I-Glioma

Ama-Gliomas abeke inselele odokotela abahlinzayo kusukela ekuqaleni kwawo-1900 ngenxa yezici zawo zamangqamuzana eziyinkimbinkimbi nezihlukene. Ziyizimila zobuchopho ezivame kakhulu, ezivela kumaseli e-glial (ama-astrocyte, ama-oligodendrocyte namaseli e-ependymal) ebuchosheni nasemgogodleni. Amathumba achazwa ngokwengqamuzana lemvelaphi, okungukuthi, i-Astrocytomas, i-Oligodendrogliomas ne-Ependymomas ngokulandelana. I-Oligodendrogliomas inemiphumela engcono kunezinye ezimbili.

Ama-glioma ahlelwe ku-1-4 ngokusekelwe ezicini zawo ze-histological kanye ne-molecular, njengoba kunconywe ukuhlukaniswa kwe-WHO kwakamuva. Inqubekelaphambili emkhakheni we-neuropathology ibambe iqhaza elibalulekile ekuthuthukiseni ukuqonda, ukuxilongwa, kanye nokwelashwa kwe-glioma. Ukuvela kokuphrofayili wamangqamuzana kuguqule ukuqonda kwethu ama-glioma, okuvumela ukuhlukaniswa okunembe kakhudlwana kanye namasu okwelapha aqondene nawe. Izimila zeBanga loku-1 zine-prognosis engcono kakhulu kanti i-grade 4 inesimo esibi kakhulu.

Iziguli ezinama-glioma ngokuvamile zinezinye noma zonke izinkinga ezilandelayo:

•  Isithuthwane siyalingana
•  Ubuhlungu bekhanda - ubuhlungu bekhanda obusanda kuqala noma ukuguquka kwesimo sekhanda elibuhlungu isikhathi eside
•  Umbono ophundlekile
•  Ubunzima bokukhuluma noma ukuqonda
•  Ukuncipha kwenkumbulo noma ushintsho ekuziphatheni
•  Ubuthakathaka noma ukufiphala kwezandla noma imilenze
•  Ukulala

Ngaphambi kokuqala ukuhlinzwa kwe-glioma, ukuhlolwa okuhle kubalulekile. Lokhu kubandakanya umlando onemininingwane kanye nokuhlolwa okuhlanganisa nokuhlola isimo sokusebenza. Okulandelayo, i-Neuroradiologist yenza i-MRI yobuchopho enemininingwane ehlanganisa izifundo ezifana ne-Perfusion, i-Spectroscopy, i-Tractography kanye ne-MRI esebenzayo ukuze ihlole ama-gliomas ngokunembile futhi inikeze ulwazi olubalulekile kudokotela ohlinzayo wokuthi ukuhlinzwa kwenziwa kanjani ngokuphepha.

Ukuhlinzwa kuyisinyathelo sokuqala ekulawulweni kwama-glioma, ikakhulukazi ukususa isimila esiningi ngangokunokwenzeka esiphephile kanye nokuthola izicubu ze-histopathological Kumathumba eBanga loku-1 ukunqunywa okuphelele kwesimila kuwukwelashwa okukhethwa kukho noma nini lapho kungenzeka. Kumathumba ebanga lesi-2-4, ukuhlinzwa kulandelwa imisebe kanye nokwelashwa ngamakhemikhali.

Kwamanye ama-glioma ajulile, noma uma isimo sesiguli singesihle, kwenziwa i-stereotactic biopsy iyodwa ukuze kutholwe inani elincane lesicubu ukuze kutholwe ukuxilongwa kwe-histological. Ukuhlinzwa kokuphaphama kwenziwa lapho izimila zitholakala noma eduze nezindawo ezibalulekile ezilawula ulimi, ukunyakaza kwezandla nemilenze nokubona. I-Neuronavigation isiza ekutholeni isimila kanye nezingxenye ezibalulekile zobuchopho ngokunembile kanye ne-intraoperative ultrasound isiza udokotela ohlinzayo asuse isimila esiningi kuyilapho ephephile ngesikhathi esifanayo.

Ngaphandle kwamasu e-microsurgical kanye nokuqapha kwe-intraoperative neurophysiological, enye impumelelo ku-neurosurgery, ukusetshenziswa kwe-intraoperative fluorescence guide for glioma resection. Le nqubo isekelwe ekusebenzelaneni phakathi kwama-agent we-fluorescent namaseli e-glioma ukuze kuthuthukiswe ukutholwa kwesimila esibi ngesikhathi sokuhlinzwa. I-5-aminolevulinic acid (5-ALA) lapho iphathwa ngomlomo esigulini ngaphambi kokuhlinzwa, ikhethwa ngokukhetha amangqamuzana e-tumor futhi i-metabolized eholela ekukhiqizeni ama-protoporphyrins angama-fluorescent. Lokhu kuwenza abonakale futhi ahlukaniseke ebuchosheni obujwayelekile ngemva kokufaka izihlungi ezithile ezixhunywe kusibonakhulu esisebenzayo.

Ukuhlanganiswa kwesiqondiso se-fluorescence ekuhlinzeni kwe-glioma kunezinzuzo eziningana:

• Izicubu ze-Glioma zihluka ngokusobala ebuchosheni obujwayelekile zisiza udokotela ohlinzayo ukuthi akhombe ngokunembile amaphethelo wesimila futhi agweme ukushiya isimila singahlosile.
• Ukuthola ukukhishwa kabusha okuphephile okuphezulu
• Inikeza impendulo yesikhathi sangempela
• Ukusinda okuthuthukisiwe

Ushicilelo lwesi-5 nolwakamuva lwesigaba se-WHO sama-glioma, olumele ukushintsha kwepharadigm ekuxilongweni kwalezi zimila, luhlanganisa izici zamangqamuzana kunqubo ye-histological.

• Ukuhlanganiswa kwezimpawu zamangqamuzana: Isigaba sakamuva sigcizelela izimpawu zamangqamuzana ezifana nokuguqulwa kofuzo kwe-isocitrate dehydrogenase (IDH), i-1p/19q co-deletion, kanye ne-methylation yomgqugquzeli we-MGMT. Laba bamaka badlala indima ekuxilongweni okunembile, ukubikezelwa kwemiphumela kanye nesinqumo sokwelashwa esiqondisayo.
• 1p/19q co-deletion ngokuvamile ibonakala oligodendrogliomas futhi ubikezela impendulo evumayo ekwelashweni.
• Izigaba ze-IDH-mutant kanye ne-IDH-wildtype: Isigaba manje sehlukanisa phakathi kwe-IDH-mutant kanye ne-IDH-wildtype gliomas, lapho lawa akamuva manje ahlukaniswa njengama-glioblastoma kungakhathaliseki ukuthi yiziphi ezinye izici.
• Ukuguqulwa kwe-H3K27M: kuvamile kuma-gliomas omugqa omaphakathi, lokhu kuguqulwa ngokuvamile kunikeza ukubikezela okubi ezimeni zezingane.

Ithimba lethu labahlinzeki bezinzwa lisebenzelana eduze kakhulu nama-radiation kanye nama-oncologists ezokwelapha, lihambela umhlangano webhodi lesimila kabili ngesonto. Isu lokwelapha elifanelekile lisetshenziswa kusetshenziswa imihlahlandlela yakamuva yokuhlukanisa ukuze kuqinisekiswe imiphumela emihle yeziguli zethu
Ucwaningo luyaqhubeka nokwembula izinguquko ezintsha zamangqamuzana okubonisa ukuthi ukwelashwa okuhlosiwe kungase kutholakale esikhathini esizayo okuzoshintsha imiphumela kuma-glioma.
Ukulandelela impilo yonke kweziguli ze-glioma kuyisinyathelo esibalulekile nesibalulekile ekuphatheni. Lezi ziguli zizohlolwa i-MRI ngezikhathi ezithile ukuze kuqinisekiswe ukulawulwa kwezifo.

Ukuze ufunde kabanzi mayelana ne-glioma yabantu abadala xhumana nethimba lethu elinolwazi e-Apollo Proton Cancer Center