Umdlavuza wamasende uwuhlobo lomdlavuza oqala emasendeni, okuyizindlala zokuzala zabesilisa ezitholakala ngaphakathi kwescrotum. Amasende anesibopho sokukhiqiza isidoda kanye ne-testosterone, ihomoni yokuqala yobulili besilisa. Umdlavuza wamasende ngokuvamile uqala emangqamuzaneni amagciwane, okungamaseli akhiqiza isidoda. Kodwa-ke, ingakhula nakwezinye izinhlobo zamaseli ngaphakathi kwamasende, njengezicubu ezisekelayo noma amaseli akhiqiza amahomoni.
Umdlavuza wamasende awuvamile uma uqhathaniswa neminye izinhlobo zomdlavuza, okubalelwa ku-1% kuphela yawo wonke umdlavuza emadodeni. Kodwa-ke, umdlavuza ovame kakhulu ezinsizweni eziphakathi kweminyaka eyi-15 nengama-35. Nakuba ungenzeka kunoma iyiphi iminyaka, uvame ukutholakala phakathi nalesi sikhathi. Umdlavuza wamasende uyelapheka kakhulu, ikakhulukazi uma utholakale kusenesikhathi. Nokho, ukuxilonga ngokushesha nokwelashwa kubalulekile ukuze kube nomphumela ongcono kakhulu.
Izinhlobo zomdlavuza wamasende
Umdlavuza wamasende ubonakala ngokuyinhloko ngezinhlobo ezimbili eziyinhloko: izimila zamangqamuzana amagciwane kanye nezimila zamangqamuzana angewona amagciwane.
a. Amagciwane cell tumors
Ama-germ cell tumors avela kumaseli egciwane ngaphakathi kwamasende, anesibopho sokukhiqiza isidoda. Bakha iningi lamacala omdlavuza we-testicular futhi baphinde bahlukaniswe ngama-subtypes:
- Ama-Seminomas: Ama-Seminomas awuhlobo lwesimila segciwane lesandulela ngculaza esivame ukwenzeka emadodeni phakathi neminyaka yawo-20 kanye nasekuqaleni kwamashumi amane. Lezi zimila zivame ukukhula kancane futhi ziyelapheka kakhulu, ngisho nasezigabeni ezithuthukile. I-Seminomas ivamise ukuvaleleka esendeni futhi ibe nesibikezelo esihle.
- Ama-non-seminomas: Ama-non-seminomas ahlanganisa izinhlobo ezincane ezimbalwa, okuhlanganisa i-embryonal carcinoma, i-yolk sac carcinoma, i-choriocarcinoma, i-teratoma, kanye namathumba e-germ cell axubile. Ama-non-seminomas avamise ukuba nolaka kunama-seminoma futhi angasabalala ngokushesha. Ngokuvamile zitholakala emadodeni amancane futhi zingadinga ukwelashwa okujulile.
b. Ama-non-germ cell tumors
Amathumba amaseli okungewona amagciwane avela ezicutshini ezisekelayo nezikhiqiza amahomoni ngaphakathi kwamasende, kunokuba asuke kumaseli egciwane ngokwawo. Nakuba kungavamile kakhulu kunezimila zamangqamuzana amagciwane, zisamelela iqoqo lomdlavuza wamasende. Izibonelo zama-non-germ cell tumors zihlanganisa:
- I-Leydig cell tumors: I-Leydig cell tumors ivela kumaseli e-Leydig, akhiqiza i-testosterone emasendeni. Lezi zimila ngokuvamile azinangozi (azinawo umdlavuza) kodwa ngezinye izikhathi zingaba yingozi.
- Izimila zamaseli e-Sertoli: Izimila zamaseli e-Sertoli zikhula zisuka kumaseli e-Sertoli, ahlinzeka ngokusekela nokondleka kumaseli akhiqiza isidoda. Njengama-cell tumors e-Leydig, izimila zamaseli e-Sertoli ngokuvamile azinabungozi kodwa zingaba yingozi kwezinye izimo.
Izimbangela zomdlavuza wamasende
Imbangela eqondile yomdlavuza wamasende ayiqondwa ngokugcwele, kodwa kutholwe izici eziningana eziyingozi ezingase zandise amathuba okuba nesifo. Lezi zici zobungozi zihlanganisa:
a. I-testicle engaphansi (Cryptorchidism)
Amadoda azalwa enesende elilodwa noma womabili angazange ehlele ku-scrotum (cryptorchidism) asengozini enkulu yokuba nomdlavuza wamasende. Kukholelwa ukuthi ukuma okungavamile kwe-testicle kwandisa amathuba okuba noshintsho olubi.
b. Umlando womndeni
Ukuba nomndeni womdlavuza wamasende kwandisa amathuba okuba nesifo. Amadoda anobaba noma umfowabo oke waba nomdlavuza wamasende asengozini enkulu uma kuqhathaniswa nalabo abangenawo umlando womndeni. Nokho, izigameko eziningi zomdlavuza wamasende zenzeka kwabesilisa abangenawo umlando womndeni walesi sifo.
c. Izici zofuzo
Izimo ezithile zofuzo, njenge-Klinefelter syndrome, zingandisa ingozi yomdlavuza wamasende. I-Klinefelter syndrome yisifo se-chromosomal lapho abesilisa bezalwa bene-X chromosome eyengeziwe (XXY esikhundleni se-XY). Okunye okungajwayelekile kofuzo kungase kube nomthelela ekwandeni kwengozi yomdlavuza wamasende.
d. Ukutheleleka nge-HIV
Ezinye izifundo ziphakamise ukuxhumana phakathi kokutheleleka nge-HIV kanye nengozi eyengeziwe yomdlavuza wamasende. Amasosha omzimba abuthakathaka ahambisana ne-HIV/AIDS angase abe nomthelela ekwakhiweni kwezinhlobo ezithile zomdlavuza, okuhlanganisa nomdlavuza wamasende.
e. Izici zemvelo
Ukuchayeka ezicini ezithile zemvelo kungase kubambe iqhaza ekuthuthukiseni umdlavuza wamasende, nakuba ubufakazi bungaqiniseki. Olunye ucwaningo luye lwaphakamisa ukuxhumana okungenzeka phakathi kokuchayeka kuzibulala-zinambuzane, amakhemikhali, noma ubuthi bendawo kanye nengozi eyengeziwe yomdlavuza wamasende. Nokho, ucwaningo olwengeziwe luyadingeka ukuze kusungulwe ubudlelwano obucacile bembangela.
f. Ukuhlukumezeka kwamasende noma ukulimala
Kunobufakazi obuncane obubonisa ukuthi ukuhlukumezeka noma ukulimala kwamasende kungase kwandise ingozi yomdlavuza wamasende. Kodwa-ke, ukuhlobana phakathi kokuhlukumezeka kwe-testicular nokuthuthukiswa komdlavuza akukasungulwa kahle, futhi ucwaningo olwengeziwe luyadingeka ukuze kucaciswe lobu budlelwano.
Izimpawu zomdlavuza wamasende
Umdlavuza wamasende uvame ukuba nezimpawu eziphawulekayo, nakuba ezinye izimo zingase zingabonakali futhi zitholakale kuphela phakathi nokuhlolwa okujwayelekile komzimba noma ukuhlolwa. Kubalulekile ukuthi amadoda aqaphele izimpawu ezilandelayo zomdlavuza wamasende.
a. Isigaxa noma ukuvuvukala kwesende
Uphawu oluvame kakhulu lomdlavuza wesende ukuba khona kwesigaxa esingenabuhlungu noma ukuvuvukala kwelinye lamasende. Lesi sigaxa singase sifane nesisindo esincane, esiqinile noma ukuvuvukala okukhudlwana, okuthambile. Kubalulekile ukuthi amadoda ajwayele ukuzihlola amasende ukuze abone noma yiziphi izinguquko kusayizi, ukuma, noma ukungaguquguquki kwamasende.
b. Ubuhlungu noma ukungakhululeki
Nakuba umdlavuza wamasende uvame ukungabi nabuhlungu, amanye amadoda angase abe nobuhlungu obufiphele noma angaphatheki kahle esendeni elithintekile noma ku-scrotum. Lokhu kuphatheka kabi kungase kuhlale njalo noma kunqamuke futhi kungase kukhanye endaweni engezansi yesisu noma inyonga.
c. Izinguquko kusayizi wesende noma ukuma
Umdlavuza wamasende ungadala ushintsho kusayizi noma ukuma kwesende elithintekile. Abesilisa bangase baqaphele ukuthi isende elilodwa lizwakala likhulu noma lisinda kunelinye, noma ukuthi i-sende elithintekile alimile ngendlela engavamile noma lihlanekezelwe.
d. Ukuzwa ubunzima ku-scrotum
Amanye amadoda anomdlavuza wamasende angase abe nomuzwa wobunzima, ingcindezi, noma ukugcwala ku-scrotum. Lo muzwa ungase uhambisane nomuzwa wokungakhululeki noma wokungakhululeki.
e. Ubuhlungu noma ukungakhululeki ngaphansi kwesisu noma i-groin
Kwezinye izimo, umdlavuza we-testicular ungase ubangele ubuhlungu noma ukungakhululeki ngaphansi kwesisu noma endaweni ye-groin. Lobu buhlungu bungase bube buncane noma bulinganisele futhi bungase bubhebhethekiswe umsebenzi womzimba noma isikhathi eside sokuhlala noma sokuma.
f. Ukukhula noma ukuthamba kwebele
Izinhlobo ezithile zomdlavuza wamasende, njengezimila zamangqamuzana amagciwane, zingakhiqiza amahomoni angabangela ukwanda kwebele noma ukuthamba emadodeni. Lesi simo, esaziwa nge-gynecomastia, singase senzeke ngokuhambisana nezinye izimpawu zomdlavuza wamasende.
Izigaba zomdlavuza wamasende
Ukuma komdlavuza wamasende kubalulekile ekunqumeni ubungako besifo kanye nezinqumo eziqondisayo zokwelashwa. Uhlelo lwesiteji oluvame ukusetshenziselwa umdlavuza wamasende uhlelo lwe-TNM, oluhlola isimila esiyinhloko (T), ama-lymph nodes aseduze (N), kanye ne-distasis metastasis (M).
Isiteji 0 (Carcinoma in situ)
Amaseli omdlavuza avalelwe ongqimbeni lwangaphakathi lwethishu ngaphakathi kwesende futhi awasakazeki ngale kwesende. Kulesi sigaba, umdlavuza uthathwa njengongahlaseleki futhi awukakakhuli ube yisimila. I-Carcinoma in situ ivame ukutholwa ngengozi phakathi nokuhlolwa kwe-biopsies ngenxa yezinye izizathu futhi ine-prognosis enhle kakhulu ngokuqaphelisisa.
Isigaba I
Umdlavuza uvaleleke esendeni futhi ungase ubandakanye i-epididymis noma intambo yesidoda kodwa awukasakazeki kuma-lymph nodes aseduze noma ezithweni ezikude. Isigaba I siphinde sehlukaniswe izigaba ezimbili ezincane:
- Isiteji IA: Umdlavuza ukhawulelwe kumasende futhi awubandakanyi imithambo yegazi noma imithambo ye-lymphatic. Isimila sincane kuno-2 amasentimitha (cm) ngosayizi.
- Isiteji IB: Umdlavuza ususakazekele emithanjeni yegazi, emithanjeni ye-lymphatic, noma kokubili, ngaphakathi kwe-testicle. Isimila singase sibe sikhulu kuno-2 cm ngosayizi kodwa asizange sisabalale kuma-lymph nodes aseduze noma ezithweni ezikude.
Isigaba II
Umdlavuza ususabalele kuma-lymph nodes aseduze esiswini noma okhalweni kodwa awukasakazeki ezithweni ezikude. Isigaba II siphinde sehlukaniswe izigaba ezimbili ezincane:
- Isigaba IIA: Umdlavuza ususabalele kuma-lymph nodes esiswini, okhalweni, noma kokubili, kodwa i-lymph node enkulu kunazo zonke enomdlavuza ingaphansi kuka-2 cm ngosayizi.
- Isigaba IIB: Umdlavuza ususakazekele kuma-lymph nodes esiswini, okhalweni, noma kokubili, kanti i-lymph node enkulu kunazo zonke enomdlavuza ingama-2 cm noma ngaphezulu ngosayizi.
Isigaba III
Umdlavuza ususabalele ezithweni ezikude, njengamaphaphu, isibindi, noma ubuchopho, futhi ungase uhlanganise nama-lymph node aseduze. Isigaba III siphinde sihlukaniswe izigaba ezimbili ezincane:
- Isigaba IIIA: Umdlavuza ususakazekele kuma-lymph nodes akude noma ezithweni ezingaphezu kwesisu kanye ne-pelvis, njengamaphaphu.
- Isigaba IIIB: Umdlavuza ususakazeke kakhulu ezithweni ezikude, njengesibindi noma ubuchopho, futhi ungase ubandakanye ama-lymph nodes aseduze.
Ukuvimbela umdlavuza wamasende
Ukuvimbela umdlavuza wamasende ngokuphelele akwenzeki ngaso sonke isikhathi ngenxa yezinto ezifana nezakhi zofuzo kanye nokungajwayelekile kokukhula. Kodwa-ke, kunezinyathelo abantu abangazithatha ukuze banciphise ubungozi babo futhi bakhuthaze ukutholwa kusenesikhathi.
a. Yenza izivivinyo ezijwayelekile zamasende (TSE)
Amadoda kufanele ajwayelane nosayizi, ukuma, kanye nokuthungwa kwamasende futhi enze ama-TSE anyanga zonke. I-TSE ihlanganisa ukuzwa kahle isende ngalinye phakathi kweminwe nezithupha ukuze kutholwe noma yiziphi izinguquko, njengezigaxa noma ukuvuvukala. Noma yikuphi ukungahambi kahle kufanele kubikwe ngokushesha kumhlinzeki wezempilo.
b. Bhekana nezinto eziyingozi
Amadoda anezici ezaziwayo ezisengozini yomdlavuza wamasende, njengomlando womndeni walesi sifo noma umlando womuntu siqu wamasende angaphansi (cryptorchidism), kufanele axoxe ngobungozi bawo nomhlinzeki wezempilo. Ukuhlolwa okuvamile noma ukugadwa kungase kunconyelwe kubantu abasengozini ephakeme.
c. Vikela ku-HIV
Olunye ucwaningo luphakamisa ukuxhumana phakathi kokutheleleka nge-HIV kanye nengozi eyengeziwe yomdlavuza wamasende. Ukwenza ucansi oluphephile, ukusebenzisa amakhondomu, nokugwema ukuziphatha okuyingozi kakhulu kungasiza ekwehliseni ubungozi bokutheleleka nge-HIV futhi kwehlisa amathuba okuba nomdlavuza wamasende kubantu abathile.
d. Gcina indlela yokuphila enempilo
Ukwamukela imikhuba enempilo, njengokudla ukudla okulinganiselayo, ukugcina isisindo esinempilo, nokuzibandakanya njalo, kungase kusize ukunciphisa ingozi yomdlavuza uwonke. Ukudla okucebile ngezithelo, imifino, okusanhlamvu okuphelele, namaprotheni angenalutho kunikeza izakhi ezibalulekile kanye nama-antioxidants asekela impilo yonke futhi angase anciphise ingozi yomdlavuza.
e. Gwema ukuchayeka kubuthi bemvelo
Nakuba ubufakazi bunomkhawulo, ezinye izifundo zisikisela ukuxhumana okungenzeka phakathi kokuchayeka kubuthi obuthile bemvelo, njengezibulala-zinambuzane noma amakhemikhali, kanye nengozi eyengeziwe yomdlavuza wamasende. Ukunciphisa ukuchayeka ezintweni ezingaba yi-carcinogens emsebenzini, ekhaya, noma endaweni ezungezile kungase kusize ukunciphisa ingozi yomdlavuza.
f. Ukuhlolwa njalo kwezempilo
Ukuhlolwa kwezempilo okujwayelekile kuvumela abahlinzeki bezempilo ukuthi baqaphe yonke impilo futhi bathole noma yikuphi ukungahambi kahle noma izinguquko ezingase zidinge ukuhlolwa okwengeziwe. Amadoda kufanele axoxisane nomhlinzeki wokunakekelwa kwezempilo ngezinto ezibabeka engcupheni yomdlavuza wamasende futhi ahambisane neziqondiso zokuhlola ezinconyiwe.
Ukuxilongwa komdlavuza wamasende
Ukuhlonzwa komdlavuza wamasende ngokuvamile kuhilela inhlanganisela yokubuyekezwa komlando wezokwelapha, ukuhlolwa ngokomzimba, ukuhlolwa kwezithombe, nokuhlolwa kwaselabhorethri.
a. Umlando wezokwelapha kanye nokuhlolwa komzimba
Umhlinzeki wezempilo uzoqala ngokuthatha umlando wezempilo ophelele, okuhlanganisa noma yiziphi izimpawu ezitholakalayo nanoma yiziphi izici eziyingozi ezifanele, njengomlando womndeni noma izimo zangaphambili zamasende. Ukuhlolwa komzimba kuzokwenziwa ukuze kuhlolwe amasende, i-scrotum, nendawo ye-groin ukuze kutholakale noma yikuphi ukungahambi kahle, njengezigaxa, ukuvuvukala, noma ukushintsha kosayizi noma ukuthungwa.
b. Ukuhlolwa kwe-Ultrasound
Uma kutholakala isigaxa noma ukungavamile ngesikhathi sokuhlolwa ngokomzimba, isinyathelo esilandelayo ngokuvamile ukwenza i-ultrasound ye-scrotum. I-Ultrasound imaging isebenzisa amaza omsindo wemvamisa ephezulu ukudala izithombe ezinemininingwane yamasende nezicubu ezizungezile. Lokhu kuhlolwa kwesithombe kungasiza ekunqumeni usayizi, indawo, nezici zanoma ibuphi uquqaba noma okungavamile ngaphakathi kwamasende.
c. Ukuhlolwa kwegazi
Ukuhlolwa kwegazi kungase kusetshenziselwe ukukala amazinga ezinye izimpawu zesimila ezivame ukuphakama emadodeni anomdlavuza wamasende. Izimpawu ze-tumor ezikalwa kakhulu zomdlavuza we-testicular zihlanganisa:
- I-Alpha-fetoprotein (AFP): Amazinga aphakeme e-AFP angase abonise ukuba khona kwezinhlobo ezithile zomdlavuza we-testicular, njengezimila ze-non-seminomatous germ cell.
- I-Beta-human chorionic gonadotropin (β-hCG): Amazinga aphakeme we-β-hCG angase abe khona kuzo zombili izimila zegciwane lesandulela-ngculazi kanye ne-non-seminomatous.
- I-Lactate dehydrogenase (LDH): Amazinga e-LDH angase aphakanyiswe ezinhlotsheni ezihlukahlukene zomdlavuza, kuhlanganise nomdlavuza wamasende. Kodwa-ke, i-LDH ayiqondile kumdlavuza wamasende njenge-AFP ne-β-hCG.
Lokhu kuhlolwa kwegazi kusiza abahlinzeki bezempilo ukuthi bahlole uhlobo lomdlavuza wamasende, baqaphe impendulo ekwelashweni, futhi bathole noma yikuphi ukuphinda kwesifo.
d. I-Biopsy
Kwezinye izimo, i-biopsy ingenziwa ukuze kuqinisekiswe ukuba khona kwamangqamuzana omdlavuza. I-biopsy ihilela ukukhipha isampula elincane lethishu esendeni ukuze lihlolwe ngaphansi kwesibonakhulu ngudokotela wezifo. Kodwa-ke, ama-biopsies awavamile ukwenzelwa umdlavuza we-testicular ngenxa yengozi yokusabalalisa amangqamuzana omdlavuza. Kunalokho, ukuxilongwa kuvame ukusekelwe ekuhlolweni kwezithombe, ukuhlolwa kwegazi, kanye nokuba khona kwezimpawu zesici.
e. Izifundo zokufanekisa
Izifundo ezengeziwe ze-imaging, ezifana ne-computed tomography (CT) scans, imaging resonance imaging (MRI) scans, noma i-positron emission tomography (PET) scan, zingenziwa ukuze kuhlolwe izinga lesifo futhi kunqunywe ukuthi umdlavuza ususabalele yini kwezinye izingxenye zesifo. umzimba, njengama-lymph nodes aseduze noma izitho ezikude, njengesisu, i-pelvis, noma isifuba.
f. Ukubonisana nochwepheshe
Ngokuya ngokutholwe kokuhlolwa kokuxilonga, isiguli singathunyelwa kudokotela oyi-urologist, oncologist, noma abanye ochwepheshe ukuze kuqhutshekwe nokuhlolwa nokuphathwa. Indlela yethimba lezinhlaka eziningi ehlanganisa ochwepheshe bezempilo abahlukahlukene ivame ukuqashwa ukuze kwakhiwe uhlelo olubanzi lokwelapha oluhambisana nezidingo zomuntu ngamunye zesiguli.
Ukwelashwa komdlavuza wamasende
Ukwelashwa komdlavuza wamasende ngokuvamile kuhilela indlela ehlukahlukene futhi kuncike ezicini eziningana, okuhlanganisa uhlobo nesigaba somdlavuza, impilo yesiguli iyonke, kanye nalokho esikukhethayo.
a. Ukuhlinzwa (Orchiectomy)
Ukwelashwa okuyinhloko komdlavuza wamasende ukususwa ngokuhlinzwa kwesende elithintekile, inqubo ebizwa nge-orchiectomy. Ngesikhathi se-orchiectomy, i-testicle yonke equkethe isimila ikhishwa ngokusikwa ku-groin. Ezimweni eziningi, kuthinteka isende elilodwa kuphela, futhi ukukhishwa kwesende akuthinti ukuzala noma amandla okuqhama noma okuqhanyelwa. Nokho, uma womabili amasende ethintekile, kungase kudingeke ukwelashwa ngamahomoni ukuze kuthathelwe indawo i-testosterone.
b. I-Chemotherapy
Ukwelashwa ngamakhemikhali kuhilela ukusetshenziswa kwemithi enamandla ukubulala amangqamuzana omdlavuza noma ukuwavimba ekukhuleni nasekuhlukaniseni. I-Chemotherapy ivame ukusetshenziswa ngemva kokuhlinzwa ukuze kucekelwe noma yimaphi amangqamuzana omdlavuza asele noma ukwelapha umdlavuza osusabalele ngale kwesende. Imithi ethile ye-chemotherapy kanye nokwelashwa kuncike ohlotsheni nesigaba somdlavuza. Izidakamizwa ezivamile ze-chemotherapy ezisetshenziselwa ukwelapha umdlavuza we-testicular zihlanganisa i-cisplatin, i-etoposide, ne-bleomycin.
c. Ukwelashwa ngemisebe
Ukwelashwa ngemisebe kusebenzisa imisebe enamandla amakhulu, njengama-X-ray noma ama-proton, ukubulala amangqamuzana omdlavuza noma ukuncipha kwezimila. Ingasetshenziswa kwezinye izimo ukwelapha ama-seminomas, ikakhulukazi uma umdlavuza ususabalele kuma-lymph nodes aseduze. Kodwa-ke, ukwelapha ngemisebe akuvamile ukusetshenziswa kunokuhlinzwa noma ukwelashwa ngamakhemikhali ekwelapheni umdlavuza wamasende.
d. Ukufakelwa kwe-stem cell
Kwezinye izimo, i-chemotherapy enedosi ephezulu ingase isetshenziselwe ukwelapha umdlavuza wamasende. I-chemotherapy enedosi ephezulu ibulala amangqamuzana omdlavuza kodwa futhi ibhubhisa ama-stem cells akha igazi emnkantsheni wethambo. Ukubuyisela ukusebenza komnkantsha onempilo, ukufakelwa kwe-stem cell kungenziwa. Ama-stem cells angase aqoqwe egazini lesiguli (ukufakelwa okuzenzakalelayo) noma kumnikeli (ukufakelwa kwe-allogeneic) abese efakwa egazini lesiguli ngemva kokwelashwa ngamakhemikhali.
Isiphetho
Umdlavuza wamasende uyinkinga enkulu yezempilo ehlasela ngokuyinhloko abesilisa abasebasha kodwa kungenzeka kunoma iyiphi iminyaka. Naphezu kokungavamile kwawo uma kuqhathaniswa neminye imidlavuza, umdlavuza wamasende udinga ukuxilongwa ngokushesha kanye nokwelashwa okufanele ukuze uthole imiphumela emihle. Ngokuhlala benolwazi futhi bematasa ngempilo yabo, abesilisa banganciphisa amathuba okuba nomdlavuza wamasende futhi bathuthukise amathuba abo okwelashwa okuphumelelayo nokuhlala isikhathi eside.