Umdlavuza we-nasopharyngeal uqala ngemuva kwezikhala, kusukela engxenyeni engaphezulu kolwanga oluthambile kuya engxenyeni engenhla yomphimbo. Abantu abanalesi simo bavame ukuba namaqhuqhuva entanyeni, bangase babe nomuzwa wokugcwala noma ubuhlungu ezindlebeni, nokungezwa. Izimpawu zakamuva zihlanganisa ikhala eligijimayo, ukuvaleka kwamakhala, ukuvuvukala kobuso nokuba ndikindiki. I-biopsy iyadingeka ukuze kwenziwe ukuxilongwa kanye nokuhlolwa kwe-imaging (CT, MRI, noma PET) ukuze kuhlolwe izinga lomdlavuza. Ukwelashwa kusekelwe ku-radiotherapy kanye nokwelashwa ngamakhemikhali futhi, ngokukhethekile, ekuhlinzeni.

Umdlavuza we-nasopharyngeal, obizwa nangokuthi i-nasopharynx, i-cavum noma i-epipharynx, umdlavuza wemvelaphi ye-epithelial, ovela emangqamuzaneni engxenyeni engenhla yepharynx, ngemuva kwemigudu yamakhala, kusukela engxenyeni engenhla ukusuka kulwanga oluthambile kuya engxenyeni engenhla ye-pharynx. umphimbo. Iningi lomdlavuza we-nasopharynx i-squamous cell carcinomas, okusho ukuthi ikhula kumaseli e-squamous ahlanganisa i-nasopharynx.

Nakuba umdlavuza we-nasopharyngeal ungakhula kunoma iyiphi iminyaka, uthinta ikakhulukazi intsha kanye neziguli ezingaphezu kweminyaka engu-50. Nakuba ungavamile e-United States naseNtshonalanga Yurophu, uvamile e-Asia futhi ungomunye wezifo zomdlavuza ezivame kakhulu phakathi kwabafuduki baseShayina e-United States. Amazwe, ikakhulukazi lawo aseNingizimu China kanye nenzalo yaseNingizimu. - E-Asia. Umdlavuza we-Nasopharyngeal awuvamile e-France ngecala elingaphansi kwesisodwa kubahlali abayi-100. Amadoda athinteka kakhulu kunabesifazane.

Izimila ze-Nasopharyngeal epithelial ziye zahlukaniswa yi-World Health Organization ngokusekelwe ezingeni lokuhlukaniswa kwamaseli ayingozi:

• Uhlobo I: i-keratinizing squamous cell carcinoma ehlukile. Okungavamile, kubonakala ikakhulukazi ezifundeni zomhlaba ezinezehlakalo eziphansi kakhulu;
• Uhlobo lwe-II: i-squamous cell carcinoma ehlukanisiwe engeyona keratinizing (35 kuya ku-40% wamacala);
• Uhlobo lwe-III: I-Carcinoma Engaziwa Yohlobo Lwe-Nasopharyngeal (UCNT: I-Undifferenciated Carcinoma Yohlobo Lwe-Nasopharyngeal). Imele amacala angama-50% eFrance, naphakathi kuka-65% (eNyakatho Melika) kanye nama-95% (eShayina) wamacala;
• I-Lymphomas emele cishe i-10 kuya ku-15% yamacala.

Ezinye izinhlobo zomdlavuza we-nasopharyngeal zihlanganisa:

• i-adenoid cystic carcinomas (i-cylindromes);
• izimila ezixubile;
• i-adenocarcinoma;
• i-fibrosarcoma;
• i-osteosarcoma;
• i-chondrosarcoma;
• i-melanoma.
  

Izici eziningana zemvelo nezokuziphatha zikhonjiswe ukuthi zingama-carcinogenic kubantu mayelana nomdlavuza we-nasopharyngeal:

• Igciwane le-Epstein-Barr: leli gciwane elivela emndenini we-herpes lithelela ama-lymphocyte amasosha omzimba kanye namaseli athile olwelwesi lomlomo kanye nepharynx. Ukutheleleka ngokuvamile kwenzeka ebuntwaneni futhi kungabonakalisa njengesifo sokuphefumula noma i-mononucleosis esithathelwanayo, isifo esithambile sobuntwana kanye nentsha. Bangaphezu kuka-90% abantu emhlabeni wonke abangenwe yileli gciwane, kodwa ngokuvamile alinangozi. Lokhu kungenxa yokuthi akubona bonke abantu abanegciwane le-Epstein-Barr ababa nomdlavuza we-nasopharyngeal;
• ukusetshenziswa kwezinhlanzi eziningi ezilondolozwe noma ezilungiselelwe ngosawoti, noma ukudla okugcinwe ngama-nitrites: le ndlela yokulondoloza noma yokulungiselela yenziwa ezindaweni eziningana zomhlaba, ikakhulukazi eNingizimu-East Asia. Kodwa-ke, indlela ehlanganisa lolu hlobo lokudla ekubunjweni komdlavuza we-nasopharyngeal ayikacaci kahle. Kubekwa ama-hypotheses amabili: ukwakheka kwe-nitrosamine kanye nokuvuselelwa kwegciwane le-Epstein-Barr;
• ukubhema: ingozi iyanda ngenani kanye nesikhathi sokusetshenziswa kukagwayi;
• i-formaldehyde: yahlukaniswa ngo-2004 phakathi kwezinto ezibangela umdlavuza ezifakazelwe kubantu ngomdlavuza we-nasopharynx. Ukuchayeka ku-formaldehyde kwenzeka ezindaweni ezingaphezu kwekhulu nasemikhakheni ehlukahlukene yomsebenzi: udokotela wezilwane, izimonyo, imithi, izimboni, ezolimo, njll.
• uthuli lwezinkuni: olukhishwa ngesikhathi sokucubungula izinkuni (ukugawulwa, ukusaha, ukugaya), ukugaywa kokhuni olumahhadlahhadla noma amaphaneli okhuni akhiwe kabusha, ukuthuthwa kwama-chips kanye ne-sawdust okubangelwa yilokhu kuguqulwa, ukuqedwa kwefenisha (i-ginning). Lolu thuli lwezinkuni lungahogelwa, ikakhulukazi abantu abavezwa ngesikhathi somsebenzi wabo.

Ezinye izici eziyingozi zomdlavuza we-nasopharyngeal zisolwa esimweni samanje solwazi:

• ukubhema ugwayi;
• Ukusetshenziswa kotshwala;
• ukusetshenziswa kwenyama ebomvu noma egayiwe;
• ukutheleleka nge-papillomavirus (HPV 16).

Isici esiyingozi sofuzo siphinde sikhonjwe ezinye izifundo.

Ezikhathini eziningi, umdlavuza we-nasopharyngeal uqala ukusabalala kuma-lymph nodes, okuholela ekutheni kube nezigaxana ezizwakalayo entanyeni, ngaphambi kwanoma yiziphi ezinye izimpawu. Ngezinye izikhathi ukuvinjelwa okuqhubekayo kwekhala noma amashubhu e-eustachian kungabangela umuzwa wokugcwala noma ubuhlungu ezindlebeni, kanye nokulahlekelwa ukuzwa, ohlangothini olulodwa. Uma ishubhu le-eustachian livimbekile, uketshezi oluphumayo lungagcwala endlebeni ephakathi.

Abantu abanalesi sifo bangase babe:

• ubuso obuvuvukele;
• ikhala eligijima ubomvu negazi;
• i-epistaxis, okungukuthi, ukopha;
• igazi ematheni;
• ingxenye ekhubazekile yobuso noma iso;
• i-lymphadenopathy yomlomo wesibeletho.

Ukuze kutholakale umdlavuza we-nasopharyngeal, udokotela uqala ukuhlola i-nasopharynx ngesibuko esikhethekile noma ithubhu encane, eguquguqukayo yokubuka, ebizwa ngokuthi i-endoscope. Uma kutholakala isimila, udokotela ube eseba ne-nasopharyngeal biopsy eyenziwe, lapho kuthathwa khona isampula yethishu futhi ihlolwe ngesibonakhulu.

Iskena se-computed tomography (CT) sesisekelo sogebhezi kanye ne-magnetic resonance imaging (MRI) yekhanda, i-nasopharynx, kanye nesisekelo sogebhezi lwekhanda kwenziwa ukuze kuhlolwe izinga lomdlavuza. Ukuskena kwe-positron emission tomography (PET) nakho kuvame ukwenziwa ukuze kuhlolwe izinga lomdlavuza nama-lymph nodes entanyeni.

Ukwelashwa kusenesikhathi kuthuthukisa kakhulu ukubikezelwa komdlavuza we-nasopharyngeal. Cishe ama-60-75% abantu abanomdlavuza wesigaba sokuqala banomphumela omuhle futhi baphile okungenani iminyaka emi-5 ngemuva kokuxilongwa.

Njengawo wonke umdlavuza we-ENT, izindlela ezihlukile kanye nesu lokwelapha kuxoxwa ngazo ku-CPR ukuze kunikezwe isiguli uhlelo lokwelapha lomuntu siqu. Lo mhlangano wenziwa phambi kwabasebenzi abahlukahlukene abathintekayo ekunakekeleni isiguli:

• udokotela ohlinzayo;
• radiothérapeute;
• i-oncologist;
• i-radiologist;
• isazi sokusebenza kwengqondo;
• i-anatomopathologist;
• udokotela wamazinyo.

Ngenxa ye-topography yabo kanye nokwandiswa kwendawo, umdlavuza we-nasopharyngeal awufinyeleleki ekwelashweni kokuhlinzwa. Ngokuvamile belashwa nge-chemotherapy kanye ne-radiotherapy, evame ukulandelwa yi-adjuvant chemotherapy:

• i-chemotherapy: isetshenziswa kakhulu, ngoba umdlavuza we-nasopharyngeal ungama-chemosensitive tumors. Izidakamizwa ezisetshenziswa kakhulu yi-bleomycin, i-epirubicin ne-cisplatin. I-chemotherapy isetshenziswa iyodwa noma ihlanganiswe ne-radiotherapy (i-concomitant radiochemotherapy);
• ukwelashwa ngemisebe yangaphandle: yelapha isimila kanye nezindawo ze-lymph node;
• i-conformational radiotherapy nge-intensity modulation (RCMI): ivumela ukuthuthuka kokumbozwa kwe-tumor dosimetric ngokulondolozwa okungcono kwezakhiwo ezinempilo nezindawo ezisengozini. Inzuzo yobuthi be-salivary ibalulekile uma iqhathaniswa nokushiswa kwemisebe evamile kanye nezinga lempilo elithuthukisiwe esikhathini eside;
• i-brachytherapy noma ukubekwa kokufakelwa kwe-radioactive: ingasetshenziswa njengesengezo ngemva kokushiswa kwemisebe yangaphandle ngemithamo egcwele noma njengendlela yokubamba uma kwenzeka ukuphindaphinda okuncane okungaphezulu.

Uma isimila siphinda sivela, ukwelashwa ngemisebe kuyaphindwa noma, ezimeni eziqondile kakhulu, kungase kuzanywe ukuhlinzwa. Lokhu kodwa kuyinkimbinkimbi ngoba ngokuvamile kuhilela ukukhishwa kwengxenye yesisekelo sogebhezi. Kwesinye isikhathi kwenziwa ngekhala kusetshenziswa i-endoscope.