Ukuze uqonde i-FL, udinga ukwazi kancane ngama-B-Cell lymphocyte akho.
I-B-Cell lymphocyte:
- Ziwuhlobo lwamangqamuzana amhlophe egazi
- Yilwa nezifo kanye nezifo ukuze uhlale unempilo.
- Khumbula izifo obunazo esikhathini esidlule, ngakho-ke uma uthola ukutheleleka okufanayo futhi, amasosha omzimba wakho angalwa nakho ngempumelelo nangokushesha.
- Zenziwe emnkantsheni wakho (ingxenye yesiponji phakathi kwamathambo akho), kodwa ngokuvamile zihlala ku-spleen yakho kanye nama-lymph nodes akho. Abanye bahlala ku-thymus yakho nasegazini futhi.
- Ungahamba ngohlelo lwakho lwe-lymphatic, uye kunoma iyiphi ingxenye yomzimba wakho ukuze ulwe nokutheleleka noma izifo.
I-Follicular lymphoma (FL) iqala lapho ama-B-cell akho eba nomdlavuza
I-FL iqala lapho amanye ama-B-cell lymphocyte akho ebiza follicular isikhungo B-amaseli abe nomdlavuza. Uma udokotela wezifo ebheka igazi lakho noma ama-biopsies, ngaphansi kwesibonakhulu uzobona ukuthi unengxube yamangqamuzana angama-centrocyte, ama-B-cell amancane kuya kosayizi omaphakathi, nama-centroblast angama-B-cell amakhulu.
I-Lymphoma yenzeka lapho la maseli ekhula ngokungalawuleki, engajwayelekile, futhi engafi lapho kufanele.
Uma une-FL ama-B-cell anomdlavuza:
- Ngeke isebenze ngempumelelo ukulwa nezifo kanye nezifo.
- Ingabukeka ihlukile kumaseli akho e-B-lymphocyte anempilo.
- Kungabangela ukuthi i-lymphoma ikhule futhi ikhule kunoma iyiphi ingxenye yomzimba wakho.
I-FL i-lymphoma ekhula kancane (indolent) evame kakhulu futhi ngenxa yesimo sokuvilapha sale lymphoma itholakala njalo uma isisezingeni eliphezulu. Isigaba esithuthukisiwe se-FL aselapheki, kodwa inhloso yokwelashwa ukulawula izifo iminyaka eminingi. Uma i-FL yakho itholwe ezigabeni zokuqala, ungelapheka ngezinhlobo ezithile zokwelapha.
Ngezinye izikhathi, i-Follicular lymphoma (FL) ingabonisa ingxube yamaseli ahlanganisa ne-aggressive (ekhula ngokushesha) i-B-Cell Lymphoma. Lolu shintsho ekuziphatheni lungenzeka ngokuhamba kwesikhathi futhi lubizwa ngokuthi 'ukuguqulwa'. I-FL eguquliwe isho ukuthi amaseli akho abukeka futhi aziphatha ngendlela efanayo Sabalalisa i-B cell lymphoma enkulu (DLBCL) noma kuyaqabukela, I-Burkitt's lymphoma (BL).
Ubani othola i-follicular lymphoma (FL)?
I-FL iwuhlobo oluncane oluvame kakhulu lokukhula kancane (indolent) Non-Hodgkin's Lymphoma (NHL). Cishe abantu abangu-2 kwabayi-10 abane-lymphoma engenzi lutho abanohlobo oluncane lwe-FL. Ivame kakhulu kubantu abangaphezu kweminyaka engama-50 ubudala, futhi abesifazane bayithola kancane kancane kunabesilisa.
I-follicular lymphoma yezingane ayivamile kodwa ingenzeka ezinganeni, intsha kanye nabantu abadala. Iziphatha ngendlela ehlukile kohlobo oluncane lwabantu abadala futhi ngokuvamile ingelapheka.
Yini ebangela i-follicular lymphoma?
Asazi ukuthi yini ebangela i-FL, kodwa izici ezihlukile zobungozi kucatshangwa ukuthi zandisa ubungozi bakho bokuyithola. Ezinye, izici zobungozi ze-FL kucatshangwa ukuthi zifaka:
- izimo ezithinta amasosha akho omzimba njengesifo seCeliac, Sjogren's syndrome, lupus, rheumatoid arthritis noma human immunodeficiency virus (HIV)
- Ngaphambi kokwelashwa komdlavuza, nge-chemotherapy noma nge-radiation therapy
- ilungu lomndeni eline-lymphoma
*Kubalulekile ukuqaphela, akubona bonke abantu abanalezi zici zobungozi abazothuthukisa i-FL, futhi abanye abantu abangenazo zalezo zici zobungozi bangakwazi ukuthuthukisa i-FL.
Okuhlangenwe nakho kwesiguli nge-follicular lymphoma (FL)
Izimpawu ze-follicular lymphoma (FL)
Ungase ungabi nazo izimpawu lapho utholakala okokuqala ukuthi une-FL. Abantu abaningi baxilongwa kuphela lapho behlolwa igazi, behlolwa, noma behlolelwa okunye okuthile. Lokhu kungenxa yokuvilapha - ukukhula kancane noma ukozela kwe-FL.
Uma uba nezimpawu, izimpawu zokuqala ze-FL kungase kube isigaxa, noma izigaxa ezimbalwa eziqhubeka nokukhula. Ungase uzizwe noma uzibone entanyeni yakho, ekhwapheni, noma enqeni. Lezi zigaxa ziyi-lymph nodes (izindlala), ezivuvukele ngokuba nama-B-cell amaningi anomdlavuza akhula kuzo. Ngokuvamile ziqala engxenyeni eyodwa yomzimba wakho, bese zisakazeka kulo lonke uhlelo lwakho lwe-lymphatic.
Lawa ma-lymph nodes angakhula kancane kakhulu isikhathi eside, okungenza kube nzima ukuqaphela uma kukhona izinguquko.
I-Follicular Lymphoma (FL) ingasakazeka kunoma iyiphi ingxenye yomzimba wakho
I-FL ingasakazeka kweyakho
- ipeni
- i-thymus
- amaphaphu
- isibindi
- amathambo
- umkantsha
- noma ezinye izitho.
Ubende lwakho yisitho esihluza igazi lakho futhi siligcine liphilile. Kuphinde kube isitho sakho se-lymphatic system lapho ama-B-cell akho ehlala khona futhi enze amasosha omzimba ukulwa nokutheleleka. Isohlangothini lwesobunxele lwesisu sakho esingaphezulu ngaphansi kwamaphaphu akho naseduze kwesisu sakho (isisu).
Uma ubunde bakho buba bukhulu kakhulu, bungase bucindezele isisu sakho futhi bukwenze uzizwe usuthe, ngisho noma ungakadli kakhulu.
I-thymus yakho nayo iyingxenye yesistimu yakho ye-lymphatic. Kuyisitho esimise okwevemvane esihlala ngemva kwethambo lakho lesifuba ngaphambili kwesifuba sakho. Amanye ama-B-cell nawo aphila futhi adlule ku-thymus yakho.
Izimpawu ezijwayelekile ze-lymphoma
Izimpawu eziningi ze-FL zingafana nezimpawu ezitholakala kubantu noma yiluphi uhlobo lwe-lymphoma lezi zingabandakanya:
- ukuzizwa ukhathele ngendlela engavamile (ukhathele)
- ezwa ephelelwa umoya
- isikhumba esilumayo
- izifo ezingapheli noma ezilokhu zibuya
- izinguquko ekuhlolweni kwegazi lakho
- amangqamuzana abomvu aphansi namaplatelet
- ama-lymphocyte amaningi kanye/noma ama-lymphocyte angasebenzi kahle
- amaseli amhlophe ehlile (kuhlanganise nama-neutrophils)
- high lactic acid dehydrogenase (LDH) – uhlobo lweprotheyini esetshenziselwa ukwenza amandla. Uma amangqamuzana akho onakaliswe i-lymphoma yakho, i-LDH ingachitheka emangqamuzaneni akho futhi iye egazini lakho
- i-beta-2 microglobulin ephezulu – uhlobo lwamaprotheni olwenziwa amaseli e-lymphoma. Ingatholakala egazini lakho, emchameni noma oketshezini lomgogodla wobuchopho
- B-izimpawu
Ezinye izimpawu ze-follicular lymphoma zingancika lapho isifo sakho sikhona emzimbeni wakho
Indawo ethintekile | Izimpawu |
Amathumbu - okuhlanganisa isisu sakho namathumbu | Isicanucanu noma ngaphandle kokuhlanza (ukuzizwa ugula esiswini noma ukulahla) Uhudo noma ukuqunjelwa (i-poo elinamanzi noma eliqinile) Igazi uma uya endlini encane Ukuzizwa usuthi noma ungadlanga kakhulu |
Isimiso sezinzwa esimaphakathi (CNS) – okuhlanganisa ubuchopho bakho nomgogodla | Ukudideka noma izinguquko zenkumbulo Izinguquko zomuntu ukuquleka Ubuthakathaka, ukuba ndikindiki, ukuvutha noma izikhonkwane nezinaliti ezingalweni nasemilenzeni yakho |
Chest | Ukuphelelwa umoya ubuhlungu besifuba Ukukhwehlela okomile |
Umkantsha | Izibalo zegazi eziphansi ezihlanganisa amaseli abomvu, amaseli amhlophe namaplatelet okuholela ku: o Ukuphelelwa umoya o Amagciwane ajulile abuyayo noma okunzima ukuwaqeda o Ukopha okungajwayelekile noma imihuzuko
|
Skin | Ukuqubuka okubukeka okubomvu noma okunsomi Amaqhubu namaqhubu esikhumbeni sakho okungenzeka kube nombala wesikhumba noma obomvu noma onsomi Itching |
Uzoxhumana nini nodokotela wakho
Kukhona ezinye izimpawu ezingase ziphakamise ukuthi i-FL yakho isiqala ukukhula noma ibe nolaka. Uma uhlangabezana nanoma yiziphi izimpawu zalezi ezingezansi, xhumana nodokotela wakho. Ungalindi ama-aphoyintimenti alandelayo. Kubalulekile ukubavumela ngokushesha ngangokunokwenzeka ukuze benze izinhlelo zokwelashwa uma ungase ugcine ukudinga.
Xhumana neyakho uma:
- babe nama-lymph nodes avuvukele angasuki, noma uma emakhulu kunalokho obungakulindela ekuthelelekeni
- ngokuvamile baphelelwa umoya ngaphandle kwesizathu
- uzizwa ukhathele kakhulu kunokuvamile futhi akubi ngcono ngokuphumula noma ukulala
- qaphela ukopha okungajwayelekile noma imihuzuko (kuhlanganise nendle, emakhaleni noma ezinsinini)
- ukuqubuka okungajwayelekile (ukuqubuka okunsomi kwamabala abomvu kungasho ukuthi unokopha okuthile ngaphansi kwesikhumba sakho)
- ukulunywa kakhulu kunokujwayelekile
- thuthukisa ukukhwehlela okusha
- thola izimpawu ze-B.
Kubalulekile ukuqaphela ukuthi eziningi zezimpawu nezimpawu ze-FL zingahlotshaniswa nezimbangela ngaphandle komdlavuza. Isibonelo, ama-lymph nodes avuvukele angenzeka uma unokutheleleka. Nokho, ngokuvamile, uma unokutheleleka, izimpawu ziba ngcono, futhi ama-lymph nodes azobuyela kusayizi ojwayelekile emasontweni ambalwa. Nge-lymphoma, lezi zimpawu ngeke ziphele. Zingase zibe zimbi nakakhulu.
Itholakala kanjani i-follicular lymphoma (FL)?
Ukuhlonza i-FL ngezinye izikhathi kungase kube nzima futhi kungathatha amasonto ambalwa.
Uma udokotela wakho ecabanga ukuthi ungase ube ne-lymphoma, uzodinga ukuhlela ukuhlolwa okuningana okubalulekile. Lezi zivivinyo ziyadingeka ukuze uqinisekise noma ukhiphe i-lymphoma njengembangela yezimpawu zakho. Ukuqinisekisa uhlobo lwe-Non-Hodgkin's Lymphoma (NHL) kubaluleke kakhulu njengoba ukuphathwa nokwelashwa kwe-subtype yakho kungase kuhluke kwezinye izinhlobo ezincane ze-NHL.
Ukuze uhlole i-FL uzodinga i-biopsy. I-biopsy iyinqubo yokukhipha ingxenye, noma yonke i-lymph node ethintekile kanye/noma umnkantsha. I-biopsy ibe ihlolwa ososayensi elabhorethri ukuze babone ukuthi azikho yini izinguquko ezisiza udokotela ahlonze i-FL.
Uma wenza i-biopsy, ungase ube ne-anesthesia yendawo noma evamile. Lokhu kuzoncika ohlotsheni lwe-biopsy nokuthi ithathwe kuyiphi ingxenye yomzimba wakho. Kunezinhlobo ezahlukene ze-biopsies, futhi ungase udinge ezingaphezu kweyodwa ukuze uthole isampula engcono kakhulu.
Ukuhlolwa kwegazi
Uzoba nokuhlolwa kwegazi okuningi ngokuhamba kwesikhathi. Uzoqala ngokuhlolwa kwegazi ngisho nangaphambi kokuthi uthole ukuthi une-FL. Uzophinde ube nawo ngaphambi nangesikhathi sokwelashwa uma udinga ukwelashwa. Banikeza udokotela wakho isithombe sempilo yakho jikelele, ukuze bakwazi ukwenza izinqumo ezingcono kakhulu kanye nawe mayelana nezidingo zakho zokunakekelwa kwezempilo kanye nokwelashwa.
Inaliti enhle noma i-core biopsy
I-core biopsy ihilela udokotela asebenzise inaliti futhi ayifake ku-lymph node yakho evuvukele noma isigaxa ukuze bakwazi ukususa isampula yezicubu ukuhlola i-lymphoma. Lokhu kuvame ukwenziwa ngaphansi kwe-anesthesia yendawo, ngenkathi uphapheme.
Uma i-lymph node ethintekile ijulile ngaphakathi emzimbeni wakho, i-biopsy ingenziwa ngosizo lwe-ultrasound noma i-x-ray ekhethekile (imaging).
I-Excisional node biopsy
I-excisional biopsy yenziwa uma ama-lymph node akho avuvukele ejulile kakhulu ukuthi angafinyelelwa ngenaliti, noma uma udokotela wakho efuna ukukhipha futhi ahlole yonke i-lymph node.
Ngokuvamile kuzokwenziwa njengenqubo yosuku ethiyetha yokuhlinza futhi uyoba nesibulali-zinzwa esivamile sokukulalisa isikhashana ngenkathi inqubo yenziwa. Uma uvuka uzoba nenxeba elincane kanye nezithungo. Udokotela noma umhlengikazi wakho uzokwazi ukukwazisa ukuthi usinakekela kanjani isilonda, nokuthi uzikhipha nini izithungo zakho.
Udokotela uzokukhethela i-biopsy engcono kakhulu.
Imiphumela
Uma udokotela wakho esethole imiphumela ekuhlolweni kwegazi lakho kanye nama-biopsies bazokwazi ukukutshela uma une-FL futhi angase akwazi ukukutshela ukuthi yiluphi uhlobo oluncane lwe-FL onalo. Bazobe sebefuna ukwenza izivivinyo ezengeziwe ukuze bafake i-FL yakho.
Ukulinganisa nokulinganisa i-follicular lymphoma
Uma usutholwe ukuthi une-FL, udokotela wakho uzoba nemibuzo eminingi mayelana ne-lymphoma yakho. Lokhu kuzobandakanya:
- Isiphi isigaba se-lymphoma yakho?
- Ingakanani i-lymphoma yakho?
- Iluphi uhlobo oluncane lwe-FL onalo?
Chofoza izihloko ezingezansi ukuze ufunde kabanzi mayelana nesiteji kanye nokugreda.
Isiteji sisho ukuthi ungakanani umzimba wakho othintwa i-lymphoma yakho - noma, ukuthi isisabalele kangakanani lapho iqale khona.
Ama-B-cell angahamba aye kunoma iyiphi ingxenye yomzimba wakho. Lokhu kusho ukuthi amaseli e-lymphoma (ama-B-cell anomdlavuza), angaphinde ahambe kunoma iyiphi ingxenye yomzimba wakho. Kuzodingeka wenze izivivinyo ezengeziwe ukuze uthole lolu lwazi. Lezi zivivinyo zibizwa ngokuthi yi-staging test futhi uma uthola imiphumela, uzothola ukuthi unesigaba sokuqala (I), isigaba sesibili (II), isigaba sesithathu (III) noma isigaba sesine (IV) FL.
Isigaba sakho se-FL sizoncika kulokhu:
- Zingaki izindawo zomzimba wakho ezine-lymphoma
- Lapho i-lymphoma ihlanganisa uma ingaphezulu, ngezansi noma nhlangothi zombili ze-diaphragm yakho (umsipha omkhulu, omise okwedome ngaphansi kwezimbambo ohlukanisa isifuba nesisu sakho)
- Ukuthi i-lymphoma isisabalele kumnkantsha wakho wethambo noma ezinye izitho ezinjengesibindi, amaphaphu, isikhumba noma ithambo.
Izigaba I no-II zibizwa ngokuthi 'isigaba sokuqala noma esilinganiselwe' (okubandakanya indawo elinganiselwe yomzimba wakho).
Izigaba III kanye ne-IV zibizwa ngokuthi 'isiteji esithuthukisiwe' (sabalale kakhulu).
1 internship | Indawo eyodwa ye-lymph node iyathinteka, noma ngaphezulu noma ngaphansi kwe-diaphragm*. |
2 internship | Izindawo ezimbili noma ngaphezulu zama-lymph node ziyathinteka ohlangothini olulodwa lwe-diaphragm*. |
3 internship | Okungenani indawo eyodwa ye-lymph node ngaphezulu kanye ne-lymph node eyodwa engaphansi kwe-diaphragm* iyathinteka. |
4 internship | I-Lymphoma itholakala kuma-lymph nodes amaningi futhi isisakazekele kwezinye izingxenye zomzimba (isb. amathambo, amaphaphu, isibindi). |
Ulwazi lwesiteji olwengeziwe
Udokotela wakho angase futhi akhulume ngesiteji sakho esebenzisa incwadi, efana no-A,B, E, X noma S. Lezi zincwadi zinikeza ulwazi olwengeziwe mayelana nezimpawu onazo noma ukuthi umzimba wakho uthinteka kanjani i-lymphoma. Lonke lolu lwazi lusiza udokotela wakho ukuthi akutholele uhlelo olungcono kakhulu lwezokwelapha.
Incwadi | Okusho | Ukubaluleka |
A noma B |
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E & X |
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S |
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(Ubende lwakho luyisitho ohlelweni lwakho lwe-lymphatic oluhluza futhi luhlanze igazi lakho, futhi luyindawo lapho ama-B-cell akho aphumula khona futhi enze amasosha omzimba) |
Ukuhlolwa kwesiteji
Ukuze uthole ukuthi yisiphi isigaba onaso, ungacelwa ukuthi wenze ezinye zalezi zivivinyo ezilandelayo:
Icwecwe le-computer tomography (CT)
Lezi zithwebuli zithatha izithombe zengaphakathi lesifuba sakho, isisu noma i-pelvis. Banikeza izithombe ezinemininingwane enikeza ulwazi olwengeziwe kune-X-ray evamile.
Ukuskena kwe-Positron emission tomography (PET)
Lesi iskena esithatha izithombe zengaphakathi lomzimba wakho wonke. Uzonikezwa futhi ufake inaliti ngomuthi othile othathwa amaseli anomdlavuza - njengamaseli e-lymphoma. Umuthi osiza ukuskena kwe-PET ukukhomba lapho i-lymphoma ikuphi kanye nosayizi nokuma ngokugqamisa izindawo ezinamaseli e-lymphoma. Lezi zindawo ngezinye izikhathi zibizwa ngokuthi "ezishisayo".
Ukukhishwa kwe-Lumbar
Ukubhoboza i-lumbar kuyinqubo eyenziwa ukuhlola ukuthi unayo yini i-lymphoma endaweni yakho isimiso sezinzwa esiyinhloko (CNS), okuhlanganisa ubuchopho bakho, umgogodla kanye nendawo ezungeze amehlo akho. Uzodinga ukuthi unganyakazi phakathi nenqubo, ukuze izingane kanye nezingane zibe nesibulali-zinzwa esivamile ukuze zilalise isikhashana inqubo yenziwa. Abantu abadala abaningi bazodinga kuphela umuthi obulala izinzwa wasendaweni ukuze inqubo iqede indawo.
Udokotela wakho uzokufaka inaliti emhlane wakho, futhi akhiphe uketshezi oluncane olubizwa ngokuthi “uketshezi lwe-cerebral spinal” (CSF) kusuka eduze komgogodla wakho. I-CSF iwuketshezi olusebenza kancane njengesibambisi sokwethuka ku-CNS yakho. Iphinde ithwale amaprotheni ahlukene kanye nokutheleleka okulwa namaseli omzimba afana ne-lymphocyte ukuvikela ubuchopho bakho nomgogodla. I-CSF ingasiza futhi ukukhipha noma iluphi uketshezi olwengeziwe okungenzeka unalo ebuchosheni bakho noma eduze komgogodla wakho ukuvimbela ukuvuvukala kulezo zindawo.
Isampula ye-CSF izobe isithunyelwa ku-pathology futhi ihlolwe noma yiziphi izimpawu ze-lymphoma.
I-bone yomnkantsha i-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.
Amasampula abe esethunyelwa ku-pathology lapho ehlolelwa khona izimpawu ze-lymphoma.
Inqubo ye-biopsies yomnkantsha ingahluka kuye ngokuthi ulashwa kuphi, kodwa ngokuvamile izofaka isibulali-zinzwa sasendaweni ukuze ndikindiki indawo.
Kwezinye izibhedlela, ungase unikezwe i-sedation elula ekusiza ukuthi uphumule futhi ingakuvimba ekukhumbuleni inqubo. Nokho abantu abaningi abakudingi lokhu futhi esikhundleni salokho bangase babe “nempempe eluhlaza” abangayincela. Le nlozi eluhlaza inomuthi obulala izinhlungu kuwo (obizwa ngePenthrox noma i-methoxyflurane), owusebenzisa njengoba kudingeka kuyo yonke inqubo.
Qiniseka ukuthi ubuza udokotela wakho ukuthi yini etholakalayo ukuze ukhululeke kakhudlwana phakathi nenqubo, futhi ukhulume nabo ngalokho ocabanga ukuthi kuyoba inketho engcono kakhulu kuwe.
Ulwazi olwengeziwe mayelana nama-biopsies omnkantsha lungatholakala ekhasini lethu lewebhu lapha.
Amaseli akho e-lymphoma anephethini yokukhula ehlukile futhi abukeka ehlukile kumaseli avamile. Ibanga le-Follicular lymphoma yakho yindlela amangqamuzana akho e-lymphoma abukeka ngayo ngaphansi kwe-microscope. Amabanga 1-2 (ibanga eliphansi) anenani elincane lama-centroblasts (ama-B-cell amakhulu). Amabanga 3a kanye ne-3b (ibanga eliphezulu) anenani elikhulu lama-centroblasts (ama-B-cell amakhulu), futhi ngokuvamile ama-centrocyte (ama-B cell amancane kuya kwaphakathi) ayabonakala futhi. Amaseli akho azobukeka ehlukile kumaseli ajwayelekile futhi akhule ngendlela ehlukile. Uma amaseli e-centroblast ethula kakhulu yilapho isimila sakho sizoba nolaka (ikhula ngokushesha). Uhlolojikelele lwamabanga lungezansi.
Inhlangano Yezempilo Yomhlaba (WHO) izinga le-follicular lymphoma (FL)
Grade | Incazelo |
1 | Izinga eliphansi: Ama-centroblasts angu-0-5 abonwa kumaseli e-lymphoma. Amaseli angu-3 kwangu-4 angama-indolent (akhula kancane) ama-follicular B-cell |
2 | Ibanga eliphansi: 6-15 centroblasts abonwa kumaseli e-lymphoma. Amaseli angu-3 kwangu-4 angama-indolent (akhula kancane) ama-follicular B-cell |
3A | Ibanga eliphakeme: Ngaphezu kwe-15 centroblasts kanye nama-centrocyte akhona kumaseli e-lymphoma. Kukhona inhlanganisela yamaseli e-lymphoma avilaphayo (akhula kancane) kanye namaseli e-lymphoma ahlaselayo (akhula ngokushesha) abizwa ngokuthi amaseli B amakhulu. |
3B | Ibanga eliphakeme: Ngaphezu kwe-15 centroblasts nge CHA ama-centrocyte abonakala kumaseli e-lymphoma. Kukhona inhlanganisela yamaseli e-lymphoma avilaphayo (akhula kancane) kanye namaseli e-lymphoma ahlaselayo (akhula ngokushesha) abizwa ngokuthi amaseli B amakhulu. ngenxa yaleliBanga lesi-3b lithathwa njenge-Diffuse Large B Cell Lymphoma subtype (DLBCL) ADD: Xhuma ku-DLBCL |
Ukuhlelwa kanye nesiteji se-FL yakho kubaluleke kakhulu njengoba kukhombisa ukuthi udinga ukwelashwa kanye nokuthi hlobo luni lokwelashwa.
- Stage I-IV FL ingase ingadingi ukwelashwa ngokushesha futhi ungase ubekwe ekuqashweni okusebenzayo (ubuke futhi ulinde) njengoba unebanga eliphansi (elikhula kancane) FL.
- Grade I-FL- 3A ne-3B iphathwa ngendlela efanayo ne-DLBCL okuwuhlobo oluncane olunolaka lwe-NHL.
Kubalulekile ukuthi ukhulume nodokotela wakho mayelana nezici zakho eziyingozi ukuze ube nombono ocacile wokuthi yini ongayilindela ekwelashweni kwakho.
Izinhlobo ezingaphansi ze-Follicular lymphoma (FL)
Uma udokotela wakho eseyitholile yonke imiphumela yakho, uzokwazi ukukwazisa ukuthi unasiphi isigaba kanye nebanga le-FL. Ungase futhi utshelwe ukuthi une-subtype ethile ye-FL, kodwa lokhu akulona icala lawo wonke umuntu.
Uma utshelwa ukuthi une-subtype ethile, chofoza izixhumanisi ezingezansi ukuze ufunde kabanzi ngalolo hlobo oluncane.
I-Duodenal-type follicular lymphoma ibizwa nangokuthi i-primary gastrointestinal follicular lymphoma (PGFL). Kuyi-FL ekhula kancane kakhulu futhi ivame ukutholakala ezigabeni zayo zakuqala.
Ikhula engxenyeni yokuqala yamathumbu akho amancane (i-duodenum), idlula isisu sakho. I-PGFL itholakala kakhulu endaweni, okusho ukuthi itholakala endaweni eyodwa kuphela, futhi ngokuvamile ayisakazeki kwezinye izingxenye zomzimba wakho.
Izimpawu
Ezinye izimpawu ongase ube nazo nge-PGFL zihlanganisa ubuhlungu besisu nesilungulela, noma ungase ungabi nazo nhlobo izimpawu. Ukwelashwa kungase kube ukuhlinzwa noma ukubuka nokulinda (ukuqapha okusebenzayo). kuye ngezimpawu zakho.
Ngisho noma kudingeka ukuhlinzwa, umphumela wabantu abanohlobo lwe-Duodenal FL muhle kakhulu.
I-FL ebonakala kakhulu iyiqembu lamaseli e-lymphoma ahlakazekile atholakala kakhulu engxenyeni eyodwa yomzimba wakho. Izimpawu eziyinhloko yinqwaba enkulu (isimila) ebonakala njengesigaxa endaweni yakho ye-groin (inguinal).
I-follicular lymphoma yezingane iwuhlobo olungavamile kakhulu lwe-follicular lymphoma. Sihlasela kakhulu izingane kodwa singahlasela nabantu abadala abafika eminyakeni engaba ngu-40 ubudala.
Ucwaningo lubonisa ukuthi i-P-TFL ihlukile futhi yehlukile ku-follicular lymphoma evamile. Iziphatha njengesimila esiyingozi (esingenawo umdlavuza) futhi ngokuvamile sitholakala engxenyeni eyodwa yomzimba wakho. Ayivamisile ukusabalala endaweni eqala ukumila kuyo.
I-PTFL ivame kakhulu kuma-lymph nodes eduze kwekhanda lakho nentamo.
Ukwelashwa kwe-follicular lymphoma yezingane kungase kuhlanganise ukuhlinzwa ukuze kukhishwe ama-lymph nodes athintekile, noma ubuke futhi ulinde (ukuqapha okusebenzayo). Ngemuva kokwelashwa okuphumelelayo, lolu hlobo oluncane aluvamile ukubuya.
Ukuqonda i-lymphoma cytogenetics yakho
Kanye nazo zonke izivivinyo ezingenhla, ungase ube nokuhlolwa kwe-cytogenetic. Yilapho igazi lakho nesampula yesimila kuhlolwa khona ukuhluka kofuzo okungenzeka kuhileleke esifweni sakho. Ukuze uthole ulwazi olwengeziwe ngalokhu sicela ubheke isigaba sethu sokuqonda i-lymphoma genetics ngokuqhubekayo kuleli khasi. Ukuhlola okusetshenziselwa ukuhlola noma yikuphi ukuguqulwa kofuzo kubizwa ngokuthi ukuhlola kwe-cytogenetic. Lokhu kuhlola kubheka ukubona ukuthi awunakho yini okushintshile kuma-chromosome nakuzakhi zofuzo.
Sivame ukuba namapheya angu-23 ama-chromosome, futhi abalwa ngokobukhulu bawo. Uma une-FL, ama-chromosome akho angase abukeke ehluke kancane.
Ayini izakhi zofuzo nama-chromosome?
Ingqamuzana ngalinye elakha umzimba wethu linenucleus, futhi ngaphakathi ku-nucleus kunamapheya angu-23 ama-chromosome. Ichromosome ngayinye yenziwe ngemicu emide ye-DNA (deoxyribonucleic acid) equkethe izakhi zethu zofuzo.
Izakhi zofuzo zethu zinikeza ikhodi edingekayo ukuze kwenziwe wonke amangqamuzana namaprotheni emzimbeni wethu futhi ibatshele ukuthi babukeke kanjani noma benze kanjani.
Uma kunoshintsho (ukuhlukahluka) kulawa ma-chromosome noma izakhi zofuzo, amaprotheni namaseli akho ngeke asebenze kahle.
Ama-lymphocyte angaba amaseli e-lymphoma ngenxa yezinguquko zofuzo (okuthiwa ukuguqulwa noma ukuhluka) ngaphakathi kwamaseli. I-lymphoma biopsy yakho ingase ibhekwe udokotela wezifo ezithile ukuze abone ukuthi awunazo yini izinguquko zofuzo.
Ingabe ukuguqulwa kwe-FL kubukeka kanjani?
Ukuveza ngokweqile
Ucwaningo luthole ukuthi izinguquko zofuzo ezahlukene (ukuguqulwa kwezakhi zofuzo) kungabangela i ukuveza ngokweqile (okuningi kakhulu) kwamaprotheni athile ebusweni bamaseli e-FL. Lapho la maprotheni evezwa ngokweqile, wona ukusiza umdlavuza wakho ukhule.
Amaprotheni ahlukene ayingxenye yeqembu elivame ukutshela amaseli ukuthi akhule, noma afe futhi agcine ibhalansi enempilo. Baphinde babone uma iseli lilimala, noma liqala ukuba nomdlavuza, bese litshela lawa maseli ukuthi azilungise wona, noma afe. Kodwa ukuvezwa ngokweqile kwamanye amaprotheni atshela amaseli e-lymphoma ukuthi akhule, kubangela ukuthi le nqubo ingalingani, futhi ivumele amangqamuzana anomdlavuza ukuthi aqhubeke ekhula futhi anda.
Amanye amaprotheni angase agcizelelwe ngokweqile kumaseli akho e-FL ahlanganisa:
- I-CD5
- I-CD10
- I-CD20
- I-CD23
- I-CD43
- I-BCL6
- I-IRF4
- UMUM1
Ukuthutha
Izakhi zofuzo nazo zingadala izinguquko ekusebenzeni nasekukhuleni ngenxa ye ukuthutha. Ukuguqulwa kwenzeka lapho izakhi zofuzo kuma-chromosome amabili ahlukene zishintsha izindawo. Ukuthutha kuvame kakhulu kubantu abane-FL. Uma une-translocation kumaseli akho e-FL, kungenzeka kube phakathi kwe-chromosome yakho ye-14 neye-18. Uma unokuguqulwa kofuzo kuma-chromosome we-14 no-18 kubhalwe ngokuthi t(14:18).
Kungani kubalulekile ukwazi mayelana nezinguquko zofuzo enginazo?
Izinguquko zofuzo zibalulekile ngoba zingasiza udokotela wakho abikezele ukuthi i-FL yakho izokwenza kanjani futhi ikhule. Iphinde ibasize bahlele ukuthi iyiphi i-tratment engakusebenzela kangcono.
Ukukhumbula igama lezinguquko zakho zofuzo akubalulekile kangako. Kodwa, ukwazi ukuthi unokunye kwalokhu kuguqulwa kofuzo kuchaza ukuthi kungani ungase udinge ukwelashwa okuhlukile noma imithi kwabanye abane-FL.
Ukutholakala kwezinguquko zofuzo ku-lymphoma kuye kwaholela ocwaningweni nasekuthuthukisweni kokwelashwa okusha okuqondise kumaprotheni noma izakhi zofuzo ezihilelekile. Lolu cwaningo lusaqhubeka njengoba kutholakala izinguquko ezengeziwe.
Ezinye zezindlela ushintsho lwakho lofuzo olungaba nomthelela ekwelapheni kwakho zihlanganisa:
- Uma i-CD20 igcizelelwe ngokweqile kumaseli akho e-FL futhi udinga ukwelashwa, ungase ube nomuthi obizwa ngokuthi i-rituximab (ebuye ibizwe ngokuthi i-Mabthera noma i-Rituxan). I-CD20 overexpression ivame kakhulu kubantu abane-follicular lymphoma.
- Uma unokuzwisisa ngokweqile kwe-IRF4 noma i-MUM1, kungase kubonise ukuthi i-FL yakho inolaka kunokuvila, futhi ingase idinge ukwelashwa.
- Ezinye izinguquko zofuzo zingase zisho ukuthi ukwelashwa okuhlosiwe kuzosebenza kangcono ukwelapha i-FL yakho.
Imibuzo okufanele uyibuze udokotela wakho
Kungaba nzima ukwazi ukuthi yimiphi imibuzo okufanele uyibuze lapho uqala ukwelashwa. Uma ungazi, yini ongayazi, ungazi kanjani ukuthi yini okufanele uyibuze?
Ukuba nolwazi olufanele kungakusiza uzizwe uqiniseka futhi wazi ukuthi yini ongayilindela. Kungakusiza nokuthi uhlele kusengaphambili lokho ongase ukudinge.
Sihlanganisa uhlu lwemibuzo ongayithola iwusizo. Yiqiniso, isimo sawo wonke umuntu sihlukile, ngakho le mibuzo ayihlanganisi yonke into, kodwa inikeza isiqalo esihle.
Chofoza isixhumanisi esingezansi ukuze udawunilode i-PDF ephrintekayo yemibuzo kadokotela wakho
Ukwelashwa kwe-Follicular Lymphoma (FL)
Uma yonke imiphumela evela kuma-biopsies akho, ukuhlolwa kwe-cytogenetic kanye nezikena zesiteji sezingenile, udokotela wakho uzokwazi ukwenza izinhlelo mayelana nendlela yokuphatha i-FL yakho. Ezimweni eziningi lokhu kungase kusho ukuthatha indlela ethi “Buka futhi Ulinde”. Lokhu kusho ukuthi i-lymphoma yakho ayidingi ukwelashwa, kodwa bazofuna ukubukela eduze ukuze babone ukuthi i-lymphoma iqala ukukhula kakhulu, noma ibangele ukuthi ube nezimpawu noma ungaphatheki kahle. Ungalanda iphepha lethu leqiniso kokuthi Buka futhi Ulinde ngokuchofoza isixhumanisi esingezansi.
Ukuqala nini ukwelashwa
Udokotela wakho uzobuyekeza lezi ukuze anqumele indlela yokwelashwa engcono kakhulu kuwe. Kwezinye izikhungo zomdlavuza, udokotela uzophinde ahlangane nethimba lochwepheshe ukuze kudingidwe indlela yokwelapha engcono kakhulu. Lokhu kubizwa ngokuthi a ithimba le-multidisciplinary (MDT) umhlangano.
Udokotela wakho uzocabangela izici eziningi mayelana ne-FL yakho. Izinqumo zokuthi udinga nini ukuqala nokuthi yikuphi ukwelashwa okungcono kakhulu zisekelwe kulokhu:
- Isigaba sakho ngasinye se-lymphoma, izinguquko zofuzo, nezimpawu
- Iminyaka yakho yobudala, umlando wezokwelapha odlule, kanye nempilo ejwayelekile
- Impilo yakho yamanje engokomzimba nengokwengqondo kanye nezinketho zesiguli.
Ukuhlolwa okwengeziwe kungase ku-odwe ngaphambi kokuba uqale ukwelashwa ukuze uqiniseke ukuthi inhliziyo yakho, amaphaphu nezinso ziyakwazi ukubhekana nokwelashwa. Lokhu kungase kuhlanganise i-ECG (i-electrocardiogram), ukuhlolwa kokusebenza kwamaphaphu noma ukuqoqwa komchamo wamahora angu-24.
Udokotela wakho noma umhlengikazi womdlavuza angakuchazela ngohlelo lwakho lokwelapha kanye nemiphumela engemihle engase ibe khona kuwe futhi ukhona ukuphendula noma yimuphi umbuzo ongase ube nawo. Kubalulekile ukuthi ubuze udokotela wakho kanye/noma unesi womdlavuza imibuzo nganoma yini ongayiqondi.
Inhloso yokwelapha i-FL yilokhu:
- Yelula ukuxolelwa
- Nikeza ukulawula izifo
- Thuthukisa izinga lokuphila
- Yehlisa izimpawu noma imiphumela engemihle ngokunakekela okusekelayo noma okudambisa ubuhlungu
Ungaphinda ushayele ucingo noma uthumele i-imeyili ku-Lymphoma Australia Nurse Helpline ngemibuzo yakho futhi singakusiza ukuthi uthole ulwazi olulungile.
Buka futhi Ulinde
Kwezinye izimo udokotela wakho angase anqume ukuthi akufanele uthole ukwelashwa okusebenzayo. Lokhu kungenxa yokuthi ngokuvamile, i-Follicular Lymphoma ayilali (noma ilele) futhi ikhula kancane kangangokuthi ingabangeli izinkinga emzimbeni wakho. Ucwaningo luye lwabonisa lokho akukho nzuzo ekuqaliseni ukwelashwa ngalesi sikhathi, futhi iza nengcuphe yemiphumela engemihle yokwelashwa.
Uma i-lymphoma “ivuka” noma iqala ukukhula ngokushesha, cishe uzonikezwa ukwelashwa okusebenzayo.
Inombolo yocingo yomhlengikazi we-Lymphoma:
Ifoni: 1800 953 081
Email: nurse@lymphoma.org.au
Kudingeka nini ukwelashwa kwe-Follicular Lymphoma (FL)?
Njengoba kushiwo ngenhla, akuwona wonke umuntu one-FL ozodinga ukuthi aqale ukwelashwa ngokushesha. Ukuze usize odokotela bakho banqume ukuthi sekuyisikhathi sokuqala ukwelashwa kwasungulwa indlela yokunquma ebizwa ngokuthi 'i-GELF criteria'. Uma unesinye noma eziningi zalezi zimpawu, kungenzeka ukuthi ungadinga ukwelashwa:
- I-tumor mass engaphezu kuka-7cm ngosayizi.
- Ama-lymph nodes ama-3 avuvukele ezindaweni ezi-3 ezihlukene, wonke amakhulu kuno-3cms ngosayizi.
- Izimpawu ze-B eziqhubekayo.
- Ubende olukhulisiwe (splenomegaly)
- Ukucindezela kunoma yiziphi izitho zakho zangaphakathi ngenxa yokuvuvukala kwama-lymph nodes.
- Uketshezi olunamaseli e-lymphoma emaphashini akho noma esiswini (ama-Pleural effusions noma ama-ascites).
- Amaseli e-FL atholakala egazini lakho noma umongo wethambo (izinguquko ze-leukemic) noma ukwehla kwamanye amangqamuzana egazi ezempilo (cytopenias). Lokhu kusho ukuthi i-FL yakho ivimba umnkantsha wakho ukuthi ukwazi ukukhiqiza amangqamuzana egazi ezempilo anele.
- I-LDH ephakeme noma i-Beta2- microglobulin (lokhu ukuhlolwa kwegazi).
Chofoza ezihlokweni ezingezansi ukuze ubone izinhlobo ezahlukene zokwelapha ezingase zisetshenziswe ukuphatha i-FL yakho.
Ukunakekelwa okusekelayo kunikezwa iziguli kanye nemindeni ebhekene nokugula okubi kakhulu. Ukunakekelwa okusekelayo kungasiza iziguli zibe nezimpawu ezimbalwa, futhi empeleni zibe ngcono ngokushesha ngokunaka lezo zici zokunakekela kwazo.
Kwabanye benu abane-FL, amangqamuzana akho e-leukemic angase akhule ngokungalawuleki futhi aminyene umnkantsha, igazi, ama-lymph nodes, isibindi noma ubende. Ngenxa yokuthi umnkantsha ugcwele amaseli e-FL mancane kakhulu ukuthi angasebenza kahle, amangqamuzana akho egazi avamile azothinteka. Ukwelashwa okusekelayo kungase kuhlanganise izinto ezifana nokuthi umpontshelwa igazi noma i-platelet ewodini noma endaweni yokufakwa emthanjeni esibhedlela. Ungase ube nama-antibiotics ukuvimbela noma ukwelapha izifo.
Kungase kuhlanganise ukubonisana nethimba labanakekeli abakhethekile noma ngisho nokunakekelwa kwe-palliative. Kungase futhi kube nezingxoxo mayelana nokunakekelwa kwesikhathi esizayo, okubizwa ngokuthi Ukuhlelwa Kokunakekelwa Okuthuthukile. Lezi zinto ziyingxenye yokuphathwa kwe-lymphoma ye-multidisciplinary.
Ukunakekelwa okusekelayo kungabandakanya ukunakekelwa kwe-palliative okusiza ukuthuthukisa izimpawu zakho kanye nemiphumela emibi, kanye nokuphela kokunakekelwa kwempilo uma kudingeka.
Kubalulekile ukwazi ukuthi ithimba Lokunakekela I-Palliative Care lingabizwa noma nini phakathi nendlela yakho yokwelashwa hhayi nje ekupheleni kwempilo. Bangasiza ukulawula nokulawula izimpawu (njengokunzima ukulawula ubuhlungu nesicanucanu) okungenzeka ukuthi unakho ngenxa yesifo sakho noma ukwelashwa kwaso.
Uma wena nodokotela wakho ninquma ukusebenzisa ukunakekelwa okusekelayo noma ukuyeka ukwelashwa kwe-lymphoma yakho, izinto eziningi zingenziwa ukuze zikusize uhlale unempilo futhi unethezekile ngangokunokwenzeka isikhathi esithile.
I-radiation therapy yindlela yokwelapha umdlavuza esebenzisa imithamo ephezulu yemisebe ukubulala amangqamuzana e-lymphoma futhi ashwabene nezimila. Ngaphambi kokuba ube nemisebe, uzoba neseshini yokuhlela. Lesi seshini sibalulekile kubelaphi bemisebe ukuthi bahlele ukuthi bangaqondisa kanjani emisebeni ku-lymphoma, futhi bagweme ukulimaza amaseli anempilo. Ukwelashwa ngemisebe ngokuvamile kuthatha phakathi kwamaviki angu-2-4. Ngalesi sikhathi, uzodinga ukuya esikhungweni semisebe nsuku zonke (ngoMsombuluko-uLwesihlanu) ukuze uthole ukwelashwa.
*Uma uhlala kude nesikhungo se-radiation futhi udinga usizo ngendawo yokuhlala ngesikhathi sokwelashwa, sicela ukhulume nodokotela noma unesi wakho mayelana nokuthi yiluphi usizo ongaluthola. Ungakwazi futhi ukuthintana neCancer Council noma i-Leukemia Foundation esifundeni sakho futhi ubone ukuthi bangasiza yini ngendawo yokuhlala.
Ungase ube le mithi njengethebhulethi futhi/noma unikezwe njengethonsi (ukufakwa) emithanjeni yakho (emgudwini wegazi lakho) emtholampilo womdlavuza noma esibhedlela. Imithi eminingana ehlukene ye-chemo ingase ihlanganiswe nomuthi we-immunotherapy. I-Chemo ibulala amaseli akhula ngokushesha ngakho-ke ingathinta namanye amaseli akho amahle akhula ngokushesha abangele imiphumela engemihle.
Ungase ube ne-MAB infusion emtholampilo womdlavuza noma esibhedlela. Ama-MAB anamathisele kuseli ye-lymphoma futhi ahehe ezinye izifo ezilwa namaseli amhlophe egazi namaprotheni kumdlavuza ukuze amasosha akho omzimba akwazi ukulwa ne-FL.
I-MABS izosebenza kuphela uma unamaprotheni athile noma izimpawu kumaseli akho e-lymphoma. Umaka ojwayelekile ku-FL yi-CD20. Uma unalo maka ungase uzuze ekwelashweni nge-MAB.
I-Chemotherapy ehlanganiswe ne-MAB (isibonelo, i-rituximab).
Ungathatha lezi njengethebhulethi noma ukumnika emithanjeni yakho. Izindlela zokwelapha eziphuzwayo zingase zithathwe ekhaya, nakuba ezinye zizodinga ukuhlala isikhashana esibhedlela. Uma unomuthi, ungawuthola emtholampilo wansuku zonke noma esibhedlela. Izindlela zokwelapha ezihlosiwe zinamathisela kuseli ye-lymphoma futhi zivimbe izimpawu ezidinga ukukhula futhi zikhiqize amaseli amaningi. Lokhu kuvimbela umdlavuza ukuthi ungakhuli futhi kubangela ukuthi amangqamuzana e-lymphoma afe.
I-stem cell noma ukufakelwa komnkantsha wethambo kwenziwa ukuze esikhundleni somnkantsha wakho ogulayo kube namaseli amasha angakhula abe amaseli egazi amasha anempilo. Ukufakelwa komnkantsha wethambo ngokuvamile kwenziwa kuphela ezinganeni ezine-FL, kuyilapho ukufakelwa kwe-stem cell kwenziwa kuzo zombili izingane ezindala.
Ekufakweni komnkantsha, ama-stem cells asuswa ngokuqondile emnkantsheni, lapho njengokufakelwa kwe-stem cell, ama-stem cells asuswa egazini.
Ama-stem cells angase akhishwe kumnikeli noma aqoqwe kuwe ngemva kokwelashwa ngamakhemikhali.
Uma wena ama-stem cell avela kumnikeli, kubizwa ngokuthi i-allogeneic stem cell transplant.
Uma ama-stem cells akho eqoqwe, kubizwa ngokuthi i-autologous stem cell transplant.
Ama-stem cells aqoqwa ngenqubo ebizwa ngokuthi i-apheresis. Wena (noma umnikezeli wakho) uzoxhunywa emshinini we-apheresis futhi igazi lakho lizokhishwa, ama-stem cells ahlukaniswe futhi aqoqwe esikhwameni, bese lonke igazi lakho libuyiselwa kuwe.
Ngaphambi kwenqubo, uzothola i-chemotherapy yomthamo omkhulu noma i-radiotherapy yomzimba ogcwele ukuze ubulale wonke amaseli akho e-lymphoma. Kodwa-ke lokhu kwelashwa ngethamo eliphezulu kuzophinde kubulale wonke amaseli omnkantsha wakho. Ngakho-ke ama-stem cells aqoqiwe azobe esebuyiselwa kuwe (atshalwe kabusha). Lokhu kwenzeka ngendlela efanayo naleyo yokumpontshelwa igazi, ngokusebenzisa i-drip emthanjeni wakho.
I-CAR T-cell therapy iwukwelashwa okusha okuzonikezwa kuphela uma usuvele unezinye izindlela zokwelapha okungenani ezimbili ze-FL yakho.
Kwezinye izimo, ungase ukwazi ukufinyelela ekwelashweni kwe-CAR T-cell ngokujoyina isilingo somtholampilo.
Ukwelashwa kwe-CAR T-cell kuhilela inqubo yokuqala efana nokufakelwa kwe-stem cell, lapho i-T-cell lymphocyte yakho ikhishwa egazini lakho ngesikhathi senqubo ye-apheresis. Njengawe-B-cell lymphocyte, ama-T-cell ayingxenye yamasosha akho omzimba futhi asebenza nama-B-cell akho ukuze akuvikele ezifweni nasekuguleni.
Uma ama-T-cell ekhishwa, athunyelwa elabhorethri lapho enziwa kabusha khona. Lokhu kwenzeka ngokujoyina i-T-cell ku-antigen eyisiza ukuthi ibone i-lymphoma ngokucacile futhi ilwe ngokuphumelelayo.
I-Chimeric isho ukuba nezingxenye ezinemvelaphi ehlukile ukuze ukuhlangana kwe-antigen ku-T-cell kuyenze ibe yi-chimeric.
Uma ama-T-cell esenziwe kabusha azobuyiselwa kuwe ukuze aqale ukulwa ne-lymphoma.
Ukwelashwa komugqa wokuqala - Ukuqala ukwelashwa
Ukuqala Ukwelapha
Uma uqala ukwelashwa, kubizwa ngokwelashwa komugqa wokuqala. Uma usuqedile ukwelashwa kwakho komugqa wokuqala, ungase ungadingi ukwelashwa futhi iminyaka eminingi. Abanye abantu badinga ukwelashwa okwengeziwe ngokushesha, kanti abanye bangathatha izinyanga noma iminyaka, ngaphambi kokudinga ukwelashwa okwengeziwe.
Uma uqala ukwelashwa, ungase ube nemithi engaphezu kowodwa. Lokhu kungase kuhlanganise ukwelashwa ngamakhemikhali, i-monoclonal antibody noma ukwelashwa okuhlosiwe. Kwezinye izimo, ungase ulashwe ngemisebe noma uhlinzwe futhi, noma esikhundleni semithi.
Imijikelezo yokwelashwa
Uma unalezi zindlela zokwelapha, uzoba nazo ngemijikelezo. Lokho kusho ukuthi uzothola ukwelashwa, bese uthola ikhefu, bese kuba omunye umzuliswano (umjikelezo) wokwelashwa. Kubantu abaningi abane-FL, i-chemoimmunotherapy iyasebenza ukuze kuzuzwe ukuxolelwa (akukho zimpawu zomdlavuza).
Uma lonke uhlelo lwakho lokwelapha luhlanganiswa, lubizwa ngokuthi isimiso sakho sokwelashwa. Ezinye izindawo zingayibiza ngohlelo lokwelapha.
Udokotela wakho uzokukhethela iphrothokholi yokwelashwa engcono kakhulu ngokusekelwe kulezi zici ezingezansi
- Isiteji kanye nebanga le-FL yakho.
- Noma yiziphi izinguquko zofuzo onazo.
- Iminyaka yakho nempilo yakho iyonke.
- Ezinye izifo noma imithi okungenzeka ukuthi uyayidla.
- Izinketho zakho ngemuva kokuxoxa ngezinketho zakho nodokotela wakho.
Izibonelo zamaphrothokholi e-chemoimmunotherapy ongathola ukwelapha i-FL
- BR inhlanganisela ye-Bendamustine ne-Rituximab (a MAB).
- I-BO noma i-GB- inhlanganisela ye-Bendamustine ne-Obinutuzumab (a MAB).
- I-RCHOP inhlanganisela ye-rituximab (a MAB) enemithi yokwelapha ngamakhemikhali i-cyclophosphamide, i-doxorubicin, i-vincristine ne-prednisolone. Le nqubo yomthetho isetshenziswa kuphela ukwelapha i-FL uma isebangeni eliphezulu, ngokuvamile i-grade 3a nangaphezulu.
- I-O- CHOP inhlanganisela ye-Obinutuzumab, i-cyclophosphamide, i-vincristine, i-doxorubicin ne-prednisolone. Le nqubo yomthetho isetshenziswa kuphela ukwelapha i-FL uma isebangeni eliphezulu, ngokuvamile i-grade 3a nangaphezulu.
Izivivinyo zemitholampilo
Ziningi izinhlolo zemitholampilo kulo lonke elase-Australia nasemhlabeni jikelele, ezifuna izindlela zokwenza ngcono ukwelashwa kwabantu abane-lymphoma. Uma ungathanda ukufunda kabanzi mayelana nezivivinyo zomtholampilo, chofoza inkinobho engezansi. Ungakwazi futhi ukukhuluma nodokotela wakho onguchwepheshe - udokotela wakho wegazi noma i-oncologist mayelana nokuthi yiziphi izivivinyo zomtholampilo ongase ufaneleke ukuzenza.
Ukwelashwa kwesondlo
Ukwelashwa kwesondlo kunikezwa ngenjongo yokukugcina usekuxolelweni isikhathi eside, ngemva kokwelashwa kwakho komugqa wokuqala.
Ukuxolelwa okuphelele
Abantu abaningi banokusabela okuhle kakhulu ekwelashweni komugqa wokuqala futhi bathole ukuxolelwa okuphelele. Lokhu kusho ukuthi uma uqeda ukwelashwa kwakho, ayikho i-FL ebonakalayo esele emzimbeni wakho. Lokhu kungaqinisekiswa ngemuva kwe-PET scan. Nokho kubalulekile ukuqonda ukuthi ukuxolelwa okuphelele akufani nokwelapha. Ngokwelashwa, i-lymphoma ayikho futhi cishe ngeke ibuye.
Kodwa siyazi ngama-lymphomas angenalutho afana ne-FL, avame ukuza ngemva kwesikhathi esithile. Lokhu kungase kube izinyanga noma iminyaka ngemva kokwelashwa kwakho, kodwa kusengenzeka kubuye. Lokhu kubizwa ngokubuyela emuva. Uma kwenzeka, ungase udinge ukwelashwa okwengeziwe, noma ungangena kokuthi “buka futhi ulinde” uma ihlala ingenzi lutho ngaphandle kwezimpawu.
Ukuxolelwa okuyingxenye
Kwabanye abantu, ukwelashwa komugqa wokuqala akulethi ukuthethelelwa okuphelele, kodwa kuholele ekuxolelweni okuncane. Lokhu kusho ukuthi iningi lesifo selihambile, kodwa kusenezimpawu ezithile ezisele emzimbeni wakho. Kuseyimpendulo enhle, ngoba khumbula ukuthi i-FL iyi-lymphoma engenzi lutho engelapheki. Kodwa uma unempendulo eyingxenye, ingase iphinde ilale, futhi ungase ungasadingi ukwelashwa okusebenzayo kodwa qhubeka ubukele futhi ulinde.
Ukuthi uxolelwe ngokuphelele noma ingxenye ethile kungabonakala ekulandeleleni kwakho i-PET scan.
Ukuzama ukukugcina uxolelwe isikhathi eside ngangokunokwenzeka, udokotela wakho angase asikisele ukuthi uye ekwelashweni kwesondlo iminyaka emibili ngemva kokwelashwa kwakho komugqa wokuqala.
Kubandakanyani ukwelashwa kwesondlo?
Ukwelashwa kwesondlo kuvame ukunikezwa kanye njalo ezinyangeni ezi-2-3 futhi kuyi-monoclonal antibody. Amasosha omzimba e-monoclonal asetshenziselwa ukulungiswa yi-rituximab noma i-obinutuzumab. Yomibili le mithi iyasebenza uma uneprotheyini i-CD20 kumaseli akho e-lymphoma, evamile nge-FL.
Ukwelashwa Kwesibili
Uma i-FL yakho iphinda iphinda noma iphikisana nokwelashwa komugqa wokuqala, ungase udinge ukwelashwa komugqa wesibili. I-Refractory FL yilapho ungenakho ukuthethelelwa okuphelele noma okuncane ekwelashweni kwakho komugqa wokuqala.
Uma uneminyaka engaphansi kuka-70 ubudala, ungase unikezwe izinhlanganisela ezahlukene zemithi, okulandelwa ukufakelwa i-stem-cell. Kodwa-ke, ukufakelwa kwe-stem cell akufanelekile kuwo wonke umuntu. Udokotela wakho uzokwazi ukukhuluma nawe kabanzi mayelana nokufaneleka kwakho komuntu siqu kwalolu hlobo lokwelashwa.
Uma ungenayo i-stem-cell transplant, kunezinye izinqubo zokwelapha ongase unikezwe zona.
Lezi zindlela zokwelapha zisetshenziselwa ukukubuyisela ekuxolelweni nokulawula i-lymphoma yakho isikhathi eside.
Imithetho yokwelashwa uma ufaka i-stem cell
RICE
I-RICE i-chemo eqinile yemithamo ehlukanisiwe (ephukile) noma yokufaka (ngokuconsa) ye-ifosfamide, carboplatin ne-etoposide. Ungase ube nalokhu uma ubuyele emuva noma ngaphambi kokufakelwa kwe-autologous stem cell. Kuzodingeka ukuthi ulashwe esibhedlela
I-R-GDP
I-R-GDP iyinhlanganisela ye-gemcitabine, i-dexamethasone ne-cisplatin. Ungase ube nalokhu uma ubuyele emuva noma ngaphambi kokufakelwa kwe-autologous stem cell.
Imithethonqubo yokwelapha uma ungenayo i-stem-cell transplant
R-CHOP/ O-CHOP
I-R-CHOP noma i-O-CHOP iyinhlanganisela ye-rituximab noma i-obinutuzumab (i-MAB) enemithi ye-chemo i-cyclophosphamide, i-doxorubicin, i-vincristine ne-prednisolone isixhumanisi ku-eviQ.
I-R-CVP
I-R-CVP iyinhlanganisela ye-rituximab, i-cyclophosphamide, i-vincristine ne-prednisolone. Ungase ube nalokhu uma usukhulile unezinye izinkinga zempilo.
O-CVP
I-O-CVP iyinhlanganisela ye-obinutuzimab, i-cyclophosphamide, i-vincristine ne-prednisolone. Ungase ube nalokhu uma usukhulile unezinye izinkinga zempilo.
Umswakama
Ukwelashwa ngemisebe kungasetshenziswa uma i-FL yakho iphinda iphinda. Ngokuvamile kwenziwa uma iphinda iphinda endaweni eyodwa futhi isiza ukulawula i-FL yakho futhi inciphise ezinye izimpawu okungenzeka ukuthi uyazithola.
Ukwelashwa komugqa wesithathu
Kwezinye izimo, ungase udinge ukwelashwa okwengeziwe ngemva kokuphinda kwesibili noma okwesithathu. Ukwelashwa komugqa wesithathu ngokuvamile kuzofana nokwelashwa okungenhla.
Kwezinye izimo, uma i-FL yakho "ishintsha" futhi iqala ukuziphatha njengohlobo oluncane lwe-lymphoma olunolaka olubizwa ngokuthi i-Diffuse big B-cell lymphoma, ungase ufaneleke ukuthola ukwelashwa kwe-CAR T-cell njengokwelashwa komugqa wesithathu noma wesine. Udokotela wakho uzokwazisa uma i-FL yakho iqala ukuguquka.
I-Lymphoma eguquliwe
I-lymphoma eguquliwe iyi-lymphoma eyatholwa ekuqaleni njengevila (ikhula kancane) kodwa isiphenduke (iguqulwe yaba) i-lymphoma enolaka (ekhula ngokushesha).
Ukuguqulwa kwe-FL yakho kungenzeka uma unezinguquko eziningi zofuzo kumaseli akho e-lymphoma ngokuhamba kwesikhathi, okubangela umonakalo owengeziwe. Lokhu kungenzeka ngokwemvelo, noma ngenxa yezinye izindlela zokwelapha. Lo monakalo owengeziwe ezakhini zofuzo kubangela ukuthi amangqamuzana akhule ngokushesha.
Ingozi yenguquko iphansi. Ucwaningo lubonisa ukuthi phakathi neminyaka eyi-10 kuya kweyi-15 ngemva kokuxilongwa, cishe abantu abangu-2-3 kwabayi-100 abane-FL unyaka ngamunye, bangase babe noguquko babe uhlobo oluncane olunolaka.
Isikhathi esijwayelekile ukusuka ekuxilongweni kuya ekuguqulweni kweminyaka emi-3-6.
Uma unoguquko olusuka ku-FL, kungenzeka ukuthi luguquke lube uhlobo oluncane lwe-lymphoma olubizwa ngokuthi i-Diffuse big B-cell lymphoma (DLBCL) noma, okungajwayelekile kakhulu i-Burkitt lymphoma. Uzodinga ukwelashwa nge-chemoimmunotherapy ngokushesha.
Ngenxa yentuthuko ekwelashweni, umphumela we-follicular lymphoma eguquliwe uye waba ngcono kakhulu eminyakeni yamuva nje.
Imiphumela emibi evamile yokwelashwa
Kunemiphumela emibi eminingi ehlukene ongayithola ekwelashweni kwakho kwe-FL. Ngaphambi kokuba uqale ukwelashwa kwakho, udokotela wakho noma unesi wakho kufanele akuchazele yonke imiphumela engemihle elindelekile ONGASE ube nayo. Ungase ungazitholi zonke, kodwa kubalulekile ukwazi ukuthi yini okufanele uyibheke nokuthi ungamthinta nini udokotela wakho. Qinisekisa ukuthi unemininingwane yokuxhumana yokuthi ubani okufanele uxhumane naye uma ululama phakathi nobusuku noma ngempelasonto lapho udokotela wakho engase angatholakali.
Omunye wemiphumela emibi evame kakhulu yokwelashwa izinguquko ekubalweni kwegazi lakho. Ngezansi kunethebula elichaza ukuthi yimaphi amangqamuzana egazi angase athinteke nokuthi lokho kungase kukuthinte kanjani.
Amaseli egazi athintwa ukwelashwa kwe-FL
Amangqamuzana amhlophe egazi | Amaseli abomvu egazi | Ama-platelet (futhi amaseli egazi) | |
Igama Lezokwelapha | Ama-Neutrophils namaLymphocyte | Ama-erythrocyte | Amapulatifomu |
Benzani? | Ukulwa Nezifo | Phatha umoya-mpilo | Yeka ukopha |
Ukushoda kubizwa ngani? | I-Neutropenia kanye ne-lymphopenia | I-anemia | Thrombocytopenia |
Lokhu kuzowuthinta kanjani umzimba wami? | Uzothola izifo eziningi futhi ungase ube nobunzima bokuqeda ngisho nokuthatha ama-antibiotics | Ungase ube nesikhumba esiphaphathekile, uzizwe ukhathele, uphelelwa umoya, ugodola kanye nesiyezi | Ungalimala kalula, noma wophe okunganqamuki ngokushesha uma usikekile |
Ithimba lami elilapha lizokwenzani ukulungisa lokhu? | ● Libazisa ukwelashwa kwakho kwe-lymphoma ● Ukunikeza ama-antibiotics ngomlomo noma ngemithambo uma unegciwane | ● Libazisa ukwelashwa kwakho kwe-lymphoma ● Ukukumpompela igazi elibomvu uma inani lamangqamuzana akho liphansi kakhulu | ● Libazisa ukwelashwa kwakho kwe-lymphoma ● Ukukunikeza i-platelet transfusion uma inani lamangqamuzana akho liphansi kakhulu |
Eminye imiphumela emibi evamile yokwelashwa kwe-FL
Ngezansi kunohlu lweminye imiphumela emibi evamile yokwelashwa kwe-FL. Kubalulekile ukuqaphela ukuthi manje zonke izindlela zokwelapha zizodala lezi zimpawu, futhi kufanele ukhulume nodokotela wakho noma unesi mayelana nokuthi yimiphi imiphumela emibi engase idalwe ukwelashwa kwakho komuntu ngamunye.
- Ukuzizwa ugula esiswini (isicanucanu) nokuhlanza.
- Umlomo obuhlungu (mucositis) nokushintsha ukunambitheka kwezinto.
- Izinkinga zamathumbu njengokuqunjelwa noma isifo sohudo (indle eliqinile noma elinamanzi).
- Ukukhathala, noma ukungabi namandla okuba ngcono ngemva kokuphumula noma ukulala (ukukhathala).
- Imisipha (myalgia) kanye ne-joint (arthralgia) ubuhlungu nobuhlungu.
- Ukulahlekelwa izinwele kanye nokuncipha (i-alopecia) - kuphela ngokwelashwa okuthile.
- Inkungu yengqondo nobunzima bokukhumbula izinto (chemo brain).
- Ukuzwa okushintshile ezandleni nasezinyaweni zakho njengokuluma, izikhonkwane nezinaliti noma ubuhlungu (i-neuropathy).
- Ukuncipha kokuzala noma ukuyeka ukuya esikhathini ngaphambi kwesikhathi (ukushintsha kwempilo).
Ukunakekelwa kokulandelela - Kwenzekani lapho ukwelashwa kuphela?
Uma uqeda ukwelashwa, ungase ufune ukuphonsa izicathulo zakho zokudansa, ubeke izingalo zakho emoyeni kanye nephathi njengalo mfana (uma unamandla), noma ungase ugcwale ukukhathazeka nokucindezeleka mayelana nokuthi yini ezayo ngokulandelayo.
Yomibili imizwa ivamile futhi ivamile. Kungokwemvelo futhi ukuzizwa ngenye indlela, umzuzu owodwa, futhi ngenye indlela umzuzwana olandelayo.
Awuwedwa lapho ukwelashwa kuphela. Usazoba nokuxhumana okujwayelekile nethimba lakho lochwepheshe, futhi ukwazi ukubashayela uma kukhona okukukhathazayo.
Usazogadwa ngokuhlolwa kwegazi nokuhlolwa ngokomzimba ukuze uhlole noma yiziphi izimpawu noma ukuphinda ugule noma imiphumela emibi ehlala isikhathi eside yokwelashwa kwakho. Kwezinye izimo, ungase ube ne-scan efana ne-PET noma i-CT, kodwa lokhu ngokuvamile akudingekile uma zonke ezinye izivivinyo zijwayelekile futhi ungazitholi izimpawu.
Isibikezelo
I-prognosis yigama elisetshenziselwa ukuchaza indlela okungenzeka yesifo sakho, ukuthi sizosabela kanjani ekwelashweni nokuthi uzokwenza kanjani phakathi nangemuva kokwelashwa.
Kunezici eziningi ezinomthelela ekubikezeleni kwakho futhi akunakwenzeka ukunikeza isitatimende esiphelele mayelana nokubikezela. Kodwa-ke, i-FL ivame ukusabela kahle kakhulu ekwelashweni futhi iziguli eziningi ezinalo mdlavuza zingaba nokukhululwa isikhathi eside - okusho ukuthi ngemva kokwelashwa, alukho uphawu lwe-FL emzimbeni wakho.
Izinto ezingaba nomthelela ku-prognosis
Ezinye izici ezingase zibe nomthelela ekubikezelweni kwakho zihlanganisa:
- Uneminyaka yobudala kanye nempilo yonke ngesikhathi sokuxilongwa.
- Indlela osabela ngayo ekwelashweni.
- Kuthiwani uma kukhona ukuguqulwa kofuzo onakho.
- Uhlobo oluncane lwe-FL onalo.
Uma ungathanda ukwazi okwengeziwe nge-prognosis yakho siqu, sicela ukhulume nochwepheshe wakho we-hematologist noma i-oncologist. Bazokwazi ukukuchazela izici zakho zobungozi kanye ne-prognosis kuwe.
Ukusinda - ukuphila ne-follicular lymphoma
Indlela yokuphila enempilo, noma ezinye izinguquko ezinhle zokuphila ngemva kokwelashwa zingaba usizo olukhulu ekululameni kwakho. Ziningi izinto ongazenza ukuze uphile kahle nazo I-DLBCL.
Abantu abaningi bathola ukuthi ngemva kokuxilongwa umdlavuza, noma ukwelashwa, ukuthi izinhloso zabo nezinto eziza kuqala ekuphileni ziyashintsha. Ukwazi ukuthi kuyini 'okujwayelekile kwakho okusha' kungase kuthathe isikhathi futhi kukhungathekise. Okulindelekile komndeni wakho nabangane kungase kwehluke kokwakho. Ungase uzizwe uhlukanisiwe, ukhathele noma iyiphi imizwa ehlukene engashintsha usuku ngalunye.
Imigomo eyinhloko ngemva kokwelashwa kwakho I-DLBCL wukubuyela ekuphileni futhi:
- Yiba matasa ngangokunokwenzeka emsebenzini wakho, emndenini, nakwezinye izindima zempilo.
- Yehlisa imiphumela emibi kanye nezimpawu zomdlavuza kanye nokwelashwa kwawo.
- Khomba futhi ulawule noma yimiphi imiphumela engemihle sekwephuzile.
- Siza ukukugcina uzimele ngangokunokwenzeka.
- Thuthukisa izinga lakho lempilo futhi ugcine impilo enhle yengqondo.
Izinhlobo ezahlukene zokuvuselela umdlavuza zinganconywa kuwe. Lokhu kungasho noma yiluphi uhlobo olubanzi yezinkonzo ezifana nalezi:
- Ukwelashwa ngokomzimba, ukuphathwa kobuhlungu.
- Ukuhlela ukudla okunomsoco nokuzivocavoca.
- Ukwelulekwa ngokomzwelo, kwezemisebenzi nakwezezimali.
