I-serous carcinoma yezinga eliphezulu i-ovary kanye ne-fallopian tube

nguJason Wasserman MD PhD FRCPC
October 7, 2022

Iyini i-high-grade serous carcinoma ye-ovary?

I-high-grade serous carcinoma uhlobo oluvame kakhulu lomdlavuza we-ovarian kanye ne-fallopian tube. Iqala emangqamuzaneni avame ukutholakala ngaphandle kwe-ovary noma ngaphakathi kweshubhu le-fallopian. Kungakhathaliseki ukuthi isimila siqala kuphi, ngokuvamile sihilela izitho zombili ngesikhathi sokuxilongwa. Kuvamile ukuthi i-serous carcinoma yezinga eliphezulu isakazekele ngokushesha kwezinye izitho ezingaphakathi kwesisu kanye ne-pelvis kanye ne-peritoneum, ungqimba oluncane lwezicubu ezimboze lezi zitho.

Yini ebangela i-serous carcinoma yezinga eliphezulu le-ovary?

Okwamanje odokotela abazi ukuthi yini ebangela i-serous carcinoma yezinga eliphezulu. Kodwa-ke, izici eziyingozi ezihlobene nalolu hlobo lomdlavuza zihlanganisa umndeni noma umlando womuntu siqu womdlavuza webele noma wesibeletho kanye nokungazali.

Kwenziwa kanjani lokhu kuxilongwa?

Ukuxilongwa kwe-serous carcinoma yezinga eliphezulu nakho kungenziwa ngemva kokukhishwa kwesampula encane yezicubu ngenqubo ebizwa ngokuthi i-biopsy. Kule nqubo, isampula encane yezicubu ezivela ku-pelvis noma isisu siyasuswa. I-ovary ngokwayo ayivamisile ukwenza i-biopsy.

Ngenxa yokuthi ngokuvamile isakazekela ku-peritoneum, i-serous carcinoma yezinga eliphezulu ingase itholakale ngemva kokukhishwa koketshezi emgodini wesisu ngenqubo ebizwa ngokuthi i-serous carcinoma. i-fine needle aspiration (FNA). Uketshezi lube seluthunyelwa kudokotela ohlola amangqamuzana oketshezini ngaphansi kwesibonakhulu.

Kwabanye besifazane, ukuhlonzwa kwe-serous carcinoma yezinga eliphezulu kwenziwa kuphela lapho isimila sisusiwe ngokuhlinzwa futhi sithunyelwe kudokotela wezifo ukuze ahlolwe. I-ovary ngokuvamile ikhishwa kanye ne-fallopian tube, kanye nesibeletho.

Udokotela wakho ohlinzayo angase acele i ukuhlinzwa or isigaba esiqandisiwe ukubonisana nodokotela wakho wezifo. Ukuxilongwa okwenziwa udokotela wakho wezifo ngesikhathi sokubonisana kwangaphakathi kungashintsha uhlobo lokuhlinzwa olwenziwa noma ukwelashwa okunikezwa ngemva kokuqedwa kokuhlinzwa.

Kungani kubalulekile uma isimila satholwa siphelele noma siqhuma?

Wonke ama-ovarian tumors ayahlolwa ukuze kubonakale ukuthi azikho yini izimbobo noma izinyembezi endaweni engaphandle yesimila noma i-ovary. Ingaphezulu libizwa ngokuthi i-capsule. I-capsule ichazwa njengephelele uma kungekho migodi noma izinyembezi ezihlonziwe. I-capsule ichazwa ngokuthi iphukile uma indawo yangaphandle iqukethe izimbobo ezinkulu noma izinyembezi.

Lolu lwazi lubalulekile ngoba i-capsule eqhuma ngaphakathi emzimbeni ingase ichithe amangqamuzana omdlavuza emgodini wesisu. I-capsule ephukile ihlotshaniswa nokubi kakhulu isibikezelo futhi isetshenziselwa ukunquma isigaba sesimila.

Ingabe amangqamuzana omdlavuza abonwa ebusweni be-ovary noma i-fallopian tube?

Amaseli omdlavuza ku-serous carcinoma yezinga eliphezulu angasabalala esuka esibelethweni aye kwesinye isitho esiseduze njengeshubhu le-fallopian noma i-ovary ngakolunye uhlangothi lomzimba. Uma amangqamuzana omdlavuza ebonakala phezu kweshubhu le-fallopian noma i-ovary, kuphakamisa ukuthi ahambile esuka kwenye indawo. Lolu lwazi lubalulekile ngoba isimila esisabalele sisuka kwesinye isitho siye kwesinye sinikezwa isiteji esiphezulu sesimila.

Yiziphi izimila ze-peritoneal futhi kungani zibalulekile?

Izimila ze-Peritoneal zingamaqembu amangqamuzana omdlavuza asakazekele ku-peritoneum, ungqimba oluncane lwezicubu ezimboza izitho ezingaphakathi kwe-pelvis nesisu. Izicubu ezivela ku-peritoneum zivame ukuthunyelwa kanye nama-ovari, amashubhu e-fallopian, nesibeletho ukuze zihlolwe udokotela wakho wezifo ukuze athole amangqamuzana omdlavuza.

Ngeshwa, kuvamile ukuthi i-serous carcinoma yezinga eliphezulu isabalale ku-peritoneum. Ukufakwa kwe-Peritoneal kuhlotshaniswa nokubi kakhulu isibikezelo futhi asetshenziselwa ukunquma isigaba sesimila.

Ingabe isimila sesisabalele kwezinye izitho noma izicubu ezisesinqeni noma esiswini?

Amasampula amancane ezithishu ngokuvamile akhishwa ngenqubo ebizwa ngokuthi a i-biopsy ukubona ukuthi ama-tumor cells asabalale ngaphandle kwe-ovary. Lawa ma-biopsies, avame ukuvela kusicubu esiku-pelvis nasesiswini esibizwa ngokuthi i-peritoneum, athunyelwa kudokotela wakho wezifo ukuze abone ukuthi isimila sisabalele noma i-metastasized. I-omentum yisitho sesisu esiyindawo evamile yokusabalala kwesimila noma i-metastasis. Lesi sitho sivame ukususwa ngokuphelele futhi sihlolwe udokotela wakho wezifo. Ezinye izitho (ezifana nesinye, ithumbu elincane, noma ithumbu elikhulu) ngokuvamile azikhishwa futhi zithunyelwe ukuze zihlolwe ukugula ngaphandle uma zinamathele ngokuqondile esimila noma esisabalele kulezi zitho kubonwa udokotela wakho ohlinzayo. Kulezi zimo, udokotela wakho wezifo uzohlola isitho ngasinye ngaphansi kwesibonakhulu ukuze abone ukuthi akhona yini amangqamuzana omdlavuza anamathele kulezo zitho. Ukuba khona kwamaseli e-tumor kwezinye izitho kusetshenziselwa ukunquma isigaba se-tumor (T) kanye nesigaba esikude se-metastatic (M).

Ingabe ama-lymph nodes ahloliwe futhi ingabe akhona amaseli omdlavuza?

Izindawo ezinama-lymph amasosha omzimba amancane atholakala kuwo wonke umzimba. Amangqamuzana omdlavuza angasakazeka esuka esimila kuye kuma-lymph nodes ngokusebenzisa imikhumbi emincane ebizwa ngokuthi i-lymphatics. Ngenxa yalesi sizathu, ama-lymph nodes avame ukususwa futhi ahlolwe ngesibonakhulu ukuze kubhekwe amangqamuzana omdlavuza. Ukuhamba kwamangqamuzana omdlavuza ukusuka esimila ukuya kwenye ingxenye yomzimba njenge-lymph node kubizwa ngokuthi a i-metastasis.

Amaseli omdlavuza ngokuvamile asakazeka kuqala kuma-lymph nodes eduze kwesimila nakuba ama-lymph nodes akude nesimila nawo angabandakanyeka. Ngenxa yalesi sizathu, ama-lymph nodes okuqala asusiwe ngokuvamile aseduze nesimila. Ama-lymph nodes aqhelelene nesimila avame ukususwa kuphela uma ekhulisiwe futhi kukhona izinsolo eziphakeme zomtholampilo zokuthi kungase kube namaseli omdlavuza ku-lymph node.

Uma noma imaphi ama-lymph node akhishiwe emzimbeni wakho, azohlolwa ngesibonakhulu udokotela wezifo futhi imiphumela yalokhu kuhlolwa izochazwa embikweni wakho. Imibiko eminingi izobandakanya inani eliphelele lama-lymph nodes ahloliwe, lapho emzimbeni kutholwe khona ama-lymph nodes, kanye nenombolo (uma ikhona) equkethe amaseli omdlavuza. Uma amangqamuzana omdlavuza abonwa ku-lymph node, usayizi weqembu elikhulu kunawo wonke lamaseli omdlavuza (okuvame ukuchazwa ngokuthi “ukugxila” noma “idiphozithi”) nawo uzofakwa.

Ukuhlolwa kwama-lymph nodes kubalulekile ngenxa yezizathu ezimbili. Okokuqala, lolu lwazi lusetshenziselwa ukunquma isigaba se-pathologic nodal (pN). Okwesibili, ukuthola amangqamuzana omdlavuza ku-lymph node kwandisa ingozi yokuthi amangqamuzana omdlavuza azotholakala kwezinye izingxenye zomzimba esikhathini esizayo. Ngenxa yalokho, udokotela wakho uzosebenzisa lolu lwazi lapho enquma ukuthi kuyadingeka yini ukwelashwa okwengeziwe okufana ne-chemotherapy, i-radiation therapy, noma i-immunotherapy.

Kusho ukuthini uma i-lymph node ichazwa njenge-positive?

Izazi zezifo zivame ukusebenzisa igama elithi “positive” ukuchaza a i-lymph node equkethe amangqamuzana omdlavuza. Isibonelo, i-lymph node equkethe amangqamuzana omdlavuza ingase ibizwe ngokuthi “positive for malignancy” noma “positive for metastatic carcinoma”.

Kusho ukuthini uma i-lymph node ichazwa njengenegethivu?

Izazi zezifo zivame ukusebenzisa igama elithi “negative” ukuchaza a i-lymph node lokho akuqukethe noma yimaphi amaseli omdlavuza. Isibonelo, i-lymph node enganawo amaseli omdlavuza ingase ibizwe ngokuthi “negative for malignancy” noma “negative for metastatic carcinoma”.

Ayini ama-isolated tumor cells (ITCs)?

Izazi ze-pathologists zisebenzisa igama elithi 'i-tumor cells ehlukanisiwe' ukuchaza iqembu lamaseli wesimila akala u-0.2 mm noma ngaphansi futhi atholakala ku-tumor cell. i-lymph node. Ama-lymph nodes anamaseli e-tumor ahlukanisiwe (ITCs) awabalwa 'njengama-positive' ngenjongo yesigaba se-pathologic nodal (pN).

Iyini i-micrometastasis?

I-'micrometastasis' iyiqembu lamaseli wesimila akala ukusuka ku-0.2 mm kuya ku-2 mm futhi atholakala ku- i-lymph node. Uma kuphela ama-micrometastase atholakala kuwo wonke ama-lymph nodes ahloliwe, isigaba se-pathologic nodal yi-pN1mi.

Iyini i-macrometastasis?

I-'macrometastasis' yiqembu lamaseli wesimila akala ngaphezu kuka-2 mm futhi atholakala ku-a i-lymph node. I-Macrometastase ihlotshaniswa nokubi kakhulu isibikezelo futhi ingadinga ukwelashwa okwengeziwe.

Kusho ukuthini ukunwetshwa kwe-extranodal?

Zonke ama-lymph node zizungezwe ungqimba oluncane lwezicubu ezibizwa ngokuthi i-capsule. Ukunwetshwa kwe-Extranodal kusho ukuthi amaseli omdlavuza ngaphakathi kwe-lymph node agqekeze i-capsule futhi asakazeka esicutshini esingaphandle kwe-lymph node. Ukunwetshwa kwe-Extranodal kubalulekile ngoba kwandisa ingozi yokuthi isimila sikhule kabusha endaweni efanayo ngemva kokuhlinzwa. Kwezinye izinhlobo zomdlavuza, ukunwetshwa kwe-extranodal futhi kuyisizathu sokucabangela ukwelashwa okwengeziwe okufana nokwelashwa ngamakhemikhali noma ukwelapha ngemisebe.

Usho ukuthini umphumela wokwelapha?

Uma welashwa nge-chemotherapy (noma ezinye izidakamizwa eziklanyelwe ukubulala amangqamuzana omdlavuza) ngaphambi kokukhishwa kwesimila ngokuhlinzwa, udokotela wakho uzohlola isimila ukuze athole iphesenti lesimila esisasebenza (amaseli aphilayo wesimila).

Impendulo izohlukaniswa kanje:

1. Cha/impendulo encane - Iningi lesimila siyasebenza.
2. Impendulo encomekayo - Esinye isimila sifile kanti esinye siyasebenza.
3. Impendulo ephelele - Cishe zonke noma zonke izimila zifile.