Umdlavuza we-Endometrial yisifo esivame ukuhlasela isistimu yokuzala. I-pathology inemvelaphi engavamile, ngakho-ke ayivame ukutholakala ezinyathelweni zakuqala. Ake sicabangele ngokuningiliziwe umdlavuza we-endometrium: izimpawu nezibonakaliso, izimbangela, amafomu, izinkomba eziyinhloko zokwelapha.
Umdlavuza we-Endometrial - izici zengozi
Kuziguli ezine nomdlavuza we-endometrial, iminyaka yobudala idlula iminyaka engu-45-50. Indlela yokuqeda izinguquko ezakhiweni emangqamuzaneni ohlaka lwesibindi yizinqubo ezihlotshaniswa nokunqamuka kwesikhashana. Ukuqedwa kwesistimu yokuzala akudluli ngaphandle komkhondo womzimba. Phakathi kwezinye izinto ezikhona ezingozini, odokotela baveza izimo ezinjengokuthi:
- ukuphazamiseka kwesimiso se-endocrine, izinqubo zokuxilonga umzimba - isifo sikashukela, ukukhuluphala;
- ukucindezeleka komzimba;
- izifo ezixhomeke kwi-hormones ohlelweni lokuzala - i-hyperestrogenism;
- izicubu ze-ovarian ezisebenza nge-hormone - Isihlungu se-Brenner kukho konke kwesihlanu sihambisana nomdlavuza;
- I-Stein-Levental syndrome - ihlanganiswe nomdlavuza we-endometrial ngamacala angu-30%;
- izakhi zofuzo;
- Ukuphila okucindezelekile - ukutholakala kwezihlobo eziseduze ze-pathologies ezinjenge-tumor;
- ukuqala kwesikhathi sokusebenza kocansi, ukungabi nalutho;
- ukungabikho kokukhulelwa nokubeletha ku-anamnesis;
- ukufika esikhathini sokuphela kwesikhathi (ngemva kweminyaka engu-55);
- ukuhamba kwe-hormone therapy (ukusetshenziswa kweTamoxifen).
Umdlavuza we-Endometrial - ukuhlukaniswa
Ngokusho kwe-Histological International Classification, umdlavuza we-endometrial wesibeletho uhlukaniswe ngamafomu alandelayo:
- i-adenocarcinoma;
- kucacisa i-cell adenocarcinoma;
- i-squamous cell carcinoma;
- umdlavuza wegciwane;
- i-mucinous;
- umdlavuza we-serous;
- i-glandular-squamous;
- umdlavuza ongenasiphelo.
Sula i-adenocarcinoma yeseli ye-endometrial
Sula i-cell adenocarcinoma kwenzeka kakhulu kaningi kunezinye izinhlobo ze-pathology. Ngoba lolu hlobo lomdlavuza lubonakala ngokuba khona ezindaweni ezithintekile zezicubu ezinkulu ze-polyhedral cell epithelial cells. Kuvame ukuphawula ukuba khona kwamaseli avamile okwenzeka ngokuhlukile ngezingxenye ze-cell-adenocarcinomas elula. Abanye ochwepheshe babonisa amaseli we-pathologies nama-meson-fusion kuleli qembu. Lezi zakhi zangaphandle zifana nesipikili esikhwameni esinesihe.
I-endometrial carcinoma ye-gland
Umdlavuza we-endometrium we-glandular yi-pathology lapho amangqamuzana amancane atholakala khona kule nqubo. Ngokwenza njalo, i-adenocarcinoma ene-glandular iyathinta umgogodla wesibindi kanye nomsele wamlomo wesibeletho. Lolu hlobo lomdlavuza lubalelwa ku-70% yazo zonke izinqubo ze-incological, okuvame ukutholakala kulabo besifazane asebekhulile, kodwa kutholakala kubantu abasha.
I-squamous cell carcinoma ye-endometrium
I-Squamous cell carcinoma yesibeletho ibhekisela kuma-neoplasms amabi. Ukwakhiwa kwe-tumor kuvela kumangqamuzana e-epithelium flat, etholakala ngezinga elihlukile le-atypia. Njengoba ukuqhubeka kwe-pathology kulezi zigaba kamuva, amangqamuzana ashintshela esifundeni somngcwabo wesibeletho. Ezimweni ezinjalo, i-oncology iyatholakala ngesikhathi sokuhlolwa komzimba. Ngenxa yokuntuleka kwesithombe somtholampilo ecacile, ayitholakali ekuqaleni. Izimpawu ezingavamile ze-pathology zifaka:
- ubuhlungu be-pelvic;
- ukungasebenzi komzimba nesibindi;
- ukuphawula kanye nokwehla.
I-Iron-squamous cell carcinoma ye-endometrium
I-Iron-squamous cell carcinoma yamathambo e-endometrium uhlobo oluthile lwe-pathology. Isici esiyingqayizivele saso kuba khona kwesikhumba esinesakhiwo esincane. Izingxenye zesigwegwe nesigxile zikhona kulezi zakhiwo. Njengomthetho, i-squamous cell igxila ngaphezu kwe-glandular. Leli fomu lomdlavuza we-endometrial libika ngamaphesenti ama-4 kuwo wonke ama-pathology. Kuvamile kubantu besifazane abakhulile kuneminyaka engama-55, ezimweni ezilodwa zenzeka kubantu abasha.
Uma kuqhathaniswa nezinye adenocarcinomas, i-glandular squamous cell carcinoma inehlukaniso oluphansi. Ngenxa yalezi zici zesakhiwo, lesi sifo ngokuvamile sizuza inkambo enobudlova. Ngokukhululekile, ngaphandle kokusetshenziswa kwezixhobo ngokunyuka okukhulu, leli fomu cishe alifani namanye ama-adenocarcinomas. Ngaphandle kufana nokubunjwa kwe-polypoid noma isilonda. Ukunquma uhlobo lwe-pathology kwenziwa ngezinga elincane, kucatshangelwa izinga lokuhlukaniswa kwezinto ezithile.
Umdlavuza wesifo se-endometrial
Umdlavuza we-serous ungokwesigaba esikhulu sama-neoplasms epithelial. I-pathology isakhiwe kusuka kumangqamuzana aguquliwe noma aphethwe yizicubu ze-epithelial. Kulesi simo, kuvame ukuba nzima ukusungula umsuka walokho. Leli fomu libhekene nokugeleza okusheshayo, futhi litholakala lapho owesifazane ehlolwa ngokungahleliwe ngomjikelezo, uhlelo lokuzala. Izimpawu zomdlavuza we-endometrial wale fomu kunzima ukuxilonga kowesifazane ngokwayo.
I-Cancer Emucinous
Loluhlobo lwe-oncology lubonakala ngokusakazeka kwamangqamuzana aqukethe i-intra-cytoplasmic mucin ngaphakathi kwabo. Leli fomu le-pathology libalelwa ku-10% kuzo zonke izimo ze-oncology yomzimba wesisu. Isici esiyingqayizivele se-neoplasm ukuhlukaniswa okuphezulu kwezici ze-tumor, okuqinisekiswa yi-diagnosis ye-ultrasound kanye ne-microscopy eqhubekayo yesampula sesisindo. Umdlavuza omuncu uvame ukwelashwa odokotela ngenxa yokuthatha ama-gestagens zokwenziwa.
Umdlavuza we-Endometrial wesibeletho - izimpawu nezimpawu
Lapho umdlavuza we-endometrial uqala, izimpawu ze-pathology zenzeka ngemva kwesikhathi eside. Iningi leziguli azikhalazi ngesikhathi se-neoplasm. Lokhu kuchaza ukuthi ukutholakala ngengozi kaningi kwesifo ngesikhathi sokufuna izimbangela zokungajwayelekile esimisweni sokuzala. Isifo esiyinhloko esibonisa umdlavuza kungukuphuma kwegazi.
Lezi zikhwama azikwazi ukuxhumana nezikhathi zokuya esikhathini. Abangenamthetho, ngokuvamile bahambisana nokukhathazeka okuncane, okuyinto ekhohlisa iziguli. Abesifazane ngokwabo bathatha izibonakaliso ngezikhathi ezingavamile ngenyanga futhi baxoxe nodokotela kuphela emva kokuphindaphinda okuphindaphindiwe. Ukwenza ukuhlonza ukuhlukana kokuhlukana kusiza ukuveza imbangela yangempela yokukhulelwa kwamanzi - umdlavuza we-endometrium yebele.
Njengoba i-pathology iqhubeka, i-symptomatology ikhula. Phakathi kwezinye izibonakaliso zesifo esinjengomdlavuza we-endometrial, kubalulekile ukuhlukanisa:
- Ukubukeka kwabamhlophe kukhishwa ngokwemvelo kusukela emthonjeni wokuzala. Yenzeke lapho isikhumba sikhula. Ukuqoqwa emgodleni wesibindi semfihlo, kubangela ukuzwa okubuhlungu esiswini esingaphansi, umlingiswa wokudonsa.
- Ukukhishwa kwamanzi okuphuma emzimbeni. Ukuhlukumeza ukuphuma kwe-leucorrhea kungabangela ukutheleleka, kuqhubekele ukwakheka kwe-pyometers - isakhiwo se-pus emgodini we-uterine. Owesifazane ngesikhathi esifanayo ulungisa ukubukeka kwemvelo yokushisa, ukwanda kokushisa komzimba, ukuwohloka kwenhlalakahle jikelele.
- I-syndrome yezinhlungu - ivela lapho inqubo ye-pathological isakazeka, izinguquko ezingenalutho emgodini we-pelvic. Ngokukhula okusheshayo kwe-tumor, kukhona ukucindezeleka kwe-ureter, kunezinhlungu esifundeni se-lumbar.
- Ukuphulwa kwenqubo yokugcoba nokuhlukunyezwa. Ubukhulu obukhulu be-tumor oyinhloko bubangela ukubonakala kwezimpawu ezengeziwe (ukukhathazeka ngokuvuthwa, ukuhlukunyezwa, i-tenesmus - yamanga, isifiso esibuhlungu sokususa).
- Ukuphulwa komjikelezo wokuya esikhathini - ukwandisa, ukunciphisa, ukwandisa ivolumu yegazi. Ngokuvamile kuhlotshaniswa nezinguquko ze-hormone emzimbeni wesiguli.
Umdlavuza we-Endometrial - izigaba
Kuye ngezibonakaliso zemitholampilo kanye nobukhulu besifo, izigaba ezilandelayo zomdlavuza wesibeletho se-endometrial ziyahlukahluka, ngokusho kokuhlukaniswa kwe-International Federation of Obstetricians kanye namaGynecologists (FIGO):
1. Isigaba se-Zero (0) - kukhona i-hyperplasia ye-endometrial e-atypical, okuyisigaba sokuqala se-oncology.
2. Isigaba sokuqala - isisu asihambanga ngaphezu komzimba wesibeletho (IA-C). Yamukelwa ukuhlukanisa:
- Isigaba - i-tumor ayifuni ngaphakathi, inqunyelwe ungqimba lwe-epithelium;
- ISIQEPHU - isendlalelo semisipha ihilelekile enkambisweni yokugula, futhi ayifinyeleli emaphakathi yayo;
- Isigaba se-ІС - i-carcinoma ihluma ingxenye yesigxathu se-muscular futhi ijulile, kodwa ayifinyeleli i-serosa.
2. Isigaba sesibili sihlukaniswe ngokuthi:
- ІІА - izimbongolo kuphela ezihilelekile;
- Isigaba sendawo - stroma sithinteka.
3. Isigaba sesithathu - umdlavuza we-endometrium ushiya umngcele wesigungu, kodwa awuhambi ngaphesheya kwesikhumba esincane. Kuye ngezici zomtholampilo, lesi sigaba sihlukaniswe ngokuthi:
- ІІІА - i-carcinoma ihlumela i-membrane noma ifaka ama-appendages;
- I-ІІІС - ibonakala ngokubonakala kwe-metastase ezindaweni eziseduze ze-lymph nodes.
4. Isine lesine:
- i-tumor ihluma esiqandisini noma i-rectum-IVA.
- ukubonakala kwezimpawu ezikude ngaphandle kwesikhumba esincane - IVB.
Umdlavuza we-Endometrial - ukuxilongwa
Izimpawu zamanje zomdlavuza wesibeletho se-endometrial ziyisibonakaliso sokuhlolwa okuphelele kwesiguli. Ngenhloso yalokhu:
- i-ultrasound yama-vagin yezitho zomzimba;
- i-hysterocervicoscopy - ukukhwa kwezicubu zomzimba kanye nomlomo wesibeletho ukuze uthole enye insizakalo encane;
- ukudweba kwezitho zangasese;
- ikholonoscopy ;
- i-cystoscopy.
Umdlavuza we-Endometrial ku-ultrasound
Umdlavuza we-Endometrial ku-ultrasound, izimpawu zawo ezichazwe ngenhla, zingatholakala nge-echography yangaphakathi. Kulolu cwaningo, udokotela uthola isimo esinqunyiwe noma esingavamile. Amathumba amancane akhulise i-echogenicity nesakhiwo esihambisanayo. Kulesi simo, umjikelezo we-tumor uvame kakhulu (ngisho nokungena, ukuguqulwa kwemiphetho). Ukwanda kwe-acoustic ye-tumor kudala umphumela we-acoustic, othuthukisa isignali ye-echo. Ngakho odokotela baxilonga umdlavuza we-endometrial wesibeletho, izimpawu zazo eziqinisekisiwe nokuhlaziywa.
Umdlavuza we-Endometrial - abaqaphi
I-Onkomarkery - izinto eziphilayo ezisebenzayo, ezakhiwe esitokisini somdlavuza. Ziqukethe i-molecule yamaprotheni lapho kufakwe khona i-lipid ne-carbohydrate. Amakethe athuthukiswa ngokuya kwesigaba senqubo yokugulisa umzimba, okuphawulekayo kwesakhiwo se-tumor. Ngenye indlela bangene egazini, lapho bebona khona ngosizo lwezinhlolovo zebholabhu. Ukuhlonza umdlavuza we-endometrial microinvasive, iziguli zanikezwa kulaba abalandeli be-tumor abalandelayo:
- squamous cell carcinoma antigen (SCCA);
- I-CA 125;
- i-cancer-embryonic antigen (CEA);
- umshini womdlavuza CA 27-29.
Umdlavuza we-Endometrial - ukwelashwa
Ngemva kokufunda ngesifo sokuxilongwa okubi, umbuzo wokuqala weziguli: noma ngabe umdlavuza we-endometrial uyaphathwa noma cha. Odokotela bakhuluma ngokutholakala okungenzeka. Umphumela ophumelelayo uncike ekutheni uhlobo lwe-pathology, ukuqina kwesifo, isigaba. Lezi zindlela zokwelashwa ezilandelayo zisetshenziselwa ukwelashwa:
- indlela yokuhlinzwa;
- ukwelashwa kwemisebe ;
- i-chemotherapy ;
- i-hormonotherapy.
Ukukhetha indlela yokwelapha kuncike ezintweni eziningi. Uma ukhetha indlela yokwelashwa kokwelapha, okulandelayo kulandelwa:
- isigaba sesifo;
- usayizi wesisu;
- isakhiwo sakhe;
- izinga lokuhlukanisa;
- ukujula kokuhluma;
- ukusabalala kwe-tumor ngaphesheya kwesigungu esithintekile.
Kulezi zindlela, ukuhlinzwa kusetshenziswe kaningi kunezinye. Linciphisa ukuphindaphindiwe komdlavuza we-endometrial. Ngesikhathi sokusebenza, odokotela abasiki nje kuphela izicubu eziphathekayo ezivela esithombeni, kodwa futhi baphinde babheke eziseduze. Isiteji sokuhlinza sihlanganisa:
- ukubuyekezwa kwesigxobo sesisu;
- ukuqhuba i-biopsy yama-lymph nodes;
- Ukuhlolwa kwe-cytological kwesampula sesisindo.
Ngokususelwa emiphumeleni etholakalayo ngesikhathi sokuhlolwa, isinqumo senziwa ngokusebenza kwalo:
- ukukhulelwa kwesibeletho (ukususwa komzimba okuphelele) nge-appendages;
- ukukhukhula okukhulu kwesibeletho nge-appendages kanye ne-lymphadenectomy - ukususwa kwesibeletho kanye nama-lymph nodes wendawo.
Umdlavuza we-Endometrial - ukubikezela
Ukunquma lapho ukubikezela umphumela wesifo yilokhu:
- isigaba sokukhubazeka;
- iminyaka;
- ukujula kwezinguquko eziphazamisayo;
- izinga lokuhlukanisa;
- usayizi wesisu.
Esinye sezici ezithatha isifo semithi yomdlavuza we-endometrium, esendaweni ye-lymph nodes. Kuye kwasungulwa ngezibalo ukuthi, njengoba kutholakala ukuthi umdlavuza we-endometrial wesigaba sokuqala, iziguli ezingama-82 zihlala iminyaka emihlanu noma ngaphezulu. Uma kutholakala lesi sifo esigabeni sesibili, kanye nokuphathwa kahle kwelashwa, 65% yazo zonke iziguli zihlala iminyaka engaphezu kwemihlanu. Ezimweni ezingu-25% zezinkinga zokukhubazeka, ukuqhubeka kwesifo ngesifo sokuhlaselwa okungahambi kahle kuphawulwe.