungaba indawo enhle kakhulu yokufunda ngocwaningo lwamuva mayelana ne-retinoblastoma. Akekho okhuthazwa kakhulu ukuthi afunde futhi ahlanganyele okutholwa okusha kunabantwana ababhekana nalesi sifo enganeni yabo.
Njengoba izingane zikhula zikhona amathuba amaningi okusekela izingane. Kukhona amaqembu asekela umdlavuza osindayo oklanyelwe ngqo abantu abasha abanomdlavuza, futhi amakamu kanye neziqhwaga ziyatholakala.
Izwi elivela
I-Retinoblastoma iyisisu esiyinqaba ehilela izicubu zesisindo kule retina. Kwenzeka kakhulu kaningi ezinganeni ezincane kakhulu. Njengoba kungavamile, kubalulekile ukuthi izingane zibonwe emtholampilo womdlavuza omkhulu noma esibhedlela sezingane, esinolwazi olujwayele kakhulu ukwelashwa okungcono kwesifo. Isibikezelo esiphezulu sihle kakhulu, kodwa ukufika lapho kungabangela abazali nabazali ukucindezela ngokomzwelo, ngokomzimba nangokwezimali. Uma ngabe ingane yakho itholakale, finyelela ukusekelwa okutholakala.
> Imithombo:
> Fernandes, A., Pollock, B., no F. Rabito. I-Retinoblastoma e-United States: Ukuhlaselwa Kweminyaka Engama-40 Nokuhlaselwa Kwesinda. I-Journal ye-Pediatric Opthalmology ne-Strabismus . 2017. (i-Epub ngaphambi kokuphrinta).
> Friedman, D., Chou, J., Oeffinger, K. et al. Izimo Zengqondo Eziphuthumayo Eziphunyuka Ngabantu Abadala I-Retinoblastoma: Imiphumela Ye-Retinoblastoma Survivor Study. I-Cancer . 2016. 122 (5): 773-81.
> National Cancer Institute. I-Retinoblastoma Ukwelashwa (i-PDQ) -I-Professional Professional Version. Kubuyekezwe 09/19/17. https://www.cancer.gov/types/retinoblastoma/hp/retinoblastoma-treatment-pdq
> Parma, D., Ferrer, M., Luce, L., uGiliberto, F., no-I. Szijan. I-RB1 Gene mutations ku-Retinoblastoma yase-Argentine Iziguli. Umthelela wokululekwa kwe-Genetic. PLoS One . 2017. 12 (12): e0189736.
> I-Library Kazwelonke Kazwelonke Yezokwelapha. I-Genetics Home Reference. I-Retinoblastoma. 12/17/17. https://ghr.nlm.nih.gov/condition/retinoblastoma#sourcesforpage