Uhlolojikelele lwe-cutaneous (isikhumba) lymphoma
I-Lymphoma uhlobo lomdlavuza oluqala kumangqamuzana amhlophe egazi abizwa ngokuthi ama-lymphocyte. Lawa maseli egazi ngokuvamile ahlala ohlelweni lwethu lwe-lymphatic, kodwa ayakwazi ukuhamba kunoma iyiphi ingxenye yomzimba wethu. Bangamangqamuzana abalulekile esimiso sethu sokuzivikela ezifweni, alwa nezifo kanye nezifo, futhi asize amanye amangqamuzana omzimba asebenze ngempumelelo.
Mayelana namaLymphocyte
Sinezinhlobo ezahlukene zama-lymphocyte, amaqembu amakhulu kuba I-B-cell lymphocyte futhi T-cell lymphocyte. Womabili ama-lymphocyte e-B kanye ne-T-cell anomsebenzi okhethekile, ane "inkumbulo ye-immunological". Lokhu kusho ukuthi uma sinesifo, isifo, noma uma amanye amangqamuzana ethu onakalisiwe (noma eguquliwe), ama-lymphocyte ethu ahlola lawa maseli bese enza “ama-memory B noma T-cell” akhethekile.
Lawa maseli enkumbulo agcina lonke ulwazi mayelana nendlela yokulwa negciwane, noma alungise amangqamuzana alimele uma ukutheleleka okufanayo noma ukulimala kwenzeka futhi. Ngale ndlela bangabhubhisa noma balungise amangqamuzana ngokushesha okukhulu nangempumelelo ngokuzayo.
- Ama-B-cell lymphocyte nawo enza amasosha omzimba (ama-immunoglobulins) ukusiza ukulwa nezifo.
- Ama-T-cell asiza ukulawula ukusabela kwethu kwamasosha omzimba ukuze amasosha ethu omzimba asebenze ngempumelelo ukuze alwe nezifo, kodwa futhi asiza ukumisa impendulo yokuzivikela komzimba lapho ukutheleleka sekuphelile.
Ama-lymphocyte angaba amaseli e-lymphoma anomdlavuza
I-Cutaneous lymphomas kwenzeka lapho ama-B-cell noma ama-T-cell ahambela esikhumbeni sakho eba nomdlavuza. Amaseli e-lymphoma anomdlavuza abe esehlukana futhi akhule ngokungalawuleki, noma angafi lapho kufanele.
Kokubili abadala kanye nezingane bangathola ama-lymphomas e-cutaneous futhi abantu abaningi abane-cutaneous lymphoma bazoba nama-T-cell anomdlavuza. Cishe abantu abangu-5 kwabangu-20 abane-cutaneous lymphoma bayoba ne-B-cell lymphoma.
I-Cutaneous lymphomas nayo ihlukaniswe yaba:
- Indolent - I-Indolent lymphomas ikhula kancane futhi imvamisa idlula ezigabeni lapho “ilele” ingakulimazi. Ungase ungadingi ukwelashwa uma une-indolent cutaneous lymphoma, nakuba abanye abantu bezokwenza. Ama-lymphomas amaningi angenalutho awasakazeki kwezinye izingxenye zomzimba wakho, nakuba amanye angavala izindawo ezahlukene zesikhumba. Ngokuhamba kwesikhathi, amanye ama-lymphoma angasebenzi angase athuthuke esiteji, okusho ukuthi asakazekela kwezinye izingxenye zomzimba wakho, kodwa lokhu akuvamile kuma-lymphomas amaningi e-cutaneous.
- Ulaka - I-Aggressive lymphomas i-lymphomas ekhula ngokushesha engakhula ngokushesha futhi isakaze kwezinye izingxenye zomzimba wakho. Uma une-aggressive cutaneous lymphoma, kuzodingeka ukuthi uqale ukwelashwa ngokushesha ngemva kokutholakala ukuthi unalesi sifo.
Izimpawu ze-Cutaneous Lymphoma
I-Indolent cutaneous lymphoma
Ungase ungabi nazo izimpawu eziphawulekayo uma une-lymphoma engasebenzi. Ngenxa yokuthi i-indolent lymphomas ikhula kancane, ikhula iminyaka eminingi, ngakho-ke ukuqubuka noma isilonda esikhumbeni sakho singase singanakwa. Uma uthola izimpawu zingase zihlanganisa:
- iqhubu elingasuki
- izindawo ezilumayo noma ezibuhlungu esikhumbeni sakho
- amabala ayisicaba, abomvu, anamaxolo esikhumba
- izilonda ezingaqhekeka futhi zophe futhi zingapholi njengoba kulindelekile
- ububomvu obujwayelekile ezindaweni ezinkulu zesikhumba
- isigaxa esisodwa, noma eziningi esikhumbeni sakho
- Uma unesikhumba esimnyama, ungase ube nezindawo zesikhumba ezikhanyayo kunezinye (kunokuba zibebomvu).
Ama-patches, ama-papules, ama-plaque kanye nezimila - Uyini umehluko?
Izilonda onazo nge-cutaneous lymphomas kungaba ukuqubuka okujwayelekile, noma kungabizwa ngokuthi ama-patches, ama-papules, ama-plaque noma izimila.
Ama-patches – ngokuvamile yizindawo eziyisicaba zesikhumba ezehlukile kunesikhumba esisizungezile. Angaba bushelelezi noma ama-scaly futhi angabukeka njengokuqubuka okuvamile.
Amapapu - yizindawo ezincane, eziqinile eziphakeme zesikhumba, futhi zingabukeka njengeqhubu eliqinile.
Amathafa - izindawo eziqinile zesikhumba ezivame ukuphakama kancane, izindawo eziminyene zesikhumba ezivame ukuba nama-scaly. Ama-plaque ngokuvamile angenziwa iphutha nge-eczema noma i-psoriasis.
Izimila - amaqhubu aphakanyisiwe, izigaxa noma amaqhuqhuva kwesinye isikhathi angaba izilonda ezingapholi.
I-Aggressive ne-Advanced cutaneous lymphoma
Uma une-cutaneous lymphoma enamandla noma ethuthukisiwe, ungase ube nanoma yiziphi izimpawu zalezi ezingenhla, kodwa ungase ube nezinye izimpawu. Lokhu kungafaka:
- Ama-lymph nodes avuvukele ongase ukwazi ukuwabona noma ukuwezwe njengesigaxa ngaphansi kwesikhumba sakho - lawa ngokuvamile ayoba sentanyeni, ekhwapheni noma embeleni.
- Ukukhathala okuwukukhathala okwedlulele okungathuthukisiwe ngokuphumula noma ukulala.
- Ukopha okungajwayelekile noma imihuzuko.
- Amagciwane alokhu ebuya noma angapheli.
- Ukuphelelwa umoya.
- B-izimpawu.
Itholakala kanjani i-cutaneous lymphoma?
Uzodinga i-biopsy noma ama-biopsies ambalwa ukuze uhlole i-cutaneous lymphoma. Uhlobo lwe-biopsy onayo luzoncika ohlotsheni lokuqubuka noma izilonda onazo, lapho zitholakala khona emzimbeni wakho nokuthi zikhulu kangakanani. Kuzophinde kuncike ekutheni yisikhumba sakho kuphela yini esithintekile, noma uma i-lymphoma isisabalele kwezinye izingxenye zomzimba wakho njengama-lymph nodes, izitho, igazi noma umnkantsha. Ezinye zezinhlobo zama-biopsies okungenzeka zinconyelwe wena zibalwe ngezansi.
Isikhumba biopsy
I-biopsy yesikhumba yilapho isampula yokuqubuka kwakho noma isilonda sisuswa futhi sithunyelwa ku-pathology ukuze sihlolwe. Kwezinye izimo, uma unesilonda esisodwa, sonke isilonda singasuswa. Kunezindlela ezahlukene zokwenza i-biopsy yesikhumba, futhi udokotela wakho uzokwazi ukukhuluma nawe mayelana ne-biopsy yesikhumba efanele yezimo zakho.
I-lymph node biopsy
Uma unama-lymph nodes avuvukele angabonakala noma azwakale, noma abonakale kuma-scans, ungase ube ne-biopsy ukuze ubone ukuthi i-lymphoma isisabalele yini kuma-lymph nodes akho. Kunezinhlobo ezimbili eziyinhloko ze-lymph node biopsies ezisetshenziselwa ukuxilonga i-lymphoma.
Zihlanganisa:
I-Core inaliti biopsy – lapho kusetshenziswa inaliti ukukhipha isampula ye-lymph node yakho ethintekile. Uzothola isibulali-zinzwa sasendaweni sokuthulisa indawo ukuze ungezwa ubuhlungu phakathi nale nqubo. Kwezinye izimo, udokotela noma i-radiologist ingase isebenzise i-ultrasound ukuze iqondise inaliti endaweni efanele ye-biopsy.
I-excision biopsy - nge-excisional biopsy cishe uzoba nesibulala-zinzwa esivamile ukuze ulale ngenqubo. I-lymph node yonke noma isilonda siyasuswa ngesikhathi kanye ne-excisional biopsy ukuze yonke indawo noma isilonda sihlolwe ku-pathology ukuze kutholakale izimpawu ze-lymphoma. Cishe uzoba nezitishi ezimbalwa kanye nezingubo zokugqoka lapho uvuka. Umhlengikazi wakho uzokwazi ukukhuluma nawe ngokuthi usinakekela kanjani isilonda, nokuthi nini/uma udinga ukukhishwa imithungo.
Izinhlobo ezingaphansi ze-indolent cutaneous T-cell lymphomas
I-Mycosis Fungoides iwuhlobo oluncane oluvame kakhulu lwe-indolent cutaneous T-cell lymphoma. Ngokuvamile kuthinta abantu abadala asebekhulile, futhi amadoda kaningi kakhulu kunabesifazane, nokho izingane nazo zingaba ne-MF. Ezinganeni sithinta abafana namantombazane ngokulinganayo futhi ngokuvamile sitholakala lapho sineminyaka eyishumi.
I-MF ivamise ukuthikameza isikhumba sakho kuphela, kodwa cishe umuntu oyedwa kwabayi-1 angaba nohlobo olunolaka lwe-MF olungasakazekela kuma-lymph nodes, igazi nezitho zangaphakathi. Uma une-MF enolaka, uzodinga ukwelashwa okufana nokwelashwa okunikezwa enye i-T-cell lymphoma enamandla.
I-ALCL ye-cutaneous eyinhloko iyi-lymphoma engenzi lutho (ekhula kancane) eqala kuma-T-cell ezingxenyeni zesikhumba sakho.
Lolu hlobo lwe-lymphoma ngezinye izikhathi lubizwa ngokuthi i-subtype ye-cutaneous lymphoma futhi ngezinye izikhathi ibizwa ngokuthi i-subtype ye I-Anaplastic Large Cell Lymphoma (ALCL). Isizathu sokuhlukaniswa okuhlukene kungenxa yokuthi amaseli e-lymphoma anezici ezifanayo nezinye izinhlobo ze-ALCL ezinjengamaseli amakhulu kakhulu abukeka ehluke kakhulu kuma-T-cell akho avamile. Nokho, ngokuvamile kuthinta isikhumba sakho kuphela futhi sikhula kancane kakhulu.
Ngokungafani nama-subtypes anolaka we-cutaneous lymphoma ne-ALCL, ungase ungadingi noma yikuphi ukwelashwa kwe-PcALCL. Ungaphila ne-PcALCL impilo yakho yonke, kodwa kubalulekile ukwazi, ukuthi ungaphila kahle nayo, futhi ingase ingabi namphumela omubi empilweni yakho. Ngokuvamile kuthinta kuphela isikhumba sakho futhi kakhulu kakhulu isakazeka esikhumbeni sakho iye kwezinye izingxenye zomzimba wakho.
I-PcALCL imvamisa iqala ngokuba nokuqubuka noma izigaxa esikhumbeni sakho ezingase zilume noma zibe buhlungu, kodwa futhi zingakubangeli ukungaphatheki kahle. Kwesinye isikhathi, kungase kufane nesilonda esingapholi ngendlela obungayilindele. Noma yikuphi ukwelashwa kwe-PcALCL kungenzeka kube ukuthuthukisa noma yikuphi ukulunywa noma ubuhlungu, noma ukuthuthukisa ukubukeka kwe-lymphoma kunokwelapha i-lymphoma ngokwayo. Kodwa-ke, uma i-PcALCL ithinta kuphela indawo encane kakhulu yesikhumba, ingasuswa ngokuhlinzwa noma nge-radiotherapy.
I-PcALCL ivame kakhulu kubantu abaneminyaka ephakathi kuka-50-60, kodwa ingathinta noma ubani wanoma iyiphi iminyaka, kuhlanganisa nezingane.
I-SPTCL ingenzeka kubantwana nakubantu abadala kodwa ivame kakhulu kubantu abadala, kanti isilinganiso seminyaka yokuxilongwa siyiminyaka engama-36 ubudala. Iqanjwe kanje ngoba ibukeka njengesinye isimo esibizwa nge-panniculitis, esenzeka lapho izicubu ezinamafutha ngaphansi kwesikhumba zivuvukala, okubangela ukuthi kukhule izigaxa. Cishe umuntu oyedwa kwabahlanu abane-SPTCL uzoba nesifo esivele sikhona sokuzivikela komzimba esidala ukuthi amasosha akho omzimba ahlasele umzimba wakho.
I-SPTCL yenzeka lapho ama-T-cell anomdlavuza ehamba futhi ehlala ezingxenyeni ezijulile zesikhumba sakho kanye nezicubu ezinamafutha, okubangela ukuba kuvele izigaxa ngaphansi kwesikhumba sakho okwazi ukukubona noma ukukuzwa. Ungase ubone ngisho nama-plaque esikhumbeni sakho. Izilonda eziningi zizungeze u-2cm ngosayizi noma ngaphansi.
Eminye imiphumela emibi ongayithola nge-SPTCL ihlanganisa:
- amahlule egazi noma ukopha okungajwayelekile
- amakhaza
- i-haemophagocytic lymphohistiocytosis - isimo lapho unamangqamuzana omzimba amaningi angasebenzi adala ukulimala komnkantsha wakho, amaseli egazi anempilo nezitho zomzimba.
- Isibindi esikhulisiwe kanye/noma ubende.
I-Lymphomatoid papulosis (LyP) ingathinta izingane kanye nabantu abadala. Akuwona umdlavuza ngakho-ke ngokusemthethweni akulona uhlobo lwe-lymphoma. Kodwa-ke, kubhekwa njengesandulela se-T-cell lymphoma e-cutaneous efana ne-Mycosis Fungoides noma i-Primary Cutaneous Anaplastic Large Cell Lymphoma, futhi kuyaqabukela. I-Hodgkin Lymphoma. Uma kutholwe ukuthi unalesi simo ungase ungakudingi ukwelashwa, kodwa uzobhekwa kakhulu udokotela wakho nganoma yiziphi izimpawu ze-LyP ephenduka umdlavuza.
Kuyisimo esithinta isikhumba sakho lapho ungase ube nezigaxa ezifika zidlule esikhumbeni sakho. Izilonda zingaqala zibe zincane futhi zikhule zibe zinkulu. Angakwazi ukuqhekeka futhi ophe ngaphambi kokoma futhi ahambe ngaphandle kokungenelela kwezokwelapha. Kungathatha izinyanga ezi-2 ukuthi izilonda ziphele. Nokho, uma kubangela ubuhlungu noma ukulunywa noma ezinye izimpawu ezingakhululekile ungase uthole ukwelashwa ukuze uthuthukise lezi zimpawu.
Uma uvame ukuqubuka noma izilonda ezifana nalezi, bonana nodokotela wakho ukuze uthole i-biopsy.
Izinhlobo ezingaphansi ze-indolent B-cell cutaneous lymphomas
I-Primary Cutaneous Follicle Centre Lymphoma (pcFCL) iyi-lymphoma ye-B-cell evilaphayo (ekhula kancane). Kuvamile emazweni asentshonalanga futhi kuthinta iziguli esezikhulile, kanti isilinganiso seminyaka yokuxilongwa siyiminyaka engama-60.
Lolu uhlobo oluncane oluvame kakhulu lwe-Cutaneous B-Cell Lymphoma. Ivamise ukuvilapha (ikhula kancane) futhi ikhula phakathi nezinyanga, noma ngisho neminyaka. Ngokuvamile kubonakala njengezilonda ezibomvu noma ezinsundu noma amathumba esikhumbeni sekhanda lakho, intamo, isifuba, noma isisu. Abantu abaningi abasoze badinga ukwelashwa kwe-pcFCL kodwa uma unezimpawu ezingakhululekile, noma ukhathazwa ukubukeka kwayo, ungase unikezwe ukwelashwa ukuze uthuthukise izimpawu noma ukubukeka kwe-lymphoma.
I-Primary Cutaneous Marginal Zone Lymphoma (pcMZL) iwuhlobo oluncane lwesibili oluvame kakhulu lwe-B-cell cutaneous lymphomas futhi ihlasela amadoda ngokuphindwe kabili kunabesifazane, nokho ingenzeka nasezinganeni. Kuvame kakhulu kubantu asebekhulile abaneminyaka engaphezu kwengu-55, nakubantu abaye baba nokutheleleka kwangaphambili nge-Lyme disease.
Izinguquko zesikhumba zingakhula endaweni eyodwa, noma ezindaweni ezimbalwa ezizungeze umzimba wakho. Ngokuvamile iqala ezingalweni zakho, esifubeni noma emhlane ibe namabala apinki, abomvu noma ansomi noma izigaxa.
Lezi zinguquko zenzeka isikhathi eside, ngakho-ke zingase zingabonakali kakhulu. Ungase ungadingi noma yikuphi ukwelashwa kwe-pcMZL, kodwa ukwelashwa kungase kunikezwe uma unezimpawu ezikubangela ukukhathazeka.
Lolu uhlobo oluncane oluyivelakancane lwe-CBCL olutholakala ezigulini ezingenamasosha omzimba asengozini futhi ezike zaba negciwane le-Epstein-Barr - igciwane elibangela imfiva yezindlala.
Cishe uzoba nesilonda esisodwa kuphela esikhumbeni sakho noma emgudwini wakho wamathumbu noma emlonyeni. Abantu abaningi abakudingi ukwelashwa kwalolu hlobo oluncane lwe-CBCL. Kodwa-ke, uma uthatha imishanguzo ye-immunosuppressive, udokotela wakho angase abuyekeze umthamo ukuze avumele amasosha akho omzimba ukuthi alulame kancane.
Ezimweni ezingavamile, ungase udinge ukwelashwa nge-monoclonal antibody noma imithi elwa namagciwane.
Izinhlobo ezingaphansi ze-Aggressive Lymphoma
I-Sezary Syndrome ibizwa kanjalo ngoba ama-T-cell anomdlavuza abizwa ngokuthi ama-Sezary cells.
I-T-cell lymphoma (CTCL) enamandla kakhulu e-cutaneous cutaneous cutaneous (CTCL) futhi ngokungafani nezinye izinhlobo ze-CTCL, amaseli e-lymphoma (Sezary) awatholakali kuphela ezingxenyeni zesikhumba sakho, kodwa futhi nasegazini kanye nomnkantsha wethambo lakho. Angase futhi asakaze kuma-lymph nodes akho nakwezinye izitho.
I-Sezary Syndrome ingathinta noma ubani kodwa ivame kakhulu emadodeni aneminyaka engaphezu kwengama-60 ubudala.
Izimpawu ongazithola nge-Sezary Syndrome zihlanganisa:
- B-izimpawu
- ukulunywa okukhulu
- ama-lymph node avuvukile
- isibindi esivuvukile kanye / noma ubende
- ukujiya kwesikhumba ezintendeni zezandla zakho noma ematheni ezinyawo zakho
- ukujiya komunwe wakho nezinzipho
- ukulahlekelwa izinwele
- ukushona kwesivalo samehlo akho (lokhu kubizwa ngokuthi i-ectropion).
Ngenxa yemvelo ekhula ngokushesha yamaseli e-Sezary, ungase usabele kahle ku-chemotherapy esebenza ngokubhubhisa amaseli akhula ngokushesha. Kodwa-ke, ukubuyela emuva kuvamile nge-Sezary Syndrome, okusho ukuthi ngisho nangemva kokusabela okuhle, kungenzeka ukuthi lesi sifo sizobuya futhi sidinga ukwelashwa okwengeziwe.
Lena i-T-cell lymphoma eyivelakancane futhi enolaka ebangela izilonda eziningi zesikhumba ezikhula ngokushesha esikhumbeni kuwo wonke umzimba. Izilonda zingaba ama-papules, amaqhuqhuva noma izimila ezingase zibe nezilonda futhi zibonakale njengezilonda ezivulekile. Amanye angase abukeke njengama-plaque noma ama-patches kanti amanye angopha.
Ezinye izimpawu zingafaka:
- B-izimpawu
- Ukulahlekelwa kwesifiso
- ukukhathala
- isifo sohudo
- oluhlanzayo
- ama-lymph node avuvukile
- isibindi esinwetshiwe noma ubende.
Ngenxa yemvelo enolaka, i-PCAETL ingasakazekela ezindaweni ezingaphakathi emzimbeni wakho okuhlanganisa ama-lymph nodes nezinye izitho.
Uzodinga ukwelashwa nge-chemotherapy ngokushesha ngemva kokuxilongwa.
I-Primary Cutaneous (isikhumba) Isakaza I-B-cell Enkulu i-lymphoma i-subtype engavamile ye-lymphoma ethinta abantu abangaphansi ko-1 kwabayi-100 abane-NHL.
Lokhu akuvamile kunezinye izinhlobo ezincane ze-Cutaneous B-Cell Lymphomas. Kuvame kakhulu kwabesifazane kunabesilisa futhi kuvame ukuba nolaka noma ukukhula ngokushesha. Okusho ukuthi kanye nokuthinta isikhumba sakho, kungasakazeka ngokushesha kwezinye izingxenye zomzimba wakho, kuhlanganise nama-lymph nodes akho nezinye izitho.
Ingakhula emavikini kuya ezinyangeni, futhi imvamisa ihlasela abantu abadala abaneminyaka ephakathi kwengama-75. Ngokuvamile iqala emilenzeni yakho (uhlobo lomlenze) njengesilonda/isimila esisodwa noma ngaphezulu kodwa ingakhula ezingalweni zakho kanye nomzimba wakho (esifubeni, emhlane nasesiswini).
Ibizwa ngokuthi i-Primary Cutaneous Diffuse Large B-cell Lymphoma ngoba ngenkathi iqala kuma-B-cell asezingqimbeni zesikhumba sakho, amaseli e-lymphoma afana nalawo atholakala kwezinye izinhlobo ezincane ze-Diffuse Large B-cell Lymphoma (DLBCL). Ngalesi sizathu, lolu hlobo oluncane lwe-B-cell Lymphoma ye-cutaneous luvame ukuphathwa ngendlela efanayo nezinye izinhlobo ezincane ze-DLBCL. Ukuze uthole ulwazi olwengeziwe nge-DLBCL, chofoza lapha.
Ukwelashwa kwe-Cutaneous Lymphoma
Uma sekuqinisekisiwe ukuthi une-cutaneous lymphoma, uzodinga ukuhlolwa okwengeziwe ukuze ubone ukuthi i-lymphoma isisabalele kwezinye izingxenye zomzimba wakho.
Ukuhlolwa komzimba
Udokotela wakho uzokwenza ukuhlolwa ngokomzimba futhi ahlole isikhumba kuwo wonke umzimba wakho ukuze abone ukuthi isikhumba sakho sithinteke kangakanani i-lymphoma. Bangase bacele imvume yakho yokuthatha izithombe ukuze babe nerekhodi lokuthi kwakubukeka kanjani ngaphambi kokuthi uqale noma yikuphi ukwelashwa. Bazobe sebesebenzisa lezi ukuze bahlole ukuthi kukhona yini ukuthuthuka ngokwelashwa. Imvume ingukuzikhethela kwakho, akudingekile ukuba ube nezithombe uma ungazizwa ukhululekile ngalokhu, kodwa uma uvuma, uzodinga ukusayina ifomu lemvume.
I-Positron Emission Tomography (PET) Scan
I-PET scan iyiskena somzimba wakho wonke. Kwenziwa engxenyeni ekhethekile yesibhedlela ebizwa ngokuthi “imithi yenuzi” futhi uzonikezwa umjovo womuthi okhipha imisebe ewumunca noma yimaphi amaseli e-lymphoma. Uma kuskenwa, izindawo ezine-lymphoma bese zikhanyisa kuskena ukuze kubonakale lapho i-lymphoma nosayizi nokuma kwayo.
I-Computed Tomography (CT) scan
I-CT scan iyi-X-ray ekhethekile ethatha izithombe ezinobukhulu obu-3 zangaphakathi lomzimba wakho. Ngokuvamile kuthatha ukuskena kwendawo yomzimba wakho njengesifuba sakho, isisu noma i-pelvis. Lezi zithombe zingakhombisa uma ngabe une-lymph nodes evuvukele ngaphakathi emzimbeni wakho, noma izindawo ezibukeka zinomdlavuza ezithweni zakho.
I-Bone Marrow Biopsy
Abantu abaningi abane-cutaneous lymphoma ngeke badinge i-bone marrow biopsy. Kodwa-ke, uma une-subtype enolaka, ungase udinge eyodwa ukuze uhlole ukuthi i-lymphoma isakaze emnkantsheni wakho.
Izinhlobo ezimbili ze-biopsies zithathwa ngesikhathi se-bone marrow biopsy:
- I-Bone marrow aspirate (BMA): lokhu kuhlola kuthatha inani elincane loketshezi olutholakala endaweni yomnkantsha
- I-Bone marrow aspirate trephine (BMAT): lokhu kuhlola kuthatha isampula elincane lomnkantsha wethambo
Uhlelo lwesiteji lwe-TNM/B lwe-cutaneous lymphoma
Isiteji se-cutaneous lymphoma sisebenzisa uhlelo olubizwa nge-TNM. Uma une-MF noma i-SS kuzongezwa enye incwadi - TNMB.
T = usayizi we Ti-umour - noma ukuthi ungakanani umzimba wakho othintwa i-lymphoma.
N = i-lymph Nodes abathintekayo - ihlola ukuthi i-lymphoma iye yangena yini kuma-lymph nodes akho, nokuthi mangaki ama-lymphoma ane-lymphoma kuwo.
M = Mi-etastasis - ihlola ukuthi ngabe i-lymphoma isisabalele kangakanani emzimbeni wakho.
B = Bi-lood - (i-MF noma i-SS kuphela) ihlola ukuthi ingakanani i-lymphoma egazini lakho kanye nomnkantsha.
Isiteji se-TNM/B se-Cutaneous Lymphoma |
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I-Lymphoma yesikhumba |
I-Mycosis fungoides (MF) noma i-Sezary Syndrome (SS) kuphela |
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TI-Tumornoma isikhumbaethintekile |
T1 – unesilonda esisodwa kuphela.T2 - unezilonda ezingaphezu kwesisodwa esikhumbeni kodwa izilonda zisendaweni eyodwa, noma izindawo ezimbili ezisondelene umzimba wakho.T3 – unezilonda ezindaweni eziningi zomzimba wakho. |
T1 – ngaphansi kuka-10% wesikhumba sakho siyathinteka.T2 - ngaphezu kwe-10% yesikhumba sakho siyathinteka.T3 – unethumba elilodwa noma ngaphezulu elikhulu kuno-1cm.T4 – une-erythema (ubomvu) evala ngaphezu kwama-80% womzimba wakho. |
NI-LymphAmakhadi |
N0 - ama-lymph nodes akho avele ajwayelekile.N1 – iqembu elilodwa lama-lymph node liyabandakanyeka.N2 - amaqembu amabili noma ngaphezulu ama-lymph nodes ayathinteka entanyeni yakho, ngaphezu kwe-clavicle, amakhwapha, inyonga noma amadolo.N3 - ama-lymph nodes ngaphakathi, noma eduze kwesifuba sakho, amaphaphu kanye nemigudu yomoya, imithambo yegazi emikhulu (i-aortic) noma ezinqulwini kuhilelekile. |
N0 – Ama-lymph nodes akho abonakala ejwayelekile.N1 – une-lymph nodes engavamile nezinguquko zebanga eliphansi.N2 - Unama-lymph nodes angavamile anezinguquko zebanga eliphezulu.Nx – unama-lymph nodes angavamile, kodwa izinga alaziwa. |
MI-Metastasis(ukubhebhetheka) |
M0 – awekho ama-lymph nodes akho athintekayo.M1 - i-lymphoma isisabalele kuma-lymph nodes ngaphandle kwesikhumba sakho. |
M0 – azikho izitho zakho zangaphakathi ezithintekayo, njengamaphaphu, isibindi, izinso, ubuchopho.M1 - i-lymphoma isisabalele kwesinye noma ngaphezulu kwezitho zakho zangaphakathi. |
BIgazi |
N / A |
B0 – ngaphansi kuka-5% (5 kwayi-100) ama-lymphocyte anomdlavuza egazini lakho.Lawa maseli anomdlavuza egazini lakho abizwa ngokuthi amaSezary cells.B1 - Ngaphezu kuka-5% wama-lymphocyte egazini lakho amaseli e-Sezary.B2 - Amaseli e-Sezary angaphezu kuka-1000 ngenani elincane kakhulu (i-microliter eyi-1) yegazi lakho. |
Udokotela wakho angasebenzisa ezinye izinhlamvu ezinjengokuthi “a” noma “b” ukuze aqhubeke echaza amaseli akho e-lymphoma. Lokhu kungase kubhekisele kusayizi we-lymphoma yakho, indlela amangqamuzana abukeka ngayo, kanye nokuthi wonke aphuma kungqamuzana elilodwa elingavamile (ama-clone) noma iseli elingaphezu kwelilodwa elingavamile.Cela udokotela wakho ukuthi akuchazele isigaba ngasinye kanye nebanga, nokuthi kusho ukuthini ngokwelashwa kwakho. |
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Ukwelashwa kwe-Indolent Cutaneous Lymphoma
Iningi lama-lymphoma angenamsebenzi awakwazi ukuphulukiswa kodwa naphezu kwalokhu, abantu abaningi abane-indolent cutaneous lymphomas abasoze badinga ukwelashwa.
I-Indolent cutaneous lymphomas ngokuvamile ayinayo ingozi empilweni yakho, ngakho-ke noma yikuphi ukwelashwa onakho kuzoba ukulawula izimpawu zakho kunokwelapha isifo sakho.
Ezinye izimpawu ezingase zizuze ekwelashweni zihlanganisa:
- ubuhlungu
- ukulunywa
- amanxeba noma izilonda ezihlala ukopha
- amahloni noma ukukhathazeka okuhlobene nendlela i-lymphoma ebukeka ngayo.
Izinhlobo zokwelashwa zingabandakanya lokhu okulandelayo.
Ukwelashwa okuqondiswe endaweni noma kwesikhumba.
Ukwelashwa kwezihloko okhilimu owagcoba endaweni ye-lymphoma, kuyilapho ukwelapha okuqondiswe esikhumbeni kungase kuhlanganise i-radiotherapy noma i-phototherapy. Ngezansi ukubuka kabanzi kwezinye izindlela zokwelapha ongase unikezwe zona.
Corticosteroids - anobuthi kumaseli e-lymphoma futhi asiza ukuwabhubhisa. Banganciphisa nokuvuvukala futhi basize ukuthuthukisa izimpawu ezifana nokuluma.
Ama-retinoids - yimithi efana kakhulu ne-vitamin A. Ingasiza ekunciphiseni ukuvuvukala, futhi ilawule ukukhula kwamangqamuzana esikhumbeni. Zisetshenziswa kancane kakhulu, kodwa ziwusizo kwezinye izinhlobo ze-lymphoma yesikhumba.
I-Phototherapy - wuhlobo lokwelapha olusebenzisa izibani ezikhethekile (ngokuvamile i-UV) ezindaweni zesikhumba sakho ezithintwe i-lymphoma. I-UV iphazamisa inqubo yokukhula kwamaseli, futhi ngokulimaza inqubo yokukhula, i-lymphoma iyabhujiswa.
Radiotherapy – isebenzisa amaX-ray ukuze idale umonakalo kuDNA yeseli (izakhi zofuzo zeseli) okwenza kungenzeki ukuthi i-lymphoma ikwazi ukuzilungisa. Lokhu kubangela ukufa kweseli. Ngokuvamile kuthatha izinsuku ezimbalwa noma ngisho amasonto ngemva kokuqala kokwelashwa ngemisebe ukuze amangqamuzana afe. Lo mphumela ungahlala izinyanga ezimbalwa, okusho ukuthi amaseli e-lymphoma anomdlavuza endaweni/ezindaweni ezilashwayo angabhujiswa ngisho nezinyanga ngemuva kokuphela kokwelashwa.
Kwezinye izimo ungase uhlinzwe, kungaba ngaphansi kwe-anesthetic yendawo noma evamile ukuze ususe yonke indawo yesikhumba ehlaselwe i-lymphoma. Lokhu kungenzeka kakhulu uma unesilonda esisodwa noma izilonda ezimbalwa ezincane. Kuvame ukusetshenziswa njengengxenye yenqubo yokuxilonga i-lymphoma yakho, kunokuba njengendlela yokwelapha.
Ukwelashwa kwesistimu
Uma unezindawo eziningi zomzimba wakho ezithintwa i-lymphoma, ungase uzuze ekwelashweni okuhleliwe okufana ne-chemotherapy, i-immunotherapy noma ukwelashwa okuhlosiwe. Lokhu kuchazwe kabanzi ngaphansi kwesigaba esilandelayo – Ukwelashwa kwe-aggressive cutaneous lymphoma.
Ukwelashwa Kwe-Aggressive noma I-Advanced Cutaneous Lymphoma
Ama-lymphoma anolaka kanye/noma athuthukile aphathwa ngendlela efanayo nezinye izinhlobo ze-lymphoma enolaka futhi angafaka:
Ukwelashwa kwesistimu
I-Chemotherapy iwuhlobo lokwelapha oluhlasela ngokuqondile amangqamuzana akhula ngokushesha, ngakho-ke ingasebenza kahle ekubhubhiseni ama-lymphomas akhula ngokushesha. Kodwa ayikwazi ukuhlukanisa phakathi kwamangqamuzana anempilo kanye nomdlavuza akhula ngokushesha, ngakho-ke ingabangela imiphumela emibi engadingeki njengokuqothuka kwezinwele, isicanucanu nokuhlanza, noma isifo sohudo noma ukuqunjelwa.
I-Immunotherapies ingasiza amasosha akho omzimba athole futhi alwe ne-lymphoma ngokuphumelelayo. Lokhu bangakwenza ngezindlela eziningi. Amanye, njengama-anti-monoclonal antibodies anamathisele ku-lymphoma ukusiza amasosha akho omzimba "abone" i-lymphoma ukuze akwazi ukuyibona futhi ayibhubhise. Bayakwazi futhi ukuthinta ukwakheka kwe-lymphoma cell wall, okubenza bafe.
- I-Rituximab yisibonelo se-monoclonal antibody engase isetshenziselwe ukwelapha ukuza I-B-cell lymphomas kuhlanganise ne-cutaneous B-cell lymphoma uma inomaka we-CD20 kuwo.
- Mogamulizumab yisibonelo se-monoclonal antibody egunyazwe abantu abane I-Mycosis Fungides noma i-Sezary Syndrome.
- I-Brentuximab vedotin iyisibonelo "se-conjugated" ye-monoclonal antibody egunyazwe ezinye izinhlobo ze Iseli le-T i-lymphoma enomaka we-CD30 kuwo. Inobuthi obunamathiselwe (obuhlanganisiwe) ku-antibody, futhi i-antibody ihambisa ubuthi buqonde kuseli ye-lymphoma ukuze bubhubhise ngaphakathi.
Amanye, njengama-interleukin nama-interferon angamaprotheni akhethekile avela ngokwemvelo emizimbeni yethu, kodwa angabuye athathwe njengomuthi. Basebenza ngokuthuthukisa amasosha akho omzimba, bawasize avuse amanye amangqamuzana omzimba, futhi ngokutshela umzimba wakho ukuthi wenze amangqamuzana omzimba amaningi ukuze alwe ne-lymphoma.
Ungase ube nama-immunotherapies ngokwawo, noma ngokuhlanganiswa nezinye izinhlobo zokwelapha ezifana ne-chemotherapy.
Izindlela zokwelapha ezihlosiwe ziyimithi eyenziwe eqondise okuthile kuseli ye-lymphoma, ngakho-ke ngokuvamile iba nemiphumela emibi embalwa kunezinye izindlela zokwelapha. Le mithi isebenza ngokuphazamisa izimpawu zamangqamuzana e-lymphoma ukuze asinde. Lapho engazitholi lezi zimpawu, amangqamuzana e-lymphoma ayayeka ukukhula, noma alambe ngoba awakutholi umsoco awudingayo ukuze aphile.
Ukufakelwa kwe-stem cell
Ukufakelwa kwe-stem cell kusetshenziswa kuphela uma i-lymphoma yakho ingaphenduli kwezinye izindlela zokwelapha (i-refractory), noma ibuya ngemva kwesikhathi sokuxolelwa (ukuphindaphinda). Ukwelapha okuyizinyathelo eziningi lapho owakho, noma ama-stem cells (amangqamuzana egazi angavuthiwe kakhulu) ekhishwa ngenqubo ebizwa ngokuthi i-apheresis, bese unikezwa yona ngokuhamba kwesikhathi, ngemva kokuba usuthole umthamo omkhulu wokwelapha ngamakhemikhali.
Nge-cutaneous lymphoma, kuvame kakhulu ukuthi uthole ama-stem cells avela kumnikeli kunowakho. Lolu hlobo lokufakelwa kwe-stem cell lubizwa ngokuthi i-Allogeneic Stem Cell transplant.
I-Extracorporeal photopheresis (ECP)
I-Extracorporeal photopheresis iwukwelashwa okusetshenziselwa kakhulu i-MF ne-SS ethuthukisiwe. Kuyinqubo "yokugeza" igazi lakho nokwenza amangqamuzana akho omzimba asebenze kakhulu ku-lymphoma ukuze abangele ukuthi amangqamuzana e-lymphoma abulawe. Uma udinga lokhu kwelashwa, udokotela wakho uzokwazi ukukunikeza ulwazi olwengeziwe.
Izivivinyo zemitholampilo
Kunconywa ukuthi noma nini lapho udinga ukuqala ukwelashwa ubuze udokotela wakho mayelana nezivivinyo zomtholampilo ongase ukufanelekele. Izivivinyo zomtholampilo zibalulekile ukuthola imithi emisha, noma inhlanganisela yemithi yokuthuthukisa ukwelashwa kwe-cutaneous lymphoma esikhathini esizayo.
Bangakunikeza nethuba lokuzama umuthi omusha, inhlanganisela yemithi noma ezinye izindlela zokwelapha ongeke ukwazi ukuzithola ngaphandle kohlolo. Uma ungathanda ukubamba iqhaza esivivinyweni somtholampilo, buza udokotela wakho ukuthi yiziphi izivivinyo zomtholampilo okufanelekela kuzo.
Kukhona izindlela zokwelapha eziningi nezinhlanganisela ezintsha zokwelapha okwamanje ezihlolwayo ezivivinyweni zomtholampilo emhlabeni wonke ezigulini ezinesifo somdlavuza wesikhumba esisanda kutholwa kanye nesiphinde sabuya.
Izinketho zokwelapha ze-aggressive or late-stage cutaneous lymphoma | |
B-cell cutaneous | T-cell cutaneous |
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Futhi buza udokotela wakho wegazi noma i-oncologist mayelana nanoma yiziphi izivivinyo zomtholampilo ongakufanelekela. | |
Kwenzekani lapho ukwelashwa kungasebenzi, noma i-lymphoma ibuya
Ngezinye izikhathi ukwelashwa kwe-lymphoma akusebenzi ekuqaleni. Uma lokhu kwenzeka kubizwa ngokuthi i-refractory lymphoma. Kwezinye izimo, ukwelashwa kungase kusebenze kahle, kodwa ngemva kwesikhathi sokukhululwa i-lymphoma ingase ibuye - lokhu kubizwa ngokuthi ukuphindaphinda.
Kungakhathaliseki ukuthi une-lymphoma ephindaphindiwe noma ye-refractory, udokotela wakho uzofuna ukuzama ukwelashwa okuhlukile okungase kukusebenzele kangcono. Lokhu kwelashwa okulandelayo kubizwa ngokuthi ukwelashwa komugqa wesibili, futhi kungase kusebenze kakhulu kunokwelashwa kokuqala.
Khuluma nodokotela wakho ngalokho okulindelwe ekwelashweni kwakho, futhi liyoba yini uhlelo uma noma iyiphi yazo ingasebenzi.
Ongakulindela lapho ukwelashwa sekuphelile
Uma uqeda ukwelashwa kwakho udokotela wakho onguchwepheshe usazofuna ukukubona njalo. Uyohlolwa njalo okuhlanganisa ukuhlolwa kwegazi kanye nezikena. Ukuthi ukwenze kangaki lokhu kuhlolwa kuzoncika esimweni sakho somuntu ngamunye futhi udokotela wakho wegazi uzokwazi ukukutshela ukuthi ufuna ukukubona kangaki.
Kungaba isikhathi esijabulisayo noma isikhathi esicindezelayo lapho uqeda ukwelashwa - ngezinye izikhathi kokubili. Ayikho indlela elungile noma engalungile yokuzizwa. Kodwa kubalulekile ukukhuluma ngemizwa yakho nalokho okudingayo nabantu obathandayo.
Ukwesekwa kuyatholakala uma unenkinga yokubhekana nokuphela kokwelashwa. Khuluma nethimba lakho elelaphayo - udokotela wakho wegazi noma umhlengikazi onguchwepheshe womdlavuza njengoba engakwazi ukukuthumela ukuze uthole usizo lokwelulekwa esibhedlela. Udokotela wangakini (udokotela ojwayelekile - GP) angasiza kulokhu.
Abahlengikazi Be-Lymphoma Care
Ungakwazi futhi ukunikeza omunye wabahlengikazi bethu be-Lymphoma Care ucingo noma i-imeyili. Vele uchofoze inkinobho ethi “Thintana nathi” ezansi kwesikrini ukuze uthole imininingwane yokuxhumana.
Isifinyezo
- I-Cutaneous lymphoma iwuhlobo oluncane lwe-Non-Hodgkin Lymphoma olubangelwa amangqamuzana egazi anomdlavuza abizwa ngokuthi ama-lymphocyte, ahambela futhi aphile ezingxenyeni zesikhumba sakho.
- I-Indolent Cutaneous Lymphomas ingase ingadingi ukwelashwa njengoba ngokuvamile ayinayo ingozi empilweni yakho, kodwa ungase uthole ukwelashwa ukuze ulawule izimpawu uma ikwenza ungakhululeki, noma uma i-lymphoma isakazekela kuma-lymph nodes noma kwezinye izingxenye zomzimba wakho.
- I-Aggressive Cutaneous Lymphomas idinga ukwelashwa ngokushesha ngemva kokuxilongwa.
- Kukhona odokotela abangochwepheshe abambalwa abahlukahlukene abangaphatha ukunakekelwa kwakho, futhi lokhu kuzoncika ezimweni zakho ngazinye.
- Uma i-lymphoma yakho ithinta impilo yakho yengqondo noma isimo sengqondo ungacela udokotela wakho ukuthi akudlulisele kudokotela wezengqondo ukuze akusize ubhekane nakho.
- Imithi eminingi ihloselwe ukuthuthukisa izimpawu zakho; kodwa-ke, ungase futhi udinge ukwelashwa ukuze ulawule i-lymphoma, futhi lokhu kungahlanganisa ukwelashwa ngamakhemikhali, amasosha omzimba e-monoclonal, ukwelapha okuhlosiwe kanye nokufakelwa kwe-stem cell.
