I-Cancer Cancer

Ukuhlinzwa Komdlavuza Wesibindi E-Hyderabad, India

Amangqamuzana omdlavuza avela esibindini abangela umdlavuza wesibindi. Isibindi siyisitho esikhulu sendlala esenza umsebenzi wokukhipha ubuthi nezinto eziyingozi. Lesi sitho sitholakala engxenyeni engenhla kwesokudla sesisu, ngaphansi kwe-diaphragm, nangaphezulu kwesisu. Ukusefa kwegazi njalo kwenziwa esibindini, esibe sesisakazwa kuwo wonke umzimba. Lesi sitho siphinde sikhiqize i-bile, into esiza ekugayeni amavithamini, imisoco, amafutha, njll. Isibindi sibuye sigcine i-glucose esiza ngezikhathi lapho singadli. 

Ukukhula kwamangqamuzana omdlavuza kulesi sitho esibalulekile kuphazamisa imisebenzi ebalulekile eyenziwa yiso. Ngokukhula kwawo kancane kancane nangokunamandla, lawa mangqamuzana omdlavuza ayaphuka endaweni yokuqala asakazekele kwezinye izingxenye nezitho zomzimba. 

Nokho, kuvame ukuqashelwa ukuthi amangqamuzana omdlavuza asakazekela esibindini esuka kwezinye izitho avame kakhulu kunamangqamuzana omdlavuza avela esibindini. 

Izinhlobo Zomdlavuza Wesibindi

• I-Hepatocellular Carcinoma: Yaziwa nangokuthi i-hepatoma. I-HCC yisigaba esivame kakhulu somdlavuza wesibindi esitholakala kubantu abadala. Lokhu kwenzeka kuma-hepatocytes, amangqamuzana esibindi avelele. Amangqamuzana omdlavuza ku-HCC anamandla okusakazekela ezithweni ezahlukene zomzimba. Abantu abanomlutha wotshwala obunzima bangabhekana nosongo lwe-Hepatocellular carcinoma.
• I-Cholangiocarcinoma: I-Cholangiocarcinoma, eyaziwa nangokuthi umdlavuza we-bile duct, itholakala emiseleni emincane, efana neshubhu ekhona esibindini. Le mibhobho yenza umsebenzi wokuletha i-bile ku-gallbladder ukuze isize ngokugaya. Umdlavuza oqala emgudwini wenyongo ubizwa nge-intrahepatic bile duct cancer. Umdlavuza uvela ezingxenyeni zomgudu ongaphandle kwesibindi, bese waziwa ngokuthi umdlavuza we-extrahepatic bile duct. 
• I-Angiosarcoma yesibindi: Lolu uhlobo lomdlavuza olungandile olutholakala emithanjeni yegazi yesibindi. Lona umdlavuza oyingozi kakhulu osakazeka ngesivinini esishaqisayo. I-angiosarcoma yesibindi kunzima ukuyibona ezigabeni zokuqala futhi ivamise ukutholakala lapho isifike esigabeni esithuthukile.
• I-hepatoblastoma: Lolu uhlobo lomdlavuza oluyivelakancane, ngokuvamile olutholakala ezinganeni ezingaphansi kweminyaka emithathu. 

Izimpawu

Endabeni yomdlavuza wesibindi, izimpawu eziningi azibonakali ezigabeni zokuqala. Izimpawu eziba khona uma isithuthukile yilezi ezilandelayo:

• Ukulahlekelwa kwesifiso
• Ukuvota
• I-nausea
• Ukushintsha umbala ophuzi kwesikhumba
• Amhlophe emehlweni 
• Ubuhlungu besisu phezulu
• Ukulimala noma ukopha kalula
• Izihlalo ezimhlophe/ezinochaki
• Ukwehla kwesisindo kungazelelwe

Izimbangela

• Ukutheleleka okungapheli nge-HBV (igciwane le-Hepatitis B) noma i-HBC (igciwane le-Hepatitis C) kungaba yingozi yomdlavuza wesibindi.
• I-cirrhosis kungenye ingozi yomdlavuza wesibindi. Lesi yisimo esiqhubekayo futhi esingenakulungiseka esidala izicubu ezibomvu esibindini, ngaleyo ndlela, sandise ingozi yomdlavuza wesibindi. 
• Abantu asebevele benesifo sikashukela noma esinye isifo sikashukela nabo banosongo lomdlavuza wesibindi. 
• Ukunqwabelana kwamafutha esibindi kuyakhathaza.
• Ukuphuza kakhulu utshwala kungolunye usongo olunganezela engcupheni yomdlavuza wesibindi.
• Izifo ezithile zesibindi ezizuzwe njengefa likaWilson noma i-hemochromatosis nazo zingaholela kumdlavuza wesibindi.
• Ukuchayeka njalo kuma-aflatoxin kungadala umdlavuza wesibindi. Lawa ma-aflatoxin atholakala ezikhunjini ezikhula ezitshalweni ezitshalwe kabi. Lezi zitshalo zihlanganisa okusanhlamvu namantongomane. 

Prevention

1. Phuza utshwala ngokulinganisela. Kungcono ukuyeka ukuphuza, kodwa uma lokho kubonakala kungenakwenzeka, khona-ke umuntu angase aphuze utshwala ngesikhathi esilinganiselwe.
2. Gcina isisindo esinempilo. Ukuzivocavoca nsuku zonke kuzogcina umzimba ufanelekile futhi unempilo hhayi nje ngaphandle kodwa nangaphakathi.
3. Thola umuthi wokugoma i-hepatitis B. Lo mgomo ungathathwa yinoma ubani, okuhlanganisa izinsana, intsha, abantu abadala, nabantu abadala. 
4. Thatha izinyathelo ngokumelene ne-hepatitis C, njengoba kungekho mithi yokugomela efanayo. Lezi zinyathelo zingathathwa ngale ndlela elandelayo:

• Ungazibandakanyi ocansini olungaqinisekile nolungavikelekile. Kungcono ukuqaphela ukuthi umlingani ungenwe yini i-HBV, HCV, nanoma yisiphi esinye isifo esithathelwana ngocansi noma cha.
• Musa ukuzitika nge-IV (izidakamizwa ezifakwa emthanjeni). Uma lokhu kubonakala kungenakwenzeka, khona-ke umuntu kufanele asebenzise izinaliti ezihlanzekile. I-Paraphernalia, imbangela evamile ye-hepatitis C, ivame ukudluliselwa ngemithi ye-IV. 
• Ngenkathi uhlela ukwenza i-tattoo noma ukubhoboza, bheka izitolo ezihlanzekile. 

Sifo

• Ukuhlolwa kwegazi kuyisinyathelo sokuqala okufanele senziwe, okusiza ekuxilongeni nasekuvezeni noma yikuphi ukungahambi kahle ekusebenzeni kwesibindi.
• Enye indlela esetshenziselwa ukuhlonza ukuba khona komdlavuza wesibindi ukuhlola izithombe. Udokotela angancoma ukuhlolwa kwezithombe okuhlukahlukene okufana nama-x-reyi, i-MRI, i-ultrasound, nezikena ze-CT ukuze anqume ukuba khona kwanoma yikuphi ukukhula okungavamile kwamaseli esibindini.
• Ukukhipha isampula lesicubu esibindini ukuze sihlolwe. I-biopsy yenziwa, lapho udokotela efaka inaliti encane esibindini ukuze aqoqe isampula yethishu. Leli sampula libe selihlolwa elabhorethri ngaphansi kwesibonakhulu ukuze kuhlolwe ubukhona bomdlavuza. 

I-Pre-Op Yokwelashwa Komdlavuza Wesibindi

Ukulungiswa kwangaphambi kokuhlinzwa kokwelashwa komdlavuza wesibindi kuhlanganisa:

• Ukuhlolwa Kwezempilo
  • Umlando Wezempilo: Udokotela wakho uzobuyekeza umlando wakho wezokwelapha ukuze aqonde impilo yakho yonke kanye nanoma yiziphi izinkinga zesibindi zangaphambilini.
  • Ukuhlolwa Komzimba: Ukuhlolwa okuphelele ukuze ubone ukuthi umzimba wakho usebenza kanjani.
• Izivivinyo nezikena
  • Ukufanekisa: Ungase ube nokuhlolwa okufana nama-ultrasounds noma ama-CT scan ukuze ubheke isibindi futhi ubone usayizi nendawo yesimila.
  • Ukuhlolwa Kwegazi: Ukuhlolwa kuzokwenziwa ukuhlola ukusebenza kwesibindi sakho futhi ubheke noma yiziphi izifo.
• Ukuhlola Impilo Yesibindi
  • Udokotela wakho uzohlola ukuthi isibindi sakho sisebenza kahle kangakanani ukuze anqume uhlelo lokwelapha olungcono kakhulu.
• Ukubonisana
  • Oncologist: Hlangana nodokotela womdlavuza ukuze nixoxe ngezinketho zokwelapha kanye nalokho okufanele nikulindele.
  • Udokotela ohlinzayo: Uma kuhlelwa ukuhlinzwa, khuluma nodokotela ohlinzayo mayelana nenqubo kanye nanoma yiziphi izingozi.
  • I-Anesthesia: Uzohlangana nodokotela obulala izinzwa ukuze nixoxe ngezinzwa zokuhlinzwa.
• Imiyalelo ye-Pre-Op
  • Imithi: Udokotela wakho uzokutshela ukuthi yimiphi imithi okufanele uyiyeke noma uqhubeke ngaphambi kokuhlinzwa.
  • Ukudla: Kungase kudingeke ukuthi ugweme ukudla neziphuzo ngaphambi kwenqubo, futhi kubalulekile ukuba kude notshwala.
  • Yeka Ukubhema: Uma ubhema, kungcono ukuyeka ukuze usize ekululameni.
• Ukusekelwa Kwezengqondo Nezomzwelo
  • Ukuhlinzeka ngezinsizakalo zokwelulekwa nezeseka ukusiza iziguli kanye nemindeni yazo ekulawuleni ukuxilongwa kanye nokulungiselela ukwelashwa okuzayo.
• Imfundo yeziguli
  • Funda Ngenqubo: Qiniseka ukuthi uyakuqonda okuzokwenzeka ngesikhathi sokwelashwa futhi ubuze noma yimiphi imibuzo onayo.

Ukwelashwa

• Ukuhlinzwa: Ezimweni eziningi, odokotela basikisela ukuhlinzwa kuye ngeminyaka, impilo iyonke, kanye nokuthandwa komuntu siqu kwesiguli. Lokhu kuhlinzwa kungabandakanya ukukhishwa kwesimila esibindini. Enye inketho yokuhlinzwa ingabandakanya inketho yokufakelwa kwesibindi, lapho isibindi esinegciwane sithathelwa indawo isibindi esinempilo.  
• I-Radiation Therapy: Lokhu kusebenzisa imisebe yamandla aphezulu, njengama-x ray noma ama-proton, ukuze kuqedwe amaseli omdlavuza. Odokotela baqondisa le misebe esibindini esinegciwane. 
• Ukwelashwa Kwezidakamizwa Okuhlosiwe: Le nqubo igxile kokungajwayelekile kumaseli omdlavuza. Lokhu okungavamile kuyavinjwa ukuze kumiswe ukukhula kwamangqamuzana omdlavuza.
• Ukwelashwa ngamakhemikhali: Lena indlela lapho izidakamizwa zisetshenziswa ukubulala ukukhula okunamandla kwamangqamuzana omdlavuza. Le mithi ingasetshenziswa ngomthambo noma ingathathwa njengamaphilisi.
• immunotherapy: Yindlela esebenzisa amasosha omzimba ukuvimba nokubulala amangqamuzana omdlavuza. Lokhu ngokuvamile kusetshenziswa ezigabeni eziphambili zomdlavuza wesibindi. 
• Ukwelashwa Kwendawo: Lezi ziqondiswa ngokuqondile kumaseli omdlavuza futhi zihlanganisa:
  • Ukushisa amangqamuzana omdlavuza. Ngale ndlela, i-radiofrequency ablation isebenzisa amandla kagesi ukuze kushise futhi kucekele phansi amangqamuzana omdlavuza. Ngosizo lwe-ultrasound, udokotela ufaka inaliti/izinaliti ezindaweni ezincane ezisesiswini, ezishiselwa ngamandla kagesi ukuze zibulale amangqamuzana omdlavuza. 
  • Ukuqandisa amangqamuzana omdlavuza. Ngale ndlela, i-cryoablation isebenzisa amakhaza amakhulu ukubulala amangqamuzana omdlavuza. Insimbi, umzimba we-cryo ogcwele i-nitrogen ewuketshezi, iqondiswe kumathumba esibindi. 
  • Ukujova utshwala esimila. Utshwala obumsulwa buqondiswe ezimila zesibindi. Lobu tshwala buzosiza ekubulaleni amangqamuzana omdlavuza.
  • Ukubeka ubuhlalu bemisebe ngaphakathi kwesibindi. Ama-sphere aqukethe imisebe afakwa esibindini. Le misebe iqondiswe esibindini, ibulale amangqamuzana omdlavuza. 

I-Post-Op Recovery Yomdlavuza Wesibindi

Ukululama ngemva kokuhlinzwa ngemva kokwelashwa komdlavuza wesibindi kuyisigaba esibalulekile esingathinta impilo yonke kanye nokuphulukiswa. 

• Ukuqapha Kwangemva Kokuhlinzwa: Ukubheka Vala endaweni yokululama, ikakhulukazi ukugxila ezimpawini ezibalulekile nokusebenza kwesibindi.
• Ukuphathwa Kwezinhlungu: Ukuphatha amasu okusiza ubuhlungu obusebenzayo ukubhekana nokungakhululeki kwangemva kokuhlinzwa.
• Ukululama kanye Nokuvuselela: Nikeza imiyalelo mayelana nokudla, amazinga omsebenzi, nokunakekelwa kwenxeba ukuze kuphole ngempumelelo ngemva kokuhlinzwa.
• Ukunakekelwa Kokulandelela: Ukuhlela ukuvakasha kokulandelela okungaguquki ukuze ulandelele inqubekelaphambili yokululama futhi uhlonze noma yiziphi izimpawu ezingaba khona zokuphindelela komdlavuza.
• Ukuphathwa Kwezempilo Kwesikhathi Eside: Itusa ukulungiswa kwendlela yokuphila, izinguquko zokudla, nokuhlolwa kwezempilo okuvamile ukuze kuthuthukiswe impilo eqhubekayo.
• Ukwesekwa Okuqhubekayo Nokwelulekwa: Ukunikeza ukusekelwa okuqhubekayo ngokomzwelo nangokwengqondo ezigulini nemindeni yazo ngemva kokwelashwa.

Izigaba Zomdlavuza Wesibindi

Umdlavuza wesibindi uvame ukuhlukaniswa ngezigaba eziningana ngokuya ngosayizi wesimila, inani lamathumba, nokuthi umdlavuza ususabalele yini. 

• Isigaba 0 (I-Carcinoma eSitu)
  • Lesi yisigaba sokuqala lapho amangqamuzana omdlavuza atholakala endaweni encane yesibindi kuphela kodwa angasakazeki ngale kwaleyo ndawo.
  • Izici: Kungase kungabi khona izimpawu eziphawulekayo. Ukwelashwa kungase kusebenze kakhulu kulesi sigaba.
• Isigaba A: Isigaba sokuqala
  • Kulesi sigaba, kukhona isimila esisodwa esingu-2 cm noma ngaphansi.
  • Izici: Umdlavuza awusabalele emithanjeni yegazi eseduze noma ama-lymph nodes. Ngokuvamile azikho izimpawu, futhi ukubikezela ngokuvamile kuhle.
• Isigaba B: Isiteji Esiphakathi
  • Lesi sigaba singabandakanya noma:
    • Isimila esisodwa esingaphezu kuka-2 cm.
    • Ithumba elingaphezu kwelilodwa, kodwa alikho elikhulu kuno-5 cm.
  • Izici: Umdlavuza awukasabalali emithanjeni yegazi eseduze noma ama-lymph nodes. Ezinye izimpawu zingase ziqale ukubonakala.
• Isigaba C: Isiteji Esithuthukile
  • Isigaba III sihlukaniswe izigaba ezimbili:
    • Isigaba IIIA: Isimila sisabalele emithanjeni yegazi eseduze noma kukhona izimila eziningi, okungenani elilodwa lawo likhulu kuno-5 cm.
    • Isigaba IIIB: Umdlavuza ususabalele ezithweni eziseduze noma ezicutshini.
  • Izimpawu: Izimpawu zingase zibonakale kakhulu, kuhlanganise nokuncipha kwesisindo, ubuhlungu besisu, kanye ne-jaundice (isikhumba namehlo aphuzi).
• Isiteji D: Isiteji Sokuphela (Itheminali)
  • Lesi yisigaba esithuthuke kakhulu futhi siphinde sehlukaniswe izigaba ezimbili ezincane:
    • Isigaba IVA: Umdlavuza ususabalele kuma-lymph nodes aseduze kodwa hhayi ezithweni ezikude.
    • Isiteji IVB: Umdlavuza ususakazekele ezithweni ezikude, njengamaphaphu noma amathambo.
  • Izici: Kulesi sigaba, iziguli zivame ukuba nezimpawu ezinzima kakhulu futhi zingadinga ukunakekelwa kwe-palliative ukuze zilawule ubuhlungu futhi zithuthukise izinga lokuphila.

Ukwelashwa NgokweSigaba Somdlavuza Wesibindi

Ukwelashwa komdlavuza wesibindi kuncike kakhulu esigabeni sesifo, ukusebenza kwesibindi sesiguli, kanye nempilo yonke. Nazi izindlela zokwelapha ezisuselwa ezigabeni zomdlavuza wesibindi ngokohlelo lwesiteji lwe-Barcelona Clinic Liver Cancer (BCLC):

• Isigaba 0: Isigaba Sasekuqaleni Kakhulu
  • Ukuhlinzwa: I-hepatectomy eyingxenye (ukususwa kwesimila kanye nengxenye yezicubu zesibindi esinempilo) kungase kucatshangelwe uma isimila sisincane futhi isibindi sisebenza kahle.
  • Ukufakelwa Kwesibindi: Kulungele iziguli ezinamathumba amancane kanye nesifo sesibindi esingaphansi, njengoba kususa kokubili isimila kanye nesibindi esigulayo.
  • I-Ablation Therapy: Amasu afana ne-radiofrequency ablation (RFA) noma i-microwave ablation (MWA) angabhubhisa izimila ezincane.
• Isigaba A: Isigaba sokuqala
  • Ukuhlinzwa: I-hepatectomy eyingxenye yesimila esisodwa noma ukufakelwa kwesibindi uma kufanele.
  • Ukukhipha: I-RFA noma i-MWA ingase isebenze kumathumba amancane.
  • I-Transarterial Chemoembolization (TACE): Lokhu kuhilela ukuletha ukwelashwa ngamakhemikhali ngqo esimila kanye nokuvimbela ukutholakala kwegazi, okusebenzayo ezigulini ezingafanelekile ukuhlinzwa.
• Isigaba B: Isiteji Esiphakathi
  • I-TACE: Lena indlela yokwelapha eyinhloko yeziguli ezinamathumba amaningi ezingakulungele ukuhlinzwa noma ukufakelwa kabusha.
  • I-Ablation: I-RFA noma i-MWA isengasetshenziselwa izimila ezincane uma zingaphansi kokuthathu.
  • Izivivinyo Zomtholampilo: Ukubamba iqhaza ezivivinyweni zomtholampilo zokwelashwa okusha kungase kube inketho.
• Isigaba C: Isiteji Esithuthukile
  • Ukwelashwa Kwesistimu:
    • Ukwelapha Okuhlosiwe: Izidakamizwa ezifana ne-sorafenib (Nexavar) noma i-lenvatinib (i-Lenvima) zingasetshenziswa ukunciphisa ukukhula kwesimila nokusabalala.
    • I-Immunotherapy: Ama-ejenti afana ne-atezolizumab (Tecentriq) ahlanganiswe ne-bevacizumab (Avastin) abonise isithembiso ekwelapheni i-HCC ethuthukisiwe.
  • I-TACE: Lokhu kusengasetshenziselwa ukuphatha izimpawu nokulawula ukukhula kwesimila.
  • Ukunakekelwa Kwe-Palliative: Gxila ekudambiseni izimpawu nasekuthuthukiseni izinga lempilo.
• Isiteji D: Isiteji Sokuphela (Itheminali)
  • Ukunakekelwa Kwe-Palliative: Gxila ekunethezekeni kanye nekhwalithi yokuphila. Lokhu kungase kuhlanganise ukuphathwa kwezinhlungu, ukwesekwa kokudla okunomsoco, nokusekelwa kwengqondo.
  • Ukulawulwa Kwezimpawu: Ukwelashwa kokulawula izimpawu ezifana ne-jaundice, ama-ascites (ukunqwabelana koketshezi esiswini), kanye nobuhlungu.

Amazinga Empumelelo Okwelashwa Kwesibindi e-India

Ukwelashwa komdlavuza wesibindi eNdiya kwaziwa ngokufinyeleleka kwazo uma kuqhathaniswa nezizwe zaseNtshonalanga, okwenza leli lizwe libe yisinqumo esidumile kwezokuvakasha kwezokwelapha emhlabeni wonke. Amazinga empumelelo ayahluka ngokuya ngesigaba somdlavuza, uhlobo lokwelashwa, kanye nekhwalithi yezikhungo zokunakekelwa kwempilo. Ingqalasizinda yokunakekelwa kwezempilo yase-India kanye nochwepheshe bezokwelapha abaqeqeshwe kakhulu babe negalelo ekuthuthukisweni kwemiphumela yokwelashwa, ikakhulukazi ezindaweni zasemadolobheni ezihlome ngezikhungo zezokwelapha ezithuthukile.

Izingozi Ezihlobene Nokwelashwa Komdlavuza Wesibindi

Izinto ezihambisana nezingozi ezihilelekile ekwelapheni umdlavuza wesibindi zihlanganisa:

• Izingozi Zokuhlinzwa: Izinkinga ezingaba khona ezifana ukuphuma, ukutheleleka, kanye nokulimala kwezitho ezizungezile phakathi nezinqubo zokuhlinzwa ezifana nokukhishwa kwesibindi noma ukufakelwa.
• I-Chemotherapy Side Effects: Imiphumela emibi efana ne isicanucanu, ukukhathala, ukulahlekelwa izinwele, kanye nezibalo ezincishisiwe zamangqamuzana egazi kungenzeka ngemithi yokwelapha ngamakhemikhali esetshenziselwa ukwelapha umdlavuza wesibindi.
• Izingozi Zokwelashwa Ngemisebe: Ukulimala okungenzeka ezicutshini ezinempilo ezizungeze indawo yesimila, okuholela emiphumeleni engemihle njengokukhathala, izinguquko zesikhumba, nezimpawu zesisu.
• Ukukhubazeka Kwesibindi: Izindlela zokwelapha zingase zithuthukise ukusebenza kwesibindi, ikakhulukazi ezigulini ezinesifo sesibindi esivele sikhona noma i-cirrhosis.
• Izinkinga ze-Immunotherapy: Izehlakalo ezimbi ezihlobene namasosha omzimba njengokuvuvukala kwezitho kanye nokusabela kwesikhumba kungavela emithini ye-immunotherapy esetshenziselwa ukwelapha umdlavuza wesibindi.
• Ukuqapha Ngemva Kokwelashwa: Ukuqapha njalo kubalulekile ukuze kutholwe ukuphindeka noma ukukhula kwezimila ezintsha, okudinga ukungenelela kwezokwelapha okuqhubekayo.