Izinketho zokwelapha zomdlavuza ongasondleki zixhomeke esiteji somdlavuza futhi zingase zibandakanye ukuhlinzeka (ukususa ingxenye noma yonke isifo), ukwelashwa kwemithi, imithi yokwelapha, ukuxilongwa okuhlosiwe, noma ukuhlanganiswa kokuhlolwa kwezivivinyo zalezi zindlela noma izifo ezintsha.
Kodwa ukwelashwa kudlula nje ukwelapha umdlavuza, futhi ukunakekelwa okunakekelwayo noma okusekela okuhloswe ukusiza abantu ukuba babhekane nemiphumela emibi ngokomzimba, ngokomzwelo nangokomoya yomdlavuza-kubalulekile ngokufanayo.
Ukukhetha Isikhungo Sokwelapha
Kungakhathaliseki ukuthi uzohlinzwa noma ezinye izifo, ukuthola isikhungo esihle somdlavuza kubalulekile. Ucwaningo luka-2017 ku- Annals of Surgery luqinisekisile ukuthi yiziphi izifundo zangaphambili ezibonisiwe. Abacwaningi bathola ukuthi abantu abanomdlavuza wokuqeda ukuhamba emigwaqeni emide kuya ezikhungweni zomdlavuza eziphakeme kakhulu bathola ukwelashwa okuhluke kakhulu futhi banemiphumela engcono kunelabo abahlala eduze nasekhaya ezikhungweni zomdlavuza eziphatha abantu abambalwa abanesifo.
Ungase ucabange ukhetha ukufuna umbono kwelinye leNational Cancer Institute-izikhungo zomdlavuza ezikhethiwe; izikhungo eziphatha izinqwaba zabantu abanomdlavuza we-esophageal (futhi kulabo abahlinzwa, benza okunye kwalokhu kuhlinzwa).
Izinketho zokwelapha ngesigaba
Ngaphambi kokungena ezikhethweni ezithintekayo zokwelashwa ezitholakalayo, kuyasiza ukuxoxa ngezinqubo ezivame ukusetshenzwa ngezigaba ezahlukene zesifo.
Zingahluka ngokuphawulekayo.
Abantu ababili abanesigaba esifanayo sesifo, isibonelo, bangase babe namagciwane ezifundeni ezihlukene ezizodinga ukwelashwa okuhlukile. Ngisho ne-kansela efana nendawo, isiteji, kanye nabantu abanempilo ejwayelekile efanayo, kubalulekile ukuqaphela ukuthi akukho khansela ezimbili ezifanayo.
Lokho kusho ukuthi indlela ejwayelekile yile ndlela elandelayo.
Isigaba 0
Isigaba 0 (i- carcinoma in situ ) noma isigaba esincane kakhulu 1A amagciwane angase asuswe ngesinye isikhathi nge-endoscopy. E-United States (ngokungafani nezinye izingxenye zomhlaba), umdlavuza we-esophageal awuvamile futhi awutholakali esiteshini kusenesikhathi ukuze kususwe i-endoscopic. Ukuhlinzwa kungasetshenziselwa lezi zicubu.
Isigaba 1
Ukwelashwa kuvame ukwelashwa okukhethiwe emdlalweni wegciwane lesigaba 1 futhi kungaba yilapho kuphela ukwelashwa okudingekayo kwezinye izimo.
Isigaba 2 no-3
I-Chemotherapy ne-radiation (noma i-chemotherapy yedwa) elandelwa ukuhlinzwa kuyindlela evame kakhulu, nakuba ngezinye izikhathi ukuhlinzwa kuphela, noma i-chemotherapy yedwa, ingasetshenziswa. Kukhona okwamanje ukuphikisana ngokuthi ngabe abantu abane-squamous cell carcinomas of the esophagus abanempendulo ephelele (akukho bufakazi besisu) ngemva kwekhemotherapy besadinga ukuhlinzwa.
Isigaba 4
Ngezifo ze-4A ze-cancer, i-chemotherapy kanye nokwelashwa kwemisebe ngezinye izikhathi kungalandelwa ukuhlinzwa (uma isifo sofuba siphendula kahle). Ukuze igciwane lesigaba 4B, i-chemotherapy ngezinye izikhathi kungabangela impendulo eyingxenye.
Abanye abantu bakhathazeka ngokuthi, ngenxa yobudala, ukwelashwa kuyoba nomfutho omkhulu, kodwa abantu abadala (abangaphezu kweminyaka engu-80) abanempilo enhle ejwayelekile babonakala bebekezelela imithi yokwelapha kahle futhi banesilinganiso sokusinda esinjengabantu abasha.
Ukuhlinzwa
Lapho kutholakala ezinyathelweni zokuqala zesifo, ukuhlinzwa kungase kube nomthelela wokuthola ukwelashwa. Ngaphambi kokucubungula ukuhlinzwa, ukulinganisa ngokucophelela kubaluleke kakhulu. Ngeshwa, uma umdlavuza usakaze ngaphesheya kwesigcawu, ukuhlinzwa akukhulisi ukusinda kodwa kunciphisa izinga lokuphila. Ngakho-ke kubalulekile ukuthola ukuthi ubani ozozuza ngokuhlinzwa.
Okubaluleke kakhulu ukuthola udokotela ohlinzayo owaziwa kakhulu ekwenzeni lezi zindlela zokuhlinza. Ngenkathi izikhungo ezinkulu zomdlavuza ziningi amathuba okuba nodokotela ohlinzayo abanolwazi olubanzi, kubalulekile ukuthatha isikhathi "sokuxoxa" nodokotela ohlinzayo ongase abe nakho mayelana nokuhlangenwe nakho kwakhe siqu ngokuhlinzeka ngokweqile.
Izinqubo
I-esophagectomy, ukuhlinzekwa okwenziwe ukususa umdlavuza we-esophageal, ibhekisela ekususweni kwayo yonke noma ingxenye yendawo. Kwezinye ukwelapha, ikakhulukazi ezisezingeni eliphansi, ingxenye yesisu isusiwe kanye. Ngaphezu kwalokho, ama-lymph nodes eseduze asuswe futhi athunyelwe ebhodini lokugula ukuze afune noma yibuphi ubufakazi bomdlavuza.
Ngemuva kokuthi isigaba sesisu sisusiwe, isisu sinamathele emkhakheni ophezulu (igama elichaza ukuthi ukuthunga lokhu kuhlanganisa "i-anastomosis"). Uma ingxenye enkulu ye-esophagus isusiwe ukuze ukunamathisela kunzima noma kungenzeki, isigaba samathumbu singasuswa futhi sibekwe phakathi kwesimo sangasese nesisu.
I-esophagectomy ingenziwa ngezindlela ezimbili ezahlukene:
- Vula i-esophagectomy: Ngenqubo evulekile, ukukhwabanisa okukhulu kwendabuko kwenziwa entanyeni, esifubeni, noma esiswini (noma ngezinye izikhathi kufaka zonke izinto ezintathu) lapho i-esophagus ifinyelelwa khona.
- I-esophagectomy encane encane: Inqubo encane encane, ukufakwa okuncane ezincane kufakwa entanyeni nasesifuba. Isilinganiso (ngekhamera) sifakwa ngalezi ziboniso futhi ukuhlinzwa kwenziwa ngezinga. Ukuhlinzwa okuncane okungenasidingo ngokuvamile kuvame ukutholakala nezicubu ezincane ezingasondleki.
Imiphumela emibi nezinkinga
Ukususa ingxenye yendawo yokuhlinzwa kuyinkimbinkimbi enkulu kanye nezinkinga akuvamile. Phakathi nokuhlinzwa, izingozi ezivame kakhulu zibandakanya ukuphuma kwegazi kanye ne-anesthesia ezinjengezinhliziyo ezingavamile nezinkinga zamaphaphu.
Ezinsukwini ezilandelayo ukuhlinzwa, ama-clots egazi ajwayelekile kakhulu ( ama-thromboses ajulile ) kanti ngezinye izikhathi angase ahambe ahambe aye emaphashini ( amapulmary emboli ). Izifo ezinjenge-pneumonia zivame ukuphulukiswa nokuvuza (futhi ukutheleleka okulandelayo nokuvuvukala) kungase kwenzeke ngezikhathi ezithile lapho i-esophagus ixhunyaniswe khona.
Isikhathi eside, abanye abantu baqhubeka behlaselwa ngenxa yokulimala kwezibilini esifubeni ngesikhathi sokuhlinzwa. Umonakalo wezinzwa nakho kungabangela izinguquko ku-motility engxenyeni engenhla yokugaya okungase iholele ekusikeni kwesisulu nokuhlanza. Njengoba i-sphincter esezansi ephansi (i-band of muscle engaphansi kwesigcawu esivimbela okuqukethwe kwesisu ekusekeleni kwesinye isisu) ivame ukususwa noma ukulimala, ukushaya isisu kuvamile, futhi abantu abaningi bayodinga imithi ye-acid reflux.
I-Chemotherapy
I-Chemotherapy isebenza ngokuhlasela amangqamuzana ahlukanisa ngokushesha futhi inganikezwa ngezindlela ezimbalwa ngomdlavuza we-esophageal. Lokhu kufaka:
- I-Neoadjuvant chemotherapy: I- Neoadjuvant chemotherapy ibhekisela ekusetshenzisweni kwe-chemotherapy ngaphambi kokuhlinzwa ukuze kunciphise ubukhulu besisu.
- I-Adjuvant chemotherapy: I- Adjuvant chemotherapy ibhekisela kuma-chemotherapy anikezwe ngemuva kokuhlinzwa. Ngisho noma kungabonakali ukuthi kunomdlavuza osele ngemuva kokuhlinzwa, amaqoqo amancane amangqamuzana omdlavuza angasala futhi abuyise ekuphindeni emuva kwesikhathi. I-Chemotherapy emva kokuhlinzwa inganciphisa ingozi yokuphindaphinda futhi ikhulise ukusinda kwabanye abantu.
- I-chemotherapy enama-palliative: I- palotherapy chemotherapy ibhekisela ekusebenziseni i-chemotherapy ukulawula izimpawu nokukhulisa impilo ngesigaba sesine, kepha hhayi ukuphilisa lesi sifo. Ngesikhathi samanje, i-chemotherapy (ngisho nalapho ihlangene nemisebe) ingakhuphula ubude bokusinda kodwa kungenzeka ukuthi ingelapheki lesi sifo.
Uma ukucutshungulwa kucatshangelwa, indlela ejwayelekile kakhulu ukunikeza i-chemotherapy (noma ngaphandle kokwelashwa kwemisebe) ngaphambi kokuhlinzwa (i-adjuvant chemotherapy noma i-chemoradiation). Kunezizathu eziningana zalokhu.
- Udokotela wakho angaqinisekisa ukuthi i-chemotherapy iyasebenza kunokuba ufunde emva kokuhlinzwa uma kungenjalo.
- I-Chemotherapy ivame ukubekezelela kangcono ngaphambi kokuhlinzwa ngaphandle kokuhlinzwa.
- I-neoadjuvant chemotherapy ingase ihlehlise isisu (yenza kube mncane) ukuze kwenziwe lula ukuhlinzwa.
- Okokugcina, kwabanye abantu (ikakhulukazi labo abane-squamous cell carcinomas), lesi sifo singase sinyamalale ukuze ukuhlinzwa kungadingeki.
Imithi ye-Chemotherapy evame ukusetshenziselwa ihlanganisa i-Paraplatin (carboplatin) ne-Taxol (paclitaxel) noma iPlatinol (cisplatin) ne-Camptosar (i-irinotecan). Esikhathini esidlule, imishanguzo ye-5-FU (5 fluorouracil) yayivame ukusetshenziswa, kodwa ijwayele ukuba yingozi kakhulu.
I-Chemotherapy Side Effects
Njengoba kunemithi yokwelashwa eminingi kangaka, kubalulekile ukukhumbula ukuthi imiphumela emibi yokwelapha umngane noma ilungu lomndeni kungenzeka ukuthi wazibonela esikhathini esidlule, akusebenzi neze ekunakekeleni kwesifo samanje. Izidakamizwa ze-Chemotherapy zivame ukunikezwa ngemigqa (isibonelo, njalo ngemva kwamasonto amathathu), izinyanga ezine kuya kweziyisithupha.
Imiphumela eminingi emibi ingenxa yezidakamizwa ezibulala amaseli avamile ahlukanisa ngokushesha kanye namaseli omdlavuza. Imiphumela emibi evamile ihlanganisa:
- Igazi eliguquguqukayo libala: Ukubala okuphansi kwegazi ( ukukhishwa kwe-bone lomnkantsha ) okuholela ekubaleni kwegazi eliphansi eliphansi (i- neutropenia ), isibalo esincane esibomvu segazi (i- anemia ), kanye nesibalo esiphansi se-platelet ( thrombocytopenia ).
- Ukulahleka kwezinwele: Izidakamizwa ezingase zidale ukushaywa izinwele azivame ukusetshenziselwa umdlavuza wokuqeda (ngaphandle kweCamptosar) kodwa ngokuvamile zibangele izinwele ezicwilisayo.
Ukudabuka nokuhlanza : Bheka ngezansi.
- I-neuropathy ye-peripheral: Ukulinganisa, ukuphazamiseka, nokuzwa ubuhlungu, ngokuvamile ukusabalalisa "ukubeka impahla nokugaya".
- Izilonda zomlomo kanye nokushintsha kwendabuko
- Ukukhathala
Njengoba nje izidakamizwa zamakhemikhali asetshenzisiwe namuhla zingaphansi kobuthakathaka, ukuphathwa kwemiphumela emibi kuye kwaba ngcono kakhulu. Abantu abaningi banesiphambeko esincane noma asikho kanye nokuhlanza ngemithi yokuvimbela. Kunezijova ezitholakalayo zokwandisa isibalo segazi elimhlophe uma kudingeka (nakuba kubalulekile ukufunda ngezindlela zokunciphisa ingozi yokutheleleka ngesikhathi se-chemotherapy ).
I-peripheral neuropathy (PN), ingenye yezimpawu ezicasula kakhulu ze-chemotherapy ngenxa yomdlavuza we-esophageal futhi ngokuvamile uhlala unomphela. Izidakamizwa ezihlobene kakhulu ne-PN zibandakanya ama-taxanes (njenge-Taxol), kanye nezidakamizwa ze-platinum (njengePlatinol neParaplatin). Njengoba inhlanganisela yalezi zivame ukusetshenziswa, umphumela ungadalwa.
Kunezifundo eziningi eziqhubekayo zibheke izindlela zokunciphisa lesi sibonakaliso (njengokusebenzisa i- L-glutamine ngenkathi ukwelashwa), futhi abantu kufanele bakhulume nodokotela babo mayelana nocwaningo lwamuva ngaphambi kokuba baqale imithi ye-chemotherapy.
I-Radiation Therapy
Ukwelashwa kwezidakamizwa kusebenzisa imisebe yamandla aphakeme ukuphatha amangqamuzana omdlavuza futhi kuvame ukusetshenziswa kanye ne-chemotherapy. Ukwelashwa kwezidakamizwa nakho kungasetshenziselwa ukunambitheka (bheka ngezansi). Inikezwa ngezindlela ezimbili eziyinhloko:
- Imisebe yangaphandle yesibhakabhaka: Imisebe yangaphandle yesibhamu yindlela abantu abaningi abajwayele ngayo, futhi banganikezwa nsuku zonke izinsuku ezimbalwa noma amasonto.
- I-Brachytherapy (yangaphakathi) yokwelashwa kwemisebe: Nge-brachytherapy, i-endoscopy yenziwa ukuze imisebe ibekwe eduze kwe-tumor ngaphakathi kwendawo. Yenziwa kaningi njengendlela yokwelapha elula ukusiza ngokugwinya.
Imiphumela emibi yomswakama
Imiphumela emibi kakhulu ye-radiation therapy kuya esifubeni yilapho isikhumba sivuvukala futhi kuhlaselwa endaweni yesimiso semisebe (njengokufana nokushisa kwelanga) nokukhathala . Ukushiswa kwesibindi esifubeni kungabangela ukuvuvukala kwamapayipi (i- radiation pneumonitis ). Uma ungaphathwa kabi ungaholela ku-fibrosis yamaphaphu. Ukuvutha kwesifo ( pulmonary fibrosis ) kungase kwenzeke.
Ukwelashwa okubhekiswe
Ukwelapha okulindelekile kusebenzisa izidakamizwa njengokwelashwa kwamakhemikhali, kepha izidakamizwa "zibhekiswe" emgwaqweni othile ekukhuleni kwamangqamuzana omdlavuza. Ngenxa yalesi sizathu kaningi babe nemiphumela emibi kakhulu kunezidakamizwa zendabuko ye-chemotherapy.
I-Cyramza (ramucirumab)
I-Cyramza i-anti-monoglonal antibody ebizwa ngokuthi i-angiogenesis inhibitor. Ukuze izikhumba zikhule, zidinga ukwakha imisha yegazi entsha ( angiogenesis ). Isidakamizwa sigwema isinyathelo esidingekayo ukwakha izitsha ezintsha.
I-Cyramza isetshenziswa kaningi uma ezinye izifo zingasasebenzi futhi zingasetshenziswa noma ngaphandle kwe-chemotherapy. Imiphumela emibi ingase ihlanganise ikhanda kanye nomfutho wegazi ophakeme kodwa ngezinye izikhathi izimpawu ezinzima, njengokuphuma kwegazi noma ukugaya emathunjini, kungenzeka.
Ngokwezifundo zango-2017, kuzo zonke izindlela zokwelashwa zamakhemikhali nokwelashwa okuhlosiwe, i-Cyramza ibonisa ngokucacile ikhono lokuthuthukisa kokubili ukusinda-mahhala okuqhubekayo nokuphila okuphelele kubantu abanezinga eliphezulu (isigaba 4) se-adenocarcinoma esophageal.
I-Herceptin (i-trastuzumab)
I-Herceptin isetshenziselwa ngezikhathi ezithile izidakamizwa ezisezingeni eliphakeme ze-adenocarcinomas ezingama-HER2 positive (afana nomdlavuza webele we-HER2).
Ukuvivinywa kwe-HER2 kwenziwa ngesampula sesitholampilo esitholwe ngesikhathi se-biopsy noma ukuhlinzwa. Lezi zomshukela zinesiprotheni HER2 ebusweni beseli, lapho izici zokukhula zibopha futhi zibangele ukukhula. I-Herceptin ibopha kulezi zitholampilo ukuze izimo zokukhula zingakwazi, ngokuyinhloko zilambile umdlavuza.
Imiphumela emibi kaningi ibumnene, njenge-headache nomkhuhlane, futhi ngokuvamile kuvame ukuhamba ngesikhathi. Isidakamizwa, ngezinye izikhathi, singabangela ukulimala kwenhliziyo. Udokotela wakho uzoxoxa ngengozi yalokhu.
Izivivinyo zemitholampilo
Kukhona okwamanje ukuvivinywa kwemitholampilo okuqhubekayo kubheka izinhlanganisela zokwelashwa okungenhla, kanye nezinqubo ezintsha zokwelapha ezifana nemithi yokuzivikela e-immunotherapy .
Nakuba ukuhlanganyela ocwaningweni locwaningo kungasabisa abanye abantu, kuyasiza ukukhumbula ukuthi yonke imithi esiphila ngayo manje ngomdlavuza we-esophageal yabuye yafundiswa esilingo somtholampilo.
Imithi Ephelele (CAM)
Ngesikhathi samanje, akukho "izindlela" zokwelapha ezandisa ukusinda noma kubangele ukwelashwa kubantu abanomdlavuza wokuqeda. Lokho kusho ukuthi ezinye izindlela zokwelashwa zingasiza ngezibonakaliso zomdlavuza nemithi yomdlavuza uma kuhlanganiswe nemithi ejwayelekile.
Eziningi zezikhungo zomdlavuza ezinkulu manje zinikeza lezi zindlela zokwelapha ezihlukile zomdlavuza kanye nokwelapha okuvamile ngomdlavuza. Imithi efana nokuzindla, i-yoga, i-acupuncture, i-massage therapy, nokunye okuningi ngezinye izikhathi kungasiza abantu ukuba babhekane nezinselele zomzimba nezingokomzwelo ezihambisana nokuxilongwa komdlavuza.
Ukunakekelwa kwe-Palliative
Ukunakekelwa kwe-palliative kuhluke ekunakekelweni kwe-hospice ngoba kungasetshenziswa ngisho nabantu abafuna ukuphulukiswa emdlalweni wabo. Ukukhathazeka okugxile ekusizeni abantu ukuphatha izimpawu zomzimba nezomzwelo ezihlobene nomdlavuza kanye nemithi yokwelashwa, kusukela ekubukeni komdlavuza kuya ekucindezelekeni.
Ukulukhuni ukugwinya ngenxa yokuvinjelwa kwesifo sofuba kuyavame ukuba nomdlavuza we-esophageal futhi kuphazamise ukudla okunempilo efanele. Uma isisu sithuthukile kakhulu ekuhlinzeni (esophagectomy) kunamathuba okunciphisa izinkinga ngokugwinya. Ezinye zazo zihlanganisa:
- Ukubeka i-stent esiteshini (nge-endoscopy) ukugcina i-oophagus evulekile.
- I-Brachytherapy (imisebe yangaphakathi) ekhonjiwe ngenhla.
- Ukwelashwa kwemisebe yangaphandle ye-beam.
- I-Electrocoagulation (ishisa indawo yesikhumba esidala isithintelo).
- Ukwelashwa kwe-Laser.
Izikhungo eziningi zomdlavuza manje zinikeza inhlangano eqenjini lokunakekela. Ukusebenza ngumpilisi wokunakekelwa kwezinhliziyo eziphuthumayo ngokuvamile kukhulisa amathuba okuthi izimpawu zakho zizolawulwa kahle nokuthi izinga lakho lokuphila lingaba ngcono ngangokunokwenzeka ngenkathi uhlala nomdlavuza.
> Imithombo:
> Bast, R., Croce, C., Hait, W. et al. Holland-Frei Cancer Medicine. UWiley Blackwell, ngo-2017.
> Janmaat, V., Steverberg, E., van der Gaast, A. et al. I-Palliative Chemotherapy kanye Nezokwelapha Ezihloswe Ngomdlavuza We-Esophageal and Gastroesophageal Junction. I-Cochrane Database yezibuyekezo ezihleliwe . 2017. 11: CD004063.
> National Cancer Institute. I-Esophageal Cancer Treatment (PDQ) -Health Professional Version. Kubuyekezwe 02/06/18.
> Speicher, P., Englum, B., Ganapathi, A. et al. Ukuya esikhungweni se-High-Volume kuhlotshaniswa nokusinda okuthuthukisiwe kweziguli ezine-Canophageal Cancer. Ama-Annal of Surgery . 2017. 265 (4): 743-749.