I-oncology yezingane ishintshe kakhulu emashumini eminyaka amuva nje: namuhla Iningi lezingane kanye nentsha enomdlavuza liyaphulukiswa.Kodwa le mpumelelo iza ngentengo ngesimo semiphumela yesikhathi eside engahambisana nabo impilo yabo yonke. Kulesi simo, indima yokunakekelwa okuyisisekelo isibe yinto ebalulekile, kokubili ekutholeni umdlavuza kusenesikhathi kanye nokuqapha eduze abasindile kanye nokulindela imiphumela engase ifike sekwephuzile.
Udokotela wezingane we Ukunakekelwa Okuyisisekelo Nguye omazi kangcono umntwana nomndeni wakhe.Uchwepheshe, oqaphela ukuvela kwalesi sifo ngokuhamba kwesikhathi, uthola izinguquko ezincane ekuziphatheni noma ekusebenzeni kwesikole futhi uba semgqeni ophambili lapho kuvela izimpawu ezingacacile kodwa eziqhubekayo. Amandla abo okusola kusenesikhathi, ukusebenzisana ne-cancer yesibhedlela, kanye nokunikeza ukwesekwa okuqhubekayo kwabasindile ngokuyinhloko kunquma ikhwalithi kanye nenani lempilo lezi ziguli ezinayo.
Ukusinda kanye nomthwalo wemiphumela yomdlavuza wezingane
Kulinganiselwa ukuthi eYurophu umuntu oyedwa kwabangu-450 abasebasha uzoba nesifo somdlavuza ebuntwaneni. Futhi ukuthi phakathi kwengane eyodwa kwezingu-500 nezingu-600 izoba nesifo esibi ngaphambi kokuba ifinyelele eminyakeni engu-15. Nokho, le mpumelelo inezinkinga: ukusabalala okukhulu kwezinkinga ezingamahlalakhona ezivela ekwelashweni, eziqongelela eminyakeni edlule futhi zingalimaza izitho ezibalulekile, ukuzala, impilo yengqondo, noma ukuhlanganiswa kwesikole nomsebenzi.
Izifundo ezinkulu zeqembu labasindile zidwebe isithombe esicacileCishe ama-60% abasindile babhekana nesimo esisodwa esingamahlalakhona okungenani eminyakeni eyishumi yesibili ngemva kokuxilongwa, kanti abafinyelela kweyesithathu baba nemiphumela emibi kakhulu lapho beneminyaka engama-30. Ezinye izifundo zibonisa ukuthi, lapho beneminyaka engama-45, abangaphezu kwama-95% abasindile bahlushwa yisimo esithile sempilo esingamahlalakhona, kanti cishe ama-80% banesifo esingathi sína, esikhubazayo, noma esisongela ukuphila, esinomthwalo wesifo odlula kakhulu owabantu abavamile abaneminyaka efanayo.
Isizathu esiyinhloko salokhu kugula okuqongelelekile ukuqina kokwelashwa komdlavuza.Ukwelashwa ngamakhemikhali amaningi, ukwelashwa ngemisebe, ukuhlinzwa okubanzi, kanye nokufakelwa kwamaseli egazi aqinile kushiya uphawu oluhlala isikhathi eside. Uma indlela iyinkimbinkimbi futhi isetshenziswa ngezindlela eziningi, ingozi yokuba yingozi kamuva iba nkulu, futhi le ngozi iyanda kakhulu uma kube nokubuyela emuva okudinga imijikelezo eyengeziwe yokwelashwa. Ubudala ekuxilongweni bubalulekile futhi: lapho ingane incane, kulapho umthelela omkhulu ekukhuleni, ekuvuthweni kwamathambo nasekukhuleni ngokocansi, kanye nasekuthuthukisweni kwengqondo.
Izindaba ezinhle ukuthi imiphumela eminingi engase ivele kamuva ingavinjelwa noma incishiswe. Uma izingozi zomuntu ngamunye zitholakala, kusungulwa izinhlelo zokuqapha ezihlelekile, futhi kungenelelwe kusenesikhathi. Lokhu kusekelwa kakhulu yindlela ecacile yokuthi izinqubo zamanjeUma ukusinda isikhathi eside sekuphezulu kakhulu, kwenziwa imizamo yokunciphisa ubuthi (isibonelo, ngokunciphisa ukwelashwa ngemisebe noma ukulungisa imithamo yamakhemikhali ngokwengozi), uma nje amathuba okwelashwa engaphazamiseki.
Amamodeli okuqapha kanye nendima yokunakekelwa okuyisisekelo
Ayikho imodeli eyodwa, ebanzi yokulandela umuntu osinde emdlavuzeni wenganeFuthi ayikho indlela eyodwa eye yabonakala ingcono kunezinye. Nokho, okusobala ukuthi le ndlela kumele yenziwe ngabanye futhi, endaweni yethu, isekelwe umsebenzi ohlanganisiwe phakathi kwe-oncology yezingane esesibhedlela kanye nenethiwekhi yokunakekelwa okuyinhloko, ngokushintshela okuhlelelwe kahle emaqenjini abantu abadala.
Isici esiyinhloko sale modeli ehlanganisiwe ukudluliswa kolwaziUmlando oningiliziwe we-oncological, okuhlanganisa uhlobo lwesimila, izinsuku zokuxilonga kanye nokuqeda ukwelashwa, izifundo zokulinganisa, ukwelashwa okutholakele (imithi kanye nemithamo eqongelelekayo, ukwelashwa ngemisebe kanye nezinkambu ezishisiwe, ukuhlinzwa, ukufakelwa), izinkinga, ukubuyela emuva, kanye nohlelo lokulandelela olunconywayo. Konke lokhu kufanele kufakwe embikweni ohlelekile ohambisana nesiguli lapho siba ngaphansi kokunakekelwa udokotela wezingane noma udokotela womndeni.
Izinsizakalo ze-Pediatric Oncology kanye ne-Hematology ziya ngokuya zivamile. Baqalise ukubonisana okuqondile “kwabasindile” kanye nalabo abashintshela ekubeni abantu abadala. Lokhu kubonisana kuhilela ukudalwa “kwepasipoti yabasindile,” umbhalo ojwayelekile ohlanganisa idatha yokwelashwa ebalulekile kanye nezincomo zokuhlolwa kwesikhathi eside. Amaphrojekthi aseYurophu afana nohlelo “lwePassport Yokusinda”, olukhuthazwa yi-SIOP Europe, kanye nohlelo lwe-SurPass enze intuthuko enkulu kule ndawo, ngamathuluzi edijithali avumelana namazwe ahlukene.
Ukuze konke lokhu kusebenze ngokoqobo, udokotela wezingane oyinhloko kufanele athathe indima eholayo. emisebenzini eminingana: ukutholakala kusenesikhathi kwemiphumela, ukukhuthaza izindlela zokuphila ezinempilo, ukuvuselela ishejuli yokugoma, ukuqapha umdlavuza wesibili, kanye, nokusola ukubuyela emuva. Ngaphezu kwalokho, lo uchwepheshe osebenza inikeza ukwesekwa ngokomzwelo emndenini futhi kusiza ukuhlanganisa ingane noma intsha esikoleni sayo kanye nendawo yayo yezenhlalo.
Iziqondiso zokuqapha zomhlaba wonke ziyinkomba ebalulekileI-Children's Oncology Group (COG) ishicilela iziqondiso ezisekelwe engozini ezibuyekezwa njalo futhi zinikeze imininingwane yokuthi yiziphi izivivinyo okufanele zenziwe kuye ngokwelashwa okutholakele. EYurophu, izincomo zeqembu laseBrithani i-UKCCSG, iziqondiso ze-Scottish SIGN, kanye nezinqubo ze-Dutch DCOG-LATER ziphawuleka kakhulu. Ukuze kuhlanganiswe izindlela zokulinganisa, kwadalwa i-International Late Effects of Childhood Cancer Guideline Harmonization Group, esevele ikhiphe izincomo zokuhlolwa kwe-cardiomyopathy, umdlavuza webele wesibili, umdlavuza we-thyroid, ukwehluleka kwesibeletho ngaphambi kwesikhathi, ubuthi be-gonado kubesilisa, kanye nobuthi be-ototoxicity.
Ukuxilongwa kusenesikhathi komdlavuza wezingane ekunakekelweni okuyisisekelo
Umdlavuza wezingane awuvamile futhi uvame ukulingisa izifo ezincane.Ukutheleleka kokuphefumula, izinhlungu ezikhulayo, i-adenitis esabelayo… Lokhu kwenza ukuxilongwa kube nzima e-Primary Care futhi kudinga ukugcina inkomba ephezulu yokusola, ikakhulukazi lapho izimpawu ziqhubeka, zingajwayelekile noma zingahambisani nesithombe esijwayelekile.
ESpain, cishe amacala amasha ayi-1.100 atholakala minyaka yonke ezinganeni ezingaphansi kweminyaka eyi-14 ubudala.kanye nokwanda okufanayo neYurophu yonke. Ukuze akunike umbono, udokotela wezingane onenqwaba yamacala ezingane ezingu-1.500 uzobona, ngokwesilinganiso, icala elilodwa elisha lomdlavuza njalo eminyakeni emihlanu. Ama-neoplasm avame kakhulu Lezi yizi: ama-leukemia, ama-tumors esimiso sezinzwa esiyinhloko kanye nama-lymphoma ezinganeni ezincane, kanye nama-tumors amathambo, ama-lymphoma kanye nama-tumors obuchopho ezinganeni ezisencane.
Cishe u-8-10% womdlavuza wezingane unesisekelo sofuzo.Lezi zimo zingabonakala njengezifo zomdlavuza noma ukuntuleka kwamasosha omzimba. Umlando womndeni ophelele uyithuluzi elinamandla kakhulu lokusola lezi zimo: amacala amaningi omdlavuza emndenini, ukuqala kusenesikhathi, izimila ezimbili noma eziningi, ukuba khona kokukhubazeka, izici ezingasebenzi kahle noma ukubambezeleka kokukhula, izimila ezingavamile, noma izimila eziningi eziyinhloko kumuntu oyedwa konke kuyizinkomba okufanele ziphakamise isifo esiyisisekelo futhi kudingeke ukuthi kudluliselwe ku-genetics. Kubalulekile ukuhlola umlando wesiguli kanye nobudlelwano obungaba khona nalezi zimo. izifo zokuthambekela komdlavuza.
Ngaphandle kwala maqembu asengozini, inselele yansuku zonke isekuchazeni kahle izimpawu kanye "namafulegi abomvu".Izifundo eziningi zibonisa ukuthi okwenza umehluko ekugcineni akukhona ukubonakala kwesibonakaliso esisodwa, kodwa ukuhlanganiswa kweziningana, ukuphikelela kwazo, kanye neqiniso lokuthi abazali bafika ngokuphindaphindiwe bekhathazekile ngoba “kukhona okungahambi kahle.” I-NICE yase-UK ifaka ngokusobala ukukhathazeka kwabazali okuqhubekayo njengendlela yokucwaninga okwengeziwe noma yokudlulisela.
Phakathi kwezibonakaliso eziyisixwayiso ezifanele kakhulu ezihlobene nomdlavuza wezingane yilezi:Lezi zimpawu zingase zihlanganise: ubomvu obumangalisayo, ukuqina okuzwakalayo (ikakhulukazi isisu noma i-mediastinal), i-lymphadenopathy enezici ze-pathological, ukuphazamiseka kwemisipha, ukuphuka noma ukuphuma kwegazi okungavamile, ukukhathala okukhulu, ikhanda elibuhlungu eliqhubekayo, ukuphazamiseka kokubona, kanye nobuhlungu bamathambo noma bamalunga obungahambisani nokulimala futhi obungathuthuki ngemithi yokunciphisa ubuhlungu. Inani elihle lokubikezela uphawu ngalunye ngokwalo liphansi, kodwa ukwenzeka kwalo okuphindaphindiwe ezingxoxweni eziningana ezinyangeni ezimbalwa kufanele kuphakamise ukukhathazeka.
Izimpawu ezithile okufanele ziphakamise ukusola
Izimpawu zekhanda kanye nezinzwa Zakha isahluko esibalulekile. Amathumba ohlelweni lwezinzwa oluphakathi ayisifo sesibili esivame kakhulu ezinganeni kanye nembangela yesibili ehamba phambili yokufa komdlavuza ebuntwaneni. Ukuvezwa kwawo kwezokwelapha kuncike endaweni, ubudala, kanye nesilinganiso sokukhula, kodwa kunezindlela okufanele zishukumise ucwaningo lwezithombe ngokushesha.
Ubuhlungu bekhanda obuhlala isikhathi esingaphansi kwezinyanga eziyisithupha buyinkinga enkulu. Lezi zimpawu, eziqhubeka njalo, zenzeka kakhulu ekuseni, noma zivuse ingane ebusuku, zihlotshaniswa nokuhlanza okubonakalayo, izinguquko zobuntu, ukubuyela emuva kwezemfundo, ukuphazamiseka kokubona noma kwe-endocrine, ubunzima bokuhamba, i-ataxia, i-strabismus entsha, noma ukuquleka kwesifo sokuwa. Ezinganeni ezingaphansi kweminyaka emine ubudala, i-macrocephaly, ukucasuka, kanye nokudinwa kungase kubangele izikhalazo zobuhlungu bekhanda ngamazwi.
Ezimilanjeni zomgogodla, izimpawu ezibalulekile ubuhlungu obuqhubekayo emhlane (okuba kubi kakhulu nge-Valsalva maneuver), ukuhamba okungajwayelekile, ukubonakala kokuphambuka komgogodla, ukulahlekelwa amandla noma ukuzwa, kanye nezinkinga ze-sphincter. Noma yikuphi ukuhlanganiswa kobuhlungu bomhlane kanye nokukhubazeka kwezinzwa enganeni kufanele kuhlolwe ngokungathi sína kakhulu.
Umkhuhlane ohlala isikhathi eside noma umkhuhlane ongaziwa ukuthi uvelaphi Lesi esinye isizathu esivame kakhulu sokubonisana. Isikhathi esiningi siyathelelana, kodwa uma sihlala isikhathi esingaphezu kwamasonto amabili ngaphandle kwencazelo ecacile, sihlotshaniswa nokwehla kwesisindo, ubomvu, ukujuluka ebusuku, i-generalized lymphadenopathy, noma i-hepatosplenomegaly, i-leukemia, i-lymphoma, nezinye izimila kufanele zifakwe ekuxilongweni okuhlukile, futhi okungenani, kufanele kwenziwe ukuhlolwa kwegazi okuphelele nge-blood smear esikhathini esifushane.
I-Lymphadenopathy idinga ukuhlaziywa ngokucophelelaKujwayelekile ukushaya ama-lymph node amancane, ahambayo ezindaweni zomlomo wesibeletho, i-axillary, noma i-inguinal, kodwa ama-lymph node amakhulu kuno-2-3 cm, aqinile, anamatshe, anamathela ezindaweni ezijulile, atholakala ezindaweni eziphezulu, ze-epitrochlear, noma ze-retroauricular, akhula ngaphandle kwezimpawu zokuvuvukala, ahlala isikhathi esingaphezu kwamasonto angu-4-6, noma ahlotshaniswa nezimpawu ezijwayelekile, imiphumela ye-hepatosplenomegaly, noma engavamile yelebhu ibhekwa njengesolisayo. Kulezi zimo, ukudluliselwa okubalulekile kuyimpoqo.
Ubuningi be-mediastinal abuvamile kakhulu kodwa bungaba bucayi kakhulungoba zingalimaza indlela yokuphefumula kanye nokujikeleza kwegazi. Ama-lymphoma e-T-cell kanye nama-leukemia yizimbangela ezivame kakhulu ku-anterior mediastinum. Ukuvezwa kwezokwelapha kungafana ne-asthma noma i-laryngitis (ukukhwehlela okomile, i-stridor, i-dyspnea, ukukhwehlela, izifo zokuphefumula eziphindaphindayo), noma kungabonakala njenge-superior vena cava syndrome (i-facial plethora, ukukhwehlela, i-orthopnea, ikhanda elibuhlungu, isiyezi). Ezinganeni ezindala ezinezimpawu zokuphefumula ezingavamile, i-X-ray yesifuba iyafuneka ngaphambi kokunikeza ama-corticosteroids ajwayelekile.
Isisindo sesisu siyindlela ejwayelekile yokubonakaliswa kwezimila zasebuntwaneni. njenge-neuroblastoma noma i-Wilms tumor. Ngokuvamile ziyizinhlayiya eziqinile, ezingenabuhlungu, ezitholwa abazali noma ngesikhathi sokuhlolwa okuvamile. Ubuhlungu besisu obuqhubekayo, ukukhukhumala, izimpawu zokuvimba, i-hematuria, noma ukuqunjelwa okuphawulekayo, kanye nomkhuhlane noma ukwehla kwesisindo, kufanele kubangele ukuhlolwa okuphelele kwesisu (kufaka phakathi ukulinganisa umfutho wegazi) kanye nesicelo sokuskena nge-ultrasound ngokushesha okukhulu.
Ubuhlungu bemisipha bungafihla ne-neoplasmUbuhlungu bethambo obuqhubekayo obuvusa ingane ebusuku, obungaphenduli emithini yokwelapha ubuhlungu evamile, futhi obuhambisana nokuqina noma ukuxhuga ngaphandle komlando wokulimala, kudinga ukususwa kwezimila zamathambo eziyinhloko njenge-osteosarcoma noma i-Ewing sarcoma. Ngakolunye uhlangothi, ubuhlungu bethambo noma amalunga amaningi, kanye nokungakhululeki okuvamile, ukuminyana, kanye nokwephuka kwesikhumba, kufanele kuphakamise izinsolo ze-leukemia, yize ukuvezwa kokuqala kungase kuphazanyiswe nesifo samathambo.
Ensimini yamehlo, i-leukocoria iyisibonakaliso esikhulu sesixwayiso se-retinoblastomaUkusabela okubomvu okungavamile kumfundi, i-strabismus esanda kukhula, ukulahlekelwa ukubona kahle, noma i-proptosis kuyizizathu zokudluliselwa kwamehlo kuqala. Ukuhlola ukusabela okubomvu ngesikhathi sokuvakasha njalo kwengane ephilile kuyindlela elula enomthelela omkhulu.
Imiphumela yesikhathi esidlule yizitho zomzimba kanye nohlelo: okufanele ukuqaphele ekubonisaneni
Uma isigaba sokwelashwa esiphuthumayo sesiphelile, umjaho webanga elide uqala Udokotela wezingane oyinhloko kufanele abukeze ngokuhlelekile umonakalo ongaba khona enhliziyweni, emaphashini, ohlelweni lwezinzwa, ezithweni zezinzwa, ohlelweni lwe-endocrine, ezinso, emathanjeni, ohlelweni lokugaya ukudla, kanye nohlelo lokuzala. Iphethini yengozi izoncika ekuhlanganisweni kwemithi, ukwelashwa ngemisebe, kanye nokuhlinzwa okwenziwe.
Ngokombono wezifo zenhliziyo, abasindile bavezwa kuma-anthracyclines noma ekwelashweni ngemisebe yesifuba Banengozi enkulu kakhulu yokwehluleka kwenhliziyo nokufa ngenxa yezimbangela zenhliziyo. Akukho mthamo "ophephile" we-anthracyclines uma umgomo uwukufeza ukusebenza kwenhliziyo okuvamile ngokuphelele esikhathini eside, kodwa imithamo ephezulu eqongelelekayo kanye nokuhlanganiswa kwayo ne-mediastinal radiotherapy kubhekwa njengengozi enkulu. Ngesikhathi sokwelashwa, iziguli kufanele ziqaphele ukuphelelwa umoya, ukungabekezeleli ukuvivinya umzimba, ukushaya kwenhliziyo, kanye nobuhlungu besifuba, futhi kufanele zenze i-cardiopulmonary auscultation, ukuqapha umfutho wegazi, kanye, ngokusho kwezincomo, i-echocardiography njalo.
Ubuthi bephaphu bungabangelwa yisifo ngokwaso, ukutheleleka okukhulu ngesikhathi sokwelashwa, noma ukwelashwa ngemisebe.Kuvamile ukuthola ukungasebenzi kahle okuncane ekuhlolweni kokusebenza kokuphefumula, noma ngabe ingane iphilile kahle ngokwempilo. Ukukhwehlela okomile okungapheli, ukuphelelwa umoya, noma ukungabekezelelani nokuzivocavoca kuyizimpawu ezibonisa ukuthi isiguli sihlolwe kahle, ukukalwa kokugcwala komoya-mpilo, kanye nokucatshangelwa kwe-spirometry.
Emkhakheni we-neuropsychological, abasindile abaningi babhekana nobunzima ngokunaka, inkumbulo, ukufunda, noma isivinini sokucubungulaLokhu kuyiqiniso ikakhulukazi uma bethole ukwelashwa ngemisebe yekhanda noma beke baba nezimila zesimiso sezinzwa esiyinhloko. Lokhu kungaholela ekusebenzeni kabi kwezemfundo, isidingo sokusekelwa kwezemfundo, izinkinga zokulungisa isimo senhlalo, noma ukuphazamiseka ngokomzwelo. Udokotela wezingane kufanele abuze ngenkuthalo ngokuziphatha ekhaya nasesikoleni futhi angangabazi ukudlulisela ingane emaqenjini e-neuropediatric, i-psychology, noma iziqondiso zemfundo lapho kutholwa izimpawu zesixwayiso.
Imiphumela ebaluleke kakhulu yezinzwa yi-cataracts kanye nokulahlekelwa ukuzwa yi-sensorineural.Ukwelashwa ngemisebe yeso noma yekhanda, ukusetshenziswa isikhathi eside kwe-corticosteroid, kanye nemithi ethile kwandisa ingozi yokungacaci kwelensi, kuyilapho i-cisplatin, i-carboplatin, kanye nokwelashwa ngemisebe endlebeni kuhlotshaniswa nokulahlekelwa ukuzwa okuqhubekayo kanye ne-tinnitus. Ukuhlolwa njalo kobukhali bokubona kanye nokuhlolwa kwe-audiometry okuhleliwe kuyanconywa, kuye ngokwelashwa okutholakele, ngaphezu kokugcizelela ukuvikelwa emsindweni omkhulu.
Uhlelo lwe-endocrine lungenye yezithinteke kakhulu esikhathini esideCishe ingxenye yabasindile izoba nokuphazamiseka kwama-hormone: ubude obufushane ngenxa yokuntuleka kwama-hormone okukhula noma imisebe yomgogodla, ukukhubazeka kwe-thyroid, ukuthomba ngaphambi kwesikhathi noma ukubambezeleka, i-hypogonadism, ukwehluleka kwama-ovari ngaphambi kwesikhathi, izinkinga zokuzala, isifo sikashukela sohlobo 2, noma i-metabolic syndrome. Ukuqapha ukuphakama, isisindo, inkomba yomzimba, umfutho wegazi, kanye nesigaba sobusha, kanye nokuhlolwa kwegazi okuqondiwe, kuvumela ukutholakala nokwelashwa kwalezi zinkinga kusenesikhathi.
Izinso kanye nomgudu womchamo kungathinteka yimithi enobuthi kanye nokwelashwa ngemisebe esiswini.Ezinye izingane zisala nenso eyodwa kuphela esebenzayo ngemva kokuhlinzwa kwesimila sezinso. Kulesi simo, ukuqapha njalo umfutho wegazi, i-creatinine, izinga lokuhlunga elilinganisiwe le-glomerular, kanye nokuhlaziywa komchamo (i-proteinuria, ukukhubazeka kwe-tubular) kubalulekile, kanye nokudluliselwa ku-Nephrology nganoma yikuphi ukukhubazeka okuqhubekayo.
Esimisweni semisipha nemisipha, i-osteopenia, i-osteoporosis, i-avascular necrosis, ukukhubazeka kwamathambo, kanye nemiphumela yokunqunywa noma yokufakelwa kungase kuvele.Lezi zimo zibhebhethekiswa kakhulu ukwelashwa ngemisebe, ukusetshenziswa isikhathi eside kwama-corticosteroids, ukuvimba ukuhamba, kanye nendlela yokuphila yokuhlala phansi. ukuvivinya umzimba njaloUkuchayeka elangeni ngendlela efanele kanye nokudla kahle i-calcium ne-vitamin D kuyingxenye yokulandelela okuyisisekelo ekunakekelweni okuyisisekelo.
Umkhakha wezabesifazane kanye nokuzala udinga ukunakwa okukhethekile emantombazaneni nasebasha Abesifazane abathole ukwelashwa ngemisebe yesifuba, isisu, noma i-pelvic, noma imithamo ephezulu ye-alkylating agents, banengozi enkulu yokuba nomdlavuza webele wesibili. Lokhu kuyiqiniso ikakhulukazi kwabesifazane abashiswa ngemisebe odongeni lwesifuba noma lwe-mediastinum ebuntwaneni, ngakho-ke izinhlelo zokuhlola i-mammographic kanye ne-MRI zinconywa ukuthi ziqale kusenesikhathi kunasemphakathini jikelele. Ngaphezu kwalokho, kubalulekile ukuxoxa ngokuzala, ukunqamuka kokuya esikhathini kusenesikhathi, kanye nokuhlela ukuzala ngokusobala nangokwethembeka, okungcono kakhulu ngokubambisana ne-Endocrinology kanye ne-Gynecology.
Ama-neoplasm esibili kanye nokufa sekwephuzile
Nakuba amazinga okusinda avela esigaxeni sokuqala ephezulu, abasindile babhekene nengozi enkulu yokufa ngaphambi kwesikhathi. kuhlotshaniswa nokubuyela emuva, ubuthi bokwelashwa okungapheli, kanye nokukhula komdlavuza wesibili. Eminyakeni embalwa yokuqala ngemva kokuxilongwa, imbangela eyinhloko yokufa ngokuvamile umdlavuza wokuqala uqobo, kodwa kusukela emashumini amabili nantathu eminyaka kuqhubeke, izinkinga zenhliziyo nemithambo yokuphefumula, kanye nomdlavuza wesibili, ziyanda.
Imininingwane evela emaqenjini amakhulu ikhombisa ukwanda okuphawulekayo kwengozi yokufa ngenxa yezimbangela zenhliziyo. (ikakhulukazi kwabesifazane kanye nabasindile ku-Hodgkin lymphoma kanye nezimila zezinso), kanye nezinkinga zokuphefumula kanye nezimila ezintsha. Kusukela eminyakeni engama-20-30 ngemva kokwelashwa, umdlavuza wesibili ungaba imbangela ehamba phambili yokufa kuleli qembu labantu, ngezingozi eziphakeme kaningana kunezo zomphakathi jikelele.
Kuchazwe ingozi enkulu ngokuphindwe ka-5-20 yokuthola umdlavuza wesibili ohlukile kowokuqala.Kwezinye izifundo, ukwenzeka kwalesi sifo kungafinyelela ku-10% uma umuntu eneminyaka engu-20 futhi kufike ku-30% uma eneminyaka engu-30. Izimila eziyinhloko ezihlotshaniswa kakhulu nale nkinga yi-Hodgkin lymphoma kanye nama-sarcoma athile, kanti izimila zesibili zifaka umdlavuza webele, umdlavuza we-thyroid, i-secondary acute myeloid leukemias, kanye nezinye i-sarcomas.
Izici ezithinta kakhulu ukuthuthukiswa kwama-neoplasms esibili ukwelashwa okutholakele kanye nokuthambekela kwezakhi zofuzo.Ama-alkylating agents kanye nama-epitodophyllotoxins ahlotshaniswa ne-myelodysplastic syndromes kanye ne-secondary acute myeloid leukemias enemiphumela emibi; ukwelashwa ngemisebe kwandisa ingozi yezimila eziqinile ezindaweni ezikhanyisiwe (ibele, i-thyroid, i-CNS, ithambo, isikhumba, esinyeni); ukufakelwa kwe-allogeneic kanye nokwelashwa okuhlala isikhathi eside kwe-immunosuppressive kungakhuthaza ama-post-transplant lymphoproliferative syndromes; kanye nama-cancer predisposition syndromes aphindaphinda umthelela wakho konke okungenhla.
Empeleni, lokhu kudinga isu elikabili ekunakekelweni okuyisisekeloNgakolunye uhlangothi, ukufundisa isiguli nomndeni ngezingozi zabo ezithile, ukukhuthaza ukuzihlola (isikhumba, ibele, amasende), ukuvikela ilangaNgakolunye uhlangothi, ukugwema ugwayi notshwala kanye nokugcina isisindo esinempilo; ngakolunye uhlangothi, ukugcina izinga eliphezulu lokusola izimpawu eziqhubekayo noma ezingachazeki, kanye nomkhawulo ophansi wokudluliselwa uma kukhona izinsolo zokubuyela emuva noma isimila esisha.
Ngesikhathi esifanayo, akumelwe sikhohlwe ngokugoma.Izingane eziningi ziqeda ukwelashwa ngezinhlelo zokugoma eziphazamisekile, ukuzivikela komzimba okuyingxenye, noma ukulahlekelwa yinkumbulo ye-immunological ngenxa ye-chemotherapy, ukufakelwa, noma imithi efana ne-rituximab. Ukulandela izincomo ezibuyekeziwe zamakomidi ezeluleko zokugoma kuvumela ukwakheka kwezinhlelo zokugoma kabusha ezivumelaniswe nohlobo lokwelashwa kanye nesikhathi esidlulile selokhu kwaqedwa.
Imisebenzi ebalulekile yodokotela wezingane oyinhloko
Uma indima yodokotela wezingane oyinhloko ekunakekelweni kwezingane oncology kwakufanele ifingqwe ngomusho owodwaUmgomo kungaba ukunciphisa ukubambezeleka kokuxilonga nokwandisa ikhwalithi yokusinda. Lokhu kuhunyushwa kube yiqoqo lamakhono athile kakhulu, kusukela ekusebenzeni okuyisisekelo kwezokwelapha kuya ekuxhumaneni namazinga akhethekile.
Esigabeni sokusola sokuxilonga, udokotela wezingane kufanele Ukwazi ukuthi ungazibona kanjani izimpawu nezixwayiso, ukuhlola umongo (ubudala, umlando womndeni, izifo ezibangelwa ukugula), kanye nokunquma ngokushesha ukuthi uzo-oda nini ukuhlolwa okwengeziwe (inani legazi, i-radiography ecacile, i-ultrasound) nokuthi uzodlulisela nini isiguli ngokushesha noma ngokuthanda esikhungweni se-oncology yezingane kubalulekile. Ukwelashwa okungase kufihle isimo noma kube kubi kakhulu i-tumor lysis syndrome, njengokusetshenziswa ngokungakhethi kwama-corticosteroids ahlelekile ezinhlungwini ze-mediastinal noma ubuhlungu bethambo obungavamile, kufanele futhi kugwenywe.
Ngesikhathi nangemva kokwelashwa komdlavuza, i-Primary Care isekela umndeni kuyo yonke inquboLokhu kusekelwa kuhlanganisa ukuqapha imiphumela emibi, ukwelapha izifo ezihambisanayo, ukusiza ngokulungiswa kwesikole, ukuhlonza izinkinga ezingokomzwelo noma zenhlalo, kanye nokusebenza njengomxhumanisi phakathi komndeni nesibhedlela. Lokhu kusekelwa okuqhubekayo kunciphisa kakhulu umthwalo ongokomzwelo kanye nomuzwa wokungabi namandla ovame ukulandela ukuxilongwa.
Esigabeni sokusinda isikhathi eside, udokotela wezingane kufanele aphathe uhlelo oluhlelekile lokuhlolwa. okuhlanganisa umlando wezokwelapha oqondiwe (izimpawu zenhliziyo, zokuphefumula, zokugaya ukudla, zemizwa, ze-endocrine, zamathambo, nezengqondo), ukuhlolwa okuphelele ngokomzimba (ukukhula, ukuthomba, umfutho wegazi, ukulalela imizwa, ukuhlikihla isisu kanye nama-lymph node, ukuhlolwa okuyisisekelo kwemizwa, isikhumba) kanye nezicelo ezivamile zokuhlolwa okuhambisanayo okulungiselelwe ingozi (ukuhlolwa kwegazi, ukuhlolwa kwezithombe, ukuhlolwa kokusebenza kwamaphaphu, i-densitometry, i-audiometry, njll.).
Ukuxhumana phakathi kwamazinga okunakekelwa kungenye insika ebalulekile.Imibiko yokukhishwa kwe-oncology kumele icace futhi iqondakale, ibonise ukuthi yiziphi izikhathi zokulandelela ezidingekayo, kangaki, nokuthi izinga lokunakekelwa lingakanani. Ngakho-ke, udokotela wezingane oyinhloko kufanele atshele udokotela wezingane oyinhloko noma uchwepheshe wabantu abadala ngemiphumela efanele, ngaleyo ndlela agweme izikhala ekulandeleni, okungeshwa, okusavamile ngesikhathi sokushintshela ekubeni umuntu omdala.
Okokugcina, ubukhulu besimo sengqondo abunakukhohlwa.Izingane ezisindile kumdlavuza zibhekana nokukhathazeka okukhulu, ukucindezeleka, ukucindezeleka ngemva kwenhlekelele, ubunzima bokuzihlanganisa esikoleni nasemsebenzini, futhi zisengozini enkulu yokuzibandakanya ekuziphatheni okuyingozi (ukubhema, ukuphuza utshwala) kunabafowabo noma ontanga bazo. Ukubonisana ngokunakekelwa okuyisisekelo kuyindawo ekahle yokuhlonza lobu bunzima, ukunikeza indawo yokulalela, kanye nokusebenzisa ukwesekwa kwengqondo nokwezenhlalo uma kudingeka.
Uma sibheka isithombe sonke, Ukunakekelwa Okuyisisekelo kuba yinto evamile emlandweni wengane obangelwa umdlavuza.Kuyasiza ekuxilongeni umdlavuza kusenesikhathi, ukuthola ukwelashwa okuphephile nokusekelwa okukhulu, nokwenza impilo ngemva komdlavuza ibe yinde, inempilo, futhi yanelise ngangokunokwenzeka ngokuthola imiphumela yangemuva, ukuvimbela izimila ezintsha, kanye nokunakekela inhlalakahle engokomzwelo yeziguli kanye nemindeni yazo.
